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3 results on '"Marilena Fiorino"'

1. Collagenous colitis presenting with bloody diarrhea and rectal erosions in a patient with celiac disease: a case report

Author

Antonio Carroccio, Tiziana Catalano, Marilena Fiorino, Accursia Bongiovì, Giuseppe Napoli, Lidia Di Prima, Giuseppe Ambrosiano, Michele Pace, Antonino Scaturro, and Gaetana Di Fede

Subjects
Celiac disease, Collagenous colitis, Colon histology, Treatment, Budesonide., Medicine
Abstract

Introduction: Collagenous colitis (CC) is a rare condition that is known to complicate inflammatory bowel diseases, but its relationship with celiac disease (CD) is more controversial. Aims: To report a case of CC that developed in a patient with CD and was manifested by rectal erosions at onset. Case report: A 46-year-old woman was diagnosed with CD and placed on a gluten-free diet. After an initial phase of improvement, her diarrhea resumed, and she began to lose weight. Despite strict adherence to the diet, the patient's diarrhea worsened. One year after diagnosis, colonoscopy was performed and mucosal biopsies were collected, but the findings were inconclusive. Two months later, the previously watery diarrhea became bloody, and a second colonoscopy was performed. Histological examination of the biopsy specimens revealed rectal erosions and CC. The patient was treated with oral prednisone plus mesalazine for 6 weeks, and her symptoms immediately disappeared. Mesalazine was continued, and the prednisone was then gradually replaced with budesonide. Six months after the CC diagnosis, the patient was asymptomatic, and a second colonoscopy revealed no macroscopic or microscopic signs of CC. She continues to take mesalazine and budesonide. An attempt to taper the dosage of the latter drug from 6 to 3 mg/day caused the reappearance of the diarrhea. Conclusion: CC is rarely associated to CD and can cause bloody diarrhea. Excellent results were obtained in this case with prednisone plus mesalazine followed by maintenance therapy with budesonide plus mesalazine.

Published
2013
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2. OC-025 Roc-king onwards: iel counts, distributions, & roles in mucosal interpretation

Author

Anna Bozzola, Amitabh Srivastava, Stefano Ferrero, Vincenzo Villanacci, Michelangelo Fiorentino, Marilena Fiorino, Masoud Sotoudeh, Michael N. Marsh, Robert D. Goldin, Cjj Mulder, Gabriel Becheanu, Ilaria Russo, Zali, Calvin Heal, Geoffrey Holmes, Jafer Ali, Marie E. Robert, Antonio Carroccio, Luca Elli, Mohammad H. Derakhshan, S Ishaq, Sherly Mathews, Azita Ganji, Roxana Maxim, Hamid Mohaghegh, Alexandra Ciobanu, Mohammad Rostami-Nejad, David Aldulaimi, Andra Neefjes-Borst, Adrian C Bateman, Carolina Ciacci, Alessandra Mandolesi, Arzu Ensari, K Ghafarzadehgan, Umberto Volta, G Bassoti, Mihai Danciu, Kamran Rostami, James J. Going, Brigitte Bancel, Carlo Catassi, and Matt W Johnson

Subjects
medicine.medical_specialty, education.field_of_study, Population, Area under the curve, Mean age, Histology, Mucosal Biopsy, Biology, Gastroenterology, Serology, Lesion, Internal medicine, medicine, Intraepithelial lymphocyte, medicine.symptom, education
Abstract

Introduction Counting intraepithelial lymphocytes (IEL) has been a prominent diagnostic histological approach for distinguishing normal disease-control (DC) mucosae from celiac disease (CD) patients for over five decades. Most surprisingly, during that period, no definitive definition of a ”normal” count has ever appeared: indeed, the existing literature on this point is extremely fragile. In this new, multi-centre study, ROC-curve analysis was used to determine the optimal cut-off between normal and CD (Marsh III lesion) mucosae, based on IEL counts on over 400 mucosal biopsy specimens. Method The study was designed during the International Meeting on Digestive Pathology, Bucharest 2015 in which investigators from 19 centres from eight countries and involving three continents recruited patients to measure numbers of IEL per 100 enterocytes in well-oriented duodenal biopsies. All centres worked to an agreed protocol to ensure uniformity of approach. Demographic and serological data were also collected, wherever feasible, to compare cases and controls. Results The mean age of DC and CD groups were 38.3 and 45.5 years respectively, of which 59% and 71% were female. The mean IEL count was 54±18/100 enterocytes for CD compared with 13±8 for DC (p=0.0001). ROC-curve analysis indicated an optimal cut-off point of 25 IEL/100 enterocytes, with a sensitivity and specificity of 99% and 92%: the area under the curve was 0.0995. Using this technique we showed that other proposals in the literature, between 20–40 IEL, were far less discriminatory. Additionally, there was a sufficiently high number of biopsies to explore IEL counts across the sub-classification of the Marsh III lesion. Conclusion The IEL count is not normally-distributed in CD. The numerical overlapping confirmed that IEL do not represent a bi-modally distributed population[s], thus being indicative of a continuously graded dose-response by IEL to environmental (gluten) antigenic influence. In the largest study of this type, we showed using ROC-curve analysis that for Marsh III lesions, a cut-off value of 25 IEL/100 enterocytes is the optimal dividing line between DC and CD biopsies. Finally, we were unable to demonstrate any difference in IEL counts between Marsh Stage III a,b,c, subdivisions, with histology or immunocytochemisty. These results are consistent with a growing literature that finds this sub-classification of little value. Disclosure of Interest None Declared

Published
2017
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3. ROC-king onwards: intraepithelial lymphocyte counts, distribution & role in coeliac disease mucosal interpretation

