Chaojie Zhang

Background: Tuberculous lymphadenitis (TBL) is a common manifestation of extrapulmonary tuberculosis (EPTB). However, establishing a definitive diagnosis can be challenging, particularly in primary healthcare settings, when the clinical presentation is atypical or when TBL coexists with another rare form of EPTB—thyroid tuberculosis (TB). Whether primary or secondary, TB remains an exceedingly uncommon clinical entity, even in the context of the persistently high overall prevalence of tuberculosis in China. Thyroid tuberculosis accounts for approximately 0.1%–0.4% of all thyroid diseases, with an even lower incidence of primary thyroid involvement. Herein, we report a case in which ¹ ⁸F-FDG PET/CT imaging initially suggested malignant lesions involving thyroid nodules and cervical lymph nodes; however, the final histopathological assessment and subsequent favorable response to diagnostic anti-tubercular therapy confirmed the diagnosis of concurrent thyroid tuberculosis and tuberculous lymphadenitis. Case description: The patient was a 68-year-old male presenting with a 10-day history of a palpable neck mass. Thyroid ultrasonography revealed multiple bilateral thyroid nodules classified as TI-RADS category 4b, accompanied by markedly elevated serum anti-thyroglobulin antibody (TGAb) and anti-thyroid peroxidase antibody (TPOAb) levels. An enlarged lymph node was detected in the right cervical region. An ¹ ⁸F-FDG PET/CT scan performed at an external institution demonstrated lesions with increased FDG uptake involving the thyroid gland, multiple systemic lymph nodes, and the lungs. To clarify the diagnosis, ultrasound-guided core needle biopsy (CNB) was performed on the bilateral thyroid nodules and the right cervical lymph node. Histopathological examination revealed granulomatous inflammation, and tuberculosis could not be excluded. Polymerase chain reaction (PCR) testing and fungal polysaccharide immunofluorescence (IF) staining were both negative, while acid-fast bacilli staining showed suspicious positive results. The patient exhibited no specific clinical symptoms and denied a history of exposure to tuberculosis-endemic areas. Based on these findings, diagnostic anti-tubercular therapy was initiated. A limited initial follow-up assessment demonstrated a favorable therapeutic response, supporting the diagnosis, although the patient was subsequently lost to long-term follow-up due to financial and adherence issues. Conclusion: This case highlights the importance of considering the possibility of thyroid tuberculosis in clinical practice. With the increasing detection of thyroid nodules during routine examinations, accurate differentiation between benign and malignant etiologies is crucial. Incorporating tuberculosis infection into the differential diagnosis may help prevent unnecessary surgical interventions for suspected thyroid malignancy.

Background: Surgical decision-making for intraductal breast lesions has traditionally relied on physician expertise and imaging characteristics, lacking a comprehensive evaluation framework that integrates oncological efficacy, perioperative safety, and patient subjective experience. This study aimed to systematically synthesise the latest evidence and incorporate patient-reported outcomes (PROs) to construct a three-dimensional evaluation model, thereby providing an evidence base for the individualised selection between vacuum-assisted excision (VAE) and open surgery. Methods: A systematic comparison and descriptive analysis were performed across three dimensions: oncological efficacy, perioperative safety, and PROs. A total of 26 studies were included. Results: Meta-analysis revealed no significant difference in residual lesion rates between the VAE and open surgery groups [risk ratios (RR) =1.02; 95% confidence interval (CI): 0.29–3.57; P=0.97]. Notably, the VAE group demonstrated a 59% significant reduction in recurrence rates (RR =0.43; 95% CI: 0.21–0.86; P=0.02). Due to the lack of direct comparative data, malignancy detection rates were presented descriptively without statistical pooling, and no inferences regarding diagnostic superiority were drawn. Regarding perioperative safety, VAE was associated with a significantly shorter operative time [mean difference (MD) =−14.38 min; 95% CI: −17.09 to −11.67; PConclusions: VAE offers clear benefits such as being minimally invasive, supporting postoperative recovery, and improving cosmetic satisfaction, making it a preferred method for radiologically localised lesions. However, current evidence is insufficient to confirm VAE as a definitive treatment for malignant or high-risk intraductal conditions. Open surgery remains essential to ensure oncological safety through thorough margin assessment and accurate detection of malignancy; the potential clinical consequences of missing malignancy greatly outweigh minor cosmetic outcomes. Future treatment options should be guided by personalised decision-making that considers lesion characteristics and patient preferences.

