Oncoscience最新文献

Giant solitary neurofibromas involving deep peripheral nerves, particularly the sciatic nerve, are exceptionally rare in pediatric patients and pose unique diagnostic and surgical challenges. They often remain asymptomatic due to their deep intermuscular location, which delays detection until significant growth occurs. We report a 13-year-old male with a painless posterior thigh swelling, incidentally noticed while playing. MRI revealed a 12.8 × 6.6 × 3.8 cm lobulated intermuscular mass along the sciatic nerve. Tru-cut biopsy suggested a cellular neurofibroma. The patient underwent function-preserving excision under microscopic magnification, with careful dissection of the tumor from individual sciatic nerve fascicles. Intraoperative neurophysiological monitoring (IONM) was not available, highlighting the challenges of ensuring nerve preservation without real-time feedback. Postoperatively, transient foot drop occurred but resolved completely with physiotherapy. Histopathology confirmed a diffuse-type cellular neurofibroma with patchy S100 and SOX10 positivity, focal CD34 expression, and low Ki-67, supporting a benign profile. This case underscores the importance of meticulous surgical technique, the potential value of IONM, and vigilant postoperative care in achieving optimal outcomes for deep-seated pediatric neurofibromas.

Background: Necrotizing fasciitis (NF) of the head and neck is a rare but rapidly progressive and life-threatening soft tissue infection that constitutes a true surgical emergency. Due to the complex anatomy of the cervicofacial region and the proximity to the upper airway, early diagnosis and management are particularly challenging, and delayed recognition is associated with high morbidity and mortality. This article aims to provide a concise and clinically oriented overview of the presentation, diagnostic pitfalls, and current management strategies for cervicofacial necrotizing fasciitis.

Methods: A narrative review of the available literature was conducted and complemented by clinical experience from a tertiary referral center. Key aspects including etiology, risk factors, clinical features, imaging findings, laboratory parameters, microbiology, surgical management, airway control, and adjunctive therapies were synthesized and critically discussed.

Results: Cervicofacial NF often presents with disproportionate pain, rapidly progressive swelling, and early systemic toxicity. Odontogenic infections represent the most common source, frequently in the presence of systemic comorbidities such as diabetes mellitus or immunosuppression. Contrast-enhanced computed tomography is the imaging modality of choice, whereas laboratory scoring systems such as the LRINEC score show limited sensitivity in head and neck infections. The cornerstone of treatment is immediate and aggressive surgical debridement combined with broad-spectrum intravenous antibiotics, early airway protection, and intensive care support. Repeated surgical interventions are frequently required. The role of adjunctive hyperbaric oxygen therapy remains controversial and cannot be routinely recommended based on current evidence.

Conclusion: Necrotizing fasciitis of the head and neck requires a high index of suspicion, prompt imaging, and decisive multidisciplinary management. Early surgical intervention and airway control are critical determinants of outcome. Given the rarity of cervicofacial NF, further multicenter studies and registries are needed to refine diagnostic tools, identify prognostic factors, and optimize treatment strategies, particularly in high-risk populations such as immunocompromised and oncologic patients.

Hyperammonemic encephalopathy (HE) is a rare but serious neurological condition characterized by an acute alteration in mental status due to elevated serum ammonia levels, occurring in the absence of known liver disease. The build-up of ammonia, a by-product of protein metabolism, in the bloodstream leads to its crossing of the blood-brain barrier, where it acts as a neurotoxin, causing potentially reversible brain damage. Chemotherapeutic agents such as 5-fluorouracil (5-FU) are known to cause drug-induced HE. Our case reports a 63-year-old woman who presented with several episodes of reduced consciousness shortly after 5-FU administration, highlighting the necessity of monitoring serum ammonia levels in patients treated with 5-FU who develop neurological symptoms, and the need for expert consultation in attempting a 5-FU rechallenge.

Background: Pancreatic adenocarcinoma is a highly aggressive malignancy often requiring pancreatectomy as part of curative treatment. However, pancreatectomy frequently leads to endocrine dysfunction, such as new-onset diabetes mellitus (NODM). But the relationship between post pancreatectomy NODM and pancreatic carcinoma and the relevant risk factors remains underexplored.

Methods: In accordance with the PRISMA guidelines, a systematic search for pertinent studies was conducted across electronic databases including MEDLINE, Cochrane, EMBASE, and Scopus, covering the period from January 2000 to March 2025. The quality of these studies was evaluated using the Newcastle-Ottawa Scale, specifically designed for cohort studies. Subgroup analysis was done in terms of different pancreatectomy procedures.

