Abu-Rumaileh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Anorectal melanoma (ARM) is a rare, aggressive disease. Given that it presents with local symptoms that resemble other common benign anorectal conditions, ARM is often low on the differential diagnosis. Delayed diagnosis and nonconsensus of treatment options lead to poor prognosis. Here, we report the case of an 85-year-old woman with a history of Irritable bowel syndrome who presented with altered bowel habits and bleeding per rectum. CT revealed a rectal mass with metastatic lesions to the bone, liver, and lungs. Immunohistochemical staining was positive for Human Melanoma Black-45, melanoma antigen recognized by T cells, and SRY-related HMG-box 10. A final diagnosis of ARM was made.

Abu-Rumaileh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Background Gastric bypass (GB) and sleeve gastrectomy (SG) remain the most effective intervention for weight loss in obesity. Our previous data showed a significant effect of preexisting diabetes on weight loss over 5 years. Since nonalcoholic fatty liver disease (NAFLD) is implicated as a precursor to clinical diabetes in obesity, we sought to determine if preexisting NAFLD modified weight loss outcomes. Methods 714 patients [79. 0% females, median age: 45 (37-53)] undergoing bariatric surgery were followed for 5 years. Clinically significant NAFLD at baseline was defined with a composite definition, combining the presence diagnosis on the medical record, definitive evidence for fat on imaging studies, presence of biopsy proving NAFLD, and/or elevation of liver function tests without another explanation. To screen for the presence of NAFLD, a natural language-processing tool EMERSE was utilized, and results were verified manually. Presence of diabetes, hypertension, and dyslipidemia were also defined using a combination of diagnostic codes, natural language processing and manual verification. Weight loss was tracked during annual visits and calculated using baseline weight and BMI. Total percent weight loss from baseline (%TWL) was also calculated. Results Of the 714 patients, 380 underwent GB [80.3% females, age 45 (35-53), median BMI 46.4 (41.6-51.9)] and 334 underwent SG [77.5% females, age 46 (39-54), BMI 49.7 (43.7-54.1)]. Overall, 31. 0% patients had clinically significant NAFLD at baseline, while the prevalence of diabetes, hypertension and dyslipidemia were 36. 0%, 54.9%, and 29.4% respectively. %TWL was impacted significantly by NAFLD in the GB group, as individuals without NAFLD lost medians of32.30 (26. 07-37.35), 32.33 (25. 04-39.21),31.12 (21.89-37.64), 26.40 (19.96-36.20), and 25.86 (18.16-34.79)%TWL versus29.63 (24.14-35.28),27.88 (21.44-35.11),24.15 (18.80-34.42),22. 09 (17. 03-30. 07), and21. 06 (14.92-30.25)%TWL compared to those with NAFLD by years1, 2, 3, 4, and 5 (p=0. 014,0. 002,0. 001,0. 002, and 0. 008). Among the SG group, differences in %TWL in NAFLD and non-NAFLD groupswere also significant, but only during year 1 and 2; non-NAFLD group had medians of25.73 (21.36-31.97) and24.55 (18.35-31.24) %TWL vs,22.48 (17.10-27.63) and22.28 (14.75-28.31)%TWL in NAFLD-group (p=<0. 001 and 0. 02). In a multivariable model for %TWL, preexisting NAFLD remained a highly significant covariate when adjusted for baseline BMI, age, gender, surgery type, time (year of follow up), time by surgery type, preexisting diabetes, baseline cholesterol and triglyceride levels (Beta; 95% CI: - 2.288; -3.938, -0.639 p=0. 0067). Of note, the only other significant covariate with regards to comorbidities was presence of baseline diabetes (Beta; 95% CI: -2.811; -4.602, -1. 021, p=0. 0022). Conclusions Preexisting NAFLD impacts weight loss outcomes in patients undergoing bariatric surgery, more so in GB than SG. Mechanisms for the role of clinically significant NAFLD or diabetes in reducing weight loss potential after bariatric surgery require further studies. Presentation: No date and time listed

We describe a case of prostate cancer recurrence 25 years after radical prostatectomy. Our patient is a 77-year-old male with past medical history pertinent for obesity and coronary artery disease. The patient’s initial presentation in 1994 was for persistent lower urinary tract symptoms. He was subsequently diagnosed with high-grade prostate adenocarcinoma and underwent radical prostatectomy. The patient was followed up postoperatively for 16 years and deemed to be in clinical and biochemical remission with undetectable prostate-specific antigen (PSA). Twenty-five years post-operatively, the patient was evaluated with an investigatory colonoscopy for tenesmus, constipation, and change in stool caliber. Colonoscopy revealed significant anal canal stenosis. Biopsy of the lesion showed prostate adenocarcinoma recurrence. Prostate cancer recurrence presenting with only gastrointestinal symptoms is highly unusual, especially in a patient who never received radiotherapy and had been in remission for 25 years.