[Show abstract][Hide abstract] ABSTRACT: Thyroid metastases are clinically rare, and usually occur in patients with a history of prior malignancy and when there are metastases elsewhere. Metastases of pancreatic carcinoma to the thyroid are extremely rare, with only three cases reported in the literature.
We report a patient who had a pancreatic carcinoma with metastasis to the thyroid as initial clinical presentation of the disease. A 63-year-old man with a history of weight loss and fatigue presented with cervical lymphadenopathies and a large nodule in the right lobe of the thyroid. A fine needle aspiration of the nodule gave inconclusive cytological results for the origin of the neoplastic cells. An ultrasound-guided core biopsy revealed the presence of a poorly differentiated adenocarcinoma infiltrating the thyroid with atrophic thyroid follicles. Immunohistochemical staining of the lesion was strongly positive for Cytokeratin 19 suggesting a pancreatic origin of the metastasis. A contrast CT scan demonstrated an enlargement of the pancreatic body, dilatation of the pancreatic duct, diffuse retroperitoneal, paraaortic and cervical lymphadenopathy and secondary lesions in the liver.
Metastases to the thyroid from pancreatic carcinoma are extremely rare. A core biopsy of the lesion excluded a thyroid carcinoma and permitted the diagnosis of the primary neoplasm.
[Show abstract][Hide abstract] ABSTRACT: We report a recently observed case of primary umbilical endometriosis (UE), with the main aim to discuss the management of this rare condition.
A 24-year-old woman complained of a painful nodule on her umbilical region, bleeding with her menstrual cycle. Ultrasonography showed a hypoechoic superficial mass in the umbilicus and no signs of intra-abdominal endometriosis. Excision of the nodule under local anesthesia was performed. Histopathological analysis confirmed the diagnosis of umbilical endometriosis. Neither symptoms nor signs of local recurrence have been observed after 24 months.
UE should be taken into account in differential diagnosis of umbilical disorders even in young nulliparous women with no typical symptoms of pelvic endometriosis. Although there is a substantial agreement about the necessity of surgery, treatment options are either local excision of the lesion or removal of the whole umbilicus with or without laparoscopic exploration of the peritoneal cavity. The decision should be tailored for the individual patient, taking into consideration the size of the lesion, the duration of symptoms and the presence of possible pelvic endometriosis.
Local excision saving the umbilicus may be the treatment of choice in patients with small UE lesions.
International journal of surgery case reports. 11/2013; 4(12):1145-1148.
[Show abstract][Hide abstract] ABSTRACT: Probiotics have proven to be useful in the treatment of a number of gastrointestinal diseases. Probiotics may compete directly with Helicobacter pylori, possibly by interference with adherence or by the production of antimicrobial molecules. Lactobacillus reuteri has been shown to inhibit H. pylori in vitro and in vivo, and theoretically may play a role in eradication therapy. The aim of this study was to examine the efficacy of L. reuteri in H. pylori eradication therapy. This was an open label single center study. H. pylori infection was defined as positive gastric histopathology and (13)C-UBT. Intervention consisted of L. reuteri (DSM 17938) 10(8) cfu plus pantoprazole 20 mg twice a day for 8 weeks. Eradication was defined as a negative (13)C-UBT, 4-6 weeks post therapy. Compliance was considered good if at least 90 % of the total number of the pills were taken. 21 of 22 subjects completed the study without protocol violation (mean age 52 years; 36 % men). L. reuteri plus pantoprazole twice a day cured 13.6 % (3/22; 95 % CI 2.9-34.9 %) of patients with H. pylori infection by ITT analysis and 14.2 % (3/21; 95 % CI 3.0-36 %) by PP analysis. Overall urease activity assessed before and 4-6 weeks post therapy showed a significant reduction with a difference of mean of 38.8 vs. 25.4 by one-tailed test (P = 0.002). In conclusion, L. reuteri may have a potential role in H. pylori eradication therapy if the cure rate can be improved by changes in dose, dosing interval, or duration of therapy.
