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Andreasi V, Ricci C, Partelli S, Guarneri G, Ingaldi C, Muffatti F, Crippa S, Casadei R, Falconi M. Predictors of disease recurrence after curative surgery for nonfunctioning pancreatic neuroendocrine neoplasms (NF-PanNENs): a systematic review and meta-analysis. J Endocrinol Invest 2022; 45:705-718. [PMID: 34773595 DOI: 10.1007/s40618-021-01705-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE Patients submitted to curative surgery for non-functioning pancreatic neuroendocrine neoplasms (NF-PanNENs) exhibit a variable risk of disease relapse. Aims of this meta-analysis were to estimate the rate of disease recurrence and to investigate the risk factors for disease relapse in patients submitted to curative surgery for NF-PanNENs. METHODS Medline/Pubmed and Web of Science databases were searched for relevant studies. A meta-regression analysis was performed to investigate the source of recurrence rate heterogeneity. Pooled hazard ratios (HRs) and 95% confidence intervals (95% CI) were used to assess the effect of each possible prognostic factor on disease-free survival. RESULTS Fifteen studies, involving 2754 patients submitted to curative surgery for NF-PanNENs, were included. The pooled rate of disease recurrence was 21% (95% CI 15-26%). Study quality (Odds ratio, OR 0.94, P = 0.016) and G3-PanNENs rate (OR 2.18, P = 0.040) independently predicted the recurrence rate variability. Nodal metastases (HR 1.63, P < 0.001), tumor grade G2-G3 (G1 versus G2: HR 1.72, P < 0.001, G1 versus G3 HR 2.57, P < 0.001), microvascular (HR 1.25, P = 0.046) and perineural (HR 1.29, P = 0.019) invasion were identified as significant prognostic factors. T stage (T1-T2 versus T3-T4, P = 0.253) and status of resection margins (R0 versus R1, P = 0.173) did not show any significant relationship with NF-PanNENs recurrence. CONCLUSION Disease relapse occurs in approximately one out of five patients submitted to curative surgery for NF-PanNENs. Nodal involvement, tumor grade, microvascular and perineural invasion are relevant prognostic factors, that should be taken into account for follow-up and for possible trials investigating adjuvant or neoadjuvant treatments.
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Affiliation(s)
- V Andreasi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - C Ricci
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy.
| | - G Guarneri
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - C Ingaldi
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - F Muffatti
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Crippa
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
| | - R Casadei
- Division of Pancreatic Surgery, IRCCS Azienda Ospedaliero Universitaria Di Bologna, Bologna, Italy
- Department of Internal Medicine and Surgery (DIMEC), S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational & Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy
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Bongiovanni A, Foca F, Menis J, Stucci L, Artioli F, Guadalupi V, Forcignanò M, Fantini M, Recine F, Mercatali L, Spadazzi C, De Vita A, Casadei R, Falasconi M, Fausti V, Pallotti M, Bertoni M, Vanni S, Ibrahim T. 1296P Immune checkpoint inhibitors with or without bone targeted therapy in NSCLC patients with bone metastases and prognostic significance of neutrophil-to-lymphocyte ratio. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1898] [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: 10/20/2022] Open
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Lof S, van der Heijde N, Abuawwad M, Al-Sarireh B, Boggi U, Butturini G, Capretti G, Coratti A, Casadei R, D'Hondt M, Esposito A, Ferrari G, Fusai G, Giardino A, Groot Koerkamp B, Hackert T, Kamarajah S, Kauffmann EF, Keck T, Marudanayagam R, Nickel F, Manzoni A, Pessaux P, Pietrabissa A, Rosso E, Salvia R, Soonawalla Z, White S, Zerbi A, Besselink MG, Abu Hilal M. Robotic versus laparoscopic distal pancreatectomy: multicentre analysis. Br J Surg 2021; 108:188-195. [PMID: 33711145 DOI: 10.1093/bjs/znaa039] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/03/2020] [Accepted: 09/15/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND The role of minimally invasive distal pancreatectomy is still unclear, and whether robotic distal pancreatectomy (RDP) offers benefits over laparoscopic distal pancreatectomy (LDP) is unknown because large multicentre studies are lacking. This study compared perioperative outcomes between RDP and LDP. METHODS A multicentre international propensity score-matched study included patients who underwent RDP or LDP for any indication in 21 European centres from six countries that performed at least 15 distal pancreatectomies annually (January 2011 to June 2019). Propensity score matching was based on preoperative characteristics in a 1 : 1 ratio. The primary outcome was the major morbidity rate (Clavien-Dindo grade IIIa or above). RESULTS A total of 1551 patients (407 RDP and 1144 LDP) were included in the study. Some 402 patients who had RDP were matched with 402 who underwent LDP. After matching, there was no difference between RDP and LDP groups in rates of major morbidity (14.2 versus 16.5 per cent respectively; P = 0.378), postoperative pancreatic fistula grade B/C (24.6 versus 26.5 per cent; P = 0.543) or 90-day mortality (0.5 versus 1.3 per cent; P = 0.268). RDP was associated with a longer duration of surgery than LDP (median 285 (i.q.r. 225-350) versus 240 (195-300) min respectively; P < 0.001), lower conversion rate (6.7 versus 15.2 per cent; P < 0.001), higher spleen preservation rate (81.4 versus 62.9 per cent; P = 0.001), longer hospital stay (median 8.5 (i.q.r. 7-12) versus 7 (6-10) days; P < 0.001) and lower readmission rate (11.0 versus 18.2 per cent; P = 0.004). CONCLUSION The major morbidity rate was comparable between RDP and LDP. RDP was associated with improved rates of conversion, spleen preservation and readmission, to the detriment of longer duration of surgery and hospital stay.
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Affiliation(s)
- S Lof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - N van der Heijde
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Abuawwad
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
| | - B Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - U Boggi
- Division of General and Transplant surgery, University of Pisa, Pisa, Italy
| | - G Butturini
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - G Capretti
- Pancreatic Surgery, Humanitas University, Milan, Italy
| | - A Coratti
- Department of Surgical Oncology and Robotics, Careggi University Hospital, Florence, Italy
| | - R Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - M D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, AZ Groeninge Hospital, Kortrijk, Belgium
| | - A Esposito
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - G Ferrari
- Department of Oncological and Minimally Invasive Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - G Fusai
- Division of Surgery and Interventional Science, Royal Free London NHS Foundation Trust, London, UK
| | - A Giardino
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - B Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - S Kamarajah
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - E F Kauffmann
- Division of General and Transplant surgery, University of Pisa, Pisa, Italy
| | - T Keck
- Clinic for Surgery, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - R Marudanayagam
- Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Trust, Birmingham, UK
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - A Manzoni
- Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
| | - P Pessaux
- Department of Digestive and Endocrine Surgery, Nouvel Hôpital Civil - IHU Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - A Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy
| | - E Rosso
- Department of Surgery, Elsan Pôle Santé Sud, Le Mans, France
| | - R Salvia
- Department of Surgery, Pancreas Institute, Verona University Hospital, Verona, Italy
| | - Z Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - S White
- Department of Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - A Zerbi
- Pancreatic Surgery, Humanitas University, Milan, Italy
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M Abu Hilal
- Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK
- Department of Surgery, Fondazione Poliambulanza - Istituto Ospedaliero, Brescia, Italy
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Ricci C, Partelli S, Landoni L, Rinzivillo M, Ingaldi C, Andreasi V, Nessi C, Muffatti F, Fontana M, Tamburrino D, Deiro G, Alberici L, Campana D, Panzuto F, Bassi C, Falconi M, Casadei R. Sporadic non-functioning pancreatic neuroendocrine tumours: multicentre analysis. Br J Surg 2021; 108:811-816. [PMID: 33724300 DOI: 10.1093/bjs/znaa141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/05/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Outcomes after surgery for sporadic pancreatic neuroendocrine neoplasms (Pan-NENs) were evaluated. METHODS This multicentre study included patients who underwent radical pancreatic resection for sporadic non-functioning Pan-NENs. In survival analysis, the risk of mortality in this cohort was analysed in relation to that of the matched healthy Italian population. Relative survival (RS) was calculated as the rate between observed and expected survival. Factors related to RS were investigated using multivariable modelling. RESULTS Among 964 patients who had pancreatic resection for sporadic non-functioning Pan-NENs, the overall RS rate was 91.8 (95 per cent c.i. 81.5 to 96.5) per cent. 2019 WHO grade (hazard ratio (HR) 5.75 (s.e. 4.63); P = 0.030) and European Neuroendocrine Tumour Society (ENETS) TNM stage (6.73 (3.61); P < 0.001) were independent predictors of RS. The probability of a normal lifespan for patients with G1, G2, G3 Pan-NENS, and pancreatic neuroendocrine carcinomas (Pan-NECs) was 96.7, 54.8, 0, and 0 per cent respectively. The probability of a normal lifespan was 99.8, 99.3, 79.8, and 46.8 per cent for those with stage I, II, III, and IV disease respectively. The overall disease-free RS rate was 73.6 (65.2 to 79.5) per cent. 2019 WHO grade (HR 2.10 (0.19); P < 0.001) and ENETS TNM stage (HR 2.50 (0.24); P < 0.001) significantly influenced disease-free RS. The probability of disease-free survival was 93.2, 84.9, 45.2, and 6.8 per cent for patients with stage I, II, III, and IV disease, and 91.9, 45.2, 9.4, and 0.7 per cent for those with G1, G2, G3 Pan-NENS, and Pan-NECs, respectively. CONCLUSION A surgical approach seems without benefit for Pan-NECs, and unnecessary for small G1 sporadic Pan-NENs. Surgery alone may be insufficient for stage III-IV and G3 Pan-NENs.
