Differentiated thyroid cancer (DTC) is the most prevalent endocrine malignancy in the world. Accurate diagnosis and prognostication are essential for optimizing its treatment and improving patient outcomes. This narrative review explores the diagnostic and prognostic histopathological, immunohistochemical, molecular, and genetic biomarkers in DTC, emphasizing their role in risk stratification and personalized management. Histopathological biomarkers, including tumor size, extrathyroidal extension, lymphovascular invasion, and aggressive subtypes (e.g., tall cell, hobnail, and insular variants), correlate with poor prognosis. Additionally, genetic alterations such as BRAF:p.V600E, RAS mutations, TERT promoter mutations, and RET/PTC rearrangements provide molecular insights into tumor progression and therapeutic response. Some of these molecular/genetic mutations have surrogate proteins that are feasible for immunohistochemical analysis, providing faster and cost-effective alternatives. Advances in next-generation sequencing have further refined risk stratification, facilitating precision medicine approaches. Future research should focus on validating novel biomarkers and developing targeted therapies to improve patient outcomes.

Introduction: Valvular heart diseases are some of the most common causes of cardiovascular morbidity and mortality worldwide. The mitral valve is estimated to be the cause of 15% of deaths in heart valve disease. Mitral valve dysfunction can be treated with a variety of operative options, one of whichis mitral valve replacement. Although it is less desirable than repair, in some situations, it is the only viable option. Thus, we conducted this systematic review to help guide future risk assessment for mitral valve replacement patients and help in the construction of pre-operative risk assessment tools. Methods: This is a systematic review of original articles discussing the topic of predictors of mortality for patients undergoing mitral valve replacement surgery. A systematic search was conducted via independent researchers across a number of databases, starting with PubMed databases utilizing its MeSH database, followed by a complementary search through Google Scholar. Results: In total, 27 original articles were included in a collective cohort of 145005 patients. Older age was the most commonly cited variable as a mortality predictor, followed by decreased left ventricular ejection fraction. EuroSCORE is a well-known scoring system that predicts in-hospital mortality following major cardiac surgeries. It was found that it overestimated mortality greatly, while another study found that the revised EuroSCORE II system was a better predictor of mortality. Overall, we note that both versions usually overestimate mortality. Conclusion: There seems to be an overall agreement over several factors, including older age, decreased ejection fraction, and the expertise of the surgeon and the institution on being clear predictors of postoperative mortality. There is also an obvious need for new tools to better predict mortality rates preoperatively, as the currently used scores often result in greatly inaccurate predictions

Fibrolamellar carcinoma (FLC) is a rare liver cancer that predominantly affects young adults without liver disease. Its typical symptoms include abdominal pain, palpable mass, and/or generalized signs such as weight loss and fatigue. Although patients with localized FLC frequently experience favorable outcomes after surgical resection, the recurrence rate is high. For patients with metastatic or unresectable FLC, alternative treatments such as chemotherapy and radiation are considered; however, standardized treatment protocols remain scarce. This case report describes a 24-year-old man with de novo metastatic FLC and peritoneal involvement. The patient was administered various therapies, including atezolizumab and bevacizumab combination therapy; lenvatinib, folinic acid, fluorouracil, oxaliplatin; and folinic acid, fluorouracil, irinotecan plus bevacizumab. The response to each regimen varied, ranging from initial response followed by disease progression to no response at all. Although metastatic FLC is an uncommon disease, it presents a substantial challenge to patients and healthcare professionals due to the absence of well-established guidelines. In addition to numerous published cases, this case report may offer clinicians valuable insights into the management of FLC.

Background: Malignant mesothelioma is a rare, lethal neoplasm of mesothelial surfaces, classically attributed to asbestos exposure. However, as regulations have reduced asbestos use, there is an increased focus on non-asbestos-related causes. Among these, the chronic serosal inflammation characteristic of Familial Mediterranean Fever (FMF) has been reported in a few cases. Although a direct causal relationship has not yet been established, such cases are critical for identifying the potential long-term risks of chronic serosal inflammation. Here, we present the fourth documented case of pleural mesothelioma associated with FMF. Case presentation: A 55-year-old male patient with known FMF was admitted to the hospital with progressive shortness of breath and cough for one month. Physical examination and chest X-ray revealed a large left-sided pleural effusion. Thoracocentesis analysis demonstrated an exudative effusion with predominant lymphocytosis. A contrast-enhanced computed tomography (CT) scan showed pleural thickening with enlarged mediastinal lymph nodes. Positron emission tomography (PET) scan revealed avid pleural uptake (SUVmax = 7.5). A pleural biopsy was therefore performed, revealing epithelioid pleural mesothelioma. The patient had no known history of asbestos exposure. However, he was poorly compliant with colchicine treatment and experienced frequent episodes of serositis, occurring on average twice monthly. The patient underwent surgical resection followed by chemotherapy and is doing well 10 months after the initial presentation. Discussion: Many cases of FMF have been reported in association with peritoneal mesothelioma, but few have been linked to pleural mesothelioma. In this case, we highlight that chronic serosal inflammation, characteristic of untreated FMF, may represent a potential risk factor for non-asbestos-related malignant pleural mesothelioma. Larger-scale registry studies may be required to establish a statistically significant association. Conclusion: This case reinforces the hypothesis that uncontrolled FMF may predispose patients to malignant mesothelioma. The presence of such an association would further stress the importance of early recognition and management of FMF.

We aim to provide a focused update on the pathogenesis, various diagnostic triaging processes, and the comprehensive treatment modalities of differentiated thyroid carcinoma. PubMed and Google Scholar databases/search engines were utilized using pertinent keywords. We prioritized recent articles from the American Thyroid Association. The diagnostic modalities span imaging features, pre-operative fine-needle aspiration, molecular and genetic analyses on these aspirates and the histopathological evaluation of resected thyroid tissue. The management protocols are variable, including surgery, radioactive iodine therapy and medical management as adjuvant treatment options. The sequence and intensity of these treatments vary and are currently dynamic. The triaging approach differs and depends on assessment of multiple risk factors of these carcinomas. This review presents recent advances in diagnostic modalities, including molecular and genetic alterations, followed by surgical, radioiodine, and targeted medical therapies. It also addresses the current standard of care and discusses the “dynamic” decision-making process. In conclusion, DTC diagnosis and management exhibited significant changes in the last two decades. Preoperative assessment by aspiration cytology is well recognized and has become standardized with evidence-based risk of malignancy assessment, and consequently triage recommendations accordingly. The spectrum of molecular and genetic signature changes of DTC is expanding and becoming available to evaluate in the preoperative evaluation phase. We review and summarize the recent consensus guidelines for surgical, radioactive iodine and medical management of DTC. We offer a discussion on the recent “dynamic risk assessment” concept as well as its relationship with the aforementioned treatment modalities.