Thyroid tumors of uncertain malignant potential (UMP) are recognized by the World Health Organization (WHO) as tumors of borderline malignancy, encompassing follicular tumor of uncertain malignant potential (FT-UMP) and well-differentiated tumor of uncertain malignant potential (WDT-UMP). Tumors classified as UMP have questionable capsular invasion (CI) and/or angioinvasion (AI); however, biological uncertainty extends beyond the possibility for invasiveness alone. We conducted a retrospective, single-center study of all thyroid tumors diagnosed as UMP (2005-2025). Upon review of our institutional UMP cohort, we identified 39 tumors that lack questionable CI and/or AI, and therefore, would not meet WHO-defined UMP criteria. This retrospective analytic group of borderline thyroid nodules (BTN) was used to interrogate the overlap between non-invasive follicular-patterned thyroid lesions and worrisome morphologic and/or molecular features. BTN show features of neoplasia (solid growth or microfollicular architecture, papillary thyroid carcinoma (PTC)-like nuclear atypia, oncocytic morphology, conspicuous mitoses, and/or abnormal molecular results) with or without procedural artifacts (mechanically disrupted capsule, squamous metaplasia or ischemic necrosis). BTN were diagnosed in 0.1% of thyroid surgeries; median age 55 years and 1.3:1 female-to-male ratio. Median tumor size was 4 cm. RAS or RAS-like variants were most frequent (25%), followed by gene fusions (10%). Negative molecular testing was identified in 10% of BTN and high-risk gene alterations, including TERT promoter and PIK3CA, were seen in 20%. Most patients underwent hemithyroidectomy (62%), with median follow-up of 2.5 years (range 1-12.5 years), and no recurrences or metastases were documented. Our findings suggest indolent behavior of BTN and support conservative management, such as hemithyroidectomy. Longer-term, multi-institutional studies will refine risk stratification and management strategies, with possible consideration for expanding UMP diagnostic criteria.

BACKGROUND Differentiating traumatic tricuspid regurgitation (TR) from infective endocarditis (IE) is clinically crucial in patients presenting with abnormal tricuspid valve findings after blunt chest trauma. Particularly, papillary muscle rupture caused by trauma can produce mobile valvular structures that closely resemble vegetations, making accurate diagnosis challenging in the acute setting. CASE REPORT A man in his 60s with pulmonary sarcoidosis was admitted after a 5-m fall, sustaining multiple fractures. Preoperative transthoracic echocardiography revealed a 7-mm mobile structure on the anterior tricuspid leaflet with flail motion and severe TR. Because of fever, IE was suspected; however, blood cultures and further investigations excluded IE. A diagnosis of traumatic TR due to papillary muscle rupture was made. Although the patient was hemodynamically stable under medical therapy, the heart team recommended surgery to prevent long-term heart failure. Four months after fracture repair, tricuspid valve repair with artificial chordae and annuloplasty was performed. The surgical findings were fully consistent with the preoperative diagnosis, and pathological examination of the ruptured papillary muscle demonstrated coagulative necrosis without significant inflammatory infiltration, supporting a traumatic etiology. At 4-year follow-up, he remains stable without signs of heart failure exacerbation. CONCLUSIONS Accurate differentiation between traumatic TR due to papillary muscle rupture and IE is essential, as misclassification may lead to unnecessary antimicrobial therapy or delayed surgical intervention. This case highlights how mobile traumatic lesions can closely mimic vegetations and underscores the importance of comprehensive evaluation to guide appropriate management and optimize outcomes.

An integrative reassessment of Tetrancistrum polymorphum (Paperna, 1972) Kritsky, Galli & Yang, 2007 (Monogenoidea: Dactylogyridae) was conducted based on specimens collected from the gills of Siganus luridus (Rüppell) (Acanthuriformes: Siganidae) from the Egyptian Red Sea. Although this species has been previously reported and morphologically described using light microscopy, its ultrastructural features, molecular identity, and pathological impact on the host have remained unexplored. In the present study, detailed morphological and morphometric analyses were performed using light microscopy to confirm species identification. Scanning electron microscopy (SEM) provided complementary information on the external morphology, allowing improved visualization of surface topography of the tegument, copulatory complex, and haptor. SEM observations revealed longitudinal tegumental folds, small dome-shaped papillary structures, subtle cephalic elevations, and the external configuration of haptoral structures, with anchors visible at the surface while bars remained embedded within deeper tissues. Molecular characterization based on partial 28S rDNA sequences provided crucial genetic data for this species and supported its phylogenetic placement within Dactylogyridae. Histopathological examination of infected gills demonstrated that T. polymorphum induces epithelial necrosis, lamellar fusion, vascular congestion, and inflammatory cell infiltration, leading to marked disruption of normal gill architecture. By integrating morphological, ultrastructural, molecular, and histopathological data, this study moves beyond traditional redescription and provides an integrative reassessment of T. polymorphum based on these complementary approaches, contributing to a better understanding of its taxonomy, phylogenetic relationships, and host-parasite interactions.

