Uterine smooth muscle tumors (USMTs) represent a diagnostically and clinically challenging subset of uterine mesenchymal neoplasms. Up to 5% of these tumors exhibit ambiguous histological features that preclude definitive classification as either benign leiomyomas or malignant leiomyosarcomas. This review provides a comprehensive synthesis of the evolving diagnostic criteria, histopathological variants, and recent advancements in immunohistochemical and molecular profiling of smooth muscle tumors with uncertain malignant potential (STUMPs). The review traces the historical development of diagnostic criteria, from the original mitotic thresholds to the "Stanford criteria," which incorporate mitotic index, cytological atypia, and tumor cell necrosis. Contemporary WHO guidelines largely uphold these principles, with nuanced refinements for spindle, myxoid, and epithelioid subtypes. However, recent studies suggest additional morphologic indicators, such as atypical mitoses, infiltrative margins, and vascular invasion, may provide prognostic insight. Notably, necrosis remains the most reliable histologic predictor of recurrence, while mitotic activity and atypia, though important, are less specific. In conclusion, STUMPs represent a heterogeneous group with unpredictable behavior that requires long-term clinical follow-up. While existing histological and molecular tools aid classification, definitive prognostic markers remain elusive. Further studies integrating histopathology, immunohistochemistry, and molecular biology are essential to refine diagnosis and improve therapeutic decision-making in this diagnostically ambiguous group of uterine tumors.

Aim: This study aimed to evaluate the diagnostic performance of the Delta Neutrophil Index (DNI) and Neutrophil-to-Lymphocyte Ratio (NLR) in distinguishing malignant from benign primary brain tumors during the preoperative period. Methods: This retrospective cohort study was conducted at a tertiary university hospital. A total of 140 participants were included 60 patients with malignant glial tumors, 50 patients with benign brain tumors, and 30 healthy controls without inflammatory, infectious, or hematologic disease. Preoperative complete blood count results obtained within seven days before surgery were analyzed. Results: Patients with malignant tumors were significantly older than those in the benign and control groups (p < 0.001). DNI, NLR, PLR, MLR, and SII values were all significantly elevated in the malignant group (p < 0.001, for all comparisons). ROC analysis revealed high diagnostic accuracy for DNI (AUC = 0.847) and NLR (AUC = 0.850), with optimal cut-off values of 3.50 and 3.95, respectively. In multivariable logistic regression adjusted for age, DNI > 3.5 (OR = 20.67; 95% CI: 3.35-127.64; p = 0.001), NLR > 3.95 (OR = 21.17; 95% CI: 3.28-136.50; p = 0.001), and CRP (OR = 1.52; 95% CI: 1.20-1.93; p = 0.001) remained independent predictors of malignancy. The combined model including DNI and NLR achieved the highest diagnostic accuracy (AUC = 0.937; age-adjusted AUC = 0.943), with a sensitivity of 88.3% and a specificity of 86.0% after age adjustment. Conclusions: Both DNI and NLR demonstrated significant value in differentiating malignant from benign primary brain tumors prior to surgery, with DNI emerging as the most powerful independent predictor. The combined use of DNI and NLR substantially improved diagnostic accuracy, suggesting that simple hematologic indices may serve as practical, noninvasive adjunctive tools in the preoperative assessment of brain tumor malignancy. These markers may assist in surgical prioritization, patient counseling, and clinical decision-making, particularly in resource-limited settings.

Ampullary carcinoma (AC) is a rare gastrointestinal malignancy arising from the ampullary complex, encompassing intestinal, pancreaticobiliary, and mixed subtypes with distinct biological behaviors. Surgery is the only potentially curative treatment, yet relapse occurs in more than half of patients. Due to the scarcity of AC-specific prospective trials, treatment guidelines are largely extrapolated from other gastrointestinal cancers. This study aimed to characterize the clinicopathological features, treatment approaches, and outcomes of AC and to identify potential prognostic factors in a single-center cohort.

