[Medullary thyroid carcinoma]. / Il carcinoma midollare della tiroide.

The authors report a case of medullary carcinoma of the thyroid diagnosed at the 2nd Surgery Clinic of IRCCS Policlinico "San Matteo" in Pavia in a series of 600 cases of thyroid pathology. Having emphasised the rarity of this pathology, the authors report the characteristic pathological aspects. They also outline the clinical signs leading to suspected diagnosis, illustrate the diagnostic techniques used to achieve an early diagnosis and underline the importance of the tumour markers CT and CEA. They identify radical surgery, total thyroidectomy with MND lymphadenectomy, as the therapy of choice, followed by accurate and careful monitoring with a view to ensuring an early diagnosis of renewed disease or recidivation.

[Primary osteogenic sarcoma of the breast. Clinical contribution]. / Sarcoma osteogenico primitivo della mammella. Contributo clinico.

A case of primary osteogenic sarcoma of the breast is reported. All its clinical, radiological, gross and histological characteristics are analyzed, nevertheless the diagnosis is difficult. The authors dwell upon the utility of fine-needle aspiration and upon the importance of histologic and immunohistochemical studies. After emphasizing the difficulty both in an adequate local control and of metastasis, the authors point to the right therapeutic ways, still debated for the rarity of the tumor, which precludes every prospective trial.

[Gastric injury by caustics: a case report]. / Su un caso di lesione gastrica isolata da caustici.

The authors get the idea from the observation of a case of ingestion of muriatic acid, recently happened by Clinical Surgery II of the IRCCS Polyclinic "San Matteo" of Pavia in order to examine carefully the matter. The rareness of the shown case is given by the whole involvement of only the stomach, without damages for the oropharynx and the esophagus. The total gastrectomy executed 6 months after the ingestion of the acid has given to the patient the whole recovery. The follow-up checked for a periodical time of 6 months for a period of about five years, permits to observe the normal intestinal canalization without stenitical symptoms or zonas with degenerative risk.

[Cervico-mediastinal goiters. Clinical aspects]. / I gozzi cervico-mediastinici. Contributo clinico.

Among 660 cases of thyroid pathology diagnosed by the 2nd Institute of Clinical Surgery, Policlinico San Matteo, IRCCS, Pavia, during the period 1984 to 1993, 34 cases of cervical-mediastinal goiter were observed with an incidence of 5%. After a careful analysis of the main contributions to the study of cervical-mediastinal goiters, paying special attention to their classification, pathogenesis, methods of growth, and unique symptomatic manifestations, the authors focus on current radiological and instrumental studies, which are widely regarded as being useful for the diagnosis of the site and nature of this disease. They review the routes for aggressive surgery and appropriate techniques for the exeresis of the mediastinal mass. Having empasised the absolute indication for surgery the authors recommend quasi-total or total thyroidectomy as the elective form of surgery.

[10 years of neoplastic pathology of the thyroid]. / Dieci anni di patologia neoplastica tiroidea.

Here the authors have reported case studies made over a ten year period from 1982 to 1991 at the Surgical Semeiology Institutes of the Surgical Pathology, and Surgery Clinic II of the IRCCS San Matteo General Hospital, Pavia. It considered 28 cases of thyroid carcinomas (18 papillary, 6 follicular, 3 anaplastic and 1 medullary). Firstly an in depth examination using the most up to date diagnostic methods available today was made with particular attention paid to cytological examination by needle suction showing the rarity of the affliction. Then the histological variables the various biological aggressiveness, the multicentric and bilateral nature of certain neoplastic forms were recorded. Finally particular attention was paid to the therapeutic problem. In agreement with the great majority of authors, they believe that the best therapy is as follows. For differentiated tumours, a total thyroidectomy and when there is a more conservative surgical choice, the isthmolobectomy should be modified by prognostic indicators (age, sex, six of the tumour, single or multi location histotype). Furthermore lymphadenectomy should not be carried out automatically, but after a careful evaluation of the lymph node areas for a simple suspicion of metastasis.

[A case of primary carcinoma of the duodenum with subampullar localization]. / Su un caso di carcinoma primitivo del duodeno a localizzazione sottoampollare.

The authors illustrate a case of previous duodenal adenocarcinoma with subvaterian localization and, after revising the literature and some general remarks, they explain their practice. They come to the conclusion that in some well selected cases, duodenal segmental resection can be correctly applied. They remember that the most important factor of the improvement of the prognosis is early diagnosis: it is indispensable for radical exerectical therapy.

[A rare case of massive digestive hemorrhage. Carcinoid of the small intestine]. / Un raro caso di emorragia digestiva massiva. Il carcinoide del piccolo intestino.

The authors reports a case of massive digestive hemorrhage produce by a carcinoid of the small intestine. Having reviewed the most frequent causes of primary hemorrhage of the mesenteric small intestine, attention is focused on the difficulties o making an etiological and topographical diagnosis, in spite of using the most advanced instrumental research methods. The paper concludes that explorative laparotomy is the sole method for making a precise diagnosis and performing appropriate surgical treatment.

[Enterovesical fistula (author's transl)]. / Le fistole entero-vescicali.

The authors get a starting point from describing a case with undecided etio-pathogenesis, to focalize the entero-vesical fistulas that represent the most frequent variety of entero-urinary fistulas. Particularly they stop a little on manifold aspects of etio-pathogenetic and classificative order, refer anamnestic, clinical, instrumental and radiological data which allow to get an undoubted diagnosis, emphasize the high rates of complete recoveries in relation to the timely application of adequate surgery.

[One case of primitive lymphoblastic malignant lymphoma of the appendix vermiformis (author's transl)]. / Su un caso di linfoma maligno linfoblastico primitivo dell'appendice vermiforme.

On the occasion of diagnosing one case of primitive malignant lymphoma of the appendix at the Institute of Surgical Semiology, University of Pavia, the authors discuss a number of aspects of the clinical picture, anatomopathology, and therapeutic approach to this rare malignancy.