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Learning objectives Background Findings and procedure details Conclusion Personal information References, Learning objectives: The present report describe a clinical case of old patient with symptomatic giant Killian-Jamieson diverticulum. A KJD, described first by Killian, is a rare form of hypopharyngeal diverticulum (unfamiliar cervical esophageal disease) 1 . This...

Aim. We report a case of congenital true pancreatic cyst with high level of enzymatic activity, rarely seen in young and children which, to the best of our knowledge, rarely has previously been reported. A young girl was admitted to our clinic with a history of abdominal swelling and pain during exercise for many months. A mobile, smooth, non-tender mass was palpated on the left side of the abdomen during physical examination. Ultrasonography and computed tomography imaging revealed a not subdivide cystic mass sized 11.51x8.2 cm. Methods. Surgical treatment was considered, but given the young age of the patient, we declined for fear of complications. Therefore, US-guided percutaneous drainage of cystic was performed. After a week, at the ultrasound check, thanks to obstruction of drainage, we decided to intervene surgically. During abdominal surgical exploration, the pancreatic tail was larger than normal, and a pancreatic cyst arising from the tail of the pancreas was observed. Total cystectomy was performed with distal pancreatectomy. Results. The postoperative period was complication free and the patient was discharged on the seventh postoperative day. No complications occurred during the six-month follow-up period. Conclusion. Early diagnosis and timely intervention have improved the results of surgical therapy in this disease. Although it is extremely rare in children, congenital true pancreatic cyst should be diagnostically considered in cases involving a cystic mass neighbouring the pancreas. Ultrasonography, computed tomography and magnetic resonance imaging is helpful in differential diagnosis of other cysts originating from neighbouring organs. Total excision with distal pancreatectomy and splenic preservation are advised for distal pancreatic cyst.

Gastrointestinal stromal tumor is not frequently type of sarouma found in the digestive system, often arise in the wall of the stomach or stromal cells of the intestinal wall.

In this study, 15 patients (4 men and 11 women, mean age: 50 +/- 13 years) with unilateral adrenal masses detected on ultrasound (US), Computed Tomography (CT) and/or Magnetic Resonance (MR) studies were submitted to positron emission tomography (PET) with fluorine-18 deoxyglucose (FDG). Histology demonstrated 3 adenomas, 1 myelolipoma, 1 angiolipoma, 1 neurinoma, 1 cyst, 1 malignant pheochromocytoma, 4 carcinomas and 3 metastases. The patient population was divided into two groups. Group 1 (n = 7) consisted of benign adrenal lesions. Group 2 consisted of malignant adrenal tumors. Lesion measurements were performed on the basis of the results of US, CT and/or MR images. In Group 1, no FDG uptake was observed in adrenal masses. Conversely, in Group 2 adrenal lesions showed abnormally increased FDG uptake, suggesting high glucose tumor metabolism. No significant difference in lesion size was observed between Groups 1 and 2 (5.6 +/- 4.0 vs 6.3 +/- 3.0 cm). Furthermore, in 6 patients of Group 2, total body PET images showed abnormal FDG uptake in extra-adrenal locations, such as chest (n = 2) and abdominal (n = 5) lymph nodes, lungs (n = 6), liver (n = 5), pancreas (n = 1), bone (n = 1) and muscle (n = 1) tissues. In conclusion, the results of this study suggest that PET imaging with FDG can characterize adrenal masses. In particular, abnormally increased FDG uptake in adrenal malignancies allows to differentiate these abnormalities from benign lesions. Furthermore, total body imaging PET can identify extra-adrenal tumor sites in patients with malignant tumors.

In this study, 15 patients (4 men and 11 women, mean age: 50 +/- 13 years) with unilateral adrenal masses detected on ultrasound (US), Computed Tomography (CT) and/or Magnetic Resonance (MR) studies were submitted to positron emission tomography (PET) with fluorine-18 deoxyglucose (FDG). Histology demonstrated 3 adenomas, 1 myelolipoma, 1 angiolipoma, 1 neurinoma, 1 cyst, 1 malignant pheochromocytoma, 4 carcinomas and 3 metastases. The patient population was divided into two groups. Group 1 (n = 7) consisted of benign adrenal lesions. Group 2 consisted of malignant adrenal tumors. Lesion measurements were performed on the basis of the results of US, CT and/or MR images. In Group 1, no FDG uptake was observed in adrenal masses. Conversely, in Group 2 adrenal lesions showed abnormally increased FDG uptake, suggesting high glucose tumor metabolism. No significant difference in lesion size was observed between Groups 1 and 2 (5.6 +/- 4.0 vs 6.3 +/- 3.0 cm). Furthermore, in 6 patients of Group 2, total body PET images showed abnormal FDG uptake in extra-adrenal locations, such as chest (n = 2) and abdominal (n = 5) lymph nodes, lungs (n = 6), liver (n = 5), pancreas (n = 1), bone (n = 1) and muscle (n = 1) tissues. In conclusion, the results of this study suggest that PET imaging with FDG can characterize adrenal masses. In particular, abnormally increased FDG uptake in adrenal malignancies allows to differentiate these abnormalities from benign lesions. Furthermore, total body imaging PET can identify extra-adrenal tumor sites in patients with malignant tumors

Composite pelvic resection with sacrectomy may provide good local control in case of locally advanced rectal cancer infiltrating the sacral bone. A combined multidisciplinary approach including chemotherapy and radiotherapy is here presented for a case of rectal tumor invading the sacrum.

