Pituitary prolactin-secreting macroadenoma combined with bilateral breast cancer in a 45-year-old male.

We describe an unusual case of bilateral breast cancer synchronous with pituitary macroprolactinoma in a young male. Up to date, only very few of such cases have been described worldwide and to our knowledge this is the first one in which both breast cancer and pituitary macroadenoma have been found together at the time of presentation. A 45-year-old male was diagnosed as having a pituitary macroprolactinoma and bilateral breast cancer on the basis of hypogonadism (testosterone 2.9 pmol/l) with very high levels of prolactin (33,100 U/l), typical neuroradiologic finding of a pituitary macroadenoma, marked bilateral gynecomastia with mammographic pattern highly suspected for cancer and subsequent hystological confirmation. Bilateral mastectomy was performed and medical therapy with bromocriptine 10 mg/day was started. After 2-year follow-up the patient is disease-free. Hormonal, neuroradiological and oncological patterns are all negative or markedly improved. We stress the importance of prolactin for its possible biological effects on breast cancer induction or growth. Moreover in any case of hyperprolactinemia we suggest a mammographic examination and, in the case of breast cancer, at least a baseline hormonal profile.

[Gastrointestinal stromal tumors (GIST). Our experience]. / I tumori stromali gastrointestinali (GIST). La nostra esperienza.

Nine cases of gastrointestinal stromal tumors (GISTs) observed in the period between 1993 and 1999 and treated with radical surgery are presented. Patients were studied with instrumental examinations (ultrasonography, TC, EGDS, RSCS, endoscopic ultra-sound) which permitted to make a temporary diagnosis of "suspect gastric or bowel neoplasm". Only after surgical resection of the neoplasm it was possible to make a definitive diagnosis, based on histologic examination of the operating piece. According to personal experience and literature data, we could affirm that GISTs' clinical manifestations are extremely heterogeneous and so these tumors are often diagnosed casually. Prognosis isn't correlated as much to neoplasm histologic and cytologic characteristics, as to next organs infiltration, which represents a sign of particular aggressiveness of lesions.

[Latero-lateral choledochoduodenostomy in benign pathology of the common bile duct. A prospective study]. / La coledocoduodenostomia latero-laterale nella patologia benigna della via biliare principale. Studio prospettico.

Biliodigestive derivations for benign diseases of the biliary tract are currently accepted in case of extended to recurrent choledochal stenosis, excessive dilation of the choledochus, impacted ampullary stones. This paper concerns 19 subjects that underwent laterolateral choledochoduodenostomy (CDS) according to the Roesner technique over the period January 1986 through December 1987 in order to evaluate long-term functional results of this operation. Hepatic serum enzymes and bilirubin were determined at intervals of two weeks during the first three months and of four weeks until the sixth month postoperatively. At this time a battery of controls was performed, namely standard plain X-ray of the abdomen, hepatobiliary sequential scintigraphy with HIDA, endoscopic examination of the anastomosis. The level of serum enzymes was then determined at 18 months postoperatively and scintigraphy was repeated as well. Based on the results of this study and the review of the recent literature, our opinion is that CDS has shown as a safe procedure with good long-term results in the treatment of benign disease of the biliary tract, mostly if high-risk aged subjects are concerned.

[Volvulus of the gallbladder. Presentation of a case and review of the literature]. / Il volvolo della colecisti. Presentazione di un caso e revisione della letteratura.

A case of acute torsion of the gallbladder in a 83-year old woman is presented. According to the literature, the pathogenetic mechanism, the anatomical bases and the clinical presentation of this disease are discussed. The age intervals more often affected are the pediatric and teen-ager and, mostly, the elderly over the 70's. The basic anatomical defect is the gallbladder flotation, congenital or acquired. The clinical feature is that of right acute abdomen, and emergency cholecystectomy is the treatment of choice.

[Malignant cutaneous lymphoma in a case of Wiskott-Aldrich syndrome with long-term survival]. / Linfoma cutaneo maligno in un caso di sindrome di Wiskott-Aldrich a lunga sopravvivenza.

The case of a 24 year old man affected with Wiskott-Aldrich syndrome (WAS) is reported. The review of the charts of previous hospital admissions revealed the presence of an inherited trait and a long history of recurrent infections and hemorrhages. This young man was referred to our surgical department with the diagnosis of right lower limb gangrene, but the biopsy showed the lesion being due to cutaneous malignant lymphoma characterized by large polymorphic cells. All clinical and immunological elements typical of WAS were present: they are discussed with regard to the recent literature.

[Surgical treatment of lithiasis of the common bile duct: our experience]. / Il trattamento chirurgico della litiasi della via biliare principale: nostra esperienza.

On the basis of their personal experience of biliary pathology, the authors present their opinion of surgical treatment of benign diseases of the common bile duct. From 1980 to 1988 a total of 930 patients were assessed, 140 of whom were affected by choledocholithiasis. Data confirmed that, with the exception of choledochotomy as a direct approach for removing stones, good results were achieved using papillosphincterotomy, since this technique best restores the physiology of the biliary tract. In cases where common duct dilation exceeded 20 mm or where the patient was in poor clinical condition, bile was drained into the gut forming a side-to-side choledochoduodenostomy.

