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Gore S, Grimaldi G, Mazzone G, Collin R, Savino G, Pagnoni M, Modugno A. Treatment strategies and long-term outcomes in patients with congenital microphthalmia-anophthalmia with cyst. Br J Ophthalmol 2022; 107:750-755. [PMID: 35101939 DOI: 10.1136/bjophthalmol-2020-318089] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/13/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Microphthalmia and anophthalmia are rare conditions, which represent ocular maldevelopment; both may be associated with orbital cysts. Current literature recommends retention to stimulate orbital growth during socket rehabilitation but does not illustrate their potential to deform the periocular tissues. This study aims to illustrate the long-term outcomes when other elements, such as forniceal and lid development, are also considered when formulating bespoke treatment plans for patients. METHODS Retrospective case series of 78 patients attending a single prosthetics clinic between 1988 and 2020. Clinical and surgical notes, radiological imaging, clinical photographs and patient/doctor satisfaction questionnaires were used to report patient outcomes and natural history data. RESULTS 89 sockets of 78 patients (11 bilateral) were included; average age of presentation being 2.8 years (9 days to 29.5 years). Cysts were clinically detected (48%) or were incidental findings (52%). The mean follow-up time was 7.2 years (6 months to 28 years). Cysts in 46% of sockets underwent surgical excision while the remainder were retained. Satisfaction surveys were obtained for 75 patients, with cosmetic outcomes rated as 'excellent' or 'good' in 90% of cases by physicians and 97% of cases by patients or guardians. CONCLUSION The favourable long-term outcomes in this study have resulted from bespoke plans which considered periocular tissue development, regional orbital growth and orbital volume replacement. The authors contemplate cyst excision if the prosthetic fitting or retention is impeded by the cyst as this often heralds the increased risk of long-term periocular distortion.
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Affiliation(s)
- Sri Gore
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, UK .,Department of Ophthalmology, Ocularistica Italiana, Rome, Italy
| | - Gabriela Grimaldi
- Department of Ophthalmology, Ocularistica Italiana, Rome, Italy.,Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Richard Collin
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Gustavo Savino
- Opthalmology, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Roma, Italy
| | - Mario Pagnoni
- Department of Maxillo-facial surgery, Your Face Surgery Villa Parioli Clinic, Rome, Italy
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Guida V, Sparascio FP, Bernardini L, Pancheri F, Melis D, Cocciadiferro D, Pagnoni M, Puzzo M, Goldoni M, Barone C, Hozhabri H, Putotto C, Giuffrida MG, Briuglia S, Palumbo O, Bianca S, Stanzial F, Benedicenti F, Kariminejad A, Forzano F, Baghernajad Salehi L, Mattina T, Brancati F, Castori M, Carella M, Fadda MT, Iannetti G, Dallapiccola B, Digilio MC, Marino B, Tartaglia M, De Luca A. Copy number variation analysis implicates novel pathways in patients with oculo-auriculo-vertebral-spectrum and congenital heart defects. Clin Genet 2021; 100:268-279. [PMID: 33988253 DOI: 10.1111/cge.13994] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 12/19/2022]
Abstract
Oculo-auriculo-vertebral spectrum (OAVS) is a developmental disorder of craniofacial morphogenesis. Its etiology is unclear, but assumed to be complex and heterogeneous, with contribution of both genetic and environmental factors. We assessed the occurrence of copy number variants (CNVs) in a cohort of 19 unrelated OAVS individuals with congenital heart defect. Chromosomal microarray analysis identified pathogenic CNVs in 2/19 (10.5%) individuals, and CNVs classified as variants of uncertain significance in 7/19 (36.9%) individuals. Remarkably, two subjects had small intragenic CNVs involving DACH1 and DACH2, two paralogs coding for key components of the PAX-SIX-EYA-DACH network, a transcriptional regulatory pathway controlling developmental processes relevant to OAVS and causally associated with syndromes characterized by craniofacial involvement. Moreover, a third patient showed a large duplication encompassing DMBX1/OTX3, encoding a transcriptional repressor of OTX2, another transcription factor functionally connected to the DACH-EYA-PAX network. Among the other relevant CNVs, a deletion encompassing HSD17B6, a gene connected with the retinoic acid signaling pathway, whose dysregulation has been implicated in craniofacial malformations, was also identified. Our findings suggest that CNVs affecting gene dosage likely contribute to the genetic heterogeneity of OAVS, and implicate the PAX-SIX-EYA-DACH network as novel pathway involved in the etiology of this developmental trait.
