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The incidence of splenic metastasis, revealed during autopsy, from solid tumours varies from 1.6% to 30% with a mean of 7%. The clinical observation of splenic metastasis in patients with carcinoma of the exocervix is only occasionally reported. In the majority of cases metastasis appears 4 or 5 years after the onset of disease. The case reported here is the only example we have found in the literature relating to an adenocarcinoma of the uterine cervix which led to an isolated splenic metastasis. A 47-years-old patient underwent radical hysterectomy according to Meigs due to a stage 1B N0 G2 endocervical adenocarcinoma. The patient was subsequently reoperated due to pelvic recurrence and received radiotherapy. Almost five years after the first operation CT showed a suspected isolate splenic recidivation following pain in the left side. Hepatosplenic scintigraphy confirmed the presence of a large central cold area, with blurred edges, suggesting metastasis. The patient again underwent laparotomy: the volume of the spleen was found to be increased with the splenic hilum covered with neoplastic tissue. Splenectomy was performed. Abdomino-pelvic and retroperitoneal inspection showed no further signs of metastasis. Histological tests confirmed the massive metastasis of the adenocarcinoma in splenic parenchymal tissue which was relatively differentiated with a clear cell appearance. Seven months later the patient was again operated following intestinal occlusion due to numerous entero-enteric adhesions. During the course of surgery a micronodule was removed from the cholecystic serosa, apparently composed of fibrin; histological analysis proved that this micronodule was the site of glandular micrometastasis. The patient then began three cycles of chemotherapy with Adriamycin (60 mg/m2).(ABSTRACT TRUNCATED AT 250 WORDS)

This study examines the accuracy of ultrasonic scanning in the recognition of malignancy in 103 "cold" thyroid nodules. All nodules underwent to surgical ablation and to histopathological examination. 10 nodules were cistic, 72 solid and 21 mixed cistic-solid on echography. None of the cistic nodules showed malignant disease while six carcinomas were present in solid nodules and one (a papillary cancer) in a mixed cistic-solid lesion. However we were unable to find echographic abnormalities pathognomonic for malignancy. Only in one case (an undifferentiated carcinoma which involved adjacent blood vessels) the diagnosis of malignant tumour was made before operation; in the other cases the echo patterns of the carcinomatous nodules were similar to those observed in benign nodules. Similar ultrasonic findings were also seen in the various types of thyroid cancer (3 follicular, 2 papillary, 1 medullary, 1 undifferentiated) a part the papillary carcinoma which appeared as cistic-solid lesion. Our data seem to limit the diagnostic value of echography in the detection of malignant thyroid nodules, nevertheless they confirm the benignancy of echografically cistic nodules.

In a series of 10 patients the hematic and plasmatic clearances of 99mTc-pyrophosphate (PYP) and 99mTc-metylene-diphosphonate (MDP) have been studied. The analysis of the results shows that the elimination both hematic and plasmatic of MDP is significantly faster than that of PYP. Moreover the plasmatic elimination of PYP is faster than its hematic elimination. This fact is probably due to a partial absorption of the radionuclide on the surface of the red cells. No significant differences result in the urinary elimination of both radionuclides. As a consequence the MDP has a lower fundus activity and a lower irradiation dose to the blood and to the whole body. For those reasons this radionuclide is proposed as the preferred agent in bones scintigraphy.