The high incidence of recurrence and metastatic disease remain the major issues for papillary thyroid cancer (PTC) patients. Previous studies have demonstrated that Syndecan-2 (SDC2) plays a key role in multiple cancers progression. However, the potential role of SDC2 in PTC progression and recurrence remains unclear. First, we performed bioinformatics analysis and western-blotting analysis to explore the potential prognostic value of SDC2 in PTC. Then we applied transient siRNA knockdown and plasmid overexpression to alter SDC2 expression level in PTC cell line B-CPAP and KTC-1. After that, we carried out scratch wound healing assay, transwell assay and cell counting kits-8 (CCK8) assay to explore the cell migration, invasiveness and viability. We also explored expressions of mesenchymal and epithelial markers, multiple thyroids differentiating markers and hedgehog signaling members to address the potential underlying mechanisms. Firstly, we found a significant negative correlation of SDC2 expression with advanced disease characters in PTC. Then bioinformatic analysis indicated the SDC2 expression was closely related to multiple key pathways and thyroid differentiation markers. Targeting SDC2 expression significantly influenced the growth and invasion of PTC cells according to series of assays. Western-blotting results of α-SMA and ZO-1 also indicated the altered EMT process. Furthermore, attenuated SDC2 expression also leads to the PTC de-differentiation, which could be due to hedgehog signaling alteration. Our findings suggest that SDC2 would be a promising therapy target for advanced radioiodine refractory thyroid cancer, but the role in PTC progression is complicated and requires further exploration.

Background Triple-negative breast cancer (TNBC) is an aggressive subtype with limited treatment options, and paclitaxel resistance remains a major therapeutic challenge. Ferroptosis, an iron-dependent cell death mechanism, and microRNAs (miRNAs) like miR-325-3p have emerged as potential regulators of chemoresistance, but their roles in TNBC are poorly understood. Objective This study aimed to investigate whether ferroptosis and miR-325-3p modulate paclitaxel resistance in TNBC and to identify the underlying molecular mechanisms. Methods Paclitaxel-resistant TNBC cell lines (MDA-MB-231/Pac, SUM159PT/Pac) were established and treated with ferroptosis modulators. miR-325-3p expression was assessed in resistant vs. sensitive TNBC tissues and cells. Functional assays (CCK-8, EdU, flow cytometry, TBARS, FerroOrange) evaluated cell viability, proliferation, apoptosis, and ferroptosis markers. GSTP1 was validated as a miR-325-3p target via dual-luciferase reporter assays and rescue experiments. In vivo xenograft models tested the therapeutic potential of miR-325-3p overexpression with/without GSTP1 restoration. Results Ferroptosis inducers (erastin, RSL3) sensitized resistant TNBC cells to paclitaxel, while inhibitors (deferiprone, NAC) attenuated this effect. MiR-325-3p was downregulated in paclitaxel-resistant tissues and cells. Its overexpression restored paclitaxel sensitivity by promoting apoptosis and ferroptosis (↑iron accumulation, ↑lipid peroxidation). GSTP1 was identified as a direct target of miR-325-3p. Rescue experiments confirmed that GSTP1 restoration partially reversed miR-325-3p-mediated ferroptosis and paclitaxel sensitization. In vivo, miR-325-3p overexpression suppressed tumor growth, while GSTP1 co-expression mitigated this effect. Conclusion The miR-325-3p/GSTP1 axis regulates paclitaxel resistance in TNBC by modulating ferroptosis. Targeting this axis represents a promising strategy to overcome chemoresistance.

