Frontiers

Frontiers in Oncology

Published by Frontiers

Online ISSN: 2234-943X

Disciplines: Geriatrics and Gerontology

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(A) This picture shows the wound breakdown of a patient affected by vulvar cancer who underwent radical vulvectomy and was repaired by advancement flaps and primary closure. The dehiscence involved the anterior perineum, in the area above the urethra, with a huge dead space under the edges of the cutaneous defect. The area of the dead space was indicated by the white circle. (B) The DIEP flap harvested from the left abdominal area. The white arrow indicated the perforator of the deep inferior epigastric artery. (C) The defect after debridement and DIEP flap inset, with closure of both the cutaneous defect and the subcutaneous dead space. The scar from the donor site was visible in the left abdominal area. (D) 12 months post-operative result, showing uneventful healing of the flap edges and normal scarring. The patient underwent adjuvant radiation therapy with no problems in the area repaired by the DIEP flap.
(A) A 72-year-old lady affected by vulvar cancer was operated on for vulvectomy and bilateral groin dissection for cancer relapse after a previous excision and radiation therapy. The patient showed two wound dehiscences: one in the right inguinal area and one in the upper perineal area. The two defects were communicating through a subcutaneous tunnel in the right bridge area. Moreover, in the left inguinal area, a skin resection had been planned to radicalize the previous groin dissection after definitive histology. (B) An ALT flap was planned from the right thigh to simultaneously repair the right groin and the perineal defect. Two myocutaneous perforators (indicated by the black arrows) were included, arising from the descending branch of the lateral circumflex iliac artery (indicated by the yellow arrow). The motor nerve (white arrow) to the vastus lateralis muscle was completely spared. An ALT flap was also planned in the contralateral thigh to repair the left inguinal defect (C) Three-week post-operative result, after bilateral ALT flaps show normal healing of perineal and inguinal scars. (D) ALT donor sites, closed primarily 3 weeks after surgery.
(A) A 75-year-old patient showing a defect involving the upper perineum, mons pubis, and left groin after radical vulvectomy repaired by advancement flaps and wound breakdown. (B) An ALT flap planned on the left thigh with a 21 × 6 cm. skin paddle. The white arrow indicated the scar of the abdominal advancement flap, joined with the dehiscent incision for groin dissection, like an abdominoplasty scar. (C) The flap inset after debridement of the defect and secondary reconstruction.
(A) A 74-year-old patient underwent, 1 month before, a radical vulvectomy for vulvar cancer and was repaired by bilateral fasciocutaneous VY advancement flaps. Relevant dehiscence with a central defect was evident already 13 days after surgery. The upper edge of the defect showed huge dead space under the mons pubis. (B) Secondary reconstruction of the defect after debridement with VRAM flap harvested from the right abdominal area. The skin paddle repaired the perineal defect, while the rectus muscular belly filled the huge dead space in the mons pubis area. The postoperative course of this patient was uneventful, and she could begin radiotherapy after 60 days since the first procedure.
(A) Defect of the entire right perineal area, including the mons pubis and right groin, after extirpation of recurrent vulvar cancer. (B) ALT flap harvested on the right thigh with a 32 × 9 cm skin paddle. (C) ALT flap inset for secondary vulvo-perineal and right groin reconstruction. (D) A detail of the pedicle of the flap, made up of two perforators (indicated by white arrows) arising from the descending branch of the lateral circumflex iliac artery (indicated by the blue arrow). The motor nerve for the vastus lateralis muscle (black arrow) was completely spared. (E, F) Late postoperative results, showing uneventful wound healing.

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Secondary post-oncologic vulvar reconstruction – a simplified algorithm

June 2023

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1,839 Reads

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9 Citations

Anna Amelia Caretto

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Maria Servillo

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Aims and scope


Frontiers in Oncology is a broad-scope, multidisciplinary journal covering all areas of cancer research to advance our knowledge of cancer epidemiology to improve diagnosis, therapeutics and management strategies.

Led by Field Chief Editor Prof Giuseppe Giaccone (Cornell University, USA, and Amgen), and Assistant Field Chief Editor Prof Sharon Pine (University of Colorado, USA), Frontiers in Oncology welcomes clinical and experimental research contributions in the various domains of cancer research, which bridge the gap between basic research and clinical applications. Topics include, but are not limited to:

  • Breast Cancer
  • Cancer Cell Signaling
  • Cancer Epidemiology and Prevention
  • Cancer Genetics
  • Cancer Imaging and Image-directed Interventions
  • Cancer Immunity and Immunotherapy
  • Cancer Metabolism
  • Cancer Molecular Targets and Therapeutics
  • Cardio-oncology
  • Gastrointestinal Cancers
  • Genitourinary Oncology
  • Gynecological Oncology
  • Head and Neck Cancer
  • Hematologic Malignancies
  • Molecular and Cellular Oncology
  • Neuro-Oncology and Neurosurgical Oncology
  • Pediatric Oncology
  • Pharmacology of Anti-Cancer Drugs
  • Radiation Oncology
  • Skin Cancer
  • Surgical Oncology
  • Thoracic Oncology

Manuscripts consisting solely of bioinformatics, computational analysis, or predictions of public databases which are not accompanied by validation (independent clinical or patient cohort, or biological validation in vitro or in vivo, which are not based on public databases) are not suitable for publication in this journal.

Frontiers in Oncology is committed to advancing developments in the field of cancer research by allowing unrestricted access to articles, and communicating scientific knowledge to researchers and the public alike, to enable the scientific breakthroughs of the future.

Recent articles


TABLE 1 Continued
Patient characteristics in this study.
Multivariate logistic regression analysis of the risk factors screened by LASSO regression.
Predictive model for postoperative pneumonia in patients with esophageal cancer after esophagectomy
  • Article
  • Full-text available

February 2025

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Background Pneumonia is one of the most common complications after esophagectomy and a risk factor affecting postoperative survival of esophageal cancer. The aim of this study was to identify risk factors and construct a predictive model for postoperative pneumonia (POP) in esophageal cancer. Methods This retrospective cohort study included esophageal cancer patients who underwent therapeutic esophagectomy from June 2019 to December 2023. Least absolute shrinkage and selection operator (LASSO) regression was used to screen predictive factors for POP, and a nomogram was constructed based on the selected predictive factors after screening. The performance of the model was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). Results A total of 667 esophageal cancer patients who underwent esophagectomy were included, of whom 61 (9.1%) developed postoperative pneumonia. After LASSO regression analysis, factors independently associated with POP included mechanical ventilation for more than 2 days (P=0.000) and blood transfusion (P=0.003). A nomogram was constructed based on these independent risk factors. The AUC of the predictive model for POP was 0.839 (95%CI: 0.768-0.911). The internal verification result showed a good discriminative power and the DCA results demonstrated a good predictive value. Conclusion The predictive model constructed in this study can predict the risk of POP in patients with esophageal cancer, and may promote early intervention for high-risk patients by clinicians to reduce the incidence of POP.


