Melina Yerolatsite

Sjögren’s disease (SjD) is a systemic autoimmune disorder associated with lymphocytic gland infiltration and an increased risk of B-cell lymphomas, particularly mucosa-associated lymphoid tissue (MALT) lymphoma. Neurological involvement may mimic multiple sclerosis (MS), while true coexistence, especially with amyloidosis, is exceptionally rare. We performed a systematic review and present a representative clinical case. A registered systematic literature review (PROSPERO CRD4201332325) was conducted according to PRISMA 2020. PubMed/MEDLINE, Scopus, the Cochrane Library, and DOAJ were searched for all records available up to July 2026. As no eligible cases were identified, additional targeted searches were performed to identify reports describing each possible combination of three of the four conditions. We also present a case report prepared according to the CARE guidelines. Among the 2,966 records identified, no studies describing the coexistence of Sjögren’s disease, amyloidosis, MALT lymphoma, and MS in the same patient were found. Additional targeted searches identified 14 case reports and one case series describing Sjögren’s disease with amyloidosis and MALT lymphoma, whereas no reports of Sjögren’s disease with amyloidosis and MS or with MALT lymphoma and MS were identified. We therefore report the first case of Sjögren’s disease complicated by pulmonary amyloidosis, gastric MALT lymphoma, and MS, highlighting the diagnostic and therapeutic challenges of this rare clinical presentation. The coexistence of Sjögren’s disease, pulmonary amyloidosis, gastric MALT lymphoma, and MS is likely to be rare. Although partial associations have been reported, our literature review did not identify any previous case describing all four conditions in the same patient. This case underscores the importance of a multidisciplinary approach and suggests that possible shared immunopathogenic mechanisms warrant further investigation. Registration PROSPERO CRD4201332325. Graphical abstract

Circulating tumor DNA (ctDNA) is a promising non-invasive biomarker for detecting minimal residual disease (MRD) and predicting recurrence after curative treatment, yet evidence in esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), and gastric cancer has largely been examined within individual tumor types. In this scoping review, we mapped this evidence across all three malignancies and clarified key methodological and clinical considerations. Following the PRISMA-ScR guidelines, we searched PubMed, Scopus, and the Cochrane Library (3 April 2026) for studies linking ctDNA to disease-free, recurrence-free, or overall survival after curative-intent treatment. Twenty-seven studies (1746 patients; 10 ESCC, 4 EAC, 8 gastric, and 5 mixed) were included. Across every tumor type, postoperative ctDNA MRD was the most informative timepoint, with independent multivariable hazard ratios for disease-free, recurrence-free, or event-free survival of 2.8 to 21.8, whereas preoperative ctDNA was seldom prognostic. Serial monitoring further improved performance and flagged recurrence 78 to 278 days before imaging. Tumor-informed assays showed higher sensitivity than tumor-agnostic ones (80% vs. 35%), though direct comparisons were limited; correction for clonal hematopoiesis was essential for tumor-agnostic assays, and blood-based assays performed poorly in diffuse-type and peritoneal disease. Postoperative ctDNA MRD is a consistent, independent prognostic biomarker across upper gastrointestinal cancers that adds prognostic information beyond conventional staging and pathological response, supporting prospective interventional trials of ctDNA-guided management.

Calcinosis cutis is a challenging complication of autoimmune connective tissue diseases, particularly dermatomyositis, and is associated with significant morbidity. Current medical treatments often show limited and inconsistent effectiveness, highlighting the need to better define the role of alternative approaches. To present a case of extensive dermatomyositis-associated calcinosis successfully managed with surgical excision and flap reconstruction, and to systematically review the role of surgical management in autoimmune-related calcinosis. A case report is presented together with a literature review conducted according to PRISMA guidelines. PubMed, Scopus, DOAJ and the Cochrane Library were searched from inception to June 21, 2026 for studies reporting surgical management of calcinosis in autoimmune connective tissue diseases. A total of 13 case reports and 3 case series were identified, including predominantly female patients with a median age of 55.3 years. Surgical intervention was mainly performed in symptomatic cases, such as pain, infection, or functional impairment. Overall, surgery was associated with pain relief and functional improvement, although recurrence and complications, including wound healing issues, were reported. Pharmacological therapies demonstrated variable and generally limited efficacy. Data on reconstructive techniques were scarce; however, available evidence suggests that flap reconstruction and grafting may improve outcomes in complex cases. Surgical management may represent a valuable treatment option for selected patients with calcinosis associated with autoimmune diseases, particularly in refractory or symptomatic cases. Reconstructive techniques may further enhance functional outcomes, although evidence remains limited. An individualized, multidisciplinary approach is recommended, and further studies are needed to establish optimal management strategies. Registration PROSPERO (CRD420261359925).

