Peripancreatic unicentric Castleman disease is rare and may mimic a primary pancreatic neoplasm because it often presents as a well-circumscribed hypervascular mass. We report a 26-year-old woman with type 2 diabetes mellitus in whom an incidentally detected upper abdominal mass was initially considered to arise from the pancreatic body. Computed tomography and magnetic resonance imaging showed a sharply marginated hypervascular lesion with diffusion restriction at the superior border of the pancreatic body, leading to a preoperative suspicion of pancreatic neuroendocrine tumor. Laparoscopic exploration revealed a well-encapsulated mass in the lesser sac closely abutting the superior surface of the pancreas. A clear dissection plane between the lesion and the pancreatic parenchyma allowed complete excision without pancreatic resection or splenectomy. Histopathological examination confirmed hyaline vascular-type unicentric Castleman disease. The postoperative course was uneventful, and no residual or recurrent lesion was detected during 1 year of follow-up; glycemic status also remained stable. This case highlights that close proximity of a hypervascular mass to the pancreas does not necessarily indicate pancreatic origin. Careful multiplanar imaging and direct intraoperative assessment of the lesion-pancreas interface may help determine the appropriate surgical extent and avoid unnecessary pancreatic resection when complete excision is technically feasible.

Diabetes mellitus is a chronic, non-communicable metabolic disorder of global public health concern. Many studies utilize metabolomics to profile metabolites in individuals with diabetes. However, these studies have shown inconsistencies in identifying metabolite signatures associated with the disease without clearly defining how it influences glucose homeostasis. Discrepancies in analytical platforms and biomarker validation limit clinical translation of metabolomic biomarkers. This review aims to integrate existing evidence on metabolomic profiles in diabetes, and address challenges related to biomarker validation and method standardization.

The review was conducted in adherence with PRISMA 2020 guidelines, from PubMed and Google Scholar databases. Peer-reviewed English-language studies published between 2010 and 2026 were retrieved using predefined and related keywords. Following thorough screening, 188 studies were included. The review synthesizes diverse metabolomics evidence into a unified model, establishing a link between metabolic disruptions and regulation of blood glucose.

Across the studies, a consistent metabolic pattern was identified, characterized by alterations in amino acid metabolism notably branched chain and aromatic amino acids, lipid metabolism including ceramides, sphingolipids, fatty acids, and central energy pathways like the TCA cycle.

Rather than being present as isolated biomarkers, they form interconnected networks that collectively influence insulin sensitivity, β-cell function, and hepatic glucose. Also, while advancement of LC-MS, GC-MS, and NMR-based metabolomics led to expansion in the identification of biomarkers, variability in experimental design and inadequate method standardization persist as constraint in reproducibility. Metabolomics offers strong framework to understand diabetes and improve early diagnosis, risk prediction, and precision glucose management, but requires better standardization.

Diabetes mellitus is a chronic metabolic disorder characterized by impaired glucose homeostasis, insulin resistance, and progressive complications. Although Cardiospermum halicacabum Linn. has demonstrated antihyperglycemic activity in traditional medicine, its molecular mechanisms remain poorly understood. This study investigated its antidiabetic mechanisms using network pharmacology, molecular docking, ADMET profiling, and in vitro α-amylase inhibition. Preliminary phytochemical screening was performed on the ethanolic extract. Phytoconstituents were retrieved from the IMPPAT database and screened for drug-likeness. Potential targets were predicted using SwissTargetPrediction and SuperPred, while diabetes-associated genes were collected from GeneCards and OMIM. Network pharmacology, GO and KEGG enrichment analysis, molecular docking with redocking validation, ADMET prediction, and in vitro α-amylase inhibition assays were conducted. Thirty-seven phytoconstituents, 417 compound-related targets, and 1,025 diabetes-related targets yielded 210 overlapping targets. Apigenin, luteolin, chrysoeriol, kaempferol, and quercetin were identified as principal phytoconstituents, while AKT1, PTPN1, PIK3CA, and MAPK8 emerged as hub targets. KEGG analysis highlighted the AGE-RAGE and MAPK signalling pathways. Apigenin showed the strongest predicted binding affinity toward PIK3CA (- 9.61 kcal/mol). The extract exhibited concentration-dependent α-amylase inhibition, reaching 71.27 ± 1.31% inhibition at 1000 μg/mL, with an IC₅₀ of 218.40 μg/mL, whereas acarbose showed 97.10 ± 0.60% inhibition at 1000 μg/mL, with an IC₅₀ of 62.43 μg/mL. Cardiospermum halicacabum may exert antidiabetic activity through multitarget mechanisms. These findings provide computational evidence supported by preliminary experimental validation; however, further target-specific in vitro, in vivo, and clinical studies are required to confirm the proposed mechanisms.

