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Undifferentiated carcinoma of the pancreas with osteoclast-like giant cells (UC-OGC) is a rare subtype of pancreatic cancer, accounting for less than 1% of all pancreatic tumors. Preoperative diagnosis is cumbersome as cross-sectional imaging is often not capable to distinguish between UC-OGC and other pancreatic tumors such as pancreatic adenocarcinoma, mucinous carcinoma or neuroendocrine tumors and specific tumor markers seem to be lacking. Endoscopic ultrasound r `m(EUS) with tissue acquisition via fine-needle aspiration (FNA) or biopsy (FNB) with microscopic HE staining and immunohistochemistry allows for an accurate diagnosis, thus influencing further treatment. We present herein the cases of two patients with osteoclast-like giant cells tumors of the pancreas diagnosed by EUS-guided fine needle biopsy and perform a literature review on the role of EUS-guided biopsy for diagnosis.

Background and aims. Patients with COVID-19 frequently present abnormal elevated liver function tests of unknown clinical significance. We aimed to investigate the characteristics and factors influencing outcome in patients with confirmed SARS-CoV-2 infection and liver injury on admission.

Skin malignant melanoma (MM) is one of the most frequent and aggressive neoplasia worldwide. Its associated high mortality rates are mostly due to its metastases, while diagnosis and treatment of MM in its early stages is of favorable prognostic. Even skin superficial MMs at incipient local stages can already present with lymph node invasion and distant metastases. Therefore, knowledge of the controllable risk factors and pathogenic mechanisms of MM development, spreading, and metastatic pattern, as well as early diagnosis, are essential to decrease the high mortality rates associated with cutaneous malignant melanoma. Genetic factors are incriminated, although lifetime-acquired genetic mutations appear to be even more frequently involved in the development of MM. Skin melanocytes divide only twice per year and have time to accumulate genetic mutations as a consequence of environmental aggressive factors, such as UV exposure. In the search for more promising therapies, matrix metalloproteinases have become of significant interest, such as MMP-1, MMP-2, MMP-9, and MMP-13, which have been linked to more aggressive forms of cancer and earlier metastases. Therefore, the development of specific synthetic inhibitors of MMP secretion or activity could represent a more promising and effective approach to the personalized treatment of MM patients. [ABSTRACT FROM AUTHOR]

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Introduction. Therapeutic options in the management of inoperable perihilar cholangiocarcinoma (pCCA) patients are very limited and include palliative chemotherapy and endoscopic drainage procedures. Recently, ERCP-guided intraductal radiofrequency ablation (RFA) has been proposed as a potential adjuvant therapy in these cases. Study aims. We aimed to evaluate the feasibility, clinical success rates and safety profile of an endoscopic treatment protocol including RFA and biliary stenting in inoperable pCCA patients. Methods. We performed an interim analysis of a single center, randomized control trial of native papilla cases of pCCA patients with ECOG 0-2 performance status and localized disease who required endoscopic biliary drainage (NCT05563870). Patients in the control arm underwent palliative stenting with plastic stents while patients in the active arm received RFA ablation with the Habib probe and plastic stenting. Treatment in both arms was planned based on preprocedural CT and MRCP, with the aim of draining as much of the viable liver volume. All patients were referred for palliative chemotherapy according to the current standard of care. Technical and clinical success rates and procedure-related adverse event (AE) rates were evaluated prospectively at 30 days. Results. We included 15 patients (6 in the RFA arm, 9 in the control arm) between April 2022-April 2023. Patients were predominantly female (9/15), mean age was 72 years and most cases were classified as Bismuth IV strictures (7/15). Median ECOG status was 1 (range 0-2) and mean bilirubin level prior to endoscopy was 15.9 mg/dL (range 1.8-36.8). Technical success was achieved in 14/15 patients and clinical success in 13/15 patients. Notably, there were 4 cases of cholangitis in the control arm compared to only 1 case in the active arm, 1 case of bleeding (control arm), 2 cases of cholecystitis (1 in each arm) and 1 perforation (active arm) and 1 case of severe pancreatitis requiring percutaneous drainage (control arm). There was no difference in the advent of moderate and severe AEs following the procedure (4 in the active arm vs. 7 in the control arm, p=0.64) and most cases were successfully managed by endoscopy, with only 1 case requiring surgery and 1 death recorded at 30 days after the procedure. 5 patients underwent systemic chemotherapy after endoscopic drainage. Conclusions. Our preliminary data suggests that RFA followed by adequate biliary drainage is technically feasible even in difficult-to-treat cases such as high-grade hilar stricture, with no additional increase in complication rate in patients receiving ablation therapy. [ABSTRACT FROM AUTHOR]