Giancarlo Pompei

Increased expression of transketolase‐like‐1 in papillary thyroid carcinomas smaller than 1.5 cm in diameter is associated with lymph‐node metastases

Patients with small papillary thyroid carcinoma (PTC) may have a high incidence of regional lymph‐node (LN) metastases at presentation, and these are considered to be an independent risk factor for tumor recurrence. A mutated transketolase transcript (TKTL1) has been found up‐regulated in different human malignancies, and strong TKTL1 protein expression has been associated with aggressiveness and poor patient survival in several epithelial cancers.

INFLAMMATION IN IRRITABLE BOWEL SYNDROME: MYTH OR NEW TREATMENT TARGET?

Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome (IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications describing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanisms underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism.

Assessment of “grading” with Ki-67 and c-kit immunohistochemical expressions may be a helpful tool in management of patients with flat epithelial atypia (FEA) and columnar cell lesions (CCLs) on core breast biopsy

It is essential to reach a better understanding of “flat epithelial atypia/columnar cell lesions” (FEA/CCLs) in breast core biopsies. Our aim was to explore their biological nature, in order to predict the likelihood of an upgrade to carcinoma. “Cytological grading” has been specially focused, in view of its possible utility in the choice of management. One hundred thirty of a total of 900 cases core needle (CN)/vacuum‐assisted biopsies (VABs), with diagnoses of “hyperplasia” and “atypia” were retrospectively re‐evaluated. Pathological findings of further excision biopsies (FEBs) performed in 40/75 patients with follow‐up were compared with the previous diagnoses. In all cases, both Ki‐67 and c‐kit immunoreactivities were explored and compared with both normal breast tissues and subsequently documented cancers, with special reference to the hyperplastic FEA/CCLs, with “mild” atypia (FEA/CCHAm). Sixteen cases were re‐diagnosed as “usual ductal hyperplasia” (UDH), 60 as “columnar cell hyperplasia” (CCH), and 54 as FEA/CCHA, 30 of which FEA/CCHAm and 24 FEA/CCHAh (with high atypia). Significantly, the Ki‐67 index proved to be on the increase and c‐kit expression on the decrease in FEA/CCHA lesions, mainly in the FEA/CCHAh group and in the subsequently observed cancers, compared with either benign tissues or the FEA/CCH cases. It was also significant that most of the carcinomas were found in FEBs within the FEA/CCHAh group. In this study cytological grading, together with Ki‐67 and c‐kit indices, proved to be helpful in FEA/CCLs evaluation. With regard to FEA/CCHAm lesions, an adequate surveillance appears to be a more appropriate management tool than FEB, as a result of their biological nature and behavior. J. Cell. Physiol. 221: 343–349, 2009.

Primary schwannoma of the thyroid gland involving the isthmus: report of a case

Primary thyroid schwannomas are extremely rare tumors and there are very few reports of such tumors in the literature. This report presents a rare case of schwannoma involving the isthmus of the thyroid in a 47-year-old male, presenting as a symptomatic predominating cold nodule within a multinodular goiter. The patient underwent total thyroidectomy. The histological examination indicated an Antoni A-type schwannoma. The clinical, radiological and pathological findings of the tumor are discussed, emphasizing the difficulty in reaching a correct preoperative diagnosis. Only 18 cases of primary schwannoma of the thyroid gland have so far been described in the literature and, this is only the second report of thyroid schwannoma localized in the isthmus.

Self-Expandable Metal Stent Placement for Closure of a Leak after Total Gastrectomy for Gastric Cancer: Report on Three Cases and Review of the Literature

In the setting of the curative oncological surgery, the gastric surgery is exposed to complicated upper gastrointestinal leaks, and consequently the management of this problem has become more critically focused than was previously possible. We report here three cases of placement of a partially silicone-coated SEMS (Evolution Controlled Release Esophageal Stent System, Cook Medical, Winston-Salem, NC, USA) in patients who underwent total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy for a gastric adenocarcinoma. The promising results of our report, despite the small number of patients, suggest that early stenting (through a partially silicone-coated SEMS) is a feasible alternative to surgical treatment in this subset of patients. In fact, in the treatment of leakage after total gastrectomy, plastic stents and totally covered metallic stents may not adhere sufficiently to the esophagojejunal walls and, as a result, migrate beyond the anastomosis. However, prospective studies with a larger number of patients might assess the real effectiveness and safety of this procedure.

USEFULNESS OF CT COLONOGRAPHY IN PATIENTS WITH OCCLUSIVE COLORECTAL CANCER BEFORE METALLIC STENT PLACEMENT: A SINGLE ENTER EXPERIENCE

Up to 15% of patients with colorectal cancer (CRC) present with large bowel obstruction. Currently, computed tomography colonography (CTC) is regarded as a promising technique for complete evaluation of the proximal colon and simultaneous assessment of extraluminal status. Aim of this retrospective, observational study is to evaluate the feasibility of using CTC for preoperative examination of the proximal colon before metallic stent placement in patients with colon obstruction caused by CRC. Sixteen patients who demonstrated colonic obstruction caused by CRC, underwent CTC immediately after incomplete colonoscopy. Perpatient sensitivity of CTC for lesions 5 mm or larger in diameter in the colon proximal to the stent was 100% (95% CI: 0.4385-1). Per-patient specificity for lesions 5 mm and larger in the proximal colon was 92.3% (95% CI:0.6669-0.9863). CTC did not generate any false diagnosis of synchronous cancer. False positive findings at CTC did not result in a change in surgical plan for any patients. Although the small number of

A rare case of hyperproliferative gastropathy.

Gastroenterology and Endoscopy Unit, Fondazione Istituto S. Raffaele – G. Giglio, Cefalu, Italy PhD Course in Surgical Biotechnology and Regenerative Medicine, School of Medicine, University of Palermo, Italy Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy Pathology Unit, Fondazione Istituto S. Raffaele – G. Giglio, Cefalu, Italy Radiology Unit Fondazione Istituto S. Raffaele – G. Giglio, Cefalu, Italy