Search Results (587)

Background/Objectives: Oligometastatic GIST, defined in this study as five or fewer metastatic lesions confined to a single organ, represents a distinct subset with a lower metastatic burden than widely metastatic disease and may have different prognostic and therapeutic considerations. Methods: We reviewed biopsy-proven oligometastatic GIST diagnosed between August 1998 and June 2025 from a prospectively maintained institutional database, collecting genomic, metastatic, treatment, ethnicity, and survival data. Overall survival (OS), calculated from diagnosis of oligometastatic disease, was estimated by Kaplan–Meier analysis and compared using the log-rank test. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards regression. Results: Of 525 subjects with GIST in our database, 96 (18.3%) had oligometastatic GIST (median age: 54 years; median OS from diagnosis of oligometastatic disease: 9.77 years). Most tested tumors were KIT-positive (91.6%), predominantly harboring KIT exon 11 alterations (69.5%). The most common metastatic sites were the liver (n = 44) and peritoneum (n = 37). Overall, 58 patients underwent surgery, including 55 cytoreductive procedures and 3 emergent operations for bleeding or obstruction. Among the cytoreductive procedures, indications included multifocal disease after tyrosine kinase inhibitor (TKI) response (n = 21), unifocal disease after TKI response (n = 18), unifocal progression on TKI (n = 13), and equivocal or undocumented TKI response (n = 3). Overall survival did not differ by liver versus peritoneal metastases (HR: 1.27; 95% CI, 0.59–2.70; p = 0.540) or Hispanic versus non-Hispanic ethnicity (HR: 0.81; 95% CI, 0.34–1.90; p = 0.624). Cytoreductive surgery combined with systemic therapy was associated with longer overall survival than systemic therapy alone (10.8 vs. 7.4 years; HR: 0.44; 95% CI, 0.22–0.89; p = 0.019). Conclusions: In this retrospective cohort, cytoreductive surgery combined with systemic therapy was associated with longer overall survival than systemic therapy alone. Full article

Background/Objectives: Robotic surgery offers an additional minimally invasive option for gastric gastrointestinal stromal tumor (GIST) resection, particularly in anatomically demanding locations. Evidence regarding its integration into routine surgical practice remains limited. This study evaluated the evolution of surgical approaches for primary localized gastric GIST following the introduction of an institutional robotic program. Methods: We retrospectively analyzed 44 consecutive patients who underwent curative-intent resection for primary localized gastric GIST at a tertiary referral center between July 2015 and June 2025. Surgical management and perioperative outcomes were described for an early era (2015–2021; n = 29) and a later era after the introduction of robotic surgery (2022–2025; n = 15). Results: Overall, 22 procedures were completed laparoscopically, six robotically, and 13 through a primary open approach; three laparoscopic procedures were converted to open surgery. In the later era, robotic surgery accounted for 40.0% of resections, and no conversions occurred. The proportion of completed minimally invasive resections was 62.1% in the early era and 66.7% in the later era. R0 resection was achieved in all patients, and no tumor rupture was documented. Median operative time was 73.5 min, median postoperative length of stay was 7.5 days, and major morbidity occurred in six patients (13.6%). One patient (2.3%) died from sepsis within 30 days after reoperation for a postoperative gastric suture-line leak. Conclusions: Following the introduction of robotic surgery, management of primary gastric GIST evolved toward a more diversified and individualized surgical strategy. Robotic surgery was incorporated as an additional minimally invasive option, while the overall proportion of completed minimally invasive resections remained stable. These findings represent an early institutional experience and do not establish equivalence or comparative superiority among surgical approaches. Full article

