Fabrizio Scognamillo

Epidemiology of Thyroid Cancer in an Area of Epidemic Thyroid Goiter

The aim of this study was to analyze and describe the epidemiological characteristics and trends of thyroid cancer in the province of Sassari (Sardinia, Italy), an area with epidemic thyroid goiter, in the period 1992–2010. Data were obtained from the local tumor registry which makes part of a wider registry web, coordinated today by the Italian Association for Tumor Registries. An increasing trend in the incidence of thyroid cancer in the province of Sassari was evidenced. This trend seems to follow the general worldwide trend and does not seem to be related to the high incidence of thyroid goiter in the area. The frequencies of the different histological subtypes were similar to those reported in numerous national and international reports. Women are affected earlier than men and, therefore, suffer greater professional, economic, and social impacts. Overall mortality is low and a relative 5-year survival is excellent, especially in comparison to other malignancies.

Breast Nodular Fasciitis: A Comprehensive Review

Background: This article describes the demographic, clinical, pathological and prognostic features of breast nodular fasciitis through a comprehensive review of the cases reported in modern literature. Material and Methods: English-language articles published from January 1970 to October 2015 and related to breast nodular fasciitis were non-systematically retrieved using the PubMed database. Titles, abstracts and references were evaluated in order to include the most relevant studies. The demographic characteristics of the patients and the signs and symptoms of the disease were reviewed, as well as the results of the radiological and diagnostic procedures employed and of the treatments adopted. Results: 26 papers reporting on 28 cases were enrolled; however, manuscripts published before 1990 were excluded because of old methodologies, technologies and clinical approaches. Thus, 22 cases included in 20 papers were analyzed in detail. Conclusion: The rarity and the unspecific clinical and radiological characteristics of breast nodular fasciitis make the differential diagnosis and management challenging. Knowledge of the clinical, pathological and prognostic aspects of this condition is crucial for breast care specialists in order to improve their diagnostic and therapeutic interventions.

Axillary lymph node dissection in patients with breast cancer and sentinel lymph node micrometastasis or isolated tumor cells: is it necessary?

AIMS AND BACKGROUND Sentinel lymph node biopsy is the standard method for axillary lymph node staging in patients with early stage breast cancer. The aim of the study was to evaluate the necessity of axillary lymph node dissection in patients with breast cancer and sentinel lymph node micrometastasis or isolated tumor cells. METHODS Sentinel lymph node biopsy was performed in 136 patients for breast cancer staging: 16 of them (11.7%) were found to have micrometastasis or isolated tumor cells and underwent axillary lymph node dissection. Micrometastases were considered when tumor invasion was ≤ 2 mm and >0.2 mm in diameter and isolated tumor cells when detected alone or in clusters of <0.2 mm in diameter. The dissection of the three axillary lymph node levels of Berg was performed in all cases. RESULTS Two patients (12.5%) presented isolated tumor cells and 14 (87.5%) micrometastasis in the sentinel lymph node. Among them, 25% presented nonsentinel axillary lymph node tumor invasion, whereas 75% had no further nodal involvement. CONCLUSIONS Results suggest that micrometastasis or isolated tumor cells of the sentinel lymph node represent the only site of cancer involvement of the axilla, especially in patients with early breast tumors, and that axillary lymph node dissection may be unnecessary in these cases and represent an overtreatment.

Single access videothoracoscopic biopsy and talc pleurodesis in patients with malignant pleural effusion

