Robotic emergency liver resection of ruptured hepatocellular carcinoma.

BACKGROUND: The spontaneous rupture of hepatocellular carcinoma (HCC) is a rare complication. The management of this complication needs a stepwise, multidisciplinary approach which considers first of all clinical conditions of the patient and also the possibility of the best curative treatment. METHODS: We report our experience of an emergency robotic liver resection for a ruptured HCC in an elderly patient. Minimally invasive liver resection is currently recognised as a safe and feasible approach to the treatment of HCC in elderly patients. RESULTS: Our patient presented haemodynamic stability, which allows us to perform a robotic resection of segment 3. To our knowledge, this is the first report of the application of a robotic platform in an emergency setting for liver resection. CONCLUSIONS: Rupture of HCC is an uncommon complication, burdened by a high rate of mortality. Its management still remains controversial. Treatment should be individualised taking into consideration the clinical status of the patient, tumour features and possibility of centre therapeutic strategy.

What really is an indeterminate FNA thyroid nodule?

BACKGROUND: Thyroid nodules are usually benign; however, 5 to 15% prove to be malignant. Fine-needle aspiration (FNA) has become the gold standard in the evaluation of thyroid nodules, especially in single nodule more than a centimeter and / or in smaller nodule with ultrasound characters of malignancy. METHODS: We evaluated retrospectively 179 patients with "undetermined" thyroid fine needle aspiration, undergoing surgery. We compared cytology and histology and we evaluated sex, age, the presence of thyroiditis and dimension of the indeterminate nodule as predictors of malignancy. RESULTS: In 48 patients (26.8%) histological examination confirmed the indeterminate cytological diagnosis and this means that the nodule underwent FNA was diagnosed in effects such as cancer. In 29 patients, on histological examination, the nodule underwent FNA was not diagnosed as cancer, but one or more carcinomas were diagnosed in the same lobe of indeterminate nodule, but in different location and / or in the contralateral lobe. In 102 patients, the definitive histological examination did not confirm the suspected diagnosis and we found a significant positive association only between male sex and histological malignancy. CONCLUSIONS: The indeterminate FNA still remains a challenge for the surgeon because it is not yet possible to discriminate patients who really need surgery from those that can be followed in follow-up. The potential of molecular diagnostics for thyroid nodules with indeterminate cytology is promising, but many of these markers are too complex or expensive for routine clinical use or are still poorly standardized. KEY WORDS: Indeterminate FNA, Thyroid, Thyroid fine needle aspiration.

Incidental carcinoma of the thyroid.

The diagnosis of incidental thyroid carcinoma in patients submitted to thyroidectomy for a benign disease is quite frequent. A retrospective analysis was performed on 455 patients submitted to surgical intervention in order to establish the incidence of this kind of carcinoma. Two hundred fifty-six patients (56%) were affected by benign disease (176 multinodular goiter, 12 uninodular goiter, 1 Plummer disease and 67 Basedow disease) and 202 (44%) by carcinoma. In 28 of 256 patients (11%), affected by benign disease, occurred a histological diagnosis of thyroid carcinoma, (10 papillary carcinoma, 1 follicular carcinoma, 29 papillary carcinoma follicular variant). In this study it's considered incidental thyroid carcinoma the one occurred in patients who never underwent Fine Needle Aspiration (FNA) and there were no suspicious features in all exams that may suggest the presence of carcinoma. Twenty-three of the 40 incidental carcinoma (57.5%) were microcarcinomas. Ten patients had a sincronous carcinoma. Actually, these patients are still in a follow up program and no recurrency of disease is occasionally observed. This study shows that the only way to put doubts on the real benignity of the disease is the fine needle aspiration; there are no other instruments that could identify the occurrence of the carcinoma. Moreover in the majority of cases the incidental carcinoma is a microcarcinoma, it doesn't reach significant volume, may be not centered by a FNA, but in most cases it's not really biologically aggressive.