Immature teratoma (IMT) is an ovarian germ cell tumour with high malignant potential. It is occasionally combined with other ovarian germ cell malignancies, but rarely just with yolk-sac tumour, which exhibits even more aggressive behaviour. We present a case of a young patient who presented with giant, atypical, steady growing tumour comprised of IMT with YST islets. Throughout adolescence the tumour grew to gigantic measures of almost 7, 2 kg, without any symptoms, and secreting no significant quantities of alpha-fetoprotein (AFP), which is the major biomarker for YST. In spite of a huge abdominal tumour, giving her body contour characteristics of a late third trimester pregnancy, the disease was fortunately in FIGO Ia stage, enabling the patient to choose the conservative treatment of fertility sparing surgery alone. The recovery was complete, with defined frequent follow-up sessions. Given that almost all of mixed malignant ovarian germ cell tumours (MOGCTs) are highly chemo-sensitive, potential neo-adjuvant chemotherapy remains an alternative treatment if the signs of recurrence appear. Today’s golden standard in chemotherapy for MOGCTs presents a BEP (bleomycine, etoposide, and cisplatin) regimen. After thorough search of recent literature we present a review of novel insights in aetiology, diagnostics and treatment options for this rare group of cancers.

PurposeTo investigate the effects of targeted modifications to a clinical 4D‐MR pulse sequence on displacement accuracy for abdominal tumor motion tracking, and to compare its performance with established 4D‐MR and 4D‐CT protocols using a motion phantom driven by clinically representative respiratory waveforms.MethodsA commercially available MRI‐compatible motion phantom was used to simulate abdominal tumor motion driven by both sinusoidal and patient‐derived respiratory waveforms. Imaging was performed on a 1.5T MRI scanner using a 3D radial stack‐of‐stars sequence for 4D‐MR imaging and a clinical CT scanner. Four acquisition parameters, slice thickness, acquisition orientation, number of radial views, and number of respiratory bins, were systematically varied. Displacement measurements were performed using line intensity profiles extracted from coronal slices and analyzed based on full‐width‐at‐half‐maximum calculations. Comparisons were made against both ground‐truth programmed displacements and clinical 4D‐CT measurements. Additional displacement measurement comparisons between a coronal 10‐bin 4D‐MR protocol and an axial 5‐bin 4D‐MR and 4D‐CT scans were evaluated on both sinusoidal and patient‐derived respiratory traces. Organ displacement measurements between the MR protocols were compared on compression‐belt patients as a preliminary study of the in vivo comparison.ResultsThe modified 4D‐MR protocol, incorporating ten respiratory bins and coronal acquisition, significantly improved displacement accuracy relative to the clinical axial MR protocol. For sinusoidal waveforms, displacement differences between coronal MR and CT were comparable (p > 0.05), being consistently within 0.5 mm of each other, while axial MR underestimated displacement by more than 1 mm across amplitudes and breathing periods (p < 0.001). Linear mixed‐effects modeling of patient‐derived respiratory waveforms showed that the coronal MR protocol outperformed the axial MR protocol by 1.70 mm for regular and 3.10 mm for irregular patterns (p < 0.001), with no significant differences observed between coronal MR and CT.ConclusionsA modified 4D‐MRI protocol incorporating optimized acquisition parameters demonstrated displacement accuracy equivalent to 4D‐CT in a 1D motion phantom, including under patient‐derived respiratory conditions. These results support the clinical feasibility of 4D‐MR as a radiation‐free alternative for motion‐resolved imaging in select cases, with further validation in multi‐directional motion and in vivo settings recommended.

