Clinical Aspects of Adolescent Endometriosis

Early diagnosis and long-term management of endometriosis is important in adolescent girls considering their potential for future pregnancy and need for preventing disease progression. However, symptoms and clinical findings of adolescent endometriosis may differ from those of typical adult endometriosis, making diagnosis difficult. In adolescents, menstrual pain may present as acyclic and unresponsive to commonly used medication. Typical imaging findings in adult endometriosis, such as ovarian endometriotic cysts and fibrotic scars, are less common in adolescents. Peritoneal lesions, characteristic of early-stage endometriosis, are commonly found in this age group. It should be noted that endometriosis may also be found in adolescents before menarche, because of premenarcheal endometriosis or congenital uterine anomaly and outflow obstruction; the latter requiring surgical correction. Although surgery is reported to be effective for pain, postsurgical recurrence rate is high, and the effect of hormonal treatment is controversial. The optimal timing for surgical intervention also remains to be determined. Here, we aim to identify the unique characteristics of endometriosis in adolescents to achieve early diagnosis and optimal management for this group of patients.

Multifocal facial Rosai Dorfman disease with postsurgical recurrence

<p class="abstract">Rosai Dorfman disease (RDD) is a histiocytic proliferative disorder with massive painless lymphadenopathy that though is rare yet has been reported more than seldom. Our report aimed to emphasis on a case with multifocal facial involvement with postsurgical recurrence, which had not yet been reported and an approach to alleviate the patient’s symptoms and avert a fatal outcome. This study was a case report and literature review. A 19 year old female presented with swelling involving right sided cheek, periorbital region and bilateral nasal cavity with palatal perforation for last 6 months. She had a past history of debulking of orbital RDD. Contrast enhanced computed tomography revealed an extraconal mass of the right orbit and left nasal mass extending to the nasopharynx. Biopsy taken from the nasal masses showed RDD on histopathology and immunohistochemistry. Though the disease was self-resolving, this patient required radiotherapy as debulking was not sufficient for its multifocal presentation and was followed by palatal reconstruction.</p>

P022 Pathologic involvement of the farnesoid X receptor/fibroblast growth factor 19 axis to the Crohn’s disease early postsurgical recurrence

Background Crohn’s disease (CD) is a chronic inflammatory bowel disease that normally requires bowel surgical resection due to intra-abdominal inflammatory complications such as fistulae and stenosis. However, 90% of patients that underwent surgery and did not receive prophylaxis, suffer from postsurgical endoscopic recurrence within one year. Methods The objective of this study is to understand the de novo postsurgical lesion formation in order to stablish a potential mechanism of action and its derived predictive signals to devise preventive strategies. To achieve it, transcriptome analyses of the inflamed and macroscopically unaffected zone of the ileocecal resection from 20 patients from a hospital cohort and 10 controls were performed. Patients were classified for early postsurgical recurrence by means of Rutgeerts index (i0&lt;i1&lt;i2&lt;i3&lt;i4) and transcriptome was analysed using different comparatives and clustering strategies. In order to replicate the results from the transcriptome analyses, the statistically significant genes and rationally related genes have been tested by qPCR in a corroboration cohort formed by 24 different patients. Results The transcriptome results showed there were no differences neither between i0, i1 and i2a (anastomotic lesions) nor when comparing i2b (non-anastomotic lesions) vs ≥i3. However, when comparing i0+i1+i2a vs. i2b+i3+i4 there were differently expressed genes highlighting ADIPOQ in the inflamed zone and the FXR/FGF19 axis in the unaffected zone. When replicating the results in the corroborative cohort, we identified FXR and other xenobiotic nuclear receptors as the genes differentially expressed in i2a vs i2b, i3 and/or i4, mainly in the macroscopically unaffected zone. Specifically, the differentially expressed genes were: MOGAT2, PXR, FXR and AHR (i2a vs i4), PPARα and FXR (i2a vs i3), TMIGD1, PPARα, FXR and AHR (i2a vs i3+i4) and FXR (i2a vs i2b+i3+i4). Conclusion Nuclear receptor FXR is activated in the ileum by bile acids action and it is key in the lipid metabolism regulation and in the bile acids production by means of FGF19. Moreover, ileal FXR, as well as other xenobiotic nuclear receptors, actively participates in the enhancement of the intestinal barrier function and in the innate immunity regulation. In conclusion, the results obtained in this study suggest a link between bowel xenobiotic metabolism and the de novo lesion formation in previously unaffected areas in the postsurgical recurrence in CD.

