Sarcoidosis in untreated chronic hepatitis C virus infection

Chronic hepatitis C has been implicated in the pathogenesis of sarcoidosis in several cases of patients treated with interferon-alpha. On the other hand, only in a few cases previously has a possible link between sarcoidosis and untreated chronic hepatitis C virus infection been demonstrated. We report on a patient with chronic hepatitis C who developed cutaneous sarcoidosis without prior interferon-alpha treatment. We hypothesize that viral persistence seen in chronic hepatitis C virus infection might be one of the potential factors that trigger cellular immune response in granulomatous reactions as seen in sarcoidosis, in genetically predisposed patients.

Induction of hepatic hematopoiesis with tenascin-C expression during the second trimester of development

OBJECTIVE

To determine the role of tenascin-C in fetal hepatic hematopoietic proliferation and differentiation in different stages of development.

STUDY DESIGN

We examined and compared the immunohistochemical expression of tenascin-C in the hepatic stromal portal fields in the first, second, and third trimester of gestation respectively, in relation to the appearance of CD34 progenitor hematopoietic, stromal progenitor and vascular endothelial positive cells.

RESULTS

Our results demonstrated a quantitative difference in the second trimester of gestation concerning the expression of tenascin-C in the connective tissue stroma of the hepatic portal fields over the equivalent expression of the protein in the first (P<0.0001, t-test) and third trimester (P<0.0001, t-test). Similar changes in the above period were found concerning the expression of CD34 over the first (P<0.0001, t-test) and third trimesters (P<0.0001, t-test), suggesting a direct involvement of tenascin-C in the sustaining of hematopoietic activity.

CONCLUSIONS

Our data provide evidence that an ECM glycoprotein component, tenascin-C, plays a relevant role in hematopoiesis through interaction between stromal cells and hematopoietic progenitor cells.

Correlation of immunohistochemically detected HER-2/neu (c-erbB-2) with histological stage and perineural invasion in pancreatic cancer

BACKGROUND/AIMS

HER-2/neu (c-erbB-2) oncoprotein is a transmembrane glycoprotein and may function as a growth factor being involved in the regulation of cell growth and cell transformation. c-erbB-2 was correlated with established outcome factors in pancreatic cancer.

METHODOLOGY

We performed an analysis of 100 patients with pancreatic cancer using an immunoperoxidase technique on formalin-fixed, paraffin-embedded tissue samples in order to determine HER-2/neu oncoprotein expression along with stage and perineural involvement.

RESULTS

HER-2/neu oncoprotein was expressed in the tumors of 21 patients (21%).

CONCLUSIONS

Histologic stage, and perineural invasion did not correlate with HER-2/neu oncoprotein.

Does neoplastic gastrin expression remodel the embryonal pattern of the protein? A study in human pancreas

BACKGROUND/AIMS

To determine the immunoreactivity of gastrin during the development of the human fetal pancreas and ductal pancreatic adenocarcinoma, given that, gastrin positive cells were demonstrated either into its embryonic anlage or into pancreatic cancer.

METHODOLOGY

Tissue sections from 15 pancreatic fetal specimens, and an equal number of ductal adenocarcinoma specimens, were assessed using immunohistochemical methods for gastrin.

RESULTS

The density of positive cells in the primitive exocrine ductal walls and outgrowing buds was significantly higher than the relevant density in the neoplastic pancreatic tissue of mixed (ductal endocrine) and pure ductal type (p1=0.017, p2<0.0001, p3<0.0001 and p4=0.019, respectively). The above values were estimated from 20-22 weeks of gestation. There was no significant difference in the density of positive cells in the islet cell epithelium from 25-30 weeks, and the neoplastic tissue of mixed (p5=0.24) and pure ductal type (p6=0.55).

CONCLUSIONS

The immunostaining for gastrin identifies a subgroup of pancreatic ductal adenocarcinomas with a neuroendocrine component (initially considered as pure ductal tumors), and mixed ductal-endocrine tumors. This pattern of expression in neoplasms recapitulates the normal pattern during the embryonal development of the organ, and may be important for the development of new therapeutic approaches with eventual clinical utility.

Ulcerative locally advanced breast cancer: the efficacy of combined anthracycline-based and hormonal therapy

AIM

In the literature there are numerous large prospective studies on patients with locally advanced breast cancer, however little is reported on the management of ulcerative breast cancer. The aim of this study was to evaluate the employment of combined anthracycline-based chemotherapy and hormonal therapy in ulcerative locally advanced mammary carcinoma.

PATIENTS AND METHODS

Four patients, aged from 67 to 83 years, presented with ulcerative breast cancer resulting in breast destruction. Histological examination of biopsy specimens revealed highly differentiated estrogen receptor-positive ductal carcinomas. All tumours were classified as locally advanced since there was no clinical or radiologic evidence of distant metastasis in any of the patients. Due to their religious beliefs all patients refused any other treatment but chemotherapy. In these patients hemostasis and reduction of bacterial overgrowth were followed by administration of anthracycline-based chemotherapy and hormonal therapy.

RESULTS

All patients responded well; ulcer healing and partial remission were achieved for a period ranging from 19 to 28 months before disease progression.

CONCLUSION

There is clinical evidence from this study that the combination of anthracycline-based palliative chemotherapy coupled with tamoxifen is beneficial for patients with inoperable ulcerative breast cancer.

Fine-needle aspiration cytology of a para-aortical solitary plasma-cell tumor

Extramedullary plasma-cell tumor (EMP) is a very rare disease and mainly arises in the head and neck area. An EMP arising in the paraaortical space was diagnosed by fine needle aspiration cytology and immunocytochemistry, in a 48-year-old male. Smears were cellular and showed dissociated monomorphic plasma cells. Immunocytochemistry demonstrated monoclonal expression of kappa-light immunoglobulin chain and CD38 positivity. Cytomorphology and immunocytochemical profile allowed a definitive diagnosis of plasmacytoma.

Induction of hepatic granulopoiesis due to chorioamnionitis during the second trimester of development

OBJECTIVE

To detect post mortem changes in fetal hematopoiesis consistent with infection from liver examination alone.

STUDY DESIGN

We investigated the immunohistochemical expression of Glycophorin C, Neutrophilic elastase, and CD34, in the hepatic parenchyma from fetuses miscarried as a result of chorioamnionitis (caused by Chlamydia trachomatis) and correlated them with the equivalent from fetuses after voluntary abortion (gestational age: 16th, 20th, and 24th weeks).

