Paola Spaggiari - Academia.edu (original) (raw)
Papers by Paola Spaggiari
Neuroendocrinology, 2016
Gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) are defined as neuroendocrine neopl... more Gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) are defined as neuroendocrine neoplasms (NENs) with >20% Ki-67 index according to the 2010 WHO classification. Some reports suggest that this category is heterogeneous. We retrospectively studied a series of 136 patients affected by grade 3 (G3) gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) with the aim to clarify the prognostic role of tumor morphological differentiation, proliferation, defect in mismatch repair proteins (MMRd), CD117 expression, and site of origin. The primary endpoint was the correlation between these parameters and the overall survival (OS). Univariable and multivariable Cox proportional hazards regression analyses were used to assess the prognostic significance of various clinical and histopathologic features. With a median follow-up of 81 months, the median OS was 12.9 months. At multivariate analysis, morphological differentiation, Ki67 index, MMRd, stage, and CD117 expression were independent prognostic markers in NECs. Three different prognostic categories of NECs were identified according to the degree of morphologic differentiation (well versus poorly-differentiated) and Ki67 index (<55% vs. ≥55%). On this basis median OS was: 43.6 months in well-differentiated neoplasms with Ki67 index 20-55% (named Type A); 24.5 months in poorly-differentiated neoplasms with Ki67 index 20-55% (Type B); and 5.3 months (p < 0.0001) in poorly-differentiated neoplasms with Ki67 index ≥55% (Type C). The present study suggests that GEP NECs represent a heterogeneous group of neoplasms which can be better classified in different prognostic categories using both tumor morphology and Ki67 index.
Alimentary Pharmacology Therapeutics, Apr 1, 2003
Background: The majority of reflux patients have nonerosive reflux disease. Aim: To evaluate the ... more Background: The majority of reflux patients have nonerosive reflux disease. Aim: To evaluate the influence of Helicobacter pylori on oesophageal acid exposure in patients with both nonerosive and erosive reflux disease and in a group of controls. The pattern and distribution of chronic gastritis were also assessed. Methods: One hundred and twelve consecutive patients with symptoms of gastro-oesophageal reflux disease agreed to undergo both upper gastrointestinal endoscopy and 24-h oesophageal pH-metry. Patients were grouped as H. pylori-positive or H. pylori-negative on the basis of both CLO-test and histology, and as cases with or without oesophagitis on the basis of endoscopy. The controls consisted of 19 subjects without reflux symptoms and with normal endoscopy and oesophageal pHmetry. Results: H. pylori was positive in 35 patients (31%) and in six controls (31%); oesophagitis was found in 44 patients (39%) and non-erosive reflux disease in 68 (61%). The prevalence of chronic gastritis in the antrum and corpus was higher in H. pylori-positive than in H. pylori-negative patients (P < 0.001), but was more frequently mild (P < 0.001) than moderate or severe. The percentage total time the oesophageal pH < 4.0 was higher in patients than in controls (P < 0.008-0.001), but there was no difference between H. pyloripositive and H. pylori-negative patients (12.3% vs. 12%, P ¼ 0.43) or H. pylori-positive and H. pylori-negative controls (1.07% vs. 1.47%, P ¼ 0.19).
Journal of Gastrointestinal Oncology, Apr 1, 2014
Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related... more Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related death with squamous cell carcinoma (SCC) accounting for almost half of all esophageal cancers. Persistent human papilloma virus (HPV) infection has been suspected to play an active role in esophageal carcinogenesis but a clear association has not still been proven and no specific indications or guidelines for possible endoscopic and surgical therapeutic approaches to this clinical scenario are available. We report a case of a 62-year-old woman with histological diagnosis of high-grade intraepithelial squamous neoplasia of distal esophagus associated with cytological modifications resembling cervical HPV infection and with a positive INNO-LiPA assay for genotype 16 HPV. A single session of radiofrequency ablation (RFA) was performed on the dysplastic esophageal area with complete endoscopic eradication as confirmed by the following endoscopic, histologic and microbiologic examinations. Our report might give further strength to the hypothesis of an etiological role of HPV in selected cases of esophageal carcinogenesis and opens a discussion on the possible use of Radio Frequency Ablation as an effective and safe endoscopic treatment for both early squamous cell neoplasia and HPV esophageal colonization.
