Development of innumerable neuroendocrine tumorlets in pulmonary lobe scarred by intralobar sequestration. Immunohistochemical and ultrastructural study of an unusual case

We describe the microscopic, histochemical, immunohistochemical, and ultrastructural features of hundreds of neuroendocrine tumorlets occurring within a pulmonary lobe severely scarred by intralobar sequestration in a nonsmoking 49-year-old white man. To our knowledge, there have thus far been no descriptions or detailed analyses of neuroendocrine tumorlets arising within a pulmonary sequestration. The neuroendocrine tumorlets appeared in the form of minute aggregates--mostly microscopic, up to a maximum of 0.3 cm in greatest diameter--of small round and short spindle-shaped cells. They were organized in compact nests of fascicles and were supplied with round or elongated euchromatic nuclei and scant weakly eosinophilic cytoplasm. The neuroendocrine tumorlets were clustered around diseased bronchioles or embedded in a fibrotic pulmonary parenchyma with a distinctive infiltrative appearance. Sometimes they lay near an artery channel without an identifiable bronchiole or herniated into distal airways. Most of the neuroendocrine tumorlets were strongly argyrophilic on Grimelius staining. Immunohistochemically, there was reactivity for markers of epithelial and neuroendocrine differentiation together with evidence of orthotopic production of calcitonin, serotonin, and gastrin-releasing peptide and ectopic production of vasoactive intestinal peptide. Ultrastructurally, most of the neuroendocrine cells showed 100- to 120-nm dense-core membrane-bound secretory granules; mucus secretory cells were also present. We prefer the term neuroendocrine tumorlets over the generally used term carcinoid tumorlets, because the nature of these lesions is undefined and the relationship with neuroendocrine pulmonary neoplasms is not yet established

Immunohistochemical identification of the uncoupling protein in human hibernoma

The expression of the uncoupling protein (UCP), a protein unique to brown adipocyte mitochondria, was studied in sections of a human hibernoma by means of immunohistochemistry. Multilocular, but not unilocular, adipocytes expressed the UCP in the tissue. Further, the immunostaining was not uniform in multilocular cells, because small adipocytes with finely multivacuolar or scanty lipid deposit showed more intense staining. This pattern is similar to that found in brown adipose tissue. Ultrastructural investigation confirmed that a majority of proliferating cells had the morphological characteristics of brown adipocyte. Results indicate that adipocytes in hibernoma may be very close to brown adipocytes both morphologically and immunocytochemically

Deep lamellar keratoplasty by intracorneal dissection: a prospective clinical and confocal microscopic study.

OBJECTIVE: To evaluate the clinical findings, visual outcomes, and confocal microscopic corneal features of a surgical technique for manual deep lamellar keratoplasty (DLKP) with intentional sparing of the most posterior stroma.DESIGN: Noncomparative, prospective, 12-month interventional study.PARTICIPANTS: Forty-six eyes of 45 patients who had corneal pathologic features without endothelial abnormalities and requiring corneal graft were treated by DLKP by manual stromal delamination. They were examined clinically after surgery and using in vivo confocal microscopy at 2 weeks and 1, 3, 6, and 12 months.INTERVENTION: The surgical technique consisted of an intracorneal deep manual stromal dissection through a 4-mm limbal incision at 50 mum from Descemet's membrane (DM). After trephination, an endothelial free graft was sutured.MAIN OUTCOME MEASURES: Topographic parameters, interface depth and reflectivity, and anterior and postinterface keratocyte density; visual acuity was correlated with these parameters.RESULTS: Two eyes had rupture of the DM. Two eyes that had delayed epithelial healing because of graft override with stromal inflammation underwent a second surgery (penetrating keratoplasty). Mean uncorrected logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity and logMAR best-corrected visual acuity (BCVA) improved from preoperative values (1.342+/-0.239 and 0.923+/-0.226, respectively) to 0.421+/-0.122 and 0.104+/-0.068, respectively, at 12 months. Mean topographic astigmatism was 3.09+/-1.30 diopters (D) at 3 months after suture adjustment, and 2.87+/-0.92 D at 12 months after suture removal. Average interface depth was 64.2+/-6.7 microm at 15 days and showed no significant changes up to 12 months. Mean interface reflectivity was highest at 15 days (95.5+/-15.7 light reflectance units [LRU]) and showed a progressive decrease over time of 55.3+/-8.7 LRU at 12 months. A significant negative correlation was observed between BCVA and topographic astigmatism up to 1 month and between BCVA and interface reflectivity starting from 6 months after surgery.CONCLUSIONS: Deep lamellar keratoplasty by intracorneal dissection provides visual and clinical results comparable with that of other DLKP techniques. Visual recovery is slow and progressive, taking up to 1 year. Confocal microscopy enables precise evaluation of corneal features, interface morphologic features, and reflectivity, demonstrating a negative correlation between interface reflectivity and BCVA showing that the progressive recovery over months of the interface transparency is correlated with the increase in visual acuity after 6 months

Secondary amyloidosis and cystic fibrosis. A morphological and histochemical study of five cases

The pathological findings of five cases of amyloidosis associated with Cystic Fibrosis are reported. Rectal biopsy led to the diagnosis of amyloidosis in four patients. In three cases the diagnosis was confirmed at autopsy , with involvement of spleen, liver, kidneys, adrenal glands, thyroid and other organs. It seems that Secondary Amyloidosis provokes a significant, although rare, complication of Cystic Fibrosis as greater numbers of these patients survive into adulthood

The CORTES Study: corneal transplant indications and graft survival in an italian cohort of patients

Purpose: To describe the corneal transplantation activity in Italy, to assess the long-term graft survival, and to begin to outline the potential risk factors for graft outcome. Methods: We followed a consecutive series of penetrating (PK) and lamellar (LK) keratoplasties performed with corneas procured and distributed by the Veneto Eye Bank Foundation, which provides about one third of the corneas grafted in Italy each year. Results: Data on 4415 PKs and 489 LKs performed in 174 clinical centers are reported. Keratoconus was the major transplant indication (47% and 66%, respectively, for the 2 groups), followed by regraft (14%) and bullous keratopathy (14%) in the PK group and keratitis (8%) and refractive reasons (4%) for the LKs. In the 2 groups, graft survival, after 1 year, was estimated to be 95% and 93%, respectively, showing a decrease of the survival rate during the second and third years of the study. Graft survival in patients with keratoconus indication was 98% in the PK group and 95% in the LK group for the whole period of observation, whereas the patients with other indications reported a survival rate ranging from 92% after 1 year to 52% after 3 years (PK) and from 89% to 85% (LK). Conclusions: CORTES is the most extensive survey on corneal transplantation in Italy that involves a large cohort of patients and a significant number of surgeons with corneal tissues processed and distributed by a single eye bank. In the first 3 years, a picture of the epidemiology of the corneal transplant has been defined. The graft survival rates were comparable to those reported by other studies for the same follow-up period. However, the follow-up of a sample of this cohort for a farther 3 years will allow us to precisely estimate the long-term graft survival and to better evaluate the risk factors related to graft failure