The clinical value of Delphian and pre-tracheal lymph nodes in predicting lateral lymph nodes metastasis of papillary thyroid carcinoma

BACKGROUND

Occult lymph node metastasis of papillary thyroid carcinoma is common. However, whether undergoing prophylactic lateral lymph node dissections is still controversial. This cross-sectional study with large cohort of patients aims to investigate the clinical value of Delphian and pre-tracheal lymph node in predicting lateral lymph node metastasis of papillary thyroid carcinoma.

MATERIALS AND METHODS

A retrospective analysis was conducted on 865 papillary thyroid carcinoma patients with Delphian and pre-tracheal lymph node data who underwent thyroidectomy plus central and lateral lymph node dissection. Data on clinicopathological characteristics were collected. Subsequently, a predictive model was established based on the results of the univariate and multivariate analyses.

RESULTS

The rates of Delphian and pre-tracheal lymph node metastasis and lateral lymph node metastasis were 54.7% and 39.1%, respectively. Having ≥ 3 or 1-2 Delphian and pre-tracheal lymph node metastasis dramatically increased the risk of lateral lymph node metastasis (OR = 8.5, 95% CI 5.3-13.4 and OR = 3.9, 95% CI 2.7-5.7, respectively). The upper tumour had a 3.7 times higher risk of lateral lymph node metastasis than other locations. Patients ≤ 42 years or tumour size >8 mm had a higher risk of lateral lymph node metastasis.

CONCLUSIONS

Delphian and pre-tracheal lymph node metastasis was associated positively with the risk of lateral lymph node metastasis. For patients without clinical lateral lymph node metastasis, the Delphian and pre-tracheal lymph node could be considered to harvest as the first step in a thyroidectomy to facilitate further conduct of the operation.

Comparison of US-guided thermal ablation and surgery for papillary thyroid cancer: a systematic review and meta-analysis

OBJECTIVE

We conducted the systematic review and meta-analysis to comprehensively compare ablation and surgery in terms of effectiveness, safety and multiple factors affecting life quality of patients with papillary thyroid cancer (PTC).

METHODS

PubMed, Embase, Scopus, Web of Science and EBSCO were searched for relevant studies published between January 1980 and September 2023. Two reviewers independently extracted data according to the PRISMA recommendations and assessed the quality of each study with the Cochrane Risk of Bias Tool. Pooled analyses were performed using random or fixed-effects models, as appropriate.

RESULTS

A total of 4829 patients with PTC from 19 eligible studies were included. Through the meta-analysis, similar tumor progression (OR: 1.07; 95% CI 0.78, 1.48; p = 0.66) and recurrence-free survival (OR: 0.86; 95% CI, 0.55, 1.34; p = 0.50) were found between the patients undergoing ablation and those undergoing surgery. More strikingly, the lower risk of major complications (OR: 0.31; 95% CI 0.24, 0.41; p < 0.001), the shorter hospital stay (MD = 3.67 d; 95% CI, -4.89, -2.44; p < 0.001), the abbreviated procedure time (MD: -66.33 min, 95% CI, -77.08, -55.59; p < 0.001), the less intraoperative blood loss (MD: -27.43 ml, 95% CI, -34.60, -20.27; p < 0.001) and the lower treatment cost (MD: -860.42 USD, 95% CI, -1008.03, -712.81; p < 0.001) were noticed in ablation techniques compared to surgical operation. Thermal ablation has shown multiple advantages by virtue of its percutaneous puncture compared with surgical resection.

CONCLUSION

As an effective, safe, minimally invasive and economical modality, thermal ablation might be a promising alternative to existing PTC management options.

Radical Resection of Differentiated Thyroid Cancer in Elderly Patients: Evaluation of the Efficacy of the Immunocolloidal Gold Strip Method Combined with Nanocarbon Negative Imaging Tracing Technology for Parathyroid Gland Imaging

OBJECTIVE

Extant imaging methods used for the proper identification of the parathyroid glands to prevent post-operative hypothyroidism associated with the resection of differentiated thyroid cancer (DTC) are limited by factors such as low specificity, high cost, and technical complexity. This study, therefore, sought to investigate the efficacy of the immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology for parathyroid gland imaging during radical resection of DTC in elderly patients.

METHODS

A total of 100 elderly patients with DTC were enrolled and randomly divided into two groups: the control group and the observation group. The control group underwent conventional radical thyroidectomy with bilateral cervical lymph node dissection, while the observation group received the immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology for parathyroid gland imaging during the surgery. The baseline characteristics, intraoperative findings, postoperative parathyroid hormone (PTH), and serum calcium levels, as well as postoperative complications, were compared between the two groups.

RESULTS

There were no significant differences in age, gender, body mass index, comorbidities, or smoking history between the two groups. The observation group had a significantly higher number of parathyroid glands identified during surgery compared with the control group. The postoperative PTH and serum calcium levels at postoperative days 1 and 3 and at 6 months were significantly higher in the observation group than those in the control group. The incidence of postoperative hypoparathyroidism was significantly lower in the observation group.

CONCLUSION

The immunocolloidal gold strip method combined with nanocarbon negative imaging tracing technology is effective in identifying and preserving parathyroid glands during radical resection of DTC in elderly patients.

Breast implant silicone exposure induces immunogenic response and autoimmune markers in human periprosthetic tissue

Silicone-based breast implants are commonly used, but there are concerns about their long-term safety. While implantation results in the formation of a periprosthetic tissue that isolates the implant from the rest of the host body, silicone can leak and reach surrounding tissues. We combined histological analysis and gene expression profiling (RNA sequencing) of samples from human patients with silicone breast implants with different fillers (silicone or serum), surface topographies and/or shell rupture, and performed systematic cross-comparisons. Our study shows that exposure to silicone gel filler, even in clinically asymptomatic cases, induces an immune response. This response includes the expression of markers associated with various autoimmune diseases. This study provides the first biological evidence of an association between silicone implants and autoimmune markers, highlighting the need for further research and stricter implant safety regulations. We suggest that implant design factors, such as filler type and surface texture, may influence the inflammatory response. Re-evaluation of existing clinical trials is warranted to investigate the association between implant characteristics and potential health risks.

Rare pancreatic cystic neoplasms: A pictorial review

Since rare pancreatic cystic tumors may differ from common pancreatic cystic neoplasms in terms of treatment plan and prognosis, the differential diagnosis of these diseases is clinically relevant. Various imaging tests play an important role in the differential diagnosis of rare cystic pancreatic tumors, but accurately distinguishing these diseases solely on the basis of imaging findings is challenging. The purpose of this pictorial review is to present CT and in particular MR imaging features of rare pancreatic cystic tumors and discuss potential elements for differential diagnosis.

Enhancing outcomes in severe lymphedema through combined treatment strategies

Lymphedema, particularly in its advanced stages, presents significant challenges in treatment, often necessitating a combination of therapies to manage symptoms effectively and improve patient outcomes. This article reviews the findings of Wang et al, regarding the use of lymphovenous anastomosis and complex decongestive therapy in treating severe, deformed stage III lymphedema with recurrent infections. The case report details the promising results achieved through this combined therapy, highlighting substantial reductions in limb volume and the complete resolution of recurrent lymphangitis. The patient experienced notable improvements in weight loss, physical function, and quality of life. Despite its strengths, the study has several limitations. It lacks specific details on the types of lymphovenous anastomoses performed and complex decongestive therapy protocols, such as frequency and adherence, making reproducibility difficult. The short follow-up period of six months limits understanding of long-term efficacy, and more consistent reporting of key metrics such as weight loss and body mass index would enhance outcome assessments. This article emphasizes the importance of integrating minimally invasive surgical techniques with conservative therapies to address both the symptoms and underlying causes of lymphedema. Further research is essential to standardize protocols and refine combined treatment strategies.

The Role of Dynamic Contrast Enhanced Magnetic Resonance Imaging in Evaluating Prostate Adenocarcinoma: A Partially-Blinded Retrospective Study of a Prostatectomy Patient Cohort With Whole Gland Histopathology Correlation and Application of PI-RADS or TNM Staging

BACKGROUND

Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in the current Prostate Imaging-Reporting and Data System version 2.1 (PI-RADS v2.1) is considered optional, with primary scoring based on T2-weighted imaging (T2WI) and diffusion weighted imaging (DWI). Our study is designed to assess the relative contribution of DCE MRI in a patient-cohort with whole mount prostate histopathology and spatially-mapped prostate adenocarcinoma (PCa) for reference.

METHODS

We performed a partially-blinded retrospective review of 47 prostatectomy patients with recent multi-parametric MRI (mpMRI). Scans included T2WI, DWI with apparent diffusion coefficient (ADC) mapping, and DCE imaging. Lesion conspicuity was scored on a 10-point scale with ≥ 6 considered "positive," and image quality was assessed on a 4-point scale for each sequence. The diagnostic contribution of DCE images was evaluated on a 4-point scale. The mpMRI studies were assigned PI-RADS scores and tumor, node, metastasis (TNM) T-stage with blinded comparison to spatially-mapped whole-mount pathology. Results were compared to the prospective clinical reports, which used standardized PI-RADS templates that emphasize T2WI, DWI and ADC.

