Spinal vascular malformations are rare causes of progressive myelopathy, often leading to misdiagnosis as inflammatory disorders like neuromyelitis optica spectrum disorder (NMOSD). We present the case of a man in his late 30s who developed a 9-month history of progressive low back pain, ascending paraesthesia and worsening paraparesis. Initial MRI showed longitudinally extensive transverse myelitis (LETM), and he was treated for seronegative NMOSD with steroids and plasmapheresis despite negative AQP4-IgG and MOG-IgG. As his condition didn't improve, a spinal dural arteriovenous fistula (SDAVF) was suspected and confirmed via digital subtraction angiography (DSA). Following successful endovascular embolisation, the patient's motor strength improved substantially and he regained the ability to ambulate with a cane. This case highlights that while double-negative (DN) NMOSD is a challenging clinical syndrome, the identification of mimics like SDAVF is of higher diagnostic priority to prevent the morbidity associated with inappropriate long-term immunosuppression.

Generative indigo carmine chromoendoscopy (generative chromoendoscopy), produced using deep learning-based synthetic image transformation, is a novel image-enhanced endoscopic approach whose clinical feasibility has not been validated. This proof-of-concept study evaluated whether generative chromoendoscopy improves the visibility of gastric neoplasms compared with conventional white-light imaging (WLI) and real chromoendoscopy.

This prospective, multicenter study was conducted at three Japanese institutions between January and August 2025. A deep neural network-based program converted WLI into generative chromoendoscopy images. Patients with early gastric cancer or adenoma sequentially underwent endoscopy using WLI, generative chromoendoscopy, and real chromoendoscopy. During live endoscopy, two endoscopists independently assessed lesion visibility using a 7-point Likert-type scale (-3 to +3). The primary endpoint was visibility of gastric neoplasms with generative chromoendoscopy relative to WLI, with comparison to real chromoendoscopy. Secondary endpoints included clinicopathologic factors associated with improved visibility.

Sixty patients were enrolled. Mean visibility scores were 0.67 ± 0.93 for generative chromoendoscopy and 0.51 ± 1.00 for real chromoendoscopy. The mean difference was 0.16 (95% confidence interval [CI] 0.01-0.30). Differentiated-type histology (odds ratio [OR] 2.19, 95% CI 1.03-4.62), current Helicobacter pylori infection (OR 2.14, 95% CI 1.02-4.46), and expert endoscopist status (OR 2.14, 95% CI 1.22-3.76) were significantly associated with higher visibility scores using generative chromoendoscopy.

Generative chromoendoscopy was feasible during live endoscopic procedures. It improved visibility of pre-identified gastric neoplasms compared with WLI and achieved visibility comparable to real chromoendoscopy.

Suicide, euthanasia, and physician-assisted suicide (PAS) represent significant clinical challenges in oncology and palliative care. Although these topics are conceptually related, they are often studied separately. Previous studies have relied on structured, close-ended measures, but none have applied semantic network analysis (SNA) to patient-generated language in this context.

The study seeks to explore patterns of lexical association related to suicide risk and attitudes toward end-of-life interventions, applying SNA to Sentence Completion Test (SCT) responses. Networks were compared by suicide risk status, approval or disapproval of active euthanasia, and PAS.

A total of 298 patients with cancer completed a seven-item SCT covering five domains: self, relationships, future, distress, and cancer appraisal. Group-specific undirected semantic networks were constructed. Global network metrics and node-level centrality were computed. Group differences were tested via permutation procedures and conceptual similarity was assessed using Jaccard similarity coefficients of top-ranking central terms.

The suicide risk networks were more narrowly illness-related terms, with words such as cancer, suffering, and death occupying more central positions. Similarly, networks of participants approving euthanasia and PAS were organized around illness and mortality-related terms, whereas disapproving groups showed more diverse and distributed patterns, including positively valenced terms such as appreciation and hope. Although there was moderate-to-high overlap in key terms across groups, each group showed distinct patterns in how these terms were organized.

Attending to emotionally salient language may provide insights into patients' experiences and could help inform psychosocial support and suicide prevention efforts.

