Total thyroidectomy associated to chemotherapy in primary squamous cell carcinoma of the thyroid

Primary squamous cell carcinoma of the thyroid (PSCCT) is a rare malignant disease with rapid fatal prognosis. The onset is generally characterized by sudden bilateral latero-cervical lymphadenopathy. The Authors report patient of 58-year-old who referred for evaluation of rapidly aggravating bilateral latero-cervical lymphadenopathy. The US highlighted the presence of a hypoechoic nodular lesion characterized by peri and intra-nodular vascularization. Multilayer CT showed diffused involvement of mediastinal and bilateral latero-cervical lymph nodes, with no evidence of primary pulmonary neoplasia or elsewhere. The patient underwent total thyroidectomy. The peri-isthmic tissue was removed due to the presence of a small roundish formation, that was due to lymph node metastasis at histological examination. Histological diagnosis: PSCCT. The immunohistochemical panel of the thyroid lesion was indispensable for the differential diagnosis between PSCCT, medullary carcinoma, anaplastic carcinoma, and thyroid metastasis of neoplasia with unknown primitiveness. The patient underwent chemotherapeutic treatment with Carboplatin and Paclitaxel with modest improvement of dysphagia symptoms and reduction of 10-15% of the target lesions. The clinical course was characterized by loco-regional progression of the disease with exitus in 10 months after diagnosis. Survival and quality of life after surgical therapy and chemotherapy were like that of patients undergoing only chemotherapy. Due to the extreme rarity of the neoplasia, 60 cases described in Literature, no exclusive guidelines are reported for PSCCT. More extensive case studies are needed to evaluate the effects of total thyroidectomy with intent R0/R1 on improving survival and quality of life of patients with PSCCT

Acute pancreatitis secondary to non-functioning pancreatic neuroendocrine tumor: uncommon clinical presentation. Clinical case and review of literature

I tumori neuroendocrini del pancreas (PNET) sono rari, e rappresentano <5% di tutte le neoplasie pancreatiche, suddivisi in PNET funzionanti con secrezione ormonale responsabile di sintomi specifici e PNET non funzionanti (nf-PNET) generalmente di diagnosi tardiva per la comparsa di metastasi o manifestazioni cliniche per effetti compressivi. L’approccio chirurgico è il trattamento di scelta per PNETs funzionanti, non-funzionanti di diametro superiore a 2 cm o sintomatici per disturbi da compressione. Osservazione personale. Donna di 76 anni ricoverata presso la UOC-Università-Chirurgia Ospedale “A. Fiorini” di Terracina per nausea e dolore ai quadranti addominali superiori con irradiazione dorso-lombare, insorti dopo un pasto serale. Dopo gli esami ematochimici e le indagini strumentali, è stata fatta la diagnosi di pancreatite acuta severa. Gli US convenzionali, CCT, CE-MRI ed EUS hanno mostrato una lesione di 2,8 cm di diametro nella giunzione testa-corpo del pancreas. L’esame citologico FNA non ha rilevato la presenza di cellule pancreatiche atipiche. La scintigrafia total body con Octreoscan® ha documentato un’area di ipercaptazione patologica situata in corrispondenza della neoformazione. La paziente è stata sottoposta a spleno-pancreasectomia corpo-coda. L’esame istologico ha dimostrato un nf-PNET di grado intermedio (G2) stenosante il vena lienale e stenosante il dotto di Wirsung, con pancreatite perilesionale. L’immunoistochimica ha mostrato un immunofenotipo positivo per CAM5.2, sinaptofisina (> 95%) e cromogranina (60%), con espressione di somatostatina intratumorale negativa. CONCLUSIONE: Sebbene raramente un nf-PNETS può essere la causa di grave pancreatite acuta non biliare da compressione del sistema duttale pancreatico. Nei casi in cui la PET / CT68Ga non può essere eseguita, la scintigrafia total body con Octreoscan® rimane il metodo più utilizzato per la diagnosi dei PNET e l’identificazione delle eventuali lesioni extra-pancreatiche. La cromogranina e la sinaptofisina sono confermate come marcatori specifici del differenziamento neuroendocrino.BACKGROUND: Pancreatic neuroendocrine tumors (PNETs) are uncommon, representing <5% of all pancreatic neoplasms, divided into functioning PNETs with secreted hormone cause of specific symptoms, and non-functioning PNETs (nf- PNETs) characterized by delayed diagnosis with metastases and clinical manifestations of compressive effects. Surgical approach is recommended for functioning and nf-PNETs >2 cm in diameter. CASE REPORT: A 76-year-old woman was admitted to the UOC-University-Surgery Hospital "A. Fiorini" in Terracina for nausea and pain in the upper abdominal quadrants with dorso-lumbar irradiation, arising after the evening meal. After the haematochemistry tests and the instrumental investigations, the diagnosis of acute, severe halitiasic pancreatitis was made. Conventional US, CCT, CE-MRI and EUS showed a 2.8cm diameter lesion in the head-body junction of the pancreas. FNA-cytological examination did not found the presence of atypical pancreatic cells. Total-body scintigraphy with Octreoscan® documented a pathological hypercaptation area located in correspondence with the neoformation. The patient underwent a body-tail spleno-pancreatectomy. The histological examination showed an intermediate grade (G2) nf-PNET infiltrating the lienal vein and stenosing the Wirsung duct, with perilesional pancreatitis. Immunohistochemistry showed CAM 5.2, Synaptophysin (>95%) and Chromogranin (60%) positive immunophenotype, with negative intratumoral Somatostatin expression. CONCLUSION: Although rarely, nf-PNETS may be the cause of severe non-biliary acute pancreatitis from pancreatic ductal system compression. In cases where PET/CT68Ga cannot be performed, total-body scintigraphy with Octreoscan® remains the most widely used method for the diagnosis of PNETs and the identification of extra-pancreatic lesions. Chromogranin and Synaptophysin are confirmed as specific markers of neuroendocrine differentiation. KEY WORDS: Acute pancreatitis, Chromogranin, Pancreatic neuroendocrine tumor, Synaptophysin, Somatostatin

