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Background To provide further information on the clinical and pathological prognostic factors in triple-negative breast cancer (TNBC), for which limited and inconsistent data are available. Methods Pathological characteristics and clinical records of 841 TNBCs diagnosed between 1994 and 2015 in four major oncologic centers from Sardinia, Italy, were reviewed. Multivariate hazard ratios (HRs) for mortality and recurrence according to various clinicopathological factors were estimated using Cox proportional hazards models. Results After a mean follow-up of 4.3 years, 275 (33.3%) TNBC patients had a progression of the disease and 170 (20.2%) died. After allowance for study center, age at diagnosis, and various clinicopathological factors, all components of the TNM staging system were identified as significant independent prognostic factors for TNBC mortality. The HRs were 3.13, 9.65, and 29.0, for stage II, III and IV, respectively, vs stage I. Necrosis and Ki-67 > 16% were also associated with increased mortality (HR: 1.61 and 1.99, respectively). Patients with tumor histotypes other than ductal invasive/lobular carcinomas had a more favorable prognosis (HR: 0.40 vs ductal invasive carcinoma). No significant associations with mortality were found for histologic grade, tumor infiltrating lymphocytes, and lymphovascular invasion. Among lymph node positive TNBCs, lymph node ratio appeared to be a stronger predictor of mortality than pathological lymph nodes stage (HR: 0.80 for pN3 vs pN1, and 3.05 for >0.65 vs <0.21 lymph node ratio), respectively. Consistent results were observed for cancer recurrence, except for Ki-67 and necrosis that were not found to be significant predictors for recurrence. Conclusions This uniquely large study of TNBC patients provides further evidence that, besides tumor stage at diagnosis, lymph node ratio among lymph node positive tumors is an additional relevant predictor of survival and tumor recurrence, while Ki-67 seems to be predictive of mortality, but not of recurrence.

Background Triple Negative breast cancer (TNBC) includes a heterogeneous group of tumors with different clinico-pathological features, molecular alterations and treatment responsivity. Our aim was to evaluate the clinico-pathological heterogeneity and prognostic significance of TNBC histologic variants, comparing “ special types ” to high-grade invasive breast carcinomas of no special type (IBC-NST). Methods This study was performed on data obtained from TNBC Database, including pathological features and clinical records of 1009 TNBCs patients diagnosed between 1994 and 2015 in the four most important Oncology Units located in different hospitals in Sardinia, Italy. Kaplan-Meier analysis, log-rank test and multivariate Cox proportional-hazards regression were applied for overall survival (OS) and disease free survival (DFS) according to TNBC histologic types. Results TNBC “ special types” showed significant differences for several clinico-pathological features when compared to IBC-NST. We observed that in apocrine carcinomas as tumor size increased, the number of metastatic lymph nodes manifestly increased. Adenoid cystic carcinoma showed the smallest tumor size relative to IBC-NST. At five-year follow-up, OS was 92.1, 100.0, and 94.5% for patients with apocrine, adenoid cystic and medullary carcinoma, respectively; patients with lobular and metaplastic carcinoma showed the worst OS, with 79.7 and 84.3%, respectively. At ten-years, patients with adenoid cystic (100.0%) and medullary (94.5%) carcinoma showed a favourable prognosis, whereas patients with lobular carcinoma showed the worst prognosis (73.8%). TNBC medullary type was an independent prognostic factor for DFS compared to IBC-NST. Conclusions Our study confirms that an accurate and reliable histopathologic definition of TNBC subtypes has a significant clinical utility and is effective in the therapeutic decision-making process, with the aim to develop innovative and personalized treatments.

Cancer incidence and mortality trends represent epidemiological indicators of fundamental importance for public health systems. The study's aim is to present recent (2013–2017) short-term cancer incidence and mortality trends in Italy, including 80 % of the Italian population, for different cancer sites by sex, age group, and areas. Joinpoint Regression models were employed. A significantly decreasing trend in the incidence of all cancers was observed for men in Italy (-1.9 % per year), particularly for cancers of the lung (-2.5 %), liver (-3.9 %), stomach (-2.8 %), colorectal (-2.2 %), prostate (-3.4 %), and leukaemias (-3.2 %). The only significant increase was seen for skin melanoma (+5.2 % per year). Among women, overall cancer incidence remained stable, with a decrease in the North (-0.6 %) and an increase in the South and Islands (+0.9 %). Decreasing trends were observed for colorectal (-1.9 %), stomach (-3.5 %), liver (-4.0 %%), and leukaemias (-2.0 %) cancers, while incidence increased for skin melanoma (+6.0 % per year), and lung cancer (2.3 %). Cancer mortality declined consistently in both sexes (-1.8 % per year in men and −0.6 % in women), across different areas, and age groups. The observed trends in men and women partly reflect the impact of risk factors affecting both sexes at different times, mainly in the case of tobacco and lung cancer. Also, some trends may be linked to organized screening initiatives (e.g. colorectal) or the decrease in opportunistic screening (e.g. prostate). The snapshot of cancer trends in Italy may highlight new opportunities for strengthening prevention activities and advancing research on early detection and target treatments. [Display omitted] •We observed decreasing incidence and mortality trends in men and stable incidence and decreasing mortality trends in women.•Skin melanoma incidence increased in both sexes, while lung cancer increased in women and decreased in men.•Stomach, colorectal, liver and leukaemias incidence decreased in both sexes.•We highlighted the need to improve cancer prevention initiatives and research in diagnostic and treatments in Italy