Jop Journal of the Pancreas, Sep 15, 2013
Context Curative (R0) resection is considered a prognostic key factor among patients undergoing s... more Context Curative (R0) resection is considered a prognostic key factor among patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). Although guidelines for the processing of PD specimens have been established, there is currently no widely accepted standard protocol, resulting in large variation of reported R1 and lymph-nodes rates; it ultimately precludes meaningful comprehension of clinicopathological correlation usually leading to therapeutic decisions. Objective Definition of a standardized pathway in processing of surgical specimens after pancreaticoduodenectomy (PD) for PDAC in a referral centre for pancreatic disease and evaluation of its impact on pathological analysis quality indexes. Methods Between January 2010 and May 2013 we performed 206 PD, of which 108 for PDAC; invasive IPMN (n=12) and neoadjuvant CT patients (n=8) were excluded. On overall 88 patients were then included in the present study: we realized a comparison between a control group of patients, treated between 2010 and 2011 (n=39), and a group composed by patients who underwent surgery between 2012 and 2013 (n=49), when a standardized pathway for specimen processing was defined: setting up of a selected group of dedicated pathologists, highly interactive with surgical team and guided by a senior pathologist acting as a tutor on specimen sampling; creation of a standard report form comprising all resection margins; frequent resampling of surgical specimens; external tutoring if necessary. Results R1% in the whole group of patients (n=88) was 34.1%; in the first group, however, it was 17.9%, while in the later it increased to 46.9% (P=0.004); the improving detection of margin infiltration is further highlighted by the R1% observed in the last months (Jan-May 2013), equal to 73.3%. Median number of lymph-nodes derived from surgical specimen was 15 (range: 1-31) in the first group, while in the second group it increased to 21 (range: 7-47)(P<0.001 at Wilcoxon test). In a similar way N1% increased from 64.1% to 83.7% (P=0.035) between first and second period. Inadequate node sampling (less than 12, according to AJCC/TNM) decreased from 23.1% (n=9) to 2.0% (n=1) (P=0.001). Conclusions As several authors suggested, R1% in PDAC surgery should be considered a pathological examination quality index, instead of a parameter regarding pure surgical technique; N1% and total lymph-node number hold a similar value. A structured pathway regarding specimen analysis, able to guarantee an high quality output, is an essential facility in a pancreatic surgery referral centre.
Anticancer research, 2015
to appraise the role of volumetric-modulated arc therapy (VMAT) in the neoadjuvant chemoradiother... more to appraise the role of volumetric-modulated arc therapy (VMAT) in the neoadjuvant chemoradiotherapy management of advanced medium and distal oesophageal cancer in terms of toxicity and response to treatment. Thirty patients were treated according to the neoadjuvant chemoradiation followed by surgery versus surgery-alone trial scheme with VMAT radiation therapy. Patients presented mainly T3-T4 stage (80%) and N1-2 (96.6%) disease. The chemotherapy scheme consisted of 3-5 cycles, while a radiotherapy course of 41.4 Gy in 23 fractions was administered to all patients. The median age of patients was 65 years, and there was a predominance of males (80%), smokers or ex-smokers (90%) and modest alcohol habit (80% negative). Primary tumor localisation was in the medium and distal third of the oesophagus in 57% of the cases, the rest being in the gastro-oesophageal junction. Modest toxicity profiles were observed, with limited incidence of grade 2-3 events. Partial or complete response was ...
