Merkel cell carcinoma with an unusual immunohistochemical profile

The clinical and morphological picture of Merkel cell carcinoma (MCC) may be rather challenging; therefore, the immunohistochemical profile plays a relevant role in confirming the microscopic diagnosis. A panel of antibodies including cytokeratins 20, 7 and epithelial membrane antigen, and neuron-specific enolase is used in confirming the morphological diagnosis of MCC. The majority of MCCs express CK20 and are CK7-negative. Herein, we present a case of primary cutaneous neuroendocrine carcinoma with an atypical immunohistochemical pattern. A 83-years old woman presented with a painless plaque, red to violaceous in colour, located in the leg. The skin tumor was excided, formalin-fixed and paraffinembedded. Tissue sections were immunostained with a panel of antibodies routinely utilized in complex primary skin tumors for evidencing epithelial and neuroendocrine differentiation of tumor cells. The neuroendocrine differentiation of tumor cells was evidenced by their immunoreactivity for synaptophysin, chromograninA and neuron-specific enolase. Tumor cells also showed diffuse cytoplasmic staining for CK7. No immunoreactivity was detected for CK20 and thyroid transcription factor-1. Our data, together with previous rare reports of CK20−/CK7+ MCCs, lay stress on the importance of routinely utilizing a panel of antibodies in the differential diagnosis of complex primary carcinomas of the skin and may have important implications in expanding the differential diagnosis of skin tumors. In particular, caution should be taken in excluding the diagnosis of MCC only on the basis of the absence of reactivity of tumor cells for CK20, favouring the wrong diagnosis of less aggressive skin tumors

An Exploratory Study of Users’ Preference for Different Planting Combinations along Rural Greenways

The literature highlights the importance of vegetation to enhance the ecological and visual qualities of streets and paths; however, when studies specifically focus on rural greenways they do not consider users' assessments of the planting design. This exploratory study aims to contribute to this issue. It is hypothesized that planting combinations characterized by greater variety and aesthetic flow may be more preferred and restorative. To this end, four virtual scenarios simulating bikers moving along a greenway at 25 km/h were created to find out the following: first, what kind of planting combination is the most preferred, and second, which planting combination is perceived as the most restorative by bicycle riders. To assess the experience, subjects were administered a questionnaire made up of: (i) the Perceived Restorativeness Scale-11 with additional items to assess compatibility, familiarity, and preference; (ii) a list of physical and aesthetic attributes; and (iii) information on bicycle use. The results show that participants' preferences were a ffected by the perception of the scenario's restorative value, which was not given exclusively by the degree of naturalness, but by the opportunity the greenway o ffered to engage in social/physical activities. This study shows that preference and restorativeness are not a "simple" matter of quantity of vegetation, but of quality instead, i.e., planting variety. Designers have to consider that the restorative value of greenways is related to the opportunities they offer to engage in physical/social activities

Anterior mitral valve aneurysm is an uncommon complication of aortic valve infective endocarditis. A case report

Objective: Rare disease Background: Mitral valve aneurysms (MVAs) are uncommon conditions frequently associated with aortic valve endocarditis. They may be complicated by perforation and severe mitral regurgitation (MR). Optimal treatment of MVA, and in particular the best timing for surgery, are uncertain. Case Report: A 62-year-old man with a recent history of dental surgery presented to the Emergency Department complaining relapsing fever. A first echocardiogram demonstrated infective endocarditis of the aortic valve. The patient was primarily managed with specific antibiotic therapy. Despite this, a few days later he suffered from splen-ic embolization and an MVA with MR was detected. Surgical replacement of the mitral and aortic valves was therefore performed. Conclusions: MVAs are infrequent but potentially severe complications of AV endocarditis. In the absence of definite treatment indication, the correct time for surgery should depend on concomitant clinical and infective features

Sustainable Co-Design with Older People: The case of a Public Restorative Garden in Milan (Italy)

The demographic aging and the evolution of lifestyles require new strategies to promote the well-being and active aging of elderly. Active aging depends on many factors: some of these are related to objective data such as physical environment, others are personal elements; it is important to improve environmental physical factors to encourage personal attitudes to the green spaces in use. To design a small sustainable restorative green space in Milan, Italy, restorative garden design criteria are summarized in the first section of the paper and both social and environmental sustainability are considered. The methodology section describes the co-design process and how it was applied to include dierent older user groups in the design of the area. In the results section authors apply a taxonomy based on the four properties of restorative settings according to the Attention Restoration Theory by Kaplan (compatibility, being away, extent, fascination): this provides a unified system to classify users\u2019 expectations and to describe the final project. The proposed co-design process combines social and environmental sustainability, as it provides designers an insight about the user\u2019s experience in nature. Such information can be fruitfully integrated with professional competences about comfort aspects and environmental protection in order to improve the whole design project

Factors Influencing Greenways Use in Italy: Definition of a Method for Estimation

