Experience of 463 cases of gastric cancer from a single surgical center.

AIM: To evaluate clinical and histopathological changes of gastric cancer (GC) in the last fifteen years and analyze factors influencing overall survival. MATERIAL OF STUDY: We have retrospectively categorized patients submitted to surgery for GC from January 1996 to December 2010. The analysis focused on two periods: 1996-2003 (period 1) and 2004-2010 (period 2). RESULTS: There was an increase in age distribution of GC in period 2 (p=0.012). Significant increase of whole GC was observed in period 2 (p=0.01). Slight but significant changes in TNM stage were found: in group 2 there was a decrease in the rate of early GC and in advanced depth of tumor invasion; increase of lymph nodes involvement was also demonstrated. Overall survival (OS) had not changed from the first to the second period. There was a significant difference in OS calculated for Lauren histotype: from ten months to surgery, patients with diffuse histotype showed worse prognosis. DISCUSSION: The most important findings were an increase in lymph node involvement and a decrease in depth of tumor invasion, an higher percentage of whole type and a decrease in palliative surgery. Overall-survival hasn't change in the last fifteen years. These results confirms the importance of extent of lymph node dissection in the standard surgical approach of GC, the tumor stage and Lauren histotypes as the main prognostic factors in GC. CONCLUSION: This work confirms the dismal prognosis of GC and the need to increase diagnosis of early gastric cancer. KEY WORDS: Gastric cancer, Lauren histotype, Overall survivall.

Diabetic mastopathy: case report.

UNLABELLED: Diabetic mastopathy is a rare fibro-inflammatory breast disease, which occurs in premenopausal women affected by longstanding type I insulin-dependent diabetes. It is a benign disease and it is often misunderstood for its clinical and radiological features that may mimic a breast cancer. The diagnosis of diabetic mastopathy is based on histological examination and it is characterized by lymphocytic lobulitis with glandular atrophy and perivascular lymphocytic infiltration. The patients do not need to undergo surgery but it is necessary to plan an adequate clinical and radiological monitoring program. KEY WORDS: Diabetic mastopathy, Diagnostic and therapeutic features.

Gastric metastasis from breast carcinoma. Report of three cases, diagnostic-therapeutic critical close examination and literature review.

Gastric metastases of breast cancer represent a not so rare event in patients affected. In fact, it occurs in 0.3% of cases. Although the introduction of new adjuvant therapies has given rise to an increase in disease free survival and overall survival rates, it has also led to more frequent occurrences of breast cancer metastatic lesions localized in bone, lung/pleura and liver, but above all in the stomach. The authors present three cases of patients suffering from breast cancer with secondary gastric neoplastic lesions from lobular and infiltrating ductal breast cancer. Lobular breast cancer is the histological type mostly involved in disseminated disease, with an incidence of 85% of cases. A review of the literature reveals that authors address the clinical and diagnostic problems of differentiating between a breast cancer metastasis to the stomach and a primary gastric cancer using recent diagnostic strategies to make an early diagnosis. Today practitioners have specific tests to detect early gastric cancer metastases of breast cancer such as endoscopic ultrasound, which provides a better endoscopic definition of the lesions, and immunohistochemical markers, able to distinguish the primary lobular histological type from ductal cancer. Besides, an early diagnosis associated with the latest adjuvant systemic therapies and hormonal treatment, alone or in combination, may grant affected patients a remission with a survival rate of 10-28 months, and a reasonable quality of life. At present the surgical approach should be reserved for selected cases and/or complications.

Central pontine and extrapontine myelinolysis despite careful correction of hyponatremia: clinical and neuropathological findings of a case.

We report clinical, radiological and pathological findings in a patient with central pontine and extrapontine myelinolysis. The patient was a 61-year-old woman who had a radical mastectomy for breast cancer. Based on clinical evidence, acute hyponatremia had set in only a few days before onset of symptoms. The patient's disease progressed in two stages and became more severe during slow hyponatremia correction after 9 days from onset. Diffusion MRI provided early evidence of neurological lesions. In spite of a therapeutic attempt, the patient died unexpectedly 18 days after onset of her neurological disease due to massive pulmonary embolism. Histologically, our findings confirmed that the major features of central pontine myelinolysis in the acute stage are demyelination, the presence of large amounts of macrophages with no lymphocytic inflammatory reaction, and moderate astrocytosis. It is interesting to note that a monotypic immunological reaction persisted 19 days after radiological demonstration of parenchymal alterations.

Giant Merkel cell carcinoma of the left arm. Case report.

Merkel cell carcinoma is a rare tumor of dermal origin generally found in sun exposed skin. We report the case of a woman of 76 years old presenting a large vascularized Merkel cell carcinoma (MCC) of the left arm lateral to the elbow joint, infiltrating the muscolo-fascial plane who was treated with surgical therapy and post operative radiotherapy.

Videolaparoscopic cholecystectomy for acute cholecystitis: analyzing conversion risk factors.

