Mucosa associated lymphoid tissue lymphoma of the thyroid gland: a case report and literature review = MALT linfoma della tiroide: caso clinico e revisione della letteratura

Mucosa associated lymphoid tissue (MALT) lymphomas are low-grade, non-Hodgkin’s B cell lymphomas, mainly occurring in the gastrointestinal tract, but also in other tissues. We describe the management of a patient with hypothyroidism, tracheoesophageal compressive symptoms and chest tightness affected by a thyroid MALT lymphoma. The patient underwent debulking thyroidectomy and temporary tracheostomy in order to reduce dysphonia and dysphagia, followed by adjuvant chemotherapy and subsequently radiation therapy. A CT scan performed at the end of radiotherapy 6 months after surgery revealed remnants of residual tissue from the thyroidectomy without any pathological findings. I linfomi MALT sono dei linfomi non-Hodgkin a cellule B a basso grado che in genere insorgono a livello del tratto gastrointestinale, ma anche in altri tessuti. Descriviamo in questo articolo il management clinico-chirurgico di un paziente con ipotiroidismo, sintomi da compressione tracheo-esofagea e senso di oppressione toracica, affetto da linfoma MALT della tiroide. Il paziente è stato sottoposto a parziale asportazione della massa tiroidea e tracheostomia allo scopo di ridurre i sintomi compressivi ed in seguito a trattamento chemioterapico e radioterapico. L’esame TC effettuato una volta conclusa la radioterapia, circa 6 mesi dopo l’intervento, ha evidenziato gli esiti della tiroidectomia parziale in assenza di altri reperti patologici

Molecular analysis of appendiceal mucinous cystadenoma and rectal adenocarcinoma in a patient with urothelial carcinoma: a case report

Introduction: In this report, we present the case of a patient affected by appendiceal cystadenoma, a colorectal adenocarcinoma, and a concomitant bladder carcinoma, as well as the results of the molecular study of the most relevant mutational pathways involved in these tumors. Case presentation: A 68-year-old Italian man was admitted to our unit complaining of macrohematuria, rectorrhagia, and rectal tenesmus for about 2 months. A colonoscopy showed the presence of a rectal lesion at 11cm from the anal margin; multiple biopsies were performed and a diagnosis of moderately differentiated adenocarcinoma was made. Abdominal ultrasonography and total body computed tomography performed subsequently to stage the rectal cancer showed the presence of two round nodules, interpreted as swollen lymph nodes of neoplastic origin, at the anterior aspect of the iliopsoas muscle and a budding lesion affecting the bladder. The patient underwent transurethral biopsy of the lesion in the right retrotrigonal region; the diagnosis was grade II urothelial carcinoma. The patient underwent an open anterior rectal resection with loco-regional lymphadenectomy. An enlarged appendix and a voluminous whitish soft-tissue lesion requiring an appendicectomy were detected perioperatively. Transurethral resection of the bladder lesion was also performed. The histological examination revealed that the nodular lesions in the appendix were due to a cystadenoma. For mutation analysis, genomic deoxyribonucleic acid was isolated from tumor tissue samples; for PIK3CA mutations, screening revealed that all three samples analyzed carried mutations in exon 9. Conclusions: Appendiceal mucoceles are rare but require adequate surgical treatment, given their malignant potential and the possibility of causing peritoneal pseudomyxoma. It is essential to make a correct preoperative evaluation based on a colonoscopy rather than ultrasound and computed tomography to exclude synchronous neoplasias often associated with mucoceles and to plan the optimum surgical strategy. The association between appendiceal mucoceles and other neoplasias is relatively frequent, especially with colorectal cancer. Oncogenic activation in the PIK3CA-depending pathway may contribute substantially to the pathogenesis of the different solid tumors in the same patient

[Gastrointestinal stromal tumors]

Comment on: Ridolfini M. P., Cassano A., Ricci R., Rotondi F., Berardi S., Cusumano G., Pacelli F., Doglietto G. B. (2011) Gastrointestinal stromal tumors, Ann. Ital. Chir. 2011 Mar-Apr;82(2):97-109

Conservative management of minor anastomotic leakage after open elective colorectal surgery

Introduction: The utility of prophylactic drainage in colorectal surgery is controversial. The aim of the present article is to study the role of drainage tubes on the management of minor anastomotic dehiscences. Patients and Methods: We retrospectively review clinical reports of 18 consecutive patients with anastomotic dehiscence after open elective colorectal surgery. The mean age was 63 years and the male – female ratio was 5:1. Nine (50%) patients underwent re-operation for fecal peritonitis (group A) while the remaining nine (50%) were managed conservatively (group B). The parameters evaluated in both groups were: time of the anastomotic breakdown, clinical findings, amount of fluid drained the day of the dehiscence, diagnostic means used, length of stay and mortality. Results: Anastomotic leakages were observed medially after 3,6 days from surgery in group A and after 5.6 days in group B. The most frequent clinical manifestations were: fecal material through the tubes (88.9%), pelvic pain (88.9%) and fever (77.8%). Patients in group A had a median faecal fluid flow of 235cc the day of the dehiscence and 130cc those in group B. Imaging was employed only in three cases in group A and in all cases in group B. The length of hospital stay was longer in patients treated surgically: 37 days versus 29 in those treated conservatively. Conclusions: Minor anastomotic leakages generally occur later than greater ones, they have a milder clinical presentation and can be managed conservatively with the use of drain tubes

