Primary adrenal tuberculosis (TB) is a rare type of extrapulmonary tuberculosis (EPTB). A pathological biopsy is usually required to make a definite diagnosis due to nonspecific symptoms. Antituberculous chemotherapy is the main treatment regimen, and cortisol replacement therapy should be added when adrenal insufficiency is involved. Here, we present a 59-year-old man who had recurrence of oral and genital aphthosis for 3 years and was diagnosed with Behcet’s disease (BD), which was cured by thalidomide. After 10 days of admission, the patient had sudden abdominal pain in the right upper quadrant with high fever and was diagnosed with acute cholecystitis attack, which was treated by percutaneous transhepatic gallbladder drainage (PTGBD). Further contrast-enhanced CT showed a right adrenal mass with a diameter of 2.0 cm, and PET-CT indicated intense ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) uptake in the right adrenal mass with a maximum standardized uptake value (SUV_max) of 15.2. As a metastatic adrenal mass was suspected, the patient underwent retroperitoneal laparoscopic adrenalectomy. Histopathological and immunohistochemical analysis revealed primary adrenal TB. After routine anti-tuberculosis treatment with isoniazid, rifampin, pyrazinamide and ethambutol for six months, the patient was cured and discharged. In summary, primary unilateral adrenal TB without adrenal insufficiency is difficult to diagnose only on the basis of clinical manifestations and examinations. Further studies are needed to develop an easier and more accurate diagnostic examination.

Urethral recurrence (UR) following radical cystectomy for bladder cancer represents an aggressive disease failure with typically poor survival outcomes. Our study aimed to assess the predictive risk factors for UR, to develop and validate an easy-to-use predictive tool of UR in our region based on machine learning algorithms and to update the meta-analysis of risk factors for UR in combination with our results to improve its accuracy and reliability. Clinicopathological data from the patients who underwent RC between 2010 and 2020 at multiple centres were collected. To confirm the independent risk factors for UR, univariate and multivariate Cox regression were applied. We conducted internal validation by randomly partitioning the dataset into train (80%) and test (20%) subsets for UR prediction model development and validation. We developed UR predictive models using ten machine learning algorithms and evaluated the model performance by the area under the ROC curve (AUC), accuracy, sensitivity, and other metrics (F1 score, Brier score, C-index). The best-performing model was selected based on these criteria. The SHapley Additive exPlanations (SHAP) method was used to calculate the contribution of each feature to the machine learning prediction with best performance and develop online calculator based on the machine model with the best performance. Moreover, to avoid bias from single-region studies for the risk factors identifications, we searched the PubMed, Embase, and Scopus databases published before April 2025 to perform a meta-analysis of patient-, tumour- and treatment-specific factors for UR. In our multi-centre study, 473 patients were analysed with a UR rate of 8.24%, concomitant CIS (HR: 2.02, p = 0.039) and tumor multifocality (HR: 2.89, p = 0.004) were demonstrated to be independent predictors for UR. Among the ten different machine learning methods, the gradient boosting machine model demonstrated the best predictive performance which reached AUC of 0.865 (95%CI: 0.805–0.926) and 0.778 (95%CI: 0.558–0.968) in train and test set respectively. Moreover, to benefit from the clinical implications of the predictive model, an easy-to-use risk calculator tool for UR was developed online (https://zluxin.shinyapps.io/make_web/) based on the GBM model. In the updated meta-analysis, a history of TURBT (HR: 2.56, p = 0.019), bladder neck or trigeminal or prostate involvement (HR: 3.39, p < 0.001), tumor multifocality (HR: 2.05, p < 0.001), concomitant CIS (HR: 1.74, p = 0.006), lymphovascular invasion (HR: 1.95, p = 0.028), diversion type (HR: 0.47, p < 0.001) and receiving neoadjuvant chemotherapy or adjuvant chemotherapy (HR: 1.36, p = 0.019) were significant predictors of UR. Tumour multifocality and concomitant CIS were independent predictors for UR in the retrospective multicentre research and meta-analysis. An easy-to-use online calculator based on GBM algorithm was developed can help predict UR for patients with bladder cancer after radical cystectomy and contribute to tailor individualized follow-up management strategies.

Background: Positive surgical margin (PSM) or apical positive surgical margin (APSM) is an established predictive factor of biochemical recurrence or disease progression in prostate cancer (PCa) patients after radical prostatectomy. Since there are limited usable magnetic resonance imaging (MRI)-based models, we sought to explore the role of three-dimensional (3D) visualization for preoperative MRI in the prediction of PSM or APSM.Methods: From December 2016 to April 2022, 149 consecutive PCa patients who underwent radical prostatectomy were retrospectively selected from the Second Affiliated Hospital of Dalian Medical University. According to the presence of PSM or APSM, patients were divided into a PSM group (n=41) and a without PSM group (n=108) and into an APSM group (n=33) and a without APSM group (n=116). Twenty-one parameters, including prostate apical shape, PCa distance to the membranous urethra, and pubic angle, were measured on 3D visualization of MRI. The development of the nomogram models was built by the findings of multivariate logistic regression analysis for significant factors.Results: To predict the probability of PSM, a longer PCa distance to the membranous urethra (OR=0.136, p=0.019) and the distance from the anterior peritoneum to the anterior border of the coccyx (work space AP, OR=0.240, p=0.030) were independent protective factors, while a type 3 prostate apical shape (OR=8.262, p=0.025) and larger pubic angle 2 (OR=5.303, p=0.029) were identified as independent risk factors. The nomogram model presented an area under the curve (AUC) of the receiver operating characteristic curve (ROC) of PSM of 0.777. In evaluating the incidence of APSM, we found that the distance to the membranous urethra (OR=0.135, p=0.014) was associated with a low risk of APSM, while larger pubic angle 1 (OR=4.666, p=0.043) was connected to a higher risk of APSM. The nomogram model showed that the AUC of APSM was 0.755.Conclusion: As 3D visualization for preoperative MRI showed good performance in predicting PSM or APSM, the tool might be potentially valuable, which also needs to be validated by multicenter, large-scale, prospective studies.

