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Context Solid pseudopapillary tumor is a rare tumor of the pancreas. Solid pseudopapillary tumor is nine times more frequent in the body and tail than in the head of the pancreas. It usually does not reach a large size. The majority of patients are young females and most of them are asymptomatic. Neoplasms of the midportion of the pancreas, not suitable for enucleation, can be treated with central pancreatectomy. The central pancreatectomy is commonly proposed for tumors that do not exceed 5 cm of dimension. Case report We report a case of seventeen-years-old woman who was admitted to our institution with abdominal pain and a palpable mass in the left hypochondrial area. US, CT and RMN scan revealed a giant (> 10 cm.) well-demarcated and encapsulated solid mass in the body of the pancreas, with a great amount of intralesional cystic-hemorrhagic component. The patient was treated by a variant of central pancreatectomy without splenectomy and pancreatic duct reconstruction. There was no metastatic disease in either the liver or peritoneum. The histological analysis identifies the tumor as a Solid pseudopapillary tumor of the pancreas. Fifteen years' follow-up period showed no recurrence. Conclusions Solid pseudopapillary tumor of the pancreas behaves like a potentially malignant tumor and has good prognosis. Surgical resection is dictated by tumor location and is the treatment of choice. The increasing interest in parenchyma-sparing pancreatic surgery has found large application in treatment of Solid pseudopapillary tumor, with the aim of preserving exocrine and endocrine pancreatic function, and achieving a better quality of life after surgery. Considering the low malignant potential, the central pancreatectomy can be considered an excellent therapeutic strategy for the treatment of this type of tumor also when they have giant dimensions and are localized in the central-pancreatic portion.

I craniofaringiomi (CP) sono tumori epiteliali benigni della regione sellare che originano da residui embrionali della tasca di Rathke. Si distinguono due sottotipi, l’adamantinomatoso (adaCP) e il papillare (papCP), che differiscono tra loro per gli aspetti istologici, etiopatogenetici e per l’outcome clinico. L’adaCP è il sottotipo più comune e, pur essendo una neoplasia istologicamente benigna (grado I sec. WHO), mostra un carattere localmente aggressivo che si manifesta con la tendenza a infiltrare le circostanti strutture cerebrali e a recidivare, sia a seguito dell’asportazione totale che di quella parziale associata a radioterapia. Tali aspetti rendono l’adaCP una neoplasia di difficile management terapeutico. Attualmente i meccanismi etiopatogenetici di questa neoplasia ed i fattori associati con la tendenza alla recidiva non sono del tutto noti, né disponiamo di efficaci marcatori prognostico-predittivi per poter individuare i casi di neoplasia caratterizzati da una maggiore aggressività biologica. Sulla base di quanto esposto, abbiamo deciso di effettuare uno studio neuropatologico ed immunoistochimico con correlazioni cliniche su un gruppo selezionato di CP, con gli obiettivi di poter meglio comprendere la patobiologia di questi complessi tumori ed i fattori associati con la tendenza alla recidiva, nello specifico del sottotipo adamantinomatoso, e, soprattutto, di individuare dei potenziali marcatori prognostico-predittivi da utilizzare, mediante metodica immunoistochimica, per identificare ab initio i casi di neoplasie biologicamente più aggressivi e, quindi, a maggior rischio di recidiva. Abbiamo quindi eseguito uno studio retrospettivo su ventisette CP asportati totalmente mediante tecnica endoscopica endonasale, pertanto la radicalità chirurgica ha rappresentato il criterio di inclusione nello studio. I casi sono stati distinti in gruppi sulla base dell’outcome clinico, ovvero presenza o assenza di recidiva tumorale. Abbiamo quindi valutato, mediante metodica immunoistochimica, l’espressione della β-catenina, l’espressione di noti marcatori di staminalità (CD133, CD166) e l’indice di proliferazione (Ki-67). Si tratta di un argomento poco studiato e con solo pochi lavori presenti in letteratura che tuttavia può fornire risultati significativi in termini di outcome prognostico. Ovvero, tali risultati potrebbero modificare il management terapeutico dei pazienti attraverso trattamenti aggiuntivi postoperatori per ridurre il rischio di recidive a lungo termine.

Background. Myelolipomas are uncommon benign tumors composed of mature adipose tissue mixed with hematopoietic elements occuring both in adrenal glands and in extra-adrenal locations; the presacral region is the most frequent extra-adrenal location. We present the unique case of a presacral myelolipomadiagnosed by fine needle cytology (FNC) and core needle biopsy (CNB) in a women-with a concurrent breast cancer. Methods. A 55 year-old women was admitted at our institution with the cytological diagnosis of right breast cancer and a non- characterized presacral lump. The images from a noncontrast pelvic CT showed a 5 x 4 cm heterogeneous presacral mass without invasion or erosion of the anterior sacrum and with mixed fat and soft tissue attenuation. The patient uderwent a CT guided FNC and CNB. The air-dried Diff Quick stained smears showed trilineage hematopoietic elements in a background of mature fat cells. The histological slides showed mature adipose tissue admixed with cellular stroma in the absence of bone trabeculae. The stroma consisted of myeloid, erythroid and megakaryocytic forming cell lines. Results. A diagnosis of presacral myelolipoma was made on the basis of these morphological findings in conjunction with the radiological imaging. MR imaging, recommended for further characterization, showed a lobulated mass, with mixed fat/soft tissue signal and without bony invasion. Pre-contrast fat-suppressed images showed loss of signal intensity in the areas which were previously iso-intense to fat, providing further confirmation of a significant fat component of the mass. The patient was treated only for the breast cancer with a right supero–external quadran -tectomy and the ipsilateral axillary lymph node dissection; surgical biopsy of the presacral mass was not performed. Follow up MR at 5 and 16 months of the presacral mass showed stability of the lesion without significant interval change in size, appearance, or signal characteristics.