BackgroundRadiation therapy planning (RTP) for abdominal tumors often requires multiple dose‐volume constraints for each organ at risk (OAR), which vary with different fractionation schemes. This variability can complicate biologically optimized treatment planning.PurposeThis study aims to extract fractionation‐independent dose constraints based on the concept of equivalent uniform dose (EUD), utilizing published clinical data for a range of fractionation regimens. The goal is to derive organ‐specific radiobiological parameters as well as the EUD for each OAR that can be used in biologically optimized treatment planning for abdominal tumors, independent of the specific fractionation scheme applied.MethodsClinical dose‐volume constraints for duodenum, stomach, and small bowel were compiled from available literature sources. These dose constraints were obtained for conventionally fractionated radiotherapy (CFRT), hypofractionated RT, and stereotactic body radiotherapy (SBRT) and were associated with less than a 10% risk of grade 3 toxicity as categorized by CTCAE v.3 or v.4, RTOG, and EORTC. For each OAR, an iso‐EUD fitting with EUD calculated based on the linear‐quadratic (LQ) model or linear‐quadratic‐linear (LQ‐L) model and a dose volume histogram generated from these dose volume constraints for each fractionation was applied to extract model parameters such as α/β ratio and ‘n’ (the volume effect of the OAR). Based on the obtained parameters, the dose constraint in EUD and the equivalent physical dose in 2Gy fraction (EQD2) were calculated.ResultsThe EUD constraints for LQ‐L (LQ) models are 52.62 (55.10) Gy, 48.22 (48.60) Gy, and 46.10 (45.06) Gy, α/β values are 5.42 (5.59) Gy, 7.67 (6.76) Gy, and 12.15 (8.20) Gy, and ‘n’ values are 0.06 (0.01), 0.03 (0.02), and 0.06 (0.08) for duodenum, small bowel, and stomach, respectively. Additional two parameters for the three OARs in LQ‐L are 5.15 Gy, 8.65 Gy, and 5.20 Gy for dt and 5.40, 4.72, and 3.33 for γ/α. The LQ‐L model fits the clinical data better than the LQ model.ConclusionsThe obtained α/β values are comparable with those published previously. The extracted EUD constraints together with the volume effect parameter ‘n’ can be used for plan optimization and evaluation.

Abdominal ectopic bronchogenic cysts (EBCs) are rare congenital malformations that are frequently misdiagnosed preoperatively due to their nonspecific and often asymptomatic presentation. This study aimed to elucidate the clinical characteristics, diagnostic challenges, and optimal management of abdominal EBCs by integrating data from a sizable single-institutional case series with a comprehensive literature review. We conducted a retrospective analysis of 12 patients with pathologically confirmed abdominal bronchogenic cysts who were treated at our institution from January 2015 to January 2024. Data on demographic characteristics, clinical presentation, imaging features, surgical management, and pathological findings were collected. A comprehensive review of the pertinent literature was also performed to identify published case reports and series. Data are presented using descriptive statistics, including medians and proportions. The cohort comprised 12 patients (7 male, 5 female) with a median age of 46years. Eight patients (66.7%) were symptomatic. The most common symptom was epigastric pain, presenting in 7 patients (58.3%). Eleven cysts (91.7%) were located in the upper abdominal retroperitoneum. Eleven patients (91.7%) were misdiagnosed preoperatively. Laparoscopic complete resection was achieved in 9 patients (75%), while 3 patients (25%) underwent open surgery. The diagnosis was histologically confirmed in all cases by the identification of ciliated pseudostratified columnar epithelium. One patient (8.3%) experienced recurrence following initial fenestration and required reoperation. Abdominal bronchogenic cysts present a considerable diagnostic challenge, resulting in a high preoperative misdiagnosis rate. It should be considered in the differential diagnosis of an abdominal cystic neoplasm. Laparoscopic complete resection represents a safe and effective therapeutic approach, yielding favorable outcomes. Complete surgical excision is paramount to prevent recurrence. Surgical intervention is, therefore, recommended to achieve both diagnostic confirmation and definitive therapy.