Internal and Emergency Medicine 11/2013; · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Drug-induced damage to the gastrointestinal mucosa has been mainly focused on damage in the upper tract. However, increasing evidence suggests that commonly used drugs may also affect the mucosa of the lower gut, and particularly in the colon. The aim of this study was to report that fairly homogeneous colonoscopic findings, correlate with histological evidence of drug-induced mucosal injury. Charts of patients with the "cherry tree" colonoscopic aspect were reviewed to correlate the endoscopic and histological findings for a possible association with the use of drugs. Data from 29 patients (5 men, 24 women, age range 16-76 years) with the "cherry tree" colonoscopic findings were analyzed. Histology revealed an increase in eosinophils in the left colon in 23 patients, pseudomelanosis coli in 3, and microscopic colitis in 3. The findings were associated with proton pump inhibitors in 19 (65.5 %), non-steroidal anti-inflammatory drugs or statins (3 cases each), and other drugs [4 cases, including estroprogestinics (1), antidepressants (2), and thyroxin (1)]. The "cherry tree" colonoscopic appearance suggests drug-induced colonic damage. Awareness of this association may prevent unnecessary, expensive and time-consuming procedures.
Internal and Emergency Medicine 03/2013; · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: INTRODUCTION: In Northern Sardinia, one-week triple standard therapies containing a proton-pump inhibitor and two antibiotics for H. pylori infection have an average cure rate of 57% largely due to a high prevalence of antimicrobial resistance. The efficacy of miocamycin-containing treatment for 10 days was evaluated. MATERIALS AND METHODS: Patients referred to the endoscopy service for dyspeptic symptoms were enrolled. H. pylori infection was defined as a positive rapid urease test, presence of the bacteria on gastric biopsies, and a positive 13C-UBT. Treatment consisted of 10 days with omeprazole 20 mg, miocamycin water-soluble 900 mg, and tinidazole 500 mg all bid. Success was evaluated 40-50 days after the end of therapy and defined by a negative 13C-UBT. Compliance was considered good if at least 90% of the total number of the pills were taken. Fluorescent in situ hybridization (FISH) technique was applied on paraffin-embedded gastric tissue sections to test susceptibility to clarithromycin of the bacteria. RESULTS: 50 patients were enrolled (mean age; 52, 36% men). Miocamycin-containing therapy cured 86% (42/49; 95% CI = 72-94%) of infected patients by PP analysis. Susceptibility data (FISH) was available for 38 patients. Cure rates for the 28 with clarithromycin-susceptible infection was 96% vs 50% for those with resistant or mixed infection, (p = .003). Good compliance was recorded in 48 patients. None of the patients discontinued therapy. CONCLUSIONS: Miocamycin appears to be a valid alternative for clarithromycin for H. pylori eradication. Head-to-head studies will be needed to ascertain whether it is superior.
[Show abstract][Hide abstract] ABSTRACT: Celiac disease (CD) was first described by Aretaeus from Cappadocia in II century after C. The impressive clinical picture of a patient with life-threatening diarrhea, malabsorption, weight loss, neurologic disorders and osteopenia is now often replaced by the mostly atypical symptoms or an asymptomatic presentation. When unrecognized and untreated, the celiac disease is associated with increased mortality. In order to collect information on the clinical presentation of celiac disease in North Sardinia, Italy, data on 287 patients with biopsy examination-proven celiac disease were obtained. Women predominated (87%). Overall 78,2%, 53,2% and 44,7% of patients showed classical, subclinical/silent or atypical, and no gastrointestinal features of celiac disease, respectively. Anemia was the main mode of presentation, occurring in 53% of patients. Diarrhea was less frequent (41,5%), although never severe. In conclusion, in North Sardinia a significant proportion of patients with CD are seen more commonly with non-diarrheal presentations than those with diarrhea. To recognize atypical symptoms could be the most important step in the diagnosis and further treatment.
Recenti progressi in medicina 12/2012; 103(12):564-9.
[Show abstract][Hide abstract] ABSTRACT: Ductal carcinoma in situ (DCIS) is a subtype of breast cancer encountered increasingly in clinical practice because of the widespread use of screening mammography. In the present study, we evaluated the usefulness of breast-specific γ-camera (BSGC) scintigraphy in DCIS identification, describing the scintigraphic findings and their correlation with mammography and histologic subtype.