Background: Substantial inter-individual variability in imatinib systemic exposure may influence both efficacy and toxicity. Based on recommendations of the International Association for Therapeutic Drug Monitoring and Clinical Toxicology (IATDMCT), the IRCCS-CRO of Aviano started in 2018 offering physicians the opportunity to monitor plasma concentrations of imatinib and its active metabolite, norimatinib, as part of a diagnostic service for patients with Gastrointestinal Stromal Tumor (GIST). This study aims to evaluate the potential clinical utility of imatinib Therapeutic Drug Monitoring (TDM) in predicting response and toxicity in a real-world cohort of 63 patients with GIST. Methods: Imatinib and its active metabolite norimatinib trough concentrations (C_min) were quantified using a validated LC–MS/MS method. Associations between drug exposure and clinical–demographic characteristics, treatment-related toxicity, and progression-free survival (PFS) were evaluated. Results: A total of 437 plasma samples from 63 patients were collected. Marked inter- and intra-patient variability in imatinib exposure was observed (43% and 31% respectively); 67% of patients receiving 400 mg/day had a C_min below the recommended target concentration (1100 ng/mL). Female sex was significantly associated with higher imatinib exposure (median C_min 1114 vs. 786 ng/mL in males; p = 0.0018). Combined age–sex analysis showed a significant difference between women and men < 60 years (1041 vs. 668 ng/mL; p = 0.0068, Bonferroni-adjusted). A strong exposure–toxicity relationship emerged, with higher imatinib levels in samples collected at toxicity occurrence vs. the others (1728 vs. 927 ng/mL; p < 0.0001), without a direct association between sex and toxicity. No significant association between C_min and PFS was observed; however, disease progression was more frequent in patients with C_min < 500 ng/mL and absent in those with C_min >1500 ng/mL (60% vs. 0%, respectively). Conclusions: TDM was found to be a potentially useful tool for predicting clinically relevant toxicity and outcome. Sex and age significantly influence exposure, supporting tailored dosing strategies. Full article

Background/Objectives: Three-dimensional (3D) reconstruction of contrast-enhanced computed tomography (CT) data has shown value in elective hepato-pancreato-biliary (HPB) surgery, but its role in complex abdominal emergencies remains poorly defined. Complex emergency HPB operations are high-acuity procedures in which precise preoperative anatomical knowledge directly influences outcome, because inadequate characterization of vascular relationships in these operations may lead to intraoperative catastrophe, unrecognized vascular injury, incomplete resection, or perioperative death. We report a retrospective proof-of-concept case series designed to test whether 3D reconstructions generated from preoperative CT datasets, when read by an operator blinded to the intraoperative findings, correspond to the intraoperative findings used as ground truth and provide anatomical information beyond the original conventional CT report. Methods: Single-center retrospective consecutive case series of five patients who underwent complex emergency HPB surgery at the Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor,” Cluj-Napoca, Romania, between July 2018 and July 2022. All operations were guided by conventional contrast-enhanced CT. Three-dimensional reconstructions were generated after surgery, from the archived preoperative CT datasets by a single reader who was blinded to the intraoperative findings, to the operative note, and to the histopathological diagnosis. The 3D reconstructions were compared qualitatively with the intraoperative findings (ground truth) and with the original radiological report. Results: Five patients (3 women, 2 men; mean age 62.2 years) were analyzed: a right colonic flexure tumor with duodenal invasion, a duodenal gastrointestinal stromal tumor (GIST), an aortoduodenal fistula, a complex bilioduodenal fistulization with right hepatic artery pseudoaneurysm, and a periampullary tumor in contact with the inferior vena cava (IVC). In all five cases the blinded 3D reconstruction corresponded closely with the intraoperative findings, whereas the original conventional CT report did not match the intraoperative ground truth as precisely—particularly with respect to the exact location, the longitudinal and circumferential extent, and the local topography of vascular involvement and of fistulous tracts. Conclusions: Under blinded retrospective comparison, post hoc 3D reconstructions—generated through independent reassessment of the archived CT imaging by a reader blinded to the intraoperative findings—corresponded more closely with intraoperative findings than the original same-day emergency CT report in depicting vascular topography across five complex emergency HPB operations. These hypothesis-generating findings motivate a prospective study of preoperative 3D reconstruction within the emergency imaging pathway. Full article