RESULTS

A statistically significant difference was found in the Neutrophilic elastase positive cells to the advantage of cases with chorioamnionitis over voluntary abortions (24th week: P=0.0001, t-test) and also at the level of total hematopoiesis (20th and 24th week: P=0.041 and 0.004, respectively, t-test). There was no quantitative difference between the two settings at the level of erythropoiesis in the three examined periods.

CONCLUSIONS

Fetal infection can be diagnosed from the liver alone. After detection of changes in fetal hematopoiesis indicative of infection, examination of additional specimens of placenta and membranes will document the diagnosis of chorioamnionitis.

Odontogenic tumor with prominent clear cell component misdiagnosed as pleomorphic adenoma by fine-needle aspiration. A case report

Clear cell tumors in the maxillofacial region, are usually originated in salivary or odontogenic tissues, or may be metastatic. They include calcifying epithelial odontogenic tumors, ameloblastoma and odontogenic carcinoma. Clear cell odontogenic tumor has been classified in the last WHO classification as a benign tumor, but current opinion is that it should be designated as a carcinoma. We report a case of clear cell odontogenic tumor documented by histology, in a 82 year-old female, misinterpreted as pleomorphic adenoma by fine-needle aspiration cytology.

Prognostic significance of HLA-DR antigen in serous ovarian tumors

The antigens encoded by the major histocompability complex (HLA-DR) are cell glycoproteins that play a fundamental role in the regulation of the immune response. The prognosis of ovarian cancer is dependent on the histological type and on the clinical stage at diagnosis. Our study reports the value of HLA-DR antigen as a prognostic marker of ovarian serous adenocarcinoma. We studied 31 cases of serous ovarian cystadenoma, 12 cases of serous ovarian borderline cystadenoma, and 39 cases of well-differentiated cystadenocarcinoma for HLA-DR monoclonal antigen. We also studied the T helper marker (CD4) in the tumor stroma of the relevant cases, given that it is now known that the dependence of immune responsiveness on the class II antigens reflects the central role of these molecules in presenting antigen to T helper cells. HLA-DR was expressed in 20 of 31 cystadenomas (64.5%), 4 of 12 borderline tumors (33.3%), and in 10 of 39 invasive carcinomas (25.6%). CD4 was expressed in 9 of 31 cystadenomas (29%), 5 of 12 borderline tumors (42%), and in 26 of 39 invasive carcinomas (67%). There was a statistically significant difference for the two examined antigens in cystadenomas ( p<0.001) and invasive carcinomas ( p<0.001), whereas there was no statistical difference in borderline tumors ( p<0.5). The results showed decreased expression of HLA-DR and increased expression of CD4 as the lesion progressed to malignancy. The aberrant expression of HLA-DR by epithelial cells of cystadenomas, of borderline tumors, and of invasive adenocarcinomas agrees with the hypothesis of the adenoma/adenocarcinoma sequence. The immune attraction mechanism by low HLADR signaling seems to be of minor importance in the malignant and metastatic potential of serous ovarian tumors.

Renal extramedullary hematopoietic tumor diagnosed by fine needle aspiration: a case report

We report a case of a 58 year-old-male with a history of sickle cell anemia, who presented with a left kidney mass. Guided fine needle aspiration of the mass revealed extramedullary hematopoiesis and enabled avoiding an unnecessary surgical procedure.

INTRODUCTION

Extramedullary hematopoiesis (EMH) generally occurs in patients with deficient bone marrow hematopoiesis secondary to either peripheral red cell destruction or marrow replacement. EMH is most commonly seen in the liver and spleen as a diffuse lesion. Rarely EMH presents as a solitary mass, posing a diagnostic dilemma. In asymptomatic patients without obvious evidence of hemato-pathology, the differential diagnosis is even more complex. Despite several reports describing the radiographic findings in EMH, fewer promote the use of fine needle aspiration (FNA) in making this diagnosis.

Presence of a bone marrow stromal cell line with myoid differentiation in reactive plasmacytosis and plasma cell myeloma

The presence of myoid cells (MCs) - stromal cells with myogenic differentiation - in human bone marrow (BM) has been observed during hematopoiesis in embryonic life, whereas during adult life, it is strictly related to various pathologic conditions. The aim of this study was to examine the presence, distribution and quantitation of cells in the stroma of the BM expressing alpha-smooth muscle actin (alpha-SMA) in reactive BM plasmacytosis and plasma cell myeloma. For this reason, a series of 10 trephine BM biopsies from patients with plasma cell myeloma and 10 specimens from healthy controls with reactive plasmacytosis were examined for the presence of stromal cells with myoid differentiation, using a monoclonal antibody recognizing alpha-SMA. Our results suggest that the incidence of MCs and subsequent fibrosis rises in plasma cell myeloma and in a lesser degree in the BM stroma of individuals with reactive plasmacytosis.

Primary lymphoproliferative lesions of the mammary gland

Occasionally, the breast is the site of a localized, primary lymphoma with no evidence of concurrent widespread or preceding extramammary disease at the time of presentation (Stage I) or within 1-6 months thereafter. Cases with concurrent or subsequent ipsilateral axillary node involvement (Stage II) have also been accepted as primary lymphomas by some investigators, and such involvement has been observed in 48.5% of the cases. More commonly, the breast is involved secondarily by widespread lymphoma. Patients with PML range in age from 9 to 90 years, with a median ranging from 55 to 68 years in various reports. Clinical symptomatology varies considerably. Most patients present with a breast mass or complain of pain. About 10% of the patients may have night sweats, fever, and weight loss. Occasionally multiple nodules may be present within the breast. These nodules can cause overlying skin changes similar to those associated with carcinoma and may even involve the nipple. Mammographically, lymphomas form relatively circumscribed masses, focal or diffuse thickening and densities, and discrete nodules with irregular margins; typically, they lack calcification and retraction.

Fetal thymic medulla functional alterations in Down's syndrome

AIM

Although the thymus is usually considered a specifically T cell organ, occasional mature B lymphocytes, B cell germinal centres and rarely plasma cells can be found in this organ, particularly in children. Ultrastructural studies have shown that these lie outside the epithelial enclosure and within the perivascular spaces of the medulla, the corticomedullary junction and septa, and this has led to a concept of 2 functional compartments of the thymus, namely an intraepithelial compartment and an extraepithelial (perivascular) compartment. These cells do not originate from the thymus but enter the organ via the bloodstream, at the 16th week of gestation. Our study points towards possible alterations in the functional histology of this lymphoid organ associated with immunization.

METHODS

A quantitative comparison of B lymphocytes in the thymic medulla in embryos after involuntary abortion during the 1(st) and 2(nd) trimester of gestation and embryos with Down's syndrome, respectively, was performed.

