Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive cancer and was ranked among the top seven leading causes of cancer-related deaths in South Africa in 2020. Highlighting the urgent need for ongoing research to identify reliable biomarkers to improve clinical outcomes. This study compared the plasma proteomes of patients with PDAC, those with benign biliary pathologies (BBP), and healthy controls (HC). We used Mag-Net, a magnetic-bead-based method that enriches membrane-bound vesicles. Comparative analyses identified distinct and overlapping dysregulated proteins between PDAC, BBP, and HC. PDAC showed enrichment for epithelial-mesenchymal transition, complement activation, hypoxia, glycolysis, and extracellular matrix remodeling pathways, consistent with aggressive tumor biology. Proteins including SPP1, THBS2, PTX3, FBLN2, SDC1, CTSS, and VCAN were significantly increased in PDAC, with LRG1 showing the strongest association with disease severity. Proteins, namely GPNMB, H4C1, SAA1, and CCDC47, demonstrated progressive upregulation across disease comparisons, suggesting potential relevance to disease progression. These findings demonstrate that plasma proteomics provides discriminatory molecular insights and supports the development of population-relevant biomarker panels. While several candidate proteins show promise for inclusion in multianalyte panels, further validation in larger cohorts is necessary to establish their diagnostic and translational utility for early detection, risk stratification, and improved differential diagnosis of PDAC.

Robotic surgery uptake is increasing rapidly, with the anticipation that most laparoscopic procedures will eventually be performed robotically. Multiple benefits have been demonstrated: reduced conversion rates, stoma rates, complications, post-operative pain and length of stay, and improved primary anastomosis rate, oncological outcomes and gastrointestinal recovery. This study aimed to assess the feasibility and outcomes of a full departmental transition to total robotic colorectal practice, in line with the National Health Service robotic surgery strategic vision. This single-centre retrospective cohort study was performed in a UK centre from 2018 to 2024, including the three-year transition period from laparoscopic to total robotic colorectal practice. The primary outcome was conversion rate. Secondary outcomes were post-operative complications, anastomotic leak, stoma rates, resection margins, lymph node harvest, intra-operative blood loss, post-operative pain, return to theatre and length of stay. 1479 operations were analysed: 584 robotic (39.4%), 807 laparoscopic (54.6%) and 88 open (5.9%). 1085 (73.4%) operations were for colorectal cancer, 394 (26.6%) for benign pathologies. All robotic surgery outcomes were non-inferior to laparoscopy. Statistically significant differences were found in conversion rate (2% vs. 12%, p = 0.001), intra-operative blood loss (p = 0.01), length of stay (4 vs. 5 days, p = 0.001), lymph node harvest (21 vs. 20, p = 0.006), R0 resection rates ( 90% vs. 87%, p = 0.0001) and median PCA volume (38 vs. 67 mls, p = 0.001). Full departmental change to total robotic colorectal practice is achievable in both colorectal cancer and benign disease with an improvement upon laparoscopic outcomes.

The modified endoscopic Denker's (MED) approach provides access to all maxillary sinus (MS) walls for resection of various MS and retromaxillary pathologies, but the anteromedial maxilla has historically been resected. This study determined complication rates and outcomes following MED with pyriform aperture (PA) preservation (MEDPAP). A prospective study was conducted on all adults who underwent MEDPAP for different MS or retromaxillary pathologies over 7.5 years. The following complications were collected at all postoperative visits: epiphora, hypesthesia or complete numbness (teeth, upper lip, lateral nasal sidewall, and cheek), crusting, nasal valve collapse (NVC), and empty nose syndrome 6-item questionnaire (ENS6Q). Complications and disease recurrence rates were determined at a minimum 1 year for most complications and outcomes and 2 years for hypesthesia if hypesthesia had not resolved. Of 52 MEDPAP patients, median age was 58.5 years; 55.8% were male. Of 34.6% who experienced epiphora postoperatively, 7.7% persisted. When epiphora resolved, it did so by median 63.0 days. Sites of initial postoperative hypesthesia or numbness included teeth (23%-50%), upper lip (42%), nasal (22%), and cheek (30%). Hypesthesia resolved in 88%-100% of subsites by median 89.5-167.0 days. Hypesthesia persisted in 12% of patients (mainly anterior teeth). Crusting resolved in 97.8% by median 91.0 days. No patients developed NVC, and median final ENS6Q = 0.5 (range = 0-8). Non-tumor disease and tumor recurrence rates were 0%. MEDPAP was 100% successful at managing benign and select malignant MS pathologies during the study period. MEDPAP patients frequently experienced temporary epiphora and dentofacial hypesthesia or numbness that resolved by 2-6 months postoperatively. Epiphora and hypesthesia or numbness persisted in 7.7% and 12% of patients, respectively. No patients developed NVC or ENS.