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Affiliation(s)
- Valentina Guida
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Francesca Piceci Sparascio
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.,Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Laura Bernardini
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Francesco Pancheri
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Daniela Melis
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Naples, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Dario Cocciadiferro
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.,Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mario Pagnoni
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Rome, Italy
| | - Marianna Puzzo
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Marina Goldoni
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Chiara Barone
- Medical Genetics, Referral Center for Rare Genetic Diseases, ARNAS Garibaldi, Catania, Italy
| | - Hossein Hozhabri
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Maria Grazia Giuffrida
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Silvana Briuglia
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Emergency Pediatrics, University of Messina, Messina, Italy
| | - Orazio Palumbo
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Sebastiano Bianca
- Medical Genetics, Referral Center for Rare Genetic Diseases, ARNAS Garibaldi, Catania, Italy
| | - Franco Stanzial
- Genetic Counseling Service, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
| | - Francesco Benedicenti
- Genetic Counseling Service, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy
| | | | - Francesca Forzano
- Clinical Genetics Department, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Teresa Mattina
- Unit of Medical Genetics, University of Catania, Catania, Italy
| | - Francesco Brancati
- Department of Life, Health and Environmental Sciences, Unit of Medical Genetics University of L'Aquila, L'Aquila, Italy
| | - Marco Castori
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Massimo Carella
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria Teresa Fadda
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Rome, Italy
| | - Giorgio Iannetti
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Rome, Italy
| | - Bruno Dallapiccola
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Bruno Marino
- Department of Pediatrics, Obstetrics and Gynecology, "Sapienza" University of Rome, Rome, Italy
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, Rome, Italy
| | - Alessandro De Luca
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
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Guida V, Calzari L, Fadda MT, Piceci-Sparascio F, Digilio MC, Bernardini L, Brancati F, Mattina T, Melis D, Forzano F, Briuglia S, Mazza T, Bianca S, Valente EM, Salehi LB, Prontera P, Pagnoni M, Tenconi R, Dallapiccola B, Iannetti G, Corsaro L, De Luca A, Gentilini D. Genome-Wide DNA Methylation Analysis of a Cohort of 41 Patients Affected by Oculo-Auriculo-Vertebral Spectrum (OAVS). Int J Mol Sci 2021; 22:ijms22031190. [PMID: 33530447 PMCID: PMC7866060 DOI: 10.3390/ijms22031190] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/12/2022] Open
Abstract
Oculo-auriculo-vertebral-spectrum (OAVS; OMIM 164210) is a rare disorder originating from abnormal development of the first and second branchial arch. The clinical phenotype is extremely heterogeneous with ear anomalies, hemifacial microsomia, ocular defects, and vertebral malformations being the main features. MYT1, AMIGO2, and ZYG11B gene variants were reported in a few OAVS patients, but the etiology remains largely unknown. A multifactorial origin has been proposed, including the involvement of environmental and epigenetic mechanisms. To identify the epigenetic mechanisms contributing to OAVS, we evaluated the DNA-methylation profiles of 41 OAVS unrelated affected individuals by using a genome-wide microarray-based methylation approach. The analysis was first carried out comparing OAVS patients with controls at the group level. It revealed a moderate epigenetic variation in a large number of genes implicated in basic chromatin dynamics such as DNA packaging and protein-DNA organization. The alternative analysis in individual profiles based on the searching for Stochastic Epigenetic Variants (SEV) identified an increased number of SEVs in OAVS patients compared to controls. Although no recurrent deregulated enriched regions were found, isolated patients harboring suggestive epigenetic deregulations were identified. The recognition of a different DNA methylation pattern in the OAVS cohort and the identification of isolated patients with suggestive epigenetic variations provide consistent evidence for the contribution of epigenetic mechanisms to the etiology of this complex and heterogeneous disorder.
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Affiliation(s)
- Valentina Guida
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (F.P.-S.); (L.B.); (A.D.L.)
- Correspondence: (V.G.); (D.G.)
| | - Luciano Calzari
- Istituto Auxologico Italiano IRCCS, Bioinformatics and Statistical Genomics Unit, Cusano Milanino, 20095 Milano, Italy;
| | - Maria Teresa Fadda
- Department of Maxillofacial Surgery, Sapienza University of Rome, 00161 Rome, Italy; (M.T.F.); (M.P.); (G.I.)
| | - Francesca Piceci-Sparascio
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (F.P.-S.); (L.B.); (A.D.L.)
