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Loizzi V, Mongelli M, Arezzo F, Romagno I, Cazzato G, Popescu O, Legge F, Trerotoli P, Silvestris E, Kardhashi A, Cormio G. BRCA Mutation Patients: Are There Other Predisposing Factors for Ovarian Cancer Occurrence? A Multicenter Retrospective Study. Gynecol Obstet Invest 2024; 89:87-94. [PMID: 38246147 DOI: 10.1159/000535012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 10/29/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVES The objective of this multicenter retrospective study aimed to evaluate the association of clinical variables and the incidence of ovarian cancer in patients with BRCA 1-2 mutation carriers who underwent risk-reducing salpingo-oophorectomy (RRSO). DESIGN Patients with a pathogenic mutation of BRCA 1-2 genes and with no evidence of disease are considered eligible. The exclusion criterion was the refusal to undergo the surgery. The retrospective study included all RRSO performed from May 2015 to April 2022 in the three gynecological Institutions of Southern Italy for were included in this retrospective study. PARTICIPANTS/MATERIALS, SETTING, METHODS Age, menarche age, BMI, menopause at time of RRSO, breast cancer first- and second-degree relatives, ovarian cancer first- and second-degree relatives, estroprogestin use, pregnancy normal full-term delivery, history of endometriosis, previous breast cancer and histologic type, previous abdominal/pelvic surgery, BRCA 1 or BRCA 2 status, preoperative serum CA-125 levels (IU/mL), age at time of RRSO and histological analysis were collected. RESULTS 184 were recruited. One was excluded. To assess cancer risk, the outcome variable was classified into three classes: no event, cancer, and other conditions excluding cancer. 14 women presented ovarian cancer and tubal intraepithelial carcinoma (STIC) on histopathologic final report. Ovarian cancer was found in 8 patients, whereas the presence of STIC was found in 6 of them. LIMITATIONS The low incidence of patients diagnosed with ovarian cancer or STIC compared with the total number of patients undergoing RRSO is a potential bias. CONCLUSIONS Our study did not demonstrate a correlation between clinical features and the occurrence of precancerous or cancerous lesions in BRCA mutation carrier patients.
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Affiliation(s)
- Vera Loizzi
- S.S.D. Ginecologia Oncologica Clinicizzata, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
- Dipartimento di Biomedicina Traslazionale e Neuroscienze (DiBraiN), University of Bari "Aldo Moro", Bari, Italy
| | - Michele Mongelli
- Obstetrics and Gynecology Unit, University of "Aldo Moro", Bari, Italy
| | - Francesca Arezzo
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
| | - Isabella Romagno
- Obstetrics and Gynecology Unit, University of "Aldo Moro", Bari, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - Ondina Popescu
- S.C. Anatomia Patologica, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, General Regional Hospital "F. Miulli", Acquaviva Delle Fonti, Italy
| | - Paolo Trerotoli
- Medical Statistic and Biometry Unit, Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Erica Silvestris
- S.S.D. Ginecologia Oncologica Clinicizzata, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Anila Kardhashi
- S.S.D. Ginecologia Oncologica Clinicizzata, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Gennaro Cormio
- S.S.D. Ginecologia Oncologica Clinicizzata, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
- Department of Interdisciplinary Medicine (DIM), University of Bari "Aldo Moro", Bari, Italy
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Lombardi A, Arezzo F, Di Sciascio E, Ardito C, Mongelli M, Di Lillo N, Fascilla FD, Silvestris E, Kardhashi A, Putino C, Cazzolla A, Loizzi V, Cazzato G, Cormio G, Di Noia T. A human-interpretable machine learning pipeline based on ultrasound to support leiomyosarcoma diagnosis. Artif Intell Med 2023; 146:102697. [PMID: 38042596 DOI: 10.1016/j.artmed.2023.102697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 10/08/2023] [Accepted: 10/29/2023] [Indexed: 12/04/2023]
Abstract
