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(1) Background: The preferred reconstructive option for closing small- or medium-sized defects of the distal half of the nose is the use of local flaps. The dorsal nasal (Rieger) flap is suitable for closing medium-sized defects at this location, especially when they are medially located, and are wider rather than tall. We describe a rotation–transposition dorsal nasal flap reconstruction for large nasal defects. The novelty of this design includes the addition of a small transposition lobe to the rotation flap, enabling the acquisition of tissue from either the lateral sidewall or the nasolabial sulcus, facilitating closure with guitar-string sutures. (2) Methods: We conducted a retrospective chart review of all the patients with large defects (>20 mm) of the nose who underwent nasal dorsum rotation–transposition flap repair between January 2019 and November 2022 at a single academic center. (3) Results: Fourteen patients (eight males, six females; ages 47–83, mean age 60 years) with defects (range: 20.00–35.00 mm) on the dorsum and nasal tip were recruited. Follow-up duration ranged from 12 months to 3 years, with all cases showing good or excellent oncologic and cosmetic results. (4) Conclusions: The rotation–transposition dorsal nasal flap was demonstrated to be a reproducible one-stage technique for large defects of the dorsum and nasal tip, with minimal risk of aesthetic or functional complications. Guitar-string sutures allowed the reduction of the defect size, facilitating a smaller flap design. [ABSTRACT FROM AUTHOR]

The text is a review of the book "Prolegomena to a Science of Antiquity" by David Hernández de la Fuente. The author highlights the importance of studying Antiquity and reflects on the different historiographical and ideological trends that have worked in this area. The book is structured into six chapters and addresses topics such as the study of Antiquity in history, the birth of the sciences of Antiquity, and the expansion and specialization of these disciplines in the 19th century. The author also emphasizes the importance of philology in the study of Antiquity. The text analyzes the origin and development of archaeology and the study of material culture, which dates back to the travels of antiquarians in search of objects in historical places. The influence of archaeological excavations in Pompeii and Herculaneum during the reign of Charles III of Spain is mentioned. The text also addresses the crisis of European thought at the end of the 19th century and the impact of Friedrich Nietzsche and Sigmund Freud on studies of Antiquity. The text also examines new forms of studying Antiquity in the 20th century and current perspectives for its study, including the feminist movement and Black Lives Matter. The importance of the classical legacy is highlighted, and the disappearance of philology in universities is criticized. [Extracted from the article]

The text is a summary of the book "From the Archaeological Record to the Museum: The Path of History. Studies in Tribute to Mercedes Unzu Urmeneta," edited by Javier Martínez Sarasate, Javier Andreu Pintado, and María Jesús Peréx Agorreta. The book presents twenty-five contributions from experts in ancient and medieval history and archaeology of Navarra, addressing topics such as prehistory, the influence of Rome in the Ebro Valley and the Pyrenean region, and aspects of the medieval and modern era. It highlights the importance of Mercedes Unzu in the study of ancient Basques and her contribution to the knowledge of this society in Navarra. The chapters of the book deal with various topics related to the ancient city of Pompaelo and other archaeological findings in the region. The authors of the chapters include several experts in the field of archaeology and ancient and medieval history. [Extracted from the article]

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Introduction: Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous neoplasm, and its incidence is on the rise. While most cSCCs have an excellent prognosis, certain risk factors, especially immunosuppression, have been associated with higher rates of local recurrence (LR), metastasis, and poor prognosis. This study aims to assess the risk factors for LR and metastasis development in cSCC among solid organ transplant recipients (SOTRs) and compare these rates with those in immunocompetent patients. Materials and Methods: A retrospective observational study included cSCC cases from the University Hospital Reina Sofía in Córdoba, Spain, between 2002 and 2019. Demographic, clinical, and histopathological data were collected. Local recurrence and metastasis rates were analyzed, along with progression-free survival. Univariate analyses were performed to identify prognostic factors in SOTRs. Results: Among 849 cSCC cases, we found higher rates of local recurrence and metastasis in tumors developed by SOTRs compared to those in immunocompetent individuals. However, no significant differences in local recurrence, metastasis, or progression-free survival were observed between the two groups. Risk factors for adverse outcomes in SOTRs included tumor size > 2 cm, depth > 4 mm, and a higher Clark level. A total of 34.4% of SOTRs developed a second primary cSCC during the follow-up. Conclusions: In our study, cSCCs in SOTRs did not exhibit statistically significant differences in the rates of adverse outcomes compared to immunocompetent patients. The prognosis of cSCCs in SOTRs may be more related to other tumor-dependent risk factors than to the immunosuppression status itself. Future studies are needed to refine risk stratification and follow-up protocols to ensure the optimal management of high-risk cSCC cases, particularly among immunosuppressed patients. [ABSTRACT FROM AUTHOR]

