[Pinch-off syndrome]. / La sindrome di pinch-off.

Totally implantable central venous access devices, or ports, are commonly used for those patients which require long-term or continuum intravenous infusion therapy. We report a case of a rare complication related to them, called pinch-off syndrome, arising by the chronic compression of the central venous catheter between the clavicle and the first rib, with consequent mechanic obstruction of the catheter and eventual complete transection and embolization of a distal fragment of it. A chest radiograph, eventually with the injection of contrast through the catheter, is require when pain and/or swelling in the chest or shoulder at the side go the port occur at the time of infusion plus malfunction of it. The therapy of pinch-off syndrome is removal of the fractured or with embolism catheter and replacement of a new one more laterally to the previous approach.

[Gallbladder injury]. / A proposito di un trauma della colecisti.

The Authors report on a rare case of blunt traumatic injury of the gallbladder. A careful clinical examination, an abdominal ultrasonography and a contrast material-enhanced computed tomography have a primary importance for a correct diagnosis. Laparoscopic surgery has an important diagnostic and, in selected cases, therapeutic role. In all traumatic gallbladder ruptures, after an accurate search of eventual associated injuries of other abdominal organs, cholecystectomy is considered the treatment of choice.

[Mesenteric fibromatosis]. / La fibromatosi mesenterica.

Mesenteric fibromatosis is a rare benign mesenteric tumour, characterised by infiltrative growth and high rates of recurrence. Histological examination is the only diagnostic procedure capable of ruling out a malignant mesenteric neoplasm. It is not always possible to perform a radical removal of the tumour mass because it may have infiltrated important anatomical structures. In the present study the Authors report two cases of mesenteric fibromatosis and analyse the main clinical-diagnostic, therapeutic and prognostic problems posed by these tumours.

Reconstructive surgery in anal giant condyloma: Report of two cases.

INTRODUCTION: Giant anal condyloma also called Buschke-Löwenstein tumor is a rare sexually transmitted disease involving anogenital region with potential malignant degeneration into invasive squamous carcinoma. Complete surgical excision is the treatment of choice and often wide wounds are necessary to reach clear margins and prevent recurrence. PRESENTATION OF CASE: The authors present two cases treated with an S-plasty rotating and a bilateral house advancement flap respectively with good functional result. DISCUSSION: Giant anal condyloma also called Buschke-Löwenstein tumor is a large exophytic, cauliflower-like mass that is characterized by local aggressive behavior. Immunosuppression favors rapid growth of the condylomas and increases the risk of their malignant transformation. In limited lesions primary excision can be safely performed leaving wounds open to granulate while in more extensive lesions flap or skin graft coverage is preferable to decrease the length of recovery and minimize risk of severe anal stricture. Abdominoperineal resection should be performed for more extensive lesions with deep invasion, malignant transformation or tumor recurrence. CONCLUSION: Giant anal condyloma also called Buschke-Löwenstein is a rare pathology with mainly sporadic single center experience reported in literature. Surgical complete excision remains the best treatment although elevate should be eventual recurrence. No sufficient data are available to recommend any medical treatment such as interferon, radiotherapy or chemotherapy.

Pancreatic-type acinar cell carcinoma of the stomach beneath a focus of pancreatic metaplasia of the gastric mucosa.

Acinar cell carcinoma is an uncommon type of carcinoma of the pancreas that can exceptionally arise in ectopic pancreatic tissue. Herein, we report a case of a 52-year-old man with pancreatic-type acinar cell carcinoma of the stomach and concomitant pancreatic metaplasia of the adjacent nonneoplastic gastric mucosa. There was neither clinical nor radiographic evidence of a tumor in the pancreas itself. A subtotal gastrectomy was performed. Macroscopically, an ulcerated tumor, measuring 4 x 1.7 cm, was found in the distal antrum. Microscopically, the biopsy and the surgical specimen revealed a neoplasm with a predominantly trabecular architecture composed of moderately atypical cells with finely dispersed chromatin and indistinct nucleoli. The neoplastic cells and those of the adjacent metaplastic mucosa were both strongly immunoreactive for alpha-1-antitrypsin, consistent with pancreatic acinar cell differentiation. Ectopic pancreatic-type acinar cell carcinoma is an extremely rare condition, having been previously reported only in 5 occasions, none of them in association with pancreatic acinar cell metaplasia of the gastric mucosa.