Significance of the Presence of Microscopic Vascular Invasion After Complete Resection of Stage I–II pT1-T2N0 Non-small Cell Lung Cancer and Its Relation with T-Size Categories: Did the 2009 7th Edition of the TNM Staging System Miss Something?

Introduction:The aim of this study was to assess the significance of microscopic vascular invasion (MVI) in a population of resected patients with early-stage non-small cell lung cancer (NSCLC), along with an analysis of the effect of the combination of MVI and tumor size for the T-size categories T1a-T2b according to the 2009 7th edition of the tumor, node, metastasis (TNM) classification.Methods:From January 1993 to August 2008, 746 patients with pT1-T2N0 NSCLC received resection at our institution. MVI was ascertained using histopathological and immunohistochemical techniques.Results:MVI was observed in 257 patients (34%). Prevalence was higher in adenocarcinoma (ADK) than in squamous cell carcinoma (p = 0.002). A significant correlation was found between MVI and ADK (p = 0.03), increased tumor dimension (p = 0.05), and the presence of tumor-infiltrating lymphocytes (p = 0.02). The presence of MVI was associated with a reduced 5-year survival overall (p = 0.003) and in ADK (p = 0.0002). In a multivariate survival analysis, MVI was an indicator of poor survival overall (p = 0.003) and in ADK (p = 0.0005). In each T category (T1a-T2b) of the 2009 TNM staging system, survival of MVI+ patients was significantly lower than the corresponding MVI− patients; T1a and T1b MVI+ patients had a survival similar to MVI− T2 patients.Conclusions:The finding of MVI in pT1-T2N0 NSCLC is frequent. MVI correlates with adenocarcinoma histotype, increased tumor dimensions, and tumor-infiltrating lymphocytes. The presence of MVI is an independent negative prognostic factor. In our experience, MVI was a stronger prognostic indicator than T size in T1a-T2b categories according to the 2009 TNM staging system

Surgery of colorectal cancer lung metastases: analysis of survival, recurrence and re-surgery

BACKGROUND: Surgery is considered an effective therapeutic option for patients with lung metastasis (MTS) of colorectal cancer (CRC). The purpose of the study was to evaluate efficacy and feasibility of lung metastasectomy in CRC patients and to explore factors of prognostic relevance. METHODS: This is a retrospective study of patients operated for lung MTS of CRC from 2004 to 2012 in a single Institution. Overall survival (OS) was the primary endpoint. Secondary endpoints were progression free survival (PFS) in resection status R0 and OS in in patients submitted to re-resections. In order to evaluate prognostic factors, a multivariable Cox proportional hazard model was performed. RESULTS: One-hundred eighty-eight consecutive patients were included in the final analysis. The median follow-up (FU) was 45 months. The 5-year OS and PFS were 53% (95% CI: 44–60%) and 33% (95% CI: 25–42%), respectively. Two- and 5-year survival after re-resection were 79% (95% CI: 63–89%) and 49% (95% CI: 31–65%), respectively. Multivariate adjusted analysis showed that primary CRC pathological TNM stages (P=0.019), number of resected MTS ≥5 (P=0.009) and lymph nodal involvement (P<0.0001) are independent predictors of poor prognosis. CONCLUSIONS: Patients operated and re-operated for lung MTS from CRC cancers showed encouraging survival rates. Our results indicated that primary CRC stage, number of MTS and lymph nodal involvement are strong predictive factors. Prognosis after surgery remained comforting up to four resected MTS. Adjuvant chemotherapy seems to have a benefit on survival in patients affected by multiple metastases. Finally, according to the high rate of unidentified lymph node involvement in pre-operative setting, lymph node sampling should be advisable for a correct staging

Pulmonary Metastasectomy for Melanoma

AbstractAfter primary tumor treatment, 30% of patients with malignant melanoma develop metastatic disease, usually associated with a poor prognosis. Effective chemotherapeutic regimens for metastatic melanoma are not currently available. Surgical treatment of pulmonary metastases remains controversial because of the dismal survival rates reported in several studies. However, for patients with good performance status, long disease-free interval, limited metastatic disease, and less aggressive tumor biology, it remains an option. The authors have analyzed their experience in 26 patients operated on between 2000 and 2008 alongside a review of the large series in the literature

Multicentric encapsulated papillary oncocytic neoplasm of the thyroid: A case diagnosed by a combined cytological, histological, immunohistochemical, and molecular approach

Fine-needle aspiration (FNA) diagnosis of oncocytic lesions is challenging. In fact, oncocytic changes occur in inflammatory, hyperplastic, and neoplastic settings, including both benign and malignant tumors. The rare oncocytic variant of papillary thyroid carcinoma (PTC), shows papillae composed by cells with large oncocytic granular cytoplasm featuring clear PTC nuclear features. A morphological similar, but biologically distinct lesion, is the encapsulated papillary oncocytic neoplasia. Here, we first report on FNA, its cytological features together with histological, immunohistochemical, and molecular correlates

CONSERVAZIONE INTEGRATA DI UNA PIANTA RARA E MINACCIATA E DELLA COMUNITA' DEI SUOI IMPOLLINATORI SELVATICI: PROGETTO LIFE+ PP-ICON (LIFE09/NAT/IT/000212)

