Low Malignant Potential Research Articles (Page 2)

BackgroundBorderline ovarian tumors (BOTs) are neoplasms of low malignant potential that predominantly affect women of reproductive age. Fertility preservation through fertility-sparing surgery is widely practiced; however, concerns remain regarding the risk of tumor recurrence and the reproductive outcomes following in vitro fertilization (IVF). This study aimed to evaluate IVF/ intracytoplasmic sperm injection (ICSI) outcomes in BOTs patients post-FSS and to assess the association between ovarian stimulation parameters and tumor recurrence.MethodsIn this retrospective cohort study conducted at Sixth Hospital of Sun Yat-sen University from May 2010 to May 2023, 65 women with a history of FSS for BOTs who underwent IVF/ICSI were identified. After propensity score matching, 61 BOTs patients were compared with 181 control patients without ovarian tumors. Key outcomes evaluated included ovarian stimulation parameters, live birth rates, neonatal outcomes and risk factors for tumor recurrence.ResultsThe BOTs and control groups exhibited similar outcomes regarding the number of oocytes retrieved, the quality and number of embryos, and live birth rates from the first IVF/ICSI cycles. The cumulative live birth rate over 13 years and neonatal parameters (gestational age, birth weight, and body length) were also comparable between groups. Tumor recurrence was observed in 8.62% of BOTs patients, with no significant association identified between recurrence and ovarian stimulation parameters or peak estradiol levels.ConclusionsIVF/ICSI following fertility-sparing surgery for BOTs patients yields reproductive and neonatal outcomes comparable to those in patients without BOTs and does not increase the risk of tumor recurrence. These findings support the safety and efficacy of IVF as a fertility treatment option for BOTs patients after conservative surgery. Further prospective studies with larger cohorts are warranted to validate these results and refine ovarian stimulation strategies.Clinical trial numberNot applicable.

BackgroundSolid pseudopapillary neoplasm (SPN) of the pancreas exhibits low malignant potential and is typically curable via surgical excision, with > 90% 5-year survival rates, including metastatic cases. Accurate preoperative diagnosis is crucial to minimize surgical extent. We aimed to elucidate distinctive imaging features of SPN on computed tomography (CT) and endoscopic ultrasound (EUS) with pathologic correlation, enabling radiologists to better recognize and distinguish them from other pancreatic lesions.MethodsThirty three patients (3 men, and 30 women; median age of 25 years) with pathologic diagnosis of SPN encountered between November 2019 and July 2024 were included in this study. CT images with pancreatic triphasic protocol were reviewed for tumor location, size, shape, margin, morphology, presence of capsule, calcification, hemorrhage, invasion, enlarged lymph nodes, and bile duct dilatation. Enhancement pattern was assessed and CT attenuation values were calculated. EUS was conducted in 15 patients and its sensitivity in diagnosing SPN was compared to CT alone.ResultsMost patients in our series were symptomatic young females. Dominant CT features included a well-defined encapsulated lesion with mixed solid/cystic appearance, variable degrees of hemorrhage and calcifications, heterogeneous hypo-enhancement during arterial phase with peak enhancement in portal venous phase, non-dilated bile duct, and absence of liver metastasis. Combining CT and EUS in 15 patients enhanced diagnostic sensitivity compared to CT alone.ConclusionA mixed solid/cystic pancreatic mass in a young woman with progressive enhancement and variable degrees of hemorrhage and calcifications is suggestive of SPN. Combining CT and EUS could enhance preoperative diagnostic accuracy. Despite being a descriptive study with limited scope, this institutional case series provides descriptive insights into tumor characteristics, aligning with existing literature and expanding the collective knowledge base.

