Abstract P3-10-24: Not presented

This abstract was not presented at the conference.

Citation Format: Gasparini E, Bisagni A, Di Cicilia R, Kuhn E, Falco G, Ferrari G, Foroni M, Tamagnini I, Bassano C, Ragazzi M, Gardini G, Cecchi F, Hembrough T, Bisagni G. Not presented [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-10-24.

Metastasizing Meningeal Melanocytoma

The first case in the literature of a metastasizing meningeal melanocytoma is described. The tumor, which arose at the D9-D11 spinal cord level of a 46-year-old woman, metastasized 7 years later to the latero-suprasellar region.

Lymphomatoid granulomatosis: a practical review for pathologists dealing with this rare pulmonary lymphoproliferative process

Lymphomatoid granulomatosis (LYG) is a rare B-cell lymphoproliferative disorder predominantly involving the lungs, but poorly-recognized among clinicians and pathologists. It is an Epstein-Barr virus (EBV)-driven disease mimicking several other diseases on clinical and radiological grounds, generally showing multiple, bilateral nodular, ill-defined infiltrates of the lungs tending to coalescence and/or cavitation. LYG often affects middle-aged males with an underlying immunodeficiency and commonly involves skin and central nervous system during disease progression. Diagnosis requires a generous biopsy and careful histologic examination with immunohistochemical staining and molecular demonstration of EBV genome in large atypical B-cells. LYG is graded as I to III based on the number of large EBV-positive B-cells; grades II/III are now considered as a peculiar variant of T-cell rich diffuse large B-cell lymphoma. In this brief review, clinical, radiologic and pathologic features of LYG will be analyzed with focus on differential diagnosis, the most appropriate treatment and prognosis.

A randomized clinical trial comparing 22G and 25G needles in endoscopic ultrasound-guided fine-needle aspiration of solid lesions

BACKGROUND AND STUDY AIMS

The study aimed to investigate whether the 25G needle is superior to the 22G needle when used in endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of solid lesions.

PATIENTS AND METHODS

The study was a single-center randomized clinical trial. The setting was a tertiary referral hospital, where EUS-FNA of solid lesions was assisted by an on-site cytopathologist, who was blinded to the needle size. The main end point was the number of passes performed to obtain adequate samples. Crossover to the other type of needle was allowed after five passes, or when the gastroenterologist experienced difficulties in puncturing the lesions.

RESULTS

A total of 129 solid lesions were randomized and data regarding 127 lesions were analyzed. The mean number of passes was 3.7 (± 1.9) in the 22G needle group and 3.8 (± 2) in the 25G needle groups (difference of means: 0.1; 95% CI: -0.59 to 0.79). Fifty-eight of 63 (92.1%) and 60/64 samples (93.7%) in the 22G and 25G needle groups respectively were adequate (difference: -1.6%; 95%CI: -12.1% to 8.9%). Crossover to the other type of needle was performed in 11/63 (17.5%) and in 12/64 (18.7%) lesions in the two groups respectively (difference: -1.2%; 95%CI: -16.2% to 13.8%). A crossover to the 25G needle was successfully performed in four masses in the uncinate process; these lesions were difficult to puncture using the 22G needle.

CONCLUSIONS

Our study failed to demonstrate that the 25G is more effective than the 22G needle in EUS-FNA of solid lesions. However, targeting of lesions in the distal duodenum may be simplified by using the 25G needle.

Comparison of HER2 status in primary and paired metastatic sites of gastric carcinoma

BACKGROUND

Trastuzumab has recently shown efficacy in the treatment of HER2-positive advanced gastric adenocarcinoma. Although antibody-based therapies target the metastatic disease, HER2 status is usually evaluated in the primary tumour because metastatic sites are rarely biopsied. The aim of this study was to compare HER2 status in primary and paired metastatic sites of gastric adenocarcinoma.

METHODS

The HER2 status was assessed by fluorescence in situ hybridisation (FISH) and immunohistochemistry (IHC) in 72 secondary lesions of gastric adenocarcinoma and in the corresponding primary tumours.

RESULTS

Concordance of FISH results, evaluable in 68 primary and matched metastatic sites, was 98.5%. Concordance of IHC results, available in 39 of the 72 paired cases, was 94.9%. Only one case showed discordance between primary tumour and metastasis, being negative by both IHC and FISH in the primary and showing HER2 overexpression and amplification in the corresponding pancreatic lymph node metastasis.

