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S Pilotti

Publications and source records attributed to S Pilotti.

At least 199 records · Page 11Linked to original sources
PubMed1987

Diagnostic efficacy of the clinical-radiological-cytological triad in solid breast lumps: results of a second prospective study on 631 patients.

The clinical-radiological-cytological triad was used for diagnostic evaluation in 631 women over 30 years old with a solid breast lump, excluding clinically obvious cancers. All the lumps were subsequently removed surgically, except for 105 cases which spontaneously regressed within 2 months. 285 of the 526 nodules removed were cancers, and 162 of 285 (57%) did not exceed 20 mm in size. The sensitivity of the individual tests (physical examination, mammography and fine-needle aspiration cytology) of the malignant lumps was respectively 0.83, 0.73 and 0.60, and it increased to 0.95 when they were associated. Of the remaining 346 benign lumps the specificity of the three tests was respectively 0.60, 0.78 and 0.98. The predictive value of a positive response (certain or probable) to the three tests was 0.63, 0.74 and 0.94. The certain positive responses of cytology (131 of 285 cases) reached a predictive value of 1.00. The predictive value of a negative response for the three tests was respectively 0.81, 0.80 and 0.82; in the absence of positive responses, the predictive value for benignancy of the triad was 0.93 (177 of 190 cases). The systematic use of the diagnostic triad and the organizational platform allowed the clinicians to select malignant cases and plan inpatient/outpatient surgical treatment.

Adult↗
PubMed1986

Human papillomavirus type 16 DNA in genital tumours: a pathological and molecular analysis.

The presence of human papillomavirus type 16 (HPV16) DNA in 34 genital tract tumours of Italian female patients was investigated by Southern blot hybridization in high stringency conditions. HPV16 DNA was detected in 16 neoplasias, including cervical invasive and intraepithelial lesions as well as vulvar intraepithelial neoplasias and, to a lesser extent, vulvar invasive carcinomas. Appropriate control tissues included in the study were negative. The data suggest that integration of viral DNA had occurred in most tumours, both in invasive and in intraepithelial lesions. HPV16 variants or defective genomes, lacking the BamHI restriction site, were detected in three tumours.

Carcinoma, Squamous Cell↗
PubMed1986

Orchiectomy alone in clinical stage I nonseminomatous testis cancer: a critical appraisal.

Sixty-two consecutive patients with clinical stage I nonseminomatous testicular cancer were entered into a prospective study to receive no treatment after orchiectomy until clinical evidence of recurrent disease. Of 59 evaluable cases, 41 (69.5%) remained continuously disease free for a median duration of 30 months (range, 18 to 46 months), and evidence of metastatic disease developed in 18 patients (30.5%) from 2 to 36 months after orchiectomy. The median disease-free interval for relapsing patients was 6 months. Retroperitoneal metastases developed in ten patients; seven patients had pulmonary metastases, and one patient had progressive elevation of the serum alpha-fetoprotein level. Relapses were significantly more frequent in patients with either embryonal carcinoma, infiltrating testicular cancer (pT greater than 1), peritumoral vascular invasion, or in those who underwent transscrotal biopsy. One patient with relapse refused salvage therapy and died. The remaining 17 patients have been rendered disease free with cisplatin combination chemotherapy and/or surgery. However, two patients showed further recurrence, with one in the lung and the other one also in the retroperitoneal nodes. In our opinion, surveillance following orchiectomy will provide useful information in clinical stage I nonseminomatous testicular cancer, but it is a difficult study. For the time being, it should be restricted to specialized centers only. In the meanwhile, retroperitoneal lymphadenectomy remains the standard treatment.

Adolescent↗
PubMed1985

Histologic evaluation of necrosis in osteosarcoma induced by chemotherapy. Regional mapping of viable and nonviable tumor.

