Tumor Recurrence Research Articles

Evaluating the diagnostic performance of [18F]ALF-NOTA-FAPI-04 PET/CT in gastric cancer: a comparative study with [18F]FDG PET/CT.

To compare the diagnostic value of [18F]ALF-NOTA-FAPI-04 positron emission tomography/computed tomography (PET/CT) and 18F-fluorodeoxyglucose (FDG) PET/CT in gastric cancer. This single-center retrospective analysis included 65 patients with gastric cancer who received both [18F]FDG and [18F]ALF-NOTA-FAPI-04 PET/CT for initial staging or restaging. Histopathological manifestations, typical imaging manifestations, follow-up imaging, and comprehensive clinical assessment were used as reference criteria. The uptakes of [18F]FDG and [18F]ALF-NOTA-FAPI-04 PET were compared using the Wilcoxon signed-rank test. McNemar's test was employed to compare the diagnostic performance of the two imaging techniques. A total of 65 patients were included (26 male and 39 female; mean age, 54.03 ± 10.41 years), Among them, 10 were newly diagnosed, 46 underwent radical gastrectomy, and 9 received only chemotherapy prior to the study. Compared with [18F]FDG PET/CT, [18F]ALF-NOTA-FAPI-04 PET/CT showed higher sensitivity in primary or recurrent tumors (100% vs. 64.52%, p < 0.001)), lymph node metastases (88.89% vs. 38.89%, p = 0.006), distant metastases (91.18% vs. 50%, p < 0.001). From the semi-quantitative evaluation, the Maximum standardized uptake value (SUVmax) and target-to-background ratio of [18F]ALF-NOTA-FAPI-04 PET/CT were significantly higher than that of [18F]FDG PET/CT in primary or recurrent tumors, lymph node metastases, and distant metastases (all p < 0.001). Our study results indicate that [18F]ALF-NOTA-FAPI-04 PET/CT outperforms [18F]FDG PET/CT in the detection of primary or recurrent tumors, lymph node metastasis, and distant metastasis in gastric cancer. Question Early diagnosis and precise staging of gastric cancer are crucial for patient prognosis; however, current imaging techniques still face significant limitations. Findings [18F]ALF-NOTA-FAPI-04 PET/CT demonstrated significantly higher sensitivity than [18F]FDG PET/CT in detecting primary or recurrent tumors and metastases in patients with gastric cancer. Clinical relevance [18F]ALF-NOTA-FAPI-04 PET/CT is an advanced imaging diagnostic technique that significantly enhances the diagnostic accuracy for gastric cancer and its metastatic lesions. This technology provides robust support for clinical decision-making, thereby improving the management of patients with gastric cancer.

Mesenchymal stem/stromal cells: dedicator to maintain tumor homeostasis.

Mesenchymal stem/stromal cells （MSCs） act as a factor in tumor recurrence after drug treatment with their involvement observed in various cancer types. As a constituent of the tumor microenvironment (TME), MSCs not only provide support to tumor growth but also establish connections with diverse cell populations within the TME, serving as mediators linking different tumor-associated components. MSCs play an important role in maintaining tumor progression due to their stem cell properties and remarkable differentiation capacity. Given the intensification of tumor research and the encouraging results achieved in recent years，the aim of this article is to investigate the supportive role of MSCs in tumor cells as well as in various cellular and non-cellular components of the tumor microenvironment. Furthermore, the article shows that MSCs do not have a specific anatomical ecological niche and describes the contribution of MSCs to the maintenance of tumor homeostasis on the basis of homing, plasticity and tumor-forming properties. By elucidating the critical roles of different components of TME, this study provides a comprehensive understanding of tumor therapy and may offer new insights into defeating cancer.

