Safety and effectiveness of Omnitrope® in patients with growth hormone deficiency: snapshot analysis of PATRO Adults study in the Italian population.

PURPOSE: PATRO adults is an ongoing, multicenter, observational, post-marketing surveillance study aimed at investigating the long-term safety (primary endpoint) and effectiveness (secondary endpoint) of the recombinant human growth hormone (rhGH) Omnitrope® during routine clinical practice. This report describes data from Italian participants in PATRO Adults with growth hormone deficiency (GHD), up to August 2017. METHODS: Participants were adults (aged > 18 years) with GHD requiring rhGH therapy and were prescribed Omnitrope®, including those who had previously received another rhGH product. Adverse events (AEs) were evaluated in all study participants. Data were collected on insulin-like growth factor (IGF)-I levels and cardiovascular risk factors, including blood pressure, lipids, and anthropometric parameters. RESULTS: From September 2007 to August 2017, 88 patients (mean age 48.9 years, 58.0% male) were enrolled at 8 sites in Italy. The mean treatment duration with Omnitrope® was 51.5 ± 37 months. AEs occurred in 54 patients; the most common were asthenia (20.5%), headache (14.8%), and arthralgia (13.6%). Serious AEs occurred in 22 patients (25%), including pneumonia (n = 2) and renal failure (n = 2). Neoplasms (2 benign and 1 malignant) developed in three patients, but none were considered to be drug-related. There were no significant changes in fasting glucose or glycosylated hemoglobin (HbA1c) during the study period. Long-term Omnitrope® therapy showed slight positive effects on lipid profile, while no significant changes were observed in body weight and BMI during the study. CONCLUSION: This snapshot analysis of Italian participants in PATRO Adults confirmed the long-term safety and effectiveness of Omnitrope® in adults with GHD.

Safety and effectiveness of a somatropin biosimilar in children requiring growth hormone treatment: second analysis of the PATRO Children study Italian cohort.

PURPOSE: To investigate the long-term safety (primary endpoint) and effectiveness (secondary endpoint) of the somatropin biosimilar Omnitrope®. METHODS: PATRO Children is an ongoing, multicenter, observational, post-marketing surveillance study. Children who received Omnitrope® for any indication were included. Adverse events (AEs) were evaluated in all study participants. Auxological data, including height standard deviation scores (HSDS) and height velocity standard deviation scores (HVSDS), were used to assess effectiveness. In this snapshot analysis, data from the Italian subpopulation up to August 2017 were reported. RESULTS: A total of 291 patients (mean age 10.0 years, 56.0% male) were enrolled at 19 sites in Italy. The mean duration of Omnitrope® treatment was 33.1 ± 21.7 months. There were 48 AEs with a suspected relationship to the study drug (as reported by the investigator) that occurred in 35 (12.0%) patients, most commonly headache, pyrexia, arthralgia, insulin-like growth factor above normal range, abdominal pain, pain in extremity and acute gastroenteritis. There were no confirmed cases of type 1 or type 2 diabetes; however, two patients (0.7%) had impaired glucose tolerance that was considered Omnitrope® related. The mean HSDS increased from - 2.41 ± 0.73 at baseline (n = 238) to - 0.91 ± 0.68 at 6.5 years (n = 10). The mean HVSDS increased from - 1.77 ± 1.38 at baseline (n = 136) to 0.96 ± 1.13 at 6.5 years (n = 10). CONCLUSIONS: In this sub-analysis of PATRO Children, Omnitrope® appeared to have acceptable safety and effectiveness in the treatment of in Italian children, which was consistent with the earlier findings from controlled clinical trials.

The tip of the iceberg of colorectal perforation from enema: a systematic review and meta-analysis.

