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Magri A, Harris JM, D'Arienzo V, Minisini R, Jühling F, Wing PAC, Rapetti R, Leutner M, Testoni B, Baumert TF, Zoulim F, Balfe P, Pirisi M, McKeating JA. Inflammatory Gene Expression Associates with Hepatitis B Virus cccDNA- but Not Integrant-Derived Transcripts in HBeAg Negative Disease. Viruses 2022; 14:1070. [PMID: 35632812 PMCID: PMC9146050 DOI: 10.3390/v14051070] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/11/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic hepatitis B virus (HBV) infection is a global health problem that presents as a spectrum of liver disease, reflecting an interplay between the virus and the host immune system. HBV genomes exist as episomal covalently closed circular DNA (cccDNA) or chromosomal integrants. The relative contribution of these genomes to the viral transcriptome in chronic hepatitis B (CHB) is not well-understood. We developed a qPCR method to estimate the abundance of HBV cccDNA- and integrant-derived viral transcripts and applied this to a cohort of patients diagnosed with CHB in the HBe antigen negative phase of disease. We noted a variable pattern of HBV transcripts from both DNA templates, with preS1/S2 mRNAs predominating and a significant association between increasing age and the expression of integrant-derived mRNAs, but not with inflammatory status. In contrast, cccDNA-derived transcripts were associated with markers of liver inflammation. Analysis of the inflammatory hepatic transcriptome identified 24 genes significantly associated with cccDNA transcriptional activity. Our study uncovers an immune gene signature that associates with HBV cccDNA transcription and increases our understanding of viral persistence.
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Affiliation(s)
- Andrea Magri
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - James M Harris
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | | | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Frank Jühling
- Institut de Recherche sur les Maladies Virales et Hépatiques, University of Strasbourg and Inserm, UMR_S1110, F-67000 Strasbourg, France
| | - Peter A C Wing
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
- Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford OX1 4BH, UK
| | - Rachele Rapetti
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Monica Leutner
- Department of Diagnostic Services and Supportive Therapies, ASL Verbano-Cusio-Ossola, 28887 Omegna, Italy
| | - Barbara Testoni
- Cancer Research Center of Lyon, UMR INSERM 1052, 69008 Lyon, France
| | - Thomas F Baumert
- Institut de Recherche sur les Maladies Virales et Hépatiques, University of Strasbourg and Inserm, UMR_S1110, F-67000 Strasbourg, France
- Pôle Hépato-Digestif, Institut Hopitalo-Universitaire, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
- Institut Universitaire de France, 75005 Paris, France
| | - Fabien Zoulim
- Cancer Research Center of Lyon, UMR INSERM 1052, 69008 Lyon, France
| | - Peter Balfe
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Jane A McKeating
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7FZ, UK
- Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford OX1 4BH, UK
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Minichsdorfer C, Fuereder T, Leutner M, Singer CF, Kacerovsky-Strobl S, Egle D, Greil R, Balic M, Fitzal F, Pfeiler G, Frantal S, Bartsch R, Gnant M. Effect of concomitant statin treatment in postmenopausal patients with hormone receptor-positive early-stage breast cancer receiving adjuvant denosumab or placebo: a post hoc analysis of ABCSG-18. ESMO Open 2022; 7:100426. [PMID: 35334418 PMCID: PMC9058905 DOI: 10.1016/j.esmoop.2022.100426] [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: 12/01/2021] [Revised: 02/11/2022] [Accepted: 02/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background Statins are cholesterol-lowering drugs prescribed for the prevention and treatment of cardiovascular disease. Moreover, statins may possess anticancer properties and interact with receptor activator of nuclear factor κB ligand expression. We aimed at evaluating a hypothetical synergistic effect of statins with denosumab in early-stage breast cancer (BC) patients from the Austrian Breast and Colorectal Cancer Study Group (ABCSG) trial 18. Patients and methods ABCSG-18 (NCT00556374) is a prospective, randomized, double-blind, phase III study; postmenopausal patients with hormone receptor-positive BC receiving a nonsteroidal aromatase inhibitor were randomly assigned to denosumab or placebo. In this post hoc analysis, we investigated the effects of concomitant statin therapy on recurrence risk (RR) of BC, fracture risk and bone mineral density (BMD). Results In the study population (n = 3420), statin therapy (n = 824) was associated with worse disease-free survival (DFS) [hazard ratio (HR) 1.35, 95% confidence interval (CI) 1.04-1.75; P = 0.023]. While no significant effect of lipophilic statins (n = 710) on RR was observed (HR 1.30, 95% CI 0.99-1.72; P = 0.062), patients on hydrophilic statins (n = 87) had worse DFS compared with patients not receiving any statins (HR 2.00, 95% CI 1.09-3.66; P = 0.026). This finding was mainly driven by the effect of hydrophilic statins on DFS in the denosumab arm (HR 2.63, 95% CI 1.21-5.68; P = 0.014). However, this effect subsided after correction for confounders in the sensitivity analysis. No association between statin use and fracture risk or osteoporosis was observed. Conclusion According to this analysis, hydrophilic statins showed a detrimental effect on DFS in the main model, which was attenuated after correction for confounders. Our data need to be interpreted with caution due to their retrospective nature and the low number of patients receiving hydrophilic statins. Statin co-medication was initially associated with a worse DFS in hormone receptor-positive early-stage BC patients. This effect was mainly driven by patients on hydrophilic statins. However, this effect subsided after correction for confounders in the sensitivity analysis. No association between statin use and fracture risk or osteoporosis was observed.
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Affiliation(s)
- C Minichsdorfer
- Departments of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - T Fuereder
- Departments of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - M Leutner
- Departments of Medicine 3, Clinical Division of Endocrinology, Medical University of Vienna, Vienna, Austria
| | - C F Singer
- Departments of Gynaecology, Medical University of Vienna, Vienna, Austria
| | | | - D Egle
- Department of Gynaecology, Medical University of Innsbruck, Innsbruck, Austria
| | - R Greil
- Department of Medicine 3, Paracelsus University Salzburg, Salzburg Cancer Research Institute-CCCIT, Cancer Cluster Salzburg, Salzburg, Austria
| | - M Balic
- Department of Medicine, Clinical Division of Oncology, Medical University of Graz, Graz, Austria
| | - F Fitzal
- General Surgery, Medical University of Vienna, Vienna, Austria
| | - G Pfeiler
- Departments of Gynaecology, Medical University of Vienna, Vienna, Austria
| | - S Frantal
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria
| | - R Bartsch
- Departments of Medicine 1, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria.
| | - M Gnant
- Austrian Breast & Colorectal Cancer Study Group, Vienna, Austria; Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
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3
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Cristoferi L, Calvaruso V, Overi D, Viganò M, Rigamonti C, Degasperi E, Cardinale V, Labanca S, Zucchini N, Fichera A, Di Marco V, Leutner M, Venere R, Picciotto A, Lucà M, Mulinacci G, Palermo A, Gerussi A, D’Amato D, Elisabeth O’Donnell S, Cerini F, De Benedittis C, Malinverno F, Ronca V, Mancuso C, Cazzagon N, Ciaccio A, Barisani D, Marzioni M, Floreani A, Alvaro D, Gaudio E, Invernizzi P, Carpino G, Nardi A, Carbone M. Accuracy of Transient Elastography in Assessing Fibrosis at Diagnosis in Naïve Patients With Primary Biliary Cholangitis: A Dual Cut-Off Approach. Hepatology 2021; 74:1496-1508. [PMID: 33724515 PMCID: PMC8518641 DOI: 10.1002/hep.31810] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Liver fibrosis holds a relevant prognostic meaning in primary biliary cholangitis (PBC). Noninvasive fibrosis evaluation using vibration-controlled transient elastography (VCTE) is routinely performed. However, there is limited evidence on its accuracy at diagnosis in PBC. We aimed to estimate the diagnostic accuracy of VCTE in assessing advanced fibrosis (AF) at disease presentation in PBC. APPROACH AND RESULTS We collected data from 167 consecutive treatment-naïve PBC patients who underwent liver biopsy (LB) at diagnosis at six Italian centers. VCTE examinations were completed within 12 weeks of LB. Biopsies were scored by two blinded expert pathologists, according to the Ludwig system. Diagnostic accuracy was estimated using the area under the receiver operating characteristic curves (AUROCs) for AF (Ludwig stage ≥III). Effects of biochemical and clinical parameters on liver stiffness measurement (LSM) were appraised. The derivation cohort consisted of 126 patients with valid LSM and LB; VCTE identified patients with AF with an AUROC of 0.89. LSM cutoffs ≤6.5 and >11.0 kPa enabled to exclude and confirm, respectively, AF (negative predictive value [NPV] = 0.94; positive predictive value [PPV] = 0.89; error rate = 5.6%). These values were externally validated in an independent cohort of 91 PBC patients (NPV = 0.93; PPV = 0.89; error rate = 8.6%). Multivariable analysis found that the only parameter affecting LSM was fibrosis stage. No association was found with BMI and liver biochemistry. CONCLUSIONS In a multicenter study of treatment-naïve PBC patients, we identified two cutoffs (LSM ≤6.5 and >11.0 kPa) able to discriminate at diagnosis the absence or presence, respectively, of AF in PBC patients, with external validation. In patients with LSM between these two cutoffs, VCTE is not reliable and liver biopsy should be evaluated for accurate disease staging. BMI and liver biochemistry did not affect LSMs.
