Predicting early recurrence after hydrostatic reduction of pediatric intussusception: A nomogram and a simplified clinical score.

Robotic retroperitoneal lymph node dissection (R-RPLND) is increasingly recognized as a treatment option for testicular cancer. This study reports contemporary perioperative outcomes from a single institution and examines national trends in R-RPLND adoption. We retrospectively reviewed patients who underwent R-RPLND at our institution between December 2022 and November 2024. Clinical and perioperative metrics were collected and analyzed using univariable statistical tests. National trends in R-RPLND utilization were assessed using data from the National Cancer Database from 2012 to 2021. Multivariable logistic regression was performed to evaluate factors associated with the use of R-RPLND. At our institution, 31 men underwent R-RPLND. The average length of stay was 1.4 days, and the average estimated blood loss was 60.3 mL. The 30-day complication rate was 3.2%, representing one case of chylous ascites. Nationally, R-RPLND utilization increased from 2.5% in 2012 to 8.3% in 2021. Patients with stages II and III disease were less likely to receive robotic surgery compared to those with stage I disease (odds ratio [OR]: 0.383, 95% confidence interval [CI]: 0.167-0.880, p = 0.024 for stage II; OR: 0.231, 95% CI: 0.098-0.545, p = 0.001 for stage III). No 90-day mortality rate was observed in either cohort. R-RPLND demonstrates favorable perioperative outcomes at both institutional and national levels, with increasing utilization over the past decade. The minimally invasive approach may reduce the morbidity of open surgery and serve as an alternative to chemoradiation in early-stage testicular cancer in selected patients. Further studies are needed to evaluate long-term oncologic outcomes and cost-effectiveness.

Gastric cancer (GC) with peritoneal metastasis frequently leads to malignant ascites (MA), a highly immunosuppressive "liquid tumor microenvironment" associated with poor prognosis. Although immune checkpoint blockade (ICB) demonstrate efficacy in some GC patients, treatment response to gastric cancer-associated peritoneal metastasis (GCPM) remains heterogeneous. The immune mechanisms driving this variability and predictive biomarkers remain unclear. We performed single-cell transcriptomics and TCR/BCR repertoire analyses on paired MA and peripheral blood mononuclear cell (PBMC) samples from 10 advanced GC patients. Cellular clustering, trajectory inference, and intercellular communication analyses characterized immune remodeling. Clinical cohorts were used to validate prognostic and therapeutic predictive significance. Immune landscape of GCMA was delineated, which unveils extensive remodeling of T cells, B cells, and myeloid lineages. Notably, we identified a novel epithelial-immune dual-phenotype cell (EIDPC) population, validated by single-cell RNA sequencing and flow cytometry, exhibiting moderate malignant characteristics and potent immunoregulatory capacity. Transcriptomic and trajectory analyses suggest an epithelial origin with reprogramming toward immune evasion. Based on 10 EIDPC core genes, we developed the immune response signature of EIDPC (IRS-EIDPC), which accurately predicts anti-PD-1 therapy response and prognosis in independent gastric cancer cohort (AUC 0.929). This study reveals the immune landscape of malignant ascites in gastric cancer, and confirms EIDPC as a transitional malignant subpopulation with potent immunomodulatory functions. The IRS-EIDPC signature may aid in predicting immunotherapy responses and survival outcomes, provides insights into immune plasticity in malignant gastric ascites, and may help inform future precision therapeutic strategies.

