UHMWPE suture induced pseudotumor following arthroscopic rotator cuff repair: A case report

UHMWPE suture shows excellent biocompatibility and complication associated with suture debris had not been described before in shoulder surgery. In this study, a case of a 38-year-old man with a wear debris pseudotumor mimicking osteochondromatosis in the subacromial bursa five years after arthroscopic rotator cuff repair using a composite braid suture (a polydioxanone core with a sleeve of UHMWPE) was presented. Histological examination confirmed the presence of suture fragments surrounded with the osteochondral layer without inflammatory reactions. The present study implies the potential risk of free fragmented remnants from the UHMWPE suture. Because of the silent nature of the histological response, a high index of suspicion should be necessary to disclose the chanciness of its use.

Enteropathies with villous atrophy but negative coeliac serology in adults: current issues

ObjectiveThe differential diagnosis and management of seronegative enteropathies is challenging due to the rarity of these conditions, the overlap of clinical and histopathological features and the current lack of an international consensus on their nomenclature.DesignThis is a narrative review providing pragmatic guide on the investigation and clinical management of seronegative enteropathies in adults based on the available literature and our clinical experience.ConclusionsSeronegative coeliac disease is the most frequent cause among the heterogeneous group of seronegative enteropathies and its diagnosis is confirmed by the clinical and histological response to a gluten-free diet after the exclusion of other causes of villous atrophy. Correct identification and targeted management of seronegative enteropathies is mandatory because of the variation in terms of clinical outcomes and prognosis.

Proton Pump Inhibitor Intake During Chemoradiotherapy for Rectal Cancer: A Retrospective Study

Purpose: Proton pump inhibitors (PPIs) are one of the most widely used drugs worldwide and are involved in several drug interactions. Recently, several studies have suggested that PPIs may interfere with the efficacy of capecitabine. This study primarily aimed to investigate the effects of PPI intake on the pathological response rate of patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy with capecitabine. Method: A retrospective study was conducted at a French Comprehensive Cancer Center. Patients with locally advanced rectal cancer treated with neoadjuvant radiochemotherapy followed by surgery were included in the study. Demographic parameters, treatment characteristics, survival data, and PPI intake data were collected. Survival data were estimated using the Kaplan-Meier method and compared using the log-rank test.Results: In total, 215 patients were included, of whom 135 (62.8%) were men. The PPI intake frequency was 16.1%. The rate of complete histological response was lower in patients on PPIs than in those not on PPIs (8.7% vs. 19%, p=0.36). PPI intake was not associated with a statistically significant decrease in recurrence-free survival (hazard ratio [HR]=1.26, 95% confidence interval [CI] 0.61–2.60, p=0.54) or overall survival (HR=0.95, 95% CI 0.33–2.76, p=0.93).Conclusion: There is a trend to a lower complete histological response with PPI co-medication in patients treated for locally advanced rectal cancer. However, the safety of PPIs could not be confirmed. Further ancillary studies of prospective clinical trials or studies using the Health Data Hub are necessary to explore the effects of PPIs on rectal cancer more accurately.

Can Interferon therapy change natural course of Hepatitis Delta infection, A clinical and pathological study.

Introduction: Chronic delta hepatitis (CDH) has a worser outcome than other viral hepatitis. High dose, long-term Interferon-α (IFNα) is the approved treatment and may ameliorate course. We evaluated long-term histological outcomes of CDH patients treated with IFNα. Method: Histologically proved non-cirrhotic CDH patients treated with high dose IFNα for at least 1 year were grouped as cirrhotic and non-cirrhotic at the end of treatment. Non-cirrhotic patients had also post-treatment liver biopsies. Patients were grouped as histologically responsive and non-responsive regarding fibrosis status. Histological, virological and biochemical courses were analyzed. Results: 48 patients were treated with IFNα (conventional and/or pegylated) for median 24 months with a post-treatment follow-up of 5 years. During the follow-up, cirrhosis developed in 24 patients, 5 of whom were decompensated. There was no difference between pre- and post-treatment fibrosis scores of 24 non-cirrhotic patients at the end of follow-up. Among patients; 13% (n:6) had decreased, 21%(n:10) had steady and 16% (n:8) had increased fibrosis scores. Persistent viral response (PVR) was achieved in 16 patients (33%). 20% of entire group was histologically responsive (decreasing or steady fibrosis scores with improved necro-inflammatory score) while near 80% had histological progression/cirrhosis. PVR was significantly associated with histological response. Conclusions : Long-term natural course of patients who were treated with high dose IFNα for at least one year was evaluated clinically and histologically. Despite the association of PVR with histological response, IFNα treatment didn’t change the natural course of CDH, clinical and histological progression continued in two-thirds of the cases despite treatment.

