Background: Sentinel lymph node (SLN) biopsy is the standard of care for breast cancer patients with non-palpable axillary lymph nodes. We evaluated the usefulness of contrast-enhanced ultrasonography in preoperative detection of malignant SLNs. Methods: 50 patients with breast cancer (median age: 60 years) underwent a color power Doppler ultrasonography with intravenous contrast (Sonovue®) preoperatively, and findings suggestive of metastatic disease to the SLN were documented. The final histopathological report and the radiological preoperative record were compared. Finally, the sensitivity, specificity and diagnostic accuracy of this evolving diagnostic modality were calculated. Results: Contrast-enhanced ultrasound scan identified a negative SLN in the axilla of 27 patients and final histopathology was negative for 30 cases in total, so negative predictive value was calculated as 90% and positive predictive value was 75%. Overall sensitivity was 83.33% and specificity was 84.38%. Moreover, the ability of contrast-enhanced ultrasound to differentiate between SLN status was only statistically significantly correlated with the actual final histopathological report (p < 0.001), while successful ultrasound prediction was not correlated with any factor. Conclusions: SLN status can be evaluated preoperatively using contrast-enhanced color Doppler ultrasonography with high accuracy.

Background: Ovarian vein thrombosis (OVT) is a rare, but serious condition that affects mostly postpartum women. A high index of suspicion is required in order to diagnose this unusual cause of abdominal pain.Case presentation: A 19-year-old woman at three days postpartum was admitted to our hospital because of severe right lower quandrant abdominal pain and fever 38.5'C. Physical examination revealed an acutely ill patient and right lower quadrant tenderness with positive rebound and Giordano signs. The patient underwent appendectomy which proved to be negative for acute appendicitis. Postoperatively fever and pain persisted and abdominal CT-scan with intravenous contrast agent demonstrated a thrombosed right ovarian vein. The patient was initiated on low-molecular weight heparin (LMWH) and antibiotic treatment and a month later a new abdominal CT-scan showed a patent right ovarian vein.Discussion: Pathophysiologically, OVT is explained by Virchow's triad, because pregnancy is associated with a hypercoagulable state, venous stasis due to compression of the inferior vena cava by the uterus and endothelial trauma during delivery or from local inflammation. Common symptoms and signs of OVT include lower abdomen or flank pain, fever and leukocytosis usually within the first ten days after delivery. The reported incidence of OVT ranges 0,05-0,18% of pregnancies and in most cases the right ovarian vein is the one affected. Anticoagulation and antibiotics is the mainstay of treatment of OVT. Complications of OVT include sepsis, extension of the thrombus to the inferior vena cava and renal veins, and pulmonary embolism. The incidence of pulmonary embolism is reported to be 13.2% and represents the main source of mortality due to OVT.Conclusions: OVT is a rare condition, usually in the postpartum period. A high index of suspicion is required for the prompt diagnosis and management especially in cases that mimic acute abdomen.

Purpose. Radical surgical resection with adjuvant chemotherapy or chemo-radiotherapy is the most effective treatment for pancreatic ductal adenocarcinoma (PDAC). However, relatively few studies investigate the prognostic significance of biological markers in PDAC. This study aims to look into the expressions of vimentin, Ki67, and CD44 in PDAC surgical specimens and their potential prognostic implications in survival. Method. The study was designed as retrospective, and vimentin, Ki67, and CD44 expressions were evaluated by immunohistochemistry in 53 pancreatic ductal adenocarcinoma cases. Overall survival was assessed by the Kaplan–Meier method. Results. Patients’ median age was 68 years. The median survival was 18 months. The tumors were T3-4 in 40/53 (75.5%), and metastases in lymph nodes were found in 42 out of 53 (79.2%) cases. On multivariate analysis, the size of primary tumor (p<0.001), the surgical resection margin status (p=0.042), and vimentin expression (p=0.011) were independently correlated with overall survival. Conclusions. Long-term survival after resection of PDAC is still about 15%. Vimentin expression is a potential independent adverse prognostic molecular marker and should be included in histopathological reports. Also, CD44 expression correlates with high Ki67, vimentin positivity, and N stage and may represent a potential target of novel therapeutic modalities in pancreatic adenocarcinoma patients.