CONCLUSION

The high concordance observed between HER2 results obtained by both IHC and FISH on primary tumours and corresponding metastases suggests that in gastric cancer HER2 status is maintained in most cases unchanged during the metastatic process.

Is a five-category reporting scheme for thyroid fine needle aspiration cytology accurate? Experience of over 18,000 FNAs reported at the same institution during 1998-2007

OBJECTIVE

Fine needle aspiration (FNA) has long been recognized as an essential technique for the evaluation of thyroid nodules. Although specific cytological patterns have been recognized, a wide variety of reporting schemes for thyroid FNA results have been adopted. This study reports our experience with a five-category reporting scheme developed in-house based on a numeric score and applied to a large series of consecutive thyroid FNAs. It focuses mainly on the accuracy of thyroid FNA as a preoperative test in a large subset of histologically distinct thyroid lesions.

METHODS

During the 1998-2007 period, 18,359 thyroid ultrasound-guided FNAs were performed on 15,269 patients; FNA reports were classified according to a C1-C5 reporting scheme: non-diagnostic (C1), benign (C2), indeterminate (C3), suspicious (C4), and malignant (C5).

RESULTS

Non-diagnostic (C1) and indeterminate (C3) FNA results totalled 2,230 (12.1%) and 1,461 (7.9%), respectively, while suspicious (C4) and malignant (C5) results totalled 238 (1.3%) and 531 (2.9%), respectively. Histological results were available in 2,047 patients, with thyroid malignancy detected in 840. Positive predictive value of FNA was 98.1% with a 49.0 likelihood ratio (LR) of malignancy in patients with a C4/C5 FNA report.

CONCLUSIONS

This five-category scheme for thyroid FNA is accurate in discriminating between the virtual certainty of malignancy associated with C5, a high rate (92%) of malignancy associated with C4, and a 98% probability of a histological benign diagnosis associated with C2. Further sub-classifications of C3 may improve the accuracy of the diagnostic scheme and may help in recognizing patients eligible for a 'wait and see' management.

When histologic diagnosis of pulmonary adenocarcinoma becomes difficult

The differential diagnosis between pulmonary adenocarcinoma and several benign mimics can be a formidable challenge for the surgical pathologist, particularly in frozen sections and in small biopsies but sometimes in surgical specimens as well. In this review we will provide a practical guide to help the pathologist facing these problematic cases.

[Enterocolic phlebitis. Description of a case and review of the literature]

OBJECTIVE

To report about a case of enterocolic phlebitis, a rare cause of ischemic intestinal necrosis.

RESULTS AND CONCLUSIONS

The patient, a 71 year-old male, presented with signs of acute abdomen. A right hemicolectomy was performed, which revealed a tubulovillous adenoma with high grade dysplasia located in the ascending colon, and a diffuse ischemic colitis. A localized lymphocytic and granulomatous phlebitis was present in the resected colon. The arteries were spared by the inflammatory process. The patient is alive and well 7 years after surgery. The literature concerning enterocolic phlebitis, a peculiar form of localized intestinal vasculitis, is briefly summarized.

[Benchmarking in pathological anatomy]

Data from five different Institution of Pathological Anatomy Hospital Services are presented in order to show one (the benchmark) of the multiple existing ways to approach the budget problem and the macroeconomic management of our Services. The aim of this work is not to show the "best" way to work in terms of cost-efficacy but only a methods to compare our results with others. Nevertheless from this study is possible also to make some considerations about medical and technical workload in different services with different habits.

[Small-cell mesothelioma of the pleura: description of a case]

