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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.

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.

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.

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.

Aims and Background: Post-irradiation sarcoma (PIS) a rare, late side effect of radiotherapy and, consequently, its natural history is not well known. For this reason, two cases treated between 1975 and 1990 are described., Case Reports: The Authors describe one case of malignant fibrous histiocytoma grown in the larynx 111 months after conservative surgery and postoperative radiotherapy, and one case of soft tissue sarcoma developed in the oral cavity 72 months after radical interstitial low dose rate brachytherapy. Both patients had chronic distress of the soft tissues after the primary treatment. The patients are alive and well respectively at 94 and 18 months from salvage surgery., Discussion: The PIS of the head and neck region is a rare event, usually with a bad prognosis. An improvement in results could be possible with early diagnosis, followed by a timely excision, when anatomically possible. As the chronic suffering of the irradiated tissues may increase the risk of PIS, a longer and more frequent follow-up is advisable in these cases.

The histology, immunohistochemistry and ultrastructure of six gastro-intestinal stromal tumors of the stomach (GSTs) showing a focal to diffuse clear cell component are reported. At light microscopy, all GSTs had typical histopathological features with one case additionally displaying stromal myxoid changes and scattered multinucleated giant cells. Immunohistochemically, 6 of 6 GSTs stained positive for vimentin, 2 of 6 for smooth muscle specific actin and 1 of 6 for desmin. At electron microscopy, GSTs showed microfilaments with focal densities as well as other smooth muscle features, such as subplasmalemmal linear densities and foci of external lamina. Ultrastructural appearances of tumor cells with clear cell features showed these not to be an artifact of fixation, but the expression of an unusual cytophagocytic activity. Inclusions of auto- and heterophagocytic nature were found responsible for the origin of the large, mostly lipidic vacuoles which displaced cell nuclei peripherally in a signet-ring fashion. It is concluded that such previously unrecognized features are ultrastructural aspects of GSTs with smooth muscle differentiation.

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.

The distribution of lysozyme in normal and pathological human gastric and colonic mucosa was studied by light and electron microscopic immunocytochemical techniques and compared with histological and histochemical features. Lysozyme was localized in pyloric glandular epithelial cells, mucous neck cells of fundic glands, Paneth cells and some crypt cells of the mature colonic mucosa. In addition, lysozyme was detected in a large spectrum of "immature" or "regenerative" epithelium: neck cells of the gastric regenerative zone, undifferentiated columnar cells of surface and hyperplastic interfoveolar crests of the stomach, regenerative cells in a healed gastric ulcer, some goblet cells in incomplete intestinal metaplasia, cells of the regenerative zone at the bottom of colonic crypts and, finally, fetal intestinal epithelium. Electron microscopically, we localized lysozyme in the central core of mucous granules in the pyloric gastric glandular epithelium and in the dense mucous granules in gastric mucous neck cells. Lysozyme was also detected in some immature mucin-producing cells of the gastric regenerative zone and in the rough endoplasmic reticulum of surface hyperplastic columnar gastric cells. At the electron microscopic level, a peculiar correlation between the immunopattern of lysozyme and the morphology of mucous granules has been postulated. All our data support and extend the view that the presence of lysozyme may be related to cell immaturity as well as to a regenerative state of the cell. Finally, the lysozyme distribution and its relation to mucosubstances in gastric and colonic carcinoma suggest that lysozyme should not be considered an exclusive marker of cells of gastric derivation.

The neoplastic involvement of the nipple-areolar complex was histologically studied in 1,291 available consecutive mastectomy specimens with primary invasive breast carcinoma. Tumor involvement of the nipple-areolar complex was found in 150 specimens (12 percent) and was not suspected on gross examination in 99 patients (8 percent). A significant finding of our study was the relatively high rate of tumor foci in the nipple-areolar complex (7 percent) in those patients with early invasive stage I or II breast carcinoma eligible for conservative therapy. Analysis of nipple-areolar complex involvement with consideration of different clinico-morphologic variables indicates that it was directly associated with tumor size. No significant correlation was found with axillary metastases, tumor histologic type, or with the presence of noninvasive cancer in the vicinity of the dominant tumor. Our estimate of the significant change of finding tumor in the nipple-areolar complex, especially in the patient group eligible for conservative therapy, underlines the need for postoperative radiation.

The histologic, histochemical, immunohistochemical, and ultrastructural features of Brenner tumor (BT) were studied. BT was compared with transitional bladder cells, and close similarities between the two tissues were identified. Abundant glycogen in all cellular layers, an alcianophilic/sialomucinic surface mucous coat, and argyrophilic cells characterized both BT and bladder epithelium. Immunohistochemically, chromogranin and neuron-specific enolase reactivity was observed in all cases examined. An additional relevant finding was the presence of serotonin-storing cells in both BT and urothelium. Moreover, carcinoembryonic antigen, epithelial membrane antigen, and keratin reaction were found in BT and urothelium, indicating an additional antigenic similarity. Additionally, malignant Brenner tumor was ultrastructurally found to share many common features with the bladder tissue. The distinct histochemical, ultrastructural, and antigenic pattern of BT, primarily of the transitional type, is emphasized.

A case of mucous-secreting villous adenoma of the urinary bladder associated with cystitis glandularis is reported which led to radical cystectomy because of the extensive bladder involvement. An immunohistochemical study was performed in order to detect ABH tissue antigens. The histogenesis and the possible malignant potential of this neoplasm are discussed.

The distribution of intermediate-filament (IF) proteins of the keratin, vimentin and desmin type in breast stromal sarcomas, carcinosarcomas, metaplastic carcinomas and phyllodes tumors has been compared using the avidin-biotin complex immunoperoxidase technique. Keratin reactivity was found in carcinomatous and pseudosarcomatous areas of all metaplastic carcinomas, in the cuboidal epithelial cells of carcinosarcomas and in the epithelial component of phyllodes tumors. Vimentin and desmin were detected in the sarcomatous portion of carcinosarcoma, focally in the stromal component of phyllodes tumors and not always in the stromal sarcomas. These data confirm that combined analysis of IF expression is a reliable and convincing way to differentiate stromal sarcomas, metaplastic carcinomas and carcinosarcomas in breast pathology.