High-grade serous ovarian carcinoma (HGSOC) frequently recurs after platinum-taxane therapy, yet recurrence-associated changes within ascites remain unclear. We performed cell-type-resolved quantitative proteomics on paired ascites samples collected at primary diagnosis and at disease recurrence from three HGSOC patients, profiling unsorted cells alongside matched CD45- tumor-enriched and CD45+ immune-enriched fractions. Conventional proteomic label-free quantitative (LFQ) analysis yielded limited significant proteins due to inter-patient heterogeneity. To address this, we applied Gene Set Enrichment Analysis (GSEA) to identify coordinated pathway-level alterations associated with recurrence. Across all cellular compartments, recurrent samples exhibited consistent downregulation of interferon-α/γ-associated pathways alongside enrichment of oxidative phosphorylation and stress-adaptive metabolic programs. In the CD45+ immune compartment, these changes were accompanied by enhanced IL-2/STAT5 signaling and reduced antigen-presentation pathways. Together, these findings suggest that recurrent ascites is characterized by a shift toward oxidative metabolism and a more immunosuppressive microenvironment.

Endometriosis may rarely present with atypical manifestations that closely mimic intra-abdominal malignancy or severe pelvic sepsis, resulting in significant diagnostic uncertainty. We present two contrasting cases of presumed severe endometriosis with uncommon clinical and radiological presentations. In the first case, a woman in her 30s presented with acute abdominal pain, progressive abdominal distension, and respiratory compromise associated with massive haemorrhagic ascites and markedly elevated cancer antigen 125 levels. Cross-sectional imaging demonstrated extensive deep infiltrative endometriosis with haemoperitoneum and multiple extra-pelvic endometriotic deposits. In the second case, a woman in her 30s presented with a complex adnexal mass, para-aortic lymphadenopathy and inflammatory features initially concerning for tubo-ovarian abscess or underlying malignancy. Following prolonged antibiotic therapy, complete radiological resolution of the adnexal lesion was observed, with subsequent imaging findings considered highly suggestive of an infected endometrioma. These cases emphasise the diverse spectrum of endometriosis presentations, the limitations of non-histological diagnosis and the importance of multidisciplinary assessment, radiological expertise and longitudinal follow-up in complex presentations.

Percutaneous transesophageal gastric catheter (PTEG) placement is an alternative technique for gastric decompression in patients who require long-term venting with contraindication(s) to traditional gastrostomy access (percutaneous, endoscopic, or surgical), such as primary or metastatic gastric cancer, refractory ascites, or altered anatomy. Despite growing evidence supporting PTEG's efficacy and safety especially for palliative care, literature on catheter removal, and follow-up is sparse. We present 4 cases of PTEG catheter removal in patients with malignant bowel obstruction (MBO) and contraindications to radiologic percutaneous gastrostomy (PG). Each case involved successful PTEG placement, followed by removal once symptoms resolved. Follow-up periods varied, with no reported complications postremoval and a median follow-up time of 599 (139-725) days. PTEG provides a viable alternative for patients requiring gastric decompression who are not candidates for PG. This case series demonstrates the safety and feasibility of PTEG catheter removal, even within the limitations of the sample size. This case series demonstrates that PTEG catheter removal after symptomatic relief of malignant bowel obstruction is safe. Further research is needed to better understand the long-term outcomes and to confirm these preliminary findings.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising therapy for peritoneal metastasis, yet variable efficacy and complications necessitate improvement. This study investigates plasma-activated solutions (PAS) as an enhancer of HIPEC against colorectal cancer-derived peritoneal metastasis. Using murine models and human colorectal cancer cell lines, PAS combined with HIPEC significantly suppresses tumor growth, reduces malignant ascites, and improves survival. Mechanistically, PAS induces oxidative stress, activating the endoplasmic reticulum stress (ER-stress) pathway to trigger cancer cell death. Reactive oxygen species (ROS) are critical mediators, as their neutralization abolishes antitumor effects. Furthermore, integrating PAS-HIPEC with anti-PD-L1 immunotherapy yields synergistic tumor control and survival benefits superior to monotherapies. These findings establish PAS-enhanced HIPEC as a promising strategy that leverages ROS-mediated cell death to potentiate chemotherapy and sensitize tumors to immunotherapy, offering a novel approach for this challenging disease.