Results: 45 quantitative studies were analysed, of which 16 (35.5%) were prospective studies and 29 (64.5%) were retrospective studies. Regarding the subgroup analysis, 11 studies analysed Pancreatico-Duodenectomy (PD) alone, another 12 studies analysed Distal Pancreatectomy (DP) alone, and the rest of the 22 studies compared PD with DP. The overall incidence of NODM was 24.5%, with the PD group incidence being 23.2%, and the DP group incidence was 26.3%. Older age, High BMI, preop hyperglycemia, pre-op high HbA1c, pre-existing chronic pancreatitis, low remnant pancreatic volume and post-operative complications were associated with a high incidence of NODM.

Conclusions: The development of NODM after partial pancreatic resections for pancreatic adenocarcinoma is a severe complication that requires prompt diagnosis, careful monitoring and systematic management. Hence, healthcare professionals should have detailed knowledge of the surgical procedure and its potential for diabetes complications postoperatively, using risk factor assessment.

Cervical carcinoma remains a major public health issue, especially in developing countries with limited access to screening. The Papanicolaou (Pap) smear is a cost effective, essential diagnostic tool for early detection and post-treatment surveillance of cervical lesions. Conization is used for early-stage disease, while advanced cases are managed with chemoradiation. In the report, a 44-year-old woman treated with hysterectomy and chemoradiation presented with a vault smear showing classic radiation-induced changes e.g. nuclear enlargement with preserved Nuclear: Cytoplasm ratio, cytoplasmic vacuolation and granularity, hyperchromasia with smudged chromatin, multinucleation, degenerative nuclear features including chromatin wrinkling, and occasional bizarre cells. Recognizing these features is vital to prevent misdiagnosis and unnecessary intervention. The present case highlights the need for heightened awareness of post-radiation cytology in clinical practice.

Background: Obesity, metabolic syndrome, and colorectal cancer (CRC) remain major public health challenges in the United States, collectively driving substantial morbidity, mortality, and economic burden. Beyond diet and genetics, the gut microbiome has emerged as a pivotal determinant of host metabolism, immunity, and carcinogenesis, influenced by both environmental and behavioral factors.

Objective: This review synthesizes current evidence linking gut microbial dysbiosis to obesity, metabolic syndrome, and CRC, emphasizing mechanistic pathways, environmental modifiers, and translational opportunities relevant to U.S. public health and precision medicine.

Methods: Comprehensive searches of PubMed and Scopus (2000-2025) identified large epidemiologic studies, mechanistic experiments, and clinical trials, prioritizing research from U.S. populations and nationally representative databases including NHANES, SEER, and the Nurses' Health Study.

Results: Microbial alterations such as enrichment of Fusobacterium nucleatum, enterotoxigenic Bacteroides fragilis, and colibactin-producing Escherichia coli contribute to CRC initiation and progression. In obesity and metabolic syndrome, shifts in Firmicutes-to-Bacteroidetes ratios, altered short-chain fatty acid metabolism, and endotoxin-mediated inflammation disrupt metabolic homeostasis. Environmental and lifestyle exposures, including air pollutants, smoking, and Westernized diets, modulate microbial ecology across the aerodigestive tract, affecting disease susceptibility. The emerging discipline of Molecular Pathological Epidemiology (MPE) integrates lifestyle, microbiome, and biomarker data to elucidate exposure-outcome relationships, enabling personalized prevention and therapeutic strategies.

Conclusions: The gut microbiome functions as both a biomarker and therapeutic target across metabolic and neoplastic diseases. Integrating microbiome science with environmental epidemiology and MPE frameworks offers transformative potential for precision prevention and equitable public health strategies in the U.S.

Background: Colorectal cancer (CRC) patients are at risk of cardiovascular problems, especially sudden cardiac death, due to aging, pre-existing comorbidities, and cardiotoxic medicines. Few large-scale epidemiologic studies on SCD trends and disparities in CRC patients exist. The goal is to examine US CRC decedent SCD trends and sociodemographic variations from 1999 to 2020.

Methods: A retrospective population-based analysis was conducted using the CDC WONDER Multiple Cause of Death database (1999-2020). Colorectal cancer (CRC) fatalities were identified using ICD-10 codes C18-C21, and sudden cardiac death (SCD) was defined using ICD-10 codes I46.1, I46.9, R96.0, I49.0, and I21-I24. Age-adjusted and crude death rates were estimated by sex, race/ethnicity, age group, and U.S. state. Temporal trends were assessed using linear regression. Subgroup analyses were also performed by age, sex, and geographic region.

Results: The age-adjusted mortality rate of SCD among CRC decedents reduced from 1.2 to 0.5 per 100,000 population between 1999 and 2020, demonstrating a steady trend. Males had greater SCD rates than females for two decades. Age-stratified analysis showed that CRC patients aged 65-84 carried the most SCD burden. Race and ethnicity affected SCD mortality, with Black and Asian/Pacific Islanders dying more than Whites. Geographic study found high SCD rates in Nebraska and Vermont and low rates in California and Texas.

