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Malignant melanoma (MM) is one of the deadliest skin cancers. BRAF mutation testing plays a predominant role in the management of MM patients, because modern targeted therapies essentially consist of inhibitors of BRAF. BRAF V600 mutation must be detected using a FDA approved (USA) or CE IVD certified (Europe) test. The aim of this study was to compare BRAF mutational testing performed by conventional nucleotide sequencing approaches with either real time PCR rtPCR ) or next generation sequencing (NGS) assays in a real life, hospital based series of advanced MM patients.

Malignant melanoma (MM) is one of the deadliest skin cancers. BRAF mutation testing plays a predominant role in the management of MM patients, because modern targeted therapies essentially consist of inhibitors of BRAF. BRAF V600 mutation must be detected using a FDA-approved (USA) or CE IVD certified (Europe) test. The aim of this study was to compare BRAF mutational testing performed by conventiona lnucleotide sequencing approaches with either real-time PCR (rtPCR )or next-generation sequencing (NGS) assays in a real-life,hospital-based series of advanced MM patients. Consecutive patients fromSardinia, Italy, with histological diagnosis of advanced MM (AJCC stages III Cand IV) and referred a the laboratory of Biomolecular Chemistry (ICB) of the National Research Council (CNR), Sassari, Italy for molecular testing from 2012 through 2019, were enrolled into the study.

In our previous experience, a high consistency of BRAF and NRAS muta- tion patterns was observed between primary tumors and lymph node me- tastases in patients with advanced melanoma. Conversely, increasing rates of discrep- ancies in BRAF/NRAS mutation pat- terns were found between primary melanomas and metastases in other sites (brain or, mostly, skin). When the distribution of BRAF/NRAS mutations was evaluated in a larger cohort, the high rate of consistency in sequence variations of these two genes was further confirmed between primary melanomas and lymph node metastases.

AIMS: The aim of this study was to evaluate the incidence of lymph node metastases in patients with atypical Spitz nevi (ASN) after sentinel lymph node biopsy (SLNB) and during follow-up, and to assess the diagnostic value of the surgical procedure. METHODS: At the National Cancer Institute of Naples, Italy, 40 patients with ASN underwent SLNB between 2003 and 2011. Medical records were reviewed and all slides of the primary tumours were retrieved, rendered separately, and assessed by four experienced dermatopathologists from two different academic institutions. Each member of the review panel assessed slides separately without recourse to medical notes and blinded to each others' diagnosis. All patients were treated with wide local excision and SLN biopsy according to the standard procedure. All cases were followed up to assess outcomes. RESULTS: The original diagnosis of ASN was confirmed in all 40 cases. No sentinel node positivity was recorded, and no patients developed nodal involvement during a median follow-up of 46 months (range 16-103). All patients were alive and without evidence of locoregional or distant relapse at time of review. CONCLUSIONS: In our experience, ASN were not associated with metastatic potential. Surgical staging procedures are not justified and careful clinical surveillance is adequate.

Based on the results of European Organization for Research and Treatment of Cancer (EORTC) 18991 trial, the US Food and Drug Administration (FDA) approved PEG-interferon α-2b (PEG-IFN) (Sylatron) as adjuvant therapy for high-risk melanoma. The EORTC 18991 trial was an open-label study of resectable stage III melanoma with 1,256 patients who were randomized to observation-alone or to treatment with PEG-IFN for up to 5 years. The median recurrence-free survival of the treatment groups was significantly longer, while overall survival, a secondary endpoint, was not significantly different between the two groups. This review, after a short summary of interferon α-2b trials, critically analyzes the EORTC18991 trial, as well as the subgroup results and future perspectives for this stage of disease.

