Contribution of CT to treatment planning in patients with GIST.

PURPOSE: The aim of this study was to illustrate the morphological and structural computed tomography (CT) patterns of gastrointestinal stromal tumours (GIST) and to discuss the technique's role in identifying lesions at a higher risk for malignant potential, in treatment planning and in the follow-up of patients with GIST. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 26 patients who underwent surgery for histologically confirmed GIST of the stomach (20 cases), the duodenum (1), the caecum (1), the small bowel (2), the descending colon (1) and the rectum (1). CT exams were performed with a single-slice scanner and a 5-mm collimation before and after the intravenous administration of contrast material. RESULTS: CT allowed us to correctly define the site, size and structure of lesions in all cases and to identify signs of invasion of neighbouring structures in some cases. The lesions exhibited solid density on the unenhanced scan and poor enhancement after contrast-medium administration; lesion structure was homogeneous in ten cases and inhomogeneous in 16; in one case, histology revealed microcalcification that had not been detected by CT. CONCLUSIONS: CT, with its panoramic capabilities and high contrast resolution, provides essential information for treatment planning and for the follow-up of GIST patients treated with surgery or chemotherapy.

[Nasopharyngeal carcinoma]. / Il carcinoma nasofaringeo.

The authors report the case of a 62-year-old woman who underwent a course of radiotherapy for an undifferentiated nasopharyngeal carcinoma. One year later the patient developed liver metastasis and underwent liver resection. The authors review the various aspect of this tumour, which is particularly frequent in the countries of South-East Asia but is exceptional in Europe and North America, focusing on the possibility of the operative management of the liver metastasis.

[Stromal tumors of the small intestine (GIST). Prognostic differences based on clinical, morphological and immunophenotypic features]. / I tumori stromali del piccolo intestino (GIST). Differenze prognostiche sulla base delle caratteristiche cliniche, morfologiche e immunofenotipiche.

Gastro Intestinal Stromal Tumors (GIST) are rare malignant non-epithelial tumors arising from gastro-intestinal tract. They represent the 0.2% of all malignancy of this site. Three cases, treated in our Department, are an example of the anatomo-clinical features of these tumors. In two cases the clinical features on admission were similar to those of acute abdominal pain; in the third one a palpable mass rapidly growing was observed. All three patients had surgical treatment but survival were quite different. The size of tumor mass in the first two cases was 5 cm; one patient was alive after ten years without relapse, the second one died five years after with liver metastasis. The third one, with a mass larger more than ten centimeters, developed 8 months after surgical resection a diffuse local relapse of the disease. The microscopic pattern and the lack of epithelial markers allowed to classify them as GIST. All cases were tested with S100 protein, smooth muscle actine, and CD-34 antigen. Two cases had both smooth muscle and nervous markers, the third resembled a malignant schwannoma. Prognosis was correlated with the size of tumor at the time of surgery and immunophenotype pattern. The tumors with high expression of nervous antigens had a worse prognosis.

[Emergency surgery: suppurating urachal cyst producing intestinal occlusion]. / In tema di chirurgia d'urgenza: cisti uracale suppurata come causa di occlusione intestinale.

Urachal cysts are anomalies related to the persistence of urachal remnants after the birth. They are seldom asymptomatic, but in some cases they mimic acute abdominal disease. We report a case of a 67-year-old man with relapsing episodes of intestinal sub-occlusion caused by the presence of an infected urachal cyst. The surgical procedure we used consisted of a viscerolysis and excision of the infected cyst, avoiding partial resection of the dome of the urinary bladder. Our article also includes a review of the literature on urachal infected cyst and its management.

[Thyroid metastasis due to right colonic carcinoma]. / Metastasi tiroidea da neoplasia del colon destro.

Clinical evident metastases to the thyroid gland are rarely found antemortem. A case of a 62 year-old man with a history of right colonic carcinoma, who presented a mass in the right lobe of his thyroid gland one year after the removal of a metachronous metastasis in his right lung, is presented. The tumour of the thyroid was found to be metastatic adenocarcinoma from his previous colonic cancer. The clinical finding of metastases to the thyroid gland is rare, particularly from a colorectal primary neoplasm. However, the possibility of a tumour of the thyroid gland representing a secondary malignancy is to be considered in any patient with a prior history of cancer.

