Solid pseudopapillary neoplasms (SPNs) are rare pancreatic tumors that predominantly affect young women and generally exhibit low malignant potential. High-grade malignant transformation with distant metastasis is uncommon, particularly in elderly males.

A 66-year-old male with hepatitis B virus-related cirrhosis presented with obstructive jaundice, abdominal pain, and significant weight loss. Contrast-enhanced computed tomography revealed a large pancreatic head mass with multiple hepatic lesions. Histopathological examination demonstrated mixed solid and pseudopapillary architecture with marked nuclear atypia, high mitotic activity, and extensive necrosis. Immunohistochemical analysis showed nuclear β-catenin positivity and expression of CD56 and CD99, with negative neuroendocrine markers, and a proliferative Ki-67 labeling index of approximately 60% in the hot spot together, these findings confirmed SPN with high-grade malignant transformation and hepatic metastases.

This case represents an aggressive and atypical presentation of an SPN. Advanced disease, extensive metastases, and underlying liver cirrhosis significantly limited therapeutic options; only palliative management was feasible.

High-grade metastatic SPNs may exhibit aggressive clinical behavior and a poor prognosis. Elderly male sex may represent a potential adverse prognostic factor for aggressive SPN variants. Early recognition and accurate diagnosis are essential, particularly in atypical populations with significant comorbidities.

Low-grade endometrial stromal sarcoma (LGESS) is a rare uterine mesenchymal neoplasm that frequently expresses estrogen and progesterone receptors. Endocrine therapy is a cornerstone of treatment for recurrent or metastatic LGESS. In premenopausal patients, bilateral salpingo-oophorectomy (BSO) is commonly performed to reduce endogenous estrogen production and would be expected to result in a postmenopausal hormonal profile.

We report the case of a patient with recurrent, metastatic estrogen receptor (ER)/progesterone receptor (PR)-positive LGESS who had previously undergone BSO. Her disease initially responded to aromatase inhibitor therapy; however, she subsequently experienced pulmonary progression, including a large endobronchial metastasis requiring bronchoscopic cytoreduction. Despite pathologically confirmed BSO, further evaluation revealed a hormone profile more consistent with persistent premenopausal estrogen exposure. Given concern that ongoing estrogen exposure may have been contributing to progression of this hormone-sensitive malignancy, treatment was changed to combined leuprolide and letrozole. Three months after initiation of combined endocrine therapy, imaging demonstrated a partial response, which was confirmed at 6 months, accompanied by estradiol levels in the postmenopausal range.

This case raises the possibility that surgical menopause may not always result in complete estrogen deprivation in LGESS. Potential explanations include assay limitations, undetectable residual gonadotropin-responsive steroidogenic tissue, peripheral aromatization, and tumor-associated estrogenic activity. Biochemical evaluation of estrogen status may be informative in select patients whose disease behavior appears discordant with presumed post-oophorectomy menopausal status.

Pancreatic TB is extremely rare, even in endemic areas. Clinically and radiographically, it may resemble a malignant process. Herein, we present a case of pancreatic TB who underwent surgery with a preoperative diagnosis of pancreatic malignancy.

A 34-year-old Afghan man presented with a one-year history of intermittent epigastric pain, accompanied by nausea and vomiting. Physical examination showed stable vital signs with mild epigastric tenderness. Laboratory examinations revealed mild anemia with mildly increased liver enzymes and lipase. The CA19-9 level in serum was mildly elevated, and the serologic test for HIV antibody was negative. An abdominal CT scan revealed a 57×30 mm multiloculated hypoattenuating mass-like lesion in the head of the pancreas with no evidence of biliary system dilation. As EUS-guided fine-needle aspiration/biopsy (EUS-FNA/FNB) was not available at our institution and the lesion was highly suspicious for pancreatic malignancy, the patient underwent Whipple resection. On macroscopic examination, a well-defined creamy soft mass with necrotic consistency was found in the head of the pancreas. Microscopic examination showed significant caseating granulomatous inflammation containing Langhans giant cells, and the Ziehl-Neelsen staining revealed a large number of acid-fast positive bacilli in favor of Mycobacterium tuberculosis. Anti-TB medicine was administered. No clinical or radiologic deficits were discovered during the 10-month follow-up visits.

Pancreatic TB should be considered a differential diagnosis in pancreatic lesions, particularly in young patients from tuberculosis-endemic areas. Whenever feasible, preoperative EUS-guided FNA/FNB combined with microbiologic study may help avoid unnecessary invasive surgeries.

