Search Results (2,991)

In laryngeal squamous cell carcinoma, hypoxia plays a major role in growth, spread, and treatment resistance. HIF-1α, VEGF, and GLUT1 are three linked biomarkers that show different aspects of this response. Low oxygen can be sensed by HIF-1α, and it follows up by activating genes that help with the survival of the tumour cells. VEGF helps to form new blood vessels, while GLUT1 increases the uptake of glucose and maintains the production of energy even when there is a lack of oxygen. Tissue and serum studies have reported higher levels of these biomarkers in malignant than in benign or normal samples, together with associations with adverse clinicopathological features. However, their diagnostic and prognostic utility remains exploratory because clinically validated thresholds, diagnostic performance measures, and independent prospective validation remain limited. Combined assessment of these biomarkers may provide complementary information on hypoxic signalling, angiogenesis and metabolic adaptation, although its diagnostic or prognostic superiority over individual biomarkers has not yet been established. However, serum measurements can be influenced by pre-analytical and systemic factors. So, in order for these biomarkers to advance enough to be used in clinical laryngology, large multicenter studies and a standardized set of testing methods will be necessary. Full article

Purpose: Early detection of glottic cancer is essential for better outcomes, but current diagnostic methods remain largely invasive, highlighting the need for reliable non-invasive alternatives. Acoustic voice signals offer a non-invasive screening input, but their clinical value depends on whether signal-processing features and learned models can distinguish malignancy from acoustically similar benign lesions rather than merely separate pathological from healthy voices. Despite growing research on acoustic analysis combined with machine learning (ML) techniques, no systematic synthesis of this evidence currently exists. Therefore, the present review aimed to identify acoustic features that differentiate early glottic malignancies from both benign vocal fold lesions and normal vocal function using various ML techniques. Method: Following PRISMA 2020 guidelines, a comprehensive literature search was conducted across Scopus, EBSCO, Ovid (Embase), and PubMed databases through November 2025. Eighteen studies met inclusion criteria, and PROBAST was used for quality appraisal of included studies. Data extraction focused on acoustic feature categories, ML techniques, classification performance metrics, and validation strategies. Results: Nine acoustic feature categories emerged, with cepstral coefficients (particularly MFCCs) most prevalent across 55.6% of studies. Binary pathological-versus-normal classification achieved consistently high accuracy (96–98.3%) across both traditional machine learning and deep learning approaches. However, malignant-versus-benign discrimination demonstrated substantially lower performance (81–87.88% accuracy, AUC 0.631–0.91), with voice-only models proving insufficient. Multimodal models incorporating clinical variables or laryngoscopic images achieved higher performance, but their results cannot be attributed to voice features alone. All 17 prediction studies were judged at high overall risk of bias, predominantly because of small effective sample sizes, model-selection optimism, possible data leakage, and limited independent validation. Conclusions: ML can detect broad voice pathology, but current evidence is insufficient to support stand-alone acoustic screening for early glottic cancer. Future studies require clearly defined cancer-specific targets, patient-level analysis, standardized acquisition, nested model development, calibration, and independent multicentervalidation. Full article

Background and clinical significance: Gestational deciduosis is a benign, progesterone-related ectopic decidual reaction that commonly involves pelvic and peritoneal surfaces and usually regresses after delivery. Although generally asymptomatic, diffuse peritoneal deciduosis may present as multiple nodular implants and closely mimic peritoneal carcinomatosis, mesothelioma, or miliary tuberculosis, creating a challenging intraoperative differential diagnosis. Prompt histopathological assessment is essential to prevent unnecessary staging procedures or oncological treatment. Case presentation: A 30-year-old primigravida at 40 weeks’ gestation underwent unplanned intrapartum cesarean section after a premature rupture of membranes, the induction of labor, and failed progression. Multiple friable, gray–yellow subcentimetric nodules were incidentally observed on the uterine serosa, adnexa, omentum, visceral intestinal peritoneum, and appendix. The macroscopic appearance raised concern for peritoneal carcinomatosis and abdominal miliary tuberculosis. No ascites or intra-abdominal masses were identified. CA-125 was elevated (207.7 U/mL), Quantiferon testing was indeterminate, and postoperative chest computed tomography showed no pulmonary disease. Histological examination showed ectopic decidual cells with abundant eosinophilic cytoplasm in a perivascular and septal distribution. The cells showed diffuse vimentin, CD10, and progesterone-receptor expression and lacked epithelial and mesothelial marker expression, supporting diffuse peritoneal deciduosis. The postoperative course was uncomplicated, and pelvic ultrasonography at 40 days postpartum showed no residual lesions. Conclusions: Diffuse peritoneal deciduosis should be considered when disseminated peritoneal nodules are encountered during pregnancy or cesarean delivery. In this setting, elevated CA-125 is nonspecific and may heighten concern for tuberculosis or malignancy without distinguishing among these entities. Correlation of the clinical context, operative findings, morphology, and targeted immunohistochemistry is essential to avoid unnecessary oncological treatment or extensive staging procedures. Full article

