This study aims to comprehensively evaluate the short-term changes in ocular surface parameters and meibomian gland function following Full-incision double-eyelid blepharoplast. In this observational self-controlled study, 50 patients (100 eyes) undergoing full-incision double-eyelid blepharoplasty were enrolled. Assessments were conducted preoperatively and at 1 week, 1 month, and 3 months postoperatively. These included the Ocular Surface Disease Index (OSDI) questionnaire, fluorescein tear film break-up time (FBUT), corneal fluorescein staining (CFS), Schirmer I test, meibum quality, meibomian gland expressibility, meibomian gland dropout (excluding 1-week), lipid layer thickness (LLT), and incomplete blinking rate (IBR). Statistical comparisons were performed using ANOVA with post-hoc analysis. Compared to baseline, OSDI scores, meibum quality, meibomian gland expressibility, and IBR showed statistically significant deterioration at both 1 week and 1 month post-surgery (all p < 0.001). In contrast, no significant changes were observed in FBUT, CFS, Schirmer I test, LLT, or meibomian gland dropout at any time point. By the 3-month follow-up, all significantly altered parameters-OSDI, meibum quality, expressibility, and IBR-had recovered to levels that were not statistically different from preoperative baseline values. Full-incision double-eyelid blepharoplasty induces a transient but significant dysfunction of the ocular surface and meibomian glands in the early postoperative period, which is closely associated with a sharp increase in incomplete blinking. These findings underscore the importance of proactive postoperative management, including dry eye counseling, artificial tears, and blink training, to enhance patient comfort during the recovery phase. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Currently, surgical resection remains the first choice for treating early breast cancer. Cryoablation, a minimally invasive ablative technique, can inactivate the target tumor in situ, after which patients typically require further treatments, including surgery. However, reports are limited on the impact of cryoablation on subsequent breast-conserving surgery (BCS). This study aims to clarify the role of preoperative cryoablation in guiding BCS for early breast cancer, specifically whether cryoablation could influence the rate of positive or close resection margin in BCS. This study retrospectively analyzed the clinical characteristics and treatment data of patients who underwent BCS at our center between December 2024 and December 2025. After propensity score matching (PSM), 111 patients were paired: 37 in the cryoablation group and 74 in the surgery group. The clinical data of both groups were compared to evaluate the feasibility of cryoablation-guided BCS for early-stage breast cancer, its impact on the outcomes of BCS and sentinel lymph node biopsy (SLNB). Ultrasound-guided cryoablation was successfully performed under local anesthesia in all 37 patients, with a complete ablation rate of 94.59% [35/37; 95% confidence interval (CI): 82.3-98.5%]. Compared to the surgery group, the cryoablation group had a lower rate of positive or close margin for BCS (5.41% vs. 32.43%, P=0.002), and a higher rate of accurate surgery (83.78% vs. 59.46%, P=0.01). The mean duration of BCS was shorter in the cryoablation group than in the surgery group (76.65±8.17 vs. 86.50±16.29 min, P<0.001). Additionally, the mean post-operative length of stay (LOS) in the cryoablation group was approximately one day shorter than that in the surgery group (1.59 vs. 2.62 days, P<0.001). Furthermore, the success rate of SLNB was 100% in both groups. This retrospective study demonstrated that cryoablation-guided BCS was feasible and safe. Compared to standard BCS, cryoablation-guided BCS was associated with a higher accuracy in resection, a lower positive or close margin rate, shorter surgical duration and post-operative LOS. Additionally, cryoablation did not negatively impact the success rate of subsequent SLNB.
