Anatomic Pathology Research Articles

Personalized total knee arthroplasty in patients with extra-articular deformities.

Over the years, with a better understanding of knee anatomy and biomechanics, superior implant designs, advanced surgical techniques, and the availability of precision tools such as robotics and navigation, a more personalized approach to total knee arthroplasty (TKA) has emerged. In the presence of extra-articular deformities, performing personalized TKA can be more challenging and specific considerations are required, since one has to deal with an acquired pathological anatomy. Performing personalized TKA surgery in patients with extra-articular deformities, the surgeon can: (1) resurface the joint, omitting the extra-articular deformity; (2) partially compensate the extra-articular deformity with intra-articular correction (hybrid technique), or (3) correct the extra-articular deformity combined with a joint resurfacing TKA (single stage or two-stage procedure). Omitting the acquired lower limb malalignment by resurfacing the knee has the advantages of respecting the joint surface anatomy and preserving soft tissue laxities. On the other hand, it maintains pathological joint load and lower limb kinematics with potentially detrimental outcomes. The hybrid technique can be performed in most cases. It circumvents complications associated with osteotomies and brings lower limb axes closer to native alignment. On the other hand, it creates some intra-articular imbalances, which may require soft tissue releases and/or constrained implants. Correcting the extra-articular deformity (through an osteotomy) in conjunction with joint resurfacing TKA represents the only true kinematic alignment technique, as it aims to reproduce native knee laxity and overall lower limb axis.

Poster 254: Improvements in Kujala at Minimum Two-Years Following Medial Patellofemoral Ligament Reconstruction are Correlated with Intraoperative Instability Measurements: A Multivariate Analysis of Risk Factors

Objectives: Isolated medial patellofemoral ligament reconstruction (MPFLR) is an effective treatment for those suffering from patellofemoral instability. Currently, many concomitant procedures are associated with MPFLR that address underlying pathologic anatomy. The indication and need for such procedures are currently not well understood and often involve the use of more invasive techniques. We aim to identify patients who may be more vulnerable to worse outcomes. The purpose of this study is to correlate demographic, anatomical, and clinical risk factors to minimum two-year outcomes following isolated MPFLR. Methods: A retrospective review of patients undergoing isolated MPFLR for recurrent patellar instability at a single institution between December 2015-June 2021 was performed. Patients with concomitant osseous procedures beyond chondroplasty and any ligamentous procedure were excluded. Included patients completed patient reported outcome (PRO) surveys preoperatively then at a minimum of 2 years postoperatively. Demographic, radiographic, surgical, and clinical data was collected. Univariate correlations to minimum 2-year delta-PRO scores were calculated, then those reaching significance were included in a multivariable linear regression analysis. Results: One hundred and thirteen MPFLR patients were included (77 female, 36 male; age: 21.6 ± 9.1 years). Final Kujala score was 88.44 ± 14.12 at 2.97 ± 1.11 years postoperatively. On univariate testing, final Kujala score was significantly correlated with age at time of surgery ( P=0.035; r=0.218), body mass index (P=0.035; r=-0.204), and the degree of knee flexion at which the patella can no longer be manually dislocated laterally during an examination under anesthesia (Instability Resolution Angle — IRA; P=0.010; r=-0.318). The delta final Kujala score (mean score 30.72 ± 19.68) was significantly correlated with age at time of surgery (P=0.032; r=-0.207), age at time of first patellar instability event (P=0.001; r=0.364), Caton-Deschamps Index (CDI; P=0.026; r=-0.235), trochlear width (P=0.016; r=0.251), the percentage of trochlear-patellar overlap on sagittal MRI (P=0.031; r=0.227), and the depth of the central trochlear trough from the lateral trochlear peak (P=0.035; r=0.221)(Table 1). On multivariable linear regression analysis, a larger IRA remained significantly correlated with worse final Kujala scores ( P= 0.018) and delta final Kujala ( P= 0.04). Conclusions: A larger IRA on examination under anesthesia is independently correlated with worse final and delta final Kujala scores at a minimum of two-years after isolated MPFLR. This finding can help guide surgeons in their decision to do an isolated MPFLR or add in larger, more invasive procedures that address underlying anatomic pathologies.

