An unusual presentation of secondary involvement of B-cell chronic lymphocytic leukemia. A case report.

Extramammary tumors rarely metastasize to the breast. The commonest tumors to metastasize in breast tissue are lymphoproliferative diseases, melanoma, lung cancer and gynecological malignancies. Primary breast lymphoma has been reported in the literature with a maximum percentage of about 0.5% of all breast malignancies, while secondary localizations of lymphomas in the breast are less well studied in the literature than primary ones. The authors report a rare case of a secondary localization of B-cell chronic lymphocytic leukemia to the breast in which the diagnosis was obtained by histopathology and immunohistochemistry and further confirmed by molecular data. This occurrence must be considered in the differential diagnosis of a breast lump so that the primary hematological disease can be adequately treated and the correct type of breast surgery performed.

[Major emergency management in ship collusion]. / Gestione della maxi-emergenza nella collisione tra navi. Nostra esperienza.

AIM OF THE STUDY: To prove that a correct management of a major emergency allowed a quick triage, trauma team, appropriate treatment, discharge and treatment of many patients injured patients when, in January 2007, a crush between a merchant ship and an hydrofoil happened in the Messina strait, that separate Sicily and Calabria. MATERIALS AND METHOD: Four deaths and 105 injuries were observed. Our experience in the emergency care refers to 25 patients of them. All patients were investigated with routine blood tests, imaging techniques and classified according to AIS and ISS. Their classification in colour code was green for 14 of them (7 Males, 7 Females); yellow for 9 (5M, 4F) and red for 2, both males. RESULTS: Of the 105 injured patients, twenty five patients were referred to our Accident and Emergency Department. Ten were affected by cranial trauma, 6 by spinal injuries, 5 by thoracic injuries, 3 had bone fractures and 1 patient with severe wounds. Among all patients, 18 had an ISS <15; 7 had an ISS of 28 (range 17-45). Mean emergency room stay, discharge and transport of patients to wards was 103 minutes. Twelve patients were admitted to the hospital; 9 refused hospitalization, 4 were discharged. DISCUSSION: Twenty six ship-collisions occurred in the Messina Strait between 1950 and 2007, were documented 10 deaths, and other four death of Segesta Jet accident. The approach to Major Emergency was carried out in according to ATLS and P.E.I.M.A.F. This allowed specific and efficacious investigations.

[Breast abnormalities: a retrospective study of 208 patients]. / Anomalie mammarie. Studio retrospettivo su 208 casi.

Ectopic breast tissue occurs in 0.4-6% of the general population. Usually, these tissues develop along the embryonic milk line but other sites are reported in the literature. Accessory breasts are commonly axillary and may undergo hormonal changes. Some pathologies of normally positioned breasts can occur in ectopic breast tissue, including carcinoma, and therefore require traditional senological flow-charts and imaging strategies. Supernumerary nipples are generally asymptomatic but may sometimes be associated with urological malformations. In our 10-year experience, 208 patients were observed (138 polythelia and 70 polymastia) and 159 surgical procedures were performed, 97 for supernumerary nipple excision and 67 for accessory breast ablation. Five neoplastic lesions and 25 fibrocystic mastopathies were detected in specimens; normal nipple or breast tissue was found in 129. In view of the potentially malignant transformation of accessory breasts, thorough physician evaluation is needed. Surgery is currently suggested in cases of suspected malignancy, in symptomatic cases and for cosmetic problems.

[Personal experience using radioimmunoguided surgery (RIGS)]. / L'utilizzo della chirurgia radioimmunoguidata nella nostra esperienza.

Radio Immuno Guided Surgery (RIGS) is a technique that has numerous uses in oncology. It is characterised by a multidisciplinary approach by nuclear physician and surgeon for diagnosis and treatment; it uses colloid radiotracers, monoclonal antibodies or non-immunological tracers. We adopted this technique in 281 patients: 256 (91.9%) (range 26-82) with breast disease (breast cancer or occult breast lesions) and 25 (8.9%) (range 42-84) with colorectal cancer localized or recurrent. We used monoclonal antibodies (ArcitumoMab 99mTc-labelled) for colorectal carcinomas and aggregates of human serum albumin 99mTc-labelled for Radioguided Occult Lesion Localization (ROLL) and Sentinel Lymph-Node Biopsy (SLNB). All patients were studied preoperatively by routine blood tests, instrumental exams and tumoral markers. Amongst patients with breast disease, 142 breast cancers and 114 occult breast lesions were found. Among patients with colorectal disease, 8 cases had localized colorectal cancer and 17 cases had locoregional recurrence and/or metastasis. In all cases pathologic sites were detected by probe during surgery. The RIGS is indicated for ROLL and SLNB; nevertheless it is also suggested for pre- and intraoperatively staging of primary and recurrent colorectal cancers. This method gives a chance for a radical surgical and oncologic treatment in localized and recurrent cancer. Prospective studies are needed in order to estimate survival and usefulness of this methodology.

[Gunshot wounds. Our experience]. / Ferite d'arma da fuoco. Nostra esperienza.

Abdominal gunshot wounds may result in elevated morbidity and mortality. The optimal management is still controversial. The authors report on their experience with treatment of 49 patients. In all patients the PATI score was used to identify trauma and all were treated surgically. Laparoscopy was employed only in one patient. The mortality was 2% and the morbidity 6%. The authors conclude that the PATI score correlated well with morbidity and mortality. Resuscitation with immediate surgical treatment may reduce the morbidity and mortality rates.