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Pepe F, Russo G, Venuta A, Scimone C, Nacchio M, Pisapia P, Goteri G, Barbisan F, Chiappetta C, Pernazza A, Campagna D, Giordano M, Perrone G, Sabarese G, Altimari A, de Biase D, Tallini G, Calistri D, Chiadini E, Capelli L, Santinelli A, Gulini AE, Pierpaoli E, Badiali M, Murru S, Murgia R, Guerini Rocco E, Venetis K, Fusco N, Morotti D, Gianatti A, Furlan D, Rossi G, Melocchi L, Russo M, De Luca C, Palumbo L, Simonelli S, Maffè A, Francia di Celle P, Venesio T, Scatolini M, Grosso E, Orecchia S, Fassan M, Balistreri M, Zulato E, Reghellin D, Lazzari E, Santacatterina M, Piredda ML, Riccardi M, Laurino L, Roz E, Longo D, Romeo DP, Fazzari C, Moreno-Manuel A, Puglia GD, Prjibelski AD, Shafranskaya D, Righi L, Listì A, Vitale D, Iaccarino A, Malapelle U, Troncone G. Non-Small Cell Lung Cancer Testing on Reference Specimens: An Italian Multicenter Experience. Oncol Ther 2024; 12:73-95. [PMID: 38200361 PMCID: PMC10881930 DOI: 10.1007/s40487-023-00252-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Biomarker testing is mandatory for the clinical management of patients with advanced non-small cell lung cancer (NSCLC). Myriads of technical platforms are now available for biomarker analysis with differences in terms of multiplexing capability, analytical sensitivity, and turnaround time (TAT). We evaluated the technical performance of the diagnostic workflows of 24 representative Italian institutions performing molecular tests on a series of artificial reference specimens built to mimic routine diagnostic samples. METHODS Sample sets of eight slides from cell blocks of artificial reference specimens harboring exon 19 EGFR (epidermal growth factor receptor) p.E746_AT50del, exon 2 KRAS (Kirsten rat sarcoma viral oncogene homologue) p.G12C, ROS1 (c-ros oncogene 1)-unknown gene fusion, and MET (MET proto-oncogene, receptor tyrosine kinase) Δ exon 14 skipping were distributed to each participating institution. Two independent cell block specimens were validated by the University of Naples Federico II before shipment. Methodological and molecular data from reference specimens were annotated. RESULTS Overall, a median DNA concentration of 3.3 ng/µL (range 0.1-10.0 ng/µL) and 13.4 ng/µL (range 2.0-45.8 ng/µL) were obtained with automated and manual technical procedures, respectively. RNA concentrations of 5.7 ng/µL (range 0.2-11.9 ng/µL) and 9.3 ng/µL (range 0.5-18.0 ng/µL) were also detected. KRAS exon 2 p.G12C, EGFR exon 19 p.E736_A750del hotspot mutations, and ROS1 aberrant transcripts were identified in all tested cases, whereas 15 out of 16 (93.7%) centers detected MET exon 14 skipping mutation. CONCLUSIONS Optimized technical workflows are crucial in the decision-making strategy of patients with NSCLC. Artificial reference specimens enable optimization of diagnostic workflows for predictive molecular analysis in routine clinical practice.
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Affiliation(s)
- Francesco Pepe
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Gianluca Russo
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Alessandro Venuta
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Claudia Scimone
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Mariantonia Nacchio
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Pasquale Pisapia
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Gaia Goteri
- Pathological Anatomy Institute, Polytechnic University of Marche Region, Ancona, Italy
| | - Francesca Barbisan
- Pathological Anatomy Institute, Polytechnic University of Marche Region, Ancona, Italy
| | | | - Angelina Pernazza
- Department of Medico-Surgical Sciences and Biotechnologies, Polo Pontino-Sapienza University, Latina, Italy
| | - Domenico Campagna
- Department of Pathology, San Giovanni-Addolorata Hospital, 00184, Rome, Italy
| | - Marco Giordano
- Department of Pathology, San Giovanni-Addolorata Hospital, 00184, Rome, Italy
| | - Giuseppe Perrone
- Research Unit of Anatomical Pathology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21-00128, Rome, Italy
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
| | - Giovanna Sabarese
- Anatomical Pathology Operative Research Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128, Rome, Italy
| | - Annalisa Altimari
- Molecular Pathology, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Dario de Biase
- Pharmacy and Biotechnology (FaBiT), Molecular Pathology Laboratory, University of Bologna, Bologna, Italy
| | - Giovanni Tallini
- Molecular Pathology, University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
- Pharmacy and Biotechnology (FaBiT), Molecular Pathology Laboratory, University of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Daniele Calistri
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - Elisa Chiadini
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - Laura Capelli
- Biosciences Laboratory, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", 47014, Meldola, Italy
| | - Alfredo Santinelli
- Anatomic Pathology Azienda Sanitaria Territoriale Pesaro-Urbino, Pesaro, Italy
| | - Anna Elisa Gulini
- Anatomic Pathology Azienda Sanitaria Territoriale Pesaro-Urbino, Pesaro, Italy
| | - Elisa Pierpaoli
- Anatomic Pathology Azienda Sanitaria Territoriale Pesaro-Urbino, Pesaro, Italy
| | - Manuela Badiali
- Laboratory of Genetics and Genomics-Pediatric Hospital A.Cao-ASL8, Cagliari, Italy
| | - Stefania Murru
- Laboratory of Genetics and Genomics-Pediatric Hospital A.Cao-ASL8, Cagliari, Italy
