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Introduction: Metastatic tumors of the pancreas are uncommon, but renal cell carcinoma is one of the few known cancers that can metastasize to the pancreas. Few cases have been reported as being metachronous multicentric metastases to the pancreas, but none associated with a pancreatic neuroendocrine tumor and reported in literature, to our knowledge. Case presentation: We describe a case of 66-year-old woman who was diagnosed with multicentric pancreatic metastases from clear renal cell carcinoma associated with concomitant pancreatic neuroendocrine tumor, after 14 years from the initial diagnosis of kidney cancer. For this patient, the symptoms were unspecific for neoplastic disease, she had multiple pancreatic metastases which is an uncommon finding, but even rarer was the association of metastases with neuroendocrine tumor in the pancreas. Because of the good outcome and survival, surgical resection is recommended for solitary and multiple pancreatic metastases, as well as for pancreatic neuroendocrine tumors. Conclusion: Differential diagnosis for multiple pancreatic tumors is undisputedly important, even though it would not have changed anything in our patient's preoperatively course. Patients with renal cell carcinoma must follow long-term surveillance with regular examination and imaging investigation so that any possible metastases can be detected early and treated properly.

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Aim: Parathyroid carcinoma (PC) is a rare endocrine malignancy that represents 0.005% of all malignant tumors. Associated PC and differentiated thyroid carcinoma (DTC) is an exceptionally rare condition, and the preoperative diagnostics and proper treatment are challenging. Almost all PCs and the majority of DTCs are diagnosed postoperatively, making correct surgical treatment questionable. Specific guidelines for parathyroid and thyroid carcinomas association treatment are lacking. The purposes of our study were to identify the association between parathyroid and thyroid carcinomas, to analyze the available published data, and to evaluate the possible relationship between preoperative diagnostic and surgical decision-making, and outcome-related issues. Material and methods: We performed a literature review of several databases from the earliest records to March 2022, using controlled vocabulary and keywords to search for records on the topic of PC and WDTC pathological association. The reference lists from the initially identified articles were analyzed to obtain more references. Results: We identified 25 cases of PC and DTC association, 14 more than the latest review from 2021. The mean age of patients was 55, with a female to male ratio of about 3:1. Exposure to external radiation was identified in only one patient, although it is considered a risk factor the development of both PC and DTC. The preoperative suspicion of PC was stated by the authors in only 25% of cases, but suspicion based on clinical, laboratory, ultrasound (US), and fine needle aspiration (FNA) criteria could have been justified in more than 50% of them. With neck ultrasound, 40% of patients presented suspicious features both for PC and thyroid carcinoma. Intra-operatory descriptions of the lesions revealed the highest suspicion (83.3%) of PC, but en bloc resection was recommended and probably performed in only about 50% of the cases. Histopathological examinations of the thyroid revealed different forms of papillary thyroid carcinoma (PTC) in most cases. Postoperative normocalcemia was achieved in 72% of patients, but follow-up data was missing in about 25% of cases. Conclusion: Associated PC and DTC is an exceptionally rare condition, and the preoperative diagnostic and treatment of the patients is a challenge. However, in most cases pre- and intraoperative suspicious features are present for identification by a highly specialized multidisciplinary endocrine team, who can thus perform the optimal treatment to achieve curability.

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Desmoid tumors (DT) are rare non-metastatic neoplasms that occur through myofibroblast proliferation in musculoaponeurotic or fascial structures of the body, being commonly diagnosed in young women during pregnancy or in the post-partum period. We present the case of a 38-year-old woman, who recently gave birth, manifesting non-specific abdominal symptoms. Computed tomography indicated the presence of a solitary tumor arising from the intestinal wall or from the mesentery. Surgery confirmed the diagnosis, revealing a tumor that was localized at the level of the jejunal mesentery, having about 7 cm in diameter, in tight contact with the duodenum and the mesenteric vessels. "En bloc" resection of the tumor was performed, together with the involved enteral loops followed by end-to-end anastomosis of the jejunum. Histopathological examination of the surgical specimen sustained the diagnosis of desmoid tumor.

