Unusual pleural effusion from vulvar squamous cell carcinoma: report of a case and review of the literature.

Vulvar tumors are not very common and account for about 4% of all cancers affecting the female genital organs. Frequently, malignant neoplasia of this site have squamous phenotype and the rare cases of metastasization are reported in the locoregional lymph nodes and in the surrounding organs. We report a case of metastasization of a vulvar squamous cell carcinoma in an unusual place such as the parietal pleura, in a relapsing patient that was submitted to a surgical vulvectomy the previous year.

Serous cystadenofibroma of the fallopian tube: case report and literature review.

INTRODUCTION: Cystadenofibromas of the Fallopian tube are very rare benign tumors of the female genital tract. These tumours are usually asymptomatic and are found incidentally. CASE REPORT: We describe a Fallopian serous cystadenofibroma in a 50 year-old woman operated for uterine leiomyoma. The histopathologic finding revealed a cystic lesion connected to the salpinx. The cyst was composed of connective stroma lined by epithelial cuboidal cells, without pleomorfism or detectable mitoses. Pseudopapillary structures were observed in the lumen of the cyst. The patient is well on follow-up. CONCLUSION: The origin of serous cystadenofibroma of the Fallopian tube is not clear. The tumor is considered an embryologic remnant rather than a proliferating neoplastic process. These tumours seem to have a benign course and a malignant potential has not been described.

Breast cancer metastatic to the submandibular gland. Case report.

Metastatic disease in the major salivary glands is rare and the parotid gland is most frequently involved. Secondary deposits in the submandibular gland are very uncommon. We report a case of a 50-year-old woman who developed a metastasis from breast cancer in the right submandibular gland, 9 years after primary surgery for G3 T1c N0 ipsilateral breast carcinoma. The peculiarity of the case was the unusual site of the metastatic disease and the difficulty in differential diagnosis with primitive ductal salivary carcinoma.

Fine-needle aspiration cytology for breast lesions and cytopathologic correlations. An Italian peripheral hospital experience with 440 cases (from 2000 to 2007).

Fine-needle aspiration cytology for breast lesions and cytopathologic correlations. An Italian peripheral hospital experience with 440 cases (from 2000 to 2007). S. Erra, D. Costamagna In the present study, we evaluate our experience with Fine-Needle Aspiration Cytology (FNAC) for the diagnosis of breast tumor. Our intent is to correlate the diagnostic accuracy of FNAC for breast lesions on the basis of their respective histopathologic results. We retrospectively examined 440 cases of breast lesions who underwent FNAC and subsequently had definitive histopathologic diagnosis. The patients were observed over a period of eight years (from January 2000 to December 2007) at the "Santo Spirito" Hospital of Casale Monferrato, a general peripheral hospital in the North-West Italy (Piemonte Region). The results of FNAC were expressed using the five diagnostic categories recommended by European Guidelines on breast tumors as follows: 159 C5 cases (36,1%), 88 C4 (20%), 51 C3 (11,6%), 42 C2 (9,5%), and 100 C1 (22,7%). The statistical analysis revealed these values: sensitivity 93.8% (C5+C4), specificity 79.6%, C5 positive predictive value 97.5%, C2 negative predictive value 83.3%, false positive fraction 2.5%, false negative fraction 16.6%, diagnostic accuracy 71.2%. In consideration to the low cost and the low disconfort for patients, we consider FNAC a safe and feasible procedure, in particular in the context of peripheral hospitals, where a sophisticated technology is not available. We remark the importance of a good selection of patients to obtain the best results from the procedure.

A rare case of extraskeletal osteosarcoma of the esophagus: an example of difficult diagnosis.

Sarcomatous lesions of the esophagus are rare. We describe a controversial case of a malignant aggressive tumor of the aesophagus, with a very poor prognosis and rapid outcome for the patient. A 74-year-old man underwent endoscopic examination for recurrent thoracic pain and dysphagia. A 8 cm mass was found in the cervical esophagus. A sarcomatous tumor with osteoid aspects was observed on the histopathological examination, without any carcinomatous component.

Acute abdomen in the elderly. A peripheral general hospital experience.

We reviewed our experience on 291 consecutive patients aged over 65 years who were operated on for acute abdomen during the period 2003-2007 at "Santo Spirito" Hospital of Casale Monferrato, a peripheral hospital in the Piedmont region. The mean age of the patients was 78 years and the male/female ratio was 149/142. A total of 126 patients (43%) had one or more associated disease. The most common causes for an emergency operation were mechanical bowel obstruction (45%), hollow viscus perforation (18%) and strangulated hernia (18%). 234 patients (80%) recovered and were free from major complications. The remaining 57 (20%) developed at least one major complication (including death). The 30-days postoperative deaths were 33 (11%). Nonlethal major complications were 24 (8%). The commonest complications were cardio-respiratory. Septic complications were 15. Total reoperations for surgical complications were 5. Mesenteric ischaemia and secondary peritonitis were the most important causes of fatal outcome (respectively 42 and 17% of mortality). We also reported high mortality among patients with peritoneal carcinomatosis (24%). Emergency surgery was relatively safe for the remaining groups of patients, with a complexive mortality ratio of 5.3%. We conclude that "acute abdomen" is still an appreciably frequent cause of death in the older age group. A high level of vigilance and early attention is therefore advocated. Anyway, excluding some severe conditions, the overall success of surgical interventions for abdominal emergency is satisfactory in the majority of older people. About the debated role of peripheral hospitals in the health care system, we conclude that the surgical treatment of the acute abdomen in the elderly is safe and feasible in the peripheral hospitals, and that these hospitals play a determining role in the management of old patients, especially in emergency.

Sporadic flat ileal adenocarcinoma: an intriguing challenge in the comprehension of a rare neoplasia and its genesis. Case report and review of literature.

Small bowel adenocarcinoma is a rare tumor, with a still not well studied tumorigenesis process, usually presenting in an advanced stage. The clinical diagnosis is often difficult; surgery is the treatment of choice when feasible, while the chemotherapeutic approach is still not well standardized. We describe the case of a 71-yr-old male patient, presenting with an acute right abdomen. At laparotomy the terminal ileum appeared chronically inflamed and thickened. An ileocecal resection with latero-lateral ileocolic anastomosis was performed. The gross appearance resembled an inflammatory bowel disease, but microscopic examination revealed the extensive presence of an infiltrating ileal adenocarcinoma. Literature about small bowel adenocarcinoma has been reviewed for better understanding its pathogenesis.

Neurocysticercosis. Case report.

In the present review we report a case of a 53-year-old woman affected with a cyst solitary cerebral hemispheric lesion causing acute generalized seizure. Clinical and neuroradiologic diagnosis of cystic astrocytoma was performed and the patient was operated. Microscopic analysis of the surgical specimen led to a diagnosis of parasitic infection, consistent with neurocysticercosis (NCC). NCC is the most frequent parasitosis of the central nervous system (CNS) in the world. The infective agent is taenia solium larvae. It is endemic in Latin America, Africa and some Asiatic countries, such as India. In Europe, many cases have been reported in Portugal, Spain, Poland and Romania. In Italy NCC is a rare disease. In recent years no cases have been described, but with high rate of immigration from endemic areas (Africa and East Europe) this parasitosis will be found in our country too, particularly affecting communities where hygienic conditions are poor. In conclusion we briefly analyze the relationship between pathogenesis of this parasitosis and its clinical symptoms.