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Montironi R, Cheng L, Lopez-Beltran A, Scarpelli M, Montorsi F. A better understating of the morphological features and molecular characteristics of intraductal carcinoma helps clinicians further explain prostate cancer aggressiveness. Eur Urol 2014; 67:504-7. [PMID: 25194910 DOI: 10.1016/j.eururo.2014.08.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Accepted: 08/25/2014] [Indexed: 02/07/2023]
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Conti A, Santoni M, Bittoni A, Andrikou K, Lanese A, Pellei C, Loretelli C, Mandolesi A, Alfonsi S, Scarpelli M, Cascinu S. Cox-2 Status Modulates the Activation of Hedgehog Pathway and Consequently the Expression of Stem Cell Markers in Patients with Pancreatic Ductal Adenocarcinoma. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Di Somma L, Iacoangeli M, Alvaro L, Di Rienzo A, Liverotti V, Della Costanza M, Brunozzi D, Polonara G, Scarpelli M, Scerrati M. P13.10 * SURGICAL TREATMENT FOR GLIOBLASTOMA MULTIFORME: OUTCOME AND ANALYSIS OF PROGNOSTIC FACTORS ESPECIALLY ORIENTED TO THE EXTENT OF SURGICAL RESECTION. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bittoni A, Andrikou K, Lanese A, Santoni M, Pellei C, Conti A, Mandolesi A, Alfonsi S, Scarpelli M, Cascinu S. Her Family Receptor Expression and Clinical Outcome in Pancreatic Cancer Patients. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu334.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mazzucchelli R, Lopez-Beltran A, Galosi AB, Zizzi A, Scarpelli M, Bracarda S, Cheng L, Montironi R. Prostate changes related to therapy: with special reference to hormone therapy. Future Oncol 2014; 10:1873-86. [PMID: 25325826 DOI: 10.2217/fon.14.37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Hormone and radiation therapy have traditionally been used in prostate cancer (PCa). Morphological effects are often identified in needle biopsies and surgical specimens. A range of histological changes are seen in the non-neoplastic prostate and in the pre-neoplastic and neoplastic areas. Other ablative therapies, including cryotherapy, and emerging focal therapies, such as high-intensity focused ultrasound, photodynamic therapy and interstitial laser thermotherapy, may induce changes on the prostate. As new compounds are developed for prostate cancer treatment, it is important to document their effects on benign and neoplastic prostate tissue.
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Orsucci D, Rocchi A, Ienco E, Alì G, LoGerfo A, Petrozzi L, Scarpelli M, Filosto M, Carlesi C, Siciliano G, Bonuccelli U, Mancuso M. Myopathic Involvement and Mitochondrial Pathology in Kennedy Disease and in Other Motor Neuron Diseases. Curr Mol Med 2014; 14:598-602. [DOI: 10.2174/1566524014666140603100131] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 10/11/2013] [Accepted: 11/24/2013] [Indexed: 11/22/2022]
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Andrikou K, Piva F, Santoni M, Conti A, Mandolesi A, Bittoni A, Pellei C, Lanese A, Loretelli C, Scarpelli M, Principato G, Cascinu S. KRAS: To be or not to be targeted? Biologic and computational analyses in pancreatic adenocarcinoma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Galosi AB, Scarpelli M, Mazzucchelli R, Lopez-Beltran A, Giustini L, Cheng L, Montironi R. Adult primary paratesticular mesenchymal tumors with emphasis on a case presentation and discussion of spermatic cord leiomyosarcoma. Diagn Pathol 2014; 9:90. [PMID: 24885500 PMCID: PMC4039061 DOI: 10.1186/1746-1596-9-90] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/15/2014] [Indexed: 01/25/2023] Open
Abstract
Background The aim of this report is related to adult primary paratesticular mesenchymal tumors with emphasis on a case presentation and discussion of the spermatic cord leiomyosarcoma. Primary paratesticular tumors are rare, only accounting for 7% to 10% of all intrascrotal tumors. In adults, more than 75% of these lesions arise from the spermatic cord, 20% being leiomyosarcoma. Tumor grade, stage, histologic type, and lymph node involvement are independently predictive of prognosis. Findings The case report concerns a 81-year-old man presented with a 3-year history of painless lump in the right hemiscrotum. Scrotal examination demonstrated a 5.1-cm, firm-to-hard mass attached to the spermatic cord. Scrotal ultrasound scan revealed a heterogeneous mass separate from the testis. He was treated with an radical orchi-funicolectomy. Histologically the lesion is composed of spindled cells with often elongated, blunt-ended nuclei and variably eosinophilic cytoplasm. Areas with pleomorphic morphology are present. The level of mitotic activity is equal to 3/10 HPF in the areas with spindle cell morphology and to 12/10 HPF in the areas with pleomorphic morphology. The final diagnosis was that a leiomyosarcoma of the spermatic cord, with grade 1 and grade 2 areas, stage pT2b cN0 and cM0. The patient has been followed up for 3 months with CT scans and shows no signs of recurrence. Conclusions Spermatic cord leiomyosarcoma, although rare, should be one of the first differential diagnoses for a firm-to-hard lump in the cord. Apart from radical orchi-funicolectomy, there has been added benefit of adjuvant radiotherapy to prevent any loco-regional lymph node recurrence. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1613030331125632
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Montironi R, Lopez-Beltran A, Mazzucchelli R, Scarpelli M, Galosi AB, Cheng L. Contemporary update on pathology-related issues on routine workup of prostate biopsy: sectioning, tumor extent measurement, specimen orientation, and immunohistochemistry. ANALYTICAL AND QUANTITATIVE CYTOPATHOLOGY AND HISTOPATHOLOGY 2014; 36:61-70. [PMID: 24902358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
While the prime goal of the needle biopsy is to diagnose prostatic adenocarcinoma (PCa), once PCa is detected further descriptive information regarding the type of cancer, amount of tumor, and grade in prostate needle cores forms the cornerstone for contemporary management of the patient and to assess the potential for local cure and the risk for distant metastasis. This review gives an update on selected pathology-related issues on routine workup of prostate biopsy with special references to adequate histologic sectioning necessary to maximize cancer yield, tumor extent measurements and methodologies, specimen orientation, and the role of immunohistochemistry in the evaluation of the prostate. Multiple factors influence the diagnostic yield of prostate biopsies. Many of these factors are fixed and uncontrollable. Other factors are controlled by the urologist, including number of cores obtained, method and location of biopsy, and amount of tissue obtained. The yield of cancer is also controlled by the pathologist and histotechnologist. It is necessary to report the number of cores submitted and the number of positive cores, thereby giving the fraction of positive cores. The percentage involvement by carcinoma with or without the linear extent of carcinoma of the single core with the greatest amount of tumor should also be provided. Using the marking technique, we can add a new pathological parameter: pathological orientation. Cancer or atypical lesions can be accurately located within the biopsy specimen and integrated to biopsy approach. Probably the most common use of immunohistochemistry in the evaluation of the prostate is for the identification of basal cells, which are absent with rare exception in adenocarcinoma of the prostate and in general positive in mimickers of prostate cancer. If a case is still considered atypical by a uropathology expert after negative basal cell staining, positive staining for alpha-methylacyl-CoA-racemase can help establish in 50% of these cases a definitive diagnosis of cancer.
