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Oncology in Clinical Practice

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2450-1654
Category:
ONCOLOGY
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Efficacy of photodynamic diagnosis in basal cell carcinoma detection and boundary delineation — a clinical study

2026-03-06

Hanh Thi Nguyen, Huu Nghi Dinh, Nhien Ngoc Y Nguyen, Phu Van Tran, Minh Viet Nhut Nguyen, Nghia Phu Nguyen, Ngo Binh Trinh

Introduction. To evaluate the utility of photodynamic diagnosis (PDD) in diagnosing basal cell carcinoma (BCC) and aiding in boundary delineation. Material and methods. In this study, 94 patients with 98 clinically suspected BCC lesions were subjected to PDD, followed by biopsies for definitive diagnosis. Biopsy samples were analyzed and categorized based on PDD findings and compared with histopathological results. Results. PDD demonstrated a sensitivity of 56.8% and specificity of 47.1% in BCC diagnosis. The rate of false-negative PDD results increased with the degree of pigmentation. For delineating BCC boundaries, PDD showed a sensitivity of 78.3% and specificity of 95.7%, with higher accuracy in non-pigmented BCCs compared to pigmented ones. Conclusions. PDD is a promising tool for identifying boundaries of non-pigmented BCC, potentially improving patient management and treatment outcomes.

The mediation role of cortisol and adrenocorticotropic hormone in the relationship between perceived health competence and immunity

2026-03-06

Eman Maher El-Baiomy, Azza El-Amir, Noha Sabry, Loay Lassem, Margaret Chesney, Kenneth Wallston

Introduction. Breast cancer is associated with stress that can affect patients’ cellular immunity. Perceived health competence (PHC) is considered one of the most important personal traits studied in cancer and has been shown to affect the psychological and immunological status of breast cancer patients. The aims of the research are to study PHC traits in breast cancer patients compared to healthy subjects, and to explore the correlation between PHC with plasma ACTH, serum cortisol levels, and immunity (blood CD56+ NK cells and CD19+ B cell counts). Material and methods. A case-control study recruited breast cancer patients presenting to the Department of Clinical Oncology, Kasr-Elaini, Cairo University and age-matched healthy women during the period from January 2023 and April 2023. Cases and controls were invited to complete the PHC scale, and peripheral blood samples were collected to measure cortisol, ACTH, NK cell%, and B cell% using ELIZA and flowcytom­etry techniques. Results. A total of 30 breast cancer patients and 26 age-matched controls (51.40 + 8.24 years old) were recruited. Breast cancer patients had higher PHC and lower B cell% than healthy controls. PHC had a positive correla­tion with cortisol, ACTH, and NK cell% and a negative correlation with B cell%. Cortisol and ACTH can mediate the correlation between PHC and immunity. Conclusions. Cortisol and ACTH can mediate the correlation between PHC and B cell% and NK cell%.

Out-of-pocket (OOP) costs incurred by breast cancer patients in Poland

2026-02-09

Mikołaj Bartoszkiewicz, Joanna Kufel-Grabowska, Zsuzsanna Beretzky, Péter Balázs, Pawel Burchardt, Valentin Brodszky

Introduction. Breast cancer is the most frequently diagnosed malignant tumor in women worldwide, the treatment of which, despite being financed by public systems, generates significant costs borne directly by patients. Aim: The study aimed to analyze out-of-pocket (OOP) costs incurred by breast cancer patients in Poland, identify the main categories of expenses, and assess their impact on patients’ financial situation. Material and methods. A survey was conducted on a group of 106 women with breast cancer, using a ques­tionnaire containing questions about the demographic situation and treatment costs. Statistical analysis was performed using IBM SPSS Statistics 26. Results. As many as 90.6% of respondents declared incurring additional treatment costs, mainly related to travel, dietary supplements, private consultations, and diagnostics. The average annual expenditure on private consultations amounted to PLN 1,137.36 (EUR 264.50), and the monthly costs of prescription drugs were PLN 193.25 (EUR 44.94). More than half of the patients also incurred costs related to rehabilitation, a specialist diet, and medical equipment. Conclusions. Breast cancer treatment in Poland is associated with a significant financial burden for patients. This indicates the need to develop systemic support mechanisms and expand the scope of reimbursement, which can improve the quality of life of patients and access to comprehensive oncological care.

