Purpose To develop a deep learning model that automatically delineates the eight liver Couinaud segments and the spleen on CT for future liver remnant (FLR) volumetry. Materials and Methods In this retrospective study (January 2001 and October 2025), eight liver Couinaud segments and the spleen were manually labeled on CT scans of patients from Institution-A and the public Medical Segmentation Decathlon dataset. A 3D nnU-Net segmentation model was trained on this dataset and evaluated on three datasets (one internal and two external). Results The training dataset included 498 patients (442 from the public Medical Segmentation Decathlon dataset and 56 from Institution-A, mean age 55 ± 7 [SD] years, 38 males), while the testing dataset included 64 patients from Institution-A (50 had liver fibrosis and 8 underwent portal vein embolization; PVE), 197 patients from the publicly available colorectal liver metastases (CRLM) dataset (mean age 59 ± 12 years, 117 males), and 50 patients (25 were healthy and 25 had cirrhosis) from an external Institution-B (mean age 49 ± 9 years, 29 males). For the whole liver in Institution-A and Institution-B, Dice scores of 0.98 ± 0.02 (95% CI: 0.97, 0.99) and 0.98 ± 0.03 (95% CI: 0.97, 0.99), and 95% percentile Hausdorff Distance (HD) errors of 2.5 ± 3.8 mm (95% CI: 1.6, 3.3) and 3.3 ± 6.6 mm (95% CI: 1.4, 5.2) were obtained, respectively. The pre-PVE FLR% and post-PVE FLR% volume differences (manual vs automated, 8 patients) were 0.03 ± 2.4 and-0.39 ± 3.0, respectively. For the FLR in the CRLM dataset, a Dice score of 0.99 ± 0.01 (95% CI: 0.99, 0.993) and an HD error of 0.9 ± 1.8 mm (95% CI: 0.6, 1.1) were achieved. Conclusion The model accurately estimated preoperative FLR volumetry and generalized well to patients with colorectal liver metastases, fibrosis, cirrhosis and healthy controls. ©RSNA, 2026.

Epithelioid angiomyolipoma is a rare variant of angiomyolipoma, with necrosis being one of its unfavourable prognostic indicators. We report a 39-year-old woman with necrotic epithelioid angiomyolipoma of the left kidney. Left Radical nephrectomy was performed and thorough follow-up was undertaken even though no sign of recurrences or distant metastasis was found.

Succinate dehydrogenase-deficient renal cell carcinoma is a rare and recently recognized distinct subtype of renal cell carcinoma. Usefulness of FDG PET/CT in the management of this tumor is rarely reported. We describe FDG PET/CT findings in a case of succinate dehydrogenase-deficient renal cell carcinoma with lung metastases. The lung metastases <2 cm showed high FDG uptake with SUVmax of 19.1, which may be due to extreme Warburg effect resulting from succinate dehydrogenase mutation. This case indicates FDG PET/CT may be useful for detecting and staging of this novel tumor, which needs to be investigated in future studies.

The metastasis from a primary lung adenocarcinoma to the thyroid is an infrequent occurrence. Typically, malignancies arising from the breast or kidney are more commonly associated with metastatic involvement of the thyroid gland. Here, we report the case of a 63-year-old female with primary lung papillary adenocarcinoma presenting moderate thyroid swelling and progressive shortness of breath. Ultrasound of the neck demonstrated diffusely enlarged and heterogeneously hypoechoic thyroid parenchyma, accompanied by microcalcifications and bilateral enlargement of level III and IV lymph nodes. Fine-needle aspiration cytology of the thyroid gland revealed papillary carcinoma, The Bethesda category VI. Immunocytochemistry positive for TTF1 and Napsin A and negative for PAX 8 proved it to be a primary lung papillary adenocarcinoma metastasizing to the thyroid. Contrast-enhanced computed tomography of the thorax demonstrated gross right pleural effusion with collapse and consolidation of the entire lung parenchyma. This case highlights the importance of cell block and immunocytochemistry in the accurate diagnosis of metastatic thyroid malignancy.