Ewing sarcoma is a highly malignant tumor whose histological appearance often overlaps with that of other undifferentiated round-cell and ovoid-cell tumors, making accurate diagnosis challenging. Selecting the most appropriate immunohistochemical and molecular tests is critical, particularly when only limited core biopsy material is available and tissue preservation for additional molecular or biomarker testing is required. Artificial intelligence (AI)-based histopathological image analysis is emerging as a promising diagnostic tool in oncology. This study evaluated the potential of AI-based histopathological analysis to assist pathologists in the morphologic classification of Ewing sarcoma and selected histological mimics using tissue microarrays (TMAs), rather than to identify or predict molecular alterations. We analyzed 1926 digitized histological cores, from 729 patients, assembled into 45 tissue microarrays. The dataset comprised 517 Ewing sarcomas (ESs), 367 rhabdomyosarcomas (RMSs), 187 chondrosarcomas (CHSs), 138 gastrointestinal stromal tumors (GISTs), and 124 synovial sarcomas (SSs). A weakly supervised multiple-instance learning (MIL) framework with transformer-based aggregation was developed using only core-level diagnostic labels. The model achieved classification accuracies of 97.1% for Ewing sarcoma, 80.0% for rhabdomyosarcoma, 85.7% for gastrointestinal stromal tumors, 80.0% for chondrosarcoma, and 76.0% for synovial sarcoma. The overall classification accuracy was 91.6%, with no misclassifications between Ewing sarcoma and rhabdomyosarcoma. These findings highlight the model’s robustness in distinguishing tumor entities that present a well-recognized diagnostic challenge in routine pathology. The AI algorithm demonstrated strong potential as a diagnostic adjunct for assisting pathologists in the morphologic classification of Ewing sarcoma and selected tumor entities based on histopathological features. Although these tumor entities are characterized by specific molecular alterations, the model was not designed to identify or predict molecular alterations directly. Instead, it supports clinical decision-making by recognizing morphologic patterns associated with diagnostically defined tumor entities. The integration of AI-based histopathological analysis with immunohistochemistry and contemporary molecular diagnostic techniques has the potential to improve diagnostic accuracy, optimize the use of ancillary testing, enhance our understanding of genotype–phenotype relationships, and ultimately support more effective patient management. Full article

Background/Objectives: Rectal gastrointestinal stromal tumors (GISTs) near the dentate line (DL) present significant surgical challenges due to anatomical constraints and difficulty preserving anal function. Endoscopic intermuscular dissection (EID) is a viable alternative in these cases. Methods: We retrospectively reviewed the medical records of patients who underwent EIDs for rectal GISTs near the DL between January 2015 and December 2023. The primary outcomes assessed were procedural efficacy—measured by en bloc and complete resection rates—and safety, evaluated regarding delayed bleeding, perforation, and tumor recurrence. Results: In total, 10 patients underwent rectal GIST EIDs. The mean tumor size, procedure time, and resection speed were 25.70 ± 14.09 mm, 81.30 ± 46.20 min, and 16.91 ± 9.94 mm²/min, respectively. The en bloc and complete resection rates were 100% and 70%, respectively. Compared with endoscopic submucosal dissection (ESD) for rectal epithelial lesions, there were no significant differences in procedure times (81.30 ± 46.20 min vs. 76.50 ± 32.42 min, p = 0.758) or complete resection rates (70% vs. 95%, p = 0.095). Regarding safety, delayed bleeding (10% vs. 10%, p = 1.000) and perforation (10% vs. 0%, p = 0.333) rates did not differ significantly between the two groups. During a median 36-month follow-up, one recurrence occurred in a patient with a high-risk GIST. Conclusions: EID for rectal GISTs near the DL appears to be a feasible and potentially safe treatment option in carefully selected patients. It may represent a less invasive alternative to surgery, particularly when preservation of anal function is a priority. Nevertheless, validation in larger prospective studies is required. Full article

