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Lucà S, Pagliuca F, Perrotta F, Ronchi A, Mariniello DF, Natale G, Bianco A, Fiorelli A, Accardo M, Franco R. Multidisciplinary Approach to the Diagnosis of Idiopathic Interstitial Pneumonias: Focus on the Pathologist's Key Role. Int J Mol Sci 2024; 25:3618. [PMID: 38612431 PMCID: PMC11011777 DOI: 10.3390/ijms25073618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Idiopathic Interstitial Pneumonias (IIPs) are a heterogeneous group of the broader category of Interstitial Lung Diseases (ILDs), pathologically characterized by the distortion of lung parenchyma by interstitial inflammation and/or fibrosis. The American Thoracic Society (ATS)/European Respiratory Society (ERS) international multidisciplinary consensus classification of the IIPs was published in 2002 and then updated in 2013, with the authors emphasizing the need for a multidisciplinary approach to the diagnosis of IIPs. The histological evaluation of IIPs is challenging, and different types of IIPs are classically associated with specific histopathological patterns. However, morphological overlaps can be observed, and the same histopathological features can be seen in totally different clinical settings. Therefore, the pathologist's aim is to recognize the pathologic-morphologic pattern of disease in this clinical setting, and only after multi-disciplinary evaluation, if there is concordance between clinical and radiological findings, a definitive diagnosis of specific IIP can be established, allowing the optimal clinical-therapeutic management of the patient.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Francesca Pagliuca
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Fabio Perrotta
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Domenica Francesca Mariniello
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Giovanni Natale
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Andrea Bianco
- Department of Translational Medical Science, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.P.); (D.F.M.); (A.B.)
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Piazza Miraglia, 2, 80138 Naples, Italy; (G.N.); (A.F.)
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (S.L.); (F.P.); (A.R.); (M.A.)
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Pagliuca F, Lucà S, De Sio M, Arcaniolo D, Facchini G, De Martino M, Esposito F, DE Vita F, Chieffi P, Franco R. Testicular/paratesticular mesothelial tumours: Uncommon histopathologic entities in a very complex anatomical site. Pathol Res Pract 2024; 253:155069. [PMID: 38181581 DOI: 10.1016/j.prp.2023.155069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Abstract
Mesothelial tumours of the testicular/paratesticular region are uncommon, poorly characterised and difficult-to-diagnose lesions. They encompass entirely benign proliferations (adenomatoid tumour) and malignant, very aggressive tumours (mesothelioma) whose morphological features can be overlapping, highly variable and confounding. Moreover, testicular/paratesticular mesothelial tumours comprise relatively new entities with indolent behaviour (well-differentiated papillary mesothelial tumour) as well as tumours which cannot be correctly included in any of the aforementioned categories and whose classification is still controversial. The molecular profile of such tumours represents an open issue. In fact, despite the recent discoveries about the genomic landscape of mesothelial proliferations at other sites (pleura, peritoneum), testicular/paratesticular mesothelial tumours, and namely mesotheliomas, are too rare to be extensively studied on large case series and they could arguably hide relevant differences in their molecular background when compared to the more common pleural/peritoneal counterparts.The aim of this review is to provide a guide for the pathological assessment of testicular/paratesticular mesothelial tumours. Herein, we describe the most recent updates on this topic according to the latest (year 2022) World Health Organisation Classification of Urinary and Male Genital Tumours (5th edition) and current literature. The diagnostic criteria, the main differentials and the role of ancillary techniques in the diagnosis of mesothelial testicular/paratesticular tumours are discussed.
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Affiliation(s)
| | - Stefano Lucà
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Marco De Sio
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy; Urology Unit, Azienda Policlinico Unversità 'L. Vanvitelli', 80131 Naples, Italy
| | - Davide Arcaniolo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy; Urology Unit, Azienda Policlinico Unversità 'L. Vanvitelli', 80131 Naples, Italy
| | - Gaetano Facchini
- Oncology Unit, "S. Maria delle Grazie" Hospital, ASL NA2 NORD, 80078 Pozzuoli, Naples, Italy
| | - Marco De Martino
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy; Institute of Endocrinology and Experimental Oncology of the CNR, 80131 Naples, Italy
| | - Francesco Esposito
- Institute of Endocrinology and Experimental Oncology of the CNR, 80131 Naples, Italy
| | - Ferdinando DE Vita
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Paolo Chieffi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy.