RESULTS

Per lesion sensitivity for PCa was 93.5%, 82.6%, 63.0%, and 58.7% on T2WI, DCE, ADC and DWI, respectively. Mean lesion conspicuity was 8.5, 7.9, 6.2, and 6.1, on T2W, DCE, ADC and DWI, respectively. The higher values on T2WI and DCE imaging were not significantly different from each other but were both significantly different from DWI and ADC (p < 0.001). DCE scans were determined to have a marked diagnostic contribution in 83% of patients, with the most common diagnostic yield being detection of contralateral peripheral zone tumor or delineating presence/absence of extra-prostatic extension (EPE), contributing to more accurate PCa staging by PI-RADS or TNM, as compared to histopathology.

CONCLUSION

We demonstrate that DCE may contribute to lesion detection and local staging as compared to T2WI plus DWI-ADC alone and that lesion conspicuity using DCE is markedly improved as compared to DWI-ADC. These findings support modification of PI-RADS v2.1 to include use of DCE acquisitions and that a TNM staging is feasible on mpMRI as compared to surgical pathology.

Diagnostic imaging challenges of mammary Paget's disease presenting with subtle clinical and imaging features: A case report

Mamary Paget's disease presents with subtle and insidious symptoms leading to late diagnosis that poses medical challenges. This uncommon pathology often has underlying ductal breast cancer, including in situ or invasive breast cancer, which makes early recognition crucial for better prognoses. A 78-year-old postmenopausal woman presented with progressive and persistent eczematous skin lesions of the nipple without breast lumps. Additional imaging procedures revealed subtle findings, but the histopathology and immunohistopathology confirmed Paget's disease. This case highlights the importance of the correlation between clinical findings and the chosen diagnostic method for establishing a definitive diagnosis of mammary Paget's disease.

Cancer-associated fibroblast-derived exosomal FAM83F regulates KIF23 expression to promote the malignant progression and reduce radiosensitivity in non-small cell lung cancer

Cancer-associated fibroblasts (CAFs) have been shown to play a crucial role in the progression of non-small cell lung cancer (NSCLC). Exosomes derived from CAFs have emerged as important mediators of intercellular communication in the tumor microenvironment, contributing to cancer progression. Therefore, it is essential to further investigate the mechanisms by which CAF-derived exosomes regulate NSCLC. CAFs promoted NSCLC cell proliferation, invasion, and migration, while also suppressing radiosensitivity. We observed an upregulation of FAM83F expression in both NSCLC cells and NSCLC cells treated with conditioned medium from CAFs. Notably, CAF-derived exosomes were found to transfer FAM83F to NSCLC cells, thereby enhancing the malignant properties of the cancer cells. In contrast, FAM83F-deficient CAF-derived exosomes exerted inhibitory effects on NSCLC cell proliferation, invasion, and migration, while also sensitizing the cells to radiotherapy. FAM83F was found to interact with KIF23 in NSCLC cells, and the overexpression of KIF23 attenuated the effects induced by FAM83F-deficient exosomes in NSCLC cells. Moreover, FAM83F-deficient CAF-derived exosomes were effective in inhibiting tumor formation in vivo. Our findings highlight the crucial role of CAF-derived exosomal FAM83F in promoting NSCLC progression and conferring resistance to radiotherapy. Targeting this signaling pathway may offer promising therapeutic strategies for combating NSCLC progression and improving patient outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10616-025-00713-x.

Comparison of the prognostic effect of pyrotinib plus trastuzumab and chemotherapy different lines therapy in HER2-positive advanced breast cancer

This study aimed to compare the efficacy of pyrotinib, trastuzumab combined with chemotherapy with different lines therapy in human epidermal growth factor receptor 2- (HER2-) positive advanced breast cancer (ABC) and analyze the factors affecting the prognosis. A total of 84 patients with median age of 49 year-old. The mPFS of patients receiving first-line pyrotinib plus trastuzumab and chemotherapy was the longest (11 months) compared with second- and third line patients (p = 0.106). The objective response rate (ORR) and disease control rate (DCR) of the total population were 33.3% and 82.1% respectively. Subgroup analysis suggested that using pyrotinib plus trastuzumab and Albumin-bound paclitaxel was not inferior to combine with Vinorelbine in regards of PFS. Histological grade (OR: 0.233[0.069 ∼ 0.781], p = 0.018) and tumor location (OR: 0.286[0.087 ∼ 0.942], p = 0.040) were independent factors influencing the ORR. Multivariate cox analysis showed that Ki-67 was independently associated with increased risk of progression (HR: 1.843[1.044-3.254], p = 0.035). The most common adverse events were diarrhea (17.9%) and neutropenia (11.9%). In the first-, second- and third-line treatment, pyrotinib plus trastuzumab and chemotherapy is effective and safe. Pyrotinib and trastuzumab combined with Albumin-bound paclitaxel may be a potential ideal treatment plan for HER2-positive advanced breast cancer.

Overexpression of FOS enhances the malignant potential of eutopic endometrial stromal cells in patients with endometriosis‑associated ovarian cancer

Endometrial cysts of the ovary (EMC) may develop into endometriosis (EM)‑associated ovarian cancer over time (EAOC), but the pathogenesis of this disease has not been determined. In the present study, RNA sequencing was used to identify a feasible biomarker, and the molecular function of this biomarker in eutopic endometrial cells from EAOC and EMC patients was evaluated to explore the potential mechanism related to EAOC and orthotopic endometrial tissue. RNA sequencing was performed on 5 EAOC and 4 EMC tissue samples, and differential expression analysis was performed. To identify biomarkers, differentially expressed genes were subjected to protein‑protein interaction network design, Gene Ontology pathway enrichment, and Gene Set Enrichment Analysis pathway enrichment. The expression of FOS in the endometrium was detected via immunohistochemical staining. Lv‑FOS was utilized to upregulate FOS in human endometrial stromal cells (hEnSCs), and Cell Counting Kit‑8, colony formation and scratch assays were performed to assess cell viability, proliferation and migration, respectively. Western blotting was used to determine protein expression. In total, 249 genes, including FOS, were differentially expressed. Pathway enrichment analysis demonstrated that the MAPK, AP‑1, ERK and other signaling pathways were involved in the EMC‑to‑EAOC conversion. FOS upregulation in hEnSCs increased cell viability, proliferation and migration. Western blot results revealed that after FOS expression was inhibited, P21 expression was upregulated, and CDK4, Cyclin D1, p‑Stat3, MMP2 and MMP9 expression was downregulated. In conclusion, mitosis and the cell cycle were found to affect the progression of EMC to EAOC. The expression of FOS, a novel biomarker, was identified to enhance the malignant potential of eutopic endometrial stromal cells in patients with EM‑associated ovarian cancer.

Superselective Versus Selective Neck Dissection in the Treatment of Papillary Thyroid Carcinoma

BACKGROUND

Superselective lateral neck dissection (SSND), defined as dissection of 2 or less contiguous lateral cervical nodal levels, has emerged as a treatment option for metastatic papillary thyroid carcinoma (PTC), in place of a selective neck dissection (SND). There are few studies exploring outcomes of SSND compared to SND in this context.

MATERIALS AND METHODS

This was a single institution retrospective study. All patients who were diagnosed with PTC and had a lateral neck dissection from 2019 to 2022 were reviewed. Patient demographics and outcomes were compared.

RESULTS

A total of 136 patients met inclusion criteria. About 106 (78%) had a SND and 30 (22%) had a SSND. There was no significant difference between patients who underwent SND versus SSND regarding frequency of post-operative complications, length of stay (2.49 vs 2.31 days), post-operative thyroglobulin >10 ng/mL (21 vs 3 patients), regional recurrence (14% vs 17%), reoperation rates (16.7% vs 17.4%), or adjuvant radioactive iodine therapy (75% vs 63%; P > .05).

CONCLUSIONS

SSND for PTC had similar short-term clinical outcomes when compared to SND.

Variability in primary thyroid lymphoma: A clinicopathological exploration of diffuse large B-cell, marginal zone, and follicular lymphoma

Primary thyroid lymphoma (PTL) is a rare condition, posing significant diagnostic challenges due to limited incidence and data. However timely and accurate diagnosis is crucial for effective management. This study aims to analyze the clinicopathological features of PTL cases observed over 15 years at a tertiary national referral hospital. PTL cases from 2009 to 2023 at Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital archives were retrospectively analyzed, with an assessment of clinical data, histopathological, and immunohistochemistry analysis. Statistical analysis was conducted using Chi-Square and Kruskal Wallis. Women constituted the majority of cases (male-to-female ratio was 1: 2.6), with a median patient age of 55 years. Of the 40 identified PTL cases, only one was a T-cell lymphoma among the non-Hodgkin lymphomas (NHL). The NHL subtypes included diffuse large B-cell lymphoma (DLBCL [72.5 %]), marginal zone lymphoma (15.0 %), and follicular lymphoma (FL [10.0 %]). An enlarged neck mass (94.7 %) was the most frequent symptom, and 42.1 % had a history of Hashimoto's thyroiditis. The overall surviving proportion in the present study is 80.7 %, with the median survival duration of 14.5 months, ranging from 1 to 54 months. The longest duration of survival documented in FL case and the shortest in DLBCL case. Lymphoepithelial lesions could be found in all lymphoma types. The main diagnostic and treatment modality used was surgery. Prompt diagnosis and personalized treatment approaches are important to improve survival outcomes. PTL should be anticipated in middle-aged women with rapid enlarged neck mass and a history of Hashimoto's thyroiditis.