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (B.D.)
| | - Laura Bernardini
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (F.P.-S.); (L.B.); (A.D.L.)
| | - Francesco Brancati
- Department of Life, Health and Environmental Sciences, Unit of Medical Genetics University of L’Aquila, 67100 L’Aquila, Italy;
- IRCCS San Raffaele Pisana, 00163 Rome, Italy
| | - Teresa Mattina
- Medical Genetics, Department of Biomedical and Biotechnological Sciences, University of Catania, 95131 Catania, Italy;
| | - Daniela Melis
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Salerno, Italy;
| | - Francesca Forzano
- Clinical Genetics Department, Guy’s & St Thomas’ NHS Foundation Trust, London SE1 7EH, UK;
| | | | - Tommaso Mazza
- Unit of Bioinformatics, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Sebastiano Bianca
- Centro di Consulenza Genetica e Teratologia della Riproduzione, Dipartimento Materno Infantile, ARNAS Garibaldi Nesima, 95123 Catania, Italy;
| | - Enza Maria Valente
- Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| | | | - Paolo Prontera
- Medical Genetics Unit, University of Perugia Hospital SM della Misericordia, 06129 Perugia, Italy;
| | - Mario Pagnoni
- Department of Maxillofacial Surgery, Sapienza University of Rome, 00161 Rome, Italy; (M.T.F.); (M.P.); (G.I.)
| | - Romano Tenconi
- Department of Pediatrics, Clinical Genetics, Università di Padova, 35122 Padova, Italy;
| | - Bruno Dallapiccola
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (B.D.)
| | - Giorgio Iannetti
- Department of Maxillofacial Surgery, Sapienza University of Rome, 00161 Rome, Italy; (M.T.F.); (M.P.); (G.I.)
| | - Luigi Corsaro
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Alessandro De Luca
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, 71013 Foggia, Italy; (F.P.-S.); (L.B.); (A.D.L.)
| | - Davide Gentilini
- Istituto Auxologico Italiano IRCCS, Bioinformatics and Statistical Genomics Unit, Cusano Milanino, 20095 Milano, Italy;
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy;
- Correspondence: (V.G.); (D.G.)
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Mandolini M, Caragiuli M, Brunzini A, Mazzoli A, Pagnoni M. A Procedure for Designing Custom-Made Implants for Forehead Augmentation in People Suffering from Apert Syndrome. J Med Syst 2020; 44:146. [PMID: 32720066 PMCID: PMC7385010 DOI: 10.1007/s10916-020-01611-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/01/2020] [Accepted: 07/15/2020] [Indexed: 10/27/2022]
Abstract
This paper presents a methodological procedure, based on the anatomical reconstruction and constrained deformation, to design custom-made implants for forehead augmentation in people affected by Apert syndrome, experiencing a frontal bone deficiency. According to the anthropometric theory, a cranial landmarks identification procedure was applied to retrieve, from a repository, a healthy skull, used as reference geometry for implant modelling. Then, using constrained deformation and free-form modelling techniques, it was possible to design a patient-specific implant. At last, the implant was realised using a custom mould, specially designed according to the patient's needs to provide an accurate fit of the defect site. The design procedure was tested on a patient suffering from Apert syndrome. Three implants were virtually modelled and 3D-printed for pre-surgical evaluation. Their shapes were 3D compared with a reference one (handcrafted by a surgeon) to test the accuracy. Deviations are negligible, and the customised implant fulfilled the surgeon's requirements.
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Affiliation(s)
- Marco Mandolini
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, Italy.
| | - Manila Caragiuli
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, Italy
| | - Agnese Brunzini
- Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, Italy
| | - Alida Mazzoli
- Department of Materials, Environmental Sciences and Urban Planning, Università Politecnica delle Marche, Via Brecce Bianche 12, 60131, Ancona, Italy
| | - Mario Pagnoni
- Mario Pagnoni, yourFACE, Clinica Parioli, Via Felice Giordano 8, 00197, Rome, Italy
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Pagnoni M, Regamey J, Adjedj J, Rogati G, Muller O, Tozzi P. Case report - coronary vasospasm in transplanted heart: a puzzling phenomenon. BMC Cardiovasc Disord 2019; 19:305. [PMID: 31856732 PMCID: PMC6924038 DOI: 10.1186/s12872-019-01280-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Coronary artery spasm (CAS) is an underdiagnosed disease especially in heart transplant patients, and in those patients the etiology and pathophysiology remain largely unknown, although it has been associated with cardiac allograft vasculopathy or graft rejection. Case presentation We report the case of a heart-transplant patient whose cardiac graft experienced two coronary vasospasms: the first before transplantation, and the other at one-month of a postoperative course complicated by primary graft failure. Conclusion Our case illustrates that a transplanted heart predisposed with coronary vasospasm may suffer from early relapse in the recipient despite of complete post-surgical autonomic denervation. Exacerbated endothelial dysfunction of the donor heart after transplant, with the addition of systemic factors in the recipient may be involved in the genesis of this puzzling phenomenon.
