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Lo spazio tiro-crico-aritenoideo (TCAS): implicazioni cliniche e prognostiche nel carcinoma laringeo.La recente letteratura riguardante la chirurgia oncologica laringea si sta sempre più focalizzando sul significato prognostico negativo del coinvolgimento da parte della neoplasia della porzione posteriore dello spazio paraglottico inferiore, che può essere definito spazio “tiro-crico-aritenoideo” (TCAS). Abbiamo valutato retrospettivamente il significato prognostico del coinvolgimento di tale sito anatomico in una coorte di 84 pazienti trattati con laringectomia parziale orizzontale open. È stato inoltre valutato mediante analisi univariata il significato prognostico dei parametri clinici e patologici. I casi con coinvolgimento del TCAS hanno avuto un maggior tasso di recidiva ed una minore sopravvivenza libera da malattia, rispetto ai casi senza coinvolgimento dello stesso. In conclusione, le neoplasie coinvolgenti questo sito laringeo dovrebbero essere considerate e trattate come tumori extra-laringei. I carcinomi glottici posteriori con invasione del TCAS hanno una prognosi peggiore quando gestiti mediante chirurgia conservativa. Nei casi di carcinoma glottico localmente avanzato con coinvolgimento del TCAS la laringectomia totale dovrebbe essere considerata il trattamento di scelta.The recent literature on laryngeal surgical oncology has increasingly focused on the negative prognostic impact of neoplastic involvement of the posterior portion of the inferior paraglottic space, which we refer to as the “thyro-cricoarytenoid space” (TCAS). We retrospectively considered the prognostic significance of TCAS involvement in a cohort of 84 patients treated with open partial horizontal laryngectomy for glottic squamous cell carcinoma. Univariate analysis was conducted on the prognostic value of several clinical and pathological parameters. Cases with TCAS involvement experienced a higher recurrence rate and shorter disease-free survival. Neoplasms involving the TCAS should be considered and treated as extralaryngeal malignancies. Posterior glottic tumours with TCAS invasion have worse prognosis when managed with conservative surgery. Total laryngectomy should be considered in cases of locally-advanced glottic carcinoma with TCAS involvement.

To assess the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) and computed tomography (CT) within Bosniak IIF/III categories.After cystic renal mass diagnosis by contrast-enhanced CT, all patients with Bosniak score ≥ II also underwent CEUS between March 2017 and March 2019. Their exams were retrospectively analyzed. One experienced uro-radiologist performed every CEUS and reviewed the exams according to the EFSUMB 2020 Position Statement, while blinded to clinical data. CT Bosniak scores were retrospectively given blindly by two uro-radiologists (CT 1 and CT 2). We compared CEUS, CT 1 and CT 2 scores to clinical findings and histological tests. Clinical performance characteristics and area under the receiver operating characteristic (ROC) curves (AUCs) were determined separately for CEUS and CT, and then compared.101 cystic masses were analyzed. In Bosniak categories IIF and III, the AUCs were 0.854 for CT 1, 0.779 for CT 2, and 0.746 for CEUS.Despite some statistical limitations, this study confirms that among cystic renal masses, those classified as Bosniak IIF and III are the most difficult to assess. The diagnostic performances of CEUS and CT are similar within this group. However, in experienced hands, CEUS could be valuable in further evaluation of ambiguous cystic masses, and in more ductile, safer, and cost-effective surveillance of those classified as Bosniak IIF and III. When challenging cystic renal masses occur, CEUS is a useful tool for clinical management and for the follow-up of non-surgical lesions.

Background The involvement of the thyroarytenoid (TA) muscle by glottic cancer may be related to an impaired vocal cord mobility, which is classified as cT2 disease. The primary endpoint was to evaluate the prognostic significance of TA muscle involvement in early glottic cancer treated with transoral laser microsurgery (TLM). Methods A review was conducted on a cohort of 209 patients consecutively treated with TLM for early glottic carcinoma. Univariate analysis was used to examine the prognostic meaning of clinical and pathological parameters. Results The statistical analysis showed that TA muscle infiltration correlated significantly with a worse prognosis in terms of recurrence rate and disease-free survival, and this was confirmed even in the subcohort with pT1a glottic cancer. Conclusions Our preliminary findings suggest that it could be considered as a criterion for upstaging a glottic cancer from pT1 to pT2.

Purpose The present paper describes our experience in surgical treatment of laryngeal ACC, and discuss the effectiveness of conservative surgery. Methods We retrospectively reviewed the clinical charts of 17 patients with laryngeal ACC treated surgically at the Otolaryngology Unit of Vittorio Veneto Hospital (Italy) from November 1989 to April 2020. Results Fourteen patients underwent partial laryngectomy, and three had a total laryngectomy. Five patients (29%) experienced a laryngeal ACC relapse after a disease-free survival of 66.6 ± 50.1 months. The distant metastasis rate was 17%. At latest follow-up, two patients had died of distant metastatic disease after 156 and 243 months. Conclusions Radical surgery for laryngeal ACC does not warrant free margins and even cases with positive deep margins rarely experience any relapsing disease. We recommend that surgical treatment for laryngeal ACC be as conservative as possible.