We retrospectively analyzed 106 patients diagnosed with AC between January 2015 and December 2023 to characterize clinicopathological features, treatment approaches, and survival outcomes, and to explore potential prognostic factors. Kaplan-Meier analysis was used to estimate recurrence-free survival (RFS) and overall survival (OS), while prognostic factors were assessed using univariate and multivariable Cox regression models.

Most patients presented with resectable disease and underwent pancreaticoduodenectomy (96.2%). The predominant histological subtype was pancreaticobiliary (45.3%). In localized disease, median RFS and OS were not reached, with 36-month RFS and OS rates of 68.1% (95% CI, 59.2-78.3) and 70.1% (95% CI, 61.1-80.3), respectively. In univariate analyses, adverse prognostic factors for both RFS and OS included the advanced T TNM category, nodal involvement, lymphovascular invasion, perineural invasion, high-grade histology, and R1 resection margins; however, only R1 resection margin remained independently associated with shorter RFS in the multivariate analysis (HR 2.5, 95% CI 1.02-5.94, p = 0.046). Survival outcomes did not differ significantly according to histological subtype. Exploratory adjusted analyses accounting for nodal status and surgical resection margin suggested an association between adjuvant therapy and improved survival, while unadjusted analyses showed no significant associations. Median OS for metastatic patients was 13.6 months.

R1 resection margin emerged as the only independent prognostic factor for RFS, with no independent association with OS, in resected AC. These findings highlight the importance of surgical margin optimization, high-quality pathological assessment, and multidisciplinary management in routine clinical practice.

Background: While research shows childhood cancer survivors experience elevated subsequent primary neoplasm (SPN) and premature mortality risks, few studies have included contemporary survivors. Methods: This study quantifies the risk of SPNs and mortality among modern survivors of childhood cancer. Utilizing a retrospective, population-based cohort of individuals diagnosed with cancer before the age of 18 in Alberta, Canada (2001-2018), we evaluated their risks of SPNs and mortality compared to the general population in Alberta, overall and after 5-year survival, using standardized mortality and incidence ratios, and absolute excess risks per 10,000 person-years. Results: Among 2581 survivors, including 1385 5-year survivors, 50 individuals developed at least one SPNs and 408 deaths were observed, with 21 SPNs and 38 deaths occurring after 5-year survival. The SPN incidence was 13.3- (95% CI: 9.8-17.5) and 10.0-fold (95% CI: 6.2-15.2) higher than expected overall and in 5-year survivors, respectively, with risks varying depending on the treatment received. For mortality, survivors experienced 62.5-fold (95% CI: 56.5-68.8) higher mortality than expected overall, equating to 233.9 (95% CI: 210.8-257.0) excess deaths per 10,000 person-years, with corresponding risks among 5-year survivors at 10.9 (95% CI: 7.7-15.0) and 43.8 (95% CI: 28.4-59.1), respectively. The excess deaths were predominantly due to recurrence/progression (89.9% overall, 66.4% in 5-year survivors), with SPNs and non-neoplastic causes contributing more excess deaths with increasing follow-up time. Risks for mortality included treatment and cancer type. Conclusions: Contemporary childhood cancer survivors in Alberta experience substantial excess SPNs and mortality, highlighting the need for long-term surveillance and tailored risk mitigation interventions.

