Goblet cell adenocarcinoma (GCA) is a rare tumor described exclusively in the appendix, comprising < 1% of gastrointestinal tumors. The 2019 WHO classification of tumors of the digestive system has renamed and defined it. This study aims to analyze the clinical presentation and evaluate the histomorphological profile of GCA. A retrospective search of our database was done spanning a period of 10.5 years (July 2014-January 2025). Clinicopathological features were analyzed. Fourteen patients included had a median age of 50 years at the time of diagnosis with a male to female ratio of 1:0.75. Six patients presented with symptoms of acute to subacute intestinal obstruction. On imaging, these patients revealed circumferential thickening in the ileocecal region. Three of the female patients presented with symptoms predominantly pertaining to the gynecological tract. Histopathological evaluation revealed tubules and clusters of goblet-like mucinous cells with a variable number of endocrine cells and Paneth-like cells. Overall mean survival was 26 months and the median survival was 24 months. Recognition of GCA warrants a high degree of suspicion as they may present to different clinical departments owing to highly variable presentation and can be mistaken for signet ring cell adenocarcinoma on biopsy samples.
BACKGROUND: Early differentiation between Alzheimer’s disease (AD) and fronto-temporal dementia (FTD) remains challenging due to overlapping clinical features and structural MRI findings. Functional MRI techniques such as arterial spin labelling (ASL) and proton magnetic resonance spectroscopy (¹H‑MRS) offer non‑invasive assessment of cerebral perfusion and metabolism that may precede overt structural changes. OBJECTIVE: To evaluate the role of ASL and ¹H‑MRS in early detection and differentiation of AD and FTD, and distinguishing these entities from age-related changes. METHODS: Fifteen patients each with AD, FTD and healthy controls underwent 3D-Pseudocontinous ASL-MRI and MRS in addition to routine imaging on 3T MRI system. Visual rating scales were used for assessment of regional atrophy. Regional cerebral blood flow (CBF) was quantified using ASL, and metabolite ratios (NAA/Cr, mI/Cr, NAA/mI) were assessed in the anterior and posterior cingulate gyri using MRS. Diagnostic performance was evaluated using receiver operating characteristic (ROC) analysis. RESULTS: FTD demonstrated predominant frontal and anterior temporal atrophy with corresponding hypoperfusion, while AD showed parietotemporal and posterior cingulate involvement. Mean CBF in the anterior cingulate gyrus differentiated FTD from controls with a sensitivity of 86.6% and specificity of 80% at cut‑off of 31.91 ml/100 g/min. Posterior cingulate hypoperfusion differentiated AD from controls with a sensitivity of 86.6% and specificity of 73.3% at cut‑off of 38.29 ml/100 g/min. On MRS, NAA/mI ratio was significantly decreased in anterior cingulate gyrus in FTD compared to both AD and controls at cut-off value of 8.56 in controls with a specificity and sensitivity of 86.6 % and 83.3% respectively, whereas in AD patients, cutoff value was 14.75 with sensitivity and specificity of 86.6% each. CONCLUSION: The use of functional neuroimaging techniques as an adjunct to conventional MRI can provide unique insights into the changes seen in neurodegenerative diseases in the form of disease-specific patterns of differences in perfusion and metabolism.
Background and Aims Endoscopic ultrasound (EUS)-guided drainage is now the preferred first-line treatment for walled-off pancreatic necrosis (WON). Necrotic tissue can be removed either at the time of initial drainage (immediate necrosectomy) or later, using a step-up approach if patients fail to improve. However, the optimal timing of necrosectomy remains unclear. We performed a systematic review and meta-analysis of randomized controlled trials to compare immediate versus step-up necrosectomy following EUS-guided drainage of WON. Methods We systematically searched PubMed/MEDLINE, Embase, and Cochrane CENTRAL from inception through March 2026 for randomized controlled trials comparing immediate necrosectomy during index drainage with a step-up (on-demand) approach. The primary outcome was reintervention-free clinical success (RFCS), defined as resolution of the collection without the need for additional procedures. Secondary outcomes included overall treatment success, adverse events (disease- and procedure-related), number of necrosectomy sessions, length of hospital stay, and mortality. A random-effects meta-analysis was performed using risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). Results Four randomized controlled trials, including 215 patients, were analyzed. Reintervention-free clinical success was significantly lower in the immediate necrosectomy group compared with the step-up approach (RR 0.07, 95% CI 0.02-0.25; I (2) = 0%). Overall treatment success, adverse events, and mortality were similar between the two strategies. However, immediate necrosectomy was associated with a substantially higher procedural burden, reflected by a greater number of necrosectomy sessions. These findings were consistent across sensitivity analyses. Conclusions Performing necrosectomy at the time of initial EUS-guided drainage does not improve clinical outcomes and significantly reduces the likelihood of achieving success without additional interventions. A step-up approach, reserving necrosectomy for selected patients who do not improve after drainage, appears to be the more appropriate strategy. Future research should focus on identifying predictors of necrosectomy requirement to support a more individualized treatment approach.
