Publications by authors named "Marco Ungari"

37 Publications

[Kidney involvement in Waldenström's disease - case report].

G Ital Nefrol 2021 Feb 16;38(1). Epub 2021 Feb 16.

UO Nefrologia e Dialisi ASST Cremona, Italia.

Waldenström's disease is a rare haematological neoplasm involving B lymphocytes, characterized by medullary infiltrated lymphoplasmacytic lymphoma and by the presence of a monoclonal M paraprotein. Although rarely, this condition may lead to heterogeneous renal involvement and cause severe renal failure. We report the clinical case of a patient with overt nephrotic syndrome in Waldenström's disease treated with a combination chemotherapy (rituximab, cyclophosphamide, dexamethasone) until complete renal and haematological remission.
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February 2021

Diffuse Micro-Nodules on Peritoneal Surfaces at Donor Organ Procurement: Highlights on the Diagnostic Challenge and Transplant Management.

Am J Case Rep 2021 Feb 13;22:e929348. Epub 2021 Feb 13.

Department of Pathology, ASST Hospital Trust of Cremona, Cremona, Italy.

BACKGROUND Guidelines have been designed to stratify the risk of cancer transmission in donors with a history of or ongoing malignancy, although this evaluation is not always straightforward when unexpected and rare lesions are found. CASE REPORT Here, we present a case of a 41-year-old African female donor who died from a cerebral hemorrhage. Her medical history was unavailable. At procurement, multiple diffuse grayish small nodules were noticed along the peritoneal cavity, some of which were sent to the on-call pathologist for urgent frozen section evaluation. Histology showed a multinodular proliferation of uniform bland-appearing spindle cells, with no evidence of necrosis, nor nuclear atypia or mitoses. The overall picture was consistent with the diagnosis of disseminated peritoneal leiomyomatosis, with overlapping morphology with uterine leiomyoma. Given the rarity of the lesion and the potential for recurrence or malignant degeneration, only the liver and heart were allocated to recipients with life-threatening conditions. The decision was taken in a forcedly limited time and took into account the benefit of transplantation and the risk of disease transmission. CONCLUSIONS This case highlights challenges that transplant teams often have to deal with, as lesions that are difficult to diagnose during donor assessment are usually not covered in guidelines. The acceptance and usage of organs in such cases has to be decided in a team-based fashion, with the collaboration of all the transplant professionals involved to optimally assess the transmission risk, carefully balancing the benefits of transplantation for the recipients and the need to guarantee a reasonable degree of safety.
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http://dx.doi.org/10.12659/AJCR.929348DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888240PMC
February 2021

Acute Generalized Exanthematous Pustulosis (AGEP) in 12 Patients Treated for SARS-CoV-2 Positive Pneumonia.

Am J Dermatopathol 2021 Jan 5;Publish Ahead of Print. Epub 2021 Jan 5.

Departments of Dermatology, and Pathology, A.S.S.T. Cremona, Cremona, Italy; Haemostasis and Thrombosis Center, A.S.S.T. Cremona, Cremona, Italy; and Departments of Infectious Disease, and Surgery, A.S.S.T. Cremona, Cremona, Italy.

Abstract: The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading throughout the world. The study describes 12 patients with SARS-CoV-2 pneumonia, who developed an acute erythematous rash with nonfollicular pinhead-sized pustules, without mucosal involvement. The clinical differential diagnosis was viral rash, acute generalized exanthematous pustulosis (AGEP), or multiform erythema. computed tomography with a diagnosis of interstitial pneumonia and a respiratory tract sample positive for SARS-CoV-2 in a reverse transcriptase polymerase chain reaction assay. Patients had signs of respiratory distress and were treated with hydroxychloroquine, darunavir, ritonavir, heparin, ceftriaxone, and azithromycin. Punch biopsies showed subcorneal pustules typical of AGEP. Dermal microvascular injury and thrombosis as described in skin damage by SARS-CoV-2 infection was not observed. The direct immunofluorescence for IgG, IgA, IgM, and C3 was negative in 8 patients investigated. A polymerase chain reaction for RNA SARS-CoV-2 performed on frozen skin was negative in 5 of 6 patients. Most of our patients were treated with systemic corticosteroids. After some days (4-10), the diffuse erythema and pustules had improved. AGEP is classified as a severe cutaneous adverse reaction, provoked by drugs and acute infections. Characteristically, removal of the offending agent leads to spontaneous resolution typically in less than 15 days. The recognition of AGEP is important, in order to avoid confusion with a systemic infection and consequently to avoid incorrect treatment. Cutaneous adverse reactions to drugs are common and are major health problems worldwide causing considerable costs for health care systems. We suggest that in the patients with AGEP during SARS-CoV-2 pneumonia, viral infection is a risk factor for developing drug reaction.
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http://dx.doi.org/10.1097/DAD.0000000000001819DOI Listing
January 2021

