Carcinoids are tumors derived from neuroendocrine cells and often produce functional peptide hormones. Approximately 54.5% arise in the gastrointestinal tract and frequently metastasize to the liver. Primary hepatic carcinoid tumors (PHCT) are extremely rare; only 95 cases have been reported. A 65-year-old man came to our attention due to occasional ultrasound findings in absence of clinical manifestations. His previous medical history, since 2003, included an echotomography of the dishomogeneous parenchymal area but no focal lesions. A computed tomography s c a n p e r fo r m e d i n 2 0 0 5 s h o w e d an enhanced pseudonodular-like lesion of about 2 cm. Cholangiomagnetic resonance imaging identified the lesion as a possible cholangiocarcinoma. No positive findings were obtained with positron emission tomography. Histology suggested a secondary localization in the liver caused by a low-grade malignant neuroendocrine tumor. Immunohistochemistry was positive for anti chromogranin antibodies, Ki67 antibodies and synaptophysin. Octreoscan scintigraphy indicated intense activity in the lesion. Endoscopic investigations were performed to exclude the presence of extrahepatic neoplasms. Diagnosis of PHCT was established. The patient underwent left hepatectomy, followed by hormone therapy with sandostatine LAR. Two months after surgery he had a lymph nodal relapse along the celiac trunk and caudate lobe, which was histologically confirmed. The postoperative clinical course was uneventful, with a negative follow-up for hematochemical, clinical and radiological investigations at 18 mo post-surgery. Diagnosis of PHCT is based principally on the histopathological confirmation of a carcinoid tumor and the exclusion of a non-hepatic primary tumor. Surgical resection is the recommended primary treatment for PHCT. Recurrence rate and survival rate in patients treated with resection were 18% and 74%, respectively.

Background: In the last years a trend towards proximalization of colorectal carcinomas (CRC) has been reported. This study aims to evaluate the distribution of CRC and adenomatous polyps (ADP) to establish the presence of proximalization and to assess the potential predictors.

Schwannoma is a myelin sheath tumor complicated with neurofibroma, neurofibromatosis and neurogenic sarcoma. Peripheral nerve sheath tumors represent 2%-6% of gastrointestinal tract stromal tumors (GIST), but there are deficient data about location of neurogenic tumors in the biliary system and only nine cases of schwannoma of the extrahepatic biliary tract have been reported. These tumors are clinically non-specific. They are usually symptomatic by compressing the close or adjacent structures when being retroperitoneal, and their preoperative diagnosis is extremely difficult. This paper reviews the literature data and describes a case of schwannoma of the common bile duct associated with cholestasis in a healthy young woman, diagnosed and treated in our department. This case is of interest on account of the complexity of its diagnosis and the atypical macroscopic growth pattern of the tumor.

We can suppose that proximalisation of carcinoma has not yet appeared in Italy.

Acquired factor VIII (FVIII) inhibitor in patients without haemophilia A is an uncommon disorder, occurring at a rate of 0.2-1.0 case per million each year [1]. Data on associated diseases are not always available and, in a consecutive cohort of patients in the UK, acquired haemophilia may be idiopathic in approximately 60% of the patients [2].A variety of clinical conditions, such as drug hypersensitivity, solid tumours, lymphoproliferative diseases, postpartum status, skin disorders, autoimmune disorders and collagen vascular diseases, have a well-established association with acquired haemophilia A [3]. It is not unexpected that auto-antibodies to FVIII can be found in patients infected with hepatitis C virus, and four cases have been reported. Only one case of HIV/HCV-co-infected patient has been described [4].In this study, we present the case of a HIV-infected patient with FVIII inhibitor. A 65-year-old man was admitted to Emergency Department on May 2008 for the appearance of spontaneous ecchymoses on his trunk and the presence of massive muscle haematomas on the left thigh. The patient also had painless haematuria for 1 week.There was no family or personal history of a congenital bleeding diathesis. The patient was diagnosed with HIV infection in 2003 and was receiving highly active antiretroviral therapy with nevirapine, lamivudine and didanosine. His HIV viral load was 1.60 < log copies mL )1 , with a CD4+ cell count of 564/mm 3 . On physical examination, the patient was afebrile, no lymph nodes were palpable and the liver and spleen were not enlarged.Blood tests showed severe anaemia (haemoglobin 6.6 g dL )1 ) and markedly prolonged activated partial thromboplastin time (APTT; 78 s.). PT, fibrinogen and platelet count were within the normal ranges. The serum creatinine was 2.6 mg dL )1 and liver function was normal. The direct and indirect CoombsÕ tests were negative.Considering the emergency of the initial clinical picture, we decided to start transfusion therapy with red blood cell concentrates (20 units of RBC were transfused during the hospital care) and fresh frozen plasma transfusion immediately. The antiretroviral therapy was promptly stopped.Hepatitis B virus serology showed anti-HBs >1000, with HBsAg, HbeAg and anti-HBe negative. HCV serology was negative. The rheumatoid factor level, the serum immunoglobulin levels, anti-cardiolipin IgG and the anti-cardiolipin IgM were normal. The antinuclear antibody was negative. Examination of malignancies and dermatological disorders, and reaction to drugs were excluded. Abdominal magnetic resonance showed a vast (10 cm) haematoma involving left thoracic and abdominal wall.The laboratory tests showed an extremely low value of FVIII (<1 U dL )1 ) and a high titre of inhibitor (118 BU mL )1 ). The patient was diagnosed as having a coagulopathy caused by an acquired FVIII inhibitor. The patient was started on oral prednisone 80 mg daily and i.v. recombinant human coagulation FVIIa [rFVIIa; NovoSeven (Princeton, NJ, USA); loading dose 90 mcg kg )1 , then 16 m...