| | - Renato Franco
- Pathology Unit, Azienda Policlinico Unversità 'L. Vanvitelli, Italy; Department of Mental and Physical Health and Preventive Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
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Lucà S, Montella M, Monti R, Accardo M, Savarese G, Sirica R, Fiorelli A, Morgillo F, Franco R. Pulmonary leiomyosarcoma arising in pulmonary hamartoma: an exceptional occurrence in a rare tumor. Pathologica 2023; 115:325-332. [PMID: 38180140 PMCID: PMC10767797 DOI: 10.32074/1591-951x-941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 01/06/2024] Open
Abstract
A solitary peripheral lung nodule was found in the left lung of a 52-year-old man. It was located in the lower lobe and measured 18.5 cm of major axis on chest computed tomography. A tru-cut core biopsy was obtained and a proliferation of bland, monomorphic, spindle cells in interlacing fascicles was observed. Accordingly, a surgical resection of the neoplasm was subsequently carried out. Macroscopically, the tumor appeared as a well-circumscribed nodule with a firm and whitish cut surface. Histologically, the neoplasm was predominantly composed of bland and monomorphic spindle cells, with a predominantly fascicular growth pattern, in which many tubular and cleft-like spaces of entrapped normal respiratory epithelium were involved. Myxoid change, stromal hyalinization and scattered bizarre mononucleated and multinucleated cells were also observed. Based on clinico-morphological, immunophenotypical and molecular features, we made a diagnosis of malignant transformation of pulmonary adenoleiomyomatous hamartoma into pulmonary leiomyosarcoma. As far as we know, this is the first described case of this exceptionally rare occurrence in an already rare neoplasm.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “L. Vanvitelli”, Naples, Italy
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “L. Vanvitelli”, Naples, Italy
| | - Riccardo Monti
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “L. Vanvitelli”, Naples, Italy
| | | | - Roberto Sirica
- AMES-Centro Polidiagnostico Strumentale, SRL, Naples, Italy
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Floriana Morgillo
- Department of Precision Medicine, Medical Oncology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Campania, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “L. Vanvitelli”, Naples, Italy
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D’Abbronzo G, Lucà S, Carraturo E, Franco R, Ronchi A. Shortage of pathologists in Italy: survey of students and residents. Pathologica 2023; 115:172-180. [PMID: 37387442 PMCID: PMC10462991 DOI: 10.32074/1591-951x-852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 07/01/2023] Open
Abstract
Objective In Italy, shortage of pathologists is a problem that affects the quality of the National Health System (NHS). The cause of the shortage of pathologists in Italy must be sought in the lack of interests in the pathologist career by Medical Course Students (MCS) and in drop out of Post-Graduate Medical Schools (PGMS). We investigated reasons of both through two surveys. Methods We developed and proposed on Facebook two surveys, one to MCSs attending last years of study and one to Pathology School Residents (PSRs). Survey for MCSs consisted of 10 questions centered on their perception about pathologist activity; survey for PSRs consisted of 8 questions and investigated the most and least appreciated aspects of Italian PGMS. Results We obtained 500 responses from the MCSs and 51 responses from the PSRs. Our results show that lack of interest of MCS may be due to their incomplete knowledge of the pathologist's activities. On the other hand, PSR answers show that some teaching aspects should be improved. Conclusions Our surveys showed that lack of interest of MCS in the pathology career depends on poor knowledge about the real clinical significance of pathology and PSRs believe that Italian PGMS do not meet their interest. One solution could be a renewal of teaching both in the pathology courses for MCS and in PGMS.
