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Vitale MG, Nasso C, Riccò B, Bocconi A, Chiavelli C, Baldessari C, Pipitone S, Bacchelli F, Botticelli L, Dominici M, Sabbatini R. Pembrolizumab in Vaginal Carcinoma: A Case Report and Review of the Literature. Case Rep Oncol 2024; 17:564-572. [PMID: 38645572 PMCID: PMC11032179 DOI: 10.1159/000535041] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/11/2023] [Indexed: 04/23/2024] Open
Abstract
Introduction Vaginal cancer is a rare gynecologic malignancy. While in a localized disease, concurrent chemoradiation grants local control and better overall survival, in a metastatic setting, the management options are very limited. Furthermore, recurrent cervical, vulvar, and vaginal carcinomas notoriously develop resistance to treatment, and consequently, their prognosis is still poor. Case Presentation We herein present the case of a woman with a nodal relapse of vaginal carcinoma, effectively treated with third-line immunotherapy. We will also provide a review of the literature on the new therapeutic strategies for advanced vaginal carcinoma, with a focus on pembrolizumab immunotherapy. Conclusion Pembrolizumab might represent a promising option for the management of vaginal and vulvar cancer, but data to support its use in this setting are still lacking. This case highlights the need for further investigation and trial designs for this rare disease.
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Affiliation(s)
- Maria Giuseppa Vitale
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Cecilia Nasso
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
- Division of Oncology, S. Corona Hospital, Pietra Ligure, Italy
| | - Beatrice Riccò
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Alessandro Bocconi
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Chiara Chiavelli
- Division of Oncology, Department of Medical and Surgical Sciences for Children & Adults, Laboratory of Cellular Therapy, University of Modena and Reggio Emilia, Modena, Italy
| | - Cinzia Baldessari
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Stefania Pipitone
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Francesca Bacchelli
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Laura Botticelli
- Department of Laboratory Medicine and Anatomy Pathology, Institute of Anatomy and Histology Pathology, University Hospital of Modena, Modena, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Roberto Sabbatini
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
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Losi L, Botticelli L, Mancini L, Negro R, Hanspeter E, Dematté E, Grandi G, Facchinetti F, Veneziano M, Malagoli C, Masini M, Fabbiani L, Rivasi F. Can immunohistochemistry improve the pathological diagnosis of placenta accreta spectrum (PAS) disorders? Arch Gynecol Obstet 2023:10.1007/s00404-023-07143-0. [PMID: 37535133 DOI: 10.1007/s00404-023-07143-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE The term of placenta accreta spectrum (PAS) disorder includes all grades of abnormal placentation. It is crucial for pathologist provide standardized diagnostic assessment to evaluate the outcome of management strategies. Moreover, a correct and safe diagnosis is useful in the medico-legal field when it becomes difficult for the gynecologist to demonstrate the suitability and legitimacy of demolitive treatment. The purposes of our study were: (1) to assess histopathologic features according to the recent guidelines; (2) to determine if immunohistochemistry can be useful to identify extravillous trophoblast (EVT) and to measure the depth of infiltration into the myometrium to improve the diagnosis of PAS. METHODS The retrospective study was conducted on 30 cases of gravid hysterectomy with histopathologic diagnosis of PAS. To identify the depth of EVT, immunohistochemical stainings were performed using anti MNF116 (cytokeratins 5, 6, 8, 17, 19), actin-SM, HPL (Human Placental Lactogen), vimentin and GATA3 antibodies. RESULTS Our cases were graded based on the degree of invasion of the myometrium. Ten were grade 1 (33.3%), 12 grade 2 (40%) and 8 grade 3A (26.7%). EVT invasion was best seen and evident by double immunostainings with actin-SM and cytokeratins, actin-SM and HPL, actin-SM and GATA3. CONCLUSION The role of pathologist is decisive to determine the different grades of PAS. A better understanding of the depth of myometrial invasion can be achieved by the use of immunohistochemistry affording an important tool to obtain reproducible grading of PAS. This purpose is crucial in the setting of postoperative quality reviews and particularly in the forensic medicine field.
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Affiliation(s)
- Lorena Losi
- Department of Life Sciences, Unit of Pathology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy.
| | - Laura Botticelli
- Unit of Pathology, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Luciano Mancini
- Unit of Pathology, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Rosa Negro
- Service of Pathology of Azienda Ospedaliera of Bolzano, Bolzano, Italy
| | - Esther Hanspeter
- Service of Pathology of Azienda Ospedaliera of Bolzano, Bolzano, Italy
| | - Eva Dematté
- Service of Pathology of Azienda Ospedaliera of Bolzano, Bolzano, Italy
| | - Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | | | - Claudia Malagoli
- Unit of Pathology, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Meris Masini
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Luca Fabbiani
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Unit of Pathology, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, Italy
| | - Francesco Rivasi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
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Taggi M, Liuzzi F, Botticelli L, De Carlini S, Longo M, Donno V, Fabbiani L, La Marca A. Evidence for the expression of vasorin in the human female reproductive tissues. Gynecol Endocrinol 2023; 39:2224457. [PMID: 37331376 DOI: 10.1080/09513590.2023.2224457] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
Objective: To investigate the expression and localization of Vasorin (Vasn) in human female reproductive system. Methods: The presence of Vasorin was evaluated by RT-PCR and immunoblotting analyses in patient-derived endometrial, myometrial and granulosa cells (GCs) primary cultures. Immunostaining analyses were performed to detect Vasn localization in primary cultures and in ovarian and uterine tissues. Results: Vasn mRNA was detected in patient-derived endometrial, myometrial and GCs primary cultures without significant differences at the transcript level. Otherwise, immunoblotting analysis showed that Vasn protein levels were significantly higher in GCs than proliferative endometrial stromal cells (ESCs) and myometrial cells. Immunohistochemistry performed in ovarian tissues revealed that Vasn was expressed in the GCs of ovarian follicles at different stages of development with a higher immunostaining signal in mature ovarian follicles such as the antral follicle or on the surface of cumulus oophorus cells than in early-stage follicles. The immunostaining of uterine tissues showed that Vasn was expressed in the proliferative stroma endometrium while it was significantly less expressed in the secretory endometrium. Conversely, no protein immunoreactivity was revealed in health myometrial tissue. Conclusions: Our results revealed the presence of Vasn in the ovary and the endometrium. The pattern of Vasn expression and distribution suggests that this protein may have a role in the regulation of processes such as folliculogenesis, oocyte maturation, and endometrial proliferation.
