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Mancari R, Cioffi R, Magazzino F, Attademo L, Sant’angelo M, Taccagni G, Mangili G, Pignata S, Bergamini A. Dermatofibrosarcoma Protuberans of the Vulva: A Review of the MITO Rare Cancer Group. Cancers (Basel) 2024; 16:222. [PMID: 38201649 PMCID: PMC10777898 DOI: 10.3390/cancers16010222] [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: 11/06/2023] [Revised: 12/19/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Vulvar dermatofibrosarcoma protuberans is an extremely rare disease. Its rarity can hamper the quality of treatment; deeper knowledge is necessary to plan appropriate management. The purpose of this review is to analyse the data reported in the literature to obtain evidence regarding appropriate disease management. METHODS We made a systematic search of the literature, including the terms "dermatofibrosarcoma protuberans", "vulva", and "vulvar", alone or in combination. We selected articles published in English from two electronic databases, PubMed and MEDLINE, and we analysed their reference lists to include other potentially relevant studies. RESULTS We selected 39 articles, with a total of 68 cases reported; they were retrospective case reports and case series. Dermatofibrosarcoma protuberans of the vulva tends towards local recurrence; an early and timely pathological diagnosis, together with an appropriate surgical approach, are of utmost importance to ensure free margins and maximise the curative potential. CONCLUSIONS Even if this is an indolent disease and it generally shows a good prognosis, appropriate management may help in reducing the rate of local recurrences that may hamper patients' quality of life. Management by a multidisciplinary team is highly recommended.
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Affiliation(s)
- Rosanna Mancari
- Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Raffaella Cioffi
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milan, Italy; (R.C.); (G.M.); (A.B.)
| | - Francescapaola Magazzino
- Complex Operating Unit Ginecologia E Ostetricia, Ospedale Civile Di San Dona’ Di Piave (Venezia), Aulss4 Veneto Orientale, 30027 San Donà di Piave, Italy;
| | | | - Miriam Sant’angelo
- Department of Surgical Pathology, San Raffaele Scientific Institute, 20132 Milan, Italy; (M.S.); (G.T.)
| | - Gianluca Taccagni
- Department of Surgical Pathology, San Raffaele Scientific Institute, 20132 Milan, Italy; (M.S.); (G.T.)
| | - Giorgia Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milan, Italy; (R.C.); (G.M.); (A.B.)
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS ‘Fondazione G Pascale’, 80144 Napoli, Italy;
| | - Alice Bergamini
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milan, Italy; (R.C.); (G.M.); (A.B.)
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Tassi E, Bergamini A, Wignall J, Sant’Angelo M, Brunetto E, Balestrieri C, Redegalli M, Potenza A, Abbati D, Manfredi F, Cangi MG, Magliacane G, Scalisi F, Ruggiero E, Maffia MC, Trippitelli F, Rabaiotti E, Cioffi R, Bocciolone L, Candotti G, Candiani M, Taccagni G, Schultes B, Doglioni C, Mangili G, Bonini C. Epithelial ovarian cancer is infiltrated by activated effector T cells co-expressing CD39, PD-1, TIM-3, CD137 and interacting with cancer cells and myeloid cells. Front Immunol 2023; 14:1212444. [PMID: 37868997 PMCID: PMC10585363 DOI: 10.3389/fimmu.2023.1212444] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/14/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Despite predicted efficacy, immunotherapy in epithelial ovarian cancer (EOC) has limited clinical benefit and the prognosis of patients remains poor. There is thus a strong need for better identifying local immune dynamics and immune-suppressive pathways limiting T-cell mediated anti-tumor immunity. Methods In this observational study we analyzed by immunohistochemistry, gene expression profiling and flow cytometry the antigenic landscape and immune composition of 48 EOC specimens, with a focus on tumor-infiltrating lymphocytes (TILs). Results Activated T cells showing features of partial exhaustion with a CD137+CD39+PD-1+TIM-3+CD45RA-CD62L-CD95+ surface profile were exclusively present in EOC specimens but not in corresponding peripheral blood or ascitic fluid, indicating that the tumor microenvironment might sustain this peculiar phenotype. Interestingly, while neoplastic cells expressed several tumor-associated antigens possibly able to stimulate tumor-specific TILs, macrophages provided both co-stimulatory and inhibitory signals and were more abundant in TILs-enriched specimens harboring the CD137+CD39+PD-1+TIM-3+CD45RA-CD62L-CD95+ signature. Conclusion These data demonstrate that EOC is enriched in CD137+CD39+PD-1+TIM-3+CD45RA-CD62L-CD95+ T lymphocytes, a phenotype possibly modulated by antigen recognition on neoplastic cells and by a combination of inhibitory and co-stimulatory signals largely provided by infiltrating myeloid cells. Furthermore, we have identified immunosuppressive pathways potentially hampering local immunity which might be targeted by immunotherapeutic approaches.
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Affiliation(s)
- Elena Tassi
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
- Cell Therapy Immunomonitoring Laboratory (MITiCi), Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alice Bergamini
- Università Vita-Salute San Raffaele, Milan, Italy
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jessica Wignall
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Miriam Sant’Angelo
- Department of Surgical Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuela Brunetto
- Department of Surgical Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Balestrieri
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Miriam Redegalli
- Department of Surgical Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia Potenza
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Danilo Abbati
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Francesco Manfredi
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Maria Giulia Cangi
- Department of Surgical Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gilda Magliacane
- Department of Surgical Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabiola Scalisi
- Department of Surgical Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eliana Ruggiero
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Maria Chiara Maffia
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Federica Trippitelli
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Emanuela Rabaiotti
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raffaella Cioffi
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Candotti
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Candiani
- Università Vita-Salute San Raffaele, Milan, Italy
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gianluca Taccagni
- Department of Surgical Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Claudio Doglioni
- Università Vita-Salute San Raffaele, Milan, Italy
- Department of Surgical Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Chiara Bonini
- Experimental Hematology Unit, Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milano, Italy
- Cell Therapy Immunomonitoring Laboratory (MITiCi), Division of Immunology, Transplantation and Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
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Sant'Angelo M, Bartolucci A, Bocciolone L, Taccagni G. Myxoid leiomyosarcoma of the ovary: a very uncommon finding. Int J Gynecol Cancer 2023:ijgc-2022-004254. [PMID: 37657819 DOI: 10.1136/ijgc-2022-004254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023] Open
Affiliation(s)
| | | | - Luca Bocciolone
- Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
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Bergamini A, Mangili G, Ambrosi A, Taccagni G, Rabaiotti E, Bocciolone L, Candotti G, Cioffi R, Pella F, Sabetta G, Saponaro C, Candiani M. Endometriosis-Related Ovarian Cancers: Evidence for a Dichotomy in the Histogenesis of the Two Associated Histotypes. Diagnostics (Basel) 2023; 13:diagnostics13081425. [PMID: 37189525 DOI: 10.3390/diagnostics13081425] [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: 02/27/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Evidence indicates that different pathways of malignant degeneration underlie the development of endometriosis-associated ovarian tumors of endometrioid and clear cell histotypes. The aim of this study was to compare data from patients affected by these two histotypes to investigate the hypothesis of a dichotomy in the histogenesis of these tumors. Clinical data and tumor characteristics of 48 patients who were diagnosed with either pure clear cell ovarian cancer and mixed endometrioid-clear cell ovarian cancer arising from endometriosis (ECC, n = 22) or endometriosis-associated endometrioid ovarian cancer (EAEOC, n = 26) were compared. A previous diagnosis of endometriosis was detected more frequently in the ECC group (32% vs. 4%, p = 0.01). The incidence of bilaterality was significantly higher in the EAOEC group (35% vs. 5%, p = 0.01) as well as a solid/cystic rate at gross pathology (57.7 ± 7.9% vs. 30.9 ± 7.5%, p = 0.02). Patients with ECC had a more advanced disease stage (41% vs. 15%; p = 0.04). A synchronous endometrial carcinoma was detected in 38% of EAEOC patients. A comparison of the International Federation of Gynecology and Obstetrics (FIGO) stage at diagnosis showed a significantly decreasing trend for ECC compared to EAEOC (p = 0.02). These findings support the hypothesis that the origin, clinical behavior and relationship with endometriosis might be different for these histotypes. ECC, unlike EAEOC, seems to develop within an endometriotic cyst, thus representing a window of possibility for ultrasound-based early diagnosis.
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Affiliation(s)
- Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alessandro Ambrosi
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Gianluca Taccagni
- Surgical Pathology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Emanuela Rabaiotti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Luca Bocciolone
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giorgio Candotti
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Francesca Pella
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Giulia Sabetta
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Costanza Saponaro
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
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Candiani M, Fedele F, DI Fatta S, Taccagni G, Dolci C, Ruffolo AF. Menopause: a trigger for simultaneous development of ulcerative colitis in sigmoid neovagina and residual colorectum? Minerva Obstet Gynecol 2023:S2724-606X.23.05224-7. [PMID: 36795324 DOI: 10.23736/s2724-606x.23.05224-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Vaginoplasty using sigmoid colon is a common technique used for the creation of a neovagina. However, the risk of adverse neovaginal bowel events is a common mentioned disadvantage. We report the case of a woman submitted to intestinal vaginoplasty for Mayer-Rokitansky-Küster-Hauser (MRKH) Syndrome at the age of 24 years who, with the onset of menopause, developed blood-stained vaginal discharge. Almost simultaneously, the patients complained chronic abdominal pain in lower left quadrant and prolonged diarrhea. General exams, Pap smear test, microbiological tests and viral test for HPV were negative. Neovaginal biopsies were suggestive for inflammatory bowel disease (IBD) of moderate activity and colonic biopsies were suggestive for ulcerative colitis (UC). The development of UC in the sigmoid neovagina and, almost simultaneously, in the remaining colon with onset of menopause raises important questions about etiology and pathogenesis of these diseases. Our case suggests that menopause may consider a trigger for the development of UC, due to the changes in the colon surface permeability related to menopause.
