Search Results (965)

Main pancreatic duct (MPD) dilatation may occur in both main-duct intraductal papillary mucinous neoplasm (MD-IPMN) and chronic pancreatitis (CP). In selected patients, MRI/MRCP, endoscopic ultrasonography (EUS), and contrast-enhanced EUS may remain inconclusive. Peroral pancreatoscopy (POPS) permits direct ductal inspection and targeted biopsy, but the available evidence is heterogeneous and does not establish diagnostic accuracy or clinical utility in the specific differential diagnosis of MD-IPMN versus CP. We performed a narrative review of POPS for suspected pancreatic duct neoplasia and report a retrospective, descriptive, single-center series of five highly selected patients evaluated between January 2023 and November 2024. The case series is presented only to illustrate a multidisciplinary diagnostic pathway; no estimates of accuracy, sensitivity, specificity, or clinical benefit were calculated. All five patients had MPD dilatation > 10 mm, imaging findings compatible with definite or possible chronic pancreatitis, and persistent concern for MD-IPMN after MRI/MRCP, EUS, and contrast-enhanced EUS. POPS-guided biopsies showed low-grade dysplasia in one patient and high-grade dysplasia in two patients. These three patients underwent surgery, and examination of the resection specimens confirmed the same dysplasia categories identified by POPS-guided biopsy. In the remaining two patients, POPS showed regular-appearing ductal epithelium with focal hyperemia, and targeted biopsies revealed nonspecific inflammatory changes. These patients were managed conservatively without surgery. As definitive surgical histopathology was not available, their final diagnostic status remained unconfirmed. Both patients underwent ongoing planned annual surveillance with MRI or EUS and serum CA 19-9 measurement to identify any morphological or biochemical changes. At the most recent follow-up, approximately 192 days (IQR, 116.5–205.5 days) after POPS, no significant changes had been observed. This small, selected series illustrates how POPS may contribute additional visual and histological information when conventional evaluation is discordant. It cannot demonstrate that POPS prevents missed lesions, excludes IPMN, reduces unnecessary surgery, or improves outcomes. Prospective multicenter studies with predefined referral criteria, blinded interpretation, complete reference standards, and long-term follow-up are needed. Full article

Background. Ductal carcinoma in situ (DCIS) is a non-invasive disease of the breast. This study assessed the impact of the CDK4/6 inhibitor palbociclib on halting cell cycle progression in DCIS between diagnostic biopsy and surgical resection of the lesion. Methods. A dual-arm study was conducted involving 17 participants with DCIS who were given either 100 mg of palbociclib PO daily for twelve days or no treatment before surgery. FFPE tissues from the diagnostic biopsy and from surgical specimens were analyzed to assess changes due to treatment. Results. Palbociclib treatment significantly reduced Ki67 staining in surgical tissues. RNA-seq analysis comparing the diagnostic biopsy and surgical specimens showed significant downregulation of cellular proliferation pathways after treatment. A cellular deconvolution analysis demonstrated a non-significant trend of a treatment-induced decrease in the abundance of mature luminal epithelial cells. Conclusions. Short-term palbociclib monotherapy before surgical resection was safe and well tolerated in participants. Tissue analysis showed a significant reduction in proliferation markers and the downregulation of cell cycle progression genes within DCIS. These results support further investigation of palbociclib in patients with DCIS. Trial registration. ClinicalTrials.gov NCT03535506. Full article

