Nasal flap or cutaneous grafting in basal cell cancer of the nose. Comparison of two reconstructive possibilities.

BACKGROUND: Basal cell cancer is a malignant tumor of the skin most common in Caucasians and more common in the areas of the head and neck. At the moment there are many suggested treatment methods, however the surgical approach remains the technique most often applied. It includes excision of the oncological safety margins and the subsequent reconstructive phase can utilize local flaps or cutaneous grafts. This study aims to select the best technique for the reconstructive phase after removal of basal cell cancer from the region of the nasal pyramid, evaluation was made in terms of functional performance and aesthetics. We have evaluated 30 patients, of whom 15 treated with cutaneous grafting and 15 with flaps.

Paget's disease of the male breast: case report and a point of view from actual literature.

INTRODUCTION: Paget disease of the nipple in man is a very rare breast cancer, and there are not standard procedures or guidelines. In any cases, a Paget's disease could hide an invasive ductal breast cancer. CASE DESCRIPTION: We report the case of a 77-years old man affected by Alzheimer's disease, who presented to our attention because of an ulcerated palpable mass in the right nipple. A biopsy of the lesion showed "intra-epidermic proliferation of epitelioid cells, associated with linfo-plasmacellular infiltration of superficial dermis, compatible with Paget's disease (pTis)". We discussed the case in the multidisciplinary meeting and decided to subject the patient to surgery, so a right mastectomy plus sentinel lymph node biopsy (SLNB) were performed. Histo-pathological examination revealed "invasive ductal carcinoma of the breast, associated with a small component of in situ ductal carcinoma and Paget's disease of the nipple with superficial ulceration". Resection margins were free. Sentinel lymph node was negative. Biological features were as follows: ER 95%, PR 60%, Her-2/neu 1+, Ki-67 35%. The patient was discharged in the third post-operative day in good conditions. In the following weeks the patient's healing process was good and free of complications. CONCLUSIONS: Clinical recognition of Paget's disease is very important also in man, because it can be the alarm bell for an underlying invasive ductal breast cancer, often more aggressive than in woman.

Hamartoma of the breast in a young woman. Case report.

Hamartoma is a benign tumor-like malformation characterized by a focal mixture of mature cells and tissues normally present in affected area. The hamartoma of the breast is rare. We report a case in an asymptomatic young woman coming to our attention for a left breast lesion detected by ultrasound screening.

Duodenal tumors: four case reports.

We report 4 cases of neuroendocrine tumors of the duodenum. Signs and symptoms were non-specific. The choice of surgery depended on the site and stage of the tumor and any concomitant diseases.

Immunohistochemical markers of the hypoxic response can identify malignancy in phaeochromocytomas and paragangliomas and optimize the detection of tumours with VHL germline mutations.

BACKGROUND: There are no reliable markers of malignancy in phaeochromocytomas (PCC) and paragangliomas (PGL). We investigated the relevance of the mammalian target of rapamycin (mTOR)/AKT and hypoxic pathways as novel immunohistochemical markers of malignancy. METHODS: Tissue microarray blocks were constructed with a total of 100 tumours (10 metastatic) and 20 normal adrenomedullary samples. Sections were immunostained for hypoxia-inducible factor 1α (Hif-1α), vascular endothelial growth factor A (VEGF-A), mTOR, carbonic anhydrase IX (CaIX) and AKT. The predictive performance of these markers was studied using univariate, multivariate and receiver operating characteristic analyses. RESULTS: In all, 100 consecutive patients, 64% PCC, 29% familial with a median tumour size of 4.7 cm (range 1-14) were included. Univariate analyses showed Hif-1α overexpression, tumour necrosis, size >5 cm, capsular and vascular invasion to be predictors of metastasis. In multivariate analysis, Hif-1α, necrosis and vascular invasion remained as independent predictors of metastasis. Hif-1α was the most discriminatory biomarker for the presence of metastatic diffusion. Strong membranous CaIX expression was seen in von Hippel-Lindau (VHL) PCC as opposed to other subtypes. CONCLUSION: Lack of vascular invasion, tumour necrosis and low Hif-1α expression identify tumours with lower risk of malignancy. We propose membranous CaIX expression as a potential marker for VHL disease in patients presenting with PCC.

