Visceral Medicine最新文献

[This corrects the article DOI: 10.1159/000548387.].

Introduction: Despite advances in multimodal therapy, local and distant recurrence remain major challenges in rectal cancer management. Preoperative MRI and pathological findings offer prognostic information on local burden of disease. However, the value of these factors in predicting recurrence is not fully defined. This study aimed to identify and reassess MRI and pathological predictors for recurrence in rectal cancer.

Methods: In this single-center retrospective study, patients with stage I-III rectal cancer who received surgery with curative intent between 2014 and 2021 at a German referral cancer center were analyzed using univariate analysis.

Results: A total of 279 consecutive patients were included. After a median follow-up of 54 months, local recurrence (LR) occurred in 20 patients (7.2%) and distant metastasis (DM) in 44 patients (15.8%). Advanced pathological UICC stage was found to be significantly associated with both LR (p = 0.003) and DM (p = 0.002). After neoadjuvant therapy, tumor downstaging correlated with a markedly lower incidence of DM (p = 0.010). A positive circumferential resection margin was found to be linked to a higher risk of DM (p = 0.035).

Conclusion: Our study identifies tumor downstaging after neoadjuvant therapy as a prognostically relevant factor. This finding emphasizes the necessity of incorporating treatment response into postoperative risk stratification to tailor an individualized surveillance strategy.

Background: Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis that can occur in the postoperative period, often mimicking surgical site infections (SSIs). The clinical overlap between PG and SSIs - including erythema, wound dehiscence, and purulent discharge - makes timely diagnosis challenging.

Case presentation: A 61-year-old female with a history of ovarian cancer and metachronous liver metastasis underwent an open left hemihepatectomy. On the fifth postoperative day, she developed erythema, wound dehiscence, and necrosis unresponsive to broad-spectrum antibiotics. Wound cultures remained sterile. Dermatologic consultation and histopathology confirmed the diagnosis of PG, characterized by dense neutrophilic infiltration and pyogenic folliculitis. High-dose corticosteroid therapy led to marked clinical improvement within 5 days, with full wound healing achieved by discharge.

Conclusion: Postoperative PG should be considered in non-resolving postoperative wound complications with negative cultures and antibiotic failure. In this context, prior exposure to PARP inhibitors may be a biologically plausible cofactor through immune modulation; however, a causal link remains unproven. Early dermatology consultation and biopsy are essential to avoid harmful debridement and expedite immunosuppression.

Background: Alveolar echinococcosis (AE) is a rare but potentially life-threatening parasitic disease caused by the larval stage of Echinococcus multilocularis, primarily affecting the liver with infiltrative, tumor-like growth. Sectional imaging plays a pivotal role in diagnosis, staging, and treatment planning. This study aimed to systematically evaluate the initial imaging findings in a cohort of patients with suspected AE, focusing on morphological and metabolic imaging features and their implications for staging and therapeutic decision-making.

Methods: We retrospectively analyzed all patients who presented with suspected AE at the University Hospital Ulm between January 2019 and December 2023 and had F-18-fluorodeoxyglucose positron emission tomography (F-18-FDG-PET/computed tomography [CT] or PET/ magnetic resonance imaging [MRI]) and/or MRI within 6 months of presentation. PET imaging was visually assessed for increased FDG uptake as a marker of metabolic activity. Lesions were classified according to the Kodama MRI classification. Imaging-based staging was performed using the PNM classification and compared with the clinical PNM stage.

Results: A total of 203 patients were included. PET imaging was performed in 198 cases (97.5%), while MRI was available in 94 patients (46.3%). Kodama types 2 (n = 30) and 3 (n = 55) were the most frequent lesion types. In the subgroup with both PET and MRI imaging (n = 89), PET activity was observed in 96.4% of Kodama type 2 and 90.6% of type 3 lesions, while no FDG uptake was noted in type 5 lesions. Imaging-based PNM classification disagreed with clinical staging in 56 cases (27.6%), likely due to standardized review by experienced radiologists and nuclear medicine specialists. PET/CT proved valuable for assessing extrahepatic and distant involvement, offering a whole-body evaluation that was more consistent than MRI, which often varied in protocol and anatomical coverage.

Conclusion: F-18-FDG-PET/CT is a cornerstone in the initial diagnostic workup and staging of AE, enabling both assessment of disease extent and evaluation of inflammatory activity in specialized centers. While MRI provides essential morphological details, its limited availability and heterogeneous acquisition protocols reduce its utility for comprehensive staging. Kodama lesion types correlate with metabolic activity, but further studies are needed to clarify their prognostic relevance. Our findings underscore the importance of standardized imaging protocols and the central role of PET/CT in managing newly diagnosed AE.