A case of mesothelioma with a small cell component in a 53-year-old, non-smoker woman. The patient had a history of asbestos exposure, and presented with thoracic pain. A total body computed tomogram showed a left pleural effusion and a 7.5-cm pleural mass. Thoracoscopy revealed a diffuse nodular thickening of the left parietal pleura, and a biopsy was performed. The patient died of the disease 4 months after diagnosis. Microscopically, the pleural neoplasm was composed of three different components: 40% of the tumor showed the classic histology of a malignant epithelial mesothelioma, 40% was composed of small- to medium-sized cells with open nuclear chromatin, evident nucleoli and high mitotic activity, and 20% of the neoplasm was indistinguishable from a small cell carcinoma. Immunohistochemically, the first component was diffusely and strongly positive for cytokeratin AE1/AE3, cytokeratin CAM 5.2 and EMA, focally positive for BER-EP4, and negative for CD15, B 72.3, CEA, LCA, chromogranin, synaptophysin, TTF-1 and CD99. The cells of the second component were positive only for cytokeratin AE1/AE3 and cytokeratin CAM 5.2, and the elements of the third component were negative for all the antibodies tested. Pleural mesothelioma with a small cell component is rare. The most useful parameters to distinguish it from other small cell malignancies that may involve the pleura, particularly small cell carcinoma of pulmonary origin, are discussed.

Oral lacidipine in the treatment of anal fissure

The aim of this prospective study was to assess the effectiveness in healing anal fissure (AF) of lacidipine, a calcium channel blocker with a better tolerability in comparison to other calcium antagonists. Twenty-one consecutive patients (16 women, 76.2%) with AF (16 chronic, situated posteriorly in 17 patients (81.0%), anteriorly in 4) with a mean age of 37.1 years (SD, 13.6, range, 20-6) were treated with oral lacidipine (6 mg daily) and warm sitz baths for 28 days, adding only stool softeners for patients with constipation. Blood pressure, pain scores (assessed from 0 to 10 on a visual analogue scale) and fissure healing were monitored at 14 days, 28 days and 2 months. At the 14-day and 28-day follow-ups, the mean systolic and diastolic pressures were not significantly different from pre-treatment levels. Seven patients (33.3%) developed side effects, but only one, who developed dyplopia, withdrew from the study at the 14-day control (non-compliance rate with treatment, 4.8%). Pain scores were significantly reduced after 14 days and continued to show a significant reduction throughout the treatment period. Three fissures (14.3%) healed by 14 days and a total of 19 (90.4%) after 28 days: among the healed AF no recurrences were seen at the 2-month control. Among the two treatment failures, one was the patient who withdrew from the study at the 14-day control due to dyplopia and the other was a patient who failed to heal up to the 2-month follow-up, although completely asymptomatic. Both patients underwent left lateral sphincterotomy and healed. In conclusion, oral lacedipine is quite well tolerated and may offer a promising alternative treatment for AF.

[Calcified pseudotumor of the pleura: description of a case]

We describe a calcifying fibrous pseudotumour of pleura in a 46-year-old female, smoker. The patient presented with a well-delimited pleural mass, 3-cm across, located at the base of the right lung and attached to the lung with a short pedicle. Seven years after surgical excision of the mass, the patient is alive and well. Microscopically, the lesion was mostly composed of dense collagenous tissue, with sparse benign spindle cells, a rich inflammatory infiltrate and scattered calcifications, sometimes laminated. Immunohistochemically, spindle cells were positive for vimentin and negative for smooth muscle actin, desmin, S100 protein, CD34, CD99 and Bcl2. Calcifying fibrous pseudotumour is rare in the pleura. Pertinent data from the literature and problems in differential diagnosis are briefly discussed.

Ancient schwannoma arising in a lymph node: report of a case and review of the literature

We report a case of an intranodal schwannoma in a 79-year-old woman. The patient underwent a left colectomy for a colonic adenocarcinoma, with regional lymph node dissection. Macroscopic examination of the specimen revealed a well-circumscribed 4 cm nodule located in the pericolic fat. Macroscopically, it was interpreted as a metastatic lymph node. Microscopically, the nodule was composed of a proliferation of bland spindle cells, was immunohistochemically positive for S100 protein, and negative for smooth muscle actin, desmin, and cytokeratin. The pathological findings led to the diagnosis of a very rare case of primary schwannoma of the lymph node.

[Pulmonary metastasis of epidermoid carcinoma of the larynx: a case with an interstitial pattern of growth]

We describe a pulmonary metastasis from a laryngeal epidermoid carcinoma, characterized by an interstitial pattern of growth. The patient, a 71-year-old man, smoker, presented with a large laryngeal neoplasm and with two pulmonary masses, one located in the apex and the other in the lower lobe of the right lung. The patient underwent a total laryngectomy and a right pneumonectomy and he died from neoplastic progression 2 years after surgery. Microscopically, the laryngeal tumour was an epidermoid carcinoma and the apical pulmonary mass was an adenocarcinoma. The pulmonary neoplasm of the lower lobe, 5.5 cm across, was an epidermoid carcinoma that we interpreted to be a metastasis from the larynx. The case is peculiar because tumour cells proliferated exclusively in the interstitium. When extensive as in our case, this pattern of growth is rare and it may pose some diagnostic problems.

