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CHIRURGIA CONSERVATIVA DOPO CHEMIOTERAPIA PRIMARIA PER CARCINOMA DELLA MAMMELLA SUPERIORE A 3 CM
No full textA peculiar case of mixed medullary-papillary thyroid carcinoma [Un raro caso di tumore misto midollare-papillare della tiroide]
No full textMixed medullary-follicular or papillary carcinomas are seldom found in the thyroid gland. The first one is defined by the WHO classification as a tumour showing both morphological features of medullary and follicular carcinoma with immunoreactive calcitonin and thyroglobulin. The second one is not enough listed in the above-mentioned classification and reports about it are still few. In the reported case, at first, multiple liver metastases were identified. Histological examination showed to be metastases of a papillary carcinoma. The patient subsequently underwent a total thyroidectomy. In the right lobe of the gland a tumour which exhibited features of both medullary and papillary carcinoma and both calcitonin and thyroglobulin immunoreactivity was found. The immunohistochemical examination of the liver metastases revealed the same immunohistochemical findings of the primary thyroid tumour, thus further confirming the diagnosis of mixed medullary-papillary carcinoma of the thyroid gland. The patient was submitted to a radioiodine treatment without success. Subsequent somatostatin analogue treatment induced a remarkable reduction of calcitonin sermn level and US liver metastases disappearance. The recognition of the rare mixed medullaryfollicular or papillary thyroid carcinoma suggests hypotheses on its histogenesis and C cells derivation. Moreover, according to some authors, this mixed tumour might constitute a new clinicopathologic entity, different from the conventional medullary one, with a specific epidemiology, clinical course and new treatment resources
Il tumore a cellule granulari della mammella maschile. Descrizione di un caso clinico
No full textGranular cell tumor of the male breast is an extremely rare neoplasm. The case of a 64-year-old man with a periareolar lump in the upper medial quadrant of his left breast of recent onset is reported. At clinical examination, it was a poorly circumscribed, irregular, hard, mobile 1 cm mass. No axillary lymph nodes were palpable. The patient was submitted to ultrasound scan which showed a 1 cm periareolar solid hypoechoic lesion with an acoustic shadowing and subsequently to fine needle biopsy that revealed the presence of also atypical ductal hyperplasia. For this reason he was submitted to excision biopsy. The definitive histology was of granular cell tumor. The immunohistochemical investigations showed an intense positiveness for S-100 protein; the staining with PAS showed a diffuse positiveness. At 18 months after treatment the patient had no recurrence of disease. Granular cell tumor of the male breast is a neoplasm whose differential diagnosis with carcinoma is often possible only with definitive histology. For this reason, also in front of a mammary lump strongly suspicious for carcinoma, it's always necessary to think it can be this neoplasm and therefore to wait for the necessary histopathologic confirmation
Moving forward with electrochemotherapy for skin metastases: The need for timely referral and comprehensive reporting
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Intraoperative ultrasonography in the detection of liver metastases of gastrointestinal cancer. [L'ecografia intraoperatoria nella diagnosi di metastasi epatiche da neoplasia gastrointestinale]
No full textThe authors illustrate their experience in the systematic use of intraoperative ultrasonography of the liver in patients undergoing surgery due to gastrointestinal cancer. The liver is the organ in which mestastases from colorectal, stomach, pancreatic, and biliary cancer are most often localised. Between January 1991 and April 1992 95 patients underwent intraoperative ultrasonographic controls of the liver. In all cases the liver was studied using traditional image diagnosis: standard ultrasonography and CAT. On the basis of their experience the authors observed 12 cases negative for metastases using CAT and traditional ultrasonography which were positive using intraoperative ultrasonography, 2 cases which were positive for secondary hepatic lesions using traditional diagnostic tools but negative following histological tests guided by intraoperative ultrasonography. In the case of false negatives using traditional methods, those metastases revealed by intraoperative ultrasonography were above all located deep down and in segments which are difficult to explore, or were so small that they were not visible or palpable during intraoperative controls of the viscera. Intraoperative ultrasonography of the liver has been found to be a more sensitive test (97% of the best series) than standard ultrasonography (65%) or CAT (43%). Higher resolution due to the characteristics of the method is coupled with the possibility that intraoperative ultrasonography may be used to guide biopsies of the metastases revealed, thus allowing histological confirmation to be obtained: for this reason the risk of false positives is virtually zero. Intraoperative ultrasonography has been found to be a very sensitive method since it enables metastases to be identified which are not revealed by preoperative staging, or, in the event that metastases have been located prior to surgery, to specify their number. Given that the prognosis for patients with gastrointestinal cancer improves if metastases are identified and treated as early as possible (especially in the case of repeated colorectal cancer), intraoperative ultrasonography allows more precise staging of cancer, thus modifying surgical tactics, initially programmed to include the removal of the primary tumour, and extending it to the removal of the metastases. When the latter are multiple and cannot be operated, surgery is therefore shown to be palliative and arterial chemotherapy is indicated. Intraoperative ultrasonography allows the major vascular and biliary structures to be recognised, making surgical procedures safer and easy to perform. Lastly, on the basis of the authors' experience the method is free of complications
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