Comparison of intraoperative imaging with a portable gamma camera with extemporaneous histology in minimally invasive surgery for primary hyperparathyroidism

IntroductionThe curative treatment of primary hyperparathyroidism (PPH) is surgical and today it can be performed by minimally invasive surgery (MIS) and also be radioguided (RG) if a radiopharmaceutical with affinity for the parathyroid tissue that can be detected with gamma-detector probes or with a portable gamma camera (PGC) is injected. AimThe objective is to assess whether intraoperative scintigraphy (GGio) with PGC can replace intraoperative pathological anatomy (APio) to determine if the removed specimen is an abnormal parathyroid. Material and method92 patients underwent CMI RG--HPP with PGC after the administration of a dose of 99 mTc-MIBI. The information provided by the PGC in the analysis of the excised specimens is qualitatively compared (capture yes/no) with the result of the intraoperative pathological anatomy (APio). The Gold standard is the definitive histology. Results120 excised pieces are evaluated with GGio and APio. There were 110 agreements (95TP and 15TN) and 10 disagreements (3FP and 7FN). Of the 120 lesions, 102 were parathyroid and 18 were non-parathyroid. There was good agreement between intraoperative scintigraphy imaging (GGio) and PA, 70.1% according to Cohen's Kappa index. The GGio presented the following values ​​of Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, Positive Likelihood Ratio, Negative Likelihood Ratio and Overall Value of the Test (93.1%, 83.3%, 96.9%, 68.2%, 5.59, 0.08 and 0.92 respectively). ConclusionGGio is a rapid and effective surgical aid technique to confirm/rule out the possible parathyroid nature of the lesions removed in PPH surgery, but it cannot replace histological study.

Beyond the Baker's Cyst: Pathology and Variant Anatomy in the Popliteal Fossa on Routine Knee MRI

Primary evaluation of the knee focuses on evaluation of cartilaginous degeneration, meniscal injury, ligamentous or tendinous abnormality, and bony lesions, rather than the posterior and extracapsular popliteal fossa. A succinct review of normal popliteal fossa anatomy and normal fat planes is key to recognizing clinically significant pathology and variant anatomy. Abnormal insertion of the medial head of the gastrocnemius, or an accessory head of the gastrocnemius, can increase the risk of popliteal artery entrapment, an underrecognized cause of posterior calf and knee pain. Abnormal branching and course of the popliteal artery can increase risk of surgical vulnerability during multiple knee procedures, including arthroscopy and high tibial osteotomy. Finally, not all masses in the popliteal fossa are Baker's cysts; synovial sarcomas, vascular malformations, and other tumors can present in this anatomic space and can mimic popliteal cysts.

Beyond the Baker's Cyst: Pathology and Variant Anatomy in the Popliteal Fossa on Routine Knee MRI

Beyond the Baker's Cyst: Pathology and Variant Anatomy in the Popliteal Fossa on Routine Knee MRI

Epidemiological and Histopathology Study of Gastric Lesions in Ouest Africa

Gastric pathologies represent a global public health problem due to their frequency and severity. The objective of the study was to epidemiologically evaluate all gastric lesions diagnosed at the Pathological Anatomy Laboratory of Saint-Louis, Senegal over a period of 30 months. In addition to sociodemographic parameters, different histological types and molecular profiles were described. A total of 372 cases was identified, 96% were biopsies and 4% were partial gastrectomy surgical specimens. The sex ratio was 0.92 with 48% men (N=179) and 52% women (N=193). The mean age was 45.08 years. The lesions were distributed as follows: gastritis accounted for 86.02% (N=320) of which 70% were Hp gastritis (N=224) followed by gastric cancers with 10.76% (N=40) of which 95% (N=38) were adenocarcinoma (ADC). Male predominance was clear with a sex ratio of 2.1 (N=26 H/12 F) and the tubular subtype was the most common at 55.26% (N=21) for these ADCs. At the molecular level, 17.14% of cases were HER2+ cotation 3+. Other types of cancer were rare, including 1 case of GIST and 1 case of lymphoma (1 case). Polyps were rarely observed with a rate of 1.67% (N=6) and mostly hyperplastic and glandulocystic type.These epidemiological data described in our study can contribute to the development of strategies and preventive measures in the fight against these diseases in sub-Saharan Africa where studies are scarce.

