Search Results (286)

Neuroblastoma is a highly aggressive pediatric malignancy originating from neural crest progenitor cells, predominantly in the adrenal medulla. Amplification of the MYCN oncogene occurs in 20–30% of all neuroblastoma cases and approximately 50% of high-risk tumors, strongly correlating with poor prognosis, relapse, and multidrug resistance. MYCN-driven oncogenesis promotes tumor progression by suppressing apoptotic signaling and enhancing survival pathways, including autophagy—a key mechanism underlying resistance to chemotherapy and immunotherapy. This review examines current therapeutic strategies and resistance mechanisms in MYCN-amplified neuroblastoma, while introducing emerging approaches utilizing exosomes as precision drug delivery systems. Exosomes, nanoscale extracellular vesicles secreted by the tumor cells, exhibit natural tropism and can be engineered to selectively target neuroblastoma-specific biomarkers such as glypican-2 (GPC2), which is highly expressed in MYCN-amplified tumors. Leveraging this property, neuroblastoma-derived exosomes can be purified, modified, and loaded with small interfering RNA (siRNA) to silence MYCN expression, combined with chloroquine—an FDA-approved autophagy inhibitor—to simultaneously inhibit autophagy and induce apoptotic signaling. This dual-targeted approach aims to overcome drug resistance, reduce off-target toxicity, and enhance therapeutic efficacy through exosome-mediated specificity. Furthermore, gut dysbiosis has emerged as a critical factor influencing tumor progression and diminishing treatment efficacy in MYCN-amplified neuroblastoma. We propose integrating microbiota-derived exosomes engineered to deliver anti-inflammatory microRNAs (miRNAs) to the gut mucosa, restoring eubiosis and potentiating systemic anti-tumor responses. Collectively, exosome-based strategies represent a paradigm shift in formulating combination therapies, offering a multifaceted approach to target MYCN amplification, inhibit autophagy, induce apoptosis, and modulate the tumor-microbiome axis. These innovations hold significant promise for improving clinical outcomes in high-risk MYCN-amplified neuroblastoma patients. Full article

Clear cell renal cell carcinoma (ccRCC) is the most common type of kidney cancer, accounting for approximately 75–80% of all renal carcinomas, and is often diagnosed incidentally on abdominal imaging, such as abdominal ultrasound or CT scan. Among other types of renal cancer, ccRCC is recognized to be highly aggressive due to its metastatic potential, which leads to a poor prognosis and an increased mortality rate. The most common sites of ccRCC metastasis are the lung, lymph nodes, bone, liver, and adrenal glands. Clear cell RCC is the most frequent primary tumor associated with secondary pancreatic involvement, while overall, pancreatic metastases represent only 2–5% of all malignant pancreatic lesions. These metastases often occur many years after nephrectomy and may present as solitary or oligometastatic disease, frequently displaying a paradoxically favorable prognosis compared with other metastatic sites. The present narrative review we conducted emerged from presentations of ccRCC with pancreatic distant metastases, potentially labeled as primary pancreatic tumors on imaging studies, mimicking pancreatic neuroendocrine tumors due to the hypervascular nature of ccRCC. Four patients were investigated in our clinic for suspicious pancreatic lesions identified on CT imaging, involving both the head and body of the pancreas. The definitive diagnosis was established by performing endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) or fine-needle biopsy (FNB) and histopathological analysis of the collected tissue samples. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) has emerged as a pivotal tool for obtaining tissue diagnosis, particularly when cross-sectional imaging is inconclusive. Through a synthesis of clinical data and literature, this article underscores the essential diagnostic role of EUS-guided tissue acquisition and its impact on therapeutic decision-making. Full article

Metastatic lesions are the most common malignant tumor of the adrenal gland. While surgery can have a favorable surgical outcome for isolated adrenal metastatic lesions, most adrenal metastases occur in the context of disseminated disease, and the overall prognosis remains poor. Although data are limited, metastatic lesions from diverse solid tumors to the adrenal gland have typically demonstrated poor response to immunotherapy, particularly immune checkpoint inhibitors with programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) blockade. This apparent resistance to immunotherapy suggests that the adrenal gland microenvironment may be influenced by local microenvironmental factors, resulting in an organ microenvironment that is immune tolerant and permissive to tumor growth. However, the current literature on the adrenal gland immune microenvironment is limited, underscoring the need for better understanding of the immunobiology of this critical endocrine organ. Thus, the current scarcity of scientific studies on this topic is a novel opportunity to investigate and develop innovative treatment strategies for adrenal solid cancer metastases. In this literature review, we summarize the available data published on the immunobiology of the adrenal gland and the potential local immune mechanisms that may be contributing to the adrenal gland’s role in promoting resistance to otherwise breakthrough immunotherapy treatments. Full article