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Mazzucchelli R, Galosi AB, Scarpelli M, Lopez-Beltran A, Cheng L, Montironi R. Contemporary update on pathology-related issues of adult renal neoplasms. ANALYTICAL AND QUANTITATIVE CYTOPATHOLOGY AND HISTOPATHOLOGY 2014; 36:1-8. [PMID: 24902365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This review gives an update on selected issues on renal neoplasia with special references to emerging new tumor entities (thyroid-like follicular renal cell carcinoma, succinic dehydrogenase B deficiency-associated renal cell carcinoma, and anaplastic lymphoma kinase [ALK] translocation renal cell carcinoma), tumor grading (the International Society of Urological Pathology grading system), and assessment of tumoral involvement of the renal sinus structures, including the sinus fat, the loose connective tissue, or any sinus-based endothelium-lined space.
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Lin Y, Scarpelli M, Paganetti H, Schuemann J. PD-0096: Quantification of gold nanoparticle induced microscopic dose enhancement using protons. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Di Primio R, Montironi R. Treatment effects in prostate cancer following traditional and emerging therapies. Int J Immunopathol Pharmacol 2013; 26:291-8. [PMID: 23755744 DOI: 10.1177/039463201302600202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Treatment options for prostate cancer consist of radical prostatectomy, hormonal therapy and radiation therapy. Hormonal and radiation therapy have well-known, often profound, effects on the histological appearance of benign and malignant prostate tissue. Novel therapies including focal ablative treatments, chemotherapies and targeted molecular therapies are beginning to emerge and pathologists will play a central role in documenting the effects of these treatments at the tissue level. As such, knowledge of treatment-related changes and access to clinical information are essential to ensure accurate interpretation and reporting of post-treatment prostate specimens by pathologists.
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Castellini P, Montironi MA, Zizzi A, Scarpelli M, Mazzucchelli R, Lopez-Beltran A, Cheng L, Paone N, Montironi R. Recurrent papillary urothelial neoplasm of low malignant potential. Subtle architectural disorder detected by quantitative analysis in DAXX-immunostained tissue sections. Hum Pathol 2013; 45:745-52. [PMID: 24565208 DOI: 10.1016/j.humpath.2013.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 01/19/2023]
Abstract
The aim of the study was to identify subtle changes in the so-called architectural predominant order in nonrecurrent and recurrent papillary urothelial neoplasm of low malignant potential (PUNLMP). Quantitative analysis was performed with a software package written in LabVIEW (National Instruments, Austin, TX) in DAXX-immunostained tissue sections. Twelve cases of PUNLMP with papillary fronds sectioned lengthwise through the core were investigated and subdivided as follows: 7 nonrecurrent and 5 recurrent PUNLMP cases. Six cases of normal urothelium (NU) were included. When an epithelial thickness threshold is set at 108 μm (ie, 400 pixels), there is a complete separation between NU and PUNLMP; however, nonrecurrent and recurrent cases fall in the same range of thickness. In setting a nuclear elongation factor threshold at 2.1, there are differences between the 2 PUNLMP groups, recurrent PUNLMP and NU cases, showing a somewhat similar proportion of elongated nuclei. The nuclear orientation separates nonrecurrent from recurrent PUNLMP groups; however, NU cases do not appear as a separate group from the 2 PUNLMP groups. In combining epithelial thickness, nuclear elongation, and orientation in a multivariate analysis, the 2 PUNLMP groups appear separate between them and from NU. NU is less thickened than the 2 PUNLMP groups and shows a combination of elongated and less elongated nuclei. Elongated nuclei are more numerous in nonrecurrent PUNLMP, whereas the nuclei in recurrent PUNLMP are less elongated and less polarized than in the other group. Such finding can be used routinely to identify those PUNLMP patients who will have recurrence.