The molecular landscape of 227 adult granulosa cell tumors of the ovary: Insights into the progression from primary to recurrence

Adult granulosa cell tumors (AGCTs) of the ovary are characterized by their propensity for late recurrences and are primarily managed surgically due to the limited efficacy of systemic treatment. The FOXL2 p.C134W somatic mutation has been identified in ∼95% of AGCT cases, and TERT promoter alterations have been linked to worse overall survival. This study highlights the potential prognostic significance of FOXO1 mutations, suggesting that they may be associated with poorer overall survival and shorter time to recurrence. A total of 183 primary AGCTs and 44 recurrences without corresponding primary tumors were analyzed. The primary AGCTs were categorized into three groups: 77 non-recurrent tumors, 18 tumors which later recurred (including 9 cases with matched primary-recurrence pairs), and 88 tumors with unknown recurrence status. Targeted next-generation sequencing was conducted on 786 cancer-related genes to investigate their genetic profile. The study aimed to identify the molecular alterations associated with AGCT pathogenesis and recurrence rate, comparing primary vs. recurrent tumors, and primary-recurrent vs. primary non-recurrent cases. Our findings confirmed the high prevalence (99%) of the FOXL2 p.C134W mutation in AGCTs. Secondary truncating FOXL2 mutations were observed in 5% of cases. Two cases with typical AGCT morphology were FOXL2 wild-type, harboring mutations in KRAS or KMT2D instead, suggesting alternative genetic pathways. TERT promoter mutations were found in 43% of cases, more frequently in recurrences. Other recurrent mutations detected in the cohort included KMT2D (10%), FOXO1 (7%), CHEK2 (5%), TP53 (3.5%), PIK3CA (3.5%), and AKT1 (3%). Two recurrent, FOXL2-mutated cases also carried DICER1 mutations. One tumor exhibited MSI-High status and a TMB of 19 mut/Mb. Our results indicate the need for further investigation into the role of FOXO1 as a potential prognostic marker in AGCTs.

Population Pharmacokinetic and Pharmacodynamic Study of Palbociclib in Children and Young Adults with Recurrent, Progressive, or Refractory Brain Tumors

Population Pharmacokinetic and Pharmacodynamic Study of Palbociclib in Children and Young Adults with Recurrent, Progressive, or Refractory Brain Tumors

Response to systemic therapies in patient-derived cell lines from primary and recurrent adult granulosa cell tumors.

In patients with the rare adult-type granulosa cell tumors (aGCT), surgery is the primary treatment for both primary and recurrent disease. In cases of inoperable disease, systematic therapy is administered, but variable response rates and drug resistance complicate predicting the most effective therapy. Drug screen testing on patient-derived cell lines may offer a solution. In a national prospective study on aGCT, fresh tissue was cultured into 2D cell lines, testing 27 clinically and experimental drugs. Dose-response curves and synergy were calculated using GraphPad Prism and Compusyn software. We established 34 patient-derived cell lines from tissue of 20 adult granulosa cell tumor patients. Of these, seven patients had a primary diagnosis of adult granulosa cell tumor and 13 patients had recurrent disease. In eight patients multiple tumor locations were cultured. On each cell line 10 monotherapies and 17 combinations of drugs were tested. Carboplatin/gemcitabine showed efficacy and synergy in almost all patient-derived cell lines. Synergy could not be detected in the regular carboplatin/paclitaxel and carboplatin/etoposide combinations. Experimental combinations alpelisib/fulvestrant and alpelisib/gemcitabine showed efficacy of more than 75%. Drug screens on patient-derived tumor cell lines reflects the reality of the variable response of systemic therapy in aGCT patients. In future research, this technique may be used to personalize the systemic treatment of aGCT patients in a clinical study. The good response to carboplatin/gemcitabine in our patient-derived cell lines can then be confirmed in a clinical setting.

