Gastrointestinal metastases from breast cancer are uncommon and occur more frequently in invasive lobular carcinoma (ILC), which exhibits a distinctive metastatic pattern involving the peritoneum, mesentery, and gastrointestinal tract. These metastases may present with nonspecific symptoms or with bowel subobstruction and obstruction, making diagnosis challenging, particularly in the absence of obvious intramural lesions on imaging studies. We report the case of a 64-year-old woman with a history of bilateral mastectomy for ILC who presented with abdominal pain, nausea, and vomiting suggestive of proximal intestinal obstruction. Upper gastrointestinal endoscopy demonstrated a severe, non-passable stenosis of the third portion of the duodenum. Contrast-enhanced CT and MRI demonstrated ill-defined enhancing peritoneal and mesenteric lesions involving the transverse mesocolon and mesenteric root, with extrinsic compression of the third and fourth portions of the duodenum and no definite primary intramural bowel mass. MRI demonstrated restricted diffusion within the lesions, and 18F-FDG PET/CT showed increased FDG uptake at the mesenteric root and transverse mesocolon. Exploratory laparoscopy with biopsy confirmed metastatic invasive lobular breast carcinoma involving the transverse mesocolon. Peritoneal metastases from ILC may cause extrinsic compression of the gastrointestinal tract and present as bowel obstruction even in the absence of radiologically detectable masses. In patients with a history of breast cancer who develop gastrointestinal symptoms, peritoneal metastatic disease should be included in the differential diagnosis. A multidisciplinary approach integrating endoscopy, advanced imaging, and histopathological confirmation is essential for accurate diagnosis and appropriate management.

Pressurised Intraperitoneal Aerosol Chemotherapy (PIPAC) is a novel drug delivery system for treating peritoneal metastasis. No PIPAC-specific formulation is available, stability data under PIPAC conditions are lacking, and the drugs are used off-label. 85% PIPAC are performed using Doxorubicin (DOX) and Cisplatin (CIS). Formulation development adhered to Investigational Medicinal Product Dossier (IMPD) requirements, covering composition, manufacturing process and controls, characterisation of actives and excipients, and in-use and long-term stability, as well as preclinical validation, including sprayability and dose equivalence in peritoneal tissue. The drug composition meets defined pharmaceutical specifications, yielding a stable, ready-to-use aqueous solution containing 0.131 mg/mL DOX and 0.656 mg/mL CIS in 0.9% sodium chloride, buffered to pH 4.4-4.5. Manufacturing followed a scalable process with controlled pH, osmolality, and purity, and packaging ensured light protection. Characterisation confirmed stability, appropriate viscosity, and physicochemical integrity. Sprayability testing with the CapnoPen® device demonstrated consistent aerosolisation and no drug-device incompatibility. A 200 mL volume provided optimal tissue uptake and lowest aerosol sedimentation, outperforming 100 mL and matching reference drugs. Tissue bioavailability of DOX and CIS was comparable to that of separate drug administration. Usability studies showed simplified handling, reduced equipment needs and minimised exposure risks. The diluted solution was stable for up to 30 h at room temperature, while long-term stability at 5 °C (undiluted) preserved DOX for 9 months and CIS for 60 months. We developed a sprayable DOX-CIS formulation specifically tailored for PIPAC therapy. Overall, the DOX-CIS composition met the predefined quality, performance, and stability criteria for use in PIPAC.

BackgroundSMARCA4 genetic alterations have been associated with aggressive neoplasms in various organs. In the uterus, SMARCA4-deficiency has been reported rarely, typically presenting as undifferentiated uterine sarcoma with a poor prognosis and younger age onset. The spectrum of SMARCA4-driven uterine tumors has recently expanded reporting hybrid features to include adenosarcoma components.Clinical PresentationWe report a 27-year-old woman who presented with abnormal uterine bleeding. The endometrial curettage revealed a high-grade adenosarcoma. One month later, the patient underwent tumor debulking surgery. The histologic examination showed a tumor with leaf-like architecture and marked stromal atypia. The stromal component exhibited epithelioid and rhabdoid features, with cells arranged in nests. Extensive lymphovascular invasion and infiltration of surrounding tissues were noted. SMARCA4 mutation was confirmed by next-generation sequencing, with no other mutations detected. Despite prompt initiation of aggressive chemotherapy, the cancer continued to spread to the lungs and peritoneum. The patient died 19 months after the initial presentation.ConclusionThis case report reinforces the emerging pattern of SMARCA4-deficient tumors presenting aggressively in premenopausal women with hybrid morphologic features. It highlights the importance of molecular testing in patients of all ages and the need for early recognition and prompt treatment of tumors harboring mutations associated with rapid progression.

