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Luca Ampollini



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    EP1.09 - Pathology (ID 199)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Pathology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.09-11 - Lipoid Pneumonia Resembling Bilateral Lung Cancer: Be Aware of Nasal Decongestants! (Now Available) (ID 2378)

      08:00 - 18:00  |  Author(s): Luca Ampollini

      • Abstract
      • Slides

      Background

      To describe a case of bilateral exogenous lipoid pneumonia mimicking lung cancer in a patient affected by obstructive sleep apnea syndrome treated with decongestants mineral oils.

      Method

      A 57 year-old male patient was referred to our surgical department for an incidental finding of a bilateral pulmonary mass during a chest X-ray made for chronic coughing. His past medical history was unremarkable; he was an everyday smoker with a 80pack/years and he was affected by obstructive sleep apnea syndrome. A chest CT and CT/PET scans was subsequently done and revealed the presence of a both pulmonary consolidations of the lower lobes bilaterally with increase in uptake of FDG (Fig. 1A-B): mediastinal lymph node was normal, no other lesions was found. Morphology of the lesions was strongly suspect for non small cells lung cancer, so the patient underwent a CT-guided lung biopsy.

      Result

      A percutaneous CT-guided lung biopsy was done in the right lower lobe. The histological examination was consistent with pulmonary adenocarcinoma with signet-ring cell features (Fig.1C): therefore, the patient was addressed to conventional chemotherapy. At that point, a multidisciplinary discussion was done: a careful revision of the chest CT-scan was carried out and focal areas of fat attenuation within the lung consolidations were observed. According to that finding, a diagnosis of lipoid pneumonia was hypothesized. A more careful questioning about patient’s medical history revealed the use of daily nasal decongestants during the last 4 years due to chronic rhinitis secondary to OSAS: the drug was composed of mineral oils. A further blind revision of the histological tissue samples was requested and confirmed the diagnosis of exogenous lipoid pneumonia. The patient was invited to discontinue the nasal oil decongestant. No other pharmacological treatment was started. Six months later, a chest CT-scan was performed but no significant changing of the pulmonary consolidations were observed (Fig. 1D). Currently, the patient is well and a reduction of chronic coughing was reported.rossi.jpg

      Conclusion

      Exogenous lipoid pneumonia is a rare condition that might be misdiagnosed with lung cancer; for this reason it should be considered in the differential diagnosis of pulmonary consolidations, especially when occurring bilaterally. A precise medical history could be resolutive.

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    EP1.15 - Thymoma/Other Thoracic Malignancies (ID 205)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.15-01 - Spontaneous Mediastinal Hematoma Resembling Mediastinal Tumor in a Haemophiliac Patient (Now Available) (ID 2415)

      08:00 - 18:00  |  Author(s): Luca Ampollini

      • Abstract
      • Slides

      Background

      To describe an extremely rare case of spontaneous mediastinal hematoma secondary to a thymic cyst bleeding and its surgical treatment in a patient with haemophilia A.

      Method

      A 22-year-old male was admitted to the Emergency Department for chest pain, fever and haematuria arisen four days before. He was a heavy smoker with a previous diagnosis of haemophilia A (factor VIII deficiency). Vital signs showed tachycardia (110 beats per minute) and fever (37.5°C); physical examination showed a superior vena cava syndrome with oedema of the neck and the left harm. Hematological examination revealed only a prolonged clotting time compatible with his hemophilic disorder. A chest X-ray was performed and a mediastinal widening was revealed. A subsequent chest CT-scan showed a mediastinal mass of 77x35x85mm with compression of the left subclavian vein and superior vena cava (Fig. 1A). A suspect of lymphoma was posed and a surgical biopsy was planned.

