Objective To evaluate the diagnostic yield of a longitudinal temporal artery biopsy (TAB) orientation relative to a transverse orientation for the diagnosis of temporal arteritis. Methods Patients with giant cell arteritis (GCA) from a multicenter prospective cohort study were included in this study. All patients included met the 1990 American College of Rheumatology classification criteria for GCA. Two independent pathologists blind to the relevant clinical data reviewed the TAB specimens. TAB positivity rates were compared between biopsy section orientations (transverse or longitudinal) with adjustment for potential confounding factors. Histological features were compared between orientations. Results This study included 337 patients with a transverse TAB section (mean age: 74.9 years, 70.6% women) and 69 patients with a longitudinal TAB section (mean age: 75.1 years, 81.4% women). After adjustment for confounding factors, longitudinal TAB section was found to be associated with a higher rate of biopsy positivity (OR: 2.93; 95% CI: 1.07 to 8.04), with 15.0% more positive TAB results. Giant cells, inflammatory cells, nerve inflammation and disruption of the internal elastic lamina were all more frequently observed on longitudinal than on transverse sections. Conclusions This is the first study to suggest that the use of a longitudinal section for TAB results in a higher diagnostic yield than the transverse orientation.

Objectif Depuis l’essai LACC, l’ESGO privilégie la laparotomie pour l’hystérectomie radicale dans les cancers du col utérin précoces au détriment de la cœlioscopie. L’objectif de notre étude était de comparer la survie sans récidive (SSR) et la morbidité de la cœlioscopie par rapport à la laparotomie. Matériel et méthodes Étude rétrospective observationnelle monocentrique (2005–2024) de patientes traitées par hystérectomie radicale de type C pour un cancer du col utérin de stades IA2–IIA1. L’usage du manipulateur endo-utérin sans réalisation de collerette vaginale était systématique en cœlioscopie. Résultats Cent-deux patientes ont été incluses, 65 opérées par cœlioscopie et 37 par laparotomie. Avec un recul moyen de 6,2 ans, aucune différence significative n’a été mise en évidence en termes de SSR (81,6 % en cœlioscopie vs 74,2 % en laparotomie ; p=0,24). Après ajustement sur le stade et la conisation, le Hazard Ratio de récidive en laparotomie était de 1,74 (IC 95 % : [0,67–4,51]). La survie globale à long terme n’a montré aucune différence selon l’approche chirurgicale. La cœlioscopie présentait des avantages significatifs concernant les pertes sanguines (140,6±264mL vs 228±229mL ; p<0,05) et la durée d’hospitalisation (4,3±2,6 j vs 7,0±2,8 j ; p<0,05). Les complications majeures (Clavien-Dindo III-IV) étaient similaires (7,7 % en cœlioscopie vs 5,4 % en laparotomie ; p=0,65). Conclusion Menée par des chirurgiens entraînés pour des tumeurs de taille moyenne<2cm, la cœlioscopie n’a pas altéré la SSR par rapport à la laparotomie, tout en réduisant significativement la morbidité périopératoire.

The aim was to study the prognostic impact of tumor infiltration of the subserosa in colonic adenocarcinoma, by evaluating the degree of tumor infiltration in the subserosa (DISS), tumor-serosa distance (DTS), and invasion of the elastic boundary of the subserosa (ILE) after elastic fiber staining. Material and methods. - All patients operated on for colonic adenocarcinoma classified as pT3 without lymph node or visceral metastasis operated on at the CHU d'Amiens between 2004 and 2017 were included. All slides were reviewed by 2 pathologists. Bivariate and subgroup analyses were performed according to the presence of a DISS < 5 mm or > 5 mm, a DTS < 1 mm or > 1 mm and the presence or absence of an ILE. These statistical analyses were then correlated with the 5-year survival. Results. - One hundred and one patients were included in the study. We performed elastic fiber staining on an average of 2 tumor blocks per case and 39.6% of patients had invasion of the elastic boundary. However, bivariate and subgroup analyses showed no statistically significant association between DISS, DTS or ILE and 5-year survival. Conclusion. - None of these three histopathological criteria proved to have prognostic value in our series, contrary to some results in the literature. However, as these data are subject to a number of confounding factors, we do not recommend that pathologists specify these different criteria in their reports. (c) 2024 Published by Elsevier Masson SAS.