High-voltage electrical burns involving the abdominal wall pose complex management challenges, including delayed bowel perforation, progressive tissue necrosis, and durable reconstruction in compromised tissue. To our knowledge, no standardized approach has been described that combines visceral surveillance with abdominal wall reconstruction in this setting. We report a case of a 43-year-old man who sustained a 22,000-volt electrical injury with 30% total body surface area burns and a full-thickness lower abdominal wall defect (16 × 13 cm) exposing the intact peritoneum. Triple-contrast computed tomography on day 3 excluded bowel perforation. On day 22, diagnostic laparoscopy was performed for delayed visceral surveillance; in the absence of bowel pathology, intraperitoneal onlay mesh reinforcement was performed during the same procedure. On day 27, a bipedicled anterolateral thigh fasciocutaneous flap was elevated; sequential 10-minute bulldog clamp testing of each perforator produced equivalent reductions in perfusion, prompting a 4-day delay for choke-vessel maturation. On day 31, the flap was re-elevated and transposed, with the fascia lata sutured to the anterior rectus sheath as a second reinforcement layer superficial to the intraperitoneal onlay mesh. At the 6-month follow-up, the patient demonstrated complete wound healing, stable abdominal wall integrity without clinical hernia on physical examination or with Valsalva maneuver, independent ambulation with a below-knee prosthesis, and return to modified work duties. This integrated single-stage laparoscopic approach combining delayed visceral surveillance with definitive abdominal wall reinforcement may inform management of similar injuries.

Endosalpingiosis (ES) is a benign, nonneoplastic condition of the Müllerian system characterized by the ectopic implantation of fallopian tube-like ciliated columnar epithelium. Unlike endometriosis, ES lacks endometrial stroma and therefore does not produce the characteristic hemorrhagic episodes or extensive inflammatory responses associated with endometriosis. Although ES is primarily identified in the visceral pelvic peritoneum, extrapelvic manifestations are exceedingly rare, with pulmonary and pleural localization, accounting for ∼0.1% of reports. This report describes the clinical presentation of thoracic ES in a 40-year-old woman who presented with catamenial spontaneous primary pneumothorax. Despite a remote surgical history for ovarian endometriosis 10 years earlier, the patient had a prolonged period of clinical latency and no evidence of current pelvic recurrence. Videothoracoscopic surgery revealed a 5-mm apical pulmonary nodule and diffusely calcified pleural plaques. Histopathology and immunohistochemistry are remain gold-standard diagnostic methods for differentiating ES from thoracic endometriosis syndrome or malignancy. The diagnosis was confirmed by epithelial immunoreactivity for Müllerian transcription factors (PAX8 and WT1), keratin 7, and estrogen/progesterone receptors, together with the absence of cluster of differentiation 10 expression, which argued against endometrial stroma, and calretinin negativity, which argued against mesothelial origin. The pathophysiology of thoracic ES may resemble that of pulmonary endometriosis, involving transdiaphragmatic or vascular migration of Müllerian cells. For symptomatic presentations, surgical excision combined with long-term suppressive hormonal therapy is recommended to reduce epithelial proliferation. Given that the emerging literature suggests a possible link between ES and gynecological malignancies, rigorous long-term postoperative surveillance remains essential.

