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The pancreas is a preferred site of metastasis from renal cell carcinoma (RCC), that may occur even after many years from a radical nephrectomy. Surgical R0 resection remains the only potentially curative treatment for solitary tumor. The possibility of a multifocality of the lesions (20-45%) must be considered.We report a case of metachronous pancreatic metastasis from RCC that occurred twice. After five years from a right polar inferior nephrectomy for a RCC, two nodular lesions were identified in the body-tail of the pancreas and were treated with distal pancreatectomy and splenectomy. After six months the CT imaging revealed a nodular lesion of few millimeters in the residual pancreatic body; we followed the slow growth and in October 2012, when the size reached 2 cm, the patient was operated to remove the residual portion of pancreatic body. After 16 months of follow-up the patient is well and there isn't relapse of disease.Patients with metachronous pancreatic lesions represent a particular group with a more indolent course of RCC, the appearance of metastases after a prolonged interval from nephrectomy is related to a more favorable prognosis. Radical lymph-node dissection is not necessary for the uncommon involvement of peripancreatic nodes, condition that explains the positive outcomes achieved with surgery.Patients with resected metastasis present an 88% survival rate at 5 years versus 47% observed in nonoperated patients; studies provide encouraging results in survival and quality of life of surgically treated patients.Le metastasi pancreatiche, originate da qualsiasi tipo di tumore primario, sono rare. In letteratura sono riportati solo pochi dati sporadici su quale sia l’approccio terapeutico ottimale. La frequenza rilevata nella casistica clinica varia dal 2% al 5% di tutti i tumori pancreatici maligni. Il pancreas è il sito preferito delle metastasi da RCC (carcinoma a cellule renali), che può presentarsi anche dopo molti anni dalla nefrectomia parziale o radicale. In caso di tumore solitario la resezione chirurgica R0 rimane il solo trattamento potenzialmente curativo, poichè RCC ha mostrato solo una relativa o incosistente risposta alle terapie sistemiche: chemioterapia, radioterapia ed immunoterapia. Nell’approccio al trattamento dei pazienti con metastasi pancreatiche da RCC deve essere considerata la possibilità della multifocalità delle lesioni, che ricorre nel 20- 45% dei casi. Riportiamo un caso di metastasi pancreatica metacrona da RCC verificatasi due volte. Dopo cinque anni dalla nefrectomia polare inferiore destra per un RCC esofitico e incapsulato delle dimensioni di 3 cm (T2N0M0), due lesioni nodulari furono identificate alla CT e alla MRI nel corpo - coda del pancreas e furono trattate con pancreasectomia distale e splenectomia. Dopo sei mesi il controllo TC rilevò la presenza di una lesione nodulare di alcuni millimetri nella parte residua del corpo pancreatico; abbiamo seguito con esami di imaging la lenta crescita della lesione secondaria e nell’ottobre 2012, quando la dimensione aveva raggiunto i 2 cm, il paziente è stato operato per rimuovere la parte residua del corpo del pancreas. Dopo 16 mesi di follow- up il paziente sta bene e non vi è stata recidiva. I pazienti con lesioni pancreatiche metacrone rappresentano un gruppo particolare con un decorso molto più lento del RCC, la comparsa di metastasi dopo un intervallo prolungato dalla nefrectomia è connessa ad una prognosi più favorevole. La radicale dissezione linfonodale non è necessaria per il coinvolgimento raro dei linfonodi peripancreatici, condizione che spiega i risultati positivi ottenuti con la chirurgia. I pazienti con metastasi resecate presentano un tasso di sopravvivenza dell’88% a 5 anni contro il 47% osservato nei pazienti non operati; gli studi forniscono risultati incoraggianti in termini di sopravvivenza e qualità di vita dei pazienti trattati chirurgicamente.

Aim of this paper is to report about a 35-year old man suffering from beta-Thalassemia major and longstanding untreated hypogonadotropic hypogonadism, who was referred because of a recent onset and painful bilateral gynecomastia, with no palpable testicular masses. Due to the finding of a solid mass at left testis ultrasonography, monolateral testicular exeresis was performed and histology revealed a Leydig Cell Tumour and testicular microlithiasis. Post-surgical restoration of testosterone/estradiol ratio under testosterone therapy was followed by a very rapid reduction of gynecomastia. Our report confirms the usefulness of scrotal ultrasonography for finding an occult testicular tumour in a patient with painful and recent onset bilateral gynecomastia and underlines: a) the important role of testosterone/estradiol ratio in the pathophysiology of gynecomastia; b) the questionable significance of testicular microlithiasis as marker of testis tumours; c) the possible association between beta-Thalassemia and tumoral pathologies.

Our experienee in the preoperative diagnostic and therapeutic management of small bowel gastrointestinal stromal tumors, cause of intestinal bleeding, by means of interventional radiological procedures is reported.From October 1999 to October 2001 6 patients admitted for melena due to bleeding of a gastrointestinal stromal tumor were treated. In all cases the lower and/or upper gastrointestinal endoscopy were the first diagnostic approaches. In two cases a Te 99m pertechnetate-labeled autologous red blood cells (TRBC) scintigraphic examination was also performed. All the patients underwent an abdominal angiography that was followed in two cases by preoperative trans-catheter arterial embolization. All the patients had the surgical resection of the bleeding neoplasm.In all patients, the endoscopic examinations weren't able to localize the exact site of bleeding. The TRBC scintigraphic examination performed in 2 patients was negative in one case, instead gave an incorrect localization of the bleeding site in the other one. The localization of the bleeding tumors was provided by the selective abdominal angiography that also suggested the presumable nature of the neoplasm on the basis of angiographic characteristics. The embolization of the two tumors was technically successful and was followed by surgical resection.On the basis of our data, we emphasize and confirm the predominant role of interventional radiological procedures in the detection and in the preoperative management of bleeding gastrointestinal stromal tumors of the small bowel.