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Background Specific data regarding coronavirus disease 2019 (COVID-19) in patients with neuroendocrine neoplasms (NENs) are lacking. The aim of this study is to describe the characteristics of patients with NENs who tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive. Material and methods This is a worldwide study collecting cases of patients with NENs along with a positive nasopharyngeal swab reverse transcriptase-polymerase chain reaction (RT-PCR) test for SARS-CoV-2 between June 1, 2020, and March 31, 2021. Centres treating patients with NENs were directly contacted by the principal investigator. Patients with NENs of any primary site, grade and stage were included, excluding small-cell lung carcinoma and mixed adenoneuroendocrine carcinoma. Results Among 81 centres directly contacted, 88.8% responded and 48.6% of them declined due to lack of cases or interest. On March 31st, 2021, eight recruiting centres enrolled 89 patients. The median age was 64 years at the time of COVID-19 diagnosis. Most patients had metastatic, non-functioning, low-/intermediate-grade gastroenteropancreatic NENs on treatment with somatostatin analogues and radioligand therapy. Most of them had comorbidities. Only 8% of patients had high-grade NENs and 12% were receiving chemotherapy. Most patients had symptoms or signs of COVID-19, mainly fever and cough. Only 3 patients underwent sub-intensive treatment, whereas most of them received medical therapies, mostly antibiotics. In two third of cases, no changes occurred for the anti-NEN therapy. More than 80% of patients completely recovered without sequelae, whereas 7.8% patients died due to COVID-19. Conclusions Patients included in this study reflect the typical NEN population regardless of SARS-CoV-2. In most cases, they overcome COVID-19 without need of intensive care, short-term sequelae and discontinuation of systemic oncological therapy.

Objective Sentinel lymph node biopsy (SLNB) usefulness in breast carcinoma N+ converted to N0 after neoadjuvant chemotherapy (NC). Material and methods Descriptive study including 16 females with infiltrating carcinoma with lymphatic metastasis confirmed by biopsy, leaving a metallic marker (MM) in pathological lymph nodes (LN). All patients underwent NC reaching a complete radiological response in LN. Lymphoscintigraphy was performed after 99mTc nanocoloid injection, obtaining planar images and SPECT/CT. Lymphatic drainage and concordance of sentinel node (SN) with MM was analyzed. Results SN was visualized in lymphoscintigraphy in 93.7% of cases. The SN coincided with the MM in 12/15 cases on SPECT/CT. The SLNB technique was completed on 14/16 patients, intraoperatively locating the GC in all of them. The SN was negative in 10 cases, 3 cases presented macrometastases and 1 micrometastases. Axillary lymphadenectomy (AL) was performed in a case of macrometastasis with >15,000 cp/μ ARNm CK-19, absence of drainage and in one case that showed no coincidence with the MM due different Berg's level location. These last two cases presented lymph node metastasis. In the other two cases with not coincidence between the SN and the MM, a total of 4 lymph nodes were removed, showing no evidence of metastasis. Patients without AL were followed up for an average of 10 months (range 6–17), with no evidence of lymph node involvement. Conclusion SLNB in breast cancer with conversion into N0 after neoadjuvant treatment is a technique with good results and a low false negative rate.

Caracterización del perfil de resistencia antimicrobiana por cultivos de lavado broncoalveolar en el hospital Santa Clara

Life cycle assessment (LCA) carries significant uncertainties and imprecision due to a number of factors, including the framework’s linearity assumptions and the wide use of aggregate unit processes in practice. In this work, we exploit the unit manufacturing process (UMP) information model (ASTM E3012-16) to enable parametric environmental analysis of manufacturing systems without disrupting the traditional LCA workflow. We present a formal mapping of an extension of the ASTM E3012 data model and the ecoSpold2 data model. We then demonstrate the utility of this mapping by (1) generating life cycle inventory (LCI) data from an example UMP model representing a vertical milling process and (2) linking the results with an existing LCI database. To show value, we use the Brightway2 framework to process the LCI data and complete a LCA. We conclude by comparing LCA results generated from the parametric milling UMP model against LCA results of a similar milling unit process model from a commercial database.

