Spinal tumors are neoplasms occurring in or around the spinal cord and can be classified based on tissue type and location within the spine. These lesions can lead to spinal cord compression and neurologic deficit. Low- and middle-income countries (LMICs) often face a significant burden of disease due to limited access to healthcare and advanced treatments. We investigate surgical and adjunctive therapies for spinal column tumors in LMICs.

A systematic search was completed to identify articles related to spinal tumors in LMICs. Data were extracted for study parameters and patient outcomes. Country-specific variables were collected for each country. A pooled meta-analysis was completed with this data.

Of 99 included articles, 67 provided data on gross total resection (GTR), while 39 articles reported use of adjunctive therapies. Since 1990, there has been an increase in the use of both treatments in LMICs; however, there were significant correlations between the use of adjunctive therapy, life expectancy, and access to healthcare.

While treatment and outcomes of spinal column tumors vary within the United States based on socioeconomic factors, including income and gender, this has not been studied on a global scale and in relation to accessibility of specific treatments in LMICs. In this study, we found that specific diagnoses and country income levels were significant drivers of GTR or adjunctive therapy rates. The poor accessibility of these treatments may be overcome with targeted investment, and this should be explored in future research.

To enhance the quality of organized mammographic screening in Italy, in accordance with national legislation, a multidisciplinary panel of experts applied the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)-ADOLOPMENT approach to adopt or adapt the European Commission Initiative on Breast Cancer (ECIBC) guidelines concerning the use of digital breast tomosynthesis (DBT). As prerequisite conditions for DBT adoption, the panel defines a full extension to women in the 45-74 age range, sufficient technical and professional resources, and an adequate monitoring system. The panel recommends the use of either DBT or digital mammography (DM) for asymptomatic women participating in organized screening programmes. However, it suggests prioritizing DBT in women with high mammographic breast density(classified as BI-RADS class c or d) when density has been previously assessed with DM. In the case of limited resources, priority in the implementation should be given to women with extremely dense breasts (BI-RADS class d). The use of DBT as an additional screening tool alongside DM is not recommended. These guidelines aim to provide a tailored approach for screening women with high mammographic breast density, improving detection while optimizing resource allocation in the context of organized screening. However, these recommendations also apply to the setting of spontaneous screening.

Mutations in RAS proto-oncogenes (NRAS, HRAS, KRAS) are common in thyroid nodules, though their prognostic significance remains unclear. This retrospective study analyzed 354 thyroid nodules from 346 patients (2018-2023) to investigate the clinical and pathological implications of isolated RAS mutations and RAS with co-occurring genetic alterations. Isolated RAS mutations were found in 41.0% (n = 145), while 54.8% (n = 194) had RAS with additional molecular alterations; NRAS was the most frequent subtype (62.1%). Among co-occurring mutations, EIF1AX (46.7%) and TERT (26.7%) were the most common, primarily in NRAS-positive cases. Surgical follow-up data from 302 cases revealed a malignancy rate of 52.3% (n = 158), with 60.1% (n = 95) being invasive encapsulated follicular variant of papillary thyroid carcinoma (IEFVPTC). NRAS mutations appeared in 64.6% of malignant cases. Isolated RAS mutations were mainly associated with benign/low-risk neoplasms (47.0%), notably follicular adenomas and encapsulated non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), or malignancies (41.0%). The malignancy rate was higher in nodules with a RAS mutation plus one concomitant molecular alteration (54.3%), and nearly 100% in those with three additional genetic alterations. Co-occurring genetic alterations with RAS mutations markedly increased the risk of malignancy compared with isolated RAS mutations (Fisher's exact test, two-tailed p = 0.0026) and were associated with more aggressive tumor phenotypes, whereas isolated RAS mutations were more common in indolent neoplasms. Comprehensive molecular profiling is essential for accurate risk stratification and management of indeterminate thyroid nodules.