Congenital Unilesional Cutaneous Langerhans Cell Histiocytosis: A Case Report.

Am J Dermatopathol 2021 Mar;43(3):e38-e42

Departments of Pathology.

Abstract: Langerhans cell histiocytosis (LCH) is a clonal proliferation of bone-marrow-derived cells, which normally reside as epidermal and mucosal dendritic cells involved in antigen presentation. It is a rare disease more common in children than adults, that is believed to be neoplastic in most cases. The diagnosis is based on clinical and radiological findings in combination with histopathologic, immunophenotypic, or ultrastructural analyses. LCH have a broad spectrum of clinical manifestations, ranging from benign cutaneous lesions to malignant multisystem disease. Based on the extent of involvement at diagnosis, LCH can be divided in single-system LCH when only one organ or system is involved, usually with multiple lesions, and multisystem LCH, when 2 or more organs or systems are involved at diagnosis. One variant of LCH is characterized by congenital isolated cutaneous involvement. It typically manifests at birth or in the postnatal period with a widespread eruption of red-to-brown papulo-nodules or, more uncommonly, a solitary lesion. The overall prognosis for single lesion skin limited LCH is excellent and most lesions spontaneously resolve within 4-18 weeks. Systemic involvement is rare. Skin findings cannot predict systemic disease and obtaining an oncology consultation is recommended for further evaluation. Herein, we present an additional case in a full-term, well-appearing, female infant with an isolated, asymptomatic, ulcerated, papule of the left arm, that was noted at birth.
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http://dx.doi.org/10.1097/DAD.0000000000001770DOI Listing
March 2021

Endoscopic Findings in Patients Infected With 2019 Novel Coronavirus in Lombardy, Italy.

Clin Gastroenterol Hepatol 2020 09 30;18(10):2375-2377. Epub 2020 May 30.

Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, and European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza.

Coronavirus disease 2019 (COVID-19) is a major worldwide threat caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), rapidly spreading to a global pandemic. As of May 11, 2020, 4,176,346 cases have been reported worldwide, 219,814 in Italy, and of them, 81,871 occurred in the Lombardy region. Although the respiratory manifestations of COVID-19 have been widely described, the impact on the gastrointestinal (GI) system remains less clear. The reported prevalence of digestive symptoms ranges from 3% to 79%, depending on the setting, but data on GI endoscopic and histologic findings in COVID-19 patients are lacking. Therefore, the aim of this study is to describe the GI endoscopic and histologic findings in COVID-19 patients.
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http://dx.doi.org/10.1016/j.cgh.2020.05.045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260560PMC
September 2020

Langerhans cell histiocytosis of an intra-mammary lymph node in an 18-year-old woman.

Pathologica 2020 Mar;112(1):50-55

Department of Pathology, ASST Cremona, Italy.