e16205 Background: Data about neuroendocrine neoplasms (NENs) patients with SARS-CoV-2 are scanty and specific indications for clinical practice are missing. Our aim is to create an international registry about NENs patients affected by SARS-CoV-2 positivity to give a worldwide representation of the situation. Methods: This is an observational retrospective/prospective multicenter survey based on a direct email invitation. All types of NEN are eligible except SCLC and MiNEN. Patients fulfilling the inclusion criteria from March 1st, 2020 up to the end pf pandemic will be recruited. Electronic CRFs are filled out using the REDCap database. Local Institutional Review Board approval is required before data entry. Results: Eighty-one centers, 24 in and 57 outside Italy, representing 39 countries and 5 continents, were contacted. Fourteen centers did not respond and 15 declined the invitation. Among the remaining 52, 6 centers are currently recruiting and 8 are active but not recruiting yet. As of the current abstract submission deadline, 67 patients have been included, mostly GEP-NET (75%), non-functioning (86%), metastatic (85%) and on active treatment [47% somatostatin analogs (SSAs), 10% everolimus, 12% tirosin-kinase inhibitors (TKIs), 10% peptide receptor radionuclide therapy (PRRT), 15% chemotherapy]. Median age at NEN diagnosis was 57 years whilst the median age at SARS-CoV-2 diagnosis was 62 years. Almost all patients reported COVID-19-related symptoms, more commonly fever (67% of patients), cough (55%) and dyspnea (51%), in 28% of cases exertional and in 22% at rest. More than one third of patients (n, 24) had a pneumonia. The most common therapies for COVID-19 were antibiotics, steroids and hydroxychloroquine. Eleven patients (16%) needed oxygen therapy, three (4%) sub-intensive care and none intensive care. Fifty-six patients (84%) clinically recovered, six (9%) with sequelae, whereas five (7%) died. Among these latter 4 had a NET and 1 a NEC, and no patients have been receiving chemotherapy. With regard to the anti-tumor therapy no change occurred in 66% of patients, temporary interruption in 30%, and definitive discontinuation in 3%, 2% missing. Conclusions: Most of the NEN patients completely recovered from COVID-19, in many cases without any anti-tumor therapy adjustment. No clear correlations were observed with type, primary site and treatment of NEN. The recruitment is ongoing.

Background: Characteristics such as gender and lifestyle are not taken in account in colorectal cancer screening and surveillance recommendations. Aims: To identify factors associated with advanced neoplasia at initial and surveillance colonoscopy. Methods: In this observational study, 750 individuals with positive faecal occult blood test, aged 50-74 years, underwent a first screening colonoscopy in 2007-2009. We collected anthropometric data as well as data on physical activity, smoking and drinking habits, fruit and vegetable consumption and low-dose aspirin use through a questionnaire. Results: At initial colonoscopy advanced neoplasia (n = 399, 53.2%) was positively associated with age, male gender, smoking and alcohol drinking, and inversely associated with physical activity, fruit and vegetables consumption and long-term use of aspirin. These 7 factors were used to calculate a risk score, ranging from 0 (no unfavourable characteristics) to 7 (all unfavourable characteristics present), which was significantly associated with advanced neoplasia (odds ratio 1.55 for one point increase, P < 0.01). Among the 372 adenoma patients who returned for follow-up surveillance colonoscopy, the score remained associated with advanced neoplasia (odds ratio 1.28 for one point increase, P = 0.01). Conclusion: Besides age and gender, modifiable factors such as lifestyle and aspirin use were associated with the risk of advanced neoplasia at initial and surveillance colonoscopy.

