Ureteral calculi are a common cause of emergency department visits worldwide. Although small stones often pass spontaneously, medical expulsive therapy is frequently used to facilitate stone clearance and reduce the need for surgical intervention. Tamsulosin, an α1-adrenergic receptor antagonist, is commonly prescribed for this purpose, but its efficacy compared with placebo remains uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials comparing tamsulosin with placebo in patients with ureteral calculi. A comprehensive search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials was performed from database inception through April 2025. The primary outcome was the stone expulsion rate, and secondary outcomes included time to expulsion and the incidence of adverse events. Pooled estimates were calculated as risk ratios or mean differences with 95 percent confidence intervals, using a random-effects model. A total of 42 randomized controlled trials involving 7,117 patients met the inclusion criteria. Compared with placebo, tamsulosin significantly increased the stone expulsion rate (risk ratio 1.42, 95 percent confidence interval 1.29 to 1.56, P < 0.001) and shortened the time to expulsion by an average of 3.04 days (95 percent confidence interval 2.28 to 3.81 days, P < 0.00001). The overall incidence of adverse events did not differ significantly between groups, although subgroup analysis indicated a lower risk of moderate to severe complications with tamsulosin (risk ratio 0.35, 95 percent confidence interval 0.22 to 0.98, P < 0.0001). Substantial heterogeneity was observed across outcomes. In conclusion, tamsulosin improves stone expulsion and reduces clearance time without increasing overall adverse events. However, given the considerable heterogeneity among studies, these findings should be interpreted with caution. Further high-quality, large-scale trials are needed to confirm the benefits of tamsulosin and to identify patient subgroups most likely to benefit from therapy.

Papillary cystadenoma (PC) is a benign epithelial tumor believed to be of mesonephric origin and is recognized as one of von Hippel-Lindau syndrome (VHL)-related neoplasms. PC tends to develop frequently in male VHL patients but rarely in females and arises from the mesosalpinx or broad ligament in females. Having experienced a case of multiple PCs in a female patient, we here report it with literature review. The patient was a 34-year-old woman. In her past medical history, VHL including multiple hemangioblastomas of the central nervous system, pancreatic neuroendocrine tumor, and multiple clear cell renal cell carcinoma (CCRCC) of the bilateral kidneys was diagnosed. In addition, a PC of the left ovary was resected seven years earlier. In the present report, she was admitted to our hospital because of lower abdominal pain, and then computed tomography revealed swelling of the right ovary and ascites. She was diagnosed with right ovarian torsion and thus salpingo-oophorectomy was performed. Histopathologically, while the tumor cells with pale or eosinophilic cytoplasm showed a papillary growth with partial cystic changes, none of apparent nuclear atypia, mitotic figure, and necrosis were observed. We finally diagnosed it as PC of the right ovary. Its pathological findings were similar to those of the previously resected left ovarian lesion. Although PC is rare in females, the presence of VHL should be kept in mind when PC is encountered. Moreover, metastatic CCRCC should also be considered to be one of differential diagnoses in VHL patients.

SMARCA4-deficient non-small cell lung cancer (SMARCA4-dNSCLC) is a rare, aggressive subtype with a high propensity for early metastasis and poor prognosis. Common metastatic sites include the bone, brain, adrenal glands, liver, and spleen; metastasis to the base of the tongue, however, is exceptionally rare. We present a unique case of SMARCA4-dNSCLC with concurrent metastases to both the adrenal gland and the base of the tongue. A 44-year-old male presented with cough and shortness of breath. Imaging revealed a right hilar mass, a left adrenal gland mass, and a nodule at the right tongue base. Histopathological examination of biopsies from the tongue base and mediastinal lymph nodes confirmed the diagnosis of SMARCA4-deficient undifferentiated NSCLC with metastases (T3N2M1c, stage IVB). Following a multidisciplinary discussion, the patient received combination therapy with paclitaxel, cisplatin, and tislelizumab. After three cycles, a partial response (PR) was achieved. The treatment was well-tolerated without significant adverse events, and the patient's condition remained stable with no signs of recurrence. This case highlights the unusual co-occurrence of a common (adrenal) and a rare (tongue base) metastatic site in SMARCA4-dNSCLC, which posed considerable diagnostic challenges. It expands the known clinical spectrum of this malignancy and underscores the importance of recognizing its rare metastatic patterns to guide accurate diagnosis and treatment.