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Affiliation(s)
- C Ricci
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Internal Medicine and Surgery; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - S Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy.,'Vita-Salute' San Raffaele University, Milan, Italy
| | - L Landoni
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - M Rinzivillo
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - C Ingaldi
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Internal Medicine and Surgery; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - V Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy.,'Vita-Salute' San Raffaele University, Milan, Italy
| | - C Nessi
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - F Muffatti
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy.,'Vita-Salute' San Raffaele University, Milan, Italy
| | - M Fontana
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - D Tamburrino
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy
| | - G Deiro
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - L Alberici
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Internal Medicine and Surgery; Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - D Campana
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Division of Oncology, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - F Panzuto
- Digestive Disease Unit, ENETS Center of Excellence, Sant'Andrea University Hospital, Rome, Italy
| | - C Bassi
- General and Pancreatic Surgery Department, Pancreas Institute-University of Verona Hospital Trust, Verona, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy.,'Vita-Salute' San Raffaele University, Milan, Italy
| | - R Casadei
- Division of Pancreatic Surgery, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Internal Medicine and Surgery; Alma Mater Studiorum, University of Bologna, Bologna, Italy
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5
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Balduzzi A, van Hilst J, Korrel M, Lof S, Al-Sarireh B, Alseidi A, Berrevoet F, Björnsson B, van den Boezem P, Boggi U, Busch OR, Butturini G, Casadei R, van Dam R, Dokmak S, Edwin B, Sahakyan MA, Ercolani G, Fabre JM, Falconi M, Forgione A, Gayet B, Gomez D, Koerkamp BG, Hackert T, Keck T, Khatkov I, Krautz C, Marudanayagam R, Menon K, Pietrabissa A, Poves I, Cunha AS, Salvia R, Sánchez-Cabús S, Soonawalla Z, Hilal MA, Besselink MG. Laparoscopic versus open extended radical left pancreatectomy for pancreatic ductal adenocarcinoma: an international propensity-score matched study. Surg Endosc 2021; 35:6949-6959. [PMID: 33398565 DOI: 10.1007/s00464-020-08206-y] [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: 10/06/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A radical left pancreatectomy in patients with pancreatic ductal adenocarcinoma (PDAC) may require extended, multivisceral resections. The role of a laparoscopic approach in extended radical left pancreatectomy (ERLP) is unclear since comparative studies are lacking. The aim of this study was to compare outcomes after laparoscopic vs open ERLP in patients with PDAC. METHODS An international multicenter propensity-score matched study including patients who underwent either laparoscopic or open ERLP (L-ERLP; O-ERLP) for PDAC was performed (2007-2015). The ISGPS definition for extended resection was used. Primary outcomes were overall survival, margin negative rate (R0), and lymph node retrieval. RESULTS Between 2007 and 2015, 320 patients underwent ERLP in 34 centers from 12 countries (65 L-ERLP vs. 255 O-ERLP). After propensity-score matching, 44 L-ERLP could be matched to 44 O-ERLP. In the matched cohort, the conversion rate in L-ERLP group was 35%. The L-ERLP R0 resection rate (matched cohort) was comparable to O-ERLP (67% vs 48%; P = 0.063) but the lymph node yield was lower for L-ERLP than O-ERLP (median 11 vs 19, P = 0.023). L-ERLP was associated with less delayed gastric emptying (0% vs 16%, P = 0.006) and shorter hospital stay (median 9 vs 13 days, P = 0.005), as compared to O-ERLP. Outcomes were comparable for additional organ resections, vascular resections (besides splenic vessels), Clavien-Dindo grade ≥ III complications, or 90-day mortality (2% vs 2%, P = 0.973). The median overall survival was comparable between both groups (19 vs 20 months, P = 0.571). Conversion did not worsen outcomes in L-ERLP. CONCLUSION The laparoscopic approach may be used safely in selected patients requiring ERLP for PDAC, since morbidity, mortality, and overall survival seem comparable, as compared to O-ERLP. L-ERLP is associated with a high conversion rate and reduced lymph node yield but also with less delayed gastric emptying and a shorter hospital stay, as compared to O-ERLP.
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Affiliation(s)
- A Balduzzi
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands. .,General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.
| | - J van Hilst
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - M Korrel
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - S Lof
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.,Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - B Al-Sarireh
- Department of Surgery, Morriston Hospital, Swansea, UK
| | - A Alseidi
- Department of Surgery, Virginia Mason Medical Center, Seattle, USA
| | - F Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - B Björnsson
- Department of Surgery in Linköping, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - P van den Boezem
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - U Boggi
- Department of Surgery, Universitá di Pisa, Pisa, Italy
| | - O R Busch
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands
| | - G Butturini
- Department of Surgery, Pederzoli Hospital, Peschiera, Italy
| | - R Casadei
- Department of Surgery, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - R van Dam
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - S Dokmak
- Department of Surgery, Hospital of Beaujon, Clichy, France
| | - B Edwin
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway
| | - M A Sahakyan
- Department of Surgery, Oslo University Hospital and Institute for Clinical Medicine, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
| | - G Ercolani
- Department of General Surgery and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna Forlì, Forlì, Italy.,Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - J M Fabre
- Department of Surgery, Hopital Saint Eloi, Montpellier, France
| | - M Falconi
- San Raffaele Hospital Pancreas Translational & Clinical Research Center, San Raffaele Hospital, Università Vita-Salute, Milan, Italy
| | - A Forgione
- Department of Surgery, Niguarda Ca' Granda Hospital, Milan, Italy
| | - B Gayet
- Department of Surgery, Institut Mutualiste Montsouris, Paris, France
| | - D Gomez
- Department of Surgery, Nottingham University Hospitals NHS Foundation Trust, Nottingham, UK
| | | | - T Hackert
- Department of Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Keck
- Department of Surgery, University Hospital Schleswig-Holstein UKSH Campus Lübeck, Lübeck, Germany
| | - I Khatkov
- Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russian Federation
| | - C Krautz
- Department of Surgery, University Hospital Erlangen, Erlangen, Germany
| | - R Marudanayagam
- Department of Surgery, University Hospital Birmingham, Birmingham, UK
| | - K Menon
- Department of Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - A Pietrabissa
- Department of Surgery, University Hospital Pavia, Pavia, Italy
| | - I Poves
- Department of Surgery, Hospital del Mar, Barcelona, Spain
| | - A Sa Cunha
- Department of Surgery, Hôpital Paul-Brousse, Villejuif, France
| | - R Salvia
- General and Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - S Sánchez-Cabús
- Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Z Soonawalla
- Department of Surgery, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - M Abu Hilal
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy. .,HPB and Minimally Invasive Surgery, Southampton University, Southampton, UK.
| | - M G Besselink
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef, 91100 AZ, Amsterdam, The Netherlands.
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De Vita A, Recine F, Miserocchi G, Pieri F, Spadazzi C, Cocchi C, Liverani C, Farnedi A, Fabbri F, Fausti V, Casadei R, Brandolini F, Ercolani G, Cavaliere D, Bongiovanni A, Riva N, Gurrieri L, Debonis S, Mercatali L, Ibrahim T. 1660P The promising role of the extracellular matrix in the activity of trabectedin in soft tissue sarcoma: A prospective study on a UPS and L-sarcoma patient-derived primary culture case series using 3D and zebrafish models. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1886] [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: 11/26/2022] Open
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Filippini DM, Grassi E, Palloni A, Carloni R, Casadei R, Ricci C, Serra C, Ercolani G, Brandi G, Di Marco M. Searching for novel multimodal treatments in oligometastatic pancreatic cancer. BMC Cancer 2020; 20:271. [PMID: 32228504 PMCID: PMC7106565 DOI: 10.1186/s12885-020-06718-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 03/05/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Metastatic pancreatic cancer has a median overall survival of less than 12 months, even if treated with chemotherapy. Selected patients with oligometastatic disease could benefit from multimodal treatments connecting chemotherapy and surgical treatment or radiofrequency ablation (RFA) of metastases. CASE PRESENTATION We present a patient with oligometastatic pancreatic cancer recurrence who was successfully treated with a multimodal therapeutic approach. A 57-year-old male initially presenting with resectable pancreatic cancer underwent pancreatoduodenectomy. The histopathological diagnosis revealed ductal pancreatic adenocarcinoma with positive surgical resection margins and negative lymph nodes. He completed six cycles of adjuvant therapy with gemcitabine (1000 mg/mq 1,8,15q 28), followed by external radiotherapy (54 Gy in 25 fractions) associated with gemcitabine 50 mg/mq twice weekly. Three years later, the patient developed multiple liver metastases, and he started FOLFIRINOX (oxaliplatin 85 mg/mq, irinotecan 180 mg/mq, leucovorin 400 mg/mq and fluorouracil 400 mg/mq given as a bolus followed by 2400 mg/mq as a 46 h continuous infusion,1q 14) as a first-line treatment. The CT scan showed a partial response after 6 cycles. After multidisciplinary discussion, the patient underwent a laparotomic metastasectomy of the three hepatic lesions. After additional postsurgical chemotherapy with 4 cycles of the FOLFIRINOX schedule, the patient remained free of recurrence for 12 months. A CT scan showed a new single liver metastasis, which was treated with radiofrequency ablation (RFA). A second radiofrequency ablation was performed when the patient developed another single liver lesion 12 months after the first RFA; currently, the patient is free from recurrence with an overall survival of 6 years from the diagnosis. CONCLUSIONS Our case has benefited from successful multimodal treatment, including surgical and local ablative techniques and systemic chemotherapy. A multimodal approach may be warranted in selected patients with oligometastatic pancreatic cancer and could improve overall survival. Further research is needed to investigate this approach.