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Affiliation(s)
- Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Fedele
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Simona DI Fatta
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Carolina Dolci
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro F Ruffolo
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy -
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Cioffi R, Cervini L, Taccagni G, Papaleo E, Pagliardini L, Bergamini A, Ferrari S, Mangili G, Candiani M. A prospective, observational study of chemotherapy-induced ovarian damage on follicular reserve and maturation. Arch Gynecol Obstet 2022; 306:1723-1729. [PMID: 35833992 DOI: 10.1007/s00404-022-06692-0] [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: 02/24/2022] [Accepted: 06/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chemotherapy negatively affects gonadal function, often resulting in premature ovarian failure (POF) due to ovarian reserve depletion. Mechanisms of gonadotoxicity, such as primordial follicle overactivation and "burnout", remain to be established. Ovarian tissue cryopreservation (OTC) before treatment plays an important role in safeguarding fertility. METHODS This is a prospective observational study that aims to evaluate the feasibility of OTC after chemotherapeutic treatment initiation. Patients were divided into 2 groups depending on whether they received chemotherapy before the harvesting procedure (Group 1) or not (Group 2). The main outcomes of this study are serum anti-Mullerian hormone (AMH) levels and histological follicular counts on ovarian tissue biopsies. RESULTS Between 2012 and 2020, 79 patients underwent OTC at our Hospital. Follicular counts from the ovarian biopsies of 30 post-pubertal patients and respective serum AMH levels were included in the analysis. AMH levels did not significantly differ between the 2 groups (P = 0.70) as well as the number of primordial follicles (P = 0.73). Ovarian biopsies of patients from Group 1 showed a higher number of primary follicles (P = 0.04) and atretic follicles (P = 0.05) with respect to Group 2. CONCLUSIONS In conclusion, OTC appears to be feasible even after the start of chemotherapeutic treatment, since in treated patients, the main ovarian reserve indicators (number of primordial follicles and serum AMH levels) were not significantly reduced compared to untreated patients. The "burnout" theory of chemotherapeutic damage to the ovary seems to be supported by the higher number of primary follicles found in the ovaries of patients who received chemotherapy before OTC.
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Affiliation(s)
- Raffaella Cioffi
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - Laura Cervini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Gianluca Taccagni
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrico Papaleo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Luca Pagliardini
- Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - Alice Bergamini
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Ferrari
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Giorgia Mangili
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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Mangili G, Giorda G, Ferrandina G, Cormio G, Cassani C, Savarese A, Danese S, Carnelli M, Vasta FM, Perrone AM, Scarfone G, Pignata S, Legge F, Raspagliesi F, Taccagni G, Candiani M, Bogani G, Mascilini F, Bergamini A. Surveillance alone in stage I malignant ovarian germ cell tumors: a MITO (Multicenter Italian Trials in Ovarian cancer) prospective observational study. Int J Gynecol Cancer 2021; 31:1242-1247. [PMID: 34035080 DOI: 10.1136/ijgc-2021-002575] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the oncological outcome of stage I malignant ovarian germ cell tumors patients included in the MITO-9 study to identify those who might be recommended routine surveillance alone after complete surgical staging. METHODS MITO-9 was a prospective observational study analyzing data collected between January 2013 and December 2019. Three groups were identified: group A included 13 patients stage IA dysgerminoma and IAG1 immature teratoma; group B included 29 patients with stage IB-C dysgerminomas, IA-C G2-G3 immature teratomas and stage IA mixed malignant ovarian germ cell tumors and yolk sac tumors; and group C included five patients (two patients with stage IC1 and one patient with stage IC2 yolk sac tumors and two patients with mixed-stage IC2 malignant ovarian germ cell tumors). RESULTS A total of 47 patients with stage I conservatively treated malignant ovarian germ cell tumors were analyzed. Two patients in group B were excluded from the routine surveillance alone group due to positive surgical restaging. Therefore, a total of 45 patients were included in the study. Median follow-up was 46.2 months (range; 6-83). In total, 14 of 45 patients (31.1%) received chemotherapy, while 31 (68.9%%) underwent surveillance alone. One patient in group A, with stage IA dysgerminoma had a relapse, successfully managed with conservative surgery and chemotherapy. None of the patients in group B and C relapsed. All patients were alive at completion of the study. Overall, among 31 patients (68.9%) who underwent surveillance alone, only one patient relapsed but was treated successfully. CONCLUSIONS Our data showed that close surveillance alone could be an alternative option to avoid adjuvant chemotherapy in properly staged IB-C dysgerminomas, IA-IC G2-G3 immature teratomas, and IA mixed malignant ovarian germ cell tumors with yolk sac tumor component.
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Affiliation(s)
- Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Giorgio Giorda
- Centro di Riferimento Oncologico di Aviano, IRCCS Aviano, Aviano, Italy
| | - Gabriella Ferrandina
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Policlinico Universitario Agostino Gemelli, Roma, Italy.,Università Cattolica del Sacro Cuore Sede di Roma, Roma, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, University of Bari, Bari, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynaecology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Saverio Danese
- Deparment of Obstetrics and Gynecology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Torino, Italy
| | - Marco Carnelli
- Unit of Gynecology and Obstetrics, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | | | - Anna Myriam Perrone
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
| | - Giovanna Scarfone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Mangiagalli Center, Milano, Italy
| | - Sandro Pignata
- Uro-Gynecological Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione "G. Pascale", Naples, Italy
| | - Francesco Legge
- Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, Puglia, Italy
| | | | | | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy.,Università Vita Salute San Raffaele, Milano, Italy
| | - Giorgio Bogani
- Department of Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Floriana Mascilini
- Dipartimento per la Salute della Donna e del Bambino e della Salute Pubblica, Policlinico Universitario Agostino Gemelli, Roma, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS Ospedale San Raffaele, Milano, Italy
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Bergamini A, Ferrandina G, Candotti G, Taccagni G, Scarfone G, Bocciolone L, Cassani C, Marinaccio M, Pignata S, Candiani M, Mangili G. Stage I juvenile granulosa cell tumors of the ovary: A multicentre analysis from the MITO-9 study. Eur J Surg Oncol 2021; 47:1705-1709. [PMID: 33583630 DOI: 10.1016/j.ejso.2021.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/04/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Juvenile type granulosa cell tumor (JGCTs) are extremely rare, mainly diagnosed in young women and pre-pubertal girls at stage I disease. Literature is scanty and guidelines regarding the optimal management are still controversial. The aim of this study is to add on the experience of the MITO group (Multicenter Italian Trials in Ovarian Cancer). METHODS Clinicopathological data from patients with stage I JGCTs were retrospectively collected. Descriptive statistics were used to characterize the patient population. Clinicopathological features and treatment variables were evaluated for association with relapse. RESULTS Seventeen patients were identified. Surgical approach was laparoscopic and open for 7 (41%) and 10 (59%) patients, respectively. Fertility sparing surgery (FSS) was performed in 15 patients (88%): unilateral salpingo-oophorectomy (USO) in 11 patients, cystectomy with subsequent USO in 2 patients and cystectomy alone in the remaining 2. Adjuvant chemotherapy was given in 2 cases. After a median follow up time of 80 months, no recurrences were registered. CONCLUSIONS Given the available data, minimally invasive surgery is safe in stage I JGCTs. Because of the good prognosis and of the young age of patients, FSS can be chosen in most of the cases. The role of cystectomy deserves further validation. The need of adjuvant chemotherapy in stage I disease is still unclear, even if available data does not seem to support treatment over surveillance.
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Affiliation(s)
- Alice Bergamini
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy.
| | - Gabriella Ferrandina
- Dipartimento per La Salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy; Università Cattolica del Sacro Cuore, Istituto di Ginecologia e Ostetricia, Roma, Italy
| | - Giorgio Candotti
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy
| | - Gianluca Taccagni
- Department of Surgical Pathology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giovanna Scarfone
- Department of Obstetrics, Gynecology, and Neonatology, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Bocciolone
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Marco Marinaccio
- Unit of Obstetrics and Gynecology, Department of Biomedical and Human Oncological Science (DIMO), University of Bari, Bari, Italy
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80138 Naples, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy; Università Vita Salute San Raffaele, Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Milan, Italy
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Di Filippo L, Vitali G, Taccagni G, Pedica F, Guaschino G, Bosi E, Martinenghi S. Cervix neuroendocrine carcinoma presenting with severe hypokalemia and Cushing's syndrome. Endocrine 2020; 67:318-320. [PMID: 31970585 DOI: 10.1007/s12020-020-02202-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/13/2020] [Indexed: 11/25/2022]
Abstract
Neuroendocrine carcinomas of the cervix are very rare, accounting for only 1-2% of all cervical cancers and <1% of all neuroendocrine tumors. Small-cell carcinoma of the cervix is associated with poor prognosis, even in early stages. Despite their neuroendocrine origin, tumors presenting with syndromes due to secreted neuroendocrine hormones are extremely rare. To date, only seven cases of cervical small-cell carcinoma associated with Cushing's syndrome due to ectopic ACTH secretion have been described. In most reports, Cushing's syndrome associated with these tumors occurred only in association with liver or lung metastasis. Only one single case of primary uterine cervix carcinoma secreting enough ACTH to induce Cushing's syndrome in the absence of metastatic disease has been described in 1994. Here, we describe a case of cervical small-cell carcinoma presenting with an acute onset of severe hypokalemia in Cushing's syndrome without metastatic disease to distant organs.
