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Zazzara M, Gardiman MP, Dal Moro F. The bladder neck preservation in robot assisted radical prostatectomy: Surgical and pathological outcome. Arch Ital Urol Androl 2023; 95:12138. [PMID: 38193218 DOI: 10.4081/aiua.2023.12138] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION The post-prostatectomy incontinence is influenced by multiple elements, anatomic components and biological factors. The bladder neck preservation, more accurate during robot assisted radical prostatectomy, works on two anatomic components responsible for post-prostatectomy continence. The bladder neck preservation spares the internal sphincter, which is responsible for passive continence, and results in earlier return to continence and lower rates of post-prostatectomy incontinence. Moreover, this surgical technique spares the zone of urothelium coaptation and provides primary resistance to the urine to maintain postprostatectomy continence. The potential risk of bladder neck positive surgical margins (PSM) may prevent the usage of the bladder neck preservation. AIM The purpose of this study is to evaluate the surgical and pathological outcome in prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation. MATERIALS AND METHODS Prospectively, we have collected demographic, clinical, surgical and pathological data of prostate cancer patients underwent robot assisted radical prostatectomy with bladder neck preservation, from January 2014 to December 2016, in Urological Clinic of the University of Padua. Moreover, it was valued the presence of alterations or continuous solutions of specimen external capsule, attributable to the surgical technique of bladder neck preservation, by microscopic and macroscopic pathological analysis. RESULTS According to D'Amico risk classification, 40 patients (45.4%) had a low risk neoplasia, 35 patients (39.8%) had an intermediate risk neoplasia, 13 patients (14.8%) had an high risk neoplasia. The median prostatic volume, valued on specimen, was 30.84 cc (21.5-44.75 cc). The median prostatic weight, valued on specimen, was 51 gr (36-67 gr). The pathological stage of disease was pT2a in 11 cases (12.5%), pT2b in 37 cases (42.1%), pT3a in 28 cases (31.8%), pT3b in 12 cases (13.6%). The pathological stage of lymph node involvement was pNx in 17 cases (19.3%), pN0 in 66 cases (75%), pN1 in 5 cases (5.7%). The prostate cancers diagnosed had a Gleason score at specimen of 6 in 10 cases (10.4%), 7 (3+4) in 30 cases (34.1%), 7 (4+3) in 20 cases (22.7%), 8 in 19 cases (21.6%) and 9 in 9 cases (10.2%). The prostatic base was involved by neoplasia in 14 patients (15.9%); of these, 5 patients (35.7%) had bladder neck PSM. The patients with bladder neck PSM had: a pathological stage of disease as pT3a in 2 cases (40%) and pT3b in 3 cases (60%); a pathological stage of lymph node involvement as pN0 in 2 cases (40%) and pN1 in 3 cases (60%); a Gleason score at specimen of 8 in 3 cases (60%) and 9 in 2 cases (40%); multiple PSM. Nobody had alterations or continuous solutions of specimen external capsule, attributable to surgical technique of bladder neck preservation. CONCLUSIONS The bladder neck preservation, during robot assisted radical prostatectomy, is a safe oncological procedure resulting in a good functional outcome, about post-prostatectomy continence, working on two anatomic components responsible for post-prostatectomy continence. The bladder neck PSM are linked to neoplasia with adverse pathological features, rather than the bladder neck preservation.
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Affiliation(s)
- Michele Zazzara
- Urology Clinic, Department of Surgical Oncological and Gastroenterological Sciences, University of Padua, Padua.
| | - Marina P Gardiman
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University of Padua, Padua.
| | - Fabrizio Dal Moro
- Urology Clinic, Department of Surgical Oncological and Gastroenterological Sciences, University of Padua, Padua.
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Villa C, Vasiljevic A, Jaffrain-Rea ML, Ansorge O, Asioli S, Barresi V, Chinezu L, Gardiman MP, Lania A, Lapshina AM, Poliani L, Reiniger L, Righi A, Saeger W, Soukup J, Theodoropoulou M, Uccella S, Trouillas J, Roncaroli F. A standardised diagnostic approach to pituitary neuroendocrine tumours (PitNETs): a European Pituitary Pathology Group (EPPG) proposal. Virchows Arch 2019; 475:687-692. [PMID: 31578606 DOI: 10.1007/s00428-019-02655-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 05/23/2019] [Revised: 05/23/2019] [Accepted: 08/22/2019] [Indexed: 10/25/2022]
Abstract
The 2017 World Health Organization (WHO) classification proposes to type and subtype primary adenohypophyseal tumours according to their cell lineages with the aim to establish more uniform tumour groups. The definition of atypical adenoma was removed in favour of high-risk adenoma, and the assessment of proliferative activity and invasion was recommended to diagnose aggressive tumours. Recently, the International Pituitary Pathology Club proposed to replace adenoma with the term of pituitary neuroendocrine tumour (PitNET) to better reflect the similarities between adenohypophyseal and neuroendocrine tumours of other organs. The European Pituitary Pathology Group (EPPG) endorses this terminology and develops practical recommendations for standardised reports of PitNETs that are addressed to histo- and neuropathologists. This brief report presents the results of EPPG's consensus for the reporting of PitNETs and proposes a diagnostic algorithm.
