Pituitary adenomas are neoplasms of the adenohypophysis (anterior pituitary gland) that can cause a multitude of symptoms secondary to the hormones they secrete (functioning adenomas) or mass effect on the optic chiasma (non-functioning adenomas). Functioning adenomas can secrete prolactin, growth hormone, adrenocorticotrophic hormone (ACTH) or thyroid-stimulating hormone, with some adenomas co-secreting more than one. This can lead to symptoms of prolactinoma, acromegaly, Cushing's disease, and TSHoma dependent on the elevated hormone. In non-functioning adenomas, visual changes, and headaches are seen. This case report follows a 19-year-old male who presented with visual acuity loss and persistent headaches, later diagnosed as a pituitary macroadenoma with a prolactin level of 794,560 mIU/L. He was subsequently treated with off-label cabergoline over three times the therapeutic limit for approximately 10 years. He was unfortunately lost to follow-up and unmonitored during this time, where he developed an impulse control disorder and showed inadequate response to the high-dose cabergoline. At the time of re-presenting to outpatient clinics, his adenoma was found to be extending into the cavernous sinuses with tentorial involvement, reducing the potential for surgical management. Discussions around medical, surgical, and radiotherapeutic management are being raised in light of this cabergoline resistance and placement. The case overall highlights the complexities of managing giant, dopamine agonist-resistant prolactinomas, especially in the setting of delayed follow-up, incomplete biochemical control, and neuropsychiatric side effects.

Primary malignant liver tumors constitute a significant global health challenge. We conducted an analysis of mortality trends across all forms of primary liver cancers, including hepatocellular carcinoma (HCC), cholangiocarcinoma, and other less prevalent types, to enhance our understanding of the overall burden these cancers impose on the US population.

The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was analyzed, and the International Classification of Diseases, 10th Revision (ICD-10), codes were utilized to identify deaths from primary malignant neoplasms of the liver from 1999 to 2020 in patients aged 25 or older. The age-adjusted mortality rates (AAMR/100,000) for the population were extracted, and trends were analyzed for age, gender, race, and year.  Result: There were a total of 445,389 deaths from primary liver cancer from 1999 to 2020. AAMR increased from 6.95 in 1999 to 10.12 in 2020. Gender analysis showed that both sexes have shown a gradual increase in AAMR over the course of years. The mean AAMR for males was 13.09 per 100,000 population (range: 12.31-13.87; SD: 1.75), which was more than twice the rate observed in females (mean: 5.45; range: 5.16-5.74; SD: 0.66). Race analysis showed that Asian or Pacific Islanders are the only race that has shown an overall decreasing trend in mortality from liver cancer, with AAMR decreasing from 15.68 in 1999 to 12.15 in 2020. Despite the decreasing trend, Asian or Pacific Islanders still have the highest mean AAMR (mean: 14.83; range: 14.21-15.46; SD: 1.41), followed by Hispanics (13.15), Black or African Americans (11.52), American Indians or Alaskan Natives (10.51), and finally Whites (8.32).  Discussion: An important aspect of understanding the disparities in mortality from primary liver cancer will be to see these disparities in the context of HCC, which accounts for 85% of primary liver malignancies. The decreasing mortality trend from primary liver cancer observed in Asians is consistent with a decreasing trend in mortality from HCC due to a decreasing incidence of hepatitis B virus (HBV). The increased mortality from primary liver cancer among males noted throughout the study period can be attributed to higher incidences of HBV and hepatitis C virus (HCV) infections, as well as greater alcohol consumption, all of which contribute to the development of HCC. Additionally, there is evidence to support that estrogens play a protective role, limiting liver inflammation and fibrogenesis and counteracting the development of HCC in females.

With an increasing mortality trend from primary malignant neoplasms of the liver, further research is needed to mitigate the risk factors and advance the treatment modalities for liver cancer.

