A Novel DNA Variant in SMARCA4 Gene Found in a Patient Affected by Early Onset Colon Cancer

Colorectal cancer is the third leading cause of death from neoplasia worldwide. Thanks to new screening programs, we are now seeing an increase in Early Onset of ColoRectal Cancer (EOCRC) in patients below the age of 50. Herein, we report a clinical case of a woman affected by EOCRC. This case illustrates the importance of genetic predisposition testing also in tumor patients. Indeed, for our patient, we used a combined approach of multiple molecular and cellular biology technologies that revealed the presence of an interesting novel variant in the SMARCA4 gene. The latter gene is implicated in damage repair processes and related, if mutated, to the onset of various tumor types. In addition, we stabilized Patient-Derived Organoids from the tumor tissue of the same patient and the result confirmed the presence of this novel pathogenic variant that has never been found before even in early onset cancer. In conclusion, with this clinical case, we want to underscore the importance of including patients even those below the age of 50 years in appropriate screening programs which should also include genetic tests for predisposition to early onset cancers.

Preservation of the inferior mesenteric artery VS ligation of the inferior mesenteric artery in left colectomy: evaluation of functional outcomes-a prospective non-randomized controlled trial

Vascular approach during elective laparoscopic left colectomy impacts post-operative outcomes. The aim of our study was to evaluate how different approaches impact positively defecatory, urinary and sexual functions and quality of life during elective laparoscopic left colectomy. A prospective non-randomized controlled trial at two tertiary center was conducted. All patients who underwent elective laparoscopic left colonic resection from January 2019 to July 2022 were analyzed. They were divided into two groups based on Inferior Mesenteric Artery (IMA) preservation with distal ligation of sigmoid branches close to a colonic wall for complicated diverticular disease and IMA high tie ligation for oncological disease. Patients were asked to fulfil standardized, validated questionnaires to evaluate pre and post-operative defecatory, urinary and sexual functions and quality of life. Defecatory disorders were assessed by high-resolution anorectal manometry preoperatively and six months after surgery. A total of 122 patients were included in the study. The 62 patients with IMA preservation showed a lower incidence of defecatory disorders also confirmed by manometer data, minor incontinence and less lifestyle alteration than the 60 patients with IMA high tie ligation. No urinary disorders such as incomplete emptying, frequency, intermittence or urgency were highlighted after surgery in the IMA preservation group. Evidence of any sexual disorders remained controversial. The IMA-preserving vascular approach seems to be an effective strategy to prevent postoperative functional disorders. It is a safe and feasible technique especially for diverticular disease. New prospective randomized and highly probative studies are needed to confirm the effectiveness in specific clinical situations.

Could Stoma Be Avoided after Laparoscopic Low Anterior Resection for Rectal Cancer? Experience with Transanal Tube in 195 Cases

Anastomotic leakage is the most-feared complication of rectal surgery. Transanal devices have been suggested for anastomotic protection as an alternative to defunctioning stoma, although evidence is conflicting, and no single device is widely used in clinical practice. The aim of this paper is to investigate the safety and efficacy of a transanal tube for the prevention of leakage following laparoscopic rectal cancer resection. A transanal tube was used in the cases of total mesorectal excision with low colorectal or coloanal anastomosis, undamaged doughnuts, and negative intraoperative air-leak test. The transanal tube was kept in place until the seventh postoperative day. A total of 195 consecutive patients were retrieved from a prospective surgical database and included in the study. Of these, 71.8% received preoperative chemoradiotherapy. The perioperative mortality rate was 1.0%. Anastomotic leakage occurred in 19 patients, accounting for an incidence rate of 9.7%. Among these, 13 patients underwent re-laparoscopy and ileostomy, while 6 patients were managed conservatively. Overall, the stoma rate was 6.7%. The use of a transanal tube may be a suitable strategy for anastomotic protection following restorative rectal cancer resection. This approach could avoid the burden of a stoma in selected patients with low anastomoses.

An encapsulated oncoytic neoplasm of follicular origin of thyroid, expressing neuroendocrine markers. A case report and literature review

A case is reported of an oncocytic tumor of the thyroid expressing simultaneously follicular and neuroendocrine markers, but not calcitonin. The data reported in the literature and the possible relationships of these lesions with the calcintonin-negative medullary carcinomas were examined.

