PELVIC ACTINOMYCOSIS MIMICKING A LOCALLY ADVANCED PELVIC MALIGNANCY--CASE REPORT.

We present the case of a former user of an intrauterine contraceptive device (IUD) for 10 years, diagnosed with a bulky, fixed pelvic tumor involving the internal genital organs and the recto sigmoid, causing luminal narrowing of the rectum, interpreted as locally advanced pelvic malignancy, probably of genital origin. Intraoperatively, a high index of suspicion made us collect a sample from the fibrous wall of the tumor mass, large Actinomyces colonies were thus identified. Surgery consisted in debridement, removal of a small amount of pus and appendectomy, thus avoiding a mutilating and useless surgery. Specific antibiotic therapy was administered for 3 months, with favorable postoperative and long-term outcomes. Pelvic actinomycosis should always be considered in the differential diagnosis of pelvic tumors in women using an IUD. The association of long-term antibiotic treatment is essential to eradicate the infection and prevent relapses.

An unusual enhanced Doppler vascular profile of a rare uterine tumor: PEComa.

PEComas represent a rare class of mesenchymal tumors, with different primary locations. There are less than 100 cases of uterine PEComas published in English literature until now and information considering imaging features of these PEComas is very limited, focusing on CT and MRI and not as much on ultrasounds (US). The authors present here a case of rapidly growing uterine PEComa, with local invasive potential and recurrence, and the review of literature on US characteristics of PEComas. Harboring a hyperechogeneous heterogeneous aspect with no clear separation from the adjacent uterus on the whole boundary, with an extremely rich central vascular network, with low impedance and a rapidly growing profile, this tumor does not show the classic US appearance of malignant PEComas, which are generally easily confused with leiomyomas. However, even if this pattern did not allow the authors to anticipate the histopathological result, it offered clear clues about its invasiveness potential.

BLASTIC PLASMACYTOID DENDRITIC CELL NEOPLASM --A RAPIDLY EVOLVING ENTITY. CASE REPORT.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN), CD4+/CD56+hematodermic neoplasm was formally known as blastic NK-cell lymphoma. It is in fact a form of acute myeloid leukemia notable for highly aggressive behavior with cutaneous, lymph node and bone marrow involvement. This entity is derived from plasmocytoid dendritic cells and has a predilection for extranodal sites, especially the skin. Elderly male patients are the most affected and the prognostic is poor. The first case was reported in 1994 and sice then, single cases and a few small series have been published. This article presents the case of a previously healthy 56-years-old man, who presented himself to a skin eruption consisting in multiple, large dermal ulcerated tumors, located on the trunk and scalp. The lesions were painless and grew in size rapidly. Physical examination was normal except for the skin lesions. Histological examination of a biopsy specimen and immunohistochemical studies (positive for next markers: CD4, CD 45, CD56, CD68, Ki 67) revealed the rare diagnostic-blastic plasmacytoid dendritic cell neoplasm.

Implementing EBUS TBNA: first experience and review of literature.

Lung cancer has a very dismal prognosis and careful diagnosis and staging is of outmost importance. EBUS has become a cornerstone investigation for diagnosis and staging and current guidelines stress that there is a steep learning curve when introducing this tech- nique in practice (only 30 procedures are considered necessary). Over a period of 10 months a total of 21 patients have been addressed to our unit for an EBUS TBNA procedure. Only three were referred for staging purposes (for lung, digestive and cervix cancers) the others being primary diagnostic approaches where simpler procedures had previously failed. Procedures were initially performed under local anesthesia (3 cases) then under general anesthesia and jet ventilation using a laryngeal mask approach. Mediastinal lymph node group 7 was the most frequent target (9 cases) followed by group 4R (8 cases) and peribronchial tumoral processes (7 cases); one case did not required any needle-aspiration. On average each examination resulted in the sampling of 1.4 targets. There were no significant procedure related severe adverse events. Although 21 G cytology needles were used, adequate histological samples were obtained for 11 cases and cytology was the examination of choice for 9 cases. The pathology/cytology results were retrospectively assessed as satisfactory for 15 cases (confirmed neoplastic or other disease) and inconclusive for 5 cases. Non neoplastic disorders were represented by sarcoidosis, tuberculosis and bronchogenic cyst (3 cases). The procedure can be considered fast and safe; trained pathology personnel play an extremely important role: presently referrals are rare for staging purposes.

