Introduction: Breast neoplasms with neuroendocrine characteristics form a rare and heterogeneous group that includes both invasive carcinomas showing neuroendocrine differentiation and primary neuroendocrine tumors arising in the breast. Because these lesions are uncommon, their clinicopathological features and biological behavior are still not fully elucidated. Methods: We conducted a retrospective analysis of 22 patients diagnosed with breast tumors showing neuro-endocrine features and treated in 1st Surgical Unit of Regional Institute of Oncology, Iasi. Clinicopathological characteristics, immunohistochemical profile and treatment patterns were analyzed. Results: The median age at diagnosis was 66.1 years (range: 35 83). Most tumors corresponded to invasive carcinoma of no special type with neuroendocrine differentiation, while a smaller subset fulfilled the criteria for primary neuroendocrine neoplasms of the breast. Immunohistochemical analysis revealed a predominantly luminal immunophenotype, characterized by strong estrogen receptor expression and absence of HER2 overexpression. T0he median Ki-67 proliferation index was 40.3%. Lymph node involvement was observed in 45.5% of cases. All patients were treated according to standard breast cancer protocols, including surgery, chemotherapy, endocrine therapy and radiotherapy when indicated. The median follow-up was 26 months. Survival analysis included 20 patients with available follow-up data, while 2 patients were lost to follow-up. During the follow-up period, 9 deaths were recorded, corresponding to an overall mortality rate of approximately 45%. Conclusions: In our study, breast tumors with neuroendocrine features exhibited a luminal immunophenotype and did not demonstrate a clearly distinct clinical behavior compared with conventional hormone receptor positive breast cancer. Neuroendocrine differentiation may therefore represent a morphological feature within the luminal spectrum rather than a distinct biological entity.

Background: Breast cancer is the most common malignancy among women and represents a leading cause of worldwide cancer-related mortality. Mammographic screening substantially reduces breast cancer-specific mortality by enabling its early detection. Organized mammographic screening is recognized as the most effective strategy for early detection, mortality reduction, and for improving quality of life. Romania currently lacks an organized, functional, invitation-based system. National data regarding the utilization of mammography remain limited and poorly characterized. Materials and Methods: A cohort of 2,500 women aged 40-90 years diagnosed with breast cancer was analyzed. The study was conducted in four medical centers in Bucharest, Romania: the Prof. Dr. Alexandru Trestioreanu Institute of Oncology, Medicover Pipera Hospital, Profmedica Clinic, and CIB Medical Clinic, between June and December 2025. Information regarding mammographic examinations performed prior to diagnosis was obtained through a structured interview and subsequently validated by reviewing medical records. The sociodemographic variables analyzed included age, place of residence, and educational level. Patients were categorized into two groups according to their pre-diagnostic mammography status: those who had never undergone mammography in their lifetime and those who had undergone at least one mammographic examination prior to breast cancer detection. For patients in the latter group, the interval between the most recent mammography and the time of diagnosis was recorded and analyzed. Results: Overall, 76% of the patients had not undergone any mammographic examination prior to diagnosis. Among those who had undergone at least one mammography, 37.3% had their most recent examination more than four years before diagnosis. When these two subgroups were combined, it was found that 85% of patients diagnosed with breast cancer had not received a recent mammographic evaluation within the four years preceding diagnosis that might have enabled earlier detection of the disease. Conclusion: This study highlights the limited use of mammography for the early detection of breast cancer in Romania through periodic examinations within an opportunistic screening setting. Consequently, most cases are diagnosed only after the onset of signs and symptoms. This finding reflects insufficient public awareness of the benefits of early detection of this disease. Among the 2,500 women with breast cancer who were interviewed in this study, 76% had never undergone a mammographic examination in their lifetime. Moreover, 85% had not undergone any mammography within the four years preceding diagnosis. The development and consolidation of public information and medical education initiatives are essential to increase participation and improve population-level understanding of the benefits of early detection for breast cancer. However, even when it is widely implemented, opportunistic screening alone is unlikely to achieve a meaningful population-level impact. A reduction in breast cancer mortality through early diagnosis can only be achieved through the implementation of an organized, national screening program.

Head and neck cancer (HNC) survivors have a high burden of depression, yet real-world antidepressant adherence and the role of patient out-of-pocket (OOP) costs in this population remain poorly characterized.