Clinical experience of cone-beam computed tomography in interventional neuroradiology

Objective ‒ to analyze the experience of using cone-beam computed tomography (CBCT) angiography during diagnostic and interventional procedures in the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine».Materials and methods. Informed consent was obtained from each patient (parent or guardian) enrolled in the study and the study protocol conforms to the ethical guidelines of the Declaration of Helsinki as reflected in a priori approval by the Institutional Ethical Review Board (Institution's Human Research Committee). Since January 2024 in the SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine» used in practical work a modern angio machine «Siemens Artis Q.zen» (Siemens, Erlangen, Germany), equipped with a set of various techniques and programs, in particular CBCT, syngo Aneurysm Guidance Neuro, 3D Roadmap. We analysed 36 diagnostic and interventional procedures was conducted from January 2024 to March 2024, during which CBCT was used. Among the procedures, 29 cases of brain aneurysms, 4 arteriovenous malformations and 3 cases of dural arteriovenous fistulas.Results. CBCT is useful for understanding vascular anatomy and allows for more detailed visualization of the curvilinear course of vessels in 3D space along any plane with the possibility of their correlation with bone structures compared to traditional angiography, and also has a higher resolution compared to more common 3D digital subtraction angiography. CBCT images are also a valuable source of information for further understanding of both pathological and normal neurovascular anatomy. Our center has implemented rotation 3D images with contrast of the CBCT at the stage of preparation and planning of the interventional procedure, rotation with subtraction (3D-DSA) ‒ to control implanted devices and its relationship to the vessels and long-term rotation of the CBCT without contrast ‒ to control the straightening and positioning of the stent. To control the position of the stent and its relations to the vessels, the «fusion» mode was used, providing additional information about the vascular structures imposed during conventional angiography, as well as the ability to rotate the volume at any angle regardless of the mechanical capabilities.Conclusions. CBCT is an accessible and unique function of modern angiomachines and helps to improve the understanding of anatomical features in various pathologies of cerebral vessels and helps in making clinical decisions.

Central neurocytoma of atypical behavior. Case report and literature review

Central neurocytomas are central nervous system (CNS) tumors that typically show benign behavior and progression. These tumors usually occur in the lateral ventricles of young individuals. We present the case of a 36-year-old male patient who presented with an intraventricular expansive lesion causing hydrocephalus and seizures. The patient underwent an incomplete resection of the lesion but developed persistent postoperative hydrocephalus, requiring a ventriculoperitoneal shunt. The progression was favorable, and the patient was discharged for outpatient follow-up. Anatomic pathology examination revealed central neurocytoma, confirmed through immunohistochemistry. This report aims to present a case of this rare neoplasm, review the literature, and highlight its significance, given the favorable prognosis.

Are invasive postmortem examinations still the ‘gold standard’ in diagnosing the cause of death?

For many years, the foundations of both its art and science in medicine grew from the observations made at the autopsy table. The observations of the pathologists formed the pathologic basis and manifestations of disease, which further advanced the development of therapeutics. For most of the 18th and 19th centuries, morbid anatomy (autopsy pathology) was considered the science of medicine. Today, the autopsy and the knowledge that derives from it do not hold the position they once did in the profession’s history. There is a belief among the medical community a complete autopsy is necessary to find out the answers when someone dies. In some jurisdictions, the forensic pathology community is reluctant to follow the targeted or minimally invasive approach in postmortem examinations due to a lack of understanding of the process. With a complete external examination, trace evidence collection, total body computed tomography (CT) scan, and minimally invasive/targeted dissection with a collection of samples for further analysis, almost all answers can be provided in hospital and medicolegal autopsy settings. We must collaborate with sister disciplines, such as experts in radiology and the legal community, to educate them on the importance of this new approach using advanced technology.Continuously evolving modern radiological imaging has remarkably increased the accuracy of clinical diagnosis. Conventionally, when you hear the word postmortem examination, people think it includes an external examination and dissection of all body cavities. In the 21st century, most questions raised by the family, clinicians, the coroner (medical examiner), courts, and law enforcement agencies can be answered with a complete external examination of the body, total body CT scan +/- magnetic resonance imaging, and targeted dissection or minimally invasive approach incorporated with sample collection for further testing. This is cost-effective and can produce reviewable data.