| | - Riccardo Murgia
- Experimental Medicine Unit, Department of Biomedical Sciences, University of Cagliari, 09124, Cagliari, Italy
| | - Elena Guerini Rocco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Konstantinos Venetis
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Denise Morotti
- Pathology Unit and Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Gianatti
- Pathology Unit and Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Daniela Furlan
- Pathology Unit, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Giulio Rossi
- Department of Anatomical Pathology, Fondazione Poliambulanza, 25124, Brescia, Italy
| | - Laura Melocchi
- Department of Anatomical Pathology, Fondazione Poliambulanza, 25124, Brescia, Italy
| | - Maria Russo
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Caterina De Luca
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Lucia Palumbo
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Saverio Simonelli
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Antonella Maffè
- Genetics and Molecular Biology Unit, Santa Croce e Carle Hospital, 12100, Cuneo, Italy
| | - Paola Francia di Celle
- Molecular Pathology, AOU Città della Salute e della Scienza di Torino, 10126, Turin, Italy
| | - Tiziana Venesio
- Candiolo Cancer Institute, FPO-IRCCS, 10060, Candiolo, Italy
| | - Maria Scatolini
- Molecular Oncology Lab, Fondazione Edo ed Elvo Tempia, Biella, Italy
| | - Enrico Grosso
- Molecular Oncology Lab, Fondazione Edo ed Elvo Tempia, Biella, Italy
| | - Sara Orecchia
- Pathology Division, S. Antonio and Biagio Hospital, Alessandria, Italy
| | - Matteo Fassan
- Department of Medicine-DIMED, University of Padua, Padua, Veneto, Italy
- Veneto Institute of Oncology-IOV-IRCCS, Padua, Italy
| | | | | | | | - Elena Lazzari
- Department of Pathology, San Bortolo Hospital, Vicenza, Italy
| | | | | | - Manuela Riccardi
- Department of Pathology, Azienda Ulss3 Serenissima, Ospedale dell'Angelo, Venice, Italy
| | - Licia Laurino
- Department of Pathology, Azienda Ulss3 Serenissima, Ospedale dell'Angelo, Venice, Italy
| | - Elena Roz
- Pathology Unit, La Maddalena Clinic for Cancer, Palermo, Italy
| | - Domenico Longo
- UOSD di Anatomia Patologica dell'Azienda Ospedaliera Papardo, Messina, Italy
| | | | - Carmine Fazzari
- UOSD di Anatomia Patologica dell'Azienda Ospedaliera Papardo, Messina, Italy
| | - Andrea Moreno-Manuel
- Molecular Oncology Laboratory, Fundación Investigación Hospital General Universitario de Valencia, 46014, Valencia, Spain
- TRIAL Mixed Unit, Centro Investigación Príncipe Felipe-Fundación Investigación Hospital General Universitario de Valencia, 46014, Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, 28029, Madrid, Spain
| | - Giuseppe Diego Puglia
- Institute for Agricultural and Forest Systems in the Mediterranean, National Research Council (ISAFOM-CNR), 95128, Catania, Italy
| | - Andrey D Prjibelski
- Center for Algorithmic Biotechnology, Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Daria Shafranskaya
- Center for Algorithmic Biotechnology, Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg, Russia
| | - Luisella Righi
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, TO, Italy
| | - Angela Listì
- Department of Oncology, San Luigi Hospital, University of Turin, Orbassano, TO, Italy
| | - Domenico Vitale
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy.
| | - Giancarlo Troncone
- Department of Public Health, Federico II University of Naples, Via S. Pansini, 5, 80131, Naples, Italy
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Amoroso A, Di Stasio F, Ranucci G, Betalli P, Cheli M, Dalla Rosa D, D’Anna C, Gaglione G, Giannotti G, Licini L, Mandato C, Massazza G, Orlando F, Morotti D, Rocco M, Sonzogni A, Tipo V, Verdoni L, D’Antiga L, Norsa L. Thrombotic Features as the Primary Cause of SARS-CoV-2 Related Acute Abdomen in Children. J Pediatr Gastroenterol Nutr 2023; 77:474-478. [PMID: 37490586 PMCID: PMC10501346 DOI: 10.1097/mpg.0000000000003893] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVES We performed a retrospective case control study to evaluate the histological characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pediatric patients undergoing laparoscopic exploration for acute abdomen symptoms. To our knowledge this is the first study that analyzes histopathological characteristics of abdominal tissues in SARS-CoV-2 children. STUDY DESIGN We enrolled 8 multisystem inflammatory syndrome in children (MIS-C) patients and 4 SARS-CoV-2 positive patients who underwent intestinal resection versus 36 control appendectomies from 2 pediatric tertiary referral centers between March 2020 and July 2021. Surgical resection samples were evaluated on several histological sections focusing on general inflammatory pattern and degree of inflammation. Peculiar histological features (endotheliitis and vascular thrombosis) were semi-quantitatively scored respectively in capillary, veins, and arteries. RESULTS All SARS-CoV-2 related surgical samples showed thrombotic patterns. Those patterns were significantly less frequent in SARS-CoV-2 negative appendectomies ( P = 0.004). The semi-quantitative score of thrombosis was significantly higher ( P = 0.002) in patients with SARS-CoV-2 related procedures. CONCLUSIONS Our results showed that SARS-CoV-2 can cause thrombotic damage in abdominal tissues both in the acute phase of the infection (SARS-CoV-2 related appendectomies) and secondary to cytokine storm (MIS-C).