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Bartoli D, Battisti A, Cassoni A, Terenzi V, Della Monaca M, Pagnoni M, Valentini V, Priore P. Contralateral botulinum injections in patients with residual facial asymmetry and contralateral hyperkinesis after primary facial palsy surgery. Ann Ital Chir 2015; 86:201-206. [PMID: 26229045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM In patient with facial paralysis, facial appearance and muscular ability are impaired, and the psychological integrity is affected. Botulinum toxin A may be used to improve facial symmetry in patients suffering with facial palsy reducing the progressive contralateral hyperkinesis and facial asymmetry after primary surgery for facial paralysis. MATERIAL OF STUDY Six patients, whom have been suffering unilateral facial palsy with an House-Brackmann score grade from III to VI, were included in this study for a residual facial asymmetry and contralateral hyperkinesis after previous facial reanimation. They were treated with 50 units of botulinum toxin type A injected in muscles of the unaffected side of face to improve muscular ability and facial symmetry. RESULTS This study demonstrated reduction in contralateral hyperkinesis and facial asymmetry that lasted approximately 120 days. All patients reported satisfactory results with the treatment. COMMENTS Botulinum toxin type A injections improved facial asymmetry and muscular function in all patients. DISCUSSION AND COMMENTS Botulinum toxin type A injections may be an indispensable technique as a nonsurgical treatment or as a complementary measure in postsurgical treatments and should be certainly considered for temporary or permanent asymmetries in patients who suffer from facial palsy. CONCLUSIONS Contralateral botulinum toxin type A injection was useful in reducing muscular hyperkinesis in patients with residual facial asymmetry after primary surgery for facial palsy, improving aesthetic and functional facial recovery with not widely common adverse events.
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Guida V, Sinibaldi L, Pagnoni M, Bernardini L, Loddo S, Margiotti K, Digilio MC, Fadda MT, Dallapiccola B, Iannetti G, Alessandro DL. A de novo proximal 3q29 chromosome microduplication in a patient with oculo auriculo vertebral spectrum. Am J Med Genet A 2015; 167A:797-801. [PMID: 25735547 DOI: 10.1002/ajmg.a.36951] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 12/21/2014] [Indexed: 01/18/2023]
Abstract
Oculo auriculo vertebral spectrum (OAVS; OMIM 164210) is a clinically and genetically heterogeneous disorder originating from an abnormal development of the first and second branchial arches. Main clinical characteristics include defects of the aural, oral, mandibular, and vertebral development. Anomalies of the cardiac, pulmonary, renal, skeletal, and central nervous systems have also been described. We report on a 25-year-old male showing a spectrum of clinical manifestations fitting the OAVS diagnosis: hemifacial microsomia, asymmetric mandibular hypoplasia, preauricular pits and tags, unilateral absence of the auditory meatus, dysgenesis of the inner ear and unilateral microphthalmia. A SNP-array analysis identified a de novo previously unreported microduplication spanning 723 Kb on chromosome 3q29. This rearrangement was proximal to the 3q29 microdeletion/microduplication syndrome region, and encompassed nine genes including ATP13A3 and XXYLT1, which are involved in the organogenesis and regulation of the Notch pathway, respectively. The present observation further expands the spectrum of genomic rearrangements associated to OAVS, underlying the value of array-based studies in patients manifesting OAVS features.
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Affiliation(s)
- Valentina Guida
- IRCCS-Casa Sollievo della Sofferenza, Mendel Institute, Rome, Italy
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Bartoli D, Fadda MT, Battisti A, Cassoni A, Pagnoni M, Riccardi E, Sanzi M, Valentini V. Retrospective analysis of 301 patients with orbital floor fracture. J Craniomaxillofac Surg 2015; 43:244-7. [DOI: 10.1016/j.jcms.2014.11.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 10/13/2014] [Accepted: 11/13/2014] [Indexed: 11/16/2022] Open
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Cassoni A, Valentini V, Della Monaca M, Pagnoni M, Prucher G, Brauner E, Guarino G, Fadda M, Jamshir S, Pompa G, Iannetti G. Keratocystic Odontogenic Tumor Surgical Management: Retrospective Analysis on 77 Patients. EUR J INFLAMM 2014. [DOI: 10.1177/1721727x1401200123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In 2005 the WHO introduced the former odontogenic keratocyst to the category of benign odontogenic tumours. The change in terminology was based on the observation that the odontogenic keratocyst behaves as a neoplasm and not like a benign cystic lesion. The present paper is a retrospective analysis on the management of keratocystic odontogenic tumor over a period of 11 years (2001–2012) in the Department of Maxillo-Facial Surgery at the University of Rome “Sapienza”, with particular focus on the surgical choices and the relative rates of relapse. The patient population consisted of 34 females and 43 males. Administered treatment modalities consisted of enucleation in 55 cases and radical resection in 22 cases. Nineteen percent of patients who underwent enucleation suffered KCOT relapse. No relapse was observed in the radical resection group with follow-up of 3–7 years. The goals of the treatment include elimination of the pathology and decrease of potential recurrence while minimizing harm to the patient. In the Authors' experience, conservative treatment still encompasses a high rate of recurrence; otherwise, resection provides the lowest recurrence rate, yet causes the most suffering to the patient. The issue surgeons encounter is whether to choose a conservative approach, reducing the morbidity to the patient, knowing that several operations may be required to eliminate recurrence; or being more aggressive and potentially more destructive, at the same time ensuring the best condition to avoid recurrence. Other studies are needed in order to find definitive guidelines for this challenging pathology.
