Alberto Angelici

The benign cystic lymphoepithelial lesion of the parotid gland is a viral reservoir in HIV type 1-infected patients

The presence of HIV-1 in cystic fluid aspirates from six cases of benign cystic lymphoepithelial lesion (BLL) of the parotid gland, a rare disorder affecting HIV-1-infected patients, has been investigated. HIV-1 p24 protein was present at a concentration ranging from 3 to 15 ng/ml, while it was undetectable in the peripheral blood of the same patients. The number of RNA copies of HIV-1 in the cystic fluids was high, ranging from 0.5 x 10(7) to 7.2 x 10(7) RNA copies/ml. BLL cystic fluid aspirates, despite the high level of HIV-1 RNA, were found to contain only a few infectious virions. The low infectivity correlated with the infrequent detection by electron microscopy of complete HIV-1 particles. The pathogenic mechanism leading to virus accumulation in the cystic fluid was studied by immunohistochemistry of tissue sections. p24 protein was associated with DRC-1+/S-100+ follicular dendritic reticulum cells, which were also present within the cystic cavities. Our findings are consistent with the possibility that the large amounts of virus present in the fluid derive from continuous shedding of HIV-1-infected cells from the surrounding lymphoid tissue.

Treatment for persistent chronic neuralgia after inguinal hernioplasty

Following an inguinal hernia repair with open or laparoscopic technique, 1–15% of patients show persistent neuralgia, a severe, potentially debilitating, complication. Several therapeutic procedures have been proposed, but consensus regarding choice of treatment has not yet been achieved. We performed a prospective study on 32 such cases. Patients underwent anaesthetic infiltration to identify, when possible, the involved nerve, and we then carried out a step-by-step therapeutic protocol. In the initial phase, patients were treated with oral analgesic and afterwards with repeated infiltrations of anaesthetic and cortisone. Surgery was reserved for patients not responding to the infiltrations, though with no good success. The authors believe that noninvasive methods are to be preferred, whereas neurectomy interventions should be reserved for selected cases.

Cystic lymphoepithelial lesions of the parotid gland in HIV-1 infection.

The benign cystic lymphoepithelial lesion (BLL) of the parotid gland is a rare disorder affecting HIV-1-infected patients. Here we describe the clinical and histopathological features of 10 cases of BLL, who presented to our observation between November 1992 and December 1996, before the combination antiretroviral therapy was introduced.

Simultaneous resection of an adenocarcinoma of the cardia and a synchronous adenocarcinoma of the sigmoid: Report of a case

Introduction Adenocarcinoma of the cardia synchronous with other intraabdominal neoplasms is very rare. We report the case of a Siewert type II adenocarcinoma of the cardia synchronous with an adenocarcinoma of the sigmoid both treated simultaneously by transjatal oesophago-gastrectomy and anterior resection of the sigmoid. Case report A 62 year-old male was admitted for a progressing dysphagia and weight loss. Oesophago-gastric fibroscopy detected an adenocarcinoma of the cardia extending to the distal 2 cm of the esophagus (Siewert typeII). A CT-scan of the chest and abdomen confirmed the cancer of the cardia and also decealed a synchronous tumor of the sigmoid. Both neoplasms were resected through a xipho-pubic laparotomy, with an ileostomy completing the procedure. Postoperative course was uneventful and ileostomy was closed four weeks later. The patient was subsequently addressed to oncological for adjuvant treatment. Discussion This report supports the indication of aggressive, simultaneous treatment of an adenocarcinoma of the cardia associated with a synchronous abdominal neoplasm, provided that both are resectable through the same surgical access, as anticipated at a preoperative, through diagnostic work-up. Conclusion Simultaneous resection of synchronous adenocarcinoma of the cardia and the sigmoid is feasible and avoids possible progression of the untreated neoplasm during the interval between two separate resections, provided that a curative resection can be obtained for both diseases.

Extraskeletal ewing's sarcoma: Insight into a ten years follow-up

Extraskeletal Ewings sarcoma is a rare malignant soft tissue tumor, classified within the Ewings Sarcoma Family Tumors. While the classical Ewings Sarcoma affects mainly the bone during youth, the Extraskeletal histotype differs for age incidence, primary location and prognosis. Peak incidence and typical location are during adolescence and in the extremities respectively. We report a 30 year old woman case with a positive outcome after ten years from first diagnosis of Extraskeletal Ewings sarcoma. Treatment was achieved through surgical resection plus adjuvant chemoradiotherapy derived from EW93 and IRS III trials. Conclusion. Our report represents an unusual case due to age of presentation, neoplasm location and long survival reached. In last decades several trials results demonstrated that long survival could be achieved by combined surgery and adjuvant multi-drug treatment.