Gastrointestinal metastases from non-small cell lung cancer (NSCLC) are rare and usually focal. Diffuse small bowel involvement without discrete lesions is uncommon and often radiographically occult.An elderly man with a history of poorly differentiated NSCLC, previously treated with pembrolizumab, presented with recurrent ascites, profound anasarca, dizziness and anaemia. Multiple endoscopic evaluations, CT scans and a positron emission tomography-CT were unrevealing. Due to prior immunotherapy exposure and diffuse jejunal inflammation, immune checkpoint inhibitor enteritis was suspected, showing transient response to corticosteroids. However, push enteroscopy later revealed diffuse, friable proximal jejunal mucosa. Biopsy confirmed metastatic carcinoma (cytokeratin 7 positive, cytokeratin 20, caudal-type homeobox transcription factor 2 and thyroid transcription factor 1 negative), and molecular profiling showed 80% programmed death-ligand 1 expression. The patient's condition deteriorated and he died shortly after the diagnosis was made.This case emphasises that diffuse intestinal metastases can evade conventional imaging and superficial biopsies, mimicking immunotherapy-related enteritis. Persistent clinical suspicion, repeat endoscopy and deep histopathological confirmation are vital.

Typical carcinoid tumors (TC) are a low-grade neuroendocrine tumor characterized by low proliferation activity and an overall favorable prognosis. Lympho-vascular invasion is uncommon in TC and is more frequently associated with atypical carcinoid. We reported a 46-year-old non-smoking woman who underwent right lower lobectomy for a right pulmonary hilar mass after multidisciplinary team (MDT) evaluation (cT1cN0M0, AJCC 9th edition, IA3). Postoperative histopathological examination confirmed typical carcinoid tumor with a low Ki-67 proliferation index (< 2%), and no tumor necrosis was identified, fulfilling the diagnostic criteria for typical carcinoid according to the current WHO classification of thoracic tumors. Unexpectedly, focal lympho-vascular invasion in the form of tumor emboli was identified. Additionally, the resected lung showed caseating granulomatous inflammation with acid-fast bacilli, suggestive of a non-tuberculous mycobacteria (NTM) infection; however, species-level identification was not performed. No lymph node metastasis was detected (pT1cN0M0, AJCC 9th edition, IA3). The patient had minimal pleural effusion on the surgical side postoperatively, and no signs of recurrence or metastasis have been detected during 20 months of follow-up to date. This report highlights a pathological discordance between the low proliferation index and the presence of lympho-vascular invasion in TC. The concomitant granulomatous inflammation may have contributed to diagnostic complexity, although a causal relationship cannot be established. This case underscores the importance of careful histopathological evaluation for invasive features in typical carcinoid tumors, even in the context of low proliferative activity. Surgical treatment alone might be safe in this specific scenario.

Lung adenocarcinoma (LUAD) is the leading cause of cancer-related death worldwide. Despite advances in surgery, targeted therapy, and immunotherapy, the 5-year survival rate of advanced LUAD remains below 20%, indicating an urgent need for reliable molecular biomarkers for early detection and prognosis. In this study, the authors hypothesized that three consistently upregulated genes could act as effective diagnostic and prognostic biomarkers for LUAD. The authors analyzed transcriptomic data from two independent cohorts, TCGA-LUAD (535 tumors, 59 normal samples) and GSE115002 (52 tumors, 52 matched normal samples), to screen differentially expressed genes. Three core genes-B3GNT3, FERMT1, and SPP1-were consistently overexpressed in LUAD tumors in both datasets. These genes showed excellent diagnostic performance, with AUC values above 0.95 in TCGA-LUAD and high accuracy in GSE115002. Survival analysis showed that high expression of each gene was significantly associated with shorter overall and disease-free survival, and multivariate Cox regression verified their independent prognostic value. Functional enrichment analysis indicated that these three genes participate in epithelial-mesenchymal transition, extracellular matrix remodeling, and immune suppression, all of which are closely related to LUAD invasion and metastasis. The authors further constructed a prognostic nomogram combining the three genes and TNM stage, achieving a concordance index of 0.743 and demonstrating good predictive performance. These findings confirm that B3GNT3, FERMT1, and SPP1 are promising diagnostic and prognostic biomarkers for LUAD, supporting the clinical application in risk stratification and management.

The relative benefits of Robotic-assisted thoracoscopic segmentectomy (RATS) versus video-assisted thoracoscopic segmentectomy (VATS) for early-stage NSCLC remain uncertain. This meta-analysis compared perioperative outcomes, lymph node assessment, and postoperative safety between the two approaches. PubMed, Cochrane Library, Embase, and Web of Science were searched from inception to April 2026. Comparative studies of RATS versus VATS segmentectomy for early-stage NSCLC were included. Outcomes were pooled as weighted mean differences or odds ratios with 95% confidence intervals. Random-effects models were used for substantial heterogeneity (I[2] >50% or P < 0.05); otherwise, fixed-effects models were applied. Leave-one-out sensitivity plots are provided in the supplementary materials. Nine retrospective comparative studies involving 19,805 patients were included. Robotic-assisted segmentectomy was associated with a greater number of lymph node stations examined (WMD = 1.16, 95% CI: 0.51, 1.81, P < 0.001) and a shorter length of hospital stay (WMD = - 0.75, 95% CI: -1.36, - 0.15, P = 0.015). No significant differences were observed in operative time (WMD = 1.86, 95% CI: -8.80, 12.52, P = 0.732), duration of drainage (WMD = - 0.37, 95% CI: -0.79, 0.06, P = 0.090), overall complications (OR = 0.94, 95% CI: 0.67, 1.34, P = 0.745), air leak (OR = 1.02, 95% CI: 0.54, 1.91, P = 0.949), pneumonia (OR = 1.33, 95% CI: 0.89, 1.99, P = 0.170), or 30-day readmission (OR = 1.09, 95% CI: 0.94, 1.26, P = 0.257). Current retrospective evidence suggests that RATS may offer more examined lymph node stations and shorter hospital stay without increased morbidity, but these findings are limited by risk of bias and should not be interpreted as evidence of oncologic superiority.

Circadian rhythm disruption (CRD), common in shift work and jet lag, promotes mammary tumorigenesis through coordinated reprogramming of tumor metabolism and the local microbiome. CRD increased immunosuppressive metabolites - kynurenic acid, spermidine, and argininosuccinic acid - that suppressed effector T-cell activity and drove macrophage polarization toward anti-inflammatory phenotypes. 16S rRNA sequencing revealed enrichment of immune-modulatory Firmicutes and Bacilli within CRD tumors. Experimental and multi-omics integrative analyses strongly support metabolome-microbiome crosstalk driving immune suppression under CRD. Inhibition of arginase-1 (ARG1) with nor-NOHA restored cytotoxic T-cell responses and reduced lung metastases. These findings establish metabolome-microbiome interactions as a central mechanism of CRD-induced immunosuppression and metastasis, revealing potential therapeutic targets for circadian disruption-associated breast cancer.