Search Results (2,846)

Background: The urea-to-creatinine ratio (UCR) is used to support the differential diagnosis of acute kidney injury (AKI); however, its diagnostic utility remains debated. We explored the clinical relevance of UCR in the initial etiological assessment of AKI, also considering relevant clinical modifiers. Methods: We retrospectively analyzed 590 hospitalized patients classified as pre-renal (n = 319), parenchymal (n = 135), or post-renal (n = 136) AKI. UCR was compared across AKI subtypes and stratified by pre-existing chronic kidney disease (CKD). Logistic regression models assessed the association between UCR and pre-renal AKI, excluding post-renal cases. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. An exploratory analysis was performed within parenchymal AKI according to histopathological patterns and the presence of nephrotic syndrome. Results: Baseline characteristics differed across AKI subtypes, including age, sex, and CKD. UCR was higher in pre-renal than in parenchymal and post-renal AKI (p < 0.001), despite substantial overlap. Stratification by CKD did not reveal differences within AKI subtypes; however, in pre-renal AKI, UCR decreased progressively with advancing CKD stage (p < 0.001). UCR was significantly associated with pre-renal AKI, and diagnostic performance improved when combined with age and advanced CKD. Within parenchymal AKI, higher UCR values were observed in glomerular disease, particularly with nephrotic syndrome. Conclusions: UCR varies across AKI etiologies and is influenced by age and baseline kidney function. Although its standalone diagnostic performance is limited, integration with simple clinical variables improves discrimination between pre-renal and parenchymal AKI, supporting its use as a complementary tool in early AKI evaluation while emphasizing the need for comprehensive clinical assessment. Full article

Translational oncology has moved rapidly from histopathology and single-analyte biomarkers toward multi-dimensional molecular profiling. Yet many clinically deployed tests still use reductionist biomarker strategies that under-represent cancer complexity. This review examines whether a mechanistic, multi-layered, and specimen-aware approach can improve cancer detection, classification, prognosis, minimal residual disease (MRD) assessment, and therapeutic selection. Evidence across solid tumours shows that genomic alterations alone incompletely explain tumour state, metastatic behaviour, immune evasion, or therapeutic vulnerability. Integrated genome and transcriptome analyses, proteogenomics, single-cell atlases, fragmentomic, methylation based cell-free DNA assays, metabolomics and microbiome assessments reveal clinically relevant biology that single modality tests cannot determine. Minimally invasive collected specimens can extend access to screening, diagnosis and longitudinal monitoring, but the choice of specimen should be matched to disease biology and analytes that represent mechanisms of oncogenesis. However, translation remains constrained by pre-analytical variability, contamination, differences in tumour shedding behaviour, clonal haematopoiesis, translation of generated models, incomplete external validation and uncertain downstream clinical utility for emerging platforms. This review provides a commentary on the future of cancer diagnostics, the considerations and barriers to clinical translation, the relationship between utility and dimensionality of biomarkers assessed and the emerging rationale towards mechanistically grounded integrated models. Full article

Background/Objectives: Oligodendroglioma-like morphology may generate diagnostic uncertainty in central nervous system tumors, although oligodendroglioma is defined by the integrated presence of IDH mutation and whole-arm 1p/19q codeletion. This study aimed to evaluate the diagnostic pitfalls of oligodendroglioma-like morphology by comparing initial microscopic impressions with final integrated diagnoses. Methods: We retrospectively reviewed 23 non-oligodendroglial central nervous system tumors showing focal or predominant oligodendroglioma-like morphology but not fulfilling the integrated diagnostic criteria for oligodendroglioma. Clinical, radiological, histopathological, immunohistochemical, molecular/cytogenetic, initial microscopic impression, final integrated diagnosis, and follow-up data were analyzed descriptively. Results: Initial microscopic impressions included low-grade glial tumor, high-grade glial tumor, dysembryoplastic neuroepithelial tumor, ependymoma, astroblastoma, oligodendroglioma, dysplasia, central neurocytoma, metastatic epithelial tumor, and pilocytic astrocytoma/low-grade glial tumor. Final integrated diagnoses were astrocytoma, IDH-mutant, CNS WHO grade 2–4 (n = 9); dysembryoplastic neuroepithelial tumor (n = 3); central neurocytoma (n = 3); metastatic renal cell carcinoma (n = 2); low-grade glioneuronal tumor (n = 2); and PLNTY, glioblastoma IDH-wildtype, supratentorial ependymoma, and pilocytic astrocytoma (n = 1 each). Conclusions: Oligodendroglioma-like morphology should be interpreted as a diagnostic pitfall pattern rather than a specific diagnosis. Structured integrated reappraisal using targeted immunohistochemical and molecular/cytogenetic testing helps refine differential diagnosis in routine neuropathology practice. Full article