Automated brain tumor recognition using equilibrium optimizer with deep learning approach on MRI images

Brain tumours (BT) affect human health owing to their location. Artificial intelligence (AI) is intended to assist in diagnosing and treating complex diseases by combining technologies like deep learning (DL), big data analytics, and machine learning (ML). AI can identify and categorize tumours by analyzing brain imaging approaches like Magnetic Resonance Imaging (MRI). The medical sector has been promptly shifted by evolving technology, and an essential element of these transformations is AI technology. AI model determines tumours’ class, size, aggressiveness, and location. This assists medical doctors in making more exact diagnoses and treatment plans and helps patients better understand their health. Also, AI is used to track the progress of patients through treatment. AI-based analytics is used to predict potential tumour recurrence and assess treatment response. This study presents Brain Tumor Recognition using an Equilibrium Optimizer with a Deep Learning Approach (BTR-EODLA) technique for MRI images. The BTR-EODLA technique intends to recognize whether or not a BT presence exists. In the BTR-EODLA technique, median filtering (MF) is deployed to eliminate the noise in the input MRI. Besides, the squeeze-excitation ResNet (SE-ResNet50) model is applied to derive feature vectors, and its parameters are fine-tuned by the design of the EO model. The BTR-EODLA technique utilizes the stacked autoencoder (SAE) model for BT detection. A sequence of experiments is performed to ensure the improved performance of the BTR-EODLA technique. The investigational validation of the BTR-EODLA technique portrayed a superior accuracy value of 98.78% over existing models.

Absorbable Haemostatic Artefacts as a Diagnostic Challenge in Postoperative Follow-Up After Oncological Resection in Head and Neck Tumours: Systematic Review of Current Literature and Two Case Reports

Objectives: This article aims to define the clinical, radiological, and pathological characteristics of non-resorbed oxidised cellulose-induced pseudotumours to raise awareness among surgeons and radiologists, to prevent misdiagnosis, and avoid unnecessary invasive procedures and delays in adjuvant oncological treatments. Methods: A systematic review of oxidised resorbable cellulose (ORC)-induced pseudotumours of the head and neck was conducted following PRISMA 2020 guidelines. Articles were retrieved from PubMed, Scopus, Cochrane, and Web of Science. Two ORC-induced pseudotumour cases from the Maxillofacial Surgery Department of Verona are also presented. Results: In most cases, pseudotumours were monitored using ultrasound. Further investigations included CT, MRI, PET-CT, and scintigraphy. Ultrasound images showed stable, elongated, and non-homogeneous masses. In CT scans, pseudotumours showed a liquefied core, and none or only peripheral enhancement. In MRI, pseudotumours presented none or only peripheral enhancement, and a heterogeneous pattern in T2-weighted images. 18-FDG PET scans demonstrated an FDG-avid mass (SUV 7.5). Scintigraphy was inconclusive. Cytology indicated a granulomatous reaction without neoplastic cells. Where surgical excision was performed, a granulomatous reaction with the presence of oxidised cellulose fibres was confirmed. Conclusions: Surgeons should consider artifacts from retained oxidised absorbable haemostatic material when suspecting tumour recurrence or metastasis on postoperative imaging, especially if certain features are present. Fine-needle aspiration cytology (FNAC) is a useful diagnostic tool, but surgical excision may be needed if FNAC is inconclusive or impractical. Collaboration between surgeons and radiologists is essential to avoid misdiagnosis and delays in treatment. Documenting the use and location of haemostatic material in operative reports would aid future understanding of these phenomena.

The role of NLRP3 and NLRP12 inflammasomes in glioblastoma.

Glioblastoma (GBM) is the deadliest malignant brain tumor, with a survival of less than 14 months after diagnosis. The highly invasive nature of GBM makes total surgical resection challenging, leading to tumor recurrence and declined survival. The heterocellular composition of the GBM reprograms its microenvironment, favoring tumor growth, proliferation, and migration. The innate immune cells in the GBM tumor microenvironment, including microglia, astrocytes, and macrophages, express pattern recognition receptors such as NLRs (Nucleotide-binding domain and leucine-rich repeat-containing) that sense pathogen- and damage-associated molecular patterns initiating inflammation. Upon activation, NLRP3 promotes inflammation by NLRP3 inflammasome formation. Auto-proteolytic cleavage and activation of Caspase-1 within the inflammasome leads to caspase-1-mediated cleavage, activation, and conversion of pro-IL-1ß and pro-IL-18 to IL-1ß and IL-18, leading to pyroptosis. In contrast, NLRP12 downregulates inflammatory responses in microglia and macrophages by regulating the NF-κB pathway. NLRP3 and NLRP12 have been implicated in the disease pathophysiology of several cancers with cell-context-dependent, pro- or anti-tumorigenic roles. In this review, we discuss the current literature on the mechanistic roles of NLRP3 and NLRP12 in GBM and the gaps in the scientific literature in the context of GBM pathophysiology with potential for targeted therapeutics.

