Lung cancer is the leading cause of cancer-related deaths. Surgery remains the best option to treat lung cancer when feasible. However, many cases are diagnosed beyond the initial stages. There has been tremendous progress in the treatment of lung cancer over the last few years. Studies have shown that biomarker-driven targeted therapies lead to better outcomes. Due to the technical difficulties and significant procedural risk associated with repeated tissue biopsies, analysis of tumor constituents circulating in the blood, such as circulating tumor DNA (ctDNA) and various proteins, is becoming more widely recognized as an alternative method of tumor sampling, i.e., liquid biopsy. Liquid biopsy is superior to tissue biopsy, as it is minimally invasive and easily repeatable. Given the recent data on changes in mutations as the disease progresses or responds to treatment, liquid biopsies can help monitor the changes and guide us in giving targeted drugs. Here we present a case of advanced NSCLC who was initially started on Alectinib based on positivity for ALK gene rearrangement found in the FISH study. At the time of progression, molecular profiling liquid biopsy was obtained, which revealed KRAS-p.G12C mutation. Thus, the patient’s therapy was later on changed to sotorasib after the FDA approved a KRAS-p.G12C mutation inhibitor.

Chordoma is a rare malignant neoplasm derived from notochordal tissue that primarily affects the axial skeleton. Almost 40% of patients have non-cranial chordoma metastases. The most common metastatic sites are the lungs, bones, lymph nodes, and subcutaneous tissue. We present a 52-year female with a history of sacral chordoma presenting with abdominal fullness, early satiety, and a palpable abdominal mass. Abdominal magnetic resonance imaging (MRI) revealed an isolated, highly vascularized, and multilobed liver mass in the left lateral segment. The mass was surgically removed using a clean surgical margin. A histological examination and immunohistochemical staining were consistent with a metastatic chordoma. Two years later, follow-up imaging studies showed a 6.5 × 4.0 × 2.0 cm right liver lesion with multiple lungs, chest wall, pleural, and diaphragmatic lesions. Microscopic- and immunohistochemical staining revealed a recurrent metastatic chordoma. Herein, we present a unique case of metastatic recurrent chordoma in the liver with the involvement of other sites. To the best of our knowledge, no other case of recurrent liver metastasis has been reported.

Percutaneous cryoablation has proved to be safe and effective for the treatment of stage T1a renal cell carcinoma (RCC). Patients with larger-sized RCCs may not be good surgical candidates or may have tumors located in anatomically unfavorable locations, which makes partial nephrectomy more challenging. In this patient population, percutaneous cryoablation can be considered a treatment option, given its less invasive nature when compared to surgery. The ablation of larger-sized RCCs requires careful planning to ensure that the tumor volume is completely covered within the ablation zone, while minimizing the risks of non-target injury to the surrounding critical organs. In this article, we share our institutional experience in treating larger-sized RCCs (> 4 cm) using percutaneous cryoablation alone. We discuss strategies to maximize the volume of the ablation zone through the precise placement of the probes. We also shed light on different techniques to protect the surrounding structures during cryoablation.

Primary paraganglioma of the trachea is a rare differential among more common tracheal masses. Definitive diagnosis of tracheal masses is obtained via endoscopic biopsy. Utilization of ⁶⁸Ga-DOTATATE PET/CT is valuable in the workup of these lesions as paragangliomas would have significantly higher radiotracer uptake compared with the more common squamous cell and adenoid cystic carcinomas. This is particularly important in tracheal paragangliomas, which are typically friable and hypervascular with higher risk of significant bleeding on biopsy. In addition, ⁶⁸Ga-DOTATATE PET/CT can be used to evaluate for local invasion and metastatic disease as a 1-step imaging modality.

Background: Focused ultrasound has emerged as a non-invasive technology with potential for treating various medical conditions, particularly neurological diseases. This article aims to explore recent advancements in the utilization of focused ultrasound for treating neurological conditions. Results: A comprehensive literature review was conducted to explore current clinical applications and investigational uses of focused ultrasound, aiming to provide an up-todate overview of the field's progress. By employing different combinations of intensity and frequency, focused ultrasound can induce diverse interactions with soft tissues, including tissue ablation, cavitation, and mechanical effects. High-intensity focused ultrasound is utilized for tissue ablation and has received FDA approval for treating medication-refractory essential tremor. Conversely, low-intensity focused ultrasound is employed for neuromodulation and opening the blood–brain barrier, facilitating enhanced drug delivery for treating brain tumors and other neurological conditions. This article reviews ongoing clinical trials investigating focused ultrasound's role in neurological condition treatment. Conclusion: Focused ultrasound holds significant promise for managing and treating various neurologic conditions. Whether employed for tissue ablation or transiently opening the blood–brain barrier to enhance drug delivery, numerous potential applications exist. Further research is necessary to evaluate its safe implementation and compare clinical outcomes with standard-of-care therapies.

Leiomyomas are a common type of benign soft tissue tumor arising from smooth muscle, most often occurring within females’ genitourinary and gastrointestinal tract. However, primary leiomyomas of the chest wall residing in the extra-pleural space are an extremely rare subset of leiomyomatous lesion presentation. We present a case of a fifty-two-year-old male who initially presented complaining of dyspnea worsening with exertion. Computed tomography imaging was performed showing an extra-pleural mass residing under the left sixth rib. Subsequent core needle biopsy and immunohistochemical staining were performed, and the definitive diagnosis of primary leiomyoma of the posterior mediastinal chest wall. Although extremely rare, this neoplastic condition should be included in your differential diagnosis when diagnostic imaging reveals a benign mass residing in the extra-pleural space, and subsequent biopsy specimens consist of smooth muscle fibers.