Phenotypes of Metabolic Dysfunction-Associated Steatotic Liver Disease-Associated Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) typically develops as a consequence of liver cirrhosis, but HCC epidemiology has evolved drastically in recent years. Metabolic dysfunction-associated steatotic liver disease (MASLD), including metabolic dysfunction-associated steatohepatitis, has emerged as the most common chronic liver disease worldwide and a leading cause of HCC. A substantial proportion of MASLD-associated HCC (MASLD-HCC) also can develop in patients without cirrhosis. The specific pathways that trigger carcinogenesis in this context are not elucidated completely, and recommendations for HCC surveillance in MASLD patients are challenging. In the era of precision medicine, it is critical to understand the processes that define the profiles of patients at increased risk of HCC in the MASLD setting, including cardiometabolic risk factors and the molecular targets that could be tackled effectively. Ideally, defining categories that encompass key pathophysiological features, associated with tailored diagnostic and treatment strategies, should facilitate the identification of specific MASLD-HCC phenotypes. In this review, we discuss MASLD-HCC, including its epidemiology and health care burden, the mechanistic data promoting MASLD, metabolic dysfunction-associated steatohepatitis, and MASLD-HCC. Its natural history, prognosis, and treatment are addressed specifically, as the role of metabolic phenotypes of MASLD-HCC as a potential strategy for risk stratification. The challenges in identifying high-risk patients and screening strategies also are discussed, as well as the potential approaches for MASLD-HCC prevention and treatment.

Role of boost radiotherapy for local control of pure ductal carcinoma in situ after breast-conserving surgery: a multicenter, retrospective study of 622 patients.

PURPOSE: To evaluate the effect of boost radiotherapy on ipsilateral breast tumor recurrence (IBTR) for ductal carcinoma in situ (DCIS) after breast-conserving surgery and whole breast radiotherapy (WBRT) with or without boost. METHODS AND MATERIALS: Retrospective, multicentre study of 622 patients (624 tumors) diagnosed with pure DCIS from 1993-2011. RESULTS: Most tumors (377/624; 60.4%) received a boost. At a median follow-up of 8.8 years, IBTR occurred in 64 cases (10.3%). A higher percentage of patients with risk factors for IBTR received a boost (p < 0.05). Boost was not associated with lower rates of IBTR than WBRT alone (HR 0.75, 95% CI 0.42-1.35). On the univariate analyses, IBTR was significantly associated with tumor size (11-20 mm, HR 2.32, 95% CI 1.27-4.24; and > 20 mm, HR 2.10, 95% CI 1.14-3.88), re-excision (HR 1.76, 95% CI 1.04-2.96), and tamoxifen (HR 2.03, 95% CI 1.12-3.70). Boost dose > 16 Gy had a protective effect (HR 0.39, 95% CI 0.187-0.824). Multivariate analyses confirmed the independent associations between IBTR and 11-20 mm (p = 0.02) and > 20 mm (p = 0.009) tumours, and re-excision (p = 0.006). On the margin-stratified multivariate analysis, tamoxifen was a poor prognostic factor in the close/positive margin subgroup (HR 4.28 95% CI 1.23-14.88), while the highest boost dose ( > 16 Gy) had a significant positive effect (HR 0.34, 95% CI 0.13-0.86) in the negative margin subgroup. CONCLUSIONS: Radiotherapy boost did not improve the risk of IBTR. Boost radiotherapy was more common in patients with high-risk disease. Tumor size and re-excision were significant independent prognostic factors.

Management of breast ductal carcinoma in situ in Catalonia, Spain: Results from the Grup Oncologic Calalà-Occità-Catalonia survey with 9-year follow up.