Background: Echinococcosis is a parasitic disease, caused by the larval stage of the genus Echinococcus. Echinococcus multilocularis and Echinococcus granulosus cause alveolar echinococcosis (AE) and cystic echinococcosis (CE) in humans. Pathologists may be confronted with the larval stage of both species. Diagnosis may be difficult due to the low incidence in daily routine. However, right diagnosis of the pathologist is still the gold standard and crucial for further treatment of the patient.

Summary: Macroscopically, specimens of AE show multiple small cysts and a bread-like appearance. Instead, CE manifests as solitary or multiple grape-like cysts. In this review, we give a short algorithm for the differential diagnosis on histological grounds. Hematoxylin and eosin staining is supported by an additional periodic acid-Schiff (PAS) staining, highlighting the laminated layer (LL) as key microscopic structure. Lymphocytes and fibrosis are present at the interface with the adjoining liver tissue. The main difference lies in the morphology of the LL. In the PAS staining, this deeply violet structure is fragmented and thin in AE, while in CE, it is broad and striated. Further important characteristics are the size of the cysts and the pericystic fibrosis. The different types of CT lesions correspond to different histological features. Treatment with benzimidazoles may influence morphology. Immunohistochemistry (IHC) with the monoclonal antibodies (mAbs) EmG3 and Em2G11 shows differences in staining patterns regarding AE and CE. IHC is decisive to settle the diagnosis in unclear situations and when only small particles of E. multilocularis (SPEMS) or E. granulosus (SPEGS) are present, e.g., in lymph nodes.

Key messages: The PAS-positive LL is the microscopic hallmark for the differential diagnosis of AE/CE. For further support in unclear situations, IHC with mAb EmG3 and mAb Em2G11 is advised.

Introduction: Hirschsprung's disease is a congenital anomaly affecting intestinal motility. Its main characteristic is the absence of ganglion cells in the distal colon, which results in chronic constipation. To date, confirmatory biopsies in the pediatric population have been obtained through suction biopsies or open surgical procedures. Therapeutic endoscopic full-thickness resection (EFTR) has been successfully used in adult endoscopy to treat various diseases of the lower gastrointestinal tract. This procedure has been shown to be safe and effective.

Methods: A single-center retrospective case series study from May 2024 to September 2025, including 13 pediatric patients aged 3.5-14.4 years (median 9.5 years) with therapy-refractory constipation, who underwent an EFTR biopsy using Ovesco diagnostic FTRD® as part of the diagnostic workup for Hirschsprung's disease. EFTR was performed in the distal rectum, 2 cm above the linea dentata, to exclude an ultrashort variant of Hirschsprung's disease.

Results: All EFTR procedures were successful, and only 1 patient had non-hemodynamically relevant rectal bleeding during the 1-year follow-up. All biopsies fulfilled the requirements to validate or exclude Hirschsprung's disease, showing an excellent success rate of full-thickness resection (100%).

Conclusions: This is the first case series of EFTR using the Ovesco diagnostic FTRD® technique in pediatric patients for the diagnosis of Hirschsprung's disease. EFTR is a safe, time-saving, and successful method that can be used to diagnose Hirschsprung's disease in pediatric patients starting from 3 years of age.

Background: Pancreatic cancer remains the fourth leading cause of cancer-related deaths in the USA despite its lower incidence, primarily due to late-stage diagnosis. While early detection could double survival rates, screening the general population is not cost-effective due to low disease prevalence and technical limitations.

Summary: This review examines the relationship between diabetes and pancreatic cancer, highlighting how diabetes types differently impact cancer risk. New-onset diabetes triples pancreatic cancer risk compared to the general population, while long-standing diabetes doubles it. Several prediction models have been developed to identify high-risk individuals among new-onset diabetes patients, with recent models achieving AUCs up to 0.91. Current biomarkers like CA 19-9 show improved utility when combined with other clinical parameters, though they remain inadequate for general population screening. Cost-effectiveness analysis suggests that screening becomes viable when 3-year cancer incidence exceeds 2% and 25% of cases are detected at a localized stage.

Key messages: (1) New-onset diabetes presents a stronger risk factor for pancreatic cancer than long-standing diabetes. (2) Multiple prediction models show promise but face challenges with missing data and cross-population validation. (3) Integrated approaches combining clinical parameters, biomarkers, and machine learning offer the most promising path forward for early detection. (4) Current detection rates fall below cost-effectiveness thresholds, highlighting the need for improved screening strategies.