FIGURE 1
Characteristics of 12 cases with hemolymphangioma of the pancreas.
Case report: An invasive and giant hemolymphangioma of the pancreas in a young man

Hemolymphangioma is a rare benign tumor, with only 12 reported cases in the pancreas as of May 2024. We present an invasive and giant hemolymphangioma of the pancreas in a young man who experienced abdominal pain and left epigastric distension for approximately 10 days. Imaging studies revealed a large cystic tumor located in the body and tail of the pancreas, which was compressing the partial lesser curvature of the stomach and spleen, displaying a “beaver tail” liver appearance on computed tomography scans. After surgery, he was diagnosed with hemolymphangioma of the pancreas, and there were no signs of recurrence upon follow-up. We conclude that diagnosing hemolymphangioma of the pancreas can be challenging. Whenever possible, radical surgical resection should be performed, and long-term follow-up is essential.


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Comparison of potentially curative therapies for sickle cell disease (20).
Beyond the traditional oncology patient: the role of palliative care in patients with sickle cell disease receiving stem cell transplantation or gene therapy

February 2025

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2 Reads

People with severe sickle cell disease (SCD) are now presented with increasing access to curative-intent therapies including allogeneic hematopoietic stem cell transplantation (HCT) and gene therapy (GT). These high-risk, high-reward therapies offer hope for cure and prevention of further injury due to SCD, but they are toxic therapies that carry risk of additional morbidity and mortality. People with severe SCD suffer due to extreme pain and serious multi-system injury which is compounded by the effects of systemic racism. The increasing availability of these complex, sometimes novel, therapies with curative-intent highlights the role for specialist palliative care (PC) in the care of people with severe SCD. Multidisciplinary PC teams employ a holistic, person-centered approach to alleviating suffering by accompanying patients through high-stakes decision making, coping with life-threatening illness, and symptom management. The role for PC beginning early in HCT has been established, though PC is infrequently integrated in HCT. Little research exists regarding the role for PC in care of people with SCD. We present concepts of PC integration for people with SCD undergoing HCT or GT and advocate for PC integration beginning once patients consider a curative-intent therapy throughout the duration and following completion of treatment. As curative-intent therapies for patients with SCD continue to evolve, there is an opportunity for PC, HCT, and SCD teams to collaborate with patients to develop implementable models for high-quality, multidisciplinary care for people with severe SCD and their families.


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Baseline characteristics.
Postoperative characteristics of the participants.
Univariate and multivariable cox regression analysis for overall survival.
Role of guanylate-binding protein 1 in the proliferation of invasive lung adenocarcinoma cells

February 2025

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Background Guanylate-binding protein 1 (GBP1) is involved in the malignant progression of lung adenocarcinoma, particularly in the acquisition of invasive potential. However, its role in tumor proliferation and therapeutic viability in invasive lung adenocarcinomas remains unclear. Methods This study included 99 patients with invasive lung adenocarcinoma, excluding those with non-invasive lepidic components, who had undergone complete pulmonary resection. Immunohistochemical staining was performed to examine the presence of GBP1, and its prognostic significance was assessed using uni- and multi-variable Cox regression analyses. Additionally, the expression levels of GBP1 gene and protein levels were evaluated in lung adenocarcinoma cell lines (PC-9, A549, NCI-H322, NCI-H441, NCI-H820, and ABC-1), and its proliferative role in these cell lines was analyzed using specific inhibitors targeting GBP1. Results GBP1 expression was detected in 45 (45.5%) patients. The 5-year overall survival rates for GBP1-positive and -negative patients were 66.0% (95% confidence interval (CI): 46.3–80.0%) and 85.7% (95% CI: 72.0–93.0%), respectively (P = 0.029). The multivariable analysis demonstrated that GBP1 positivity was an independent factor for poor overall survival (hazard ratio [HR] = 2.52 [95% CI: 1.02–6.22], P = 0.045). GBP1 gene and protein were markedly expressed in NCI-H820 than in NCI-H322 and ABC-1. The inhibitor targeting GBP1 significantly suppressed the growth of NCI-H820 but not that of NCI-H322 or ABC-1. Conclusions GBP1 is a prognostic factor that may be involved in the proliferation of invasive lung adenocarcinoma, suggesting that inhibiting GBP1 activity may be a promising therapeutic approach for lung adenocarcinoma patients expressing GBP1.


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The association between NPS and anemia in cancer survivors.
Cox regression analysis for all-cause and cause-specific mortality among cancer patients according to NPS.
Association of Naples Prognostic Score with anemia in cancer survivors: a study based on NHANES database