A Rare Case of Peripheral Osteoma of the Alveolar Bone of the Maxilla in a 13-Year-Old Boy

Background: This report aims to augment the presently limited knowledge on the characteristics of jawbone osteomas in children by presenting an exceptionally rare case of this tumor located on the buccal aspect of the alveolar process of the maxilla in a 13-year-old boy. Methods: A well-defined, painless, bony, hard, spherical enlargement on the maxillary alveolar ridge was identified and thoroughly evaluated through clinical examination, panoramic radiographs, CBCT (Cone Beam Computed Tomography) scans, and histopathological analysis. The tumor was surgically removed, and the patient participated in postoperative clinical follow-ups for eight years. Results: Based on the clinical characteristics and CBCT scan findings, a jawbone tumor was suspected. After histopathological analysis, the definitive diagnosis was a peripheral trabecular osteoma. There were no signs of tumor recurrence during the postoperative follow-up period. Conclusions: This report presents the youngest documented case of peripheral osteoma in the maxillary alveolar ridge, and highlights the need to consider this rare lesion in the differential diagnosis of similar pathological changes in this region, even in pediatric patients. The absence of clinical signs of recurrence over eight years of follow-up underscores the long-term stability and favorable prognosis of peripheral jawbone osteoma in children.

Myriad factors and pathways influencing tumor radiotherapy resistance

Abstract Radiotherapy is a cornerstone in the treatment of various tumors, yet radioresistance often leads to treatment failure and tumor recurrence. Several factors contribute to this resistance, including hypoxia, DNA repair mechanisms, and cancer stem cells. This review explores the diverse elements that drive tumor radiotherapy resistance. Historically, resistance has been attributed to cellular repair and tumor repopulation, but recent research has expanded this understanding. The tumor microenvironment – characterized by hypoxia, immune evasion, and stromal interactions – further complicates treatment. Additionally, molecular mechanisms such as aberrant signaling pathways, epigenetic modifications, and non-B-DNA structures play significant roles in mediating resistance. This review synthesizes current knowledge, highlighting the interplay of these factors and their clinical implications. Understanding these mechanisms is crucial for developing strategies to overcome resistance and improve therapeutic outcomes in cancer patients.

Percutaneous radiofrequency ablation of hepatocellular carcinomas abutting the right posterior diaphragm: factors associated with tumor recurrence and overall survival.

Radiofrequency ablation (RFA) of subphrenic hepatocellular carcinomas (HCCs) using ultrasound (US) guidance presents a challenge. To evaluate local tumor progression (LTP) and overall survival (OS) after RFA of right posterior subphrenic HCCs, and to identify the risk factors for LTP and OS after RFA. We screened patients who underwent US-guided RFA for a single HCC <3 cm in the right posterior subphrenic area. Cumulative rates of LTP and OS were compared between multiple- and single-electrode treatments and artificial pleural effusion versus no-effusion groups using Kaplan-Meier curves and the log-rank test. The risk factors for LTP and OS were assessed. A total of 36 patients were included. The cumulative 5-year and 10-year LTP rates were 32.9% and 39.6%, respectively, and the corresponding OS rates were 72.2% and 48.7%, respectively. The multiple-electrode group had significantly lower cumulative LTP rates compared to the single-electrode group (P < 0.001). The group receiving artificial pleural effusion showed a trend towards lower LTP rates than the no-effusion group (P = 0.076). The albumin-bilirubin (ALBI) grade was the only risk factor for LTP (hazard ratio [HR] = 4.17, 95% confidence interval [CI] = 1.26-14.55; P = 0.020). A lower albumin level was a risk factor for mortality (HR = 0.24, 95% CI = 0.07-0.79; P = 0.020). US-guided RFA with multiple electrodes and artificial pleural effusion tends to be linked with lower LTP rates. The ALBI grade and serum albumin level are risk factors for LTP and OS, respectively.

