Impact of the COVID-19 pandemic on HPV vaccination coverage in the general population and in PLWHs.

OBJECTIVE: On March 11, 2020, the World Health Organization (WHO) has declared the novel coronavirus (COVID-19) outbreak as a global pandemic. COVID-19 pandemic has impacted health services, including immunization programs, with a consequent reduction in vaccination coverage in those categories for which the prevention of vaccine-preventable diseases is strongly recommended. SUBJECTS AND METHODS: We conducted a retrospective cross-sectional study on the general population and on PLWHs, comparing anti-human papillomavirus (HPV) vaccination coverage data in 2019, before COVID-19 pandemic, and the 2020 data, after the announcement of the pandemic state and the lockdown and the implementation of restrictive measures to contain the contagion. RESULTS: Compared to 2019, 2020 data show a 42% reduction in HPV vaccine coverage in the general population and 36% in PLWHs. The greatest reduction in anti-HPV vaccination coverage occurred during periods of greatest restriction and mainly concerned the general population. CONCLUSIONS: The prevention of vaccine-preventable diseases remains essential. Above all, it is essential to increase and recover the anti-HPV vaccine coverage, in consideration of the data that show its preventive oncological efficacy.

The expanding role of endobronchial ultrasound in patients with centrally located intrapulmonary tumors.

OBJECTIVES: Tissue acquisition of lung tumors is crucial for diagnostic and treatment purposes. In patients with centrally located lung tumors without endobronchial abnormalities the yield of conventional bronchoscopy is poor. Objective of this study was to assess diagnostic yield of EBUS-TBNA in patients with lung tumors, located near or adjacent to the major airways. METHODS: International multicenter retrospective analysis (2013-2018) of linear EBUS databases in Bologna, Italy and Amsterdam, The Netherlands. Patients with a centrally-located lung tumor without endobronchial abnormalities who underwent lung tumor search with linear EBUS were included. Diagnostic yield, feasibility of EBUS guided tumor sampling, complication rate, adequacy of the aspirates for mutational analysis, and assessment of mediastinal/vascular invasion (T4) were evaluated. RESULTS AND CONCLUSION: Real-time EBUS-TBNA diagnostic yield to sample centrally located intrapulmonary tumor was 83% (136/163) and it was independent of tumor location (paratracheal, mainstem, lobar, segmental bronchus). The feasibility to sample the lung tumor was 89% (145/163). In 4 cases the tumor was not found with EBUS. In the other 14 cases, tumor sampling was not performed due to: loss of the echo window after needle insertion [n = 3], interposition of a large vessel [n = 7], switch to radial EBUS [n = 1], switch and sampling through EUS or EUS-B [n = 3]. No major complications occurred. Mutational analysis was successful in 54/63 (86%) of samples. Using surgery as reference standard, EBUS proved more reliable than CT (24/24, 100% versus 22/24, 91.7%, respectively) in the assessment of mediastinal/vascular tumor invasion (T4 status). IN CONCLUSION: Lung tumors presenting without endobronchial abnormalities and located adjacent to the major airways can be safely sampled by EBUS-TBNA resulting in high diagnostic yield irrespective of tumor location. Successful molecular profiling and reliable assessment of mediastinal/vascular invasion (T4) in patients with advanced disease provide additional value to EBUS procedures in the setting of centrally-located lung lesions.

Granular cell tumor of the trachea as a rare cause of dyspnea in a young woman.

Tracheal granular cell tumors are rare neurogenic neoplasms characterized by an indolent behavior. We report the case of a young woman affected by this tumor with non-specific clinical presentation. We performed a literature search in order to identify all the cases of tracheal granular cell tumor and to summarize the current state of knowledge about this rare disease.

Adenocarcinoma classification: patterns and prognosis.