Background: Phyllodes tumors (PTs) are rare fibroepithelial breast neoplasms spanning a benign-to-malignant spectrum, and the extent of surgery and reconstruction differs markedly by histologic grade. The primary aim of this study was to derive a grade-stratified surgical and reconstructive algorithm. Methods: The charts of patients diagnosed with phyllodes tumor at Kyungpook National University Chilgok Hospital between January 2011 and February 2026 were retrospectively reviewed. Tumors were classified by World Health Organization criteria as benign, borderline, or malignant, and the treatment protocols, extent of surgery, and immediate reconstruction after mastectomy were analyzed. Results: Of 417 patients charted, 401 were confirmed to have phyllodes tumors and 334 carried a definitive histologic grade. Together, they formed the analyzed cohort: 251 benign (75.1%), 55 borderline (16.5%), and 28 malignant (8.4%). Benign tumors were managed predominantly by breast-conserving surgery (BCS). Twenty-six patients formed the surgical cohort, defined by the reconstructive requirement of the resection defect: all total mastectomies (n = 19) together with all breast-conserving resections reconstructed by the plastic surgical team (oncoplastic breast-conserving surgery, n = 7). Reconstruction was performed in 21 (80.8%) with latissimus dorsi-based flaps, local flaps, or direct-to-implant reconstruction. Adjuvant radiotherapy was confined to malignant disease (7 of 15 malignant PTs, 46.7%; p = 0.010). Over a median follow-up of 32.7 months, local recurrence developed in four patients (15.4%) and two malignant tumors were fatal. In an illustrative case of recurrent malignant PT with rib metastasis, a widely opened pleural cavity was sealed with a single sheet of non-fenestrated acellular dermal matrix (ADM), which was found to be fully incorporated and still sealing the pleura at later implant explantation. Conclusions: A grade-stratified strategy (BCS for benign tumors and mastectomy with reconstruction for borderline/malignant disease) balances oncologic safety with aesthetic outcome. Full article

Choroidal tumors encompass a heterogeneous group of lesions ranging from benign melanocytic nevi and vascular tumors to malignant melanomas and metastatic lesions. Their evaluation increasingly relies on multimodal imaging combining techniques that interrogate different physical and biological properties of the lesion and surrounding tissues. This narrative review examines the principles, clinical contributions, and limitations of optical and acoustic imaging in the assessment of choroidal tumors. Modern optical modalities—including spectral-domain and swept-source optical coherence tomography (OCT), OCT angiography (OCT-A), fundus autofluorescence, ultra-widefield imaging, and scanning laser ophthalmoscope (SLO)-based techniques—provide high-resolution information on lesion morphology where optically accessible, as well as on associated retinal pigment epithelium alterations, subretinal fluid, photoreceptor changes, fluorophore-related signals, and vascular flow or permeability. However, many of these findings reflect responses of the retina, RPE, or choroidal vasculature adjacent to the tumor rather than intrinsic tumor characteristics. Ultrasonography provides different information based on acoustic backscatter and attenuation, including lesion dimensions, internal reflectivity and echo patterns, and remains particularly important for larger or peripheral lesions and when optical visualization is limited by media opacity. Its interpretation and measurement are nevertheless operator- and scan-dependent, with limitations related to spatial resolution, insonation geometry, boundary definition, and reproducibility, particularly for small lesions. Representative examples of choroidal nevi, melanomas, circumscribed choroidal hemangiomas, metastases, and selected pseudotumoral lesions illustrate how multimodal findings contribute to differential diagnosis, longitudinal assessment, and clinical decision-making. Emerging techniques such as OCT-A and Retro mode imaging provide additional structural or flow-related information, although their tumor-specific diagnostic performance remains incompletely validated. Multimodal imaging can substantially narrow the differential diagnosis but cannot always establish tissue diagnosis, and biopsy or systemic investigation may remain necessary in selected cases. Accurate evaluation of choroidal tumors therefore depends on integrating the distinct information and limitations of each modality with clinical findings and longitudinal evolution. Full article