BACKGROUND:The STRIDE II guidelines recognize endoscopic healing (EH) as one of the main therapeutic goals in ulcerative colitis (UC). Nevertheless, histological healing (HH) could reduce the risk of long-term complications in UC. The aim of this study was to assess the risk of relapse in UC depending on the degree of remission achieved. METHODS:We conducted a prospective study including all consecutive UC patients in clinical remission and EH (MES 0 or 1) between January 2021 and January 2024. The primary endpoint was UC relapse, defined as the need for treatment intensification and/or corticosteroids initiation and/or UC-related hospitalization and/or colectomy. Patients were followed up every 6 months for two years. HH was defined as a Nancy index ≤ 1 (blinded double reading). RESULTS:A total of 75 patients were included. The median disease duration was 12 years (IQR [7.5-19.0]) and 66 (82 %) patients had a left side colitis (E2) or pancolitis (E3). Patients were treated for a median of 3 years (IQR [1.2 - 6.9]) prior to colonoscopy, 49 (65 %) patients had MES 0. Fifty-nine (79 %) patients of the cohort had HH. After a median follow-up of 21.0 months (IQR [12.0 - 26.5]), relapse was observed in 13 patients (17 %) after a median delay of 11 months (IQR [6.0 - 18.0]). There was no difference in the risk of relapse between patients with MES 1 and MES (13.6 % vs. 30.7 % respectively p = 0.275). The risk of relapse in patient with MES 1 was significantly higher among patient with absence of HH (39.7 % versus 20.1 % respectively p = 0.04). Similarly, in patients with MES 0, the risk of relapse was significantly higher among patients without HH (70.0 % versus 27.4 % respectively, p = 0.023). No UC-related hospitalizations or colectomy were reported during follow-up. In multivariate analysis, absence of HH was the only factor associated with disease relapse (HR 4.55 [1.69; 12.22], p = 0.0118). CONCLUSION:In this prospective cohort, histological healing was the only associated with improved long-term outcome in UC patients whatever the degree of endoscopic mucosal healing.

BACKGROUND AND AIMS:Despite increasing interest in endoscopic and histological remission as a treatment target in ulcerative colitis (UC), the accuracy of endoscopic and histological findings in the left colon and/or rectum to detect pancolonic remission is poorly known. We aimed to compare the diagnostic accuracy of rectosigmoidoscopy (RS) and rectoscopy for detecting endoscopic and histological healing elsewhere in the colon. METHODS:Consecutive UC patients who underwent colonoscopy were prospectively included. Endoscopic healing was defined by a Mayo endoscopic score (MES) = 0 on all explored segments and histological healing was defined by a Nancy index ≤ 1 (2 biopsies/segments). The agreement between colonoscopy, RS, and rectoscopy for endoscopic and histological healing was assessed using Cohen's kappa coefficient. RESULTS:Eighty patients were included. Thirty-four had an MES = 0 by RS and colonoscopy. The agreement between colonoscopy and RS was almost perfect, with a к index of 0.95 (%-agree 97.5) for Mayo 0, and к of 0.95 for Mayo 0-1 (%-agree 97.5, P < .0001). The agreement between RS and colonoscopy was also almost perfect (к = 0.877, (%-agree 91.7, P < .001) for the assessment of histological healing. The agreement between rectoscopy and colonoscopy for the evaluation of endoscopic (Mayo 0) and histological healing was almost perfect as well (к = 0.83 (%-agree 91.2, P < .001) and к = 0.80 (%-agree 91.7, P < .001)). CONCLUSION:For UC patients undergoing treat-to-target interventions, endoscopic and histological findings in the rectum alone provide good accuracy for determining pancolonic endoscopic and histological remission. Rectal examination could be an alternative to RS for monitoring UC patients.

INTRODUCTION:The study aimed to investigate the experience of pathologists facing medical errors. MATERIALS AND METHODS:A qualitative study conducted with 18 pathologists in the Hauts-de-France region. Data were collected through semi-structured interviews and analyzed using grounded theory method. RESULTS:Pathologists experienced three main stages after a diagnostic error: initial shock, re-mobilization, and enrichment. Most symptoms dissipated in the short term. Professional adjustments to prevent new errors were common. The term "second victim," referring to healthcare professionals affected by an error, was unfamiliar to participants. Most did not identify as "second victims," questioning the relevance of the term and emphasizing their responsibility in the error. To minimize errors, participants underlined the importance of communication, collaboration, and better working conditions. They called for ongoing training and improvement in managing medical errors, as well as increased recognition of the psychological impacts of such errors on healthcare professionals. DISCUSSION:The results align with existing literature on other healthcare professionals. Currently, the term "second victim" is being questioned by some physicians and patient associations. CONCLUSION:The study sheds light on pathologists' experience with medical errors, emphasizing the importance of prevention, communication, and support for affected healthcare professionals. Further quantitative research is needed to confirm these findings.