      Result

      Through a right uniportal VATS, the anterior mediastinal pleura was incised to reach the mass, and suddenly 400ml of hematinic liquid leaked out and multiple biopsies of the remnant mediastinal tissue were performed. A mediastinal hematoma was then suspected. Post-operative chest X-ray showed a reduction of the mediastinal widening. A chest CT scan performed a few days later revealed an impressive reduction of the mass (Fig. 1B). Histological examination was consistent with a thymic cyst surrounded by a large amount of haemorrhagic and inflammatory tissue. A chest MRI at 3 and 6 month after surgery demonstrated a gradual and complete reduction of the mediastinal mass (Fig. 1C).panza.jpg

      Conclusion

      Spontaneous mediastinal hematoma is a very rare condition that could radiologically be misdiagnosed with a mediastinal tumour. A suspect must be posed in patients with bleeding disorders presenting with a mediastinal widening.

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    EP1.17 - Treatment of Early Stage/Localized Disease (ID 207)

    • Event: WCLC 2019
    • Type: E-Poster Viewing in the Exhibit Hall
    • Track: Treatment of Early Stage/Localized Disease
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall
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      EP1.17-14 - Less Is More: An Unusual Case of Benign Emptying of the Post - Pneumonectomy Space (Now Available) (ID 2362)

      08:00 - 18:00  |  Author(s): Luca Ampollini

      • Abstract
      • Slides

      Background

      To describe an unusual case of benign emptying of the post-pneumonectomy space.

      Method

      A 68-years-old man presented to our clinic with a large swelling located on the previous thoracotomy increasing at Valsalva maneuvers. One month before he underwent right pneumonectomy for lung adenocarcinoma. He was discharged on the seventh post-operative day uneventfully. Patient denied any history of chest trauma, fever, neither productive cough nor vomica. Chest X-Ray showed a drop of the air-fluid level within the post-pneumonectomy space. Suspecting of a broncho-pleural fistula (BPF), patient underwent a flexible fiberoptic bronchoscopy which showed a regular bronchial stump. A chest CT-scan revealed an empty right hemithorax associated with an air collection in the subcutaneous tissues. No pleural puncture was performed, in order to avoid any contaminations of the pleural cavity. A BPF was ruled out; a watchful waiting approach without surgical intervention or antimicrobial therapy was decided. A roentgenogram 10 weeks later showed the almost refill of the pleural cavity and at physical examination the swelling was dramatically decreased. At chest CT-scan 3 months later the post-pneumonectomy space was completely filled by fluid associated with an overexpansion of the residual lung. After one year the patient is healthy and disease-free.

      Result

      Patient’s presentation meets the clinical and laboratory criteria of Benign Emptying of the Postpneumonectomy Space (BEPS) (afebrile, normal WBC, no fluid expectoration, negative bronchoscopy, negative pleural culture if performed). Among the hypotheses about the pathogenesis of BEPS we advocated the valve-like mechanisms of “occult bronchopleural fistula”, which was large enough to let enter only air into the postpneumonectomy space although arresting the passage of pleural effusion to the airways. A spontaneous healing of the micro-fistula was maybe the underlying mechanisms of the refilling of the thoracic cavity. BEPS seldom occurred after pneumonectomy although it should be considered during differential diagnosis of a sudden drop of the pleural fluid especially in asymptomatic patients, in order to avoid unnecessary invasive procedures.

      beps_image.jpg

      Conclusion

      Benign emptying of the postpneumonectomy space should be considered when facing with a sudden drop of the pleural fluid in asymptomatic patients in order to avoid unnecessary invasive procedures.

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    IBS06 - Multimodality Treatment - Realtime Data from National Registries (Ticketed Session) (ID 37)

    • Event: WCLC 2019
    • Type: Interactive Breakfast Session
    • Track: Mesothelioma
    • Presentations: 1
    • Now Available
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      IBS06.01 - Realtime Data from Europe ETOP / ESTS Database (Now Available) (ID 3331)

      07:00 - 08:00  |  Author(s): Luca Ampollini

      • Abstract
      • Presentation
      • Slides

      Abstract

      Title: Mesothelioma Realtime Data from Europe - ETOP Mesoscape / ESTS Database

      Introduction:

      Malignant pleural mesothelioma (MPM) is an aggressive malignancy with increasing prevalence and poor prognosis. Despite a still increase in incidence, it remains an orphan disease and studying limited numbers of MPM cases hampers the derivation of solid conclusions.

