Smooth muscle tumors of uncertain malignant potential (STUMPs) represent a group of rare uterine neoplasms whose morphological features are between those of leiomyoma and leiomyosarcoma.1 STUMP recurrence poses a major challenge because no gold standard for treatment has been established. The present case highlights the effective use of intraoperative radiotherapy (IORT) as a salvage technique in a patient with twice recurrent STUMP, with the treatment resulting in more than 5 years of disease-free survival.
A 46-year-old woman presented with large myoma and compression symptoms and underwent laparoscopic myomectomy. Her pathology report revealed STUMPs requiring laparoscopic hysterectomy. Six months postoperation, the patient visited our outpatient department for dull intermittent right-lower-quadrant abdominal pain. Laboratory data revealed elevated C-reactive protein (58.5 mg/dL) and CA-125 levels (Figure 1A). Transabdominal sonography revealed a right adnexal mass measuring 5.44 × 5.29 cm2 with complex echogenicity. Abdominal computed tomography (CT) revealed a large cystic lesion in the right adnexa (Figure 1B). Therefore, laparoscopic surgery was performed, revealing multiple peritoneal nodules, a few bloody ascites, and a lesion on the right fallopian tube. Hence, peritoneal tumor excision, right salpingo-oophorectomy, and ascites collection were performed. Cytological analysis of the ascites revealed no malignant cells. However, histopathological analysis of the peritoneal tumor and right fallopian tube revealed STUMPs (Figure 1C). No subsequent events were observed throughout the patient's outpatient follow-up. However, 7 months postoperation, outpatient sonography revealed left-upper- and right-lower-quadrant abdominal masses with complex echogenicity. Therefore, abdominal CT was performed to confirm STUMP recurrence resulting in ileus (Figure 1D). Midline laparotomic tumor excision with IORT (20 Gy/1 fx) and seromuscular layer repair of the descending colonic wall were performed (Figure 1E). Histopathology again confirmed recurrent STUMPs (Figure 1F). After the operation, the patient regularly received outpatient ultrasound and CT scan follow-up and has remained recurrence-free for more than 7 years.
Pseudomyogenic hemangioendothelioma (PHE) is an indolent and low-grade tumor that often mimics other benign and malignant lesions, making accurate diagnosis crucial for effective patient management.1 The variable clinical presentations and pathological features of PHE pose diagnostic challenges for inexperienced radiologists.2 Here, we present a 17-year-old man with PHE, characterized by ultrasonography and magnetic resonance imaging, and confirmed by pathological examination.
A 17-year-old male presented to our hospital with a complaint of pain in his leg while walking for the past 10 months. During the physical examination, multiple palpable masses were detected in the right thigh, which were hard, ill-defined, and had poor mobility. High-frequency ultrasound revealed that the largest mass in the muscle of the right thigh was hypoechoic, well-defined, and irregular (Figure 1A), with a few blood flow signals both inside and around the mass (Figure 1B). Magnetic resonance imaging suggested that the largest mass appeared as a high signal on T1-weighted (Figure 1C) and T2-weighted imaging (Figure 1D), with significant enhancement (Figure 1E). Finally, the patient underwent a surgical resection of masses, and a pathological examination confirmed the diagnosis of PHE. Hematoxylin and eosin staining revealed a diffuse growth of epithelioid cells with abundant cytoplasm and slightly off-centered nuclei (Figure 1F). Immunohistochemical staining results were positive for ERG, Fli-1, INI-1, Vim, and partially positive for CD31. Weakly positive staining was observed for CK, SMA, Cal, desmon, while CD34, CD56, Desmin, MyoD1, Myogenin, S-100, WT-1, EMA, HMB-45, Melan-A were negative. The Ki-67 proliferation index was approximately 5%.
Pulmonary lymphoepithelial carcinoma (PLEC) is a rare and challenging subtype of non-small cell lung cancer (NSCLC), accounting for only 0.25%–0.9% of all NSCLC cases.1 Due to its rarity, there are currently no established standardized treatment protocols for PLEC, leading physicians to often rely on multimodal treatment strategies, especially in advanced-stage cases.1, 2 This treatment typically includes a combination of chemotherapy, radiotherapy, and immunotherapy.
We present a compelling case of a 71-year-old nonsmoking Taiwanese woman with dementia who was diagnosed with PLEC. She initially presented with a chronic cough, which led to the discovery of an 11.4 cm mass in her left upper lung (Figure 1A), extending to the mediastinum and accompanied by metastases and pleural effusion. Biopsies confirmed lymphoepithelial carcinoma, and a computed tomography scan revealed clinical stage IVA. Immunohistochemical tests were positive for p40, and in situ hybridization for Epstein–Barr encoded region revealed positive neoplastic cell nuclei (magnification ×200; Figure 1B) with a high expression of programmed death-ligand 1 (PD-L1) of up to 90% in the tumor cells. Notably, there were no significant genomic alterations, including in the epidermal growth factor receptor, anaplastic lymphoma kinase, or reactive oxygen species-1 genes.
Initially, she was treated with pembrolizumab 200 mg alone every 21 days. After four cycles, the tumor size decreased. However, 8 months and 12 cycles later, the disease recurred, marked by an increase in tumor size and pleural effusion (Figure 1C). This led to a shift in treatment strategy, and chemotherapy with gemcitabine and carboplatin was introduced alongside a reduced dose of pembrolizumab (100 mg). Remarkably, there was a
Bladder cancer (BCa) is one of the common malignancies. Circular RNAs (circRNAs) play regulatory roles in cancer progression. CircITGA7 is a circRNA generated from several exons of ITGA7. The potential role of circITGA7 in BCa remains unknown and needs to be explored. Quantitative real time polymerase chain reaction (qRT-PCR) was used to assess circITGA7 and miR-330-3p expression in BCa tissues and cell lines. Kaplan-Meier analysis was used to evaluate the overall survival of these BCa patients. The biological function of circITGA7 was examined by overexpression of circITGA7 using CCK-8, EdU, wound-healing, and Transwell assays. Xenograft assay was performed to further validate the in vitro results. To explore the mechanism of circITGA7, luciferase reporter, RNA pull-down, fluorescence in situ hybridization (FISH) assays were employed to examine the binding interaction among circITGA7, miR-330-3p and kruppel-like factor 10 (KLF10). Western blot was used to study the protein levels of KLF10.CircITGA7 was downregulated in BCa tissues and cell lines and indicated longer overall survival. Moreover, circITGA7 restricted cell proliferation, migration and invasion of BCa through negatively regulating miR-330-3p. The in vivo model showed that circITGA7 influenced the tumor growth. Besides, the overexpression of miR-330-3p promoted cell progression by directly targeting KLF10. Mechanistically, circITGA7 inhibited BCa progression by activating KLF10 via targeting miR-330-3p.CircITGA7 alleviates BCa cell progression via circITGA7/hsa-miR-330-3p/KLF10 axis, which may provide novel therapeutic targets for BCa.
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