Introduction. - Recto-colic graft-versus-host disease (GVHD) is a frequent and serious complication of hematopoietic stem cell allogeneic transplantation, which is sometimes difficult to diagnose. The aim of our study was to identify histological diagnostic and prognostic criteria for recto-colic GVH. Material and method. - Patients allografted at Amiens university hospital from 2012 to 2017 were retrieved. Those who had a recto-colic biopsy were included and divided into two groups (final diagnosis of GVH and non-GVH), then biopsies were reviewed by 2 pathologists. Results. - One hundred and nineteen patients were included. Sixty-seven were allocated to the GVH group and 52 to the non-GVH group. In the GVH group, we observed a significantly greater number of apoptotic bodies (AB) on standard HES staining and with the anti-Caspase 3 immunohistochemistry, cryptolytic AB abscesses, atrophy, regenerative glands and glands lined with eosinophilic cells (P < 0.001). Anti-Caspase 3 immunohistochemistry revealed more AB than standard HES staining (P < 0.005). But to differentiate GVH cases from non-GVH cases, we obtained a threshold value of 3.5 AB per 10 contiguous crypts on standard HE staining and with the anti-Caspase 3 immunohistochemistry. From 4 AB per 10 contiguous crypts, on HES staining and anti-Caspase 3 immunostaining, the diagnosis of GVH became consistent. No nonGVH case had more than 6 AB per 10 contiguous crypts. GVH patients with more than 8 AB per 10 contiguous crypts had a worse prognosis (P < 0.001). Conclusion. - We confirm the value of AB and their counting in the diagnosis of GVH, with a diagnostic threshold of 4 AB and a prognostic threshold of 8 AB. Glands lined with eosinophilic cells could be an additional diagnostic criterion in favor of GVH to be confirmed by further studies. (c) 2024 The Authors. Published by Elsevier Masson SAS. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Introduction L’étude avait pour objectif d’étudier le vécu des médecins anatomopathologistes face aux erreurs médicales. Matériel et méthode Étude qualitative menée auprès de 18 médecins anatomopathologistes dans la région des Hauts-de-France. Les données ont été recueillies à travers des entretiens semi-dirigés, analysés par méthode de théorisation encrée. Résultats Les médecins pathologistes traversaient trois étapes principales après une erreur : le choc initial, la remobilisation puis l’enrichissement. La plupart des symptômes se dissipaient sur le court terme. Les ajustements professionnels pour éviter de nouvelles erreurs étaient très courants. Le terme « seconde victime », désignant les professionnels de santé affectés par une erreur, n’était pas familier aux participants. La majorité ne s’identifiait pas comme des « secondes victimes », remettant en question sa pertinence et soulignant plutôt leur responsabilité dans l’erreur. Pour minimiser les erreurs, les participants soulignaient l’importance de la communication, de la collaboration et de meilleures conditions de travail. Ils appellent à une formation continue et à une amélioration de la gestion des erreurs médicales, ainsi qu’à une reconnaissance accrue des impacts psychologiques chez les professionnels de santé. Discussion Les résultats sont similaires à ceux existants dans la littérature, concernant d’autres professionnels de santé. Actuellement, le terme « seconde victime » est remis en question par certains médecins et associations de patients. Conclusion L’étude met en lumière l’expérience des médecins anatomopathologistes face aux erreurs médicales, soulignant l’importance de la prévention, de la communication et de la prise en charge des professionnels de santé affectés. Des recherches quantitatives plus approfondies sont suggérées pour confirmer ces résultats.

