Research

10 pages, 2746 KiB

Open AccessArticle

Clinical Predictors of Grade Group Upgrading for Radical Prostatectomy Specimens Compared to Those of Preoperative Needle Biopsy Specimens

by Masayuki Tomioka, Chiemi Saigo, Keisuke Kawashima, Natsuko Suzui, Tatsuhiko Miyazaki, Shinichi Takeuchi, Makoto Kawase, Kota Kawase, Daiki Kato, Manabu Takai, Koji Iinuma, Keita Nakane, Tamotsu Takeuchi and Takuya Koie

Diagnostics 2022, 12(11), 2760; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12112760 - 11 Nov 2022

Viewed by 1079

Abstract

Background: Decision-making and selection of treatment modalities for newly diagnosed prostate cancer (PCa) are often determined by risk stratification using grade group (GG), prostate-specific antigen (PSA), and clinical stage. The discrepancies between needle biopsy (NB) and radical prostatectomy (RP) specimens often occur because [...] Read more.

Background: Decision-making and selection of treatment modalities for newly diagnosed prostate cancer (PCa) are often determined by risk stratification using grade group (GG), prostate-specific antigen (PSA), and clinical stage. The discrepancies between needle biopsy (NB) and radical prostatectomy (RP) specimens often occur because of the sampling errors in NB or multifocal features of PCa. Thus, we aimed to estimate the preoperative clinical factors for predicting GG upgrading after robot-assisted RP (RARP). Methods: In this retrospective study, we reviewed the clinical and pathological records of patients who underwent RARP at Gifu University Hospital. We focused on patients with organ-confined PCa who had not received neoadjuvant therapy prior to RARP. The primary endpoint was identified as the predictive factor of GG upgrading for RARP specimens compared to those of NB specimens. Results: Eighty-one patients were included in this study. The enrolled patients were divided into two groups: those who had GG upgrading for RARP specimens (the NB upgrade group) or those who did not have GG upgrading (the no upgrade group). The median age of all patients was 70 years, and the median body mass index (BMI) was 22.9 kg/m². The median neutrophil count was 3720/μL, lymphocyte count was 1543/μL, and neutrophil-to-lymphocyte ratio (NLR) was 2.24. In univariate analysis, BMI, PSA, neutrophil count, and NLR were significantly associated with GG upgrading in RARP specimens compared to NB specimens. BMI and NLR were identified as strong predictive factors for GG upgrading in RARP specimens in the multivariate analysis. Conclusions: Although this study’s small number of enrolled patients was a vital weakness, BMI and NLR might have been significantly correlated with GG upgrading for RP specimens compared with NB specimens. Therefore, BMI and NLR may have potential benefits for newly diagnosed patients with PCa in terms of decision-making and the selection of treatment modalities. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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9 pages, 2297 KiB

Open AccessArticle

Visible Lymph Affluents in the D3 Volume: An MDCTA Pictorial Essay

by Bojan V. Stimec and Dejan Ignjatovic

Diagnostics 2022, 12(10), 2441; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102441 - 09 Oct 2022

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Abstract

Background: There seems to be a gap in knowledge of the anatomy of mesenteric lymphatics between the superior mesenteric nodes and the intestinal trunk. To our knowledge, these central lymph vessels were not hitherto systematically searched for, described, or morphometrically analyzed. Our aim [...] Read more.

Background: There seems to be a gap in knowledge of the anatomy of mesenteric lymphatics between the superior mesenteric nodes and the intestinal trunk. To our knowledge, these central lymph vessels were not hitherto systematically searched for, described, or morphometrically analyzed. Our aim was to identify those vessels on the routine multidetector computerized tomography angiography (MDCTA), performed prior to right colectomy for cancer, with extended mesenterectomy, central vascular ligation, and D3 lymphadenectomy. Methods: A total of 420 MDCTA datasets were analyzed utilizing manual segmentation and 3D reconstruction, with the aid of image processing software Osirix, Mimics, and 3-matic. The 3D models and masks underwent a detailed topographic and morphometric analysis. Results: Significant vascular-like structures, having neither origin nor termination on the blood vessels, were noted in 18 cases (4.3%) in the D3 volume. The dimensions of visible lymph vessels varied, their mean diameter was 1.81 ± 0.61 mm, and the mean length was 38.07 ± 22.19 mm. In the vast majority of cases, the lymph vessels were situated in front of the superior mesenteric artery (SMA), coursing either longitudinally cranially (13 cases) or transversely/obliquely to the left (5 cases). In all cases but one, the lymph vessel passed at the left-hand side of the middle colic artery. As for the course shape, in seven cases, the lymph vessel appeared highly serpiginous. Conclusions: The regular MDCTA can provide valuable information on mesenteric lymphatics and aid in surgical planning. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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11 pages, 1302 KiB

