Background/Objectives: Lung cancer remains the leading cause of cancer-related mortality worldwide, with a high proportion of cases diagnosed at advanced stages. Accurate mediastinal staging is essential to guide optimal therapeutic decisions. This study aimed to evaluate the diagnostic performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and to develop a composite clinical–molecular score (EXPoSURE) for risk stratification. Methods: A retrospective study was performed that included 131 patients diagnosed with lung cancer between December 2023 and December 2024 at a regional oncology center in Oltenia, Romania. All patients underwent bronchoscopy and EBUS-TBNA using a standardized protocol. Clinical, pathological, and molecular data were collected to assess diagnostic yield, staging performance, and the association with molecular markers. The EXPoSURE score integrated PD-L1, p63, EGFR status, comorbidities, histological type, and TNM stage. Results: EBUS-TBNA provided a conclusive diagnosis in 91.6% of cases, with a low rebiopsy rate of 8.4% and no requirement for mediastinoscopy. Most patients (68%) were diagnosed at stage IV. PD-L1, p63, and EGFR expression showed no significant correlation with TNM stage, while the EXPoSURE score demonstrated promising stratification capability. Occupational exposure appeared to influence disease severity in some subgroups, although further validation is needed. Conclusions: EBUS-TBNA is a valuable, safe, and effective approach for minimally invasive diagnosis and mediastinal staging of lung cancer. The proposed EXPoSURE composite score may contribute to a multidimensional risk assessment, supporting more tailored management strategies and warranting prospective validation.

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide. Timely and accurate diagnosis and staging are crucial for treatment decisions. Objective: To assess the feasibility, safety, and diagnostic/staging yield of a bronchoscopy-based pathway supported by EBUS-TBNA in a regional Romanian center. Bronchoscopy combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) may reduce the need for surgical confirmation, yet its implementation in regional centers is inconsistent. Materials and Methods: This retrospective study included 67 patients with suspected lung cancer evaluated at a regional oncology center between December 2023 and February 2024. All patients underwent bronchoscopy, and EBUS-TBNA was performed in those with mediastinal lymphadenopathy on imaging, with endoscopic tissue biopsies (endobronchial/EBUS-TBNA). Demographic, clinical, histological, and molecular data were collected and analyzed using descriptive statistics and chi-square/Fisher’s exact tests. Results: Among the 67 patients, 42 (62.7%) underwent EBUS-TBNA. The majority were diagnosed in advanced stages (stage III–IV: 83.6%), with adenocarcinoma being the most frequent histological subtype. PD-L1 expression was positive in 52.2% of cases, and p63 in 67.2%. No significant procedural complications occurred, and adequate tissue sampling for histopathological and molecular analyses was achieved in all cases. Associations were found between PD-L1 and advanced TNM stage (p = 0.026), as well as between p63 status and TNM stage (p = 0.002). Conclusions: This study supports the feasibility and safety of a bronchoscopy-based diagnostic and staging algorithm supported by EBUS-TBNA, achieving reliable sampling and avoiding surgical confirmation in a regional oncology setting. Further prospective studies are warranted to validate these findings.

Background/Objectives: Immune thrombocytopenia (ITP) is a rare but significant hematologic disorder in children. While most pediatric ITP cases resolve spontaneously, some require intervention, and treatment responses with platelet recovery patterns can vary widely. We conducted a retrospective, three-year observational cohort study including 100 children (aged 5 months–17 years) diagnosed with ITP at a single tertiary center (January 2022–December 2024). The primary objective of this study was to characterize the clinical presentation, coexisting conditions, and short-term platelet response to first-line therapy in hospitalized children with newly diagnosed ITP. Methods: Clinical data (demographics, presentation, and laboratory results) were collected at admission and throughout hospitalization, and outcomes were assessed at discharge. Results: Our analysis showed a balanced urban–rural distribution overall; however, sex distribution differed by residence, with a slight female predominance in rural areas and an overwhelming male predominance in urban areas. Over 40% of patients were under 5 years old. Platelet counts at presentation ranged from 3 × 10⁹/L to 30 × 10⁹/L, yet nearly all children showed substantial platelet count recovery by hospital discharge under first-line therapy. Most patients had additional minor clinical findings at admission, but these were considered concurrent rather than causative factors, in accordance with current hematology guidelines. These conditions were considered coexisting clinical conditions or concurrent findings rather than definitive secondary causes of ITP, in accordance with established hematological guidelines. These findings reflect only short-term, in-hospital outcomes and may not be generalizable to all children with ITP, particularly milder or outpatient cases. Conclusions: Our three-year cohort study underscores that pediatric ITP often presents in very young children with concurrent conditions, but standard first-line treatment leads to robust platelet recovery by discharge. These findings highlight the importance of comprehensive initial evaluation and supportive care in managing pediatric ITP.