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Affiliation(s)
- Marilena Taggi
- Department of Medical and Surgical Sciences for Children & Adults, University, Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Liuzzi
- Department of Medical and Surgical Sciences for Children & Adults, University, Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Laura Botticelli
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Serena De Carlini
- Department of Medical and Surgical Sciences for Children & Adults, University, Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Maria Longo
- Department of Medical and Surgical Sciences for Children & Adults, University, Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Donno
- Department of Medical and Surgical Sciences for Children & Adults, University, Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Luca Fabbiani
- Department of Medical and Surgical Sciences for Children & Adults, University, Hospital of Modena and Reggio Emilia, Modena, Italy
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children & Adults, University, Hospital of Modena and Reggio Emilia, Modena, Italy
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Grandi G, Botticelli L, Fraia PD, Babalini C, Masini M, Unfer V. The Association of Four Natural Molecules-EGCG, Folic Acid, Vitamin B12, and HA-To Counteract HPV Cervical Lesions: A Case Report. J Pers Med 2023; 13:jpm13030567. [PMID: 36983748 PMCID: PMC10051187 DOI: 10.3390/jpm13030567] [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: 12/16/2022] [Revised: 02/21/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Precancerous lesions of the uterine cervix, due to HPV infections, are still today a great medical challenge. This clinical case highlighted the effectiveness of epigallocatechin gallate (EGCG), vitamin B12, folic acid, and hyaluronic acid (HA) in counteracting HPV lesions in a 39-year-old patient with a long history of viral persistence, cervical lesions of various degree, and several unsuccessful surgical approaches. After eight weeks of treatment, both the histological and cytological analyses revealed only a chronic cervicitis without any malignant lesions or cellular dysplasia, thus reducing the urgency of an invasive surgery, a total hysterectomy.
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Affiliation(s)
- Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, 41125 Modena, Italy
| | - Laura Botticelli
- Department of Pathology, Azienda Ospedaliero Universitaria Policlinico, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | | | | | - Meris Masini
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Obstetrics and Gynecology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, 41125 Modena, Italy
| | - Vittorio Unfer
- UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
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Giulini S, Grisendi V, Sighinolfi G, Di Vinci P, Tagliasacchi D, Botticelli L, La Marca A, Facchinetti F. Chronic endometritis in recurrent implantation failure: Use of prednisone and IVF outcome. J Reprod Immunol 2022; 153:103673. [PMID: 35905659 DOI: 10.1016/j.jri.2022.103673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 11/19/2022]
Abstract
In recurrent implantation failure patients (RIF), the main criteria for diagnosis of chronic endometritis, is the presence of plasma cells CD138+ in endometrial biopsy. The aim of the present study was to evaluate if treatment with prednisone, in patients with RIF and chronic endometritis, improve IVF outcome. A retrospective study was performed between 2019 and 2020. A total of 27 patients with RIF and an endometrial biopsy positive for CD56+ cells were enrolled. The treatment with prednisone 10 mg per day is began together with controlled ovarian stimulation (COS). Among endometrial biopsies, 13 (48.14%) were positive also for CD138 cells, and an antibiotic treatment was added. In all patients, after therapy, in the subsequent IVF cycle, the clinical pregnancy rate was 25.9% and the live birth rate was 22.2%. Analysing pregnancies according to the percentage of CD 56 cells on endometrial biopsy, the live birth rate in the subgroup of patients with marked endometritis (defined by the presence of >10% CD56+cells) was 29.41%, while in the subgroup with mild endometritis (CD 56 >5% and <10%) was 10%. In the subgroup with mild endometritis with CD 138 positive the live birth was 25%, while in patients with CD 138 negative no live birth were observed. In patients with RIF the count of at least two cell types (CD 138 and CD 56 cells) on endometrial biopsies is advisable. Our study suggests a benefit of prednisone and antibiotic treatment on live birth rate in a subsequent IVF cycle.
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Affiliation(s)
- Simone Giulini
- Unit of Reproductive Medicine, Institute of Obstetrics and Gynecology, Mother Infant Department, University Hospital Policlinico of Modena, 41125 Modena, Italy.
| | - Valentina Grisendi
- Unit of Reproductive Medicine, Institute of Obstetrics and Gynecology, Mother Infant Department, University Hospital Policlinico of Modena, 41125 Modena, Italy
| | - Giovanna Sighinolfi
- Unit of Reproductive Medicine, Institute of Obstetrics and Gynecology, Mother Infant Department, University Hospital Policlinico of Modena, 41125 Modena, Italy
| | - Pierluigi Di Vinci
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniela Tagliasacchi
- Unit of Reproductive Medicine, Institute of Obstetrics and Gynecology, Mother Infant Department, University Hospital Policlinico of Modena, 41125 Modena, Italy
| | - Laura Botticelli
- Institute of Anatomy and Histology Pathology, Department of Laboratory Medicine and Anatomy Pathology, University Hospital Policlinico of Modena, 41125 Modena, Italy
| | - Antonio La Marca
- Unit of Reproductive Medicine, Institute of Obstetrics and Gynecology, Mother Infant Department, University Hospital Policlinico of Modena, 41125 Modena, Italy
| | - Fabio Facchinetti
- Unit of Reproductive Medicine, Institute of Obstetrics and Gynecology, Mother Infant Department, University Hospital Policlinico of Modena, 41125 Modena, Italy
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Alboni C, Spanò Bascio L, Camacho Mattos L, Gallo G, Botticelli L, Cabry F, Facchinetti F, Gelmini R. Ileocecal deep infiltrating endometriosis with intestinal mucinous metaplasia and high-grade dysplasia. J OBSTET GYNAECOL 2022; 42:1593-1596. [PMID: 34989295 DOI: 10.1080/01443615.2021.2006158] [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: 10/19/2022]
Affiliation(s)
- Carlo Alboni
- Minimally Invasive and Robotic Gynecologic Surgery Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ludovica Spanò Bascio
- Minimally Invasive and Robotic Gynecologic Surgery Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ludovica Camacho Mattos
- Minimally Invasive and Robotic Gynecologic Surgery Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Graziana Gallo
- Department of Pathology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Botticelli
- Department of Pathology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Cabry
- Oncologic Surgery Unit, Department of Surgical, Medical and Dental, Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Minimally Invasive and Robotic Gynecologic Surgery Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.,Obstetrics and Gynecology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberta Gelmini
- Department of Pathology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Alboni C, Mattos LC, Botticelli L, Malmusi S, Facchinetti F, Pecchi A. Surgical treatment of deep endometriosis with adenomyosis externa: a challenging case in an infertile woman. Fertil Steril 2021; 115:1084-1086. [PMID: 33750620 DOI: 10.1016/j.fertnstert.2020.11.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To describe the management and the fertility-enhancing potential of surgery in an infertile patient with deep-infiltrating endometriosis and adenomyosis externa. DESIGN Video case report. SETTING Minimally invasive and robotic gynecologic surgery unit of a university hospital. PATIENT(S) A 31-year-old nulliparous patient with dysmenorrhea, dysuria, dyspareunia, and primary infertility. INTERVENTION(S) Bimanual examination, transvaginal ultrasound, and magnetic resonance imaging (MRI) were performed as a comprehensive preoperative workup. The findings were consistent with bladder endometriosis and a 4-cm right pararectal cystic mass suggestive of adenomyosis externa. Laparoscopic excision of all visible endometriosis was performed. A pararectal lesion was found, completely developing in the retroperitoneal spaces, from the right medial pararectal space to the rectovaginal space, reaching the pelvic floor fascia without infiltration of the levator ani muscle. According to Koninckx classification, this kind of lesion corresponds to type III endometriosis or adenomyosis externa. Nerve-sparing eradication of the nodule was performed. The decision to use these techniques was taken with the intention to treat the patient, and not with the aim of testing the procedures performed. Therefore, as a common clinical practice in our institution and for the above reasons, there was no need for consultation of the institutional review board for approval. MAIN OUTCOME MEASURE(S) Improvement of symptoms and spontaneous conception after surgical removal of all endometriotic implants. RESULT(S) There were no intraoperative or postoperative complications, and the patient was discharged after 3 days. She discontinued postoperative hormone therapy with gonadotropin-releasing hormone analogue after 3 months because she desired fertility. She conceived spontaneously after 2 months of attempting. She delivered vaginally and had no complications during pregnancy and labor. Neither recurrence of pain symptoms nor voiding or rectal dysfunctions were reported by the patient. CONCLUSION(S) In the management of a case of deep endometriosis, the preoperative assessment should be carefully carried out to give the surgeon the most accurate information about the extent of the disease and the patient's main objectives. Imaging techniques such as ultrasound and MRI play a fundamental role along with the clinical evaluation in also detecting lesions that are not visible at first laparoscopic inspection. In this case of a young woman without any detectable fertility issues except for endometriosis, the laparoscopic excision of endometriosis was feasible, safe, and effective in improving the patient's fertility and pain symptoms. The fertility-enhancing potential of complete eradication of pelvic endometriosis, including removal of deep posterior localizations such those presented in this case, has been hypothesized by various investigators. It has been suggested that skilled surgical management for symptomatic deep endometriosis may be followed by a high pregnancy rate, with most pregnancies resulting from postoperative natural conception even in patients with primary infertility.