We describe an 18-year-old woman with several month's history of a 12 x 7 mm palpable mammary nodule, that was hypoechoic, with regular margins and vascularization areas by ultrasound. A fibroadenoma was hypothesized (American College of Radiology BI-RADS 3). A 14 G needle biopsy was performed, showing a LC proliferation suspected for LCH of a lymph node, with florid dermatopathic lymphadenopathy in differential diagnosis. The multidisciplinary team of the breast clinic decided to perform a lumpectomy and a diagnosis of LCH involving an intra-mammary lymph node was made. Langerhans cells (LC) are dendritic cells characterized by grooved nuclei, irregular nuclear contours, and abundant cytoplasm, that normally reside in the skin and mucosal surfaces. They were positive for CD1a, langerin/CD207, and S100 by immunohistochemistry. Langerhans cell histiocytosis (LCH) is a clonal proliferation of histiocytes that is thought to be neoplastic in most cases. Reactive LC can be distinguished from LCH by cyclin D1 immunostaining, which is positive only in LCH. About 50% of cases have BRAF V600E mutations. The revised classification of histiocytes divides LCH in subtypes: LCH SS (single system), LCH lung positive, LCH Multiple System/Risk Organ negative and LCH Multiple System/Risk Organ positive. Localized disease can progress to multisystem involvement. The diagnosis of LCH is based on clinical and radiological findings in combination with histopathological, immunophenotypic or ultrastructural analyses identifying tissue infiltration by LC. It is recommended that biopsy confirmation of suspected LCH be performed in all cases. Lymph nodes may be the only site of disease or a part of multisystem involvement by LCH. The histologic differential diagnosis is discussed.
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http://dx.doi.org/10.32074/1591-951X-27-19DOI Listing
March 2020

Microsatellite Instability in Medullary Carcinoma of the Colon.

Rare Tumors 2017 Mar 30;9(1):6541. Epub 2017 Mar 30.

Department of Pathology, ASST Istituti Ospitalieri, Cremona, Italy.

Medullary carcinoma (MC) of the large intestine is a relatively new histological type of adenocarcinoma characterized by poor glandular differentiation and an intraepithelial lymphocytic infiltrate. MC can be associated to a defective mechanism for DNA mismatch repair, caused by the so-called microsatellite instability (MSI). We present the case of a 44 years old Caucasian woman, who referred to the Emergency Room with symptoms mimicking an acute appendicitis. Computed tomography and colonoscopy demonstrated an ulcerated and stenotic lesion of the caecum without signs of metastasis and peritoneal carcinosis. Patient underwent a laparoscopic right colectomy. The final pathologic findings provided the diagnosis of medullary carcinoma with MSI. Patient then underwent adjuvant chemotherapy according to the FOLFOX-4 protocol (association of 5-Fluorouracil, Leucovorin, and Oxaliplatin) for twelve cycles. At two-years follow-up, patient is disease free. MC in association with MSI is a non-frequent tumor of the colon characterized by a better prognosis compared to other types of poorly differentiated adenocarcinoma. In the observed case, 24 months after the surgical operation, the patient is in good health and there is no evidence of metastasis or relapse.
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http://dx.doi.org/10.4081/rt.2017.6541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391516PMC
March 2017

Tumor-infiltrating lymphocytes and breast cancer: Beyond the prognostic and predictive utility.

Tumour Biol 2017 Apr;39(4):1010428317695023

1 UO Multidisciplinare di Patologia Mammaria, US Terapia Molecolare e Farmacogenomica, AO Azienda Istituti Ospitalieri di Cremona, Cremona, Italy.

The importance of the immune system as a potent anti-tumor defense has been consolidated in recent times, and novel immune-related therapies are today demonstrating a strong clinical benefit in the setting of several solid neoplasms. Tumor-infiltrating lymphocytes reflect the attempt of the host to eradicate malignancies, and during the last decades, they have been shown to possess an interesting prognostic utility for breast cancer, especially in case of HER2 positive and triple-negative molecular subtypes. In parallel, the clinical evaluation of tumor-infiltrating lymphocytes has been shown to effectively predict treatment outcomes in both neoadjuvant and adjuvant settings. Currently, tumor-infiltrating lymphocytes are promising further predictive utility in view of novel immune-related therapeutic strategies which are coming into the clinical setting launching a solid rationale for the future next-generation treatment options. In this scenario, tumor-infiltrating lymphocytes might represent an important resource for the selection of the most appropriate therapeutic strategy, as well as further evaluations of the molecular mechanisms underlying tumor-infiltrating lymphocytes and the immunoediting process would eventually provide new insights to augment therapeutic success. Considering these perspectives, we review the potential utility of tumor-infiltrating lymphocytes in the definition of breast cancer prognosis and in the prediction of treatment outcomes, along with the new promising molecular-based therapeutic discoveries.
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http://dx.doi.org/10.1177/1010428317695023DOI Listing
April 2017

A Case of Acrodermatitis Continua of Hallopeau Following Chronic Pustular Cheilitis.