Background Anemia is a prevalent issue among cancer survivors, which greatly affects their quality of life and overall prognosis. The Naples Prognostic Score (NPS), an inflammation-based prognostic tool, is increasingly acknowledged for its potential in predicting clinical outcomes. This study aims to assess the correlation between anemia status, prognosis, and NPS in cancer survivors. Methods This study utilized data from the National Health and Nutrition Examination Survey (NHANES) database spanning from 2003 to 2018, along with death data from the National Death Index (NDI) up to December 31, 2019. A total of 80,312 participants were included, of whom 4,260 were identified as cancer survivors. After applying rigorous exclusion criteria for missing variables, 3,143 participants were retained in the final analysis. NPS was calculated using serum albumin (ALB), total cholesterol (TC), neutrophil to lymphocyte ratio (NLR), and lymphocyte to monocyte ratio (LMR). After adjusting relevant confounding factors, weighted univariable and multivariable logistic regression were utilized to calculate the odds ratios (OR) and 95% confidence intervals (CI). Kaplan-Meier (KM) curves and Log-rank test were employed to compare survival differences among the three patient groups, while Cox proportional regression was utilized to estimate hazard ratio (HR) and 95% CI. Additionally, subgroup analyses were performed to assess the consistency of the outcomes. Results Univariable and multivariable analyses indicated positive correlation between NPS and anemia in cancer survivors ( P < 0.05). When NPS was treated as continuous variable, crude model showed that higher NPS scores were linked to higher likelihood of anemia in cancer survivors (OR: 1.77, 95% CI: 1.55 - 2.02; P < 0.001), and this association remained significant even after adjusting for all confounding variables (OR: 1.66, 95% CI: 1.45 - 1.90; P < 0.001). Moreover, with Q1 (score = 0) as the reference category, the analysis demonstrated positive association between NPS and the prevalence of anemia in cancer survivors, regardless of whether the model was crude or fully adjusted ( P < 0.001). KM analysis indicated that the decline in overall survival from all causes and other causes was significantly more pronounced among anemic cancer survivors in the Q3 (score = 3 or 4) group ( P < 0.05). After accounting for all confounding factors, individuals with the highest NPS had HR of 2.46 (95% CI: 1.81 - 3.34) for all-cause mortality. However, there were no significant differences in mortality trends related to cardiovascular or cancer causes ( P > 0.05). Subgroup analyses and sensitivity analysis revealed no statistically significant interactions ( P for interaction < 0.05). Conclusions The study highlights the correlation between higher NPS and an increased prevalence of anemia in cancer survivors, indicating that NPS may serve as a valuable tool for assessing the prognosis of cancer survivors in clinical practice and for guiding interventions aimed at mitigating anemia-related complications.


FIGURE 1
FIGURE 2 Postoperative specimen findings and pathological results of the patient. (A, B) Intraoperative specimen and profile (yellow arrow indicates breast skin, blue coil indicates breast mass); (C, D) Stained bands and the hyperstained bands were arranged alternately, and the light-stained areas were spindled to polymorphic histiocytes with large volumes and varying numbers of lymphocytes and plasma cells in the cytoplasm. The arrows showed the protrusion phenomenon [original magnification of H & E: (C) × 40, scale bar = 200mm; (D) × 400, scale bar = 20mm]; (E, F) Immunohistochemistry showed positive CD68 (IHC: × 100, scale bar = 100mm) and partial positive S100 expression (IHC: × 100, scale bar = 200mm).
A case report of breast Rosai-Dorfman disease and a literature review

February 2025

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Rosai-Dorfman disease (RDD) is a rare idiopathic histiocytoproliferative disease that usually affects the lymph nodes of the head and neck, but can also involve extranodal sites such as the skin, sinuses, and soft tissues. Breast RDD is exceedingly rare. It may be clinically and radiographically similar to neoplastic and non-neoplastic diseases. We report a case of breast RDD in a 68-year-old female patient and describe the clinical imaging and pathological features of the patient. The management of extranodal RDD is individualized, and there are no standardized guidelines for treatment. We highlight the importance of considering the diagnosis of extranodal breast RDD, and suggest that surgical resection is an effective way to treat this disease, particularly for single-focal breast lesions with RDD.


FIGURE 1 FDG PET/CT with treatment response to imatinib. (A) At diagnosis, FDG PET/CT imaging demonstrated a large right renal tumor with peripheral enhancement and necrosis. (B) After treatment initiation, while tumor size is comparably similar, peripheral avidity has decreased, consistent with overall treatment response.
FIGURE 2 (A) Microscopic examination reveals a neoplastic proliferation of spindle cells arranged in fascicles and in a myxoid background, with mitotic figures (arrow, hematoxylin and eosin stain, 200× magnification). The tumor cells are negative for (B) PAX8 while diffusely and strongly positive for (C) CD117 and (D) DOG1 (200×).
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FIGURE 4
Case report: Clinical and molecular features of renal gastrointestinal tumor

February 2025

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1 Read

While gastrointestinal stromal tumors (GISTs) often arise within the GI tract, it is well known that GISTs may also rarely emanate outside of the digestive system. Prior case reports have documented various primary sites in non-GI organs [extra-intestinal GIST (EGIST)], yet only one report has described a localized GIST of renal origin. Here, we describe a patient who presented with bilateral renal masses who was found to have a large unresectable renal GIST tumor treated with imatinib. We discuss treatment experience and response with systemic therapy and describe molecular data to contextualize this ultra-rare presentation within the landscape of EGIST tumors.


FIGURE 3
FIGURE 4 Presentation of postoperative pathological results. (A) Microscopic images of postoperative tissue sections of the left thyroid nodule, with 100X, 200X conventional staining and 200X congo red staining, respectively. (B) Microscopic images of postoperative tissue sections of the right thyroid nodule, with 100X and 200X conventional staining, respectively. (C) Immunohistochemical marker images under a 200X microscope are Calcitonin, CEA, CgA, Syn, and TG.
Diagnosis and treatment of a rare bilateral primary thyroid cancer: a case report

February 2025

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9 Reads

Preoperative ultrasound examination of thyroid nodules is the most economical and effective screening method for diagnosing thyroid nodules. Fine-needle aspiration biopsy (FNAB) cytology guided by ultrasound has high sensitivity and specificity in distinguishing benign and malignant thyroid nodules. However, approximately 25% of thyroid nodules cannot be determined by FNAB, and accurate differentiation of benign and malignant thyroid nodules is critical for patient prognosis. Here, we report the diagnosis and surgical treatment process of a rare patient with bilateral thyroid malignant tumor of independent origin. This patient had significantly elevated levels of calcitonin (Ctn: 130.00 pg/mL) and carcinoembryonic antigen (CEA: 16.13 ng/mL). Ultrasound shows a solid nodule on the left side of the thyroid gland, measuring 1.2*0.8*0.9cm, TI-RADS 4A; right solid nodule, 1.3*0.7*0.9 cm, TI-RADS 3. A fine needle biopsy of the left nodule showed little glandular epithelium and no evidence of malignancy. Multi-gene joint analysis of RET C634R in the left nodule and BRAF V600E in the right nodule indicated a potential diagnosis of left medullary thyroid carcinoma (MTC) and right papillary thyroid carcinoma (PTC). Postoperative pathology revealed the left thyroid nodule was MTC and the right nodule was PTC. The patient’s bilateral thyroid nodules are independent primary malignant lesions. This case emphasizes the important significance of combined analysis of ultrasound, serum biomarkers, cellular pathology, molecular detection, and paraffin pathology in the differential diagnosis of benign and malignant multiple thyroid nodules. It provides a reference for future diagnosis and treatment decisions of multiple thyroid nodules.