BACKGROUND: Although rare, perforation following an enema used to treat constipation is a dangerous complication. However, no recommendations or guidelines for enema use are available. So, in common clinical practice, the diagnostic approach and the treatment are not standardized. In an attempt to resolve this clinical dilemma associated with high mortality and potential medicolegal claims for malpractice, we have performed a systematic review and meta-analysis of studies reporting on colorectal perforation secondary to enema use for adult patients with constipation. METHODS: A systematic search of PubMed, Web of Science and Scopus was performed according to the PRISMA statement up until February 2020. Studies that reported on colorectal perforation from enema use in adult patients with constipation were included. The primary outcomes were the rate of hospital mortality and pooled prevalence estimates of mortality from perforation secondary to enema use. The secondary outcomes were the administration of rectal enemas, site of visceral perforation, signs, symptoms, radiological evaluation, and type of treatment RESULTS: A total of 15 studies were included in the final analysis (49 patients). Across all studies, the pooled prevalence estimate of mortality for patients with perforation secondary to enema use was 38.5%, (95% CI [22.7%, 55.5%]). This rate was lower in patients who had surgery (35%) than in patients treated conservatively (57.1%). The sites of perforation were intraoperatively reported in 84% of cases, but in 16% of patients the rectal perforation was undiagnosed, and surgical decision making was problematic. The primary location of the perforation was the rectum in 80.9% of the patients. The enema was administered by a nurse in 90% of the cases, self-administered in 7.5% and a family doctor in 2.5%. The main objective of emergency surgery in this setting is resection of the perforation caused by the enema; when it is not possible to resect the perforated rectum, faecal diversion is needed. Hartmann's procedure was most commonly performed by the surgeons in this review (60.7%), with other reported treatments included a diverting proximal loop colostomy and sigmoid segment exteriorization CONCLUSIONS: Considering the studies available, it is not possible to undertake a thorough evaluation of enema use, including the associated complications and their management. Further data are required to allow the development of guidelines to advice on safe enema use and management of complications.

Medical ethics questions of COVID-19 vaccination in pregnant and lactating women in East Asia and Oceania.

Abstract: We aimed to investigate some of the medical ethics issues that characterize the COVID-19 vaccination phase in pregnancy and breast-feeding. A literature search was conducted using PubMed, Scopus, Web of Science, focusing mainly on the countries of East Asia and Oceania. Vaccination during pregnancy and breastfeeding appears to help protect babies from COVID-19 by enabling antibodies to pass from mother to baby. However, individual countries of the same continent may adopt conflicting policy positions. Not only that, indications on the type of vaccine sometimes vary, depending on whether a woman is pregnant or breastfeeding. In this review we have taken into considerationp the policy positions on pregnancy and lactation by country and type of Covid-19 vaccine in East Asia and Oceania. Ten out of the 18 countries considered (representing more than two thirds of the population of East Asia and Oceania) provide different vaccine indications for pregnant and breastfeeding women. Can this diversity of recommendations be seen as a form of optimal protection for women in these categories, or does it suggest that some countries have taken a defensive position to avoid compensation claims in the event of complications? Is it ethically correct to leave questions concerning informed consent open? Misin-formation during a health crisis leaves people without protection and with increased vaccine hesitancy, especially for vulnerable populations in hard-to-reach areas of East Asia and Oceania.

The influence of endoscopic biliary stents on the accuracy of endoscopic ultrasound for pancreatic head cancer staging.

BACKGROUND AND STUDY AIMS: Biliary stents have been found to interfere with endoscopic ultrasound (EUS) tumor (T) and nodal (N) staging in patients with periampullary cancer. Our aim was to determine whether this also occurs in patients with pancreatic head cancer. PATIENTS AND METHODS: We studied a consecutive series of patients who were undergoing preoperative EUS for diagnosis and staging of suspected pancreatic cancer, some of whom had biliary stents in situ and some of whom did not. The main end point was the uni- and multivariate association of biliary stenting with T and N mis-staging by EUS. The surgical T and N stages were used as gold standards. RESULTS: A total of 65 patients were identified (19 with biliary stents in situ and 46 without). Surgical stage T4 was found more frequently in patients with stents (53% vs. 22%, P = 0.014). The T stage by EUS was correct in 85% of the patients without biliary stents and in 47% of the patients with stents. The frequency of mis-staging by EUS was significant only among patients with a biliary stent. The distribution by EUS N stage did not differ significantly from the surgical N-stage distribution in the two groups of patients. According to the multivariate analysis, patients with stents were 6.55 times more likely to be incorrectly T staged (95% confidence interval [CI] 1.69-25.49) and 3.71 times more likely to be incorrectly N staged (95% CI 1.11-12.45) than patients without stents. CONCLUSIONS: The results add support to the recommendation that EUS staging of pancreatic head neoplasms should be performed prior to stent placement.

Hydrogen peroxide-related colitis (previously known as "pseudolipomatosis"): a series of cases occurring in an epidemic pattern.