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Affiliation(s)
- Angela Amoroso
- From the Paediatric Department, University of Milano Bicocca, Fondazione MBBM, Onlus San Gerardo Hospital, Monza, Italy
| | - Fabiana Di Stasio
- From the Paediatric Department, University of Milano Bicocca, Fondazione MBBM, Onlus San Gerardo Hospital, Monza, Italy
| | - Giusy Ranucci
- the Paediatric Department, AORN Santobono Pausilipon, Napoli, Italy
| | - Pietro Betalli
- the Paediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maurizio Cheli
- the Paediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Dalla Rosa
- the Paediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Carolina D’Anna
- the Paediatric Emergency Department, AORN Santobono Pausilipon, Napoli, Italy
| | - Giovanni Gaglione
- the Paediatric Surgery Department, AORN Santobono Pausilipon, Napoli, Italy
| | - Giulia Giannotti
- the Paediatric Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lisa Licini
- the Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Claudia Mandato
- the Paediatric Department, AORN Santobono Pausilipon, Napoli, Italy
| | | | | | - Denise Morotti
- the Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michele Rocco
- the Department of Pathology, AORN Santobono Pausilipon, Napoli, Italy
| | | | - Vincenzo Tipo
- the Paediatric Emergency Department, AORN Santobono Pausilipon, Napoli, Italy
| | - Lucio Verdoni
- the Paediatric Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo D’Antiga
- the Paediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Lorenzo Norsa
- the Paediatric Hepatology Gastroenterology and Transplantation Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
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Marzano AV, Moltrasio C, Genovese G, De Andrea M, Caneparo V, Vezzoli P, Morotti D, Sena P, Venturini M, Battocchio S, Caputo V, Rizzo N, Maronese CA, Venegoni L, Boggio FL, Rongioletti F, Calzavara-Pinton P, Berti E. SARS-CoV-2 detection by digital polymerase chain reaction and immunohistochemistry in skin biopsies from 52 patients with different COVID-19-associated cutaneous phenotypes. Dermatology 2023:000530746. [PMID: 37075721 DOI: 10.1159/000530746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/11/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND COronaVIrus Disease 19 (COVID-19) is associated with a wide spectrum of skin manifestations, but SARS-CoV-2 RNA in lesional skin has been demonstrated only in few cases. OBJECTIVE To demonstrate SARS-CoV-2 presence in skin samples from patients with different COVID-19-related cutaneous phenotypes. METHODS Demographic and clinical data from 52 patients with COVID-19-associated cutaneous manifestations were collected. Immunohistochemistry and digital PCR (dPCR) were performed in all skin samples. RNA in situ hybridization (ISH) was used to confirm the presence of SARS-CoV-2 RNA. RESULTS Twenty out of 52 (38%) patients presented SARS-CoV-2 positivity in the skin. Among these, 10/52 (19%) patients tested positive for spike protein on immunohistochemistry, five of whom had also positive testing on dPCR. Of the latter, one tested positive both for ISH and ACE-2 on immunohistochemistry while another one tested positive for nucleocapsid protein. Twelve patients showed positivity only for nucleocapsid protein on immunohistochemistry. CONCLUSIONS SARS-CoV-2 was detected only in 38% of patients, without any association with a specific cutaneous phenotype, suggesting that the pathophysiology of cutaneous lesions mostly depends on the activation of the immune system. The combination of spike and nucleocapsid immunohistochemistry has higher diagnostic yield than dPCR. Skin persistence of SARS-CoV-2 may depend on timing of skin lesions, viral load and immune response.
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Patanè L, Cadamuro M, Massazza G, Pirola S, Stagnati V, Comerio C, Carnelli M, Arosio M, Callegaro AP, Tebaldi P, Rigoli E, Gianatti A, Morotti D. Evidence of vertical transmission of SARS-CoV-2 and interstitial pneumonia in second trimester twin stillbirth in asymptomatic woman. Case report and review of the literature. Am J Obstet Gynecol MFM 2022; 4:100589. [PMID: 35131495 PMCID: PMC8815276 DOI: 10.1016/j.ajogmf.2022.100589] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 11/18/2022]
Abstract
Data on the vertical transmission rate of COVID-19 in pregnancy are limited, although data reporting mother-fetal transmission in the second trimester of pregnancy are controversial. We described a case of second-trimester twin stillbirth in a woman with SARS-CoV-2 infection in which placental and fetal markers of infection were detected, despite the absence of respiratory syndrome. The patient developed clinical chorioamnionitis and spontaneously delivered 2 stillborn infants. Placental histology and immunohistochemistry demonstrated SARS-CoV-2 infection mostly within the syncytiotrophoblast, and fetal autopsy showed the development of interstitial pneumonia. Our findings demonstrated that in utero vertical transmission is possible in asymptomatic pregnant women with SARS-CoV-2 infection and that infection can lead to severe morbidity in the second trimester of pregnancy.
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Affiliation(s)
- Luisa Patanè
- Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy.