This study aimed to investigate the dynamics, pharmacokinetic characteristics, and radiation dosimetry of [[68]Ga]Ga-OncoACP3-DOTA, a novel prostatic acid phosphatase (ACP3)-targeted radioligand, in patients with metastatic castration-resistant prostate cancer. Methods: Seven patients with metastatic castration-resistant prostate cancer had dynamic or multiple-time-point PET/CT scans after intravenous injection of [[68]Ga]Ga-OncoACP3-DOTA available. Five patients had early dynamic scans over the thorax, and 6 had dynamic whole-body PET scans during the first hour after injection. Five patients underwent an additional late-time-point whole-body PET scan (median, 3.2 h postinjection). SUVs for volumes of interest were determined for normal organs and metastases, and uptake dynamics and tumor-to-background ratios were calculated. Pharmacokinetic modeling was performed for multiple compartment models and evaluated in accordance with the Akaike information criterion. Dosimetry calculations were performed using MIRDfit and MIRDcalc, with time-integrated activity coefficients scaled to the International Commission on Radiological Protection 133 Adult Male Reference Phantom. Results: [[68]Ga]Ga-OncoACP3-DOTA displayed declining uptake in most organs, except for organs involved in excretion, and stable uptake was observed only in the prostate. Dual renal and hepatobiliary excretion was noted. Declining blood kinetics were well-fitted by a triexponential function. Metastases showed an increase in uptake from early to late time points, with intensely increasing tumor-to-background ratios. Pharmacokinetic modeling indicated that a 2-tissue compartment model with irreversible binding was most appropriate for describing metastatic uptake. Bone and lymph node metastases exhibited significant differences in K 1 and K i values. The mean effective dose was 0.0192 mSv/MBq, resulting in an effective dose of 3.50 mSv for a standard injection of 2.5 MBq/kg. The highest absorbed doses were observed in bone marrow (0.0913 mGy/MBq), kidneys (0.0657 mGy/MBq), and liver (0.0563 mGy/MBq), whereas salivary glands showed a negligible absorbed dose (0.0135 mGy/MBq). Conclusion: [[68]Ga]Ga-OncoACP3-DOTA demonstrated favorable pharmacokinetics with increasing tumor uptake and tumor-to-background ratios at later time points, suggesting potential benefits for delayed imaging, especially with high-sensitive PET systems or radiolabeling with isotopes with longer half-lives. The dosimetry profile was favorable, with a lower effective dose compared with many prostate-specific membrane antigen-targeted radiopharmaceuticals and negligible salivary gland uptake, potentially reducing side effects during radiopharmaceutical therapy. Future studies are warranted to evaluate its clinical value.

BACKGROUND Crossed fused renal ectopia (CFRE) is an uncommon congenital renal anomaly in which 1 kidney crosses the midline and fuses with the contralateral kidney. Although CFRE is often asymptomatic, its rare association with renal malignancy poses substantial diagnostic and surgical challenges due to abnormal anatomy and vascular supply. This report describes clear cell renal cell carcinoma (RCC) arising in CFRE with direct invasion into the contralateral, normally positioned kidney. CASE REPORT A 60-year-old man presented with a 2-month history of mild left loin pain without urinary or systemic symptoms. Initial laboratory findings were unremarkable. Imaging studies, including contrast-enhanced computed tomography, demonstrated a congenitally ectopic right kidney fused to the left kidney, consistent with CFRE, and a large heterogeneously enhancing mass replacing most of the ectopic kidney and extending into the lower pole of the normally located left kidney. Positron emission tomography showed no evidence of distant metastasis. The patient underwent radical nephrectomy of the ectopic right kidney combined with partial nephrectomy of the invaded segment of the left kidney, with preservation of renal perfusion. Histopathologic examination confirmed clear cell RCC, World Health Organization/International Society of Urological Pathology grade 3, staged as pT3a, with negative surgical margins. The postoperative course was uneventful, and renal function was preserved. CONCLUSIONS This is the first documented report of RCC arising in CFRE with invasion into the contralateral normal kidney. It emphasizes the importance of detailed preoperative imaging, individualized surgical planning, and nephron-sparing strategies in the management of complex renal anomalies with malignancy.

The increased use of imaging has led to more frequent detection of small renal masses (SRMs), often prompting percutaneous renal mass biopsy (RMB) to guide management. While generally safe, RMB carries rare risks, including tumour seeding. We present a case of a 29 mm papillary renal cell carcinoma in a man in his 50s, where tumour seeding into the perinephric fat was identified along the biopsy tract following partial nephrectomy. This was associated with pathological upstaging and contributed to a decision for more intensive postoperative surveillance at the discretion of the multidisciplinary meeting. The case underscores the importance of careful patient selection for RMB, particularly in surgically amenable SRMs, where the risk of tumour seeding should be carefully considered.

