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Di Lorenzo P, Conteduca V, Scarpi E, Adorni M, Multinu F, Garbi A, Betella I, Grassi T, Bianchi T, Di Martino G, Amadori A, Maniglio P, Strada I, Carinelli S, Jaconi M, Aletti G, Zanagnolo V, Maggioni A, Savelli L, De Giorgi U, Landoni F, Colombo N, Fruscio R. Advanced low grade serous ovarian cancer: A retrospective analysis of surgical and chemotherapeutic management in two high volume oncological centers. Front Oncol 2022; 12:970918. [PMID: 36237308 PMCID: PMC9551309 DOI: 10.3389/fonc.2022.970918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Simple summaryLow-grade serous ovarian cancer (LGSOC) represents an uncommon histotype of serous ovarian cancer (accounting for approximately 5% of all ovarian cancer) with a distinct behavior compared to its high-grade serous counterpart, characterized by a better prognosis and low response rate to chemotherapeutic agents. Similar to high-grade serous ovarian cancer, cytoreductive surgery is considered crucial for patient survival. This retrospective study aimed to analyze the outcomes of women affected by advanced stages (III–IV FIGO) of LGSOC from two high-volume oncological centers for ovarian neoplasm. In particular, we sought to evaluate the impact on survival outcomes of optimal cytoreductive surgery [i.e., residual disease (RD) <10 mm at the end of surgery]. The results of our work confirm the role of complete cytoreduction (i.e., no evidence of disease after surgery) in the survival of patients and even the positive prognostic role of a minimal RD (i.e., <10 mm), whenever complete cytoreduction cannot be achieved.BackgroundLow-grade serous ovarian cancer (LGSOC) is a rare entity with different behavior compared to high-grade serous (HGSOC). Because of its general low chemosensitivity, complete cytoreductive surgery with no residual disease is crucial in advanced stage LGSOC. We evaluated the impact of optimal cytoreduction on survival outcome both at first diagnosis and at recurrence.MethodsWe retrospectively studied consecutive patients diagnosed with advanced LGSOCs who underwent cytoreductive surgery in two oncological centers from January 1994 to December 2018. Survival curves were estimated by the Kaplan–Meier method, and 95% confidence intervals (95% CI) were estimated using the Greenwood formula.ResultsA total of 92 patients were included (median age was 47 years, IQR 35–64). The median overall survival (OS) was 142.3 months in patients with no residual disease (RD), 86.4 months for RD 1–10 mm and 35.2 months for RD >10 mm (p = 0.002). Progression-free survival (PFS) was inversely related to RD after primary cytoreductive surgery (RD = 0 vs RD = 1–10 mm vs RD >10 mm, p = 0.002). On multivariate analysis, RD 1–10 mm (HR = 2.30, 95% CI 1.30–4.06, p = 0.004), RD >10 mm (HR = 3.89, 95% CI 1.92–7.88, p = 0.0004), FIGO stage IV (p = 0.001), and neoadjuvant chemotherapy (NACT) (p = 0.010) were independent predictors of PFS. RD >10 mm (HR = 3.13, 95% CI 1.52–6.46, p = 0.004), FIGO stage IV (p <0.0001) and NACT (p = 0.030) were significantly associated with a lower OS.ConclusionsOptimal cytoreductive surgery improves survival outcomes in advanced stage LGSOCs. When complete debulking is impossible, a RD <10 mm confers better OS compared to an RD >10 mm in this setting of patients.