Canine prostatic carcinoma is a highly aggressive malignancy with a poor prognosis and limited long-term treatment options. Prostatic artery embolization (PAE) has emerged as a minimally invasive alternative, but long-term intraprostatic imaging changes after PAE in dogs remain poorly documented. We performed PAE on a 13-year-old neutered male Chihuahua with prostatic carcinoma. Designating PAE as Day 0, we monitored the prostate, bladder, and lungs with computed tomography (CT), ultrasonography (US), and thoracic radiography for approximately 900 days. Clinical signs remained well controlled; the dog survived until Day 918. CT showed intraprostatic hypoattenuating lesions (Day 33) that enlarged with gas accumulation (Day 173); US showed hypoechoic lesions (Day 271) that became scattered hyperechoic foci (Day 678). Following PAE, the prostatic parenchymal volume decreased by approximately 33% and remained stable until Day 481. No serious PAE-related complications were observed. These findings suggest that PAE induced sustained ischemic, cavitary, and chronic remodeling changes within the prostate, which may have contributed to the prolonged local disease control observed in this dog. To our knowledge, this represents the longest time-course imaging reported after PAE in a dog with prostatic carcinoma and illustrates the potential of PAE as a feasible, minimally invasive treatment option in general veterinary practice.

Mechanical high-intensity focused ultrasound releases tumor antigens and danger signals. It provides a potential substrate for immune checkpoint blockade. However, antigen release does not necessarily generate productive dendritic cell priming. In colorectal cancer, this transition occurs within a mucosal microenvironment shaped by epithelial barrier integrity, microbial exposure and myeloid clearance. Neutrophils can support epithelial repair or reinforce tumor-associated suppression. Macrophages remove apoptotic granulocytes and regulate inflammatory resolution. They can also restrain dendritic cell cytokine production. These context-dependent functions may determine whether mechanically released antigens initiate cytotoxic immunity or enter a nonproductive clearance response. This mini review integrates intestinal myeloid homeostasis with experimental evidence for mechanical ultrasound ablation and PD-1/PD-L1 blockade. It distinguishes antigen uptake from cross-presentation, protective resolution from tumor-permissive suppression, and colorectal evidence from observations in other tumor models. Functional dendritic cell readouts, lineage-resolved checkpoint measurements and concurrent barrier assessment provide a framework for evaluating combination therapy. The therapeutic objective is to preserve mucosal protection while sustaining antigen-specific immunity.

Pancreatic cystic lesions are being identified more frequently with widespread use of cross-sectional imaging. While most pancreatic cysts are mucinous neoplasms or pseudocysts, congenital cysts of foregut origin are exceptionally rare in this location, with these being commonly found in the mediastinum. Their occurrence in the hepatobiliary system is rare, and pancreatic involvement is even rarer. Fewer than 20 cases have been reported in literature since it was first described in the 1990s. Ciliated foregut cysts arise from abnormal development of the primitive foregut and, histologically, are lined by ciliated epithelium. In the pancreas, they may be asymptomatic and difficult to radiologically distinguish from other lesions, posing a diagnostic challenge. Given their rarity, reporting cases of ciliated foregut cysts of the pancreas adds valuable clinical insight. We present the case of a 67-year-old man with an incidentally discovered cyst in the body of the pancreas.

Inflammatory myofibroblastic tumor is a rare neoplasm. Its preferred location is intrathoracic; there are few reports of intra-abdominal involvement, where it may affect the mesentery and retroperitoneum. A 7-year-old girl was brought in for evaluation due to fever, nonspecific lower abdominal pain, fatigue, and progressive weight loss. Laboratory tests revealed anemia, thrombocytosis, and elevated CRP. An abdominal ultrasound showed a hypoechoic mass with well-defined borders and heterogeneous content, measuring approximately 67 × 52 × 79 mm. Complete excision was performed via laparotomy. Its low incidence, varied location, nonspecific histology, and clinical heterogeneity make diagnosis extremely difficult. Only histopathology allows for a definitive diagnosis, and the cornerstone of treatment remains complete removal of the tumor. This rare condition should be included in the pediatric differential diagnosis because of its nonspecific clinical presentation, intra-abdominal mass, and high recurrence rate after incomplete resection.