Dermatol Ther (Heidelb) 2016 Mar 26;6(1):89-94. Epub 2016 Feb 26.

Department of Dermatology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy.

We describe the case of a young male affected by chronic pustular psoriasis of the lips that remained the only manifestation of acrodermatitis continua of Hallopeau (ACH) for years before the onset of the characteristic hand lesions.
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http://dx.doi.org/10.1007/s13555-016-0100-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4799033PMC
March 2016

Sinonasal mucosal melanoma: A 12-year experience of 58 cases.

Head Neck 2016 04 17;38 Suppl 1:E1737-45. Epub 2015 Dec 17.

Department of Otorhinolaryngology, University of Brescia, Brescia, Italy.

Background: Sinonasal mucosal melanoma is a rare malignancy with poor prognosis.

Methods: Patients with sinonasal malignant melanoma who underwent surgery by different approaches were included in this study. Overall survival (OS) and event-free survival were calculated, and statistically significant variables by univariate analysis were entered in a multivariate Cox regression model.

Results: Pathological staging was pT3, pT4a, and pT4b in 30 cases (51.7%), 17 cases (29.3%), and 11 cases (19.0%). At 3 and 5 years, OS was 43.5% and 29% and event-free survival was 23.6% and 12.4%, respectively. At univariate analysis, OS was significantly influenced by male sex, advanced pT classification, positive margins, and surgical approach; event-free survival was affected by positive margins. At multivariate analysis, the risk of death was independently associated with male sex (hazard ratio [HR] = 2.27; p = .04) and positive margins (HR = 2.32; p = .03).

Conclusion: Male sex and positive margins were negative prognostic factors. Endoscopic resection did not show an increased risk of death compared with more extensive surgical approaches. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1737-E1745, 2016.
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http://dx.doi.org/10.1002/hed.24309DOI Listing
April 2016

Lupus miliaris disseminatus faciei in a young male.

G Ital Dermatol Venereol 2019 Dec 8;154(6):714-716. Epub 2015 Sep 8.

Department of Dermatology, University Hospital Spedali Civili, Brescia, Italy.

We report a case of a healthy 26-year-old male with multiple asymptomatic reddish papules and papule-nodules on the central area of the face, persisting from more than 2 months and gradually increasing in number. An incisional skin biopsy revealed a confluent dense granulomatous infiltrate centred by large areas of eosinophilic necrosis consistent with the diagnosis of lupus miliaris disseminatus faciei (LMDF). This is a rare dermatosis first described in 1878 by Fox, that often poses a clinical challenge as it is a disease process which is difficult to diagnose. In fact, in our case, a diagnosis of LMDF was made on skin biopsy. We think that collaboration among dermatologists and General Practitioners is very important for diagnosis of rare dermatosis and especially for management of it, in order to prevent the development of depressed scars.
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http://dx.doi.org/10.23736/S0392-0488.17.05169-0DOI Listing
December 2019

Primary Merkel Cell Carcinoma of the Submandibular Gland: When CK20 Status Complicates the Diagnosis.

Head Neck Pathol 2015 Jun 15;9(2):309-14. Epub 2014 Oct 15.

Department of Otorhinolaryngology, University of Brescia, Piazza Spedali Civili 1, 25100, Brescia, Italy.

Merkel cell carcinoma is a neuroendocrine tumor that occurs predominantly on the sun-exposed skin, with rare cases in the extracutaneous sites. It represents one of the extremely rare malignant neuroendocrine tumors of the salivary glands. We report a case of primary Merkel cell carcinoma of the right submandibular gland. The preoperative diagnosis was doubtful and the definitive histological diagnosis proved to be very difficult considering the extreme rarity of this tumor. The intraoperative evaluation of the macroscopic characteristics of the lesion led to an elective lymph node dissection. The extreme aggressiveness of the disease has resulted in the necessity of a new post-operative staging and in a multimodal treatment. This is the first primary submandibular gland Merkel cell carcinoma described in the literature. Differential diagnosis may be challenging and proper hematoxylin-eosin staining and immunohistochemical studies are mandatory.
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http://dx.doi.org/10.1007/s12105-014-0573-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424209PMC
June 2015

SDF-1 inhibition targets the bone marrow niche for cancer therapy.