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Affiliation(s)
- D M Filippini
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
| | - E Grassi
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy.
| | - A Palloni
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
| | - R Carloni
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
| | - R Casadei
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - C Ricci
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - C Serra
- Department of Organ Failure and Transplantation, Ultrasound Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - G Ercolani
- Department of Medical and Surgical Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.,General and Oncologic Surgery, Morgagni-Pierantoni Hospital, AUSL Romagna, Forlì, Italy
| | - G Brandi
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
| | - M Di Marco
- Department of Experimental, Diagnostic and Specialty Medicine University of Bologna, Sant'Orsola-Malpighi Hospital, Massarenti Street 11, 40100, Bologna, Italy
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8
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De Vita A, Recine F, Mercatali L, Miserocchi G, Liverani C, Spadazzi C, Casadei R, Cavaliere D, Bongiovanni A, Pieri F, Medri L, Riva N, Fausti V, Ibrahim T. The role of chemotherapy in the landscape of liposarcoma. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy299.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Casadei R, Drago G, Di Pressa F, Donati D. Humeral metastasis of renal cancer: Surgical options and review of literature. Orthop Traumatol Surg Res 2018; 104:533-538. [PMID: 29654934 DOI: 10.1016/j.otsr.2018.03.009] [Citation(s) in RCA: 17] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 03/15/2018] [Accepted: 03/20/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The humerus is the second most common long bone site of metastatic disease from renal cell carcinomas (RCC) after femur. Surgery has an important role in the treatment of these lesions due to renal cell tumor's resistance to chemotherapy and radiotherapy. HYPOTHESIS Prosthetic replacement is an effective and safe solution in treatment of renal humeral metastasis. MATERIAL AND METHODS Fifty-six patients affected by RCC bone metastases of the humerus that underwent a surgical reconstruction were rewised. Thirty-five lesions were localized on proximal third, 12 on the shaft, 9 on distal third. Among proximal 29 were treated with resection and endoprosthetic replacement and 6 with plate and cement. Six diaphyseal lesions were stabilized with intramedullary nailing, 5 with plate and cement and 1 with an intercalary prosthesis. Regarding distal lesions, 7 elbow prostheses and 2 plates and cement were used. RESULTS The average age was 63years. Metastasis was single in 55% of cases, and in 45% metachronous. A pathologic fracture (PF) occurred in 64% of cases. Only 9% of patients had a mechanical complication, 7% an infection and 5% neurological deficit. A local recurrence occurred in 14% of patients. An implant failure has been observed in 10 patients, 5 for mechanical complications, 2 for infections and 3 for local recurrence; of these 7 were treated with a prosthesis and 3 with plate and cement. The mean value of MSTS score was 64%, 63% and 59% respectively in patients with proximal, diaphyseal and distal humerus metastases. DISCUSSION Solitary and metachronous bone metastases have a longer survival. Disease-free interval>2years is another important prognostic factor. Reconstruction with a modular prosthesis is recommended in proximal and distal third. Instead in diaphyseal lesions a closed reduction and fixation with intramedullary locked nailing are preferred. When surgical indications are correctly followed, good oncologic and functional outcomes are obtained, leading to markedly improvement of patients' quality of life. RETROSPECTIVE STUDY Level of evidence: IV.
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Affiliation(s)
- R Casadei
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - G Drago
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - F Di Pressa
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - D Donati
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy
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10
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Bacci G, Picci P, Briccoli A, Avella M, Ferrari S, Femino FP, Monti C, Ruggieri P, Rizzente AG, Casadei R. Osteosarcoma of the Extremity Metastatic at Presentation: Results Achieved in 26 Patients Treated with Combined Therapy (Primary Chemotherapy Followed by Simultaneous Resection of the Primary and Metastatic Lesions). Tumori 2018; 78:200-6. [PMID: 1440945 DOI: 10.1177/030089169207800311] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 11/17/2022]
Abstract
From September 1986 to December 1989, 26 selected patients with high-grade osteosarcoma of the extremities metastatic at presentation were treated with primary chemotherapy (high doses of methotrexate, -cisplatinum and adriamycin) followed by surgery. Twenty-one cases underwent resections of the primary and metastatic tumor at the same time; owing to the disappearance of lung metastases after preoperative chemotherapy in 3 cases, only the primary tumor was operated on. Due to progression of the disease in 2 patients, no surgery was performed. Histologic examination of the resected specimen was performed to evaluate the percentage of necrosis produced by chemotherapy on the primary and metastatic tumor. After surgery, the patients received further chemotherapy with the same drugs used preoperatively plus ifosfamide and VP-16. The histologic response of the primary tumor was good (> 90 % tumor necrosis) in 25 % of the cases; in the resected metastatic nodules, 23 % had good responses. A discrepancy between the histologic response of the primary and secondary tumor was observed in only 15 % of the cases. These results seem to confirm the validity of the strategy (widely used today in the neoadjuvant treatment of non-metastatic osteosarcoma) of changing the postoperative treatment when the histologic response of the primary tumor is poor. At an average follow-up of 3.5 years, only 6 patients remained disease-free; 19 patients relapsed and 1 patient died for adriamycin cardiotoxicity. Of the 19 relapsed patients, 16 died and 3 are still alive but with uncontrolled disease. These results are much worse than those obtained in 144 cases of non-metastatic osteosarcoma of the extremities treated in the same period with the same preoperative chemotherapy (77 % with good response in the primary tumor and 78 % with continues disease-free survival). The data suggest that a very effective neoadjuvant chemotherapy for nonmetastatic osteosarcoma of the extremities gives disappointing results in osteosarcoma of the extremities which is metastatic at presentation.
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Affiliation(s)
- G Bacci
- Sezione Chemioterapia Tumori Ossei, Istituto Ortopedico Rizzoli, Bologna, Italy
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11
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Stacchiotti S, Gronchi A, Fossati P, Akiyama T, Alapetite C, Baumann M, Blay JY, Bolle S, Boriani S, Bruzzi P, Capanna R, Caraceni A, Casadei R, Colia V, Debus J, Delaney T, Desai A, Dileo P, Dijkstra S, Doglietto F, Flanagan A, Froelich S, Gardner PA, Gelderblom H, Gokaslan ZL, Haas R, Heery C, Hindi N, Hohenberger P, Hornicek F, Imai R, Jeys L, Jones RL, Kasper B, Kawai A, Krengli M, Leithner A, Logowska I, Martin Broto J, Mazzatenta D, Morosi C, Nicolai P, Norum OJ, Patel S, Penel N, Picci P, Pilotti S, Radaelli S, Ricchini F, Rutkowski P, Scheipl S, Sen C, Tamborini E, Thornton KA, Timmermann B, Torri V, Tunn PU, Uhl M, Yamada Y, Weber DC, Vanel D, Varga PP, Vleggeert-Lankamp CLA, Casali PG, Sommer J. Best practices for the management of local-regional recurrent chordoma: a position paper by the Chordoma Global Consensus Group. Ann Oncol 2018; 28:1230-1242. [PMID: 28184416 PMCID: PMC5452071 DOI: 10.1093/annonc/mdx054] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [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] [Indexed: 12/16/2022] Open
Abstract
Chordomas are rare, malignant bone tumors of the skull-base and axial skeleton. Until recently, there was no consensus among experts regarding appropriate clinical management of chordoma, resulting in inconsistent care and suboptimal outcomes for many patients. To address this shortcoming, the European Society of Medical Oncology (ESMO) and the Chordoma Foundation, the global chordoma patient advocacy group, convened a multi-disciplinary group of chordoma specialists to define by consensus evidence-based best practices for the optimal approach to chordoma. In January 2015, the first recommendations of this group were published, covering the management of primary and metastatic chordomas. Additional evidence and further discussion were needed to develop recommendations about the management of local-regional failures. Thus, ESMO and CF convened a second consensus group meeting in November 2015 to address the treatment of locally relapsed chordoma. This meeting involved over 60 specialists from Europe, the United States and Japan with expertise in treatment of patients with chordoma. The consensus achieved during that meeting is the subject of the present publication and complements the recommendations of the first position paper.
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Affiliation(s)
| | - A Gronchi
- Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Fossati
- CNAO National Center for Oncological Hadrontherapy, Pavia.,Department of Radiotherapy, IEO-European Institute of Oncology, Milan, Italy
| | - T Akiyama
- Department of Orthopaedic Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - C Alapetite
- Department of Radiotherapy, Institut Curie, Paris.,Institut Curie-Centre de Protonthérapie d'Orsay (ICPO), Orsay, France
| | - M Baumann
- Department of Radiation Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - J Y Blay
- Cancer Medicine Department, Centre Léon Bérard, Lyon
| | - S Bolle
- Department of Radiotherapy, Gustave Roussy, Villejuif Cedex, France
| | - S Boriani
- Department of Degenerative and Oncological Spine Surgery, Rizzoli Institute Bologna, Bologna
| | - P Bruzzi
- Department of Epidemiology, IRCCS Azienda Ospedaliera Universitaria San Martino, IST Istituto Nazionale per la Ricerca sul Cancro, Genova
| | - R Capanna
- University Clinic of Orthopedics and Traumatology AO Pisa, Pisa
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - R Casadei
- Orthopedic Department, Rizzoli Institute Bologna, Bologna, Italy
| | - V Colia
- Departments of Cancer Medicine
| | - J Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - T Delaney
- Department of Radiation Oncology, Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, USA
| | - A Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), Queen Elizabeth Hospital, Birmingham
| | - P Dileo
- Department of Oncology, University College London Hospitals (UCLH), London, UK
| | - S Dijkstra
- Department of Orthopaedic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - F Doglietto
- Institute of Neurosurgery, University of Brescia, Brescia, Italy
| | - A Flanagan
- University College London Cancer Institute, London.,Histopathology Department, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - S Froelich
- Department of Neurosurgery, Paris Diderot University, Hôpital Lariboisière, Paris, France
| | - P A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - H Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Z L Gokaslan
- Department of Neurosurgery, Brown University School of Medicine, Providence, USA
| | - R Haas
- Department of Radiotherapy, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C Heery
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, Bethesda, USA
| | - N Hindi
- Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - P Hohenberger
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - F Hornicek
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - R Imai
- National Institute of Radiological Sciences, Research Center Hospital for Charged Particle Therapy, Chiba, Japan
| | - L Jeys
- Department of Orthopaedics, Royal Orthopaedic Hospital Birmingham, Birmingham
| | - R L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - B Kasper
- Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany
| | - A Kawai
- Musculoskeletal Oncology and Rehabilitation Medicine, National Cancer Center, Tokio, Japan
| | - M Krengli
- Radiotherapy Department, University of Piemonte Orientale, Novara, Italy
| | - A Leithner
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria
| | - I Logowska
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - J Martin Broto
- Department of Cancer Medicine, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - D Mazzatenta
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche, Bologna
| | - C Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Nicolai
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - O J Norum
- Department of Tumor Orthopedic Surgery, The Norwegian Radium Hospital, Oslo, Norway
| | - S Patel
- Department of Sarcoma Medical Oncology, MD Anderson Cancer Center, Houston, USA
| | - N Penel
- Cencer Medicine Department, Oscar Lambret Cancer Centre, Lille, France
| | - P Picci
- Laboratory of Oncologic Research, Istituto Ortopedico Rizzoli, Bologna
| | - S Pilotti
- Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - S Radaelli
- Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - F Ricchini
- Palliative Care Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - S Scheipl
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Graz, Austria
| | - C Sen
- Department of Neurosurgery, NYU Langone Medical Center, New York
| | - E Tamborini
- Laboratory of Molecular Pathology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - K A Thornton
- Center for Bone and Soft Tissue Sarcoma, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - B Timmermann
- Particle Therapy Department, West German Proton Therapy Centre Essen, University Hospital Essen, Essen, Germany
| | - V Torri
- Oncology Unit, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - P U Tunn
- Department of Orthopaedic Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - M Uhl
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany
| | - Y Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D C Weber
- Paul Scherrer Institut PSI, Villigen, Switzerland
| | - D Vanel
- Department of Radiology, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - P P Varga
- National Center for Spinal Disorders, Budapest, Hungary
| | | | | | - J Sommer
- Chordoma Foundation, Durham, USA
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12
