To investigate the pathological outcomes, re-excision rates, local recurrence, patient satisfaction, and cosmetic results associated with level II oncoplastic surgery (OBS) techniques compared to conventional breast-conserving surgery (BCS) in the treatment of breast cancer with a ductal carcinoma in situ (DCIS) component. Between January 2020 and December 2023, 163 patients with invasive carcinoma associated with DCIS were deemed suitable for breast-conserving surgery. The patients were divided into two groups: those who underwent conventional BCS and those who underwent level II OBS. Forty patients underwent level II OBS, while 123 patients underwent conventional BCS. The median age was 50 (range 29-65) years for the patients in the level II OBS group and 52 (range 25-68) years for those in the conventional BCS group. Re-excision was performed in three patients (10%) in the level II OBS group compared to 37 patients (30%) in the conventional BCS group, indicating a statistically significant difference (p = 0.035). The median tumor size was 16 (range 3-45) mm in the OBS cohort and 15 (range 4-50) mm in the BCS cohort. Donut mastopexy was the most commonly performed level II oncoplastic procedure (50%). No statistically significant differences were found between the groups in terms of other demographic and histopathological parameters (e.g., tumor laterality, menopausal status, ER, PR, and HER2 positivity, and E-cadherin expression). According to the BREAST-Q survey, the patients in the OBS group reported higher satisfaction with their breasts, better psychosocial well-being, and improved sexual well-being compared to those in the BCS group, with these differences being statistically significant (p < 0.001). In breast cancer with a DCIS component, patients who underwent level II OBS had significantly lower re-excision rates, higher patient satisfaction, and better cosmetic outcomes compared to those who underwent conventional BCS.

Highly-selected sporadic, apparently unifocal cN0 MTC may benefit from unilateral surgery. A proof of concept in a high-volume institution.

Disparities in survival and tumor characteristics in patients with single and multiple primary Merkel cell carcinomas.

BackgroundMalignant phyllodes tumors (MPT) are rare, aggressive fibroepithelial breast neoplasms with limited consensus on optimal management. While wide local excision (WLE) with ≥1cm margins is standard, recurrence remains common, and the role of adjuvant therapy remains unclear.MethodsWe conducted a 28-year retrospective review of 14 histologically confirmed MPTs in 11 patients at a single urban safety-net hospital. Clinical, pathologic, and treatment data were analyzed to assess recurrence, metastasis, and treatment outcomes.ResultsThe median tumor size was 7.6cm. Most patients (73%) presented with stage II disease. Surgical management included WLE alone (45.5%), WLE with radiation (27.3%), mastectomy alone (9.1%), and mastectomy with adjuvant radiation (18.2%). Local recurrence occurred in 3 patients (27.3%), all of whom were initially treated with surgery alone. Those who recurred received adjuvant radiation; no recurrences occurred after adjuvant radiation. One patient developed metastases and received systemic chemotherapy. Only 1 patient underwent genetic testing, which revealed a TP53 mutation.ConclusionsRecurrence occurred often despite margin-negative resections, highlighting the limitations of current surgical guidelines and the potential importance of tumor biology. These findings support a more individualized treatment approach that incorporates histologic features and, when appropriate, genetic testing. Adjuvant radiation may reduce the risk of recurrence in high-risk cases, although our small cohort precludes definitive conclusions. These findings should be considered hypothesis-generating and highlight the need for prospective or registry-based studies.

Abstract Aim To evaluate survival outcomes and recurrence patterns following curative-intent resection of pancreatic neuroendocrine tumours at a UK tertiary centre, and to identify prognostic clinicopathological factors. Method Patients undergoing curative-intent surgical resection for PNETs between August 2010 and March 2024 were retrospectively reviewed. Data included demographics, histopathology, recurrence, and survival outcomes. Results Eighty-six patients were included, with a median age of 61.5 years (IQR: 50–71) and equal sex distribution. Most tumours were solitary (88.4%), located in the pancreatic tail (57%), with distal pancreatectomy in 75% of cases. Median tumour size was 25 mm (IQR: 13–40). Lymph node metastases were seen in 23.3%, and R0 resection achieved in 67%. Tumours were predominantly WHO grade 1 (65.1%) or grade 2 (26.7%). Postoperative morbidity occurred in 37.2%, and mortality was 15%. Recurrence occurred in 13.95%, mainly as distant metastases (58.3%), with a median interval of 36.3 months. Five-year overall survival (OS) was 83.0%, with median OS and disease-free survival (DFS) of 143.3 and 147.0 months, respectively. Multivariate analysis showed shorter DFS was independently associated with larger tumour size (p = 0.009), higher grade (p = 0.006), male sex (p = 0.039), vascular (p = 0.003) and perineural invasion (p = 0.042), and nodal metastases (p = 0.015). OS was significantly influenced by Charlson Comorbidity Index (p &amp;lt; 0.001) and tumour grade (p = 0.025). Conclusions PNETs have excellent long-term survival following resection. However, adverse pathological features are linked to increased risk of recurrence and poorer prognosis.

