Algorithmic Detection of Adverse Bleeding Events among Percutaneous Liver and Renal Biopsies.

Delayed Rupture of Subcapsular Hepatic Gastrointestinal Stromal Tumor Metastasis Following Percutaneous Biopsy.

Follicular lymphoma with signet ring cell morphology: Clinicopathologic analysis of 31 cases.

Tumour seeding after transbronchial biopsy: Mechanisms, clinical implications, and prevention strategies-A narrative review.

A 57-year-old female presented to urgent care with exertional dyspnea, back pain, and several months of night sweats. Imaging showed an anterior mediastinal mass with concurrent hepatic and vertebral lesions, raising suspicion for a hematolymphoid malignancy. Fine needle aspiration (FNA) and needle core biopsies were obtained from the liver lesion, with morphologic features compatible with pleomorphic adenoma (PA) without evidence of malignant or high-grade cytologic features, adding to the complexity of interpretation. Revisiting her history revealed a diagnosis of a benign salivary gland tumor in the left parotid, which was surgically removed almost 40 years ago. This piece of clinical information put the morphology into perspective and subsequent molecular testing detected an unusual PLAG1 gene rearrangement, confirming the diagnosis of a benign metastasizing PA in this unique case.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin lymphoma. Central nervous system (CNS) involvement at diagnosis occurs in approximately 5% of cases. We report an uncommon presentation of a 52-year-old woman diagnosed with CD30-positive DLBCL with synchronous systemic and CNS involvement. She presented with generalized lymphadenopathy and intermittent headaches. Brain magnetic resonance imaging (MRI) revealed a 2.0 × 2.7 × 2.0 cm extra-axial infratentorial mass, while systemic imaging demonstrated widespread nodal disease. Excisional lymph node biopsy confirmed CD30-positive DLBCL. Cerebrospinal fluid analysis was negative for malignant cells. The patient received alternating R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) and R-HIDAC (rituximab plus high-dose cytarabine) with intercalated high-dose methotrexate (HD-MTX), resulting in clinical and neurologic improvement. Post-treatment positron emission tomography–computed tomography (PET-CT) demonstrated a complete metabolic response. End-of-treatment brain MRI confirmed complete radiologic remission. This case underscores the importance of early neuroimaging in DLBCL patients with neurologic symptoms and supports the integration of CNS-directed therapy, particularly in resource-limited settings.

Primary Retroperitoneal Mature Cystic Teratoma in an Adult Diagnosed Using Percutaneous Needle Biopsy: A Case Report

To compare Trajectory Recommendation Algorithm for CT-guided Biopsy (TRAX)-generated lung biopsy puncture pathways versus physician-chosen paths. TRAX is an artificial intelligence (AI)-based algorithm that uses segmentation and physician-chosen logic rules to generate lung biopsy pathways. Once a target lesion is defined by the physician, TRAX generates and ranks ∼20,000 candidate pathways within an axial angle of ±20°. Blinded radiologists retrospectively rated pathways chosen by physicians (n=53) versus TRAX (n=53) from the same patients and setup scans prior to lung biopsies (scale: 1 to 3 safe, 4 to 5 unsafe). The quality and metrics of the pathways were compared. All TRAX and physician-chosen pathways were determined safe by physician reviewers (rating 1 to 3). Ratings were identical in 93/159 (58%) cases; TRAX was superior in 36/159 (23%) cases, and physician paths were superior in 30/159 (19%) (no significant difference between pathways, P=0.61). TRAX pathways were shorter than physician pathways (7.2±2.5 vs. 7.8±2.1cm, P=0.046). Most TRAX pathways were outside of the axial plane [n=27/53 (50.9%)], mean gantry angle=11.4±6.0°. The majority of physician-generated pathways were in the axial plane [n=43/53 (81.1%)], mean gantry angle=0.9±2.9° (TRAX vs. physician P<0.05 for proportion of paths in the axial plane and mean gantry angle). TRAX appears to be a promising AI tool to assist physicians in selecting needle trajectories for percutaneous CT-guided lung biopsies, particularly those outside the axial plane.