RESULTS

Our results showed: 1) A statistically significant difference in the number of B cells together with infrequent primary follicles in the cases of embryos with Down's syndrome over those after voluntary abortion, during the 20(th) week of gestation (p=0.013). 2) No statistically significant difference in the number of B cells in both categories during the 1(st) trimester of gestation (p=0.34) and the 24(th) week of gestation (p=0.14).

CONCLUSION

The occurrence of increased number of B cells along with primary follicles in the cases with Down's syndrome, in the 2(nd) trimester of gestation imply that the thymic medulla - at least part of it - works and behaves as a peripheral lymphoid organ receiving mature lymphocytes, and turning them from inactive to immunoefficient cells, in the affected fetuses.

Gains and losses of CD8, CD20 and CD56 expression in tumor stroma-infiltrating lymphocytes compared with tumor-associated lymphocytes from ascitic fluid and lymphocytes from tumor draining lymph nodes in serous papillary ovarian carcinoma patients

Serous papillary ovarian cancer (SPC) is a highly aggressive tumor. About two-thirds of women have advanced disease at the time of diagnosis. Although many women with disseminated disease respond at first to combinations of surgery and chemotherapy, nearly 90% of tumors recur and women die of disease. Update progress in our knowledge of tumor-associated antigens and insight into mechanisms involved in immune-mediated recognition of these antigens, have provided a strong starting point for using the immune system as a model for novel therapy. In this study we determined the immunological profile of tumor-infiltrating lymphocytes (TILs), tumor-associated lymphocytes (TALs) in ascitic fluids, and lymphocytes from tumor draining regional lymph nodes (LNs) in SPC patients by CD20 (L26), CD8, and CD56 immunostaining. We examined 14 cases of TILs, 15 cases of TALs and 19 cases of LNs. TILs were infiltrating tumor stroma. No significant difference was detected in TILs, TALs and LNs in the expression of the B-cell marker CD20. In contrast, CD8 (T-cytotoxic) and CD56 (natural killer cell, NK) markers were dominant in LNs and TALs, but not in TILs. We conclude that SPC tumor lymphocytic infiltrate demonstrates a deplete T cytotoxic (CD8+) and NK cell (CD56+) immunophenotypic profile. This might in part explain the poor clinical outcome of the disease.

Imprint cytology for rapid evaluation of lung and mediastinal lesions

BACKGROUND

Frozen-section biopsy (FSB) of pulmonary and mediastinal tumors is commonly used in the evaluation of diagnostic tissue in thoracic surgery. However, FSB can be labor intensive for the pathology department and time-consuming while the patient is anaesthetised. Imprint cytology is more rapid than the FSB procedure (average, 1 min versus 10 min per tissue sample) and allows more extensive sampling of the specimen.

METHODS

In this preliminary study we compared the diagnostic accuracy of imprint cytology and permanent sections on lung and mediastinal lesions from 38 patients.

RESULTS

There were no false-positive results and 2 false-negative results. The sensitivity was 99.13%, the specificity was 100% and the positive predictive value was 100%, as no false-positive results were observed. These results match favorably with those in other studies comparing the diagnostic accuracy of imprinting cytology with that of FSB and with reported accuracy rates of the FSB method.

CONCLUSION

Our findings confirm the usefulness of this procedure as an adjunt or alternative for FSB in the pathologic evaluation of lung and mediastinal space-occupying lesions.

Gains and losses of glycoprotein CD44 and secretory component expression in endometrial hyperplasia and neoplasia

CD44 is an adhesion molecule, which binds hyaluronic acid and participates in a number of cell-cell interactions, including lymphocyte homing. The CD44 antigen is expressed on approximately 90% of lymphocytes, monocytes, granulocytes, and, in lower amounts on thymocytes, fibroblasts, and erythrocytes. Platelets lack CD44. In non-haematopoietic tissues, CD44 is widely distributed. The secretory component is isolated from human colostrum and is of help in more precise grading of endometrial carcinoma. In this study we examined CD44 and secretory component expression in adenomatous hyperplasia, atypical adenomatous hyperplasia and well-differentiated adenocarcinoma (cribriform pattern). The results showed decreased expression of CD44 and increased expression of secretory component as the lesion progressed to malignancy.

Immunohistochemical expression of vimentin and secretory component antigens in endometrial hyperplasia and neoplasia

Vimentin is an intermediate filament protein normally expressed in mesenchymal cells, but evidence is accumulating in the literature which suggests that the aberrant expression of vimentin in epithelial cancer cells might be related to local invasiveness and metastatic potential. Previous studies strongly support the implication of vimentin in the metastatic progression of breast and cervical lesions. The secretory component is isolated from human colostrum and is of help in more precise grading of endometrial carcinoma. In this study we examined vimentin and secretory component (SC) expression in adenomatous hyperplasia, atypical adenomatous hyperplasia and well-differentiated adenocarcinoma (cribriform pattern). The results showed decreased expression of vimentin and increased expression of the secretory component as the lesion progressed to malignancy.

Immunohistochemical expression of alpha-smooth muscle actin in infiltrating ductal carcinoma of the breast with productive fibrosis

Myoepithelial cells are normally located between the epithelial cells and the basal lamina of secretory elements of exocrine glands. Their role in the histogenesis of breast tumours has been studied extensively, and a definite differentiation towards myoepithelial cells has been demonstrated in adenoid cystic carcinoma, adenomyoepithelioma, low-grade adenosquamous (syringomatous) carcinoma, pure malignant myoepithelioma and poorly differentiated myoepithelial-rich breast carcinoma. All these tumours are of low malignancy, with the exception of malignant myoepithelioma and poorly differentiated myoepithelial-rich carcinoma. We examined the possibility that invasive ductal carcinoma of the breast might show differentiation towards both epithelial and myoepithelial cells because there is no reason to assume that one type of differentiation necessarily excludes the other. We performed the avidin-biotin immunohistochemical analysis of 20 cases of infiltrating ductal carcinomas (IDCs) with diffuse fibrosis, 20 cases of IDCs without fibrosis and five cases of metaplastic carcinomas, to detect myoepithelial differentiation of the tumour cells. Myoepithelial differentiation was determined by the expression of alpha-smooth muscle actin (alpha-SMA). We concluded that IDCs with diffuse fibrosis are associated with a myoepithelial immunophenotype of carcinoma cells.

