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Impact of tumour rupture risk on the oncological rationale for the surgical treatment choice of gastrointestinal stromal tumours

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1559-1563页

作者： Nadia Peparini azienda sanitaria locale roma 6 CiampinoRome 00043Italy

Tumour rupture of gastrointestinal stromal tumours(GISTs)has been considered to be a remarkable risk factor because of its unfavourable impact on the oncological *** tumour rupture has not yet been included in the current tumor-node-metastasis classification of GISTs as a prognostic factor,it may change the natural history of a low-risk GIST to a high-risk ***,tumour rupture was defined as the spillage or fracture of a tumour into a body cavity,but recently,new definitions have been *** definitions distinguished from the prognostic point of view between the major defects of tumour integrity,which are considered tumour rupture,and the minor defects of tumour integrity,which are not considered tumour ***,it has been demonstrated that the risk of disease recurrence in R1 patients is largely modulated by the presence of tumour ***,after excluding tumour rupture,R1 may not be an unfavourable prognostic factor for ***,after the standard adjuvant treatment of imatinib for GIST with rupture,a high recurrence rate *** review highlights the prognostic value of tumour rupture in GISTs and emphasizes the need to carefully take into account and minimize the risk of tumour rupture when choosing surgical strategies for GISTs.

关键词： Gastrointestinal stromal tumours Tumour rupture Residual tumour Resection margin Prognostic factors Surgical treatment

The "meso" of the rectum and the "meso" of the pancreas: similar terms but distinct concepts in surgical oncology

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hepatobiliary & Pancreatic Diseases International 2015年第5期14卷 548-551页

作者： Nadia Peparini Roberto Caronna Piero Chirletti azienda sanitaria locale roma h-distretto 3 Department of Surgical Sciences Sapienza University of Rome

A correspondence between the ＂meso＂ of the rectum and of the pancreas has recently been reported. here we highlight the differences between mesorectum and mesopancreas. Based on anatomical findings from a series of 89 consecutive pancreaticoduodenectomies and 71 consecutive total mesorectal excisions, we observed that in contrast to the mesorectum, the mesopancreas did not have well-defined anatomic boundaries and was continuous and connected through its components with the para-aortic area. In rectal cancer,tumor deposits and nodal involvement could be confined to the mesorectum（i.e., within the mesorectal fascia）, whereas in pancreatic carcinoma, tumor deposits and nodal metastases occurred in the boundless mesopancreatic area. Total mesorectal excision was made en bloc with the rectum by dissecting along the mesorectal fascia; this was not the case for mesopancreatic excision since anatomical demarcation of the mesopancreas did not exist. Moreover, the growth pattern of pancreatic cancer showed greater dispersion, which was more prominent at the invasive front of the tumor and could potentially affect the status of the resection margin. These findings indicate that the mesorectum and mesopancreas are completely distinct from the pathological, surgical, and oncological standpoints.

关键词： pancreatic head carcinoma surgical procedure therapy pancreatic cancer

Diet and nutrition against inflammatory bowel disease: Trick or treat(ment)?

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World Journal of Experimental Medicine 2022年第5期12卷 104-107页

作者： Salvatore Greco Beatrice Bonsi NicolòFabbri Department of Translational Medicine University of FerraraFerrara 44100Italy Department of Internal Medicine Azienda UnitàSanitaria Locale Di FerraraOspedale del DeltaAzienda UnitàSanitaria Locale di FerraraFerrara 44100Italy Unit of General Surgery Azienda UnitàSanitaria Locale di FerraraOspedale del DeltaAzienda UnitàSanitaria Locale di FerraraFerrara 44100Italy

Even if the relationships between nutrition and inflammatory bowel disease(IBD)remain underexplored,the current literature is providing,day by day,much more evidence on the effects of various diets in both prevention and treatment of such *** dietary habits,together with other environmental factors such as pollution,breastfeeding,smoke,and/or antibiotics,are among the theoretical pathogenetic causes of IBD,whose multifactorial aetiology has been already *** some of these risk factors are potentially reversible,some others cannot be avoided,and efficient treatments become necessary to prevent IBD spread or ***,the drugs currently available for treatment of such disease provide low-to-no effect against the symptoms,making the illnesses still strongly *** nutrition and specific diets will prove to effectively interrupt the course of IBD has still to be clarified and,in this sense,further research concerning the applications of such dietary interventions is still needed.