Early melanoma invasivity correlates with gut fungal and bacterial profiles

7openInternationalItalian coauthor/editorBackground The microbiome is emerging as a crucial player of the immune checkpoint in cancer. Melanoma is a highly immunogenic tumour, and the composition of the gut microbiome has been correlated to prognosis and evolution of advanced melanoma and proposed as a biomarker for immune checkpoint therapy. Objectives We investigated the gut fungal and bacterial compositions in early-stage melanoma and correlated microbial profiles with histopathological features. Methods Sequencing of bacterial 16S rRNA and the fungal internal transcribed spacer region was performed on faecal samples of patients with stage I and II melanoma, and healthy controls. A meta-analysis with gut microbiota data from patients with metastatic melanoma was also carried out. Results We found a combination of gut fungal and bacterial profiles significantly discriminating patients with melanoma from controls. In patients with melanoma, we observed an abundance of Prevotella copri and yeasts belonging to the order Saccharomycetales. We found that the bacterial and fungal community correlated to melanoma invasiveness, whereas the specific fungal profile correlated to melanoma regression. Bacteroides was identified as general marker of immunogenicity, being shared by regressive and invasive melanoma. In addition, the bacterial communities in patients with stage I and II melanoma were different in structure and richer than those from patients with metastatic melanoma. Conclusions The composition of the gut microbiota in early-stage melanoma changes along the gradient from in situ to invasive (and metastatic) melanoma. Changes in the microbiota and mycobiota are correlated to the histological features of early-stage melanoma, and to the clinical course and response to immune therapies of advanced-stage melanoma, through direct or indirect immunomodulation.openVitali, F.; Colucci, R.; Di Paola, M.; Pindo, M.; De Filippo, C.; Moretti, S.; Cavalieri, D.Vitali, F.; Colucci, R.; Di Paola, M.; Pindo, M.; De Filippo, C.; Moretti, S.; Cavalieri, D

Engineering fidelity echoes in Bose-Hubbard Hamiltonians

We analyze the fidelity decay for a system of interacting bosons described by a Bose-Hubbard Hamiltonian. We find echoes associated with "non-universal" structures that dominate the energy landscape of the perturbation operator. Despite their classical origin, these echoes persist deep into the quantum (perturbative) regime and can be described by an improved random matrix modeling. In the opposite limit of strong perturbations (and high enough energies), classical considerations reveal the importance of self-trapping phenomena in the echo efficiency.Comment: 6 pages, use epl2.cls class, 5 figures Cross reference with nlin, quant-phy

Properties of projectile-fragments in the 40^{40}Ar + 27^{27}Al reaction at 44 A MeV. Comparison with a multisequential decay model

GANIL-EXPResults on projectile fragment–fragment coincidences in the forward direction and for the reaction 40Ar + 27Al at 44 A MeV are presented and compared with the predictions of two different entrance channel models, a two-body and a three-body mechanism both followed by a binary multisequential decay including fission. This analysis shows that many features of the projectile decay products are well accounted for by the binary multisequential decay model. However the results depend critically upon the initial masses and excitation energies of the primary projectile fragments. In this respect, the three-body approach underestimates the excitation energy imparted to the primary fragments whereas the two-body scenario overestimates it. The present data put strong constraints on the initial excitation energy imparted to the primary fragments which appears to be intermediate between the predictions of the two models

Quantizing the damped harmonic oscillator

We consider the Fermi quantization of the classical damped harmonic oscillator (dho). In past work on the subject, authors double the phase space of the dho in order to close the system at each moment in time. For an infinite-dimensional phase space, this method requires one to construct a representation of the CAR algebra for each time. We show that unitary dilation of the contraction semigroup governing the dynamics of the system is a logical extension of the doubling procedure, and it allows one to avoid the mathematical difficulties encountered with the previous method.Comment: 4 pages, no figure

Projected Quasi-particle Perturbation theory

The BCS and/or HFB theories are extended by treating the effect of four quasi-particle states perturbatively. The approach is tested on the pairing hamiltonian, showing that it combines the advantage of standard perturbation theory valid at low pairing strength and of non-perturbative approaches breaking particle number valid at higher pairing strength. Including the restoration of particle number, further improves the description of pairing correlation. In the presented test, the agreement between the exact solution and the combined perturbative + projection is almost perfect. The proposed method scales friendly when the number of particles increases and provides a simple alternative to other more complicated approaches

Alpha-particle clustering in excited expanding self-conjugate nuclei

The fragmentation of quasi-projectiles from the nuclear reaction 40Ca + 12C at 25 MeV/nucleon was used to produce alpha-emission sources. From a careful selection of these sources provided by a complete detection and from comparisons with models of sequential and simultaneous decays, strong indications in favour of $\alpha$-particle clustering in excited 16O, 20Ne and 24}Mg are reported.Comment: 8 pages, 4 figures, 12th International Conference on Nucleus-Nucleus collisions (NN2015), 21-26 June 2015, Catania, Ital