The predominant sites of viable and nonviable tumor were determined in the primary lesions of 50 patients with osteosarcoma after initial treatment with preoperative chemotherapy. The degree of tumor destruction was classified as good, fair, and poor and a map of the sites revealing viable and nonviable tumor was constructed. The study revealed several preferential sites where viable tumor was likely to persist: soft tissues, cortex, subcortex, ligaments, and areas in contact with cartilage (growth plate and/or articular cartilage). Localized areas of hemorrhage and necrosis, designated "lacunae," were noted within the tumor. They were frequently surrounded by bundles of viable tumor and appeared to correlate with open surgical biopsies. Factors responsible for this phenomenon and the persistence of viable tumor are discussed. The findings have important implications in the design of surgical treatment and in the use of needle biopsies to determine the effects of preoperative treatment.

Adolescent↗
PubMed1985

Early resection of residual tumor during cisplatin, vinblastine, bleomycin combination chemotherapy in stage III and bulky stage II nonseminomatous testicular cancer.

Sixty consecutive patients with Stage III or bulky Stage II nonseminomatous germinal testis tumors were treated with cisplatin, vinblastine, bleomycin combination chemotherapy (PVB). One patient died of acute toxicity after the first course of therapy, 16 entered complete remission (CR) after two or three inductions, and 36 underwent surgery for removal of residual masses after the third cycle. No residual tumor was found in 16 cases, 10 had mature teratoma, and residual malignant tumor was completely resected in 8 of 10 patients. On the whole, 52 of 59 cases (88%) who completed the therapy entered CR, 34 (58%) with PVB and 18 (30%) with PVB and resection of the residual disease. The major beneficiaries of surgery were patients with bulky metastases (17 of 45, 38%) and those with primary teratocarcinoma (13 of 24, 54%). All of the patients who entered CR received two additional inductions and no maintenance. After a median follow-up period of greater than 3 years, 40 patients (68%) remain continuously disease-free, 1 died in CR, and 3 of the 11 who had relapse were salvaged. All of the 32 patients with lung deposits less than 5 cm and/or lymph node metastases less than 10 cm entered CR after the combined treatment modality, and 29 (91%) are alive disease-free. Also, 20 of 27 patients (74%) with far-advanced disease (lung and lymph node metastases larger than 5 and 10 cm, respectively, extrapulmonary disease) entered CR after PVB and surgery, but only 11 (41%) are continuously disease-free. Early resection of the residual tumor during PVB combination chemotherapy greatly increased the CR rate, but relapses were very frequent in patients with far-advanced disease.

Adolescent↗
PubMed1985

Systematic use of the clinical-mammographic-cytologic triplet for the early diagnosis of mammary carcinoma.

Of about 8500 women with a minimum age of 30 years who had a breast examination at our Outpatient Clinic from April 1982 to March 1983, we found in 286 cases a clinically evident carcinoma, and in 534 cases an apparently benign or suspect solid lump. All 534 of these cases were subjected to the triplet clinical, mammographic and cytologic diagnostic investigation by needle aspiration within 1 to 4 days. The clinical judgment was based on a method of scoring of the characters of 9 physical features (Clinical Diagnostic Index) in use at our Institute. The results of the examinations were grouped into 5 categories: 1) certain benignancy or negativity of the examination; 2) probable benignancy (excluding the cytologic examination); 3) probable malignancy; 4) certain malignancy; 5) nonevaluability of the examination (excluding the clinical examination). Except for 80 cases with collectively negative examinations which were clearly or completely regressed at the control within 2 months, all the others were subjected to surgery. On the basis of the histologic examination (or if regression occurred), 284 of the 534 lumps examined were found to be benign or nontumoral, whereas the other 250 (47%) were carcinomas. Of the latter, 57% were not more than 20 mm in size, whereas in 67.6% there was no microscopic evidence of axillary metastases. Sensitivity of the clinical, mammographic and cytologic examinations was 0.79, 0.76 and 0.72, respectively; specificity 0.71, 0.75 and 0.94, respectively, and the predictive value for malignancy of the positive response of the three examinations 0.71, 0.75 and 0.93, respectively. The use of the diagnostic triplet demonstrated an overall sensitivity of 0.95, specificity of 0.59, and a predictive value for malignancy of 0.98 and 0.93 for benignancy. These results confirm the usefulness of the systematic use of the diagnostic triplet in solid breast lumps of over thirty aged women for the early detection of cancer.