Preoperative chemoradiation allows downstaging of locally advanced rectal cancer and in selected patients also a sufficient downsizing to ensure sphincter preservation. Selection of patients warranting a preoperative approach is improved by magnetic resonance imaging (MRI) which is able to define the involvement of mesorectal circumferential margin. Similarly it would be crucial to define the response to chemoradiation during the treatment but traditional morphologic imaging techniques may fail in differentiating neoplastic tissue from scarring. PET-FDG has been successfully used in the detection of metastatic colorectal cancer allowing imaging of deposits as small as 0.5 cm and may have a role in evaluating early response to chemoradiation.In the present study, in patients with T3-T4 rectal cancer undergoing preoperative chemoradiation PET-FDG and flow cytometry analysis on endoscopic biopsy specimen have been performed before, during and after preoperative chemoradiation.Chemoradiation treatment has been successful in terms of downsizing and downstaging of the tumor. PET-FDG was able to demonstrate local response at only ten-fifteen days after the beginning of neoadjuvant therapy, also identifying non responding patients.FDG-PET may have a role in defining the response to chemoradiation and modulate the treatments strategy in patients with advanced rectal cancer.

The authors evaluated the results of a study using clindamycin phosphate plus gentamicin in short-term therapy in patients with tumors submitted to surgery for removal of the primary lesion. Only 6.6% of these patients became infected, and these good results are most likely due to the synergic activity of clindamycin with the physiological immune response. This agent, in fact, was able to interfere with IgM/IgA immunoregulatory balance by enhancing IgM production and, consequently, phagocytic mechanisms.

The purpose of this publication is to describe the clinical and imaging findings of rare symptomatic giant Killian-Jamieson diverticulum (KJD) detected in a 97-year-old female patient and discuss diagnostic and therapeutic protocols to be implemented. The clinical history began implementing anamnesis and physical examination, followed by laryngoscopy, esophagogastroduodenoscopy, sonographic examination and subsequently a double-contrast pharyngoesophagram evaluations, to our symptomatic old patient with results of typically KJD, with maximal dimension of 5 cm. The KJD was successfully treated with a surgical approach, esophagomyotomy in addition to a diverticulopexy; these techniques were used for adequate visualization of the tissue bridge of the diverticulum and protection of the surrounding tissue during dissection of the tissue bridge. Our patient has benefit from the operation immediately, with resolution of the disease. The follow-up (on-going), up to now, showed no recurrence of the pathological and no complications, making sure the authors of the efficacy of the surgical treatment. According to the authors the surgical treatment was the only procedure to cure the patients and, to date, our successful experience suggests that only surgical approach can be a safe and effective method for the treatment of symptomatic giant KJD, due to its close proximity to the recurrent laryngeal nerve and the concern of possible nerve injury.

Background: The arginine-degrading enzyme, arginine deiminase conjugated to polyethylene glycol (ADI-SS PEG 20 000 mw), reduces extracellular arginine, has minimal toxicity, decreases tumor burden and improves liver function in patients with chronic hepatitis C virus infection (HCV) and inoperable hepatocellular carcinoma (HCC). Reduced extracellular arginine inhibits viral replication through unknown mechanisms. It is hypothesized that ADI-SS PEG 20 000 mw reduces HCV viral titers through nitric oxide (NO)-dependent effects. Methods: The effects of ADI-SS PEG 20 000 mw (dose, 160 IU/m2; three cycles of four once-weekly i.m. injections) on HCV titers, serum NO and plasma arginine, were evaluated using archived plasma from patients with HCC and HCV and in vitro cell model measurements of HCV replication. Results: ADI-SS PEG 20 000 mw selectively inhibited HCV replication in vitro (IC50 = 0.027 IU/mL). Fifteen HCC/HCV patients completed treatment. The HCV titers were reduced by up to 99% in five out of 10 (50%) HCV-serotype 1b patients (P = 0.0093). These patients also experienced significant improvements in liver function (P = 0.0091). There were concomitant reductions of plasma arginine and serum NO levels. The HCV titer was not reduced in HCV-type 2c patients. Conclusion: Reduction of extracellular arginine by ADI-SS PEG 20 000 mw in HCC patients reduces HCV viral titers and improves liver function, possibly through suppression of NO.