An unusual case of exclusive liver metastases from adenoid cystic carcinoma of the submandibular gland: a role for surgery? Report of a case.

Adenoid cystic carcinoma (ACC) is a relatively rare tumor of the salivary glands, accounting for approximately 5%-10% of all salivary gland tumors. An important feature of ACCs is the long clinical course with a high rate of distant metastases, with an incidence of more than 40% for ACC of submandibular glands. The preferential sites of metastases are the lung and bone, followed by the brain and liver. Most liver metastases are derived from nonparotid ACCs, and the presentation is often related to local recurrence or metastases to other organs. We herein report the case of a patient with liver metastases treated by a hepatectomy, which occurred 18 months after the primary resection of an ACC of the submandibular gland. We furthermore review the literature concerning the management of these tumors.

Indicators of sexual and somatic development and adolescent body size in relation to prostate cancer risk: results from a case-control study.

OBJECTIVES: To examine the relationship between the indicators of sexual and somatic development (ie, age at first shaving and maximal shoe size) and adolescent anthropometric characteristics (ie, body size at age 10 to 13 years) and prostate cancer risk. METHODS: We analyzed the data from a population-based case-control study in Erie and Niagara Counties, New York. The participants were 64 men with incident, primary, histologically confirmed, clinically apparent (Stage B and greater) prostate cancer and 218 controls, who had been frequency matched by age and residential area. Information regarding the variables of interest was self-reported. We compared the adjusted mean age at first shaving and age at maximal shoe size and calculated the odds of body size at ages 10 to 13 years using logistic regression models. RESULTS: The patients showed no evidence of older age at first shaving (adjusted mean, 18.0 versus 17.8 years, P = 0.46) or significant evidence of older age at the maximal shoe size (20.1 versus 17.6 years, P <0.05). The participants who defined themselves as being as heavy as or heavier than their peers at age 10 to 13 years showed a decreased prostate cancer risk compared with participants who were thinner than their peers (odds ratio 0.36, 95% confidence interval 0.15 to 0.83; and odds ratio 0.38, 95% confidence interval 0.17 to 0.87, respectively). CONCLUSIONS: Our results support a role for the indicators of somatic development and adolescent body size in predicting prostate cancer risk, suggesting that risk determinants operating early in life affect men's subsequent prostate cancer risk.

[Critical analysis of the long-term management of a case of cancer of the breast]. / Analisi critica della gestione a lungo termine di un caso di cancro mammario: a proposito di un caso clinico.

We describe a case of gastric metastases from a lobular carcinoma of the breast in a 73-year-old woman who had undergone a left mastectomy with axillary dissection 15 years earlier. The initial diagnosis was diffuse-type gastric carcinoma as evaluated both by analysis of gastric biopsy findings and ultrasonographic endoscopy. The definitive diagnosis of metastatic breast cancer was confirmed after subtotal gastrectomy for a presumed primary gastric carcinoma and was obtained using a panel of specific immunohistochemical markers. The distinction between primary and secondary gastric malignancies in patients with a history of lobular breast carcinoma may not be merely an academy exercise, since the treatment and prognosis of the two situations are different.

[GIST: a clinical case as a model of surgical and pharmacological therapy of solid tumours]. / GIST: un caso clinico come modello della terapia chirurgica e farmacologica dei tumori solidi.

Gastrointestinal stromal tumour: report of a case as a model of surgical and pharmacological therapy of solid tumours. mutation of this protein is present in most of these tumours. Gastrointestinal stromal tumours are notoriously unresponsive to chemotherapy and radiotherapy and prior to the recent introduction of the kit inhibitor imatinib, there was no effective therapy for advanced, metastatic disease. We report a case of metastatic gastrointestinal stromal tumour located primarily in the ileum and examine it in detail in order to contribute both to identifying factors capable of predicting its clinical course and evaluating the efficacy of imatinib as adjuvant therapy for this rare type of tumour. We share the opinion that, given the present state of the art, surgical resection remains the gold standard of treatment for these tumours and imatinib is a valid systemic therapy for metastastic and locally unresectable gastrointestinal stromal tumours.

Rectal cancer surgery with sphincter preservation: functional results related to the level of anastomosis. Clinical and instrumental study.

BACKGROUND/AIMS: Unsatisfactory functional results have been reported not only after coloanal anastomosis, but also after anterior resection with colorectal anastomosis. The aim of this study is to establish functional outcome predictive factors related to surgical technique and especially the real impact of residual rectum length to identify patients who could benefit from colonic pouch reconstruction. METHODOLOGY: Sphincter preservation was achieved in 214 of 327 patients who underwent surgery for rectal cancer. Patients have been subdivided according to the level of anastomosis measured by a rigid proctoscope from the anal verge. In 93 patients functional results have been assessed by clinical control and anorectal manometry. RESULTS: Functional alterations such as leakage (13%), incontinence (5%), urgency (5%) and difficulty in evacuation (10%) appeared in patients who underwent anterior resection with anastomosis 4 to 6 cm from the anal verge. Nevertheless, comparing anterior resection with anastomosis 6 to 8 cm and that with anastomosis 4 to 6 cm rectal compliance was the only parameter whose difference is statistically significant. CONCLUSIONS: This result makes us to believe that patients who undergo anterior resection with no more than 2-3 cm of residual rectum could benefit from a colonic pouch reconstruction.