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Affiliation(s)
- Carlo Alboni
- Minimally Invasive and Robotic Gynecologic Surgery Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ludovica Camacho Mattos
- Minimally Invasive and Robotic Gynecologic Surgery Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy.
| | - Laura Botticelli
- Department of Pathology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Malmusi
- Gynecology and Obstetrics Unit, Sassuolo Civil Hospital, Sassuolo, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Annarita Pecchi
- Department of Radiology, Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
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Losi L, Botticelli L, Garagnani L, Fabbiani L, Panini R, Gallo G, Sabbatini R, Maiorana A, Benhattar J. TERT promoter methylation and protein expression as predictive biomarkers for recurrence risk in patients with serous borderline ovarian tumours. Pathology 2020; 53:187-192. [PMID: 33032810 DOI: 10.1016/j.pathol.2020.07.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 01/18/2023]
Abstract
Epithelial ovarian neoplasms can be divided into three distinct clinicopathological groups: benign, malignant and borderline tumours. Borderline tumours are less aggressive than epithelial carcinomas, with an indolent clinical course and delayed recurrence. However, a subset of these cases can progress to malignancy and relapse, and death from recurrent disease can occasionally occur. Telomerase activation is a critical element in cellular immortalisation and cancer. The enzyme telomerase comprises a catalytic subunit (TERT) expressed in various types of cancers and regulated by promoter methylation mainly in epithelial tumours. The aim of this study was to investigate the promoter methylation status and the expression of TERT in 50 serous borderline tumours (SBTs) and their correlation with clinicopathological features and outcome. TERT methylation was analysed by bisulfite pyrosequencing and TERT expression by immunohistochemistry. Methylation of TERT promoter was only observed in four SBTs. A good correlation with immunostochemistry was found: nuclear positivity for TERT expression was observed in the methylated cases, whereas no expression was detected in unmethylated tumours. One of these patients had a recurrence after 7 years and another patient died from the disease. SBTs with hypomethylated tumours and absence of TERT expression showed a good clinical behaviour. Our study highlights the low presence of TERT methylation in SBTs, confirming that these tumours have a different biology than serous carcinomas. Furthermore, the concordance between TERT promoter methylation and TERT expression and their association with clinical outcomes leads to consider TERT alteration as a potential predictive biomarker for recurrence risk identifying patients who should undergo a careful and prolonged follow-up.
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Affiliation(s)
- Lorena Losi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy; Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
| | - Laura Botticelli
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Lorella Garagnani
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Fabbiani
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Rossana Panini
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Graziana Gallo
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto Sabbatini
- Division of Medical Oncology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Antonino Maiorana
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy; Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Jean Benhattar
- Aurigen, Centre de Génétique et Pathologie, Lausanne, Switzerland
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Fiocchi F, Monelli F, Besutti G, Casari F, Petrella E, Pecchi A, Caporali C, Bertucci E, Busani S, Botticelli L, Facchinetti F, Torricelli P. MRI of placenta accreta: diagnostic accuracy and impact of interventional radiology on foetal-maternal delivery outcomes in high-risk women. Br J Radiol 2020; 93:20200267. [PMID: 32706979 DOI: 10.1259/bjr.20200267] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess accuracy and reproducibility of MRI diagnosis of invasive placentation (IP) in high-risk patients and to evaluate reliability of MRI features. Secondary aim was to evaluate impact of interventional radiology (IR) on delivery outcomes in patients with IP at MRI. METHODS 26 patients (mean age 36.24 y/o,SD 6.16) with clinical risk-factors and echographic suspicion of IP underwent 1.5 T-MRI. Two readers reviewed images. Gold-standard was histology in hysterectomised patients and obstetric evaluation at delivery for patients with preserved uterus. Accuracy and reproducibility of MRI findings were calculated. RESULTS Incidence of IP was 50% (13/26) and of PP was 11.54% (3/26). MRI showed 100% sensitivity (95% CI = 75.3-100%) and 92.3% specificity (95% CI = 64.0-100%) in the diagnosis of IP. Gold-standard was histology in 10 cases and obstetric evaluation in 16. MRI findings with higher sensitivity were placental heterogeneity, uterine bulging and black intraplacental bands. Uterine scarring, placental heterogeneity, myometrial interruption and tenting of the bladder showed better specificity. MRI inter-rater agreement with Cohen's K was 1. 11 patients among 14 with MRI diagnosis of IP received IR assistance with positive impact on delivery outcomes in terms of blood loss, red cells count, intense care unit length of stay, days of hospitalisation and risk of being transfused. CONCLUSION MRI is an accurate and reproducible technique in prenatal diagnosis of IP. MRI helps planning a safe and appropriate delivery eventually assisted by IR, which positively affects foetal and maternal outcomes. ADVANCES IN KNOWLEDGE The adoption of MRI evaluation in patients with high risk of invasive placentation allows a more accurate diagnosis in terms of both presence of the disease and its extension to or through or even beyond the myometrium. This led to a better dedicated delivery management with eventual adoption of interventional radiology with a global positive effect on foetal and maternal outcomes.
