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The prognosis of stage IV metastatic melanoma is poor. An overall 1-year survival of 25.5% and a median survival of 6.2 months were reported without any significant improvement during the last 30 years before the introduction of new drugs (immune checkpoint inhibitors and targeted therapies) which completely modified the therapeutic approach and induced an overwhelming improvement on the survival rates of these patients. This review will analyze the therapeutic tools available for the treatment of patients with metastatic melanoma, including adjuvant interferon and locoregional therapies (surgery, radiotherapy and electrochemotherapy) and will mainly focus on the presentation of results obtained by the new treatments (checkpoint inhibitors and targeted therapies).

Aim: Many studies have indicated that lymph node metastases and the depth of invasion of the primary tumor are the most reliable prognostic factors for patients with radically resected gastric cancer. Recently the ratio between metastatic and examined lymph nodes (n ratio) has been proposed as a new prognostic indicator. The aim of this study was to evaluate the prognostic value of n ratio in patients with gastric cancer., Methods: We retrospectively reviewed the data of 399 patients who had undergone radical resection for gastric carcinoma., Results: N ratio was significantly greater in patients with large and undifferentiated tumors. Moreover, it was significantly related to both the number and location of lymph node metastases. Survival curves showed that n ratio was strictly related to patients' survival. Multivariate analysis confirmed that it was an important independent prognostic indicator., Conclusion: N ratio is useful to better evaluate the status of lymph node metastases in patients with gastric cancer submitted to radical surgery. Moreover it is a very important independent prognostic factor for gastric cancer.

Myelolipoma is a rare benign pathology whose pathogenesis is still unclear. It is most frequently localised in the adrenal gland, followed by the presacral region, mediastinum, and perirenal and hepatic region. It varies in size from a few millimetres to several centimetres. The lesion is usually capsulated, detachable from the surrounding tissues and hypovascularised. In histological terms, it is composed of lipomatous and hematopoietic tissues. A 65-year-old female patient was referred to our unit after the finding of a nonbiopsied, pelvic mass during earlier surgery. The patient was in considerable pain owing to the extrinsic compression of the mass on abdominal and pelvic organs. Preoperative tests confirmed the presence of a voluminous presacral neoformation that appeared to have a possible medullary origin (chordoma or schwannoma). During surgery, the lesion was found to be capsulated and mainly adherent to the rectum. Histological analysis confirmed the myelolipomatous nature of the lesion. A review of 21 cases reported in the literature is presented.

Solitary fibrous tumors of the pleura represent a rare clinicopathological entity: 456 cases only have been reported since 1991. A interesting case of solitary fibrous tumor of the pleura is described here, because it turned up in a female patient followed up for a bilateral breast cancer and so with the exact determination of the period of beginning. The complex morphological picture is illustrated in relation to other cases reported in the literature. Immunohistochemical results are stressed, particularly as regards the coexpression of vimentin and desmin without necrosis and the low number of mitosis. As there are no criteria to determine the possible aggressive or malignant behaviour of the tumor, surgical resection of the lesion is indispensable both to resolve the diagnosis and to carry out the only proposable therapy.

Posterior partial fundoplication can be as effective as total fundoplication in the long-term control of gastroesophageal reflux if the gastric fundus valve is encircled around the distal esophagus for no less than 270 degrees to obtain effective pressures in the newly built sphincter. In order to minimize the adverse effects, to reach constant results and to guarantee the reproducibility of the technique we have modified the 270 degrees posterior fundoplicatio (formerly described by Lind) according to the following principles: 1) the length of the gastric valve must be limited to 3 cm for each side of the esophagus; 2) the gastric valve must be fixed to the right and left side of the hiatal orifice by a single stitch; 3) the gastric valve must be calibrated with an intraoperative manometry, this allowing the standardization of the valve pressure to an average value of 35 mmHg by varying its wrapping angle; 4) the hiatal orifice must not be closed unless it is large enough for thoracic migration of the gastroplasty. Since 1984 to 1991 43 patients with proven gastroesophageal reflux not controlled by medical treatment were submitted to surgery. Twelve Nissen procedures (NP) and 31 posterior calibrated fundoplications (PCF) were performed; PCF seemed to be superior to NP in terms of postoperative mobility. After two years 20 patients treated with PCF were evaluated clinically, manometrically and by 24-hour pH monitoring. No dysphagia was reported; in two patients a pH-metric, asymptomatic relapse was observed, while one patient complained mild and occasional heartburn.(ABSTRACT TRUNCATED AT 250 WORDS)