Introduction: The demand for structured training in orthopaedic surgery, particularly in total hip arthroplasty (THA), is increasing. Cadaver labs provide valuable experience for surgical access and anatomical exposure; however, the availability of specimens with predefined pathological features, such as dysplastic hip anatomy, is limited and difficult to standardize. This study presents a preliminary assessment of an integrated curriculum combining cadaver-based practice and patient-specific phantom simulation for task-oriented THA training. Methods: The curriculum included theoretical lessons, cadaver lab practice, and phantom-based training. The phantom models were developed from CT data of a patient with severe hip dysplasia and designed to reproduce selected anatomical and procedural challenges. Eight novice trainees and three expert tutors completed a multidomain 5-point Likert questionnaire assessing realism, face and content validity, perceived usefulness, and the complementary role of cadaver- and phantom-based sessions. Results: Participants reported high satisfaction and perceived the integrated pathway as useful. Cadaver training was rated higher for surgical access realism, whereas phantom simulation was considered valuable for rehearsing pathology-specific tasks involving altered femoral and acetabular anatomy. Conclusions: Integrating patient-specific phantoms into cadaver-based THA training appears feasible and was perceived as educationally valuable, adding a reproducible, pathology-specific simulation component and supporting future assessment strategies with objective performance metrics. Full article

Background/Objectives: To evaluate the surgical and functional outcomes of robot-assisted simple prostatectomy (RASP) for men with bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH), aiding informed clinical decision-making. Methods: We conducted a prospective study of 69 patients undergoing RASP for BPH-related LUTS or acute urinary retention (AUR). Three high-volume robotic urologists from a single center, utilising a modified Millins technique, performed the RASP procedures. Pre-operative data included demographics (age, prostate-specific antigen (PSA), prostate volume), LUTS measures (International Prostate Symptom Score (IPSS), quality-of-life (QOL), flow rates, pad use), and intraoperative parameters (operative time, blood loss, histology, hospital stay). Postoperative outcomes were collected at 6–8 weeks and included symptom scores, flow rates, pad use, and patient satisfaction. Data were analysed using descriptive statistics and multivariate linear logistic regression; significance was set at 95% confidence. Results: Median patient age was 74 years (interquartile range (IQR) 72–77) with a median prostate volume of 143 cc (IQR 123–195) and preoperative IPSS of 19 (IQR 15.0–23.0). Median console time was 60 min (IQR 50.0–65.0), estimated blood loss was 350.0 mL (IQR 200–500), and specimen weight was 105.5 g (IQR 67.25–132.5). Median hospital stay was 1.0 day; all patients passed their trial of void (TOV) postoperatively, with an IPSS improvement of 78.9% (12 points), QOL improvement of 75% (3 points), maximum flow rate (Qmax) increase of 16.3 mL/s and an overall patient satisfaction of 10 out of 10 (extremely satisfied), independent of specimen size, operative duration, or pad usage. Conclusions: RASP appears to be a safe and effective surgical option for men with high-volume BPH and bothersome LUTS, offering substantial symptom improvement and excellent patient satisfaction. Its advantages may extend to patients with very large prostates or concurrent bladder pathology. However, findings are limited by our modest sample size and short follow-up. Larger prospective and comparative trials are warranted to better define the role of RASP in the treatment algorithm for BPH. Full article

Background and Objectives: This retrospective cohort study aimed to analyze the surgical evolution, clinical outcomes, and adoption of uterus-preserving techniques in placenta previa (PP) and placenta accreta spectrum (PAS) cases managed by a single senior surgeon over an uninterrupted 13-year period. Materials and Methods: A total of 324 patients who underwent cesarean section by a single experienced surgeon with a diagnosis of placenta previa between 1 January 2013 and 1 January 2026 were included in the study. The demographic and obstetric characteristics of the patients, the surgical methods applied, perioperative blood product requirements, complications, and neonatal outcomes were evaluated retrospectively. Uterus-preserving surgical methods included a temporary uterine tourniquet, intrauterine hemostatic sutures, bilateral internal iliac artery ligation (IIAL), Bakri balloon tamponade, B-Lynch suture, uterine lower segment resection, and uterine packing, applied in a stepwise manner. The perioperative hemoglobin change (ΔHb) was calculated as an objective indicator of blood loss. Results: Placenta previa constituted a substantial proportion of all cesarean sections performed by the same surgeon during the study period. Total previa was the predominant type, and almost half of the operations were carried out under emergency conditions. Peripartum hysterectomy was required in a minority of patients, and placenta accreta spectrum was histopathologically confirmed in most of these hysterectomy specimens. The proportion of cases managed with uterus-preserving techniques increased progressively across the series, rising from none in the first year to the great majority of cases in the later years, while the peripartum hysterectomy rate declined correspondingly. On multivariable analysis, a greater number of previous cesarean sections independently increased, and operation during the later years of the series independently reduced the likelihood of peripartum hysterectomy. Perioperative transfusion of at least one blood product was required in more than half of the patients, whereas intensive care admission and perioperative complications were infrequent; bladder perforation was the most common complication. Compared with women whose uterus was preserved, those undergoing hysterectomy were older and had markedly longer operative times, greater blood product consumption, longer hospital stays, and a substantially higher complication rate. No maternal death occurred throughout the 13-year period. Conclusions: In this 13-year single-surgeon experience, the gradual adoption of uterus-preserving techniques was sustainably associated with low maternal morbidity and zero maternal mortality. The markedly higher complication burden observed in the hysterectomy group compared with the uterus-preserving group demonstrates that a standardized step-up surgical approach offers an applicable and effective management strategy even in resource-limited centers. Full article