The gold standard for diagnosing central precocious puberty(CPP) is the gonadotropin-releasing hormone stimulation test, along with magnetic resonance imaging(MRI) of the brain and hypothalamus-pituitary region to rule out central organic causes. Recent advancements have led to a new medical imaging approach called radiomics. Our recent study showed that pituitary gland radiomics is a promising tool for diagnosing CPP. However, the role of the pineal gland in the onset of puberty has long been debated. Therefore, we investigated radiomic features of the pineal gland associated with puberty onset to identify changes that could assist physicians in the diagnostic workup of CPP. 45 girls with a confirmed diagnosis of CPP and 47 pre-pubertal, age-and sex-matched subjects(controls) were retrospectively enrolled. Two readers(R1, R2) with different levels of expertise in pediatric neuroradiology blindly segmented the pineal gland on MRI studies for radiomic features(RFs) calculation and manually evaluated the number and diameter of pineal cysts. Cross-validated linear discriminant analysis was used to develop, for each reader, both a radiomic model and a reference model based on pineal cyst features. Radiomics was evaluated in terms of predictive performances(ROC-AUC) and reliability of predictors between readers (intraclass correlation coefficient). Finally, the correlation between cysts' features and basal/peak gonadotropin and estradiol levels was also investigated. Two radiomic features were identified as the most predictive of CPP for both readers. However, these features were not the same for R1 and R2 readers and their values showed poor inter-reader reliability. Unpromising performance in the validation set was observed for pineal gland radiomics (ROC-AUC of 0.64 for R1 and 0.59 for R2). Similarly, the reference model based on pineal cyst features demonstrated a poor performance (ROC-AUC = 0.52, both readers). No significant correlations between cyst features and basal/peak gonadotropin levels were observed. Radiomic features of the pineal gland in girls did not show consistent and relevant changes with the onset of puberty and do not hold promise for the CPP diagnosis at variance with previous findings in the pituitary gland. Similarly, the number and size of cysts were not found to be specific for the onset of puberty.
This study aims to summarize the spectrum, characteristics, treatment strategies, and long-term prognosis of pediatric parotid gland masses. The authors retrospectively reviewed 136 children who underwent surgeries for parotid gland masses from January 2015 to December 2024. This review analyzed data regarding clinical presentations, imaging examinations, postoperative pathologic findings, and the results of long-term follow-up (≥12 mo). Congenital lesions were the most common, accounting for 63.2% (86/136) of cases, and included hemangiomas, lymphangiomas, and first branchial cleft fistulas. Pleomorphic adenomas of the parotid gland represented 15.4% (21/136), while all malignant tumors identified were lymphomas, comprising 6.6% (9/136). During a median follow-up period of 38 months, the incidence of temporary facial nerve palsy following surgery was recorded at 5.1% (7/136), and the overall recurrence rate was 7.4% (10/136). A total of 119 patients achieved complete remission, with no deaths occurring during the study period. Benign lesions are the predominant type of parotid gland masses in children, and CT scans are vital for the diagnosis and preoperative assessment of these lesions. Surgery is the main treatment method. Long-term follow-up has shown that for vascular lymphatic malformations prone to recurrence, local injection of bleomycin is a safe and effective adjunctive therapy. This study provides empirical evidence for optimizing the clinical management pathway for this disease.
Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the parotid gland. High-grade MEC has a high degree of malignancy, strong invasiveness, lacks obvious clinical and imaging features, and is prone to misdiagnosis. Moreover, the literature on the ultrasonic characteristics of MEC is limited. This article retrospectively analyzes the multimodal ultrasound features of a case of MEC. A 68-year-old Asian man noticed a raised mass beneath his right earlobe one year ago. Initially, the mass was painless, leading the patient to delay seeking medical attention. Over time, the mass has increased in size, prompting the patient to seek further evaluation at this hospital. Upon examination, a palpable mass measuring approximately 2.5 cm ×2.0 cm was identified beneath the right earlobe. The mass exhibited distinct borders, fair mobility, no tenderness, normal skin surface, and low skin temperature. The patient denies any significant family history of disease and has no history of infectious diseases or prior radiation therapy. Following comprehensive multimodal ultrasound diagnostic evaluation, the lesion was suspected to be a malignant neoplasm of the parotid gland. Subsequent pathological examination confirmed the diagnosis of MEC of the parotid gland. So the patient underwent surgery to remove the parotid gland mass under general anesthesia. This report provides a detailed description of the multimodal ultrasound imaging features of MEC. It underscores the potential value of this technique in the diagnostic process. The case aims to improve the understanding of this disease and enhance clinicians' ability to achieve an early diagnosis, thereby reducing the risks of misdiagnosis and delayed treatment.
This study aims to compare the effect of meibomian gland expression (MGX) combined with lid hygiene versus lid hygiene alone on the meibomian gland's morphology and function for obstructive meibomian gland dysfunction (oMGD). In this assessor-masked, parallel-group, randomized controlled trial, 64 oMGD patients with mild and moderate meibomian gland (MG) dropout were randomly allocated 1:1 into the MGX and control groups. All participants were informed to do lid hygiene once daily, while the intervention group received MGX every 2 weeks. The primary outcome was the change in MG dropout. Secondary outcomes included the Ocular Surface Disease Index (OSDI), tear stability, MG functions, changes in tear cytokine levels, and safety of MGX in a 12-week follow-up. Sixty-two eyes of sixty-two patients were enrolled in this study. The dropout area of MG decreased significantly in both groups following treatment at all time points. The recovery was faster in the MGX group at 4 weeks (p<0.001). However, no significant difference was observed between the groups after 8 to 12 weeks. Additionally, the MGX group also showed better improvement in OSDI and meibum quality than the control group, while no significant differences were observed between groups for other measures. No adverse events were reported, and the pain level was mild. MGX combined with lid hygiene results in a 13% reduction in MG dropout in the upper and lower eyelids. Moreover, the rate of improvement in MG morphology was faster in patients who underwent additional MGX than in those who performed lid hygiene alone.