A cribriform architecture and intraductal carcinoma of the prostate (IDC-P) are recognized as aggressive histopathological features in prostate cancer. However, their prognostic significance in metastatic castration-sensitive prostate cancer (mCSPC), when assessed from diagnostic biopsy specimens, remains uncertain. This retrospective multicenter cohort study included 131 patients with mCSPC who received doublet or triplet therapy incorporating an androgen receptor pathway inhibitor. Diagnostic prostate biopsy specimens were examined for cribriform structures and IDC-P. When the former were present, they were subclassified as small or large types. The primary endpoint was castration-resistant prostate cancer-free survival (CRPC-FS). Large cribriform structures were identified in 54.2% of patients, while small ones were observed in 19.8%. IDC-P was present in 67.2% of cases and was strongly associated with the large-type cribriform architecture (P<.001). Patients with that pattern experienced significantly shorter CRPC-FS compared to those without cribriform structures (P=.013), whereas the small-type architecture was not associated with disease progression. In multivariable analysis, IDC-P and an extent of disease score≥3 were independently associated with shorter CRPC-FS, whereas large cribriform architecture did not retain independent significance. However, incorporation of large cribriform architecture improved model discrimination for predicting castration-resistant prostate cancer progression. In diagnostic biopsy specimens, the large-type cribriform architecture is associated with adverse outcomes in mCSPC patients receiving androgen receptor pathway inhibitor-based therapy. Although its prognostic impact overlaps with that of IDC-P, its identification at diagnosis may provide clinically relevant information for contemporary mCSPC management.

Systemic lupus erythematosus (SLE) and systemic vasculitides associated with antineutrophil cytoplasmic antibodies (ANCA-associated vasculitides, AAV) are severe chronic autoimmune diseases with multisystem involvement. Despite substantial differences in pathogenesis, they share frequent and prognostically unfavorable kidney involvement, which largely determines the course and outcome of the disease. The use of the classic invasive method for dynamic assessment of renal pathology – percutaneous kidney biopsy – has serious limitations. Therefore, the search for noninvasive biomarkers that allow evaluation of glomerulonephritis activity becomes particularly relevant. For this purpose, in particular, monocyte chemoattractant protein 1 (MCP1/CCL2), soluble CD163 receptor (sCD163), integrin CD11b, calprotectin, and others may be used. Such “liquid biopsy” components of the kidney may have significant diagnostic and prognostic value in SLE and AAV.

Deep-seated lesions within the head and neck, such as those in the parapharyngeal space, carotid space, or skull base, present a significant challenge for percutaneous biopsy due to their proximity to critical neurovascular structures and difficult visualization with ultrasound. The paramaxillary approach provides a safe, reproducible, and effective CT-guided pathway to access these difficult areas. This video article demonstrates the detailed anatomy and technical considerations of utilizing this approach. Indications, relative contraindications, and biopsy selection (FNA vs. core biopsy) are discussed. The procedure is illustrated with case examples, highlighting the necessary anatomical landmarks, potential pitfalls, and tips for successful tissue acquisition. This technique serves as a foundational roadmap for interventional and neuroradiologists performing highly precise, low-morbidity biopsies of challenging head and neck masses. The patient whose images appear in this video article provided explicit, written consent for their use. VIDEO.

We present the case of a43-year-old multiparous pregnant patient at 29weeks of gestation admitted to the emergency department with altered consciousness (minimally conscious state), vomiting, and pain in the upper part of the abdomen. Ultrasound examination on admission revealed intrauterine fetal demise of amale fetus. Considering the general condition and intrauterine fetal demise, cesarean section was performed. Postoperatively, the condition of the patient required admission to the intensive care unit (ICU). Treatment included corticosteroid therapy, ursodeoxycholic acid, and correction of acoagulation disorder. Disseminated intravascular coagulopathy was excluded based on laboratory findings, which revealed liver insufficiency with impaired synthetic and excretory function as well as acute kidney injury. Screenings for hepatotropic viruses (hepatitisA, B, C; cytomegalovirus, Epstein-Barr virus, herpes simplex virus types1 and2) as well as autoimmune and metabolic liver diseases were negative. Computed tomography (CT) of the abdomen was performed, indicating acute fatty liver of pregnancy (AFLP). The diagnosis was confirmed by ultrasound-guided percutaneous liver biopsy and histopathological analysis. During further treatment, synthetic and excretory liver function recovery was achieved, along with complete improvement of renal function parameters. The patient was discharged to home care in with asatisfactory general condition and laboratory findings.

