Unusual Presentation of Recurrent Early Stage Endometrial Carcinoma 28 Years after Primary Surgery.

Endometrial carcinoma is the most common neoplasia of female genital tract. The prognosis of early stage disease (FIGO I and FIGO II) is excellent: recurrence after surgery is less than 15%, most of which are reported within 3 years after primary treatment. Herein we report a case of late rectal recurrence from FIGO Ib endometrial adenocarcinoma. Patient had also familiar and personal history of colonic adenocarcinoma and previous findings of microsatellite instability (MSI); molecular analysis evidenced heterozygotic somatic mutation in MLH1 gene. Twenty-eight years after hysterectomy and bilateral salpingoovariectomy, a rectal wall mass was detected during routine colonoscopy. Patients underwent CT scan, pelvic MRI, and rectal EUS with FNA: histopathological and immunohistochemical analysis revealed differentiated carcinoma cells of endometrial origin. No neoadjuvant treatment was planned and low rectal anterior resection with protective colostomy was performed; histology confirmed rectal lesion as metastasis from endometrial carcinoma. Recurrence of early stage endometrial carcinoma after a long period from primary surgery is possible. It is important to keep in mind this possibility in order to set a correct diagnostic and therapeutic algorithm, including preoperative immunohistochemical staining, and to plan a prolonged follow-up program.

A rare case of IgG4-related systemic disease manifesting with pancreatic head mass mimicking borderline resectable cancer.

INTRODUCTION: Autoimmune pancreatitis (AIP) is a rare pancreatic disorder among chronic pancreatitis that can mimick pancreatic cancer (PC). Patients with type 1 AIP usually present obstructive jaundice associated with high level of IgG4 in serum and a pancreatic mass at radiological imaging; these disorders may be associated with other organs lesions presenting the same histopathological features, and in these cases AIP should be considered a pancreatic localization of an IgG4-related systemic disease. PRESENTATION OF CASE: We report the case of a young man with initial suspect of PC to be treated with surgery, and final diagnosis of AIP in the context of an IgG4-related systemic disease. DISCUSSION: Because of its similar features, several algorithms have been proposed for AIP diagnosis, based on combination of clinical/serological and radiological criteria. However, histology represents the only way to obtain definitive diagnosis, even if sometimes it is difficult to obtain biological samples. CONCLUSION: IgG4-related systemic disease must be taken into account among differential diagnosis during the workup for PC, in order to avoid unnecessary surgery.

Cholangioscopic management of intrahepatic papillomatosis unsuitable for surgical treatment.

INTRODUCTION: Biliary papillomatosis can arise in any tract of the biliary three and is characterized by multiple papillary proliferation of the epithelial cells. CASE REPORT: A 65 year old woman was diagnosed been affected by biliary papillomatosis after many recurrent cholangitis episodes. Liver transplantation was excluded because of neoplastic degeneration with systemic involvement. After a percutaneous drainage and with palliative intent we performed an Argon plasma coagulation of the papillary lesions. DISCUSSION: Clinical behaviour consists of recurrent cholangitis episodes and obstructive jaundice. There aren't specific radiological features, only mucobilia observed during an ERCP is pathognomonic. Biliary papillomatosis grow according to the sequence adenoma-carcinoma with malignant transformation and poor prognosis due to multifocality and high recurrence rate. Radical surgery and liver transplantation represents the gold standard. Among palliative procedures must be considered percutaneous management with drainage and stenting, and intraluminal brachytherapy with I 192. CONCLUSION: We propose a palliative treatment with cholangioscopic Argon plasma coagulation of the biliary lesions that can be performed during a surgical exploration or a percutaneous management.

Emisacrectomy, experience in 11 cases.

Emisacrectomy is a challenging surgery in the treatment of tumours that affect the sacrum. Authors report their experience in 11 cases affected by tumours of the sacrum (9 chordomas, 1 ependymoma, 1 monostotic bladder metastasis) operated on at the Orthopaedic Department of A.S.O S. Giovanni Battista Molinette in Turin, Italy, from 1998 through 2005 discussing planning surgery, level of osteotomy, functional and oncological results and complications of the treatment at a median follow-up of 5 years (range 2-9), describing the surgical and medical teaching learned from the treatment of these patients. Despite the potential complications, emisacrectomy can be performed successfully and is an important procedure in the treatment of sacral tumours.

Leiomyosarcoma of the inferior vena cava. Report of two cases and review of the literature.

INTRODUCTION: Leiomyosarcoma (LMS) occurs most frequently in the inferior vena cav (IVC). Since Perl's first description in 1871, about 300 cases of IVX have been reported in English literature. The Authors present their personal experience of two case of IVC leiomyosarcoma treated in their Institution. PATIENTS AND METHODS: Clinical and pathologic data, surgical management, ourcomes and follow-up of two patients admitted nb the Authors' Division respectively on February and November 2004 were collected. RESULTS: There were a 49-years-old female with rare epigastric pain and a 42-years-old female with one-month history of abdominal discomfort and weight loss. After preoperative evaluation, both of the patients had localised and resectable tumors and underwent radical surgical excision, with prosthetic replacement of the IVC in the first patient and ligation of the IVC in the other one. The first patient is still alive but in an advanced disease. The second patient died of recurrence at seven months. DISCUSSION: LMS of IVC is a rare tumor. The diagnosis is often delayed because of non-specificic symptoms. Radical resection with surgical margins free of tumor is the treatment of choice. The extent of venous resection does not seem to affect the survival. The type of IVC reconstruction is based on the extent of venal wall involvement. The prognosis is often poor because of tumor recurrence and/or metastatic disease. The role of chemo and radio therapy is not clear yet. CONCLUSION: Long term survival is related to an extensive surgery, being surgical margins free of tumor the only prognostic factor with significant influence on patients survival.

Specific detection of cytokeratin 20-positive cells in blood of colorectal and breast cancer patients by a high sensitivity real-time reverse transcriptase-polymerase chain reaction method.

A real-time reverse transcriptase-polymerase chain reaction (RT-PCR) method for detection of cytokeratin 20-positive cells in blood characterized by two novel features was developed and tested on 99 patients with colorectal cancer, 110 with breast cancer, and 150 healthy subjects. To optimize the specificity and sensitivity of the method, two novel features were used. First, a primer overlapping two adjacent exons was generated to inhibit nonspecific amplification both in healthy donors and cancer patients; second, a non-end-point first-round amplification was used to increase sensitivity. The number of first-round cycles was chosen to reach the highest level of sensitivity while conserving quantitative characteristics. PCR efficiency increased from 88.9% in single-round RT-PCR to 99.0% in nested real-time RT-PCR. To establish sensitivity and specificity of the method, HT29 cells were serially diluted with normal blood. Detection limit improved from 100 HT29 cells (single-round RT-PCR) to 1 to 10 cells (nested real-time RT-PCR) per 3 ml of whole blood. None of the healthy subjects was positive, whereas 22 and 29% of all colorectal and breast cancer patients, respectively, had cytokeratin 20 cell equivalents in blood. The association between cytokeratin 20 cell equivalents and metastasis was statistically significant for breast (P = 0.026) but not colorectal cancer patients (P = 0.361). Negativity of all 150 healthy controls examined confers diagnostic potential to the method.