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Mangano VD, Campani D, Cacciato Insilla A, Coco B, Gomez Morales MA, Brunetto M, La Rosa G, Ludovisi A, De Simone P, Bruschi F. An Unexpected Case of Opisthorchis felineus Infection Revealed during Liver Transplantation. Pathogens 2023; 12:1003. [PMID: 37623963 PMCID: PMC10459204 DOI: 10.3390/pathogens12081003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
A man with hepatitis B infection was admitted to Pisa University Hospital for hepatological evaluation, which revealed multiple cystic lesions and suggested a cirrhotic evolution. Treatment with Entecavir 0.5 mg/day was started, resulting in rapid viral load suppression and alanine aminotransferase normalization. After 10 years, imaging documented a single nodule of hepatocellular carcinoma (HCC), and a robot-assisted nodule resection was performed. One year later, HCC recurrence prompted orthotopic liver transplantation, during which the patient died because of the sudden rupture of the donor's organ and rapid multiorgan deterioration before retransplantation. During post-mortem liver examination, adult worms were evidenced within large biliary ducts, suggesting infection with Opisthorchis or Clonorchis spp. flukes. Sequencing of the ITS2 locus, following PCR amplification of DNA extracted from liver tissue, revealed 100% identity with the reference sequence of O. felineus. Infection of the patient with O. felineus was confirmed by the presence of specific IgG detected by ELISA in the patient's sera. Two major alkaline phosphatase serum levels peaks observed during the first two years of antiviral therapy support the hypothesis that O. felineus infection worsened liver function. This case report highlights the importance of a very careful screening of parasitic infections in solid organ transplantation candidates.
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Affiliation(s)
- Valentina D Mangano
- Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, 56126 Pisa, Italy;
| | - Daniela Campani
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell’Area Critica, Università di Pisa, 56126 Pisa, Italy
- Unità Operativa di Anatomia Patologica 1, Azienda Ospedaliera Universitaria Pisana, 56126 Pisa, Italy
| | - Andrea Cacciato Insilla
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell’Area Critica, Università di Pisa, 56126 Pisa, Italy
- Unità Operativa di Anatomia Patologica 1, Azienda Ospedaliera Universitaria Pisana, 56126 Pisa, Italy
| | - Barbara Coco
- Unità Operativa Epatologia, Azienda Ospedaliera Universitaria Pisana, 56126 Pisa, Italy
| | | | - Maurizia Brunetto
- Unità Operativa Epatologia, Azienda Ospedaliera Universitaria Pisana, 56126 Pisa, Italy
| | - Giuseppe La Rosa
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, 00161 Roma, Italy
| | - Alessandra Ludovisi
- Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, 00161 Roma, Italy
| | - Paolo De Simone
- Unità Operativa Chirurgia Epatica e Trapianto di Fegato, Azienda Ospedaliera Universitaria Pisana, 56126 Pisa, Italy
| | - Fabrizio Bruschi
- Dipartimento di Ricerca Traslazionale e Nuove Tecnologie in Medicina e Chirurgia, Università di Pisa, 56126 Pisa, Italy;
- Programma Monitoraggio delle Parassitosi, Azienda Ospedaliera Universitaria Pisana, 56126 Pisa, Italy
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Cervelli R, Cencini M, Cacciato Insilla A, Aringhieri G, Boggi U, Campani D, Tosetti M, Crocetti L. Ex-vivo human pancreatic specimen evaluation by 7 Tesla MRI: a prospective radiological-pathological correlation study. Radiol Med 2022; 127:950-959. [DOI: 10.1007/s11547-022-01533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
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Guzzardi MA, La Rosa F, Campani D, Collado MC, Monleon D, Cacciato Insilla A, Tripodi M, Zega A, Dattilo A, Brunetto MR, Maffei M, Bonino F, Iozzo P. Liver and White/Brown Fat Dystrophy Associates with Gut Microbiota and Metabolomic Alterations in 3xTg Alzheimer’s Disease Mouse Model. Metabolites 2022; 12:metabo12040278. [PMID: 35448465 PMCID: PMC9028874 DOI: 10.3390/metabo12040278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/16/2022] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
Metabolic impairments and liver and adipose depots alterations were reported in subjects with Alzheimer’s disease (AD), highlighting the role of the liver–adipose–tissue–brain axis in AD pathophysiology. The gut microbiota might play a modulating role. We investigated the alterations to the liver and white/brown adipose tissues (W/BAT) and their relationships with serum and gut metabolites and gut bacteria in a 3xTg mouse model during AD onset (adulthood) and progression (aging) and the impact of high-fat diet (HFD) and intranasal insulin (INI). Glucose metabolism (18FDG-PET), tissue radiodensity (CT), liver and W/BAT histology, BAT-thermogenic markers were analyzed. 16S-RNA sequencing and mass-spectrometry were performed in adult (8 months) and aged (14 months) 3xTg-AD mice with a high-fat or control diet. Generalized and HFD resistant deficiency of lipid accumulation in both liver and W/BAT, hypermetabolism in WAT (adulthood) and BAT (aging), abnormal cytokine–hormone profiles, and liver inflammation were observed in 3xTg mice; INI could antagonize all these alterations. Specific gut microbiota–metabolome profiles correlated with a significant disruption of the gut–microbiota–liver–adipose axis in AD mice. In conclusion, fat dystrophy in liver and adipose depots contributes to AD progression, and associates with altered profiles of the gut microbiota, which candidates as an appealing early target for preventive intervention.
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Affiliation(s)
- Maria Angela Guzzardi
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.L.R.); (M.T.); (A.Z.); (M.M.); (P.I.)
- Correspondence: ; Tel.: +39-050-3152722
| | - Federica La Rosa
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.L.R.); (M.T.); (A.Z.); (M.M.); (P.I.)
| | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Division of Pathology, Pisa University Hospital, 56124 Pisa, Italy; (D.C.); (A.C.I.)
| | - Maria Carmen Collado
- Institute of Agrochemistry and Food Technology-National Research Council (IATA-CSIC), 46980 Valencia, Spain;
| | - Daniel Monleon
- Faculty of Medicine, Health Research Institute INCLIVA/CIBERFES for Frailty and Healthy Aging, University of Valencia, 46003 Valencia, Spain;
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Division of Pathology, Pisa University Hospital, 56124 Pisa, Italy; (D.C.); (A.C.I.)
| | - Maria Tripodi
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.L.R.); (M.T.); (A.Z.); (M.M.); (P.I.)
| | - Alessandro Zega
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.L.R.); (M.T.); (A.Z.); (M.M.); (P.I.)
| | | | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy;
- Hepatology Unit, Department of Medical Specialties, Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Pisa University Hospital, 56124 Pisa, Italy
- Institute of Biostructure and Bioimaging (IBB), National Research Council (CNR), 80145 Napoli, Italy;
| | - Margherita Maffei
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.L.R.); (M.T.); (A.Z.); (M.M.); (P.I.)
| | - Ferruccio Bonino
- Institute of Biostructure and Bioimaging (IBB), National Research Council (CNR), 80145 Napoli, Italy;
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (F.L.R.); (M.T.); (A.Z.); (M.M.); (P.I.)