| | | | | | - Serena Pirola
- Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Valentina Stagnati
- Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Comerio
- Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Carnelli
- Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Arosio
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Biobank Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Paola Callegaro
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; Biobank Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Tebaldi
- Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Elena Rigoli
- Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Andrea Gianatti
- Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Denise Morotti
- Department of Pathology, ASST Papa Giovanni XXIII, Bergamo, Italy
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Morotti D, Caroli E, Forlani V, Cadamuro M, Gianatti A. How to Mimic a Histological Sample Slide for RNAscope TM Applications from BAL Cytological Specimens. J Cytol 2022; 38:231-232. [PMID: 35002117 PMCID: PMC8670455 DOI: 10.4103/joc.joc_61_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/06/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Denise Morotti
- Department of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Emma Caroli
- Department of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valeria Forlani
- Department of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Andrea Gianatti
- Department of Pathology, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Robustelli Test E, Sena P, Locatelli AG, Carugno A, di Mercurio M, Moggio E, Gambini DM, Arosio MEG, Callegaro A, Morotti D, Gianatti A, Vezzoli P. RNAscope in situ hybridization and RT-PCR for detection of SARS-CoV-2 in chilblain-like lesions: A clinical, laboratory and histopathological study. Pediatr Dermatol 2022; 39:77-83. [PMID: 34989043 DOI: 10.1111/pde.14903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/16/2021] [Accepted: 12/11/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, an increasing number of chilblain-like lesions (ChLL) have been increasingly reported worldwide. To date, the causal link between ChLL and SARS-CoV-2 infection has not been unequivocally established. METHODS In this case series, we present demographic, clinical, laboratory, and histopathological information regarding 27 young patients with a clinical diagnosis of ChLL who referred to the Dermatology Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, from 1 April 2020 to 1 June 2020. RESULTS The mean age was 14.2 years, and 21 patients (78%) experienced mild systemic symptoms a median of 28 days before the onset of cutaneous lesions. ChLL mostly involved the feet (20 patients - 74%). Among acral lesions, we identified three different clinical patterns: (i) chilblains in 20 patients (74%); (ii) fixed erythematous macules in 4 children (15%); (iii) erythrocyanosis in 3 female patients (11%). Blood examinations and viral serologies, including parvovirus B19, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and coxsackievirus were normal in all. Three patients (11%) underwent nasopharyngeal swab for RT-PCR for SARS-CoV-2 showing only 1 positive. Histopathological examinations of 7 skin biopsies confirmed the clinical diagnosis of chilblains; vessel thrombi were observed only in 1 case. Our findings failed to demonstrate the direct presence of SARS-CoV-2 RNA in skin biopsies, both with real-time polymerase chain reaction (RT-PCR) and RNAscope in situ hybridization (ISH). LIMITATIONS Limited number of cases, unavailability of laboratory confirmation of COVID-19 in all patients, potential methodological weakness, and latency of skin biopsies in comparison to cutaneous lesions onset. CONCLUSIONS These observations may support the hypothesis of an inflammatory pathogenesis rather than the presence of peripheral viral particles. Although, we could not exclude an early phase of viral endothelial damage followed by an IFN-I or complement-mediated inflammatory phase. Further observations on a large number of patients are needed to confirm this hypothesis.
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Affiliation(s)
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Erica Moggio
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Marco Enrico Giovanni Arosio
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Biobank Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Annapaola Callegaro
- Microbiology and Virology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy.,Biobank Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Denise Morotti
- Pathology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Pamela Vezzoli
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
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Schwartz DA, Baldewijns M, Benachi A, Bugatti M, Bulfamante G, Cheng K, Collins RRJ, Debelenko L, De Luca D, Facchetti F, Fitzgerald B, Levitan D, Linn RL, Marcelis L, Morotti D, Morotti R, Patanè L, Prevot S, Pulinx B, Saad AG, Schoenmakers S, Strybol D, Thomas K, Tosi D, Toto V, van der Meeren LE, Verdijk RM, Vivanti AJ, Zaigham M. Hofbauer cells and coronavirus disease 2019 (COVID-19) in pregnancy: Molecular pathology analysis of villous macrophages, endothelial cells, and placental findings from 22 placentas infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with and without fetal transmission. Arch Pathol Lab Med 2021; 145:1328-1340. [PMID: 34297794 DOI: 10.5858/arpa.2021-0296-sa] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can undergo maternal-fetal transmission, heightening interest in the placental pathology findings from this infection. Transplacental SARS-CoV-2 transmission is typically accompanied by chronic histiocytic intervillositis together with necrosis and positivity of syncytiotrophoblast for SARSCoV-2. Hofbauer cells are placental macrophages that have been involved in viral diseases including HIV and Zika virus, but their involvement in SARS-CoV-2 in unknown. OBJECTIVE - To determine whether SARS-CoV-2 can extend beyond the syncytiotrophoblast to enter Hofbauer cells, endothelium and other villous stromal cells in infected placentas of liveborn and stillborn infants. DESIGN - Case-based retrospective analysis by 29 perinatal and molecular pathology specialists of placental findings from a preselected cohort of 22 SARS-CoV-2-infected placentas delivered to pregnant women testing positive for SARS-CoV-2 from 7 countries. Molecular pathology methods were used to investigate viral involvement of Hofbauer cells, villous capillary endothelium, syncytiotrophoblast and other fetal-derived cells. RESULTS - Chronic histiocytic intervillositis and trophoblast necrosis was present in all 22 placentas (100%). SARS-CoV-2 was identified in Hofbauer cells from 4/22 placentas (18%). Villous capillary endothelial staining was positive in 2/22 cases (9%), both of which also had viral positivity in Hofbauer cells. Syncytiotrophoblast staining occurred in 21/22 placentas (95%). Hofbauer cell hyperplasia was present in 3/22 placentas (14%). In the 7 cases having documented transplacental infection of the fetus, 2 occurred in placentas with Hofbauer cell staining positive for SARS-CoV-2. CONCLUSIONS - SARS-CoV-2 can extend beyond the trophoblast into the villous stroma, involving Hofbauer cells and capillary endothelial cells, in a small number of infected placentas. Most cases of SARS-CoV-2 transplacental fetal infection occur without Hofbauer cell involvement.
