Long-term Surveillance Research Articles

Results After Surgical Correction of Coarctation of the Aorta in Adults

Aim: This retrospective study aimed to determine the impact of coarctation surgical repair on arterial blood pressure in adults over 18 years of age. Materials and methods: This retrospective study included 17 patients with aortic coarctation in QSUT, Cardiac Surgery Service, from January 2007 to March 2024. Results: 22 patients with coarctation of the aorta included in this study were mostly male12(70%) versus 5 (30%) females. All patients had preoperative hypertension. Main systolic blood pressure was 160 ± 28mm Hg (range, 120 to 220 mm Hg). All patients had preoperative CT Angiography (the mean gradient across the coarctation was 62 ± 27 mm Hg). After surgical repair, the mean gradient was 24 ±4.3 mmHg. The operative technique was an extra-anatomic bypass for 22 patients. Of the 22 patients with preoperative hypertension, 5 were normotensive (systolic blood pressure ≤ 140 mm Hg, diastolic blood pressure ≤ 90 mm Hg) with no medication. 4 patients were receiving medication: 1 required single-drug therapy, and 3 patients required two drugs. There were no repeat operations. No patient had evidence of a cerebrovascular accident. There were no hospital deaths and no late morbidity. Conclusions: Surgical repair of coarctation in adults has proved to be an effective procedure and significantly reduces arterial hypertension. However, long-term surveillance is mandatory and should include exercise testing to identify patients with potential hypertension. Echocardiography is the most patient’s friendly method to evaluate CoA.

Endovascular abdominal aortic aneurysm repair (EVAR) outcomes of unibody and single/double docking limb endografts in Medicare beneficiaries between 2012 and 2018.

The evaluation of perioperative and long term outcomes for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA) using anatomic (unibody) and proximal neck fixated (docking limbs) endografts across consecutive time cohorts. This study compares the outcomes of EVAR in Medicare patients stratified by mode of fixation. All patients who underwent EVAR between 2012 and 2018 were identified in the Medicare database. Anatomic fixation (AF) and proximal fixation (PF) grafts were differentiated using Current Procedural Terminology (CPT) codes. The AF population was divided into three-time cohorts based on iterative changes in graft design: Cohort 1: (01/01/2012-20/07/2014); Cohort 2: (21/07/2014-09/05/2016); and Cohort 3: (10/05/2016-31/12/2017). The PF cohort was similarly divided into these three periods. Outcomes were evaluated through 31/12/2020 and included all-cause mortality, aortic rupture, and aortic-related reintervention. 32,031 patients underwent EVAR during the study period; 4729 were AF and 27,302 were PF. There were more women (p < .001) and patients with peripheral vascular disease (PVD) (p < .001) in the AF group. There were no group differences in perioperative outcomes. In Cohort 1, there was a higher rate of reintervention (11.9% vs 7.6%; p < .001) and aortic rupture (5.3% vs 4.0%; p = .019) in the AF group compared to the PF group. In Cohort 2, reintervention, aortic rupture, and reintervention rates were similar between the two groups (p = NS). In Cohort 3, the reintervention and aortic rupture rates were similar between the two groups (p = NS). The higher rates of aortic rupture and reintervention seen in the AF group in Cohort 1 when compared with the PF group did not persist in Cohorts 2 and 3. This suggests that improvements in graft design may have led to durability which is similar to that of PF grafts. However, late aneurysm related complications are inherent risks after EVAR and long-term surveillance remains necessary.

SURG-39. LONG-TERM RESULTS OF INTERVENTION FOR GROWING INCIDENTAL MENINGIOMAS OR CONTINUED ACTIVE SURVEILLANCE, A PROSPECTIVE COHORT STUDY