INTRODUCTION: Reliable data on DCIS incidence and management are not available in many countries. The present study describes the management of DCIS in Catalonia, Spain in the year 2005 and compares these findings to data obtained in France. Local recurrence and late toxicity rates from 2005 through the end of 2014 are reported. MATERIALS AND METHODS: Observational survey of patients with pure DCIS (n = 270) diagnosed during 2005. A written questionnaire, the same as used in the French survey, was completed by 14 doctors at 12 cancer centres in Catalonia, Spain. RESULTS: Median patient age was 55 years (range, 29-89). Diagnosis was mammographic in 225 cases (83.3%). Treatment approaches included: mastectomy (10.4% of cases), breast-conserving surgery (BCS) alone (3.7%), and BCS plus radiotherapy (RT) (85.5%). Sentinel node biopsy and axillary dissection were performed in 27.4% and 5.6% of patients, respectively. Hormonotherapy was prescribed in 45.2% of cases. Tumour nuclear grade was as follows: low (16.7% of cases), intermediate (23%), and high (55.6%). Excision was complete (margins ≥1 mm) in 75% of patients treated with BCS alone vs. 95.7% for BCS+RT. The treatment approach varied widely: mastectomy rates ranged from 7.1% to 26.7% of centres, BCS+RT from 55.5% to 87.8%, and hormonotherapy from 3.3% to 83.3%. At a median follow-up of 102.6 months, 14 patients (5.6%) presented ipsilateral breast tumour recurrence. CONCLUSIONS: These findings on DCIS management in Catalonia are consistent with previous international reports. The inter-centre differences observed are similar to those reported in other international surveys during the same period.

Biological and pathological features in pregnancy-associated breast cancer: a matched case-control study.

BACKGROUND: The prognosis for breast cancer has been considered to be worsened by the coexistence of pregnancy. However, to date, significant controversy still exists regarding the pathological tumor features and prognosis of patients diagnosed with pregnancy-associated breast cancer (PABC). The aim of the present study was to analyze the different prognostic factors and outcome in PABC subset versus a non-PABC control group matched for age and year of diagnosis. MATERIALS AND METHODS: A total of 56 PABC cases were diagnosed from 1990 to 2008, for whom 73 non-PABC patients were identified. Pathological characteristics, immunohistochemical fea- tures, and differences in overall and disease-free survival were compared between both groups. RESULTS: Compared to non-PABC controls, PABC patients presented more advanced disease (31% vs 13%, p = 0.024) and greater lymph node involvement (53% vs 34%, p = 0.034). Pathological and tumor features tended to present poorer prognostic factors in the PABC subset. Survival was poorer in the PABC patients (five-year DFS 68% in PABC vs 86% in non-PABC, p = 0.12). However, analysing survival adjusted for stage and age, the authors did not find significant differences between both groups. CONCLUSIONS: PABC patients tended to be diagnosed in advanced breast disease and presented tumors with adverse pathological prognostic factors. While the authors found a poorer outcome in PABC group, no significant differences were observed with stage-matched analysis. The present results may suggest that the poorer prognosis observed within PABC women could not be due to pregnancy itself, but with a delay in diagnosis and tumor subtype pathological features.

Hormone receptor and HER2 status: The only predictive factors of response to neoadjuvant chemotherapy in breast cancer.

We report our experience in neoadjuvant breast cancer chemotherapy in a single centre between 2000 and 2011. We looked for predictive factors for response to neoadjuvant chemotherapy in the present study. A total of 110 consecutive breast cancer patients were treated with neoadjuvant chemotherapy in our centre. Pathological response was achieved in 24 HR+/HER2- (38.7%), 25 HER2+ (67.6%) and five triple-negative (45.5%) (p = 0.02) patients. No statistically significant differences were found in pathological tumour response according to T stage. The multivariate analysis revealed tumour subtype was the only associated factor for pathological response, with HER2 + tumours the best responders, OR 3.9 (1.5-9.9): 5-year DFS was 40% HER2+/no response; 78% HER2+/response; 65% HR+/HER2-/no response; 82% HR+/HER2-/response; 25% triple-negative/no response and 100% triple-negative/response. HR and HER2 status were the only prognostic factors for pathological response. pCR was correlated with survival in all tumour subtypes.

Role of lymphadenectomy in endometrioid endometrial cancer.