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Affiliation(s)
- A. Cassoni
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - V. Valentini
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - M. Della Monaca
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - M. Pagnoni
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - G.M. Prucher
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - E. Brauner
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - G. Guarino
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - M.T. Fadda
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - S. Jamshir
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - G. Pompa
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
| | - G. Iannetti
- Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome, Italy
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Pagnoni M, Fadda MT, Spalice A, Amodeo G, Ursitti F, Mitro V, Iannetti G. Surgical timing of craniosynostosis: what to do and when. J Craniomaxillofac Surg 2013; 42:513-9. [PMID: 24075801 DOI: 10.1016/j.jcms.2013.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 05/22/2013] [Accepted: 07/31/2013] [Indexed: 11/27/2022] Open
Abstract
Craniosynostosis, both isolated and syndromic, are challenging malformations for the craniofacial team. They present the team with an articulated cascade of choices, which need to be addressed early in life and in the growing age to intercept, remove, or correct the direct and indirect consequences of the malformation. Timing of treatment is thus critical and it stands on the experience of a multi-specialty trained craniofacial team. In this paper the authors discuss the timing of treatment of the major craniosynostosis, isolated and syndromic, reviewing the options for treatment and their experience in this complex field.
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Affiliation(s)
- Mario Pagnoni
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 9, 00185 Rome, Italy
| | - Maria Teresa Fadda
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 9, 00185 Rome, Italy
| | - Alberto Spalice
- Department of Pediatrics, Child Neurology Division, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 9, 00185 Rome, Italy
| | - Giulia Amodeo
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 9, 00185 Rome, Italy.
| | - Fabiana Ursitti
- Department of Pediatrics, Child Neurology Division, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 9, 00185 Rome, Italy
| | - Valeria Mitro
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 9, 00185 Rome, Italy
| | - Giorgio Iannetti
- Department of Maxillo-Facial Surgery, Policlinico Umberto I, Sapienza University of Rome, Piazzale Aldo Moro 9, 00185 Rome, Italy
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Brauner E, Valentini V, Guarino G, Cassoni A, Jamshir S, Minasi R, Fadda M, Pagnoni M, Pompa G. Osteoradionecrosis of a Mandible: A Case Report of Implant-Supported Rehabilitation. EUR J INFLAMM 2013. [DOI: 10.1177/1721727x1301100229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E. Brauner
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
| | - V. Valentini
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
| | - G. Guarino
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
| | - A. Cassoni
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
| | - S. Jamshir
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
| | - R. Minasi
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
| | - M.T. Fadda
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
| | - M. Pagnoni
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
| | - G. Pompa
- Department of Oral And Maxillo-Facial Sciences, Sapienza University Of Rome, Italy
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12
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13
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Meazzini MC, Allevia F, Mazzoleni F, Ferrari L, Pagnoni M, Iannetti G, Bozzetti A, Brusati R. Long-term follow-up of syndromic craniosynostosis after Le Fort III halo distraction: A cephalometric and CT evaluation. J Plast Reconstr Aesthet Surg 2012; 65:464-72. [DOI: 10.1016/j.bjps.2011.09.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/22/2011] [Accepted: 09/27/2011] [Indexed: 10/14/2022]
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14
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Abstract
UNLABELLED Craniosynostosis (craniostenosis) is premature fusion of the sutures of the cranial vault. Several factors can affect the growth of the cranial vault during embryonic life and after birth, leading to different types of craniosynostosis; these can be classified on the basis of the specific sutures that are fused. Prognosis is improved by early diagnosis, and it is important to establish the correct approach to these patients on the basis of clinical and neuroradiological investigation. The first priority is to identify the type of craniosynostosis and to distinguish between the types that require surgical intervention and those that do not. We report on the different forms of nonsyndromic craniosynostosis, their clinical and neuroradiological diagnoses, and surgical strategies. CONCLUSION The aim of this review is to provide to paediatricians a correct diagnostic approach and management of children affected from nonsyndromic craniosynostosis, for which a careful physical, ophthalmological and neurological examination is fundamental, whereas brain Computed tomography and magnetic resonance imaging are necessary for patients in which the diagnosis is uncertain or for cases of syndromic craniosynostosis.