FIGURE 1
Characteristics of the study patients (n=1074).
Univariate analysis.
The relationship between lateral cervical lymph node positivity rate and recurrence after comprehensive treatment in differentiated thyroid carcinoma: a single-center retrospective cohort study from China

February 2025

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2 Reads

Introduction The lateral cervical lymph node positivity rate has been hypothesized to correlate with the recurrence risk in differentiated thyroid carcinoma (DTC) patients. However, the extent of this association within the Chinese population remains understudied. This study seeks to elucidate the potential causal link between the lymph node positivity rate and DTC recurrence. Methods We conducted a retrospective cohort study, examining clinical records of 4,731 DTC patients who received surgical treatment at the First Medical Center of the General Hospital of the Chinese People’s Liberation Army from January 2015 to May 2020. The study variables encompassed demographic and clinical characteristics, including sex, age, tumor size, location, laterality, capsular invasion, lymph node metastasis counts, lymph node positivity rates, histological subtypes, Hashimoto’s thyroiditis co-occurrence, and the timing of iodine-131 therapy post-surgery. After applying strict inclusion criteria, 1,074 patients were selected for analysis. Recurrence was defined as structural incomplete response (SIR), confirmed by imaging or histological means. The lymph node positivity rate was calculated as the proportion of positive lymph nodes to the total lymph node count. Results Multivariate analysis revealed a nonlinear association between the lateral cervical lymph node positivity rate and post-treatment recurrence, with a significant threshold at 0.5. The recurrence risk was substantially elevated with a positivity rate below this threshold (HR: 27.48, 95% CI: 7.21–104.70, P<0.0001), while no significant association was observed above it (HR: 0.17, 95% CI: 0.02–1.57, P=0.119). Subgroup analysis within the high-risk cohort did not yield a significant association between the positivity rate and recurrence risk (HR=0.43, 95% CI: 0.10–1.79, P=0.246). Discussion In conclusion, this study identifies a nonlinear relationship between the lateral cervical lymph node positivity rate and the risk of DTC recurrence post-treatment. A positivity rate of less than 0.5 is positively associated with recurrence, while this association diminishes in significance among high-risk patients. This differs from the results previously reported. Further studies are needed to determine the potential mechanisms of the associations observed in observational studies.


Research trends and hotspots evolution of artificial intelligence for cholangiocarcinoma over the past 10 years: a bibliometric analysis

February 2025

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5 Reads

Objective To analyze the research hotspots and potential of Artificial Intelligence (AI) in cholangiocarcinoma (CCA) through visualization. Methods A comprehensive search of publications on the application of AI in CCA from January 1, 2014, to December 31, 2023, within the Web of Science Core Collection, was conducted, and citation information was extracted. CiteSpace 6.2.R6 was used for the visualization analysis of citation information. Results A total of 736 publications were included in this study. Early research primarily focused on traditional treatment methods and care strategies for CCA, but since 2019, there has been a significant shift towards the development and optimization of AI algorithms and their application in early cancer diagnosis and treatment decision-making. China emerged as the country with the highest volume of publications, while Khon Kaen University in Thailand was the academic institution with the highest number of publications. A core group of authors involved in a dense network of international collaboration was identified. HEPATOLOGY was found to be the most influential journal in the field. The disciplinary development pattern in this domain exhibits the characteristic of multiple disciplines intersecting and integrating. Conclusion The current research hotspots primarily revolve around three directions: AI in the diagnosis and classification of CCA, AI in the preoperative assessment of cancer metastasis risk in CCA, and AI in the prediction of postoperative recurrence in CCA. The complementarity and interdependence among different AI applications will facilitate future applications of AI in the CCA field.


FIGURE 1
FIGURE 2 The distinct features of multiple tumors. (A) The gross feature showed a barrel-shaped cervix. (B) GEA was composed of variable shapes and sizes of glands (HE: ×16). (C) The tumor cells had prominent eosinophilic cytoplasm, hyperchromatic and enlarged nuclei, localized necrosis, and goblet cell development in certain regions (HE: ×200). (D) Positive staining for HER2 by immunohistochemistry (IHC: ×100). (E) P53 staining (IHC: ×100). (F) AB-PAS staining showed pink−red (×200). (G) Cytology test results (HE: ×400). (H) SCVM was under normal glands (HE: ×50). (I) Small to medium-sized vascular proliferation with hyaline degeneration (HE: ×100). (J) Focal positivity of Desmin staining (IHC: ×100). (K) Diffuse positivity of CD34 staining (IHC: ×200). (L) The positive index of PR was approximately 30% (IHC: ×100). (M) SCTAT in bilateral ovaries (HE: ×100). (N) HSIL of the vagina (IHC: ×200). (O) Diffuse positive immunoreaction of p16 in HSIL (IHC: ×100). (P) HPV DNA detection results. The upper panel displays the negative GEA results; the lower panel displays the HPV-18 infection of HSIL. GEA: A-G; SMFGT: H-L.
FIGURE 3 Fluorescence in situ hybridization (FISH) results. (A) HER2 amplification. (B) The 1 red signal represents the heterozygous deletion; the 0 red signals suggest the homozygous deletion of RB1. (C) HMGA2 rearrangement was negative.
FIGURE 4 Somatic mutation of GEA. (A) The proportion of base substitutions in somatic mutations. (B) The network interaction of the main somatic mutation genes. (C) Oncoprint for the genomic mutation profile. (D) Circos plot of somatic mutations displaying the mutation frequencies, distributions, and CNV results. From the outside to the inside: the first circle represents the genome karyotype (24 chromosomes and the corresponding number); the second circle represents somatic CNV; the third circle represents LOH; the fourth circle represents somatic mutation SNV; and the last circle represents somatic mutation Indel. The red histogram column indicates mutations with functional effects, including stop gain, nonsynonymous, and frameshift effects; the blue histogram column indicates mutations without functional effects. The mutation frequencies are represented by the height of the column.
Gastric-type endocervical adenocarcinoma, superficial myofibroblastoma, sex cord-stromal tumors, and HSIL in Peutz−Jeghers syndrome: a rare case report, genetic characterization, and review of literature