We analyzed a retrospective cohort of US adults with HNC and a new antidepressant prescription in Merative MarketScan databases (2016-2023). We measured 180-day adherence using the medication possession ratio (MPR; adherent if MPR ≥ 80%) and 180-day persistence as no pharmacy-claims gap > 15 days. We summarized antidepressant cost-sharing and used multivariable logistic regression to evaluate associations between index-fill OOP cost and adherence; Kaplan-Meier and Cox models assessed time to first therapy gap by antidepressant class.

Among 9267 HNC survivors (median age 61 years; 61% male), 42% were adherent and 80% were persistent over 180 days. Six-month antidepressant OOP spending was low (median $10; mean $18). Higher index-fill OOP cost was statistically associated with adherence (adjusted OR 1.02, 95% CI 1.02-1.03), but the magnitude was small over the observed cost range and was not clinically meaningful. Persistence did not differ by single antidepressant class; however, use of multiple antidepressant classes was associated with higher discontinuation risk (HR 2.08, 95% CI 1.84-2.34) relative to SSRI monotherapy.

In this claims-based cohort of HNC survivors, antidepressant OOP costs were modest and did not appear to be a major barrier to adherence. Adherence remained suboptimal, and discontinuation risk was concentrated among patients receiving multiple antidepressant classes, suggesting the need to focus on nonfinancial and clinical drivers of medication continuity.

We evaluated the association between hepatitis C virus (HCV) infection and the risk of intrahepatic and extrahepatic cancers. Specifically, we compared "1st" versus "1st or 2nd" primary cancers to capture the true disease burden, which is often underestimated in conventional analyses. Additionally, we evaluated the chemopreventive effect of direct-acting antiviral (DAA) therapy on these risks.

Using the Korean National Health Insurance database (2005-2023), we compared 119 565 HCV-infected individuals with 2 267 700 controls. Adjusted subdistribution hazard ratios (aHRs) were calculated using competing risk models. Direct-acting antivirals (DAA) effectiveness was evaluated in a sub-cohort of 23 147 patients (2016-2020) using time-dependent Cox models to account for immortal time bias.

In the analysis of 1st or 2nd cancers, HCV infection significantly increased the risk of intrahepatic (aHR 16.35; 95% CI, 15.81-16.90) and extrahepatic cancers (aHR 1.14; 95% CI, 1.12-1.16). Notably, expanding the endpoint to include 2nd cancers increased the aHR for extrahepatic cancer from 1.09 to 1.14, indicating that traditional analyses underestimate the true burden. Significant risk elevations were observed for haematological, biliary, pancreatic, and renal cancers. In the DAA sub-cohort analysis using the time-dependent model, DAA treatment significantly reduced the risk of intrahepatic cancer (aHR 0.54-0.61) and extrahepatic cancers (aHR 0.77) after adjusting for competing risks.

HCV infection significantly increases both intrahepatic and extrahepatic cancer risks. Excluding 2nd cancer underestimates this burden. Given that DAA therapy significantly reduces the risk of both intrahepatic and extrahepatic cancers, accelerating HCV elimination policies is imperative.

IntroductionAchieving the global goal of cervical cancer elimination faces major challenges, particularly in ensuring the large-scale and sustained implementation of proven technologies. In Argentina, HPV testing as primary screening was introduced through the Jujuy Demonstration Project (JDP) in 2012. The aim of this study is to analyze barriers and facilitators of the implementation of HPV testing in two provinces-Jujuy, and Catamarca-a decade after the JDP's completion.MethodsWe carried out a descriptive in-depth case study using a mixed-method approach, using qualitative and quantitative methods. Data were collected through participant observations in health services, semi-structured interviews with key informants, analysis of secondary sources, and program indicators. Barriers and facilitators were analyzed using an adapted Health System Framework focusing on four key dimensions: stewardship, organizational capacity, financing, and technology.ResultsRegarding stewardship, reduced technical support and monitoring from the National Program emerged as significant barrier. About financing, the most critical obstacle was the national interruption in the provision of HPV tests. Although both provinces have initiated procedures to purchase tests using provincial funds, this process was constrained by limited financial resources and competing priorities. Finally, regarding organizational capacity, challenges persisted in maintaining laboratory centralization, sustaining the offer of self-collection, and fully utilizing information systems for program monitoring. Facilitators related to stewardship included the stability of human resource in both provinces and the long-standing institutional recognition and leadership of provincial program staff. Sustained adherence to national guidelines and the existence of provincial resolutions were key enablers of continuity. In addition, acceptability of the technology remained high, with HPV testing continuing to be widely accepted in both provinces.ConclusionsOur findings reveal barriers and facilitators in the implementation ten years after JDP finalization, providing valuable lessons for scaling up HPV-based screening in national cancer control programs.

