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R Giardini

Publications and source records attributed to R Giardini.

At least 37 records · Page 2Linked to original sources

No evidence of WT1 involvement in a Burkitt's lymphoma in a patient with Denys-Drash syndrome.

BACKGROUND: We previously reported the case of a patient affected with Denys-Drash syndrome (DDS), who developed disseminated EBV-related Burkitt's lymphoma (BL) after kidney transplantation. Here, we describe the molecular characterisation of the WT1 gene in the constitutional and tumour DNA of this patient. PATIENTS AND METHODS: WT1 exons 2 to 10 were sequenced in constitutional and tumour DNAs. By Southern blotting the latter was also investigated for the presence of gene rearrangements. Gene expression analysis in tumour cells was performed by reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: A germline missense mutation affecting one of the zinc finger domains of the gene, and previously reported in other DDS cases, was observed. No alterations of the constitutionally wild-type WT1 allele and no expression of the gene were observed in BL cells. A small group of BLs from other paediatric patients showed a variable expression of WT1. CONCLUSIONS: Our findings indicate that WT1 is unlikely to be involved in the onset of BL in our case. However, a possible role of the gene in at least a subset of these lymphoproliferative diseases may be suggested.

Abnormalities, Multiple↗

Evaluation of residual cellularity and proliferation on preoperatively treated breast cancer: a comparison between image analysis and light microscopy analysis.

Histopathology has been suggested as a reliable method for tumour reduction evaluation of preoperatively treated breast cancer. Immunocytochemistry can be used to enhance the visibility of residual tumour cellularity and in the evaluation of its proliferative activity. We compared Image Analysis (IA) with Light Microscopy Analysis (LMA) on sections of breast carcinomas treated with preoperative chemo- or chemo/radiotherapy in the evaluation of the Neoplastic Cell Density (NCD) (69 cases) and the Proliferation Index (PI) (35 cases). NCD was expressed as the immunoreactive area to cytokeratin over the total original neoplastic area and PI was expressed as the number of immunostained tumoural nuclei with MIB 1 MoAb over the total of tumoural nuclei. The intraobserver agreement and that between IA and LMA for both indices were estimated by the common (kappa(w)) and the jackknife weighted kappa statistic (kappa(w)). The extent of agreement of each considered category was also assessed by means of the category-specific kappa statistics (kappa(cs)). The intraobserver agreement within LMA for NCD and PI and that between IA and LMA for PI were both satisfactory. Upon evaluation of the NCD, the agreement between IA and LMA showed unsatisfactory results, especially when the ratio between the residual tumour cells and the background was critical.

Antibodies, Monoclonal↗

Initial chemotherapy for primary resectable large-cell lymphoma of the stomach.

BACKGROUND: We aimed to evaluate the safety and effectiveness of a conservative approach with short-term chemotherapy with or without consolidation radiotherapy in primary resectable large-cell gastric lymphoma in patients not requiring emergency surgery at presentation. PATIENTS AND METHODS: Seventeen consecutive patients presenting with resectable primary large-cell lymphoma of the stomach not requiring immediate surgery were initially treated with chemotherapy with or without consolidation radiotherapy. Subtotal or total resection of the stomach was planned only as salvage treatment for those patients who failed locally, or as emergency surgery in instances of acute iatrogenic complications of treatment. Chemotherapy included four to six cycles of an anthracycline-containing regimen, and consolidation radiotherapy was planned on the entire stomach and surrounding lymph node areas for complete responders readily capable of compliance with a daily treatment schedule at our Institution. RESULTS: None of the patients in the present series experienced acute iatrogenic morbidity or mortality from local complications. After a median follow-up of almost six years, two patients failing first-line chemotherapy have died of progressive lymphoma, while 15 patients are well and currently disease-free. CONCLUSIONS: Up-front chemotherapy as initial treatment for primary gastric large-cell lymphoma appears to be a safe and effective treatment by which most patients can probably be spared surgical gastrectomy. Consolidation radiation therapy on the stomach can probably improve on the effectiveness of chemotherapy alone. More experience is needed to elucidate the prognostic factors, treatment-related long-term toxic effects and the feasibility of such a treatment administered outside of highly specialized institutions.

Adult↗

PCR analysis of IgH and BCL2 gene rearrangement in the diagnosis of follicular lymphoma in lymph node fine-needle aspiration. A critical appraisal.

