[Colonic metastasis from primary carcinoma of the lung. Case report]. / Metastasi del colon da tumore primitivo del polmone. Caso clinico.

Lung cancer is the most common cause of cancer-related death in both men and women in Western countries. About one-half of patients with lung cancer have metastatic disease at the time of initial diagnosis. Metastasis to the gastrointestinal tract from primary lung cancer has rarely been described. The most common metastatic site is the small bowel whereas large bowel secondary lesions are very rare. The majority of patients are referred to a surgeon only after the intestinal secondary lesion becomes symptomatic posing a threat to the patient's life. Although the outcome is still unfavourable, the development of chemotherapy and of surgical techniques allows aggressive treatment when facing a single intestinal metastasis from lung cancer. We report on a case of a patient who came to our observation for a neoplastic stenosis of the descending colon with a single liver secondarism. Histology proved both lesions to be metastases of primitive adenocarcinoma of the lung.

Intraoperative ultrasound score to predict recurrent hepatocellular carcinoma after radical treatments.

Despite the high complete necrosis rate of radio-frequency ablation (RFA) or the complete removal following curative hepatic resection (HR), recurrent hepatocellular carcinoma (HCC) remains a significant problem. The aim of the study is to identify some intraoperative ultrasound (IOUS) patterns, predicting intrahepatic recurrences. From January 1997 to July 2009, 410 patients with HCC were treated (162 HR and 248 RFA through a surgical access). All patients were submitted to IOUS examination: 148 IOUS were performed during the laparotomic access while 262 IOUS were performed during the laparoscopic access. Primary HCC was classified according to diameter, HCC pattern (nodular or infiltrative), echogenicity (hyper- or hypo-echoic), echotexture (homogeneous or inhomogeneous), capsular invasion, mosaic pattern, nodule in nodule aspect and infiltration of portal vessels. Number of HCC nodules was also considered. Multivariate analysis (Cox model) was performed to determine features associated with recurrent HCC using IOUS patterns that independently predicted recurrent HCC, a IOUS score was developed. The patients were followed for 3-127 months, (median follow-up: 21.5 months). In 220 patients (54%), intrahepatic recurrences occurred. In 155 patients (38%), distant intrahepatic recurrences arose in different segments at the primary tumor site. In 65 HCC cases (16%), local recurrences were found. At multivariate analysis, multiple nodules, HCC diameter (>20 mm), HCC pattern (infiltrative), hyperechoic nodule and portal infiltration were statistically significant for risk factor of intrahepatic recurrences. Therefore, a IOUS scoring system was calculated on the basis of multivariate analysis and identified three risk categories of patients: in group 1 recurrences occurred in 37%, group 2 in 46% and group 3 in 66% (p = 0.0001). IOUS is an accurate staging tool during "surgical" procedures. This study showed an added value of IOUS: it permitted to identify ultrasound patterns, which can predict the risk of HCC recurrences. The calculated IOUS score permits to intraoperatively evaluate the actual surgical choice and to program the best treatment strategies during the follow-up period.