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De Vita A, Recine F, Mercatali L, Miserocchi G, Liverani C, Spadazzi C, Casadei R, Bongiovanni A, Pieri F, Riva N, Fausti V, Amadori D, Ibrahim T. Molecular characterization and pharmacological profile of myxofibrosarcoma primary cultures. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx427.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Casadei R, De Paolis M, Drago G, Romagnoli C, Donati D. Total elbow arthroplasty for primary and metastatic tumor. Orthop Traumatol Surg Res 2016; 102:459-65. [PMID: 27084091 DOI: 10.1016/j.otsr.2015.12.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/05/2015] [Accepted: 12/23/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Prostheses can be used in elbow reconstruction in both primary and metastatic lesions. Several authors have reported their experience with different types of implant, but not with modular prostheses. HYPOTHESIS Limb salvage using an elbow prosthesis is effective in obtaining good functional results and reliable local tumor control. MATERIAL AND METHODS Forty-seven patients treated at the Rizzoli Institute for elbow neoplasm from 1990 to 2012 were evaluated. There were 30 primary tumors (64%), 24 bone tumors and 6 soft tissue sarcomas, and 17 bone metastases. Elbow reconstruction used a modular prosthesis in 25 patients and a standard prosthesis in 22. Reconstruction was primary in 30 patients and secondary in 17. RESULTS At last control, 15 (32%) were dead of disease (DOD) at a mean follow-up of 35 months, 12 (25%) were alive with disease (AWD) at a mean follow-up of 29 months, 19 (40%) showed no evidence of disease (NED) at a mean follow-up of 80 months. Early complications were related to unexpected neurological damage, observed in 12 patients (25%): in 5 cases the deficit resolved in a mean 6 months; in the others, no or only partial recovery was observed. Two implants (4%) developed infection: 1 was treated with antibiotic therapy, and the other required implant revision. One implant showing cement extrusion was revised. In 3 patients (6%) radiography showed a radiolucent halo around the stem (2 humeral, 1 ulnar); no measures were taken, as the patients were completely asymptomatic at every follow-up. In 3 patients (6%) partial resorption of the allograft was observed on X-ray, but remained unchanged at last follow-up, without pain or functional impairment. Seven local recurrences (15%) were observed, at a mean of 16 months after surgery; 5 were treated by resection and/or radiotherapy, and 2 by amputation. Mean functional scores on MEPS and MSTS were respectively 84% and 22/30 (73%). CONCLUSIONS Elbow prostheses provided better function in primary than in metastatic tumor. Elbow prosthesis reconstruction after tumor resection is a viable option both for primary and secondary bone neoplasms. TYPE OF STUDY Therapeutic. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- R Casadei
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - M De Paolis
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - G Drago
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - C Romagnoli
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
| | - D Donati
- Department of Musculoskeletal Oncology, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy.
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14
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Jais B, Rebours V, Malleo G, Salvia R, Fontana M, Maggino L, Bassi C, Manfredi R, Moran R, Lennon AM, Zaheer A, Wolfgang C, Hruban R, Marchegiani G, Fernández Del Castillo C, Brugge W, Ha Y, Kim MH, Oh D, Hirai I, Kimura W, Jang JY, Kim SW, Jung W, Kang H, Song SY, Kang CM, Lee WJ, Crippa S, Falconi M, Gomatos I, Neoptolemos J, Milanetto AC, Sperti C, Ricci C, Casadei R, Bissolati M, Balzano G, Frigerio I, Girelli R, Delhaye M, Bernier B, Wang H, Jang KT, Song DH, Huggett MT, Oppong KW, Pererva L, Kopchak KV, Del Chiaro M, Segersvard R, Lee LS, Conwell D, Osvaldt A, Campos V, Aguero Garcete G, Napoleon B, Matsumoto I, Shinzeki M, Bolado F, Fernandez JMU, Keane MG, Pereira SP, Acuna IA, Vaquero EC, Angiolini MR, Zerbi A, Tang J, Leong RW, Faccinetto A, Morana G, Petrone MC, Arcidiacono PG, Moon JH, Choi HJ, Gill RS, Pavey D, Ouaïssi M, Sastre B, Spandre M, De Angelis CG, Rios-Vives MA, Concepcion-Martin M, Ikeura T, Okazaki K, Frulloni L, Messina O, Lévy P. Serous cystic neoplasm of the pancreas: a multinational study of 2622 patients under the auspices of the International Association of Pancreatology and European Pancreatic Club (European Study Group on Cystic Tumors of the Pancreas). Gut 2016; 65:305-12. [PMID: 26045140 DOI: 10.1136/gutjnl-2015-309638] [Citation(s) in RCA: 173] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 05/11/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Serous cystic neoplasm (SCN) is a cystic neoplasm of the pancreas whose natural history is poorly known. The purpose of the study was to attempt to describe the natural history of SCN, including the specific mortality. DESIGN Retrospective multinational study including SCN diagnosed between 1990 and 2014. RESULTS 2622 patients were included. Seventy-four per cent were women, and median age at diagnosis was 58 years (16-99). Patients presented with non-specific abdominal pain (27%), pancreaticobiliary symptoms (9%), diabetes mellitus (5%), other symptoms (4%) and/or were asymptomatic (61%). Fifty-two per cent of patients were operated on during the first year after diagnosis (median size: 40 mm (2-200)), 9% had resection beyond 1 year of follow-up (3 years (1-20), size at diagnosis: 25 mm (4-140)) and 39% had no surgery (3.6 years (1-23), 25.5 mm (1-200)). Surgical indications were (not exclusive) uncertain diagnosis (60%), symptoms (23%), size increase (12%), large size (6%) and adjacent organ compression (5%). In patients followed beyond 1 year (n=1271), size increased in 37% (growth rate: 4 mm/year), was stable in 57% and decreased in 6%. Three serous cystadenocarcinomas were recorded. Postoperative mortality was 0.6% (n=10), and SCN's related mortality was 0.1% (n=1). CONCLUSIONS After a 3-year follow-up, clinical relevant symptoms occurred in a very small proportion of patients and size slowly increased in less than half. Surgical treatment should be proposed only for diagnosis remaining uncertain after complete workup, significant and related symptoms or exceptionally when exists concern with malignancy. This study supports an initial conservative management in the majority of patients with SCN. TRIAL REGISTRATION NUMBER IRB 00006477.
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Affiliation(s)
- B Jais
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
| | - V Rebours
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
| | - G Malleo
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - R Salvia
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - M Fontana
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - L Maggino
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - C Bassi
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - R Manfredi
- The Pancreas Institute, G.B. Rossi Hospital, University of Verona Hospital Trust, Verona, Italy
| | - R Moran
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A M Lennon
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Zaheer
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Wolfgang
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Hruban
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Division of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - G Marchegiani
- Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - C Fernández Del Castillo
- Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - W Brugge
- Departments of Surgery and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Y Ha
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - M H Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - D Oh
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - I Hirai
- First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - W Kimura
- First Department of Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - J Y Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - S W Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - W Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - H Kang
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - S Y Song
- Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - C M Kang
- Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - W J Lee
- Department of Surgery, Yonsei University College of Medicine, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - S Crippa
- Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Ancona-Torrette, Italy
| | - M Falconi
- Pancreatic Surgery Unit, Department of Surgery, Polytechnic University of Marche Region, Ancona-Torrette, Italy
| | - I Gomatos
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J Neoptolemos
- NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - A C Milanetto
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy
| | - C Sperti
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy
| | - C Ricci
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - R Casadei
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - M Bissolati
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Balzano
- Pancreatic Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - I Frigerio
- Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - R Girelli
- Hepato-Pancreato-Biliary Unit, Pederzoli Hospital, Peschiera del Garda, Italy
| | - M Delhaye
- Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - B Bernier
- Department of Gastroenterology, Hepatopancreatology and GI Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - H Wang
- Institute of Hepatopancreatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - K T Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - D H Song
- Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - M T Huggett
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - K W Oppong
- Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - L Pererva
- National Institute of Surgery and Transplantology named after Shalimov, Kiev, Ukraine
| | - K V Kopchak
- National Institute of Surgery and Transplantology named after Shalimov, Kiev, Ukraine
| | - M Del Chiaro
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - R Segersvard
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet at Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - L S Lee
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - D Conwell
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - A Osvaldt
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - V Campos
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - B Napoleon
- Hôpital Privé Mermoz, Gastroentérologie, Lyon, France
| | - I Matsumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - M Shinzeki
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - F Bolado
- Gastroenterology Department, Hospital de Navarra, Pamplona, Spain
| | | | - M G Keane
- Department of Gastroenterology and Hepatology, University College Hospital, London, UK
| | - S P Pereira
- Department of Gastroenterology and Hepatology, University College Hospital, London, UK
| | - I Araujo Acuna
- Department of Gastroenterology, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - E C Vaquero
- Department of Gastroenterology, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M R Angiolini
- Department of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Zerbi
- Department of Pancreatic Surgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - J Tang
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
| | - R W Leong
- Gastroenterology and Liver Services, Concord Hospital, Sydney, New South Wales, Australia
| | - A Faccinetto
- Radiological Department, General Hospital Cá Foncello, Treviso, Italy
| | - G Morana
- Radiological Department, General Hospital Cá Foncello, Treviso, Italy
| | - M C Petrone
- Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy
| | - P G Arcidiacono
- Division of Gastroenterology and Gastrointestinal Endoscopy, San Raffaele Scientific Institute, Milan, Italy
| | - J H Moon
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - H J Choi
- Department of Internal Medicine, Digestive Disease Center and Research Institute, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - R S Gill
- Department of Gastroenterology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
| | - D Pavey
- Department of Gastroenterology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
| | - M Ouaïssi
- Department of Digestive Surgery, Timone Hospital, Marseille, France
| | - B Sastre
- Department of Digestive Surgery, Timone Hospital, Marseille, France
| | - M Spandre
- Gastrohepatology Department, San Giovanni Battista Molinette Hospital, University of Turin, Turin, Italy
| | - C G De Angelis
- Gastrohepatology Department, San Giovanni Battista Molinette Hospital, University of Turin, Turin, Italy
| | - M A Rios-Vives
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca-IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Concepcion-Martin
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Institut de Reçerca-IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - T Ikeura
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - K Okazaki
- The Third Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - L Frulloni
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - O Messina
- Department of Medicine, Pancreas Center, University of Verona, Verona, Italy
| | - P Lévy
- Department of Gastroenterology and Pancreatology, Beaujon Hospital, AP-HP, Clichy, France
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15
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Righi A, Gambarotti M, Manfrini M, Benini S, Gamberi G, Cocchi S, Casadei R, Picci P, Vanel D, Dei Tos AP. Sclerosing epithelioid fibrosarcoma of the thigh: report of two cases with synchronous bone metastases. Virchows Arch 2015. [DOI: 10.1007/s00428-015-1810-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND Patellar tumors are rare; only a few series have been described in the literature and radiographic diagnosis can be challenging. We reviewed all patellar tumors at one institution and reviewed the literature. MATERIALS AND METHODS In an evaluation of the database at one institution from 1916 to 2009, 23,000 bone tumors were found. Of these, 41 involved the patella. All had imaging studies and microscopic diagnostic confirmation. All medical records, imaging studies, and pathology were reviewed. RESULTS There were 15 females and 26 males, ranging from 8 to 68 years old (average 30). There were 30 benign tumors; eight giant cell tumors, eight chondroblastomas, seven osteoid osteomas, two aneurysmal bone cysts, two ganglions, one each of chondroma, exostosis, and hemangioma. There were 11 malignant tumors: five hemangioendotheliomas, three metastases, one lymphoma, one plasmacytoma, and one angiosarcoma. CONCLUSION Patellar tumors are rare and usually benign. As the patella is an apophysis, the most frequent lesions are giant cell tumor in the adult and chondroblastoma in children. Osteoid osteomas were frequent in our series and easily diagnosed. Metastases are the most frequent malignant diagnoses in the literature; in our series malignant vascular tumors were more common. These lesions are often easily analyzed on radiographs. CT and MR define better the cortex, soft tissue extension, and fluid levels. This study presents the imaging patterns of the more common patellar tumors in order to help the radiologist when confronted with a lesion in this location.
