Patras Olympian Hospital

Background: Granular cell tumors (GCTs) are rare, usually benign tumors arising anywhere in the body. Breast GCTs are reported to be even rarer and small in size, with most cases in literature reporting approximately 2–4 cm in diameter. The objective of this case report is to present a multi-disciplinary surgical strategy and approach to a rare case of large GCT located in the breast, requiring wide resection, chest wall and breast reconstruction. Case Description: We present the case of a 70-year-old female patient who presented with a self-palpated right breast mass. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a 5.1 cm × 3.1 cm × 5.2 cm mass on her right breast, invading the pectoralis major muscle and in direct contact with the anterior thoracic wall. Open surgical biopsy confirmed it to be GCT. Surgical treatment involved multiple surgical teams and included right breast nipple sparring mastectomy en bloc with the overlying breast quadrant, pectoralis major muscle and the underlying 4th and 5th rib in contact with the mass. Chest reconstruction was achieved with a Gore-Tex mesh, while immediate breast reconstruction was performed with a silicone implant covered with a pedicled musculocutaneous latissimus dorsi flap. There were no clinical concerns up to the 1 year follow-up, while three-dimensional (3D) chest CT confirmed the integrity of the chest wall reconstruction. Conclusions: This case presented a challenge due to the location and size of the mass requiring a multi-disciplinary approach, from the initial differential diagnosis process to the surgical excision and immediate reconstruction involving three surgical specialty teams in the same operation.

Objective To characterize the systemic treatment patterns and current state of moderate-to-severe psoriasis patients in real-world settings in Greece. Methods CRYSTAL-Greece was a multicenter, cross-sectional and retrospective chart review study assessing Psoriasis Area and Index (PASI), Dermatology Life Quality Index (DLQI) and EuroQol-5-Dimensions 5-Levels (EQ-5D-5L). Eligible patients were consented adults (18–75 years old) on continuous treatment with any approved systemic therapy regimen for ≥24 weeks. Results 280 eligible patients were enrolled between 07APR2020 and 30NOV2020. Current treatment at the study visit was biologic monotherapy in 78.2% of patients, non-biologic monotherapy in 16.1%, and conventional systemic + biologic in 5.7%. Median absolute PASI score was 1.8; of patients, 36.8%/64.6%/83.9% had PASI ≤ 1/≤3/≤5. Rates of absolute PASI > 5 were 13.7% and 28.9% in the biologic and non-biologic monotherapy subgroups, respectively. Median DLQI score was 2.0, with 18.9% of patients having DLQI > 5 (16.0% and 26.7% in the biologic and non-biologic monotherapy subgroups, respectively). The correlation between DLQI and absolute PASI was low positive (Spearman rho = 0.432; p < 0.001). Most affected EQ-5D-5L dimensions were anxiety/depression (58.6%) and pain/discomfort (28.6%). Conclusion A considerable proportion of patients still do not achieve complete or almost complete skin clearance, while one fifth of the population experience at least moderate impairment of quality of life.

IntroductionRheumatoid arthritis (RA) is a systemic, inflammatory disease affecting multiple organs and causing physical disability over time.ObjectiveThe primary objective was to evaluate treatment persistence to subcutaneous tocilizumab (TCZ-SC). Additionally, treatment effects on persistence and their associations with clinical and patient-reported outcomes were assessed.MethodWe performed a multicenter, non-interventional, 52-week observational study on 222 patients with moderate or severe RA. Clinical outcomes were evaluated by using disease activity score for 28 joints (DAS28) and European League Against Rheumatism (EULAR) response, and patients’ perceptions were evaluated by using Health Assessment Questionnaire (HAQ), Visual Analog Scale (VAS) for pain, and patient global assessment (PtGA) of disease activity. Safety was assessed throughout the study.ResultsThe mean age of the overall cohort was 62.2 ± 12.3 years, and 83.8% were females. Persistence to TCZ-SC was 89.6% at week 24 and 85.1% at week 52 in the overall cohort with slightly increased persistence in the combination group. At week 52, changes from the baseline were − 2.68 in DAS28, − 0.76 in HAQ, − 43.21 in VAS pain, and − 41.66 in PtGA (p < 0.0001 for all). Moderate and good EULAR response was achieved in 83.2% of patients. Non-serious and serious adverse events occurred in 18.5% and 3.2% of the participants, respectively.ConclusionsThe current study confirms the favorable safety and effectiveness of TCZ-SC as well as its acceptability by RA patients in Greece, with sustained high persistence rates up to 52 weeks. TCZ-SC offers a sustainable treatment response in RA.Key Points• Based upon clinical and patient-reported outcomes, TCZ-SC is a highly effective and safe treatment modality in patients with moderate-to-severe RA.• Persistence to TCZ-SC was high throughout the study, both as monotherapy and in combination with csDMARDs.• TCZ-SC is effective both as monotherapy and when used in combination with other csDMARDs regardless of the line of treatment.

Objectives:We report the effectiveness and safety of certolizumab pegol (CZP) treatment in a real-world Greek axial spondyloarthritis (axSpA) population, including patients with radiographic (r-axSpA) and non-radiographic (nr-axSpA) disease.Methods:We performed a sub-analysis of the Greek cohort from CIMAX (NCT02354105), a multicentre, non-interventional cohort study that prospectively investigated CZP treatment in patients with axSpA. The primary outcome was change from baseline (CfB) in Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) to Week 52.Results:Across 12 sites in Greece, 126 patients (r-axSpA: 91; nr-axSpA: 35) received ≥1 dose of CZP and were included in the Safety Set (SS), with 120 patients (r-axSpA: 86; nr-axSpA: 34) included in the Full Analysis Set (FAS). The mean (standard deviation [SD]) CfB in BASDAI at Week 52 was −3.8 (2.0) in the overall axSpA population, with numerically greater improvements observed for nr-axSpA patients compared with r-axSpA (nr-axSpA: −4.2 [2.1]; r-axSpA: −3.7 [2.0]). Improvements in the axSpA population, including r-axSpA and nr-axSpA subpopulations, were observed in key secondary and additional outcomes at Week 52. Overall, 14.3% (18/126) of patients in the axSpA population experienced ≥1 adverse event (AE). There were no serious AEs or deaths reported during the study.Conclusions:Patients with r-axSpA and nr-axSpA treated with CZP in clinical practice in Greece showed improvements in disease activity and key symptoms. CZP treatment may therefore help address the substantial health burden associated with axSpA in Greece.