Thirty-three women, aged 41-81 y, with surgically proven DCIS were retrospectively reviewed. Before surgery, all patients underwent breast scintigraphy using a high-resolution semiconductor-based BSGC, starting 10 min after intravenous injection of 740 MBq of (99m)Tc-tetrofosmin. All patients had previously undergone mammography. A definitive histologic diagnosis was obtained in all cases after scintigraphy, and the scintigraphic findings were correlated with mammography and histologic subtype.
Mammography was positive in 30 of 33 patients (sensitivity, 90.9%), showing calcifications in 22 of 30 (73.3%), masses in 3 of 30 (10%), and masses plus calcifications in the remaining 5 of 30 (16.7%). Scintigraphy was positive in 31 of 33 patients (sensitivity, 93.9%), showing patchy irregular uptake in patients with calcifications and focal uptake in masses; sensitivity was higher in low- to intermediate-grade DCIS than in intermediate/high- and high-grade DCIS (100% vs. 91.3%), but the difference was not statistically significant. Two comedo-type DCIS (one 20-mm intermediate/high-grade and one 15-mm high-grade) with heterogeneously or highly dense breasts at mammography and one papillary low/intermediate-grade DCIS associated with Paget disease were true positive only at scintigraphy. Moreover, scintigraphy better assessed disease extent than did mammography in 5 additional patients. Two comedo-type DCIS (one 6-mm intermediate/high-grade and one 15-mm high-grade) were true positive only at mammography. The difference in sensitivity between scintigraphy and mammography was not statistically significant. The combined use of mammography and scintigraphy achieved 100% sensitivity.
BSGC scintigraphy proved to be a highly sensitive diagnostic tool in the detection of DCIS, irrespective of histologic subtype, and with a scintigraphic pattern of uptake that correlated well with mammography findings. In our series, BSGC scintigraphy demonstrated a slightly higher sensitivity than mammography and a better assessment of local disease extent. Thus, BSGC scintigraphy should represent a useful adjunctive tool in breast cancer diagnosis.
Journal of Nuclear Medicine 08/2012; 53(10):1528-33. · 5.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We investigated the clinical impact of breast scintigraphy acquired with a breast specific γ-camera (BSGC) in the diagnosis of breast cancer (BC) and assessed its incremental value over mammography (Mx). A consecutive series of 467 patients underwent BSGC scintigraphy for different indications: suspicious lesions on physical examination and/or on US/MRI negative at Mx (BI-RADS 1 or 3), characterization of lesions suspicious at Mx (BI-RADS 4), preoperative staging in lesions highly suggestive of malignancy at Mx (BI-RADS 5). Definitive histopathological findings were obtained in all cases after scintigraphy: 420/467 patients had BC, while 47/467 patients had benign lesions. The scintigraphic data were correlated to Mx BI-RADS category findings and to histology. The incremental value of scintigraphy over Mx was calculated. Scintigraphy was true-positive in 97.1% BC patients, detecting 96.2% of overall tumor foci, including 91.5% of carcinomas ≤10 mm, and it was true-negative in 85.1% of patients with benign lesions. Scintigraphy gave an additional value over Mx in 141/467 cases (30.2%). In particular, scintigraphy ascertained BC missed at Mx in 31 patients with BI-RADS 1 or 3, including 26 patients with heterogeneously/high dense breast (19/26 with tumors ≤10 mm) and detected additional clinically occult ipsilateral or controlateral tumor foci (all <10 mm) or the in situ component sited around invasive tumors in 77 BC patients with BI-RADS 4 or 5, changing surgical management in 18.2% of these cases; moreover, scintigraphy ruled out malignancy in 33 patients with BI-RADS 4. BSGC scintigraphy proved a highly sensitive diagnostic tool, even in small size carcinoma detection, while maintaining a high specificity. The procedure increased both the sensitivity of Mx, especially in dense breast and in multifocal/multicentric disease, and the specificity as well as it better defined local tumor extension, thus guiding the surgeon to a more appropriate surgical treatment.