HSPA2 Expression Predicts Early Postsurgical Relapse and Promotes Tumor Cell Migration and Invasion in Pancreatic Cancer

Background: Heat shock protein A2 (HSPA2) is known to relate to the pathogenesis and progress of cancer. This study aimed to investigate the connection between HSPA2 and early postsurgical relapse, and the influences of HSPA2 on cell biological behaviors in pancreatic cancer (PC).Methods: Expression of HSPA2 in cancerous and noncancerous samples was determined by bioinformatics and immunostaining methods. The significance of HSPA2 expression in predicting early postsurgical recurrence was assessed. The biological role and potential mechanisms of HSPA2 in PC progression were uncovered by enrichment analysis. HSPA2 expression in human PC cells was detected by immunoblotting. Silencing of HSPA2 in BxPC-3 cells and upregulation of HSPA2 in PANC-1 cells were achieved with siRNA and overexpression plasmid, respectively, and then the impacts of HSPA2 downregulation and upregulation on cancer cell biological behaviors were estimated.Results: HSPA2 expression in tumor specimens was markedly elevated compared with nontumor specimens. HSPA2 overexpression could independently predict early postsurgical recurrence, and combined with malignant clinicopathological characteristics had greater predictive power and potential application value. Enrichment analysis revealed that HSPA2 expression was closely associated with PC progression. HSPA2 was expressed in BxPC-3, PANC-1 and SW1990 cells, with the highest and lowest levels in BxPC-3 and PANC-1 cells, respectively. Cell migration and invasion abilities were remarkably restrained in HSPA2-silenced BxPC-3 cells and significantly enhanced in HSPA2-overexpressed PANC-1 cells.Conclusion: HSPA2 expression predicts early postoperative recurrence and promotes cell migration and invasion, and is expected to become a useful molecular target of antitumor treatment in PC.

HSPA2 Expression Predicts Early Postsurgical Relapse and Promotes Tumor Cell Migration and Invasion in Pancreatic Cancer

Background: Heat shock protein A2 (HSPA2) is known to relate to the pathogenesis and progress of cancer. This study aimed to investigate the connection between HSPA2 and early postsurgical relapse, and the influences of HSPA2 on cell biological behaviors in pancreatic cancer (PC).Methods: Expression of HSPA2 in cancerous and noncancerous samples was determined by bioinformatics and immunostaining methods. The significance of HSPA2 expression in predicting early postsurgical recurrence was assessed. The biological role and potential mechanisms of HSPA2 in PC progression were uncovered by enrichment analysis. HSPA2 expression in human PC cells was detected by immunoblotting. Silencing of HSPA2 in BxPC-3 cells and upregulation of HSPA2 in PANC-1 cells were achieved with siRNA and overexpression plasmid, respectively, and then the impacts of HSPA2 downregulation and upregulation on cancer cell biological behaviors were estimated.Results: HSPA2 expression in tumor specimens was markedly elevated compared with nontumor specimens. HSPA2 overexpression could independently predict early postsurgical recurrence, and combined with malignant clinicopathological characteristics had greater predictive power and potential application value. Enrichment analysis revealed that HSPA2 expression was closely associated with PC progression. HSPA2 was expressed in BxPC-3, PANC-1 and SW1990 cells, with the highest and lowest levels in BxPC-3 and PANC-1 cells, respectively. Cell migration and invasion abilities were remarkably restrained in HSPA2-silenced BxPC-3 cells and significantly enhanced in HSPA2-overexpressed PANC-1 cells.Conclusion: HSPA2 expression predicts early postoperative recurrence and promotes cell migration and invasion, and is expected to become a useful molecular target of antitumor treatment in PC.