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Affiliation(s)
- C Villa
- Department of Pathological Cytology and Anatomy, Foch Hospital, 40 rue Worth, 92151, Suresnes, France. .,INSERM U1016, CNRS UMR 8104, Cochin Institute, Paris Descartes University, 24 rue du faubourg Saint Jacques, 75014, Paris, France. .,Department of Endocrinology, CHU de Liège, University of Liège, Sart Tilman B35, 4000, Liège, Belgium.
| | - A Vasiljevic
- Université de Lyon 1, Université de Lyon, F-69000, Lyon, France.,Faculté de Médecine Lyon-Est, F-69372, Lyon, France.,Centre de Recherche en Cancérologie de Lyon (CRCL), INSERM U1052, CNRS UMR5286, Université de Lyon, Lyon, France.,Centre de Pathologie et de Neuropathologie Est, Groupement Hospitalier Est, Hospices Civils de Lyon, Bron, France
| | - M L Jaffrain-Rea
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Neuromed Institute, IRCCS, Pozzilli, Italy
| | - O Ansorge
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - S Asioli
- Department of Biomedical and Neuromuscular Sciences, Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, University of Bologna, Bologna, Italy.,Pituitary Unit - Center for the Diagnosis and Treatment of Hypothalamic and Pituitary Diseases, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - V Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Chinezu
- Department of Histology, Pharmacy, Sciences and Technology of Tirgu Mures, University of Medicine, Târgu Mureș, Romania
| | - M P Gardiman
- Department of Medicine DIMED, Surgical Pathology & Cytopathology Unit, University Hospital of Padova, Padova, Italy
| | - A Lania
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Hospital, Rozzano, Italy
| | - A M Lapshina
- Department of Fundamental Pathomorphology, Endocrine Research Center, Ministry of Health of Russia, Moscow, Russia
| | - L Poliani
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - L Reiniger
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - A Righi
- Department of Pathology, Rizzoli Institute, Bologna, Italy
| | - W Saeger
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Soukup
- The Fingerland Department of Pathology, University Hospital and Faculty of Medicine, Hradec Kralove, Charles University, Sokolska 581, 500 05, Hradec Kralove, Czech Republic
| | - M Theodoropoulou
- Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - S Uccella
- Unit of Pathology, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - J Trouillas
- Université de Lyon 1, Université de Lyon, F-69000, Lyon, France.,Faculté de Médecine Lyon-Est, F-69372, Lyon, France
| | - F Roncaroli
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Barbot M, Ceccato F, Lizzul L, Daniele A, Zilio M, Gardiman MP, Denaro L, Emanuelli E, Vianello F, Lombardi G, Rolma G, Scaroni C. Perioperative multidisciplinary management of endoscopic transsphenoidal surgery for sellar lesions: practical suggestions from the Padova model. Neurosurg Rev 2019; 43:1109-1116. [PMID: 31227951 DOI: 10.1007/s10143-019-01132-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/08/2019] [Revised: 05/03/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
Abstract
Perioperative management of patients with sellar lesion submitted to endoscopic transsphenoidal neurosurgery (TSS) lacks standardization and therefore it is committed to each center clinical practice. Although neurosurgical procedure remains the same for all sellar lesions, perioperative approach can require different measures depending on the underlying disease. With the aim of standardizing our perioperative procedures and sharing our experience with other centers involved in the management of pituitary disease, we developed a clinical care path for patients with sellar lesions candidate to endoscopic TSS. For the drafting of the following protocol, the national and international guidelines published in the last 5 years have been evaluated and integrated with our center experience accumulated in decades of clinical practice. A steering committee including medical doctors involved in management of patients with pituitary masses at the Padua Hospital reviewed current knowledge on this topic. The committee developed a first draft which was shared with a broader group of medical doctors to reach a preliminary consensus; when it was reached, the clinical care assistance pathway was confirmed, validated, and published in the local web-based health service. We want to present and share our experience with colleagues involved in the perioperative management of pituitary diseases in other centers.