Thyroid-like follicular carcinoma of the kidney (TLFC-K) is a rare primary kidney carcinoma with fewer than 60 reported cases. Current data suggest that TLFC-K has low malignant potential, with only a few reported cases of unfavorable clinical behavior. Histologically, TLFC-K is indistinguishable from kidney metastasis of well-differentiated follicular cell-derived thyroid carcinomas. Furthermore, folliculo-tubular patterns can be seen in different types of kidney lesions, making assessing follicular architecture in the kidney diagnostically challenging. We present a case of TLFC-K with a list of differential diagnoses. A hyperechoic tumor was found incidentally in the upper pole of the right kidney of a 66-year-old man. The patient underwent a radical nephrectomy. Histologically, the tumor was well-circumscribed, composed of follicular/tubular structures of different sizes filled with colloid-like material. Immunohistochemically, the absence of a positive reaction for thyroglobulin and TTF-1 excluded the secondary origin of the tumor from the thyroid. Tumor cells also showed diffuse positivity for vimentin and PAX8 and focal positivity for CK7 and CD10. The results of all other applied immunostaining tests did not align with those of different types of kidney tumors that may exhibit predominantly follicular patterns. Accordingly, TLFC-K was diagnosed. The patient shows no signs of disease relapse at the 5-month follow-up.

Glomangiopericytoma of the sinonasal type is a rare sinonasal soft tissue tumor of low malignant potential. Its nosologic nature was controversial after it was first reported by Stout and Murray in 1942, who termed it as sinonasal haemangiopericytoma. It behaves very indolently as compared to its soft tissue counterparts, and now its cell of origin is known to be a perivascular modified glomus-like cell with myoid features. Clinically, it has many mimics ranging from inflammatory nasal polyps to epithelial neoplasms and vascular tumors. Here, we report a case in a 52-year-old male patient who presented with epistaxis and sinonasal polypoid mass. CT/CECT showed a polypoid lesion involving the right nasal cavity between the right middle turbinate and bony nasal septum with the possibility of a small mucosal nasal polyp. Total resection was performed by endoscopic nasal route. On histopathology and immunohistochemical examination, it was diagnosed as sinonasal glomangiopericytoma (GPC). We discuss the histology features and differentials to help in the diagnosis of this rare nasal neoplasm that presents with common symptoms of epistaxis diagnosis.

Background: Urinary bladder cancer is the most common malignancy involving the urinary system and the ninth most common malignancy worldwide. Proliferation marker kinase inhibitor (Ki67) is a nuclear and nucleolar non-histone DNA-binding protein that is encoded by the MKi67 gene in humans. Human epidermal growth factor receptor 2 (HER2) is a transmembrane tyrosine kinase receptor that is involved in cellular growth, survival, and migration. Materials and Methods: The cross-sectional study was conducted for the duration of one year in the Department of Pathology, BPS Medical College for Women, Khanpur Kalan, Sonepat. Tissue sections, after proper processing, were stained with haematoxylin and eosin. A total of 50 histopathologically proven cases of urothelial tumors were included in the study. Correlation of urothelial tumors was studied with age, gender, smoking, and tumor grading. Urothelial tumors were classified according to the WHO classification of tumors of the urinary bladder (2016), and IHC markers Ki67 and HER2/neu expressions were evaluated. Results: Among 50 cases of urothelial tumors, 25 (50%) cases were low-grade urothelial carcinoma, followed by 22 (44%) cases of high-grade urothelial carcinoma. Two cases of squamous cell carcinoma and one case of papillary urothelial neoplasm of low malignant potential were also observed. Ki67 expression was significantly associated with urothelial carcinoma (p-value = 0.01). HER2/neu expression showed a significant association with muscle-invasive tumors (p-value = 0.02). Conclusion: Positive Ki67 and HER2/neu expression correlated with tumor grade. Assessing HER2/neu status could identify patients with high-grade disease who might benefit from adjuvant HER2/neu treatment after radical cystectomy.