      The combination of two databases including clinical as well as pathological information will allow researchers to improve the knowledge and facilitate decision-making in patients with MPM.

      The European Thoracic Oncology Platform (ETOP) Mesoscape project and the European Society of Thoracic Surgeons’ (ESTS) database are designed to address clinical, pathological, and molecular characteristics of mesothelioma patients and their impact on outcome. The joined analysis of both databases is a unique approach to real-time data reflecting the reality of mesothelioma characteristics, treatment and prognosis in Europe.

      Materials and Methods:

      A decentralized biobank with fully annotated tissue samples is established for ETOP Mesoscape. Selection criteria for participating centers included sufficient number of cases, and documented ethical approval. Patient selection is based on availability of comprehensive clinical data with adequate follow-up, and adequate quantity and quality of formalin-fixed tissue.
      The ESTS database is a clinical database with pre-operative, intra-operative and post-operative data. A minimum set of data is captured, including demographic, histology, treatment, staging and follow up data.

      The characteristics between the two databases are compared using the Fisher’s exact test (for categorical variables) and Mann-Whitney test (for continuous variables), while Kaplan-Meier method (with log-rank test).

      Results:

      Up to 29 May 2019, the ETOP Mesoscape included information on 497 patients from 10 centers, diagnosed between 1999-2018. In the ESTS database, as of April 2019, 2269 patients are included, diagnosed between 1989-2019.

      Patients in both databases are primarily men (84% in the ETOP, 71% in the ESTS), of 0/1 ECOG Performance status (46/46% and 59/29% in ETOP and ESTS respectively), with known previous exposure to asbestos (75% and 93%) and median ages 64 and 67 years old.

      Significant differences are detected between the two data sources with respect to gender, exposure to asbestos and age (p-value <0.001).

      The primary histology of patients is epithelioid (72% in ETOP and 70% in ESTS), followed by biphasic (22%; 17%) and sarcomatoid (6%; 9%) (not significantly different between the two databases).

      Clinical staging is available for 77% of the patients in ETOP, but only for the 28% in the ESTS database. The stage distribution (I/II/III/IV) is 14/29/42/15% in the ETOP and 23/21/41/16% in the ESTS (significantly difference p<0.001).

      Among the biomarkers common in both data sources, Calretinin and WT1 are detected in the vast majority of patients tested (Calretinin: 97% in both cases; WT1: 89% and 87% in the ETOP and ESTS database respectively).

      For the ETOP cases 90% (of those tested) are CK5/6 positive, 91% D2-40 positive and 97% Pan-CK positive.

      Palliative treatment has been administered in 41% of the ETOP cases. Among them, 84% received palliative chemotherapy (with the vast majority 92%, using multiple agents). Palliative surgery was undertaken in 32% (62 of 194 patients with available information) and palliative radiotherapy for 13% of the patients.

      Complete resection has been performed in 59% of the ETOP Mesoscape patients. This was combined with induction chemotherapy (81%), while adjuvant chemotherapy and radiotherapy was administered in 4% and 37% respectively.

      The surgical approach adopted for the ESTS patients was either video-assisted thoracoscopic surgery (VATS) (59%) or thoracotomy (41%) based on a subset of 887 patients with available information. Post-operation treatment information is available for 620 ESTS patients. Among them, 71% received chemotherapy, 54% underwent surgery and 15% radiotherapy.

      Conclusion:

      We present the combined results from the ETOP Mesoscape and the ESTS database, one of the largest databases. These two series allow us to report on mesothelioma epidemiology and treatment.

      Up to now, the comparison of the baseline characteristics of the patients of the two data sources revealed some statistically significant differences with respect to gender, age, exposure to asbestos and clinical stage.

      As tissue from all ETOP Mesoscape patients is preserved locally and is available for detailed molecular investigations, Mesoscape provides an excellent basis to evaluate the influence of molecular parameters on the disease outcome, besides providing an overview of the molecular landscape.

