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Objective: The aim of this study was to assess the anatomical space above the perineal floor, under the properitoneal pelvic tissues, while attempting to capture its details and related surgical relevance in gynaecological oncology. Materials And Methods: The authors used 12 fresh surgical specimens of female cancer patients submitted to an extralevator abdomino-perineal rectal resection, "en monobloc" with a total hysterectomy and posterior colpectomy, or a total cystectomy plus hysterectomy. They obtained as many histological macro-slides, which have been investigated with anatomo-topographic intent. Results: The authors successfully identified a small anatomical structure with a simple texture of adipose tissue, a scanty network of blood and without proper lymph nodes or nervous plexuses, wrapping the lower parts of the pelvic organs and directly continuing back and up with the retroperitoneum. Conclusion: The lower pelvic space is a real anatomic structure, with a corresponding radiological imaging. It can be affected by primary tumors of the pelvic organs, and its excision can be considered in radical pelvic surgery. [ABSTRACT FROM AUTHOR]

Background: The new cross-sectional radiological tools, 3D computed tomography and magnetic resonance, allow a precise study of the liver anatomy. Thanks to these imaging techniques, a new space inside the liver parenchyma, the “hepatic core,” was recently recognized, where the hila of liver segments are present.Methods: On the basis of anatomical and radiological observations, we identified a new virtual plane of dissection, named “hepato-portal,” which is useful in liver segmentectomy, if integrated with the classical planes of dissection.Results: Simulated surgical procedures can be intra-operatively transferred by ultrasounds. In this way, we performed ten “proper” liver segmentectomies through preliminary sections of the hilar vessels and a precise dissection of the boundaries of each segment.Conclusions: Our experience underlines the value of integrating anatomy and radiology in the simulated liver surgery. [ABSTRACT FROM AUTHOR]

The acantholytic dermatosis of the vulvocrural area (ADVA) is a rare skin disorder of unknown etiology, described for the first time by Chorzelski et al. in 1984. It is characterized by solitary or multiple skin-coloured to white, smooth papules or plaques, involving the genitocrural region, in particular the vulva. Here, the authors refer a case of ADVA in an 80-year-old female patient affected by recurrent endometrial carcinoma. The immunohistochemical investigation demonstrated the exclusive presence of G immunoglobulins inside the skin lesions, so indicating a paraneoplastic immunological action. The findings shed light on the etiopathogenetic mechanisms at the basis of this still scantly known nosological entity. [ABSTRACT FROM AUTHOR]

An enigmatic category of uterine mesenchymal neoplasms is descriptively referred to as uterine tumors resembling sex cord-gonadal stromal tumor. First described by Clement and Scully in 1976, they were subsequently subcategorized in 1) endometrial stromal tumors with sex cord-like elements (ESTSCLE) and 2) mural uterine tumors resembling ovarian sex cord tumors (UTROSCT). In the first subcategory, the prognosis depends on the type, grade, and stage of the underlying stromal neoplasm, while in the second one, a low-grade malignant behavior has been postulated on the basis of occasional local recurrences. Here, the authors report a new case of metastasizing UTROSCT in an 83-year-old Caucasian woman, providing a literature review, and emphasizing its metastatic potential. This tumor entity shows a variable immunohistochemical profile with possible co-expression of sex cord (inhibin, calretinin, WT1, MART1/melanA), epithelial, smooth muscle (actin, caldesmon), and miscellaneous markers, such as estrogen or progesterone receptors. For this aberrant expression of immunohistochemical markers, the final diagnosis of metastatic UTROSCT appears a diagnostic challenge. Finally, the authors detected the cdkn2a (p16INK4a) expression in about half of the neoplastic cells; this finding suggests a possible involvement of the CDKN2A gene in the genesis of an aggressive tumor clone, as observed in other uterine sarcomas. [ABSTRACT FROM AUTHOR]

Renal cell carcinoma is the sixth leading cause of death for cancer in industrialized countries and one third of patients has metastases at the time of diagnosis. The three most common histological types of renal cell carcinoma are: clear cell carcinoma (70–80%), papillary carcinoma (10–15%) and chromophobe cell carcinoma (5%). The location of metastases vary according to histotype: lung metastases are found in 53.6% of cases in patients with clear cell carcinoma, whereas in patients with papillary carcinoma or chromophobe cell carcinoma in 33.3% and 28.2% of cases, respectively. In contrast, chromophobe cell carcinoma is more often associated with liver metastases (33.3%), compared with clear cell carcinoma (9.7%) or papillary carcinoma (18%). Patients with renal cell carcinoma metastatic to a single organ have a better prognosis than patients with metastases in multiple organs and the overall survival of patients with localized lung metastases is similar to that of patients with exclusive bone metastases. The overall survival, therefore, is related more to the number of organs involved by metastasis rather than by the location of metastases. The widespread use of abdominal non-invasive diagnostic procedures, with an incidental finding of renal cell carcinomas still in a low stage of development, and the refinement of surgical techniques for resection of metastatic disease (metastasectomy) have led to only a slight improvement in overall survival in the last 30 years for the resistance of the tumor to common chemo-radiotherapy Surgery remains the best therapeutic option and a rising in cutting-edge molecular therapies is strongly needed. [ABSTRACT FROM AUTHOR]