Radiotherapy-based metastasis-directed therapy (MDT) has emerged as a treatment strategy for oligometastatic clear cell renal cell carcinoma (ccRCC). However, optimal integration of MDT with immune checkpoint inhibition (ICI) is unclear, especially in light of the M1 no evidence of disease subgroup analysis of KEYNOTE-564. We undertook an exploratory cohort study of two previously reported trials evaluating either MDT+ICI (NCT02855203) or MDT (NCT03575611) for oligometastatic ccRCC. The objective was primarily to compare RECIST-defined progression-free survival (PFS) and secondarily to compare peripheral immune populations. Among the 150 patients included in the analysis (MDT+ICI: 30; MDT: 120), the MDT+ICI cohort had more metastases (median 3 vs 1) and was slightly younger (median 62 vs 66) than MDT. After a median follow-up time of 34 mo, there was evidence for longer PFS after MDT+ICI vs MDT that did not reach statistical significance (hazard ratio, 0.57; 95% confidence interval: 0.32-1.02; p = 0.058). Interaction testing demonstrated greater PFS benefit with MDT+ICI among patients with previous receipt of systemic therapy. Immediate systemic induction of activated CD8[+] T cells (ICOS[+]) was more common after MDT+ICI, as were decreases in less functional CD8[+] T cell subsets. Taken together, this study provides evidence that adding maintenance ICI to MDT improves clinical outcomes for patients with oligometastatic ccRCC. MDT+ICI-evoked immunomodulatory signals are promising and support the observed superiority in clinical outcomes. The A Randomized Trial of Maintenance Systemic Therapy After Radiation for Oligometastatic Renal Cell Carcinoma (ASTROs) trial (NCT06004336) has been initiated to test the hypotheses generated by the present study.

Objective: To investigate the effects and underlying mechanisms of the recombinant bee venom peptide LSSDR412 on the malignant biological behavior of cervical cancer in vitro and in vivo, and to provide a theoretical basis for its potential clinical translation. Methods: Peptide LSSDR412 was obtained by chemical synthesis. Different concentrations of LSSDR412 were used as treatment groups. The effects of peptide LSSDR412 on the survival and proliferation of cervical cancer cell lines (Hela cells and Caski cells) were detected by cell counting kit-8 (CCK-8) and clone formation assay. Transwell chamber assay was used to detect the effect on cell migration and invasion. Western blot and co-immunoprecipitation assay were used to detect the expression and interaction of epithelial-mesenchymal transition (EMT) and Wnt/β-catenin signaling pathway related proteins. The cervical cancer xenograft model was established in nude mice, and the volume of subcutaneous xenograft tumor was detected after intraperitoneal injection of LSSDR412. The expression of the proliferation associated nuclear antigen (Ki-67) was detected by immunofluorescence. The lung metastasis model of cervical cancer bearing nude mice was established, and HE staining was used to detect the effect of intraperitoneal injection of LSSDR412 on lung metastasis. Results: Compared with the cells without LSSDR412 treatment, the survival rate, clone number, invasive and migratory cell number of Hela and Caski cells were significantly decreased after LSSDR412 treatment (all P<0.05), and showed a concentration-dependent trend. LSSDR412 could inhibit the EMT process of cervical cancer and inhibit the Wnt/β-catenin signaling pathway through Claudin-4 (CLDN4) to play an anti-cervical cancer effect. The results of in vivo experiments showed that the tumor weight of the LSSDR412 group was significantly lower than that of the control group [(0.292±0.073) vs (0.480±0.117) g; t=3.341, P=0.008]. The positive rate of Ki-67 in tumor tissue was significantly lower than that in the control group (21.95%±5.60% vs 87.27%±6.35%; t=26.72, P<0.001), and the proportion of intrapulmonary metastases was significantly lower than that of the control group [25.0% (16.3%, 45.0%) vs 39.1% (31.3%, 48.3%); U=31.00, P=0.044]. There was no significant pathological change in liver and kidney tissue structure in the LSSDR412 group. Conclusions: Peptide LSSDR412 shows significant inhibitory effects on the proliferation, migration and invasion of cervical cancer cells both in vitro and in vivo with no apparent toxic side effects. Its antitumor activity is primarily mediated through the suppression of the CLDN4-mediated Wnt/β-catenin signaling pathway.