Radical nephroureterectomy (RNU) is the gold standard therapy for patients with upper urinary tract urothelial carcinoma (UTUC). In this study, we compared the effect of two surgical techniques, single-position complete retroperitoneoscopic radical nephroureterectomy (SCRNU) and laparoscopic nephroureterectomy with open bladder cuff excision (LNOBE), on perioperative and long-term oncological outcomes in UTUC patients. We retrospectively collected information on baseline characteristics, clinicopathological characteristics, surgical approaches, perioperative data, and survival outcomes from 174 patients who underwent RNU for UTUC between January 2018 and June 2023 in our center. The data were analyzed using the Mann-Whitney test, Fisher’s exact test, Chi-square test. Linear regressions were applied to explore the effect of surgery approach on the continuous outcomes. Log-rank test and Kaplan-Meier survival curves were plotted to describe the survival outcome. Univariate and Multivariate Cox regressions were conducted to explore the independent prognostic factors. To address potential selection bias, we also employed an Inverse Probability of Treatment Weighting (IPTW) strategy. Patients who underwent SCRNU had shorter operative times (p < 0.001), reduced estimated blood loss (p < 0.001), less drainage on the first postoperative day (p = 0.009), shorter hospital stays (p = 0.001), and better intravesical recurrence-free survival than those who underwent LNOBE (IVRFS, HR: 0.17, 95% CI: 0.07–0.44, p = 0.007). Moreover, SCRNU was confirmed to be a protective factor for IVRFS after IPTW-adjusted Cox regression analysis was performed (HR: 0.17, 95% CI: 0.04–0.77, p = 0.021). SCRNU not only avoids intraoperative repositioning but also improves perioperative outcomes, including the reduction of operative time, blood loss, and length of hospital stay, and is associated with better IVRFS.

Prostate cancer (PCa) is one of the most common malignancies affecting men, with primary treatments involving surgery, radiotherapy, and hormonal therapy. The introduction of precision medicine and next-generation sequencing (NGS) has profoundly influenced the clinical management of PCa, particularly by enabling the assessment of genetic alterations that guide treatment decisions. Liquid biopsy using diverse sample types, including plasma, urine, and semen, offers non-invasive alternatives to tissue biopsies. This study sought to compare the performance of NGS-based mutation detection across various sample types in PCa patients. Thirty-seven PCa patients, diagnosed with intermediate to advanced stages (II-IV), were enrolled. All collected samples, including tissues (n = 34), plasma (n = 37), urine (n = 32), and seminal fluids (n = 9), underwent targeted NGS of 437 cancer-related genes. The detection sensitivity, mutational landscape, and maximum variant allele frequencies (MVAFs) were compared across different sample types. Tissue samples, serving as the gold standard, achieved a 100% mutation detection rate. Plasma and urine samples demonstrated high detection sensitivities, reaching 67.6% and 65.6%, respectively, while semen samples showed a lower detection rate of 33.3%. Mutations in FOXA1, SPOP, and TP53 were commonly detected across most sample types with comparable prevalence. AR mutations were observed with similar frequencies in plasma and semen samples, but were absent in tissue and urine samples. The average MVAFs were at similar levels among tissue, plasma, urine, and semen, although urine sediment samples exhibited the lowest MVAFs. Advanced disease stages correlated with increased circulating tumor DNA (ctDNA) detection in both plasma and urine samples. No significant survival advantage associated with ctDNA negativity was observed, likely due to the small sample size. This study validates the utility of urine and plasma samples as non-invasive and sensitive liquid biopsy options for PCa, showing comparable ctDNA detection rates. Seminal fluid samples also demonstrate potential, despite current sampling challenges. These findings offer insights into the advantages of different sampling methods for PCa detection and reinforce the clinical utility of liquid biopsies in PCa management.

Background: Bronchogenic cysts are benign congenital anomalies originating from embryonic foregut development. Although typically located in the mediastinum or lung parenchyma, retroperitoneal bronchogenic cysts are exceedingly rare, with only a limited number of cases reported in the literature. We present a case of a bronchogenic cyst situated in the left retroperitoneal space, along with a concise review of previously documented cases, summarizing their common epidemiological, clinicopathological, and prognostic features.Case summary: A 48-year-old female was admitted with unexplained left lumbar pain. Computed tomography (CT) revealed a slightly hyperdense cystic mass measuring 43×37×36 mm in the left adrenal region. The lesion was successfully resected using robot-assisted laparoscopic surgery. Histopathological examination confirmed the diagnosis of a bronchogenic cyst. The patient remained hemodynamically stable and recovered well postoperatively. At the 6-month follow-up, she remained asymptomatic with no evidence of recurrence.Conclusion: Given the rarity of retroperitoneal bronchogenic cysts, preoperative imaging is often insufficient to definitively differentiate them from other retroperitoneal neoplasms. Consequently, definitive diagnosis usually depends on postoperative pathological evaluation. This case highlights the diagnostic challenge posed by this rare entity and underscores the importance of pathological examination for definitive diagnosis.