Introduction: Renal cystic lesions are the most commonly encountered kidney pathologies, which can fall into developmental, acquired, genetic, infectious and neoplastic categories. Prompt histological diagnosis, in co-ordination with radiological findings, is very important for the further management of these lesions. Aim: To study the histopathological features of renal cystic lesions and to examine the immunological expression of Cytokeratin 7 (CK7) in cystic renal tumours. Materials and Methods: The present study is a cross-sectional study conducted in the Department of Pathology, Narayana Medical college, Nellore, Andhra Pradesh, India. Study was conducted over a period of five years, from June 2018 to May 2023, both prospectively and retrospectively. It includes 38 cases of cystic renal lesions out of 147 kidney specimens, which included cyst walls and nephrectomy specimens. Out of the 38 cystic renal lesions, 11 cases of cystic renal tumours were identified. Cytokeratin 7 Immunohistochemistry (IHC) was performed on these 11 cases of cystic renal tumours. Only diffuse membranous or cytoplasmic immunostaining in tumour cells is considered positive, while weak or focal immunostaining is considered negative. The data was entered into Microsoft (MS) Excel sheet and descriptive measures obtained included frequencies and percentages. Results: Among the 38 cases of cystic renal lesions, the most common were 17 cases of simple cysts, followed by 10 cases of clear cell renal cell carcinoma with a cystic component, three cases of acquired cystic disease, three cases of renal dysplasia, two cases of hydatid cyst, one case of mucinous cyst, one case of adult polycystic kidney disease and one case of a cystic renal neoplasm of low malignant potential. All 11 cases of cystic renal tumours exhibited clear cell morphology. Cytokeratin 7 immunostaining was performed on the 11 cases of cystic renal tumours, of which only the lining cells in a single case of cystic renal neoplasm of low malignant potential showed both intense and diffuse cytoplasmic positivity. The remaining 10 cases of clear cell Renal Cell Carcinoma (RCC) were negative, showing no immunoreactivity. Conclusion: Renal cystic lesions encompass a broad range of pathologies that have many overlapping features on histopathology. The use of immunohistochemical markers aids in differentiating low malignant potential cystic renal tumours from malignant ones.

This review discusses the evaluation of renal cell carcinoma (RCC) subtypes using computed tomography (CT) and magnetic resonance imaging (MRI). RCC is a malignancy with different histopathological subtypes, constituting approximately 90% of adult kidney tumors. It has been reported that these subtypes show significant differences in terms of clinical behavior, treatment response, and prognosis. In the study, CT and MRI findings of subtypes such as clear cell RCC (ccRCC), papillary RCC (pRCC), chromophobe RCC (chRCC), medullary RCC (mRCC), collecting duct RCC (cdRCC), and multiloculated cystic RCC (mcRCC) were compared. It was stated that CT is the first-choice imaging method in the staging and surgical planning of RCC and provides detailed information about the tumor size, vascularity, and metastatic spread. On the other hand, it has been emphasized that MRI allows better characterization of RCC subtypes with its soft-tissue resolution and contrast agent usage advantage. The study draws attention to the different imaging features of each subtype and details the role of these findings in the clinical decision-making process. It has been stated that ccRCC exhibits intense contrast enhancement and rapid washout pattern in the corticomedullary phase on CT and appears hyperintense on T2A and hypointense on T1 weighted imaging (T1A) on MRI. It has been stated that pRCC has hypovascular features, has lower contrast enhancement, and has homogeneous borders. It has been stated that chRCC has a less vascular structure and exhibits moderate contrast enhancement in the corticomedullary phase. It has been reported that mRCC has invasive features and is usually diagnosed at an advanced stage while cdRCC has a very aggressive clinical course. It has been stated that mcRCC contains distinct cystic areas between the septa, has a well-circumscribed structure, and generally has a low malignancy potential. As a result, it has been stated that detailed evaluation of CT and MRI findings of RCC subtypes plays a critical role in the diagnosis, treatment, and prognosis of these subtypes. It has been emphasized that the findings presented in this study will contribute to the development of more targeted treatment approaches in RCC management.