Background/Objectives: The level of the sciatic nerve bifurcation is clinically relevant for diagnostic ultrasonography, ultrasound-guided popliteal sciatic nerve block, posterior-thigh interventions, and surgical approaches to the hip, thigh, and popliteal region. Although the sciatic nerve is classically described as dividing near the popliteal fossa, its terminal branching level may vary considerably. This study aimed to evaluate the level of sciatic nerve bifurcation and its morphometric relationship to clinically relevant anatomical landmarks, with particular emphasis on the posterior intercondylar reference line. Methods: This study was conducted on 56 formalin-fixed adult human lower-extremity specimens. The bifurcation level was categorized as femoral-level, gluteal-level, or separate emergence of the tibial and common fibular components. The sciatic nerve–piriformis relationship was assessed according to the Beaton and Anson classification. Morphometric measurements were obtained from the bifurcation point to the greater trochanter, ischial tuberosity, and posterior intercondylar reference line. Results: Femoral-level bifurcation was observed in 51 of 56 specimens (91.1%), gluteal-level bifurcation in 1 specimen (1.8%), and separate emergence in 4 specimens (7.1%). Type A was the predominant Beaton and Anson pattern, observed in 50 specimens (89.3%). Type B and Type D were each observed in 2 specimens (3.6%), and 2 specimens (3.6%) demonstrated an atypical superior gemellus-related course. All measurable bifurcation points were located proximal to the posterior intercondylar reference line. Among femoral-level bifurcations, the mean distance from this line to the bifurcation point was 8.67 ± 4.89 cm. No statistically significant sex- or side-based differences were observed in the available morphometric parameters. Conclusions: Sciatic nerve bifurcation most commonly occurred at the femoral level, but clinically relevant variations were observed. The posterior intercondylar reference line may provide a useful distal femoral orientation landmark for posterior knee and distal thigh assessment. However, it should complement, rather than replace, direct ultrasonographic visualization of the sciatic nerve and its terminal branches. Full article

Background/Objectives: Metatypical basal cell carcinoma (MTBCC) is a rare and aggressive variant of non-melanoma skin cancer (NMSC) characterised by overlapping histological features of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). Owing to its increased propensity for local invasion, recurrence, and metastasis, MTBCC poses diagnostic and therapeutic challenges. This study aimed to characterise the epidemiological, histopathological, and clinical features of MTBCC and to evaluate temporal changes in tumour characteristics and aggressiveness before, during, and after the COVID-19 pandemic. Methods: A retrospective cohort study was conducted on 129 histologically confirmed MTBCC lesions diagnosed in the Pathology Department of the Mures Clinical County Hospital, Targu Mures, Romania, between January 2017 and December 2025. Demographic data, tumour location, histological subtypes, differentiation of the squamous component, aggressiveness parameters, and volumetric measurements of tumours and excision specimens were analysed. Volumetric analyses were restricted to cases with complete three-dimensional measurements. Statistical comparisons were performed across demographic variables and the following three time periods: pre-pandemic, pandemic, and post-pandemic. Results: The median age at diagnosis was 71 years, with a slight male predominance (p = 0.25) and a significant predominance of patients from urban areas (p < 0.001). Most tumours were located in the head and neck region. Mixed-type MTBCC was significantly associated with higher tumour aggressiveness (p = 0.0019) and with high-risk histological subtypes, particularly micronodular and adenoid–cystic variants. Tumour volume showed a significant inverse correlation with year of diagnosis (p = 0.0139; r = (−) 0.50), whereas excision specimen volume differed significantly according to year of diagnosis (p = 0.0425). Neither tumour volume nor excision specimen volume was associated with histopathological aggressiveness. Conclusions: Metatypical basal cell carcinoma is a rare skin malignancy in which biological behaviour appears to be determined primarily by histopathological architecture rather than tumour size. Mixed-type lesions were associated with significantly higher aggressiveness, underscoring the need for accurate histopathological assessment. These findings support a pathology-driven approach to management and emphasise the importance of adequate surgical treatment and long-term follow-up in patients with MTBCC. Full article