The preoperative evaluation of myometrial tumors is essential to avoid delayed treatment and to establish the appropriate surgical approach. Specifically, the differential diagnosis of leiomyosarcoma (LMS) is particularly challenging due to the overlapping of clinical, laboratory and ultrasound features between fibroids and LMS. In this work, we present a human-interpretable machine learning (ML) pipeline to support the preoperative differential diagnosis of LMS from leiomyomas, based on both clinical data and gynecological ultrasound assessment of 68 patients (8 with LMS diagnosis). The pipeline provides the following novel contributions: (i) end-users have been involved both in the definition of the ML tasks and in the evaluation of the overall approach; (ii) clinical specialists get a full understanding of both the decision-making mechanisms of the ML algorithms and the impact of the features on each automatic decision. Moreover, the proposed pipeline addresses some of the problems concerning both the imbalance of the two classes by analyzing and selecting the best combination of the synthetic oversampling strategy of the minority class and the classification algorithm among different choices, and the explainability of the features at global and local levels. The results show very high performance of the best strategy (AUC = 0.99, F1 = 0.87) and the strong and stable impact of two ultrasound-based features (i.e., tumor borders and consistency of the lesions). Furthermore, the SHAP algorithm was exploited to quantify the impact of the features at the local level and a specific module was developed to provide a template-based natural language (NL) translation of the explanations for enhancing their interpretability and fostering the use of ML in the clinical setting.
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Affiliation(s)
- Angela Lombardi
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy.
| | - Francesca Arezzo
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Eugenio Di Sciascio
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy
| | - Carmelo Ardito
- Department of Engineering, LUM "Giuseppe Degennaro" University, Casamassima, Bari, Italy
| | - Michele Mongelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Di Lillo
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | | | - Erica Silvestris
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Anila Kardhashi
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Carmela Putino
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Ambrogio Cazzolla
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vera Loizzi
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Interdisciplinar Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Gerardo Cazzato
- Section of Pathology, Department of Emergency and Organ Transplantation (DETO), University of Bari "Aldo Moro", Bari, Italy
| | - Gennaro Cormio
- Gynecologic Oncology Unit, Interdisciplinar Department of Medicine, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy; Interdisciplinar Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Tommaso Di Noia
- Department of Electrical and Information Engineering (DEI), Politecnico di Bari, Bari, Italy
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Comes MC, Arezzo F, Cormio G, Bove S, Calabrese A, Fanizzi A, Kardhashi A, La Forgia D, Legge F, Romagno I, Loizzi V, Massafra R. An explainable machine learning ensemble model to predict the risk of ovarian cancer in BRCA-mutated patients undergoing risk-reducing salpingo-oophorectomy. Front Oncol 2023; 13:1181792. [PMID: 37519818 PMCID: PMC10374844 DOI: 10.3389/fonc.2023.1181792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction It has been estimated that 19,880 new cases of ovarian cancer had been diagnosed in 2022. Most epithelial ovarian cancer are sporadic, while in 15%-25% of cases, there is evidence of a familial or inherited component. Approximately 20%-25% of high-grade serous carcinoma cases are caused by germline mutations in the BRCA1 and BRCA2 genes. However, owing to a lack of effective early detection methods, women with BRCA mutations are recommended to undergo bilateral risk-reducing salpingo-oophorectomy (RRSO) after childbearing. Determining the right timing for this procedure is a difficult decision. It is crucial to find a clinical signature to identify high-risk BRCA-mutated patients and determine the appropriate timing for performing RRSO. Methods In this work, clinical data referred to a cohort of 184 patients, of whom 7.6% were affected by adnexal tumors including invasive carcinomas and intraepithelial lesions after RSSO has been analyzed. Thus, we proposed an explainable machine learning (ML) ensemble approach using clinical data commonly collected in clinical practice to early identify BRCA-mutated patients at high risk of ovarian cancer and consequentially establish the correct timing for RRSO. Results The ensemble model was able to handle imbalanced data achieving an accuracy value of 83.2%, a specificity value of 85.3%, a sensitivity value of 57.1%, a G-mean value of 69.8%, and an AUC value of 71.1%. Discussion In agreement with the promising results achieved, the application of suitable ML techniques could play a key role in the definition of a BRCA-mutated patient-centric clinical signature for ovarian cancer risk and consequently personalize the management of these patients. As far as we know, this is the first work addressing this task from an ML perspective.
