Panniculitis comprises a group of diseases characterized by inflammation of the subcutaneous fat, and may present as a distinctive cutaneous paraneoplastic syndrome. Herein, we describe a case of paraneoplastic panniculitis caused by a duodenal neoplasm. The 79-year-old man presented with painful erythematous subcutaneous nodules on the lower extremities without any gastrointestinal symptoms. Histopathological manifestations of the skin included fat necrosis, calcification, and ghost cells. Laboratory test results revealed significantly elevated serum lipase levels (4144.7 U/L). Imaging revealed a normal pancreas, but identified a duodenal tumor with liver metastases. The patient was diagnosed with panniculitis secondary to a duodenal neoplasm with hepatic metastases and died 3 months after diagnosis. This case highlights panniculitis as a warning sign of occult duodenal neoplasms, facilitating clinical diagnosis and intervention.

Synchronous double primary hepatocellular carcinoma and intrahepatic cholangiocarcinoma (sdpHCC-ICC) is rare, particularly when evolving metachronously from solitary HCC. This study reports a unique case of such transformation over two decades and reviews the relevant literature. A 55-year-old male with chronic hepatitis B underwent curative resection for HCC in 2005. Following multiple recurrences treated with local therapies over 19 years, subsequent resection in 2024 revealed two distinct malignancies: recurrent HCC and a spatially separate intrahepatic cholangiocarcinoma (ICC), confirmed by immunohistochemistry. We additionally analyzed 31 reported sdpHCC-ICC cases to summarize their clinicopathological characteristics and outcomes. The patient eventually developed systemic metastases despite adjuvant therapy. Our review highlights the marked biological heterogeneity and diagnostic challenges associated with sdpHCC-ICC. This case suggests that prolonged tumor evolution in chronically injured livers may be associated with biological heterogeneity and phenotypic divergence. Our findings support the potential value of long-term surveillance and repeated pathological reassessment in selected long-term HCC survivors with atypical recurrence patterns.

BackgroundNeuroendocrine tumors frequently metastasize to the liver. The histologic features of eosinophilic cytoplasm with a trabecular growth pattern surrounded by a capillary network mimic those of hepatocellular carcinoma. No previous studies have extensively investigated aberrant HepPar 1 expression in well-differentiated neuroendocrine tumors metastasized to the liver.DesignWe identified 75 tumors of well-differentiated neuroendocrine tumors metastasized to the liver from January 2020 to June 2023 and collected clinicopathologic data, including age, sex, and pathologic diagnosis. Twenty-six specimens were biopsy samples, and forty-nine were surgical specimens. A representative block was chosen for immunohistochemistry. Aberrant expression of HepPar 1 in metastatic well-differentiated neuroendocrine tumors was examined immunohistochemically.ResultsThe 75 patients comprised 37 men and 38 women ranging in age from 21 to 87 years (mean: 61.5 years). Thirty-eight tumors were grade 1, 27 were grade 2, and 10 were grade 3. Only 1 grade 3 tumor (1%) showed diffuse aberrant HepPar 1 expression; 8 tumors (5 grade 2 and 3 grade 3) (11%) showed rare aberrant expression; and the remaining 66 tumors (88%) were completely negative. Aberrant HepPar 1 staining was significantly associated with higher tumor grade (P < .05).ConclusionAberrant HepPar 1 expression in well-differentiated neuroendocrine tumors metastasized to the liver is extremely rare. HepPar 1 can be reliably used to differentiate neuroendocrine tumors from hepatocellular carcinomas, with some caveats.

Frontline systemic therapy for metastatic clear cell renal cell carcinoma (RCC) has evolved to include doublet immunotherapy (IO/IO) and immunotherapy-tyrosine kinase inhibitor combinations (IO/TKI), with selection typically guided by histology and risk stratification. However, optimal regimen selection remains undefined owing to limited head-to-head data. Subanalyses of landmark clinical trials and emerging real-world multicenter study data suggest differential treatment benefit derived by metastatic site, particularly for bone metastases. Evidence suggests that bone metastases promote an immunosuppressive tumor microenvironment and may preferentially upregulate genes encoding angiogenic factors, compared with other sites. Such biology-driven patterns provide a rationale for the hypothesis that IO/TKI may confer greater activity in bone-predominant disease. Liver metastases may also exhibit similar site-specific patterns due to harboring an immunosuppressive and vascular environment, but RCC-specific data remain scarce. This overview summarizes the mechanistic rationale, clinical evidence, and practical implications of tailoring treatment by disease site, highlighting critical gaps as well as future research priorities.