Background: Urinary bladder neoplasms encompass a wide range of benign and malignant tumors, with urothelial carcinoma being the most prevalent histological subtype. These tumors pose significant diagnostic and therapeutic challenges due to their high recurrence rate and potential for progression. Histopathological evaluation remains the cornerstone for accurate diagnosis, grading, and staging, all of which are essential for optimal management. Objectives: This study aimed to evaluate the histopathological spectrum of urinary bladder neoplasms, classify them according to WHO criteria, and correlate histological findings with relevant clinical parameters. Materials and Methods: A prospective study was conducted in the Department of Pathology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, from September 2022 to July 2023. A total of 132 bladder biopsy and resection specimens were included. Detailed clinical information, including age, gender, symptoms, and radiological findings, was recorded. All specimens were formalin-fixed, paraffin-embedded, and stained with hematoxylin and eosin. Tumors were classified and graded based on the 2016 WHO/ISUP classification. Invasion status and variant histologies. were also assessed. Results: The majority of cases were urothelial carcinomas, accounting for 88.6% of all tumors. Among these, high-grade urothelial carcinoma constituted 54.3% and low-grade 34.3%. A small proportion of cases were squamous cell carcinoma (4.5%), adenocarcinoma (3.0%), and papillary urothelial neoplasm of low malignant potential (PUNLMP) (3.8%). The most commonly affected age group was 51–70 years, with a male-to-female ratio of 3.2:1. Painless hematuria was the most frequent presenting symptom. Muscle invasion was noted in 42.4% of urothelial carcinoma cases. Conclusion: Urothelial carcinoma remains the predominant histological subtype in urinary bladder neoplasms. High-grade lesions with muscle invasion are common in the older population and indicate poor prognosis. Routine histopathological analysis of all bladder lesions is crucial for diagnosis, risk stratification, and planning of further management. The study highlights the importance of early detection and pathological classification in improving clinical outcomes.

Background: Granulosa cell tumors (GCTs) are rare neoplasms with predominantly low malignant potential, primarily affecting peri-menopausal individuals. This case series investigates six patients diagnosed with GCT, emphasizing clinical features, prognostic markers, and treatment strategies. Methods: This retrospective analysis focuses on patients diagnosed with GCT at Safdarjung Hospital between June 2022 and June 2023. Data collection included demographics, clinical presentations, diagnostic findings, treatment modalities, and follow-up outcomes. Results: The case series comprised various presentations, ranging from asymptomatic masses to complications such as ovarian torsion and tumor rupture. Most patients presented with hormonally active tumors, predominantly producing estrogen. Surgical management, including unilateral salpingo-oophorectomy or total abdominal hysterectomy with bilateral salpingo-oophorectomy, was the primary treatment modality. Prognostic factors such as tumor size, stage, and mitotic index were identified, guiding clinical decision-making. Close surveillance post-surgery was essential due to the potential for late recurrences. Conclusion: This case series enhances understanding of ovarian GCTs, providing insights into their clinical management and prognosis. Early detection, prognostic marker assessment, and vigilant surveillance are crucial for optimizing patient outcomes