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Affiliation(s)
- Federica Fiocchi
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Filippo Monelli
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Giulia Besutti
- University of Modena and Reggio Emilia, Clinical and Experimental Medicine PhD program, Modena, Italy
| | - Federico Casari
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Elisabetta Petrella
- Department of Medical and SurgicaSciences for Mothers, Children and Adults, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Annarita Pecchi
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Cristian Caporali
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
| | - Emma Bertucci
- Department of Medical and SurgicaSciences for Mothers, Children and Adults, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Stefano Busani
- Departement of intensive care medicine, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Laura Botticelli
- Departement of Pathology, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and SurgicaSciences for Mothers, Children and Adults, Azienda ospedaliero - universitaria Policlinico di Modena, Modena, Italy
| | - Pietro Torricelli
- Department of Radiology, Azienda ospedaliero- universitaria Policlinico di Modena, Modena, Italy
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Grandi G, Caroli M, Alboni C, Cortesi L, Toss A, Barbieri E, Botticelli L, Facchinetti F. Primary fallopian tube carcinoma (PFTC) in a BRIP-1 mutation carrier: the first case report. Fam Cancer 2020; 19:291-295. [PMID: 32328861 DOI: 10.1007/s10689-020-00179-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/20/2020] [Indexed: 12/20/2022]
Abstract
Some hereditary ovarian cancer cases can be associated with a mutation of a gene involved in the DNA double-strand break repair system other than BRCA, such as BRIP1. This mutation is an emerging indication for prophylactic risk-reducing salpingo-oophorectomy (RRSO): however, anomalous tubal pathologic lesions have not yet been reported during RRSO performed for this specific indication (BRIP1), as largely reported for BRCA mutation carriers. An asymptomatic 64-year-old woman with a family history of ovarian and breast cancer agreed to undergo RRSO for a pathogenic variant of the BRIP1 gene (heterozygous NM_032043.2: c.124delT, p. Cys42Valfs) with normal BRCA genes. Histological examination showed the presence of high-grade serous carcinoma of the fimbria of the right tube of a maximum diameter of 0.4 cm (final FIGO stage IIB). The pathogenic mechanism that leads to the development of high-grade serous ovarian/fallopian tube cancer in patients with mutations of BRIP1 should be the same as for patients with mutations of BRCA1 and 2. Our case confirms to consider BRIP1 mutation to be sufficient to justify RRSO at 45-50 years old.
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Affiliation(s)
- Giovanni Grandi
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy. .,Azienda Ospedaliero- Universitaria Policlinico, Obstetrics and Gynaecology Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy.
| | - Martina Caroli
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Carlo Alboni
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Laura Cortesi
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero- Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Angela Toss
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero- Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Elena Barbieri
- Department of Oncology, Haematology and Respiratory Disease, Azienda Ospedaliero- Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Laura Botticelli
- Department of Pathology, Azienda Ospedaliero-Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - Fabio Facchinetti
- Department of Medical and Surgical Sciences for Mother, Child and Adult, Azienda Ospedaliero Universitaria Policlinico, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
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11
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Losi L, Bertolini F, Guaitoli G, Fabbiani L, Banchelli F, Ambrosini-Spaltro A, Botticelli L, Scurani L, Baldessari C, Barbieri F, Cascinu S, Maiorana A. Role of evaluating tumor‑infiltrating lymphocytes, programmed death‑1 ligand 1 and mismatch repair proteins expression in malignant mesothelioma. Int J Oncol 2019; 55:1157-1164. [PMID: 31545419 DOI: 10.3892/ijo.2019.4883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/26/2019] [Indexed: 11/06/2022] Open
Abstract
The tumor immune microenvironment (TME) and immune checkpoints have been reported to serve a role in the pathogenesis of malignant mesothelioma (MM) and treatment outcome. Additionally, mismatch Repair (MMR) deficiency appears to enhance the response to checkpoints blockade in several tumors. The aim of the present study was to analyze programmed death‑1 ligand 1 (PD‑L1) expression in MM and to characterize the TME. This could help to understand the immune response, and evaluate its prognostic and predictive values. We also investigated MMR protein expression. We retrospectively analyzed 55 mesotheliomas to determine PD‑L1, CD4+, CD8+, mutL homolog 1 (MLH1), mutS homolog 2 (MSH2), mutS homolog 6 (MSH6) and PMS1 homolog 2, mismatch repair system component (PMS2) expression. We used an immunoscore (1+, 2+ and 3+) to evaluate tumor‑infiltrating lymphocytes (TILs). TILs were observed in all but two samples (53/55); the majority had an immunoscore 1+ (30/53), while 2+/3+ was reported for 23/53 samples. A predominance of CD8+ was highlighted in 8 cases (15%). PD‑L1 expression of ≥1% on tumor cells was displayed in 40 cases; in 9 of these, ≥50% expression was reported. Of note, alterations in MMR staining was not observed. In addition, survival analysis revealed that epithelioid subtype was associated with better prognosis. We observed a trend towards poorer prognosis for ≥50% PD‑L1 expression on tumor cells, lower immunoscore (1+) and CD8+ TIL predominance. The present study highlighted the importance of exploring the TME and the standardization of PD‑L1 assessment guidelines to apply in the field of immunotherapy.
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Affiliation(s)
- Lorena Losi
- Department of Life Sciences, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
| | - Federica Bertolini
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Giorgia Guaitoli
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Luca Fabbiani
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
| | - Federico Banchelli
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
| | | | - Laura Botticelli
- Unit of Pathology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Letizia Scurani
- Department of Life Sciences, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
| | - Cinzia Baldessari
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Fausto Barbieri
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Stefano Cascinu
- Division of Medical Oncology, Azienda Ospedaliero‑Universitaria Policlinico, I‑41124 Modena, Italy
| | - Antonino Maiorana
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, I‑41124 Modena, Italy
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Grandi G, Perrone AM, Chiossi G, Friso S, Toss A, Sammarini M, Facchinetti F, Botticelli L, Palma F, De Iaco P. Increasing BMI is associated with both endometrioid and serous histotypes among endometrial rather than ovarian cancers: a case-to-case study. Gynecol Oncol 2019; 154:163-168. [DOI: 10.1016/j.ygyno.2019.04.684] [Citation(s) in RCA: 5] [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] [Received: 03/05/2019] [Revised: 04/27/2019] [Accepted: 04/30/2019] [Indexed: 12/28/2022]
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13
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Losi L, Bertolini F, Scurani L, Guaitoli G, Baldessari C, Ambrosini Spaltro A, Botticelli L, Maiorana A, Barbieri F, Cascinu S. Role of evaluating tumor infiltrating lymphocytes, programmed death-ligand 1 and mismatch-repair proteins expression in malignant mesothelioma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy301.002] [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: 11/14/2022] Open
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14
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Losi L, Fonda S, Saponaro S, Chelbi ST, Lancellotti C, Gozzi G, Alberti L, Fabbiani L, Botticelli L, Benhattar J. Distinct DNA Methylation Profiles in Ovarian Tumors: Opportunities for Novel Biomarkers. Int J Mol Sci 2018; 19:ijms19061559. [PMID: 29882921 PMCID: PMC6032431 DOI: 10.3390/ijms19061559] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 01/16/2023] Open
Abstract
Aberrant methylation of multiple promoter CpG islands could be related to the biology of ovarian tumors and its determination could help to improve treatment strategies. DNA methylation profiling was performed using the Methylation Ligation-dependent Macroarray (MLM), an array-based analysis. Promoter regions of 41 genes were analyzed in 102 ovarian tumors and 17 normal ovarian samples. An average of 29% of hypermethylated promoter genes was observed in normal ovarian tissues. This percentage increased slightly in serous, endometrioid, and mucinous carcinomas (32%, 34%, and 45%, respectively), but decreased in germ cell tumors (20%). Ovarian tumors had methylation profiles that were more heterogeneous than other epithelial cancers. Unsupervised hierarchical clustering identified four groups that are very close to the histological subtypes of ovarian tumors. Aberrant methylation of three genes (BRCA1, MGMT, and MLH1), playing important roles in the different DNA repair mechanisms, were dependent on the tumor subtype and represent powerful biomarkers for precision therapy. Furthermore, a promising relationship between hypermethylation of MGMT, OSMR, ESR1, and FOXL2 and overall survival was observed. Our study of DNA methylation profiling indicates that the different histotypes of ovarian cancer should be treated as separate diseases both clinically and in research for the development of targeted therapies.