Background: Pheochromocytoma is a rare adrenal neuroendocrine tumor characterized by excessive catecholamine secretion, which can lead to significant perioperative hemodynamic instability. Despite advances in anesthetic and surgical management, intraoperative hypotension is a common complication. This study aimed to identify preoperative and intraoperative predictors of hemodynamic instability during adrenalectomy for pheochromocytoma in order to improve intraoperative management and patient safety. Methods: This retrospective study included adult patients who underwent adrenalectomy for pheochromocytoma at the University Clinical Center of Serbia between January 2022 and June 2025. Preoperative clinical and biochemical data, tumor characteristics evaluated by imaging methods (CT or MRI), surgical approach, and intraoperative hemodynamic parameters were analyzed. Intraoperative hypotension was defined as mean arterial pressure (MAP) < 60 mmHg despite adequate volume resuscitation. Univariate and multivariate logistic regression analyses were performed to identify predictors of hypotension. Results: A total of 51 adult patients were included in the analysis. Intraoperative hypotension occurred in 26 patients (51%) and was significantly associated with larger tumor size and increased intraoperative fluid requirements. Multivariate analysis identified tumor diameter ≥ 49 mm (OR 0.176, 95% CI 0.034–0.895, p = 0.036) and intraoperative crystalloid infusion ≥ 1200 mL/h (OR 0.132, 95% CI 0.030–0.574, p = 0.007) as independent predictors of intraoperative hypotension. Preoperative catecholamine levels, surgical approach, and type of alpha-blocker were not significant predictors. Conclusions: Tumor size was identified as a significant predictor of intraoperative hemodynamic instability during adrenalectomy for pheochromocytoma. Careful preoperative assessment and individualized intraoperative fluid management may help reduce the risk of hypotension and optimize perioperative outcomes. Full article

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors primarily involving the adrenal medulla and its associated paraganglia, with heterogeneous clinical behavior and complex molecular drivers. This study aimed to characterize DNA methylation and gene expression patterns in PPGLs to understand the molecular differences between tumor subtypes and malignancy. We performed an integrative analysis of DNA methylation (Illumina EPIC 850K) and gene expression profiles (Affymetrix microarrays) in 24 PPGLs, comparing these with The Cancer Genome Atlas (TCGA) data, to delineate cluster- and malignancy-specific epigenetic patterns. Comparison between pseudohypoxic Cluster I and kinase-signaling Cluster II tumors revealed 13 differentially methylated CpG sites, with a specific CpG within DSCAML1 showing hypermethylation in Cluster II accompanied by increased expression, suggesting context-dependent gene body methylation effects. Benign versus malignant comparisons identified 101 differentially methylated CpGs, including hypermethylated CpG in BAIAP2L1 and hypomethylated CpG in SHANK1 in malignant tumors. Pathway enrichment of differentially methylated genes revealed alterations in Notch signaling, adherens junctions, cytoskeletal regulation, and intracellular transport. Gene expression analysis demonstrated partial overlap between clusters, with malignant tumors exhibiting distinct transcriptional profiles involving RNA processing, metabolism, and adhesion pathways. Correlation between methylation and expression was generally limited, emphasizing that methylation-dependent gene regulation is a locus-specific and context-dependent regulation. These findings illustrate a complex interplay between epigenetic modifications and transcriptional programs in PPGLs, enhancing our understanding of molecular heterogeneity and tumor classification, and identifying candidate biomarkers and therapeutic targets for malignant progression. Full article