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Affiliation(s)
| | | | | | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Lucà S, Franco R, Napolitano A, Soria V, Ronchi A, Zito Marino F, Della Corte CM, Morgillo F, Fiorelli A, Luciano A, Palma G, Arra C, Battista S, Cerchia L, Fedele M. PATZ1 in Non-Small Cell Lung Cancer: A New Biomarker That Negatively Correlates with PD-L1 Expression and Suppresses the Malignant Phenotype. Cancers (Basel) 2023; 15:cancers15072190. [PMID: 37046851 PMCID: PMC10093756 DOI: 10.3390/cancers15072190] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Non-small cell lung cancer (NSCLC), the leading cause of cancer death worldwide, is still an unmet medical problem due to the lack of both effective therapies against advanced stages and markers to allow a diagnosis of the disease at early stages before its progression. Immunotherapy targeting the PD-1/PD-L1 checkpoint is promising for many cancers, including NSCLC, but its success depends on the tumor expression of PD-L1. PATZ1 is an emerging cancer-related transcriptional regulator and diagnostic/prognostic biomarker in different malignant tumors, but its role in lung cancer is still obscure. Here we investigated expression and role of PATZ1 in NSCLC, in correlation with NSCLC subtypes and PD-L1 expression. A cohort of 104 NSCLCs, including lung squamous cell carcinomas (LUSCs) and adenocarcinomas (LUADs), was retrospectively analyzed by immunohistochemistry for the expression of PATZ1 and PD-L1. The results were correlated with each other and with the clinical characteristics, showing on the one hand a positive correlation between the high expression of PATZ1 and the LUSC subtype and, on the other hand, a negative correlation between PATZ1 and PD-L1, validated at the mRNA level in independent NSCLC datasets. Consistently, two NSCLC cell lines transfected with a PATZ1-overexpressing plasmid showed PD-L1 downregulation, suggesting a role for PATZ1 in the negative regulation of PD-L1. We also showed that PATZ1 overexpression inhibits NSCLC cell proliferation, migration, and invasion, and that Patz1-knockout mice develop LUAD. Overall, this suggests that PATZ1 may act as a tumor suppressor in NSCLC.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Antonella Napolitano
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
| | - Valeria Soria
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Carminia Maria Della Corte
- Department of Precision Medicine, Medical Oncology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Floriana Morgillo
- Department of Precision Medicine, Medical Oncology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Alfonso Fiorelli
- Translational Medical and Surgical Science, Thoracic Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Antonio Luciano
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Giuseppe Palma
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Claudio Arra
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Sabrina Battista
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
| | - Laura Cerchia
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
| | - Monica Fedele
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
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Lucà S, Zannini G, Morgillo F, Della Corte CM, Fiorelli A, Zito Marino F, Campione S, Vicidomini G, Guggino G, Ronchi A, Accardo M, Franco R. The prognostic value of histopathology in invasive lung adenocarcinoma: a comparative review of the main proposed grading systems. Expert Rev Anticancer Ther 2023; 23:265-277. [PMID: 36772823 DOI: 10.1080/14737140.2023.2179990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
INTRODUCTION An accurate histological evaluation of invasive lung adenocarcinoma is essential for a correct clinical and pathological definition of the tumour. Different grading systems have been proposed to predict the prognosis of invasive lung adenocarcinoma. AREAS COVERED Invasive non mucinous lung adenocarcinoma is often morphologically heterogeneous, consisting of complex combinations of architectural patterns with different proportions. Several grading systems for non-mucinous lung adenocarcinoma have been proposed, being the main based on architectural differentiation and the predominant growth pattern. Herein we perform a thorough review of the literature using PubMed, Scopus and Web of Science and we highlight the peculiarities and the differences between the main grading systems and compare the data about their prognostic value. In addition, we carried out an evaluation of the proposed grading systems for less common histological variants of lung adenocarcinoma, such as fetal adenocarcinoma and invasive mucinous adenocarcinoma. EXPERT OPINION The current IASLC grading system, based on the combined score of predominant growth pattern plus high-grade histological pattern, shows the stronger prognostic significance than the previous grading systems in invasive non mucinous lung adenocarcinoma.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Giuseppa Zannini
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Floriana Morgillo
- Department of Precision Medicine, Medical Oncology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Carminia Maria Della Corte
- Department of Precision Medicine, Medical Oncology, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Alfonso Fiorelli