PurposeChronic Post-Surgical Pain (CPSP) is a common surgical complication, but the association between perioperative complications, patients’ intrinsic mental status, and 3-month CPSP remains unclear in elderly surgical populations. This study thus aims to identify perioperative risk factors for 3-month CPSP in elderly patients after non-cardiac surgery, with CPSP here defined as pain intensity ≥3 on the Numerical Rating Scale at 3-month follow-up.Patients and MethodsThis retrospective study included 367 elderly patients. We first analyzed variables with descriptive statistics, then conducted all subsequent analyses separately for each of the three surgical subgroups, allowing for potential nuances in the contributory patterns of key factors across groups. To predict 3-month CPSP, we used 10 machine learning algorithms. Model performance was assessed via repeated 5-fold cross-validation, and top-performing models were interpreted using SHapley Additive exPlanations (SHAP) to clarify how key factors contribute.ResultsOf 367 patients, the overall prevalence of 3-month CPSP was 25.07%, with significant variation across surgical subgroups: 48.05% in orthopedic surgery, 10.34% in urinary tumor surgery, and 7.14% in abdominal tumor surgery. The Random Forest model showed strong, consistent predictive ability across the three subgroups. Frailty was a key shared risk factor for CPSP across all surgical types, and further analyses identified surgery-specific risk factors.ConclusionThese findings demonstrate that data-driven models can reliably predict CPSP across studied surgical types, with frailty state as a universal risk factor and distinct surgery-specific profiles supporting tailored perioperative risk assessment and prevention strategies.

Laparoscopic assisted percutaneous cryoablation of abdominal wall desmoid tumor: a case report of a novel technical approach

A rare case of biliary adenocarcinoma mimicking an abdominal wall soft tissue tumor.

Baihua Dangen Tang inhibits the peritoneal metastasis of colon cancer by modulating the bacterial metabolite gentisic acid to suppress MDSCs.

Abdominal Wall Tumour Resection and Reconstruction: A 15-year Experience from a Tertiary Sarcoma Centre

Wandering spleen is a very rare disease, which might lead to a misdiagnosis as other abdominal masses. We report a 40-years-old male presenting to our hospital with chronic pain in the lower abdomen. An abdominal computed tomography scan revealed a solid, contrast-enhanced tumor in the hypogastric region with a size of 50x65mm, and the spleen was not seen at the normal anatomical site. The patient was preoperatively diagnosed with a mesenteric gastrointestinal stromal tumor (GIST) and underwent resection surgery. However, postoperative histopathology was benign splenic tissue. Diagnosis of a wandering spleen can be difficult. In this circumstance, the patient was only diagnosed correctly based on postoperative histopathology.

Mantle cell lymphoma is clinically and biologically heterogeneous disease, ranging from the indolent non-nodal leukemic variant to the highly malignant blastoid variant. Despite many recent therapeutic advances, mantle cell lymphoma (MCL) remains a largely incurable disease. The median age at diagnosis of MCL is 60–65 years. MCL usually presents with advanced extra nodal, bone marrow, peripheral blood, spleen, and gastrointestinal involvement. First-line treatment consists of chemoimmunotherapy, which may result in prolonged remission, but relapse should be expected. Sustained long-term remissions are achievable following autologous stem cell transplantation. In this case report, we present a case of MCL in 60-year-old men diagnosed initially presented with an abdominal tumor. The patient underwent autologous stem cell transplantation after achieving first remission.

Postoperative pain management poses unique challenges in older adult patients undergoing laparoscopic abdominal tumor surgery. While morphine remains a standard analgesic option, its use in this population is frequently complicated by adverse effects. Tegileridine represents a potential alternative with distinct pharmacological properties that warrant clinical evaluation. This will be a single-center, randomized, assessor-blinded, active-controlled trial. A total of 66 older adult patients undergoing laparoscopic abdominal tumor surgery will be randomized in a 1:1 ratio to receive either tegileridine (0.1mg bolus) or morphine (1mg bolus) via patient-controlled intravenous analgesia. The primary endpoint is the incidence of moderate-to-severe movement-related pain (NRS ≥ 4) at 24h postoperatively. Secondary assessments include pain at rest, requirement for rescue analgesia, safety outcomes, and recovery parameters. Registered at the Chinese Clinical Trial Registry on October 14, 2025. ChiCTR2500110485.

