Narrative review of prostate cancer grading systems: will the Gleason scores be replaced by the Grade Groups?

The Gleason grading system, proposed by Dr. Donald F. Gleason in 1966, is one of the most important prognostic factors in men with prostate cancer (PCa). At consensus conferences held in 2005 and 2014, organized by the International Society of Urological Pathology (ISUP), the system was modified to reflect the current diagnostic and therapeutic approaches. In particular, in the 2014 Conference, it was recognized that there were weaknesses with the original and the 2005 ISUP modified Gleason systems. Based on the results of a research conducted by Prof. JI Epstein and his group, a new grading system was proposed by the ISUP in order to address some of such deficiencies: i.e., the five distinct Grade Groups (GGs). Since 2014, results of studies have been published by different groups and societies, including the Genitourinary Pathology Society (GUPS), giving additional support to the prognostic role of the architectural Gleason patterns and, in particular, of the GGs. A revised GG system, taking into account the percentage of Gleason pattern (GP) 4, cribriform and intraductal carcinoma, tertiary GP 5, and reactive stroma grade, has shown to have some advantages, however not ready for adoption in the current practice. The aim of this contribution was to review the major updates and recommendations regarding the GPs and GSs, as well as the GGs, trying to give an answer to the following questions: “How has the grade group system been used in the routine?” and “will the Gleason scoring system be replace by the grade groups?” We also discussed the potential implementation in the future of molecular pathology and artificial intelligence in grading to further define risk groups in patients with PCa.     

Mulibrey nanism: Three additional patients and a review of 39 patients

We report on 3 patients with Mulibrey nanism (MN), or Perheentupa syndrome: the first 2 sibs from Argentina and a new patient from Spain. All 3 patients had growth failure, short stature, abnormal pigmentary retinal changes, and a J-shaped sella turcica. These findings are considered major criteria of MN. Two had pericardial constriction, which is a frequent and lifethreatening abnormality in this syndrome. MN is a rare autosomal recessive condition. Reviewing the 39 patients described so far, we have classified the anomalies into the very frequent (present in more than 66%), frequent (in at least 25%), and not frequent. Identifying the anomalies specific to MN should help its early diagnosis and treatment. © 1995 Wiley-Liss, Inc.     

Ambroxol inhibits interleukin 1 and tumor necrosis factor production in human mononuclear cells

We have studied the effect of Ambroxol on the production of Interleukin-1 (IL-1) and Tumor Necrosis Factor (TNF) in human mononuclear cells (MNC). For this purpose MNC were cultured for 24 h in the presence of endotoxin and different doses of Ambroxol. The results indicate that Ambroxol markedly inhibited IL-1 and TNF production at doses of 10–100 g/ml, without any apparent toxicity.     

Sporadic Duane's Retraction Syndrome Associated with Imperforate Anus: Case Report

Duane's retraction syndrome is sometimes associated with developmental ocular and extraocular abnormalities. This disorder may also be present in association with specific malformative syndromes. The authors report the clinical features of a seven-year-old female affected by Duane's retraction syndrome (D.R.S.), rectoperineal fistula, imperforate anus and other congenital malformations. From two extensive reviews of 106 reports published before 1982 and from a search (using Medline 1981-1994) for reports of congenital malformations associated with this syndrome, no cases of sporadic D.R.S. associated with the perineal malformations mentioned were found, even though imperforate anus is considered the commoner of hindgut malformation.     

Radiological aspects of osteosarcoma of the jaws

OBJECTIVES: To categorize the radiological presentation of osteosarcoma of the jaws. METHODS: Conventional radiographs and CT scans of nine patients with histologically proven osteosarcoma were reviewed. RESULTS: Five patients were men and four women, aged between 20 and 51; four lesions were in the maxilla and five in the mandible. Three radiological presentations of osteosarcoma of the jaw were identified. The first was radiolucent, characterized by a total absence of bone formation within the tumour. The second had a mottled appearance with small areas of amorphous ossification separated by non-ossified tumour tissue. The third, with lamellar ossification, was typically characterized by bony plates irradiating from a focus like a 'sunburst'. CONCLUSION: Radiological diagnosis of osteosarcoma of the jaw can be difficult because of its variable appearance. CT is particularly useful.     

