Citations

ABSTRACT Objective To estimate the pooled prevalence of lymphedema among adults with mucosal head and neck cancer treated with radiation therapy. Data Sources PubMed, Embase, Scopus, and Cochrane Library. Review Methods A comprehensive literature search of PubMed, Embase, Scopus, and Cochrane Library (2000–2025) identified cohort, case series, cross‐sectional, and clinical trial studies reporting lymphedema after radiotherapy for head and neck cancer. Logit‐transformed lymphedema prevalence was pooled using a DerSimonian‐Laird random‐effects model with Hartung‐Knapp‐Sidik‐Jonkman variance correction; statistical heterogeneity was evaluated using I 2 . This review was not prospectively registered. Results A total of 26 studies ( n = 3133 patients) met inclusion criteria. The pooled prevalence of lymphedema was 49% (95% CI, 36%–62%), with considerable heterogeneity (I 2 = 94%). Subgroup analyses yielded a pooled prevalence of 37% (12%–71%) for external and 45% (31%–60%) for internal lymphedema. Among studies reporting severity‐graded data, the pooled prevalence of clinically significant (grade ≥ 2) lymphedema was 32% (14%–59%). Lymphedema definitions and assessment methods varied across the included studies, most commonly employing clinical grading. Methodological quality was mixed, reflecting the predominantly retrospective, single‐arm nature of the available evidence. Overall certainty of evidence was very low. Funnel plot inspection and Egger's test suggested small‐study effects ( p = 0.06). Conclusion Lymphedema affects nearly half of patients following radiation for head and neck cancer. These findings may support routine surveillance, early identification, and timely referral for lymphedema management within survivorship care pathways. Future prospective studies should adopt standardized definitions and outcome measures to refine risk estimates and guide prevention strategies. Level of Evidence N/A.

Abstract Background Prostate artery embolization (PAE) requires precise visualization of complex pelvic arterial anatomy and can be aided by advanced vessel navigation tools. Photon counting detector (PCD) CT provides simultaneous ultra‐high resolution and material‐specific imaging, potentially improving automatic vessel tracing workflow for procedural planning and guidance. Purpose To identify, within a PCD‐CT workflow, the reconstruction that provides the most robust and consistent automatic vessel tracing for pre‐procedural PAE planning. Methods Ten patients underwent PCD‐CT angiography of the prostate arteries in ultra‐high‐resolution mode. Four reconstruction approaches were evaluated: conventional reconstructions with (1) standard of care kernel and (2) sharper kernel (Bv64), along with (3) monoenergetic 50 keV, and (4) iodine map spectral results. Using commercial embolization guidance software, three vessels were manually traced for each patient to establish ground truth segmentation. Subsequently, automatic vessel traces were generated using identical start/end points as the ground truth. Root mean squared error (RMSE) between automatic traces and ground truth was used to quantify tracing accuracy. Results Comparing individual traces, iodine maps demonstrated consistency with median RMSE of 0.7 mm (0.4 mm interquartile range (IQR)) versus 0.7 mm (12.5 mm IQR), 1.5 mm (14.7 mm IQR), and 0.8 mm (6.7 mm IQR) for Bv56, Bv64, and 50 keV reconstructions, respectively. Iodine maps produced fewer outliers, with 13.3% of traces and 40.0% of patients having one or more traces exceeding 5 mm RMSE, compared with 26.7%–36.7% of traces and 60.0%–80.0% of patients for the other reconstructions. Conclusions Material‐specific iodine reconstructions from PCD‐CT yield more robust automatic vessel tracing for PAE planning, offering a workflow‐compatible solution requiring minimal protocol modifications.

BACKGROUND Spindle cell oncocytoma (SCO) is a rare, nonadenomatous sellar tumor that often mimics pituitary adenomas both radiographically and clinically, making diagnosis and treatment difficult. OBSERVATIONS A 67-year-old male presented with fatigue and weakness, with MRI revealing an enhancing sellar mass with suprasellar extension and laboratory findings consistent with panhypopituitarism. He underwent endoscopic endonasal resection, which revealed a fibrous, highly vascular tumor adherent to surrounding tissue, consistent with SCO on final pathological analysis. Gross-total resection (GTR) was achieved, and the patient has been monitored regularly with no signs of recurrence at 9 months postoperatively. LESSONS SCOs are an exceedingly rare entity often indistinguishable from pituitary adenomas preoperatively, yet their intraoperative hypervascularity and fibrous texture can complicate resection and predispose patients to recurrence. Accurate identification of these tumors and GTR when possible are essential to appropriate treatment. https://thejns.org/doi/10.3171/CASE26333