Secondary hyperparathyroidism (SHPT) is a major component of chronic kidney disease-mineral and bone disorder (CKD-MBD), reflecting progressive disturbances in mineral metabolism, endocrine signaling, skeletal remodeling, and parathyroid-gland biology. Traditionally, preoperative parathyroid hormone (PTH) has been used primarily as a biochemical threshold for surgical referral. However, persistent PTH elevation in advanced CKD-related SHPT may reflect more than isolated endocrine activity; available evidence suggests it integrates parathyroid-gland remodeling, receptor resistance, skeletal turnover, treatment refractoriness, and systemic CKD-MBD severity. This review summarizes key molecular and cellular mechanisms of progressive SHPT, including diffuse-to-nodular hyperplastic transition, downregulation of calcium-sensing receptor (CaSR) and vitamin D receptor (VDR) signaling, disruption of the fibroblast growth factor 23 (FGF23)-Klotho axis, and activation of transforming growth factor-α (TGF-α)/epidermal growth factor receptor (EGFR) proliferative pathways. Building on this mechanistic framework, we discuss how persistent PTH elevation has been linked to glandular remodeling, resistance to calcimimetic and vitamin D therapy, high-turnover renal osteodystrophy, hungry bone syndrome, altered intraoperative PTH kinetics, postoperative endocrine-skeletal remodeling, and long-term recurrence. Severe SHPT is also increasingly recognized as a systemic CKD-MBD phenotype associated with vascular calcification, cardiovascular risk, metabolic instability, and impaired quality of life. Within this framework, preoperative PTH is best interpreted as an integrated biomarker within a broader assessment of glandular remodeling, skeletal metabolic activity, endocrine resistance, and systemic CKD-MBD biology, rather than as an isolated biochemical threshold.
Perioperative nutritional management is crucial for patients undergoing prostate cancer (PCa) surgery, as malnutrition is prevalent and strongly associated with increased complications and impaired recovery. Despite numerous guidelines for cancer or surgical patients, evidence specific to the perioperative care of prostatectomy patients remains fragmented, inconsistent, and lacks a unified, up-to-date synthesis, creating a barrier to consistent clinical application. This review aimed to systematically search, appraise, and synthesize the best available evidence on perioperative nutritional support for patients undergoing PCa surgery, addressing the current fragmentation in existing guidelines and recommendations. The PICOS framework defined the scope: Patients undergoing PCa surgery; Interventions of perioperative nutritional management; Compared to standard care or alternative strategies; Outcomes including nutritional indicators, complications, and quality of life; Study types including guidelines, expert consensus, systematic reviews, evidence summaries, and randomized controlled trials (RCTs). A comprehensive search of PubMed, Embase, CINAHL, Cochrane Library, and CNKI was conducted up to March 2026. Two reviewers (T.C., M.L.) independently screened studies, assessed quality [using Appraisal of Guidelines for Research & Evaluation II (AGREE II) for guidelines and JBI tools for other study types], and extracted data. Evidence was synthesized and graded (JBI system, Level 1-5). Fourteen studies were included: 4 guidelines, 5 expert consensus documents, 3 systematic reviews, 1 evidence summary, and 1 RCT. The guidelines demonstrated high methodological quality. All other study types were rated as "yes" across all evaluated items, indicating acceptable to high quality. From these, 30 best-evidence recommendations were synthesized, covering six domains: preoperative nutritional assessment, optimal timing of supplementation, personalized formulation, enteral nutrition selection, management strategies, and health education. This review consolidates evidence-based recommendations to guide perioperative nutritional care for prostatectomy patients, supporting early screening, personalized oral nutritional supplements (ONS), and sustained health education. However, evidence regarding stage-specific needs, particularly for patients receiving androgen deprivation therapy (ADT), remains limited and represents a key priority for future high-quality research.