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Guzzardi MA, La Rosa F, Campani D, Cacciato Insilla A, Nannipieri M, Brunetto MR, Bonino F, Iozzo P. Evidence of a Gastro-Duodenal Effect on Adipose Tissue and Brain Metabolism, Potentially Mediated by Gut-Liver Inflammation: A Study with Positron Emission Tomography and Oral 18FDG in Mice. Int J Mol Sci 2022; 23:ijms23052659. [PMID: 35269799 PMCID: PMC8910830 DOI: 10.3390/ijms23052659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023] Open
Abstract
Interventions affecting gastrointestinal (GI) physiology suggest that the GI tract plays an important role in modulating the uptake of ingested glucose by body tissues. We aimed at validating the use of positron emission tomography (PET) with oral 18FDG administration in mice, and to examine GI effects on glucose metabolism in adipose tissues, brain, heart, muscle, and liver, and interfering actions of oral lipid co-administration. We performed sequential whole-body PET studies in 3 groups of 10 mice, receiving i.p. glucose and 18FDG or oral glucose and 18FDG ± lipids, to measure tissue glucose uptake (GU) and GI transit, and compute the absorption lumped constant (LCa) as ratio of oral 18FDG-to-glucose incremental blood levels. GI and liver histology and circulating hormones were tested to generate explanatory hypothesis. Median LCa was 1.18, constant over time and not significantly affected by lipid co-ingestion. Compared to the i.p. route, the oral route (GI effect) resulted in lower GU rates in adipose tissues and brain, and a greater steatohepatitis score (+17%, p = 0.03). Lipid co-administration accelerated GI transit, in relation to the suppression in GIP, GLP1, glucagon, PP, and PYY (GI motility regulators), abolishing GI effects on subcutaneous fat GU. Duodenal crypt size, gastric wall 18FDG uptake, and macro-vesicular steatosis were inversely related to adipose tissue GU, and positively associated with liver GU. We conclude that 18FDG-PET is a suitable tool to examine the role of the GI tract on glucose transit, absorption, and bio-distribution. The GI effect consists in the suppression of glucose metabolism selectively in organs responsible for energy intake and storage, and is blunted by lipid ingestion. Modulation of gut and liver inflammation, as reflected by high GU, may be involved in the acute signalling of the energy status.
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Affiliation(s)
- Maria Angela Guzzardi
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (M.A.G.); (F.L.R.)
| | - Federica La Rosa
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (M.A.G.); (F.L.R.)
| | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Division of Pathology, Pisa University Hospital, 56124 Pisa, Italy; (D.C.); (A.C.I.)
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Division of Pathology, Pisa University Hospital, 56124 Pisa, Italy; (D.C.); (A.C.I.)
| | - Monica Nannipieri
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (M.R.B.)
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (M.R.B.)
- Hepatology Unit, Department of Medical Specialties, Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Pisa University Hospital, 56124 Pisa, Italy
- Institute of Biostructure and Bioimaging (IBB), National Research Council (CNR), 80145 Napoli, Italy;
| | - Ferruccio Bonino
- Institute of Biostructure and Bioimaging (IBB), National Research Council (CNR), 80145 Napoli, Italy;
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (M.A.G.); (F.L.R.)
- Correspondence:
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Boggi U, Baronti W, Amorese G, Pilotti S, Occhipinti M, Perrone V, Marselli L, Barsotti M, Campani D, Gianetti E, Insilla AC, Bosi E, Kaufmann E, Terrenzio C, Vistoli F, Marchetti P. Treating Type 1 Diabetes by Pancreas Transplant Alone: A Cohort Study on Actual Long-term (10 Years) Efficacy and Safety. Transplantation 2022; 106:147-157. [PMID: 33909390 DOI: 10.1097/tp.0000000000003627] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Physiologically regulated insulin secretion and euglycemia are achievable in type 1 diabetes (T1D) by islet or pancreas transplantation. However, pancreas transplant alone (PTA) remains a debated approach, with uncertainties on its relative benefits and risks. We determined the actual long-term (10 y) efficacy and safety of PTA in carefully characterized T1D subjects. METHODS This is a single-center, cohort study in 66 consecutive T1D subjects who received a PTA between April 2001 and December 2007, and were then all followed until 10 y since transplant. Main features evaluated were patient survival, pancreas graft function, C-peptide levels, glycemic parameters, and the function of the native kidneys. RESULTS Ten-year actual patient survival was 92.4%. Optimal (insulin independence) or good (minimal insulin requirement) graft function was observed in 57.4% and 3.2% of patients, respectively. Six (9.0%) patients developed stage 5 or 4 chronic kidney disease. In the remaining individuals bearing a successful PTA, estimated glomerular filtration rate (eGFR) decline per year was -2.29 ± 2.69 mL/min/1.73 m2. Reduction of eGFR at 1 y post-PTA was higher in those with pre-PTA hyperfiltration and higher HbA1c concentrations; eGFR changes afterward significantly correlated with diabetes duration. In recipients with normoglycemia at 10 y, 74% of normoalbuminuric or microalbuminuric subjects pre-PTA remained stable, and 26% progressed toward a worse stage; conversely, in 62.5% of the macroalbuminuric individuals albuminuria severity regressed. CONCLUSIONS These long-term effects of PTA on patient survival, graft function, and the native kidneys support PTA as a suitable approach to treat diabetes in selected T1D patients.
