A rare malignancy: A case report of early progression of anal Buschke-Löwenstein tumor into squamous cell carcinoma in an immunocompetent patient.

INTRODUCTION AND IMPORTANCE: Buschke-Löwenstein tumor (BLT) is a rare perianal lesion caused by low-risk mucosal HPV 6 or 11 but less frequently associated with high-risk HPV types. It is a large, exophytic, verrucous lesion of the anogenital region. BLT presents as a benign tumor but exhibits malignant clinical behavior and has a high rate of local recurrence and malignant transformation. The optimal treatment approach for BLT is still debated due to the lack of consensus. Various therapeutic modalities have been proposed, including topical agents, surgical excision, immunotherapy, chemo-radiotherapy, and electrocoagulation. CASE PRESENTATION: This case report presents a heterosexual, immunocompetent patient with anal pain, pruritus, and spontaneous bleeding. The physical examination revealed an exophytic, pedunculated verrucous lesion, which appeared to be a typical fibroepithelial lesion. CLINICAL DISCUSSION: The patient underwent wide excision, followed by a re-excision due to a surgical margin issue. The tumor exhibited malignant transformation into a well-differentiated SCC. However, due to the tumor's stage, size, location, histological type, and the extended time interval between the two surgeries, postoperative radiotherapy was not performed. Follow-up examinations over 12 months revealed no evidence of recurrence in either the patient's clinical evaluation or pelvic MRI. CONCLUSIONS: Although comprehensive research is lacking, wide local excision is considered the preferred first-line treatment for early-stage cases without evidence of local invasion. Furthermore, HPV immunization can prevent the development of Buschke-Löwenstein tumor, and early administration of the HPV vaccine is recommended to avoid acquiring HPV infection.

Laparoscopic resection of ganglioneuroma from the hepatoduodenal ligament: A case report.

INTRODUCTION AND IMPORTANCE: Ganglioneuromas are extremely rare, slow-growing, benign tumors that arising from Schwann cells, ganglion cells, and neuronal or fibrous tissue. Their malignant degeneration occurs very rarely, complete surgical removal is recommended to eliminate possible symptoms or to prevent possible malignant transformation. Reviewing the literature, there is currently insufficient data available on laparoscopic resection of retroperitoneal ganglioneuromas. CASE PRESENTATION: 20-year-old young woman with no previous medical history or regular medication use complaints of abdominal pain. Abdominal CT scan found a cystic mass measuring up to 50 mm in diameter with a thick fluid density and no contrast accumulation, was identified in the porta hepatis region extrahepatically. Ultrasound-guided biopsy was performed, histopathological finding revealed mature benign neurogenic tumor tissue consisting of mature ganglion cells, mature Schwann cells, and branching stroma. CLINICAL DISCUSSION: A laparoscopic surgery was performed, the 5 cm large tumor was excised from the hepatoduodenal ligament. The tumor was removed from the region of the inferior caval vein, portal vein, and the common and proper hepatic arteries. Final histological diagnosis is ganglioneuroma of the hepatoduodenal ligament. After uneventful postoperative period, the patient was discharged home on the 6th day. CONCLUSIONS: Retroperitoneal tumors were previously excised during laparotomy. However, in recent decades, with the development of laparoscopic surgical techniques and tools, laparoscopic removal of some retroperitoneal tumors seems to be the ideal approach. The use of laparoscopy improves visibility of the relationship of the tumor to the surrounding, often vital, structures. Based on a review of the international literature and our own experience, laparoscopic ganglioneuroma resection is the recommended procedure with careful patient selection, as well as appropriate preoperative imaging and diagnostics, and with adequate expertise.

Indications and technical aspects of proximal gastrectomy.

According to the World Health Organization, gastric cancer is the fifth most common type of tumor, and is the third most common cause of tumor-associated death. Although gastric cancer incidence rates have decreased in the past few decades, the prevalence of proximal gastric cancer has been steadily rising in developed countries. Techniques regarding the improvement of treatment options must thus be developed. This can be achieved through incorporating both a wider use of endoscopic surgery (endoscopic mucosal resection-EMR, endoscopic submucosal dissection-ESD) and a review of applied surgical interventions. Even though there is no single international consensus available, the Japanese Gastric Cancer Association (JGCA) recommends proximal gastrectomy with D1+ lymphadenectomy in early gastric tumors. Despite recommendations from Asian guidelines and the short term outcomes of the KLASS 05 trial, surgical treatments in Western countries still rely on total gastrectomy. This is mostly due to technical and oncological challenges regarding surgical interventions in a proximal gastrectomy. However, the residual stomach after a proximal gastrectomy has been shown to diminish the incidence of dumping syndrome and anemia, and even improve postoperative quality of life (QoL). Therefore, it is necessary to define the place of proximal gastrectomy in the treatment of gastric cancers.

Significance of preoperative blood tests in the prognosis of colorectal cancer: A prospective, multicenter study from Hungary.

BACKGROUND: The focus of this study was to analyze the prognostic value of different combinations of inflammatory and coagulation factors using preoperative blood and to appraise the clinical importance of these biomarkers in colorectal cancer patients. METHODS: A prospective, multicenter study included patients undergoing radical colorectal surgery in three county hospitals. Inflammatory and coagulation markers were analyzed preoperatively. RESULTS: Two hundred and one patients were included. We examined patients based on their tumor localization. Colon cancer group involved patients with the tumor localized in the colon (n = 105, 52.24%) and rectal cancer group the patients with the tumor in the rectum (n = 96, 47.76%). Examining coagulation factors, univariate Cox analysis of colon cancer patients showed that activated partial thromboplastin time (p = 0.020) was significantly associated with overall survival, but we could not prove it in multivariate analysis. In colon cancer patients, neutrophil-to-lymphocyte ratio (NLR, p < 0.001) was positively correlated with tumor size and had significant association (χ2  = 5.48, p = 0.019, df = 1) with perineural invasion. Univariate and multivariate Cox analysis of colon cancer patients showed that NLR (p = 0.011 and p = 0.048) was significantly associated with disease-free survival (DFS). CONCLUSION: NLR was proved to be an independent prognostic factor for DFS in patients with non-metastatic colon cancer. NLR might help to recognize the high-risk patients between patients with the same tumor-node-metastasis stage and could help with the decision on adjuvant chemotherapy. Since the biomarkers in preoperative blood tests are habitually evaluated, NLR could be an inexpensive prognostic marker that can be easily assessed in clinical practice.

Optimal extent of lymph node dissection in gastric cancer.

Gastric cancer still remains a major cause of cancer-related deaths globally. Stage-adapted, individualized treatment is crucial to achieving optimal oncological outcomes. Postoperative morbidity and accurate nodal staging are heavily influenced by the extent of lymph node dissection. On one hand, insufficient lymphadenectomy may result in understaging and undertreatment of a patient, on the other hand, unnecessary lymph node dissection may result in a higher rate of postoperative complications. Approximately one-third of patients with gastric cancer undergoes an avoidable lymph node dissection. Many of the recent treatment updates in the management of gastric cancer have a major influence on both surgical and oncological approaches. Currently, a wide range of endoscopic, minimally invasive, and hybrid surgical techniques are available. The concept of sentinel node biopsy and utilization of the Maruyama Computer Program are significant components of stage-adapted gastric cancer surgery. Likewise, centralization and application of national guidelines, widespread use of neoadjuvant therapy, and the stage migration phenomenon are serious concerns to be discussed. Our goal is to review the available surgical strategies for gastric cancer, with a primary focus on lymphadenectomy.