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Affiliation(s)
- M Barbot
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy.
| | - F Ceccato
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy
| | - L Lizzul
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy
| | - A Daniele
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy
| | - M Zilio
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy
| | - M P Gardiman
- Surgical Pathology & Cytopathology Unit, Department of Medicine DIMED, University Hospital of Padova, Padua, Italy
| | - L Denaro
- Neurosurgery Unit, Department of Neurosciences, University of Padova, Padua, Italy
| | - E Emanuelli
- Institute of Otorhinolaryngology, Department of Neuroscience, University Hospital of Padova, Padua, Italy
| | - F Vianello
- Radiotherapy Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - G Lombardi
- Clinical and Experimental Oncology, Medical Oncology 1, Veneto Institute of Oncology, Padua, Italy
| | - G Rolma
- Neuroradiology Unit, Department of Radiology, University Hospital of Padova, Padua, Italy
| | - C Scaroni
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Via Ospedale Civile, 105, 35128, Padua, Italy
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Galuppini F, Opocher E, Tabori U, Mammi I, Edwards M, Campbell B, Kelly J, Viel A, Quaia M, Rivieri F, D'Avella D, Arcella A, Giangaspero F, Fassan M, Gardiman MP. Concomitant IDH wild-type glioblastoma and IDH1-mutant anaplastic astrocytoma in a patient with constitutional mismatch repair deficiency syndrome. Neuropathol Appl Neurobiol 2019; 44:233-239. [PMID: 29130549 DOI: 10.1111/nan.12450] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/02/2017] [Indexed: 02/01/2023]
Affiliation(s)
- F Galuppini
- Surgical Pathology Unit, Department of Medicine (DIMED), University-Hospital of Padua, Padua, Italy
| | - E Opocher
- Pediatric Hematology-Oncology, Department of Woman and Child Health, University-Hospital of Padua, Padua, Italy
| | - U Tabori
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - I Mammi
- Center for the Study of Hereditary Colorectal Cancers, Venetian Oncology Institute, Padua, Italy
| | - M Edwards
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - B Campbell
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - J Kelly
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - A Viel
- Funcional Onco-Genomics and Genetics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - M Quaia
- Funcional Onco-Genomics and Genetics, CRO Aviano National Cancer Institute, Aviano, Italy
| | - F Rivieri
- Medical Genetic Service, Departmen t of Laboratory, Santa Chiara Hospital, Trento, Italy
| | - D D'Avella
- Neurosurgery Unit, Department of Neurosciences (DNS), Padua University, Padua, Italy
| | | | - F Giangaspero
- IRCCS Neuromed, Pozzilli, Italy.,Department of Radiological, Oncological, and Anatomo-Pathological Science, Sapienza University of Rome, Rome, Italy
| | - M Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University-Hospital of Padua, Padua, Italy
| | - M P Gardiman
- Surgical Pathology Unit, Department of Medicine (DIMED), University-Hospital of Padua, Padua, Italy
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Garolla A, Selice R, Menegazzo M, Valente U, Zattoni F, Iafrate M, Prayer-Galetti T, Gardiman MP, Ferlin A, Di Nisio A, Foresta C. Novel insights on testicular volume and testosterone replacement therapy in Klinefelter patients undergoing testicular sperm extraction. A retrospective clinical study. Clin Endocrinol (Oxf) 2018; 88:711-718. [PMID: 29446828 DOI: 10.1111/cen.13572] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 11/23/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Abstract
STUDY QUESTION To investigate whether sperm recovery is related to clinical features, hormone parameters and testosterone replacement therapy (TRT) in patients with Klinefelter syndrome (KS). SUMMARY ANSWER This study provides three interesting insights: (i) the probability to retrieve sperm is not related to testicular volume; (ii) TRT does not affect sperm retrieval rate (SRR); and (iii) reduced levels of LH and FSH represent a negative predictor of sperm retrieval in patients with TRT. WHAT IS KNOWN ALREADY Classical KS shows a karyotype with one extra X chromosome in all of somatic cells and clinical manifestations characterized by hypergonadotropic hypogonadism and infertility. STUDY DESIGN, SIZE AND DURATION We performed a retrospective cohort study. Data from 111 consecutive KS azoospermic patients undergoing testicular sperm extraction (TESE) were collected from 2005 to 2016. PARTICIPANTS/MATERIALS, SETTING AND METHODS Data on anthropometric parameters, reproductive hormones and testicular volumes were collected. SRR was related to clinical characteristics and compared between TRT and untreated patients. MAIN RESULTS AND THE ROLE OF CHANCE A total of 38 patients (34.2%) had successful sperm recovery. The comparison of clinical characteristics did not differ between patients with and without sperm recovery. Sperm retrieval was successful also in subjects with smaller testes. The comparison of SRR in patients with or without TRT was not different (33.3% vs 34.6%). In TRT group, LH and FSH levels were significantly lower in subjects with no sperm retrieval (P values, respectively, <.05 and <.001). LIMITATIONS AND REASONS FOR CAUTION Well-designed controlled studies are necessary to confirm these data aimed to set the best therapeutic approach for fertility management in hypogonadal patients with nonmosaic KS. WIDER IMPLICATIONS OF THE FINDINGS Age at TESE, anthropometric measures, testis volume, sex hormones levels and semen parameters are not predictive parameters of SRR. Among TRT patients, reduced gonadotropin is related to failure in sperm retrieval.