Italy, home to one of the world’s oldest populations, has traditionally shown geographic differences in cancer incidence, with rates decreasing from north to south. The cancer registries that have been accredited by the Italian Cancer Registry Network (AIRTUM), during the last 20 years altogether cover the 90 % of the Italian population, aiming to improve data quality, standardize procedures, and promote research. This study presents the methodological approaches used for data collection, quality control, and analysis to describe current patterns of cancer incidence, mortality, and survival across Italy's three macro-areas (North, Central, South). Estimates of incidence rates and case numbers for 2025 were also produced. Data from 34 accredited cancer registries were analyzed, comprising over 4.6 million cases from 1981 to 2020, with a detailed focus on the 2008–2017 period, which includes over 3 million cases. Cancer incidence and mortality data were collected according to ICD-O-3 and ICD-10 classifications and processed for statistical analysis using tools such as SEERPrep, SEERStat, and the Joinpoint Regression Program. Age-standardized rates were calculated, and incidence and mortality trends from 2013 to 2017 were modeled. Five-year cumulative net survival was estimated using the Pohar-Perme method to adjust for competing risks. Survival trends were analyzed by geographic areas and cancer sites, revealing regional disparities in cancer outcomes. •Cancer registries provide affordable population-based statistics on cancer epidemiology.•Incidence, mortality and survival are the main indicators used for cancer surveillance.•Appropriate methodologic approaches make comparisons intelligible.•In Italy there are historical differences in cancer figures by macro-areas.•There is a need to provide cancer statistics updated to the pre-Covid-19 era in Italy.

We report the results of the quality assessment on data collected by cancer registries belonging to the Italian network of Cancer Registries (AIRTUM). For all malignant cancers diagnosed in 2013–2017, overall percentages of cases known from the death certificate only (DCO), and those of cases with cyto-histological confirmation (MV), were provided. The overall percentage of DCOs was small (1.2 %). The percentage of microscopic verification was overall high (87.6 %), with some variations among registries. DCO proportion varied from 0.1 % for cutaneous melanoma to 3.8 % for liver and pancreatic tumours. Differences across sites in MV proportion were linked to the different diagnostics. The rate of cases lost to follow-up was on average very low (0.7 %). This quality evaluation confirmed that data provided by the Italian cancer registries were affordable. •Data from Italian cancer registries have long been included in IARC and ENCR publications.•Data from cancer registries should not be produced only for cancer registries.•Quality indices should also address aspects that are more useful and understandable for other stakeholders.•The Italian network of cancer registries (AIRTUM) has provided updated cancer statistics

Purpose Acute appendicitis (AA) is among the most common causes of lower abdominal pain and admissions to the emergency department. Over the past 20 years, there has been a renewed interest in the conservative management of uncomplicated AA, and several studies demonstrated that an antibiotic-first strategy is a viable treatment option for uncomplicated AA. The aim of this prospective non-randomized controlled, multicenter trial is to compare antibiotic therapy and emergency appendectomy as treatment for patients with uncomplicated AA confirmed by US and/or CT or MRI scan. Methods All adult patients in the age range 18 to 65 years with suspected AA, consecutively admitted to the Surgical Department of the 13 participating Italian Hospitals, will be invited to take part in the study. A multicenter prospective collected registry developed by surgeons, radiologists, and pathologists with expertise in the diagnosis and treatment of uncomplicated acute appendicitis represents the best research method to assess the long-term role of antibiotics in the management of the disease. Comparison will be made between surgical and antibiotic-first approaches to uncomplicated AA through the analysis of the primary outcome measure of complication-free treatment success rate based on 1-year follow-up. Quality of life, length of hospital stay, pain evaluation, and time to return to normal activity will be evaluated as secondary outcome measures. Trial registration Clinicaltrials.gov ID: NCT03080103