Peritoneal pathology is commonly encountered in clinical practice yet remains diagnostically challenging due to substantial overlap in imaging appearances. Findings such as ascites, peritoneal thickening, and nodularity are often attributed to peritoneal carcinomatosis (PC), a metastatic condition associated with a worse prognosis than metastatic disease without peritoneal involvement. Accurate diagnosis is therefore essential for staging, treatment planning, and prognostication. However, a variety of benign and malignant conditions can produce similar findings. These "peritoneal pretenders" include inflammatory, infectious, traumatic, iatrogenic, and non-carcinomatous malignant processes. This imaging similarity can lead to diagnostic uncertainty, unnecessary investigations, or delays in appropriate management. Understanding peritoneal anatomy, fluid dynamics, and predictable patterns of disease spread is critical for accurate localization and interpretation. This review presents a practical pattern-based multimodality imaging approach to peritoneal pathology, integrating clinical context, disease acuity, imaging morphology and distribution, and targeted advanced imaging to distinguish PC from its benign and malignant mimics.

Portal vein thrombosis (PVT) is a heterogeneous and clinically significant complication of liver cirrhosis, primary hepatobiliary malignancy, and various systemic prothrombotic states. It is associated with advanced portal hypertension, increased surgical complexity during liver transplantation, and higher mortality. The aim of this manuscript is to provide a narrative review of PVT and portal vein recanalization combined with transjugular intrahepatic portosystemic shunt (PVR-TIPS), detailing epidemiology, pathophysiology, and diagnostic classifications while exploring evolving medical and interventional management strategies. A comprehensive narrative review of the existing literature was conducted, incorporating clinical practice guidelines from major societies (AASLD, Baveno VII, EASL, and AGA) and recent prospective and retrospective studies regarding the management of non-malignant PVT in both cirrhotic and non-cirrhotic patients. PVT occurs in approximately 1% of the general population but affects up to 44% of candidates for liver transplantation (LT). Its development is governed by Virchow's triad, with reduced portal flow velocity (<15 cm/s) being the primary independent predictor in cirrhosis. Diagnosis relies on Doppler ultrasound as a first-line screening tool, followed by contrast-enhanced computed tomography or magnetic resonance imaging to define the degree of occlusion, extent, and chronicity using standardized nomenclature. Medical management with anticoagulation is the cornerstone for recent PVT (<6 months), achieving recanalization in 40%-75% of cases. For chronic obliterative PVT or refractory complications (variceal bleeding or refractory ascites), PVR-TIPS has emerged as a safe and highly successful intervention, with technical success rates ranging from 75% to 100% in expert centers. PVR-TIPS facilitates physiologic end-to-end portal anastomosis during LT in up to 96%-100% of cases, significantly improving transplant feasibility and outcomes. The management of PVT has transitioned toward highly individualized strategies. Standardized classification remains essential for guiding therapy. While medical management is effective for recent-onset disease, PVR-TIPS represents a transformative interventional advancement for chronic obliterative PVT, restoring physiologic flow and optimizing candidates for curative liver transplantation.

Haemorrhagic ascites (HA) is an uncommon clinical entity commonly caused by cirrhosis, malignancy and iatrogenic intervention. In the absence of these causes, it poses a diagnostic challenge. We present a case of a female with recurrent massive HA with a negative extensive work-up of common causes of HA. Laparoscopically obtained tissue eventually confirmed the diagnosis of endometriosis. This case demonstrates important diagnostic pitfalls in HA and highlights consideration of rarer causes.