Reconstruction of the auricular concha poses a challenge due to its difficult access and limited tissue flexibility; however, there are no recommendations in the literature on which reconstructive technique should be favored for this anatomical site. This systematic review intends to describe and compare the reconstructive techniques used in conchal bowl reconstruction following cutaneous oncologic surgery of this region, with regard to their complications and aesthetic results. In doing so, we aim to identify the best suited reconstructive procedure(s) for the conchal bowl. The six databases searched (PubMed, Scopus, Web of Science, Ovid, SciELO, and CENTRAL) yielded twelve eligible studies that explored the revolving door flap, split-thickness skin grafts (STSG), full-thickness skin grafts (FTSG), second intention healing, the preauricular translocation flap, subcutaneous pedicle grafts, and other local flaps. Qualitative synthesis of the results concluded that the revolving door flap could be the reconstructive procedure of choice for the auricular concha, following skin cancer excision. It has a low risk of necrosis, infection, and postoperative hemorrhage, as well as excellent aesthetic outcomes. STSG may be used as an alternative. Nonetheless, due to the low sample size and the high risk of bias in some studies, further investigations must be conducted on this subject. [ABSTRACT FROM AUTHOR]

Simple Summary: The aim of this study is to compare the risk of local recurrence and metastases in patients with cSCC based on the presence or absence of prior sun exposure in the region of tumor development. A retrospective observational epidemiological study including 558 patients from January 2017 to December 2020 was conducted. Among the 463 patients with cSCC in highly sun-exposed areas, 73 (15.8%) were diagnosed with local recurrence versus only 7 of 95 patients (7.4%) in less sun-exposed areas. No differences were found in terms of metastasis between both groups. In regions with low sun exposure, the variables linked to a heightened risk of recurrence include tumor depth and the involvement of surgical margins. Our results suggest that highly sun-exposed areas could have a greater risk of developing local recurrence, conferring a worse prognosis for the patients. Background: The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing over the years. Risk factors for local recurrence and metastasis have been widely studied in highly sun-exposed areas of the body but less data exist about less sun-exposed ones. The main objective of this study is to compare the risk of local recurrence and metastases in patients with cSCC in highly sun-exposed areas compared to cSCC in less sun-exposed areas. Material and methods: A retrospective observational study was carried out, including 558 patients with histopathologically confirmed cSCC at the Reina Sofía University Hospital (HURS), Córdoba, during the period from 1 January 2017 to 31 December 2020. Demographic, clinical and anatomopathological data were collected. Results: Local recurrence occurs more often in highly sun-exposed areas (15.8%) compared to less sun-exposed ones (7.4%) (p < 0.05). However, no differences in the rate of metastases in both groups were found. The presence of affected surgical margins and tumor thickness were identified as independent risk factors for cSCC in low sun-exposure areas. Conclusions: cSCC located in anatomical areas of high sun exposure presented a greater risk of developing local recurrence in our population, which could suggest that these tumors have worse prognosis than those that lie in areas that do not receive chronic sun exposure. [ABSTRACT FROM AUTHOR]

Background: Repairing lower extremity defects presents challenges due to the scarcity of available local tissue. Skin grafting is a widely employed technique for addressing non-healing ulcers, improving the quality of life of patients and minimizing discomfort. However, using traditional donor sites, such as the thigh, can hinder mobility and result in noticeable scarring and pigmentation changes. Objectives: This study aims to assess the effectiveness of a novel approach utilizing autologous ultra-thin split-thickness skin grafts (STSGs) harvested from the scalp using a disposable, commercially available razor blade named DermaBlade. Methods: Fifteen patients (median age: 72 years, eight males and seven females) with diverse lower limb lesions, including carcinomas and ulcers of varying etiologies, were prospectively enrolled. Donor sites included the sideburn extending to the hairy temporal skin (nine cases) and hairy occipital skin (six cases). Ultra-thin skin strips (<0.2 mm thick) were obtained from the scalp through the use of the disposable flexible blade DermaBlade. The strips were positioned over the receptor area with no sutures in most cases and secured using dressings. A substantial majority of patients (90%) achieved successful graft take with no complications. Swift re-epithelialization occurred within a median of 12 days for the donor site and 24 days for the receptor site. No hair transfer or alopecic scars were noted. Conclusions: In contrast to traditional grafting methods, DermaBlade-assisted scalp grafting yields highly viable STSGs that adhere to wound beds without the need for sutures. Notable advantages of this technique encompass rapid wound healing, minimal complications, and superior cosmetic outcomes. Furthermore, it avoids scarring and alopecia, making it a promising approach for addressing lower extremity defects. [ABSTRACT FROM AUTHOR]

