Alessandro Cois

Inflammatory pseudotumor of the liver. A report of two cases with unusual histologic picture.

Two cases of inflammatory pseudotumor (IPT) of the liver are reported. Clinical presentation was vague and aspecific. Laboratory tests and data from imaging techniques provided no specific information on the actual nature of the lesions and were misleading, suggesting a malignant lesion in one patient and a complicated hydatid cyst in the other. On gross examination, the tumors appeared yellowish ore grey-yellow in color, with a firm cut surface and well circumscribed from the surrounding parenchyma, although a true capsule was not evident. Variability in the histological pattern was also observed, even though the major finding was in both cases an admixture of lymphocytes, plasmacells, granulocytes and monocytes. Lymphocytes were immunohistochemically heterogeneous; monocytes showed in one case large hyperchromic atypical nuclei, confirming the previously, reported possibility that some cases of IPT may be mistaken for sarcomas. Further evidence is added in support of the hypothesis that some liver IPT may result from the evolution of cholangitic abscesses.

Gastric Cancer in the Young: Is It a Different Clinical Entity? A Retrospective Cohort Study

Background. The rate of gastric cancer in young patients has increased over the past few decades. The aim of this study was to search for independent risk factors related to patients of younger age. Methods. From January 1996 to December 2012, a series of 179 consecutive patients were admitted to our surgical department because of a gastric cancer. We carried out a retrospective cohort study in 20 patients younger than 50 and in 112 patients aged 50 and older treated by curative gastrectomy. The comparison involved the evaluation of patient and tumor characteristics. Results. Younger patients had significantly less comorbidities and a more favorable American Society of Anesthesiology score; they had significantly less preoperative weight loss and a significantly longer duration of symptoms; Helicobacter pylori infection and diffuse histological type were significantly associated with younger age. There was no statistically significant difference regarding overall and cancer-related 5-year survival; advanced cancer stage and diffuse histological type were the independent negative prognostic factors influencing cancer-related survival. Conclusions. We do not have sufficient evidence to consider gastric cancer in younger patients as a different clinical entity. Further studies are needed to understand carcinogenesis in younger patients and to improve gastric cancer classification.

A rare cause of an unresolving liver abscess.

We report the case of a hepatic abscess trigged by a foreign body, which caused long hospital stay and prolonged medical therapy. A 68-year-old man was admitted to our surgical department for the treatment of an idiopathic liver abscess. A few weeks before, he developed upper abdominal pain with nausea and fever. Initial investigations revealed a hepatic abscess (Fig. 1) of unknown origin and antibiotic therapy was started. No improvement was observed and the patient manifested complications of prolonged antibiotic therapy. Further abdominal sonography (Fig. 2) finally showed the presence of a toothpick embedded in the liver and the patient was submitted to surgical treatment (Fig. 3). Foreign-body ingestion is a rare cause of liver abscess. Diagnosis is difficult and sometimes achieved only at surgery (1). There are several cases of foreign body ingestion described in the literature. In most of the cases, the patient experienced no consequences. When present, however, complications can widely range in severity mostly depending on delay in correct diagnosis and appropriate treatment. Diagnostic imaging (ultrasound and computed tomography scans) can accurately define liver lesions, assess intra-abdominal pathologies and additionally identify foreign bodies (2, 3). In spite of that, foreign body can be missed and a high level of suspicion is essential (1). Adequate treatment is essential in avoiding complications and must include the removal of the foreign body. Surgical management still remains the most appropriate treatment, when no other less invasive options are applicable (1, 4).