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Williamson SR, MacLennan GT, Lopez-Beltran A, Montironi R, Tan PH, Martignoni G, Grignon DJ, Eble JN, Idrees MT, Scarpelli M, Cheng L. Cystic partially regressed clear cell renal cell carcinoma: a potential mimic of multilocular cystic renal cell carcinoma. Histopathology 2013; 63:767-79. [DOI: 10.1111/his.12239] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 07/24/2013] [Indexed: 12/01/2022]
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Montironi R, Scarpelli M, Cheng L, Lopez-Beltran A, Kirkali Z, Montorsi F. Reply to Jérôme Verine's Letter to the Editor re: Rodolfo Montironi, Marina Scarpelli, Liang Cheng, et al. Immunoglobulin G4–related Disease in Genitourinary Organs: An Emerging Fibroinflammatory Entity Often Misdiagnosed Preoperatively as Cancer. Eur Urol. In press. http://dx.doi.org/10.1016/j.eururo.2012.11.056. Eur Urol 2013; 64:e53-4. [DOI: 10.1016/j.eururo.2013.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
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Montironi R, Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L. Update on selected renal cell tumors with clear cell features. With emphasis on multilocular cystic clear cell renal cell carcinoma. Histol Histopathol 2013; 28:1555-66. [PMID: 23893851 DOI: 10.14670/hh-28.1555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clear cell renal cell carcinoma (CCRCC) is the most common malignant tumor of renal epithelial origin and, with the exception of some rare tumors, the most deadly. The exception is represented by the multilocular cystic CCRCC, whose prognosis is excellent with survival rates of 100% when diagnosis is made according to the WHO definition. For this reason a proposal has been made to rename this tumor as multilocular cystic renal cell neoplasms of low malignant potential. Another exemption could be the clear cell (tubulo) papillary renal cell carcinoma/clear cell papillary renal cell carcinoma (CCPRCC), a tumor with tubulopapillary architecture and clear cytoplasm. Published data indicates that these are neoplasms with indolent clinical behavior. No cases with metastasis have been reported. Neoplasms meeting criteria for CCPRCC will subsequently be reclassified as of "low malignant potential" rather than carcinoma. The stroma of CCPRCC not infrequently demonstrates smooth muscle metaplasia. It should be remembered, however, that smooth muscle stromal metaplasia and proliferation are not entirely specific to this entity. Hence, it is suggested that smooth muscle metaplasia in the kidney may be a nonspecific common reaction to a variety of stimuli. Xp11 translocation renal cell carcinomas are a group of neoplasms distinguished by chromosomal translocations with breakpoints involving the TFE3 transcription factor gene, which maps to the Xp11.2 locus. The most distinctive histologic pattern of the Xp11 translocation renal cell carcinoma is that of a neoplasm with both clear cells and papillary architecture, and abundant psammoma bodies. TFE3 immunohistochemical staining is reported to be sensitive and specific for a diagnosis of translocation-associated carcinoma as long as the labeling is strong, diffuse, and nuclear. This immunostaining is particularly useful if the differential diagnosis includes CCRCC and CCPRCC. In conclusion, recognition of CCRCC and differentiation from other renal cell neoplasms with clear cytoplasm is important not only for prognostication but also for treatment-related reasons.
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Zizzi A, Montironi MA, Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Paone N, Castellini P, Montironi R. Immunohistochemical analysis of chromatin remodeler DAXX in high grade urothelial carcinoma. Diagn Pathol 2013; 8:111. [PMID: 23819605 PMCID: PMC3751668 DOI: 10.1186/1746-1596-8-111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 06/25/2013] [Indexed: 01/06/2023] Open
Abstract
Background/Aims The chromatin remodeler DAXX, a predominantly nuclear protein, regulates the status of chromatin organization. The aim of this exploratory immunohistochemical study was to evaluate DAXX protein expression in high grade invasive urothelial carcinoma (UC) of the bladder as a biological regulator of aggressiveness. Methods Quantitative analysis was made on DAXX immunostained nuclei in tissue sections from 5 cases of bladder normal urothelium (NU) and 5 cases of bladder pT1 UC. Carcinoma in situ (CIS) and high grade papillary carcinoma (HGPCa) were identified in 2 out of 5 UC cases. Results The nuclei in UC show an open configuration of the chromatin composed of granules varying in size and distribution and a mean nuclear area 1.7 times greater than that in NU (UC: mean and SD 24.4 ± 11.4 square microns; NU: 14.8 6.5 square microns. The differences are statistically significant). 70% of the NU nuclei are immunostained, whereas 90% of UC nuclei are positive. The mean gray level value in UC, related to the intensity of nuclear immunostaining, is lower than in NU by a factor of 0.94 (UC: mean and SD 100 ± 15; NU: 106 ± 15. The differences are statistically significant). In particular, the value in the nuclei adjacent to the stroma in UC is slightly lower than in the intermediate cell layers by factor of 0.98, whereas in NU it is slightly greater by a factor 1.02 and 1.04 compared to the intermediate and superficial cell layers. The values in CIS and HGPCa are similar to those in UC. Conclusions The quantitative immunohistochemical analysis shows an altered protein expression of chromatin remodeler DAXX in UC and in its preinvasive phases, when compared to NU. DAXX evaluation, if associated with markers related to global DNA methylation and histone acetylation, could be used in clinical practice as a marker of aggressiveness. Virtual slides The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1398457297102379
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Zizzi A, Montironi MA, Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Di Primio R, Paone N, Castellini P, Montironi R. Karyometry and quantitative immunohistochemical analysis of the urothelium in tissue sections: a feasibility study based on chromatin remodeler DAXX immunostaining. J BIOL REG HOMEOS AG 2013; 27:913-917. [PMID: 24152857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The aim of this study was to investigate the feasibility of applying a software traditionally used in the field of engineering to pathology, in particular to tissue sections from normal urothelium (NU) immuno-stained for the chromatin remodeler DAXX (death domain-associated protein). The study included 5 cases of NU. Images were recorded with a Nikon digital camera. The nuclear area and the intensity of nuclear staining were analyzed with a software package developed in LabVIEW environment. The nuclear size is 14.8 plus or minus 6.5 square microns. The nuclei in the cells adjacent to the stroma are slightly smaller than in the intermediate cells by a factor of 0.86. The mean nuclear area of the nuclei in the superficial cell layer in NU is identical to the nuclei in the intermediate cell layers. For each nucleus intensity of nuclear staining is calculated based on the gray value of the individual picture elements in the green color plane. The mean and standard deviation of nuclear gray value are 106 plus or minus 15. The mean value in the nuclei adjacent to the stroma is slightly greater by a factor 1.02 and 1.04 compared to the intermediate and superficial cell layers. In conclusion, this exploratory study shows that karyometry and quantitative immunohistochemical analysis can be done accurately by using a digital camera commonly available to pathologists and an image analysis software routinely used in the field of engineering.