Liver metastases are associated with dismal prognosis in solid tumors. This retrospective study evaluated the efficacy and safety of anlotinib in patients with solid tumors and liver metastases in the real-world setting.

Colorectal liver metastases (CRLM) and intrahepatic cholangiocarcinoma (iCCA) often present challenges due to extensive liver involvement that limits surgical resection. Hepatic artery infusion (HAI) therapy enables high local drug concentrations by exploiting the hepatic artery's dominant role in tumor perfusion. Historically performed via open surgery, HAI port placement has evolved with the advent of robotic-assisted techniques, offering reduced morbidity and enhanced precision. This study reports the initial experience of robotic HAI port placement for liver-directed chemotherapy at a tertiary care Indian cancer center-the first such report from India. Eleven patients with CRLM underwent robotic-assisted HAI port placement between July 2024 and April 2025. Preoperative multidetector CT angiography assessed hepatic arterial anatomy. The procedure utilized the DaVinci X robotic system, with port placement into the gastroduodenal artery and mandatory cholecystectomy. Key perioperative data-including operative time, blood loss, and complications-were recorded. Postoperative outcomes were analyzed, excluding combined resection cases where relevant. The cohort's mean age was 58.4 years; 81.8% were male. Aberrant arterial anatomy was identified in 27.3% of patients. No conversions to open surgery occurred. Mean operative time was 187 min (124 min for HAI-alone cases); mean blood loss was 134 ml (83 ml for HAI-alone cases). Three patients (27.3%) underwent simultaneous colorectal resection. Median hospital stay was 4 days (2 days for HAI-alone cases). Only one minor postoperative complication occurred, and no major complications were reported. Robotic-assisted HAI port placement is a safe, feasible, and effective minimally invasive option for regional chemotherapy in CRLM. Our initial experience demonstrated excellent technical success, minimal morbidity, and rapid recovery, even in patients with variant hepatic arterial anatomy. These promising results suggest robotic placement may surpass traditional methods, warranting further validation in larger studies with extended follow-up.

Intussusception occurs when a segment of the bowel telescopes into an adjacent segment, potentially leading to obstruction and intestinal ischemia. Intussusception in adults is likely caused by a pathological lead point (PLP), and it can be challenging to diagnose due to its broad clinical presentation, which requires a high degree of clinical suspicion. This case report describes a rare presentation of cecal adenocarcinoma in a young patient that caused ileocolic intussusception. A 31-year-old woman presented to the emergency department with progressively worsening intermittent abdominal pain, nausea, and bloating. She denied fever, chills, vomiting, hematochezia, and unintentional weight loss. Computed tomography (CT) scan of the abdomen and pelvis suggested ileocecal intussusception and two irregular cystic masses in the liver. After a colonoscopy showed a necrotic intraluminal mass, the patient underwent an exploratory laparotomy with right hemicolectomy due to the high risk of malignancy-associated intussusception. Pathology results from the hemicolectomy were consistent with adenocarcinoma of colonic origin. Furthermore, a liver biopsy was conducted to confirm metastases. The recovery was uncomplicated, with a gradual return of bowel function and tolerance of oral intake. A central venous port was placed for anticipated systemic chemotherapy, and the patient was referred for outpatient oncology follow-up, including positron emission tomography (PET)-CT imaging and initiation of chemotherapy. This case highlights the importance of considering colorectal malignancy in the differential diagnosis of young adults presenting with nonspecific gastrointestinal symptoms. Early diagnosis with high-contrast CT imaging is critical for identifying intussusception, evaluating for PLPs, and detecting metastatic disease, while prompt surgical intervention remains essential given the rarity of adult intussusception and the high likelihood of an underlying malignant etiology.