Tovorafenib is an oral, selective, CNS-penetrant, type II inhibitor of BRAF and CRAF. BRAF fusions and CRAF/RAF1 fusions and amplifications are rare oncogenic drivers in many solid tumors. The phase II DAY101-102a substudy of FIRELIGHT-1 (ClinicalTrials.gov identifier: NCT04985604) investigated the efficacy and safety of tovorafenib monotherapy in recurrent/refractory solid tumors with structural alterations in BRAF or CRAF.

Patients ≥12 years of age with a recurrent/refractory solid tumor with a BRAF fusion or CRAF fusion or amplification were enrolled into a melanoma cohort or tumor-agnostic cohort. The primary end point was overall response rate (ORR), as assessed by investigators. Tovorafenib was administered at 600 mg once weekly (adult dose), continuously, in 28-day cycles.

Twenty-three patients were enrolled; eight in the melanoma cohort and 15 in the tumor-agnostic cohort. The median age was 53 years (range, 21-71), and 57% of patients had ≥2 lines of prior therapy. Fourteen patients had tumors with BRAF fusion, six CRAF fusion, two CRAF amplification, and one CRAF fusions and amplification. The median duration of tovorafenib treatment was 5.3 months (range, 0.8-22.5). The ORR was 43% (10/23 patients), including 50% (4/8) in patients with melanoma and 40% (6/15) in patients with other tumors. The median time to response was 1.8 months. The median duration of response was 9.2 months. The most common treatment-related adverse events (any grade) were anemia (39%), pruritus (30%), increased creatine phosphokinase (26%), and rash (26%).

Tovorafenib demonstrated single-agent clinical activity in solid tumors with BRAF fusions or CRAF fusions or amplification and had a manageable safety profile. Tovorafenib may offer a new targeted treatment option for adult patients with tumors harboring these rare genomic driver alterations.

Organ preservation is a priority in early-stage rectal cancer as total mesorectal excision (TME) can reduce quality of life. The Canadian Cancer Trials Group CO.28 trial demonstrated that neoadjuvant chemotherapy followed by transanal excision was effective in patients with cT1-3, node-negative (N0) rectal cancer. Here, we explored circulating tumor DNA (ctDNA) from the trial as a potential future decision aid to guide TME.

Fifty-three of 58 patients (91.4%) from CO.28 had at least one sample available for ctDNA analysis using the Guardant Reveal epigenomic assay from the following time points: prechemotherapy, postchemotherapy, pretransanal endoscopic surgery (TES), and on follow-up at months 12, 24, and 36.

ctDNA was detected in 45.8% of patients before neoadjuvant chemotherapy. Detection was similar by T-stage (P = .18). The rate of detectable ctDNA significantly decreased after chemotherapy (and pre-TES) to 8.7% (P < .0001), with 41.4% of evaluable patients moving from detectable ctDNA to completely undetectable following chemotherapy. ctDNA detection postchemotherapy and pre-TES was associated with poor response and persistent cancer (P = .03), with recommended TME for 100% (n = 4 of 4) of patients with ctDNA detected versus 38.1% (n = 16 of 42) of patients with undetectable ctDNA. Five patients had recurrence during follow-up (two local, three distant), 50% of whom (1 of 2, both local) had longitudinal plasma collected had detectable ctDNA at progression.

ctDNA testing identified cancers with inadequate response to chemotherapy in patients for whom TME was recommended. A tissue-free assay may enable faster turnaround times compared with tumor-informed assays and provide a tool to support organ preservation. Further exploration of these assays in early-stage rectal cancers is warranted.

Primary pulmonary lymphoma (PPL) is an extremely rare malignant lung tumor that is frequently misdiagnosed as pneumonia or lung cancer due to its atypical radiological and clinical presentation. The rationale of this report is to elucidate the diagnostic value of combining computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in evaluating a rare presentation of PPL.

A 44-year-old male was admitted after an incidental lung lesion was discovered during routine screening. He was completely asymptomatic, lacking respiratory or systemic "B symptoms."