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Affiliation(s)
- David A Schwartz
- Department of Pathology, Medical College of Georgia, Augusta, GA
| | | | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, Clamart, France
| | - Mattia Bugatti
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Gaetano Bulfamante
- Hospital Complex for Pathological Anatomy and Medical Genetics, ASST Santi Paolo e Carlo, Milan, Italy Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Rebecca R J Collins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Larisa Debelenko
- Department of Pediatric and Perinatal Pathology, Columbia University Medical Center, New York, NY
| | - Danièle De Luca
- Neonatology Division of Pediatrics, Transportation and Neonatal Critical Care APHP, Paris Saclay University Hospitals, Medical Center "A.Béclère" & Physiopathology and Therapeutic Innovation Unit, Paris-Saclay University, Paris, France
| | - Fabio Facchetti
- Pathology Unit, Department of Molecular and Translational Medicine, Università degli Studi di Brescia, Brescia, Italy
| | - Brendan Fitzgerald
- Department of Pathology, Cork University Hospital, Wilton, Cork, Ireland
| | - Daniel Levitan
- Department of Pathology, SUNY Downstate Medical Center, Brooklyn, NY
| | - Rebecca L Linn
- Department of Pathology & Lab Medicine, Perelman School of Medicine at the University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Denise Morotti
- Pathology Unit and Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Raffaella Morotti
- Department of Pathology and Pediatrics, Autopsy Service, Yale University School of Medicine, New Haven, CT
| | - Luisa Patanè
- Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sophie Prevot
- Division of Pathology, Bicêtre Hospital, Paris Saclay University Hospitals, APHP, Le Kremlin-Bicêtre, France
| | - Bianca Pulinx
- Department of Clinical Biology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Ali G Saad
- Department of Pathology, University of Miami Miller School of Medicine/Jackson Health System/Holtz Children's Hospital, Miami, FL
| | - Sam Schoenmakers
- Department of Obstetrics and Gynaecology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - David Strybol
- Department of Pathology, Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Kristen Thomas
- Department of Pathology, NYU Langone Health, Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, NY
| | - Delfina Tosi
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Valentina Toto
- Hospital Complex for Pathological Anatomy and Medical Genetics, ASST Santi Paolo e Carlo, Milan, Italy
| | - Lotte E van der Meeren
- Department of Pathology, Leiden University Medical Center, and Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert M Verdijk
- Department of Pathology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynecology, Antoine Beclere Hospital, APHP, Université Paris Saclay, Clamart, France
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Skåne University Hospital, Malmö, Sweden and Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Schwartz DA, Baldewijns M, Benachi A, Bugatti M, Collins RRJ, De Luca D, Facchetti F, Linn RL, Marcelis L, Morotti D, Morotti R, Parks WT, Patanè L, Prevot S, Pulinx B, Rajaram V, Strybol D, Thomas K, Vivanti AJ. Chronic Histiocytic Intervillositis With Trophoblast Necrosis Is a Risk Factor Associated With Placental Infection From Coronavirus Disease 2019 (COVID-19) and Intrauterine Maternal-Fetal Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission in Live-Born and Stillborn Infants. Arch Pathol Lab Med 2021; 145:517-528. [PMID: 33393592 DOI: 10.5858/arpa.2020-0771-sa] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The number of neonates with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is increasing, and in a few there are reports of intrauterine infection. OBJECTIVE.— To characterize the placental pathology findings in a preselected cohort of neonates infected by transplacental transmission arising from maternal infection with SARS-CoV-2, and to identify pathology risk factors for placental and fetal infection. DESIGN.— Case-based retrospective analysis by a multinational group of 19 perinatal specialists of the placental pathology findings from 2 cohorts of infants delivered to mothers testing positive for SARS-CoV-2: live-born neonates infected via transplacental transmission who tested positive for SARS-CoV-2 after delivery and had SARS-CoV-2 identified in cells of the placental fetal compartment by molecular pathology, and stillborn infants with syncytiotrophoblast positive for SARS-CoV-2. RESULTS.— In placentas from all 6 live-born neonates acquiring SARS-CoV-2 via transplacental transmission, the syncytiotrophoblast was positive for coronavirus using immunohistochemistry, RNA in situ hybridization, or both. All 6 placentas had chronic histiocytic intervillositis and necrosis of the syncytiotrophoblast. The 5 stillborn/terminated infants had placental pathology findings that were similar, including SARS-CoV-2 infection of the syncytiotrophoblast, chronic histiocytic intervillositis, and syncytiotrophoblast necrosis. CONCLUSIONS.— Chronic histiocytic intervillositis together with syncytiotrophoblast necrosis accompanies SARS-CoV-2 infection of syncytiotrophoblast in live-born and stillborn infants. The coexistence of these 2 findings in all placentas from live-born infants acquiring their infection prior to delivery indicates that they constitute a pathology risk factor for transplacental fetal infection. Potential mechanisms of infection of the placenta and fetus with SARS-CoV-2, and potential future studies, are discussed.
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Affiliation(s)
- David A Schwartz
- The Department of Pathology, Medical College of Georgia, Augusta (Schwartz)
| | - Marcella Baldewijns
- The Department of Pathology, University Hospitals Leuven, Leuven, Belgium (Baldewijns)
| | - Alexandra Benachi
- The Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, Clamart, France (Benachi)
| | - Mattia Bugatti
- The Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (Bugatti)
| | - Rebecca R J Collins
- The Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Collins, Rajaram)
| | - Danièle De Luca
- The Division of Pediatrics, Transportation and Neonatal Critical Care APHP, Paris Saclay University Hospitals, Medical Center "A.Béclère" & Physiopathology and Therapeutic Innovation Unit, Paris-Saclay University, Paris, France (De Luca)
| | - Fabio Facchetti
- The Department of Molecular and Translational Medicine, University of Brescia, Italy (Facchetti)
| | - Rebecca L Linn
- The Department of Pathology, Perelman School of Medicine at the University of Pennsylvania & Children's Hospital of Philadelphia, Philadelphia (Linn)