Immunophenotypic profile of tumor infiltrating lymphocytes in medullary carcinoma of the breast

Medullary carcinoma (MC) of the breast is considered to carry a more favorable prognosis than other subtypes of infiltrating ductal carcinoma. This is a biological paradox because its clinical behavior contrasts with its anaplastic morphology. MC is characterized by a dense lymphocytic infiltrate. In this study, we determined the immunological profile of tumor infiltrating lymphocytes (TILs) in MC by CD20 (L26), CD8, and CD45RO (UCHL 1) immunostaining on paraffin-embedded sections. We examined 14 cases of typical MC (TMC), 15 cases of atypical MC (AMC) classified according to Ridolfi criteria (1977) and 19 cases of poorly differentiated infiltrating ductal carcinoma (PDC-NOS). TILs were quantified separately into cells infiltrating tumor nests (intraepithelial) and cells infiltrating tumor stroma (stromal). The number of CD8 positive and CD20 positive cells infiltrating tumor nests and tumor stroma were significantly increased in TMC and AMC as opposed to the PDC-NOS group. There was a loss in the number of CD45RO positive cells, both intraepithelial and stromal, in TMC and AMC as opposed to the PDC-NOS group. We conclude that MC tumor lymphocytic infiltrate demonstrates a mixed-T cytotoxic (CD8+) and B cell (CD20+)-immunophenotypic profile. This might in part explain the improved clinical outcome of the disease.

Nucleolar organizer regions (NORs). Their significance in the determination of the origin of the lymphoid vessels

AIM

The aim of this study is the evaluation of the cellular activity of the embryonal mesenchyme in order to investigate if the primitive lymph vessels are derived from clefts of the mesenchyme or from capillary offshoots from the endothelium of the veins. For this reason we applied the quantitative estimation of nucleolar organizer regions (NORs) in the endothelial cells of the lymph and blood vessels, as well as in the mesenchymal cells that surround these vessels.

METHODS

Our material consisted of the histological sections from the proper mesenterium of 30 embryos in different stages of development (10th, 12th, 15th, 20th, 23th and 30th week).

RESULTS

A statistically significant difference in the average AgNORs value in the endothelial (ANOVA, p<0.0001) and the mesenchymal cells (ANOVA, p<0.0001) between lymph vessels, blood vessels at close and blood vessels at distant regions (10th, 12th, 15th week) was found. There was no statistically significant difference of the average AgNORs value in the endothelial (ANOVA, p=0.55) and the mesenchymal cells (ANOVA, p=0.49) between lymph vessels, blood vessels at close and blood vessels at distant regions (20th, 23th, 30th week).

CONCLUSION

The above results suggest that the development of the lymph vessels follows that of the blood vessels. Furthermore, the intense protein synthesis that is expressed by means of NORs in the mesenchymal cells surrounding lymph vessels from the 10th to the 15th week of development is an additional proof of the view that the primitive lymph vessels are derived from clefts into the embryonal mesenchyma and not from capillary offshoots of the endothelium of the blood vessels.

Detection of chromosome 1p deletion using FISH on meningioma touch imprints suggest a region outside chromosome 22 as important in tumor recurrence

BACKGROUND

Atypical and anaplastic meningiomas tend to recur and to invade adjacent brain, bone, and skin. They can also metastasize to extracranial organs such as the lung, liver, or bone causing death. The classic genetic abnormality is loss in chromosome 22. Recent reports have indicated that allelic deletion of chromosome 1p is associated with malignant progression of meningiomas.

METHODS

Cytogenetic analysis of 4 meningiomas was performed using double target fluorescent in situ hybridization and focusing on chromosomes 1 and 22. The meningioma series included 4 patients whose tumors were histologically benign.

RESULTS

One patient's tumor had recurred. FISH was performed on 500 nuclei/tumors. All our cases showed a loss of chromosome 22q while only 1 meningioma showed an additional loss of chromosome 1p, and this was the recurred one.

CONCLUSIONS

The results of this study support the existence of tumor suppressor gene(s) on 1p associated with recurrence in meningiomas and suggest that status of chromosome 1p by FISH may assist physicians in predicting prognosis of patients affected by this tumor. However more in-vestigation is needed in this direction, as our re-sults refer to a small number of subjects studied.

A quantitative study of collagen production by human smooth muscle cells during intestinal morphogenesis

Differentiating mesenchymal cells and the extracellular matrix that these cells produce constitute the structural basis for developing organs. The splanchnopleuric mesenchyme surrounding the developing gut and respiratory tubes provides connective tissue cells to the lamina propria/submucosa and smooth muscle cells to the muscularis musosae/muscularis externa. In human fetal intestine, the identity of the matrix-producing cell or cells has begun to be elucidated. The smooth muscle cell is one of the sources of collagen fibers in the extracellular matrix in the developing human fetal intestine and collagen production is a significant function of smooth muscle cells during intestinal organogenesis. The aim of the current study was the quantitative investigation of collagen production by human fetal intestinal smooth muscle cells in various stages of development (10 to 23 weeks of gestational age). Identification of the mesenchymal cells/extracellular matrix was confirmed by immunohistochemical techniques using the following monoclonal antibodies: actin, desmin, vimentin, collagen IV and fibronectin. Histochemical stains for the presence of extracellular matrix components were also performed. Immunohistochemical analysis and the results of the histochemistry of the fetal human intestine in various stages of development revealed that the muscle cells of the muscularis externa contribute to the production of collagen in collaboration with the mesenchymal cells. This is more evident between 10 to 14 weeks of gestational age.

Testicular tumors manifested as inferior vena cava thromboses. Case reports

Four cases of asymptomatic testicular tumors with inferior vena cava (IVC) involvement are reported. All patients were referred to our hospital with non-specific abdominal pain and abdominal US revealed an inferior vena cava thrombosis. CT showed an IVC thrombus extending from the first to second lumbar vertebrae and also retroperitoneal lymphadenopathy in 3 patients. Scrotal US demonstrated intratesticular tumors. IVC thrombosis may result from asymptomatic intratesticular tumors (single or multiple). Because of that, scrotal US is of paramount importance as a routine screening test in patients who radiographically demonstrate caval thrombosis.

Immunocytochemical profile of malignant pleural effusions of small-cell lung cancer

BACKGROUND

Small-cell lung carcinoma (SCLC) is a highly malignant tumour of a somewhat distinctive cell type. The aim of this study was to determine the immunocytochemical profile of tumor cells and lymphoid cell in SCLC pleural fluids.

METHODS

Nine cases of malignant pleural fluids of SCLC were studied using cell block preparation. In pleural effusions cytologically proven to be malignant in 9 patients with SCLC, the immunocytological features of tumor cells, together with the determination of lymphocytic subsets were documented.

RESULTS

In all 9 cases, tumor cells reacted with neuron-specific enolase (NSE) (100%), whereas in 6 of 9 cases (66,66%) tumor cell expressed synaptophysin, thyroid transciption factor-1 (TTF-1) and chromogranin A antigens. Phenotyping of the lymphocytes revealed in the majority of cases an expression of CD3 and CD4 antigens (8 and 7 cases, respectively) in contrast to CD8 and CD20 expression (1 and 1 case, respectively).