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Affiliation(s)
- Ugo Boggi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Walter Baronti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriella Amorese
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Silvia Pilotti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Margherita Occhipinti
- Diabetes Unit, Versilia Hospital, Azienda ASL Area Vasta Nord-Ovest, Lido di Camaiore, Lucca, Italy
| | - Vittorio Perrone
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Lorella Marselli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy
| | | | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Elena Gianetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Emanuele Bosi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Emanuele Kaufmann
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Chiara Terrenzio
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Vistoli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
- Division of General and Transplant Surgery, Cisanello University Hospital, Pisa, Italy
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Departmental Section of Endocrinology and Metabolism of Organ and Cellular Transplantation, Cisanello University Hospital, Pisa, Italy
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Guzzardi MA, La Rosa F, Campani D, Cacciato Insilla A, De Sena V, Panetta D, Brunetto MR, Bonino F, Collado MC, Iozzo P. Maturation of the Visceral (Gut-Adipose-Liver) Network in Response to the Weaning Reaction versus Adult Age and Impact of Maternal High-Fat Diet. Nutrients 2021; 13:nu13103438. [PMID: 34684436 PMCID: PMC8541006 DOI: 10.3390/nu13103438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/23/2021] [Accepted: 09/26/2021] [Indexed: 01/01/2023] Open
Abstract
Metabolic-associated fatty liver disease is a major cause of chronic pathologies, of which maternal obesity is a frequent risk factor. Gut wall and microbiota, visceral fat, and liver form a pre-systemic network for substrates and pro-inflammatory factors entering the body, undergoing accelerated maturation in early-life when the weaning reaction, i.e., a transitory inflammatory condition, affects lifelong health. We aimed to characterize organ metabolism in the above network, in relation to weaning reaction and maternal obesity. Weaning or 6-months-old offspring of high-fat-diet and normal-diet fed dams underwent in vivo imaging of pre-/post-systemic glucose uptake and tissue radiodensity in the liver, visceral fat, and intestine, a liver histology, and microbiota and metabolic pathway analyses. Weaning mice showed the dominance of gut Clostridia and Bacteroidia members, overexpressing pathways of tissue replication and inflammation; adulthood increased proneness to steatohepatitis, and Desulfovibrio and RF39 bacteria, and lipopolysaccharide, bile acid, glycosaminoglycan, and sphingolipid metabolic pathways. In vivo imaging could track organ maturation, liver inflammation, and protective responses. A maternal high-fat diet amplified the weaning reaction, elevating liver glucose uptake, triglyceride levels, and steatohepatitis susceptibility along the lifespan. The visceral network establishes a balance between metabolism and inflammation, with clear imaging biomarkers, and crucial modulation in the weaning time window.
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Affiliation(s)
- Maria Angela Guzzardi
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (M.A.G.); (F.L.R.); (V.D.S.); (D.P.)
| | - Federica La Rosa
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (M.A.G.); (F.L.R.); (V.D.S.); (D.P.)
| | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Division of Pathology, Pisa University Hospital, 56124 Pisa, Italy; (D.C.); (A.C.I.)
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, Division of Pathology, Pisa University Hospital, 56124 Pisa, Italy; (D.C.); (A.C.I.)
| | - Vincenzo De Sena
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (M.A.G.); (F.L.R.); (V.D.S.); (D.P.)
| | - Daniele Panetta
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (M.A.G.); (F.L.R.); (V.D.S.); (D.P.)
| | - Maurizia Rossana Brunetto
- Department of Clinical and Experimental Medicine, University of Pisa, 56124 Pisa, Italy;
- Department of Medical Specialties and Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses, Pisa University Hospital, 56124 Pisa, Italy
- Institute of Biostructure and Bioimaging (IBB), National Research Council (CNR), 80145 Napoli, Italy;
| | - Ferruccio Bonino
- Institute of Biostructure and Bioimaging (IBB), National Research Council (CNR), 80145 Napoli, Italy;
| | - Maria Carmen Collado
- Institute of Agrochemistry and Food Technology-National Research Council (IATA-CSIC), 46980 Valencia, Spain;
| | - Patricia Iozzo
- Institute of Clinical Physiology, National Research Council (CNR), 56124 Pisa, Italy; (M.A.G.); (F.L.R.); (V.D.S.); (D.P.)
- Correspondence: ; Tel.: +39-050-315-2789
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Salani F, Ugolini C, Catanese S, Cacciato Insilla A, Fornaro L, Campani D, Vasile E, Fontanini G, Masi G, Vivaldi C. In Reply. Oncologist 2021; 26:e1895-e1896. [PMID: 34176190 DOI: 10.1002/onco.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Francesca Salani
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Clara Ugolini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Silvia Catanese
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Daniela Campani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Enrico Vasile
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gabriella Fontanini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Gianluca Masi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Caterina Vivaldi
- Unit of Medical Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.,Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Haeberle L, Insilla AC, Kapp AC, Steiger K, Schlitter AM, Konukiewitz B, Demir IE, Friess H, Esposito I. Stroma composition and proliferative activity are related to therapy response in neoadjuvant treated pancreatic ductal adenocarcinoma. Histol Histopathol 2021; 36:733-742. [PMID: 33769550 DOI: 10.14670/hh-18-332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tumor regression grading (TRG) based on histopathology is the main tool to assess therapy effects after neoadjuvant therapy (NAT) of pancreatic ductal adenocarcinoma (PDAC). However, reliable markers to distinguish therapy effects from pre-existing tumor features are lacking. The aim of this study was the characterization of PDAC after NAT, focusing on the stroma. MATERIAL AND METHODS Tissue samples from patients resected for PDAC after NAT (n=27) were analyzed. TRG was assessed using the Royal North Shore (RNS) system. Stromal composition was evaluated by Movat's stain. Immunohistochemistry (IH) for Ki-67 and five previously established stroma markers (alpha-Crystallin B, alpha-Smooth muscle actin (alpha-SMA), Neurotrophin-3 (NT-3), SPARC and Tenascin C) was also performed. Results were compared with therapy-naïve PDACs (n=10). RESULTS Most cases showed a moderate response (RNS 2; 74%), while 15% displayed a poor response (RNS 3), and 11% a good response (RNS 1). No complete response was observed. Poor regression was associated with mucin-rich stroma, while good regression was associated with collagen-rich stroma. Cases with poorer therapy response had significantly higher proliferation. Higher peritumoral staining intensity for alpha-SMA and Tenascin C also showed a trend towards an association with poor regression. CONCLUSIONS Similar to the stroma in therapy-naïve PDAC, the stroma of PDAC after NAT is heterogeneous. Distinguishing between desmoplastic stroma and therapy-induced fibrosis by single markers is not possible. Movat's pentachrome stain, IH for Ki-67, and to some extent for Tenascin C and alpha-SMA, can help detect poor histopathological response to NAT.