The aim of this study was to evaluate the clinical outcomes of extensive submucosal dissection involving more than three-fourths of the circumference (eESD) for gastric epithelial neoplasia. Consecutive patients treated by eESD for gastric epithelial neoplasia were retrospectively included at 7 medical centers between 2015 and 2025. Short-term outcomes were en bloc resection, R0 resection, curative resection, procedure time, and adverse events, whereas long-term outcomes were local recurrence rate (LRR), simultaneous multiple carcinomas incidence rate (SMCIR), heterochronous multiple carcinomas incidence rate (HMCIR), and cancer metastasis incidence rate (CMIR). Forty-three patients with 47 lesions (median tumor size: 6.0cm) were analyzed. The en bloc resection, R0 resection, and curative resection rates were 100, 97.9, and 93.6%, respectively. The median procedure time was 115min. Two patients had postoperative fever (4.7%) and two patients had delayed bleeding (4.7%). Postoperative abdominal pain occurred in 30 patients (69.8%). No patient occurred intraoperative and delayed perforations. Eight patients experienced post-eESD pyloric stenosis (18.6%). Within a median follow-up of 32.0months, the LRR, SMCIR, HMCIR, and CMIR were 4.7, 2.3, 0.0, and 2.3%, respectively. Transverse extent of the mucosal defect more than 64mm was a significant risk factor for post-eESD pyloric stenosis (OR: 15.99, 95% CI: 1.56-163.66, P = 0.017). Tumor depth of invasion (submucosal invasion depth ≥ 500μm) was a significant risk factor for lymphovascular invasion (OR: 71.13, 95% CI: 3.03-1672.42, P = 0.008). eESD for gastric epithelial neoplasia might be technically feasible and highly curative treatment.

BACKGROUND Complete pathological response (CPR) after transcatheter arterial chemoembolization (TACE) is associated with improved posttransplant outcomes in patients with hepatocellular carcinoma (HCC). This study evaluated the prognostic significance of TACE-induced CPR in patients with HCC who underwent liver transplantation (LT). MATERIAL AND METHODS The records of 2238 patients who underwent primary LT for HCC between January 2006 and December 2020 were retrospectively reviewed; of these, 253 achieved explant pathology-confirmed TACE-induced CPR. Their clinical outcomes were analyzed. RESULTS These 253 patients underwent an average of 2.2±2.3 TACE sessions. The median number of non-viable tumors was 1, and the median maximal tumor size was 1.6 cm. At 1, 3, 5, 10, and 15 years, cumulative post-LT recurrence rates were 1.2%, 3.3%, 3.3%, 5.6%, and 5.6%, respectively; overall patient survival rates were 96.0%, 93.7%, 92.4%, 91.3%, and 82.1%, respectively. Larger tumors (>2 cm) and multiple non-viable tumors were independently associated with higher recurrence and reduced survival rates (P≤0.036). Cluster analysis identified patients with multiple non-viable tumors larger than 2 cm as a high-risk group; others comprised a low-risk group. Recurrence (P<0.001) and survival (P=0.018) rates were significantly lower in the high-risk group than in the low-risk group. CONCLUSIONS TACE-induced CPR is a strong prognostic indicator of favorable long-term outcomes after LT in patients with HCC. Stratification based on non-viable tumor size and number can identify high-risk patients with CPR who require closer surveillance. Less intensive follow-up may be sufficient for low-risk patients.

