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.

Outcome of Resection and Chemotherapy versus Chemotherapy Alone for Retroperitoneal Recurrence of Testicular Cancer Involving the Inferior Vena Cava: A Retrospective Cohort Study of 22 Consecutive Patients.

BACKGROUND/AIM: Optimal treatment strategy for retroperitoneal recurrence of testicular cancer involving the inferior vena cava (IVC) is uncertain. The purpose of this study was to validate the hypothesis that surgical resection, en-bloc with the involved segment of IVC and its subsequent reconstruction followed by chemotherapy, would yield better oncologic results than chemotherapy alone. PATIENTS AND METHODS: Two consecutive series of patients with retroperitoneal recurrence of testicular cancer involving the IVC, treated with surgical resection plus chemotherapy (group A, n=14) or chemotherapy alone (group B, n=8) were retrospectively reviewed. The mean duration of follow-up was was 65 months (range=8-184). Operative mortality and morbidity in group A, response to chemotherapy in group B, disease-specific survival and quality adjusted life-years (QALY) for both groups, were primary end-points of the study. RESULTS: Postoperative mortality and morbidity (group A) were, respectively, nil and 14%. In group B, two patients (25%) fully responded to chemotherapy and remained free from disease progression. Disease-specific survival at 3 and 5 years was 81% and 54% in group A and 36% in group B both at 3 and 5 years, respectively (p=0.02). QALY was 3.92 in group A and 0.77 for both 3 and 5 years in group B, respectively, (p=0.031). CONCLUSION: En bloc resection of retroperitoneal recurrence of testicular tumors invading the IVC, followed by chemotherapy, allows a better survival rate compared to chemotherapy alone.

The Lynch syndrome: a management dilemma.

The case of a familial Lynch syndrome is reported. The criteria for early diagnosis, management and surveillance are briefly reviewed. A germline mutation of genes responsible for mismatch repair is at the basis of the Lynch syndrome. Carriers are predisposed to colorectal cancer and other tumors. Two members of the presently reported family developed colorectal cancer, whereas two others developed other neoplasms. The syndrome was confirmed in members of the same family with appropriate genetic workup. Clinical examination and endoscopy were consequently scheduled once-a-year. Given the high risk of neoplastic disease, such yearly controls can be proposed as the standard follow-up of this condition.

Outpatient treatment for liposarcoma of the spermatic cord.

Liposarcoma of the spermatic cord is a very rare neoplastic disease. In effect little more than two hundred cases are described in literature. Natural history of this tumour is characterized by high local recurrence rate although hematogenic and lymphatic spread is usually a late event and involves high-grade tumours. The clinical diagnosis of spermatic cord liposarcoma can be difficult particularly for non expert surgeons, and is often mistaken for different diagnoses. Radical orchiectomy with high cord ligation is the treatment of choice to prevent local recurrence. Otherwise than commonly advised, the treatment is suitable to be performed under local anaesthesia and the patient easily and safely discharged few hours after surgery.

An inguinal bladder diverticulum Case report of a rare finding in a recurrent inguinal hernia.

We report a rare case of recurrent right inguinal hernia with bladder diverticulum incarcerated in a 63 years old male. Patient complained of painful swelling in inguinoscrotal region associated with urinary discomfort. Preoperatively diagnosis was made possible by ultrasound and urography imaging. Surgical treatment was achieved, by infra-umbilical incision, a reduction of the herniated and fixed diverticulum followed by a mesh repair of the wall defect. Patient was discharged five days after surgery and became free of symptomatology soon after surgical procedure. Bladder diverticulum involvement in a direct inguinal hernia is rare finding and define a potential pitfall for surgeon if not diagnosed preoperatively. There are no other cases of incarcerated bladder diverticulum incarcerated in a recurrent inguinal hernia described in Literature. KEY WORDS: Bladder diverticulum, Bladder hernia, Inguinal hernia.

Distinct cytokine patterns associated with different forms of chronic dysimmune neuropathy.

To better understand the presumed immune system dysregulation of chronic dysimmune neuropathy (CDN) patients, we designed a study to evaluate the levels of pro- and anti-inflammatory cytokines in the most common forms of CDN: chronic inflammatory demyelinating polyneuropathy (CIDP), and anti-myelin-associated glycoprotein (MAG)-related polyneuropathy (MAGnp). Sixteen patients fulfilled diagnostic criteria for CIDP, 14 were diagnosed with MAGnp, and 36 were classified as exhibiting "chronic idiopathic polyneuropathy" (CIP). Cytokine production in mitogen-stimulated peripheral blood mononuclear cells (PBMCs) was analyzed by flow cytometry. CIDP and MAGnp patients were compared with CIP patients, those with monoclonal gammopathy without polyneuropathy (MGUS), and healthy controls (HC). We observed an increase in pro-inflammatory cytokines in the CIDP group, whereas interleukin-10 (IL-10) was augmented in the MAGnp patients. These distinctive immune alterations may represent a biological tool in differential diagnosis and future therapeutic approaches.