Pancreas preserving surgery for duodenal gastrointestinal stromal tumor removal.

BACKGROUND: We reported our experience with high-risk, non-metastatic second portion duodenal gastrointestinal stromal tumor (GIST)s in patients who underwent 1-month neoadjuvant cycles with imatinib therapy followed by pancreas-preserving surgery and 12-month of adjuvant chemotherapic regimen including imatinib. This study was conducted to evaluate the short and long-term results. METHODS: The study was conducted between January 2010 and May 2015. Medical charts and operative logbooks of patients were retrospectively reviewed. RESULTS: Nine patients form the basis of the current analysis. All patients underwent curative resection with pancreas preservation, and all specimens had histologically negative margins. The median follow-up was 35 months. Eight patients were alive, 1 patient died for myocardial infarction at a mean follow-up of 10 months, 1 patient had a recurrence at a mean follow-up of 32 months and no patients developed distant metastases. CONCLUSIONS: We are confident to suggest the use of neoadjuvant and adjuvant Imatinib therapy to those patients affected with D2, high-risk, duodenal GISTs to allow a limited resection.

Epidermal inclusion cyst of the breast: A literature review.

An epidermal inclusion cyst (EIC) of the breast is a rare, benign condition that may potentially be malignant. The present study conducted a systematic review of the literature in order to identify pathological hypotheses, clinical characteristics, and diagnostic and treatment options. A search for relevant studies was conducted through the Scopus, Embase and Medline databases during September 2014. The search term employed was ῾epidermal inclusion cyst breast᾽. Studies were selected if they contained adequate information regarding symptoms at presentation, diagnostic tools, pathology, characteristics, type of procedure performed and follow-up routines. A total of 35 papers describing 91 patients affected by EIC of the breast were identified. Following this, a total of 82 patients, including an additional case supplied from the present study, were selected for further analysis. EIC of the breast typically occurs during the fifth decade of life. A palpable mass of the breast was present in 65 (79%) patients. Ultrasonographic imaging was consistently utilized as a diagnostic tool in all the cases analyzed, whereas fine-needle aspiration cytology was used in 70% of the cases and mammography in 65%. No tumor recurrence was reported at a mean follow-up time of 53 months. The present study demonstrated that elliptical excision is the preferred treatment for EIC of the breast, with pathological analysis required to exclude malignancy.

Peliosis hepatis: Personal experience and literature review.

Peliosis hepatis (PH) is a disease characterized by multiple and small, blood-filled cysts within the parenchymatous organs. PH is a very rare disease, more common in adults, and when it affects the liver, it comes to the surgeon's attention only in an extremely urgent situation after the lesion's rupture with the resulting hemoperitoneum. This report describes the case of a 29-year-old woman affected by recurring abdominal pain. Computed tomography scans showed a hepatic lesion formed by multiple hypodense areas, which showed an early acquisition of the contrast during the arterial phase. Furthermore, it remained isodense with the remaining parenchyma during the late venous phase. We decided on performing a liver resection of segment VII while avoiding a biopsy for safety reasons. The histopathologic examination confirmed the diagnosis of focal PH. PH should always be considered in the differential diagnosis of hepatic lesions. Clinicians should discuss the possible causes and issues related to the differential diagnosis in addition to the appropriate therapeutic approach. The fortuitous finding of a lesion, potentially compatible with PH, requires elective surgery with diagnostic and therapeutic intents. The main aim is to prevent the risk of a sudden bleeding that, in absence of properly equipped structures, may have a fatal outcome.

Surgery for symptomatic colon lipoma: a systematic review of the literature.

AIM: Isolated colon lipomas are rare benign tumors. We herein conducted a systematic review of the literature to identify clinical characteristic, diagnostic and treatment options. MATERIALS AND METHODS: A search for relevant studies was conducted in Scopus, Embase and Medline databases until the end of May 2014. The search terms were "colonic lipoma and colon lipoma". Articles were included if they had information on symptoms, lipoma characteristics and type of procedure performed. RESULTS: 88 articles describing 184 patients affected with colonic lipomas were found. One hundred and twenty-seven patients were selected for further analysis. The most common signs included abdominal pain, rectal bleeding and alteration in bowel habits. Colonic lipomas were frequently localized in the right colon (50%). The majority of patients had open surgery, whereas current treatment is laparoscopic resection. CONCLUSIONS: Laparoscopic surgery is the current standard-of-treatment of symptomatic colonic lipomas greater than 2 cm in diameter or when malignancy can not be preoperatively excluded.