[Primary carcinoma of the gallbladder]. / Il carcinoma primitivo della colecisti.

Primary carcinoma of the gallbladder, while infrequent, is the most representative among the malignant neoplasms of the biliary tract. The diagnosis of carcinoma of the gallbladder was made in 22 out of 1252 operations performed for gallbladder disease (1.8%) since January 1980 through June 1988: only in 9% of the subjects a malignant tumor of the gallbladder was suspected preoperatively. In 21 cases the carcinoma was associated with chronic lithiasic cholecystitis. The 22 cases were assessed according to the classification proposed by Nevin. The operations performed were: 4 routine cholecystectomies (stages I and II) 4 cholecystectomies with lymphadenectomy (stages I and II); 4 cholecystectomies with lymphadenectomy and liver wedge resection of the bed of the gallbladder (stages II, III, IV, V); 7 explorative laparotomies and 3 gastrojejunal anastomoses (stage V). A complete follow-up was available for each of the 22 subjects: cumulative survival rates were calculated according to Kaplan-Meyer. The overall 5-year cumulative survival rate after operation was 19% for the whole group, whereas it reached 76% for the subgroup of 9 patients classified in stages I and II. This analysis reinforces the statement that surgical therapy can achieve excellent results if brought about before cancer overwhelms the muscular layer of the gallbladder wall. Thus, as the preoperative diagnosis of gallbladder carcinoma is extremely difficult and uncertain, any delay in performing cholecystectomy seems to be unwise in all those cases of chronic benign disease of the gallbladder (whether lithiasic in nature or not) that are suspected to be a major risk factor for cancer degeneration because of their frequent association with the carcinoma of the gallbladder.

[Current indications for percutaneous transhepatic cholangiography (PTC)]. / Indicazioni attuali alla colangiografia percutanea transepatica (PTC).

Percutaneous transhepatic cholangiography (PTC) showed its widest diffusion during the late '70s while since the early '80s it was gradually replaced by endoscopic retrograde cholangiopancreatography (ERCP). Anyway, a well definite role for PTC still exists. PTC was performed in 60 of 131 cases of obstructive disease of the biliary tree: the indications are illustrated in detail. The statistical indicators utilized to choose this examination were: echographic determination of the diameter of the biliary tree, bilirubinemia, alkaline phosphatase (ALP) and serum gamma-GT. Data collected during this study showed that biliary dilation has a significant correlation to serum levels of ALP, while bilirubin has not. Biliary dilation is currently well established by echography: in some instances, however, biliary obstruction is earlier suggested by elevated serum enzymes of biliary stasis, while it is clearly demonstrated that biliary dilation is a precursor of jaundice, better defined as an expression of biliary hypertension. Based on these observations and on the review of the literature, the Authors believe that PTC still remains a second choice examination as compared to ERCP: when the latter be not effective for diagnosis or decompression of the biliary tree, then PTC can be resolutive.

[Leukocyte adhesiveness and chemotaxis during infusion of Intralipid]. / Studio della adesivita e chemiotassi leucocitaria durante infusione di Intralipid.

The effect of an intravenously administered lipid emulsion (Intralipid) on granulocyte functions has been studied. The study has been carried out in 20 healthy individuals, divided into two groups: 10 individuals have been infused with Intralipid 10% i.v.; the other 10 individuals (controls) have not been infused with any pharmacologically active solution. In all the subjects the following parameters have been studied: blood granulocyte count, granulocyte and leucocyte chemotaxis. The results showed a transient fall of granulocyte adherence during the intralipid infusion; no alterations of granulocyte count and leucocyte chemotaxis were found.

[Adhesivity and chemotaxis of leukocytes during infusion of Intralipid]. / Studio della adesivita e chemiotassi leucocitaria durante infusione di Intralipid.

The effect of an intravenously administered lipid emulsion (Intralipid) on granulocyte functions has been studied. The study has been carried out in 20 healthy individuals, divided into two groups: 10 individuals have been infused with Intralipid 10% i.v.; the other 10 individuals (controls) have not been infused with any pharmacologically active solution. In all the subjects the following parameters have been studied: blood granulocyte count, granulocyte adherence and leucocyte chemotaxis. The results showed a transient fall of granulocyte adherence during the intralipid infusion; no alterations of granulocyte count and leucocyte chemotaxis were found.

[Immunological monitoring of patients operated on for epidermoid bronchogenic carcinoma]. / Monitoraggio immunologico di pazienti operati per carcinoma broncogeno epidermoidale.

Sequential monitoring of non specific immunity has been carried out in 16 patients with squamous cell bronchogenic carcinoma undergoing radical surgery. At the time of diagnosis total lymphocyte counts, T-lymphocyte counts and the blastogenic response of lymphocytes to PHA were only slightly depressed; on the contrary C3c and C4 serum levels were significantly increased (P less than 0.01). Sequential determinations of the immunologic profile at monthly intervals up to the 12th postoperative month showed a transient increase of total lymphocyte and T-lymphocyte levels; the lymphocyte blastogenic response to PHA and also C3c and C4 serum levels progressively decreased. Delayed hypersensitivity response to cutaneous antigens, neutrophil chemotaxis, serum levels of IgG, IgA, IgM and B-lymphocyte counts were constantly found within normal range.