Open AccessArticle

Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

by Chaoran Yu, Zhiyuan Zhou, Bin Liu, Danhua Yao, Yuhua Huang, Pengfei Wang and Yousheng Li

Diagnostics 2022, 12(10), 2289; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12102289 - 22 Sep 2022

Cited by 1 | Viewed by 1425

Abstract

Background: Gastric signet ring cell carcinoma (GSRCC) is a subset of gastric cancer with distinct histological and inconsistent prognosis outcome. Currently, the association between the adequate regional lymph node and proper nodal staging in GSRCC is rarely noticed. Materials and methods: Clinical data [...] Read more.

Background: Gastric signet ring cell carcinoma (GSRCC) is a subset of gastric cancer with distinct histological and inconsistent prognosis outcome. Currently, the association between the adequate regional lymph node and proper nodal staging in GSRCC is rarely noticed. Materials and methods: Clinical data of GSRCC were retrieved from the Surveillance, Epidemiology, and End Results database. Beta-binomial distribution model was employed for the estimation of the probability of missing nodal disease, followed by the development of a nodal staging score (NSS). Results: A total of 561 GSRCC patients were included in this study, with 193 in lymph node-negative and 368 in lymph node-positive diagnoses. As the number of examined lymph nodes increased, the probability of missing nodal disease decreased rapidly, with T stage-specific curves. The probability of missing nodal disease in T4 was lower than that in T1. NSS calculation indicated that T1 stage patients commonly had NSS > 0.8. However, with the NSS of T2–T4 to reach 0.8, the number of examined lymph node was required to be larger than 12 in T2, 17 in T3 and 27 in T4. NSS ≥ 0.75 (quantile 75%) subgroup in T2–T4 subgroups tended to have better outcome; however, without significant prognostic value. Conclusions: NSS is served as a reliable and feasible tool in adequate nodal staging of GSRCC with statistical basis and provides further evidence for clinical decision making. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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Review

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25 pages, 1523 KiB

Open AccessReview

Pregnancy and Gastric Cancer: A Narrative Review

by Adrian Constantin, Roxana Constantin, Florin Achim, Bogdan Socea and Dragos Predescu

Diagnostics 2023, 13(11), 1909; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13111909 - 29 May 2023

Viewed by 1849

Abstract

Cases of digestive cancers diagnosed during pregnancy are rare. The increasing prevalence of pregnancy in women aged 30–39 years (and not exceptionally 40–49 years) could explain the frequent co-occurrence of cancers and pregnancy. The diagnosis of digestive cancers in pregnancy is difficult due [...] Read more.

Cases of digestive cancers diagnosed during pregnancy are rare. The increasing prevalence of pregnancy in women aged 30–39 years (and not exceptionally 40–49 years) could explain the frequent co-occurrence of cancers and pregnancy. The diagnosis of digestive cancers in pregnancy is difficult due to the overlap between neoplasm symptomatology and the clinical picture of pregnancy. A paraclinical evaluation may also be difficult depending on the trimester of the pregnancy. Diagnosis is also delayed by practitioners’ hesitation to use invasive investigations (imaging, endoscopy, etc.) due to fetal safety concerns. Therefore, digestive cancers are often diagnosed during pregnancy in advanced stages, where complications such as occlusions, perforations, and cachexia have already arisen. In this review, we highlight the epidemiology, clinical aspects, paraclinical evaluation, and particularities of the diagnosis and treatment of gastric cancer during pregnancy. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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17 pages, 880 KiB

Open AccessReview

Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review

by Narcis Octavian Zarnescu, Ioana Dumitrascu, Eugenia Claudia Zarnescu and Radu Costea

Diagnostics 2023, 13(1), 1; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13010001 - 20 Dec 2022

Cited by 5 | Viewed by 3049

Abstract

Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results [...] Read more.

Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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Other

Jump to: Research, Review

8 pages, 3951 KiB

Open AccessInteresting Images

Schwannoma: A Rare Case of Submucosal Gastric Tumor

by Cosmina Fugărețu, Cătalin Mișarca, Lucian Petcu, Raluca Șoană, Andrada Cîrnațiu, Marin Valeriu Surlin, Stefan Patrascu and Sandu Ramboiu

Diagnostics 2023, 13(12), 2073; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13122073 - 15 Jun 2023

Cited by 1 | Viewed by 999

Abstract

Schwannoma is a tumor that originates from the Schwann cells that surround a neuron’s axon. This tumor is very rare in the gastrointestinal tract and develops submucosally from intestinal nerve plexuses. The most common location for gastrointestinal schwannomas is the stomach, where they [...] Read more.

Schwannoma is a tumor that originates from the Schwann cells that surround a neuron’s axon. This tumor is very rare in the gastrointestinal tract and develops submucosally from intestinal nerve plexuses. The most common location for gastrointestinal schwannomas is the stomach, where they account for only 0.2% of gastric tumors. We present the case of a 56-year-old asymptomatic patient who was diagnosed, following a routine ultrasound examination, with an abdominal tumor. An abdominal MRI confirmed the gastric origin of the tumor. Although a subsequent upper-digestive endoscopic ultrasound was performed, a definitive diagnosis could not be established. Thus, a laparoscopic wedge resection of the stomach was performed. The immunohistochemical examination of the tumor established the diagnosis of benign schwannoma. Despite the availability of advanced endoscopy and imaging techniques, the diagnosis of gastric schwannoma is very rarely preoperative. The immunohistochemical identification of S-100 on the surgical specimen confirmed the diagnosis. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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9 pages, 1479 KiB

Open AccessCase Report

Giant Gallbladder Tumor, Unusual Cancer—Case Report and Short Review of Literature

by Adrian Constantin, Florin Achim, Tudor Turcu, Adelina Birceanu, Anca Evsei, Bogdan Socea and Dragos Predescu

Diagnostics 2023, 13(2), 194; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics13020194 - 05 Jan 2023

Viewed by 1950

Abstract

Background: Giant gallbladder is an uncommon condition that can result from a benign pathology and rarely presents with malignancy. Intracholecystic papillary–tubular neoplasm (ICPN) is a relatively new entity first described by V. Adsay in 2012 and included in the World Health Classification of [...] Read more.

Background: Giant gallbladder is an uncommon condition that can result from a benign pathology and rarely presents with malignancy. Intracholecystic papillary–tubular neoplasm (ICPN) is a relatively new entity first described by V. Adsay in 2012 and included in the World Health Classification of Digestive System Tumours in 2019. Intracholecystic papillary-tubular neoplasm is a preinvasive lesion with an incidence of around 1% that may present as four histologic subtypes—biliary, gastric, intestinal, or oncocytic—of which the biliary subtype has the highest risk of associated invasive cancer. Although invasive carcinoma is present in about 50% of cases of ICPN, these patients have a significantly better prognosis than those with usual gallbladder cancer, suggesting that the entities may have distinct biological signatures. Case report: A 77-year-old female presented to the hospital with progressive swelling in the right hemiabdomen, a loss of appetite, and weight loss. MRI highlighted a giant abdominal tumor located in the right hypochondrium and right abdominal flank with liver invasion (segment V). Preoperatively, a gallbladder 25 × 17 cm in size was noted, and the patient underwent radical cholecystectomy. It was surprising to find such a giant malignant gallbladder tumor, diagnosed as invasive poorly cohesive carcinoma associated with ICPN. Discussion: A megacholecyst is a rare discovery. Although most often found in benign pathologies, giant gallbladder cancer can be considered. The neoplastic features and the loco-regional extension of the tumor must be evaluated by imaging scans. Few cases of giant benign gallbladder have been reported in the literature; however, this appeared to be the largest resectable gallbladder carcinoma reported to date according to the literature. Conclusion: The stage of gallbladder neoplasia is not correlated with the size of the gallbladder. Regardless of tumor size, the prognosis seems to be directly related to the stage, morphology, and resectability. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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5 pages, 2232 KiB