Risk of glioma malignant progression after biopsy-induced oncotaxis — a systematic review

2026-02-05

Tomasz Tykocki, Łukasz Rakasz

Introduction. Glioma biopsy remains the cornerstone of diagnosis and treatment planning. However, increasing evidence suggests that biopsy-induced tissue disruption and inflammatory responses may accelerate tumor progression and malignant transformation. Objectives. To systematically review clinical and preclinical evidence regarding the biological mechanisms and risks of glioma malignant transformation after biopsy. Material and methods. A systematic search was conducted in PubMed, Embase, Web of Science, and Cochrane Library (2000–2024). Eligible studies included clinical reports, experimental models, and mechanistic studies investigating glioma progression, invasion, or malignant transformation following biopsy or surgical trauma. Data extraction was performed independently by two reviewers. Risk of bias was assessed using ROBINS-I for non-randomized clinical studies and SYRCLE’s tool for animal studies. Results. Of 732 records identified, 24 studies met eligibility criteria. Mechanistic studies demonstrated that biopsy-induced trauma initiates epithelial-mesenchymal transition (EMT), upregulates matrix metalloproteinases (MMP-2, MMP-9), and activates hypoxia-inducible pathways, thereby enhancing glioma cell motility and invasion. The CXCL12/CXCR4 axis and TRP channels (TRPV1, TRPV4, TRPM7) were consistently implicated in post-biopsy oncotaxis. Clinical evidence indicated that neutrophil infiltration and inflammatory cytokines promote glioblastoma progression after biopsy, and case reports described rapid transformation of low-grade gliomas to glioblastoma. Nonetheless, study heterogeneity and lack of prospective controlled designs limited the strength of causal inference. Conclusions. Biopsy-induced inflammatory and molecular responses may contribute to glioma aggressiveness and malignant progression. Minimizing tissue disruption during biopsy and developing adjunctive anti-inflammatory strategies should be prioritized in future research.

The use of stereotactic radiotherapy in the treatment of lung malignancies — a scoping review

2026-02-05

Chara Chantzara, Eleni Tzanetou, Hatham El-Ghobashy, Sotiris Christoforou, Datis Kalali

Introduction. Lung cancer remains as main cause of cancer-related mortality, despite new advances, with many patients remaining inoperable. Novel methods of radiotherapy, including stereotactic body radiotherapy (SBRT), can provide survival benefits in lung cancer, mainly in inoperable patients. However, its use in many forms of lung cancer is still heavily debated. To this end, the present scoping review was undertaken to assess the clinical outcomes of stereotactic radiotherapy in patients with lung cancer. Material and methods. Major electronic databases were searched using keywords and Boolean operators for relevant records. Records were filtered according to the PRISM-ScR guidelines and eligible records were selected. Data regarding clinical outcomes, including the survival rate and toxicities, were extracted from each included study. Results. The literature search retrieved a total of 16,006 records, out of which 15 were included in the synthesis of the review. Stereotactic body radiotherapy showed favorable results in patients with non-small lung cancer as well as patients with bronchial carcinoid tumors and other subtypes of lung cancer, with few significant toxicities reported. Conclusions. Stereotactic body radiotherapy can be further implemented for clinical use in patients with different subtypes of lung cancer. Nevertheless, further research is required to establish standardized dosing protocols, improve toxicity reporting, and explore SBRT’s role in more complicated and rare cases.

