[Multiple intestinal perforations due to tuberculosis: a case report and review of the literature]. / Perforazioni intestinali multiple tubercolari: descrizione di un caso e revisione della letteratura.

The incidence of tuberculosis in Italy steadily decreased until two decades ago, but the infection is now frequently diagnosed in common clinical practice. The Authors describe a rare acute abdominal presentation of the disease featuring a double intestinal perforation in a subject affected by pulmonary, renal and gastrointestinal miliary tuberculosis. A review of the literature is also presented. Intestinal resection is the treatment of choice in such cases, even if it leads to frequent, major complications, but the authors stress that there may be a possibility for a less radical form of management of these patients.

Mesenteric chylous cysts simulating a pelvic disease: a case report.

Mesenteric chylous cysts, also known as retroperitoneal chylomatous cysts, mesenteric lymphangiomas or chyloma of the mesentery, are extremely rare and their aspecific clinical presentation can mimic other diseases. In addition, imaging techniques, which are rarely helpful in the correct diagnosis, can demonstrate aspecific features. The Authors report the case of a 62-year-old woman admitted to the hospital for two incidental abdominal masses diagnosed during a yearly monitoring examination and considered to be large adnexal masses. The abdominal masses were removed at laparotomy. Both frozen section and final histopathological examination showed mesenteric chylous cysts. Mesenteric chylous cysts are usually a benign abdominal pathology. As illustrated by this case, even if they are extremely rare, they should be not underrated. The Authors review the literature, confirming the rarity of the disease and defining its characteristics.

[Acute abdomen: experience with 196 consecutive cases]. / L'addome acuto: esperienza su 196 casi consecutivi.

The authors studied 196 consecutive emergency admissions to their unit with a diagnosis of non-traumatic acute abdomen. The data were analysed in order to evaluate the demographic data, the diagnostic procedures performed and treatments administered, and the reliability of the admission diagnosis in comparison with the final diagnosis. During the study period acute abdomen emergencies amounted to 7% of the total admissions to the unit. Laboratory tests and abdominal ultrasonography were the most frequently used diagnostic tools, followed by plain film of the abdomen and CT scans, the latter being used in a distinctly lower number of cases. Seventy patients out of 196 (35.7%) underwent an emergency surgical procedure. The most frequently reported disease was acute appendicitis. Sixty-one of the subjects (31.1%) with acute abdomen were successfully treated conservatively while 65 (33.2%) were diagnosed as being affected by non-splanchnic-diseases, and thus categorised as cases of false acute abdomen The Authors conclude that the diagnostic work-up for acute abdomen always needs a precise clinical history and a complete physical examination, but in some instances the support of widely available facilities, such as plain x-rays, ultrasonography, or CT scans can help to avoid useless surgical procedures or, conversely, potentially dangerous delays in administering treatment.

Preliminary study on radioguided sentinel node identification in colon cancer.

The purpose of this study was to prove the prognostic value of the sentinel node (SN) in colon tumors, and to validate radioguided surgery in identifying the SN. Nodal metastases are a strong prognostic factor in patients operated on for colon or rectal cancer, decreasing the 5-year survival rate by approximately 20 per cent and dropping it to 30 per cent. Unfortunately, of 50 per cent of patients judged to be nodal disease-free at surgery, about 20 to 30 per cent will die from a local tumor relapse or distant metastases within 5 years of diagnosis. These data suggest that other steps are needed for more precise staging of patients, and specifically, to accurately harvest and study the nodes on which to base the prognosis. Mapping lymph nodes predictive of the whole basin status, referred to as SN, may help focus the pathologist's attention on a small but representative target, and achieve correct nodal harvesting, which includes atypical drainage pathways, when present. Twenty selected patients with colon tumor were administered a subserosal, peritumoral, intraoperative injection of blue dye and 99mTc-marked colloidal particles. The SN was identified visually and with a handheld gamma probe and was subsequently stitch-labeled. The operation was then conducted after standard surgical procedures, and the required lymphadenectomy was performed. Later, the probe was used to confirm radioactivity in the excised specimen and the absence of radioactivity in the operative field after resection; the purpose of the latter was to exclude the presence of aberrant routes of lymphatic drainage. The labeled SN were stained with hematoxylin and eosin and, in case of negative findings, cytokeratin immunostaining was performed. The remaining resected nodes were stained with hematoxylin and eosin. The probe identification of SN was 95 per cent overall (19/20); in 13 patients, a single SN was labeled, and two were labeled in six patients, harvesting 25 SN. In the 19 patients in whom a radioemitting SN was labeled, we recorded only one false-negative; in one case, a micrometastasis in the SN was the only extracolonic site. The blue dye identified the SN in 14 cases; in some of them, the number of nodes was overestimated (five single, seven double, and two triple SN) in comparison with the radioisotope, but at least one of the dyed nodes was also radioemitting. SN identification in colon cancers is a safe, fast, and easy procedure for ultrastaging the nodal basin. The technique involves a relatively flat learning curve and could become standard care for identifying the presence of nodal micrometastases at a low cost, thereby also making it affordable at small health centers.