We report several cases of hydrogen peroxide-related colitis that occurred in an epidemic pattern in our gastrointestinal endoscopy center during a 2-month period in early 2007. During colonoscopy using sterilized endoscopes that had been flushed with hydrogen peroxide after the peracetic acid cycle, instantaneous effervescence and blanching (the "snow white sign") were observed on the intestinal mucosa when the water button was depressed. Biopsy specimens revealed features resembling a clinical condition which used to be known as "pseudolipomatosis." At follow-up, no patient was found to have suffered morbidity associated with this peroxide colitis. Endoscopists should consider hydrogen peroxide colitis when they see a snow white sign during colonoscopy which cannot be attributed to active inflammation or organic disease of the digestive tract.

Growth hormone in inflammatory bowel disease.

Crohn's disease and ulcerative colitis are inflammatory diseases of the gastrointestinal tract characterized by chronic relapsing inflammation and catabolism. Growth hormone/insulin-like growth factor-I axis is important in inflammatory bowel disease, because of the effects on epithelial cell kinetics, collagen deposition and immunomodulation. The potential of growth hormone as a therapeutic option in inflammatory bowel disease has been proven in various clinical settings. Acquired growth hormone resistance in inflammatory bowel disease seems to be mediated by a combination of undernutrition and active inflammation. In particular, proinflammatory cytokines, such as TNF-a and interleukin-6, have been implicated as potential mediators of growth hormone resistance. The introduction of anti-TNF-alpha monoclonal antibodies has proven very efficacious in patients with inflammatory bowel disease. By reducing cytokines levels in inflammatory cells of intestinal mucosa, infliximab could interfere with cytokine-induced growth hormone resistance. Recent in vivo data have shown that acquired growth hormone resistance in patients with inflammatory bowel disease may be reversed after the administration of anti-TNF-alpha therapy.

One-week therapy for Helicobacter pylori eradication: ranitidine bismuth citrate plus medium-dose clarithromycin and either tinidazole or amoxycillin.

BACKGROUND: One-week ranitidine bismuth citrate (RBC)-based triple regimens may be effective for the eradication of Helicobacter pylori. We evaluated the efficacy of two short-term RBC-based eradicating therapies including RBC plus medium-dose clarithromycin and either tinidazole or amoxycillin. METHODS: Seventy consecutive patients, who underwent gastroscopy for dyspeptic symptoms and were found to be H. pylori-positive, were randomly subdivided into two groups receiving either RBC 400 mg b.d. plus clarithromycin 250 mg t.d.s. and tinidazole 500 mg b.d. (group RBCCT) or RBC 400 mg b.d. plus clarithromycin 250 mg t.d.s. plus amoxycillin 1 g b.d. (group RBCCA). H. pylori status was evaluated by means of histology and rapid urease test at entry, and by 13C-urea breath test alone 8 weeks after treatment. RESULTS: Sixty-nine out of 70 enrolled patients completed the study: 35/35 in group RBCCT and 34/35 in group RBCCA. One patient in group RBCCA was lost to follow-up. In group RBCCT, at the end of treatment, 32 of 35 patients were H. pylori-negative (per protocol analysis 91%, intention-to-treat analysis 91%; 95% CI: 77-98%). In group RBCCA, 31 of 34 patients returned H. pylori-negative (per protocol 91%; 95% CI: 76-98%, intention-to-treat 89%; 95% CI: 73-97%). Slight side-effects occurred in 3/35 patients (9%) in group RBCCT and in 3/34 (9%) in group RBCCA. CONCLUSIONS: One-week regimens consisting of RBC plus clarithromycin and either tinidazole or amoxycillin, combine high eradication rates with modest side-effects. No substantial difference was found between the two treatment regimens tested in this trial.

Effect of moderate and heavy alcohol consumption on intestinal transit time.

BACKGROUND: Alcohol abusers frequently have gastrointestinal symptoms, such as diarrhea, nausea and vomiting. In the genesis of these symptoms multiple mechanisms are involved, including alteration of gastrointestinal motility. The aim of our study was to investigate oro-cecal transit time (OCTT) using the H2-breath test (H2-BT) in moderate and heavy drinkers. MATERIALS AND METHODS: We studied 40 chronic drinkers: 20 with heavy alcohol consumption (> or = 60 g/day for men and > or = 40 g/day for women) and 20 with moderate alcohol intake (< 60 g/day for men and < 40 g/day for women). The control group consisted of 20 teetotal subjects. All subjects underwent a lactulose H2-BT to assess OCTT. RESULTS: OCTT in heavy alcohol drinkers ranged from 100 to 240 min, with a mean of 149.5 min, while OCTT in moderate drinkers ranged from 70 to 140 min, with a mean of 109 min. In the control group the mean OCTT was 100 mins, ranging from 70 to 130 min. The difference between alcohol abusers and controls was statistically significant; on the contrary, there was no statistically significant difference between moderate alcohol drinkers and teetotallers. CONCLUSIONS: Our study shows that only in chronic heavy alcohol drinkers is OCTT clearly increased. Multiple mechanisms are hypothesized to explain motility disorder, such as visceral autonomic neuropathy, inflammation and loss of contractile proteins of smooth muscle layer of the small intestine.