Giant abdominopelvic epithelioid angiomyolipoma associated with tuberous sclerosis: Report of a case

(Received for publication on July 16, 1998; accepted on Mar. 11, 1999)     

Reduced platelet glutamate uptake in Parkinson's disease

Summary. Defects in mitochondrial enzymes have been found not only in substantia nigra, but also in platelets from Parkinson's Disease (PD) patients, suggesting a systemic impairment of energy metabolism. Since platelets present an energy-dependent glutamate uptake similar to that described in central nervous system, glutamate uptake was determined in platelets from 34 PD patients and 21 age-related normal controls, as Na⁺-dependent [³H]glutamate influx; glutamate level was also analyzed by reverse-phase HPLC. A 50% reduction of glutamate uptake (p < 0.001) was observed in idiopathic PD patients, respect to controls and secondary parkinsonian syndromes. The decrease correlated with the severity of PD, measured by the UPDRS (r = −0.54; P < 0.05). Glutamate level was increased in platelets of PD patients, but was not correlated to the uptake decrease. Both phoenomena may be explained by the modifications of mitochondrial enzymes described in platelets, which could be used as a peripheral model of glutamatergic function in PD. Received October 7, 1998; accepted January 7, 1999     

Video thoracoscopy in the diagnosis of pleural effusions

BACKGROUND: At present video thoracoscopy is a primary diagnostic procedure in the diagnosis of pleural diseases, particularly when pleural effusions have unknown origin. METHODS: In this article the personal experience is reported about 20 patients in which video thoracoscopy was very important in the diagnosis of pleural effusions. RESULTS: Thoracoscopy permits to explore the thoracic cavity and to do a lot of biopsies. Video thoracoscopy, made it possible to diagnose 10 cases of malignant mesothelioma, 2 cases of pleural metastases (renal mts and mammary mts) and 8 cases of inflammatory diseases. CONCLUSIONS: At last, is laid on the contribution of video thoracoscopy to determine the stage of malignant mesothelioma.     

An apocrine hidrocystoma of the scrotum. A case report

A benign neoplastic lesion of the skin originating from cystic proliferation of apocrine secretory glands is defined as an apocrine hidrocystoma or cystadenoma. The tumor usually occurs in adults as a solitary cystic lesion; it is commonly found on the periorbital region, neck, upper torso and limbs. The case presented is unusual because of the age of the patient--cystadenoma is very rare in childhood--and the localization of the lesion. From a literature review and to the best of our knowledge, a scrotal cyst has never been previously described. Surgical excision is the treatment of choice since the lesion does not tend to recur.     

Laparoscopic cholecystectomy. An analysis of the reasons for a conversion to conventional surgery in an elective surgery department]

BACKGROUND: To assess which factors determined conversion to laparotomy in patients undergoing laparoscopic elective cholecystectomy. Setting: department of General Surgery. University of Genoa. Italy. METHODS: Two hundred sixty-four consecutive laparoscopic cholecystectomies were performed in our Department. Interventions: laparoscopic cholecystectomy was performed according to Dubois's technique. Duration of the procedure was not considered a reason for conversion. RESULTS: 121 patients showed "difficult intraoperative situations" with further conversion risk factor. Conversion to laparotomy was necessary in 11 patients (4.16%). Five patients underwent conversion in the first 50 cases (10%), while six in the last 214 (2.8%). We had to convert to open cholecystectomy only in eleven patients, despite the high rate of technical difficulties and anatomic anomalies even in cases which, in the past, represented a contraindication to this kind of technique. The use of new instruments and new surgical techniques has reduced to only factors of increased risk in those situations that in the past were considered as contraindications to laparoscopic cholecystectomy. CONCLUSIONS: Conversion to open cholecystectomy is based on the surgeon's decision and the safety should be the main consideration in performing laparoscopic cholecystectomy. The use of a careful dissection could avoid the conversion in many patients.