Hypoxia and human papillomavirus status in head and neck squamous cell carcinoma — biological insights and implications for personalized treatment

2026-02-04

Daria M. Kamińska, Michał Skrzycki, Dorota Kiprian

Hypoxia is a central feature of the tumor microenvironment in head and neck squamous cell carcinoma (HNSCC). It profoundly affects tumor biology, progression, treatment response, and patient prognosis. Oxygen deprivation activates complex adaptive pathways, largely driven by hypoxia-inducible factors (HIFs). These pathways repro­gramme cellular metabolism, stimulate angiogenesis, promote epithelial–mesenchymal transition, induce genomic instability, and shape the immune response. Collectively, these processes drive the development of a more ag­gressive phenotype, characterized by increased resistance to radiotherapy, chemotherapy, and immunotherapy. Growing evidence highlights that HPV-positive and HPV-negative tumors exhibit distinct biological responses to hypoxia. The former often retain greater radiosensitivity, whereas in HPV-negative tumors hypoxia more often triggers resistance mechanisms. Incorporating hypoxia biomarkers such as imaging modalities, gene expression signatures, and molecular markers into clinical practice could allow more accurate patient stratification. This, in turn, would enable better tailoring of treatment intensity and modality to the tumor’s biological profile. In recent years, several therapeutic strategies targeting hypoxia have been developed. These include hypoxia-activated prodrugs, HIF inhibitors, angiogenesis modulators, metabolic therapies, and immunotherapeutic approaches, some of which are already in clinical trials. This article reviews current knowledge on the role of hypoxia in HNSCC, its relationship with HPV biology, and its influence on treatment response. It also highlights potential therapeutic directions in which the integration of hypoxia assessment with HPV status could support the optimization of treatment strategies.

Association of superior vena cava syndrome with small cell lung cancer

2026-02-04

Faruk Tas, Akin Ozturk, Kayhan Erturk

Introduction. Small cell lung cancer (SCLC) is one of the most common malignant causes of superior vena cava syndrome (SVCS). Still, the clinical consequences of this syndrome have yet to be fully understood. In this study, the aim was to determine the clinical significance of SVCS in patients with SCLC. Material and methods. A total of 374 SCLC patients were retrospectively investigated and evaluated. Results. Small cell lung cancer was present in 24 (6.4%) patients at the time of diagnosis. In SVCS patients, all tumors were located in the right lung (p = 0.0001); most were in the upper lobes (n = 19, p = 0.009); and a greater number of tumors were larger than 5 cm (n = 21, p = 0.002). No correlation was found between the presence of SVCS and other clinical parameters, such as age, gender, weight loss, performance status, clinical stage, metastasis pattern, chemotherapy response, and recurrence. Overall survival rates were found to be similar in patients with and without SVCS (p = 0.1). Conclusions. While tumor location and size were found to be associated with SVCS in SCLC patients, SVCS was not found to have prognostic value in terms of survival.

Analysis of adverse events associated with VEGFR-TKIs and their impact on prognosis in patients with mRCC — narrative review

2026-02-04

Piotr Domański, Szymon Staneta, Weronika Fortuniak, Adam Kobiernik, Mateusz Piętak, Barbara Kruczyk, Karol Grela, Mikołaj Sobczyński, Beata Janas, Elżbieta Sarnowska, Jakub Kucharz

Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) remain a cornerstone in the treatment of metastatic renal cell carcinoma (mRCC), particularly in favorable-risk patients, in cases where immunotherapy is contraindicated, and in subsequent lines of therapy after progression or toxicity. Differences in drug profiles, adverse events (AEs) spectra, and pharmacokinetics among VEGFR-TKIs enable treatment individualization. Proper management of AEs may contribute to increased treatment tolerance and improved outcomes. This narrative review summarizes key differences in AEs among VEGFR-TKIs, evaluates their impact on prognosis, and discusses risk factors and predictive relevance, including implications for clinical practice in the context of sequential therapy after immune checkpoint inhibitors.

