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Massimiliano Paci

Publications and source records attributed to Massimiliano Paci.

14 recordsLinked to original sources
PubMed2006

The role of diagnostic VATS in penetrating thoracic injuries.

BACKGROUND: Penetrating chest injuries account for 1-13% of thoracic trauma hospital admissions and most of these are managed with a conservative approach. Nevertheless, 18-30% of cases managed only with tube thoracostomy have residual clotted blood, considered the major risk factor for the development of fibrothorax and empyema. In addition, 4-23% of chest injury patients present persistent pneumothorax and 15-59% present an injury to the diaphragm, which is missed in 30% of cases. In order to make a correct diagnosis, reduce the number of missed injuries, chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity. METHODS: 1270 patients who sustained thoracic trauma were admitted to our hospital between 1994 and 2004. Of these, 16 patients had penetrating injuries: thirteen were surgically explored by means of Video Assisted Thoracic Surgery (VATS), and 3 with thoracotomy due to hemodynamic instability or suspected lesion of the heart or great vessels. RESULTS: In the 13 patients who underwent VATS, 5 injuries to the diaphragm, 3 lesions to an intercostal artery, and 1 lesion to the diaphragmatic artery were detected. In 12 of these patients a laceration of the pulmonary parenchyma was also present. A conversion to thoracotomy was necessary due to a broad laceration of the diaphragm and due to hemostasis of an intercostal artery. In all but one case, which was later converted, diagnostic imaging missed the diagnosis of laceration of the diaphragm. There was no intra- or postoperative mortality, and average hospital stay was five days. CONCLUSION: VATS is a safe and effective way to diagnose and manage penetrating thoracic injuries, and its extensive use leads to a reduction in the number of missed, potentially fatal lesions as well as in chronic sequelae.

Journal Article↗
PubMed2006

Pleural malignant solitary fibrous tumor with sarcomatous overgrowth showing PDGFRbeta mutation.

Pleural malignant solitary fibrous tumors (SFTs) are uncommon, and little is known about their histogenesis and molecular features. We report a case of pleural SFT with sarcomatous overgrowth that showed expression for PDGFRbeta and a missense mutation on exon 18 of the PDGFRbeta gene. The involvement of the PDGFRbeta gene in SFT is compatible with a pericytic derivation, also supporting a possible role of this tyrosine kinase in malignant transformation and in the adoption of novel molecular therapies.

Aged↗
PubMed2004

Large cell neuroendocrine carcinoma of the lung: a 10-year clinicopathologic retrospective study.

BACKGROUND: Large cell neuroendocrine carcinoma is a recently recognized histologic entity whose clinical features and optimal treatment have not yet been well defined and are still being assessed. We report our retrospective assessment of cases of large cell neuroendocrine carcinoma observed from 1989 to 1999 in terms of survival. METHODS: Cases of large cell neuroendocrine carcinoma diagnosed between 1989 and 1999 were reassessed retrospectively according to the World Health Organization classification. The clinical outcome and pathologic features of all cases are described. Survival rates of patients with large cell neuroendocrine carcinoma are compared with those patients with small cell lung cancer treated in the same period. RESULTS: Patients were 41 men and 7 women with an average age of 63.7 years. Twenty-nine patients (60.4%) had pathologic stage I disease, 11 patients (22.9%) had pathologic stage II disease, and 7 patients (14.6%) had pathologic stage IIIA disease. One patient (2.1%) had pathologic stage IIIB disease. No patient underwent induction chemotherapy. Two patients underwent adjuvant chemotherapy and 2 underwent mediastinal radiotherapy for N2. No death was reported in the perioperative period. The median follow-up was 5 years. The actuarial survival for the entire group was 60.4% at 1 year, 27.5% at 3 years, and 21.2% at 5 years. The actuarial survival of accurately staged, stage I patients at 5 years was 27%. CONCLUSIONS: The findings suggest that treating large cell neuroendocrine carcinoma by means of applying treatment for nonsmall cell lung cancer leads to a prognosis that is worse than that for nonsmall cell lung cancer, even in terms of low pathologic stages.

Adult↗
PubMed2004

Placental transmogrification of the lung: clinicopathologic, immunohistochemical and molecular study of two cases, with particular emphasis on the interstitial clear cells.

Two cases of placental transmogrification of the lung are reported. The lesions presented in the left lung, in one case as a giant bulla of the upper lobe and in the other as a cystic nodule of the lower lobe. A segmentectomy was performed in both cases, and the patients were alive and well 5 years and 2 months after surgery, respectively. In our opinion, pulmonary placental transmogrification is not a variant of emphysema, as generally considered, but rather probably represents a benign proliferation of immature interstitial clear cells with secondary cystic change. This report presents a histological, immunohistochemical, ultrastructural and molecular study of these peculiar cells, together with a review of the literature.

Adult↗
PubMed2004

Alveolar adenoma of the lung: a clinicopathologic, immunohistochemical, and molecular study of an unusual case.