Delayed postoperative hyponatremia (DPH) is a common complication following pituitary surgery. Although hypocortisolism has been proposed as a contributing factor, the temporal interplay between cortisol and sodium levels remains unclear. This study aimed to elucidate the relationship between postoperative cortisol and sodium dynamics, identify independent predictors of DPH and assess potential protective factors. We retrospectively analyzed 261 patients who underwent fully endoscopic surgery for clinically non-functioning pituitary neuroendocrine tumors (Pit-NETs, also known as pituitary adenomas) between 2021 and 2024. Serial measurements of serum sodium and morning cortisol were collected from the immediate postoperative period through 3-month follow-up. Comparative analyses between patients with and without DPH were performed to characterize hormonal and electrolyte trends. The frequency of hypocortisolism during hyponatremic episodes was compared, and multivariable logistic regression identified independent predictors. The potential protective role of preoperative steroid replacement was also evaluated. DPH occurred in 54 patients (20.7%), with symptomatic cases accounting for 4.2% of the cohort. The median time to nadir sodium was 8 days with a median nadir of 129 mEq/L. The serum cortisol level between hyponatremia and non-hyponatremia group did not show significant differences. For propensity score matched comparison, median nadir cortisol levels were lower in the DPH group (6.10 vs. 7.34 µg/dL, p = 0.29), and hypocortisolism during hyponatremic episodes was more frequent (48.2% vs. 40.7%, p = 0.52), though neither difference reached statistical significance. Multivariate analysis identified age > 60 years (OR 2.09, 95% CI 1.11-3.96, p = 0.023) and postoperative pneumocephalus (OR 3.28, 95% CI 1.59-6.81, p = 0.001) as independent predictors. Preoperative cortisol replacement did not demonstrate a protective effect against DPH. Hypocortisolism does not appear to be the primary mechanism underlying DPH following pituitary surgery, as evidenced by the lack of temporal correlation. Advanced age and postoperative pneumocephalus emerge as key risk factors for DPH, supporting a multifactorial etiology. Although preoperative ACTH deficiency was linked to a higher incidence of DPH, preoperative cortisol replacement was not associated with protection.
To characterize age-related changes in the tarsal plate, with a focus on meibomian gland loss and alterations in collagen, elastic, and reticular fibers. Central sagittal sections of 31 upper eyelids from 20 East Asian cadavers, fixed in 10% formalin, aged 36 to 97 years were examined using Masson's trichrome staining. Additional sections of 25 upper eyelids from 16 cadavers, fixed in 10% formalin, aged 36-94 years were evaluated with Elastica-van Gieson and silver staining. In individuals in their 30s and 40s, acini extended to the superior tarsal region in most specimens, although 2 specimens from one 36-year-old individual showed complete acinar loss. Acinar loss became more apparent in the 50s and was pronounced after the 60s, although some specimens still retained acini in the central to superior tarsus. Acinar loss was consistently greater on the conjunctival side than on the skin side. Elastic fibers were typically present around the meibomian ducts but were nearly absent in acinar-loss areas. Reticular fibers were abundant in acinar-containing regions and remained densely distributed in acinar-loss areas, where collagen fibers filled the original acinar spaces. Meibomian gland volume generally decreased with age, although individual variation was evident. Preferential acinar loss on the conjunctival side suggests regional susceptibility. The disappearance of elastic fibers, together with dense reticular and collagen fiber deposition, raises the possibility that inflammatory remodeling may contribute to age-related meibomian gland loss.