Unsaturated hydrocarbons with fruity and floral odors.

Hydrocarbons usually do not exhibit odors of interest or well-defined character. However, certain cyclic alkenes have been associated with typical and pleasant notes, such as fruity, green, and floral. One of the best known examples is represented by the isomeric megastigmatrienes, endowed with a pleasant smell of tropical fruits. From the structures of these odorants, 24 analogues and homologues, most of them cyclic alkenes, but including also some open-chain alkenes, have been synthesized to define structural parameters related to the characteristic odors of these compounds. The number and position of double bonds, the substitution on the ring, and the size of the ring are the variables taken into account. Most of the new compounds present a mainly fruity character, associated in several cases with floral and green notes, producing an overall sensation described as "tropical fruit".

Infliximab in the treatment of steroid-dependent ulcerative colitis.

BACKGROUND AND OBJECTIVES: Infliximab has proven efficacious in the treatment of Crohn's disease. Limited and contrasting data are available on effectiveness of anti-TNF alpha therapy in ulcerative colitis. We evaluated the efficacy of infliximab in the management of steroid-dependent ulcerative colitis. METHODS: We report preliminary data from a randomized, open-label, methylprednisolone-controlled trial of infliximab in the induction and maintenance of remission of patients with moderate to severe steroid-dependent ulcerative colitis. Twenty patients received either three infusion of infliximab (5 mg/kg) at 0, 2 and 6 weeks and thereafter every 8 weeks (group A) or methylprednisolone (0,7-1 mg/kg) daily for one week followed by a tapering regimen up to the minimal dose to maintain a symptom-free condition (group B). Clinical remission was defined as a DAI score less than 3. RESULTS: Ten patients in group A (DAI: 8.9+/-1.4) achieved remission after the first infusion (DAI: 1.6+/-0,7; p = 0.005) and steroids were progressively discontinued. At present (mean follow-up: 9.8+/-1.1 months), 9 out of 10 patients maintain clinical remission, while one patient relapsed at 3 months. Ten patients in group B (DAI: 8.7+/-1.4) reached clinical remission at one week (DAI: 1.9+/-0.3; p = 0.005). Eight out of 10 patients were maintained at a minimal steroid dosage without any relapse at 9.7+/-1.0 months follow-up. Two patients relapsed at 6 and 8 months, respectively. CONCLUSIONS: Infliximab seems to be as effective as steroids in the management of moderate to severe steroid-dependent ulcerative colitis. These preliminary data suggest the potential efficacy of repeated treatment with infliximab for short-term maintenance of remission and steroid withdrawal in glucocorticoid-dependent ulcerative colitis.

[Determination of lymphocyte subpopulations, defined with monoclonal antibodies, in patients with iron deficiency anemia]. / Determinazione delle sottopopolazioni linfocitarie, definite con anticorpi monoclonali, in pazienti con anemia sideropenica.

Lymphocytary subpopulations have been determined, by means of monoclonal antibodies, in 24 patients afflicted with iron deficient anaemia, repeating the determination in 15 of the patients after an adequate iron therapy. In iron deficient patients a significant reduction of the percentage of lymphocytes T (OKT3+) has been observed, in comparison with normal controls, as well as a significant reduction of the percentage of cells OKT8+, with a significant increase of the OKT4+/OKT8+ ratio. In the 10 patients who at the moment of the revaluation did not present any longer either anaemia or iron deficiency, the percentage of lymphocytes OKT3+ and OKT8+ had returned to normal values, as well as the OKT4+/OKT8+ ratio. The 5 patients still resulting anaemic in course of control presented, on the contrary, a significant reduction of cells OKT3+ and OKT8+, while the OKT4+/OKT8+ ratio resulted lightly increased, however not significantly.