Upper tract access in patients with urinary diversions

Urinary tract diversions are a common reconstructive solution for patients with malignant, anatomic or functional pathologies of the lower urinary tract. Although urinary diversions often represent the patient’s best alternative, they are not devoid of complications. Some of these complications, mainly anastomotic strictures and kidney stones, can be managed endoscopically, although upper tract access of such patients is not straightforward, requiring a fundamental understanding of the many types of diversions. In this article we will review the inherent difficulties of accessing the upper tract of patient with different diversions, the different approaches to the upper tract of diverted patients, and the equipment and techniques that can help facilitate upper tract access in diverted patients.

Histopathologic and molecular profile of gliomas diagnosed in Lagos, Nigeria

Abstract Background The optimal diagnosis and management of patients with brain tumors currently uses the 2021 WHO integrated diagnosis of histomorphologic and molecular features. However, neuro-oncology practice in resource-limited settings usually relies solely on histomorphology. This study aimed to classify glioma cases diagnosed in the Department of Anatomic and Molecular Pathology, Lagos University Teaching Hospital, using the 2021 WHO CNS tumor classification. Methods Fifty-six brain tumors from 55 patients diagnosed with glioma between 2013 and 2021 were reevaluated for morphologic diagnosis. Molecular features were determined from formalin-fixed paraffin-embedded (FFPE) tissue using immunohistochemistry (IHC) for IDH1-R132H, ATRX, BRAF-V600E, p53, Ki67, and H3-K27M, OncoScan chromosomal microarray for copy number, targeted next generation sequencing for mutation and fusion and methylation array profiling. Results Of 55 central nervous system tumors, 3 were excluded from histomorphologic reevaluation for not being of glial or neuroepithelial origin. Of the remaining 52 patients, the median age was 20.5 years (range: 1 to 60 years), 38(73%) were males and 14(27%) were females. Seventy-one percent of the gliomas evaluated provided adequate DNA from archival FFPE tissue blocks. After applying the 2021 WHO diagnostic criteria the initial morphologic diagnosis changed for 35% (18/52) of cases. Diagnoses of 5 (9.6%) gliomas were upgraded, and 7 (14%) were downgraded. Conclusions This study shows that the incorporation of molecular testing can considerably improve brain tumor diagnoses in Nigeria. Furthermore, this study highlights the diagnostic challenges in resource-limited settings and what is at stake in the global disparities of brain tumor diagnosis.

Differences in merlin and p53 expression as a predisposing factor in orbital meningioma

Objectives: The behavior of orbital meningiomas is difficult to predict. The p53 tumor suppressor gene mutation and the neurofibromatosis 2 gene’s inactivation in the merlin formation are two of the several mechanisms that contribute to the development of tumors. This considers the comparison of merlin and p53 expression as an inclination to evaluate the orbital meningiomas. Materials and Methods: This investigation is an observational expository considered within the shape of cross-sectional (cross-sectional). The samples/objects of this study were 44 patients with orbital meningioma who had a clinical, radiological, and histopathological diagnosis at the anatomical pathology laboratory at Cicendo Eye Hospital and Hasan Sadikin Bandung in 2017–2020, then an immunohistochemical examination of merlin and p53 expression was performed. Results: The study indicated that there was no relationship between p53 expression and orbital meningioma grading, also there is no relationship between merlin expression and orbital meningioma grading. However, based on the analysis test results, grade 3 orbital meningiomas tended to have a positive p53 expression rather than a negative expression and tend to have a negative merlin expression instead of a positive. Conclusion: Meningiomas with negative merlin expression have a tendency to express positive p53. Likewise, the higher grade (grade 3) tends to express positive p53 and negative merlin, which may play a key role in tumorigenesis of orbital meningioma, hence, an added value for clinical information and behavioral descriptions of orbital meningioma itself.

Is PAS Stain Necessary to Exclude Whipple Disease in Duodenal Biopsies?

