Current Oncology

The sacrum is a common site for a wide range of pathological processes, including benign and malignant tumors as well as non-neoplastic conditions. Accurate diagnosis of sacral lesions remains challenging due to overlapping imaging features and the anatomical complexity of the region. This review provides a comprehensive overview of sacral lesions, with emphasis on imaging characteristics, diagnostic challenges, and clinical implications. Key imaging findings are highlighted to help narrow the differential diagnosis. While certain imaging patterns may suggest specific etiologies, image-guided biopsy is often necessary for definitive diagnosis. Familiarity with the spectrum of sacral pathologies is essential for radiologists to effectively contribute to diagnosis, patient management, and multidisciplinary care.

Purpose: Choroid plexus papilloma (CPP) is a rare, benign intraventricular tumor that typically has an excellent long-term survival rate after gross total resection. Nevertheless, some patients develop delayed leptomeningeal dissemination (LMD) years after the initial diagnosis, a phenomenon that remains poorly understood. The authors encountered a case of CPP with delayed LMD 14 years after resection, which prompted this systematic review to identify potential risk factors. Methods: A systematic review was conducted according to PRISMA guidelines to identify CPP reports with subsequent delayed LMD. Studies of atypical CPP, choroid plexus carcinoma, or concurrent LMD at diagnosis were excluded. Extracted variables included demographics, tumor location, extent of resection, recurrence, proliferative index, and latency to dissemination. Results: Thirty patients developed delayed LMD after initial diagnosis. Seventeen patients underwent gross total resection, ten underwent subtotal resection, and three were unreported. Delayed LMD occurred with tumor recurrence in 14 patients. Histological transformation was observed in nine patients: eight progressed to aCPP and one to CPC. The extent of resection, recurrence, and tumor transformation were not significantly associated with delayed LMD. Conclusions: The pathogenesis and optimal treatment strategy of this phenomenon remain unclear. No significant risk factors for delayed LMD development in CPP were identified. Future studies incorporating molecular characterization are needed to clarify the mechanisms of LMD in patients with CPP and to improve risk stratification, underscoring the importance of lifelong surveillance and the integration of molecular profiling in clinical management.

(1) Background: Pancreatic cancer causes significant morbidity and mortality, and guidelines recommend early integration of palliative care alongside active treatment. As access to palliative care is often mediated by oncology clinicians, this survey sought to understand these clinicians’ perspectives on barriers and facilitators to clinician palliative care referral and patient palliative care access. (2) Methods: An online survey was distributed via community and academic institutions across Canada to oncology clinicians who were able to refer a pancreatic cancer patient to palliative care (e.g., oncology nurses, medical oncologists). (3) Results: Of 134 clinicians from ten provinces, almost all (97%) believe that palliative care is ‘very important’ in pancreatic cancer care. The greatest perceived barriers to patient palliative care access included patient-family reluctance to accept palliative care (73%), lack of knowledge about services (50%), and lack of support from other healthcare professionals (40%). Perceived barriers to referring included patient-family reluctance to accept palliative care (57%) and lack of available specialist services (58%). Most providers suggested patient education as a strategy to overcome barriers (85%). (4) Conclusions: Perceptions about public acceptance may preclude oncology clinicians from referring to palliative care, despite nearly universal belief in its importance. The findings highlight service and education gaps for future intervention.