Abstract Incidental meningiomas are common findings. They represent a clinically challenging cohort, without a detailed consensus on their management. The risk of tumor progression and that of intervention must be considered. Long-term prospective data on incidental meningiomas are sparse. We aimed to evaluate the long-term effect of Gamma Knife Radiosurgery (GKRS), surgical resection and continued observation for growing incidental meningiomas. A prospective database of 62 patients (70 tumors) commenced under active surveillance was established in 2009. Radiological and clinical data was obtained until sept 2023. The results of long-term observation (group 1) and intervention with GKRS (group 2) or surgery (group 3) at progression was analyzed. Due to growth, 41 (58.6%) tumors were treated. The mean growth rate was higher prior to GKRS (2.1 cm 3 /y) and surgery (0.4 cm 3 /y) than during long-term active surveillance (0.009 cm 3 /y) (p &amp;lt; 0.001). The meningiomas became in mean 31.3% and 99.1% smaller after GKRS and resection, respectively. In comparison, tumors under long-term surveillance increased in mean 27.2% (p &amp;lt; 0.001). According to the RANO response criteria, the complete, partial, and minimal response versus stable disease rates were higher following intervention, the overall progressive disease rates were similar (Group 1; 20.7%, group 2: 11.4% and group 3: 16.7%) (p = 0.232). Treatment versus no-treatment did not affect overall survival (Group 1; 10.3 y, group 2: 11.8 y and group 3: 13.5 y (p = 0.264). No symptom development was registered in group 1. In group 2, 2.9% experienced transient (grade 2) adverse events, and in group 3, 50% suffered permanent (grade 4) adverse events according to the Common Terminology Criteria for Adverse Events (CTCEAv5). Intervention reduces tumor volume; however, the clinical significance remains uncertain and side effects are not negligible. Active surveillance is safe, saves &amp;gt; 40% of patients from unnecessary interventions and does not compromise future treatments. The optimal timing of intervention should be further explored.

Diagnostic Value of Maximal Systolic Acceleration Measurements in the Follow-up of Complex Endovascular Aortic Repair: Illustration of a Concept.

After complex endovascular aortic repair (cEVAR), long-term surveillance is advocated to monitor for potential (stent-related) complications. Although various imaging modalities are used, computed tomography angiography remains the standard in current clinical practice worldwide. However, radiopaque markers can cause metal artifacts and scattering, hampering assessment of patency of side branches. The maximal systolic acceleration (ACCmax) is a relatively new duplex ultrasound (DUS) parameter measured distal to a stenosis, avoiding in-stent assessment and scattering. The aim of this article is to illustrate the potential diagnostic utility of the ACCmax after cEVAR and visceral artery stenting in general. The ACCmax is measured at the maximal slope of the upstroke during the systolic phase in arterial flow. By manually connecting 2 points, a tangent line is created in which the maximal acceleration is automatically calculated and expressed in m/s2. A higher value reflects better arterial perfusion proximal to its measurement point. One measurement of a visceral artery takes about 5 minutes. ACCmax measurements can be a useful addition during DUS follow-up after cEVAR or visceral artery stenting, possibly decreasing radiation exposure, nephrotoxicity, and health care costs. Long-term surveillance after complex endovascular aortic repair (cEVAR) is necessary to monitor for potential (stent-related) complications. Although CTA is the most common modality for imaging, metal artifacts and scattering can hamper the assessment of stent patency. The maximal systolic acceleration (ACCmax) is a duplex ultrasound based parameter that reflects arterial perfusion proximal to its measurement point. Due to its noninvasive nature, it can be a useful addition during follow-up after cEVAR or visceral artery stenting, possibly decreasing radiation exposure, nephrotoxicity and health care costs as well.

Measuring the Vaccine Success Index: A Framework for Long-Term Economic Evaluation and Monitoring in the Case of Rotavirus Vaccination

New vaccination programs measure economic success through cost-effectiveness analysis (CEA) based on an outcome evaluated over a certain time frame. The reimbursement price of the newly approved vaccine is then often reliant on a simulated ideal effect projection because of limited long-term data availability. This optimal cost-effectiveness result is later rarely adjusted to the observed effect measurements, barring instances of market competition-induced price erosion through the tender process. However, comprehensive and systematic monitoring of the vaccine effect (VE) for the evaluation of the real long-term economic success of vaccination is critical. It informs expectations about vaccine performance with success timelines for the investment. Here, an example is provided by a 15-year assessment of the rotavirus vaccination program in Belgium (RotaBIS study spanning 2005 to 2019 across 11 hospitals). The vaccination program started in late 2006 and yielded sub-optimal outcomes. Long-term VE surveillance data provided insights into the infection dynamics, disease progression, and vaccine performance. The presented analysis introduces novel conceptual frameworks and methodologies about the long-term economic success of vaccination programs. The CEA evaluates the initial target vaccination population, considering vaccine effectiveness compared with a historical unvaccinated group. Cost-impact analysis (CIA) covers a longer period and considers the whole vaccinated and unvaccinated population in which the vaccine has direct and indirect effects. The economic success index ratio of CIA over CEA outcomes evaluates long-term vaccination performance. Good performance is close to the optimal result, with an index value ≤1, combined with a low CEA. This measurement is a valuable aid for new vaccine introductions. It supports the establishment of robust monitoring protocols over time.

