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B7-H6 and PD-L1 belong to the B7 family co-stimulatory molecules fine-tuning the immune response. The present work investigates the clinical effect of B7-H6 protein expression with PD-L1 status and the infiltration of natural killer cells as potential biomarkers in breast tumor inflammatory microenvironment. The expression levels of B7-H6 protein by cancer cells and immune infiltrating cells in human breast cancer tissues and evaluate their associations with PD-L1 expression, NK cell status, clinical pathological features and prognosis were explored. The immunohistochemistry labeling method was used to assess B7-H6 and PD-L1 proteins expression by cancer and immune cells. The associations between immune checkpoint, major clinical pathological variables and survival rates were analyzed. B7-H6 protein was depicted in both breast and immune cells. Results showed that Tumor B7-H6 expression is highly associated with Her-2 over expression. B7-H6 + immune cells are highly related to the Scarff–Bloom–Richardson grade and associated with PD-L1 expression and NK cells status. Survival analysis revealed a better prognosis in patients with low expression of B7-H6 by cancer cells. Conversely, B7-H6 + immune cells were significantly associated with longer survival. Findings strongly suggest an interaction between B7 molecules that contributes to a particular design of the inflammatory microenvironment. This may influence the efficiency of therapies based on antibodies blocking the PD-L1/PD1 pathway and can explain the detection of clinical benefits only in a fraction of patients treated with immune checkpoint inhibitors.

Mixed hepatocellular-neuroendocrine carcinoma (HCC-NEC) is a rare entity with a poor prognosis. We report a case of a 44-yearold Tunisian man who was admitted for diffuse abdominal pain. Body computed tomography showed multinodular hepatomegaly. Pathologic findings concluded to HCC-NEC. Clinicians should be aware about this entity. Further collection of case reports is needed to standardize the optimal treatment.

Intramedullary spinal cord metastasis (IMSC) from solid tumors is rare. In this report, we describe the case of a patient treated at our center for breast cancer with intramedullary spinal cord metastases without bone and brain metastases or meningitis. Management of the disease remains challenging even with recent advances in the treatment of metastatic breast cancer. Treatment options include surgery, radiotherapy and chemotherapy. The prognosis of these patients still very poor.

Table 1 Factors correlated with the diagnosis of breast cancer and cancer concerns Diagnosis of cancer Cancer concerns P value χ2 value P value χ2 value Family history of breast cancer 0.07 2.456 0.06 2.586 Educated versus illiterate 0.1 1.231 0.03 3.5624 Work versus no work 0.2 1.564 0.08 2.356 Age>40 versus ≤40 years 0.0001 6.779 0.001 5.352 BIRADS 5 versus BIRADS 4 0.0001 5.872 0.2 1.235 Mass at physical examination versus no mass 0.0001 5.601 0.02 4.521 Right versus left breast 0.09 2.786 0.7 1.256 p significant if <0.05. Cancer is often described as the ‘number one’ health fear, but little is known about whether this affects quality of life by translating into high levels of concerns or distress in everyday life. Because cancer fear is an unpleasant emotion, as well as potentially influencing cancer-protective behaviours, it is important to gain a better understanding of its origins and consequences, and find ways to minimise its impact on quality of life without undermining participation in cancer prevention.2 We suggest that these women may particularly benefit from discussions regarding the possibility of false-positive test results. Contributors WBK: data collection, statistical analysis, writing and revision.

Common cardiovascular toxicities of sunitinib mainly include hypertension, QT prolongation, left ventricular dysfunction (LVD) and less frequently, congestive heart failure (CHF). Here, we report the case of a 67-year-old woman who developed heart failure after 24 months of sunitinib. Our case highlights the importance of strict and regular cardiovascular monitoring during sunitinib. It also shows that the reintroduction of sunitinib with maintaining heart failure treatment can be safe. The exact mechanisms of this cardiotoxicity have not been understood. There is no protective therapy available. Therefore, further investigations are needed in these areas. Medical specialists who prescribe and treat patients with sunitinib should be aware of the possible occurrence of these conditions and perform regular checkup of sunitinib-treated patients.

