Search Results (1,454)

Intracranial aneurysms are common vascular lesions with a highly variable natural history. While most unruptured intracranial aneurysms remain stable throughout life, a biologically aggressive subset progresses to growth and rupture, resulting in aneurysmal subarachnoid hemorrhage with substantial morbidity and mortality. Contemporary evidence demonstrates that aneurysm behavior is dynamic rather than static and reflects the interaction of hemodynamic forces, inflammatory vascular remodeling, genetic susceptibility, and environmental risk factors. Rupture risk is not constant over time and may be highest early after aneurysm formation, followed by a period of relative quiescence in selected lesions. Traditional population-based risk estimates have therefore evolved toward individualized risk stratification incorporating aneurysm size, location, morphology, growth, patient-specific factors, and emerging imaging and computational biomarkers. This chapter reviews the epidemiology, pathobiology, growth patterns, and rupture risk of intracranial aneurysms, integrating foundational observational studies with recent advances in genetics, vessel wall imaging, and predictive modeling. Understanding the natural history of brain aneurysms is essential for balancing the risks of observation against intervention and for guiding future innovations in aneurysm management. Full article

Background and Clinical Significance: Juvenile nasopharyngeal angiofibroma (JNA) is a benign but locally aggressive vascular tumor, classically affecting adolescent males. Diagnosis in adulthood is exceptionally uncommon and may mimic other vascular or malignant nasopharyngeal lesions. This patient also had chronic hypocalcemia with Fahr-like intracranial calcifications secondary to long-standing postoperative hypoparathyroidism after thyroid carcinoma treatment. To our knowledge, this coexistence has not been previously reported. Case Presentation: A 34-year-old Caucasian male with papillary thyroid carcinoma treated with total thyroidectomy developed postoperative hypoparathyroidism with chronic hypocalcemia and Fahr-like intracranial calcifications. During admission for acute respiratory insufficiency due to tracheostomy dysfunction, imaging revealed a 37 × 33 × 32 mm heterogeneous, hypervascular nasopharyngeal mass extending into the right pterygopalatine fossa (PPF) with bone remodeling and focal bony dehiscence. Digital subtraction angiography demonstrated a markedly hypervascular tumor, predominantly supplied by branches of the right internal maxillary artery (via the sphenopalatine artery). Endoscopic resection was performed, and histopathology confirmed JNA. Most JNA cases occur between 7 and 19 years of age; presentations in men older than 30 years are rare and often generate diagnostic uncertainty, particularly when differentiating from nasopharyngeal carcinoma or other lesions. In adults, magnetic resonance imaging/computed tomography for assessment of local extent and angiography for vascular mapping are key to minimizing hemorrhagic risk. The concurrent endocrine disorder emphasizes the need for multidisciplinary perioperative metabolic optimization, without implying a pathophysiological link. Conclusions: This report illustrates JNA diagnosed in adulthood in a male with Fahr-like intracranial calcifications secondary to chronic hypoparathyroidism. It highlights the necessity of considering JNA in the differential diagnosis of hypervascular nasopharyngeal masses in adults, especially in patients with complex comorbidities. Full article

Hepatic hemangiomas are the most common benign liver tumors and are typically small and asymptomatic; however, pedunculated and exophytic variants are extremely rare and may mimic extrahepatic lesions on imaging, posing a potential diagnostic challenge. The aim of this study was to describe the multimodal imaging features of a pedunculated hepatic hemangioma arising from the left triangular ligament and to review the available literature with particular attention to MRI findings and diagnostic considerations. A 52-year-old man underwent contrast-enhanced thoracoabdominal CT for unrelated symptoms, which incidentally revealed a pedunculated hepatic lesion. Further evaluation was performed with multiparametric MRI at 1.5T, including diffusion-weighted imaging and dynamic contrast-enhanced sequences. A review of the English-language literature published up to 2025 focusing on pedunculated and exophytic hepatic hemangiomas was also conducted. CT and MRI demonstrated imaging features consistent with hepatic hemangioma, including peripheral nodular enhancement with progressive centripetal fill-in and marked T2 hyperintensity. Multiplanar MRI depicted a thin vascular pedicle connecting the lesion to the hepatic capsule, supporting its hepatic origin. Fewer than approximately 30 well-documented cases have been reported in the English literature. Recognition of these imaging findings may facilitate correct diagnosis and help avoid unnecessary invasive procedures. Full article

