Massimiliano Paci - Academia.edu (original) (raw)

Papers by Massimiliano Paci

American Journal of Respiratory and Critical Care Medicine, Sep 15, 2014

The Journal of trauma

Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... An abstract is unavailable. This article is ...

The Thoracic and cardiovascular surgeon, Jan 28, 2015

Objective Cushing syndrome (CS) caused by bronchopulmonary carcinoids (BCs) is a very rare entity... more Objective Cushing syndrome (CS) caused by bronchopulmonary carcinoids (BCs) is a very rare entity. The aim of this study was to revisit the features of a multicenter clinical series to identify significant prognostic factors. Methods From January 2002 to December 2013, the clinical and pathological data of 23 patients (treated in five different institutions) were retrospectively reviewed. Survival analysis was performed to explore the relative weight of potential prognostic factors. Results Median age and male/female ratio were 48 years and 14/9, respectively. Most (> 80%) of the patients presented with CS-related symptoms at diagnosis. Tumor location was peripheral in 13 patients (57%) and central in 10 (43%). All patients but two (treated with chemotherapy) underwent surgical resection with curative intent. Definitive cyto/histology was indicative of typical carcinoid (TC) in 16 cases (70%) and atypical carcinoid (AC) in 7 cases (30%). A complete remission of CS was obtained in...

Interactive cardiovascular and thoracic surgery, 2015

American Journal of Respiratory and Critical Care Medicine, 2014

Interactive CardioVascular and Thoracic Surgery, 2014

Objectives: Pulmonary carcinoids (PCs) causing Cushing's syndrome (CS) are very rarely reported. ... more Objectives: Pulmonary carcinoids (PCs) causing Cushing's syndrome (CS) are very rarely reported. The aim of this study was to revisit the characteristics and outcomes of patients affected by PCs causing CS in a relative large multicentre study in order to identify the main prognostic factors. , a total of 20 patients were treated in 4 institutions. Clinical and pathological data were retrospectively reviewed. The Kaplan-Meier method, Breslow and log-rank tests were used for the statistical analysis when indicated. Results: Mean age and male/female ratio were 51 ± 13 years and 14/6, respectively. All patients but 2 (treated with chemotherapy) underwent surgical resection with curative intent. At diagnosis, 8 patients (40%) presented with advanced (or locally advanced) disease. The overall median and 5-year survivals were 47 months and 71.5%, respectively. A complete remission of CS was obtained in 14 cases (70%). Four patients (25%) experienced a relapse of disease after radical surgery. Log-rank analysis identified the tumour location ( peripheral versus central; P = 0.004), the histology (atypical versus typical carcinoids; P = 0.064), the pTNM-staging (P = 0.020), the number of mitosis (P = 0.001), the ki-67% index (P = 0.001) and the persistence of CS (P = 0.035) as prognostic factors in such cohort of patients. Conclusions: Pulmonary carcinoids causing Cushing's syndrome are characterized by a high rate of lymph nodal involvement at diagnosis (N2 disease in 30% of patients), a suboptimal prognosis (5-year survival = 71.5%) and a remarkable risk of relapse ( 25%) even after radical resection. Tumour location ( peripheral location), histology (atypical carcinoids), high number of mitosis, high ki-67% index, advanced p-Stage and the persisting of the CS after surgery correlate with a poor prognosis in such patients. Disclosure: No significant relationships.

Thoracic Surgery Clinics, 2014

Distinct features of different pulmonary neuroendocrine tumors (pNETs) include their pathologic c... more Distinct features of different pulmonary neuroendocrine tumors (pNETs) include their pathologic characteristics as well as their clinical behavior, epidemiology, treatment, and prognosis. Typical carcinoids (TCs) are indolent neoplasms with a good prognosis, whereas atypical carcinoids (ACs) have a less indolent behavior with a certain propensity for metastatic spread. Both are well-differentiated pulmonary NETs are optimally treated with complete surgical excision. More aggressive pNETs, such as large cell neuroendocrine lung cancer and small cell lung cancer, often present with local invasion, thoracic lymph nodal metastases, and distant spread. As a result, affected patients may not be candidates for surgical resection and are treated with chemotherapy with or without radiation therapy, showing a poor prognosis. Taking into account the different biologic behavior of various pNET subtypes, achieving an accurate preoperative diagnosis is a key element for planning the best strategy of care. Recent evidence suggests that, even when surgery is indicated, the extent of both pulmonary resection and lymph nodal dissection are determined by the cytohistologic characteristics of pNETs. TCs and ACs share structural radiological findings and a clear differentiation is not possible through radiological findings only. The functional imaging evaluation using nuclear medicine techniques has improved in the last two decades with the aim of helping the physicians in the challenging clinical decision-making process of these rare entities.