AIM: To analyze the efficacy and safety of Gamma Knife radiosurgery (GKRS) in the management of thyroid cancer brain metastases (TCBM). MATERIAL and METHODS: This retrospective study analyzed patients who underwent GKRS for TCBM at two centers between September 2005 and February 2025. Patients' clinical and radiological outcomes, including local tumor control and overall follow-up, were investigated. RESULTS: Among the 3,834 patients who underwent GKRS for brain metastases at two centers, only 0.26% had primary thyroid cancer. A total of 10 patients with 40 TCBM were treated by GKRS, with a median of two metastases per patient. The most common metastasis site was the frontal lobe (47.5%), and 60% of patients had multiple metastases. Papillary carcinoma was the most frequent histological subtype (57.1%). The median latency from thyroid cancer diagnosis to the development of brain metastases was 22 months. The median GKRS dose was 23 Gy, and local failure occurred in 5% of treated metastases. Radiation-induced necrosis was observed in one case and resolved without clinical impact. Intracranial distant metastases developed in two patients. The median follow-up was 8 months, and 80% of patients died during follow-up, with one death attributed to brain metastasis. CONCLUSION: The limited number of patients and the short follow-up period, partly reflecting the aggressive nature of TCBM, may have influenced the study results. Nevertheless, despite the short follow-up, GKRS provided favorable local control without significant adverse effects, suggesting that it may be an effective treatment option for TCBM.

Background and Clinical Significance: Cardiac and mediastinal angiosarcomas are rare, aggressive malignancies that often present with nonspecific symptoms and pose significant diagnostic challenges. Tumor heterogeneity and necrosis may lead to false-negative biopsy results; Case Presentation: We report a 64-year-old man who initially presented with cardiac tamponade of unclear etiology. Despite an extensive workup, the patient remained asymptomatic for five months before re-presenting with dyspnea and a large mediastinal mass compressing the right heart, along with a lytic rib lesion. Initial ultrasound-guided biopsy of the rib lesion demonstrated a benign vascular proliferation consistent with Masson tumor (intravascular papillary endothelial hyperplasia), which was discordant with aggressive imaging findings. Further evaluation with positron emission tomography-computed tomography (PET-CT) revealed peripheral metabolic activity, and cardiac magnetic resonance imaging (MRI) demonstrated a heterogeneous mass with central necrosis and peripheral enhancement. A repeat CT-guided biopsy targeting the metabolically active region confirmed angiosarcoma, with immunohistochemical staining demonstrating diffuse positivity for ERG, CD31, and CD34. The patient was treated with palliative radiation and paclitaxel-based chemotherapy but experienced rapid clinical decline and transitioned to comfort-focused care; Conclusions: This case highlights the importance of correlating imaging with pathology and emphasizes the risk of sampling error in necrotic tumors. PET-guided biopsy targeting viable tumor regions is essential in cases with discordant findings.

Papillary cystadenoma (PC) is a benign epithelial tumor believed to be of mesonephric origin and is recognized as one of von Hippel-Lindau syndrome (VHL)-related neoplasms. PC tends to develop frequently in male VHL patients but rarely in females and arises from the mesosalpinx or broad ligament in females. Having experienced a case of multiple PCs in a female patient, we here report it with literature review. The patient was a 34-year-old woman. In her past medical history, VHL including multiple hemangioblastomas of the central nervous system, pancreatic neuroendocrine tumor, and multiple clear cell renal cell carcinoma (CCRCC) of the bilateral kidneys was diagnosed. In addition, a PC of the left ovary was resected seven years earlier. In the present report, she was admitted to our hospital because of lower abdominal pain, and then computed tomography revealed swelling of the right ovary and ascites. She was diagnosed with right ovarian torsion and thus salpingo-oophorectomy was performed. Histopathologically, while the tumor cells with pale or eosinophilic cytoplasm showed a papillary growth with partial cystic changes, none of apparent nuclear atypia, mitotic figure, and necrosis were observed. We finally diagnosed it as PC of the right ovary. Its pathological findings were similar to those of the previously resected left ovarian lesion. Although PC is rare in females, the presence of VHL should be kept in mind when PC is encountered. Moreover, metastatic CCRCC should also be considered to be one of differential diagnoses in VHL patients.

