Search Results (1,873)

Artificial intelligence (AI) is reshaping ultrasound diagnosis by converting operator-dependent grayscale, Doppler, elastography, contrast-enhanced, automated-volume, and video data into reproducible decision support. In breast ultrasound, the most mature evidence involves benign–malignant lesion classification, BI-RADS risk stratification, reduction in unnecessary biopsy in selected low-risk lesions, assistance for less experienced readers, automated breast volume scanning, video-based assessment, axillary staging, and prediction of biologic markers such as molecular subtype, HER2 status, Ki-67 expression, lymphovascular invasion, and nodal metastasis. AI does not replace sonographers, radiologists, pathologists, or clinical judgment; rather, it can standardize feature extraction, prompt second-reader review, quantify uncertainty, and integrate imaging with clinical context. This review summarizes current clinical applications of AI in ultrasound diagnosis, which has a strong recent multicenter evidence base. It also discusses implementation requirements, including standardized acquisition, external validation, calibration, imaging–pathology concordance, workflow integration, data security, and equity across scanners and patient populations. Full article

Background: Cervical osteochondromas invading the vertebral canal are rare but may cause spinal cord compression requiring surgical resection. Conventional open laminectomy may disrupt posterior stabilizing structures and potentially increase the risk of postoperative cervical deformity. This technical note describes a contralateral-structure-preserving endoscopic technique for cervical osteochondroma resection. Methods: A 25-year-old man with multiple hereditary exostosis presented with neck pain, mild numbness, and a positive Lhermitte’s sign. Computed tomography and magnetic resonance imaging revealed a 9 × 6 × 10 mm osteochondroma originating from the base of the C3 spinous process and extending into the vertebral canal with spinal cord compression and cord signal change. Preoperative clinical assessment included a Visual Analog Scale (VAS) for neck pain of 6/10, a modified Japanese Orthopedic Association (mJOA) score of 16/18, a Neck Disability Index (NDI) of 30%, and Nurick grade 1. The lesion was treated using unilateral biportal endoscopic spine surgery through a partial unilateral laminectomy and sublaminar endoscopic corridor, aiming for en bloc resection while preserving the contralateral lamina, posterior ligamentous complex, and posterior tension band. Continuous intraoperative neurophysiological monitoring (SSEP and MEP) was used throughout the procedure. Results: The osteochondroma was completely resected en bloc using a diamond burr and Kerrison rongeur. Histopathological examination confirmed osteochondroma, and negative margins were identified without residual tumor. The patient’s symptoms resolved completely without postoperative complications, and he was discharged on postoperative day 3. At the 18-month clinical and radiological follow-up, the patient remained symptom-free, with VAS improved to 1–2/10, mJOA improved to 18/18, NDI improved to 4%, and Nurick grade improved to 0, with partial regression of the cord signal change and no evidence of tumor recurrence on follow-up imaging. Cervical lordosis was maintained at the immediate postoperative timepoint. Conclusions: Contralateral-structure-preserving endoscopic resection may represent a potential minimally invasive alternative to conventional wide laminectomy or fusion-based approaches in carefully selected cases of benign cervical osteochondroma. Larger comparative studies with long-term follow-up are required to confirm the potential biomechanical and clinical benefits of this approach. Full article

Background/Objectives: Accurate bone lesion classification on radiographs is critical for clinical decision-making and forensic identification. Existing deep learning approaches treat radiographs as whole images, neglecting available spatial annotations and clinical metadata. To develop an ROI-guided deep learning framework integrating clinical metadata for three-class (Normal, Benign, Malignant) bone lesion classification and to assess its clinical safety profile. Methods: Using the BTXRD (3746 radiographs: 1879 Normal, 1525 Benign, 342 Malignant), an EfficientNetV2-S backbone was combined with an 11-dimensional metadata MLP trained on ROI-cropped regions. Training employed Focal Loss with adaptive class weighting, Mixup/CutMix augmentations, Stochastic Weight Averaging, and Test-Time Augmentation. Five-fold stratified cross-validation with bootstrap confidence intervals (n = 2000) and probability calibration metrics were used. Results: The framework achieved 96.05% accuracy (95% CI: 95.41–96.66%), 93.94% balanced accuracy, 92.62% macro F1-score, and 99.21% macro-AUC (95% CI: 98.89–99.42%). Critically, near-zero Malignant-to-Normal misclassifications occurred (1/342, 0.29%; 95% Clopper–Pearson CI: 0.01–1.62%) across all 3746 predictions. The minority Malignant class attained F1 = 83.53% despite comprising only 9.1% of the dataset. Conclusions: ROI-guided deep learning with metadata fusion achieves state-of-the-art bone lesion classification with clinically safe error patterns and probability outputs whose calibration was explicitly quantified, supporting its potential as a decision support tool in diagnostic radiology and forensic anthropology, pending external validation on independent cohorts. Full article