Hyperthermic Intraperitoneal Chemotherapy in the Management of Ovarian, Fallopian Tube and Peritoneal Carcinomas

Ovarian cancer (OC) is a leading cause of gynecologic cancer-related deaths. Despite improvements, the 10-year survival rate has remained relatively unchanged in recent years. Disease recurrence occurs in nearly 80% of patients with advanced disease symptoms. Hyperthermic intraperitoneal chemotherapy (HIPEC) is a therapy that targets common sites of OC recurrence with heated chemotherapy during surgery, which promotes either direct cell death, heightened deoxyribonucleic acid damage, or increased tumor susceptibility to chemotherapeutics. Clinical trials utilizing HIPEC have shown promising results. This paper aims to provide an overview of HIPEC, including historical trials, mechanistic insights, recent advances, and ongoing clinical trials.

Functional analysis of the effects of propofol on tamoxifen‑resistant breast cancer cells: Insights into transcriptional regulation

Although 70% of patients with estrogen receptor-positive breast cancer benefit from tamoxifen (TAM) therapy, the development of resistance to TAM leads to high rates of metastasis and a poor prognosis. Propofol, a commonly used anesthetic, can inhibit the occurrence and progression of breast cancer. In the present study, the effects of propofol on TAM-resistant (TR) breast cancer cells were evaluated. MCF7-TR cells were treated with or without propofol. Subsequently, cell cycle progression and the induction of apoptosis were detected by flow cytometry, whereas cell proliferation was assessed using Cell Counting Kit-8 and colony formation assays. Furthermore, the potential transcriptional regulatory effects of propofol on MCF7-TR cells were investigated using RNA sequencing. The results indicated that propofol significantly promoted cell cycle arrest, induced apoptosis, and inhibited proliferation and colony formation in MCF7-TR cells. Furthermore, transcriptome sequencing analysis revealed 1,065 differentially expressed genes between propofol-treated MCF7-TR and untreated MCF7-TR cells. Gene Ontology annotation enrichment analysis, Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis and Gene Set Enrichment Analysis indicated that propofol affected the expression levels of genes located on the 'plasma membrane' and 'cell periphery', while mainly regulating signals involved in cancer biology, immune response and metabolic pathways. These results identified the potential effects of propofol on TR breast cancer cells and provided a theoretical basis for clinical treatment, particularly for individuals with TAM resistance.

Nuclear pseudoinclusion is associated with BRAFV600E mutation: Analysis of nuclear features in papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) is the most prevalent thyroid neoplasm, classified into BRAF-like and RAS-like subtypes. Nuclear alterations serve as a diagnostic criterion of PTC and are fully manifested in BRAF-like. This single-center retrospective study aimed to assess the different presentation of nuclear features in 40 samples of BRAFV600E- and 40 samples of RAS-mutated PTCs using both bivariate and multivariate analytic approaches. Nuclear features are evaluated histologically using the 3-point and 8-point scoring systems established by the World Health Organization and the Asian Thyroid Working Group, respectively. We found the presence of membrane irregularities, nuclear elongation, nuclear groove, sickle-shaped nuclei, nuclear pseudoinclusion, and higher nuclear scores are significantly associated with BRAFV600E. Multivariate analysis showed that nuclear pseudoinclusion is predictive for the presence of BRAFV600E mutation (OR = 10.97, 95%CI = 2.81-42.96, p = 0.001) and has sensitivity of 55 %, specificity of 92.5 %, positive predictive value of 88 %, negative predictive value of 67.3 %, and accuracy of 73.8 %. There are various pathways and protooncogenes associated with the development of thyroid neoplasm. This study found significant differences in nuclear features between BRAFV600E and RAS-mutated PTC. BRAFV600E tend to display florid nuclear features, whereas the RAS- mutation is associated with subtle nuclear features. These findings emphasize the distinct cytological profiles of BL and RL PTC, reinforcing the need for precise subtyping to guide tailored management.

Molecular mechanism of long chain non coding RNA LINC00511 influencing breast cancer stem cells: Mechanism of VEGFR1 protein

A comprehensive investigation into the mechanism of VEGFR1 protein in this process was undertaken. Lentivirus-mediated RNA interference was employed to inhibit the expression of LINC00511 in breast cancer cell lines, and changes in breast cancer stem cell markers, including CD44+/CD24-, were monitored using flow cytometry. Additionally, the interaction between VEGFR1 protein and LINC00511 and the activation of its downstream signaling pathway were investigated through co-immunoprecipitation (Co-IP) and Western blot techniques. The co-immunoprecipitation experiment revealed the direct interaction between LINC00511 and VEGFR1 protein. Western blot analysis showed that after knocking down LINC00511, the phosphorylation level of VEGFR1 protein decreased, suggesting that its activity was inhibited. After treatment with the VEGFR1 inhibitor, the properties of the breast cancer stem cells were similarly inhibited, which is consistent with the effect of knocking down LINC00511.

Prognostic value of preoperative modified Glasgow prognostic score in predicting overall survival in breast cancer patients: A retrospective cohort study

The modified Glasgow prognostic score (mGPS), based on C-reactive protein and albumin levels, is an inflammation-based prognostic tool used in various cancers. However, related research in breast cancer is limited. The present study evaluated the prognostic value of the preoperative mGPS in predicting overall survival (OS) of patients with breast cancer undergoing surgery. A retrospective cohort study was conducted involving 300 patients with breast cancer with up to 10 years of follow-up. Patients were categorized into three groups based on mGPS scores of 0, 1 and 2, and their clinical and pathological data were collected. Kaplan-Meier survival analysis and Cox proportional hazards models were used to assess survival outcomes and identify risk factors associated with higher mGPS scores. A prognostic nomogram was developed based on multivariate analysis to predict 5- and 10-year OS. Patients with high mGPS scores showed significantly poor survival outcomes. The 5- and 10-year survival rates for mGPS 0, 1 and 2 were 80, 70 and 55%, and 71, 55 and 22%, respectively (P<0.001). Multivariate Cox analysis identified the mGPS, age, smoking, PAM50 and TNM stage as independent predictors of OS. The nomogram based on the mGPS demonstrated good predictive accuracy (concordance index: 0.81) and calibration. The preoperative mGPS is an independent prognostic factor for OS of patients with breast cancer. It is a simple, cost-effective tool that can aid in risk stratification and guide treatment strategies. Further validation in larger cohorts is recommended.

Predictors of Bilateral Disease in Low-Risk Papillary Thyroid Cancer: Histopathologic Insights and Preoperative Ultrasonography

BACKGROUND

With the current shift toward de-escalation of surgical management in low-risk papillary thyroid cancer (PTC), understanding predictors and the clinical significance of additional tumors in the contralateral lobe is important. This study investigated the histopathologic predictors of bilateral disease in low-risk PTC patients and the utility of preoperative ultrasonography in guiding completion thyroidectomy decisions.

METHODS

Patients treated with total thyroidectomy (TT) for low-risk PTCs (< 4 cm) at the Endocrine Surgical Unit of the Royal North Shore Hospital, University of Sydney from 2013 to 2020 were identified from a prospectively maintained database. The primary objective was to evaluate whether specific histopathologic factors can reliably predict the likelihood of bilateral disease in low-risk PTC patients after hemithyroidectomy. The secondary objective was to assess the accuracy of preoperative ultrasonography for patients with bilateral disease.

RESULTS

Of the 737 patients in this study, 194 (26.3%) had bilateral disease. The multivariate analysis showed that larger median tumor size (odds ratio [OR] 1.043 per mm; 95 % confidence interval [CI] 1.025-1.062; P < 0.001), ipsilateral multifocal disease (MFD) (OR 2.010; 95% CI 1.338-3.020; P < 0.001), and venous invasion (OR 1.693; 95% CI 1.058-2.707) had a significant association with bilateral disease. However, in the prediction of clinically significant contralateral disease (≥ 10 mm), median tumor size (OR 1.104 per mm; 95% CI 1.059-1.152; P < 0.001) and venous invasion (OR 2.815; 95% CI 1.044-7.589; P = 0.041) were significantly correlated, whereas ipsilateral MFD lost its significance. These significant contralateral tumors were identified preoperatively and associated with higher Thyroid Imaging, Reporting and Data System (TIRADS) and/or Bethesda cytology classifications in 94% of cases.

CONCLUSION

In low-risk PTC patients, larger tumor size, venous invasion, and ipsilateral MFD are significantly associated with disease in the contralateral thyroid lobe.

Ultrasound and clinical factors predicting central lymph node metastases in patients with unilateral multifocal papillary thyroid carcinoma

OBJECTIVE

This retrospective study involving a large dataset of unilateral multifocal papillary thyroid carcinoma (UM-PTC) sought to identify factors that predict central lymph node metastases (CLNM) in patients.

METHODS

We identified a cohort of 158 patients who underwent cervical ultrasonography followed by UM-PTC diagnosis based on postoperative pathology. The relationship between CLNM and UM-PTC clinical ultrasound features was evaluated using univariate and multivariate analyses. Receiver operating characteristic (ROC) curve analysis was used to determine the ability of total tumor diameter (TTD) to predict CLNM.

RESULTS

Among the 158 UM-PTC patients, the incidence of CLNM was 29.7% (47/158). Univariate and multivariate analyses revealed that a number of similarity of sonographic features (NSSF) ≥4 (odds ratio [OR] = 11.335, 95% confidence interval [CI]: 3.95-32.50, p = 0.000), microcalcifications (OR = 3.54, 95% CI: 1.30-9.70, p = 0.014), a TTD of ≥2 cm (OR = 4.48, 95% CI: 1.62-12.34, p = 0.004), number of nodules ≥3 (OR = 13.17, 95% CI: 3.24-53.52, p = 0.000), and Lateral cervical lymph node metastasis (LLNM) (OR = 5.57, 95% CI: 1.59-19.48, p = 0.007) were independently associated with CLNM in UM-PTC. ROC curve analysis revealed that the TTD cut-off of 1.795 cm had a sensitivity of 0.723 and a specificity of 0.676 for predicting CLNM.