[Partial remission of non-Hodgkin's lymphoma (stage IV-B) following immunostimulating therapy with thymopentin]. / Remissione parziale di LMNH stadio IV-B in seguito a terapia immunostimolante con timopentina.

Therapy of low-grade of malignancy non-Hodgkin's lymphoma in an advanced stage is still under discussion: aggressive poly-chemotherapies, such as radiotherapy and conventional chemotherapies did not prove to be more effective than conservative treatments. We report the case of a woman suffering from a low-grade of malignancy non-Hodgkin's lymphoma (stage IV-B). She was in such bad general conditions that she could not be treated with chemotherapy. She received an immunostimulating drug, thymopentin for 10 months. After this treatment, the general condition of the patient was improved and a partial remission of the lymphoproliferative disease was observed. The patient is still in constant fairly good health.

[Systemic mastocytosis without skin involvement. Presentation of a case and review of the literature]. / Mastocitosi sistemica senza interessamento cutaneo. Presentazione di un caso e revisione della letteratura.

A case of SMCD without apparent cutaneous involvement is described. It has however been possible to demonstrate, by a test of cutaneous biopsy at the optical and electron microscope, an increased number of aberrant mast cells, together with a cutaneous melanosis due to the intense melanin deposit. The meaning of this association is unknown and never previously notified in the literature.

[Immunological indices in myelodysplastic syndromes]. / Indici immunologici nelle sindromi mielodisplastiche.

Several studies aiming to describe the immunological abnormalities occurring in patients affected by myelodysplastic syndromes (MDS) have been carried out in recent years. We report on the immunological abnormalities found in 22 myelodysplastic patients at the time of diagnosis (RA: 2 cases; ASIA: 4 cases; AREB: 6 cases; AREB-T: 6 cases. LMMC: 4 cases). Matched with similarly aged healthy people (controls) all our patients revealed a significant lymphocytopenia mainly due to a reduction both in number and percentage of T-helper series with decreased OK T4/OK T8 ratio as a result; even B-cells were reduced in number but their percentage still overlapped with the controls. Out of 22 patients, 13 showed hypergammaglobulinemia (polyclonal in 12 cases, monoclonal in the one left) and 2 read positive for Coomb's and Ana-test respectively. The involvement of T-cell immunity in the course of MDS can be explained if we consider the clonal origin of such diseases. Among myelodysplastic patients the ones affected by LMMC, AREB and AREB-T show the heaviest immunological abnormalities: in these cases the whole of T-cells subsets and NK cells as well are affected. Eventually, the mentioned abnormalities are of paramount importance to explain how easily these patients can develop both severe infectious diseases and abrupt acute leukemia.

[Determination of lymphocyte subpopulations in multiple myeloma and monoclonal gammopathies of undetermined significance]. / Determinazione delle sottopopolazioni linfocitarie nel mieloma multiplo e nelle gammopatie monoclonali di significato indeterminato.

By means of monoclonal antibodies, the lymphocyte subpopulation in 12 patients affected by multiple myeloma, 3 by Waldenström's macroglobulinemia, 7 by M.G.U.S. and 8 patients affected by accompanying monoclonal gammopathy have been determined. The group of patients affected by multiple myeloma or Waldenström's macroglobulinemia presented, against control, a significant reduction in the OK T3+ and OK T4+ cell percentage, with a remarkable reduction of the OK T4+/OK T8+ ratio. The OK T8+ cell average, if considered as an absolute value, was not modified in comparison to normal value, while the absolute number of OK T4+ cells was substantially reduced. No significant modifications have been ascertained in the percentage of SIg+ cells. The patients affected by M.G.U.S. did not present significant difference against controls, with regard to the lymphocyte number and the percentage of OK T3+ and OK T4+ cells. On the contrary, a significant increase of the percentage and absolute number of OK T8+ cells was observed. Also in these cases, a significant reduction of the OK T4+/OK T8+ ratio was observed. Finally, the patients affected by accompanying monoclonal gammopathy presented a significant reduction of OK T3+ and OK T8+ cells, with an increase of the percentage of OK T4+ cells and of the OK T4+/OK T8+ ratio.

Troponin I serum concentration: a new marker of left ventricular hypertrophy in patients with essential hypertension.