There are various surgical approaches for laparoscopic radical right hemicolectomy. However, the Henle's trunk and middle colic vessels often reveal anatomical variations, and improper handling may lead to vascular injury. This protocol presents a "cranial-first" approach combined with complete mesocolic excision (CME) to attempt to overcome the aforementioned technical difficulties. 86 cases were collected from September 2023 to April 2026. First, the gastrocolic ligament was opened to expose the right gastroepiploic vessels and the pancreatic head. The colic branches of Henle's trunk and the middle colic vein (MCV) were dissected and ligated along the inferior border of the pancreas. Dissection then continued caudally along the superior mesenteric vein (SMV) and laterally along the retroperitoneal plane to the duodenum. Second, a medial approach was adopted. The assistant lifted the transverse and the ileocolic mesocolon. The peritoneum was incised between the jejunal origin and the ileocolic projection. The lymphatic and adipose tissue on the superior mesenteric artery (SMA) and SMV surface was dissected medially to laterally. The middle colic artery (MCA) or its right branch and the ileocolic vessels were ligated. Finally, the ileocecal mesentery was incised, and the right mesocolon was completely mobilized along Toldt's space. The median operative time was 182.0 min, the blood loss was 45.0 ml, and the number of lymph node dissections was 28.0. The median time to flatus was 3.0 days, and the postoperative hospital stay was 6.0 days. Wound infection occurred in 4 patients, and ileus occurred in 2 patients, but no postoperative death occurred. Preliminary results indicated that this approach was safe and feasible.

Gastrin regulates gastric acid secretion and mucosal homeostasis via the cholecystokinin-2 receptor (CCK2R). Aberrant signaling via CCK2R (cholecystokinin family) and the distinct class A GPCR, gastrin-releasing peptide receptor (GRPR; bombesin family), drives oncogenesis across diverse GI and non-GI malignancies through calcium mobilization, MAPK/PI3K activation, EGFR transactivation, and constitutive splice variants like CCK2Ri4sv. Furthermore, precursor forms such as progastrin remodel the tumor microenvironment by interacting with non-CCK binding sites (p78, Annexin A2), converting fibroblasts into pro-invasive CAFs and sustaining cancer stem cells. Chronic hypergastrinemia, induced by Helicobacter pylori infection, autoimmune gastritis, or long-term proton pump inhibitor (PPI) therapy, drives enterochromaffin-like (ECL) cell hyperplasia, promoting gastric neuroendocrine tumors and diffuse-type carcinomas. Beyond gastroenteropancreatic physiology, selective expression of CCK2R on ECL and thyroid C-cells, combined with widespread ectopic GRPR overexpression in solid tumors, establishes versatile platforms for molecular imaging and radiotheranostics. Radiolabeled peptide antagonists and stabilized minigastrin/bombesin analogs conjugated to diagnostic ([68]Ga, [64]Cu) or therapeutic radionuclides ([177]Lu,[225]Ac, [212]Pb) enable high-resolution PET imaging and targeted radionuclide therapy (PRRT/TAT). These strategies demonstrate high diagnostic accuracy and localized cytotoxicity in medullary thyroid carcinoma, small cell lung cancer, prostate neoplasms, and ER+ breast cancers. Concurrently, novel circulating biomarkers, including multi-genomic liquid biopsies (NETest®) and ProGRP, significantly improve non-invasive disease tracking. Unraveling these receptor pathways bridges tumor biology with translational medicine, offering transformative potential for personalized diagnosis, risk stratification, and targeted radionuclide therapy.

Pheochromocytomas and paragangliomas (PPGLs) are neuroendocrine tumors derived from chromaffin cells that produce catecholamines. The primary treatment for PPGLs is surgical resection, and even in cases with distant metastases, metastasectomy may be considered. Other therapeutic options for distant metastatic disease include radionuclide therapy, such as [131]I-metaiodobenzylguanidine (MIBG) and [177]Lu-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid-(Tyr[3])-octreotate (DOTATATE). However, clear evidence is lacking regarding which patients with distant metastases are the best candidates for metastasectomy or radionuclide therapy. Herein, we report a case of a 58-year-old man who underwent resection of a left pheochromocytoma 10 years prior and was admitted for treatment of recurrent metastases to the liver and peritoneum. Sequential [131]I-MIBG and [177]Lu-DOTATATE therapies were administered, which contributed to disease control and reduction of catecholamine levels but did not achieve a complete response. Subsequently, all metastatic lesions were successfully resected, leading to normalization of catecholamine secretion. This case suggests that metastasectomy may be preferable to radionuclide therapy in carefully selected patients with limited, resectable metastatic disease, despite the presence of distant and multiple metastases. Furthermore, it highlights the importance of periodic reassessment of resectability in patients with distant metastases, even when radionuclide therapy is initially selected, and consideration of metastasectomy once complete resection becomes feasible.