Adult↗
PubMed1985

Characteristics of thyroid cancer following irradiation.

Studies in humans and animals have suggested that the distribution of histologic types of radio-induced thyroid cancers is different from that of naturally occurring tumors. In an attempt to verify that finding, histologic results of 31 patients with thyroid cancer, who had received irradiation to the head, neck or upper chest for other causes, were compared with those of 389 non irradiated patients. The two groups were homogeneous for age and sex. There was a significantly higher prevalence of the papillary type in the irradiated group, with an higher incidence of metastatic lymph nodes. Other histopathologic findings, coexisting with the papillary carcinoma (i.e., ground glass subtype, size less than 1.5 cm, multicentricity) did not differ significantly in the two groups. Some theoretical considerations concerning radio-induced thyroid carcinoma are proposed.

Adolescent↗
PubMed1985

Relapse pattern of pathologic stage I nonseminomatous germ cell tumors of the testis following orchidectomy and lymphadenectomy.

A retrospective analysis of patients with pathologic stage I nonseminomatous germinal testis tumors treated with orchidectomy and retroperitoneal lymphadenectomy was done in an attempt to define the relapse pattern and to eventually identify risk factors predisposing to tumor recurrence. Of 102 patients, 91 (89.2%) remain disease free with a median follow-up of greater than 5 years (range 3-10 years), and 11 (10.8%) suffered relapse 3-35 months after lymphadenectomy (median free interval 6 months). 9 of 11 patients developed primarily intrathoracic recurrences. The tumor was so rapidly progressing at relapse, that it was diagnosed when clinically advanced in 7 of 11 cases. Nevertheless, 8 of 11 patients were salvaged with effective available chemotherapy and resection of residual disease. Only scrotal violation showed a significant increased risk of tumor recurrence (5 of 24 cases, versus 6 of 78 who had inguinal orchidectomy, p less than 0.05). We recommend a very close follow-up for all patients with pathologically assessed stage I nonseminomatous germinal testis tumors during the first 3 years following orchidectomy and retroperitoneal lymphadenectomy. With early recognition of relapse, an approximately 100% cure rate will be achieved with effective available chemotherapy.

Adolescent↗
PubMed1985

Inclusion-cytology versus smear-cytology in fine needle abdominal biopsy.

1568 patients underwent percutaneous fine needle biopsy (22-23 g. Chiba). 761 of these had histologic type confirmation of malignant disease. Among the latter, 313 cases had adequate samples retrieved from the same lesion for smear cytology (SC) and inclusion cytology (IC), 400 for SC alone (378 performed before the use of IC) and 48 for IC alone. SC was stained by Papanicolaou and MGG, IC by haematoxylin-eosin technique. In SC + IC group typing accuracy was 0.64 for SC and 0.86 for IC, in SC group was 0.66, in IC group was 0.87. IC permitted an easier preparation and interpretation of special stains. In conclusion, IC routine is recommended. Some interesting observations were possible because material was collected from three hospitals.

Abdomen↗
PubMed1985

Human fibroblast interferon in cervical and vulvar intraepithelial neoplasia associated with viral cytopathic effects. A pilot study.

Sixteen patients with cervical intraepithelial neoplasia (CIN), grades 2 and 3, and vulvar intraepithelial neoplasia (VIN), grade 3, associated with human papillomavirus (HPV) infection were treated with human fibroblast interferon (HFI). Treatment consisted of 2-3 X 10(6) IU/day injected intra- and perilesionally for five days per week for two to three weeks with or without topically applied cream (1.2 X 10(6) IU/day for five days). Eight complete and two partial regressions occurred. The duration of the response ranged from 4 to 20 months. Fever, chills and fatigue with or without headache were the side effects. Our preliminary results indicate that HFI was active against CIN and VIN associated with HPV infection.