A baseline chest CT identified a 3.9 × 3.5 cm soft-tissue mass in the right hilar region that compressed the right upper lobe bronchus, leading to secondary post-obstructive consolidation that lacked the characteristic air bronchogram sign. The CT also revealed an incidental 2.6 × 2.6 cm anterior mediastinal nodule. Subsequent whole-body 18F-FDG PET/CT demonstrated intense tracer uptake in the right hilar mass with a maximum standardized uptake value of 7.1 and mild-to-moderate uptake in an adjacent regional lymph node (maximum standardized uptake value of 3.2). The scan showed completely absent uptake in the anterior mediastinal nodule and the post-obstructive consolidation, arguing against metabolically active malignancy in those areas. Histopathological and immunohistochemical analysis from a bronchoscopic transbronchial lung biopsy confirmed primary pulmonary mucosa-associated lymphoid tissue lymphoma.

The patient underwent localized radiotherapy targeting the right hilar mass and the FDG-avid regional hilar/posterior mediastinal lymph node. A total dose of 66 Gy was delivered in 18 fractions over the course of 3 weeks.

At the 2-month post-discharge follow-up, a repeat chest CT revealed a marked reduction in the size of both the hilar lesion and the regional lymph nodes. The patient remained completely asymptomatic, and his laboratory parameters normalized.

Differentiating PPL from central lung cancer and coexisting benign mediastinal abnormalities presents a significant clinical challenge, particularly when atypical radiological features mimic aggressive carcinomas. Whole-body 18F-FDG PET/CT serves as an invaluable, noninvasive modality for metabolic characterization, accurate loco-regional staging, and preventing clinical overstaging by effectively differentiating metabolically active lymphoma from concurrent benign lesions.

Ambrisentan is an endothelin receptor antagonist broadly used for the treatment of pulmonary arterial hypertension. However, multiple adverse events (AEs) were reported with its use, and we intended to evaluate potential ambrisentan-associated AE signals through the US Food and Drug Administration Adverse Event Reporting System. Reports from March 2019 to December 2022 were selected for disproportionality analysis. Four signal detection methods were applied, namely the reporting odds ratio, the proportional reporting ratio, the information component, and the empirical Bayes geometric mean, to assess ambrisentan-associated AE signals. Ambrisentan was identified as a suspected drug in 30,060 reports. AEs associated with ambrisentan covered 8 system organ classes and showed potential signals at the preferred-term level, such as peripheral edema and dyspnea, as well as cardiac AE signals including palpitations and cardiac failure. The median time to onset of ambrisentan-associated AEs was 240 days, and approximately half (49.66%) of the AEs with documented time to onset occurred after 1 year of use. Our research identifies potential safety signals of cardiac AEs associated with ambrisentan use. These signals are hypothesis-generating and warrant confirmation in prospective studies, as well as continued pharmacovigilance monitoring.

Myasthenia gravis (MG) is a chronic autoimmune disorder predominantly driven by pathogenic autoantibodies directed against postsynaptic acetylcholine receptors, impairing neuromuscular transmission. Although cardiovascular complications remain relatively uncommon among MG patients, their emergence markedly elevates the risk of fatal outcomes. This review synthesizes existing evidence to delineate the clinical manifestations of MG-associated myocardial damage, offering clinicians a comprehensive framework for early detection and evidence-based therapeutic intervention.

We analyzed 84 cases of myasthenia gravis associated with myocardial damage from the database and comprehensively evaluated their clinical characteristics.

The average age of patients presenting with myasthenia gravis and concurrent myocardial damage was 64.5 years. Cardiac complications predominantly included myocarditis, takotsubo cardiomyopathy, acute myocardial infarction, and coronary spastic angina. Serological analysis revealed 2 principal autoantibodies: acetylcholine receptor (AChR) antibody and anti-titin antibody. Clinical outcomes demonstrated a 72.6% survival rate alongside a 23.8% case fatality rate. These variables were more frequently observed among fatal cases but were not statistically associated with mortality: AChR antibody positivity, thymoma, myocarditis, immune checkpoint inhibitor use, and acute myocardial infarction.

This study represents the inaugural comprehensive analysis examining the association between myasthenia gravis and concurrent cardiac injury. Our research elucidates potential pathophysiological pathways underlying this clinical entity. These findings highlight the need for clinical awareness and screening of myocardial involvement in MG patients and may provide preliminary evidence for future consensus development.