A Retrospective Radiologic Analysis of the Treatment Outcomes of Ameloblastomas

ABSTRACTIntroductionThe current study reviewed the postoperative radiologic findings of 156 cases of ameloblastoma diagnosed at a tertiary institution in South Africa.MethodsHistologically diagnosed cases of ameloblastomas between 2012 and 2022 were retrospectively reviewed. Only cases with both pre‐ and postoperative radiographs of diagnostic quality were included in the study. The demographics, treatment and follow‐up radiologic findings, including recurrences, were assessed. This clinical data was collected from all available patient records and histopathologic reports.ResultsSeventy‐nine cases of ameloblastoma (50.97%) diagnosed at the institution had post‐treatment radiographs available and were included in the study for further analysis. Conservative treatment, including marsupialisation and/or enucleation, was performed in 11 cases (13.92%). The recurrence rate for conservatively treated cases was 44.4% after a mean follow‐up of 31.4 months. Tumour resection was performed in 72 cases (91.1%), including 4 recurrent cases previously treated conservatively. Tumour recurrence was only noted in 4 cases (7.5%) treated via surgical resection after a mean follow‐up of 25 months. Spontaneous bone regeneration was seen in 19 cases (35.8%) of ameloblastomas treated via surgical resection.ConclusionAmeloblastomas are benign neoplasms with high recurrence rates, emphasising the need for appropriate treatment and extended follow‐up periods. The high recurrence rate reported in cases of ameloblastoma managed conservatively highlighted its inappropriate use in treating conventional subtypes. The presence of bony regeneration in this study was higher than the reported literature, correlating with the overall younger age of the current sample.

Asystematic review and meta-analysis of clinical prognostic factors linked to extravesical recurrence after radical nephroureterectomy to treat upper tract urothelial carcinoma

ObjectiveNumerous studies have investigated predictors of intravesical recurrence following radical nephrectomy (RNU) in patients with upper urinary tract uroepithelial carcinoma (UTUC). In contrast, extravesical recurrence (EUR) has received less focus. Consequently, this study aims to evaluate the significant predictors of EUR after RNU through a systematic review of the literature and a meta-analysis.MethodologyWe conducted a computerized bibliographic search across PubMed, Embase, and Cochrane databases to identify reports that include detailed results from multivariate analyses of predictors of EUR. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) criteria, we selected thirteen retrospective studies, each with a sample size exceeding 100 cases. Using Review Manager 5.4 software, we performed cumulative analyses of available HR and their corresponding 95% confidence intervals to evaluate potential predictors of EUR.ResultsOur findings indicate that patient-specific predictors include preoperative Ki-67 with a HR of 3.61 (P = 0.003), neutrophil-to-lymphocyte ratio with an HR of 2.20 (P = 0.0005), and glomerular filtration rate with an HR of 3.35 (P = 0.0009). Tumor-specific predictors identified were tumor stage with an HR of 4.67 (P &amp;lt; 0.00001), lymphovascular invasion with an HR of 2.37 (P = 0.004), and lymph node status with an HR of 2.68 (P &amp;lt; 0.0001). Regarding treatment-specific predictors, positive surgical margins were associated with an HR of 3.97 (P = 0.0005), and adjuvant chemotherapy was associated with an HR of 1.65 (P = 0.03).DiscussionOur study identified three significant predictors across patient, tumor, and treatment dimensions for extravesical recurrence following radical nephroureterectomy in patients with upper urinary tract uroepithelial carcinoma. We hypothesize that history of bladder cancer, platelet-to-lymphocyte ratio, and urinary cytology could also be strong predictors of post- RNU extravesical recurrence in patients with upper UTUC, assuming adequate sample size and controlled heterogeneity. This research aims to provide urological clinicians with enhanced guidance for postoperative decision-making.

