HER2 expression or gene amplification is crucial for performing targeted theraphy. We assessed p185 HER2 (p185) expression, HER2 amplification and copy number of chromosome 17 centromere (CEP17) in pancreatic adenocarcinoma (PAC). We analyzed 26 tumours at diagnosis, 21 metastatic lymph nodes (mLN) and 38 distant metastases (mTS) by immunohistochemistry and by FISH. p185 overexpression was shown in 4% of primary PAC, 6% of mLN and 29% of mTS. Amplification was found restricted to 10% of the mTS and increased CEP17 in 21% of mTS and 16% of mLN. Overexpression of p185 was present in all amplified cases but in only 36% of increased CEP17. In conclusion HER2 amplification and increased CEP17 were mainly related to mTS or mLN and increased CEP17 was not always linked to overexpression of p185.

The role of laparoscopic appendectomy in complicated appendicitis is still not widely accepted. The authors report their retrospective study performed to evaluate the effectiveness of the laparoscopic approach in the management of complicated appendicitis. From January 2003 to October 2008, 552 patients underwent appendectomy in our surgical department. Among these, 358 were not complicated appendicitis while 194 were complicated. Of the 194 cases of complicated appendicitis, 121 patients underwent laparoscopic appendectomy while the remaining 73 cases were treated by conventional open surgery. The average length of hospital stay was 5.7 days, with a range from 4 to 13 days. Post-operative complications were observed in a total 11 patients (9.1%), including 3 cases of intra abdominal abscess (2.5%), 2 cases of umbilical wound infection (1.6%) and 6 cases of prolonged ileus (4.9%). Our experience suggests that the laparoscopic procedure is a valid, safe and feasible option to manage acute complicated appendicitis.

We investigated the association of circulating tumor cells (CTC) with poor prognostic markers in breast cancer (BC) at time of diagnosis. Peripheral blood (PB) samples from 190 patients with invasive BC, 12 patients with in situ BC, before theraphy and/or surgery, and 330 from patients without BC were tested for CTCs by RT-PCR for human mammaglobin (hMAM). hMAM was expressed only in PB of invasive BC (9.5%) and a significant correlation was found between CTCs with lymph node involvement, tumour size and negative ER. We conclude that CTC detention in invasive BC may be an additional poor prognostic indicator.

Three cases of histologically proven primary non-ampullary adenocarcinoma of the duodenum, observed in our Department from 2001 to 2004, are described. The cases were treated by pancreaticoduodenectomy, duodenal resection and transduodenal excision, respectively. The rarity of this pathology is documented by few retrospective studies and justifies discussion about the main prognostic factors and the best therapeutic approach. We analyze diagnostic, therapeutic and prognostic factors after a revision of literature.

Acute right lower abdominal pain is often clinically difficult to diagnose. The diagnosis, especially in young patients, is frequently oriented to appendicular disease. Surgical exploration only confirms diagnosis or surprises the surgeon, revealing an unexpected right colon diverticulitis. This emergency condition challenges the surgeon with the dilemma about the best therapeutic choice: conservative or radical treatment? The elective localization of diverticulitis to the right colon is very rare (6.6-14%). The authors report a case of covered perforation of a solitary cecal diverticulum.

Human mammaglobin (hMAM) has recently been recognized as a breast associated glycoprotein. Although the biological role of hMAM is unknown, it has been previously reported that hMAM gene expression is a marker of low biological and clinical aggressiveness of breast cancer (BC). In this study, 148 cases of BC tissues were investigated for hMAM mRNA expression by reverse transcriptase-polymerase chain reaction (RT-PCR). In order to evaluate its prognostic value, hMAM was correlated with age of patients, type and size of tumor, nodal stage, histologic grade, c-erbB-2 over expression, Ki67 labelling index, estrogen receptor (ER) status and progesterone receptor (PGR) status. Fisher's exact test was used to examine the association between different parameters and hMAM. hMAM was expressed in 138/148 (93%) of BC tissues examined. Among the 10 hMAM negative cases, 8 were invasive ductal carcinomas (microscopically higher G3 grade) and 2 infiltrating lobular carcinomas. We found a significant association (p = 0.020) between absence of hMAM mRNA and G3 histologic grade but not with any other prognostic parameters studied. The present study indicates that lack of hMAM expression is restricted to the BC with G3 grading. Further studies are needed to clarify the biological basis and the clinical significance of our results.

