Aysan Nozheh

BACKGROUND: Medullary thyroid cancer (MTC) is one of the rare neuroendocrine malignancies. This cancer is hereditary in approximately 20% of cases. Although lymph node (LN) metastasis is prevalent in MTC, distant metastasis is not commonly seen in these patients. The most common locations for metastasis are the lungs, liver, and bones. This study presents an extremely rare MTC metastasis to bone marrow (BM) and adrenal gland, which has not been reported before. CASE: The patient was a 50-year-old man with a diagnosis of MTC and total thyroidectomy 2 months before his presentation. He came to the emergency department (ED) complaining of dyspnea, diffuse bone pain, nonbloody diarrhea, and abdominal cramps starting in the last month before. Initial treatment with intravenous fluid infusion and loperamide, due to the provisional diagnosis of infectious diarrhea, was ineffective. Further assessments revealed severe pancytopenia and a massive tumor above the left kidney. Bone marrow aspiration (BMA) and biopsy (BMB) led to the diagnosis of invasive metastasis of the MTC to the BM and the left adrenal gland. In the initial evaluations, his COVID-19 test became positive, and despite all efforts, his condition deteriorated, and he died 5 days after admission due to respiratory distress. CONCLUSION: Most MTC cases present with thyroid nodules in the initial steps and are confined to the thyroid gland or the adjacent LNs. These cases are mostly cured by thyroidectomy and LN dissection. This neuroendocrine cancer infrequently becomes aggressive and involves other parts of the body. However, involving BM or adrenal gland has been scarcely reported. Due to ineffective red and white blood cell production, BM metastasis can cause pancytopenia and, consequently, pallor, fatigue, dyspnea, and susceptibility to infections. High calcitonin levels can also cause diarrhea. The initial diagnosis is mostly with neck ultrasound (US) and fine needle aspiration (FNA). Total thyroidectomy is the main therapeutic option for these patients. Calcitonin and carcinoembryonic antigen (CEA) are sensitive indicators of recurrence or remaining tumors, which might be helpful for the initial diagnosis and postoperation follow-up. Although extremely rare, invasive metastasis of MTC might involve unusual body organs such as the BM or adrenal glands. In cases of unjustifiable pancytopenia or adrenal dysfunction in MTC-positive patients, these possibilities should be considered and ruled out by some specific evaluations, such as bone marrow biopsy and contrast-enhanced imaging.

Gastric cancer (GC) remains a significant global health burden, characterized by high mortality rates, often due to late-stage diagnosis, resistance to conventional therapies, and metastatic dissemination. This narrative review synthesizes current preclinical and early clinical evidence on the diverse roles of curcumin, a natural polyphenolic compound derived from Curcuma longa (turmeric), in the context of gastric cancer. A comprehensive search of databases, including PubMed, Scopus, and Web of Science, was conducted, and approximately 140 studies were critically appraised to identify mechanistic insights and translational barriers. In this context, curcumin’s potential in preventing GC is explored, specifically regarding its potent anti-inflammatory and antioxidant properties, modulation of precancerous lesions, and anti-Helicobacter pylori activity. Furthermore, the review details curcumin’s mechanisms in treating established GC, including its ability to inhibit cancer cell proliferation, induce apoptosis (via pathways like PI3K/Akt/mTOR, NF-κB, STAT3), and exert anti-angiogenic effects. Crucially, its capacity to inhibit GC metastasis by reversing epithelial-mesenchymal transition (EMT), suppressing matrix metalloproteinases (MMPs), and modulating key signaling pathways involved in invasion and migration is highlighted. Additionally, curcumin’s role in overcoming chemoresistance is discussed. Despite its promising pleiotropic actions, the clinical translation of curcumin is significantly challenged by its poor bioavailability. Moreover, various strategies to enhance systemic absorption are addressed, emphasizing the critical need for well-designed clinical trials to validate its efficacy and safety in human GC patients. This review underscores curcumin’s potential as a valuable complementary or integrative therapeutic agent in gastric cancer management.

A 46-year-old woman scheduled for an elective total abdominal hysterectomy was incidentally found to have a rare P-null (p) phenotype during routine preoperative testing. Although her ABO/Rh type was A positive, the antibody screen demonstrated strong pan-reactivity with all panel cells, while the autocontrol was negative, indicating an alloantibody. This prompted referral to a reference immunohematology laboratory, where the pan-agglutinating antibody was ultimately identified as specific anti-P1Pk, consistent with the patient's rare P-null phenotype. Consequently, the patient was flagged as requiring future transfusions with P-null, ABO/Rh-compatible red blood cells. Surgery proceeded without the need for transfusion, but identification of this rare phenotype has substantial implications for long-term care, particularly given the known association of anti-PP1Pk with severe hemolytic transfusion reactions and recurrent pregnancy loss. This case highlights the importance of comprehensive pretransfusion testing, early collaboration with specialized laboratories, meticulous documentation, and proactive transfusion planning, particularly in regions where such phenotypes may be underrecognized.

Introduction: Stomach cancer is a serious health problem worldwide, as it is one of the most common cancers and the fourth leading cause of cancer-related death. Mast cells perform functions in the immunity system and are a type of discriminated myeloid cell. In this study, we evaluated the correlation between tryptase-positive mast cell density with prognostic histopathological findings in gastric cancer. Materials and Methods: The study was conducted as a cross-sectional study, using tissue samples from 40 patients who underwent radical gastrectomy at Sina Hospital between 2022 and 2023. After histopathological examination and determination of tumor histopathological characteristics, the samples were subjected to immunohistochemical staining using a monoclonal antibody against mast cell tryptase. Results: In this study, the median density of mast cells in tumor tissue was 8/10 high power fields. There was no significant relationship between mast cell density and the number of lymph nodes involved, as well as tumor type, grade, location, and size. Furthermore, there was no significant relationship between mast cell density and tumor vascular invasion or neural invasion. Conclusion: Mast cells have vital roles in normal immune systems and pathological situations. Mast cell density in tumor tissue might be considered for the prognosis of patients before treatment but the function of mast cells has not been completely explained in gastric cancer and needs confirmation to introduce new target therapy.

INTRODUCTION: Antibiotic resistance is a critical global health issue, primarily driven by inappropriate antibiotic prescribing. Identifying reliable biomarkers to guide antibiotic use is essential to combat this challenge. Procalcitonin (PCT) testing has emerged as a promising tool for differentiating bacterial infections from non-bacterial conditions and supporting antibiotic stewardship programs. This literature review evaluates evidence from randomized controlled trials, observational studies, and real-world clinical data to assess the clinical utility of PCT testing in guiding antibiotic prescribing decisions. RESULTS: Across randomized controlled trials and real-world studies, PCT-guided algorithms typically yielded reductions in antibiotic duration of approximately 0.9 to 3 days in large adult cohorts, with some smaller or source-specific trials reporting reductions of up to 6 days. Relative decreases in antibiotic exposure varied widely across studies (ranging from approximately 8% to > 50%). Importantly, these reductions were achieved without increases in short-term or 28-day mortality, while hospital length of stay remained largely unchanged. Studies generally indicate that PCT-guided strategies are cost-effective, primarily driven by reduced antibiotic use. However, challenges such as interpretive difficulties, false-positive and negative results, and implementation barriers remain. CONCLUSION: Incorporating PCT testing into antibiotic stewardship strategies offers a promising approach to enhance prescribing accuracy, reduce antibiotic resistance risks, and improve patient care quality. Future research should focus on refining clinical guidelines, expanding applicability across diverse patient populations, and addressing practical challenges to facilitate widespread adoption of PCT testing in routine clinical settings.