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Affiliation(s)
- Maria Colomba Comes
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Francesca Arezzo
- Dipartimento di Medicina di Precisione e Rigenerativa e Area Jonica - (DiMePRe-J), Università di Bari “Aldo Moro”, Bari, Italy
- Ginecologia Oncologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Gennaro Cormio
- Ginecologia Oncologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Dipartimento Interdisciplinare di Medicina (DIM), Università di Bari “Aldo Moro”, Bari, Italy
| | - Samantha Bove
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Angela Calabrese
- Unità Operativa Semplice di Radiodiagnostica Avanzata, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Annarita Fanizzi
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Anila Kardhashi
- Ginecologia Oncologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Daniele La Forgia
- Struttura Semplice Dipartimentale di Radiologia Senologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Francesco Legge
- Unità di Ginecologia Oncologica, “F. Miulli” Ospedale Generale Regionale, Acquaviva delle Fonti, Bari, Italy
| | | | - Vera Loizzi
- Ginecologia Oncologica, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- Dipartimento Interdisciplinare di Medicina (DIM), Università di Bari “Aldo Moro”, Bari, Italy
| | - Raffaella Massafra
- Struttura Semplice Dipartimentale di Fisica Sanitaria, I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
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Arezzo F, Cormio G, Putino C, Di Lillo N, Silvestris E, Kardhashi A, Cazzolla A, Lombardi C, Mongelli M, Cazzato G, Loizzi V. Overlap of Suspicious and Non-Suspicious Features in the Ultrasound Evaluations of Leiomyosarcoma: A Single-Center Experience. Diagnostics (Basel) 2023; 13:diagnostics13030543. [PMID: 36766648 PMCID: PMC9914677 DOI: 10.3390/diagnostics13030543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/21/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
Leiomyosarcoma (LMS) is a rare type of mesenchymal tumor. Suspecting LMS before surgery is crucial for proper patient management. Ultrasound is the primary method for assessing myometrial lesions. The overlapping of clinical, laboratory, as well as ultrasound features between fibroids and LMS makes differential diagnosis difficult. We report our single-center experience in ultrasound imaging assessment of LMS patients, highlighting that misleading findings such as shadowing and absent or minimal vascularization may also occur in LMS. To avoid mistakes, a comprehensive evaluation of potentially overlapping ultrasound features is necessary in preoperative ultrasound evaluations of all myometrial tumors.
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Affiliation(s)
- Francesca Arezzo
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
- Correspondence: ; Tel.: +39-3274961788
| | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
- Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Carmela Putino
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Nicola Di Lillo
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Erica Silvestris
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | - Anila Kardhashi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | - Ambrogio Cazzolla
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | - Claudio Lombardi
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Michele Mongelli
- Department of Biomedical Sciences and Human Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Gerardo Cazzato
- Section of Molecular Pathology, Department of Emergency and Organ Transplantation, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Vera Loizzi
- Interdisciplinar Department of Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
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Loizzi V, Cicinelli E, Del Vecchio V, Arezzo F, Deromemaj X, Kardhashi A, Paradiso A, Legge F, Natalicchio MI, Resta L, Resta N, Loconte DC, Cormio G. A prospective multicentric study of risk-reducing salpingo-oophorectomy in BRCA mutation patients. Acta Biomed 2022; 93:e2022051. [PMID: 36043985 PMCID: PMC9534247 DOI: 10.23750/abm.v93i4.11695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIM OF THE WORK BRCA1/2 are tumour-suppressor genes involved in DNA homologous recombination and ovarian cancer development. The study evaluated the risk of tumor cancer in women presenting the BRCA mutations. METHODS Risk-reducing surgery (RRS) was performed in 100 patients carrying BRCA1 (aged between 30-73 years, median age was 51 years) and BRCA 2 mutation (aged between 36-70 years, median age was 53 years). Fifty-eight patients had previous history of breast cancer. RESULTS Between the 100 patients, 82 women underwent risk-reducing salpingo-oophorectomy (RRSO) through a laparoscopic minimally invasive approach, 7 (7 %) underwent laparoscopic RRSO and contextual hysterectomy, 1 woman (1 %) underwent RRSO through a laparotomic approach and 10 women (10 %) laparotomic RRSO and hysterectomy. During 5 (5 %) laparoscopic RRSO, prophylactic bilateral mastectomy was also performed. Early and late complication occurred in 3 patients (3 %). Two patients (2 %) were found to have occult Serous Tubal Intraepithelial Carcinoma (STIC) and three patients (3 %) occult cancer. CONCLUSIONS RRSO is safe and feasible in BRCA mutation carriers. The procedure is effective for genetic prevention of ovarian cancer.