Optimizing testicular cancer therapy: Survivorship perspectives on reducing late toxicities without compromising outcomes.

Uterine fibroids (UFs) and endometrial polyps (EPs) are common benign gynecological conditions with distinct anatomical origins. However, their molecular impact on endometrial function remains poorly understood. This study aimed to descriptively explore shared and condition‑associated transcriptomic patterns within endometrial tissue by analyzing pathological endometrial tissue (PET) and adjacent macroscopically normal endometrial tissue (NET), sampled from areas without visible lesions in uteri affected by UFs or EPs. Paired PET and NET samples were collected during hysteroscopy from women diagnosed with UFs or EPs, with RNA‑sequencing performed on samples derived from premenopausal and perimenopausal patients. RNA sequencing and differential gene expression analysis were performed using DESeq2, followed by functional enrichment via GO and Reactome databases. Only nine differentially expressed genes (DEGs) were identified when comparing NET samples associated with UFs and EPs. In contrast, comparison of PET samples between UFs and EPs revealed 398 DEGs. Furthermore, PET versus NET comparisons demonstrated a pronounced quantitative difference between conditions, with 3163 DEGs identified in EPs and only 77 DEGs in UFs. EP-associated DEGs were enriched in immune activation, epithelial remodeling, and hormonal signaling pathways, while UF-associated DEGs reflected localized changes in inflammation, oxidative stress, and extracellular matrix remodeling. A small subset of genes (FOSB, DPP4, TM4SF4, DNER, AOX1, and PAEP) was consistently dysregulated across both conditions, suggesting shared transcriptional patterns associated with altered tissue contexts. This exploratory study provides insights into transcriptomic features of endometrial tissue associated with UFs and EPs. The findings highlight both shared and context‑dependent transcriptional patterns and identify candidate genes that warrant further investigation in future, independent studies aimed at elucidating endometrial responses to benign uterine pathology.

Filarial infestation of the nasolacrimal duct is exceptionally rare and often misdiagnosed as benign lacrimal pathology. We present a 12-year-old boy with progressive medial canthal swelling initially suspected to be a dermoid cyst or inflammatory lesion. Magnetic resonance imaging revealed a well-defined enhancing lesion at the nasolacrimal duct with preseptal edema. Histopathology demonstrated a parasite with a thick eosinophilic cuticular wall and inflammatory infiltrate rich in eosinophils and foreign-body giant cells, consistent with filarial infestation, possibly Onchocerca species. Surgical excision followed by antifilarial therapy resulted in complete recovery without recurrence at 3-month follow-up. Heightened clinical awareness in endemic regions is essential to enable timely diagnosis and effective management.

Postchemotherapy orchiectomy in metastatic testicular germ cell tumors: Pathologic findings and predictors of residual viable disease.

Factors Associated With Lack of Pre-Operative Stoma Site Marking Before Ostomy Surgery.