BACKGROUND Given the relevance of any tumor invasion of the arytenoid cartilage or crico-arytenoid unit to the planning open partial horizontal laryngectomy (OPHL) for laryngeal squamous cell carcinoma (LSCC), it is important to have a reliable radiological test to assess impairments of these structures. METHODS We retrospectively compared the endoscopic, radiological, and pathological findings in patients with glottic LSCC who underwent OPHL. RESULTS The endoscopic finding of a reduced (impaired or absent) vocal cord motility proved more sensitive, with better positive and negative predictive values, but less specific than the radiological finding of complete arytenoid sclerosis in detecting histologically assessable infiltration of the arytenoid cartilage. CONCLUSIONS Endoscopy retains a key role in the preoperative workup for glottic LSCC. CT evidence of complete sclerosis of the arytenoid cartilage is related to a dangerous contiguity of the tumor to the cartilage.

Colorectal cancer incidence in patients undergoing screening protocols is decreasing because of the higher rate of discovered preneoplastic colonic lesions; however, adenomatous polyps may not always be removable endoscopically and surgery may still be necessary. The aim of this study was to assess the vascular endothelial growth factor expression in the different steps of colorectal carcinogenesis to explore its potential role as a marker of malignancy in polypoid lesions. A total of 92 subjects with colonic adenoma or cancer who underwent screening colonoscopy or surgery were prospectively enrolled. Real-time reverse transcription polymerase chain reaction for VEGF-A messenger RNA expression and immunohistochemistry for VEGF-A were performed. Immunoassays for VEGF-A, VEGF-C, VEGFR-1, VEGFR-2, and VEGFR-3 were also performed. Non-parametric statistics, receiver operating characteristic curve analysis, and logistic multiple regression analysis were used. VEGF-A messenger RNA expression was higher in patients with high-grade dysplasia or colorectal cancer than in those with low-grade dysplasia adenomas (p = 0.01). At immunohistochemistry, VEGF-A expression was significantly higher in colorectal cancer patients compared to dysplastic adenomas (p

// Marco Scarpa 1,* , Cesare Ruffolo 2,* , Fabio Canal 3 , Melania Scarpa 1 , Silvia Basato 4 , Francesca Erroi 4 , Alain Fiorot 2 , Lucia Dall’Agnese 4 , Anna Pozza 4 , Andrea Porzionato 5 , Ignazio Castagliuolo 5 , Angelo P. Dei Tos 3 , Nicolo Bassi 2 and Carlo Castoro 1 1 Surgical Oncology Unit, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy 2 General Surgery Unit (IV), “Ca’ Foncello” Hospital, Treviso, Italy 3 Pathology Unit, “Ca’ Foncello” Hospital, Treviso, Italy 4 Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Padova, Italy 5 Department of Molecular Medicine, University of Padova, Padova, Italy * These authors have contributed equally to this work Correspondence to: Marco Scarpa, email: // Keywords : mismatch repair, colorectal cancer, immune surveillance, CD80 Received : June 03, 2015 Accepted : October 07, 2015 Published : October 19, 2015 Abstract Background: There is evidence that colorectal cancers (CRC) with DNA mismatch repair deficiency (MMR-D) are associated with a better prognosis than the generality of large bowel malignancies. Since an active immune surveillance process has been demonstrated to influence CRC outcome, we investigated whether MMR-D can enhance the immune response in CRC. Patients and Methods: A group of 113 consecutive patients operated for CRC (42 stage I or II and 71 with stage III or IV) was retrospectively analyzed. The expression of MMR genes (MSH2, MLH1, MSH6 and PSM2) and co-stimulatory molecule CD80 was assessed by tissue microarray immunohistochemistry. In addition, tumor infiltrating mononuclear cells (TIMC) and T cell subpopulations (CD4, CD8, T-bet and FoxP-3) were quantified. The effect of specific siRNA (siMSH2, siMLH1, siMSH6 and siPSM2) transfection in HT29 on CD80 expression was quantified by flow cytometry. Non parametric statistics and survival analysis were used. Results: Patients with MMR-D showed a higher T-bet/CD4 ratio ( p = 0.02), a higher rate of CD80 expression and CD8 lymphocyte infiltration compared to those with no MMR-D. Moreover, in the MMR-D group, the Treg marker FoxP-3 was not expressed ( p = 0.05). MMR-D patients with stage I or II and T-bet expression had a significant better survival ( p = 0.009). Silencing of MSH2, MLH1 and MSH6, but not PSM2, significantly increased the rate of CD80+ HT29 cells ( p = 0.007, p = 0.023 and p = 0.015, respectively). Conclusions: CRC with MMR-D showed a higher CD80 expression, and CD8+ and Th1 T-cell infiltration. In vitro silencing of MSH2, MLH1 and MSH6 significantly increased CD80+ cell rate. These results suggest an enhanced immune surveillance mechanism in presence of MMR-D.