Advanced Cancer-A Bad Consequence of a Missed Follow-Up after ESD in Barrett's Esophagus.

Barrett's esophagus(BE)is a precursor to adenocarcinoma of the esophagogastric transition. Thus, endoscopic surveillance is essential for the early diagnosis of dysplasia and neoplasm, allowing proper therapeutic. However, during the COVID-19 pandemic, surveillance frequently failed. We present a case of a male, caucasian, 65 years old, patient with early adenocarcinoma in BE. Submitted an endoscopic resection, but due to the COVID-19 pandemic patient lost the follow-up endoscopic exams. Returned with a T3N1 adenocarcinoma esophagus in resection area. The present report illustrates the consequences of the failure in follow-up after submucosal resection in COVID-19 pandemic context.

Prognostic Value of Tumor Regression Grade Based on Ryan Score in Squamous Cell Carcinoma and Adenocarcinoma of Esophagus.

PURPOSES: Tumor regression grade (TRG) of the primary tumor after neoadjuvant therapy is one of the most sensitive prognostic factors among patients with locally advanced esophageal cancer, although no TRG system is fully accepted. The Ryan score was proposed in 2005 to evaluate TRG in rectal cancer and could be adaptable for pathological evaluation of esophageal cancer. The objective of this study is to evaluate the prognostic value of the Ryan score for esophageal cancer in the setting of trimodal therapy. METHODS: We performed a retrospective cohort study in which patients with locally advanced esophageal cancer, submitted to neoadjuvant therapy followed by surgical resection, were selected. One hundred thirty-four patients were selected. All tissue specimens were assessed as per the TRG system proposed by Ryan et al. Survival curves were assessed by the Kaplan-Meier method and log-rank test. Chi-square test or likelihood-ratio test was used for absolute and relative variables. Kruskal-Wallis and analysis of variance tests were used to assess significant differences on a continuous dependent variable by a categorical independent variable. RESULTS: Of the 134 included patients, 94 (70.1%) had squamous cell carcinoma, and 40 (29.9%) adenocarcinoma. Ryan score was correlated with histological type (p < 0.001), and clinical (p = 0.044) and pathological (p < 0.001) staging. Mean follow-up was 31.1 months. Multivariate analysis showed that Ryan score can safely predict survival, and systemic and lymphatic recurrence (p < 0.05). CONCLUSIONS: Ryan score is an effective system to evaluate TRG and can predict risk for lymph node or distant metastasis, overall survival, and disease-free survival.

PANCREATIC SOLID-PSEUDOPAPILLARY NEOPLASM IN PATIENTS WITH FAMILIAL ADENOMATOUS POLYPOSIS.

BACKGROUND: Solid pseudopapillary neoplasm of the pancreas is an uncommon pancreatic tumor, which is more frequent in young adult women. Familial adenomatous polyposis is a genetic condition associated with colorectal cancer that also increases the risk of developing other tumors as well. AIM: The aim of this study was to discuss the association of familial adenomatous polyposis with solid pseudopapillary neoplasm of the pancreas, which is very rare. METHODS: We report two cases of patients with familial adenomatous polyposis who developed solid pseudopapillary neoplasm of the pancreas of the pancreas and were submitted to laparoscopic pancreatic resections with splenic preservation (one male and one female). RESULTS: ß-catenin and Wnt signaling pathways have been found to play an important role in the tumorigenesis of solid pseudopapillary neoplasm of the pancreas, and their constitutive activation due to adenomatous polyposis coli gene inactivation in familial adenomatous polyposis may explain the relationship between familial adenomatous polyposis and solid pseudopapillary neoplasm of the pancreas. CONCLUSION: Colonic resection must be prioritized, and a minimally invasive approach is preferred to minimize the risk of developing desmoid tumor. Pancreatic resection usually does not require extensive lymphadenectomy for solid pseudopapillary neoplasm of the pancreas, and splenic preservation is feasible.

Common variable immunodeficiency: an important but little-known risk factor for gastric cancer.

INTRODUCTION: although it is a rare disease, common variable immunodeficiency (CVID) stands out as the most frequent primary symptomatic immunodeficiency. Carriers are prone to a variety of recurrent bacterial infections, in addition to the risk of developing autoimmune diseases and neoplasms including gastric cancer (GC). Despite the recognized risk, there are no specific standardized protocols for the management of GC in these patients, so the reported oncological results are varied. Thus, this study aims to describe the clinicopathological characteristics and prognosis of patients with CVID undergoing surgical treatment of GC. METHODS: all patients with GC undergoing surgical treatment between 2009 and 2020 were retrospectively evaluated. Later, patients diagnosed with CVID were identified and this group was compared with the remaining patients without any immunodeficiency. RESULTS: among the 1101 patients with GC evaluated in the period, 10 had some type of immunodeficiency, and 5 were diagnosed with CVID. Patients with CVID had younger age, lower BMI, and smaller lesions compared to those without CVID. Four patients underwent curative gastrectomy and one patient underwent jejunostomy. Two patients died (1 palliative and 1 curative) and one patient had disease recurrence. There was no statistically significant difference regarding the incidence of postoperative complications and survival between the evaluated groups. CONCLUSION: the CVID incidence in patients with GC undergoing surgical treatment was 0.5%, occurring at a less advanced age, but with no difference regarding surgical and oncological results.

