The clinical significance of intraductal lesions detected as primary findings on screening breast ultrasound (US) remains unclear. This study aimed to determine the malignancy rate of retroareolar intraductal lesions detected by supplemental screening breast US in asymptomatic women with mammographically dense breasts and to identify imaging features associated with malignancy.

This multicenter retrospective study included asymptomatic women with dense breasts who had intraductal lesions located in the retroareolar area detected on screening breast US between January 2012 and December 2021. Sonographic and mammographic features were evaluated by three radiologists. Logistic regression analysis was conducted to identify imaging and clinicopathologic factors associated with malignancy. The diagnostic performance of imaging features for predicting malignant retroareolar intraductal lesions was assessed. A reader study was performed to evaluate interreader agreement for sonographic features.

Among 550 intraductal lesions in 544 women (mean age ± standard deviation, 49.8 ± 9.3 years), 529 (96.2%) were benign, and 21 (3.8%) were malignant. Multivariable analysis demonstrated that a beyond-the-duct appearance (adjusted odds ratio [OR], 11.4; 95% confidence interval [CI], 2.4-53.3; P = 0.002) and the presence of vascularity on color Doppler US (adjusted OR, 10.0; 95% CI, 1.3-76.7; P = 0.027) were independently associated with malignancy. The beyond-the-duct appearance on US demonstrated a sensitivity of 14.3% (3 of 21) and a high specificity of 99.1% (524 of 529). The presence of vascularity on color Doppler US demonstrated a sensitivity of 95.2% (20 of 21) and a low specificity of 41.2% (218 of 529). Interreader agreement for sonographic features ranged from marginal to excellent (lower bounds of the 95% CI for Fleiss' kappa, 0.39-0.89).

Retroareolar intraductal lesions detected on screening US in women with dense breasts exhibited a low malignancy rate of 3.8%. A beyond-the-duct appearance and the presence of vascularity on color Doppler US were independently associated with malignancy in retroareolar intraductal lesions detected on screening breast US.

Bruton tyrosine kinase inhibitors are central to the treatment of relapsed or refractory mantle cell lymphoma, but cardiovascular and bleeding toxicities influence treatment selection. Ibrutinib has been associated with atrial fibrillation/flutter and other cardiovascular adverse events, whereas second-generation covalent BTK inhibitors were developed to improve kinase selectivity and tolerability. Mantle cell lymphoma-specific real-world comparative safety data across ibrutinib, acalabrutinib, and zanubrutinib remain limited.

To compare cardiovascular and bleeding outcomes among patients with mantle cell lymphoma treated with ibrutinib, acalabrutinib, or zanubrutinib.

We conducted a retrospective propensity score-matched TriNetX cohort study of patients with mantle cell lymphoma treated with ibrutinib, acalabrutinib, or zanubrutinib. Alternate BTK inhibitor exposure and prior recorded outcomes were excluded. Outcomes included newly recorded atrial fibrillation/flutter, heart failure, and gastrointestinal bleeding. Matching included demographics, comorbidities, cardiovascular risk factors, anthracycline exposure, and antithrombotic use.

After matching, the 365-day cohorts included 738 patients per group for acalabrutinib versus ibrutinib, 522 per group for zanubrutinib versus ibrutinib, and 532 per group for acalabrutinib versus zanubrutinib. Newly recorded atrial fibrillation/flutter was lower with acalabrutinib than ibrutinib, 4.5% versus 12.0%, RR 0.371, HR 0.387, and with zanubrutinib than ibrutinib, 5.0% versus 12.3%, RR 0.408, HR 0.421. Atrial fibrillation/flutter rates were similar between acalabrutinib and zanubrutinib, 4.0% versus 5.7%, RR 0.704, HR 0.714. Heart failure did not differ statistically, and 180-day sensitivity analyses were consistent. Exploratory gastrointestinal bleeding was higher with ibrutinib than acalabrutinib, 4.3% versus 2.2%, and numerically higher with ibrutinib than zanubrutinib, 4.7% versus 3.3%; acalabrutinib-versus-zanubrutinib gastrointestinal bleeding output was unavailable.