Background: The differentiation of pheochromocytoma (PCC) from other adrenal lesions, particularly in incidentalomas with non-benign radiological characteristics (size > 4 cm or density > 10 HU), remains a clinical challenge. The study aimed to develop and validate an interpretable machine learning (ML) model for pairwise differentiation of PCC from adrenocortical carcinomas (ACCs) and non-functioning adrenal adenomas (NAAs) and to identify the most important clinical features. Methods: We analyzed a dataset of 50 clinical, laboratory, and radiological parameters from 123 patients with histologically verified adrenal tumors (63 PCC, 30 ACC, 30 NAA). Four classifiers—Logistic Regression (LR), Random Forest (RF), Linear Discriminant Analysis (LDA), and Extreme Gradient Boosting (XGBoost)—were trained for binary classification tasks (PCC vs. ACC, PCC vs. NAA, ACC vs. NAA) using a robust nested stratified cross-validation pipeline to ensure generalizability and avoid overfitting. Results: All four models showed strong predictive performance, with discrimination (AUC) more than 0.8. Our analysis, based on the interpretable LR model, identified the key discriminators differentiated PCC from both ACC and NAA: maximum systolic blood pressure, grade 3 hypertension, headache, palpitation, tachycardia, male sex, and concomitant gastric and duodenal ulcers. In contrast, lower back pain and general weakness were strong signs of lower probability of PCC. The tumor density specifically differentiated PCC from NAA, whereas tumor size was an important marker for distinguishing PCC and ACC. Conclusions: We developed robust ML models capable of accurately differentiating PCC from other adrenal tumors in complex cases. The models provide a clinically actionable tool for pre-surgical decision support. Furthermore, the identification of key discriminative features enhances the clinical understanding of PCC and facilitates its differential diagnosis prior to histological verification. Full article

Background: Lung adenocarcinoma in non-smoking women represents a distinct clinical entity that cannot be fully explained by traditional exposure-centered carcinogenic models. Although ambient air pollution is a recognized risk factor, sex-specific vulnerability suggests the involvement of additional biological modulators shaping inflammatory, immune, and proliferative responses. Main body: In this conceptual review, we integrate epidemiological, experimental, and mechanistic evidence to propose a multisystem framework of lung carcinogenesis in non-smoking women. We delineate a central carcinogenic spine encompassing lung epithelial injury, chronic inflammation, growth factor signaling activation—particularly epidermal growth factor receptor (EGFR) pathways—and tumor microenvironment remodeling. Within this framework, three interacting domains function as biological modulators that amplify carcinogenic processes: chemosensory–neural–immune modulation, hormonal–endocrine signaling including estrogen–EGFR crosstalk, and psychosocial stress–hypothalamic–pituitary–adrenal (HPA) axis dysregulation. These domains converge through feedback mechanisms that reinforce systemic dysregulation and tumor-promoting microenvironments. Implications: This integrative model provides a biologically grounded perspective on female-specific vulnerability to lung adenocarcinoma and informs precision prevention, risk stratification, and ESG-informed public health strategies beyond conventional exposure reduction. Full article

Artificial intelligence (AI) and machine learning (ML) are reshaping cancer research and care. In pediatric oncology, early evidence—most robust in imaging—suggests value for diagnosis, risk stratification, and assessment of treatment response. Pediatric endocrine tumors are rare and heterogeneous, including intra- and extra-adrenal paraganglioma (PGL), adrenocortical tumors (ACT), differentiated and medullary thyroid carcinoma (DTC/MTC), and gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN). Here, we provide a pediatric-first, entity-structured synthesis of AI/ML applications in endocrine tumors, paired with a methods-for-clinicians primer and a pediatric endocrine tumor guardrails checklist mapped to contemporary reporting/evaluation standards. We also outline a realistic EU-anchored roadmap for translation that leverages existing infrastructures (EXPeRT, ERN PaedCan). We find promising—yet preliminary—signals for early non-remission/recurrence modeling in pediatric DTC and interpretable survival prediction in pediatric ACT. For PGL and GEP-NEN, evidence remains adult-led (biochemical ML screening scores; CT/PET radiomics for metastatic risk or peptide receptor radionuclide therapy response) and serves primarily as methodological scaffolding for pediatrics. Cross-cutting insights include the centrality of calibration and validation hierarchy and the current limits of explainability (radiomics texture semantics; saliency ≠ mechanism). Translation is constrained by small datasets, domain shift across age groups and sites, limited external validation, and evolving regulatory expectations. We close with pragmatic, clinically anchored steps—benchmarks, multi-site pediatric validation, genotype-aware evaluation, and equity monitoring—to accelerate safe, equitable adoption in pediatric endocrine oncology. Full article