Artificial intelligence (AI) is increasingly integrated into clinical decision-making, including applications in pathology, radiomics, and multidisciplinary tumor boards (MDT) for head and neck (ENT) cancer. However, the current scope and performance of AI tools within MDT settings remain unclear.

To systematically evaluate the existing literature on the use and performance of AI models in MDT decision-making for ENT cancer.

Systematic review.

Studies assessing AI applications in MDT for head and neck (ENT) cancer.

A systematic search of Cochrane, Embase, Medline, PubMed, and Scopus was conducted from database inception to March 4, 2025. Studies were included without language or date restrictions. The review was conducted in accordance with PRISMA guidelines.

AI performance across 4 key domains: therapy option selection, clinical recommendations, explanation capabilities, and summarization abilities.

Of 791 records screened, 37 underwent full-text review and 7 met inclusion criteria. Six AI models were evaluated, with ChatGPT-4 featured in 71% of included studies. Across assessed domains, ChatGPT-4 demonstrated superior performance compared to other models, particularly in therapy selection, recommendation quality, and explanatory capacity.

The current evidence base regarding AI integration in MDT decision-making for ENT cancer remains limited and heterogeneous. Although ChatGPT-4 shows promising performance across multiple domains, concerns regarding clinical accuracy, consistency, and transparency persist. Further research is required to optimize AI reliability and validate its clinical utility.

Clarifying the capabilities and limitations of AI within MDT settings is essential to ensure safe integration into oncologic decision-making and to support future development of reliable, transparent AI-assisted clinical tools.

Klippel-Trénaunay syndrome (KTS) is a rare congenital vascular-overgrowth disorder within the broader spectrum of PIK3CA-related overgrowth syndromes. Although clinical, radiologic, and orthopedic manifestations are well described, the histologic spectrum of KTS-associated pathology remains under-characterized. Clinicopathologic findings from 21 patients with clinically established KTS were reviewed, including 18 with longitudinal clinical follow-up and 3 consultation cases of rare malignant mesenchymal neoplasms. Cases were identified from institutional pathology and clinical databases, and available hematoxylin and eosin-stained sections and ancillary studies were reviewed. The cohort included 11 males and 10 females. Among the 18 clinically followed patients, 12 had limb length discrepancy or asymmetric limb overgrowth, 9 had documented deep vascular malformations, 4 had intra-articular/synovial malformations, and 10 underwent initial orthopedic evaluation or intervention before age 18. Orthopedic morbidity clustered into mechanical overgrowth-related, vascular malformation-related, and soft tissue/wound-related complications. Histologic findings included superficial and/or deep slow-flow vascular malformations, ulceration and granulation tissue, hemosiderin-laden reactive synovium, and destructive hemorrhagic arthropathy. Intra-articular disease recapitulated a hemophilic arthropathy-like pattern, with hemosiderotic synovitis, papillary synovial hyperplasia, and progressive joint destruction with loss of articular cartilage, exposed subchondral bone destruction and remodeling, all attributable to long-standing intra-articular hemorrhage. Three consultation cases showed malignant mesenchymal neoplasia, including 2 angiosarcomas. Recognition of these patterns is important for pathologists evaluating specimens from patients with known or suspected KTS, particularly when findings mimic hemophilic arthropathy, diffuse-type tenosynovial giant cell tumor, nonsyndromic vascular malformation, and/or end-stage destructive arthropathy.

Melatonin has demonstrated antitumor activity in various cancer models, but its effects may depend on the therapeutic dose and cellular environment. We found that melatonin at millimolar concentrations significantly downregulated transglutaminase 2 (TGM2), histone serotonylation (H3K4me3Q5ser), and YTHDF1/m⁶A (N6-methyladenosine) in a colorectal cancer model. Cross-interference between TGM2 and YTHDF1 supports a link between these regulatory processes, while molecular docking, pharmacological interventions, and co-immunoprecipitation experiments suggest the existence of a signaling pathway involving melatonin and the HTR2B receptor. A combined analysis of CHIP-seq and meRIP-seq identified salt-induced kinase 1 (SIK1) as a potential downstream target, and SIK1 interference affected the proliferation and migration of colorectal cancer. Collectively, these findings support a working model in which melatonin-induced tumor suppression is associated with coordinated changes in TGM2/H3K4me3Q5ser and YTHDF1-associated m⁶A regulation, with SIK1 emerging as a potential convergent downstream effector.