- Division of Thoracic Surgery, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Severo Campione
- A. Cardarelli Hospital, Department of Advanced Diagnostic-Therapeutic Technologies and Health Services Section of Anatomic Pathology, Naples, Italy
| | - Giovanni Vicidomini
- Division of Thoracic Surgery, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 2, 80138, Naples, Italy
| | - Gianluca Guggino
- Thoracic Surgery Department, AORN A. Cardarelli Hospital, Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Marina Accardo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "L. Vanvitelli", Naples, Italy
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Montella M, Lucà S, Ronchi A, Marino FZ, Caputo A, Sica A, Zeppa P, Franco R, Cozzolino I. How to Diagnose Anaplastic Large Cell Lymphoma on Cytological Samples? A Series with Emphasis on Diagnostic Clue and Pitfalls. Acta Cytol 2023:1-10. [PMID: 36634640 DOI: 10.1159/000528533] [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: 09/07/2022] [Accepted: 11/28/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Anaplastic large cell lymphoma (ALCL) is a rare mature T-cell non-Hodgkin's lymphoma characterized by large and pleomorphic neoplastic CD30-positive T cells. ALCL includes different subtypes with different clinical and biological features: systemic ALCL, primary cutaneous ALCL, breast implant-associated ALCL (BIA-ALCL). Anaplastic lymphoma kinase (ALK) is overexpressed and rearranged in some systemic cases. Diagnosis of ALCL may be challenging on cytological samples, but the correct diagnosis is mandatory for the management of the patient. METHODS A retrospective series of 12 ALCLs diagnosed by cytology is reported. Cytological samples included lymph nodes and skin lesions fine needle aspiration cytology, peritoneal effusion, and periprosthetic fluid. Microscopic evaluation was performed on direct smears, cell-block sections, and cytocentrifugated slides. Immunocytochemistry was performed on cell-block sections, direct smears, and cytocentrifugated slides. Molecular evaluation by fluorescent in-situ hybridization (FISH) was performed on cell-block sections. RESULTS The series included 4 ALK+ ALCLs, 5 ALK- ALCLs, and 3 BIA-ALCLs. FNAC was performed on lymph nodes in 8 cases and on skin lesion in 1 case. In this last case, a peritoneal effusion was also evaluated. Breast periprosthetic fluids were evaluated in 3 cases. A large immunocytochemical panel was performed in each case, and FISH in 3 cases, demonstrating ALK rearrangement in a case of ALK+ ALCL. A final diagnosis was rendered in all cases. In the case of skin lesion, the differential diagnosis between systemic ALCL and primary cutaneous ALCL was possible. CONCLUSION The cytological diagnosis of ALCL may be challenging, and the proper management of the collected sample is mandatory. The rapid on-site evaluation and the realization of a cell block are strongly recommended. Immunocytochemistry is mandatory for the diagnosis and a large antibodies panel is needed as differential diagnosis includes many different neoplasms. FISH may be useful to evaluate ALK rearrangements. When properly managed, cytology can lead to a reliable final diagnosis of ALCL.
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Affiliation(s)
- Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Alessandro Caputo
- Pathology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Antonello Sica
- Oncohaematology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Pio Zeppa
- Pathology Unit, San Giovanni di Dio e Ruggi D'Aragona University Hospital, Salerno, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Immacolata Cozzolino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
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Giofrè F, Arturi F, Ventura M, Pelle M, Cloro C, Zaffina I, Forte V, Lucà S, Melina M, Clausi C, Sciacqua A. P418 CARDIOMETABOLIC ALTERATIONS IN OBESE PATIENTS WITH OBSTRUCTIVE SLEEP APNEA SYNDROME. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.403] [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: 11/14/2022]
Abstract
Abstract
Background
Obesity and Obstructive Sleep Apnea Syndrome (OSAS) has been recognized as two of the major cardiac risk factors and they often coexist in one patient. OSAS increase the risk of as myocardial infarction, heart failure and arrhythmias. On the other hand, obesity is and independent predictor of cardiovascular mortality since it causes insulin resistance, dyslipidemia, sympathetic hyperactivation, chronic inflammation and endothelial dysfunction.
Aim
To evaluate cardiometabolic profile, echocardiographic alterations and the presence of arrhythmias in obese patients with Obstructive Sleep Apnea Syndrome and non obese patients.
Patients and Methods
67 obese patients (37 male/30 female) and 52 non obese patients (40 male/12 female) were enrolled. All subjects underwent anthropometrical evaluation and a venous blood sample for biochemical and hormonal determinations including fasting plasma glucose, fasting plasma insulin, Hba1c and OGTT to 5 hours. The insulin resistance was evaluated by HOMA–IR. All the patients underwent echocardiographic examination, polysomnographic evaluation, in order to diagnose the OSAS, and a simultaneous 12–lead Holter ECG to evaluate the presence of nocturnal arrhythmias.