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Affiliation(s)
- Laura Cristoferi
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly,Bicocca Bioinformatics Biostatistics and Bioimaging Centre‐B4School of Medicine and SurgeryUniversity of Milan‐BicoccaMonzaItaly
| | - Vincenza Calvaruso
- Section of Gastroenterology and Hepatology, PROMISEUniversity of PalermoPalermoItaly
| | - Diletta Overi
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics SciencesSapienza University of RomeRomeItaly
| | - Mauro Viganò
- Division of HepatologyOspedale San GiuseppeUniversity of MilanMilanItaly
| | - Cristina Rigamonti
- Department of Translational MedicineUniversità degli Studi del Piemonte Orientale “A. Avogadro”NovaraItaly
| | - Elisabetta Degasperi
- CRC “A. M. e A. Migliavacca” Center for Liver Diseases, Division of Gastroenterology and HepatologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Vincenzo Cardinale
- Department of Medico‐Surgical Sciences and BiotechnologiesPolo Pontino “Sapienza” University of RomeLatinaItaly
| | - Sara Labanca
- Department of Internal MedicineUniversity of GenoaGenoaItaly
| | | | - Anna Fichera
- Section of Gastroenterology and Hepatology, PROMISEUniversity of PalermoPalermoItaly
| | - Vito Di Marco
- Section of Gastroenterology and Hepatology, PROMISEUniversity of PalermoPalermoItaly
| | | | - Rosanna Venere
- Department of Precision and Translational MedicineSapienza University of RomeRomeItaly
| | | | - Martina Lucà
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Giacomo Mulinacci
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Andrea Palermo
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Alessio Gerussi
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Daphne D’Amato
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Sarah Elisabeth O’Donnell
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Federica Cerini
- Division of HepatologyOspedale San GiuseppeUniversity of MilanMilanItaly
| | - Carla De Benedittis
- Department of Translational MedicineUniversità degli Studi del Piemonte Orientale “A. Avogadro”NovaraItaly
| | - Federica Malinverno
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Vincenzo Ronca
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Clara Mancuso
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Nora Cazzagon
- Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly
| | - Antonio Ciaccio
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Donatella Barisani
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly
| | - Marco Marzioni
- Department of GastroenterologyUniversità Politecnica delle MarcheAnconaItaly
| | - Annarosa Floreani
- Studiosa SeniorUniversity of PaduaPaduaItaly,Scientific ConsultantIRCCS NegrarVeronaItaly
| | - Domenico Alvaro
- Department of Medico‐Surgical Sciences and BiotechnologiesPolo Pontino “Sapienza” University of RomeLatinaItaly
| | - Eugenio Gaudio
- Department of Anatomical, Histological, Forensic Medicine and Orthopedics SciencesSapienza University of RomeRomeItaly
| | - Pietro Invernizzi
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
| | - Guido Carpino
- Department of Movement, Human and Health ScienceUniversity of Rome “Foro Italico”RomeItaly
| | - Alessandra Nardi
- Department of MathematicsUniversity of Rome Tor VergataRomeItaly
| | - Marco Carbone
- Division of GastroenterologyCenter for Autoimmune Liver DiseasesDepartment of Medicine and SurgeryUniversity of Milano‐BicoccaMonzaItaly,European Reference Network on Hepatological Diseases (ERN RARE‐LIVER)San Gerardo HospitalMonzaItaly
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Vassia V, Croce A, Ravanini P, Leutner M, Saglietti C, Fangazio S, Quaglia M, Smirne C. Unusual presentation of fatal disseminated varicella zoster virus infection in a patient with lupus nephritis: a case report. BMC Infect Dis 2020; 20:538. [PMID: 32703300 PMCID: PMC7376941 DOI: 10.1186/s12879-020-05254-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 07/14/2020] [Indexed: 11/26/2022] Open
Abstract
Background The risk of life-threatening complications, such as visceral disseminated varicella zoster virus (VZV) infection, is greater in immunosuppressed individuals, such as systemic lupus erythematosus (SLE) patients. Case presentation Here, a case is reported of a Caucasian woman diagnosed with lupus nephritis and anti-phospholipid syndrome, who was subjected to mycophenolate mofetil and high-dose steroid remission-induction therapy. Two months later she developed abdominal pain followed by a fatal rapid multi-organ failure. As no typical skin rashes were evident, death was initially attributed to catastrophic anti-phospholipid syndrome. However, autopsy and virological examinations on archival material revealed a disseminated VZV infection. Conclusions Overall, this case highlights the importance of having a high clinical suspicion of fatal VZV infections in heavily immunosuppressed SLE patients even when typical signs and symptoms are lacking.
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Affiliation(s)
- Veronica Vassia
- Department of Translational Medicine, DiMet, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Alessandro Croce
- Department of Translational Medicine, DiMet, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Paolo Ravanini
- Laboratory of Molecular Virology, AOU Maggiore della Carità, Novara, Italy
| | - Monica Leutner
- Histopathology Unit, AOU Maggiore della Carità, Novara, Italy
| | | | - Stefano Fangazio
- Department of Translational Medicine, DiMet, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Marco Quaglia
- Department of Translational Medicine, DiMet, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy
| | - Carlo Smirne
- Department of Translational Medicine, DiMet, Università del Piemonte Orientale, via Solaroli 17, 28100, Novara, Italy.
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5
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Perardi F, Abbate G, Iannuzzelli LR, Contini R, De Munari M, Sciuto FG, Leutner M, Scotti A. Angioleiomyoma of the Larynx: A Case Report and Literature Review. Ear Nose Throat J 2020; 99:658-663. [PMID: 32603184 DOI: 10.1177/0145561320934930] [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] [Indexed: 11/16/2022] Open
Abstract
Angioleiomyoma is a benign smooth muscle and vessel tumor; laryngeal localization is extremely rare with only 24 cases described in the literature; moreover, it should be considered in the differential diagnosis of laryngeal mass. Endoscopic complete surgical excision with dissection along capsule is now considered the gold-standard treatment for small and well-circumscribed laryngeal angioleiomyoma. We present a case of laryngeal angioleiomyoma successfully treated with carbon dioxide laser technology which resulted in a bleeding reduction and adequate hemostasis with less tissue damage and good functional outcome.
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Affiliation(s)
- Federica Perardi
- ENT and Cervicofacial Surgery Department, "S. Biagio" Hospital, Domodossola (VB), Italy
| | - Giuseppe Abbate
- ENT and Cervicofacial Surgery Department, "S. Biagio" Hospital, Domodossola (VB), Italy
| | | | - Rossella Contini
- ENT and Cervicofacial Surgery Department, "S. Biagio" Hospital, Domodossola (VB), Italy
| | - Manuela De Munari
- ENT and Cervicofacial Surgery Department, "S. Biagio" Hospital, Domodossola (VB), Italy
| | - Francesco G Sciuto
- ENT and Cervicofacial Surgery Department, "S. Biagio" Hospital, Domodossola (VB), Italy
| | - Monica Leutner
- Pathology Department, "Castelli" Hospital, Verbania (VB), Italy
| | - Antonio Scotti
- ENT and Cervicofacial Surgery Department, "S. Biagio" Hospital, Domodossola (VB), Italy
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6
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Pirovano A, Matino E, Zecca E, Costanzo M, Croce A, Leutner M, Romito R, Pirisi M. A 28-Year-Old Woman with Ascites and Multiple Focal Spleen Lesions. Eur J Case Rep Intern Med 2019; 6:001061. [PMID: 31157180 PMCID: PMC6542493 DOI: 10.12890/2019_001061] [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: 01/30/2019] [Accepted: 04/15/2019] [Indexed: 11/12/2022] Open
Abstract
Serous effusions complicating the course of lymphomas occur commonly in the pleural space but seldom in the peritoneum, where they most often present as chylous ascites with diagnostic cytology. Almost invariably, in these rare cases, the serum to ascites albumin gradient is low. We describe a 28-year-old woman with anasarca, ascites and a serum to ascites albumin gradient of 1.1 g/dl, consistent with portal hypertension. No tumour cells were detected in the ascitic fluid. However, a CT scan of the chest and abdomen disclosed liver and spleen enlargement and multiple enlarged retroperitoneal lymph nodes, suspicious for a lymphoproliferative disorder. Bone marrow aspiration and biopsy were not diagnostic, so a decision was made to proceed with a splenectomy despite the onset of low-grade disseminated intravascular coagulation. Surgery was uneventful. Diffuse large B cell lymphoma was diagnosed. A liver biopsy taken at the time of surgery demonstrated that the liver parenchyma was massively infiltrated by reactive T lymphocytes surrounding rare large CD20+ tumour cells. This infiltrate had likely led to increased portal pressure attended by ascites formation, which resolved completely after chemotherapy. The case emphasizes the rewards of pursuing a diagnosis supported by a high prior probability even in the presence of apparently discordant laboratory findings, as well as the importance of performing a diagnostic splenectomy in case of splenomegaly with unexplained focal lesions.