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Affiliation(s)
- Lorena Losi
- Department of Life Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy.
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy.
| | - Sergio Fonda
- Department of Life Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Sara Saponaro
- Department of Life Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy.
- Institute of Pathology, Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Sonia T Chelbi
- Institute of Pathology, Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Cesare Lancellotti
- Department of Life Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Gaia Gozzi
- Department of Life Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Loredana Alberti
- Institute of Pathology, Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Luca Fabbiani
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy.
| | - Laura Botticelli
- Unit of Pathology, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy.
| | - Jean Benhattar
- Institute of Pathology, Lausanne University Hospital, 1011 Lausanne, Switzerland.
- Aurigen, Centre de Génétique et Pathologie, 1004 Lausanne, Switzerland.
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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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Donati A, Damiani E, Domizi R, Botticelli L, Castagnani R, Gabbanelli V, Nataloni S, Carsetti A, Scorcella C, Adrario E, Pelaia P, Preiser JC. Glycaemic variability, infections and mortality in a medical-surgical intensive care unit. CRIT CARE RESUSC 2014; 16:13-23. [PMID: 24588431] [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: 06/03/2023]
Abstract
OBJECTIVE In critically ill patients, glycaemic variability (GV) was reported as a better predictor of mortality than mean blood glucose level (BGL). We compared the ability of different GV indices and mean BGLs to predict mortality and intensive care unit-acquired infections in a population of ICU patients. DESIGN, SETTING AND PARTICIPANTS Retrospective study on adult ICU patients with ≥ three BGL measurements. GV was assessed by SD, coefficient of variation (CV) and mean amplitude of glycaemic excursion (MAGE), and by one timeweighted index, the glycaemic lability index (GLI), and compared with mean BGL. We studied 2782 patients admitted to the 12-bed medical-surgical ICU of a teaching hospital from January 2004 until December 2010. MAIN OUTCOME MEASURES Logistic regression analyses were performed to assess the association between GV and ICU mortality and ICU-acquired infections. The areas under receiver operating characteristic curves were calculated to compare the discriminatory ability of GV and mean BGL for infections and mortality. RESULTS Mortality was 16.6%, and 30% of patients had at least one infection. Patients with infections or diabetes or who were treated with insulin had a higher mean BGL and GV than other patients. GLI, SD, CV and MAGE were significantly associated with infections and mortality; mean BGL was not. Quartiles of increasing GLI were independently associated with higher mortality and an increased infection rate. Patients in the upper quartile of mean BGL and GLI had the strongest association with infections (odds ratio, 5.044 [95% CI, 1.695-15.007]; P = 0.004). CONCLUSION High GV is associated with higher risk of ICUCrit acquired infection and mortality.
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Affiliation(s)
- Abele Donati
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy.
| | - Elisa Damiani
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Roberta Domizi
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Laura Botticelli
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Roberta Castagnani
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Vincenzo Gabbanelli
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Simonetta Nataloni
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Andrea Carsetti
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Claudia Scorcella
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Erica Adrario
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Paolo Pelaia
- Anaesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Jean-Charles Preiser
- Department of General Intensive Care, Erasme University Hospital, Brussels, Belgium
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Donati A, Botticelli L, Castagnani R, Gabbanelli V, Damiani E, Domizi R, Pelaia P. Relationship between glycemic Lability Index, infections and outcome in critically ill patients. Crit Care 2012. [PMCID: PMC3363584 DOI: 10.1186/cc10773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Morelli A, Donati A, Ertmer C, Rehberg S, Kampmeier T, Orecchioni A, Di Russo A, D'Egidio A, Landoni G, Lombrano MR, Botticelli L, Valentini A, Zangrillo A, Pietropaoli P, Westphal M. Effects of vasopressinergic receptor agonists on sublingual microcirculation in norepinephrine-dependent septic shock. Crit Care 2011; 15:R217. [PMID: 21929764 PMCID: PMC3334762 DOI: 10.1186/cc10453] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Revised: 07/28/2011] [Accepted: 09/19/2011] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The present study was designed to determine the effects of continuously infused norepinephrine (NE) plus (1) terlipressin (TP) or (2) arginine vasopressin (AVP) or (3) placebo on sublingual microcirculation in septic shock patients. The primary study end point was a difference of ≥ 20% in the microvascular flow index of small vessels among groups. METHODS The design of the study was a prospective, randomized, double-blind clinical trial. NE was titrated to maintain mean arterial pressure (MAP) between 65 and 75 mmHg after establishment of normovolemia in 60 septic shock patients. Thereafter patients (n = 20 per group) were randomized to receive continuous infusions of either TP (1 μg/kg/hour), AVP (0.04 U/minute) or placebo (isotonic saline). In all groups, open-label NE was adjusted to maintain MAP within threshold values if needed. The sublingual microcirculatory blood flow of small vessels was assessed by sidestream dark-field imaging. All measurements, including data from right heart catheterization and norepinephrine requirements, were obtained at baseline and 6 hours after randomization. RESULTS TP and AVP decreased NE requirements at the end of the 6-hour study period. The data are medians (25th and 75th interquartile ranges (IQRs)): 0.57 μg/kg/minute (0.29 to 1.04) vs. 0.16 μg/kg/minute (0.03 to 0.37) for TP and 0.40 μg/kg/minute (0.20 to 1.05) vs. 0.23 μg/kg/minute (0.03 to 0.77) for AVP, with statistical significance of P < 0.05 vs. baseline and vs. placebo. There were no differences in sublingual microcirculatory variables, systemic hemodynamics, oxygen transport and acid-base homeostasis among the three study groups during the entire observation period. The proportions of perfused vessels increased in relation to baseline within all study groups, and there were no significant differences between groups. The specific data were as follows (median (IQR)): 9.7% (2.6 to 19.8) for TP, 8.9% (0.0 to 17.8) for AVP, and 6.9% (3.5 to 10.1) for placebo (P < 0.05 vs. baseline for each comparison), as well as perfused vessel density 18.6% (8.6 to 36.9) for TP, 20.2% (-3.0 to 37.2) for AVP, and 11.4% (-3.0 to 19.4) for placebo (P < 0.05 vs. baseline for each comparison). CONCLUSIONS The present study suggests that to achieve a MAP of 65 to 75 mmHg in septic patients treated with NE, the addition of continuously infused low-dose TP or AVP does not affect sublingual microcirculatory blood flow. In addition, our results suggest that microcirculatory flow abnormalities are mainly related to other factors (for example, volume status, timing, hemodynamics and progression of the disease) rather than to the vasopressor per se. TRIAL REGISTRATION ClinicalTrial.gov NCT00995839.