Background and Objectives: Uterine leiomyomas are common benign tumors, whereas uterine sarcomas are rare but aggressive malignancies. Preoperative differentiation among leiomyoma, smooth muscle tumor of uncertain malignant potential (STUMP), and uterine sarcoma remains a major clinical challenge, with diagnosis often established only after histopathological evaluation. The identification of reliable circulating biomarkers could improve preoperative risk stratification and guide surgical decision-making. This study aimed to evaluate the usefulness of galectin-1 and mucin-1 in the diagnosis of uterine tumors. Materials and methods: This prospective, single-center case–control study was conducted at the Third Department of Obstetrics & Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, between 2013 and 2024. Serum galectin-1 and mucin-1 levels were measured preoperatively using ELISA and electrochemiluminescence immunoassay (ECLIA), respectively. Group comparisons were performed using non-parametric tests. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. Multivariable logistic regression was used to assess independent associations with sarcomas/STUMP status. Results: The study population comprised 156 women (49 healthy controls, 90 patients with uterine myomas, 8 with STUMP and 9 patients with uterine sarcomas) treated during the study period. Galectin-1 differed significantly across the four histological groups (p < 0.001), with higher concentrations in uterine sarcoma than in healthy controls (p < 0.001) and leiomyoma (p = 0.002). MUC1 also differed overall (p = 0.031), with higher concentrations in uterine sarcoma than in leiomyoma (adjusted p = 0.031). In the primary leiomyoma versus sarcoma/STUMP ROC analysis, galectin-1 showed modest discrimination (AUC 0.693, 95% CI 0.559–0.826), while MUC1 showed weaker discrimination (AUC 0.618, 95% CI 0.468–0.768). Conclusions: Serum galectin-1 may have potential as an adjunctive biomarker in the preoperative assessment of uterine tumors, but its modest discrimination and unstable cutoff-dependent performance may preclude its use as a standalone diagnostic test. MUC1 showed limited diagnostic utility in the primary clinical comparison. Given the clinical implications of misdiagnosis, particularly regarding surgical management, further validation in larger cohorts and multimarker approaches are warranted. Full article

Background/Objectives: This study aimed to evaluate the discriminative performance of routine systemic inflammation- and nutrition-based indices for distinguishing histopathologically confirmed gastric malignancy from non-malignant endoscopic findings. Methods: This retrospective case–control study included 211 patients who underwent upper gastrointestinal endoscopy with histopathological evaluation: 139 non-malignant endoscopic controls (129 benign/non-neoplastic and 10 premalignant findings) and 72 gastric malignancy cases. Premalignant lesions were not considered malignant outcomes. Discrimination was evaluated using univariable ROC analyses and multivariable logistic models. The fixed predictor set was assessed using 10-fold out-of-fold validation and 500-resample bootstrap optimism correction; a separate fully nested selection-inclusive audit was used to quantify uncertainty arising from variable selection. Results: NLR (AUC = 0.792), INR (AUC = 0.791), and SIRI (AUC = 0.783) showed the highest univariable discrimination. Among the variables retained in Model 1, higher ESR and RDW, lower MPV and HDL, higher INR values, and male sex showed statistically significant multivariable associations. Model 1 had an apparent AUC of 0.928 (95% CI, 0.890–0.959), a fixed-set 10-fold out-of-fold AUC of 0.890, and a bootstrap optimism-corrected AUC of 0.901. A fully nested selection-inclusive audit yielded an out-of-fold AUC of 0.873 and a bootstrap-corrected AUC of 0.869. Conclusions: Routine inflammation- and nutrition-related laboratory measures discriminated gastric malignancy from non-malignant endoscopic findings in this endoscopy-selected cohort. The model remains exploratory and requires prospective external validation. These data do not establish screening performance or diagnostic accuracy for early or asymptomatic gastric cancer. Full article