Adult↗
PubMed1984

Retroperitoneal lymphadenectomy and aggressive chemotherapy in nonbulky clinical Stage II nonseminomatous germinal testis tumors.

In a former series of 60 resected Stage II nonseminomatous germinal testis tumors the authors succeeded in demonstrating that adjuvant cisplatin, vinblastine, and bleomycin (PVB) was able to significantly improve survival (100% in 11 treated versus 28.5% in 7 historical controls, P less than 0.01) only in patients with retroperitoneal metastases greater than 5 cm, macroscopic extranodal spread, tumor invasion into retroperitoneal veins (pathologic Stage II-C). Forty-eight evaluable patients with clinical nonbulky Stage II nonseminomatous testis cancer underwent retroperitoneal lymphadenectomy as primary treatment. Four courses of postoperative PVB were administered only to 18 clinically understaged patients (14 pathologic Stage II-C, and 4 postoperatively reclassified as Stage III). The remaining 30 patients were followed at monthly intervals. After a median follow-up of 25 months, relapses were: 1 (10%) in 10 pathologic Stage I patients; 8 (40%) in 20 pathologic Stage II-A and II-B; null in the 18 treated. Eight of the nine patients (89%) who had relapse entered continuous complete remission following salvage therapy. The overall 2-year disease-free survival in this case series is 98%. Retroperitoneal lymphadenectomy followed by compulsive follow-up and selective use of aggressive chemotherapy is an alternative to remission induction chemotherapy as primary treatment in clinical nonbulky Stage II nonseminomatous testis cancer, and to immediate adjuvant chemotherapy in all patients with resected Stage II disease.

Adolescent↗
PubMed1984

Immunohistochemical and ultrastructural evidence of papilloma virus infection associated with in situ and microinvasive squamous cell carcinoma of the vulva.

Of 21 patients with predominantly intraepithelial carcinoma of the vulva, 14 had coexisting papilloma virus (PV)-related cytopathic changes in the neoplastic and non-neoplastic epithelial cells. A PV species-nonspecific internal capsid antigen (PV-Ag) was detected in 64% of the cases in a variable number of nuclei by avidin-biotin complex-immunoperoxidase tests. Intranuclear viral particles were identified in 44% of specimens by electron microscopy. The main clinicopathologic features were the gross appearance of multiple papillary growths or, less often, of giant condyloma, the young age of the patients (75% of whom were less than 40 years old), the association in 57% of the cases with simultaneous intraepithelial neoplasia of the cervix or perineal skin, and an incidence of recurrences in 28%. PV infection of the genital area recurred in 14% of the cases. Nodal metastases of squamous cell carcinoma were observed in two cases. The histopathologic features and the main characteristics in terms of natural history of this PV-associated neoplasia are very similar to so-called bowenoid carcinoma and different from those of verrucous carcinoma of the vulva, six cases of which were investigated for comparison. In the latter, the search for PV-Ag was consistently negative, the patients were much older, and metastatic nodal involvement was absent.

Adult↗
PubMed1984

Adjuvant chemotherapy in resected stage-II nonseminomatous germ cell tumors of testis. In which cases is it necessary?

In an attempt to reduce the recurrence rate and to improve survival in resected stage-II nonseminomatous testicular cancer, two consecutive series of patients were treated with adjuvant vinblastine-bleomycin (VB) continuous infusion, or cisplatin, vinblastine, bleomycin (PVB). 11 former patients who received no adjuvant chemotherapy and 5 who refused the adjuvant treatment were considered historical controls. After a median follow-up of 5 years, relapses were 4 in 15 patients treated with VB (27%), 1 in 29 treated with PVB (3%) and 8 in the untreated (50%). Adjuvant PVB significantly reduced the recurrence rate (p less than 0.001), while VB did not (p = 0.4). However, the advantage of adjuvant PVB was evident only in patients with retroperitoneal metastases larger than 5 cm, macroscopic extranodal spread, and tumor invasion into retroperitoneal veins, who were classified as pathologic stage II-C: no relapse and 100% survival following adjuvant PVB in 11 cases, versus 86% relapses and 28.5% survival in 7 untreated patients (p less than 0.01); 2 relapses and 2 survivors in 3 treated with VB. On the other hand, only 1 of the 39 patients with less extensive retroperitoneal disease died of testicular cancer, and he was in the VB adjuvant treatment group. We conclude that only aggressive adjuvant chemotherapy significantly reduces the recurrence rate and improves survival in resected stage-II nonseminomatous testis cancer. However, it is mandatory only in the very high risk subset II-C of patients, while the others could be carefully followed at monthly intervals and safely treated with aggressive chemotherapy only in the event of relapse.

