Search Results (208)

Persistent high-risk human papillomavirus (hr-HPV) infection drives cervical carcinogenesis, yet improved molecular biomarkers are needed to define high-risk groups. Circulating microRNAs (miRNAs), stable in blood and involved in carcinogenic pathways, represent promising liquid biopsy biomarkers. This study assessed five miRNAs for distinguishing high-grade squamous cell intraepithelial lesions (HSILs) and cervical cancer from healthy controls and for HPV stratification. Circulating miRNAs were quantified in blood samples from 80 women (38 HSIL, 10 cervical cancer, and 32 controls). Relative expression by disease and HPV status was measured by RT-qPCR and normalized to miRNA-23a. Diagnostic performance of single and combined miRNAs was evaluated by logistic regression and ROC curve analysis. Three circulating miRNAs (miR-21, miR-205, and miR-218) were found to be significantly differentially dysregulated in the patient cohorts. A combination of the three markers showed the best diagnostic value for HSIL (AUC of 0.81, sensitivity of 79%, and specificity of 71%) and cancer (AUC of 0.81, sensitivity of 90%, and specificity of 65%). Whereas miR-205 was significantly associated with HPV16/18 in HSIL patients, the combined model had the highest diagnostic performance for multiple HPV infections. Circulating miRNA signatures show promise as liquid biopsy biomarkers for detecting cervical dysplasia and stratifying for HPV status in HSIL, warranting validation in larger prospective studies. Full article

Background: Early detection of oral potentially malignant disorders (OPMDs) and early-stage oral squamous cell carcinoma (OSCC) remains a major clinical challenge, as initial lesions often present with subtle or nonspecific findings during conventional white-light examination. Narrow-band imaging (NBI) enhances visualization of mucosal microvasculature and may improve the identification of dysplastic and malignant transformation. Methods: A narrative review of the literature was conducted in the PubMed, Scopus and Google Scholar databases. Studies published between January 2012 and January 2025 evaluating clinical applications of NBI in oral mucosal lesions, OPMDs, or OSCC were included. Results: NBI enhances visualization of intraepithelial papillary capillary loops (IPCLs), whose morphological alterations correlate with epithelial dysplasia and malignant transformation. Evidence suggests high diagnostic sensitivity (up to 87–100%) and specificity (approximately 83–96%) for detecting high-grade dysplasia and early OSCC. NBI also improves biopsy site selection, reduces sampling error, and supports surveillance of high-risk patients. Conclusions: NBI represents a valuable adjunctive diagnostic tool in oral medicine and dentistry. Although it does not replace histopathological examination, its integration into clinical assessment may enhance early cancer detection and improve management of patients with OPMDs. Full article

Background: Gastric cancer remains one of the leading causes of cancer-related mortality worldwide, underscoring the need for more effective diagnostic strategies. This study aims to use annotated digitized histological slides of gastric cancer and precancerous lesions to develop artificial intelligence algorithms for the diagnosis of gastric lesions. Materials and Methods: We developed a deep learning tool using a training cohort of 970 digitized gastric biopsy slides. Convolutional neural networks (CNNs) were trained for histological recognition and ICD-10 code assignment. The model was validated on an independent test cohort of 250 cases, with expert consensus as the reference standard. Performance was assessed using sensitivity, specificity, and Cohen’s kappa. Survival analysis used Kaplan–Meier, log-rank tests (SPSS 16.0; p < 0.05 significant). Results: Analysis of the training cohort led to a scoring system predicting fatal outcomes based on age and morphology (high-grade component > 70%, ulceration, absence of metaplasia/dysplasia). High-risk patients (4–5 points) had significantly worse survival than low-risk patients (0–3 points) (Log Rank = 14,754; p < 0.0001). One-year survival was 71% (low-risk) vs. 40% (high-risk); mean survival was 19.2 vs. 11.3 months. In the test cohort, the AI algorithm demonstrated 79.6% sensitivity and 86.7% specificity (p < 0.0001) for differentiating malignant from benign gastric lesions. Conclusions: A system combining AI-based analysis with a prognostic scoring model has been developed to reduce diagnostic errors and improve risk stratification in gastric cancer pathology. Full article

