Neoplastic Degeneration Research Articles

Breast Imaging of Axillary Supernumerary Breast: About a Clinical Case

Axillary breast is a subject that is poorly studied in the medical literature. We report the case of a 41-year-old woman who consulted for a painful right axillary mass, increasing in volume during menstrual cycles. The clinical examination revealed a 3 cm diameter axillary swelling, mobile, soft, without inflammatory signs or discharge. The mammography showed a dense and homogeneous area in the right axillary region, corresponding to an ectopic mammary glandular parenchyma. The ultrasound confirmed the presence of an axillary fibroglandular component, without focal anomaly or adenopathy. The diagnosis of accessory axillary breast was retained. This case illustrates the interest of imaging for the diagnosis and assessment of the accessory axillary breast, a rare anomaly but potentially at risk of neoplastic degeneration.

Neoplastic degeneration of chronic sacrococcygeal pilonidal sinus: report of seven cases and literature review

Neoplastic degeneration of chronic sacrococcygeal pilonidal sinus: report of seven cases and literature review

Clinical and Anatomo-Pathological Study of Digestive Polyps at Point G Teaching Hospital

Introduction: The aim of our study was to describe the aspects clinical and pathology of digestive polyps. Methods: This was a descriptive and analytical study with retrospective and prospective collection from January 2014 to September 2020, i.e. a duration of 72 months. Our study focused on all cases of non-cancerous digestive pathologies. The data were collected from registers, medical files and reports from the anatomy and pathological cytology department of the Point G University Hospital. All of this data was entered on an individual survey form. This sheet includes demographic data, qualitative and quantitative variables. Results: We conducted a study of 131 cases of digestive polyps. The frequency of digestive polyps was 3.65%. The mean age of our patients was 44.6 ± 21 years with extremes of 2 years and 79 years, with a male predominance and a sex ratio of 1.01. The biopsy was the type of sample most represented in 77.1%. The digestive polyps were located in stomach in 37.4%; the colon in 27.5% then the rectum 21.4%. The polyp sessile accounted for 65.6%. Histological examination revealed that adenomatous polyps were predominant in 77% of cases, followed by juvenile polyps in 9.2%, then hyperplastic polyps in 6.2%. Low grade dysplasia was found in adenomatous polyps in 61.53% and high grade found in 38.4%. Gastritis due to Helicobacter pylori (Hp) was found in 16% of cases. Conclusion: Digestive polyps are common in the general population. The prognosis is linked to the risk of neoplastic degeneration of adenomas.

Update on the pathogenesis and genetics of Paget's disease of bone.

Studies over the past two decades have led to major advances in the pathogenesis of Paget’s disease of bone (PDB) and particularly on the role of genetic factors. Germline mutations of different genes have been identified, as a possible cause of this disorder, and most of the underlying pathways are implicated in the regulation of osteoclast differentiation and function, whereas other are involved in cell autophagy mechanisms. In particular, about 30 different germline mutations of the Sequestosome 1 gene (SQSTM1) have been described in a significant proportion of familial and sporadic PDB cases. The majority of SQSTM1 mutations affect the ubiquitin-binding domain of the protein and are associated to a more severe clinical expression of the disease. Also, germline mutations in the ZNF687 and PFN1 genes have been associated to severe, early onset, polyostotic PDB with increased susceptibly to neoplastic degeneration, particularly giant cell tumor. Mutations in the VCP (Valosin Containing Protein) gene cause the autosomal dominant syndrome “Inclusion Body Myopathy, PDB, Fronto-temporal Dementia,” characterized by pagetic manifestations, associated with myopathy, amyotrophic lateral sclerosis and fronto-temporal dementia. Moreover, germline mutations in the TNFRSF11A gene, which encodes for RANK, were associated with rare syndromes showing some histopathological, radiological, and clinical overlap with PDB and in two cases of early onset PDB-like disease. Likewise, genome wide association studies performed in unrelated PDB cases identified other potential predisposition genes and/or susceptibility loci. Thus, it is likely that polygenic factors are involved in the PDB pathogenesis in many individuals and that modifying genes may contribute in refining the clinical phenotype. Moreover, the contribution of somatic mutations of SQSTM1 gene and/or epigenetic mechanisms in the pathogenesis of skeletal pagetic abnormalities and eventually neoplastic degeneration, cannot be excluded. Indeed, clinical and experimental observations indicate that genetic susceptibility might not be a sufficient condition for the clinical development of PDB without the concomitant intervention of viral infection, in primis paramixoviruses, and/or other environmental factors (e.g., pesticides, heavy metals or tobacco exposure), at least in a subset of cases. This review summarizes the most important advances that have been made in the field of cellular and molecular biology PDB over the past decades.

