Pathologica 4-07.pdf - Pacini Editore

PATHOLOGICA 2007;99:174-181
Acne inversa associated with diffuse
malignant peritoneal mesothelioma arisen in
the absence of predisposing factors: report
of a case
V. Barresi, E. Vitarelli, G. Barresi
Dipartimento di Patologia Umana, Università di Messina
Introduction. Diffuse malignant peritoneal mesothelioma
(DMPM) is a relatively rare neoplasm. Risk factors associated
with its development include asbestos exposure, chronic
irritation or inflammation of the peritoneum, abdominal radiotherapy,
familial Mediterranean fever, and simian virus
40. A familial segregation of this neoplasia has been reported
in small villages of the Cappadocian region of Turkey, and it
has been postulated that hereditary factors may predispose to
mesothelioma, even with exposure to small amounts of asbestos.
We report a case of DMPM which apparently occurred
in the absence of predisposing factors.
Methods. A 47 year-old physician was admitted to our hospital
with ascites and abdominal pain. Neither exposure to
asbestos nor chronic irritation or irradiation of the peritoneum
was reported. The past clinical history was significant
for 25-years-duration acne inversa complicated by a squamous
cell carcinoma. Considering the family history, none of
his family members had been exposed to asbestos, but the 20year
old son of the patient’s sister was also affected by acne
inversa. Cytologic examination of the ascitic fluid and histological
evaluation of a peritoneal biopsy were performed. Peritoneal
fragments obtained at biopsy were formalin-fixed
and paraffin-embedded and sections were stained with H&E
for histologic diagnosis. An ascitic fluid cytologic smear was
stained with Papanicolau stain, and the sediment was stained
with H&E. Immunohistochemistry against calretinin, CEA,
EMA and CK 5/6 was carried out on the cytologic sediment
as well as on the peritoneal biopsy fragments.
Results. Cytology of the ascitic fluid and microscopic evaluation
of the peritoneal biopsy samples revealed the presence
of a neoplastic process. Considering the immunohistochemical
findings (calretinin+, EMA+, cytokeratins 5/6+, CEA)
the neoplasm was classified as a tubulo-papillary DMPM.
Conclusions. The association of acne inversa with non-melanoma
skin cancer and tumours other than those involving
skin has been highlighted. Nevertheless the association with
Dermopatologia
DMPM had never been reported before. The genetic locus for
acne inversa has recently been identified within the 1p21.1-
1q25.3 chromosomal region. Interestingly, frequent losses in
chromosomal region 1p.21-22 have been found in mesothelioma
as well. It is thus tempting to speculate that genetic
mutations involving chromosome 1p.21-22 may account for
the development of both diseases.
Carcinoma a cellule di Merkel: profilo
immunoistochimico, su 10 casi, dei recettori 2
e 5 della somatostatina
E. Venturino, C. Ciocca, S. Ardoino, L. Caliendo, A. Dellachà,
C. Marino, A. Pastorino
Ospedale “S. Paolo”, ASL 2 Savonese
Introduzione. Il carcinoma di Merkel (CM) è un tumore
neuroendocrino cutaneo di rara incidenza, caratterizzato da
alta aggressività, descritto per la prima volta nel 1972 da
Toker. Istogeneticamente è considerato derivare dalla cellula
di Merkel che risiede fisiologicamente alla base dell’epidermide.
Gli Autori si propongono di studiare l’espressione immunoistochimica
dei Recettori della Somatostatina 2 (SSTR-
2) e 5 (SSTR-5) su 10 casi di carcinoma di Merkel d’archivio.
Metodi. I 10 casi istologici estratti dai nostri archivi con diagnosi
di CM sono stati rivalutati da un unico patologo per dati
clinici, aspetti istopatologici e immunoistochimici (CK20,
CD117, CD99, Cromogranina A (CR-A), SStr-2, SSTR-5 e
Ki67).
Risultati. Il 70% della casistica presa in esame interessava
individui di sesso femminile; il 50% aveva come sede la cute
del volto. La CK20 era reattiva nel 90% dei casi;In nessun
caso (0%) abbiamo dimostrato positività per CD99; il CD117
era positivo nel 70% dei casi con una caratteristica espressione
granulare citoplasmatica spesso con rinforzo di membrana.
Un solo tumore (10%) è risultato reattivo per SSTR-5
con caratteristica positività dot-like paranucleare; Significativa
la reattività a SSTR-2 nel 40% dei tumori. In tabella sono
riassunti i risultati complessivi.
Sesso Età Sede Dim. cm Ck20 CD99 CR-A SSTR2 SSTR5 CD117 Ki67
F 44 Gluteo 4 x 2,8 + - + + - - 90%
F 76 Gamba 3,5 + - + - - + 60%
M 68 Fronte 0,8 - - + - - + 70%
M 43 Dito mano 1,2 + - + + - + 75%
F 67 Coscia 1 x 0,7 + - + + - + 80%
F 90 Naso 0,4 + - + - + - 60%
F 77 Fronte 1,1 + - + - - - 90%
F 80 Avambraccio 1,5 x 2 + - + + - + 90%
M 84 Volto 1,6 x 1 + - + - - + 80%
F 87 Palpebra 1,3 + - + - - + 90%