The prognostic significance of a histological response to preoperative chemotherapy in patients with synchronous colorectal liver metastases

Objective: Preoperative chemotherapy (PC) for colorectal liver metastasis (CRLM) is widely used to improve prognosis, but its clinical benefit has not been fully established. This study aimed to assess the effectiveness of PC for synchronous CRLM and the correlation between the histological response to PC and survival. Summary of Background Data: We enrolled 69 patients who underwent initial hepatectomy for synchronous CRLM between 2004 and 2018 at Gifu University Hospital. Methods: We retrospectively analyzed the clinicopathological factors and outcomes of 69 patients who underwent hepatectomy after receiving PC (PC group: n = 43) or who underwent upfront hepatectomy (non-PC group: n = 26). In the PC group, the patients were divided into the Grade 1 (n = 27) and Grade 2/3 (n = 16) groups according to their histological responses to PC. Results: The median survival and 5-year overall survival (OS) rates were 80.9 months and 61.5%, respectively, in the PC group and 71.7 months and 61.5%, respectively, in the non-PC group ( P = 0.867). Regarding recurrence-free survival (RFS) and remnant liver-RFS, there were no significant differences between the two groups ( P = 0.087 and 0.291). However, in a subgroup analysis, the median 5-year OS, RFS, and remnant liver RFS were significantly longer in the Grade 2/3 than Grade 1 group ( P = 0.008, P = 0.002, and P < 0.001, respectively). Conclusions: Some patients benefit from PC, and the histological response to PC had prognostic significance for patients with synchronous CRLM.

Histological regression of gastrointestinal peritoneal metastases after systemic chemotherapy

Objectives Peritoneal metastases (PM) are relatively resistant to systemic chemotherapy, and data on histological response to therapy is rare. The aim of this study was to quantify the treatment response of PM after systemic chemotherapy. Methods Retrospective monocentric cohort study of 47 consecutive patients with PM from gastrointestinal origin undergoing surgery (cytoreduction: CRS + Hyperthermic IntraPEritoneal Chemotherapy [HIPEC] or Pressurized IntraPeritoneal Aerosol Chemotherapy [PIPAC]) after prior systemic chemotherapy from 1.2015 to 3.2019. Tumor response was assessed using the 4-scale Peritoneal Regression Grading System (PRGS) (4: vital tumor to 1: complete response). Results Patients had a median of 2 (range: 1–7) lines and 10 (3–39) cycles of prior systemic chemotherapy. A median of four biopsies (range: 3–8) was taken with a total of 196 analyzed specimens. Twenty-four biopsies (12%) showed no histological regression (PRGS4), while PRGS 3, two and one were diagnosed in 37 (19%), 39 (20%), and 69 (49%) specimens, respectively. A significant heterogeneity was found between peritoneal biopsies in 51% patients. PRGS correlated strongly with peritoneal spread (PCI, p<0.0001), and was improved in patients with more than nine cycles of systemic chemotherapy (p=0.04). Median survival was higher in patients with PRGS < 1.8 (Quartiles one and 2) than higher (Q3 and Q4), but the difference did not reach significance in this small cohort. Conclusions PRGS is an objective too to describe histological response of PM of GI origin after systemic chemotherapy. This response differs significantly between patients, allowing to distinguish between chemosensitive and chemoresistant tumors.

Comparison of Methods for Analyzing Radiological Response of Colorectal Cancer Liver Metastasis After Neoadjuvant Chemotherapeutic Treatment

Background: We analyzed different methods used to assess the radiological responses of patients undergoing neoadjuvant chemotherapy and metastasectomy treatment for liver metastases associated with colorectal cancer (CRC) by comparing the response evaluation criteria in solid tumors (RECIST) 1.1, the modified RECIST, and the criteria of the European Association for the Study of the Liver (EASL) methods and the histological response obtained after metastasectomy. Objectives: We aimed to determine the optimal radiological method to assess the response of colorectal liver metastases to neoadjuvant chemotherapy. Materials and Methods: We conducted a retrospective study of CRC patients treated for liver metastases who had received neoadjuvant chemotherapy in our hospital between January 2000 and December 2017. We analyzed the agreement between the methods for analyzing the radiological response using the quadratic weighted kappa coefficient (κ). We studied the overall survival and analyzed factors related to survival using the Kaplan-Meier method. We performed multivariate analysis to study the prognostic factors of survival. We analyzed the relationship between the radiological and histological responses using Goodman and Kruskal's gamma (γ). Results: A significant agreement was observed between the modified RECIST and EASL methods (κ = 0.841, P < 0.001). Cox regression multivariate analysis indicated the RECIST 1.1 criteria as an independent prognostic factor (P = 0.03). The γ value showed a significant relationship between the three radiological response methods and histological response. Conclusion: In our study, we showed that using RECIST 1.1 criteria is the ideal radiological analysis method for studying CRC liver metastases treated with neoadjuvant chemotherapy when compared to other methods that are based on functional imaging markers.