Kaposi''s sarcoma: aetiopathogenesis, histology and clinical features

Kaposi's sarcoma (KS) represents today one of the most common skin cancers in transplanted Mediterranean subjects and, since the epidemic of human immunodeficiency virus/acquired immune deficiency syndrome, in young unmarried single men. The disease has been associated with the recent identified human herpesvirus (HHV)-8 or KS herpesvirus and its incidence in the general population shows a north to south gradient that parallels the HHV-8 increasing prevalence from Nordic countries to sub-Saharan regions. The identification of the aetiopathogenetic mechanisms (viral agents and immunodeficiency) involved in the pathogenesis of KS, are relevant for identifying susceptible subjects (HHV-8 seropositive subjects), monitoring the immune levels in iatrogenic immune suppressed patients, and developing new therapeutic approaches based on antiviral and immune modulators. Learning objective: This article should enable the reader: (i) to learn about the clinical and molecular aspects of KS in order to have a multidisciplinary approach to a tumour that shows unique features; (ii) to consider the role of viral agents and immunity; and (iii) to recognize properties of an opportunistic neoplasm. The identification of the HHV-8 role in KS pathogenesis should establish a relevant tool in the clinical management of KS patients.     

Intravenous pulsatile administration of gonadotrophins in an in-vitro fertilization programme.

A group of 70 patients with 181 previously failed cycles of in-vitro fertilization (IVF) (including intra-muscular administration of gonadotrophins) achieved ongoing pregnancy rates of 29.3% per started cycle when gonadotrophins were administered intravenously in a pulsatile fashion, during suppression with a gonadotrophin releasing hormone analogue. The ongoing pregnancy rates of 175 patients treated with gonadotrophins intramuscularly and who also had at least one previous failed IVF cycle and who were treated during the same period in the same IVF programme was 15.6% per started cycle. This rate was significantly lower than that in the group treated intravenously.     

Urinary tract malakoplakia with extension into the retroperitoneum with secondary gastrointestinal involvement

A rare case of malakoplakia of the urinary tract with diffuse retroperitoneal extension is presented. Sonographically guided cytologic puncture revealed the pathologic diagnosis. The splenic flexure of the colon and the stomach appeared to be secondarily involved in the inflammatory retroperitoneal tumor. The relative role of the various imaging modalities in defining retroperitoneal extension of the disease is illustrated, with a special reference to computed tomography and endosonography. After antimicrobial treatment and left nephrectomy, partial regression of the retroperitoneal mass was documented.     

Hereditary spastic dystonia with Leber's hereditary optic neuropathy: neuropathological findings.

Neuropathological findings in a 59-year-old male case of hereditary spastic dystonia with Leber's hereditary optic atrophy included: marked depletion of myelinated nerve fibres in the posterior funiculi, corticopontine tracts and striatum; practically complete neuronal depletion in the putamen and lateral part of the caudate, and mild cell loss in the substantia nigra. The putamina had changed into a spongy fibrillary scar, the pallidal fibres and laminae were practically all degenerated. Moreover, there was generalised mild fibre degeneration of the white matter. The optic nerve showed marked, predominantly central, loss of nerve fibres with demyelination.     

Adenomyosis and leiomyoma: differential diagnosis with MR imaging

To assess the capability of magnetic resonance (MR) imaging to enable differentiation of adenomyosis from leiomyoma, a prospective study was performed in 21 premenopausal patients with a strong clinical suggestion of adenomyosis. Histologic findings from hysterectomy (19 patients) and biopsy specimens (two patients) showed that eight patients had adenomyosis (three focal, five diffuse) and 12 had leiomyomas (five of the 12 also had microscopic foci of adenomyosis); one patient had a normal uterus. All eight cases of adenomyosis were correctly diagnosed from MR images. On T2-weighted MR images, diffuse adenomyosis appeared as a thickening of the junctional zone, whereas focal adenomyosis appeared as a low-signal-intensity mass poorly marginated from the adjacent myometrium. Ten of the 12 leiomyomas were correctly diagnosed from MR images. In the other two cases of leiomyoma, differentiation between focal adenomyosis and leiomyoma was not possible. Microscopic foci of adenomyosis were not demonstrated with MR imaging.