Laparoscopic splenic artery aneurysmectomy with ICG guided partial splenectomy: alternative approach

We herein report the case of a voluminous splenic artery aneurysm (SAA) diagnosed in a 48 year-old Caucasian male patient. After endovascular treatment failure, considering the volumetric aneurysm increase and recurrent symptoms, a laparoscopic splenic artery aneurysmectomy with partial splenectomy guided by indocyanine green fluorescence (ICG) was performed. This conservative strategy leads to save a spleen volume of about 10 cm³ to avoid postsplenectomy thrombocytosis and infections, potential immunodeficiency and overwhelming postsplenectomy infection syndrome (OPSS) and to preserve pancreatic vascularization preventing distal pancreas injuries.

A rare neurendocrine tumor of the lung: sclerosing paraganglioma. A neoplasm that is difficult to diagnose and a source of dangerous pitfalls. A case report and literature review

An endobronchial obstructing neoformation was found in a 58-year-old man. The histology and immunohistochemical profile oriented the authors towards a diagnosis of paraganglioma, sclerosing variant. This very difficult diagnosis, especially in a pulmonary localization, may lead to erroneous conclusions both in terms of histogenetic interpretation and that of its biological behavior. The pulmonary localization of the paraganglioma is very rare and even more rare the sclerosing variant, recently reported. Differential diagnosis and literature are discussed.

Study on the so-called «Pseudosarcoma» Associated with Carcinoma of the Larynx

On the basis of two personal observations of the so-called « pseudosarcoma » associated with carcinoma of the larynx, the literature on this subject is reviewed. The clinical behaviour and pathological findings of these cases and the data emerging from literature show the existence of two types of « pseudosarcoma ». The first type is characterized by macroscopical polypoid morphology and very atypical sarcomatous pattern, in which, however, some characters of the granulation tissue are detectable; the carcinomatous component is very incospicuous and frequently in situ. The second type is characterized by a vegetant non polypoid fibrosarcoma-like stromal proliferation; transitional aspects between the epithelial cells of the squamous-cell carcinoma, and the spindle cells of stromal component are present. The first type of «pseudosarcoma» pursues comparatively benign clinical course, while the second shows clinical behaviour like usual forms of the laryngeal invasive carcinoma.

Malakoplakia: A Pseudoneoplastic Disease of the Rectum

A review of the literature on extraurinary malakoplakia is followed by the description of a typical case, located in the rectum, whose clinical and rectoscopic features suggested the existence of neoplastic disease. This condition should therefore be borne in mind in the course of differential diagnosis of anorectal tumors.

Kaposiform hemangioendothelioma in an adult with rheumatoid arthritis

This report describes a case of kaposiform hemangioendothelioma arising in an adult man during the course of rheumatoid arthritis treated with steroids and methotrexate. The vascular proliferation began in the terminal phase of the disease, which culminated in acute renal failure and death. We discuss the possible relationship between rheumatoid arthritis, its treatment, and the onset of vascular proliferation, as well as the role of kaposiform hemangioendothelioma in aggravating the autoimmune disease and leading to its fatal outcome.

Lane's type pseudosarcoma of glans penis

We herein present a rare case of polypoid "pseudosarcomatous lesion" of the glans penis, associated with in situ or mini-invasive squamous carcinoma. These lesions, described by Lane, in the upper aerodigestive tract, can rarely occur elsewhere. Immunohistochemistry is crucial for a correct diagnostic interpretation, confirming that the aytpical cells are components (fibroblasts, myofibroblasts, endothelial) of granulation tissue.

A peculiar fibroma-like lesion of superficial soft tissue: morphologic and immunophenotypic evaluation

Apeculiar lesion of superficial soft tissue characterised by fibroma-like morphology and an immunohistochemical profile consisting of CK+, VIM+, CD34+, CD31+/-, FLI1+ and INI-1 retained is described. The lesion entered into differential diagnosis with the so-called fibroma-like variant of epithelioid sarcoma, with the entities defined as ES-like/pseudomyogenic haemangioendothelioma and the recently identified entity defined as superficial CD34+ fibroblastic tumour. All of these entities share a common morphological structure, but differ in their immunophenotypic profile.

