Background Previous studies on imaging of hepatocellular carcinoma (HCC) have shown inconsistency in the growth of tumor vascularity and gross morphologic features. Contrast-enhanced US (CEUS) is one of the few methods that can depict both features simultaneously, making it valuable for assessing this inconsistency and its potential clinical influence. Purpose To evaluate and establish a new CEUS feature representing inconsistency between vascularity and gross morphologic features (perfusion beyond margin [PBM]) and analyze its underlying biologic mechanisms and prognostic influence. Materials and Methods This multicenter retrospective study included patients with HCC from January 2015 to August 2023. Three radiologists (5-8 years of experience) measured tumor diameter using gray-scale US and CEUS. Mathematic, prognostic, and bioinformatics analyses were used to quantify the PBM diagnostic standard. Prognostic analysis included recurrence-free survival after laparoscopic hepatectomy and local tumor progression-free survival after thermal ablation. Bioinformatics analysis included pathologic and immunohistochemical evaluation and RNA sequencing. Results This study included 1076 patients (mean age ± SD, 60 years ± 10.5; 854 men, 1166 HCCs). PBM was defined as the tumor diameter on arterial phase exceeding that at gray-scale US by 5 mm. PBM was associated with worse recurrence-free survival (hazard ratio [HR], 1.76 [95% CI: 1.05, 2.94]; P = .03); worse local tumor progression-free survival (HR, 2.40 [95% CI: 1.84, 3.13]; P < .001); and higher rates of microvascular invasion (52.2% [12 of 23] vs 25.0% [29 of 116]; P = .02), cytokeratin-7 positivity (26.2% [11 of 42] vs 11.3% [14 of 124]; P = .04), and cytokeratin-19 positivity (26.9% [seven of 26] vs 8.8% [13 of 148]; P = .02) compared with the non-PBM group. PBM occurrence was related to upregulation of genes for angiogenesis (VEGA, PIGF), epithelial-mesenchymal transition (TGFB1, MMP2), and immunosuppressive tumor microenvironment (CD163). PBM was more common in patients with cirrhosis (26.8% [236 of 880]; P = .04; odds ratio, 1.41), recurrent tumors (28.4% [161 of 567]; P = .02; odds ratio, 1.38), and tumors greater than 3 cm (30.8% [92 of 298]; P = .01; odds ratio, 1.46). Conclusion Perfusion beyond margin, a new imaging feature, was identified through contrast-enhanced US in patients with hepatocellular carcinoma; it was associated with greater invasive potential and poorer prognosis. © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Shafaat and Reis in this issue.

To compare the efficacy of an estriol-lactobacilli combination vaginal tablet (E3/L) and polycarbophil-based vaginal moisturizer (PBVM) in women with post-radiation vaginitis following cervical cancer treatment.

This open-label, randomized controlled trial recruited 34 women with Stages I-III cervical cancer who had completed pelvic radiotherapy and developed vaginal toxicity symptoms. Participants were randomized 1:1 to E3/L (Gynoflor) or PBVM (Regelle) for 4 weeks. The primary outcome was change in vaginal maturation value (VMV). Secondary outcomes included changes in vaginal pH, vaginal toxicity symptom scores, and Female Sexual Function Index (FSFI) scores.

The median improvement in VMV was significantly greater with E3/L than with PBVM (19.65 [IQR: 0-39.5] vs. 2.08 [IQR: 0-20.1] points; p = 0.035; 95% CI: 10.22-32.59). Vaginal dryness and inflammation improved significantly in the E3/L group. Changes in vaginal pH, dyspareunia, and vaginal pain were similar between groups. Although the FSFI change was greater with E3/L (median +6 vs. +2; p = 0.01), absolute FSFI scores at Week 4 were similar, and clinical significance is uncertain. Both treatments were well tolerated.

In women with cervical cancer and radiation-induced vaginitis, E3/L showed greater short-term improvements in vaginal epithelial maturation, dryness, and inflammation than PBVM over 4 weeks. These findings are exploratory given the modest sample size, open-label design, and short follow-up; larger double-blind randomized trials with extended follow-up are needed to confirm these results.

Thai Clinical Trials Registry: TCTR2024051001.