Background: The characterization of thyroid lesions is essential in clinical practice. Recent advances in imaging modalities, including nuclear imaging (NM), color Doppler ultrasonography, and sonography, have markedly improved the diagnostic accuracy for thyroid nodules. Objective: To assess thyroid diseases using Doppler ultrasound, nuclear scintigraphy, and sonography. Results: In this cross-sectional single-center study, 144 patients were examined to determine their thyroid structure and function using a multimodal imaging approach. Fine-needle aspiration cytology (FNAC) indicated that most thyroid nodules were benign (62.5%), with 37.5% being malignant. Doppler vascularity demonstrated a sensitivity of 70.4% and a specificity of 40% (AUC = 0.514) for malignancy detection, while scintigraphy uptake in hypofunctioning nodules (nodules with decreased radionuclide uptake) showed a sensitivity of 37% and a specificity of 54.4% (AUC = 0.388). Thyroxine hormone levels showed a sensitivity of 57.4% and a specificity of 45.6% (AUC = 0.503) for detecting malignant thyroid nodules. In multivariate logistic regression, increased Doppler vascularity remained an independent predictor of malignancy (OR = 2.39; 95% CI: 1.15–4.96; p = 0.019), whereas decreased scintigraphic uptake showed a borderline effect (OR = 1.82; p = 0.069); high T4 level and increased uptake were not significant predictors. The combined Doppler ultrasound, scintigraphy, and thyroxine level model yielded an AUC of 0.72 (95% CI: 0.63–0.81), markedly higher than any single parameter. At the optimal Youden threshold (0.43), the model achieved 79.6% sensitivity, 68.2% specificity, and 72.4% accuracy, highlighting the superior diagnostic performance of the integrated approach for pre-FNAC stratification of thyroid malignancies. There was a strong, significant linear association between thyroxine levels and thyroid scintigraphy uptake (p-value < 0.001). Most patients with normal thyroxine levels exhibited decreased uptake (66.1%), whereas a minority (6.5%) demonstrated elevated uptake levels. This study found a strong correlation between mixed-echogenicity nodules and thyroid scintigraphy uptake (p-value = 0.019). Mixed-echogenicity nodules were most often associated with reduced uptake (57.8%), and hypoechoic nodules often had normal uptake (57.1%). Conclusions: The complementary integration of color Doppler vascularity, Tc-99m thyroid scintigraphy, and serum thyroxine levels yields superior Doppler–scintigraphy uptake correlation, increases the overall diagnostic accuracy, and offers a practical, non-invasive algorithm for differentiating benign from malignant thyroid nodules prior to FNAC or surgery. Full article

Background: PIK3CA-related overgrowth spectrum (PROS) comprises a heterogeneous group of mosaic disorders caused by activating variants in the PIK3CA gene, resulting in dysregulation of the PI3K/AKT/mTOR signaling pathway and abnormal tissue overgrowth. Targeted inhibition of this pathway has recently emerged as a promising therapeutic strategy. Methods: We conducted a literature review to identify published reports describing patients with PROS treated with alpelisib, a selective inhibitor of the p110α catalytic subunit of PI3K. Data regarding patient characteristics, genetic variants, treatment regimens, clinical outcomes, radiological response, and adverse events were extracted and analyzed. Results: Seventeen publications met the inclusion criteria, comprising a total of 114 patients treated with alpelisib. The majority of patients were pediatric (68.4%), with a median age at treatment initiation of 12 years. Clinical manifestations were heterogeneous and included segmental overgrowth, vascular malformations, and soft-tissue hypertrophy. Clinical improvement in at least one disease manifestation was reported in 111 patients (97.3%). Radiological response, defined as reduction ≥20% in lesion volume, was documented in 26 of 60 evaluable cases (47.3%). Adverse events were reported in 64 patients (56.1%) and were generally mild and manageable, with hyperglycemia and diarrhea being the most common. Conclusions: Available real-world evidence suggests that alpelisib provides meaningful clinical benefit across multiple PROS phenotypes, with an acceptable safety profile. However, current data remain limited by small cohort sizes, heterogeneous outcome reporting, and variable follow-up duration. Prospective studies with standardized outcome measures are needed to better define long-term efficacy and safety of PI3K inhibition in PROS. Full article