Total necrotizing colitis proximal to obstructive left colon cancer: case report and literature review.

BACKGROUND: Necrotizing colitis (NC) is a rare complication of the obstructive cancer of the left colon and it is the result of intramural ischemia due to impairment of blood supply secondary to increased endoluminal pressure. CASE PRESENTATION: A 70 years old patient with significant comorbidities (ASA 4) was admitted for intestinal obstruction.The extensive necrosis of the entire proximal colon secondary to an obstructive sigmoid colon cancer has been diagnosed intraoperatively. Total colectomy and terminal ileostomy have been performed. The postoperative course was uneventful and the ileostomy closure with ileo-rectal anastomosis was performed 7 months later. A review of the literature discussing the epidemiology, pathogenesis, diagnosis and therapeutic approach of this type of colitis, was performed. CONCLUSIONS: NC implies diagnosis and therapeutic difficulties,especially from point of view of surgical strategy. We advocate of large colic resections, beyond the macroscopic limits of the necrosis in order to avoid the postoperative complications. We also consider seriate surgical procedures as a good choice for the high risk patients.

[Early results of the surgical management of gastrointestinal stromal tumors (gist)--the experience of the 3rd surgical unit]. / Rezultate imediate in managementul chirurgical al tumorilor stromale gastrointestinale primare (gist)-- experienta clinicii a III-A chirurgicale.

UNLABELLED: This study provides a clinical and paraclinical algorithm of assessment of gastrointestinal stromal tumors (GIST), with the possibilities and limits of their current management. It is focused on defining an optimal imaging and anatomoclinic diagnosis protocol. In the absence of specific algorithm of surgical management, the study proposes an evaluation of possible histologic diagnosis and the indication for surgery, and the assessing the immediate results of thesurgical treatment. MATERIALS AND METHODS: A retrospective analysis was carried out over a period of 8 years (2004-2011), including patients with pathologic results of resection specimens revealing the stromal nature. There were analyzed the tumor characteri stics, the association with other digestive tumors, the biologic behavior, clinical manifestations and the comorbidities of the patient, the indication for surgery, and also, the surgical morbidity and mortality. From 2004 to 2011 there have been operated 24 cases of GIST diagnosed histologically by common stains. Among them, a total of 16 patients (beginning with 2007) were confirmed immunohistochemicaly. RESULTS: During the study, each clinical suspicion of GIST was an opportunity for thorough assessment of the clinical picture, imaging studies or anatomoclinical aspects (intraoperative macroscopical aspects, pathological and immunhistochemical examination). We have tried a standardization of diagnostic and therapeutic algorithm. Positive diagnosis of GIST was clinicaly suspected in patients with digestive tract tumors (22 cases out of 24) without mucosal involvement, or based on intraoperative macroscopic appearance. The lesions were confirmed by the pathologist. The surgical morbidity (4 cases--16.6%), was to the surgery (a single case of anastomotic leakage) or due to patient's comorbidities (diabetus, chronic renal failure, etc), and has been framed to acceptable extent. No deaths occurred in relation to the surgery. CONCLUSIONS: The diagnostic difficulties are overcome in terms of a positive laboratory features revealed by immunhistochemical examination. The surgical approach of GIST is different from that of a carcinoma. The postoperative immunhistochemical confirmation of GIST, leads the patient to a specific adjuvant treatment.

Myasthenia gravis associated with thymoma and toxic multinodular goiter. A case report.

Adequate antithyroid drug treatment or surgery usually generates remission of myasthenia gravis (MG) in patients with thymus hyperplasia associated with Graves' hyperthyroidism. The case of a 46-year-old woman diagnosed with MG based on the clinical picture, anticholinesterase drug test and positive electromyography (EMG) is presented. The cervico-thoracic computer tomography revealed a compressive nodular goiter and normal antero-superior mediastinum and led to the diagnosis of MG secondary to the hyperthyroidism. An uneventful total thyroidectomy was performed, but postoperatively the MG symptoms worsened. TC99m tetrofosmin scintigraphy revealed an area of hyperfixation in the antero-inferior mediastinum, suggestive for thymoma, as confirmed by a repeated thoracic CT scan. Following a longitudinal sternotomy, a well incapsulated tumor of approximately 6/5 cm located in the antero-inferior mediastinum was found and an extensive thymomectomy was performed. The postoperative course was uneventful and the patient was discharged 9 days later with complete remission of myasthenia. The pathology report of the specimen revealed a mixt thymoma or AB thymoma after Muller-Hermelink and WHO classification, with invasive capsular foci corresponding to Masaoka II stadium. In conclusion, scintigraphy proved to be useful in the diagnosis and decision making of a thymoma.

