Abstract: Most mesenchymal tumours of the gastrointestinal tract are now referred to as gastrointestinal stromal tumours (GISTs) These tumours typically express c-kit (CD117) and CD34; 30-50% are (often focally) positive for alpha-smooth muscle actin, and all are negative for desmin and S100 protein Recently, mutations in exon 11 of the c-kit gene have been identified as a molecular genetic marker for the subset of GISTs In this report, we describe a mesenchymal tumour removed from the pelvic cavity of a 34-year-old man The tumour was strongly attached to the external wall of the urinary bladder The neoplasm grossly resembled a leiomyoma, and was histologically composed of sheets of spindle cells with a dense collagenous background The mitotic activity was low (less then 1 per 50 high-power fields) Immunohistochemically, tumour cells were negative for alpha-smooth muscle actin and desmin and positive for CD117 and CD34 This case illustrates that tumours which are phenotypically and genotypically similar to GISTs may present in sites other than the tubular gastrointestinal tract

Abstract: Thin-layer cytology (TLC) is an automated method for processing cells harvested in a liquid solution and collected onto a single slide. The leftover material can be used for other techniques such as immunocytochemistry, molecular biology and flow cytometry. TLC has been applied with good results in exfoliative cytology of pulmonary, urinary, gastrointestinal and oral districts as well as in the evaluation of serous effusions. The main advantages of TLC over conventional techniques (CS) are: (a) simplification of the sampling technique; (b) decrease in cellular artefacts leading to a lesser amount of inadequate diagnoses; and (c) applicability of additional investigations. The limits of TLC are: (a) changes in the morphologic picture of some lesions; (b) increase of the workload for technical staff; and (c) increased cost. The application of TLC to non-gynaecologic specimens favours many innovative developments and can be regarded as an appropriate substitute for CS.

Abstract: Invasive micropapillary carcinoma is associated with frequent lymph node metastases and adverse clinical outcome. It has been reported in breast, urinary bladder, lung and the parotid gland, but very rarely in the colon. We report a new case in a 63-year-old man involving the colon, and discuss the clinicopathologic features of this rare and particularly aggressive tumour.

Abstract: We report a case of a 29-year-old male patient with a respiratory epithelial adenomatoid hamartoma (REAH) of the nasal cavity. REAH is a polypoid proliferation of glandular spaces lined by ciliated epithelium and goblet cells in the upper aerodigestive tract. Although REAHs are benign lesions, they may be confused with a variety of other pathologies such as inflammatory polyps, inverted Schneiderian papillomas and low-grade sinonasal adenocarcinomas. The recognition of this entity is important as complete excision is curative.

Abstract: Glomus tumours are uncommon neoplasms usually arising in the dermis and subcutaneous tissues where glomus bodies are generally found. Occasionally glomus tumours can occur in extracutaneous sites such as the gastrointestinal tract, bone, genitourinary system and respiratory tract. Primary pulmonary glomus tumours are very rare (only 17 cases reported in the literature), and are often confused with other solid neoplasms such as carcinoids, hemangiopericytomas and tumours belonging to the family of Ewing's sarcoma/primitive neuroectodermal tumours. We present a case of a primary pulmonary glomus tumour originating in the right main bronchus with focal invasion of the submucosa in a 69-year-old man. Histological and immunohistochemical features are reported. The current literature is briefly reviewed, with special attention to differential diagnosis and malignancy criteria.

Abstract: Vulvar cancer represents about 4% of all neoplasms of the female genital tract. Two different pathways give rise to vulvar carcinoma, a HPV-dependent pathway, and a pathway linked to inflammatory dermatoses. The aim of the present study was to evaluate the impact of HPV infection in the pathogenesis of vulvar cancer by HPV genotyping in 22 cases of squamous cell carcinoma. Our results provides further evidence that vulvar squamous cell carcinoma is a multifactorial disease that may develop though different pathways, very often in the presence of classic or differentiated vulvar intraepithelial neoplasia in 16 out 22 cases.