Background/Objectives: Primary biliary neuroendocrine tumors (PBilNETs) are exceptionally rare biliary tract neoplasms that are frequently misdiagnosed preoperatively as cholangiocarcinoma because of overlapping clinical and radiological findings. This systematic review aimed to summarize overall evidence regarding presentation, diagnostic evaluation, surgical management, and outcomes of PBilNETs. Methods: A systematic search of PubMed, Scopus, and Embase databases was performed according to PRISMA guidelines for studies published between January 2000 and December 2025. Studies including adult patients with histologically confirmed and surgically treated PBilNETs were eligible. Data regarding demographics, symptoms, imaging findings, surgical treatment, histopathology, immunohistochemistry, and outcomes were extracted and analyzed. Results: Fifty-eight studies involving 79 patients met the inclusion criteria. Median age at diagnosis was 49 years, with female predominance. Obstructive jaundice, abdominal pain, and pruritus were the most common presenting symptoms. Most tumors originated from the hilar or extrahepatic bile ducts. Preoperative diagnosis was challenging, as most lesions were initially considered cholangiocarcinomas. Surgical resection was the main therapeutic approach and included bile duct excision with biliary reconstruction, pancreaticoduodenectomy, or hepatic resection according to tumor location. Histopathological analysis demonstrated predominantly well- or moderately differentiated neuroendocrine neoplasms with frequent chromogranin A and synaptophysin positivity. Favorable long-term outcomes were reported, with high postoperative survival and limited recurrence during follow-up. Conclusions: PBilNETs remain diagnostically challenging because of their rarity and nonspecific presentation; however, they appear to exhibit a less aggressive biological behavior than conventional biliary adenocarcinomas. Surgical resection remains the cornerstone of treatment, while further multicenter studies are required to optimize diagnostic and therapeutic strategies. The findings also support an individualized multidisciplinary approach integrating clinical presentation, advanced imaging, histopathological grading, and immunohistochemical profiling to optimize personalized management of these rare tumors. Full article

Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant—yet often underrecognized—cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care. Full article

Background/Objective: Bartonella henselae, the causative agent of cat-scratch disease (CSD), usually causes a self-limiting zoonotic infection. Osteomyelitis is a rare but increasingly recognized manifestation, particularly in children, and may closely mimic malignant or other infectious bone diseases. We present a case of multifocal pediatric Bartonella henselae osteomyelitis and discuss the associated diagnostic and therapeutic challenges in the context of the current literature. Case presentation: We report the case of a previously healthy 10-year-old girl who presented with a one-month history of fever, fatigue, limping, and progressive thigh and groin pain following cat-scratch exposure. During the course of the illness, she developed unilateral facial nerve palsy and Parinaud oculoglandular syndrome. Initial laboratory investigations demonstrated elevated inflammatory markers and reactive thrombocytosis. Serological testing for Bartonella henselae was positive for both IgM and IgG antibodies, whereas polymerase chain reaction (PCR) testing of both peripheral blood and the bone biopsy specimen was negative. Plain radiographs were unremarkable; however, magnetic resonance imaging (MRI) revealed multifocal lesions involving the right femoral diaphysis, right pubic bone, and left iliac wing, together with focal hepatic and splenic lesions suggestive of disseminated disease. Because of the radiological suspicion of malignancy, a femoral bone biopsy was performed and demonstrated osteomyelitis with necrosis and microabscess formation, without evidence of malignancy. Following targeted antimicrobial therapy, the patient showed rapid clinical and laboratory improvement, with progressive regression of the lesions on follow-up MRI. Conclusions: Bartonella henselae osteomyelitis should be considered in the differential diagnosis of multifocal bone lesions in children, particularly in patients with a history of cat exposure. Because the disease may closely mimic malignancy both clinically and radiologically, establishing the diagnosis requires careful integration of epidemiological, clinical, serological, radiological, molecular, and histopathological findings. Early recognition and appropriate antimicrobial treatment are associated with an excellent prognosis. Full article

