Acute gastrointestinal bleeding caused by duodenal tumors remains a clinical challenge. Conventional endoscopic hemostasis has limited efficacy in preventing rebleeding, and surgical resection presents significant risks and is often not feasible. Endoscopic ultrasound-guided embolization (EUS-VE) with cyanoacrylate is widely performed for variceal bleeding, but its application to tumor-related bleeding is uncommon. In this study, we used EUS-VE for acute duodenal tumor-related bleeding. A total of 13 EUS-VE procedures were performed in 12 patients from August 2024 to December 2025. The technical success rate was 100%, and the clinical success rate within 30 days was 84.6% (11/13). Among the 12 patients, the 90-day rebleeding and mortality events occurred in 1 (8.33%) and 3 (25%) patients, respectively. Three patients (25%) developed fever after EUS-VE, including one case suspected to be procedure-related. This pilot study suggests that EUS-VE may be a feasible alternative for duodenal tumor-related bleeding. Its efficacy and safety require further validation with larger sample sizes.

Cushing's Disease (CD) is caused by pituitary adenomas, leading to hypercortisolism. This condition burdens patients socioeconomically, with a reduced quality of life and higher mortality. Transsphenoidal surgery (TSS) is the first-line treatment, offering a 78% remission rate. This study aims to identify factors influencing TSS outcomes to find the predictors of remission for improved treatment planning. A systematic search of electronic databases was performed based on the PRISMA guideline. Studies were selected if they reported data on remission and non-remission groups. A comparative meta-analysis was performed based on the variable type. This review included 11,666 patients treated with TSS for CD, with a remission rate of 73.88%. The mean age was 39.1 years, predominantly female (75.21%), with an average follow-up of 53.29 months. Remission rates were higher in patients with positive MRI results (78.47% vs. 66.11%, P < 0.01), microadenomas (79.16% vs. 64.70%, P < 0.01), without cavernous sinus invasion (78.50% vs. 47.54%, P < 0.01), first-time TSS (81.98% vs. 63.80%, P < 0.01), selective adenectomy surgery (81.24% vs. 64.54%, P < 0.01), and positive adenoma pathology (80.37% vs.54.65%, P < 0.01). Patients who achieved long-term remission exhibited significantly lower immediate post-operative serum cortisol, Adrenocorticotrophic Hormone (ACTH), and urinary-free cortisol (UFC) levels. The risk of bias was low across most studies. Our systematic review and meta-analysis demonstrate MRI findings, histopathology, tumor size, post-operative cortisol, ACTH, UFC, tumor invasion, and repetition of surgery as predictors of remission. These factors should be considered in patient selection for TSS to maximize clinical benefits.

The prognostic impact of tumor number among surgically treated colorectal liver metastases (CLMs) remains incompletely understood, particularly in patients with extensive disease.

We retrospectively analyzed 303 patients who underwent initial hepatectomy for CLMs between 2008 and 2024. Prognostic factors for overall survival (OS) were evaluated using multivariable Cox regression analysis. Estimated mortality hazard at three and five years after surgery was modeled according to the number of liver lesions.

Tumor number (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00-1.03; P = 0.025), positive primary nodal status (HR, 1.39; 95% CI 1.04-1.87; P = 0.029), and extrahepatic disease (HR, 1.60; 95% CI, 1.13-2.25; P = 0.007) were independently associated with OS. Mortality hazard gradually increased with increasing tumor number, particularly between 5-30 lesions, although the increase was modest. Among patients with ≥ 10 CLMs, median OS was 39.0 months.

Tumor number was associated with prognosis after hepatectomy, but increasing tumor burden did not result in a steep increase in mortality hazard. Tumor number alone should not preclude surgical consideration in selected patients.

To test whether pre-operative primary CT-based 3D tumor volume (TV) improves prediction of cervical spread in oral squamous cell carcinoma (OSCC) beyond conventional size metrics.

We retrospectively analyzed 132 consecutive primary OSCC patients (2014-2019). Contrast-enhanced CT datasets were semi-automatically segmented to obtain 3D TV (cm³), verified by a second observer. Multivariable logistic regression related log-TV to pathologic lymph-node metastasis (LNM), extranodal extension (ENE), and skip metastasis. Performance of radiologic TV, depth of invasion (DOI), and ellipsoid pathologic volume was compared by ROC/AUC and decision-curve analyses.

Median CT-derived TV was 12.6 cm³. Log-TV independently predicted LNM (odds ratio 3.00, 95% CI 1.21-7.68; AUC 0.815), outperforming DOI (AUC 0.541) and pathologic volume (AUC 0.498). A non-linear pattern linked very small (< 1.8 cm³) and large (> 16 cm³) tumors to increased skip-metastasis probability (AUC 0.733). Radiologic and pathologic volumes showed minimal concordance (R² = 0.0002). Decision-curve analysis demonstrated consistent net benefit of the volume model across clinically relevant threshold probabilities for elective neck dissection.

