Hidradenitis suppurativa (HS) is a systemic inflammatory disease associated with an increased risk of malignancies, in which chronic inflammation and immune dysregulation have been proposed as contributing factors. We report the case of a 22-year-old male with severe follicular occlusion tetrad (Hurley III) since pre-puberty (age 11), who developed severe cytopenias at age 16, subsequently diagnosed with myelodysplastic neoplasm. Despite extreme transfusion dependence (>110 cumulative units of red cells and platelets over six years) and persistent bone marrow failure, treatment with Ixekizumab (anti-IL-17A) achieved significant cutaneous improvement, reducing the International Hidradenitis Suppurativa Severity Score (IHS4) from 21 to 11. This case highlights a possible association between long-standing severe HS and myeloid disease, suggesting a biologically plausible link between chronic cutaneous inflammation and myeloid dysfunction. Although late inflammatory control resulted in meaningful dermatologic improvement, it did not reverse established bone marrow failure, emphasizing the importance of early intervention and hematological surveillance in patients with severe HS.

When medicine is no longer able to offer hope to a patient, we come up against the dreaded feeling of incurability and the end of life. This frustrating situation is experienced by the doctor and the patient but also by the caregivers who find themselves forced to adapt to it.

This work was done to study the impact of aid on the lives of caregivers of cancer patients, to measure the burden and study their coping strategies.

This was a two-month cross-sectional study of primary caregivers of patients with lung cancer. Burden was measured using the ZARIT abbreviated scale. Anxiety was assessed using the STAI-Y anxiety inventory. Depression was assessed using the BDI questionnaire. Coping mechanisms were assessed using the Brief-COPE.

Seventy-four caregivers were included in the study. Among them, 66% were women, with a mean age of 47.7 years. In 58% of cases, the carer was a spouse. Smoking was noted in 12 carers (16%). Co-addiction to alcohol and tobacco was noted in 5 parents (7%). In 40.5% of cases, help had been provided for 3 to 6 months, and in 70.3% of cases it was provided on a daily basis. In 37.8% of cases, the help lasted more than two hours a day. Carers complained about the lack of information provided about the disease, treatments and what to do in the event of incidents in 41.9% of cases. Welcoming a caregiver at home was reported in 14.8%. Assistance constituted an obstacle to parenthood in 13.5% of cases. The burden score according to the abbreviated Zarit scale was 18.39±11.27 with extremes ranging from 0 to 47. A level of state anxiety varying from average to very high was noted in 47.3 % of cases. A level of trait anxiety varying from medium to very high was noted in 33% of cases. The frequently mentioned source of anxiety was felt responsibility (77%). Fifty-eight percent (58%) of caregivers presented with a depressive syndrome, including 17.6% suffering from severe depression. Among the caregivers surveyed, the most used coping mechanism was focusing on the problem (with a mean of 2.97 and a standard deviation of 0.73). A high burden score was associated with young age (p=0.02), female gender (p-0.001), frequency and nature of help (p=0.05, and p=0.002 respectively), the absence of emotional support (p=0.003), and professional difficulty (p=0.05). Trait anxiety and depression were also associated with burden (p=0.023 and p=0.001) respectively.

Undetected, underdiagnosed depression and anxiety in the patient's family circle, particularly in their natural caregivers, hinder the continuity of assistance and alter its quality, hence the need to implement possible improvements, essentially taking in psychological burden which is unfortunately almost absent in our country.

Epithelial ovarian cancers make up about 90% of ovarian malignancies and are often diagnosed late due to its vague symptoms. Cancer Antigen-125 (CA-125) and Carcinoembryonic Antigen (CEA), play a pivotal role in differentiating benign from malignant ovarian tumors and aid in assessing malignancy risk.

The study was hospital-based cross-sectional study conducted at Paropakar Maternity and Women's Hospital among 53 women diagnosed with ovarian tumors scheduled for surgery. Data were collected between July to December 2023. Non-epithelial tumors were excluded after obtaining final histopathology report. Preoperative CA-125 and CEA levels were correlated with epithelial ovarian tumors. Data analysis was performed using Statistical Package for Social Sciences software version 29.

