Fabio Motta

Wilms' tumor 1 (WT1) protein expression in human developing tissues.

Several genes playing crucial roles in human development often reproduce a key role also during the onset and progression of malignant tumors. WT1, a transcription factor expressed with a dynamic pattern during human development, has either oncogenic or suppressor tumor properties. A detailed analysis of the immunohistochemical profile of WT1 protein in human developmental tissues could be exploitable as the rational for better understanding its role in cancerogenesis and planning innovative WT1-based therapeutic approaches. This review focuses on the dynamic immunohistochemical expression and distribution of WT1 protein during human ontogenesis, providing illustrations and discussion on the most relevant findings. The possibility that WT1 nuclear/cytoplasmic expression in some tumors mirrors its normal developmental regulation will be emphasized.

Benign Prostatic Hyperplasia, Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: Is Metaflammation the Link?

The prevalence of prostatic inflammation (PI) is very frequent in patients affected by benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). To investigate the relationship between prostatic inflammation (PI) and the presence of MetS and non‐alcoholic fatty liver disease (NAFLD) in a cohort of patients affected by BPH/LUTS.

Rhabdomyomatous mesenchymal hamartoma (RMH) of the anal region: an unusual location for such a rare lesion

Rhabdomyomatous mesenchymal hamartoma (RMH) is a rare tumour-like lesion, which occurs in the skin of newborns, principally of the face and neck. RMH has also been reported in unusual sites, including oral cavity, nasal vestibule and vagina. In this case report we describe a rare case of RMH arising as a nodular mass at the anal margin of a male newborn. This is an unusual site for such a rare lesion. The histological examination of the lesion showed the typical features of RMH. Desmin and S100 expression has been determined by immunohistochemical analyses to assess the distribution of the mature skeletal muscle cells and small-sized nerves, which represented the principal components of the nodular mass. Our case emphasizes the possibility that RMH may occur in the perianal region and awareness of this possibility is crucial for pathologists to avoid confusion with other skeletal muscle-containing lesions, especially rhabdomyosarcoma.

Metabolic syndrome is not associated with greater evidences of proliferative inflammatory atrophy and inflammation in patients with suspected prostate cancer

INTRODUCTION AND OBJECTIVES To evaluate the association between metabolic syndrome (MetS) and proliferative inflammatory atrophy (PIA) in patients with suspected prostate cancer (PCa). PATIENTS AND METHODS From June 2015 to July 2016, we conducted the FIERY (Flogosis Increased Events of pRostatic biopsY) study at the Urology section, Department of Surgery of the University of Catania (Local registration number: #131/2015). A total of 205 patients with elevated prostate-specific antigen (≥ 4 ng/ml) or clinical suspicion of PCa who underwent primary transperineal prostate biopsy were included in this cross-sectional study. The assessment of PIA, HGPIN, and PCa were performed by 2 experienced pathologists and samples were investigated for the presence of an inflammatory infiltrate, according to the Irani score. Primary and secondary Gleason grade of tumor in positive biopsies were evaluated according to the 2016 ISUP Modified Gleason System. RESULTS In the entire cohort, median age was 68.0 (interquartile range: 62.0-74.5), median prostate-specific antigen was 6.5 (interquartile range: 5.51-9.57). The prevalence of MetS was 34.1%, the detection rate of PCa was 32.7%, the rate of PIA was 28.3%, the rate of HGPIN was 32.2%, whereas the rate of severe intraprostatic inflammation (Irani-score ≥4) was 28.8%. When comparing clinical and histological variables in patients without and with PIA, metabolic aberrations where not significantly different in both groups. We did not find statistical association in detection rate of PCa (29.3% vs. 34.0%; P = 0.07) and HGPIN (27.6% vs. 34.0%; P = 0.37) in patients with and without PIA, respectively. When considering metabolic aberrations, MetS was not associated with Irani-score ≥4 (28.6% vs. 28.4%; P = 0.96) and none of each component was statistically predictive of severe inflammation. At the multivariable logistic regression analysis, PIA, HGPIN, and MetS were not associated with greater risk of PCa. CONCLUSION In this study, we did not show an association between MetS and PIA and PCa. Although the small sample size and the cross-sectional nature of the study, we do not suppose that MetS could be associated with greater evidence of PIA. Further studies should be conducted to evaluate the exact nature of this pathological lesion.

STAT6 expression in spindle cell lesions of the breast: An immunohistochemical study of 48 cases

The diagnosis of spindle cell lesions of the breast parenchyma is challenging. Some of these lesions share the expression of CD34, posing differential diagnostic problems, especially in core biopsies. Recently, antibodies against the STAT6 C-terminal, are being used in paraffin-embedded tissues as a surrogate for identifying the NAB2-STA6 fusion gene which is considered a specific molecular marker for solitary fibrous tumor. Accordingly, we investigated the expression of STAT6 in a large series of uncommon spindle cell tumor-like and tumor lesions occurring primarily in the breast parenchyma. We collected 10 classic-type myofibroblastomas, 9 desmoid-type fibromatosis, 6 spindle cell metaplastic carcinoma, 5 benign fibroblastic spindle cell tumors, 3 solitary fibrous tumors, 7 pseudoangiomatous stromal hyperplasias, 2 reactive spindle cell nodules, 1 leiomyoma, 1 spindle cell lipoma, 1 case of inflammatory pseudotumor, 1 nodular fasciitis, 1 myxoma and 1 dermatofibrosarcoma protuberans. A diffuse and strong nuclear STAT6 expression was restricted only to solitary fibrous tumors, while the other lesions were negative or showed only weak cytoplasmic expression. The present study confirms that the demonstration of a diffuse and strong STAT6 nuclear staining is very helpful in distinguishing solitary fibrous tumor from other spindle cell mimics arising in the breast.

