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Background and Objectives: Lymph node management in cutaneous melanoma has undergone a paradigm shift, transitioning from routine complete lymph node dissection (CLND) to a more selective, individualized approach. This narrative review explores the historical evolution, current evidence and clinical guidelines surrounding lymphadenectomy for a patient with Stage III of melanoma. Materials and Methods: A comprehensive literature search was conducted across PubMed, Scopus and Web of Science, focusing on randomized controlled trials, meta-analyses and updated international guidelines published in the past 15 years. Results: Traditional surgical approaches favored radical lymphadenectomy for regional disease control. However, pivotal trials such as the Multicenter Selective Lymphadenectomy Trial II (MSLT-II) and German Dermatologic Cooperative Oncology Group Selective Lymphadenectomy Trial (DeCOG-SLT) demonstrated no survival advantage from immediate CLND following a positive sentinel lymph node biopsy (SLNB), underscoring increased surgical morbidity. Consequently, guidelines from Associazione Italiana di Oncologia Medica (AIOM), the European Society for Medical Oncology (ESMO), and the National Comprehensive Cancer Network (NCCN) now endorse SLNB as the standard for nodal staging, reserving CLND for select high-risk cases. Conclusions: The role of lymphadenectomy in melanoma is increasingly becoming selective, shaped by tumor burden, nodal involvement and response to systemic therapy. SLNB remains central to staging and treatment planning, while CLND is no longer routine. Continued clinical trials and integration with immunotherapy will further refine surgical strategies in melanoma care.

Background In the last decade, two research groups, the French group by Clough et al. (Br J Surg. 97:1659–65, 2010) and the Chinese one by Li et al. (ISRN Oncol 2013:279013, 2013), proposed two types of classification of axillary lymph nodes in breast cancer, identifying novel anatomic landmarks for dividing the axillary space in lymph node dissection. Main body Knowledge of the exact location of the sentinel node helps to focus the surgical dissection and to reduce the morbidity of sentinel lymph node biopsy procedures, in particular the risk of arm lymphedema, without compromising sensitivity. Conclusion In this article, we aimed at focusing on the clinical impact that the most recent classifications of axillary lymph nodes have obtained in literature, highlighting the importance of defining new demarcations to preserve the axillary lymph nodes as much as possible in breast surgery.

BACKGROUND: The genitofemoral nerve is the most variable nerve of the lumbar plexus in terms of its course and bifurcation, and therefore it must be taken into consideration during extended pelvic lymph node dissection. Its borders, during robotic, laparoscopic or open radical prostatectomy for intermediate or high-grade prostate cancer, have long been defined and must be respected; the genitofemoral nerve represents the extended pelvic lymph-node dissection lateral boundary, and the fact that it may vary from case to case puts its integrity at risk. MATERIALS AND METHODS: For the first time, we report genitofemoral nerve branching pattern data obtained from extended pelvic lymph node dissection during videolaparoscopic radical prostatectomy. We also propose a further sub-classification to identify the exact genitofemoral nerve bifurcation point in correlation with the injury risk. RESULTS: Our results show the prevalence of a genitofemoral nerve originating as a single trunk which divides into two branches, and highlight how this condition occurs at the external iliac artery upper third in more than 75% of cases. Furthermore, at the femoral canal inlet, the genitofemoral nerve two branches were mainly seen lying laterally and below the external iliac artery, or in the middle of the external iliac artery and external iliac vein. CONCLUSIONS: Better understanding of the genitofemoral nerve course and bifurcation points deduced from the extended pelvic lymph node dissection, which are, in any case, applicable to all major pelvic surgery, would prove helpful in avoiding iatrogenic nerve injuries during extended pelvic lymph node dissection.