[Right colon cancer--clinicopathological findings]. / Cancerul colonului drept--particularitati anatomo-clinice.

BACKGROUND: The right colon cancer (RCC) has some particularities from point of view of epidemiology, clinical aspects, therapy and prognosis. MATERIAL AND METHODS: We retrospectively analyzed the patients operated in the First Surgical Unit Iasi during 2004 until 2009, for right colon cancer. The patients' data from the medical files were digitally encoded and included into a MS Access database, and statistically analyzed. RESULTS: 219 cases were included into the analysis, which represents 24.17% from all the patients with colorectal cancer. The median age was 66 years old. A palpable mass into the right abdominal quadrant was founded in 41.5% and anemia in 65.3%. Abdominal ultrasound exam has been performed in all the patients, with 71.3% sensitivity for primary tumor positive diagnosis. Resectability was 89.5% but without multivisceral resections. The intraoperative complication rate was 6.8%; postoperative morbidity was 19.4% with an incidence of anastomotic leak of 1.38%. The postoperative mortality rate was 2.77%. The mean overall survival was 40.13 +/- 1.93 months (median: 49.26). The prognosis factors for the survival rate were: histologic type of the tumor, stage and tumor grading, vascular and perineural invasion. The presence of metastasis in more than 3 lymphnodes as well as resection of fewer than 11 lymphnodes were found as negative prognosis factors for the survival rate. CONCLUSIONS: RCC has an increasing incidence and it is associated especially with elderly patients. The RCC resectability is about 90% with acceptable rates of morbidity and mortality. Perineural and vascular invasion as well as rate of positive lymphnodes and count of resected lymphnodes are prognosis factor for overall survival rate.

[Distal pancreatectomy with spleen preservation in a pseudopapillary pancreatic tumor case]. / Pancreatectomia corporeocaudala cu prezervarea splinei intr-un caz de tumora solida pseudopapilara de pancreas.

Pseudopapillary pancreatic tumors represent about 1-2% of all exocrine pancreatic tumors, studies in the literature about this type of tumor is limited. We present a female patient of 18 years hospitalized for nonspecific abdominal symptoms, diagnosed with corporeal pancreatic tumor approximately 3-4 cm. It takes practice surgical distal pancreatectomy with spleen preservation, pathological examination revealing a pseudopapillary pancreatic tumor. Postoperative evolution was favorable. Distal pancreatectomy with spleen preservation was indicated due to patient age.

[Dermoid cyst of the parotid gland]. / Chistul dermoid al glandei parotide.

Dermoid cyst of the parotid gland is a rare clinical entity. Definitive clinical diagnosis is often difficult to determine preoperatively because of the lack of pathognomonic features. The most frequent location of a parotid dermoid cyst is a triangular area lying above the pinna. Imaging studies do not definitely diagnose a parotid dermoid cyst. Although parotid dermoid cyst is (generally) well-encapsulated, complete removal of the cyst wall is not sufficient to cure it, so it is mandatory to perform careful excision of the cyst by parotidectomy, in terms of preserving facial nerve integrity. Histopathology of the parotid gland tumor removed by parotidectomy makes a diagnosis of certainty, by revealing a cyst wall with keratinization of the squamous epithelium and the presence of skin annexes (hair follicles, sweat glands, sebaceous glands). We present a rare case of parotid dermoid cyst in a 21-year-old male patient with symptoms and imaging rather suggestive of arch I branchial cyst and a brief review of data in the medical literature of the last 20 years.

[Malherbe's calcifying epithelioma--comment on two clinical cases]. / Epiteliom calcificat malherbe--observatii pe marginea a doua cazuri clinice.