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Affiliation(s)
- Lena Haeberle
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular and Critical Care Pathology, University of Pisa, Pisa, Italy
| | - Anne-Christine Kapp
- Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Katja Steiger
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | | | - Björn Konukiewitz
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Ihsan Ekin Demir
- Department of General Surgery, Klinikum Rechts der Isar, School of Medicine Technical University Munich, Munich, Germany
| | - Helmut Friess
- Department of General Surgery, Klinikum Rechts der Isar, School of Medicine Technical University Munich, Munich, Germany
| | - Irene Esposito
- Institute of Pathology, Heinrich Heine University and University Hospital of Duesseldorf, Duesseldorf, Germany
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Lombardo C, Cacciato Insilla A, Boraschi P, Donati F, Romanini A, Campani D, Caramella D, Boggi U. Preoperative Diagnostic Challenges and Management in Pancreatic Metastasis From Dermatofibrosarcoma Protuberans: A Case Report and Review of the Literature. Pancreas 2021; 50:e29-e31. [PMID: 33835981 DOI: 10.1097/mpa.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Karamitopoulou E, Esposito I, Zlobec I, Insilla AC, Wartenberg M, Schaeffer DF, Kalloger S, La Rosa S, Sempoux C, Ramos Centeno I, Lohneis P. Reproducibility of tumor budding assessment in pancreatic cancer based on a multicenter interobserver study. Virchows Arch 2020; 478:719-726. [PMID: 33330964 PMCID: PMC7990816 DOI: 10.1007/s00428-020-02987-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/02/2020] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
Tumor budding has been reported to be an independent prognostic factor in pancreatic ductal adenocarcinoma (PDAC). Its use in daily diagnostics would improve the prognostic stratification of patients. We performed a multicenter interobserver study to test various budding assessment methods for their reproducibility. Two serial sections of 50 resected, treatment-naïve PDACs were stained for Hematoxylin and Eosin (H&E) and pancytokeratin. Tumor budding was scored by independent observers at five participating centers in Switzerland, Germany, and Canada. Pathologists assessed tumor budding on a digital platform comparing H&E with pancytokeratin staining in 10 high-power fields (10HPF) and one HPF hotspot (1HPF). Additionally, tumor budding was assessed in one H&E hotspot at × 20 magnification, as suggested by the International Tumor Budding Consensus Conference (ITBCC). Correlation coefficients for bud counts between centers ranged from r = 0.58648 to r = 0.78641 for H&E and from r = 0.69288 to r = 0.81764 for pancytokeratin. The highest interobserver agreement across all centers was observed for pancytokeratin 10HPFs (ICC = 0.6). ICC values were 0.49, 0.48, 0.41, and 0.4 for H&E in 1HPF hotspot, H&E in 10HPFs, pancytokeratin in 1HPF, and H&E in one hotspot at ×20, respectively (ITBCC method). This interobserver study reveals a range between moderately poor to moderate agreement levels between pathologists for the different tumor budding assessment methods in PDAC. Acceptable levels of agreement were reached with the pancytokeratin 10HPF method, which can thus be recommended for the assessment of tumor budding in PDAC resection specimens. To improve the levels of interobserver agreement, the implementation of machine learning applications should be considered.
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Affiliation(s)
- Eva Karamitopoulou
- Pancreatic Cancer Research Group, Institute of Pathology, University of Bern, Bern, Switzerland.
| | - Irene Esposito
- Institute of Pathology Heinrich-Heine University & University Hospital, Duesseldorf, Germany
| | - Inti Zlobec
- Pancreatic Cancer Research Group, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Andrea Cacciato Insilla
- Institute of Pathology Heinrich-Heine University & University Hospital, Duesseldorf, Germany
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Martin Wartenberg
- Pancreatic Cancer Research Group, Institute of Pathology, University of Bern, Bern, Switzerland
| | - David F Schaeffer
- Department of Pathology & Laboratory Medicine, University of British Columbia and Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, Canada
| | - Steve Kalloger
- Department of Pathology & Laboratory Medicine, University of British Columbia and Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, Canada
| | - Stefano La Rosa
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Irene Ramos Centeno
- Pancreatic Cancer Research Group, Institute of Pathology, University of Bern, Bern, Switzerland
| | - Philipp Lohneis
- Faculty of Medicine and University Hospital Cologne, Institute of Pathology, University of Cologne, Cologne, Germany
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11
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Cervelli R, Cencini M, Buonincontri G, Campana F, Cacciato Insilla A, Aringhieri G, De Simone P, Boggi U, Campani D, Tosetti M, Crocetti L. 7-T MRI of explanted liver and ex-vivo pancreatic specimens: prospective study protocol of radiological-pathological correlation feasibility (the EXLIPSE project). Eur Radiol Exp 2020; 4:58. [PMID: 33057851 PMCID: PMC7560686 DOI: 10.1186/s41747-020-00185-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022] Open
Abstract
The study focuses on radiological-pathological correlation between imaging of ex vivo samples obtained by a 7-T scanner and histological examination. The specimens will be derived from native explanted cirrhotic livers, liver grafts excluded from donation because of severe steatosis, and primary pancreatic tumours. Magnetic resonance imaging (MRI) examinations will be performed within 24 h from liver or pancreatic lesion surgical removal. The MRI protocol will include morphological sequences, quantitative T1, T2, and fat-, water-fraction maps with Cartesian k-space acquisition, and multiparametric methods based on a transient-state “MRI fingerprinting”. Finally, the specimen will be fixed by formalin. Qualitative imaging analysis will be performed by two independent blinded radiologists to assess image consistency score. Quantitative analysis will be performed by drawing regions of interest on different tissue zones to measure T1 and T2 relaxation times as well as fat- and water-fraction. The same tissue areas will be analysed by the pathologists. This study will provide the possibility to improve our knowledge about qualitative and quantitative abdominal imaging assessment at 7 T, by correlating imaging characteristics and the corresponding histological composition of ex vivo specimens, in order to identify imaging biomarkers. Trial registration: ClinicalTrials.gov: 13646. Registered 9 July 2019—retrospectively registered
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Affiliation(s)
- Rosa Cervelli
- Division of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2 - Cisanello Hospital, 56100, Pisa, Italy
| | | | | | - Francesco Campana
- Division of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2 - Cisanello Hospital, 56100, Pisa, Italy
| | | | - Giacomo Aringhieri
- Division of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2 - Cisanello Hospital, 56100, Pisa, Italy
| | - Paolo De Simone
- Division of Hepatic Surgery and Liver Transplant, University of Pisa, Pisa, Italy
| | - Ugo Boggi
- Division of General and Transplant and Surgery, University of Pisa, Pisa, Italy
| | | | | | - Laura Crocetti
- Division of Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa, 2 - Cisanello Hospital, 56100, Pisa, Italy.
