Hotspots of Anal Cancer Screening in a High-risk Population: A Clinical Study on Free Provision, Best Method, Self-sampling, and Independent Risk Factors.

BACKGROUND/AIM: As of 2024, anal cancer (AC) has been steadily increasing worldwide but, due to insufficient evidence, anal cancer screening (ACS) has yet to be standardized. Furthermore, most high-risk people in the world have no help paying for it. Therefore, our primary endpoint was to assess the best screening method for these subjects through a provision that was free of charge (all costs were covered by the Italian public health service). Awareness-raising campaign, determination of risk factors, education on anal self-examination, and sampling (ASS) were secondary objectives. PATIENTS AND METHODS: Screening was on a voluntary basis. Engaging in receptive anal intercourse and having a history of cervical dysplasia were the main inclusion criteria. Level 1 ACS tools included digital ano-rectal examination, anoscopy, anal Pap, and anal human papillomavirus (HPV) DNA test (both through self- and proctologist- sampling); high-resolution anoscopy (HRA) with (HRAB) or without biopsy comprised level 2 screening. High-risk people were enrolled until the available funds were exhausted. RESULTS: Fifty high-risk people (40 men who had sex with men -MSM-, 9 women, and 1 heterosexual man) were enrolled. AC was found in one HIV-seropositive MSM, high-grade squamous intraepithelial lesion in 10 (20%) MSM, low-grade squamous intraepithelial lesion LSIL in 13 cases (12 MSM and 1 woman). The combination of HRAB and Pap smear screening achieved the highest values for sensitivity, specificity, and accuracy. ASS HPV DNA test provided excellent results comparable to clinician retrieval. Overweight and college education were identified as independent factors for the risk of and prevention of AC, respectively. CONCLUSION: A free ACS not only appears justified but also recommended to people screened for AC. Excess weight represents a further risk for this population.

Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR).

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula.

Leiomyosarcoma of the rectum: A systematic review of recent literature.

Leiomyosarcomas (LMSs) are rare tumors originating from the muscular layer. We performed a literature review of cases of confirmed rectal leiomyosarcomas (rLMSs) to clarify the history of such an infrequent tumor arising at such an uncommon location. In this research local recurrence was related to poorly differentiated rLMS and no other association between recurrence and any criteria was found. Concerning overall survival (OS), rLMS patients developing recurrence presented shorter longevity compared with the group without.

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Tonsillectomy as Prevention of Tonsil and Base of Tongue Cancer: Systematic Review and Meta-analysis on the Immuno-Oncological Effect of One Among the Most Common Surgeries in the World.

Otorhinolaryngology tradition is that tonsillectomy (TE) is conducted among children and adolescents for obstructive sleep apnea secondary to adenotonsillar hypertrophy and in adults for chronic disease of the tonsils and adenoids (recurrent tonsillitis). Nevertheless, over the last 50 years, we have observed a decline in TE worldwide. As a result, there is an emerging concern of a correlated possible increased risk of tonsil cancer (TC) and other subtypes of oropharyngeal squamous cell carcinoma. Since the available data on such topics are limited and controversial, our aim was to elucidate the impact of TE on the incidence mainly of TC through a systematic review of the literature and a meta-analysis of the studies. After a thorough search, 7 retrospective studies were considered eligible for review and meta-analysis (MA). At MA, patients with a history of TE seem to show a reduced risk of TC but a higher predisposition for base of tongue (BOT) cancer (p<0.001): however, the elevated heterogeneity of the studies hampers drawing firm and convincing conclusions (statistical inconsistency >95%). In future, randomized control trials will be welcome to elucidate the prophylactic role of TE against TC and its real impact on BOT cancer.

Open surgical cholecystostomy under local anaesthesia as salvage therapy of acute cholecystitis during the 4th COVID-19 wave in Northern Italy: experience from a rural hospital.

The COVID-19 pandemic outbreak delayed interventions of elective surgery worldwide. In Italy, the first western country to be affected, 410000 operations formerly planned were cancelled with the beginning of the first wave. Symptomatic cholelithiasis represents one of the most common, benign medical conditions in the world leading the affected patients to general surgeons'attention; in 0.5% of cases gallstones (symptomatic or not) can complicate with acute lithiasic cholecystitis (ALC) whose universally acknowledged treatment of choice is laparoscopic cholecystectomy. Delaying in surgery of ALC can increase the rate of complications like severe ALC, acute cholangitis and sepsis. The 4th wave of COVID 19 in Northern Italy induced further stress on the healthcare system. In fact, the occurrence of difficult communication and delays in ALC patients transfer between first and second level hospitals lead to the re-emergence of obsolete surgical procedures. In our rural hospital, in fact, a 92 years old patient affected with ALC and several comorbidities was treated with a successful emergency surgical procedure of transperitoneal cholecistostomy in lieu of a radiological transperitoneal approach. Such a choice was dictated by the absence of an interventional radiology unit in our hospital as well as the unavailability of patient transfer to our central referral hub (the hospital of Parma) due to hospital overcrowding secondary to the 4th wave of COVID 19 pandemic.

Local excision of T1 colorectal cancer: good differentiation, absence of lymphovascular invasion, and limited tumor radial infiltration (≤4.25 mm) may allow avoiding radical surgery.