Background. Myofibroblastoma of the breast is an uncommon benign mesenchymal neoplasm that occurs predominantly in elderly men. Methods. A 64-years-old woman presented a slowly growing lump in her left breast. A mammogram revealed a 15 mm radiopaque lesion with regular margins and no microcalcifications and ultrasonography showed well-circumscribed, oval, hypoechoic mass measuring 28 mm, in the upper outer quadrant of the left breast. A US-Guided Fine Needle Aspiration Cytology (US-FNAC) was performed, showing tumour cells arranged in cohesive groups or in fascicular clusters and, in the background, naked nuclei. The cells were spindle shaped with a scanty amount of cytoplasm, oval nuclei with finely granular chromatin and occasional inconspicuous nucleoli. Fragments of stromal collagen were observed. The lesion was diagnosed as a mesenchymal proliferation without atypia and surgical biopsy was recommended. The patient underwent a surgical excision biopsy and histologic examination showed a 2.8 x 2.1 cm nodular mass, well- circumscribed although not truly capsulated, firm, rubbery, with a whirling appearance and a greyish external surface on cut sections. The slides showed a well-defined hyalinised tumour with a spindle cell proliferation and abundant dense fibrous collagen; the lesion was circumscribed by a thin “pseudocapsule” of compress glandular stroma. The spindle cells were arranged in short and haphazardly intersecting fascicles and clusters and were mixed with broad bands of brightly eosinophilic hyalinised collagen. Individual cells were bland-looking and showed a single ovoid nucleus with, occasionally, one or two nucleoli. Mitotic figures were uncommon and cytological atypia was not observed. Mast cells were conspicuous. The spindle cells stain positively for vimentin, CD34, desmin, H-caldesmon, CD99, bcl2. Results. The morphologic features, in conjunction with the immunophenotype, were consistent with a myofibroblastoma of the breast (classic type).

Myelolipomas are uncommon benign tumors composed of mature adipose tissue mixed with hematopoietic elements; these tumors can occur in both the adrenal glands and extra-adrenal locations, the presacral region being the most frequent extra-adrenal site. We present a case of presacral myelolipoma diagnosed by fine needle aspiration (FNA) and core needle biopsy (CNB) in a 55-year-old woman with concurrent invasive ductal breast cancer. TC and RM imaging were consistent with the diagnosis of presacral myelolipoma. The lesion was discovered incidentally during the staging procedure for breast malignancy. The purpose of our work is to describe the FNA and CNB finding in combination with the imaging features of this uncommon lesion.

Background In case of clinical suspicion of lymphoma, the histological examination of lymphadenopathy is essential for defining a correct diagnosis and for developing a proper treatment plan. An open surgical biopsy (OSB) is still the "gold standard", owing to the large amount of tissue obtained. The sensitivity of lymph node core-needle biopsy under imaging guidance requires validation. Aims This randomized study compared the ultrasound-guided core-needle cutting biopsy (CNCB) approach with OSB approach. Patient and methods Institutional review board approval and informed consent were obtained. In a single center between 1 January 2009 and 31 December 2015, patients with lymph node enlargement suspected for lymphoma were randomly assigned (1:1) to biopsy with either OSB (standard group) or ultrasound-guided 16 gauge modified Menghini needle (core-needle group). In the core-needle group, the lymph node to undergone biopsy was determined by power Doppler US, in particular, the main criterion to select the node to be biopsied was the hypervascularization. The primary endpoint was to test the superiority of sensitivity for diagnosis of malignancy for ultrasound-guided CNCB compared with OSB. Secondary endpoints were negative predictive values, likelihood ratio of negative test, biopsy related complications, costs and times to biopsy. Results A total of 372 patients were randomized either to standard group (N= 187) or core-needle group (N= 185). Sensitivity for detection of malignancy was significantly better for US-guided CNCB [98.8%; 95% confidence interval (CI), 95.9-99.9] than standard biopsy [88.7%; 95% CI, 82.9-93] (P Conclusions This study is the first to compare in a randomized fashion the sensitivity of US-guided CNCB and OSB in detecting lymphoma. Power Doppler US and CNCB are diagnostic tools that enable effective, safe, fast and low-cost routine biopsy for patients with suspected lymphoma, avoiding psychological and physical pain of an unnecessary surgical intervention. We suggest this approach as first-line mini-invasive procedure for patients with a suspected lymphoma and not merely when surgical intervention is not possible, or to document relapse. Disclosures No relevant conflicts of interest to declare.