HSPA2 Expression Predicts Early Postsurgical Relapse and Promotes Tumor Cell Migration and Invasion in Pancreatic Cancer

Background: Heat shock protein A2 (HSPA2) is known to relate to the pathogenesis and progress of cancer. This study aimed to investigate the connection between HSPA2 and early postsurgical relapse, and the influences of HSPA2 on cell biological behaviors in pancreatic cancer (PC).Methods: Expression of HSPA2 in cancerous and noncancerous samples was determined by bioinformatics and immunostaining methods. The significance of HSPA2 expression in predicting early postsurgical recurrence was assessed. The biological role and potential mechanisms of HSPA2 in PC progression were uncovered by enrichment analysis. HSPA2 expression in human PC cells was detected by immunoblotting. Silencing of HSPA2 in BxPC-3 cells and upregulation of HSPA2 in PANC-1 cells were achieved with siRNA and overexpression plasmid, respectively, and then the impacts of HSPA2 downregulation and upregulation on cancer cell biological behaviors were estimated.Results: HSPA2 expression in tumor specimens was markedly elevated compared with nontumor specimens. HSPA2 overexpression could independently predict early postsurgical recurrence, and combined with malignant clinicopathological characteristics had greater predictive power and potential application value. Enrichment analysis revealed that HSPA2 expression was closely associated with PC progression. HSPA2 was expressed in BxPC-3, PANC-1 and SW1990 cells, with the highest and lowest levels in BxPC-3 and PANC-1 cells, respectively. Cell migration and invasion abilities were remarkably restrained in HSPA2-silenced BxPC-3 cells and significantly enhanced in HSPA2-overexpressed PANC-1 cells.Conclusion: HSPA2 expression predicts early postoperative recurrence and promotes cell migration and invasion, and is expected to become a useful molecular target of antitumor treatment in PC.

The Role of Active Inflammation and Surgical Therapy in Crohn’s Disease Recurrence

An altered balance between effector and regulatory factors is supposed to sustain the tissue-damaging immune response in inflammatory bowel disease (IBD). Several studies demonstrate that severe active inflammation is a strong predictor for surgical complications and recurrence. Indeed, bowel resection in Crohn’s disease (CD) patients has a high surgical recurrence rate. In this review, we examined the IBD inflammatory pathways, the current surgical treatments, and the almost inevitable recurrence. The question that might arise is if the cure of intestinal CD is to be found in the surgical approach. A selective search of two databases (PubMed and the Cochrane Library) has been carried out without considering a specific time horizon as inclusion criteria. The scope of this literature review was investigating on the role of inflammation in the management of CD. The following key words have been used to develop the query string: (i) inflammation; (ii) Crohn’s disease; (iii) surgery; and (iv) postsurgical recurrence.

Superior Strategy in Benign Tracheal Stenosis Treatment: Surgery or Endoscopy?

Introduction Due to the variations in (laryngeal) tracheal stenosis (TS) patient groups, there is still no consensus on which patient should be treated with endoscopy or surgery. The aim of the present study was to generate an algorithm in the light of the related literature and the data obtained from a clinic where both endoscopic and surgical treatments are conducted. Method A retrospective analysis was performed on the data of a total of 56 patients during 2013 to 2019. A total of 38 patients were subject to surgery with 31 as a first treatment option and 7 due to the unsatisfactory results of endoscopic treatments. Endoscopic approaches were tried on a total of 29 patients with 25 as initial treatment and 4 due to postsurgical recurrence. Results Symptomatic full control ratio was determined as 69% with endoscopic treatments, 89.5% in subglottic stenosis (SGS) surgery (n = 19), and 89.5% in trachea surgery (n = 19). However, success rates with no recurrence were determined, respectively, as 40.0, 36.4, and 36.4% for patients subject to dilatation, stent, or T tube treatment. Dilatation was observed to be successful in patients with stenotic segment lengths of less than 1.5 cm (p = 0.02). Failure rates increased in SGS (p = 0.03) and TS (p = 0.12) in the surgical group with increasing stenotic segment length. The presence of comorbidities was not effective on treatment success. Conclusion Endoscopic methods are preferred in cases of web-like stenosis. Surgical methods should first be considered for other patients and endoscopic methods should be used on patients who are not suited for surgery or in cases of postsurgical recurrence.