CONCLUSIONS

The reactivity pattern of the tumor cells with the markers used in our study is a specific for SCLC. No significant difference in the distribution of lymphocytic subpopulations is observed in correlation with other malignant and no malignant processes involving the pleural cavity.

Large granular lymphocytes (LGLS) activity in women with spontaneous abortions during the 1st trimester of gestation

BACKGROUND

Despite increasing knowledge about the cell subsets that exist in the decidua in normal early pregnancy, little is known about the decidual cell subsets in women with spontaneous pregnancy failure. Decidual large granular lymphocytes (LGLs) are the most abundant lymphoid cell type found in 1st trimester maternal decidua. The function of LGLs remains controversial although freshly isolated LGLs have been shown to exert a weak natural killer cell (NK) activity.

METHODS

Decidual leukocytes were investigated in 15 cases of spontaneous abortion and 15 cases of voluntary miscarriage, at 8th, 10th and 12th gestational week using a panel of monoclonal antibodies against Granzyme B (GRAN-B), CD2, CD38, CD56, and CD57 antigens and the immunoperoxidase technique. LGLs were demonstrated with the phloxine-tartazine stain.

RESULTS

There was a statistically significant increase in the number of CD56 and CD57 positive cells (33.3%) to the advantage of spontaneous abortions (p<0.0001). No statistically significant difference was found in the number of GRAN-B, CD2 and CD38 positive cells in normal early pregnancy and in spontaneous abortion (overall gestational age p=0.22, 8th gestational week p=0.18, 10th and 12th gestational week, p=0.091).

CONCLUSIONS

Our findings confirm previous studies referring that LGLs may have a cytotoxic activity similar to the NK activity and suggest an adverse pregnancy outcome.

Nucleolar organizer regions: their significance in protein synthesis and consequent release of factors that attract immature lymphocytes in different types of thymic epitheliocytes and in different stages of thymic development

The thymus is a lymphoepithelial organ that has the central role in T-lymphocyte development. Unlike other lymphoid structures, where the supportive framework is chiefly collagenous reticular tissue, the thymus is permeated by a network of interconnected epithelial cells (thymic epitheliocytes) between which lodge lymphoid and other cells of the organ. There is much evidence that many distinctive functional roles are subserved by the thymic epitheliocytes such as, the differentiation of T lymphocytes, the production of soluble thymic factors or hormones, supportive functions, or their role in MHC restriction of T-cell immune responses. Nucleolar organizer regions (NORs), which are important for regulating protein synthesis, were identified in 30 fetal thymuses in different stages of development ( 10th, 14th, 15th, 19th, 20th, 23rd, 31st, and 35th week), by means of a silver (Ag) staining technique (AgNOR). The aim of our study was to estimate the AgNOR counts in the six different types of fetal thymic epitheliocytes, following suggestions that there may be a possible association between AgNOR values and consequent protein synthesis in the different types of these cells and in different stages of thymic development. The results showed that: First Type I epitheliocytes (subcapsular-perivascular) of the cortex represent a higher number of AgNORs in comparison with the other cellular types, a difference that was observed every week of our study, and especially between the 10th and 15th week of development (p < 0.01). The increased number of AgNORs in Type I epitheliocytes reflect their intense protein synthesis, a fact that explains the increased secretion of factors, e.g. beta2-microglobulin, that release immature lymphocytes from the yolk sac and the liver. Second, gradual increase of the average AgNOR in all thymic epitheliocytes from the 10th till the 35th week, without any statistical variation. This increase might be due to the intense functional activity of the whole number of epitheliocytes that participate in the proliferation, differentiation and issue in the circulation of mature T lymphocytes, which takes place after the 17th week of development. The 17-week thymus appears fully differentiated, and after this time it produces the main type of thymocyte also present throughout life (designated TdT +).

Expression of alpha-smooth muscle actin in the stromal cells of bone marrow in fetuses in different stages of development, in multiple myeloma and monoclonal gammopathy of unknown significance

Several disorders are associated with a monoclonal immunoglobulin detected by serum or urine electrophoresis, the most common being a monoclonal gammopathy of unknown significance, multiple myeloma, Waldenstrom's macroglobulinemia, and amyloidosis. Plasma cells, the immunoglobulin secretory cells of the immune system, are normal constituents of bone marrow (BM). Plasma cells are seen in small numbers in the stroma, surrounding blood vessels in the marrow. Their perivascular disposition is consistent with their secreting capacity. The hematopoietic microenvironment has a crucial role homing and regulating precursor cell growth both in physiologic and pathologic conditions. Cellular components such as branched adventitial reticular cells, macrophages, endothelial cells and fat cells constitute the supporting framework (stroma) for hematopoiesis, which takes place in the extravascular compartment. The presence of myiod cells (MCs) in human bone marrow has been observed during hematopoiesis in embryonic life, whereas during adult life, it is strictly related to various pathologic conditions. The aim of this study was to examine in the stroma of BM the presence, distribution and quantitation of cells expressing a-smooth muscle actin (MCs) from patients with monoclonal gammopathy of unknown significance, those with plasma cell myeloma and embryos (gestational age 15 to 25 weeks). For this reason, a series of 20 trephine bone marrow biopsies from adult patients and ten fetal specimens of the spine and femur were examined for the presence of stromal myoid cells using a monoclonal recognising alpha-smooth muscle actin, a contractile microfilament expressed solely by smooth muscle cells, myofibroblasts and related cells. Our results suggest that the appearance of MCs and subsequent fibrosis is not a feature of malignant BM disorders such as MM but it is also seen to a lesser degree in the BM stroma of individuals with monoclonal gammopathy of unknown significance (MGUS). Stromal cells with phenotypic smooth muscle features appear in bone marrow during pathological situations in a manner reminiscent of what occurs during normal development.