Sentinel lymph node biopsy (SLNB) usefulness in breast carcinoma N+ converted to N0 after neoadjuvant chemotherapy (NC).Descriptive study including 16 females with infiltrating carcinoma with lymphatic metastasis confirmed by biopsy, leaving a metallic marker (MM) in pathological lymph nodes (LN). All patients underwent NC reaching a complete radiological response in LN. Lymphoscintigraphy was performed afterSN was visualized in lymphoscintigraphy in 93.7% of cases. The SN coincided with the MM in 12/15 cases on SPECT/CT. The SLNB technique was completed on 14/16 patients, intraoperatively locating the GC in all of them. The SN was negative in 10 cases, 3 cases presented macrometastases and 1 micrometastases. Axillary lymphadenectomy (AL) was performed in a case of macrometastasis with15,000cp/μARNm CK-19, absence of drainage and in one case that showed no coincidence with the MM due different Berg's level location. These last two cases presented lymph node metastasis. In the other two cases with not coincidence between the SN and the MM, a total of 4 lymph nodes were removed, showing no evidence of metastasis. Patients without AL were followed up for an average of 10 months (range 6-17), with no evidence of lymph node involvement.SLNB in breast cancer with conversion into N0 after neoadjuvant treatment is a technique with good results and a low false negative rate.

The increase in the global land temperature, expected under predictions of climate change, can directly affect the transmission of some infectious diseases, including Chagas disease, an anthropozoonosis caused by Trypanosoma cruzi and transmitted by arthropod vectors of the subfamily Triatominae. This work seeks to study the effects of temperature on the development of the life cycle, fertility and fecundity of the insect vector Rhodnius prolixus and on the metacyclogenesis of T. cruzi. All of the variables were subjected to 3 temperatures: 26°C, 28°C and 30°C. Hatching time was evaluated, along with time to fifth instar, time to adult, fecundity studied using the e-value, and egg viability during the first 3 reproductive cycles. In addition, the amounts of metacyclic trypomastigotes of the TcI and TcII DTUs in R. prolixus were evaluated from days 2 to 20 at two-day intervals and from weeks 6 to 8 post-infection. Decreases were observed in time to hatching (15–10 days on average) and in time to fifth instar (70–60 days on average) and transition to adult (100–85 days on average). No significant differences in egg viability were observed in any of the reproductive cycles evaluated, but an increase in fecundity was observed at 30°C during the third reproductive cycle. At 30°C, there was also an increase in the number of infective forms and a decrease in the time at which metacyclic trypomastigotes were detected in the rectal ampulla of the insects for both TcI and TcII. According to these results, the expected temperature increase under climate change would cause an increase in the number of insects and a greater probability of infection of the parasite, which affects the transmission of Chagas disease., Author summary Chagas disease is an anthropozoonosis caused by the flagellated protozoan Trypanosoma cruzi and mainly transmitted through the infected faeces of insects of the subfamily Triatominae. Because these insects are sensitive to climatic conditions, it is expected that disease transmission may be affected by the increase in global land temperature, predicted under climate change. Therefore, we wanted to evaluate the effect of temperature increase on the development, viability of eggs and fertility of R. prolixus, the most important vector insect in Colombia, and on the development of the parasite within this insect. We observed a decrease in the development time of R. prolixus and an increase in the number of infectious forms of T. cruzi in the insect as the temperature increased. These results suggest that if the temperature increases as expected, there may be an increase in the number of insects that can transmit the disease, as well as an increase in the likelihood of infection due to the increase in the number of infectious forms. Our data contributes to the understanding of the possible effects of the expected temperature increase under climate change on Chagas disease transmission and can be used to make predictive models that can more accurately predict the future of Chagas disease.

Purpose Several studies have demonstrated the oncologic equivalence of laparoscopic (LS) and open (OS) rectal cancer surgeries and have shown how challenging LS may become. Robotic surgery (RS) has emerged as a practical alternative, offering interesting advantages in comparison to both LS and OS. The aim of this study is to resolve the clinicopathologic outcome advantages of RS with respect to OS and LS techniques. Methods Patients with rectal cancer undergoing OS, RS, or LS were evaluated within the period from April 2009 to August 2011. The evaluations were carried out in 4 Italian hospitals. Perioperative clinicopathologic data, postoperative complications, and 3-year overall and disease-free survival (DFS) rates were analyzed. Results A total of 160 patients (94 male, 66 female) were included. A total of 105 patients underwent mini-invasive procedure (40 LS; 65 RS), whereas OS was performed in 55 patients. Anterior resection of rectal cancer was the most performed surgical procedure (139; 87%). Median operation time was significantly longer in the RS group (pConclusions Although RS for rectal cancer requires more time to be performed than LS and OS techniques, the analysis shows comparatively the feasibility and safety of RS in terms of perioperative clinicopathologic and medium-term outcomes.