| | - Lukas Marcelis
- The Department of Pathology, UZ Leuven, Leuven, Belgium (Marcelis)
| | - Denise Morotti
- The Pathology Unit and Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy (D Morotti)
| | - Raffaella Morotti
- The Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (R Morotti)
| | - W Tony Parks
- The Department of Pathology and Laboratory Medicine, University of Toronto and Mt Sinai Hospital, Toronto, Ontario, Canada (Parks)
| | - Luisa Patanè
- The Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy (Patanè)
| | - Sophie Prevot
- The Division of Pathology, Bicêtre Hospital, Paris Saclay University Hospitals, APHP, Le Kremlin-Bicêtre, France (Prevot)
| | - Bianca Pulinx
- The Department of Clinical Biology (Pulinx), Sint-Truiden, Belgium
| | - Veena Rajaram
- The Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Collins, Rajaram)
| | - David Strybol
- The Department of Pathology (Strybol), Sint-Trudo Hospital, Sint-Truiden, Belgium
| | - Kristen Thomas
- The Department of Pathology, NYU Langone Health-Main Campus & Bellevue Hospital Center, New York University School of Medicine, New York, New York (Thomas)
| | - Alexandre J Vivanti
- The Department of Obstetrics and Gynecology, Antoine Béclère Hospital, APHP, Université Paris Saclay, Clamart, France (Vivanti)
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Schwartz DA, Morotti D, Beigi B, Moshfegh F, Zafaranloo N, Patanè L. Confirming Vertical Fetal Infection With Coronavirus Disease 2019: Neonatal and Pathology Criteria for Early Onset and Transplacental Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 From Infected Pregnant Mothers. Arch Pathol Lab Med 2020; 144:1451-1456. [PMID: 32886737 DOI: 10.5858/arpa.2020-0442-sa] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 11/06/2022]
Abstract
Increasing numbers of pregnant women with coronavirus disease 2019 are being reported around the world. The majority of neonates delivered to pregnant women infected with severe acute respiratory syndrome coronavirus 2 have been negative for the virus, but a small number have tested positive for infection. It is important to determine whether vertical transmission of coronavirus disease 2019 occurs and the mechanisms for its development. Based on a number of clinical and laboratory findings, it has been suggested that transplacental transmission may be occurring, but a method to confirm this is necessary. This communication analyzes and evaluates the covariables that have been discussed as potential indicators of vertical and, specifically, intrauterine transmission, including the timing of onset of neonatal illness, neonatal viral test positivity, neonatal antibody testing for immunoglobulin (Ig) G and IgM, and viral analysis of swabs of whole specimens of placental tissue. None of these methods can provide confirmatory evidence that infection developed prior to labor and delivery, or that transplacental transmission occurred. This commentary proposes that diagnosis of early-onset neonatal coronavirus disease 2019 infection should be limited to neonates with positive reverse transcription polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 within the initial 72 hours of life. It also proposes that the occurrence of intrauterine transplacental severe acute respiratory syndrome coronavirus 2 among infected mother-infant dyads be based upon identification of severe acute respiratory syndrome coronavirus 2 in chorionic villus cells using immunohistochemistry or nucleic acid methods such as in situ hybridization. Evaluating placentas from neonates with coronavirus disease 2019 using these methods will be instrumental in determining the potential role and prevalence of transplacental transmission of the coronavirus.
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Affiliation(s)
- David A Schwartz
- From the Department of Pathology, Medical College of Georgia, Augusta University, Augusta (Schwartz)
| | - Denise Morotti
- The Pathology Unit (Morotti), ASST Papa Giovanni XXIII, Bergamo, Italy.,The Medical Genetics Laboratory (Morotti), ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Babak Beigi
- The Department of Neonatology, Tehran University of Medical Sciences and Universal Scientific and Educational Network, Tehran, Iran (Beigi)
| | - Fereshteh Moshfegh
- The Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (Moshfegh, Zafaranloo)
| | - Nazanin Zafaranloo
- The Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (Moshfegh, Zafaranloo)
| | - Luisa Patanè
- The Obstetrics and Gynecology Department (Patanè), ASST Papa Giovanni XXIII, Bergamo, Italy
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10
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Schwartz DA, Morotti D. Placental Pathology of COVID-19 with and without Fetal and Neonatal Infection: Trophoblast Necrosis and Chronic Histiocytic Intervillositis as Risk Factors for Transplacental Transmission of SARS-CoV-2. Viruses 2020; 12:v12111308. [PMID: 33203131 PMCID: PMC7697563 DOI: 10.3390/v12111308] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [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: 10/29/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 02/07/2023] Open
Abstract
The mechanism(s) by which neonates testing positive for coronavirus disease 2019 (COVID-19) acquire their infection has been largely unknown. Transmission of the etiological agent, SARS-CoV-2, from mother to infant has been suspected but has been difficult to confirm. This communication summarizes the spectrum of pathology findings from pregnant women with COVID-19 based upon the infection status of their infants and addresses the potential interpretation of these results in terms of the effects of SARS-CoV-2 on the placenta and the pathophysiology of maternal-fetal infection. Placentas from pregnant women with COVID-19 and uninfected neonates show significant variability in the spectrum of pathology findings. In contrast, placentas from infected maternal-neonatal dyads are characterized by the finding of mononuclear cell inflammation of the intervillous space, termed chronic histiocytic intervillositis, together with syncytiotrophoblast necrosis. These placentas show prominent positivity of syncytiotrophoblast by SARS-CoV-2, fulfilling the published criteria for transplacental viral transmission as confirmed in fetal cells through identification of viral antigens by immunohistochemistry or viral nucleic acid using RNA in situ hybridization. The co-occurrence of chronic histiocytic intervillositis and trophoblast necrosis appears to be a risk factor for placental infection with SARS-CoV-2 as well as for maternal-fetal viral transmission, and suggests a potential mechanism by which the coronavirus can breach the maternal-fetal interface.
