Background and Objectives: The incidence of papillary thyroid microcarcinoma (PTMC) has increased. Some patients present with lymph node metastases (LNM), while risk factors remain unclear. This study aims to examine clinicopathological markers predictive of LNM in PTMC. Materials and Methods: We retrospectively analyzed 170 patients with a histological diagnosis of PTMC. The patients were grouped based on the presence of LNM. Results: Our cohort consisted of 133 females and 37 males, aged 47.14 ± 12.81 years. Twenty-seven (15.9%) individuals had LNM. Median tumor size was 5 mm (4.25, 0.15–10), and multifocality was present in 37.1% of patients. Thyroid capsular invasion (TCI) was observed in 22.9% of patients. Extrathyroidal extension (ETE) and aggressive variants were present in 12.9% and 8.8% of patients, respectively. Forty-four patients had a history of autoimmune thyroid disease. From univariate analysis, age < 55 years (OR: 6.317; p = 0.015), TCI (OR: 2.824; p = 0.020), and ETE (OR: 2.987; p = 0.034) were independent predictors of LNM. Multivariate analysis showed that younger patients are at a significantly increased risk of LNM in PTMC (OR: 6.30910; p = 0.016). Conclusions: The findings of this study highlight the need for greater attention to PTMC in younger patients with ultrasonographic features of TCI and ETE, as they may require a more thorough evaluation of LNM, strict follow-up, and may benefit from a surgical decision of lymphadenectomy.

Over the last few decades, due to improvement in imaging techniques, the increased detection of adrenal incidentalomas is observed. Non-aldosterone producing adrenal adenomas (NAPACAs) often co-exist with second benign or malignant lesions. In the present study, we aimed to assess the presence of second neoplasms, both benign and malignant, in patients with NAPACAs, and to investigate possible correlations with clinical parameters, hormonal characteristics and the emergence of comorbidities. A total of 130 NAPACA patients were included in this single-center retrospective study. In this cohort, 35.4% of NAPACA patients carried any second neoplasm (either benign or malignant) whereas, 26.9% had a second malignant neoplasm. Cortisol levels after 1 mg overnight dexamethasone suppression test (F-ODS) were significantly higher in patients without a second neoplasm (p = 0.02), and this finding was consistent even when categorizing patients with and without malignancies (p = 0.02). In line with this observation, ACTH/F-ODS levels were significantly higher in patients with second malignancies (p < 0.05). Interestingly, the presence of mild autonomous cortisol secretion tended to be lower in patients with second malignancies (p = 0.08). No remarkable differences in the comorbidities of NAPACA patients with and without a second neoplasm were documented. Further prospective studies will be needed to elucidate the role of mild hypercortisolemia on the development of these second tumors in NAPACA patients.

Background and Objectives: Bile leak is a common complication after hepatopancreatobiliary surgery, requiring timely management to prevent life-threatening outcomes. Endoscopic retrograde cholangiopancreatography (ERCP) is essential in treatment, but large data concerning optimal timing and technique selection are unavailable. This study evaluates whether the timing of ERCP influences healing and if different bile duct injuries affect outcomes. Materials and Methods: Data from a prospectively maintained database over 25 years (2001–2025) included 176 patients (M/F: 91/85, mean age 62) undergoing ERCP for bile leaks. Results: Most leaks followed cholecystectomy (n = 143, 81.5%). The median time from leak to ERCP was 7 days. Ten patients (5.7%) had complete common bile duct (CBD) transection—considered major leaks—requiring surgery. Among the 166 minor leaks, the cystic duct stump (40.1%) was the most common injury site, followed by the CBD (24.1%) and the gallbladder bed (15.4%). Healing occurred in 90.6%. Stent placement improved healing rates (93.9% vs. 75.9%, p = 0.007), with no difference between pig-tail and (Amsterdam) straight plastic stents (90% vs. 96%, p = 0.267). Retained CBD stones or CBD strictures did not affect outcomes. Leaks from the cystic duct stump had a 96.9% resolution rate, whereas gallbladder bed leaks healed in 88%. The median healing time was 2 days, unaffected by stent placement or ES alone (p = 0.842), but later ERCP correlated with longer healing (RR: 0.362, p < 0.001). Following a right aberrant bile leak, the time for healing was longer than in leaks from other sites. Conclusions: ERCP with stenting remains the first-line approach for minor bile leaks. Early ERCP accelerates healing, emphasizing the importance of prompt intervention.

Breast cancer is the most common invasive malignancy among women and represents the second leading cause of cancer-related mortality in this population, following lung cancer. While metastases typically involve the bones, liver and lungs, less common metastatic sites have also been documented. Metastatic involvement of the pancreas or duodenum from an extrapancreatic primary tumour is rare, accounting for less than 3% of all pancreatic and periampullary malignancies. We report a case of isolated ampullary metastasis originating from invasive lobular breast carcinoma in a female patient in her late 50s, more than a decade after the initial diagnosis, accompanied by a review of the relevant literature. Given the limited number of published cases, this report underscores the importance of considering metastatic breast cancer in the differential diagnosis of women presenting with obstructive jaundice, particularly in the presence of a relevant clinical history.

Background: Osteoporotic fractures are a common clinical sign of Cushing syndrome (CS). However, Cushing diagnosis can occur years after this clinical manifestation. Methods: Herein, we present the case of a 45-year-old woman who was referred to our department for further diagnosis and treatment. Results: The patient was already under treatment for arterial hypertension and osteoporosis and was recently diagnosed with dyslipidemia and type 2 diabetes. She reported several previous fractures starting already 8 years before presentation. An adrenal CS was diagnosed, and the patient was treated with laparoscopic adrenalectomy, with a subsequent complete remission of her hypercortisolism. This case report presenting a particularly long time gap between initial osteoporosis signs and the final diagnosis underlines the need for an investigation into secondary osteoporosis in low-energy fractures also in the peripheral skeleton. In this context, we performed a literature review, including case reports with fragility fractures that were attributed to endogenous CS. Conclusions: In summary, a delayed diagnosis of CS in patients with a previous accumulation of such fractures is a worrisome observation and should be considered in everyday clinical practice in order to improve the timely diagnosis and treatment of CS.