Adventitial cystic disease (ACD) is a rare vascular condition, representing approximately 0.1% of all vascular diseases, with about 325 cases reported in the literature since its first description in 1947, including 72 venous cases. This study aims to highlight the diagnostic and therapeutic challenges of venous ACD, which is frequently misdiagnosed as deep vein thrombosis (DVT), femoral varices, aneurysms, venous tumors, or lymphadenopathy due to its rarity. Clinical, imaging, and treatment data from reported cases of venous adventitial cystic disease (VACD) were reviewed. The disease most commonly involved the common femoral vein (56%) and external iliac vein (24%), with less frequent involvement of the saphenous and popliteal veins (7%). Symptoms commonly mimic deep vein thrombosis (DVT), with unilateral swelling resulting from progressive cyst enlargement and subsequent venous luminal stenosis. Doppler ultrasound typically shows a hypoechoic lesion in the venous wall with preserved flow and normal D-dimer levels, while CT angiography and MRI confirm an adventitial cyst occupying ≥ 90% of the lumen without thrombus. Surgical intervention, particularly transadventitial cyst evacuation with excision, is the preferred method of treatment due to lower recurrence rates (7–20%) as compared to cyst aspiration and drainage with higher recurrence (83.3%). These findings highlight the need for heightened clinical suspicion and advanced imaging to optimize the diagnosis and management of venous ACD and reduce misdiagnosis and recurrence. Further studies are needed to optimize diagnostic protocols and treatment strategies, but the limited number of cases hampers meaningful scientific research. Full article

Background: Aneurysmal bone cysts (ABCs) of the proximal humerus in children are rare, locally aggressive lesions associated with substantial recurrence rates and risk of structural instability. Conventional treatment by curettage and bone grafting is often limited by recurrence, while selective arterial embolization (SAE) alone may not provide sufficient structural support. This study evaluates a single-stage treatment strategy combining embolization and structural reconstruction to address both the vascular and mechanical components of the disease. Methods: A retrospective analysis was performed on 12 pediatric patients (median age 9 years) with proximal humerus ABCs treated between 2020 and 2024. All patients underwent a standardized single-stage protocol consisting of preoperative SAE, intralesional resection with high-speed burr, and reconstruction using an allogeneic fibula graft combined with cancellous bone augmentation. Radiological consolidation, recurrence, and functional outcomes were assessed. Associations between prior surgery, cyst size, and recurrence were analyzed. Results: Primary consolidation was achieved in 75% of patients, with an overall healing rate of 91.7% after secondary interventions. Recurrence occurred in 16.7% of cases and was significantly associated with prior surgical treatment (p = 0.045). No significant correlation was found between cyst size and recurrence (p = 0.151). At final follow-up (median 8.5 months), all patients demonstrated complete healing according to the modified Neer classification following completion of treatment. Functional outcomes were favorable, with 91.7% of patients regaining full range of motion and no neurovascular complications observed. Conclusions: The presented single-stage approach combining SAE, intralesional resection, and structural allograft reconstruction addresses both the vascular supply and mechanical instability of proximal humerus ABCs. This strategy demonstrated high healing rates and favorable functional outcomes, with acceptable recurrence rates in this cohort while avoiding donor site morbidity. It represents a practical and effective treatment concept for this rare pediatric condition. Full article