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Affiliation(s)
- Vera Loizzi
- Obstetrics and Gynecology Unit, Interdisciplinar Department of Medicine, University of Bari, Italy
| | - Ettore Cicinelli
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Vittoria Del Vecchio
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Francesca Arezzo
- Gynecology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Xheni Deromemaj
- Obstetrics and Gynecology Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Anila Kardhashi
- Gynecology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Angelo Paradiso
- Institutional BioBank, Experimental Oncology and Biobank Management Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Francesco Legge
- Gynecologic Oncology Unit, General Regional Hospital “F. Miulli” of Acquaviva delle Fonti, Italy
| | | | | | - Nicoletta Resta
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Daria Carmela Loconte
- Medical Genetics Unit, Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Gennaro Cormio
- Gynecology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Interdisciplinar Department of Medicine, University of Bari, Italy
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Loizzi V, Ranieri G, Laforgia M, Gadaleta CD, Gargano G, Kardhashi A, De Liso M, Naglieri E, Del Vecchio V, Cicinelli E, Cormio G. PARP inhibitors and epithelial ovarian cancer: Molecular mechanisms, clinical development and future prospective. Oncol Lett 2020; 20:90. [PMID: 32831909 PMCID: PMC7439101 DOI: 10.3892/ol.2020.11951] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/30/2020] [Indexed: 12/13/2022] Open
Abstract
Epithelial ovarian cancer (EOC) has a poor prognosis. Since the introduction of paclitaxel as antineoplastic agent >20 years ago, only a few phase III randomized trials have shown challenging data regarding different therapeutic options for facing its aggressive clinical course and granting active therapies to patients. Different studies have shown the utility of poly(ADP-ribose) polymerase (PARP) inhibitors in women with EOC with or without BRCA mutations, both germline and somatic. Three PARP inhibitors, olaparib, rucaparib and niraparib, have been recently approved by the Food and Drug Administration for clinical use in EOC patients, though with different clinical indications and profiles of toxicity, while two other molecules, veliparib and talazoparib, are still under clinical investigation. The aim of the present paper is to evaluate the current status of PARP inhibitors in terms of molecular activity, pharmacodynamic properties and clinical applications.