Background and Clinical Significance: Placental site trophoblastic tumour (PSTT) is a malignant tumour of the implantation site intermediate trophoblasts. It has historically been described using terms such as atypical chorioepithelioma, atypical choriocarcinoma, syncytioma, and chorioepitheliosis. It belongs to one of the heterogeneous spectrums of gestational trophoblastic disease. It accounts for about 0.25 to 5% of all gestational trophoblastic neoplasia. The typical clinical presentation is alternating menorrhagia and amenorrhea, mildly elevated β-hCG, and radiological findings of a uterine mass. Case Presentation: A 32-year-old woman presented with a history of intermittent menorrhagia and amenorrhea, with a persistent mildly raised β-hCG level. Ultrasonography showed a hypoechoic lesion on the right side of the posterior wall of the uterus. She was diagnosed with a missed miscarriage, and an evacuation of the products of conception was performed. Histologically, the tissue fragments comprised cords and sheets of atypical intermediate trophoblast cells, with characteristic features of myometrial smooth muscle infiltration, vascular invasion, and vascular wall replaced by the neoplastic cells. Immunohistochemically, these cells are positive for β-hCG and GATA3, while negative for P63. Conclusions: PSTT is a rare form of gestational trophoblastic neoplasia. Early recognition of PSTT is essential because its clinical presentation may mimic benign pregnancy-related conditions, and diagnosis relies heavily on histopathological and immunohistochemical evaluation. Full article

Tumors of the lacrimal drainage system are rare and include benign and malignant variants. Their presentation frequently mimics inflammatory or obstructive lacrimal disease, which often results in delayed diagnosis and diagnostic uncertainty. A high index of suspicion, appropriate imaging, and timely biopsy are required to verify the histology and guide management. Surgical excision remains the cornerstone of treatment for most lesions, with the aim of achieving histologically clear margins. Advances in endoscopic and combined surgical approaches have enabled radical tumor resection whilst reducing morbidity and improving globe preservation. Adjuvant radiotherapy is commonly employed in malignant disease, while systemic chemotherapy, immunotherapy, and targeted therapies may be considered in selected advanced or recurrent cases. Emerging molecular insights and evolving surgical techniques may further refine future treatment strategies. This review summarizes current evidence and clinical principles to provide a practical framework for the diagnosis and management of lacrimal drainage system tumors. Full article

Background/Objectives: Malignant transformation of soft tissue lesions is uncommon but represents a significant diagnostic challenge with substantial clinical consequences. This spectrum encompasses four interrelated processes but biologically distinct processes: (1) true malignant transformation of benign lesions; (2) dedifferentiation of low-grade or intermediate malignancies; (3) secondary malignancy arising in chronic inflammatory or non-neoplastic conditions; and (4) apparent progression related to tumor heterogeneity and sampling error. Although these four entities involve biologically distinct mechanisms, they are grouped under “malignant progression” for conceptual clarity. While this umbrella approach has limitations due to biological heterogeneity, this unified radiologic framework aims to supplement, rather than oversimplify, their distinct biological behaviors. Representative examples include neurofibroma and epidermal inclusion cyst among benign lesions; atypical lipomatous tumor/well-differentiated liposarcoma, dermatofibrosarcoma protuberans, and solitary fibrous tumor among lesions showing dedifferentiation or malignant progression; and chronic inflammatory or scar-related conditions and previously irradiated tissue associated with secondary malignancy. Some lesions that appear to progress during follow-up may represent initial underdiagnosis rather than true biologic progression. Methods: This narrative review summarizes current imaging features, underlying pathologic mechanisms, and clinical risk factors associated with these processes in soft tissue lesions. Particular emphasis is placed on radiologic–pathologic correlation and conditions prone to histopathologic misinterpretation. Results: Imaging red flags—including interval or rapid growth, deep fascial invasion, heterogeneous enhancement, perilesional edema, and necrosis—should raise concern for malignant progression across these categories. However, overlapping imaging features and sampling errors may result in pathologic misdiagnosis and delayed treatment. Particularly, atypical lipomatous tumors are frequently misdiagnosed as simple lipomas, while fibrosarcomas may be erroneously interpreted as aggressive fibromatosis. Advanced imaging and multidisciplinary review may help reduce diagnostic errors. Patients with predisposing factors such as genetic syndromes, chronic inflammation, prior burns, or previous radiation exposure warrant close surveillance. Conclusions: Accurate diagnosis of soft tissue lesions with true malignant transformation, dedifferentiation, or secondary malignancy—as well as recognition of diagnostic pitfalls—is essential for appropriate management. Integrated radiologic–pathologic assessment may help improve diagnostic accuracy and clinical decision-making in soft tissue oncology. Full article

