Francesco Barillaro

Laparoscopic partial nephrectomy of thyroid cancer metastasis: case report and review of the literature

Background Follicular cell thyroid carcinoma is a quite aggressive form of thyroid cancer. About 10% of follicular thyroid carcinoma shows multiple metastases: lung and bone are the most common sites of metastasis. Renal involvement from thyroid primary cancer is very rare with incidence of 4.5%–5.9%. Purpose We report the first laparoscopic conservative treatment of renal metastasis from thyroid cancer. This is a new and useful approach in order to delay malignant disease progression and to reduce the surgical discomfort of the patient. Patients and methods We present the case of a 67-year-old woman, undergoing total thyroidectomy for follicular thyroid cancer with bone and lung metastasis. During adjuvant radiometabolic treatment, renal metastasis was diagnosed. Renal metastasis showed high metabolic activity, reducing the effectiveness of radioiodine therapy for secondary lesions. For this reason, we performed a laparoscopic simple enucleation of the single renal metastasis using extraperitoneal access and a clampless procedure. Results The excision of the renal lesion improved the effectiveness of adjuvant radioiodine therapy: two months after surgery, the patient underwent adjuvant radiometabolic treatment with iodine-131 (150 mCi) and the following whole body scan showed only a small uptaking area at the level of the vertebral metastasis. The lung micrometastases were not detectable. At 36 months follow-up, malignant disease was clinically stable and well controlled. Conclusion Minimally invasive renal surgery with preservation of renal function and rapid recovery contributed to the success of radioiodine therapy and delayed the progression of the disease.

Expression of inflammasome-related genes in bladder cancer and their association with cytokeratin 20 messenger RNA.

BACKGROUND Inflammation plays a crucial role in different stages of cancer development and has long been associated with various types of cancer. Strong associations between dysregulated inflammasome activity and human heritable and acquired inflammatory diseases highlight the importance of this pathway in the immune response. The inflammasome is a large complex of NOD-like receptors called NLRs and drives growth and progression of different tumors. The aim of the present study was the characterization of some NLR genes, NLRP3, NLRP4, NLRP9, and NAIP, in urine sediment of patients with bladder cancer. Cytokeratin 20 and survivin were used as confirmed markers of bladder cancer. BASIC PROCEDURES For this study, 3 groups of subjects were considered: patients harboring bladder cancer, subjects affected by bladder inflammation (CTR1), and healthy subjects (CTR0). Total RNA was extracted from urine sediments and resulting complementary DNA was used for amplification by real-time polymerase chain reaction. Results were stratified according to tumor stage, grade, and risk of progression and recurrence. MAIN FINDINGS The expression of cytokeratin 20 was always significantly higher in patients with bladder cancer when compared with that in both the tumor-free groups. NLRP3, NLRP4, NLRP9, and NAIP were overexpressed in patients with BCa when compared with that in CTR0. Stratification according to tumor stage, grade, and risk of recurrence and progression showed NLRP up-regulations in patients with early-stage cancer. NAIP was overexpressed in high-risk patients in comparison to CTR0 and in high-grade patients compared with CTR0 and CTR1. PRINCIPAL CONCLUSIONS These data are relevant to demonstrate the role of inflammasome in urothelial carcinoma, making NLR genes in urine sediment potential candidates for bladder cancer diagnosis.

Robot assisted laparoscopic excision of a paraganglioma: new therapeutic approach

The Paraganglioma is the most common extra-adrenal pheochromocytoma arising from neural crest (1) (It will better to write: The paraganglioma is an extra-adrenal pheocromocytoma arising from the neural crest. 10% of pheocromocytomas are extra-adrenal and can arise form chromaffin tissue derived from primitive neuroectoderm). Minimally invasive techniques allow surgeons to perform the procedure without wide exposure and mobilization of intra abdominal organs. To our knowledge we present the third case of robotic excision of a retroperitoneal paraganglioma.

Characterization of Kallireins and microRNAs in Urine Sediment for the Discrimination of Prostate Cancer from Benign Prostatic Hyperplasia

Objectives: Prostate Cancer (PCa) and Benign Prostatic Hyperplasia (BPH) are frequently coexisting in elderly men. The measurement of serum PSA together with Digital Rectal Examination (DRE) represents the primary diagnostic tool to suspect PCa, whereas definitive diagnosis is achieved by prostate biopsy. The low specificity of PSA and the modest detection rate of biopsy convict the patient to a quite often unnecessary and uncomfortable clinical itinerary. There is a urgent need for new and more accurate methodologies to diagnosize PCa. In the present study, the expression of 4 mRNAs and 2 miRNAs was evaluated in post DRE urine cell pellets from patients suffering PCa and age-matched subjects affected by BPH with elevated PSA levels. We also evaluated the diagnostic accuracy of markers in predicting PCa. Materials and methods: The expression levels of 4 mRNAs (3 kallikreins - KLK3, KLK11, KLK13 and a prostate cancer antigen - PCA3) and 2 microRNAs (miR-9-3p and miR-19a-3p) were assayed by means of real-time PCR in post DRE urine of 79 men undergoing prostate biopsy for PSA levels > 3 ng/mL. The diagnostic power of tested markers was evaluated through logistic regression analysis. Results: PCA3 was undetectable in 22 out of 38 BPH subjects. KLK3 and KLK11 were significantly upregulated in PCa group (p value < 0.001), while miR-9-3p and miR-19a-3p were up-regulated in BPH group (p value <0.001 and < 0.01, respectively). KLK13 was not differentially expressed between groups. MiR-19a-3p and miR- 9-3p reached the highest specificity (64.29%) and sensitivity (81.08%), respectively. The more accurate bivariate logistic model was obtained combining KLK11 with either miR-9-3p and miR-19a-3p. Conclusions: Our findings demonstrated that selected kallikreins and miRNAs proved to be an accurate diagnostic tool for PCa. Urine cells pellets obtained after DRE represent a reliable biological matrix for minimally invasive gene expression assays.