KIT mutations are recurrent genetic alterations in myeloid neoplasms (MNs), with the D816 hot-spot variant recognized as a poor prognostic marker in acute myeloid leukemia (AML) with RUNX1::RUNX1T1 and as a diagnostic criterion for systemic mastocytosis (SM). In contrast, the clinical and biological relevance of KIT mutations outside codon 816 remains insufficiently characterized. We retrospectively analyzed 40 MNs with pathogenic KIT mutations, comparing 26 cases harboring D816 variants to 14 cases with non-D816 changes. Clinicopathologic features, cytogenetics, molecular profiles, immunohistochemical data, and survival outcomes were evaluated. The two groups showed similar distributions of MN subtypes and cytogenetic abnormalities. However, the non-D816 group exhibited significantly lower mast-cell burden by CD117 immunohistochemistry and no cases of SM, whereas 31% of D816 cases showed concurrent or subsequent SM. D816 cases displayed more complex co-mutational profiles and a higher rate of KIT acquisition as a secondary event. Non-D816 cases demonstrated significantly longer overall survival. In the subset of AML with t(8;21), D816 variants trended toward inferior survival compared with non-D816 variants. Our findings suggest that non-D816 KIT mutations are associated with a less aggressive clinical phenotype, lower mast-cell differentiation, and improved outcomes. These results support a biologically distinct role of non-D816 KIT variants in MNs and highlight the need for refined risk stratification incorporating KIT variant classes.

Colorectal cancer (CRC) is a leading cause of cancer mortality. The extracellular matrix (ECM) plays a critical role in tumor progression, and its associated genes may serve as prognostic biomarkers. This study investigated three ECM-related genes, CILP, MFAP4, and MMRN1, to evaluate their expression and clinical significance in CRC development.

RNA-seq data from TCGA-COAD and microarray datasets (GSE23878, GSE89076) were analyzed to identify differentially expressed genes (DEGs). Bioinformatics analyses included functional enrichment, protein-protein interaction (PPI) network construction, and immune infiltration evaluation. Experimental validation was performed using RT-qPCR on 20 paired CRC and adjacent non-cancerous tissues. Associations between gene expression, clinicopathological features, and overall survival were assessed.

Both RNA-seq and microarray analyses revealed significant downregulation of CILP, MFAP4, and MMRN1 in CRC tissues compared to non-cancerous samples (p < 0.05). RT-qPCR confirmed lower expression levels in tumor tissues (p < 0.0001). TIMER database analysis for immune cell infiltration revealed positive correlations between target genes and tumor-infiltrating lymphocytes, particularly CD₈⁺ T cells and macrophages. Moreover, MFAP4 expression showed a significant association with lymph node status (p < 0.05), while both MFAP4 and MMRN1 were found to be correlated with smaller tumor size (p = 0.04). Survival analysis showed non-significant trends toward poorer prognosis in patients with lower gene expression.

These findings demonstrated that CILP, MFAP4, and MMRN1 function as potential tumor suppressors and immunomodulators in CRC. Their significant downregulation in tumor tissues, along with associations with immune infiltration and clinical features, suggest a possible role in CRC pathogenesis and make them potential therapeutic targets.

Rare cancers are usually defined as an incidence of <6/100,000 persons per year. Gynecological oncology is characterized by a paradoxical high prevalence of rare cancer subtypes, especially in ovarian tumors. Ovarian germ cell tumors, clear cell ovarian cancer and gestational trophoblastic disease encompass this set of gynecologic tumors. The WHO classification distinguishes epithelial cell tumors (85% of malignant tumors) from non-epithelial tumors, sex cord stromal tumors (8% of malignant tumors), and germ cell tumors (6% of malignant tumors). The current treatment for these tumors is similar to that for ovarian cancer but advancing quickly to incorporate targeted therapy. Gestational trophoblastic tumors are usually curable, even when widely metastatic disease is present. Ovarian clear-cell carcinoma (OCCC) remains a challenging disease characterized by intrinsic chemoresistance and distinct molecular features. A more biologically aligned treatment strategy has emerged. Continued integration of molecular selection and microenvironmental modulation will likely define the next phase of therapeutic development in OCCC. The clinical features, staging, and current treatment of each of these tumors is reviewed.

To review the prognostic impact of spread through air spaces (STAS) and visceral pleural invasion (VPI) in early-stage non-small-cell lung cancer (NSCLC), assess their relevance to the increasing use of sublobar resection, and describe current limitations in their preoperative and intraoperative assessment.

A comprehensive literature review was conducted to summarize key original studies, meta-analyses, and major clinical trials addressing STAS, VPI, diagnostic modalities, and surgical strategies for early-stage NSCLC.