Abstract: Desmoplastic spitz nevus (DSN) is an uncommon melanocytic lesion. The histologic features of this benign tumour may mimic those of certain benign (dermatofibroma and desmoplastic cellular blue nevus) or malignant (metastatic carcinoma and malignant melanoma) neoplasms. We report the case of a male with a DSN, and also review the clinical characteristics, histologic features and differential diagnosis of this extremely rare lesion. The lesion is identified as an asymptomatic reddish-brown dome-shaped papule on the forearm. Microscopic examination showed a symmetric lesion in the dermis. The neoplastic cells were large and epithelioid-shaped, and were either isolated as individual cells or arranged in small nests in a paucicellular hyalinized stroma. Nuclei were large and vesicular with small nucleoli and no mitoses. Diffuse expression of S100 and the absence of staining with antibodies to melan-A and HMB45 was observed. A diagnosis of DSN with free margins was made. The histologic presentation of this benign lesion mimics both benign and malignant neoplasms. The immunohistochemical profile (S100 positive, HMB-45 negative and cytokeratin negative) may be helpful to differentiate it from other lesions.

Abstract: Malignant tumours of the prostate other than carcinomas are rare. One such malignant tumours arising from the specialised stromal tissue of the prostate is stromal prostatic sarcoma (namely low-grade and high-grade). Herein, we report the clinico-pathological features of a high grade stromal sarcoma of the prostate occurring in a 65-year-old man who presented for urinary obstructive symptoms. The clinical picture suggested a benign prostatic hyperplasia, and surgery consisting in a transcapsular adenomectomy was performed. Following a pathological diagnosis of high grade prostatic stromal sarcoma, a radical cystoprostatectomy and bilateral pelvic node dissection was performed showing residual high grade stromal sarcoma of the prostate and incidental in situ urothelial carcinoma of the bladder. No further medical treatments were planned. One year after surgery the patient is well with no evidence of local disease or distant metastases.

Abstract: Renal cell neoplasms are a heterogeneous group of tumours in terms of pathological features and prognostic behaviour. The genetics of these tumours may aid in correct diagnosis and accurate assessment of prognosis. In ambiguous cases it may be necessary to utilise new markers that are capable of further discerning renal cell neoplasms. Fluorescence in situ hybridization (FISH) on formalin-fixed, paraffin-embedded tissue is an increasingly useful technique in the detection of many diagnostic chromosomal abnormalities, among which chromosomes 1, 2, 3p, 6, 7, 10, 17 and Y are the most common. The addition of FISH to histological evaluation improves the diagnostic accuracy of core biopsies from renal masses, which may have an important impact in clinical management of many cases due to newer therapeutic approaches, including cryo- or radiofrequency ablation, nephron-sparing surgeries and target therapies.

Abstract: We describe the case of an 18-year-old girl with an oligodendroglioma arising in an immature ovarian teratoma. The oligodendroglioma, which closely involved the cystic teratoma, was moderately cellular, composed of monomorphic cells with uniform round nuclei and perinuclear halos with a characteristic "fried-egg" appearance. Rare microcalcifications and a dense network of branching capillaries with a chicken-wire appearance were also observed. By immunohistochemistry, tumour cells showed positivity for S-100, but were negative for GFAP, synaptophysin and neuro-specific enolase. The patient is free of disease on follow-up examination at 24 months.

Abstract: Renal angiomyolipoma is a benign tumour histologically characterized by a mixture of adipose tissue, smooth muscle cells and thick walled blood vessels. Long-believed to be a benign hamartoma, angiomyolipoma is now considered to arise from perivascular epithelioid cells. Epithelioid angiomyolipoma is a rare type of angiomyolipoma, composed partially or completely of epithelioid cells, with a potentially aggressive behaviour. Histologically it can mimic renal cell carcinoma. Positivity for HMB45, Melan A, CD68 and CD117 are useful for diagnosis. Herein, we report the clinicopathologic and immunohistochemical features of a renal tumour composed of large epithelioid mononucleated or multinucleated cells with abundant acidophilic cytoplasm and prominent nucleoli. Despite the morphologic resemblance of this tumour to renal cell carcinoma, its phenotype (HMB45, Melan A and CD68 positivity and keratin negativity) parallels the phenotypic profile of angiomyolipoma. Therefore, immunohistochemistry should be considered when diagnosing this variant of angiomyolipoma.