BACKGROUND: The basal vein of Rosenthal (BVR) is a venous structure in the deep cerebral venous system. It plays an important role in cerebral haemorrhages, particularly subarachnoid haemorrhages and perimesencephalic haemorrhages. The aim of this study was to evaluate the BVR’s anatomical and functional classification and its role in various clinical situations. AIM OF THE STUDY: The review was conducted from its inception up to 27 September, 2024. It was made according to the PRISMA Statement 2020 and using the following databases: Scopus, Pubmed and Web of Science. Studies were considered eligible if they provided precise data and information on the anatomical variation of the basal vein of Rosenthal. The quality assessment was assessed using the Newcastle-Ottawa Quality Assessment Scale. MATERIALS AND METHODS: A total of 12 articles, the studies behind which were conducted in different countries, were included. Data on the classification of the basal vein of Rosenthal, surgical or radiological, and the outcome, mainly haemorrhagic, were reported. BVR type b or c correlates with increased venous fragility and an outcome of idiopathic haemorrhage. CONCLUSIONS: The anatomical classification of the BVR highlights the importance of careful surgical planning and prophylactic measures while providing valuable insights into idiopathic cerebral haemorrhages.

It has been shown that the pathogenic variants (PVs) of the DNA Damage Response (DDR) genes, whether of a germinal or somatic nature, represent a predictive biomarker of high sensitivity to treatment with inhibitors of the enzyme poly-ADP-ribose polymerase (PARP) in patients with hormone-resistant metastatic prostate cancer (HRPCa). Moreover, the detection of PVs of the Homologous Recombination Repair (HRR) genes in PCa patients can help to define the patient’s prognosis and the choice of the therapeutic procedure. Among men with metastatic PCa, the frequency of PVs in HRR genes ranges from 11% to 33%, which is a significantly higher rate compared to non-metastatic PCa, where the incidence is between 5% and 10%. Next-Generation Sequencing (NGS) results were more commonly obtained from newly acquired somatic samples compared to archived samples (prostate biopsy or prostatectomy). We developed an experimental multidisciplinary prospective study in patients with a new diagnosis of high-risk PCa at biopsy. The aim was to evaluate the presence of PVs of different HRR genes in patients with the first diagnosis of PCa in relation to a metastatic or non-metastatic stage, tumor aggressiveness, and early risk of progression. Among 43 initial tumor samples from 22 patients, 25 samples from 12 patients were selected for library preparation based on their DNA concentration and quality. After the NGS, 14 different DNA variants were prioritized. Oncogenetic and likely oncogenetic variants were found in the ATM, BRCA1, PTEN, KMT2D, and CDH1 genes. Moreover, variants of uncertain significance were found in ATM, DDR2, FANCA, FOXA1, PLCB4, PTCH1, and RB1.

Over the last few years, a great advance has been made in the comprehension of the molecular pathogenesis underlying thyroid cancer progression, particularly for the papillary thyroid cancer (PTC), which represents the most common thyroid malignancy. Putative cancer driver mutations have been identified in more than 98% of PTC, and a new PTC classification into molecular subtypes has been proposed in order to resolve clinical uncertainties still present in the clinical management of patients. Additionally, the prognostic stratification systems have been profoundly modified over the last decade, with a view to refine patients’ staging and being able to choose a clinical approach tailored on single patient’s needs. Here, we will briefly discuss the recent changes in the clinical management of thyroid nodules, and review the current staging systems of thyroid cancer patients by analyzing promising clinicopathological features (i.e., gender, thyroid auto-immunity, multifocality, PTC histological variants, and vascular invasion) as well as new molecular markers (i.e., BRAF/TERT promoter mutations, miRNAs, and components of the plasminogen activating system) potentially capable of ameliorating the prognosis of PTC patients.

BackgroundAnisakiasis, a zoonotic disease caused by the nematode Anisakis, poses a significant concern for public health, particularly in regions with high consumption of raw or undercooked fish.Case PresentationWe present a case report of a 41-year-old woman who developed severe abdominal symptoms, ultimately diagnosed with intestinal obstruction due to Anisakis infestation, requiring surgery. Despite the absence of prominent eosinophilia or specific radiological findings, the diagnosis was confirmed through histological examination, highlighting the importance of considering anisakiasis in patients with a history of raw seafood consumption.ConclusionThe case underscores the diagnostic challenges associated with anisakiasis, emphasizing the need for increased awareness among healthcare professionals and the public regarding the risks of consuming raw or undercooked seafood. Effective management requires a multidisciplinary approach, including clinical assessment, imaging studies, and histological evaluation, to ensure timely diagnosis and appropriate treatment.