Risk stratification systems (RSSs) have had an increasing role in standardizing thyroid ultrasound reports. The VA Northern California Healthcare System (VA-NCHCS) Radiology department adopted the American College of Radiology Thyroid Imaging Reporting and Data System (TI-RADS) in 2018. We aimed to assess what effect the adoption of TI-RADS at VA-NCHCS had on thyroid surgical practices. A 10-year retrospective review of the VA corporate data warehouse was completed (approximately 5 years prior and 5 years after universal adoption of TI-RADS) (i.e: 1/1/2013-7/1/2018 and 7/2/2018-12/30/2023). Using CPT and diagnosis codes, data were collected on all thyroid surgeries, including demographics, type of surgery performed, final pathology, staging of malignancy, and any incidental findings. A two-sample t-test with equal and unequal variances was used for comparative statistics. 3985 patients (1921 PRE-TIRADS vs. 2064 POST-TIRADS) and 7908 thyroid ultrasounds (3411 vs. 4497) were identified. 2859 FNAs were performed (1245 vs. 1614). One hundred and ninety-three surgeries (96 vs. 97) were performed with a decreasing trend in surgeries for benign pathology (56 vs. 45) and an increasing trend in surgeries for malignancy (39 vs. 51). We identified an increase in partial thyroidectomy surgeries for cancer diagnoses (11 vs. 18). Finally, there was a significant decrease in total thyroidectomies performed for benign pathology (30 vs. 13, p = 0.02). After the institution of TIRADs at our single institution, there was a dramatic increase in the number of ultrasounds and FNAs performed, despite near stable thyroid surgical numbers. There was a significant trend towards less-invasive surgical practices.

Introduction: This study aimed to evaluate the diagnostic yield and surgical morbidity of isolated axillary surgery in non-breast pathologies, specifically comparing the safety profiles of excisional biopsy and axillary dissection.Methods: A retrospective review was conducted on patients who underwent isolated axillary surgery at a secondary-level center between 2018 and 2024. Data on demographics, surgical parameters, and pathology were analyzed. Comparative statistical analyses were performed using Fisher's exact and Mann-Whitney U tests.Results: A total of 42 patients were included (mean age: 58.1±14.4 years). Excisional biopsy was the most common procedure (71.4%), followed by axillary dissection (23.8%). Patients with malignancy were significantly older than those with benign pathologies (65.3 vs. 54.9 years; p=0.026). While the overall morbidity was 16.7%, a significant disparity was observed based on the surgical approach: morbidity was 70% in the axillary dissection group compared to 0% in the excisional biopsy group (p

Hematochezia presenting in the neonatal period requires a thorough exploration of life‐threatening and benign pathologies, including food protein–induced allergic proctocolitis (FPIES). This non‐IgE–mediated food allergy is most commonly associated with cow’s milk protein (CMP). It classically presents in the first weeks to months of life, following the introduction of a cow’s milk–based formula or breast milk where the maternal diet includes cow’s milk. We present a rare case of extremely early onset of CMP‐induced proctocolitis, in a neonate presenting at 12 h of life with hematochezia. How does a food allergy develop at such a young age? We explore the current theories explaining this phenomenon.

BackgroundMultifocal epithelial hyperplasia (MEH) is a rare, benign epithelial pathology associated with the human papillomavirus (HPV) infection, affecting the oral mucosa. It is primarily observed in children, particularly those from indigenous populations of Latin American origin and typically resolves during adolescence. However, this case report presents a patient with persistent lesions into adulthood. Despite pharmacological treatment, no significant improvements were observed.Case ReportA 55‐year‐old female patient of indigenous descent presented with multiple asymptomatic papillomatous lesions of varying sizes, which had been present since the age of 12. There were no systemic comorbidities. The presence of multiple lesions and the patient′s age, differential diagnoses such as Cowden syndrome and oral papillomatosis were considered and subsequently ruled out following clinical evaluation. Histopathological analysis confirmed the initial findings, establishing a definite diagnosis of MEH. The patient underwent combined surgical and pharmacological treatment, involving the application of 80% trichloroacetic acid and 5% imiquimod.ConclusionFew case reports of MEH in adult patients exist, and none have thoroughly evaluated the effectiveness of pharmacological treatments. This case underscores the inconsistency of pharmacological therapies in adults, as most studies have focused predominantly on pediatric populations. Therefore, further investigation into alternative pharmacological approaches is warranted for the management of MEH in adult patients.