The article "Preliminaries to a Science of Antiquity" is a review of the book written by David Hernández de la Fuente. The author highlights the importance of studying Antiquity and reflects on the different historiographic and ideological trends that have worked in this area. The book addresses topics such as the study of Antiquity in its beginnings, the birth of the Sciences of Antiquity, and the expansion and specialization of these disciplines in the 19th century. The importance of philology in the study of Antiquity and the difficulty of reconstructing the past due to separate copies of historical sources are also mentioned. The text analyzes the origin and development of archaeology and the study of material culture, as well as the influence of archaeological excavations in Pompeii and Herculaneum during the reign of Charles III of Spain. The crisis of European thought at the end of the 19th century and the importance of Friedrich Nietzsche and Sigmund Freud in studies on Antiquity are also addressed. The new forms of studying Antiquity in the 20th century and the influence of social movements such as feminism and Black Lives Matter on the understanding of Antiquity are mentioned. The importance of the classical legacy in Western society is highlighted, and the disappearance of philology in universities is criticized. [Extracted from the article]

Simple Summary: This study evaluates the occurrence of second primary neoplasms (SPNs) in individuals with a history of melanoma (MM) and identify factors that increase the risk in our population. A prospective cohort study was conducted, involving 529 MM survivors from January 2005 to August 2021. Among the 529 patients, 89 were diagnosed with SPNs, with 62 being skin tumors and 37 being solid organ tumors. The estimated probability of developing SPNs after MM diagnosis was found to increase over time, reaching 4.1% at 1 year, 11% at 5 years, and 19% at 10 years. Several factors were significantly associated with a higher risk of SPNs, including older age, primary MM location on the face or neck, and the histologic subtype of lentigo maligna MM. We conclude that individuals with primary MM located on the face and neck, as well as those with the histological subtype of lentigo maligna-MM, have a higher risk of developing SPNs. Age also independently influences the risk. Understanding these risk factors can assist in developing MM guidelines that provide specific follow-up recommendations for individuals at the highest risk. (1) Introduction: The association between melanoma (MM) and the occurrence of second primary neoplasms (SPNs) has been extensively studied, with reported incidence rates ranging from 1.5% to 20%. This study aims to evaluate the occurrence of SPNs in patients with a history of primary MM and to describe the factors that make the risk higher in our population. (2) Material and Methods: We conducted a prospective cohort study and calculated the incidence rates and relative risks (RR) for the development of different SPNs in 529 MM survivors from 1 January 2005 to 1 August 2021. Survival and mortality rates were obtained, and the Cox proportional hazards model was used to determine the demographic and MM-related factors that influence the overall risk. (3) Results: Among the 529 patients included, 89 were diagnosed with SPNs (29 prior to MM diagnosis, 11 synchronous, and 49 after MM), resulting in 62 skin tumors and 37 solid organ tumors. The estimated probability of developing SPNs after MM diagnosis was 4.1% at 1 year, 11% at 5 years, and 19% at 10 years. Older age, primary MM location on the face or neck, and histologic subtype of lentigo maligna mm were significantly associated with a higher risk of SPNs. (4) Conclusions: In our population, the risk of developing SPNs was higher in patients with primary MM located on the face and neck and with the histological subtype of lentigo maligna-MM. Age also independently influences the risk. Understanding these hazard factors can aid in the development of MM guidelines with specific follow-up recommendations for individuals with the highest risk. [ABSTRACT FROM AUTHOR]