Real-time tissue identification during laser-guided surgery is a critical unmet need for collateral damage avoidance and margin delineation. Laser-Induced Breakdown Spectroscopy (LIBS) is compatible with pulsed laser surgical systems and offers rapid, label-free elemental analysis. This study presents a machine learning pipeline classifying five ex vivo bovine tissue classes, plus one synthetic null-signal control class, from LIBS spectra, designed to control specimen-level data leakage and class imbalance bias. Key contributions are (i) a ‘peak max over baseline’ aggregation strategy suppressing shot noise while preserving emission peaks; (ii) a repeated, group-based cross-validation protocol (GroupShuffleSplit, N = 10) enforcing specimen-level separation; and (iii) a comparison of 30 configurations (10 classifiers × 3 pipelines). Extra Trees with normalization reached the highest weighted F1-score (0.934 ± 0.118); excluding the synthetic control, five-class scores fall to 0.875–0.915 and the ranking changes, so these are the reference figures for biological tissue discrimination. Support Vector Machines were less accurate but more consistent (0.917 ± 0.069). Acquisition takes approximately 3 s per point; inference is sub-millisecond. With five source animals, the best configuration chosen on the same outer splits, and inner tuning that was not group-aware, these estimates are an exploratory step toward real-time guided surgery. Full article

Background/Objectives: Rapid optical assessment of freshly excised basal cell carcinoma (BCC) specimens may shorten the interval between excision and margin evaluation. This prospective pilot study estimated the diagnostic performance of ex vivo line-field confocal optical coherence tomography (LC-OCT) for detecting residual BCC at lateral surgical margins, using histopathology as the reference standard. Methods: Fifty-five clinically suspicious lesions from 48 patients were examined at two centers. Results were analyzed for the complete cohort and for a post-training inclusion phase comprising 32 lesions from 31 patients. Overall lesion-level consensus classifications were recorded separately from classifications of the four clock-face quadrants. Lesions with a negative overall LC-OCT assessment and at least one non-evaluable quadrant were classified as indeterminate and excluded from the primary lesion-level analysis. Thirteen lesions also underwent exploratory ex vivo fusion confocal microscopy (evFCM). Results: In the inclusion phase, 125 of 128 quadrants were evaluable. Thirteen true-positive, 106 true-negative, 2 false-negative, and 4 false-positive quadrant results yielded 86.7% sensitivity, 96.4% specificity, and 95.2% accuracy. At the lesion level, 2 of 32 results were indeterminate. Among the remaining 30 lesions, LC-OCT yielded 5 true-positive, 22 true-negative, 2 false-negative, and 1 false-positive results, corresponding to 71.4% sensitivity, 95.7% specificity, and 90.0% accuracy. The evFCM analysis was descriptive because the subset was small and nonconsecutive. Conclusions: Ex vivo LC-OCT showed promising specificity and overall accuracy for assessing lateral BCC margins after training. The limited number of margin-positive lesions, indeterminate results, clustered quadrant data, and absence of systematic deep-margin imaging require cautious interpretation. LC-OCT should not replace histopathological margin assessment on the basis of the present data. Full article