Multiple myeloma is a malignant plasma cell proliferation located in the bone marrow and bones. It can secondarily manifest with extraosseous involvement, but the gastrointestinal tract locations are rare. We report 3 cases of gastric and colonic localizations of myeloma in two males and one female, aged 66, 71 and 77 years. Multiple myeloma had been diagnosed 1 to 7 years before. Digestive symptoms were epigastric pain, rectal bleeding or an obstructive syndrome. Endoscopy revealed ulcerated and budding tumors in the stomach, and nodular pseudo-polypoid tumor formations or an ulcerated erythematous area in the colon. Histopathological examination of the biopsies showed a diffuse tumor cell proliferation in the lamina propria composed of cells with a plasmacytoid or plasmablastic appearance, expressing plasma cell markers such as CD138 on immunohistochemistry. The 3 patients died in the weeks following the diagnosis. The prognosis of digestive localizations of multiple myeloma remains very poor despite new therapies. In the presence of any digestive symptoms in these patients with multiple myeloma, more systematic endoscopy may allow an earlier diagnosis and the implementation of more effective therapies. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Introduction La maladie du greffon contre l’hôte (GVH) recto-colique est une complication fréquente et grave de l’allogreffe de cellules souches hématopoïétiques, de diagnostic parfois difficile. L’objectif de notre étude était de mettre en évidence des critères histologiques diagnostiques et pronostiques de la GVH recto-colique. Matériel et méthode Les patients allogreffés au CHU d’Amiens de 2012 à 2017 ont été recensés. Ceux ayant eu une biopsie recto-colique ont été inclus et divisés en deux groupes (diagnostic final de GVH et non-GVH), puis les biopsies ont été relues par 2 pathologistes. Résultats Cent dix-neuf patients ont été inclus. Soixante-sept ont été répartis dans le groupe GVH et 52 dans le groupe non GVH. Au sein du groupe GVH, nous avons observé de manière significative un nombre plus important de corps apoptotiques (CA) sur coloration standard HES et avec l’anticorps anti-Caspase 3, d’abcès cryptolytiques à CA, d’atrophie, de glandes régénératives et de glandes bordées de cellules éosinophiles (p<0,001). L’anticorps anti-Caspase 3 mettait en évidence plus de CA que la coloration standard HES (p<0,005). Mais pour différencier les cas GVH des cas non GVH, nous avons obtenu une valeur seuil de 3,5 CA pour 10 cryptes contiguës sur coloration standard HES et avec l’anticorps anti-Caspase 3. À partir de 4 corps apoptotiques pour 10 cryptes contiguës, sur la coloration HES et l’étude immunohistochimique avec l’anticorps anti-Caspase 3, le diagnostic anatomopathologique de GVH devenait plus fiable. Aucun cas non GVH n’avait plus de 6 corps apoptotiques pour 10 cryptes contiguës. Les malades GVH avec plus de 8 corps apoptotiques pour 10 cryptes contiguës avaient un pronostic plus péjoratif (p<0,001). Conclusion Nous confirmons l’intérêt des corps apoptotiques et de leur comptage dans le diagnostic de la GVH avec un seuil diagnostique de 4 CA et une valeur seuil pronostique de 8 CA. Les glandes bordées de cellules éosinophiles pourraient être un critère diagnostique supplémentaire en faveur de la GVH, devant être confirmé par d’autres études.

Le myélome multiple correspond à une prolifération plasmocytaire maligne de localisation classiquement médullaire et osseuse. Il peut se manifester secondairement par des atteintes extra-osseuses, mais les atteintes digestives sont rares. Nous rapportons 3 cas de localisations gastrique et coliques de myélome, diagnostiquées chez deux hommes et une femme, âgés de 66, 71 et 77 ans. Les atteintes digestives étaient diagnostiquées 1 à 7 ans après la découverte du myélome. Les patients consultaient pour des épigastralgies, des rectorragies ou un syndrome occlusif. L’endoscopie retrouvait au niveau gastrique des formations tumorales ulcérobourgeonnantes, et au niveau colique des formations tumorales nodulaires pseudopolypoïdes et une plage érythémateuse ulcérée. L’analyse anatomopathologique des biopsies retrouvait, au sein du chorion des muqueuses digestives, une prolifération tumorale d’architecture diffuse, composée de cellules plasmocytoïdes ou plasmablastiques, exprimant à l’étude immunohistochimique les marqueurs plasmocytaires. Les 3 patients décédaient dans les semaines suivant le diagnostic. Le pronostic des localisations digestives de myélome reste très mauvais malgré les nouvelles thérapies. Devant tout symptôme digestif chez les patients porteurs d’un myélome, une endoscopie plus systématique pourrait peut-être permettre un diagnostic plus précoce et la mise en œuvre de thérapies plus efficientes.