Most advanced ovarian cancer patients develop malignant ascites, which describes a buildup of fluid in the peritoneal cavity caused by increased vascular permeability and obstructed lymphatic drainage. Malignant ascites contains cancer cells, which can aggregate as spheroids, as well as stromal cells, cancer-associated fibroblasts, and blood cells that create a complex tumor microenvironment. This study explores the proteome of ascites and how this environment affects the viability, phenotypes, proteomes, and treatment responses of ovarian cancer cells. Using label-free proteomics, we compared the proteomes of cell-free malignant ascites from ovarian cancer patients with those of serum. Additionally, we examined the ex vivo chemotherapy responses of cancer spheroids cultured in ascites. Through detailed proteomic analysis of cells grown as 2D or 3D in tissue culture medium or ascites, we identified biological pathways and specific proteins induced by ascites. Finally, we performed orthogonal validation of a candidate marker, TGM2, using immunofluorescent staining. Proteomics of cell-free ascites identified increased levels of extracellular, secreted, and membrane proteins when compared to serum. Ascites enhanced the baseline cell viability and spheroid formation of immortalized ovarian cancer cell lines compared to standard cell culture medium. However, chemotherapy-induced cell death of spheroids grown in standard cell culture medium remained proportional to changes observed in ascites-cultured spheroids. Ascites-driven phenotypic changes were not recapitulated by adding selected chemokines nor periostin to the cell culture medium, suggesting that additional factors are required. Notably, ascites induced similar ECM, secreted, and membrane proteins across 2D and 3D models, including TGM2, which was validated in spheroids through immunofluorescent staining. This study contributes to our understanding of the role of ascites in the regulation of the proteome and viability of cancer cells. It provides evidence for the induction of TGM2 expression by ascites. Results from this pilot study warrant further study in a larger cohort.

Deep learning of pretreatment ascites cytopathology for platinum-resistance risk stratification in advanced epithelial ovarian cancer.

Intussusception is the telescoping of one bowel segment into another, causing obstruction and ischemia. It is uncommon in adults and is most often associated with an underlying neoplasm. Colonic involvement is less frequent, and arteriovenous malformations (AVMs) represent an unusual etiology, with no previously reported fatal rectosigmoid cases to our knowledge. We describe the case of a 41-year-old man with a medical history of tuberculosis and gastrointestinal disease who suddenly developed severe abdominal pain at home. His condition rapidly deteriorated, and he was transported to the emergency department, where he arrived in cardiac arrest. External examination revealed no signs of trauma. Autopsy showed bilateral pleural effusion and markedly emphysematous lungs. Abdominal examination revealed peritoneal effusion, diffuse bowel wall thickening, and hemorrhagic intraluminal content. A colo-recto-sigmoid intussusception causing near-complete obstruction was identified, with a firm intraluminal mass acting as the lead point. Histopathologic analysis demonstrated a vascular lesion composed of arteries, veins, and capillaries associated with neural hyperplasia, favoring a vascular malformation with AVM-like features. No malignancy was found. This case describes a fatal rectosigmoid intussusception associated with a colonic vascular lesion showing AVM-like features and underscores the importance of considering vascular lesions as potential lead points in adult intussusception.

Micellar curcumol reprograms tumor-associated macrophages and reverses PARP inhibitor resistance in recurrent ovarian cancer.

The emergence of COVID-19 and the resulting disease necessitated significant changes to the healthcare system. The effect of hospital-acquired infection on the healthcare system and patients is significant and continues to grow. Antimicrobial resistance is particularly concerning in intensive care units (ICUs), where options for empiric therapy are limited. The misuse of antibiotics and reduced surveillance for antibioticresistant species may contribute to resistance. This study was designed to assess antibiotic resistance patterns and hospital-acquired infections among COVID-19 patients. A total of 31 culture and sensitivity reports from COVID-19-positive patients who were admitted to the hospital were obtained. The Burkholderia cepacia was the most frequently detected pathogen in blood samples, followed by Acinetobacter baumannii and Klebsiella pneumoniae. Others included Pseudomonas species and Escherichia coli in urine and ascitic fluid. Antibiotic sensitivity patterns indicated that Polymyxin B is effective against multiple organisms, while B. cepacia responds to Levofloxacin, Chloramphenicol, Cotrimoxazole, Meropenem, Minocycline, and Ceftazidime. E. coli in urine samples is sensitive to Fosfomycin, Amikacin, and Nitrofurantoin. An A. baumannii strain in blood is resistant to all tested antibiotics, indicating multidrug-resistance. K. pneumoniae demonstrated limited susceptibility, primarily to Polymyxin B and fourth-generation Cefepime. The frequent isolation of B. cepacia in blood suggests further investigation. The reliance on Polymyxin B in multiple cases indicates extensive drug-resistant infections, emphasizing the need for robust antibiotic stewardship. This study identifies B. cepacia, A. baumannii, and K. pneumoniae as the top three organisms in culture, while the most effective antibiotics against multidrug-resistant organisms are Polymyxin B, Levofloxacin, and Ceftazidime.