Inflammatory fibroid polyp (IFP) or Vanek’s tumor is a rare benign submucosal lesion of the gastrointestinal tract that may radiologically mimic mesenchymal gastric tumors, particularly gastrointestinal stromal tumors. We present the case of a 65-year-old patient with a contrast-enhancing gastric submucosal mass detected on computed tomography, initially interpreted as a suspected mesenchymal neoplasm. CT imaging demonstrated a well-defined enhancing lesion arising from the gastric wall without evidence of metastatic disease. Surgical resection was performed because imaging findings were considered highly suggestive of GIST. Gross intraoperative appearance and pathological examination, however, established the final diagnosis of gastric inflammatory fibroid polyp (Vanek’s tumor). Histopathological analysis demonstrated characteristic spindle-cell proliferation with inflammatory eosinophil-rich infiltrates, while immunohistochemistry excluded GIST. This case highlights the diagnostic challenge in differentiating IFP from other gastric submucosal neoplasms based solely on imaging findings and emphasizes the importance of histopathological confirmation for definitive diagnosis. Full article

Target speaker extraction (TSE) aims to isolate speech spoken by a target speaker out of a mixture using speaker information in an enrollment utterance. Recently, several methods have been proposed that exploit the relationship between the enrollment utterance and the input mixture using cross-attention, without extracting speaker embeddings from the enrollment. Previous approaches applied the cross-attention to the encoded representations or to the real and imaginary parts of the compressed spectrograms separately, which may not have a physical meaning. In this paper, we propose a two-stage TSE method with a physically interpretable modified cross-attention block and a dual post-refinement structure. In the first stage, the attention weights to fuse the enrollment and mixture are derived from the cross-correlation between the complex spectra for the two signals in a form analogous to the phase-sensitive mask. The fused features along with the mixture features were subsequently fed into a speech extraction network to obtain a coarsely extracted target speech. The second stage consists of two parallel branches, where one branch refines the first-stage output using the enrollment in a similar way to the first stage, and the other utilizes the mixture to complement possibly attenuated target speech. In addition, the low-dimensional speaker embeddings extracted from the enrollment and the first-stage output are incorporated into the second stage to exploit the speaker discriminability. Experimental results show that the proposed method consistently outperformed existing TSE methods on the Libri2Mix dataset under both clean and noisy conditions, in terms of speech quality, speech intelligibility, and signal distortion measures. Full article

Background: Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms, accounting for approximately 1–3% of all gastrointestinal tumors, with an annual incidence of 1–2 cases per 100,000 population worldwide. They arise from the interstitial cells of Cajal and are most commonly located in the stomach and small intestine. Methods: We report a case of a 39-year-old man admitted with a preliminary diagnosis of an appendiceal inflammatory mass with suspected abscess formation. Results: The patient presented with right iliac fossa pain, fever, signs of pronounced systemic intoxication and laboratory findings consistent with inflammatory syndrome. Abdominal computed tomography revealed a mass in the right iliac region with infiltration of the surrounding adipose tissue, suggestive of an appendiceal infiltrate. Emergency surgical exploration identified a tumor originating from the cecum. Radical resection of the ileocecal region with side-to-side ileo-ascending anastomosis was performed. Histopathological examination confirmed a spindle-cell variant of GIST. The postoperative course was uneventful. Conclusions: This case highlights the diagnostic challenges of atypically localized GISTs, which may clinically and radiologically mimic inflammatory conditions such as appendiceal infiltrate. Conventional imaging modalities may be insufficient for definitive differential diagnosis. Surgical resection remains the cornerstone of treatment, with histopathological and immunohistochemical evaluation establishing the final diagnosis. Early identification and complete tumor excision are essential for optimizing clinical outcomes and long-term prognosis. Adjuvant therapy with tyrosine kinase inhibitors should be considered based on individual recurrence risk. Full article

