[Neoplasms of the major and minor salivary glands. The diagnostic and therapeutic approaches and case presentations]. / Neoplasie delle ghiandole salivari maggiori e minori. Approccio diagnostico, terapeutico e presentazione di una casistica.

Between January 1982 and December 1988, 37 patients with neoplasm of salivary glands have been treated in our Division of Surgical Oncology. The sites of tumors were: parotid 26, submandibular gland 4, minor salivary gland 7. The preoperative diagnostic procedures were: sialogram, ultrasonogram, fine needle aspiration. Malignant tumors were 16:5 adenoca., 4 metastases, 3 adenoid cystic, 2 mucoepidermoid, 1 acinic cells, 1 lymphoma. Twenty-one patients affected by neoplasms and 5 by malignant tumors were treated with surgery only. Nine patients affected by malignant tumors were treated with surgery and RT. Two patients were treated with RT only. The first therapeutic step is surgery; in order to control local evolution of tumor, postoperative irradiation is recommended. Possible indications of preoperative diagnostic procedures and the therapeutic choices are discussed.

Myelolipoma of the adrenal gland: sonographic and CT features.

The radiologic findings in 13 patients with pathologically proved adrenal myelolipomas were reviewed. All lesions involved the right adrenal gland; they ranged from 2 to 9 cm in diameter. Sonograms showed hyperechoic tumors in 11 cases (five homogeneous, six heterogeneous). Two myelolipomas composed primarily of myeloid tissue were hypoechoic. A propagation speed artifact was seen in seven lesions, all of which were composed primarily of fat and larger than 4 cm. CT identified fat-density tissues in all lesions. Contrast-enhanced CT showed positive attenuation values in the two predominantly myeloid tumors. CT appears to be sensitive for the diagnosis of adrenal myelolipomas. However, precontrast images are required to avoid errors.

Fine-needle aspiration cytodiagnosis: a simple and safe procedure for cancer of the pancreas.

One hundred fine-needle aspirations (45 percutaneous ultrasonically-guided and 55 intraoperative) were performed in 82 patients suspected of having pancreatic cancer, in order to evaluate the contribution of cytologic data to definitive diagnosis of this tumor. The overall success rate of both cytologic methods was 90.6 p. 100 in our 64 patients who were histologically proved to have pancreatic cancer. Sensitivity was 77.4 p. 100 with percutaneous and 75.5 p. 100 with intraoperative aspirations. In all 18 cases with the final diagnosis of chronic pancreatitis results of both techniques were negative. Neither relevant morbidity nor mortality were recorded in any of the 82 patients. These cytologic studies are at present reliable, rapid, highly cost-effective (especially percutaneous aspiration) and most important, safer than histologic examinations. We believe that fine-needle aspiration cytology has gained a primary role in the diagnostic process of pancreatic carcinoma. Therefore the old view of considering examination of cytologic material only as a screening procedure should be abandoned.

Sonographic appearance of fecal masses.

Fecal impaction, caused by incomplete evacuation of feces over an extended length of time, may lead to the formation of a fecaloma, a large, firm mass of stool. Sonography is commonly used as the first imaging procedure in patients presenting with abdominal masses. In the five cases cited, fecaloma was suspected by sonography in four cases; confirmation was obtained by rectal examination in three cases and by radiographic studies in two cases. A representative case report is presented of a 74-year-old woman who had a large pelvic mass detected on physical examination. Sonographically, the fecaloma had a highly echogenic surface and a posterior acoustic shadow. Radiographic examination showed a "soap bubble" appearance, suggestive of stool. Thus, fecaloma should be considered in the differential diagnosis of patients with highly reflective and shadowing abdominal and/or pelvic masses.

Ultrasonographic appearances of gastric cancer.

In 32 patients with known gastric cancer involving different segments of the stomach, an attempt was made to image the tumour by ultrasonography. Identification of the lesion was possible in 31/32 cases. The tumour always appeared as a focal or diffuse thickening of the gastric wall, with irregular outer margins and luminal echoes; in many cases, a "target" pattern was seen. Although ultrasonography cannot be considered a sensitive test in the diagnosis of gastric cancer, knowledge of the possible appearances of tumours in all different portions of the stomach is important, since this method is often used as the first imaging procedure in a large variety of abdominal complaints, and clinically unsuspected gastric carcinomas may be imaged first by it.

Sonographic staging of gastric cancer.

The sonographic images obtained in 32 patients with known gastric cancer, who were referred to sonography for evaluation of liver metastases and in whom a specific attempt was made in order to visualize the tumor, were reviewed and evaluated for the extent of exogastric neoplasm. Surgical correlation was available in 21 cases. Sonography allowed identification in five of seven patients who had distant metastases, 12 of 15 who had lymphadenopathy, and nine of 12 patients who had direct spread to structures surrounding the tumor; ascites was always correctly identified. In only one case, a false-positive diagnosis of lymph nodes metastases was made. These results indicate that sonography has good specificity in the staging of gastric cancer and that, when patients are referred for evaluation of liver metastases, it is worthwhile to gather useful additional information about tumor extent by performing a complete sonographic examination of the abdomen and pelvis and by making an attempt to visualize the primary neoplasm and its relations to surrounding organs.

Ultrasonic findings of subcutaneous emphysema: a case report.

We have recently examined a patient in whom sonographic visualization of the most lateral part of the right lobe of the liver was impossible due to the presence of subcutaneous emphysema of the right flank. To our knowledge, this is the first ultrasonic report of this condition.