In order to improve the cytomorphologic diagnosis of malignant lymphoma on lymph node fine-needle aspiration (FNA), and to make a confident discrimination between low-grade follicular non-Hodgkin's lymphoma (NHL) and lymphoid hyperplasia, polymerase chain reaction (PCR) analysis was performed of the Ig CDR3 region and BCL2 breakpoint region in 25 nonselected cases of malignant lymphoma (17 NHL and 8 Hodgkin's disease [HD]) with histologic control, and 22 cases of lymph nodal hyperplasia with histologic and/or clinical control. Among lymphomas, IgH monoclonality was detected in 7 (77%) of 9 NHLs and BCL2 rearrangement in 3 (17.6%) of 17 NHLs, all of which were follicular centroblastic-centrocytic (FCBCC). Three BCL2/JH negative FCBCC cases were monoclonal for CDR3. Neither IgH monoclonality nor BCL2 rearrangement were found in HD. Among cytologically diagnosed lymphoid hyperplasias, one IgH polyclonal case was considered false-negative, being histologically diagnosed as lymphoplasmacytic NHL on the subsequent excisional biopsy. Another 4 cases (2 BCL2 rearranged and 2 monoclonal for IgH) were considered false-positive on the basis of histologic features or clinical control. These data indicate that the combined PCR analysis of IgH and BCL2 rearrangements can confirm a cytologic diagnosis of lymphoma in FNAs while, due to the occurrence of both false-positive and false-negative results, it is of limited value in the distinction between follicular lymphoma and lymphoid hyperplasia without morphologic or clinical support.

Biopsy, Needle↗

Alpha 4 beta 7 integrin expression is associated with the leukemic evolution of human and murine T-cell lymphoblastic lymphomas.

We have previously shown that the in vivo coordinated expression of individual alpha 4 and beta 7 integrin chains correlated with the leukemic potential displayed by cell lines derived from murine lymphoblastic T-cell lymphomas (T-LBLs) when transplanted subcutaneously into syngeneic AKR mice. In the present study, by using immunofluorescence and immunocytochemical analyses, we have confirmed that the in vivo up-regulation of the alpha 4 beta 7 heterodimeric complex is associated with the leukemic behavior of AKR T-LBLs. In addition, when compared with the parental, highly leukemic NQ22 cells, the variant cell line NQ22V exhibited a reduced leukemic potential that was invariably associated with a delayed alpha 4 beta 7 up-regulation in vivo Moreover, the leukemic cell line SJ-1, derived from a spontaneous T-LBL of the SJL strain, also displayed high levels of alpha 4 beta 7 expression with a pattern of tissue distribution similar to that of NQ22 cells from leukemic AKR animals. Of note, in most of the tissues involved by murine T-LBL dissemination, and particularly in liver, kidney, and lung, alpha 4 beta 7-positive leukemic cells were always located around strongly VCAM-1-positive vascular spaces. These findings are consistent with a possible role of alpha 4 beta 7/VCAM-1 interactions in the extravasation and, consequently, in the leukemic dissemination of murine T-LBL cells. Immunocytochemical analysis carried out in 11 human T-LBLs showed that pathological lymph nodes from all 7 cases with bone marrow infiltration at presentation carried alpha 4 beta 7-positive cells, whereas all 4 aleukemic T-LBLs were repeatedly alpha 4 beta 7 negative, also in metachronous lesions. These findings suggest that alpha 4 beta 7-positive human T-LBLs may represent a distinct clinicopathological entity. In addition, alpha 4 beta 7 expression was significantly more prevalent in younger patients (< 11 years; P = 0.02), further supporting such a hypothesis. Moreover, as in murine T-LBLs, the pattern of alpha 4 beta 7 positivity in involved lymph nodes was mainly focal, whereas nearly all neoplastic cells infiltrating bone marrow expressed this integrin, suggesting a possible role for alpha 4 beta 7 in the leukemic dissemination also of human T-LBLs.

Adolescent↗

MIB-1 and S-phase cell fraction predict survival in non-Hodgkin's lymphomas.