Benign anastomotic colonic stenosis sometimes occur after surgery and usually require surgical or endoscopic dilation. Endoscopic dilation of anastomotic colonic strictures by using balloon or bougie-type dilators has been demonstrated to be safe and effective in multiple uncontrolled series. However, few data are available on safety and efficacy of endoscopic electrocautery dilation. The aim of our study was to retrospectively investigate safety and efficacy of endoscopic electrocautery dilation of postsurgical benign anastomotic colonic strictures.Sixty patients (37 women; median age 63.6 years, range 22.6-81.7) with benign anastomotic colonic or rectal strictures treated with endoscopic electrocautery dilation between June 2001 and February 2013 were included in the study. Anastomotic stricture was defined as a narrowed anastomosis through which a standard colonoscope could not be passed. Only annular anastomotic strictures were considered suitable for electrocautery dilation which consisted of radial incisions performed with a precut sphincterotome. Treatment was considered successful if the colonic anastomosis could be passed by a standard colonoscope immediately after dilation. Recurrence was defined as anastomotic stricture reappearance during follow-up.The time interval between colorectal surgery and the first endoscopic evaluation or symptoms development was 7.3 months (1.3-60.7). Electrocautery dilation was successful in all the patients. There were no procedure-related complications. Median follow-up was 35.5 months (2.0-144.0). Anastomotic stricture recurrence was observed in three patients who were successfully treated with electrocautery dilation and Savary dilation.Endoscopic electrocautery dilation is a safe and effective treatment for annular benign anastomotic postsurgical colonic strictures.

Background Both Peptydil arginine deiminase of P. gingivalis (pPAD), and the human enzyme (hPAD), could citrullinarize peptides from the bacteria and human host in Rheumatoid Arthritis patients (RA). Chronic periodontitis (CP) could be associated with a constant generation of citrullinated proteins, and it lead to a proportional hPAD enzymatic production. Objectives The aim was to demonstrate the association between serum levels of hPAD4 and severe Periodontitis in patients with rheumatoid arthritis. Methods Patients with RA (n=127) matched with healthy controls (n=120) were studied in a cross-sectional study. Levels of human recombinant antigens for hPAD4; cyclic citrullinated peptide antibody (CCP3, IgG), Rheumatoid factor (IgM) and C-reactive protein (CRP); determined by ELISA test. The CP was classified according to the recommendations of the International Workshop for Classification of Periodontal Diseases and Conditions. Bivariate analysis to demonstrate the associations, and non-parametric analyzes were used according to the case. Results There were no significant demographic diffrences between the two groups. The median hPAD4 level was 1.21 (95% CI 1.4–1.7) in RA and 0.75 (95% CI 0.94–1.26) ng/ml in controls, (p The frequency of CP was higher in patients with RA than in controls (66.9 vs 43%, p A significant correlation was found between levels of hPAD4 with the DAS28 ESR score (p 2.0) correlated with hPAD4 levels (P Conclusions hPAD4 levels correlate with the severity of CP independent of the RA presence and in RA subjects with high score of disability and activity disease. The hPAD4 could be proposed as a serological marker of clinical severity in chronic diseases such as CP and RA. References Rose, H.M., C. Ragan, and et al., Differential agglutination of normal and sensitized sheep erythrocytes by sera of patients with rheumatoid arthritis. Proc Soc Exp Biol Med, 1948. 68(1): p. 1–6. Girbal-Neuhauser, E., et al., The epitopes targeted by the rheumatoid arthritis-associated antifilaggrin autoantibodies are posttranslationally generated on various sites of (pro)filaggrin by deimination of arginine residues. J Immunol, 1999. 162(1): p. 585–94. Lundberg, K., et al., Antibodies to citrullinated alpha-enolase peptide 1 are specific for rheumatoid arthritis and cross-react with bacterial enolase. Arthritis Rheum, 2008. 58(10): p. 3009–19. Mikuls, T.R., et al., Periodontitis and Porphyromonas gingivalis in patients with rheumatoid arthritis. Arthritis Rheumatol, 2014. 66(5): p. 1090–100. Disclosure of Interest None declared

