ABSTRACTWith the improvement of survival in multiple myeloma (MM), therapy‐related acute myeloid leukemia (t‐AML) has emerged as a clinically relevant second primary malignancy (SPM). We report a case of MM evolving into t‐AML after multi‐agent chemotherapy and review the literature on therapy‐related leukemias in MM. We report a case of a patient diagnosed with primary plasma cell leukemia (IgG‐λ type, R‐ISS stage III) who achieved complete remission following maintenance therapy with daratumumab, lenalidomide, and dexamethasone after receiving a treatment regimen based on proteasome inhibitors. The patient progressed to therapy‐related acute myeloid leukemia 18 months later, and we present the clinical features. Additionally, we conducted a literature review. Given the patient's age and debilitated physical condition, treatment with azacitidine combined with venetoclax was administered. Following the treatment, the patient developed grade IV post‐chemotherapy myelosuppression complicated by infection and extensive ischemic stroke. Despite aggressive supportive care, the patient's condition continued to deteriorate and he succumbed in August 2025. This case illustrates the leukemogenic risk of cytotoxic exposure in MM, highlights the adverse genetic profile of therapy‐related AML, and emphasizes the need for vigilant monitoring and preventive strategies in long‐term MM survivors.

ABSTRACTRetrograde recanalization of chronic total occlusion can be challenging for its association with a greater risk of device entrapment and fracture. Aggressive advancement of retrograde guidewire through tortuous collateral may increase the risk of guidewire fracture. Stent jailing technique can sometimes be adopted based on the location, length, and morphology of the fractured guidewire when the patient was clinically stable and percutaneous attempts failed to retrieve. Intravascular ultrasound plays a critical role in assessing the length of the retained guidewire and guiding the final stenting to jail the wire filament into the vessel wall.

ABSTRACTRasmussen's encephalitis (RE) is a rare, chronic inflammatory neurological disorder affecting one cerebral hemisphere and presenting with drug‐resistant epilepsy, progressive hemiparesis, and cognitive decline. This case report describes the clinical course and management of a 21‐year‐old patient with refractory epilepsy and progressive neurological deterioration due to RE, followed over 12 years. The patient initially presented with persistent focal seizures characterized by automotor features, visual hallucinations, and postictal confusion, along with progressive right hemispheric atrophy and metabolic disturbances, including hypokalemia and bicarbonate deficits. Diagnosis was established through neuroimaging, revealing significant right hemispheric atrophy and EEG findings of frequent multifocal discharges. Management included immunomodulatory therapies, surgical intervention (right temporal lobectomy), and antiseizure medications. Despite partial seizure control, disease progression could not be arrested.

ABSTRACTIatrogenic retained foreign bodies can occur even after minimally invasive procedures like liposuction or dental interventions. Persistent or unexplained cutaneous symptoms should raise clinical suspicion. Early imaging and prompt removal are crucial to prevent complications and ensure patient safety.

ABSTRACTPapillary tumor of the pineal region (PTPR) is a rare central nervous system neoplasm with an unpredictable clinical course. Gross total resection, the preferred treatment, is often unachievable due to the tumor's deep‐seated location, necessitating alternative therapies. We report the case of a 24‐year‐old male with recurrent grade 3 PTPR. Initial subtotal resection followed by adjuvant volumetric modulated arc therapy (50.4 Gy in 28 fractions) failed to control tumor progression. After a second subtotal resection for recurrence, the patient underwent fractionated stereotactic radiotherapy (fSRT) using Gamma Knife Icon, delivering a total dose of 28 Gy in eight fractions. One year post‐fSRT, significant tumor shrinkage was observed, and the patient maintained clinical stability. This case highlights fSRT's potential as an effective salvage treatment for recurrent PTPR, particularly in anatomically challenging regions where gross total resection is not feasible. To our knowledge, this is the first report detailing the successful use of fractionated Gamma Knife radiosurgery for a large, recurrent primary PTPR refractory to previous multimodal treatment, suggesting a valuable therapeutic option for this challenging condition.