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Affiliation(s)
| | - Erica Matino
- Università del Piemonte Orientale, Novara, Italy
| | - Erika Zecca
- Università del Piemonte Orientale, Novara, Italy
| | | | | | - Monica Leutner
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Raffaele Romito
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Mario Pirisi
- Università del Piemonte Orientale, Novara, Italy.,Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
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7
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Howell J, Atkinson SR, Pinato DJ, Knapp S, Ward C, Minisini R, Burlone ME, Leutner M, Pirisi M, Büttner R, Khan SA, Thursz M, Odenthal M, Sharma R. Identification of mutations in circulating cell-free tumour DNA as a biomarker in hepatocellular carcinoma. Eur J Cancer 2019; 116:56-66. [PMID: 31173963 DOI: 10.1016/j.ejca.2019.04.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 04/03/2019] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is increasing globally. Prognostic biomarkers are urgently needed to guide treatment and reduce mortality. Tumour-derived circulating cell-free DNA (ctDNA) is a novel, minimally invasive means of determining genetic alterations in cancer. We evaluate the accuracy of ctDNA as a biomarker in HCC. METHODS Plasma cell-free DNA, matched germline DNA and HCC tissue DNA were isolated from patients with HCC (n = 51) and liver cirrhosis (n = 10). Targeted, multiplex polymerase chain reaction ultra-deep sequencing was performed using a liver cancer-specific primer panel for genes ARID1A, ARID2, AXIN1, ATM, CTNNB1, HNF1A and TP53. Concordance of mutations in plasma ctDNA and HCC tissue DNA was determined, and associations with clinical outcomes were analysed. RESULTS Plasma cell-free DNA was detected in all samples. Lower plasma cell-free DNA levels were seen in Barcelona Clinic Liver Cancer (BCLC A compared with BCLC stage B/C/D (median concentration 122.89 ng/mL versus 168.21 ng/mL, p = 0.041). 29 mutations in the eight genes (21 unique mutations) were detected in 18/51 patients (35%), median 1.5 mutations per patient (interquartile range 1-2). Mutations were most frequently detected in ARID1A (11.7%), followed by CTNNB1 (7.8%) and TP53 (7.8%). In patients with matched tissue DNA, all mutations detected in plasma ctDNA detected were confirmed in HCC DNA; however, 71% of patients had mutations identified in HCC tissue DNA that were not detected in matched ctDNA. CONCLUSION ctDNA is quantifiable across all HCC stages and allows detection of mutations in key driver genes of hepatic carcinogenesis. This study demonstrates high specificity but low sensitivity of plasma ctDNA for detecting mutations in matched HCC tissue.
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Affiliation(s)
- Jessica Howell
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK; Centre for Population Health, Macfarlane-Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia; Department of Medicine, University of Melbourne, St Vincent's Hospital, 55 Victoria Pde, Fitzroy, 3065, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 85 Commercial Rd, Melbourne 3004, Australia
| | - Stephen R Atkinson
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - David J Pinato
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Susanne Knapp
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK; Department of Women's Cancer, Institute for Women's Health, University College London, 72 Huntley St, London, WC1C6DD, UK
| | - Caroline Ward
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Rosalba Minisini
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Via Solaroli 17, 28100, Novara, Italy
| | - Michela E Burlone
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Via Solaroli 17, 28100, Novara, Italy
| | - Monica Leutner
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Via Solaroli 17, 28100, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Via Solaroli 17, 28100, Novara, Italy
| | - Reinhard Büttner
- Institute for Pathology, University Hospital of Cologne and Center of Integrative Oncology, University Clinic of Cologne and Bonn, Kerpener Str. 62, 50924, Cologne, Germany; The Center of Molecular Medicine, The Center for Molecular Medicine Cologne (CMMC), 50931, Cologne, Germany
| | - Shahid A Khan
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Mark Thursz
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK
| | - Margarete Odenthal
- Institute for Pathology, University Hospital of Cologne and Center of Integrative Oncology, University Clinic of Cologne and Bonn, Kerpener Str. 62, 50924, Cologne, Germany; The Center of Molecular Medicine, The Center for Molecular Medicine Cologne (CMMC), 50931, Cologne, Germany
| | - Rohini Sharma
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, W120HS, London, UK.
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8
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Affiliation(s)
- Elia Armellini
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Monica Leutner
- Department of Pathology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Davide Stradella
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Marco Ballarè
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
| | - Pietro Occhipinti
- Department of Gastroenterology, "Maggiore Della Carità" Hospital, Novara, Italy
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9
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Miglino B, Tiberio R, Boggio P, Astolfi S, Leutner M, Colombo E. Cutaneous extramedullary hematopoiesis. Ital J Dermatol Venerol 2017; 152:540-542. [PMID: 28906093 DOI: 10.23736/s0392-0488.16.05355-4] [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: 11/08/2022]
Affiliation(s)
- Benedetta Miglino
- Department of Dermatology, "Maggiore della Carità Hospital", UPO, Novara, Italy -
| | - Rossana Tiberio
- Department of Dermatology, "Maggiore della Carità Hospital", UPO, Novara, Italy
| | - Paolo Boggio
- Department of Dermatology, "Maggiore della Carità Hospital", UPO, Novara, Italy
| | - Stefano Astolfi
- Department of Dermatology, "Maggiore della Carità Hospital", UPO, Novara, Italy
| | - Monica Leutner
- Department of Pathology, "Maggiore della Carità Hospital", UPO, Novara, Italy
| | - Enrico Colombo
- Department of Dermatology, "Maggiore della Carità Hospital", UPO, Novara, Italy
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10
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Pinato DJ, Victor S, Spina P, Trivedi P, Pirisi M, Burlone M, Black JM, Minisini R, Leutner M, Boldorini R, Mauri FA, Sharma R. Intra-tumour heterogeneity in the regulation of immune-tolerogenic pathways in primary and metastatic hepatocellular carcinoma (HCC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e14614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14614 Background: Anti-PD-1/PD-L1 checkpoint inhibitors have shown preliminary evidence of activity in HCC. PD-L1 status is a putative predictor of response, however PD ligands expression can be heterogeneous across sampled sites, with implications in the development of immunotherapy. Methods: We constructed a tissue microarray from 77 patients: 56 with surgically resected and 21 with intermediate/advanced HCC in whom 20 matching metastases were also available. Tumour and surrounding cirrhosis were analysed for PD-L1 and PD-L2 expression by immunohistochemistry. FFPE-extracted RNA was analyzed on the NanoString nCounter system using 12 paired primary/metastatic HCC cores from 6 patients, with validation in a subset of further 24 specimens. Results: Surgically resected cases were Child A (51/56, 91%), BCLC A (45/56, 80%). In resected tumour cores 11/56 (20%) were PD-L1 and 18/56 (32%) were PD-L2 positive. Surrounding cirrhotic liver revealed PD-L1 in the lymphocytic infiltrate in 8/56 samples (14%), whilst PD-L2 expression was found in the cirrhotic background in 29/56 cases (52%). PD-L2 expression in cirrhotic (p = 0.03) but not in tumour cores (p = 0.13) correlated with more advanced BCLC stage. In patients with intermediate-advanced HCC (n = 21), the prevalence of tumour PD-Ls expression was 40% (8/21) for both markers. Concordance between PD-L1 positive primary and metastases was 33% and 85% in PD-L1 negative tumours. In contrast, there was universal concordance between in PD-L2 expression between primary and metastatic HCC (p < 0.001). Targeted transcriptomic profiling revealed a subset of 40 genes involved in innate and adaptive immunity to be differentially regulated across primary and metastatic disease. Conclusions: Intra-tumour heterogeneity in the expression of PD-L1 is common in HCC, whilst PD-L2 is homogeneously distributed in primary and metastatic deposits. Unsupervised transcriptomic profiling confirms differential activation of innate and adaptive immune-related pathways in the metastatic dissemination of liver cancer. This has profound implications in the clinical development of immune response biomarkers in HCC.
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Affiliation(s)
| | - Stephane Victor
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - Paolo Spina
- Università del Piemonte Orientale, Novara, Italy
| | - Pritesh Trivedi
- Department of Histopathology, Imperial College London, London, United Kingdom
| | - Mario Pirisi
- Università del Piemonte Orientale, Novara, Italy
| | | | - James M Black
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | | | | | - Francesco A Mauri
- Department of Pathology, Imperial College London, London, United Kingdom
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11
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Göbl C, Bozkurt L, Leutner M, Husslein P, Eppel W, Kautzky-Willer A. Auswirkung bariatrischer Chirurgie auf den Glukosestoffwechsel in der Schwangerschaft. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602323] [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] Open
Affiliation(s)
- C Göbl
- Abteilung für Geburtshilfe und Feto-maternale Medizin, Univ.-Klinik für Frauenheilkunde, Medizinische Universität Wien
| | - L Bozkurt
- Abteilung für Geburtshilfe und Feto-maternale Medizin, Univ.-Klinik für Frauenheilkunde, Medizinische Universität Wien
| | - M Leutner
- Abteilung für Geburtshilfe und Feto-maternale Medizin, Univ.-Klinik für Frauenheilkunde, Medizinische Universität Wien
| | - P Husslein
- Abteilung für Geburtshilfe und Feto-maternale Medizin, Univ.-Klinik für Frauenheilkunde, Medizinische Universität Wien
| | - W Eppel
- Abteilung für Geburtshilfe und Feto-maternale Medizin, Univ.-Klinik für Frauenheilkunde, Medizinische Universität Wien
| | - A Kautzky-Willer
- Abteilung für Geburtshilfe und Feto-maternale Medizin, Univ.-Klinik für Frauenheilkunde, Medizinische Universität Wien
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12
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Hornung-Praehauser V, Ploessnig M, Zauchner-Studnicka S, Kautzky-Willer A, Leutner M. Better insight into gender-specific diabetes self-management for more effective diabetes services. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw174.121] [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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13
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Göbl C, Ott J, Bozkurt L, Feichtinger M, Rehmann V, Cserjan A, Heinisch M, Steinbrecher H, Just-Kukurova I, Tuskova R, Leutner M, Vytiska-Binstorfer E, Kurz C, Weghofer A, Tura A, Egarter C, Kautzky-Willer A. To assess the association between glucose metabolism and ectopic lipid content in different clinical classifications of PCOS. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1584116] [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: 10/21/2022]
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14
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Miglino B, Tiberio R, Astolfi S, Graziola F, Boggio P, Leutner M, Valente G, Franchini R, Colombo E. Basal Cell Carcinoma of the Nipple in a Male Patient: A Particular Case Report. Breast J 2016; 22:339-341. [PMID: 26923527 DOI: 10.1111/tbj.12577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Basal cell carcinoma (BCC) is a common skin cancer worldwide. However, BCC of the nipple and areola complex is rare. Men are more affected than women. Most of the cases were treated with simple excision. We report a case of BCC of the right nipple-areola complex in a 75-year-old man, treated with Mohs surgery and simple mastectomy.