Background: Non-colorectal cancer liver metastases (NCRLMs) represent a therapeutically challenging condition with poorly defined locoregional treatment options. This study evaluates the safety, oncological efficacy, and survival outcomes of microwave ablation (MWA) for NCRLMs in a large single-centre series. Methods: Retrospective analysis of patients undergoing MWA for NCRLM between January 2010 and December 2024 at a high-volume hepatobiliary centre. Endpoints were safety, efficacy, textbook outcome (TO) achievement, and overall survival (OS). Results: A total of 138 patients underwent 172 MWA procedures across eight primary tumour categories via a video-assisted (n = 110, 64%) or percutaneous (n = 62, 36%) approach. Major complications (Clavien–Dindo ≥ 3) occurred in 1.8% of procedures, with a median hospital stay of 2 days and a 90-day mortality of 1.7%. The median follow-up was 24.9 (10.3, 55.8) months. Complete response (CR) was achieved in 77% of procedures and TO in 54%, with incomplete response as the main driver of TO failure. The 5-year OS varied by histology, from 100% (GIST) and 80.0% (GEP-NET) to 44.7% (breast) and 0% (pancreatic adenocarcinoma). The video-assisted ablation was associated with superior OS compared to the percutaneous one (5-year OS 54.4% vs. 26.0%, p = 0.00025). In the multivariable analysis, the percutaneous approach (HR 2.44), ECOG PS ≥ 2 (HR 6.06) and a higher tumour burden score (HR 1.09) independently predicted worse OS, whereas the histological group was not independently associated with OS. Repeat MWA was the most frequent treatment for first hepatic recurrence, and 50% of patients reached no evidence of disease (NED) at last follow-up. Conclusions: MWA is a safe and repeatable locoregional treatment for NCRLMs, with outcomes shaped by tumour biology, disease burden, patient fitness and procedural approach. The high rate of liver-dominant recurrence treated with repeat MWA, combined with a final NED rate of 50%, supports MWA as a platform for iterative locoregional disease control in selected patients. Full article

Background and Clinical Significance: Thyroid cancer is increasing, particularly the differentiated type, with decreasing incidence of the anaplastic type. Anaplastic thyroid carcinoma (ATC) is a rare, aggressive, and often lethal form. It frequently presents with metastatic disease, regional and systemic, with common distant metastasis to the lung, bone, brain, and adrenal, and rarely to other places; Case presentation: A 74-year-old Arab male presented with symptomatic anemia and melena and was admitted for investigation of the cause. The patient was found to have a large retrosternal goiter and gastric tumor. CT scan showed a pedunculated, nonobstructive mass, suggestive of a GIST or leiomyoma. The neck mass presented with compressive symptoms. He underwent a combined neck and abdominal surgical resection based on a multidisciplinary team decision, as prior biopsies were not conclusive. The final pathology report identified similar tumors in the two specimens and suggested an anaplastic thyroid carcinoma as the primary tumor with metastasis to the stomach. Furthermore, the workup, including a PET scan 2 weeks post-surgery, revealed widespread metastases in the bone, lung, and liver, and the treatment was palliative. He was followed up in the outpatient clinic for 4 and a half months post-operatively. The patient developed sepsis and cardiopulmonary arrest and died; Conclusions: ATC can metastasize to many places in the body, including the stomach (as shown in our case), which can cause significant upper gastrointestinal bleeding and anemia. Metastatic ATC carries a poor prognosis; thus, physicians need to keep a high index of suspicion in approaching similar cases. A multidisciplinary approach for the management is of utmost importance for appropriate treatment. This disease’s pathology, behavior, and targeted new treatment modalities must be explored further. Full article

This study examines how auditory contexts, or soundscapes, shape chocolate taste perception, affective response, hedonic liking, and the extent to which emotion mediates these effects. Using a within-subjects design with 120 participants aged 18–25 years, four auditory conditions were compared: silence, natural soundscape, relatively low-pitched soundscape, and relatively high-pitched soundscape. Participants evaluated perceived bitterness, sweetness, acidity, emotional valence, arousal, and overall liking after tasting the same 65% dark chocolate under each auditory condition. The results showed that auditory context significantly modulated taste perception, affective response, and liking. The natural soundscape produced the most favorable profile, increasing liking and emotional valence while reducing arousal. In contrast, the relatively high-pitched condition increased arousal and enhanced perceived acidity (Δ ≈ 6.77 VAS points). Effect sizes indicated stronger effects on arousal (partial η² ≈ 0.46), liking (partial η² ≈ 0.29), acidity (partial η² ≈ 0.28), and valence (partial η² ≈ 0.26) than on sweetness perception (partial η² ≈ 0.05). Mediation analysis showed that emotional valence partially explained the relationship between the natural soundscape and liking, whereas arousal did not play a significant mediating role. These findings suggest that auditory environments influence chocolate evaluation through both affective and crossmodal pathways. Overall, the study provides controlled evidence that sound can function as a relevant contextual variable in multisensory chocolate-tasting experiences, with implications for sensory evaluation, gastronomy, and experience design. Full article