Background: Intraductal papillary mucinous neoplasm (IPMN) is a mucin-producing pancreatic tumor with variable malignant potential. While most are asymptomatic and indolent, a subset progress to invasive carcinoma or cause local complications such as pancreatitis. Spontaneous fistulation into adjacent organs is an increasingly recognized phenomenon with impact on prognosis and management. The incidence of fistulation in IPMN in the reported literature is 1.9–6.6%. The most common sites are the stomach, duodenum and bile duct. Reported outcomes are poor, with a median survival of approximately 16 months. Methods: We describe four patients with IPMN complicated by fistula, confirmed by endoscopic or histopathological evaluation with CT and MRI images and discuss the available literature of fistulating IPMN. Results: Fistulation occurred at the common bile duct, stomach, duodenum and duodeno-jejunal junction. Two of four patients passed away at 4.8 and 24.8 months from detection of fistula. Histology revealed high-grade dysplasia or invasive carcinoma in most patients, highlighting the aggressive nature of IPMNs complicated by fistulae. Conclusions: Our findings reinforce the importance of recognizing fistula formation as a marker of aggressive disease in IPMN. Although surgical resection remains the treatment of choice in suitable candidates, the rarity of this entity means that standardized management guidelines are lacking. Full article

Background: Endoscopic assessment is central to the management of inflammatory bowel disease (IBD), particularly within treat-to-target strategies. However, conventional high-definition white-light endoscopy (HD-WLE) is limited by interobserver variability and its inability to reliably reflect microscopic inflammation or predict long-term outcomes. Over the last decade, multiple technological innovations have reshaped the role of endoscopy in both disease activity monitoring and dysplasia surveillance. Methods: This narrative review provides a comprehensive and clinically oriented overview of emerging endoscopic technologies in IBD, including image-enhanced endoscopy, ultra-high-magnification techniques, artificial intelligence (AI), and molecular imaging. We discuss their diagnostic performance, prognostic implications, and potential integration into clinical practice. Results: Image-enhanced endoscopy improves visualization of subtle mucosal and vascular alterations and demonstrates stronger correlation with histological activity compared with HD-WLE alone. Confocal laser endomicroscopy and endocytoscopy enable in vivo microscopic assessment of epithelial architecture and barrier integrity, redefining remission beyond macroscopic healing. AI systems have shown expert-level performance in grading inflammatory severity in ulcerative colitis and high sensitivity in capsule endoscopy for Crohn’s disease, supporting objective and reproducible assessment. In surveillance, targeted high-definition inspection has replaced random biopsies, while adjunctive optical and AI-based tools enhance lesion detection and characterization. Molecular imaging introduces a predictive dimension by enabling visualization of drug–target engagement and dysplasia-specific pathways. Conclusions: Endoscopy in IBD is evolving from a descriptive modality toward a multimodal precision tool integrating enhanced imaging, AI-driven standardization, and molecular profiling. Although further validation and cost-effectiveness studies are required, these innovations have the potential to improve therapeutic stratification, surveillance strategies, and long-term patient outcomes. Full article

Background: Although HPV vaccination is highly effective in the primary prevention of cervical cancer, its potential role in women already diagnosed with HPV-associated cervical dysplasia remains uncertain. This study aimed to evaluate the association between post-diagnosis HPV vaccination and short-term clinical outcomes in HPV-positive women with cervical dysplasia. Methods: Women aged ≥18 years with abnormal cervical screening results suggestive of squamous intraepithelial lesions and high-risk HPV positivity were retrospectively evaluated. High-grade disease was defined as histologically confirmed CIN2/3. HPV vaccination (9-valent) was recommended to all eligible patients at the time of diagnosis. Vaccination status was primarily analyzed as vaccinated (≥1 dose) versus unvaccinated; additionally, dose-stratified analyses (0, 1–2, and 3 doses) were performed to explore potential dose–response relationships. Results: A total of 392 women were included (173 unvaccinated and 219 vaccinated). At 12 months, regression occurred in 51.1% of vaccinated patients compared with 41.0% of unvaccinated women (OR 1.50, 95% CI 1.02–2.20, p = 0.04). A dose–response pattern was observed, with regression rates of 41.0% in unvaccinated patients, 46.1% in partially vaccinated patients, and 54.6% in fully vaccinated patients (p for trend = 0.012). In the HSIL subgroup, regression occurred in 49.0% of vaccinated women versus 33.8% of unvaccinated patients (OR 1.88, 95% CI 1.01–3.52, p = 0.047). When stratified by treatment modality, vaccination was significantly associated with higher regression in the non-LEEP cohort (OR 1.67, p = 0.04) but not in the LEEP cohort (p = 0.22). In multivariable analysis adjusting for age, smoking, HPV genotype, baseline histopathologic grade (CIN1 vs. CIN2/3), and treatment modality, HPV vaccination remained independently associated with regression (aOR 1.55, 95% CI 1.05–2.30, p = 0.028). Conclusions: Post-diagnosis HPV vaccination was associated with a higher probability of cervical dysplasia regression at 12 months, particularly among women with baseline HSIL. These findings suggest that HPV vaccination may provide a beneficial adjunct effect in the clinical management of HPV-associated cervical dysplasia. Prospective studies are required to confirm these observations and clarify the mechanisms underlying this association. Full article