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Affiliation(s)
- Paolo Di Lorenzo
- Obstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- *Correspondence: Paolo Di Lorenzo, ; Ugo De Giorgi,
| | - Vincenza Conteduca
- Department of Medical Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Italy
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Emanuela Scarpi
- Biostatistics and Clinical Trials Unit, Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Italy
| | - Marco Adorni
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Francesco Multinu
- Division of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy
| | - Annalisa Garbi
- Division of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy
| | - Ilaria Betella
- Division of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy
| | - Tommaso Grassi
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Tommaso Bianchi
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giampaolo Di Martino
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Andrea Amadori
- Obstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Paolo Maniglio
- Obstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Isabella Strada
- Obstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Silvestro Carinelli
- Department of Pathology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy
| | - Marta Jaconi
- Department of Pathology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Giovanni Aletti
- Division of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy
- Department of Hemato-Oncology, University of Milan, Milano, Italy
| | - Vanna Zanagnolo
- Division of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy
| | - Angelo Maggioni
- Division of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy
| | - Luca Savelli
- Obstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS) Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori”, Meldola, Italy
- *Correspondence: Paolo Di Lorenzo, ; Ugo De Giorgi,
| | - Fabio Landoni
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Nicoletta Colombo
- Division of Gynecologic Oncology, European Institute of Oncology, Istituto di ricovero e cura a carattere scientifico (IRCCS), Milano, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Maniglio P, Noventa M, Tartaglia S, Petracca M, Bonito M, Ricciardi E, Ambrosini G, Buzzaccarini G, Laganà AS. The Obstetrician Gynecologist's role in the screening of infants at risk of severe plagiocephaly: Prevalence and risk factors. Eur J Obstet Gynecol Reprod Biol 2022; 272:37-42. [PMID: 35279639 DOI: 10.1016/j.ejogrb.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/26/2022] [Accepted: 03/03/2022] [Indexed: 11/27/2022]
Abstract
This study was conducted to determine the prevalence, maternal and/or neonatal risk factors for severe plagiocephaly in order to early detect and refer infants at risk. A prospective observational study was conducted, involving 4337 infants who visited the Perinatology Center at San Pietro Fatebenefratelli Hospital in Rome, evaluated following the Plagiocephaly Severity Scale of Atlanta. ©The plagiocephaly prevalence resulted 1.89%, considering moderate to severe forms. Maternal risk factors include primiparity, older age, gestational diabetes, and uterine fibromatosis. Neonatal risk factors are early term gestational age, low weight, twin pregnancy, and prolonged labor with an emergency cesarean section. Screening for severe plagiocephaly should begin antenatally. Although the low prevalence, identifying infants at risk can prevent potential permanent sequelae. We suggest a multidisciplinary approach for the management of plagiocephaly, involving the figure of the Obstetrician Gynecologist, who can highlight the risk factors ranging from obstetric and birth conditions.
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Affiliation(s)
- Paolo Maniglio
- AUSL Romagna Ospedale "G.B. Morgagni L. Pierantoni", Forlì, Italy
| | - Marco Noventa
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Silvio Tartaglia
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | | | - Marco Bonito
- Ospedale San Pietro Fatebenefratelli, Rome, Italy
| | | | - Guido Ambrosini
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Giovanni Buzzaccarini
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health, University of Padua, Padua, Italy.
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
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Domeniconi L, Amadori A, Maniglio P, Saragoni L. Atypical polypoid adenomyoma of the endometrium: diagnosis and treatment. A case report. Pathologica 2020; 112:214-218. [PMID: 33393525 PMCID: PMC8183343 DOI: 10.32074/1591-951x-112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022] Open
Abstract
Atypical polypoid adenomyoma (APA) is a rare uterine lesion that commonly recurs after local excision and is occasionally associated with or anticipates the development of atypical hyperplasia or endometrioid adenocarcinoma. We report a case of a 45-year-old woman affected by APA treated with local resection.