Accidental parathyroidectomy as a risk factor for postoperative hypocalcemia in thyroid surgery

Introduction Hypocalcemia is the most common complication in thyroid surgery. The identification of risk factors is useful toavoid postoperative hypocalcemia and prolonged hospital stay in patients who underwent total thyroidectomy. The aim of this study was to evaluate the impact of accidental parathyroidectomy during thyroidectomy on the postoperative calcemic status of the patients. Materials and Methods Clinical and pathological data of 102 patients who underwent total thyroidectomy were reviewed. We compared postoperative serum calcium levels of 51 patients without accidental removal of the parathyroids (group A) with those of 51 patients with unintentional parathyroidectomy (group B). Furthermore, calcemic levels were stratified in relation to the number of parathyroids accidentally removed. Results Biochemical postoperative hypocalcemia was observed in 40 (39%) patients overall: eleven of them belonged to Group A and 29 to Group B. The mean value of postoperative calcemia was 8.5 mg/dL in group A and 7.9 mg/dL in Group B. Patients with one parathyroid excised presented hypocalcemia in 50% of cases, while biochemical hypocalcemia was observed in all patients with more than one gland excised. Conclusion Biochemical postoperative hypocalcemia was observed in 40 (39%) patients overall: eleven of them belonged to Group A and 29 to Group B. The mean value of postoperative calcemia was 8.5 mg/dL in group A and 7.9 mg/dL in Group B. Patients with one parathyroid excised presented hypocalcemia in 50% of cases, while biochemical hypocalcemia was observed in all patients with more than one gland excised.</br

Robotic-assisted approach to Median Arcuate Ligament Syndrome with left gastric artery originating directly from the aorta. Report of a case and review of the current mini-invasive treatment modalities

Background: Median Arcuate Ligament Syndrome (MALS) is a rare clinical condition. Methods: Through the analysis of a case report and a review of the international literature, we examined whether robotic and laparoscopic MAL release are safe and feasible. Results: Of 354 and 19 patients who underwent laparoscopic MAL release (LMALr) and robotic-assisted MAL release (RMALr), respectively, conversion to open surgery occurred in 6.8% of cases following LMALr, whereas no case of conversion was reported following RMALr. Immediate symptomatic improvement was reported in 92.1% of cases following LMALr and in 84.2% of cases following RMALr. In the LMALr group 9% of patients presented with recurrence of symptoms, whereas the percentage in the RMALr group was 5.3%. LMALr was related to a higher overall complication rate when compared with RMALr (7.3% vs 5.3%). Conclusions: Both laparoscopic and robotic-assisted MAL lysis with celiac ganglionectomy can be safely performed with minimal patient morbidity

Clinical features and surgical management of patients with gastrointestinal stromal tumor of the stomach

Gastrointestinal stromal tumors (GISTs) have an annual incidence of approximately 8000–9000 cases in Europe and 4000–5000 cases in the USA even if several autoptic studies registered higher incidences. The median age of onset is approximately 60 years without a clear gender predilection. The 60% of GISTs are located in the stomach. The aim of this study is to describe the clinical characteristics and to define the appropriate surgical management of gastric GISTs

Gastric cancer in north Sardinia, Italy: an epidemiological report

Aims:The aim of this study was to describe the epidemiological characteristics and trends of gastric cancer in north Sardinia, Italy, in the period 1992-2010. Materials and methods. Data were obtained from the cancer registry of the province of Sassari, which makes part of a wider registry web coordinated by the Italian Association for Tumor Registries. Results. The overall number of gastric cancer cases registered was 1227. The male-to-female ratio was 1.7:1 and the mean age 69 years for males and 71 years for females. The standardized incidence rates were 15.6/100,000 and 7.3/100,000 and the standardized mortality rates 11.7/100,000 and 5.8/100,000 for males and females respectively. Conclusions. Low and stable trends in incidence and mortality of gastric cancer in both sexes were evidenced in North Sardinia, in the period under investigation. Nevertheless, the relative survival at 5 years from diagnosis was relatively low. This suggests that there must be an enhancement of surveillance policies, and that the diagnosis and treatment methods adopted in the area must improve.</br

Surgical management of hepatocarcinoma c hest wall metastasis: a case report

Metastatic tumor are the most frequent neoplastic lesions of the thoracic wall. We present a case of hepatocarcinoma metastasis, the surgical strategy adopted and a brief review of the literature on the management of such conditions

A prospective non-randomized controlled, multicenter trial comparing Appendectomy and Conservative Treatment for Patients with Uncomplicated Acute Appendicitis (the ACTUAA study)

Purpose: Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20 years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan. Methods: All adult patients in the age range 18 to 65 years with suspected AA, consecutively admitted to the Surgical Department of the 13 participating Italian Hospitals, will be invited to take part in the study. A multicenter prospective collected registry developed by surgeons, radiologists, and pathologists with expertise in the diagnosis and treatment of uncomplicated acute appendicitis represents the best research method to assess the long-term role of antibiotics in the management of the disease. Comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Quality of life, length of hospital stay, pain evaluation, and time to return to normal activity will be evaluated as secondary outcome measures. Trial registration: Clinicaltrials.gov ID: NCT03080103