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Affiliation(s)
- F Ursitti
- Department of Pediatrics, Child Neurology Division, University of Sapienza, Rome, Italy
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15
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Tecco S, Saccucci M, Nucera R, Polimeni A, Pagnoni M, Cordasco G, Festa F, Iannetti G. Condylar volume and surface in Caucasian young adult subjects. BMC Med Imaging 2010; 10:28. [PMID: 21194477 PMCID: PMC3019198 DOI: 10.1186/1471-2342-10-28] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 12/31/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been no quantitative standards for volumetric and surface measurements of the mandibular condyle in Caucasian population. However, the recently developed cone-beam computed tomography (CBCT) system allows measurement of these parameters with high accuracy. METHODS CBCT was used to measure the condylar volume, surface and the volume to surface ratio, called the Morphometric Index (MI), of 300 temporo-mandibular joints (TMJ) in 150 Caucasian young adult subjects, with varied malocclusions, without pain or dysfunction of TMJs. RESULTS The condylar volume was 691.26 ± 54.52 mm3 in males and 669.65 ± 58.80 mm3 in, and was significantly higher (p< 0.001) in the males. The same was observed for the condylar surface, although without statistical significance (406.02 ± 55.22 mm2 in males and 394.77 ± 60.73 mm2 in females).Furthermore, the condylar volume (693.61 ± 62.82 mm3 ) in the right TMJ was significantly higher than in the left (666.99 ± 48.67 mm3, p < 0.001) as was the condylar surface (411.24 ± 57.99 mm2 in the right TMJ and 389.41 ± 56.63 mm2 in the left TMJ; t = 3.29; p < 0.01). The MI is 1.72 ± 0.17 for the whole sample, with no significant difference between males and females or the right and left sides. CONCLUSION These data from temporomandibular joints of patients without pain or clinical dysfunction might serve as examples of normal TMJ's in the general population not seeking orthodontic care.
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Affiliation(s)
- Simona Tecco
- Department of Oral Science, Nano and Biotechnology, University G,D'Annunzio, Via dei Vestini 31, Chieti, 66013, Italy.
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16
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Fadda M, Pagnoni M, Bartoli D, Anelli A, Mitro V, Iannetti G. O.034 Intraoral distraction osteogenesis in mandibular hypoplasia. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71158-2] [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: 10/21/2022] Open
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17
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Pagnoni M, Fadda M, Ramieri V, Rojas M, Andreoli C, Gualdi G, Iannetti G. O.044 Radiologic assessment of craniosynostosis. J Craniomaxillofac Surg 2008. [DOI: 10.1016/s1010-5182(08)71168-5] [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: 11/16/2022] Open
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18
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Affiliation(s)
- Giorgio Iannetti
- Cattedra di Chirurgia Maxillo-Facciale, Università degli Studi di Roma La Sapienza, Rome, Italy
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Ungari C, Rocchi G, Rinna C, Agrillo A, Lattanzi A, Pagnoni M. Hypophosphaturic mesenchymal tumor of the ethmoid associated with oncogenic osteomalacia. J Craniofac Surg 2004; 15:523-7. [PMID: 15111823 DOI: 10.1097/00001665-200405000-00036] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Oncogenic osteomalacia is an uncommon syndrome characterized by bone pain, proximal muscle weakness, hypophosphatemia, hyperphosphaturia, and a low plasma concentration of 1,25-dihydroxy-vitamin D. The disease affects both sexes at around 40 years of age, although it can sometimes affect children and adolescents. Generally, the syndrome is associated with a tumor, usually benign, of mesenchymal origin and is resolved after removal of the tumor; this syndrome can sometimes be associated with malignant tumors. These tumors seem to be histologically heterogeneous and are generally localized in soft tissues and bone. In this article, a case of oncogenic osteomalacia associated with a hypophosphaturic mesenchymal tumor of the ethmoid is reported in a 24-year-old man. After surgical and radical removal of the tumor, the patient noted a decrease in the clinical symptoms and signs.
