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Zhou L, Liu Y, Xu T, Dong L, Yang X, Wang C. Malignant solitary fibrous tumor of the kidney with IGF2 secretion and without hypoglycemia. World J Surg Oncol 2024; 22:179. [PMID: 38982409 PMCID: PMC11234528 DOI: 10.1186/s12957-024-03342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/14/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Solitary fibrous tumor (SFT) is a rare fibroblastic mesenchymal tumor that mostly involves the pleura and infrequently involves extra-pleural sites. De novo SFT of the kidney is uncommon, and malignant SFT is extremely rare. CASE PRESENTATION We report a case of a 51-year-old man with a large malignant SFT in the left kidney. Pathological examination confirmed the diagnosis of SFT based on typical morphology, nuclear STAT6 expression, and NAB2-STAT6 gene fusion. The malignant subtype was determined by a large tumor size (≥ 15 cm) and high mitotic counts (8/10 high-power fields). KRAS mutation was identified by DNA sequencing. Insulin-like growth factor 2 (IGF2) was diffusely and strongly expressed in tumor cells, however, hypoglycemia was not observed. Hyperglycemia and high adrenocorticotropic hormone (ACTH) concentration were observed one month after surgery. Hormone measurements revealed normal blood cortisol and aldosterone levels, and increased urinary free cortisol level. A pituitary microadenoma was identified using brain magnetic resonance imaging, which may be responsible for the promotion of hyperglycemia. CONCLUSIONS We report a case of renal malignant SFT with a KRAS mutation, which was previously unreported in SFT and may be associated with its malignant behavior. Additionally, we emphasize that malignant SFT commonly causes severe hypoglycemia due to the production of IGF2. However, this effect may be masked by the presence of other lesions that promote hyperglycemia. Therefore, when encountering a malignant SFT with diffuse and strong IGF2 expression and without hypoglycemia, other lesions promoting hyperglycemia need to be ruled out.
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Affiliation(s)
- Luting Zhou
- Department of Pathology, Shanghai Jiaotong University Medical School Affiliated Ruijin Hospital, Number 197, Ruijin Er Road, Huangpu District, Shanghai, China
| | - Yang Liu
- Department of Pathology, Shanghai Jiaotong University Medical School Affiliated Ruijin Hospital, Number 197, Ruijin Er Road, Huangpu District, Shanghai, China
| | - Teng Xu
- Department of Pathology, Shanghai Jiaotong University Medical School Affiliated Ruijin Hospital, Number 197, Ruijin Er Road, Huangpu District, Shanghai, China
| | - Lei Dong
- Department of Pathology, Shanghai Jiaotong University Medical School Affiliated Ruijin Hospital, Number 197, Ruijin Er Road, Huangpu District, Shanghai, China.
| | - Xiaoqun Yang
- Department of Pathology, Shanghai Jiaotong University Medical School Affiliated Ruijin Hospital, Number 197, Ruijin Er Road, Huangpu District, Shanghai, China.
| | - Chaofu Wang
- Department of Pathology, Shanghai Jiaotong University Medical School Affiliated Ruijin Hospital, Number 197, Ruijin Er Road, Huangpu District, Shanghai, China.