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Affiliation(s)
- Luigi Di Filippo
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy
| | - Giordano Vitali
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy
| | - Gianluca Taccagni
- Unit of Gineco-Pathology, Department of Pathology, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy
| | - Federica Pedica
- Unit of Gineco-Pathology, Department of Pathology, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy
| | - Giulia Guaschino
- Unit of General Medicine and Advanced Care, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy
| | - Emanuele Bosi
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy
- Diabetes Research Institute, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy
| | - Sabina Martinenghi
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy.
- Diabetes Research Institute, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milano, Italy.
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10
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Bergamini A, Tassi E, Wignall J, Bocciolone L, Candiani M, Potenza A, Manfredi F, Taccagni G, Scalisi F, Doglioni C, Mangili G, Bonini C. Activated effector T cells co-expressing multiple inhibitory receptors (IRs) are enriched in the tumor immune microenvironment in high grade serous ovarian cancer (HGSOC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz268.027] [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] [Indexed: 11/13/2022] Open
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11
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Losi L, Botticelli L, Taccagni G, Longinotti E, Lancellotti C, Scurani L, Zannoni GF. Malignant peritoneal mesothelioma in a woman with bilateral ovarian serous borderline tumour: Potential interactions between the two diseases. Gynecol Oncol Rep 2018; 24:39-42. [PMID: 29915796 PMCID: PMC6003403 DOI: 10.1016/j.gore.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 12/24/2022] Open
Abstract
We report a case of a 59-year-old woman with peritoneal malignant mesothelioma and no previous exposure to asbestos with a diagnosis of bilateral ovarian serous borderline tumour with peritoneal implants one year before. We discuss the histopathological and immunohistochemical findings to explain possible and potential interactions between the two diseases. To our knowledge, the association of both serous borderline ovarian tumour and malignant peritoneal mesothelioma has never been described before in the same woman and in such a tight temporal connection. This finding raises numerous issues about the origin of the two tumours and further biomolecular studies are needed to fully understand the carcinogenetic process. From a clinical point of view, this case report can be useful to gynaecologists because it leads to recommend a careful examination of the peritoneal cavity during a surgical resection of borderline serous tumour. Moreover, it may suggest performing a close follow-up associated with a careful surveillance of the patient, especially in the case of micropapillary pattern, to oncologists. A complete clinical approach could help to detect sooner possible relapses or other metachronous malignancies. Serous borderline ovarian tumour usually has an indolent course. Malignant peritoneal mesothelioma is an aggressive malignancy. The concurrence of both diseases has never been described before in the same woman. We discuss the possible and potential interactions between the two diseases.
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Affiliation(s)
- Lorena Losi
- Unit of Pathology, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Botticelli
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | | | - Ernesto Longinotti
- Unit of Surgery, Ospedale "Santa Maria" Borgo Val di Taro (Parma), Italy
| | - Cesare Lancellotti
- Unit of Pathology, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Letizia Scurani
- Unit of Pathology, Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Viganò PV, Ottolina J, Colombo R, Taccagni G, Ferrari S, Candiani M. Endometriosis of the ureteral stump: an entity with severe manifestations. CLIN EXP OBSTET GYN 2017. [DOI: 10.12891/ceog3700.2017] [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] [Indexed: 11/01/2022]
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13
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Garavaglia E, Sala C, Taccagni G, Traglia M, Barbieri C, Ferrari S, Candiani M, Panina-Bordignon P, Toniolo D. Fertility Preservation in Endometriosis Patients: Anti-Müllerian Hormone Is a Reliable Marker of the Ovarian Follicle Density. Front Surg 2017; 4:40. [PMID: 28791295 PMCID: PMC5524724 DOI: 10.3389/fsurg.2017.00040] [Citation(s) in RCA: 17] [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: 05/31/2017] [Accepted: 07/10/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze the ovarian reserve via measurement of follicular density and anti-Müllerian hormone (AMH) in endometriosis patients participating to a clinical program of cortical ovarian cryopreservation. DESIGN Retrospective analysis of serum AMH levels and prospective investigation of ovarian follicle number. SETTING University Hospital. PATIENTS Two hundred and two women with endometriosis and 400 controls. INTERVENTIONS Blood samples and ovarian biopsies. MAIN OUTCOME MEASURES Correlation of serum AMH levels and the number of non-growing follicles in the biopsied cortical tissues in endometriosis and control subjects, including age, type of AMH kit, and the laboratory performing the analysis as covariates. RESULTS AMH levels were shown to decrease with age in untreated endometriosis patients (P < 1.0 × 10-5) but they were significantly lower in endometriosis compared to controls only in patients over 36 years old (P = 2.7 × 10-4). The AMH decrease was faster in endometriosis compared to controls (beta = 0.27, P = 4.0 × 10-4). Primordial follicle number decreased with the reduction of AMH levels in both cases and controls (beta = 0.3; P = 0.04). CONCLUSION AMH is a reliable marker of ovarian reserve in endometriosis patients, and it can predict follicular density in women undergoing ovarian tissue cryopreservation.
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Affiliation(s)
| | - Cinzia Sala
- Genetics of Common Disorders, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Michela Traglia
- Genetics of Common Disorders, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Caterina Barbieri
- Genetics of Common Disorders, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Ferrari
- Obstetrics and Gynaecology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Obstetrics and Gynaecology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Paola Panina-Bordignon
- Reproductive Sciences, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Toniolo
- Genetics of Common Disorders, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
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14
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Saba E, Panina-Bordignon P, Pagani I, Origoni M, Candiani M, Doglioni C, Taccagni G, Ghezzi S, Alcami J, Vicenzi E, Poli G. 5-Hydroxytyrosol inhibits HIV-1 replication in primary cells of the lower and upper female reproductive tract. Antiviral Res 2017; 142:16-20. [PMID: 28286236 DOI: 10.1016/j.antiviral.2017.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 09/06/2016] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
Abstract
We investigated the potential anti-HIV-1 activity of the candidate microbicide 5-hydroxytyrosol (5-HT) both in primary human cervical tissue explants (CTE), established from tissues of women undergoing histerectomy, and in endometrium-associated leukocytes (EAL). CTE were exposed to either the laboratory-adapted HIV-1BaL or to primary viral isolates in the presence or absence of 5-HT or 3TC/lamivudine as control and were then monitored for 12 days in terms of HIV-1 p24 Gag antigen production in culture supernatants. HIV-1BaL replication was also evaluated in EAL by reverse transcriptase (RT) activity. The highest nontoxic concentrations of 5-HT (200 and 100 μM for CTE and EAL, respectively) exerted a significant inhibitory effect on virus replication in both primary cell systems. 5-HT did not cause significant alterations of the activation profile of CD4+ and CD8+ T cells, in terms of CD4, CCR5, CD25, CD69 and HLA-DR expression, although it decreased the percentage of CD38+CD8+ T cells. Thus, 5-HT deserves consideration as a potential candidate microbicide for preventing HIV-1 transmission or curtailing its replication in the female reproductive tract.
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Affiliation(s)
- Elisa Saba
- AIDS Immunopathogenesis Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy.
| | - Paola Panina-Bordignon
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy.
| | - Isabel Pagani
- Viral Pathogens and Biosafety Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy.
| | - Massimo Origoni
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy; Vita-Salute San Raffaele University, School of Medicine, Via Olgettina 58, 20132, Milano, Italy.
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy; Vita-Salute San Raffaele University, School of Medicine, Via Olgettina 58, 20132, Milano, Italy.
| | - Claudio Doglioni
- Vita-Salute San Raffaele University, School of Medicine, Via Olgettina 58, 20132, Milano, Italy; Pathology Unit, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy.
| | - Gianluca Taccagni
- Pathology Unit, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy.
| | - Silvia Ghezzi
- Viral Pathogens and Biosafety Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy.
| | - José Alcami
- AIDS Immunopathology Department, National Centre of Microbiology, Instituto de Salud Carlos III. Cra Majadahonda a Pozuelo, 28220, Majadahonda, Madrid, Spain.
| | - Elisa Vicenzi
- Viral Pathogens and Biosafety Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy.
| | - Guido Poli
- AIDS Immunopathogenesis Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Via Olgettina 58, 20132, Milano, Italy; Vita-Salute San Raffaele University, School of Medicine, Via Olgettina 58, 20132, Milano, Italy.
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15
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De Marzi P, Bergamini A, Luchini S, Petrone M, Taccagni G, Mangili G, Colombo G, Candiani M. Reply to "Hysteroscopic Resection in Fertility-Sparing Surgery for Atypical Hyperplasia and Endometrial Cancer: How Important Are Intrauterine Adhesions?". J Minim Invasive Gynecol 2015; 23:454-5. [PMID: 26724717 DOI: 10.1016/j.jmig.2015.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/18/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Patrizia De Marzi
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - Alice Bergamini
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - Stefania Luchini
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - Micaela Petrone
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - Gianluca Taccagni
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - Giorgia Mangili
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - Gabriella Colombo
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
| | - Massimo Candiani
- Department of Obstetrics and Gynecology, San Raffaele Hospital, Milan, Italy
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16
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Bergamini A, Candiani M, Taccagni G, Rabaiotti E, Viganò R, De Marzi P, Ferrari D, Mangili G. Different Patterns of Disease Spread between Advanced-Stage Type I and II Epithelial Ovarian Cancer. Gynecol Obstet Invest 2015; 81:10-4. [DOI: 10.1159/000381261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 02/26/2015] [Indexed: 11/19/2022]
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17
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Saba E, Origoni M, Taccagni G, Doglioni C, Auñón D, Gomez-Acebo E, Alcami J, Poli G, Vicenzi E. Candidate Microbicide 5-hydroxytyrosol (5-HT) Inhibits Productive R5 HIV-1 Infection of Human Cervical Tissue Explants (CTE). AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5593.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elisa Saba
- San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Origoni
- San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, School of Medicine, Milan, Italy
| | | | - Claudio Doglioni
- San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, School of Medicine, Milan, Italy
| | | | | | - Josè Alcami
- Instituto de Salud Carlos III University of Alcala, Madrid, Spain
| | - Guido Poli
- San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, School of Medicine, Milan, Italy
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Bergamini A, Almirante G, Taccagni G, Mangili G, Viganò P, Candiani M. Endometriosis-associated tumor at the inguinal site: report of a case diagnosed during pregnancy and literature review. J Obstet Gynaecol Res 2014; 40:1132-6. [PMID: 24612049 DOI: 10.1111/jog.12310] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [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: 06/03/2013] [Accepted: 09/26/2013] [Indexed: 11/28/2022]
Abstract
Malignant degeneration of endometriosis in the inguinal region is rare, and has only been reported in six cases in the literature, none of which was detected during pregnancy. We present the first case of endometriosis-associated adenocarcinoma in the inguinal region in a 34-year-old woman who was 35 weeks' pregnant. The tumor rapidly grew in the last 2 months of pregnancy as a left inguinal painful mass. Histologically, the tumor consisted of a moderate-to-poorly differentiated ovarian-type endometrioid adenocarcinoma arisen in endometriosis foci of both typical and atypical type. Elective labor induction was performed at 35 weeks of gestation and subsequently the patient underwent a conservative surgical treatment followed by chemotherapy. This case raises issues on the management of such an unusual tumor both during and outside pregnancy.
