Glioblastoma (GBM) is the most common and aggressive primary malignant brain tumor in adults and almost always recurs. In recurrent GBM, conventional MRI has limited ability to detect microscopic tumor infiltration and distinguish progression from treatment-related change. Spectroscopic MRI (sMRI) provides quantitative metabolic maps across much of the brain, including choline (Cho) and N-acetylaspartate (NAA), a marker of healthy tissue. Because Cho/NAA is commonly used to define metabolically abnormal tissue, and prior radiation therapy (RT) can alter metabolite levels, we evaluated whether prior RT shifts baseline Cho/NAA in recurrent disease. We retrospectively studied 20 patients with recurrent GBM previously treated with maximal safe resection, RT, and temozolomide who underwent whole-brain sMRI at recurrence. The median interval from RT completion to sMRI was 8.99 months. T1-weighted images were co-registered to sMRI in MIDAS and aligned with planning CT in MIM to generate radiation dose maps. MIDAS generated tissue-water-referenced Cho, NAA, and creatine (Cr) maps, and Cho/NAA was normalized to contralateral normal-appearing white matter. Voxel-wise linear regression was performed between prior radiation dose and metabolite values at recurrence. Higher prior dose was associated with reduced NAA (-0.26%/Gy, r² = 0.011, p < 0.001) and Cr (-0.18%/Gy, r² = 0.004, p < 0.001), while Cho changed minimally (-0.023%/Gy, r² = 0.001, p < 0.001). Accordingly, normalized Cho/NAA increased with dose, with a mean slope of 0.0018/Gy (p < 0.001). A standard Cho/NAA threshold of 2 corresponded to a median of 2.39 (range, 1.91-2.72) in tissue previously receiving 60 Gy. These findings suggest prior RT modestly elevates baseline Cho/NAA, primarily through NAA reduction, and that dose-corrected Cho/NAA maps may improve tumor delineation in recurrent GBM.

This study aimed to compare the incidence of postoperative ileus (POI) between end-to-end hand-sewn and side-to-side stapled ileo-ileal anastomoses and to identify independent risk factors associated with POI.

We conducted a retrospective analysis of patients who underwent radical cystectomy with urinary diversion at Ankara Etlik City Hospital between October 2022 and October 2024. Patients were categorized according to the anastomosis technique used: end-to-end hand-sewn or side-to-side stapled. Perioperative data, including demographic characteristics, comorbidities, preoperative laboratory parameters, operative variables, and postoperative outcomes, were collected. POI was defined as intolerance to oral intake accompanied by abdominal distension and absence of flatus or stool beyond postoperative day five, requiring medical or surgical management. Univariable and multivariable logistic regression analyses were performed to identify risk factors for POI.

A total of 71 patients were included in the analysis. POI occurred in nine patients (23.7%) in the hand-sewn group and in four patients (12.1%) in the stapled group, indicating a significantly lower incidence in the stapled group. Multivariable analysis identified side-to-side stapled anastomosis as an independent protective factor against POI. Additional independent predictors included age ≥65 years, abnormal body mass index (BMI), preoperative constipation, hypoalbuminemia, and prolonged operative time. Receiver operat-ing characteristic (ROC) curve analysis demonstrated good predictive performance of the model.

Side-to-side stapled ileo-ileal anastomosis is associated with a lower risk of POI compared to end-to-end hand-sewn anastomosis in patients undergoing radical cystectomy with urinary diversion.

Pancreaticoduodenectomy is one of the most technically demanding procedures in digestive surgery. Historically, laparoscopy in pancreatic surgery was limited to staging and palliative interventions. Since the first laparoscopic pancreaticoduodenectomy was completed in 1994, significant advances have improved perioperative safety, operative time, and lowered postoperative morbidity. Nevertheless, the complexity of pancreatic surgery paired with the technical challenges of pancreatic minimally invasive approach have restricted laparoscopic pancreatoduodenectomy to high-volume centers until recent times. The aim of this technical note presentation is to describe novel laparoscopic techniques of performing the three anastomoses - pancreaticojejunostomy and pancreaticogastrectomy, hepaticojejunostomy, and gastrojejunostomy- in an intracorporeal fashion, highlighting methods of facilitating the reconstructive process. This technical note s purpose is to also present new training models for surgeons, meant to reduce post-operative complications, such as pancreatic fistula or biliary leakage, to shorten operating times, and, ultimately, to increase the availability of laparoscopic pancreaticoduodenectomy as a safe and efficient treatment option.

Background: Breast cancer management has undergone an important evolution, from aggressive, invasive surgical interventions towards personalized, multidisciplinary strategies guided by tumor biology and patient oriented outcomes. Recent advances: Randomized trials have enabled the possibility of less invasive surgery in some cases, while advances in systemic therapy including targeted agents, antibody drug conjugates (ADCs) such as Trastuzumab emtansine (T-DM1) and Trastuzumab deruxtecan (T-Dxd), endocrine therapy and immunotherapy in selected cases have improved survival and quality of life. Emerging technologies such as oral selective estrogen receptor degraders (SERDs), selective estrogen receptor covalent antagonists (SERCAs), proteolysis targeting chimeric (PROTACs) and complete estrogen receptor antagonists (CERANs) are expanding therapeutic options. Conclusions: Modern breast cancer management is defined by precision medicine, multidisciplinary integration and less invasive surgical interventions in selected cases. Ongoing challenges include therapeutic resistance, toxicity, cost, and equitable access to innovation.

