A New Medium (HistoCold) for Surgical Specimens Preserving to Improve the Preanalytic Issues in Histopathological Samples Handling: Morphologic and Antigenic Analysis.

Introduction: The onset of precision medicine has led to the integration of traditional morphologic tissues evaluation with biochemical and molecular data for a more appropriate pathological diagnosis. The preanalytic phase and, particularly, timing of cold ischemia are crucial to guarantee high-quality biorepositories of formalin-fixed paraffin-embedded (FFPE) tissues for patients' needs and scientific research. However, delayed fixation using the gold-standard and carcinogenic fixative neutral-buffered formalin (NBF) can be a significant limitation to diagnosis and biopathological characterization. HistoCold (patented; Bio-Optica Milano S.p.A., Milano, Italy) is a nontoxic, stable, and refrigerated preservative solution for tissue handling. This study examined HistoCold's potential role in improving the preanalytic phase of the pathological diagnostic process. Materials and Methods: Breast, lung, or colorectal cancers (20, 25, and 10 cases, respectively) that were to be surgically resected were recruited between 2019 and 2021. Once specimens were surgically removed, three residual samples for each patient were first promptly immersed into HistoCold for 24, 48, and 72 hours and then FFPE. These were compared with routine specimens regarding morphologic features (hematoxylin and eosin) and tissue antigenicity (immunohistochemical stains). Results: Good concordance regarding both the morphologic characteristics of the neoplasms and their proteins expression between the routine and HistoCold handled tissues were found. The tissue handling with the solution never affected the histopathological diagnosis. Conclusions: The use of HistoCold for samples transporting is easy, allows for improving the management of cold ischemia time, and monitoring the fixation times in NBF, resulting in good quality tissue blocks for biobanking. Moreover, it could be a candidate to eliminate formalin from operating theaters. HistoCold looks very promising for the preanalytic phase of human tissues handling in the era of precision medicine, to provide the best service to patients, and to scientific research.

Retroperitoneal and iliopsoas abscess as Crohn's disease onset mimicking a common lumbosciatic pain.

Crohn's Disease (CD) refers to a chronic transmural bowel inflammation affecting a range between 5 and 15 per 100,000 person-years worldwide 1. In patients with stricturing CD, the transmural pattern of inflammation may trigger the development of sinus tracts able to connect to other tissues, leading to the formation of fistulas or abscesses 2. Intra-psoas abscesses are rare, affecting between 0.4-4.3% of patients with CD 3. We present the case of a 36-year-old male with no past medical history except for a two-week worsening lumbosciatalgia not responding to standard nonsteroidal anti-inflammatory drugs, who complained sudden abdominal pain, with right lower abdominal stiffness combined to a severe edema and erythema of the right lower limb, extended from the gluteus down to the knee, involving the anteromedial and posteromedial areas of his thigh. Patient was septic and CT scans revealed a large complex air-fluid collection within the right iliac region, involving terminal ileum, right retroperitoneum and right lateral abdominal wall towards the inner edge of his thigh. Diagnosis of CD was made on histopathology and the patient gained full recovery thanks to a prompt surgical intervention followed by high-dose antibiotic infusion and vacuum-assisted wound closure. Intra-psoas abscesses, albeit rare, are a known manifestation of CD and frequently lead to misdiagnosis because of their rarity and their unusual location easily mimicking other diseases. Therefore, clinician's awareness must be heightened for complicated CD in the setting of intra-psoas abscesses in order to avoid delayed treatment. KEY WORDS: Crohn disease, Psoas abscess, Sciatica, Late onset disorders, Negative pressure Wound therapy.

An extremely rare finding of goblet cell carcinoid of the appendix. A case report.

Goblet cell carcinoid or carcinoma (GCC) refers to an extremely rare appendiceal tumor usually diagnosed on post-operative histology as an incidental finding. Primary cancers of the vermiform appendix are quite rare, representing less than 1% of all gastrointestinal malignancies. GCCs are considered as a distinct entity of appendiceal tumors, consisting of both epithelial (glandular) and neuroendocrine elements containing goblet cells. This entity tends to be more aggressive than typical carcinoid tumors as it often presents with metastatic disease. Therefore, an early recognition and an appropriate grading is essential. The 5-year overall survival is 14-22% in stage III-IV disease. As a matter of fact, GCC warrants more aggressive surgical and medical (chemotherapy) treatments than typical carcinoid tumors. We, hereby, report a case of a 67-year old male presenting with an acute abdominal obstruction and a severe tenderness predominant in his right lower quadrant, together with an endoscopic and radiological suspect of left colonic malignancy and acute appendicitis. Left hemicolectomy and appendicectomy were performed and pathological specimens revealed a lowgrade adenocarcinoma of the descending colon and a high-grade appendiceal goblet cell carcinoid. Subsequent right hemicolectomy was performed according to the current guidelines. GCCs are more aggressive compared with conventional appendiceal tumors but less aggressive compared with adenocarcinomas and they often present with serosal and mesoappendiceal involvement. The lack of a standardized classification system for GCC and the discrepancies in specific reliable markers are responsible for an insufficient prognostic and predictive value at diagnosis. KEY WORDS: Appendiceal neoplasms, Carcinoid tumor, Colectomy, Goblet cells, Immunochemistry.

A rare finding of Actinomyces odontolyticus abdominal actinomycosis presenting as abdominal wall and pericolic pseudotumoral mass.