We describe a case of refractory chylous ascites (RCA) successfully managed with a Denver shunt (DS) after conversion surgery for unresectable locally advanced pancreatic cancer. A 55-year-old woman developed RCA 6 months after distal pancreatectomy with celiac axis and portal vein resection. Conservative therapy, lymphangiography, and repeated paracentesis were ineffective. After confirming negative cytology, culture, and endotoxin tests, DS placement on postoperative day 425 resulted in rapid resolution of ascites, accompanied by improvement in body weight and hypoalbuminemia. No early major complications were observed after DS placement, and she was discharged safely. Although the shunt was removed 29 months later because of internal jugular vein thrombosis, no reaccumulation of ascites was observed thereafter. The patient remains alive without reaccumulation of ascites or tumor recurrence 60 months after curative resection. Although careful patient selection is essential because of potential complications, DS may serve as an effective salvage option for postoperative RCA when conservative approaches fail.

Concentration of calprotectin in ascitic fluid has been proposed as the possible diagnostic marker for spontaneous bacterial peritonitis. This study aimed to choose the optimal preanalytical conditions for the determination of the concentration of calprotectin in ascitic fluid. Study was performed using 20 samples of ascitic fluid of inflammatory etiology. Number of total nucleated (TNC) and polymorphonuclear cells (PMN) were determined on Advia 2120i (Siemens Healthineers). Ascitic samples were collected into three tube types (K2EDTA, tubes with clot activator and Li-heparin tubes) and centrifuged under three different conditions (400xg, 1500xg and 3000xg 15 minutes). Concentration of calprotectin was determined using Bühlmann's turbidimetric assay and potassium and lactate dehydrogenase using standard laboratory methods on Atellica Solution (Siemens Healthineers). Data was evaluated by Friedman test and Spearman's correlation coefficient. The highest concentration of calprotectin was observed in red tubes with clot activator (centrifuged 1500xg 15 minutes; median 0.349 mg/L, IQR 0.094-1.129 mg/L) and the lowest in lavender tubes (centrifuged 3000xg 15 minutes; median 0.109 mg/L, IQR: 0.037-0.850 mg/L). Friedman test showed statistically significant difference between concentration of calprotectin in different preanalytical conditions (P < 0.001). According to the desirable biological variation criteria, differences in calprotectin concentration were clinically significantly different for different preanalytical conditions. To determine the concentration of calprotectin in ascites, we suggest using a test tube with a red cap and centrifugation conditions of 1500xg 15 minutes which is consistent with the relevant national and international guidelines.

Sirolimus is the standard disease-modifying therapy for lymphangioleiomyomatosis (LAM), but long-term routine-care data integrating pulmonary, lymphatic, extrapulmonary, and biomarker outcomes remain limited. To assess long-term effectiveness and safety of sirolimus in routine clinical practice. We retrospectively analyzed consecutive adults with definite LAM treated with sirolimus at a national tertiary referral center in Poland between 2010 and 2020. Seventy-one patients were included (70 women; 57/71 [80%] with sporadic LAM and 14/71 [20%] with TSC-associated disease). The median duration of available functional follow-up was 5.0 years [IQR, 2.0-5.0], and mean trough sirolimus concentration was 7.85 (2.36) ng/mL. Baseline chylous pleural and/or peritoneal effusions were present in 15/71 (21%), renal angiomyolipomas in 33/71 (46%), and lymphangioleiomyomas in 28/71 (39%) patients. FEV1 increased at 12 months by a median Δ of 0.03 L [IQR, -0.10 to 0.30] from baseline (n=66; P=0.03). FVC and 6-minute walk distance also improved during early follow-up, while TLCO remained generally stable. Chylous effusions resolved in all affected patients by 12 months without recurrence, and renal angiomyolipoma and lymphangioleiomyoma volumes decreased significantly in patients with paired MRI measurements. Higher baseline VEGF-D was associated with lymphatic involvement, and VEGF-D decreased during treatment. Adverse events were mostly mild; permanent discontinuation occurred in approximately 6%. In routine practice, sirolimus was associated with long-term stabilization of lung function, marked improvement of lymphatic disease, reduction of angiomyolipoma burden, and acceptable tolerability. VEGF-D aligned with lymphatic phenotype and declined with treatment, supporting its role as a monitoring biomarker.