The use of artificial intelligence (AI) in endoscopic ultrasonography (EUS) is receiving increasing attention, particularly in the field of pancreatic diseases, where early and accurate diagnosis remains a major clinical challenge. This narrative review focuses on current and emerging applications of AI in pancreatic EUS, covering both image-based diagnostic support and the analysis of samples obtained through EUS-guided tissue acquisition. The first part of the review discusses how AI is being applied to improve EUS image interpretation, ranging from lesion detection to characterization and differentiation between benign and malignant pancreatic findings. The review also discusses early evidence and future perspectives for real-time procedural support, where diagnostic performance remains highly operator-dependent. The second part explores a less frequently discussed but equally relevant area: the use of AI in the analysis of cytological specimens obtained through EUS-guided fine-needle aspiration or fine-needle biopsy. Although cytopathology may appear to lie outside the traditional clinical scope of EUS, it represents an essential step in the diagnostic workflow of pancreatic diseases. Recent developments in AI-assisted digital cytology and pathology have shown promising potential to support and standardize cytological interpretation, with possible benefits in terms of diagnostic consistency, reproducibility, and turnaround time. By bridging imaging and pathology, AI may enhance the entire pancreatic EUS workflow, contributing to more efficient, accurate, and personalized diagnostic pathways in pancreatic disease management. Full article

Genetic alterations are closely associated with prostate cancer development and progression, but the RNA-derived transcriptional allele landscape of prostate cancer and cancer stem cells (CSCs) remains poorly understood. To characterize cancer-associated transcriptional alleles, we analyzed bulk and single-cell RNA sequencing (RNA-seq) data from primary human prostate cancer cells and their matched benign epithelial cells from non-cancerous regions of the same patients. Sequencing reads were aligned to the human reference genome (hg38) using STAR, and sequence variants were annotated with ANNOVAR. Most detected transcriptional alleles were located in noncoding regions, particularly within 3′ and 5′ untranslated regions, with single-nucleotide variants predominating and C>T substitutions occurring most frequently. Comparison of cancer and matched benign samples identified 223 genes carrying cancer-associated transcriptional alleles consistently detected across three independent patients. Seven of these genes showed differential expression between CSC and non-CSC populations, while 19 contained non-synonymous alleles, including 11 that are predicted to have potentially damaging effects. We identified ATF6 and KDM3A as candidate genes of potential functional interest. Single-cell RNA-seq analyses revealed differences in the number and distribution of detected transcriptional alleles between culture conditions, with 2D cancer cultures detecting more total, coding, and non-synonymous alleles than CSC-enriched 3D spheroids. CSC populations also exhibited fewer detected transcriptional alleles than non-CSC populations. Our findings provide a framework for characterizing transcriptional allele heterogeneity within the prostate cancer cellular hierarchy and identify candidate CSC-associated alterations for further investigation and functional validation. Finally, the cancer–benign matched strategy used in this study provides additional molecular evidence supporting the malignant origin of the tumor-derived cancer cells. Full article

Endoscopic retrograde cholangiopancreatography (ERCP) remains the reference standard for biliary drainage, yet it fails in up to 15% of cases, most notably when a surgically altered anatomy (SAA) is present. The expanding use of bariatric and oncologic gastrointestinal surgery has increased the number of patients in whom the papilla is displaced, unreachable, or replaced by a biliodigestive anastomosis, making conventional access difficult or impossible. This narrative review appraises the current evidence on endoscopic biliary drainage in SAA, focusing on procedural efficacy, anatomical peculiarities, adverse-event profiles and technical considerations to guide clinical decision-making. Available strategies include luminal techniques, duodenoscope-assisted ERCP, forward-viewing (cap-assisted colonoscope) ERCP, and enteroscope-assisted ERCP, as well as endoscopic ultrasound-guided biliary drainage (EUS-BD), encompassing EUS-guided hepaticogastrostomy, EUS-guided antegrade stenting, EUS-guided rendezvous and EUS-directed transgastric/transenteric ERCP (EDGE/EDEE), and laparoscopic-assisted ERCP (LA-ERCP). No single approach is universally superior and available comparative data is mainly retrospective and affected by major selection bias. Technique selection should be tailored to the reconstruction type, indication (benign vs. malignant), limb length, expected survival, and local expertise, ideally within a multidisciplinary, high-volume setting. Adequately powered randomized trials incorporating quality-of-life and cost-effectiveness endpoints are still needed to define the optimal first-line strategy. This literature review encompasses the multiple strategies to achieve biliary drainage in surgically altered anatomy, highlighting strengths and weaknesses of each technique, as well as the preferred approach for each type of anatomical reconstruction. Full article