Background and Aims: Autoimmune gastritis (AIG) is a chronic immune-mediated condition characterized by corpus-predominant atrophy, which can lead to vitamin B12 deficiency, achlorhydria, and an increased risk of gastric adenocarcinoma (GC) and neuroendocrine tumours. Diagnosis is often challenging due to a long asymptomatic phase and variable clinical presentation. This study aimed to assess the prevalence of gastric cancer and advanced premalignant lesions and to identify risk factors associated with a worse endoscopic outcome. Methods: This retrospective observational study involving AIG patients undergoing endoscopic surveillance (2006–2024) at the Hospital Clínic de Barcelona. Patients with AIG were identified based on the presence of anti-parietal cell antibodies and/or intrinsic factor antibodies and underwent endoscopic surveillance with histological assessment. Clinical, serological, endoscopic, and histological data were evaluated to estimate the prevalence of gastric lesions. Potential risk factors were evaluated using logistic regression. Results: A total of 70 patients met the inclusion criteria (median age 60 years; 60% female). Advanced premalignant findings (high- and low-grade dysplasia) were identified in 15.7% of the patients, while GC was found in 5.7%. Atrophy and intestinal metaplasia were present in 98.6% and 74.3% of patients, respectively. Female sex was independently associated with a lower risk of advanced neoplastic findings (OR = 0.24; 95% CI: 0.06–0.95; p = 0.044), whereas older age at diagnosis was associated with an increased risk (OR = 1.06; 95% CI: 1.00–1.11; p = 0.031). Conclusions: Given the high prevalence of premalignant lesions in AIG, endoscopic surveillance appears essential for early detection. The observed associations with female sex and older age, toward lower and higher probabilities of advanced neoplastic findings, respectively, may contribute to future risk stratification models. However, the limited identification of significant predictors underlines the complexity of AIG progression and supports the development of individualized follow-up protocols. Full article

Background and Clinical Significance: Foreign body ingestion represents an endoscopic emergency, with a risk of organ perforation of up to 35%, where increased prevalence was noticed among people with mental disorders and institutionalized patients. Case Presentation: The patient—male, 23 years old, and institutionalized for sequelae of infantile encephalopathy—was admitted for epigastric pain and hyperemetic syndrome that began 10 days earlier. Endoscopically, 12 hard plastic foreign bodies with sharp edges and sizes of 6–7 cm were identified, followed by extraction that was successfully performed in two sessions using a polypectomy snare and a Foreign Body Hood Protector. Additionally, multiple sessile exulcerated polypoid lesions were observed, measuring around 1–3 cm each, occupying the entire antrum. Histological examination showed inflammatory/regenerative elements, with features of moderate-to-high-grade dysplasia, while a rapid urease test for Helicobacter pylori infection was positive. As a consequence, the patient was administered triple eradication therapy. In addition, the patient presented marked features of hypereosinophilia and splenomegaly. Upon endoscopic reevaluation after 3 years and 8 months, no polyps were present and the H. pylori test was negative, while a complete and spectacular remission of both the hypereosinophilia and splenomegaly was observed. Conclusions: This case illustrates that the development and progression of gastric polyposis may be caused by the coexistence of chronic mucosal irritation from foreign bodies and H. pylori infection, which is a rare association. H. pylori eradication and endoscopic removal of the foreign bodies resulted in significant mucosal improvement. Full article