February 2025

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2 Reads

Peutz-Jeghers syndrome (PJS) is characterized by an increased risk of gynecologic tumors. Gastric-type endocervical adenocarcinoma (GEA) is a rare non-human papillomavirus (HPV)-related tumor. We reported an uncommon case of a 39-year-old woman with PJS who developed GEA, superficial cervical vaginal myofibroblastoma, sex cord-stromal tumors with annular tubules of the ovaries, and cervical and vaginal high-grade squamous interepithelial neoplasia (HSIL). Before being verified GEA, the patient had been experiencing suspicious symptoms for over 9 years, with nabothian cysts and vaginitis being misdiagnosed. HSIL displayed widespread p16 immunostaining, and HPV DNA screening confirmed HPV-18 infection, although GEA was negative. Further, we verified TP53 mutation and HER2 amplification of GEA by fluorescence in situ hybridization (FISH). TP53 was the most commonly mutated gene. The therapy with the anti-HER2 antibody trastuzumab was suggested based on HER2 amplification. We also analyzed the somatic mutations of GEA by whole genome sequencing (WES). There were 157 single nucleotide variations (SNVs) and 215 indels, with all of them being heterozygotes. Nonsynonymous and frameshift insertions were the most common kinds of mutations. The germine STK11 gene mutation was found, which may play an important role in tumor development. According to gene function enrichment analyses, the genomic changes primarily implicated general transcription or expression pathways and cell cycle pathways. In addition, the JAK2/STAT3 pathway could be a major focus of targeted therapy for GEA patients with PJS. Our findings show that the patient with PJS can have a variety of unusual gynecologic tumors. Patients with PJS must have routine gynecological, ultrasonographic, and cytological examinations to detect precursor or early-stage lesions. The patient’s abnormal symptoms must be treated early with caution. A comprehensive genomic study reveals the potential causative genetic factors, therapeutic targets, and chemotherapy resistance of GEA. Further research will focus on the main driving genes, molecular mechanisms, and molecular target therapy in more patients.


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TABLE 1 Continued
Solitary plasmacytoma of the genitourinary tract-review of the literature.
Radiotherapy as a primary treatment modality for a young man with a primary urethral plasmacytoma: case report and literature review

February 2025

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5 Reads

Primary urethral plasmacytoma is an extremely rare form of solitary plasmacytoma, with only 10 cases reported in the literature. It involves localized clonal proliferation of plasma cells without systemic disease. This report presents a 29-year-old man with acute urinary retention and a urethral mass, confirmed as solitary plasmacytoma. The patient was treated with 45 Gy of local radiotherapy, resulting in complete tumor resolution without recurrence or progression at a 2-year follow-up. Given its rarity, treatment strategies for primary urethral plasmacytoma are not well-defined. Radiotherapy is preferred over surgery in young patients due to the radiosensitivity of plasma cell tumors and its ability to preserve sexual and urinary function. A review of previous cases treated with radiotherapy alone, using doses of 40–50 Gy, showed favorable outcomes with no recurrences reported over follow-up periods ranging from 6 months to 12 years. Only one patient experienced minor long-term complications. This report highlights the effectiveness of radiotherapy as a primary modality for managing primary urethral plasmacytoma, offering excellent local control while preserving organ function. Individualized treatment plans should consider patient age, fertility concerns, and tumor characteristics. Further research is necessary to optimize treatment protocols and long-term surveillance strategies due to the potential risk of recurrence or progression to multiple myeloma.


FIGURE 1
Basic characteristics and quality evaluation.
Adverse events of HAIC-L-P group vs L-P group.
Enhanced antitumor activity of combined hepatic arterial infusion chemotherapy with Lenvatinib and PD-1 inhibitors in unresectable hepatocellular carcinoma: a meta-analysis

February 2025

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Background Hepatic arterial infusion chemotherapy (HAIC) is increasingly recognized as a primary treatment option for patients with unresectable hepatocellular carcinoma (uHCC), providing a focused treatment for localized tumors. The combination of lenvatinib, a multikinase inhibitor, with PD-1 inhibitors has demonstrated significant survival benefits in HCC. This meta-analysis aims to assess whether the integration of HAIC with lenvatinib and PD-1 inhibitors (referred to as the HAIC-L-P group) leads to better treatment effectiveness and security compared to lenvatinib and PD-1 inhibitors alone (L-P group) in uHCC. Methods An exhaustive search of the literature was conducted, including PubMed, the Cochrane Library, Embase, ClinicalTrials.gov, and Web of Science, from the start of each database until September 2024, to ensure a thorough and up-to-date compilation of relevant studies. Extract data on outcome measures such as overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). Subsequently, meta-analyses were performed using RevMan 5.4 to quantitatively evaluate the aggregated effect of the HAIC-L-P regimen versus the L-P regimen alone. Results In our systematic meta-analysis of eight retrospective cohort studies, the HAIC-L-P regimen demonstrated markedly enhanced OS, with an HR of 0.54 (95% CI: 0.45-0.64; p < 0.00001), and enhanced 1-year and 2-year OS rates. Superior PFS was also observed in the HAIC-L-P group, with an HR of 0.64 (95% CI: 0.55-0.75; p < 0.0001), and higher 1-year and 2-year PFS rates. Response rates were markedly higher in the HAIC-L-P group, with an ORR risk ratio of 2.15 (95% CI: 1.84-2.50; p < 0.00001) and a DCR risk ratio of 1.28 (95% CI: 1.20-1.43; p < 0.0001). The AEs classified as grade 3 or above were elevated in the HAIC-L-P group, with notable risk ratios for vomiting, elevated AST, elevated ALT, thrombocytopenia, neutropenia, and hyperbilirubinemia. No life-threatening AEs were reported. Conclusion The HAIC-L-P regimen correlated with enhanced tumor responses and prolonged survival, alongside manageable adverse effects, indicating its potential as a viable therapeutic strategy for individuals afflicted with uHCC. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42024594109.