Suspected abdominal neoplasms in children encompass a wide range of malignant and benign tumors originating from various abdominal organs and structures. Neoplasms often present with a palpable abdominal mass, which may be accompanied by other symptoms such as abdominal pain, distension, or systemic signs. However, not all palpable masses in children represent neoplasms, as they may also result from benign conditions such as constipation or hernias. Imaging plays a vital role in differentiating these conditions. The role of imaging is to characterize the mass, identify the organ of origin, assess the extent of disease, and guide treatment decisions. This document provides imaging guidelines for children presenting with three clinical scenarios: palpable abdominal mass with suspected neoplasm at initial imaging, palpable abdominal mass with suspected neoplasm following negative radiography, and palpable abdominal wall mass with suspected abdominal wall neoplasm at initial imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

CALR mutation is a key driver of myeloproliferative neoplasms (MPN) and has become a critical biomarker in clinical diagnostics and therapy. However, its function and mechanisms in solid tumors, particularly bladder cancer (BLCA), remain unclear. This study demonstrates that CALR expression is significantly elevated in BLCA, closely associated with poor patient prognosis, and serves as a critical factor promoting tumor progression. Further investigation reveals that the high expression of CALR stems from a novel positive feedback loop with HIF-1α in the tumor microenvironment: CALR stabilizes HIF-1α protein by von Hippel-Lindau (VHL), while HIF-1α transcriptionally upregulates CALR expression, thereby self-sustaining its high expression levels in BLCA. Mechanistically, CALR promotes the epithelial-mesenchymal transition (EMT) process by inducing intracellular reactive oxygen species (ROS) accumulation and activating the AKT signaling pathway, ultimately driving EMT-associated tumor progression. Finally, we identify the natural small-molecule compound-Sinapine as a direct inhibitor of CALR for the first time. Both in vitro and in vivo experiments confirmed that targeted inhibition of CALR effectively suppresses BLCA growth. This study not only elucidates the mechanism by which CALR maintains high expression through the CALR/HIF-1α positive feedback loop and promotes malignant progression in BLCA but also provides a theoretical foundation for its potential use as a prognostic biomarker and therapeutic target.

Hepatoid tumors are rare neoplasms that arise outside the liver but exhibit morphological and immunophenotypic features resembling hepatocellular carcinoma. Although hepatoid differentiation sometimes occurs in pancreatic ductal adenocarcinoma, its occurrence in solid pseudopapillary neoplasm (SPN) is exceedingly rare. Consequently, the clinicopathological characteristics and natural history of this variant remain poorly understood. We report a case of a 37-year-old asymptomatic male with a 6 mm solid pancreatic body lesion that was incidentally detected during routine abdominal ultrasonography. Multimodal imaging showed a well-circumscribed solid mass showing early-phase hyperenhancement relative to the surrounding pancreatic parenchyma. Tissue samples obtained via endoscopic ultrasonography contained polygonal epithelioid cells with abundant eosinophilic cytoplasm and a hepatoid appearance. In immunohistochemistry, HepPar-1 and CD10 were diffusely positive, chromogranin A and synaptophysin were absent, and β-catenin accumulated within the nucleus, all supporting a diagnosis of SPN with hepatoid differentiation. Although surgical resection was recommended, the patient declined and was subsequently managed with active surveillance. After 5 years of follow-up, the lesion remained morphologically stable without clinical progression. To our knowledge, this case report is the first to describe the long-term natural course of a pancreatic hepatoid SPN managed nonoperatively. The patient's maintained stability supports the indolent biological behavior of this rare variant. Thus, conservative management with close surveillance may be feasible for carefully selected patients with small, asymptomatic tumors. However, additional cases are needed to clarify optimal management strategies.

Persistent leukocytosis, massive splenomegaly, and eosinophilia are common manifestations in patients with myeloproliferative neoplasms (MPNs), particularly in those with chronic myeloid leukemia (CML). CML is characterized by the BCR::ABL fusion gene, typically associated with the t(9;22)(q34;q11) translocation. Herein, we report a case of myeloid neoplasm with a rare variant translocation, t(4;22)(q12;q11), involving the BCR::PDGFRA fusion gene and coexisting PDGFRA variants, accompanied by persistent leukocytosis, massive splenomegaly, and eosinophilia. Laboratory tests showed elevated white blood cell counts, with increased monocytes, neutrophils, and eosinophils. Bone marrow aspiration revealed a granulocytic-erythrocytic ratio of 189:1, marked granulocytic hyperplasia, and numerous immature granulocytes. Genetic testing confirmed an uncommon BCR::PDGFRA and coexisting PDGFRA mutations (c.1666G>A and c.1701A>G), confirming the diagnosis of myeloid neoplasm with BCR::PDGFRA rearrangement. Treatment with imatinib, a tyrosine kinase inhibitor, resulted in a continuous complete molecular response (CMR). To our knowledge, this is the first report to demonstrate the clinical and cytogenetic manifestations of BCR::PDGFRA positive myeloid neoplasm coexisting PDGFRA mutations. Furthermore, it emphasizes the effectiveness of targeted therapy and the significance of personalized management.