Osteoarthritis (OA) of the knee is characterized by cartilage matrix degeneration, which eventually leads to joint dysfunction and surgical replacement. Preoperative radiography, the standard for treatment decision making, provides limited information on the extent of degeneration, emphasizing the need for quantitative intraoperative techniques. This study evaluates the potential of vibroacoustic signals generated from instrument–tissue interactions to assess cartilage degeneration severity. A total of 136 ex vivo cartilage specimens of varying degeneration severity, histologically graded using the OARSI score, were collected from 41 patients undergoing arthroplasty. The specimens were classified into three groups: healthy cartilage (OARSI $\le 2.0$), degenerated cartilage (OARSI ≥ 2.5), and subchondral bone. Vibroacoustic signals were captured during specimen palpation using a vibration measurement system affixed to a surgical probe. 26 characteristic signal features were extracted using Continuous-Wavelet Transformation, and their discriminative power was assessed using Support Vector Machine and k-Nearest-Neighbor classifiers under patient- and specimen-level grouped cross-validation with nested hyperparameter tuning. Bone was distinguished from cartilage with 84–$91\%$ recall. Healthy cartilage (OARSI $\le 2.0$) was identifiable with 74–$80\%$ sensitivity, whereas the specificity for degenerated cartilage (OARSI ≥ 2.5) remained limited (40–$57\%$), constituting the principal limitation of the approach. Interpreting the binary cartilage classification as a diagnostic test, a receiver-operating characteristic (ROC) analysis yielded an area under the curve (AUC) of up to $0.66$ ($95\%$ CI [$0.56$, $0.76$]). The study demonstrates that vibroacoustic signals from instrument–tissue interactions may provide complementary information for intraoperative cartilage evaluation and may contribute to decision making in arthroplasty, while the reliable grading of cartilage degeneration remains an open challenge. Full article

Oral squamous cell carcinoma (OSCC) is a malignancy characterized by a complex immunosuppressive tumor microenvironment. Immunomodulatory cytokines and immune checkpoints such as PD-L1 (programmed death-ligand 1) and CTLA-4 (cytotoxic T-lymphocyte-associated protein 4) play a crucial role in tumor development. Due to its high mortality rate, OSCC remains one of the major challenges in modern oncology. The aim of this retrospective study was to assess the expression of PD-L1, CTLA-4, IL-10, and IL-18 in paraffin-embedded tumor specimens and to analyze their associations with selected clinicopathological parameters in 79 patients treated surgically between 2011 and 2023. Most patients exhibited intermediate expression of PD-L1 (1–49%; 81.0%), CTLA-4 (1–49%; 87.3%), IL-18 (11–25%; 78.5%), and IL-10 (11–25%; 58.2%). PD-L1 and CTLA-4 expression showed a very strong association (p < 0.001, Cramer’s V = 0.823). IL-18 expression was negatively correlated with both PD-L1 (p = 0.017, Cramer’s V = 0.322) and CTLA-4 (p = 0.004, Cramer’s V = 0.322). A positive correlation between IL-18 and IL-10 expression was also observed (p < 0.001, Cramer’s V = 0.403). Among all analyzed biomarkers, only IL-10 expression showed a significant association with 5-year survival in univariate analysis (p = 0.009), with higher IL-10 expression associated with shorter survival. However, this finding did not retain statistical significance in multivariate analysis after adjustment for age and tumor stage. The results indicate a strong relationship between PD-L1 and CTLA-4, suggesting their complementary role in tumor-associated immunosuppression. The observed associations between IL-18 and PD-L1, and between IL-18 and CTLA-4, highlight the complexity of the mechanisms regulating the antitumor immune response. Although IL-10 did not retain independent prognostic significance, the findings from the univariate analysis may indicate a potential role for IL-10 in mechanisms related to tumor progression, warranting further investigation. Future studies should further clarify the interactions between cytokine-related immunoregulatory mechanisms and immune checkpoint pathways in OSCC, particularly in relation to IL-10, IL-18, PD-L1, and CTLA-4 expression. Full article