Malherbe's calcifying epithelioma (also called trichomatricoma, pilomatrixoma or pilomatricoma) is an uncommon benign cutaneous tumor, which takes the form of a solitary, firm, asymptomatic, slowly growing nodule, developed subcutaneously on the face, neck, or proximal upper extremity. With an incidence of 1/800-1000 cutaneous tumors, pilomatricoma is more common in the first two decades of life, predominantly affecting the women. Multiple locations and associations between this entity and other diseases such as Steinert's myotonic dystrophy or Gardner syndrome have been described in the literature. The clinical diagnosis is often difficult, most cases being mistaken as sebaceous cysts. The treatment of choice is surgical excision. Incomplete surgical excision can be followed by local recurrence because most lesions are poorly defined; therefore, patients should be monitored after surgical excision to prevent this from happening. We present two cases admitted in 2010 and 2011 to the Iasi Department of Oral and Maxillo-Facial Surgery: a 55-year-old female patient with a Malherbe's calcifying epithelioma located in the left temporal region, and a 51-year-old female patient with the same disease but located in the left masseter region.

Epidemiology and histology of malignant thyroid nodules in North East Region of Romania (Moldavia) before and after alimentary salt universal iodination.

UNLABELLED: Research on the relationship between iodine exposure and thyroid cancer risk is limited and the findings are inconclusive. OBJECTIVES: Given this molecular data on iodine we decided to evaluate the changes of incidence and histology of thyroid cancer in the North-Eastern region of Romania (Moldavia) after the government decision from 2004 that introduced the universal iodination of alimentary salt. After this decision values of urinary iodine increased from 50 microg/L (2001-2002) to 117 microg/L (2006 -2008). MATERIAL AND METHODS: We compared the incidence and the histology of thyroid cancer in residents living in an area known as a mild endemic goiter region (Moldavia-Romania) between 2001-2004 with the incidence and the histology of thyroid cancer between 2005-2008 in the same region after the introduction of universal iodization of alimentary salt. RESULTS: The number of papillary cancers increased from 125 cases (2001-2004) to 276 cases (2005-2008). The number of follicular cancer decreased from 52 cases (2001-2004) to 27 cases (2005-2008). The ratio between papillary and follicular cancers increased from 4.80 / 1 (2001-2004) at 10.61 / 1 (2005-2008). The number of medullar thyroid carcinoma increased from six cases (2001-2004) to 24 cases (2005-2008). Thyroid anaplastic carcinomas number increased from 7 cases (2001-2004) to 12 cases (2005-2008). The total number of thyroid cancer has increased dramatically after the introduction of universal iodination of alimentary salt with 178% compared to 2001-2004 (from 190 cases in 2001-2004 to 339 cases in 2005-2008), despite the fact that the number thyroidectomies decreased from 1734 (2001-2004) to 1449 (2005-2008). CONCLUSION: After the introduction the universal iodination of alimentary salt starting from 2004 the total number of thyroid cancers increased comparative with the period before universal iodination of alimentary salt.

Treatment of gastrointestinal stromal tumors--initial experience.

BACKGROUND: Gastrointestinal Stromal Tumors (GIST) offered the first opportunity of a specific treatment in neoplasms (tyrosine-kinase inhibitors) and also a new perspective of management of other neoplasms. METHODS: We have prospectively recorded the clinical characteristics, type of surgery, pathologic findings, adjuvant treatment, and recurrence of the patients with confirmed GISTs admitted between January 2004 and December 2008. RESULTS: There were 18 patients. Location of the tumor was gastric (44.44%), duodenal (11.11%), jejunal (16.67%), right colon (5.55%) and rectal (22.22%). None of our patients had clinical, imagistic or macroscopic metastases. All the patients had R0 resections, except a patient with local excision and another with R1 anterior resection for rectal GISTs. Postoperatively, 4 patients received Imatinib therapy. The mean follow-up period is 32 months (range 8-58 months); 2 recurrences, both after rectal GISTs. The rest of patients are tumor-free and subjects of prospective follow-up. CONCLUSION: We present the first 5 years experience of a prospective study of GIST started in 2004. The complete resection and the malignant potential according to Fletcher index are the most significant prognostic factors. Imatinib treatment may improve outcome in incomplete resected or high risk GISTs.