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Affiliation(s)
| | - Andrea Amadori
- Gynecology Unit, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Paolo Maniglio
- Gynecology Unit, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
| | - Luca Saragoni
- Department of Pathology, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy
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Maniglio P, Ricciardi E, Meli F, De Marco MP, Costanzi F, Caserta D. A pilot study of soft gel technology: a new vaginal device to improve the symptomatology of vulvovaginal atrophy in post-partum, menopause and in patients with recurrent vulvovaginitis. Eur Rev Med Pharmacol Sci 2019; 23:6035-6044. [PMID: 31364105 DOI: 10.26355/eurrev_201907_18416] [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: 06/10/2023]
Abstract
OBJECTIVE This is a pilot study to evaluate the effectiveness of the treatment with Vaginal Soft gels technology in the improvement of common signs and symptoms in postmenopausal, postpartum and with recurrent vulvovaginitis patients. These conditions may cause the onset of Vulvovaginal Atrophy (VVA) with effects on sexual activity, self-confidence and daily activities. The main symptoms are itching, irritation and dryness. Many therapies have been evaluated and almost all those without hormonal component have shown poor results. PATIENTS AND METHODS Women diagnosed with severe VVA from January to September 2018 were recruited. The study groups were composed of 25 postmenopausal women, 30 post-partum women and 30 women with recurrent vulvovaginitis. For each group, patients were randomized 1:1 among those who carried out the experimental treatment and those that did not perform it. The efficacy of treatment was evaluated with a clinical visit in which Vaginal Health Index (VHI) was estimated. The symptomatology was determined through the questionnaire Female Sexual Function Index (FSFI). RESULTS A significant improvement has been shown with regard to the sexual function (orgasm, lubrification, pain) in patients who performed the treatment. A significant increase in VHI has been evaluated in postmenopausal patients (4 months p=0.054, 6 months p=0.005) and in recurrent vulvovaginitis but not in post-partum patients (4 months p=0.681, 6 months p=0.109). An improvement of lubrication, satisfaction, orgasm, pain, as well as dyspareunia, was observed in the three study groups. CONCLUSIONS In this pilot study the treatment with soft gels seems to be effective in improving sexual health and atrophy being a treatment available for all types of patients thanks to the absence of systemic and local side effects. It is an excellent alternative especially for patients who cannot use hormones. These findings must be confirmed by larger and randomized further studies.
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Affiliation(s)
- P Maniglio
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy.
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Peiretti M, Congiu F, Ricciardi E, Maniglio P, Mais V, Angioni S. Conservative treatment for well-differentiated endometrial cancer: when and why it should be considered in young women. Ecancermedicalscience 2019; 13:892. [PMID: 30792809 PMCID: PMC6369973 DOI: 10.3332/ecancer.2019.892] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Indexed: 12/25/2022] Open
Abstract
The aim of this review was to update current knowledge on the conservative treatment of endometrial cancer (EC) based on a literature review. A web-based search in the MEDLINE database was carried out on EC management and treatment. All relevant information has been collected and analysed. Case series were mainly found in the literature search. Conservative treatments were offered to young patients with stage I low-grade endometrioid carcinomas of the endometrium. Different options included high/low dose progestin treatments, hysteroscopic resection of the disease, a levonorgestrel intrauterine device or a combination of various strategies. The overall complete response rate was near 76.5% with a recurrence rate of up to 33.8%. Pregnancy outcomes reached rates of 64.8% for live births. The current clinical outcomes show that conservative treatment aimed at preserving fertility is feasible for stage I endometrial well-differentiated adenocarcinomas in motivated patients under close monitoring.
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Affiliation(s)
- Michele Peiretti
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, 09124 Cagliari, Italy
| | - Francesca Congiu
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, 09124 Cagliari, Italy
| | - Enzo Ricciardi
- Department of Gynäkologie and Gynäkologische Onkologie, Kliniken Essen-Mitte, 45136 Essen, Germany
| | - Paolo Maniglio
- Department of Scienze Medico-Chirurgiche e di Medicina Traslazionale, Sapienza University of Rome, 00185 Rome, Italy
| | - Valerio Mais
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, 09124 Cagliari, Italy
| | - Stefano Angioni
- Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, 09124 Cagliari, Italy
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Abstract
The most recent evidences suggest the use of progesterone mimicking drugs for the treatment of endometriosis. Particularly, dienogest has been largely tested. However, the standard treatment of extra-pelvic endometriosis is debated. Particularly, cerebral localization of endometriosis is a very rare clinical condition. The surgical approach for such a particular disorder would consist in difficult procedures, thus leading to prefer the medical treatment. We hereby report the clinical case of a cerebral localization of endometriosis treated with dienogest who experienced a complete remission of the disease.