18F-FET PET/CT can aid in diagnosing patients with indeterminate MRI findings for brain tumors: a prospective study.

This prospective study aimed to evaluate the diagnostic value of fluorine-18-labeled fluoroethyltyrosine (18F-FET) positron emission tomography (PET)/computed tomography (CT) in diagnosing brain tumors within an Asian patient population. Patients suspected of having primary or recurrent brain tumors were prospectively recruited. Each patient underwent 18F-FET and fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT on separate days within 1week. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy to compare the diagnostic performance of the two PET scans. The standardized uptake value (SUV) and tumor-to-background ratio (TBR) of the lesions were determined using static images. Additionally, time-activity curves (TACs) and time-to-peak (TTP) were generated from the dynamic PET images. From September 2019 to December 2023, 33 subjects were enrolled for reasons including suspected brain tumors (n = 20) or suspicious glioma recurrence (n = 8) on magnetic resonance imaging (MRI) and restaging for glioma (n = 5). Among the patients with suspected brain tumors or glioma recurrence on MRI, 25% had false-positive results. 18F-FET PET/CT accurately identified 86% of these false positives. The sensitivity, specificity, PPV, NPV, and accuracy of visual interpretation of 18F-FET PET/CT were 96.2%, 85.7%, 96.2%, 85.7%, and 93.9%, respectively. The corresponding 18F-FDG PET/CT values were 73.1%, 71.4%, 90.5%, 41.7%, and 72.7%. 18F-FET PET/CT demonstrated significantly higher sensitivity and accuracy than 18F-FDG PET (p = 0.031 and p = 0.030, respectively). Using TBRmean as an adjunct reference index enhanced the diagnostic accuracy of 18F-FET PET/CT, achieving a sensitivity and NPV of 100%. Wash-out TAC or TTP < 20min was associated with a PPV of 100% for brain tumors. 18F-FET PET/CT appears to be a valuable tool for assessing brain tumors with indeterminate MRI findings in this Asian cohort. 18F-FET PET/CT offers benefits over 18F-FDG PET in differentiating brain tumors from nontumor brain lesions, particularly when using semiquantitative analysis with TBR. This study was registered on CinicalTrial.gov (NCT06563024).

Decoding Chemotherapy Resistance of Undifferentiated Pleomorphic Sarcoma at the Single Cell Resolution: A Case Report

Background: Undifferentiated pleomorphic sarcoma (UPS) is a highly malignant mesenchymal tumor that ranks as one of the most common types of soft tissue sarcoma. Even though chemotherapy increases the 5-year survival rate in UPS, high tumor heterogeneity frequently leads to chemotherapy resistance and consequently to recurrences. In this study, we characterized the cell composition and the transcriptional profile of UPS with resistance to chemotherapy at the single cell resolution. Methods: A 58-year-old woman was diagnosed with a 13.6 × 9.3 × 6.0 cm multi-nodular tumor with heterogeneous cysto-solid structure at the level of the distal metadiaphysis of the left thigh during magnetic resonance tomography. Morphological and immunohistochemical analysis led to the diagnosis of high-grade (G3) UPS. Neoadjuvant chemotherapy, surgery (negative resection margins), and adjuvant chemotherapy were conducted, but tumor recurrence developed. The UPS sample was used to perform single-cell RNA sequencing by chromium-fixed RNA profiling. Results: Four subpopulations of tumor cells and seven subpopulations of tumor microenvironment (TME) have been identified in UPS. The expression of chemoresistance genes has been detected, including KLF4 (doxorubicin and ifosfamide), ULK1, LUM, GPNMB, and CAVIN1 (doxorubicin), and AHNAK2 (gemcitabine) in tumor cells and ETS1 (gemcitabine) in TME. Conclusions: This study provides the first description of the single-cell transcriptome of UPS with resistance to two lines of chemotherapy, showcasing the gene expression in subpopulations of tumor cells and TME, which may be potential markers for personalized cancer therapy.