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Montironi R, Cheng L, Lopez-Beltran A, Mazzucchelli R, Scarpelli M. Combined handling of prostate base/bladder neck and seminal vesicles in radical prostatectomy specimens: our approach with the whole mount technique. Histopathology 2013; 63:431-5. [DOI: 10.1111/his.12158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Galosi AB, Cheng L, Lopez-Beltran A, Montorsi F, Scarpelli M, Mazzucchelli R, Montironi R. Precise morphologic documentation with large-format histology of clinical findings in a bladder cancer patient. Eur Urol 2013; 64:519-21. [PMID: 23778020 DOI: 10.1016/j.eururo.2013.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 06/03/2013] [Indexed: 11/29/2022]
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Morroni M, Marzioni D, Ragno M, Di Bella P, Cartechini E, Pianese L, Lorenzi T, Castellucci M, Scarpelli M. Role of electron microscopy in the diagnosis of cadasil syndrome: a study of 32 patients. PLoS One 2013; 8:e65482. [PMID: 23799017 PMCID: PMC3684609 DOI: 10.1371/journal.pone.0065482] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 04/26/2013] [Indexed: 11/24/2022] Open
Abstract
Background and Purpose Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by NOTCH3 gene mutations that result in vascular smooth muscle cell (VSMC) degeneration. Its distinctive feature by electron microscopy (EM) is granular osmiophilic material (GOM) detected in VSMC indentations and/or the extracellular space close to VSMCs. Reports of the sensitivity of EM in detecting GOM in biopsies from CADASIL patients are contradictory. We present data from 32 patients clinically suspected to have CADASIL and discuss the role of EM in its diagnosis in this retrospective study. Methods Skin, skeletal muscle, kidney and pericardial biopsies were examined by EM; the NOTCH3 gene was screened for mutations. Skin and muscle biopsies from 12 patients without neurological symptoms served as controls. Results and Discussion All GOM-positive patients exhibited NOTCH3 mutations and vice versa. This study i) confirms that EM is highly specific and sensitive for CADASIL diagnosis; ii) extends our knowledge of GOM distribution in tissues where it has never been described, e.g. pericardium; iii) documents a novel NOTCH3 mutation in exon 3; and iv) shows that EM analysis is critical to highlight the need for comprehensive NOTCH3 analysis. Our findings also confirm the genetic heterogeneity of CADASIL in a small Italian subpopulation and emphasize the difficulties in designing algorithms for molecular diagnosis.
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Lopez-Beltran A, Montironi R, Vidal A, Scarpelli M, Cheng L. Urothelial dysplasia of the bladder: diagnostic features and clinical significance. ANALYTICAL AND QUANTITATIVE CYTOPATHOLOGY AND HISTOPATHOLOGY 2013; 35:121-129. [PMID: 24344498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The 2004 World Health Organization classification system for urothelial neoplasia identifies urothelial dysplasia (low-grade intraurothelial neoplasia) as a premalignant lesion of the urothelium. Although diagnostic criteria of urothelial dysplasia have been improved in recent years, there is a frequent lack of interobserver reproducibility. Follow-up studies suggest that dysplasia is a marker for urothelial instability and disease progression in up to 19% of patients, thus supporting an active clinical follow-up in these patients. The main differential diagnosis of urothelial dysplasia includes flat urothelial lesions with atypia, mainly flat (simple) urothelial hyperplasia, reactive urothelial atypia, urothelial atypia of unknown significance, and urothelial carcinoma in situ (high-grade intraurothelial neoplasia). In most cases, morphologic features alone suffice for diagnosis. Some cases may require a panel of immunohistochemical antibodies consisting of cytokeratin 20, p53 and CD44 for diagnosis. We present pathologic features and clinical significance of urothelial dysplasia with emphasis on differential diagnosis from common flat urothelial lesions with atypia.
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Cosentini V, Cosaro A, Gammaro L, Tonin P, Scarpelli M, Campo S, Oldrizzi L. [A case of acute renal failure secondary to late-onset McArdle's disease]. GIORNALE ITALIANO DI NEFROLOGIA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI NEFROLOGIA 2013; 30:gin/00075.17. [PMID: 23832480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Mc Ardles disease, also known as Type V glycogen storage disease, is a rare deficiency of the enzyme glycogen phosphorylase in muscle cells, inherited as an autosomal recessive trait. In the absence of this enzyme, muscles cannot break down glycogen during exercise, so in patients affected by McArdles disease even moderate physical activity produces cramps, pain and fatigue. Anaerobic activity leads to severe fixed contractures and rhabdomyolisis with myoglobinuria and raised serum creatine-kinase, which, in turn, can lead to acute renal failure. Disease onset is usually in early childhood, although diagnosis is often not made until the second or third decade. CASE REPORT We present the case of a 68-year-old man who presented to the Emergency Room with fatigue, vertigo, diarrhea and oliguria. The patient underwent five daily hemodialysis sessions, diuresis reappeared and there was progressive recovery of renal function. The patient described episodes of fatigue and muscular pain occurring since childhood: the positive personal history, together with persistently raised CPK levels in the absence of any infective or toxic cause of myositis, led us to suspect the presence of this rare metabolic disease, which was subsequently confirmed by muscle biopsy. CONCLUSION To date, there is no specific treatment for type V glycogenosis, although a diet rich in protein and saccarose, vitamin B6 supplementation and creatine administration are generally recommended. Moderate physical activity can help manage symptoms by improving exercise tolerance and blood supply to the muscles, ensuring provision of glucose and free fatty acids for the muscle fibers.