Chirurgia italiana
We present a case of schwannoma of the neck in 49-year-old man, which was symptomatic for a long ... more We present a case of schwannoma of the neck in 49-year-old man, which was symptomatic for a long period: paraesthesia for one year, cervical mass for 2-3 months and dysphagia during the last 20 days. After ultrasonography and magnetic resonance the patient was operated on and complete excision of the mass was performed. The operation was performed via a cervical approach: the nerves and vascular and muscular structures were carefully isolated and then preserved. The tumour arose from the cervical sympathetic chain. The diagnosis of schwannoma was possible only at histopathological examination. After 24 months no local recurrence or postoperative complications related to the intervention were found. At present, however, the patient presents a moderate lowering of the voice, such as may be due to impairment of the superior laryngeal nerve, though this was already present preoperatively. These lesions are uncommon and most often occur as asymptomatic solitary neck masses. The preoperat...
The American Journal of Gastroenterology, 2005
BACKGROUND: Histology is generally considered as a tool of limited value in the diagnosis of gast... more BACKGROUND: Histology is generally considered as a tool of limited value in the diagnosis of gastro-esophageal reflux disease (GERD).
Journal of gastrointestinal and liver diseases : JGLD, 2012
Endoscopic submucosal dissection (ESD) is effective and safe for the removal of neoplastic lesion... more Endoscopic submucosal dissection (ESD) is effective and safe for the removal of neoplastic lesions in the general population, but its role in patients with cirrhosis is not clear. We evaluated data on feasibility and safety of ESD for gastric lesions in cirrhotic patients. A systematic review of the literature with pooled-data analysis was performed. Data of all consecutive cirrhotics who underwent ESD for gastric neoplastic lesions in a single centre were also reported. In reviewing the published literature, 68 ESD procedures for gastric neoplastic lesions have been performed in 61 cirrhotics, including 5 patients from our experience. En bloc removal and the R0 resection were successful in 88.2% and 89.7% of procedures, respectively. Post-ESD bleeding occurred in 8 (13.1%) patients, and perforation in 1 (1.6%). All patients were successfully managed by endoscopic treatment. No procedure-related death was observed. Patients with advanced cirrhosis, with either INR >1.33 and/or pl...
Journal of gastrointestinal oncology, 2014
Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related... more Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related death with squamous cell carcinoma (SCC) accounting for almost half of all esophageal cancers. Persistent human papilloma virus (HPV) infection has been suspected to play an active role in esophageal carcinogenesis but a clear association has not still been proven and no specific indications or guidelines for possible endoscopic and surgical therapeutic approaches to this clinical scenario are available. We report a case of a 62-year-old woman with histological diagnosis of high-grade intraepithelial squamous neoplasia of distal esophagus associated with cytological modifications resembling cervical HPV infection and with a positive INNO-LiPA assay for genotype 16 HPV. A single session of radiofrequency ablation (RFA) was performed on the dysplastic esophageal area with complete endoscopic eradication as confirmed by the following endoscopic, histologic and microbiologic examinations. O...
BioMed Research International, 2014
Introduction. Pancreatic surgery is challenging and associated with high morbidity, mainly repres... more Introduction. Pancreatic surgery is challenging and associated with high morbidity, mainly represented by postoperative pancreatic fistula (POPF) and its further consequences. Identification of risk factors for POPF is essential for proper postoperative management. Aim of the Study. Evaluation of the role of morphological and histological features of pancreatic stump, other than main pancreatic duct diameter and glandular texture, in POPF occurrence after pancreaticoduodenectomy. Patients and Methods. Between March 2011 and April 2013, we performed 145 consecutive pancreaticoduodenectomies. We intraoperatively recorded morphological features of pancreatic stump and collected data about postoperative morbidity. Our dedicated pathologist designed a score to quantify fibrosis and inflammation of pancreatic tissue. Results. Overall morbidity was 59,3%. Mortality was 4,1%. POPF rate was 28,3%, while clinically significant POPF were 15,8%. Male sex ( = 0.009), BMI ≥ 25 ( = 0.002), prolonged surgery ( = 0.001), soft pancreatic texture ( < 0.001), small pancreatic duct ( < 0.001), pancreatic duct decentralization on stump anteroposterior axis, especially if close to the posterior margin ( = 0.031), large stump area ( = 0.001), and extended stump mobilization ( = 0.001) were related to higher POPF rate. Our fibrosis-and-inflammation score is strongly associated with POPF ( = 0.001). Discussion and Conclusions. Pancreatic stump features evaluation, including histology, can help the surgeon in fitting postoperative management to patient individual risk after pancreaticoduodenectomy.
