The global incidence of renal cell carcinoma (RCC) has shown a significant upward trend in recent years, with growing health inequities related to its incidence. RCC remains the most lethal urological cancer. Although with the gradual popularization of physical examination screening, an increasing number of RCC patients have been detected and treated at an early stage, approximately 30% of patients are still diagnosed with locally advanced or metastatic RCC at the time of initial diagnosis. The treatment landscape for advanced or metastatic RCC has evolved substantially with the introduction of immune checkpoint inhibitors (ICIs) combined with tyrosine kinase inhibitors (TKIs). Neoadjuvant ICI-TKI combinations may downstage primary tumors and enable deferred cytoreductive nephrectomy (CN), but evidence regarding feasibility, efficacy, and safety remains limited. We present the case of a 50-year-old man with advanced clear-cell RCC and pulmonary metastases who received three cycles of neoadjuvant axitinib plus toripalimab. The regimen resulted in marked tumor shrinkage and necrosis, allowing safe robotic-assisted deferred CN. Pathology revealed extensive necrosis with minimal viable tumor. The treatment was overall well tolerated, and the patient recovered without recurrence. This case supports the feasibility and potential efficacy of neoadjuvant axitinib plus toripalimab followed by delayed CN in selected patients. Further studies are warranted to validate this sequential strategy and optimize perioperative safety management.

Multiple prospective trials have validated the efficacy and safety of neoadjuvant immunochemotherapy (nICT) in resectable esophageal squamous cell carcinoma (ESCC), yet patients with stable disease (SD) or progressive disease (PD) following nICT have limited benefit and are at risk for suboptimal surgical and pathological outcomes. The secondary induction radiotherapy prior surgery may represent a potential therapeutic strategy in this setting.

We conducted a retrospective study involving 23 patients with locally advanced, resectable ESCC who demonstrated poor response to nICT (19 with SD and 4 with PD). All patients subsequently received secondary induction radiotherapy via intensity-modulated techniques or tomotherapy (median dose, 41.4 Gy). The primary endpoint was the rate of R0 resection. The secondary endpoints included pathological complete response (pCR), major pathological response (MPR), the objective response rate (ORR), the disease control rate (DCR), tumor downstaging, and treatment-related adverse events (TREAs).

Among the 23 patients (median age, 63 years; 82.6% male), 30.4%, 60.9%, and 8.7% had clinical stages II, III, and IVa disease, respectively. Following secondary induction radiotherapy, 4 patients (17.4%) achieved a complete response (CR), and 8 (34.8%) achieved a partial response, yielding an ORR of 52.2% and a DCR of 100%. All patients underwent resection, with an R0 resection rate of 100%. MPR was achieved in 43.5% of patients, and pCR was achieved in 21.7%. Clinical downstaging occurred in 60.9% of patients, and pathological downstaging occurred in 69.6%. The median interval from the end of radiotherapy to surgery was 48 days. Grade 3-4 surgical complications occurred in 8.7% of the patients. Radiation-related grade 3-4 adverse events included myelosuppression in 13.0% and gastrointestinal symptoms in 8.7% of the patients.

In patients with resectable ESCC and a poor response to nICT, secondary induction radiotherapy was associated with encouraging surgical and pathological outcomes and an acceptable safety profile. Prospective studies are warranted to confirm these findings.

Malignant melanoma is a neoplasm originating from melanocytes and may arise at cutaneous or extracutaneous sites. Penile involvement is uncommon and may present with variable clinical manifestations. We describe a case of a 47-year-old male who presented with a progressively enlarging lesion involving the glans penis, initially associated with pruritus and later with severe local pain and bilateral inguinal lymphadenopathy. Histopathological examination of an incisional biopsy confirmed malignant melanoma of the penis. Imaging studies performed for staging demonstrated regional lymph node involvement and disseminated visceral disease. The patient underwent surgical management followed by systemic treatment after multidisciplinary evaluation. This case illustrates the clinical presentation, diagnostic approach, and management of penile malignant melanoma.

Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm that most commonly arises in the pleura. Renal SFT is extremely uncommon, and local recurrence after complete surgical resection is rarely reported. In our case, an 81-year-old woman underwent laparoscopic radical nephrectomy for an incidentally detected left renal mass. Histopathological and immunohistochemical analysis confirmed a malignant SFT, with STAT6 and CD34 positivity, and classified it as intermediate risk according to the modified Demicco model. Despite negative imaging at six months, local recurrence was detected one year postoperatively and confirmed by biopsy. Renal SFTs may demonstrate unpredictable biological behavior, including local recurrence after apparently complete resection. Close and long-term follow-up is essential for optimal patient management.