Renal malignant solitary fibrous tumor with single lymph node involvement: report of unusual metastasis and review of the literature

Solitary fibrous tumors are rare mesenchymal spindle cell neoplasms that are usually found in the pleura. The kidneys are an uncommon site and only few cases of renal solitary fibrous tumor exhibit malignant behavior metastasizing to the liver, lung, and bone through the hematogenous pathway. Purpose To describe the first case of lymph node metastasis from renal solitary fibrous tumor in order to increase the knowledge about the malignant behavior of these tumors. Patients and methods A 19-year-old female patient had intermittent hematuria for several months without flank pain or other symptoms. A chest and abdomen CT scan was performed and showed a multi-lobed bulky solid mass of 170 × 98 × 120 mm in the left kidney. One day before the surgery, the left renal artery was catheterized and the kidney embolization was performed using a Haemostatic Absorbable Gelatin Sponge and polyvinyl alcohol. We then performed a radical nephrectomy with hilar, para-aortic, and inter-aortocaval lymphadenectomy. Results Estimated intraoperative blood loss was 200 mL and the operative time was 100 minutes. No postoperative complications occurred. The hospital stay was 7 days long. The histological examination was malignant solitary fibrous tumor of the kidney. Cancerous tissue showed cellular atypia, with an increased mitotic index (up to 7 × 10 hpf). Immunohistochemical analysis showed positive results for CD34, BCL2, partial expression of HBME1, and occasionally of synaptophysin. Histological evaluation confirmed the presence of metastasis in one hilar node. The patient did not receive any other therapy. At 30-month follow-up, the patient was in good health and no local recurrence or metastases had occurred. Conclusion This is the first case of lymph node metastasis from a renal solitary fibrous tumor showing unusual malignant behavior; this finding adds new information about the biology and progression of these tumors, which remain unclear.

Colovesical fistulae in the sigmoid diverticulitis

In most cases Colovesical fistulae are complications of diverticular disease and representing the most common kind of colodigestive fistula; less common are colovaginal, colocutaneous, coloenteric and colouterine fistula. In this article we review the literature concerning colovesical fistulae in colorectal surgery for sigmoid diverticulitis and report on two cases that required a surgical treatment, one elective and the other in emergency. In both cases we performed a sigmoid resection with a primary anastomosis and small vesical window-ectomy placing a Foley catheter for about 10 days.

Immediate Radical Cystectomy for Massive Bleeding of Bladder Cancer

Objective. To investigate feasibility and safety of our surgical strategy and clinical and oncological efficacy. Materials and Methods. In a high volume tertiary institution 225 radical cystectomies were performed from January 2012 to December 2014. We prospectively collected data of a cohort of 12 patients who underwent immediate open radical cystectomy for bladder cancer causing massive haematuria, acute anemia, and impossibility of postponing surgery. A retrospective study was carried out to evaluate operative data, intra- and postoperative complications, and oncologic outcomes. The Clavien-Dindo Classification was used to grade complications. The oncologic outcome was evaluated in terms of positive overall and soft tissue surgical margins and cancer specific survival at a median follow-up of 26 months. Results. Mean preoperative haemoglobin was 6.8 mg/dL. Mean operative time was 278 minutes. Mean blood loss was 633 mL. The overall transfusion rate was 100% with a mean of 3.6 blood units per patient before surgery and 1.8 units postoperatively. No intraoperative complications occurred. Major complications (defined as grades III, IV, and V according to Clavien-Dindo Classification) were 18,5%. In fact grade III complications were 14.8% and grade IV complications were 3.7%. Grade V did not occur. The positive surgical margin rate was 33.3% and cancer specific survival was 58,3% at median follow-up of 26 months. Conclusions. Immediate surgical management seems feasible, safe, and efficacious.

The surgical treatment of colorectal cancer in patients over seventy-five years old. Risk factor analysis in patients operated in election and in emergency

We assessed the risk factors of the surgical treatment in the elective and emergency management. Among the 47 patients electively treated, 33 were affected by cardiocirculatory diseases, 23 by kidney diseases, 14 by metabolic and endocrine diseases, and 11 patients by respiratory diseases. In the 19 patients, who underwent emergency surgery, 75% had intestinal obstruction, and 25% had intestinal perforation.

The primary gastric stump cancer in geriatric patients

Methods The authors present 7 cases of primary gastric stump cancer surgically treated in our department during the period 1999–2002. The age of patients was between 61 and 79 years. The average time between primary gastric resection and diagnosis of carcinoma of gastric stump was 19 years (6–32 years). All patients considered operable underwent total gastrectomy and restoration of intestinal transit according to Rouxs technique.