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Affiliation(s)
- Andrea Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Riccardo Selice
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Massimo Menegazzo
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Umberto Valente
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Filiberto Zattoni
- Unit of Urology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Massimo Iafrate
- Unit of Urology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Tommaso Prayer-Galetti
- Unit of Urology, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Marina P Gardiman
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University Hospital of Padova, Padova, Italy
| | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Di Nisio
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
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Drusco A, Fadda P, Nigita G, Fassan M, Bottoni A, Gardiman MP, Sacchi D, Calore F, Carosi M, Antenucci A, Casini B, Kelani H, Pescarmona E, Di Leva G, Zanesi N, Berger MS, Croce CM. Circulating Micrornas Predict Survival of Patients with Tumors of Glial Origin. EBioMedicine 2018; 30:105-112. [PMID: 29643013 PMCID: PMC5952410 DOI: 10.1016/j.ebiom.2018.03.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 11/24/2022] Open
Abstract
The World Health Organization has recently introduced molecular prognostic-diagnostic biomarkers in the classification of Central Nervous System (CNS) tumors. In order to characterize subclasses of tumors that cannot find a precise location in the current classification, and, or cannot be tested because of scant material, it is important to find new molecular biomarkers in tissue and, or biological fluid samples. In this study, we identified serum microRNAs that could serve as biomarkers for the diagnosis and prognosis of patients with tumors of glial origin. We retrospectively analyzed microRNA expression in the serum extracellular vesicles of patients with tumors of glial origin. Extracellular vesicles RNA was analyzed by Nanostring. qRT-PCR confirmed 6 overexpressed microRNAs: hsa-miR-4443, hsa-miR-422a, hsa-miR-494-3p, hsa-miR-502-5p, hsa-miR-520f-3p, and hsa-miR-549a. Hsa-miR-4443 was the only microRNA that showed significant differences in most comparisons. In situ hybridization (ISH), confirmed that our signature was mostly expressed in cancer cells. Importantly, hsa-miR-549a and hsa-miR-502-5p expression predicted prognosis in patients with tumors of glial origin. Although more studies are needed, we demonstrated that serum vesicles microRNA profiles are promising diagnostic and prognostic molecular biomarkers that will find an actual application in the clinical practice of CNS tumors.
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Affiliation(s)
- Alessandra Drusco
- Dept. of Cancer Biology and Genetics (CBG), The Ohio State University, Columbus, OH, United States.
| | - Paolo Fadda
- CCC - Genomics Shared Resource, The Ohio State University, Columbus, OH, United States
| | - Giovanni Nigita
- Dept. of Cancer Biology and Genetics (CBG), The Ohio State University, Columbus, OH, United States
| | - Matteo Fassan
- Dept. of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Italy
| | - Arianna Bottoni
- Dept. of Cancer Biology and Genetics (CBG), The Ohio State University, Columbus, OH, United States
| | - Marina P Gardiman
- Dept. of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Italy
| | - Diana Sacchi
- Dept. of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Italy
| | - Federica Calore
- Dept. of Cancer Biology and Genetics (CBG), The Ohio State University, Columbus, OH, United States
| | - Mariantonia Carosi
- Dept. of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Antenucci
- Dept. of Clinical Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Beatrice Casini
- Dept. of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Hesham Kelani
- Dept. of Cancer Biology and Genetics (CBG), The Ohio State University, Columbus, OH, United States
| | - Edoardo Pescarmona
- Dept. of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Nicola Zanesi
- Dept. of Cancer Biology and Genetics (CBG), The Ohio State University, Columbus, OH, United States
| | - Mitchell S Berger
- Dept. of Neurological Surgery, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Carlo M Croce
- Dept. of Cancer Biology and Genetics (CBG), The Ohio State University, Columbus, OH, United States.
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Dal Moro F, Gardiman MP. Scoring surgical skill in robotic prostatectomy as adherence to the surgical plan: proposal for a new tool (ScAPSA). MINERVA UROL NEFROL 2016; 68:424-428. [PMID: 26354613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The plethora of instruments (trifecta, pentafecta, etc.) used to evaluate the outcomes of robotic prostatectomy (RARP) has recently been subjected to criticism. In this paper, a novel approach called ScAPSA (Scoring Adherence to Prostatic Surgical Aims) is proposed to assess surgical proficiency, considering surgical success as perfect adherence to a correct surgical plan, and not related solely to clinical outcomes. METHODS In order to define (and quantify) such adherence, and to evaluate both learning curves and surgeons' skill, a 20-point scoring system has been developed. The specific surgical plan (improved with predictive tools) is compared with pathological findings to identify any surgical errors. Adding data on postoperative complications, a score from 0 (better) to 20 (worst surgical result) can easily be calculated. Considering the number of reported cases needed to complete the RARP learning curve, we decided to analyze the first 25 consecutive single-surgeon RARPs. RESULTS Testing ScAPSA on the first consecutive (initial learning curve) single-surgeon RARPs confirmed that this tool can faithfully describe and quantify both learning curves and surgical skill. CONCLUSIONS ScAPSA may represent a useful novel tool, not only for describing RARP learning curves objectively, but also for determining and quantifying success rates, allowing surgeons to check intra-operative errors and monitor their own surgical proficiency. Further external validations are needed to confirm these results.
