[Malignant pheochromocytoma. Personal experience, review of the literature]. / Considerazioni sul feocromocitoma maligno. Esperienza personale, revisione della letteratura.

Pheochromocytoma is a catecholamine-producing tumor of the sympathetic nervous system which in 4-14% of the cases may be malignant. The differentiation between benign and malignant phoechromocytomas is very difficult, the presence of metastatic lesions and gross invasion into surrounding tissues are the lonely accettable parameters to confirm malignancy. Since the patients with malignant pheochromocytomas have a very poor survival rate, care must be taken for an early detections and a careful follow up. Three cases of malignant pheochromocytoma are reported. In one of these cases the tumor was a functioning mass; the other two cases presented by a hemorrhagic complication. A careful review of the pertinent literature allows to outline the correct approach to this rare pathology as for the diagnosis and the treatment, also including the actual criteria to establish its malignancy.

[Therapeutic approach in Riedel thyroiditis]. / Atteggiamento terapeutico nella tiroidite di Riedel.

Riedel's invasive fibrous thyroiditis is a rare disorder of unknown origin with progressive extension and invasion of adjacent structures. Clinically it is impossible to distinguish between Riedel's/thyroiditis and other diseases as undifferentiated carcinoma, Hashimoto's disease etc... The patients often have dyspnea, dysphagia, paralysis of the vocal cord; fine needle puncture-aspiration and biopsy themselves may be insufficient, Surgical treatment depends on the stage of the disease, when both lobes are involved generous wedge resection of the isthmus may be the treatment of choice to relieve tracheal compression; in earlier stages radical operation are considered. Corticosteroid treatment in Riedel's thyroiditis, as multifocal disease has been successfully used. Other drugs with antifibrosing actions have also utilised in small groups of patients with encouraging results.

[Assessment of conventional approaches in adrenalectomy]. / Valutazione delle vie di accesso tradizionali nella surrenalectomia.

The choice of operative approach represents one of the main problems of adrenal gland surgery, nowadays the minimally invasive techniques (laparoscopic adrenalectomy) in selected cases may be an important alternative to conventional approaches. Retrospective analysis was performed on 140 patients with adrenal gland tumors from 1980-1997; there were 95 women and 45 men: The tumors were resected through flank extraperitoneal approach (35 patients), transabdominal (91), thoraco-abdominal (14). Operating time, perioperative blood loss, postoperative course were evaluated. The authors conclude that in functioning and non-functioning adenomas, in pheochromocytoma, smaller than 6 cm., with precise pre-operative unilateral localization, flank extraperitoneal approach may be sufficient, in patients with Cushing disease resistant to pituitary surgery or irradiation, in patients with familiar history or bilateral pheochromocytoma, in patients with suspected malignant disease, a thorough surgical exploration of the abdominal cavity is recommended.

[Parathyroid cysts: comments apropos a case]. / Le cisti paratiroidee: considerazioni a proposito di un caso.

A case of non-functioning parathyroid cyst is reported, in which the preoperative diagnosis was missed. A careful review of the pertinent literature allows to outline the correct approach to this rare pathology as for the diagnosis and the treatment; as well, to enlight the current controversies about the physiopathology and the pathology.