Background: Undifferentiated pleomorphic sarcoma (UPS) of the bone is a rare, high-grade malignancy of uncertain origin, most commonly affecting the extremities of adults. Its diagnosis may be challenging, particularly when clinical and radiological findings are confounded by trauma-related conditions. Case presentation: In this paper, the case of a 51-year-old man who sustained a high-energy trauma resulting in a diaphyseal fracture of the left tibia and fibula, initially treated with intramedullary nailing. Preoperative radiographs raised suspicion of an osteolytic lesion in the distal tibia; however, second-level imaging was performed postoperatively, suggesting a benign process. At initial evaluation at a primary Musculoskeletal Oncology Centre, strict clinical and radiological follow-up was recommended, but the patient failed to adhere. Over the following years, persistent symptoms were attributed to post-traumatic and inflammatory conditions, including suspected complex regional pain syndrome. Progressive clinical deterioration led to repeat imaging, revealing an aggressive lesion. A biopsy (March 2025) ultimately confirmed a primary bone high-grade UPS with no metastasis. Following multidisciplinary discussion, below-knee amputation was performed, achieving clear surgical margins. At one-year CT imaging follow-up, the patient remained disease-free and was able to ambulate with a prosthesis. Conclusions: High-energy trauma and later attribution of symptoms to post-traumatic conditions may complicate the diagnostic process, contributing to diagnostic delay. Early referral to specialised Musculoskeletal Oncology Centres, strict adherence to follow-up, and timely histological confirmation are essential to optimise outcomes. Suspicious bone lesions should always be fully characterised prior to surgical intervention. Full article

Background: Prostate cancer (PCa) remains one of the most frequently diagnosed cancers in men worldwide, and there is growing interest in the role of metabolic reprogramming in its development. Key metabolic pathways include alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), which are enzymes involved in the oxidation of alcohols and aldehydes, the detoxification of xenobiotics, and the regulation of cell proliferation and the oxidative stress response. Despite well-documented changes in enzyme activity in other malignancies, their activity in prostate tissue has not yet been thoroughly investigated. This study aimed to evaluate the activity of total ADH and its isoenzymes (classes I–IV), and ALDH classes I and III, in prostate cancer tissue compared with benign prostatic hyperplasia (BPH). Methods: Enzyme activities were determined using spectrophotometric and fluorometric methods in prostate tissue obtained from 48 patients with PCa (26 with low-risk and 22 with intermediate-risk disease) and from 42 patients with benign prostatic hyperplasia (BPH). The study groups were compared using non-parametric statistical tests, with p < 0.05 considered statistically significant. Results: The isoenzyme ADH class III showed the highest activity in both studied groups. The activity of ADH class I was significantly higher in PCa tissue compared with BPH (p = 0.0499), while ALDH I and III activity was also significantly higher in PCa tissue than in BPH (p = 0.0007). No significant differences were observed in total ADH or its other isoenzymes. Significant correlations were found among some ADH isoenzymes, but not with ALDH. Conclusions: Increased activity of class I ADH and ALDH enzymes in prostate cancer tissue may reflect disease-related metabolic changes and suggest their potential significance in the biology of prostate cancer. These findings provide new insights into metabolic reprogramming in prostate cancer and support the need for further studies to determine the biological and potential clinical significance of these enzymes. Full article