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Jha S, Mohanty SK, Sampat NY, Naik S, Baisakh MR, Pattnaik N, Lobo A, Rauta S, Sharma S, Munjal G, Jain D, Arora S, Malik V, Jain E, Sahoo B, Bhardwaj M, Mishra SK, Jaiswal S, Barik LM, Balzer BL, Chakrabarti I, Parwani AV. Solitary Fibrous Tumor of the Adrenal Gland. Am J Clin Pathol 2022; 158:546-554. [PMID: 35993354 DOI: 10.1093/ajcp/aqac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/06/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Solitary fibrous tumor (SFT) is a mesenchymal neoplasm that can arise at various anatomic locations. It is characterized by inv12(q13q13)-derived NAB2::STAT6 fusion, resulting in the nuclear expression of STAT6. Primary SFT of the adrenal gland is rare. We launched a multi-institutional collaboration to comprehend the overarching demographics, clinical and follow-up, macroscopic, microscopic, IHC, and FISH features of 9 patients with SFT of the adrenal gland. METHODS We added a series of 9 patients to the collection of adrenal SFTs where the clinicopathologic parameters, including clinical presentation, imaging, histopathology, IHC, molecular profiles, and management and follow-up data, were analyzed comprehensively. A modified 4-variable risk stratification model, including age, tumor size, and necrosis, was applied. RESULTS Our series consisted of 6 male and 3 female patients, ranging in age from 19 to 64 years (mean, 49.3 years). Abdominal pain (4) and fever with abdominal pain (1) were the presenting symptoms in 5 patients. In the remaining 4 patients, the tumors were detected by abdominal imaging for hypertension and diabetes. The size of the tumor ranged from 2 cm to 10.5 cm in maximum dimension. All tumors exhibited the morphology of a spindle cell SFT with a patternless architecture; 3 had a focal storiform arrangement. STAT6 positivity was observed in all tumors, and 7 were positive for CD34. Surgical resection was the primary modality of treatment. No adjuvant therapy was administered. Follow-up ranging from 7 months to 23 months was available for 7 patients. All were alive without disease recurrence or metastasis. Risk stratification placed 8 (88.9%) patients into a low-risk category and 1 into an intermediate-risk category. CONCLUSIONS This series is the largest of adrenal SFTs to date. These tumors of the adrenal gland are predominantly spindle cell neoplasms with indolent behavior, with a wide age distribution and a slight male preponderance. Combining our cohort with the previously published cases, the majority of tumors fall into the low-risk category for the propensity to develop metastases. Owing to the rarity and age distribution associated with these tumors, the differential diagnosis is wide and requires a systematic approach for ruling out key differential diagnoses aided by STAT6 IHC.
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Affiliation(s)
- Shilpy Jha
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Sambit K Mohanty
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Nakul Y Sampat
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Subhasini Naik
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India
| | - Manas R Baisakh
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India.,Department of Pathology and Laboratory Medicine, Apollo Hospital and Apollo Cancer Institute, Bhubaneswar, India
| | - Niharika Pattnaik
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Anandi Lobo
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Sudhasmita Rauta
- Department of Pathology and Laboratory Medicine, Prolife Diagnostics, Bhubaneswar, India
| | - Shivani Sharma
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Gauri Munjal
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Deepika Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Samriti Arora
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Vipra Malik
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Ekta Jain
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Biswajit Sahoo
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Mohit Bhardwaj
- Department of Pathology and Laboratory Medicine, CORE Diagnostics, Haryana, India
| | - Saurav K Mishra
- Department of Medical Oncology, Apollo Cancer Institute, Bhubaneswar, India
| | - Sunil Jaiswal
- Department of Surgical Oncology, Apollo Cancer Institute, Bhubaneswar, India
| | - Lalit M Barik
- Department of Pathology and Laboratory Medicine, Advanced Medical Research Institute, Bhubaneswar, India
| | - Bonnie L Balzer
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA,USA
| | - Indranil Chakrabarti
- Department of Pathology and Laboratory Medicine, North Bengal Medical College, Siliguri, India
| | - Anil V Parwani
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
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Yonli DS, Chakroun M, Mokadem S, Saadi A, Rammeh S, Chebil M. Adrenal solitary fibrous tumor: A case report. Urol Case Rep 2019; 27:100919. [PMID: 31687355 PMCID: PMC6819790 DOI: 10.1016/j.eucr.2019.100919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022] Open
Abstract
Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm, originally described in the pleural cavity. It may also occur in extrapleural organs like adrenal gland. We present a case of a fifty two-year old Arab man who has been admitted in urology department for right lumbar pain. A suspect malignant adrenal mass has been detected. He underwent right adrenalectomy and histologically it was SFT. The follow-up three years after surgery is unremarkable. The prognosis of SFT after surgery is unpredictable. A long term follow-up is mandatory to detect local recurrence or distant metastasis.