Clinicopathologic characteristics of the study population.
Univariate analyses for postoperative complication.
Univariate and multivariate analyses for progression-free survival.
Summary of neoadjuvant radiotherapy in two cases of vulvar EMPD.
The impact of radiotherapy on disease control in vulvar extramammary Paget’s disease: a retrospective study from a single institution

February 2025

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Objective Vulvar extramammary Paget’s disease (EMPD) is a rare intraepithelial carcinoma that affects apocrine gland-bearing skin, predominantly in postmenopausal women. Due to its rarity, optimal treatment strategies, including the role of radiotherapy (RT), remain poorly established. This study aimed to evaluate the role of radiation therapy in vulvar EMPD, focusing on preserving functional and aesthetic vulvar tissue without compromising survival rates. Materials and methods We conducted a retrospective cohort study of 32 patients diagnosed with vulvar EMPD at Seoul National University Hospital between 2000 and 2024. Clinicopathologic data, including demographics characteristics, clinical presentations, histopathological findings, treatment modalities, and outcomes, were collected. Patients were divided into two groups: those who received neoadjuvant or adjuvant RT ( n = 9) and those who did not ( n = 21). Univariate and multivariate analyses were performed to assess factors related to recurrence and progression-free survival (PFS). Result The median age at diagnosis was 63.8 years (range: 38.0–87.8), with 84.4% of patients being postmenopausal. Among the 32 patients, 30 (93.8%) underwent surgery, and nine (28.1%) received adjuvant RT. Recurrence rates were similar between the RT (66.7%) and non-RT (66.7%) groups. The median PFS was longer in the RT group (28.1 months) compared to the non-RT group (23.4 months), although this difference was not statistically significant ( p = 0.395). Univariate and multivariate analyses identified age ≥ 60 years as a borderline predictor of poorer PFS ( p = 0.053), while no significant associations were found between RT and postoperative complications or recurrence risk. Conclusion In conclusion, although RT did not show a statistically significant survival benefit, both our data and previous studies strongly suggest that RT holds potential for disease control. It may be the primary treatment before and after surgery in patients with extensive vulvar EMPD.


FIGURE 2 Chemoradiotherapy-induced alterations in 34 patients with circulating high CD8 + T cells. The proportion of circulating CD8 + T cells (A), CD3 + T cells (B), CD4 + /CD8 + ratio (C), and CD4 + T cells (D) after chemoradiotherapy. (E) The proportion of CD4 + T cells were low in 26 cases (normal range, 21.0-46.0%). (F) The proportion of CD4 + T cells were normal in 8 cases (normal range, 21.0-46.0%). Post-CRT 1M represented the values at one month after chemoradiotherapy. **p < 0.01; ***p < 0.001.
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Clinical characteristics of 91 patients with non-metastatic nasopharyngeal carcinoma.
Correlation between lymphocyte subsets alterations and clinical characteristics.
Effect of chemoradiotherapy on the dynamics of circulating lymphocyte subsets in patients with non-metastatic nasopharyngeal carcinoma

Background Chemoradiotherapy (CRT) is the primary and most effective treatment for non-metastatic nasopharyngeal carcinoma (NPC), exerting antitumor effects by modulating immune cells. Distinct subpopulations of immune cells exhibit specific sensitivity to CRT. This study aimed to characterize the dynamics of the proportions and absolute counts of peripheral circulating lymphocyte subsets in non-metastatic NPC before and after CRT, and to elucidate their association with clinical responses. Methods A total of 91 patients with non-metastatic NPC were enrolled. Flow cytometry was employed to detect the expression of CD3, CD4, CD8, CD56, and CD19 on peripheral blood cells. The composition of lymphocyte subsets before treatment, post-completion of CRT, and one month following CRT was retrospectively analyzed. Further, the relationship between the composition of circulating lymphocyte subpopulations and distinguish clinical responses was evaluated. Results The proportion of CD3 ⁺ T cells showed an initial increase followed by a significant decrease at baseline, post-completion of CRT, and one month following CRT. The proportions of CD3 ⁺ CD4 ⁺ T cells, CD4 ⁺ /CD8 ⁺ ratio, and CD19 ⁺ B cells continued to decline at baseline, post-completion of CRT, and one month following CRT, while the proportions of CD3 ⁺ CD8 ⁺ T cells and CD16 ⁺ CD56 ⁺ NK cells progressively increased. The absolute counts of circulating lymphocyte subsets, including CD3 ⁺ T cells, CD3 ⁺ CD4 ⁺ T cells, CD3 ⁺ CD8 ⁺ T cells, CD45 ⁺ , CD19 ⁺ B cells, and CD16 ⁺ CD56 ⁺ NK cells, demonstrated a trend of initial decrease followed by an increase at baseline, post-completion of CRT, and one month following CRT. Patients with complete response (CR) and partial response (PR) presented similar dynamic trends in the percentages and absolute counts of circulating lymphocyte subpopulations at baseline, post-completion of CRT, and one month following CRT. The proportions and absolute counts of CD3 ⁺ CD4 ⁺ T cells in CR patients were distinctly higher than those in PR patients at the end of CRT, whereas the absolute counts of CD16 ⁺ CD56 ⁺ NK cells were remarkably lower in CR patients compared to PR patients. The baseline proportion and absolute count of CD19 ⁺ B cells, as well as the absolute count of CD3 ⁺ CD4 ⁺ T cells, were significantly higher in CR patients compared with PR patients. Conclusion CRT induced dynamic alterations in the peripheral lymphocyte profile of non-metastatic NPC patients. Assessing the variations in the distribution of circulating lymphocyte subsets among patients with different clinical treatment responses will be helpful in developing protocols for the concurrent utilization of immunotherapeutic drugs and CRT.



FIGURE 2 Pathological results of two cases: [(A) Case 1; (B) Case 2].
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Basic characteristics of our 2 reported cases.
Two rare cases of primary clear cell adenocarcinoma of the urethra: clinical experience, case report and literature review

Background Primary clear cell adenocarcinoma of the urethra (CCAU) is a kind of extremely rare genitourinary cancer. Despite the similarity in the clinical manifestations of these reported cases, diagnosis and determination of standard therapy remain challenging due to the rarity of findings and similarity with other urethral tumors. Case presentation Herein, we reported two cases of CCAU with the same chief complaint of hematuria: a 71-year-old female and a 66-year-old male. The male patient reported concomitant symptoms of frequent and painful urination. CT scans show abnormal enhancements. After a cystoscopy examination, both patients are diagnosed with malignant urethral tumors. Surgical resections and additional pathological examinations support the diagnosis of CCAU (palliative resection for case 1 and transurethral resection for case 2). Case 1 undergone progression 6 months after initial treatment with transurethral resection and chemotherapy with a 15-month overall survival. In contrast, the prognosis of case 2 remained uneventful 10 months after surgery without recurrence. After presenting our cases, we launched a literature review that included 23 articles and 33 cases of CCAU to summarize the characteristics of the disease. Conclusion Primary clear cell adenocarcinoma of the urethra is a rare malignant urethral tumor with controversial histological origins. Primary symptoms include hematuria and changes in voiding habits. Middle-aged and elderly females are more susceptible to primary clear-cell adenocarcinoma of the urethra. Unfortunately, it is difficult to differentiate primary clear-cell adenocarcinoma of the urethra from other urethral tumors due to similar clinical features. However, imaging tools such as CT, MRI, and cystoscopy are adjunctive in confirming diagnoses. Even though surgical resection is the primary treatment to relieve clinical symptoms, prevent recurrence, and confirm diagnosis, no standard surgical protocol is available. The therapeutic effect of postoperative adjuvant therapies remains unclear. Future investigations on CCAU are necessary to advance clinical knowledge and to provide treatment guidance.