Aim-BackgroundRecurrent pleural effusion is frequently observed in clinical experience and malignancy is one of the most frequent causes. Although it is generally necessary to prevent the recurrence of effusion in patients with disseminated neoplastic disease, in others, a diagnosis is required. The aim of this study was to determine the efficacy and safety of biopsy and pleurodesis by a single access videothoracoscopic approach.MethodsWe report a consecutive series of 20 patients (12 men, 8 women, aged 39 to 83 years) who underwent single access videothoracoscopy with pleural biopsy and talc pleurodesis for recurrent pleural effusion. In all cases, indication for the procedure was a recurrent pleural effusion, suspicious for malignancy. Videothoracoscopy was performed under general anaesthesia. For pleurodesis, an average of 8g of sterile talc powder was used. A six-month follow-up was completed for all patients, and efficacy was judged by clinical examination and chest X-ray.ResultsDiagnosis was obtained in all cases. In five cases, the diagnosis was a pleural involvement by breast cancer metastasis, and in four cases, a primary lung cancer was detected. Eight were mesotheliomas and one a parapneumonic collection. In two cases, an unknown-malignancy recurrent pleural effusion was observed. No deaths, talc-induced ARDS or malignant invasion of the scar occurred, but only a postoperative empyema and two subcutaneous emphysemas treated successfully without further operation.ConclusionsSingle access videothoracoscopic pleural biopsy and talc pleurodesis is a safe and effective method for the diagnosis and treatment of malignant pleural effusions.

Proteomic analysis of human plasma and peripheral blood mononuclear cells in Systemic Lupus Erythematosus patients

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease with a broad spectrum of clinical presentations and incompletely understood pathogenesis. This autoimmune disease is characterized by alterations in both the innate and adaptive immune system that lead to the loss of immunologic tolerance. In autoimmune diseases particularly in SLE, early diagnosis, flare or remission phases can be difficult to identify. Proteomics can help to find new therapeutic targets and it also could help to better understand the cellular mechanisms. The aim of this study was to observe the variations in plasma and Peripheral Blood Mononuclear Cells (PBMCs) proteome in order to increase our knowledge about pathogenesis and to find possible diagnostic markers and/or therapeutic targets for improving diagnosis and treatment. The comparative proteomic analyses showed that several proteins were differentially expressed in the PBMCs from SLE patients. Among these, PRDX2 may be used as candidate biomarker or target protein for further investigations. In plasma, we showed that plasma clusterin levels increased in SLE patients compared to healthy controls, but this increase is not statistically significant. These proteomic results provide suggestions for understanding the molecular mechanisms of SLE, as well as the physiological changes correlated with SLE disease.

Small bowel emergencies: two surgical centers’ experience and literature review

SummaryBackgroundSmall bowel surgical emergencies are potentially life-threatening conditions. The aim of this study is to evaluate the clinical, diagnostic and therapeutic aspects of small bowel surgical emergencies to identify proper options for their management.MethodsWe retrospectively investigated 54 consecutive patients who underwent emergency surgery for small bowel disease. All clinical, surgical, and pathological data were collected from clinical records and referrals.ResultsIntraperitoneal adhesions were the main cause of small bowel obstruction, followed by abdominal wall defects (primitive and incisional hernias), phytobezoars, internal hernias, and neoplasias. The most frequent surgical procedure performed was adhesiolisis, followed by small bowel resections and correction of abdominal wall defects.ConclusionsIn-depth knowledge of the diseases which cause small intestine emergencies is crucial for emergency surgeons, given the absence of specific clinical, laboratory or radiological features, that makes the diagnosis and the decision to perform surgery challenging.

Molecular analysis of appendiceal mucinous cystadenoma and rectal adenocarcinoma in a patient with urothelial carcinoma: a case report