Abstract: Mature cystic teratoma is a benign neoplasm, but malignant transformation of one component may occur in 2% of cases. Although very different types of carcinomas may be arise from mature cystic teratoma, invasive squamous cell carcinoma is the most frequent type of malignancy found, comprising about 80% of all malignancies arising from dermoid tumours. Although invasive squamous cell carcinoma is relatively frequent, it is surprising that so few cases of squamous cell carcinoma in situ in mature cystic teratoma have been reported. We describe a case of squamous cell carcinoma in mature cystic teratoma without an invasive component.

Abstract: BACKGROUND Renal epithelioid angiomyolipoma is a recently recognized variant of angiomyolipoma, closely simulating renal cell carcinoma both clinically and histologically. Only a relatively small number of cases of epithelioid angiomyolipoma of the kidney have been reported. AIM To highlight clinicopathological features of this rare tumour. OBSERVATION We report herein a new case of renal epithelioid angiomyolipoma in a 38-year-old male with no stigmata of tuberous sclerosis. The tumour was composed of diffuse sheets of epithelioid cells, small numbers of adipocytes and occasional blood vessels. Immunohistochemically, neoplastic cells were immunoreactive for HMB-45, but negative for cytokeratin. The patient showed no evidence of recurrence or metastatic disease one year after radical nephrectomy. CONCLUSIONS Epithelioid angiomyolipoma may be locally aggressive and can metastasise; therefore, long-term post-operative follow-up is mandatory.

Abstract: Collision epithelial and stromal tumours of the stomach are uncommon, and only a few cases have been reported in the literature. We describe a new case of a 54-year-old man who presented with bloody emesis. An oesophagogastroduodenoscopy revealed a stomach induration, and preoperative histological diagnosis was signet ring carcinoma. Total gastrectomy was performed and histological examination revealed a gastric collision tumour composed of gastrointestinal stromal tumour intermixed with a primary signet ring carcinoma. The neoplastic cells of the gastrointestinal stromal tumour were diffusely positive for CD117, while the signet ring cells were positive for cytokeratin. There was no transition between the two components.

Abstract: Echinococcal involvement of the breast is extremely rare, even in the endemic countries. We report the case of a 31-year-old woman who presented with a 5 cm mammary mass. Mammography and sonography showed a well-circumscribed cystic lesion. Diagnosis of hydatid cyst was confirmed by pathological examination.

Abstract: Multicystic peritoneal mesothelioma is a rare lesion occurring mainly in women in a reproductive age. Its pathogenesis is unclear. We report three cases of multicystic peritoneal mesothelioma in patients that were 28, 38 and 47 years of age (one male, two females). A history of abdominal surgery was reported in two cases. Explorative laparotomy was presumptive of a pseudomyxoma peritoni in two cases, and hyperthermic intraperitoneal chemotherapy was performed. Histological examination demonstrated multicystic lesions with mesothelial cells lining confirmed by immunohistochemical analysis. Unusual findings such as hyperplasia, hobnail features, cytoplasmic vacuolisation and papillary pattern were occasionally noted. The clinical presentation, pathogenesis and pathologic features including differential diagnosis of multicystic peritoneal mesothelioma are discussed.

Abstract: Brainstem gliomas are a heterogeneous group of tumours commonly found in children, comprising about 10% of central nervous system tumours in paediatric patients, but less than 2% in adults. Pilocytic astrocytomas usually involve the midbrain and the medulla, and their surgical resection, when feasible, is generally curative. Thin calcifications can be normally found within low grade gliomas, but densely calcified pilocytic astrocytomas of the brainstem have been only rarely reported. We present the case of a young man presenting with a large brainstem calcification involving the medulla, which was subtotally resected using a posterior suboccipital approach. The definitive pathological diagnosis was calcified pilocytic astrocytoma.