The exact reasons behind rheumatoid arthritis (RA) are still unknown, though multiple contributing factors include genetic factors, family history, environmental factors, hormones, age, etc. Identifying complicated genetic variants may help create new treatments and enable personalized medicine based on a person's genetic composition. Promising medicinal fruits are increasingly being incorporated into functional nutrition. Overall, these fruits possess significant therapeutic challenges not only for immunomodulation but also for a variety of inflammatory diseases. Fortunately, Cordia myxa can effectively inhibit signaling pathways crucial for inflammation at most Tumor Necrosis Factor (TNF-α) and Cyclooxygenase-2 (COX), a mechanism that explicates its anti-inflammatory properties. The objective of this protocol was to assess the therapeutic benefits of Cordia myxa (Bumber) as an herbal alternative to COX-2 and TNF-α inhibitor drugs in male Wistar rats with rheumatic arthritis (RA) induced by type II collagen. Male rats of the Wistar strain, weighing 200 ± 10 g, were allocated into 4 groups: a control group, Bumber group [15% Cordia myxa of the diet weight], Arthritic group [CII 1.0 mL/rat by both intraperitoneal (I.P.) & intradermal (I.D.) injection], and treated group [Bumber (15% Cordia myxa of the diet weight) + CII (1.0 mL/rat i.p.)]. All groups were subjected to their respective treatments daily for 60 consecutive days; the C. myxa was concurrently administered with collagen. Rheumatic arthritis disease activity using the titer of rheumatoid factor (RF), markers of inflammation, and the apoptotic BAX gene was assayed. The arthritic group evidenced a marked elevation in blood RF compared to the distilled water-treated group. The positivity level of both TNF-α and COX-2 was significantly (P < 0.05) expressed in hepatocytes and enterocytes from RA rats compared to those in control samples. Consistent results were demonstrated for the Bax protein expression in the RA group. Histopathological examination revealed osteoarthritis with papillary and granulomatous lesions, hepatocyte necrosis, and intestinal necrosis in arthritic rats. Concurrent administration of Cordia myxa by the arthritic group reduced (P < 0.05) the rise in these indices. Whereas, Bumber lessened the severity of collagen II-induced arthritis and tissue damage. To conclude, Cordia myxa excites a possible immunodulatory effect on collagen-induced RA. A prospective study for the elucidation of the detailed mechanisms of this protective role is inevitable; however, the radical scavenging activity of Cordia myxa might be involved.

Renal papillary necrosis (RPN) is an uncommon but important cause of hematuria in patients with sickle cell trait. We report a 28-year-old female with sickle cell trait and beta thalassemia who developed recurrent, transfusion-dependent gross hematuria. Despite extensive imaging, endoscopic evaluation, and conservative management, bleeding persisted. Ureteroscopy demonstrated findings consistent with RPN. The patient required intensive multidisciplinary care and 21 units of packed red blood cells. Hematuria ultimately resolved following treatment with oral epsilon-aminocaproic acid. This case highlights the potential severity of RPN in sickle cell trait and supports consideration of antifibrinolytics as salvage therapy in refractory cases.

The annual incidence of papillary thyroid cancer (PTC) has shown a steady increase in the number of cases. Advances in minimally invasive surgical techniques and the growing frequency of late-stage diagnoses have collectively heightened the complexity of PTC management and treatment. Tumor necrosis factor receptor-associated factor-interacting protein (TRAIP), which has been implicated in the progression of various malignancies, remains inadequately characterized in terms of its expression patterns and functional roles in papillary thyroid carcinoma. In this study, we implemented a comprehensive experimental strategy integrating tissue-based analyses, cellular functional assays, and in vivo animal models. We constructed a protein-protein interaction network and established stable cell lines with TRAIP overexpression, knockdown, knockout, and mutation. These models were subsequently analyzed using Western blotting and co-immunoprecipitation (co-IP) assays. Experimental results demonstrated significantly upregulated TRAIP expression in PTC. Silencing TRAIP markedly inhibited PTC cell proliferation and migratory potential. BRAF, a critical oncogene in PTC pathogenesis, exhibited a positive correlation with TRAIP expression both in vitro and in vivo. TRAIP was shown to regulate BRAF ubiquitination and was linked to MAPK pathway activation. However, mutation-based studies indicated that BRAF degradation did not occur via TRAIP-dependent ubiquitination. Furthermore, TRAIP was found to physically interact with both TRAF2 and BRAF, with TRAF2 displaying a higher binding affinity for TRAIP than BRAF. Overexpression of TRAIP reduced the interaction between TRAF2 and BRAF, whereas TRAF2 independently mediated BRAF ubiquitination. These findings demonstrate that TRAIP attenuates TRAF2-mediated BRAF ubiquitination, thereby promoting MAPK pathway activation in PTC cells, which subsequently enhances their proliferation and migration.