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Affiliation(s)
- R Casadei
- Department of Orthopaedic Oncology, Istituto Ortopedico Rizzoli, Bologna, Italy.
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17
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Di Marco M, Macchini M, Ricci C, Taffurelli G, D'Ambra M, Vecchiarelli S, Pallotti MC, Pezzilli R, Martoni AA, Casadei R, Biasco G. Prognostic factors for recurrence in resected pancreatic adenocarcinoma: A single-center experience. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e14541] [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: 11/20/2022] Open
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18
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Di Marco M, Macchini M, di Cicilia R, Vecchiarelli S, Casadei R, Barbieri E, Calculli L, Pantaleo MA, Biasco G. Neoadjuvant therapy for resectable pancreatic adenocarcinoma: An interim report of a prospective randomized study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e14604] [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: 11/20/2022] Open
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19
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Pezzilli R, Casadei R, Calculli L, Santini D, Morselli-Labate AM. Serum determination of CA 19-9 in diagnosing pancreatic cancer: an obituary. Dig Liver Dis 2010; 42:73-4. [PMID: 19473891 DOI: 10.1016/j.dld.2009.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 04/09/2009] [Accepted: 04/14/2009] [Indexed: 12/11/2022]
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20
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Pezzilli R, Morselli-Labate AM, Campana D, Casadei R, Brocchi E, Corinaldesi R. Evaluation of patient-reported outcome in subjects treated medically for acute pancreatitis: a follow-up study. Pancreatology 2009; 9:375-82. [PMID: 19451747 DOI: 10.1159/000181171] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Accepted: 10/29/2008] [Indexed: 12/11/2022]
Abstract
AIMS To explore the quality of life in patients treated medically during the acute phase of pancreatitis as well as at 2 and 12 months after discharge from the hospital. PATIENTS 40 patients were studied. The etiology of the pancreatitis was biliary causes in 31 patients and non-biliary causes in 9; mild disease was present in 29 patients and severe disease in 11. 30 patients completed the two surveys at 2 and 12 months after hospital discharge. METHODS The SF-12 and EORTC QLQ-C30 questionnaires were used for the purpose of the study. RESULTS The two physical and mental component summaries of SF-12, all the domains of EORTC QLQ-C30 (except for physical functioning and cognitive functioning) and some symptom scales of EORTC QLQ-C30 (fatigue, nausea/vomiting, pain, and constipation) were significantly impaired during the acute phase of pancreatitis. There was a significant improvement in the SF-12 physical component summary, and global health, role functioning, social functioning, nausea/vomiting, pain, dyspnea, and financial difficulties (EORTC QLQ-C30) at 2 months after discharge as compared to the basal evaluation. Similar results were found after 12 months except for the mental component score at 12-month evaluation, which was significantly impaired in acute pancreatitis patients in comparison to the norms. The physical functioning of the EORTC QLQ-C30 at basal evaluation was significantly impaired in patients with severe pancreatitis in comparison to patients with mild pancreatitis. CONCLUSIONS Two different patterns can be recognized in the quality of life of patients with acute pancreatitis: physical impairment is immediately present followed by mental impairment which appears progressively in the follow-up period.
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Affiliation(s)
- R Pezzilli
- Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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21
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Ibrahim T, Mercatali L, Serra P, Ricci R, Flamini E, Fabbri L, Casadei R, Falasconi M, Galassi R, Bazzocchi O, Amadori D. Multidisciplinary Osteo-Oncology Center for the management of bone metastases. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.20694] [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: 11/20/2022] Open
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22
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Di Marco M, Nobili E, Di Cicilia R, Brandi G, Bertolini S, Derenzini E, Dell’Arte S, Casadei R, Calculli L, Biasco G. GEMOX as first-line chemotherapy in advanced pancreatic cancer (APC): A monoinstitutional experience. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15179] [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
15179 Background: To date, gemcitabine (GEM) remains the cornerstone of chemotherapy (CHT) for APC. According to GERCOR and GISCAD phase III trials the combination of GEM and oxaliplatin (GEMOX) has proven superior to GEM alone in terms of response rate (RR), time to progression (TTP) and clinical benefit rate (CBR). Methods: We conducted a retrospective analysis on 19 patients (pts) affected with histologically-confirmed APC, in order to determine the impact of GEMOX as first-line chemotherapy in terms of objective responses (OR) and TTP, using the Kaplan-Meier method. Among the 19 pts considered there were 15 males and 4 females (median age at diagnosis of 60.84 yrs; ECOG 0–2). The staging, according to AJCC criteria, was: IIB in 1 case, III in 5 cases and IV in the 13 remaning cases. The only metastatic site was the liver (in 13/19 pts). Ten of the 19 pts underwent surgical treatment prior to CHT: 2 radically resected (R0) subsequently treated with GEMOX after recurrence, 4 with positive margins (R1) and 4 surgically palliated. All pts received GEM 1000 mg/m2/d1 + oxaliplatin 100 mg/m2/d2 every 2 weeks. The median number of cycles was 5.89. Results: Among the 19 pts, 3 had a partial response (PR, 15.69%), 6 had stable disease (SD, 31.57%); no complete response was observed and 10 pts had progressive disease (PD, 52.63%). The overall disease control rate (DCR: PR + SD) was 47.37% while the OR were 15.69%. The median survival observed was 9.03 months (95% C.I. 5.15–12.91) and the median TTP was 6.13 months (95% C.I. 2.81–9.46). The main toxicities were: leucopenia, piastrinopenia, diarrhoea, nausea, fever and peripheral neuropathy; 3 pts discontinued the treatment due to grade 3–4 neurotoxicity. Conclusions: In our experience GEMOX gives an improved control of APC in terms of OR and TTP, with acceptable toxicity. The OS is in accordance to literature as well as the other data. No significant financial relationships to disclose.
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Affiliation(s)
| | - E. Nobili
- S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - G. Brandi
- S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | | | | | - R. Casadei
- S. Orsola-Malpighi Hospital, Bologna, Italy
| | | | - G. Biasco
- S. Orsola-Malpighi Hospital, Bologna, Italy
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23
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Pezzilli R, Casadei R, Santini D. Autoimmune pancreatitis associated with anisakis infection. Dig Liver Dis 2007; 39:273. [PMID: 17267310 DOI: 10.1016/j.dld.2006.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 10/17/2006] [Accepted: 10/17/2006] [Indexed: 02/08/2023]
Affiliation(s)
- R Pezzilli
- Department of Internal Medicine and Gastroenterology, S Orsola-Malpighi Hospital, Bologna, Italy.
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24
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Fantini L, Zanini N, Fiscaletti M, Calculli L, Casadei R, Campana D, Pezzilli R. Autoimmune pancreatitis: the classification puzzle. Adv Med Sci 2007; 52:71-75. [PMID: 18217393] [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: 05/25/2023]
Affiliation(s)
- L Fantini
- Department of Internal Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy
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25
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Casadei R, Zanini N, Morselli-Labate AM, Calculli L, Pezzilli R, Potì O, Grottola T, Ricci C, Minni F. Prognostic Factors in Periampullary and Pancreatic Tumor Resection in Elderly Patients. World J Surg 2006; 30:1992-2001; discussion 2002-3. [PMID: 16957825 DOI: 10.1007/s00268-006-0122-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND More than half of all patients with pancreatic adenocarcinoma are over 70 years of age. Life expectancy for the elderly population is increasing and currently major pancreatic resection provides the only meaningful chance of cure for periampullary and pancreatic tumors. Controversy over what constitutes the correct treatment of these tumors in elderly patients continues to this day. The aim of our study was to determine whether age alone or age plus some prognostic factors constitute contraindications to major pancreatic resections. METHODS Between 2000 and 2005, data from 88 consecutive patients who had major pancreatic resection for periampullary or pancreatic tumors were entered into a prospective database. Fifty-three patients under 70 years of age (young patients), and 35 patients 70 years of age or older (elderly patients) were compared with respect to several characteristics and the postoperative course. RESULTS Postoperative mortality and morbidity, length of hospital stay, and long-term survival were similar in the two groups. In the elderly group, the mortality rate was significantly higher in patients with chronic obstructive pulmonary disease (COPD), and the morbidity rate was significantly higher in patients with ASA 3 than in patients with ASA 1-2, in whom a pancreaticoduodenectomy or total pancreatectomy had been performed. CONCLUSIONS Age alone is not a contraindication for major pancreatic resection. In elderly patients a careful evaluation of the co-morbidities and of the type of surgical procedure is mandatory in order to allow the proper selection of those patients best suited for surgery in specialized centers.