Introduction. - Chronic inflammatory bowel disease (IBD) is thought to increase the risk of high-grade histological intraepithelial lesions (HGIL) and cervical cancer. The risk factors for developing these lesions are poorly understood. Materials and methods. - This is a single-center retrospective case-control study including IBD patients followed at our University Hospital Center from 2011 to 2021 who presented with HGIL or cervical cancer. Four controls were case-matched according to IBD type, age, active smoking and multiparity. Results. - Eighteen cases and 72 controls were included. We found no significant differences between the 2 groups with regard to mean age at IBD diagnosis, mean duration of IBD, IBD location, history of IBD-related surgery or even association with another chronic inflammatory disease. In our study, the use of immunosuppressants/biotherapies in these patients [50% (9/18) for cases vs. 56% (40/72) for controls; P = 0.9] was not a risk factor for IGRA or cervical cancer. Similarly, neither the total duration of exposure to immunosuppressants/biotherapies (9.9 +/- 8 years for cases vs. 6.6 +/- 5.3 years for controls; P = 0.1), nor combined therapies [11% (2/18) for cases vs. 6% (4/72) for controls; P = 0.3], nor azathioprine or methotrexate use [22% (4/18) for cases vs. 11% (8/72) for controls; P = 0.3] were found to be risk factors. Conclusion. - In our study, we found no risk factors for patients with IBD to develop IGRA or cervical cancer. (c) 2024 The Author(s). Published by Elsevier Masson SAS. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Abstract Background and Aims Acute kidney disease (AKD) is associated with a long-term risk of cardiovascular mortality and major cardiovascular events, particularly heart failure and acute myocardial infarction. To date, the underlying mechanisms responsible for this elevated cardiovascular risk remain poorly understood. Patients with AKD show increased circulating levels of indoxyl-sulfate (IS), a uremic toxin known to promote oxidative stress, inflammation and apoptosis in cultured vascular and cardiac cells. In this context, we hypothesized that IS elevation during AKD might promote acute myocardial and vascular lesions, which over time favour the onset of cardiovascular events. In a first attempt to test this hypothesis, we aimed to verify whether IS elevation in mice with normal renal function induces myocardial and vascular dysfunctions similar to that observed in AKD. Method Thirty female C57BL6J mice were divided into three groups: control (CT, n = 10), IS (n = 10) and AKD (n = 10). AKD was induced by 5/6 nephrectomy. Blank surgeries were performed in the CT and IS groups. IS was administered continuously for 15 days via drinking water (2.5 g/L) to reach, in IS mice, the IS serum concentrations found in AKD mice, as monitored by a validated high-performance liquid chromatography-tandem mass spectrometry method. Cardiac and vascular functions were assessed by echocardiography at baseline and at D15. Expression of markers of contractility (SERCA-2a for myocardium, αSMA for aorta), inflammation (TNF-α, IL-1β), and endothelial dysfunction (VCAM-1, ICAM-1, iNOS) were assessed by qRT-PCR and western blot. The presence of cardiac lesions was assessed histologically. Results Elevation of serum IS concentrations was similar in IS and AKD mice (serum IS: 10.7 ± 3.4 µg/mL in IS-group and 10.9 ± 5.8 µg/mL in AKD-group vs. 4.0 ± 2.1 µg/mL in CT-group (p < 0.001 in CT vs IS and AKD group). Compared with CT mice, IS and AKD mice showed systolic and diastolic dysfunctions as evidenced by decreased ejection fraction (EF: 62.4% [58.0-72.3] in CT vs. 50.1% [45.0-57.0] in IS (p < 0.05 vs CT) and 51.3% [45.6-57.1] in AKD (p < 0.01 vs CT)), decreased fractional shortening (FS: 33.6% [30.1-40.4] in CT vs. 24.8% [21.9-29.7] in IS (p < 0.05 vs CT) and 25.8% [22.4-29.6] in AKD (p < 0.01 vs CT)) and increased isovolumic relaxation time (IVRT: 17.2 ± 1.6 ms in CT vs. 20.7 ± 1.3 ms in IS (p < 0.001 vs CT) and 19.0 ± 1.7 ms in AKD (p < 0.05 vs CT)), respectively. For all echocardiographic parameters assessed, there were no significant differences observed between IS and AKD mice. Myocardium from IS and AKD mice showed decreased expression of SERCA-2a and elevated expression of both IL-1β and TNF-α at the mRNA and protein levels compared to CT mice. Aortas from IS and AKD mice also showed decreased mRNA expression of α-SMA and increased mRNA expression of IL-1β, VCAM-1, and iNOS compared to aortas from CT mice. The mRNA and protein expression of these inflammatory and contractile markers were not statistically different in the hearts and aortas from IS compared to AKD mice. No signs of vascular dysfunction were observed in either of the groups on ultrasound. Conclusion Systemic exposure to IS in mice without renal failure leads to significant cardiac and vascular dysfunctions that were similar to those observed in mice with AKD. Additional studies are needed to confirm the causal role of IS in the cardiovascular impact of AKD, and to determine whether IS could represent a valuable prognostic tool and therapeutic target for preventing AKD-associated cardiovascular complications.

