[Role of D2 lymphadenectomy in the surgical treatment of gastric cancer. Preliminary results]. / Ruolo della linfoadenectomia D2 nel trattamento chirurgico del cancro gastrico. Risultati preliminari.

The extent of lymphadenectomy in the treatment of gastric cancer is still a matter of debate. Japanese studies show better long-term survival with D2 dissection. In the west, D2 lymphadenectomy has not obtained the same degree of approval. The aim of this study was to evaluate the preliminary results obtained in our centre in the light of the literature.

[Voluminous cystic lymphangioma of the retroperioneum in an adult. A case report]. / Voluminoso linfangioma cistico retroperitoneale nell'età adulta. Presentazione di un caso.

Intra-abdominal cystic lymphangiomas are very rare tumours in adults. They are preferentially located in the neck, extremities and axillae in children. The authors report a case occurring in a 37-year-old female who had been experiencing dyspepsia and abdominal tension for a few weeks and was successfully treated surgically.

[Neuroendocrine tumors. A rare case of duodenal carcinoids]. / Tumori neuroendocrini. Un raro caso di carcinoidi duodenali.

The authors report their experience with a case of double duodenum carcinoid tumors occurring in a 59-year-old female patient. She presented with a one-year history of frequent abdominal painful episodes, associated with dyspepsia, emesis, pyrosis, eructation, skin flushing and easy strain. The laboratory examinations point out high hematic values of serotonin and gastrin, with a raising of urinary 5-HIAA. Preoperative endoscopic examinations showed the presence of 2 little sessile polypoid growths, placed in the duodenal bulb, one of this interested muscular tunic. The patient underwent Billroth I resection and was discharged on postoperative day 8. The authors after a little dissertation on that topic, go on to examine the current diagnostic and therapeutic possibilities. They confirm the elective role of surgical treatment of these rare tumors.

The oestrogen-progesterone receptor ratio: an indicator of breast cancer evolution.

Two groups of patients were chosen from among 4,025 subjects examined in a breast screening program, one consisting of patients with stage I and the other of patients with stage IV breast cancer, characterized by neoplastic recurrence. In this comparison p53, HER and grading are of no direct help. We investigated receptor status at the time of the first operation and after complete surgical excision of the recurrence. The following variables were determined: oestrogen and progesterone receptor measures (ER, PR) in f.mol/ml, the 4 receptor phenotypes, the oestrogen-progesterone ratio and histological tumour grading in relation to oestrogen receptor positivity or negativity. Surgery consisted in quadrantectomy or total mastectomy, with axillary dissection or complete surgical excision of the recurrence. Adjuvant therapy was administered. The results show a different receptor percentage in recurrence compared to early breast cancer, which though not significant, indicates a reduced presence of ER+ PR+, ER- PR-, and an increase in the ER+PR- phenotype. Recurrence occurs more frequently when the lesion at the first operation is more advanced and if radiotherapy has not been included in the treatment. Histological grading shows a greater number of undifferentiated cells and a reduction in ER+ in recurrence, thus indicating a reduced target for the most widely used hormone treatments. The oestrogen-progesterone ratio is significantly increased (P < 0.01) in recurrence compared to stage I cancers. The cause of recurrence is a neoplastic embolism, often documented histologically. Recurrence does not necessarily mean a poor prognosis, because there is a survival rate after two years of 77% of the cases treated. These results obtained with widely used methods show the aggressiveness of some breast tumours, which can evolve and have a very poor prognosis even with the most complete therapy.

[Treatment of adenocarcinoma of the duodenum: presentation of 4 clinical cases and review of the literature]. / Trattamento dell'adenocarcinoma del duodeno: presentazione di quattro casi clinici e revisione della letteratura.

The Authors comment on the difficulty of diagnosing and treating duodenal tumours. The most appropriate indications and extent of resection of these neoplasms are discussed. The Authors report 4 cases of primitive adenocarcinoma of the duodenum treated by pancreaticoduodenectomy (2 cases), segmental resection (1 case) and palliative surgery (1 case) for the presence of omental and lymph-node metastases. Survival was 18 and 14 months in the patients who underwent pancreaticoduodenectomy and 9 months for the patient receiving palliative treatment; the patient who underwent segmental resection is still alive and healthy after 12 months. The Authors point out that adenocarcinoma of the duodenum is an uncommon neoplasm and stress the difficulty encountered in establishing an accurate diagnosis and appropriate surgical management. Better results can be obtained only with an early diagnosis. Chemotherapy and radiotherapy do not significantly improve survival.