ABSTRACTMerkel cell carcinoma is an aggressive form of cancer with poor prognosis, particularly for individuals deemed unsuitable for surgical resection. With new immunotherapy agents being used alone or as an adjuvant treatment, improving long term outcomes are being seen, even for those deemed to be treated with palliative intent.

ABSTRACTMelatonin is a neurohormone that primarily regulates sleep patterns and circadian rhythms by interacting with melatonin receptors MT1 and MT2. Disruptions in circadian rhythms may contribute to mood disorders; for example, individuals with major depressive disorder often have significantly lower melatonin levels compared to healthy individuals. In this report, we present a patient who experienced a depressed mood and nighttime sleep disturbances and was treated with melatonin. In patients with depression, factors such as insomnia or poor psychosocial conditions can increase the risk of suicidal thoughts.

ABSTRACTTriplet births, particularly those achieved by assisted reproductive technologies, entail markedly elevated maternal and fetal risks, including hypertensive diseases. Intracerebral hemorrhage is an uncommon but devastating complication during the postpartum period. The main aim of our work is to throw light on the association of intracerebral hemorrhage in pregnancy with severe consequences. We presented and compared similar cases. We present a rare case of a 34‐year‐old lady who was pregnant with triplets conceived by in vitro fertilization. She had a significant intracerebral hemorrhage 2 h post elective lower‐segment cesarean section. Her blood pressure was normal during prenatal and perioperative periods. A postoperative hypertensive emergency (200/110 mmHg) resulted in neurological decline and seizure, necessitating urgent airway protection and neuroimaging. The MRI indicated a substantial intracerebral hemorrhage with intraventricular and subarachnoid extension. Neurosurgical procedures included external ventricular drainage and decompressive craniectomy. The patient exhibited modest neurological improvement throughout neurocritical care. This case shows that women who have triplets are at a greater risk of experiencing a serious increase in blood pressure after giving birth, even if they had normal blood pressure before. High‐risk factors like advanced maternal age and the use of assisted reproductive technologies further increase the risk of triplet pregnancy. Our case highlights the importance of frequent blood pressure monitoring postpartum. Immediate neurological consultation and, if necessary, intervention followed by intensive neurocritical care are central to management for better outcomes for the patient. All healthcare teams need to be alert for possible complications from pregnancy, like intracerebral hemorrhage, especially in high‐risk groups such as older patients with multiple pregnancies or those who have used assisted reproductive techniques.

ABSTRACTGastric MANEC (gMANEC) is a rare tumor composed of at least 30% each adenocarcinoma and neuroendocrine carcinoma (NEC) components. A 52‐year‐old male underwent total D2 gastrectomy for gastric cancer. Final pathology revealed MANEC. We compare outcomes and mortality rates between gastric MANEC and conventional adenocarcinoma. MANEC has poorer disease‐free survival (DFS) and post‐recurrence survival (PRS), and higher risk of distant recurrence, compared with clear adenocarcinoma. Rigorous follow‐up and adjuvant therapy tailored to the more aggressive component are advised.

Postoperative bleeding is a well-known complication of tonsillectomy. Although inadequate hemostasis and vascular injury are common causes, occult coagulation disorders may also contribute. Factor XIII deficiency is an extremely rare condition that is particularly difficult to detect preoperatively because PT and APTT typically remain normal. A 27-year-old man underwent bilateral tonsillectomy for a recurrent peritonsillar abscess. Despite normal coagulation screening, the patient developed repeated postoperative hemorrhages requiring surgical management. Further evaluation revealed reduced Factor XIII activity (36%). After Factor XIII concentrate administration, bleeding ceased, and the postoperative course stabilized. Factor XIII deficiency should be considered in patients with recurrent postoperative bleeding despite normal routine coagulation tests. Early recognition and timely replacement therapy may prevent severe complications.