Breast cancer exhibits a well-documented but incompletely explained predilection for the upper outer quadrant (UOQ), accounting for 45-50% of all cases, followed by the lower inner quadrant (LIQ) as the second most common site. We propose a mechanical hypothesis: chronic, repetitive mechanical stress from sexual partner-initiated breast manipulation - specifically the four-finger pinch grasp - creates sustained micro-injury and subsequent reparative proliferation preferentially targeting the UOQ, thereby increasing local mutational burden. The thumb opposes on the LIQ, offering a natural explanation for its secondary incidence pattern. This hypothesis generates specific, testable predictions, including dose-response relationships between cumulative exposure and quadrant-specific risk, as well as lateral asymmetry based on partner handedness. A large-scale epidemiological questionnaire study is proposed as the initial validation step. If confirmed, this hypothesis may transform breast cancer risk reduction into a modifiable behavioral domain.

[This corrects the article on p. 869 in vol. 13, PMID: 32509057.].

Acute promyelocytic leukemia (APL) is characterized by a translocation t(15;17), which leads to the fusion of the promyelocytic leukemia (PML) gene with the retinoic acid receptor alpha (RARA) gene. This entity represents a true medical emergency due to the high risk of coagulopathy and disseminated intravascular coagulation (DIC); thus, early diagnosis is crucial to initiate treatment and achieve a better outcome. Here, we present a challenging case of APL in a 25-year-old male that mimicked classic acute myeloid leukemia (AML) based on morphologic and immunophenotypic features. Furthermore, marked myelofibrosis was identified in our patient - an unusual finding for APL. By sharing this observation, we emphasize the importance of a comprehensive approach in achieving an accurate and timely diagnosis of APL, including the integration of morphologic assessment, immunohistochemistry, flow cytometry, and molecular techniques.

Liver cancer bone metastasis, a severe complication of liver cancer, is a leading cause of cancer death in China, featuring poor prognosis, intractable pain, and impaired quality of life. At present, the research of liver tumor bone metastasis mostly focuses on the treatment means and biological behavior analysis of malignant liver cancer, but the construction of the microenvironment before liver tumor metastasis is rarely studied. Unpredictable tumor metastasis hinders early intervention, leading to low cure rates. Since proposed the "premetastatic niche" concept was proposed in 2009, it has offered a novel framework for explaining liver cancer bone metastasis, supplementing traditional theories (e.g., "soil theory", "seed theory") and becoming a research focus. Herein, we review the premetastatic niche theory's origin, induction factors, mechanisms, and advances in liver cancer bone metastasis. Premetastatic niche formation is mainly induced by two factors: primary tumor-derived soluble factors (TDSFs) and extracellular vesicles (EVs). TDSFs (e.g., LOX, G-CSF, CCL2) are secreted under hypoxia and inflammation, reaching target organs via blood to promote matrix remodeling, recruit BMDCs, and establish immunosuppression. EVs carry mRNA, microRNA, and integrins, modifying target cell biology to facilitate PMN formation (e.g., Src phosphorylation, proinflammatory factor upregulation). BMDCs - especially MDSCs, neutrophils, and macrophages - are core PMN components. They interact with resident cells (e.g., hepatic stellate cells, osteoblasts) to secrete growth factors and matrix proteins, remodeling the microenvironment for tumor colonization. Animal studies confirm key regulatory molecules: TIMP-1 induces liver niches via SDF-1 upregulation and Ly6G+ neutrophil recruitment; CXCR2 inhibition reduces metastasis by limiting BMDCs and boosting immunity. While premetastatic niche research in liver cancer bone metastasis remains preliminary, it holds promise for clinical prevention and diagnosis. Future studies should clarify its molecular mechanisms and validate findings in clinical samples, laying the groundwork for translating this theory to improve patient prognosis.