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Affiliation(s)
- R Casadei
- Dipartimento di Scienze Chirurgiche e Anestesiologiche, Alma Mater Studiorum-Università di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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26
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Tomassetti P, Campana D, Piscitelli L, Casadei R, Santini D, Nori F, Morselli-Labate AM, Pezzilli R, Corinaldesi R. Endocrine pancreatic tumors: factors correlated with survival. Ann Oncol 2005; 16:1806-10. [PMID: 16085691 DOI: 10.1093/annonc/mdi358] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [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: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the survival rate of patients with endocrine tumors of the pancreas, functioning or non-functioning, associated or not with MEN 1 syndrome. PATIENTS AND METHODS Eighty-three patients with pancreatic endocrine tumors diagnosed in our department from 1978 to 2003 were studied. RESULTS The study included 37 men (44.6%) and 46 women (55.4%). The median age of patients at diagnosis was 55 years (range 19-81 years). Fifty-two patients (62.7%) had non-functioning endocrine tumors, 16 (19.3%) had functioning endocrine tumors and 15 (18.1%) had MEN 1 disease with pancreatic involvement. Twenty-seven patients (32.5%) had liver metastases at the time of diagnosis, involvement of the lymph nodes was found in 47 out of 79 patients (59.5%). Forty patients (48.2%) had radical surgery, 20 (24.1%) had palliative surgery and 53 were treated medically. The survival rate was significantly related to the presence of metastases, lymph node involvement, and the type of tumor and treatment. CONCLUSIONS Tumor resection, the absence of liver and lymph node metastases, and the presence of MEN 1 syndrome are related to a better survival rate. Radical surgery continues to have a central role in the therapeutic approach to endocrine tumors of the pancreas.
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Affiliation(s)
- P Tomassetti
- Dipartimento di Medicina Interna e Gastroenterologia, Università di Bologna, Italy.
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27
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Giannone S, Strippoli P, Vitale L, Casadei R, Canaider S, Lenzi L, D'Addabbo P, Frabetti F, Facchin F, Farina A, Carinci P, Zannotti M. Gene expression profile analysis in human T lymphocytes from patients with Down Syndrome. Ann Hum Genet 2005; 68:546-54. [PMID: 15598213 DOI: 10.1046/j.1529-8817.2003.00123.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [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: 11/20/2022]
Abstract
Down Syndrome (DS) is caused by the presence of three copies of the whole human chromosome 21 (HC21) or of a HC21 restricted region; the phenotype is likely to have originated from the altered expression of genes in the HC21. We apply the cDNA microarray method to the study of gene expression in human T lymphocytes with trisomy 21 in comparison to normal cells. Two patients with DS were investigated, along with two normal subjects as a control, all being tested in independent, duplicated cell culture experiments. The most consistent finding was the overexpression of the superoxide dismutase gene (SOD1), located on 21q, and of MHC DR beta 3 (HLA-DRB3), GABA receptor A gamma 2 (GABRG2), acetyltransferase Coenzyme, A 2 (ACAT2) and ras suppressor protein 1 (RSU1) genes. When the data were clustered according to chromosome localization, the HC21 gene set showed, on average, the highest expression in DS cells in all the experiments. Moreover, separate clustering of patients and controls was obtained when analysis was restricted to HC21 gene expression values. These findings reinforce the specific gene dosage theory for the pathogenesis of the DS phenotype, and show a consistent overexpression of the SOD1 gene on 21q.
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Affiliation(s)
- S Giannone
- Center for Research in Molecular Genetics Fondazione CARISBO, at the Institute of Histology and General Embriology, University of Bologna, V. Belmeloro 8, 40126 Bologna, Italy
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28
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Biagini R, Casadei R, Favale L, Salducca N, Erba F, Gigli M, Boriani S, Gamberini G, Rocca M, Briccoli A, Perin S, Pelosi M, Mercuri M. Vertebral hemi-resection for bone tumor with wide invasion of the vertebral canal: modified surgical method. Chir Organi Mov 2004; 89:293-8. [PMID: 16048050] [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: 05/03/2023]
Abstract
The authors describe a variation in the method of vertebral hemi-resection used for the treatment of neoplasms that present a wide invasion of the vertebral canal. This is followed by a review of the literature on the subject.
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Affiliation(s)
- R Biagini
- V Divisione e Centro Tumori dell'Apparato Locomotore-Istituto Ortopedico Rizzoli, Bologna, Italy
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29
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Bastian PJ, Albers P, Hanitzsch H, Fabrizi G, Casadei R, Haferkamp A, Schumacher S, Müller SC. Die modifizierte Ureterosigmoidostomie (Mainz Pouch�II) als kontinente Form der Harnableitung. Urologe A 2004; 43:982-8. [PMID: 15067407 DOI: 10.1007/s00120-004-0560-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The purpose of this study was to examine the outcome of the "Mainz Pouch II" urinary diversion at two different centers (the Klinik und Poliklinik für Urologie, Bonn and the Ospedale "San Salvadore", Pesaro, Italy) in terms of different techniques of ureteral implantation. MATERIALS AND METHODS Between March 1995 and February 2003, the procedure was performed on 83 patients with 165 renal units (RU). Ureteral implantation with the Goodwin-Hohenfellner technique was performed in 57 RU, with the Abol-Enein modification in 23 RU and the Le-Duc procedure in 85 RU. Follow-up was available for 71 patients (85%) with a period of 1 to 82 months (mean 19.5 months, median 12 months). A non-validated questionnaire was used in the Bonn series to determine specific urinary diversion items. RESULTS Early complications occurred in 12%, three requiring surgical intervention. Two patients died within the first 30 days after initial surgery. Pyelonephritis occurred in 12 RU (14% of the patients, 8.5% of the RU). Ureteral stenosis requiring reimplantation was found in two RU. The continence rate was 100% during daytime in the Bonn series; all but one patient had to get up for urination at night. A total of 63% of the patients were able to distinguish between stool and urine. CONCLUSION Mainz pouch II is a quick, safe and easy to perform urinary diversion which serves as a satisfying alternative to other forms of continent diversion. Follow-up shows a low complication rate with good results in terms of continence; however, long term results have to be evaluated. There are no significant differences in complication rates for the different ureteral implantation techniques.
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Affiliation(s)
- P J Bastian
- Klinik und Poliklinik für Urologie, Universitätsklinikum Bonn, Rheinische Friedrich-Wilhelms Universität Bonn.
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D'Addabbo P, Lenzi L, Facchin F, Casadei R, Canaider S, Vitale L, Frabetti F, Carinci P, Zannotti M, Strippoli P. GeneRecords: a relational database for GenBank flat file parsing and data manipulation in personal computers. Bioinformatics 2004; 20:2883-5. [PMID: 15145799 DOI: 10.1093/bioinformatics/bth321] [Citation(s) in RCA: 5] [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: 11/15/2022] Open
Abstract
UNLABELLED Extracting the desired data from a database entry for later analysis is a constant need in the biological sequence analysis community; GeneRecords 1.0 is a solution for GenBank biological flat file parsing, as it implements a structured representation of each feature and feature qualifier in GenBank following import in a common database managing system usable in a personal computer (Macintosh and Windows environments). This collection of related databases enables the local management of GenBank records, allowing indexing, retrieval and analysis of both information and sequences on a personal computer. AVAILABILITY The current release, including the FileMaker Pro runtime application (built for Windows and Macintosh environments), is freely available at http://apollo11.isto.unibo.it/software/
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Affiliation(s)
- P D'Addabbo
- Center for Research into Molecular Genetics Fondazione CARISBO, Institute of Histology and General Embriology, University of Bologna, Via Belmeloro, 8-40126 Bologna, Italy
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Casadei R, Minni F, Selva S, Marrano N, Marrano D. Cystic lymphangioma of the pancreas: anatomoclinical, diagnostic and therapeutic considerations regarding three personal observations and review of the literature. Hepatogastroenterology 2003; 50:1681-6. [PMID: 14571816] [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: 04/27/2023]
Abstract
Cystic lymphangioma is a very rare pathology and the pancreatic ones represent an exceptional report that must be considered in the differential diagnosis with others and more frequent cystic lesions of the pancreas. In this paper we describe three cases of cystic lymphangiomas of the pancreas observed in our Institute and we report on the literature review. Anatomopathological, clinical and therapeutics aspects of pancreatic cystic lymphangioma were analyzed for a better knowledge of this cystic lesion and to recognize some specific findings that could allow a preoperative diagnosis and, subsequently, a proper treatment.
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Affiliation(s)
- R Casadei
- Dipartimento di Scienze Chirurgiche e Anestesiologiche-I Clinica Chirurgica, Policlinico S Orsola-Malpighi, Via Massarenti, 9, 40138, Bologna, Italy.
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Casadei R, Donati D, Ferraro A, Giacomini S, Gozzi E, Gigli M, Boni F, Mercuri M. Knee resection arthrodesis with allograft: a long-term follow-up study. Chir Organi Mov 2003; 88:123-35. [PMID: 14735819] [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: 04/28/2023]
Abstract
A consecutive series of 57 patients treated by knee resection arthrodesis for malignant or aggressive tumor around the knee was reviewed. Infection was present only after repeated surgery for other complications, delayed union or non-union occurred in 50% of the cases that could be evaluated, but were still easy to manage. Fracture incidence was higher than expected (32.6%) even occurring after 10 years; this was difficult to deal with and it often led to failure. The best possible method of fixation is still being debated, but locked nail and allograft cementation is often advised. Several satisfactory functional results were however achieved when surgery was performed in young patients; final results can be less satisfactory when there is leg length discrepancy and poor acceptance on the part of the patient. In recent years this type of surgery has been limited to younger male patients (10 to 14 years of age) in whom extra-articular knee resection was required or when most of the quadriceps muscle must be removed.