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FIGURE 2 CD44 and ESRP1. (A) CD44 gene structure and its related isoform structure diagram. Reproduced with authorization (26) (2021). Federation of European Biochemical Societies. (B) Protein structure of CD44 Isoforms. Reproduced with authorization (26) (2021). Federation of European Biochemical Societies. (C) The interaction between CD44 and ESRP1. Reproduced with authorization (27). Chen et al., Journal of Hematology & Oncology (2018) 11:64. Modified color and shape. https://creativecommons.org/licenses/by/4.0/.
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The role of ESRP1 in solid tumor development through the regulation of CD44 splicing and EMT processes

February 2025

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4 Reads

According to the World Health Organization’s statistics, cancer is the second leading cause of death worldwide, following cardiovascular diseases. Despite significant progress in the field of cancer treatment in recent years, cancer remains one of the main factors shortening human life expectancy. The field of cancer research is increasingly focusing on the role of tumor-related oncogenes and heterogeneous proteins in the development of cancer. Studies indicate that there is a close connection between solid tumors and epithelial splicing regulatory protein 1 (ESRP1). ESRP1 is a key intracellular molecule that plays a crucial role in cell growth and differentiation. As an emerging biomarker, ESRP1 has a decisive impact on the formation and development of solid tumors by regulating the alternative splicing of CD44 and the epithelial-mesenchymal transition (EMT) process. Research shows that abnormal expression of ESRP1 is closely related to the formation and development of various solid tumors, including breast cancer, lung cancer, stomach cancer, and others, and is closely associated with the invasiveness, metastasis, and poor prognosis of tumors. Therefore, given ESRP1’s critical role in cancer development, it is gradually becoming a potential biomarker and therapeutic target. This review primarily discusses the molecular mechanisms of ESRP1 in regulating cancer metastasis, particularly its regulatory effects on CD44 splicing and the EMT process. These research findings provide new targets for cancer treatment, aiming to bring more precise diagnosis and more effective treatment strategies to patients.


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Aortic intimal sarcoma with abdominal metastasis: case report and management approach

February 2025

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2 Reads

Background Aortic intimal sarcoma is an exceptionally rare malignancy with a poor prognosis. Tumors are predominantly located in the abdominal aorta, thoracic aorta, and thoracoabdominal aorta. Abdominal metastasis of aortic sarcoma is rarely documented, and effective treatment regimens are lacking. Case presentation A 55-year-old female presented with recurrent abdominal pain and a history of hypertension and mesenteric thrombosis. Initial arterial computed tomography angiography (CTA) revealed multiple thrombi with significant luminal narrowing, leading to a diagnosis of aortic thrombosis. She was referred to the First Affiliated Hospital of Zhejiang University for surgical intervention. Pathological analysis confirmed a diagnosis of aortic intimal sarcoma with MDM2 positivity. One month later, the patient developed severe abdominal pain, and positron emission tomography-computed tomography (PET-CT) showed accumulation in the small intestine, jejunum, and back muscles. Palliative tumor removal was performed, and the patient received chemotherapy with platinum drugs and epirubicin. Post-treatment PET-CT indicated no significant tumor staining or progression. Discussion Aortic intimal sarcoma is a rare neoplasm with limited treatment options. MDM2 overexpression is commonly observed, but similar histological features can appear in other conditions, making diagnosis challenging. Imaging modalities, including MRI and PET-CT, are crucial for diagnosis and monitoring. Current treatment strategies are non-standardized, but small-molecule inhibitors targeting MDM2 show promise. This case highlights the potential effectiveness of combined surgical and chemotherapeutic approaches for managing abdominal metastasis of aortic intimal sarcoma and provides a foundation for future clinical trials.


FIGURE 1 Expression of AT1PB3 varies by glioma grade. (A) Analysis of the CGGA database ATP1B3 expression is positively correlated with glioma grade (P<0.001). (B) U87MG and U251MG had considerably greater levels of ATP1B3 expression than HMC3 **P<0.01 and *P<0.05, respectively. (C) Analysis via immunohistochemistry. On a scale of 50 mm, grade 2 is yellowish +, grade 3 is yellowish brown ++, and grade 4 is brown +++. (D) Patients with high ATP1B3 expression had a considerably lower productivity than those with low expression, with a P-value of less than 0.001.
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ATP1B3 may promote glioma proliferation and migration through MAPK/NF-KB signaling pathway

February 2025

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2 Reads

Objective To investigate the function of ATPase Na+/K+ Transporting Subunit Beta 3 (ATP1B3) in gliomas and the molecular mechanisms associated with them in order to identify a novel target and approach for glioma clinical diagnosis and treatment. Methods The Cancer Genome Atlas (TCGA), a public tumor database, and the Chinese Glioma Genome Atlas (CGGA) were used to evaluate the differential expression of ATP1B3 in glioma cells of various grades. Its connection to patient survival and prognosis; The siRNA interference approach instantly reduced the amount of ATP1B3 expression in the glioma cell lines U87MG and U251MG. The knockdown efficiency was assessed by Western Blotting (WB) and RT-qPCR. Following ATP1B3 knockdown, the ability of glioma cells to proliferate, migrate, and invade was identified using the Transwell assay and CCK-8. The proteins that might interact with ATP1B3 were filtered out using the TCGA database and literature analysis. The WB assay was used to determine the expression level of Protein Phosphatase 1 Catalytic Subunit Alpha (PPP1CA) following ATP1B3 deletion, immunoprecipitation was used to determine the direct influence of the two proteins, and immunofluorescence was used to analyze the distribution of ATP1B3 and PPP1CA proteins in glioma cells. Cyclin D1 and vascular endothelial growth factor A(VEGFA) expression alterations following ATP1B3 deletion were identified using the WB assay. Following ATP1B3 knockdown, the WB assay was used to determine the expression levels of p-Raf1, p-MEK 1/2, p-ERK 1/2, p-IκBα, and p-P65 in the MAPK and NF-κB signaling pathway. Results Database analysis revealed a negative correlation between the patients’ prognosis and the expression level of ATP1B3, and a positive correlation with the malignant degree of the glioma. The mRNA and protein expression levels of ATP1B3 were significantly decreased after knockout, and the proliferation, migration and invasion ability of cells in knockout group were significantly lower than those in control group, with statistical difference. The immunoprecipitation results were negative, and the knockdown group’s PPP1CA expression was lower than the control group’s. Following ATP1B3 knockdown, Cyclin D1 and VEGFA protein expression levels dropped, and the effects were statistically significant. There was a statistically significant drop in the expression levels of p-Raf1, p-MEK 1/2, p-ERK 1/2, p-IκBα, and p-P65 following ATP1B3 deletion. Conclusion In gliomas, ATP1B3 is highly expressed. Glioma cell motility, invasion, and proliferation all decline when ATP1B3 expression is lowered. The downstream protein PPP1CA is indirectly regulated by ATP1B3. By controlling the MAPK and NF-κB signaling pathways, ATP1B3 may have a role in the invasion, migration, and proliferation of glioma cells. As a result, the ATP1B3 gene might be a biological target for treatment and a possible neurotumor diagnostic.


