Domenico Santangelo

Introduction: Giant retroperitoneal liposarcomas (GRPLs) are rare tumors that often reach considerable size before diagnosis due to their indolent growth and deep anatomical location. Surgery represents the only potentially curative treatment, yet recurrence rates remain high. While histological subtype is a recognized predictor of recurrence, the prognostic role of tumor size, particularly in giant tumors, remains controversial. This study evaluates the impact of tumor size and histological subtype on recurrence risk in a literature-based retrospective cohort. Materials and Methods: Data were extracted from a literature-based database of GRLPs published between 2004 and 2023. Only tumors >20 cm treated without positive surgical margins were included; patients receiving adjuvant therapy or with missing follow-up were excluded. Histological subtype (well-differentiated vs. other) was the main variable of interest. Recurrence-free survival (RFS) was defined as the primary endpoint and estimated using the Kaplan–Meier method. The association between histological subtype and recurrence risk was evaluated using a Cox proportional hazards model. A sensitivity analysis was performed to explore the potential interaction between tumor size and histological subtype. Results: Our final cohort yielded a total of 81 patients, of whom 47 (58%) had a well-differentiated GRLPs. The median tumor size was 38 cm and median follow-up was 16 months, with 24 recurrences observed. At 24 months, RFS was higher in well-differentiated tumors than in other histological subtypes (81% vs. 41%). In multivariable Cox analysis, histology was independently associated with recurrence risk (HR 3.2, 95% CI 1.28–8.17, p = 0.01), whereas tumor size showed no association with recurrence. Interaction analysis confirmed no differential effect of tumor size across histological subtypes. Conclusions: In this literature-based cohort of GRLPs treated with surgery, histological subtype independently predicted recurrence, whereas tumor size showed no prognostic value, either overall or within individual histological subtypes.

Background: Inflammatory Bowel Disease (IBD), comprising Crohn’s disease and ulcerative colitis, requires accurate assessment over time. Imaging techniques play a crucial role in diagnosis, monitoring disease activity, and guiding therapeutic response. This review summarizes the current evidence on radiologic imaging techniques in IBD, focusing on intestinal ultrasound (IUS), computed tomography enterography (CTE), magnetic resonance enterography (MRE), and other emerging technologies. Methods: A literature review was conducted using PubMed, EMBASE, Scopus, and the Cochrane Library, encompassing publications up to 31 October 2024. Results: IUS offers a non-invasive tool for assessing bowel wall thickness, vascularity, and complications. CTE and MRE provide detailed visualization of luminal and extraluminal disease, with MRE preferred for routine monitoring due to the absence of ionizing radiation. Standardized indices and scoring systems aid in objective disease activity assessment. Emerging technologies like Positron Emission Tomography (PET)/MRI and radiomics show promise in combining metabolic and morphological information for complex cases. Conclusions: Imaging has a central role in IBD management, with IUS, CTE, and MRE demonstrating high diagnostic accuracy. Radiomics and Artificial Intelligence (AI) are paving the way for precision imaging. Integrating advanced imaging techniques, scoring systems, and AI-driven analytics represents a transformative step toward more effective and individualized care for patients with IBD.

Accurate assessment of safety margins after percutaneous thermal ablation of liver tumours is critical to minimize local tumour progression (LTP). However, post-ablation margin assessment remains challenging, especially given that ablated tumours cannot be readily appreciated on standard post-ablation imaging. This pictorial essay illustrates the use of contrast-based tumour tagging during CT hepatic arteriography (CTHA)-guided ablation, which preserves tumour conspicuity on post-ablation imaging. By injecting contrast medium and starting energy delivery at the time of maximal tumour enhancement, the contrast agent depicts the tumour, rendering it hyperdense on post-ablation CT scans. This enables direct visualization of the ablated tumour and its margins on post-ablation scans, facilitating both visual and software-assisted margin evaluation. Eleven clinical cases are presented, demonstrating the versatility, reproducibility, and potential pitfalls of this technique. Prospective studies are warranted to validate its impact on local tumour control and to optimize integration into standard image-guided ablation protocols. Graphical Abstract

Purpose To evaluate the impact of CT-assessed liver steatosis (LS) on functional and volumetric hypertrophy in patients undergoing liver venous deprivation (LVD) prior major hepatectomy and surgical outcome. Materials and Methods A single-center retrospective analysis was conducted on patients undergoing LVD between June 2019 and September 2024. LS was defined as mean liver density < 45HU on pre-LVD unenhanced CT-scan. Volumetric data, including future liver remnant (FLR), degree of hypertrophy (DH), kinetic growth rate (KGR = DH/week), and FLR increase, were collected at three different timepoints: i) pre-LVD, ii) at 0–15 days post-LVD (T1) and iii) at 15–30 days post-LVD (T2). Pre/post-procedural scintigraphy data and surgical outcome were collected. Results Fifty-four patients (n = 16 LS; n = 38 non-LS) were included. LVD technical success was achieved in all procedures, without any major complications. The LS group showed significantly lower DH, KGR, and FLR volume increase at T1 and T2, respectively, 4.8 vs 7.7%, (p = 0.034), (3.89 vs 5%/week (p = 0.02), and 16.7% vs 25.4% (p = 0.048) at T1; 6.9% vs 11.9% (p = 0.022), 1.7%/week vs 3.5%/week (p = 0.001), and 26.4% vs 34.2% (p = 0.035) at T2. LS group demonstrated lower FLR function (%/min/m2) than non-LS both before (1.81 vs 2.03, p = 0.06) and after LVD (2.19 vs 3.2, p = 0.006), without difference in FLR function hypertrophy. LS patients needed longer time to undergo surgery (55 vs 38 days, p = 0.002), with fewer patients reaching planned surgery (9 vs 32, p = 0.028) and had more major complications. Conclusion In this retrospective study, volumetric FLR increase was lower in LS than non-LS patients, with similar functional increase. CT-assessed LS may help identify low-responder patients prior to LVD. Graphical Abstract

Background/Objectives: Giant Retroperitoneal Liposarcomas (giant RPLs) represent a rare malignant disease of adulthood that does not yet have a univocal definition in the scientific literature. The symptoms may be late, depending on the position and the size reached. The weight may exceed 20 kg, and the diameter 25 cm. The main treatment is the surgical approach. This systematic review aims to collect data from the present literature and to answer some questions on the nature of this pathology. Methods: We performed a search on the PubMed, Cochrane, and Scopus databases using specific search strings. Non-English written articles and abstracts were excluded. Results: Dimensional, histological, and pathological data of giant RPLs were extracted and recorded in an electronic database, and charts were used to synthesize the results. We selected 126 manuscripts, all case reports and case series, and obtained data for 157 giant RPLs. The major axis varied from 15 to 80 cm, and the weight ranged between 2.5 and 98 kg. Sex distribution was homogenous. Age was reported 146 times, and almost 1/3 of the study population was under 50 years old. The most frequent hystotype reported was well-differentiated liposarcomas, while the rarest was pleomorphic liposarcomas. In 139 cases, the symptoms were reported and generally included a mass effect on surrounding organs. The exclusive surgical operation was the most frequent treatment option, and it included both the resection of the tumor and other organs involved. Chemo- and radiotherapy were also performed, in a few cases. In 36 reports, distant metastasis was suspected, but only 6 were effectively positive. Conclusions: Giant RPLs are a clinical entity that shares some common features with normal-size liposarcomas but are different in dimensions, age distribution, histologic prevalence, rate of incidental diagnosis, organ sparing, and R0 resection. More studies are needed to completely characterize these tumors.