BACKGROUND Pheochromocytoma is a rare neuroendocrine tumor. Some patients are asymptomatic, and misdiagnosis is common, especially when it lacks typical imaging features. In asymptomatic patients misdiagnosed with pheochromocytoma, hemodynamic instability often occurs during surgical procedures, posing significant challenges to surgeons and anesthesiologists. This case report presents a patient who was misdiagnosed as having a pancreatic cystadenoma prior to surgery, aiming to explore the intraoperative decision-making and considerations for such cases. CASE REPORT A 48-year-old woman with abdominal pain was preoperatively diagnosed with pancreatic cystadenoma by imaging. Laparoscopic surgery was performed following standard procedures, including patient positioning, stomach suspension, tumor search, and tissue dissection. The surgery lasted 156 min, with minimal blood loss (50 mL). Intraoperative hemodynamic instability occurred, and the final histopathological report confirmed the tumor as a pheochromocytoma. The patient was monitored in the intensive care unit (ICU) after surgery and was discharged on the 8th postoperative day, without complications. CONCLUSIONS Clinicians should be aware of the limitations of imaging. When dealing with abdominal tumors lacking typical features, especially those located in the adrenal gland or para-adrenal region, a high suspicion for asymptomatic pheochromocytoma is necessary. In the event of intraoperative hemodynamic instability, a high degree of suspicion for pheochromocytoma is needed. Moreover, it is crucial to strengthen multidisciplinary collaboration and emphasize the optimization of preoperative laboratory tests and examinations to compensate for the limitations of imaging studies. Surgeons need to be prepared for unexpected findings during surgery and adjust the surgical plan according to local anatomy to improve surgical safety and success rates.

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally aggressive cutaneous sarcoma characterized by high recurrence rates and the development of resistance to imatinib. The scarcity of preclinical models hinders research into DFSP pathogenesis and the development of novel therapeutic strategies. In this study, we established and characterized a novel DFSP cell line, designated DFSP-DPH1, derived from a 47-year-old male patient with an abdominal tumor. Comprehensive characterization confirmed that DFSP-DPH1 retains key features of the original tumor, including the fibroblast-like spindle morphology and expression of diagnostic markers CD34 and vimentin, with absence of factor XIIIa. Short tandem repeat profiling confirmed the cell line's origin and excluded cross-contamination. Sanger sequencing revealed a COL1A1 exon 46-PDGFB exon 2 fusion transcript, a breakpoint not previously reported in established DFSP cell lines. Functionally, DFSP-DPH1 exhibits robust proliferative capacity, forms three-dimensional spheroids under anchorage-independent conditions, and demonstrates significant migratory and invasive capabilities. Drug sensitivity screening of a panel of 48 PDGFR inhibitors confirmed its resistance to imatinib and identified several compounds with superior efficacy compared to imatinib. Transcriptomic analysis confirmed the dominance of the COL1A1::PDGFB fusion transcript and revealed enrichment of pathways related to cancer, viral infection, and neuroactive ligand-receptor interaction. This novel imatinib-resistant DFSP cell line, DFSP-DPH1 provides a valuable preclinical model for investigating the molecular mechanisms underlying DFSP pathogenesis, drug resistance, and tumor progression, and for developing and evaluating novel therapeutic strategies.

Objective: The relationship between surgical outcomes and metastatic sites in ovarian cancer (OC) is known, but the role of metastatic site-specific tumor burden remains unclear. Methods: We prospectively analyzed data from 202 OC patients. We developed a preoperative protocol evaluating tumor burden in 30 metastatic sites and created a predictive score for suboptimal cytoreduction, which was externally validated. Results: MRI-assessed tumor burdens demonstrated superior consistency with surgical findings compared to CT (κ = 0.4-1.0). Three site-specific tumor burdens (diaphragmatic spleen surface, hepatorenal recess, mesentery), upper abdominal tumor burden, and two clinical factors were identified as predictors of suboptimal cytoreduction. The predictive score incorporating these factors achieved an AUC of 0.873 (0.815 externally validated), outperforming metastatic site-integrated scores including the simulated Fagotti score (AUC: 0.656) and Suidan score (AUC: 0.8308). R0 resection rates were inversely correlated with predictive scores: 94.87% for scores of 0-3 versus 8.57% for scores >14. The peak of Youden's index reached 11, and patients with predictive scores <11 had longer median progression-free survival. Conclusions: We demonstrated that site-specific tumor burden is correlated with surgical outcomes in OC. Incorporating tumor burden into preoperative assessment enhances prediction performance. We developed a clinically applicable tool, marking a shift from evaluating metastatic sites to assessing metastatic site-specific tumor burden.