The online version contains supplementary material available at https://doi.org/10.1007/s40203-026-00756-8.

Breast cancer heterogeneity and its complex tumor microenvironment (TME) are key drivers of therapeutic failure and multidrug resistance (MDR). Drug delivery systems (DDS) provide an important approach, but their clinical translation remains limited by biological variability, formulation complexity, and manufacturing challenges. This review delineates the evolution of breast cancer DDS from passive carriers to increasingly functional and responsive platforms, focusing on three core dimensions. First, regarding decisive barriers, we dissect the constraints imposed by the three-dimensional collagen network, pH/glutathione (GSH) gradients, and tumor-associated macrophages (TAMs) on drug penetration. These factors not only act as physical and biochemical obstacles but can also be harnessed as endogenous triggers for responsive design. Second, in terms of diversified platforms, we critically evaluate liposomes, polymeric nanoparticles, hydrogels, extracellular vesicles, and antibody-drug conjugates (ADCs). We highlight the potential of solid lipid nanoparticles to address drug resistance, the development of carrier-free delivery enabled by prodrug self-assembly, and the clinical significance of ADCs (eg, T-DXd) in expanding treatment options for HER2-low breast cancer. Third, we examine inter- and intratumoral heterogeneity, metastatic site-specific delivery barriers in the brain, bone, and lung, the multilayered resistance network from efflux pumps to cancer stem cells, and the sequential barriers nanomedicines must traverse from systemic circulation to intracellular targets. We propose three strategic directions: personalized precision delivery integrating liquid biopsy, organoids, and functional imaging to support patient stratification and treatment adaptation; AI-assisted formulation optimization using machine learning to develop material-structure-function predictive models and support data-driven formulation design; and multi-responsive systems leveraging endogenous signals such as pH, GSH, and enzymes, together with exogenous stimuli including light, magnetism, and ultrasound, for spatiotemporally controlled combination therapy. This review summarizes key considerations from biological barriers to clinical translation, emphasizing that alignment of tumor subtype, metastatic site, microenvironmental characteristics, and patient-specific factors may improve the clinical applicability of drug delivery strategies.

Indolent pulmonary adenocarcinoma spectrum lesions can remain radiographically stable for years and often demonstrate little to no fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET), making diagnosis and management challenging. We report the case of a 74-year-old Caucasian woman with a remote five-year smoking history and a strong family history of lung cancer who was followed for a persistent right upper lobe ground-glass pulmonary nodule. Despite gradual enlargement, PET imaging performed seven years later demonstrated no significant FDG uptake. Serial computed tomography (CT) scans over the following years showed slow progression from a pure ground-glass nodule to a mixed ground-glass and part-solid lesion with an enlarging solid component, raising concern for an indolent adenocarcinoma. Transbronchial needle aspiration demonstrated atypical epithelioid cells, and immunohistochemical staining was positive for thyroid transcription factor-1 (TTF-1) and cytokeratin 7 (CK7) and negative for p40, confirming pulmonary adenocarcinoma. Repeat PET imaging two years later demonstrated mild FDG uptake despite histopathologic evidence of malignancy. This case highlights the prolonged radiographic evolution of a persistent ground-glass pulmonary nodule and demonstrates that limited FDG uptake does not exclude an indolent pulmonary neoplasm. Development or enlargement of a solid component within a persistent ground-glass nodule should prompt careful reassessment even when the metabolic activity remains low.