Cell Rep 2014 Oct 25;9(1):118-128. Epub 2014 Sep 25.

Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA. Electronic address:

Bone marrow (BM) metastasis remains one of the main causes of death associated with solid tumors as well as multiple myeloma (MM). Targeting the BM niche to prevent or modulate metastasis has not been successful to date. Here, we show that stromal cell-derived factor-1 (SDF-1/CXCL12) is highly expressed in active MM, as well as in BM sites of tumor metastasis and report on the discovery of the high-affinity anti-SDF-1 PEGylated mirror-image l-oligonucleotide (olaptesed-pegol). In vivo confocal imaging showed that SDF-1 levels are increased within MM cell-colonized BM areas. Using in vivo murine and xenograft mouse models, we document that in vivo SDF-1 neutralization within BM niches leads to a microenvironment that is less receptive for MM cells and reduces MM cell homing and growth, thereby inhibiting MM disease progression. Targeting of SDF-1 represents a valid strategy for preventing or disrupting colonization of the BM by MM cells.
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http://dx.doi.org/10.1016/j.celrep.2014.08.042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194173PMC
October 2014

Pigmentation of axillary sentinel nodes from extensive skin tattoo mimics metastatic melanoma: case report.

Int J Dermatol 2014 Jun 30;53(6):773-6. Epub 2013 Dec 30.

Department of Dermatology, Brescia Civic Hospital, Brescia, Italy.

Background: The relationship between the occurrence of skin diseases and skin tattoos remains unclear. Dermatologic disorders have been reported to occur in about 2% of cases. In addition, tattoo pigment can migrate to the regional lymph nodes through the lymphatic vessels and subsequently mimic metastatic disease from melanoma.

Methods: A 23-year-old Caucasian man presented with a pigmented lesion on the left scapular region, which had slowly enlarged over time. The patient exhibited an extensive tattoo on the left upper arm, left shoulder, and part of the upper back. His medical history was unremarkable. The pigmented lesion was excised. Histology confirmed malignant melanoma. Ultrasound examination of the abdomen, neck, and inguinal and axillary lymph nodes and a total body computed tomography scan showed no sign of disease. A re-excision with 2-cm margins and sentinel lymph node biopsy (SLNB) were performed. Two grossly enlarged, black sentinel lymph nodes (SLNs) highly suggestive of melanoma metastases were removed.

Results: No evidence of melanoma metastasis was found in any of the sampled tissues. Large amounts of pigment were present within the subcapsular space and sinusoid areas of the two clinically suspicious lymph nodes. Immunohistochemical analysis was negative.

Conclusions: Sentinel lymph node biopsy is widely performed in cutaneous melanoma. Histologic confirmation of any enlarged, pigmented SLN is essential prior to radical surgery, especially when pigmented SLNs are found near a tattoo. Tattoo pigments may deposit in the regional lymph nodes and may clinically mimic metastatic disease. A history of tattooing should be considered in all melanoma patients eligible for SLNB. In a finding of darkly pigmented nodes during SLNB, radical lymphadenectomy should be withheld until immunohistologic confirmation of metastasis in the SLN is obtained.
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http://dx.doi.org/10.1111/ijd.12417DOI Listing
June 2014

Salivary duct carcinomas can be classified into luminal androgen receptor-positive, HER2 and basal-like phenotypes.

Histopathology 2012 Oct;61(4):629-43

Department of Histopathology, Royal Surrey County Hospital, Guildford, SurreyDivision of Clinical Medicine, University of Surrey, Guildford, SurreyDepartment of Histopathology, Royal Devon and Exeter Hospital, Exeter, DevonThe Breakthrough Breast Cancer Research Centre - Institute of Cancer Research, London, UKDepartment of Pathology, Faculty of Medicine, Charles University in Prague, Plzeň, Czech RepublicDepartment of Pathology, Spedali Civili Brescia, Brescia, ItalyDepartment of Histopathology, Imperial College Healthcare Trust, Charing Cross Hospital, LondonDepartment of Oncology, St Lukes Cancer Centre, Royal Surrey County Hospital, Guildford, Surrey, UK.

Aims: The aim of this study was to devise a molecular classification for salivary duct carcinomas (SDCs) based on the similarities between SDCs and breast carcinomas and on characteristics of the microarray-based gene expression profiling-defined molecular subtypes of breast cancer.