Background/Objectives: Ultrasound elastography (UE) is a non-invasive imaging technique that evaluates tissue stiffness and may complement conventional ultrasound in the assessment of uterine diseases. This systematic review aimed to summarize the current evidence on the role of strain elastography (SE) and shear wave elastography (SWE) in the diagnosis and management of benign and malignant uterine pathologies. Methods: A systematic literature search of MEDLINE (PubMed) and Embase was performed to identify studies published between January 2018 and February 2026. Original studies evaluating UE in adenomyosis, uterine fibroids, cervical lesions, and endometrial pathologies were included. Data were qualitatively synthesized according to pathology type and elastographic technique. Results: Twenty studies met the inclusion criteria. In benign myometrial disorders, adenomyosis and uterine fibroids generally showed higher stiffness than normal myometrium, although differentiation between these entities was not always consistent across studies. In cervical disease, malignant and high-grade lesions typically demonstrated increased stiffness compared with benign or low-grade lesions. In endometrial pathology, endometrial carcinoma was generally associated with higher stiffness values than benign lesions and elastography also showed potential in assessing myometrial invasion. Across studies, UE demonstrated promising diagnostic performance, but substantial heterogeneity was observed in acquisition methods, parameters, and reported thresholds. Conclusions: UE appears to be a promising adjunct to conventional ultrasound for the evaluation of uterine pathologies. However, further standardized, large-scale studies are needed to define reproducible protocols and clinically applicable diagnostic thresholds. Full article

Perinatal lymphangiomas are rare benign congenital malformations of the lymphatic system, whose potential for rapid growth and local invasiveness may pose significant risks to fetal well-being. This report presents a case of a large fetal lymphangioma diagnosed prenatally during a second-trimester ultrasound examination. The lesion was initially asymptomatic but subsequently progressed, resulting in ascites and pericardial effusion. In light of progressive fetal deterioration, prenatal sclerotherapy was performed using ultrasound-guided transabdominal administration of bleomycin. Despite the technical success of this procedure, the neonate developed severe cardiorespiratory failure and died shortly after delivery. This case highlights both the potential benefits and limitations of prenatal intervention in severe lymphatic malformations. This study also includes a concise review of current perinatal and postnatal management strategies. Despite advances in prenatal imaging and therapy, further studies are needed to optimize treatment and improve neonatal outcomes. Full article

Intramuscular lipomas are uncommon benign adipocytic neoplasms characterized by infiltrative growth within skeletal muscle. This report describes the clinical, imaging, surgical, and histopathologic findings of an infiltrative lipoma arising from the masseter muscle in a dog presenting with orofacial discomfort suggestive of neurologic or painful orofacial disorders. Ultrasonography demonstrated heterogeneously hyperechoic adipose tissue within the right masseter muscle. Computed tomography identified a progressively enlarging fat-attenuating intramuscular lesion containing infiltrative extensions and linear soft-tissue strands consistent with entrapped muscle fibers. Although imaging findings strongly favored an infiltrative intramuscular lipoma, well-differentiated liposarcoma could not be definitively excluded. Histopathology confirmed a non-encapsulated infiltrative intramuscular lipoma composed of mature adipocytes infiltrating between skeletal muscle fibers. Surgical debulking resulted in complete resolution of clinical signs during six months of follow-up. This case highlights that infiltrative fat-containing lesions of the masticatory musculature may mimic neurologic or painful orofacial disorders and emphasizes the value of cross-sectional imaging and histopathology for diagnosis and surgical planning. Full article

