BackgroundOvarian cancer, a leading cause of gynecological cancer mortality, rarely metastasizes to the pancreas. This review seeks to consolidate knowledge about metachronous pancreatic metastases from ovarian cancer, emphasizing clinical presentations, diagnostic challenges, treatment options and outcomes.MethodsFollowing PRISMA guidelines, a systematic literature search was conducted in PubMed, EMBASE, and the Cochrane library between 1989 and December 2023. Only studies with histological proof of ovarian cancer metastasis to the pancreas were considered.ResultsWe identified 7 studies that reported a total of 8 cases. Most metastases originated from a primary high-grade serous carcinoma. The treatment options varied and included surgical excision and chemotherapy; we considered both radiological and histological outcomes.ConclusionsAlthough rare, metachronous pancreatic metastases from ovarian cancer pose a unique clinical challenge. Elucidating this possible metastatic pathway may enhance patient outcomes and help identify the most appropriate management.

Introduction/Background: Management of advanced endometrial cancer (EC) presents a significant therapeutic challenge, with ongoing debate regarding optimal treatment sequencing. Primary cytoreductive surgeries (PCSs) with adjuvant therapy and neoadjuvant chemotherapy followed by interval Debulking surgery (NACT-IDS) are both employed as treatment strategies. This study analyses outcomes of both treatment strategies in Nottingham University Hospitals Cancer Centre. Methodology: We conducted a retrospective cohort analysis of patients with advanced EC (FIGO Stages III-IV) treated at our centre between 2013 and 2023. Patients who received either PCS with adjuvant therapy or neoadjuvant chemotherapy followed by interval Debulking surgery (NACT-IDS) are included in the study. Data collection included demographic characteristics, treatment approaches, surgical parameters, and outcome measures. Primary outcomes were progression-free survival (PFS) and overall survival (OS). Secondary outcomes included perioperative outcomes and recurrence patterns. Results: Treatment pathways included NACT-IDS (n = 8) and PCS with adjuvant therapy (n = 57). Stage IV disease was notably more prevalent in patients who received NACT-IDS therapy compared to the PCS group (75.0% versus 5.3%, p < 0.001). Analysis revealed a PFS duration of 18.5 months for NACT-IDS patients, whilst PCS patients demonstrated a longer duration of 35.5 months (HR 1.18, 95% CI: 0.56-2.48, p=0.328). Median OS was 22.0 months in the NACT-IDS group versus 41.0 months in the PCS group (HR 1.35, 95% CI: 0.64-2.83, p=0.145). Mean operative time was longer in the NACT-IDS group (239.7 vs 165.5 min, p=0.209). All NACT-IDS procedures were performed via open laparotomy compared to 49.1% in the PCS group (p < 0.001). Hospital stay was significantly longer in the NACT-IDS group (median 8 vs 3 days, p=0.036). Radiotherapy was administered to 25.0% (n = 2) of NACT-IDS patients and 59.6% (n = 34) of PCS patients. Recurrence rates were higher in the NACT-IDS group, 37.5%, compared to 33.3% in the PCS patients (p=0.823). Conclusion: This comprehensive analysis provides valuable insights into treatment outcomes and surgical parameters for advanced EC. Whilst the small sample size of the NACT-IDS cohort limits the ability to draw definitive conclusions, the study provides meaningful evidence that can inform clinical decision-making. The findings lay important groundwork for future prospective, multicentre studies aimed at optimising patient selection and treatment sequencing in this challenging disease.

Multi-center collaboration is essential to achieve the sample sizes required for robust and informative research studies for less common medical conditions. Substantial logistical and governance support is needed to ensure that the clinical and molecular data generated are of high quality and benefit the international research community and patients.

