Spontaneous perforation of solitary ulcer of transverse colon.

Spontaneous ruptures of the colon and rectum are extremely uncommon clinical entities and always require laparotomy. A 44-year-old female was admitted with a 12-hour history of severe abdominal pain periumbilically and at the right hypochondrium. The patient was immediately transferred to the department of surgery for close surgical observation. Computed tomography (CT) of the entire abdomen performed just before the operation demonstrated thickening of the wall of the ascending colon with pericolic fat stranding. Surgery revealed a perforation at the antimesenteric wall of the transverse colon and segmental colectomy of the transverse colon was performed. The histological evaluation demonstrated a perforated solitary ulcer of the transverse colon. There are only few known etiologic factors concerning spontaneous ruptures of the colon and rectum and usually none of these causative factors can easily be recognised. Their clinical appearance is most of the times acute abdomen and, despite the use of all appropriate diagnostic methods, the diagnosis is usually set postoperatively.

A case of early depressed-type ampullary carcinoma treated by wire-guided endoscopic resection.

A 72-year-old man, with known prostate cancer, was admitted to our endoscopic unit for further evaluation of an obstruction at major papilla level. Endoscopic cholangiopancreatography revealed a depressed-type carcinoma at the ampulla of Vater and dilation of both the common bile and pancreatic ducts without intraductal filling defects. Intraductal ultrasonography showed a hypoechoic mass limited to the ampulla of Vater. Endoscopic wire-guided ampullectomy was performed after informed consent was obtained. Histologic examination of the resected specimen showed a completely excised well-differentiated adenocarcinoma limited to the ampulla of Vater. Both accurate preoperative staging and proper histologic evaluation of the resected specimen seem to justify endoscopic treatment of early ampullary cancer by an experienced endoscopist.

Case report: microcystic transitional cell carcinoma of the urinary bladder.

We report a rare case of microcystic transitional cell carcinoma involving the urinary bladder, in a 38-year-old man, and we add our experience in the treatment of this neoplasm. The tumor was muscle invasive, and a radical cystectomy was performed. The patient received no postoperative chemotherapy or radiotherapy, and he has not signs of local recurrence or distal metastasis after 3 years of intense follow up. Even though the number of cases documented so far, is insufficient to draw safe conclusions regarding the optimal treatment of the microcystic variant of transitional cell carcinoma. Our case indicates that even in cases of microcystic transitional cell carcinoma with infiltrative nature, aggressive therapy is associated with good control of the disease locally and distally.

Paratesticular well-differentiated, adipocytic type liposarcoma presenting as inguinal hernia.

Paratesticular masses can pose difficult diagnostic and therapeutic problems to the physician. We report a rare case of paratesticular liposarcoma with the clinical symptomatology of an inguinal hernia. The treatment was surgical and included radical orchiectomy and wide excision of the tumor mass to the macroscopically healthy margins. The patient is well and with no evidence of recurrence 1 year after the operation. We review the literature, and discuss the role of radical orchiectomy, radiation, and chemotherapy in the treatment of paratesticular liposarcomas.