Introduction

Plummer-Vinson syndrome is a rare entity that associates dysphagia, iron deficiency anemia, and cervical esophageal membrane. Our work aimed to describe the clinical profile and to specify the predictive factors of degeneration in patients with Plummer-Vinson syndrome associated with esophageal cancer and to show interest in endoscopic surveillance.

Aims & Methods

It was a retrospective descriptive and analytical study over 30 years (1993-2023) including all patients treated and followed up for Plummer-Vinson syndrome and who presented esophageal cancer. Data collection and statistical analysis were performed by SPSS version 20.0 software.

Results

Out of the 160 patients treated for Plummer-Vinson syndrome, 15 patients had associated esophageal cancer resulting in a prevalence of 9.37%. The median age was 50.6 years with extremes of 28 and 74 years, with a sex ratio of M/F = 2/13. The interval between the diagnosis of Plummer-Vinson syndrome and the appearance of cancer was 8 years +/- 7.4.
All our patients with associated cancer had dysphagia with weight loss, odynophagia in 92.9% (n=13), clinical anemia syndrome in 59 %(n=8), and upper gastrointestinal bleeding in 10%(n=1). All patients had hypoferritinemia with a median value of ferritin 6.2μg/l.
The location of the Plummer-Vinson ring was at the level of the Killian triangle at 46%(n=7) and the upper third of the esophagus at 54%(n=8).
The location of the cancerous process at the level of Killian's triangle was in 46% of cases (n=7), and the location at the level of the upper third of the esophagus was in 19.7%(n=3). In 33.3% of cases (n=5) in the middle third. It was squamous cell carcinoma in all cases. Surgical treatment was initiated in 14% of cases (n=2), radio-chemotherapy in 72% (n=11) and refusal of treatment in 14% of cases (n=2). Two patients progressed well with the disappearance of dysphagia, 10 patients died between 5 months and 5 years of cancer progression, and the rest of the patients could not be followed up.
In multivariate analysis, the statistically significant predictive factors for the degeneration of Plummer-Vinson syndrome were: Age>50.6 years (OR= 2.37, p=0.003 CI=1.875-4.236), Ferritinemia <6.2 μg/l (OR=3.02, p=0.001 CI=0.977-12. 516) and location of the ring at the level of the Killian triangle (OR=1.140, p=0.001 CI=1.057-1.229). Gender and dysphagia did not appear to be associated with degeneration with (p=0.26) and (p=0.35) respectively.

Conclusion

Plummer-Vinson syndrome is a precancerous lesion requiring endoscopic surveillance. In our series, the prevalence was 9.37%. Malignant transformation of this ring at the level of the triangle of Killian was present in 46% of cases. The predictive factors of degeneration were advanced age, low ferritinemia, and the location of the ring in the mouth of Killian.

Clinical Case Summary

A 72-year-old man with a 49-year history of ulcerative colitis (UC), characterized as pancolitis and steroid-dependent, underwent routine surveillance colonoscopy. A congested, ulcerated mass was found in the recto-anal region, with no signs of active colitis in the rest of the colon.
From 2000–2012, he was treated with infliximab, discontinued due to secondary failure, followed by azathioprine (2012–2017), which was stopped due to leukopenia. Since then, he has been on vedolizumab. His medical history also includes hypertension and previous tobacco use.
The patient had been in clinical and biochemical remission for the last two years. Given his long-standing UC and the resection of a lateral spreading tumor (LST) via mucosectomy in 2019 showing hyperplastic mucosa with a focus of low-grade dysplasia, he has been under annual endoscopic surveillance.
At the current exam, a large exophytic, ulcerated mass with superficial necrosis and fibrin (Kudo IV) was seen in the recto-anal region, occupying approximately 1/6 of the luminal circumference and bleeding spontaneously.
Histology revealed a poorly differentiated neuroendocrine carcinoma (NEC) with a high proliferative index (Ki-67: 60%). Staging workup, including CT, pelvic MRI, and endoscopic ultrasound, identified a suspicious regional lymph node, that was confirmed by FDG-PET to be metabolically active.
After multidisciplinary discussion, the decision was made to start systemic chemotherapy without delay. If the patient responds, a total proctocolectomy with permanent ileostomy will be considered.
This case is notable for the rarity of recto-anal NECs, especially in UC patients. Their poor prognosis and unclear association with long-term UC or immunosuppressive treatment complicate management and raise important clinical questions.