AimsCancer diagnostics have been evolving rapidly. In England, the new National Health Service Genomic Medicine Service (GMS) provides centralised access to genomic testing via seven regional Genomic Laboratory Hubs. The PATHways survey aimed to capture pathologists’ experience with current diagnostic pathways and opportunities for optimisation to ensure equitable and timely access to biomarker testing.MethodsA nationwide survey was conducted with consultant pathologists from regional laboratories, via direct interviews based on a structured questionnaire. Descriptive analysis of responses was undertaken using quantitative and qualitative methods.ResultsFifteen regional centres completed the survey covering a median population size of 2.5 (1.9–3.6) million (each for n=12). The median estimated turnaround time (calendar days) for standard molecular markers in melanoma, breast and lung cancers ranged from 2 to 3 days by immunohistochemistry (excluding NTRKfus in breast and lung cancers, and PD-L1 in melanoma) and 6–15 days by real-time-PCR (excluding KIT for melanoma), to 17.5–24.5 days by next-generation sequencing (excludingPIK3CAfor breast cancer). Tests were mainly initiated by pathologists and oncologists. All respondents discussed the results at multidisciplinary team (MDT) meetings. The GMS roll-out was perceived to have high impact on services by 53% of respondents, citing logistical and technical issues. Enhanced education on new pathways, tissue requirements, report interpretation, providing patient information and best practice sharing was suggested for pathologists and other MDT members.ConclusionOur survey highlighted the role of regional pathology within the evolving diagnostic landscape in England. Notable recommendations included improved communication and education, active stakeholder engagement, and tackling informatics barriers.

Objectives: To establish if routine 3D/4D ultrasound scan is a feasible diagnosis in congenital M üllerian anomalies and to evaluate the impact of ultrasound guidance during hysteroscopic procedures for those anomalies.Methods: We conducted a retrospective study including the hysteroscopic procedures performed in our unit in the last 5 years for M üllerian Duct Congenital anomalies (MCDA).There were 2 study groups one performed under ultrasound guidance and the other without ultrasound assistance.We evaluated the time, the incidence of complications, and the post procedural results in both groups.Results: In the last five years we performed 175 hysteroscopic procedure from which 16 were for MCDA, in 11 cases the type was U2a, and in six cases U2b.The ultrasound-guided procedures were

Background Rare cystic lung diseases are increasingly recognised due the wider application of CT scanning making cystic lung disease management a growing part of respiratory care. Cystic lung diseases tend to have extrapulmonary features that can both be diagnostic but also require surveillance and treatment in their own right. As some of these diseases now have specific treatments, making a precise diagnosis is crucial. While Langerhans cell histiocytosis, Birt-Hogg-Dubé syndrome, lymphoid interstitial pneumonia and lymphangioleiomyomatosis are becoming relatively well-known diseases to respiratory physicians, a targeted and thorough workup improves diagnostic accuracy and may suggest other ultrarare diseases such as light chain deposition disease, cystic pulmonary amyloidosis, low-grade metastatic neoplasms or infections. In many cases, diagnostic information is overlooked leaving uncertainty over the disease course and treatments. Aims This position statement from the Rare Disease Collaborative Network for cystic lung diseases will review how clinical, radiological and physiological features can be used to differentiate between these diseases. Narrative We highlight that in many cases a multidisciplinary diagnosis can be made without the need for lung biopsy and discuss where tissue sampling is necessary when non-invasive methods leave diagnostic doubt. We suggest an initial workup focusing on points in the history which identify key disease features, underlying systemic and familial diseases and a clinical examination to search for connective tissue disease and features of genetic causes of lung cysts. All patients should have a CT of the thorax and abdomen to characterise the pattern and burden of lung cysts and extrapulmonary features and also spirometry, gas transfer and a 6 min walk test. Discussion with a rare cystic lung disease centre is suggested before a surgical biopsy is undertaken. Conclusions We suggest that this focused workup should be performed in all people with multiple lung cysts and would streamline referral pathways, help guide early treatment, management decisions, improve patient experience and reduce overall care costs. It could also potentially catalyse a national research database to describe these less well-understood and unidentified diseases, categorise disease phenotypes and outcomes, potentially leading to better prognostic data and generating a stronger platform to understand specific disease biology.

Benchmarking identifies a system with superior performance, breaking down what makes such performance, and then comparing those processes to other system.Healthcare operates on a business model where performance metrics need to be compared to the industry best performers.This helps implement changes with superior outcomes.This editorial is a benchmarking exercise between two healthcare systems.The idea is to measure the outcome of investment in healthcare in United Kingdom (UK) and Pakistan.The Coronavirus disease occurred in Wuhan in December 2019, which spread all over the world within two months.1 Other dangerous viruses are Ebola, Rabies, HIV, Dengue, Hanta Virus, Rota virus, Influenza, smallpox, and hepatitis viruses.Infections have a global impact due to ease with transportation of humans and animals, adding a growing list of global health issues.In the UK, by the end of Word War II, the concept of state-funded hospital service was established.In 1948, national health service (NHS) was created which provided preventive and curative services.2 The founding principle is free service at the point of use independent of color, creed, race, gender, religion, and based on need rather than the ability to pay.The NHS budget was £14 Billion at today's price.This has increased to £277.6 Billion/year which is more than 10% of UK's GDP.The US-based Commonwealth fund ranked NHS as the best of 11 advanced nations.3 Data on healthcare standards is published by OECD, the organisation which brings together 35 rich nations.Life expectancy for males in UK has increased from 66 to 79.2 years and for females from 70 to 82.9 years in last 70 years.Doctors/dentists regulated by GMC and GDC are 110,000 and 285,097 nurses are working for the NHS.Health board took control of 2751 of UK's 3000 hospitals.By the day of its launch, 94% of the public was enrolled in NHS.In 1951, the founder leader Bevan resigned in protest for voting to bring charges for dental care, prescriptions, and spectacles.