[Pulmonary carcinoma with myoepithelial differentiation, analogous to basal cell adenocarcionma of the salivary glands: description of a case]

We describe a case of pulmonary carcinoma with myoepithelial differentiation, analogous to basal cell adenocarcinoma of salivary glands. The patient, a 60 year-old man, smoker, presented with three peripheral nodules of the left lung. Preoperative staging was negative for metastatic disease and the patient underwent a surgical resection of the nodules. After 22 months, the patient is alive with no evidence of disease. Microscopically, the tumours were composed of atypical cells arranged in lobules, separated by basal membrane-like material. Immunohistochemically, tumour cells were positive for cytokeratin AE1/AE3, cytokeratin 14, vimentin, calponin, S-100 protein and gliofibrillary acid protein (GFAP). Electron microscopy showed features of epithelial and myoid differentiation and confirmed the myoepithelial nature of the tumour. Pulmonary tumours with myoepithelial differentiation are rare, but they have a wide and distinctive morphological spectrum.

[Bronchiolitis obliterans-organizing pneumonia (BOOP) containing asbestos bodies: clinico-pathological study of a case]

We describe a case of bronchiolitis obliterans-organizing pneumonia (BOOP) with asbestos bodies. A 65-year-old man, treated in the past for gastric lymphoma and with an history of asbestos exposure, presented with fever and two nodular opacities in the lower lobe of the left lung. Histologic examination revealed a BOOP pattern; in the inflammatory tissue some asbestos bodies were present. Patients exposed to asbestos may rarely present with localized inflammatory pulmonary lesions. In these cases, the possible etiopathogenetic role of asbestos needs further studies.

Agmatine induces apoptosis in rat hepatocyte cultures

BACKGROUND/AIMS

Agmatine, the compound formed by decarboxylation of arginine, is believed to be an endogenous neurotransmitter through interaction with the imidazoline receptors. However, it also appears to regulate rat hepatocyte polyamines by modifying both their synthesis and their catabolism. As the decrease in polyamine content has been correlated with apoptosis, we examined the possibility that agmatine has an effect on this phenomenon.

METHODS

Apoptotic cells were detected by visualizing nuclear shrinkage/fragmentation in hepatocytes cultured at 21 and 5% oxygen tension. Caspase-3 activity, cleavage of PARP, release of cytochrome c and mitochondrial swelling were therefore measured in the two conditions and in the presence or not of agmatine.

RESULTS

In rat hepatocytes agmatine promoted apoptosis, procaspase 3 processing and increase of caspase-3 like activity. This occurred through mitochondria swelling and release of cytochrome c. Cyclosporin A and catalase blocked the swelling.

CONCLUSIONS

Our experiments show that agmatine, besides all the known biological effects, has also part, at least in hepatocytes, in the modulation of programmed cell death.

[Clear-cell tumor of the lung: description of a case 1 mm in diameter ("micro-sugar tumor")]

Clear cell ("sugar") tumour of the lung is a rare neoplasm, generally presenting as a discrete nodule on the chest X-ray. We report a case of clear cell tumour of the lung in a 64-year-old woman. The tumour at presentation was 1 mm in diameter.

[Combined neoplasia of the lung: description of a case of adenocarcinoma mixed with typical carcinoid]

OBJECTIVE

To report about a lung tumor that was a combination of typical carcinoid and adenocarcinoma.

RESULTS AND CONCLUSIONS

The patient, a 71-year-old male, presented with a 2.5-cm pulmonary nodule that, microscopically, was a combination of an adenocarcinoma (tubular with clear cell features and bronchioloalveolar) and a typical carcinoid. Immunohistochemically, both components were positive for cytokeratin, but only the carcinoid component was positive for chromogranin and synaptophysin. In the range of neuroendocrine tumors of the lung, a combination with other histological types of carcinoma (squamous, adeno, large cell and pleomorphic) can be found with both small cell carcinoma and large cell neuroendocrine carcinoma, but is very rare with typical and atypical carcinoids.