Background and Clinical Significance: This report presents the case of a 33-year-old female with recurrent miscarriage, investigated for an adrenal cortical adenoma characterized by autonomous secretion of 17-hydroxyprogesterone (17-OHP). The findings challenge the established diagnostic paradigm, which predominantly attributes elevated serum 17-OHP to congenital adrenal hyperplasia (CAH) or non-classical CAH (NCCAH). Case Presentation: The patient was found to have elevated serum 17-OHP and a 2 cm left adrenal mass. Normal testosterone and precursor levels, along with whole-exome sequencing (WES), argued against a diagnosis of non-classical 21-hydroxylase deficiency (NC-21OHD). An ACTH stimulation test elicited a mild-to-moderate rise in 17-OHP, while adrenal venous sampling (AVS) confirmed marked lateralization of 17-OHP hypersecretion to the left side. Postoperative normalization of 17-OHP levels further supported the diagnosis of a 17-OHP-secreting tumor. Histopathological analysis identified tumor regions with non-uniformly high expression of CYP17A1 and CYP21A2. Preliminary transcriptomic profiling revealed that differentially expressed genes (DEGs) were enriched in microRNA-related and PI3K-Akt signaling pathways. Conclusions: This paradigm-shifting case indicates that, in addition to 21OHD, a 17-OHP-hypersecreting adrenal adenoma should be considered in the differential diagnosis of elevated 17-OHP. The integration of multimodal diagnostic techniques, particularly AVS, is valuable for localizing hormonally active tumors. Preliminary mechanistic insights suggest a potential role for epigenetic dysregulation in the pathogenesis of this tumor type. Full article

Background: Germ cell tumors are benign or malignant tumors that originate from the human embryo’s primordial germ cells. This study aims to conduct a retrospective analysis of germ cell tumors followed up at our institution, including their epidemiological data, treatment, and prognosis. Patients and Methods: Ninety-three cases were included and retrospectively evaluated for socio-demographic features, clinical data, presenting symptoms, histopathological findings, localization, staging, treatment protocol, and survival analysis. Results: Patients were diagnosed between 10 days and 17 years 10 months (median 27.2 months); 37 (40.7%) were male, 54 (59.3%) female. The tumors were located in the sacrococcygeal region (33.3%), ovaries (26.8%), testes (25.8%), abdomen (7.5%), CNS (2.1%), liver, adrenal gland, anterior mediastinum, and spine. Thirty-nine lesions were benign, and 54 were malignant. Mature cystic teratomas (40.8%), endodermal sinus tumors (28.0%), mixed germ cell tumors (12.9%), immature teratomas (9.7%), germinoma (6.5%), gonadoblastoma (1.1%), and choriocarcinoma (1.1%) were the different types of histology. We observed metastases in 17 malignant cases, with the lungs being the most commonly affected (10.7%). Stages I, II, III, and IV included 16, 17, 11, and 10 cases, respectively. Survival rates for all cases were 95.8%, and for malignant tumors, they were 92.7%. For malignant cases, the event-free survival rate was 84.2%. Conclusions: The findings provide comprehensive epidemiological and clinical data on germ cell tumors, enhancing understanding of their distribution, treatment outcomes, and prognosis. The high survival rates observed highlight the effectiveness of current treatment protocols, as well as the importance of early diagnosis and appropriate management. Full article

Heat-killed Lactiplantibacillus plantarum SNK12 (SNK), isolated from a traditional Japanese fermented food, has been suggested to influence sleep quality, but human data on sleep improvement with heat-killed lactic acid bacteria (postbiotics) remain limited. We conducted a randomized controlled trial to test whether heat-killed SNK (≥1 × 10¹¹ cells/day for 4 weeks) improves sleep quality and alters stress-related immune and neuroendocrine biomarkers. Healthy adults received SNK or a placebo for 4 weeks. The primary outcome was the Oguri–Shirakawa–Azumi Sleep Inventory MA version (OSA-MA) factor “Sleepiness on Rising”; secondary outcomes were other OSA-MA factors and the stress-related biomarkers salivary cortisol and plasma tumor necrosis factor-α (TNF-α). Compared with placebo, SNK improved Sleepiness on Rising (p = 0.032) and Initiation and Maintenance of Sleep (p = 0.010). Salivary cortisol (p = 0.016) and plasma TNF-α (p = 0.037) were also lower with SNK, and no safety concerns emerged. These concomitant changes in subjective sleep indices and stress-related biomarkers are consistent with modulation of hypothalamic–pituitary–adrenal axis activity and inflammatory pathways along the gut–brain axis. SNK may, therefore, represent a practical postbiotic option to support sleep quality. Full article

