[Adenomatous tissue in colorectal carcinomas: clinical significance and probable histogenetic implications of morphological differences]. / Tessuto adenomatoso in carcinomi colorettali. Significato clinico e probabili implicazioni istogenetiche di differenze morfologiche.

In this study we tested the hypothesis that colorectal cancers containing adenoma (CCA) could be a different entity from colon cancers without adenoma (CSA). Clinical data, histologic preparations of operative specimens and survival of 210 patients who underwent resective surgery for colorectal cancer were studied. Adenomatous tissue within the cancer was found in 62 of 210 carcinomas (CCA), the other 148 cancers were lacking adenomatous features (CSA). CCA occurred more frequently in female patients (p = 0.003). Synchronous adenomas were detected in the resected colon of 19 out 62 CCA and of 24 out 148 CSA (p = 0.04). CCA showed the extent of intraparietal spread (p = 0.001), grade (p = 0.007) and stage (p = 0.004) lower than CSA. These characteristics also appeared statistically related to size of the cancers. The adenomatous tissue within CCA was tubular in 4 cases, tubulo-villous in 34 and villous in 24 cases. The villous histotype was statistically related to the older age of patients (p < 0.0001), larger cancer size (p = 0.01), presence of synchronous adenomas in the resected colon (p = 0.02) and higher histologic grade of the cancer (p < 0.05). Patients with CCA evidenced a higher 5-year survival rate (p = 0.02). Our results evidence epidemiologic, clinical and pathologic differences between CCA and CSA and suggest a possible double histogenesis of colon cancer.

[Residual gastric mucosa after gastrectomy: development of precancerous lesions]. / Mucosa gastrica residua a gastroresezione: dinamica delle lesioni precorritrici del carcinoma.

The gastric remnant can be regarded as a model to investigate the events of gastric carcinogenesis of intestinal type. Histologic changes precursor of the malignancy develop in higher incidence in the postoperative stomachs than in non-resected ones. 316 patients hemi-gastrectomized for peptic ulcer were assessed by an endoscopic-histologic study to provide further informations on the sequential chain of histologic lesions that precede the development of cancer. The anastomosis was by far the commonest diseased area at endoscopy, particularly in the patients with a Billroth II resection (p < 0.0004). The 10% of the 233 patients biopsied evidenced a normal gastric mucosa, in the others Superficial Gastritis 74%, Chronic Atrophic Gastritis 36%, Cystic Dilatation 52%, Foveolar Hyperplasia 29%, Intestinal Metaplasia 39%, moderate-severe Dysplasia 6% as single abnormality or variously associated were observed. The stoma was the most damaged area at histology. The occurrence of the DC, the FI and the IM at the anastomotic site was significative (p values between 0.02 and 0.001). The earliest postoperative histologic lesion was the CAG, evidenced, in mean 13 years after operation, the latest the DC observed in mean 18 years after surgery (p < 0.004). The IM, the IF, the CD, and the dysplasia in association with the CAG were observed at postoperative intervals shorter when non-associated with CAG (respective p value: NS, < 0.03, < 0.0002, NS). The probability of transition from an histologic lesions to a more advanced one in our patients was similar to that of a non resected population at medium--high risk of gastric cancer.

[Biliary tract surgery in patients of 70 and older: an assessment of our experience with 100 consecutive cases]. / La chirurgia delle vie biliari nei pazienti di 70 anni ed oltre: bilancio di una esperienza su 100 casi consecutivi.

A series of 100 consecutive patients aged 70 years and older having biliary tract lithiasis observed over a 19-year period (1970-1989) at the 1st Surgical Department of the University of Rome was analyzed in an effort to define morbidity and mortality. Eighty-eight patients underwent surgical treatment. Three patients died postoperatively (3.4%); 12 patients had local and 13 general complications. The highest incidence of complications occurred in patients with associated diseases and bacteriobilia. A long-lasting symptomatology involved a more frequent exploration of the common bile duct. Morbidity and mortality were not significantly related to the type of surgical procedure performed. Elective biliary tract surgery is a safe procedure even in aged patients.