1H-MRS parameters in non-enhancing peritumoral regions can predict the recurrence of glioblastoma

This study aimed to evaluate the predictive value of metabolic parameters in preoperative non-enhancing peritumoral regions (NEPTRs) for glioblastoma recurrence, using multivoxel hydrogen proton magnetic resonance spectroscopy (1H-MRS). Clinical and imaging data from patients with recurrent glioblastoma were analyzed. Through co-registration of preoperative and post-recurrence MRI, we identified future tumor recurrence regions (FTRRs) and future non-tumor recurrence regions (FNTRRs) within the NEPTRs. Metabolic parameters were recorded separately for each region. Cox regression analysis was applied to assess the association between metabolic parameters and glioblastoma recurrence. Compared to FNTRRs, FTRRs exhibited a higher Cho/Cr ratio, higher Cho/NAA ratio, and lower NAA/Cr ratio. Both Cho/NAA and Cho/Cr ratios were recognized as risk factors in univariate and multivariate analyses (P < 0.05). The Cox regression model indicated that Cho/NAA > 1.99 and Cho/Cr > 1.73 are independent risk factors for early glioblastoma recurrence. Based on these cut-off values, patients were stratified into low-risk and high-risk groups, with a statistically significant difference in recurrence rates between the two groups (P < 0.01). The Cho/NAA and Cho/Cr ratios in NEPTRs are independent predictors of future glioblastoma recurrence. Specifically, Cho/NAA > 1.99 and/or Cho/Cr > 1.73 in NEPTRs may indicate a higher risk of early postoperative recurrence at these regions.

Exposition of an unusual presentation: a case report of benign tumor arising from an uncommon origin

The inverted papilloma is a benign neoplasm that originates from the sinonasal mucosa, which is also referred to as a Ringertz tumor. It mostly affects men, falling within the age groups of 50 to 60 years. Our case is rare of its type as it was present in an unusual site, which is from the middle turbinate. Here in our study, we report a case of a 25-year-old female presented to the ENT outpatient department with complaints of left-sided nasal obstruction for 4 years. The patient had noticed a pinkish mass in the left nasal cavity. She complained of intermittent episodes of left-sided nasal bleeds. The patient was planned for functional endoscopic sinus surgery with a partial middle turbinectomy under general anaesthesia. Histopathological examination showed polypoidal tissue fragments lined predominantly by non-keratinized stratified squamous epithelium, along with focal areas lined by respiratory-type pseudostratified columnar epithelium and transitional epithelium, with multiple foci of inward proliferation of the epithelium in the form of nests into the underlying sub epithelium with an intact basement membrane, which is suggestive of inverted papilloma. After one week of postoperative follow-up, patient’s symptoms of nasal obstruction were relieved. During the subsequent 6 months of follow-up, the patient had no evidence of tumor recurrence. In our case, we wanted to emphasize that not all cases that do not involve the maxillary sinus or the medial wall of the maxilla on a CT scan require medial maxillectomy.

An innovative approach to the multidisciplinary treatment of uninsured breast cancer patients.

A significant proportion of many populations remain uninsured. The aim of the study was to assess differences in breast cancer outcomes before and after the implementation of an innovative approach to the multidisciplinary treatment of uninsured breast cancer patients. Retrospective review was performed of patients seen at a safety net hospital from January 2000 to December 2020. Beginning July 2006, an innovative approach was implemented to lower patient costs and facilitate care of uninsured patients. The study included 1,797 patients, 661 patients before the changes (BCS), and 1136 patients after implementation of the new cost saving approach (ACS). The mean age was 53years. The majority were uninsured (56%) or insured by Medicaid (31%). Only 18% underwent screening mammography. The ACS group had a higher rate of breast conservation (75% vs 47%, p < 0.001). A higher percentage of the ACS group received adjuvant therapy: Chemotherapy (91% vs 70%, p < 0.001), Radiation therapy (91% vs 70%, p < 0.001), and initiated endocrine therapy (87% vs 67%, p < 0.001). After follow-up of 8years, these changes resulted in lower ipsilateral breast tumor recurrence (2% vs 16%, p < 0.001) and chest wall recurrence (5% versus 8%) and improvement in overall survival (90% vs 81%, p < 0.001). Peer-reviewed literature is replete of studies documenting disparities in breast cancer treatment. The current study describes a successful cost-limiting method which takes advantage of existing financial assistance programs to improve care in uninsured patients.