Acute haemothorax and pleuropulmonary blastoma: Two extremely rare complications of extralobar pulmonary sequestration

Extralobar bronchopulmonary sequestration (eBPS) is a congenital lung malformation characterized by non-functional lung tissue with no connection with the bronchial tree, receiving systemic blood supply and covered by its own visceral pleura. It is mostly asymptomatic, however it can rarely get complicated with infections and neoplastic degeneration. Its management is still debated: many authors suggest observation for asymptomatic cases and intervention only in case of symptoms, others advocate surgery even in asymptomatic patients. Pleuropulmonary blastoma (PPB) is a rare malignant sarcomatous neoplasm, representing the most common primary lung malignancy in children. Typically, PPB is associated with congenital pulmonary airway malformation (CPAM). eBPS is rarely associated with PPB. We report a case of a previously healthy three-year-old boy presented to our emergency room with massive hemothorax after a low-energy chest trauma. Imaging revealed active thoracic bleeding by an anomalous artery arising from the celiac tripod, and an irregular mass in the lower right hemithorax. After performing biopsy, pathologic examination revealed a PPB. The patient underwent four cycles of chemotherapy before surgery. The operative findings revealed a right supradiaphragmatic extralobar mass, with no communication with the bronchial tree, strictly adherent to the right middle lobe. After mass excision, histological analysis confirmed the diagnosis of PPB type 2. The patient underwent postoperative chemotherapy. No recurrence nor metastasis were noted during the current follow-up. DICER-1 research revealed biallelic mutation on the tumor and on the surrounding normal tissue. We reviewed the literature concerning PPB and BPS. Based on these data, we would recommend intervention even in case of asymptomatic eBPS.

Molecular Pathways in Peritoneal Mesothelioma: A Minireview of New Insights.

Mesothelioma is a rare malignant neoplasm with poor survival. It mainly affects the pleura (90%) but can arise in all serous cavities: peritoneum (5-10%), pericardium and tunica vaginalis testis (<1%). The onset of pleural mesothelioma is strictly related to asbestos exposure with a long latency time. The causal link with asbestos has also been suggested for peritoneal mesothelioma, while the importance of exposure in the onset of pericardial and tunica vaginalis testis mesotheliomas is not well known. Mesothelioma remains an aggressive and fatal disease with a five-year mortality rate higher than 95%. However, new therapeutic approaches based on molecular-targeted and immunomodulatory therapies are being explored but have conflicting results. In this context, the identification of critical targets appears mandatory. Awareness of the molecular and physiological changes leading to the neoplastic degeneration of mesothelial cells and the identification of gene mutations, epigenetic alterations, gene expression profiles and altered pathways could be helpful for selecting targetable mechanisms and molecules. In this review, we aimed to report recent research in the last 20 years focusing on the molecular pathways and prognostic factors in peritoneal mesothelioma and their possible diagnostic and therapeutic implications.

Parity associates with chromosomal damage in uterine leiomyomas

Mechanical forces in a constrained cellular environment were recently established as a facilitator of chromosomal damage. Whether this could contribute to tumorigenesis is not known. Uterine leiomyomas are common neoplasms that display relatively few chromosomal aberrations. We hypothesized that if mechanical forces contribute to chromosomal damage, signs of this could be seen in uterine leiomyomas from parous women. We examined the karyotypes of 1946 tumors, and found a striking overrepresentation of chromosomal damage associated with parity. We then subjected myometrial cells to physiological forces similar to those encountered during pregnancy, and found this to cause DNA breaks and a DNA repair response. While mechanical forces acting in constrained cellular environments may thus contribute to neoplastic degeneration, and genesis of uterine leiomyoma, further studies are needed to prove possible causality of the observed association. No evidence for progression to malignancy was found.