Abdominal actinomycosis refers to a rare chronic suppurative infectious occurrence, caused by filamentous Gram-positive microaerophilic and anaerobic bacteria Actinomyces, that may appear as an abdominal mass and/or abscess, feasibly mimicking a malignancy 1,2. Due to its rarity and unspecific clinical evidence, the majority of cases are diagnosed after tissue specimen. We hereby report a case of a 69-year-old patient with a one week worsening abdominal pain and swelling. A large tender palpable mass in the epigastric region was noted on physical exam. An ultrasound-guided drainage followed by a surgical excision approach became both a way to confirm the diagnosis and a therapeutic tool. Diagnosis of actinomycosis was made on histopathology and microbiology. Even though the incidence of actinomycosis has decreased, the abdominal presentation has been observed with increasing frequency 3. KEY WORDS: Actinomycosis, Abdominal wall, Abdominal abscess, foreign-body reaction, Colonic neoplasms.

Laparoscopic peritoneal lavage: our experience and review of the literature.

INTRODUCTION: Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. AIM: This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. MATERIAL AND METHODS: We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. RESULTS: The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. CONCLUSIONS: Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage.

Robotic Total Gastrectomy With Intracorporeal Robot-Sewn Anastomosis: A Novel Approach Adopting the Double-Loop Reconstruction Method.

Gastric cancer constitutes a major health problem. Robotic surgery has been progressively developed in this field. Although the feasibility of robotic procedures has been demonstrated, there are unresolved aspects being debated, including the reproducibility of intracorporeal in place of extracorporeal anastomosis.Difficulties of traditional laparoscopy have been described and there are well-known advantages of robotic systems, but few articles in literature describe a full robotic execution of the reconstructive phase while others do not give a thorough explanation how this phase was run.A new reconstructive approach, not yet described in literature, was recently adopted at our Center.Robotic total gastrectomy with D2 lymphadenectomy and a so-called "double-loop" reconstruction method with intracorporeal robot-sewn anastomosis (Parisi's technique) was performed in all reported cases.Preoperative, intraoperative, and postoperative data were collected and a technical note was documented.All tumors were located at the upper third of the stomach, and no conversions or intraoperative complications occurred. Histopathological analysis showed R0 resection obtained in all specimens. Hospital stay was regular in all patients and discharge was recommended starting from the 4th postoperative day. No major postoperative complications or reoperations occurred.Reconstruction of the digestive tract after total gastrectomy is one of the main areas of surgical research in the treatment of gastric cancer and in the field of minimally invasive surgery.The double-loop method is a valid simplification of the traditional technique of construction of the Roux-limb that could increase the feasibility and safety in performing a full hand-sewn intracorporeal reconstruction and it appears to fit the characteristics of the robotic system thus obtaining excellent postoperative clinical outcomes.

Robotic pylorus-preserving pancreaticoduodenectomy: Technical considerations.

Laparoscopy has revolutionized the way of thinking abdominal surgery, however, to date there are still limitations making it difficult to apply this technique to some types of surgical procedures considered technically demanding even when performed by open surgery, such as the pancreaticoduodenectomy. This technical note provides a complete description of the surgical procedure performed for the execution of a robotic pancreaticoduodenectomy through the use of the "Da Vinci Si" robotic system. Robotic systems represent a real evolution in minimally invasive surgery. We wish to emphasize this concept, highlighting the application of this technology to complex procedures in digestive surgery.

Endoscopic rendez-vous after damage control surgery in treatment of retroperitoneal abscess from perforated duodenal diverticulum: a techinal note and literature review.

INTRODUCTION: The duodenum is the second seat of onset of diverticula after the colon. Duodenal diverticulosis is usually asymptomatic, but duodenal perforation with abscess may occur. CASE PRESENTATION: Woman, 83 years old, emergency hospitalised for generalized abdominal pain. On the abdominal tomography in the third portion of the duodenum a herniation and a concomitant full-thickness breach of the visceral wall was detected. The patient underwent emergency surgery. A surgical toilette of abscess was performed passing through the perforated diverticula and the Petzer's tube drainage was placed in the duodenal lumen; the duodenostomic Petzer was endoscopically removed 4 months after the surgery. DISCUSSION: A review of medical literature was performed and our treatment has never been described. CONCLUSION: For the treatment of perforated duodenal diverticula a sequential two-stage non resective approach is safe and feasible in selected cases.

Bronchogenic cyst of the ileal mesentery: a case report and a review of literature.

INTRODUCTION: Bronchogenic cyst is a rare clinical entity that occurs due to abnormal development of the foregut; the majority of bronchogenic cysts have been described in the mediastinum and they are rarely found in an extrathoracic location. CASE PRESENTATION: We describe the case of an intra-abdominal bronchogenic cyst of the mesentery, incidentally discovered during an emergency laparotomy for a perforated gastric ulcer in a 33-year-old Caucasian man. CONCLUSIONS: Bronchogenic cyst should be considered in the differential diagnosis of subdiaphragmatic masses, even in an intraperitoneal location.

Unicentric Castleman's disease approached as a pancreatic neoplasm: case report and review of literature.

Castleman's disease is a rare lymphoproliferative disorder. Most cases occur in the mediastinum and the pancreatic localization is uncommon; currently there are only nine reported cases in the literature about peripancreatic localization. We report a case of a 62 years old man with a Castleman's disease mimicking a pancreatic neoplasm.

The single-photon emission computed tomography/computed tomography: a new procedure to perform the sentinel node biopsy in patients with head and neck melanoma.

The aim of this study was to define and validate a new technique to detect the sentinel node (SN) in patients treated for head and neck melanoma. In a small series of 23 head and neck melanoma patients, lymphatic mapping was followed by SN biopsy, using in 12 patients a new diagnostic imaging technique, single-photon emission computed tomography/computed tomography. The procedure is described and the major problems encountered are discussed. The preliminary data show that identification of SN using single-photon emission computed tomography/computed tomography never failed in 12 patients, and biopsies performed, compared with those in a standard group, took significantly less time (Mann-Whitney test P=0.006). In conclusion, the authors underline the possibility of a wide use for this technique.

[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.