AimsFibroepithelial lesions (FELs) of the breast are a heterogeneous group of neoplasms that present diagnostic challenges, particularly on core needle biopsy. This study aimed to evaluate the diagnostic accuracy of breast core biopsy in detecting phyllodes tumors (PTs) using traditional and evidence-based methods, and to identify additional clinical factors that may aid surgical decision-making.Methods and ResultsConsecutive core biopsy specimens from 2017 to 2019 were reviewed, with surgical pathology or clinical follow-up as reference standards. Discordant lesions underwent re-review. Diagnostic accuracy was assessed using Bayesian methods, calculating likelihood ratios (LRs) and integrating them with Fagan nomograms to estimate post-test probabilities. Logistic regression identified factors that improved diagnostic precision. Among 425 patients with FELs on biopsy (369 fibroadenoma [FA], 9 PT, 47 indeterminate), 91 underwent excision and 337 had follow-up (mean 36 months). The overall upgrade rate to PT was 19.7%, but only 7% of FA patients upgraded, reflecting a low false-negative rate. Of nine biopsy-diagnosed PTs, seven were confirmed (false-positive rate 22%). Diagnostic LRs demonstrated strong performance: FA (LR = 0.06) effectively ruled out PT, indeterminate FELs (LR = 6) warranted excision, and PT (LR = 78) strongly supported surgical management. Older age and larger tumor size were significantly associated with PT, while BIRADS, needle gauge, clinical presentation, and prior breast cancer were not predictive.ConclusionsCore biopsy effectively stratifies FELs and guides management. While indeterminate lesions remain challenging, integrating clinical factors such as age and size enhances decision-making, reduces overtreatment of FA, and ensures timely diagnosis of PT.

Primary gastric lymphoma (PGL) is a rare form of lymphoma that arises within the gastric mucosa-associated lymphoid tissue (MALT), often linked to Helicobacter pylori (Hp) infection. The endoscopic features of PGL are heterogeneous, and understanding these characteristics could help distinguish between different lymphoma subtypes. This study aims to systematically assess the endoscopic features of PGL and explore the role of complement receptor type 2/B-cell lymphoma 6 protein (CD21/BCL6)-based grading of lymphoid follicular disruption in predicting the effectiveness of Hp eradication (HPE) treatment in gastric MALT lymphoma. A retrospective study was conducted involving 100 patients diagnosed with PGL at Peking University Third Hospital between January 2010 and January 2025. Patients were divided into two groups based on histopathological findings: indolent and aggressive lymphoma. The clinical and endoscopic characteristics of these two groups were compared. Survival analysis, including overall survival (OS) and progression-free survival (PFS), was performed using Kaplan-Meier curves and Log-rank tests. A subgroup of 25 patients with gastric MALT lymphoma and known HPE outcomes was selected for further analysis. Diagnostic biopsies were immunohistochemically stained with CD21 and BCL6 and graded from G0 to G4 based on follicular disruption. Logistic regression analysis was used to identify factors associated with HPE failure. Among the 100 patients, the average age was 63.0 (55.8, 71.0) years, with 47 men and 53 women. Aggressive lymphoma showed a significantly higher incidence of B symptoms compared with indolent lymphoma (49.0% vs. 19.6%, P= 0.004). Endoscopically, aggressive lymphoma presented more frequently with ulcerative or mixed morphologies (P < 0.001) and exhibited higher rates of mucosal erosion, ulceration with white slough, lesion friability, bleeding tendency, gastric stenosis, and impaired peristalsis (P < 0.001 for all). Aggressive lymphoma also had significantly worse OS and PFS (OS: P=0.009; PFS: P=0.003). In the subgroup of 25 MALT lymphoma patients, those with ineffective HPE were more likely to be Hp-negative (P=0.049) and had a significantly higher degree of follicular disruption (P=0.015). Multivariable Logistic regression revealed that follicular disruption grading was independently associated with HPE failure (AOR=3.63, 95%CI: 1.14-11.58, P=0.021), while Hp infection status was not (P=0.240). PGL demonstrates considerable variability in its endoscopic presentation. Features, such as ulcerative/mixed morphology, friability, bleeding tendency, stenosis, and impaired peristalsis are indicative of more aggressive disease and correlate with poorer survival outcomes. The CD21/BCL6-based grading of lymphoid follicular disruption provides a valuable tool for identifying patients at high risk of HPE failure, supporting early intervention and risk stratification for gastric MALT lymphoma treatment.

