Splenic abscess is a very rare complication of laparoscopic sleeve gastrectomy (LSG). Clinical presentation includes fever, leucocystosis, and abdominal pain. CT SCAN is a must for diagnosis. The preferred treatment is either conservative, with intravenous antibiotics and percutaneous drainage, or splenectomy. We report the thirteen case of a splenic abscess after LSG. In our patient, the abscess occurred three weeks after LSG in a 21-year-old man, and it was successfully treated conservatively.

Immune checkpoint inhibitors (ICI) are becoming an integral part of the management of cancer patients. PD-1 and PD-L1 inhibitors led to distinguished clinical responses in patients with different types of cancer ranging from 20 to 30% when used in monotherapy. Anti-PD1 and anti-PDL1 agents are approved by the US FDA in the treatment of multiple malignancies from renal cell carcinoma, classical Hodgkin lymphoma, non-small-cell lung cancer, squamous cell carcinoma of head and neck, metastatic melanoma and urothelial carcinoma of the bladder [1].Defining predictive biomarker of treatment response and toxicity represents one of the challenges of these new agents. In fact, several biomarkers were evoked in order to explain the response to ICI such as PD-L1 expression/amplification, high tumor mutational burden and mismatch repair gene defect [2]. These immune checkpoint inhibitors were also associated with specific adverse events which were mainly immune related such as colitis, hypophysitis and pneumonitis. Some predictive biomarkers are under investigation to predict these adverse events like neutrophil activation markers (CD117 and CEACAM1), several immunoglobulin genes, Il6 level at baseline and Il17/eosinophil pathway element's level [3]. Interestingly, immunotherapy may also result in a unique tumor response pattern such as pseudo-progression defined as initial tumor increasing size on imaging tools followed by delayed tumor response. Recent anecdotal reports described a subset of patients whose disease paradoxically rapidly progressed after ICI administration suggesting that immunotherapy may have a deleterious effect by accelerating the disease [4,5]. Hyper-progression disease definition & outcome Two recent reports by Champiat et al. and Kato et al. described this new pattern of progression in patients treatedwith PD-1/PD-L1 inhibitors [2,6]. The definition of hyper-progressive disease (HPD) is still not clear and is different according to each study methodology. Kato et al. defined HPD as time to treatment failure <2 months, >50% increase in tumor burden compared with preimmunotherapy imaging that was obtained within 2 months of the initiation of immunotherapy, and >2-fold increase in progression pace [6]. However, Champiat et al. defined it as RECIST progression after the first evaluation and ≥2-fold increase of the tumor growth rate between the reference and experimental periods, tumor growth rate being a measure to assess tumor growth over time allowing for quantitative and dynamic evaluation of the tumor. Champiat et al. reported in their study a prevalence of 9% of HPD (12 patients/131 evaluable patients); these patients were significantly older than patients without HPD which can be due to a different immunological background in older patients such as higher inflammatory cytokines concentrations. HPD was associated with shorter overall survival (4.6 vs 7.6 months; p = 0.19). No association was reported between HPD and tumor burden at baseline, tumor type, number of metastatic sites, number of previous...

Background: Granulomatous prostatitis (GnP) is an interesting complication of bacillus Calmette–Guérin (BCG) therapy as it mimics prostate cancer on clinical, biochemical and imaging examinations. In the era of multiparametric prostate MRI (mpMRI), differentiation of GnP from prostate cancer on imaging is essential. Case presentation: We report a case of post-BCG GnP in a patient with nonmuscle invasive bladder cancer, presenting with a prostate-specific antigen level of 21.6 ng/ml and prostate imaging reporting and data system (PI-RADS) 5 peripheral lesions. A mpMRI performed 6 months before showed a score 2 of PI-RADS. Conclusion: The comparison of mpMRI images before and after BCG administration gives urologists, oncologists and radiologists a precise idea of the mpMRI changes that occur following BCG administration to eventually prevent unnecessary biopsies in future patients.