International Journal of Oncology 05/2012; 41(2):483-9. · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ectopic thyroid tissue in ovarian teratoma or in struma ovarii appears to be histologically identical to the thyroid gland tissue and may virtually exhibit all the pathological patterns found in the thyroid gland. However, the concurrent lymphocytic infiltration of the thyroid gland, as found in Hashimoto's thyroiditis, and of the ectopic thyroid tissue is extremely rare. We describe the case of an 18-years old patient, in which a right ovarian 4 cm cyst has been found during pelvic ultrasound exam. The cyst was resected and microscopic examination of the mass revealed a mature cystic teratoma in which epidermal-like lining with skin adnexa, admixed with respiratory type epithelium, and areas of mature fatty, chondroid and dentigerous tissues were found. In a peripheral area of 0.7 cm × 0.5 cm, a prominent lymphocytic infiltrate surrounding thyroid follicles was identifiable. Thyroid function evaluation at different time points after surgery, revealed the development of mild hypothyroidism. Anti-TPO and anti-Tg autoantibodies were elevated, at fine needle aspiration biopsy a lymphocytic infiltrate, compatible with Hashimoto's thyroiditis, was present. We report here a rare case of Hashimoto's thyroiditis occurring both in the thyroid and in the ectopic thyroid tissue in the context of a benign cystic teratoma of the ovary.
[Show abstract][Hide abstract] ABSTRACT: Colorectal cancer is ranked the third most common cancer worldwide in terms of incidence and the second in terms of mortality. Recent advances in therapeutic approaches to colorectal cancer have identified a potential role of anti-epidermal growth factor receptor (EGFR) targeted therapies as adjuvant treatment in advanced disease. New evidences showed that patients harboring KRAS mutations on codons 12 and 13 are not responsive to anti-EGFR monoclonal antibodies. Therefore, new mutational screening tools have been proposed to select patients who will benefit from anti-EGFR targeted therapy, reducing inappropriate, expensive treatments and unwarranted side effects. We evaluated the performance of a reverse-hybridization-based assay in the identification of the most frequent KRAS mutations on a series of 50 formalin-fixed, paraffin-embedded, advanced colorectal cancer specimens, in comparison with the direct gene sequencing technique. Thirty-two of the 50 cases (64%) showed KRAS single point mutations by reverse-hybridization technique. In particular, 93.8% of the mutations were reported on codon 12, whereas 6.2% of the mutations were reported on codon 13. Direct gene sequencing showed KRAS mutations on 28 of the 50 cases (56%) with 96.4% of the mutations on codon 12 and 3.6% on codon 13. Concordance between the assays was observed in 92% of the cases. Both reverse hybridization and gene sequencing methods have been shown to be suitable tests in detecting KRAS mutations from formalin-fixed, paraffin-embedded tumor specimens. In our experience, reverse-hybridization technique has been shown to be an effective and more sensitive assay for the identification of the most common KRAS mutations.
Diagnostic molecular pathology: the American journal of surgical pathology, part B 11/2010; 19(4):201-8. · 2.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The clinical evaluation of patients with chronic diarrhea and/or abdominal pain requires a complex work-up. The aim of the study was to evaluate whether routine duodenal biopsy sampling of macroscopically normal mucosa of patients with irritable bowel syndrome-like symptoms undergoing upper endoscopy assists in diagnosis and management.
Consecutive adults scheduled for upper endoscopy for evaluation of uninvestigated dyspepsia and abdominal pain and/or chronic diarrhea based upon the history, were enrolled. Gastric biopsies and 3 duodenal biopsies were taken for histological evaluation.
A total of 786 sets of biopsies from 262 consecutive patients (200 females and 62 males, mean age 46 years; range: 15-82), were analyzed. Microscopic damage was observed in 212 of 262 patients (81%) with normal mucosa. Mild to moderate and severe duodenitis or villi atrophy was histologically confirmed in 65%, 26% and 8% of 212 patients respectively. The negative predictive value of a normal appearing duodenal mucosa was 19%. Additional tests confirmed celiac disease in 12 patients. Lactose malabsorption was present in 42%, bacterial overgrowth in 14%, and H. pylori infection in 28%. Colonoscopy performed in 92 patients revealed non specific colitis (25%), microscopic colitis (28%), Crohn's disease (1%), and diverticulosis (15%).