Among 53 cases, 13 (33.30%) cases belonged to 40-49 years age group, while 5 (45.40%) cases of malignant tumors were in the 50-59 years age group. There were 5 (45.50%) cases of malignant tumors in women with parity two, while 11 (28.20%) cases of benign tumors in women with parity two. There were 39 (73.60%) benign cases, 3 (5.65%) borderline, and 11 (20.75%) malignant tumors. There were 36 (67.90%) serous tumors and 15 (28.30%) cases were mucinous tumors. Cancer Antigen-125 (>35 IU/mL) had high sensitivity 90.90%) and specificity (87.20%) for malignancy, while Carcinoembryonic Antigen (>3 ng/mL) had sensitivity 36.40% and high specificity 89.70% for malignancy.

Cancer Antigen-125 showed high sensitivity and specificity in distinguishing malignant from benign epithelial ovarian tumors. Carcinoembryonic Antigen, while less sensitive, provided high specificity.

Progression-free survival (PFS) is widely used as an alternative endpoint for overall survival (OS) due to its ability to shorten clinical trial cycles and reduce interference with subsequent treatments. However, PFS based on tumor measurements is susceptible to evaluation bias, insufficient statistical power, and confounding effects of subsequent treatments, leading to doubts about its clinical value, especially in the field of ovarian cancer where controversy is significant. Although the benefits of PFS may not necessarily translate into extended OS or improved quality of life, it is not advisable to completely negate the clinical value of the drug simply because the secondary endpoint OS did not show significant benefits. This article explains the disconnect between PFS and OS in gynecological tumors, proposes the necessityofoptimizing endpoint selection to reduce statistical bias, and emphasizes the importance of precision medicine as the guide to promote clinical trial design innovation. The aim is to provide a strategic framework for balancing accelerated approval and clinical benefit verification, guiding future research to focus more on the dual improvement of endpoint selection scientificity and patient survival improvement.

Due to its heterogeneous morphology and its rarity, anaplastic lymphoma kinase gene-rearranged renal cell carcinoma (ALK RCC) is a diagnostically challenging entity, often leading to labelling these tumors as RCC, not otherwise classified. This may have clinical and managerial implications, given that patients with ALK oncogene rearrangement may benefit from ALK-inhibitors. Therefore, we attempted to elucidate the clinicopathologic and immunophenotypical characteristics of ALK RCC in a large international cohort. Sixteen multi-institutional tumors were included in the study. Clinical, macroscopic, microscopic, immunohistochemical (IHC), molecular (DNA and RNA sequencing, FISH) and follow-up data were evaluated. There were 9 male and 7 female patients with tumor size ranging from 2 to 12.2 cm (mean=7.1 cm). All tumors had solid, tan-white with focal cystic changes and gelatinous appearance. Cystic changes and necrosis were seen in 7 and 6 tumors, respectively. Microscopically, a heterogeneous growth pattern was observed including solid (12), tubular (7), papillary (5), tubulocystic (2), pleomorphic epithelioid cells (6), sarcomatoid (2), rhabdoid (4), and intranuclear pseudoinclusions. All tumors were ALK-positive, coexpressing PAX8, KRT7, SDH, FH, and variably CD10, Vimentin, and AMACR. Molecular analysis through next-generation sequencing (NGS) was performed on 14/16 tumors. EML4::ALK (n=5) was the most common gene fusion observed; others included TPM1::ALK(n=4), TPM3::ALK(n=2), SLIT1::ALK(n=2)and VCL::ALK(n=1). Despite focal TFE3 immunoreactivity in 4/13 cases, the absence of TFE3 gene rearrangement by molecular analysis excludes TFE3- rearranged RCC as a differential diagnosis. Our study further expands the clinicopathologic, morphologic, and molecular genetic spectrum of ALK-RCC. ALK-RCC can be morphologically heterogeneous and mimic other well-established entities posing a misdiagnosis if appropriate IHC and/or molecular studies are not performed. Accurate diagnosis is of clinical significance as patients with this neoplasm may potentially benefit from ALK-inhibitors, particularly in a metastatic setting. As TFE3 immunoreactivity is not uncommon in ALK-RCC, documentation of ALK gene rearrangement is critical, either by surrogate IHC staining or cytogenetic/molecular analysis is essential.

