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OBJECTIVES: To assess the survival predictivity of baseline blood cell differential count (BCDC), discretised according to two different methods, in adults visiting an emergency room (ER) for illness or trauma over 1 year. DESIGN: Retrospective cohort study of hospital records. SETTING: Tertiary care public hospital in northern Italy. PARTICIPANTS: 11 052 patients aged >18 years, consecutively admitted to the ER in 1 year, and for whom BCDC collection was indicated by ER medical staff at first presentation. PRIMARY OUTCOME: Survival was the referral outcome for explorative model development. Automated BCDC analysis at baseline assessed haemoglobin, mean cell volume (MCV), red cell distribution width (RDW), platelet distribution width (PDW), platelet haematocrit (PCT), absolute red blood cells, white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, basophils and platelets. Discretisation cut-offs were defined by benchmark and tailored methods. Benchmark cut-offs were stated based on laboratory reference values (Clinical and Laboratory Standards Institute). Tailored cut-offs for linear, sigmoid-shaped and U-shaped distributed variables were discretised by maximally selected rank statistics and by optimal-equal HR, respectively. Explanatory variables (age, gender, ER admission during SARS-CoV2 surges and in-hospital admission) were analysed using Cox multivariable regression. Receiver operating curves were drawn by summing the Cox-significant variables for each method. RESULTS: Of 11 052 patients (median age 67 years, IQR 51-81, 48% female), 59% (n=6489) were discharged and 41% (n=4563) were admitted to the hospital. After a 306-day median follow-up (IQR 208-417 days), 9455 (86%) patients were alive and 1597 (14%) deceased. Increased HRs were associated with age >73 years (HR=4.6, 95% CI=4.0 to 5.2), in-hospital admission (HR=2.2, 95% CI=1.9 to 2.4), ER admission during SARS-CoV2 surges (Wave I: HR=1.7, 95% CI=1.5 to 1.9; Wave II: HR=1.2, 95% CI=1.0 to 1.

BACKGROUND: I tumori neuroendocrini del pancreas (PNET) sono un gruppo di tumori rari che rappresentano il 2% di tutte le neoplasie del pancreas, anche se la loro incidenza è aumentata negli ultimi 20 anni. La maggior parte dei PNET sono sporadici e tendono a colpire gli individui più anziani. A differenza dei tumori funzionali, che si presentano con i sintomi derivanti dall’ormone specifico in fase di elaborazione, i tumori neuroendocrini del pancreas non funzionanti (NF-PNET) presentano tipicamente sintomi correlati all’effetto massa locale o a malattia metastatica. Oggi, a causa del crescente uso di imaging addominale, i NF-PNET presentano un’incidenza aumentata. CASE REPORT: Una donna di 32 anni è giunta al nostro pronto soccorso per l’aggravarsi di un dolore addominale irradiantesi alla schiena. Poco dopo l’ammissione, lo stato della paziente peggiora ulteriormente sviluppando segni di shock e peritonite. Una scansione tomografica computerizzata addominale ha mostrato una massa solida (9 x 12 cm) della coda del pancreas con emoperitoneo. La paziente è stata sottoposta a laparotomia esplorativa e successiva splenopancreasectomia distale per un tumore sanguinante. Il rapporto istopatologico ha mostrato un tumore neuroendocrino ben differenziato (G1). Il decorso postoperatorio è stato regolare, la paziente è stata dimessa in X giornata post-operatoria. CONCLUSIONE: la rottura spontanea di neoplasie neuroendocrine solide del pancreas può causare addome acuto con effetti potenzialmente devastanti., BACKGROUND: Pancreatic neuroendocrine tumors (PNETs) are a group of rare tumors that account for 2% of all pancreatic malignancies, even though their incidence has been increasing over the past 20 years. Most PNETs are sporadic and tend to affect older individuals. Differently from functional tumors, which present with symptoms resulting from the specific hormone being elaborated, non-functioning pancreatic neuroendocrine tumors (NF-PNETs) typically present with symptoms related to local mass effect or metastatic disease. Today, due to the increasing use of abdominal imaging, NFPNETs are frequently discovered incidentally. CASE REPORT: A 32-year-old woman was admitted to our emergency department for worsening upper abdominal pain radiating to the back. Shortly after the admission, shock and peritoneal signs developed. An abdominal computerized tomography scan showed a solid mass (9 x 12 cm) of the pancreatic tail with severe hemoperitomeum. Exploratory laparotomy and subsequent distal splenopancreasectomy were performed for a bleeding tumor. Histopathological report showed a neuroendocrine, well differentiated tumor (G1). The postoperative course was uneventful and the patient was successfully discharged on 10th postoperative day. CONCLUSION: Spontaneous rupture of solid neuroendocrine neoplasms of the pancreas can cause acute abdomen with potentially devastating effects. KEY WORDS: Abdominal pain, acute abdomen, Hemorrhagic shock, Pancreatic neuroendocrine tumor.

Il condiloma acuminato gigante (GCA) è una rara lesione simile a cavolfiore, nota anche come tumore di Buschke-Lewenstein (BLT). Sebbene sia caratterizzato da caratteristiche istologiche benigne, il comportamento locale del GCA può essre estremamente aggressivo, mostrando una progressiva infiltrazione delle strutture circostanti che portano alla distruzione del tessuto mediante compressione. Poiché la correlazione tra lo sviluppo di HPV e GCA è aumentata, la maggior parte degli Autori è giunta alla conclusione che l’HPV non solo può causare condilomatosi, ma, associato a particolari fattori di rischio, può portare a condizioni molto più gravi come BLT. Poiché il trattamento della GCA non è ancora standardizzato, è necessaria un’analisi preoperatoria molto accurata delle lesioni per pianificare l’approccio terapeutico più adatto. Sulla base delle attuali conoscenze, la valutazione macroscopica dell’invasione locale del tumore e l’estesa resezione radicale sembrano essere l’unico approccio terapeutico valido. In attesa di nuove tecniche e nuovi trattamenti di risparmio tissutale, al momento, la GCA dovrebbe essere trattata con un’escissione radicale senza una ricostruzione tissutale immediata; complicazioni a lungo termine, come la stenosi, possono essere prevenute con un’adeguata guarigione delle ferite e con un programma di follow-up particolarmente intenso e a lungo termine., Giant condyloma acuminatum (GCA) is a rare cauliflower-like lesion, also known as Buschke-L ewenstein tumor (BLT). Although characterized by benign histological features, the local behavior of GCA is extremely aggressive, showing progressive infiltration of the surrounding structures leading to tissue destruction by compression. As the correlation between HPV and GCA development grew stronger, the majority of the Authors came to the conclusion that HPV can not only cause CA but, associated with particular risk factors, it can lead to much more serious conditions such as BLT. Since the treatment of GCA is still not yet standardized, a very accurate pre-operative analysis of the lesions is required to plan the most suitable treatment approach. Based on current knowledge, macroscopic evaluation of local tumor invasion and extensive radical resection appear to be the only valid therapeutic approach, due to its association with longterm survival and minimal recurrence. Looking forward for new techniques and new tissue sparing treatments, at the moment, GCA can be safely treated with radical excision without immediate tissue reconstruction; long-term complications, such as stricture and stenosis, can be prevented by adequate wound healing and by a particularly intense and long- term follow-up program. KEY WORDS: Anus, Giant condyloma acuminatum.