Introduction Additional immunocytochemical staining is frequently required in routine cytodiagnosis to refine presumptive diagnoses. However, optimal conditions for preserving antigenicity in cytological specimens over time remain unclear. This study evaluated the effects of preparation method, storage temperature, and storage duration on antigen preservation in clinical cytology specimens and cultured malignant tumor cells. Methods Residual sediments from 12 pleural or ascitic fluid cytology specimens were fixed in BD CytoRich Red for 1 h and processed using the SurePath liquid-based cytology method. Immunocytochemical staining performed immediately after preparation served as the baseline control. Specimens were stored as glass smears or in preservative fluid at 4 °C or -20 °C for 1 week, 1 month, or 3 months. Ki-67 and calretinin were used as primary antibodies. To reflect routine cytology practice, Papanicolaou-stained preparations were also included. Cultured malignant tumor cell lines (TCC-Meso-1, MCF-7, and KATO III) were prepared as Papanicolaou-stained, coverslipped slides and stored at room temperature. Results In clinical glass smears, neither Ki-67 nor calretinin showed a significant decline compared with baseline across storage conditions. In preservative fluid, Ki-67 positivity differed from glass smears and was associated with storage temperature; 4 °C storage resulted in significant reductions from 1 week onward. At -20 °C, reductions were limited, although selected short-term comparisons with baseline reached statistical significance. In clinical Papanicolaou-stained preparations, Ki-67 showed a significant time-dependent decrease evident at 3 months, with a similar pattern observed for calretinin. In FDR-adjusted comparisons with the non-stored baseline, Pap-stained samples exhibited the greatest reductions in rate ratios, whereas most cooled non-Pap preparations retained relatively preserved immunopositivity. In cultured Pap-stained cell preparations, Ki-67 reductions were modest and tumor type-related, with no decrease observed in TCC-Meso-1 cells. Conclusion Fixation followed by glass smear preparation and low-temperature storage (4 °C or -20 °C) allows relatively stable preservation of Ki-67 and calretinin immunoreactivity. Storage at -20 °C may be preferable when longer preservation periods are required. In contrast, delayed immunocytochemical staining of Papanicolaou-stained specimens may result in tumor type-related variability in Ki-67 immunoreactivity and therefore should be interpreted with caution.

Gastric cancer peritoneal metastasis is not simply an extension of the primary tumor into the abdominal cavity. It represents a biologically distinct disease context shaped by interactions between disseminated tumor cells, peritoneal fluid, mesothelial surfaces, submesothelial stroma, extracellular matrix, immune populations, and malignant ascites. In this narrative review, we examine peritoneal metastasis as a transition between three related but physiologically different states: the primary gastric tumor, free-floating tumor cells or spheroids in the peritoneal fluid, and established mesothelial or submesothelial metastatic implants. We discuss how tumor cells acquire dissemination competence in the primary tumor, survive detachment and fluid-phase stress, adhere to remodeled mesothelium, recruit stromal and immune support, and adapt to ascites-mediated signaling. We also review how the peritoneal niche may contribute to biomarker discordance, immune exclusion, therapeutic resistance, and limitations of conventional response assessment. Where relevant, we distinguish evidence derived directly from gastric cancer peritoneal metastasis from preclinical data, extrapolation from other peritoneal malignancies, and hypothesis-generating interpretation. Finally, we summarize practical implications for tissue sampling, ascites and lavage analysis, biomarker interpretation, translational modeling, and peritoneal-directed therapeutic strategies. A clearer understanding of the biological divergence between the primary tumor, the fluid-phase compartment, and peritoneal implants may improve the study and clinical management of gastric cancer peritoneal metastasis.