Background/Objectives: Differentiating high-grade glioma recurrence from treatment-related changes remains challenging on conventional MRI. This study evaluated non-contrast arterial spin labeling (ASL) perfusion MRI for this distinction and compared its performance with dynamic susceptibility contrast (DSC) perfusion MRI. Methods: Postoperative follow-up MRI examinations obtained between November 2019 and May 2021 were retrospectively reviewed. The cohort included 63 MRI examinations from 36 adults treated for high-grade glioma. ASL, routine MRI, and DSC images were independently assessed by two neuroradiologists. Final diagnosis was based on histopathology or longitudinal clinical and imaging follow-up. Reader agreement, diagnostic performance, and an exploratory patient-level grouped machine learning analysis using ASL-only, DSC-only, and combined ASL–DSC features were evaluated. Results: ASL- and DSC-derived perfusion parameters were significantly higher in tumor recurrence than in treatment-related changes (all p < 0.001). Both techniques showed high diagnostic performance; DSC achieved the highest accuracy, whereas ASL provided high specificity across readers. Inter-reader agreement ranged from substantial to almost perfect. In grouped cross-validation, ASL-only, DSC-only, and combined models achieved mean AUCs of 0.946, 0.997, and 0.997, respectively. Permutation testing confirmed that combined-model performance exceeded chance expectations (empirical p = 0.002). Conclusions: Non-contrast ASL perfusion showed diagnostic performance comparable to DSC for differentiating high-grade glioma recurrence from treatment effects. ASL may provide a reliable non-invasive alternative for longitudinal surveillance, particularly when gadolinium administration is undesirable or contraindicated. Full article

A 66-year-old man with hypertension, type 2 diabetes mellitus, and a 50-year smoking history was presented with acute chest pain clinically consistent with unstable angina. Coronary computed tomography angiography (CCTA) showed multivessel atherosclerosis and, more strikingly, diffuse sheath-like pericoronary soft-tissue cuffing around the major epicardial arteries—an appearance reported as the “mistletoe sign” and compatible with immunoglobulin G4 (IgG4)-related coronary periarteritis. CT-derived fractional flow reserve (CT-FFR) measured 0.75 in the left anterior descending artery, 0.68 in the left circumflex artery, and 0.94 in the right coronary artery. Invasive angiography identified a 90% proximal left circumflex stenosis as the flow-limiting lesion; drug-eluting stent implantation restored Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. Serum IgG4 (145 mg/dL) was only marginally above the diagnostic threshold, and troponin was unavailable, so the diagnosis remained clinical. Without histopathology, the findings support possible rather than definite IgG4-related disease, and the contribution of the pericoronary process to the stenosis could not be established. The patient remained stable on conventional medical therapy. CCTA, CT-FFR, and angiography answer complementary questions; diffuse pericoronary change warrants serologic and systemic evaluation for inflammatory coronary involvement, with cautious etiologic attribution. Full article