Objective: To review response characteristics relating to emerging neoadjuvant treatment strategies of non-small cell carcinoma of lung, including analysis of scoring systems developed to assess tumour specific effects.Background: Rapid progress has been made in recent years with regard to the management of patients with non-small cell lung cancer as a consequence of discovery of relevant oncogenic signalling pathways governing cancer cell growth and metastasis, introduction of immune checkpoint inhibitors in lung cancer therapy, and targeted screening for lung cancer in high-risk populations.Histopathologists have diagnostic involvement in interpretation of cytology, biopsy and resection specimen from treated lung cancer patients.They are at the forefront of molecular testing of tissue samples and PD-L1 scoring in lung cancers.Pathologists assessment of tumour resection specimens facilitates assessment of cellular and stromal effects of those novel and emerging neoadjuvant therapy compounds which can include development of scoring methods to assess tumour response following chemo-radiotherapy and targeted therapy.For example, immunotherapy induced changes can be seen in treated tumours and a scoring system has been designed which includes immune related pathologic response criteria (irPRC).Methods: Experience of increasing involvement with molecular testing of lung cancers, multi-disciplinary team (MDT) attendance and input from treating oncologists, literature review & search, attendance at courses/conferences and working in multiple tumour sites are behind the writing this invited review.Conclusions: Targeted therapies in non-small cell lung carcinomas impact on surgical outcomes and prognosis.Treatment options have expanded and currently include surgery, chemotherapy, radiotherapy, targeted therapy and immune therapy.Histopathologists are being increasingly involved in treatment response evaluation of tumour resection specimens relating to various modalities.They need to familiarize themselves with relevant treatment specific changes.Surgeons and clinicians need to provide detailed information along with the specimen from treated lung cancer patients.This review will focus on pathology related issues arising from advances in lung cancer neoadjuvant treatment.

Purpose SRTR data currently suggests that induction therapy in simultaneous heart-kidney transplantation (SHKT) with rabbit antithymoglobulin (ATG) provides survival advantage compared to interleukin-2 receptor antagonist (IL2-RA). We are reporting the outcomes of recipients with SHKT treated with IL2-RA as induction therapy. Methods This is a single center, retrospective study of 26 patients who received SHKT at our institution from Dec 2018 to Oct 2021. A multidisciplinary team composed of heart and kidney transplant medical and surgical members determined appropriate recipient-donor SHKT candidate pairs. The majority of patients received IL2-RA induction therapy, and all patients received triple immunosuppression therapy with prednisone, mycophenolate mofetil and tacrolimus. Adjustments in long term therapy were made in collaboration between the heart and kidney transplant teams. Results From Dec 2018 to Oct 2021, 26 patients underwent SHKT. 23 patients (88%) were male, the median age was 57 years, and 5.4% were ≥ 65 years. 18 patients (69%) had non ischemic cardiomyopathy and 24 patients (92%) had CKD (mean GFR ≤ 35%). 18 patients were listed Status 2 and 2 patient Status 5. One patient received a DCD donor and 12 patients (46%) received hep C donors. 25 patients (96%) received induction therapy with IL2-RA. During the first 3 months post-transplant, the only patient who received ATG had 7 severe infections; 11 patients (44%) and 13 patients (52%) who received IL2 -RA had no infections and ≤ 4 mild infections, respectively. One patient died due to COVID 19 pneumonia complicated by multisystem organ failure. For a median follow up period of 410 (187-707) days, 8% patients in the IL2-RA induction cohort experienced a 2R/3A heart rejection, 8% patients remained on HD due to primary kidney graft non-function, and the survival rate was 96%. Conclusion Compared with present literature, our data support the use of IL2- RA as an induction strategy in SHKT with excellent patient survival.