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12
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Vivaldi C, Fornaro L, Ugolini C, Niccoli C, Musettini G, Pecora I, Cacciato Insilla A, Salani F, Pasquini G, Catanese S, Lencioni M, Masi G, Campani D, Fontantini G, Falcone A, Vasile E. HER2 Overexpression as a Poor Prognostic Determinant in Resected Biliary Tract Cancer. Oncologist 2020; 25:886-893. [PMID: 32353192 PMCID: PMC7543291 DOI: 10.1634/theoncologist.2019-0922] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 04/01/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND HER2 overexpression has been investigated as a potential biomarker and therapeutic target in biliary tract cancer (BTC), but a prognostic role of such alteration has not been demonstrated yet. MATERIALS AND METHODS We retrospectively evaluated HER2 protein expression by immunohistochemistry (IHC) in 100 patients with radically resected BTC. HER2 gene amplification was assessed by fluorescence in situ hybridization (FISH) in 2+ and 3+ cases at IHC. High HER2 protein expression was defined as either IHC 3+ or 2+ associated with FISH positivity. The primary objective of the study was to evaluate the prognostic role of HER2 overexpression in terms of disease-free survival (DFS) and overall survival (OS). Secondary endpoints were the prevalence of HER2 overexpression and the possible correlation with other clinicopathological features. RESULTS HER2 overexpression was identified in 11 patients and was not related to other clinicopathological factors. DFS was significantly shorter in HER2-positive compared with HER2-negative patients (10.6 vs. 20.9 months, log-rank p = .017). HER2 confirmed its prognostic value for DFS at multivariate analysis (hazard ratio 2.512; 95% confidence interval, 1.232-5.125; p = .011) together with nodal stage (p < .001), resection margin (p = .027), and tumor site (p = .030). There was no difference in OS between HER2-positive and -negative patients (p = .068). CONCLUSION HER2 overexpression represents an independent prognostic factor for disease recurrence in patients with BTC treated with potentially curative surgery. IMPLICATIONS FOR PRACTICE HER2 overexpression may play an independent role in promoting an aggressive behavior in resectable biliary tract cancer. This evidence could be helpful in improving prognostic stratification after resection and, primarily, should endorse the rationale to investigate HER2 as a therapeutic target in biliary tract cancer.
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Affiliation(s)
- Caterina Vivaldi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of PisaPisaItaly
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Lorenzo Fornaro
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Clara Ugolini
- Department of Laboratory Medicine, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Cristina Niccoli
- Department of Laboratory Medicine, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Gianna Musettini
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Irene Pecora
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathology, University of PisaPisaItaly
| | - Francesca Salani
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Giulia Pasquini
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Silvia Catanese
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Monica Lencioni
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Gianluca Masi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of PisaPisaItaly
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathology, University of PisaPisaItaly
| | - Gabriella Fontantini
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Pathology, University of PisaPisaItaly
| | - Alfredo Falcone
- Department of Translational Research and New Technologies in Medicine and Surgery, University of PisaPisaItaly
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
| | - Enrico Vasile
- Unit of Medical Oncology 2, Azienda Ospedaliero‐Universitaria PisanaPisaItaly
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13
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Cacciato Insilla A, Vivaldi C, Giordano M, Vasile E, Cappelli C, Kauffmann E, Napoli N, Falcone A, Boggi U, Campani D. Tumor Regression Grading Assessment in Locally Advanced Pancreatic Cancer After Neoadjuvant FOLFIRINOX: Interobserver Agreement and Prognostic Implications. Front Oncol 2020; 10:64. [PMID: 32117724 PMCID: PMC7025535 DOI: 10.3389/fonc.2020.00064] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022] Open
Abstract
Neoadjuvant therapy represents an increasingly used strategy in pancreatic cancer, and this means that more pancreatic resections need to be evaluated for therapy effect. Several grading systems have been proposed for the histological assessment of tumor regression in pre-treated patients with pancreatic cancer, but issues like practical application, level of agreement and prognostic significance are still debated. To date, a standardized and widely accepted score has not been established yet. In this study, two pathologists with expertise in pancreatic cancer used 4 of the most frequently reported systems (College of American Pathologists, Evans, MD Anderson, and Hartman) to evaluate tumor regression in 29 locally advanced pancreatic cancers previously treated with modified FOLFIRINOX regimen, to establish the level of agreement between pathologists and to determine their potential prognostic value. Cases were additionally evaluated with a fifth grading system inspired to the Dworak score, normally used for colo-rectal cancer, to identify an alternative, relevant option. Results obtained for current grading systems showed different levels of agreement, and they often proved to be very subjective and inaccurate. In addition, no significant correlation was observed with survival. Interestingly, Dworak score showed a higher degree of concordance and a significant correlation with overall survival in individual assessments. These data reflect the need to re-evaluate grading systems for pancreatic cancer to establish a more reproducible and clinically relevant score.
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Affiliation(s)
- Andrea Cacciato Insilla
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Caterina Vivaldi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Mirella Giordano
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Enrico Vasile
- Division of Medical Oncology, Pisa University Hospital, Pisa, Italy
| | - Carla Cappelli
- Diagnostic and Interventional Radiology, Pisa University Hospital, Pisa, Italy
| | - Emanuele Kauffmann
- Department of Transplant and General Surgery, University of Pisa, Pisa, Italy
| | - Niccolò Napoli
- Department of Transplant and General Surgery, University of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | - Ugo Boggi
- Department of Transplant and General Surgery, University of Pisa, Pisa, Italy
| | - Daniela Campani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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14
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Vivaldi C, Fornaro L, Cappelli C, Pecora I, Catanese S, Salani F, Cacciato Insilla A, Kauffmann E, Donati F, Pasquini G, Massa V, Napoli N, Lencioni M, Boraschi P, Campani D, Boggi U, Caramella D, Falcone A, Vasile E. Early Tumor Shrinkage and Depth of Response Evaluation in Metastatic Pancreatic Cancer Treated with First Line Chemotherapy: An Observational Retrospective Cohort Study. Cancers (Basel) 2019; 11:cancers11070939. [PMID: 31277449 PMCID: PMC6678367 DOI: 10.3390/cancers11070939] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/30/2022] Open
Abstract
Early tumor shrinkage (ETS) and depth of response (DoR) predict favorable outcomes in metastatic colorectal cancer. We aim to evaluate their prognostic role in metastatic pancreatic cancer (PC) patients treated with first-line modified-FOLFIRINOX (FOLFOXIRI) or Gemcitabine + Nab-paclitaxel (GemNab). Hence, 138 patients were tested for ETS, defined as a ≥20% reduction in the sum of target lesions’ longest diameters (SLD) after 6–8 weeks from baseline, and DoR, i.e., the maximum percentage shrinkage in the SLD from baseline. Association of ETS and DoR with progression-free survival (PFS) and overall survival (OS) was assessed. ETS was reached in 49 patients (39.5% in the FOLFOXIRI, 29.8% in the GemNab group; p = 0.280). In the overall population, ETS was significantly associated with better PFS (8.0 vs. 4.8 months, p < 0.001) and OS (13.2 vs. 9.7 months, p = 0.001). Median DoR was −27.5% (−29.4% with FOLFOXIRI and −21.4% with GemNab, p = 0.016): DoR was significantly associated with better PFS (9.0 vs. 6.7 months, p < 0.001) and OS (14.3 vs. 11.1 months, p = 0.031). Multivariate analysis confirmed both ETS and DoR are independently associated with PFS and OS. In conclusion, our study added evidence on the role of ETS and DoR in the prediction of outcome of PC patients treated with first-line combination chemotherapy.