Thyroid malignancy represents the most common type of endocrine cancer, with an increasing incidence all over the world, including an increasing rate of detection among younger adults, 90% to 95% of all cases being non-medullary types. Poorly differentiated thyroid cancer, accounting 1% to 5% of all thyroid malignancies, is a less understood neoplasm compared to the other more frequent and better described thyroid cancers, associating various histological patterns that might bring pitfalls of diagnosis in everyday practice. We aimed to provide an updated analysis in the field of poorly differentiated thyroid carcinoma, based on a multimodal approach, including emergent biomarkers. The current data offers a robust framework for elucidating the biology of poorly differenced thyroid malignancy and further on, it provides the basis for a multilayered therapeutic approach. Emergent biomarkers might be detected from cytological analysis based on fine-needle aspiration or blood assays as cell-free deoxyribonucleic acid (cfDNA), but the most important remains the identification of the molecular and genetic constellation in terms of analyzing RAS, telomerase reverse transcriptase (TERT), B-Raf proto-oncogene, serine/threonine kinase (BRAF), tumor protein p53 (TP53), phosphatase and tensin homolog (PTEN), copy number alterations (CNA) and phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) profile, which serve as prognostic markers and pointers of anti-cancer medical therapy. Overall, despite recent advances in multimodal management, the prognostic remains severe. The issue is ongoing, and we expect a massive expansion within the following years, across a guideline-based, as well as a personalized decision.

Background: Type 2 diabetes (T2D) has been placed among the risk factors for fragility (osteoporotic) fractures, particularly in menopausal women amid modern clinical practice. Objective: We aimed to analyze the bone status in terms of mineral metabolism assays, blood bone turnover markers (BTM), and bone mineral density (DXA-BMD), respectively, to assess the 10-year fracture probability of major osteoporotic fractures (MOF) and hip fracture (HF) upon using conventional FRAX without/with femoral neck BMD (MOF-FN/HF-FN and MOF+FN/HF+FN) and the novel model (FRAXplus) with adjustments for T2D (MOF+T2D/HF+T2D) and lumbar spine BMD (MOF+LS/HF+LS). Methods: This retrospective, cross-sectional, pilot study, from January 2023 until January 2024, in menopausal women (aged: 50–80 years) with/without T2D (group DM/nonDM). Inclusion criteria (group DM): prior T2D under diet ± oral medication or novel T2D (OGTT diagnostic). Exclusion criteria: previous anti-osteoporotic medication, prediabetes, insulin therapy, non-T2D. Results: The cohort (N = 136; mean age: 61.36 ± 8.2y) included T2D (22.06%). Groups DM vs. non-DM were age- and years since menopause (YSM)-matched; they had a similar osteoporosis rate (16.67% vs. 23.58%) and fracture prevalence (6.66% vs. 9.43%). In T2D, body mass index (BMI) was higher (31.80 ± 5.31 vs. 26.54 ± 4.87 kg/m²; p < 0.001), while osteocalcin and CrossLaps were lower (18.09 ± 8.35 vs. 25.62 ± 12.78 ng/mL, p = 0.002; 0.39 ± 0.18 vs. 0.48 ± 0.22 ng/mL, p = 0.048), as well as 25-hydroxyvitamin D (16.96 ± 6.76 vs. 21.29 ± 9.84, p = 0.013). FN-BMD and TH-BMD were increased in T2D (p = 0.007, p = 0.002). MOF+LS/HF+LS were statistically significant lower than MOF-FN/HF-FN, respectively, MOF+FN/HF+FN (N = 136). In T2D: MOF+T2D was higher (p < 0.05) than MOF-FN, respectively, MOF+FN [median(IQR) of 3.7(2.5, 5.6) vs. 3.4(2.1, 5.8), respectively, 3.1(2.3, 4.39)], but MOF+LS was lower [2.75(1.9, 3.25)]. HF+T2D was higher (p < 0.05) than HF-FN, respectively, HF+FN [0.8(0.2, 2.4) vs. 0.5(0.2, 1.5), respectively, 0.35(0.13, 0.8)] but HF+LS was lower [0.2(0.1, 0.45)]. Conclusion: Type 2 diabetic menopausal women when compared to age- and YSM-match controls had a lower 25OHD and BTM (osteocalcin, CrossLaps), increased TH-BMD and FN-BMD (with loss of significance upon BMI adjustment). When applying novel FRAX model, LS-BMD adjustment showed lower MOF and HF as estimated by the conventional FRAX (in either subgroup or entire cohort) or as found by T2D adjustment using FRAXplus (in diabetic subgroup). To date, all four types of 10-year fracture probabilities displayed a strong correlation, but taking into consideration the presence of T2D, statistically significant higher risks than calculated by the traditional FRAX were found, hence, the current model might underestimate the condition-related fracture risk. Addressing the practical aspects of fracture risk assessment in diabetic menopausal women might improve the bone health and further offers a prompt tailored strategy to reduce the fracture risk, thus, reducing the overall disease burden.