A complex association between derivatives from the neural crest. A case report

We report the case of a very complex proliferation arose in the context of the soft tissues of the axilla, composed of elements derived from the neural crest: several of hamartomatous significance: ("cafe au lait spots without neurofibroma, groups of nevoids cells), others clearly neoplastic with the characters of the melanoma and the MPNST. The melanoma cells express, furthermore, neuroendocrine markers. Differential diagnostic characters are discussed and emphasizes the importance of this kaleidoscopic, transient, structure in determining the phylogeny and ontogeny of living beings.

Histogenetic and taxonomic considerations on a case of post-traumatic bizarre parosteal osteochondromatous proliferation (BPOP)

A case of bizarre parosteal osteochondromatous proliferation (BPOP) arising in the head of the fibula of a young man following injury on the lateral aspect of the knee is reported. Microscopically, four zones could be recognized proceeding from the periphery to the deep portion: 1) an outer thick fibrous cap showing an abundant cellular component, composed of thin spindled elements of fibroblastic appearance, haphazardly arranged and exhibiting intense and diffuse immunohistochemical expression of S100 protein (a previously unreported observation); 2) an irregular and atypical cartilaginous cap beneath the fibrous cap; 3) a layer of blue bone in which islands of atypical chondrocytes are still present but gradually decreasing, moving towards the deeper areas; 4) a layer of mature bone, pink bone, which is implanted in the skeletal segment (the deep margin is devoid of periosteum). The intratrabecular spaces of blue or pink bone did not contain haematopoietic marrow, but rather a loose myxoid stroma. This case confirms the fact that BPOP can occur in skeletal segments other than those indicated in the original report of Nora, and that trauma, even if minor, is an important factor in the development of the lesion. The latter begins at the periosteal level, where fibroblasts may acquire a chondroformative function (becoming chondrofibroblasts), as witnessed by the strong and widespread expression of P S100, first documented in this report.

Pancreatic-type acinar cell carcinoma of the stomach beneath a focus of pancreatic metaplasia of the gastric mucosa

Acinar cell carcinoma is an uncommon type of carcinoma of the pancreas that can exceptionally arise in ectopic pancreatic tissue. Herein, we report a case of a 52-year-old man with pancreatic-type acinar cell carcinoma of the stomach and concomitant pancreatic metaplasia of the adjacent nonneoplastic gastric mucosa. There was neither clinical nor radiographic evidence of a tumor in the pancreas itself. A subtotal gastrectomy was performed. Macroscopically, an ulcerated tumor, measuring 4 x 1.7 cm, was found in the distal antrum. Microscopically, the biopsy and the surgical specimen revealed a neoplasm with a predominantly trabecular architecture composed of moderately atypical cells with finely dispersed chromatin and indistinct nucleoli. The neoplastic cells and those of the adjacent metaplastic mucosa were both strongly immunoreactive for alpha-1-antitrypsin, consistent with pancreatic acinar cell differentiation. Ectopic pancreatic-type acinar cell carcinoma is an extremely rare condition, having been previously reported only in 5 occasions, none of them in association with pancreatic acinar cell metaplasia of the gastric mucosa.

Morphologic and immunohistochemical observations on the mammary and extramammary Paget's disease: implications for the histogenesis

Using a panel of three anti-CK MoAbs, belonging to Gown's Classes II, III and IV, the Paget's cells shown a variable reactivity to such antibodies indicating a more frequent immunocytochemical similarity to the cells of the epidermal basal-ductal system than to the cells of the glandular secreting section of the epidermal derivatives. According these findings the P.C. not necessarily is the result of a cellular migration from ductal section toward the epidermis, but may arise from a epidermal basal-stem cell, from a ductal or more rarely from glandular secreting cell. This assumption is enforced also by the expression of the CEA from morphologically bonafide basal epidermal cells in proximity of the pagetic lesion.