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Affiliation(s)
- R Casadei
- 1o Clinica Ortopedica dell'Istituto Rizzoli, Bologna
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33
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Biagini R, Boriani S, Bandiera S, Casadei R, Favale L, Salducca N, Erba F, Lari S, Gamberini G, Mercuri M. Substitution in vertebral resections. Chir Organi Mov 2003; 88:185-91. [PMID: 14735828] [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: 04/28/2023]
Abstract
The authors discuss the reconstructive methods used after curettage and/or vertebral resection possibly associated with removal of surrounding muscular, visceral and nervous structures.
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Affiliation(s)
- R Biagini
- Istituto Ortopedico Rizzoli, Bologna
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34
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Biagini R, Casadei R, Boni F, Mascari C, Sturiale C, Bortolotti C, Boriani S, Gamberini G, Di Fiore M, Mercuri M. Spondylectomy (thoracolumbar spine) combined with dural resection for bone tumor: surgical technique. Chir Organi Mov 2002; 87:97-101. [PMID: 12508708] [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: 04/19/2023]
Abstract
The authors describe the technique of vertebral resection combined with resection and reconstruction of the dura mater for bone tumor. The literature relevant to this topic is reviewed.
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Affiliation(s)
- R Biagini
- Clinica Ortopedica dell'Università, Istituto Ortopedico Rizzoli, Bologna, Italy
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Abstract
Pain in the anterior knee has become synonymous with patella chondromalacia. However, pain also is the first sign of a tumor of the patella. Tumors of the patella are rare, but they often are mistaken for other benign lesions. Benign tumors of the patella are more frequent than malignant tumors (73% versus 27%). The most common benign neoplasms are giant cell tumor and chondroblastoma. Margin of the lesion, cortical involvement, trabecular pattern, and type of the matrix are important features for a radiographic diagnosis. Bone scans, computed tomography scans, and magnetic resonance images are used for staging of the tumor before surgery. Curettage only should be considered for patients with Stage 1 or Stage 2 benign lesions. Patellectomy is indicated for patients with Stage 3 aggressive benign tumors and for patients with Stage IA malignant tumors. A patellectomy with excision of involved soft tissues is used in patients with Stage IB tumors, whereas in patients with Stage IIA tumors, an extensive patellectomy is indicated. In patients with Stage IIB tumors, an extraarticular resection of the knee is preferred when there is a small soft tissue involvement, but amputation is necessary when there is a large soft tissue mass.
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Affiliation(s)
- M Mercuri
- 1 Clinica Ortopedica dell'Università di Bologna, Istituto Ortopedico Rizzoli
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36
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Abstract
Diagnosis of pancreatic cancer is made late, and prognosis remains extremely poor. This study was carried out to investigate whether symptoms exist before pain or jaundice that could suggest pancreatic cancer and favor earlier diagnosis. The study involved 305 patients with confirmed pancreatic cancer and 305 controls. All subjects were interviewed personally at least twice about their clinical history; pancreatic cancer patients were asked about any disturbances before abdominal pain or jaundice. Of the 305 pancreatic cancer patients, 151 (49.5%) had some prior disturbances, 108 (35.4%) 6 months or less before pain or jaundice and 43 (14.1%) more than 6 months before. Among the latter, 14 (4.6% of all patients) had had anorexia and/or early satiety and/or asthenia (7-20 months before pain or jaundice), 11 (3.6%) had disgust for coffee and/or smoking and/or wine (7-20 months before), 14 (4.6%) had diabetes (7-24 months before), and four (1.3%) had acute pancreatitis (8-26 months before). Among the controls, the only reports of these symptoms were two (0.7%) cases of asthenia (4 and 6 years earlier), 22 (7.2%) cases of diabetes (of which only two [0.7%] were diagnosed 7-24 months before the interview), and one (0.33%) case of acute pancreatitis (10 years earlier). Apart from acute pancreatitis, all the other differences between patients and controls were statistically significant. In approximately 15% of patients, disturbances existed more than 6 months before pain or jaundice, which, although not specific, could raise suspicion of the possibility of pancreatic cancer. These disturbances could represent the one current opportunity for an earlier diagnosis in a significant minority of pancreatic cancer patients.
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Affiliation(s)
- L Gullo
- Department of Internal Medicine and Gastroenterology, University of Bologna, S. Orsola Hospital, Italy.
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Abstract
AIM The aim of this study was to assess the value of plasma chromogranin A (CgA), a protein produced by neuroendocrine cells, in the diagnosis of neuroendocrine tumours. METHODS Eighty subjects with neuroendocrine tumours were studied. Thirty-four had carcinoids, 21 nonfunctioning endocrine pancreatic tumours, 17 multiple endocrine neoplasia type 1 (MEN 1) (six of these also had gastrinomas), and eight had functioning pancreatic tumours (four gastrinomas, two glucagonomas, two somatostatinomas). Twenty-eight healthy subjects were studied as controls. A fasting plasma sample was obtained from each subject, and CgA plasma levels were measured by the ELISA method using a kit (Dako A/S, Denmark). RESULTS In control subjects, plasma CgA values were below 5 U/l. Among the patients, 20 of the 34 with carcinoid tumours, 12 of the 21 with nonfunctioning pancreatic tumours, nine of the 17 with MEN 1 (including the six with gastrinomas), and the four gastrinomas of the eight functioning pancreatic tumours, i.e. overall, 45 of the 80 patients (56.3%) had abnormally high CgA values (22-961 U/l). Most of the patients with elevated CgA values, except nine of the 10 with gastrinomas, had multiple liver metastasis. CONCLUSIONS The results show that the diagnostic value of plasma CgA in neuroendocrine tumours is relatively low; it may be of some interest only in patients with advanced disease and liver metastasis. Gastrinoma seems to be an exception, because in this tumour high CgA values are generally found even in the absence of liver metastasis.
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Affiliation(s)
- P Tomassetti
- Department of Internal Medicine and Gastroenterology, University of Bologna, Italy.
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Bacci G, Ferrari S, Bertoni F, Ruggieri P, Picci P, Longhi A, Casadei R, Fabbri N, Forni C, Versari M, Campanacci M. Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the istituto ortopedico rizzoli according to the istituto ortopedico rizzoli/osteosarcoma-2 protocol: an updated report. J Clin Oncol 2000; 18:4016-27. [PMID: 11118462 DOI: 10.1200/jco.2000.18.24.4016] [Citation(s) in RCA: 272] [Impact Index Per Article: 11.3] [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: 11/20/2022] Open
Abstract
PURPOSE To provide an estimate of long-term prognosis for patients with osteosarcoma of the extremity treated in a single institution with neoadjuvant chemotherapy and observed for at least 10 years. PATIENTS AND METHODS Patients with nonmetastatic osteosarcoma of the extremity were preoperatively treated with high-dose methotrexate, cisplatin, and doxorubicin (ADM). Postoperatively, good responders (90% or more tumor necrosis) received the same three drugs used before surgery, whereas poor responders (less than 90% tumor necrosis) received ifosfamide and etoposide in addition to those three drugs. RESULTS For the 164 patients who entered the study between September 1986 and December 1989, surgery was a limb salvage in 136 cases (82%) and a good histologic response was observed in 117 patients (71%). At a follow-up ranging from 10 to 13 years (median, 11.5 years), 101 patients (61%) remained continuously free of disease, 61 relapsed, and two died of ADM-induced cardiotoxicity. There were no differences in prognosis between good and poor responding patients. ADM-induced cardiotoxicity (six patients), male infertility (10 of the 12 assessable patients), and second malignancies (seven patients) were the major complications of chemotherapy. Despite the large number of limb salvages performed, only four local recurrences (2.4%) were registered. CONCLUSION With an aggressive neoadjuvant chemotherapy, it is possible to cure more than 60% of patients with nonmetastatic osteosarcoma of the extremity and amputation may be avoided in more than 80% of them. Because local or systemic relapses, myocardiopathies, and second malignancies are possible even 5 years or more after the beginning of treatment, a long-term follow-up is recommended for these patients.
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Affiliation(s)
- G Bacci
- Service of Chemotherapy, Laboratory of Pathology, Fifth Service of Orthopedic Surgery, and Laboratory of Oncologic Research, Department of Musculoskeletal Oncology, I.F. Goidanich of the Istituto Ortopedico Rizzoli, Bologna, Italy.
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Calculli L, Casadei R, Nocco AM, La Donna M, Gavelli G. [The role of helical computer tomography in pancreatic metastasis of renal carcinoma. A rare case and review of the literature]. Radiol Med 2000; 99:398-400. [PMID: 10938714] [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: 02/17/2023]
Affiliation(s)
- L Calculli
- Dipartimento di Scienze Radiologiche ed Istocitopatologiche, Policlinico S. Orsola-Malpighi, Bologna
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Abstract
It is often difficult to identify the characteristics of soft-tissue tumors of the chest wall. This paper describes the peculiarities of elastofibroma dorsi, a rare pseudotumor of this site, to exclude many dangerous misconceptions. During the period between 1987 and 1997, we treated nine patients with elastofibroma dorsi. In six patients, the lesion was unilateral and in three it was bilateral. All these lesions were excised and no evidence of local recurrence or shoulder disability was observed at the last clinical evaluation. Elastofibroma dorsi is a rare, slow-growing, pseudotumoral lesion of the soft tissues of the chest wall with a peculiar radiographic and histologic pattern.