Duodenal biopsies revealed abnormalities in the majority of adults with chronic diarrhea and/or abdominal pain despite macroscopically normal gross findings. These results suggest that duodenal biopsies could be helpful in patients with chronic diarrhea and/or abdominal pain for the following work up.
[Show abstract][Hide abstract] ABSTRACT: Planar scintimammography (SM) acquired with a conventional gamma camera has proved a useful complementary tool to mammography (Mx) in breast cancer (BC) diagnosis, but with unsatisfactory sensitivity in small size carcinomas. In this study we assessed the role of planar SM with a high-resolution dedicated breast camera (DBC) in BC diagnosis, comparing the results with those of Mx.A consecutive series of 145 patients scheduled for biopsy for suspected BC underwent Tc-99m tetrofosmin planar SM using a newly developed DBC. Scintigraphic data were compared with Mx findings and correlated to histology.Histopathologic analysis revealed 165 lesions: 143 malignant and 22 benign. SM detected 139/143 carcinomas (overall sensitivity: 97.2%) and was true negative in 19/22 benign lesions (overall specificity: 86.4%). SM sensitivity was 91% in < or =10-mm carcinomas. SM was more accurate than Mx in 42/145 cases (29%), detecting cancer in 9 patients with Mx indeterminate for dense breasts (8/9 tumors were <10 mm), assessing additional tumor foci (all <10 mm) in 5 points with multifocal disease and correctly classifying 28 patients with inconclusive mammographic findings as affected by cancer or by benign disease. Mx was more accurate than SM in 3 patients, in each detecting 1 subcentimeter BC false negative on SM.DBC planar SM seems a highly sensitive diagnostic tool in the detection of BC, even when small in size, and in the assessment of multifocal disease. A wider employment of this procedure is thus suggested, especially in indeterminate or inconclusive mammographic findings to improve sensitivity and specificity of Mx.
Clinical nuclear medicine 11/2008; 33(11):739-42. · 3.92 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: AIM: We evaluated the usefulness of planar scintimammography (SM) with a high resolution dedicated breast camera (DBC) in comparison with single photon emission computed tomography (SPECT)/computed tomography (CT) in primary breast cancer detection. METHODS: A consecutive series of 157 patients with breast lesions suspicious for cancer at conventional diagnostic procedures were studied with both DBC planar SM and SPECT/CT using [(99M)Tc]tetrofosmin as radiotracer. Scintigraphic data have been related with definitive histopathological findings in all cases. RESULTS: Breast cancer was ascertained in 127/157 patients and benign disease in the remaining 30 cases, with a total of 140 carcinomas and 33 benign lesions. DBC planar SM detected 95.7% of overall carcinomas, while SPECT/CT 90.7% (P<0.01). In =/<10 mm carcinomas, sensitivity was 89.1% for DBC planar SM and 78.3% for SPECT/CT (P<0.05); in carcinomas>10 mm the corresponding values were 98.9% and 96.8%, respectively. Specificity value was 87.9% for both procedures; accuracy value was 94.2% for DBC and 90.2% for SPECT/CT (P<0.01). Forty-six out of 127 breast cancer patients had axillary lymph node metastases; SPECT/CT was positive in 36/46 (78.3%) cases and showed a 96.4% specificity value. DBC planar SM identified metastases in only 4 cases. CONCLUSION: DBC planar SM proved a useful diagnostic method in primary breast cancer detection, showing significantly higher sensitivity and accuracy values than SPECT/CT, especially in small size carcinomas. Thus, DBC planar SM should be preferred, although SPECT/CT, given its high performance, could represent a useful alternative when DBC is not available. Moreover, SPECT/CT, but not DBC, can contribute to providing information on axillary lymph node status.