Esophagectomy in a patient with pulmonary histoplasmosis: A case report of surgical aspects and complications (with video).

INTRODUCTION: Esophagectomy is a challenging procedure associated with considerable morbidity. Previous pulmonary diseases, such as histoplasmosis fungal infection, may interfere in operative and postoperative outcomes after esophagectomy. Anastomotic leakage is one of the most feared complications after esophagectomy. However, new therapies developed such as vacuum procedure and esophageal prosthesis have been provenly beneficial. PRESENTATION OF CASE: We present a case with squamous cell carcinoma of the mid esophagus portion on a young patient with a pulmonary histoplasmosis history. After a multidisciplinary board, the patient underwent transhiatal esophagectomy with gastric-pull up and cervical anastomosis due to pulmonary disease. The patient later developed an anastomotic leak with mediastinal abscess. We describe this complication's management via an endoscopic vacuum system, esophageal prosthesis, and exhibit a video illustrating the technique. DISCUSSION: We illustrate the management of esophageal cancer associated with previous pulmonary disease. Histoplasmosis may misunderstand the esophageal cancer staging, and it can contribute to anastomotic leakage occurrence. An endoscopic vacuum system is an excellent tool for treating esophagogastric anastomosis fistula after esophagectomy, even when the drainage is accumulated in the mediastinum. The esophageal prosthesis may be used after mediastinal abscess resolution. CONCLUSION: Treatment of the association of esophageal cancer and histoplasmosis is feasible. However, care should be taken to avoid highly potential postoperative complications.

Pancreatic solid-pseudopapillary neoplasm in patients with familial adenomatous polyposis / Neoplasia sólida pseudopapilífera pancreática em pacientes com polipose adenomatosa familiar

ABSTRACT BACKGROUND: Solid pseudopapillary neoplasm of the pancreas is an uncommon pancreatic tumor, which is more frequent in young adult women. Familial adenomatous polyposis is a genetic condition associated with colorectal cancer that also increases the risk of developing other tumors as well. AIM: The aim of this study was to discuss the association of familial adenomatous polyposis with solid pseudopapillary neoplasm of the pancreas, which is very rare. METHODS: We report two cases of patients with familial adenomatous polyposis who developed solid pseudopapillary neoplasm of the pancreas of the pancreas and were submitted to laparoscopic pancreatic resections with splenic preservation (one male and one female). RESULTS: ß-catenin and Wnt signaling pathways have been found to play an important role in the tumorigenesis of solid pseudopapillary neoplasm of the pancreas, and their constitutive activation due to adenomatous polyposis coli gene inactivation in familial adenomatous polyposis may explain the relationship between familial adenomatous polyposis and solid pseudopapillary neoplasm of the pancreas. CONCLUSION: Colonic resection must be prioritized, and a minimally invasive approach is preferred to minimize the risk of developing desmoid tumor. Pancreatic resection usually does not require extensive lymphadenectomy for solid pseudopapillary neoplasm of the pancreas, and splenic preservation is feasible.

RESUMO RACIONAL: A neoplasia sólida pseudopapilífera do pâncreas é um tumor pancreático incomum, mais frequente em mulheres jovens. A polipose adenomatosa familiar, por sua vez, é uma condição genética associada a câncer colorretal e que também aumenta o risco de desenvolvimento de outros tumores. OBJETIVOS: Discutir a associação entre polipose adenomatosa familiar e neoplasia sólida pseudopapilífera, que é bastante rara. MÉTODOS: Reportamos dois casos de pacientes com polipose adenomatosa familiar, um homem e uma mulher, que desenvolveram neoplasia sólida pseudopapilífera do pâncreas e foram submetidos a ressecção laparoscópica com preservação esplênica. RESULTADOS: As vias de sinalização da ß-catenina e Wnt tem um papel importante na tumorigênese da neoplasia sólida pseudopapilífera, e sua ativação constitutiva devido a inativação do gene adenomatous polyposis coli na polipose adenomatosa familiar pode explicar a relação entre polipose adenomatosa familiar e neoplasia sólida pseudopapilífera. CONCLUSÕES: A ressecção do cólon deve ser priorizada, com preferência pela abordagem minimamente invasiva para minimizar o risco de desenvolvimento de tumor desmoide. A ressecção pancreática geralmente não requer linfadenectomia extensa para neoplasia sólida pseudopapilífera, portanto, a preservação esplênica é factível.