CONCLUSIONS

Patients with UM-PTC are at high risk of CLNM. NSSF ≥4, microcalcifications, TTD of ≥2 cm, LLNM, and a number of nodules ≥3 were independently associated with CLNM. Our data show that ultrasound may guide surgical decisions in the treatment of UM-PTC.

The Age-Old Question in Nipple-Sparing Mastectomy: Is Older Age a Contraindication?

BACKGROUND

Nipple-sparing mastectomy (NSM) is infrequently performed in older women, at least in part owing to concerns regarding age-related complications. We describe postoperative outcomes of NSM in older women and risk factors for complications, with the goal of informing patient selection and decision-making.

PATIENTS AND METHODS

Cases of NSM with immediate implant-based reconstruction were identified from an institutional database (2009-2019). Patient characteristics and postoperative complications were compared between women 45-54 years, 55-64 years, and  ≥ 65 years. Regression models were used to identify risk factors for serious complications and reconstruction failure.

RESULTS

Of 1998 NSMs in 1197 women, 1296 were in women 45-54 years, 521 in women 55-64 years, and 181 in women ≥ 65 years. Women ≥ 65 years had higher rates of comorbidities and more frequently incurred early postoperative complications (11% versus 7.3% in 55-64 years and 5.2% in 45-54 years, p = 0.005), particularly hematoma (5.0% versus 1.5% in 55-64 years and 1.2% in 45-54 years, p < 0.001). On univariate analysis, unadjusted rates of infection, necrosis, serious complications, and reconstruction failure did not differ significantly by age. Permanent reconstruction failure occurred in eight (4.4%) women ≥ 65 years. On multivariable analysis, age was not an independent predictor of serious complications or reconstruction failure, though current smoking, in addition to factors more common in older women (diabetes, hypertension, anticoagulation, prior radiotherapy), emerged as independent risk factors.

CONCLUSIONS

After adjusting for patient factors, older age did not increase risk of complications after NSM. Studies on functional and quality-of-life outcomes may help further refine patient selection and facilitate decision-making.

Impacts of Nutlin-3a and exercise on murine double minute 2-enriched glioma treatment

JOURNAL/nrgr/04.03/01300535-202504000-00029/figure1/v/2024-07-06T104127Z/r/image-tiff Recent research has demonstrated the impact of physical activity on the prognosis of glioma patients, with evidence suggesting exercise may reduce mortality risks and aid neural regeneration. The role of the small ubiquitin-like modifier (SUMO) protein, especially post-exercise, in cancer progression, is gaining attention, as are the potential anti-cancer effects of SUMOylation. We used machine learning to create the exercise and SUMO-related gene signature (ESLRS). This signature shows how physical activity might help improve the outlook for low-grade glioma and other cancers. We demonstrated the prognostic and immunotherapeutic significance of ESLRS markers, specifically highlighting how murine double minute 2 (MDM2), a component of the ESLRS, can be targeted by nutlin-3. This underscores the intricate relationship between natural compounds such as nutlin-3 and immune regulation. Using comprehensive CRISPR screening, we validated the effects of specific ESLRS genes on low-grade glioma progression. We also revealed insights into the effectiveness of Nutlin-3a as a potent MDM2 inhibitor through molecular docking and dynamic simulation. Nutlin-3a inhibited glioma cell proliferation and activated the p53 pathway. Its efficacy decreased with MDM2 overexpression, and this was reversed by Nutlin-3a or exercise. Experiments using a low-grade glioma mouse model highlighted the effect of physical activity on oxidative stress and molecular pathway regulation. Notably, both physical exercise and Nutlin-3a administration improved physical function in mice bearing tumors derived from MDM2-overexpressing cells. These results suggest the potential for Nutlin-3a, an MDM2 inhibitor, with physical exercise as a therapeutic approach for glioma management. Our research also supports the use of natural products for therapy and sheds light on the interaction of exercise, natural products, and immune regulation in cancer treatment.

Breast cancer outcomes after skin- and nipple-sparing mastectomy in BRCA pathogenic mutation carriers versus non-BRCA carriers

Our previous study on breast cancer BRCA carriers disclosed a high local recurrence (LR) rate in patients who underwent skin sparing (SSM) or nipple sparing mastectomy (NSM) without postoperative radiation therapy (RT), compared to breast conservation surgery or mastectomy with RT. The current study compares the LR rates in BRCA versus non BRCA carriers after SSM/NSM in relation the receipt of RT.

METHODS

The study was approved by the institutional ethics committee. Data collected included patient- (e.g., age), tumour- (e.g., subtype, stage), and treatment-related factors and outcomes. LR was defined as ipsilateral chest wall recurrence. P value ≤ 0.05 was considered statistically significant.

RESULTS

A total of 255 patients (127 BRCA, 128 non-BRCA) were included. Patients who did not receive RT had an earlier disease stage (most N0). No differences were found for LR rate in non-BRCA versus BRCA groups per involved breast and per patient. Comparing the subgroup of patients who did not receive RT, there were no statistically significant differences in LR between non-BRCA versus BRCA (p-value > 0.05). Similarly, there were no significant differences in LR for the subgroup of patients who did receive RT (p-value > 0.05). Regardless of BRCA status, patients who received RT had significantly lower LR rates. No differences in overall survival were noted between the groups.

CONCLUSIONS

Our results confirm high LR rates after SSM and NSM in patients who are not treated with RT, independent of BRCA-status. This mandate further investigation, as previous studies did not show a benefit of postmastectomy RT in the early breast cancer stage of those patients.

Artificial Intelligence and Breast Cancer Management: From Data to the Clinic

Breast cancer (BC) remains a significant threat to women's health worldwide. The oncology field had an exponential growth in the abundance of medical images, clinical information, and genomic data. With its continuous advancement and refinement, artificial intelligence (AI) has demonstrated exceptional capabilities in processing intricate multidimensional BC-related data. AI has proven advantageous in various facets of BC management, encompassing efficient screening and diagnosis, precise prognosis assessment, and personalized treatment planning. However, the implementation of AI into precision medicine and clinical practice presents ongoing challenges that necessitate enhanced regulation, transparency, fairness, and integration of multiple clinical pathways. In this review, we provide a comprehensive overview of the current research related to AI in BC, highlighting its extensive applications throughout the whole BC cycle management and its potential for innovative impact. Furthermore, this article emphasizes the significance of constructing patient-oriented AI algorithms. Additionally, we explore the opportunities and potential research directions within this burgeoning field.

Outcome Analysis of Parathyroid Gland Auto-transplantation in Pediatric Patients: A Retrospective Review

Parathyroid gland (PG) auto-transplantation is performed to preserve the function of de-vascularized or unintentionally removed PGs, however, little has been published about the technique and outcomes in children. In our study, we aimed to present the results of PG auto-transplantation in children undergoing thyroidectomy or parathyroidectomy at a tertiary single institution. A retrospective review identified 14 patients (<18 years of age) who underwent PG auto-transplantation from January 2000 to December 2022. 57.1% (8/14) had transient postoperative hypocalcemia and 14.3% (2/14) had permanent postoperative hypocalcemia. Eight patients had transient hypoparathyroidism, correlating with the rate of transient hypocalcemia. The most common reimplantation site was the sternocleidomastoid (11/14) and it was significantly associated with normalized calcium levels 6 months after auto-transplantation (p=0.033). Bilateral central neck dissection and surgical indication of cancer had a statistically significant association with transient hypocalcemia (p=0.03 and p=0.005, respectively). Our study provides valuable insights into the outcomes of PG auto-transplantation in pediatric patients, highlighting the potential for successful engraftment and factors associated with hypocalcemia.

Short-term Patient-Reported Outcomes Following Bilateral Risk-Reducing Mastectomy for Patients at a High Risk for Breast Cancer: A Systematic Review

BACKGROUND

Bilateral risk-reducing mastectomies (RRMs) have been proven to decrease the risk of breast cancer in patients at high risk owing to family history or having pathogenic genetic mutations. However, few resources with consolidated data have detailed the patient experience following surgery. This systematic review features patient-reported outcomes for patients with no breast cancer history in the year after their bilateral RRM.

METHODS

The databases MEDLINE, Embase, and Scopus were used to identify studies. Studies were then evaluated by multiple authors, and their quality was assessed by using the Methodological Index for Non-Randomized Studies score.

RESULTS

Our search identified 1858 unique studies, of which 11 met our inclusion criteria. Only two of these studies included patients who did not receive postmastectomy reconstruction. The included studies were either retrospective cohort studies or prospective studies. General satisfaction with the outcome of RRM and the decision to undergo RRM was high across many of the studies, with low levels of regret. There was also a noticeable trend of improved psychosocial outcomes following RRM. For postoperative sexual well-being, body image, aesthetic satisfactions, and somatosensory function, there were a mix of positive and negative outcomes.

CONCLUSIONS

The patients who elected to manage their breast cancer risk with bilateral RRM (mostly with reconstruction) tend to be satisfied with their decision and the surgical outcomes. This may be related to decreased cancer-related anxiety. Postmastectomy psychosocial well-being tends to improve while physical health after surgery varies by patient.