Prostate cancer significantly impacts not only the individuals diagnosed but also their partners, who frequently undertake extensive caregiving responsibilities. Despite their crucial role, the experiences and needs of partners remain underrepresented in cancer care literature and policy, particularly in Ireland.

A qualitative descriptive study exploring the lived experiences of nine partners of men with prostate cancer in Ireland was employed. Semi-structured interviews were conducted in person, by phone, or virtually. Data were analysed using Braun and Clarke's thematic analysis, supported by NVivo software, and interpreted through Meleis' Transition Theory.

Five major themes emerged: (1) Invisible Needs: Experience in Care, (2) Alone Together: Missing Couple-Centred Support, (3) Knowledge Deficit and Under preparedness, (4) Hesitancy, Silence and Emotional Restraints and (5) The Cost of Caring: Strain, Self-Care and Advocacy. Participants highlighted critical issues of marginalisation, emotional burden, under preparedness, and lack of inclusion for a specific group within a normal conventional care setting, which are precisely the experiences that need to be understood and addressed, not dismissed as representing a minority.

Partners of men with prostate cancer, especially those from LGBTQ+ communities, face significant psychosocial challenges that are often overlooked by the healthcare system. Findings underscore the urgent need for inclusive, couple-centred support models and tailored educational interventions. Enhancing caregiver involvement and wellbeing through systemic and policy-level changes could improve outcomes for both patients and their partners.

Patients and members of the public were not involved in the design or conduct of this research. Although participants contributed their perspectives as part of the qualitative study, there was no formal PPI in shaping the research process. The authors recognise the importance of involving patients and the public in co-designing research and will consider this in future studies.

IntroductionImmune checkpoint inhibitors (ICIs) are standard therapy for metastatic non-small cell lung cancer (NSCLC). Blood transfusions, particularly erythrocyte suspension (ES) transfusions, may induce immunomodulatory effects and potentially influence cancer outcomes. This study investigated the association between transfusions and survival in NSCLC patients treated with nivolumab.MethodsWe retrospectively reviewed 88 patients with metastatic NSCLC who received nivolumab between January 2018 and December 2023. Transfusion status, baseline inflammatory markers, progression-free survival (PFS), and overall survival (OS) were evaluated. Survival outcomes were assessed using Kaplan-Meier analysis and univariable statistical methods.ResultsThe median patient age was 64 years (range, 41-76). Median PFS was 5.93 months (95% Confidence Interval [CI], 3.72-8.14), and median OS was 8.23 months (95% CI, 6.19-10.27). Patients who received ES transfusions during nivolumab therapy experienced shorter PFS (p=0.033) and OS (p=0.039), predominantly driven by the non-squamous subgroup (PFS: p=0.002; OS: p=0.008). In univariable analyses, nivolumab cycle count, pre-treatment hemoglobin, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), and systemic immune-inflammation index were associated with PFS, while programmed cell death ligand-1 (PD-L1) status, treatment line, number of cycles, pre-treatment hemoglobin, NLR, CAR, and prognostic nutritional index were associated with OS (all p< 0.05).ConclusionES transfusions administered during nivolumab therapy were associated with poorer PFS and OS in patients with metastatic NSCLC, particularly in those with non-squamous histology. Given the retrospective design and limited number of transfused patients, these findings should be interpreted with caution and considered hypothesis-generating. Larger, prospective multicenter studies are warranted to further clarify the relationship between transfusion exposure and ICI outcomes.

Introduction Postoperative temporary facial nerve dysfunction (TFND) is a common complication after parotidectomy, and the tumor location is believed to influence its risk. This study aimed to evaluate the relationship between tumor location and postoperative TFND, as well as to assess the effects of lobe involvement and surgical approach. Methods This prospective observational study was conducted at Bangladesh Medical University, Dhaka, between June 2022 and December 2023, and 35 patients with parotid neoplasms who underwent surgery were enrolled in this study. Preoperative magnetic resonance imaging was used to determine the tumor location (anterior/posterior, superior/inferior, superficial/deep), and lobe involvement was confirmed intraoperatively. Facial nerve function was assessed via the House-Brackmann grading system on postoperative day 2 and at one and three months. Univariate and multivariate logistic regression were performed to analyze the TFND risk factors. Results The participants had a mean age of 48.80 ± 11.92 years, with a female predominance. Pleomorphic adenoma was the most common tumor type (60%). TFND occurred in 54.3% of patients on postoperative day 2, 51.4% at one month, and 45.7% at three months, most commonly involving the marginal mandibular branch. On multivariate analysis, anterior tumor location (OR: 25.05; 95% CI: 1.29-484.05; p = 0.033), bilobar involvement (OR: 21.84; 95% CI: 1.13-421.84; p = 0.041), and total conservative parotidectomy (OR: 20.89; 95% CI: 1.05-413.72; p = 0.046) were significantly associated with increased risk of TFND on postoperative day 2. At one month, anterior tumor location remained a significant predictor (OR: 31.75; 95% CI: 2.02-497.19; p = 0.014). At three months, anterior tumor location (OR: 13.59; 95% CI: 1.72-107.22; p = 0.013) and bilobar involvement (OR: 10.14; 95% CI: 1.39-73.92; p = 0.022) remained independently associated with persistent TFND. No significant association was observed between TFND and age, sex, tumor size, or histopathology. Conclusion Anterior tumor location, bilobar involvement, and extensive surgery significantly increase TFND risk and persistence. These findings suggest that careful preoperative imaging-based localization and meticulous surgical planning may help reduce the risk of TFND in parotid surgery.