Carcinoma of the thyroid showing thymoma-like features

A new case of thyroid carcinoma with thymoma-like features, occurring in a 45-year-old lady, is reported. In order to establish the incidence of residual thymic tissue, 2575 consecutive surgically removed thyroid glands were also examined. Thymic tissue was found to be present in up to 1.4% of the cases. The clinicopathological and immunohistochemical features of the case together with its possible relationship with the persistence of aberrant nodules of thymic tissue in the neck are discussed.

[Atypical lipoma, floret-like pleomorphic variant. A lipomatous lesion simulating a liposarcoma]

A case of submucous lump of the majus labium of a 56 year old female has reported. This is a composite lesion which shows a loose connectival texture and a high cellularity with spindle cells, multivacuolated cells of irregular shape and hyperchromatic nuclei; moreover, there are characteristic multinucleated floret-like cells. This is a particular variant of Atypical Lipoma defined as Pleomorphic Lipoma by Enzinger. Despite this ominous cellularity, the lesion is perfectly benign. The small size and the superficial site are the majors elements of good prognosis. In retroperitoneal localization lesions with similar histologic presentation and of major size show more severe prognosis and are classified as Low Grade Well Differentiated Liposarcoma.

Atypical Reserve Cell Hyperplasia of Cervical Glands, Simulating Adenocarcinoma. An Undescribed Reversible Lesion in a Woman Taking Oral Contraceptives

On the basis of a characteristic lesion of the endocervical mucosa in a woman who had taken contraceptives for 4 years, the authors review the problem of these alterations, also in light of their personal experience.

Histological Typing and Nuclear Evaluation of Endometrial Adenocarcinoma

On the basis of the nuclear pattern « homologous adenocarcinoma » of the endometrium, arising in women under 40, may be divided into three cytologically distinguishable entities: 1) atypical adenomatous hyperplasia Grade 1; 2) atypical adenomatous hyperplasia Grade 2; 3) adenocarcinoma; probably different also at biological level.

Endometrial Carcinoma under the Age of 40

Endometrial adenocarcinoma in women under the age of forty presents a different course according to its histology. Adenocarcinomas of the endometrium may be classified into 4 main types: type 1, homologous or endometrioid; type 2, fallopian-like; type 3, cervical-like; type 4, unclassifiable. The majority of homologous adenocarcinomas have a relatively benign course, whereas the other types are definitely malignant. There is no room for doubt between adenocarcinoma and atypical endometrial hyperplasia in women under forty unless the histological pattern is of the homologous or endometrioid type, because the other patterns are definitely malignant.

Morphological Typing of Endometrial Adenocarcinoma as the Basis of the Natural History of the Tumor

Current ideas on Müllerian tumors of the ovary are applied to the classification of endometrial adenocarcinomas, which are divided into four main histotypes: Type 1 or homologous or endometrioid (65 % of cases); Type 2 or Fallopianlike (15.8 %); Type 3 or cervical-like (13.4%) and Type 4 or unclassifiable (5%). This classification aims to provide a useful morphological criterion for forecasting the sensitivity of endometrial adenocarcinomas to endocrine treatment with progestational agents. Type 1 accounts for about 80 % of all adenocarcinomas of the endometrium in the fifth decade of life, which is supposed to be the period most exposed to estrogenic stimulation. These adenocarcinomas represent only 14 % of all endometrial adenocarcinomas. The above results are based on a 155-case series.

Giant Cell Fascial Histiocytosarcoma

After a survey of the modern concepts regarding malignant giant cell tumors of soft tissues, the authors describe two cases that arose in the aponeurosis of external abdominal oblique muscle following intervention for inguinal hernia. The peculiar characteristics of these tumors are discussed and compared with other malignant giant cell tumors of soft tissues. It is proposed that this particular neoplasm be called « Giant Cell Fascial Histiocytosarcoma ».

Anatomoclinical Report on a Case of Pseudosarcomatous Proliferative Myositis

A case of pseudosarcomatous proliferative myositis of the left sartorius muscle in a 73-year-old patient is reported. This is the 42nd case of the disease in the world literature. The process is interpreted as a fibromatosis rich in myoblasts representing an attempt at regeneration of the muscle fibers.