Breast-conserving surgery after neoadjuvant chemotherapy in patients with locally advanced cancer. Preliminary results.

Neoadjuvant chemotherapy (NACT) in locally advanced breast tumors may allow an adequate control of the disease impossible with surgery alone. Moreover, NACT increases the chance of breast-conserving surgery. Between 2008 and 2012, we treated with NACT 83 patients with locally advanced breast cancer. We report the preliminary results evaluating the impact of NACT on the type of surgery.

Cathepsin-k as a diagnostic marker in the identification of micro-granulomas in Crohn's disease.

Crohn's disease is a chronic inflammatory bowel disease, whose aetiology and pathogenesis are still unknown. The occurrence of epithelioid granulomas is one characteristic feature of the disease since these lesions are found in the bowel wall in 50-87% of colectomy specimens. Although granulomas are not pathognomonic, their identification is considered a relevant element for diagnosis. Cathepsin-k, a papain-like cysteine protease, is involved in bone remodelling, and has been widely used as a immunohistochemical marker for the in situ detection of osteoclasts. Interestingly, the expression of this potent protease is also significantly increased in stimulated tissue macrophages, epithelioid cells and granulomas, but is not expressed in resident tissue macrophages. In the present study, we evaluated Cathepsin-k expression as a diagnostic tool in the identification of small granulomas in Crohn's disease. Formalin-fixed and paraffin-embedded samples of 10 cases of Crohn's disease were collected from surgical ileo-colic resections followed by comparison of Cathepsin-k and CD68 immunoreactivity. Granulomas were identified in 4 of 10 cases examined in haematoxylin & eosin preparations. Cathepsin-k enabled the identification of small granulomas (with a diameter between 100 and 200 microm) in 6 of 10 cases, mainly localized within the submucosa and muscular layers. When compared to CD68, Cathepsin-k immunoreactivity was generally absent or only weakly expressed in resting tissue macrophages, thus allowing better identification of activated epithelioid cells. Based on these results, Cathepsin-k appears to be a reliable tool for the precise and rapid identification of small epithelioid granulomas in Crohn's disease.

[Advantages and limits of tumescent anesthesia in outpatient surgery]. / Vantaggi e limiti dell'anestesia per tumescenza in chirurgia ambulatoriale.

The Authors report the results of the tumescent anesthesia in 187 patients submitted to various outpatient surgical procedures comparing with those in patients submitted to local anesthesia by direct infiltration.

[Diagnostic and surgical problems of ectopic breast cancer]. / Problemi diagnostici e chirurgici del carcinoma nella mammella in sede atipica.

Cancer of supernumerary breast or ectopic breast tissue has haigher incidence than the cancer on ortotopic breast. This finding puts some problems about the diagnosis and therapy of ectopic breast cancer. The Authors describe their personal experience in three patients surgically treated and discuss about problems and solutions of this pathology.

[Cutaneous B-cell non-Hodgkin lymphoma: clinical aspects, diagnostic and surgical approach]. / Linfoma cutaneo non Hodgkin a immunofenotipo B: clinica, orientamento diagnostico e chirurgico.

By clinical observation and surgical treatment of a patient with cutaneous B-cell non-Hodgkin lymphoma, the Authors describe the nosological approach, the correct diagnosis and the surgical treatment in this disease.

[Seroma in residual fibrous capsule after breast implant explantation: a case report]. / Su un caso di sieroma della capsula fibrosa residua dopo rimozione di impianto protesico mammario.

The Authors present a singular case of seroma which developed in residual fibrous capsule after explantation of breast prostheses without replacement. Mammographic and sonographic findings of the seroma make difficult the diagnosis: mammograms revealed a radiopaque, well-circumscribed mass anterior to the pectoralis major muscle in the region of the prior sub-glandular implant, that was initially misinterpreted as breast implant radiographic feature. It is particularly important review and carefully correlate mammographic and sonographic findings with patient's surgical history for a correct diagnosis.

[Multiple repetitive mammary fibroadenomas. Case report]. / I fibroadenomi multipli recidivi della mammella. Case report.

