Anaplastic thyroid carcinoma in a 49 year-old woman with a long-standing goiter. A case report.

A 49 year-old woman with anaplastic thyroid carcinoma came, for the first time, to our clinic with an enlarged supraclavicular lymph node. Ten years earlier she received a diagnosis of benign nodular goiter and has been followed up with ultrasonography, which never demonstrated any enlargement of her thyroid nodule and with fine needle aspiration biopsies (FNAB), that always proved normal. An ultrasonographic control, performed 10 months before diagnosis, showed the onset of a shell calcification all around the thyroid nodule that forbade the performance of FNAB. At initial examination in our endocrinology centre she was found to have an enlarged thyroid nodule (changing from 3.5 cm to 4.5 cm) and a supraclavicular lymph node 3 cm wide. The patient was therefore sent to the surgeon who performed a total thyroidectomy and a lymph node exenteration. The histological examination reported a thyroid anaplastic carcinoma, composed of osteoclast-like cells and large calcifications, which showed signs of local invasion and vessel infiltration; the supraclavicular lymph node proved to be a large metastasis of anaplastic thyroid cancer. Total body CT scan, bone scintigraphy and brain CT scan showed, respectively, lung, bone and brain metastasis. Postoperative chemotherapy was rapidly interrupted for acute toxicity. The patient died for lung, bone and brain metastasis, 2 months after initial examination.

[Asymptomatic lithiasis of the common bile duct: diagnostic difficulty and essentiality of intraoperative cholangiography]. / La litiasi asintomatica della via biliare principale: difficoltà diagnostiche ed irrinunciabilità della colangiografia intraoperatoria.

Biliary lithiasis is a widespread pathology the diagnosis of which, following the introduction of ultrasonography, is increasingly easy. The frequent possibility of association between gallstones and choledocholithiasis, demands pre- or intraoperative recognition. The inadequacy of ultrasonography in excluding lithiasis of the common biliary tract with certainty, notwithstanding its other unquestionable advantages, and the disproportionate costs and risks of other investigations (cholangiography, ERCP, ecc.) which are such as to discourage routine use, confirm the role of operative cholangiography in the diagnosis of asymptomatic choledocholithiasis, so permetting its treatment. Personal experience of 100 consecutive cases of gallstones which showed fully 10 of them to be negative to preoperative investigation were found to have lithiasis of the common biliary tract.

[Acute cholecystitis: surgical treatment]. / La colecistite acuta: trattamento chirurgico.

Personal experience in the observation of 177 patients suffering from acute cholecystitis and treated in the five-year period 1981-1985 is reported. In particular, problems related to surgical treatment are pointed out.