Differentiated thyroid cancer in adolescents - does extent of disease at presentation differ with age?

OBJECTIVES

The authors sought to assess whether the age of 18 reflects a true pathological inflection point that justifies transitioning between pediatric and adult paradigms of care with differentiated thyroid cancer (DTC).

METHODS

A retrospective chart review was conducted for patients aged 12-24 undergoing hemithyroidectomy or total thyroidectomy for papillary or follicular thyroid carcinoma from 2010 to 2020.

RESULTS

A total of 153 patients receiving surgery for DTC were assessed for pathological stage, nodal metastasis, and thyroid neoplasm characteristics. When comparing pathologic tumor staging of patients <18 vs. ≥18 years old, there was a significant relationship between age and pT stage (p=0.009), but not between age and pN stage (p=0.319). However, when comparing patients ≤15 vs. >15 years, there was a significant relationship between age and pT stage (p=0.015) and age and pN stage (p=0.016). Patients ≤15 years of age most commonly had stage pT2 tumors (48.9 %, n=22), whereas most >15 years had stage pT1 tumors (37.9 %, n=41). Of patients whose lymph nodes were analyzed, patients ≤15 years were most likely to have pN1b disease (31.1 %, n=14), while patients >15 years were most likely to have pN0 disease (33.3 %, n=36).

CONCLUSIONS

In this sample, separating children and adults at an age of 15, rather than 18, yielded more significant differences in risk of nodal involvement. Markers of invasive histology were more common in patients older than 15, while nodal involvement was more common in patients 15 and under.

Clinical progression following acellular dermal matrix use for volume replacement after breast-conserving surgery

BACKGROUND

The cosmetic outcomes of breast-conserving surgery (BCS) have recently gained increasing attention, and surgeons are exploring the use of the acellular dermal matrix (ADM) as a safe and effective method of breast reconstruction. This study evaluated the clinical progress of patients with breast cancer following the application of sheet-type ADM for breast reconstruction after BCS.

METHODS

This retrospective study included 137 patients who underwent BCS using ADM at a single center between October 2019 and October 2021. During surgery, sheet-type ADM was folded and inserted into the excised defects. Complications and cancer recurrence were evaluated during surveillance follow-up until December 2023, and maintenance of the inserted ADM was quantitatively compared using volume analysis of the first and last follow-up computed tomography (CT).

RESULTS

Of the 137 evaluated patients, 16 (11.6%) had minor complications, and 17 (12.4%) underwent biopsy during the surveillance period. One patient was diagnosed with recurrence. ADM volume was measured in 55 patients. The mean volume reduction between the first and last CT scans was 1.81 ± 2.06 cm³ (a decrease of 17.42 ± 19.82%), which was statistically significant (p < 0.001).

CONCLUSIONS

The insertion of ADM after BCS is a safe and effective method for addressing volume defects, even though a slight reduction occurs in ADM volume.

Risk factors of cervical lymph node metastasis and distant metastasis in patients with primary squamous cell carcinoma of the thyroid: a population-based study

To analyze the risk factors associated with the occurrence of cervical lymph node metastasis (LNM) and distant metastasis (DM) in patients with primary squamous cell carcinoma of the thyroid (PSCCT). Clinical data of 96 patients with PSCCT from SEER database were obtained and analyzed by logistic regression for clinicopathological characteristics, including age, marital status, race, gender, tumor size (mm), extrathyroidal extension (ETE), multifocality, T stage, M stage and other indicators. Differences were considered statistically significant when P < 0.05. (1) Analysis of risk factors for the occurrence of cervical lymph node metastasis in patients with PSCCT: The results of univariate analysis showed that compared with patients without lymph node metastasis, patients with metastasis had a higher percentage of patients with the age ≥ 70 years old, tumor sizes greater than 40 mm, extrathyroidal extension, multifocal tumors, T4 stage and distant metastasis, the difference was statistically significant (P < 0.05). The results of multivariate analysis showed that multifocality and M stage were independent risk factors for the occurrence of LNM in PSCCT patients (P < 0.05). (2) Analysis of risk factors for the occurrence of distant metastasis in PSCCT patients: The results of univariate analysis showed that the percentage of patients who developed distant metastasis with age ≥ 70 years old, tumor size > 40 mm, T4 stage, and lymph node metastasis was higher than that of those who did not develop distant metastasis, and the difference was statistically significant (P < 0.05). The results of multivariate logistic regression analysis showed that cervical lymph node metastasis was an independent risk factor for the occurrence of distant metastasis in PSCCT patients (P < 0.05). (3) Relevant clinicopathologic features have not been found to be statistically significant with lung and bone metastasis, with P values greater than 0.05. Multifocality and M stage are independent risk factors for LNM in PSCCT patients, and cervical lymph node metastasis is an independent risk factor for distant metastasis in PSCCT patients. The findings of this study may provide guidance for individualized treatment plans for PSCCT patients.

The impact of age at diagnosis on central lymph node metastasis in clinically low-risk papillary thyroid microcarcinoma patients

BACKGROUND

Age is an independent risk factor for central lymph node metastasis (CLNM) in clinically negative lymph node (cN0) papillary thyroid microcarcinoma (PTMC) patients. The objective of this study was to investigate the impact of age on CLNM in clinically low-risk PTMC patients.

METHODS

A retrospective analysis was performed on patients with clinically low-risk PTMC who underwent surgery between January 2016 and December 2018. Logistic regression analysis was used to examine the impact of age on the risk of CLNM. The associations between age and pN1a and the lymph node ratio (LNR) were examined by a restricted cubic spline (RCS) curve with logistic regression models.

RESULTS

A total of 1352 patients (mean [range] age, 43[18-76] years; 325 males [24.0%]) were enrolled in this study. Logistic regression analysis revealed that age was a significant factor influencing the risk of CLNM (OR 0.95, 95% CI 0.94-0.96; p < 0.001). The RCS curve revealed a significant nonlinear association between age and pN1a status and the LNR. For patients under the age of 55, the risk of CLNM (OR 0.59, 95% CI 0.55-0.65, p < 0.001) and the LNR (beta - 0.23, 95% CI -0.27, -0.19, p < 0.001) significantly decreased as age increased. For patients aged ≥ 55 years, the risk of LNM (OR 1.03, 95% CI 0.81-1.32; p = 0.79) and the LNR (Beta - 0.03, 95% CI -0.07,0.13, p = 0.54) did not change with age.

CONCLUSIONS

This study confirmed that age was a significant factor influencing the risk and severity of CLNM in patients with low-risk PTMC. The risk and severity of LNM were lowest in patients aged ≥ 55 years.

Multi-omics clustering analysis carries out the molecular-specific subtypes of thyroid carcinoma: implicating for the precise treatment strategies

Thyroid cancer (TC) is the most prevalent endocrine malignancy worldwide. This study aimed to explore the molecular subtypes and improve the selection of targeted therapies. We used multi-omics data from 539 patients with DNA methylation, gene mutations, mRNA, lncRNA, and miRNA expressions. This study employed consensus clustering algorithms to identify molecular subtypes and used various bioinformatics tools to analyze genetic alterations, signaling pathways, immune infiltration, and responses to chemotherapy and immunotherapy. Two prognostically relevant TC subtypes, CS1 and CS2, were identified. CS2 was associated with a poorer prognosis of shorter progression-free survival times (P < 0.001). CS1 exhibited higher copy number alterations but a lower tumor mutation burden than CS2. CS2 exhibited activation in cell proliferation and immune-related pathways. Drug sensitivity analysis indicated CS2's higher sensitivity to cisplatin, doxorubicin, paclitaxel, and sunitinib, whereas CS1 was more sensitive to bicalutamide and FH535. The different activated pathways and sensitivity to drugs for the subtypes were further validated in an external cohort. Twenty-four paired tumors and adjacent normal tissues by immunohistochemical staining further demonstrated the prognostic value of CXCL17. In conclusion, we identified two distinct molecular subtypes of TC with significant implications for prognosis, genetic alterations, pathway activation, and treatment response.

Integrating radiomics into predictive models for low nuclear grade DCIS using machine learning

Predicting low nuclear grade DCIS before surgery can improve treatment choices and patient care, thereby reducing unnecessary treatment. Due to the high heterogeneity of DCIS and the limitations of biopsies in fully characterizing tumors, current diagnostic methods relying on invasive biopsies face challenges. Here, we developed an ensemble machine learning model to assist in the preoperative diagnosis of low nuclear grade DCIS. We integrated preoperative clinical data, ultrasound images, mammography images, and Radiomic scores from 241 DCIS cases. The ensemble model, based on Elastic Net, Generalized Linear Models with Boosting (glmboost), and Ranger, improved the ability to predict low nuclear grade DCIS preoperatively, achieving an AUC of 0.92 on the validation set, outperforming the model using clinical data alone. The comprehensive model also demonstrated notable enhancements in integrated discrimination improvement and net reclassification improvement (p < 0.001). Furthermore, the Radiomic ensemble model effectively stratified DCIS patients by risk based on disease-free survival. Our findings emphasize the importance of integrating Radiomic into DCIS prediction models, offering fresh perspectives for personalized treatment and clinical management of DCIS.

Secondary cytoreductive surgery for ovarian cancer recurrence and first-line maintenance therapy: A multicenter retrospective study

PURPOSE

To investigate surgical and oncologic outcomes of secondary cytoreductive surgery for ovarian cancer recurrence, considering the exposure to previous first-line maintenance therapy.