Background/Objectives: Image-guided adaptive brachytherapy (IGABT) has transformed the standard of care for locally advanced cervical cancer (LACC), enabling volumetric target definition and dose-volume histogram (DVH)-based planning to improve pelvic tumor control while limiting severe late toxicity. Methods: A comprehensive literature search of PubMed/MEDLINE and Embase was done for articles published up to August 2024, using combinations of the following keywords and Medical Subject Heading (MeSH) terms: "cervical cancer", "endometrial cancer", "vaginal cancer", "uterine neoplasms", "brachytherapy", "high-dose-rate", "image-guided", "MRI-guided", "3D brachytherapy", "IGABT", "interstitial", "locoregional control", "toxicity", "quality of life", and "patient-reported outcomes". Results: We summarized the contemporary evidence on IGABT for cervical, endometrial, and primary or recurrent vaginal cancers, focusing on local control, survival, late morbidity, and patient-reported outcomes. We described the key target volume concepts (gross tumor volume, high- and intermediate-risk clinical target volumes), and the role of MRI-, CT-, and ultrasound-based planning with intracavitary, intracavitary-interstitial, and interstitial applicators. Conclusions: Image-guided adaptive brachytherapy has redefined the standard of care for the management of locally advanced cervical cancer. Through the integration of volumetric target concepts, DVH-based dose reporting, and advanced imaging, IGABT has enabled consistent dose escalation to the residual tumor while accounting for organ-at-risk constraints, resulting in high local control rates and reduced severe morbidity compared with historical 2D brachytherapy.

Multiple myeloma (MM) is a plasma cell neoplasm. Studies of chemokines in MM pathogenesis have primarily focused on CCR1 ligands such as CCL3 (MIP-1α), CXCL12 and its receptor CXCR4, as well as CXCR2 and CXCR3 ligands. However, the roles of the remaining 30 chemokines have been investigated much less frequently. This review compiles current knowledge on the significance of lesser-known chemokines in MM tumor processes, including CXCL13, CCR2 ligands (CCL2 [MCP-1], CCL7 [MCP-3]), CCL4, CCL5 (RANTES), CCL17, CCL20, CCL27, CCL28, and CX₃CL1 (fractalkine). It describes their impact on bone destruction, bone marrow angiogenesis, chemoresistance, and the recruitment of cells into the MM niche, such as macrophages, myeloid-derived suppressor cells, and cytotoxic lymphocytes, along with their effects on mesenchymal stromal cells. A bioinformatic analysis highlights the significance of these chemokines in MM, and the possibility of targeting them in MM therapy is also considered.

The prognostic value of conventional high-risk factors and the benefits of adjuvant chemotherapy (ACT) in stage II colon cancer with deficient mismatch repair (dMMR) remain controversial. The function of ACT in stage II dMMR colon cancer and survival results were assessed in this research.

273 patients with stage II dMMR colon cancer who had curative resection between August 2010 and October 2023 underwent a retrospective analysis. Clinicopathologic variables, postoperative treatment strategies, and survival endpoints were systematically assessed. Independent prognostic factors were identified using a multivariable Cox proportional hazards regression model. For subgroup analyses, a propensity score-matched (PSM) approach was used to minimize intergroup imbalances. Overall survival (OS) and disease-free survival (DFS) were evaluated using the Kaplan-Meier approach.

177 (64.8%) patients had at least one high-risk factor. With a median follow-up of 62.6 months, the estimated 5-year OS and DFS rates were 94.7% and 89.8%. Age ≥ 65 years and examination of fewer than 12 lymph nodes were independently associated with OS. For DFS, age ≥ 65 years, LNs < 12, and receipt of ACT were identified as independent prognostic factors. According to subgroup analyses, ACT was linked to better OS and DFS in patients with high-risk features or poorly differentiated histology. Results were similar after propensity score matching.

Traditional high-risk features also exert prognostic impact on this population. ACT appeared to be associated with improved survival in selected high-risk patients, particularly those with poorly differentiated histology.

Hypofractionated stereotactic radiosurgery (hfSRS) is increasingly used for benign intracranial tumors that are large or located near critical neural structures to reduce treatment-related toxicity. However, the optimal interval between fractions remains poorly defined, particularly for slowly proliferating benign tumors. This study evaluated clinical outcomes and longitudinal volumetric response patterns following Gamma Knife hfSRS delivered at fixed two-week intervals, with particular attention to the biological relevance of fraction timing.