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Affiliation(s)
- Fabrizio Dal Moro
- Section of Urology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy -
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8
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Drusco A, Bottoni A, Laganà A, Acunzo M, Fassan M, Cascione L, Antenucci A, Kumchala P, Vicentini C, Gardiman MP, Alder H, Carosi MA, Ammirati M, Gherardi S, Luscrì M, Carapella C, Zanesi N, Croce CM. A differentially expressed set of microRNAs in cerebro-spinal fluid (CSF) can diagnose CNS malignancies. Oncotarget 2016; 6:20829-39. [PMID: 26246487 PMCID: PMC4673232 DOI: 10.18632/oncotarget.4096] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [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: 05/02/2015] [Accepted: 05/14/2015] [Indexed: 12/12/2022] Open
Abstract
Central Nervous System malignancies often require stereotactic biopsy or biopsy for differential diagnosis, and for tumor staging and grading. Furthermore, stereotactic biopsy can be non-diagnostic or underestimate grading. Hence, there is a compelling need of new diagnostic biomarkers to avoid such invasive procedures. Several biological markers have been proposed, but they can only identify specific prognostic subtype of Central Nervous System tumors, and none of them has found a standardized clinical application.The aim of the study was to identify a Cerebro-Spinal Fluid microRNA signature that could differentiate among Central Nervous System malignancies.CSF total RNA of 34 neoplastic and of 14 non-diseased patients was processed by NanoString. Comparison among groups (Normal, Benign, Glioblastoma, Medulloblastoma, Metastasis and Lymphoma) lead to the identification of a microRNA profile that was further confirmed by RT-PCR and in situ hybridization.Hsa-miR-451, -711, 935, -223 and -125b were significantly differentially expressed among the above mentioned groups, allowing us to draw an hypothetical diagnostic chart for Central Nervous System malignancies.This is the first study to employ the NanoString technique for Cerebro-Spinal Fluid microRNA profiling. In this article, we demonstrated that Cerebro-Spinal Fluid microRNA profiling mirrors Central Nervous System physiologic or pathologic conditions. Although more cases need to be tested, we identified a diagnostic Cerebro-Spinal Fluid microRNA signature with good perspectives for future diagnostic clinical applications.
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Affiliation(s)
| | | | - Alessandro Laganà
- Dept. of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mario Acunzo
- MVIMG, The Ohio State University, Columbus, OH, USA
| | - Matteo Fassan
- Dept. of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | - Luciano Cascione
- Lymphoma & Genomics Research Program, IOR Institute of Oncology Research, Bellinzona, Switzerland.,IOSI Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Anna Antenucci
- UOSD of Clinical Pathology, Regina Elena Institute, Rome, Italy
| | | | - Caterina Vicentini
- ARC-NET Research Centre, University and Hospital Trust of Verona, Verona, Italy
| | - Marina P Gardiman
- Dept. of Medicine (DIMED), Surgical Pathology & Cytopathology Unit, University of Padua, Padua, Italy
| | | | | | - Mario Ammirati
- Dept. of Neurological Surgery, The Ohio State University, OH, USA
| | | | - Marilena Luscrì
- Dept. of Anesthesiology, Sandro Pertini Hospital, Rome, Italy
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9
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Antonelli M, Nizza P, Gardiman MP, Buttarelli FR, Cerati M, Milanaccio C, Coli A, Massimino M, Pollo B, Moi L, Badiali M, Giangaspero F. HG-11BRAF V600E MUTATION IN PEDIATRIC ASTROBLASTOMAS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now073.09] [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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Dal Moro F, Bovo A, Crestani A, Vettor R, Gardiman MP, Zattoni F. Effect of hypertension on outcomes of high-risk patients after BCG-treated bladder cancer: a single-institution long follow-up cohort study. Medicine (Baltimore) 2015; 94:e589. [PMID: 25738480 PMCID: PMC4553954 DOI: 10.1097/md.0000000000000589] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Immunotherapy with Bacillus Calmette-Guérin (BCG) is the most efficacious treatment for high-risk bladder cancer (BC) (Ta/T1 or carcinoma in situ) to reduce the risk of recurrence. Our aim was to evaluate whether hypertension and diabetes influence the outcome of patients with noninvasive BC treated with BCG instillations.In order to collect homogeneous data, we considered as "hypertensive" only those patients who had previous diagnosed hypertension and a history of taking medical therapy with antihypertensive drugs (AHT), and as "diabetic" only those prescribed oral antidiabetics or insulin (ADT).We analyzed 343 high-risk BC patients undergoing BCG (1995-2010) with a median follow-up of 116 months (range 48-238). The distribution of various kinds of AHT and antidiabetic drugs was homogeneous, with no significant differences (p > 0.05).In both univariate and multivariate analyses, the only statistically significant parameter prognostic for recurrence after BCG treatment was AHT. Recurrence-free survival curves showed a significant correlation with AHT (p = 0.0168, hazards ratio [HR] 1.45, 95% confidence interval [CI] 1.0692-1.9619); there was no correlation (p = 0.9040) with ADT (HR 0.9750, 95% CI 0.6457-1.4721). After stratification of AHT and ADT according to drug(s) prescribed, there were no significant differences in the BC recurrence rate (p > 0.05).In this study with a very long-term follow-up, hypertension alone (evaluated by AHT) revealed the increased risk of BC recurrence after BCG treatment.Several hypotheses have been formulated to support these findings, but further prospective studies are needed to both evaluate the real influence of hypertension and identify a possible prognostic factor to be used in selecting poor-prognosis BC patients as early candidates for surgical treatment.