Beyond BRCA1 and BRCA2 — a germline PALB2 deletion and CHEK2 substitution in a woman with breast cancer and family history of cancer

2026-02-04

Natalia Krzyżanowska, Paweł Krawczyk, Kamila Wojas-Krawczyk, Łukasz Gajek, Adrian Obara

Genes that encode proteins involved in DNA repair have been extensively studied in relation to tumorigenesis and cancer treatment. Many germline variants that significantly increase the risk of cancer development have been identified, with PALB2 and CHEK2 being among those genes of interest, as they influence the likelihood of cancer occurrence, such as breast and prostate cancer. This study presents a family with multiple cancer cases carrying germline variants in PALB2 (c.172_175del, p.Gln60Argfs) and CHEK2 (c.470T>C, p.Ile157Thr). In the individual in whom the variants were first discovered, early-onset breast cancer occurred. While one variant is considered pathogenic, the other remains questionable. This paper aims to describe the family’s characteristics and discuss the genetic alterations that contribute to tumor development among its members.

Tamoxifen-induced hepatotoxicity and symptomatic tarlov cyst in a breast cancer survivor — coexistence or consequence?

2026-01-29

Omer Esmez, Gulnihal Deniz, Merve Yildiz Esmez

Invasive breast carcinoma is among the most prevalent malignancies affecting women globally. This case presents a 47-year-old female diagnosed with invasive breast carcinoma, treated with mastectomy, chemother­apy, targeted therapy, and hormonal therapy. During follow-up, she developed hepatic dysfunction attributed to tamoxifen and subsequently experienced lower back pain due to a Tarlov cyst. The case underscores the importance of comprehensive and sustained surveillance in breast cancer survivors for the early detection and management of treatment-related complications and musculoskeletal manifestations.

Development and validation of a mobile application assisting oncologists with prescribing appropriate thromboprophylaxis for ambulatory cancer patients with high risk of thromboembolism — a pilot study

2026-01-29

Marwa Akram Tariq, Ehab Mudher Mikhael, Elaf Ali Witwit

Introduction. Cancer significantly increases the risk of venous thromboembolism (VTE), with approximately one in five VTE events associated with malignancy. Although VTE can be prevented through appropriate prophylaxis, under-prophylaxis remains prevalent, particularly in Middle Eastern countries. Technology, particularly mobile applications, offers a promising solution for supporting decision-making in VTE management. This study aimed to develop a mobile application to assist oncologists in making informed decisions regarding thromboprophylaxis for ambulatory cancer patients. Material and methods. The scientific content of the application was developed in accordance with the latest thromboprophylaxis guidelines and validated by a panel of three experts. For pilot testing of the application, it was given to all four oncologists working in the main oncology center at Al-Diwaniya Teaching Hospital. To assess the advantages and disadvantages of the application, each participant was asked to provide feedback using a 3-point Likert scale (good, fair, and poor). Results. Three of the studied parameters received good ratings from all four participating oncologists (application’s ease of use, accuracy in detecting VTE risk, and recommending a suitable [safe] thromboprophylactic agent). Meanwhile, the other two parameters (reducing the time needed for assessing VTE risk and accuracy of decid­ing a suitable anticoagulant dose) were rated as good by 75% of participants and fair by 25% of participants. Conclusions. The newly developed mobile application gained high acceptance from all oncologists at Al-Diwaniya Teaching Hospital. These oncologists considered the application an effective tool in supporting clinical deci­sion-making and enhancing patient care in this critical area of oncology.

Stage IV lung adenocarcinoma — complete response and long-term survival

2026-01-29

Monika Żeleźnicka, Joanna Filipow, Filip Grydź, Tomasz Sarosiek

The article presents the case of a 52-year-old patient (currently 61 years old) diagnosed with stage IIa non-smallcell adenocarcinoma of the left lung. The patient underwent surgical resection with negative margins (R0) and received adjuvant chemotherapy with cisplatin and vinorelbine (PN regimen). One year later, a relapse occurred with a solitary brain metastasis, indicating disease progression to stage IV. Stereotactic radiotherapy using the Gamma Knife technique was performed, followed by systemic treatment with cisplatin and gemcitabine (PG regimen), which was discontinued due to poor tolerance. Subsequently, an immunotherapy with nivolumab was administered and complete response was achieved after 51 treatment cycles. As of the date of publication, no recurrence has been observed, with the patient remaining in remission for six years. He is professionally active, reports no symptoms, and continues outpatient follow-up. This case highlights the importance of personalized therapy, the critical role of clinical trials in expanding treatment options for oncology patients, and the growing significance of immunotherapy in the management of advanced non-small-cell lung cancer.