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Affiliation(s)
- Claudio Ungari
- Department of Maxillofacial Surgery, University of Rome La Sapienza, Rome, Italy
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20
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Giuliani M, Lajolo C, Pagnoni M, Boari A, Zannoni GF. Granular cell tumor of the tongue (Abrikossoff's tumor). A case report and review of the literature. Minerva Stomatol 2004; 53:465-9. [PMID: 15278025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Granular cell tumor (GCT), also known as Abrikossoff's tumor, is a relatively uncommon neoplasm presenting as a benign, single, well-circumscribed nodule, usually arising on the tongue. Histologically, GCT shows numerous strands of large polyhedral granular cells, separated by collagen bundles, with no evidence of encapsulation. Recurrences may occur following inadequate excision. A 32-year-old woman, presenting a non-painful nodule embedded in the chorion of her tongue, underwent a first excisional biopsy which revealed a GCT and the margins of the bioptic sample appeared free. Immunohistochemistry for protein S-100 revealed the tumor cells invading the margins of the sample. A second intervention was made to excise the possible remaining neoplastic tissue. This case, owing to its uncommon clinical appearance, seemed particularly interesting. Immunohistochemical assay for S-100, whenever a CGR is suspected, is always mandatory to discover tumor cells infiltrating the margins of the sample. Furthermore, immunohistochemical assay can make the diagnosis more precise excluding other more serious tumors which could arise in the oral cavity. In any event, the patient should be reassured of the benign nature of the tumor and a careful follow-up is necessary in order to diagnose relapses.
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Affiliation(s)
- M Giuliani
- Department of Dentistry, Sacro Cuore Catholic University, Rome, Italy.
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21
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Abstract
Hemangiopericytoma is a rare vascular tumor featuring the uncontrolled proliferation of pericytes. This tumor tends to develop in subcutaneous tissue and skeletal muscle. The localization of hemangiopericytoma in the orbit is particularly rare. Clinical signs and symptoms are, in order of frequency, proptosis, perception of an intraorbital mass, pain, diplopia, reduction of visus, tumescence, and ecchymoses of the eyelids. Hemangiopericytomas have higher potential of relapse, local invasiveness, and the possibility of producing distant metastases. Surgery must be as radical as possible to avoid incomplete tumor resection and high frequency of relapse together with increased duration of the disease and a higher risk of malignant development. The current report is a study of two cases of hemangiopericytoma in the orbital cavity treated at the Unit of Maxillo-Facial Surgery of the University of "La Sapienza" in Rome. The present data demonstrate that complete en bloc excision of the mass with its capsule is important to avoid the risk of relapse. To this end, an appropriate first surgical treatment should be chosen so as to obtain a wide "surgical light" and complete view of the mass. In the reported cases, the use of a combined anterolateral approach was preferred to attack the tumor from different sides. Indeed, such an approach allows one to obtain optimal exposition of the orbital region and temporal and infratemporal fossae contemporaneously.
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Affiliation(s)
- Valentino Valentini
- Cattedra di Chirurgia Speciale Odontostomatologica, Università degli Studi di Roma Tor Vergata, Rome, Italy
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Guo K, Searfoss G, Krolikowski D, Pagnoni M, Franks C, Clark K, Yu KT, Jaye M, Ivashchenko Y. Hypoxia induces the expression of the pro-apoptotic gene BNIP3. Cell Death Differ 2001; 8:367-76. [PMID: 11550088 DOI: 10.1038/sj.cdd.4400810] [Citation(s) in RCA: 242] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2000] [Revised: 10/25/2000] [Accepted: 11/08/2000] [Indexed: 11/09/2022] Open
Abstract
It has been shown that oxygen deprivation results in apoptotic cell death, and that hypoxia inducible factor 1 (HIF1) and the tumor suppressor p53 play key roles in this process. However, the molecular mechanism through which hypoxia and HIF1 induce apoptosis is not clear. Here we show that the expression of pro-apoptotic gene BNIP3 is dramatically induced by hypoxia in various cell types, including primary rat neonatal cardiomyocytes. Overexpression of HIF1alpha, but not p53, induces the expression of BNIP3. Overexpression of BNIP3 leads to a rather unusual type of apoptosis, as no cytochrome c leakage from mitochondria was detected and inhibitors of caspases were unable to prevent cell death. Taken together, these data suggest that HIF1-dependent induction of BNIP3 may play a significant role during hypoxia-induced cell death.