Purpose To develop and validate a contrast-enhanced CT-based prediction model for identifying occult lymph node metastasis (OLNM) in patients with early-stage non-small cell lung cancer (NSCLC), with the goal of supporting individualized lymph node dissection (LND) strategies. Materials and Methods This retrospective study included patients with preoperative clinical stage I-IIA (cT1-T2bN0M0) solid NSCLC who underwent lobectomy with systematic LND between January 2021 and April 2024. Univariable and multivariable logistic regression analyses were used to identify independent preoperative CT predictors of OLNM and to construct a nomogram. Model performance was assessed using the area under the receiver operating characteristic curve, and specificity was evaluated at a fixed sensitivity of 95%. Results Among 329 patients with solid NSCLC (median age, 65 years; IQR, 58-70 years; 168 male patients), 22.2% (73 of 329) had OLNM, including 47.9% (35 of 73) with N1 and 52.1% (38 of 73) with N2 metastases. Independent predictors of OLNM were a decreased inner margin ratio (odds ratio [OR], 0.02; 95% CI: 0.00, 0.10; P < .001), presence of the lollipop sign (OR, 3.48; 95% CI: 1.87, 6.49; P < .001), and tumor-pleura relationship type II (OR, 6.95; 95% CI: 2.62, 18.44; P < .001) and type III (OR, 13.27; 95% CI: 5.11, 34.45; P < .001). The nomogram achieved an area under the receiver operating characteristic curve of 0.81 (95% CI: 0.76, 0.87), with a sensitivity of 78.1% and specificity of 73.4%; specificity was 39.1% at 95% sensitivity. Conclusion A contrast-enhanced CT-based nomogram incorporating inner margin ratio, lollipop sign, and tumor-pleura relationship enabled effective preoperative risk stratification for OLNM in early-stage solid NSCLC and may aid in tailoring LND strategies. Keywords: Imaging Modality, Lung, Neoplasms-Primary, Thorax Supplemental material is available for this article. © The Author(s) 2026. Published by the Radiological Society of North America under a CC BY 4.0 license.

Routine resection of all RAS-positive nodules may result in overtreatment for up to 50% of patients. We evaluated the management strategy and outcomes of RAS-positive nodules.

Following implementation of reflexive ThyroSPEC^TM molecular testing (MT) for all Bethesda III and IV thyroid nodules in July 2020, we identified patients with isolated RAS mutations between July 30, 2020, and September 30, 2024, using an institutional prospective thyroid nodule database. Patients were categorized by management strategy: surgery versus surveillance. Exclusion criteria included: absence of ultrasound (US) within 12 months prior to MT, incomplete post-MT management data, comutations with RAS, initial lobectomy before MT, concomitant fine-needle aspiration-proven papillary thyroid carcinomas or metastatic lymph nodes, and presence of contralateral high-risk nodules. This study represents a retrospective analysis of institutional registry data from a single health care region.

Among 203 patients with RAS-positive nodules (175 Bethesda III, 28 Bethesda IV), 126 (62%) underwent surgery and 77 (38%) were under surveillance (median follow-up: 24 months, interquartile range 14-37). Final pathology in surgery group revealed malignancy in 43 (34%), with 8 (19%) 2025 American Thyroid Association (ATA) intermediate-high or high risk, 57 (45%) benign lesions, and 26 (21%) neoplasms of uncertain or very low malignant potential. Surgical patients were younger (45 vs. 53 years, p = 0.001) with larger nodules (maximum diameter 2.9 vs. 2.5 cm, volume 6.2 vs. 3.8 cm³, p < 0.05 for both). Bethesda III nodules were more frequently managed with surveillance than surgery (95% vs. 81%, p = 0.010). Nuclear atypia was more frequent in malignant versus benign resected nodules (70% vs. 40%, p = 0.007). Seven patients crossed over to surgery during surveillance due to patient preference, nodule growth, or symptoms; two had malignant pathology (both ATA low-intermediate risk). Nodule stability was evaluated in 48 surveillance patients with at least one post-MT US and minimum 1-year follow-up. Using a threshold of 50%, 3/48 (6%) exhibited growth, with a 2% cumulative incidence of growth at 2 years.

Isolated RAS mutation alone may not uniformly mandate surgery. Active surveillance represents a viable and safe alternative to surgery in appropriately selected patients with RAS-positive nodules, though further long-term data are needed.

Parapharyngeal space (PPS) tumors are uncommon, accounting for 0.5%-1% of head and neck neoplasms. Diagnosis and treatment of parotid pleomorphic adenomas (PPA) extending to the PPS are difficult because the PPA is situated deep in the tissue.

A 49-year-old woman presented with a sore throat, odynophagia, and foreign body sensation in the throat for 6 weeks. Physical examination revealed a bulge in the oropharynx. Imaging revealed a clearly demarcated lesion in the right PPS of the neck. PPA diagnosis was confirmed using fine-needle aspiration cytology. Surgical removal of the tumor was performed via a transcervical transparotid approach with preservation of the facial nerve. Histopathological examination confirmed the diagnosis of pleomorphic adenoma, and the patient's symptoms were alleviated, with no recurrence at 8 months of follow-up.

