[Clinico-pathologic considerations on 9,952 appendices removed at the Busto Arsizio Hospital from 1966 to 1989]

The histological examination of all the surgically removed appendices at the Busto Arsizio Hospital started in 1966. Several interesting pathological features were recognized, together with a significant change of the clinician's attitude toward "appendicopathies". Elmintiasis was relatively frequent especially in the cases operated before 1980; the decrease of this condition may be due to the improvement of the hygienic conditions. There were 53 carcinoid tumors, more frequently in young females. Some time histology simulated malignancy, not confirmed by the biologic behavior. Several other pathologic conditions were observed, and retained occasionally responsible of the abdominal symptoms. In the more recent years a relatively large number of appendices were removed during surgical procedures for other pathological conditions. The most surprising results concern however the decrease of the number of appendectomies performed yearly (755 in the late 60s, vs. 160 more recently) as well as the elevation of the age of the operated patients. The systemic histological examination of the appendix and the accurate recording of clinicopathological data is therefore a recommended procedure for a quality control of both the surgical and the anatomopathological activities.

[Loosening of total hip prosthesis]

The problem of total hip prosthesis is an immediate and long-term stability. An insufficient bone anchorage of the prosthesis produces a tissue reaction around the implant that causes a loosening. The hight incidence of loosening of cemented total prosthesis has spurred the research into uncemented implants. The experience at the Busto Arsizio Hip Center (Director Prof. R. Bombelli) with more than 2,800 R.M. uncemented isoelastic total hip prostheses was favorable and the study with the cooperation of Pathology Department (Director Prof. P. Lampertico) of the 82 loosening hips has shown: 1) the importance of the elasticity for a stress transmission to the surrounding bone; 2) the pursuit of the most suitable stem calibre and length; 3) the necessity of a stable primary mechanical fixation, waiting for a biological reaction.

[Lymphoma of the prostate: case reports and subject review]

Malignant lymphomas involving the prostate are rare whether as primary lymphoma or as secondary to generalized disease. Middle age, histotype prevalently non Hodgkin, intermediate and high grade of malignancy, symptoms of bladder outflow obstruction, diagnosis generally made after histological examination, severe prognosis are the most important features that result from literature review. The evaluation of therapeutic treatments is difficult as most reports do not include a sufficient number of cases. The Authors presenting two cases of lymphoma of the prostate point out the usefulness of radiotherapy since the prostate is usually a bulky seat of disease and suggest the combination with multiple drug chemotherapy for intermediate and high grade of malignancy and in advanced stages. The authors suggest that prognosis depends on histotype rather than on prostatic involvement of disease.

Detection of hepatitis B virus DNA in formalin-fixed, paraffin-embedded liver tissue by the polymerase chain reaction

DNA isolated from formalin-fixed, paraffin-embedded liver tissues from nine patients with hepatocellular carcinoma and six control patients was screened for hepatitis B virus (HBV) DNA with surface (S) and core (C) gene-specific primers by a modification of the polymerase chain reaction--southern blot technique (PCR-SB). PCR-SB results were correlated with histologic, immunohistochemical, and serologic findings. All cases with an established HBV etiology were positive by PCR-SB, as were three cases with negative immunohistochemistry and serology. Often there was selective amplification with one primer set and, in two cases, smaller than expected HBV amplification products suggesting internal deletions. The presence of a potent PCR inhibitor in nucleic acid preparations from tissue blocks that can be removed by Sephadex G-50 chromatography was confirmed. PCR-SB will be a powerful method for the diagnosis and follow-up of patients with HBV infection and may provide new insights into viral hepatocarcinogenesis.

[Papillary carcinoma in thyroglossal duct cyst remnant: review of the literature and presentation of a clinical case]

The authors report a case of papillary carcinoma arising from thyroglossal duct remnant. It was the only case observed in the last 20 years among 9000 thyroidectomies performed. After a survey of Literature, the role of total thyroidectomy combined to Sistrunk's technique is underlined.