METHODS

We retrospectively identified all women who underwent secondary cytoreductive surgery for ovarian cancer recurrence with cytoreductive intent at three Italian Gynecologic Oncology centers (1997-2022). Data on clinical, surgical, and pathological characteristics, neoadjuvant, adjuvant, and maintenance therapy, as well as follow-up information, were retrieved from prospectively collected databases and medical records.

RESULTS

We identified 189 patients. Maintenance therapy in the first-line setting was implemented in 108/189 (57 %) cases: bevacizumab in 77.7 % (84/108), PARP inhibitors (Olaparib, Niraparib, or Rucaparib) in 15.7 % (17/108), and bevacizumab + PARP-inhibitors in 4.6 % (5/108). Complete cytoreduction rate and perioperative complications in secondary surgery were not associated with previous maintenance therapy. Complete cytoreduction was achieved in 75 % (140/189) of patients, and any residual tumor was the strongest predictor of poor progression-free (Hazard ratio [HR] 3.91, 95 %CI 2.48-6.16) and cause-specific survival (HR 4.27, 95 %CI 2.36-7.70). First-line bevacizumab was independently associated with worse progression-free survival among patients with any residual tumor at secondary surgery. First-line PARP inhibitors were independently associated with worse progression-free and cause-specific survival regardless of complete cytoreduction. Second-line maintenance therapies were independently associated with better survival regardless of residual tumor after secondary surgery.

CONCLUSION

Complete cytoreduction during secondary surgery for ovarian cancer recurrence is the strongest predictor of prognosis. First-line maintenance therapies do not appear to affect the safety and feasibility of secondary cytoreduction, although they may influence prognosis after secondary surgery.

Postoperative Outcomes and Complications in Menopaused Patients after Reduction Mammoplasty

Background

Symptomatic macromastia is a debilitating condition that affects millions of women worldwide. Although reduction mammoplasty is the gold standard treatment, the association between estrogen levels and wound healing has been established in literature. Hence, this study aimed to compare the postoperative outcomes and complications between menopaused and non-menopaused women after reduction mammoplasty.

Method

This study offers a retrospective multimodal observation and analysis comparing menopaused and non-menopaused women. Using data collected from January 2018 to May 2024, patients who met the selection criteria were divided into 2 groups. Complications following reduction mammoplasty were recorded and analyzed.

Results

A total of 110 patients were included in this study, among them 80 patients were in the non-menopaused group and 30 in the menopaused group. Our statistical analysis indicated that the hospital stay was significantly longer in the menopaused group (P=0.008). Additionally, postoperative dog ears were significantly more frequent in the menopaused group (P=0.034). Conversely, scar hypertrophy occurred more frequently in non-menopaused patients (P=0.02).

Conclusion

Although menopaused women undergoing single or bilateral reduction mammoplasty had longer duration of hospital stay, they did not have higher risk of postoperative complications, except for higher rate of developing dog ears, which may be ascribed to the faltering estrogen levels of this population. Non-menopaused women had a higher rate of hypertrophic scars.

Outcomes for Patients with Obesity Undergoing Adrenalectomy for Pheochromocytoma: An International Multicenter Analysis

OBJECTIVE

The impact of obesity on outcomes after adrenalectomy for pheochromocytoma is unclear. This study aims to evaluate outcomes after minimally invasive and open adrenalectomy for pheochromocytoma in patients with obesity and to determine factors that may affect outcomes. Patients undergoing adrenalectomy for pheochromocytoma in 46 international centers between 2012 and 2022 were reviewed, analyzing baseline information, length of hospital stay (LOS), and postoperative complications.

PATIENTS AND METHODS

Obese (body mass index (BMI) ≥ 30 kg/m2) and nonobese patients were compared. Multivariable analysis was utilized to evaluate outcomes and risk factors for complications, LOS, and increased comprehensive complication index (CCI).

RESULTS

Of the 2016 patients, 639 (31.7%) had obesity. Operative time (110.0 versus 105.0 min; p = 0.467), conversion to open rate (3.1% versus 4.7%; p = 0.079), estimated blood loss (20.0 versus 20.0 ml, p = 0.088), rate of complications (19.3% versus 20.8%; p = 0.425), and CCI were similar. However, patients with obesity required a median of 1 day longer LOS (4.0 days versus 5.0 days; p < 0.001). On multivariable analysis, obesity was not significantly associated with complications or higher CCI. Analyzing solely obese patients, laparoscopic (OR 0.24; p < 0.001) and robotic (OR 0.22; p = 0.011) approaches were independently associated with less morbidity. Additionally, multivariable modeling demonstrated that a retroperitoneal approach in patients with BMI ≥ 30 kg/m2 was independently associated with reduced CCI (- 3.74; p = 0.017). Similar results were demonstrated when analyzing severe obesity (BMI ≥ 35).

CONCLUSIONS

Obesity does not increase complications or CCI following pheochromocytoma resection, but it does increase LOS. A retroperitoneal approach may uniquely benefit patients with obesity. In view of rising obesity rates, these results warrant further research to validate findings.

Sensory restoration following breast reconstruction with operative reinnervation: A systematic review and meta-analysis

BACKGROUND

There is currently no consensus on the efficacy of operative reinnervation at the time of post-mastectomy reconstruction. This review compares postoperative sensation between innervated and non-innervated flaps in breast reconstruction through systematic review and meta-analysis.

METHODS

EMBASE, Ovid, and CENTRAL were searched from inception to December 6, 2023. The primary outcome was level of sensation postoperatively. Secondary outcomes included presence of sensation, breast-related complications, operative time, and quality of life. Meta-analysis was conducted using mean difference (MD) or standardized mean difference (SMD) for continuous outcomes and odds radio (OR) for dichotomous outcomes. Quality of evidence was appraised using RoB-2/ROBINS-I. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluations.

RESULTS

Twenty-eight studies were included; studies were observational studies except one randomized controlled trial. Common flaps were deep inferior epigastric perforator (11/28, 39.3%) and transversus rectus abdominis muscle (9/28, 32.1%). Innervated flaps were significantly associated with improved level of postoperative sensation (SMD: -0.94, 95% CI: [-1.35; -0.53], I2: 78%, p < 0.01), presence of postoperative sensation (OR: 11.4, 95% CI: [5.09; 24.5], I2: 0%, p < 0.01), and improved postoperative BREAST-Q scores (MD: 8.11, 95% CI: [4.33; 11.89], I2: 27%, p < 0.01). However, certainty of evidence was low/very low for all outcomes. Most studies had moderate risk of bias (56.5%). There were no statistically significant differences in breast-related complications or operative time.

CONCLUSIONS

Operative reinnervation in breast reconstruction is significantly associated with improved level and presence of postoperative sensation and BREAST-Q scores without significant increase in breast-related complications/operative time. More high-quality studies are required to improve the certainty of outcomes.

Role of tranexamic acid (TXA) in plastic and reconstructive surgery: A national perspective

PURPOSE

Despite the widespread use of tranexamic acid (TXA) in plastic surgery, guidelines for the safe and effective administration have yet to be established. The present study reports the current practices of TXA usage in plastic and reconstructive surgery procedures among members of the American Society of Plastic Surgeons (ASPS).

METHODS

An online survey was distributed to all active members of the ASPS. The survey was organized into three general parts: (1) demographic data and practice profiles; (2) familiarity, perceptions, and experience with TXA in various plastic surgery fields including craniofacial surgery, aesthetic surgery, burn care, microsurgery, and Mohs surgery; and (3) TXA dosage, mode, and time of administration.

RESULTS

Five hundred two ASPS members completed the survey (21% response rate). Among the respondents, TXA use was most common in aesthetic surgery (90.3%), craniofacial surgery (78.2%), and breast reconstruction (61.8%). The most common procedures performed under TXA were facial procedures, including facelift (83.6%), neck lift (77.1%), forehead and browlift (54.8%), and rhinoplasty (55.0%). TXA administration protocols in aesthetic procedures included IV bolus (52.3%) and topical administration (50.5%). The most common IV bolus dose was 1 g (43.2%) and the most common TXA solution concentration was 3% (36.0). A total of 92.4% of respondents reported that they had never observed any TXA-related complications.

CONCLUSIONS

The results reflect the widespread use of TXA among ASPS members, the preferred administration protocols in plastic surgery, and TXA's efficacy and favorable safety profile across a wide range of procedures.

Sensory preservation in reduction mammoplasty using the nipple-areola complex-carrying pedicle technique for gigantomastia: A systematic review and meta-analysis

Background

Gigantomastia is a disabling condition characterized by excess breast tissue. Historically, free nipple graft (FNG) has been preferred, prioritizing the nipple-areola complex (NAC) vascularity. The NAC-carrying pedicle technique, which is most commonly used in case of hypertrophy of the breast, has been suggested as a viable alternative for gigantomastia according to recent evidence, with reduced rates of NAC necrosis and improved outcomes. Nevertheless, a detailed outcome evaluation of the technique in terms of sensory preservation is currently lacking. Therefore, this systematic review and meta-analysis aimed to assess the risk of sensory loss associated with the NAC-carrying pedicle technique in cases of gigantomastia.

Methods

Following the PRISMA guidelines, a literature search identified studies reporting postoperative sensitivity with the NAC-carrying pedicle technique in resections exceeding 1000 g of adipo-glandular tissue. Then, a proportion meta-analysis was conducted to assess the pooled rate of sensation loss through the NAC-carrying pedicle technique.