Il progetto PP-ICON (Plant Pollinator Integrated CONservation approach: a demonstrative proposal) è un progetto LIFE+ Biodiversità della durata di 4 anni incentrato sulla conservazione integrata di una pianta localmente rara, Dictamnus albus L., e sulla comunità dei suoi impollinatori. Il sito di intervento si trova all'interno di un’area protetta della provincia di Bologna (Parco Regionale dei Gessi Bolognesi e Calanchi dell'Abbadessa), che è anche un sito di interesse comunitario (SIC-ZPS IT4050001 Rete Natura2000). Le azioni si concentrano in quattro ambiti principali: gestione dell'habitat, salvaguardia degli impollinatori, sensibilizzazione degli stakeholders e divulgazione. Gli interventi sull’habitat sono consistiti nella creazione di schiarite boschive, al fine di ristabilire le migliori condizioni ambientali per la persistenza della pianta, che soffre per la chiusura del bosco. Sono stati individuati gli impollinatori effettivi del dittamo, al fine di fornire loro siti di nidificazione idonei, e alcune specie di bombi sono state allevate artificialmente e reintrodotte nella zona. Il sostentamento degli impollinatori è stato anche favorito dall'incremento delle fonti mellifere, ossia della flora spontanea necessaria a fornire loro nettare e polline. A tale scopo sono state scelte 16 specie già presenti nell'area e con una fioritura scalare, per garantire la presenza di fonti alimentari per tutto il periodo di sviluppo degli insetti. Il successo delle azioni di conservazione viene valutato attraverso il monitoraggio periodico della fitness della pianta e della diversità degli impollinatori. Dopo tre anni dall'inizio del progetto la gestione del bosco ha dato esito positivo, con un incremento della luce incidente nelle due aree di taglio di rispettivamente 5 e 2 volte rispetto alle due aree di controllo, e un aumento di 6 volte del numero di piante fiorite. L'introduzione di 6 gruppi di nidi artificiali ha avuto successo per diverse specie di api solitarie (es. varie Megachilidae e Xylocopa sp.), mentre i 10 nidi per bombi non sono stati colonizzati. Tuttavia, in tre anni, 17 colonie di Bombus terrestris sono state allevate con successo in laboratorio e reintrodotte nella zona. Le piante nettarifere trapiantate vengono assiduamente visitate dagli impollinatori selvatici e, anche se i dati del monitoraggio indicano ancora una generale scarsità di fauna impollinatrice, vi è una relazione positiva tra abbondanza degli impollinatori e diversità delle specie di fiori; nell’anno successivo all’introduzione delle nettarifere infatti l’indice di Shannon è aumentato in media di 0,25 punti ogni mese rispetto all’anno precedente. Gli eventi di divulgazione, che si concentrano sul rapporto tra piante e impollinatori e sulle strategie per la loro conservazione, hanno attirato un numero sempre crescente di persone negli anni del progetto, contribuendo a sensibilizzare l'opinione pubblica sull'importante tema della conservazione della biodiversità

Pulmonary adenocarcinomas: a single-centre validation study of the clinical and prognostic utility of the WHO/ IASLC subtype classification

Objective: Adenocarcinoma is the most frequently reported histological subtype of lung carcinoma in many series as well as the most histologically variable and heterogeneous form. A WHO/IASLC classification of pulmonary adenocarcinomas was proposed in 2004 suggesting clinical and prognostic implications for the different subtypes. The aim of the present study was to analyze our patient population of resected patients with adenocarcinoma according to the WHO/IASLC classification to evaluate its clinical and prognostic utility Methods: From January 2004 to October 2008 a total of 277 patients received curative resection of primary lung adenocarcinoma at our Institution. There were 191 men (69%) and 86 women (31%) with a mean age of 65 years (range 42-82 years). The tumours were classified according to the 2004 WHO/IASLC classification into: acinar adenocarcinomas (AC), papillary/micropapillary adenocarcinomas (PAP), bronchiolo-alveolar carcinomas (BAC), and solid adenocarcinomas with mucin production (SOL). Adenocarcinomas with mixed subtypes were reclassified according to the most prevalent histotype. Prevalence, correlations and survival analysis both univariate and multivariate using some clinico-pathological variables (age, microscopic vascular invasion, grading, perineural invasion, tumourinfiltrating lymphocytes, T, N status and pathologic Stage) were performed among the different subgroups. Results: There were 41 AC, 82 PAP ( 45 pure papillary and 37 mixed papillary/micropapillary when a >5% micropapillary component was present), 30 BAC, 15 SOL. 10 adenocarcinomas were variant subtypes, including clear cell (4), signet ring (4) and pseudosarcomatous (2) adenocarcinomas. In 99 patients the histological subtype could not be defined. BAC were significantly associated with a less microscopic vascular invasion (p=0.01), a lower grading (G1) (p=0.0001) and a lower N status (p=0.02). Acinar and solid adenocarcinomas showed no significant correlation with any clinico-pathological variable. Papillary/micropapillary adenocarcinomas were associated with a higher grading (G3) (p=0.05). 3-year survival rates for the different subtypes were: BAC, 78%; AC, 75%; SOL, 67% and PAP 62% (pure papillary 68%, mixed papillary/micropapillary 53%). The 99 undefined adenocarcinomas had a 3 year survival rate of 75%. The differences among the groups were not significant (p=0.6). In multivariate analysis, the subgroup classification was not an independent prognostic indicator (HR 1.02, 95%CI 0.84-1.23). Conclusions: In our experience, about one-third of resected pulmonary adenocarcinomas cannot be classified into subtypes using standard histopathologic techniques. The papillary/micropapillary pattern is associated with a higher dedifferentiation, and the micropapillary component confers a survival disadvantage which however was not significant in the present series. Classification of pulmonary adenocarcinomas into subtypes was not an independent prognostic factor in multivariate survival analysis. Although promising, the prognostic utility of the WHO/IASLC adenocarcinoma classification needs to be verified on a larger number of patients