Introduction: Axillary lymph node dissection (ALND) has been the gold standard for axillary staging in breast cancer for over a century. The introduction of sentinel lymph node biopsy (SLNB) in the 1990s offered a minimally invasive alternative with comparable staging accuracy and significantly reduced morbidity. Multiple landmark randomized controlled trials have since demonstrated that completion ALND can be safely omitted in selected patients with positive sentinel lymph nodes without compromising oncologic outcomes. This narrative review aims to examine the evolution from ALND to SLNB, critically evaluate the landmark trials that shaped current practice, and discuss ongoing controversies and future directions in axillary management in early breast cancer. Materials and Methods: A comprehensive literature search was performed using PubMed/MEDLINE, Scopus, and Web of Science databases. Search terms included "sentinel lymph node biopsy", "axillary lymph node dissection", "breast cancer", and "axillary management." Landmark randomized controlled trials, systematic reviews, meta-analyses, and current clinical practice guidelines were identified and reviewed. Results: The NSABP B-32 trial validated SLNB as an accurate staging tool equivalent to ALND. The ACOSOG Z0011 trial demonstrated no survival benefit from completion ALND in patients with 1-2 positive sentinel lymph nodes undergoing breast-conserving surgery. The AMAROS trial demonstrated that irradiation of the axilla provides equivalent locoregional disease control compared to surgical dissection, while carrying a substantially more favorable morbidity profile.The IBCSG 23-01 trial confirmed that ALND can be omitted for sentinel node micrometastases. Most recently, the SENOMAC trial extended these findings to patients with 1-2 macrometastases in a broader population. Conclusions: SLNB has become the established standard for axillary staging in early breast cancer with a clinically negative axilla, superseding ALND entirely. Progressive de-escalation of axillary surgery has been consistently supported by high-level evidence without compromising survival. Future research will determine the feasibility of further de-escalation, particularly after neoadjuvant chemotherapy.

Introduction: Accurate risk stratification, essential for the therapeutic approach (especially surgical) of prostate cancer, is based on standard histopathological criteria. The biological heterogeneity of this neoplasm requires the identification of complementary markers that reflect the molecular mechanisms of tumor progression. The aim of this study was to evaluate the correlation between immunohistochemical markers of metabolism (AMACR, NKX3.1) and proliferation (Ki-67) and histopathological aggressiveness in ADK (prostate adenocarcinoma). Methods: This retrospective, single-center clinicopathological study included 385 patients with prostatic lesions from Sf. Apostol Andrei Emergency Clinical Hospital in Constanta (2023 2024). Of these, 198 cases of ADK were selected for the main immunohistochemical analysis. The cases were classified according to the Gleason system and Grade Groups. The expression of AMACR, NKX3.1 and Ki-67 markers was assessed by immunohistochemistry and correlated with Grade Groups, as well as with the presence of chronic inflammation and peritumoral glandular atrophy. Results: Increased AMACR expression (93.9% of cases) and increased Ki-67 index ( 20% in 29.3% cases) were significantly correlated with high Grade Groups (p 0.001). Loss of NKX3.1 expression increased from Grade Group 1 to Grade Group 4, followed by a lower frequency in Grade Group 5, indicating a non-linear association with histopathological grade (p for trend 0.001). The concomitant presence of chronic inflammation and glandular atrophy was associated with high Grade Groups and with a significantly higher Ki-67 index (p=0.001 and p 0.001). Triple staining (AMACR/p63/HMWCK) showed no discordant cases in distinguishing ADK from benign lesions that mimic prostate cancer. Conclusions: The extended immunohistochemical profile (AMACR, NKX3.1, Ki-67) provides valuable biological information correlated with tumor aggressiveness. Integrating these markers into the preoperative evaluation, along with standard histopathological evaluation and the peritumoral microenvironment, may contribute to a more accurate risk stratification. However, these findings are correlative, and their clinical applicability requires validation through further prospective studies.

Background: Sarcopenia is a frequent and clinically relevant condition in patients with pancreatic neoplasm, contributing to poor prognosis, reduced therapeutic tolerance, and increased mortality. The identification of reliable circulating biomarkers, alongside imaging-based muscle assessment, may improve early detection and risk stratification. Methods: This randomized prospective study included 61 patients, of whom 36 had pancreatic neoplasm associated with sarcopenia and 25 served as controls. Serum levels of osteonectin (SPARC), C-terminal agrin fragment (CAF), procollagen type III N-terminal peptide (P3NP), myostatin (MSTN), and insulin-like growth factor-1 (IGF-1) were measured using ELISA. Skeletal muscle index (SMI) and psoas muscle index (PMI) were assessed using CT at the L3 level. Results: Patients with pancreatic neoplasm and sarcopenia showed significantly altered biomarker profiles compared to controls. Osteonectin (median 936.4 vs. 539.9, p 0.001), CAF (2135.9 vs. 1165.5, p 0.001), P3NP (8.01 vs. 5.34, p 0.001), myostatin (47.71 vs. 7.85, p 0.001), and IGF-1 (142 vs. 106.7, p 0.001) were all elevated. The highest biomarker levels were consistently observed in the pancreatic neoplasm group compared to other disease groups. Additionally, 100% of patients with pancreatic neoplasm exhibited reduced SMI, confirming the high prevalence of sarcopenia. Biomarker levels were not significantly influenced by tumor location. Conclusions: The combined use of circulating biomarkers and CT-derived muscle indices provides a clinically relevant approach for identifying sarcopenia in pancreatic cancer.

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.