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Affiliation(s)
- Caterina Vivaldi
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy.
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy.
| | - Lorenzo Fornaro
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Carla Cappelli
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Irene Pecora
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Silvia Catanese
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Francesca Salani
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Emanuele Kauffmann
- Department of Transplant and General Surgery, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Francescamaria Donati
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Giulia Pasquini
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Valentina Massa
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Niccolò Napoli
- Department of Transplant and General Surgery, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Monica Lencioni
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Piero Boraschi
- Department of Diagnostic Imaging, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Daniela Campani
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Ugo Boggi
- Department of Transplant and General Surgery, Pisa University Hospital, Via Paradisa 2, 56124 Pisa, Italy
| | - Davide Caramella
- Diagnostic and Interventional Radiology, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Alfredo Falcone
- Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, Via Savi 6, 56126 Pisa, Italy
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
| | - Enrico Vasile
- Division of Medical Oncology, Pisa University Hospital, Via Roma 67, 56126 Pisa, Italy
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15
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Kauffmann EF, Napoli N, Menonna F, Iacopi S, Lombardo C, Bernardini J, Amorese G, Cacciato Insilla A, Funel N, Campani D, Cappelli C, Caramella D, Boggi U. A propensity score-matched analysis of robotic versus open pancreatoduodenectomy for pancreatic cancer based on margin status. Surg Endosc 2019; 33:234-242. [PMID: 29943061 DOI: 10.1007/s00464-018-6301-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND No study has shown the oncologic non-inferiority of robotic pancreatoduodenectomy (RPD) versus open pancreatoduodenectomy (OPD) for pancreatic cancer (PC). METHODS This is a single institution propensity score matched study comparing RPD and ODP for resectable PC, based on factors predictive of R1 resection (≤ 1 mm). Only patients operated on after completion of the learning curve in both procedures and for whom circumferential margins were assessed according to the Leeds pathology protocol were included. The primary study endpoint was the rate of R1 resection. Secondary study endpoints were as follows: number of examined lymph nodes (N), rate of perioperative transfusions, percentage of patients receiving adjuvant therapies, occurrence of local recurrence, overall survival, disease-free survival, and sample size calculation for randomized controlled trials (RCT). RESULTS Factors associated with R1 resection were tumor diameter, number of positive N, N ratio, logarithm odds of positive N, and duodenal infiltration. The matching process identified 20 RPDs and 24 OPDs. All RPDs were completed robotically. R1 resection was identified in 11 RPDs (55.0%) and in 10 OPDs (41.7%) (p = 0.38). There was no difference in the rate of R1 at each margin as well as in the proportion of patients with multiple R1 margins. RPD and OPD were also equivalent with respect to all secondary study endpoints, with a trend towards lower rate of blood transfusions in RPD. Based on the figures presented herein, a non-inferiority RCT comparing RPD and OPD having the rate of R1 resection as the primary study endpoint requires 3355 pairs. CONCLUSIONS RPD and OPD achieved the same rate of R1 resections in resectable PC. RPD was also non-inferior to OPD with respect to all secondary study endpoints. Because of the high number of patients required to run a RCT, further assessment of RPD for PC would require the implementation of an international registry.
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Affiliation(s)
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Francesca Menonna
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Sara Iacopi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Carlo Lombardo
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Juri Bernardini
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy
| | - Gabriella Amorese
- Division of Anesthesia and Intensive Care, University of Pisa, Pisa, Italy
| | | | - Niccola Funel
- Division of Pathology, University of Pisa, Pisa, Italy
| | | | | | | | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. .,Azienda Ospedaliera Universitaria Pisana, Università di Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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16
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Insilla AC, Proietti A, Borrelli N, Macerola E, Niccoli C, Vitti P, Miccoli P, Basolo F. TERT promoter mutations and their correlation with BRAF and RAS mutations in a consecutive cohort of 145 thyroid cancer cases. Oncol Lett 2017; 15:2763-2770. [PMID: 29435002 PMCID: PMC5778878 DOI: 10.3892/ol.2017.7675] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/13/2017] [Indexed: 11/06/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common type of endocrine malignancy and accounts for ~80% of thyroid carcinomas in adults and 90% in children. Risk stratification is important for identifying patients at higher risk and, for this reason, recent advances in molecular genetics of thyroid cancer can be applied to provide novel biomarkers useful in understanding tumor behavior. B-Raf proto-oncogene, serine/threonine kinase (BRAF) and rat sarcoma (RAS) mutations have been widely studied and appear to have an important role in thyroid tumorigenesis. Somatic telomerase reverse transcriptase (TERT) promoter mutations have been recently identified in several types of malignant tumors, including thyroid neoplasia; however, the actual role of TERT mutations in thyroid tumorigenesis is still under debate. In the present study, the mutational status of BRAF, RAS and TERT was analyzed in order to elucidate the roles of these genes in thyroid tumorigenesis. The TERT mutational analysis was also correlated with an immunohistochemical study of TERT protein expression. According to the literature, our data provide evidence of the BRAF and RAS roles in thyroid tumorigenesis, supporting an association between BRAF (V600E) mutations and the more aggressive clinical and pathological features of thyroid tumors. By contrast, TERT mutations were not significantly associated with any clinical parameters; therefore, its role in initial tumorigenesis should be further investigated.