Background. Glucocorticoid-induced osteoporosis represents a well-known type of secondary osteoporosis (SOp). While the most prevalent sub-category includes corticotherapy, another important contributor is represented by Cushing’s syndrome. In this traditional landscape, adrenal incidentalomas do not involve a standard cause of SOp, since most of them are non-functioning adrenal tumours (NFATs). Yet, 30–40% of them are not entirely “non-functioning”, due to mild autonomous cortisol secretion (MACS). Despite not being a guideline-based diagnosis, a lower ACTH might point to various NFATs/MACS complications. Objective. This study aimed to determine the relationship between the bone health status of post-menopausal women with NFATs/MACS and their baseline morning ACTH level. The bone health indicators were DXA, FRAX, and bone remodelling markers. Methods. This was a retrospective, real-life, transversal study in adult females who were hospitalized in a single tertiary centre of endocrinology. They were all anti-osteoporotic drug-naïve. The subjects underwent CT and DXA scanning and a 1 mg dexamethasone suppression test (DST). Results. The cohort (sample size of N = 84 patients, 61.49 ± 7.86 years) had a type 2 diabetes rate of 18%, arterial hypertension rate of 75%, and a dyslipidemia rate of 78%. Median ACTH was 11.89 pg/mL. The prevalence of MACS was 30.95%. The mean largest tumour diameter (LTD) was 2.25 ± 0.99 cm. ACTH correlated with second-day cortisol after the 1 mg DST (r = −0.301, p = 0.024), and LTD (r = −0.434, p < 0.001). ROC analysis for the bone resorption marker CrossLaps showed an AUC of 0.647 (p = 0.05), with the highest Youden index for the cut-off at 0.32 ng/mL (sensitivity 87.50%, specificity 39.50%). Bone impairment (osteoporosis + osteopenia) was found in 65% of patients, with an osteoporotic fracture prevalence of 4.76%. The lowest mean T-score (−1.12 ± 1.00) showed osteopenia, and the median trabecular bone score pointed a partially degraded microarchitecture [median (interquartile interval): 1.320 (1.230, 1.392)]. FRAX and FRAXplus estimations correlated with bone mineral density (BMD) at all three central DXA sites, regardless of the ACTH cut-off. Patients with a low ACTH (<10 pg/mL) displayed similar bone/adrenal features when compared to those with normal ACTH, except forbut they had a higher MACS rate (45.45% versus 21.57%, p = 0.021) and a larger LTD (2.67 ± 0.98 versus 1.98 ± 0.92 cm, p = 0.003). Fracture estimation showed that only in patients with a low ACTH, the 10-year fracture risk for major osteoporotic fractures (MOF) adjusted for lumbar BMD was lower than the risk for MOF adjusted for diabetes (p = 0.036), and the 10-year hip fracture risk was lower when adjusted for lumbar BMD (p = 0.007). ACTH correlated with lumbar BMD (r = 0.591, p = 0.002) only in the group with an ACTH < 10 pg/mL, suggesting its potential usefulness as a bone biomarker in these cases. On the other hand, MACS-negative subjects with a low ACTH versus those with a normal ACTH showed higher CrossLaps (0.60 ± 0.27 versus 0.42 ± 0.21 ng/mL, p = 0.022), indicating an elevated bone resorption even in patients with tumours that are regarded as true non-secretors. Conclusions. A subgroup of patients diagnosed with NFATs/MACS might be prone to skeletal damage, and biomarkers such as ACTH (specifically, suppressed ACTH) might serve as a surrogate pointer to help refine this higher risk in daily practice. Further research to address other ACTH cut-offs will place ACTH assays in the overall bone status evaluation in these patients, most probably not as a single biomarker, but in addition to other assays.