Breast implant-associated anaplastic large cell lymphoma with lymph node localization: case report and review of literature: Images for surgeons

therapy, the patient’s inflammatory markers were within normal range. Management of pericardial effusions depends on the clinical severity at presentation, haemodynamic status of the patient, volume of the effusion and signs of infection. Efficient diagnosis is critical. Intensive care unit surgical patients with signs of cardiac tamponade undergo prompt chest wound re-exploration and evacuation of pericardial haematoma. Haemodynamically stable patients with large sterile pericardial effusions are commonly treated with percutaneous pericardiocentesis. Patients with AM and sternal wound infection undergo surgical wound washout, debridement and sternal re-wiring. Patients with deep sternal wound infection and necrosis of the sternum are treated with sternal removal and omental transposition or muscle flap reconstruction. Preoperative risk factors for AM after cardiac surgery include patient age, body mass index, diabetes, logistic EuroScore, type of hospital admission and the length of preoperative hospital stay. Among intraoperative risk factors, combined coronary artery bypass and aortic valve replacement, duration of aortic cross-clamp and cardiopulmonary bypass were predictive of AM. The widely used Society of Thoracic Surgery Adult Cardiac Surgery Database might underestimate the risk of AM. By these criteria, the preoperative risk for deep sternal wound infection in our patient would have been 0.23%. This case demonstrates the significance of a raised C-reactive protein following cardiac surgery as well as limitations of the chest X-ray and echocardiography in diagnosing pericardial empyema. Computed tomography was highly effective in depicting the loculated pericardial collection and the presence of gas bubbles was pathognomonic for pericardial empyema.

Rhabdomyoblasts in Pediatric Tumors: A Review with Emphasis on their Diagnostic Utility

Rhabdomyosarcoma is a soft tissue pediatric sarcoma composed of cells which show morphological, immunohistochemical and ultrastructural evidence of skeletal muscle differentiation. To date four major subtypes have been recognized: embryonal, alveolar, spindle cell/sclerosing and pleomorphic. All these subtypes are defi ned, at least in part, by the presence of rhabdomyoblasts, i.e. cells with variable shape, densely eosinophilic cytoplasm with occasional cytoplasmic cross-striations and eccentric round nuclei. It must be remembered, however, that several benign and malignant pediatric tumours other than rhabdomyosarcoma may exhibit rhabdomyoblaststic and skeletal muscle differentiation. This review focuses on the most common malignant pediatric neoplasm that may exhibit rhabdomyoblastic differentiation, with an emphasis on the most important clinicopathological and differential diagnostic considerations. Review Article

MP44-09 NON-ALCOHOLIC FATTY LIVER DISEASE IS ASSOCIATED WITH GREATER SEVERITY OF INTRA PROSTATIC INFLAMMATION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

INTRODUCTION AND OBJECTIVES: It has been previously demonstrated the association between metabolic syndrome (MetS), benign prostatic hyperplasia (BPH) and prostate inflammation. We have recently shown that insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD) were associated with greater severity of lower urinary tract symptoms (LUTS). In this study we aimed to investigate the association between IR, NAFLD and intraprostatic inflammation in patients undergoing transurethral resection of the prostate (TURP) for moderate-to-severe LUTS. METHODS: Between January 2012 and June 2013, we enrolled 129 consecutive patients with IPSS 1⁄412, PSA <4 ng/ml or PSA 1⁄44 ng/ml but previous negative prostate biopsy, Qmax <15 mL/ sec, prostate volume 1⁄430 ml and 1⁄480 ml. A condition of IR was defined in the presence of a value homeostasis model assessment (HOMA) greater than or equal to 3. The presence of NAFLD was defined in the presence of a value of Fatty Liver Index (FLI) greater than or equal to 40 (specificity 72 %, sensitivity 82%, AUC 81%). The protocol was approved by the local ethics committee (ID: 578). During TURP procedure we collected tissue samples for the evaluation of the degree of inflammatory infiltrate according to the classification used by Irani et al. The degree of inflammatory score (IS) was obtained by combining three different histological parameters (grade and aggressiveness), with a score ranging between 0 and 6. RESULTS: The median HOMA -Index was 1.69 (IQR: 0.893.43), the median FLI was 44.83 (IQR: 26.98-69.07) and the median IS was 3 (IQR: 2-4). Forty-two patients (31.8%) had IR, 75 (56.8%) had NAFLD, 75 (56.8%) had MetS and 36 (27.3%) had a IS 1⁄44. Patients with IS 1⁄44 showed higher levels of FLI (60.6 vs. 36.84; p< 0.05) and HOMA-index (2:41 vs. 1:56; p<0.05) than patients with IS<4. The logarithmic regression showed that for every increase of FLI was observed an increase of the IS 0.44% (p<0.01). No relationship was found, however, between Homa-index and IS. The multivariate logistic regression analysis, showed that the presence of NAFLD is an independent risk factor for IS 1⁄44 (OR: 2.84; p< 0.05). CONCLUSIONS: We have demonstrated that the FLI, expression of NAFLD, is associated with a more severe inflammatory infiltrate prostate. In particular, for each increase of FLI it was observed an increase of 0.44 % of the severity of the inflammation. Finally, the presence of NAFLD increases the risk of having a severe inflammatory infiltrate (SI 1⁄44). These results may be useful in order to assess in detail the possible interaction between fatty liver and intra prostatic inflammation. The presence of IR was not found to play a key role for prostate inflammation.