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Affiliation(s)
- Benedetta Miglino
- Dermatology and Venereology Department, "Maggiore della Carità" Hospital and "A. Avogadro", University of Eastern Piedmont, Novara, Italy
| | - Rossana Tiberio
- Dermatology and Venereology Department, "Maggiore della Carità" Hospital and "A. Avogadro", University of Eastern Piedmont, Novara, Italy
| | - Stefano Astolfi
- Dermatology and Venereology Department, "Maggiore della Carità" Hospital and "A. Avogadro", University of Eastern Piedmont, Novara, Italy
| | - Francesca Graziola
- Dermatology and Venereology Department, "Maggiore della Carità" Hospital and "A. Avogadro", University of Eastern Piedmont, Novara, Italy
| | - Paolo Boggio
- Dermatology and Venereology Department, "Maggiore della Carità" Hospital and "A. Avogadro", University of Eastern Piedmont, Novara, Italy
| | - Monica Leutner
- Department of Medical Sciences, "Maggiore della Carità" Hospital and "A. Avogadro", University of Eastern Piedmont, Novara, Italy
| | - Guido Valente
- Department of Medical Sciences, "Maggiore della Carità" Hospital and "A. Avogadro", University of Eastern Piedmont, Novara, Italy
| | - Roberto Franchini
- Surgical Department, "Maggiore della Carità" Hospital, Novara, Italy
| | - Enrico Colombo
- Dermatology and Venereology Department, "Maggiore della Carità" Hospital and "A. Avogadro", University of Eastern Piedmont, Novara, Italy
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15
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Rossi L, Leutner M, Sola D, Bartoli E. Leishmaniasis Mimicking Lymphoma and/or Liver Cirrhosis. Eur J Case Rep Intern Med 2014. [DOI: 10.12890/2014_000032] [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: 11/05/2022] Open
Affiliation(s)
- Luca Rossi
- University of Eastern Piedmont “A.Avogadro”, Novara
| | | | - Daniele Sola
- University of Eastern Piedmont “A.Avogadro”, Novara
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16
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Costamagna D, Pagano L, Caputo M, Leutner M, Mercalli F, Alonzo A. Incidental cancer in patients surgically treated for benign thyroid disease. Our experience at a single institution. G Chir 2013; 34:21-26. [PMID: 23463928] [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: 06/01/2023]
Abstract
Increased incidence of incidental cancer in patients operated for benign thyroid disease has been reported. We report our experience about incidental thyroid cancer (ITC) in order to better characterize this nosologic entity. Between 2001 and 2009 a total of 568 patients underwent surgery for benign thyroid disease. Patients with preoperative cytology undetermined or positive for malignancy were excluded. The most frequent indication for surgery was multinodular or diffuse nontoxic goiter. We performed total thyroidectomy in 499 cases and emithyroidectomy in 69 cases. Final histology revealed ITC in 53 patients (9.3%): 44 had papillary carcinoma (20 classic variant and 24 follicular variant), 4 follicular carcinoma, 4 medullary carcinoma and 1 primitive thyroid paraganglioma. The preoperative diagnosis was multinodular or diffuse goiter in 45 cases of ITC and uninodular goiter in 8 cases. We performed total thyroidectomy in 46 case, emithyroidectomy in 4 patients with past history of lobectomy, emithyroidectomy in 3 patients with following radicalization and central neck dissection. In 14 patients the tumor was multifocal and in 12 of these patients the tumor foci were bilateral. The lesion was a microcarcinoma in 34 cases. Mean diameter of the ITC was 1.14 cm. We retrospectively reconsidered the results of preoperative ultrasound examinations in relation to the exact position of the tumor in the specimens and we found a statistically significant association between echogenicity and papillary histotype. Twenty-six patients were followed up at our Hospital. The mean follow-up period was 38.2 months. A relapse was observed in 3/26 patients. Incidental thyroid cancer in patients operated for benign disease has its own surgical and oncological relevance. A correct preoperative assessment, with a careful selection of nodules for fine-needle aspiration cytology on the basis of ultrasound pattern, could better address the choice of surgical procedure. The non irrelevant incidence of incidental thyroid cancer, the eventuality of multifocality and bilaterality and the possible occurrence of relapse, support that total thyroidectomy without residuum is a valuable option for treating benign thyroid conditions such as multinodular goitre. When an incidental cancer is diagnosed after emithyroidectomy, a radicalization with central neck dissection could be considered. We suggest that natural history of papillary microtumors and the correct surgical approach for these lesions could be better defined with a more extensive use of "Porto proposal" criteria.
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Affiliation(s)
- D Costamagna
- Maggiore della Carità University Hospital, Novara, Italy
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17
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Abstract
The incidence of chronic idiopathic inflammatory bowel diseases (IBD) is growing in western countries, making their histological diagnosis an everyday task for all pathologists. Reviews from the literature strongly suggest that such diagnosis cannot be performed on the histological ground alone but requires a clinical-pathological approach. Moreover, bewildering variations can be observed in the terminology employed to report either individual lesions or diagnostic categories. The aim of the present paper is to suggest a practical diagnostic algorithm summarizing the main data from the literature. Particular emphasis has been placed on minimum clinical information required and the accurate definition of individual lesions. Diagnostic categories to employ and to avoid in daily practice have furthermore been stressed.
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Affiliation(s)
- Matteo Cornaggia
- Department of Laboratory Medicine, Pathology Unit, Clinica S. Carlo, Paderno Dugnano, Milano, Italy.
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18
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Pirisi M, Leutner M, Pinato DJ, Avellini C, Carsana L, Toniutto P, Fabris C, Boldorini R. Reliability and reproducibility of the edmondson grading of hepatocellular carcinoma using paired core biopsy and surgical resection specimens. Arch Pathol Lab Med 2011; 134:1818-22. [PMID: 21128781 DOI: 10.5858/2009-0551-oar1.1] [Citation(s) in RCA: 26] [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] [Indexed: 11/06/2022]
Abstract
CONTEXT It has been claimed that the Edmondson and Steiner grading system (EGS) values should be obtained preoperatively to select patients with hepatocellular carcinoma for liver transplantation. However, EGS reliability in biopsy specimens has been questioned. OBJECTIVE To verify the reliability of the EGS using core biopsy specimens and its reproducibility among pathologists. DESIGN Paired biopsy and surgical specimens obtained from 40 patients (subset 1) were retrieved by means of computer-aided search of the pathology records and blindly and independently reviewed. The EGS interrater agreement was measured using κ statistics. After having held a consensus meeting, pathologists graded an additional 21 paired hepatocellular carcinoma specimens (subset 2). RESULTS Analyzing subset 1, pathologists gave significantly lower EGS grades to the biopsy specimens (P < .001), for which the observed agreement was 32.5% (κ = 0.021), which increased to 82.5% (κ = 0.186) if only 2 categories were considered (low grade, EGS I-II; high grade, EGS III-IV). The observed agreement in the case of the surgical specimens was 52.5% (κ = 0.199), which increased to 62.5% (κ = 0.275) when the low- and high-grade scores were merged. The observed agreement between the assessments of paired biopsy and surgical specimens was 50.0% for pathologist 1 (κ = 0.057) and 35.0% for pathologist 2 (κ = 0.078). Merging the EGS grades did not improve the strength of the agreement. Analyzing subset 2 (after the consensus meeting), the observed agreement between pathologists improved more on biopsies (76.2%, κ = 0.614) than on surgical specimens (61.9%, κ = 0.434). CONCLUSIONS The EGS is easily underestimated in core biopsy specimens, and interrater disagreement between pathologists can be significant unless consensus meetings are held.
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Affiliation(s)
- Mario Pirisi
- Department of Clinical Medicine, University of Eastern Piedmont "A. Avogadro," Novara, Italy.