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Affiliation(s)
- Alice Bergamini
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milan, Italy
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19
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Saba E, Origoni M, Taccagni G, Ferrari D, Doglioni C, Nava A, Lisco A, Grivel JC, Margolis L, Poli G. Productive HIV-1 infection of human cervical tissue ex vivo is associated with the secretory phase of the menstrual cycle. Mucosal Immunol 2013; 6:1081-90. [PMID: 23385427 PMCID: PMC4153411 DOI: 10.1038/mi.2013.2] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [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: 08/17/2012] [Accepted: 12/21/2012] [Indexed: 02/04/2023]
Abstract
Cervical tissue explants (CTEs) from 22 HIV-1 seronegative women were exposed to R5 HIV-1 ex vivo. Eight CTEs were productively infected in terms of HIV-1 p24Gag release in culture supernatants, whereas 14 were not. Nonetheless, both accumulation of HIV-1gag DNA and of p24Gag(+) CD4(+) T cells and macrophages occurred in both productive and, at lower levels, in nonproductive CTEs. Nonproductive CTEs differed from productive CTEs for higher secretion of C-C motif chemokine ligand 3 (CCL3) and CCL5. A post-hoc analysis revealed that all productive CTEs were established from women in their secretory phase of the menstrual cycle, whereas nonproductive CTEs were derived from women either in their secretory (28%) or proliferative (36%) menstrual cycle phases or with an atrophic endometrium (36%). Thus, our results support the epidemiological observation that sexual HIV-1 transmission from males to women as well as from women to men is more efficient during their secretory phase of the menstrual cycle.
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Affiliation(s)
- Elisa Saba
- AIDS Immunopathogenesis Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy,Università Vita-Salute San Raffaele, School of Medicine, Milano, Italy
| | - Massimo Origoni
- Università Vita-Salute San Raffaele, School of Medicine, Milano, Italy,Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milano, Italy
| | - Gianluca Taccagni
- Department of Pathology, San Raffaele Scientific Institute, Milano, Italy
| | - Davide Ferrari
- Department of Obstetrics and Gynecology, San Raffaele Scientific Institute, Milano, Italy
| | - Claudio Doglioni
- Department of Pathology, San Raffaele Scientific Institute, Milano, Italy
| | - Alice Nava
- AIDS Immunopathogenesis Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy
| | - Andrea Lisco
- Program in Physical Biology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jean-Charles Grivel
- Program in Physical Biology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Leonid Margolis
- Program in Physical Biology, Eunice Kennedy-Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA,Correspondence: Prof. Guido Poli, M.D., P2/P3 Laboratories, DIBIT-1, Via Olgettina 58, 20132, Milano, Italy. Tel: +39-02-2643-4909; Fax: +39-02-2643-4905; , Dr. Leonid Margolis, Ph.D., NIH, 10 Center Drive, Bldg 10, Room 9D58, Bethesda MD 20892, USA. Tel: 301-5942-476; fax: 301-4800-857;
| | - Guido Poli
- AIDS Immunopathogenesis Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milano, Italy,Università Vita-Salute San Raffaele, School of Medicine, Milano, Italy,Correspondence: Prof. Guido Poli, M.D., P2/P3 Laboratories, DIBIT-1, Via Olgettina 58, 20132, Milano, Italy. Tel: +39-02-2643-4909; Fax: +39-02-2643-4905; , Dr. Leonid Margolis, Ph.D., NIH, 10 Center Drive, Bldg 10, Room 9D58, Bethesda MD 20892, USA. Tel: 301-5942-476; fax: 301-4800-857;
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Mangili G, Bergamini A, Taccagni G, Gentile C, Panina P, Viganò P, Candiani M. Unraveling the two entities of endometrioid ovarian cancer: a single center clinical experience. Gynecol Oncol 2012; 126:403-7. [PMID: 22609111 DOI: 10.1016/j.ygyno.2012.05.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 05/09/2012] [Accepted: 05/09/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Due to the increasing prevalence of the benign condition, ovarian carcinoma arising from endometriosis is emerging as a relevant clinical entity with an unclear biological signature. We have investigated clinical and histologic features of endometriosis-associated endometrioid ovarian cancer using an institutional retrospective database. METHODS Patients diagnosed with endometrioid ovarian cancer at our institution were divided into two groups according to the fulfillment or not of Sampson's and Scott's criteria for the detection of endometriosis-associated ovarian cancer. Clinical and histological data were reported and compared. Survival analysis was obtained using the log-rank test in an unadjusted Kaplan-Meier method. Multivariate analysis was performed using the Cox proportional hazards regression model to establish independent factors associated with endometriosis-associated endometrioid ovarian cancer and to identify predictors of survival. The degree of concordance was evaluated by Cohen's Kappa measures. RESULTS Patients with endometriosis-associated endometrioid ovarian cancer were significantly younger, had a lower disease stage (62% vs 23%; p=0.003), a less prevalent high grade tumor (38% vs 82%; p=0.002) and a higher prevalence of squamous and mucinous metaplasia. The rate of endometrial cancer diagnosis was significantly higher in women with endometriosis-associated endometrioid ovarian cancer (33%) than in other patients (11%) (p=0.04) with a 92% concordance between ovarian and endometrial histologic tumor grade. A significant difference in survival rate could not be demonstrated between patients with or without endometriosis. CONCLUSIONS The analysis of a retrospective endometrioid ovarian cancer database may allow to suggest a 40 molecular, morphological and clinical parallelism between endometrial and endometrioid ovarian cancers.
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Affiliation(s)
- Giorgia Mangili
- Obstetrics and Gynecology Unit, San Raffaele Scientific Institute, Milano, Italy.
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Garavaglia E, Pella F, Montoli S, Voci C, Taccagni G, Mangili G. Treatment of recurrent or metastatic low-grade endometrial stromal sarcoma: three case reports. Int J Gynecol Cancer 2011; 20:1197-200. [PMID: 21495227 DOI: 10.1111/igc.0b013e3181ef6d87] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The treatment of recurrent or metastatic low-grade endometrial stromal sarcoma (LG-ESS) is still controversial. Recurrent disease mainly develops in the lung or in the pelvis. When the evidence of extrauterine tumor extension exists, debulking is recommended. Responses to hormonal therapy have been reported, because of the presence of estrogen and progestin receptors. Also chemotherapy has been used, but the percentage of response is low. CASES Three patients with lung and pelvic localization of LG-ESS are reported. The first patient showed lung relapse 22 months after pelvic surgery. The second patient developed pelvic and abdominal recurrences, managed by surgery, 33 months after primary treatment and a subsequent lung recurrence 11 years later. The third patient had lung metastases at the primary diagnosis. All these patients underwent hysterectomy, bilateral salpingo-oophorectomy, and exeresis of lung recurrences. Our 3 patients were all treated with medroxyprogesterone acetate for long periods. They all presented regression or stabilization of metastatic lesions. At present, they are alive and without any evidence of disease (39, 70, and 28 months). CONCLUSIONS In LG-ESS, the combined treatment of surgery and progestin therapy is effective in achieving both local and distant disease control. Metastatic lesions, especially pulmonary lesions, seem to benefit from surgical removal, followed by progestin therapy. Hormonal therapy should be maintained for an indefinite period. On account of the long period existing between primary tumor and recurrent disease, a long-term follow-up is always recommended after the primary treatment.
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Affiliation(s)
- Elisabetta Garavaglia
- Obstetrics and Gynaecology Department, San Raffaele Hospital, Vita-Salute University, Milan, Italy.