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Affiliation(s)
- A Briccoli
- Surgical Department, Modena University, via Del Pozzo 71, Modena, Italy
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Affiliation(s)
- R Casadei
- Department of Surgical and Anaesthesiological Sciences, 1st Surgical Clinic, S. Orsola Hospital, University of Bologna, Italy
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Casadei R, Tomassetti P, Rossi C, la Donna M, Migliori M, Marrano D. Treatment of metastatic glucagonoma to the liver: case report and literature review. Ital J Gastroenterol Hepatol 1999; 31:308-12. [PMID: 10425577] [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: 04/13/2023]
Abstract
Glucagonoma, a rare neuroendocrine pancreatic tumour, is frequently malignant and often accompanied by hepatic metastases. Our aim was to consider the different treatments of metastatic glucagonoma to the liver and their results. A case of glucagonoma with metachronous, small, multiple and bilobar liver metastases is reported. Combined treatment with octreotide and hepatic arterial chemoembolization was applied with good results in terms of symptom relief, plasma glucagon levels and regression of hepatic metastases. Survival rates were also improved. Based on our experience, glucagonoma with metachronous, multiple, diffuse and bilobar hepatic metastases should be treated with octreotide plus hepatic arterial chemoembolization with improved outcome and prognosis.
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Affiliation(s)
- R Casadei
- Department of Surgical and Anaestesiological Sciences, S. Orsola Hospital, Italy
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Zanelli M, Casadei R, Santini D, Gallo C, Verdirame F, La Donna M, Marrano D. Pseudomyxoma peritonei associated with intraductal papillary-mucinous neoplasm of the pancreas. Pancreas 1998; 17:100-2. [PMID: 9667528 DOI: 10.1097/00006676-199807000-00014] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Calculli L, Casadei R, Diacono D, Caputo M, Cavina M, Minguzzi MT, Marrano D, Gavelli G. [Role of spiral computerized tomography in the staging of pancreatic carcinoma]. Radiol Med 1998; 95:344-8. [PMID: 9676213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Few pancreatic carcinomas (5-22%) are resectable at the time of diagnosis because this lesion is seldom diagnosed in an early stage. Unresectability is mainly due to the presence of metastases to the liver, peritoneum and lymph nodes and to tumor spread especially to the portal mesenteric trunk where it can invade, compress, reduce, or occlude the vessels. We investigated the diagnostic yield of multiplanar and 3D spiral CT in the assessment of pancreatic carcinoma resectability. MATERIAL AND METHODS Twenty-seven patients with histologically confirmed pancreatic head cancer were submitted to spiral CT and color Doppler US in the Surgical Clinic I of the Bologna University. The examination results were correlated with the intraoperative findings of careful inspection and palpation and of US studies of the pancreatic mass and adjacent structures. The tumors were classified in relation to some CT parameters: tumor size (T), infiltration of the stomach (S) and/or duodenum, lymph nodes (N) or distant (M) metastases, involvement of vascular structures (V), particularly of portal or superior mesenteric vein, or superior mesenteric artery. Five grades of vascular involvement were considered. The results of these techniques were correlated with intraoperative findings from careful inspection and palpation and with US studies of the pancreatic mass and adjacent structures. RESULTS Spiral CT revealed vascular involvement in 19 of 27 cases (70.4%): involvement of portal and superior mesenteric vein was found in 14 (73.6%), superior mesenteric vein was involved in 2 (10.6%), the portal vein in one (2%) and, finally the portal, superior mesenteric vein and superior mesenteric artery in 2 cases (10.6%). The spiral CT results were confirmed intraoperatively in 26 of 27 cases (96.3%); spiral CT did not reveal hepatic metastasis only in one case. Spiral CT with multiplanar reconstructions had very high specificity and sensitivity (100%) in the assessment of vascular involvement, while color Doppler US had the same specificity but lower sensitivity (84.2%). Spiral CT was less sensitive (80%) in the detection of liver metastases. CONCLUSIONS We believe that spiral CT is currently the best technique for pancreatic carcinoma staging, providing useful information for correct surgical planning.
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Affiliation(s)
- L Calculli
- Dipartimento di Scienze Radiologiche ed Istocitopatologiche, Policlinico Sant'Orsola, Malpighi, Bologna
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Casadei R, Greggi T, Miglietta A, Perozzi M, Barchetti M, Parisini P. Posterior surgery for the treatment of thoracolumbar pathologic fractures in metastatic patients. Chir Organi Mov 1998; 83:149-158. [PMID: 9718823] [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: 05/22/2023]
Abstract
A total of 25 pathologic fractures in patients affected with thoracolumbar vertebral metastases associated with neurologic deficit are reported. None of the pathologic fractures were stable, while 14 were unstable and 11 were very unstable. Decompression with intralesional excision of the neoplastic mass compressing the dural sac was performed in all of the cases. Posterior stabilization was performed in the first cases using systems of sublaminar segmental fixation, and thereafter using systems of pedicle fixation. Removal of the vertebral body followed by anterior fusion after preventive posterior stabilization was performed in 2 cases. Pain symptoms regressed in 85% of the cases and in more than 50% of the patients there was improvement in the neurologic findings and in vertebral deformity consequent to fracture. Mean survival rate was 12 months. Despite the limited number of cases posterior stabilization of pathological fractures is a good choice of treatment in patients with severe neurologic deficit.
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Affiliation(s)
- R Casadei
- Divisione di Chirurgia Vertebrale, Istituto Ortopedico Rizzoli, Bologna
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Abstract
We describe our experience with color Doppler ultrasonography (CDU) in the preoperative staging of pancreatic cancer and, particularly, in detecting the involvement of the portal-mesenteric trunk (PMT). Of the 54 patients studied, 43 (79.6%) underwent surgery and 11 (20.4%) did not because of evident infiltration of the PMT. Of the 43 patients operated on, the CDU study was normal in 8 cases (18.6%), abnormal in 33 (76.7%), and not possible in the remaining 2 cases (4.7%). Results of the CDU were confirmed intraoperatively in 39 cases (diagnostic accuracy, 95.1%). In only two cases (4.9%) did the CDU not show involvement of the PMT, which was, instead, demonstrated by intraoperative ultrasonography (false negatives). Of the 11 nonoperated patients, all showed morphological alterations at CDU, while only 7 showed hematic flow changes. The sensitivity of CDU was 94.2% and the specificity 100%. The positive predictive value was 100%; the negative predictive value, 75%. The results indicate that CDU may be the first imaging technique for preoperative assessment of PMT involvement in pancreatic cancer.
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Affiliation(s)
- R Casadei
- Dipartimento di Scienze Chirurgiche e Anestesiologiche--Clinica Chirurgica I, Bologna, Italy
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Minni F, Casadei R, Santini D, Verdirame F, Zanelli M, Vesce G, Marrano D. Gastrointestinal autonomic nerve tumor of the jejunum. Case report and review of the literature. Ital J Gastroenterol Hepatol 1997; 29:558-63. [PMID: 9513833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastrointestinal autonomic nerve tumor is very rare and it is difficult to distinguish this tumor from other gastrointestinal tumors due to the absence of clinical, instrumental and macroscopic features which allow pre- or intraoperative diagnosis. Our aim was to recognize the characteristic features (preoperative, intraoperative, pathological) that would allow diagnosis of gastrointestinal autonomic nerve tumor. A case of gastrointestinal autonomic nerve tumor of the jejunum is reported. Surgical specimen was routinely processed. Immunohistochemical staining was performed according to modified immunoperoxidase Avidin-Biotin-Peroxidase Complex method. An electron microscopy study was also performed. The tumor mass showed some characteristic pathological findings: histologically, it was composed of spindle cells and epithelioid cells; immunohistochemically, a focal positivity for Neuron Specific Enolase was shown, and finally, ultrastructural examination showed neuron-like cells with long cytoplasmic processes containing microtubules and bulbouns synapse-like structures with dense core neurosecretory-type granules. Preoperatively gastrointestinal autonomic nerve tumor of the jejunum must be considered and treated as a malignant tumor. A correct diagnosis is possible only with immunohistochemical and ultrastructural studies. It is probable that this tumor is more common than previously thought.
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Affiliation(s)
- F Minni
- Department of Surgical and Anaesthesiological Science, University of Bologna, Italy
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48
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Biagini R, Boriani S, Casadei R, Bandiera S, De Iure F, Campanacci L, Demitri S, Orsini U, Di Fiore M. Reconstruction techniques in the treatment of vertebral neoplasms. Chir Organi Mov 1997; 82:341-55. [PMID: 9618973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The authors present a new system for the topographical description of vertebral neoplasms. The general criteria of reconstruction after curettage or vertebral resection are evaluated. The literature is reviewed in terms of the use of prostheses, bone grafts, cement and stabilization systems in the treatment of tumors of the spine. Indications for the different methods are discussed.
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Affiliation(s)
- R Biagini
- Clinica Ortopedica I dell'Università degli Studi, Istituto Ortopedico Rizzoli, Bologna
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49
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Calculli L, Casadei R, Diacono D, Minni F, La Donna M, Fadda ME. [Spiral computed tomography in the assessment of a case of cystic lymphangioma of the pancreas]. Radiol Med 1997; 94:266-9. [PMID: 9446138] [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: 02/05/2023]
Affiliation(s)
- L Calculli
- Dipartimento di Scienze Radiologiche e Istocitopatologiche Radiodiagnostica III, Università di Bologna
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50
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D'Ettorre C, De Chiara G, Casadei R, Boraschi D, Tagliabue A. Functional epitope mapping of human interleukin-1 beta by surface plasmon resonance. Eur Cytokine Netw 1997; 8:161-71. [PMID: 9262965] [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]
Abstract
A panel of monoclonal antibodies to human IL-1 beta has been used to probe its conformational and functional characteristics. Real time antibody-protein interaction was assessed by surface plasmon resonance with a BIAcore apparatus, in order to determine the kinetic and thermodynamic parameters of the interaction and to map the recognition sites of the antibodies on the IL-1 beta surface. Topological analysis was thus compared to the inhibitory capacity of antibodies for IL-1 beta bioactivity and binding to the activating receptor IL-1RI. This functional mapping analysis allows the following hypothesis. At least two discrete areas of IL-1 beta, located within the sequences 133-147 and 177-186 (as defined by mAbs MhC1 and BRhD2, respectively), are apparently involved in IL-1RI-independent agonist activity, and thus possibly take part in the interaction with the receptor accessory protein IL-1RAcP. Another area in the 133-147 sequence (defined by mAb BRhC3) is involved in agonist binding to its receptor CDw121a (IL-1RI), whereas a site recognized by mAb BRhG5 within the sequence 218-243 is selectively responsible for non-agonist binding to the activating receptor. The loop between the 4th and the 5th beta-strand, at the open end of the IL-1 beta-barrel structure, may possibly take part in both non-agonist binding to IL-1RI and in the interaction with IL-1RAcP.
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