Laparoscopic management of gastrointestinal stromal tumours.

UNLABELLED: Gastrointestinal stromal tumours (GISTs) represent the most common non-epithelial tumour of the digestive tract. Laparoscopic approach may be considered ideal for the resection of these tumours. Their particular biological behaviour allows for a curative resection even without large resection margins and extensive lymphadenectomies. METHOD: Over a period of five years, eight patients benefited from laparoscopic resections (six patients with primary gastric GIST and two patients with small bowel GIST). Pathological features were analyzed including tumour size, surgical margin status, immunohistochemical staining profile, and tumour mitotic index. All cases were confirmed GISTs by immunohistochemical staining. RESULTS: The mean age of the patients was 61.6 years (range 48-71 years). Of these patients, five initially presented to hospital with acute gastrointestinal haemorrhage (four cases) or occult bleeding (one case). Gastric or small bowel tumours were identified during subsequent investigation. A presumptive diagnosis of gastric GIST was made in gastric lesions based on endoscopic, ultrasonic, and CT scan characteristics. Small bowel tumours were identified and presumed to be GIST based on information gathered from video capsule endoscopy, enteroscopy and CT scan. Complete resection was obtained with laparoscopic approach in six cases, while in two cases resection was laparoscopically assisted, with added oncology safety margins as preoperative definitive diagnosis was not available. Tumours varied in dimension from 2.5 cm to 9 cm and their malignant risk score using Fletcher criteria was low in three cases, intermediate in three cases and high in two cases. Mean postoperative stay was 3.8 days and there were no complications, nor postoperative mortality. After a mean follow-up of 26 months (range 1 to 60 months) all patients are symptom free and free of recurrent disease. CONCLUSIONS: A selective approach to laparoscopic resection of gastro-intestinal GISTs allows safe resection and very good results, on the condition that a clear diagnosis of GIST has been established on preoperative assessment. The laparoscopic feasible and safe considering the biological particularities of GIST, and it carries no additional risks.

[Immunohistochemic staining for CK5/6 and P63 significance in prostate premalignant lesions and adenocarcinoma]. / Semnificatia imunohistochimica a CK5/6 si P63 în leziunile premaligne si î adenocarcinomul de prostata.

UNLABELLED: The morphologic information from usual hematoxiline-eosine staining are sometimes insufficient in certifying or excluding the adenocarcinoma of the prostate, cases who must be study by immunohistochemistry. AIM: The investigation of staining for CK5/6 and P63 in cases diagnosed with prostate adenocarcinoma associated with high grade prostatic intraepithelial neoplasia. MATERIAL AND METHODS: The study was realized on 56 cases analyzed in Pathology Laboratory of Focsani Emergency Hospital. RESULTS: We registered a positive correct diagnosis for atypical adenomatous hyperplasia in 86% of cases and for prostate adenocarcinoma grade 1 in 14% of cases. CONCLUSIONS: CK5/6 and P63 are useful markers for elucidating a positive false diagnosis for prostate adenocarcinoma grade 1.

[Surgical treatment of hyperparathyroidism]. / Tratamentul chirurgical al hiperparatiroidismului.