Background: Territorial logistics management has become increasingly important in turbulent environments, where digitalization, sustainability, resilience, and governance interact to shape regional logistics performance. This study aims to identify the strategic dimensions that structure territorial logistics management. Methods: A sequential mixed-methods design was adopted. First, relevant variables were identified through a structured literature review and expert judgment. Second, a survey of 376 specialists was analyzed using principal component analysis (PCA) to explore the empirical structure of the retained variables. Results: The analysis identified a four-dimensional structure comprising: (1) digital infrastructure and intelligent logistics, (2) sustainability and circular economy, (3) systemic resilience and risk management, and (4) territorial logistics, governance, and accessibility. Together, these dimensions explained more than 70% of the total variance. Conclusions: The findings suggest that territorial logistics management is a multidimensional phenomenon shaped by the interaction of technological, environmental, institutional, and spatial factors. The study provides an empirically grounded exploratory framework for understanding territorial logistics and supporting more integrated strategies for smart, sustainable, and resilient supply chains. Full article

A 66-year-old woman was referred for evaluation of a large pelvic mass suspected to be ovarian cancer. Contrast-enhanced computed tomography (CECT) revealed a giant multiseptated cystic pelvic mass with enhancing solid components; although its superior aspect closely abutted the gastric serosa, its predominant pelvic location raised concern for an adnexal malignancy. Subsequent [¹⁸F]fluorodeoxyglucose positron emission tomography/computed tomography ([¹⁸F]FDG PET/CT) demonstrated mild uptake confined to the viable solid portion (SUVmax 2.72) without hypermetabolic nodal or distant metastases. Exploratory laparotomy revealed a giant pedunculated tumor arising from the gastric antrum and descending into the pelvis. Histopathology confirmed an epithelioid gastrointestinal stromal tumor positive for CD117, DOG1, and CD34. This case highlights an important diagnostic pitfall in which a giant exophytic gastric GIST may mimic ovarian cancer because of its pelvic location and cystic-solid appearance. Careful correlation of CECT, fused [¹⁸F]FDG PET/CT, and pathologic findings is essential for accurate assessment of the organ of origin in large abdominopelvic masses. Full article

This study presents a controlled empirical and comparative analysis of existing data augmentation techniques for text generation in Turkish, a morphologically rich, low-resource language. A collection of 265 Turkish reading passages for Grades 4 and 5 was augmented using four techniques: paraphrasing with GPT-3.5-turbo (Generative Pre-trained Transformer 3.5 Turbo), back translation (Turkish–English–Turkish and Turkish–French–Turkish) via Google Translate, synonym replacement via GPT-3.5-turbo, and random insertion via GPT-3.5-turbo. Human evaluators assessed the fluency, coherence, grammaticality, logical flow, and naturalness of the augmented datasets. Each augmented dataset, along with the original, was then used to fine-tune a Turkish GPT-2-medium model, which was evaluated using automatic metrics such as BLEU (Bilingual Evaluation Understudy), ROUGE (Recall-Oriented Understudy for Gisting Evaluation), METEOR (Metric for Evaluation of Translation with Explicit ORdering), chrF (CHaRacter-level F-score), BERTScore (Bidirectional Encoder Representations from Transformers Score), and cosine similarity. According to the human evaluation of the original and augmented datasets, the original texts received the highest ratings, followed by those generated through random insertion, paraphrasing, synonym replacement, and back translation variants, with cosine similarity results between original and augmented texts showing a comparable trend; however, the differences between methods were generally small. The results from text generation indicate that models trained on the original dataset generally achieved slightly higher performance across evaluation metrics compared to those trained on augmented datasets. Among the augmented methods, synonym replacement showed marginally better performance, followed by back translation, random insertion, and paraphrasing; however, the differences between methods were small and not statistically significant. Full article