Preliminary study of some of the main intratumor stroma components in gastric carcinomas.

AIM: The relationship between stromal compartment and tumor behavior in gastric carcinomas is still poorly understood and defined. Therefore, the authors started, with this preliminary study, an analysis of stromal compartment morphology and behavior in tumors arising from gastric mucosa epithelium. MATERIALS AND METHODS: The study group included 75 patients operated for gastric carcinoma. Five parameters describing tumor morphology and behavior and eight parameters describing tumor stroma (TS) morphology were assessed. Histopathological examination included six serial sections of formalin-fixed, paraffin-embedded tumor tissue samples, stained with three classical stains and three antibodies to reveal the different parameters. For data comparison, Pearson's correlation test and the chi-squared (χ²) correlation test were used. RESULTS: Studied tumors were, usually, infiltrating, undifferentiated∕diffuse type, invasive in subserous spaces and with a Ki67 index higher than 20%. Collagen fibers dominated the stromal components, with a predominance of mature type and an average fibrillary index of 2.7. The whole amount of stromal components accounted for around one quarter of the tumor area. Mature collagen fibers were in opposite correlation with their immature counterpart, and both were in opposite correlation with smooth muscle fibers and expressed an opposite trend of correlation with components of vascular compartment. The whole amount of stromal components had divergent behavior with the components of vascular compartment. The latter expressed generally an opposite trend of correlation with individual fibrillary stromal components. We found only isolated relationships statistically significant between stromal components and tumor characteristics. CONCLUSIONS: TS is in a continuous remodeling process in relation to the evolution of tumor parenchyma, tumors less differentiated proving to have an immature stroma, with newly formed collagen fibers and higher vascular density. Further studies are required.

Spindle Cell Rhabdomyosarcoma of the Inguinal Region Mimicking a Complicated Hernia in the Adult-An Unexpected Finding.

Rhabdomyosarcoma is a rare tumor that is diagnosed mostly in children and adolescents, rarely in adults, representing 2-5% of all soft tissue sarcomas. It has four subtypes that are recognized: embryonal (50%), alveolar (20%), pleomorphic (20%), and spindle cell/sclerosing (10%). The diagnosis of rhabdomyosarcoma is based on the histological detection of rhabdomyoblasts and the expression of muscle-related biomarkers. Spindle cell/sclerosing rhabdomyosarcoma consists morphologically of fusiform cells with vesicular chromatin arranged in a storiform pattern or long fascicles, with occasional rhabdomyoblasts. Also, dense, collagenous, sclerotic stroma may be seen more commonly in adults. We present a rare case of an adult who presented to the hospital with a tumor in the left inguinal area, was first diagnosed with a left strangulated inguinal hernia and was operated on as an emergency, although the diagnosis was ultimately a spindle cell rhabdomyosarcoma of the inguinal region.

Colorectal Cancer-The "Parent" of Low Bowel Obstruction.

Introduction: Despite the improvement of early diagnosis methods for multiple pathological entities belonging to the digestive tract, bowel obstruction determined by multiple etiologies represents an important percentage of surgical emergencies. General data: Although sometimes obstructive episodes are possible in the early stages of colorectal cancer, the most commonly installed intestinal obstruction has the significance of an advanced evolutionary stage of neoplastic disease. Development of Obstructive Mechanism: The spontaneous evolution of colorectal cancer is always burdened by complications. The most common complication is low bowel obstruction, found in approximately 20% of the cases of colorectal cancer, and it can occur either relatively abruptly, or is preceded by initially discrete premonitory symptoms, non-specific (until advanced evolutionary stages) and generally neglected or incorrectly interpreted. Success in the complex treatment of a low neoplastic obstruction is conditioned by a complete diagnosis, adequate pre-operative preparation, a surgical act adapted to the case (in one, two or three successive stages), and dynamic postoperative care. The moment of surgery should be chosen with great care and is the result of the experience of the anesthetic-surgical team. The operative act must be adapted to the case and has as its main objective the resolution of intestinal obstruction and only in a secondary way the resolution of the generating disease. Conclusions: The therapeutic measures adopted (medical-surgical) must have a dynamic character in accordance with the particular situation of the patient. Except for certain or probably benign etiologies, the possibility of colorectal neoplasia should always be considered, in low obstructions, regardless of the patient's age.