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Affiliation(s)
- Andrea Morelli
- Department of Anesthesiology and Intensive Care, University of Rome, "La Sapienza," Viale del Policlinico 155, Rome I-00161, Italy
| | - Abele Donati
- Department of Neuroscience-Anesthesia and Intensive Care Unit, Università Politecnica delle Marche, Via Tronto 10, Torrette di Ancona I-60020, Italy
| | - Christian Ertmer
- Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Strasse 33, Muenster D-48149, Germany
| | - Sebastian Rehberg
- Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Strasse 33, Muenster D-48149, Germany
| | - Tim Kampmeier
- Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Strasse 33, Muenster D-48149, Germany
| | - Alessandra Orecchioni
- Department of Anesthesiology and Intensive Care, University of Rome, "La Sapienza," Viale del Policlinico 155, Rome I-00161, Italy
| | - Alessandro Di Russo
- Department of Anesthesiology and Intensive Care, University of Rome, "La Sapienza," Viale del Policlinico 155, Rome I-00161, Italy
| | - Annalia D'Egidio
- Department of Anesthesiology and Intensive Care, University of Rome, "La Sapienza," Viale del Policlinico 155, Rome I-00161, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Via Olgettina 60, Milan I-20132, Italy
| | - Maria Rita Lombrano
- Department of Neuroscience-Anesthesia and Intensive Care Unit, Università Politecnica delle Marche, Via Tronto 10, Torrette di Ancona I-60020, Italy
| | - Laura Botticelli
- Department of Neuroscience-Anesthesia and Intensive Care Unit, Università Politecnica delle Marche, Via Tronto 10, Torrette di Ancona I-60020, Italy
| | - Agnese Valentini
- Department of Neuroscience-Anesthesia and Intensive Care Unit, Università Politecnica delle Marche, Via Tronto 10, Torrette di Ancona I-60020, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Via Olgettina 60, Milan I-20132, Italy
| | - Paolo Pietropaoli
- Department of Anesthesiology and Intensive Care, University of Rome, "La Sapienza," Viale del Policlinico 155, Rome I-00161, Italy
| | - Martin Westphal
- Department of Anesthesiology and Intensive Care, University Hospital of Muenster, Albert-Schweitzer-Strasse 33, Muenster D-48149, Germany
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Brausi M, Giliberto G, Simonini G, Botticelli L, Di Gresgorio C. UP-02.131 Irreversible Electroporation (IRE), A Novel Technique for Focal Ablation of Prostate Cancer (PCa): Results of a Interim Pilot Safety Study in Low Risk Patients with PCa. Urology 2011. [DOI: 10.1016/j.urology.2011.07.949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Donati A, Loggi S, Scorcella C, Lombrano MR, Botticelli L, Melia MC, Carsetti A, Domizi R, Tondi S, Pelaia P. Cardiac cycle efficiency as prognostic index in ICUs. Crit Care 2011. [PMCID: PMC3061685 DOI: 10.1186/cc9475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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21
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Morelli A, Donati A, Ertmer C, Rehberg S, Orecchioni A, Di Russo A, Citterio G, Lombrano MR, Botticelli L, Valentini A, Pelaia P, Pietropaoli P, Westphal M. Effects of vasopressinergic V1 receptor agonists on sublingual microcirculatory blood flow in patients with catecholamine-dependent septic shock. Crit Care 2011. [PMCID: PMC3061721 DOI: 10.1186/cc9511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Donati A, Loggi S, Carsetti A, Lombrano MR, Botticelli L, Valentini A, Fiori V, Domizi R, Scorcella C, Pelaia P. Pressure recording analytical method versus PiCCO in hemodynamic unstable patients. Crit Care 2011. [PMCID: PMC3061693 DOI: 10.1186/cc9483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Donati A, Romanelli M, Botticelli L, Valentini A, Gabbanelli V, Nataloni S, Principi T, Pelaia P, Bezemer R, Ince C. Recombinant activated protein C treatment improves tissue perfusion and oxygenation in septic patients measured by near-infrared spectroscopy. Crit Care 2009; 13 Suppl 5:S12. [PMID: 19951384 PMCID: PMC2786114 DOI: 10.1186/cc8010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The purpose was to test the hypothesis that muscle perfusion, oxygenation, and microvascular reactivity would improve in patients with severe sepsis or septic shock during treatment with recombinant activated protein C (rh-aPC) (n = 11) and to explore whether these parameters are related to macrohemodynamic indices, metabolic status or Sequential Organ Failure Assessment (SOFA) score. Patients with contraindications to rh-aPC were used as a control group (n = 5). MATERIALS AND METHODS Patients were sedated, intubated, mechanically ventilated, and hemodynamically monitored with the PiCCO system. Tissue oxygen saturation (StO2) was measured using near-infrared spectroscopy (NIRS) during the vascular occlusion test (VOT). Baseline StO2 (StO2 baseline), rate of decrease in StO2 during VOT (StO2 downslope), and rate of increase in StO2 during the reperfusion phase were (StO2 upslope) determined. Data were collected before (T0), during (24 hours (T1a), 48 hours (T1b), 72 hours (T1c) and 96 hours (T1d)) and 6 hours after stopping rh-aPC treatment (T2) and at the same times in the controls. At every assessment, hemodynamic and metabolic parameters were registered and the SOFA score calculated. RESULTS The mean +/- standard deviation Acute Physiology and Chronic Health Evaluation II score was 26.3 +/- 6.6 and 28.6 +/- 5.3 in rh-aPC and control groups, respectively. There were no significant differences in macrohemodynamic parameters between the groups at all the time points. In the rh-aPC group, base excess was corrected (P < 0.01) from T1a until T2, and blood lactate was significantly decreased at T1d and T2 (2.8 +/- 1.3 vs. 1.9 +/- 0.7 mmol/l; P < 0.05). In the control group, base excess was significantly corrected at T1a, T1b, T1c, and T2 (P < 0.05). The SOFA score was significantly lower in the rh-aPC group compared with the controls at T2 (7.9 +/- 2.2 vs. 12.2 +/- 3.2; P < 0.05). There were no differences between groups in StO2 baseline. StO2 downslope in the rh-aPC group decreased significantly at all the time points, and at T1b and T2 (-16.5 +/- 11.8 vs. -8.1 +/- 2.4%/minute) was significantly steeper than in the control group. StO2 upslope increased and was higher than in the control group at T1c, T1d and T2 (101.1 +/- 62.1 vs. 54.5 +/- 23.8%/minute) (P < 0.05). CONCLUSIONS Treatment with rh-aPC may improve muscle oxygenation (StO2 baseline) and reperfusion (StO2 upslope) and, furthermore, rh-aPC treatment may increase tissue metabolism (StO2 downslope). NIRS is a simple, real-time, non-invasive technique that could be used to monitor the effects of rh-aPC therapy at microcirculatory level in septic patients.
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Affiliation(s)
- Abele Donati
- Department of Neuroscience, Intensive Care Unit, Marche Polytechnical University, Via Tronto 10/A, 60020 Torrette di Ancona, Italy.