Myelosuppression after autologous stem cell transplantation (ASCT) exposes patients with multiple myeloma to substantial infection and bleeding risks and may be accompanied by marked psychological distress during protective isolation. Although supportive care is central to posttransplant recovery, reports describing how narrative nursing can be integrated into routine transplantation care remain limited.

A 46-year-old married man with multiple myeloma was admitted 7 months after ASCT because of fever for half a day and erosive oral-labial mucosal lesions. He presented with febrile neutropenia, oral mucositis, severe pancytopenia, anxiety, hopelessness, and concern about his family role as the main financial provider.

The patient was diagnosed with multiple myeloma after ASCT complicated by prolonged myelosuppression, febrile neutropenia, oral mucositis, and severe pancytopenia. Delayed hematopoietic reconstitution and infection, including possible fungal infection, were considered during the clinical course.

The patient received protective isolation in a laminar airflow room, empiric broad-spectrum antimicrobial therapy, granulocyte colony-stimulating factor, hemostatic prophylaxis, blood component support, meticulous oral and skin-mucosal care, nutrition and hydration support, and dynamic monitoring. A supplemental infusion of autologous hematopoietic stem cells was administered on hospital day 2. Individualized narrative nursing was provided through repeated one-to-one conversations, emotional validation, misconception correction, achievable daily goal setting, family communication, and discharge planning.

During the 16-day hospitalization, fever and mucositis resolved, leukocyte and neutrophil counts gradually recovered, inflammatory markers declined, and no new infection or major bleeding occurred. The patient reported reduced fear, improved sleep, and greater willingness to participate in care and follow-up.

This case suggests that structured narrative nursing can be feasibly embedded in routine ASCT supportive care during prolonged myelosuppression and may support emotional adjustment, treatment engagement, and family-centered coping.

We present the case of gallbladder adenomyomatosis (GA)-induced cholecystogastric fistula (CGF) that mimicked an invasive gastric gastrointestinal stromal tumor (GIST), leading to diagnostic and surgical challenges in an emergency setting.

A 71-year-old woman presented to the emergency department with acute abdominal pain and clinical signs of mechanical small-bowel obstruction (SBO).

Contrast-enhanced abdominal computed tomography (CT) revealed a 6-cm mass along the gastric antrum with apparent hepatic invasion and concurrent features of SBO. The gallbladder was not visualized. Esophagogastroduodenoscopy (EGD) demonstrated a subepithelial tumor-like bulge with a small mucosal opening in the gastric antrum, raising suspicion of a fistulous tract.

Emergency exploratory laparotomy identified two phytobezoars in the small bowel, which were treated by segmental resection and primary anastomosis. The gastric mass was found to be densely adherent to the liver, and bile leakage was encountered during dissection, prompting intraoperative hepatobiliary consultation.

Histopathological examination of the resected specimen confirmed GA with inflammatory granulation tissue at the gallbladder-gastric serosal interface, with no evidence of malignancy. The patient recovered uneventfully and was discharged 29 days postoperatively.

This case highlights a novel and clinically significant diagnostic pitfall: GA-induced CGF can convincingly simulate an invasive gastric neoplasm on multimodal imaging and endoscopy. Recognition of biliary red flags, including non-visualization of the gallbladder on CT, a mucosal opening adjacent to a subepithelial-appearing lesion on EGD, and intramural cystic foci on imaging, is essential for accurate preoperative diagnosis.

In patients with advanced cancer, newly detected pulmonary nodules are often interpreted as metastatic progression. The distinctive feature of this case was the appearance of multiple new lung nodules during otherwise controlled systemic disease: the primary colonic lesion and hepatic metastases remained stable while tumor marker levels declined. This radiologic-clinical discordance prompted reconsideration of metastatic progression and broadened the differential diagnosis.

A patient with advanced colon cancer, who was undergoing systemic chemotherapy and had otherwise stable disease, was found to have developed new pulmonary nodules on routine surveillance imaging. The patient was entirely asymptomatic from a respiratory standpoint. The primary clinical concern was the discordance between the radiologically suspicious findings and the patient's overall stable clinical condition.