Background/Objectives: Oocyte donation (OD) pregnancies involve complete maternal–fetal genetic disparity and are associated with increased placental dysfunction and adverse perinatal outcomes. However, a unified histopathological framework to characterize alloimmune-mediated placental injury in OD gestations is lacking. This study evaluates immune and vascular alterations in OD triplet placentas and proposes a structured scoring system, the Placental Allograft Rejection-like Score (PARS), to quantify immunovascular dysregulation. Methods: This retrospective study included all OD triplet pregnancies with placental examination performed during 24 years at a tertiary referral center. Maternal, obstetric, fetal, neonatal, and pathological variables were analyzed at the pregnancy level. Histological and immunohistochemical features previously shown to differ between OD and non-OD pregnancies were grouped into six domains: innate immunity, adaptive immunity, checkpoint regulation, vascular remodeling, complement activation, and trophoblastic behavior. Binary thresholds, immunoreactive scores or established morphological cut-offs, were applied to construct a 20-point score classified into three grades. Results: Forty-five OD triplet pregnancies were analyzed. Intra-pregnancy concordance for PARS components was high, with intraclass correlation coefficient ≥0.70 in 87.3% pregnancies. Increasing PARS grades demonstrated a clear clinical gradient. Grade 3 pregnancies had significantly lower birthweight, higher rates of prematurity (<34 weeks), and increased fetal growth restriction. Placental weight decreased progressively with higher PARS. Histologically, grade 3 placentas showed significantly increased accelerated villous maturation and intervillous fibrin deposition. Conclusions: PARS integrates immune and vascular placental lesions into a structured and reproducible framework that correlates with clinically relevant perinatal outcomes and may support future clinical risk stratification, although further validation in larger, multicenter prospective cohorts is required. Full article

Background: Wireless capsule endoscopy is widely used for diagnosing gastrointestinal diseases, but manual interpretation of capsule videos is time-consuming and can vary between clinicians. Artificial intelligence has been increasingly studied to support capsule analysis and reduce clinical workload. This systematic literature review and meta-analysis summarizes current evidence on artificial intelligence methods applied to wireless capsule endoscopy, with a focus on diagnostic performance, validation strategies, and clinical readiness. Methods: A systematic search was conducted in PubMed, Scopus, Embase, Web of Science, and Google Scholar. Original journal articles were included based on predefined eligibility criteria. The reviewed studies addressed multiple artificial intelligence tasks, including detection, classification, segmentation, and localization of gastrointestinal abnormalities. Results: A total of 72 studies were included. Meta-analysis using random effects models showed high pooled diagnostic performance across clinical indications and gastrointestinal tract locations, with the strongest results reported for bleeding and vascular lesions and more variable performance for inflammatory bowel disease and mixed abnormality categories. The review also identified important clinical and technical barriers that may limit reliability and slow clinical adoption. These included limited external validation, small patient cohorts, retrospective study designs, and inconsistent reporting and evaluation practices. Conclusions: Artificial intelligence methods show strong potential to support wireless capsule endoscopy interpretation. Based on the findings, we propose practical recommendations to improve study design and validation. If these recommendations are applied, future studies may report more robust and reliable results, supporting better translation into clinical workflows. Full article

Landmark epidemiological studies and clinical trials, such as the Seven Countries Study, the Lyon Diet Heart Study, the PREDIMED Study and the CORDIOPREV Study, have shown significant reductions in cardiovascular events in those following the Mediterranean diet (MD). The aim of the present work is to summarize the most robust available evidence and the major biological pathways underlying the protective effects of the MD, with particular emphasis on the role of PAF inhibitors. Mechanistically, MD functions through a complex synergy of antioxidant, anti-inflammatory, and antithrombotic effects that collectively improve lipid profiles, enhance endothelial function, optimize postprandial metabolism and cell membrane signaling, making it a functional model for human longevity. The PAF-Implicated Atherosclerosis Theory has emerged as a key unifying framework, proposing that Platelet-Activating Factor (PAF)—a highly potent lipid inflammatory mediator—plays a central role in the initiation and progression of atherosclerosis. Oxidized LDL promotes the production of PAF and PAF-like lipids, leading to endothelial dysfunction, vascular inflammation, and atherosclerotic plaque formation. Traditional Mediterranean foods are rich in natural PAF inhibitors, particularly the polar lipid fractions of extra virgin olive oil, as well as wine, fish, vegetables, onions, and garlic. Animal studies demonstrate that these compounds can reduce or even regress atherosclerotic lesions, independently of serum cholesterol levels. Human dietary interventions have further shown that MD-based meals and functional foods enriched with PAF inhibitors reduce PAF activity and improve thrombosis-related biomarkers. This mechanistic framework helps explain phenomena such as the “French Paradox” and the cardio-protective effects associated with fish consumption. Moreover, the extraction of PAF inhibitors from Mediterranean food by-products, such as olive pomace, offers promising ecological and economic advantages. Collectively, targeting PAF and increasing dietary intake of PAF inhibitors represent promising strategies for the prevention and management of atherosclerosis and other inflammatory diseases, supporting the view that PAF may function as a major, modifiable risk factor in these conditions. Full article

