A pilot study: ensuring optimal adjustment for determinations of predictive values of preoperative investigations before starting a non-operative management protocol in locally advanced mid-distal rectal cancer

Purpose: Before starting a non-operative-management (NOM) protocol in locally advanced mid-distal rectal cancer, we have conducted a pilot study to find out the predictive value of our preoperative investigations. Methods: Between 2013 and 2017, 35 patients with locally advanced (cT3-4, N-any) primary mid-distal rectal adenocarcinoma were included in the study. We had two groups: Standard long-term chemoradiotherapy (CRT) (Group-1) and CRT + Consolidation chemotherapy (Group-2) groups. Both groups were evaluated regarding clinical (endoscopic-radiological) and pathologic response to neoadjuvant therapy. Each patient's data were prospectively recorded and findings were assessed according to NOM protocol and the clinical decisions recorded. The study was oriented to specify the predictive value of oncology team's hypothetical decisions in determining the right candidate for nonoperative management of rectal cancer. All patients underwent surgery with total mesorectal excision (TME) technique; thus, the hypothetical clinical decisions and pathologic results were compared. Results: The sensitivity and specificity of endoscopy were 57.1% and 87.5%; PPV was 80%, NPV was 70%, and accuracy was 73.3%. The sensitivity of MRI tumor regression grade scoring was 60%, specificity was 90%, PPV was 75%, NPV was 81.8%, and accuracy was 80%. The sensitivity and specificity of the final clinical decision were 80% and 90%; PPV was 80%, NPV was 90%, and accuracy was 86.6% in predicting proper management Conclusion: An institutional adjustment for determinations of predictive values of preoperative investigations is beneficial before the start of nonoperative management protocol

Collagenous Colitis: A Retrospective Survey of Patients with Chronic Diarrhea

Background/Aims: The aim of this retrospective survey is to determine the frequency of collagenous colitis among patients who presented with chronic diarrhea to our gastroenterology outpatient clinic and to evaluate the demographic, clinical and laboratory findings of these patients and the treatment modalities. Methodology: We reviewed the charts of the patients who had presented with chronic diarrhea to our outpatient clinic during four years. We identified the patients who were diagnosed to have collagenous colitis on histopathological examination. Results: Among the 93 patients who presented with chronic diarrhea, 7 (7.5%) were diagnosed as collagenous colitis. Six of these patients were female, the mean age was 64 +/- 11.5 years. Celiac disease was diagnosed in 2 of these patients. Laboratory examination showed anemia in 2 patients, hypoalbuminemia in 4 patients and high C-reactive protein levels in 3 patients. Five patients, were treated with mesalazine, 1 patient with salazopyrine and 1 with methylprednisolone. Remission was obtained in all of these patients except for one; in this case budesonide was started instead of mesalazine. Conclusions: Collagenous colitis was detected in 7.5% of the patients who presented with chronic diarrhea to our gastroenterology outpatient clinic. They were usually middle aged female patients. Mesalazine was effective in most of these patients

Primary diffuse large B cell lymphoma of the breast eight years after the diagnosis of gastric MALT lymphoma: report of first case

Primary breast lymphoma (PBL) is an uncommon type of extranodal non-Hodgkin's lymphoma (NHL), accounting for approximately 1% of all extranodal NHL. Diffuse large B cell lymphoma (DLBCL) is the most frequent histology. Both primary mucosa-associated lymphoid tissue (MALT) lymphoma of the breast and its relapse have been documented previously. We report on a 63-year-old woman with primary DLBCL of the breast which was diagnosed 8 years after gastric MALT lymphoma. Following chemotherapy, complete response was obtained. We suggest that for women presenting with a breast mass who received cytotoxic treatment for the other lymphoma, PBL should be considered in the differential diagnosis of the breast mass together with primary breast carcinoma

Sphincter-Saving Robotic Total Mesorectal Excision Provides Better Mesorectal Specimen and Good Oncological Local Control Compared with Laparoscopic Total Mesorectal Excision in Male Patients with Mid-Low Rectal Cancer

Introduction: Laparoscopic rectal resection with total mesorectal excision is a technically challenging procedure, and there are limitations in conventional laparoscopy. A surgical robotic system may help to overcome some of the limitations. The aim of our study was to compare long-term oncological outcomes of robotic and laparoscopic sphincter-saving total mesorectal excision in male patients with mid-low rectal cancer