Nucleolar organizer regions: their significance in the maturation of the gut-associated lymphoid tissue

Nucleolar organizer regions (NORs) are important for regulating protein synthesis. Our study points towards the possibility of determining gut-associated lymphoid (GAL) cell proliferation and maturation in fetuses from ten to 35 weeks of gestation by means of the Argyrophilic (Ag) staining for NORs. This technique was performed on paraffin-embedded small intestine and mesentery tissue sections from 30 fetuses at the 10th, 14th, 15th, 19th, 20th, 23rd, 31st, and 35th week of gestation. Our results showed that there was no statistically significant difference concerning the mean AgNOR values, between GAL cells and mesentery lymphoid cells (2.81 +/- 0.63 to 2.63 +/- 0.71; p > 0.1), from ten to 15 weeks' gestation. In this specific period, the lymphoid cells first appear and Peyer's patches are formed in the small intestinal mucosa. In contrast, in fetuses from 19 to 35 fetal weeks NOR counts were statistically significantly greater in GAL cells than in fetuses from ten to 15 gestational weeks (as compared to NOR counts in GAL cells in fetuses at an earlier fetal age) (3.28 +/- 0.73 to 2.81 +/- 0.63). Mean AgNOR values in mesentery lymphoid cells remained unchanged (2.62 +/- 0.57) (p < 0.001). In conclusion, increasing protein synthesis from the 19th till the 35th week of gestation is indicative of immune system maturation, given that at the same time GAL cells become fully mature. Mesentery lymphoid cells pass (migrate) to the small intestinal mucosa from the bloodstream, and they form the whole out-associted lymphoid tissue (GALT) organ (Peyer's patches). The lymphatics associated with mucosa associated lymphoid tissue (MALT) are all efferent; it seems that during fetal life due to genetically determined factors, draining vessels operating as afferent lymphatics at that time, change to efferent (where the immunological response is greatly amplified) as embryonal life progresses.

Marginal-zone B-cell lymphoma, extranodal-malt-type: report of three cases

A high proportion of extranodal lymphoid infiltrates are diffuse small lymphocytic proliferations [1, 2] and therefore pose a particularly challenging diagnostic problem [1-4]. Their benign or malignant nature cannot be determined using clinical and radiologic criteria. The application of traditional morphologic criteria (i.e., cytologic maturity and polymorphism favor benignancy, while cytologic atypia and monomorphism favor malignancy) [5, 6], has probably improved diagnostic accuracy. However, these criteria generally have not been helpful in evaluating the large number of lymphoid infiltrates composed of monomorphic collections of small cytologically-mature appearing lymphoid cells [1-4] and, therefore, have not always accurately predicted clinical behavior. Extranodal lymphoid proliferations are also of considerable biologic interest since their pathogenesis and natural history have not been fully elucidated. Localized non-Hodgkin's lymphoma, extranodal-MALT-type. was diagnosed in our Department in three cases: Two arose in the orbit and the third one in the tonsil. The tumors had a typical histologic appearance. The microscopical features and immunohistochemical profile are discussed.

Differential expression of alpha-smooth muscle actin molecule in a subset of bone marrow stromal cells, in b-cell chronic lymphocytic leukemia, autoimmune disorders and normal fetuses

Lymphocytes are a constituent of normal marrow. Both B and T lymphocytes are derived from bone marrow stem cells. Lymphocytes are found in normal marrow as single cells and in lymphoid aggregates or follicles. Lymphocytes and precursors are particularly prominent in bone marrow from children in which they may account for up to 40% of the bone marrow cells. The development of hematopoetic cells within the bone marrow (BM) occurs in intimate association with cells of the bone marrow microenvironment. This phenotypically diverse population of connective tissue-type cells includes fibroblasts, macrophages, adipocytes and endothelial cells and, collectively, represents the stromal tissue of the bone marrow. The presence of myoid cells in human bone marrow has been observed during hemopoiesis in embryonic life, whereas during adult life, it is strictly related to different pathologic conditions such as metastatic carcinoma, Hodgkin's disease, hairy cell leukemia and chronic myelo-proliferative diseases. Under normal circumstances, lymphoid cells may constitute up to 20% of the population of nucleated cells in the bone marrow. However, there may be an absolute or a relative increase, the latter due to a reduction in hematopoietic tissue, as in some skeletal areas in advancing age, or in hypoplastic conditions. The aim of this study was to examine the presence, distribution and quantitation of cells expressing alpha-smooth muscle actin in the stroma of the BM of patients with nodular type b-cell chronic lymphocytic leukemia (B-CLL), patients with autoimmune disorders and embryos (gestational age 15 to 25 weeks). For this reason, we investigated the presence of myoid cells (MCs) in a series of 20 trephine bone marrow biopsies from adult patients and ten fetal specimens of the spine and femur, using a monoclonal antibody recognizing alpha-smooth muscle actin, a contractile microfilament expressed exclusively by smooth muscle cells, myofibroblasts and related cells. The results of our study showed that: 1. BM stromal myoid cells represent a distinct subpopulation of reticular cells in the bone marrow, undergoing cytoskeletal remodeling in response to various stimuli (fetuses). 2. The appearance of BM stromal myoid cells is not only seen as a characteristic feature in B-CLL, but is also seen, to a lesser degree, in the stroma of bone marrow in patients with autoimmune disorders. 3. Stromal cells with phenotypic smooth muscle features appear in bone marrow during pathological situations in a manner reminiscent of what occurs during normal development.

Spontaneous abortions with increased CD5 positive cells in the placental tissue during the first trimester of gestation

Most spontaneous abortions occur before 12 weeks' gestation, and most are due to chromosomal errors in the conceptus. Relatively few truly spontaneous abortions take place between 12 and 20 weeks' gestation. Thereafter, between 20 and 30 weeks another type of premature spontaneous termination due to ascending infection becomes prevalent. The number of cells expressing the various lymphocytic markers changes throughout pregnancy. In the present study, we investigated the immunohistochemical expression of mononuclear infiltrations in paraffin-embedded placentas, from fetuses after spontaneous abortion (8th, 10th, and 12th week of gestational age), and those after therapeutic abortion at the same time, using a panel of monoclonal antibodies for the identification of leukocytes (CD45/LCA), B-lymphocytes (CD20/L-26), T-lymphocytes (CD45RO/UCHL1) and CD5 cells. Immunologic factors in human reproductive failure are plausible mechanisms of infertility and spontaneous abortion. Approximately 25% of cases of premature ovarian failure appear to result from an autoimmune etiology. Unfortunately, current therapeutic options for these women are limited to exogenous hormone or gamete substitution. Local inflammation at the sites of endometriosis implants are postulated to mediate the pain and reduce fecundability associated with this clinical syndrome. The recruitment of immune cells, particularly monocytes and T cells, neovascularization around foci of invading peritoneal lesions, and the possible development of antiendometrial autoantibodies support an immunologic basis of this disorder. To date, treatment of pain and infertility associated with endometriosis is primarily surgical, although immune-based adjuvants are theoretical possibilities for the future. Finally, although hypotheses supporting immunologic mechanisms of recurrent pregnancy loss have been popular over the past decade, most clinical investigations in this area do not provide compelling evidence for this position. Reputable specialists in reproductive medicine use experimental immunotherapies judiciously in selected cases of repetitive abortion. For example, the use of anticoagulation therapy can be beneficial in cases with documented antiphospholipid antibodies. At present, however, efficacious immunotherapy protocols for general application have not been established. Despite these caveats, continued strides in our understanding of human reproductive immunology, should yield considerable future progress in this field. We conclude that, 1) maternal cells, probably CD45RO/UCHL1 positive cells, cross the maternofetal barrier and participate in spontaneous (involuntary) abortions, 2) a small proportion of maternal cells (approximately 30%), probably CD5 positive cells, also cross the maternal fetal barrier and cause growth delay and recurrent reproductive failure. The results were statistically significant (p < 0.0001, Student's t-test).