We examined a series of 176 consecutive patients scheduled for videolaparoscopic cholecystectomy for acute cholecystitis to identify the independent parameters most likely to lead to conversion to laparotomy. This prospective study was conducted from June 2001 to December 2003 on 176 consecutive patients who were scheduled for videolaparoscopic cholecystectomy for acute cholecystitis. Of the 176 patients, 119 (group A) underwent videolaparoscopic chlecystectomy, and 57 (32.3%) were converted to laparotomy (group B). Patients were assessed for gender, age, time between onset of symptoms and surgery, previous surgery, ASA (American Society of Anesthesia) risk, leukocytosis, echotomographic findings, average operating time, intra- and post-operative complications, and conversion rate. Our study found that the parameters of age, ASA risk, duration of symptoms, leukocytosis, and operative time are independent conversion risk factors.

[Considerations regarding the role of arterial embolization with an angiographic approach in the treatment of upper gastrointestinal bleeding: personal experience]. / Considerazioni sul ruolo dell'embolizzazione celiaco-mesenterica con approccio arteriografico nel trattamento delle emorragie gastrointestinali alte: esperienza personale.

Upper gastrointestinal bleeding can be produced by varicose, inflammatory-ulcerative or neoplastic lesions of the eosophageal-gastric-duodenal anatomical district. The aim of this study was to define the role of arterial embolotherapy with an angiographic approach in the treatment of these conditions, starting from our personal experience and a review of the literature. The treatment of upper gastrointestinal bleeding is based on a multimodal approach in which arterial embolotherapy has its place alongside endoscopy and surgery.

[Rupture of the spleen in angiosarcoma: a case report and review of the literature]. / Rottura di milza in angiosarcoma: considerazioni su di un caso clinico e revisione della letteratura.

Splenic angiosarcoma is a rare neoplasm originating from endothelial cells of the blood vessels. Its incidence is about 0.14-0.25 per million. We report the case of a patient admitted in a state of hypovolaemic shock with haemoperitoneum due to rupture of the spleen. Splenectomy was performed with evacuation of the haemorrhagic effusion. The blood was aspirated and in part instilled during the operation through intraoperative blood salvage due to the large haemoperitoneum. Histological examination revealed a splenic angiosarcoma. Splenic angiosarcoma should be suspected in cases of splenomegaly with unknown anaemia and no lymphoma, leukaemia or myelofibrosis, because of its neoplastic aggressiveness and its invariably fatal outcome. It is important to perform a splenectomy before splenic rupture owing to its negative impact on long-term survival.

Wireless capsule endoscopy in a case of small bowell obstruction: not always contraindicated.

Wireless capsule endoscopy is a new diagnostic technique used especially for investigating the entire small bowel. Recent studies have demonstrated its superior ability to detect and evaluate small bowel lesions compared to other radiological examinations. Performing video capsule endoscopy is regarded as contraindicated when an intestinal occlusion is documented. We present a case of hidden intestinal bleeding which underwent wireless capsule endoscopy and was treated successfully despite documented ileal stenosis.

Bouveret's syndrome: a case report.

Duodenal obstruction due to a gallstone from a cholecystoduodenal fistula (Bouveret's syndrome) is a rare complication of gallstone disease. Patients present gastric outlet occlusion with vomiting, abdominal distension and a state of dehydration. Plain film of the abdomen, ultrasonography and CT scans reveal pneumobilia and the obstructing gallstone. Endoscopy is essential for diagnosis and therapy, with a view to the possibility to relieving the occlusion. Endoscopy, however, cannot be used to treat the fistula and is often unsuccessful because of the very large size of the stone. Surgical therapy can be effective both for relieving the occlusion and for fistula treatment. The authors report a case of Bouveret's syndrome successfully treated surgically in an otherwise healthy patient. In critically ill patients, the primary goal of therapy is relief of the occlusion.

[Gastric polyps: a clinical contribution]. / I polipi gastrici: contributo clinico.

The incidence of diagnosis of gastric polyps is now higher than in past years owing to the introduction of endoscopy in the diagnosis and treatment of upper digestive tract disease. One hundred and sixty-four polyps removed from January 1984 to August 2000 were analyzed. The median age of the patients was 61.4 years (range: 16-84 yrs). Polypoid lesions were more frequent in males (M:F = 1.5:1). Seventy-nine patients were asymptomatic (48.2%). Sixty-four percent of the polyps were located in the antrum. We diagnosed 73 hyperplastic polyps, 27 adenomatous lesions, 8 inflammatory polyps and 56 pseudopolyps. Malignant lesions were detected in 9 adenomatous polyps (4 type I and 5 type II early gastric cancers). Endoscopy is the examination of choice in the diagnosis and treatment of gastric polyps. We confirm that there is a relationship between histological type, neoplastic change and the size of the polyps.

Gastrointestinal stromal tumours: an analysis based on personal experience.

We present our experience in the treatment of 18 patients affected by gastrointestinal stromal tumours (GIST) from January 1988 to march 2002. The ratio M.F was of 2:1 and the median age of 68.6 years. In 13 patients the tumours were located in the stomach while in 5 patients in the jejunum ileum area. In 7 patients the neoplasms were malignant. All the patients were operated and in 11 patients a partial gastric resection was carried out. 2 patients had a total gastrectomy and 5 had a small bowel resection. The diagnostic and therapeutic options and the uncertain prognosis of these neoplasms are discussed.