Background: Hypophosphatemia is a frequently underestimated metabolic disorder, yet it can be one of the first biochemical findings in primary hyperparathyroidism (PHPT). Current diagnostic and surgical criteria for PHPT do not include serum phosphate, despite its potential value as an early marker. Methods: We report the case of a 79-year-old woman with type 2 diabetes mellitus, hypertension and osteoarthritis, followed since 2015 for persistent hypophosphatemia (0.8 mg/dL) and stress fractures. Results: Initial calcium and vitamin D levels were normal, but PTH was elevated. Bone scintigraphy revealed multiple stress fractures, while ultrasound and sestamibi scan were inconclusive. Despite cholecalciferol and calcitriol supplementation, hypophosphatemia persisted. From 2023, progressive hypercalcemia developed (10.9 mg/dL), with sustained hypophosphatemia (1.7 mg/dL), persistently high PTH (121 pg/mL) and markedly elevated FGF-23 (1694 kRU/L). Renal phosphate wasting was demonstrated, with reduced tubular reabsorption. An 18F-fluorocholine PET-CT performed in 2024 identified two right parathyroid adenomas, establishing the diagnosis of PHPT. The patient was referred for parathyroidectomy. Conclusions: Hypophosphatemia may serve as a complementary biomarker in the diagnostic and therapeutic approach to PHPT, but only after other potential causes of low phosphate levels have been excluded, as illustrated in this case. Its consideration could facilitate the early identification of PHPT and improve clinical decision-making, particularly in patients who do not meet classical surgical indications.

An abstract is unavailable.

T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is a rare, aggressive subtype of diffuse large B-cell lymphoma characterized by a profoundly immunosuppressive tumor microenvironment. PD-L1 overexpression by tumor cells is a recognized immune escape mechanism and may underlie resistance to cellular therapies, including CAR T-cell therapy. We report a case of a 29-year-old woman with refractory stage IV-B THRLBCL treated with anti-CD19 CAR T-cell therapy (varnimcabtagene autoleucel), who achieved an initial response (day +28) but experienced disease progression by day +100 despite robust CAR T-cell expansion. Peripheral blood analysis revealed persistent absolute B-cell aplasia, while bone marrow biopsy confirmed CD19-positive disease. Comparative immunohistochemistry demonstrated markedly increased PD-L1 expression in post-CAR T-cell samples, suggesting adaptive immune resistance via PD-1/PD-L1-mediated CAR T-cell inhibition. Nivolumab was initiated at month +4 to overcome this checkpoint-mediated resistance. Notably, a complete metabolic response was documented on PET/CT after four doses of nivolumab (month +6). The patient remains in sustained remission, with persistent B-cell aplasia, four years post-intervention. This case provides clinical and pathological evidence supporting the use of immune checkpoint blockade to rescue CAR T-cell efficacy, highlighting the potential of this synergistic approach in THRLBCL and possibly other B-cell malignancies exhibiting similar immune evasion.

Background: Optical coherence tomography angiography (OCTA) enables non-invasive, high-resolution visualization of the retinal microvasculature and is increasingly utilized in pediatric ophthalmology. However, its clinical application in children is limited by the absence of age-specific normative d...

Endometriosis is a chronic, estrogen-dependent inflammatory disease with heterogeneous clinical manifestations and uncertain systemic immune involvement. This study aimed to characterize peripheral immune profiles and circulating tumor markers in women with ovarian endometrioma (OE) and deep infiltrating endometriosis (DIE), and to explore their associations with disease severity, symptom burden, and physical health perception. Peripheral blood leukocyte subsets, plasma cytokines, and tumor markers (CA125, CA19-9, CEA, HE4) were analyzed in 146 patients and 50 healthy controls. OE was associated with increased monocyte counts and reduced neutrophil proportions, while DIE showed elevated levels of IL-8 and Galectin-1. IL-33 levels correlated negatively with the revised American Society for Reproductive Medicine (rASRM) scores and positively with neutrophil proportion, suggesting a role in systemic immune regulation. Tumor marker levels varied by subtype: CA19-9 was higher in OE, and CEA in DIE. CA125 correlated with disease severity, and CEA with monocyte levels. Exploratory heatmaps revealed consistent immune-tumor associations linked to anatomical severity and symptom profiles. Although exploratory, these findings highlight the presence of distinct systemic immune patterns in endometriosis and support the potential of integrative blood-based biomarkers for future diagnostic and stratification strategies.

