Paragonimiasis is a foodborne zoonosis transmitted mostly by the consumption of inadequately cooked crabs and crayfish harboring Paragonimus metacercariae. We present the case of a 38-year-old male with a history of crab ingestion who developed severe eosinophilia, transaminitis, and serositis. Initial presentation included fever, epigastric pain, weight loss, and pleural effusion. He was managed empirically with albendazole and corticosteroids along with other supportive measures. Two months later, he re-presented with hemoptysis and hypoxemia. HRCT showed multiple cavitary pulmonary lesions, pleural nodules, and left-sided pneumothorax. Sputum wet mount demonstrated Paragonimus species ova, confirming pulmonary paragonimiasis. The patient was managed with intercostal tube drainage, tranexamic acid nebulization, and praziquantel with clinical improvement. This case highlights the importance of considering paragonimiasis in patients, even with pneumothorax, when the patient has hemoptysis and eosinophilia in the background of ingestion of raw or undercooked crustaceans in endemic regions.

Osteosarcoma is a malignant osteogenic tumour of mesenchymal origin and is the most commonly reported neoplasm primarily affecting the appendicular skeleton in dogs and cats. When there is no involvement of bones, and the soft tissue is the primary site of the neoplasia, it is known as extraskeletal osteosarcoma (EOS). EOS is well documented in dogs and cats but is rarely reported in non-domestic species. Microscopically, an osteosarcoma is characterized by neoplastic proliferation of mesenchymal cells with production of osteoid matrix or immature bone. The aim of this study is to report two cases of EOS in guinea pigs (Cavia porcellus), as well as to identify and correlate clinical, radiographic, pathological and immunohistochemical findings. In case 1, multiple mesenteric and pancreatic nodules were present. Case 2 had a large subcutaneous mass with pulmonary and renal metastases. In both cases, radiographs revealed soft tissue masses with mineralized areas but no skeletal involvement. Histological examination confirmed malignant mesenchymal proliferation with osteoid deposition. Immunohistochemistry was applied, with the caveat that there are no specific immunohistochemical markers for definitive diagnosis of osteosarcoma. The neoplastic cells in both cases were strongly immunopositive for vimentin and RUNX2. The cases showed variable immunolabelling for S100 and alpha-smooth muscle actin, Ki-67 and p63. These cases enhance the clinicopathological spectrum of EOS in guinea pigs and highlight the importance of combining radiographic, histopathological and immunohistochemical evaluation for accurate diagnosis.

Kaposi sarcoma (KS) is an acquired immunodeficiency syndrome (AIDS)-defining malignancy that can involve the skin, lymph nodes, and visceral organs in patients with advanced human immunodeficiency virus (HIV). We report the case of a 35-year-old man with no known prior medical history who presented to the charity care clinic complaining of recurrent thrush and two weeks of progressive right lower extremity swelling. His physical examination revealed painful, pruritic violaceous papules and plaques over the proximal right thigh that had been present for one week. He was referred to the emergency department (ED) for further workup. Venous duplex ultrasonography was negative for deep venous thrombosis (DVT). He was found to have a newly diagnosed HIV-1 infection with advanced immunosuppression, oral thrush with odynophagia and dysphagia concerning for esophageal candidiasis, and a reactive rapid plasma reagin titer of 1:32 with retinal white dot lesions concerning for ocular syphilis. Computed tomography (CT) demonstrated diffuse right lower extremity soft tissue edema, extensive right inguinal, external iliac, and intrapelvic lymphadenopathy, bilateral axillary lymphadenopathy, and multiple bilateral pulmonary nodules. Punch biopsy of a right thigh lesion revealed KS with tumor cells positive for cluster of differentiation 31 (CD31), CD34, ERG, and human herpesvirus 8 (HHV-8), and an excisional lymph node biopsy demonstrated findings consistent with disseminated KS. Furthermore, cerebrospinal fluid (CSF) analysis confirmed neurosyphilis with a positive Venereal Disease Research Laboratory (VDRL). He was treated with bictegravir/emtricitabine/tenofovir alafenamide, trimethoprim-sulfamethoxazole prophylaxis, fluconazole, and intravenous penicillin G. The patient showed early clinical improvement with resolution of ocular symptoms and a declining HIV viral load following initiation of therapy and before discharge. This case highlights biopsy-proven KS as the presenting manifestation of previously undiagnosed advanced HIV, with unilateral limb lymphedema and pulmonary nodules suggesting disseminated disease. Additionally, our case underscores the need for early HIV testing in patients with recurrent mucocutaneous candidiasis and unexplained lymphedema, and for prompt evaluation of concomitant opportunistic and sexually transmitted infections.