BACKGROUND: Hyperparathyroidism (HPT), the result of excessive secretion of the parathormone, is one of the most common endocrine disorders. In most forms of HPT, surgical parathyroidectomy is the best choice. AIM: This paper aims to examine patients with hyperparathyroidism operated in First Surgical Unit Iasi, in terms of indications, surgical technique and postoperative results. MATERIAL AND METHOD: We performed a retrospective study, in First Surgical Unit Iasi, during 2000-2008. Clinical, laboratory, intraoperative and histopathological data were included in a MS Access Office XP database. Statistical analysis was performed with the SPSS ver. 15.0 for Windows (Statistical Package for the Social Sciences, Chicago, Ilinois). RESULTS: There were examined 34 patients with HPT: 32 cases were primary HPT (94.12%), and two cases with secondary HPT (patients with renal failure). The men/women ratio was 6/28 and mean age was 50.09 +/- 2.23 years old. Clinical presentation was variable: the dominant symptoms were osteoarticular (67.6%) followed by neuropsychological (64.7%), digestive (17.6%) and renal (11.8%). Associated diseases were recorded at 47.06% of patients: arterial hypertension--32.4%, coronary heart disease--23.5%, heart rhythm disorders--17.6%, diabetes--11.8%, biliary lithiasis--5.9%, renal lithiasis--8.8% and thyroid hypertrophy--55.9%. In 8 cases, primary hyperparathyroidism was associated with other diseases of the endocrine glands: 4 cases with Multiple Endocrine Neoplasia (MEN) type 1; a patient with von Recklinghausen disease; a patient with associated hypothyroidism and diabetes; two cases that with papillary thyroid carcinoma. Positive diagnosis was supported by determining serum calcium, phosphorus and serum concentration of the parathormone (PTH). All patients were evaluated by ultrasound exam; the sensitivity of the investigation was 88.23%. 99Tc-sestamibi scintigraphy was performed in 32.35% of patients with a sensitivity of 72.72%. Parathyroidectomy was performed by Kocher's incision in 88.23% and minimally-invasive open approach in 11.76%. The following types of interventions have been performed: tumor resections (73.53%), subtotal parathyroidectomies (17.6%), total parathyroidectomies (8.82%). In patients with associated thyroid disease total thyroidectomies (26.5%) and subtotal thyroidectomies were done (11.8%). The postoperative morbidity rate was 2.9% (transient hypocalcemia). Histopathological examination revealed the presence of parathyroidian adenoma in 67.6% of patients (N=23), parathyroidian hyperplasia in 26.5% (N=9) and parathyroidian carcinoma in the others 5.9% (N=2). CONCLUSIONS: The diagnosis of HPT involves positive determination of calcium and PTH. The most useful imaging techniques, are 99Tc-sestamibi scintigraphy and ultrasonography, which locates in most cases, the parathyroid pathological glands. Surgical treatment is the only curative treatment of HPT, with medical treatment only role in preoperative preparation. The precise site of the parathyroidian lesion facilitates minimally-invasive approach. The postoperative follow-up is mandatory because of the increased potential for recurrence and for diagnosis of other endocrine tumors (in patients with MEN).

[Present trends in abdominal actinomycosis]. / Tendinte actuale în actinomicoza abdominala.

BACKGROUND: Actinomycosis is a chronic infectious disease caused by bacteria in the Actinomyces genus. The pathologic, clinic and imagistic polymorphism and the rare incidence of this disease make it so frequent misdiagnosed. MATERIAL AND METHOD: Single unit retrospective nonrandomized clinical study on over 40 years of experience in diagnosing and treating abdominal actinomycosis. RESULTS: First case of abdominal actinomycosis was diagnosed in our clinic in 1968. During the next 36 years, between 1968 and 2004, there were registered only 3 cases, all ileo-cecal actinomycosis. In the next 3 years interval, 5 more cases were diagnosed: 4 associated with intrauterine devices (IUDs) and 1 associated with intraperitoneal remnant calculi after laparoscopic cholecystectomy. We present these last 5 cases, the first 3 having been reported elsewhere. CONCLUSIONS: Abdominal actinomycosis is a rare disease, with variable and deceiving clinical and imagistic characters. In Romania we witness a shift in the epidemiology of this disease as a result of the introducing of the IUDs for the first time after 1990. Confronted with a female patient carrying an IUD that has an inflammatory and a pelvic tumoral syndrome of variable intensity, one should consider also the diagnosis of abdominal actinomycosis. Preoperative establishing of this diagnosis may allow, by a long antibiotic therapy, the elimination of the need for surgery or at least the decrease of its limits. A very rare cause of intraperitoneal actinomycosis is intraperitoneal gallstones remnant after laparoscopic cholecystectomy. To our knowledge, our case is the first reported in the medical literature.

Small Bowell Malignant Melanoma-Report of Three Cases and Review of Literature.