Background/Objectives: Ampullary adenomas are neoplasms of the gastrointestinal tract with malignant potential. They are thought to develop through pathways similar to those involved in colorectal neoplasia. This study aimed to determine the prevalence of colonic polyps in patients with ampullary adenoma. Methods: This retrospective study included a total of 35 patients with ampullary adenoma diagnosed between 2023 and 2024 and 105 sex-matched controls. Colonoscopic findings of the patient and control groups were compared with respect to polyp prevalence. In addition, the effects of dysplasia grade of the ampullary adenoma and patient age on polyp prevalence were evaluated. Results: The study included 35 patients (57% male) and 105 controls (59% male). The mean age was 67.06 ± 13.32 years in patients and 61.28 ± 8.42 years in controls. Colonic polyps were detected in 13 (57%) patients in the low-grade dysplasia (LGD) group, 6 (66%) patients in the high grade dysplasia (HGD) or adenocarcinoma group, and 54 (51%) patients in the control group (p = 0.02). After adjusting for age, colonic polyps remained significantly more frequent in the adenoma group than in controls (p = 0.05). Polyp prevalence was not associated with dysplasia grade on ampullary biopsy, and no significant differences were observed between groups regarding polyp histopathology, location, or size. Conclusions: In conclusion, our study indicates that colorectal polyp prevalence is increased among patients with ampullary adenomas and that this association may be independent of age as well as dysplasia severity. Therefore, colonoscopic evaluation may be recommended for all patients diagnosed with ampullary adenoma. Full article

Background/Objectives: Fundic gland polyps (FGPs) are the most common type of gastric polyp and have increased in prevalence in the proton pump inhibitor (PPI) era. Although traditionally considered benign, dysplasia has been described in both syndromic and sporadic FGPs; data from Asian cohorts remain limited. We evaluated the prevalence of FGPs with dysplasia (FGPD) and described associated clinical and endoscopic features in a Taiwanese tertiary-care cohort. Methods: We retrospectively searched institutional pathology archives for all gastric biopsy or polypectomy specimens diagnosed as FGP between January 2000 and December 2024 and mapped these specimens to unique patients using medical record numbers. Candidate dysplastic cases underwent slide review by gastrointestinal pathologists to confirm FGPD and grade dysplasia as low- or high-grade according to standard gastric dysplasia criteria. Cases were classified as syndromic if a hereditary polyposis syndrome was documented; otherwise, they were classified as sporadic. Clinical and endoscopic variables were abstracted from electronic medical records. Patient-level prevalence estimates among patients with FGP are reported with exact 95% confidence intervals (CIs). Results: Among 35,806 unique patients with histologically confirmed FGP, 25 FGPD cases were confirmed (21 sporadic, 4 syndromic). The patient-level prevalence of sporadic FGPD was 0.059% (21/35,806; 95% CI: 0.036–0.090%). Among sporadic cases, dysplasia was low-grade in 19 (90.5%) and high-grade in 2 (9.5%). Sporadic cases occurred at a median age of 48 years (interquartile range [IQR]: 37–63.5 years), and 57.1% were female. Documented PPI exposure before the index FGPD endoscopy was present in 33.3% of patients (median documented duration: 36 months [IQR: 12–125]). No case had documented current Helicobacter pylori infection at the index evaluation. Endoscopically, sporadic FGPDs were commonly multiple, sessile, located in the gastric body/fundus, and small (median size: 0.5 cm [IQR: 0.3–0.575]). Conclusions: Sporadic FGPD was exceedingly rare in this 25-year Taiwanese cohort and was predominantly low-grade. Although typically small and body/fundus-predominant, FGPs with erythema or surface irregularity—particularly with irregular microvascular patterns on narrow-band imaging—should prompt histologic assessment to exclude dysplasia. Full article