Current state of knowledge about toripalimab in the treatment of esophageal squamous cell carcinoma — a systematic review

2026-01-29

Natalia Picheta, Julia Piekarz, Katarzyna Szklener

Introduction. Esophageal squamous cell carcinoma (ESCC) remains a major oncological challenge due to its aggressive clinical course, late diagnosis, and limited effectiveness of standard chemotherapy. With poor long-term survival rates, new treatment strategies are urgently needed. Immunotherapy, especially immune checkpoint inhibitors (ICI) targeting the programmed death 1 (PD-1)/programmed death ligand 1 (PD-L1) pathway, has emerged as a promising option. Toripalimab, an anti-PD-1 monoclonal antibody, shows potential in improving treatment outcomes for ESCC patients. Material and methods. This paper reviews current knowledge on the mechanism of action, clinical application, and therapeutic potential of toripalimab in the treatment of ESCC. Three randomized controlled trials (RCTs) were selected, examining a total of 668 patients. Inclusion criteria were RCTs, toripalimab as an intervention, diagnosis of esophageal squamous cell carcinoma, studies conducted in English, and study period 2020–2025. Results. Toripalimab enhances T-cell activity by blocking the PD-1/PD-L1 interaction, reversing tumor-induced immune suppression. Clinical data demonstrate improved overall survival and higher pathological response rates in patients receiving toripalimab with chemotherapy compared to chemotherapy alone. The treatment is generally well tolerated, with immune-related adverse events being manageable and not significantly increasing perioperative risk in resectable cases. Conclusions. Toripalimab represents a promising addition to the therapeutic landscape of ESCC. Its ability to improve survival and pathological outcomes, combined with an acceptable safety profile, supports further investigation and potential inclusion in standard treatment protocols. Immunotherapy may shift the treatment paradigm for this aggressive cancer in patients with limited options.

Clinical significances of variations in main hematological parameters at the time of diagnosis in patients with small cell lung cancer

2026-01-29

Faruk Tas, Akin Ozturk, Kayhan Erturk

Introduction. Variations in white blood cell (WBC), hemoglobin (HGB), and platelet (PLT) values, the main components of complete blood count (CBC), are often encountered at the time of diagnosis in small cell lung cancer (SCLC) patients. Their clinical significance is not fully known; thus, in this retrospective study, the aim was to clarify this interaction. Material and methods. A total of 378 SCLC patients were enrolled in the study and analyzed retrospectively. The CBC values obtained at the time of diagnosis and before the onset of any kind of treatment were collected from patient files. Cut-off laboratory values of the medical center, where a definite diagnosis was first made, were used to evaluate the parameters. Results. The frequency of leukocytosis, anemia, and thrombocytosis in limited-disease SCLC (LD-SCLC) and extended-disease SCLC (ED-SCLC) patients was 29.8 vs. 41.3%, 14.5 vs. 30.4%, and 11.5 vs. 20.6%, respectively. Thrombocytosis in LD-SCLC (p = 0.05) and anemia in ED-SCLC (p = 0.008) were statistically significant in poor responders to chemotherapy. Anemic ED-SCLC patients had significantly poorer survivals than those with normal HGB (p = 0.0001); however, there were no significant associations between other CBC components and survival rates in either LD-SCLC or ED-SCLC patients. Moreover, in multivariate analysis, both performance status and chemotherapy responsiveness-maintained significance on survival, but the importance of anemia in ED-SCLC patients disappeared and became non-significant. Conclusions. Variations in CBC parameters are encountered in SCLC patients at the time of diagnosis, and they might be used as predictive and prognostic indicators to foresee the response to chemotherapy and survival.