Surgical decision-making for intraductal breast lesions has traditionally relied on physician expertise and imaging characteristics, lacking a comprehensive evaluation framework that integrates oncological efficacy, perioperative safety, and patient subjective experience. This study aimed to systematically synthesise the latest evidence and incorporate patient-reported outcomes (PROs) to construct a three-dimensional evaluation model, thereby providing an evidence base for the individualised selection between vacuum-assisted excision (VAE) and open surgery. A systematic comparison and descriptive analysis were performed across three dimensions: oncological efficacy, perioperative safety, and PROs. A total of 26 studies were included. Meta-analysis revealed no significant difference in residual lesion rates between the VAE and open surgery groups [risk ratios (RR) =1.02; 95% confidence interval (CI): 0.29-3.57; P=0.97]. Notably, the VAE group demonstrated a 59% significant reduction in recurrence rates (RR =0.43; 95% CI: 0.21-0.86; P=0.02). Due to the lack of direct comparative data, malignancy detection rates were presented descriptively without statistical pooling, and no inferences regarding diagnostic superiority were drawn. Regarding perioperative safety, VAE was associated with a significantly shorter operative time [mean difference (MD) =-14.38 min; 95% CI: -17.09 to -11.67; P<0.01] and reduced intraoperative blood loss (MD =-9.10 mL; 95% CI: -11.29 to -6.92; P<0.01). Furthermore, VAE significantly lowered the risks of skin ecchymosis (RR =0.43; 95% CI: 0.20-0.95; P=0.04), wound infection (RR =0.31; 95% CI: 0.14-0.69; P=0.004), and breast deformity (RR =0.19; 95% CI: 0.05-0.74; P=0.02). For PROs, patients in the VAE group reported significantly higher cosmetic satisfaction (RR =1.34; 95% CI: 1.15-1.56; P<0.001) and lower postoperative pain scores (MD =-1.61; 95% CI: -2.68 to -0.54; P=0.003). VAE offers clear benefits such as being minimally invasive, supporting postoperative recovery, and improving cosmetic satisfaction, making it a preferred method for radiologically localised lesions. However, current evidence is insufficient to confirm VAE as a definitive treatment for malignant or high-risk intraductal conditions. Open surgery remains essential to ensure oncological safety through thorough margin assessment and accurate detection of malignancy; the potential clinical consequences of missing malignancy greatly outweigh minor cosmetic outcomes. Future treatment options should be guided by personalised decision-making that considers lesion characteristics and patient preferences.
Hypercalcaemic crisis (HCC) is a serious and potentially life-threatening complication of increased serum calcium concentration. It is most commonly due to primary hyperparathyroidism (PHPT), from a parathyroid hormone (PTH) secreting tumour. This paper looks at factors affecting outcomes of parathyroid surgeries in HCC patients. Data were collected retrospectively including demographics, biochemistry and histology results, details of localisation studies, time from referral to surgery, disease related admissions, length of hospital stay. Statistical analysis was performed between the mild (2.6-2.9 mmol/L), moderate (3-3.5 mmol/L) and severe (>3.5 mmol/L) hypercalcaemia (HC) groups. Operative cure was analysed as a drop of post-operative PTH and normalisation of adjusted calcium after 6 months. A total of 175 patients (132 female, 43 male) were identified to have undergone parathyroid surgeries between 2018 and 2025. Seventy-three percent (n=128) of patients had mild HC, 23% (n=40) had moderate HC and 4% had severe HC (n=7). Preoperative adjusted calcium and preoperative PTH concentrations were statistically significantly higher in the severe HC group (P<0.001). The weight of gland in the severe hypercalcaemic group of patients was statistically significantly higher (P<0.001) with a mean of 10.28 g (range, 0.172-52 g). Nine percent (n=11) of patients with mild, 25% (n=10) with moderate, and 100% of patients (n=7) with severe HC had disease related admission (P<0.001). The statistically significant post-operative drop in PTH and adjusted calcium gave us a success rate of 93% overall, which again is broadly in line with current guidelines and with no statistically significant difference in operative success with the patients presenting level of HC. This study intends to raise awareness for service providers to understand the need to prioritise the surgical treatment of this benign but potentially fatal condition.
This single-center prospective cohort study evaluated the clinical outcomes of thick acellular dermal matrix (ADM) for partial volume correction in breast reconstruction. Small-to-moderate volume deficits commonly occur after partial or total mastectomy in Asian women with relatively small breasts and may not justify additional major flap surgery. This study aimed to evaluate the safety and efficacy of thick ADM (≤5 mm) for intraoperative partial volume correction across oncoplastic and reconstructive settings. Between July 2022 and June 2023, thick ADM was applied as a deep onlay beneath glandular reshaping flaps, rotation flaps, or latissimus dorsi (LD) flaps in 20 prospectively enrolled cases, while 124 cases without thick ADM (67 partial mastectomy, 57 total mastectomy) served as a reference cohort; clinical variables, complications up to 6 months, and patient-reported satisfaction using a modified KNU Breast-Q were analyzed using appropriate statistical tests. The thick ADM group more frequently underwent oncoplastic volume displacement or replacement and received postoperative radiotherapy. However, rates of seroma, hematoma, dehiscence, fat necrosis-like firmness, infection, and reoperation were comparable between groups. No reconstruction failures or implant removals occurred in the thick ADM cohort. Both groups reported high satisfaction across all domains. Thick ADM is a safe, practical option for targeted partial volume correction following partial or total mastectomy, enabling restoration of contour and symmetry without increased short-term complications.