Persistent Müllerian duct syndrome (PMDS) is a rare disorder of sex development characterized by the persistence of Müllerian duct derivatives in genetically and phenotypically male animals. This report describes the clinical presentation, diagnostic work-up, surgical management, histopathological findings, and cytogenetic characterization of a 9-year-old intact male Schnauzer dog presented with a 3-day history of progressively worsening vomiting, diarrhea, unilateral testicular enlargement, oliguria, and dysuria. Diagnostic evaluation included abdominal radiography, ultrasonography, exploratory laparotomy, histopathology, and cytogenetic analysis using R-replicative banding after bromodeoxyuridine incorporation. Imaging and surgical exploration revealed cryptorchidism, persistent Müllerian duct derivatives, including uterine horn-like structures, and an abnormal gonadal structure. Histopathological examination confirmed severe seminiferous tubular atrophy, persistence of Müllerian-derived tissues, and a unilateral Sertoli cell tumor. Cytogenetic analysis demonstrated a normal male karyotype (78,XY) without evidence of chromosomal mosaicism or structural abnormalities, supporting the diagnosis of a 78,XY disorder of sex development and excluding major chromosomal defects. This case highlights the importance of integrating clinical evaluation, diagnostic imaging, histopathology, and cytogenetic analysis to identify findings compatible with PMDS and emphasizes that this condition should be considered in the differential diagnosis of cryptorchid male dogs presenting with reproductive tract abnormalities or associated testicular neoplasia. Full article

Background and Objectives: Artificial intelligence (AI) is increasingly used in clinical dentistry, but its diagnostic accuracy for oral mucosal lesions based on clinical photographs remains insufficiently validated. This prospective observational study compared the Top-1 diagnostic accuracy of ChatGPT-4o and ChatGPT-5 in identifying normal anatomical variants and pathological oral mucosal lesions and evaluated their performance across anatomical sites. Materials and Methods: Seventy adults with either normal anatomical variants (n = 21) or pathological oral mucosal lesions (n = 49) were consecutively recruited at the Department of Dental Medicine, University Hospital of Split, Croatia. One standardized clinical photograph per patient was analyzed by ChatGPT-4o and ChatGPT-5 under image-only and image-plus-text conditions using identical prompts. The reference diagnosis was established by an oral medicine specialist, with histopathological examination (HPE) performed when clinically indicated. Diagnostic performance was assessed using Top-1 accuracy and McNemar’s test. Results: Both models showed low accuracy with image-only input, but performance improved significantly after clinical information was added (p < 0.001). Overall Top-1 accuracy increased from 19.0% to 69.0% for ChatGPT-4o and from 9.0% to 51.0% for ChatGPT-5. For normal anatomical variants, accuracy increased from 14.3% to 81.0% and from 14.3% to 76.2%, respectively. For pathological oral mucosal lesions, accuracy increased from 20.4% to 63.3% and from 6.1% to 40.8%, respectively. ChatGPT-4o showed numerically higher accuracy than ChatGPT-5, particularly for pathological oral mucosal lesions, but no statistically significant difference was found between the models in the corresponding paired comparisons. Conclusions: Diagnostic performance was limited with image-only input but improved substantially when standardized clinical information accompanied the images. The numerical differences between models, particularly for pathological oral mucosal lesions, may be clinically relevant but do not establish superiority or equivalence. Neither model can currently replace conventional clinical diagnosis, and AI should be regarded as a clinical decision-support tool for evaluating oral mucosal lesions. Full article

Background/Objectives: Cutaneous melanoma prognosis is largely determined at diagnosis, with Breslow thickness, subtype and other histopathological aspects being key prognostic indicators. Variations in healthcare organization and environmental factors may influence melanoma presentation. This study aimed to compare epidemiological, clinical, and histopathological characteristics of primary cutaneous melanoma between two national referral centers in Southeastern Europe. Methods: A multicenter retrospective cohort study was conducted at the University Clinical Center of Serbia (Belgrade) and the Clinical Center of Montenegro (Podgorica). Consecutive patients treated for primary cutaneous melanoma between January 2018 and December 2022 were included. Data of interest were extracted from medical records. Annual regional sunshine hours were obtained from publicly available climatological databases. Group comparisons were performed using appropriate parametric and non-parametric tests, followed by a multivariable ordinal logistic regression analysis. Results: A total of 412 patients were analyzed. Age and sex distributions were comparable between cohorts. Nodular melanoma predominated in Montenegro, whereas superficial spreading melanoma was most common in Belgrade (p < 0.001). Median Breslow thickness was significantly higher in Montenegro (p = 0.001), with a greater proportion of tumors >4 mm (p = 0.001). In multivariable analysis, increasing age (p < 0.001), male sex (p = 0.027), and treatment in Montenegro (p = 0.001) were independently associated with higher Breslow thickness categories. Conclusions: Patients treated in Montenegro presented with thicker melanomas and a higher proportion of nodular subtype. These differences may reflect multifactorial influences, including healthcare accessibility and diagnostic pathways. Further prospective studies incorporating other histopathological aspects, time-to-diagnosis and survival outcomes are warranted. Full article