BACKGROUND: Troponin I, a specific cardiac muscle protein, has proven to be very helpful in detecting myocardial damage in ischemic heart disease. In order to assess if this laboratory test may also characterize some hypertensive subjects with proven cardiac damage, we compared troponin I serum concentrations of a group of patients affected by systemic hypertension and left ventricular hypertrophy (LVH) with troponin I serum concentrations of hypertensive patients without LVH and with normal controls. METHODS: Of 100 hypertensive patients consecutively enrolled in the study, 27 had an increased left ventricular mass by M-mode/two-dimensional echocardiographic examination. Of these, 4 were excluded for significant Holter ST-segment modification. Troponin I was measured in the remaining 23, in 23 age- and sex-matched hypertensive patients with normal left ventricular mass and in 23 normal controls. RESULTS: Troponin I serum concentration was higher than the upper limit of the normal values (0.5 ng/mi) in 12 of the 23 hypertensives with LVH. On the contrary, all hypertensives without LVH and all normal controls had troponin I serum concentration below the upper limit of the normal values. Consequently, the mean troponin I serum value was significantly higher in the group of hypertensive patients with LVH than in the group of patients without LVH (0.88 +/- 0.93 vs 0.27 +/- 0.08 ng/ml, p = 0.002) and in normal controls (0.88 +/- 0.93 vs 0.22 +/- 0.04 ng/ml, p = 0.0001). CONCLUSIONS: Our data indicate that a significant proportion of patients affected by essential hypertension with LVH have slightly elevated troponin I serum concentrations. This test seems to identify two subgroups of hypertensive subjects with LVH, and, considering that troponin I is a marker of myocardial damage, higher serum values probably indicate a more important cardiac involvement in the setting of a hypertensive disease.

[The neuroglycopenic syndrome due to insulinoma. A clinical case report]. / Sindrome neuroglicopenica da insulinoma. Descrizione di un caso clinico.

The authors report a case of a woman affected by pancreatic insulinoma who had been suffering from recurrent and misdiagnosed hypoglycemic attacks since 3 years. The total loss of warning neurogenic symptoms replaced by sudden onset of neuroglycopenic symptoms had delayed the proper and early diagnosis because of repeated and useless cardiovascular and neurological investigations. Moreover, it is stressed how difficult is to reveal such neoplasia that, despite the severe symptoms, are usually small in size and often undetectable even with TC scan. Therefore, when clinical pattern is strongly suggestive for insulinoma the use of invasive angiography or other techniques is mandatory and often conclusive. Actually clinical data have the priority in whole diagnostic pathway.

[The modes of transmission of Helicobacter pylori infection]. / Modalità di trasmissione dell'infezione da Helicobacter pylori.

Helicobacter pylori plays an essential role in the development of several both acid-related and neoplastic gastroduodenal pathologies. There are still uncertainties about the transmission routes and the sources of H. pylori infection. Man is the only well established "reservoir" of H. pylori, while the role of other mammalians (cat, pig, primates), as sources of infection, is still controversy. Literature data suggest four different modalities of transmission of the infection: faeco-oral, oro-oral, gastro-oral, gastro-gastric. By faeco-oral route, the bacterium, excreted with faeces, might colonize water sources, becoming so available to be transmitted to man and other mammalians. By oro-oral route, H. pylori, which colonizes dental plaque and saliva, may be transmitted by saliva to other individuals. The gastro-oral route is the typical modality of transmission in the childhood, when H. pylori uses the mucous achlorhydric vomitus of the children to infect a new host. Finally, by gastro-gastric route the bacterium might be transmitted by endoscopic procedures. In conclusion, we believe the different modalities of transmission may be contemporaneously involved, since none per se is able to explain the widespread occurrence of H. pylori infection.

[Primary extranodal non-Hodgkin's lymphoma of muscle tissue]. / Linfoma non-Hodgkin extranodale primitivo del tessuto muscolare.

Primary muscular involvement is extremely rare in non-Hodgkin's lymphomas. To our knowledge few cases are reported in literature and all of them concern patients with unifocal muscular lymphoid masses usually growing in one of the extremities. Our case-report, instead, regards a 78 years-old woman presenting primary multifocal muscular involvement by extranodal non-Hodgkin's lymphoma (right upper and lower limbs affected at the same time). Therefore, in contrast with the therapeutic approach suggested by other Authors in such neoplasms (radiotherapy or combined radio-chemotherapy), we preferred to administer only chemotherapy. The treatment led to a complete regression of all lymphoid masses. By now the woman is healthy and disease-free as confirmed at the one-year haematological follow-up.