Cardiac tumor as first presentation of melanoma

2026-01-28

Magdalena K. Zielińska, Monika Dudzisz-Śledź, Krzysztof Ostaszewski, Aneta Borkowska, Anna M. Czarnecka

Melanoma metastases most commonly involve the skin, lungs, central nervous system, and liver. In 1.8% of all patients with melanoma, cardiac metastases are diagnosed. Melanomas with an unknown primary origin account for about 3% of cases and should be treated as cutaneous melanomas. A 66-year-old woman presented at a primary physician office with chest pain and reduced physical capacity lasting four months. Echocardiography showed a 55 mm tumor in the left ventricle. Initial pathology examination of the resected tumor suggested syno­vial sarcoma. A PET-CT two weeks post-surgery confirmed a 20 mm residual lesion in the heart muscle without distant metastases, but the patient was not eligible for reoperation. Histopathology in the reference center ruled out the initial diagnosis and identified a malignant peripheral nerve sheath tumor (MPNST) and melanoma as likely diagnoses. Ultimately, a BRAF -negative melanoma of unknown primary was confirmed. Pembrolizumab treatment at 200 mg every three weeks was initiated with complete remission (CR) of the cardiac lesion after three cycles. This remission persisted over 27 cycles. Treatment pauses were needed due to grade 2 toxicities affecting the skin, liver, pancreas, and lungs. After 27 cycles, the patient started drug holidays, with the last cycle of pembrolizumab administered 40 months ago (as of January 2025). Given the diagnostic challenges in sus­pected sarcoma cases, patients should be referred to specialized centers after biopsy. Multidisciplinary teams should guide treatment decisions, supported by comprehensive examination and next-generation sequencing (NGS) testing where indicated.

Oral mucositis pain management — an overview of current guidelines and clinical approaches

2026-01-28

Grzegorz W. Borowski, Maria Zasadzińska, Piotr Bakuła, Kamila Jałocha

Oral mucositis (OM) is a painful complication of cancer treatments, particularly in patients receiving radio­therapy for head and neck cancers or undergoing stem cell transplants. The pain often requires opioids for relief, but current Multinational Association of Supportive Care in Cancer and the International Society of Oral Oncology (MASCC/ISOO) guidelines offer limited recommendations due to insufficient research and varying study methods. This review explores OM pain management, focusing on MASCC/ISOO guideline-based rec­ommendations and other strategies not yet included. Opioids like morphine are the most effective treatments, with topical morphine suggested in some cases. However, other treatments, including transdermal fentanyl and doxepin mouthwash, lack sufficient evidence for inclusion in the guidelines. Most available treatments focus on preventing OM or reducing its duration rather than directly managing pain. Some procedures, such as cryo­therapy and photobiomodulation, show promise, with photobiomodulation also providing potential pain relief. Until more research is available, clinicians should follow the World Health Organization (WHO) analgesic ladder, tailor pain management to individual patients, and refer to updated MASCC/ISOO guidelines for optimal care.

Clinical implications of adrenal incidentaloma — a mini review

2026-01-28

Zofia Olejniczak, Izabela Walendowicz, Anna Prus, Franciszek M. Deresz

In the era of rapid advancements in imaging techniques and improved accessibility to diagnostic imaging, the detection of focal adrenal lesions in patients who undergo examinations for unrelated reasons has been steadily increasing. Most adrenal incidentalomas are hormonally inactive adrenal cortical adenomas with benign radiological features. However, some lesions may be hormonally active and/or exhibit radiological characteristics of malignant growth (pheochromocytomas, adrenocortical carcinomas, metastatic lesions). In such cases, prompt therapeutic intervention is necessary. The 2023 guidelines issued by the European Society of Endocrinology introduced significant updates to the recommendations for diagnosing and managing these lesions, particularly in terms of the evaluation of mild autonomous cortisol secretion (MACS). Given that adrenal incidentalomas may occur in up to 10% of elderly patients and are likely to be diagnosed with increased frequency due to the improvement in quality and availability of imaging, the aim of this paper is to provide a comprehensive overview of current approach to adrenal tumors.