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    MA20 - Thymic Tumors: From Molecular to Clinical Results and New Challenges in Other Rare Thoracic Tumors (ID 149)

    • Event: WCLC 2019
    • Type: Mini Oral Session
    • Track: Thymoma/Other Thoracic Malignancies
    • Presentations: 1
    • Now Available
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      MA20.07 - Thymomectomy and Total Thymectomy or Simple Thymomectomy for Early Stage Thymoma Without Myasthenia Gravis: An ESTS Thymic Working Group Study (Now Available) (ID 1683)

      11:30 - 13:00  |  Author(s): Luca Ampollini

      • Abstract
      • Presentation
      • Slides

      Background

      Resection of thymic tumors has traditionally included removal of the tumor and the thymus gland (thymothymomectomy). Nevertheless, in recent years, some authors questioned the need to remove the thymus gland in non-MG thymomas, suggesting that resection of the tumor (simple-thymomectomy) is enough from an oncological point of view in Stage I (TNM stage classification) thymoma patients. The aim of our study was to compare short- and long-term outcome of thymothymomectomy vs. simple-thymomectomy using European Society of Thoracic Surgeons (ESTS) Thymic Database.

      Method

      We investigated 1131 patients with thymic epithelial tumors included in the ESTS-Thymic Database. Three-hundred twenty-four clinical stage I (cT1N0M0, according to the 8th edition of the UICC/AJCC TNM stage classification) without Myasthenia Gravis (non-MG) thymoma cases were evaluated from 23 contributing centers (2000-2017), of which 300 (93%) thymothymomectomy and 24 (7%) simple-thymomectomy. Surgical upstaging was evaluated. In pathological stage I, we compared the completeness of resection, the rate of complications, the 30-day mortality, the overall survival and the disease-free survival (DFS).

      Result

      Overall, we observed an upstaging to stage III in 10 (3%) patients. We did not observe any significant difference between the two techniques in terms of the completeness of resection, the rate of complications and the 30-day mortality. The 5-year overall survival rate was 94% in the thymothymomectomy group and 56% in the simple-thymomectomy group (Figure 1 - P= 0.0004). The 5-year DFS was 95% in the thymothymomectomy group and 82% in the simple-thymomectomy group (Figure 1 -P= 0.013).

      figure 1.png

      Conclusion

      Patients affected by stage I TNM non-MG thymoma submitted to thymothymomectomy presented a significantly better DFS and overall survival than those submitted to simple-thymomectomy. Thymothymomectomy should be considered the procedure of choice in Stage I TNM non-MG thymomas, also considering the not negligible rate of pathological upstaging.

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    P2.09 - Pathology (ID 174)

    • Event: WCLC 2019
    • Type: Poster Viewing in the Exhibit Hall
    • Track: Pathology
    • Presentations: 1
    • Now Available
    • Moderators:
    • Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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      P2.09-02 - Exploring the Features of the Short and Long-Term Survivors for Lung Adenocarcinoma: A Single Center Experience (Now Available) (ID 2808)

      10:15 - 18:15  |  Author(s): Luca Ampollini

      • Abstract
      • Slides

      Background

      The aim of this study was to identify an objective way to define a long-term survivors(LTS) and short-term survivors(STS) in patients with surgically resected lung adenocarcinoma (ADK), and secondly to find peculiar clinicopathological features in these two groups of patients.

      Method

      all patients who underwent major lung resection for lung ADK from 2000 to 2015 were studied.LTS and STS were extrapolated considering the overall survival(OS) and pathological tumour stage:the first and the fourth quartile of those patients with cancer-related death were considered for statistical analysis.

      Result

      from 600 ADK patients we found 79 STS and 77 LTS;clinico-pathologic baseline characteristics are presented in Table 1.Considering STS patients, smoking habit, histotype, tumour necrosis, pleural invasion and pathological stage were significantly associated with OS at univariate analysis (Fig.1). In LTS patients, smoking habit, neoadjuvant chemotherapy, tumour-infiltrated lymphocytes and pathological stage were significantly associated with OS (Fig.2).On multivariate analysis, smoking status, lymphoid infiltrate, pleural invasion and stage remained significantly associated with OS (Table 2).