关键词： Crohn’s disease Ulcerative colitis Inflammatory bowel disease Diet Nutrition Treatment

Digestive cancer surgery in the era of sentinel node and epithelial-mesenchymal transition

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World Journal of Gastroenterology 2013年第47期19卷 8996-9002页

作者： Nadia Peparini azienda sanitaria locale roma h via Mario Calo’ 5 - 00043 CiampinoItalyItaly

Lymph node involvement is one of the most important prognostic indicators of carcinoma of the digestive *** the therapeutic impact of lymphadenectomy has not been proven and the number of retrieved nodes cannot be considered a measure of successful cancer surgery,an adequate lymph node count should be guaranteed to accurately assess the N-stage through the number of involved nodes,lymph node ratio,number of negative nodes,ratio of negative to positive nodes,and log odds,i.e.,the log of the ratio between the number of positive lymph nodes and the number of negative lymph nodes in digestive *** lymphadenectomy is not without complications,sentinel node mapping has been used as the rational procedure to select patients with early digestive carcinoma in whom nodal dissection may be omitted or a more limited nodal dissection may be ***,due to anatomical and technical issues,sentinel node mapping and nodal basin dissection are not yet the standard of care in early digestive ***,in light of the biological,prognostic and therapeutic impact of tumor budding and tumor deposits,two epithelial-mesenchymal transition-related phenomena that are involved in tumor progression,the role of staging and surgical procedures in digestive carcinomas could be redefined.

关键词： Lymph node count Lymph node ratio Sentinel node Tumor budding Tumor deposits

^(18)F-fluorodeoxyglucose positron emission tomography for intrahepatic cholangiocarcinoma N-and M-staging:should guidelines recommend it at last?

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hepatobiliary Surgery and Nutrition 2022年第5期11卷 789-792页

作者： Maurizio Zizzo Magda Zanelli Francesca Sanguedolce Annibale Versari Pierpaolo Pattacini Andrea Morini Federica Mereu Antonia Lavinia Zuliani Alessandro Giunta Surgical Oncology Unit Azienda UnitàSanitaria Locale-IRCCS di Reggio EmiliaArcispedale Santa Maria Nuova di Reggio EmiliaReggio EmiliaItaly Pathology Unit Azienda UnitàSanitaria Locale-IRCCS di Reggio EmiliaArcispedale Santa Maria Nuova di Reggio EmiliaReggio EmiliaItaly Pathology Unit Azienda Ospedaliero-UniversitariaOspedali Riuniti di FoggiaFoggiaItaly Nuclear Medicine Unit Azienda UnitàSanitaria Locale-IRCCS di Reggio EmiliaArcispedale Santa Maria Nuova di Reggio EmiliaReggio EmiliaItaly Radiology Unit Azienda UnitàSanitaria Locale-IRCCS di Reggio EmiliaArcispedale Santa Maria Nuova di Reggio EmiliaReggio EmiliaItaly

We really appreciated Lin et al.’s“The influence of ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography on the N-and M-staging and subsequent clinical management of intrahepatic cholangiocarcinoma”in hepatoBiliary Surgery and Nutrition(1).A 291-patient population affected by intrahepatic cholangiocarcinoma(ICC)was retrospectively analyzed with the aim of assessing the accuracy of preoperative staging and treatment reallocation by ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT)(1).

关键词： positron deoxy

Does antecolic reconstruction decrease delayed gastric emptying after pancreatoduodenectomy?

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World Journal of Gastroenterology 2012年第45期18卷 6527-6531页

作者： Nadia Peparini Piero Chirletti azienda sanitaria locale roma h 00043 RomeItaly Department of Surgical Sciences Sapienza University of Rome00161 RomeItaly

Delayed gastric emptying(DGE) is a frequent complication after pylorus-preserving pancreatoduodenectomy(PpPD).Kawai and colleagues proposed pylorus-resecting pancreatoduodenectomy(PrPD) with antecolic gastrojejunal anastomosis to obviate DGE occurring after *** we debate the reported differences in the prevalence of DGE in antecolic and retrocolic gastro/duodeno-jejunostomies after PrPD and PpPD,*** concluded that the route of the gastro/duodeno-jejunal anastomosis with respect to the transverse colon;i.e.,antecolic route or retrocolic route,is not responsible for the differences in prevalence of DGE after pancreatoduodenectomy(PD) and that the impact of the reconstructive method on DGE is related mostly to the angulation or torsion of the gastro/*** report a prevalence of 8.9% grade A DGE and 1.1% grade C DGE in a series of 89 subtotal stomach-preserving PDs with Roux-en Y retrocolic reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic *** anastomosis of the isolated first jejunal loop to the gastric remnant allows outflow of the gastric contents by gravity through a "straight route".

