ABSTRACT
INTRODUCTION: The management of patients with advanced gastric cancer requires a stable venous access required at different stages of disease (treatment phase, palliative phase). Totally implantable central venous access in the arm, named PICC-PORT, is used in a patient with results of extensive skin burns of the neck, chest and right arm and surgical outcomes of multiple skin grafts of chest. The described clinical case is the first event in the scientific literature. PRESENTATION OF CASE: We report a case of a patient with results of extensive skin burns of the neck, chest and right arm and surgical outcomes of multiple skin grafts of chest that must perform chemotherapy with a port. In this patient, due to the difficulty of implanting a door in the cervico-thoracic district, we opt for the totally subcutaneous implantation of the vascular device (PICC-PORT 5 Fr) in the left arm. DISCUSSION: In this patient for the difficulty of implanting a port in the cervico-thoracic district, we opt for the totally subcutaneous implantation of the vascular device (PICC-PORT) in the arm. The PICC-PORT is positioned with the same technique as the PICC (ultrasound-guided vein puncture, with modified Seldinger technique and tip location with ECG technique); presents all the functional and aesthetic advantages of a totally subcutaneous device.The case described is the first case in the scientific literature. CONCLUSION: In Europe in recent years for the availability of the vascular device of small dimensions and materials increasingly compatible, the "PICC-PORT" is positioned in the veins of the arm with ultrasound-guidance without complications such as pneumothorax, arterial puncture, hematoma of the neck, Pinch-off syndrome, such as the clinical case presented with extensive scars on the chest and neck. Thoracic devices (chest port, tunnel venous catheter) are not indicated in thickened and inelastic skins, due to the high risk of dehiscence of the surgical wound.
ABSTRACT
INTRODUCTION: Mixed medullary-follicular carcinoma of the thyroid with pleomorphic pattern is an uncommon malignant epithelial tumor characterized by clinical and immunohistochemical features of both follicular and parafollicular thyroidal C cells. MATERIAL AND METHODS: We describe a rare case of this type of tumor observed in a 56 year old woman, undergone total thyroidectomy for suspected thyroid carcinoma, without lymph node metastasis. Preoperative basal calcitonin levels were in the limits, while thyroglobulin resulted increased. Presence of the latter suggests a potential usefulness of radioiodine therapy as an additional therapeutic tool for this type of tumor. RESULTS: Histological and immunohistochemical findings were surprising showing characteristic patterns and thyroglobulin and calcitonin positivity. After postoperative diagnosis the patient undergone specific endocrine and scintigraphic tests. CONCLUSIONS: Early diagnosis of a mixed medullary-follicular thyroid carcinoma is essential, considering its special therapy and negative prognosis. In fact it constitutes another clinicopathologic entity, different from typical medullary thyroid carcinoma and it's associated with a more favourable clinical course than the former. A precise diagnosis of this uncommon variety of medullary carcinoma of the thyroid is fundamental for an accurate treatment of the patient, but also for familiar genetic screening excluding MEN II syndromes. A radical surgical therapy plays a key-role for the treatment and the follow-up of this rare tumoral entity.