Occult carcinoma cells in peripheral blood of breast cancer (BC) patients is generally associated with poor disease prognosis. Reverse transcriptase-polymerase chain reaction (RT-PCR) is a sensitive method for revealing rare circulating cancer cells. The target mRNA must be carefully chosen, as it must be expressed only by malignant cells. In this study, we developed a nested RT-PCR assay for mammaglobin (hMAM) and assessed both its specificity and its sensitivity in the detection of cancer cells in peripheral blood of BC patients. hMAM mRNA was detected by RT-PCR in 156/165 (95%) of fresh BC tissues analyzed. All samples from 66 healthy blood donors and 151 patients with benign breast disease were hMAM negative as assessed by nested RT-PCR. In contrast, hMAM was detected in 16/137 (12%) of peripheral blood samples deriving from BC patients: 0/9 in stage 0, 1/50 (2%) in stage I, 3/33 (9%) in stage II, 1/18 (5%) in stage III and 11/27 (41%) in stage IV. Using nested RT-PCR, we were able to amplify hMAM transcript of one tumour cell/10(6) normal cells. Our data demonstrate that hMAM mRNA detection by RT-PCR is a specific assay potentially suitable for identification of occult cancer cells in peripheral blood of BC patients.

Aims: This paper aims to evaluate the diagnostic efficacy and costs of follow-up tailored according to risk of recurrence compared with minimal surveillance. Methods: A total of 358 patients treated by surgery alone for colorectal cancer were prospectively divided into two groups of 200 and 158 patients considered at high and low risk of recurrence respectively, according to prognostic factors. They were further randomized into two subgroups: group 1, 192 patients undergoing risk-adapted follow-up, intensive and low-intensity; group 2, 145 patients undergoing minimal surveillance. Twenty-one cases dropped out. Median follow-up was 61.5 months and 42 months for cases at high risk (intensive follow-up) and at low risk (low-intensity follow-up) respectively. Results: At the end of the study, 52.6% of patients undergoing risk-adapted follow-up and 57.2% undergoing minimal follow-up had developed recurrence. In patients at high risk, a significant difference in the incidence of curative re-operations was observed between the subgroups undergoing risk-adapted follow-up and subgroups undergoing minimal surveillance (P<0.05). The actuarial 5 year survival of patients at high and at low risk of recurrence undergoing risk-adapted follow-up is significantly better than that of cases undergoing minimal follow-up. The economic costs for 34 patients in the intensive follow-up group and for the 57 patients in the low-intensity follow-up group who were free from disease after primary surgery was very similar. Conclusions: Risk-adapted follow-up has significantly improved the targeting of curative re-operations and overall survival of patients independently of risk of recurrence and has allowed a reduction in the costs of following up of disease-free patients.

Background/Aims: To identify subgroups of patients at high risk of local relapse after curative surgery for rectal cancer.Methodology. Thirty-five variables of 216 patients observed from January 1987 to December 1995 were retrospectively analyzed according to univariate and multivariate methods. Median follow-up was 38 months.Results: High and moderate grade (P = 0.0001), Size greater than or equal to 5cm (P = 0.013), lymph nodes involvement (P = 0.002) and patients with locally advanced rectal cancer underwent extensive surgery and postoperative radiation significantly increased local relapse; whereas surgical procedure and experience of surgeons had no influence.Conclusions: The above-mentioned prognostic factors of rectal cancer that show a risk of local relapse 2- to 3.5-times higher than comparative conditions could be useful in identifying subgroups of patients at high risk for local recurrence. These patients should undergo a careful selection according to risk factors of relapse in order to increase local control of disease performing "optimal" primary surgery, effective postoperative radiation and tailored follow-up.

