Symptomatic acinar cell cystadenoma of the pancreas.

Acinar cystic transformation (ACT), also known as 'acinar cell cystadenoma', is an uncommon cystic neoplasm of pancreas with unknown malignant potential. This case regards a woman with symptomatic pancreatic head ACT, revealed with pathological exam of specimen after pancreaticoduodenectomy. A 57-years-old patient presented mild hyperbilirubinemia and recurrent cholangitis; she underwent to ERCP, EUS and MRI, and these exams revealed a large cyst of the pancreatic head that caused biliary compression. The discussion of the case by the multidisciplinary group indicated surgical resection. Pancreatic ACT is so rare, and its preoperative diagnosis is difficult. The symptoms of the patients and the features of the cyst are the criteria to choose a surgical resection.

Robotic-assisted distal pancreatectomy with splenectomy in a paediatric patient for solid pseudopapillary tumour.

Solid pseudopapillary tumour is a rare low-grade malignant potential carcinoma of the pancreas that typically occurs in females in their third decade. It most commonly occurs in the tail of the pancreas, although any site can be affected. Surgical resection is the standard treatment and offers an excellent prognosis. We report a case of a 17-year-old female with an acute onset abdominal pain and a radiological diagnosis of a cystic lesion in the distal pancreas. A robotic-assisted distal pancreatectomy with splenectomy was performed. Robotic-assisted surgery is an emerging technique for the treatment of pancreatic neoplasms. This approach can be considered for younger patients, thanks to the potential advantages of the robotic Da Vinci Xi System.

Laparoscopic treatment of symptomatic Dunbar syndrome: a case report.

INTRODUCTION AND AIM OF THE STUDY: Dunbar syndrome is a rare disorder due to the external compression of the celiac trunk by the median arcuate ligament. The symptoms include abdominal pain, nausea and vomiting with a significative reduction in patients' quality of life. Laparoscopy has proven to be a safe procedure. The aim of this study is to present a case of Dunbar syndrome undergoing laparoscopic surgery. CASE PRESENTATION: A 40-year-old male patient presented at Emergency Room with upper abdominal pain and dyspepsia, related to food intake. A selective arteriography of the celiac trunk revealed stenosis due to compression of the celiac artery. CLINICAL DISCUSSION: Laparoscopic decompression of the celiac trunk by the median arcuate ligament was performed. Postoperative course was uneventful and the patient was discharged on the 5th postoperative day. CONCLUSION: Minimally invasive surgical division of the arcuate ligament is feasible and safe and it can restore patients' quality of life.

Primary ovarian Burkitt's lymphoma presentation in a young woman: A case report.

INTRODUCTION AND IMPORTANCE: Burkitt's lymphoma is one of the fastest growing human cancers and it needs a rapid diagnosis. CASE PRESENTATION: A young woman presented to our institution with acute abdominal pain, tenderness and constipation. Ultrasound reported a right ovarian mass; at laparoscopy, we discovered ascites, peritoneal carcinomatosis and a voluminous pelvic mass. CLINICAL DISCUSSION: Diagnosis was confirmed as non-Hodgkin sporadic Burkitt's lymphoma: the careful workup was the key to initiate multiagent chemotherapy. CONCLUSION: Primary ovarian Burkitt's lymphoma, in a young woman in a non-endemic zone, is a rarity that represents a strong diagnostic challenge, but rapid identification can lead the patient to appropriate therapies and improvement of prognosis.

Incidental carcinoma in multinodular goiter: risk factors.

The aim of the study was to analyze the frequency of incidental thyroid carcinoma (unknown tumor smaller than or equal to 10 mm) in a consecutive series of 462 total thyroidectomies for multinodular goiter and to investigate the clinical risk factors for this type of malignancy. A retrospective, single-center study of outcome data collected from patients with preoperative diagnosis of multinodular goiter who underwent total thyroidectomy at the General Surgery Unit of Pavia (Italy) between January 2000 and December 2008 was performed. Possible risk factors for malignancy were: gender, age, time of evolution of goiter, presence of a dominant nodule in multinodular goiter, hyperthyroidism, history of radiation to the neck, residence in an area of endemic goiter, prior thyroid surgery, calcifications in the goiter detected by neck ultrasound or chest X-rays, and a family history of thyroid diseases. In a 9-year period, 462 patients underwent total thyroidectomy. We found 41 cases of incidental thyroid carcinoma; the most common histopathological type was papillary. The multivariable analysis demonstrated that the clinical variables associated with occult carcinoma were a personal history of radiation therapy to the neck, the presence of calcifications detected by ultrasound or neck X-rays, and a family history of thyroid diseases; residence in an area of endemic goiter was a protective factor. A personal history of radiation to the neck, detection of calcifications by ultrasound or by neck X-rays, and a family history of thyroid diseases should be considered clinical risk factors for malignancy in multinodular goiter.