Results
As expected, we found a better antropometrics profile in non obese patients. Obese patients display a severe OSAS compared to non–obese patient as shown by higher values of AHI (26.37 ±24.95 vs 16.58 ±14.07; P < 0.05), TC90 (19.61 ±24.45 vs 8.63 ±17.80; P < 0.05) and ODI (40.55 ±27.41 vs 21.06 ±22.78; P < 0,05). In obese patients we also found a significant reduction of both ejection fraction (55.54 ±7.97 vs 66.52 ±8.95; P < 0.05) and A–wave (0.75 ±0.17 vs 0.83 ±0.19; P < 0.05). In 20% of obese patients, 12–lead Holter ECG showed the presence of cardiac pause > 3 sec during apnea. In obese population alone we demonstrated a significant negative correlation between AHI and E–wave (r= –0.3; P = 0.04) and a positive correlation with interventricular septum (r = 0.38; P = 0.01) and left ventricular mass (r = 0.32; P = 0.02). Post–hoc analysis shown how these findings maintained statistical significance even when the obese patients were stratified in subgroups according to the severity of OSAS.
Conclusions
Our data, even if preliminary, seem to indicate that OSAS is not only linked to obesity but it also acts as a negative factor on the cardiometabolic risk.
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Affiliation(s)
- F Giofrè
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - F Arturi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Ventura
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Pelle
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - C Cloro
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - I Zaffina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - V Forte
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - S Lucà
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Melina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - C Clausi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - A Sciacqua
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
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9
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Giofrè F, Pelle M, Zaffina I, Lucà S, Forte V, Arturi F, Cloro C, Ventura M, Trapanese V, Sciacqua A. P386 OBESITY AND CARDIOMYOPATHY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.372] [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: 11/13/2022]
Abstract
Abstract
Background
Obesity cardiomyopathy is a heart failure unexplained by others etiologies that can vary from a subclinical left ventricular dysfunction to overt dilated cardiomyopathy.
Aim
To evaluate the changes in echocardiogram in both normotensive and hypertensive obese and to evaluate obesity and/or hypertension impact on cardiomyopathy.
Methods
383 subjects (236F–147M) were enrolled. They were divided into two groups based on BMI: non–obese subjects (BMI<30kg/m2) and obese subjects (BMI>30kg/m2). The obese subjects were divided in different degrees (groups) of obesity according with obesity classification: group 1= BMI >30<35, 2= BMI >35<40, 3= BMI >40 kg/m2. 208 of 383 enrolled subjects were hypertensive. All subjects underwent to an echocardiogram with evalutation of left atrial diameter (LAD), left ventricular end–diastolic diameter (LVEDD), left ventricular end–systolic diameter (LVESD), ventricular septum, cardiac mass and left ventricular mass index (LVMI).
Results
Obese subjects showed a progressive increase in left atrial diameter (LAD)(P = 0.000), left ventricular end–diastolic diameter (LVEDD)(P = 0.000), left ventricular end–systolic diameter (LVESD)(P = 0.001), ventricular septum (P = 0.000) and cardiac mass (P = 0.000) according to the degree of obesity. Subjects in the 3° group of obesity showed higher value of LAD and LVESD when compared with subjects in first two groups (P = 0.000; P = 0.032; P = 0.000; P = 0.001, respectively). Similarly, subjects in the 3° group of obesity showed higher value of ventricular septum and cardiac mass when compared with the first two groups of obesity (P = 0.005; P = 0.002; P = 0.000; P = 0.005; respectively). LAD, LVEDD, LVESD, ventricular septum and cardiac mass were positively related with the obesity degree. In order to avoid that echocardiographic modifications were caused by hypertension, data were adjusted for hypertension so linear regression documented that degree of obesity predicts echocardiographic changes (LAD, LVEDD, LVESD) better than hypertension.
Conclusions
Our data suggested that the in obese subjects the severity of cardiomyopathy is correlated with degree of obesity and that the degree of obesity is a better predictor than hypertension for echocardiographic changes.