Cancer survivors and cardiovascular diseases: from preventive strategies to treatment.

During the last decades, progress in the treatment of oncological diseases has led to an increase in the survival of cancer patients: cancer survivors (CS). Thus, the incidence of CS has increased enormously, in both adult CS and childhood and adolescent CS. Unfortunately, CS treated with anthracyclines, chest radiotherapy (RT) and other potentially cardiotoxic drugs have a higher risk of cardiovascular (CV) toxicity: heart failure with reduced ejection fraction (HFrEF), valve diseases, coronary artery diseases, vascular diseases and pericardial diseases. In fact, chest irradiation can cause coronary artery diseases that can be latent until at least 10 years after exposure; also, valvular heart diseases can appear after >20 years following irradiation; heart failure may appear later, several years after anticancer drugs or RT. Therefore, it is very important to stratify the CV risk of cancer patients at the end of cardiotoxic drugs, to plan the most appropriate long-term surveillance program, in accordance with 2022 ESC Guidelines on Cardio-Oncology, to prevent late cardiovascular complications. Monitoring of cancer patients must not stop during anticancer treatment but it must continue afterwards, depending on the patient's CV risk. CV toxicity risk should be reassessed 5 years after therapy to organize long-term follow-up. Considering late cardiotoxicity in CS, our review aims to evaluate the incidence of cardiovascular diseases in CS, their mechanisms, surveillance protocols, preventive strategies, diagnosis and treatment.

FREQUENCY OF SQUAMOUS CELL CARCINOMA IN POST BURN PATIENTS

Burn injuries, particularly those leading to chronic scars, can predispose individuals to the development of squamous cell carcinoma (SCC). The risk of malignant transformation increases with burn severity and long-term scarring. Understanding the prevalence of SCC in post-burn patients is crucial for implementing preventive and management strategies. Objective: To assess the frequency of squamous cell carcinoma (SCC) in patients with post-burn scars and evaluate associations between demographic and burn-related factors with the development of SCC. Methods: A prospective descriptive study was conducted on 70 patients with a history of burn injuries and resulting scars. The study was carried out over a defined period at a tertiary care hospital. Patient demographic variables such as age, gender, socioeconomic background, and education level were collected. The severity of burns was categorized as partial-thickness or full-thickness, and the aetiology of burns was classified as thermal, chemical, or electrical. Burn locations were also documented. Histopathological examination of biopsy specimens from suspicious scars confirmed SCC diagnosis. Statistical analysis using chi-square tests was employed to identify associations between categorical variables and SCC occurrence. Results: Of the 70 patients included, 53 were males (75.7%) and 17 females (24.3%), with a mean age of 53.97 ± 4.91 years. Full-thickness burns were observed in 57.1% of the patients, while 42.9% had partial-thickness burns. The most common burn cause was thermal (45.7%), with the lower extremities being the most affected region (57.1%). SCC developed in 8.6% (6 out of 70) of the patients. The latency period for SCC ranged between 28 and 37 years, with an average of 31.5 years. Full-thickness burns were more commonly associated with SCC development compared to partial-thickness burns. Conclusion: The study reported a frequency of 8.6% for squamous cell carcinoma in patients with post-burn scars. Full-thickness burns were associated with a higher risk of SCC development. Long-term surveillance and proactive management of burn scars are critical in preventing malignant transformations.

One Year of Wastewater Surveillance in South Africa Supporting COVID-19 Clinical Findings Across Two Waves of Infection

Wastewater-based epidemiology (WBE) has been an important tool for the detection of COVID-19 outbreaks. The retrospective analysis of COVID-19 data is vital to understand the spread and impact of the virus as well as to inform future planning and response efforts. In this study, we evaluated the SARS-CoV-2 RNA levels in wastewater from 21 wastewater treatment plants (WWTPs) in the City of Cape Town (South Africa) over a period of 12 months and compared the (inactive) SARS-CoV-2 viral RNA in wastewater between wave 2 (November 2020 to January 2021) and wave 3 (June 2021 to September 2021). The SARS-CoV-2 RNA expression was quantified in wastewater using quantitative real-time PCR (qRT-PCR) by targeting the nucleocapsid (N) gene, and the resultant signal was normalized to the WWTP design capacity and catchment size. Our findings show that the maximum SARS-CoV-2 RNA signal was significantly higher in wave 3 than in wave 2 (p &lt; 0.01). The duration of wave 3 (15 weeks) was longer than that of wave 2 (10 weeks), and the wastewater surveillance data supported the clinical findings, as evidenced by the two distinct waves. Furthermore, the data demonstrated the importance of long-term wastewater surveillance as a key indicator of changing trends.

