[Merkel cell carcinoma: a report of two cases]. / Carcinoma a cellule di due osservazioni.

The Authors report two cases of Merkel cell carcinoma and describe their diagnostic and therapeutic difficulties in the management of these tumours. The main therapeutic problem consists in establishing the size of the excision margins in relation to the neoplastic aggressiveness. The first case was characterised by major lymphophilia and by a tendency to relapse. Radical excision was achieved by low invasive surgery using a radioguided technique to search for microscopic disease. The radioguided technique takes the place of the intra-operative anatomo-pathological examination. After adjuvant ra- diotherapy and chemotherapy the patienthas remained in remission for three years. The second case is characterized by a rapid haematic diffusion with metastasis and exitus after one year. Radiotherapy and chemotherapy were ineffective. In this case surgery was limited to a bioptic approach since extirpative surgery would have been inappropriate. Our experience shows the wide biological variability of Merkel cell carcinoma and the importance of eclectic treatment to avoid ineffective extirpative surgery.

[Traumatic rupture of the pancreatic isthmus complicated by concomitant rupture of the duodenum and right kidney]. / Rottura traumatica dell'istmo pancreatico complicata da rotture concomitanti del duodeno e del rene destro.

The Authors describe a case of complete traumatic transection of the pancreatic isthmus associated with complete transection of the first portion of the duodenum and the isthmus of a horseshoe kidney. The treatment of the pancreatic lesion was intestinal drainage of the distal portion of the pancreas and closure of the proximal one. The authors stress the advantages and good outcome of the conservative operation, performed at an early stage, with the clinical indications and adequate surgical techniques.

[Gastrin-secreting neuroendocrine carcinoma: two cases identified and treated surgically with a radio-guided technique]. / Carcinoma neuroendocrino a secrezione gastrinica: due casi identificati e trattati chirurgicamente con tecnica radioguidata.

The authors present two cases of gastrin-producing carcinoma demonstrated by scintigraphy with In-111 pentetreotide. The possible malignant evolution of such tumours and the good results that can be achieved with surgical therapy suggest the usefulness of a radio-guided intraoperative strategy to locate the lesions and minimise invasive procedures. This approach enabled us to detect a lymph-node metastasis concealed in the adipose tissue in the first case and to exclude any other gastrin-producing tumour localisations in the second. We recommend that the radio-guided strategy should be included among the guidelines for the treatment of gastrinomas and believe that the procedure can also be used in other functioning endocrine tumours.