Mismatch repair deficiency (MMRd) is a critical biomarker in endometrial cancer (EC) for prognostication, Lynch syndrome screening, and immunotherapy eligibility. This study aimed to determine the prevalence of MMRd and its correlation with clinicopathological characteristics in EC. This prospective observational cohort included 93 patients with EC undergoing primary surgical treatment, managed as per the European Society of Gynaecological Oncology (ESGO) guidelines. MLH1, PMS2, MSH2, and MSH6 expression was assessed through immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded hysterectomy specimens. Associations between mismatch repair (MMR) status and histology, grade, lymphovascular space invasion (LVSI), myometrial invasion, FIGO 2023 stage, nodal status, recurrence, and survival were analyzed. The median age was 66 years. Most tumors were endometrioid (86%), 29% were grade 3, 45.2% showed deep myometrial invasion, and 23.7% had substantial LVSI. MMRd was identified in 41.9% of cases, with MLH1 and PMS2 loss being most frequent, and was significantly associated with endometrioid histology (p = 0.027) and deep myometrial invasion (p = 0.011). No significant correlations were found with grade, LVSI, FIGO stage, nodal involvement, recurrence, or overall survival. Routine MMR assessment may refine risk stratification and guide individualized treatment decisions. Full article

Background/Objectives: PgRMC1 is a progesterone-binding protein often overexpressed in breast cancer, correlating with tumor progression and chemoresistance. Identifying predictive markers for neoadjuvant chemotherapy (NAC) response is crucial for guiding therapeutic decisions. This study examines PgRMC1 expression in breast cancer tissues and its correlation with clinicopathological characteristics and NAC response. Methods: PgRMC1 expression in normal and cancerous breast tissues was evaluated via immunohistochemistry (IHC). Expression of ER, PgR, HER2, AR, and PGRMC1 mRNA was determined by qPCR in 112 patients. A separate 44-patient neoadjuvant chemotherapy (NAC) cohort was assessed for intrinsic subtypes (pretreatment biopsies) alongside PgRMC1 IHC expression and pathological response (post-NAC surgical specimens). In vitro chemoresistance and qPCR analyses were performed in breast cancer cell lines following PgRMC1 overexpression or siRNA-mediated knockdown. Results: PgRMC1 expression was detected in breast cancer tissue, while no immunoreactivity was observed in normal breast tissue. PGRMC1 mRNA expression levels were significantly higher in luminal and HER2 subtypes. In the distinct cohort of patients treated with NAC, those with a poorer pathological response had significantly higher PgRMC1 expression than those with a good response. In vitro, forced overexpression of PgRMC1 in two breast cancer cell lines, MCF7 and MDA-MB-468, significantly reduced chemosensitivity. Overexpression of PgRMC1 modulated the expression of epithelial and differentiation markers, including CDH1, AR, KRT19, and GATA3. Conclusions: PgRMC1 may contribute to chemoresistance and serves as a candidate biomarker for assessing neoadjuvant chemotherapy sensitivity. Full article