The issue of non-motorized mobility in the last decades has seen increasing attention at the international level. Also in Italy we assisted at the creation of hundreds of miles of trails dedicated to cycling and walking, many of which meet the greenway definition of the European Greenways Association: “Communication routes reserved exclusively for non-motorized journeys, developed in an integrated manner which enhances both the environment and quality of life of the surrounding area. These routes should meet satisfactory standards of width, gradient, and surface condition to ensure that they are both user-friendly and low-risk for users of all abilities. In this respect, canal towpaths and disused railway lines are a highly suitable resource for the development of greenways” (EGWA, 2002). More generally, greenways are green infrastructures that can be planned at different scales and for multiple purposes (ecological, recreational, cultural, non-motorized mobility) (Fabos, 1995; Ahern, 1995). Various methodologies and several studies on greenways planning have been conducted also in Italy (Rovelli et al., 2004; Toccolini et al., 2006; Senes et al., 2010). The growing number of infrastructures built and the related costs, combined with the recent economic crisis, led to an increasing need for public bodies to evaluate each project in terms of its ability to meet the needs of the communities, particularly in terms of attractiveness for users and benefits (not only economic) for local communities. To do this, planners and decision makers need to be provided with: 1) updated and consistent data on greenways and trails users; 2) models, based on the previous data, that can help to predict the number of users on a planned infrastructure. In such a context, the aim of this research was to assess the relationships between the number of users detected along some Italian greenways and the characteristics of the territory crossed (in terms of population and environment), in order to define a model capable of estimating the potential users of a greenway before it is realized. It represents one of the first attempts in Italy

Immunoreactivity for alpha-smooth muscle actin characterizes a potentially aggressive subgroup of little basal cell carcinomas

Basal cell carcinoma (BCC) is a very common malignant skin tumor that rarely metastatizes, but is often locally aggressive. Several factors, like large size (more than 3 cm), exposure to ultraviolet rays, histological variants, level of infiltration and perineural or perivascular invasion, are associated with a more aggressive clinical course. These morphological features seem to be more determinant in mideface localized BCC, which frequently show a significantly higher recurrence rate. An immunohistochemical profile, characterized by reactivity of tumor cells for p53, Ki67 and alpha-SMA has been associated with a more aggressive behaviour in large BCCs. The aim of this study was to verify if also little (<3 cm) basal cell carcinomas can express immunohistochemical markers typical for an aggressive behaviour

An Individual&apos;s Connection to Nature Can Affect Perceived Restorativeness of Natural Environments : Some Observations about Biophilia

This study investigates the relationship between the level to which a person feels connected to Nature and that person's ability to perceive the restorative value of a natural environment. We assume that perceived restorativeness may depend on an individual's connection to Nature and this relationship may also vary with the biophilic quality of the environment, i.e., the functional and aesthetic value of the natural environment which presumably gave an evolutionary advantage to our species. To this end, the level of connection to Nature and the perceived restorativeness of the environment were assessed in individuals visiting three parks characterized by their high level of "naturalness" and high or low biophilic quality. The results show that the perceived level of restorativeness is associated with the sense of connection to Nature, as well as the biophilic quality of the environment: individuals with different degrees of connection to Nature seek settings with different degrees of restorativeness and biophilic quality. This means that perceived restorativeness can also depend on an individual's "inclination" towards Nature

Cytokeratin 20-positive hepatocellular carcinoma

The differential diagnosis between hepatocellular carcinoma (HCC), cholangiocarcinoma (CC) and metastatic colorectal adenocarcinoma (MCA) may be difficult when only based on morphology. For this purpose immunohistochemical analyses are often required, utilizing antibodies directed against CK8-18, Hep-Par1, glypican 3, CK7, CK19, CK20. Here we report a case of a 65-year-old man who presented with a clinical picture of decompensated cirrhosis. Ultrasonography revealed two nodular areas in the right liver lobe. Liver needle biopsy revealed micro-macronodular cirrhosis associated with HCC with trabecular and pseudoglandular patterns. Immunohistochemically, tumour cells were diffusely positive for CK8-18 and also diffusely immunostained by glypican 3 and Hep-Par1. Interestingly, a diffuse and strong staining for CK20 was detected in the vast majority of tumor cells, particularly in the areas showing a pseudo-glandular pattern. No immunostaining for CK7 and CK19 was found in the tumor cells. The tumor behaved aggressively, with a rapid diffusion to the whole liver. The patient died from the disease few months after presentation. These findings underline that the interpretation of the expression of CK20 alone in the differential diagnosis among HCC, CC and MCA should be done with caution because a diffuse immunoreactivity for CK20 alone may not rule out the diagnosis of HCC

Plasma cells in the carotid plaque: occurrence and significance

OBJECTIVE: Atherosclerosis is one of the leading causes of disability and mortality worldwide. Inflammation, including monocytes, T and B cells, plays a key role in its pathogenesis. Our purpose was to evaluate plasma cells’ presence in a large series of carotid artery plaques and the clinical association. PATIENTS AND METHODS: Forty-eight consecutive patients treated with carotid endarterectomy were retrospectively analyzed to assess plasma cells’ presence inside the plaque. A semiquantitative grading score was applied, ranging from absence, scattered, clusters of 5-10, and sheets of &gt;10 plasma cells. Plasma cell’s location, as intraplaque, subendothelial or peri-adventitial, was also defined. RESULTS: In 75% of plaques analyzed, plasma cells were detected: scattered in 63.9%, in clusters in 22.2%, and in sheets in 13.9% of cases. In all cases, plasma cells were observed only inside the plaque. In 13.9% and in 11.1% of cases, plasma cells showed, respectively, a concomitant subendothelial or peri-adventitial distribution. In 5.6% of plaques, there was a simultaneous distribution in subendothelial, peri-adventitial layer, and intraplaque. Association between the presence of symptoms and plasma cells infiltrate was found. CONCLUSIONS: Our results suggest that plasma cells could be a key parameter linked to plaque instability. Some types of configurations are significantly associated with the occurrence of cerebrovascular symptoms