BACKGROUND: Early colorectal cancer (ECC) is defined as T1NXM0 colorectal cancer (CRC). Although a non-negligible number of T1-CRCs presents metastatic lymph-nodes, local excision is increasingly proposed as alternative to radical resection. Several criteria have been suggested to identify low-risk T1-CRC, but recommendations on this topic are still heterogeneous. This study aims to identify criteria associated with N+ T1-CRC, to select patients to undergo (or not) local excision. METHODS: A retrospective analysis of demographic, clinical, and histology criteria of 122 consecutive T1-CRC patients undergoing radical resection at Parma University Hospital between 2000 and 2018 has been performed. RESULTS: Lymph-node metastasis (LNM) was observed in 15/122 patients (12.3%). No LNM was observed among well-differentiated (G1) tumors (0/37), while 10/65 (15.4%) G2 cases as well as 5/20 (25%) G3 patients presented LNM. G1 was associated with absence of LNM (p = 0.013). After excluding G1 patients, the rate of N + T1-CRC was 17.6% (15/85). LNM was observed in 4/8 (50%) patients with lymphovascular invasion (LVI) and in 11/77 (14.2%) without LVI. LVI resulted being associated with LNM (p < 0.042). LNM was reported in 28.3% of cases with a tumor infiltration >4.25 mm (13/46), compared to 5.1% in cases with an infiltration ≤4.25 mm (2/39) (p = 0.012). In Cox regression analysis, the higher hazard ratio (HR) was reported for the LVI + and infiltration >4.25 mm (HR 24.849). CONCLUSIONS: In patients with ECC (pT1NXM0), good differentiation (G1), absence of lymphovascular invasion (LVI-), and tumor radial infiltration ≤4.25 mm may allow performing local resection and avoiding radical surgery.

Amyand's hernia: which oncologic risk can be hidden in the sac?

Amyand's hernia (AH) is a rare condition in which the appendix is found in the sac of an inguinal hernia. It occurs in only 1% of adult inguinal hernias. The herniated appendix can occasionally range varying degrees of acute inflammation up to neoplastic transformation. An appendiceal tumor can be rarely described inside the AH sac. We describe a case of gangrenous appendicitis in AH and offer a review of the literature on AH when presenting with appendicitis associated with appendiceal cancer. As of 2022, only nine cases of AH presenting with appendicitis associated with appendiceal cancer have been reported by the pertinent literature. In order of decreasing frequency, AH, AH-related appendicitis and AH-related appendicitis associated with appendiceal cancer are three rare conditions. Particular attention should be kept in each situation as diagnosis is achieved postoperatively most of the times.

Intussusception of the bowel in adult women due to bulky inflammatory fibroid polyp treated in emergency. A case report.

Introduction: Intussusception represents a rare form of bowel obstruction in the adult, which is defined as the telescoping of a proximal segment of the gastrointestinal tract into the lumen of the adjacent distal segment of the GI tract Case Report: We report the case of a 50-year-old woman was admitted in our hospital with acute bowel obstruction. CT showed intestinal occlusion secondary to intussusception. the patient underwent emergency surgery. Surgery confirmed intussusception at the level of the distal ileum (about 30 cm from the ileocecal valve) due to a 3-4 oval mass of hard consistency that appeared to be suspicious for GIST. Was performed a resection of the ileal segment involved associated with oncologically radical lymphadenectomy. The histological examination reported benign ileal mesenchymal neoformation compatible with inflammatory fibroid polyp. Patient had a regular course Discussion: In adults, 90% of invaginations manifest as a result of an organic lesion caused by benign or malignant tumors. The clinical presentation in adults is generally chronic or nonspecific. The emergence of acute symptoms due to complete intestinal obstruction occours in fewer than 20% of patients. Abdominal computed tomography (CT) is the most sensitive radiologic method to confirm intussusception. As many cases are secondary to organic pathologies with malignant potential, surgical resection of the affected bowel segment with oncological procedures is the primary method of treatment Conclusion: Due to the fact that adult intussusception is often frequently associated with organic lesions, surgical intervention is necessary. Treatment usually requires formal resection of the involved bowel segment. (www.actabiomedica.it).

Exosomal Functional Cargoes from Liquid Biopsy of Gastric Cancer: A Systematic Review of Studies With Potential Clinical Relevance.

BACKGROUND/AIM: Liquid biopsy (LB) is a promising non-invasive tool to detect cancer. Over the last few years, exosomes recruited from LB have attracted the attention of researchers for their involvement in cancer. We focused on the role of LB exosomes in gastric cancer (GC). MATERIALS AND METHODS: We investigated the world literature on exosome-encapsulated functional biomarkers (non-coding RNAs and DNAs) taken from GC patients' LBs. Only the studies exploring serum, intraperitoneal fluid or gastric lavage were included. RESULTS: As of 2022, fifty articles with an overall count of 3552 GC patients were investigated. Given the statistically significant associations with the clinicopathological categories of tumor depth, lymph node metastasis, staging class and tumor size, most exosome-mediated microRNAs, long non-coding RNAs and circular RNAs proved to exert a potentially important bioclinical role in terms of diagnosis, screening, prognosis and therapeutic targets. CONCLUSION: In the future, resorting to exosomal biomarkers taken from LB of affected patients could revolutionize the non-invasive fight against GC.