492 Background: TFE3-rearranged renal cell carcinoma (rRCC) is uncommon, and demonstrates unique heterogenous morphological features and distinct immune characteristics. MED15-TFE3 is a rare gene fusion that usually present as an extensive cystic mass with low malignant potential and is more susceptible to immune check point inhibitor. Identifying the clinical characteristics is crucial for the treatment. Methods: All samples were collected retrospectively from West China Hospital between 8/2011 and 5/2024. Diagnosis of MED15-TFE3 gene fusion was confirmed by RNA sequencing and fluorescence in situ hybridization. Both clinicopathological features and follow-up prognosis information were collected for further analysis. Results: The detailed information of 16 cases were described in the table. The median age was 47.5 years (range, 22 to 70 years). Majority of the cases were female (12/16). All patientes were surgically treated (radical nephrecomy: 8; partial nephrectomy: 7; cytoreductive surgery: 1). At initial diagnosis, most cases (14/16) were localized disease, while two patients had positive regional lymph nodes metastasis, and one patient had distant metastasis. For the patients without distant metastasis (n=15), two patients developed metastasis with disease-free survival of 11.4 and 29.0 months, respectively. As for the pathological features, 14 (87.5%) of the casess presented cystic morphologically, and other two (12.5%) were papillary. Except for one patient with diatant metastasis at initial diagnosis, all patients (15/16) were in G2 by ISUP score. For metastatic patients, 3 received first-line therapy (1 axitinib, 1 axitinib + sintilimab, 1 sunitinib), 2 received second-line therapy (1 axitinib + sintilimab, 1 axitinib + toripalimab), 1 received third-line therapy (axitinib + toripalimab and combined with everolimus). They are still under follow-up. Conclusions: MED15-TFE3rRCC mainly present low-grade cystic renal neoplasm with favorable prognosis. For metastatic MED15-TFE3 rRCC, there is no standard therapy currently. Clinicopathological characteristics and prognosis of 16 MED15-TFE3 rRCC cases. Characteristics Cases Age, median (range), years 47.5 (22, 70) Gender Male 4 Female 12 Morphology Cystic 2 Papillary 14 Tumor size, median (range), cm 5.6 (3.3, 14.0) Nephrectomy Radical 8 Partial 7 Cytoreductive 1 T stage T1 10 T2 3 T3 3 N stage N0 14 N1 2 M stage M0 15 M1 1 ISUP grade 2 15 3 1 Distant metastasis Synchronous 2 Metachronous 2 No 12 Survival status Alive 15 Dead 1

BACKGROUND: The recommended follow-up for Bosniak IIF renal masses includes imaging at 6 months, 12 months, and then annually for 5 years. These suggested follow-up intervals for class IIF masses are based on expert opinion. Successive studies indicate that most class IIF masses have low malignant potential, and those identified as malignant tend to exhibit slow biological progression. Consequently, the necessity of early imaging follow-up at 6 months remains uncertain. OBJECTIVES: To investigate the frequency and timing of upgrade and malignancy rate on follow-up imaging for class IIF masses. These observations may be useful for the development of future management guidelines and for lengthening the initial follow-up period. METHODS: This retrospective study comprised 41 localized class IIF masses identified between January 2019 and December 2023. Patients underwent both an initial and at least one subsequent renal-mass protocol contrast-enhanced CT or MRI examination. Two radiologists evaluated the masses at all follow-up intervals to classify them as either stable (remaining as localized class IIF) or upgraded (classified as class III or IV or showing solid components). Discrepancies were resolved by a third radiologist. The incidence rate of upgrade was calculated, and the median time to upgrade and histopathologic outcomes were assessed for masses that underwent resection. RESULTS: Out of 41 masses only 12.19% (N= 5) were upgraded to Bosniak III (9.8%) and IV (2.4%). The majority of masses (85.4%) remained stable in their Bosniak class. The minimum time of progression was 15.5 months, whereas the median progression time was 34 months. The average age of the patients was 63 years, with a notable variability of 16 years. The gender distribution showed a slightly higher representation of males (58.5%) compared to females (41.5%). In terms of mass characterization, the median size of the masses was 3 cm, with a considerable range from 6 to 2 cm. A majority of the masses exhibited many thin septa (68.3%), while a significant proportion also showed minimally thickened septa or walls (31.7%). Regarding the location of the masses, there was a slight predominance of masses in the left kidney (61.0%) compared to the right kidney (39.0%). In terms of management, a large majority of the masses (85.4%) were managed through follow-up, indicating a conservative approach in the initial management of these lesions. However, a notable proportion of masses underwent surgical intervention (N=5), with 7.3% undergoing partial nephrectomy, 4.9% undergoing total nephrectomy, and 2.4% undergoing embolization. Among the resected masses (N = 5), four were malignant, and the distribution of malignancy types varied. The majority (50%) were classified as clear cell carcinoma, while 25% each were multilocular cystic tumors with low malignant potential and papillary carcinomas. All malignant masses were categorized as T1a, N0, M0. CONCLUSION: Bosniak v2019 class IIF masses are unlikely to represent aggressive malignancy; only 12.19% were upgraded over time and never at the initial 6-month follow-up.