CT-based 3D volumetry is an independent pre-operative predictor of cervical LNM, flags tumors prone to skip spread, and offers greater clinical utility than linear measures.

Integrating radiologic volumetry into staging could refine nodal management-particularly in clinically node-negative patients-by supporting risk-adapted selection between sentinel lymph-node biopsy and elective neck dissection; prospective validation is warranted.

Prostate cancer is the second-highest cause of cancer-related incidence and the fifth-highest cause of cancer mortality in males. Prostate cancer is a heterogeneous disease with a wide spectrum of clinical behaviour, ranging from indolent to highly aggressive. Molecular approaches, such as genomic testing, can augment existing clinical risk stratifications and tailor management to the individual. Genomic tests that sample biopsy or surgical tissue can provide a molecular risk assessment and identify actionable therapy targets. Liquid biopsy, while still emerging, may provide a non-invasive alternative to tissue tests and enable longitudinal monitoring of tumour status. We first discuss the molecular landscape of prostate cancer, before providing a detailed overview of the molecular approaches available for early detection and prognostication. Furthermore, methodological considerations and barriers towards clinical implementation for these tests are discussed, highlighting areas of future research.

With the widely increasing implementation of modern next generation sequencing (NGS) technologies in routine molecular pathology practice, the fraction of cancers with a definite or probable hereditary background has been steadily increasing. Currently, it is assumed that 5-10% of all malignancies develop in the context of germline predisposition diseases. Not rarely, the diagnosis and recognition of cancer predisposition syndromes rely on distinctive histopathological and/or immunophenotypical findings that proved to be highly reliable and reproducible in uncovering hereditary neoplastic diseases that would otherwise have gone undetected by clinicians. This is especially true in patients with new mutations and, hence, negative family history. Examples of such neoplasms are the fumarate hydratase-deficient renal cell carcinoma (FH-RCC), succinate dehydrogenase-deficient RCC (SDH-RCC), and hereditary gastrointestinal stromal tumor (GIST) syndromes. Notably, many of these inherited cancer syndromes may present as unifocal lesions at advanced age of onset so that they are mostly misinterpreted as sporadic on clinical grounds. The availability of effective disease-specific specialized cancer screening and follow-up programs for several hereditary cancer syndromes underlines the importance of timely recognition of these disorders to enable enrollment of "at-risk individuals" in such programs for early detection and timely prevention/treatment of these mostly aggressive neoplasms. This review highlights and discusses the major clinicopathological, topographic-anatomical, and histological features that are highly suggestive of a hereditary neoplastic disease. The details of some of the entities are dealt with in review articles devoted to them in this special issue.

IDH-wt diffuse gliomas with histologic grade 2-3 features and distinct molecular characteristics are now classified as molecular glioblastoma, yet outcomes and optimal management remain incompletely defined in a contemporary cohort.

Adults with histologic grade 2-3 IDH-wt gliomas diagnosed from 1996 to 2019 were retrospectively identified. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan-Meier methods, with Cox regression used to assess prognostic factors. To account for noncanonical IDH mutations, subgroup analyses were performed in those age > 55 or with next generation sequence (NGS) IDH testing.

A total of 134 patients were included, with a median follow-up of 29.8 months. Median OS was 35 months (95% CI: 28.8-43), and median PFS was 20.9 months (95% CI: 14.5-27.4). Grade 2 tumors demonstrated significantly improved outcomes compared to grade 3 tumors (median OS 94.5 vs. 29.8 months; median PFS 50.6 vs. 15.3 months). Among grade 3 tumors, sequential radiation and chemotherapy yielded a median OS of 29.8 months versus 29.8 months with concurrent chemoradiation followed by chemotherapy (p = 0.17); median PFS was 22.2 months versus.

IDH-wt gliomas with grade 2-3 histology have heterogeneous outcomes. Grade 3 tumors show survival comparable to molecular glioblastoma, while a subset of grade 2 tumors exhibit prolonged survival. Concurrent chemoradiation did not confer a survival advantage over sequential therapy in grade 3 tumors, supporting reevaluation of treatment intensity in selected patients.

Differentiating prolactinomas from non-functional pituitary adenomas (NFPAs) with stalk effect relies on biochemical thresholds that assume a linear relationship between tumor size and prolactin secretion. We applied a pathology-informed Prolactin Secretory Efficiency (PSE) framework to characterize diagnostic overlap between prolactinomas and NFPAs and evaluate the limitations of current prolactin thresholds.

