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Introduction: At the time of diagnosis, most patients with lung cancer are in an inoperable stage, with distant metastases. Most often, these patients have metastases to the brain, adrenal glands, liver, or bones. This article presents the case of a patient with non-small-cell lung cancer (NSCLC) metastases in the abdominal wall.

Introduction: Enchondromas are benign tumors originating in the cartilaginous tissue of the hyaline gristle, rarely located in the chest wall. They sometimes undergo a sarcomatous transformation, becoming secondary chondrosarcomas.

Introduction: With primary small bowel tumors being relatively rare, the vast majority of them being neuroendocrine tumors, metastases at this site are relatively uncommon. The most frequent primary tumor with metastatic affinity for this location is considered to be cutaneous melanoma. Objective: We aimed to report a series of 4 cases of small bowel metastases with different locations for the primary tumor, emphasizing the heterogeneity of origin for those tumors. Materials and Methods: A series of 4 patients undergoing segmental enterectomy for small bowel tumors were diagnosed with metastatic disease, primary tumor being either lung adenocarcinoma, cutaneous melanoma, or cervical and laryngeal squamous carcinomas. For all 4 diagnoses, it was used standard histological techniques: light microscopy and standard hematoxylin-eosin staining, and to establish the origin of the metastasis, we used tumor specific immune markers. Regarding the pulmonary tumor, metastases in small bowel were incidentally discovered at the autopsy. Results: First small bowel metastasis reported is from cutaneous melanoma. Secondary tumor was diagnosed 4 years after the primary diagnosis. The microscopic aspect revealed diffusely infiltrated intestinal wall by a proliferation of epithelioid cells, with marked citonuclear atypia and frequent mitoses. Metastases were present in 3 out of 12 mesenteric lymph nodes. The melanoma-origin was confirmed by the positivity for S100 and Melan A markers. The second case origin was a squamous cell cervical carcinoma. The primary, cervical tumor was diagnosed 2 years before the detection of intestinal involvment. Microscopic assessment of the matastasis revealed numerous small tumor cells, organized in clusters with different shapes and sizes, with pronounced atypia and frequent mitoses. The immune profile was identical to that of the primary tumor, respectively positive for pancitokeratin and p63. The third case represented a metastasis from a laryngeal squamous cell carcinoma. The primary tumor was diagnosed 1 year before the metastasis. Also, the microscopic assessment and the immune profile were identical between those two. The origin from the laryngeal carcinoma was demonstrated by the positivity of p63 and pancitokeratin, respectively negativity for CD117, DOG1, Synaptophysin and Chromogranin. The last case was and incidental autopsy finding in case of a patient diagnosed with pulmonary adenocarcinoma 3 months before death. The microscopic aspect of the intestinal tumor showed similarities with that from the pulmonary site, and also shared the same immune panel: positivity for pancitokeratin, cytokeratin 7, respectively negativity for cytokeratin 5/6, S100, CD3, CD20 and CD138. Conclusions: Even though the literature report cutaneous melanoma as being the most frequent tumor which metastasize to small intestine, there was demonstrated a heterogeneity of this aspect, all 4 consecutive metastatic small bowel tumors having 4 different origins. [ABSTRACT FROM AUTHOR]