Methods And Results: Forty-two pure salivary duct carcinomas, 35 of which contained an in-situ component as defined by histological review and/or immunohistochemical analysis, were stained with antibodies for oestrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR) and cytokeratin (CK) 5/6. Based on these markers, tumours were classified into HER2, luminal androgen receptor-positive, basal-like, luminal and indeterminate phenotype. Analysis revealed that 16.7%, 69%, 4.8%, 9.5% and 0% were of HER2, luminal androgen receptor-positive, basal-like, indeterminate and luminal phenotype, respectively. The in-situ and invasive components displayed the same molecular subtype in all but one case.

Conclusion: Salivary duct carcinomas can be classified into molecular subgroups approximately equivalent to those in the breast. We also report on the existence of a subgroup of bona fide pure salivary duct carcinomas that have a 'basal-like' phenotype. Understanding the phenotypic complexity of SDCs may help to expedite the identification of novel therapeutic targets for these aggressive tumours.
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http://dx.doi.org/10.1111/j.1365-2559.2012.04252.xDOI Listing
October 2012

Sinonasal mucosal melanoma: Molecular profile and therapeutic implications from a series of 32 cases.

Head Neck 2013 Aug 12;35(8):1066-77. Epub 2012 Jul 12.

Department of Otorhinolaryngology, University of Brescia, Brescia, Italy.

Background: Primary sinonasal mucosal melanomas are aggressive tumors with a poor clinical control by current treatments, raising the urgent need of novel strategies.

Methods: By fluorescence in situ hybridization (FISH), direct sequencing, and immunohistochemistry, we investigate the spectrum of molecular abnormalities in a cohort of 32 cases of primary sinonasal mucosal melanomas.

Results: We found that all primary sinonasal mucosal melanomas lack BRAF V600E mutation; in addition, they are characterized by somatic mutations of NRAS (22%) and KIT (12.5%), together with amplification of RREB1 (100%) and loss of MYB (76%). The large majority of cases showed KIT protein expression (96.9%). Among tumor suppressor genes, primary sinonasal mucosal melanomas showed loss of PTEN (48.1%) and p16/INK4a (55.2%). All tested cases showed expression of pAkt and pErk, suggesting a combined activation of PI3K/Akt and RAS-mitogen-activated protein kinase (MAPK) pathways.

Conclusions: This molecular fingerprint strongly argues against the clinical efficacy of BRAF-inhibitors, but could candidate primary sinonasal mucosal melanomas to therapeutic strategies targeting RAS and KIT mutations or inhibiting PI3K-Akt-mTOR pathway.
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http://dx.doi.org/10.1002/hed.23079DOI Listing
August 2013

Dermoscopic, histological and immunohistochemical evaluation of cancerous features in acquired melanocytic nevi that have been repeatedly exposed to UVA or UVB.

Exp Dermatol 2012 Feb 22;21(2):86-90. Epub 2011 Nov 22.

Department of Dermatology, University of Brescia, Brescia, Italy.

Previous studies have reported that repeated solar and artificial UVB (280-320 nm) and UVA (320-400 nm) exposures can modify acquired melanocytic nevi (AMN). We therefore investigated the clinical, dermoscopic, histological and immunohistochemical changes in AMN exposed to UVB and UVA radiation. Twenty healthy volunteers with at least three AMN on the trunk were enrolled in the present study and randomized into two groups to receive equally effective doses of narrow-band (NB)-UVB or UVA1. Three exposures per week were delivered for a total of 4 weeks. During exposures, one AMN was left unprotected, a second one was shielded with an opaque adhesive tape and the third nevus was covered with a commercial sunscreen. After the irradiation cycle, the AMN were surgically removed and underwent histological and immunohistochemical assessment of melanocyte/melanogenesis-related proteins (MART-1, tyrosinase, HMB-45), cell cycle activation markers (Ki-67, topoisomerase IIalpha, p53, Cdk2) and transcription factors (microphthalmia-associated transcription factor, STAT3). Nevi that were exposed to NB-UVB or UVA1 also showed statistically significant increase in size and changes in their dermoscopic features, including overall darkening, increased pigment network expression, formation of branched streaks, and increased number and size of brown globules and dots. AMN that had been covered with opaque tape or sunscreen did not show changes in size or dermoscopic features following UVA1 or NB-UVB exposure. Histological and immunohistochemical analysis did not show any significant change in exposed AMN in comparison with AMN shielded with an opaque adhesive tape or covered with the sunscreen.
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http://dx.doi.org/10.1111/j.1600-0625.2011.01397.xDOI Listing
February 2012

Pseudolymphoma tattoo-induced.

