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Vannelli A.,Unit of Surgical Oncology | Poiasina E.,Azienda Ospedaliera Papa Giovanni XXIII | Battaglia L.,Unit of Colo rectal Surgery
European Review for Medical and Pharmacological Sciences

OBJECTIVE: Current trends in the management of rectal cancer, identify accurate local assessment of positive lymph nodes (LN), as the strongest predictor for stratifying patients who would benefit from preoperative therapy. We a present retrospective analysis of a prospective data collection, to determine the clinical concordance between the suspicious LN at the pre-operative EUS (uN) and a post-operative EUS detection (pN). PATIENTS AND METHODS: From March 2009 to March 2011, 31 patients with suspicious LNs at EUS (uN positive) were enrolled. The surgeon performed pre-operative EUS and directly in the operating room, an ex vivo EUS of the specimen. The immediate mesorectal LN sampling by the surgeon was delivered to the pathologist. Endosonographic staging was compared to postoperative pathological staging. RESULTS: Preoperative EUS identified 67 suspicious LN. The LN medium size was 6.8 mm. We repeated the EUS after surgery. The pathologist found 41 positive LN. The definitive LN medium size was 6.3 mm. Eleven LN presented the same size between ultrasound and pathological examination, 11 LN a smaller size and 41 a bigger size, the remnants 4 were not discovered. EUS LN staging presented 83.9% in overstaging and 3.2% in understaging. Although endo ultrasonography (EUS) is a very effective method for assessing LN metastasis, this is still a difficult challenge. Inaccurate assessment of LNs can conceivably lead to either under-staging or overstaging. The present study indicates that the clinical concordance between the suspected metastatic LN at the pre-operative EUS (uN) and a post-operative (ex-vivo) ultrasound LN detection, is moderate. CONCLUSIONS: We should re-consider all this strategy: we need to switch from morphological information to biological behavior. Source

Panzacchi R.,University of Bologna | Gallo C.,University of Bologna | Fois F.,Unit of Pneumology | Dalpiaz G.,Unit of Radiology | And 3 more authors.

Sarcoidosis is a systemic granulomatous disease of unknown aetiology. The breast is involved in less than 1% of cases. Breast can be either a primary or a secondary site of presentation. Breast sarcoidosis often mimics carcinomas at clinical examination. We report a case of breast sarcoidosis detected during screening mammography in a 57-year-old woman. The lesion presented as a 1.4 cm nodule located in the right breast. On histology, it was characterized by non-caseating giant cell granulomas. Differential diagnoses included idiopathic granulomatous mastitis, tuberculosis, fungal infection, cat-scratch disease and sarcoid-like reactions to cancer. Further clinical and laboratory investigations were consistent with a diagnosis of sarcoidosis. Specifically, serum levels of angiotensin-converting enzyme (ACE) were elevated and a CT scan showed small bilateral pulmonary nodules distributed along the pleura and bronchovascular bundles (perilymphatic pattern), as well as enlarged bilateral hilar and mediastinal lymph nodes. The patient received corticosteroid treatment, and is presently asymptomatic. Breast involvement by sarcoidosis, although rare, should be considered when dealing with granulomatous lesions of the breast. Source

Marchio S.,University of Turin | Marchio S.,Institute for Cancer Research at Candiolo IRCC | Marchio S.,APAvadis Biotechnologies srl | Soster M.,University of Turin | And 25 more authors.
EMBO Molecular Medicine

Homing of colorectal cancer (CRC) cells to the liver is a non-random process driven by a crosstalk between tumour cells and components of the host tissue. Here we report the isolation of a liver metastasis-specific peptide ligand (CGIYRLRSC) that binds a complex of E-cadherin and α6 integrin on the surface of CRC cells. We identify angiopoietin-like 6 protein as a peptide-mimicked natural ligand enriched in hepatic blood vessels of CRC patients. We demonstrate that an interaction between hepatic angiopoietin-like 6 and tumoural α6 integrin/E-cadherin drives liver homing and colonization by CRC cells, and that CGIYRLRSC inhibits liver metastasis through interference with this ligand/receptor system. Our results indicate a mechanism for metastasis whereby a soluble factor accumulated in normal vessels functions as a specific ligand for circulating cancer cells. Consistently, we show that high amounts of coexpressed α6 integrin and E-cadherin in primary tumours represent a poor prognostic factor for patients with advanced CRC. © 2012 The Authors. Source