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19
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Pirisi M, Leutner M, Pinato DJ, Avellini C, Carsana L, Toniutto P, Fabris C, Boldorini R. Reliability and reproducibility of the edmondson grading of hepatocellular carcinoma using paired core biopsy and surgical resection specimens. Arch Pathol Lab Med 2011. [PMID: 21128781 DOI: 10.1043/2009-0551-oar1.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
CONTEXT It has been claimed that the Edmondson and Steiner grading system (EGS) values should be obtained preoperatively to select patients with hepatocellular carcinoma for liver transplantation. However, EGS reliability in biopsy specimens has been questioned. OBJECTIVE To verify the reliability of the EGS using core biopsy specimens and its reproducibility among pathologists. DESIGN Paired biopsy and surgical specimens obtained from 40 patients (subset 1) were retrieved by means of computer-aided search of the pathology records and blindly and independently reviewed. The EGS interrater agreement was measured using κ statistics. After having held a consensus meeting, pathologists graded an additional 21 paired hepatocellular carcinoma specimens (subset 2). RESULTS Analyzing subset 1, pathologists gave significantly lower EGS grades to the biopsy specimens (P < .001), for which the observed agreement was 32.5% (κ = 0.021), which increased to 82.5% (κ = 0.186) if only 2 categories were considered (low grade, EGS I-II; high grade, EGS III-IV). The observed agreement in the case of the surgical specimens was 52.5% (κ = 0.199), which increased to 62.5% (κ = 0.275) when the low- and high-grade scores were merged. The observed agreement between the assessments of paired biopsy and surgical specimens was 50.0% for pathologist 1 (κ = 0.057) and 35.0% for pathologist 2 (κ = 0.078). Merging the EGS grades did not improve the strength of the agreement. Analyzing subset 2 (after the consensus meeting), the observed agreement between pathologists improved more on biopsies (76.2%, κ = 0.614) than on surgical specimens (61.9%, κ = 0.434). CONCLUSIONS The EGS is easily underestimated in core biopsy specimens, and interrater disagreement between pathologists can be significant unless consensus meetings are held.
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Affiliation(s)
- Mario Pirisi
- Department of Clinical Medicine, University of Eastern Piedmont "A. Avogadro," Novara, Italy.
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20
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Bottini C, Platini F, Rinaldi M, Leutner M, Alabiso O, Garavoglia M, Tessitore L. p27Kip1 is inactivated in human colorectal cancer by cytoplasmic localization associated with activation of Akt/PKB. Int J Oncol 2009; 34:69-77. [PMID: 19082479] [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: 05/27/2023] Open
Abstract
p27Kip1 is a nuclear member of the Kip/Cip family of cyclin-dependent kinase inhibitors and is a negative cell cycle regulator that is thought to play a role in tumour suppression. Reduced levels of p27Kip1 are frequent in human cancers and these have been associated with poor prognosis. We have analysed p27Kip1 expression and intracellular localization in 70 human colorectal cancers by western blotting and immunohistochemistry and the results related to Akt expression and clinical pathological parameters. p27Kip1 protein expression, as evaluated by western blotting, was absent or reduced in about 63% of colorectal cancers compared with both peritumoral and normal tissue. Cytoplasmic p27Kip1 was detected, by immunohistochemical analysis, in 30% (21 of 70) of cases indicating that translocation of p27Kip1 protein into the cytoplasm may be responsible for p27Kip1 inactivation. The analysis of phosphorylated Akt by western blotting indicated that it was expressed in 38% (8 of 21) of tumours showing cytoplasmic p27Kip1. Patients whose cancer presented accumulation of cytoplasmic p27Kip1 showed poorer outcomes for cancer-related relapse and survival. These results suggest that cytoplasmic p27Kip1 localization, associated or not with Akt activation, may contribute to colorectal tumorigenesis and metastasis and it may be useful as a negative prognostic factor for the outcome of patients with colorectal cancer.
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Affiliation(s)
- C Bottini
- Department of Food, Chemical, Pharmaceutical and Pharmacological Sciences (DISCAFF), University of East Piedmont 'A. Avogadro', 28100 Novara, Italy
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21
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Rapetti R, Scaglia E, Fangazio S, Burlone ME, Leutner M, Pirisi M. Pancreatobiliary reflux resulting in pancreatic ascites and choleperitoneum after gallbladder perforation. Case Rep Gastroenterol 2008; 2:433-8. [PMID: 21897795 PMCID: PMC3166807 DOI: 10.1159/000161567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 12/25/2022] Open
Abstract
A 65-year-old man with chronic hepatitis C and no history of alcohol abuse was admitted to our liver unit for the recent development of massive ascites and presumed hepatorenal syndrome. In the preceding two weeks, he had received medical treatment for acute pancreatitis and cholecystitis. Abdominal paracentesis demonstrated a cloudy, orange peritoneal fluid, with total protein concentration 3.6 g/dl, serum-ascites albumin gradient 1.0 g/dl, and ratios of ascites-serum bilirubin and amylase approximately 8:1. Diagnostic imaging demonstrated no pancreatic pseudocysts. Ten days later, at laparotomy, acalculous perforation of the gallbladder was identified. After cholecystectomy, amylase concentration in the ascitic fluid dropped within a few days to 40% of serum values; ascites disappeared within a few weeks. We conclude that in the presence of a perforated gallbladder, pancreatobiliary reflux was responsible for this unusual combination of choleperitoneum and pancreatic ascites, which we propose to call pancreatobiliary ascites.
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Affiliation(s)
- Rachele Rapetti
- Department of Clinical and Experimental Medicine, University of Eastern Piedmont 'A. Avogadro', Novara, Italy
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22
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Fabris C, Smirne C, Toniutto P, Colletta C, Rapetti R, Minisini R, Falleti E, Leutner M, Pirisi M. Usefulness of six non-proprietary indirect markers of liver fibrosis in patients with chronic hepatitis C. Clin Chem Lab Med 2008; 46:253-9. [PMID: 18324909 DOI: 10.1515/cclm.2008.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of the study was to perform a comprehensive diagnostic evaluation of six popular, non-proprietary, indirect markers of liver fibrosis in a cohort of patients with chronic hepatitis C representing the full spectrum of disease severity. METHODS A total of 167 consecutive, hepatitis C virus RNA positive, untreated patients with chronic hepatitis C were studied. Liver biopsy with histological evaluation and age/platelet index, aspartate aminotransferase/alanine aminotransferase ratio, aspartate aminotransferase to platelet ratio index, Bonacini's discriminant score, Forn's fibrosis index and FibroIndex were assessed in all patients. RESULTS The area under the receiver operating characteristic curves of the six tests was always greater when performed to discriminate patients with METAVIR score F4 than when assessed to discriminate patients with METAVIR score > or =F2. At step-wise discriminant analysis the only indirect marker of fibrosis entered was FibroIndex, with the following correct classification of the patients: total=52.1, patients with scores F0-F1=62.2, patients with scores F2-F3=26.0 and patients with score F4=68.4. CONCLUSIONS The ability to correctly classify patients using a panel of non-proprietary indirect markers of liver fibrosis is far from being ideal. Among them, FibroIndex appears to possess the best discriminating capacity. The simultaneous use of several indirect markers of liver fibrosis does not improve their diagnostic accuracy.
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Affiliation(s)
- Carlo Fabris
- DPMSC Medical Liver Transplantation Unit, University of Udine, Udine, Italy
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23
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Rivasi F, Boldorini R, Criante P, Leutner M, Pampiglione S. Detection of Dirofilaria (Nochtiella) repens DNA by polymerase chain reaction in embedded paraffin tissues from two human pulmonary locations. APMIS 2006; 114:567-74. [PMID: 16907864 DOI: 10.1111/j.1600-0463.2006.apm_423.x] [Citation(s) in RCA: 22] [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: 11/30/2022]
Abstract
We here report two new cases of human pulmonary dirofilariasis in men aged 62 and 64 from Northern and Central Italy, respectively. Both were asymptomatic and the infections were discovered incidentally when chest radiographs taken for another reason revealed the presence of a coin lesion. The initial clinical diagnosis was oriented towards a lung tumour, and an excisional lung biopsy after thoracotomy was necessary for the final diagnosis. Pathologically, the lesion consisted of a roundish subpleural infarct with a central thrombotic artery containing sections of an immature nematode: Dirofilaria repens was diagnosed histologically in one case, the necrotic condition of the worm allowing only genus identification, Dirofilaria, in the other case. In both samples, PCR analysis amplified a 246 bp product, specific for the IpS insert 11 of D. repens. The authors stress the role of PCR in the diagnosis of this parasite from paraffin samples, also in cases in which identification of the species was not possible by conventional morphology due to poor conservation of the worm. These cases represent the first PCR-based diagnosis of D. repens in a human pulmonary dirofilariasis on samples embedded in paraffin.
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Affiliation(s)
- Francesco Rivasi
- Department of Diagnostic and Laboratory Service and Forensic Medicine, Section of Pathological Anatomy, University of Modena and Reggio Emilia, Modena, Italy.
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Abstract
Uterine myxoid leiomyosarcoma is a very rare and aggressive variant of uterine sarcoma, of which only 26 cases have been described in the literature published in English. A 59-year-old woman, who had been menopausal for 5 years and had a huge abdominal mass underwent laparotomy; histopathology of the bulky tumor revealed the particular characteristics of a myxoid leiomyosarcoma. Immunohistochemically, Ki-67 contributed toward indicating a malignancy, whereas p53 and progesterone and estrogen receptors were negative. The level of serum Ca125 was high at diagnosis, within normal limits after the fifth cycle of chemotherapy, and subsequently increased again at recurrence. Sixteen months after surgery, the patient died of respiratory failure. Immunohistochemistry and Ca125 levels can aid the diagnosis, management, and prognosis of uterine myxoid leiomyosarcoma.