The role of extended total gastrectomy in advanced gastric cancer.

BACKGROUND/AIMS: Extended total gastrectomy represents, in our experience, 52 out of 443 (11.7%) surgical resections for gastric cancer (1976-1998, 269 total gastrectomies). METHODOLOGY: Enlarged resections were performed on left liver lobe (5 cases), transverse colon (8 cases), pancreas body-tail (35 cases), mesocolon (4 cases), diaphragm (6 cases), jejunum (1 case), and adrenal gland (1 case). RESULTS: Morbidity rate was 18 out of 52 cases (34.60%); 1 esophagus-jejunum anastomosis leakage, 6 cases of pneumonia, 1 pancreatic fistula, 1 p.o. pancreatitis, 3 subphrenic abscesses, 4 cardiocirculatory complications, successfully resolved with conservative therapy. There was one case of postoperative death (1.9% due to cardiac failure). There was a 5-year survival rate for 36.5% of the patients, with follow-ups from 6 months to 11 years. The authors, based on their data, international literature (Roder 1993, Cordiano 1996, Shchepotin 1998) and taking into account mortality and morbidity rates estimate a 5-year survival rate in 30-52% of the cases. CONCLUSIONS: In conclusion, we believe that major surgical procedures for gastric cancer are indicated for every case of suspected neoplastic infiltration of contiguous organs.

[Carcinoma of the pancreatic remnant developing after pancreaticoduodenectomy for adenocarcinoma of the head of pancreas]. / Carcinoma del moncone pancreatico dopo duodenocefalopancreasectomia per adenocarcinoma della testa.

In November 1996 a 44-year-old man with an adenocarcinoma of the pancreatic head (T2 N1 Mx- UICC 1998 Stage III) underwent a Traverso-Longmire pancreaticoduodenectomy. Early reoperation was required owing to postoperative acute pancreatitis and haemorrhage of the pancreatic remnant, after which he received chemo- and radiotherapy. Twenty-nine months later, an increase in the level of CA19.9 was observed with neither clinical nor radiological evidence of cancer recurrence. Forty months later, there was evidence of a new neoplasia of the pancreatic remnant. Since the recurrence involved only the pancreatic remnant with no evidence of metastases and the patient was in good condition and enough time had elapsed since surgical eradication of the primary cancer, we decided to perform an en bloc resection of the pancreatic body and tail and the spleen. Histologically, the tumour proved to be a pancreatic adenocarcinoma (T2). It is difficult to assess whether this cancer of the pancreatic remnant was a recurrence or a second primary cancer because of the long recurrence-free survival period, the absence of neoplastic invasion of the resection margins of the two surgical specimens and the absence of multicentricity both of the portion of the gland removed by the first operation and that removed by the second.

Billroth I versus Billroth II versus Roux-en-Y after subtotal gastrectomy. Prospective [correction of prespective] randomized study.

BACKGROUND/AIMS: The aim of this study was to evaluate functional results after Billroth I, Billroth II and Roux-en-Y reconstruction in subtotal gastrectomy. METHODOLOGY: Forty-five patients were randomized between 1990 and 1995 and stratified in 3 different groups: 15 BI, 15 BII and 15 Roux. They were investigated by esophagogastroduodenoscopy with multiple biopsies and upper gastrointestinal scintiscanning, to evaluate gastroesophageal reflux and dynamics of gastric emptying. They also answered a questionnaire: Gastrointestinal Quality of Life. Index. RESULTS: A reflux esophagitis was found in 5 BI, in 7 BII and in 2 Roux (p < 0.001). No gastric lesions were found in 6 BI, in 5 BII and in 12 Roux, (BI vs. Y, p < 0.05; BII vs. Y, p < 0.001). Chronic superficial gastritis was present in 9 BI, in 4 BII and in 3 Roux (BI vs. Y, p < 0.05). Dynamic scintiscan demonstrated the presence of gastroesophageal reflux in 5 BI and gastric emptying was fast (37' < T 1/2 < 86'), but incomplete (60' residual activity: 49-62%). Gastroesophageal reflux was evident in 7 BII with slow (28' < T 1/2 < 143') and incomplete (60' residual activity: 48-72%) gastric emptying. Gastroesophageal reflux was detected in 2 Roux and radioactive bolus progression in the Roux limb was fast (24' < T 1/2 < 53') and complete (60' residual activity: 42-52%) (BI vs. Y; BII vs. Y, p < 0.001). There was no statistical significance between Gastrointestinal Quality of Life Index score in the 3 groups. CONCLUSIONS: The Authors affirm that Roux-en-Y is the technique of choice in subtotal gastrectomy, if compared with BI and BII.