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Affiliation(s)
- Diataga Sylvestre Yonli
- Department of Urology, Yalgado Ouedraogo University Hospital of Ouagadougou, 03 BP 7022 Ouagadougou 03, Burkina Faso
| | - Marouene Chakroun
- Department of Urology, Charles Nicolle University Hospital of Tunis, Boulevard du 9 Avril 1938, 1006, Tunis, Tunisia
| | - Seif Mokadem
- Department of Urology, Charles Nicolle University Hospital of Tunis, Boulevard du 9 Avril 1938, 1006, Tunis, Tunisia
| | - Ahmed Saadi
- Department of Urology, Charles Nicolle University Hospital of Tunis, Boulevard du 9 Avril 1938, 1006, Tunis, Tunisia
| | - Soumaya Rammeh
- Department of Pathology, Charles Nicolle University Hospital of Tunis, Tunis, Tunisia
| | - Mohamed Chebil
- Department of Urology, Charles Nicolle University Hospital of Tunis, Boulevard du 9 Avril 1938, 1006, Tunis, Tunisia
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A Pleural Solitary Fibrous Tumor, Multiple Gastrointestinal Stromal Tumors, Moyamoya Disease, and Hyperparathyroidism in a Patient Associated with NF1. Case Rep Surg 2015; 2015:375416. [PMID: 26442164 PMCID: PMC4579307 DOI: 10.1155/2015/375416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022] Open
Abstract
Neurofibromatosis type 1 (NF1), also called von Recklinghausen's disease, is a multisystemic disease caused by an alteration of the NF1 gene, a tumor suppressor located on the long arm of chromosome 17 (17q11.2). Loss of the gene function, due to a point mutation, leads to an increase in cell proliferation and the development of several tumors. We report a 60-year-old female patient manifesting hypercalcemia due to hyperparathyroidism, a solitary fibrous tumor (SFT) of the pleura, multiple gastrointestinal stromal tumors (GISTs), and moyamoya disease associated with NF1. The SFT and GISTs were removed by staged operations. Then, hypercalcemia was successfully controlled after resection of the parathyroid adenoma. Based on a literature review, these combinations have never been reported, and the relevant literature is briefly discussed.
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Benassai G, Perrotta S, Furino E, De Werra C, Aloia S, Del Giudice R, Amato B, Vigliotti G, Limite G, Quarto G. "Ductal adenocarcinoma in anular pancreas". Int J Surg 2015; 21 Suppl 1:S95-7. [PMID: 26118607 DOI: 10.1016/j.ijsu.2015.04.086] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 01/29/2023]
Abstract
INTRODUCTION The annular pancreas is a congenital anomaly in which pancreatic tissue partially or completely surrounds the second portion of the duodenum. Its often located above of papilla of Vater (85%), rarely below (15%). This pancreatic tissue is often easily dissociable to the duodenum but there is same cases where it the tissue is into the muscolaris wall of the duodenum. MATERIAL AND METHODS We describe three case of annular pancreas hospitalized in our facility between January 2004 and January 2009. There were 2 male 65 and 69 years old respectively and 1 female of 60 years old, presented complaining of repeated episodes of mild epigastric pain. Laboratory tests (including tumor markers), a direct abdomen X-ray with enema, EGDS and total body CT scan were performed to study to better define the diagnosis. EUS showed the presence of tissue infiltrating the muscle layer all around the first part of duodenum. Biopsies performed found the presence of pancreatic tissue with focal areas of adenocarcinoma. Subtotal gastrectomy with Roux was performed. The histological examinations shows an annular pancreas of D1 with multiple focal area of adenocarcinoma. (T1aN0M0). RESULTS We performed a follow up at 5 years. One patients died after 36 months for cardiovascular hit. Two patients, one male and one female, was 5-years disease-free. DISCUSSION Annular pancreas is an uncommon congenital anomaly which usually presents itself in infants and newborn. Rarely it can present in late adult life with wide range of clinical severities thereby making its diagnosis difficult. Pre-operative diagnosis is often difficult. CT scan can illustrate the pancreatic tissue encircling the duodenum. ERCP and MRCP are useful in outlining the annular pancreatic duct. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment.
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Affiliation(s)
- Giacomo Benassai
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy.
| | - Stefano Perrotta
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
| | - Ermenegildo Furino
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
| | - Carlo De Werra
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
| | - Sergio Aloia
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
| | - Roberto Del Giudice
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
| | - Bruno Amato
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
| | - Gabriele Vigliotti
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
| | - Gennaro Limite
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
| | - Gennaro Quarto
- Università degli Studi di Napoli "Federico II", Dipartimento Universitario di Medicina Clinica e Chirurgia Direttore Prof Giovanni Di Minno, Italy
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Benassai G, Quarto G, Perrotta S, Furino E, Benassai GL, Amato B, Bianco T, De Palma G, Forestieri P. Long-term survival after curative resection for pancreatic ductal adenocarcinoma--Surgical treatment. Int J Surg 2015; 21 Suppl 1:S1-3. [PMID: 26118618 DOI: 10.1016/j.ijsu.2015.06.050] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 03/23/2015] [Accepted: 04/10/2015] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Recent reports have demonstrated improvement in the 5-years serviva with resecate ductal adenocarcinoma. The aim of study is to determinate the factor influencing long-term survival after DCP. MATERIALS AND METHODS We have critically reviewed a group of 85 patients how were admitted to our department with diagnosis of ductal adenocarcinoma of the head of pancreas between January 1974 and January 1998. RESULTS Patients were stratified according to stage using TNM classification; in stage I 31 patients with 5 T1aN0M0 disease, 11 patients with T1bN0M0 and 15 patients T2N0M0 disease. By contrast, in stage III 54 patients with 48 patients T2N1M0 and 6 patients with T3N1M0. Tumour size was recorded for 72 patients with a median of 3.8 cm. The R1 dissection was performed in 67 patients. The R2 resection was performed in 18 patients. In our series we verified and analysed the histopathologic features of 5 patients with 15-years survival (5.8%). The features regard age, male or female, tumours size, stage and positive lymph node resection. DISCUSSION We found a specifically subset of patients where the combination of prognostic factors, in particular, negative surgical margins R0, tumour size ≤ 30 mm and the absence of lymph node metastasis independently reduced the mortality indicating that earlier tumour detection and histologically curative resection are important factors contributing to long term survival and healing of ductal adenocarcinoma of the head of the pancreas.