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Affiliation(s)
| | - Agnese Proietti
- Department of Surgical Pathology, University Hospital of Pisa, I-56126 Pisa, Italy
| | - Nicla Borrelli
- Department of Surgical Pathology, University Hospital of Pisa, I-56126 Pisa, Italy
| | - Elisabetta Macerola
- Department of Surgical Pathology, University Hospital of Pisa, I-56126 Pisa, Italy
| | - Cristina Niccoli
- Department of Surgical Pathology, University Hospital of Pisa, I-56126 Pisa, Italy
| | - Paolo Vitti
- Department of Endocrinology, University Hospital of Pisa, I-56126 Pisa, Italy
| | - Paolo Miccoli
- Department of Endocrine Surgery, University Hospital of Pisa, I-56126 Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical Pathology, University Hospital of Pisa, I-56126 Pisa, Italy
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17
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Torregrossa L, Rotondo MI, Cacciato Insilla A, Galleri D, Guidoccio F, Miccoli P, Livolsi VA, Basolo F. Metastasis of renal cell carcinoma to the parathyroid gland 16 years after radical nephrectomy: A case report. Oncol Lett 2016; 12:3224-3228. [PMID: 27899986 PMCID: PMC5103923 DOI: 10.3892/ol.2016.5071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 04/15/2016] [Indexed: 01/15/2023] Open
Abstract
Renal cell carcinoma (RCC) has a high metastatic potential, and most commonly metastasizes via the bloodstream, although lymphatic metastases also occur. RCC is well-known for its propensity to metastasize to unusual sites, and late metastasis, even after a number of years, is common. The occurrence of RCC metastasis to the head and neck region is uncommon, and occurs primarily in the thyroid gland and in patients with widespread dissemination. Involvement of the parathyroid gland in metastatic carcinoma is extremely rare. In the present report, a case of metastasis confined to the parathyroid gland is described, likely with intrathyroidal localization, arising from a RCC that occurred 16 years after nephrectomy. A 66-year-old man was referred to the Department of Surgery of the University Hospital of Pisa (Pisa, Italy) with a preoperative fine-needle aspiration diagnosis of a follicular lesion in the context of nodular goiter of the thyroid gland. The previous medical history of the patient included a right nephrectomy for the treatment of clear cell RCC in February 1997. No other distant metastases were identified as of the latest follow-up in March 2014. At the time of thyroid surgery, the thyroid and parathyroid function tests were normal. The gross appearance of the surgical specimen was a multinodular goiter with a solid nodule measuring 33 mm on the left lobe of the thyroid gland. Microscopic examination revealed a completely encapsulated lesion consisting of clear cells arranged in a solid pattern and intermixed with fragments of parathyroid tissue. Following immunohistochemical examination, the clear cell lesion was negative for thyroid transcription factor-1 and thyroglobulin and strongly positive for epithelial membrane antigen, cluster of differentiation 10 and vimentin. To the best of our knowledge, this is the second case of metastasis to the parathyroid gland from a RCC reported in the literature.
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Affiliation(s)
- Liborio Torregrossa
- Department of Surgical Pathology, University Hospital of Pisa, Pisa I-56126, Italy
| | | | | | - David Galleri
- Department of Endocrine Surgery, University Hospital of Pisa, Pisa I-56126, Italy
| | - Federica Guidoccio
- Regional Center of Nuclear Medicine, University Hospital of Pisa, Pisa I-56126, Italy
| | - Paolo Miccoli
- Department of Endocrine Surgery, University Hospital of Pisa, Pisa I-56126, Italy
| | - Virginia A Livolsi
- Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA
| | - Fulvio Basolo
- Department of Surgical Pathology, University Hospital of Pisa, Pisa I-56126, Italy
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Insilla AC, Faviana P, Pollina LE, Simone PD, Coletti L, Filipponi F, Campani D. Lymphoepithelioma-like hepatocellular carcinoma: Case report and review of the literature. World J Gastroenterol 2015; 21:10468-10474. [PMID: 26420974 PMCID: PMC4579894 DOI: 10.3748/wjg.v21.i36.10468] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/29/2015] [Accepted: 07/03/2015] [Indexed: 02/06/2023] Open
Abstract
Lymphoepithelioma-like hepatocellular carcinoma (LEL-HCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here, a case of LEL-HCC is described. An 81-year-old woman with a chronic hepatitis C infection was referred to the general surgery department of our hospital in August 2013 with a diagnosis of HCC. A past ultrasound examination had revealed a 60 mm-diameter nodular lesion in the third segment of the liver. After a needle biopsy, the lesion was diagnosed as HCC. The patient underwent surgery with a liver segmentectomy. Two additional nodes on the gastric wall were detected during the surgical operation. The histology of the removed specimen showed a poorly differentiated HCC with significant lymphoid stroma. Immunohistochemical studies revealed that the epithelial component was reactive for CK CAM5.2, CK8, CK18, CEA (polyclonal) and was focally positive for hepar-1 and that the lymphoid infiltrate was positive for CD3, CD4 and CD8. The tumor cells were negative for Epstein-Barr virus. The gastric nodes were ultimately determined to be two small gastrointestinal stromal tumors (GISTs). The synchronous occurrence of HCC and GIST is another very uncommon finding rarely described in the literature. Here, we report the clinicopathological features of our case, along with a review of the few cases present in the literature.
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MESH Headings
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Biopsy, Needle
- Carcinoma, Hepatocellular/chemistry
- Carcinoma, Hepatocellular/pathology
- Carcinoma, Hepatocellular/surgery
- Carcinoma, Hepatocellular/virology
- Epithelial Cells/chemistry
- Epithelial Cells/pathology
- Female
- Gastrointestinal Stromal Tumors/pathology
- Hepatectomy
- Hepatitis C, Chronic/complications
- Hepatitis C, Chronic/diagnosis
- Humans
- Immunohistochemistry
- Liver Neoplasms/chemistry
- Liver Neoplasms/pathology
- Liver Neoplasms/surgery
- Liver Neoplasms/virology
- Lymphocytes/chemistry
- Lymphocytes/pathology
- Neoplasms, Multiple Primary
- Stomach Neoplasms/pathology
- Tomography, X-Ray Computed
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Elisei R, Lorusso L, Piaggi P, Torregrossa L, Pellegrini G, Molinaro E, Agate L, Bottici V, Pani F, Cacciato Insilla A, Casella F, Ciampi R, Tognetti I, Materazzi G, Basolo F, Romei C. Elevated level of serum carbohydrate antigen 19.9 as predictor of mortality in patients with advanced medullary thyroid cancer. Eur J Endocrinol 2015; 173:297-304. [PMID: 26034076 DOI: 10.1530/eje-15-0304] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 06/01/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Medullary thyroid cancer (MTC) is capable of secreting several proteins, such as calcitonin (Ct), carcinoembryonic antigen (CEA), chromogranin and others. Recently, we observed an aggressive MTC with high levels of serum carbohydrate antigen 19.9 (Ca 19.9) and a rapid evolution to death. OBJECTIVE The aim of this study was to evaluate whether high levels of serum Ca 19.9 could be a prognostic factor of death in patients with advanced MTC. PATIENTS AND METHODS We measured Ca 19.9, CEA and Ct in 100 advanced structural recurrent/persistent MTC patients and in 100 cured or biochemically affected MTC patients. Clinical and pathological data were also collected. RESULTS Sixteen percent of the patients with advanced MTC had high levels of Ca 19.9. The group with abnormal Ca 19.9 levels had significantly higher levels of CEA and Ct compared with the group with normal values of Ca 19.9 (P<0.0001 for both Ct and CEA). At variance, all 100 patients in the MTC control group showed normal levels of Ca 19.9. Moreover, among the advanced cases, the Ca 19.9-positive group showed a higher mortality rate than the group with normal levels. A logistic regression analysis demonstrated that an elevated level of Ca 19.9 is a predictor of mortality (OR=3.78, P=0.04), independent from Ct doubling time. CONCLUSIONS These results demonstrated that an elevated value of serum Ca 19.9 appears to be a predictive factor of poor prognosis in advanced MTC patients and identifies those cases with a higher risk of mortality in the short term.