International Journal of Case Reports and Images, 2014
Virchows Archiv, 2009
Patients with non-erosive reflux disease may show microscopic damage. This study is aimed to desc... more Patients with non-erosive reflux disease may show microscopic damage. This study is aimed to describe distribution, sensitivity, and specificity of histological lesions (i.e., basal cell hyperplasia-BH, papillae elongation-PE, dilatation of intercellular spaces-DIS, intraepithelial eosinophils-IE, neutrophils, and erosions) and sampling criteria. Four groups were identified on the basis of symptoms, endoscopy, and pH monitoring: (1) erosive esophagitis (n=48), (2) non-erosive esophagitis with abnormal pH (n=59), (3) non-erosive esophagitis with normal pH (n=12), and (4) controls (n=20). Biopsies were taken at the Z-line and 2 and 4 cm above it. BH, PE, DIS, IE, neutrophils, and erosions were assessed. A global severity score was calculated on the basis of the above parameters and allowed the distinction of patients from controls with 80% sensitivity and 85% specificity. Lesions were more severe at Z-line than proximally and more expressed in erosive than in non-erosive disease, although more than 70% of latter patients still showed histological damage. Esophageal biopsy seems very attractive in non-erosive disease where it may contribute to diagnosis and play a role in the comparative evaluation of different therapies.
Journal of Crohn's and Colitis, 2011
Neuroendocrinology, 2016
Gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) are defined as neuroendocrine neopl... more Gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) are defined as neuroendocrine neoplasms (NENs) with &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;20% Ki-67 index according to the 2010 WHO classification. Some reports suggest that this category is heterogeneous. We retrospectively studied a series of 136 patients affected by grade 3 (G3) gastroenteropancreatic (GEP) neuroendocrine carcinomas (NECs) with the aim to clarify the prognostic role of tumor morphological differentiation, proliferation, defect in mismatch repair proteins (MMRd), CD117 expression, and site of origin. The primary endpoint was the correlation between these parameters and the overall survival (OS). Univariable and multivariable Cox proportional hazards regression analyses were used to assess the prognostic significance of various clinical and histopathologic features. With a median follow-up of 81 months, the median OS was 12.9 months. At multivariate analysis, morphological differentiation, Ki67 index, MMRd, stage, and CD117 expression were independent prognostic markers in NECs. Three different prognostic categories of NECs were identified according to the degree of morphologic differentiation (well versus poorly-differentiated) and Ki67 index (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;55% vs. ≥55%). On this basis median OS was: 43.6 months in well-differentiated neoplasms with Ki67 index 20-55% (named Type A); 24.5 months in poorly-differentiated neoplasms with Ki67 index 20-55% (Type B); and 5.3 months (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) in poorly-differentiated neoplasms with Ki67 index ≥55% (Type C). The present study suggests that GEP NECs represent a heterogeneous group of neoplasms which can be better classified in different prognostic categories using both tumor morphology and Ki67 index.