Background: Cervical intraepithelial neoplasia (CIN) represents a precancerous condition whose effective management is crucial for preventing invasive cervical cancer, a disease that remains a leading cause of cancer-related mortality among women worldwide. The long pre-invasive phase of cervical carcinogenesis and the availability of effective screening and treatment procedures make CIN a largely preventable and curable entity. Objectives: This review aimed to analyze therapeutic options applied in CIN, correlating interventions with lesion grade and guideline recommendations, in order to outline a management model adapted to the Romanian clinical setting. Materials and Methods: A structured narrative review of 20 published articles addressing cervical intraepithelial neoplasia (CIN 1–3) published between 2021 and 2023 was performed. Relevant studies were identified through a targeted literature search and analyzed descriptively. This study synthesized data from the recent literature and international clinical guidelines to identify management trends and context-specific adaptations. Results: Extracted variables included lesion grade, reported therapeutic approach (surveillance, excisional, or ablative treatment), reproductive considerations, and patient compliance, with international guidelines used as reference standards. Across the reviewed studies, excisional procedures (conization and LEEP) were predominantly reported for high-grade neoplasia (CIN 2–3), while low-grade lesions (CIN 1) were managed either conservatively or through close surveillance. Treatment decisions described in the literature were strongly influenced by patient age, fertility preservation needs, and obstetric history. Overall, management approaches reported in Romanian and international studies were broadly aligned with current guideline recommendations, although variations were observed in the expectant management of younger patients. Conclusions: The findings emphasize the importance of individualized management in cervical dysplasia, integrating lesion characteristics with patient-specific factors. While international guidelines provide a robust framework, their adaptation to the Romanian healthcare context should prioritize patient education, compliance, and structured post-treatment follow-up strategies. Full article

Intrahepatic cholangiocarcinomas (iCCAs) are histologically subdivided into small duct-type (SD-iCCA) and large duct-type (LD-iCCA). LD-iCCA versus SD-iCCA may differ in the molecular/genetic profiles and oncogenesis, including precursor lesions. While several precursors, such as high-grade biliary intraepithelial neoplasm (BilIN) and intraductal papillary neoplasm of bile duct (IPNB), have been proposed for LD-iCCA, the potential SD-iCCA precursors remain to be identified. Amid growing interests in the precursors of SD-iCCA, benign “biliary lesions/neoplasms developing in the hepatic parenchyma (BLNP)” such as von Meyenburg complexes (VMCs), bile duct adenomas (BDAs), and biliary adenofibroma (BAF), have been noted to determine whether they have the potential for precursor of SD-iCCA. Herein, these BLNPs were reviewed. BLNP can be classified into three categories. First, traditional VMC and BDA in normal livers which lack atypical features are categorized as “traditional BLNP”. Second, a constellation of several lesions such as VMC and BDA detectable in the background livers of SD-iCCA and in chronic liver disease (unusual VMC and BDA), VMC with dysplastic features, BDA located in the deep hepatic parenchyma, multiple BDA, BDA presenting the BRAF V600E mutation, and BAF harboring variable dysplasia or in situ carcinomas, which may include neoplastic lesions but do not show invasive growth, are categorized as “unusual/dysplastic BLNP”. Third, tubulocystic carcinoma with BAF-like features (AI-TCC) and SD-iCCA with ductal plate malformation (DPMP) which share overlapping features and show relatively good post-operative outcomes and retained features of VMC or DPM, and BDA and BAF, are categorized as “low-grade malignant BLNP”. While the first category is benign and may not be related to SD-iCCA, some of the second category may be related to SD-iCCA, and the third category is malignant and shows invasive growth. The latter two categories may form a common biliary tumorigenic spectrum involving BLNP. Precursors of SD-iCCA, if they exist, may be included in the second category, and the third category may represent unique carcinomas possibly associated with or followed by conventional SD-iCCA. In conclusion, this novel approach to categorize BLNPs into three categories guarantees further studies of precursors of and their progression to conventional SD-iCCA. Full article