Background: To evaluate the clinical efficacy of gasless and single-port gas-insufflation transaxillary approaches in subcutaneous mastectomy for treating patients with gynecomastia (GM).Methods: This study enrolled 46 patients with GM from May 2022 to October 2023. Twenty patients underwent subcutaneous mastectomy using the single-port gas-insufflation transaxillary approach (gas-insufflation group), while the other 26 patients received the same procedure through the gasless transaxillary approach (gasless group). This study further conducted inter-group comparisons in terms of the operation time, intraoperative bleeding, volume of postoperative drainage, timing of drainage tube removal, short-term postoperative complications, length of postoperative hospital stay, and medical costs.Results: All the 46 patients completed the operation successfully without conversion to open surgery, with confirmed diagnosis of GM through pathology. The average surgical time for the gasless group was significantly shorter than that of the gas-insufflation group (38.20 ± 10.773 vs. 62.96 ± 15.311 min, P < 0.01). There were no significant differences between groups in incision length, intraoperative bleeding, unilateral postoperative drainage volume, drainage tube retention time, length of postoperative hospital stay, or postoperative cosmetic outcomes (all P > 0.05).Conclusion: This study supports the clinical feasibility of using gasless transaxillary approach for subcutaneous mastectomy of patients with GM.

Introduction: Gasless unilateral trans-axillary approach (GUA) thyroidectomy has witnessed rapid development in technologies and applications. However, the existence of surgical retractors and limited space would increase the difficulty of guaranteeing the visual field and disturb safe surgical manipulation. We aimed to develop a novel zero-line method for incision design to access optimal surgical manipulation and outcomes.Methods: A total of 217 patients with thyroid cancer who underwent GUA were enrolled in the study. Patients were randomly classified into two groups (classical incision and zero-line incision), and their operative data were collected and reviewed.Results: 216 enrolled patients underwent and completed GUA; among them, 111 patients were classified into the classical group, and 105 patients were classified into the zero-line group, respectively. Demographic data, including age, gender, and the primary tumor side, were similar between the two groups. The duration of surgery in the classical group was longer (2.66 ± 0.68 h) than in the zero-line group (1.40 ± 0.47 h) (p < 0.001). The counts of central compartment lymph node dissection were higher in the zero-line group (5.03 ± 3.02 nodes) than that in the classical group (3.05 ± 2.68 nodes) (p < 0.001). The score of postoperative neck pain was lower in the zero-line group (1.0 ± 0.36) than that in the classical group (3.3 ± 0.54) (p < 0.05). The difference in cosmetic achievement was not statistically significant (p > 0.05).Conclusion: The “zero-line” method for GUA surgery incision design was simple but effective for GUA surgery manipulation and worth promoting.

Original Article Value of dissection of lymph nodes posterior to the right recurrent laryngeal nerve in patients with cN₀ papillary thyroid carcinoma Xiangyuqin Xiao, Yaqin Wu, Lianhong Zou, Yiru Chen, Chaojie Zhang