Advances in single-cell and spatial profiling have enabled detailed characterization of heterogeneous samples, but analyzing this data remains challenging in settings involving multiple comparisons. While tools like UMAP and t-SNE are valuable for visualization, their stochastic, parameter-sensitive nature limits their use in longitudinal comparisons, treatment group analysis, and multicenter trials. Although OT was first described in the 19th century, the Sinkhorn algorithm makes it computationally tractable for high-dimensional data. By directly comparing distributions of cellular states, OT provides reproducible measures of change in high-dimensional space. This framework is amenable to integration with machine learning, including deep generative models.

Despite major advances in nanomedicine, therapeutic efficacy remains constrained by unfavorable host responses that influence nanotherapeutic retention, biodistribution, and activity. Biological strategies capable of enhancing nanomedicine performance through modulation of host-response pathways, rather than additional nanoparticle engineering, remain largely unexplored. Herein, we investigated whether a microbial levan produced by Weissella paramesenteroides could potentiate the therapeutic activity of a PEGylated β-cyclodextrin-capped benzimidazole-curcumin nanocomplex (BMPE-Cur) in an Ehrlich ascites carcinoma (EAC)-induced hepatic tumor model. Pharmacokinetic, biochemical, histopathological, angiogenic, immunological, molecular, and computational analyses were performed to evaluate therapeutic efficacy and explore underlying mechanisms. The co-administration of levan increased hepatic BMPE accumulation by 2.3-fold and significantly enhanced the therapeutic efficacy of BMPE-Cur, improving survival to 95.45% compared with 60.66% mortality in untreated tumor-bearing mice. Combination therapy produced 86% inhibition of angiogenesis, markedly suppressed tumor-associated biomarkers, oxidative stress, inflammatory mediators, and immunosuppressive cell populations, and restored hepatic function. These effects were accompanied by reduced expression of components of the TLR2/MyD88/NF-κB pathway, including an 80.05% reduction in MyD88 and a 78.93% reduction in NF-κB, together with 6.59-fold and 7.45-fold increases in FXR and FGF15 expression, respectively. Molecular docking supported potential interactions of BMPE, curcumin, and levan-derived structural motifs with TLR2, while isobolographic analysis demonstrated predominantly synergistic interactions across multiple biological endpoints. These findings support the potential of microbial levan as a promising biological potentiator of nanotherapeutic efficacy, with concurrent enhancement of hepatic nanocomplex retention and coordinated immunometabolic remodeling. More broadly, microbial exopolysaccharides may represent a promising class of host-response modulators, supporting a therapeutic paradigm in which optimizing the biological environment may complement conventional nanocarrier engineering to improve the performance of cancer nanomedicine.

A 72-year-old man was diagnosed with advanced gastric cancer with severe gastric stenosis, lymph node metastasis, and portal vein invasion. He underwent ileo-gastrostomy, then received chemotherapy using 4 cycles of S-1 and 2 cycles of SOX. The response to this therapy was judged PD; thus, second-line therapy of wPTX + RAM was introduced, although icterus and ascites were recognized then. After a single injection of wPTX + RAM, G4 neutropenia, anorexia, and severe ascites were observed. Thus, the chemotherapy was discontinued. At that point, he had been diagnosed with severe liver cirrhosis, and internal treatment was introduced. Six weeks after the last injection of anti-cancer drugs, CT revealed tumor shrinkage and highly reduced serum CEA, although ascites increased. Subsequently, ascites and general condition gradually recovered without anti-cancer therapy. One year after the last injection of anti-cancer drugs, the primary tumor, lymph node metastasis, and portal vein invasion were not observed on CT and endoscopy, and the patient was judged cCR. This rare case demonstrated prolonged effect of wPTX + RAM that caused the depression of liver metabolism. Therefore, anti-cancer immune response has been induced by an unknown mechanism.