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Affiliation(s)
- Vera Loizzi
- Department of Biomedical Sciences and Human Oncology, University of Bari, I-70121 Bari, Italy
| | - Girolamo Ranieri
- Interventional and Medical Oncology Unit, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico 'Giovanni Paolo II', I-70124 Bari, Italy
| | - Mariarita Laforgia
- Pharmacy Unit, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico 'Giovanni Paolo II', I-70124 Bari, Italy
| | - Cosmo Damiano Gadaleta
- Interventional and Medical Oncology Unit, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico 'Giovanni Paolo II', I-70124 Bari, Italy
| | - Giulio Gargano
- Gynecology Unit, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico 'Giovanni Paolo II', I-70124 Bari, Italy
| | - Anila Kardhashi
- Gynecology Unit, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico 'Giovanni Paolo II', I-70124 Bari, Italy
| | - Maria De Liso
- Gynecology Unit, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico 'Giovanni Paolo II', I-70124 Bari, Italy
| | - Emanuele Naglieri
- Medical Oncology Unit, IRCCS Istituto di Ricovero e Cura a Carattere Scientifico 'Giovanni Paolo II', I-70124 Bari, Italy
| | - Vittoria Del Vecchio
- Department of Biomedical Sciences and Human Oncology, University of Bari, I-70121 Bari, Italy
| | - Ettore Cicinelli
- Department of Biomedical Sciences and Human Oncology, University of Bari, I-70121 Bari, Italy
| | - Gennaro Cormio
- Department of Biomedical Sciences and Human Oncology, University of Bari, I-70121 Bari, Italy
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Silvestris E, D’Oronzo S, Cafforio P, Kardhashi A, Dellino M, Cormio G. In Vitro Generation of Oocytes from Ovarian Stem Cells (OSCs): In Search of Major Evidence. Int J Mol Sci 2019; 20:ijms20246225. [PMID: 31835581 PMCID: PMC6940822 DOI: 10.3390/ijms20246225] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 02/07/2023] Open
Abstract
The existence of ovarian stem cells (OSCs) in women as well as their physiological role in post-menopausal age are disputed. However, accumulating evidence demonstrated that, besides the animal models including primarily mice, even in adult women putative OSCs obtained from ovarian cortex are capable to differentiate in vitro into oocyte-like cells (OLCs) expressing molecular markers typical of terminal stage of oogonial cell lineage. Recent studies describe that, similarly to mature oocytes, the OSC-derived OLCs also contain haploid karyotype. As proof of concept of their stem commitment, OSCs from mice differentiated to oocytes in vitro are suitable to be fertilized and implanted in sterilized animals resulting in embryo development. Despite enthusiasm for these data, which definitely require extended confirmation before considering potential application in humans for treatment of ovarian insufficiency, OSCs appear suitable for other clinical uses, restoring the endocrine derangements in premature ovarian failure or for fertility preservation in oncologic patients after anti-cancer treatments. In this context, the selection of viable oocytes generated from OSCs before chemotherapy protocols would overcome the potential adjunct oncogenic risk in women bearing hormone-dependent tumors who are repeatedly stimulated with high dose estrogens to induce oocyte maturation for their egg recruitment and cryopreservation.
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Affiliation(s)
- Erica Silvestris
- Gynecologic Oncology Unit, National Cancer Center, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.K.); (M.D.); (G.C.)
- Correspondence:
| | - Stella D’Oronzo
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, 70124 Bari, Italy; (S.D.); (P.C.)
- National Cancer Center, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy
| | - Paola Cafforio
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Aldo Moro, 70124 Bari, Italy; (S.D.); (P.C.)
| | - Anila Kardhashi
- Gynecologic Oncology Unit, National Cancer Center, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.K.); (M.D.); (G.C.)
| | - Miriam Dellino
- Gynecologic Oncology Unit, National Cancer Center, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.K.); (M.D.); (G.C.)
| | - Gennaro Cormio
- Gynecologic Oncology Unit, National Cancer Center, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy; (A.K.); (M.D.); (G.C.)