Alimentary Pharmacology Therapeutics, Apr 1, 2003
Background: The majority of reflux patients have nonerosive reflux disease. Aim: To evaluate the ... more Background: The majority of reflux patients have nonerosive reflux disease. Aim: To evaluate the influence of Helicobacter pylori on oesophageal acid exposure in patients with both nonerosive and erosive reflux disease and in a group of controls. The pattern and distribution of chronic gastritis were also assessed. Methods: One hundred and twelve consecutive patients with symptoms of gastro-oesophageal reflux disease agreed to undergo both upper gastrointestinal endoscopy and 24-h oesophageal pH-metry. Patients were grouped as H. pylori-positive or H. pylori-negative on the basis of both CLO-test and histology, and as cases with or without oesophagitis on the basis of endoscopy. The controls consisted of 19 subjects without reflux symptoms and with normal endoscopy and oesophageal pHmetry. Results: H. pylori was positive in 35 patients (31%) and in six controls (31%); oesophagitis was found in 44 patients (39%) and non-erosive reflux disease in 68 (61%). The prevalence of chronic gastritis in the antrum and corpus was higher in H. pylori-positive than in H. pylori-negative patients (P < 0.001), but was more frequently mild (P < 0.001) than moderate or severe. The percentage total time the oesophageal pH < 4.0 was higher in patients than in controls (P < 0.008-0.001), but there was no difference between H. pyloripositive and H. pylori-negative patients (12.3% vs. 12%, P ¼ 0.43) or H. pylori-positive and H. pylori-negative controls (1.07% vs. 1.47%, P ¼ 0.19).
Journal of Gastrointestinal Oncology, Apr 1, 2014
Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related... more Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related death with squamous cell carcinoma (SCC) accounting for almost half of all esophageal cancers. Persistent human papilloma virus (HPV) infection has been suspected to play an active role in esophageal carcinogenesis but a clear association has not still been proven and no specific indications or guidelines for possible endoscopic and surgical therapeutic approaches to this clinical scenario are available. We report a case of a 62-year-old woman with histological diagnosis of high-grade intraepithelial squamous neoplasia of distal esophagus associated with cytological modifications resembling cervical HPV infection and with a positive INNO-LiPA assay for genotype 16 HPV. A single session of radiofrequency ablation (RFA) was performed on the dysplastic esophageal area with complete endoscopic eradication as confirmed by the following endoscopic, histologic and microbiologic examinations. Our report might give further strength to the hypothesis of an etiological role of HPV in selected cases of esophageal carcinogenesis and opens a discussion on the possible use of Radio Frequency Ablation as an effective and safe endoscopic treatment for both early squamous cell neoplasia and HPV esophageal colonization.
Jop Journal of the Pancreas, Sep 15, 2013
Context Curative (R0) resection is considered a prognostic key factor among patients undergoing s... more Context Curative (R0) resection is considered a prognostic key factor among patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). Although guidelines for the processing of PD specimens have been established, there is currently no widely accepted standard protocol, resulting in large variation of reported R1 and lymph-nodes rates; it ultimately precludes meaningful comprehension of clinicopathological correlation usually leading to therapeutic decisions. Objective Definition of a standardized pathway in processing of surgical specimens after pancreaticoduodenectomy (PD) for PDAC in a referral centre for pancreatic disease and evaluation of its impact on pathological analysis quality indexes. Methods Between January 2010 and May 2013 we performed 206 PD, of which 108 for PDAC; invasive IPMN (n=12) and neoadjuvant CT patients (n=8) were excluded. On overall 88 patients were then included in the present study: we realized a comparison between a control group of patients, treated between 2010 and 2011 (n=39), and a group composed by patients who underwent surgery between 2012 and 2013 (n=49), when a standardized pathway for specimen processing was defined: setting up of a selected group of dedicated pathologists, highly interactive with surgical team and guided by a senior pathologist acting as a tutor on specimen sampling; creation of a standard report form comprising all resection margins; frequent resampling of surgical specimens; external tutoring if necessary. Results R1% in the whole group of patients (n=88) was 34.1%; in the first group, however, it was 17.9%, while in the later it increased to 46.9% (P=0.004); the improving detection of margin infiltration is further highlighted by the R1% observed in the last months (Jan-May 2013), equal to 73.3%. Median number of lymph-nodes derived from surgical specimen was 15 (range: 1-31) in the first group, while in the second group it increased to 21 (range: 7-47)(P<0.001 at Wilcoxon test). In a similar way N1% increased from 64.1% to 83.7% (P=0.035) between first and second period. Inadequate node sampling (less than 12, according to AJCC/TNM) decreased from 23.1% (n=9) to 2.0% (n=1) (P=0.001). Conclusions As several authors suggested, R1% in PDAC surgery should be considered a pathological examination quality index, instead of a parameter regarding pure surgical technique; N1% and total lymph-node number hold a similar value. A structured pathway regarding specimen analysis, able to guarantee an high quality output, is an essential facility in a pancreatic surgery referral centre.