Thanks to their molecular affinity with natural hormones, endocrine disruptors (EDs) can interfere with the endocrine system by activating or blocking the receptor signal transduction. According to the World Health Organization, EDs and potential EDs are mostly man-made, found in various materials such as pesticides, metals, personal care products, additives or contaminants in food, and the human exposure to EDs occurs via ingestion of food, dust and water, via inhalation of gases and particles in the air, and through the skin. In 2015, the Endocrine Society released its second scientific statement about the evidence that EDs have effects on female reproduction, breast development and hormone-sensitive cancers in females, such as breast cancer, endometrial cancer, and ovarian cancer. Therefore, prevention campaigns to reduce the female exposure to EDs and, consequently, the death burden of hormone-sensitive female cancers are needed. [ABSTRACT FROM AUTHOR]

The media carry stories of patients who, thanks to early diagnosis of malignancy, claim to have been saved by their cancer-sniffing pets. It is established that the brain of a dog features a wide olfactory cortex, compared to that of humans, where the visual cortex predominates. The cat also possesses an acute sense of smell, due to its well-developed olfactory bulb and a large surface of olfactory mucosa. A series of diagnostic hallmarks of malignancy have been defined, among which tumor necrosis. It is a form of hypoxic death resulting in an accumulation of cell debris and decomposing tissue. It is well known that the decomposition process produces foulsmelling molecules, such as cadaverine and putrescine. Given their remarkable sense of smell, it is more than likely that some pets are able to detect on themselves and in their owner's body the odor of tumor necrosis deriving from aggressive cancers. [ABSTRACT FROM AUTHOR]

Neoplastic spread to lymph nodes is one of the most important prognostic factors in female cancer and one of the well known TNM classification parameters, together with tumor size and distant metastases. The nodal status is in faet a significant predictor, which supports clinicians to decide on the most appropriate surgical approach and subsequent therapy. The precise intraoperative assessment of sentinel lymph node and eventual metastatic burden is therefore decisive for providing high diagnostic quality and reliable staging. Since methodologies differ across institutions, standardization of results is also a challenge. Today, one step nucleic acid amplification (OSNA) meets all these needs. [ABSTRACT FROM AUTHOR]

I Editor i The interesting study by Hobeika suggests non-invasive methods to evaluate the liver haemodynamics, important in cirrhosis and other conditions or prior to laparoscopic liver surgery1-3. We implemented a CT morpho-quantitative study of the intra-parenchymal venous network in a group of 30 patients with Child-B/-C liver cirrhosis. Using simple mathematical equations, we calculated the decrease in size of venous pedicles feeding liver segments and of the hepatic veins compared with the portal vein and the inferior vena cava. [Extracted from the article]

I The Editors welcome topical correspondence from readers relating to articles published in the Journal. 1 Merkel S, Weber K, Matzel KE, Agaimy A, Göhl J, Hohenberger W. Prognosis of patients with colonic carcinoma before, during and after implementation of complete mesocolic excision. [Extracted from the article]

Endocrine disruptors are chemical substances that can interfere with the endocrine system. They include pesticides, metals, additives or contaminants in food, and personal care products. Pesticides are the only substances intentionally released into our environment to kill living things (herbicides, insecticides, fungicides, rodenticides). There is scientific evidence that exposure to pesticides produces a growing number of human pathological conditions; among these, stillbirth is an emerging issue. [ABSTRACT FROM AUTHOR]

In literature there are no data related to mitochondrial DNA (mtDNA) content in sudden intrauterine unexplained death syndrome (SIUDS). To test the hypothesis that a quantitative excess of mtDNA could play a role in the pathogenesis of SIUDS, mtDNA content was measured in cerebral cortex of 9 SIUDS and in 7 controls. The median (interquartile range) mtDNA in SIUDS and controls was 14,000 (8600–33,500), 3400 (0–8500) copies per nuclear DNA, respectively ( p = 0.007). If mitochondria are involved in SIUDS, then higher mitochondrial DNA content may be a biomarker of this syndrome. [ABSTRACT FROM AUTHOR]