Transport and metabolism of agmatine in rat hepatocyte cultures

Rat hepatocytes in culture take up [14C]-agmatine by both a high-affinity transport system [KM = 0.03 mM; Vmax = 30 pmol x min x (mg protein)-1] and a low-affinity system. The high-affinity system also transports putrescine, but not cationic amino acids such as arginine, and the polyamines spermidine and spermine. The rate of agmatine uptake is increased in cells deprived of polyamines with difluoromethylornithine. Of the agmatine taken up, 10% is transformed into polyamines and 50% is transformed into 4-guanidinobutyrate, as demonstrated by HPLC and MS. Inhibition by aminoguanidine and pargyline shows that this is due to diamine oxidase and an aldehyde dehydrogenase. 14C-4-aminobutyrate is also accumulated in the presence of an inhibitor of 4-aminobutyrate transaminase.

[Extrarenal retroperitoneal angiomyolipoma: description of a case and review of the literature]

A case of retroperitoneal extrarenal angiomyolipoma is described. The patient, a 61-year-old woman, presented with a large retroperitoneal lipomatous mass. Histologically, it consisted of lipomatous tissue. Focally, there was interstitial and perivascular proliferation of bland oval and epithelioid cells with a large, eosinophilic or clear cytoplasm. Immunohistochemically, these elements were positive for smooth muscle actin and HMB-45. The literature on retroperitoneal extrarenal angiomyolipoma is briefly reviewed. It is important that the pathologist recognize this lesion, even when it is located in the retroperitoneum outside the kidney, and differentiate it from a liposarcoma.

Stromal osseous metaplasia in metastatic adenocarcinoma of the gallbladder

A case of stromal osseous metaplasia in the abdominal scar metastasis of a gallbladder adenocarcinoma is described. The occurrence of stromal osseous metaplasia in carcinomas probably does not affect prognosis; however, it must be recognized to avoid a misdiagnosis of carcinosarcoma.

[Sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid: description of a case]

INTRODUCTION

A case of sclerosing mucoepidermoid carcinoma with eosinophilia of the thyroid gland is described.

RESULTS

The patient, a 32 year-old female with Hashimoto's thyroiditis, presented with a 4 cm nodule of the right lobe of the thyroid gland. The tumour was constituted by squamoid cords infiltrating a dense fibro-jaline stroma rich in eosinophils. The patient is alive and well 14 months after surgery.

DISCUSSION

The literature is briefly reviewed and the differential diagnosis is discussed. In the Author's opinion, sclerosing mucoepidermoid carcinoma with eosinophilia of the tyroid is a well defined clinicopathological entity.

Juvenile Leigh syndrome with protracted course presenting as chronic sensory motor neuropathy, ataxia, deafness and retinitis pigmentosa: a clinicopathological report

We herein describe a male patient who died at 37 years of age, after having suffered from a slowly progressive syndrome of chronic sensory motor neuropathy, deafness, retinitis pigmentosa and ataxia. The neuropathological study showed symmetric areas of necrosis and demyelination affecting the cerebellum and brainstem. The type of lesion was consistent with the characteristics of Leigh Syndrome. On the basis of the histology of the lesions, we believe that they appeared only a few months before the death of the patient. We underline the atypical clinical picture and suggest that, in certain cases, brain MRI may not be a reliable diagnostic tool.

[Neural infiltration in benign gallbladder lesions. Description of a case]

Neural infiltration is considered a very useful marker of malignancy in the biliary tract. Aim of this study is to report a case of benign epithelium of the gallbladder with neural infiltration and to review the literature.

[Monophasic sarcomatoid carcinoma of the ileum. Description of a case and review of the literature]

INTRODUCTION

A case of monophasic sarcomatoid carcinoma of the ileum is described.

RESULTS

The patient was a 76 year old woman, presenting with a 5 cm perforated mass of the ileum. The tumor was constituted by epithelioid and spindle atypical cells, arranged in fascicles and in solid sheets; no clear-cut carcinomatous component was evident. Immunohistochemically, the neoplastic cells were positive for cytokeratin and, focally, for vimentin. The patient died of disease 2 months after surgery.