Dermatol Reports 2011 Oct 29;3(3):e47. Epub 2011 Nov 29.

Department of Dermatology and.

Tattooing has become more and more popular in today's society. The most common dermatological tattoo complications are represented by hypersensitivity reaction to tattoo pigments like irritant and allergical contact dermatitis, development of lichenoid areas and granulomatous responses, such as sarcoid granulomas or foreign body granulomas. Less frequently patients developing discoid lupus erythematous have been reported. Pseudolymphoma is an uncommon reactive lymphocytic proliferation mimicking the histological and clinical features of a malignant skin lymphoma. We herein report a pseuldoymphoma limited to the red area of a multicolour tattoo of the leg.
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http://dx.doi.org/10.4081/dr.2011.e47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211496PMC
October 2011

Multiple eruptive clear cell acanthoma.

J Dermatol Case Rep 2010 Nov;4(2):25-7

Department of Dermatology, University of Brescia, Brescia, Italy.

Background: Clear cell acanthoma is a rare solitary benign epidermal tumor of unknown etiology. The disease arises in the middle-age, with no sex predominance. It appears as a single reddish papule or papule-nodule and a peripheral scaling collarette is characteristic. Although solitary lesions are the rule, less than 30 cases of multiple Clear cell acanthoma have been described in the literature to date.

Main Observations: We report an unusual case of a healthy 74-year-old male with multiple clear cell acanthoma on the lower extremities treated successfully with cryotherapy.

Conclusions: Despite significant progress in treatment of clear cell acanthoma, cryotherapy, based on liquid nitrogen, remains an important alternative in treating multiple clear cell acanthomas.
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http://dx.doi.org/10.3315/jdcr.2010.1048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157811PMC
November 2010

Merkel cell carcinoma arising in immunosuppressed patients treated with high-dose ultraviolet A1 (320-400 nm) phototherapy: a report of two cases.

Photodermatol Photoimmunol Photomed 2010 Oct;26(5):263-5

Department of Dermatology, University of Brescia, Azienda Spedali Civili, Brescia, Italy.

Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumour of the skin. Though immunodeficiency is the most relevant risk factor, ultraviolet (UV) radiation is also involved, but as of yet we do not know the action spectrum, pattern or dose which would produce a dangerous exposure. A retrospective study of two immunosuppressed patients who developed MCC during, or soon after a treatment cycle with high dose UVA1 exposures was conducted, in order to understand wether repeated exposures to suberythemogenic UVA1 radiation may have a cancerogenic activity provoking MCC in immunosuppressed patients.
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http://dx.doi.org/10.1111/j.1600-0781.2010.00529.xDOI Listing
October 2010

Congenital systematized basaloid follicular hamartoma with microphthalmia and hemimegalencephaly.

Pediatr Dermatol 2011 Sep-Oct;28(5):555-60. Epub 2010 Nov 9.

Section of Dermatology, Department of Surgical Sciences, University of Parma, Parma, Italy.

The lines of Blaschko are a cutaneous pattern of mosaicism present in a variety of skin disorders. Developmental abnormalities affecting other tissues derived from the embryonic ectoderm and mesoderm are sometimes associated. Here, we describe a 5-year-old boy with basaloid follicular hamartoma affecting the left side of the body in linear multiple bands, following Blaschko lines. Lesions were predominantly hypopigmented macules and streaks, but among these, we could observe brownish atrophic patches and brown papules. Furthermore, ipsilateral hemimegaloencephaly and microphthalmia were present. These findings suggest a neurocutaneous condition recently described by Happle and Tinschert. Its nosologic classification will be discussed.
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http://dx.doi.org/10.1111/j.1525-1470.2010.01225.xDOI Listing
February 2012

Advances in the molecular morphology of hematopathology.