Background/Objectives: Early neurological deterioration (END) is a frequent and clinically relevant complication in patients with a single small subcortical infarction (SSI), including lacunar infarction and branch atheromatous disease (BAD). Despite initially mild symptoms, END occurs in approximately 20–25% of cases and is strongly associated with poor functional outcomes. However, definitions, mechanisms, predictors, and therapeutic strategies remain heterogeneous. This review aims to synthesize current evidence regarding the incidence, pathophysiology, predictors, and management of END in SSI. Methods: We performed a narrative review of published studies addressing END in patients with lacunar stroke or SSI. We analyzed data on END definitions and incidence, imaging and clinical predictors, proposed pathophysiological mechanisms, and preventive and rescue therapeutic strategies. Results: END definitions vary across studies, most commonly defined as a ≥2-point increase in the National Institutes of Health Stroke Scale within 48–72 h. Hemodynamic compromise due to proximal perforator pathology, particularly in BAD, appears central to END development. Advanced imaging studies demonstrate perfusion abnormalities beyond the infarct core, supporting the concept of a “lacunar penumbra.” Lesion topology, proximal infarct patterns, parent artery plaques, larger infarct size, and vertical extension are consistent imaging predictors. Clinical factors such as diabetes mellitus, higher baseline severity, systemic inflammation, and increased arterial stiffness further modulate risk. Preventive strategies, including early dual antiplatelet therapy and intensified antithrombotic regimens, show promising signals, while induced hypertension may benefit selected patients as a rescue therapy. However, evidence remains largely observational or derived from subgroup analyses. Conclusions: END in SSI is a multifactorial and potentially modifiable process driven by interactions between proximal vascular pathology, hemodynamic failure, and tissue vulnerability. Standardized definitions, MRI-based phenotyping, and mechanism-driven trials are needed to optimize risk stratification and develop targeted preventive and rescue strategies. Full article

Background and Clinical Significance: Intrapericardial ectopic thyroid tissue is extremely rare and can mimic vascular mediastinal or cardiac lesions. Case Presentation: We describe a 62-year-old woman with dyspnea, palpitations, and flushing for several months, progressively worsening, associated with nonspecific ST-segment abnormalities on ECG. Contrast-enhanced CT revealed a small, highly vascularized epicardial mass anterior to the ascending aorta. 18F-FDG PET/TC findings were inconclusive, and biopsy was not feasible due to the anatomical location. Surgical excision via upper ministernotomy was performed, leading to resolution of symptoms. Histology confirmed benign ectopic thyroid tissue. Conclusions: With fewer than ten similar intrapericardial cases reported in the English-language medical literature, this presentation underlines the diagnostic difficulty of such lesions and the importance of including ectopic thyroid tissue among the less common differential diagnostic considerations for intrapericardial masses, particularly in patients with prior thyroid disease. Full article

Nevus lipomatosus superficialis (NLS) is an uncommon benign hamartoma characterized by ectopic adipocytes within the dermis and may present with features that overlap clinically with other soft, pedunculated, or cerebriform lesions. We report a rare presentation with mixed morphologic traits that created diagnostic uncertainty on gross examination. The lesion demonstrated atypical surface contour and texture, prompting multimodal evaluation to clarify the differential diagnosis and support safe outpatient management. Point-of-care ultrasound (POCUS) was used to evaluate lesion architecture and vascularity. Findings provided real-time, noninvasive support for benign morphology and informed procedural planning. Subsequent histopathologic analysis established the diagnosis by demonstrating dermal adipose deposition consistent with NLS. This case underscores the value of integrating gross examination with sonographic assessment and histopathology when cutaneous lesions have overlapping clinical features. In addition, it contributes to the limited literature describing ultrasound findings in NLS. Incorporating POCUS into the assessment of atypical cutaneous growths may improve diagnostic confidence, reduce unnecessary escalation of care, and support efficient, safe treatment in outpatient settings. Full article