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FIGURE 2 Magnetic resonance imaging of the patient of breast desmoid-type fibromatosis (white arrow). (A) Axial view of contrast enhancement of T1 signal. (B) Axial view of T2 signal. (C) Sagittal view of the mass of right breast. (D, E) Time-signal intensity curve of the pattern of contrast enhancement in region-of-interest.
Differential diagnosis of breast desmoid-type fibromatosis.
Desmoid-type fibromatosis of the breast: a case report and literature review

Breast desmoid-type fibromatosis (BDF) is a rare tumor predominated by mesenchymal cells. It has a high recurrence rate, although distal metastasis is uncommon. It resembles breast cancer clinically, and histological pathology is the only approach to a confirmed diagnosis. Comprehensive and individualized treatments were recommended for BDF patients. Here, we presented a case of BDF secondary to primary breast carcinoma in our center. A 47-year-old female complained of a large mass in her left breast for 2.5 months. She has a past history of left breast carcinoma with a failure of surgical and systemic intervention. Despite an active re-operation, she still suffered from disease progression with a bad prognosis. After our report, the clinicopathological traits, differential diagnosis of BDF and current recommendation of management were discussed. This case report aimed to make a clear recognition of this rare and aggressive disease and elaborate up-to-date treatment recommendations. More effective drugs and larger sample clinical studies are encouraged for better management of refractory and progressive BDF.


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Association between age of menopause and gynecologic cancer.
Participant characteristics (N = 8,219) in NHANES 1999-2020.
The influence of menopause age on gynecologic cancer risk: a comprehensive analysis using NHANES data

February 2025

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5 Reads

Background Menopause, a natural transition, affects women’s health risks, including gynecologic cancers. Early menopause, linked to lower estrogen, may increase cancer susceptibility. This study analyzed NHANES data from 1999 to 2020 for 8,219 postmenopausal women to explore the relationship between menopausal age and gynecologic cancers. We used regression models and RCS models to assess the risk. Methods This study utilized data from the NHANES spanning 1999 to 2020, focusing on 8,219 postmenopausal women selected through stratified sampling. Variables including socioeconomic factors, health behaviors, nutritional status, and medical history were assessed in relation to participants’ menopausal age and gynecologic cancer prevalence. We analyzed the relationship between menopausal age and gynecologic cancers (cervical, ovarian, and uterine) using multiple regression models. Additionally, we employed RCS models to evaluate nonlinear relationships between menopausal age and gynecologic cancer risk. Results Our findings indicate a significant inverse association between menopausal age and the risk of gynecologic cancers. After controlling for confounding factors such as age, race, BMI, and lifestyle variables, a later age at menopause was associated with a reduced risk of cervical, ovarian, and uterine cancers. The RCS model revealed a non-linear, low-L-shaped relationship, particularly highlighting increased cancer risks at younger menopausal ages. Subgroup analyses demonstrated consistent results across demographic and lifestyle factors, confirming the robustness of the observed associations. Conclusion This study reveals the link between menopausal age and gynecologic cancer prevalence. Early menopause is a significant risk factor for cervical, ovarian, and uterine cancers. Our findings support tailored cancer screening based on menopausal age, potentially improving preventive care for postmenopausal women.


Karyotypes at different stages of disease progression.
A novel truncated fusion gene ETV6::AC010198.2 in post-MPN acute myeloid leukemia caused by del(12)(p13p11)

The gene ETV6 has been confirmed to be a genetic susceptibility gene for thrombocytopenia and leukemia. Here, we report a long-chain noncoding RNA AC010198.2 as a novel fusion partner of ETV6, showing a karyotype of del(12)(p13p11), with poor prognosis in a post-MPN AML that has never been reported, which may be an vital initial event in the transformation of MPN to AML and deterioration of disease.


FIGURE 1 Skin nodules and ulcers in the right axilla of the patient. (A) Presentation of ulcerated axillary skin nodules at initial discovery. (B) Skin nodules disappeared significantly after several cycles of systematic treatment.
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Timeline of medical management and disease progression for the patient with MOBC.
Case report: Unraveling a unique case of male occult breast cancer with axillary intricacies and a comprehensive literature dive

Male breast cancer is a rare neoplasm, accounting for approximately 1% of all breast cancer cases. It typically presents as a painless, retroareolar mass. An exceedingly rare variant is male occult breast cancer, which is primarily characterized by axillary lymph node enlargement without an identifiable primary breast tumor. We report an intriguing case of a septuagenarian patient diagnosed with male occult breast cancer. The patient presented with both axillary lymph node enlargement and an associated axillary skin ulcer, and was subsequently diagnosed with male occult breast cancer with metastases to the axillary and clavicular lymph nodes, as well as more distant sites. His treatment involved a multidisciplinary approach, including HER2-targeted therapy, chemotherapy, axillary lymph node dissection, and radiotherapy. Regular follow-ups have shown that his condition remains stable. Notably, this is the first documented case of male occult breast cancer with distant metastasis that was successfully treated with surgery and radiotherapy following systemic therapy. This case highlights the complex clinical presentation and management of male occult breast cancer. Our findings suggest that surgical intervention may be a feasible option post-downstaging by systemic therapy, even in the presence of distant metastases.


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