Retrospective study of 425 patients undergoing first-time surgery for pituitary adenomas: 115 pathology-confirmed lactotroph adenomas, 291 NFPAs, and 19 mammosomatotrophs. Patients with clinical or biochemical evidence of ACTH- or GH-secreting tumors were excluded. PSE was calculated as the serum prolactin-to-tumor volume ratio [Formula: see text]). Primary outcomes included PSE-based group separation and diagnostic accuracy of the 200 ng/mL threshold.

While no NFPA exceeded 200 ng/mL, 42% of pathology-confirmed macroprolactinomas and 49% of macro-NFPAs fell within the diagnostic grey zone (ULN < prolactin < 200 ng/mL). PSE achieved superior group separation versus raw prolactin, yet a paradox emerged: high-efficiency stalk effect in some NFPAs produced PSE values exceeding those of low-efficiency macroprolactinomas.

Rigid biochemical thresholds fail to capture the full spectrum of lactotroph adenoma biology. Significant secretory ambiguity exists for macroadenomas below 200 ng/mL, creating risk of misclassification. D2-agonist trials may serve as a low-risk diagnostic probe in this grey zone, ensuring low-efficiency prolactinomas receive appropriate first-line medical management.

Whether gross total resection (GTR) remains associated with survival among MGMT-methylated IDH-wildtype glioblastoma patients receiving chemoradiation remains uncertain. We evaluated whether GTR versus less-than-GTR (< GTR) was associated with overall survival across MGMT promoter methylation and chemoradiation strata.

We retrospectively reviewed 261 patients undergoing biopsy or resection for newly diagnosed IDH-wildtype glioblastoma at a single institution from 2010 to 2024. Extent of resection was dichotomized as GTR versus < GTR, and chemoradiation was coded as receipt of postoperative radiation and temozolomide. Overall survival was assessed using Kaplan-Meier analysis and multivariable Cox models with prespecified EOR × MGMT × chemoradiation interaction testing, adjusted for age, KPS, tumor location, and mFI-5.

GTR was associated with longer overall survival than < GTR in the overall cohort and within all four MGMT × chemoradiation strata. MGMT-methylated patients receiving chemoradiation had a median overall survival of 17.02 months after GTR versus 10.65 months after < GTR (log-rank p = 0.001), and the model-derived adjusted hazard ratio for < GTR versus GTR was 2.12 (95% CI 1.27-3.54; p = 0.004). The three-way EOR × MGMT × chemoradiation interaction was not significant (likelihood-ratio p = 0.309). In a 6-week sensitivity analysis, all survival associations remained, but EOR × chemoradiation was no longer significant.

GTR was associated with longer survival across all MGMT and chemoradiation-defined subgroups, including MGMT-methylated patients receiving chemoradiation. These findings are consistent with maximal safe resection when feasible but should be interpreted cautiously because of small subgroups as well as treatment-selection and immortal-time biases.

Complete resection of skull base meningiomas (SBMs) is often limited by their proximity to critical neurovascular structures, potentially increasing the risk of postoperative progression. This study quantified long-term progression risk after SBM resection, identified predictors of progression, and developed a data-driven MRI surveillance protocol using Bayesian methods.

Patients undergoing SBM resection between 2002 and 2020 at two neurosurgical centres were analysed. Kaplan-Meier and Cox regression analyses were used to estimate intervention-free survival (IFS). Conditional probability modelling was used to derive an MRI surveillance schedule that maintained a ≤ 3% risk of progression requiring intervention, stratified by extent of resection.

A total of 358 SBMs were included. Median age at diagnosis was 57 years (IQR 18), and 76.0% of patients were female. WHO Grade 1 tumours accounted for 80.3% of cases and Grade 2 for 19.7%. Median follow-up was 97 months (IQR 64-128). Progression requiring re-intervention occurred in 14.1% of patients. Subtotal resection (STR) increased the risk of re-intervention (HR 2.62, 95% CI 1.30-5.30, p = 0.009), whereas higher comorbidity burden (HR 0.78, 95% CI 0.62-0.98, p = 0.038) and incidental presentation (HR 0.11, 95% CI 0.01-0.88, p = 0.038) were associated with lower risk. Conditional probability modelling demonstrated higher annual progression risk following STR, supporting more intensive imaging surveillance. Recommended MRI schedules were: gross total resection (GTR), scans at 3 months, 2, 5, 8, and 10 years; STR, scans at 3 months, 1 year, 18 months, annually from years 2-8, and at 10 years.

Progression requiring re-intervention occurs in approximately 17% of patients after SBM resection and is strongly associated with extent of resection. A conditional-risk-based MRI surveillance protocol provides an evidence-based framework for long-term follow-up.