Clear Cell Carcinoma Arising in an Abdominal Wall Cesarean Section Scar: A Case Report With Description of Pathological and Molecular Features.

Clear cell carcinoma is a clinically and biologically distinct type of carcinoma predominantly encountered in the ovary and endometrium. In the ovary, it is frequently associated with endometriosis, which is a well-known risk factor. Endometriosis has often been described in the abdominal wall of women who had a cesarean section; however, malignant transformation is a very rare event, occurring in <1% of cases. The authors report a case involving a 52-year-old woman with an abdominal wall nodule at a cesarean section scar. Radiology revealed a mass, measuring 8 cm in size, in the abdominal wall suggestive of a soft tissue tumor. After resection, histology revealed the presence of clear, eosinophilic, and hobnail cells, which, together with immunohistochemical and molecular findings, enabled the diagnosis of clear cell carcinoma of the abdominal wall. The present report describes the clinical, radiological, pathological, and molecular features of an unusual abdominal lesion that represents a rare but challenging diagnosis.

Adipose stem cell niche reprograms the colorectal cancer stem cell metastatic machinery.

Obesity is a strong risk factor for cancer progression, posing obesity-related cancer as one of the leading causes of death. Nevertheless, the molecular mechanisms that endow cancer cells with metastatic properties in patients affected by obesity remain unexplored.Here, we show that IL-6 and HGF, secreted by tumor neighboring visceral adipose stromal cells (V-ASCs), expand the metastatic colorectal (CR) cancer cell compartment (CD44v6 + ), which in turn secretes neurotrophins such as NGF and NT-3, and recruits adipose stem cells within tumor mass. Visceral adipose-derived factors promote vasculogenesis and the onset of metastatic dissemination by activation of STAT3, which inhibits miR-200a and enhances ZEB2 expression, effectively reprogramming CRC cells into a highly metastatic phenotype. Notably, obesity-associated tumor microenvironment provokes a transition in the transcriptomic expression profile of cells derived from the epithelial consensus molecular subtype (CMS2) CRC patients towards a mesenchymal subtype (CMS4). STAT3 pathway inhibition reduces ZEB2 expression and abrogates the metastatic growth sustained by adipose-released proteins. Together, our data suggest that targeting adipose factors in colorectal cancer patients with obesity may represent a therapeutic strategy for preventing metastatic disease.

Uniportal thoracoscopy combined with laparoscopy as minimally invasive treatment of esophageal cancer.

A 67-year-old man was referred to our attention for management of esophageal adenocarcinoma, localized at the level of the esophagogastric junction and obstructed the 1/3 of the esophageal lumen. Due to the extension of the disease (T3N1M0-Stage IIIA), the patient underwent neo-adjuvant chemo-radiation therapy and he was then scheduled for a minimally invasive surgical procedure including laparoscopic gastroplasty, uniportal thoracoscopic esophageal dissection and intrathoracic end-to-end esophago-gastric anastomosis. No intraoperative and post-operative complications were seen. The patient was discharged in post-operative day 9. Pathological study confirmed the diagnosis of adenocarcinoma (T2N1M0-Stage IIB) and he underwent adjuvant chemotherapy. At the time of present paper, patient is alive and well without signs of recurrence or metastasis. Our minimally approach compared to standard open procedure would help reduce post-operative pain and favours early return to normal activity. However, future experiences with a control group are required before our strategy can be widely used.

Perineal scar endometriosis ten years after Miles' procedure for rectal cancer: Case report and review of the literature.

Endometriosis within a perineal scar after a Miles' procedure has not been previously reported in literature. We report a case of a 35-year-old-female who was treated 10 years before at the same institution for a low rectal cancer that presents with two discrete subcutaneous bulges within her perineal wound. Since the patient was asymptomatic and the complete work up for recurrent disease showed no evidence of malignancy, first line therapy was conservative. After two pregnancies and a caesarean section, the patient presented at our observation with enlarged and tender perineal nodules. The patient was treated with a wide excision of the perineal scar en-bloc with the nodules. Final pathology report was consistent with scar endometriosis.

Laparoscopic sleeve gastrectomy for morbid obesity. Our initial experience.

AIM OF THE STUDY: The outcomes and initial results of laparoscopic sleeve gastrectomy (LSG) were evaluated at our Institution. METHODS: A retrospective analysis of the initial 6 patients who underwent laparoscopic sleeve gastrectomy (LSG), between November 2006 and May 2008, was performed. The aim of this study was to assess the safety and short-term efficacy of LSG as a treatment option for weight reduction. Data collected included operative time, postoperative complications, length of hospital stay and degree of weight reduction. RESULTS: Our 6 morbidly obese patients, who underwent LSG had an average preoperative BMI 58.2 kg/m2. There were 2 women and 4 men, with mean age 45 (range 41 to 55 years). Indication for LSG was related to BMI, high perioperative risk, and body habitus for five patients. One patient underwent LSG as an alternative to laparoscopic adjustable gastric banding (LAGB). Mean operative time was 2 hours (range 1.5-2.5). We had no conversion to open procedure. There were neither postoperative complications nor mortality. Median hospital stay was 2 days. For our first 4 patients Average %EWL and BMI were 24% and 44.5 kg/m2 at 6 months and % 31.2 and 41.2 kg/m2 at 1 year respectively. No patients have subsequently undergone a second-stage procedure. CONCLUSIONS: In our initial experience, LSG is a safe and effective treatment option for the high-risk and super super-obese patient. Follow-up will be necessary to evaluate long-term results when performed as single stage operation for morbid obesity.