Leptomeningeal disease (LMD) is one of the most devastating complications of advanced non-small cell lung cancer (NSCLC), historically associated with profound neurologic morbidity and poor survival. Advances in cerebrospinal fluid (CSF)-based diagnostics, improved molecular characterization, and the development of central nervous system (CNS)-penetrant targeted therapies have begun to reshape both disease assessment and treatment expectations, particularly in oncogene-driven NSCLC. Available data suggest that outcomes in LMD are highly heterogeneous and are influenced by molecular subtype, performance status, systemic disease control, and access to effective CNS-active therapies. In selected patients, especially those with epidermal growth factor receptor- or anaplastic lymphoma kinase-altered disease, contemporary targeted agents have demonstrated meaningful leptomeningeal and intracranial activity, supporting more durable and compartment-specific disease control. At the same time, diagnosis still relies on imperfect but complementary modalities, including magnetic resonance imaging and CSF cytology, whereas emerging liquid biopsy approaches may improve detection and longitudinal monitoring. Treatment failure is further shaped by the pharmacokinetic constraints of the leptomeningeal compartment, where limited drug penetration contributes to therapeutic resistance. This review highlights the evolving biology, diagnosis, prognostic determinants, and therapeutic landscape of NSCLC-associated LMD, while emphasizing persistent limitations in diagnostic standardization, response assessment, and clinical trial design. It also underscores the need for leptomeningeal-specific end points, longitudinal CSF-based biomarker integration, and more inclusive trial strategies to improve evidence generation and patient outcomes.

Pancreatic ductal adenocarcinoma (PDAC) remains among the most lethal malignancies, and activating KRAS mutations occur in more than 90% of tumors. Direct RAS targeting has moved from proof of concept to randomized clinical benefit: in previously treated metastatic PDAC, daraxonrasib improved median overall survival, progression-free survival, and objective response rate versus chemotherapy. Mutation-selective G12C and G12D inhibitors, targeted degraders, and first-line RAS(ON) combinations further broaden the landscape. Comprehensive germline and somatic profiling remains essential even with the availability of multi-selective KRAS inhibitors. KRAS alleles differ biologically, drug activity against individual alleles is not yet fully characterized, and eligibility for clinical trials often depends on the specific genotype. In addition, KRAS wild-type tumors may harbor actionable alterations, including gene fusions, amplifications, or mismatch-repair deficiency. This review synthesizes RAS biology, molecular-testing implications, clinical efficacy and toxicity data, and ongoing phase 2 and phase 3 trials. Priority questions include optimal sequencing, management of rash and mucositis, resistance, biomarker development, and integration into first-line and curative-intent therapy.

Intracranial solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms, and cases of tumor bleeding are rarely seen. While radiographically similar to meningioma, SFTs exhibit a more aggressive clinical course. The mainstay of treatment is surgical resection followed by adjuvant radiotherapy. We present the first case of a hemorrhagic SFT located at the cerebellopontine (CP) angle, which was successfully treated with multimodal therapy. A 31-year-old man presented with a headache and altered consciousness. Neuroimaging revealed a large dural-based tumor at the left CP angle with subdural hematoma (SDH). The patient underwent preoperative endovascular embolization and near-total surgical resection. Further histopathological analysis confirmed the diagnosis of intracranial SFT. The patient recovered favorably and underwent adjuvant gamma-knife stereotactic radiosurgery (SRS) for the residual tumor. To the best of our knowledge, this is the first reported case of a hemorrhagic SFT treated with a combination of preoperative endovascular embolization and adjuvant SRS. This case illustrates that tailored multimodal treatment is both effective and safe for managing hemorrhagic intracranial SFTs.

AIM: To report our experience with the outcomes of open microsurgical management of third ventricular colloid cysts. MATERIAL and METHODS: This retrospective study presents the surgical outcomes of 33 patients who underwent open microsurgical resection-either through the interhemispheric transcallosal or transcortical transventricular approach-for third ventricular colloid cysts between 2010 and 2023. RESULTS: The mean follow-up period was 41.57 months. All patients were symptomatic, and severe, intractable headache was the most common presenting symptom. No perioperative mortality or postoperative infection occurred. During follow-up, five patients (15.15%) developed shunt-dependent hydrocephalus, and eight (24.24%) developed seizures. At the last follow-up, seven of the eight patients were seizure-free and no longer required antiepileptic medication. Thirty-two patients (96.96%) had no recurrence, and in one patient with a small residual lesion, no progression was observed. CONCLUSION: Open microsurgery, whether via the interhemispheric transcallosal or transcortical transventricular approach, is safe and offers a high likelihood of total resection with low recurrence. Shunt-dependent hydrocephalus and postoperative seizures remain the most common complications, underscoring the need for long-term surveillance, particularly for late-onset seizures even after complete removal. Although endoscopic surgery is now widely adopted, our findings demonstrate that open microsurgery continues to be a reliable and durable option with favorable recurrence and complication profiles.