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Affiliation(s)
- Fabrizio Dal Moro
- From the Department of Surgical, Oncological and Gastroenterological Sciences-Urology (FDM, AB, AC, FZ); Department of Medicine DIMED (RV), Metabolic Diseases and Cardiovascular Risk Unit; and Department of Pathology (MPG), Azienda Ospedaliera di Padova, Padova, Italy
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11
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Barbot M, Albiger N, Koutroumpi S, Ceccato F, Frigo AC, Manara R, Fassina A, Gardiman MP, Scanarini M, Mantero F, Scaroni C. Predicting late recurrence in surgically treated patients with Cushing's disease. Clin Endocrinol (Oxf) 2013; 79:394-401. [PMID: 23278711 DOI: 10.1111/cen.12133] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/06/2012] [Accepted: 12/17/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Cushing's disease (CD) has an uncertain prognosis because patients achieving remission after transsphenoidal pituitary neurosurgery (TSS) may relapse. We aimed to identify factors predicting relapse, focusing on desmopressin (DDAVP) and corticotropin-releasing hormone (CRH) tests after surgery. MATERIALS AND METHODS Fifty-seven patients with CD (mean age 36 years) after TSS experienced remission (24 cases), late relapse (LR) (15 cases), or persistent disease (18 cases). RESULTS The median time to relapse was 40 months. ACTH levels increased after both DDAVP and CRH stimulation, with a significantly higher response in the late recurrence group, showing this to be an indicator of increased risk of relapse. In the logistic regression model, a rise in ACTH >9 pg/ml after DDAVP and >36·7 pg/ml after CRH showed a sensitivity of 93% and 73%, respectively, a specificity of 82% and 76% in LR group. The area under the curve was 0·91 for DDAVP, 0·80 for CRH and 0·95 for DDAVP+CRH test, i.e. the combined tests performed better than each test alone, but not to a statistically significant degree. A response to both tests resulted in a positive predictive value (PPV) of 100%, while no response to either test in a negative predictive value (NPV) of 100%. CONCLUSIONS ACTH hyper-responsiveness to DDAVP stimulation proved a valuable indicator of relapsing patients with high sensitivity and specificity; in selected cases when a clear high increment of ACTH level is not evident, the CRH test might be used as additional tool to confirm the risk of future relapses.
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Affiliation(s)
- Mattia Barbot
- Endocrinology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
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12
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Gardiman MP, Fassan M, Nozza P, Orvieto E, Garrè ML, Milanaccio C, Severino M, Perilongo G, Giangaspero F. Diffuse leptomeningeal glioneuronal tumours: clinico-pathological follow-up. Pathologica 2012; 104:428-431. [PMID: 23547428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Glioneuronal tumours are a group of primary brain neoplasms of relatively recent acquisition in the World Health Organization (WHO) Classification of the Central Nervous System tumours. In diagnostic practice it is still possible to encounter glioneuronal tumours that cannot be placed into any of the well-defined WHO categories despite a growing list of entities. We have recently published four paediatric cases of diffuse leptomeningeal tumours that cannot be easily classified in the currently used CNS WHO classification, but which have histological and immunohistochemical criteria to be considered as glioneuronal tumours. The clinical, neuroradiological and pathological long-term follow-up of an unusual diffuse leptomeningeal glioneuronal tumour is presented herein.
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Affiliation(s)
- M P Gardiman
- Department of Medicine (DIMED), University Hospital of Padua, Padua, Italy.