Perianal leiomyosarcoma as a rare sequela of rectal cancer radiotherapy: a case report

Radiation-induced sarcomas (RIS) are iatrogenic malignancies that arise following high-dose radiotherapy, posing a significant clinical challenge due to their poor prognosis and resistance to conventional treatments. The incidence of RIS is increasing with advancements in radiotherapy techniques. This report presents a case of a 71-year-old male diagnosed with stage III rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy and curative surgery. Three years postoperatively, he developed a low-grade radiation-induced leiomyosarcoma in the perianal region. Histopathological examination confirmed a spindle cell neoplasm with notable immunohistochemical markers. RIS often presents as aggressive high-grade tumors resistant to radiotherapy and chemotherapy, necessitating surgical resection as the primary treatment. This case underscores the importance of long-term surveillance post-radiotherapy and highlights the need for innovative therapeutic strategies, including immunotherapy. Despite being rare, RIS poses a significant risk following cancer treatment, making early detection through vigilant monitoring and advancements in therapeutic approaches crucial for improving patient outcomes.

Electro-capacitive cancer therapy using wearable electric field detector: a review

Electro-capacitive cancer therapy (ECCT), a less invasive and more targeted approach using wearable electric field detectors, is revolutionizing cancer therapy, a complex process involving traditional methods like surgery, chemotherapy, and radiation. The review aims to investigate the safety and efficacy of electric field exposure in vital organs, particularly in cancer therapy, to improve medical advancements. It will investigate the impact on cytokines and insulation integrity, as well as contribute to improving diagnostic techniques and safety measures in medical and engineering fields. Wearable electric field detectors have revolutionized cancer therapy by offering a non-invasive and personalized approach to treatment. These devices, such as smart caps or patches, measure changes in electric fields by detecting capacitance alterations. Their lightweight, comfortable, and easy to-wear nature allows for real-time monitoring, providing valuable data for personalized treatment plans. The portability of wearable detectors allows for long-term surveillance outside clinical settings, increasing therapy efficacy. The ability to collect data over extended periods provides a comprehensive view of electric field dynamics, aiding researchers in understanding tumor growth and progression. Technology advancements in electro-capacitive therapy, including wearable devices, have revolutionized cancer treatment by adjusting electric field intensity in real-time, enhancing personalized medicine, and improving treatment outcomes and patient quality of life.

Granulosa cell tumor – Different faces of one neoplasm. A case series

IntroductionGranulosa cell tumor (GCT) accounts for 3–5 % of all ovarian malignancies, being the most common among those originating from the sex cords and ovarian stroma. GCTs can be divided into juvenile and adult types, with the latter occurring mostly in perimenopausal women. These hormonally active tumors present diverse clinical manifestations, primarily related to elevated estrogen levels. The treatment is primarily surgical; other methods, mainly chemotherapy, are also used. Presentation of casesThree cases highlight the heterogeneity of GCTs. Case 1 involved a 34-year-old woman diagnosed with ovarian tumor during routine gynecological follow-up. Stage IA GCT was diagnosed. Fertility-sparing surgery followed by chemotherapy led to a favorable outcome, including two pregnancies. Case 2 involved a postmenopausal woman with a large pelvic mass. Surgery revealed a Stage IA GCT. Chemotherapy was stopped early due to complications. Case 3 featured a 47-year-old with acute abdominal symptoms caused by a ruptured GCT, leading to emergency surgery and subsequent radical treatment. DiscussionGCTs are hormonally active, causing symptoms such as abnormal bleeding or abdominal discomfort. Prognosis is generally favorable, especially in early-stage cases. Long-term surveillance is essential due to the potential for late recurrences. Fertility-sparing surgery is feasible in young patients, while chemotherapy is mainly used for advanced disease or recurrence. ConclusionGCTs, in addition to being rare, present with a wide range of clinical manifestations. Individualized treatment based on patient age, tumor stage, and fertility plans is crucial for favorable outcomes. Long-term monitoring is recommended due to the risk of late recurrence.