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Donati A, Nardella R, Gabbanelli V, Scarcella M, Romanelli M, Romagnoli L, Botticelli L, Pantanetti S, Pelaia P. The ability of PiCCO versus LiDCO variables to detect changes in cardiac index: a prospective clinical study. Minerva Anestesiol 2008; 74:367-374. [PMID: 18414371] [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: 05/26/2023]
Abstract
BACKGROUND Both PiCCO and LiDCO can provide dynamic preload parameters, pulse pressure variation (PPV) and stroke volume variation (SVV). The PiCCO device also provides a measure of intrathoracic blood volume index (ITBVI). We investigated the agreement between SVV and PPV, as well as the reliability of LiDCO- and PiCCO-measured SVV, PPV and ITBVI, in detecting fluid responsiveness before and after fluid challenge (FC). METHODS We performed a prospective clinical study in University Hospital ICU. Nine adult ICU patients with cardiovascular instability were enrolled in the study. All patients were sedated and mechanically ventilated with intermittent positive pressure ventilation. The PiCCO and LiDCO systems were both connected to each patient. The PiCCO pulse waveform system was joined by a 5-French (Fr) thermistor-tipped arterial catheter inserted into the femoral artery. LiDCO measurements were performed through radial artery pulse contour analysis. Fluid challenge was performed using a rapid infusion of 7 mL/kg of 6% hydroxyethylstarch over 30 min. RESULTS Measurements of CI, ITBVI, SVV, and PVV were made using both techniques before and after FC. Pre-FC cardiac index (CI) measurements were similar with both devices, although the reading was higher after FC with the PiCCO device (P<0.001). The correlation coefficient between PiCCO-CI and LiDCO-CI was 0.85 (95% CI: 0.69 to 0.93; P<0.001); for P-PPV and L-PPV, it was 0.74 (95% CI: 0.49 to 0.88; P<0.001). Only ITBV had a significant correlation with LiDCO-CI or PiCCO-CI. CONCLUSION We found a narrow bias but less accurate precision in cardiac index values measured by a radial artery-site LiDCO catheter and a femoral artery-site PiCCO catheter, with poor agreement between radial and femoral-derived SVV and PPV measurements. ITBVI proved to be the best predictor of fluid responsiveness. The SVV does not seem to be reliable for preload optimization in ICU patients.
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Affiliation(s)
- A Donati
- Anesthesia and Intensive Care Unit, Department of Neurosciences, Polytechnic University of Marche, Ancona, Italy.
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25
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Donati A, Botticelli L, Anastasi C, Romanelli M, Romagnoli L, Nardella R, Pelaia P. Variation of hemodynamic parameters after fluid challenge. Crit Care 2008. [PMCID: PMC4088461 DOI: 10.1186/cc6311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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26
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Donati A, Botticelli L, Anastasi C, Romanelli M, Romagnoli L, Beato V, Pelaia P. Tissue perfusion evaluation with near-infrared spectroscopy during treatment with activated protein C. Crit Care 2008. [PMCID: PMC4088438 DOI: 10.1186/cc6288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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27
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Donati A, Botticelli L, Romagnoli L, Romanelli M, Marzocchini S, Anastasi C, Pelaia P. Multiparametric evaluation of sedation in the ICU. Crit Care 2008. [PMCID: PMC4088640 DOI: 10.1186/cc6490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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28
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De Marco L, Carlinfante G, Botticelli L, Di Maira PV, Putrino I, Cavazza A. [Mixed neoplasia of the stomach: description of a case of tubular adenoma combined with carcinoid]. Pathologica 2003; 95:214-6. [PMID: 14577207] [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: 04/27/2023] Open
Abstract
We report about a gastric polyp that was a combination of tubular adenoma and carcinoid. The patient, a 76 year-old male, presented with 1 cm sessile polyp, located in the gastric body, that was a combination of a tubular adenoma with moderate dysplasia and a small carcinoid. Immunohistochemically, the latter component was positive for chromogranin and synaptophysin. The patient is alive and well 10 months after endoscopical polypectomy.
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Affiliation(s)
- L De Marco
- Unità Operative di Anatomia Patologica, Ospedale Ramazzini di Carpi, via Molinari 2, 41012 Carpi, MO
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Botticelli AR, Casali AM, Botticelli L, Zaffe D. Immunohistochemical detection of cell-cycle associated markers on paraffin embedded and formalin fixed needle biopsies of prostate cancer: correlation of p120 protein expression with AgNOR, PCNA/cyclin, Ki-67/MIB1 proliferation-scores and Gleason gradings. Eur J Histochem 1998; 42:41-8. [PMID: 9615190] [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: 02/07/2023] Open
Abstract
Paraffin embedded and formalin fixed needle biopsies of prostate cancer (PC) were used to immunocytochemically detect the p120 nucleolar protein in relation to the Gleason histological gradings (GHG), the labelling indices of proliferating nuclear immunocytochemical markers (PCNA/Cyclin, Ki-67/MIB1) and the argyrophilic nucleolar region (AgNOR) rate. The twenty-six cases of PC (6 from large histological samples and 20 from needle biopsies) were equally distributed into low (< or = 6) or high (> or = 7) GHG groups. The p120 nucleolar protein immunocytochemical reaction was randomly expressed in large histological sections but uniformly distributed without gaps in needle biopsy sections. Only on the latter were quantitative values of PCNA/Cyclin (23.2 in low and 45.3 in high GHG), Ki-67/MIB1 (13.8 in low and 43.3 in high GHG) and AgNOR (5.0 in low and 7.5 in high GHG) related to those of p120 nucleolar protein (0.8 in low and 3.8 in high GHG). The values of all these cell cycle markers increased from low to high GHG of PC, all four reaching high statistical significance between the two groups (ANOVA-two tailed p < 0.0001). The PCNA/Cyclin index showed a higher positivity than the Ki-67/MIB1 index in PC with low GHG but not in PC with high GHG. In conclusion, paraffin embedded and formalin fixed PC needle biopsies exhibit a higher diagnostic PCNA/Cyclin than Ki-67/MIB1 index for cases presenting differentiated features, whereas p120 nucleolar protein detection seems to be a suitable marker of poorer outcome of PC.
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Affiliation(s)
- A R Botticelli
- Dipartimento di Patologia Umana ed Ereditaria, Università di Pavia, Italy
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30
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Ansovini R, Barbolini G, Migaldi M, Botticelli L, De Rienzo B. [AIDS splenomegaly and related iron problems]. Pathologica 1998; 90:133-9. [PMID: 9619056] [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: 02/07/2023] Open
Abstract
Spleens collected from 85 consecutive autopsies of AIDS patients (mean age 37 years) were studied. Splenomegaly, observed in 59 cases (69.4%), does not statistically correlate with life style and blood transfusions. Eleven very large spleens (over 890 g) were associated with opportunistic infections (i.e.: mycobacteria, true fungi and rochalimaea). The histological pattern was characterized by marked lymphoid depletion of the white pulp and--in 67 cases (89.4%)--packing of the pulp cords by macrophages engulfed of brown pigment which was strongly positive to the Perls reaction for ferric iron. The contemporary presence of Perls positive and p24 immunoreactive material was diffusely observed in the cytoplasm of splenic macrophages, also positive to the alkaline tetrazolium reaction. The same was observed in the cytoplasm of monocytes/macrophages of lung and brain (in 5 out of 5 patients with splenomegaly > 600 g, randomly selected). We believe that our findings deal with the formation of a haemoglobin--p24 complex and are in keeping with recent data which suggest the formation of disulphide bonds between viral proteins and haemoglobin.