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Affiliation(s)
- Rossella Elisei
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Loredana Lorusso
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Paolo Piaggi
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Liborio Torregrossa
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giovanni Pellegrini
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Eleonora Molinaro
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Laura Agate
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Valeria Bottici
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Fabiana Pani
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Andrea Cacciato Insilla
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Francesca Casella
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Raffaele Ciampi
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Ilaria Tognetti
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gabriele Materazzi
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Fulvio Basolo
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cristina Romei
- Endocrine UnitDepartment of Clinical and Experimental MedicineDepartment of SurgicalMedical, Molecular Pathology, University of Pisa, Pisa, Italy andClinical Chemistry LaboratoryAzienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Miccoli P, Torregrossa L, Borrelli N, Materazzi G, Cacciato Insilla A, Miccoli M, Basolo F. E-selectin expression and BRAF status in papillary thyroid carcinomas: Correlation with clinicopathologic features. Surgery 2014; 156:1550-7; discussion 1557-8. [PMID: 25456953 DOI: 10.1016/j.surg.2014.08.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 08/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cell adhesion molecules, represented by the immunoglobulin family and selectins, play an important role in the progression of cancer. A correlation between selectins and tumor aggressiveness has been demonstrated in several reports. METHODS Eighty-eight patients (mean age, 41.0 ± 14 years) with papillary thyroid carcinoma (conventional variant and sized approximately 20 mm) were divided in 2 groups: 41 with encapsulated tumors and 47 with tumors with extrathyroidal extension. E-selectin expression was evaluated by immunohistochemical staining and semiquantitative real-time reverse-transcription polymerase chain reaction and normalized by calculating the z-score (positive: value above the population mean; negative: below the mean). RESULTS Lymph node metastasis (LNM) was found in 2 of 41 encapsulated tumors (4.8%) and in 19 of 47 tumors (40.4%) with extrathyroidal extension. BRAF mutation was present in 21 encapsulated tumors (51.2%) and in 31 tumors with extrathyroidal extension (65.9%). The mean E-selectin z-score was -0.32 for encapsulated tumors and 0.28 for tumors with extrathyroidal extension. E-selectin expression correlates with neoplastic infiltration (P = .04), the American Joint Commission on Cancer stage (P = .02), and BRAF mutation (P = .03). CONCLUSION E-selectin overexpression in association with BRAF mutation status could promote a more aggressive phenotype in papillary thyroid carcinoma.
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Affiliation(s)
- Paolo Miccoli
- Department of Surgical, Medical, Molecular and Critical Area Pathology, Università degli Studi di Pisa, Pisa, Italy.
| | - Liborio Torregrossa
- Department of Surgical, Medical, Molecular and Critical Area Pathology, Università degli Studi di Pisa, Pisa, Italy
| | - Nicla Borrelli
- Department of Surgical, Medical, Molecular and Critical Area Pathology, Università degli Studi di Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular and Critical Area Pathology, Università degli Studi di Pisa, Pisa, Italy
| | - Andrea Cacciato Insilla
- Department of Surgical, Medical, Molecular and Critical Area Pathology, Università degli Studi di Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Translational Research and of New Surgical and Medical Technologies, Università degli Studi di Pisa, Pisa, Italy
| | - Fulvio Basolo
- Department of Surgical, Medical, Molecular and Critical Area Pathology, Università degli Studi di Pisa, Pisa, Italy
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21
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Cacciato Insilla A, Granai M, Gallippi G, Giusti P, Giusti S, Guadagni S, Morelli L, Campani D. Deep endometriosis with pericolic lymph node involvement: A case report and literature review. World J Gastroenterol 2014; 20:6675-6679. [PMID: 24914394 PMCID: PMC4047358 DOI: 10.3748/wjg.v20.i21.6675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 12/11/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Deep infiltrating endometriosis is an often-painful disorder affecting women during their reproductive years that usually involves the structures of the pelvis and frequently the gastrointestinal tract. We present the case of a 37-year-old female patient with an endometrial growth on the sigmoid colon wall causing pain, diarrhea and the presence of blood in the feces. The histology of the removed specimen also revealed the involvement of the utero-vesical fold, the recto-vaginal septum and a pericolic lymph node, which are all quite uncommon findings. To identify the endometrial cells, we performed immunohistochemical staining for CD10 and the estrogen and progesterone receptors.
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Elisei R, Lorusso L, Romei C, Bottici V, Mazzeo S, Giani C, Fiore E, Torregrossa L, Insilla AC, Basolo F, Guerini A, Menghi A, Poletti A, Cugudda L, Vitti P. Medullary thyroid cancer secreting carbohydrate antigen 19-9 (Ca 19-9): a fatal case report. J Clin Endocrinol Metab 2013; 98:3550-4. [PMID: 23861463 DOI: 10.1210/jc.2013-1940] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND During follow-up for patients with medullary thyroid cancer (MTC), the levels of serum calcitonin and carcinoembryonic antigen are important, and the doubling time of these biomarkers significantly correlates with disease progression. Other antigens are present in tumor tissue and the sera of patients with MTC, but there are scarce published data on the serum levels of carbohydrate antigen 19-9 (Ca 19-9), a tumor marker primarily used for the diagnosis and follow-up of pancreatic and gastrointestinal neoplasias. Recently, the case of a 56-year-old woman with multiple endocrine neoplasia type 2B with high serum levels of Ca 19-9 was reported; this patient experienced rapid disease progression that led to her death. CASE PRESENTATION A 28-year-old man was referred to the Department of Endocrinology of the University Hospital of Pisa with suspected MTC with laterocervical lymph node metastasis, a single liver lesion (10 mm), several bone metastases, and bilateral pheochromocytomas. RET genetic testing revealed a germline Cys634Arg mutation. During the hospitalization, the carcinoembryonic antigen and Ca 19-9 levels increased while the calcitonin concentration remained stable; despite the apparent stability of the lesions, the condition of the patient worsened rapidly and resulted in death. CONCLUSIONS High levels of serum Ca 19-9 could be considered a marker of the dedifferentiation of MTC and disease aggressiveness, but additional data on the association between Ca 19-9 and advanced MTC are required to confirm this hypothesis.
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Affiliation(s)
- Rossella Elisei
- Section of Endocrinology, Department of Clinical and Experimental Medicine, and World Health Organization Collaborating Center for the Study and Treatment of Thyroid Diseases and Other Endocrine and Metabolic Disorders, University Hospital of Pisa, 56126 Pisa, Italy.
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