Ki67 in endocrine neoplasms: to count or not to count, this is the question! A systematic review from the English language literature.

BACKGROUND: Endocrine neoplasms are generally slow-growing tumors that can show hormonal activity and give metastases. In most cases they are benign and clearly malignant forms are easy to diagnose. However, borderline forms may occur and be, for the pathologists, very difficult to classify. In these cases, there is a strong need to identify factors that may aid. Official classification systems for endocrine neoplasms are based on the evaluation of proliferation and, in most cases, they rely on mitotic count. In support, the study of Ki67 is carried out which, however, has not yet been included in any official classification system, except for neuroendocrine neoplasms of the gastro-entero-pancreatic tract. PURPOSE: The aim of the present study was to investigate the proven or unproven role of Ki67 in endocrine neoplasms, in different districts, in order to bring to light the substantial differences, in terms of proliferation, existing between neoplasms so similar, but at the same time, so different. METHODS: A thorough search of English language literature was performed, looking for articles concerning Ki67 in five endocrine neoplasms (pituitary adenomas, thyroid neoplasms, adrenocortical neoplasms, pheochromocytomas and paragangliomas). RESULTS: From 2170, 236 articles were selected and it was seen that the endocrine neoplasm in which Ki67 was most studied was the pituitary, where it still shows a controversial role. In other neoplasms different roles were identified. CONCLUSION: The pathologist should be aware of the contribution that this proliferative marker can give to the diagnosis and, sometimes, to the therapy selection, for the clinician.

Endoscopic repair of cerebrospinal fluid leak in paediatric patients.

BACKGROUND: In scientific literature exist fewer case series regarding endoscopic treatment of paediatric cerebrospinal fluid fistulas. Compared to craniotomy endoscopic repair does not reach wider consent even if craniotomy carries higher complications rate. OBJECTIVE: The aim of the present study was to report our institutional experience on paediatric cerebrospinal fluid leak to demonstrate the safety and efficacy of the endoscopic approach in a variety of cases. METHODS: Clinical records of all paediatric patients who underwent endoscopic repair of anterior and middle fossa skull base defects are reviewed for several parameters. RESULTS: 10 patients were enrolled, 6 males and 4 females with a mean age of 10 years. The aetiology of the leak was congenital in 2 cases, trauma-induced in 6 cases and iatrogenic in 2 cases. In all the cases the defect was localized by computed tomography. Remedial was obtained using multiple grafts technique with autologous materials during a single procedure in all but one case, this one case requiring a second operation for delayed recurrence. The mean follow-up duration is 36 months. CONCLUSION: CSF fistulas can be approached in paediatrics of any age with high success and low complications rate using the endonasal technique.