Massimo Scarpini

Incidence and circumstances of cervical hematoma complicating thyroidectomy and its relationship to postoperative vomiting

Cervical hematoma is hardly a predictable complication of thyroid surgery. Postoperative vomiting has been reported as a likely risk factor.

Metastasis to the Pancreas from Breast Cancer: Difficulties in Diagnosis and Controversies in Treatment

Background: Metastasis to the pancreas originating from malignant tumours is a rare event and, in the literature, we have found only 11 reported cases of solitary pancreatic metastases originating from breast cancer. Case Report: We report a case of a 51-year-old woman with primary breast cancer who developed obstructive jaundice and epigastric pain after 2 years without any symptoms. The pancreatic mass revealed by computed tomography (CT) scan and magnetic resonance imaging (MRI) was not recognised as a metastasis from breast cancer and the patient underwent cephalic pancreaticoduodenectomy. Conclusions: We discuss all aspects of the case management, stressing the importance of a careful evaluation of the clinical history and the primary cancer features and the usefulness of a multi-disciplinary approach. These aspects are of main importance for a correct diagnostic process and an appropriate therapeutic choice when a pancreatic lesion develops in a patient with prior neoplasm.

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.

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.