OBJECTIVE: To assess the risk factors associated with node involvement. STUDY DESIGN: In the period 1990-2008 a total of 265 endometrial cancers were treated in the Institut Universitari Dexeus. We analysed the rate of myometrial invasion, tumour grade, histological type and node involvement. RESULTS: Overall, 86% of tumours were endometrioid, 5.3% papillary serous, 4.9% mixed and 2.6% endometrial stroma sarcoma. Among those with endometrioid histology, lymphadenectomy was not performed (NL) in 85 cases (37.2%), whereas pelvic lymphadenectomy (PL) or pelvic and aortic lymphadenectomy (PAL) was carried out in 84 (36.84%) and 59 patients (25.87%), respectively. In NL patients the overall disease-free survival (DFS) rate at five years was 92.8%. In the PL group, node involvement was observed in 2.4% of cases and the five-year DFS rate was 92.3%. Among PAL patients, 18.6% showed node involvement (72.7% positive pelvic nodes and 63.6% aortic). Aortic involvement was present in 5.9% of cases when there was no pelvic disease, whereas in the presence of positive pelvic nodes the rate of aortic involvement was 50%. The DFS rate at five years was 93.6%. Referring to the risk factors, when infiltration was > 50% of the myometrium, lymph node involvement occurred in 37% of cases and G3 tumors in 45.5%. CONCLUSIONS: Node involvement is more commonly observed in cases with > 50% myometrial invasion and G3, accounting for 25% of cases that can be considered as at-risk patients. When node involvement is present it is equally distributed between the pelvic and aortic levels. As node involvement is a predictive factor for distant metastasis, the 25% of patients considered to be at risk should undergo pelvic and aortic lymphadenectomy

Conservative treatment by endoscopy of a cesarean scar pregnancy: two case reports.

BACKGROUND: Cesarean section scar pregnancy is the rarest form of ectopic pregnancy and the most dangerous due to the high risk of uterine rupture and hemorrhage. CASE: We present two case reports of women diagnosed with an ectopic cesarean scar pregnancy. We performed conservative treatment because both patients desired fertility preservation. The first case was treated with laparoscopy and hysteroscopy simultaneously. For the second case the treatment started with an ultrasound-guided injection of methotrexate. Surgical laparoscopy and hysteroscopy were subsequently performed simultaneously. Four months later, the first woman had a spontaneous singleton pregnancy. An elective cesarean was performed. CONCLUSION: In these two case reports we have presented our experience with endoscopic surgery in the management of two patients who had a cesarean scar pregnancy and desired to preserve their fertility.

Detección de la adecuación del tratamiento mediante atenolol en los hipertensos del Área Básica de Salud de Súria / No disponible

No disponible

Cribado de la hipertensión arterial y detección del tabaquismo en la población de 44 y 45 años del Área Básica de Salud de Súria / No disponible

No disponible

Neurofibroma of the vaginal wall.

BACKGROUND: Von Recklinghausen's disease is characterized by cutaneous manifestations but it is a systemic disease which may affect the genitourinary tract. CASE: A 20-year-old woman with a history of type-1 neurofibromatosis attended our center due to a vaginal nodule. Surgical treatment consisted of an incisional biopsy of the nodule. The anatomopathological diagnosis was plexiform neurofibroma. CONCLUSION: Periodical check-ups are recommended in asymptomatic vaginal neurofibroma whereas its radical excision should be avoided as such surgery is highly aggressive.

Carcinoma oculto de la mama metastásico en ganglio intramamario / No disponible

Se presenta un caso de una mujer de 63 años con un nóduloen los cuadrantes externos de la mama derecha con característicasmamográficas y ecográficas de benignidad, en la queel estudio citológico evidencia un carcinoma, el cual histológicamentecorresponde a un ganglio linfático intramamario metastásicocon un primario en la glándula mamaria no detectado

A case of a 63-year old woman with a nodular lesion in theexternal quadrants of the right breast. The lesion was mammographicallyand ultrasonographically benign, but fine needleaspiration showed a carcinoma. Pathologic examinationrevealed a metastatic intramammary lymph node, but the primarycarcinoma in the breast could not be detected

Tuberculosis peritoneal. Descripción de un caso / Peritoneal tuberculosis. Report of a case