The monoclonal antibody anti-Ki67 is used to detect proliferating cells, but its main limitation is the requirement of fresh-frozen material. On a series of patients with non-Hodgkin's lymphoma, we used a Ki67 equivalent monoclonal antibody, the recently proposed MIB-1, on formalin-fixed histopathological material using microwave antigen retrieval. MIB-1 expression was analysed in relation to other proliferation indices, such as autoradiographic H-thymidine labelling index (HTL1) and flow cytometric S-phase cell fraction (FCM-S) and to pathological status. Moreover, the prognostic relevance of the cell kinetic indices was defined in uni- and multivariate analyses including histology and tumour stage. The relationship between MIB-1 index and the other proliferation indices was statistically significant even though the correlation coefficient was around 0.6. The MIB-1 index was also related to the REAL (Revised European American Lymphoma) classification, but not to the Ann Arbor stage classification. Univariate analysis showed that the MIB-1 index was a significant predictor of 6-year survival in the overall series and in distinctly analysed low-grade and high-grade lymphoma subgroups. With regard to S-phase indices, HTLI was a powerful prognosticator in patients with high-grade histologies and FCM-S in patients with low-grade histologies. Multivariate analyses revealed that MIB-1 index, HTLI and FCM-S retained their prognostic significance independent of histology. In conclusion, the MIB-1 antibody provides prognostic information in non-Hodgkin's lymphomas and has the main advantage that it can be used in formalin-fixed, paraffin-embedded specimens.

Adolescent↗

Spontaneous lung metastases in a human lung tumor xenograft: a new experimental model.

The cell line NIH-H460, derived from a human large-cell carcinoma of the lung, because metastatic in the lung of athymic mice after S.C. injection. Using serial S.C. passages of the lung metastasis, a cell line was selected, H460M, which was characterized by an increased metastatic potential compared to the parental cells after s.c. (Spontaneous metastases) or i.v. injection (experimental metastases). For the high frequency of lung metastases in the mouse and the short time required to develop metastatic foci, the H460M cells transplanted in nude mice represent a unique preclinical model for biological and therapeutic studies. The paper describes the growth and some biological properties (invasion and migration capability, membrane profile) of this experimental in vivo model.

Animals↗

Evaluation of the reproducibility of Auer's classification of DNA histogram in breast carcinoma.

In order to evaluate the reproducibility of the interpretation of DNA histograms obtained by two Static Image Analysis Systems (SIAS), the imprints of 50 cases of breast cancers of patients registered at Istituto Nazionale Tumori of Milan were analysed. The imprints were obtained by a single operator. After fixation, the cytological preparations were stained with the Feulgen reaction. The histograms were independently classified, according to Auer's classification, by four investigators. To evaluate the reproducibility of the classification (within investigator agreement) the histograms were submitted to each investigator at two distinct times and the within investigator agreement was estimated by the weighted kappa statistic (kw). The results of the reproducibility of Auer's classification were not entirely satisfactory (kw about 0.70). This preliminary result confirm the suggestion to adopt alternative methods of classification of the ploidy histograms.

Adenocarcinoma↗

Submandibular gland metastasis of breast carcinoma: a case report and review of the literature.

We report a female patient who developed a solitary metastasis in the submandibular salivary gland 2 years after primary surgery for a grade II T1 N0 M0 breast cancer. A review of the literature shows that metastases in the submandibular gland are uncommon but when they arise the site of the primary tumour is more likely to be distant than in the head and neck region. In female patients, breast tumours predominate.

Breast Neoplasms↗

Successful local regional therapy with topotecan of intraperitoneally growing human ovarian carcinoma xenografts.

The therapeutic effects of intraperitoneal topotecan, a water-soluble camptothecin analogue, were investigated in two models of human ovarian carcinoma xenografted intraperitoneally into nude mice: the IGROV-1 tumour, which originated from an untreated patient, and the A2780 tumour, selected for resistance in vitro to cisplatin (A2780DDP). In IGROV-1 tumour-bearing mice, the optimal dose (10 mg kg-1) of topotecan, given intraperitioneally every 4 days for four occasions markedly increased survival time over control mice (300 T/C%) and cured 4/9 mice, and such effects were not achieved by any of the clinically available drugs tested, i.e. cisplatin carboplatin and doxorubicin delivered intraperitonally according to their optimal doses and schedules. In the treatment of A2780DDP tumour-bearing mice, topotecan was very effective since, at dose levels of 6.6 and 10 mg kg-1 every 4 days for four occasions, 15/18 mice survived more than 100 days, and most of them (12/15) were found to be tumour free. The high responsiveness of this tumour to topotecan might be related to the elevated expression of the target enzyme topoisomerase I. From these results, intraperitoneal treatment with topotecan appears to be a promising approach in the therapy of refractory ovarian cancer confined to the peritoneal cavity.