Background: Oral lichen planus (OLP) is a chronic inflammatory mucocutaneous disorder that is well documented in adults but remains relatively uncommon in the pediatric population. Due to its rarity, knowledge regarding its epidemiology, etiology, clinical behavior, diagnosis, and management in children remains limited. Objective: To review the current literature regarding epidemiology, pathogenesis, clinical presentation, diagnosis, histopathological characteristics, treatment, and outcomes of OLP in pediatric patients. Materials and Methods: An electronic search of the literature was conducted in the PubMed, Scopus, and Cochrane Library databases to identify OLP-associated case reports in the pediatric population. The search was limited to English-written publications of the past decade. The initial PubMed search yielded 228 publications. Following restriction to studies published between 2016 and 2026, 97 records remained. Limiting the search to English-language publications resulted in 95 studies. Screening for patients younger than 18 years identified 51 potentially relevant publications. After title, abstract, and full-text review, 10 studies fulfilled the inclusion criteria. To ensure comprehensive literature coverage, supplementary searches were subsequently conducted in the Scopus and Cochrane Library databases, identifying three additional eligible studies after excluding the duplicates. Consequently, a total of 13 studies were included in the final review. Results: Pediatric OLP is considerably less common than adult disease. The available evidence suggests an immune-mediated pathogenesis, although the exact mechanism remains unclear. Clinical presentations include reticular, erosive, plaque-like, linear, and severe mucocutaneous forms, with the reticular subtype being the most frequently reported. Histopathological findings consistently demonstrate basal cell degeneration and a dense subepithelial lymphocytic infiltrate. Topical corticosteroids remain the most commonly prescribed treatment and are generally associated with favorable clinical outcomes. Conclusions: Although relatively uncommon, OLP should be considered in the differential diagnosis of persistent oral white lesions in children. Early diagnosis and appropriate management are essential for symptom control and prevention of complications. Additional research is needed to better understand disease pathogenesis and establish evidence-based treatment protocols for pediatric patients. Full article

Background/Objectives: Primary thyroid lymphoma accounts for approximately 0.2–2% of thyroid malignancies. Plasmablastic lymphoma (PBL), an aggressive large B-cell neoplasm with plasma-cell differentiation and frequent loss of conventional B-cell markers, is a rare thyroid presentation. We report a thyroid PBL presenting as an acute surgical airway emergency in an immunocompetent patient and highlight the diagnostic and management pitfalls that distinguish this from anaplastic thyroid carcinoma. Case Presentation: A 75-year-old man without any significant past medical history presented with rapidly progressive right-sided neck swelling, dysphagia, inspiratory stridor, and respiratory failure. Imaging demonstrated a large, thyroid-centered mass with tracheal involvement, initially raising concern for anaplastic thyroid carcinoma. Histopathology revealed a diffuse infiltrate of large, atypical cells with immunoblastic and plasmablastic morphology. The neoplastic cells were CD20- and CD138-negative but strongly MUM1-positive, with lambda light-chain restriction, bright CD38 by flow cytometry, a Ki-67 proliferation index exceeding 95%, aberrant cytoplasmic CD3 expression, and a MYC::IGH rearrangement, supporting a diagnosis of PBL. Staging identified extranodal perinephric disease and mesenteric lymphadenopathy, consistent with disseminated extranodal Ann Arbor stage IV disease. The patient underwent systemic treatment and initially had an excellent response; however, one month after the last treatment cycle they presented to the hospital with a mass consistent with recurrence. Discussion: Rapid growth, fixation, and tracheal invasion strongly suggest anaplastic thyroid carcinoma in routine clinical practice. However, plasmablastic lymphomas can present similarly and require fundamentally different treatment. In this case, loss of conventional B-cell markers, CD138 negativity, and aberrant cytoplasmic CD3 expression created substantial diagnostic challenges. Light-chain restriction, plasma-cell-associated markers, flow cytometry, and MYC cytogenetics were vitally important. Conclusions: Thyroid-presenting PBL is exceptionally rare and may closely mimic anaplastic thyroid carcinoma, including presentation with life-threatening airway compromise and tracheal involvement. This case highlights several diagnostic pitfalls: CD138 negativity despite plasma-cell differentiation, and aberrant cytoplasmic CD3 expression. Prompt airway stabilization, adequate tissue acquisition, broad immunophenotyping, light-chain assessment, flow cytometry, EBV/HHV8/ALK testing, and MYC cytogenetics are essential for accurate diagnosis and lymphoma-directed treatment. Full article