Frailty is increasingly recognized as a predictor of adverse perioperative outcomes in hepatobiliary and pancreatic (HBP) surgery. However, vulnerability in HBP practice is often shaped by disease- and procedure-specific stressors, including cholestasis, recurrent infection, tumor-related inflammation, hepatic dysfunction, and extensive resection. Consequently, commonly used frailty tools may not adequately stratify perioperative risk or guide optimization. This narrative review critically synthesizes current evidence and proposes an implementation-oriented, HBP-specific framework, HBP onco-frailty, to support perioperative assessment and future validation. We conducted a targeted narrative review of publications from January 2010 through December 2025 using PubMed, Embase, and Google Scholar, supplemented by hand-searching of reference lists and relevant society or consensus guidance where applicable. After relevance screening and full-text review, 232 studies were retained for the final narrative synthesis. Evidence was synthesized across four domains of HBP onco-frailty: sarcopenia, malnutrition, impaired physical function, and systemic inflammation. Widely used indices, including the modified Frailty Index (mFI) and Liver Frailty Index, are feasible and prognostically informative, but may underrepresent the inflammation- and nutrition-related biology central to many HBP malignancies. Across the literature, frailty-related measures were generally associated with postoperative complications, delayed recovery, prolonged hospitalization, and poorer tolerance of multimodal therapy, although interpretation is limited by heterogeneity in definitions, assessment timing, and outcomes. Biologically enriched approaches, including albumin-containing modified frailty indices, may improve risk discrimination in selected settings. We also describe a pragmatic strategy integrating routinely available biomarkers, including C-reactive protein, albumin, the C-reactive protein-to-albumin ratio, and the Geriatric Nutritional Risk Index, with performance-based measures to support risk stratification for endpoints including postoperative complications, delayed recovery, length of stay, readmission, and tolerance of multimodal oncologic therapy. This framework is intended not as a deterministic label, but as a scaffold linking assessment to targeted optimization, including nutrition support, prehabilitation, infection control, and treatment-timing decisions. HBP onco-frailty provides a clinically grounded framework that incorporates HBP-specific stress biology and shifts frailty assessment toward intervention guidance. However, the evidence remains heterogeneous, and no standardized HBP-specific definition has been established. Priorities include standardized definitions, prospective multicenter validation, and implementation studies within perioperative pathways.
Currently, there are limited studies on individualized assessment tools for predicting patients with positive sentinel lymph nodes during breast cancer surgery and exempting axillary lymph node dissection (ALND). Constructing a prediction model based on clinical and pathological features to explore the feasibility of exempting ALND for patients with positive sentinel lymph nodes during breast cancer surgery is of great significance. This study aims to guide the management of axillary lymph nodes in breast cancer patients, so as to ensure the treatment effect while minimizing surgical complications and improving the quality of life of patients. We conducted a retrospective study by collecting data from 133 breast cancer patients who were admitted to the Breast and Thyroid Surgery Department of Liuzhou People's Hospital within the time frame spanning from January 2023 to August 2025. Subsequently, we employed both univariate and multivariate Logistic regression analyses to screen for clinical and pathological features that exhibited a significant association with axillary lymph node metastasis. Based on the identified significant features, we constructed a prediction model aimed at forecasting axillary lymph node metastasis in breast cancer patients. To comprehensively evaluate the predictive performance of the developed model, we utilized receiver operating characteristic (ROC) curves to assess its discriminatory ability, and diagnostic calibration curves to evaluate the accuracy of its predicted probabilities. Multivariate analysis revealed that age, the number of positive sentinel lymph nodes, vascular tumor thrombus, and preoperative axillary lymph node diameter were significantly associated with axillary lymph node metastasis. The ROC curve of the prediction model constructed based on these 4 features showed an area under the curve (AUC) of 0.760, and the diagnostic calibration curve indicated that the model had good fit. The predictive model established based on age, the number of positive sentinel lymph nodes, vascular tumor thrombus, and the preoperative diameter of axillary lymph nodes can preliminarily predict the risk of axillary lymph node metastasis in patients with positive sentinel lymph nodes during breast cancer surgery.
