The aim of the work is to evaluate the Optical Coherence Tomography (OCT) capabilities in identifying the microstructural pattern of reticular Oral Lichen Planus (OLP) and compare it with the histopathological findings, to identify a common interpretation key and validate OCT as a diagnostic tool for this autoimmune inflammatory pathology. Eight patients were recruited (aged between 44 and 71 years). The anatomical sites chosen is the buccal mucosa, since it is typical of lichen lesions to be analysed. We took into consideration typical white signs of OLP: reticular and plaque lesions. Comparison between OCT scans and histological slides were carried out. Results show a strong correlation between OCT and histopathological evaluations. Hyperkeratosis occurs as a superficial hyperreflective zone. The lamina propria loses its hyper-reflective characteristic. This is probably due to the presence of the inflammatory infiltrate, which causes a decrease in signal strength. For the basement membrane, difficulties were encountered in interpreting it. This study shows that it is possible to identify clear differences between pathological tissue and healthy counterpart in OCT, both in epithelial and connective tissues. In addition, we observed a concordance in epithelial measurements between OCT image and histological image. These observations indicate promising potentials and need to be confirmed by further studies, in order to compare the results and arrive to an objective pattern of OLP, framing the possible role of OCT as a non-invasive diagnostic tool.

Cholangiopathies encompass a wide range of chronic liver diseases that target biliary epithelial cells, leading to significant morbidity and mortality due to their progressive nature, limited treatment options, and complex clinical management. Currently, clinically validated biomarkers capable of distinguishing obstructive cholangiopathies, such as biliary atresia (BA), from other cholangiopathies are lacking, hindering timely intervention. RNA-binding proteins (RBPs) have been increasingly linked to human diseases but their roles in cholangiopathies remain underexplored. We assessed the expression of the RBP epithelial splicing regulatory protein 1 (ESRP1) in murine models of cholangiopathies and in the human system. Our findings demonstrate that ESRP1 is highly and specifically expressed in cholestatic liver injury models, including bile duct-ligated, diethoxycarboncyl-1,4-dihydrocollidine-treated, and Mdr2−/− mice when compared with other liver injury models. Importantly, ESRP1 is markedly elevated in the livers of patients with BA and cystic fibrosis-related liver disease, localizing to cholangiocytes and peri-biliary hepatic cells, but is minimal in primary sclerosing cholangitis and primary biliary cholangitis. Moreover, patient-derived BA organoids and biliatresone-treated healthy organoids also display ESRP1 expression. Bioinformatics analysis further implicates ESRP1 in key cholangiopathy-associated pathways, warranting deeper mechanistic investigation. Thus, ESRP1 holds potential as a molecular marker for obstructive cholangiopathies, warranting further mechanistic studies.

Liver allograft steatosis is a significant risk factor for postoperative graft dysfunction and has been associated with inferior patient and graft survival, particularly in the case of moderate or severe macrovesicular steatosis. In recent years, the increasing incidence of obesity and fatty liver disease in the population has led to a higher proportion of steatotic liver grafts being used for transplantation, making the optimization of their preservation an urgent necessity. This review discusses the mechanisms behind the increased susceptibility of fatty livers to ischemia-reperfusion injury and provides an overview of the available strategies to improve their utilization for transplantation, with a focus on preclinical and clinical evidence supporting donor interventions, novel preservation solutions, and machine perfusion techniques.