Laparoscopic adrenalectomy (LA): keys to success: correct surgical indications, adequate preoperative preparation, surgical team experience.

BACKGROUND: Laparoscopic adrenalectomy (LA) has become the surgical procedure of choice for the treatment of most adrenal lesions. Controversy still remains about the treatment for primary and secondary malignant lesions and for pheochromocytoma. MATERIALS AND METHODS: From September 1997 to December 2005, 77 patients were operated on for adrenal tumors in a single center. Three patients had bilateral lesion for a total of 80 adrenalectomies. Selection criteria for laparoscopic treatment included benign characteristics of the lesions regardless of size and absence of virilization syndrome. A multidisciplinary approach was used for adequate preparation of patients with functional lesions. Fifty-five patients were eligible for LA and 22 for open surgery. RESULTS: Mean operative time was 142 minutes (range 45 to 240) in the laparoscopic group (53 patients) and 161 minutes (range 90 to 300) for the open group (24 patients). In 2 patients (4%) conversion to open procedure was necessary for intraoperative bleeding. Laparoscopic surgery in patients with pheochromocytoma was associated with a better intraoperative hemodynamic stability. CONCLUSIONS: LA is the treatment of choice for benign adrenal tumors regardless of size. Appropriate selection of patients, adequate preoperative preparation of patients with functional lesions and expertise in adrenal surgery and advanced laparoscopic skills are necessary to allow reduction of perioperative morbidity and early recovery.

Rare complication after anterior resection of the rectum and colon reconstruction: severe constipation with obstructed defecation. Report of a case.

OBJECTIVE: The aim of this manuscript is to verify the impact that some recanalization procedures for intestinal continuity could have in bowel function and quality of life. STUDY MATERIAL: We describe a clinical case of a rectal cancer patient who underwent anterior resection of the rectum with colo-anal anastomosis, colo-plasty and diverting ileostomy. RESULTS: After the diverting ileostomy closure, suffered of severe bowel function problems. The establishment of a colo-plasty caused a syndrome of such severe obstructed defecation to necessitate the reestablishment of a diverting ileostomy. DISCUSSION: Anterior resection with total mesorectal excision and colo-anal anastomosis is the gold standard surgical treatment of rectal carcinoma. The so called "anterior resection syndrome" is well known after such surgical procedures. The establishment of a reservoir such as the J-pouch and more recently the transverse pouch (colo-plasty) are procedures used to improve the quality of life after anterior resection of the rectum. CONCLUSIONS: The presence of bowel obstruction without mechanical causes makes us consider the colo-plasty as its cause with a Hirschprung like mechanism or similar to the "obstructed defecation". The peristalsis stops at the colo-plasty level impeding the progression of feces. The colo-plasty or the pouch do not function as a reservoir to accommodate feces, but because they stop the peristalsis.

Potential pathological understaging of pT3 rectal cancer with less than 26 lymph nodes recovered: a prospective study based on a resampling of 50 rectal specimens.

The aim of the paper was to establish if the 12 lymph nodes recommended by tumor-node-metastasis (TNM) system are sufficient for a correct staging of rectal cancer. For this purpose, we first compared the mean number of lymph nodes recovered in the same surgical specimen at the routine sampling and at a resampling performed by a second expert gastrointestinal pathologist. The study was performed on 50 cases of pT2N0 and pT3N0 rectal cancers, with a minimum number of 12 lymph nodes recovered at first sampling, histologically negative for metastases. Resampling retrieved a variable number (1 to 24) of nodes missed at first sampling. The final pN0 status was maintained in pT2 patients, whereas in 18.7% of pT3 patients, metastatic lymph nodes were detected if the mean number of lymph nodes increased from 17.8 to 26.8 after the second sampling. Interestingly, all pN1 patients had only a single metastatic lymph node measuring less than 4.9 mm. As we have shown that most (five out of six) missed metastatic lymph nodes were detected in specimens in which a maximum number of 19 lymph nodes had been originally recovered, we strongly suggest a resampling of pT3N0 rectal specimens if less than 20 lymph nodes have been recovered.

Surgical approaches to solitary parathyroid adenoma: state of the art. Our early experience with intraoperative parathyroid hormone measurement.

We report our early experience with focused radioguided parathyroidectomy with intraoperative parathyroid hormone measurement in patients affected by primary hyperparathyroidism. Over a period of 2 months we performed 4 consecutive focused parathyroidectomies with intraoperative parathyroid hormone measurement, 3 of which radioguided. All patients had a preoperative localization of single gland disease by sestamibi scanning and/or ultrasound. Blood samples for parathyroid hormone measurement were taken at baseline (induction of anaesthesia), 10 minutes after adenoma excision and the day after surgery. Three of the 4 patients were discharged within 24 hours. In all cases a solitary adenoma was successfully identified and removed. As predicted by the appropriate fall in intraoperative parathyroid hormone levels, all patients were considered cured on the basis of normal levels of calcium and parathyroid hormone at 1-month follow-up. Targeted parathyroidectomy can be successfully performed in patients with preoperatively localized solitary adenoma. The appropriate decrease in intraoperative parathyroid hormone levels assures a curative operation. The use of radioguidance should be recommended when difficulties with gland identification are foreseen.