Utility of ascitic fluid analysis in patients with malignancy-related ascites

One-hundred and thirty-three consecutive ascitic patients hospitalized in our Liver Unit were prospectively investigated, to define the accuracy of ascitic fluid analysis in identifying malignancy. Patients with extrahepatic cancer and peritoneal carcinomatosis were characterized by positive cytology and higher ascitic levels of fibronectin, lactic dehydrogenase, carcinoembryonic antigen, and total protein than both patients with uncomplicated cirrhosis and patients with cirrhosis and liver cancer. Ascitic cytology, fibronectin, and lactic dehydrogenase (LDH) were the most sensitive and specific markers of extrahepatic malignancy. In contrast, none of these markers was useful in identifying patients with primary liver cancer complicating cirrhosis. For them, the only alteration of the ascitic fluid was an elevated alpha-fetoprotein concentration. The sensitivity, specificity, and accuracy of ascitic alpha-fetoprotein for detecting liver cancer were 87%, 95%, and 94%, respectively. Combining cytology with the determinations of fibronectin (or LDH) and alpha-fetoprotein in ascitic fluid satisfactorily differentiated 28 of 32 cases of malignancy-related ascites, with very low incidence of false-positives (4-6%). Therefore, in view of the frequent difficulties in detecting liver cancer as a complication of cirrhosis in patients with ascites, it is advisable to determine all these three markers in the same ascitic sample.

Serum type III procollagen peptide and laminin (Lam-P1) detect alcoholic hepatitis in chronic alcohol abusers

The diagnosis of alcoholic hepatitis is difficult to establish by conventional clinical and laboratory methods, and a firm diagnosis relies on liver histology. Since there are severe limitations in following patients with repeated liver biopsies, noninvasive procedures are needed to assess the presence of alcoholic hepatitis in chronic alcohol abusers. It has been suggested that serum Type III procollagen peptide levels correlates with the degree of inflammation in chronic liver disease. Since inflammation is a major histological finding in alcoholic hepatitis, we therefore studied the usefulness of measuring serum Type III procollagen peptide and laminin values in 45 consecutive chronic alcohol abusers, with or without cirrhosis, in detecting those with alcoholic hepatitis. The results showed that both Type III procollagen peptide and laminin values were elevated in all of the patients with established liver damage. However, the values were highest in those with liver cirrhosis plus alcoholic hepatitis (Type III procollagen peptide 50.4 +/- 36.4 ng per ml vs. 8.1 +/- 2.6 in controls, p less than 0.01; laminin 4.50 +/- 1.49 units per liter vs. 1.24 +/- 0.26 units per liter in controls, p less than 0.01), followed by subjects with alcoholic hepatitis alone (Type III procollagen peptide 23.5 +/- 17.6 ng per ml, p less than 0.01; laminin 2.60 +/- 1.09 units per liter, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Serum procollagen type III peptide levels in patients with acute viral hepatitis

Serum levels of procollagen type III peptide were measured by radioimmunoassay in 76 consecutive patients with acute viral hepatitis, in order to see if this index of hepatic fibrogenesis is also predictive for the development of chronic active hepatitis in high-risk patients. Serum procollagen levels were high (from 14.2 to 109.2 ng/ml, median 33.7 ng/ml) in 74 (97%) patients and normal (from 4 to 14 ng/ml, median 9.1 ng/ml) in 2 (3%) patients. The baseline serum procollagen levels were similar in all the subgroups of patients independently of the type of hepatitis. In the 59 patients with resolving hepatitis, serum procollagen levels returned to normal values from 2 to 48 weeks (mean 15). In the 17 patients with unresolved hepatitis, procollagen levels remained within the normal limits in 6 of 7 patients with non-progressive chronic disease, while were elevated (from 17.4 to 22.2 ng/ml) in 4 of 5 patients with chronic active hepatitis. Unlike transaminase activity, which could not discriminate between benign and progressive liver disease, serum levels of procollagen helped in identifying patients with unresolved hepatitis, who were developing chronic active disease.

Cytology and hormonal receptors in breast cancer

Even in advanced tumors of the breast, it may be interesting to know the steroid receptor status (RS) for therapeutic and prognostic purposes. When, for clinical reasons, surgical biopsy is not advisable, a morphologic technique may be attempted on cytological material. In the past few years, we have employed the cytochemical method described by Lee (RSf) on cytological material obtained from 31 primary and 34 secondary tumors; adequate material and follow-up were available in 42 cases. Patients with positive results (strong and diffuse fluorescence of neoplastic cells) usually had better prognosis and longer disease-free interval and total duration of disease. The majority of patients responded to endocrine manipulation. In contrast, weak positivity or negative results were associated with a poorer prognosis. If these results are confirmed in larger series of cases and for longer periods of observation, the morphological evaluation of RS on cytological material could significantly contribute to the management of breast cancer patients.