A. Caporale

Silent colon carcinoma presenting as a hepatic abscess

Penetration and abscess formation in an adjacent parenchymal organ as presentation of a colon cancer is very uncommon. We report a rare case of pyogenic liver abscess as the first manifestation of an infiltrative and penetrating hepatic flexure colon carcinoma without liver metastases. A 50-year-old woman was admitted with right abdominal pain, fever and chills. The initial diagnosis was a pyogenic liver abscess. Subsequent CT scan and colonoscopy evidenced a hepatic flexure colon cancer abscessed within segment 6 of the liver. Eight months after a right colectomy and liver resection there was no evidence of disease. The occurrence of a pyogenic liver abscess should raise the suspicion of a silent colon cancer.

Gastric Cancer Precursor Lesions and Helicobacter pylori Infection in Patients with Partial Gastrectomy for Peptic Ulcer

The mucosa of the gastric stump is considered at greater risk of dysplastic and neoplastic changes than that of the intact stomach. The combination of enteric reflux and Helicobacter pylori infection may have a synergistic damaging effect on the mucosa of the gastric remnant, both producing and increasing mucosal proliferation. The aim of this study was to assess whether the occurrence of H. pylori infection in the remnant mucosa of partially gastrectomized subjects for peptic ulcer disease is associated with an increase of the mucosal precursor lesions of malignancy. A series of 151 subjects who underwent partial gastrectomy for peptic ulcer disease were submitted to upper digestive endoscopy for long-term surveillance. Biopsy specimens of the gastric stump were tested for the occurrence of H. pylori infection and for the presence of precancerous mucosal lesions. The prevalence of H. pylori colonization in the remnant stomach was less than 30% and similar in subjects with different time intervals between gastrectomy and endoscopy. Age at surgery (χ2: p = 0.03) and H. pylori infection (χ2: p = 0.002) were significantly associated with the grading of mucosal lesions. The prevalence of normal mucosa was 10 times higher in H. pylori-negative patients as in H. pylori-positive ones (22.0% vs. 2.4%), and the prevalence of intestinal metaplasia was four times higher in H. pylori-positive patients than in H. pylori-negative ones (19.6% vs. 4.6%). We concluded that H. pylori infection may play a causal role in the development of gastric lesions in the operated stomach.

Is desmoplasia a protective factor for survival in patients with colorectal carcinoma

BACKGROUND & AIMS The role of desmoplasia in colorectal carcinoma progression is unclear and the presence of collagen stroma may represent a barrier against cancer diffusion and vascular invasion or a stroma to build up and support the tumor. The aim of this study was to evaluate the effect of desmoplastic response on long-term survival of patients who underwent radical resection for colorectal carcinoma. METHODS The study included 429 patients who underwent radical colorectal resection for cancer with a median follow-up period of 72.8 months. RESULTS At univariate analysis significant associations were observed between desmoplasia and histologic type, parietal infiltration, growth pattern, and staging. No associations were found between desmoplasia and the other clinical and histologic parameters. The multivariate analysis stratified for tumor stage revealed that the factor showing the most favorable influence on time to death was desmoplasia. The presence of desmoplasia was likely to decrease the failure rate to a third of the rate experienced by patients without desmoplasia. Parietal infiltration was associated with an increased risk for a shortened time to death. CONCLUSIONS Our results favor the view that desmoplasia is a protective factor for survival in patients with colorectal carcinoma. This finding is consistent with the hypothesis that desmoplasia may prevent cancer invasiveness by building a barrier against tumor diffusion.

True aneurysm of the ulnar artery in a soccer goalkeeper: A case report and surgical considerations

An aneurysm of the ulnar artery was first described by Guattani in 1772. It is a rare lesion, usually caused by blunt or penetrating trauma, often the result of occupational or athletic activity. Aneurysms of the ulnar artery have been found in manual laborers who repetitively use a hammer, a screwdriver, or other tool against fixed objects and in athletes who receive repetitive blunt injury to the hand. Smokers are particularly at high risk because tobacco may have deleterious effects on the arterial vasculature when superimposed on an aneurysmal defect. Aneurysms are generally located in the superficial segment of the ulnar artery at the level of the carpal hamate bone and may be true or false. A false aneurysm has a fibrous wall vessel, whereas a true aneurysm shows a marked change of the three vascular layers. The true aneurysm often follows a blunt injury of the hand, whereas a false aneurysm generally results from a penetrating artery injury. We report a case of a sports-related true ulnar artery aneurysm.