Open cell aluminum foams have been recently studied for its use in heat exchangers, heat sink and electronics cooling. In this paper, a conceptual design of a heat energy exchange recovering system for residual heat at low temperatures is studies for its potential industrial application. Experimental samples were produced by infiltration process using vacuum pressure. Samples with different pore sizes of 0.5, 1.0 and 2.0 mm were obtained. The samples dimensions were 50 mm x 50 mm x 5 mm and the material was characterized by structure analysis and fluid flow (pressure drop) and heat transfer measurements under transitory and steady state conditions. The experimentation carried on in regards of the fluid flow and heat transfer properties, shown that these two properties are extremely dependent on the pore size of the aluminum foam. In this preliminary study, the thermo-physical characteristics of the aluminum foams useful for energy exchange system in recuperating of residual heat (heat transfer efficiency, transfer time, amount of heat transferred and pressure drop generated), had been presented and used to create a conceptual design. From the tested parameters, the best foam structure and some process parameters have been established for a conceptual design a heat exchanger for a heat recovery system.

Background Diagnosis and management of Barrett's oesophagus are controversial. Technical improvements in real-time recognition of intestinal metaplasia and neoplastic foci provide the chance for more effective target biopsies. Confocal laser endomicroscopy allows to analyze living cells during endoscopy. Aims To assess the diagnostic accuracy, inter- and intra-observer variability of endomicroscopy for detecting in vivo neoplasia (dysplasia and/or early neoplasia) in Barrett's oesophagus. Methods Prospective pilot study. Patients referred for known Barrett's oesophagus were screened. Endomicroscopy was carried out in a circular fashion, every 1–2 cm, on the whole columnar-lined distal oesophagus. Visible lesions, when present, were analyzed first. Targeted biopsies were taken. Confocal images were classified according to confocal Barrett classification. Endomicroscopic and histological findings were compared. Results Forty-eight out of 50 screened patients underwent endomicroscopy. Visible lesions were observed in 3 patients. In a per-biopsy analysis, Barrett's-oesophagus-associated neoplasia could be predicted with an accuracy of 98.1%. The agreement between endomicroscopic and histological results was substantial ( κ = 0.76). Conclusions This study suggests that endomicroscopy can provide in vivo diagnosis of Barrett's oesophagus-associated neoplasia. Because it allows for the study of larger surface areas of the mucosa, endomicroscopy may lead to significant improvements in the in vivo screening and surveillance of Barrett's oesophagus.

Obstruction is a common complication of advanced colorectal cancer. Stent insertion can reduce the need for emergency surgery and allows chemotherapy to begin immediately.To evaluate the technical and clinical success and long-term outcome of stent placement in the management of acute malignant colorectal obstruction.From July 2002 to April 2005, 29 self-expanding metal stents were placed in 24 patients (13 men, mean age 67 years, range 36-83). Stents were inserted under endoscopic and fluoroscopic control. Patients were clinically and endoscopically followed up.Twenty-eight out of 29 stents were successfully placed (96.5%) in 23 out of 24 patients with 25 strictures. The clinical success rate was 95.8% (23/24). Two early stent migrations were observed in two patients (8.3%). Late complications developed in eight patients (33.3%) after a median of 3.8 months (range1-8.6): two migrations and six occlusions. The median survival was 9.8 months (range1-27). Eleven patients (45.8%) died from progressive disease without any clinical evidence of recurrent obstruction.Stent placement is safe and effective. Stent complications are frequent but not life-threatening, and are easy to manage. An improvement in stent design and well-scheduled follow-up are needed in order to prevent such complications.

The association between gastric carcinoma and lymphoma is rare. Confocal laser endomicroscopy is a new diagnostic tool that allows the identification of cellular and vascular architecture during endoscopy. This is the first report of an in vivo early gastric carcinoma diagnosis by confocal laser endomicroscopy in a patient successfully treated for a primary gastric diffuse large-B-cell lymphoma.

