[Cervico-thoracic liposarcoma in an HIV patient]

Association between cervico-thoracic liposarcoma and HIV infection is uncommon. The etiopathology remains unclear and clinical symptoms can be various, often not very evident or absolutely absent. Preoperative diagnosis is based on modern imaging techniques. In selected cases, the ideal procedure is surgical treatment which allows good long-term results. A case of cervico-thoracic liposarcoma in HIV patient is presented.

[Integrated treatment of breast cancer: review of our experience]

In the industrialized West countries the breast cancer represents the most frequent malignant neoplasia in the women. From over 30 years we have a progressive increase of frequency of breast carcinoma. Mortality is substantially unchanged. The Authors, on the base of casuistry accumulated in five years of activity, trace a diagnostic-therapeutic run to the purpose to favour a line of behavior, practice and actual, for the management of breast cancer.

[Endoscopic resection of a gastric haemangioma: case report]

Gastric haemangiomas are an infrequent histological type of gastrointestinal benign tumors. Diagnosis is based on imaging but only pathological examination can give certainty. Endoscopic resection, according some specific criteria, is the gold standard procedure. Authors present a case of cavernous haemangioma diagnosed and treated by endoscopic procedure.

[Changes in the expression of cellular alpha and beta tubulins in patients with sporadic type colorectal cancer]

The aim of this preliminar report is to evaluate alfa and beta tubulins, components of cellular microtubules, alterated expression in sporadic colorectal cancer patients. The Authors considered 16 patients who underwent surgery for sporadic colorectal carcinoma with radical intent. Alfa and beta tubulins were evaluated in tumoral mucosa by immunohistochemistry. In 56.2% of the examined patients a low expression of alfa and beta tubulins was showed while the alteration of alfa tubulin was showed in 81.2% of the patients. This finding supports the hypothesis of Porter that alterations in microtubule structure might be part of the cellular response to DNA damage.

[From molecular biology to new treatment approaches to colorectal cancer: basic research, experimental trials and surgical implications]

The Authors review the natural history of colorectal cancer from the point of view of molecular biology and genetics from aberrant crypts foci and familiar adenomatous polyposis to hereditary non polyposis colon cancer and sporadic colorectal cancer. They carry out international literature about basis knowledges, experimental trials and personal studies. Up to day traditional colorectal cancer surgical treatments and adjuvant or neoadjuvant pharmacological therapy cannot be modified, nevertheless "new drugs generation" known as signal transduction inhibitor could, in the future, prove to be an effective cancer treatment. The Authors highlight recent experimental clinical trials probably able to prevent sporadic colorectal cancer spreading and precursor evolution.

[Primary colonic lymphoma: report of two cases]

Primary colonic lymphoma is a rare condition. It may be associated with immunosuppressed states and inflammatory bowel disease. The pattern of presentation is not specific, this leads to lengthy in diagnosis. Authors report two personal cases and discuss the problem of diagnosis. Surgery followed by adjuvant chemotherapy is the standard treatment. Using this approach 5-years survival ranges from 27-55%.

[Prognostic markers of the epithelial tumors of the large intestine]

The surgical treatment of large bowel malignant tumors is now the most important therapeutic approach. The aim of our study was to evaluate a possible prognostic implication of ploidy and NM23 expression. The study includes 120 non selected patients who underwent surgery for colorectal cancer. The analysis of ploidy was obtained with cytometric test. The cases with only one gaff G0/G1 were considered as diploid. Patteras with more than one aneuploidic population were classified as multiploidic or poliploidic. While NM23 expression was evaluated with a double blind retrospective study by two separate equipe of authors in different centres. NM23 positivity degree was classified in 3 classes: absent or weak if < 10%; moderate if 10-50%; strong if > 50%. Forty-two patients (35%) were classified as diploidic; 30 patients (25%) as aneuploidic; 40 patients (33.2%) as multiploidic; in 8 cases (6.7%) the material was inadequate. Among the two groups who evaluated NM23 expression the group I a positivity: absent or weak in 32 cases (26.7%); moderate in 62 cases (51.7%); strong in 26 cases (21.6%); while the group II shows positivity: absent or weak in 30 cases (25%); moderate in 52 cases (43.3%); strong in 38 cases (31.7%). We cannot consider ploidy and the NM23 research as independent prognostic factor.