Kimura's disease is a chronic inflammatory pathology belonging to the angio-lymphatic proliferative disorders. The clinical features are a tumour-like swelling usually in the head and neck, with or without lymphadenopathy, often accompanied by eosinophilia and elevated serum IgE. It could be confused with angiolymphoid hyperplasia with eosinophilia. Other clinical differential diagnosis to Kimura's disease are reactive lymphadenopathy, lymphoma, parotid tumor with nodal metastasis and Mikulicz disease. The diagnosis is achieved by excisional biopsy which is also the therapy of choice. The prognosis is excellent. A case of Kimura's disease in an Italian female is presented together with a review of the literature.

Kimura's disease is a chronic inflammatory pathology belonging to the angio-lymphatic proliferative disorders. The clinical features are a tumour-like swelling usually in the head and neck, with or without lymphadenopathy, often accompanied by eosinophilia and elevated serum IgE. It could be confused with angiolymphoid hyperplasia with eosinophilia. Other clinical differential diagnosis to Kimura's disease are reactive lymphadenopathy, lymphoma, parotid tumor with nodal metastasis and Mikulicz disease. The diagnosis is achieved by excisional biopsy which is also the therapy of choice. The prognosis is excellent. A case of Kimura's disease in an Italian female is presented together with a review of the literature.

Endoscopic dilatation and stenting are the procedures of choice in the treatment of oesophago-gastric anastomotic stricture following oesophagectomy, leading to immediate relief of dysphagia with a low procedure-related risk. Prosthesis displacement is a described late complication, easy detected and sorted out whenever possible with endoscopic retrieval. A case in which stent migration ended at the terminal part of the small intestine, presenting with the clinical features of mechanical ileum, is described.

Kimura's disease is a chronic inflammatory pathology belonging to the angio-lymphatic proliferative disorders. The clinical features are a tumour-like swelling usually in the head and neck, with or without lymphadenopathy, often accompanied by eosinophilia and elevated serum IgE. It could be confused with angiolymphoid hyperplasia with eosinophilia. Other clinical differential diagnosis to Kimura's disease are reactive lymphadenopathy, lymphoma, parotid tumor with nodal metastasis and Mikulicz disease. The diagnosis is achieved by excisional biopsy which is also the therapy of choice. The prognosis is excellent. A case of Kimura's disease in an Italian female is presented together with a review of the literature.

BACKGROUND/AIM:Three hundred and eighty-seven patients surgically treated for colorectal adenocarcinoma were assessed by a multivariate analysis and the factors influencing incidence and extension of metachronous liver metastases studied.METHODOLOGY:A series of 387 patients which had been surgically treated for colorectal adenocarcinoma between January 1980 to December 1990 and followed-up over a minimum of a 5-year period was retrospectively studied.RESULTS:The most reliable prognostic markers are represented by tumor site (p < 0.05) and, more specifically, by wall infiltration (p < 0.01) and metastatic lymph-nodes (p < 0.05). The only independent variable with a significant impact on stage of metachronous liver metastases was proved to be the depth of wall infiltration (p < 0.05).CONCLUSION:This study confirms the reliability of some indicators of primary tumor in influencing incidence, but not extension, of metachronous liver metastases and this is the main problem when it comes to using prognostic factors in order to modulate the intervals of postoperative follow-up according to risk category.

Short- and long-term results of the treatment of 54 patients (12.5%) with synchronous hepatic metastases were critically reviewed by means of retrospective analysis of 431 colorectal cancer patients surgically treated over a period ranging from January 1980 to December 1989. Incidence and stage of hepatic metastases (Gennari Classification, 1984) are not significantly correlated to stage (T3), grade (G2-G3) and mucinous colorectal tumours; but they are significantly correlated to metastatic lymph nodes (p < 0.01). Actuarial survival is significantly influenced by surgery (p < 0.01) and stage of liver metastases (p < 0.05). The restriction of preoperative exclusion criteria and the simultaneous surgical treatment of primary colorectal and secondary hepatic metastases seem to be responsible for the high rates of operative mortality.

