Case report: Reconstruction exposed bone following excision of malignant scalp tumors, multidisciplinary approach of an old method with new materials.

INTRODUCTION: Basal cell carcinoma and squamous cell carcinoma are malignant epithelial tumors that frequently occur on the scalp. The reconstruction of large surgical breaches in which the scalp was removed leaving the bone bare has always been a difficult problem to solve. CASE PRESENTATION: An 84-year-old patient in good general condition with an extensive surgical breach in the scalp comes to our observation where a sessile squamous cell carcinoma was removed 2 months ago in another hospital; The surgeon had removed the aponeurotic galea with bone exposure. CLINICAL DISCUSSION: There are numerous surgical solutions proposed: reconstruction by a secondary intention, grafts of dermal matrix, transposition flaps and finally an old technique that involves the perforation of the cranial theca. Dermal matrices cannot be used on bone as they still need blood support to facilitate the repair process. Local flaps could not be used as the skin was seriously photodamaged and treatment of this would further delay the repair. In our case the solutions adopted with other patients were not applicable, therefore we evaluated the literature to determine which solution could be adopted. We had experience with tissue perforation in large ulcers and position punch grafting to facilitate re-epithelialization therefore we also drew inspiration from this method. CONCLUSION: The technique adopted allowed an immediate reconstruction limiting the discomfort to the patient with few dressings and complete healing in about 1 month. Scalp, the graft is completely rooted in 3 month.

Pseudomembranous collagenous colitis with superimposed drug damage.

Pseudomembranous collagenous colitis is a rare pathological condition, not related to infectious agents, and characterized by thickening of the subepithelial collagen and formation of pseudomembranes. We report one such case, which responded to budesonide treatment after failures of previous approaches given, being unaware of the correct diagnosis.

Primary vulvar Ewing's sarcoma/primitive neuroectodermal tumor in a post-menopausal woman: a case report.

Ewing's sarcomas/peripheral primitive neuroectodermal tumors (ES/pPNETs) are high-grade malignant neoplasms rarely found outside the skeletal system. Only 12 cases of vulvar ES/pPNET have so far been reported, all involving children or women of child-bearing age. We describe the case of a 52-year-old woman who was admitted to our hospital for the local excision of a 4cm vulvar mass, originally thought to be a Bartholin's gland cyst. It was subsequently found to consist of small round cells positive for anti-CD99 antibody, thus suggesting a diagnosis of ES/pPNET. The demonstration of EWSR1 gene translocations by means of fluorescent in situ hybridization excluded small-cell carcinoma, squamous cell carcinoma of the small type, Merkel cell carcinoma, and lymphoblastic lymphoma. After surgery, the patient received six cycles of polychemotherapy and radiotherapy; she is still alive and well after 1 year of follow-up. Our findings underline the crucial role of molecular biology techniques in the differential diagnosis of small round cell tumors in these unusual locations.

Prognostic value of thymidine phosphorylase expression in breast carcinoma.

Thymidine phosphorylase (TP), also known as platelet-derived endothelial cell growth factor (PD-ECGF), is an enzyme that catalyzes the reversible dephosphorylation of thymidine, deoxyuridine and their analogs. TP has also angiogenic properties, although the precise mechanism by which it promotes angiogenesis is not known. We examined TP expression using immunohistochemistry (654-1 Mab) in 182 invasive breast carcinomas (67 N0 and 115 N1/2; median follow-up 78 months [range, 3-177]; 51 patients treated with adjuvant systemic cyclophosphamide, methotrexate and 5-fluorouracil [CMF] chemotherapy and 82 with tamoxifen). High TP expression was found in 142 cases (78%) and correlated with lower histologic grade and low p53 expression. No correlation was found between TP expression and vascular density. TP-positive tumors had a significant increase in both disease-free survival (DFS; p = 0.0025) and overall survival (OS; p = 0.0070) in the total cohort of patients and in the subgroups of node-positive patients and patients treated with CMF adjuvant therapy; no significant difference in either DFS or OS was observed in patients without CMF treatment. Our findings suggest that TP has little effect on tumor angiogenesis of breast carcinoma, whereas it could represent an interesting marker that could predict response to CMF chemotherapy.