Parathyroid Cancer-A Rare Finding during Parathyroidectomy in High Volume Surgery Centre.

Background and Objectives: Parathyroid cancer is a very rare endocrine tumor, especially in patients with secondary hyperparathyroidism due to end stage renal disease failure. This pathology is difficult to diagnose preoperatively because it has nonspecific clinical manifestations and paraclinical aspects. Our study of the literature identified 34 reported cases of parathyroid carcinoma over the last 40 years in patients undergoing dialysis. We present our experience as illustrative of the features of clinical presentation and histopathological findings of parathyroid carcinoma and assess its management considering the recent relevant literature. Materials and Methods: From January 2012 to November 2022, 650 patients with secondary hyperparathyroidism undergoing dialysis were treated at our academic Department of General Surgery and only two cases of parathyroid carcinoma were diagnosed on histopathological examination. Results: All patients presented with symptomatic hypercalcemia, with no clinical or imaging suspicion of malignant disease and were surgically treated by total parathyroidectomy. Histopathological examination revealed morphologic aspects of parathyroid carcinoma in two cases and immunostaining of Ki-67 was performed for diagnostic confirmation. Postoperative follow-up showed no signs of recurrence and no oncological adjuvant treatment or surgical reinterventions were needed. Conclusions: Parathyroid neoplasia is a particularly rare disease, that remains a challenge when it comes to diagnosis and proper management. Surgical approach is the only valid treatment to remove the malignant tissue and thus improve the patient's prognosis. Medical and oncologic treatment may be beneficial to control hypercalcemia in case of tumor recurrence.

Epithelioid hemangioendothelioma - an unexpected diagnosis of a mediastinal tumor with extensive local thrombosis.

Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor and the mediastinal localization is amongst the most infrequent. We present the case of a 37-year-old woman with a history of resected left thyroid tumor that presented to our department for evaluation of a left supraclavicular palpable mass in close contact with local vascular structures, and with heterogeneous contrast enhancement as described by computed tomography (CT) and magnetic resonance imaging (MRI). Considering the history of the patient, the presumptive diagnosis of thyroid tumor recurrence was established, and the patient was referred to surgical department. During procedure, we encountered important bleeding from a ruptured jugular vein branch, which we assumed to be a newly formed tumor blood vessel. After surgery (48 hours postoperatively), the patient developed important local thrombosis that encompassed the left internal jugular vein, left subclavian vein and the left brachiocephalic trunk that partially subsided after anticoagulant therapy. The histological examination revealed the presence of a vascular tumor proliferation of epithelioid endothelial cells that was characteristic of an EHE confirmed later on the immunohistochemical studies as Yes-associated protein 1-transcription factor E3 (YAP1-TFE3) subtype. In addition to the case report, some relevant information from the scarce literature data about mediastinal EHE were reviewed here.

SRED-ARCE Recommendations for Minimally Invasive Interventions During the COVID-19 Pandemic in Romania.

The Romanian Society of Digestive Endoscopy (SRED) and the Romanian Association of Endoscopic Surgery (ARCE) have decided to establish a joint working group to elaborate specific recommendations for organizing the diagnostic and the minimally invasive interventional procedures, in the context of the COVID-19 pandemic. The recommendations are based on the guidelines of the international societies of endoscopy and gastroenterology (ESGE / BSG / ASGE / ACG / AGA), respectively endoscopic surgery (EAES SAGES) (4-8), on the experience of countries severely affected by the pandemic (Italy, France, Spain, USA, Germany, etc.) and they will be applied within the limits of measures imposed at local and governmental level by the competent authorities. On the other hand, these recommendations should have a dynamic evolution, depending on the upward or downward trend of the COVID-19 pandemic at regional and local level, but also according to the findings of professional and academic societies, requiring regular reviews based on the publica tion of further recommendations or international clinical trials. The objectives of the SRED and ARCE recommendations target the endoscopic and laparoscopic surgery activities, to support their non discriminatory used for diagnostic or therapeutic purposes, pursuing the demonstrated benefits of these procedures, in safe conditions for patients and medical staff.