References

Images that will be uploaded are: endoscopic findings of the colonic mass, histological specimens of the NEC, radiologic findings (PET)

Introduction

Mental health is an overlooked aspect of inflammatory bowel disease (IBD) patient care and the most common psychological conditions in patients with IBD are anxiety and depression¹. The objective of this study was to examine the possible factors that will impact mental health burden of CD patients in Europe.

Aims & Methods

A multi-centre online medical chart review study of patients with CD was conducted between Jul – Sep 2022 among UK, FR, DE, IT & ES gastroenterologists practicing across hospital and private practices. Physicians were screened for practice duration and patient volume. Charts of patients prescribed with advanced therapy were included in the analysis.

Results

206 sampled physicians collectively reported 1178 CD patients. From the reported CD patients, 190 suffered mental health burden (depression or anxiety) and 988 CD patients did not suffered any mental health burden. Among CD patients suffered mental health burden, a higher proportion of CD patients are female vs those who did not suffered any (55% vs 46%). ‘Family history of IBD’ was the co-morbidity more likely to experience in reported CD patients suffered mental health burden vs those who did not (11% vs 7%).
When looking at employment status between these two patient groups, reported CD patients suffer mental health burden was less likely to be in full-time employment vs those not suffered mental health burden. A higher proportion of reported CD patients suffered mental health burden were in part-time employment or housewife/househusband.

Table 1: Employment status in reported CD patients (% patients)

CD patients	Suffered mental health burden	NOT suffered mental health burden
% full-time employment	47%	62%
% part-time employment	22%	14%
% housewife/ husband	8%	4%

CD patients with mental health burden had greater CRP level than patients without mental health burden (CRP mean: 16 vs 12). This aligns with reported CD patients with mental health burden had frequent surgery times vs without mental health burden (Mean surgery times: 2 vs 1) and had greater steroid usage (% reported patients currently on steroids – 18% vs 13%).

Conclusion

Comparisons in this study cohort highlight there are other factors could impact CD patients’ mental health burden other than IBD itself. This coincided with low full-time employment rate that attributed to financial stress may increase CD patients’ mental health burden. Also, higher rate of surgery and steroid usage in CD patients experienced mental health burden might suggest they had more severe or complications with their disease that will impact overall mental health. Further investigation using comparator cohort is warranted.

References

1. Shurong Hu, Yiping Chen, Yan Chen & Caihua Wang (2021): Depression and Anxiety Disorders in Patients With Inflammatory Bowel Disease, NCBI, DOI: 10.3389/fpsyt.2021.714057

Introduction

Pancreatic neuroendocrine tumors (pNETs) are a heterogeneous group of tumors with different treatment options depending on pathological grading, clinical staging, and presence of symptoms related to hormonal secretion. Their classification is made on mitotic count and Ki-67 index.
The current standard for Grading assessment is analysing the material obtained from EUS-guided fine needle aspiration/biopsy (EUS-FNA/FNB). However this technique is not free from adverse events and could be challenging for NETs localization.
The evidence of high grade of fibrosis and microvascular density decrease (MVD) on tumor pathological specimens has led many authors to search for undirected malignant features of pNET extrapolated from non-invasive techniques. The introduction of ancillary techniques, such as second-generation contrast agents (CH-EUS), has improved study of pNET. Particularly, at CH-EUS examination contrast pattern well correlates with behaviour and grading of NETs. However, the use of contrast agents entails a prolongation of procedure time and additional costs. An innovative ultrasound Doppler technique, Detective Flow Imaging EUS (DFI-EUS), involves no additional time or cost as it doesn’t require the administration of contrast agent. There is still no standardisation of this technique and few studies have validated its use.