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Montironi R, Lopez-Beltran A, Cheng L, Montorsi F, Scarpelli M. Central prostate pathology review: should it be mandatory? Eur Urol 2013; 64:199-201; discussion 202-3. [PMID: 23608669 DOI: 10.1016/j.eururo.2013.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/03/2013] [Indexed: 11/27/2022]
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Lopez-Beltran A, Cheng L, Vidal A, Scarpelli M, Kirkali Z, Blanca A, Montironi R. Pathology of renal cell carcinoma: an update. ANALYTICAL AND QUANTITATIVE CYTOPATHOLOGY AND HISTOPATHOLOGY 2013; 35:61-76. [PMID: 23700715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of classic and newer methodologies, including histopathology, electron microscopy, immunohistochemistry, cytogenetics, and molecular diagnostic techniques, has greatly influenced distinctions between various types of renal carcinoma. The most recent World Health Organization classification of renal neoplasms encompassed nearly 50 distinctive renal neoplasms. These categories have been expanded during recent years, incorporating newer histotypes, thus suggesting that the next revision of this classification will incorporate some of the recently recognized entities. In this review we examine the clinicopathologic and genetic features of renal carcinomas most often seen in clinical practice. Emphasis is placed on defining risk categories by incorporating pathologic predictive paradmeters and tumor histotypes. Since pathology of renal cell cancer is a rapidly evolving field, we also include brief comments on newer tumor variants for which there currently is not enough clinicopathologic information to permit classification as distinctive tumor histotypes.
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Montironi R, Lopez-Beltran A, Cheng L, Scarpelli M. Reply to Jérôme Verine's letter to the editor Re: Rodolfo Montironi, Antonio Lopez-Beltran, Liang Cheng, Marina Scarpelli. Re: Multilocular cystic renal cell carcinoma with focus on clinical and pathobiological aspects. Eur Urol 2013;63:400-1. Eur Urol 2013; 63:e74-5. [PMID: 23473578 DOI: 10.1016/j.eururo.2013.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022]
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Montironi R, Lopez-Beltran A, Cheng L, Scarpelli M. Re: Multilocular Cystic Renal Cell Carcinoma with Focus on Clinical and Pathobiological Aspects. Eur Urol 2013; 63:400-1. [DOI: 10.1016/j.eururo.2012.11.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ragno M, Trojano L, Pianese L, Boni MV, Silvestri S, Mambelli V, Lorenzi T, Scarpelli M, Morroni M. Renal involvement in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL): report of a case with a six-year follow-up. Histol Histopathol 2013; 27:1307-14. [PMID: 22936449 DOI: 10.14670/hh-27.1307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a disorder of the cerebral small blood vessels caused by a mutation in the NOTCH3 gene, which encodes a large transmembrane receptor NOTCH3. It is associated with systemic arteriopathy involving small arteries, besides the brain, in skin, spleen, liver, muscle, aorta and in the kidney. The key pathological finding is the accumulation of granular osmiophilic material (GOM) on degenerating vascular smooth muscle cells. In the kidney GOMs have been described only in a very limited number of CADASIL patients. We describe a genetically confirmed CADASIL patient with mild renal dysfunction and GOMs in the interlobular and juxtaglomerular arteries and, for the first time, also within the glomerulus, whose nephrology conditions remained stable, whereas the neurological manifestations markedly worsened over a six-year follow-up period. The reasons for this discrepancy are probably related to differences in the structure and function of brain and kidney blood vessels.
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Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Di Primio R, Montironi R. Morphological Analysis of Radical Prostatectomy Specimens: Recent Topics Relevant to Prognosis. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The pathology report should include clinically relevant information as well as provide clinically useful information derived from the macroscopic examination and microscopic evaluation of the radical prostatectomy (RP) specimens. The reporting pathologist should pay particular attention to the evaluation of the prognostic factors proven to be of prognostic importance and useful in clinical patient management, including histological type, grade and volume of cancer, the extent of local invasion and stage of cancer as well as the surgical margins status.
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Iacoangeli M, Di Rienzo A, Colasanti R, Zizzi A, Gladi M, Alvaro L, Nocchi N, Di Somma LGM, Scarpelli M, Scerrati M. Endoscopy-verified occult subependymal dissemination of glioblastoma and brain metastasis undetected by MRI: prognostic significance. Onco Targets Ther 2012; 5:449-56. [PMID: 23271915 PMCID: PMC3526147 DOI: 10.2147/ott.s39429] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although various prognostic indices exist for patients with malignant brain tumors, the prognostic significance of the subependymal spread of intracranial tumors is still a matter of debate. In this paper, we report the cases of two intraventricular lesions, a recurrent glioblastoma multiforme (GBM) and a brain metastasis, each successfully treated with a neuroendoscopic approach. Thanks to this minimally invasive approach, we achieved good therapeutic results: we obtained a histological diagnosis; we controlled intracranial hypertension by treating the associated hydrocephalus and, above all, compared with a microsurgical approach, we reduced the risks related to dissection and brain retraction. Moreover, in both cases, neuroendoscopy enabled us to identify an initial, precocious subependymal tumor spreading below the threshold of magnetic resonance imaging (MRI) detection. This finding, undetected in pre-operative MRI scans, was then evident during follow-up neuroimaging studies. In light of these data, a neuroendoscopic approach might play a leading role in better defining the prognosis and optimally tailored management protocols for GBM and brain metastasis.
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Montironi R, Scarpelli M, Cheng L, Lopez-Beltran A, Burattini M, Kirkali Z, Montorsi F. Immunoglobulin G4-related disease in genitourinary organs: an emerging fibroinflammatory entity often misdiagnosed preoperatively as cancer. Eur Urol 2012; 64:865-72. [PMID: 23266239 DOI: 10.1016/j.eururo.2012.11.056] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 11/30/2012] [Indexed: 01/13/2023]
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Montironi R, Scarpelli M, Lopez-Beltran A, Cheng L. "No pay, no play" or from "defensive or passive pathology" to "active, clinically oriented pathology". Arch Pathol Lab Med 2012. [PMID: 23194036 DOI: 10.5858/arpa.2012-0219-le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Williamson SR, Scarpelli M, Lopez-Beltran A, Montironi R, Conces MR, Cheng L. Urethral caruncle: a lesion related to IgG4-associated sclerosing disease? J Clin Pathol 2012. [DOI: 10.1136/jclinpath-2012-201218] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AimsUrethral caruncle is a benign, polypoid urethral mass that occurs almost exclusively in postmenopausal women. Despite that these lesions are routinely managed with topical medications or excision, their pathogenesis is not well understood. We investigated the possibilities of autoimmune, viral and inflammatory myofibroblastic proliferations as possible aetiologies.MethodsIn 38 patients with urethral caruncle, we utilised immunohistochemistry for immunoglobulin G (IgG) and IgG4 to assess for a potential autoimmune aetiology. Immunohistochemistry was performed in nine patients for Epstein–Barr virus, BK virus, human herpesvirus 8, human papillomavirus, adenovirus and anaplastic lymphoma kinase.ResultsFour patients (11%) showed infiltrates of ≥50 IgG4-positive plasma cells per high power field, of which all showed an IgG4 to IgG ratio greater than 40%. A statistically significant difference (p<0.01) was detected in the mean number of IgG4-positive cells (14.73 per high power field) compared with control benign urethral specimens (mean, 1.19). One patient with increased counts below this threshold had rheumatoid arthritis; none had documented autoimmune pancreatitis or other known manifestations of systemic IgG4-related sclerosing disease. All lesions showed negative reactions for the viral and inflammatory myofibroblastic markers.ConclusionsUrethral caruncle is a benign inflammatory and fibrous polypoid urethral mass of unclear aetiology. It appears unrelated to viral infection and lacks the abnormal expression of anaplastic lymphoma kinase protein, as seen in inflammatory myofibroblastic tumours. Increased numbers of IgG4-positive plasma cells in a subset of lesions raise the possibility that some cases may be related to the autoimmune phenomena of IgG4-associated disease.