BACKGROUND:Since November 2020, Italy was the first country to carry out a protocol and use liver from COVID-19 donors. We aimed to evaluate the medium-term outcome of patients who underwent liver transplant (LT) with those grafts.METHODS:We consecutively enrolled 283 patients who underwent first LT from November 2020 to December 2022 in our Center (follow-up 468 days). Twenty-five of 283 (8.8%, study population) received a graft from donors with previous (4%) or active (96%) SARS-CoV-2 infection, and 258/283 (91.2%, control group) received a graft from COVID-19-negative donors. SARS-CoV-2-RNA was tested on graft tissue of COVID-19 donors and their recipients underwent weekly evaluation of SARS-CoV-2-RNA in nasal swabs for the first month after LT.RESULTS:One-year and 2-year patient survival was 88.5% and 88.5% in study group versus 94.5% and 93.5% in control group, respectively (p = .531). In study population there was no evidence of donor-recipient virus transmission, but three (12%) patients (vs. 7 [2.7%] of control group, p = .048) developed hepatic artery thrombosis (HAT): they were SARS-CoV-2-RNA negative at LT and 1/3 grafts tested SARS-CoV-2-RNA positive on liver tissue. COVID-19 donor was independently associated with HAT (odds ratio (OR) = 4.85, 95% confidence interval (CI) 1.10-19.15; p = .037). By comparing study population with control group, acute rejection and biliary complication rates were not significantly different (16% vs. 8.1%, p = .26; 16% vs. 16.3% p = .99, respectively).CONCLUSIONS:Our 1-year results of transplant strategy including liver grafts from COVID-19 donors were favorable. HAT was the only complication with significantly higher rate in patients transplanted with COVID-19 donors compared with control group.

Ulcers in the oral mucosa is a relatively common, although challenging, entity in oral medicine, as it can arise due to a wide range of traumatic, infective, autoimmune, and neoplastic disorders. Although histopathology of lesional and peri-lesional tissues remains the gold standard for persistent oral breaching, optical coherence tomography (OCT) has been recently suggested as a potential ally to enhance the early or non-invasive diagnosis of likely causation. The aim of the present study was to provide an in-vivo OCT analysis and description from a sample of 70 patients affected by traumatic or neoplastic-related ulcers, located on the buccal mucosa, tongue or gingiva, and compare the OCT data with those of 20 patients with healthy oral mucosa. OCT dynamic scans revealed clear distinction of epithelial layer (EP), lamina propria (LP) of healthy buccal mucosa, gingiva, and tongue as well as allowing observation of the keratin layer in gingiva, and the subepithelial vascularization of each site. Traumatic lesions had an EP of reduced in thickness, with an irregular, if not disrupted surface. Interestingly, LP seemed to preserve its reflectiveness and vascularization only in the traumatic lesions. Among neoplastic lesions, regardless their site of onset, both EP integrity/homogeneity, and LP reflectiveness/vascularization were lost and unrecognizable when compared to their healthy counterparts. OCT scanning allowed some differentiation between traumatic and malignant ulcers and thus may a useful and non-invasive means of determining the need and/or urgency of histopathological examination of oral lesions.

BACKGROUND The thoracic lymphadenectomy during an esophagectomy for esophageal cancer includes resection of the thoracic duct (TD) compartment containing the TD lymph nodes (TDLNs). The role of TD compartment resection is still a topic of debate since metastatic TDLNs have only been demonstrated in squamous cell carcinomas in Eastern esophageal cancer patients. Therefore, the aim of this study was to assess the presence and metastatic involvement of TDLNs in a Western population, in which adenocarcinoma is the predominant type of esophageal cancer. METHODS From July 2017 to May 2020, all consecutive patients undergoing an open or robot-assisted transthoracic esophagectomy with concurrent lymphadenectomy and resection of the TD compartment in the University Medical Center Utrecht in Utrecht, the Netherlands, and the Citta della Salute e della Scienza University Hospital in Turin, Italy, were included. The TD compartment was resected en bloc and was separated in the operation room by the operating surgeon after which it was macroscopically and microscopically assessed for (metastatic) TDLNs by the pathologist. RESULTS A total of 117 patients with an adenocarcinoma (73%) or squamous cell carcinoma (27%) of the esophagus were included. In 61 (52%) patients, TDLNs were found, containing metastasis in 9 (15%) patients. No major complications related to TD compartment resection were observed. CONCLUSIONS This study demonstrates the presence of metastatic TDLNs in adenocarcinomas of the esophagus. This result provides a valid argument to routinely extend the thoracic lymphadenectomy with resection of the TD compartment during an esophagectomy for esophageal cancer. (C) 2022 by The Society of Thoracic Surgeons. Published by Elsevier Inc.

