Giovanni B. Bolis

Fine Needle Aspiration Biopsy of Salivary Gland, 1985–1995

OBJECTIVE To evaluate the utility of fine needle aspiration biopsy (FNAB) in the study of salivary gland pathologies and to assess its capacity to provide an accurate diagnosis and discriminate between cases requiring surgery or not. STUDY DESIGN From January 1985 through December 1995, FNABs were carried out on 153 patients with salivary gland tumors. In 4 of the 153 cases the aspiration was inadequate. Of the remaining 149 FNAB diagnoses, 63 were checked histologically and 86 clinically. RESULTS Regarding the capacity to discriminate between neoplastic (malignant and benign) and nonneoplastic lesions FNAB correctly diagnosed 144 lesions (135 true negative [TN] and 9 true positive [TP]) and failed in 5 cases (false negative [FN]). Regarding the capacity to discriminate between tumors requiring surgery or not, the FNAB diagnoses were true in 146 cases (83 TP, 63 TN) and false in 3 (2 FN, 1 false positive). The values for sensitivity, specificity, negative predictive value and total diagnostic accuracy were 97.64%, 98.43%, 96.92% and 97.98%, respectively. CONCLUSION FNAB has an impact on the treatment of salivary gland masses. The data on its ability to distinguish between lesions requiring surgery or not are encouraging.

Pyothorax-associated lymphoma: Description of the first two cases detected in Italy

BACKGROUND Pyothorax-associated lymphoma (PAL) is a rare, but distinct, clinico-pathologic entity which occurs most often in Japanese people; to the best of our knowledge, only six cases of it have been reported in Western countries. The tumour develops several decades following artificial pneumothorax or chronic pleuritis due to tuberculous infection, produces pleural effusion associated with extensive local lymphomatous infiltrates, and is sustained by a polymorphic large B-cell clonal proliferation showing EBV integration in the genoma of the neoplastic cells. PATIENTS AND METHODS Herein we describe two cases of PAL observed in Italian patients, both extensively studied on the clinical, pathological, phenotypic, virological, and molecular levels. RESULTS The two cases occurred, respectively, 45 and 50 years after therapeutic pneumothorax because of tuberculous pleuritis and were characterized by a pleural mass extending to the thoracic wall, which on histological examination were seen to consist of large elements with immunoblastic morphology. Immunohistochemistry show monotypic restriction of Ig light chains, as well as the expression of CD45, B-cell markers (CD20, CD79a, CD45RA), bcl-2 oncogene product, EBNA-2 and, partially, LMP-1. The ratio of cycling cells was extremely high as was the number of mitotic figures. In situ hybridization displayed the presence in the neoplastic cells of the EBV-related small RNAs EBER 1 and 2, which in turn, along with the positivity for EBNA-2 and LMP-1, further strengthened the close relationships between PAL and latent viral infection. Molecular studies revealed, on one hand, clonal rearrangement of the Ig heavy chain J region genes, and on the other, negativity for HHV8 in one case and positivity in the other. CONCLUSIONS These cases of PAL are the first to be documented in Italy; they serve to direct attention to the fact that this condition is not confined to Japanese people, and that its occurrence in Western countries might be underestimated.

Lymphoepithelial Cyst of the Pancreas

BACKGROUND: Lymphoepithelial cysts of the pancreas are very rare lesions. To the best of our knowledge, 24 cases are reported in the literature. CASE: A 64-year-old male presented with gastrointestinal complaints. A computed tomography scan of the abdomen disclosed a 55 x 30-mm, homogeneous mass anterior to and contiguous with the pancreas. Fine needle aspiration biopsy (FNAB) showed threads of tissue composed of stratified squamous epithelium with subepithelial lymphocytic infiltrate and keratinous material. CONCLUSION: This case illustrates that FNAB is a rapid and reliable technique that can be used as the first diagnostic step in cases of cystic lesions of the pancreas. To our knowledge, this is the third case reported of this entity diagnosed with FNAB.

Endoscopic and histological criteria for preoperative evaluation of the depth of infiltration of gastric carcinoma.

Because the therapeutic approach to gastric carcinoma differs according to the stage of development, a study was carried out to investigate whether there are any factors which would allow the depth of infiltration of a gastric carcinoma to be evaluated preoperatively. The criteria used were endoscopic and histological. The first provide information on size and macroscopic aspect; the second reveal the relationship between bioptic specimens that are positive for carcinoma and those that are negative. On the basis of these standards, small, benign-looking neoplasias with bioptic positivity for carcinoma lower than 30% were classified as probably early. Of the 200 gastric carcinomas investigated, 55 were considered probably early and 145 probably advanced. Surgical fragment findings confirmed the diagnosis in 169 cases (37 true negatives and 132 true positives) and failed to confirm it in the other 31 cases (13 false positives and 18 false negatives). The specificity, sensitivity, negative predictive value, positive predictive value, and total diagnostic accuracy indices were 74.00%, 88.00%, 67.27%, 91.03%, and 84.50%.