Background and objectivesTo explore cognitive, EEG, and MRI features in COVID-19 survivors up to 10 months after hospital discharge.MethodsAdult patients with a recent diagnosis of COVID-19 and reporting subsequent cognitive complaints underwent neuropsychological assessment and 19-channel-EEG within 2 months (baseline, N = 49) and 10 months (follow-up, N = 33) after hospital discharge. A brain MRI was obtained for 36 patients at baseline. Matched healthy controls were included. Using eLORETA, EEG regional current densities and linear lagged connectivity values were estimated. Total brain and white matter hyperintensities (WMH) volumes were measured. Clinical and instrumental data were evaluated between patients and controls at baseline, and within patient whole group and with/without dysgeusia/hyposmia subgroups over time. Correlations among findings at each timepoint were computed.ResultsAt baseline, 53% and 28% of patients showed cognitive and psychopathological disturbances, respectively, with executive dysfunctions correlating with acute-phase respiratory distress. Compared to healthy controls, patients also showed higher regional current density and connectivity at delta band, correlating with executive performances, and greater WMH load, correlating with verbal memory deficits. A reduction of cognitive impairment and delta band EEG connectivity were observed over time, while psychopathological symptoms persisted. Patients with acute dysgeusia/hyposmia showed lower improvement at memory tests than those without. Lower EEG delta band at baseline predicted worse cognitive functioning at follow-up.DiscussionCOVID-19 patients showed interrelated cognitive, EEG, and MRI abnormalities 2 months after hospital discharge. Cognitive and EEG findings improved at 10 months. Dysgeusia and hyposmia during acute COVID-19 were related with increased vulnerability in memory functions over time.

Obesity is a chronic, complex pathology associated with a risk of developing secondary pathologies, including cardiovascular diseases, cancer, type 2 diabetes (T2DM) and musculoskeletal disorders. Since skeletal muscle accounts for more than 70% of total glucose disposal, metabolic alterations are strictly associated with the onset of insulin resistance and T2DM. The present study relies on the proteomic analysis of gastrocnemius muscle from 15 male and 15 female C56BL/J mice fed for 14 weeks with standard, 45% or 60% high-fat diets (HFD) adopting a label-free LC–MS/MS approach followed by bioinformatic pathway analysis. Results indicate changes in males due to HFD, with increased muscular stiffness (Col1a1, Col1a2, Actb), fiber-type switch from slow/oxidative to fast/glycolytic (decreased Myh7, Myl2, Myl3 and increased Myh2, Mylpf, Mybpc2, Myl1), increased oxidative stress and mitochondrial dysfunction (decreased respiratory chain complex I and V and increased complex III subunits). At variance, females show few alterations and activation of compensatory mechanisms to counteract the increase of fatty acids. Bioinformatics analysis allows identifying upstream molecules involved in regulating pathways identified at variance in our analysis (Ppargc1a, Pparg, Cpt1b, Clpp, Tp53, Kdm5a, Hif1a). These findings underline the presence of a gender-specific response to be considered when approaching obesity and related comorbidities.

Background: The catecholamine-induced hypertensive crisis is a rare, life-threatening condition caused by excessive catecholamine release, often resulting in cardiogenic shock and multiorgan failure. Management is challenging, especially when hemodynamic instability persists despite standard medical therapy. Methods: We conducted a narrative review of published articles between 2013 and 2025. The search was conducted in MEDLINE (PubMed, Scholar and Embase). We also presented a case managed at our reference center. Results: Overall, 42 studies including 69 patients were included. ECMO was the most commonly used modality, often serving as a bridge to surgery. The overall hospital mortality rate was 17.4%. Timing of adrenalectomy varied, with no clear consensus on the optimal approach. We report also a case of a 43-year-old woman with neurofibromatosis type 1 who developed acute cardiogenic shock due to an adrenal paraganglioma. She was supported with ECMO and underwent emergency bowel resection for intestinal ischemia, followed by adrenalectomy. Despite aggressive treatment, the patient died from progressive multiorgan failure. Conclusions: This case highlights the complexity of managing paraganglioma crisis, the potential role of ECMO as a bridge to surgery, and the importance of individualized, multidisciplinary care. Early recognition and referral to specialized centers are essential, though further studies are needed to guide optimal management strategies.

Phaeochromocytomas and paragangliomas (PPGL) are rare neuroendocrine tumours that arise not only in adulthood but also in childhood and adolescence. Up to 70–80% of childhood PPGL are hereditary, accounting for a higher incidence of metastatic and/or multifocal PPGL in paediatric patients than in adult patients. Key differences in the tumour biology and management, together with rare disease incidence and therapeutic challenges in paediatric compared with adult patients, mandate close expert cross-disciplinary teamwork. Teams should ideally include adult and paediatric endocrinologists, oncologists, cardiologists, surgeons, geneticists, pathologists, radiologists, clinical psychologists and nuclear medicine physicians. Provision of an international Consensus Statement should improve care and outcomes for children and adolescents with these tumours. Phaeochromocytomas and paragangliomas (PPGL) are rare endocrine tumours that can affect paediatric patients as well as adults. In this first international Consensus Statement on PPGL in paediatric patients, the authors discuss the diagnosis, management and long-term surveillance of these tumours in children and adolescents.