Ibrutinib was associated with a higher risk of atrial fibrillation/flutter than acalabrutinib or zanubrutinib. These findings may support individualized BTK inhibitor selection, particularly among patients with baseline cardiovascular risk.

Childhood cancer survivors (CCSs) are at increased risk of cancer therapy-related cardiac dysfunction following anthracycline chemotherapy. Although left atrial (LA) strain assessed by speckle-tracking echocardiography has emerged as a sensitive marker of diastolic dysfunction, it remains unclear when during survivorship LA dysfunction becomes detectable in CCSs treated with anthracyclines.In this retrospective observational case-control study, 92 CCSs (aged 4-32 years) and 96 age-matched healthy controls underwent echocardiography. Participants were stratified into three age groups (4-12, 13-18, and 19-32 years). LA reservoir, conduit, and pump strains were measured using two-dimensional speckle-tracking echocardiography from the apical four-chamber view. Conventional echocardiographic parameters, including mitral inflow velocities (E and A waves), E/A ratio, and tissue Doppler-derived e' and E/e', as well as left ventricular longitudinal strain (LVLS), were assessed.Conventional diastolic parameters did not significantly differ between CCSs and controls within corresponding age groups. However, in young adult CCSs (19-32 years), all three components of LA phasic strain (reservoir, conduit, and pump strains) were significantly reduced compared with age-matched controls. LVLS was also significantly lower in this group, whereas younger CCSs showed no significant differences in LA strain.LA phasic dysfunction was most evident in young adult CCSs despite preserved conventional diastolic indices, suggesting that age-stratified LA strain assessment may help identify survivorship stages at which atrial dysfunction becomes detectable.

Lenalidomide, an immune-modulatory drug, is used to treat multiple myeloma (MM). Lenalidomide has also been investigated as a treatment for myelofibrosis (MF); however, its efficacy in this setting has not been established. We report a case of secondary MF progressing from polycythemia vera (PV) that had the poor prognostic factor del (7q) and concurrent MM, in which del (7q) disappeared and MF improved after treatment with lenalidomide. A 69-year-old woman presented to our hospital with PV in March 2022. Bone marrow examination revealed grade 2 fibrosis. The diagnosis was secondary MF progressing from PV, with JAK2 V617F and del (7q), along with IgG-κ monoclonal gammopathy of undetermined significance (MGUS). In May 2023, the appearance of new bone lesions indicated progression of MGUS to MM. Treatment with lenalidomide plus dexamethasone achieved a partial response. After this treatment, del (7q) disappeared and MF improved. The efficacy of lenalidomide in MF with del (7q) has never been reported. This case shows that lenalidomide may improve the prognosis of MF with del (7q).

Nodal T follicular helper cell lymphoma, follicular type (nTFHL-F), is an exceptionally rare subtype of peripheral T-cell lymphoma derived from T follicular helper cells. Although diagnostic criteria have been refined in recent classifications, standardized therapeutic strategies have yet to be established. Although molecular evidence indicates that the histone deacetylase inhibitor tucidinostat is preferentially active against tumors with a TFH phenotype, quantitative clinical data remain limited, and no subtype-specific analyses have been reported to date. We encountered a case of CD30-positive nTFHL-F in which first-line treatment with A-CHP chemotherapy, incorporating brentuximab vedotin, achieved a complete metabolic response (CMR). The patient was a 71-year-old man who presented with left cervical lymphadenopathy and was diagnosed with nTFHL-F based on histopathological and immunophenotypic findings. Given the CD30 positivity, A-CHP was selected, and six cycles were completed, resulting in a CMR on PET-CT. Although the response only lasted approximately six months before relapse occurred, subsequent treatment with tucidinostat induced a second objective response. Reports describing the efficacy of A-CHP and tucidinostat in CD30-positive nTFHL-F are extremely rare, and this case provides clinical insight into treatment sequencing and response durability in this setting.