Navigating through unusual — esophageal spindle cell carcinoma

2026-01-27

Prajwal R, Diptajit Paul, Nikhar Mukati, Rakesh Dhankhar, Ashok Chauhan

Introduction. Esophageal spindle cell carcinoma is a rare neoplasm of esophagus with unique presentation having varying clinical, histopathological, radiological, and molecular features. It has dual nature of histology consisting of epithelial and sarcomatous components present within the tumor cells. High recurrences are noted in lymph nodes following surgery. Here we report an unusual case of spindle cell carcinoma of middle thoracic esophagus treated with radiation and chemotherapy. Case report. A 47-years-old adult male presented to Radiation Oncology outpatient department with complains of progressive dysphagia of 2-month duration, associated with hoarseness of voice and weight loss. Contrast enhanced computed tomography showed esophageal thickening and growth in the middle thoracic region. Histopathological examination of growth confirmed esophageal spindle cell carcinoma with vimentin and cytokeratin positivity. Patient underwent external beam radiation therapy followed by salvage oral metronomic chemotherapy. After 2-months of oral chemotherapy, patient lost to follow up. Conclusions. Spindle cell carcinoma is uncommon malignancy of esophagus, owing to their dual nature of histology within tumor tissue. Patients tend to present with early symptoms. Surgery remains important intervention in management of spindle cell carcinoma. However, lack of uniform consensus underscores the complete management of these uncom­mon neoplasms. Through this case report and short review, we aim to contribute in establishing uniform consensus.

Progressive respiratory failure in a patient with wood dust exposure — a case report with an unexpected outcome of adenocarcinoma with ALK gene rearrangement

2026-01-27

Jan Wojtas, Anna Rekowska, Joanna Pec, Weronika Pająk, Jakub Kleinrok, Paulina Duda, Paweł Krawczyk, Tomasz Kucharczyk, Marta Adamczyk-Korbel, Adam Krusiński, Dorota Lewkowicz, Janusz Milanowski

Lung cancer remains the leading cause of cancer-related deaths among both men and women in Poland. There are various types of lung cancer, with non-small cell lung cancer (NSCLC) being the most prevalent. Within NSCLC, adenocarcinoma is the most common subtype. Lung adenocarcinoma poses significant challenges in effective treatment due to its complex molecular profile. Recently, significant advancements have been observed in targeted therapies for lung cancer, which are based on the molecular diagnosis of cancer subtypes. Patients with adenocarcinoma with ALK gene rearrangements have the possibility of effective therapy with ALK inhibitors, especially the third generation of these drugs — lorlatinib. Here, a 39-year-old male admitted to the documented clinic with symptoms of respiratory failure is presented. He had a long-term history of employment in the wood industry. The course of the disease was rapid and it did not allow for diagnosis and treatment before the patient’s death. In the autopsy material pneumonic type of lung adenocarcinoma (PLADC) was diagnosed, and immunohistochemical method revealed expression of aberrant ALK protein. This case report is the first according to the literature in which ALK gene rearrangement was found in a non-smoking, young patient exposed to wood dust.

Relationship between BRAF V600E mutation and recurrence of differentiated thyroid cancer — a systematic review

2026-01-27

Nur Qodir, Bima Indra, Afifah Zulfa Salsabila

Introduction. The BRAF V600E mutation is implicated in the tumorigenesis of differentiated thyroid cancer, and its role in cancer recurrence remains debated. This systematic review aims to assess the relationship between BRAF mutations and the recurrence of DTC and its impact on lymph node metastasis and mortality. Methods. Following PRISMA 2020 guidelines, a comprehensive search was performed across PubMed and ScienceDirect databases covering studies published up to September 2024. Eligible studies reported on the association between BRAF V600E mutation and recurrence in DTC. Data on patient characteristics, recurrence rates, metastasis, and mortality were extracted for synthesis. Results. A total of seven studies with 4660 patients were included. Most of the patients had papillary thyroid carcinoma, and the mean age ranged from 40 to 54 years. Three studies found no significant association be­tween BRAF V600E mutation and DTC recurrence, while two studies reported a significant association. Lymph node metastasis was associated with BRAF mutation in three studies, without contradictory findings. Regarding mortality, two studies found no significant association, whereas one study reported an increased mortality risk with BRAF mutation. Conclusions. The relationship between BRAF V600E mutation and recurrence in DTC is inconclusive, with mixed findings across the studies. BRAF V600E mutation is more consistently linked to lymph node metastasis, though its role in predicting recurrence and mortality remains uncertain. Further research with standardized methodologies is required to better understand the clinical implications of BRAF V600E mutations in DTC.