This study reports an exceptionally rare clinical encounter of synchronous multiple primary cancers involving high-grade serous ovarian carcinoma (HGSOC) and well-differentiated appendiceal mucinous adenocarcinoma in a 73-year-old woman. Presenting with abdominal distension and complex abdominopelvic masses, the patient's ascitic fluid revealed 2 morphologically distinct malignant cell populations. Following cytoreductive surgery, histopathological and immunohistochemical (IHC) analyses confirmed a dual-origin malignancy: ovarian lesions exhibited PAX8, WT1, and mutant-pattern TP53 expression, while the appendiceal lesion demonstrated strong keratin 20 positivity. Crucially, targeted gene sequencing validated these findings by identifying mutually exclusive mutational profiles-the HGSOC harbored a TP53 c.549del mutation, whereas the well-differentiated appendiceal mucinous adenocarcinoma carried KRAS p.G12D, GNAS p.R201C, and ATR p.R1951* mutations. Beyond simple coexistence, this patient had extensive cross-metastasis and tumor-to-tumor metastasis within both primary sites and metastatic deposits, likely facilitated by mucinous ascitic dissemination and lymphovascular invasion. Such diagnostic complexity necessitates a multidimensional approach integrating histomorphology, IHC, and molecular profiling to prevent misdiagnosis. Our findings emphasize that when imaging or cytology suggests multiorigin components, clinicians should pursue thorough intraoperative exploration, multisite biopsies, and prophylactic appendectomy. Ultimately, the management of such patients requires highly individualized surgical and chemotherapeutic strategies that account for the divergent biological behaviors and therapeutic sensitivities of both HGSOC and well-differentiated appendiceal mucinous adenocarcinoma to optimize oncological outcomes.

Background: Epithelial ovarian cancer (EOC) is characterized by aggressive peritoneal dissemination and an immunosuppressive tumor microenvironment in which tumor-associated macrophages (TAMs) play a central role. Chemokine signaling pathways regulate macrophage recruitment and function; however, the contribution of the CX3CL1-CX3CR1 axis to ovarian cancer progression and TAM-mediated effector mechanisms remains unclarified. This study aimed to clarify the role of CX3CL1-CX3CR1 signaling in ovarian cancer progression, focusing on macrophage-derived pro-tumorigenic factors. Methods: CX3CL1 and CX3CR1 expression was examined in human EOC and healthy ovarian tissues by real-time polymerase chain reaction and immunohistochemistry. Functional effects of CX3CL1 on ovarian cancer cells were evaluated via migration and proliferation assays in the murine ID8 cell line. An intraperitoneal syngeneic ovarian cancer model was established by injecting ID8 cells into wild-type and Cx3cr1-deficient mice. Tumor burden, ascites formation, survival, macrophage infiltration, and expression levels of matrix metalloprotease-2 (MMP-2) and transforming growth factor-β (TGF-β) were assessed by histological, immunohistochemical, and molecular analyses. Results: CX3CL1 and CX3CR1 expression was significantly upregulated in human EOC tissues and associated with marked macrophage infiltration. CX3CL1 stimulation enhanced migration, but not proliferation, of ID8 cells. Cx3cr1 deficiency significantly suppressed intraperitoneal tumor growth, reduced ascitic fluid volume, and prolonged survival. This was accompanied by reduced CX3CR1+ TAM accumulation and decreased MMP-2 and TGF-β expression, which were predominantly produced by infiltrating macrophages. Conclusions: The CX3CL1-CX3CR1 axis promotes ovarian cancer progression by recruiting MMP-2- and TGF-β-producing macrophages. Targeting CX3CR1-dependent TAM functions may represent a therapeutic strategy for limiting peritoneal dissemination in ovarian cancer.

ABSTRACTThis case describes a child with T‐cell acute lymphoblastic leukemia (T‐ALL) presenting atypically with ascites and bilateral pedal edema, initially suggesting autoimmune hepatitis. The diagnosis was established only after flow cytometry of ascitic fluid. It underscores that pediatric malignancies may present atypically and highlights the importance of a broad, flexible diagnostic approach to avoid delays in life‐saving treatment.

Patients with ovarian cancer often present with massive ascites, leading to significant protein loss during surgical procedures. Although cell-free concentrated ascites reinfusion therapy (CART) is used in palliative settings to mitigate protein loss, its application in intraoperative settings remains unexplored. We retrospectively evaluated patients who underwent intraoperative CART for ovarian cancer treatment between March 2022 and 2025, compared two ascitic fluid collection methods (syringe and roller pumping), and analyzed operative parameter, fluid collection efficiency, albumin recovery, and adverse event-related data. Among the 12 patients included in this study, seven (58.3%) underwent CART using the roller pumping method, which significantly reduced the collection time compared with the syringe method (9 vs. 22 min, p < 0.05). The median collection speed was also significantly higher with the roller pumping method (404 vs. 140 mL/min, p < 0.05). Approximately 70% of the albumin in the collected ascitic fluid was successfully reinfused. Adverse events included transient hypotension (16.7%) and hypertension (25.0%), both of which resolved without intervention. Intraoperative CART is a feasible and safe technique for protein loss management in patients undergoing surgery for ovarian cancer. The roller pumping method significantly shortened ascites collection time and reduced surgical burden.