Native Nephrectomy in Patients With Autosomal Dominant Polycystic Kidney Disease Evaluated for Kidney Transplantation

Native nephrectomy (NN) in patients with autosomal dominant polycystic kidney disease (ADPKD) is indicated in cases of recurrent urinary tract infections and hematuria, neoplastic degeneration, and encumbrance. Timing, indication, and surgical approach of NN depends on the symptoms or policy of the center. The aim of our study is to evaluate our experience.In our retrospective study, we included 130 patients with a diagnosis of ADPKD from 530 patients evaluated for renal transplantation from 2011 to 2017. We analyzed the etiologic indication, the timing, and the complications of NN.In our cohort, 53 patients underwent open NN, 85% pre-kidney transplantation (KT), 13% post-KT, and only 1 case simultaneous with KT. In the pre-KT group, indications included: major indication was encumbrance in the. In the post-KT group, the major indication was infection followed by encumbrance, which developed after KT. Complications were: 3 cases of bleeding (1 required relaparotomy, 2 evolved into hematoma and radiological derange); 1 iatrogenic iliac artery injury, which was contextually repaired, and 5 cases of incisional hernia. At 35 ± 7.2 months follow-up, patients’ survival was 96%; 1 patient died at the induction of anesthesia and 1 patient from sepsis after double NN and removal of nonfunctional transplanted kidney.NN is not without complications and should be performed when clearly indicated. In our experience, we preferred to perform NN before KT.

Impact of c-MYC expression on proliferation, differentiation, and risk of neoplastic transformation of human mesenchymal stromal cells

BackgroundMesenchymal stromal cells isolated from bone marrow (MSC) represent an attractive source of adult stem cells for regenerative medicine. However, thorough research is required into their clinical application safety issues concerning a risk of potential neoplastic degeneration in a process of MSC propagation in cell culture for therapeutic applications. Expansion protocols could preselect MSC with elevated levels of growth-promoting transcription factors with oncogenic potential, such as c-MYC. We addressed the question whether c-MYC expression affects the growth and differentiation potential of human MSC upon extensive passaging in cell culture and assessed a risk of tumorigenic transformation caused by MSC overexpressing c-MYC in vivo.MethodsMSC were subjected to retroviral transduction to induce expression of c-MYC, or GFP, as a control. Cells were expanded, and effects of c-MYC overexpression on osteogenesis, adipogenesis, and chondrogenesis were monitored. Ectopic bone formation properties were tested in SCID mice. A potential risk of tumorigenesis imposed by MSC with c-MYC overexpression was evaluated.ResultsC-MYC levels accumulated during ex vivo passaging, and overexpression enabled the transformed MSC to significantly overgrow competing control cells in culture. C-MYC-MSC acquired enhanced biological functions of c-MYC: its increased DNA-binding activity, elevated expression of the c-MYC-binding partner MAX, and induction of antagonists P19ARF/P16INK4A. Overexpression of c-MYC stimulated MSC proliferation and reduced osteogenic, adipogenic, and chondrogenic differentiation. Surprisingly, c-MYC overexpression also caused an increased COL10A1/COL2A1 expression ratio upon chondrogenesis, suggesting a role in hypertrophic degeneration. However, the in vivo ectopic bone formation ability of c-MYC-transduced MSC remained comparable to control GFP-MSC. There was no indication of tumor growth in any tissue after transplantation of c-MYC-MSC in mice.ConclusionsC-MYC expression promoted high proliferation rates of MSC, attenuated but not abrogated their differentiation capacity, and did not immediately lead to tumor formation in the tested in vivo mouse model. However, upregulation of MYC antagonists P19ARF/P16INK4A promoting apoptosis and senescence, as well as an observed shift towards a hypertrophic collagen phenotype and cartilage degeneration, point to lack of safety for clinical application of MSC that were manipulated to overexpress c-MYC for their better expansion.

Paget's Disease of Bone.

Paget's disease of bone (PDB) is a chronic and focal bone disorder, characterized by increased osteoclast-mediated bone resorption and a subsequent compensatory increase in bone formation, resulting in a disorganized mosaic of woven and lamellar bone at one or more affected skeletal sites. As a result, bone pain, noticeable deformities, arthritis at adjacent joints, and fractures can occur. In a small proportion of cases neoplastic degeneration in osteosarcoma, or, less frequently, giant cell tumor has been also described at PDB sites. While recent epidemiological evidences clearly indicate a decrease in the prevalence and the severity of PDB, over the past 2 decades there have been consistent advances on the genetic mechanisms of disease. It is now clear that PDB is a genetically heterogeneous disorder, with mutations in at least two different genes (SQSTM1, ZNF687) and more common predisposing variants. As a counterpart to the genetic hypothesis, the focal nature of lesions, the decline in prevalence rates, and the incomplete penetrance of the disease among family members suggest that one or more environmental triggers may play a role in the pathophysiology of PDB. The exact nature of these triggers and how they might interact with the genetic factors are less understood, but recent experimental data from mice models suggest the implication of paramixoviral infections. The clinical management of PDB has also evolved considerably, with the development of potent aminobisphosphonates such as zoledronic acid which, given as a single intravenous infusion, now allows a long-term disease remission in the majority of patients.