[Association between breast and colorectal cancer and polyps. Screening and epidemiological study]

BACKGROUND

Studies regarding the associations between different types of cancer in the same patient are very few and not always come to the same conclusions. Several hypothesis are suggested and particularly genetic and socioeconomical ones seem to offer an interpretation of this issue. Early detection of a second neoplasm allows to improve prognosis and survival. The knowledge of correlations between tumors help to select a population, with a high risk to develop a second cancer, to be included in a screening program. Nowadays thanks to early detection of breast cancer, ten years survival is more than 75%. Women who had breast cancer now live longer and so could have a higher risk to develop a second cancer.

METHODS

From September 1998 to September 1999 in our Department 71 patients operated for breast cancer, underwent screening colonscopy. No patients refused to be included in the study. Mean age was 61 years (range 36-87). Each patient had a clinician interview in order to explain the goals of the study.

RESULTS

Results show that among all patients 3 (4.2%) presented a history of colon cancer, 18.3% (13 cases) presented large bowel polyps. In 84.60% patients (11 cases) polyps were found not over 40 cm. This study shows that 93% of patients (66 cases) had a relative with cancer history.

CONCLUSIONS

Our results compared with those of other authors seem to show an increased risk for breast cancer patients in developing polyps or colon cancer, so we suggest to insert sigmoidoscopy in standard follow-up of breast cancer patients.

[Multicenter prospective study of informed consent in general surgery]

To understand the level of acceptance, awareness and usefulness of informed consent, a group of 119 patients (59 men and 60 women) from different types of hospitals were given a questionnaire which required only 'YES or NO' answers, both before and after surgery. The questionnaire concerned the patient's knowledge about pathology, operative risks, approval, anxiety caused, understanding of information received and consent given, and also if he would inform a relative in the same condition. From the analysis of the results it was established that: the more information a patient has about his illness and operation risks, the more he will want to have; the less he knows the less he will want to know, and he will also have more faith in the doctors. Some patients would not inform a relative with a similar pathology. To conclude, informed consent, instead of being a right of the patient is progressively becoming more a right of the doctor. It does not have any real effect on the patient's choice but is useful, as it represents a moment of personalised attention from medical personnel, though the patient may not completely understand the information received. There are few advantages in strictly medical terms but informed consent has increased malpractice litigation.

[Lymphadenectomy in the surgical treatment of bronchogenic carcinoma]

Bronchogenic carcinoma is one of the tumors with the statistically most markedly rising incidence, at least in western countries. For many years both the resectability and the long-term results have remained invariable due to the serious delay with which the disease is usually diagnosed. In addition, the success of treatment appears to be closely correlated with disease stage; in particular lymph node involvement has a major influence on the long-term survival following adequate treatment. As a consequence, a strong conviction has established itself in recent years, that radical removal of all mediastinal lymph node stations ipsilateral to the operated lung represents not only a necessary staging procedure, but also a useful measure to improve the prognosis of these patients. However, the real utility of radical lymphadenectomy is questioned by a number of groups: on the one hand the supporters of lymph node "sampling", inasmuch as the usefulness of radical lymphadenectomy has not been demonstrated by randomized clinical trials; on the other hand those workers, in particular from Japan, who on the basis of observations of the lymphatic flow in the mediastinum stress the necessity to extend lymph node clearance to the nodal station contralateral to the tumor. The current opinion is changing under the influence of recent developments, for instance the possible use of the sentinel technique also in lung cancer, and the possibility of "reasonable" or targeted lymphadenectomies, planned in relation to the lobar location of individual tumor. Whichever of these approaches is chosen--and this choice is still a matter of debate--many agree about the importance of neoadjuvant treatment not only to render patients eligible for surgery but also to improve the prognosis for patients at the most advanced stages of the disease.