Smooth Muscle Tumours with Uncertain Malignant Potential (STUMPs) represent a rare and diagnostically challenging category within uterine neoplasms. These tumours exhibit biological features similar to both benign leiomyomas and malignant leiomyosarcomas, complicating diagnosis and management. STUMPs are characterised by their potential for unpredictable clinical behaviour, including local recurrence and, in rare cases, metastasis, necessitating careful postoperative monitoring. Classifying uterine mesenchymal tumours is difficult due to significant overlap with terms such as atypical leiomyoma, atypical leiomyoma with low risk of recurrence, and atypical leiomyoma with low malignant potential. Despite their infrequent occurrence, STUMPs have garnered increasing attention due to their ambiguous nature and the clinical implications they pose. Diagnostic criteria and management strategies for STUMPs remain areas of active research and debate within gynaecological pathology and oncology. The present case series was aimed to contribute to the existing body of literature by presenting three cases of female patients (aged 38-year-old, 34-yearold and 47-year-old) of large uterine leiomyomas that were later diagnosed as STUMPs postoperatively following hysterectomy. Each case underscores the complexities involved in diagnosing and managing these tumours, emphasising the importance of multidisciplinary collaboration and long-term follow-up in optimising patient outcomes.

Inflammatory myofibroblastic tumor (IMT) is a rare soft tissue neoplasm with low malignant potential. These patients present with a certain probability of malignant potential. The management of IMT has not been standardized, especially for the patients with fertility needs. Thirteen patients with IMT who attended in the Department of Gynecology, Women's Hospital, Zhejiang University School of Medicine were enrolled between 2019 and 2023. The data of the clinical and pathological features was analyzed. The mean age of the patients was 45.31 ± 12.80 years. Seven of the 13 cases (53.85%) had abnormal uterine bleeding. Five of them (38.46%) had a rapidly growing mass, and 2 of them (15.38%) had no obvious symptoms. With regard to surgical strategies, 7 patients underwent hysterectomy, and 6 patients underwent mass resection only. All the patients were alive with no evidence of disease at an average of 9.58 months of follow-up. One of them gave birth to a full-term male infant at 40 weeks of gestation after hysteroscopic resection, without recurrence. Uterine inflammatory myofibroblastic tumor can be diagnosed by the anaplastic lymphoma kinase overexpression. Complete excision under hysteroscopy or laparoscopy seems to be effective and safe. Because there is a certain risk of recurrence and metastasis, conservative surgery should be performed carefully to preserve fertility in patients who can undergo close follow-up.

Solid Pseudopapillary Tumor of the Pancreas: Insights into a Rare Neoplasm with Low Malignancy Potential

ABSTRACT Soft tissue tumours are a heterogeneous group, including a few characterised by low malignant potential. The pleomorphic hyalinising angiectatic tumour (PHAT) is one such entity, which is slow growing and non-metastasising. The origin of this tumour is uncertain and has several clinical and morphological mimics. We present the case of a 65-year-old male, who was diagnosed with urothelial carcinoma, and he underwent radical cystectomy with an ileal conduit, after neoadjuvant chemotherapy. Pre-operative ultrasonography of the abdomen also showed a pedunculated soft-tissue lesion in the lower abdominal wall in the subcutaneous plane, which was excised. The histopathological examination of the excised swelling showed features of a rare soft-tissue neoplasm, i.e. PHAT. PHAT is a neoplasm primarily of adults, occurring mostly over the lower extremities. Grossly, they are circumscribed, solid firm masses with blood-filled cystic spaces. Microscopically, typical PHAT is characterised by sheet-like proliferation of the spindle or pleomorphic cells, thin-walled hyalinised ectatic and small vessels and haemosiderin laden in a myxoid extracellular matrix. They often express vimentin and CD34 and may be positive for CD99 and vascular endothelial growth factor. The absence of aneuploidy in PHAT indicates a non-malignancy. However, it is considered to be an intermediate category because of its aggressive behaviour warranting surgical excision with wide margins as treatment of choice. Awareness of the classical morphological features can prevent an erroneous diagnosis of malignancy.