Anticancer research, 2015
to appraise the role of volumetric-modulated arc therapy (VMAT) in the neoadjuvant chemoradiother... more to appraise the role of volumetric-modulated arc therapy (VMAT) in the neoadjuvant chemoradiotherapy management of advanced medium and distal oesophageal cancer in terms of toxicity and response to treatment. Thirty patients were treated according to the neoadjuvant chemoradiation followed by surgery versus surgery-alone trial scheme with VMAT radiation therapy. Patients presented mainly T3-T4 stage (80%) and N1-2 (96.6%) disease. The chemotherapy scheme consisted of 3-5 cycles, while a radiotherapy course of 41.4 Gy in 23 fractions was administered to all patients. The median age of patients was 65 years, and there was a predominance of males (80%), smokers or ex-smokers (90%) and modest alcohol habit (80% negative). Primary tumor localisation was in the medium and distal third of the oesophagus in 57% of the cases, the rest being in the gastro-oesophageal junction. Modest toxicity profiles were observed, with limited incidence of grade 2-3 events. Partial or complete response was ...
Chirurgia italiana
We present a case of schwannoma of the neck in 49-year-old man, which was symptomatic for a long ... more We present a case of schwannoma of the neck in 49-year-old man, which was symptomatic for a long period: paraesthesia for one year, cervical mass for 2-3 months and dysphagia during the last 20 days. After ultrasonography and magnetic resonance the patient was operated on and complete excision of the mass was performed. The operation was performed via a cervical approach: the nerves and vascular and muscular structures were carefully isolated and then preserved. The tumour arose from the cervical sympathetic chain. The diagnosis of schwannoma was possible only at histopathological examination. After 24 months no local recurrence or postoperative complications related to the intervention were found. At present, however, the patient presents a moderate lowering of the voice, such as may be due to impairment of the superior laryngeal nerve, though this was already present preoperatively. These lesions are uncommon and most often occur as asymptomatic solitary neck masses. The preoperat...
The American Journal of Gastroenterology, 2005
BACKGROUND: Histology is generally considered as a tool of limited value in the diagnosis of gast... more BACKGROUND: Histology is generally considered as a tool of limited value in the diagnosis of gastro-esophageal reflux disease (GERD).
Journal of gastrointestinal and liver diseases : JGLD, 2012
Endoscopic submucosal dissection (ESD) is effective and safe for the removal of neoplastic lesion... more Endoscopic submucosal dissection (ESD) is effective and safe for the removal of neoplastic lesions in the general population, but its role in patients with cirrhosis is not clear. We evaluated data on feasibility and safety of ESD for gastric lesions in cirrhotic patients. A systematic review of the literature with pooled-data analysis was performed. Data of all consecutive cirrhotics who underwent ESD for gastric neoplastic lesions in a single centre were also reported. In reviewing the published literature, 68 ESD procedures for gastric neoplastic lesions have been performed in 61 cirrhotics, including 5 patients from our experience. En bloc removal and the R0 resection were successful in 88.2% and 89.7% of procedures, respectively. Post-ESD bleeding occurred in 8 (13.1%) patients, and perforation in 1 (1.6%). All patients were successfully managed by endoscopic treatment. No procedure-related death was observed. Patients with advanced cirrhosis, with either INR >1.33 and/or pl...