Pyonephrosis is a rare, life-threatening suppurative disease of the kidney characterised by the accumulation of purulent exudate within the renal pelvis and the destruction of renal parenchyma. It is typically associated with azotaemia and urinary tract obstruction. Extreme leucocytosis (>100 × 10³/µL), known as a leukemoid reaction, has been rarely reported in feline pyonephrosis. A 13-year-old neutered domestic shorthair female cat was brought to a veterinary clinic with symptoms of lethargy and apathy, as well as a significantly enlarged abdominal cavity. Physical examination revealed dehydration and a large, non-painful mass occupying the left abdominal cavity. Haematology revealed severe leucocytosis of 123.22 × 10³/µL and anaemia with haematocrit (HCT) 18.6% and serum biochemistry showed elevated SDMA 17 µg/dL, AST 97 U/L, with hypokalaemia, hypochloraemia and hypoproteinaemia. Creatinine (1.5 mg/dL) and blood urea nitrogen (BUN) (23 mg/dL) remained within reference values. Abdominal X-ray and ultrasound revealed a large mass of anechoic structure encompassing the entire left side of the abdominal cavity, consistent with pyonephrosis. Microbiological studies of purulent material obtained by ultrasound-guided fine-needle aspiration and culturing revealed the presence of Escherichia coli. The day after admission, the patient underwent surgical laparotomy with unilateral nephrectomy. Histopathology confirmed severe inflammatory infiltration of the mucosa, connective tissue proliferation and fibrosis, with partial glomerular hyalinisation and without cellular atypia. Six days after surgical intervention, the leukocyte count decreased to 44.81 × 10³/µL. The patient was alive and clinically healthy 3 months after surgery. This case illustrates that massive unilateral pyonephrosis can occur in geriatric cats without azotaemia due to the compensatory function of the contralateral kidney. Marked leucocytosis of 123.22 × 10³/µL probably represents a leukemoid reaction secondary to severe suppurative inflammation. Moreover, pyonephrosis should be considered in the differential diagnosis of large abdominal masses in cats, even in the presence of a normal creatinine level. Full article

Sexually transmitted infections (STIs) are common and probably underreported causes of proctitis and colitis. Bacterial (chlamydia, gonorrhoea, syphilis, Mycoplasma genitalium), viral (herpes simplex virus, mpox), and amoebic (Entamoeba histolytica) pathogens can cause inflammatory proctitis or colitis, which, depending on the pathogen, can mimic inflammatory bowel disease both on endoscopy and histopathology. Rectal and colonic masses are uncommon, but important manifestations of these infections, especially with chlamydia, syphilis, and E. histolytica. Testing for HIV is important in this context, since it allows for the inclusion of opportunistic pathogens into the differential diagnosis. Chronic diarrhoea can be a feature of chronic HIV infection. Enteric pathogens, such as Salmonella spp., Shigella spp., or Campylobacter spp., can be transmitted during sex, especially during oral–anal contact (“rimming”). The most common STI, human papillomavirus, is not associated with colitis, but is important because of its causal association with genital warts and anal cancer. Full article