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Affiliation(s)
- G Benassai
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy.
| | - G Quarto
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy
| | - S Perrotta
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy
| | - E Furino
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy
| | - G L Benassai
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy
| | - B Amato
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy
| | - T Bianco
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy
| | - G De Palma
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy
| | - P Forestieri
- A.O.U. Federico II Napoli, Dipartimento Universitario di Medicina Clinica e Chirurgia, Direttore Prof. Giovanni di Minno, Italy
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Mauriello C, Napolitano S, Gambardella C, Candela G, De Vita F, Orditura M, Sciascia V, Tartaglia E, Lanza M, Santini L, Conzo G. Conservative management and parenchyma-sparing resections of pancreatic neuroendocrine tumors: Literature review. Int J Surg 2015; 21 Suppl 1:S10-4. [PMID: 26118605 DOI: 10.1016/j.ijsu.2015.04.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 03/23/2015] [Accepted: 04/10/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pancreatic neuroendocrine tumors (pNETs) are uncommon entities. pNETs are often small, slow growing, clinically silent neoplasms. However, they have an almost unpredictable biological behaviour with a not negligible malignant potential. Surgery still represents the treatment of choice, but the high morbidity associated to the enucleation or the formal pancreatectomy should be considered in the decision of the proper treatment. Management of these neoplasms is still debated, and indications for a conservative observational approach and for parenchyma sparing resections are not yet standardized. METHOD We review the state of art on the indications for the conservative management of pNETs. Searches on MEDLINE database were performed to identify articles reporting prognostic systems, biochemical screening, observational management, medical treatment and surgical strategies for pNETs. DISCUSSION Currently, an accurate 'wait-and-see' policy is recommended by the European Neuroendocrine Tumor Society (ENETS) only for non-functioning pNETs (NF-pNETs) <2 cm. A biochemical screening, based on sampling of serum levels of pancreatic polypeptide (PP) and chromogranin A, can address to early conservative surgery for MEN-1 associated NF-pNETs <2 cm to prevent their malignant transformation. The subtotal (80%) distal pancreatectomy first proposed by Thompson, often with the enucleation of possible pancreatic head tumors, still represents a good compromise between oncological radicality and prevention of pancreatic endocrine/exocrine insufficiency caused by standard radical resections for the treatment of inherited syndromes associated with NF-pNETs >2 cm and symptomatic F-pNETs of any size. CONCLUSION More studies are needed to further clarify and predict the biologic behaviour of pNETs and increase the indications for conservative observational management and parenchyma sparing pancreas resections.
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Affiliation(s)
- Claudio Mauriello
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Salvatore Napolitano
- Medical Officer, Italian Air Force Medical Corps, Ministry of Defence, Rome, Italy.
| | - Claudio Gambardella
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Giancarlo Candela
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Ferdinando De Vita
- Department of Clinical and Experimental Medicine, Divisions of Oncology, School of Medicine, Second University of Naples, Italy.
| | - Michele Orditura
- Department of Clinical and Experimental Medicine, Divisions of Oncology, School of Medicine, Second University of Naples, Italy.
| | - Valerio Sciascia
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Ernesto Tartaglia
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Michele Lanza
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Luigi Santini
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
| | - Giovanni Conzo
- Department of Anaesthesiologic, Surgical and Emergency Sciences, Unit of General and Oncologic Surgery, School of Medicine, Second University of Naples, Italy.
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