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Affiliation(s)
- F Giofrè
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Pelle
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - I Zaffina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - S Lucà
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - V Forte
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - F Arturi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - C Cloro
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - M Ventura
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - V Trapanese
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
| | - A Sciacqua
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA DI CATANZARO, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA
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10
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Ventura M, Giofrè F, Lucà S, Pelle M, Zaffina I, Forte V, Cloro C, Melina M, Miceli S, Sciacqua A, Segura Garcia C, Currò G, Arturi F. C72 THE EFFECTS OF BATRIATIC SURGERY ON CARDIO–METABOLIC PROFILE AND CARDIAC REMODELING. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.070] [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: 11/12/2022]
Abstract
Abstract
Background
Obesity is associated with cardiac remodeling resulting in hypertrophy of the left ventricle (LV) with a predominantly concentric pattern. LV remodeling and fibrosis induce mechanical and electrical dysfunction of the myocardial tissue, an increase in cardiac output, an increase of myocardial workload and mean arterial pressure.
Objective
To evaluate the impact of bariatric surgery, and therefore of anthropometric and cardio–metabolic variations, on cardiac structure and function.
Methods
Twenty–six obese patients treated with bariatric surgery were enrolled. All the patients at baseline and at 6 and 12 months underwent a complete anthropometrical evaluation, laboratory determinations and echocardiogram evaluation. The IR has been assessed by HOMA–IR. The patients were divided into two groups: the first group (8 patients) carried out a follow–up at 6 months post–surgery; the second group (18 patients) at 12 months post–surgery.
Results
As expected, an improvement in the anthropometric and metabolic profile in patients treated with bariatric surgery was observed. Echocardiographic data showed a significant increase in the Ejection Fraction (P < 0.001) and the E/A Ratio (P < 0.001) 6 months after bariatric surgery, a significant reduction in the Interventricular Septum thickness at 6 months (P < 0.001) and at 12 months (P < 0.002) post–surgery and a significant reduction in the Left Ventricular Mass at 6 months (P = 0.02) and at 12 months (P = 0.05) after bariatric surgery. A reduction no significant in the Left Ventricular posterior wall thickness has been observed.
Conclusions
Our data showed an increase of the systolic function, an increase of the left ventricular diastolic compliance and a reduction in subclinical cardiac organ damage. Therefore, significant weight loss obtained with bariatric surgery may lead to reverse cardiac remodeling, associated with beneficial effects on myocardial structure and systo-diastolic function.
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Affiliation(s)
- M Ventura
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - F Giofrè
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - S Lucà
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - M Pelle
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - I Zaffina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - V Forte
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - C Cloro
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - M Melina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - S Miceli
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - A Sciacqua
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - C Segura Garcia
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - G Currò
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
| | - F Arturi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA, COSENZA; AOU “MATER DOMINI”, CATANZARO
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11
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Giofrè F, Ventura M, Sacchetta L, Arturi F, Clausi C, Pelle M, Zaffina I, Lucà S, Sciacqua A, De Rosa F, Cloro C. C77 EFFECT OF SACUBITRIL/VALSARTAN ON BOTH METABOLIC PARAMETER AND INSULIN RESISTANCE IN NON OBESE NON DIABETIC PATIENTS WITH HEART FAILURE. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.075] [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: 11/14/2022]
Abstract
Abstract
Background
Sacubitril/Valsartan has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF). Moreover Sacubitril/Valsartan showed a significantly reduction in the HbA1c in diabetic patients. The effect of Sacubitril/Valsartan on metabolic parameter and insulin resistence in both, non obese and non diabetic patients, have not been previously described.
Aim
We evaluated the effects of the Sacubitril/Valsartan on both glycaemic and metabolic parameter, on HOMA–IR and on echocardiographic parameters in patients with HFrEF.
Methods
A total of 59 non obese and non diabetic patients with a diagnosis of HFrEF (EF < 35%) have been enrolled. All the patients underwent a complete anthropometrical evaluation, laboratory determinations (including fasting glucose, fasting insulin, HbA1c) and echocardiogram evaluation. Data analysis was made after 24 weeks of treatment. The insulin resistance has been assessed by HOMA–IR.
Results
Data analysis demostrated a significant reduction in fasting plasma glucose (111.4 + 11.5 vs 106 + 10 mg/dl, P = 0.03), fasting plasma insulin (13.6 + 5.9 vs 10.5 + 4.4 µUI/ml), HbA1c value (6.14 + 0.5% vs 5.9 + 0.3%, P < 0.01) and insulin resistance (HOMA–IR, 3.74 + 2.2 vs 2.7 + 2.1, P = 0.03). The echocardiogram evaluation showed a significant reduction of the end–diastolic left ventricular volume (168 + 44 vs 150 + 38 ml, P < 0.05), a no significant reduction of the end–systolic left ventricular volume (98 + 26 vs 88 + 22 ml, P = 0.07), a significant reduction of E/e1 ratio and an average 7.8% increase in ejection fraction (EF), from a mean baseline of 32.3 + 2.4 to 40.1 + 3.8% (P < 0.0001). No differences in interventricular septal (IVS) thickness, posterior wall (PW) thickness, A–wave, E–wave and E/A ratio have been observed. No differences in anthropometrical parameters (weight, body mass index, waist circumference) and blood pressure were observed.