Solid pseudopapillary pancreatic tumor is a rare entity with low malignant potential and good prognosis that mainly affects young women. The clinical manifestations are nonspecific, most are asymptomatic, and gastrointestinal bleeding, as in the case presented, is rare.

Epstein-Barr Virus (EBV)-positive inflammatory follicular dendritic cell sarcoma (EBV-IFDCS) is a rare tumor of low malignant potential. Abundant lymphocytes and plasma cells often infiltrate into this tumor tissue with lymphoid follicles and sarcoid-like granulomas, so that the differential diagnosis of this tumor includes inflammatory lesions such as IgG4-related disease, morphologically. This tumor typically arises in the spleen or liver, and shows follicular dendritic cell (FDC)-like immunophenotype. Here we presented a case of EBV-IFDCS arising in intrapancreatic accessory spleen, which was preoperatively considered as a pancreatic tumor. Immunohistochemistry revealed its fibroblastic reticular cell-like phenotype, namely alpha SMA, l-caldesmon, tenascin C, and transglutaminase II positivity, while FDC marker expression such as CD21 and clusterin was focal. Positivity for EBV-encoded small RNA in situ hybridization (EBER ISH) distinguished it from inflammatory lesions or conventional FDC sarcoma. The differential diagnosis of EBV-IFDCS is broad, ranging from non-neoplastic lesions to sarcoma, particularly when it arises in unusual sites. Therefore, careful gross and microscopic examination and adequate immunohistochemistry application including EBER ISH are important to diagnose it properly.

To investigate clinicopathologic characteristics and prognosis in secretory breast carcinoma (SBC) and to determine chemotherapy benefits stratified by different subgroups. SBCs and triple-negative invasive ductal carcinoma patients (TN-IDCs) were enrolled from three cancer centers between January 2011 and December 2020. SBCs were further divided into two subgroups: those with triple negativity (TN-SBCs) and those without (non-TN-SBCs). Clinicopathologic characteristics were thoroughly compared among the three subgroups associated with triple negativity. Kaplan-Meier estimates and Cox proportional hazard models were performed for survival analysis. A total of 80 SBCs and 310 TN-IDCs were included in the study. The TN-SBC subgroup consisted of 35 individuals (43.75%) with mild clinical behaviors and a satisfying prognosis in comparison to non-TN-SBCs and TN-IDCs. In SBCs, N stage (N1 vs. N0: HR = 11.176, 95% CI 0.843-148.132, p = 0.067; N2-3 vs. N0: HR = 30.409, 95% CI 1.378-671.169, p = 0.031), LNR (HR = 23.894, 95% CI 1.614-353.835, p = 0.021), and histological grade (HR = 28.634, 95% CI 2.745-298.703, p = 0.005) were significantly correlated with disease-free survival (DFS). Patients in high LNR group receiving chemotherapy achieved a prolonged DFS (p = 0.025), while chemotherapy did not confer a survival benefit in TN-SBCs of our interest (p = 0.12). TN-SBC is a unique entity with low malignant potential. Advanced N stage, high LNR, and advanced histological grade are adverse determinants of DFS in SBC. Adjuvant chemotherapy provides superior DFS in high LNR SBCs rather than TN-SBCs, hence it is recommended for high LNR SBCs.