Neuronal astrocytes rely on a cytoskeletal element known as glial fibrillary acidic protein (GFAP), which facilitates their main structural framework, maintaining neurological function, repair, and lastly the blood-brain barrier. Pathologies such as neoplasms, autoimmune-mediated inflammation, and even genetic dysfunction can directly harm this element and result in malfunctioning astrocytes, CNS inflammation, and cell death. In this case report, we will create a timeline from presentation to remission of a rare entity known as autoimmune GFAP astrocytopathy for a middle-aged male with a wide variety of exposures and concomitant conditions. This case is unique, as in many cases, only one antibody marker was found on CSF analysis. After careful review of imaging from our institutional PACS, select slices were anonymized and organized here for review. The study aims to highlight the timeline of imaging features and their evolution. Advanced imaging techniques were also present and contributed to previous supporting evidence. Prior studies describe this entity with a wide variety of imaging features. Its most unique feature may be radial perivascular enhancement. What was not previously known is when these findings may present and how their absence within the time period of imaging may impact the investigation.

Duodenal leiomyomas are uncommon benign smooth muscle tumors that may remain clinically silent but can occasionally manifest with significant gastrointestinal bleeding, creating diagnostic difficulty because of their submucosal location. We report the case of a 72-year-old man who presented with acute gastrointestinal hemorrhage characterized by melena. Esophagogastroduodenoscopy revealed a bleeding submucosal lesion in the duodenum, and endoscopic biopsy was subsequently performed. Histopathological examination confirmed the diagnosis of duodenal leiomyoma. This case underscores the importance of considering duodenal leiomyoma in the differential diagnosis of acute gastrointestinal bleeding and highlights the diagnostic value of endoscopic biopsy in establishing a definitive histological diagnosis.

The prognostic role of thyroid nodules (TNs) in patients with heart failure with reduced ejection fraction (HFrEF) complicated by anemia and hyperuricemia (HUA) remains unclear. This study aimed to investigate the association of TNs with cardiovascular comorbidity burden and long-term prognosis in this high-risk population.

A retrospective cohort of 185 inpatients with HFrEF, anemia, and HUA (2018-2022) was divided into TN (n=94) and non-TN (n=91) groups based on ultrasound findings. Baseline characteristics, laboratory parameters (thyroid function, coagulation), and psychological status (Hospital Anxiety and Depression Scale, HADS) were compared. The primary composite endpoint included all-cause mortality, heart failure rehospitalization, and cardiovascular events. Multivariable logistic and Cox regression analyses identified factors associated with TNs and prognosis.

The TN group had higher prevalence of coronary heart disease (65.9% vs 31.8%), atrial fibrillation (71.3%vs 27.5%), and depression scores (8.32 vs 6.02). Logistic regression identified depression (OR = 4.81, 95%CI 2.56-9.41), atrial fibrillation (OR = 4.46, 95%CI 2.09-9.51), and coronary heart disease (OR = 2.45, 95%CI 1.32-4.54) as independent factors associated with TNs. Depression and anxiety scores positively correlated with HbA1c (P<0.01) and negatively with NT-proBNP (P<0.05). During median follow-up of 21.8 months, 99.5% patients experienced adverse outcomes. Cox regression showed atrial fibrillation (HR = 1.95, 95%CI 1.35-2.80), diabetes (HR = 1.32, 95%CI 1.02-1.70), and prothrombin activity (HR = 1.01, 95%CI 1.00-1.01) as independent risk factors. Depression was associated with shorter median survival (14.0 vs 18.0 months).

Thyroid nodules are associated with greater cardiovascular comorbidity burden, depression, and poorer prognosis in HFrEF patients with anemia and HUA. This association highlights the need for comprehensive management that includes cardiovascular risk assessment and psychological evaluation.

Currently, the therapeutic treatment of differentiated thyroid carcinoma (DTC) is based on the use of radioactive iodine; the effectiveness of treatment depends on the sensitivity of tumor cells to therapy. Factors associated with a high risk of radioactive iodine resistance of DTC (RAIR-DTC) are poorly understood in the current literature, but understanding their role may help optimize patient care. The aim of our study is to assess the relationship between the clinical and pathological characteristics of DTC and the risk of radioiodine resistance.

We conducted a case-control study involving a targeted sample of patients with differentiated thyroid carcinoma (DTC). The study included a total of 373 patients, of whom 60 were radioiodine-resistant and 313 were radioiodine-sensitive. For the molecular analysis, an additional sub-cohort was selected from the overall sample (n = 167), in which mutations in BRAF V600E, NRAS (codon 61) and pTERT (C228T/C250T) were determined using ddPCR.