Introduction: Les maladies inflammatoires chroniques intestinales (MICI) seraient plus à risque de lésions histologiques intra-épithéliales de haut grade (LIEHG) et de cancers du col de l’utérus. Les facteurs de risque de développer ces lésions sont mal connus.

L’objectif était d’étudier l’impact pronostique de l’infiltration tumorale de la sous-séreuse dans l’adénocarcinome colique en évaluant le degré d’infiltration tumorale dans la sous-séreuse (DISS), la distance tumeur-séreuse (DTS), et l’invasion de la limitante élastique de la sous-séreuse (ILE) après coloration des fibres élastiques. Matériel et méthodes Tous les patients opérés d’un adénocarcinome colique classé pT3 sans métastase ganglionnaire ou viscérale opérés au CHU d’Amiens entre 2004 et 2017 ont été inclus. Toutes les lames ont été relues par 2 pathologistes. Des analyses bivariées et en sous-groupes ont été réalisées en fonction de la présence d’un DISS≤5mm ou>5mm, d’une DTS≤1mm ou>1mm et de la présence ou non d’une ILE. Ces analyses statistiques ont ensuite été corrélées à la survie à 5 ans. Résultats Cent un patients ont été inclus dans l’étude. Nous avons réalisé une coloration des fibres élastiques sur 2 blocs de tumeur par cas en moyenne et 39,6 % des patients avaient une invasion de la limitante élastique. Cependant, les analyses bivariées et en sous-groupe n’ont pas montré d’association statistiquement significative entre la DISS, DTS ou ILE et la survie à 5 ans. Conclusion Aucun de ces trois critères histopathologiques n’avait de valeur pronostique dans notre série contrairement à certains résultats de la littérature. Toutefois, ces données faisant l’objet d’un certain nombre de facteurs confondants, nous ne recommandons pas aux pathologistes de préciser ces différents critères dans leurs comptes rendus.

Combined hepatocholangiocarcinoma is a rare cancer with a grim prognosis composed of both hepatocellular carcinoma and intrahepatic cholangiocarcinoma morphologic patterns in the same tumor. The aim of this multicenter, international cohort study was to compare the oncologic outcomes after surgery of combined hepatocholangiocarcinoma to hepatocellular carcinoma and intrahepatic cholangiocarcinoma.Patients treated by surgery for combined hepatocholangiocarcinoma, hepatocellular carcinoma, and intrahepatic cholangiocarcinoma from 2000 to 2021 from multicenter international databases were analyzed retrospectively. Patients with combined hepatocholangiocarcinoma (cases) were compared with 2 control groups of hepatocellular carcinoma or intrahepatic cholangiocarcinoma, sequentially matched using a propensity score based on 8 preoperative characteristics. Overall and disease-free survival were compared, and predictors of mortality and recurrence were analyzed with Cox regression after propensity score matching.During the study period, 3,196 patients were included. Propensity score adjustment and 2 sequential matching processes produced a new cohort (n = 244) comprising 3 balanced groups was obtained (combined hepatocholangiocarcinoma = 56, intrahepatic cholangiocarcinoma = 66, and hepatocellular carcinoma = 122). Kaplan-Meier overall survival estimations at 1, 3, and 5 years were 67%, 45%, and 28% for combined hepatocholangiocarcinoma, 92%, 75%, and 55% for hepatocellular carcinoma, and 86%, 53%, and 42% for the intrahepatic cholangiocarcinoma group, respectively (P = .0014). Estimations of disease-free survival at 1, 3, and 5 years were 51%, 25%, and 17% for combined hepatocholangiocarcinoma, 63%, 35%, and 26% for the hepatocellular carcinoma group, and 51%, 31%, and 28% for the intrahepatic cholangiocarcinoma group, respectively (P = .19). Predictors of mortality were combined hepatocholangiocarcinoma subtype, metabolic syndrome, preoperative tumor markers alpha-fetoprotein and carbohydrate antigen 19-9, and satellite nodules, and recurrence was associated with satellite nodules rather than cancer subtype.Despite data limitations, overall survival among patients with combined hepatocholangiocarcinoma was worse than both groups and closer intrahepatic cholangiocarcinoma, whereas disease-free survival was similar among the 3 groups. Future research on immunophenotypic profiling may hold more promise than traditional nonmodifiable clinical characteristics (as found in this study) in predicting recurrence or response to salvage treatments.