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AIM: The aim of this study was to evaluate the correlation between EpCAM expression in colon cancer tissue and the clinico-pathological characteristics of the patients. MATERIAL AND METHODS: This is a prospective, longitudinal, observational study on 80 patients undergoing for colon cancer between January - December 2017. EpCAM expression at tumoral level was analyzed in relation with clinical and pathological variables of the patients using anti-EpCAM specific antibody. RESULTS: EpCAM expression was predominant in tumoral tissue compared to normal colonic mucosa and most of the cases (58.7%) showed increased EpCAM expression. Although increased EpCAM expression was observed in advanced stages and in patients with advanced locoregional disease, there was no statistically significant correlation with the clinical and pathological characteristics of the patients. DISCUSSION: The majority of the analyzed samples showed increased EpCAM expression in tumoral tissue suggesting its involvement in the carcinogenesis process. Numerous studies have identified EpCAM overexpression in colon cancer as a negative prognostic factor, being associated with advanced stage of the disease and a poor prognosis of the patient but results are inconsistent. Nevertheless, assessing a possible correlation between EpCAM expression at tumoral level and clinico- pathological characteristics is dependent on the type of antibody used to identify the molecule of interest. CONCLUSIONS: EpCAM detection in colon cancer using anti-human CD326/EpCAM clone VU-1D9 does not allow the correlation between its expression and the clinico-pathological characteristics of the patients and it should only be used for EpCAM identification in colon cancer tissues. KEY WORDS: Cancer, Colon, EpCAM, Immunohistochemistry.

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INTRODUCTION: We report the case of a 77-year-old female patient with the diagnosis of pancreatic head insulinoma, in whom we used near infrared light (NIR) to detect synchronous pancreatic tumors and potential secondary lymph node or liver involvement. The patient presented with hypoglycemia manifesting by lipothymia. With the diagnosis of secretory neuroendocrine tumor (insulinoma) of the pancreatic head, cephalic pancreatoduodenectomy with the preservation of the pylorus was performed after NIR visualization of the pancreatic tumor mass. At 6, 12, 18 months postoperatively, the patient no longer had hypoglycemia and her general state was good. CONCLUSION: NIR with indocyanine green (ICG) evidences pancreatic neuroendocrine tumors, as well as possible synchronous tumors and secondary lymph node or liver involvement.

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AIM: The aim of this study was to determine the impact of patient, tumor and surgery-related parameters on 1-year postoperative mortality in a cohort of patients operated in a single tertiary center. MATERIALS AND METHODS: The study included 605 patients diagnosed with colon cancer between January 2013 and December 2015 that underwent radical surgery in a tertiary center. Patient demographics, comorbidities, preoperative biological parameters alongside with tumor and surgery-related factors were prospectively recorded and then analyzed in relation 1-year postoperative mortality. RESULTS: One-year mortality rate in the study group was 10.9%. Independent risk factors in relation to 1-year mortality were advanced TNM stage (OR 3.10, 1.10 - 8.75 95% CI ), emergency surgery (OR 1.91, 1.11 - 3.74 95% CI ), location of the tumor in the ascending colon (OR 2.17, 1.32 - 3.57 95% CI ), multiorgan resections (OR 2.07, 1.15 - 3.74 95% CI), age over 63 years (OR 2.05, 1.16 - 3.62 95% CI) and the history of alcohol consumption (OR 2.058, 1.17 - 3.61 95% CI ). DISCUSSION: Postoperative complications are still being reported in colon cancer surgery, despite technological progress and constant research in the field. So far, factors that influence postoperative mortality have been mostly studied up to 30 days postoperatively. According to some recent papers, reporting 30-day mortality data can underestimate accurate communication of postoperative adverse events. Thus, 1-year mortality in colon cancer surgery could be a better indicator of the impact on surgery on postoperative period of this patients and factors that influence it should be well known. KEY WORDS: Surveillance, Colon cancer, 1-year mortality.

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AIM: This study analyzes risk factors implicated in postoperative complications and mortality after anterior resection in rectal cancer. MATERIAL AND METHODS: A total number of 378 patients with anterior rectal resection, diagnosed with rectal cancer and admitted at the IIIrd Surgery Clinic, "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Romania, between 2009 and 2016. The inclusion criteria were anterior rectal resections with curative visa for rectal cancer. The complications we assessed are the following: anastomotic fistula, intra-abdominal infections, postoperative bowel obstruction and wound infection. RESULTS: There was statistical significance regarding male gender, emergency hospitalization, hypoproteinemia and the resumption of intestinal transit. Anterior rectal resection of tumors located on the middle rectum was associated with high rate of anastomotic fistula. Patients with manual suture of anastomosis developed intraabdominal abscess more frequently. In the multivariate analysis, hypoproteinemia and a number of lymph nodes >1 remained independently associated with the occurrence of wound infection. The 30-day mortality rate was 4.8% with 18 deaths and morbidity rate 20.6% with 78 cases. CONCLUSIONS: Major complications after radical resection for rectal cancer are dependent on multiple variables such as male patients, those admitted in emergency and patients with hypoproteinemia. Location of tumor on middle rectum, manual suture of anastomosis, number of lymph nodes > 1 were associated with high rate of morbidity. Patients with coronary heart disease and diabetes mellitus didn't had statistical significance, but the rate of morbidity and mortality remains high in this groups. KEY WORDS: Complications, Radical anterior resection, Rectal cancer, Risk factors.

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