Lung cancer is the most frequent human malignancy and the principal cause of cancer-related death worldwide. Adenocarcinoma is now the main histologic type, accounting for almost half of all the cases. The 2015 World Health Organization has adopted the classification recently developed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification has incorporated up-to-date advances in radiological, molecular and oncological knowledge, providing univocal diagnostic criteria and terminology. For resection specimens, new entities have been defined such as adenocarcinoma in situ and minimally invasive adenocarcinoma to designate adenocarcinomas, mostly nonmucinous and ≤ 3 cm in size, with either pure lepidic growth or predominant lepidic growth with ≤ 5 mm invasion, respectively. For invasive adenocarcinoma, the new classification has introduced histological subtyping according to the predominant pattern of growth of the neoplastic cells: lepidic (formerly non mucinous brochioloalveolar adenocarcinoma), acinar, papillary, micropapillary, and solid. Of note, micropapillary pattern is a brand new histologic subtype. In addition, four variants of invasive adenocarcinoma are recognized, namely invasive mucinous (formerly mucinous brochioloalveolar adenocarcinoma), colloid, fetal, and enteric. Importantly, three variants that were considered in the previous classification have been eliminated, specifically mucinous cystadenocarcinoma, signet ring cell, and clear cell adenocarcinoma. This review presents the changes introduced by the current histological classification of lung adenocarcinoma and its prognostic implications.

Prognostic relevance of cell proliferation in major salivary gland carcinomas.

Several proliferation markers, such as DNA ploidy, Ki67, MiB1 and proliferating cell nuclear antigen have been shown to correlate with clinical course and prognosis in several epithelial tumours and lymphomas. In the present study, the prognostic relevance of these markers was evaluated in major salivary gland carcinomas. A sample of 36 cases out of 85 patients submitted to surgery for major salivary gland carcinomas at our institution between 1987 and 1997 were studied. The sample comprised 8 adenoid-cystic carcinomas, 6 ductal carcinomas, 11 mucoepidermoid carcinomas and 11 acinic cell carcinomas. Follow-up ranged from 1 to 12 years (mean 6.2). In some patients, DNA ploidy (euploid or aneuploid) was studied by flow cytometry. In others, proliferation activity was studied by means of monoclonal antibody MiB1, identifying cells in the proliferative cycle. In some patients, both techniques were used. Follow-up was related to these indices, TNM and stage. Even if ploidy suggested a favourable outcome in diploid cancer (13 favourable vs. 2 unfavourable) and poor outcome in aneuploid cancer (4 favourable vs. 5 unfavourable), the difference was not statistically significant with p = 0.06 in Fisher's exact test. Instead, the proliferative tumour cell fraction, evaluated by MiB1, was statistically correlated with prognosis. Comparing survival curves by Log rank Test it yielded p = 0.007 using an MiB1 cut-off of 5. Applying a cut-off of 20 yielded p = 0.001. Of particular interest were MiB1 values in acinic cell carcinomas for which grading is challenging and lacks consensus. In our group of acinic cell carcinomas, survival correlated with values of MiB1 > or < 15 with p = 0.009 in Log rank test. In conclusion, despite a trend towards correlation between ploidy and prognosis, the present study yielded p = 0.06, whereas the proliferative fraction assessed by MiB1 was significantly correlated with outcomes. Indeed, "growth fraction" in acinic cell carcinomas may stratify different classes of risk.

Primary malignant lymphoma of sciatic nerve. Report of a case.

A 72-year-old man with a 2-year history of motor-sensory neuropathy of the right foot was found to have a lymphoma involving a 50-cm length of the sciatic nerve. This occurred in the absence of any other evidence of disease by detailed clinical staging. The lymphoma was of large follicular center-cell type. The cells strongly expressed a B-cell marker detected by the 4KB5 monoclonal antibody and selectively infiltrated the nerve bundles, dissociating preexisting myelin-producing Schwann cells and axons. This is the second report of similar localization. Primary selective involvement of a nerve is a rare mechanism of peripheral neuropathy in lymphoproliferative disorders, to be added to systemic dissemination of lymphomas and leukemias, direct spread of an adjacent tumor, and immunologically mediated disease.

Morphologic changes leading to bronchiolitis obliterans in a patient with delayed non-infectious lung disease after allogeneic bone marrow transplantation.

A 37-year-old man developed delayed non-infectious lung disease after undergoing bone marrow transplantation (BMT) for acute myeloid leukaemia. Over a 15-month period, the progression of morphologic changes from cellular interstitial pneumonia to bronchiolitis obliterans organizing pneumonia and cicatricial bronchiolitis obliterans was documented. Pulmonary function tests, high-resolution CT, bronchoalveolar lavage, lung biopsy and extensive microbiological studies were used as diagnostic tools either at onset and during the follow-up. This represents the first reported case in which a model--supported by longitudinal biopsy results--for the evolution of histologic lesions toward bronchiolitis obliterans after BMT is suggested; therapeutic implications are discussed.