Plasma cell mastitis (PCM) is a chronic inflammatory breast disorder that primarily affects women. It is exceptionally rare in men and poses a diagnostic challenge due to its high recurrence rate and features that can mimic malignancy. Currently, there is no standardized treatment protocol for refractory PCM, particularly for recurrent cases in male patients. The aim of this case report is to present a unique instance of recurrent male PCM that was successfully managed with a stepwise approach: initial corticosteroid therapy followed by ultrasound-guided microwave ablation (MWA). Accordingly, this minimally invasive and tissue-preserving approach could be considered a treatment option alongside conventional surgical resection for managing such challenging recurrences. A 30-year-old man presented with an ipsilateral recurrence of a retroareolar mass, accompanied by erythema and swelling, 18 months after initial surgical excision. Imaging and core needle biopsy confirmed recurrent PCM with suppurative inflammation. To avoid the trauma of repeat open surgery, the patient was treated with a step-up regimen: systemic corticosteroids (prednisone) were first administered to reduce the acute inflammatory burden, followed by ultrasound-guided MWA for definitive local control. At the 18-month follow-up, there was no clinical or sonographic evidence of recurrence, and the patient reported high cosmetic satisfaction and significantly improved quality of life compared with his initial surgery. The main take-away lesson from this case is that a step-up approach-corticosteroid bridging followed by MWA-offers a promising, minimally invasive alternative to repeat surgery for recurrent male PCM. This strategy provides a significant clinical impact by balancing effective disease control with superior cosmetic outcomes. Further prospective studies are warranted to confirm its long-term implications.
A 56-year-old woman presented with hematemesis and melena. She was hemodynamically stable, with hemoglobin at 5.2 g/dL. Upper gastrointestinal endoscopy after transfusion showed twisting of the second duodenum (D2). Computed tomography and magnetic resonance imaging revealed intussusception caused by a duodenal mass without ischemia. Endoscopic ultrasound was inconclusive, and tumor markers were normal. Exploratory laparotomy found no peritoneal carcinomatosis. Duodenotomy exposed a 7 cm pedunculated submucosal tumor in D 2. Cannulation of the cystic duct identified the papilla, and an Escat drain was inserted. The mass was resected using Endo-GIA. Postoperative recovery was uneventful; the drain was removed on Day 3, and the patient was discharged on Day 4. Histopathology confirmed a completely resected benign Brunner's gland harmartoma. After four years, no recurrence was observed. Brunner's gland hamartomas are benign tumors. Surgery is indicated when endoscopic treatment is not feasible.
Breast cancer prognosis and treatment planning largely depend on the tumor-node-metastasis (TNM) staging system, with T category mainly based on maximum tumor diameter (TD). Irregular three-dimensional (3D) growth of most breast tumors means that a single linear measurement cannot fully reflect tumor burden. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows tumor volume (TV) assessment, yet its incremental prognostic value remains uncertain. This study aimed to compare MRI-derived TV and conventional TD-based T staging for prognostic stratification of breast cancer. This single-center retrospective cohort study included 574 consecutive women with non-metastatic invasive breast cancer who underwent surgery at The First Affiliated Hospital of Nanjing Medical University between January 2016 and June 2019. Eligible patients had histologically confirmed invasive ductal carcinoma, preoperative 3.0-T breast MRI suitable for three-dimensional volumetric analysis, complete clinicopathological and follow-up data, no neoadjuvant therapy, and standardized treatment according to contemporaneous clinical practice guidelines. TV was measured using semi-automatic segmentation in 3D Slicer (version 5.5.0). Follow-up commenced at surgery and was conducted through outpatient visits, telephone interviews, and electronic medical record review until September 30, 2024. Disease-free survival (DFS) was defined as the interval from surgery to the first occurrence of local, regional, or distant recurrence, disease progression, or death from any cause; overall survival (OS) was defined as the interval from surgery to death from any cause. Cox regression and concordance index (C-index) analyses with 1,000 bootstrap resampling iterations were performed. In the overall cohort, TV was strongly correlated with TD (r=0.781, 95% CI: 0.734-0.820, P<0.001), but this correlation weakened markedly when TD was >2.5 cm (r=0.341, 95% CI: 0.141-0.494, P<0.001). In multivariable Cox regression for DFS, compared with V1 (TV ≤2 cm3), V2 (>2-5 cm3) and V3 (>5 cm3) were independently associated with poorer DFS, with hazard ratios (HRs) of 2.721 (95% CI: 1.181-6.271, P=0.02) and 6.069 (95% CI: 2.640-13.950, P<0.001), respectively. In the TD-based model, compared with T1, the HRs were 2.227 (95% CI: 1.185-4.187, P=0.01) for T2 and 4.691 (95% CI: 1.424-15.457, P=0.01) for T3. The TV-based model had a C-index of 0.744, compared with 0.702 for the TD-based model; the corresponding bootstrap-corrected values were 0.749 (95% CI: 0.674-0.818) and 0.704 (95% CI: 0.619-0.795), respectively. In subgroup analyses, the TV-based model also showed higher discrimination in lymph node-positive disease (0.778 vs. 0.752, P=0.02), HER2- tumors (0.717 vs. 0.683, P=0.02), and Ki-67-high tumors (0.715 vs. 0.680, P=0.03). MRI-derived three-dimensional TV may complement conventional diameter-based staging by providing additional prognostic information in non-metastatic breast cancer. TV-based models showed higher discrimination in this cohort, particularly in selected biologically aggressive subgroups, although further prospective multicenter validation is warranted.