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Iacoangeli M, Di Rienzo A, Colasanti R, Alvaro L, Nocchi N, Polonara G, Di Somma LGM, Zizzi A, Scarpelli M, Scerrati M. Rare synchronous association of vestibular schwannoma and indolent insular oligodendroglioma in a patient without neurofibromatosis: controversial issue of timing for surgical treatment of asymptomatic low-grade gliomas. Onco Targets Ther 2012. [PMID: 23180968 PMCID: PMC3505077 DOI: 10.2147/ott.s39276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The co-occurrence of a vestibular schwannoma and a low-grade glioma is rare, and even rarer is the association with an oligodendroglioma. Although various authors have addressed the problem of treating patients with incidentally discovered indolent low-grade gliomas, an established protocol does not exist to date. The common approach is to reserve surgery until there is radiological evidence of tumor growth or high-grade transformation. However, because incidental low-grade glioma may represent the first stage of unavoidable pathological progression towards high-grade glioma, early and radical surgical resection should be advocated in order to increase the chance of a "cure" and prolonged survival. This case report supports this view, and suggests reflection on a possible change from a conservative philosophy to preventative surgical treatment.
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Mazzucchelli R, Scarpelli M, Barbisan F, Santinelli A, Lopez-Beltran A, Cheng L, Montironi R. Immunohistochemical expression of prostate tumour overexpressed 1 (PTOV1) in atypical adenomatous hyperplasia (AAH) of the prostate: additional evidence linking (AAH) to adenocarcinoma. Cell Oncol (Dordr) 2012; 36:37-42. [PMID: 23132460 DOI: 10.1007/s13402-012-0111-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prostate tumour overexpressed 1, PTOV1, was recently identified as a novel gene and protein during a differential display screening for genes overexpressed in prostate cancer (PCa). It has been suggested that overexpression of PTOV1 can contribute to the proliferative status of prostate tumour cells and thus to their biological behaviour. METHODS PTOV1 and Ki67 were immunohistochemically evaluated in PCa, atypical adenomatous hyperplasia (AAH), high-grade prostatic intraepithelial neoplasia (HGPIN), and normal-looking epithelium (NEp) of the transition zone (TZ) in 40 radical prostatectomies with pT2a Gleason score 6 PCa (20 with AAH and 20 with HGPIN) and in 10 simple prostatectomies (SPs) (5 with AAH and 5 with HGPIN). The aim was to evaluate PTOV1 protein expression as a marker for tumor development and progression from AAH to PCa. RESULTS The proportions of PTOV1 and Ki67 positive cells increased from NEp through AAH and HGPIN to PCa. In particular, the mean Hscore of PTOV1 expression in AAH was 110.90, i.e., close to three times that of NEp (40.76), similar to that of HGPIN (105.61) and lower than that of PCa (137.03). The mean values in AAH and HGPIN associated with cancer in the RPs were slightly higher than in the SPs. CONCLUSION Our findings related to PTOV1 expression in AAH, similar to those in HGPIN, provide additional evidence linking AAH to prostatic adenocarcinoma.
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Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Di Primio R, Montironi R. A contemporary update on pathology reporting for urinary bladder cancer. Int J Immunopathol Pharmacol 2012; 25:565-71. [PMID: 23058006 DOI: 10.1177/039463201202500302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Providing the best management for patients with bladder cancer relies on close cooperation among uro-oncologists and pathologists. The pathologist is involved in the diagnosis and assessment of prognostic and therapeutic factors in bladder biopsies, transurethral resection (TUR) and cystectomy specimens. The pathologist must report accurately the key features using terms that are well understood by clinicians. Adequate clinical information is important to pathologists in deciding the best approach in handling and processing the surgical specimens.