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Affiliation(s)
- A Vigone
- Department of Obstetrics and Gynecology, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy.
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Abstract
Uterine myxoid leiomyosarcoma is a very rare and aggressive variant of uterine sarcoma, of which only 26 cases have been described in the literature published in English. A 59-year-old woman, who had been menopausal for 5 years and had a huge abdominal mass underwent laparotomy; histopathology of the bulky tumor revealed the particular characteristics of a myxoid leiomyosarcoma. Immunohistochemically, Ki-67 contributed toward indicating a malignancy, whereas p53 and progesterone and estrogen receptors were negative. The level of serum Ca125 was high at diagnosis, within normal limits after the fifth cycle of chemotherapy, and subsequently increased again at recurrence. Sixteen months after surgery, the patient died of respiratory failure. Immunohistochemistry and Ca125 levels can aid the diagnosis, management, and prognosis of uterine myxoid leiomyosarcoma.
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Affiliation(s)
- Mario Pirisi
- Department of Medical Sciences. University of East Piedmont, Novara, Italy
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27
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Abstract
Pulmonary dirofilariasis is a rare entity caused by Dirofilaria, a dog worm that is transmitted to humans by mosquitoes. The filarial nematode enters the subcutaneous tissue, travels to the right ventricle, dies and then embolizes the pulmonary vessels causing a small pulmonary infarction, which subsequently appears as a solitary nodule. Although these nodules are usually identified incidentally by chest radiography in asymptomatic patients, the lesion is generally presumed to be neoplastic. Diagnosis is made by surgical excision. Awareness of this benign entity is important in the differential diagnosis of pulmonary coin-lesions.
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Affiliation(s)
- Ottavio Rena
- Thoracic Surgery Department, University of Torino, Ospedale San Giovanni Battista, Via Genova 3, 10126 Torino, Italy.
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Mazzucco G, Bertani T, Fortunato M, Bernardi M, Leutner M, Boldorini R, Monga G. Different patterns of renal damage in type 2 diabetes mellitus: a multicentric study on 393 biopsies. Am J Kidney Dis 2002; 39:713-20. [PMID: 11920336 DOI: 10.1053/ajkd.2002.31988] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.4] [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: 11/11/2022]
Abstract
The frequency of various types of renal changes in patients with type 2 diabetes is not clearly defined in the literature. Reported discrepancies likely are caused by ethnic and geographic factors. However, policies used in nephrological centers for the selection of patients to undergo renal biopsy also may have an influence. The present study reports 393 renal biopsies in patients with type 2 diabetes performed in a group of centers in northwestern Italy using different (restricted [CRPs] or unrestricted [CUP]) biopsy policies. On the basis of light microscopic, immunofluorescence, and ultrastructural findings, cases were subdivided into three classes characterized by the presence of diabetic glomerulosclerosis (class 1), prevailing vascular (arterioarteriolosclerotic) and ischemic glomerular changes (class 2), other glomerulonephritides superimposed on diabetic glomerulosclerosis (class 3a), or glomerulonephritides without the presence of diabetic glomerulosclerosis (class 3b). Although no significant differences were found for class 2 (detected in 15% and 16% of patients from CRPs and the CUP, respectively), the frequency of the other two classes was strongly biased by the biopsy policy. Class 1 was found in 29% and 51% of cases, and class 3 in 57% and 33% of cases from CRPs and the CUP, respectively. Moreover, class 3a was more common (67%) in the CUP, and class 3b (78%) in CRPs. Our findings may explain conflicting data from the literature and the influence that type of adopted biopsy policy may have on an epidemiological evaluation. This study helps clarify the frequency of renal changes in patients with type 2 diabetes and suggests more extensive use of renal biopsy to obtain reliable prognostic indications and plan a rational therapeutic approach.
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Affiliation(s)
- Gianna Mazzucco
- Dipartimento di Scienze Biomediche e Oncologia Umana, Facoltà di Medicina e Chirurgia, Università di Torino, Torino, Italy
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29
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Boldorini R, Tosoni A, Leutner M, Ribaldone R, Surico N, Comello E, Min KW. Multiple small intestinal stromal tumours in a patient with previously unrecognised neurofibromatosis type 1: immunohistochemical and ultrastructural evaluation. Pathology 2002. [PMID: 11523947 DOI: 10.1080/00313020126313] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Neurofibromatosis type 1 could be associated with multiple gastrointestinal stromal tumours, although their presence is not considered among the major diagnostic criteria. We present here a case of a 50-year-old female complaining of abdominal pain, with about 100 small intestinal stromal tumours. This finding prompted us to suspect a neurofibromatosis which was clinically confirmed afterwards. Light microscopy examination revealed a low-grade stromal tumour with skeinoid fibres. Mixed neural-interstitial cells of Cajal origin or, alternatively, neural differentiation of interstitial cells of Cajal are discussed on the basis of immunophenotype (CD117+, CD34+) and ultrastructure. A 2-year follow-up did not indicate an aggressive course in the case of this neoplasm.
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Affiliation(s)
- R Boldorini
- Dipartimento di Scienze Mediche Facoltà di Medicina e Chirurgia, Università Amedeo Avogadro del Piemonte Orientale, Novara, Italy.
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30
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Guzzardi G, Natrella M, Barini M, Leutner M, Cotroneo AR. [Mature teratoma of the anterior mediastinum: a case report]. Radiol Med 2001; 102:180-3. [PMID: 11677462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- G Guzzardi
- Istituto Universitario di Radiologia Diagnostica e Interventistica, Università degli Studi del Piemonte Orientale A. Avogadro, Novara, Italy
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31
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Boldorini R, Tosoni A, Leutner M, Ribaldone R, Surico N, Comello E, Min KW. Multiple small intestinal stromal tumours in a patient with previously unrecognised neurofibromatosis type 1: immunohistochemical and ultrastructural evaluation. Pathology 2001; 33:390-5. [PMID: 11523947] [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: 02/21/2023]
Abstract
Neurofibromatosis type 1 could be associated with multiple gastrointestinal stromal tumours, although their presence is not considered among the major diagnostic criteria. We present here a case of a 50-year-old female complaining of abdominal pain, with about 100 small intestinal stromal tumours. This finding prompted us to suspect a neurofibromatosis which was clinically confirmed afterwards. Light microscopy examination revealed a low-grade stromal tumour with skeinoid fibres. Mixed neural-interstitial cells of Cajal origin or, alternatively, neural differentiation of interstitial cells of Cajal are discussed on the basis of immunophenotype (CD117+, CD34+) and ultrastructure. A 2-year follow-up did not indicate an aggressive course in the case of this neoplasm.
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Affiliation(s)
- R Boldorini
- Dipartimento di Scienze Mediche Facoltà di Medicina e Chirurgia, Università Amedeo Avogadro del Piemonte Orientale, Novara, Italy.
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32
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Boldorini R, Tosoni A, Leutner M, Ribaldone R, Surico N, Comello E, Min KW. MULTIPLE SMALL INTESTINAL STROMAL TUMOURS IN A PATIENT WITH PREVIOUSLY UNRECOGNISED NEUROFIBROMATOSIS TYPE 1: IMMUNOHISTOCHEMICAL AND ULTRASTRUCTURAL EVALUATION. Pathology 2001. [DOI: 10.1080/00313020120063054] [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: 10/17/2022]
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33
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Crippa F, Leutner M, Belli F, Gallino F, Greco M, Pilotti S, Cascinelli N, Bombardieri E. Which kinds of lymph node metastases can FDG PET detect? A clinical study in melanoma. J Nucl Med 2000; 41:1491-4. [PMID: 10994727] [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: 02/17/2023] Open
Abstract
UNLABELLED The purposes of this study were to establish the diagnostic accuracy of FDG PET for lymph node metastases and to determine the smallest detectable volume of disease. METHODS Using FDG PET, we preoperatively studied 56 lymph node basins in 38 patients with a clinical or instrumental diagnosis of lymph node metastases from melanoma. All lymph node basins underwent node dissection. The FDG PET results were compared with the postoperative histopathology results. PET images were obtained using a GE 4096 WB scanner, after injection of a mean activity of 496 MBq (range, 366-699 MBq) of FDG. RESULTS The efficacy of FDG PET in the diagnosis of involved lymph node basins was good. Sensitivity was 95% (35/37); specificity, 84% (16/19); accuracy, 91% (51/56); positive predictive value, 92% (35/38); and negative predicative value, 89% (16/18). Metastases were shown histologically in 114 of 647 surgically removed lymph nodes. FDG PET detected 100% of metastases > or = 10 mm, 83% of metastases 6-10 mm, and 23% of metastases < or = 5 mm. Moreover, FDG PET had high sensitivity (> or = 93%) only for metastases with more than 50% lymph node involvement or with capsular infiltration. CONCLUSION Our study shows that FDG PET has a reasonable sensitivity and specificity for detecting the presence or absence of lymph node metastases in patients with melanoma. However, even if able to detect small volumes of subclinical macroscopic disease, FDG PET cannot detect subclinical microscopic disease with acceptable sensitivity. The specificity of FDG PET is good, but some false-positive results may occur.