Quantitative Investigation of Desmoplasia as a Prognostic Indicator in Colorectal Cancer

ABSTRACT Background: The role of desmoplastic reaction (DR) in colorectal cancer invasion is still an open question. The presence of fibrous connective tissue may represent a barrier against cancer diffusion or a stroma to build up and support the tumor. Aims of the present study were to evaluate the influence of DR on long-term survival and to validate a reliable quantitative method to measure the desmoplastic tissue. Methods: This retrospective study included 86 patients who underwent radical colorectal resection for cancer, from a database of 429 patients. To achieve a quantitative histochemical measurement of DR, digital images were analyzed by a computerized image analysis program. DR was related to the overall survival and the quantitative method was related to the traditional one. Results: By using the Kaplan-Meier analysis, DR was found to be significantly associated with overall survival. Patients with a higher value of DR survived longer than those with smaller DR and the quantitative results were in accordance with those obtained by using the traditional methods. Conclusions: Desmoplasia seems to be a protective factor for survival in patients with colorectal carcinoma. The quantitative technique is easily standardized and can be routinely performed, so that DR may be a useful prognostic indicator. Notwithstanding, the conflicting outcomes reported in literature about DR need further biological and molecular studies to achieve definitive conclusions.

Oesophagocardioplasty for residual dysphagia following multiple pneumatic dilatations for achalasia

.Cardioplastywithagastricpatchwasemployedfor the treatment of these patients.Patients and methodsCardioplasty was performed in eight patients who hadundergone three to six previous pneumatic dilatationsfor achalasia. No patient had previously had surgery forachalasia.Therewerefivewomenandthreemenagedmean(range) 45 (38–65) years who had experienced dysphagiafor 5–13 years. Seven patients had gross megaoesophagusand one had marked fibrosis at the cardia. No patienthad oesophageal reflux on pH monitoring. Manometricstudies showed high pressure in the lower oesophagealsphincter (mean(s.d.) 37·0(6·8) (range 28–40) mmHg),weak simultaneous contractions in the body and absentsphincter relaxation.

Leiomyosarcoma of the rectum after pelvic radiation therapy for endometrial carcinoma.

during the same examination. In this respect, it is noteworthy that, out of 163 CD patients newly diagnosed by Dickey and Hughes, 33 (20%) were suspected of having the disease and biopsied only because of the presence of endoscopic signs. Celiac sprue is a disease with a wide spectrum of clinical manifestations, varying from overt malabsorbtion to subclinical or even silent forms (4); the golden standard for the diagnosis relies on histological abnormalities that improve under a gluten-free diet (5). Although initially considered to be relatively uncommon, it has now been found to be one of the most frequent genetically based diseases in the general population (6–8). The real problem is deciding which patients should be submitted to duodenal biopsies: at present, clinical history and symptoms, biochemical findings suggestive of malabsorbtion, and/or positive serological markers (antigliadin, antiendomysium, and antitransglutaminase antibodies) are considered indications for obtaining an intestinal biopsy; the presence of duodenal markers is a very important adjunctive tool that must strongly induce endoscopists to perform duodenal biopsies.

Surgical Management of Nonparasitic Cysts of the Liver: Report of 17 Cases

A retrospective study of 17 patients with symptomatic nonparasitic liver cysts, surgically treated over a 19-year period at the First Surgical Clinic, University of Rome ‘La Sapienza’, was carried out to evaluate the incidence, symptoms and management of this condition. The incidence of liver cysts was 4.28/1,000 with respect to the number of abdominal surgical procedures performed between 1987 and 1990, and 1.75/1,000 with respect to the number of ambulatory liver ultrasonographies carried out in the same time period as the last 12 cases. The critical diameter at which the cyst becomes symptomatic was found to be 5 cm (p

Areas of Adenoma in Advanced Colorectal Carcinomas: Relationship to Clinical and Pathological Features

Although most evidence suggests that colorectal carcinomas arise from a preexisting adenoma, some observations support the possibility that colorectal cancers may also develop from a nondysplastic colonic mucosa without preexisting precursor lesions. In order to investigate whether the presence or absence of an adenoma within advanced colorectal carcinomas could be correlated to clinical, pathological and prognostic features, we studied 210 patients resected for colorectal cancer. Sixty-two of the 210 patients (30%) had a cancer containing adenoma (CCA). Sex incidence and cancer dimension, histological degree, intraparietal spread and stage were significantly different in cases of CCA as compared to cases of cancer without adenoma (CWA). Regarding the enclosed adenoma, the tubulovillous type was the more frequently observed type. The patient’s age, the size of the carcinoma and the occurrence of other adenomas in the resected colon were statistically different in relation to the type of residual adenoma. The deaths due to recurrence were significantly more frequent in patients resected for CWA. Our results indicate that CCA shows specific pathological features and probably has a different clinical evolution from CWA.

Primary Gastric Non-Hodgkin’s Lymphoma: A Surgical Experience

Clinicopathologic data from 59 patients with primary gastric non-Hodgkin’s lymphoma (NHL) were reviewed. Lymphomas in 13 patients were limited to the gastric wall, in the remaining cases nodes or adja