BackgroundThe COVID-19 pandemic has likely affected the most vulnerable groups of patients and those requiring time-critical access to healthcare services, such as patients with cancer. The aim of this study was to use time trend data to assess the impact of COVID-19 on timely diagnosis and treatment of head and neck cancer (HNC) in the Italian Piedmont region.MethodsThis study was based on two different data sources. First, regional hospital discharge register data were used to identify incident HNC in patients ≥18 years old during the period from January 1, 2015, to December 31, 2020. Interrupted time-series analysis was used to model the long-time trends in monthly incident HNC before COVID-19 while accounting for holiday-related seasonal fluctuations in the HNC admissions. Second, in a population of incident HNC patients eligible for recruitment in an ongoing clinical cohort study (HEADSpAcE) that started before the COVID-19 pandemic, we compared the distribution of early-stage and late-stage diagnoses between the pre-COVID-19 and the COVID-19 period.ResultsThere were 4,811 incident HNC admissions in the 5-year period before the COVID-19 outbreak and 832 admissions in 2020, of which 689 occurred after the COVID-19 outbreak in Italy. An initial reduction of 28% in admissions during the first wave of the COVID-19 pandemic (RR 0.72, 95% CI 0.62–0.84) was largely addressed by the end of 2020 (RR 0.96, 95% CI 0.89–1.03) when considering the whole population, although there were some heterogeneities. The gap between observed and expected admissions was particularly evident and had not completely recovered by the end of the year in older (≥75 years) patients (RR: 0.88, 0.76–1.01), patients with a Romano-Charlson comorbidity index below 2 (RR 0.91, 95% CI: 0.84–1.00), and primary surgically treated patients (RR 0.88, 95% CI 0.80–0.97). In the subgroup of patients eligible for the ongoing active recruitment, we observed no evidence of a shift toward a more advanced stage at diagnosis in the periods following the first pandemic wave.ConclusionsThe COVID-19 pandemic has affected differentially the management of certain groups of incident HNC patients, with more pronounced impact on older patients, those treated primarily surgically, and those with less comorbidities. The missed and delayed diagnoses may translate into worser oncological outcomes in these patients.

Background Gallbladder hemangioma is an exceptionally rare entity, with only ten cases reported in literature hitherto. The here described case is the first report of a gallbladder hemangioma coexisting with gallstones. Case presentation A 76-year-old male was hospitalized following repeated episodes of epigastric pain. Patient’s medical history included primary hypertension, type 2 diabetes mellitus, dyslipidemia, obesity and hyperuricemia. Physical examination revealed marked pain in the right hypochondriac region, and laboratory workup was notable for mildly elevated glycemia (125 mg/dL) and pancreatic amylase (60 IU/L). Abdominal ultrasound showed multiple gallstones, a thickened gallbladder wall and mild edema of the perivisceral adipose tissue as well as a hepatic angioma. During surgery, an incidental subserosal nodule of about 1 cm was detected within the gallbladder fundus. After surgery, the clinical course was uneventful and the patient was discharged. Histopathological examination of the subserosal nodule showed multiple dilated vascular channels within a sclerosing matrix, a finding consistent with a cavernous hemangioma. Diffuse chronic cholecystitis was also present. Conclusions Gallbladder hemangiomas represent a rare, likely underdiagnosed condition which can be undetected during the preoperative workup.