Conclusions
Our data, even if preliminary, seem to indicate that sacubitril/valsartan might enhance glycaemic control and improve insulin resistance in non obese/non diabetic patients with HFrEF. Also, our data confirm that sacubitril/valsartan treatment is able to improve ejection fraction in HFrEF patients.
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Affiliation(s)
- F Giofrè
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - M Ventura
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - L Sacchetta
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - F Arturi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - C Clausi
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - M Pelle
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - I Zaffina
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - S Lucà
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - A Sciacqua
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - F De Rosa
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
| | - C Cloro
- UNIVERSITÀ DEGLI STUDI MAGNA GRAECIA, CATANZARO; AO “SS ANNUNZIATA” COSENZA
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12
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Ronchi A, Lucà S, Errico ME, D'Onofrio V, Mariani P, Laino L, Franco R, Cozzolino I. Congenital sialoblastoma in a newborn: diagnostic challenge of a rare entity. Minerva Dent Oral Sci 2021:S2724-6329.21.04440-X. [PMID: 33929129 DOI: 10.23736/s2724-6329.21.04440-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The occurrence of a head and neck tumoral mass at birth or shortly afterwards may cause concern and the differential diagnosis may be complex. Sialoblastoma is a rare epithelial tumor of the salivary glands of uncertain malignant potential, which typically affects children and arises more frequently in the parotid gland. The diagnosis may be challenging, as the differential diagnosis is wide. METHODS The present paper reports a case of sialoblastoma, present at birth, diagnosed in a 20-day-old girl. The patient was submitted to surgery and the neoplasm was excised "en bloc". We also carried out a thorough review of all cases of sialoblastoma, diagnosed in the first year of life and reported in the literature, using the PubMed database. RESULTS A final diagnosis of sialoblastoma was rendered through histological examination and immunohistochemistry. The neoplasm resulted entirely excised with disease-free surgical margins, and no other therapy was necessary. The 2 years clinical and instrumental follow-up was uneventful. CONCLUSIONS Through the present case and the review of the literature, the state of the art is established with regard the clinical aspects, the morphological and immunophenotypic features for diagnostic purpose. Moreover, parameters that can influence the prognosis are evaluated, paying attention especially to the cases of sialoblastoma diagnosed in the first year of life.
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Affiliation(s)
- Andrea Ronchi
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Stefano Lucà
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | | | - Pierluigi Mariani
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Laino
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania Luigi Vanvitelli, Naples, Italy -
| | - Renato Franco
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | - Immacolata Cozzolino
- Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
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Panarese I, Lucà S, Ronchi A, Franco R, Panico L, Lo Faro C, Colella G. Gingival manifestation of a therapy-related acute myelomonocytic leukemia in a patient with previously treated with R–CHOP scheme for diffuse large B-cell lymphoma. Oral and Maxillofacial Surgery Cases 2020. [DOI: 10.1016/j.omsc.2020.100182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Zamboli P, Lucà S, Borrelli S, Garofalo C, Liberti ME, Pacilio M, Lucà S, Palladino G, Punzi M. High-flow arteriovenous fistula and heart failure: could the indexation of blood flow rate and echocardiography have a role in the identification of patients at higher risk? J Nephrol 2018; 31:975-983. [DOI: 10.1007/s40620-018-0472-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/08/2018] [Indexed: 11/28/2022]
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15
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Zamboli P, Lucà S, Borrelli S, Garofalo C, Liberti ME, Pacilio M, Punzi M. SP580HIGH-FLOW AVF AND HEART FAILURE: COULD THE INDEXATION OF BLOOD FLOW RATE HAVE A ROLE IN THE IDENTIFICATION OF PATIENTS AT HIGHER RISK? Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv198.03] [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: 11/12/2022] Open
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