Vanishing bile duct syndrome (VBDS) is a rare condition characterized by progressive loss, destruction, and disappearance of the intra-hepatic bile ducts, leading to cholestasis and ductopenia. The exact mechanism of development of VDBS has not been established yet. Diagnosis of VBDS mainly relies on clinical and disease related presentations, but liver biopsy is compulsory for diagnosis. Due to the low incidence reported in the literature, a standardized treatment of VDBS has not been established; hence, this rare condition must be managed at a tertiary liver referral center. Here, we report the management and treatment of VBDS of an 81-year-old woman without any history of exposure to antibiotics, neoplasms, etc.

Dermatofibrosarcoma protuberans (DFSP) is a rare neoplasm characterized by a high rate of local recurrence and a low risk of metastases. Occurrence in the breast is extremely rare and requires an adequate preoperative diagnosis for a correct management. We report a case of a giant exophytic DFSP of the right breast in a young-aged woman. Radical mastectomy was carried out without clinical evidence of local recurrence after 2 years follow-up. Specific pathological features and recommendations for the clinical management are discussed.

Background: Survivorship considerations have gained increasing importance in patients with early breast cancer. Every surgical procedure poses a risk of complications and a potential negative impact on patient‐reported outcomes (PROs), thereby driving growing interest in de‐escalation strategies in breast cancer surgery. In this context, we aimed to assess complication rates, the potential role of physiatric rehabilitation in managing these complications, and the impact of axillary surgery on PROs. Methods: This retrospective single‐center cohort study included breast cancer patients who underwent surgery between January 2022 and March 2023 at the Breast Unit of Policlinico Umberto I, Rome. Among 164 patients operated on during the study period, 71 who underwent axillary surgery and received postoperative physiatric evaluation according to the institutional care pathway (PDTA) were included. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was administered to evaluate PROs. Results: Among the included patients ( n = 71), SLNB was performed in 71.83% and ALND in 21.13%. A total of 34/71 patients (47.89%) developed complications requiring rehabilitative treatment and were classified as cases, while the remaining patients constituted the control group. Overall, shoulder painful mobility limitation (56.34%) (SPML), motor deficit (54.93%) (MD), and sensory deficit (46.48%) (SD) were the most frequent complications, whereas lymphedema (LE) and scapular winging (SW) occurred in 4.23% each. More extensive axillary procedures were associated with a higher number of lymph nodes removed ( p < 0.0001). Cases had significantly more lymph nodes removed than controls ( p = 0.0003). Patients requiring rehabilitation were younger on average than controls. Recovery time differed significantly between cases and controls ( p < 0.0001), with most patients recovering within 3 months from the first physiatric visit. DASH scores were significantly worse in patients requiring rehabilitative treatment than in controls ( p < 0.0001). The mean DASH score was 14%. Higher DASH values were associated with postoperative complications requiring rehabilitation and delayed or absent recovery, particularly SPML, DM, DS, and SW. Conclusions: Functional impairment of the upper limb remained frequent and may affect patients’ daily activities. These findings support the importance of integrating surgical management with early physiatric evaluation and rehabilitation to optimize functional recovery. Systematic assessment using patient‐reported outcome measures (PROMs), such as the DASH questionnaire, may help identify disability early and support patient follow‐up.

The aging population is rapidly increasing the volume and complexity of geriatric surgery, with a growing number of elective and emergency procedures. Older adults may gain substantial benefits from surgery, yet they face higher vulnerability to complications and slower recovery due to reduced physiological reserve and frailty, which is distinct from multimorbidity. Decision-making must therefore be individualized, integrating patient preferences, functional status, and long-term goals. Risk stratification requires multidimensional approaches combining American Society of Anesthesiologists (ASA) status, Charlson Comorbidity Index and frailty indices. Preoperative optimization including comorbidity management, nutritional support and prehabilitation, polypharmacy review, and cognitive/functional screening—reduces complications and healthcare costs. Intraoperatively, careful anesthetic dosing, goal-directed fluid therapy, temperature control, and continuous monitoring are essential; delirium prevention relies on minimizing deliriogenic drugs, ensuring orientation, promoting mobilization, and maintaining hydration. Specialty-specific considerations must be taken into account. Preoperative multidisciplinary team discussions enhance decision-making and outcomes. Postoperative Enhanced Recovery After Surgery (ERAS®) strategies emphasize early feeding, multimodal analgesia, mobilization, and prevention of delirium, infection, venous thromboembolism, and pressure ulcers. Future perspectives involve precision medicine, artificial intelligence, telemedicine, and dedicated geriatric surgical pathways.

Basosquamous cell carcinoma (BSCC) is a rare malignancy usually arising on sun-exposed areas of the skin. BSCC is described as a rare variant of Basal cell carcinoma (BCC) which shows clinical and microscopic features of both BCC and of Squamous cell carcinoma (SCC). We report the case of a 70-year-old male with a cutaneous lesion of the nipple-areola complex (NAC); to the best of our knowledge, this is the first ever reported patient with BSCC in this area. The lesion had a fast growth, but, due to the COVID19 crisis, the patient only came to our observation one year after onset of this condition. Physical examination showed a bleeding red ulcerated lesion that involved the NAC, measuring 27 mm × 20 mm. Biopsy showed a BSCC. Pre-operative breast ultrasound scan, mammogram and MRI were all performed before surgery, which consisted of simple mastectomy and sentinel lymph-node biopsy. The patient was discharged home on the 4th post-operative day, and at 18-month follow-up there are no signs or clinical evidence of local recurrence or metastases. Diagnosis of BSCC of the nipple-areola complex requires high index of suspicion and a thorough differential diagnosis, management, and suitable radical treatment due to well described high rates of recurrence and of metastases. Differential diagnosis with similar lesions (e.g., Paget’s disease, Bowen’s disease, BCC, and SCC) should also be taken into account.