      Table 1

      Variable

      Full samplea

      STS (N=79)a

      LTS (N=77)a

      p-value

      Age at diagnosis (median)

      68 (62-74)

      68 (61-74)

      69 (64-75)

      0.301

      Gender (M:F)

      110:46 (70.5%:29.5%)

      60:19 (24,1%:75,9%)

      27:50 (35,1%:64,9%)

      0.131

      Smoking status

      <0.001

      Never smoker

      23 (19,6%)

      5 (6,8%)

      18 (27,3%)

      Smoker + Former smoker

      117 (81,4%)

      69 (93,2%)

      48 (72,7%)

      Other previous primary tumor

      0.936

      Yes

      43 (27,6%)

      22 (27,8%)

      21 (27,3%)

      No

      113 (72,4%)

      57 (72,2%)

      56 (72,7%)

      Side

      0.079

      Right

      70 (44,9%)

      30 (38,0%)

      40 (51,9%)

      Left

      86 (55,1%)

      49 (62,0%)

      37 (48,1%)

      Histotype

      0.085

      Lepidic

      5 (3,2%)

      0 (0,0%)

      5 (6,5%)

      Papillary

      21 (13,5%)

      11 (13,9%)

      10 (13,0%)

      Acinar

      37 (23,7%)

      16 (20,3%)

      21 (27,3%)

      Micropapillary

      18 (11,5%)

      8 (10,1%)

      10 (13,0%)

      Solid

      75 (48,1%)

      44 (55,7%)

      31 (40,3%)

      Grade

      0.034

      G1

      2 (1,3%)

      0 (0,0%)

      2 (2,6%)

      G2

      23 (14,7%)

      7 (8,9%)

      16 (20,8%)

      G3

      131 (84,0%)

      72 (91,1%)

      59 (76,6%)

      Lymphatic invasion

      0.864

      Yes

      101 (64,7%)

      51 (67,1%)

      50 (65,8%)

      No

      51 (32,7%)

      25 (32,9%)

      26 (34,2%)

      Blood invasion

      0.128

      Yes

      47 (30,1%)

      28 (36,4%)

      19 (25,0%)

      No

      106 (67,9%)

      49 (63,6%)

      57 (75,0%)

      Pleural invasion

      0.439

      PL0

      78 (50,0%)

      37 (46,8%)

      41 (53,2%)

      PL1

      41 (26,3%)

      24 (30,4%)

      17 (22,1%)

      PL2

      20 (12,8%)

      8 (10,1%)

      12 (15,6%)

      PL3

      17 (10,9%)

      10 (12,7%)

      7 (9,1%)

      Necrosis

      0.419

      Yes

      70 (46,7%)

      37 (50,0%)

      33 (43,4%)

      No

      80 (53,3%)

      37 (50,0%)

      43 (56,6%)

      Lymphoid infiltrate

      0.787

      Absent

      57 (37,0%)

      27 (35,1%)

      30 (39,0%)

      Mild

      63 (40,9%)

      34 (44,2%)

      29 (37,7%)

      Moderate

      21 (13,6%)

      9 (11,7%)

      12 (15,6%)

      Marked

      13 (8,4%)

      7 (9,1%)

      6 (7,8%)

      Neoadjuvant chemotherapy

      0.371

      Yes

      11 (7,1%)

      7 (8,9%)

      4 (5,2%)

      No

      145 (92,9%)

      72 (91,1%)

      73 (94,8%)

      Table 2

      Variables

      p-value.

      HR

      95% CI

      Smoking Habit

      0,003

      2,317

      1,325

      4,052

      Histotype

      0,817

      ,951

      ,620

      1,459

      Tumor Necrosis

      0,065

      ,667

      ,434

      1,025

      Limphoyd Infiltrate

      0,024

      1,598

      1,063

      2,402

      Neoadjuvant CHT

      0,160

      ,502

      ,192

      1,313

      Pleural Invasion

      0,021

      ,421

      ,201

      ,879

      Stage

      0,002

      ,480

      ,305

      ,755

      fig.1+2.jpg

      Conclusion

      Our findings suggest that the unexpected survival of STS and LTS ADK-patients is determined by a concert of clinical and pathological features. Biological characterizazion of these kind of patients will likely improve the understanding of their unusual course.

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