[Primary carcinoma of the cystic duct. A rarity in surgery]

The Authors describe a case of primary carcinoma of the cystic duct as reported in the data od another 29 cases described in literature. The subjects it generally strikes are elderly men and its symptomatology is rather non specific. A preoperative diagnosis is as difficult as ever even with the aid of the most modern diagnostic techniques. The postoperative survival time is comparatively superior to other tumors of gallbladder and biliary tract, independently of the type of the surgical treatment adopts: cholecystectomy with the resection of the cystic duct associated less with lymphadenectomy and partial resection of the hepato-choledochus.

[Mottled hyperpigmentation of the fundus oculi associated with angioid streaks in pseudoxanthoma elasticum]

The Authors report mottled fundus in association with pseudoxanthoma elasticum in 8 of 9 patients. The mottled hyperpigmentation is an early uncommonly described finding, consisting of a speckled, yellowish mottling of the posterior pole temporal to the macula at ophthalmoscopic examination; this appearance, called "peau d'orange", is believed to be caused by changes in the retinal pigmented epithelium overlying a calcified and degenerating Bruch's membrane. This finding is virtually pathognomonic of pseudoxanthoma elasticum and may be present even in the first decade of the disease, prior to the appearance of the angioid streaks. The Authors emphasize the significance of the retinal finding, that may represent an incomplete genetic expression of an autosomal recessive carrier state.