Unusual presentation of gouty tophus in the liver with subsequent appearance in the same site of HCC: a correlate diagnosis? Case report

BackgroundAlthough gout is a common disease, the presence of gouty tophi outside joints is rare and in literature, there is to date only one report of hepatic tophaceous nodule. We would like to highlight here the difficult diagnostic workup in a patient with history of cancer and the presence of a tophus inside the liver. Moreover, we address the possible etiologic role of chronic inflammation related to tophi and liver cancer.Case presentationWe present the case of a 72-year-old man with a localization of gouty tophus in the liver, who thereafter developed a hepatocellular carcinoma (HCC) in the same site. The patient was followed up after surgery for left renal cancer from 1992 to 2011, when a hepatic nodule was discovered for the first time. After a detailed evaluation, the nodule was classified as a urate tophus of the liver. However, further follow-up showed that the nodule increased in size and changed its characteristics, bringing to the diagnosis of HCC.ConclusionsWith the present case report, we would discuss the possible neoplastic degeneration of a gouty tophus and its etiologic role favouring cellular degeneration linked to chronic inflammation. We would also highlight the importance of histopathological evaluation of hepatic lesions in gouty patients at high risk of liver neoplasm, due to the difficulty in characterizing gouty tophi by imaging.

Breast Plasty by Selective Mastectomy on Thoracic Supernumerary Breast: A Case Report

Background: Supernumerary breasts result from the persistence of ectopic mammary buds on the path of the primary mammary crest. The thoracic location with presence of glandular tissue remains exceptional. In its management, the surgeon is confronted not only with the aesthetic concern but also with the problem of surveillance given the risk of neoplastic degeneration due to the persistence of the supernumerary breast. It is then a question of determining the moment of the surgery and especially the appropriate operative technique. Presentation of the case: A 14-year-old girl was received for aesthetic gene linked to the presence of two nipples on her left breast. The physical examination revealed an asymmetry of left and right breasts volume. The left breast was classified as class I mammary glands according to KAJAVA classification. The mammogram described two mammary glands juxtaposed 180 and 80cm³ respectively. After performing the preoperative schema, the surgical procedure consisted of a selective mastectomy by complete excision of the lower mammary gland of 80 cm³ with remodeling by sub-mammary detachment over 2 cm of the remaining gland. The postoperative course was simple. Conclusion: Selective mastectomy for thoracic supernumerary breast is a technique of easy realization. The surgeon must find his anatomy to properly choose the preoperative schema. The postoperative result in our case was satisfactory.

Jaundice caused by protrusion of a hepatic cyst into common bile duct that was resolved by choledochoscopic needle-knife electrotomy: a case report

BackgroudHepatic cysts are the most frequent, innocuous, space-occupying lesions of the liver. The majority of solitary liver cysts are nonsymptomatic. When liver cysts reach a large size, there are some complications, including infection, rupture, spontaneous hemorrhage, obstructive jaundice, and neoplastic degeneration. Percutaneous aspiration, fenestration, hepatic resection, and liver transplantation have been proposed for symptomatic patients.Case presentationIn this case report, we describe a 41-year-old woman who presented with persistent liver dysfunction, indolent xanthochromia, and skin itching for 3 months. After a series of tests, she has a 5.0 × 5.3 cm hepatic cyst with many separations in the left medial liver lobe. The obstructive jaundice was caused by a large pedunculated lump protruding into the common bile duct from the left hepatic duct. She was treated with laparotomy and this lump was completely removed from the root by choledochoscopic needle-knife electrotomy with a good clinical response. Postoperative pathology of the lump suggested a hepatic cyst wall without heterocysts or tumor cells.ConclusionHepatic cyst wall protruding into the common bile duct can form capsular lump and result in indolent jaundice. Choledochoscopic high-frequency needle-knife electrotomy could be considered as a simple, safe and effective complementary approach for benign mass on the bile duct wall.