Sturge-Weber syndrome (SWS) is a congenital, sporadic, and rare neurocutaneous disorder, characterized by the presence of a facial port-wine birthmark (PWB), glaucoma, and neurological manifestations including leptomeningeal angiomatosis and seizures. It is caused by a postzygotic, somatic, gain-of-function variant of the GNAQ gene, and more recently, the GNA11 gene in association with distinctive clinical features. Neuroimaging can help identify and stratify patients at risk for significant complications allowing closer follow-up; although no presymptomatic treatment has been demonstrated to be effective to date, these patients could benefit from early treatment and/or supportive interventions. Choroid plexus (CP) thickness measurements in brain magnetic resonance imaging (MRI) have a high sensitivity and specificity for early and incipient changes in SWS. In contrast, the absence of pathologic findings makes it possible to rule out associated neurological involvement and leads to periodical observation, with new imaging studies only in cases of new clinical signs/symptoms. Periodic ophthalmological examination is also recommended every 3 months during the first year and yearly afterwards to monitor for glaucoma and choroidal hemangiomas. Treatment for SWS depends on the extent and areas that are affected. These include laser surgery for PWB, anticonvulsants in the case of brain involvement, with either seizures or abnormal EEG, and medical treatment or surgery for glaucoma. Sirolimus has been used in a limited number of patients and appears to be a safe and potentially effective treatment for cutaneous and extra-cutaneous features, however controlled clinical studies have not been carried out. Better knowledge of GNAQ/GNA11 molecular pathways will help to develop future targeted treatments. [ABSTRACT FROM AUTHOR]

Read the original articleSánchez-Espino LF, Ivars M, Antoñanzas J, Baselga E. Appl Clin Genet. 2023;16:63–81.It has come to our attention that there is an error in the paper title on page 63, the title "Sturge-Weber Syndrome: A Review of Pathophysiology, Genetics, Clinical Features, and Current Management Approache" should read "Sturge-Weber Syndrome: A Review of Pathophysiology, Genetics, Clinical Features, and Current Management Approach".By Luis Fernando Sánchez-Espino; Marta Ivars; Javier Antoñanzas and Eulalia BaselgaReported by Author; Author; Author; Author [Extracted from the article]

This article discusses the successful treatment of epidermal nevus (EN) in a patient with phacomatosis spilosebacea (PSS) using topical sirolimus. EN is a type of birthmark, while PSS is a rare disorder characterized by the presence of EN along with other organ system involvement. Treatment of EN can be challenging, but topical sirolimus has shown promising results in managing difficult-to-treat dermatological disorders. In this case, a patient with PSS experienced a marked decrease in thickness of the EN lesions after 5 weeks of treatment with topical sirolimus, with no adverse effects reported. Further follow-up is needed to confirm the long-term improvement. [Extracted from the article]

The article summarizes María Engracia Muñoz-Santos' book on the spectacles in ancient Rome, focusing on the events that took place in the city of Rome. The author uses various sources to support her argument, including political, historical, epic texts, artistic and iconographic sources, as well as skeletal remains. The book examines different types of spectacles, such as gladiatorial battles, venationes, and damnationes, as well as chariot races in the circus. The origins of these events, the places where they took place, and the participants involved, including the editors, spectators, and other protagonists, are also mentioned. However, it is noted that the book does not provide enough information about the spectacles outside the city of Rome. [Extracted from the article]

The appearance of morphea after vaccination has been reported to date as single and deep lesions that appear exactly at the site of the skin puncture. It was therefore postulated that the origin could be the trauma related to the injection. The aim of this article is to review the various hypotheses offered in the published literature about generalized morphea following vaccination. We present two cases of generalized morphea after COVID‐19 vaccination and review the published literature on immune‐related cutaneous reactions. As previously reported, antigenic cross‐reactivity between vaccine spike proteins and human tissues could cause certain immune‐mediated diseases, including generalized morphea. Herein we report two cases of generalized morphea probably induced by the COVID‐19 vaccine, given the temporal relationship with its administration. In summary, environmental factors such as vaccination against SARS‐COV‐2 could induce an immune system dysregulation, which would have an important role in the pathogenesis of morphea. We present two cases of generalized morphea probably induced by the COVID‐19 vaccine, given the time elapsed between vaccination and the onset of the skin lesions. [ABSTRACT FROM AUTHOR]