The initial radiologic impression favored pulmonary metastases. However, multidisciplinary review recognized the discordance between the new lung lesions and the otherwise stable systemic disease and raised concern for an opportunistic infection. Serum (1,3)-β-D-glucan and qualitative cryptococcal capsular polysaccharide antigen tests were positive, supporting a diagnosis of pulmonary cryptococcosis.

After cerebrospinal fluid evaluation excluded central nervous system involvement, fluconazole 400 mg once daily was initiated. The anticancer strategy was not escalated on the basis of the pulmonary findings alone.

Follow-up chest computed tomography demonstrated marked regression of the pulmonary nodules.

When new pulmonary lesions arise despite stability or response at established tumor sites, apparent radiologic progression should not automatically be equated with oncologic progression. Integrating the longitudinal treatment response, tumor marker trends, clinical symptoms, imaging features, and targeted infectious testing can prevent unnecessary changes in cancer therapy and may avoid invasive procedures when a sufficiently supported alternative diagnosis is available.

Angioimmunoblastic T-cell lymphoma (AITL), classified as nodal T-follicular helper cell lymphoma, angioimmunoblastic type, is an aggressive lymphoma frequently complicated by immune dysregulation. Owing to overlapping histopathological features, particularly Hodgkin/Reed-Sternberg-like cells, AITL may be initially misdiagnosed as Hodgkin lymphoma, leading to delayed recognition and inappropriate management.

A 72-year-old man presented with progressive fatigue, recurrent fever, severe pancytopenia, and splenomegaly after an outside diagnosis of Hodgkin lymphoma based on inguinal lymph node biopsy.

Laboratory findings revealed hypertriglyceridemia and marked hyperferritinemia, consistent with secondary hemophagocytic lymphohistiocytosis (HLH). Reevaluation of archived lymph node tissue demonstrated Epstein-Barr virus-encoded RNA positivity, T-cell receptor gene rearrangement, and an immunophenotype diagnostic of nodal T-follicular helper cell lymphoma, angioimmunoblastic type with scattered Hodgkin/Reed-Sternberg-like cells. Plasma Epstein-Barr virus DNA was detected at low levels. The disease was staged as Lugano stage III with B symptoms and classified as high risk by the International Prognostic Index.

HLH-directed therapy with etoposide and dexamethasone was initiated for rapid disease control, followed by cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy for lymphoma treatment.

Partial remission was achieved after 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. The patient later experienced disease progression with clinically suspected recurrent HLH despite salvage therapy and died on March 29, 2025.

This case underscores the diagnostic pitfalls of AITL complicated by HLH and highlights the importance of early pathological reassessment and a stepwise treatment approach prioritizing control of hyperinflammation in patients with discordant clinical and pathological findings.

This report describes an exceptionally large recurrent tumor with a long-standing and recurrent clinical course, thereby adding to the limited literature on giant myxoid liposarcoma.

A 48-year-old male with a 13-year history of recurrent liposarcoma presented with progressive abdominal distension and marked abdominal enlargement over 4 months. Imaging demonstrated a massive abdominopelvic mass measuring 352 mm in maximum diameter.

Histopathological examinations from multiple prior resections had consistently confirmed recurrent myxoid liposarcoma.

During the current admission, the patient underwent complete resection of a giant retroperitoneal tumor, with pathology again verifying myxoid liposarcoma. No adjuvant chemotherapy or radiotherapy was administered.

At 18-month follow-up, the patient developed multiple abdominopelvic metastases, indicating the aggressive biological behavior and high recurrence risk of retroperitoneal myxoid liposarcoma.

This case describes an exceptionally large recurrent retroperitoneal liposarcoma measuring 43 × 32 × 23 cm and weighing approximately 20 kg, with a prolonged 13-year clinical course characterized by multiple recurrences and repeated surgical resections. It demonstrates that even an extremely large recurrent tumor may remain amenable to surgical resection following comprehensive imaging evaluation and multidisciplinary planning, with appropriate preparation for possible adjacent-organ resection. Nevertheless, the development of multifocal abdominopelvic recurrence 18 months after surgery underscores the persistent risk of recurrence and the need for structured, long-term postoperative surveillance. This case contributes to the limited literature by illustrating both the feasibility and the inherent limitations of repeated surgical management for giant recurrent retroperitoneal liposarcoma.