Guerrieri M.,Marche Polytechnic University | Campagnacci R.,Marche Polytechnic University | De Sanctis A.,Marche Polytechnic University | Lezoche G.,Marche Polytechnic University | And 6 more authors.
Surgery Today

Background and Purpose There is still debate about the practicality of performing laparoscopic colectomy instead of open colectomy for patients with curable cancer, although laparoscopic surgery is now being performed even for patients with advanced colon cancer. We compared the long-term results of laparoscopic versus open colectomy for TNM stage III carcinoma of the colon in a large series of patients followed up for at least 3 years. Methods The subjects of this prospective non-randomized multicentric study were 290 consecutive patients, who underwent open surgery (OS group; n = 164) or laparoscopic surgery (LS group; n = 126) between 1994 and 2005, at one of the four surgical centers. The same surgical techniques were used for the laparoscopic and open approaches to right and left colectomy. The distribution of TNM substages (III A, III B, IIIC) as well as the grading of carcinomas (G1, G2, G3) were similar in each arm of the study. The median follow-up periods were 76.9 and 58.0 months after OS and LS, respectively. Results There were 10 (6.1 %) versus 9 (7.1 %) deaths unrelated to cancer, 15 (9.1 %) versus 5 (4 %) cases of local recurrence, 7 (4.2 %) versus 5 (4 %) cases of peritoneal carcinosis, and 37 (22.5 %) versus 14 (11.1 %) cases of metastases in the OS and LS groups, respectively. There was also one case of port-site recurrence after LS (0.8 %). The OS group had a significantly higher probability of local recurrence and metastases (P < 0.001) with a significant higher probability of cancer-related death (p = 0.001) than the LS group. Conclusions These findings support that LS is safe and effective for advanced carcinoma of the colon. Although the LS group in this study had a significantly better longterm outcome than the OS group, further investigations are needed to draw a definitive conclusion. © Springer 2012. Source

Cirocchi R.,University of Perugia | Farinella E.,Imperial College London | Trastulli S.,University of Perugia | Cavaliere D.,Unit of Surgical Oncology | And 9 more authors.
World Journal of Surgical Oncology

Primitive Gastrointestinal Lymphomas (PGIL) are uncommon tumours, although time-trend analyses have demonstrated an increase. The role of surgery in the management of lymphoproliferative diseases has changed over the past 40 years. Nowadays their management is centred on systemic treatments as chemo-/radio- therapy. Surgery is restricted to very selected indications, always discussed in a multidisciplinary setting. The aim of this systematic review is to evaluate the actual role of surgery in the treatment of PGIL.A systematic review of literature was conducted according to the recommendations of The Cochrane Collaboration. Main outcomes analysed were overall survival (OS) and disease free survival (DFS).There are currently 1 RCT and 4 non-randomised prospective controlled studies comparing surgical versus medical treatment for PGIL. Seven hundred and one patients were analysed, divided into two groups: 318 who underwent to surgery alone or associated with chemotherapy and/or radiotherapy (surgical group) versus 383 who were treated with chemotherapy and/or radiotherapy (medical group).Despite the OS at 10 years between surgical and medical groups did not show relevant differences, the DFS was significantly better in the medical group (P = 0.00001). Accordingly a trend was noticed in the recurrence rate, which was lower in the medical group (6.06 vs. 8.57%); and an higher mortality was revealed in the surgical group (4.51% vs. 1.50%).The chemotherapy confirms its primary role in the management of PGIL as part of systemic treatment in the medical group. Surgery remains the treatment of choice in case of PGIL acutely complicated, although there is no evidence in literature regarding the utility of preventive surgery. © 2011 Cirocchi et al; licensee BioMed Central Ltd. Source

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