Prolonged clinical response is possible with regorafenib in refractory osteosarcoma: A case report

&lt;b&gt;Background:&lt;/b&gt; Treatment options for metastatic unresectable osteosarcoma are limited, and there is no standard approach after the failure of first-line chemotherapy. Conventional chemotherapy in the second and subsequent lines typically yield a median progression-free survival (PFS) of less than 4 months, with objective response rates ranging from 3 to 29%. The activity of anti-vascular endothelial growth factor receptor multi-tyrosine kinase inhibitors (TKIs) in bone sarcomas has been demonstrated. We present a case of metastatic osteosarcoma exhibiting a durable response to regorafenib treatment.&lt;br /&gt; &lt;b&gt;Case: &lt;/b&gt;We discuss a 30-year-old male with metastatic osteosarcoma who had extensive bone and lung metastases and was ineligible for metastasectomy. The patient had received all active chemotherapy regimens in the early and metastatic stages except ifosfamide. Next generation sequencing analysis of resected tumor tissue revealed a possibly pathogenic missense mutation (P.G472E) in NOTCH1 gene. Due to the presence of heart failure with a reduced ejection fraction, chemotherapy was not considered, and regorafenib was initiated. After four cycles of regorafenib, a partial metabolic response was achieved. The patient was followed up without progression under regorafenib for 15 months, without requiring dose reduction. Unfortunately, the treatment had to be interrupted for an extended period due to challenges with recurrent tumor infection and the necessity for repeated surgeries. Following successful wound site control, we restarted full-dose regorafenib and achieved a metabolic partial response again.&lt;br /&gt; &lt;b&gt;Conclusion: &lt;/b&gt;To our knowledge, this case represents the longest achieved PFS with regorafenib in metastatic osteosarcoma. TKIs can provide a durable clinical response in metastatic osteosarcoma patients. Clinical and molecular biomarkers are required to determine which patients are most likely to benefit from these treatments.

Evaluating the Accuracy and Efficiency of Imaging Modalities in Guiding Ablation for Metastatic Spinal Column Tumors: A Systematic Review

Background/Objectives: Spinal metastases are a frequent and serious complication in cancer patients, often causing severe pain, instability, and neurological deficits. Thermal ablation techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) have emerged as minimally invasive treatments. These techniques rely on precise imaging guidance to effectively target lesions while minimizing complications. This systematic review aims to compare the efficacy of different imaging modalities—computed tomography (CT), magnetic resonance imaging (MRI), fluoroscopy, and mixed techniques—in guiding thermal ablation for spinal metastases, focusing on success rates and complications. Methods: A systematic literature search was conducted across PubMed, OVID, Google Scholar, and Web of Science databases, yielding 3733 studies. After screening, 51 studies met the eligibility criteria. Data on success rates, tumor recurrence, complications, and patient outcomes were extracted. Success was defined as no procedure-related mortality, tumor recurrence or expansion, or nerve injury. This systematic review followed PRISMA guidelines and was registered with PROSPERO (ID: CRD42024567174). Results: CT-guided thermal ablation demonstrated high success rates, especially with RFA (75% complete success). Although less frequently employed, MRI guidance showed lower complication rates and improved soft-tissue contrast. Fluoroscopy-guided procedures were effective but had a higher incidence of nerve injury and incomplete tumor control. Mixed imaging techniques, such as CBCT-MRI fusion, showed potential for reducing complications and improving targeting accuracy. Conclusions: CT remains the most reliable imaging modality for guiding thermal ablation in spinal metastases, while MRI provides enhanced safety in complex cases. Fluoroscopy, although effective for real-time guidance, presents limitations in soft-tissue contrast. Mixed imaging techniques like CBCT-MRI fusion offer promising solutions by combining the advantages of both CT and MRI, warranting further exploration in future studies.