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Abstract: Background: The WHO-classification was shown to be an independent prognostic marker in some but not all retrospective studies possibly due to lack of reproducibility. We investigated the reproducibility of the WHO-classification and its prognostic implication using a large series of resected thymomas. Methods: Four independent pathologists histologically classified a surgical series of 129 thymic tumors in a blinded fashion. Fleiss’ kappa-coefficient was used to assess the pathologists’ overall agreement, and Cohen-Kappa to assess the agreement between two observers. Disease-related-survival (DRS) and progression-free-survival (PFS) curves were generated by Kaplan–Meier method and compared by log-rank test. Results: In 63/129 (48.8%) cases there was a complete agreement; in 43/129 (33.3%) cases 3/4 pathological diagnoses were identical; in 15/129 (11.6%) cases the diagnoses were identical by pair; in 8/129 (6.2%) cases three different pathological diagnoses were on record. The Kappa-correlation coefficient was only moderate (0.53). A following web review carried out on the 23 cases with at least two different diagnoses reached a complete consensus. The histotype showed a statistically significant impact on PFS and DRS in the classification provided by only two pathologists. Conclusions: In this study, the agreement on WHO classification of thymomas was only moderate and this impacted on patients management. Web consensus conference on the diagnosis, more stringent diagnostic criteria or the adoption of referral diagnostic centres may substantially reduce discrepancies. [Copyright &y& Elsevier]

Background: Breast cancer micrometastases are frequently found during pathological examination of sentinel lymph nodes and complete axillary lymph node dissection. Despite this, their clinical relevance is still debated. The aim of this study is to investigate features that affect disease-free survival (DFS) and overall survival (OS) in patients with nodal micrometastases from breast cancer. [ABSTRACT FROM PUBLISHER]

Aims: We investigated the origin of myoid cells in benign stromo-epithelial lesions of the breast in order to ascertain their myoepithelial or myofibroblastic origin. Methods and results: We selected 22 stromo-epithelial lesions of the breast and reviewed their morphological features at haematoxylin–eosin (H&E) level. The lesions were classified as fibrous stromo-epithelial lesions (without evidence of myoid differentiation at H&E level) (13 cases), type 1 myoid stromo-epithelial lesions (myoid cells directly merging with the myoepithelial layer) (three cases), type 2 myoid stromo-epithelial lesions (bundles of myoid cells unrelated to the glands) (six cases). All cases were studied immunohistochemically and myoid stromo-epithelial lesions were also studied with electron microscopy. The myoid component in two out of three cases of type 1 myoid lesions showed immunohistochemically co-expression of smooth muscle and myoepithelial markers. In contrast, the remainder showed immunohistochemical results identical to those found in type 2 myoid lesions (positivity with SMA, desmin, calponin, CD34 and bcl2 and negativity with cytokeratin 14 and p63). Ultrastructural study confirmed the presence of cells with myoepithelial features in type 1 myoid lesions and of cells with myofibroblastic features in type 2 myoid lesions. Conclusions: Myoid cell differentiation is common in stromo-epithelial lesions of the breast, and is evident in H&E sections in up to 40% of cases. In addition, the origin of myoid cells is myofibroblastic in most cases, but in some cases, cells present immunohistochemical and ultrastructural evidence of myoepithelial origin. [ABSTRACT FROM AUTHOR]

Objective To determine the effect on kidney oxalate-salt deposition of a prolonged diet which induced vitamin B6 deficiency in adult rats, as there are reports of the pathogenic involvement of vitamin B6 deficiency in the formation of renal calcium oxalate calculi. Materials and methods The study comprised 24 6-month-old male albino Wistar rats; 12 were fed with a purified vitamin B6 -deficient diet and the others provided with the same diet but supplemented with 6 mg/kg of vitamin B6 . After 12 weeks, all rats were killed, and their kidneys fixed in formalin and routinely processed to paraffin for morphological examination; some fragments were fixed in glutaraldehyde and prepared for ultrastructural examination. From each rat consecutive sections of both kidneys were cut and stained with haematoxylin and eosin, periodic-acid Schiff, Sirius red and the Von Kossa method for calcium. Sections were examined in polarized light and by electron microscopy. Results The histopathological and ultrastructural features of the kidney of vitamin B6 -deficient rats were those of tubular-interstitial nephritis, characterized by tubular atrophy, interstitial fibrosis and chronic inflammatory infiltration. Oxalate and phosphate crystals were present in the papillary and parenchymal connective tissue. Ultrastructural features confirmed severe tubular epithelial lesions and the presence of an interstitial and intraepithelial inflammatory infiltrate; there was mild interstitial fibrosis. None of these features were apparent in the kidney of control rats. Conclusions Histopathological and ultrastructural data indicate that a prolonged vitamin B6 -deficient diet may contribute to the formation and deposition of calcium phosphate and oxalate crystals, which lead to severe damage of the renal parenchyma. This phenomenon may occur not only in growing rats, which have more active protein metabolism and consequently higher... [ABSTRACT FROM AUTHOR]

Focuses on the characteristics of colonic adenolipomas. Presence of submucosal lipomas in the gastrointestinal tract; Description of the colonic adenolipomas; Existence of lesions in the colon.