Aims Chromogranin-A (CG), a cytoplasmic glycoprotein, is one of the markers most frequently used to identify the presence of neuroendocrine cells in the human gastrointestinal tract. Several authors have identified a subgroup of colorectal cancer patients with a severe prognosis whose tumors contained neuroendocrine CG-positive cells. In the present study, CG expression in 100 patients with colorectal adenocarcinoma treated from January 1983 to December 1988 with potentially curative surgery was analyzed and correlated with other prognostic factors and 5-year survival rate. Methods Samples tested immunohistochemically for CG were divided into three groups: I) negative; II) less than 1 CG-positive cell/mm2; III) more than 1 CG-positive cell/mm2. Results Of 100 patients with primary colorectal adenocarcinoma, 79% had tumors comprised of CG-negative cells, 17% had rare CG-positive cells, and 4% of cases could be classified in group III. No significant relation between CG expression and location of primary tumor, bowel wall infiltration, stage of disease or tumor grade according to Broders and Jass was observed. The 5-year survival was 53% and 52% for CG-positive and CG-negative lesions, respectively. Survival of patients with Dukes-Kirklin stage C and D was comparable in patients with CG-positive (33.3%) and CG-negative (30%) tumors. Conclusions CG expression cannot, at present, be recommended as a marker to identify prognostic subgroups in colorectal cancer patients.

Aims and Background: In patients undergoing potentially curative surgery for colorectal adenocarcinoma, the presence of occult disease is thought to be responsible for distant metastases, particularly of the liver. During the 1980's preoperative intra-arterial chemotherapy was used in patients with adenocarcinoma of the sigmoid colon since it was thought that the biological effects induced by radiation in rectal lesions could be induced by cytotoxic agents in sigmoid cancer which was found to be less sensitive to radiation. The aim of the present paper is to report long-term results of an early pilot study on 20 patients with sigmoid colon adenocarcinoma treated with a 6 preoperative intra-arterial infusion of mitomycin-C followed by curative surgery. Methods: From January 1980 to December 1986, 20 patients with adenocarcinoma of the sigmoid colon were treated with a 6 hours preoperative intra-arterial infusion of mitomycin-C followed by potentially curative surgery (Group A). Eighteen hours prior to surgery the patients underwent selective arteriography of the inferior mesenteric artery through puncture of the femoral artery at the inguinal fold. The Seldinger technique was applied and Cook BP6 catheter was used. At the end of the examination, the catheter was positioned in the inferior mesenteric artery and mitomycin-C, 10 mg/m(2), was infused in 500 ml of normal saline over a 6 hours period after which the catheter was definitively removed. Within 18 hours following intra-arterial mitomycin-C infusion all 20 patients underwent potentially curative surgery of their sigmoid adenocarcinoma. During the same period, 48 comparable sigmoid colon cancer patients underwent potentially curative resection alone (Group B). Results: At 5 years overall recurrence rate was 30% and 39.6% in Group A and B patients, respectively (P = n.s.). In patients with Stage C disease, recurrence was less frequently observed in Group A (44.4%) than in Group B (77.7%) (P = n.s.). Overall survival at 5 years was comparable in the two groups of patients (70% and 64% for Group A and B, respectively) and median survival was >60 months in both groups. In patients with Stage C lesions, there was a trend for improved survival at 5 years in Group A patients (55%; median >60 months) compared to Group B (22%; median 27 months) patients (P = n.s.). Conclusions: Although the difference indicating decreased recurrences and improved survival for Stage C patients treated with preoperative intra-arterial mitomycin-C were not statistically significant, the long term results of this small pilot study are encouraging.