Robot-assisted thoracoscopy (RATS) is rapidly emerging as the preferred approach for the resection of thymic epithelial tumors (TET). Current challenges include the role of RATS in locally advanced disease and combined additional resections. This single-center study included all consecutive robot-assisted surgeries for TET performed between 2018 and 2024. We report perioperative outcomes and findings from a large center for robotic surgery center. One hundred and forty-three patients underwent RATS for the resection of histologically confirmed TET, including 130 (91%) patients with thymoma and 13 (9%) patients with thymic carcinoma. The median tumor size was 54 mm (35.5-75) and most patients presented in a localized stage of disease, with 120 patients (83.9%) in TNM stage I (TNM 8th edition). The conversion rate to open surgery was 4.2% and R0 resection was achieved in 134 (93.7%) patients. Combined extended resections that included lung, pericardium or great vessels were performed in 44 (30.8%) patients and were the only independent predictor of postoperative complications in a multivariable logistic regression model (OR 2.87; p = 0.03). Robot-assisted surgery is feasible and without unexpected safety concerns for TET. Combined extended resections, often necessary for locally advanced disease, are a significant predictor of postoperative complications.

Mural nodules arising in ovarian mucinous tumors are rare neoplasms encompassing anaplastic carcinoma, sarcoma-like mural nodules (SLMNs), and true sarcoma. Anaplastic carcinoma is characterized by pleomorphic, rhabdoid, and spindle cells, yet lacks specific prognostic markers. A previous report documented loss of SWI/SNF chromatin-remodeling complex proteins in anaplastic carcinoma, indicating a poor prognosis, but this finding has not been further explored. Fourteen cases of mural nodules (anaplastic carcinoma) arising in ovarian mucinous tumors are reviewed for clinical, morphological, and immunohistochemical (SMARCA4, SMARCA2, and SMARCB1) features. The median age was 42 years (range, 18-71 years). The median tumor size was 18 cm (range, 12-29 cm). Morphologically, 7 cases exhibited pleomorphic features, 3 exhibited sarcomatoid features, 3 exhibited rhabdoid features, and 1 case had mixed rhabdoid and sarcomatoid features. Immunohistochemically, five cases (36%) exhibited deficiency of at least one SWI/SNF subunit, including 2 with isolated loss of SMARCA2 (2/9), 1 with isolated loss of SMARCB1, and 2 with dual loss of SMARCA4/SMARCA2; no isolated loss of SMARCA4 was observed. Patients with loss of any SWI/SNF complex protein were younger than those with retained expression (median age, 34 vs. 52 years; p = 0.015). In univariate analysis, advanced FIGO stage (p = 0.018) and loss of SMARCA4 (p = 0.010) were associated with shorter overall survival (OS). Multivariate analysis confirmed that both advanced FIGO stage and loss of SMARCA4 were independent adverse prognostic factors. This study demonstrates the clinical utility of SWI/SNF complex evaluation, wherein SMARCA4 loss specifically pinpoints an aggressive tumor subset, providing a crucial tool for risk stratification.

Operative Considerations and Long-Term Outcomes after Resection of Primary Inferior Vena Cava Leiomyosarcomas with Caval Reconstruction.

Virilizing ovarian tumors (VOT) are rare in the paediatric population. The literature regarding their clinical spectrum, hormonal profile, imaging characteristics, histology, and outcomes is limited. Here, we perform a systematic review on the characteristics of paediatric VOT. A systematic review was conducted in accordance with PRISMA guidelines. Databases including PubMed and Google Scholar were searched to identify English-language reports of paediatric (< 20 years) VOT with biochemical evidence of hyperandrogenemia and histological confirmation of an ovarian neoplasm. Data on demographics, clinical features, hormone profiles, imaging, tumor histology, management and outcomes were extracted and analysed. A total of 117 paediatric patients (median age: 15 years) with VOT were included. The most common symptoms were hirsutism (73.5%), clitoromegaly (68.4%), menstrual irregularity (n = 79), and voice change (60.7%). Children < 8 years had shorter diagnostic latency with less frequent hyperandrogenic manifestations. Baseline 17-hydroxyprogesterone (17-OHP) and dehydroepiandrosteroe sulfate (DHEAS) were elevated in 70% and 18.3% of patients, respectively. Median tumor size was 6.6 cm, whereas tumors were bilateral in eight patients. Juvenile granulosa cell tumors and Sertoli-Leydig cell tumors were most common in the < 8 years and > 13 years groups, respectively. Recurrence was rare over a median follow-up of 1 year. Hyperandrogenic manifestations are less frequent in children < 8 years with VOT. Elevated 17-OHP and/or DHEAS should not exclude the possibility of VOT. Etiological spectrum of paediatric VOT is relatively age-specific. Larger multicenter studies with longer follow-up are warranted to better delineate prognosis and management strategies.