AimsNovel prognostic markers are warranted for gastrointestinal stromal tumours. Caveolin-1 is a multifunctional protein that proved to be associated with outcome in multiple tumour types. Aim of this study was to investigate Caveolin-1 expression and prognostic efficacy in a series of gastrointestinal stromal tumours.MethodsCaveolin-1 expression was assessed by immunohistochemistry in a retrospective series of 66 gastrointestinal stromal tumours representative of the different molecular subtypes. Correlations with clinical, histopathological and molecular features were investigated. Statistical analyses were performed as appropriate.ResultsThirty-five cases out of 66 (53.0%) expressed Caveolin-1. Presence of Caveolin-1 expression correlated with favourable histopathologic and clinical traits, including a lower mitotic count (p=0.003) and lower relapse rate (p=0.005). Caveolin-1 expression also resulted associated with the presence ofPDGFRAmutations (p=0.010). Outcome analyses showed a favourable prognostic significance of Caveolin-1 expression in terms of relapse-free survival (HR=0.14; 95% CI=0.03 to 0.63) and overall survival (HR=0.29; 95% CI=0.11 to 0.74), even after adjusting for the mutational subgroup (relapse-free survival: HR=0.14, 95% CI=0.04 to 0.44; overall survival: HR=0.29, 95% CI=0.11 to 0.51) and imatinib treatment (relapse-free survival: HR=0.14, 95% CI=0.02 to 0.81; overall survival: HR=0.29, 95% CI=0.17 to 0.48).ConclusionCaveolin-1 represents a novel prognostic marker in gastrointestinal stromal tumours. Further studies are warranted to validate these results and to explore the mechanisms linking Caveolin-1 expression with thePDGFRAoncogenic pathway.

Enolase (ENO) 1 is a key glycolytic enzyme and important player in tumorigenesis. ENO1 overexpression has been correlated with tumor progression and/or worse prognosis in several solid malignancies. However, data concerning the impact of ENO1 in cancer conflict. The study correlated local and circulating ENO1 protein levels in esophageal cancer (EC) with clinicopathological data, to assess its potential clinical value. ENO1 expression was analyzed by immunohistochemistry in paired tumor and non-tumor tissue samples from 40 EC cases and mucosal biopsies from 45 Barrett's esophagus (BE) cases, plus in plasma from these patients and 25 matched healthy controls. ENO1 was abnormally elevated in cancer-cell cytoplasm in both EC types, in esophageal squamous cell carcinoma and in adenocarcinoma (EAC), increasing significantly with tumor stage progression and the transition from BE to EAC. EAC patients exhibited significantly lower ENO1 plasma concentrations than normal subjects. Neither local nor systemic ENO1 expression levels were significantly associated with overall survival. These results indicate ENO1 as potential biomarker, delineating a population of patients with Barrett's esophagus at high risk of cancer, and as new therapeutic opportunity in EC patient management. However, further confirmation might be necessary.

Background. The impact of graft fibrosis and inflammation on the natural history of pediatric liver transplants is still debated. Our objectives were to evaluate the evolution of posttransplant fibrosis and inflammation over time at protocol liver biopsies (PLBs), risk factors for fibrosis, presence of donor-specific antibodies (DSAs), and/or their correlation with graft and recipient factors. Methods. A single-center, retrospective (2000–2019) cross-sectional study on pediatric liver transplant recipients who had at least 1 PLB, followed by a longitudinal evaluation in those who had at least 2 PLBs, was conducted. Fibrosis was assessed by the Liver Allograft Fibrosis Semiquantitative score, inflammation by the rejection activity index, DSAs by Luminex. Results. A total of 134 PLBs from 94 patients were included. Fibrosis was detected in 87% (30% mild, 45% moderate, and 12% severe), 80% in the portal tracts. There was an increase in fibrosis between the 1–3 and the 4–6 y group (P = 0.01), then it was stable. Inflammation was observed in 44% (30% mild, 13% moderate, and 1% severe), 90% in the portal tracts. Anti-HLA II (IgG) DSAs were detected in 14 of 40 (35%). Portal fibrosis was associated with portal inflammation in the 1–3 y group (P = 0.04). Low immunosuppression levels were correlated with sinusoidal fibrosis (P = 0.04) and DSA positivity (P = 0.006). There was no statistically significant correlation between DSA positivity and the presence of graft fibrosis or inflammation. Conclusions. This study corroborates the concept of an early evolution of silent graft fibrosis. Suboptimal immunosuppression may play a role in the development of fibrosis and DSAs.

