[Laparoscopy in traumatic abdominal emergencies]. / La videolaparoscopia nelle urgenze addominali non traumatiche.

Over the past few years the laparoscopic technique has changed most of the concepts of traditional surgery and is today the standard approach in elective surgery for many pathologies requiring surgery. Unfortunately the same cannot be said for emergency surgery, though much progress has been made in this field, too. The Authors examine the most important abdominal diseases that can be diagnosed and, possibly, treated by the laparoscopic approach in the emergency setting, concluding that laparoscopic management of such conditions is a feasible proposition in many cases. Technological improvements and the development of new, more versatile surgical instruments will undoubtedly contribute to the increasingly widespread use of the laparoscopic approach also in emergency procedures.

[Appendiceal mucocele]. / Il mucocele appendicolare.

Mucocele of the appendix is a rare lesion, characterised by distension of the lumen due to accumulation of mucoid substance. Mucocele is often asymptomatic and is found incidentally during surgical explorations or ultrasonography studies. This report illustrates the clinicopathologic features of a case of appendiceal mucocele observed during an emergency laparotomy. The surgical treatment consisted in appendicectomy. Colonscopic examination subsequently revealed a left colonic precancerous lesion that was treated with endoscopic polypectomy. The case described underlines the importance of colonic surveillance in patients with mucocele.

[Conservative treatment of hepatic trauma]. / Il trattamento conservativo dei traumi epatici.

Liver trauma has increased over the past few years. In haemodynamically stable patients with hepatic injuries a conservative approach is possible, mainly as a result of the reliability of the diagnostic tools available which allow accurate monitoring of the patients. Computed tomography (CT) of the abdomen is extremely useful for documenting the extent of the damage. Of 16 patients treated for blunt hepatic injury, 10 were managed non-operatively. In this group of patients there were no deaths or delayed laparotomies. Total hospital stay and transfusion requirements were lower. The advantages of non-operative therapy include a lower incidence of abdominal septic complications. All patients managed non-operatively were monitored until their CT scans showed complete resolution. The authors conclude that non-operative management of hepatic injury is a safe technique applicable to haemodynamically stable patients.

[Intrabiliary rupture of hepatic hydatid cyst]. / Rottura intrabiliare di cisti d'echinococco epatica.

Spontaneous hepatic hydatid cyst rupture into the biliary tract is unusual. The authors describe a case of a 62-year-old man with a hepatic hydatid cyst, showing that it is possible to confirm rupture into the biliary system with cholangiography-MRI. Surgical treatment remains the best form of management. Endoscopic management is a therapeutic possibility in all cases in which surgery is contraindicated. In the case observed endoscopic sphinctererotomy resolved the biliary obstruction, while the hydatid cyst was treated by transbiliary irrigation with scolicidal solutions and pharmacological therapy. The treatment permitted complete clinical resolution of the hepatic hydatosis.

[Diagnostic problems of choledochal cysts in the adult]. / Problematiche diagnostiche delle cisti del coledoco nell'adulto.

Choledochal cysts are rare malformations of the biliary tree, the precise pathogenesis of which remains unclear. The authors present the case of a 21-year-old man with a choledochal cyst and discuss the main issues regarding the diagnosis and treatment of this uncommon lesion. In particular, of all the diagnostic techniques available, magnetic resonance cholangiopancreatography (MRCP) could become the imaging technique of choice for defining the pancreatobiliary ductal anatomy with at least the same degree of accuracy as that of diagnostic ERCP, while avoiding the potential complications associated with the latter. The patient was treated by surgical operation and, after a 12 month follow-up, is disease-free. Surgical treatment is necessary owing to the possibility of malignant transformation.

A rare case of male breast cavernous-type angioleiomyoma.

Cutaneous leiomyomas of the breast are extremely rare, particularly in men. Leiomyomas are categorized into three groups: angioleiomyomas, pilar leiomyomas and genital leiomyomas. Angioleiomyomas, or vascular leiomyomas, are benign tumors arising from smooth muscle cells of arterial or venous walls. We report the case of a 70-year-old man who was admitted to the surgery unit because of a painful lump in the left periareolar region. Ultrasound investigation showed a well-delimited, hyperechogenic, inhomogeneous nodular lesion. The final diagnosis was made after surgical excision and pathological evaluation of the mass. The histological features and immunohistochemical profile, characterized by positive expression of the spindle-shaped tumor cells for desmin and smooth muscle actin and by positive expression of the endothelial cells of the vascular channels for pan-endothelial markers CD34 and CD31, confirmed the diagnosis of a cavernous-type angioleiomyoma.

Pleomorphic ductal carcinoma of the male breast: report of a rare case and review of literature.

Male breast carcinoma is a rare neoplasm, accounting for fewer than 1% of all malignancies of the breast. We report the case of a 65-year-old man who presented at our institution with a lump in his left breast. Histologically, the tumour had marked nuclear pleomorphism and contained multinucleated giant cells. Immunohistochemical staining demonstrated that the tumour cells were positive for cytokeratin AE1/AE3, E-cadherin, p53, Ki-67, cyclin D1, estrogen and progesterone receptor proteins, but negative for c-ERB-B2 and CD68. Based on the latest World Health Organization classification, the tumour was diagnosed as pleomorphic ductal carcinoma of the breast. To the Authors' knowledge, this is the first case report of pleomorphic carcinoma of male breast.