New onset of left ventricular dysfunction and diastolic dysfunction are uncommon in patients with her2+ breast cancer after completion of cancer therapy

Abstract Background Cardiotoxicity from anthracyclines and trastuzumab is common among patients with breast cancer during therapy. However, there are limited data on new onset of cardiotoxicity (systolic or diastolic dysfunction) after completion of therapy. This knowledge has implications to guide long-term follow-up. Purpose The aim of this study was to evaluate the incidence of cancer therapy related cardiac systolic dysfunction (CTRCD) and diastolic dysfunction (DD) in women with HER2+ breast cancer after completion of cancer therapy and compare to incidence during cancer therapy. Methods We conducted a prospective cohort study of women with HER2+ breast cancer who were treated with sequential anthracycline and trastuzumab therapy, with or without radiation therapy (The EMBRACE-MRI trial, NCT02306538). Comprehensive surveillance echocardiograms were performed at baseline and every 3 months during treatment, early post-trastuzumab, then at years 1, 2, and 3 post trastuzumab completion. CTRCD was defined as a reduction in 3D-left ventricular ejection fraction (LVEF) by ≥ 10% from baseline to &amp;lt; 55%. Diastolic dysfunction was defined as per the American Society of Echocardiography guidelines. Results A total of 136 female patients, with a mean age of 51.1 ± 9.2 years were recruited. Among them, 15.4% had hypertension, 3.7% had diabetes mellitus, and 10.3% had dyslipidemia. The mean cumulative doxorubicin equivalent dose was 203.9 ± 12.5 mg/m2, 120 patients received radiation therapy with the mean heart dose of 170.8 ± 75.9 cGy. During cancer treatment, 27 out of 136 patients (19.9%) developed CTRCD. In long-term follow-up, due to death or interruption due to the COVID-19 pandemic, follow-up was available in 128 patients at 1 year, 117 at 2 years and 111 at 3 years. 5 of the 27 patients still had persistent LV dysfunction (3 at 1 year, 1 at 2 year and 1 at 3 year), however, there were no new diagnosis of CTRCD post completion of therapy. Of 129 patients with baseline normal or indeterminate diastolic function, new DD was identified in 25/129 patients (19.4%) during cancer treatment (17 grade I, 2 grade II, 6 unable to grade). After completion of cancer therapy, 5 patients had persistent DD. In patients with no DD during therapy and completed 3 year follow-up, 5 patients developed new DD after therapy (2 grade I, 3 unable to grade). Figure 1 illustrates the percentage of patients with new CTRCD or new diastolic dysfunction at each timepoint. None of the patients developed clinical heart failure. Conclusion Although both CTRCD and diastolic dysfunction are common during sequential therapy with anthracyclines and trastuzumab in women with HER2+ breast cancer, new onset after treatment completion is rare during a careful follow-up. These findings have implications for long-term surveillance.

Genetic diversity and molecular evolution of the internal transcribed spacer regions (ITS1–5.8S–ITS2) of Babesia vogeli

Canine babesiosis, a severe haemoparasitic disease caused by Babesia species, has a significant global presence and can be fatal if left untreated. The current study was aimed to perform the population genetic characterization of B. vogeli on the basis of the internal transcribed spacer regions (ITS1–5.8S–ITS2). A maximum likelihood tree constructed with the Hasegawa-Kishino-Yano model grouped all sequences into a single major clade (BvG1), with the exception of a Taiwanese isolate (EF186914), which branched separately. This Taiwanese isolate represented a novel genotype (BvG2) identified in the present study. Nucleotide sequences (n = 62) exhibited 92.5–100 % nucleotide identity among themselves. However, the BvG1 and BvG2 genotypes shared a lower identity of 92.5–93.8 % between them. Notably, the newly generated Indian sequences (n = 21) demonstrated a high degree of homology, with 98.3–100 % identity. Alignment of the nucleotide sequences revealed 58 variations across the dataset. Additionally, 32 sites exhibited variation within the BvG1 genotype, while 56 sites differed between BvG1 and BvG2 genotypes. Within different B. vogeli populations, the nucleotide diversity (π) was low, but the haplotype diversity (Hd) was high. The haplotype diversity of the Indian population, BvG1 genotype, and the combined dataset was ∼0.8 suggesting a high haplotype diversity. The median-joining haplotype network displayed a total of 21 haplotypes, out of which six haplotypes consisted of more than one sequence (2–25 sequences). Haplotype distribution showed significant geographical structuring, with most haplotypes confined to a single country. Only two haplotypes (9.52 %; Hap_1 and Hap_4) were shared between countries, whereas 19 haplotypes (90.48 %) were country-specific. Hap_1, Hap_6, and Hap_4 were the most representative haplotypes, comprising 25, 10, and four sequences, respectively. India exhibited the highest number of haplotypes (h = 13) followed by China (h = 4), the United States of America (h = 3), Taiwan and Tunisia (h = 2), and Thailand (h = 1). Both location-wise and genotype-wise median joining haplotype networks clustered the haplotypes in two groups, representing two distinct genotypes (BvG1 and BvG2). The B. vogeli populations between Thailand and Tunisia exhibited the highest genetic differentiation (FST = 0.80) with a low gene flow (Nm = 0.125) between them. Results of AMOVA revealed a higher genetic variation within populations (69.43 %) as compared to the variation between them (30.57 %). Neutrality indices and the mismatch distributions of the Indian population and the overall dataset of B. vogeli indicated a constant population size to population expansion and population expansion, respectively, with the presence of two distinct genotypes. These data provide information about parasite population genetics and highlight the importance of starting a long-term molecular surveillance program. In conclusion, a high genetic diversity along with the presence of two distinct genotypes of B. vogeli were observed on the basis of internal transcribed spacer regions (ITS1–5.8S–ITS2).