On the basis of six surgically operated patients, current thinking with regard to the treatment of Zollinger-Ellison syndrome is outlined. Total gastrectomy which for many years was the most common surgical intervention, is now confined to just a very specially indicated few cases because the introduction of anti-H2 gives good control of gastric secretion. The operation should therefore be targeted at removing the gastrinoma, helped in this by modern methodologies for pinpointing the neoplasia. Long-term however include a certain number of failures.

Intrathoracic thyroid cancer is an unusual finding, and few reports are available on this item. Literature data have been reviewed, and some considerations on epidemiologic characteristics of the disease and on its treatment were gained from an analysis of reports based on the files of I Surgical Clinic of the University of Turin, Surgical service of the Oncological Department of the S. Giovanni Battista Hospital and II Pathological Anatomy Service of the University of Turin. No correlation was found between previous thyroid disease, sex, histological findings, previous radiotherapy and incidence of the disease. Older age at the onset and recurrent laryngeal nerve lesions are frequently associated with intrathoracic thyroid cancer; papillary carcinoma is rarely found. Intrathoracic situation is not likely, in Author's opinion, to affect the long term prognosis more than usual risk factors.

In evaluating pre- and post-operative immunological status of 15 patients with malignant breast and thyroid tumors and of 9 patients with benign breast and thyroid lesions, rosette E test, CEA, cortisol, immunocomplexes and determination of circulating leukocytes, B lymphocytes and immunoglobulins was employed. The obtained data were not significative to show a lack of immune response in tumor bearing patients. Among the reexamined parameters, CEA was the only one that apparently correlated with prognosis; its serum levels, being at a high rate in a high percentage of malignancies, tended to fall down after surgical treatment.

One particularly interesting problem in the treatment of breast carcinomas relates to the strategy to be adopted in locally advanced forms. In 10-25% of cases surgery in itself offers no guarantee of radicality and the prognosis is particularly poor. Once considered suitable only for radiation treatment, such cases now tend to be treated by mixed therapy adopting different modes and sequences. The present paper fully and carefully examines current concepts and treatment possibilities.

As complete as possible a picture of the current state of cytostatic chemotherapy in the treatment of metastatic breast carcinoma is offered. Attention is therefore mainly concentrated on application modalities of this form of therapy in relation to the clinical stage of the disease and to the use of other treatment possibilities. Methods and results of cytostatic therapy are then considered. The present situation is reviewed and the pharmacological and toxic aspects of prolonged antiblastic treatment are assessed. After outlining a number of special problems relating to the treatment of CNS and pleural metastases, the personal series is presented and results, which do not differ from other reported series, reported. In conclusion, stress is laid on the importance and effectiveness of cytostatic therapy in the treatment of metastatic breast carcinoma, but extended, controlled studies are also recommended.

The Authors have treated 11 patients with benign breast diseases (fibroadenosis or fibrocystic disease) with two prolactin inhibitor drugs -- metergoline and bromocriptine -- at the dose of 8 mg/die and 7,5 mg/die respectively for sixty days with a 30 days interval from one to the other. All patients, except one, had normal serum prolactin levels before the trial; during the treatment with metergoline no long-term changes in serum prolactin levels were observed; on the contrary, bromocriptine reduced significantly prolactin values for the whole duration of the therapy. Negative clinical results were obtained with the first drug, while bromocriptine allowed to reach an 80% of positive results at the end of the trial. Coming from previous experience, the Authors conclude that the positive therapeutic effect of bromocriptine treatment is connected with the maintenance of prolactin reduction.