Human Pathology, 2004

Two cases of placental transmogrification of the lung are reported. The lesions presented in the ... more Two cases of placental transmogrification of the lung are reported. The lesions presented in the left lung, in one case as a giant bulla of the upper lobe and in the other as a cystic nodule of the lower lobe. A segmentectomy was performed in both cases, and the patients were alive and well 5 years and 2 months after surgery, respectively. In our opinion, pulmonary placental transmogrification is not a variant of emphysema, as generally considered, but rather probably represents a benign proliferation of immature interstitial clear cells with secondary cystic change. This report presents a histological, immunohistochemical, ultrastructural and molecular study of these peculiar cells, together with a review of the literature. HUM PATHOL 35:517-521.

Lung Cancer, 2009

Objectives: The presence of circulating DNA in plasma of patients with malignant neoplasm has bee... more Objectives: The presence of circulating DNA in plasma of patients with malignant neoplasm has been a known fact for over 30 years. Since then, the concentration of free circulating plasma DNA has been studied as well as the genetic alterations and epigenetic alterations of tumour DNA of patients that suffer from various types of tumours. The analysis of circulating plasma DNA may be a useful marker to get an early diagnosis on malignant neoplasms. This study has been specifically designed to validate the quantification of circulating DNA in order to design a test useful for the early identification of non-small cell lung cancer patients and the monitoring of lung cancer progression. A second aim of this work is the sensibility and specificity evaluation of such method for future applications. Methods: The quantity of plasma DNA was determined using quantitative Real-Time PCR with amplification of the human telomerase reverse transcriptase (hTERT) gene in 151 patients that suffer from lung cancer and 79 healthy controls. The performance of the test was evaluated with a ROC curve. The relationship between the DNA concentration and main demographic, clinical and pathological variables was examined with logistic regression models as well as multiple linear regression models. Results: The concentration of circulating plasma DNA was about four times higher in patients with lung cancer with respect to the controls (12.8 vs 2.9 ng/mL). The area under the ROC curve was 0.79 (95% CI, 0.710-0.83). The concentration of circulating DNA proved to be an important risk factor for the presence of the illness and a prognostic index in the follow-up. Conclusions: The use of quantitative Real-Time PCR revealed that higher values of circulating DNA can be found in patients with lung neoplasm compared to the healthy controls.

Vascular and endovascular surgery, Jan 22, 2016

Right-side aortic arch is a rare congenital aortic anomaly occurring in 0.05% to 0.1% of the gene... more Right-side aortic arch is a rare congenital aortic anomaly occurring in 0.05% to 0.1% of the general population. Approximately, half of these cases may be associated with an aberrant left subclavian artery and occasionally with aneurysmatic change at its origin known as Kommerell diverticulum or aneurysm (KA). Herein we report a challenging case of a right-side aortic arch associated with KA incidentally observed in a 73-year-old male with metastatic lung cancer. After careful multidisciplinary discussion, a conservative strategy of care was successfully adopted.

Lung, Jan 14, 2016

Pulmonary sarcomatoid carcinoma (PSC) is a very rare and uninvestigated subtype of non-small cell... more Pulmonary sarcomatoid carcinoma (PSC) is a very rare and uninvestigated subtype of non-small cell lung cancer (NSCLC). The aims of this study were to define the radiometabolic features (by (18)F-FDG PET/CT) in a bi-centric cohort of 49 PSC patients and to explore their relation with clinico-pathological characteristics and long-term survival results after surgical treatment. There were 40 males and 9 females aged 65.2 ± 10.47 years. Overall long-term survival was 26.7 % at 5 years. Mean and median values of SUVmax were 15.21 and 15, respectively (SD ±5.5). Performing an age-, gender- and staging-matched analysis comparing PSC Stage-I only with a cohort of Stage-I NSCLC (n = 93), we observed significantly higher SUVmax values in PSC group (15.11 vs 7.66, p = 0.001). No differences in terms of SUVmax were found with regard to tumour dimensions, histology (pure vs mixed, pleomorphic vs others), pathological stage and pattern of recurrence. P-stage, surgical radicality, vascular/lymphat...

