F Capra

Primary hydatid cysts of psoas muscle

Background:  Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in muscle is not common, accounting for 2−3% of all sites; even rarer is the development of multiple cysts.

Does long-course radiotherapy influence postoperative perineal morbidity after abdominoperineal resection of the rectum for cancer?

Aim  The aim of the study was to define risk factors for perineal wound complications after abdominoperineal resection (APR), with particular reference to preoperative radiotherapy.

Giant sigmoid lipoma covered by a villous adenoma

Dear Editor: We would like to report an interesting case of a giant sigmoid lipoma covered by adenomatous mucosa. A 39-year-old male, with a family history of colon cancer (one brother dead), presented to our Clinic after an episode of rectal bleeding. A colonoscopy demonstrated 35 cm from the anal verge a sessile, fungoid mass (5×5 cm), almost completely occupying the lumen. The covering mucosa appeared normal at the base, while it was eroded at the head of the tumour. Biopsies were taken, but they revealed only a markedly inflamed mucosa. Subsequently, he was admitted in a good general condition and clinical examination was unremarkable. Haematological exams, liver and renal function tests, haemocoagulation and tumoral markers (CEA, Ca 19.9, αFP) were within normal ranges. A US scan of the abdomen did not show any other abnormalities. Considering the dimensions of the lesion and the impossibility of excluding its malignant nature, it was decided to perform an anterior resection with colorectal stapled anastomosis. The patient’s subsequent recovery was uneventful. The macroscopic examination of the specimen confirmed the presence of an ovoid, sessile, intraluminal tumour, about 5 cm in diameter. The mucosa at the base of the tumour was smooth, whilst it was largely eroded in the apical portion. At the cut surface the tumour showed a lipomatous aspect. Histology confirmed a submucosal proliferation of typical fatty cells with a lining mucosa that was almost completely ulcerated, except for the base, which was circumferentially involved by hyperplastic epithelium with villous adenomatous morphology (flat villous adenoma). This case is of particular interest because of its rarity and its pathogenetic implications. Colonic lipomas are benign tumours with low tendency to malignancy. They generally occur in the right colon, the sigmoid being involved in less than 5% of all cases. Although they are the commonest mesenchymal colonic tumours, their incidence in clinical and autoptic series is 0.2–4.4% [1, 2]. Patients, usually asymptomatic, may present with diarrhea, constipation, haemorrhage and abdominal pain, especially when the lipoma reaches 2–3 cm in diameter. Different authors have described alterations in the mucosa covering a lipoma, such as hyperplasia [3, 4], atrophy [5], ulceration [6–8] and necrosis [9]. To the best of our knowledge the association of lipoma and adenoma has been reported only once, but it concerned a very small adenomatous polyp on the top of a colonic lipoma in the distal transverse colon [10]. It is not clear whether this is due to a coincidence or whether there is a correlation between these entities. F. Capra (*) . L. Zorcolo . F. Scintu . G. Casula Chirurgia Generale II, Universita degli Studi di Cagliari, Ospedale Binaghi, Cagliari, Italy e-mail: facapra@tiscali.it Tel.: +39-070-6093011 Fax: +39-070-304462