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Mazzucchelli R, Scarpelli M, Montironi R, Cheng L, Lopez-Beltran A. Multilocular cystic renal cell neoplasms of low malignant potential. ANALYTICAL AND QUANTITATIVE CYTOPATHOLOGY AND HISTOPATHOLOGY 2012; 34:235-238. [PMID: 23301382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Montironi R, Cheng L, Lopez-Beltran A, Scarpelli M. Editorial comment from Dr Montironi et al. to malignant mixed epithelial and stromal tumor of the kidney: report of the first male case. Int J Urol 2012; 20:451-2. [PMID: 22989311 DOI: 10.1111/j.1442-2042.2012.03164.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Conces MR, Williamson SR, Montironi R, Lopez-Beltran A, Scarpelli M, Cheng L. Urethral caruncle: clinicopathologic features of 41 cases. Hum Pathol 2012; 43:1400-4. [DOI: 10.1016/j.humpath.2011.10.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 10/12/2011] [Accepted: 10/14/2011] [Indexed: 11/24/2022]
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Montironi R, Scarpelli M, Cheng L, Lopez-Beltran A, Zhou M, Montorsi F. Do Not Misinterpret Intraductal Carcinoma of the Prostate as High-grade Prostatic Intraepithelial Neoplasia! Eur Urol 2012; 62:518-22. [DOI: 10.1016/j.eururo.2012.05.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 05/28/2012] [Indexed: 10/28/2022]
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Montironi R, Scarpelli M, Mazzucchelli R, Cheng L, Lopez-Beltran A. The spectrum of morphology in non-neoplastic prostate including cancer mimics. Histopathology 2012; 60:41-58. [PMID: 22212077 DOI: 10.1111/j.1365-2559.2011.04000.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The spectrum of morphology in non-neoplastic prostate includes lesions of prostatic epithelial origin, the most common being atrophy, including partial atrophy, adenosis (atypical adenomatous hyperplasia), basal cell hyperplasia and crowded benign glands, as well as those of non-prostatic origin, such as seminal vesicle epithelium. These lesions often mimic lower-grade prostatic adenocarcinoma whereas others, such as granulomatous prostatitis, for example, are in the differential diagnosis of adenocarcinoma, Gleason grades 4 or 5. Diagnostic awareness of the salient histomorphological and relevant immunohistochemical features of these prostatic pseudoneoplasms is critical to avoid rendering false positive diagnoses of malignancy.
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Capitanio U, Cheng L, Lopez-Beltran A, Scarpelli M, Freschi M, Montorsi F, Montironi R. Corrigendum to "The Importance of Interaction Between Urologists and Pathologists in Incidental Prostate Cancer Management" [Eur Eurol 2011;60;75-7]. Eur Urol 2012; 62:e47. [PMID: 27989299 DOI: 10.1016/j.eururo.2012.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mazzucchelli R, Cheng L, Lopez-Beltran A, Scarpelli M, Montironi R. Clinicopathological significance of lymphovascular invasion in urothelial carcinoma. ANALYTICAL AND QUANTITATIVE CYTOPATHOLOGY AND HISTOPATHOLOGY 2012; 34:173-179. [PMID: 23016463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Lymphovascular invasion is an important prognostic marker in the assessment of bladder cancer, including both cystectomy and transurethral resection of the bladder specimens, and should routinely be reported upon in the pathological report. Strict criteria must be utilized in establishing a diagnosis of lymphovascular invasion in urothelial carcinoma to distinguish it from peritumoral stromal retraction, a common finding that often mimics a vascular space. The use of immunohistochemistry (CD31, CD34, D2-40) for the diagnosis of intravascular invasion in urothelial carcinoma should be used only in selected histologically equivocal cases for confirmation. Routine use of immunohistochemistry for endothelium as a screening test in all cases cannot be recommended.
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Mazzucchelli R, Cheng L, Lopez-Beltran A, Scarpelli M, Montironi R. Classification and grading of noninvasive and invasive neoplasms of the urothelium. ANALYTICAL AND QUANTITATIVE CYTOLOGY AND HISTOLOGY 2012; 34:111-119. [PMID: 23016457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The classification and grading of the noninvasive, intraepithelial neoplasms of the urothelium are based on the morphological pattern of growth, i.e., papillary and flat (and endophytic), and on their degree of architectural and cytologic abnormalities. Recent advances in the morphological, molecular and quantitative evaluation of these lesions have contributed to the refinement of the current classification and grading schemes. However, some controversies on the precise criteria and terminology, especially when the papillary lesions are concerned, are still present.
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Tirabassi G, Kola B, Ferretti M, Papa R, Mancini T, Mantero F, Scarpelli M, Boscaro M, Arnaldi G. Fine-needle aspiration cytology of adrenal masses: a re-assessment with histological confirmation. J Endocrinol Invest 2012; 35:590-4. [PMID: 21979196 DOI: 10.3275/8010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Fine-needle aspiration (FNA) of adrenal masses is a method currently indicated in lesions suspected of being extra-adrenal in origin; even though its diagnostic reliability has already been determined in many studies, few have used histological examination obtained after adrenalectomy for diagnostic confirmation. AIM To analyze the diagnostic performance of adrenal FNA in subjects with an available histological confirmation. SUBJECTS AND METHODS Fifty subjects (26 benign adrenal lesions, 9 primary malignant lesions, and 15 metastatic lesions) who had undergone ultrasound (US)-guided adrenal FNA and then adrenalectomy were re-analyzed retrospectively. RESULTS FNA guaranteed a sensitivity of 85.7% and a specificity of 100% in all subjects; after having divided the subjects into oncologic and non-oncologic groups, the sensitivity of the test in oncologic patients (100%) increased significantly compared to non-oncologic (57.1%) with no difference in specificity (100% in both groups). Considering also non-diagnostic samples in our analysis (no.=11; 22% of all samples studied), FNA correctly diagnosed malignancy only in 75% of the cases and benignancy only in 66.6%; however, even after including non-diagnostic samples, the percentage of correct malignancy diagnosis remained significantly higher in oncologic (93.3%) than in non-oncologic patients (44.4%) without significant statistical difference between the 2 groups regarding the percentage of correct benignancy diagnosis (respectively 100% and 63.6%). CONCLUSIONS Our study, based on histological confirmation, underlines the low discriminant value of US-guided adrenal FNA, though the method may have value in oncologic patients.
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Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L, Montironi R. Spectrum of prostatic nonepithelial tumors and tumorlike conditions with spindle cell features. ANALYTICAL AND QUANTITATIVE CYTOLOGY AND HISTOLOGY 2012; 34:139-144. [PMID: 23016459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
There exists a wide and heterogeneous spectrum of spindle cell lesions that can originate from the prostatic stroma. This includes benign and malignant neoplasms as well as tumorlike conditions. Their diagnosis in small biopsy specimens is often difficult because of the potential for sampling error. The utility of ancillary studies, including immunohistochemistry, is often limited and the main criteria for diagnosis are the morphologic findings by routine hematoxylin and eosin stain.
