[Neuroendocrine carcinoma of the breast. Our experience and a proposal of a therapeutic algorithm for a rare tumor]. / Il carcinoma neuroendocrino della mammella. Nostra esperienza e proposta di un algoritmo terapeutico per un tumore raro.

The neuroendocrine carcinoma of the breast is a very rare tumor. In this paper we describe our experience in 10 cases of neuroendocrine carcinoma of the breast, and an integrated diagnostic-therapeutic proposal for this tumor. Since no positive association has been shown between neuroendocrine differentiation and tumor size, staging, grading, survival and therefore prognosis, we consider that surgical therapy for neuroendocrine tumors of the breast should be the same as that performed in common invasive histotypes. Due to the presence of specific cellular receptors in neuroendocrine tumors of the breast, somatostatin has been claimed as a useful tool both for diagnostic (Octreoscan) and therapy (for metastatic disease). As for therapy, synthetic analogs show advantages versus native somatostatin, because of a longer half-life, and data from literature report encouraging results obtained by using radiolabelled somatostatin analogs. One of these is 90 Y-Dotatoc; we have already used it in patients with neuroendocrine tumors of the lung. Our algorithm for neuroendocrine tumors of the breast includes diagnostic scintigraphy with Octreoscan and receptor-mediated radiolabelled therapy with 90 Y-Dotatoc in patients with confirmed scintigraphic expression of somatostatin receptors in tumoral tissue.

[Primary angiosarcoma of the thyroid. Presentation of a case (epithelioid type) and nosological problems]. / L'angiosarcoma primitivo della tiroide. Presentazione di un caso (varietà "epitelioidea") e promlematiche nosologiche.

There is a great deal of confusion in the literature as to whether or not true angiosarcomas of the thyroid exist or whether these are all anaplastic carcinomas of the thyroid which have an angiosarcomatoid appearance. Due to the fact that undifferentiated carcinomas of this organ can strikingly resemble various sarcomas it is recommended that great care should be taken prior to qualify as an angiosarcoma a malignant thyroid tumor. A lot of viewpoints have been expressed so far in literature concerning this theme, and they can be summarized as follows. On one side and not admitting the existence of angiosarcoma in this location there are opinions which think of it as a "variant" of undifferentiated carcinoma (a pure carcinoma with a pseudovascular pattern or a carcinoma with an intermingled non-neoplastic reactive vascular component), or as a neoplasm in transition from epithelial to endothelial differentiation ("mesenchymal neometaplasia"), or as a carcinoma with aberrant expression of endothelial markers, or as a carcinoma with a non-specific uptake of endothelial antigens(e.g. from serum in case of F-VIII R-Ag positivity). On the other side there are opinions in favor of the existence of such an entity, based upon light microscopy features coupled with immunocytochemical results (endothelial antigens expression without or with cytokeratins expression) and with the possible support of electron microscopy. Anyway ultrastructural findings of specific markers (Weibel-Palade bodies, pericellular basal lamina, tight junctions, subplasmalemmal pinocytotic vesicles) according to some authors are not a prerequisite: so poorly differentiated neoplasma can fail to show those histogenetic markers.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary splenic cysts. Report of 5 cases, 4 of which unpublished and review of the literature]. / Cisti spleniche primitive. Presentazione di cinque casi di cui quattro inediti e revisione della letteratura.

After a complete review of the literature with an amount of 280 previously reported cases, the authors report on five total cases of primary (true) cysts of the spleen one of which already published. All these cases occurred in pediatric age and were treated by total splenectomy. All were large solitary cysts (size ranged from 4.5 up to 15 cm) but one, the largest of which in addition to the main cavity exhibited some more microscopic cysts of the same type few mm sized. Three of them were lined on their inner surface by a multilayered squamous epithelium, which in one case was also keratinized. The other two cysts showed a single layered epithelium which appeared flattened in one case, cubic in the other one. The discussion concerns the pathogenetic mechanisms which can lead to cyst formation, the imaging diagnosis of these rare lesions prior to surgical intervention, their treatment, and the correct histological recognition of these true cysts versus secondary (false) cysts or pseudocysts which commonly occur following trauma. One of the cases herein presented qualifies as a "pseudo-pseudocysts" due to the fact that a history of trauma was on record and to the fact that almost the entire epithelium was mechanically lost due to hemorrhage which filled the cyst cavity.

[Torsion of the ovary: an unusual cause of acute abdomen in childhood. Presentation of a case]. / Torsione dell'ovaio: una causa rara di addome acuto in età pediatrica. Presentazione di un caso.

Torsion of a normal ovary is difficult to diagnose. This usually leads to a delayed treatment hesitating in hemorrhagic infarction and necrosis. We report here a case in a 40 days old girl detected at operation following a clinical and radiological picture of acute abdomen.