Results

Seventeen studies (843 patients, 1685 breasts) met the inclusion criteria. The meta-analysis revealed an exceptionally low risk of sensory loss with the NAC-carrying pedicle technique (1.3%; 95% confidence interval: 0.7-2.0), without significant statistical heterogeneity.

Conclusion

This study provides the first comprehensive evaluation of sensory preservation with the NAC-carrying pedicle technique in gigantomastia. The NAC-carrying pedicle technique emerges as the first choice, offering safety and favorable functional outcomes. Surgical caution remains crucial with the option to switch to FNG as required, ensuring patient safety and procedure success. Further research on the impact of different NAC-carrying pedicle techniques on sensory preservation is warranted.

Limited consensus on the diagnosis and treatment of lymphedema after head and neck cancer: results from an International Delphi study

PURPOSE

To explore current practice variation and degree of consensus among international clinical experts regarding the diagnosis, classification, measurement, and treatment of head and neck lymphedema (HNL) after head and neck cancer treatment.

MATERIALS AND METHODS

We conducted an online Delphi study. Eligible participants were clinical researchers who had (co)authored at least one publication on HNL and healthcare professionals who had treated at least five patients with HNL the last two years. The first round was to collect views about current best practices. The second and third rounds delved deeper into these topics using statements with 7-point adjective rating scales.

RESULTS

An expert panel of seventeen participants (7 clinicians, 8 researchers, and 2 others) from 8 countries completed all rounds. Regarding diagnosis, there was limited consensus on most subjects, with palpation being most endorsed. No consensus was reached on the need to use standardized classification systems. As a treatment method, complex decongestive therapy (CDT) was the most commonly used in practice and investigated in the literature. However, no consensus was reached on the importance of aspects of CDT.

CONCLUSIONS

There is substantial intra- and international practice variation in the management of HNL. This calls for more robust evidence and guidelines.

Disorders of Lymphatic Architecture and Flow in Critical Illness

OBJECTIVES

To provide a narrative review of disordered lymphatic dynamics and its impact on critical care relevant condition management.

DATA SOURCES

Detailed search strategy using PubMed and Ovid Medline for English language articles (2013-2023) describing congenital or acquired lymphatic abnormalities including lymphatic duct absence, injury, leak, or obstruction and their associated clinical conditions that might be managed by a critical care medicine practitioner.

STUDY SELECTION

Studies that specifically addressed abnormalities of lymphatic flow and their management were selected. The search strategy time frame was limited to the last 10 years to enhance relevance to current practice.

DATA EXTRACTION

Relevant descriptions or studies were reviewed, and abstracted data were parsed into structural or functional etiologies, congenital or acquired conditions, and their management within critical care spaces in an acute care facility.

DATA SYNTHESIS

Abnormal lymph flow may be identified stemming from congenital lymphatic anomalies including lymphatic structure absence as well as acquired obstruction or increased flow from clinical entities or acute therapy. Macro- and microsurgical as well as interventional radiological techniques may address excess, inadequate, or obstructed lymph flow. Patients with deranged lymph flow often require critical care, and those who require critical care may concomitantly demonstrate deranged lymph flow that adversely impacts care.

CONCLUSIONS

Critical care clinicians ideally demonstrate functional knowledge of conditions that are directly related to, or are accompanied by, deranged lymphatic dynamics to direct timely diagnostic and therapeutic interventions during a patient's ICU care episode.

Adrenocorticotropin-Secreting Pure Adrenal Ganglioneuroma Leading to Cushing Syndrome

Adrenal ganglioneuromas (AGNs) are rare benign neoplasms of neural crest origin that are typically asymptomatic and endocrinologically inactive. However, on occasion, AGNs have been noted to demonstrate secretion of various hormones. We present a case of a 23-year-old man who presented with hypertension and clinical symptoms concerning for a catecholamine excess state with evidence of a right adrenal mass with elevated Hounsfield units (HU) on abdominal computed tomography (CT) and laboratory values consistent with mild hypercortisolism concerning for adrenocorticotropin (ACTH)-producing pheochromocytoma leading to Cushing syndrome (CS). The patient underwent adrenalectomy with pathology results demonstrating a pure AGN with positive ACTH staining. While secretory AGNs are rare, it is important that providers remain cognizant of this pathology and consider it within the evaluation of adrenal lesions at large with an understanding that clinical presentation may be difficult to interpret and will likely vary based on the underlying hormone(s) being secreted. Additionally, secretory AGNs can mimic other adrenal neoplasms and histopathologic evaluation is required for definitive diagnosis. This case demonstrates how ACTH-producing AGNs should be considered when evaluating cases of ACTH-dependent CS.

Incidence of lymphedema among adults with cerebral palsy

BACKGROUND

Lymphedema is a chronic and progressive condition but is understudied among adults with cerebral palsy (CP).

OBJECTIVE

To compare the 2-year incidence of lymphedema between adults with versus without CP before and after accounting for multimorbidity, cancer diagnosis/treatment, and lymph node/channel surgery.

DESIGN

Retrospective cohort study.

SETTING

Nationwide commercial claims data from January 1, 2011 to December 31, 2017.

PARTICIPANTS

Adults ≥18 years old with and without CP with at least 12 months of continuous health plan enrollment, defined as the baseline period, were included for analysis. The 12-month baseline period was used to establish information on preexisting lymphedema (for exclusion), presence of cancer, including radiation treatment and lymph node surgery, and the Whitney Comorbidity Index (WCI).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The 2-year incidence rate (IR) and IR ratio (IRR) of lymphedema were evaluated. Cox regression estimated the hazard ratio (HR) of 2-year lymphedema after adjusting for age, gender, WCI, cancer diagnosis/treatment, and lymph node/channel surgery.

RESULTS

The 2-year IR of lymphedema was 5.73 (95% confidence interval [CI] = 4.59-6.88) for adults with CP (n = 9922) and 1.81 (95% CI = 1.79-1.83) for adults without CP (n = 12,932,288); the IRR was 3.17 (95% CI = 2.59-3.87) and the adjusted HR was 2.43 (95% CI = 1.98-2.98). There was evidence of effect modification by gender, age, and WCI score. All HRs were elevated, but men with versus without CP had higher HRs than women with versus without CP; HRs for adults with versus without CP were higher for younger participants and those with lower WCI scores.

CONCLUSIONS

Adults with CP had a higher 2-year rate of lymphedema compared with those without CP. Men with CP had a disproportionately higher rate than women with CP when compared with their gender-based reference cohorts without CP.

Nipple Preserving Wise-Pattern Mastopexy Following Deep Inferior Epigastric Perforator Flap Breast Reconstruction: Description of the Surgical Technique and Clinical Results

Breast revision surgery is often necessary in patients following postmastectomy breast reconstruction with free autologous flaps for aesthetic improvement. Indications for nipple-sparing mastectomy continue to be expanded oncologically. However, revision techniques for aesthetic concerns following breast reconstruction are underreported in the literature. Therefore, we describe a mastopexy technique following deep inferior epigastric perforator (DIEP) flap breast reconstruction after nipple-sparing mastectomy to correct ptosis and reshape the breast. The blood supply of the nipple-areolar-complex is through the microvasculature of the DIEP flap and subdermal plexus. We report three patients who underwent nipple preserving Wise-pattern mastopexy following DIEP flap breast reconstruction.

Global perspectives on practices and preferences in autologous free flap breast reconstruction: From flap selection to postoperative care A descriptive quantitative study

Background

The purpose of this study was to evaluate the present-day practices in the preparation, peri-, and postoperative care for patients undergoing autologous free flap breast reconstructions (ABR) worldwide, with the aim of enhancing informed decision-making for plastic surgeons during the planning stages of ABR.

Methods

A global survey was conducted among 280 plastic surgeons and 39 plastic and reconstructive surgery societies worldwide, enquiring about flap and donor site selection, surgical actions, perforator imaging, and perioperative care during ABR.

Results

Eighty-two responses were received, among which 71% (n=58) were completed questionnaires. The preferred flap of choice was the deep inferior epigastric perforator flap (85%, n=51), with the internal mammary artery as the most commonly used recipient vessel. Preoperative imaging for ABR was typically performed using computed tomography angiography (75%, n=44) and often combined with a handheld Doppler. Handheld Doppler was the most frequently used modality to localize perforator vessels during surgery (33%, n=19), with the majority using either one (47%, n=24) or two (51%, n=26) perforators intraoperatively. These preferences were consistent across all clinic types.Postoperatively, flap monitoring was primarily performed by the nursing staff, initially every hour on the first day and at reduced frequencies on subsequent days.The most commonly used modality for monitoring flap viability was the handheld Doppler. The average length of hospital stay was 5 days.

Conclusion

This study provides valuable insights into the current preparations and peri- and postoperative care in ABR procedures worldwide, aiding in the development of standardized practices and potentially improving patient outcomes.

Magnetic resonance imaging features of primary lower extremity lymphedema: A retrospective analysis of 228 patients

BACKGROUND

The value of magnetic resonance imaging (MRI) presentation of primary lower extremity lymphedema in assessing the severity of lower extremity lymphedema is uncertain. The purpose of this study was to assess the role of MRI presentation in staging primary lower extremity lymphedema.