Mesenteric cysts are defined as a heterogeneous group of intra-abdominal cystic lesions of the mesentery or omentum that may be found in any portion of the gastrointestinal tract from the duodenum to the rectum. The clinical condition is entirely asymptomatic in many patients, particularly with small cysts. The diagnosis is typically incidental and secondary to imaging performed for other purposes. In symptomatic patients, the clinical picture is characterized by nonspecific gastrointestinal signs and symptoms. Treatment may be surgical or via interventional radiology. We report the case of a 55-year-old female patient complaining of left-sided abdominal discomfort and constipation lasting three months. An abdominal ultrasound showed the presence of a 10 × 14 × 16 cm anechoic cystic mass filling the whole anterior and left abdominal cavity, confirmed by CT and MRI. The cyst, removed laparoscopically, was histologically a simple mesothelial cyst. We reviewed the international literature over the last 10 years of all cases with mesenteric cysts > 10 cm in evaluating gastrointestinal symptoms at diagnosis, histology, performed treatment, and outcome.

Persistent Primitive Hypoglossal Artery (PPHA) is a developmental anomaly of the brain superficial arterial circulation and is classified as a condition of carotid-vertebrobasilar anastomosis persistence caused by lack of reabsorption of the vascular network running on the hindbrain surface between the 4th and 5th embryonic week. It has an incidence between 0.03 and 0.9%, it is the second most frequent seen persistence of carotid-vertebrobasilar anastomoses after the trigeminal artery (TA), representing 85% of all persistent vestigial arteries (0.1–0.6%). Here a case of Persistent Primitive Hypoglossal Artery (PPHA) is reported being detailed in its morphological and clinical aspects. The patient, a 55-year-old female patient with high cardiovascular risk without specific symptoms presents at radiological morphological examination with an anomalous bifurcation of the ICA which gives rise to the ICA itself, which ascends without collateral branches up to the carotid foramen in the cranial base, and to an accessory artery, which enters the hypoglossal canal on the contour of the great occipital foramen, as a PPHA. A comprehensive embryologic analysis of this anatomical variant is offered and clinical awareness on it raised in view of a more informed an effective realization of it in daily clinical practice.

Anaplastic thyroid carcinoma (ATC) is an extremely difficult disease to tackle, with an overall patient survival of only a few months. The currently used therapeutic drugs, such as kinase inhibitors or immune checkpoint inhibitors, can prolong patient survival but fail to eradicate the tumor. In addition, the onset of drug resistance and adverse side-effects over time drastically reduce the chances of treatment. We recently showed that Twist1, a transcription factor involved in the epithelial mesenchymal transition (EMT), was strongly upregulated in ATC, and we wondered whether it might represent a therapeutic target in ATC patients. To investigate this hypothesis, the effects of harmine, a β-carboline alkaloid shown to induce degradation of the Twist1 protein and to possess antitumoral activity in different cancer types, were evaluated on two ATC-derived cell lines, BHT-101 and CAL-62. The results obtained demonstrated that, in both cell lines, harmine reduced the level of Twist1 protein and reverted the EMT, as suggested by the augmentation of E-cadherin and decrease in fibronectin expression. The drug also inhibited cell proliferation and migration in a dose-dependent manner and significantly reduced the anchorage-independent growth of both ATC cell lines. Harmine was also capable of inducing apoptosis in BHT-101 cells, but not in CAL-62 ones. Finally, the activation of PI3K/Akt signaling, but not that of the MAPK, was drastically reduced in treated cells. Overall, these in vitro data suggest that harmine could represent a new therapeutic option for ATC treatment.