Primary TMAU is a rare metabolic disorder that results from the failure of hepatic FMO3 to oxidize TMA due to a mutation in the I FMO3 i gene. Trimethylaminuria (TMAU) is a rare metabolic disorder characterized by an unpleasant body odor resembling decaying fish.[1] Biochemically, all affected patients present with an increased amount of trimethylamine (TMA) due to a mutation in the I FMO3 i gene, leading to the inability to oxidize this amine to the non-odorous metabolite, trimethylamine N-oxide (TMAO).[2] Patients with TMAU may experience serious psychosocial phenomena that limit their quality of life and also several systemic diseases.[3] Many therapeutic regimens have been proposed, and TMAU symptoms can be temporarily alleviated with certain drugs. Our patient exhibited a substantial and sustained improvement after a deprivation diet, underlining the importance of avoiding food containing elevated amounts of TMA in patients with mutations affecting the I FMO3 i gene. [Extracted from the article]

Immunofluorescence of the patient affected skin with monoclonal antibodies against high molecular weight keratins (34 E12), OSMR and caspase-3 was also performed (Supplementary Data). Keywords: amyloidosis; apoptosis; caspases EN amyloidosis apoptosis caspases 1638 1640 3 10/06/22 20221001 NES 221001 Primary localized cutaneous amyloidosis (PLCA) is a rare form of cutaneous amyloidosis, characterized by the presence of flat-topped papules and macules with amyloid deposits in the superficial dermis. [Extracted from the article]

Hailey-Hailey disease (HHD) is a rare genodermatosis caused by a mutation in the ATP2C1 gene, which codes for a calcium channel. Therefore, we suggest the combined use of apremilast with BoNT infiltrations as rescue treatment for lesions located in skin folds with excessive sweating activity. Here we present a case of refractory HHD who experienced an excellent response after treatment with apremilast and botulinum toxin-A (BoNT) infiltrations. [Extracted from the article]

Granuloma annulare (GA) is an entity of unknown origin classified among granulomatous skin diseases. GA diagnosis was made and treatment with cyclosporine 200 mg per day was started with only partial improvement after 10 months. TNF is known to participate in the formation and maintenance of granulomas, especially in its transmembrane form.1 Therefore, it seems logical to speculate that drugs that inhibit TNF- could prevent GA progression. [Extracted from the article]

A case study reports a 23-year-old man with asymptomatic, skin-colored, indurated papules on his left temporal region for 3 years, diagnosed as multiple miliary osteomas cutis (MMOC). MMOC, a variant of primary osteoma cutis, often appears in middle age, is associated with past acne lesions and may have an underestimated incidence, with clinical diagnosis and ultrasonography as potential tools for identification and various treatment options available.

Juvenile xanthogranuloma (JXG) is a non-Langerhans cell histiocytosis usually occurring in infants and typically located in the head or neck.1 Clinically, solitary skin lesions are found in 60%-82% of patients and the most common variant is characterized by one yellowish nodule. Further studies are needed to help determine the efficacy and safety of this treatment in non-spontaneously resolved JXG and in other non-Langerhans cell histiocytoses limited to the skin, in which it could also be an alternative. In this respect, it is worthy of mention that characteristic histopathological clues of JXG as presence of xanthomatous/foamy histiocytes or Touton cells were not observed in any case.10 As noted above, spontaneous resolution of adult onset JXG is uncommon, and an area of atrophy frequently develops. [Extracted from the article]

Plasma torch gasification (PTG) is currently researched as a technology for solid waste recovery. However, scientific studies based on evaluating its environmental implications considering the life cycle assessment (LCA) methodology are lacking. Therefore, this work is focused on comparing the environmental effect of the emissions of syngas combustion produced by refuse derived fuel (RDF) and PTG as alternative fuels, with that related to fossil fuel combustion in the cement industry. To obtain real data, a semi-industrial scale pilot plant was used to perform experimental trials on RDF-PTG.The results highlight that PTG for waste to energy recovery in the cement industry is environmentally feasible considering its current state of development. A reduction in every impact category was found when a total or partial substitution of alternative fuel for conventional fuel in the calciner firing (60 % of total thermal energy input) was performed. Furthermore, the results revealed that electrical energy consumption in PTG is also an important parameter from the LCA approach. [ABSTRACT FROM AUTHOR]

Unilateral linear capillaritis is a rare variant of the pigmented purpuric dermatoses that can be misdiagnosed due to confusion with other cutaneous diseases that follow a linear distribution. We present the case of an 8‐year‐old boy with hyperpigmented patches linearly distributed on the right arm, initially diagnosed with segmental neurofibromatosis. [ABSTRACT FROM AUTHOR]

