Short-term outcomes in obese and non-obese patients undergoing transperitoneal laparoscopic adrenalectomy for benign or malignant adrenal diseases: an updated systematic review and meta-analysis.

BACKGROUND: Transperitoneal laparoscopic adrenalectomy (TLA) is the most frequently chosen approach in adrenal surgery. At present, impact of obesity on patient outcomes following adrenal surgery is frequently under discussion. We intended to offer updated evidence thanks to a comparison between intraoperative and perioperative outcomes in non-obese and obese patients, who underwent TLA for benign or malignant adrenal diseases. METHODS: Our systematic review made use of Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. Articles of interest turned out from a search with PubMed/MEDLINE, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials-CENTRAL), Web of Science (Science and Social Science Citation Index), and Scopus databases. We evaluated two groups of outcomes: intraoperative (operative time, intraoperative complications rate, estimated blood loss (EBL), transfusion rate, conversion to open surgery rate) and postoperative (overall postoperative complications rate, major postoperative complications rate, length of hospital stay). RevMan (Computer program) Version 5.4 was used to perform the meta-analysis. The heterogeneity of the included studies in the meta-analysis was assessed by using the I2 statist. RESULTS: The 8 included comparative studies (1,646 patients: 995 non-obese versus 651 obese) had a time frame of approximately 30 years (1994-2020) and an observational nature. Meta-analysis showed no differences in terms of operative time, intraoperative complications rate, EBL, transfusion rate, conversion to open surgery rate, overall postoperative complications rate, major (Clavien-Dindo ≥ III) postoperative complications rate, length of hospital stay between non-obese and obese populations. CONCLUSIONS: We can say that obesity does not impact TLA safety and effectiveness. Due to biases among meta-analyzed studies (small overall sample size and small number of events analyzed, in particular), careful interpretation is needed to interpret our results. Additional randomized, possibly multi-center trials may contribute to confirm our results.

The "Forgotten" Subtypes of Breast Carcinoma: A Systematic Review of Selected Histological Variants Not Included or Not Recognized as Distinct Entities in the Current World Health Organization Classification of Breast Tumors.

Breast carcinoma is the most common cancer in women. Nineteen different subtypes of breast carcinomas are recognized in the current WHO classification of breast tumors. Except for these subtypes, there are a number of carcinomas with special morphologic and immunohistochemical features that are not included in the 5th WHO classification, while others are considered special morphologic patterns of invasive breast carcinoma of no special type. In this manuscript, we systematically review the literature on four different subtypes of invasive breast carcinoma, namely lymphoepithelioma-like breast carcinoma, breast carcinoma with osteoclast-like giant cells, signet-ring breast carcinoma, and metaplastic breast carcinoma with melanocytic differentiation. We describe their clinicopathological characteristics, focusing on the differential diagnosis, treatment, and prognosis.

Malignant Brenner Tumor of the Ovary: A Systematic Review of the Literature.

BACKGROUND: Malignant Brenner tumors are rare ovarian tumors, accounting for less than 1% of malignant ovarian neoplasms. The aim of this manuscript is to systematically review the current literature concerning malignant Brenner tumors. METHODS: We searched three medical databases (PubMed, Scopus, and Web of Science) for relevant articles published until 15 September 2023. RESULTS: After applying inclusion and exclusion criteria, 48 manuscripts describing 115 cases were included in this study from the English literature. CONCLUSIONS: We analyzed the demographic, clinical, pathological, and oncological characteristics of 115 patients with malignant Brenner tumors. The statistical analysis showed that recurrence was marginally statistically significantly related to tumor stage and was more common in patients with ascites and in women with abnormal CA-125 levels; patients that were treated with lymphadenectomy had better disease-specific survival.

Diagnostic Challenges during Inflammation and Cancer: Current Biomarkers and Future Perspectives in Navigating through the Minefield of Reactive versus Dysplastic and Cancerous Lesions in the Digestive System.

In the setting of pronounced inflammation, changes in the epithelium may overlap with neoplasia, often rendering it impossible to establish a diagnosis with certainty in daily clinical practice. Here, we discuss the underlying molecular mechanisms driving tissue response during persistent inflammatory signaling along with the potential association with cancer in the gastrointestinal tract, pancreas, extrahepatic bile ducts, and liver. We highlight the histopathological challenges encountered in the diagnosis of chronic inflammation in routine practice and pinpoint tissue-based biomarkers that could complement morphology to differentiate reactive from dysplastic or cancerous lesions. We refer to the advantages and limitations of existing biomarkers employing immunohistochemistry and point to promising new markers, including the generation of novel antibodies targeting mutant proteins, miRNAs, and array assays. Advancements in experimental models, including mouse and 3D models, have improved our understanding of tissue response. The integration of digital pathology along with artificial intelligence may also complement routine visual inspections. Navigating through tissue responses in various chronic inflammatory contexts will help us develop novel and reliable biomarkers that will improve diagnostic decisions and ultimately patient treatment.

The Correlation Between Progesterone and Mammographic Density in Postmenopausal Women: A Systematic Review of the Literature and Meta-Analysis.

Higher mammographic breast density in premenopausal and postmenopausal women is related to a higher breast cancer risk. In this review, we analyze the correlation between estrogen, progesterone, and mammographic density in postmenopausal women and clarify whether these findings are consistent across different types of mammographic breast density. We extracted data concerning mammographic density increases in the populations treated with estrogen-only hormone replacement therapy and those treated with estrogen and progestin hormone replacement therapy. Postmenopausal women treated with estrogen and progesterone regimens had a statistically significant lesser mammographic density increase than estrogen-only hormone replacement therapy regimens.