Open AccessInteresting Images

Spontaneous Left External Iliac Vein Rupture

by Cosmina Fugărețu, Cătalin Mișarca, Gina Vlada, Andrada Cîrnațiu, Cosmin Buzea and Daniela Marinescu

Diagnostics 2022, 12(11), 2820; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12112820 - 16 Nov 2022

Cited by 1 | Viewed by 1396

Abstract

Spontaneous rupture of the Iliac Vein is very rare in practice. In over 90% of cases, the venous lesion is located on the left side. The exact etiology of this condition is unknown. Spontaneous injury of the iliac vein is thought to be [...] Read more.

Spontaneous rupture of the Iliac Vein is very rare in practice. In over 90% of cases, the venous lesion is located on the left side. The exact etiology of this condition is unknown. Spontaneous injury of the iliac vein is thought to be favored by intense exercise, constipation, cough, labor, May-Thurner syndrome or pre-existing inflammatory changes in the venous wall are also implicated. We present the case of an 83-year-old woman who is brought to the Emergency Department for abdominal pain located in the left flank and in the left iliac fossa, which appeared after a medium physical exertion. After an emergency contrast-enhanced abdominal CT scan, the diagnosis of spontaneous rupture of the left external iliac vein is established. Surgery is performed with extreme urgency by retroperitoneal approach and due to the very precarious condition of the patient, venous ligation is done, wishing to perform a Palma-Dale venous bypass at a later time. Although a rare cause of spontaneous retroperitoneal hematoma, a non-traumatic rupture of the common or external iliac vein should be considered in patients in shock with massive retroperitoneal bleeding, accompanied by a high mortality rate. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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15 pages, 1905 KiB

Open AccessSystematic Review

Look beyond the Mirror: Laparoscopic Cholecystectomy in Situs Inversus Totalis—A Systematic Review and Meta-Analysis (and Report of New Technique)

by Octavian Enciu, Elena Adelina Toma, Adrian Tulin, Dragos Eugen Georgescu and Adrian Miron

Diagnostics 2022, 12(5), 1265; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051265 - 19 May 2022

Cited by 6 | Viewed by 2223

Abstract

Background: Laparoscopic cholecystectomy in situs inversus totalis (SIT) is a technically and physically demanding procedure for surgeons and there is still a lack of consensus regarding the best technical approach in such cases. We conducted a systematic review and meta-analysis to evaluate port [...] Read more.

Background: Laparoscopic cholecystectomy in situs inversus totalis (SIT) is a technically and physically demanding procedure for surgeons and there is still a lack of consensus regarding the best technical approach in such cases. We conducted a systematic review and meta-analysis to evaluate port placement, the dominant hand of the surgeon, preoperative imaging, morbidity, and mortality. Methods: We searched MEDLINE, SCOPUS, Web of Science, and the Cochrane Library for studies of patients with SIT that underwent laparoscopic cholecystectomy. Of 387 identified records, 101 met our inclusion criteria, all of them case reports or case series of maximum of 6 patients. Results: Out of the 121 patients included in the analysis, 94 were operated on using a “mirrored American” technique, 12 using the “Mirrored French”, 9 employed single-port techniques, and 6 described novel port placements. Even though most surgeries were conducted by a right-handed surgeon (93 cases), surgeries performed by the seven left-handed surgeons yielded shorter intervention times (p = 0.024). Preoperative imaging (CT, MRI, MRCP, ERCP) also correlated with a lower duration of surgery (p = 0.038. Length of stay was associated with the type of disease, but not with other studied endpoints. Morbidity was less than 1%, and conversion rates and mortality were nil. Conclusions: Cholecystectomy in SIT is a safe but challenging procedure and surgeons should prepare in advance for the unfamiliar aspects of completing such a task. While preoperative imaging and a left-handed surgeon are beneficial in terms of surgery length, when these are not available surgeons should focus on achieving the most comfortable setting based on their experience and tailor their approach to the patient at hand. Further studies are needed in order to properly describe and evaluate intraoperative findings as well as surgeon-dependent factors that could improve future recommendations. Full article

(This article belongs to the Special Issue Abdominal Surgical Diseases: Diagnosis, Treatment and Management 2.0)

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