[Technical and organisational considerations regarding surgical debulking]. / Alcune considerazioni tecniche e organizzative sull'oncocitoriduzione chirurgica.

The Authors report on their experience with debulking surgery, based on 46 patients affected by advanced cancers and treated between January 2001 and May 2003 to reduce the tumour mass. Thirty-eight out of 46 (82%) were women. The Authors performed 23 pelvic peritonectomies, 16 multicompartmental peritonectomies according to the Sugarbaker technique, 8 hysterectomies with bilateral ovariectomy, 4 ureteral resections with end-to-end reconstruction, 4 pelvic lymphectomies and 2 resections of the bladder. No perioperative mortality is reported, and major morbidity amounted to less than 5%. The Authors stress the problems encountered while performing debulking surgery and are of the opinion that the majority of the problems could be overcome by precise organization in dedicated surgical centres specifically or mainly devoted to surgical debulking.

[Thyroidectomy for thyroid carcinoma. Our experience]. / Linfectomia per carcinoma della tiroide. Nostra esperienza.

The surgical management of thyroid carcinoma involves different degrees of lymphadenctomy, according to features such as the nature, the site and the severity of the disease. The authors present their experience in order to contribute to the debate on the standard management of nodal metastasis in well-differentiated thyroid cancers. The authors describe their six years of experience in 302 thyroid cancer patients with a total of 291 thyroidectomies performed. According to the different pathological findings, the treatment involved a monolateral dissection in 42 patients and a bilateral modified neck dissection in 21. A number of anatomical considerations regarding the pathway of lymphatic drains are summarized and follow-up results are also presented. The slow progression of the disease and its low incidence make long-term prospective studies difficult, thus hindering any definitive assessment of lymph node management in well-differentiated thyroid cancers.

[Medullary cancer arised in cervical accessory thyroid. Case report]. / Carcinoma midollare insorto su tiroide accessoria cervicale. Considerazioni su un caso clinico.

The Authors present a recent case of a medullary thyroid cancer arised in an ectopic accessory gland, whose definitive diagnosis was only set after the pathologist observation of the resected specimen. The Authors then review the causes of the anomaly and the literature classification of thyroid ectopies together with the commonest clinical, laboratory and imaging diagnostic features. In conclusion Authors indicate the importance of thinking about the possible ectopic thyroidal nature of an undiagnosed cervical mass, in order to recognize an unusual disease thus avoiding a delayed therapy.

Ret/PTC activation does not influence clinical and pathological features of adult papillary thyroid carcinomas.

OBJECTIVE: RET proto-oncogene rearrangements (ret/PTCs) represent the most common genetic alterations found in papillary thyroid carcinomas (PTCs). Correlation of ret/PTC expression with clinical outcome is controversial. The aim of the present study was to analyze the frequency of RET rearrangements in adult PTCs, and to investigate if ret/PTCs influence biological behavior and clinical features of the cancers. DESIGN: Ret/PTC rearrangements were looked for in tIssue samples of 48 PTCs collected at our institution. Data about clinical and pathological features of the tumors were also reviewed. Three separate association analyses were carried out on the cohort evaluating the effects of, respectively, ret/PTC positivity, preferential RET tyrosine kinase domain (RET-TK) expression, and ret/PTC plus RET-TK positivity, on age, sex, tumor size, staging, number of neoplastic foci, and histological subtype. METHODS: The genetic study was conducted with the RT-PCR-Southern blot technique. Standard Student's t-test and Fisher exact test were applied for the association analyses. RESULTS: The molecular genetic study demonstrated the positivity of ret/PTC1 and ret/PTC3 in 13 of 48 tumors (27.1%), and an exclusive or preferential RET-TK expression in 17 cases (35.4%). None of the three genetico-clinical analyses showed any significant association between ret/PTC expression and the clinical and pathological features of the cancers. CONCLUSIONS: These data indicate that RET rearrangements may not play any distinctive role in driving histotype development and cancer progression in these neoplasms. Moreover, they weaken the possibility of using ret/PTC as a prognostic marker for papillary thyroid carcinomas.

[Biopsy of the sentinel lymph node in the staging of patients with malignant melanoma]. / La biopsia del linfonodo senti nella nello staging dei pazienti affetti da melanoma maligno.

Sentinel node biopsy, in the treatment of stage I and II skin melanomas (according to the American Joint Cancer Committee classification), has been advocated by several authors as the best compromise between radical intent and minimal surgical invasiveness. The authors present their personal experience based on 64 sentinel node biopsies in patients with stage I and II skin melanoma of the trunk and limbs (30 males and 34 females; age range: 29-77 years). Sentinel node detection was radio-guided and was conducted in the armpit in 43 cases and in the groin in the remaining 21. Eleven patients who presented metastatic nodes underwent a regional lymphadenectomy (8 axillary and 3 groin dissections) with low morbidity and no perioperative mortality.