The schwannoma: an uncommon type of cystic lesion of the pancreas.

Schwannomas of the pancreas are rare and their number is lower than is usually reported in the literature since some were probably neurofibromas. We report a further case characterized by cystic feature, clinically mimicking a pancreatic pseudocyst. Cystic lesions of the pancreas also comprise the schwannomas, both benign or malignant, as has been previously reported and is stressed by the present case. Cyst formation characterizes many diseases of the pancreas, both neoplastic and not. Difficulties in the differential diagnosis of cysts are fortunately reduced by the preponderance of pseudocysts (i.e. non-neoplastic cysts) and, among neoplastic ones, of cystadenomas and cystadenocarcinomas. As a consequence, uncommon cystic neoplasms are neglected and very often misdiagnosed. We reported a case of solitary schwannoma mimicking a pancreatic pseudocyst, interesting both because of its rarity and because of its cystic feature which was previously reported in the literature but not emphasized.

[Comparative analysis of the technics of preoperative localization of the parathyroid glands]. / Analisi comparativa delle tecniche di localizzazione pre-operatoria delle paratiroidi.

Parathyroid surgery needs an appropriate diagnosis and a preoperative localization. We conducted a prospective study to compare the efficacy of 4 different imaging modalities in 17 patients: thallium-technetium subtraction scintigraphy, ultrasonography, computed tomography and arteriography. The sensitivity was: scintigraphy 58%, echotomography 86%, Tc 92% and arteriography only 33%. Neck exploration confirmed the imaging results. We found 15 cases of adenomas (2 cases of double adenoma) and 1 case of hyperplasia; in 1 patient, no lesions were found. We conclude that the association of such techniques appears to be the optimal strategy in about 100% of the patients.

[Boerhaave's syndrome. Emergency surgery]. / La sindrome di Boerhaave. Nota di chirurgia d'urgenza.

The Authors report a case of spontaneous rupture of the esophagus in a 66-year-old alcoholic. The symptomatology was characterized essentially by epigastralgie and vomiting culminating in violent retrosternal pain radiating to the back and by shock. X-rays taken an hour after hospitalization showed an increase of pulmonary hypodiaphania with presence of pleural effusion at the left base, cervicothoracic subcutaneous emphysema. Emergency surgery was performed by thoracotomy associated with suture of the esophageal opening with drainage of the supradiaphragmatic and pleural region. However, the patient died on the 10th day of broncopulmonary complications. The Authors therefore believe that the triad pain, shock and mediastinal thoracico-cervical emphysema should be considered pathognomonical of Boerhaave's syndrome and thus be kept in mind by the surgeon employed in a Division of Emergency Surgery and First Aid.

[Primary lung neoplasm of rare incidence: giant cell carcinoma]. / Una neoplasia primitiva del polmone di non frequente riscontro: il carcinoma a cellule giganti

Primary giant-cell carcinoma of the lung is an infrequent observation. It is distinguished clinically solely its fairly rapid development but otherwise it does not seem to have any predilection for localization, age or sex. Histologically, differential diagnosis with othe tumours such as angiosarcoma, rhabdomyosarcoma, chorioepithelioma and others is of interest. Three cases of primary giant-cell carcinoma of the lung are reported and the various clinical and anatomopathological aspects discussed.

[Thoracic diseases with predominant abdominal symptomatology]. / Malattie toraciche a prevalente sintomatologia addominale

Common and uncommon diseases whose symptom picture includes signs that may lead to an incorrect diagnosis are examined. Questions of this kind are obviously important in both medicine and emergency surgery, since incorrect diagnosis may involve either delay in the commencement of suitable treatment or the taking of what may even be dangerous therapeutic measures. Instances of heart and lung disease frequetly marked by abdominal symptomatologies are presented: bronchopulmonitis of various aetiologies, myocardial infarct, rhythm disturbances. In addition to the more atypical signs, such as epigastric pain in infarct and right hypochondriac pain in right basal bronchopulmonitis, manifestations such as vomiting, diarrhoea, diffuse abdominal pains and intestinal occlusion must be borne in mnd in establishing the correct diagnosis.