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Mangili G, Montoli S, De Marzi P, Sassi I, Aletti G, Aletti G, Taccagni G. The role of DNA ploidy in postoperative management of stage I endometrial cancer. Ann Oncol 2008; 19:1278-1283. [DOI: 10.1093/annonc/mdn041] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Ferreri AJM, Verona C, Bolognesi A, Taccagni G, Ponzoni M, Ferrari S. Successful pregnancy after chemo-immuno-radiation therapy for aggressive lymphoma of the uterus. Br J Haematol 2008; 142:141-3. [DOI: 10.1111/j.1365-2141.2008.07083.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Seresini S, Origoni M, Lillo F, Caputo L, Paganoni AM, Vantini S, Longhi R, Taccagni G, Ferrari A, Doglioni C, Secchi P, Protti MP. IFN-gamma produced by human papilloma virus-18 E6-specific CD4+ T cells predicts the clinical outcome after surgery in patients with high-grade cervical lesions. J Immunol 2007; 179:7176-83. [PMID: 17982110 DOI: 10.4049/jimmunol.179.10.7176] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cervical neoplastic lesions are associated with infection by high-risk human papilloma viruses (HPVs). HPV-16 and HPV-18 are the most common genotypes. It has been proposed that development of HPV-16-positive cervical lesions is associated with impaired CD4(+) T cell immunity against early Ags. The aim of the study was to evaluate whether this impairment also applies to HPV-18. We investigated the presence and the quality of anti-HPV-18 E6 CD4(+) T cell responses in the blood of 37 consecutive patients with high-grade cervical lesions, 25 normal donors, and 20 cord bloods. The immune infiltrate in the cervical lesions was also evaluated. The characteristics of the responses were correlated to the clinical outcome. We found that one or more HPV-18 E6 peptides, containing naturally processed epitopes, were able to induce a response in 40-50% of the patients, depending on the effector function tested. Importantly, these percentages rose to 80-100% when HPV-18-positive patients were considered. HPV-18 E6-specific CD4(+) T cells produced mixed Th1/Th2 responses and statistical analysis of the cytokines produced revealed that the amount of IFN-gamma released could predict infection persistence and/or disease relapse after surgery. Finally, we found that a higher number of infiltrating CD4(+) and T-bet(+) T cells in the lesions correlated with a favorable clinical outcome. Our results strongly suggest a relevant role for CD4(+) T cells in the control of the HPV-18 compared with HPV-16 infections in patients with high-grade cervical lesions and identify an immunologic parameter potentially useful for patients' stratification.
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Affiliation(s)
- Samantha Seresini
- Tumor Immunology Unit, Scientific Institute H. San Raffaele, Milan, Italy
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Garavaglia E, Taccagni G, Montoli S, Panacci N, Ponzoni M, Frigerio L, Mangili G. Primary stage I–IIE non-Hodgkin's lymphoma of uterine cervix and upper vagina: evidence for a conservative approach in a study on three patients. Gynecol Oncol 2005; 97:214-8. [PMID: 15790461 DOI: 10.1016/j.ygyno.2004.07.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2003] [Indexed: 10/25/2022]
Abstract
BACKGROUND Non-Hodgkin's Lymphomas (NHL) frequently affect the uterine corpus, cervix, and vagina in cases of advanced disease. However, these organs are rarely the site of origin of this type of neoplasia. Because of the rarity of primary genital tract lymphomas, a standard treatment has not been defined. CASE Three patients with large B-cell primary Non-Hodgkin's lymphoma of the lower genital tract (vaginal, cervical and cervico-vaginal) presented with bulky lesions and underwent diagnostic evaluation, staging, and chemotherapy with adriamycin-containing regimens. All three patients, including two with stage IIE and one with stage IE disease demonstrated complete remission and are alive and well without evidence of disease at 10, 7, and 6 years of follow-up, respectively. CONCLUSIONS Our observations suggest that young patients with large B-cell lymphomas of lower genital tract stages I-IIE, even with bulky lesions, may benefit from chemotherapy alone as initial treatment.
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Affiliation(s)
- Elisabetta Garavaglia
- Division of Gynecology and Obstetrics, University "Vita e Salute", S. Raffaele Hospital, V. Olgettina 60, 20132 Milan, Italy.
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26
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Lillo FB, Lodini S, Ferrari D, Stayton C, Taccagni G, Galli L, Lazzarin A, Uberti-Foppa C. Determination of Human Papillomavirus (HPV) Load and Type in High-Grade Cervical Lesions Surgically Resected from HIV-Infected Women during Follow-up of HPV Infection. Clin Infect Dis 2005; 40:451-7. [PMID: 15668870 DOI: 10.1086/427032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2004] [Accepted: 09/08/2004] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The role of human papillomavirus (HPV) load and the importance of multiple-strain HPV infections as biomarkers for the development of cervical disease were evaluated in human immunodeficiency virus (HIV)-positive women. METHODS A total of 108 samples were analyzed, 64 of which were obtained from 16 HIV-positive women who underwent surgical resection of the cervical cone for treatment of a histologically confirmed high-grade cervical intraepithelial neoplasm (cases) and 44 of which were obtained from 22 HIV-positive women who had high-risk HPV but a negative colposcopy result (controls). Each patient underwent periodic examinations at 6-12-month intervals that included colposcopy, Papanicolaou testing, biopsy (if indicated), and cervical brushing for HPV testing. Viral typing was performed by reverse dot-blot hybridization and quantification of viral load by in-house real-time PCR and commercial assays. RESULTS Analysis of the cervical-brush samples collected when high-grade squamous intraepithelial lesions were diagnosed revealed that all cases had HPV loads that were significantly higher than those of controls (P=.0004 and P=.0003, by PCR and the Hybrid Capture 2 index [Digene], respectively). Decreasing concentrations of HPV load were observed when comparing samples obtained before and after treatment (P<.0001). The number and type of HPV strains that were detected were not statistically different between cases and controls. CONCLUSIONS The significantly higher HPV load detected in women with high-grade cervical dysplasia, as well as the dramatic decrease in the load after surgical removal of the lesion, suggest that HPV load is a possible prognostic marker of high-grade SIL.
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Affiliation(s)
- Flavia B Lillo
- Laboratory of Virology, Scientific Institute San Raffaele, Milan, Italy.
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27
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Abstract
Primary pleomorphic adenomas of the respiratory tract are rare tumors. They usually originate from the bronchial glands, but may also be unrelated to the bronchial tract and be localized in the pulmonary parenchyma. These salivary-gland type neoplasms have peculiar histological and clinical features: they usually behave as low-grade malignant neoplasms, but may also have more aggressive features. The diagnostic and therapeutic approach in a patient with a pulmonary pleomorphic adenoma is described.
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Affiliation(s)
- Angelo Carretta
- Department of Thoracic Surgery, Scientific Institute H San Raffaele, Vita-Salute San Raffaele University, Via Olgettina, 60 -20132 Milano, Italy.
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Sironi S, Messa C, Mangili G, Zangheri B, Aletti G, Garavaglia E, Vigano R, Picchio M, Taccagni G, Maschio AD, Fazio F. Integrated FDG PET/CT in Patients with Persistent Ovarian Cancer: Correlation with Histologic Findings. Radiology 2004; 233:433-40. [PMID: 15516617 DOI: 10.1148/radiol.2332031800] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [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: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the accuracy of integrated positron emission tomography (PET) and computed tomography (CT) for depiction of persistent ovarian carcinoma after first-line treatment, with use of histologic findings as the reference standard. MATERIALS AND METHODS Thirty-one women (mean age, 55.9 years) with ovarian carcinoma treated with primary cytoreductive surgery and followed up with platinum regimen chemotherapy were included. All 31 patients were scheduled for surgical second-look. Before surgical second-look, all patients underwent fluorodeoxyglucose (FDG) PET/CT. At PET/CT, three main categories of persistent disease were considered for data analysis: lymph nodal lesion, peritoneal lesion, and pelvic lesion. In all patients, imaging findings were compared with results of histologic examination after surgical second-look to determine the diagnostic accuracy of PET/CT in the evaluation of disease status. The kappa statistic (Cohen kappa) was used for statistical analysis. RESULTS Seventeen (55%) of 31 patients had persistent tumor at histologic analysis after surgical second-look, and fourteen (45%) had no histologically proved tumor. The total number of lesions that was positive for tumor cells at histologic analysis was 41 (lymph nodes, n = 16; peritoneal lesions, n = 21; pelvic lesions, n = 4); maximum diameter of these lesions was 0.3-3.2 cm (mean, 1.7 cm). A correlation was found between PET/CT and histologic analysis (kappa = 0.48). The overall lesion-based sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT were 78%, 75%, 77%, 89% and 57%, respectively. In the detection of a tumor, a size threshold could be set at 0.5 cm, as this was the largest diameter of a lesion missed at PET/CT. CONCLUSION Integrated PET/CT depicts persistent ovarian carcinoma with a high positive predictive value.
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Affiliation(s)
- Sandro Sironi
- School of Medicine, University of Milano-Bicocca, Milan, Italy; Institute for Molecular Imaging and Physiology of the National Research Council of Italy, Milan
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Mangili G, Taccagni G, Garavaglia E, Carnelli M, Montoli S. An unusual admixture of neoplastic and metaplastic lesions of the female genital tract in the Peutz-Jeghers Syndrome. Gynecol Oncol 2004; 92:337-42. [PMID: 14751181 DOI: 10.1016/j.ygyno.2003.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [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: 11/18/2022]
Abstract
BACKGROUND Peutz-Jeghers Syndrome (PJS) is a rare autosomal dominant condition with variable penetrance characterized by gastrointestinal hamartomatous polyps and mucocutaneous pigmentation. Patients with PJS have an increased risk for breast, gastrointestinal and female genital tract cancers. CASE Multiple genital tract neoplasms in a 41-year-old Italian woman with PJS are described. The patient presented with abdominal pain due to intussusception. A CT scan of the abdomen also showed a left adnexal mass, diagnosed as ovarian mixed serous and mucinous borderline tumor. An ovarian microscopic sex cord tumor with annular tubules (SCTAT) was incidentally diagnosed together with a minimal deviation mucinous adenocarcinoma of the uterine cervix. Also areas of typical hyperplasia of the tubal mucosa with mucinous metaplasia were found. CONCLUSION This appears to be one of the rare cases reported in literature in which PJS is complicated by multiple and contemporaneous genital tract tumors and rare histological findings. The clinical significance of recurrence of these unusual genital tract tumors and histological alterations in PJS patients is reviewed.
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Affiliation(s)
- Giorgia Mangili
- Division of Gynecology and Obstetrics, University "Vita e Salute", S Raffaele Hospital, Milan, Italy.