Increased cardiovascular risk in testicular cancer survivors — analysis based on metabolic study findings in a single–center cohort

2026-01-27

Kinga Begier, Jakub Czarny, Zachariasz Rytelewski, Jan Linkiewicz, Natalia Wojczyszyn-Kottisch, Anna Sowińska, Olga Milbrandt, Rodryg Ramlau

Introduction. Testicular cancer is a significant health problem among young men, accounting for a substan­tial percentage of morbidity and death in Poland. Treatment included surgical approaches, radiation therapy and chemotherapy can lead to metabolic and cardiovascular disorders. This study aims to evaluate the effect of systemic treatment on laboratory parameters indicating potential metabolic disorders after therapy. Material and methods. Patients selected were treated at the Institute of Oncology. They were diagnosed with testicular cancer, had undergone systemic treatment, and had performed metabolic follow-up for 2–10 years after the end of treatment. Twenty-six patients fulfilled the criteria. The results of lipid profiles, testosterone, creatinine, uric acid, urea, random blood sugar, thyroid stimulating hormone (TSH), NT-proBNP and lactate dehydrogenase (LDH) were ana­lyzed. Patients were divided according to age at diagnosis, treatment used and time since discontinuation of therapy. Results. 84% of patients had abnormal results in at least one lipid profile parameter. Lower levels of testosterone were linked to higher triglyceride (TAG) values (p = 0.0067). Patients diagnosed before the age of 30 were predis­posed to lower high density lipoprotein (HDL) values after treatment (p = 0.026), and the use of the bleomycin-free regimen led to lower testosterone levels (p = 0.0145). Conclusions. The study showed a statistically significant dependence between lower testosterone levels and higher TAG values. Testicular cancer survivors are more likely to present lipid profile disorders at younger ages than the general population, which increases the risk of cardiovascular issues. It is recommended to monitor these disorders actively and consider testosterone therapy when necessary. Collaborative efforts between oncologists and family physicians are vital for early detection and treatment of abnormalities, thereby reducing cardiovascular risk.

The rare co-occurrence of cholangiocarcinoma and chronic eosinophilic leukemia

2026-01-27

Bilgesah Kilictas, Murat Araz, Melek Karakurt Yılmaz, Mehmet Artaç, Sinan Demircioğlu, Kübra Yel Uygun, Pembe Oltulu, Havva Nur Çalışkan

Introduction. Cholangiocarcinoma (CCA) is a rare and highly aggressive malignancy of the bile ducts with a poor prognosis and a 5-year survival rate of approximately 5%. Chronic eosinophilic leukemia (CEL), characterized by clonal eosinophil proliferation, is a rare hematologic malignancy often progressing to acute leukemia. The simultaneous occurrence of these two malignancies is exceedingly rare, according to available research, this is the first case reported in the literature. Case report. This is the case of a 44-year-old female presenting with fatigue, diagnosed with metastatic CCA following imaging and biopsy. During chemotherapy with gemcitabine and cisplatin, the patient developed unex­plained leukocytosis and eosinophilia, leading to a subsequent diagnosis of CEL. Despite aggressive treatment, the patient experienced complications, including cholangitis and renal failure, and succumbed to her illness four months post-diagnosis. Conclusions. This case highlights the rare co-occurrence of CCA and CEL, emphasizing the importance of vigilant monitoring for secondary hematologic malignancies in oncology patients. Early recognition and treatment of concur­rent disorders can improve clinical outcomes and inform future research on such rare malignancy combinations.