Background: Acinetobacter baumannii is an important opportunistic pathogen responsible for healthcare-associated infections, particularly among critically ill, intensive care unit (ICU), and post-surgical patients. The emergence of carbapenem-resistant A. baumannii (CRAB) has become a major therapeutic challenge worldwide because of its multidrug-resistant nature and limited treatment options. Despite the increasing prevalence of CRAB in Pakistan, information regarding the molecular characterization of carbapenem resistance genes among isolates recovered from surgical site infections (SSIs) remains limited. Methods: A cross-sectional study was conducted from November 2023 to February 2024 at Khalifa Gul Nawaz Hospital, Bannu, Khyber Pakhtunkhwa, Pakistan. A total of (n = 118) surgical wound specimens were collected from patients with clinically diagnosed SSIs. A. baumannii isolates were identified using standard biochemical tests and confirmed by 16S rRNA gene sequencing. In vitro antimicrobial susceptibility was determined by Kirby–Bauer disk diffusion according to CLSI 2024 guidelines. In addition, the concentration-dependent inhibition-zone response of imipenem and meropenem against carbapenem-resistant isolates was evaluated using an agar well diffusion assay. Molecular detection of blaNDM-1 and blaOXA-23 was performed by polymerase chain reaction (PCR), and representative amplicons were subjected to Sanger sequencing for further analysis. Results: In the current study, the total number of (n = 118) wound specimens from healthcare-associated patients were processed, in which A. baumannii-positive isolates (n = 23, 19.5%) were documented. Its prevalence was higher in males (69.6%) compared to females, and was strongly associated (78.2%) with elderly patients (aged 51–68 years). In vitro susceptibility testing revealed that 91.3% of isolates harbored multidrug-resistant (MDR) attributes. Antimicrobial susceptibility profiling revealed high levels of multidrug resistance, with 82.6% of isolates resistant to imipenem and meropenem, as well as 100% resistance to aztreonam and gentamicin. Colistin showed the highest activity, with 87.0% of isolates remaining susceptible. In the agar well diffusion assay, measurable inhibition of the carbapenem-resistant isolates by imipenem and meropenem occurred only at higher concentrations. Molecular screening of resistance genes identified blaOXA-23 in 60.9% and blaNDM-1 in 30.4% of isolates. Co-expression of both genes was detected in some (n = 4) isolates. Among the selected MDR isolates included in the gene resistance analysis, imipenem and meropenem resistance were recorded in 9/14 blaOXA-23-positive isolates and 5/7 blaNDM-1-positive isolates. Conclusions: This study substantiates an escalated incidence of carbapenem-resistant, MDR A. baumannii in post-surgical infections. blaOXA-23 were documented as the predominant carbapenemase gene, with co-expression of blaNDM-1 in a substantial proportion of isolates. These findings provide an important phenotypic and molecular characterization of selected carbapenemase genes in healthcare-associated infections, highlighting the exigency for strengthened antimicrobial stewardship and infection control strategies in the hospitals of the region. Full article

Introduction: Uterine leiomyosarcoma (uLMS) is a rare, highly aggressive malignancy arising from the smooth muscle tissue of the uterine wall. It typically presents with abnormal vaginal bleeding, pelvic pain, or a pelvic mass. In rare instances, symptoms may result from local invasion or metastasis. We report a case of uLMS initially diagnosed following colonic perforation due to direct tumor invasion, accompanied by a comprehensive narrative review of the literature on the incidental identification of uterine sarcomas during emergency general surgery to further emphasize the diagnostic challenges, treatment approaches, and need for individualized care in these complex cases. Case Presentation: A 45-year-old woman presented to the Emergency Department with acute abdominal pain of several hours’ duration, in the absence of other associated symptoms. An emergency exploratory laparotomy was performed, revealing feculent peritonitis secondary to sigmoid colon rupture, resulting from local invasion by a large uterine mass. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was undertaken, followed by en bloc resection of the sigmoid colon, appendectomy and construction of a terminal colostomy. Her postoperative course was uneventful, and she was discharged on postoperative day eight. Histopathological examination of the specimen revealed a high-grade uterine leiomyosarcoma. Following evaluation by a multidisciplinary oncology board, the patient received adjuvant chemotherapy. Methods and Results: A narrative review of the literature was performed to identify cases of uterine sarcomas incidentally diagnosed during emergency surgery performed by general surgeons. Including the present case, six cases were identified. Most patients presented with acute abdomen mimicking gastrointestinal pathology, with diagnosis established intraoperatively or postoperatively. Definitive surgical management was achieved during the initial emergency procedure in all cases. Conclusion: Although exceptionally rare, uterine sarcoma should be considered in the differential diagnosis of acute abdomen in female patients undergoing emergency surgery. Awareness of this atypical presentation, the appropriate diagnostic approach, real-time intraoperative adaptability, and individualized multidisciplinary management are essential for ensuring appropriate surgical management and optimizing patient care. Full article