Objective. Whipple disease, caused by Tropheryma whipplei, is a rare infectious condition primarily presenting with malabsorptive diarrhea. Small bowel biopsies typically reveal foamy macrophages containing periodic acid-Schiff-positive/diastase (PAS/D) resistant T. whipplei bacilli, and PAS(D) staining is occasionally requested by clinicians in duodenal biopsies, which are often histologically unremarkable. The yield of PAS(D) staining in such biopsies has never been reported to our knowledge. Methods. The anatomic pathology database was searched for all specimens of duodenal biopsies stained with PAS(D) from 1993 to 2021. Specimens were categorized by the following histomorphologic features: unremarkable, nonspecific changes, or expansion of the lamina propria by aggregates of foamy histiocytes. Follow-up information was collected, including microbiologic confirmatory testing. Results. There was a total of 193 specimens of duodenal biopsies stained with PAS(D). Biopsies lacking foamy histiocytes on H&E (n = 158) were never PAS-positive. Thirteen biopsies contained PAS-positive histiocytes; 9 out of the 13 PAS-positive specimens were subsequently confirmed to be T. whipplei. Of the 193 specimens, 124 specimens had a clinical request for PAS(D) staining. Only 3 of the 124 (2.4%) specimens showed foamy histiocytes containing PAS-positive granules, all of which were confirmed positive for T. whipplei. Conclusion. PAS(D) staining is unnecessary to exclude Whipple disease in duodenal biopsies without foamy macrophage aggregates, regardless of clinical suspicion. Clinical suspicion-driven biopsies often yield negative results for Whipple disease.

Factors Affecting Extrapulmonary Tuberculosis Reinfection in Pulmonary Tuberculosis Patients in Gorontalo City

Tuberculosis is a disease caused by the bacteria Mycobacterium tuberculosis. Tuberculosis does not only occur in the lungs, which is called pulmonary tuberculosis but can occur outside the lung organs, which is called extrapulmonary tuberculosis. Reinfection from Pulmonary tuberculosis to Extrapulmonary tuberculosis can occur due to several factors. This study aims to determine the factors that can influence the occurrence of reinfection Extrapulmonary tuberculosis in pulmonary tuberculosis sufferers. Method Analytical research with a cross-sectional approach. The number of samples was 49 samples of Pulmonary tuberculosis sufferers who underwent initial diagnosis at the Anatomical Pathology Laboratory, Prof. Dr. Hi. Aloei Hospital. Saboe Gorontalo City. The results of the study showed that the variables Adherence to treatment (p: 0.047), and BCG Vaccine (p: 0.018) were < α value: 0.05, while the significance value of comorbidity for EPTB Reinfection was (p: 0.991). The conclusion is that adherence to treatment and the BCG vaccine have a significant effect on the incidence of reinfection Extrapulmonary tuberculosis (EPTB) in patients with pulmonary tuberculosis (PTB), while comorbidities do not have a significant effect on the incidence of reinfection Extrapulmonary tuberculosis (EPTB) in patients with pulmonary tuberculosis (PTB).

Tiempos y condiciones de almacenamiento de las muestras en anatomía patológica. Recomendaciones de la Sociedad Española de Anatomía Patológica parte 1: muestras destinadas al diagnóstico

IntroductionThe correct storage of specimens in the Pathology service is of vital importance for patient safety. However, there are no clear recommendations as regarding how long samples should be stored for a minimum period. Material and methodsA working group of the Spanish Society of Anatomic Pathology has reviewed a series of recommendations established in the literature and after two rounds of consultations and a discussion and voting phase has established a series of storage time proposals. ResultsEach of the proposals is presented with the data found in the literature and sometimes offers definitions and exceptions to the proposal. ConclusionThese recommendations, which are minimums, establish a period of at least 10 years for paraffin embedded blocks (including cell blocks), histological preparations, general cytology, pathologic cervico-vaginal cytology and electron microscopy blocks; at least 3 years for cervico-vaginal cytology, 5 years for extracted nucleic acids, at least 4 weeks for tissue in formalin and from the time of diagnosis for liquid cytology material and fluids.