Background: Seborrheic keratosis (SK) is a common benign epidermal tumor with predominance in adult patients, showing an increasing incidence with age. Different histologic and clinical subtypes have been identified. The great variability of SK raises some difficulties in diagnosis. Dermoscopy is the most frequently used non-invasive diagnostic method to differentiate pigmented SK from other pigmented tumors, especially malignant melanoma (MM). Objective: The aim of this paper is to highlight clinical, dermoscopic and histopathological correlations in a case of SK. Materials and methods: We present the case of a 63-year-old patient attending Dermatology for an older skin lesion, who has begining to change recently, growing in size, becoming darker and irregular. Dermoscopic examination showed a scaly, hyperkeratotic surface, comedo- like openings, but also redish structureless areas and regression central area, mimicking blue-white veil, highly specific for MM. The dermoscopic score was 4,4. The excision of the lesion was performed, and the histopathological report highly expected. It came out to be a true sebborrheic keratosis, consisting of a proliferation of basaloid keratinocytes without atypia. Results: The particularity of the case is the clinical and dermoscopical resemblance of SK to MM. Conclusions: SK is the most common benign skin tumors in human, frequently treated without biopsy. Due to the clinical variability, SKs can be easily confused with MM. Dermoscopy may lead to correct diagnosis, different retrospective studies revealed 0,7-9% associated with melanomas and 48 dermoscopic features on the check list. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the gastrointestinal tract. Major advances in their definition and classification and the understanding of their molecular mechanisms have recently been made. These advances have become a model of targeted therapy in oncology. The diagnosis of GISTs relies on histological arguments--proliferation of spindle-shaped cells in 70% of cases, of epithelioid cells in 20%, histological variants are rare--, and on immunohistochemical arguments--expression of CD117 in 95%, usually associated with CD34 expression in 70% of cases. Most GISTs are associated with molecular abnormalities in low target genes: KIT and PDGFRA. The differential diagnosis of GISTs includes the other mesenchymal tumors of the gastrointestinal tract, such as leiomyomas, leiomyosarcomas, schwannomas and intra-abdominal fibromatosis. The evaluation of the prognosis is essential and is based on a simple algorithm using two histoprognostic parameters, tumor size and mitotic index. The treatment of localized GISTs is surgical resection and that of advanced or unresecable GISTs is based on the use of targeted therapy, imatinib, which is a pharmacological antagonist of the c-kit protein. Proper understanding and utilization of the diagnostic criteria and classification of GISTs by pathologists are essential for good patient management.

Aim: This paper proposes the presentation of a decision-making algorithm in colorectal cancer with synchronous hepatic metastases, as stressing the importance of I-colic time in obtaining the R0 desideratum., Material and Method: There is no worldwide consensus regarding the surgical attitude in metastatic colorectal cancer. There are some predominantly conservative attitudes which use stenting and neoadjuvant chemotherapy followed by periodical re-evaluation or more aggressive surgical treatment. In the pertinent literature, emphasis is on surgery in two stages, on the separation of the colic stage from the hepatic one, the majority proposing stage one cholic and stage two hepatic, thus there are also situations in which the liver may be dealt with from the first intention., Results: We propose to present, taking the examples from clinical cases, the main techniques of dealing with the cases of metastatic colorectal cancer, stressing personal attitude: aggressive surgery in a short step, which is either radical or creates the conditions for a step II radical one., Conclusion: In our vision the liver is the key to the surgical treatment in metastatic colorectal cancer and we must take into account from the first step through interventions with radical intent any time it is possible or through other operations: ligature of portal branch, partial hepatectomies, unilateral local destruction, preparing the way to radical step II.

The intraoperative hemorrhage is the most life threatening complication during a liver resection, reason why the intraoperative vascular control represents one of the key points in the liver resection. This work presents the liver vascular exclusion without caval occlusion technique and also studies the first cases operated in University Surgery Clinic Nr. 1, Targu Mures, Romania. LVE consists of an association between hilum occlusion by Pringle manoeuvre and selective clampage of the three hepatic veins. Once achieved, the technique allows resection without blood lose and no special cautions, a continue clampage of 60-90 minutes being useful for the reconstruction of the possibly harmed or resected structures during the hepatectomy. The indications of the technique are voluminous center located liver tumors, multiple liver tumors, tumors in contact with hepatic veins or with hilum bifurcation. University Surgery Clinic Nr. 1 Targu Mures's experience in this technique began in 2005 consists in 8 cases. Preoperative diagnosis were: 2 right liver voluminous benign tumors (hemangiomas), 5 cases of colo-rectal metastasis and one resection for metastases of gastro-intestinal stromal tumor. Postsurgery evolution was very good with an average hospitalisation of 6 days. Mortality rate and morbidity were zero. We strongly recommend the use of LVE technique for selected cases of difficult liver resection, LVE being one of the most advanced techniques of liver resection.