Neuroblastoma (NB), a pediatric cancer of sympatho-adrenal (SA) lineage, is marked by disrupted differentiation and cellular heterogeneity. INSM1, a zinc-finger transcription factor, is highly expressed in NB and developing SA tissues, where it regulates neuroendocrine differentiation, especially in chromaffin cells. We investigated INSM1’s role in maintaining an undifferentiated, progenitor-like state in NB and its regulation via metabolic and epigenetic mechanisms. Transcriptomic profiling, promoter assays, and metabolic flux analysis revealed that INSM1 expression correlates with methionine cycle activity, particularly the S-adenosylmethionine (SAM)/S-adenosylhomocysteine (SAH) ratio. Disruption of SAM/SAH balance altered INSM1 promoter activity and histone methylation, implicating epigenetic control in NB cell fate. Retinoic acid-induced differentiation downregulated INSM1 and N-Myc, linking INSM1 to tumor cell immaturity. INSM1 overexpression in SH-SY-5Y cells upregulated neuroendocrine and thyroid hormone-related genes (CHGA, CHGB, DDC, NCAM1, DIO3, TH), while suppressing genes involved in cell cycle (RRM, CDC25A), methionine metabolism (AHCY, MAT2A), transcriptional regulation (MYBL2, EZH2), and oncogenic signaling (ALK, LINC011667). These findings suggest that INSM1 promotes NB aggressiveness by sustaining a neuroendocrine progenitor-like phenotype through metabolic-epigenetic coupling. Full article

Background and Objectives: Adrenal gland tumors are frequently discovered incidentally. They remain challenging to evaluate because of their heterogeneous nature and overlapping imaging characteristics. Surgical resection continues to represent the primary treatment option for both benign and malignant lesions. This study aimed to characterize the clinical, demographic, and pathological features of adrenal tumors and to assess surgical management patterns in a tertiary referral center. Materials and Methods: A retrospective analysis was conducted on 112 patients who underwent adrenalectomy between 2015 and 2022. Demographic, clinical, radiological, and surgical data were reviewed. Histopathological findings were classified as benign tumors, primary adrenal malignancies, or adrenal metastases. Both laparoscopic adrenalectomy and open surgery were performed. The operative approach was determined by tumor characteristics and oncologic considerations. Results: Among the 112 patients, 48% had benign adrenal tumors, 32% had adrenal metastases, and 19.6% were diagnosed with primary adrenal malignancies. Most patients with adrenocortical carcinoma were women over 55 years of age. Benign lesions were predominantly managed with simple adrenalectomy and minimally invasive techniques, while malignant tumors frequently required complex oncologic resections and open surgical approaches. Distinct metastatic patterns were observed, with renal cell carcinoma representing the most common primary source of adrenal metastasis. Conclusions: Adrenal tumors demonstrate marked demographic and pathological variability. Surgical resection remains essential for definitive diagnosis and treatment, underscoring the importance of tailoring the operative approach. Minimally invasive surgery is appropriate for benign lesions, whereas open adrenalectomy is preferred for malignant or advanced tumors, where surgical expertise is critical to achieving optimal oncologic outcomes. Full article

Two old cases of adrenocortical tumors with contradictory diagnostic findings and opposite conclusions are revisited in light of the recent WHO guidelines, as follows: a 34-year-old woman and a 15-month-old girl, both with severe virilization and adrenal mass at radiological investigation, studied in 1966 and 1977, respectively, in accordance with the diagnostic procedures available in those years. Dynamic hormonal findings seemed to exclude malignancy in the woman but were in favor of malignancy in the girl. Instead, a 305 gr mass on the right adrenal gland was removed in the woman and histopathologically verified as adrenocortical carcinoma, whereas in the girl, a 140 gr mass in the right adrenal gland was removed and histopathologically verified as adrenocortical adenoma. After a six-month span of clinical condition improvement, the woman developed recurrence with multi-organ metastases. Mitotane treatment temporarily improved her condition, but it progressively worsened until her death 11 months later. The girl instead showed progressive improvement in clinical and laboratory findings until complete normalization in 18 months. The use of dated radiological and laboratory investigations suggests caution against generalization of our assumption; however, these cases suggest that only histopathological findings from surgical specimens ensure a correct diagnosis of adrenocortical masses. Full article