Liquid biopsy has become an increasingly important tool in clinical oncology due to the utility of circulating tumor DNA (ct‑DNA). Plasma ct‑DNA levels reflect the tumor burden of patients and provide valuable information for personalized treatment strategies. Colorectal cancer (CRC) is among the most frequently diagnosed malignancies worldwide and remains a leading cause of cancer‑related mortality. The implementation of personalized therapy can notably improve clinical outcomes in these patients. The present study aimed to evaluate ct‑DNA in patients with metastatic CRC undergoing therapy at the Department of Medical Oncology, University Hospital of Ioannina (Ioannina, Greece), using next‑generation sequencing (NGS) to identify tumor mutations in both tissue and cell‑free plasma DNA. A total of 45 patients newly diagnosed with metastatic CRC were enrolled in the current study. ct‑DNA evaluation was performed at diagnosis, and both tissue and plasma samples were analyzed using NGS to assess the mutational profile. The most frequent mutation identified was in KRAS. A high level of concordance was observed between tissue and plasma samples regarding ct‑DNA detection and mutational status. Sequential ct‑DNA analysis during therapy revealed dynamic changes in mutation profiles over the course of treatment. In conclusion, liquid biopsy offers marked clinical value as a minimally invasive tool for personalized therapy in metastatic CRC. NGS‑based liquid biopsy enables real‑time evaluation of ct‑DNA and mutation status during treatment, supporting therapeutic decision‑making and disease monitoring.

Introduction Brain metastases from solid tumours are the most common intracranial neoplasms and significantly impact patients’ quality of life and overall survival (OS). Despite advances in oncological therapies, these patients have often been excluded from clinical trials, limiting our...

Idiopathic inflammatory myopathies (IIM) are rare autoimmune disorders primarily affecting skeletal muscles, with occasional involvement of other organs and an increased risk of malignancy. Dermatomyositis (DM), a major IIM subtype, is characterized by proximal muscle weakness, distinctive skin manifestations, and characteristic biopsy findings. Antineutrophil cytoplasmic antibody (ANCA)–associated vasculitides (AAV), including microscopic polyangiitis (MPA), involve small- to medium-sized vessels and can affect the kidneys and lungs. Although uncommon, overlap syndromes between IIM and AAV have been described. We report two cases of DM-MPA overlap. The first involved a 67-year-old male with interstitial lung disease (ILD), muscle weakness, and proteinuria. The second concerned a 53-year-old female presenting with characteristic skin rash, arthralgias, proteinuria, and mild pulmonary involvement. Both patients received high-dose corticosteroids and cyclophosphamide (CYC), resulting in clinical and laboratory improvement, including resolution of proteinuria and improved pulmonary function, maintained over a 6-month follow-up. The literature review identified five relevant case reports and one case series. Fifteen patients from these six studies were included, predominantly female (13/15), with ages ranging from 15 to 84 years. DM was the most common IIM subtype (7/15), followed by polymyositis (PM) (6/15), inclusion body myositis (IBM) (1/15), and clinically amyopathic dermatomyositis (CADM) (1/15). MPA accounted for 87% (13/15) of AAV cases, while GPA was reported in 2/15. Renal involvement was frequent, often presented as pauci-immune crescentic glomerulonephritis, whereas pulmonary involvement was less common. MPO-ANCA was positive in 12/15 patients. Initial therapy typically involved corticosteroids, with or without immunosuppressants, tailored according to the dominant organ involvement. Outcomes were variable; most patients achieved remission, although some experienced persistent organ dysfunction. IIM-AAV overlap is rare but potentially severe, frequently involving renal, pulmonary, muscular, and occasionally cardiac systems. Early recognition and individualized immunosuppressive therapy can yield favorable outcomes. Multicenter studies are required to clarify the epidemiology, clinical spectrum, and optimal management of this complex syndrome, and further research is needed to elucidate underlying pathogenic mechanisms.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy by enhancing the immune response against tumors. However, they can cause immune-related adverse events (irAEs), including rare but potentially fatal myocarditis. We describe a 71-year-old man with stage IIIA lung adenocarcinoma treated with adjuvant pembrolizumab who developed severe ICI-associated myocarditis. Despite early diagnosis, treatment with intensive immunosuppression and mechanical support, he suffered fatal cardiac complications. A systematic review of the literature up to May 2025 identified 44 cases of ICI-associated myocarditis. Data on clinical features, diagnostics, treatment, and outcomes were extracted and analyzed. Most cases involved older patients with lung cancer treated with pembrolizumab or nivolumab. Onset varied from days to years after therapy initiation. Presentations included dyspnea, chest pain, arrhythmias, and elevated cardiac biomarkers. The biopsy showed T-cell and macrophage infiltration. High-dose corticosteroids were the primary treatment; additional immunosuppressants were used in cases that were refractory. Mortality was 45%, mainly due to cardiac failure and sepsis. Discussion: ICI-associated myocarditis arises from immune dysregulation affecting cardiac tissue, potentially involving shared antigens and systemic inflammation. Early detection and aggressive immunosuppression are crucial but often insufficient, resulting in high mortality. This underscores the urgent need for a better understanding of pathogenesis and the development of effective management strategies to improve patient outcomes. Finally, a multidisciplinary approach is important to improve outcomes in ICI-associated myocarditis.