DISCUSSION

The literature on small intestine sarcomatoid carcinoma is reviewed and the differential diagnosis is discussed. In the Author's opinion, the term sarcomatoid carcinoma (monophasic or biphasic) should be used in the small intestine for those neoplasms previously described as enteroblastoma, carcinosarcoma or pleomorphic carcinoma.

[Male diabetic mastopathy: description of a case]

A case of diabetic mastopathy in a male is described. The patient is a 44 year old man with an insulin-dependent diabetes of long duration, presenting with a poorly defined nodule in his left breast. The lesion was constituted by a dense fibrous tissue with epithelioid stromal cells and a perivascular nodular lymphoid infiltrate. The differential diagnosis and the literature on diabetic mastopathy are briefly reviewed, particularly regarding male patients. The present case indicates that diabetic mastopathy may arise in the male breast.

Determination of ErbB2 protein in breast cancer tissues by different methods. Relationships with other biological parameters

Four different methods to measure in parallel the erbB2 protein expression (p185neu) were evaluated in order to: a) compare two enzyme immunoassays with the immunohistochemical assays (IHC) and western blotting (WB) and b) extrapolate eventual relationships between erbB2 and biological parameters. Tissue samples from 248 patients with primary breast cancer were consecutively assayed. We used two different cut-off levels for WB, ELISA, and EIA, defined as follows: 1) the highest level of expression of non malignant tissue was chosen as the discriminant threshold between 'low' and 'elevated' samples: 2) the elevated group was further subdivided into two subgroups: 'intermediate' and 'high', according to their median value. According to the first cut-off, the results were considered 'elevated' in about 52% of cases with the three biochemical methods, while using the second cut-off the percentage lowered to about 26%. Considering this cut-off, the concordance rates between the paired biochemical methods ranged between: 78.4% (WB vs EIA), 93% (ELISA vs EIA), and 82.6% (ELISA vs WB). The comparison between biochemical and immunohistochemical methods gave these concordance rates: 82% (WB vs IHC), 90.5% (ELISA vs IHC), and 85.5% (EIA vs. IHC). According to the first cut off level, 27.5% of tumor samples showed IHC detectable p185 levels, in agreement with other immunohistochemical studies. The relationship between high erbB2 and estrogen and progesterone receptors showed an inverse association. No relationship was found between erbB2 and axillary lymph node positivity or tumor size. In short, the results of the four methods seem generally well correlated; nevertheless, it appears that different methodological approaches of measuring p185neu are not completely equivalent, and there is a need for an authoritative standardization and quality control for clinical applications.

[Quality control of intraoperative diagnosis. Annual review of 1490 frozen sections]

A retrospective evaluation of the accuracy of frozen section diagnoses over 1-year period has been carried out. Of 20998 surgical pathology specimens accessioned during 1991, 1265 (6.0%) had intraoperative pathologic consultation; 1490 were the frozen section examinations effectively carried out, with an average of 1.2 frozen section diagnoses per case. Of all frozen sections performed, 4.6% were deferred; in the remaining cases, the concordance between frozen sections and the final histologic diagnoses was 97%. The reasons for diagnostic discordances were gross sampling error (51.2%), misinterpretation (44.2%), microscopic sampling (9.3%), technical problems in sectioning (2.3%). We believe that a similar continuous monitoring should be performed in every pathology department, to recognize the reasons of errors and, if possible, to reduce them.

Comparison between western blotting, immunohistochemical and ELISA assay for p185neu quantitation in breast cancer specimens

The protein encoded by erbB2 oncogene was evaluated by three different methodological approaches (Western blotting, ELISA and immunohistochemistry) in 147 breast cancer specimens. A highly significant correlation was found between Western blotting and ELISA results (p < 0.001). The data from ELISA and Western blotting were categorized as negatives (-), low-overexpressing (+) and high-overexpressing (++). Immunohistochemical results were classified as (-) or (+) according to the absence or the presence of specific staining. Overall positive cases (+ and ++) were 42.2% by Western blotting and 51% by ELISA, while (++) cases were 23.8% and 25.2% respectively. Histochemical staining was found in 29.8% of cases. The two by two evaluation of the assays showed a close association (chi2, p < 0.0001). In particular, the comparison between both ELISA and Western blotting with immunohistochemistry showed concordance rates of 78.9% for ELISA and 83.1% for Western blotting considering the + and ++ cases as a single group. When only the ++ cases were considered as positive, the overall agreement rises to 93.3% and 89.1% respectively. From these preliminary data we conclude that p185 values obtained with the three evaluated methods are possibly superimposable. Nevertheless, the biochemical methods seem to identify an intermediate p185 expression group, whose clinical meaning should be investigated.