For thoracoscopic resection to be successful, accurate preoperative and intraoperative localization is necessary due to the growing detection of small, non-palpable lung nodules using low-dose CT scanning. Accurate localization is required rather than optional in robot-assisted thoracic surgery (RATS) since the total lack of tactile feedback makes it extremely difficult to identify deep, tiny, and subsolid nodules. With a focus on RATS-specific criteria, this study offers a modern, clinically focused framework for technique selection. This is a narrative review of the current literature. A structured literature search was conducted in PubMed, Embase, and Web of Science from January 2015 to May 2026, and 116 relevant articles were included for qualitative synthesis. We summarized the principles, clinical efficacy, complications, and RATS‑specific adaptability of CT-guided percutaneous, bronchoscopy-assisted, and intraoperative localization techniques. No quantitative meta-analysis or bias risk assessment was performed in this study. Nodule traits, patient considerations, and institutional resources should all be taken into consideration when choosing a technique. Although percutaneous techniques have a high success rate (88-100%), there is a risk of bleeding and pneumothorax (up to 40%). First-line options for RATS are indocyanine green (ICG) fluorescence marking and microcoil localization. ICG uses robotic near-infrared channels to achieve 100% intraoperative identification and R0 resection rates, while microcoils allow sublobar resection in 90.6% of patients with 100% R0 resection. Transbronchial approaches (virtual bronchoscopic navigation [VBN], electromagnetic navigation bronchoscopy [ENB]) eliminate external marker interference and greatly lower the incidence of pneumothorax (88% reduction, 3.3% vs. 28.3% for CT-guided transthoracic aspiration, P < 0.001). Electromagnetic interference is completely avoided in next-generation shape-sensing robotic bronchoscopy. Single-stage hybrid operating room methods are favored by workflow integration. Resource-stratified approaches are suggested: low-resource settings may employ VBN/VAL-MAP or percutaneous methylene blue; mid-resource centers benefit from ENB/VBN with ICG; high-resource centers may use single-stage cone-beam CT or robotic bronchoscopy. The best RATS-compatible selection is guided by the "three-zero" approach (zero external indicators, zero transport danger, and zero electromagnetic interference). Nodule traits, patient considerations, and institutional resources must all be considered when choosing a localization technique. Precise localization is required in RATS in order to maintain negative margins, lower conversion rates, and make up for tactile deficiencies. The best balance is frequently achieved using multimodal techniques. Further increases in pulmonary nodule localization accuracy, safety, and workflow efficiency are anticipated due to ongoing advancements in robotic bronchoscopy, hybrid operating rooms, and artificial intelligence.

Pulmonary nodules are commonly evaluated using the CT-guided transthoracic biopsy; however, it is highly dependent on operator skill and can be associated with extended procedure duration and increased radiation exposure. Although robotic-assisted systems are intended to enhance procedural precision, there is limited comparative evidence against conventional techniques. Accordingly, this systematic review and meta‑analysis was conducted to compare robotic-assisted biopsy with conventional CT-guided transthoracic biopsy. We systematically searched Scopus, Web of Science, PubMed, CNKI, and the Cochrane Library until February 2026. Both randomized trials and cohort studies comparing robotic and conventional (manual) CT-guided transthoracic needle biopsy in adults were included in this review. The outcomes included procedural efficiency, diagnostic performance, radiation exposure, and safety. Meta-analysis was conducted using RevMan 5.4.1, presenting MD, RR, or OR with 95% CIs. Heterogeneity and publication bias were assessed. Nine studies were included. Compared with conventional (manual) CT-guided biopsy, the robotic approach was associated with shorter procedure time (MD = -4.94, 95% CI [-9.56, -0.32], P = 0.04) and lower radiation exposure (DLP) (MD = -211.55, 95% CI [-305.07, -118.03], P < 0.00001). Additionally, the robotic approach reduced the number of needle adjustments required, pneumothorax incidence, and overall complication incidence (RR = 0.460, 95% CI [0.290, 0.720], P = 0.0008). A reduction in the number of CT scans was observed only in the sensitivity analysis. Technical success, diagnostic yield, pulmonary hemorrhage, and chest tube placement were similar between the robotic-assisted and conventional techniques. Robot-assisted CT-guided biopsy was associated with lower radiation exposure, reduced procedural complexity, and fewer complications while maintaining comparable technical success and diagnostic yield. However, these findings should be interpreted cautiously, given the limited number of included studies, substantial heterogeneity, and observational nature of much of the available evidence. Further large prospective studies are required to validate these findings.

Rosai-Dorfman disease (RDD) is a rare, benign, non-Langerhans cell histiocytosis disorder. Extranodal involvement is present in a significant number of cases; however, renal manifestations are infrequent, often resembling malignant conditions, leading to a diagnostic challenge. We present the case of a 51-year-old male with a six-month history of fatigue, generalized weakness, and cervical lymphadenopathy. Computed tomography (CT) revealed multiple pulmonary nodules, mild hepatomegaly, and bilateral renal masses encasing the renal vessels and proximal ureters. Positron emission tomography-computed tomography (PET-CT) showed metabolically active renal lesions along with hypermetabolic cervical and abdominal lymphadenopathy, which were initially suggestive of lymphoma. On renal biopsy, sheets of large histiocytes displaying emperipolesis, with immunohistochemical positivity for S100 and CD68, were found, thereby confirming RDD. This case highlights the significance of considering RDD in the differential diagnosis of bilateral renal masses accompanied by systemic lymphadenopathy. The definitive diagnosis depends on histopathological analysis, and prompt systemic therapy can lead to stabilization of the disease.