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INTRODUZIONE: Il tumore desmoide è una rara neoplasia dei tessuti molli caratterizzata da tendenza all’invasività locale, da un elevato rischio di recidiva locale dopo asportazione. Colpisce maggiormente il sesso femminile, soprattutto in età fertile.CASE REPORT: Donna caucasica di 31 anni, unipara, con una tumefazione al terzo medio del muscolo retto sinistro dell’addome non dolente, insorta da circa un mese. Un’ecografia e una RMN dell’addome pongono il sospetto di un tumore desmoide della parete addominale. Si pone indicazione al trattamento chirurgico di enucleazione della lesione e ricostruzione dei piani muscolari senza ausilio di reti protesiche. Il follow-up eseguito a 1 anno non ha evidenziato alcuna recidiva.CONCLUSIONI: La mancata raccolta dei dati e la mancanza di un registro che differenzi tumori desmoidi localizzati in sedi diverse e l’accorpamento di lesioni primitive e secondarie presente in letteratura non hanno standardizzato un corretto iter terapeutico. Sicuramente di fronte a desmoidi della parete addominale il trattamento chirurgico può essere ritenuto il trattamento di scelta. Il prossimo futuro sviluppo di terapie geniche potrà contribuire a migliorare il trattamento e la prognosi dei pazienti. BACKGROUND: Desmoid tumor is a rare soft tissues neoplasia characterized by local invasiveness and by a tendency towards local recurrence although not towards metastasization.DISCUSSION: Etiology is not clear. Desmoid tumors originate from the monoclonal proliferation of one mesenchymal cell and develop in the context of fascial, muscular and aponeurotic tissue. They are free of capsule and do not usually metastatize, although they do present a high risk of local recurrence CONCLUSION: In the absence of a systematic data collection and of a clear distinction, in the existing databases, between primitive and recurrent lesions and between lesions of different sites, there are no standard guidelines for a correct management of desmoids.KEY WORDS: Aggressive fibromatos Desmoid tumor, Soft tissue neoplasia.

Stapled anopexy is considered the gold standard in treating haemorroidal disease associated to mucosal prolapse, but severe complications have been described. Among these, a minimal anastomotic leakage may lead to gas spreading into surrounding soft tissues.We report the case of a 61 year old male who developed pneumoretroperitoneum and pneumomediastinun two days after a Stapled Anopexy. CT scans showed a minimal leakage with no abscess. The patient was successfully treated by bowel rest, antibiotics and total parenteral nutrition, avoiding surgical approach.A minimal anastomotic leakage following Stapled Anopexy, when leading to air diffusion into soft tissues and not associated to abscess or peritonitis may be treated conservatively avoiding ileostomy or colostomy.Anastomotic leakage, Pneumoretroperitoneum, Stapled Anopexy.La stapled anopexy è considerata il gold standard nel trattamento della malattia emorroidaria associata a prolasso mucoso. In letteratura sono state descritte gravi complicanze. Tra queste, una minimo leakage anastomotico può portare ad un retropneumoperitoneo e alla sepsi grave. Generalmente questi sono casi in cui il chirurgo opta per il confezionamento di una stomia escludente (associato eventualmente al drenaggio di eventuali ascessi). Tuttavia in alcuni casi è possibile una gestione conservativa. In questo lavoro, riportiamo il caso di un un uomo di 61 anni che ha sviluppato pneumoperitoneo e pneumomediastino due giorni dopo una mucoprolassectomia. Il paziente è stato trattato con successo mediante digiuno, antibioticoterapia e nutrizione parenterale totale, evitando un approccio chirurgico. Il caso clinico è corredato da una revisione della letteratura precedente che riporta come siano pochissimi i casi simili già descritti.

BACKGROUND: Previous Literature has never evaluated the effectiveness of fiber intake after surgery for obstructed defecation in improving residual constipation and defecation urgency. METHODS: From May 2010 to June 2011, 65 patients were randomly assigned to either the active group (N.=32) or placebo group (N.=33) receiving 3.5 g/day of pure Psyllium fiber or inert compound respectively. During the 6-month follow-up score systems were evaluated: Longo's Obstructed Defecation Syndrome Score, Cleveland Constipation Score; Wexner incontinence Score and Visual Analogic Scale. We also recorded the incidence of postoperative defecation urgency. RESULTS: Active group reported less constipation at 1 week (ODS: 6.25±3.55 vs. 11.94±4.99, P

Introduction Perianal giant condyloma acuminatum is a rare clinical condition related to human papillomavirus infection and characterized by a circumferential, exophytic, cauliflower-like mass with an irregular warty surface localized in the anal region. Technique A circular incision with a diathermocoagulator was performed on macroscopically healthy skin, 1 cm from the margin of the lesion. The dermis was divided from the subcutaneous tissue. This way, a mucocutaneous cylinder including the whole lesion was obtained. A median radial incision was carried out to open the cylinder at its front. A progressive circumferential section on healthy mucosa (≈1 cm above the margin of the lesion) by means of a radiofrequency dissector allowed for the complete removal of the mass. The healthy mucosa of the anal canal was pulled out by Allis forceps and was sutured to the external margin of the internal sphincter with single layer of Vicryl (polyglactin 910) 2-0 sutures. Results Two months after surgery, no findings of anal stenosis or mucosal ectropion were reported. At the 1-year follow-up there was no recurrence of condylomatosis in any of the 3 cases. Conclusions Our procedure seems simpler to perform when compared with other techniques and reduces hospital stay and complications such as anal stenosis and mucosal ectropion.

Key Clinical Message A hard and bleeding anal and perianal mass stenotized the anus and required left-sided colostomy. Incisional biopsy showed a moderately differentiated spiniocellular carcinoma. Chemoradiotherapy treatment alone reduced significantly the mass.