Aneurysmal bone cysts (ABCs) are benign but locally aggressive osteolytic lesions that are rarely reported in dogs and may progress or recur following surgical treatment. This case report describes the diagnosis, surgical management, postoperative progression, and long-term outcome of an ABC affecting the left ulna of a four-month-old Labrador Retriever. Radiography and computed tomography revealed a rapidly progressive, expansile osteolytic lesion with marked cortical thinning. Histopathological examination supported the diagnosis of ABC, with no evidence of malignancy. Initial treatment consisted of corticotomy, intralesional curettage, autologous bone grafting, and stabilization of the cortical segment with lag screws. Despite complete clinical resolution of lameness, surveillance radiographs six weeks postoperatively demonstrated progression of the lesion proximal to the original surgical site. Revision surgery involving a larger cortical window and more extensive curettage was subsequently performed, followed by bone grafting. Histopathology again confirmed ABC without malignant transformation. The dog regained normal limb function, and serial radiographic and computed tomographic examinations demonstrated progressive osseous remodeling with no evidence of further progression or recurrence through 35 months of follow-up. This case highlights the importance of adequate surgical excision and scheduled postoperative imaging, as ABC progression may occur despite apparent clinical recovery. Full article

Uterine leiomyosarcoma (uLMS) is a rare but highly aggressive mesenchymal malignancy of smooth-muscle origin that represents a significant therapeutic challenge due to its poor prognosis and limited treatment options. Despite advances in molecular characterization, diagnosis remains difficult, and systemic therapies have shown limited success, contributing to a high recurrence rate and poor survival. Recent proteomic investigations have provided new insights into uLMS biology by exploring the global protein expression patterns that define malignant transformation and progression. Using high-resolution mass spectrometry (MS)-based techniques, quantitative proteomics, and integrated multi-omics approaches, researchers have begun to identify dysregulated proteins, signaling pathways, and post-translational modifications (PTMs) linked to tumor metabolism, extracellular matrix (ECM) remodeling, cell-cycle regulation, and chemoresistance. These studies have also uncovered candidate biomarkers that may improve the discrimination of uLMS from benign leiomyoma and have proposed novel therapeutic targets associated with metabolic reprogramming, kinase activation and tumor microenvironment (TME) modulation. This review summarizes recent advancements in uLMS proteomics, discusses their methodological underpinnings, highlights key molecular mechanisms and biomarkers, and explores their translational potential. Finally, we outline current limitations and future directions toward clinical implementation of proteomic findings in precision oncology for uLMS patients. Full article

Background: Accurate breast lesion classification and localization from mammograms remain challenging because lesions vary in size, morphology, density, contrast, and boundary clarity. This study proposes MSF-Swin-ICFNet, an image-derived Multi-Scale Swin Transformer framework with Image-Derived Cross-Scale Fusion (ICF) for joint benign–malignant classification and lightweight lesion localization. Methods: The proposed framework extracts hierarchical representations from four Swin Transformer stages and aligns, adaptively recalibrates, and fuses these multi-scale features into a shared representation for classification and lesion-mask prediction. The model was evaluated on CBIS-DDSM, comprising 891 patients and 1592 mammograms, and RTM, comprising 573 patients and 10,070 mammograms. Patient-level stratified partitioning was used to ensure that mammograms and associated annotations from the same patient remained within a single data partition. Classification was evaluated using accuracy, precision, recall, F1-score, and AUC-ROC, while lesion localization was assessed using the Dice coefficient. Results: MSF-Swin-ICFNet achieved strong mammogram-level classification performance on the patient-disjoint test cohorts. On CBIS-DDSM, the model achieved 0.949 accuracy, 0.931 F1-score, and 0.985 AUC-ROC. On RTM, it achieved 0.968 accuracy, 0.956 F1-score, and 0.992 AUC-ROC. The corresponding Dice coefficients for lesion localization were 0.786 on CBIS-DDSM and 0.878 on RTM. Ablation experiments further supported the contribution of cross-scale fusion, scale recalibration, feature refinement, and the boundary-aware localization head. Conclusions: MSF-Swin-ICFNet demonstrates promising retrospective performance for image-based breast lesion classification with complementary lesion localization. The results support the technical potential of adaptive hierarchical feature fusion for mammographic analysis. However, the model is not intended as a standalone diagnostic system, and independent multicentre validation and radiologist reader studies are required before clinical deployment. Full article