Multiloculated omental cystic tumor hiding an angioleiomyoma: case report of a rare and atypical presentation and literature review.

Angioleiomyoma is a rare benign tumor arising from vascular smooth muscle and generally located in the subcutaneous tissue of the extremities. We reported a rare case of an intra-abdominal localization originating from the small omentum in which progressive growth detected on radiological follow-up indicated surgical excision. Histology documented a cavernous angioleiomuscular tumor with uncertain potential for malignancy. Although angioleiomyoma is described as a benign tumor, the uncertain behavior for malignancy of this case could have led to neoplastic degeneration. Early diagnosis followed by surgical excision of the neoplasia is crucial.

Early and late outcomes of a series of 255 patients with Crohn's disease who underwent resection: 10 years of experience at a single referral center.

Patients with Crohn's disease experience an increased risk of postoperative complications and disease recurrence. The aim of this study was to investigate the role of the risk factors in determining these outcomes and whether preoperative removal of some of these risk factors would optimize the results. We conducted a retrospective study analyzing a consecutive series of 255 patients who underwent surgical resection for Crohn's disease between 2010 and 2020. We considered short- and long-term endpoints, such as postoperative complications categorized according to the Clavien-Dindo classification and the appearance of surgical and endoscopic postoperative recurrence. Univariable and multivariable analyses showed that multiple and extensive localizations increased the incidence of postoperative complications (OR = 2.19; 95% CI 1.05-4.5; p = 0.035 and OR = 1.015; 95% CI 1.003-1.028; p = 0.017 for each cm of resected segment, respectively). Regarding theoretically modifiable factors, preoperative hypoalbuminemia (for each g/L reduction) increased the risk of complications with an OR = 1.1; 95% CI 1.02-1.12; p = 0.003. Preoperative steroid therapy exerted a similar effect, with an OR = 2.6; 95% CI 1.1-5.9; p = 0.018. Modifying these last two risk factors by improving the nutritional status or discontinuing steroid therapy significantly reduced complications.Microscopic positivity of the resection margins was a risk factor for surgical recurrence (OR = 8.7; 95% CI 1.9-40; p = 0.05). Based on the results of the present study, surgeons must examine modifiable risk factors, and careful preoperative tailored management may reduce postoperative complications and disease recurrence.

Use of electrochemotherapy in a combined surgical treatment of local recurrence of rectal cancer.

Recurrence of rectal cancer (RRC) affects up to one-third of patients. The survival is strictly dependent on the possibility of performing surgery without microscopic tumor residues (R0). Electrochemotherapy (ECT) is based on the effect that electric pulsations have on increasing the permeability of the cell membrane to certain drugs. We propose the association of ECT to the surgical excision of perineal RRC in a 72-year-old male patient. Given the proximity between the recurrence and the urethra, it was decided to use ECT in order to clean any further neoplastic residues 10 mm from the surgical resection margin. Pelvic MRI at 4 and 7 months and clinical follow-up conducted for 9 months did not document disease recurrence. ECT combined with surgery can prove to be a valid choice in selected cases and could be the best treatment the patient is willing to accept.

Role of PTEN in gastrointestinal stromal tumor progression.

CONTEXT: Gastrointestinal stromal tumors (GISTs) are Kit/CD117-expressing mesenchymal neoplasms of uncertain malignant potential. The lack of a reliable method of prognostication hampers the selection of patients eligible for STI571 therapy. 10q22-q23 is a region involved in chromosomal losses found in a fraction of malignant primary and metastatic GISTs harboring PTEN (phosphatase and tensin homologue deleted on chromosome 10), a tumor suppressor gene often altered in human neoplasms. OBJECTIVE: To investigate the role of PTEN in GISTs, an issue that to our knowledge has not been addressed previously. DESIGN: PTEN status was determined in a series of 21 GISTs, with follow-up ranging between 6 and 198 months, using immunohistochemistry correlated with clinical data. RESULTS: A greater than 25% fraction of cells with low or absent PTEN immunostaining was detected in 9 GISTs, including all those showing malignancy. By the log-rank test, a fraction of PTEN-deficient cells greater than 25% was associated with malignancy (P <.001). Percentage of cells underexpressing PTEN, size, cellularity, MIB-1 immunoreactivity, and coagulative necrosis proved to be associated with malignancy by Cox proportional hazards univariate analysis; low or absent expression of PTEN was the only factor selected by multivariate analysis (P =.03). CONCLUSIONS: PTEN downregulation is implied in GIST progression. The immunohistochemical assessment of PTEN status appears to be a promising method of GIST prognostication.