Combined multi-omics and multi-spectral profiling of plasma extracellular vesicles reveals liquid biopsy biomarkers for glioma diagnosis.

Proliferating pilar tumors (PPTs) are rare neoplasms arising from the outer root sheath of hair follicles, with approximately 90% occurring on the scalp. These tumors predominantly affect women over 50 years of age and may occasionally undergo malignant transformation, necessitating careful histopathological evaluation. We present the case of a 60-year-old female who presented with a gradually enlarging, non-tender lump on the right cheek of 1.5 years' duration. Local examination revealed a firm, 3×2 cm solid mass with no overlying skin changes or palpable cervical lymphadenopathy. Excisional biopsy was performed and histopathological analysis demonstrated a lobulated lesion composed of proliferative squamous cells with hyperchromatic nuclei, brisk mitotic activity, and abrupt keratinization — findings consistent with a proliferating pilar tumor. Post-operative MRI of the head, face, and neck with contrast revealed no evidence of residual or recurrent tumor. This case highlights an uncommon presentation of PPT on the cheek, a site rarely reported in the literature.

The aim of this report is to present a case of unicentric hyaline vascular Castleman disease in the neck and to discuss its treatment in the light of the current literature. A 52-year-old man presented with a painless, non-progressive swelling in the right submandibular region for one year. Physical examination revealed a 2 × 3 cm firm, fixed mass located outside the submandibular gland. Radiological tests identified a well-circumscribed lesion located outside the submandibular gland. As lymphoid cells were reported in fine-needle aspiration cytology, an excisional biopsy was performed and hyaline vascular Castleman disease was diagnosed. As the disease was unicentric, no further treatment was planned, and the patient was taken into follow-up. During five years of clinical and radiological follow-up, there was no evidence of recurrence.

This invited commentary discusses the recent study by Alali et al , published in the World Journal of Gastrointestinal Endoscopy , which investigated the feasibility and safety of endoscopic ultrasound-guided liver biopsy (EUS-LB) for diagnosing parenchymal liver disease. The study demonstrated a high diagnostic yield and a low rate of serious complications, supporting the efficacy of EUS-LB as an alternative to percutaneous liver biopsy. The study also highlighted technical factors that improve tissue acquisition. While commending the multi-center findings and technical insights, we discuss limitations of the retrospective design and modest sample, compare EUS-LB with traditional biopsy modalities, and emphasize the need for larger prospective studies to validate and generalize these results.

We report the case of a male in his mid-80s who presented to the triple assessment breast clinic with a right-sided palpable breast mass. Mammography showed a well-circumscribed, oval, high-density mass without calcifications; targeted ultrasound demonstrated a circumscribed, parallel-oriented solid mass with mixed echogenicity and no internal vascularity. Core biopsy confirmed mammary myofibroblastoma, a rare benign spindle cell tumour, and the lesion was excised with clear margins. This case highlights the importance of triple assessment in all breast lesions, including in men, and while core biopsy usually establishes the diagnosis, surgical excision may still be required for confirmation.

Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare primary malignant hepatic neoplasm, defined by the concurrent presence of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) components, which vary in proportion and degree of differentiation. Characterized by insidious onset, high invasiveness, and marked heterogeneity, cHCC-CCA often eludes early diagnosis, leading to a generally dismal prognosis. Its survival outcomes typically fall between those of HCC and intrahepatic cholangiocarcinoma (iCCA). Epidemiological data derived from surgical resection specimens and percutaneous biopsy samples indicate that cHCC-CCA accounts for approximately 0.4%–14.2% of all primary liver cancers. Due to its rarity, standardized treatment protocols are currently lacking. Surgical resection and liver transplantation are considered the primary potential curative approaches. However, only a minority of patients meet surgical criteria at diagnosis, and postoperative recurrence rates are substantially high. For non-surgical candidates, local or systemic therapies are generally administered based on treatment regimens for HCC or iCCA. Additionally, the pronounced genetic and molecular heterogeneity of cHCC-CCA significantly compromises the efficacy of current therapeutic strategies. Its unique biological behaviors, histological features, and immunophenotypic profiles present multifaceted challenges to diagnosis, treatment, and research endeavors. This review aims to comprehensively synthesize the classification systems and pathological characteristics of cHCC-CCA, with a particular focus on the underlying organelle dysfunction. By integrating advances in clinical diagnosis and management, we seek to enhance disease awareness and provide a new reference for clinical practice.