Background and Objectives: Placental vascular lesions are significant histopathological findings that indicate disruptions in uteroplacental and fetoplacental circulations and are associated with adverse pregnancy outcomes such as preeclampsia, intrauterine growth restriction (IUGR), and perinatal morbidity. This study aimed to re-examine the frequency and distribution of placental vascular lesions in placentas submitted for histopathological analysis at our center, based on criteria established by the Amsterdam Placental Workshop Group Consensus Statement. Materials and Methods: In this retrospective study, placental samples examined in the Department of Pathology at Akdeniz University Faculty of Medicine from 2016 to 2019 were analyzed. A total of 571 cases with at least one placental vascular lesion identified on histopathology were included. Hematoxylin–eosin-stained sections from all cases were re-evaluated, and maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and other placental vascular pathologies were assessed according to the Amsterdam consensus criteria. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were compared using the chi-square or Fisher’s exact test, while continuous variables were analyzed with the Mann–Whitney U test. Results: MVM and FVM were considered the primary outcomes of the study. MVM was identified in 95.1% of cases, whereas FVM was present in 1.9%. Among individual lesions, chorangiosis (97.2%) and villous/perivillous fibrinoid deposition (88.3%) were the most frequent findings, followed by mucinous cystic degeneration of the umbilical cord (61.5%) and dystrophic calcification (58.1%). Retroplacental hematoma was observed in 38.4% of cases. Although no significant association was found between MVM and placental weight or size, umbilical cord length was significantly shorter in MVM-positive cases (p = 0.032). In contrast, FVM showed significant associations with chorangiosis (p = 0.035) and placentomegaly (p = 0.003). The high frequency of chorangiosis may reflect a compensatory angiogenic response to chronic intrauterine hypoxia, potentially mediated by vascular growth factors, with variable effectiveness depending on the severity of the underlying condition. Conclusions: These findings suggest that placental vascular lesions are not only markers of obstetric complications but also serve as morphological indicators of fetoplacental adaptive responses. Full article

Lactococcosis caused by Lactococcus garvieae is an emerging threat to warmwater aquaculture, yet evidence integrating field outbreaks with robust molecular confirmation and controlled virulence testing remains limited for Thailand’s cage-cultured tilapia. From May to October 2025, acute mortality events were investigated in cage-cultured Nile tilapia (Oreochromis niloticus) in a reservoir in Ubon Ratchathani Province, Thailand. Suspected outbreaks were defined by abrupt daily mortality exceeding 5% accompanied by septicemia-like clinical signs. Water quality during sampling covered the following ranges: temperature 28.6–31.9 °C, pH 6.5–7.0, salinity 0.02–0.03 ppt, electrical conductivity 0.036–0.046 mS/cm, TDS 22.20–26.50 mg/L, total alkalinity 17.0–34.0 mg/L as CaCO₃, total hardness 12.0–60.0 mg/L as CaCO₃, dissolved oxygen 6.5–7.0 mg/L, and NH₃ were below the limit of detection. Full-length 16S rRNA tissue profiling revealed strong tissue partitioning: blood microbiomes were consistently dominated by Lactococcus and L. garvieae at the species level, whereas gills showed higher richness and mixed communities with multiple opportunistic taxa. Culture isolation was more reliable from blood than gills, yielding 16 Gram-positive, catalase-negative isolates (AAHM-LG2501–AAHM-LG2516) that clustered within the L. garvieae clade in near full-length 16S rRNA phylogenetic analysis and were separated from closely related Lactococcus lineages. A representative blood isolate (AAHM-LG2501) showed dose-dependent virulence in controlled challenges, with an LD₅₀ of ~1.05 × 10⁵ CFU/fish by intraperitoneal injection and an LC₅₀ of ~1.20 × 10⁶ CFU/mL by immersion. Histopathology supported systemic dissemination, with injection producing more consistent multi-organ lesions than immersion, particularly in head kidney, liver, and spleen, while gills exhibited route-associated epithelial and vascular alterations. Together, these findings confirm L. garvieae as a major etiological agent of septicemic outbreaks in cage-cultured tilapia in Thailand and support a practical surveillance framework prioritizing blood sampling, molecular confirmation, and risk-based monitoring to guide biosecurity and vaccine-oriented prevention. Full article