Clinical spectrum of adult chronic bronchiolitis.

Inflammation involving the small airways is a quite common report in pathological dissertations. However the radiologic, clinical patterns and functional impairment of adult bronchiolitis have been discussed in detail only in the last ten years. In this review a brief summary of the anatomic and histologic characteristic of small airways is reported. A pathologic classification of bronchiolitis is at first discussed. Cellular bronchiolitis, proliferative bronchiolitis with or without intraalveolar loose fibrosis (BOOP pattern), occlusive and constrictive bronchiolitis are the main patterns taken into account: peculiar subtypes (follicular bronchiolitis, diffuse panbronchiolitis, neuroendocrine cell hyperplasia with fibrous bronchiolitis) are included in the pathologic discussion. Radiologic features are reported and presented as nonspecific. HRCT Scan findings are classified with the appropriate pathologic features in: nodules and branching lines; low attenuation and mosaic perfusion; ground glass attenuation and/or alveolar consolidation. The clinical entities considered are: bronchiolitis secondary to irritant inhalation; infectious and post-infectious bronchiolitis; drug induced bronchiolitis; bronchiolitis in patients with collagen-vascular disease; diffuse panbronchiolitis; bronchiolitis in transplanted patients; neuroendocrine cell hyperplasia with fibrous bronchiolitis: cryptogenic bronchiolitis; idiopathic BOOP; respiratory bronchiolitis with interstitial lung disease (RB-ILD). Their clinical presentation, functional impairment, pathogenetic mechanisms when deemed clinically useful, BAL findings and therapeutical schemes are discussed.

Well-differentiated angiosarcoma of the skin following radiotherapy. Report of two cases.

Two cases of well-differentiated angiosarcoma following radiotherapy together with an immunocytochemical and electron-microscopical study are reported. Both cases occurred in young females (16- and 22-yr-old respectively) who had been irradiated after birth for an "angiomatous" lesion. These cases have to be added to 34 similar cases reported in the literature.

Nucleolar organizer regions in normal skeletal muscle and benign and malignant rhabdomyoblastic tumors.

The silver staining of interphase nucleolar organizer regions (NORs) has been shown to have an important application in diagnostic histopathology for distinguishing some benign from malignant conditions. In this study, normal fetal and adult skeletal muscles and tissue from fetal and adult rhabdomyomas as well as rhabdomyosarcomas were stained with the silver method for NORs. The morphologic distribution of NORs in rhabdomyosarcomas was found to be very different from that in normal skeletal muscles. In addition, cases of rhabdomyoma were easily differentiated from rhabdomyosarcomas. Statistical analysis of data, from all cases, regarding the diameter of NORs and number per nucleus confirmed these observations.

[Treatment of single hepatic metastasis from surgically treated breast carcinoma. (Report of a clinical case and review of the literature)]. / Trattamento di metastasi epatica singola da carcinoma mammario operato. (Presentazione di un caso clinico e revisione della letteratura).

In the natural history of the breast cancer, the liver metastatic location represents a clear element of an advanced stage of the disease, because it is often accompanied to multiple locations in the same organ and/or in different organs and tissues. The finding into two years after the primary intervention, during the ordinary follow-up, of an insulated metastasis in the 3rd hepatic segment in a patient operated for breast carcinoma, and the following surgical treatment of the metastasis, have suggested us to draft this note. The finding of a single metastasis in the liver in patients operated for breast carcinoma imposes a revaluation of the stage of sickness to highlight the contemporary presence of subsequent distance metastatic location; the negativity of the instrumental investigations performed has triggered the question about the type of therapeutic treatment to do to the patient. The range of therapeutic hypothesis spaces from the ultrasound guided mini-invasive techniques (alcoholization, infusion of LAK cells, use of radio frequencies), to the chemotherapy, so general that local one, by means of super selective catheterization of the hepatic artery, up to the, finally, minus usual (in these cases) surgical therapy. In the patient observed we have chosen the surgical treatment, consisting of a segmentary resection, we haven't any complication, neither intra- nor post-operative, and the patient was discharged in 8th day. Our choice of the surgical approach has bean consequence of an attentive evaluation so of the clinical indicators of the patient (good general conditions, bulk of the injury and surgical treatableness) that of the biological parameters of the neoplasm. The results of our experience, in line with whet indicated from the other AA., encourage the choice of the surgical treatment of the insulated hepatic metastasis from breast carcinoma, with the awareness of the concept of "adjuvant" that it necessarily engages in such circumstances, and, however, after an accurate selection of the patients.