Animals↗

Ki-1 (CD30) anaplastic large-cell lymphoma in children.

BACKGROUND: Ki-1 (CD30) ALCL is a rare and distinct type of high-grade NHL. A relevant feature is young age at presentation. Most reported pediatric series are retrospective analyses of heterogeneously-treated cases. PATIENTS AND METHODS: Between 1976 and 1993, Ki-1 ALCL was diagnosed in 32 children (20 males 12 females; median age 9 years; 10.4% of childhood NHL). Before 1987, original diagnoses had been malignant histiocytosis in 14 cases, and immunoblastic NHL in 2. The treatment program for childhood T-lymphoblastic NHL, except for CNS prophylaxis, was applied in 28/32 cases. Radiotherapy to involved sites not in complete remission within 4 weeks after treatment start was used only prior to 1987. RESULTS: In 78% of cases, Ki-1 ALCL presented in skin, bone, spleen and lung. Lymph nodes were frequently involved, often in association with periadenitis. Bone marrow and spinal fluid were negative in all cases. Eleven patients were classified as stage I/II, 21 as stage III. Fewer was present in 65% of patients. Cell phenotype was T in 21/32, and null in the remaining 11. Treatment results were evaluable in 27/32 children, all of whom achieved complete remission. Seven relapsed and 4 died of their disease. Five-year survival and progression-free survival were 84% and 72% respectively. Involvement of peripheral lymph nodes, absence of spleen, liver, lung and mediastinum involvement, and male sex were favourable indicators. CONCLUSIONS: Ki-1 ALCL is a high-grade NHL with a relatively good prognosis when treated with multiagent intensive chemotherapy. Because of its clinical peculiarities a unique treatment approach in probably warranted.

Adolescent↗

[Root canal overfilling. Periapical immune reactions].

The authors studied the immunological answer of periapex to look for causes of osteolysis. They did six apicoectomies in teeth with periapical lesions containing extruded material, and found an inflammatory infiltrate of T lymphocytes and macrophages with birifrangent bodies. They suppose that this immunitary answer to extruded material, prevents the periapex cure.

Apicoectomy↗

Pilomatrix carcinoma: a case report and review of the literature.

Pilomatrix carcinomas are malignant uncommon tumors of hair matrix origin. The clinicopathologic features of a case of pilomatrix carcinoma are described and compared with those of the previously reported cases. Because these tumors behave similarly to a basal cell carcinoma, a complete excision is necessary in order to minimize the likelihood of relapse.

Adult↗

Diagnostic problems of second primary malignancies detected by fine-needle aspiration cytology.

BACKGROUND: The diagnosis of second malignant tumors, the incidence of which is increased because of the increased duration of survival for many tumor types in patients treated for cancer, represents one of the most important aspects of application of fine-needle aspiration (FNA). METHODS: Forty patients who had been treated for a malignant tumor and who developed a second primary tumor detected by FNA and subsequently confirmed by histologic examination were studied. The primary tumors were malignant lymphoma (15 cases); breast carcinoma (10 cases); cutaneous melanoma (3 cases); carcinoma of the larynx and of the uterine cervix (2 cases each); and dysgerminoma of the ovary, chronic myeloid leukemia, and carcinoma of the nose, floor of the mouth, tonsil, anus, kidney, and skin (one case each). The interval between the diagnosis of the first and second malignant tumors ranged from 1 month to 22 years. RESULTS: Carcinoma of the lung, mainly represented by adenocarcinoma, was the most frequent second malignant tumor that occurred in this series (15 cases). It was followed by carcinoma of the breast (5 cases); soft tissue sarcoma (3 cases); and carcinoma of the liver, kidneys, ovaries, thyroid gland (2 cases each), parotid gland, and skin. Five cases of non-Hodgkin lymphoma and one of Hodgkin disease developed in patients with a previous carcinoma at various sites. Four non-Hodgkin lymphomas occurred as the second primary malignant tumor in patients treated with radiation therapy for a mammary carcinoma. One case of multiple myeloma occurred. CONCLUSION: The accuracy of FNA in diagnosing second primary tumors (100%) and in classifying them by histologic type (62.5%) was demonstrated.