The clinical onset is typically insidious and is characterized by a gradually enlarging mass in the parotid or upper neck, while oropharyngeal signs, such as dysphagia, snoring, dysphonia, or airway compromise, develop late in the course of the disease when the mass is sufficiently large or manifests as an intraoral bulge in the tonsillar or paratonsillar region.

This case highlights the importance of meticulous diagnosis using radiography and tailored surgical treatment for PPA in PPS. The transcervical transparotid approach enables tumor removal while preserving facial nerve function.

While inflammation is recognized as a key driver of solid tumor progression, the diagnostic and pathophysiological relevance of cellular inflammatory biomarkers in central nervous system (CNS) neoplasms remains incompletely defined.

Clinical and hematological data were analyzed from 44 patients with glioblastoma, 32 with brain metastases, and 33 patients with meningioma who underwent primary surgical treatment between 2024 and 2025. A control group of healthy age-matched volunteers (n = 20) was included for comparison. The diagnostic performance of cellular inflammatory markers was evaluated across tumor entities, with additional stratification according to glucocorticosteroid exposure.

Patients with intracerebral tumors exhibited higher neutrophil and monocyte counts, as well as elevated neutrophil-to-lymphocyte ratio (NLR) and pan-immune inflammation value (PIV), along with a lower lymphocyte-to-monocyte ratio (LMR) compared to both the meningioma group and healthy volunteers (p<0.05). In glioblastoma patients, dexamethasone administration significantly affected neutrophil and monocyte counts, NLR and PIV (p<0.05). In the group with metastatic brain lesions, glucocorticoid therapy led to an increase in neutrophil count and NLR (p<0.05). The LMR level was not influenced by dexamethasone.

For patients with glioblastoma, the LMR serves as a diagnostically significant inflammatory biomarker independent of glucocorticoid administration. In patients with metastatic brain lesions, the most significant diagnostic value was demonstrated by monocyte counts, PIV and LMR.

Lyso-thermosensitive liposomal doxorubicin (LTLD) is a thermosensitive nanomedicine designed to release doxorubicin rapidly at mild hyperthermic temperatures. Unlike systemic doxorubicin, which is limited by cardiotoxicity and poor tumor penetration, LTLD enables targeted drug delivery enhanced by localized hyperthermia through heat-triggered release. While LTLD has demonstrated improved drug delivery with tumor-localized hyperthermia, comparative analyses of intravenous (IV) versus intra-arterial (IA) delivery routes for rectal targeting remain unexplored. This study evaluates doxorubicin pharmacokinetics and rectal tissue accumulation following LTLD administration via IV or IA routes, with or without localized rectal hyperthermia in swine, to identify the optimal delivery strategy for maximizing rectal drug concentrations while minimizing systemic exposure.

Eight healthy swine were assigned to four groups: IV LTLD with or without rectal hyperthermia, IA free doxorubicin with hyperthermia, or IA LTLD with hyperthermia. Animals received 30-min drug infusions (0.7 mg/kg) via the jugular vein or by bilateral selective catheterization of the internal iliac arteries. Serial blood samples were collected for 1 hour, followed by post-mortem tissue collection from the rectal wall, heart, and perirectal fat. A custom rectal heating device produced homogeneous localized hyperthermia.

IV and IA LTLD combined with localized hyperthermia markedly increased doxorubicin accumulation (µg/g) in rectal tissue (7.45 ± 6.18, 8.41 ± 5.15, respectively) compared with normothermic IV LTLD (0.49 ± 0.16) or hyperthermic IA free-drug controls (0.67 ± 0.46). Plasma AUC_0-60min (µg/mL·min) was lowest with IA administration of free drug (12.7 ± 8.36) compared to IV LTLD with and without hyperthermia (424 ± 85.6, 544 ± 148, respectively) and IA LTLD with hyperthermia (305 ± 221). Doxorubicin concentrations in the heart did not differ among treatment groups. Fluorescence microscopy confirmed enhanced doxorubicin distribution within the rectal wall when LTLD was delivered via either route and combined with rectal hyperthermia.

Intravenous and intra-arterial LTLD combined with localized rectal hyperthermia produced similar increases in rectal doxorubicin concentrations in a swine model. These findings support the feasibility of integrating thermosensitive liposomal drug delivery with localized rectal hyperthermia and intra-arterial catheter-based delivery.