[Merkel cell tumor: a case report and literature review]. / Tumore a cellule di Merkel: presentazione di un caso clinico e revisione della letteratura.

Merkel cell tumor (MCT) is extremely rare, being discovered so far about 400 cases in literature. It is classified among neuroendocrine tumors. We report a case of MCT in the subclavicular region in a 93 years old woman. We confirm the efficacy of radiotherapy associated with octreotide, which these tumours express specific receptors for.

[Pseudo-thrombophlebitic syndrome of the leg caused by cyst in the inner popliteal hamstrings. A case report]. / Sindrome pseudo-tromboflebitica dell'arto inferiore da cisti del cavo popliteo. Presentazione di un caso clinico.

The Authors present a clinical case of pseudo-thrombophlebitic syndrome caused by a cyst of the inner popliteal hamstrings. Pointing out anatomic characteristics of the area involved together with the physiopathology and etiology of the formation that fill the space of the inner popliteal hamstrings, in agreement with the observations reported in literature, and intervene in determining a great number of venous blockage observed in the leg. In conclusion, they observe how a correct clinical-anamnestic approach is important in the diagnosis and consequent prompt and aimed therapy, and how this approach should use the modern instruments available today for a definite diagnosis in the presence of a syndrome of venous stasis of the lower limbs.

[Tumors of the testicle]. / I tumori del testicolo.

The authors describe, in the light of the current literature, the clinical, diagnostic, and therapeutic characteristic of testicular cancer. They remark the good results of adjuvant therapy in this type of tumor.

[Treatment of rectal carcinoma: our experience]. / Trattamento del carcinoma del retto: nostra esperienza.

Authors' experience with 53 patient operated on for adenocarcinoma of the rectum in Oncologic Surgery Department--University of Messina (Italy) was analysed. The development of mechanical devices has allowed surgeons to perform sphincter-saving in patients with medium-lower tumors of the rectum. In this experience abdominoperineal amputation was performed in cases of distal rectal tumors, local transanal excision was performed in 6 cases. There were no statistically significant differences between low anterior resection and abdomino-perineal resection with respect to local (17% vs 16.6%) and distant (16% vs 16%) recurrence.

Granulomatous lung disease.

Granulomas are a frequent challenge for pathologists, which can be identified both in histological and cytological material in a number of conditions. With regard to interstitial lung diseases, granulomas can be associated with infection (e.g. mycobacterial), immunological conditions (e.g. hypersensitivity pneumonitis), or may be idiopathic (e.g. sarcoidosis). Considering morphology, features that should be identified are the presence of necrosis, the cohesiveness and coalescence of granulomas, the presence of fibrosis and the amount and quality of the associated inflammatory infiltrate. The most interesting approach to granulomatous lung disease is indeed represented by their pattern of distribution within the secondary lobule; in fact, granulomas can be distributed along lymphatic routes (e.g. sarcoidosis), randomly (miliary infections, e.g. mycobacterial and fungal infections), or along the airways (hypersensitivity pneumonitis, hot tub lung, aspiration pneumonia and sometimes infections). We propose a combined radiological-histopathological approach for defining the morphological features and anatomic localization of granulomatous ILDs. In addition, a detailed review of their clinical features is provided, together with a description of the main procedures used to obtain respiratory samples for pathology and microbiology studies in these patients.

Diffuse alveolar damage.

Diffuse alveolar damage (DAD) is a characteristic histopathologic pattern that has time dependent findings: intraalveolar and interstitial oedema, and hyaline membranes in the acute phase, myofibroblastic accumulation in the alveolar spaces and type II alveolar cell proliferation in the proliferative phase and fibrosis in the more advanced phases. The diagnosis of DAD is sometimes feasible on small specimens obtained by transbronchial lung biopsy or on cytological slides. Surgical lung biopsy is rarely needed.