ACR Appropriateness Criteria® Management of Chylothorax.

The study of proteins and N-glycosylation in human body fluids (HBFs) is crucial for understanding both physiological and pathological states, providing valuable insights for disease diagnostics and monitoring. However, systematic and comprehensive research on HBF (glyco)proteomics based on standardized sample processing and mass spectrometry (MS) analysis workflows remains scarce. As a result, it is hard to make parallel comparisons between different HBFs. In this study, we present a (glyco)proteomics dataset (GlycoHBF) featuring 15 types of precious HBFs (plasma (P), urine (U), cerebrospinal fluid (CSF), pleural fluid (PF), ascitic fluid (AF), synovial fluid (SF), pericardial fluid (PCF), peritoneal dialysis effluent (PDE), bile (B), gastric juice (GJ), seminal plasma (SP), saliva (SA), pancreatic juice (PJ), sweat (SW), and tear (T)). We also provide detailed, standardized, and clinically applicable protocols for HBF-specific protein processing in cohort studies. The resulting peptides and enriched intact N-glycopeptides (IGPs) were analyzed via liquid chromatography-tandem mass spectrometry (LC-MS/MS) in data independent acquisition (DIA) mode and combined electron transfer/higher-energy collisional dissociation and stepped collision energy/higher-energy collisional dissociation (EThcD-sceHCD) mode, respectively. Our results demonstrate that hundreds of proteins and IGPs can be quantified in a single LC-MS/MS run, while significant heterogeneity exists in different HBFs. This study establishes a standardized analytical workflow for (glyco)proteomics studies of diverse HBFs and offers a reference framework for identifying potential disease biomarkers in clinical cohort studies.

Malignant serous effusions (MSEs), including pleural, pericardial, and peritoneal effusions, are common in advanced lung adenocarcinoma (LUAD). However, integrated clinicopathologic, molecular, treatment, and outcome data across effusion sites remain incompletely defined. This study retrospectively analyzed 120 cytology-confirmed LUAD-associated MSE cases from a single academic center by integrating gross fluid features, cytopathology, immunohistochemistry, targeted next-generation sequencing (NGS), systemic therapy, and clinical outcomes, including survival from first malignant effusion (SME) and overall survival (OS). Effusions were pleural (85 of 120; 70.8%), pericardial (28 of 120; 23.3%), and peritoneal (7 of 120; 5.8%). Median SME was 3.8 months, and was shortest in the small peritoneal effusion subgroup (1.0 months). OS differed by site, with pericardial involvement showing the shortest OS (6.1 months). Thyroid transcription factor 1 (TTF-1) was positive in 72.5% of cases. Programmed death ligand 1 (PD-L1) testing (n=85) showed a tumor proportion score (TPS) of ≥1% in 80% of cases and TPS of ≥50% in 36.5% of cases. Molecular profiling was completed in 111 of 120 cases (92.5%) by identifying TP53 mutations in 47 of 111 (42.3%) and actionable driver alterations in 42.3% of cases, most commonly involving EGFR, KRAS, BRAF, ALK, and ROS1. TTF-1 positivity was associated with higher rates of actionable driver alterations and higher PD-L1 expression. PD-L1 negativity, TTF-1 negativity, and an absence of actionable driver alterations were associated with shorter SME and OS. Dual TTF-1/PD-L1 negativity defined the poorest risk subgroup (median SME, 1.2 months; median OS, 1.4 months). Multivariable analysis confirmed that TTF-1 negativity and a lack of actionable drivers remained independently adverse. Among treated patients, immunotherapy-based regimens were associated with the longest SME (6.7 months), whereas tyrosine kinase inhibitor-based therapy was associated with the longest OS (26.0 months). Integration of cytology, immunophenotype, genomics, and treatment delineates distinct prognostic subsets in LUAD with MSE. The absence of actionable driver alterations and TTF-1 negativity remains an independent adverse prognostic factor, with dual TTF-1/PD-L1-negative MSE showing particularly poor SME and OS.