We describe an alveolar adenoma of the lung with 3 previously unreported findings, which expand both the clinical and the morphologic spectrum of this rare tumor: presentation as a cystic nodule, foci of mature adipocytes, and S-100 positivity of the mesenchymal cells. Furthermore, using a laser capture microdissection technique under microscope visualization, we analyzed multiple chromosomal loci in both the epithelial and mesenchymal components of the lesion, showing microsatellite alterations and loss of heterozygosity in the former but not in the latter.

Adenoma↗
PubMedDate not supplied

A case of metastatic epithelioid angiosarcoma in the lamina propria of a sigmoid tubulovillous adenoma.

Epithelioid angiosarcoma is an extremely rare tumor. It is generally a secondary tumor and the preferred sites of such metastases are the heart, pericardium, lung, breast, liver, spleen, bone, and brain. In rare cases the lung has been described as the primary site. The prognosis of this neoplasm is extremely poor. We report a case of epithelioid angiosarcoma with multiple bilateral lung infiltration, bone metastasis, and metastasis of the lamina propria of a tubulovillous adenoma of the colon.

Adenoma↗
PubMedDate not supplied

Videothoracoscopic evaluation of thoracic injuries.

Residual thoracic collections after thoracic traumas occur in 5-30% of patients and are a major risk factor for development of empyema. Management with a thoracostomy tube is the traditional treatment but it requires a prolonged hospital stay and 20% of patients treated continue to have a residual clot. Forty-two haemodynamically stable patients with chest trauma (36 blunt and 6 penetrating) were examined thoracoscopically. Indications for videothoracoscopy included suspected diaphragmatic injury (8 patients), persistent pneumothorax (8), continued haemorrhage (6) and clotted haemothorax (20). Diaphragmatic lacerations were confirmed thoracoscopically in 7 patients. Four of them were successfully repaired with thoracoscopic techniques and three were repaired after conversion to open thoracotomy for large diaphragmatic lacerations. In patients with persistent pneumothorax, limited lung lacerations were correctly diagnosed and repaired thoracoscopically. In all patients with continued haemorrhage intercostal artery injury was confirmed and repaired by diathermy. All clotted haemothorax cases were successfully evacuated. No complications occurred. Videothoracoscopy appears to be a safe, accurate and reliable operative therapy for the assessment of diaphragmatic injuries, control of continued bleeding and evacuation of clotted haemothorax, reducing the hospital stay and possible complications.

Adult↗
PubMedDate not supplied

Well-differentiated giant "lipoma-like" liposarcoma of the posterior mediastinum: a case report.

While liposarcoma is the most common malignant mesenchymal neoplasm in adults, a mediastinal position is rare. We describe here the case of a 74-year-old female with an hourglass-shaped mass in the posterior mediastinum, which was probably present on a roentgenogram 4 years earlier. On a CT scan of the chest, the mass appeared non-homogeneous with a mainly adipose content. A preoperative ultrasonically guided tru-cut transthoracic biopsy revealed the presence of adipose tissue with mildly atypical cytological features. The mass was therefore completely excised by means of a right thoracotomy. The postoperative course was uneventful and the patient is alive and well and has had no recurrence in the 6 months since surgery. We review here the natural history, pathology, and prognosis of the disease, and discuss methods of diagnosis and management of such lesions.

Aged↗
PubMedDate not supplied

Diagnosis of anterior mediastinal masses with ultrasonically guided core needle biopsy.

The various techniques used to perform percutaneous guided biopsies of mediastinal masses have already been amply described, with particular attention to the type of needle used. In this study our experience with mediastinal transthoracic core needle biopsy has been compared with reported descriptions of ultrasonically guided fine needle aspiration to determine which is better and the respective influence on pathological diagnosis. Between January 1998 and July 2002, 47 patients underwent anterior mediastinal core needle biopsy with ultrasonic guidance. An accurate diagnosis was achieved in all patients, with 100% sensitivity and specificity. In all patients with lymphoma and thymoma it proved possible to establish the histological type. Two cases of pneumothorax were seen with pleural drainage and a 5-day hospital stay required in one of the cases. The remaining 45 patients were treated as outpatients and were discharged within 4 hours of the procedure. Ultrasonically guided percutaneous needle biopsy is a safe procedure; fine needle aspiration usually suffices for solid malignant lesions while a core needle biopsy should be performed when lymphoma or thymoma masses are suspected in order to obtain larger specimens for a precise histological diagnosis. The core needle procedure avoids repetition of unsuccessful fine- needle aspirations and reduces the number of mediastinoscopies and videothoracoscopies carried out for diagnostic purposes.

Adolescent↗
PubMedDate not supplied

Multiple pulmonary nodules: a decisional algorithm.

The present international system for staging lung cancer classifies multiple pulmonary nodules present in one pulmonary lobe or in distinct ipsilateral or controlateral pulmonary lobes as stage IIIB and IV, respectively. In our opinion this approach does not guarantee the patient the best choice of therapy. Moreover, some studies support the choice of surgery for patients with multiple pulmonary nodules without mediastinal lymph node involvement. Introducing PET may be of considerable help in making an informed choice. In this work we propose a diagnostic/therapeutic decisional algorithm for patients with multiple pulmonary nodules.

Algorithms↗