[Pelvic splenomegaly. Ptosic, migrant or accessory spleen?]. / Splenomegalia in sede pelvica. Milza ptosica, migrante o accessoria?

A wandering or ectopic spleen is a rare condition in which the spleen is not located in the left upper quadrant but is found lower in the abdomen or in the pelvic region caused by improper fixation of the ligamentous attachments. Laxity of the peritoneal attachments of the spleen results in splenic hyper mobility, known as wandering spleen. Congenital and acquired causes have been advocated to explain its onset. However, the precise aetiology is not completely understood. Many patients with wandering spleen are asymptomatic and therefore, the real incidence is unknown. Symptomatic patients may have intermittent abdominal pain because of splenic congestion with intermittent torsion of the splenic pedicle and its spontaneous detorsion, or may present acutely with pedicle torsion with subsequent infarction. Pain and dangerous potential evolution recommend surgery, splenoplexy or splenectomy. The Authors report the case of a 48-year-old man with painful abdominal mass suspected for wandering splenomegaly after diagnostic imaging (abdominal Ultrasonography and TC). Laparotomy evidenced a large spleen (DL 22 cm.) with a long (1 mt) and tortuous vascular pedicle, both removed. Histopathologic examination showed partial infarction of the spleen. The postoperative course was uneventful.

[Benign phylloides tumor of the breast. Considerations on a clinical case]. / Tumore fillode gigante benigno della mammella. Considerazioni a proposito di un caso clinico.

Phyllodes tumors are unusual biphasic fibroepithelial neoplasms of the breast, accounting for < 1% of all breast tumors and raising issues of diagnosis and therapeutic choice. They can grow quickly and when the maximum diameter is greater than 10 cm. We talk about giant phyllodes tumors. Ultrasound, Mammography and FNA are not effective. A potentially useful diagnostic modality is MRI. Core tissue biopsy or incisional biopsy represent the preferred means of pre-operative diagnosis. Conservative treatment can be effective also in giant tumors depending upon the size of the tumor and the breast if a complete excision with an adequate margin of normal breast tissue can be achieved, so avoiding local recurrence often accompanied by worse histopathology. The Authors report the case of a giant benign phyllode tumor of the breast treated with conservative surgery, quadrantectomy and oncoplasty. No local recurrence at 4 years follow-up.