- Department of Biomedical Sciences and Human Oncology, Unit of Obstetrics and Gynecology, University of Bari Aldo Moro, 70124 Bari, Italy
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Loiacono RMR, Traversi P, Deliso MA, Gargano G, Kardhashi A, Francescato R, Loizzi V, Spinelli M, Lovascio S, Fiorito M, Resta L, Popescu O, Cicinelli E, Cormio G. Paget disease of the vulva an analysis of 24 cases. Medicine (Baltimore) 2019; 98:e17018. [PMID: 31593076 PMCID: PMC6799860 DOI: 10.1097/md.0000000000017018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Paget's disease can arise in the breast (mammary Paget disease) or in other locations (extramammary Paget disease) such as anogenital skin in both males and females (Paget disease of the vulva [PDV]). Underlying adenocarcinoma can be found in some cases. This study aims to report clinical aspects, surgical procedures, outcomes, and recurrences of patients with PDV.A retrospective chart review was conducted on patients with pathologically confirmed diagnosis of PDV managed at the Department of Obstetrics and Gynecology, University of Bari, and the "Giovanni Paolo II" National Cancer Institute in Bari, between 1998 and 2018.Records of 24 cases of PDV were examined. Median age of the patients at diagnosis was 69.3 (range 38-84), diagnosis of synchronous cancer was made in 2 cases and in 2 other cases of metachronous disease. Three patients had previously been diagnosed with other oncological diseases. All patients underwent surgery including wide local excision (6), simple vulvectomy (8), and extended vulvectomy (10). Lymphadenectomy was performed in 2 cases and reconstructions with advancement flaps in 7 cases. Four patients were found to have invasive disease and 1 had inguinal node involvement. Positive margins were found in 11 patients. Wound dehiscence and urethral stenosis were found in 4 and 1 case each. Eight recurrences (33.33%) were observed, regardless of positive surgical margins.PDV has a low rate of malignancy but a high rate of recurrence. It should be diagnosed early to avoid repeated surgery and to reduce symptoms and morbidity.
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Affiliation(s)
| | | | | | - Giulio Gargano
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”
| | - Anila Kardhashi
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”
| | | | | | | | | | | | | | - Ondina Popescu
- Department of Pathology, IRCCS Istituto Tumori “Giovanni Paolo II,” Bari, Italy
| | | | - Gennaro Cormio
- Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”
- Department of Obstetrics and Gynecology
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9
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Digennaro M, Sambiasi D, Tommasi S, Pilato B, Diotaiuti S, Kardhashi A, Trojano G, Tufaro A, Paradiso AV. Hereditary and non-hereditary branches of family eligible for BRCA test: cancers in other sites. Hered Cancer Clin Pract 2017; 15:7. [PMID: 28559958 PMCID: PMC5445420 DOI: 10.1186/s13053-017-0067-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 05/17/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The analysis of relationships of BRCA alterations with cancer at sites other than breast/ovary may provide innovative information concerning BRCA pathogenic role and support additional clinical decisions. Aim of this study is to compare presence of cancers in other sites in members of hereditary (H) and not-hereditary (nH) branches of families of patients eligible to BRCA test. METHODS We retrospectively analyzed the incidence of cancer in other sites in members of 136 families eligible for hereditary breast/ovarian cancer genetic counseling at Centro Studi Tumori Eredo-familiari of our Institute; we compared the frequency of other cancer types in 1156 members of the H-branch with respect to 1062 members of nH-Branch. The families belonging to a proband case and with informative members in at least three generation entered the present study. RESULTS The frequency of other Cancers in members of H-branch was significantly higher than that in members of nH-branch (161 vs 75 cancers; p < 0.0001). In specific, members of H-branch had a significantly higher probability to have more lung cancer (38 vs 9;p < 0.0006), kidney cancer (23 vs 5;p < 0.0005), liver cancer (13 vs 3;p < 0.02) and larynx cancer (14 vs 4;p < 0.03). Interestingly, to belong to H-branch resulted significantly associated with a higher probability of lung cancer (OR 4.5; 2.15-9.38 95%C.I.), liver cancer (OR: 4.02; 1.14-14.15 95% C.I.) and larynx cancer (OR:3.4; 1.12-10.39 95%C.I.) independently from Gender and Age. CONCLUSIONS Members belonging to the H-branch of families of patients eligible to BRCA test have a higher risk of tumors in lung, larynx and liver. Clinicians should consider the increased risk for these cancers to activate prevention/early diagnosis practices in members of families with breast/ovarian familial cancer syndrome.