Acute kidney injury (AKI) and chronic kidney disease (CKD) are major health concerns due to their increasing incidence and high mortality. They are interconnected syndromes; AKI without recovery evolves into acute kidney disease (AKD), which can indicate an AKI-to-CKD transition. Both AKI and CKD are associated with a risk of long-term cardiovascular complications, but whether vascular and cardiac dysfunctions can occur as early as the AKD period has not been studied extensively. In a mouse model of kidney injury (KI) with non-recovery, we performed vasoreactivity and echocardiography analyses on days 15 (D15) and 45 (D45) after KI. We determined the concentrations of two major gut-derived protein-bound uremic toxins known to induce cardiovascular toxicity—indoxyl sulfate (IS) and para-cresyl sulfate (PCS)—and the levels of inflammation and contraction markers on D7, D15, and D45. Mice with KI showed acute tubular and interstitial kidney lesions on D7 and D15 and chronic glomerulosclerosis on D45. They showed significant impairment of aorta relaxation and systolic-diastolic heart function, both on D15 and D45. Such dysfunction was associated with downregulation of the expression of two contractile proteins, αSMA and SERCA2a, with a more pronounced effect on D15 than on D45. KI was also followed by a rapid increase in IS and PCS serum concentrations and the expression induction of pro-inflammatory cytokines and endothelial adhesion molecules in serum and cardiovascular tissues. Therefore, these results highlight that AKD leads to early cardiac and vascular dysfunctions. How these dysfunctions could be managed to prevent cardiovascular events deserves further study.

Enteritis cystica profunda is a rare and benign disease defined as the invagination of the intestinal epithelium into the submucosa and more profound layers of intestinal wall leading to the formation of mucin-filled cystic spaces. We reported the case of a 45-year-old female, suffering from a Crohn's disease, with a Koenig's syndrome, diarrhea, abdominal pain and weight loss. The colonoscopy and the abdominopelvic scan showed a terminal ileal stenosis, with parietal calcifications. A surgical ileocecal resection was decided. Gross examination of the ileocecal resection showed a thickening of the ileal wall, with many mucin-filled cysts measuring 1 mm to 2 cm, with some calcifications. The ileal mucosa was ulcerated, and showed a stenotic sector extending over 3 cm. Histological examination showed acute ulcerated ileitis lesions, with chronic ileitis lesions and stenosis, compatible with the known diagnosis of Crohn's disease. There were also many cysts into the ileal wall. They were lined with a regular ileal epithelium. The cysts contained mucus, with some calcifications. Some cysts were ruptured, with extravasation of mucus within the wall. Cystica profunda can be found anywhere along the digestive tract. The physiopathology is not yet well understood, but it seems to be favored by chronic aggression of the intestinal wall. This pathology most often coexists with Crohn's disease. The main differential diagnosis is mucinous adenocarcinoma. Cystica profunda does not require any specific treatment. (c) 2023 Elsevier Masson SAS. All rights reserved.