Human decidual cells can express the Hodgkin's cell-associated antigen Ki-1 (CD30) in spontaneous abortions during the first trimester of gestation

CD30 (Ki-1) antigen has been considered to be expressed on hematopoietic cells including the ones of the recently described anaplastic large cell lymphoma (ALCL), the Reed-Sternberg (RS) cells of Hodgkin's disease and the scattered large parafollicular cells in normal lymphoid tissues. Since then, several reports have been published describing CD30 expression in non-hematopoietic and malignant cells, such as cultivated human macrophages, human decidual cells, histiocytic neoplastic cells, mesothelioma cells, embryonal carcinoma, and seminoma cells. In the present study, we investigated the immunohistochemical expression of CD30 antigen in 15 paraffin-embedded placentas from fetuses after spontaneous abortion in the first trimester of gestation (8th, 10th, and 12th week, respectively) using the monoclonal antibody Ber-H2. All the pregnant patients had been given hormonal medication to support gestation. In addition, a panel of monoclonal antibodies for the identification of leukocytes (CD45/LCA), B-lymphocytes (CD20/L-26), and T-lymphocytes (CD45RO/UCHLI) was performed. Our findings were correlated with those found in 15 placentas obtained from 15 fetuses at the same time, after therapeutic or voluntary abortions. This study demonstrates that, 1) decidual endometrial stromal cells are able to express the CD30 (Ki-1) antigen, 2) the expression of CD30 in decidual cells is higher in cases of hormonal administration (to support gestation), than that found in normal gestation. In the former cases (hormonal support of gestation), a mild mononuclear infiltration of the decidua by UCHLI (T marker) positive cells, accompanies the CD30 positive cells.

K statistic as a measure of quality control in cervicovaginal cytology

Quality assessment schemes are widespread in most branches of pathology but are uncommon in the more subjective areas of histopathology and cytology. Researchers in many fields have become increasingly aware of the observer as an important source of measurement error. The validity of any method of reporting evidence of an abnormal process in cellular material is based on the degree of correlation with the actual disease process as it exists in the tissue and its reproducibility. Correlations can be tested in retrospective studies in which diagnoses based on cellular evidence are matched against the disease process present in biopsy specimens. Correlations can also be tested by examination of a set of unknown cellular preparations obtained in the presence of proven disease. While reproducibility is indirectly related to correlation, it is meant to imply satisfactory utilization of the method by other groups of cytotechnologists and cytopathologists. While cytopathology will continue to play an important role as a screening technique for the detection of cancer of the uterine cervix, its usefulness in the study of the early manifestations of the disease process is yet to be realized on a universal basis.

Primary muscular hydatidosis. US, CT and MR findings

We present a rare case of primary muscular hydatidosis in the left thigh of a 40-year-old female patient. US, CT and MR imaging showed a typical multilocular hydatid cyst deep in the vastus intermedius and vastus medialis muscles. Histopathological examination, which followed surgical excision, established the diagnosis of echinococcus cyst.

Primary muscular hydatidosis. US, CT and MR findings

We present a rare case of primary muscular hydatidosis in the left thigh of a 40-year-old female patient. US, CT and MR imaging showed a typical multilocular hydatid cyst deep in the vastus intermedius and vastus medialis muscles. Histopathological examination, which followed surgical excision, established the diagnosis of echinococcus cyst.

Germline mutations in the ribonuclease L gene in families showing linkage with HPC1

Although prostate cancer is the most common non-cutaneous malignancy diagnosed in men in the United States, little is known about inherited factors that influence its genetic predisposition. Here we report that germline mutations in the gene encoding 2'-5'-oligoadenylate(2-5A)-dependent RNase L (RNASEL) segregate in prostate cancer families that show linkage to the HPC1 (hereditary prostate cancer 1) region at 1q24-25 (ref. 9). We identified RNASEL by a positional cloning/candidate gene method, and show that a nonsense mutation and a mutation in an initiation codon of RNASEL segregate independently in two HPC1-linked families. Inactive RNASEL alleles are present at a low frequency in the general population. RNASEL regulates cell proliferation and apoptosis through the interferon-regulated 2-5A pathway and has been suggested to be a candidate tumor suppressor gene. We found that microdissected tumors with a germline mutation showed loss of heterozygosity and loss of RNase L protein, and that RNASEL activity was reduced in lymphoblasts from heterozyogous individuals compared with family members who were homozygous with respect to the wildtype allele. Thus, germline mutations in RNASEL may be of diagnostic value, and the 2-5A pathway might provide opportunities for developing therapies for those with prostate cancer.

Differential expression of Bcl-2 proto-oncogene in the trophoblast from embryos with Down's syndrome and those after spontaneous abortion

Down's syndrome (trisomy 21) was the first human chromosomal syndrome to be recognized (in 1959 by Lejeune and colleagues). It is also the most frequent chromosomal aberration occurring in one out of 700 live newborns. In the present study we investigated the immunohistochemical expression of the apoptosis-suppressing protein Bcl-2 in placental trophoblastic cells from embryos with Down's syndrome (gestational age 12th, 15th and 22nd week) and correlated the findings with equivalent trophoblastic cells from embryos after spontaneous abortion. In our cases with Down's syndrome a weak Bcl-2 expression was noted in the cytotrophoblast and syncytiotrophoblast of chorionic villi in contrast to strong Bcl-2 staining of the same cells in the cases of spontaneous abortions (p < 0.0001). Although there are no specific findings that truly characterize a placenta with trisomy, obtaining a small piece of chorionic villus tissue (chorionic villus biopsy) and immunohistochemical control for Bcl-2 protein could be an additional prenatal examination available to the perinatologist to detect chromosomal abnormalities.