Hidrocystoma is a rare benign cystic tumor of sweat gland origin, most commonly located in the periorbital region, with uncommon occurrence in the retroauricular area. This article presents a case of a 14-year-old patient with a retroauricular mass present for approximately four years, which had remained stable in size until a gradual enlargement was observed over the preceding 11 months. The lesion was associated with intermittent fluid discharge and periodic episodes of local skin inflammation, likely related to mechanical irritation from earrings worn by the patient. Otherwise, the lesion was asymptomatic, with no persistent pain or systemic signs of infection. Clinical examination revealed a well-circumscribed, cystic lesion located in the retroauricular region. Ultrasonographic evaluation demonstrated features consistent with a benign cystic structure. Based on clinical and imaging findings, the lesion was qualified for surgical excision. Complete removal of the mass was performed without complications. Histopathological examination confirmed the diagnosis of hidrocystoma. The postoperative course was uneventful, with no recurrence observed during follow-up. This case highlights a rare location and atypical clinical course of hidrocystoma in an adolescent patient, emphasizing the role of clinical assessment and ultrasonography in preoperative evaluation, as well as the potential impact of chronic mechanical irritation on local inflammatory episodes. Surgical excision remains an effective definitive treatment. Full article

Background: The biliary and pancreatic tract is increasingly recognized as a microbial ecosystem rather than a sterile environment. Dysbiosis contributes to inflammation, bile acid alterations, and carcinogenesis, with distinct microbiota profiles linked to progression from benign to malignant conditions. Clinical factors, including gut–liver axis disruption and biliary stenting, may further exacerbate microbial imbalance. Objective: The objective of this study is to synthesize current evidence and identify knowledge gaps on the role of biliary microbiota in pancreaticobiliary carcinogenesis and its implications for diagnosis, prognosis, and therapy. Methods: This scoping review was conducted following PRISMA-ScR guidelines. A systematic search of PubMed, Web of Science, and Scopus was performed for studies published between January 2015 and December 2025, guided by the PICo framework. Results: Included studies primarily characterized changes in microbiota composition to identify microbial biomarkers associated with pancreaticobiliary diseases. Predictive bioinformatics analyses suggest that dysbiosis may promote carcinogenesis through metabolic and inflammatory pathways. Machine learning approaches identified microbiota-based signatures with potential diagnostic value for precancerous lesions, although discrimination remains limited. Biliary dysbiosis was also associated with outcomes related to biliary stenting, chemoprophylaxis, postoperative complications, and responses to chemotherapy or surgery. Conclusions: Integration of microbiota profiling with predictive bioinformatics and machine learning may improve understanding of pancreaticobiliary carcinogenesis. Identifying microbial and functional biomarkers could enable personalized diagnostic and therapeutic strategies, ultimately improving patient outcomes. Full article

In this review, we explore the evolving role of endoscopic ultrasound (EUS) in diagnosing and managing pancretobiliary malignancies. For solid pancreatic lesions, techniques like fine-needle biopsy (FNB), contrast-enhanced EUS (CE-EUS), and macroscopic on-site evaluation (MOSE) improve sample quality and diagnostic accuracy. In cystic pancreatic lesions, fine-needle aspiration (FNA), molecular testing, and confocal laser endomicroscopy (nCLE) aid in distinguishing benign from malignant cysts. For cholangiocarcinoma, EUS guided sampling is more accurate than CT in assessing distal lesions and lymph node metastases, while combining EUS with magnetic resonance cholangiography (MRC) enhances diagnostic sensitivity. In gallbladder cancer, EUS surpasses CT and MRI in detecting lymphadenopathy and staging tumors. EUS-FNB (Fine needle biopsy) improves biopsy accuracy, especially for unresectable cases. These advancements highlight EUS as a critical tool for early cancer detection, staging, and tissue acquisition. Beyond diagnosis, EUS plays a pivotal therapeutic role in managing complications such as malignant biliary obstruction and gastric outlet obstruction, offering minimally invasive alternatives like EUS-guided biliary drainage and gastroenterostomy with high clinical success and improved patient outcomes. Full article