Patients diagnosed with metastatic or recurrent cancer experience uncertainty and distress; however, their consultation needs remain insufficiently quantified. We conducted a web survey in Japan (January 23-29, 2025) among adults (≥18 years) with a history of metastatic or recurrent cancer (n=522). Participants selected concerns from 21 items across four domains, and for each endorsed concern, they indicated whether they wished to consult hospital and/or community pharmacists; consultation intention was calculated among those endorsing each item. Hospital-community differences were evaluated using McNemar's test or Mid-P exact test using a significance threshold of p<0.001. The mean age was 58.9±12.9 years; cancers were colorectal (22.2%), breast (18.2%), lung (11.9%), and gastric (11.1%). 88.7% reported at least one concern. The most common concerns were treatment-related side effects (51.0%), anticancer drug mechanism/efficacy (46.9%), treatment costs (42.1%), mental distress (35.1%), and medications used to alleviate cancer- or treatment-related physical discomfort (34.7%). Consultation intention was higher for hospital than community pharmacists for issues including side effects (43.2 vs. 16.2%), mechanism/efficacy (42.9 vs. 18.0%), and symptom-relief medications (48.6 vs. 24.9%). Although concerns regarding medications other than cancer treatment were uncommon (<10% each), consultation intention exceeded 40% when present. These findings indicate that patients with metastatic or recurrent cancer may perceive different consultation roles for hospital and community pharmacists, particularly according to the type of concern. Because these results are based on self-reported consultation intentions rather than actual consultation behavior, they should be regarded as hypothesis-generating and as a basis for future studies on coordinated pharmacist support.

To investigate surgeons' perspectives on the management of right-sided obstructing colon cancer, with particular focus on their views regarding bridge-to-surgery strategies.

A national cross-sectional descriptive survey study was conducted in the Netherlands between January and October 2024. Questionnaires were distributed among surgeons with an interest in colorectal surgery and surgical trainees specialising in gastrointestinal surgery.

Fifty completed questionnaires were analysed; 80% of the respondents were surgeons, 20% were surgical trainees. Emergency resection was reported as the sole treatment option for right-sided obstructing colon cancer in 4% (n = 2), while 64% (n = 32) indicated that emergency resections were performed alongside other treatment strategies. The majority of the respondents preferred a bridge-to-surgery strategy, with bowel decompression with nasogastric tube (38%) and ileostomy (38%) being the most favoured strategies. Endoscopic stenting was not offered in 90%, largely due to the lack of trained endoscopists.

Management of right-sided obstructing colon cancer varies considerably, though most surgeons and surgical trainees favour bridge-to-surgery approaches. Greater consistency may be achieved through further research and guideline development.

AIM (apoptosis inhibitor of macrophage), also known as CD5L, is a macrophage-derived scavenger protein with broad immunomodulatory roles in mammals. Secreted by tissue macrophages, AIM circulates bound to IgM pentamers, which stabilize the protein in blood; free AIM is released during inflammation to influence immune signaling and cellular homeostasis. (Yang et al. 2023). In cats, AIM exhibits distinctive structural and biochemical properties, existing as both a three-domain (37 kDa) and a four-domain (45 kDa) variant generated through exon 3 duplication (Evangelista et al. 2025), and binding IgM approximately 1000-fold more tightly than murine AIM due to a species-specific positively charged cluster in its third SRCR domain (Miyazaki et al., 2018). These differences suggest feline AIM may function distinctly from human/mouse AIM. Feline injection-site sarcomas (FISS) arise in the context of chronic inflammation and frequently contain abundant tumor-associated macrophages (TAMs)associated with tumor aggressiveness and progression (Gomes et al., 2025). Given AIM's macrophage origin and its established roles in inflammatory regulation, autophagy signaling, and complement-mediated tumor targeting, we propose a directional hypothesis: that the high-affinity IgM-binding of feline AIM constrains free AIM availability in vivo, shifting the functional balance away from complement-mediated tumor cytotoxicity and toward macrophage-intrinsic M2-polarizing pathways, thereby promoting an immunosuppressive tumor microenvironment that contributes to FISS progression. Exploring AIM in this context may provide new perspectives for investigation in feline tumor immunology.