Introduction Many types of research have been performed to improve the diagnosis, therapy, and prognosis of oropharyngeal carcinomas (OP-SCCs). Since they arise in lymphoid-rich areas and intense lymphocytic infiltration has been related to a better prognosis, a TREM-1 putative function in tumour progression and survival has been hypothesized.Materials and methods Twenty-seven human papillomavirus (HPV) 16+ OP-SCC specimens have been analyzed to relate TREM-1 expression with histiocytic and lymphocytic markers, HPV presence and patients’ outcome.Results No differences have been shown between intratumoral and stromal CD4+ cells, while intratumoral CD8+ lymphocytes are higher with respect to the tumour stroma (p = .0005). CD68+ cells are more than CD35+ and TREM-1+; their presence is related to CD35± and TREM-1± histiocytes (p = .005 and .026, respectively). Intratumoral CD4+ lymphocytes are higher in p16+ cases (11/27) than in p16− (p = .042); moreover, p16 positivity correlates to a better survival (p = .034). CD4+, CD8+ and CD35+ cells have no impact on survival, while CD68 expression heavily influences progression and bad outcome (p = .037). TREM-1 positivity also leads to worst overall survival (p = .001): peritumoral expression and death-cause relationship are always significant, particularly when the cause is OP-SCC (p = .000).Conclusion While p16 shows to better stratify HPV16+ patients’ outcome, TREM-1+ macrophages suggest their key importance in HPV-related OP-SCCs progression.KEY MESSAGESTREM-1 positivity correlates to the worst overall survival of HPV16-positive OPSCCs-affected patients.p16-positive HPV16 related OPSCCs patients have a better prognosis with respect to p16-negative ones.

Oral lichen planus (OLP) is a common premalignant chronic inflammatory disorder. Optical Coherence Tomography (OCT) provides a real-time, non-invasive, and in-situ optical signature using light of varying wavelengths to examine tissue. Aim of the present study was to assess the possible role of OCT as diagnostic tool for atrophic-erosive OLP by examining OCT scans of healthy buccal mucosa, and comparing their ultrastructural features with those of a buccal mucosa affected by atrophic-erosive OLP, using their histopathological counterparts as the gold standard. Through grayscale (enface scan) and an application in which the vascularization of the tissue is visible (dynamic scan), it was possible to distinguish the healthy from the lichenoid pattern from 20 controls (12 M; 8 F; mean age: 41.32 years) and 20 patients with histologically confirmed atrophic-erosive OLP (7 M; 13 F; mean age: 64.27 years). In detail, mean width of stratified squamous epithelium (EP) and lamina propria (LP) were evaluated. Among controls, EP and LP showed a mean width of 300 (±50) and of 600 (±50) μm respectively; among cases, disruption of membrane basement prevented from any measurement. Furthermore, a differential pattern of EP and LP emerged between the two groups: a light-grayish, hypo-reflective, homogeneous area of EP recurring in controls turned into a hyper-reflective, non-homogeneous area among cases. Dynamic scan showed a differential profile of LP vascularization, varying from a hypo-reflective red area with small blood vessels in the control group, to a hypo/hyper-reflective area, completely overrun by a denser, wider blood flow amid OLP cases. Although histopathological examination remains the gold standard for OLP diagnosis, OCT could be a potentially helpful tool for the clinician and the pathologist, since it allows analysis of the vascularization of the sample without adversely affecting histological processing.