Multiple and ripetitive mammary fibroadenomas represent a rare disease. The etiology is uncertain. The diagnostic radiology is able to allow a correct diagnosis. The authors report a case of a woman 22 years old undergone a surgical treatment many times to remove multiple and ripetitive mammary fibroadenomas. The proposed management provides for periodic radiological exams; the surgical treatment is proposed only for the lesions with a rapid growth.

[Pseudosarcomatous lesions: report of two cases]. / In tema di lesioni "pseudosarcomatose".

Of unknown etiology, mainly located on the upper limbs, the nodular fasciitis nowadays is considered as a reactive inflammatory lesion more than a neoplastic one. With very few symptoms, it can be diagnosed through histology and the extent of the excision is related to the report of the pathological examination.

[Breast lymphoma: diagnostic and surgical approach]. / Il linfoma della mammella: orientamento diagnostico e chirurgico.

By clinical observation and surgical treatment of a patient with a primitive lymphoma of the breast, the authors describe the nosological approach, the correct diagnosis and the relative surgical treatment in that disease.

Gastric mucinous adenocarcinoma with cutaneous metastases in a dog: diagnosis by fine-needle aspiration cytology.

A 12-year-old, intact, male mixed-breed dog was presented with anorexia, vomiting and multiple cutaneous nodules on its neck, trunk and hindlimbs. Fine-needle aspiration cytology of the nodules was characterised by a pleomorphic population of cells arranged singly or in small cohesive clusters, embedded in an amorphous mucinous material stained positive by periodic acid-Schiff (PAS). Acinar structures were occasionally found. Cells appeared either small with scant basophilic cytoplasm or large with a histiocytic appearance. Large cells had cytoplasm filled with a PAS-positive granular material. A presumptive diagnosis of cutaneous metastases of a mucinous adenocarcinoma was made. A primary, gastric, signet-ring mucinous adenocarcinoma was confirmed at postmortem examination and by histopathology. To the authors' knowledge, this is the first report of a gastric mucinous adenocarcinoma with cutaneous disseminated metastases in a dog.

[Post-mastectomy breast reconstruction by tissue expanders: technical note]. / Ricostruzione mammaria con espansore tissutale post-mastectomia: note di tecnica.

The aim of post-mastectomy breast reconstruction by tissue expanders is the mammary symmetry. The Authors report a personal experience in immediate (55 pts) and delayed (12 pts) breast reconstruction with implants. The technique is simple and safe with good aesthetical and functional results.

[Rare pathology of the breast: adenoma of the nipple]. / In tema di patologie rare della mammella: adenoma del capezzolo.

Adenoma of the nipple is a benign pathology which histologically interests the epithelium of the galactophorous ducts. This pathology looks like Paget's disease both macroscopically and microscopically, therefore an exact differential histologic diagnosis is needed with the breast's carcinoma to undertake the most timely surgical therapy.

[Mesothelial cyst of the diaphragm. Report of a case and review of the literature]. / Le cisti mesoteliali del diaframma. Osservazione di un caso e revisione della letteratura.

A case of mesothelial cyst of the right hemidiaphragm in a 44 year old man is reported. Origin (most likely due to a recess of the primary coelomiatic cavity), topographical, histological and therapeutic features are discussed, stressing that it is now more frequently recognised thanks to progress in diagnostic imaging techniques. Complete surgical excision is mandatory to definitely differentiate such lesion from primary diaphragmatic neoplasm, not infrequently malignant.

[Pilomatrixoma or Malherbe's calcifying epithelioma. A case report and review of the literature]. / Il pilomatrixoma o epitelioma calcifico di Malherbe. Descrizione di un caso e revisione della letteratura.

The case of a upper extremity calcifying epithelioma of Malherbe in a 16-year-old boy is reported. Clinical and pathological features of this extremely rare tumour, arisen from hair cortex cells, are reviewed. Pilomatrixoma has been reported not only as a benign lesion, or as a low-grade malignant lesion with a tendency to recur locally, but also as a highly malignant tumour. Factors influencing clinical differential diagnosis and prognosis are discussed as well.

[Facial rejuvenation with chemical peeling using phenol (Exoderm)]. / Ringiovanimento del volto con peeling chimico al fenolo (Exoderm).

The authors report their personal experience in the treatment of the resurfacing by means of phenol chemical peeling using a new solution described by Dr. Yoram Fintsi and called Exoderm. They report dressing technique and possible contraindications as well.