Background: Breast reconstruction following mastectomy has become an essential procedure in breast cancer treatment due to its positive impact on patients’ quality of life. Among the various reconstruction techniques, the use of expanders followed by implants has gained popularity. In this context, acellular dermal matrices (ADM) have been introduced as an adjunct to improve implant coverage, lower pole support, and aesthetic outcomes. However, their use has also been associated with higher costs and a potential increase in postoperative complications, which remains a matter of debate. We aimed to determine the relationship between acellular dermal matrix and postoperative outcomes and complications. Methods: An observational retrospective study was conducted with patients who underwent immediately breast mastectomy followed by tissue expander reconstruction from January 2022 to June 2024. Patients were divided into two groups depending on reconstructive plane. Results: The final cohort contained 87 patients. Smoking, radiotherapy and dermal matrix were associated with a higher complication rates. After risk-adjustment, dermal matrix use led to a higher rates of surgical site infection (OR 7.62, p = 0.029) in the prepectoral plane, and higher rates of overall complications (OR 3.34, p = 0.05) and surgical wound dehiscence (OR 6.04, p = 0.048) in the retropectoral plane. Conclusions: These findings highlight the importance of individualized surgical planning, particularly concerning the use of acellular dermal matrix, which were associated with increased risks of surgical site infection, dehiscence, and global complications. Further research is required to establish standardized guidelines for the optimal selection surgical technique.

Background/Objectives: The presence of distant metastases is the main cause of death in medullary thyroid carcinoma (MTC). However, due to the rarity of this cancer, few studies have thoroughly analyzed the variables influencing the development of distant metastases. The objective of this study was to evaluate, in patients with MTC, the factors associated with the occurrence of synchronous and metachronous distant metastases. Methods: An analytical, observational, retrospective cohort study was conducted at a tertiary hospital. Patients with histologically confirmed MTC, both sporadic and familial (MEN2 syndrome), were included. The influence of epidemiological variables, heredity, complementary tests, surgical factors, histological features, staging, and disease progression was assessed. A univariate comparative analysis was first performed, followed by a multivariate analysis using logistic regression. Results: This study included 146 patients, of whom 75% (n = 109) had familial MTC. Lymph node involvement at diagnosis was observed in 36% (n = 52). During follow-up, distant metastases developed in 14% (n = 21) of patients, including five cases present at the time of diagnosis. The median follow-up was 214 months (IQR 106–289). The presence of distant metastases was associated with an increased risk of mortality. Factors associated with distant metastases included age, calcitonin level, hereditary status, lymph node involvement, and overall stage. In multivariate analysis, the lymph node ratio (LNR) remained the only significant predictor (OR 29.124). Conclusions: Several variables were related to the presence of distant metastases. Among them, the LNR emerged as the independent predictor of both synchronous and metachronous distant metastases.

Incretin-based therapies, particularly glucagon-like peptide-1 receptor agonists (GLP-1RAs), exert a wide range of beneficial effects beyond glycemic control, largely mediated by their anti-inflammatory properties. Chronic low-grade inflammation is a common pathological mechanism underlying metaboli...

Annals of Surgical Oncology -

Aims To analyse the impact of a participatory process of awareness and reflection on compassion, in the face of end-of-life processes, in students aged 12–23 years in six Spanish regions, and to und...

Inherited thrombocytopenia (IT) caused by germline variants in RUNX1, ETV6 or ANKRD26 carries a high risk of developing haematological malignancy. This study examined the clinical, platelet and molec...

Background External Cephalic Version (ECV) is an effective procedure for modifying fetal position to achieve a cephalic presentation. ECV is usually performed with tocolysis and spinal anesthesia. Recently, propofol has been proposed as a sedative agent for ECV, showing promising results in observational studies. This clinical trial aims to compare the outcomes of ECV performed under tocolysis with either propofol or spinal anesthesia. Methods The PropoSpinECV randomized clinical trial is designed as a single-center, randomized, open-label trial. Participation will be offered to every pregnant woman with a non-cephalic presentation undergoing external cephalic version. Sedation with propofol and spinal analgesia with bupivacaine and fentanyl will be compared for ECV with a 1:1 allocation ratio. All procedures will be performed under tocolysis with ritodrine. The breech progression angle before ECV will be measured for all participants. The main outcome will be the ECV success rate. ECV complication rates and post-procedure pain will also be evaluated. Discussion The PropoSpinECV trial will thoroughly evaluate the efficacy of propofol in ECV. Additionally, this trial will investigate the role of the breech progression angle prior to ECV as a predictive variable for the success of the procedure. Trial registration The PropoSpinECV clinical trial is registered in the European Union Clinical Trial Database (EU CT number: 2024-510701-29-00) and in the ClinicalTrials.gov Database (NCT06449430) with the Clinical Trial Registry (2024-06-03).

Juan Carlos Miralles-López [email protected], Juan José Cortés Collado2, Yulia Petryk Petryk3, Francisco-Javier Bravo-Gutierrez4,, Rubén Andújar-Espinosa5, Mercedes Ramírez Hernández6, Manuel Castilla-Martínez7, Cayetano Díaz-Chantar8, Inmaculada Ibarra-Calabuig3, José Valverde...