The term “periapical lesion” refers to a pathological change in the tissues surrounding the apex of a tooth root, defined by its anatomical location rather than a distinct disease entity. Periapical lesions may be of endodontic origin, most commonly resulting from microbial infection of the root canal system following pulp necrosis due to caries, trauma, or other insults, or of non-endodontic origin, such as developmental cysts, benign and malignant odontogenic and non-odontogenic tumors, and fibro-osseous lesions. Accurate diagnosis requires a systematic approach combining patient history, clinical examination, pulp vitality testing, and radiographic assessment; histopathological evaluation is indicated when clinical and radiographic findings are inconsistent or suspicious. The pathophysiology of these lesions involves dynamic interactions between root canal microorganisms and the host immune-inflammatory response. The primary management for endodontic periapical lesions is root canal treatment, which aims to reduce or eliminate root canal microorganisms through mechanical debridement and chemical disinfection. Persistent or extensive endodontic lesions and non-endodontic lesions may require surgical intervention. Molecular and inflammatory biomarkers have been investigated as adjunctive tools for assessing disease activity and prognosis; however, these remain largely investigational and are not yet part of routine clinical practice. Future developments in artificial intelligence, advanced imaging, molecular diagnostics, and personalized therapies may enhance the diagnosis and management of periapical lesions, although further clinical validation is required. Full article

Human papillomaviruses (HPVs) comprise more than 200 types associated with diverse clinical outcomes, ranging from benign lesions caused by low-risk types to cancers driven by high-risk types. These differences are partly driven by variation in the Long Control Region (LCR), a non-coding element that regulates viral gene expression through interactions with viral and host transcription factors (TFs). Although individual TF binding sites have been mapped in a few well-studied HPV types, the broader regulatory differences between high-risk and low-risk HPVs remain poorly defined. Here, we systematically analyzed LCR sequences from 207 HPV types using TF motif scanning and identified 104 TFs with significantly different binding site densities between risk groups. Integration with TCGA transcriptomics data showed that 50 of 69 TF enriched in high-risk types are expressed in HPV-positive head and neck tumors (HNSC) and 53 in HPV-positive cervical tumors (CESC). Analysis of published ChIP-seq datasets further confirmed LCR occupancy for seven of these TFs in HPV18-positive cells. In addition, conservation analysis across clinical isolates of HPV-16 and HPV-18 identified highly conserved TF binding sites overlapping multiple high-risk-enriched TF motifs, suggesting functional constraint on key regulatory elements. Together, these findings reveal distinct TF binding landscapes associated with HPV risk groups and identify candidate host regulators that may contribute to differences in viral transcriptional programs and oncogenic potential across HPV types. Full article

Carcinosarcoma is a rare and aggressive malignancy characterized by both epithelial and mesenchymal components. It most commonly arises in the uterus, lung, or gastrointestinal tract, whereas occurrence in the oral cavity is exceptionally rare. Here, we report a rare case of an aggressive neoplasm with mixed epithelial and sarcoma-like features that initially presented as a benign-appearing upper lip lesion. A 47-year-old male first presented in March 2025 with a painless upper lip mass that had persisted for two months. The lesion appeared clinically benign, and an excisional biopsy was performed. However, during surgery, intraoperative frozen section analysis revealed features highly suspicious for malignancy. Following surgery, systemic imaging demonstrated multiple hypermetabolic lesions in the lung, colon, liver, pancreas, adrenal glands, and lymph nodes. Biopsies from the lip, colon, and lung revealed a high-grade malignant tumor with variable epithelioid and sarcomatoid features across sampled sites. Immunohistochemistry showed co-expression of cytokeratin and vimentin, supporting mixed epithelial and sarcoma-like features. As no primary tumor was identified despite extensive work-up, the available findings favored an aggressive malignant neoplasm of uncertain primary origin with mixed epithelial and sarcoma-like features, although the final histologic sub-classification remained uncertain due to incomplete original pathology information. The patient subsequently received palliative systemic chemotherapy with an alectinib-based targeted regimen starting in April 2025, but showed progressive disease on follow-up, even with additional second-line gemcitabine/cisplatin and third-line pembrolizumab therapy. The patient ultimately succumbed in September 2025. This case highlights that even relatively subtle-appearing lesions require a high index of suspicion for malignancy, emphasizing the importance of early biopsy and comprehensive systemic evaluation. Carcinosarcoma, though rare, should be considered in the differential diagnosis of aggressive tumors arising in atypical locations. Full article