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Affiliation(s)
- David A. Schwartz
- Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence:
| | - Denise Morotti
- Pathology Unit and Medical Genetics Laboratory, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy;
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11
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MESH Headings
- Betacoronavirus/genetics
- Betacoronavirus/metabolism
- COVID-19
- COVID-19 Testing
- Clinical Laboratory Techniques
- Coronavirus Infections/complications
- Coronavirus Infections/diagnosis
- Coronavirus Infections/pathology
- Endarteritis/etiology
- Endarteritis/pathology
- Fatal Outcome
- Humans
- Infarction/diagnosis
- Infarction/etiology
- Infarction/pathology
- Infarction/surgery
- Intestinal Mucosa/metabolism
- Intestinal Mucosa/virology
- Intestine, Small/blood supply
- Intestine, Small/metabolism
- Intestine, Small/surgery
- Male
- Mesenteric Ischemia/diagnosis
- Mesenteric Ischemia/etiology
- Mesenteric Ischemia/pathology
- Mesenteric Ischemia/surgery
- Middle Aged
- Pandemics
- Pneumonia, Viral/complications
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/pathology
- RNA, Messenger/metabolism
- SARS-CoV-2
- Shock, Septic/etiology
- Spike Glycoprotein, Coronavirus/genetics
- Thrombosis/etiology
- Thrombosis/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- Lorenzo Norsa
- Paediatric Hepatology Gastroenterology and Transplantation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Clarissa Valle
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo; Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano, Italy
| | - Denise Morotti
- Pathology Department, Papa Giovanni XXIII, Hospital, Bergamo, Italy; Medical Genetics Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Pietro Andrea Bonaffini
- Radiology Department, Papa Giovanni XXIII Hospital, Bergamo; Post-Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Milano, Italy
| | - Amedeo Indriolo
- Gastroenterology and Endoscopy Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Aurelio Sonzogni
- Pathology Department, Papa Giovanni XXIII, Hospital, Bergamo, Italy
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12
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Sonzogni A, Previtali G, Seghezzi M, Grazia Alessio M, Gianatti A, Licini L, Morotti D, Zerbi P, Carsana L, Rossi R, Lauri E, Pellegrinelli A, Nebuloni M. Liver histopathology in severe COVID 19 respiratory failure is suggestive of vascular alterations. Liver Int 2020; 40:2110-2116. [PMID: 32654359 PMCID: PMC7404964 DOI: 10.1111/liv.14601] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
SARS2-CoV-2 breakout in Italy caused a huge number of severely ill patients with a serious increase in mortality. Although lungs seem to be the main target of the infection, very few information are available about liver involvement, possibly evocating a systemic disease. Post-mortem wedge liver biopsies from 48 patients died from severe pulmonary COVID-19 disease with respiratory failure were collected from two main hospitals in northern Italy. No patient had clinical symptoms of liver disease or signs of liver failure before and during hospitalization; for each of them liver function tests were available. All liver samples showed minimal inflammation features. Histological pictures compatible with vascular alterations were observed, characterized by increase in number of portal vein branches associated with lumen massive dilatation, partial or complete luminal thrombosis of portal and sinusoidal vessels, fibrosis of portal tract, focally markedly enlarged and fibrotic. SARS-CoV-2 was found in 15 of 22 samples tested by in situ hybridization method. Our preliminary results confirm the clinical impression that liver failure is not a main concern and this organ is not the target of significant inflammatory damage. Histopathological findings are highly suggestive for marked derangement of intrahepatic blood vessel network secondary to systemic changes induced by virus that could target not only lung parenchyma but also cardiovascular system, coagulation cascade and endothelial layer of blood vessels. It still remains unclear if the mentioned changes are directly related to virus infection or if SARS-CoV-2 triggers a series of reactions leading to striking vascular alterations.
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Affiliation(s)
| | - Giulia Previtali
- Department of Laboratory MedicinePapa Giovanni XXIII HospitalBergamoItaly
| | - Michela Seghezzi
- Department of Laboratory MedicinePapa Giovanni XXIII HospitalBergamoItaly
| | | | - Andrea Gianatti
- Department of PathologyPapa Giovanni XXIII HospitalBergamoItaly
| | - Lisa Licini
- Department of PathologyPapa Giovanni XXIII HospitalBergamoItaly
| | - Denise Morotti
- Department of PathologyPapa Giovanni XXIII HospitalBergamoItaly
| | - Pietro Zerbi
- Department of PathologyLuigi Sacco HospitalMilanoItaly,Department of Biomedical and Clinical SciencesUniversity of MilanMilanoItaly
| | - Luca Carsana
- Department of Biomedical and Clinical SciencesUniversity of MilanMilanoItaly
| | - Roberta Rossi
- Department of Biomedical and Clinical SciencesUniversity of MilanMilanoItaly
| | | | | | - Manuela Nebuloni
- Department of PathologyLuigi Sacco HospitalMilanoItaly,Department of Biomedical and Clinical SciencesUniversity of MilanMilanoItaly
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13
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Patanè L, Morotti D, Giunta MR, Sigismondi C, Piccoli MG, Frigerio L, Mangili G, Arosio M, Cornolti G. Vertical transmission of coronavirus disease 2019: severe acute respiratory syndrome coronavirus 2 RNA on the fetal side of the placenta in pregnancies with coronavirus disease 2019-positive mothers and neonates at birth. Am J Obstet Gynecol MFM 2020; 2:100145. [PMID: 32427221 PMCID: PMC7233206 DOI: 10.1016/j.ajogmf.2020.100145] [Citation(s) in RCA: 248] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Luisa Patanè
- Department of Gynecology and Obstetrics, ASST Papa Giovanni XXIII, Piazza OMS, 1, Bergamo 24127, Italy
| | - Denise Morotti
- Pathology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,Medical Genetics Laboratory, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Cristina Sigismondi
- Department of Gynecology and Obstetrics, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Luigi Frigerio
- Department of Gynecology and Obstetrics, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giovanna Mangili
- Department of Neonatology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Marco Arosio
- Department of Microbiology and Virology, and the Bio Bank, ASST Papa Giovanni XXIII, Bergamo, Italy
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Fusco N, Bonometti A, Augello C, Fabris S, Boiocchi L, Fiori S, Morotti D, Fracchiolla N, Berti E, Gianelli U. Clonal reticulohistiocytosis of the skin and bone marrow associated with systemic mastocytosis and acute myeloid leukaemia. Histopathology 2017; 70:1000-1008. [PMID: 28074480 DOI: 10.1111/his.13166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS The aims of this study were to define whether diffuse cutaneous reticulohistiocytosis could be underpinned by somatic genetic alterations and represent a precursor of more aggressive forms of disease. METHODS AND RESULTS A 59-year-old man with diffuse cutaneous reticulohistiocytosis experienced bone marrow localization of the disease, with associated systemic mastocytosis and acute myeloid leukaemia. Cytogenetic analyses of the bone marrow aspirate revealed the presence of a derivative chromosome giving rise to a partial trisomy of chromosome 1q and a partial monosomy of chromosome 9q. Therefore, we characterized the cutaneous lesions before and after chemotherapy by using an integrative approach combining histopathology, electron microscopy, and fluorescence in-situ hybridization. Histologically, the skin lesions belonged to the spectrum of diffuse cutaneous reticulohistiocytoses, as confirmed by immunohistochemistry and ultrastructural analyses. Fluorescence in-situ hybridization in the skin nodules confirmed the presence of the genetic alterations previously detected in the bone marrow. CONCLUSIONS Here, we provide circumstantial evidence to suggest that at least a subset of cutaneous reticulohistiocytoses harbour clonal molecular alterations. Furthermore, we confirm that these lesions have the potential to arise in the setting of concurrent haematological disorders. In this hypothesis-generating study, two possible tumorigenesis models are proposed.