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Affiliation(s)
- M Digennaro
- Centro Studi Tumori Eredo-familiari. Istituto Tumori G Paolo II,IRCCS, 70124 Bari, Italy
| | - D Sambiasi
- Centro Studi Tumori Eredo-familiari. Istituto Tumori G Paolo II,IRCCS, 70124 Bari, Italy
| | - S Tommasi
- Laboratorio Genetica Molecolare; Istituto Tumori G Paolo II, IRCCS, 70124 Bari, Italy
| | - B Pilato
- Laboratorio Genetica Molecolare; Istituto Tumori G Paolo II, IRCCS, 70124 Bari, Italy
| | - S Diotaiuti
- UO Senologia Tumori. Istituto Tumori G Paolo II,IRCCS, 70124 Bari, Italy
| | - A Kardhashi
- UO Senologia Tumori. Istituto Tumori G Paolo II,IRCCS, 70124 Bari, Italy.,UO Ginecologia Oncologica, Istituto Tumori G Paolo II, IRCCS, 70124 Bari, Italy
| | - G Trojano
- ASST Fatebene Fratelli, Milan, Italy
| | - A Tufaro
- Biobanca Istituzionale, Istituto Tumori G Paolo II, IRCCS, 70124 Bari, Italy
| | - A V Paradiso
- Centro Studi Tumori Eredo-familiari. Istituto Tumori G Paolo II,IRCCS, 70124 Bari, Italy.,Centro Studi Tumori Eredo-Familiari, Istituto Tumori G Paolo II, IRCCS, Via O. Flacco, 65, 70124 Bari, Italy
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10
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Loiacono RMR, Trojano G, Del Gaudio N, Kardhashi A, Deliso MA, Falco G, Sforza R, Laera AF, Galise I, Trojano V. Hysteroscopy as a valid tool for endometrial pathology in patients with postmenopausal bleeding or asymptomatic patients with a thickened endometrium: hysteroscopic and histological results. Gynecol Obstet Invest 2015; 79:210-6. [PMID: 25765014 DOI: 10.1159/000371758] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 12/26/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study compares hysteroscopic and histopathological results in postmenopausal women with abnormal uterine bleeding (AUB) and asymptomatic postmenopausal women with a thickened endometrium. MATERIALS AND METHODS This is a retrospective study of 570 cases hysteroscopically examined between January 2008 and July 2012. The patients were followed up at the Istituto Tumori 'Giovanni Paolo II', Bari, Italy. RESULTS A total of 320 of the 570 cases were selected. The inclusion criteria were transvaginal ultrasound, hysteroscopy and endometrial biopsy. In the AUB group, if the hysteroscopy results were normal, a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100, 95, 71 and 100%, respectively, were achieved, while in the asymptomatic group these values were 100, 97, 90 and 100%, respectively. For both the group with polyps and that with myomas, the sensitivity, specificity, PPV and NPV were 100%. For endometrial hyperplasia, hysteroscopy showed a sensitivity, specificity, PPV and NPV of 81, 96, 87 and 93%, respectively, in the AUB group, while in the asymptomatic group, the sensitivity was 60%, the specificity and PPV were 100%, and the NPV was 98%. The sensitivity of hysteroscopy for endometrial cancer was 63%, the specificity 97%, the PPV 77%, and the NPV 95%. CONCLUSIONS In postmenopausal women with a thickened endometrium with or without AUB, hysteroscopy allows for an accurate diagnosis in benign endometrial pathology. Hysteroscopy also allows directed biopsies of suspicious lesions, which is useful in malignant endometrial pathology.