Adolescent↗
PubMed1984

Human fibroblast interferon in cervical and vulvar intraepithelial neoplasia associated with papilloma virus infection.

The follow-up is presented for 13 patients with cervical intraepithelial neoplasia (CIN) grade II-III and vulvar intraepithelial neoplasia (VIN) grade III associated with papilloma virus infection, treated with human fibroblast interferon. Treatment consisted of 2-3 X 10(6) IU interferon per day injected intra- and peri-lesionally for five days per week for 2-3 weeks, with or without a cream topically applied at the dose of 1.2 X 10(6) IU/day X five days. Among the 13 patients with CIN and VIN, 7 complete (54%) and 2 partial regressions were observed. The duration of response appeared to be between 2 and 14 months. Fever, chills and fatigue were the tolerable side-effects. Our results indicate that treatment with interferon is active against CIN and VIN associated with papilloma virus infection.

Adult↗
PubMed1983

Fine-needle aspiration biopsy in parotid masses.

Seventy-nine cases of parotid masses were punctured by fine needle for cytologic examination and subsequently operated on. Of the material obtained, conventional smears, as well as formalin-fixed, paraffin-embedded histologic sections were prepared. The two procedures detected 16 malignant tumors and 63 nonmalignant lesions, with a high sensitivity (86%) and absolute specificity (100%). These data confirm the validity of this combined method and favor the complementary use of the two procedures, which improves the accuracy (80%) of preoperative diagnosis and histologic typing of parotid tumors.

Biopsy, Needle↗
PubMed1983

Immunohistochemistry and electron microscopy of intravascular bronchioloalveolar tumor of the lung.

We report on an intravascular bronchioloalveolar tumor (IVBAT) detected in the lungs of a 45-year-old female. The results of the immunohistochemical and ultrastructural investigations stress the already suggested endothelial origin of the tumor. The clinical and histopathologic differential diagnoses between IVBAT and other rare tumors of the lung are discussed. Similarities of IVBAT with other more or less recently described endothelial tumors of the liver, skin and soft tissues are pointed out.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1983

Accuracy of breast cancer diagnosis by physical, radiologic and cytologic combined examinations.

Physical examination, mammography and fine-needle aspiration cytology were performed in 1498 consecutive cases with a solitary solid lump of the female breast. The intent was to verify the validity of this diagnostic triplet in the accuracy of the preoperative diagnosis of breast cancer. Clinically sure cancers were excluded from the study. The collected data were evaluated in terms of sensitivity, specificity and predictivity of any procedure alone or in combination. In 1138 cases confirmed by histology (514 carcinomas and 669 benign or non-neoplastic lesions), the physical examination and mammography were very sensitive (respectively 96% and 84%) but with a high rate of false-positive reports (respectively 20% and 18%). The cytologic diagnosis was less sensitive (65%), mostly due to many inadequate smears, but highly specific (93%) and predictive for malignancy (99%) when the cytologic report was frankly positive. Any single procedure improved the overall sensitivity, and taken together this triplet appears to be the most effective noninvasive diagnostic combination that provides in a short time with minimal cost and discomfort, a diagnosis of certain malignancy in about 50% of carcinomas with a predictivity close to 100%, when cytology detected malignancy.

Adult↗