Preoperative concomitant radiochemotherapy with a 5-fluorouracil plus folinic acid bolus in the combined treatment of locally advanced extraperitoneal rectal cancer: a long-term analysis on 27 patients.

AIMS AND BACKGROUND: Many studies of preoperative chemoradiation in resectable rectal cancer have focused on down-staging and sphincter-saving procedures. The aim of this study was to evaluate long-term outcome in resectable rectal cancer treated with preoperative chemoradiation and surgery by only one surgical team irrespective of the tumor downstaging. MATERIAL AND METHODS: From 1992 to 2001, in a cooperative study between the Institute of Semeiotica Chirurgica and the Division of Radiotherapy of the Catholic University of the Sacred Heart, 27 patients with locally advanced rectal cancer were treated with preoperative chemoradiation, followed by surgery after 4-6 weeks, and, just for 6 of them, by adjuvant chemotherapy. Seventeen patients were staged T3 N1 (63%), 4 patients T3N0 (15%), 4 patients T3N2 (15%) and 2 T4N2 (7.5%). Twenty-three patients (85.1%) had signs of nodal involvement at combined imaging. Radiation therapy was delivered to the posterior pelvis at a dose of 45 Gy to the tumor (clinical target volume) and the whole pelvis (planning target volume). Fractionation was conventional: 1.8 Gy/day, 5 fractions a week. Radiotherapy was started on Monday for all patients and was delivered with a linear accelerator. Concomitant chemotherapy consisted of 5-fluorouracil (350 mg/m2/day, as an intravenous bolus on days 1-5 and 29-33 of radiotherapy) and folinic acid (L-isomer) (10 mg/m2 as an intravenous bolus on days 1-5 and 29-33). This chemotherapy was generally administered about 1 hr before radiotherapy. Data were analyzed on July 2002; median follow-up was 59 months (range, 20-116 months). No patient was lost during the follow-up. RESULTS: All patients completed the treatment. Grade > 3 acute toxicity occurred in 11% of the patients and late toxicity was 15%. A pathologic complete response was recorded in 22% of patients; sphincter-preserving surgery was feasible in 44%. Seven patients died: 2 of them perioperatively, 1 patient died with local recurrence, and 1 died with distant metastases; 3 patients died during the follow-up for other causes. Five-year local control was 95% and overall survival was 84%. CONCLUSIONS: Our study, although limited in number, demonstrated good results in local control and disease-free survival with a limited toxicity.

[Diverticular disease: complications and treatment]. / La malattia diverticolare: complicanze e trattamento.

This study reports on 10 years of experience in observing diverticular disease. The study considers 77 patients, 41 males and 36 females, aged from 50 to 88 years (mean age: 70 years), observed from January 1991 to December 2001. Sixty-two patients were admitted from the Accident and Emergency Unit and 15 were elected patients. Five patients underwent emergency surgery, while 72 received only antibiotic therapy. The overall mortality rate was 0. The morbidity rate was 22% in those patients undergoing emergency surgery. In only one of the elected patients was wound suppuration detected. Diverticular disease, in most cases, is treated by antibiotic therapy alone, but in 30% of cases surgery is necessary. Colon resection and immediate anastomosis are the first choice operation also in the emergency setting, provided local conditions (inflammation, septic contamination) make anastomosis safe. In patients with major peritoneal contamination, Hartman's operation and subsequent recanalization after 6 months are to be preferred.

Benign multicystic mesothelioma of the peritoneum: a case report.

The aim of this study is to report the experience of a case of benign multicystic mesothelioma of the peritoneum presented with acute appendicitis symptomatology. A 28 years old man with right lower and upper abdominal pain was admitted into hospital. Because of the clinical picture, the symptomatology and the leukocytosis a diagnosis of acute appendicitis was made and the patient underwent appendicectomy according to Mc Burney. At laparotomy some cc of purulent fluid were sucked and a cystic mass that contained clear fluid was revealed. In consequence of the incidental diagnosis a following middle laparotomy was made with a careful surgical excision of the mass and of the appendix. Macroscopically the lesion was identified like a neoplastic mass 25 centimeters in diameter, with a multicystic and fibrous-adipose aspect, with cysts 5 centimeters in diameter. The cystic spaces were lined by a layer of eptelial cells which presented positive reaction for cytokeratin and EMA, whereas endothelium markers were absent. The ultrastructural, morphological and immunohistochemical findings were diagnostic of a benign multicystic mesothelioma.