An unusual case of a well-differentiated neuroendocrine tumour of the ileum with peritoneal carcinomatosis: a case report.

Neuroendocrine tumours (NETs) are a family of neoplasms that come from neuroendocrine cells and express neural markers, such as synaptophysin or chromogranin A.The current classifications of these tumours are presented by the WHO 2000 classification, based on histological parameters, and the WHO 2010 classification, based on the proliferative index, that divides the NETs into a neuroendocrine tumour of a low grade, neuroendocrine tumour of a intermediate grade and neuroendocrine carcinoma (NEC) of a high grade.We are reporting a very rare case of a G1 low-grade neuroendocrine tumour (NET) of the ileum with a peritoneal carcinomatosis.This case is challenging because the tumour expresses low proliferative index as G1 tumours, but it has an aggressive clinical behaviour such as node metastasis and peritoneal carcinomatosis.The peritoneal carcinomatosis is not actually considered by the current classifications of NETs, so it is difficult to predict the prognosis of this patient.

Metachronous occurrence of gastric carcinoma after gastric stromal tumor. Considerations on therapeutic strategy.

INTRODUCTION: To our knowledge, the metachronous occurrence of a stromal and epithelial gastric tumour has not been previously reported in the Literature. CASE REPORT: A 73-year-old man underwent open resection of a gastric stromal tumour located in the posterior antrum wall. The maximum size of the tumour was 5 cm, and final histological examination diagnosed it as a primary gastrointestinal autonomic nerve tumour (the so-called GAN tumour); mitotic index was intermediate (10 x 50 HPF). Twelve months later, during endoscopic follow-up, a small ulcerated adenocarcinoma was found at the gastric angulus and subtotal gastrectomy with D2 lymphadenectomy was performed. Final pathological stadiation was T1smN0. The patient is alive and disease free 50 months later. Since he has had two tumours, it would appear that this patient has a tendency to develop neoplasia. However, no risk factor was found being consistent with an aetiological role in both tumours, if we exclude the presence of chronic atrophic gastritis with intestinal metaplasia in the gastric mucosa around both tumours. CONCLUSIONS: In those cases of gastric stromal tumours, of intermediate size and mitotic index, in whom a wedge gastric resection may be proposed, a radical gastrectomy should be considered as a valid alternative, especially when, as in the described patient, chronic atrophic gastritis with intestinal metaplasia is associated.

[Laparoscopic adrenalectomy: an initial experience]. / Surrenectomia laparoscopica: considerazioni su un'esperienza iniziale.

Our aim was to evaluate the short-term results of a series of 65 consecutive laparoscopic adrenalectomies performed on 63 patients with benign or metastatic tumours measuring < or = 7 cm. The surgical indication was primary hyperaldosteronism in 32 cases, pheochromocytoma in 7, Cushing syndrome and disease in 5 and 2 cases, respectively, incidentaloma in 11 and metastasis in 8 cases. The mean tumour size was 3.9 cm (range 0.6-7). Operative time averaged 130 min (range 45-270). In one case we produced an iatrogenic lesion by sectioning a peripheral recurrent branch of the left renal artery with consequent partial renal infarction. The conversion rate to the open approach was 6.1%; the morbidity rate was 4.6%. The mean hospital stay was 4 days (range 3-11). All patients were re-examined 30 days after surgery and no additional complications were observed. At this time 93.2% of patients with primary secreting tumours showed normal hormonal assays. Considering the 38 patients chronically treated during the preoperative period, we noted that the intake of specific drugs was suspended in 34.2%, reduced in 36.8%, maintained in 26.4% and transitorily augmented in 2.6%. On these basis we confirm the efficacy and safety of this surgical treatment.

Surgical treatment for gastric carcinoma in the elderly.

BACKGROUND AND OBJECTIVES: The incidence of gastric cancer is increasing in the elderly. The aim of this study is to evaluate the impact of advanced age (> or =80 years) on morbidity, mortality and late outcome after curative surgery for gastric cancer. METHODS: The cases of 30 octogenarians (Group A) with gastric cancer who underwent surgical treatment in our Institution from 1990 to 2003 were reviewed and compared to a simultaneous group of 228 younger patients (Group B). RESULTS: The rate of resective and curative procedures was not different in the two groups, although the American Society of Anaesthesiologists (ASA) risk was significantly higher in the elderly (P < 0.001) and the lymphatic dissection was less extended in group A. In the two groups, the curability was directly correlated to the cancer stage, but not affected by the ASA risk. The postoperative morbidity and mortality rates were similar in the two groups and were not related to the ASA risk. Considering the mortality for gastric cancer alone, the two groups showed a similar survival rate, only correlated to the cancer stage. CONCLUSIONS: In the elderly, an oncologically correct surgical procedure can safely be prosecuted with satisfactory immediate and late results.

Aggressive recurrence after radiofrequency ablation of liver neoplasms.

Radiofrequency ablation is considered safe for inoperable liver neoplasms; with small lesions the rate of success is very high, the local recurrence is marginal and generally suitable for a retreatment. We have little information about the possibility of rapid regrowth of the tumor after a response judged as complete. We present four patients, affected by primary (3 patients) and metastatic (1 patient) uninodular cancer. All the lesions were small, superficial and well suited for surgery, but were treated by radiofrequency ablation elsewhere. The early instrumental evaluations stated a complete result in all the patients. Cancer regrowth was diagnosed at 3, 4, 6 and 12 months after radiofrequency ablation, always starting from the treated lesion. In case 1 the whole right lobe was involved together with a controlateral multinodular recurrence; cases 2 and 3 presented an extensive liver and parietal wall involvement; while in the fourth patient a diffuse biliary colonization was observed. Only 1 patient was suitable for surgery; the others died 6, 2 and 4 months, respectively, after recurrence. Recurrence after radiofrequency ablation may show an aggressive evolution precluding any possibility of cure. Radiofrequency ablation must not be considered a suitable alternative to surgery in patients with a low surgical risk.