AIM: To report our experience in implementing functional mapping-guided resection for eloquent diffuse low-grade gliomas (DLGGs) in a low- and middle-income country (LMIC) setting. There are logistical barriers to achieving onco-functional balance through glioma surgery in LMICs. MATERIAL and METHODS: The study is a retrospective chart review of adult patients who underwent surgical resection of their DLGGs that were located within supratentorial eloquent brain areas (within 15 mm). Functional mapping-guided surgery was performed using electrophysiological brain mapping techniques, namely intraoperative neuromonitoring (IONM) with or without awake craniotomy (AC). The primary outcome was the rate of postoperative neurological deficits. The secondary outcomes were the extent of resection, the rate of surgical complications, the Engel Outcome Scale score, and the progression-free survival (PFS) rate. RESULTS: Twenty-eight patients were included (43% males), with a mean age of 37.5 years. Their median preoperative Karnofsky Performance Scale score was 90. The predominant histopathology was astrocytoma (n = 20, 71%), and the primary site was perirolandic in 19 patients (68%). Seizures were the most common presenting symptom (71%). Resection was performed using either IONM alone (39%) or combined with AC (61%). Gross total resection was achieved in 20 patients. Six patients (21%) developed postoperative complications. Patients were followed up for a mean of 39.9 months. At discharge, 12 patients (43%) had experienced new or worsened neurological deficits, but nine of them later showed significant improvement. Sixteen patients achieved Engel class 1 seizure control, and the median PFS was 34 months. Two patients died during the study period. CONCLUSION: This study demonstrates that our institution's protocol for integrating functional mapping into the surgical management of DLGGs achieves a solid onco-functional balance.

AIM: To establish an effective predictive model to inform clinical practice for brainstem glioma, a rare and highly aggressive tumor of the central nervous system, given the lack of prior retrospective studies using the SEER database that have included both pediatric and adult patients. MATERIAL and METHODS: Cases of brainstem tumors diagnosed between 2000 and 2022 were identified from the SEER database. X-tile software and Maxstat were used to define the optimal tumor size cutoff value and risk subgroups for brainstem glioma. Independent prognostic factors were determined using univariate and multivariate Cox proportional hazards regression. These factors were used to construct two nomograms predicting 1-, 2-, and 3-year overall survival and cancer-specific survival for brainstem glioma. RESULTS: Age, tumor size, histological type, surgery, radiation, and chemotherapy were identified as independent prognostic factors for overall and cancer-specific survival. Notably, gross total resection was significantly associated with improved survival outcomes. CONCLUSION: This work enhances our understanding of the prognosis of brainstem glioma and corroborates the importance of surgical resection as a prognostic factor in its management. The validated nomograms offer a superior and personalized tool for risk stratification and prognostic estimation, which may be helpful for clinical decision making and patient counseling.

Hepatocellular carcinoma (HCC) remains a major public health issue across East Asia due to the high prevalence of hepatitis B viral infection in this area, and each country develops its own guideline according to clinical evidence and local health care resources. The latest guidelines from Taiwan, Hong Kong, China, Korea, and Japan were comprehensively reviewed. We highlight and compare the similarities and differences in epidemiology, surveillance, diagnosis, staging, and treatment strategies. Variations were observed in the issue of surveillance and early diagnosis by tumor marker integration, imaging modalities adoption, and individualized risk assessment tools, which reflect the local health resource availability and disease patterns. However, East Asian guidelines recommend broader criteria for curative treatment, such as liver resection and local ablation, which are beyond the criteria of Western guidelines. The introduction of immune checkpoint inhibitors and targeted therapy changes the treatment landscape for advanced HCC. The conversion strategies and drug-off criteria for patients who achieve tumor control have drawn great attention and discussion. The evolving treatment highlights the importance of the integration of global evidence-based practices and region-specific considerations to improve the treatment outcomes for HCC patients.

Non-Hodgkin lymphomas (NHLs) are associated malignancies with different morphological, genetic, immunophenotypic, and clinical characteristics. Research on genetic susceptibility to NHL is needed to identify at-risk groups and define important disease pathways. Interleukins (ILs) are cytokines that play important immunomodulatory roles. IL-6 stimulates IgG production, exerts antiviral effects, and has been linked to various diseases. Research on IL-6 mutations and NHL is important due to the role of IL-6 in immune regulation and cancer pathogenesis; however, direct causative links remain unclear. The purpose of this study was to investigate the association between the IL-6 genetic polymorphism at the rs1800796 locus and the risk of NHL in Egyptians using a case-control study. The study comprised 100 patients diagnosed with NHL and 100 age- and gender-matched healthy individuals. Risk factors for NHL were associated with lower hemoglobin and albumin levels, increased aspartate aminotransferase, and substantial outcomes in kidney function tests. The study found an absence of the CC genotype in NHL patients, whereas it was found in five healthy volunteers, suggesting a weak potential protective association. The GG genotype was found in more patients than healthy individuals (84 vs. 75); however, no significant association was found. The G allele was found to be more dominant in NHL patients than controls (184 vs. 170; P=0.02). These findings suggest that individuals carrying the G allele may be at twice the risk of developing NHL compared with those carrying the C allele (OR=2.02; 95% CI: 1.07-3.85). The study found no significant association between the IL-6 polymorphism and clinical presentation, tumor stage, or relapse status in NHL patients. These results support the use of the IL-6 variation in the diagnosis and genetic screening of NHL but not for therapeutic choices.