Sporadic aggressive fibromatosis of the colon and abdominal wall in an emergency setting.

AIM: Our aim is to present an utterly unique case of sporadic aggressive fibromatosis (AF), infiltrating both the abdominal wall and the colon; and especially, to discuss the usefulness of porcine dermal meshes for the reconstruction of a large parietal gap in contaminated surgery and in an emergency setting. CASE EXPERIENCE: We report the case of a 40 years old woman affected by sporadic AF, involving both the anterior abdominal wall and the colon, with an effective intestinal stricture. The surgery consisted in removing "en bloc" the portions of the colon and abdominal wall affected by fibromatosis, with no residual tumor (R0), that left an important parietal gap. A biological prosthesis of cross-linked acellular porcine dermal collagen (APDC) has been used for the contextual reconstruction of the abdominal wall, sutured inlay by a double line of non absorbable stitches. No complications have been observed. After one year follow up, there is no tumour recurrence and the abdominal wall has fully consolidated. DISCUSSION: The peculiar problems arising about differential diagnosis, therapeutic indications and reconstructive surgical procedures are discussed, especially with regard to prosthetic implants in contaminated surgery and to cross-linked APDC prosthesis. CONCLUSIONS: Complete surgical removal is the first line treatment in sporadic AF, whenever feasible. In the reported case, an R0 resection was obtained at the cost of a wide parietal gap. According to our experience, cross-linked APDC is effective for the prosthetic reconstruction of abdominal wall in contaminated surgery and in an emergency setting. KEY WORDS: Abdominal wall, Aggressive fibromatosis, Desmoid tumor, Prosthetic devices, Reconstructive surgical procedures, desmoid tumor.

Brachial artery aneurysm in a patient with HIV infection. A case report.

The authors present a case of a brachial artery aneurysm in a patient with HIV infection. Aneurysms of unusual arteries, such as the common carotid, brachiocephalic, subclavian, superior mesenteric arteries and arteries of the upper extremity distal to the axillary artery, may be related to HIV infection. Chronic inflammatory infiltrate (plasma cells, B and T lymphocytes) around the vasa vasorum is noted in many reports. This condition may represent a "distinct clinicopathology entity". The best therapeutic option is operative repair. Reconstruction with autologous material is preferable since bacterial involvement of synthetic grafts is possible in individuals with an immunocompromised condition.

Papillary carcinoma of the thyroid: evidence for a role for hepatocyte growth factor (HGF) in promoting tumour angiogenesis.

The pattern of vascularization of papillary carcinoma was investigated in tumour sections from 31 cases and in primary cultures from 12 cases. Tumour sections were immunostained for von Willebrand Factor (vWF) to visualize blood vessels; for endothelial-specific nitric-oxide-synthase (EC-NOS), as a marker of endothelial cell activation; and for Ki-67 to evaluate endothelial cell proliferation. It was found that endothelial cells lining venous vessels located in peritumoural fibrous tissue were intensely EC-NOS-positive and occasionally Ki-67-positive. Capillary vessels of tumour papillae were not stained for Ki-67 and were weakly EC-NOS-positive. Primary cultures of papillary carcinoma cells were used as a potential source of factors active on endothelial cells. It was found that thyroid tumour cells contain RNAs for angiopoietin, vascular endothelial growth factor (VEGF), and VEGF-C; moreover, they release large amounts of VEGF into culture supernatants and exert chemotactic activity in vitro for the endothelial cell line SIEC. The ability of papillary carcinoma cells to release angiogenic factors could be stimulated in vitro. Hepatocyte growth factor (HGF; 25 ng/ml) induced a 1.2- to 5-fold increase in the amount of VEGF released by tumour cells and a 1.2- to 4.2-fold increase in the amount of chemotactic activity present in culture supernatants. Met protein, the high affinity HGF-receptor, is overexpressed in a large proportion of cases of papillary carcinoma. These findings are consistent with the possibility that HGF-Met protein interaction is one of the molecular mechanisms promoting the vascularization of papillary carcinoma of the thyroid.