The quarterly journal of nuclear medicine and molecular imaging: official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of... 08/2008; · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Conventional imaging procedures have proved of limited value in assessing tumor response to neoadjuvant chemotherapy in locally advanced primary breast cancer (LAPBC). We evaluated the usefulness of radioisotopic procedures comparing planar scintimammography (SM) to SPECT, monitoring pre-surgery neoadjuvant chemo- or hormonotherapy response in 32 LAPBC patients. In all cases, 99mTc-tetrofosmin conventional planar SM and SPECT were acquired by dual-head gamma camera with HR parallel hole collimators. In 15 cases, planar SM with small field of view high resolution dedicated breast camera (DBC) was also acquired. Scintigraphic data always correlated with histopathological findings. At surgery, 4/32 patients had pathological complete remission (pCR), while 28/32 patients had residual tumors. Both conventional planar SM and SPECT were true negative in 4/4 (100%) pCR patients, as was DBC in the only studied case. Conventional planar SM and SPECT detected residual tumors in 23/28 (82%) and in 25/28 (89.2%) cases, respectively. Both procedures missed 2 multifocal, scattered microscopic residues, only evidenced at DBC. Conventional planar SM also missed 3 further macroscopic residues (15-20 mm), while SPECT only one of these, a mucinous BC, in which DBC was not performed. DBC correctly classified all other 12 patients in whom the procedure was performed. Both conventional planar SM and SPECT proved useful diagnostic tools in monitoring neoadjuvant chemo/hormono therapy response in LAPBC with SPECT appearing more sensitive; however, our data, although in a limited number of cases, suggest that sensitivity can further be increased using high resolution DBC, especially in detecting microscopic residual tumor foci.
International Journal of Oncology 07/2008; 32(6):1275-83. · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare preoperative planar scintimammography (SM) with high resolution dedicated breast camera (DBC) and conventional mammography in the detection of multifocal, multicentric and bilateral breast cancer and its impact on surgical planning.
A series of 264 consecutive patients, 232 with breast cancer and 32 with benign lesions, underwent [(99m)Tc]tetrofosmin planar SM with a newly developed DBC (LumaGEM 3200S/12K, Gamma Medica-Ideas Inc.). Scintigraphic with mammography data were compared and correlated with histopathological findings.
At surgery, ipsilateral multifocal or multicentric breast cancer in 40 patients, invasive in 24 cases (group 1) and in situ in 16 (group 2) was ascertained, and synchronous bilateral breast cancer in 4 patients (group 3). Globally, SM was positive for cancer in 41 out of the 44 breast cancer patients (93.2%) and mammography was positive in 40 out of 44 (90.1%). SM revealed multifocal/multicentric disease in 87.5% of group 1/goup 2 patients and mammography in 47.5% (P<0.0005): SM detected a significantly higher number of additional invasive foci than mammography (89.6% vs 37.9%, P<0.0005); only SM revealed ipsilateral multifocality/multicentricity in 35% of cases. Bilaterality was detected by SM in 100% of group 3 patients and by mammography in 75%. Overall specificity was 88.2% for SM and 52.9% for mammography. SM correctly changed surgical management in 16% of cases.
DBC planar SM proved a more highly sensitive diagnostic method than mammography in the preoperative assessment of both ipsilateral multifocal/multicentric breast cancer and synchronous bilateral breast cancer. The procedure contributed to correctly changing patient surgical management in some cases, suggesting its wider use complementary to mammography.
The quarterly journal of nuclear medicine and molecular imaging: official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society of... 04/2008; 53(2):133-43. · 1.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background The chromosome 9p21 and its CDKN locus, with the p16 tumour suppressor gene ( CDKN2A ), are recognized as the genomic regions involved in the pathogenesis of melanoma.
Objectives To elucidate further the role of such regions during the different phases of melanocytic tumorigenesis.
Methods Tissue sections from naevi, primary and metastatic melanomas were investigated by fluorescence in situ hybridization for allelic loss at the 9p21 chromosome and by immunochemistry for p16CDKN2A expression.