Immune-mediated necrotizing myopathy (IMNM), a type of inflammatory myopathy, is associated with anti-SRP or anti-3-hydroxy-3-methylglutaryl coenzyme A reductase (anti-HMGCR) antibodies, with statin use potentially inducing statin-associated IMNM (SAIMNM) due to HMGCR targeting. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors may offer a safer alternative for lipid-lowering in these patients. This study aims to describe the clinical characteristics of SAIMNM patients and evaluate the safety of PCSK9 inhibitors after myositis onset. We present the clinical characteristics of five SAIMNM patients and evaluate the safety of PCSK9 inhibitors in these cases. Additionally, we conducted a literature review using four different databases (Medline/PubMed, Scopus, Cochrane and DOAJ) to summarize the available data on IMNM. While numerous articles discussed statin-induced myositis, we selected only those studies that addressed the treatment of dyslipidemia after the management of IMNM. All five patients were women, with four having a history of statin use. One statin-naïve patient was positive for anti-SRP antibodies, while the others had anti-HMGCR antibodies. After a mean follow-up of 18.2 months, creatine phosphokinase (CPK) levels dropped from 1028.6 IU/L to 135 IU/L, and LDL cholesterol levels decreased from 206.2 mg/dL to 87.2 mg/dL. All patients were treated with steroids (with a gradual dosage reduction), and four of the five received second line immunosuppressive therapy, such as intravenous immunoglobulin, methotrexate, azathioprine, and mycophenolate mofetil. No disease recurrence occurred after starting PCSK9 inhibitors. A review of seven studies (15 patients) showed a mean CPK of 1531.9 IU/L. 40% received steroids and another immunosuppressant. Statin rechallenge caused relapse in two cases, but PCSK9 inhibitors were well tolerated, with only one patient needing additional immunosuppression. Additionally, ezetimibe and bempedoic acid were used successfully in some patients. Finally, lipid levels appeared to be lower after treatment with PCSK9 inhibitors. Administration of PCSK9 inhibitors appears to be an effective and safe option for the treatment of dyslipidaemia in patients with IMNM.

Background: Immune checkpoint inhibitors (ICIs) are increasingly included in management guidelines for various types of cancer. However, immune-related adverse events (irAEs) are an inevitable consequence of these therapies. Some of these side effects, such as pneumonitis, can be particularly serious. Additionally, the combination of ICIs with radiotherapy (RT) may further increase the risk of pneumonitis. Objective: The aim of this systematic review is to examine all available studies on pneumonitis following the use of ICIs and RT to assess its appearance and severity. Methods: We systematically searched four different databases (PubMed, Scopus, Cochrane, and DOAJ) to identify all relevant studies within our scope. Additionally, we reviewed the references of the studies we found, as well as those of other systematic reviews and meta-analyses. We assessed the risk of bias using the Cochrane Risk of Bias Tool version 2 for randomized controlled trials and the RTI Risk of Bias Item Bank for non-randomized trials. Finally, we extracted relevant data into an Excel file and presented them in tables throughout this study. Results: A total of 58 articles met our inclusion criteria, comprising 4889 patients across multiple studies and nine case reports. Due to significant heterogeneity in study methodologies and data reporting, a cumulative statistical analysis was not performed. The included studies were published between 2017 and 2025. The incidence of pneumonitis varied, with retrospective studies showing higher rates compared to randomized and non-randomized controlled trials. Case reports described a range of pneumonitis presentations, treatments, and outcomes, with corticosteroids being the primary treatment. Conclusions: The incidence of pneumonitis varied, with retrospective studies showing the highest rates compared to other study designs. Early detection and management of pneumonitis in patients receiving RT and/or ICIs are crucial for improving outcomes. Identifying high-risk patients through predictive models, radiomics, and biomarkers may help tailor treatment strategies and minimize toxicity. Further research is needed to establish the most appropriate diagnostic criteria, optimize management approaches, and refine advanced imaging and biomarker-based risk stratification to improve patient care. Interdisciplinary collaboration is essential for reducing the risk of pneumonitis and improving patient outcomes.