Expression of laminin, type IV collagen and fibronectin molecules is related to embryonal skin and epidermal appendage morphogenesis

Basement membrane zones are specialized sheets--like arrangements of extracellular matrix proteins and glycosaminoglycans, and act as an interface between parenchymal cells and support tissue. They separate epithelium, endothelium, muscle cells and Schwann cells from adjacent connective tissue stroma, and also from a limiting membrane in the central nervous system. They are involved in several cellular and biological processes, including adhesion, migration and cellular differentiation. Basement membranes have five major components: collagen type IV, laminin, heparan sulfate, entactin, and fibronectin. In addition, there are numerous minor and poorly characterized protein and glycosaminoglycan components. The various components of the basement membranes of the skin (collagen type IV, proteoglycans--heparan sulfate, laminin, entactin and fibronectin) are products of the epithelial (epidermal) cells. We studied immunohistochemically the origin, the first appearance and distribution of the adhesive extracellular glycoprotein laminin and the fibrillar proteins of the extracellular matrix collagen type IV and fibronectin in the basement membranes of fetal human skin between 12 to 21 weeks of gestational age. Additionally, we studied the expression of vimentin in the extracellular matrix of the epithelial/mesenchyme junction of the skin. This study demonstrates clearly that the expression of the antigens laminin, collagen type IV and fibronectin starts in the germinative epithelial cells of the skin at the bulbs of the hair follicles (12th week for fibronectin and 19th week for laminin and collagen type IV), and migrating progressively involves the epithelial epidermal cells of the covering skin, as well as, the basement membrane at the dermal-epidermal junction in that region (between 20 to 21 weeks of gestational age).

Imprint cytology of non-specific granulomatous mastitis

Non-specific granulomatous mastitis (NSGM) is a tumor-like inflammatory condition involving breast lobules. Its recognition is of great significance because of clinical masquerade to invasive carcinoma. A 25-year-old woman developed a palpable breast lump with clinical and mammographic findings suggestive of malignancy. Touch imprint cytology of the excised lump was consistent with a granulomatous inflammation while histopathological examination documented a NSGM with central necrosis. Clinical, radiologic and laboratory testing failed to identify any specific causative agent.

Expression of the intermediate filament vimentin and fibrillar proteins of the extracellular matrix related to embryonal heart development

During organogenesis, the heart is one the first organs to develop and the earliest organ to function. The early appearance of cardiac activity in the tubular hearts of chick and rat embryos was noted many years ago. It arises from two plates of the splanchnic mesoderm which fuse to form a single tubular structure composed of endocardial and myocardial cells and, between them, the extracellular cardiac matrix. There is considerable variation in the formation of the extracellular matrix in the various regions of the heart during development. The endocardial lining cells of the vertebrate embryos show a regional specificity that remains an unexplained phenomenon in cardiac morphogenesis. The great majority of the endocardial lining cells remain epithlial. However, a restricted population of endothelial cells, lining the atrioventricular (AV) canal and the reputed proximal outflow tract (OT), transforms into mesenchyme; the latter being the reputed progenitor of the valves and membranous septa. The purpose of this study was to investigate the extracellular cardiac matrix of the human fetal heart in different regions and in various stages of development, and also the heterogeneity of the endocardial cell lining, in connection with the endothelial cells of other cardiac vessels. Identification of the mesenchymal cells/extracellular matrix was confirmed by immunohistochemical techniques using the following monoclonal antibodies: actin, desmin, vimentin, collagen IV and fibronectin. The present results provide evidence that the extracellular matrix of the heart is of mesodermal origin but at the level of the valves the mesenchyme is derived from the endothelial lining cells rather than the primitive mesenchyme.

Expression of fibrillar proteins and vimentin in developing chorionic villi is related to fetal maturation

Using an immunocytochemical technique, the extracellular matrix components fibronectin, vimentin, laminin and collagen type IV were investigated in human chorionic villi of various stages of development. Fibronectin and laminin were consistently positive throughout embryonic development. Vimentin and collagen type IV were negative in first and second trimester chorionic villi, but became positive in term placentas. With the exception of laminin, all extracellular matrix molecules were detected in the villous stroma and, with the exception of vimentin, they were localized in the basement membranes. Our data suggest that fibronectin and laminin are essential components of the villous structure, while the presence of vimentin and collagen type IV in the chorionic villi should be regarded as an indicator of fetal maturation.

The immunophenotypic profile of hepatic hemopoiesis in fetuses with Down's syndrome during the second trimester of development

The yolk sac and aorto-gonad-mesonephros region are well recognized as the principal sites of hematopoiesis in the developing embryo, and the liver is the principal site of hematopoiesis in the fetus. In the present study, we investigated the immunohistochemical expression of Glycophorin C (erythrocytes), Neutrophilic elastase (granulocytes), and CD34 (progenitor hematopoietic stem cells, progenitor stromal cells, and vascular endothelial cells) in hepatic parenchyma from fetuses with Down's syndrome (DS) (16th, 20th, and 24th week of gestational age), and correlated the findings with the equivalent of the hepatic parenchyma from fetuses after spontaneous abortion. Our results did not demonstrate a quantitative difference at the level of erythropoiesis in all three periods examined. In contrast, an important numerical difference was shown in the expression of CD34 positive cells in liver parenchyma from fetuses with DS, in comparison with those found in liver parenchyma from fetuses after spontaneous abortion (p < 0.02). Furthermore, a modest but significant difference was demonstrated at the level of granulopoiesis between the 20th and 24th week (p < 0.01). Given that, the living newborns with Down's syndrome manifest diverse haematological abnormalities, including a transient leukemoid reaction that usually disappears after some weeks or months, a significantly increased number of CD34 positive and a less significantly increased number of neutrophilic elastase positive cells between the 20th and 24th gestational week could explain this phenomenon in combination with the respective results, if any, in the bone marrow. Regarding our finding of increased stromal CD34 positive cells in the hepatic portal triads, it raises the possibility that a process similar to fibrosis of the bone marrow may contribute to the hepatic fibrosis in DS.

Primary diffuse large B-cell lymphoma of the breast: a case report

Mammary non-Hodgkin's lymphomas are uncommon and account for 2% of all extranodal lymphomas. Stringent diagnostic criteria are applied in the diagnosis of primary lymphoma considering that the breast is a recognized site for disseminated extranodal lymphoma. Our case report was established by histology alone.

Appraisal of imprint cytology in the diagnosis of mucinous carcinoma of the breast: a case report

A case of mucinous carcinoma of the breast is reported in a female aged 71 years. On gross examination of the left mastectomy specimen two relatively well-circumscribed masses with a gelatinous cut surface were found. Touch imprint cytology was consistent with a low-grade malignancy and histologic and histochemical examination revealed a mucinous carcinoma. Careful prospective correlation between the cytological appearances of cells in imprints and the subsequent histopathology may lead to a more precise cytodiagnosis of a tumor associated with a comparative good prognosis.