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Affiliation(s)
- F Crippa
- Division of Nuclear Medicine, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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34
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Boldorini R, Tosoni A, Ribaldone R, Surico N, Leutner M, Nebuloni M, Monga G. [Intestinal stromal tumors with skenoid fibers in patients with type I neurofibromatosis: histological and ultrastructural evaluation of a case]. Pathologica 2000; 92:132. [PMID: 10838889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- R Boldorini
- Dipartimento di Scienze Mediche Facoltà di Medicina e Chirurgia Amedeo Avogadro del Piemonte Orientale, Novara
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35
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Silvestrini R, Costa A, Lequaglie C, Mochen C, Veneroni S, Leutner M, Ravasi G. Bcl-2 protein and prognosis in patients with potentially curable non-small-cell lung cancer. Virchows Arch 1998; 432:441-4. [PMID: 9645443 DOI: 10.1007/s004280050188] [Citation(s) in RCA: 27] [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] [Indexed: 02/07/2023]
Abstract
The bcl-2 proto-oncogene functions as a cell death suppressor, and its expression prolongs cell survival by blocking apoptosis. Data available on the clinical relevance of bcl-2 protein expression in patients with non-small-cell lung cancer (NSCLC) are controversial. We analysed the role of bcl-2 protein expression on 6-year relapse-free survival in 229 patients with stage I-IIIa NSCLC (101 squamous cell carcinomas and 128 adenocarcinomas) subjected to surgery, with curative intent. Immunohistochemical analysis was performed on archival material by using a monoclonal antibody anti-bcl-2 (clone 124). Bcl-2 protein expression, which was detected in 22% of the cases, was significantly related to stage, histology and grading, and was an indicator of clinical outcome. The probability of relapse-free survival at 6 years was longer for patients with bcl-2-positive tumours (74%) than for those with bcl-2-negative tumours (57%) (P=0.02). This finding was mainly evident for the subgroups of patients with stage IIIa tumours (P=0.05), squamous cell carcinoma (P=0.03) or moderately/poorly differentiated tumours (P=0.02). However, multivariate analysis by Weibull's regression model indicated that bcl-2 protein expression was not an independent prognostic risk factor in patients with curable NSCLC when the information provided by stage was available.
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Affiliation(s)
- R Silvestrini
- Oncologia Sperimentale C, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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36
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Bajetta E, Celio L, Di Leo A, Bartoli C, Pilotti S, Leutner M, Bono A, Ferrari L, Buzzoni R, Zilembo N, De Candis D, Moglia D. Effects of short-term pre-operative tamoxifen on steroid receptor and Ki-67 expression in primary breast cancer: an immunocytochemical study. Int J Oncol 1998; 12:853-8. [PMID: 9499446 DOI: 10.3892/ijo.12.4.853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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: 02/06/2023] Open
Abstract
The effects of the short-term pre-operative administration of tamoxifen (TAM, 20 mg once daily) on the tumor levels of steroid receptors and the nuclear proliferation Ki-67 antigen, were investigated in 32 elderly patients with hormone-sensitive, operable primary breast cancer by means of fine-needle aspiration biopsy (FNAB). The FNAB smears before (pre-TAM) and after six weeks of treatment (post-TAM) were stained immunocytochemically in order to obtain an H-score for steroid receptors, and the percentage of cellular nuclei containing Ki-67. The mean oestrogen receptor (ER) score between the pre- and post-TAM specimens fell from 181.2 9.7 ( SEM) to 148.1 7.9 (Wilcoxon's matched-pairs signed-rank test, p=0. 01) and there was also a significant decrease in both the mean progesterone receptor (PgR) score (178.4 10.6 vs 148.5 10.6; p=0.01) and mean Ki-67 index (8.2% 1.2 vs 4.9% 0.9; p=0.0002). The reliability of FNAB as a sampling method was checked by comparing the results of the immunocytochemical assay (ICA) of the post-TAM biopsies with those of the immunohistochemical assay (IHA) of the corresponding excised tumors. There was a positive correlation between the ICA and IHA scores: ER (Spearman's correlation coefficient, rho=0.66, p<0.001), PgR (rho=0.84, p<0.001) and Ki-67 (rho=0.96, p<0.001). We conclude that the sequential use of FNAB is a reliable means of assessing the behaviour of within-tumor biomarkers during endocrine therapy.
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Affiliation(s)
- E Bajetta
- Medical Oncology Division, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, Milano, 20133, Italy
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37
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Pazzaglia UE, Andrini L, Leutner M, Di Nucci A. The effects of bone resorption inhibitors on the growth plate and proximal tibial metaphysis of rats: clinical implications. Orthopedics 1998; 21:195-9. [PMID: 9507271 DOI: 10.3928/0147-7447-19980201-14] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study investigated the effects of diphosphonates at scalar doses in a high bone turnover structure, namely, the proximal tibial metaphysis of rats. Arrest of bone modeling was represented by cylindrical-shaped metaphyses, increased height of the perichondrial bone bark, and persistence of primary metaphyseal trabeculae; these changes were dose-related. Higher doses of the inhibitors produced extension of the growth plate and arrest of the mineralization process. The dose-related dissociation between the effects on bone resorption and mineralization allows the therapeutic use of this class of drugs.
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Affiliation(s)
- U E Pazzaglia
- Clinica Ortopedica 2a Facolta' di Medicina e Chirurgia, Universita' di Pavia, Varese, Italy
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38
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Crippa F, Agresti R, Seregni E, Greco M, Pascali C, Bogni A, Chiesa C, De Sanctis V, Delledonne V, Salvadori B, Leutner M, Bombardieri E. Prospective evaluation of fluorine-18-FDG PET in presurgical staging of the axilla in breast cancer. J Nucl Med 1998; 39:4-8. [PMID: 9443729] [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: 02/05/2023] Open
Abstract
METHODS The presurgical, noninvasive staging of axillary nodes for metastases was prospectively investigated in 68 patients who were diagnosed with primary breast cancer using PET with 18F-fluorodeoxyglucose (FDG). Four patients had bilateral nodules; therefore, the total number of evaluable cases was 72. Visual analyses of attenuation-corrected PET images and standardized uptake values (SUVs) of FDG uptake in carcinomas were compared with histopathological surgical findings. The SUV distribution differences between carcinomas with and without axillary metastases were evaluated by means of statistical and receiver operating characteristics analyses. RESULTS PET correctly classified 64 of the 72 cases; four false-positive and four false-negative PET results were found. The overall sensitivity, specificity and accuracy of PET for axillary metastases were 85%, 91% and 89%, respectively. With respect to the clinical axillary stage of the patients (TNM, or tumor-node-metastasis, classification), we obtained the following results: N0 patients, sensitivity = 70%, specificity = 92%, accuracy = 86%; N1a patients, sensitivity = 85.5%, specificity = 100%, accuracy = 95%; and N1b-2 patients, sensitivity = 100%, specificity = 67%, accuracy = 87%. The median SUV in carcinomas with axillary metastases (4.6) was significantly higher than that in carcinomas without metastases (2.9), but there was a great SUV overlap between the two groups (interquartile ranges = 2.7-7.2 and 1.9-4.5, respectively). Analysis of the receiver operating characteristics curve showed that a high sensitivity of SUV in predicting axillary metastases was associated with a very low specificity and vice versa. With the best SUV cutoff value of 2.9, the sensitivity and specificity were 74% and 56%, respectively. CONCLUSION PET showed good overall diagnostic accuracy in the detection of axillary metastases (86%). The very high accuracy (95%) in N1a patients is of particular importance. False-negative PET findings, however, can be encountered. SUVs of breast carcinoma cannot predict the spread of the disease to the axilla, even if higher values are often associated with axillary metastases. Any decision on the use of PET in the presurgical staging of breast cancer should be incorporated into a more general debate on axillary management. In selected patients with a very low probability of axillary metastases (T1a), in whom axillary surgery can already be avoided according to data from follow-up studies, 18F-FDG PET could be proposed as a noninvasive imaging modality to improve the diagnosis of axillary relapses.
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Affiliation(s)
- F Crippa
- Division of Nuclear Medicine, National Cancer Institute, Milan, Italy
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39
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Leutner M, Gschwind RM, Liermann J, Schwarz C, Gemmecker G, Kessler H. Automated backbone assignment of labeled proteins using the threshold accepting algorithm. J Biomol NMR 1998; 11:31-43. [PMID: 9615996 DOI: 10.1023/a:1008298226961] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The sequential assignment of backbone resonances is the first step in the structure determination of proteins by heteronuclear NMR. For larger proteins, an assignment strategy based on proton side-chain information is no longer suitable for the use in an automated procedure. Our program PASTA (Protein ASsignment by Threshold Accepting) is therefore designed to partially or fully automate the sequential assignment of proteins, based on the analysis of NMR backbone resonances plus C beta information. In order to overcome the problems caused by peak overlap and missing signals in an automated assignment process, PASTA uses threshold accepting, a combinatorial optimization strategy, which is superior to simulated annealing due to generally faster convergence and better solutions. The reliability of this algorithm is shown by reproducing the complete sequential backbone assignment of several proteins from published NMR data. The robustness of the algorithm against misassigned signals, noise, spectral overlap and missing peaks is shown by repeating the assignment with reduced sequential information and increased chemical shift tolerances. The performance of the program on real data is finally demonstrated with automatically picked peak lists of human nonpancreatic synovial phospholipase A2, a protein with 124 residues.