Spread through air spaces is associated with a higher risk of loco-regional recurrence after sublobar resection, and this risk is not adequately reduced by wider surgical margins. Anatomic resection, such as segmentectomy, provides more favourable outcomes than non-anatomic wedge resection in STAS-positive disease. Visceral pleural invasion is associated with an increased risk of distant metastasis, which may contribute to the comparable survival observed between segmentectomy and lobectomy in small VPI-positive tumours. The preoperative and intraoperative identification of both features remains limited due to the low sensitivity of frozen-section analysis for STAS and the modest accuracy of current radiologic predictors.

Tumour size alone is insufficient to guide surgical planning in early-stage NSCLC. Spread through air spaces and VPI have measurable prognostic effects and should be considered when determining the extent of resection. Improved predictive tools and prospective studies incorporating these pathological factors are needed to optimize surgical decision-making and treatment selection.

Minimally invasive thymectomy has transformed the surgical management of thymic epithelial tumours and myasthenia gravis (MG). Video-assisted thoracoscopic surgery (VATS) is well established, whereas robot-assisted thoracoscopic surgery (RATS) provides technical and ergonomic advantages but at a higher cost. We reviewed current evidence to clarify the indications, oncological validity, perioperative performance, and economic implications of RATS compared with VATS and open thymectomy.

A structured narrative review was conducted, drawing on multi-institutional cohorts, registry-based propensity-matched studies, and systematic reviews. Evidence was organized by tumour characteristics, special populations (MG, obesity, recurrent thymoma), perioperative and long-term outcomes, surgeon-centred considerations, and cost-effectiveness.

In early-stage thymoma and MG, both VATS and RATS achieve R0 resection rates ≥95% and recurrence outcomes comparable with sternotomy. Robot-assisted thoracoscopic surgery is associated with lower blood loss, fewer conversions, and signals of faster recovery, with particular advantages in obese or redo cases. Long-term survival appears equivalent across minimally invasive approaches, without evidence of oncological superiority. However, RATS incurs higher per-case costs, primarily from instrumentation and platform expenses.

VATS remains efficient for straightforward cases, whereas RATS may safely extend minimally invasive eligibility to anatomically complex scenarios while maintaining oncological integrity. Adoption should be indication-driven and resource-conscious. Further multicentre studies with long-term follow-up, patient-reported outcomes, and cost-effectiveness analyses are needed to define the sustainable role of RATS in thymectomy.

Not applicable.

The role of upper mediastinal lymph node dissection (UMLND) in distal oesophageal and oesophagogastric junction (AEG) cancers remains debated, requiring a balance between potential oncologic benefit and surgical risk. This review provides an updated perspective on its role.

We analysed current evidence from retrospective studies, meta-analyses, and ongoing clinical trials, focusing on histology, tumour location, staging, neoadjuvant therapy response, and surgical outcomes.

Routine UMLND is not supported for all distal oesophageal and AEG cancers. A standard 2-field dissection is sufficient for most patients with AEG adenocarcinoma. Extended 2-field dissection may be beneficial for squamous cell carcinoma of the upper and middle oesophagus and for adenocarcinoma with high-risk features, such as clinically positive upper mediastinal nodes or bulky abdominal/low-mid-mediastinal nodes. Current evidence highlights the need for a tailored surgical approach rather than uniform application.

UMLND should not be considered routine but applied selectively according to tumour biology, location, and response to multimodal therapy. Future randomized data, particularly incorporating immunotherapy and advanced imaging and surgical techniques, will better define the optimal extent of lymphadenectomy in distinct patient subgroups.

Antigen heterogeneity substantially limits the efficacy of chimeric antigen receptor-modified T (CAR T) cell therapy against solid tumors. Our study highlights the potent antitumor activity of low-dose decitabine-primed CAR T (dCAR T) cells in solid tumor models, a benefit previously confirmed in hematologic malignancies. Notably, dCAR T cell infusion in immunocompetent mice led to substantial elimination of mixed tumor masses containing both antigen-positive and antigen-negative cells, without the need for prior lymphodepletion. Our analysis showed notable proinflammatory remodeling of the tumor immunosuppressive microenvironment. Crucially, antigen-activated dCAR T cells sustained high levels of interferon-γ production, which induced immunogenic cell death in tumor cells and activated conventional dendritic cells. This, in turn, stimulated endogenous CD8⁺ T cells, enhancing their antigen-spreading capacity and aiding in the clearance of abscopal antigen-negative tumors. These findings reveal the robust antigen-spreading capability of dCAR T cells, underscoring their clinical potential in addressing solid tumors with inherent antigen heterogeneity.