BackgroundUpper urinary tract urothelial carcinoma (UTUC) is a rare and highly aggressive malignancy characterized by poor prognosis, making the accurate identification of high-grade (HG) UTUC essential for subsequent treatment strategies. This study aims to develop and validate a nomogram model using computed tomography urography (CTU) images to predict HG UTUC.MethodsA retrospective cohort study was conducted to include patients with UTUC who underwent radical nephroureterectomy and received a CTU examination prior to surgery. In the CTU images, tumor lesions located in the renal calyces, renal pelvis and ureter were segmented, and radiomics features from the unenhanced, medullary, and excretory phases were extracted. The maximum relevance minimum redundancy algorithm, least absolute shrinkage and selection operator, and various machine learning (ML) algorithms—including random forest, support vector machine, and eXtreme gradient boosting—were employed to select radiomics features and calculate radiomics scores. Logistic regression (LR) analysis was performed to identify the independent influencing factors of clinical baseline characteristics. Multiple datasets of radiomics features were constructed by integrating single-phase radiomics features with the most significant independent factor. Both LR and ML algorithms were utilized to develop predictive models. The area under the receiver operating characteristic curve (AUC values), accuracy, sensitivity, and specificity were assessed for model performance evaluation. Decision curve analysis was conducted to evaluate the clinical net benefits.ResultsA total of 167 patients were enrolled in this study. Among them, 56 were diagnosed with low-grade UTUC (including papillary urothelial neoplasms with low malignant potential and low-grade urothelial carcinoma) as confirmed by postoperative pathological examination results, and 111 were of HG. These patients were randomly allocated to the training set and the validation set at a ratio of 7:3. The training set comprised 116 patients with a mean age of 63.5 ± 9.38 years and 38 males. The validation set comprised 51 patients with a mean age of 65.6 ± 11.1 years and 18 males. Hydronephrosis was identified as the most significant independent factor in the clinical baseline features. Models that include mixed-phase development achieve better performance compared to models that rely simply on single-phase development. The nomogram model had excellent predictive ability for HG UTUC, with AUC values of 0.844 and an accuracy of 0.793 in the validation sets. The nomogram model can enhance accuracy by 14.1% (79.3% vs. 65.2%) and sensitivity by 32.8% (93.2% vs. 60.4%) compared to urinary cytology.ConclusionsThis study developed a nomogram model, which significantly improved the diagnostic ability for HG UTUC compared to urinary cytology. Furthermore, the results of the decision curve analysis showed that the model had a net benefit and could provide a non-invasive and potentially diagnostic reference tool for HG UTUC.

The 2019 Bosniak classification has improved the precise and detailed quantitative evaluation criteria, making the diagnosis of cystic renal masses (CRMs) more accurate and objective. This study addresses the clinical value of quantitative analysis and aims to investigate the feasibility of combining contrast-enhanced ultrasound (CEUS) with quantitative analysis for diagnosing Bosniak ≥ II CRMs. We retrospectively obtained 58 CRMs with confirmed pathology, which underwent CEUS and Contrast-enhanced computer tomography (CECT) evaluations according to Bosniak classification between January 2013 and August 2024. These lesions were divided into benign and malignant groups, followed by a quantitative analysis of the morphological details detected by CEUS. All morphological parameters were compared, and the diagnostic efficiencies were evaluated using receiver operating characteristics (ROC) curves, logistic regression (LR) analysis, and diagnostic curve analysis (DCA). Additionally, a cohort of 72 lesions was monitored for a period of ≥ 3years, and changes in Bosniak classification were analyzed by categorizing them into stable, upgraded, and downgraded categories. The analysis revealed no statistically significant difference between CEUS and CECT in our cohort's malignancy predictive rates across different Bosniak grades (p = 0.640). All morphological quantitative parameters showed statistically significant differences between the two groups (p < 0.001). ROC curve analysis revealed that the sum of enhanced wall thickness and enhanced septum thickness among quantitative parameters had the highest AUC value (AUC: 0.9226). Both LR models demonstrated superior clinical diagnostic performance with similar level of accuracy between qualitative and quantitative analysis, as evidenced by ROC (AUC: 0.9470, 0.9619, respectively) and DCA analyses. None of the lesions in the follow-up cohort were upgraded, suggesting that CRMs are relatively stable tumors with a low malignant potential. This retrospective study demonstrated that CEUS combined with Bosniak classification and quantitative analysis could enhance diagnostic confidence in differentiating Bosniak ≥ II CRMs and could serve as a viable alternative to CECT in specific cases.