Gastric cancer (GC) is the fifth most common cancer worldwide, with the highest incidence in East Asia. Although H. pylori is a well-known risk factor, carcinogenesis can occur independently of H. pylori infection, and approximately 43% of adults carry H. pylori as part of their native microbiota. This study aimed to identify potential oral and gastric microbial markers across different histological stages of GC in both H. pylori-positive and -negative patients. Buccal swabs and gastric mucosa samples were collected from patients with intestinal metaplasia, low-grade dysplasia, high-grade dysplasia, early GC, or advanced GC. Total DNA was extracted, and 16S rRNA gene amplicon sequencing was performed. Microbiome diversity generally remained stable across histological stages, with no directional shifts in community structure. Differential abundance analysis revealed higher relative abundances of Anaerostipes, Phocaeicola, and Collinsella in the gastric antrum of cancerous samples. Anaerostipes and Phocaeicola are typically enriched in the intestinal microbiota but are rarely observed in the stomach, suggesting their potential ecological and pathological relevance in gastric carcinogenesis. In H. pylori-negative patients, however, a different stage-associated abundance pattern was observed, in which Faecalibacterium, a genus predominantly associated with the intestinal environment, was less abundant in advanced gastric cancer samples than in earlier histological stages within the gastric body. These findings suggest that microbial changes during gastric cancer progression may follow different trajectories depending on H. pylori infection status. In oral samples, Haemophilus and Prevotella were more abundant in intestinal metaplasia than in low-grade dysplasia, and network analysis indicated links between Neisseria and Filifactor at oral and gastric sites. However, as the study population was limited to a single country and ethnicity, the applicability of these microbial markers should be carefully considered. Full article

Background and Clinical significance: Cowden syndrome is an autosomal dominant disorder caused by germline loss-of-function mutations in the PTEN tumor suppressor gene. It is characterized by multiple hamartomas and an increased lifetime risk of malignancies affecting the breast, thyroid, endometrium, and gastrointestinal (GI) tract. Pediatric presentations may include macrocephaly, scrotal tongue, and intellectual disability. Gastrointestinal involvement is frequent, with juvenile-like hamartomatous polyps occurring in at least half of patients and distributed throughout the GI tract, posing a risk for malignant transformation. Early diagnosis and surveillance are crucial for improving patient outcomes. Case Presentation: We report a case of a 10-year-old Caucasian female with Cowden syndrome, with a history of a malignant germ cell tumor of the ovary consisting of a yolk sac tumor and low-grade immature teratoma diagnosed at age six, and thyroidectomy at age nine. The patient has mild intellectual disability. Routine radiological surveillance revealed a right colon intraluminal mass, prompting referral for pediatric gastroenterology evaluation. Endoscopy identified multiple polyps throughout the colon, stomach, and small intestine. Polypectomy of larger lesions was performed, and histopathology confirmed juvenile-like hamartomatous polyps without dysplasia or malignancy. This case highlights the necessity of comprehensive gastrointestinal evaluation in pediatric Cowden syndrome patients. Endoscopic surveillance is essential for early detection and management of polyps. Conclusions: Given the multisystem involvement and elevated cancer risk associated with PTEN mutations, a multidisciplinary approach that includes genetic counseling, dermatologic evaluation, and ongoing oncologic monitoring is recommended. Increased awareness of gastrointestinal manifestations enables timely intervention and may reduce morbidity and mortality in this high-risk population. Full article

Background/Objectives: Barrett’s esophagus (BE) is a precursor to esophageal adenocarcinoma (EAC), and neoadjuvant chemoradiation therapy (NCRT) is commonly used in the treatment of EAC. However, the impact of NCRT on non-tumorous BE and dysplasia is poorly understood. Our study aims to evaluate the effects of NCRT on BE segment length and dysplasia in patients undergoing esophagectomy for EAC. Methods: This multicenter, retrospective cohort study includes EAC patients who underwent esophagectomy with or without NCRT between 2014 and 2020. Patients with histologically confirmed BE and dysplasia (low- or high-grade) were analyzed. Preoperative and postoperative pathology were compared to assess BE regression, dysplastic changes, and segment length. Statistical analyses included chi-square and t-tests, with p < 0.05 considered significant. Results: Of 101 patients who were diagnosed with EAC, 28 patients were found to have BE, with 18 receiving NCRT in addition to surgery and 10 undergoing surgery alone. The NCRT group showed significantly higher BE regression than the control group (77.8% versus 10%, p < 0.001). Regression of dysplasia occurred in 66.7% of the NCRT group versus 20% of the control group (p = 0.079) and residual dysplasia was lower in the NCRT group (33.3%) compared to the control group (80%) (p = 0.018). Conclusions: NCRT significantly reduces BE and dysplasia, suggesting it may improve surgical outcomes by minimizing residual disease. These findings support the potential of NCRT to enhance surgical precision in EAC treatment, though further research is needed to explore underlying mechanisms and refine treatment strategies. Full article