METHODS

We enrolled 228 patients with clinically diagnosed primary lower limb lymphoedema from January 2018 to December 2019 in our hospital retrospectively. Patients were divided into stages I, II, and III based on the 2020 International Society of Lymphology clinical staging standards. Two radiologists assessed the following characteristics of the short-term inversion recovery sequence: the extent of edema (longitudinally and transversely); the frequency of MRI manifestations, including the presence of dermal thickening; and the morphology of edema (grid, honeycomb, parallel lines, banded, crescent, and lymphatic lake). The kappa test was used to assess interobserver agreement. The χ2 test was used to compare the frequency differences of MRI manifestations between different clinical stages. The Spearman test evaluated the correlation between edema extent and clinical stage.

RESULTS

The extent of edema was correlated positively with clinical stage, both longitudinally and transversely. When comparing stages, the incidence of dermal thickening in stages II and III was significantly higher than in stage I. The incidence of parallel lines in stage I was significantly higher than that in stages II and III. The grid and banded sign incidence in stages I and II were significantly higher than in stage III. The incidence of honeycomb in stages II and III was significantly higher than in stage I. The incidence of lymphatic lake and crescent in stage III was significantly higher than in stages I and II (P < .001).

CONCLUSIONS

Short-term inversion recovery can sensitively diagnose lymphedema and assist in clinical staging. MRI manifestations of primary lower extremity lymphedema in different stages have specific MRI features.

Long-Term Follow-Up of Surgical Outcomes and Oncological Results of Nipple-Sparing Mastectomy with Immediate Reconstruction Through a Single Axillary Incision with Different Approach Methods

BACKGROUND

We investigated the perioperative outcome and oncologic safety of performing nipple-sparing mastectomy (NSM) through a single axillary incision (NSM-SAI) compared with performing NSM through a conventional incision (NSM-C).

METHODS

We retrospectively reviewed 725 patients who underwent NSM for breast cancer between January 2010 and December 2023; 333 patients who underwent NSM with immediate reconstruction (IR) were enrolled. Surgical outcomes and oncologic outcomes of NSM-C (n = 184), NSM performed through SAI with a freehand approach (NSM-SAI-F; n = 92), and with an endoscopic approach (NSM-SAI-E; n = 57) were demonstrated. The risk factors for resection margins, nipple-areolar complex (NAC), and skin flap necrosis were evaluated separately for NSM-C and NSM-SAI.

RESULTS

NAC and skin flap necrosis occurrence rates among the NSM-C, NSM-SAI-F, and NSM-SAI-E groups were similar (insignificant), regardless of autologous or prosthesis reconstruction. The tumor-to-nipple distance among patients who underwent NSM-C was an independent risk factor for NAC necrosis in the NSM-C group (odds ratio [OR] 6.02, p = 0.007); being overweight and tumor location in the lower breast were risk factors for skin necrosis in the NSM-C group (OR 3.36, p = 0.041; and OR 4.32, p = 0.011, respectively). These risk factors were not associated with the NSM-SAI group. The three groups had comparable positive resection margins, local recurrence-free survival, and distant metastasis-free survival rates (p = 0.857, 0.543, and 0.975, respectively).

CONCLUSIONS

NSM-SAI combined with IR by the freehand or endoscopic approaches can provide good aesthetic outcomes and oncologic safety for well-selected patients with breast cancer. The risk factors for NAC and skin flap necrosis differ between the NSM-SAI and NSM-C groups.

Breast sensibility after reconstruction: Comparison of different methods

BACKGROUND AND OBJECTIVES

Sensibility of the breast area is a key factor in quality-of-life evaluation after breast reconstruction (BR). Breast sensation can be assessed using numerous tools that are already largely described in the literature, including the Semmes Weinstein filaments which remain the most frequently used. Although different reconstruction techniques are available, post-BR sensitivity is rarely described. The aim of this study was to evaluate post-BR sensibility of the breast according to each reconstruction technique.

MATERIAL AND METHODS

Fifteen patients were included in each group, i.e. 90 patients in total: before BR, Latissimus Dorsi (LD) flap with implant, LD flap with fat grafting, exclusive fat grafting, Deep Inferior Epigastric Perforator (DIEP) flap, implant. A single evaluator assessed the sensibility with Semmes Weinstein filaments testing 7 zones on both sides. The native breast was considered as control. Various potential confounding factors were collected.

RESULTS

Patients who benefited from BR with fat grafting alone had a significantly better sensation of the reconstructed breast compared to the other groups (DIEP flap (P<0.0001), LD flap+implant (P=0.0013), LD flap with fat grafting (P=0.0073), implant (P=0.00315)). Comparing those results to the ones obtained in the group before reconstruction, only the fat grafting and DIEP flap groups showed a difference, the fat grafting group (P=0.0061) had higher sensibility whereas DIEP flaps were less sensitive (P=0.00233).

CONCLUSION

We compared mammary sensibility depending on the BR technique used. Our study is the first comparing breast sensitivity among all major breast reconstruction methods. Fat grafting resulted in better breast sensitivity in delayed breast reconstruction than implant or flap-based BR.

Multiparameter and Ultrasound Radiomics Nomogram to Predict the Aggressiveness of Papillary Thyroid Carcinomas: A Multicenter, Retrospective Study

RATIONALE AND OBJECTIVES

To construct a multiparameter radiomics nomogram based on ultrasound (US) to predict the aggressiveness of thyroid papillary carcinoma (PTC).

MATERIALS AND METHODS

In total, 471 consecutive patients from three institutions were included in this study. Among them, patients from institution 1 were used for training (n = 294) and internal validation (n = 92), while 85 patients from institution 2 and institution 3 were used for external validation. Radiomics features were extracted from the conventional US. The least absolute shrinkage was employed to select the most relevant features for the aggressiveness of PTC, along with the maximum relevance minimum redundancy algorithm and selection operator. These features were then used to construct the radiomics signature (RS). Subsequently, relevant multiparameter ultrasound (MPUS) features from shear-wave elastic (SWE) and strain elastography (SE) will be extracted using multivariable logistic regression. The final radionics nomogram was conducted using the RS, clinical information, and conventional US and MPUS features. The receiver operating characteristic (ROC), calibration, and decision curves were used to evaluate the performance of the nomogram.

RESULTS

Multivariable logistic regression analysis indicated that age, nodule size, capsule abutment, SWV tumor, and RS were independent predictors of the aggressiveness of PTC. The radiomics nomogram, utilizing these characteristics, displayed impressive performance with an AUC of 0.920 [95% CI, 0.889-0.950], 0.901 [95% CI, 0.839-0.963], and 0.896 [95% CI, 0.823-0.969] in the training, internal, and external validation cohort. It outperformed the clinical US, MPUS, and RS models (p < 0.05). The decision curve analysis indicated that the nomogram offered valuable clinical utility.

CONCLUSION

The nomogram incorporated MPUS and radiomics have good diagnostic performance in predicting the aggressiveness of PTC which may help in the selection of the surgical modality.

Preoperative Prediction of Occult Level V Lymph Node Metastasis in Papillary Thyroid Carcinoma: Development and Validation of a Radiomics-Driven Nomogram Model

RATIONALE AND OBJECTIVES

The study aimed to analyze the patterns and frequency of Level V lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC), identify its risk factors, and construct predictive models for assessment.

METHODS

We conducted a retrospective analysis of 325 PTC patients who underwent thyroidectomy and therapeutic unilateral bilateral modified radical neck dissection from October 2020 to January 2023. Patients were randomly allocated into a training cohort (70%) and a validation cohort (30%). The radiomics signature model was developed using ultrasound images, applying the minimum Redundancy-Maximum Relevance and Least Absolute Shrinkage and Selection Operator regression to extract high-throughput quantitative features. Concurrently, the clinic signature model was formulated based on significant clinical factors associated with Level V LNM. Both models were independently translated into nomograms for ease of clinical use.

RESULTS

The radiomics signature model, without the inclusion of clinical factors, showed high discriminative power with an area under the curve (AUC) of 0.933 in the training cohort and 0.912 in the validation cohort. Conversely, the clinic signature model, composed of tumor margin, simultaneous metastasis, and high-volume lateral LNM, achieved an AUC of 0.749 in the training cohort. The radiomics signature model exhibited superior performance in sensitivity, specificity, positive predictive value, negative predictive value across both cohorts. Decision curve analysis demonstrated the clinical utility of the radiomics signature model, indicating its potential to guide more precise treatment decisions.

CONCLUSION

The radiomics signature model outperformed the clinic signature model in predicting Level V LNM in PTC patients. The radiomics signature model, available as a nomogram, offers a promising tool for preoperative assessment, with the potential to refine clinical decision-making and individualize treatment strategies for PTC patients with potential Level V LNM.

Spontaneous hemorrhage in adrenal myelolipoma treated with elective laparoscopic adrenalectomy following selective arterial embolization

Introduction

Adrenal myelolipoma is a benign adrenal tumor that is typically asymptomatic and is rarely associated with hemorrhage or rupture. Here, we present a case of adrenal myelolipoma with spontaneous hemorrhage.

Case presentation

A 72-year-old man with a history of obesity and hypertension visited the Department of Emergency Medicine with a sudden onset of severe left flank pain. Enhanced computed tomography showed a left adrenal tumor containing a fat component with a focus of contrast medium visualized extravasation. The patient was diagnosed with adrenal myelolipoma with spontaneous hemorrhage. Selective adrenal arterial embolization was performed to manage the severe pain, and the condition immediately improved. Four months later, laparoscopic left adrenalectomy was performed via a transperitoneal approach. Histopathological examination confirmed the diagnosis of adrenal myelolipoma.

Conclusion

Urgent transarterial embolization followed by elective laparoscopic adrenalectomy is a safe and minimally invasive treatment option for managing adrenal myelolipomas with hemorrhage.