There is strong evidence that CME offers a longer central pedicle that contains more lymph nodes than conventional surgery for colon cancer. CME represents the surgical background for the maximum lymph node harvest, an important quality marker for the surgical outcome. However, and according to present data, there is limited evidence that colectomy in terms of CME leads to improved long-term oncological outcomes.

Gastrointestinal stromal tumors (GIST) are uncommon mesenchymal spindle-cell or epithelioid neoplasms, located mainly with higher frequency in the stomach and small bowel. GISTs represent the majority of primary non-epithelial neoplasms of the digestive tract, most frequently expressing the KIT protein a transmembrane tyrosine kinase receptor for stem cell factor. Extra-gastrointestinal stromal tumors tend to present In fewer than 5% of cases; they originate primarily from the mesentery, omentum or peritoneum. Furthermore, these extra-gastrointestinal tumors (EGIST) tend to be more common in patients over the age of 50 years. EGISTs are neoplasms with overlapping immunohistological features, occurring in the abdomen outside the gastrointestinal tract with no connection to the gastric or intestinal wall. We describe here a rare case of EGIST of the lesser omentum and report the clinical, macroscopic, immunohistological and radiological features of an EGIST arising in the lesser omentum of a 63-year old man. Clinical course and the prognostic factors of such lesions will also be discussed. EGISTs in the lesser omentum can grow slowly and remain silent despite a large tumor size. In most cases, a pre-operative diagnosis is not possible, and the patient undergoes a surgical operation for the generic diagnosis of abdominal mass. During the intervention it is important to achieve a complete removal of the mass and to examine every possible adhesion to the gastrointestinal wall.

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Objectives This study aims to evaluate the performance of clinical, imaging, and cytopathological criteria in the identification of high-grade dysplasia/carcinoma (HGD/Ca) in pancreatic mucin-producing cystic neoplasms. Methods Sixty-eight consecutive, histopathologically confirmed mucin-producing cystic neoplasms, evaluated by endoscopic ultrasound-guided fine-needle aspiration, were enrolled; specifically, 39 branch duct intraductal papillary mucinous neoplasms (BD-IPMNs), 21 main duct IPMNs, and 8 mucinous cystic neoplasms. The associations between HGD/Ca in histopathology and findings of endoscopic ultrasound and cytology, demographic, lifestyle, and clinical parameters were evaluated, separately in IPMNs and mucinous cystic neoplasms. Results Age 65 years or more was associated with HGD/Ca in IPMNs. In BD-IPMNs, cyst diameter 3 cm or greater (sensitivity, 68.8%; specificity, 65.2%), a mural nodule (sensitivity, 56.3%; specificity, 78.3%), main pancreatic duct diameter 5 to 9 mm (sensitivity, 50.0%; specificity, 87.0%), and suspicious cytology (sensitivity, 81.3%; specificity, 100%) signaled the presence of HGD/Ca. Similarly, in main duct IPMNs, suspicious cytology predicted HGD/Ca with high sensitivity (88.9%) and excellent specificity (100%). Regarding cytopathological criteria, in BD-IPMNs, HGD/Ca was associated with a high nuclear/cytoplasmic ratio, background necrosis, presence of papillary structures, hypochromatic nuclei, hyperchromatic nuclei, and major nuclear membrane irregularities (thickening and/or indentations). Conclusions Clinical, imaging, and cytopathological criteria are useful in the identification of HGD/Ca in IPMNs.