Sertoli cell tumors are rare gonadal stromal tumors. Extragenital manifestations, particularly in the adrenal gland, are exceptionally uncommon. We present a case of an adrenal Sertoli cell tumor in a male patient, presenting with a pathological (1 mg overnight) dexamethasone suppression test. An 82-year-old otherwise healthy man was referred for evaluation of an incidentally detected left adrenal mass. The patient was asymptomatic with no clinical signs of catecholamine excess, hypercortisolism, hyperaldosteronism, or B-symptoms. Initial CT scan revealed a 44 × 42 mm lesion, which increased to 50 × 46 mm within three months and showed suspicious washout characteristics. Endocrinological work-up showed a pathological (1 mg overnight) dexamethasone suppression test, while metanephrines and aldosterone testing were normal. Tumor markers [alpha-fetoprotein (AFP), beta-human chorionic gonadotropin (β-HCG)] were unremarkable. A hormonally active adrenal adenoma with autonomous cortisol production was suspected. After discussion at the interdisciplinary tumor board, robotic-assisted adrenalectomy was performed. Complete resection was achieved without complications; the patient was discharged on the third postoperative day. Histopathological examination showed a Sertoli cell tumor with complete excision and no evidence of local infiltration or malignancy. Immunohistochemistry showed positivity for cluster of differentiation (CD)56, CD99, synaptophysin, and partial positivity for SF1, calretinin, and inhibin. Chromogranin A and MART1 were negative. Molecular analysis revealed no FOXL2 or DICER1 mutations. Postoperatively, hydrocortisone replacement was initiated due to a submaximal cortisol response to adrenocorticotropic hormone (ACTH) stimulation testing. At six-month follow-up, CT imaging showed no recurrence or metastases, and tumor markers remained normal.  Adrenal Sertoli cell tumors represent an extremely rare entity lacking specific management guidelines. In this case, robotic-assisted adrenalectomy proved safe and feasible. We observed good short-term oncological and clinical outcomes. Further reports are needed to clarify hormonal associations and establish standardized follow-up and treatment strategies.

The accuracy of serum thymidine kinase 1 (TK1S) as a biomarker of lymphoma in horses is variable. The value of measurement in body cavity fluid (TK1F) has not been established.

(1) TK1F and TK1S will be higher in horses with lymphoma compared to diseased controls (DCs); (2) TK1F will be higher than TK1S; and (3) there will be a strong correlation between both measurements.

Twenty animals in the lymphoma and 31 animals with nonneoplastic, gastrointestinal/respiratory disorders in DC group.

This was a cross-sectional study using prospectively collected data and samples obtained during routine diagnostic evaluation at referral hospitals. Thymidine kinase 1 was measured using chemiluminescence immunoassay and presented as median (and interquartile range). Nonparametric tests compared TK1F and TK1S between and within groups and Kendall's Tau assessed correlation between TK1F and TK1S.

Median TK1F was 7.48 (2.20-48.23) U/L in horses with lymphoma vs 2.50 (0.59-4.83) U/L in the DC group (P = .007); median TK1S was 4.26 (0.46-9.37) U/L vs 0.40 (0.40-0.75) U/L (P < .001), respectively. Both biomarkers showed good discrimination (area under the curve > 0.70) between lymphoma and the DC group, with optimal cutoff values of 5.7 and 2.5 U/L, respectively. Thymidine kinase 1 activity in body cavity fluid (3.62 [0.85-9.86] U/L) was significantly higher than TK1S (0.50 [0.40-2.09] U/L; P < .001) and there was no significant correlation between them within groups.

Thymidine kinase 1 activity in body cavity fluid and TK1S provide different information and should be interpreted independently. They proved useful in lymphoma diagnosis, but not as a standalone test.

Handgrip strength (HGS) is a widely used clinical and prognostic tool in oncology and is associated with several outcomes in palliative care (PC).