Int J Surg Pathol 2010 Jun;18(3 Suppl):128S-132S

Department of Pathology, University of Brescia, Brescia, Italy.

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http://dx.doi.org/10.1177/1066896910370613DOI Listing
June 2010

Thin primary cutaneous melanoma in childhood and adolescence: report of 12 cases.

Pediatr Dermatol 2009 May-Jun;26(3):356-7

Department of Dermatology, University Hospital Spedali Civili, Brescia, Italy.

Approximately, 1-4% of all new melanoma cases occur in patients younger than 20 years. The clinical presentation of melanoma in the young is often challenging. We report the experience of the Melanoma Unit of University Hospital Spedali Civili of Brescia, Italy. Study subjects were drawn from 1470 patients with histologically confirmed melanoma. From this group, melanoma developed in 12 patients younger than 19 years. For each melanoma diagnosed, histologic characteristics, treatment, and outcomes were evaluated. Of the 12 patients described in this study, four were men and eight were women. The average age was 15.6 years ranging from 11 to 18 years. Regarding invasive melanomas, Breslow thickness ranged from 0.15 to 0.66 mm with a mean thickness of 0.36 mm. Primary treatment of 12 patients included wide local excision of their primary lesions. In many cases reported in literature lesions are amelanotic, nodular, and resemble pyogenic granuloma. From our case studies it was found that the clinical characteristics detected in melanomas diagnosed in childhood and adolescence have been the same as those described in adults and that the ABCDE clinical criteria may be helpful basics of melanoma.
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http://dx.doi.org/10.1111/j.1525-1470.2009.00920.xDOI Listing
December 2009

Amplification and overexpression of HER2/neu gene and HER2/neu protein in salivary duct carcinoma of the parotid gland.

Arch Otolaryngol Head Neck Surg 2007 Oct;133(10):1031-6

Department of Pathology, University of Brescia, Piazza Spedali Civili 1, 25100 Brescia, Italy.

Objectives: To detect amplification of the HER2/neu gene by means of fluorescence in situ hybridization (FISH) in a series of 13 salivary duct carcinomas (SDCs) and to compare the results with immunohistochemical (IHC) assessment of HER2/neu protein expression.

Design: Retrospective analysis.

Setting: Department of Pathology, University of Brescia.

Patients: We studied 13 cases of SDC diagnosed between January 1, 1997, and June 30, 2004, all arising from the parotid gland. Twelve patients were treated with surgery and radiotherapy, and 1 patient received only palliative radiotherapy. Seven patients died of disease, 3 patients were alive with disease, and 3 were free of disease.

Main Outcome Measures: HER2/neu protein expression and HER2/neu gene amplification detected by means of IHC assessment and FISH, respectively.

Results: With IHC assessment, 10 cases showed overexpression (grade 3+) of HER2/neu protein, whereas 3 cases were negative for this protein (grade 0/1+). Using FISH, amplification of the HER2/neu gene was found in 8 of the 10 grade 3+ cases, whereas none of the cases negative for the protein according to IHC assessment had amplification of the gene. Because of the small number of patients, it was not possible to statistically correlate HER2/neu protein expression or HER2/neu gene amplification and survival.

Conclusion: Our data demonstrate that HER2/neu protein is frequently overexpressed in SDC, and in contrast to previous reports, overexpression of the protein is associated in most cases with HER2/neu gene amplification.
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http://dx.doi.org/10.1001/archotol.133.10.1031DOI Listing
October 2007

MMA monoclonal antibody is a superior anti-CD15 reagent for the diagnosis of classical Hodgkin's lymphoma?

Haematologica 2007 May;92(5):708-9

CD15 is a useful immunohistochemical marker to identify Reed-Sternberg cells in classical Hodgkin's lymphoma (HL) and to distinguish it from HD-like neoplasms, but data from the literature concerning its expression in HL are quite variable. Using immunohistochemistry we compared the reactivity of three different anti-CD15 clones (MMA, C3D1 and BY87) and found that anti-CD15 MMA clone is a superior reagent in identifying atypical cells, detecting more numerous cells in 28.2%, and being the only positive marker in 12.8% of cases. We conclude that it is advisable to include this reagent in diagnostic immunohistochemical panels.
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http://dx.doi.org/10.3324/haematol.11002DOI Listing
May 2007