In the group of patients with RAIR-DTC, total thyroidectomy with radical lymph node dissection was performed twice as often, which indicates more aggressive tumor invasion in this category of patients (p<0.001). The main risk factors for RAIR-DTC were female gender, total thyroidectomy with radical lymph node dissection, the presence of metastases in the lymph nodes, the total radiation dose, the absence of distant metastases, and the total number of lymph nodes removed, in the histological subcohort (n = 167), the presence of the double BRAF+pTERT mutation was also identified. Multivariate regression analysis showed that statistically significant risk factors for radioiodine resistance were the total radiation dose, the absence of distant metastases, and the total number of removed lymph nodes. These results were confirmed by ROC analysis; AUC was 0.796 (95% CI 0.726-0.865), p<0.0001.

The obtained data highlight the interplay between clinical and molecular factors in the development of radioiodine resistance in differentiated thyroid cancer (DTC). The co-occurrence of BRAF and TERT mutations has potential prognostic significance. These findings suggest that integrating clinical and molecular data enables more accurate risk stratification for radioiodine resistance and helps define the direction of future research.

This scoping review focuses on financial toxicity in cancer patients, aiming to identify its measurement time points, assessment tools, developmental trends, and influencing factors. Based on existing evidence, this review reveals the occurrence trajectory and long-term impacts of financial toxicity among cancer patients. It can provide a reference for improving patients' financial well-being in clinical practice and optimizing the medical security system at the health policy level and also points out key directions for future related research.

This study strictly followed the methodology of scoping review. A systematic search was performed across the databases including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wan Fang Data, VIP, and Chinese Biomedical Literature Database (CBM). The search period covered from the inception of each database to November 8, 2025.

A total of 14 articles were included in this study. The common measurement time points were selected as before the initiation of treatment, 3 months, 6 months, and 12 months after the start of treatment. The research tools combined subjective scales with objective data measurement, and the Comprehensive Score for Financial Toxicity-Patient-Reported Outcome Measure (COST-PROM) was adopted in most studies. The changing trend of financial toxicity among breast cancer patients tended to be stable. The financial toxicity of colorectal cancer patients showed a continuous upward trend, while that of esophageal cancer patients presented a continuous downward trend. The financial toxicity of cervical cancer patients also demonstrated a declining trend, though the magnitude of change was smaller than that of esophageal cancer patients. A total of 25 influencing factors of financial toxicity in cancer patients were identified, involving four dimensions: sociodemographic factors (4), disease-related factors (4), economic-related factors (11), and psychosocial factors (6).

The measurement time points of financial toxicity in cancer patients are mostly concentrated within one year after treatment, with insufficient research on long-term follow-up. The existing assessment tools lack applicability for long-term tracking and specificity for different cancer types, and objective indicators fail to effectively reflect patients' economic status due to disparities in regional economic development levels. Patients with different types of cancer exhibit distinct developmental trends of financial toxicity, indicating population heterogeneity. Future research still needs to further explore the influencing factors and developmental trajectories of financial toxicity among different cancer types.

Northern Thailand experiences severe annual air pollution (PM_2.5 > 35 μg/m³), primarily due to agricultural burning. While ambient PM_2.5 has been linked to gastrointestinal cancer deaths, its effect on colon cancer survival in high-exposure areas remains understudied.

In this 15-year retrospective cohort study, we used data on 5,018 patients with colon cancer (2003-2018) obtained from the Chiang Mai Cancer Registry. Time-varying exposure to PM_2.5, PM₁₀, NO₂, SO₂, CO, and O₃ was evaluated by exploiting annually updated Copernicus Atmosphere Monitoring Service data and linking them to residential districts. Multivariable time-dependent Cox models adjusted for demographics, tumor characteristics, and treatment were used in the analysis.

Over 18,650 person-years of follow-up (PYFU), 72% of patients died (mortality rate: 19.4 per 100 PYFU). Exposure to PM_2.5 ≥ 37.5 μg/m³ (a regionally relevant threshold) was independently linked to double the risk of all-cause mortality (adjusted hazard ratio (aHR) = 1.96, 95% confidence interval: 1.49-2.58, p < 0.001), as was having a low body mass index (aHR = 1.54) and being male (aHR = 1.23). Patients who died had significantly higher mean time-updated PM_2.5 exposure (with consistent annual exposure differences) compared to the survivors (37.7 vs. 35.5 μg/m³; p < 0.001). No significant associations were found between colon cancer and PM₁₀, O₃, NO₂, SO₂, or CO exposure. The PM_2.5 effect size was larger than estimates from regions with lower exposure levels.

Long-term exposure to ambient PM_2.5 markedly increases the risk of death among colon cancer patients in northern Thailand. As a modifiable risk factor, PM_2.5 mitigation urgently needs to be incorporated into environmental and survivorship care strategies in high-exposure areas.