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We present a case of renal angiomyolipoma, sporadic form, late diagnosed in a female patient without any history of kidney disease. Preoperative diagnosis was established by echography and abdominal CT scan. The tumor was about 28/18 cm, complicated with haemorrhage and severe anaemia, which prompted for emergency nephrectomy, without further preoperative investigations. The evolution was favourable after the treatment. We present this case because it is a rare pathology and the diagnosis was difficult. [ABSTRACT FROM AUTHOR]

Hirschsprung's disease is a congenital disease defined by the absence of myenteric and submucosal ganglion cells in the distal alimentary tract. We report the case of a 49-year-old male admitted to our unit with intermittent intestinal obstruction and chronic constipation. The patient was diagnosed with megacolon at 22 years of age; at that time, a left hemicolectomy was performed, with a transverso-rectal anastomosis. The later evolution of the patient was complicated by reccurence of the megacolon, with chronic constipation and episodes of suboclusion. Colonoscopy and CT scan showed a spastic rectum and a megacolon upstream. The surgical rectal biopsy revealed the absence of myenteric and submucosal ganglion cells in superior rectum, distal to anastomosis, and the presence of these cells in the rest. After solving the obstructional episode, we performed a total colectomy with ileo-rectal anastomosis. Subsequent evolution was good. [ABSTRACT FROM AUTHOR]

Abdominal tuberculosis is a rarely disease with unspecific clinical symptoms. They were studied 7 patients, with the average age 36,7, diagnosticated with abdominal tuberculosis in the IVth Surgical Clinic during 2007-2008. Out of the 7 patients with abdominal tuberculosis, 5 cases were diagnosed with peritoneal tuberculosis, 1 of them with intestinal tuberculosis and 1 patient with apendicular tuberculosis. All of the patients had unspecific clinical symptoms: intestinal occlusion, acute appendicitis, diffuse abdominal pain. The patients with peritoneal tuberculosis were diagnosed by laparoscopy. Postoperative management was carried out in accordance with the treatment of extra pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Hypothesis. Gallstone disease increases slightly the risk for colorectal cancer. This association could lead to omission of the diagnosis of colorectal cancer in patients with gallstones in the situation of mistaken interpretation of clinical data and premature closure of diagnosis. Materials and methods. A retrospective study including 693 patients operated by the same surgeon over a period of 15 years was performed. Patients who already had cholecystectomy (56) and those in whom the cholecystectomy was performed no more than 2 years before the diagnosis of colorectal cancer (9) were identified. For the latter 9 patients the chronological relationship between the onset of symptoms, the moment of cholecystectomy and the moment of diagnosis of colorectal cancer was assessed. Patients in whom colorectal cancer could have been diagnosed in the moment when the gallstone disease was treated were identified. The cognitive mechanisms of possible diagnostic errors were analyzed. Results. In 7 patients the colorectal tumor could have been diagnosed at the moment of cholecystectomy; 4 patients had also symptoms that were not related to the gallstones. The omission of the diagnosis of colorectal cancer was related to the superficial/incomplete patient examination (4 cases), premature closure of diagnosis (3 cases), confirmation errors (1) and heuristic failure (1). Conclusions. Missing the diagnosis of colorectal cancer in gallstone patients is infrequent, but when it appears it determines a delay in the treatment of neoplastic disease. The error is due to premature closure of diagnosis, misinterpretation of symptoms or incomplete patient examination. [ABSTRACT FROM AUTHOR]

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a commonly used minimally invasive method for the diagnosis and staging of lung cancer. In order to improve its diagnostic accuracy, rapid on-site cytologic evaluation (ROSE) is being utilized in some institutions. ROSE, performed by a cytopathologist in the examination room, allows the assessment of the adequacy of the collected samples, identifies malignant cells and sometimes establishes diagnosis on the spot, thus improving diagnostic sensitivity. As non-small cell lung carcinomas (NSCLC) require not only pathological subtyping, but also molecular characterization, obtaining the adequate amount of tissue is crucial. Only a limited number of studies have analyzed the suitability of EBUS-TBNA samples for assessment of epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK) and programmed death-ligand 1 (PD-L1) status., Aim: We intended to examine the diagnostic yield of ROSE in NSCLC and the results and feasibility of molecular analysis performed on EBUS-TBNA small samples., Methods: 100 patients with lung tumors and hilar and/or mediastinal lymphadenopathy on CT or PET/CT scans were retrospectively identified over a 3-year period, from a prospectively maintained EBUS-TBNA database. All examinations were accompanied by on-site cytological exam - ROSE, histopathological exam (HPE) and, in the case of NSCLC, molecular testing. After the sampling of the lymph nodes, specimens were Diff-Quik stained and a rapid preliminary diagnosis was established. Immunohistochemistry and mutational testing were performed using cell blocks., Results: Adenocarcinoma was the most frequent diagnosis in both ROSE (34%) and histopathology (53%). Overall sensitivity and positive predictive value of ROSE in NSCLC, considering HPE the gold standard, were 92.18% and 93.65%, respectively, with a specificity and negative predictive value of 75% and 70.58%, respectively. All samples that were tested for EGFR mutation and ALK rearrangement were adequate for analysis. The adequacy ratio for PD-L1 was 91.66%; 37.5% of patients showed a high PD-L1 expression level, with a tumor proportion score TPS ≥50%., Conclusion: EBUS-TBNA is a valuable method for lung cancer diagnosis. ROSE proved to have a moderate prediction of the final diagnosis in NSCLC. Molecular analysis of EGFR, ALK and PD-L1 can be successfully accomplished on EBUS-TBNA small tissue samples.