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Biliary tree gastrinomas in multiple endocrine neoplasia type 1 syndrome

World Journal of Gastroenterology 2013年第45期19卷 8312-8320页

作者： Francesco Tonelli Francesco Giudici gabriella nesi Giacomo Batignani Maria Luisa Brandi Department of Surgery and Translational Medicine University of Florence50014 Florence Italy

AIM:To describe our patients affected with ectopic biliary tree gastrinoma and review the literature on this ***:Between January 1992 and June 2012,28 patients affected by duodenopancreatic endocrine tumors in multiple endocrine neoplasia type 1(MEN1)syndrome underwent surgery at our *** retrospective review article analyzes our experience regarding seventeen of these patients subjected to duodenopancreatic surgery for Zollinger-Ellison syndrome(ZES).Surgical treatment consisted of duodenopancreatectomy(DP)or total pancreatectomy(TP).Regional lymphadenectomy was always *** hepatic tumoral lesions found were removed during *** MEN1 patients,removal of duodenal lesions can sometimes lead to persistence or recurrence of *** possible explanation for this unfavorable outcome could be unrecognized ectopic localization of gastrin-secreting *** study described three cases among the seventeen patients who were found to have an ectopic gastrinoma located in the biliary ***:Seventeen MEN1 patients affected with ZES were *** mean age was 40 *** patients underwent DP and two *** histopathological examination,duodeno pancreatic endocrine tumors were found in all 17 ***-one gastrinomas were detected in the first three portions of the *** one gastrinoma was found in the *** mean number of gastrinomas per patient was 5(range 1-16).Malignancy was established in 12 patients(70.5%)after lymph node,liver and omental metastases were *** patients exhibited biliary tree gastrinomas as well as duodenal gastrinoma(s).In two cases,the ectopic gastrinoma was removed at the same time as pancreatic surgery,while in the third case,the biliary tree gastrinoma was resected one year after DP because of recurrence of ***:These findings suggest the importance of checking for the presence of ectopic gastrinomas in the biliary tree in MEN1 patients undergoing Z

关键词： Gastrinoma Multiple endocrine neoplasia type 1 Zollinger-Ellison Syndrome Ectopic gastrinoma Biliary tree Duodenopancreatectomy

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Genomic and genetic alterations influence the progression of gastric cancer

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World Journal of Gastroenterology 2011年第3期17卷 290-299页

作者： Stefania Nobili Lorenzo Bruno Ida Landini Cristina Napoli Paolo Bechi Francesco Tonelli Carlos A Rubio Enrico Mini gabriella nesi Department of Preclinical and Clinical Pharmacology University of Florence Department of Critical Care Medicine and Surgery University of Florence Department of Clinical Physiopathology University of Florence Department of Pathology Karolinska Institute and University Hospital Division of Pathological Anatomy Department of Critical Care Medicine and SurgeryUniversity of Florence

Gastric cancer is one of the leading causes of cancerrelated deaths worldwide, although the incidence has gradually decreased in many Western countries. Two main gastric cancer histotypes, intestinal and diffuse, are recognised. Although most of the described genetic alterations have been observed in both types, different genetic pathways have been hypothesized. Genetic and epigenetic events, including 1q loss of heterozygosity (LOH), microsatellite instability and hypermethylation, have mostly been reported in intestinal-type gastric carcinoma and its precursor lesions, whereas 17p LOH, mutation or loss of E-cadherin are more often implicated in the development of diffuse-type gastric *** this review, we summarize the sometimes contradictory findings regarding those markers which influence the progression of gastric adenocarcinoma.

关键词： Gastric cancer Gene alterations Prognosis Molecular pathology

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Epithelial turnover in duodenal familial adenomatous polyposis: A possible role for estrogen receptors?

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World Journal of Gastroenterology 2016年第11期22卷 3202-3211页

作者： Alfredo Di Leo gabriella nesi Mariabeatrice Principi Domenico Piscitelli Bruna Girardi Maria Pricci Giuseppe Losurdo Andrea Iannone Enzo Ierardi Francesco Tonelli Gastroenterology Section Department of Emergency and Organ TransplantationUniversity of Bari Pathology Section Department of Surgery and Translational MedicineUniversity of Florence Pathology Section Department of Emergency and Organ TransplantationUniversity of Bari General Surgery Section Department of Surgery and Translational MedicineUniversity of Florence