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Affiliation(s)
- Paolo Maniglio
- a Department of "Scienze Medico-Chirurgiche e di Medicina Traslazionale" , "Sapienza" University of Rome (Sant'Andrea) , Rome , Italy
| | - Enzo Ricciardi
- b Department of "Gynäkologie & Gynäkologische Onkologie" , Kliniken Essen-Mitte , Essen , Germany
| | - Federica Meli
- a Department of "Scienze Medico-Chirurgiche e di Medicina Traslazionale" , "Sapienza" University of Rome (Sant'Andrea) , Rome , Italy
| | - Federica Tomao
- c Department of "Scienze Ginecologico-Ostetriche e Scienze Urologiche" , "Sapienza" University of Rome , Rome , Italy
| | - Michele Peiretti
- d Department of "Scienze Ginecologico-Ostetriche" , "Azienda Ospedaliera Universitaria di Cagliari e Sassari" , Cagliari , Italy
| | - Donatella Caserta
- a Department of "Scienze Medico-Chirurgiche e di Medicina Traslazionale" , "Sapienza" University of Rome (Sant'Andrea) , Rome , Italy
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Maniglio P, Ricciardi E, Meli F, Vitale SG, Noventa M, Vitagliano A, Valenti G, La Rosa VL, Laganà AS, Caserta D. Catamenial pneumothorax caused by thoracic endometriosis. Radiol Case Rep 2018; 13:81-85. [PMID: 29552245 PMCID: PMC5850814 DOI: 10.1016/j.radcr.2017.09.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Revised: 09/01/2017] [Accepted: 09/05/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Thoracic endometriosis syndrome is a rare form of extrapelvic endometriosis characterized by the presence of functioning endometrial tissue in pleura, lung parenchyma, and airways, associated with a high rate of infertility. CASE REPORT We have reported a case of successful management and treatment of thoracic endometriosis syndrome that occurred in a 37-year-old female patient. She underwent thoracoscopic resection of the lesion. During follow-up, we revealed the recurrence of a previously surgically treated thoracic endometriosis. She was initially treated with a gonadotropin-releasing hormone agonist; subsequently this was replaced by a prophylactic treatment with Dienogest. CONCLUSION The diagnosis of thoracic endometriosis is challenging. The first line of treatment is medical, whereas the surgical treatment is performed secondly. Moreover, surgical treatment can lead to a significant rate of recurrence, often reduced by a coadjutant medical treatment.
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Affiliation(s)
- Paolo Maniglio
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psycology, University of Rome “Sapienza”, Via di Grottarossa 1035, 00139 Rome, Italy
| | - Enzo Ricciardi
- Department of Gynecological Surgery, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Federica Meli
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psycology, University of Rome “Sapienza”, Via di Grottarossa 1035, 00139 Rome, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Amerigo Vitagliano
- Department of Woman and Child Health, University of Padua, Via Giustiniani 3, 35128, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Via Santa Sofia 78, 95124 Catania, Italy
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
| | - Donatella Caserta
- Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psycology, University of Rome “Sapienza”, Via di Grottarossa 1035, 00139 Rome, Italy
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Paul C, Laganà AS, Maniglio P, Triolo O, Brady DM. Inositol's and other nutraceuticals' synergistic actions counteract insulin resistance in polycystic ovarian syndrome and metabolic syndrome: state-of-the-art and future perspectives. Gynecol Endocrinol 2016; 32:431-8. [PMID: 26927948 DOI: 10.3109/09513590.2016.1144741] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The incidence of metabolic syndrome (MetS), type II diabetes (T2D) and polycystic ovarian syndrome (PCOS) has been progressively increasing. Insulin resistance (InsR) seems to play a key role in a majority of phenotypes of these conditions, altering metabolic homeostasis, within muscle, liver, adipose and other tissues. Hyperinsulinemia is often associated with InsR and causes hormonal imbalances especially within ovaries and adrenals. Inositol is a polyalcohol, naturally occurring as nine stereoisomers, including D-chiro-inositol (DCI) and myo-inositol (MI), which have prominent roles in the metabolism of glucose and free fatty acids. MI and DCI have been classified as insulin-sensitizers and seem to adequately counteract several InsR-related metabolic alterations with a safe nutraceutical profile. Based on our analysis of selected studies that investigated MI and/or DCI, we conclude that supplementation with MI and/or DCI complement each other in their metabolic actions and act in synergy with other insulin sensitizing drugs and/or nutraceuticals. Nevertheless, considering the possible severe bias due to different methodologies across published studies, we conclude that there is a need for further studies on larger cohorts and with greater statistical power. These should further clarify outcomes and suitable therapeutic dosages of MI and DCI, possibly based on each patient's clinical status.