To evaluate the efficacy, tolerability, acceptability and feasibility of bisacodyl plus low volume polyethyleneglycol-citrate-simeticone (2-L PEG-CS) taken the same day as compared with conventional split-dose 4-L PEG for late morning colonoscopy.Randomised, observer-blind, parallel group, comparative trial carried out in 2 centres. Out patients of both sexes, aged between 18 and 85 years, undergoing colonoscopy for diagnostic investigation, colorectal cancer screening or follow-up were eligible. The PEG-CS group received 3 bisacodyl tablets (4 tablets for patients with constipation) at bedtime and 2-L PEG-CS in the morning starting 5 h before colonoscopy. The control group received a conventional 4-L PEG formulation given as split regimen; the morning dose was taken with the same schedule of the low volume preparation. The Ottawa Bowel Preparation Scale (OBPS) score was used as the main outcome measure.A total of 164 subjects were enrolled and 154 completed the study; 78 in the PEG-CS group and 76 in the split 4-L PEG group. The two groups were comparable at baseline. The OBPS score in the PEG-CS group (3.09 ± 2.40) and in the PEG group (2.39 ± 2.55) were equivalent (difference +0.70; 95%CI: -0.09-1.48). This was confirmed by the rate of successful bowel cleansing in the PEG-CS group (89.7%) and in the PEG group (92.1%) (difference -2.4%; 95%CI: -11.40- 6.70). PEG-CS was superior in terms of mucosa visibility compared to PEG (85.7% vs 72.4%, P = 0.042). There were no significant differences in caecum intubation rate, time to reach the caecum and withdrawal time between the two groups. The adenoma detection rate was similar (PEG-CS 43.6% vs PEG 44.7%). No serious adverse events occurred. No difference was found in tolerability of the bowel preparations. Compliance was equal in both groups: more than 90% of subjects drunk the whole solution. Willingness to repeat the same bowel preparations was about 90% for both regimes.Same-day PEG-CS is feasible, effective as split-dose 4-L PEG for late morning colonoscopy and does not interfere with work and daily activities the day before colonoscopy.

This study focuses on gene expression during crucial biological phenomena of the dimorphic fungal human pathogen Paracoccidioides brasiliensis, the conidia-to-yeast (C-Y) transition and the conidia-to-mycelia (C-M) germination. We studied 10 genes involved in different cellular functions: oxidative stress response (alternative oxidase (AOX), superoxide dismutase (SOD), flavodoxin, conserved hypothetical protein (Y20)); cell metabolism (glyceraldehyde-3-phosphate dehydrogenase (GADPH), cholestenol Delta-isomerase (ChDI), glycine dehydrogenase (GDh)) and heat shock response (Heat shock protein 90 (HSP90)), and cell synthesis and wall structure (glucan synthase-1 (GS-1), α-1,3-glucan synthase (αGS), and mannosyltransferase (MT)). Gene expression was measured during the first 72 h and 96 h of C-Y and C-M, respectively, previously shown to be a fundamental time frame for the consolidation of these cellular processes. The gene expression of AOX, GAPDH, HSP90, MT, αGS, and GDh was significantly increased during the C-Y transition, while SOD, ChDI, GAPDH, MT, GDh, and GS-1 were increased during C-M germination. Additionally, some were highly expressed in each process: AOX, HSP90, and αGS during C-Y; SOD, ChDI, and GS-1 during C-M. Altogether, these data add new information regarding gene expression during the C-Y and C-M processes. Future research will be targeted to further characterize the true relevance of the studied genes during the morphological transition, either during adaptation to the environment or to the infected host.