A metachronous splenic metastases from esophageal cancer: a case report.

The spleen is an infrequent site for metastatic lesions, and solitary splenic metastases from squamous cell carcinoma of the esophagus are very rare: only 4 cases have been reported thus far. These lesions are whitish nodules that are macroscopically and radiologically similar to primary splenic lymphomas. We report a case of metachronous splenic metastases from esophageal cancer and multiple splenic abscesses, which developed nine months after apparently curative esophagectomy without adjuvant chemotherapy. The patient underwent splenectomy dissection followed by adjuvant chemotherapy, but liver and skin metastases developed, and the patient died 9 months later.

Complex hydatid cysts of the liver: a single center's evolving approach to surgical treatment.

In our study, we arbitrarily define complex hydatid cysts of the liver as either cysts with a diameter > or =10 cm, or as multiple and recurrent cysts. These types of cysts were then divided into two subgroups: giant cyst identified as a cyst with a diameter > or =10 cm, and complicated cyst as multiple, recurrent, abscessed cysts, or those resistant to conservative treatment. The aim of this study was to retrospectively analyze a series of 38 consecutive patients who underwent surgery for complex hydatid cysts over a period of 9 years at the same institute to determine the evolution of the surgical treatment and the risk factors for recurrence. Fourteen (36.8%) of these patients were women and 24 (63.2%) men (median age 48.1; range 16-71 years). The mean postoperative followup was 24 +/- 10.8 months. All patients were treated prophylactically with albendazole (10 mg/Kg/day) for 15 days preoperatively and for 2 months postoperatively. Partial cystectomy was performed in two cases (5.26%) and radical pericystectomy in 20 cases (52.63%). In 15 cases the patients underwent liver resection (39.47%): left hepatectomy was performed in eight cases (21.05%), and right hepatectomy in seven cases (18.42%). In one case, both wedge resection and pericystectomy were performed. There were no deaths and only one patient (2.63%) showed signs of recurrence at follow-up. Radical surgery is the most effective treatment for complex hydatid cysts. In our experience, partial or total pericystectomy virtually eliminated, over time, the need for hepatic resection.

Malignant diverticulitis of the left colon complicating heart transplantation.

BACKGROUND: Colonic diverticular disease is rare in developing nations but common in Western and industrialized societies. Many studies show that heart and lung transplantation increase the risk of having severe diverticulitis, although the exact magnitude of this risk remain unclear because many of these studies have been small with short follow up. The term malignant diverticulitis has been employed to describe an extreme form of colon diverticulitis that is characterized by an extensive phlegmon and inflammatory reaction extending below the peritoneal reflection, with a tendency toward obstruction and fistula formation. CASE REPORT: We report a 57-year-old male, transplanted in our Institute for dilated cardiomyopathy due to previous myocardial ischemia, in whom, during the post-transplantation period, a malignant diverticulitis requiring an aggressive surgical approach was diagnosed, the diagnosis of diverticulosis was made during a colonoscopy in a pre-transplant work-up. CONCLUSIONS: Immunosuppressed patients should be considered at high risk for developing a complicated malignant diverticular disease, and when diagnosed in a pre-transplant work-up, should be managed aggressively in terms of surgical approach when symptoms and signs suggest a diverticulitis.

Colonoscopy is mandatory after Streptococcus bovis endocarditis: a lesson still not learned. Case report.

BACKGROUND: Even though the relationship between certain bacterial infections and neoplastic lesions of the colon is well-recognized, this knowledge has not been sufficiently translated into routine practice yet. CASE PRESENTATION: We describe the case of a 51-year-old man who was admitted to our Surgical Department due to rectal bleeding and abdominal pain. Preoperative colonoscopy, staging exams and subsequent surgery demonstrated a stenotic adenocarcinoma of the sigmoid colon, invading the left urinary tract and the homolateral bladder wall, with regional lymph nodes involvement and massive bilobar liver metastases (T4N1M1). After Hartmann's rectosigmoidectomy and despite systemic chemotherapy, a rapid progression occurred and the patient survived for only 5 months after diagnosis. Five years before detecting this advanced colonic cancer, the patient underwent aortic valve replacement due to a severe Streptococcus bovis endocarditis. Subsequent to this infection he never underwent a colonoscopy until overt intestinal symptoms appeared. CONCLUSION: As this case illustrates, in the unusual setting of a Streptococcus bovis infection, it is necessary to timely and carefully rule out occult colon cancer and other malignancies during hospitalization and, if a tumor is not found, to schedule endoscopic follow-up. Rigorous application of these recommendations in the case described would have likely led to an earlier diagnosis of cancer and maybe saved the patient's life.