Thinking beyond the mass: ANCA-associated vasculitis mimicking a pancreatic malignancy.

Isolated pancreatic involvement is a rare initial presentation in patients with ANCA-associated vasculitis. We report a patient with a suspected malignant pancreatic mass, referred to our hospital for pancreaticoduodenectomy. However, the pancreatic mass proved to be the initial manifestation of ANCA-associated vasculitis.

One-stop-shop treatment for basal cell carcinoma, part of a new disease management strategy.

BACKGROUND: The number of skin cancer patients, especially patients with basal cell carcinoma (BCC), is rapidly increasing. Resources available at dermato-oncology units have not increased proportionally, which affects the throughput time of patients. OBJECTIVE: To assess the feasibility and safety of implementation of the one-stop-shop concept for the treatment of patients with BCC at a dermato-oncology unit. METHODS: A pilot study on a one-stop-shop concept for BCC was performed to investigate procedure safety and patient satisfaction. Fresh frozen sections were used to diagnose the tumours, and subsequently treatment with photodynamic therapy or excision was performed on the same day. Time spent in the hospital was measured and questionnaires were used to evaluate patient satisfaction. RESULTS: Sixteen patients, who together had 19 tumours, were included. Diagnoses were made within a mean time of 100 min (range 27-160 min). The mean throughput time was 4 hours and 7 min (range 60-420 min). No complications were observed, and patient satisfaction was high. CONCLUSION: The one-stop-shop concept for the treatment of skin cancer patients is feasible and efficient for both patients and dermato-oncology units. Further research is necessary to investigate cost-effectiveness when larger patient groups are involved.

Scrotal cancer: incidence, survival and second primary tumours in the Netherlands since 1989.

BACKGROUND: Since the 1970s there have been few epidemiological studies of scrotal cancer. We report on the descriptive epidemiology of scrotal cancer in the Netherlands. METHODS: Data on all scrotal cancer patients were obtained from the Netherlands Cancer Registry (NCR) in the period 1989-2006 and age-standardised incidence rates were calculated also according to histology and stage. Relative survival was calculated and multiple primary tumours were studied. RESULTS: The overall incidence rate varied around 1.5 per 1,000,000 person-years, most frequently being squamous cell carcinoma (27%), basal cell carcinoma (19%) and Bowen's disease (15%). Overall 5-year relative survival was 82%, being 77% and 95% for patients with squamous and basal cell carcinoma, respectively. In all, 18% of the patients were diagnosed with a second primary tumour. CONCLUSION: The incidence rate of scrotal cancer did not decrease, although this was expected; affected patients might benefit from regular checkups for possible new cancers.

Local recurrence in rectal cancer can be predicted by histopathological factors.

AIM: The main cause of local recurrence (LR) in rectal cancer is involvement of the circumferential resection margin (CRM). However, patients with a negative CRM can also develop LR, suggesting that additional factors are important for LR. The aim of this study was to identify histopathological factors predictive for the development of LR after primary rectal cancer treatment. METHODS: T x N x M0 patients treated for locally recurrent rectal cancer at the Catharina hospital from 1994 to 2006 (n=92) were matched with a control group of patients who did not develop LR after primary rectal cancer treatment for at least 2 years (n=185) based on the type of neoadjuvant treatment in a 1:2 ratio. The pathology of all primary rectal cancers was reviewed. Patient, treatment and histopathological characteristics were studied in relation to the development of LR with logistic regression. RESULTS: Logistic regression indicated the presence of lymphovascular invasion (LVI, OR 4.66, P<0.001), extramural venous invasion (EMVI, OR 4.54, P<0.001), positive CRM (OR 2.56, P=0.032), serosal involvement (OR 6.74, P=0.035) and poor differentiation (OR 2.59, P=0.012) as factors with an increased risk to develop LR. Older age was a protective factor (OR 0.95, CI 0.93-0.98, P=0.001). CONCLUSION: Apart from a positive CRM and serosal involvement, LVI, EMVI and poor differentiation are important independent predictive factors for the development of LR. Adjuvant therapy may be considered in the presence of these features in order to decrease the risk of a local recurrence.