Author

Ilaria Russo, Andra Neefjes-Borst, Kamran Ghaffarzadehgan, Vincenzo Villanacci, Anna Bozzola, Matt W Johnson, Azita Ganji, Mohammad H. Derakhshan, Alessandra Mandolesi, Alexandra Ciobanu, Angelo Sidoni, Arzu Ensari, Geoffrey Holmes, Marie E. Robert, Marilena Fiorino, Michael N. Marsh, Stefano Ferrero, James J. Going, Masoud Sotoudeh, David Aldulaimi, Kamran Rostami, Hamid Mohaghegh, Mihai Danciu, Carlo Catassi, Antonio Carroccio, Chris J. J. Mulder, Brigitte Bancel, Amitabh Srivastava, Calvin Heal, Gabrio Bassotti, Carolina Ciacci, Sauid Ishaq, Luca Elli, Mohammad Reza Zali, Mohammad Rostami-Nejad, Adrian C Bateman, Umberto Volta, Roxana Maxim, Michelangelo Fiorentino, Gabriel Becheanu, Sherly Mathews, Rostami, Kamran, Marsh, Michael N, Johnson, Matt W, Mohaghegh, Hamid, Heal, Calvin, Holmes, Geoffrey, Ensari, Arzu, Aldulaimi, David, Bancel, Brigitte, Bassotti, Gabrio, Bateman, Adrian, Becheanu, Gabriel, Bozzola, Anna, Carroccio, Antonio, Catassi, Carlo, Ciacci, Carolina, Ciobanu, Alexandra, Danciu, Mihai, Derakhshan, Mohammad H, Elli, Luca, Ferrero, Stefano, Fiorentino, Michelangelo, Fiorino, Marilena, Ganji, Azita, Ghaffarzadehgan, Kamran, Going, James J, Ishaq, Sauid, Mandolesi, Alessandra, Mathews, Sherly, Maxim, Roxana, Mulder, Chris J, Neefjes-borst, Andra, Robert, Marie, Russo, Ilaria, Rostami-nejad, Mohammad, Sidoni, Angelo, Sotoudeh, Masoud, Villanacci, Vincenzo, Volta, Umberto, Zali, Mohammad R, Srivastava, Amitabh, Gastroenterology and hepatology, AGEM - Re-generation and cancer of the digestive system, AGEM - Endocrinology, metabolism and nutrition, AGEM - Digestive immunity, Pathology, Other Research, and Rostami K, Marsh MN, Johnson MW, Mohaghegh H, Heal C, Holmes G, Ensari A, Aldulaimi D, Bancel B, Bassotti G, Bateman A, Becheanu G, Bozzola A, Carroccio A, Catassi C, Ciacci C, Ciobanu A, Danciu M, Derakhshan MH, Elli L, Ferrero S, Fiorentino M, Fiorino M, Ganji A, Ghaffarzadehgan K, Going JJ, Ishaq S, Mandolesi A, Mathews S, Maxim R, Mulder CJ, Neefjes-Borst A, Robert M, Russo I, Rostami-Nejad M, Sidoni A, Sotoudeh M, Villanacci V, Volta U, Zali MR, Srivastava A.

Subjects
Male, Pathology, Settore MED/09 - Medicina Interna, ROC-curve analysi, Biopsy, Coeliac disease, Serology, 0302 clinical medicine, intraepithelial lymphocytes, Diagnosis, 80 and over, ROC-curve analysis, coeliac disease, Lymphocytes, Intestinal Mucosa, Child, medicine.diagnostic_test, Area under the curve, Gastroenterology, hemic and immune systems, Middle Aged, Prognosis, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, medicine.symptom, tissues, Adult, medicine.medical_specialty, Adolescent, chemical and pharmacologic phenomena, Biology, digestive system, Lesion, 03 medical and health sciences, medicine, Humans, Lymphocyte Count, Preschool, Aged, Receiver operating characteristic, Infant, Histology, medicine.disease, Newborn, Aged, 80 and over, Case-Control Studies, Celiac Disease, Child, Preschool, Diagnosis, Differential, Infant, Newborn, ROC Curve, Differential, Intraepithelial lymphocyte
Abstract

ObjectivesCounting intraepithelial lymphocytes (IEL) is central to the histological diagnosis of coeliac disease (CD), but no definitive ‘normal’ IEL range has ever been published. In this multicentre study, receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off between normal and CD (Marsh III lesion) duodenal mucosa, based on IEL counts on >400 mucosal biopsy specimens.DesignThe study was designed at the International Meeting on Digestive Pathology, Bucharest 2015. Investigators from 19 centres, eight countries of three continents, recruited 198 patients with Marsh III histology and 203 controls and used one agreed protocol to count IEL/100 enterocytes in well-oriented duodenal biopsies. Demographic and serological data were also collected.ResultsThe mean ages of CD and control groups were 45.5 (neonate to 82) and 38.3 (2–88) years. Mean IEL count was 54±18/100 enterocytes in CD and 13±8 in normal controls (p=0.0001). ROC analysis indicated an optimal cut-off point of 25 IEL/100 enterocytes, with 99% sensitivity, 92% specificity and 99.5% area under the curve. Other cut-offs between 20 and 40 IEL were less discriminatory. Additionally, there was a sufficiently high number of biopsies to explore IEL counts across the subclassification of the Marsh III lesion.ConclusionOur ROC curve analyses demonstrate that for Marsh III lesions, a cut-off of 25 IEL/100 enterocytes optimises discrimination between normal control and CD biopsies. No differences in IEL counts were found between Marsh III a, b and c lesions. There was an indication of a continuously graded dose–response by IEL to environmental (gluten) antigenic influence.

Published
2017
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