[Biliary cystadenocarcinoma. A case report]. / Il cistoadenocarcinoma biliare. Descrizione di un caso.

The authors report a case of cystadenocarcinoma of the biliary tract, an uncommon tumor of the liver. A 68 aged white Caucasian jaundiced male subwent intervention for a tumor of the 4th hepatic segment. Forty-two months after discharge he is still alive without any secondary lesion. On the 16th follow-up month a prostatic malignancy was diagnosed. Differential diagnosis with other cystic lesion is an exacting and difficult target. Usual techniques such as US, CT, NMR infrequently get a correct diagnosis. Often only in surgical room a real diagnosis is achieved. In the aim to avoid tumor relapse the best surgical procedure is a large hepatic resection.

[Primary adenocarcinoma of the jejunum arising in the anastomotic loop of a Roux-en-Y esophago-jejunostomy: a case report]. / Adenocarcinoma primitivo del digiuno insorto in ansa anastomotica di esofago-digiunostomia su ansa ad "Y" secondo Roux: descrizione di un caso.

The authors report a case of primary adenocarcinoma arising in the jejunal limb of a Roux-en-Y esophago-jejunostomy in a 76-years-old Caucasian woman. She was affected by esophageal achalasia and in another surgical department underwent gastric resection for adenocarcinoma 6 months before admission. A total gastrectomy performed was due to severity of achalasia symptoms conditioning a high degree of malnutrition. Two years after discharge the patient underwent surgery for total dysphagia, epigastric pain and inexorable weight loss. Histological response was adenocarcinoma of the long arm of Roux-en-y loop. Primary malignancies of the jejunum and ileum are extremely rare and many pathogenetic hypotheses were done but none of them received clinical or experimental demonstration. Symptoms are not specific and diagnosis is difficult and late, x-rays and endoscopy leading to it, US, CT and MNR are useful for differential diagnosis and staging. Prognosis is severe. Surgical therapy is large resection, if possible, but often it is only palliative.

[Malignant pheochromocytoma of the adrenal gland. Diagnosis 14 years after an incidental discovery of a contralateral pheochromocytoma]. / Phéochromocytome malin de la surrénale. Découverte occasionnelle 14 ans après un incidentalome. Phéochromocytome controlatéral.

The authors present a case of malignant adrenal phaeochromocytoma incidentally discovered 14 years after a similar finding in the controlateral adrenal gland. The rarity of incidentally discovered malignant adrenal phaeochromocytoma (second report in the literature) and the importance of isotope scan with MIGB for the investigation of asymptomatic and nonfunctioning phaeochromocytomas are outlined.

[Leiomyosarcoma of the rectum]. / Il leiomiosarcoma del retto.

Two cases of leiomyosarcoma of the rectum observed between 1980 and 1990 are reported. Both patients underwent abdominoperineal resection: one is still alive at three years from surgery, whereas the other died for neoplastic diffusion after three years. Epidemiological, clinical and therapeutic features of this rare tumor are discussed.

[Primary intrahepatic lithiasis]. / La lithiase intra-hépatique primitive.

Isolated intrahepatic lithiasis is a very rare condition in western countries; the reported case has to be added to the 29 cases described to date in the literature. The pathogenesis of this disease is unknown; physical and chemical bile alterations favouring lithogenesis is the most reliable hypothesis. In this case the Roux-en-Y hepaticojejunostomy with cutaneous stoma allowed us to perform periodic cleaning of intrahepatic bile ducts until complete elimination of all stones.

[Primary intrahepatic lithiasis]. / La lithiase intra-hépatique primitive.

Isolated intrahepatic lithiasis is a very rare condition in western countries; the reported case has to be added to the 29 cases described to date in the literature. The pathogenesis of this disease is unknown; physical and chemical bile alterations favouring lithogenesis is the most reliable hypothesis. In this case the Roux-en-Y hepaticojejunostomy with cutaneous stoma allowed us to perform periodic cleaning of intrahepatic bile ducts until complete elimination of all stones.

[Cloacogenic carcinoma]. / II carcinoma cloacogenico.

Four cases of cloacogenic carcinoma (CC) observed between 1982 and 1987 out of 175 operations performed in the same period for anorectal tumors are reported. All the patients underwent abdominoperineal resection; 3 of them are still alive at 16.30 and 42 months from surgery respectively. The fourth died for neoplastic diffusion after 12 months. Epidemiological, clinical and therapeutic features of this rare tumor are discussed.

Pheochromocytoma during pregnancy.

A case of pheochromocytoma observed in a 31-year old woman at the sixth month of pregnancy is reported. The treatment was successful for both the mother and fetus. Oral phenoxybenzamine has allowed most favourable pressure control and completion of pregnancy at term with cesarean section and tumor resection performed at the same time. The prognostic role of early diagnosis is stressed and the therapeutic problems posed by this rare association at high maternal and fetal risk, are discussed.

Skin grafts in the surgical treatment of incisional hernias.

The results of dermal or autologous full-thickness skin graft implantation in a series of 20 patients are reported. Seventeen patients were affected by incisional hernia, 2 by a large umbilical hernia and 1 by fibromatosis of the abdominal wall. The surgical procedure is described together with the histological findings of the skin grafts, 4 years after implantation.