Event Abstract Back to Event Diffuse oral ulcerations as the only presentation of secondary syphilis: a case report Marco Cabras1*, Alessio Gambino1, Luigi Chiusa1, Dora Karimi1, Roberto Broccoletti1 and Paolo Giacomo Arduino1 1 University of Turin, Department of Surgical Sciences, Oral Medicine Section, Italy Aim. Syphilis is a sexually transmitted disease caused by an anaerobic helical bacterial species, Treponema pallidum. It is classified into four stages: primary, secondary, latent, and tertiary. Oral lesions are mainly correlated to secondary syphilis, even though oral signs can appear at any stage. Due to the large variety of clinical appearance, for whom it is usually defined as “the great imitator”, diagnosis can be delayed, especially if no skin or genital involvement is detected. Aim of this study is to present a peculiar case of a male patient with just diffuse oral ulcerations, without cutaneous or genital involvement, leading to a conclusive diagnosis of secondary syphilis. Materials and Methods. In July 2018, a 43-year-old patient was referred to the Oral Medicine Section of CIR-Dental School, University of Turin, for painful diffuse oral ulcers, arisen four months before on the lower lip and tongue, for which he was treated with antifungal and antiviral therapy to no avail. Anamnesis revealed smoke habit (10 cigarettes per day), with no history of drug intake or aphthous recurrent stomatitis. Conventional oral examination (COE) revealed a wide ulcerated lesion with fibrinous borders on top of a swollen internal surface of the lower lip; an exuberant mucous plate on the right side of the tongue, a smaller white patch on the tongue tip, and a non-homogeneous white-and-red plaque on the posterior left side of the tongue. Although aphthous and drug-related ulcers could be easily excluded through anamnesis, due to the nonspecific clinical appearance, a biopsy with direct immunofluorescence (DIF) was performed on the injured right side of the tongue, in order to assess the occurrence of an underlying bullous or granulomatous disease. Complete blood count (CBC), anti-desmoglein 1 and 3 antibodies and serum angiotensin converting enzyme (s-ACE) were also required at the time of the first investigation. Between biopsy and pathological examination, the patient was treated with systemic corticosteroids (75 mg of prednisone daily for the first five days, followed by 50 mg daily for the next seven days, and 25 mg daily for the last ten days), and chlorhexidine 0.20% mouthrinse (Curasept® three times a day for three weeks). Three weeks later, the patient reported a mild improvement of symptoms, whereas COE still showed no complete remission nor blatant decrease in diameter of lips and tongue lesions. Moreover, the specimen analysis did not display morphological elements suggestive of bullous or granulomatous disease: DIF was negative, whereas hematoxylin and eosin staining revealed hyperkeratosis, acanthosis and spongiosis with a mild lymphoplasmacellular infiltrate and exocytosis of neutrophil granulocytes. PAS and GROCOTT stainings highlighted sporadic fungal ifae within the epithelium. CBC showed mild neutrophilia (10.61^10.9/L; range 1.50-1.80) and monocytosis (1.45 ^10.9/L; range 0.20-1.00), with normal s-ACE (26.1; range 8-53 µl) and no anti-desmoglein 1 and 3 antibodies (<5U/ml for both). The clinical hypothesis of an underlying autoimmune disease was then put aside, and a new recollection of anamnestic data was carried out, suspecting an infectious etiology for such unusual lesions: questioned on risky behaviors, the patient admitted to having unprotected sex with his male partner in the last year. Treponema Pallidum, HCV and HIV tests were immediately required: no HCV and HIV antibodies were detected, whereas VDRL was suggestive of active disease (1:16), with highly positive TPPA (>1:10240; range <1:80) and CLIA for Treponema Antibodies (>70.00; range <0.9). Results. Although the patient does not recollect a genital or oral chancre-like lesion in the previous months or years, nor displays any skin or genital concurrent signs, a diagnosis of oral secondary syphilis was formulated. He has been referred to the Infectious Diseases Unit of the “Ospedale Amedeo di Savoia”, Turin, for proper evaluation and treatment. Discussion. The diagnosis of syphilis is based on a combination of full sexual history, clinical examination, serological tests and histological examination, if carried out with special stains. In our case, anamnesis played a key role in correcting the algorithm of differential diagnosis. Questions regarding risky behaviors such as unprotected sex should always be included in the recollection of anamnestic data, bearing in mind that patients will provide an honest and reliable answer to such intimate queries only if they perceive to be engaged in a trusting relationship with their oral health providers. In light of the most recent epidemiological evidences, which show an increasing incidence of syphilis in Europe, it is important for dental practitioners and oral physicians to consider syphilis in patients with atypical oral lesions/ulcerations, especially on those otherwise healthy individuals who appear to be unresponsive to topical or systemic corticosteroids. References 1. Carbone PN, Capra GG, Nelson BL. Oral Secondary Syphilis. Kojima Head Neck Pathol 2016;10:206-208. 2. de Paulo LF, Servato JP, Oliveira MT Oral Manifestations of Secondary Syphilis Int J Infect Dis 2015;35:40-42. 3. European Centre for Disease Prevention and Control. Syphilis. In: ECDC. Annual epidemiological report for 2015. Stockholm: ECDC; 2017. Keywords: Syphilis, Secondary syphilis, oral cavity, oral ulcers, Treponema pallidum Conference: 5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018. Presentation Type: Poster Presentation Topic: Oral Diseases Citation: Cabras M, Gambino A, Chiusa L, Karimi D, Broccoletti R and Arduino P (2019). Diffuse oral ulcerations as the only presentation of secondary syphilis: a case report. Front. Physiol. Conference Abstract: 5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine.. doi: 10.3389/conf.fphys.2019.27.00009 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 11 Oct 2018; Published Online: 09 Dec 2019. * Correspondence: Dr. Marco Cabras, University of Turin, Department of Surgical Sciences, Oral Medicine Section, Turin, Piedmont, 10124, Italy, marcomascitti86@hotmail.it Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Marco Cabras Alessio Gambino Luigi Chiusa Dora Karimi Roberto Broccoletti Paolo Giacomo Arduino Google Marco Cabras Alessio Gambino Luigi Chiusa Dora Karimi Roberto Broccoletti Paolo Giacomo Arduino Google Scholar Marco Cabras Alessio Gambino Luigi Chiusa Dora Karimi Roberto Broccoletti Paolo Giacomo Arduino PubMed Marco Cabras Alessio Gambino Luigi Chiusa Dora Karimi Roberto Broccoletti Paolo Giacomo Arduino Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Clinical studies have demonstrated the effectiveness of low-level laser therapy (LLLT) in [...]