Adult↗

Cell proliferation as a long-term prognostic factor in diffuse large-cell lymphomas.

The relevance of cell proliferation rate--defined as the 3H-thymidine labeling index (3H-dT LI)--in predicting response to treatment (complete remission, CR), freedom from progression (FFP) and overall survival (OS) was evaluated in 86 patients with diffuse large-cell lymphoma (DLCL). The biologic variable was not associated with most of the established clinical factors, such as gender and age of the patient, performance status, B symptoms, tumor bulk, or extranodal disease, but was directly related to stage. 3H-dT LI significantly predicted short- and long-term clinical outcome. In fact, more patients with slowly proliferating DLCL reached CR and had longer median FFP and OS than patients with rapidly proliferating DLCL. Multiple-regression analysis to evaluate the relative contribution of the different biologic and clinical variables in predicting CR, FFP and OS showed that 3H-dT LI and Ann Arbor stage were the only 2 stable factors, which retained their prognostic significance even in the presence of other conventional factors, and that 3H-dT LI was the most powerful as an indicator of risk of death in DLCL patients.

Adolescent↗

Role of surgery in patients with primary non-Hodgkin's lymphoma of the stomach: an old problem revisited.

The literature after 1980 dealing with the treatment of primary gastric non-Hodgkin's lymphoma (stages I and II) is reviewed. Gastrectomy is recommended for patients with acute symptoms at presentation or with complications of chemotherapy or radiotherapy. In elective cases, patients with stage I disease may be candidates for gastrectomy as a single therapy, provided that tumour-free resection margins are achieved. There is no evidence of substantial benefit from adding postoperative chemotherapy or radiotherapy after an apparently radical resection. In stage II disease, the best results are achieved with ablative surgery plus adjuvant therapy. The resection volume should be limited to macroscopically involved structures, in principle avoiding total gastrectomy and extensive lymph node dissection, since residual disease may be optimally controlled with radiotherapy or chemotherapy. Primary chemotherapy, with or without radiotherapy, represents an experimental approach; the advantages of sparing the stomach must be balanced against the toxicity of an aggressive chemotherapy regimen and the risk of emergency operation for iatrogenic complications.

Emergencies↗

Fenretinide (4-HPR) in chemoprevention of oral leukoplakia.

A controlled clinical trial has been underway at the Istituto Nazionale Tumori (INT) of Milan since 1988. The goal of the trial is to evaluate the effectiveness of fenretinide (4-HPR) in preventing relapses, new localizations, and carcinomas in patients with benign postoperative diagnoses who have been surgically treated for oral leukoplakias. This paper presents the design and the preliminary results of this study. To date, 137 patients have been randomized, following surgical excision of oral leukoplakia, to receive either 200 mg 4-HPR daily for 52 weeks or no intervention. Twenty local relapses or new localizations have occurred so far in the control group and 9 in the 4-HPR group. Seven patients have interrupted the intervention because of toxicity. No impaired dark adaptation has been observed. We conclude that 4-HPR is well-tolerated and appears to be effective in preventing relapses and new localizations during the treatment period.

Adult↗

Risk of preneoplastic and neoplastic events in operated oral leukoplakias.

We retrospectively analysed 167 consecutive patients with oral leukoplakias operated on by CO2 laser resection in the Day Hospital of the Istituto Nazionale Tumori in Milan from January 1981 to December 1988, with post-operative histological examination negative for cancer. Within 5 years there were 69 patients with at least one unfavourable event. First unfavourable events were: 31 local relapses, 27 new leukoplakias, 5 oral carcinomas and 6 other neoplasms elsewhere. To identify possible prognostic factors we recorded age, sex and history of previous oral leukoplakias or head and neck cancers; also number, site, size and type of lesion; as well as tobacco and alcohol consumption and oral hygiene. The Cox regression model was employed to compare disease-free survival between different patient groups, both by univariate and multivariate analysis. From this analysis it emerges that age of operated patients and size of resected lesion are significantly predictive for development of relapses, new leukoplakias and carcinomas.

Adult↗