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Affiliation(s)
- Cristiana Paul
- a Independent Nutrition Research Consultant , Los Angeles, CA , USA
| | - Antonio Simone Laganà
- b Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina , Messina , Italy
| | - Paolo Maniglio
- c Department of Obstetrics, Gynecology and Urology, Sant'Andrea Hospital , Sapienza University of Rome , Rome , Italy , and
| | - Onofrio Triolo
- b Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina , Messina , Italy
| | - David M Brady
- d Human Nutrition Institute, University of Bridgeport , Bridgeport, CT , USA
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Maniglio P, Ricciardi E, Laganà AS, Triolo O, Caserta D. Epigenetic modifications of primordial reproductive tract: A common etiologic pathway for Mayer-Rokitansky-Kuster-Hauser Syndrome and endometriosis? Med Hypotheses 2016; 90:4-5. [DOI: 10.1016/j.mehy.2016.02.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/12/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
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Ricciardi E, Vecchione A, Marci R, Schimberni M, Frega A, Maniglio P, Caserta D, Moscarini M. Clinical factors and malignancy in endometrial polyps. Analysis of 1027 cases. Eur J Obstet Gynecol Reprod Biol 2014; 183:121-4. [PMID: 25461364 DOI: 10.1016/j.ejogrb.2014.10.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 07/28/2014] [Accepted: 10/22/2014] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To assess the prevalence of polyps carrying a malignancy and match association between clinical factors and oncologic progression. STUDY DESIGN A retrospective study (Canadian Task Force classification II-3) at a university hospital in Rome, Italy. We retrospectively analyzed data from 1027 women consecutively treated for endometrial polyps at our center in the period 2002-2011. The association of malignancy with hormonal status, tamoxifen, hypertension, symptoms, diabetes mellitus, obesity, and hormonal replacement therapy in pre- and post-menopausal women was assessed. RESULTS Mean age was 45.8±10.8 years. Benign polyps accounted for 95.8% of the total, pre-malignant for 2.67%, malignant for 1.54%. Our data showed that post-menopausal and older women (>60y) with endometrial polyps have a higher risk of developing a related endometrial cancer (OR: 3.05, 95% CI [1.54, 6.19], p<0.001 and OR: 2.8, 95% CI [1.38, 5.56], p≤0.003. Also we observed that women with AUB in the post-menopausal period displayed a risk of malignancy (OR: 31.1, 95% CI [10.3,111], p value <0.001). CONCLUSION Special attention should be drawn to symptomatic post-menopausal patients that appear to be at higher risk of malignancy. Symptomatic pre-menopausal women and asymptomatic post-menopausal women with polyps may be a group with intermediate-risk. These patients should undergo an individualized management plan, balancing both risks and benefits of surgical intervention after discussion with the patient.