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Uberti-Foppa C, Ferrari D, Lodini S, Reina S, Ameglio F, Grasso MA, Gallotta G, Ferrari A, Taccagni G, Lazzarin A, Lillo FB. Long-term effect of highly active antiretroviral therapy on cervical lesions in HIV-positive women. AIDS 2003; 17:2136-8. [PMID: 14502023 DOI: 10.1097/00002030-200309260-00021] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pruneri G, Masullo M, Renne G, Taccagni G, Manzotti M, Luini A, Viale G. Follicular dendritic cell sarcoma of the breast. Virchows Arch 2002; 441:194-9. [PMID: 12189511 DOI: 10.1007/s00428-002-0660-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2002] [Accepted: 04/16/2002] [Indexed: 12/01/2022]
Abstract
Extranodal follicular dendritic cell sarcoma (FDCS) is an extremely uncommon tumor with only a single case arising in the breast having been reported. We describe the clinico-pathological features of an additional FDCS of the lower outer quadrant of the right breast in a 40-year-old woman. The tumor showed three patterns of growth, i.e., diffuse, myxoid and fascicular. The neoplastic cells were large, polygonal, with a slightly eosinophilic cytoplasm and oval or convoluted nuclei. They were intermingled with small lymphocytes, plasma cells and a few bizarre multinucleated giant cells. In the fascicular areas, the cells were spindled, while in the myxoid areas they showed a dendritic-like appearance, with long cytoplasmic processes. Mitoses were numerous and often atypical. The neoplastic cells were intensely immunoreactive for CD21, S-100 protein and epithelial membrane antigen, and focally for CD35, CD68 and cytokeratins. Polymerase chain reaction analysis did not reveal any Epstein Barr virus genome in the neoplastic tissue. Electron microscopy highlighted numerous interdigitating cytoplasmic processes with intercellular junctions of the serrated, immature desmosomal or undifferentiated types. The post-surgical course of the patient was uneventful and she is currently free of disease 19 months after surgery.
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Affiliation(s)
- Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, School of Medicine, Via Ripamonti 435, 20141, Milan, Italy
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Lillo FB, Ferrari D, Veglia F, Origoni M, Grasso MA, Lodini S, Mastrorilli E, Taccagni G, Lazzarin A, Uberti-Foppa C. Human papillomavirus infection and associated cervical disease in human immunodeficiency virus-infected women: effect of highly active antiretroviral therapy. J Infect Dis 2001; 184:547-51. [PMID: 11494160 DOI: 10.1086/322856] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2000] [Revised: 05/24/2001] [Indexed: 11/04/2022] Open
Abstract
To determine the effect of highly active antiretroviral therapy (HAART) on high-risk human papillomavirus (HR-HPV) infections and related cervical lesions, the virologic and cytologic markers of HPV infection were prospectively studied in 163 human immunodeficiency virus (HIV)-infected women, including 27 untreated, 62 treated with reverse transcriptase inhibitors, and 74 treated with HAART. A high prevalence of both infections with HR-HPV types (68%) and squamous intraepithelial lesions (SILs; low grade, 20.2%; high grade, 6.2%) was observed. The risks of infection and disease were inversely correlated with CD4 cell counts (P=.015 and P=.022, respectively). During the observation period (mean, 15.4 months; range, 6-24 months), CD4 cell counts increased significantly only in subjects receiving HAART (P<.001). Persistence of HR-HPV infection and progression of SILs were comparable in the 3 groups. These results indicate that, even in the era of HAART, HIV-infected women should be monitored carefully for the emergence of high-grade SILs and cervical cancer.
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Affiliation(s)
- F B Lillo
- Laboratory of Virology, San Raffaele Hospital, 20127 Milan, Italy.
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Alessandri G, Girelli M, Taccagni G, Colombo A, Nicosia R, Caruso A, Baronio M, Pagano S, Cova L, Parati E. Human vasculogenesis ex vivo: embryonal aorta as a tool for isolation of endothelial cell progenitors. J Transl Med 2001; 81:875-85. [PMID: 11406648 DOI: 10.1038/labinvest.3780296] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
SUMMARY Vasculogenesis, the de novo formation of new blood vessels from undifferentiated precursor cells or angioblasts, has been studied with experimental in vivo and ex vivo animal models, but its mechanism is poorly understood, particularly in humans. We used the aortic ring assay to investigate the angioforming capacity of aortic explants from 11- to 12-week-old human embryos. After being embedded in collagen gels, the aorta rings produced branching capillary-like structures formed by mesenchymal spindle cells that lined a capillary-like lumen and expressed markers of endothelial differentiation (CD31, CD34, von Willebrand factor [vWF], and fms-like tyrosine kinase-1 [Flk-1]/vascular endothelial growth factor receptor 2 [VEGFR2]). The cell linings of these structures showed ultrastructural evidence of endothelial differentiation. The neovascular proliferation occurred primarily in the outer aspects of aortic rings, thus suggesting that the new vessels mainly arose from immature endothelial precursor cells localized in the outer layer of the aortic stroma, ie, a process of vasculogenesis rather than angiogenesis. The undifferentiated mesenchymal cells (CD34+/CD31-), isolated and cultured on collagen-fibronectin, differentiated into endothelial cells expressing CD31 and vWF. Furthermore, the CD34+/CD31+ cells were capable of forming a network of capillary-like structures when cultured on Matrigel. This is the first reported study showing the ex vivo formation of human microvessels by vasculogenesis. Our findings indicate that the human embryonic aorta is a rich source of CD34+/CD31- endothelial progenitor cells (angioblasts), and this information may prove valuable in studies of vascular regeneration and tissue bioengineering.
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Affiliation(s)
- G Alessandri
- Laboratory of Microbiology, University of Brescia, Brescia
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Mangili G, Garavaglia E, De Marzi P, Zanetto F, Taccagni G. Metastatic placental site trophoblastic tumor. Report of a case with complete response to chemotherapy. J Reprod Med 2001; 46:259-62. [PMID: 11304870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasia, commonly insensitive to chemotherapeutic agents. CASE We report on long-term remission in a patient with metastatic PSTT after etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine combination chemotherapy. The 27-year-old patient with metastatic lung PSTT was alive, without evidence of disease, > 40 months after treatment. CONCLUSION Treatment with multiagent chemotherapy can produce long-term remission, even in patients with metastatic PSTT.
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Affiliation(s)
- G Mangili
- Department of Obstetrics and Gynecology, Ospedale San Raffaele, Via Olgettina 60, 20100 Milan, Italy
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Losa M, Saeger W, Mortini P, Pandolfi C, Terreni MR, Taccagni G, Giovanelli M. Acromegaly associated with a granular cell tumor of the neurohypophysis: a clinical and histological study. Case report. J Neurosurg 2000; 93:121-6. [PMID: 10883914 DOI: 10.3171/jns.2000.93.1.0121] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [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: 11/06/2022]
Abstract
Acromegaly is usually caused by a growth hormone (GH)-secreting pituitary adenoma, and hypersecretion of GH-releasing hormone (GHRH) from a hypothalamic or neuroendocrine tumor accounts for other cases. The authors report on the unusual association of acromegaly with a granular cell tumor of the neurohypophysis. A 42-year-old woman with a 10-year history of acral enlargement, headache, and menstrual abnormalities was referred to our department for a suspected GH-secreting pituitary adenoma. The patient's basal GH levels were mildly elevated at 4.8 microg/L, were not suppressed in response to an oral glucose tolerance test, and increased paradoxically after administration of thyrotropin-releasing hormone. The patient's insulin-like growth factor-1 (IGF-1) level was elevated at 462 microg/L, whereas a magnetic resonance image of the sella turcica revealed an intra- and suprasellar lesion that was compatible with a diagnosis of pituitary adenoma. A transsphenoidal approach to remove the lesion, which was mainly suprasellar, was successful during a second operative attempt, resulting in the clinical and biochemical regression of the patient's acromegaly. Four months postoperatively, the patient's basal GH level was 0.9 microg/L and her IGF-1 level was 140 microg/L. Histological analysis of the operative specimen demonstrated a granular cell tumor of the neurohypophysis, which when stained proved negative for pituitary hormones and GHRH. This case represents the first reported association between a granular cell tumor of the neurohypophysis and acromegaly. Granular cell tumor of the neurohypophysis could be added to the restricted list of neoplastic causes of acromegaly secondary to hypersecretion of a GH-releasing substance.
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Affiliation(s)
- M Losa
- Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele, University of Milan, Milano, Italy.
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Di Carlo V, Ferrari G, Castoldi R, De Nardi P, Bergamo C, Taccagni G, Salvioni M, Angeli E, Venturini M, Del Maschio A. Pre-operative chemoembolization of hepatocellular carcinoma in cirrhotic patients. Hepatogastroenterology 1998; 45:1950-4. [PMID: 9951846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND/AIMS The aim of the study was to evaluate clinical and pathological effects of transcatheter arterial chemoembolization (TACE) before surgical resection for hepatocellular carcinoma (HCC) in cirrhosis (55 patients); results were compared with a group of 45 patients undergoing surgical resection without TACE. METHODOLOGY From March 1989 to December 1997, 55 cirrhotic patients, affected by surgically resectable HCC not larger than 5 cm with unifocal or bifocal tumor lesions, underwent TACE pre-operatively. RESULTS Massive necrosis was observed in 26%, necrosis > 50% in 38% of lesions. Neoplastic cells were found in 47% of cases within the capsule or in the pericapsular tissue. Satellite nodules showed a low rate of necrosis. Mortality and morbidity in the pre-operative TACE group were 1.8% and 29%, respectively, and 4.4% and 33%, respectively, in the control group. One-, 3- and 5-year patient survival rates were 87%, 70% and 39%, respectively, versus 79%, 38% and 19%, respectively (p<0.02), in the control group. Disease-free survival was 40% and 28% at 3 years and 5 years with pre-operative TACE versus 20% and 11% (p<0.05). CONCLUSIONS Pre-operative TACE can be performed with low morbidity. TACE can necrotize the main lesion and temporarily arrest portal diffusion of neoplastic cells by acting on microvascular infiltration. No evident effect on satellites and pericapsular neoplastic foci was observed. The long-term patients and disease-free survival rates were improved upon.