Surgical considerations for removal of giant tumor of the right adrenal.

BACKGROUND/AIM: Complete surgical removal is the only potentially curative approach for adrenal tumors. Our series of patients affected with giant right adrenal tumors, as well as the open surgical modalities used to obtain a complete tumor resection with safe vascular control were analyzed. MATERIALS AND METHODS: Nine patients (mean age=57 years) affected with a giant right adrenal tumor who underwent open surgical removal of the mass form the basis of the present analysis. A midline incision was performed. Large mobilization of the liver was performed to obtain good and safe exposure of the vascular pedicles. RESULTS: An en bloc R0 tumor resection was accomplished in all cases. Histology revealed an adrenal cortical carcinoma in all patients. No local recurrence was noted at a mean follow-up of 14 months. CONCLUSION: Radical surgery is the only curative approach and is recommended for all patients, whenever technically feasible, through open access in cases of giant right adrenal carcinoma.

Surgical treatment of pheochromocytoma in MEN 2.

Multiple endocrine neoplasia type 2 (MEN 2) is a rare autosomal dominant cancer syndrome. Forty to fifty percent of patients with MEN 2A develops pheochromocytoma. Surgeons treating these patients with pheochromocytoma have always been faced with question of whether to perform mono-or bilateral adrenalectomy and the timing of surgical intervention. Over the past 20 years, thanks to the development of ever more sophisticated techniques of diagnostic imaging (TC, MRI, Scintigraphy, PET), which make it possible to identify small lesions, and to ever more rapid laboratory tests, there has been a change in the surgical management of this condition. Surgeons moved from bilateral open adrenalectomy (6- 9) to laparoscopic partial adrenalectomy and cortical sparing (10-13). After partial adrenalectomy one third of the patients require replacement therapy because the function of the residual parenchyma was compromised by excessive devascularization during surgery. In patients with bilateral pheochromocytoma it is advisable to perform only partial adrenalectomy of at least one gland, i.e. to completely remove the gland with the larger lesion and remove part of the gland with the smaller lesion to reduce the risk of recurrence. The authors report 4 cases of MEN 2, including 2 first-degree relatives, which illustrate the progress made in surgical treatment for pheochromocytoma.

A rare case of malignant epithelioid angiomyolipoma in multiple locations: multifocal disease or metastases?

BACKGROUND: Perivascular epithelioid cell tumors (PEComas), make up a family of extremely rare mesenchymal neoplasms, with characteristic morphological, immunohistochemical and molecular findings. Malignant PEComas and gastrointestinal epithelioid angiomyolipoma (E-AML) are especially rare. To the best of our knowledge E-AML have not been found in the breast. The difficulty in determining what constitutes optimal therapy for PEComas, owing to the sparse literature available, led us to report this rare case. METHODS: We report a case of a 44-year-old woman, with a family history of multiple endocrine neoplasia syndrome (MEN) (gastrinoma, medullary thyroid cancer and parathyroid hyperplasia), affected by PEComa located in the kidney, stomach, ileum, liver and breast. RESULTS: The renal, gastric, ileal and mammarian tumors were completely resected, with no evidence of local disease. Liver lesions were biopsied. The morphological and immunohistochemical findings confirm the diagnosis of PEComa. CONCLUSION: On this basis it is difficult to determine if some E-AML are multifocal tumors or metastatic disease.

Usefulness of harmonic focus during axillary lymph node dissection: a prospective study.

BACKGROUND: Axillary node dissection (ALND) is affected by various complications, (hematoma, seroma, lymphocele, infections). The aim of this study was to evaluate the effectiveness of Harmonic Focus (HF) in reducing these complications. MATERIALS AND METHODS: 92 patients requiring ALND, were divided into two group: Group A (HF) (33 women, 14 men), and Group B (control) (28 women, 17 men). RESULTS: Operating time was lower in Group A than in Group B. The amount of drain volume was lower in Group A than in Group B, the drain was removed earlier in Group A than in Group B. Seroma incidence was lower in Group A than in Group B. CONCLUSIONS: The use of HF during ALND is effective in reducing operating time, drain volume and complications.