Journal of Thoracic Oncology Official Publication of the International Association For the Study of Lung Cancer, Apr 1, 2006

International Journal of Molecular Sciences, 2016

The identification of molecules that can reliably detect the presence of a tumor or predict its b... more The identification of molecules that can reliably detect the presence of a tumor or predict its behavior is one of the biggest challenges of research in cancer biology. Biological fluids are intriguing mediums, containing many molecules that express the individual health status and, accordingly, may be useful in establishing the potential risk of cancer, defining differential diagnosis and prognosis, predicting the response to treatment, and monitoring the disease progression. The existence of circulating soluble growth factor receptors (sGFRs) deriving from their membrane counterparts has stimulated the interest of researchers to investigate the use of such molecules as potential cancer biomarkers. But what are the origins of circulating sGFRs? Are they naturally occurring molecules or tumor-derived products? Among these, the epidermal growth factor receptor (EGFR) is a cell-surface molecule significantly involved in cancer development and progression; it can be processed into biological active soluble isoforms (sEGFR). We have carried out an extensive review of the currently available literature on the sEGFRs and their mechanisms of regulation and biological function, with the intent to clarify the role of these molecules in cancer (and other pathological conditions) and, on the basis of the retrieved evidences, speculate about their potential use in the clinical setting.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, Jan 5, 2016

Pulmonary Sarcomatoid Carcinoma (PSC) is a rare and aggressive subset of NSCLC, with limited trea... more Pulmonary Sarcomatoid Carcinoma (PSC) is a rare and aggressive subset of NSCLC, with limited treatment options. The molecular characterization of PSC has been strongly hampered by the relative rarity of these tumors. However, understanding the molecular and genetic bases of PSCs is critical to pave the way to new treatment options. In this work, we aimed to explore the complexity of genetic asset of PSC, and to investigate its prognostic impact on survival in a large cohort of PSC patients. Next-generation sequencing analysis of a panel of 26 genes with potential clinical relevance was performed on surgical specimens of 49 PSCs. The prognostic impact of genetic profiles on patient survival and the association between the genetic alterations and clinico-pathological features were tested. Fifty-five somatic mutations were detected in 13 genes. Thirty-nine PSC (80%) showed at least one mutation. Survival probability decreased in patients with mutated PSC compared with PSC without mutat...

The Annals of thoracic surgery, 2016

Chest Journal, Aug 1, 2002

... Massimiliano Paci, MD,; Giorgio Sgarbi, MD,; Guglielmo Ferrari, MD,; Salvatore De Franco, MD ... more ... Massimiliano Paci, MD,; Giorgio Sgarbi, MD,; Guglielmo Ferrari, MD,; Salvatore De Franco, MD and; Valerio Annessi, MD. Santa Maria Nuova Hospital ... long-term survival potential in patients with stage T4, resectable lung tumors (ie, in the vertebra, superior vena cava, and atrium ...

Journal of Thoracic and Cardiovascular Surgery, Mar 1, 2005

Chirurgia italiana

While liposarcoma is the most common malignant mesenchymal neoplasm in adults, a mediastinal posi... more While liposarcoma is the most common malignant mesenchymal neoplasm in adults, a mediastinal position is rare. We describe here the case of a 74-year-old female with an hourglass-shaped mass in the posterior mediastinum, which was probably present on a roentgenogram 4 years earlier. On a CT scan of the chest, the mass appeared non-homogeneous with a mainly adipose content. A preoperative ultrasonically guided tru-cut transthoracic biopsy revealed the presence of adipose tissue with mildly atypical cytological features. The mass was therefore completely excised by means of a right thoracotomy. The postoperative course was uneventful and the patient is alive and well and has had no recurrence in the 6 months since surgery. We review here the natural history, pathology, and prognosis of the disease, and discuss methods of diagnosis and management of such lesions.

Tumori

Epithelioid angiosarcoma is an extremely rare tumor. It is generally a secondary tumor and the pr... more Epithelioid angiosarcoma is an extremely rare tumor. It is generally a secondary tumor and the preferred sites of such metastases are the heart, pericardium, lung, breast, liver, spleen, bone, and brain. In rare cases the lung has been described as the primary site. The prognosis of this neoplasm is extremely poor. We report a case of epithelioid angiosarcoma with multiple bilateral lung infiltration, bone metastasis, and metastasis of the lamina propria of a tubulovillous adenoma of the colon.