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Affiliation(s)
- Rosalia Maria Rita Loiacono
- Division of Gynaecologic Oncology, Apulian Cancer Registry, National Cancer Research Centre, Istituto Tumori 'Giovanni Paolo II', Bari, Italy
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11
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Sambiasi D, Lambo R, Pilato B, Tommasi S, Trojano G, Kardhashi A, Digennaro M, Trojano V, Simone G, Paradiso A. BRCA1/2 and clinical outcome in a monoinstitutional cohort of women with hereditary breast cancer. Oncol Rep 2013; 31:365-9. [PMID: 24145998 DOI: 10.3892/or.2013.2802] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/17/2012] [Indexed: 11/05/2022] Open
Abstract
The clinical outcome of BRCA mutation carriers and non-carriers still remains a topic of discussion. In order to interpret controversial data, in the present study, we analyzed a large consecutive monoinstitutional series of breast cancer patients and relatives with familial features carrying or not carrying BRCA mutations. The intense research in recent years regarding the clinical genetics of patients with breast or ovarian cancer and their relatives has allowed the organization of a unique database comprising anamnestic, clinical, pathological and molecular data. Families with two or more cases of breast cancer under the age of 50 years, or with three cases at any age, were identified. From June, 2003 to June, 2010, a total of 202 patients (136 probands + 66 relatives) from 45 families were included in the analysis. A total of 136 (49 carrier and 87 non-carrier) cases had a cancer diagnosis at the time of their genetic testing. Twenty and 24 events were observed in the carrier and control group, respectively. The 10-year disease-free suvival rate was 57% for patients in the control group compared with 50% for patients carrying a BRCA mutation (P=0.15 by log-rank test). Finally, 66 (32 genetic and 34 control) cases were unaffected at the time of molecular analysis, and 6 new cases of cancer were observed in the carriers, while no new cases were detected in the control cohort. Thus, at age 50, 40% of carriers had a high risk of disease (P=0.0069 by log-rank test). Our data support the hypothesis that the presence of BRCA mutations does not alter the clinical outcome for hereditary breast cancer patients. Conversely, BRCA mutations are proven to be crucial for prediction of risk in healthy relatives from carrier families.
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Affiliation(s)
- Domenico Sambiasi
- National Cancer Research Centre 'Giovanni Paolo II', I-70124 Bari, Italy
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12
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Addati T, Caponio M, Petroni S, Popescu O, Trojano G, Falco G, Kardhashi A, Trojano V, Simone G. M404 P16INK4A EXPRESSION IN UTERINE METASTASES OF EXTRAUTERINE ORIGIN: UTILITY FOR METASTATIC ADENOCARCINOMAS IDENTIFICATION. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61595-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kardhashi A, Renna A, Deliso M, Falco G, Del Gaudio N, Trojano G, Loiacono R, Laera A, Mattioli V, Trojano V. M361 THE FEASIBILITY OF ONCOLOGIC SURGERY IN ELDERLY PATIENTS WITH GYNAECOLOGICAL CANCER. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kardhashi A, Assunta Deliso M, Renna A, Trojano G, Zito FA, Trojano V. Benign granular cell tumor of the vulva: first report of multiple cases in a family. Gynecol Obstet Invest 2012; 73:341-8. [PMID: 22517025 DOI: 10.1159/000336256] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 01/04/2012] [Indexed: 12/17/2022]
Abstract
Granular cell tumors (GCTs) are uncommon soft tissue tumors of neural derivation, as supported by immunohistochemical and ultrastructural evidence. Vulvar involvement has been reported in 7-16%. This paper presents the cases of a 60-year-old woman and her 32-year-old niece with a strong family history of cancer, both presenting with an enlarging mass on their left labia majora. The lesions were treated by simple surgical excision. Histopathological examination revealed a benign vulvar GCT in both lesions. This is the first reported case of GCT of the vulva in the same family. The possible familial component of GCT needs further investigation. A systematic review of the literature on vulvar GCTs is carried out, the most complete one to date. This review unexpectedly reveals that there have been more than 130 cases of GCT of the vulva reported to date, only 7 of which were malignant. Since 5-25% of patients have multiple lesions, before planning treatment, clinicians should exclude multicentric lesions. After surgical treatment, if there is any evidence of tumor in the surgical margin, wider local excision should be performed. Regular follow-up is important for diagnosing a possible recurrence or a new lesion.
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Affiliation(s)
- Anila Kardhashi
- Division of Gynaecologic Oncology, Cancer Institute Giovanni Paolo II, Bari, Italy.
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