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Scarpelli M, Mazzucchelli R, Barbisan F, Santinelli A, Lopez-Beltran A, Cheng L, Montironi R. Is there a role for prostate tumour overexpressed-1 in the diagnosis of HGPIN and of prostatic adenocarcinoma? A comparison with alpha-methylacyl CoA racemase. Int J Immunopathol Pharmacol 2012; 25:67-74. [PMID: 22507319 DOI: 10.1177/039463201202500109] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prostate Tumour Overexpressed-1 (PTOV1) was recently identified as a novel gene and protein during a differential display screening for genes overexpressed in prostate cancer (PCa). Alpha-Methyl-CoA racemase (AMACR) mRNA was identified as being overexpressed in PCa. PTOV1 and racemase were immunohistochemically evaluated in PCa, high-grade prostatic intraepithelial neoplasia (HGPIN), atrophy and normal-looking epithelium (NEp) in 20 radical prostatectomies (RPs) with pT2a Gleason score 6 prostate cancer with the aim of analyzing the differences in marker expression between PTOV1 and AMACR. The level of expression of PTOV1 and AMACR increased from NEp and atrophy through HGPIN, away from and adjacent to prostate cancer, to PCa. With the ROC curve analysis the overall accuracy in distinguishing PCa vs HGPIN away from and adjacent to cancer was higher for AMACR than for PTOV1. In conclusion, AMACR can be considered a more accurate marker than PTOV1 in the identification of HGPIN and of PCa. However, PTOV1 may aid in the diagnosis of PCa, at least to supplement AMACR as another positive marker of carcinoma and to potentially increase diagnostic accuracy.
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Shen SS, Truong LD, Scarpelli M, Lopez-Beltran A. Role of immunohistochemistry in diagnosing renal neoplasms: when is it really useful? Arch Pathol Lab Med 2012; 136:410-7. [PMID: 22458903 DOI: 10.5858/arpa.2011-0472-ra] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT With the refinement of molecular and histologic classifications of renal neoplasms and the availability of more-effective molecular targeted therapy for specific renal neoplasms, immunohistochemical techniques will play an increasingly important role in the diagnosis of renal neoplasm. During the past few decades, many markers have been evaluated for their role in the diagnosis, prognosis, and prediction of treatment for renal neoplasms. The number of useful markers in our routine practice continues to increase. The challenge will be to choose among them and to decide in which situations immunohistochemistry will be truly useful. OBJECTIVES To review the diagnostic utility of molecular markers for renal neoplasms and common diagnostic scenarios that call for immunohistochemistry in routine practice. DATA SOURCES This review is based on published literature and personal experience. CONCLUSIONS Some of the most important and useful markers for the diagnosis of renal neoplasm include cytokeratins, vimentin, PAX2, PAX8, RCC marker, CD10, E-cadherin, kidney-specific cadherin, parvalbumin, claudin-7, claudin-8, α-methylacyl coenzyme A racemase, CD117, TFE3, thrombomodulin, uroplakin III, p63, CD57, and carbonic anhydrase IX. Each marker has its diagnostic role in a specific diagnostic setting. The common diagnostic situations that call for immunohistochemical staining are differential diagnoses of renal versus nonrenal neoplasms, histologic subtyping of renal cell carcinoma, diagnosis of rare primary renal neoplasms, diagnosis of renal neoplasms in small core-biopsy specimens, diagnosis of possible metastatic renal carcinomas, and less frequently, molecular prognostication.
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McCourt C, Maxwell P, Mazzucchelli R, Montironi R, Scarpelli M, Salto-Tellez M, O'Sullivan JM, Longley DB, Waugh DJJ. Elevation of c-FLIP in castrate-resistant prostate cancer antagonizes therapeutic response to androgen receptor-targeted therapy. Clin Cancer Res 2012; 18:3822-33. [PMID: 22623731 DOI: 10.1158/1078-0432.ccr-11-3277] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To characterize the importance of cellular Fas-associated death domain (FADD)-like interleukin 1β-converting enzyme (FLICE) inhibitory protein (c-FLIP), a key regulator of caspase-8 (FLICE)-promoted apoptosis, in modulating the response of prostate cancer cells to androgen receptor (AR)-targeted therapy. EXPERIMENTAL DESIGN c-FLIP expression was characterized by immunohistochemical analysis of prostatectomy tissue. The functional importance of c-FLIP to survival and modulating response to bicalutamide was studied by molecular and pharmacologic interventions. RESULTS c-FLIP expression was increased in high-grade prostatic intraepithelial neoplasia and prostate cancer tissue relative to normal prostate epithelium (P < 0.001). Maximal c-FLIP expression was detected in castrate-resistant prostate cancer (CRPC; P < 0.001). In vitro, silencing of c-FLIP induced spontaneous apoptosis and increased 22Rv1 and LNCaP cell sensitivity to bicalutamide, determined by flow cytometry, PARP cleavage, and caspase activity assays. The histone deacetylase inhibitors (HDACi), droxinostat and SAHA, also downregulated c-FLIP expression, induced caspase-8- and caspase-3/7-mediated apoptosis, and increased apoptosis in bicalutamide-treated cells. Conversely, the elevated expression of c-FLIP detected in the CRPC cell line VCaP underpinned their insensitivity to bicalutamide and SAHA in vitro. However, knockdown of c-FLIP induced spontaneous apoptosis in VCaP cells, indicating its relevance to cell survival and therapeutic resistance. CONCLUSION c-FLIP reduces the efficacy of AR-targeted therapy and maintains the viability of prostate cancer cells. A combination of HDACi with androgen deprivation therapy may be effective in early-stage disease, using c-FLIP expression as a predictive biomarker of sensitivity. Direct targeting of c-FLIP, however, may be relevant to enhance the response of existing and novel therapeutics in CRPC.
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Montironi R, Scarpelli M, Mazzucchelli R, Cheng L, Lopez-Beltran A, Montorsi F. Extent of Cancer of Less Than 50% in Any Prostate Needle Biopsy Core: How Many Millimeters Are There? Eur Urol 2012; 61:751-6. [DOI: 10.1016/j.eururo.2011.12.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/26/2011] [Indexed: 11/17/2022]
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