Pathologica 4-07.pdf - Pacini Editore

POSTERS
the underlying causes. The first case of fatal AE due to ES
was described in 1988 1 , and the first fatal case of systemic
AE due to ERCP was reported in 1997 2 . So far less than 10
cases of AE after ERCP have been reported. An additional
case is described herein.
Case report. We report on an unfortunate 78-year-old male
who developed systemic venous AE during ERCP. This patient,
who many years previously had undergone both gastroduodenal
resection for duodenal ulcer and cholecystectomy
for gallstones, was admitted for recurrent ascending cholangitis
secondary to stones. While undergoing ES and two ER-
CP procedures for the removal of bile duct stones, he was also
diagnosed with CLL. After 3 months, he underwent a 3 rd
operative ERCP for recurrent stones, during which he suffered
a cardiopulmonary arrest. CT scan demonstrated abundant
air in the pulmonary artery, right heart and tributary
veins of both superior and inferior vena cava. Cerebral venous
AE was also found. Autopsy was performed.
Results. Pulmonary artery and right heart AE were confirmed.
The liver was taken out en-bloc and investigated with
both anterograde portography and retrograde suprahepatic
venography via 3 suprahepatic veins. Bench radiographs revealed
reflux of the contrast medium into the biliary tree,
providing evidence for the presence of small veno-biliary fistulas
at both the portal and systemic radicle level. On sectioning
the liver surface was punctuated by many parenchymal
micro-abscesses containing impacted biliary sand and
minute stones, which were histologically confirmed.
Conclusions. The air was thought to have entered the portal
venous system via intrahepatic radicles of both the suprahepatic
and portal veins, which might have undergone perforation
on the background of chronic ischemic damage secondary
to prolonged impaction and infection of the involved
ducts. Air insufflation during cholangioscopy created the gradient
pressure that resulted in portal gas and AE.
References
1 Simmons TC. Am J Gastroenterol 1988;83:326-8.
2 Kennedy C, et al. Gastrointest Endoscop 1997;45:187-8.
HER2/neu overexpression is potentially
involved in midgut carcinoids development
C. Azzoni, L. Bottarelli, N. Campanini, C. Lagrasta, E.
Tamburini, S. Pizzi, T. D’Adda, G. Rindi, C. Bordi
Department of Pathology and Laboratory Medicine, Section
of Pathological Anatomy, Parma University, Italy
Introduction. HER-2/neu oncogene overexpression and/or
gene amplification has been documented in several human
malignancies, frequently correlates with increased tumor aggressiveness,
and can be used as a basis of treatment with
trastuzumab. Among neuroendocrine neoplasms of the gastrointestinal
tract, the carcinoids of midgut show peculiar
features of malignancy with frequent liver metastases at the
time of diagnosis. Despite recent advances in the diagnosis,
localization, and treatment of these tumors, no etiologic factors
have been proven to be associated with them, little is
known about the molecular determinants of their growth, and
no useful prognostic factors have been identified by molecular
studies.
Methods. We investigated HER-2/neu abnormalities in 24
primary midgut ileal carcinoids including 7 metastatic tissues
and in 38 endocrine carcinomas from other regions of the
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gastroenteropancreatic (GEP) tract using immunohistochemistry
and fluorescent in situ hybridization (FISH).
Results. In primary ileal carcinoids the percentage of immunoreactive
tumor cells was 100% in 20 cases (84%), ranging
from 70 to 80% in the remaining 4 cases (16%). According
the breast scoring system based on the patterns of membranous
staining 5 cases (21%) showed score 3+; 16 cases
(67%) score 2+ and 3 cases (13%) score 1+. In two cases increased
values were observed in metastasic as compared to
primary tissues with regard to the percentage of immunoreactive
cells and the breast scoring. FISH analysis has revealed
chromosomal polysomy in 7 cases of midgut carcinoid
(35%) all showing immunohistochemic al score 3+. No
gene amplification was found in all immunoreactive tumors.
The majority of 38 endocrine tumors from other GEP regions
were consistently unreactive for HER-2/neu, with the exception
of 6 (16%) cases showing a weak immunoreactivity and
with a high significant statistical difference (p < 0.000000) as
compared with midgut carcinoids.
Conclusions. These results show that HER-2/neu overexpression
may be involved) in the carcinogenetic process of
malignant ileal carcinoids. Further study are needed to evaluate
if patients exhibiting HER-2/neu overexpression might
constitute potential candidates for adjuvant therapy based on
the use of humanized monoclonal antibodies.
Cisti linfoepiteliale del pancreas con
differenziazione sebacea
M. Casiello, G. Napoli, R. Scamarcio, G. Renzulli, R.
Ricco
Dipartimento di Anatomia Patologica, Policlinico di Bari
Introduzione. Le cisti linfoepiteliali rappresentano una rara
variante delle cisti pancreatiche, morfologicamente simili alle
cisti derivanti dai residui della tasca branchiale.
Metodi. Uomo di 64 anni con ittero ostruttivo e pregressa
pancreatite acuta. Sottoposto ad indagini strumentali (TC ed
ecografia) si apprezza, in corrispondenza del corpo-coda del
pancreas, processo espansivo a densità fluida, diametri 6 x 5
cm. Eseguito esame citologico su agoaspirato con esito non
diagnostico per la presenza esclusivamente di materiale necrotico.
Al tavolo operatorio la neoformazione pancreatica risultò
una formazione cistica a contenuto poltaceo. Effettuato
esame intraoperatorio di un frammento della parete della cisti
la diagnosi risultò negativa (frammento fibroconnettivale
parzialmente rivestito da elementi cellulari coartati. Assenza
di cellule maligne). Il paziente fu sottoposto ad intervento di
pancreasectomia parziale (corpo-coda) e splenectomia.
Risultati. L’esame macroscopico evidenziò formazione cistica
multiloculata del pancreas, diametro 4 cm, contenenti materiale
poltaceo. All’esame microscopico le cisti apparivano
rivestite da epitelio pavimentoso composto cheratinizzante,
con focale differenziazione sebacea, e con stroma linfoide
spesso aggregato in centri germinativi.
Conclusioni. Le cisti linfoepiteliali pancreatiche probabilmente
si sviluppano a partire da dotti pancreatici protrudenti
in linfonodi o da milza accessoria intrapancreatica. In tal caso
si potrebbero correlare anatomicamente e patogeneticamente
alle cisti linfoepiteliali derivate da residui della tasca
branchiale della testa, del collo e del mediastino.