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13
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Fassan M, D'Arca D, Letko J, Vecchione A, Gardiman MP, McCue P, Wildemore B, Rugge M, Shupp-Byrne D, Gomella LG, Morrione A, Iozzo RV, Baffa R. Mitostatin is down-regulated in human prostate cancer and suppresses the invasive phenotype of prostate cancer cells. PLoS One 2011; 6:e19771. [PMID: 21573075 PMCID: PMC3089640 DOI: 10.1371/journal.pone.0019771] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 04/04/2011] [Indexed: 12/02/2022] Open
Abstract
MITOSTATIN, a novel putative tumor suppressor gene induced by decorin overexpression, is expressed in most normal human tissues but is markedly down-regulated in advanced stages of mammary and bladder carcinomas. Mitostatin negatively affects cell growth, induces cell death and regulates the expression and activation levels of Hsp27. In this study, we demonstrated that ectopic expression of Mitostatin in PC3, DU145, and LNCaP prostate cancer cells not only induced a significant reduction in cell growth, but also inhibited migration and invasion. Moreover, Mitostatin inhibited colony formation in soft-agar of PC3 and LNCaP cells as well as tumorigenicity of LNCaP cells in nude mice. Conversely, targeting endogenous Mitostatin by siRNA and anti-sense strategies in PC3 and DU145 prostate cancer cells enhanced the malignant phenotype in both cell lines. In agreement of these anti-oncogenic roles, we discovered that Mitostatin was absent in ∼35% (n = 124) of prostate tumor samples and its overall reduction was associated with advanced cancer stages. Collectively, our findings indicate that MITOSTATIN may acts as a tumor suppressor gene in prostate cancer and provide a novel cellular and molecular mechanism to be further exploited and deciphered in our understanding of prostate cancer progression.
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Affiliation(s)
- Matteo Fassan
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Department of Diagnostic Medicine and Special Therapies, University of Padova, Padova, Italy
| | - Domenico D'Arca
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Juraj Letko
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Andrea Vecchione
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- Division of Pathology, II Faculty of Medicine, University “La Sapienza,” Ospedale Sant'Andrea, Rome, Italy
| | - Marina P. Gardiman
- Department of Diagnostic Medicine and Special Therapies, University of Padova, Padova, Italy
| | - Peter McCue
- Department of Pathology, Anatomy and Cell Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Bernadette Wildemore
- Department of Pathology, Anatomy and Cell Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Massimo Rugge
- Department of Diagnostic Medicine and Special Therapies, University of Padova, Padova, Italy
| | - Dolores Shupp-Byrne
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Leonard G. Gomella
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Andrea Morrione
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Renato V. Iozzo
- Department of Pathology, Anatomy and Cell Biology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Raffaele Baffa
- Department of Urology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Della Puppa A, Rossetto M, Berti F, Zustovich F, Manara R, Gardiman MP, Scienza R. Internal auditory canal metastasis. J Neurosurg Sci 2010; 54:159-162. [PMID: 21423087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Metastasis of the inner auditory canal is a really rare event. Clinically, it usually presents with rapid worsening cranial nerve palsy. Authors present a review of the literature reporting clinical features, radiological findings, intraoperative aspects of an illustrative case. A 56-year-old female patient presented with a peripheral facial nerve palsy. MRI showed two left p-fossa tumors whose one into the inner canal. Rapid worsening of facial damage despite corticosteroid treatment and the possibility to remove both tumors in the same surgical step suggested authors to operated on the patient. Intraoperatively, inner canal tumor looked totally involving the VII-VIII nerve complex so surgical extirpation was only partially feasible. Posterior wall drilling of the meatus was performed which improved facial palsy. Leptomeningeal spinal seeding occurred and spinal irradiation was performed. The case highlights the importance of maintaining a high degree of awareness of the auditory canal metastasis in patients with a previous history of malignancy who develop a rapid progressive peripheral VII nerve palsy. Furthermore, our case and literature data suggest that inner canal metastasis is a distinct entity from temporal bone and ponto-cerebellar angle metastasis on the base of the peculiarity of clinical features, prognosis, therapeutic strategies. In fact, inner canal metastases usually arise in patients apparently cured, and they imply a better prognosis even if with an higher risk of leptomeningeal seeding. Moreover, surgery rarely allows the removal of the lesion, also if symptoms relief may be achieved, as in our case.
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Affiliation(s)
- A Della Puppa
- Department of Neurosurgery, Padua University Hospital, Padua, Italy.
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15
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Persano L, Moserle L, Esposito G, Bronte V, Barbieri V, Iafrate M, Gardiman MP, Larghero P, Pfeffer U, Naschberger E, Stürzl M, Indraccolo S, Amadori A. Interferon-alpha counteracts the angiogenic switch and reduces tumor cell proliferation in a spontaneous model of prostatic cancer. Carcinogenesis 2009; 30:851-60. [PMID: 19237608 DOI: 10.1093/carcin/bgp052] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [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] Open
Abstract
Interferon (IFN)-alpha is a cytokine with marked therapeutic activity in transplantable tumor models, that is in part due to angiogenesis inhibition. Aim of this study was to investigate the effects of IFN-alpha during the early phases of tumor development in the transgenic adenocarcinoma of the mouse prostate (TRAMP) model. To provide sustained IFN-alpha production, TRAMP mice were injected intraperitoneally with lentiviral vectors. IFN-alpha administration resulted in rapid and protracted upregulation of IFN-alpha-regulated genes associated with antiangiogenic and antiproliferative functions in the prostate of TRAMP mice, including guanylate-binding protein 1 (GBP-1), IFI204 and CXCL10-11. These transcriptional changes were accompanied by effects on the tumor vasculature, including significant reduction of intraductal microvessel density and increased pericyte coverage, and marked reduction of tumor cell proliferation, without induction of tumor necrosis. Intriguingly, GBP-1 and myxovirus resistance A, two IFN-regulated proteins, were found expressed in approximately 40% of human prostate cancer samples analyzed, suggesting expression of endogenous IFN-alpha. Overall, these findings demonstrate that IFN-alpha is able to counteract the angiogenic switch and impairs tumor cell proliferation in preinvasive lesions. Since the angiogenic switch also marks progression of human prostatic cancer, these results highlight the potential of angiogenesis inhibitors for the development of chemoprevention strategies in high-risk individuals.
