Two-thirds of pregnant women have anal symptoms during pregnancy and postpartum, especially haemorrhoidal complications and anal fissure. The most important risk factor is constipation. The prevention of constipation in pregnant women is therefore highly recommended.
Breast-implant associated (BIA) lymphoma is an infrequent type of cancer occurring in the fluid and fibrous capsule around a textured breast implant. Recently, both the 2022 WHO 5th edition classification of Haematological tumours (WHO HAEM5) and 2022 International Consensus Classification of Mature Lymphoid Neoplasms (22ICC), recognized breast implant-associated Anaplastic Large Cell Lymphoma (BIA-ALCL) as a definitive entity, defined as a mature CD30-positive T-cell lymphoma, confined by a fibrous capsule, in a breast implant setting. Only few B-cell lymphomas have been reported in the literature to be associated with breast implants. Here we report two EBV-positive Diffuse Large B-cell lymphomas (EBV + DLBCL) in relation to a breast implant, both expressing CD30 as well as EBV latency type 3. Both lesions were considered as DLBCL associated with chronic inflammation (CI-DLBCL), but one presented as a 7 cm solid mass, while the other presented as a fibrin-associated DLBCL (FA-DLBCL) in an HIV patient. Clinically, both are in complete remission 6 months or longer after capsulectomy and graft removal, without additional chemotherapy.Such cases, characterized by large CD30-positive cells, can easily be misdiagnosed as BIA-ALCL if the cell of origin is not further established. Therefore, a diagnostic panel including lineage-specific B-and T-cell markers and EBER in situ hybridization is essential to recognize this rare entity, to understand lymphomagenesis, to predict outcome and to define clinical approach.
IntroductionMany pregnant women have anal symptoms during pregnancy and postpartum. The most common proctological problems reported are haemorrhoids, anal fissures and anal incontinence. Literature about this problem is scarce.The aim of this study is to determine the prevalence of anal problems and constipation during the second and third trimester of pregnancy, in the immediate postpartum and up to three months after childbirth. We also want to identify the risk factors for the development of anal symptoms.MethodThis is a prospective cohort study. Women between their 19th and 25th week of pregnancy are included. High-risk pregnancy and non-Dutch speaking are exclusion criteria. Ninety-four women were followed with a symptom questionnaire in the second and third trimester, in the immediate postpartum (within 3 days) and three months postpartum. Descreptive data were obtained from the patient files. A specific proctological diagnosis was presumed on the basis of combined symptoms (rectal bleeding, anal pain and swelling). Constipation was defined by the Rome III criteria. Statistical analysis was performed with SPSS and risk factors were identified using multivariate analysis with binary logistic regression.ResultsSixty-eight percent of the women developed anal symptoms during the whole study period. Anal symptoms occured in 50% of the women during pregnancy, in 56,2% in the immediate postpartum and in 62,9% during the three months postpartum. The most prevalent symptom was anal pain. Constipation was reported by 60,7% during the whole study period. The most prevalent diagnoses were: hemorrhoidal thrombosis (immediate postpartum), hemorrhoidal prolaps (3rd trimester and immediate postpartum) and anal fissure (not episode-related). Anal incontinence was only reported in 2% during the postpartum. Multivariate analysis identified constipation and a history of anal problems as significant risk factors for the development of anal complaints pre-and postpartum.ConclusionTwo thirds of pregnant womed deal with anal symptoms during pregnancy and/or postpartum, especially hemorrhoidal complications and anal fissure. This high prevalence emphasises the clinical importance of this problem. The most important risk factor is constipation. Therefore, prevention of constipation pre-and postpartum is recommended.Disclosure of InterestNone Declared
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