Multidisciplinary treatment approach for primary thyroid spindle cell sarcoma: A case report.

A 25-year-old female with high-grade spindle cell sarcoma of the thyroid persistent after thyroidectomy performed at another hospital was referred to our institute. Chemotherapy followed by surgery with intraoperative radiotherapy and postoperative intensity-modulated radiotherapy were planned within the sarcoma board. Chemotherapy was discontinued after two cycles because of local disease progression and surgery with intraoperative radiotherapy, was anticipated. The treatment was completed with postoperative radiotherapy. After 36 months off-therapy, the patient was free of disease without significant late effects. Thyroid sarcomas are very rare and there is no consensus on their clinical management. Hence, case reports are useful to share treatment options. In this patient case, the histotype and the high-grade disease required a combined therapy program, managed in a multidisciplinary setting.

HER2 status in advanced gastric carcinoma: A retrospective multicentric analysis from Sicily.

According to the ToGA trial, HER2 has been shown to be predictive for the success of treatment with trastuzumab in advanced gastric cancer (AGC). A number of studies have analyzed HER-2/neu overexpression in gastric carcinoma and identified the rate of HER2 positivity to be markedly varied. To date, the prevalence of HER2 overexpression in Sicilian people with AGC is unknown. Therefore, in the present study, a retrospective immunohistochemical analysis of HER2 was performed in a cohort of 304 AGC samples that were obtained from the archives of 10 Sicilian anatomopathological diagnostic units in order to verify the positive rate of HER2-positive cases. Furthermore, the characteristics of histotype, grade, stage and Ki-67 expression were also analyzed. HER2 overexpression was encountered in 17.43% of all the gastric adenocarcinomas, which was consistent with the results that have been reported elsewhere in the literature. A progressive increase in HER2 overexpression was observed, from the poorly cohesive histotype to the tubular adenocarcinomas and gastric hepatoid adenocarcinomas. HER2 overexpression was significantly associated with a high grade, advanced stage and high Ki-67 labeling index. Further investigations performed jointly by pathologists and oncologists within the geographical area of the present study should confirm that the association of trastuzumab with chemotherapy results in an improvement of survival in patients with AGC.

[Post-thymectomy extrathymic tumors]. / Tumori extratimici post-timectomia.

The Authors report the case of a 78 year old woman affected with two synchronous primary cancers (epidermoid bronchial and rectal adenocarcinoma); 16 years previously, after the discovery of a thymoma, she underwent thymectomy. Thus, the discussion issue is if post-thymectomy extra-thymic malignancies are to be considered just a simple coincidence or a true syndrome.

Histopathology of thalassemic heart disease: an endomyocardial biopsy study.

Right ventricle endomyocardial biopsies were obtained from 13 thalassemic patients. Clinical profiles were investigated, and serum ferritin tests were assessed using diagnostic kits. Histochemical iron detection (Perls method) and immunohistochemical stain for ferritin were performed in the endomyocardial samples. Histologic iron overload was observed in eight patients, and variable iron deposits were recognized by a semiquantitative method. There was a statistically evident correlation between serum ferritin and myocardial iron storage. Marked iron deposition was associated with higher immunohistologic ferritin concentration. Iron-negative tissue samples showed bland immunohistochemical positivity. Myocardial interstitial fibrosis was observed in 12 cases; diffuse perimyocytic or perivascular fibrosis and endocardium thickening were the main histologic patterns identified. One biopsy was characterized by marked fibrolipomatous infiltration. Myocyte hypertrophy, myocytolysis, and severe capillary congestion also were observed.

Cardiac iron overload in thalassemic patients: an endomyocardial biopsy study.

Secondary heart failure induced by organ siderosis is the main cause of death in patients affected by thalassemia major. At present it cannot be predicted whether heart siderosis is correlated with iron overload and little is known about the real cardiac histological pattern of post transfusional hemochromatosis in patients with thalassemia major and intermedia. The study aim was to evaluate cardiac iron overload by non invasive and invasive techniques. Fifteen thalassemic patients were investigated and endomyocardial biopsy performed in ten revealed different grades of endomyocardial iron overload with histochemical positivity. Non invasive techniques are not able to furnish an exact picture of the cardiac hemochromatosis. There was a significant correlation between serum ferritin and myocardial iron grade. Patients with elevated ferritin levels and poor compliance to chelating therapy are at high risk of severe heart hemochromatosis. It was seen that endomyocardial biopsy is a useful tool in studying myocardial iron.

[Echocardiography in the early diagnosis of acute rejection in patients with heart transplant]. / L'ecocardiografia nella diagnosi precoce di rigetto acuto nei pazienti sottoposti a trapianto cardiaco.

The aim of our study was to assess the sensibility and specificity of Doppler echocardiographic evaluation of left ventricular diastolic function during acute cardiac rejection. We studied 34 patients who had undergone a recent heart transplant and compared the echocardiographic results with the histologic findings. We considered the following parameters of left ventricular filling: early peak of mitral flow velocity; pressure half-time (PHT); isovolumic relaxation time (IVRT). We divided the patients into two groups according to the histologic findings: Group I (25 patients who had at least 1 episode of mild-moderate rejection), Group II (6 patients without documented rejection after at least three consecutive biopsies). Three patients with clinically evident rejection were excluded from the analysis. In Group I cardiac rejection was associated with a statistically significant decrease in IVRT (p < 0.0005), without significant changes in heart rate and in the early peak of mitral flow velocity. In Group II Doppler parameters remained unchanged. These variations were not associated with changes in echocardiographic morphologic parameters and in parameters of ventricular systolic function. IVRT and PHT returned to normal values after adequate immunosuppressive treatment. Considering variations of IVRT and PHT of at least 20%, we obtained a sensibility of 88% for isolated variations of PHT and a specificity of 93% for consensual variations of PHT and IVRT. Therefore, the assessment of the left ventricular diastolic function by Doppler echocardiography represents a safe and non-invasive method for an early detection of acute cardiac rejection.