We retrospectively analyzed 126 patients with benign intracranial tumors, including meningioma, non-functioning pituitary neuroendocrine tumor (PitNET), vestibular schwannoma, and craniopharyngioma, treated between 2016 and 2022. Treatment was delivered in 2-5 fractions at fixed two-week intervals using Gamma Knife radiosurgery. Radiological outcomes included tumor control rate and longitudinal volumetric changes, while clinical outcomes included visual, auditory, and endocrine function. Propensity score matching was performed in PitNET and vestibular schwannoma cohorts to compare hfSRS with single-fraction stereotactic radiosurgery while minimizing baseline imbalances.

The overall tumor control rate was 98.4%. Across the entire cohort, tumors demonstrated a median volume reduction of -0.64% per month. In the propensity score-matched PitNET cohort, tumor control was comparable between treatment groups, whereas hfSRS was associated with earlier and greater volumetric reduction over time compared with single-fraction treatment. In the matched vestibular schwannoma cohort, long-term tumor control was similar between groups; however, transient tumor enlargement occurred more frequently after hfSRS without adversely affecting long-term tumor control or functional hearing outcomes.

Hypofractionated stereotactic radiosurgery delivered at fixed two-week intervals achieved excellent tumor control with acceptable toxicity in selected benign intracranial tumors. These findings support the clinical feasibility of a fixed two-week inter-fraction interval and suggest that fraction timing may represent a biologically relevant treatment parameter influencing early volumetric response patterns without compromising long-term outcomes.

Burkitt lymphoma (BL) is an aggressive mature B-cell lymphoma that represents one of the most studied human malignancies. Initially described in equatorial Africa by the Irish surgeon Denis P. Burkitt, African (endemic) Burkitt lymphoma was the first human neoplasm shown to be associated with a virus, the Epstein-Barr virus (EBV), and also the first human neoplasm shown to harbor a recurrent chromosomal aberration, the t(8;14) (q24;q32) translocation that led to the identification of the central role of the MYC gene in tumorigenesis. In this review, we provide a brief historical introduction, followed by a presentation of important aspects of epidemiology, pathogenesis, and of diagnostic features including morphology, cytogenetics and molecular findings. We also provide a comprehensive overview of the findings convincingly demonstrating that subtyping of BL into EBV-positive and EBV-negative better describes the biological heterogeneity of this lymphoma entity than the historical subtyping into endemic, sporadic, and immunodeficiency-associated. As the distinction of BL from other B-cell lymphomas is important for providing optimal oncological care, we also discuss the differential diagnosis and how this lymphoma can be distinguished from other aggressive B-cell lymphomas.

Background/Objectives: Robot-assisted radical prostatectomy (RARP) is widely used in contemporary prostate cancer surgery; however, surgeons enter robotic practice through heterogeneous training pathways. This study aimed to compare early oncological and functional outcomes after RARP between two experienced robotic surgeons with different surgical backgrounds after completion of the learning curve. Methods: We conducted a retrospective, consecutive, single-center study including patients undergoing RARP after completion of the learning curve (> 40 cases) by two experienced robotic surgeons with different surgical backgrounds. Baseline characteristics, perioperative variables, and early oncological and functional outcomes were compared between surgeons. Pentafecta achievement was assessed as an exploratory composite outcome. Appropriate non-parametric and categorical statistical tests were applied as appropriate. Results: Ninety-three patients were included (55 operated on by surgeon A and 38 by surgeon B). Preoperative clinical and pathological characteristics were largely comparable between groups, except for prostate volume. Median operative time was significantly shorter for surgeon A (70 vs. 120 min, p < 0.001). Postoperative morbidity was low, with no major complications and no differences in length of hospital stay. At 6 months, urinary continence and erectile function recovery rates were high and comparable between surgeons. Oncological outcomes, including positive surgical margin rates and biochemical recurrence, did not differ significantly, although recurrence events were infrequent and follow-up was limited. Overall pentafecta achievement was modest and similar between groups (23.6% vs. 21.1%, p = 0.77), with positive surgical margins emerging as the main limiting factor. Conclusions: In this exploratory post-learning curve analysis, early oncological and functional outcomes after RARP were similar between surgeons with different surgical backgrounds. These findings should be interpreted cautiously and considered hypothesis-generating.