ZNF687 mutations are frequently found in pagetic patients from South Italy: implication in the pathogenesis of Paget's disease of bone.

Paget's disease of bone (PDB) is a skeletal disorder whose molecular basis is not fully elucidated. However, 10% of patients show a familial PDB and 35% of them carry mutations in the SQSTM1 gene. We recently reported a founder mutation (p.Pro937Arg) in the ZNF687 gene, underlying PDB complicated by giant cell tumor (GCT/PDB) and rarely occurring in PDB patients without neoplastic degeneration. Since 80% of Italian GCT/PDB patients derive from Avellino, we hypothesized that ZNF687 mutation rate was higher in this region than elsewhere. Interestingly, our molecular analysis on 30 PDB patients showed that 33% hosted ZNF687 mutations, with the p.Pro937Arg identified in 8 familial cases. Two novel ZNF687 mutations (p.Pro665Leu and p.Gln784Glu) were detected in 2 sporadic patients. Only 2 subjects were positive for the p.Pro392Leu mutation in SQSTM1. ZNF687-mutated patients showed a severe PDB, with a remarkable number of affected sites. in vitro studies revealed that the ZNF687-mutant osteoclasts appeared as giant sized with up to 150 nuclei, never described in PDB. Finally, we also confirmed the causality of the p.Pro937Arg mutation in 4 additional GCT/PDB cases deriving from the same geographic area, indicating that PDB and GCT/PDB represent 2 sides of the same coin.

Relationship between mannose-binding lectin-2 gene polymorphism and CD25 with hepatocellular carcinoma-induced hepatitis-C development

Objectives The aim of the study was to evaluate the role of mannose-binding lectin-2 ( MBL-2) gene polymorphism and soluble CD25 (sCD25) in the development of hepatitis C-inducing hepatocellular carcinoma (HCC) in Egyptian patients. Background Hepatitis C virus (HCV) plays a major role as a cause of chronic liver injury, with potential for neoplastic degeneration. HCC represents an important public health problem in Egypt. MBL is an important constituent of the human innate immune system that acts as an acute-phase reactant and is secreted by the liver. It affects the inflammation severity or disease progression. Patients and methods Blood samples from 118 individuals – 88 patients (58 HCC patients and 30 HCV positive patients) and 30 apparently healthy individuals as a control group – were tested for MBL-2 gene polymorphism by real-time PCR and soluble CD25 by using ELISA. Results MBL-2 genotype GC was significantly higher among HCC cases than among HCV cases [odds ratio: 8.25 and 95% confidence interval (CI): 2.81–24.24]. Moreover, genotype was significantly more frequent in HCC cases than in HCV cases (odds ratio: 7.22 and 95% CI: 2.67–19.49). On comparing alleles, G allele was of higher rate among HCC cases than among HCV cases (odds ratio: 3.53 and 95% CI: 1.63–7.65). There was a significant increase in (sCD25) level in HCC cases compared with control and HCV groups. CD25 was significantly higher among GG/GC than among CC genotype patients in the HCC group only. In addition, there was significant positive correlation between CD25 and aspartate aminotransferase, total protein, albumin, direct bilirubin, total bilirubin, and α-fetoprotein. Conclusion Functionally relevant MBL-2 promoter polymorphism may play a role in the development of HCV-related HCC, and sCD25 can be used to distinguish HCC from appropriate controls with early tumors.

Identification of the short arm of the Y chromosome by cytogenetic and molecular analyses

Isochromosome Y is one of the structural anomalies of the Y chromosome associated with a 45,X cell line and a broad spectrum of phenotypes. We present a case of de novo 46,X,+mar detected in a 17-yearold male patient. He had shortening of the right leg, bilateral breast enlargement, pubic, underarm and facial hair development, small penis and testicles, low serum cortisol, ACTH and total testosterone levels, normal LH value, high FSH value, normal testicles and epididymis, minimal left varicocele. The chromosome aberration was detected by cytogenetic analysis. Cytogenetic and molecular analysis was performed by conventional karyotyping and quantitative florescence PCR, respectively. The molecular analyses by PCR detected the presence of the SRY and AMXY genes, confirming the presence of the short arm of the Y chromosome. PCR demonstrated that the marker chromosome is of Y origin and corresponds to an authentic isochromosome for the short arm of the Y chromosome, i(Yp). We suggest that the structural alteration of the Y chromosome was a new mutation, which occurred in the initial mitotic division of the embryo, originally 46,XY. The result of accurate evaluation provides correct sex assignment and the prevention of the neoplastic degeneration of a dysgenetic gonad. The karyotype 46,X,i(Yp) indicates that the patient is preserving the SRY gene.