Aims & Methods

The aim of this study is to evaluate the DFI role in defining NET vascularization and its correlation with CH-EUS. The second aim of the study is to assess DFI role in predicting histological grading.
Single center retrospective analysis on consecutive patients with solid pancreatic lesions who underwent EUS at Therapeutic Digestive Endoscopy Unit of the Fondazione Policlinico Universitario Campus Bio-Medico in Rome.
After activation of DFI, each lesion was observed for at least 30 seconds. Lesions was classified into three grades, according to the degree of vascularisation at DFI: (grade 0 absence of microvascularization of the tumor; grade 1 minimal/isovascularization of the tumor; grade 2 markedly increased microvascularization).
All lesion with final hystological diagnosis of NET were enrolled.
Grading and Ki-67 index of tumors were reported.
Data about lesion’s features and procedure were collected.

Results

From April 2024 to February 2025, 17 patients were enrolled (58.8% male; mean age 57±12 years old). The majority of lesion (53%) were localized in the body of the pancreas and the mean lesion’ s size was 28±20 mm. The final histological diagnosis classified 50% lesions as G1, 38.8% G2 and 5.5% G3.
At the CEH-EUS the 70.6% of lesion showed hyper-enhancement. About the DFI evaluation the 17.6% of lesion was hypo-vascular, 17.6% Iso-vascular and 64.7% was hyper-vascular. There was excellent correlation between DFI characterization of the lesion and the CH-EUS (ICC 0.9)
Among the NET G1, 66.7% were Hypervascular at DFI and 33.3% Isovascular. Among the G2, 71.4% were Hypervascular at DFI and 28.6% Hypovascular. The only G3 lesion was Hypovascular.
There was inverse correlation between the NET grade and the DFI grade (Pearson coefficient -0.56; p 0.02).

Conclusion

DFI-EUS can provide a fast evaluation of the micro-vascularization of pNET with excellent correlation with CH-EUS. Hyper-vascular pattern at DFI correlates with low Ki-67 index.

Introduction

Pancreatic Ductal Adenocarcinoma (PDAC) is a highly aggressive and lethal malignancy of the pancreas due to limited treatment response and lack of early diagnosis. PDAC accounts for more than 90% of all pancreatic neoplasms and early PDAC may be missed on Computed Tomography (CT) scan due to similar attenuation as healthy pancreas, small size and hidden location.

Aims & Methods

The current study aims at improving detection of PDAC with CT scans using a deep learning model. It uses three different Convolutional Neural Network (CNN) models namely, Visual Geometry Group 19 (VGG19), Residual Neural Network 50 (ResNet-50) and Inception-v3. A compendium of 129,910 abdomen CT images (107 patients) of PDAC patients and 18,942 abdomen CT images (80 patients) of healthy controls were considered from The Cancer Imaging Archive. Additionally, several pre-processing and image augmentation methods were used to prevent overfitting and improve accuracies.

Results

The current model showed high construct validity with markedly lowered computational power. The Inception-v3 model showed the highest accuracy in the detection of PDAC with an accuracy of 97.93%. Specificity of the VGG-19 model was the highest at 98.77 whereas sensitivity was the highest for the Inception-v3 model at 98.75%. Data on the CNN models’ Performance Metrics (accuracy, sensitivity, specificity and area under ROC) ​were all compared.

Conclusion

The deep learning enabled tool accurately detected PDAC on CT scans versus healthy controls. The models were also reasonably sensitive for tumours below 2 cm.

References

1. Ushio J, Kanno A, Ikeda E, et al. Pancreatic Ductal Adenocarcinoma: Epidemiology and Risk Factors. Diagnostics (Basel). 2021;11(3):562. doi:10.3390/diagnostics11030562
2. Qureshi TA, Gaddam S, Wachsman AM, et al. Predicting pancreatic ductal adenocarcinoma using artificial intelligence analysis of pre-diagnostic computed tomography images. Cancer Biomark. 2022;33(2):211-217. doi:10.3233/CBM-210273
3. Ahmed HS. BEYOND TRADITIONAL TOOLS: EXPLORING CONVOLUTIONAL NEURAL NETWORKS AS INNOVATIVE PROGNOSTIC MODELS IN PANCREATIC DUCTAL ADENOCARCINOMA. Arq Gastroenterol. 2024;61:e23107. doi:10.1590/S0004-2803.24612023-117