TFE3-rearranged renal cell carcinoma (TFE3-rRCC) is a rare, aggressive subtype that predominantly affects adolescents and young adults. Its marked morphologic heterogeneity can delay recognition and downstream confirmatory testing.

We assembled a two-center retrospective cohort of patients < 30 years with renal cell carcinoma (n = 228; 59 TFE3-rRCC), using fluorescence in situ hybridization (FISH) as the reference standard. Model development was performed in a development cohort (n = 129), followed by independent external validation (n = 99). We developed TFE3-DualNet, an ensemble of weakly supervised CLAM models trained on routine hematoxylin and eosin (H&E) whole-slide images (WSIs) using patch embeddings extracted from two pathology foundation models (UNI and CHIEF). We compared performance with three immunohistochemistry (IHC) scoring methods and a feature-fusion CLAM baseline using concatenated H&E-derived UNI and CHIEF features, and assessed interpretability by attention mapping.

In the external validation cohort, TFE3-DualNet achieved an area under the receiver operating characteristic curve (AUROC) of 0.932, with accuracy 0.879, sensitivity 0.893, and specificity 0.873. The model outperformed IHC scoring methods (AUROC 0.793-0.819; all p < 0.05) and exceeded the feature-fusion baseline (AUROC 0.906). Attention hotspots localized to diagnostically relevant tumor regions and showed concordance with TFE3 IHC patterns.

TFE3-DualNet showed encouraging performance as an interpretable H&E WSI-based screening model for TFE3-rRCC in young patients, supporting its potential use to prioritize confirmatory testing and pathologist review in routine diagnostic workflows.

Early detection of childhood cancer is a key determinant of survival, as diagnostic delays result in advanced disease, higher treatment toxicity, and increased mortality. In low- and middle-income countries (LMICs), limited cancer education and awareness among primary care providers (PCPs) contribute to diagnosis delays, highlighting the need for educational interventions that support clinical decision-making. Mobile health (mHealth) tools offer a promising cancer education strategy; however, few are designed to address learning needs in local contexts. With support from the My Child Matters program and based on the Pan-American Health Organization (PAHO) Integrated Management of Childhood Illness-Cancer (IMCI-Cancer) "traffic-light" risk-stratification framework, we co-developed with PCPs S-IMCICA_V.2 (Sistema de Información para el Manejo Integral del Cáncer Infantil_Versión.2; Information System for Comprehensive Management of Childhood Cancer_Version.2), an mHealth educational and clinical decision support tool aimed at improving detection and referral of childhood cancer in Colombia. Applying user-centered design, we completed three phases: (1) app design and content development based on local educational needs, (2) participatory co-design sessions, and (3) iterative usability testing and prototype production. Seventy-nine stakeholders (37 PCPs, 8 nurses, 14 pediatric oncologists, 20 allied staff) participated. Rapid thematic analysis informed refinements in app content, usability, and functionality. The final high-fidelity prototype was perceived as intuitive and valuable for supporting cancer education and clinical reasoning, reinforcing knowledge and emphasizing timely referrals. Stakeholder input led to improvements in app personalization, navigation, clinical logic checks, educational content and referral guidance. Embedding educational content within mHealth clinical tools may enhance cancer knowledge retention and behavior change in clinical practice. Integrating S-IMCICA_V.2 into an e-learning curriculum and evaluating regional impact are underway.