Parathyroid cancer as rare cause of primary hyperparathyroidism. Case report and review of the literature.

Primary hyperparathyroidism (PHPT) due to parathyroid carcinoma is rare, and affects more frequently women in their 4th-5th decades of life. Parathyroid cancer (PC) accounts for 0.5% up to 5% of the patients with primary hyperparathyroidism (PHPT). Diagnosis of PC is not easy, and a lot of patients with PHPT receive no pre-operative or intra-operative diagnosis of malignancy. Most of PC are hyperfunctioning, with marked serum PTH levels, and symptoms occurs more frequently than in benign disease. We report the case of a 52 years old woman that underwent a single parathyroidectomy for hyperfunctioning gland. Histological examination revealed carcinoma. Parathyroid carcinoma is rare and surgery represent the only curative approach, although there can be a local recurrence of the disease. A pre-operative diagnosis is not easy, and many features that suggest the diagnosis of malignancy are controversial. According to the literature, we think that the cure of the parathyroid cancer is difficult to achieve. After two years of follow- up, our patient is in good conditions and has no evidence of disease. A careful follow up is of primary importance to diagnose the local recurrence of disease and perform a second surgical treatment, to achieve the control of hypercalcemia, which causes severe metabolic alterations and visceral lesions until the death.

[Subareolar injection for sentinel lymph node biopsy in multiple breast cancer]. / L'iniezione subareolare per la biopsia del linfonodo sentinella nei tumori multipli della mammella

In this study we performed subdermal injection of 99mTc-labeled albumin combined with subareolar (SA) injection of blue dye to axillary lymphatic mapping and sentinel lymph node biopsy (SNLB) in patients with multifocal and multicentric breast cancer (MC) to evaluate the feasibility and accuracy of this technique. We compared the results with a group of patients with unifocal breast cancer. From January 1999 to March 2006 axillary lymph node mapping and SLNB was performed on 250 patients followed by a complete axillary lymph node dissection. Retrospective analysis showed that 32 (12.8%) of these patients have MC on final histopathologic examination and 218 (87.2%) have unifocal cancer. In statistical analysis tumor size shows a significant difference (p=.01) with largest lesions in MC. In MC often histological type is invasive lobular with or without in situ cancer (p= .001). Metastatic lymph node involvement was significantly higher in the MC group compared to unifocal cancer group (p=.001). False negative (FN) rate was 5.8% in MC and 9.6% in unifocal cancers. The overall accuracy of lymphatic mapping was 96.8% in MC and 97.6% in unifocal cancers. Sensitivity was 94.4% in MC and 91.2% in unifocal cancers. In this study we provide further evidence that lymphatic mapping may be reliable even in patients with MC. SA injection technique demonstrates a high sentinel lymph node identification rate and low FN rate; therefore this technique should been recommended to SLNB in patients with MC of the breast.

Mucocutaneous paraneoplastic syndromes (MCPS). A clinical-pathologic review.

Mucocutaneous paraneoplastic syndromes (MCPS) are a common group of dermatoses exhibiting a variable morphologic and pathologic picture which can occur in association with solid tumors or hematologic malignancies. In this review the Authors report the most important clinical characteristics and commonly associated malignancies of these dermatoses. Their identification is important because their superficial appearance and precocious arising are useful in the early diagnosis of an otherwise asymptomatic visceral malignancy and because differential diagnosis between skin metastases and malignancy-associated dermatoses is very important for a careful staging and management of the neoplasm. At the same time, MCPS may also be suggestive of the specific type of cancer present. Finally, the presence of a MCPS often carries grave oncologic implications. Once, therefore, the diagnosis of these dermatoses has been established, either an appropriate evaluation for an asymptomatic neoplasm in a cancer-free individual or an investigation for the recurrence of malignancy in an oncologic patient should be initiated.

[Multifocal carcinoma of the small intestine]. / Il carcinoma multifocale del tenue.

A recently observed case of carcinoma of the small intestine is report because of its rarity and the exceptional nature of polycentrism in these neoplasias. Interest in the case was also due to the onset of carcinoma in a patient who had already undergone gastrosection, a condition which permitted endoscopic diagnosis. The literature did not throw up any other cases of small intestine carcinoma with localization at the afferent loop of a previous gastroenteroanastomosis.