Kaempferol (kaem) is a dietary flavonoid found in a variety of fruits and vegetables. The inhibitory effects of kaem on primary tumour growth have been extensively investigated; however, its effects on tumour metastasis are largely unknown. In the present study, we found that kaem significantly suppresses both primary tumour growth and lung metastasis in mouse breast tumour model. Furthermore, decreased expression of citrullinated histone H3 (H3‐cit), a biomarker of neutrophil extracellular traps (NETs), had been founded in metastatic lung upon treated with kaem. The reduction of H3‐cit is not, however, due to the cytotoxicity of kaem on neutrophils since the frequency of CD11b ⁺ Ly6G ⁺ neutrophils did not change in lung, tumour or blood in the presence of kaem. We then confirm the anti‐NETs effects of kaem in vitro by co‐culturing mouse neutrophils and kaem. Supplementing the neutrophils with GSK484, a potent NET inhibitor, totally abrogated the inhibitory effects of kaem on tumour metastasis while having little or no impact on primary tumour growth, indicating the specificity of kaem acting on NET formation and tumour metastasis. We also found that kaem suppressed ROS production in mouse bone‐marrow derived neutrophils. Supplementing with the ROS scavenger DPI abrogated kaem's effects on NET formation, suggesting the involvement of kaempferol in NADPH/ROS‐NETs signalling. Finally, we applied the kaem on NET‐deficient PAD4 ^‐/‐ mice and found decreased primary tumour volume and weight but similar lung metastatic tumour with kaempferol treatment. Therefore, our findings reveal a novel mechanism of kaem in breast cancer development by targeting NETs induced tumour metastasis.

Background: The etiology and pathogenesis of granulomatous lobular mastitis (GLM) remain unknown, with no unified evaluation criteria or standard treatments. This study aimed to assess the etiology and features of GLM, as well as the effects of surgery (lesion excision + stage I breast reconstruction; LE + BR) for GLM. Methods: This study evaluated 178 female GLM patients retrospectively in 2006–2015. The surgery and non-surgery groups included 164 and 14 patients, respectively. All patients received conservative therapy (traditional Chinese medicine combined with regional wet compress and pus drainage). In addition, the surgery group (n=164) underwent LE + BR. Clinical data, including disease course, causes, lesion size, marital status, and treatment approaches, were assessed. Results: Follow-up was 13–117 months. Seventy-five of the 178 patients had no overt causes (42.1%); meanwhile, 63 (35.4%) and 16 (9.0%) had congenital nipple retraction and a history of psychotropic drugs for >1 year, respectively. The surgery group showed lesions significantly shrunk (≤1 quadrant) with acute inflammation fully controlled; 8 showed recurrence, indicating a cure rate of 95.1% (156/164). In the non-surgery group, 4 cases showed relapse after 6–14 months (cure rate =71.4%; 10/14). Therefore, surgical treatment was significantly more efficient than non-surgical treatment (P=0.001). Kaplan-Meier survival curves for the two treatment types showed a significant difference in recurrence (log rank =11.84, PConclusions: In GLM patients, LE + BR is safe and effective with respect to cosmetic results, recovery time, and recurrence. Successful surgery should be performed for patients whose lesions ≤1 quadrant, aim to achieve optimal GLM treatment.

Background: Some thyroid cancers are found after thyroidectomy for benign lesions, implying additional surgery and treatments. This work aimed to investigate the role of intraoperative sentinel lymph node biopsy (SLNB) for diagnosis of incidental thyroid carcinoma. Methods: This was a retrospective study of 541 consecutive patients who underwent thyroid surgery between 02/2012 and 02/2014 at the Hunan Provincial People's Hospital. All patients were diagnosed with thyroid benign lesions preoperatively and intraoperatively. Among them, 375 underwent successful intraoperative SLNB using carbon nanoparticles (CNs). Results: The preoperative diagnoses were nodular goiter (n=472), I Iashimoto's disease with nodules (n=24), hyperthyroidism with nodules (n=16), and thyroid cysts with obstructive symptoms (n=29). In the SLNB group, SIN metastasis of thyroid microcarcinoma was confirmed in 21/392 cases (5.4%). These 21 patients received radical surgical treatment for thyroid carcinoma during the initial operation. In the no-SLNB group n=149), seven patients (4.7%) were finally diagnosed with thyroid microcarcinoma. Six patients had to undergo a second surgery. Conclusions: Intraoperative SLNB could help diagnose differentiated thyroid microcarcinoma that may be missed preoperatively and intraoperatively. This could prevent the need for a second surgery since the intraoperative frozen section examination of the SLNs can reveal metastasis from thyroid cancer.