关键词：十二指肠胃排空切除术延迟肠吻合术 DGE 患病率胃内容物

Mesopancreas:A boundless structure,namely the rationale for dissection of the paraaortic area in pancreaticoduodenectomy for pancreatic head carcinoma

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World Journal of Gastroenterology 2015年第10期21卷 2865-2870页

作者： Nadia Peparini azienda sanitaria locale roma h- distretto 3 00043 Ciampino (Rome)Italy

This review highlights the rationale for dissection of the 16a2 and 16b1 paraaortic area during pancreaticoduodenectomy(PD)for carcinoma of the head of the *** advances in surgical anatomy of the mesopancreas indicate that the retropancreatic area is not a single entity with well defined boundaries but an anatomical site of embryological fusion of peritoneal layers,and that continuity exists between the neuro lymphovascular adipose tissues of the retropancreaticand paraaortic *** advances in surgical pathology and oncology indicate that,in pancreatic head carcinoma,the mesopancreatic resection margin is the primary site for R1 resection,and that epithelialmesenchymal transition-related processes involved in tumor progression may impact on the prevalence of R1 resection or local recurrence rates after R0 *** concepts imply that mesopancreas resection during PD for pancreatic head carcinoma should be extended to the paraaortic area in order to maximize retropancreatic clearance and minimize the likelihood of an R1 resection or the persistence of residual tumor cells after R0 *** PD for pancreatic head carcinoma,the rationale for dissection of the paraaortic area is to control the spread of the tumor cells along the mesopancreatic resection margin,rather than to control or stage the nodal *** mesopancreatic resection cannot be considered"complete"or"en bloc",it should be"extended as far as possible"or be"maximal",including dissection of16a2 and 16b1 paraaortic areas.

关键词： Pancreatic carcinoma Mesopancreas Mesopancreas res

Atypical cutaneous lesions in advanced-stage hodgkin lymphoma: A case report

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World Journal of Clinical Cases 2019年第17期7卷 2513-2518页

作者： Fulvio Massaro Angela Ferrari Enrico Zendri Magda Zanelli Francesco Merli hematology Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia

BACKGROUND Cutaneous involvement in hodgkin lymphoma (hL) is a rare *** cases have been reported in literature,most describing paraneoplastic *** very few papers have described primary hL skin infiltration,reporting a wide range of clinical presentations that frequently include ulcers;plaques,nodules and papules have also been *** SUMMARY We report the case of a 56-year-old man who presented fever,multiple adenomegalies of neck and axilla and thick serpiginous skin lesions involving bilateral pectoral *** an initial diagnostic workup for a suspected active infectious disease,a lymph node biopsy was performed,which showed a neoplastic invasion from a mixed cellularity classical *** same histological pattern was described in a cutaneous biopsy of the chest *** other staging procedures performed revealed an advanced disease,with unfavourable clinical prognostic *** patient was prescribed 6 cycles of ABVD chemotherapy scheme (doxorubicin,bleomycin,vinblastine,dacarbazine),a regiment that requires demonstration of metabolic response achievement at the interim PET/CT scan to confirm continuation or to change therapeutic *** Skin involvement in hL is a rare finding and may represent a challenging clinical presentation due to extremely various types of lesions observed.

关键词： hodgkin lymphoma Skin lesions Advanced stage ABVD Case report

Collision nodal metastasis of bladder cancer and melanoma:The first reported case and literature review

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Current Urology 2022年第3期16卷 168-171页

作者： Francesca Sanguedolce Francesco Troiano Giovanni Musci Magda Zanelii Maurizio Zizzo Stefano Ascan Giuseppe Carrieri Luigi Cormio Department of Pathology University HospitalFoggia71121Italy Department of Urology and Renal Transplantation University of FoggiaFoggiaItaly Pathology Unit Azienda UnitàSanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly Surgical Oncology Unit Azienda UnitàSanitaria Locale-IRCCS di Reggio EmiliaReggio EmiliaItaly Clinical and Experimental Medicine University of Modena and Reggio EmiliaModenaItaly Pathology Unit Azienda Ospedaliera Santa Maria di TerniUniversity of PerugiaTerniItaly

Collision metastasis is a rare phenomenon of concomitant localization of 2 or more different tumors in the same lymph *** most cases,primary malignancies are synchronous carcinomas arising in the same organ or area of the body.A 82-year-old man presented with hematuria and acute renal failure;he had undergone dermatological consultation ten months ago because of a large deep brown skin lesion in his dorso-lumbar region,which was not excised upon patient's *** underwent radical cystectomy with extended pelvic lymphadenectomy due to nonpapillary high-grade urothelial carcinoma,with focal squamous features,infiltrating the bladder wall and prostate *** one left iliac lymph node,small foci of metastatic urothelial carcinoma(positive for P63 and CK34betaE12)were close to melanoma cells(positive for hMB45).The patient refused further treatment and died of metastatic disease 12 months after *** is no specific clinical feature for nodal collision metastasis.A polymorphic histologic appearance poses the suspect,but immunohistochemical stains are needed to define the primary *** metastases are thought to carry a poor *** clinical relevance is linked to the fact that the patient faces 2 different metastatic tumors that may require specific multidisciplinary approach once diagnosed as *** present,to the best of our knowledge,the first case of collision nodal metastasis from bladder cancer and melanoma,and describe its clinical and histopathological characteristics to raise awareness on this rare occurrence,which portends a poorer prognosis than each single tumor.

关键词： Bladder Cancer Collision tumor Melanoma Nodal metastasis