Abstract: Gynandroblastoma is a rare variant of ovarian sex cord stromal tumours that demonstrates morphological evidence of both male and female differentiation. We report a new case of gynandroblastoma in a 22-year-old nulliparous female with a history of menstrual disturbance. Physical examination disclosed a painless pelvic mass measuring 20 cm across with normal secondary sex characteristics, and no signs of virilisation. Histological examination of the surgically resected primary tumour revealed a predominant adult granulosa cell component admixed with a minor Sertoli cell component that did not exceed 20% of the tumour. Immunohistochemical analysis showed positive immunostaining of Sertoli cell areas with inhibin. The final diagnosis was gynandroblastoma. The post-operative course was uneventful and there was no evidence of recurrence during the 9-month follow-up period.

Abstract: We report two cases, with overlapping cyto-histological characteristics, of invasive neuroendocrine carcinoma of the breast with associated stromal features distinctive of carcinoma with osteoclastic giant cells. Fine-needle aspiration cytology showed monomorphic, medium-sized, mildly atypical neoplastic cells, with interspersed multinucleated giant cells and lympho-histiocytic components; hemosiderin deposits were also appreciable. Macroscopic features were typical of invasive carcinoma, but with unusual brown staining. Light microscopy revealed moderately differentiated invasive carcinoma mainly composed of solid sheets of round to polygonal medium-sized cells with a tendency to produce peripheral palisading (carcinoid-like morphology); osteoclast-like multinucleated giant cells, lymphocytes and histiocytes were dispersed only among tumour cells in the distinctive stroma of the carcinoma with osteoclastic giant cells; this stroma was characterised by reactive/fibroblastic features, hypervascularization, extravasated blood cells and hemosiderin deposits that gave rise to the typical staining seen macroscopically. Immunohistochemically, cancer cells were diffusely positive for the neuroendocrine marker synaptophisin with partial chromogranin and NSE staining; the ostoclastic giant cell and histiocyte component were strongly positive for CD68. Both cases also had lymph node metastases; the epithelial neoplastic cells, with regards to neuroendocrine markers, were overlapping to the primitive tumour, the histiocytic/giant cell component appeared present, although with a lower degree, while the distinctive stroma was absent. Breast neuroendocrine carcinomas, associated with multinucleated giant cells and stroma typical of the carcinoma with osteoclastic-like cells, to our knowledge, have not been reported.

Abstract: Myasthenia gravis (MG) is an autoimmune neuromuscular junction disorder that is frequently associated with other autoimmune diseases. It has been only rarely reported in association with thymic Hodgkin's lymphoma. We report a case of a 22-year-old man who presented with thoracic symptoms. Clinical examination was normal. Simple chest radiography showed a heterogeneous mediastinal mass. Thoracic computed tomography revealed an antero-superior mediastinal mass measuring 6 cm and invading the upper lobe of the left lung with parenchymal micronodules of the left lung and an involvement of mediastinal nodes. In order to consider a diagnosis of thymoma, electromyography was performed despite the fact that the patient was asymptomatic. This exam demonstrated signs specific of MG. After stabilising the MG with symptomatic therapies, surgical intervention was performed. Histological and immunohistochemical findings led to the diagnosis of thymic Hodgkin's lymphoma. The MG regressed completely after surgical removal of the lesion. The patient is currently receiving complementary chemotherapy. An association between asymptomatic MG and thymic Hodgkin's lymphoma has not been documented in the literature, and the present case appears to be the first reported. The pathogenesis of this association remains unknown. Some authors support a genetic origin, while others propose a hypothesis based on immunological studies. The treatment of thymic Hodgkin's lymphoma is based on Cotswold staging system. Nonetheless, MG generally regresses after surgical removal of the thymic lesion.

Abstract: We report a well-documented case of pulmonary mucinous cystic tumour of borderline malignancy involving the left lower lobe The lesion was found incidentally by chest radiograph and CT scan with a provisional diagnosis of bronchioloalveolar carcinoma The tumour was 4 cm in its greatest dimension, cystic and filled with gelatinous mucus Microscopically, the neoplastic mucinous epithelium was composed of cuboidal cells with focally nuclear stratification and mild to moderate nuclear atypia The patient has remained free from recurrence or metastases for 6 years Pulmonary mucinous cystic tumour of borderline malignancy is a rare, recently described neoplasm, which spans a spectrum of tumours with malignant potential The recent World Health Organization classification of lung tumours does not recognize this entity, which has a very good prognosis, and as such should be distinguished from classic pulmonary adenocarcinoma Histological diagnosis can be difficult to distinguish from cystic bronchioloalveolar carcinoma or metastatic mucinous adenocarcinoma