Polydopamine/chitosan layer-by-layer coating of Bacillus cereus enhances the robustness of live anti-oxidation materials for the treatment of radiation enteritis

Abdominal reconstruction by sublay reinforcement after radical resection of abdominal desmoid tumors.

Background: Infective endocarditis (IE) due to Gemella species is extremely rare and typically associated with dental disease, mucosal disruption, or valvular pathology. To our knowledge, this is the first reported case of Gemella morbillorum IE involving a transcatheter aortic valve replacement (TAVR) prosthesis. This case underscores the importance of recognizing uncommon pathogens in prosthetic valve endocarditis (PVE), even in the absence of typical infection sources. Case: A 70-year-old man with a remote history of lymphoma (treated with abdominal tumor resection and radiation) and severe aortic stenosis status post-TAVR presented with a 1.2 cm vegetation on the bioprosthetic valve. One month prior, he had Gemella bacteremia, treated with IV vancomycin and oral minocycline. Although clinically improved, repeat transesophageal echocardiography (TEE) revealed a new valve vegetation (Figure 1A). Blood cultures were negative, and he remained afebrile and hemodynamically stable. He denied recent dental work. Maxillofacial CT showed no dental infection. Abdominal imaging revealed a stable soft tissue mass in the posterior mediastinum, consistent with residual changes from his prior lymphoma. His abdominal surgery and radiation likely led to long-term mucosal barrier injury, predisposing to translocation of Gemella, a GI tract commensal. With recent bacteremia, a new valve vegetation, and a prosthetic valve, PVE was diagnosed. He received six weeks of IV vancomycin and ultimately underwent surgical TAVR explant and valve replacement (Figure 1B). Discussion: TAVR-related PVE is rare (0.5–1.5% annually) and typically involves Staphylococcus or Enterococcus. Gemella morbillorum is an exceptionally uncommon cause, with only isolated reports of IE involving surgically implanted valves and none in TAVR recipients. Misidentification as viridans streptococci may delay diagnosis. TAVR imaging is also challenging due to prosthetic shadowing. This case is unique in its presentation of culture-negative TAVR PVE caused by Gemella morbillorum. The patient's prior oncologic treatment likely disrupted mucosal integrity, enabling bacterial translocation. This report highlights the need to consider rare pathogens like Gemella morbillorum in PVE, particularly in patients with prior mucosal compromise or immunosuppression.

Abstract Extragonadal germ cell tumors (EGGCTs) are rare malignancies that arise outside the gonads and occur infrequently in the gastrointestinal tract. Their presentation often mimics that of other abdominal neoplasms, posing diagnostic challenges. Histopathological and immunohistochemical confirmation, along with tumor marker evaluation, is essential for diagnosis. Early diagnosis and platinum-based chemotherapy can significantly improve patient outcomes. A 25-year-old male presented with abdominal pain, a palpable mass in the umbilical region, and subacute intestinal obstruction. Imaging revealed a heterogeneously enhancing lesion in the mesentery and a subcapsular lesion in the left kidney. Emergency debulking surgery was then performed. Histopathology and immunohistochemistry confirmed an EGGCT favoring a yolk sac tumor. Serum marker levels were elevated with AFP (alpha-fetoprotein) of 854 IU/mL, 23 mIU/mL of β-human chorionic gonadotrophin (β-hCG); 277 U/L of LDH. Ultrasonography of the testes revealed microcalcifications in the left testis, without overt malignancy. The patient was diagnosed with a Stage IIIC extragonadal non-seminomatous germ cell tumor. He was started on an EP regimen owing to poor pulmonary function, followed by BEP, and was scheduled for a high inguinal orchidectomy. This case highlights the importance of including EGGCTs in the differential diagnosis of abdominal masses in young males. A multidisciplinary approach with timely histological and oncological assessments is vital. Early intervention with platinum-based chemotherapy offers a favorable prognosis, even in advanced stages. Given the rarity of this presentation, further studies are needed to refine diagnostic and therapeutic strategies.

Clinical and molecular characterization of pure erythroid leukemias and sarcomas driven by nfia::CBFA2T3