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Affiliation(s)
- Luca Persano
- Oncology Section, Department of Oncology and Surgical Sciences, University of Padova, Padova I-35128, Italy
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Pavesi G, Amistà P, Munari M, Gardiman MP. Intraventricular hemorrhage caused by peripheral anterior choroidal artery aneurysm rupture. A case report. Neuroradiol J 2008; 21:717-20. [PMID: 24257017 DOI: 10.1177/197140090802100518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Accepted: 09/07/2008] [Indexed: 11/16/2022] Open
Abstract
Intraventricular hemorrhage is a severe ictal event secondary to several pathological conditions (anticoagulation therapies, hypertension, post-surgical, traumatic, neoplastic, vascular malformations), leading to blockage of CSF flow and possible hydrocephalus, often justifying surgical intervention. We describe an uncommon source of intraventricular hemorrhage in a 54-year-old woman caused by a peripheral anterior choroidal artery aneurysm rupture.
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Affiliation(s)
- G Pavesi
- Neurosurgery, Padua City Hospital; Padua Italy -
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Testa RM, Albiger N, Occhi G, Sanguin F, Scanarini M, Berlucchi S, Gardiman MP, Carollo C, Mantero F, Scaroni C. The usefulness of combined biochemical tests in the diagnosis of Cushing's disease with negative pituitary magnetic resonance imaging. Eur J Endocrinol 2007; 156:241-8. [PMID: 17287414 DOI: 10.1530/eje.1.02332] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The etiological diagnosis of ACTH-dependent Cushing's syndrome is often a problem. In fact, no endocrine or radiological examination can conclusively distinguish the ectopic from the pituitary source of disease. The aim of our study was to evaluate the role of stimulation and suppression endocrine tests in the diagnostic and therapeutic approach of patients with Cushing's disease (CD) and negative pituitary magnetic resonance imaging (MRI), considering their post-surgical outcome in comparison with patients with CD and positive MRI. PATIENTS AND METHODS We retrospectively analyzed 31 patients (25 women and 6 men, median age 40 +/- 15 years) with a confirmed diagnosis of CD who underwent transsphenoidal pituitary surgery by the same neurosurgeon between 2001 and 2005. Preoperative endocrine assessment included corticotropin-releasing hormone (CRH), desmopressin (dDAVP), and overnight 8 mg dexamethasone suppression tests (8-DST) in all patients. Fifteen patients had a normal pituitary MRI and sixteen had a clearly evident pituitary microadenoma. Bilateral inferior petrosal sinus sampling (BIPSS) was performed in patients with discordant biochemical results or with signs and symptoms highly suggestive of an ectopic source of ACTH. Post-surgical median follow-up was 38.4 +/- 22.0 months. RESULTS Among patients with negative MRI, 60% had concordant positive endocrine tests and underwent neurosurgery without other examinations. BIPSS was performed in three other patients prompted by discordant endocrine tests (negative dDAVP) and in two patients with clinical suspicion of ectopic disease. Among patients with positive MRI, 87% underwent neurosurgery without BIPSS that was performed in two patients because of negative concomitant response to dDAVP and CRH tests. A pituitary adenoma, confirmed by pathological examination, was found in 40 and 81% of patients with negative and positive MRI respectively (P<0.05), corticotroph hyperplasia resulted more frequent in the group with negative MRI. Remission rate was not different between patients with negative and positive MRI (73 and 75% respectively; P=0.61) and between patients with negative MRI who did not undergo BIPSS and patients with positive MRI (P=0.56). The recurrence rate was also similar between groups (P=0.64), but higher, although not statistically different (P=0.07) in patients with corticotroph hyperplasia at histology. CONCLUSIONS An accurate evaluation of presurgical endocrine tests results enabled us to reduce the number of BIPSS in patients with a negative MRI without any fallout on their post-surgical outcome. In the hands of an expert pituitary surgeon, the outcome after surgeryand the subsequent recurrence rate are much the same in patients with negative or positive MRI.
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Affiliation(s)
- R M Testa
- Endocrinology Unit, Department of Medical and Surgical Sciences, University of Padua, Italy
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