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Affiliation(s)
- V Di Carlo
- University of Milan, Department of Surgery, San Raffaele Hospital, Milano, Italy
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Taccagni G, Rovere E, Masullo M, Christensen L, Eyden B. Myofibrosarcoma of the breast: review of the literature on myofibroblastic tumors and criteria for defining myofibroblastic differentiation. Am J Surg Pathol 1997; 21:489-96. [PMID: 9130998 DOI: 10.1097/00000478-199704000-00017] [Citation(s) in RCA: 69] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case of myofibrosarcoma of the breast is described. A 55-year-old woman presented with a small mammary nodule. A large recurrent lesions appeared a month later, and the patient died 11 months following initial presentation from diffuse pleuropulmonary metastases. Histologically, the primary tumor consisted mainly of spindled cells, arranged in fascicles and surrounded by varying quantities of dense hyaline collagen. The recurrent lesion had a more pleomorphic organization. In both lesions, there was positive immunostaining for vimentin, smooth-muscle actin, and fibronectin, and negative results for desmin, laminin, and type IV collagen. Electron microscopy revealed abundant rough endoplasmic reticulum, myofilaments with focal densities, and the fibronexus junctions and fibronectin fibrils characteristic of myofibroblasts. Given these cellular features and behavior, the tumor was interpreted as a malignant neoplasm showing myofibroblastic differentiation, i.e., a myofibrosarcoma. This case enlarges the group of myofibrosarcoma of breast, also with the demonstration of fibronexus and fibronectin fibrils. The paper emphasizes the criteria required for myofibroblastic differentiation and reviews lesions of the breast reported in the literature as myofibroblastic.
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Affiliation(s)
- G Taccagni
- Department of Pathology, Scientific Institute H San Raffaele, Milano, Italy
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Frigerio L, Agnello A, Sassi I, Mangili F, Taccagni G, Mariani A, Ferrari A. Adjuvant role of MIB1 index in differentiating serous ovarian tumors-preliminary report. Anticancer Res 1997; 17:1287-92. [PMID: 9137487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Atypically proliferating serous tumors (APST) account for 15% of all ovarian serous epithelial neoplasms. The differences between benign, borderline and malignant ovarian tumors is principally due to their cellular proliferative potential. By means of MIB1 expression we could recognize differences in proliferation among serous ovarian tumors, overcoming interobserver variability. Thirty-three patients with serous ovarian tumors, treated at S. Raffaele Hospital, University of Milan between November 1, 1992 and July 31, 1994 were used as study the population: 9 patients had serous cystoadenocarcinoma, 14 patients had APST and 10 patients had serous cystoadenoma. Pathological slides of all the cases were reviewed and immunohistochemical analysis was performed on formalin fixed, paraffin was embedded tissue. Pearson's Chi-square test and Fisher's exact test were performed for statistical evaluation. The percentage of MIB1 positive neoplastic cells ranged from, 0% to 2.1% (median 0.45%; mean 0.69%) in cystoadenomas, 1.3% to 7% (median 2.9%; mean 3.98%) in APSTs and 4.7% to 20.3% (median 6.95%; mean 9.51%) in cystoadenocarcinomas (p < 0.0001; F = 47.7). A High percentage expression of MIB1 in a serous tumor, initially diagnosed as APST, promoted a wider sampling of the surgical specimen confirming the presence of a carcinomatous component. MIB1 index is reported as representative of cellular proliferative potential. The analysis of MIB1 index provided valuable information in addition to that gained by conventional microscopic study in all cases where diagnostic difficulties arose in assessing APST.
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Affiliation(s)
- L Frigerio
- Department Obstetrics and Gynecology, S. Raffaele Hospital University of Milan, Italy
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Affiliation(s)
- M Sironi
- Department of Pathology, Legnano Hospital, Milan, Italy
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Sironi S, De Cobelli F, Zerbi A, Angeli E, Balzano G, Taccagni G, Di Carlo V, Del Maschio A. Pancreatic adenocarcinoma: assessment of vascular invasion with high-field MR imaging and a phased-array coil. AJR Am J Roentgenol 1996; 167:997-1001. [PMID: 8819400 DOI: 10.2214/ajr.167.4.8819400] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 02/02/2023]
Abstract
OBJECTIVE We performed this study to determine the value of MR imaging for assessing vascular invasion in preoperative staging of pancreatic carcinoma. SUBJECTS AND METHODS In 73 consecutive patients with an established diagnosis of pancreatic duct adenocarcinoma, spin-echo T1-weighted and breath-hold multiplanar gradient-recalled (MPGR) images were obtained at 1.5 T with a phased-array coil before and after bolus injection of gadopentetate dimeglumine. Major peripancreatic vessels were evaluated for contiguity with tumor and tumor encasement. All patients subsequently underwent surgery. Results of unenhanced and enhanced MR imaging studies were compared with the histologic findings in the resected specimens of 49 tumors and with the surgical findings of 24 nonresected tumors. RESULTS In 39 patients, tumor contiguity with adjacent vessels was found at pathologic examination. Of the remaining 34 patients, 10 had vascular encasement by tumor seen on pathologic examination of the resected specimen; the other 24 had unresectable tumors encasing adjacent vessels at surgical evaluation. In the assessment of vascular tumor contiguity, the accuracy was 85% for unenhanced spin-echo T1-weighted imaging, 87% for enhanced spin-echo T1-weighted imaging, 67% for unenhanced MPGR imaging, and 69% for enhanced MPGR imaging. In the assessment of vascular tumor encasement, the accuracy was 91% for unenhanced spin-echo T1-weighted imaging, 94% for enhanced spin-echo T1-weighted imaging, 74% for unenhanced MPGR imaging, and 76% for enhanced MPGR imaging. CONCLUSION MR imaging is helpful for preoperative assessment of vascular involvement caused by pancreatic carcinoma. For this purpose, unenhanced and enhanced spin-echo T1-weighted images seem to be more accurate than images obtained with other pulse sequences.
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Affiliation(s)
- S Sironi
- Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Milan, Italy
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Di Carlo V, Ferrari G, Castoldi R, Nadalin S, Marenghi C, Molteni B, Taccagni G, Castrucci M. Surgical treatment and prognostic variables of hepatocellular carcinoma in 122 cirrhotics. Hepatogastroenterology 1995; 42:222-9. [PMID: 7590569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 10-year experience in surgical treatment of HCC in 122 cirrhotic patients has been reviewed in order to evaluate: perioperative mortality and morbidity, survival rates and prognostic variables by multiple-logistic analysis. Mortality rate declined from 7% in period 1983-88 to 2% in period 1989-92. Operative complications also decreased from 46% to 30%. The 3-year and 5-year overall survival rates were 42.6% and 23.3%. The 3-year and 5-year survival of patients who died only for HCC was 51.1% and 34.2% and the disease-free survival 30.6% and 19.1%. The good results of overall survival were vanished by the high rate of recurrence (19.1%). Multiple logistic regression analysis for the probability of mortality was significant for satellite nodules (RR 2.437), microvascular infiltration (RR 2.432), tumor size (RR 1.147); the model for the probability of recurrence was significant for microvascular infiltration (RR 2.290), satellite nodules (RR 2.280), lesions number (RR 2.216) and tumor size (RR 1.247).
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Affiliation(s)
- V Di Carlo
- University of Milan, Institute of General Surgery, IRCCS San Raffaele, Italy
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Sironi S, De Cobelli F, Livraghi T, Villa G, Zanello A, Taccagni G, DelMaschio A. Small hepatocellular carcinoma treated with percutaneous ethanol injection: unenhanced and gadolinium-enhanced MR imaging follow-up. Radiology 1994; 192:407-12. [PMID: 8029405 DOI: 10.1148/radiology.192.2.8029405] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.2] [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: 01/28/2023]
Abstract
PURPOSE To determine the value of magnetic resonance (MR) imaging in follow-up of small (< 3 cm) hepatocellular carcinoma treated with percutaneous ethanol injection (PEI). MATERIALS AND METHODS Fifty-seven patients underwent MR imaging before and after PEI. At follow-up every 6 months, MR images were correlated with results of fine-needle aspiration biopsy (FNAB). In 12 patients, correlation with histologic findings in surgical specimens was possible. RESULTS In 39 patients followed up for 24 months, the treated lesions showed hypointensity on unenhanced (T2-weighted) images and loss of enhancement on enhanced (T1-weighted) images. At 6-month follow-up in six patients, the lesions showed areas of hyperintensity on unenhanced images and enhancement on enhanced images. These lesions contained residual viable tumor at FNAB. Twelve patients underwent surgical resection after 6-month follow-up. Correct diagnosis of complete or partial tumor necrosis was made in nine of these 12 patients with enhanced images and in three with unenhanced images. CONCLUSION Gadolinium-enhanced T1-weighted MR imaging is more accurate than unenhanced T2-weighted MR imaging in evaluation of PEI therapy.