Pulmonary arteriovenous malformation in children.

Pulmonary arteriovenous malformations (PAVMs) are rare abnormalities observed mainly in children with hereditary haemorrhagic telangiectasia (HHT). A majority of patients are asymptomatic at the time of detection. However, complications such as hypoxemia, stroke, cerebral abscess and massive hemoptysis can arise if larger PAVMs remain untreated. Larger PAVMs are usually managed successfully with embolization, although reperfusion of PAVMs have been reported post procedure. Early screening for PAVMs is recommended in asymptomatic children with HHT or those at risk for HHT. Longer term surveillance is also essential, to enable timely identification and management of PAVMs.

Study on sentinel hosts for surveillance of future COVID-19-like outbreaks

The spread of SARS-CoV-2 to animals has the potential to evolve independently. In this study, we distinguished several sentinel animal species and genera for monitoring the re-emergence of COVID-19 or the new outbreak of COVID-19-like disease. We analyzed SARS-CoV-2 genomic data from human and nonhuman mammals in the taxonomic hierarchies of species, genus, family and order of their host. We find that SARS-CoV-2 carried by domestic dog (Canis lupus familiaris), domestic cat (Felis catus), mink (Neovison vison), and white-tailed deer (Odocoileus virginianus) cluster closely to human-origin viruses and show no differences in the majority of amino acids, but have the most positively selected sites and should be monitored to prevent the re-emergence of COVID-19 caused by novel variants of SARS-CoV-2. Viruses from the genera Panthera (especially lion (Panthera leo)), Manis and Rhinolophus differ significantly from human-origin viruses, and long-term surveillance should be undertaken to prevent the future COVID-19-like outbreaks. Investigation of the variation dynamics of sites 142, 501, 655, 681 and 950 within the S protein may be necessary to predict the novel animal SARS-CoV-2 variants.

Association between radiation therapy for primary endometrial cancer and risk of second primary malignancies: a retrospective cohort study

Our objective was to evaluate the association of adjuvant radiation therapy (RT) to subsequent second primary malignancies (SPMs) in endometrial cancer survivors. Patients with endometrial cancer as their first malignancy were identified from 8 registries of the Surveillance, Epidemiology, and End Results (SEER) database. SPMs were defined as any type of primary malignancy that occurred more than 12 months after the diagnosis of endometrial cancer. Fine-Gray competing risk regression and Poisson regression were used to evaluate the radiotherapy-associated risk (RR) for SPMs. The Kaplan-Meier method was applied to assess the survival outcomes of endometrial cancer patients. Of 62,108 endometrial cancer patients,16,846 patients (27.12%) were in the RT group, and 45,262 patients (72.88%) were in the no-RT group. During the 30-year follow-up period, the cumulative incidence of SPMs was 20.9% and 19.7% in each group, respectively. In both multivariable competing risk regression analysis and Poisson regression analysis, adjuvant RT was found to be associated with a higher risk of developing colon and rectum cancer (adjusted hazard ratio (HR), 1.29; 95% confidence interval (CI), 1.12–1.50; P < 0.001; adjusted RR, 1.29; 95% CI, 1.11–1.49; P < 0.001), lung and bronchus cancer (adjusted HR, 1.27; 95% CI, 1.08–1.50; P = 0.004; adjusted RR, 1.26; 95% CI, 1.07–1.49; P = 0.005), vulva cancer (adjusted HR, 1.72; 95% CI, 1.04–2.85; P = 0.036; adjusted RR, 1.74; 95% CI, 1.03–2.88; P = 0.035), urinary bladder cancer (adjusted HR, 1.86; 95% CI, 1.41–2.46; P < 0.001; adjusted RR, 1.85; 95% CI, 1.40–2.44; P < 0.001), and non-Hodgkin lymphoma (adjusted HR, 1.37; 95% CI, 1.06–1.77; P = 0.016; adjusted RR, 1.37; 95% CI, 1.05–1.76; P = 0.017). However, a slightly decreased risk of breast cancer was observed in patients who underwent adjuvant RT (adjusted HR, 0.89; 95% CI, 0.80–0.98; P = 0.021; adjusted RR, 0.88; 95% CI, 0.80–0.98; P = 0.020). The RR for colon and rectum cancer decreased with age and elevated with increasing latency since endometrial cancer diagnosis, and the RR for urinary bladder cancer showed a similar tendency with latency. SPMs can significantly impair the survival outcomes of primary endometrial cancer survivors. Our findings suggest that adjuvant RT for endometrial cancer patients increases the risk of non-Hodgkin lymphoma and several types of solid cancer. Long-term surveillance of these patients should be recommended for detecting SPMs.