Angiogenesis, the formation of new blood vessels, is a pivotal process in breast cancer (BC) progression and metastasis, intricately regulated by complex interactions within the tumor microenvironment (TME). While the vascular endothelial growth factor (VEGF) pathway represents a cornerstone of these pro-angiogenic mechanisms, resistance to anti-VEGF therapies is common, underscoring the involvement of alternative pathways. Key insights reveal that hypoxia, metabolic reprogramming, and stromal components including cancer-associated fibroblasts (CAFs), cancer-associated adipocytes (CAAs) and immune cells, cooperate to drive aberrant angiogenesis and treatment resistance. This review synthesizes emerging evidence on the multifaceted regulation of angiogenesis by endothelial cells (ECs), pericytes, immune cells, and stromal components in shaping the angiogenic landscape, and discusses innovative therapeutic strategies. These include hypoxia-targeted agents, immune modulation, and combination therapies that co-target compensatory pathways. We emphasize that overcoming resistance requires integrated approaches that remodel the TME rather than solely inhibiting VEGF. Finally, we highlight ongoing clinical trials and translational opportunities aimed at improving outcomes and reducing metastasis in breast cancer patients.

Bone metastases from hepatocellular carcinoma (HCC) are unusual. Optimal treatment strategies are not well defined. The prognosis of this entity is very poor with a survival that does not exceed 1 year. We report here a new case of metastatic HCC with longer overall survival of more than 5 years in a 67‐year‐old man. We report here a new case of metastatic hepatocellular carcinoma with longer overall survival of more than 5 years in a 67‐year‐old man.

Metastases of ovarian carcinoma to the breast are uncommon. The incidence of ovarian metastasis to the breast ranges from 0.5% to 1.2%. Nevertheless, its detection and distinction from other primaries, especially primary breast carcinoma, is important as treatment and prognosis differ significantly. We report the case of a 38-year-old Tunisian woman with bilateral metastases to breast from ovarian carcinoma. Through a review of literature, we discuss the clinical, radiological and histological characteristics of ovarian metastases to the breast.

This article covers an interesting topic. Paraneoplastic pruritus is rare but can be severe. It can sometimes be resistant to usual treatments. In our case, it was resistant to antihistamines but was relieved by inhibitors of serotonin scrapping. This article covers an interesting topic. Paraneoplastic pruritus is rare but can be severe. It can sometimes be resistant to usual treatments. In our case, it was resistant to antihistamines but was relieved by inhibitors of serotonin scrapping.

ObjectiveChemotherapy-induced peripheral neurotoxicity (CIPN) ranges from simple paresthesia to paralysis, which may be transient or irreversible. The aim of our study was to detect CINP in our patients undergoing chemotherapy and to study the cumulative neurotoxic doses for the different drugs.MethodsThis is a cross-sectional prospective study carried out in the medical oncology department of the Habib Bourguiba University Hospital in Sfax. A survey was conducted to detect and explore possible chemo-induced peripheral neuropathy in patients undergoing known potentially neurotoxic anti-cancer treatments.ResultsSeventy-three patients were included in the study. The average age was 51.8 years (13–80 years). The prevalence of CIPN was 52.1%. CIPN was classified as grade I in 24 (63.2%) cases and grade II in 14 (36.8%) cases. No grade III or IV peripheral neuropathy was detected in our patients. Paclitaxel was the drug with the highest incidence of CIPN (76.9%). The chemotherapy (CT) protocols most prone to chemotherapy-induced peripheral neurotoxicity (CIPN) were based on taxanes (47.3%) and oxaliplatin (59%). Paclitaxel was the drug most likely to cause CIPN (76.9%) (p=0.031). Paclitaxel single dose per cycle of 175 mg/m2 (66.67%) was more associated with the occurrence of CIPN than 80 mg/m2 (40%), but without significant difference (p=0.437). The average cumulative dose was estimated at 315 mg/m2 for docetaxel, 474 mg/m2 for oxaliplatin and 579 mg/m2 for paclitaxel (p=0.16).ConclusionThe prevalence of NPCI was 51.1% in our series. Oxaliplatin and taxanes were the main contributors to this complication with cumulative dose over than 300 mg/m2.