Incidental case of primary renal lymphoma (PRL) in a patient with chronic hepatitis C infection. Report of a rare case.

Chronic viral hepatitis C (CHC) is a global health problem, being responsible for about 399 000 deaths worldwide, mostly from cirrhosis and hepatocellular carcinoma. Virus C infection has well known hepatic manifestations - cirrhosis and liver cancer - but the extrahepatic ones are responsible for up to 75% of morbidity in these patients. The well-known hepatitis C virus (HCV) lymphotropism is probably linked with the most frequent extrahepatic manifestations, mixed cryoglobulinemia and B-cell non-Hodgkin's lymphoma (BCNHL). We report a very rare entity, the case of an 82-year-old female with Child-Pugh class A viral C cirrhosis associated with a primary renal lymphoma (PRL). PRL is a non-Hodgkin's lymphoma (NHL) localized in the kidney, without any involvement of extrarenal lymphatic tissue. In addition to the case report, some relevant data from the literature were reviewed here.

Laparoscopic exploration in pediatric surgery emergencies.

The laparoscopic approach of pediatric surgery emergencies represents a specific preoccupation in hospitals everywhere in the world. Nowadays, when confronted with this pathology, pediatric surgeons are able to apply certain well-defined therapeutic protocols, depending on the technical equipment at their disposal and their laparoscopic expertise and training. We hereby present some of the surgical pediatric emergencies that have been subjected to minimally invasive celioscopic techniques, in the Department of Pediatric Surgery "Maria Sklodowska Curie" Hospital, from August 1999 to July 2007. Out of 83 exploratory laparoscopies, 12 were performed for emergency pathology, other than acute appendicitis (in its various forms, including peritonitis) or acute cholecystitis. However, during the above-mentioned period, the number of therapeutic laparoscopies for emergencies has grown significantly (239 from a total of 663 laparoscopies), reflecting to a large extent the activity of a clinic with an emergency surgery profile. The authors conclude that exploratory laparoscopies in pediatric surgery emergencies are suited for surgical teams with a solid experience in celioscopy and a certain professional maturity, necessary to correctly appreciate the surgical and anesthetic risks involved by each individual case. It is not recommended that inexperienced laparoscopic surgeons embark on the "adventure" of this minimally invasive approach for this type of pathology. Only when the training and learning process is fully and correctly completed, specialists are offered the advantage of continuing a celioscopic exploration by performing a minimally invasive therapeutic procedure, even for a pediatric emergency case.

Exploratory laparoscopy--diagnosis method in pediatric surgery pathology.

The purpose of this article is to establish the important place of laparoscopy in the diagnosis management of pediatric surgery pathology. In addition, it is intended to become a pleading, concerning the true and realistic benefit, for the pediatric patient, of minimally invasive surgery. In our country, the method was taken over from general surgery and had a few years of latency in imposing itself. We consider that each pediatric surgeon is required to have a mandatory period of training in this topic. This is the reason why we appeal to the young generations of pediatric surgeons but also to the surgeons with many years of experience in classical surgical techniques, who are able to perfect the diagnostic and treatment methods in many medical specialties. The clinical research took place in a retro and prospective manner from August 1999 to July 2007 in the Department of Pediatric Surgery "Maria Sklodowska Curie" Hospital and studied 663 laparoscopic surgeries. 83 of them were exploratory laparoscopies (39 boys and 44 girls) and the other 580 were therapeutic procedures with accurate pre-operatory diagnostics. The surgical activity of our department concerning exploratory laparoscopy was also appreciated due to the decisional and therapeutic algorithms that were conceived. The motivations for exploratory laparoscopic procedures are multiple and arise from many causes, from right lower quadrant pain syndrome and abdominal tumors to congenital malformations and non-palpable testis. The processed data revealed the utility of laparoscopy, concerning most of the pediatric surgical pathologies and in the same time allowing them to continue the exploratory method of diagnosis with a minimally invasive therapy. The discrepancy between the exploratory benefit (sometimes minor) and the surgical trauma of an open exploratory surgery, explains the utility of laparoscopy that took over most of open surgery indications.