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Affiliation(s)
- Nicola Fusco
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, Milan, Italy
| | - Arturo Bonometti
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - Claudia Augello
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
| | - Sonia Fabris
- Oncohaematology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Leonardo Boiocchi
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Division of Anatomical and Molecular Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefano Fiori
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,School of Pathology, University of Milan, Milan, Italy
| | - Denise Morotti
- Laboratory of Medical Genetics, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Fracchiolla
- Oncohaematology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Emilio Berti
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, Milan, Italy.,Department of Dermatology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Umberto Gianelli
- Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy.,Haematopathology Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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15
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Cattaneo D, Morotti D, Bucelli C, Cannone M, Zappa M, Guerneri S, Iurlo A. Comprehensive Molecular Analyses in a Case of Masked Philadelphia Chronic Myeloid Leukemia. Cytogenet Genome Res 2015; 147:35-40. [PMID: 26636412 DOI: 10.1159/000442039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/19/2022] Open
Abstract
Here, we report the case of an 80-year-old woman with masked Philadelphia chronic myeloid leukemia (Ph CML). At diagnosis, qualitative PCR demonstrated the presence of a typical e14a2 configuration, and chromosome analysis showed an apparently normal female karyotype. However, FISH with BCR-ABL1 dual fusion probes gave a positive signal in 152/200 analyzed nuclei, with the fusion signal detected on the long arm of a cytogenetically normal chromosome 9. Using locus-specific probes for chromosome 9 and 22 telomeres, a third chromosome involvement was excluded. Furthermore, microarray analysis from the same specimens showed a normal result. Due to a high Charlson Comorbidity Index, the patient was treated with a reduced dose of imatinib, achieving a rapid hematological response after 1 month. However, after 6 months of imatinib therapy, she had to be considered as warning (Ph+ 26.5%, BCR-ABL1 >1%) according to the European LeukemiaNet 2013 recommendations. In conclusion, we confirmed the importance of a combination of cytogenetic and molecular techniques for the diagnosis and therapy monitoring of masked Ph CML, but, different from what has been reported in the literature so far, we cannot completely exclude the fact that the unusual cytogenetic pattern of this patient may have negatively influenced her response to tyrosine kinase inhibitor therapy.
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Affiliation(s)
- Daniele Cattaneo
- Oncohematology Division, IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, Milan, Italy
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Oneda B, Baldinger R, Reissmann R, Reshetnikova I, Krejci P, Masood R, Ochsenbein-Kölble N, Bartholdi D, Steindl K, Morotti D, Faranda M, Baumer A, Asadollahi R, Joset P, Niedrist D, Breymann C, Hebisch G, Hüsler M, Mueller R, Prentl E, Wisser J, Zimmermann R, Rauch A. High-resolution chromosomal microarrays in prenatal diagnosis significantly increase diagnostic power. Prenat Diagn 2014; 34:525-33. [PMID: 24919595 DOI: 10.1002/pd.4342] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 02/10/2014] [Accepted: 02/10/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine for the first time the reliability and the diagnostic power of high-resolution microarray testing in routine prenatal diagnostics. METHODS We applied high-resolution chromosomal microarray testing in 464 cytogenetically normal prenatal samples with any indication for invasive testing. RESULTS High-resolution testing revealed a diagnostic yield of 6.9% and 1.6% in cases of fetal ultrasound anomalies and cases of advanced maternal age (AMA), respectively, which is similar to previous studies using low-resolution microarrays. In three (0.6%) additional cases with an indication of AMA, an aberration in susceptibility risk loci was detected. Moreover, one case (0.2%) showed an X-linked aberration in a female fetus, a finding relevant for future family planning. We found the rate of cases, in which the parents had to be tested for interpretation of unreported copy number variants (3.7%), and the rate of remaining variants of unknown significance (0.4%) acceptably low. Of note, these findings did not cause termination of pregnancy after expert genetic counseling. The 0.4% rate of confined placental mosaicism was similar to that observed by conventional karyotyping and notably involved a case of placental microdeletion. CONCLUSION High-resolution prenatal microarray testing is a reliable technique that increases diagnostic yield by at least 17.3% when compared with conventional karyotyping, without an increase in the frequency of variants of uncertain significance.
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Affiliation(s)
- Beatrice Oneda
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
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