Debemos pensar en el diagnóstico de tuberculosis peritoneal en cualquier paciente con dolor abdominal de etiología desconocida, ascitis y fiebre. Puede presentarse de manera insidiosa (forma clásica), o bien como infertilidad primaria o secundaria (forma actual). El diagnóstico se realiza con el estudio anatomopatológico de los granulomas caseificantes y mediante el cultivo del líquido peritoneal. Nuevas pruebas diagnósticas, como el estudio del ADA (ascitis fluid adenosine deaminasa), pueden cambiar el algoritmo diagnóstico de esta enfermedad (AU)

Adenocarcinoma in situ de cérvix / In situ adenocarcinoma of the cervix

Objetivo: Considerar las indicaciones del tratamiento conservador en el adenocarcinoma in situ cervical (AIS).Material y métodos: Mediante la serie conjunta del Institut Universitari Dexeus y Hospital Materno-Infantil de la Vall d'Hebron se valoran retrospectivamente (1989-1998) una serie de 51 adenocarcinomas cervicales (incluyendo 11 AIS). Seguimiento medio: 30,5 meses.Resultados: Correlación con CIN en 55 por ciento AIS. La correlación citológica con adenocarcinoma fue alta (59,3 por ciento), pero sólo de 3,7 por ciento con AIS. Inicialmente el 72 por ciento (ocho) de los casos fueron tratados mediante conización. De ellos, el 25 por ciento presentan margen afecto (todos tratados mediante asa). Pese al margen libre se realizó histerectomía en cinco pacientes. De las tres pacientes con tratamiento conservador, una quedó gestante (embarazo normal a término). Se detectó una recidiva (VAIN III), pero tratada de primera intención mediante histerectomía.Conclusiones: La conización es una opción a plantear en pacientes con deseo genésico y que acepten un riego de enfermedad residual del 8 por ciento (AU)

Lymphadenectomy in ovarian cancer.

Current guidelines for the surgical staging of ovarian cancer include the removal of retroperitoneal lymph nodes (pelvic and aortic). In most centres this is achieved by means of laparotomy, but advanced laparoscopic techniques have also been performed and still further prospective controlled studies with long-term follow-up are necessary to validate the efficacy. Lymph node sampling, short of complete dissection, should be avoided because it may be insufficient to detect metastasis. In any case, laparoscopic lymphadenectomy as well as open surgery, should be in the hands of properly trained subspecialists in gynaecologic oncology. Of 97 patients with ovarian carcinoma studied in our hospital, 68% were treated by means of complete staging laparotomy (FIGO). Lymphadenectomy was spared in 14 cases with stage I tumours (mainly serous) without changes in overall survival. In 15% metastases in pelvic lymph nodes were present. In the same proportion aortic lymph nodes were positive. In 5.5%, aortic metastases were present in the absence of pelvic involvement.

Ovarian germ cell tumors.

UNLABELLED: Ovarian germ cell tumors (OGCT) are a special type of ovarian cancers due to their histology, age of presentation, prognosis and treatment. MATERIAL AND METHODS: Eighteen cases of OGCT out of 313 total ovarian cancer diagnosed in Hospital Materno-Infantil Vall d'Hebredn between 1975 and 1994 are present. RESULTS: Mean age of the patients was 36 years. The most frequent symptom at diagnosis was abdominal bloating (44.5%). Echography was the most used diagnostic method (67%). Surgery was conservative in 44% of the cases, radical in 50% of the cases and palliative in one case. The histological types were 6 dysgerminomas and 6 malignant teratomas (33.3%), 3 malignant dermoid cysts (16.7%), 2 yolk sac tumors (11%) and 1 embryonal carcinoma. According to FIGO 1987 staging classification 14 patients were in stage I disease and 4 in stage III disease. Polychemotherapy was performed on 6 patients and postsurgical radiotherapy was performed on 2 patients. Five patients recurred in an average time of 25 months. The five-year survival rate, according to the Kaplan-Meier method, was 80% in stage I and 0% in stage III. Five-year survival rate of patients only surgically treated was 65% and in patients who underwent postsurgical co-adjuvant treatment it was 100%. CONCLUSION: Conservative surgery followed by a BEP regimen may be performed nowadays with efficacy and acceptable toxicity while conserving the fertility of these patients.