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AIM: In patients with non-hypersecreting adrenal masses, tumor characterization is clinically relevant to establish the appropriate treatment planning. The aim of this study was to comparatively characterize such adrenal lesions using MR and radionuclide techniques. METHODS: Thirty patients with non-hypersecreting unilateral adrenal tumors underwent both MR and adrenal scintigraphy. MR was performed using SE T1- (pre- and post-gadolinium DTPA) and T2-weighted images as well as in- and out-phase chemical-shift imaging (CSI). MR qualitative and quantitative (signal intensity ratios) evaluation was performed. Radionuclide studies consisted of iodine-131 nor-cholesterol (n=20), iodine-131 MIBG (n=15) and fluorine-18 FDG PET (n=11) scans. Histology (n=16), biopsy (n=3) or clinical-imaging follow-up (n=11) demomstrated 13 adenomas, 3 cysts, 2 myelolipomas, 4 pheochromocytomas (pheos), 4 carcinomas, 1 sarcoma and 3 metastases. Comparative imaging analysis was focused on adenomas, pheos and malignant tumors. RESULTS: Qualitative MR evaluation showed: signal T2-hyperintensity in 46% of adenomas and in 100% of pheos and malignant tumors, no gadolinium enhancement in 92% of adenomas and definite signal intensity loss on CSI in 100% of such tumor lesions, gadolinium enhancement in 100% of pheos and in 63% of malignancies and no absolute change of signal intensity on CSI in 100% of both pheos and malignancies. Quantitative MR analysis demonstrated: significantly higher signal T2-hyperintensity of pheos compared to adenomas and malignancies as well as significantly higher enhancement after gadolinium in pheos compared to adenomas and malignancies (p

Bressanone 4-7/09/2002

Stapling devices introduction in gastroesophageal surgery has allowed better results.An analysis is made of a consecutive series of 108 patients operated on with total gastrectomy and mechanical esophagojejunostomy for gastric neoplasm, in the last decade (1984-1995).The incidence of anastomotic clinical leakage was 2.4% with a perioperative mortality of 0.9% (1 patient) while the incidence of stenosis, treated in every patient with endoscopic dilatation, was 3.2%. These data are in accordance with previous reports. After an accurate analysis of the factors influencing the complication rate pointed out that in most of the cases a technical error in the anastomosis confection is present.The conclusion is drawn that the use of stapling devices in gastroesophageal surgery represents an elective indication. Nevertheless it is mandatory to respect the principles of visceral mechanical anastomosis after an adequate training.

INTRODUCTION: Magnetic Resonance Imaging (MRI) has been proposed as the diagnostic technique of choice to characterize adrenal tumors. However, the results of the current studies are controversial. MATERIAL AND METHODS: Forty-nine patients with unilateral adrenal masses were submitted to MRI for lesion characterization on the basis of MR signal intensity. Cytology and/or histology demonstrated 14 pheochromocytomas (pheos), 11 adenomas, 3 cysts, 2 myelolipomas, 4 carcinomas, 3 metastases and 1 fibrosarcoma; a clinical diagnosis of adenoma was made in the remaining 11 patients. MR studies were performed using spin-echo (SE) sequences with T1 (TR/TE = 600/17 ms) and T2 (TR/TE = 2000/15-90 ms) weighting. T1-weighted images were also acquired after Gadolinium-DTPA (Gd-DTPA) administration. MR studies were integrated with in- and out-of-phase (TR/TE = 100/4-6 ms) chemical-shift (CS) sequences. MR signal intensity (SI) was analyzed qualitatively and quantitatively; MR results were correlated with tumor type and hormone secretion. RESULTS: The qualitative analysis of T2 images showed high signal intensity in the majority (80%) of adrenal lesions (14 pheos, 12 adenomas, 3 cysts, 2 myelolipomas and 8 malignancies). The quantitative analysis of post-Gd-DTPA T1 images permitted to distinguish adenomas, cysts and myelolipomas from pheos and malignancies. The qualitative analysis of post-Gd-DTPA T2 and T1 images permitted to distinguish pheos and cysts from adenomas and malignancies (p < .05); however, pheos and cysts as well as adenomas and malignancies were not differentiated. MR SI was similar in secreting and nonsecreting adenomas from both a qualitative and a quantitative viewpoints. CS MRI permitted to distinguish adenomas (decreased signal intensity on out-phase relative to in-phase images) from other benign and malignant lesions (no signal change from out-phase to in-phase images). CONCLUSIONS: The qualitative analysis of MR SI on conventional T1 and T2 images does not permit to differentiate adrenal masses. The qualitative evaluation of T1 images after Gd-DTPA administration, the quantitative analysis and CS sequences are technical options improving lesion characterization.