The Role of Histopathology and Immunohistochemistry in the Diagnosis of Neuroendocrine Biliary Duct Tumor.

Neuroendocrine tumors of the biliary tract are rare entities developed form Kulchitsky cells which undergo a process of malignant transformation. However, the differential diagnostic between neuroendocrine tumors of the biliary tract and hilar cholangiocarcinoma is very difficult to be established during the preoperative workup; therefore, most patients are submitted to surgery with radical intent and the final diagnostic remains to be confirmed through histopathological and immunohistochemistry studies of the specimen of resection. We present the case of a 60 year old patient who was submitted to en bloc extended right hepatectomy (including segment IV and caudate lobe) with extra hepatic biliary tree resection and left hepatic duct preservation, left cholangiojejunostomy (Roux-En-Y technique), celiac and common hepatic arteries lymphadenectomy and segmental portal vein resection with end-to-end anastomosis for a tumor of the biliary carrefour extended to the right biliary duct and invading the portal vein. The histopathological and immunohistochemistry studies confirmed the presence of a grade 1 neuroendocrine tumor, the staining being positive for Chromogranin A, Neuron-Specific Enolase (NSE) and Ki-67 (1% nuclear positive). At 24 months follow-up the patient is free of recurrent disease.

Parietal Endometriosis: A Challenge for the General Surgeon.

Background: Parietal endometriosis (PE) is a rare pathology, which usually develops in fertile women, after surgical or gynecological procedures. Its quasi-pathognomonic symptomatology consists in catamenial pain with or without palpable mass. The diagnosis can be challenging because it may be confused with stitch granuloma, hematoma, hernia or even cancer. Patients and methods: Between January 2007 and December 2017, 10 female patients with PE were referred for diagnosis and surgery to our clinic. Results: The mean age of the patients was 35.8 years. The primary symptom was pain (9/10 patients) and a palpable mass was present in all patients. Five cases were correctly preoperatively diagnosed as PE and five were misdiagnosed as tumors (4 patients) and stitch granuloma (1 patient). Eight patients had a history of gynecological procedure (cesarean section, episiotomy) and two had no previous surgical interventions. The size of the mass varied from 1 cm to 14 cm. Resection of PE required parietal reconstruction with mesh in five patients but for the rest of the patients no mesh was needed. Conclusions: Our study confirms PE as a rare surgical entity and indicates the necessity of thorough history and physical examination, as well as imaging exams, for making the correct diagnosis in order to choose the appropriate surgical procedure.