Primary pulmonary rhabdomyosarcoma(PPRMS) is an extremely rare neoplasm.Herin,we report a case of a 60-year-old male who presented with a one-week history of progressive chest tightness and non-radiating chest pain. Contrast-enhanced thoracic computed tomography (CT) demonstrated a large,11cm mass in the right inferior lung lobe. Intraoperative frozen-section analysis initially misclassified the lesion as a poorly differentiated carcinoma. The patient subsequently underwent thoracoscopic right lower lobectomy with systematic mediastinal lymph node dissection. Histological examination demonstrated sheets of uniformly sized epithelioid cells arranged in an organoid nesting growth pattern, with areas of geographic necrosis and no definitive morphological features indicative of rhabdomyoblastic differentiation. Immunohistochemical(IHC) staining confirmed diffuse positivity for skeletal muscle lineage markers(desmin, myogenin, MyoD1) in the tumor cells, thereby establishing a definitive diagnosis of rhabdomyosarcoma. Notably, this case showed diffuse expression of thyroid transcription factor 1 (TTF-1) using both the 8G7G3 and SPT24 clones, alongside immunoreactivity for neuroendocrine markers(CD56, PGP9.5) and focal expression of epithelial markers(AE1/AE3, CAM5.2), This immunophenotypic profile may mimic that of poorly differentiated neuroendocrine carcinoma, contributing to diagnostic confusion. The constellation of these unusual histological and immunophenotypic features presents a substantial diagnostic challenge. We herein elaborate on these findings to enhance clinical awareness and facilitate accurate diagnosis in future cases. To the best of our knowledge, To the best of our knowledge, this is the first reported case of epithelioid rhabdomyosarcoma demonstrating diffuse and strong nuclear TTF-1 immunoreactivity across two distinct antibody clones.

Solid-basaloid adenoid cystic carcinoma (SB-AdCC) of the breast is a rare neoplasm. We report the case of a 78-year-old woman who presented with a progressively enlarging right breast mass over 3 years. Clinical examination revealed a 6-cm mass with visible skin ulceration and right axillary lymphadenopathy. Imaging suggested malignancy, and biopsy showed a poorly differentiated tumor composed of basaloid cells arranged in solid nests with focal cribriform areas and necrosis. Immunohistochemically, the epithelial cells were positive for CD117 and CK7, whereas the myoepithelial component showed focal positivity for p63, CK5/6, and S100, and the tumor was negative for ER, PR, and HER2, with a Ki-67 index of approximately 40%. These findings supported a diagnosis of SB-AdCC of the breast with nodal metastasis. After multidisciplinary discussion, the patient underwent palliative mastectomy. At 12-month follow-up, local recurrence and bilateral axillary metastases were identified. This case emphasizes the diagnostic challenge of SB-AdCC, its overlap with basaloid carcinoma, and the importance of recognizing its distinct morphological and molecular features.

The role of metastasis-directed radiotherapy (MDRT) in oligometastatic cervical carcinoma (OCC) remains unclear. This study evaluated clinical outcomes of MDRT in patients with OCC and identified prognostic factors associated with survival.

Patients with OCC who received MDRT between 2019 and 2022 were retrospectively reviewed. Eligible patients had ≤ 5 metastatic lesions treated using stereotactic ablative radiotherapy (SABR), defined as radiotherapy delivered in ≤ 5 fractions with a fractional dose of ≥ 5 Gy. Oligometastatic disease was classified according to the ESTRO-EORTC consensus. Radiologic response, patterns of failure, progression-free survival (PFS), overall survival (OS), and treatment-related toxicities were analyzed.

A total of 83 patients with 114 temporally independent MDRT courses delivered using SABR were included. Repeat oligorecurrence was the most common oligometastatic subtype, observed in 35 patients. Lymph nodes were the most frequently treated sites (37 patients, 44.6%). Systemic therapy was administered either before and/or after MDRT in 54 patients (65.1%). With a median follow-up of 20 months, the local control rate was 60.8%, and disease progression predominantly occurred outside the treated fields. The 2-year PFS and OS rates were 14.5% and 62.9%, respectively. In multivariable analysis, oligometastatic disease classification and RT response were independently associated with OS. No grade 3 or higher treatment-related toxicities were observed.

MDRT using SABR achieved favorable outcomes with minimal toxicity in OCC. Oligometastatic disease classification may assist in selecting appropriate patients for MDRT under multidisciplinary approach. Prospective studies are warranted to validate these findings and to define optimal MDRT strategies.