Conclusions: Despite age-adjusted rate decreases over two decades, SCD remains a significant contributor to death in CRC patients. Persistent discrepancies by gender, race, and geography underline the importance of individualized cardio-oncology surveillance, equitable preventative initiatives, and focused public health interventions.

The most predominant and aggressive form of ovarian cancer is high grade serous ovarian carcinoma (HGSOC), characterized by late-stage diagnosis and poor prognosis. The TP53 gene, the molecular underpinnings of this malignancy studying in vitro model to serve as a valuable. The Sanger sequencing was used for clinical and laboratory wild type TP53 gene and making it an ideal profiling to offers a precise method for detecting comparable specific gene. In this study, drug repurposing agent's metformin, chlorpromazine (CPZ) alone and combine were tested on both clinical and laboratory ovarian cancer samples to evaluate on hemocytometer and clonogenic assay for dead cell and proliferation respectively. Following drug treatment, both samples were further analyzed using Sanger sequencing to detect TP53 profiling. The resulting data were analyzed to achieve successfully known target region and worked as a bridge between clinical and laboratory model. The insights gained from this study not only validate OVCAR3 as a representative model for HGSOC but also provide a foundation for developing targeted therapeutic strategies.

Lymphomas represent a diverse group of hematologic malignancies with variable clinical behavior and underlying biology. The fifth edition of the WHO classification (WHO-HAEM5, 2022) provides an updated, lineage-based framework to categorize lymphoid neoplasms, integrating immunophenotypic, genetic, and clinical features. With advancements in molecular profiling and immunotherapy, targeted treatments have transformed the therapeutic landscape of both Hodgkin and non-Hodgkin lymphomas. This review delineates the critical role of cell surface and intracellular receptors-including CD19, CD20, CD30, PD-1, and CCR4-in lymphoma pathogenesis and as therapeutic targets. We comprehensively evaluate FDA-approved targeted agents, including monoclonal antibodies (rituximab, brentuximab vedotin, obinutuzumab, mogamulizumab), immune checkpoint inhibitors (nivolumab, pembrolizumab), CAR T-cell therapies (axi-cel, tisa-cel, liso-cel, brexu-cel), bispecific T-cell engagers (mosunetuzumab, epcoritamab), and small-molecule inhibitors (ibrutinib, idelalisib, venetoclax). Each class is appraised for mechanism of action, efficacy, and safety in key lymphoma subtypes. Despite significant progress, therapeutic resistance remains a major obstacle. We categorize resistance mechanisms as antigen loss or modulation, pathway reactivation, immune microenvironment adaptation, and genetic/epigenetic evolution. Examples include CD19 antigen loss post-CAR-T therapy, BTK mutations conferring ibrutinib resistance, and immune checkpoint upregulation impairing T-cell function. Emerging strategies to counteract resistance include rational combination therapies, dual-targeted CAR constructs, next-generation bispecific antibodies, and precision-guided immunotherapy. Integration of biomarker profiling, real-time resistance monitoring, and novel immune-engineering approaches offers potential to overcome current therapeutic limitations. In conclusion, understanding the molecular basis of lymphoma and resistance mechanisms is critical to optimizing targeted therapy. This review synthesizes current evidence to inform clinical decision-making and outlines future directions for durable, personalized lymphoma care.

Introduction: Vulvovaginal cysts are typically benign and asymptomatic, often going unnoticed during routine clinical evaluations. However, rare variants, such as vulvar mucinous cysts, can present atypically, sometimes mimicking more common lesions, like lipomas. Bartholin gland cysts, though common, may coexist with other unusual vulvar cysts, making accurate diagnosis essential for appropriate management.

Case report: A 36-year-old multiparous woman presented with lower abdominal and back pain, accompanied by a single episode of prolonged menstrual bleeding. On local examination, a soft, pedunculated, asymptomatic mass measuring 3 × 4 cm was observed on the left labia majora, clinically resembling a vulvar lipoma. In addition, multiple smaller, non-tender cystic lesions were noted along the inner surface of the left labia minora. Surgical excision of all lesions was performed. Histopathological evaluation identified the labial mass as a mucinous vulvar cyst and the smaller lesions as multiple Bartholin gland cysts, with no evidence of atypia. The postoperative course was uneventful, and the patient was discharged in stable condition with advice to follow up after the next menstrual cycle.

Conclusion: This case emphasizes the importance of considering rare vulvar mucinous cysts in the differential diagnosis of asymptomatic vulvar masses. Coexistence with multiple Bartholin cysts adds to the diagnostic complexity. Surgical excision not only provides a definitive diagnosis but also prevents future complications. Histopathological evaluation remains crucial for accurate classification and guiding follow-up.