SpyGlass-assisted percutaneous transhepatic cholangioscopy is increasingly used to evaluate biliary strictures when standard endoscopic approaches are limited. This study evaluates the clinical indications, diagnostic performance, and safety of SpyGlass-assisted percutaneous transhepatic cholangioscopy with targeted forceps biopsy for biliary strictures at a tertiary centre. A retrospective single-centre review identified all SpyGlass-assisted percutaneous transhepatic cholangioscopy procedures performed between May 2021 and January 2025 where biopsy of a biliary stricture was attempted. Demographic characteristics, clinical presentation, procedural details, histological findings, and complications were obtained from the hospital's electronic database. The primary outcome was technical and diagnostic success. Technical success required cholangioscope advancement, visualisation of the biliary tree, and attempted biopsy. Diagnostic success required a definitive histopathological diagnosis from the biopsy sample. Secondary outcomes included complication rates, length of hospital stay, and subsequent clinical outcomes. Among 99 total procedures, 39 involved biopsies of biliary strictures. The mean patient age was 67 years, and 66.7% were male. Cholangioscopy was used as the first-line intervention in most procedures (87.2%). Technical success was achieved in all procedures. Diagnostic success was 84.6%, identifying malignancy in 24 procedures and benign pathology in 9. Six biopsies (15.4%) were non-diagnostic due to atypical cells, crush artefact, or insufficient tissue. Two procedures demonstrated discordance, with negative or atypical biopsy results despite later confirmation of malignancy. Complications occurred in 16 procedures, most commonly Grade II, including one procedure-related death. Median hospital stay was 11 days. SpyGlass-assisted percutaneous transhepatic cholangioscopy demonstrates high technical success and strong diagnostic performance for biliary strictures.

Small renal masses (SRMs), defined as renal tumors < 4cm, are increasingly detected due to the widespread use of imaging modalities. Data from India regarding the clinical characteristics and outcomes of SRMs remain limited. This multi-institutional study led by the Society of Genitourinary Oncologists aims to delineate the demographic, radiological, and pathological profiles of SRMs in the Indian population and evaluate management outcomes following partial nephrectomy. A retrospective analysis was conducted across multiple tertiary care centers in India from January 2013 to December 2022. Patients aged ≥ 18years with SRMs undergoing partial nephrectomy were included. Data on demographics, clinical presentation, radiology (including RENAL nephrometry score), intraoperative factors, postoperative outcomes, and histopathology were analyzed. Statistical associations between renal scores, BMI, tumor stage, and histologic type were assessed. A total of 432 patients were analyzed, with a male predominance (76.6%) and mean age of 51.8 ± 12.9years. Most SRMs (80.3%) were incidentally detected. Robotic-assisted partial nephrectomy was performed in 85% of cases, with a mean operative time of 228.7 ± 91.8min and clamp time of 25.5 ± 9.1min. The overall complication rate was 7%. Clear cell RCC was the most common histology (71.1%), while benign lesions accounted for 11.6%. Positive margins were seen in 1.4% of cases. BMI correlated significantly with renal complexity (p = 0.010). At a median follow-up of 36months, recurrence occurred in 0.9% of patients. Female patients under 45years had a higher incidence of benign pathology (34.1%, p < 0.001). This first large-scale Indian collaborative study highlights unique epidemiologic and pathologic trends in SRMs, including lower benign histology rates and higher complexity in obese patients. Robotic partial nephrectomy demonstrated favorable perioperative and oncologic outcomes. The findings support individualized management strategies and emphasize the need for structured follow-up protocols in the Indian setting.