Long-term genomic surveillance reveals the circulation of clinically significant Salmonella in lymph nodes and beef trimmings from slaughter cattle from a Mexican feedlot.

This longitudinal study characterized Salmonella circulating in lymph nodes (LN, n = 800) and beef trimmings (n = 745) from slaughter cattle from a Mexican feedlot. During two years, LN and beef trimming samples were collected 72-96 h post-slaughter, and we obtained 77 isolates of the serovars Anatum (n = 23), Reading (n = 22), Typhimurium (n = 10), London (n = 9), Kentucky (n = 6), Fresno (n = 4), Give, Muenster, and monophasic 1,4,[5],12:i- (n = 1 each). These isolates were subjected to whole genome sequencing, single-nucleotide polymorphism (SNP)-based phylogenetic analysis, reconstruction of their ancestral isolation sources through evolutionary analysis, and virulence profiling. Although LN and beef trimmings were not mixed, evolutionary analysis estimated that the common ancestor of all study isolates was likely of LN origin. Moreover, isolates from both sources were highly clonal (0-21 SNP distance), highlighting the complexity of Salmonella transmission dynamics. The pathogen persisted across cattle cohorts, as shown by clonality between isolates collected in different years (1-20 SNP distance). Major virulence genes were highly conserved (97-100% identity to the reference sequences) and most isolates carried a conserved version of pathogenicity islands 1-5, 9, 11, and 12. Typhimurium strains carried the Salmonella plasmid virulence operon (spvRABCD), and a Muenster isolate carried the st313td gene, both of which are associated with invasive phenotypes. Most isolates (49/77) were genetically similar (1-43 SNPs) to strains involved in human salmonellosis, highlighting their public health significance. Further research is needed on Salmonella transmission dynamics in cattle and the mechanisms determining subclinical infection and persistence in farm environments.

Central nervous system solitary fibrous tumors: Case series in accordance with the WHO 2021 reclassification. Framework for patient surveillance.

Solitary fibrous tumors (SFTs) are a rare type of mesenchymal tumors. The World Health Organization reclassified SFTs in 2021. Currently, guidelines concerning treatment and follow-up are lacking. We performed a retrospective case series with reclassification of SFTs, according to the most recent WHO classification, to explore tumor-behavior. The purpose is to build a framework for long-term patient surveillance. A retrospective case study was performed according to the PROCESS guidelines. Inclusion criteria were: patients operated on between 2013 and 2023 in two neurosurgical centers with the diagnosis of 'hemangiopericytoma' or SFT on histopathological stains. Patients were excluded if the original stains of the primary tumor were unavailable. The following demographic, radiologic and therapeutic parameters were included in the review: age, sex, original and reclassified anatomopathological diagnosis, location, extent of resection, use of postoperative radiotherapy, location of and time to recurrence, location of-and time to metastasis, and survival. Histological material was re-examined by experienced neuropathologists. Ten patients were identified with a solitary fibrous tumor of the central nervous system (CNS) (three females) between 2013 and 2023. Age at diagnosis ranged from 38 up to 81. Eight patients were treated by gross total resection (GTR) and postoperative radiotherapy (RT) was applied in five cases. Initial WHO grading consisted of three grade I, two grade II, and six grade III lesions. Reclassification according to the WHO 2021 classification of CNS tumors resulted in seven reclassifications, all towards a lower grade. Four patients showed local recurrence, six to eight years after diagnosis, and five patients developed systemic metastases, nine to 13 years after diagnosis. Although rare, SFT should be included in the differential diagnosis of intracranial tumors with extra-axial growth patterns. The current histological grade according to the WHO 2021 does not seem to account for local recurrence rate or systemic metastasis. When a solitary fibrous tumor is presumed, gross total resection is the recommended treatment. Lifelong patient follow-up is necessary due to the risk of delayed recurrence and distant metastasis, even after gross-total resection. We would advocate for the use of CT thorax-abdomen or full body PET in the detection of systemic metastases at diagnosis and during follow-up, however optimal intervals remain unclear.