Objective: the objective of the present study was to analyze the characteristics of resected incidental lesions of the pancreas., Material and Methods: a retrospective study was performed of pancreatectomies due to incidentalomas between 1995 and 2018., Results: one hundred pancreatectomies were performed due to incidental lesions; 64 (64%) were solid and 36 (36%) were cystic lesions. The cytological analysis agreed with the diagnosis in 67/71 (88.7%) cases. Thirty-six tumors were cystic, 48 were neuroendocrine and 16 were adenocarcinomas. Disease-free survival for patients with cystic, neuroendocrine tumors and adenocarcinomas was 100%, 79% and 57.7% (p < 0.04)., Conclusion: pancreatic incidentalomas have a heterogeneous phenotype and should be treated in experienced centers.

Background: the aim of the present study was to analyze the clinicopathological features of patients undergoing pancreatic surgical resections due to cystic neoplasms of the pancreas., Material and Methods: demographic data, form of presentation, radiologic images and location of the tumors within the pancreas were analyzed. Data was also collected on the type of surgery (open/laparoscopic), postoperative complications and their severity and oncologic outcomes., Results: eighty-two pancreatic resections were performed. The mean age of patients was 57 years and 49 (59%) were female. Forty-one tumors (50%) were incidental and the most frequent symptoms in the group of symptomatic patients were abdominal pain (63.4%) and weight loss (36.5%). Thirty-two tumors (39%) were located in the tail of the pancreas, 25 (30.5%) in the head and 20 (24.4%) in the body. Thirty-nine (47.5%) distal pancreatectomies, 16 central, ten duodenal pancreatectomies and one enucleation were performed; 40 (48.5%) were carried out laparoscopically. Mean hospital stay was ten days and eight patients (7%) experienced severe complications, one was a pancreatic fistula. Sixty-six tumors (80.5%) were recorded as non-invasive and 16 (19.5%) as invasive: seven intraductal mucinous papillary tumors, one cystic mucinous tumor, four solid pseudopapillary tumors and four cystic neuroendocrine tumors. There was a median follow-up of 64 months; disease-free survival at five and ten years was 97.4% in the patients with non-invasive tumors and 84.6% and 70.5% in the invasive tumors group (p < 0.01)., Conclusions: fifty percent of cystic neoplasms of the pancreas are incidental. Two phenotypes exist, invasive and non-invasive.

Objective: the objective of this study was to analyze the anatomical and clinical features and long-term oncologic outcomes of 25 patients that underwent surgery due to intraductal papillary mucinous neoplasm of the pancreas., Material and Methods: patients undergoing surgery for intraductal papillary mucinous neoplasm of the pancreas were identified from a prospective database of pancreatic resections. Demographic data, symptoms, type of surgery and type of lesion (branch type, main duct or mixed) were recorded. The lesions were classified into invasive (high grade dysplasia and carcinoma) and noninvasive (low- or intermediate-grade dysplasia). Postoperative complications were analyzed as well as the pattern of recurrence and disease-free survival at five and ten years., Results: the most common symptoms in the 25 patients (14 males and eleven females) were abdominal pain and weight loss. Eight (32%) cases were diagnosed incidentally. Twelve (48%) of the lesions were of the branch type, three affected the main duct and ten (40%) were mixed. Twelve cephalic duodenopancreatectomies and seven total pancreatectomies were performed; three were central; two, distal; and one, enucleation. Seven cases (32%) had an invasive phenotype. Three patients had locoregional and distant recurrence at six, 16 and 46 months after surgery with a median follow-up of 7.7 years. Disease-free survival at five and ten years for the noninvasive type was 94% and 57% for invasive phenotypes (p < 0.05)., Conclusions: intraductal papillary mucinous neoplasm is a heterogeneous entity with well differentiated phenotypes, which requires a tailored strategy and treatment, as established in the current consensus guidelines due to its malignant potential.

We are grateful for the helpful comments of Varas et al. with regard to the phenotype of cystic pancreatic neuroendocrine tumors (CPNT) reported in a recent meta-analysis of 436 patients. Varas et al. highlight the lower incidence of CPNT diagnosed incidentally in 135 patients (44.6%) in comparison with a recent series of 49 patients with an incidental tumor diagnosis of 56.5%.