Robot-assisted partial nephrectomy with the Hugo™ RAS system: Perioperative outcomes from a single-center cohort including moderate-to-highly complex renal masses.

Same-Day versus Multiday Planning/Treatment Radioembolization with Yttrium-90 Resin Microspheres in Patients with Liver Cancer ≥5 cm.

Renal epithelioid angiomyolipoma: A multi-institutional, international cohort study with emphasis on clinicopathologic prognostic indicators.

BackgroundMagnetic seeds have comparable performance to guidewires in breast lesion localization with the advantages of shorter operating time, facilitated logistics, and higher staff satisfaction. However, the high cost of the device remains a concern and warrants health economic evaluation.MethodsThis is a predefined health economic analysis of a pragmatic RCT including 426 patients (median age of 65 (interquartile range (i.q.r.) 56–71) years, median BMI of 26.6 (i.q.r. 24.0–29.8) kg/m2, and a median tumour size of 11 (i.q.r. 8–15) mm) with non-palpable breast cancer, randomized to localization of the tumour with either a magnetic seed or a guidewire. Sentinel lymph node detection was performed using superparamagnetic iron oxide nanoparticles, enabling a totally magnetic approach. A cost-minimization analysis was conducted, from a healthcare system perspective, using unadjusted and adjusted analyses of costs.ResultsThe unadjusted analysis did not show any difference in incremental costs (guidewire €3337 versus magnetic seed €3274; difference −€63 (95% c.i. −€302 to €174); P = 0.599). The adjusted analysis, including marker, type of breast surgery performed, and single-session lesion and SLN localization, showed that the magnetic seed was associated with reduced costs (guidewire €3514 versus magnetic seed €3123; difference −€391 (95% c.i. −€422 to −€360); P = 0.002), corresponding to a 11.1% reduction. Sensitivity analyses did not change direction of outcome.ConclusionIn this predefined health economic analysis of an RCT, the use of magnetic seeds resulted in incremental cost containment, despite the increased cost of the device. Contributing factors included shorter localization time, shorter operating time, and process streamlining.

More than just stuck in the middle: papillary thyroid cancer of the isthmus may present with aggressive features and nodal metasasis.

Noninvasive follicular thyroid neoplasia with papillary-like nuclear characteristics (NIFTP) is characterised by an indolent behaviour and was defined in 2016 to avoid overtreatment in differentiated thyroid cancer (DTC). To report the clinicopathological characteristics and outcomes of patients with NIFTP treated at a Chilean centre between 2016 and 2023. Observational retrospective study. Of 1103 patients with thyroid neoplasia treated with surgery, 104 (9.42%) had NIFTP. Clinicopathological variables were recorded, including ultrasound characteristics, fine-needle aspiration biopsy (FNAB) results, genetic testing when available, type of surgery, tumour size, and follow-up data. Of 104 patients, 85 (81.7%) were female, age of 44 ± 14.2 years and a median tumour size of 1.7 cm (range 0.1-7.1). Eighty-six (82.7%) had available preoperative staging ultrasound: 1 (1.2%), 39 (45.3%), 38 (44.2%), and 8 (9.3%) were ACR-TIRADS 2, 3, 4, and 5, respectively. Sixteen (15%) NIFTP were incidental, which were smaller than non-incidental NIFTP (median 0.4 cm (0.1-2.2) vs. 1.9 cm (0.6-7.1), p < 0.001). Of the 86 FNAB results available, 2 (2.3%), 10 (11.6%), 20 (23.3%), 24 (27.9%), and 30 (34.9%) were Bethesda I, II, III, IV, and V, respectively. Forty-three patients (41.3%) were treated with lobectomy, 58 (55.8%) with total thyroidectomy (TT), and only 3 (2.9%) with TT and lymph node dissection. In Bethesda II patients, surgery was indicated in cases of nodule growth, showing a larger tumour size than other Bethesda categories (3.0 ± 1.4 vs. 1.8 ± 1.02 cm, p = 0.015). ThyroidPrint® was performed in 12 patients with Bethesda III or IV, resulting suspicious in 11 (92%): of these, 8 (67%) underwent lobectomy. There were no significant differences between lobectomy and TT regarding sex, ACR-TIRADS, tumour size, or ThyroidPrint® results. Twelve (11.5%) were multifocal and 5 (4.8%) bilateral. Fifty-two patients (54%) were followed for ≥ 1 year using follow-up criteria and response to treatment for low-risk DTC recurrence. Thirty-four (65%) had excellent response, 15 (28.8%) indeterminate (13 (25%) by biochemical criteria and 2 (3.8%) by ultrasound), 3 (5.7%) incomplete biochemical (2 (3.8%) due to elevated Tg and 1 (1.9%) due to elevated anti-Tg antibodies), and none with incomplete structural response. There were no differences between lobectomy and TT ± lymph node dissection regarding the type of response. At the end of the follow-up, there were no deaths, and no new interventions were required due to recurrence. In this series, NIFTP showed indolent behaviour and excellent prognosis. Ultrasonographically, 90% presented as ACR-TIRADS 3 or 4, with less than 10% as ACR-TIRADS 5. Regarding FNAB, nearly half were indeterminate, one-third were Bethesda V, and none Bethesda VI. No significant differences in clinical outcomes were found between lobectomy and TT.