Background Because of the many therapeutic options available, a reliable staging is crucial for rectal neoplasia management. Adenomas and cancers limited to the submucosa without lymph node involvement may be treated locally. Aims The aim of this study is to evaluate the diagnostic accuracy of endorectal ultrasonography in the staging of neoplasias suitable for local treatment. Methods We considered all patients who underwent endorectal ultrasonography between 2001 and 2010. The study population consisted of 92 patients with 92 neoplasias (68 adenocarcinomas and 24 adenomas). A 5 and 7.5 MHz linear array echoendoscope was used. The postoperative histopathologic result was compared with the preoperative staging defined by endorectal ultrasonography. Adenomas and cancers limited to the submucosa were considered together (pT0–1). Results The sensitivity, specificity, overall accuracy rate, positive predictive value, and negative predictive value of endorectal ultrasonography for pT0–1 were 86%, 95.6%, 91.3%, 94.9% and 88.7%. Those for nodal involvement were 45.4%, 95.5%, 83%, 76.9% and 84%, with 3 false positive results and 12 false negative. For combined pT0–1 and pN0, endorectal ultrasonography showed an 87.5% sensitivity, 95.9% specificity, 92% overall accuracy rate, 94.9% positive predictive value and 90.2% negative predictive value. Conclusion Endorectal linear array ultrasonography is a reliable tool to detect rectal neoplasias suitable for local treatment.

are incidental lesions rarely encountered during upper gastrointestinal endoscopy. We report a case of gastric xanthomatosis in a 49-year-old asymptomatic woman affected by pulmonary B-cell lymphoma. She underwent esophagogastroduodenoscopy to stage her lymphoproliferative disease. The previous medical history was unremarkable, blood chemistry was normal, and she was not receiving any medication. The upper endoscopy showed soft, white/yellowish, isolated, and confluent multiple nodules, 3 –8 mm in diameter, mainly distributed in the gastric corpus, primarily along the greater curvature (l" Fig. 1). The histopathologic diagnosis was established by the observation of foamy histiocytes in the mucosal layer with hematoxylin and eosin (H&E) staining (l" Fig. 2). The absence of nuclear atypia and cytokeratins (l" Fig. 3) excluded any gastric malignancies. No follow-up was suggested. Xanthelasma is usually observed in elderly women and the most frequent gastrointestinal site is the stomach. Gastric xanthomas frequently occur in a mucosa where pathological changes such as chronic gastritis, intestinal metaplasia, atrophic gastritis, or gastric ulcer are observed [1]. Although the pathogenesis of xanthelasma is still unclear, it has been suggested that its development might be a response to mucosal damage by a mechanism in which lipids derived from broken-down cell membranes are captured by intestinal histiocytes [2]. The typical endoscopic appearance of xanthelasma is of yellow-white, well-demarcated, single or multiple nodules or plaques, ranging in size from 1 to 10 mm in diameter [3]. On histopathologic evaluation, they are characterized by the presence of numerous foamy histiocytes in the lamina propria. This microscopic appearance is reminiscent of that observed in signet ring-cell carcinoma, which is histologically the main differential diagnosis associated with xanthelasma [4]. No treatment or follow-up is necessary but histologic assessment is mandatory because some gastric malignancies may also macroscopically resemble these benign lesions [5]. Endoscopy_UCTN_Code_CCL_1AB_2AC_3AB Endoscopy_UCTN_Code_CCL_1AB_2AC_3AH A massive gastric xanthomatosis

Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) has been reported to detect colorectal adenomas. Aims This study aimed at evaluating the sensitivity of 18F-FDG PET with computed tomography image fusion (PET/CT) for detecting colorectal adenomas. Methods We retrospectively compared the results of 92 18F-FDG PET/CT studies followed by colonoscopy. Colonoscopy and histology were considered as the gold standard. Results One hundred fifty-seven lesions were observed. All the 12 malignancies were identified by 18F-FDG PET/CT but only 27 out of 119 resected adenomas (sensitivity 22.7%) and none of the hyperplastic polyps were detected. At the univariate and multivariate analyses there was a significant statistical association between adenomas sized more than 10 mm, presence of villous component and high-grade dysplasia and the ability of 18F-FDG PET/CT to detect adenomas. 18F-FDG PET/CT showed an overall sensitivity of 29.8%, a specificity of 81.1%, a positive predictive value (PPV) of 84.8% and a negative predictive value (NPV) of 24.6% for the neoplastic colorectal lesions globally considered. Conclusion 18F-FDG PET/CT has a low sensitivity for detecting adenomas. However, because of the specificity and PPV of the technique for neoplastic colorectal lesions, the presence of a focal colorectal FDG uptake justifies the patient undergoing colonoscopy.