AIM: To investigate estrogen receptors expression in duodenal familial adenomatous polyposis (FAP) and any relationship with epithelial proliferation/apoptosis ***: Twenty-two patients affected by FAP undergoing duodenal resection for malignancies were recruited. Controls were 15 healthy subjects undergoing endoscopy for dyspeptic symptoms. ER-α, ER-α, Ki-67, TUNEL and caspase 3 expression (labeling index: percentage of positive cells) were evaluated by immunohistochemistry or immunofluorescence and examined by light or confocal microscopy. Samples were assigned to four groups: normal tissue, low (LGD) and high-grade dysplasia (HGD), adenocarcinoma (AC). One-way analysis of variance, corrected by Bonferroni’s test, and Pearson’s correlation test were applied for statistical ***: ER-beta showed a progressive decline: normal tissue (23.5 ± 4.9), LGD (21.1 ± 4.8), HGD (9.3 ± 3.5), AC (7.1 ± 3.1). The normal tissue of FAP subjects expressed ER-beta like the controls (23.9 ± 6.2). Conversely, ER-α showed a progressive increase from normal tissue (24.8 ± 5.6) to AC (52.0 ± 8.2); the expression in normal tissue was similar to controls (22.5 ± 5.3). Ki67 demonstrated a statistically significant progressive increase at each disease stage up to AC. TUNEL did not reveal differences between controls and normal tissue of FAP subjects, but progressive decreases were observed in LGD, through HGD to AC. Pearson’s correlation test showed a direct relationship between ER-β and TUNEL LI (r = 0.8088, P < 0.0001). Conversely, ER-α was inversely correlated with TUNEL LI (r = - 0.7257, P < 0.0001). The co-expression of ER-β and caspase 3 declined progressively from normal to neoplastic ***: This study confirmed that ER-β is strongly decreased in duodenal FAP carcinomas, declining in a multiple

关键词： Familial adenomatous polyposis Duodenal cancer Estrogen receptors Immunohistochemistry Confocal microscopy Dysplasia

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Peripancreatic paraganglioma:Lesson from a round table

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World Journal of Gastroenterology 2022年第21期28卷 2396-2402页

作者： Federica Petrelli Geri Fratini Andrea Sbrozzi-Vanni Andrea Giusti Raffele Manta Claudio Vignali gabriella nesi Andrea Amorosi Andrea Cavazzana Marco Arganini Maria Raffaella Ambrosio Pathology Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Surgery Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Endoscopic Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Endoscopic Unit Santa Maria Misericordia HospitalPerugia 06122Italy Interventional Radiology Unit Azienda Sanitaria Toscana Nord OvestPisa 56121Italy Department of Health Sciences University of FlorenceFlorence 50139Italy Pathology Unit UniversitàMagna GraeciaCatanzaro 88100Italy

We described the case of a peripancreatic paraganglioma(PGL)misdiagnosed as pancreatic *** exploration revealed an unremarkable pancreas and a large well-defined cystic mass originating at the mesocolon *** enucleation of the mass was performed,preserving the pancreatic ***,a diagnosis of PGL was ***,two previously unreported mutations,one affecting the KDR gene in exon 7 and another on the JAK3 gene in exon 4 were *** mutations are known to be *** and cytologic findings were blindly reviewed by an expert panel of clinicians,radiologists,and pathologists to identify possible causes of the *** major issue was lack of evidence of a cleavage plane from the pancreas at imaging,which prompted radiologists to establish an intraparenchymal *** blinded revision shifted the diagnosis towards an extrapancreatic lesion,as the pancreatic parenchyma showed no structural alterations and no dislocation of the Wirsung *** post,the identified biases were the emergency setting of the radiologic examination and the very thin mesocolon sheet,which hindered clear definition of the lesion *** endoscopic ultrasonography diagnosis was confirmed,emphasizing the intrinsic limit of this technique in detecting large ***,pathologic review favored a diagnosis of PGL due to the morphological features and immonohistochemical *** months after tumor excision,the patient is asymptomatic with no disease relapse evident by either radiology or laboratory *** report strongly highlights the difficulties in rendering an accurate preoperative diagnosis of PGL.

关键词： Peripancreatic paraganglioma Pancreatic neuroendocrine tumor Solid pseudopapillary neoplasm S100 Succinate dehydrogenase subunit B gene and expression Fine needle biopsy

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A New Early Gastric Cancer after Subtotal Gastric Resection for Early Cancer: Case Report and Review of the Literature

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Journal of Cancer Therapy 2014年第14期5卷 1450-1453页

作者： Lorenzo Bruno Lucia Barni gabriella nesi Sabrina Pacciani Gaia Masini Filippo Melli Gherardo Maltinti Tiku Zalla Lorenzo Dioscoridi Antonio Taddei Giancarlo Freschi Paolo Bechi Department of Surgery and Translational Medicine University of Florence Florence Italy Division of Pathological Anatomy Department of Surgery and Translational Medicine University of Florence Florence Italy

Although the prognosis of early gastric cancer (EGC) is considered to be satisfactory, some patients experience tumor relapse after curative surgery. Both pathogenesis and risk factors of recurrence remain unclear. We describe a case report of a 49-year-old male who underwent subtotal gastric resection D2A for angular gastric cancer. Histological examination revealed gastric adenocarcinoma with low grade of differentiation and colloid areas, intramucosal, and absence of neoplastic proliferation in the surgical margins, in omental stroma and in the six examined lymph nodes (pT1, pN0). 11 years later, the same patient underwent D2 total gastrectomy for gastric cancer in the remnant stomach. New histological examination revealed again gastric adenocarcinoma, intramucosal, medium degree of differentiation, no documentable neoplastic proliferation within the limits of surgical resection, in the thirty-three examined lymph nodes and in the omentum (pT1, pN0).

关键词： Early Gastric Cancer Remnant Gastric Cancer Long Term Follow-Up

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