L’entérite kystique profonde (enteritis cystica profunda) est une pathologie rare et bénigne définie comme une invagination de l’épithélium glandulaire au sein de la paroi grêle formant des cavités kystiques emplies de mucine. Nous rapportons le cas d’une patiente de 45 ans, suivie pour une maladie de Crohn, qui présentait un syndrome subocclusif, avec diarrhée, douleurs abdominales et amaigrissement. La coloscopie et le scanner abdominopelvien révélaient une sténose iléale terminale, accompagnée de calcifications pariétales à l’imagerie. Une résection iléocolique était réalisée. L’examen macroscopique de la pièce opératoire retrouvait une paroi grêlique épaissie, fibreuse et qui comportait de nombreux kystes, de 1mm à 2cm, de contenu mucoïde, blanchâtre, parfois calcifié. Il existait un secteur de sténose iléale sur 3cm. À l’examen histologique, il existait des lésions d’iléite aiguë ulcérée sur des lésions d’iléite chronique, compatibles avec le diagnostic connu de maladie de Crohn. On retrouvait également de nombreuses invaginations d’allure diverticulaire développées aux dépens de la paroi iléale. Elles étaient bordées d’un épithélium de type grêle régulier. La lumière comportait du mucus, avec quelques calcifications. Certaines glandes étaient rompues avec une extravasation de mucus au sein de la paroi. Cette pathologie serait favorisée par une agression chronique de la paroi intestinale. Elle survient le plus souvent dans le cadre d’une maladie de Crohn. Le principal diagnostic différentiel à éliminer est l’adénocarcinome mucineux. En l’absence de complication occlusive, l’entérite kystique profonde ne requiert pas de traitement spécifique.

Crohn's disease is an inflammatory bowel disease for which surgery is required in approximately 80% of cases. However, surgery does not cure Crohn's disease. The type of surgery is important, as there are intraoperative risk factors for recurrence, including microscopic inflammation at the resection margins. This point is crucial, as a too large resection may result in short bowel syndrome and a too short resection (microscopic inflammation at the resection site) a higher risk of postoperative recurrence (75% vs 46% at 18 months). Based on the results of a randomised control trial, surgeons are encouraged to perform a limited resection (2 cm from macroscopic Crohn's disease). However, such a macroscopically non-inflamed resection margin may show microscopic inflammation (up to 80%). Thus, it would be useful to evaluate whether there is microscopic inflammation at the resection margin. Moreover, there is an increasing interest in the role of the mesentery in recurrence, which is still unclear. Thus, it would be informative to also clarify the border between inflamed and non-inflamed mesentery. Cellvizio is a type of confocal laser endomicroscopy system that provides the possibility to obtain high-magnification in-vivo images of the gut epithelium. This allows real-time examination of the gastrointestinal mucosa at the cellular and subcellular level. Cellvizio has never been used during surgery for Crohn's disease. The aim of this study is to evaluate the intraoperative use of Cellvizio to determine the optimal ileal resection margins in Crohn's disease. The primary outcome is the concordance between the evaluation of microscopic inflammation at the ileal resection margin by the Cellvizio system and pathology. The secondary outcomes are the concordance between the Cellvizio system and pathology in evaluating inflammation of the serosa (transmural inflammation) and mesentery and the length of the ileum (in cm) between the surgical margin and the theoretical resection site to have a resection margin free of microscopic inflammation as determined by the Cellvizio system (for the mucosa and serosa). This is a prospective, single centre, interventional study. inclusion criteria: Patients who require an ileocecal resection for Crohn's disease, regardless of the phenotype. exclusion criteria: Patients who are under 18 years of age, are pregnant or breastfeeding, have had an ileocolic resection for a surgical recurrence of Crohn's disease, have had emergency surgery for peritonitis, and those who have a contra indication for fluoresceine injection or severe allergy to any drug. This is a single-arm study. During surgery an intravenous injection of fluoresceine will be performed. The surgeon will then evaluate the ileal section margins of the mucosa, serosa, and mesentery to evaluate whether the section margin shows microscopic inflammation. The surgeon will then evaluate (in cm) the length between this section margin and the theorical section margin to be within non-inflamed tissue of the mucosa, serosa, and mesentery. The data will be recorded during surgery, blind from the pathological analysis. The pathological analysis will also be performed blind from the Cellvizio data. A video collection will be performed anonymously. 41 patients We assume an estimated Kappa coefficient of 90%, a lower bound of 70%, and a frequency of microscopic inflammation at the ileal resection margin of 70%. Given this hypothesis and an alpha risk of 5%, the inclusion of 41 patients will be necessary.