Functional inferior canalicular reconstruction using a monocanalicular probe after tumor resection of the medial third of the lower eyelid

Purpose: To describe a surgical technique for functionally reconstructing a lacrimal drainage duct and to assess its long-term functionality.Methods: This observational review includes six cases involving reconstruction of the inferior canaliculus after surgical resection of lower eyelid carcinoma. Following lesion excision with safety margins, the epithelium of the distal portion of the inferior canaliculus is located and intubated with a monocanalicular probe. Subsequently, the eyelid lamellae are reconstructed without displacing the probe. The Monoka collarette is then sutured using a 10/0 nylon suture. Data collection included anatomic pathology of the lesion and data from ophthalmic examinations at each visit (including epiphora, inferior canalicular irrigation, and fluorescein dye disappearance test (FDDT)), as well as stent extrusion or other complications.Results: No complications were observed during the surgeries. The stents remained in place for an average of 4 months, with no extrusions prior to removal. The mean follow-up period was 4.8 years (SD=2.0), during which no other complications were noted. Only one patient experienced intermittent epiphora, also present in the fellow eye. At the final visit, FDDT was normal in all eyes, and all patients demonstrated patency of the inferior canaliculus upon irrigation.Conclusion: Primary reconstruction of an inferior lacrimal drainage duct following tumor resection can be successfully performed, resulting in favorable functional recovery.

Giorgio Armeno Baglivi - Reappraisal of a seventeenth century physician scientist

The seventeenth century was an exciting transformative period of creativity in the generation of new medical knowledge. It was then that the scholasticism of the past was formally replaced by the new spirit of inquiry, experimentation, quantification, and validation that had originated in the Scientific Revolution of the previous century. It was then that within the prevailing notions of iatromechanics that anatomical observations at postmortem were linked to clinical symptoms of diseases and launched the discipline of pathological anatomy, and when the introduction of anatomical experimentation and quantification that was reasonably analyzed launched the discipline of physiology. It was also then that iatrochemistry transformed the alchemy of the past into chemistry and launched the quest for the elements that constitute matter. It is in this creative environment that Giorgio Armeno Baglivi (1668-1707), a disciple of Marcello Malpighi (1628-1694), was born, matured, trained and became a distinguished physician of the period. Reputed as a strict iatromechanist, careful scrutiny of the writings of Baglivi reveal a pioneering physician scientist with broader and more insightful views of the body in health and disease. He was a strong promoter of correlating postmortem findings to antemortem clinical symptoms of patients that would lead to the emergence of pathology and the nosography of disease. In dealing with the circulation, he was limited in addressing the composition of blood, but considered the maintenance of fluid equilibrium essential to normal bodily functions. He attributed acute diseases to changes in fluid composition and equilibrium, and their progression to chronicity to the solidification of those changes in affected organs observed at autopsy. It would take three centuries of investigation and technological developments to resolve these problems of homeostasis as we understand them now. The difficulties Baglivi faced in dealing with them is a classic example of the intellectual hardships that pioneers in the scientification of medicine had to toil with in the seventeenth century to bring medicine to its present stage of a scientific discipline rather than just another professional occupation.The seventeenth century was a transformative period when the concepts and methods of the Scientific Revolution that were developed in the previous two centuries were tested, verified, validated, enriched, and by the close of the century set the stage for the Enlightenment that followed. It was a time when new medical knowledge was made, exchanged, and spread. It was then that scholasticism was formally replaced by inquiry and forums for their consideration and evaluation created under the patronage of local authorities such as the Accademia dei Lincei in Rome in 1603, the Accademia del Cimento in Florence in 1657, the Royal Society of Medicine in London in 1662, and the Académie des Sciences in Paris in 1666. It was a time that fostered the exchange of ideas by the distribution of relatively short, published tracts and by correspondence between its primaries, which by the end of the century evolved into the self-proclaimed “Republic of Letters” of the intellectual community that would blossom into the Enlightenment which followed. It was the time when the 1543 “Fabrica” (structure) of Vesalius (1514-1564) evolved and was incorporated into the “anatome”, “anatomia”, and “anatomica” in the title of the books and tracts published then (Fig. 1).

Biomarkers in breast cancer 2024: an updated consensus statement by the Spanish Society of Medical Oncology and the Spanish Society of Pathology.