Abstract Background: Radical prostatectomy (RP) remains a cornerstone treatment for patients with localized prostate cancer. Previous studies have suggested that prior RP may impact clonal evolution of metastatic disease and response to subsequent systemic therapies. In this study, we sought to investigate whether a history of prior RP is associated with treatment response and survival outcomes in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with ¹⁷⁷Lu-PSMA. Methods: In a single-institution retrospective study, we identified 260 patients who underwent 177Lu-PSMA for mCRPC. Patients were categorized based on the history of prior PR into two groups; Group A (n=147) included patients with prior PR, and Group B (n=113) included patients with intact prostate. The primary outcome was prostate-specific antigen (PSA) response, defined as a ≥50% decline from baseline (PSA50). Overall survival (OS) was evaluated as a secondary outcome. Univariable and multivariable regression analyses were performed to identify factors associated with PSA50 and OS. Results : Among 260 patients, PSA50 was achieved in 55.1% of patients with prior RP compared with 34.5% of those with an intact prostate. On multivariable logistic regression, prior RP remained independently associated with greater odds of achieving PSA50 (OR 2.1, 95% CI 1.09–4.1; p=0.03), whereas de novo metastatic disease was not independently associated with PSA50 (OR 0.97, 95% CI 0.44–2.15; p=0.9). Prior RP was also associated with improved OS on multivariable Cox regression (HR 0.60, 95% CI 0.4–0.8; p=0.008). Conclusion: In our experience, Prior RP was independently associated with improved PSA response and OS among patients with mCRPC treated with ¹⁷⁷Lu-PSMA. These findings suggest that prior treatment of the primary tumor may be associated with subsequent response to PSMA-targeted radioligand therapy, although the underlying mechanisms and potential influence of treatment selection and disease biology warrant further investigation.

ABSTRACT Background and Aims Autoimmune hepatitis is an immune‐mediated liver disease characterized by chronic inflammation and progressive fibrosis. Tissue‐resident memory T cells mediate organ‐specific immunity, but their role in autoimmune hepatitis remains poorly understood. We characterized tissue‐residency‐associated T‐cell populations and their cytokine profiles, assessed associations with disease severity and determined whether these signatures were reflected in peripheral blood. Methods Paired blood and liver samples were obtained from 19 patients with autoimmune hepatitis. Comparator cohorts included 20 patients with metabolic dysfunction‐associated steatotic liver disease and 20 surgical patients providing non‐inflamed adjacent non‐tumorous liver tissue. Multiparameter flow cytometry assessed tissue‐residency markers, T‐cell differentiation and cytokine production after polyclonal stimulation. Immune phenotypes were correlated with histological and clinical parameters. Results Autoimmune hepatitis was associated with compartment‐specific remodelling of T‐cell differentiation states and intrahepatic enrichment of CD8 + T cells expressing CD69, CD103 and CXCR6 relative to paired blood and comparator liver tissues. Intrahepatic CD8 + T cells exhibited an interferon‐γ‐dominant cytokine profile, whereas CD4 + T cells showed broader interferon‐γ‐, interleukin‐17A‐ and interleukin‐4‐associated responses. Despite the enrichment of tissue‐residency‐associated CD8 + T cells, cytokine‐producing CD8 + T‐cell populations with and without a tissue‐resident memory phenotype contributed comparably to the hepatic T‐cell compartment. Tissue‐residency‐associated phenotypes correlated positively with Ishak fibrosis stage, whereas the frequency of interferon‐γ‐positive intrahepatic CD8 + T cells correlated inversely with fibrosis. Conclusions Autoimmune hepatitis was characterized by intrahepatic accumulation of phenotypically distinct and functionally active CD8 + tissue‐resident memory T cells associated with fibrosis. This immune profile was not reflected in paired blood, indicating compartmentalized hepatic immune remodelling.

Cholera toxin (CTx) is a potent enterotoxin and widely used mucosal adjuvant, yet the acute host response to CTx itself, in the absence of a co-administered antigen, remains vague. In this study, we integrated physiological and metabolic phenotyping with intestinal transcriptomics, epithelial imaging, immune profiling, hepatic gene-expression analysis, and paired microbiome profiling to characterize the response to a single oral CTx exposure in mice. Within 24 h, CTx remodeled immune-cell composition in both epithelial and lamina propria compartments, with responses shaped by sex and genetic background. Recurrent changes included increased epithelial group 3 innate lymphoid cells, reduced lamina propria RORγt+ regulatory T cells, and decreased epithelial ILC1/NK cells in males of both strains. CTx also increased villus DCLK1+ tuft cells and reduced MUC2 immunoreactivity. Jejunal transcriptomics revealed induction of inflammatory defense, glycolytic, autophagy, and lipid-utilization programs together with suppression of proliferative and mitochondrial programs, consistent with coordinated stress adaptation. These local changes were accompanied by rapid restructuring of the fecal microbial community and by systemic hypometabolism, despite markedly different hypothermic responses across strains. CTx also elicited a selective hepatic stress and metabolic program, including conserved suppression of Cyp7a1 across sexes and strains. Together, these findings show that CTx alone rapidly reorganizes the intestinal immune, epithelial, metabolic, and microbial environment while suppressing whole-body metabolism. This work provides an integrated framework for understanding the acute host response to CTx and for interpreting its widespread use as a mucosal adjuvant.