Pleomorphic adenoma (PA) of the salivary gland, particularly of the parotid gland, is generally considered benign but exhibits heterogeneous biological behavior, including recurrence and malignant transformation. While benign pleomorphic adenoma (BPA) and carcinoma ex pleomorphic adenoma (CXPA) are well defined, lesions with borderline or atypical features represent a clinically challenging gray zone with unclear surgical implications. This study aimed to characterize the clinicopathological features of borderline/atypical PA (BaPA) within the PA spectrum and to evaluate its recurrence parttern and malignant transformation risk. We conducted a single-center retrospective cohort study of surgically treated PAs diagnosed between 2008 and 2023. Cases were categorized as BPA, BaPA, and CXPA based on standardized histopathological re-review. BaPA and CXPA were considered higher-risk lesions within the PA spectrum. Preoperative fine-needle aspiration (FNA) concordance, Ki-67 proliferation index, surgical approach, and recurrence were analyzed, with follow-up focused on pathology-confirmed recurrence. A total of 1,306 cases were included, of which 87.9% arose in the parotid gland. FNA concordance with final diagnosis was high in BPA (84.0%) but substantially lower in BaPA (54.4%) and CXPA (32.1%). Ki-67 increased stepwise across tumor categories and showed good discriminative ability for malignant transformation (area under the curve =0.841), with an optimal cutoff value of 10%. During follow-up, recurrence occurred in 15.5% of BaPA and 27.0% of CXPA cases. In BaPA, recurrence was associated with surgical approach; in sensitivity analysis excluding enucleation cases, recurrence remained significantly lower after total parotidectomy than after superficial parotidectomy (7.0% vs. 19.2%, P=0.01). Among recurrent BaPA cases, malignant transformation occurred in 41.7% and was associated with longer tumor duration. In CXPA, recurrence was primarily associated with advanced T category and stage. These findings support PA as a clinicopathological continuum and suggest that BaPA may represent an intermediate-risk subgroup within this spectrum. Adequate local surgical control, awareness of the limitations of FNA, and incorporation of Ki-67 (≥10%) may aid individualized risk stratification and postoperative surveillance, while further validation of this category is warranted.
This study aims to describe the clinical spectrum, imaging localization, surgical approaches, and histopathology of orbital space-occupying lesions treated at a tertiary center. A retrospective review was conducted on 59 consecutive patients with orbital masses who were treated at the Central Hospital of Wuhan, from July 2018 to January 2025. Demographics, laterality, compartmental localization using the new 5-compartment model (intraconal, extraconal, eyeball zone, optic nerve sheath, subperiosteal), management, and pathology were summarized descriptively. We found that among the 59 lesions, 48 were benign (81.36%) and 11 were malignant (18.64%). The most frequent benign lesions were cavernous venous malformation (10/59, 16.95%), dermoid cyst (8/59, 13.56%), inflammatory pseudotumor (6/59, 10.17%), and pleomorphic adenoma of the lacrimal gland (5/59, 8.47%). Lymphoma was the most common malignant lesion (8/59, 13.56%). Fifty patients underwent surgery (lateral, anterior, or medial orbitotomy, or endoscopic transnasal approach), and 9 were managed conservatively. Benign tumors rarely recur after surgical resection and have a favorable prognosis. Malignant tumors such as lymphoma are difficult to be radically resected through surgery, requiring postoperative adjuvant radiotherapy and chemotherapy, with a high risk of recurrence and metastasis. In this single-center series, benign orbital masses were predominant, with cavernous venous malformation being the most common benign entity and lymphoma the leading malignancy. Compartment-based imaging analysis is beneficial for differential diagnosis and surgical planning; infiltrative patterns in lymphoma often preclude complete resection and necessitate adjuvant therapy.