Nasal Obstruction due to Fibrous Dysplasia Invading Inferior and Middle Turbinates: A Case Report and Literature Review

Fibrous dysplasia (FD) is a rare type of fibro-osseous lesion characterized by fibroblastic proliferation and progressive substitution of the normal bone with fibrotic disorganized bony trabeculae. Although several etiological theories, such as neoplastic degeneration and genetic or embryologic modification, have been proposed, the exact pathogenesis of FD is still unknown. 70% of all FD cases are of the monostotic form, and only 10% of these involve the craniofacial bones. 30% of all FD cases are of the polyostotic form, and more than 50% of these involve the craniofacial bones. The polyostotic form may be associated with McCune-Albright syndrome, which is the most severe form of polyostotic FD. As FD has a tendency to affect membranous bones such as the femur or tibia, involvement of the sinonasal cavity is rare, and involvement of the inferior and/or middle turbinate bones is extremely rare. In this report, we describe a case of severe FD involving the right inferior and middle turbinates and the almost-complete obstruction of the right nasal cavity. We also review previously-reported cases of FD-induced nasal obstruction symptoms with inferior and/or middle turbinate involvement.

Peripheral Osteoma in the Mandibular Angle.

Osteoma is a benign tumor that occurs from the proliferation of cancellous bone, compact bone, or their combination [1]. It can be classified into 3 types, namely, central, peripheral, and extraskeletal osteoma. Central osteoma occurs in the endosteum, peripheral osteoma occurs in the periosteum, and extraskeletal osteoma occurs mostly within muscles [2].

Tecnica chirurgica open a minima invasività per la nefrectomia del rene policistico (PKD)

La malattia policistica renale (PKD) è una malattia genetica, con frequente compromissione di organi e apparati extrarenali, la cui evoluzione può portare a insufficienza renale terminale con necessità di ricorrere a un trattamento sostitutivo dialitico (emodialisi o dialisi peritoneale) o al trapianto renale o combinato fegato-rene. L'asportazione di un rene policistico non deve essere considerata routinaria, ma può rendersi necessaria in caso di ripetute emorragie cistiche e di infezioni recidivanti, di fronte al sospetto di una degenerazione neoplastica o al fine di creare uno spazio addominale idoneo per il trapianto. In corso di PKD, la nefrectomia è un atto chirurgico non semplice, in considerazione delle dimensioni della massa da asportare e delle aderenze frequentemente presenti; la classica tecnica chirurgica per via lombotomica extraperitoneale spesso obbliga a un'incisione ampia e invasiva. La via intraperitoneale, a cielo aperto o per via laparoscopica, altera l'integrità peritoneale limitando poi l'opportunità della dialisi peritoneale. Un'incisione lombotomica breve (10–12 cm), con conservazione costale e risparmio dell'integrità peritoneale, per minimizzare l'invasività della classica tecnica open, consente l'isolamento della massa renale e puntura, aspirazione e svuotamento mirato in asepsi di cisti renali. Questa manovra porta al rimodellamento morfologico dell'organo e rende possibile la sua asportazione in tempi chirurgici peraltro contenuti e senza complicanze specifiche intra e peri-operatorie.

PKD Open Nephrectomy: Minimally Invasive Tecnique

The polycystic kidney disease (PKD) is a genetic disorder with frequent damage of extrarenal organs and systems; functional impairment can lead to end stage renal disease needing for dialysis replacement therapy (hemodialysis or peritoneal dialysis) or both kidney and liver-kidney transplantation.The removal of a polycystic kidney should not be considered common, but necessary if repeated bleeding, recurrent infections and neoplastic degeneration are present or in order to create abdominal suitable space for transplantation.PKD nephrectomy is not a simple surgical procedure because of the size of the mass to remove and frequent adhesions; classic surgical lombotomic extraperitoneal technique often requires a large and invasive access. Intraperitoneal technique, both open and laparoscopic, alters peritoneal integrity, limiting the real possibility of peritoneal dialysis.In order to minimize the invasiveness of the classic open technique a short (10–12 cm) lombotomic incision, with costal preservation and s...