A 57-year-old man with unremarkable previous medical history presented with acute cholangitis and cholestasis. An abdominal computed tomography showed a dilation of the biliary system with hypodense irregular filling defects in the common bile duct (CBD) and previously unknown liver cirrhosis. The papilla was normal; a subsequent intraductal ultrasonography showed multiple papillary projections in the CBD (Fig. 1). These findings were confirmed by cholangioscopy [1], which identified multiple lesions with “fish-egg” appearance protruding in a dilated CBD filled with whitish mucus (Fig. 2). Biopsies with microforceps on the papillary lesions (Fig. 3) were performed, and histological examination highlighted the presence of papillary proliferation with focal high-grade dysplasia without stromal invasion, thus confirming the final diagnosis of intraductal papillary neoplasm BillN-3 (Fig. 4) [2].

OBJECTIVES:Veno-occlusive disease after liver transplant has been sporadically reported, and significant uncertainty exists concerning the best treatment and the long-term outcomes. Here, we reviewed our experience to evaluate clinical presentation, treatment, and the long-term outcomes of these patients.MATERIALS AND METHODS:Between 2000 and 2015, 2165 patients underwent liver transplant at our center. The incidence of veno-occlusive disease was 0.3% (7/2165).RESULTS:Timing of veno-occlusive disease onset (median 4.7 mo; interquartile range, 2.5-11.1 mo) varied widely as did clinical presentation, which was characterized by a variable association of liver failure and portal hypertension and different disease pro-gression rates. In all cases, diagnosis of veno-occlusive disease was confirmed by liver biopsy. Six patients (85.7%) presented with veno-occlusive disease after a previous episode of acute cellular rejection. Three patients died due to veno-occlusive disease (n = 2) or due to hepatocellular carcinoma recurrence (n = 1). Two patients were treated by increasing immunosuppression and with interventional procedures (pleurodesis and transjugular intrahepatic portosystemic shunt, respectively), and 2 had successful retransplants. 5-year patient and graft survival rates were 57.1% and 28.6%, respectively.CONCLUSIONS:A tailored approach based on clinical features and including retransplant can achieve acceptable long-term survival in patients with veno-occlusive disease after liver transplant.