[Genetic factors and colorectal cancer: a new approach to clinical experimentation]

The Authors point out the basis for a better characterisation of colo-rectal cancer and precursory lesions. In fact the etiology of familial adenomatous polyposis (FAP), aberrant crypt foci (ACF), hereditary non polyposis colon cancer syndrome (HNPCC) seems to be correlated to molecular pathology. Therefore the Authors review colo-rectal cancer natural history which frequently appears to be not related to clinical evolution.

[Cystic polyps of the stomach: review of our case series]

The Authors report their experience with gastric polyps based upon 3,384 endoscopies performed from October 1992 to August 1995. The incidence of cystic polyps with respect to the examinations performed and to the number of gastric polyps found was 0.45% and 21.3% respectively. The cases were taken into account with respect to sex, age, number of lesions, location, size and association to Gardner's syndrome. A comparison between the observed cases and a comprehensive review of the relevant Literature was performed.

[Large cystic polyps of the stomach]

The Authors report the case of a 83 year old woman with large cystic polyps of the stomach. Gastric cystic polyps are polypoid lesions which may develop following functional disorders such as increased mucosal stimulation by gastrin, or excessive retention of gastric secretions. The incidence of these polyps is variable, depending on their being underestimated since they are not always macroscopically visible. The case here reported is very interesting not only for the number of lesions (over 50), but also for their size (5-25 mm in diameter).

[Gastric xanthomatosis in a patient with severe lipid metabolic disorder]

Gastric xanthomas are rare in routine endoscopy, generally ranging from to 2 to 5 mm in diameter, mostly isolated, but in some cases multiple. Their nature has not yet been cleared. In fact, even if they have histochemical characteristics similar to cutaneous xanthelasmas, they are not generally considered closely related to lipid metabolism disorders. The Authors report a case with some peculiarities regarding number, location and dimension of the gastric xanthomas, and point out the possibility of a metabolic disorder in their aetiopathogenesis.

[Evaluation of the effect of H2-histamine antagonists in the natural history of stomach cancer]

On a study population of 131 patients the Authors evaluate possible differences related to the use of H2 blockers. Patients were divided in 2 groups: one (70 cases) studied before the introduction of H2 blockers and the other (61 cases) treated with H2 blockers. The influence of endoscopy for the early diagnosis of gastric cancer was also considered. The Authors conclude that H2 blockers do not have a negative influence from a surgical point of view, however the correct diagnosis may often be delayed and this is not acceptable for an era in which early diagnosis is feasible.

[A case of multiple intestinal perforations due to TBC in a female patient with HIV-1 infection]

The authors report a case of HIV-1 infection, primary miliary tuberculosis of the lung and secondary intestinal tuberculosis complicated with multiple intestinal perforations. The surgical emergency therapy, supported by specific antitubercular drugs, antibiotics, and total parenteral nutrition, consisted in suturing seven perforative sites of the small and large intestine. The Authors stress the possibility that in the future tubercular complications up till now considered atypical may become more and more frequent because of the HIV-1 infection association.

Endocrine cells in intestinal metaplasia of the stomach

In this study we have investigated the mucin profile and the endocrine cell population in gastric endoscopic biopsies from 22 patients affected by chronic gastritis and intestinal metaplasia and in five surgical specimens of stomachs removed because of intestinal-type carcinoma (4) or peptic ulcer (1). High iron diamine-Alcian blue (HID-Ab) staining and peptide immunocytochemistry (peroxidase anti-peroxidase technique) were used. Forty-one foci of intestinal metaplasia were detected, 15 produced sulphomucins and 26 sialomucins. Of the endocrine cells investigated, gastrin and somatostatin cells were the most frequently observed, while cholecystokinin, glucose-dependent insulinotropic peptide-, secretin- and enteroglucagon-containing cells were also found in the metaplastic areas, but less frequently. No significant correlation was found between the type of mucin and the types of endocrine cells present, the latter usually resembling those normally found in the small intestine. On the basis of these results we conclude that intestinal metaplasia involves mucin- and peptide-producing cells of the stomach in a variable manner, with no correlation between the two.