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Affiliation(s)
- S Sironi
- Department of Radiology, Scientific Institute S Raffaele, University Hospital, Milan, Italy
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Taccagni G, Sambade C, Nesland J, Terreni MR, Sobrinho-Simões M. Solitary fibrous tumour of the thyroid: clinicopathological, immunohistochemical and ultrastructural study of three cases. Virchows Arch A Pathol Anat Histopathol 1993; 422:491-7. [PMID: 8333152 DOI: 10.1007/bf01606459] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We describe three cases of solitary fibrous tumour (SFT) arising from thyroid stroma. Grossly, the tumours were clearly delimited but only partly encapsulated. The following histomorphological growth patterns were observed: bundles of cells in storiform configuration; non-structured bundles; prevalence of fibrous matrix; highly cellular, non-structured; prevalence of loose, non-structured extracellular substance; cellular proliferation and vascular spaces in a haemangiopericytic configuration and a lipomatous component. Immunohistochemical investigation demonstrated intense, diffuse vimentin positivity and focal, less intense actin positivity in all three cases. At electron microscopy we observed a primitive cell of mesenchymal type, with cytoplasm poor in organelles and rich in filaments; this cell sometimes presented differentiation characteristics. SFT is at present the most correct term for the lesions presented here despite some morphological characteristics which differ from cases reported in the literature.
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Affiliation(s)
- G Taccagni
- Department of Pathology, University of Milan, San Raffaele Hospital, Italy
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Saccomanno K, Taccagni G, Bosi E, Preti P, Dozio N, Cantaboni A. Immunoelectron microscopy: a new method for detection of insulin antibodies. J Histochem Cytochem 1993; 41:1233-9. [PMID: 8331287 DOI: 10.1177/41.8.8331287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 01/29/2023] Open
Abstract
The aim of the present study was to set up a sensitive technical alternative to the classical procedures for detection of human insulin antibodies. We developed a method of post-embedding immunoelectron microscopy (IEM) using as the substrate fresh human pancreas, embedded in acrylic resin to maintain its antigenic structure. The antigen was insulin within the mature secretory granule. Serum samples obtained from 10 patients with insulin antibodies detected at various titers by either radio binding assay (RBA) or enzymatic immunoassay (EIA) were incubated for 2 hr at 37 degrees C at dilutions of 1:25, 1:100, 1:400, 1:1600, 1:6400, 1:25,600, and 1:102,400. The electron microscope photographs were analyzed by computerized morphometry and the number of protein A-gold-IgG complexes was calculated per micron2 of insulin granule. IEM results were compared with those obtained with EIA. The specificity of both techniques towards insulin was assessed as the difference between the signals (number of gold particles per micron2 of insulin granule in IEM or optical density > or = 0.193 in EIA) with and without excess insulin. Sensitivity was defined as the detection limit of the assay. In all the 10 sera investigated, IEM was more sensitive, with a 12- to 40-fold lower detection limit than EIA. IEM, with native insulin granules as substrate, is a specific, reproducible, and sensitive method for detection of human serum insulin antibodies. These findings also suggest IEM as a procedure potentially suitable for identifying antigen specificity of autoantibodies circulating at low concentration.
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Affiliation(s)
- K Saccomanno
- Department of Medicine, University of Milan, Scientific Institute H San Raffaele, Italy
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Isimbaldi G, Sironi M, Taccagni G, Declich P, Dell'Antonio A, Galli C. Tripartite differentiation (squamous, glandular, and melanocytic) of a primary cutaneous neuroendocrine carcinoma. An immunocytochemical and ultrastructural study. Am J Dermatopathol 1993; 15:260-4. [PMID: 8517496 DOI: 10.1097/00000372-199306000-00012] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [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: 02/05/2023]
Abstract
We report a case of primary cutaneous neuroendocrine carcinoma (PCNEC) with squamous, glandular, and melanocytic differentiation and associated Bowen disease. The paranuclear globular positivity of low-molecular-weight cytokeratins agrees with the ultrastructural observations of paranuclear fibrous bodies in the small neuroendocrine cells, while the diffuse cytoplasmic positivity corresponds to the sparse intermediate filaments in large cells with squamous differentiation. "Transitional forms" are characterized by both diffuse and globular cytoplasmic positivity for cytokeratins and by the ultrastructural evidence of neuroendocrine and squamous features. Therefore the ultrastructural demonstration of intracytoplasmic tonofibrils and tonofilaments, intercellular glandular lumina, lined by well-formed microvilli, and immature premelanosomes in the neurosecretory cells supports the proposed tripartite differentiation of neuroendocrine cells of this case of PCNEC.
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Affiliation(s)
- G Isimbaldi
- U.O. di Anatomia ed Istologia Patologica e Citodiagnostica, USSL 70 Ospedale Civile di Legnano, Milan, Italy
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Sironi S, Livraghi T, Angeli E, Vanzulli A, Villa G, Colombo E, Taccagni G, DelMaschio A. Small hepatocellular carcinoma: MR follow-up of treatment with percutaneous ethanol injection. Radiology 1993; 187:119-23. [PMID: 8383864 DOI: 10.1148/radiology.187.1.8383864] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [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: 01/30/2023]
Abstract
To assess the potential role of magnetic resonance (MR) imaging in the follow-up evaluation of small hepatocellular carcinoma (HCC) treated with percutaneous ethanol injection (PEI), 31 patients with a single HCC lesion less than 3.0 cm in diameter underwent MR imaging at 0.5 T before and after treatment. Posttreatment follow-up included contrast material-enhanced computed tomography (CT) and fine-needle biopsy in all cases. The most important characteristic of the treated HCC lesions was hypointensity on T2-weighted MR images in cases (27 of 31) in which complete tumor necrosis was achieved with PEI. This feature corresponded to a nonenhanced, low-attenuation area on follow-up contrast-enhanced CT scans. Four HCCs were positive for malignant cells at 6-month fine-needle biopsy; in these lesions, residual tumor tissue was of high signal intensity on T2-weighted MR images and of high attenuation on contrast-enhanced CT scans. In each case, incomplete tumor necrosis was confirmed at pathologic examination of the surgical specimen.
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Affiliation(s)
- S Sironi
- Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Milan, Italy
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Sironi S, Colombo E, Villa G, Taccagni G, Belloni C, Garancini P, DelMaschio A. Myometrial invasion by endometrial carcinoma: assessment with plain and gadolinium-enhanced MR imaging. Radiology 1992; 185:207-12. [PMID: 1523309 DOI: 10.1148/radiology.185.1.1523309] [Citation(s) in RCA: 119] [Impact Index Per Article: 3.7] [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: 12/27/2022]
Abstract
A prospective study was designed to determine the sensitivity and specificity of nonenhanced T2-weighted and contrast material-enhanced T1-weighted magnetic resonance (MR) imaging in assessing the depth of myometrial invasion in patients with proved endometrial cancer. In 56 consecutive patients with clinically determined early-stage disease, findings of the two MR imaging techniques were compared with results of histologic examination of surgical specimens. Myometrial invasion was classified as absent (stage IA), superficial (stage IB), or deep (stage IC). In the assessment of each tumor stage, the sensitivity and specificity of contrast-enhanced T1-weighted MR imaging were higher than those of non-enhanced T2-weighted MR imaging. In determining the degree of myometrial tumor invasion, the overall sensitivity of enhanced T1-weighted MR imaging was 87.5%, whereas that of nonenhanced T2-weighted MR imaging was 71.4% (P less than .05). The use of contrast material may improve the ability to assess, with MR imaging, the depth of myometrial invasion by endometrial cancer.
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Affiliation(s)
- S Sironi
- Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Milan, Italy
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Abstract
In patients with early-stage endometrial cancer, preoperative knowledge of myometrial tumor extension has important prognostic and therapeutic implications. The purpose of this prospective study was to determine the sensitivity and specificity of MR imaging for assessing the depth of myometrial invasion in patients with endometrial cancer that clinically was thought to be confined to the uterine corpus. Sixty-five consecutive patients were included in the study. All patients had MR imaging before radical surgery. MR imaging findings were compared with microscopic pathologic findings in all cases. On MR images and at histologic analysis, myometrial invasion was classified as absent (tumor confined to the endometrium), superficial (less than 50% of myometrial thickness), or deep (50% or more of myometrial thickness). At histologic examination, tumor limited to the endometrium was proved in 14 cases, superficial myometrial invasion by tumor was present in 34 cases, and deep tumor invasion was demonstrated in 17 cases. In determining the presence of tumor confined to the endometrium, MR imaging had a sensitivity of 57% and a specificity of 96%. In the assessment of tumor with superficial myometrial invasion, MR imaging had a sensitivity and a specificity of 74%, whereas in assessing deep myometrial penetration, the sensitivity and specificity of MR were 88% and 85%, respectively. Errors in MR interpretation when determining myometrial tumor spread were more frequently overestimations rather than underestimations. Our results indicate that MR imaging is useful for the preoperative assessment of myometrial invasion in patients with proved endometrial cancer.
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Affiliation(s)
- S Sironi
- Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Milan, Italy
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Abstract
To evaluate assessment of tumor regression with magnetic resonance (MR) imaging, the authors studied 21 consecutive patients with cervical carcinoma tumors that were more than 3 cm in diameter. Thirteen of the 21 also demonstrated parametrial invasion. In all cases, MR imaging was performed both before and after chemotherapy. Pathologic specimens were obtained at hysterectomy in all patients. Comparison of pathologic and MR imaging findings after chemotherapy showed that all tumors decreased in size. Size of tumor was correctly determined at MR in 17 cases and was slightly overestimated in four cases. Five patients had residual parametrial invasion that was histologically confirmed. In detecting parametrial spread after treatment, MR imaging had an accuracy of 90.4%. Tumors had high signal intensity on T2-weighted images, whereas intratumoral necrosis was characterized by low signal intensity on the same images. Peritumoral inflammatory tissue found at pathologic examination in four of 21 cases was not specifically identified on MR images. In patients with invasive cervical carcinoma, MR imaging may be useful in evaluating tumor response to preoperative chemotherapy.
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Affiliation(s)
- S Sironi
- Department of Radiology, Scientific Institute San Raffaele, University Hospital, Milan, Italy
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