Nevus sebaceous of Jadassohn (NSJ) is a congenital, benign hamartomatous lesion characterized by a well-demarcated, hairless, yellowish plaque, usually located on the scalp or face. In adolescence or adulthood, benign or malignant secondary tumors may develop within the nevus sebaceous. The most frequently associated benign tumors include trichoblastoma and syringocystadenoma papilliferum. The presence of an eccrine poroma within a nevus sebaceous is extremely rare, with only six cases documented in the literature. We present a case of a 33-year-old woman with a long-standing alopecic plaque on the scalp that progressively developed into two nodular growths. Histopathological examination of the biopsy revealed features compatible with a sebaceous nevus associated with an eccrine poroma and trichoblastoma. Complete surgical excision of the sebaceous nevus, including both neoplasms, was performed. This study represents one of the few reported cases of an eccrine poroma arising within a nevus sebaceous, underscoring the importance of surveillance and timely excision when indicated.

Salivary sialadenoma papilliferum (SP), an infrequent benign salivary gland neoplasm, resembles an uncommon benign tumor of sweat gland origin called syringocystadenoma papilliferum. The purpose of this paper is to report a case of SP of a minor salivary gland, near the parotid gland orifice, in an adult female patient presenting as intraoral growth and extraoral swelling. The present case highlights the SP's clinical and microscopic features, considering other exophytic papilliferous oral lesions and understanding the need to explore the nature and malignant potential of the tumor.

Hairy cell leukemia (HCL) is a rare, indolent B-cell neoplasm accounting for less than 2% of all leukemias. It is characterized by the presence of mature lymphocytes with typical hairy projections within the peripheral blood, bone marrow, and spleen, resulting in pancytopenia and splenomegaly. Purine analogs such as cladribine and pentostatin have been the mainstay of treatment for HCL. Despite high responsiveness to first-line therapy with purine analogs, almost half of the patients with HCL relapse and become progressively resistant to these medications. Treatment with a combination of BRAF V600E inhibitor and anti-CD20 monoclonal antibody has achieved durable responses in relapsed HCL. Here, we present a patient with relapsed and refractory HCL who achieved only partial response with three months of treatment with high-dose vemurafenib and rituximab, following which he was maintained on low-dose vemurafenib plus monthly rituximab for almost a year, after which he achieved complete morphologic and molecular response.

Atypical teratoid/rhabdoid tumor (ATRT) is a rare and highly malignant central nervous system (CNS) neoplasm, most commonly diagnosed in children and only infrequently reported in older adults. Classified as a World Health Organization (WHO) grade IV tumor, ATRT carries a poor prognosis and typically requires aggressive, multimodal treatment. Management in elderly patients is particularly challenging due to comorbidities, a lack of evidence-based guidelines, and heightened risk of treatment-related toxicity. We report the case of a 75-year-old woman with hypertension and hyperlipidemia who presented with progressive dizziness, headache, and blurry vision. Imaging revealed a pituitary macroadenoma compressing the optic chiasm. Following transsphenoidal hypophysectomy, histopathology unexpectedly confirmed ATRT, CNS WHO grade IV. The patient initiated craniospinal radiation and systemic chemotherapy; however, her course was complicated by severe thrombocytopenia, critical illness myopathy, and persistent encephalopathy attributed to prolonged steroid use and metabolic derangements. Interval imaging demonstrated stable disease with reduced mass effect on the optic chiasm. Due to poor treatment tolerance, radiation therapy was discontinued after 26 sessions, and she was discharged to rehabilitation with plans for continued chemotherapy. Unfortunately, her condition further deteriorated due to treatment-related complications, and she ultimately passed away under hospice care. This case underscores the diagnostic and therapeutic challenges of ATRT in older adults, a population for whom standard pediatric-based regimens may be excessively toxic. It highlights the need for individualized, patient-centered treatment strategies that prioritize disease control, treatment tolerance, functional status, and quality of life.

We report the case of an 82-year-old woman who developed a 70-mm cystic lesion in the breast. The cyst contained a papillary mass with numerous delicate fibrovascular stalks within a cystic space surrounded by a thick fibrous capsule. No myoepithelial cells were identified along the fibrovascular stalks. The neoplastic epithelial cells were arranged in micropapillary and cribriform structures. The tumor was composed of cells ranging from spindle-shaped to polygonal, with intermediate-grade nuclei. There were no densely cellular or solid nests of neoplastic cells. In some areas, tumor cells were also present in the cyst wall. Initially, the tumor was considered an encapsulated papillary carcinoma (EPC). However, more than 70% of the neoplastic cells were positive for synaptophysin and neuron-specific enolase (NSE), both markers of neuroendocrine differentiation. Therefore, the tumor was judged to represent a neuroendocrine neoplasm. Additional Alcian blue staining demonstrated a small amount of mucin in the extracellular space and lumens. Accordingly, the present case was diagnosed as a mucinous carcinoma (MC) of hypercellular type with neuroendocrine differentiation. To the best of our knowledge, a cystic MC of the breast exhibiting growth patterns of EPC has not been previously described.

Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm that commonly presents in the bone, lung, and liver. EHE can have a slow-growing, locally aggressive, or metastatic potential. EHE of the auricle is rare, with few reported cases. Various treatment strategies have been reported on, but due to the rarity of EHE, their effectiveness has yet to be established. Surgical resection is the most common form of treatment, and adjuvant chemotherapy and radiation therapy have been performed in select cases. This report presents a case of auricular EHE, highlighting diagnostic challenges and therapeutic considerations. It aims to demonstrate the potential utility of adjuvant radiotherapy in managing EHE following surgical resection.

Access to chimeric antigen receptor (CAR) T cell therapy remains limited in many developing countries. We conducted a single-arm, open-label, phase 1 trial (NCT05333302) at two Belarusian centers, evaluating an in-house manufactured CD19 CAR T cell product (BY19) in pediatric and adult patients with relapsed/refractory B cell malignancies. Lymphodepletion included fludarabine/cyclophosphamide, with or without decitabine. Twenty-three patients received therapy: seventeen B cell acute lymphoblastic leukemia, one chronic lymphocytic leukemia, and five non-Hodgkin lymphomas. Cytokine release syndrome (CRS) occurred in 67% of infusions, mostly grade 1-2, with severe CRS in 19%. Immune effector cell-associated neurotoxicity occurred in 44%, with severe cases in 18.5%. The overall response rate was 80% (16/20 evaluable), with complete remission achieved in 75% at day 28. Median progression-free survival (PFS) was 23 months; 12-month PFS was 83.3% in lymphoma and 48.3% in B cell acute lymphoblastic leukemia (B-ALL). Higher C_max levels tended to correlate with better response rates (p = 0.0416); however, no clear advantage in PFS was observed. BY19's safety and efficacy profiles were comparable to approved CD19 CAR T cell products. This study underscores the translational potential of localized CAR T cell manufacturing to expand global access to advanced immunotherapies, especially in middle-income countries. Decitabine-containing lymphodepletion showed potential benefit and warrants further study.

Background: Oral cancer represents a critical global health equity challenge, with over 80% of cases occurring in low- and middle-income countries (LMICs) and markedly lower survival rates in these regions compared to high-income countries (HICs). Objective: To examine oral cancer disparities in LMICs through a global health equity lens by analyzing prevention strategies, early detection programs, and treatment access barriers, with the aim of identifying evidence-based interventions to reduce these inequities. Methods: This comprehensive narrative review synthesized evidence from peer-reviewed literature (2020-2025), including systematic reviews and reports from international health organizations. We searched PubMed, Web of Science, and Scopus using terms related to oral cancer, global health disparities, LMICs, prevention, screening, and treatment access. Results: Oral cancer demonstrates profound global disparities. LMICs bear ~82% of the global disease burden yet achieve five-year survival rates of only 25-45%, compared to 65-85% in HICs. Key contributing disparities include the following: tobacco use remains high (LMICs account for 1.3 billion tobacco users) due to weak control programs. Limited human papillomavirus vaccination coverage is under 50% in most LMICs (vs. ~70-85% in HICs), and 70% of LMICs have no systematic oral cancer screening. In addition, 60-80% of oral cancer cases in LMICs present at advanced stages (vs. ~40-60% in HICs). They have severely limited access to surgery, radiotherapy, and chemotherapy (roughly 1 available service for every 5-10 needed). Conclusions: Addressing oral cancer disparities in LMICs requires comprehensive strategies, including strengthened tobacco control, cost-effective screening programs using innovative technologies, task shifting to expand the health-care workforce, and international partnerships to improve treatment infrastructure in resource-poor settings. These combined efforts are essential to close the outcome gap and achieve global health equity in oral cancer care.