To evaluate the factors associated with low HGS in patients with advanced cancer receiving PC.

A cross-sectional study was conducted at the Brazilian National Cancer Institute between 2023 and 2025, including patients with advanced cancer receiving PC. HGS was measured using a Jamar® hydraulic dynamometer. HGS values below the first tertile were classified as low HGS. Clinical, sociodemographic, functional, and nutritional data were collected. Analyses, stratified by sex, included logistic regression, with odds ratios (ORs) and 95% confidence intervals (CI) as estimators.

Five hundred twenty-seven patients were included, with a median age of 66 years, predominantly women (58%), and with primary tumor sites in the gastrointestinal tract (24%) and gynecological (21%). The cutoff points defining low HGS (1^st tertiles) were: ≤ 12 kg for women and ≤ 20 kg for men. A higher risk of low HGS was observed among older women (OR: 2.29; 95% CI: 1.31-4.01) and those with Karnofsky Performance Status (KPS) 40-50% (OR: 5.06; 95% CI: 3.01-8.49); as well as among older men (OR: 4.02; 95% CI: 2.36-8.35) and those with KPS 40-50% (OR: 3.89; 95% CI: 2.52-6.34).

Advanced age and lower KPS were independently associated with low HGS in patients with advanced cancer receiving palliative care. These findings support HGS as an objective indicator of physical vulnerability in this population.

Evaluate the preoperative health-related quality of life (HRQoL) of patients with malignant brain tumors (MBT) and explore changes in HRQoL and factors associated with it within 3 months after surgery.

Patients with MBT who underwent surgery were included in the study. Patients were evaluated using the EORTC QLQ-C30 and QLQ-BN20 scales, as well as the Karnofsky Performance Status Scale. Sociodemographic, tumor history, and surgical data were collected.

A total of 140 patients (98 glioma cases and 42 brain metastasis cases) completed the preoperative assessment. Seven days after surgery, overall health status, physical function, role function, fatigue, pain, and lower extremity weakness deteriorated significantly (p < 0.05). However, most glioma patients' functions returned to baseline levels one month later. Patients with brain metastases experienced a decline in physical, role, and social functions seven days after surgery. One month later, cognitive function, future uncertainty, and headaches improved. Multivariate linear regression analysis revealed that sociodemographic, tumor, and surgical factors significantly predicted various domains of HRQoL at different time points. Overall health condition exhibited a V-shaped trend after the operation.

Age, tumor location, surgical method and KPS score are important factors associated with HRQoL. Regular assessment of these factors may help formulate individualized interventions to optimize patients' quality of life.

Orthostatic hypotension (OH) is a common complication in cancer care, increasing the risk of falls. However, in hematopoietic cell transplantation (HCT) and cellular therapy, few studies have focused on OH, and its incidence and risk factors remain unclear.

This single-center retrospective study included 297 (autologous, 153; allogeneic, 127; and CAR-T, 17) patients. Blood pressure and heart rate were measured with the patient supine, and again at 1 min and at 3 min after standing. Data were collected to calculate OH incidence by day 30 post-infusion.

The cumulative incidence of any OH by day 30 was 57.6% (median onset, day 5), with symptomatic OH at 21.9% (median onset, day 4). Stratified by therapy type, the cumulative incidence of any and symptomatic OH at day 30 were 62.8% and 28.8% in the auto-HCT, 52.0% and 15.7% in the allo-HCT, and 52.9% and 5.9% in the CAR-T group, respectively. Multivariate analysis identified outpatient treatment (HR = 3.60, p < 0.01) and prior OH history (HR = 1.76, p < 0.01) as significant risk factors for any OH. For symptomatic OH, outpatient status (HR = 4.66, p < 0.01), > 2% weight loss (HR = 2.09, p = 0.02), and infection (HR = 2.57, p = 0.01) were associated with higher risk.

It is important to assess OH before and after cellular therapy. In addition, daily weight monitoring and optimal fluid management may reduce the risk of OH development and lead to improved patient care and quality of life.