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Affiliation(s)
- K Guo
- Cardiovascular Biology, Aventis Pharma, Room 245, Industriepark Hochst, H825, 65926 Frankfurt a. Main, Germany
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Abstract
BACKGROUND Focal nodule lesions in patients with cirrhotic livers may be visualized by using imaging techniques; however, the diagnostic and prognostic judgment of biopsies from borderline lesions may be difficult using conventional histologic criteria. METHODS The diagnostic and prognostic value of DNA ploidy analysis determined by image cytometry of Feulgen-stained isolated hepatocytes was investigated in ultrasound-guided biopsies from 50 nodular lesions found in patients with cirrhotic livers (39 hepatocellular carcinomas [HCCs] and 11 macroregenerative nodules) and from 10 patients with livers affected by viral chronic hepatitis. Of the 11 macroregenerative nodules, 7 presented a subsequent neoplastic behavior. Specimens from the morphologically normal livers of five patients who underwent liver surgery served as control tissues. Image cytometry was performed on Feulgen-stained cytologic preparations, obtained by enzymatic digestion of formalin fixed biopsies. The DNA ploidy of the main stem line and the distribution of mononucleated and binucleated hepatocytes (nuclearity) were compared using histologic diagnosis, Edmondson's grade, tumor size, and patient follow-up. RESULTS The main stem line was peridiploid in all benign specimens and in 31 clinically confirmed HCCs, peritetraploid in 11 HCCs, perioctaploid in 1 HCC, and aneuploid in 3 HCCs. The fraction of mononucleated polyploid hepatocytes was found to be the best diagnostic parameter in euploid HCCs and was significantly correlated with the Edmondson grade and the nodular size. Survival information was available for 43 patients, with a median observation period of 350 days. A DNA ploidy value of the main stem line greater than 3c was an important determinant of survival as a single parameter and in association with histologic grade and greatest dimension of tumor. CONCLUSIONS This study suggests that the ploidy distribution analysis of mononucleated and binucleated hepatocytes can provide valuable information for making correct diagnoses and for predicting survival outcome for patients with HCCs.
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Affiliation(s)
- C Melchiorri
- Institute of Oncology, S. Orsola Hospital, Bologna, Italy
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24
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Abstract
BACKGROUND Focal nodule lesions in patients with cirrhotic livers may be visualized by using imaging techniques; however, the diagnostic and prognostic judgment of biopsies from borderline lesions may be difficult using conventional histologic criteria. METHODS The diagnostic and prognostic value of DNA ploidy analysis determined by image cytometry of Feulgen-stained isolated hepatocytes was investigated in ultrasound-guided biopsies from 50 nodular lesions found in patients with cirrhotic livers (39 hepatocellular carcinomas [HCCs] and 11 macroregenerative nodules) and from 10 patients with livers affected by viral chronic hepatitis. Of the 11 macroregenerative nodules, 7 presented a subsequent neoplastic behavior. Specimens from the morphologically normal livers of five patients who underwent liver surgery served as control tissues. Image cytometry was performed on Feulgen-stained cytologic preparations, obtained by enzymatic digestion of formalin fixed biopsies. The DNA ploidy of the main stem line and the distribution of mononucleated and binucleated hepatocytes (nuclearity) were compared using histologic diagnosis, Edmondson's grade, tumor size, and patient follow-up. RESULTS The main stem line was peridiploid in all benign specimens and in 31 clinically confirmed HCCs, peritetraploid in 11 HCCs, perioctaploid in 1 HCC, and aneuploid in 3 HCCs. The fraction of mononucleated polyploid hepatocytes was found to be the best diagnostic parameter in euploid HCCs and was significantly correlated with the Edmondson grade and the nodular size. Survival information was available for 43 patients, with a median observation period of 350 days. A DNA ploidy value of the main stem line greater than 3c was an important determinant of survival as a single parameter and in association with histologic grade and greatest dimension of tumor. CONCLUSIONS This study suggests that the ploidy distribution analysis of mononucleated and binucleated hepatocytes can provide valuable information for making correct diagnoses and for predicting survival outcome for patients with HCCs.
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Affiliation(s)
- C Melchiorri
- Institute of Oncology, S. Orsola Hospital, Bologna, Italy
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25
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Chieco P, Pagnoni M, Romagnoli E, Melchiorri C. A rapid and simple staining method, using toluidine blue, for analysing mitotic figures in tissue sections. Histochem J 1993; 25:569-77. [PMID: 7691782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Mitotic index is a clinically important parameter in cancer pathology. We developed a staining method using Toluidine Blue to detect efficiently and rapidly mitotic figures in sections of formalin-fixed paraffin-embedded human and rat tissues. Sections were stained at acid pH with a 0.01% Toluidine Blue solution after removal of RNA with hydrochloric acid or ribonuclease. The optimal pH of the TB staining solution was found to be 4.5 for rat tissues and 3.5 for human tissues. This procedure stained mitotic figures much more intensely than other (extra)cellular structures. A quantitative estimate of the total number of nuclei in the field where mitotic figures were counted, was obtained in an adjacent section hydrolysed in 5 N hydrochloric acid and stained by the Feulgen reaction with a Schiff-type reagent containing 0.01% Toluidine Blue. This method specifically stained interphase and mitotic nuclei and the field cellularity could be quantified by image cytometry. When these procedures were performed on two consecutive serial sections, a mitotic index could be determined accurately by relating the count of mitotic figures to the number of tumour cells.
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Affiliation(s)
- P Chieco
- Institute of Oncology, Bologna, Italy
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