(1) Background: To determine the impact of the COVID-19 pandemic in the management of colorectal cancer patients requiring surgery and to examine whether the restructuring of healthcare systems led to cancer stage upshifting or adverse treatment outcomes; (2) Methods: A systematic literature search of the MedLine, Scopus, Web of Science, and CNKI databases was performed (PROSPERO ID: CRD42021288432). Data were summarized as odds ratios (OR) or weighted mean differences (WMDs) with 95% confidence intervals (95% CIs); (3) Results: Ten studies were examined, including 26,808 patients. The number of patients presenting with metastases during the pandemic was significantly increased (OR 1.65, 95% CI 1.02–2.67, p = 0.04), with no differences regarding the extent of the primary tumor (T) and nodal (N) status. Patients were more likely to have undergone neoadjuvant therapy (OR 1.22, 95% CI 1.09–1.37, p < 0.001), while emergency presentations (OR 1.74, 95% CI 1.07–2.84, p = 0.03) and palliative surgeries (OR 1.95, 95% CI 1.13–3.36, p = 0.02) were more frequent during the pandemic. There was no significant difference recorded in terms of postoperative morbidity; (4) Conclusions: Patients during the pandemic were more likely to undergo palliative interventions or receive neoadjuvant treatment.

The aim of this manuscript is to review controversies in managing severe pancreatic fistula after pancreatic surgery. Significant progress in surgical technique and perioperative care has reduced the mortality rate of pancreatic surgery. However, leakage of the pancreatic stump still accounts for the majority of surgical complications after pancreatic resection. Various strategies have been employed in order to manage pancreatic fistula. Nonetheless high grade pancreatic fistula evokes controversy in relation to the choice of treatment. A Medline search was performed, with regard to conservative treatment options versus completion pancreatectomy for the management of pancreatic fistula grade C. Pancreatic fistula rates remain unchanged with an incidence ranging from 5%-20% and this is considered as the most important cause of postoperative death. Many authors claim that completion pancreatectomy has probably lost its role in favour of interventional radiology procedures, while others believe that completion pancreatectomy continues to have a place in the management of patients with severe clinical deterioration after pancreatic fistula who do not respond to non-surgical interventions. There is no agreement on the best clinical management of severe pancreatic fistula after pancreatic surgery. Completion pancreatectomy is reserved for patients not improving with conventional measures.

Gastrosplenic fistula is a rare clinical condition that occurs mostly in association with splenic or gastric lymphomas [ 1 ]. We report a case of a gastrosplenic fistula that formed secondary to a diffuse large B-cell splenic lymphoma and presented as upper gastrointestinal bleeding with hematemesis. A 68-year-old man was admitted to our hospital due to hematemesis. Endoscopy revealed a large cavitary lesion with necrotic material at the posterior gastric fundus ([ Fig. 1 ]), and histological examination of biopsy specimens taken from the cavity showed diffuse large B-cell non-Hodgkin’s lymphoma ([ Fig. 2 ]). Computed tomography (CT) revealed a large splenic mass with a fistulous tract between the gastric lumen and an air-filled necrotic splenic cavity ([ Fig. 3 ]). Surgical treatment with en bloc resection was preferred as initial treatment rather than chemotherapy, to avoid the risk of recurrence of bleeding. Chemotherapy was started 30 days postoperatively. The patient continues to remain under evaluation. Fig. 1 Endoscopic view following insertion of an endoscope into the cavitary lesion via a fistula. The patient was 68 years old and presented with hematemesis. Fig. 2 a, b Microscopic view of infiltration of the splenic parenchyma by diffuse large B-cell lymphoma (a original magnification × 100; b original magnification × 400). c Immunostaining of the neoplastic population with CD79a. Fig. 3 Abdominal computed tomography (CT) scan showing a large splenic mass infiltrating the gastric fundus. The mass contained air bubbles, suggestive of communication with the stomach. In cases of splenic lymphoma, close proximity of the gastric fundus to the spleen and the presence of the gastrosplenic ligament facilitate the union of these organs and the formation of a fistula as a result of growth and spread of the tumor cells, as well as tumor necrosis or infection. The gastrosplenic fistula may occur either spontaneously or secondary to chemo- or radiation therapy, with the possibility of massive hematemesis secondary to erosion of the splenic vessels by the gastric contents [ 2 ] [ 3 ]. Endoscopy usually aids direct visualization of the fistulous tract opening, which is seen as a cavitary lesion, and abdominal CT provides the definite diagnosis. Although there are reports of gastrosplenic fistula resolving with chemotherapy, early radical surgical resection seems to be the best initial treatment approach to avoid re-bleeding. Gastrosplenic fistula should be suspected in patients with splenic lymphoma and upper gastrointestinal bleeding. Definitive surgical treatment is warranted in such cases to avoid massive gastrointestinal bleeding [ 4 ] [ 5 ]. Endoscopy_UCTN_Code_CCL_1AB_2AD_3AB