This revised consensus statement of the Spanish Society of Medical Oncology (SEOM) and the Spanish Society of Pathological Anatomy (SEAP) updates the recommendations for biomarkers use in the diagnosis and treatment of breast cancer that we first published in 2018. The expert group recommends determining in early breast cancer the estrogen receptor (ER), progesterone receptor (PR), Ki-67, and Human Epidermal growth factor Receptor 2 (HER2), as well as BReast CAncer (BRCA) genes in high-risk HER2-negative breast cancer, to assist prognosis and help in indicating the therapeutic options, including hormone therapy, chemotherapy, anti-HER2 therapy, and other targeted therapies. One of the four available genetic prognostic platforms (Oncotype DX®, MammaPrint®, Prosigna®, or EndoPredict®) may be used in ER-positive patients with early breast cancer to establish a prognostic category and help decide with the patient whether adjuvant treatment may be limited to hormonal therapy. In second-line advanced breast cancer, in addition, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) and estrogen receptor 1 (ESR1) should be tested in hormone-sensitive cases, BRCA gene mutations in HER2-negative cancers, and in triple-negative breast cancer (TNBC), programmed cell death-1 ligand (PD-L1). Newer biomarkers and technologies, including tumor-infiltrating lymphocytes (TILs), homologous recombination deficiency (HRD) testing, serine/threonine kinase (AKT) pathway activation, and next-generation sequencing (NGS), are at this point investigational.

Management of Cancer in the Digestive System

Cancer is a non-communicable disease characterized by the presence of abnormal cells/tissues that are malignant, grow quickly and uncontrollably and can spread to other places in the patient's body. Cancer cells are malignant and can invade and damage the function of the tissue. Digestive cancer, also called gastrointestinal cancer, attacks the organs of the digestive system. Digestive cancer also includes gastrointestinal cancer, liver cancer, stomach cancer, colorectal cancer, and pancreatic cancer. Risk factors for digestive cancers are varied because many different organs can be affected. Some factors that contribute to cancer throughout the digestive system include age, heavy drinking (alcohol), smoking, and diabetes sufferers. This type of liver cancer is cancer that grows in liver cells. Liver cancer is a type of cancer that ranks second as the cancer that causes the most deaths in the world. Gastric cancer is a group of malignant diseases that have multifactorial causes, namely genetic, lifestyle and environmental factors. The symptoms caused by stomach cancer are initially not as typical as the symptoms of general digestive complaints. The diagnosis of colorectal cancer can be carried out in stages, including through an appropriate history, physical examination, and supporting examinations in the form of laboratory examinations, both from clinical laboratories and anatomical pathology laboratories. The etiology of colorectal cancer is currently still unknown. Symptoms of colorectal cancer are varied and non-specific. The main complaints of patients with colorectal cancer relate to the size and location of the tumor. Tumors in the right colon, where the contents of the colon are fluid, tend to remain hidden until they are very advanced.

Liver Transplantation for Hepatocarcinoma: Results over Two Decades of a Transplantation Programme and Analysis of Factors Associated with Recurrence.

In recent years, many studies have attempted to develop models to predict the recurrence of hepatocarcinoma after liver transplantation. A single-centre, retrospective cohort study analysed patients receiving transplants due to hepatocarcinoma during the 20 years of the transplant programme. We analysed patient survival, hepatocarcinoma recurrence and the influence of the different factors described in the literature as related to hepatocarcinoma recurrence. We compared the results of previous items between the first and second decades of the transplantation programme (1995-2010 and 2010-2020). Of 265 patients, the patient survival rate was 68% at 5 years, 58% at 10 years, 45% at 15 years and 34% at 20 years. The overall recurrence rate of hepatocarcinoma was 14.5%, without differences between periods. Of these, 54% of recurrences occurred early, in the first two years after transplantation. Of the parameters analysed, an alpha-fetoprotein level of >16 ng/mL, the type of immunosuppression used and the characteristics of the pathological anatomy of the explant were significant. A trend towards statistical significance was identified for the number of nodules and the size of the largest nodule. Logistic regression analysis was used to develop a model with a sensitivity of 85.7% and a specificity of 35.7% to predict recurrences in our cohort. Regarding the comparison between periods, the survival and recurrence rates of hepatocarcinoma were similar. The impact of the factors analysed in both decades was similar. Most recurrences occur during the first two years post-transplantation, so closer follow-ups should be performed during this period, especially in those patients where the model predicts a high risk of recurrence. The detection of patients at higher risk of recurrence allows for closer follow-up and may, in the future, make them candidates for adjuvant or neoadjuvant systemic therapies to transplantation.