Journal of gastrointestinal oncology, 2014
Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related... more Esophageal cancer is the eight most common cancer worldwide and the sixth cause of cancer related death with squamous cell carcinoma (SCC) accounting for almost half of all esophageal cancers. Persistent human papilloma virus (HPV) infection has been suspected to play an active role in esophageal carcinogenesis but a clear association has not still been proven and no specific indications or guidelines for possible endoscopic and surgical therapeutic approaches to this clinical scenario are available. We report a case of a 62-year-old woman with histological diagnosis of high-grade intraepithelial squamous neoplasia of distal esophagus associated with cytological modifications resembling cervical HPV infection and with a positive INNO-LiPA assay for genotype 16 HPV. A single session of radiofrequency ablation (RFA) was performed on the dysplastic esophageal area with complete endoscopic eradication as confirmed by the following endoscopic, histologic and microbiologic examinations. O...
BioMed Research International, 2014
Introduction. Pancreatic surgery is challenging and associated with high morbidity, mainly repres... more Introduction. Pancreatic surgery is challenging and associated with high morbidity, mainly represented by postoperative pancreatic fistula (POPF) and its further consequences. Identification of risk factors for POPF is essential for proper postoperative management. Aim of the Study. Evaluation of the role of morphological and histological features of pancreatic stump, other than main pancreatic duct diameter and glandular texture, in POPF occurrence after pancreaticoduodenectomy. Patients and Methods. Between March 2011 and April 2013, we performed 145 consecutive pancreaticoduodenectomies. We intraoperatively recorded morphological features of pancreatic stump and collected data about postoperative morbidity. Our dedicated pathologist designed a score to quantify fibrosis and inflammation of pancreatic tissue. Results. Overall morbidity was 59,3%. Mortality was 4,1%. POPF rate was 28,3%, while clinically significant POPF were 15,8%. Male sex ( = 0.009), BMI ≥ 25 ( = 0.002), prolonged surgery ( = 0.001), soft pancreatic texture ( < 0.001), small pancreatic duct ( < 0.001), pancreatic duct decentralization on stump anteroposterior axis, especially if close to the posterior margin ( = 0.031), large stump area ( = 0.001), and extended stump mobilization ( = 0.001) were related to higher POPF rate. Our fibrosis-and-inflammation score is strongly associated with POPF ( = 0.001). Discussion and Conclusions. Pancreatic stump features evaluation, including histology, can help the surgeon in fitting postoperative management to patient individual risk after pancreaticoduodenectomy.
International Journal of Case Reports and Images, 2014
Virchows Archiv, 2009
Patients with non-erosive reflux disease may show microscopic damage. This study is aimed to desc... more Patients with non-erosive reflux disease may show microscopic damage. This study is aimed to describe distribution, sensitivity, and specificity of histological lesions (i.e., basal cell hyperplasia-BH, papillae elongation-PE, dilatation of intercellular spaces-DIS, intraepithelial eosinophils-IE, neutrophils, and erosions) and sampling criteria. Four groups were identified on the basis of symptoms, endoscopy, and pH monitoring: (1) erosive esophagitis (n=48), (2) non-erosive esophagitis with abnormal pH (n=59), (3) non-erosive esophagitis with normal pH (n=12), and (4) controls (n=20). Biopsies were taken at the Z-line and 2 and 4 cm above it. BH, PE, DIS, IE, neutrophils, and erosions were assessed. A global severity score was calculated on the basis of the above parameters and allowed the distinction of patients from controls with 80% sensitivity and 85% specificity. Lesions were more severe at Z-line than proximally and more expressed in erosive than in non-erosive disease, although more than 70% of latter patients still showed histological damage. Esophageal biopsy seems very attractive in non-erosive disease where it may contribute to diagnosis and play a role in the comparative evaluation of different therapies.
Journal of Crohn's and Colitis, 2011