Results Dysplastic naevi and primary or secondary melanomas were found to carry hemizygous deletions within the entire 9p21 region at similar frequencies (varying from 55% to 62%). Allelic deletion spanning the CDKN locus was observed at significantly increased rates moving from early (7%) to advanced (28%) primary melanomas and to secondary melanoma lesions (37%) ( P = 0·018). Also, inactivation of the p16 gene ( CDKN2A ) was absent in naevi and present at steadily increasing rates moving from primary melanomas (7% early lesions to 17% advanced lesions) to melanoma metastases (62%) ( P = 0·004).
Conclusions Our findings indicate that, in a model of sequential accumulation of genetic alterations, 9p21 deletions may play a role in melanocytic transformation and tumour initiation whereas rearrangements at the CDKN locus, and p16 gene ( CDKN2A ) inactivation may contribute to tumour progression.
British Journal of Dermatology 03/2008; · 4.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We evaluated the usefulness of (99m)Tc-tetrofosmin planar scintigraphy acquired with a high-resolution (HR) dedicated breast camera in comparison with conventional single-photon emission computed tomography (SPECT) and pinhole-SPECT (P-SPECT) in breast cancer (BC) axillary lymph node metastasis detection in a consecutive series of 76 BC patients, 28 of whom had axillary lymph node metastases, including 9 positive at clinical examination. HR planar scintigraphy was true positive in only 7 patients with >3 palpable metastases (sensitivity: 25%), while SPECT was true positive in 23 of 28 cases (sensitivity: 82.1%) and P-SPECT in 25 of 28 (sensitivity: 89.3%). SPECT was false negative in 5 patients with nonpalpable <or= 3 nodes, including 2 with one micrometastatic node, while P-SPECT was false negative in the latter 2 cases, and in another of the cases, false negative at SPECT with one macrometastatic node. Neither planar nor SPECT had false-positive findings (specificity: 100%), while P-SPECT had two (specificity: 95.8%). P-SPECT presented the best resolution in showing the metastatic nodes and was the only procedure able to define the number of involved nodes, thus delivering important prognostic information. HR planar scintigraphy appears an ineffective diagnostic tool in BC axillary lymph node metastasis detection, only succeeding in identifying palpable and >3 metastatic nodes. SPECT should be preferred, significantly improving the sensitivity of planar scintigraphy, especially when using a pinhole collimator.
Cancer Biotherapy and Radiopharmaceuticals 01/2008; 22(6):799-811. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to assess the usefulness of planar scintimammography (SM) with a high-resolution dedicated breast camera (DBC) compared to SPECT in unifocal and multifocal/multicentric primary breast cancer (BC) detection. DBC planar SM and conventional SPECT were acquired using 99mTc-tetrofosmin as radiotracer in 85 consecutive patients suspect for BC at conventional imaging and clinical examination. Scintigraphic data were related to histology in all cases. BC was proven in 74/85 patients, unifocal in 56/74 cases and multifocal/multicentric in 18/74; 90 carcinomas were ascertained. Benign lesions were found in 12 cases, including one who also had BC in the contralateral breast. DBC planar SM and SPECT were true-positive in 72/74 and in 70/74 BC patients, respectively, and globally detected 96.7% and 92.2% of carcinomas. DBC and SPECT sensitivity were, respectively, 90.3% and 80.6% in <or=10-mm carcinomas and 100% and 98.3% in larger ones; sensitivity values in non-palpable carcinomas were 92.6% and 77.8%, respectively, and 98% for both procedures in palpable ones. DBC planar SM and SPECT correctly assessed multifocality/multicentricity in 91.7% and 83.3% of cases, respectively. Sensitivity differences were not significant. Both procedures showed only a false-positive result. DBC planar SM and SPECT proved highly sensitive and specific in BC detection, representing a useful complementary tool to mammography. However, DBC planar SM showed technical advantages and better clinical performance than SPECT in both subcentrimetric carcinoma detection and multifocal/multicentric disease assessment. Thus, DBC planar SM should be preferred, but SPECT remains a useful alternative when DBC is unavailable.
International Journal of Oncology 08/2007; 31(2):369-77. · 2.77 Impact Factor