IntroductionIn this report, we present the case of a patient affected by appendiceal cystadenoma, a colorectal adenocarcinoma, and a concomitant bladder carcinoma, as well as the results of the molecular study of the most relevant mutational pathways involved in these tumors.Case presentationA 68-year-old Italian man was admitted to our unit complaining of macrohematuria, rectorrhagia, and rectal tenesmus for about 2 months. A colonoscopy showed the presence of a rectal lesion at 11cm from the anal margin; multiple biopsies were performed and a diagnosis of moderately differentiated adenocarcinoma was made. Abdominal ultrasonography and total body computed tomography performed subsequently to stage the rectal cancer showed the presence of two round nodules, interpreted as swollen lymph nodes of neoplastic origin, at the anterior aspect of the iliopsoas muscle and a budding lesion affecting the bladder. The patient underwent transurethral biopsy of the lesion in the right retrotrigonal region; the diagnosis was grade II urothelial carcinoma. The patient underwent an open anterior rectal resection with loco-regional lymphadenectomy. An enlarged appendix and a voluminous whitish soft-tissue lesion requiring an appendicectomy were detected perioperatively. Transurethral resection of the bladder lesion was also performed. The histological examination revealed that the nodular lesions in the appendix were due to a cystadenoma. For mutation analysis, genomic deoxyribonucleic acid was isolated from tumor tissue samples; for PIK3CA mutations, screening revealed that all three samples analyzed carried mutations in exon 9.ConclusionsAppendiceal mucoceles are rare but require adequate surgical treatment, given their malignant potential and the possibility of causing peritoneal pseudomyxoma. It is essential to make a correct preoperative evaluation based on a colonoscopy rather than ultrasound and computed tomography to exclude synchronous neoplasias often associated with mucoceles and to plan the optimum surgical strategy. The association between appendiceal mucoceles and other neoplasias is relatively frequent, especially with colorectal cancer. Oncogenic activation in the PIK3CA-depending pathway may contribute substantially to the pathogenesis of the different solid tumors in the same patient.

Impact of Age on the Quality of Lymphadenectomy for Colorectal Cancer

The aim of this study was to evaluate the impact of patient age on the number of lymph nodes dissected during surgery for colorectal cancer. Clinical and histopathological data of 231 consecutive patients who underwent elective surgery for colorectal cancer were reviewed retrospectively. Patients were divided into those aged ≤70 years and >70 years. Our findings suggest that patients age influences the number of lymph nodes detected in surgical specimens; this number was lower in patients aged >70 years and decreased with further aging.

Deciduoid mesothelioma of the thorax: A comprehensive review of the scientific literature.

Deciduoid mesothelioma is a rare variant of malignant epithelioid mesothelioma. It often involves the peritoneum, but also thoracic cases have been reported. The aim of the present review is to describe the demographic, clinical, radiological, and pathological features of such a rare variant of thoracic mesothelioma, and the state of the art regarding the therapeutic approaches currently available.

Re: Neutrophil-to-lymphocyte ratio predicts anastomotic dehiscence: Letters to the Editor

We read with interest the article by Walker et al. on the role of several biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), in predicting anastomotic dehiscence (AD). We recently evaluated the role of NLR in this setting with a case-match approach, and we obtained similar results. In our study, the archives of the surgical units involved were searched, and 44 patients who had a postoperative clinically manifested AD from 2012 through 2017 were enrolled. Subsequently, a control group with a rigorous matching in terms of sex, age, disease location, American Society of Anesthesiologists score, body mass index and surgical approach was retrieved. In cancer cases, we matched also the stage of the disease, and in those with rectal cancer, the distance from the anal verge. The NLR before the operation, and in the first and fourth post-operative days was calculated. No significant differences were found in the median values of NLR between the groups before surgery and in the first post-operative day. At the fourth post-operative day, the median NLR value was significantly higher in patients with AD, in comparison to those without (8.8, interquartile range (IQR): 5.37–11.87 versus 5.50, IQR: 3.40–7.00). The area under the curve (AUC) was lower than that obtained by Walker et al.: 0.697 (95% confidence interval (CI): 0.581–0.797). The best cutoff value in our study was 8.7, with sensitivity and specificity 52% (95% CI: 33.5–69.2) and 88% (95% CI: 74.9–96.1), respectively, while in the study of Walker et al. the best cutoff value was 6.18, with a sensitivity of 100% and a specificity of 61.8%. Our study, performed with a different approach, confirms the potential usefulness of NLR measured at the fourth post-operative day in predicting AD, but its diagnostic accuracy needs to be further investigated.