This study aims to evaluate health-related quality of life (HRQoL) in patients who underwent surgical treatment for upper extremity bone tumors, using validated patient-reported outcome measures, and to explore clinical factors associated with better or worse outcomes. Between January 2015 and January 2024, a total of 55 patients (26 males, 29 females; mean age: 42.4 ± 19.0 years; range, 16 to 81 years) who were treated surgically for upper extremity bone tumors and evaluated at least six months postoperatively were included. The patients completed the EuroQol EQ-5D-5L and the Short Form-12 (SF-12) questionnaires. Clinical variables included age, sex, tumor site, pathology, treatment modality, and adjuvant or neoadjuvant therapies. The humerus was the most frequent tumor site (60%), and joint involvement was present in 80% of cases. Benign tumors accounted for two-thirds of patients, while malignant tumors represented one-third. Curettage-based procedures predominated, and only two patients required amputation. Postoperative complications and recurrences were both observed in 7.3% of patients. On the EQ-5D-5L, 65.5% of patients reported no difficulty with mobility or self-care, but half experienced limitations in usual activities. Pain and discomfort were reported by 74.5%, and anxiety or depression by 67.3%. The mean EQ-5D-5L index was 0.55 ± 0.49 and the mean EQ-VAS was 70.9 ± 20.1. The mean SF-12 physical component score (PCS) and mental component score (MCS) were 42.6 ± 11.3 and 47.0 ± 11.2, respectively, indicating that physical functioning was more impaired than mental well-being. Correlation analyses demonstrated strong associations between EQ-5D-5L, EQ-VAS, and SF-12 scores, supporting convergent validity. Subgroup analyses revealed that younger patients (< 50 years), those with benign pathology, and individuals without adjuvant or neoadjuvant therapies reported significantly higher HRQoL scores. Patients undergoing surgery for upper extremity bone tumors frequently experience pain and psychological distress despite preserved independence in mobility and self-care. Age, pathology, treatment intensity and tumor location were associated with HRQoL. These findings highlight the importance of rehabilitation and psychosocial support in postoperative care, alongside oncological and surgical management.

Comparison of the Efficacy and Safety of Single-Site Laparoscopic Hysterectomy with and without Robotic Assistance: A Meta-Analysis.

Background: Hysterectomy is one of the most common gynecological surgical procedures for benign conditions. In clinical practice, the choice of approach is often influenced by technology availability, leading to selection bias rather than to a decision based on standardized clinical criteria. The study aims to propose a standardized decision-making algorithm, based on objective clinical criteria, for selecting the surgical approach in total hysterectomy. Methods: This is a prospective, observational, analytical study conducted from November 2021 to June 2025, including a cohort of 332 patients who underwent total hysterectomy (LH, VH, AH) for benign gynecological pathology at two major centers in Bucharest. We proposed a decision algorithm based on the results obtained from predictive modelling and the quantified risk factors. Results: The choice of surgical approach is a critical factor in hematological stability, and the presence of comorbidities was associated with the type of approach (p < 0.001). Patients without comorbidities predominantly benefited from laparoscopy (48.85%), but as the anesthetic risk increased (ASA III and IV), the vaginal or abdominal routes were preferred. Conclusions: The convergence of these elements suggests that such a tool can standardize therapeutic decisions and improve the efficiency of interventions, offering a modern and predictable framework for gynecological surgery.

Routine Histology After Hemorrhoidectomy: Uncovering the Hidden Risk of Malignancy?

Perioperative thrombin generation and fibrinolytic activation in patients undergoing major gynaecologic surgery for benign and malignant pathology: a pilot study

Objectives: CD93, an angiogenesis-related transmembrane glycoprotein, is transcriptomically downregulated in uterine corpus endometrial carcinoma, yet circulating protein levels have not been clinically evaluated. This study aimed to evaluate serum CD93 as a diagnostic biomarker for EC and to examine its association with clinicopathological parameters. Methods: In this single-center case–control study, serum CD93 concentrations were measured by enzyme-linked immunosorbent assay in 46 patients with histologically confirmed primary EC and 35 controls with histologically verified benign gynecological pathology. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed. Results: Serum CD93 was significantly lower in EC patients than controls (median 4.55 [IQR 3.51–6.97] vs. 10.24 [7.18–12.14] ng/mL; p < 0.001). In multivariable analysis adjusted for age and body mass index, lower CD93 remained independently associated with EC (OR = 0.521; 95% CI 0.061–0.720; p < 0.001). ROC analysis yielded an area under the curve of 0.845 (95% CI 0.759–0.921), with 82.6% sensitivity and 74.3% specificity at a cut-off of 7.338 ng/mL. CD93 levels showed no significant association with histological subtype, grade, lymphovascular space invasion, nodal metastasis, or recurrence. Conclusions: Serum CD93 is significantly reduced in EC and demonstrates independent diagnostic performance, supporting its prospective validation as a non-invasive biomarker in larger multicenter cohorts.