Therapeutic mammaplasties: full local control of breast cancer in one surgical stage with frozen section.

AIM: To evaluate the effectiveness of therapeutic mammoplasty with frozen section in achieving negative surgical margins in a single-stage surgery for breast cancer. METHODS: Fifty patients affected by early stage breast cancer treated by therapeutic mammaplasties were retrospectively reviewed in this study. Fifty-two therapeutic mammaplasties were accomplished. After resection the specimen was sent to pathologist for examination with frozen section. Tumour positive margins were defined as presence of cancerous cells at ≤ 2 mm from the edge of the specimen. In case of positive margins a second large re-excision was accomplished intra-operatively. All patients were followed every 4 months for the first 2 years and twice a year subsequently. RESULTS: Fifty-two procedures were evaluated (median follow-up of 72.6 months). The overall survival rate was 98% we had a single case of local recurrent disease (1.9%) that progressed to metastatic disease and patient's death. Frozen section as a diagnostic tool for identification of positive margins has been tested. In conclusion we report a sensitivity of 0.83 and a specificity of 0.93; the predictive positive value was 0.62 and the negative predictive value was 0.97, for a final accuracy of 0.94. CONCLUSION: Frozen section coupled to oncoplastic resections allows a proper control of local disease and can minimize any second surgical look for margins revision.

[Retroperitoneal leiomyosarcoma: a case report]. / Il leiomiosarcoma del retroperitoneo: descrizione di un caso clinico.

The Authors report a rare case of retroperitoneal leiomyosarcoma in a 80 years woman with respiratory symptoms and right abdominal pain. A large neoplasm occupied the right abdomen, looking asymmetric. Upper abdominal CT showed a retroperitoneal neoplasm close to right kidney, liver, aponeurosis of right oblique muscles, producing a left-side dislocation of the intraabdominal organs. A surgical "en bloc" resection of the neoplasm was performed; neoplasm was plurilobed and capsulated. The histologic examination confirmed the diagnosis of leiomyosarcoma. The best treatment of these neoplasms is surgery, that in the last years has drawn advantage from more sensible and specific diagnostic procedures, which show a more radical surgical option. Though metastases are occasional, local recurrences can be taken into consideration and, after a careful tumoral re-staging, they can be resected once more. Therefore, a careful follow-up is necessary on the basis of neoplastic grading, extension and involvement of the closer structures.

[Gastric lymphomas: surgical indications]. / I linfomi gastrici: indicazioni all'intervento chirurgico.

Primary gastric lymphoma (PGL) are lymphomas with an exclusive gastric localization. Histologically they are B-like non-Hodgkin lymphomas. Aim of Authors' study is to define the role of surgery in the treatment of PGL, on the basis of their series casistics and a review of the more recent literature data. The Authors observed 41 patients (23 F and 18 M) in a period of 10 years: 35 patients underwent to surgical operation associated in 18 of them to chemotherapic treatment; in 6 cases medical eradication of Helicobacter Pylori (H.P.) was performed as unique treatment. Antibiothic treatment allows the eradication of H.P. in 97% of the patients and a histologic decreasing of MALT lymphoma in 70% of the patients in about 6 months. That represents the first therapeutic choice for the low grade of malignancy MALT PGL at I and II stages. In the cases of partial decreasing or progression of PGL, the Authors consider opportune surgical operation. In the majority of the cases the surgical option represents, according to our advise, the best choice for the high percentage of definitive recoveries, allowing a 10 or more years of surviving of the 90%, if it is done in the first stages of the disease. The results of the association with neoadjuvant or aduvant chemotherapy are still controversial. On the basis of their experience total gastrectomy can be considered the elective choice operation, with IID level lymphadenectomy and possible splenectomy.