Summary: Surgical drapes are a physical barrier between the surgical team''s sterile working space (the operating field) and the non-sterile environment of the anaesthesia team and the nursing team within the operating theatre. Once the patient''s position has been checked and the skin preparation has been done, they are put in place. They are usually opaque, leaving visible just the areas where the surgical and anaesthesia teams will be working. When the patient''s position is changed perioperatively, malpositions may be unnoticed and cause complications. Using a transparent head drape allows one to check the position of the head and upper limbs at all times, thus reducing the risk of complications. It is a simple, easy, economic, non-restrictive method which will produce an improvement in the quality of patient care. [Copyright &y& Elsevier]

Mast cells are essential not only for allergies but also for innate and acquired immunity, autoimmunity and inflammation, and they are recognized as a new type of immunoregulatory cells capable of producing different cytokines. Natural compounds have long been recognized to possess anti-inflammatory, antioxidant and anticancergenic activity. Quercitin is an inhibitor for mast cells and is a potent antioxidant, cytoprotective and anti-inflammatory compound and has a negative effect on intracellular regulator signal events initiated by FceRI receptor cross-linking and other activating receptors on mast cells. These observations candidate quercitin as a therapeutic compound in association with other therapeutic molecules. Capsaicin is a compound derived from peppers, especially capsicum, and is involved in stimulating circulation aiding digestion and relieving pain. Capsaicin receptor sub type I (VRI) is expressing in neurons and is present in a number of brain nuclei and in non-neuronal tissues, mediating inflammatory response. Capsaicin is involved in migraine, allergic symptoms, arthritis pain and gastric secretion. In this paper we review the biological effects of quercitin and capsaicin. [ABSTRACT FROM AUTHOR]

We report the case of a 34-year-old woman affected by breast cancer that had metastasized to the bone. She had been treated with oral cyclophosphamide and methotrexate (metronomic chemotherapy) and achieved 3.5 years of clinical remission. To our knowledge, this is the first description of such a prolonged response to therapy. This case report adds weight to known data on metronomic treatment and supports further investigation of this therapy. [ABSTRACT FROM AUTHOR]

The impact of KRAS mutations on cetuximab sensitivity in epidermal growth factor receptor fluorescence in situ hybridisation-positive (EGFR FISH+) metastatic colorectal cancer patients (mCRC) has not been previously investigated. In the present study, we analysed KRAS, BRAF, PI3KCA, MET, and IGF1R in 85 mCRC treated with cetuximab-based therapy in whom EGFR status was known. KRAS mutations (52.5%) negatively affected response only in EGFR FISH+ patients. EGFR FISH+/KRAS mutated had a significantly lower response rate (P=0.04) than EGFR FISH+/KRAS wild type patients. Four EGFR FISH+ patients with KRAS mutations responded to cetuximab therapy. BRAF was mutated in 5.0% of patients and none responded to the therapy. PI3KCA mutations (17.7%) were not associated to cetuximab sensitivity. Patients overexpressing IGF1R (74.3%) had significantly longer survival than patients with low IGF1R expression (P=0.006), with no difference in response rate. IGF1R gene amplification was not detected, and only two (2.6%) patients, both responders, had MET gene amplification. In conclusion, KRAS mutations are associated with cetuximab failure in EGFR FISH+ mCRC, even if it does not preclude response. The rarity of MET and IGF1R gene amplification suggests a marginal role in primary resistance. The potential prognostic implication of IGF1R expression merits further evaluation. [ABSTRACT FROM AUTHOR]

A computer-aided image analysis system was applied to evaluate the Sirius-red stained collagen fibers amount (CF), their spatial organization, and to simulate the impact of stromal deposition/degradation. B Results: b An increased deposition from natural pancreatic tissue (nPA: 2.23±0.28%) to chronic pancreatitis (iPA: 14.27±1.27%) to PC (22.30±2.031%), (p<0.0001) and a statistically significant difference in the spatial organization between nPA (1.35±0.02) vs iPA (1.70±0.01) and PC (1.73±0.01) (p<0.0001) were found. [Extracted from the article]

A computer-aided image analysis system was applied to evaluate the Sirius-red stained collagen fibers amount (CF), their spatial organization, and to simulate the impact of stromal deposition/degradation. B Results: b An increased deposition from natural pancreatic tissue (nPA: 2.23±0.28%) to chronic pancreatitis (iPA: 14.27±1.27%) to PC (22.30±2.031%), (p<0.0001) and a statistically significant difference in the spatial organization between nPA (1.35±0.02) vs iPA (1.70±0.01) and PC (1.73±0.01) (p<0.0001) were found. [Extracted from the article]

B Background: b Combined hepatocellular carcinoma and mass-forming cholangiocarcinoma (cHCC-MFCCC) is a rare tumor. B Conclusion: b Patients with cHCC-MFCCC showed similar rates of OS and DFS to those patients with classic HCC and MFCCC. Further evaluations of differences in tumor features and biology are necessary to better characterize the prognosis of patients with cHCC-MFCCC. [Extracted from the article]

B Background: b Combined hepatocellular carcinoma and mass-forming cholangiocarcinoma (cHCC-MFCCC) is a rare tumor. B Conclusion: b Patients with cHCC-MFCCC showed similar rates of OS and DFS to those patients with classic HCC and MFCCC. Further evaluations of differences in tumor features and biology are necessary to better characterize the prognosis of patients with cHCC-MFCCC. [Extracted from the article]

The treatment of benign broncho-oesophageal fistula is usually surgical but sometimes other methods of treatment are preferred. The case history is described of an adult in poor general condition in which an endoscopic approach combined with the use of fibrin glue on the bronchial side and metallic clips on the oesophageal side was used to close the fistula. [ABSTRACT FROM AUTHOR]