Anorectal melanoma is a rare and aggressive malignancy arising from melanocytes within the mucosal epithelium of the anorectal region. Because presenting symptoms such as rectal bleeding frequently mimic benign anorectal conditions, diagnosis is often delayed until advanced stages of the disease. Mucosal melanoma is characterized by aggressive local invasion and early metastatic spread. We present the case of a 54-year-old female with metastatic rectal melanoma whose disease course was complicated by extensive pelvic tumor burden, malignant venous compression leading to deep venous thrombosis, obstructive uropathy, and tumor-associated hemorrhage. Cross-sectional imaging demonstrated a massive posterior pelvic mass occupying the rectouterine space with displacement of surrounding structures, additional rectal tumor extension, metastatic lesions in the liver, and locally invasive disease adjacent to the patient's colostomy. Diagnosis was confirmed through sequential biopsy, molecular analysis, and definitive surgical pathology, demonstrating a poorly differentiated malignant neoplasm with melanocytic differentiation and immunohistochemical positivity for S100, SOX10, Melan-A, and HMB45. Despite thrombectomy with iliac vein stenting, percutaneous nephrostomy tube placement, arterial embolization, and multidisciplinary oncologic management, the patient experienced progressive metastatic disease and ultimately transitioned to hospice care. This case highlights the aggressive nature of anorectal melanoma and illustrates how advanced pelvic malignancy may produce complex multisystem complications requiring multidisciplinary management.

Giant hepatic hemangiomas, particularly those involving central hepatic segments (IV, V, and VIII), present unique surgical challenges due to their proximity to major hepatic veins and first-order portal structures. While laparoscopic approaches have been described, detailed guidance for open enucleation across a range of lesion locations and complexities remains limited. This technical report describes a systematic open parenchyma-preserving enucleation technique and presents a retrospective consecutive case series of six patients who underwent the described procedure over an eight-year period at a tertiary hepatobiliary center (American University of Beirut Medical Center, AUBMC). Patient demographics, tumor characteristics, operative details, and postoperative outcomes were retrospectively extracted from medical records following a structured chart review. All patients were followed clinically postoperatively, with no evidence of recurrence or late complications during the available follow-up period. Six patients (5 female, 1 male), with ages ranging from 26 to 50 years, underwent open enucleation using a uniform Cavitron Ultrasonic Surgical Aspirator (CUSA)-guided pseudocapsular technique without inflow occlusion (Pringle maneuver). Tumor locations included purely central segments (n=2), mixed central and peripheral segments (n=3), and a complex suprahepatic lesion with inferior vena cava (IVC) involvement (n=1). Preoperative tumor sizes ranged from 7 to 12.9 cm. Documented estimated blood loss ranged from 150 to 500 mL; five of six cases required no transfusion. One case involving direct IVC adherence required primary suture repair and intraoperative transfusion (3 units; Clavien-Dindo grade III). One patient experienced urinary retention (Clavien-Dindo grade I). No conversions to formal hepatectomy, bile leaks, postoperative liver failure, or mortality occurred. Length of hospital stay ranged from 5 to 10 days. All pathology specimens confirmed cavernous hemangioma. The described CUSA-guided pseudocapsular enucleation technique without the Pringle maneuver is feasible and safe for giant hepatic hemangiomas across central, peripheral, and complex tumor locations. This technical report provides detailed operative guidance applicable across central and peripheral tumor locations, with particular attention to centrally located lesions where proximity to major hepatic veins and portal structures demands structured operative planning and heightened technical vigilance.