The COVID-19 pandemic was associated with a decrease in the incidence of breast cancers in 2020 and was expected to be associated with advanced stage at presentation in the post-pandemic era. The primary objective of this study is to compare stage at presentation and biological tumor characteristics of breast cancers treated before and after the initial phase of the COVID pandemic. A retrospective chart review was performed of patients diagnosed with breast cancer within a single New York City health care system between March-August 2019 (pre-pandemic; PP) and March - August 2021 (post- acute phase pandemic; PAP). There were 381 patients with breast cancer in the 2019 PP cohort and 558 patients diagnosed in the 2021 PAP cohort. The PAP cohort was more likely to have a larger median tumor size (16mm vs 12mm, p < 0.001) and more tumors > 2cm at surgery (OR 1.48, p = .048). PAP patients were more likely to have node positive disease at surgery (OR 2.54, p = 0.0003), grade 3 tumors (OR 1.29, p = 0.046) and pathologic stage II or III disease at upfront surgery (OR 2.89, p = 0.003). The PAP cohort was also more likely to have > 24months since their last imaging test (p < 0.001) and less likely to have their breast cancer detected by screening breast MRI (OR .36, p = .016). Breast cancer diagnosed in the post-acute pandemic period had a greater odds of having a > 24-month interval since their last screening mammogram and pathologic stage II & III disease than pre-pandemic patients.

Neoadjuvant pembrolizumab and tyrosine kinase inhibitor to facilitate imperative partial nephrectomy for renal cell carcinoma.

Testicular frozen section examination on excisional biopsy (FSEB) is an underused pathological and surgical approach, considering the increasing number of small benign testicular lesions found on radical orchidectomy specimens. This study aims to determine the diagnostic accuracy of FSEB and to provide a pathological summary of the most frequent diagnoses and pitfalls. We report the pathological findings and definitive outcome of 135 FSEB for small testicular masses performed between 2005 and 2024 in a single institute. The median tumour size was 0.9 cm (Interquartile Range [IQR] 0.5-1.3 cm). The most common FSEB diagnoses were Leydig cell hyperplasia/tumour (n = 37; 28%) and seminoma (n = 36; 27%). On FSEB, benign diagnoses represented 58% of cases which allowed us to avoid 81 unnecessary radical orchidectomies. The sensitivity and specificity of FSEB for malignancy were 100% and 96.3%, respectively. Excluding three indeterminate cases on FSEB, the concordance rate was 97.7% (129/132). On definitive assessment, the majority of cases were benign (84/135, 62%) and 51 (38%) cases were malignant. The three indeterminate cases were ultimately confirmed as benign. There were three false-positive diagnoses of (favoured) malignancy and no false negatives. FSEB is accurate for patient management of small testicular lesions, allowing us to save young men from unnecessary radical orchidectomy. We provide an in-depth overview of the most prevalent pathological diagnoses encountered.