Abstract: A 54-year-old male, non smoker, began to suffer from persistent dyspnoea and fever. X-ray and CT scan showed a cystic lesion located in the left anterior mediastinum. This lesion was removed instead of the initially scheduled surgical resection with video-assisted thoracoscopic surgery (VATS) preceded by fine needle aspiration (FNA). A diagnosis of thymoma arising in the wall of thymic cyst was made. Such a rare tumour should be taken into consideration in treating patients with a cystic mediastinal lesion, before VATS and FNA.

Abstract: Human Papilloma Virus plays an essential role in the development of cervical cancer. We investigated the global prevalence of Human Papilloma Virus infection in a population of 699 women recruited at the Ospedali Riuniti in Foggia for gynaecological controls from September 2005 to March 2007, and compared with a group of 90 women, selected on clinical aspects for Human Papilloma Virus features. The observed prevalence was 27.4%, which is higher that that reported in the literature. In the study group, the most frequent viral type was 16, while type 18 was considerably less frequent compared with other emergent viral types (39, 52, 56, 58, 59). The high prevalence of Human Papilloma Virus-DNA in women with negative cytology or inflammatory changes raises doubts about the utility of the Human Papilloma Virus-DNA method as a primary screening test because of the low cost/benefit ratio. The absence of uniform and standardised reports does not allow objective comparison between different methods of analysis (cytology, colposcopy and molecular biology), pointing out the need for a unique centre for collection and data analysis.

Abstract: Cutaneous gamma-delta T-cell lymphoma (CGD-TCL) is an uncommon lymphoma composed of a clonal proliferation of mature activated gamma-delta T-cells expressing a cytotoxic phenotype. Malignant lymphoma is rarely associated with Behcet's disease, as only 12 cases have been reported in the literature, including a case of cutaneous T-cell lymphoma. In this report, the authors present a new case of CGD-TCL emerging in the course of Behcet's disease in a 40-year-old man. Diagnosis of CGD-TCL was established based on the combination of clinical, histological, immunophenotypical and molecular findings. Through a review of the current literature, the authors analyse the unique clinicopathological, molecular and immunohistochemical features of this rare cutaneous lymphoma.

Abstract: Malignant neoplasms arising in the epithelial component of breast fibroadenomas are rare. The most frequent types are lobular and ductal intra-epithelial carcinomas, with a minority of infiltrating carcinoma. We report a case of 36-year-old patient with invasive mucinous carcinoma (30 x 30 mm) arising in a complex breast fibroadenoma (130 x 60 x 30 mm). The patient underwent mastectomy with dissection of the axillary lymph nodes, which were free of tumour. The patient is alive without disease five years later. To the best of our knowledge, this is the first report of an invasive mucinous carcinoma arising within breast fibroadenoma. Our case provides information about the clinicopathologic characteristic of this unusual tumour.

Abstract: AIMS Sarcomas of the broad ligament are exceptionally rare. To our knowledge, the present case is the first description of undifferentiated pleomorphic sarcoma (UPS) occurring in the broad ligament. Herein, we report this unusual case, and discuss differential diagnoses and treatment. RESULTS A 55-year-old postmenopausal woman was admitted for lower abdominal pain and vaginal spotting. Radiological examination revealed a latero-uterine mass that was independent of the surrounding organs. Treatment consisted in a total resection of the mass in addition to total abdominal hysterectomy and bilateral salpingo-oophorectomy. Based on histological examination, immunohistochemical study and quantitative PCR, a diagnosis of undifferentiated pleomorphic sarcoma (UPS) was made. The patient was lost to follow-up for 6 months, and then presented with a local recurrence of the tumour in addition to secondary pulmonary and vertebral localizations. The patient died less than one year after the first diagnosis. CONCLUSIONS Diagnosis of UPS of the broad ligament is based on exclusion using a large panel of antibodies. There is no consensus for treatment. The prognosis of this disease cannot be assessed due to its rarity, but it can be hypothesized that early recurrence is indicative of poor prognosis.