Malignant melanomas have a predilection to metastasize to the small bowel. Three patients with malignant melanoma involving the small bowel are reported. Two patients were operated on for small bowel obstruction and the third for gastrointestinal bleeding with anemia. Two patients remained well 6 month and 2 years, respectively, after surgery. One patient died of metastatic cerebral melanoma 6 months postoperatively. One should suspect small bowel metastasis in every patient with malignant melanoma in his past medical history, who presents with recent changes in bowel habits, intestinal obstruction or gastrointestinal bleeding. Preoperative assessment can only raise the suspicion, even with advanced imaging methods: capsule endoscopy, enteroscopy, CT or PET-CT. The only therapeutic procedure is surgical resection, offering both short term survival as well as an improvement in the quality of life. Although prognosis is dismal there are factors associated with prolonged survival: complete surgical resection with no residual primary or metastatic tumor, so-called primary small bowel tumors in patients aged more then 60 years, LDH < 200 U/L, lack of tumor spread in mesenteric lymph nodes.

[Parathyroid glands involvement in multiple endocrine neoplasia]. / Interesarea paratiroidelor in neoplaziile endocrine multiple.

UNLABELLED: Multiple endocrine neoplasias are syndromes characterized by the involvement of at least two endocrine glands. Parathyroid gland involvement is usually noted in Multiple Endocrine Neoplasia (MEN) type I and type II. Parathyroid glands tumor associated with endocrine pancreatic tumor, as well as pituitary tumors is the typical pattern of MEN I. The parathyroid gland is the most frequent abnormality in MEN I. CASES REPORTS: We presented five cases with MEN I and parathyroid glands involvement. In three cases with young ages (28-33 years old) and familial setting, the MEN I syndrome was "complete" (parathyroid adenoma, gastrinoma or insulinoma and pituitary adenoma--prolactinoma or GH-secreting tumors), and, in the other two cases, with 57 and 68 years old respectively, the MEN I syndrome was "incomplete" with parathyroid glands and pituitary gland involvement. The cases with gastrinomas were operated in emergency for complication of peptic ulcer (perforation associated with peritonitis and gastro-intestinal bleeding); then the pancreatic tumors were diagnosed and left pancreatectomy with spleen preservation and respectively, tumor resection have been performed. Hyperparathyrodism was then diagnosed and subtotal parathyroidectomy has been performed in both cases. Unfortunately one patients died due to severe endocrine disorder. During the necropsy, the pituitary adenoma has been diagnosed. The third case with "complete" MEN was a women of 33 years old, admitted for severe hypoglycemia. The imagistic and laboratory test diagnosed a tumor situated into the pancreatic body, and an parathyroid adenoma. The resection of pancreatic tumor associated with resection of the parathyroid adenoma, in the same time, were performed. The other two cases with "incomplete" MEN were older then the first patients, and were diagnosed with hyperparathyrodism and pituitary gland tumor. The resection of parathyroid gland adenoma has been performed in both cases, with uneventful postoperative course. The literature data was also discussed. CONCLUSIONS: The parathyroid glands involvement in MEN is common. There are two kinds of MEN associated with parathyroid gland involvement: the "complete" form, especially in young patients, with diffuse involvement of the parathyroid glands, and the subtotal parathyroidy is the best choice, and the "incomplete" form, especially in elderly, with the involvement of a single parathyroid gland; in this way, the resection of the adenoma associated with biopsy from the other parathyroid gland is the best approach. The presence of gastrinomas, complicate the disease prognosis and the surgical approach. The treatment of these patients is challenging and has to be done in multidisciplinary team.

Small bowel malignant melanoma--report of three cases and review of literature.

Malignant melanomas have a predilection to metastasize to the small bowel. Three patients with malignant melanoma involving the small bowel are reported. Two patients were operated on for small bowel obstruction and the third for gastrointestinal bleeding with anemia. Two patients remained well 6 month and 2 years, respectively, after surgery. One patient died of metastatic cerebral melanoma 6 months postoperatively. One should suspect small bowel metastasis in every patient with malignant melanoma in his past medical history, who presents with recent changes in bowel habits, intestinal obstruction or gastrointestinal bleeding. Preoperative assessment can only raise the suspicion, even with advanced imaging methods: capsule endoscopy, enteroscopy, CT or PET-CT. The only therapeutic procedure is surgical resection, offering both short term survival as well as an improvement in the quality of life. Although prognosis is dismal there are factors associated with prolonged survival: complete surgical resection with no residual primary or metastatic tumor, so-called primary small bowel tumors in patients aged more then 60 years, LDH < 200 U/L, lack of tumor spread in mesenteric lymph nodes.