Isolated Perianal Langerhans Cell Histiocytosis in a Human Immunodeficiency Virus-Positive Adult: A Rare Incidental finding

Abstract Introduction/Objective Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal proliferation of antigen-presenting cells, primarily Langerhans cells. Although it commonly affects bones, skin, and lungs, involvement of the gastrointestinal tract is rare. Specifically, isolated perianal LCH is exceptionally uncommon, with only a few documented cases reported in the literature. Here, we report a case of incidental perianal LCH in an adult HIV patient, highlighting the exceptional rarity and clinical importance of this occurrence. Methods/Case Report A 56-year-old Caucasian male with HIV underwent surgical resection of a 0.5 x 0.4 x 0.3 cm verrucous lesion on the posterior anal margin. His past medical history included granulomatous lymphadenitis, penile warts, and anal dysplasia. Microscopic examination of the excised tissue revealed Langerhans cells with characteristic features, including abundant eosinophilic cytoplasm and irregular nuclear membranes (resembling “coffee-bean” or “folded paper” appearance). Immunohistochemical analysis confirmed the diagnosis by demonstrating positivity for CD1a, S100, and CD68. The BRAF mutation was evaluated on the same paraffin-embedded block, which revealed the lack of the mutant BRAF V600E. PET-CT imaging showed no evidence of metastatic disease, emphasizing the isolated nature of the perianal LCH in this patient. Results (if a Case Study enter NA) NA Conclusion This case highlights the significance of recognizing and thoroughly evaluating rare and incidental conditions such as LCH in HIV patients. Our findings emphasize the importance of maintaining a high index of suspicion for LCH among healthcare providers and ensuring proper follow-up to rule out systemic involvement. Furthermore, there is a need for future studies to investigate the correlation between LCH and HIV. Given its rarity and diverse clinical presentation in immunocompromised individuals, a multidisciplinary approach, tailored treatment plans, and long-term surveillance with imaging modalities like PET/CT are essential for effectively managing adult-onset isolated LCH.

LONG-TERM SURVIVAL OF TANYCYTIC EPENDYMOMA OF LATERAL VENTRICLE WITH ADJACENT FRONTAL LOBE INVASION: CASE REPORT AND LITERATURE REVIEW

Abstract AIMS Tanycytic ependymoma (TE) of lateral ventricle is a rare variant of ependymoma often challenging to diagnose due to its distinctive histological features and similarity to other central nervous system neoplasms. This report presents a case of TE in a 48 years-old lady with 20 years of long-term survival and provides a comprehensive review of the literature to elucidate the clinical, radiological, and pathological characteristics of this entity. METHOD A 48-year-old woman presented with a left lateral ventricular tumor invading the left frontal lobe and pericallosal region, subsequently diagnosed as TE after stereotactic biopsy followed by radical radiotherapy. Epidemiological features, preoperative and postoperative radiological surveillance, and functional performance after adjuvant radiotherapy were reviewed. Additionally, we review the current literature to explore current perspective of TE. Three major medical database engines, PubMed (Medline), Scopus (ELSEVIER), and Cochrane were used to conduct a thorough literature search. RESULTS The patient exhibited notable neurological improvement following stereotactic biopsy and radical radiotherapy, with long-term surveillance demonstrating stability and reduction in tumor size over a 20-year period. Our literature review underscores the rarity of TE and its diagnostic challenges, emphasizing the importance of histopathological examination and immunohistochemical analysis for accurate diagnosis. TE exhibit unique ultrastructural features, requiring meticulous examination for proper classification. Additionally, we discuss the implications of TE’s histological resemblance to other intramedullary tumors and its potential impact on therapeutic decisions. CONCLUSION Tanycytic ependymomas pose diagnostic dilemmas due to their morphological overlap with other CNS tumors. However, heightened awareness among clinicians and pathologists is crucial for accurate identification and appropriate management. Further research into the molecular mechanisms underlying TE is warranted to enhance diagnostic precision and refine treatment strategies, ultimately improving patient outcomes.