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Affiliation(s)
- M Leutner
- Institut für Organische Chemie und Biochemie, München, Germany
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40
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Abstract
A case of disappearing bone disease of the proximal femur is reported with histopathological and immunohistochemical studies. There was a densely packed cellular tissue, positive to endothelial antibodies, in areas of massive bone destruction. A more differentiated vascular tissue was present where trabecular cancellous or cortical bone was preserved with only focal zones of accelerated bone remodelling. The self-limited course correlates well with two phases of evolution of the histopathological lesions with neoplastic-like proliferation of endothelial cells corresponding to the rapid and massive bone destruction, and a later differentiation of the cells in mature vascular structures, but still with accelerated bone resorption which is partly compensated by appositional activity.
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Affiliation(s)
- U E Pazzaglia
- Clinica Ortopedica, 2a Facoltà di Medicine e Chirurgia, Università di Pavia, Varese, Italy
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41
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Silvestrini R, Veneroni S, Benini E, Daidone MG, Luisi A, Leutner M, Maucione A, Kenda R, Zucali R, Veronesi U. Expression of p53, glutathione S-transferase-pi, and Bcl-2 proteins and benefit from adjuvant radiotherapy in breast cancer. J Natl Cancer Inst 1997; 89:639-45. [PMID: 9150188 DOI: 10.1093/jnci/89.9.639] [Citation(s) in RCA: 70] [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] Open
Abstract
BACKGROUND In clinical breast cancer research, the utility of certain biomarkers as predictors of response to surgery, chemotherapy, or hormonal therapy has been studied intensively. Much less research has been done on the relevance of biologic predictors of response to radiotherapy, which represents an effective local-regional treatment for breast cancer. PURPOSE The utility of biomarkers involved in DNA damage repair (p53 protein), control of programmed cell death (p53 and Bcl-2 proteins), and cellular detoxification (glutathione S-transferase-pi [GST-pi] enzyme) in predicting local breast cancer recurrence was analyzed retrospectively in two cohorts of breast cancer patients. These patients had had no detectable metastases in the axillary lymph nodes (i.e., node-negative) or in distant sites and had had similar distributions of clinicopathologic and biologic prognostic features. They had been treated by conservative surgery alone (139 case patients) or by conservative surgery followed by adjuvant radiotherapy (496 case patients) during the period from 1984 through 1990. METHODS The expression of the p53, GST-pi, and Bcl-2 proteins in the specimens of primary breast tumor obtained from these patients was determined by use of immunohistochemistry; cell proliferation activity and levels of steroid receptors were determined by use of a [3H]thymidine-labeling index assay and the dextran-coated charcoal technique, respectively. The median time of follow-up of patients was 6 years. In the analyses of patient outcomes, only local failures that presented as first events were considered. RESULTS After surgery alone, the risk of local recurrence at 6 years was higher for patients with tumors exhibiting elevated levels of p53 and GST-pi protein expression than for patients with low levels (hazard ratio [HR] = 3.1, 95% confidence interval [CI] = 1.3-7.7, two-sided P = .012; HR = 2.7, 95% CI = 1.1-6.4, two-sided P = .026, respectively). Weak or no observable expression of Bcl-2 protein was only suggestive of a higher frequency of local failures. Adjustment for patient age, tumor size, cell proliferation, and estrogen receptor status did not change these findings. Conversely, in the series of patients given conservative surgery followed by radiotherapy, there was no difference in local tumor recurrence between patients with tumors expressing or not expressing each of the three markers. CONCLUSIONS Our study provides indirect evidence of a benefit from radiation therapy in preventing local breast cancer relapse, particularly among node-negative patients with tumors that express elevated levels of the p53 or GST-pi proteins or that express little or no Bcl-2 protein.
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Affiliation(s)
- R Silvestrini
- Oncologia Sperimentale C, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy
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42
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Gschwind RM, Gemmecker G, Leutner M, Kessler H, Gutknecht R, Lanz R, Flükiger K, Erni B. Secondary structure of the IIB domain of the Escherichia coli mannose transporter, a new fold in the class of alpha/beta twisted open-sheet structures. FEBS Lett 1997; 404:45-50. [PMID: 9074635 DOI: 10.1016/s0014-5793(97)00084-7] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The mannose transporter of the Escherichia coli bacterial phosphotransferase system consists of three subunits: IIAB, IIC and IID. IIABMan transfers phosphoryl groups to the transported substrate via phosphohistidine intermediates. Its IIB domain was overexpressed and isotopically labelled with 13C, 15N and 2H. Heteronuclear 3D triple-resonance NMR experiments combined with a semi-automatic assignment procedure yielded the sequential assignment of the 1H, 13C and 15N backbone resonances. Based on the evaluation of conformationally sensitive parameters, the secondary structure of the IIBMan domain has been determined as an alpha/beta twisted open-sheet structure consisting of a six-stranded parallel beta-sheet with the novel strand order 3-2-4-1-5-6, six helices and a short two-stranded antiparallel beta-sheet.
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Affiliation(s)
- R M Gschwind
- Institut für Organische Chemie und Biochemie II, Technische Universität München, Germany
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43
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Silvestrini R, Daidone MG, Luisi A, Mastore M, Leutner M, Salvadori B. Cell proliferation in 3,800 node-negative breast cancers: consistency over time of biological and clinical information provided by 3H-thymidine labelling index. Int J Cancer 1997; 74:122-7. [PMID: 9036880 DOI: 10.1002/(sici)1097-0215(19970220)74:1<122::aid-ijc20>3.0.co;2-g] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For breast cancer, many prognostic markers that initially appeared promising have failed to maintain their clinical predictive value. Few reports have analyzed the consistency over time of biological and clinical information provided by biomarkers. Tumour cell proliferation has acquired relevance as an indicator of prognosis and of response to treatment. Since its clinical role has been investigated for some decades, cell proliferation represents an ideal marker for an over-time validation. In 3,800 node-negative breast cancers recruited between 1972 and 1991, the consistency of information provided by the 3H-thymidine labelling index (TLI), in terms of basic relations with other clinico-pathological and biological variables and clinical predictivity, was evaluated using a combined analysis of results previously published by our group for distinct series of patients. Clinical predictivity was analyzed on a subset of 2,067 patients given local-regional therapy until relapse and followed for a median time from 6 to 10 years. Over the entire period TLI maintained a weak direct relation with tumour size and an inverse strong relation with steroid receptors. An increase in TLI was observed for tumours in post-menopausal patients up to the mid 1980s. During 3 different accrual periods (1972-1983; 1984-1987; 1988-1991), TLI was a consistent and independent predictor of relapse-free time, distant metastasis and overall survival, regardless of its consideration as a continuous variable or with a cutoff value of 3%. The reproducibility of our results over time provides support to the consistency of the methodology used and of the biological and clinical information obtained when using TLI as an indicator of breast cancer cell proliferation.
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Affiliation(s)
- R Silvestrini
- Oncologia Sperimentale C, Istituto Nazionale Tumori, Milan, Italy
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Abstract
This review summarizes knowledge on pathology of proliferative lesions of the pituitary gland in multiple endocrine neoplasia syndrome type 1 (MENS 1). When compared with sporadic tumors occurring in general population, pituitary adenomas associated with MENS 1 show the following distinguishing features: (1) they are more often endocrinologically functional, (2) they are more often GH or PRL-producing and (3) they are more frequently plurihormonal. The study of autoptic cases discloses that pituitary PRL or mixed GH-PRL cell adenomas in MENS are multiple and are associated with PRL or GH cell hyperplasia of the peritumoral parenchyma.
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Affiliation(s)
- C Capella
- Department of Human Pathology and Genetic, University of Pavia, II Faculty of Medicine, Varese, Italy
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Riva C, Leutner M, Capella C, Usellini L, la Rosa S, Brianza MR, Buffa R. Different expression of chromogranin A and chromogranin B in various types of pituitary adenomas. Zentralbl Pathol 1993; 139:165-70. [PMID: 8396420] [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: 01/30/2023]
Abstract
Two hundred and nineteen (33 GH, 21 GH-PRL, 38 PRL, 16 ACTH, 1 TSH cell functioning and 38 FSH-LH, 17 alpha-chain, 8 mixed, 27 minimal glycoprotein--MIN-GLYC--, 11 small argyrophil granule--SAG--, 4 silent TSH-sTSH--and 5 silent ACTH-sACTH--cell nonfunctioning) adenomas were investigated immunohistochemically with antibodies against ACTH, GH, PRL, TSH, FSH, LH alpha-hCG, chromogranin A (CgA) and chromogranin B (CgB). For immunostaining of CgB a novel monoclonal (B 11) antibody was employed. All types of adenomas were positive for CgB. CgA was widely expressed in nonfunctioning FSH-LH, MIN-GLYC, SAG, MIXED, alpha-chain adenomas and in the single TSH cell functioning adenoma. CgA was lacking both in PRL and ACTH functioning adenomas and was poorly expressed in GH and GH-PRL functioning adenomas. The distribution of Grimelius' silver paralleled that of CgA-IR, but not that of CgB-IR. We conclude that: 1) CgB may be considered as an universal granular marker for pituitary adenomas, 2) CgA is an important marker for nonfunctioning adenomas, 3) the pattern of distribution of CgA and CgB for most nonfunctioning ("null cell" according to Kovacs et al.) adenomas favors their origin from glycoprotein producing (FSH/LH, TSH) cells.
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Affiliation(s)
- C Riva
- Department of Human Pathology, II Medical Faculty, University of Pavia, Varese, Italy
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