Well-differentiated angiosarcoma of the skin following radiotherapy. Report of two cases

Two cases of well-differentiated angiosarcoma following radiotherapy together with an immunocytochemical and electron-microscopical study are reported. Both cases occurred in young females (16- and 22-yr-old respectively) who had been irradiated after birth for an "angiomatous" lesion. These cases have to be added to 34 similar cases reported in the literature.

Gastric carcinoids and their precursor lesions. A histologic and immunohistochemical study of 23 cases

A histologic and immunohistochemical study was carried out in 23 unselected nonantral gastric carcinoids and their precursor lesions classified according to Solcia et al. None of the patients showed Zollinger-Ellison syndrome. Two variants of carcinoids showing distinctive pathologic and pathogenetic characteristics were identified on the basis of presence or absence of associated chronic atrophic gastritis type A (A-CAG). Chronic atrophic gastritis type A was found in 19 cases showing either single or multiple neoplasms, tumor extension limited to the mucosa or submucosa, consistent endocrine cell precursor changes in extratumoral mucosa, and consistent hypergastrinemia and/or G cell hyperplasia. Associated precursor lesions were only hyperplastic in all but two cases with single carcinoids whereas they were also dysplastic in all but one case with multiple carcinoids. The four tumors arising in nonatrophic mucosa were all single, more aggressive, and not associated with extratumoral endocrine cell proliferations or with signs of gastrin hypersecretion. Tumor cells were diffusely immunoreactive for chromogranin A and synaptophysin but usually negative for chromogranin B or HISL-19. Scattered serotonin cells were found in ten carcinoids. They were more frequent in infiltrating than in intramucosal tumors as were the less represented pancreatic polypeptide cells whereas the reverse was found for alpha-subunit-containing cells. These results are of relevance for tumor pathogenesis and may provide the rationale for a less aggressive therapeutic approach in the patients.

Gastric carcinoids and their precursor lesions. A histologic and immunohistochemical study of 23 cases

A histologic and immunohistochemical study was carried out in 23 unselected nonantral gastric carcinoids and their precursor lesions classified according to Solcia et al. None of the patients showed Zollinger-Ellison syndrome. Two variants of carcinoids showing distinctive pathologic and pathogenetic characteristics were identified on the basis of presence or absence of associated chronic atrophic gastritis type A (A-CAG). Chronic atrophic gastritis type A was found in 19 cases showing either single or multiple neoplasms, tumor extension limited to the mucosa or submucosa, consistent endocrine cell precursor changes in extratumoral mucosa, and consistent hypergastrinemia and/or G cell hyperplasia. Associated precursor lesions were only hyperplastic in all but two cases with single carcinoids whereas they were also dysplastic in all but one case with multiple carcinoids. The four tumors arising in nonatrophic mucosa were all single, more aggressive, and not associated with extratumoral endocrine cell proliferations or with signs of gastrin hypersecretion. Tumor cells were diffusely immunoreactive for chromogranin A and synaptophysin but usually negative for chromogranin B or HISL-19. Scattered serotonin cells were found in ten carcinoids. They were more frequent in infiltrating than in intramucosal tumors as were the less represented pancreatic polypeptide cells whereas the reverse was found for alpha-subunit-containing cells. These results are of relevance for tumor pathogenesis and may provide the rationale for a less aggressive therapeutic approach in the patients.

[The correlation of bacteriobilia/wound infections in elective biliary surgery]

The authors report their experience concerning the cultural study of bile samples taken during elective biliary surgery. All the operations were carried out after a randomized preoperative antibiotic prophylaxis. Among the 138 cases examined the presence of surgical infections (wound infection) was taken into account. A lack of correlation between the germs present in the bile and those isolated from samples of complicated cases, was registered. However, the Authors emphasize that, although antibiotic prophylaxis gives a reduced percentage of postoperative infections, it is unable to sterilize the bile.