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Affiliation(s)
- Enzo Ricciardi
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy; Department of Obstetrics and Gynecology, Universitätsklinikum Freiburg, Freiburg i.Br., Germany.
| | - Andrea Vecchione
- Department of Pathology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Roberto Marci
- Department of Biomedical Sciences and Advanced Therapies, University of Ferrara, Ferrara, Italy
| | - Mauro Schimberni
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Antonio Frega
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Maniglio
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Donatella Caserta
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Massimo Moscarini
- Department of Obstetrics, Gynecology and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
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Frega A, Sesti F, Sopracordevole F, Biamonti A, Scirpa P, Milazzo GN, Catalano A, Assorgi C, Lombardi D, Gentile M, Maniglio P, Ricciardi E, Cozza G, Marziani R, Moscarini M. Imiquimod 5% cream versus cold knife excision for treatment of VIN 2/3: a five-year follow-up. Eur Rev Med Pharmacol Sci 2013; 17:936-940. [PMID: 23640441] [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: 06/02/2023]
Abstract
BACKGROUND Vulvar intraepithelial neoplasia (VIN) is a premalingnant condition. For long time, surgery was considered the first-line therapy in the treatment of high grade VIN. Imiquimod was recently introduced as an alternative to surgery. AIM To compare the overall complete response, the recurrence rate and the risk factors for relapse among patients with VIN 2/3 treated with Imiquimod or surgical excision. PATIENTS AND METHODS Eighty women who had histological diagnosis of VIN 2 and VIN 3 were enrolled in this prospective study. Patients immunocompromised, with recurrent VIN, with well differentiated type VIN or VIN 1 and women treated more than once were excluded from the study. Patients were divided into two groups: group A was treated with Imiquimod, group B underwent surgical excision. Patients' characteristics analyzed were: age, smoking, degree of the primary lesion, state of margins, multifocal disease. We have evaluated the recurrence rate, the relapse rate, and the overall complete response, considering as recurrence the onset of a lesion after an initial complete response to Imiquimod and/or after the surgical treatment and as relapse all patients who had a recurrence plus those with medical treatment failure. RESULTS Multifocal lesions (p = 0.03) and VIN 3 (p = 0.002) were associated with a higher risk of relapse. The recurrence rate was higher in the group B (p = 0.009), but the relapse rate was higher in the group A (p = 0.04). The overall complete response was better in the group B (p = 0.04). CONCLUSIONS Although the advent of new medical options can decrease the morbidity associated with invasive surgical procedures, surgical treatments remain the best treatment modality for VIN with regard to relapse and overall complete response.
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Affiliation(s)
- A Frega
- Department of Gynecological, Obstetric and Urological Sciences, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Frega A, Puzio G, Maniglio P, Catalano A, Milazzo GN, Lombardi D, Nitiema H, Bianchi P. Obstetric and neonatal outcomes of women with FGM I and II in San Camillo Hospital, Burkina Faso. Arch Gynecol Obstet 2013; 288:513-9. [PMID: 23471548 DOI: 10.1007/s00404-013-2779-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Female genital mutilation (FGM) is still performed in the world. Women who underwent FGM have marked psychological, gynecological and obstetric consequences. This article contributes to the spread of knowledge about obstetric and neonatal outcomes in women with FGM I and II. METHODS Our observational study compared the obstetric outcomes of 85 women with FGM I and II (case group) and 95 women without it (control group). We evaluated age, need of oxytocin during labor, duration of the expulsion phase, need of episiotomy, weight of the newborn, Apgar score at birth, resuscitation of the newborn, stillbirth. We observed the rate of cesarean sections and their main indications. We compared the rate of cesarean sections among the cases and the controls. RESULTS Controls were younger than women who underwent FGM. Intravenous oxytocin injection was higher in cases. The expulsion phase was longer in women with FGM than in the controls. FGM is related to a higher risk of episiotomy. Apgar score 9/10 was more frequently assigned to babies from mothers without FGM. There were more resuscitated babies and more stillbirth in the group of cases. Ten percent of all women underwent cesarean section. FGM is related to a higher incidence of cesarean section. CONCLUSION FGM is associated with a higher risk of gynecological and obstetrical consequences, acting on women's health and also on the economy of resource limited countries. Because of migration, health professionals could interface with women who underwent FGM and have to know their related complications.