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Affiliation(s)
- R Ansovini
- Dipartimento di Scienze Morfologiche e Medico Legali, Università di Modena
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Abstract
Liver histopathology of segmental portal ischemia occurring over a long-term period has not been previously described. For these reasons histological changes in the rat liver were studied from 1 h to up to 90 days after a left lateral and middle segmental portal obstruction. Within 3 h, the hepatocytes showed glycogen depletion in Rappaport zones 1 and 2 and pericentral and central lobular congestion of sinusoids and veins, whereas within 3 days, vein thrombosis appeared in the center of the lobule and liver necrosis was observed in Rappaport zones 2 or 3 or both, followed by restitutio ad integrum of the liver lobule morphology after 20-40 days. These results can be explained in light of two conditions occurring in the rat liver: (i) the peculiar low sensitivity of the liver to O2 debit and the protective or vasoactive effects used during hypoxia; and (ii) the sinusoidal network as a collateral source of the hepatic vascular system. Therefore, morphological assessment of this arteriolar and sinusoidal system, implicated in assuring efficient collateral blood supply in the rat liver with portal ischemia, is essential for understanding the mechanisms behind a natural and timely repair of ischemic injuries in the human liver.
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Affiliation(s)
- A Manenti
- Cattedra di Chirurgia d'Urgenza, Geriatria Università di Modena, Italy
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Manenti A, Botticelli L, Bertoli R, Martinelli AM, Botticelli AR. Experimental acute infectious pancreatitis in rats: histological observations. Pathologica 1996; 88:286-90. [PMID: 8956545] [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: 02/03/2023] Open
Abstract
Microbic contamination has been shown to be a secondary pathogenetic factor in different models of acute pancreatitis. In this paper, we developed an experimental bacterial model of necrotizing acute pancreatitis (NAP). Forty rats were treated by direct inoculation of a suspension of a clinically isolated strain of Escherichia coli, with three different single 0.33 ml injections, into the head, body and tail of the pancreas. Twenty five rats were sham operated and injected with saline. All animals were sacrificed at 48 hours, 4, 6, and 12 days. This experimental model appeared easy to execute without evidence of mortality. Histomorphologically, haemorrhagic NAP was observed, with its final recovery and minimal residual and focal fibrosis of the gland. As reported in the literature, our data underline the relevance of the bacterial component on pathogenesis of NAP, especially as an aggravating factor.
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Affiliation(s)
- A Manenti
- Dipartimento di Patologia Umana ed Ereditaria, Università di Pavia
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Manenti A, Martinelli AM, Botticelli L, Botticelli AR. Experimental acute hepatic vein occlusion: histological observations in the rat. Pathologica 1995; 87:522-4. [PMID: 8868179] [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: 02/02/2023] Open
Abstract
The histological consequences of hepatic venous outflow obstruction were studied in the rat. Circulatory changes as venous congestion and interstitial fluid accumulation are followed by signs of cellular damage progressing till hemorrhagic infiltration and focal necrosis. These are quite completely reversible in a period of 15 days.
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Affiliation(s)
- A Manenti
- Cattedra di Chirurgia d'Urgenza, Università di Modena
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De Marco L, Scotti R, Negro R, Migaldi M, Zunarelli E, Botticelli L, Criscuolo M. Detection of PR and KI-67 in paraffin-embedded tissue: A comparison with fresh tissue results. Eur J Cancer 1994. [DOI: 10.1016/0959-8049(94)90741-2] [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: 10/26/2022]
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35
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Manenti A, Botticelli A, Gibertini G, Botticelli L. Experimental congestive splenomegaly: histological observations in the rat. Pathologica 1993; 85:721-4. [PMID: 8170720] [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: 01/29/2023] Open
Abstract
In course of experimental pre-hepatic portal hypertension in the rat, the most important histological alterations in the spleen, are represented by pooling of blood in the red pulp, activation of the macrophagic system, with hyperplasia of the histiocytes, increase of reticular fibers and of subcapsular myo-fibroblasts, and finally by evolution towards a diffuse fibrosis all over the parenchyma.
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Affiliation(s)
- A Manenti
- Cattedra di Patologia speciale Chirurgica, Università di Modena
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Botticelli AR, Criscuolo M, Martinelli AM, Botticelli L, Filoni A, Migaldi M. Proliferating cell nuclear antigen/cyclin in incidental carcinoma of the prostate. Virchows Arch A Pathol Anat Histopathol 1993; 423:365-8. [PMID: 7906910 DOI: 10.1007/bf01607149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Monoclonal antibody to proliferating cell nuclear antigen (PCNA) has been used to identify the growth fraction in ten cases of benign prostatic hyperplasia (BPH), in 20 prostatic microcarcinomas (PMC) and in 30 cases of infiltrating prostatic carcinoma (PC). Ten year follow-up was available on all cases by means of clinical, serological, radiological and echographic examinations. The percentage of PCNA-staining nuclei was independently counted by two observers. Statistical analysis showed significant differences between PCNA/cyclin score of BPH and PMC without recurrences with respect to those of PMC with progression and of PC. PCNA immunostaining may represent a reliable method for assessing cellular proliferative activity. It may be used as a more powerful diagnostic hallmark of PMC than patterns of non-malignant microglandular proliferation and is also a useful additional test for assigning histological grades to PMC and PC. Statistical analysis indicated that PCNA/cyclin index was an independent significant prognostic indicator of predicting malignant progression (P < or = 0.01) and survival rates (P < or = 0.05) of PC and PMC (> 5 mm diameter).
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Affiliation(s)
- A R Botticelli
- Institute of Pathological Anatomy, University of Pavia, Italy
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Abstract
Alterations in blood pressure (BP) during two aversive behavioral tasks were studied in five chronically-prepared dogs. During a signalled-avoidance task, BP levels were not altered, although heart rate (HR) increased. While propranolol (0.3 mg/kg, IA) led to slight increases in resting pressure, and phenoxybenzamine (1.0 mg/kg) reductions, the tachycardia at avoidance onset was not affected. Exposure to an unsignalled-avoidance task led to elevated diastolic BP levels during a preavoidance period and to increases in systolic BP, HR and aortic dP/dt at the inception of the avoidance session. Again, neither drug affected the tachycardia during avoidance, but both agents precluded BP and aortic dP/dt increases. Patterns of intercorrelations among cardiovascular variables were similar for both tasks, and suggested that the basis of the BP maintenance shifted from vasomotor to cardiac control during the avoidance periods. The differential cardiovascular adjustments during these tasks could not be accounted for in terms of differences in response rate. Rather, the critical variable seemed to be the amount of feedback the animal received for responding.
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Affiliation(s)
- C J Gaebelein
- Neurobiology Program, Biological Sciences Research Center, Child Development Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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