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Affiliation(s)
- Antonio Frega
- Department of Gynecological-Obstetric and Urological Sciences, Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy
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Ricciardi E, Maniglio P, Marziani R, Frega A, Moscarini M. Gynecologic sarcoma: a clinico-pathological review. EUR J GYNAECOL ONCOL 2013; 34:379-386. [PMID: 24475570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Most of the cases showing good prognosis in literature are probably intermediate tumors between benign and malignant of undetermined malignant potential (UMP) and other tumors with intermediate features which are currently not considered among sarcomas. Misdiagnosis of a malignant lesion as a benign one has a tragic outcome for the patient. Best therapic choice for sarcomas remains surgery, while chemotherapy (CTX) and radiation therapy (RT) could be used in adjuvant settings. A major effort should be played in the understanding of biological features and behavior of the disease to address a better clinical practice. Uterine sarcomas are rare gynecological tumors; their incidence has been increasing during the last few years.
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Affiliation(s)
- E Ricciardi
- Department of Obstetrics, Gynecology, and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
| | - P Maniglio
- Department of Obstetrics, Gynecology, and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - R Marziani
- Department of Obstetrics, Gynecology, and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - A Frega
- Department of Obstetrics, Gynecology, and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M Moscarini
- Department of Obstetrics, Gynecology, and Urology, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
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Ricciardi E, Maniglio P, Frega A, Marci R, Caserta D, Moscarini M. Fertility-sparing treatment of endometrial cancer precursors among young women: a reproductive point of view. Eur Rev Med Pharmacol Sci 2012; 16:1934-1937. [PMID: 23242719] [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: 06/01/2023]
Abstract
BACKGROUND Early-stage endometrial cancer and complex atypical hyperplasia are treated with hysterectomy and bilateral salpingo-oophorectomy. An emerging issue among younger women affected is the possibility of a fertility-sparing treatment with progestative therapy and close follow-up. AIM To assess the possibility of conceiving after a diagnosis of atypical endometrial hyperplasia among women younger than 40 years old, in term of delaying definitive treatment and achieving pregnancy. MATERIALS AND METHODS 15 women younger than 40 years old with complex CAH or early carcinoma of the endometrium and a wish to preserve fertility. Progestins were administered orally for at least a 12 weeks period. Endometrial biopsies were used at follow-up. RESULTS In 11 women, a complete pathological remission of the disease was observed. 4 pregnancies were attained in 4 women. 3 showed progression and underwent definitive surgery at 18 months. 1 showed no response at 24 months and 3 cycles and was counseled to receive a hysterectomy. CONCLUSIONS A conservative approach in patients younger than 40 years appears a valid option, and a progestative therapy trial should be attempted whether a valid consensus is attained. Considering the risk to find AEH at biopsies and eventually a carcinoma at hysterectomy (25% of cases) a careful management is strictly required.
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Affiliation(s)
- E Ricciardi
- Department of Obstetrics, Sapienza University of Rome, Rome, Italy.
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Ricciardi E, Jakimovska M, Maniglio P, Schimberni M, Frega A, Kobal B, Moscarini M. Laparoscopic injury of the obturator nerve during fertility-sparing procedure for cervical cancer. World J Surg Oncol 2012; 10:177. [PMID: 22931409 PMCID: PMC3499187 DOI: 10.1186/1477-7819-10-177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 08/15/2012] [Indexed: 12/04/2022] Open
Abstract
Background Intraoperative injury of the obturator nerve has rarely been reported in patients with gynecological malignancies undergoing extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end-to-end anastomosis or grafting when achieving tension-free anastomosis is not possible. Case presentation A 28-year-old woman with stage IB cervical cancer underwent fertility–sparing surgery, including conization and bilateral pelvic lymphadenectomy. The left obturator nerve was damaged intraoperatively during pelvic dissection. Conclusion Immediate laparoscopic repair was successful and there was no functional deficit in the left thigh for six months postoperatively.
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Affiliation(s)
- Enzo Ricciardi
- Department of Obstetrics and Gynecology, Sapienza University of Rome, Sant'Andrea Hospital, via di Grottarossa, 1035-1039, Rome 00189, Italy.
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Ricciardi E, Di Martino G, Maniglio P, Schimberni M, Frega A, Jakimovska M, Kobal B, Moscarini M. Life-threatening bleeding after pelvic lymphadenectomy for cervical cancer: endovascular management of ruptured false aneurysm of the external iliac artery. World J Surg Oncol 2012; 10:149. [PMID: 22799878 PMCID: PMC3468405 DOI: 10.1186/1477-7819-10-149] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/16/2012] [Indexed: 11/18/2022] Open
Abstract
Late rupture of external iliac artery pseudo-aneurysm is an uncommon complication in patients who undergo extensive gynecologic radical surgeries. A 28-year-old woman with stage IB cervical cancer underwent pelvic lymphadenectomy and extrafascial trachelectomy. Two months after surgery, massive bleeding from ruptured pseudo-aneurysm of the external iliac artery occurred. Endovascular management with covered stent placement was feasible and safe to stop bleeding.
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Affiliation(s)
- Enzo Ricciardi
- Department of Obstetrics and Gynecology, Sapienza University of Rome, Sant'Andrea Hospital, Roma, Italy.
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Moscarini M, Ricciardi E, Quarto A, Maniglio P, Caserta D. Vaginal treatment of endometrial cancer: role in the elderly. World J Surg Oncol 2011; 9:74. [PMID: 21752282 PMCID: PMC3161879 DOI: 10.1186/1477-7819-9-74] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 07/13/2011] [Indexed: 12/01/2022] Open
Abstract
Background To compare abdominal hysterectomy, the most currently used for treating cancer of the endometrium, to the vaginal hysterectomy in term of survival, morbidity and failure rates. Methods We retrospectively analyzed 68 cases divided into two sub-groups. A study group of 31 cases received vaginal surgery; a control group of 37 cases was treated with a laparotomy. Mean operative time, median hospital stay, intra- and post-operative complications, DFS and OS time as well as occurrence of local or distant recurrences have been evaluated and reported. Cases included patients with a higher rate of medical morbidities (p = 0.01) than controls. Results Mean age was 76.2 and 70.4 years in the vaginal (V) group and abdominal (A) group respectively. Mean operative time was longer for the group A. Group V patients had a lower mean post-operative hospital stay (p < 0.05). Differences in the two groups regarding intra- and post-operative complications, occurrence of local or distant recurrences and DFS time were not statistically significant. Disease specific survival time at 5 years scored 97% for group V, and 97% for group A. Conclusions Results show how vaginal approach had a similar outcome in selected patients. Vaginal surgery could therefore be the proper choice in patients with early stages and lower surgical risk, in addition to elderly patients exposed to a higher surgical risk.
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Affiliation(s)
- Massimo Moscarini
- Department of Women's Health and Territorial Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Roma, Italy
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Ricciardi E, Maniglio P, Schimberni M, Moscarini M. A case of high-grade leiomyosarcoma of the bladder with delayed onset and very poor prognosis. World J Surg Oncol 2010; 8:16. [PMID: 20302611 PMCID: PMC2847558 DOI: 10.1186/1477-7819-8-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 03/19/2010] [Indexed: 02/02/2023] Open
Abstract
Mesenchymal tumors represent a small number of bladder cancer cases. Leiomyosarcoma is the most common histology with over 100 cases reported in the whole literature. This tumor is been historically considered as highly aggressive and showing a poor prognosis. Despite very low survival rates showed in older reports, some authors indicate that some patients could have a better outcome. We report a review of the literature and a case of high-grade LMS of the bladder in a 68 years old woman. Diagnosis was delayed and disease was locally advanced. Symptoms and imaging of our case first oriented to a gynecologic condition with an adnexal or uterine origin of the mass, and, a genitourinary origin could be unveiled only intra-operatively.
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Affiliation(s)
- Enzo Ricciardi
- Department of Gynecology, Perinatology and Child Health, Sapienza University of Rome, Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00195 Rome, Italy.
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