Surgical resection combined with chemotherapy offers the best chance of survival in pancreatic ductal adenocarcinoma (PDAC), but many will experience recurrence and early mortality. We examined soluble AXL (sAXL), a blood protein, for its ability to predict 6-month mortality after resection and compared it to CA19-9. Fifty-four patients with PDAC who underwent tumour resection were analyzed to assess biomarker performance and identify optimal cut-off levels. The cut-off for sAXL was 40.26 ng/mL (sensitivity 0.729; specificity 0.643), while it 253.3 U/mL for CA19-9 (sensitivity 0.591; specificity 0.621). Patients with sAXL > 40.26 ng/mL had a non-significant trend toward worse survival (log-rank p = 0.088). Univariate Cox regression revealed that high tumour grade (3 + 4) and positive resection margin significantly predicted early mortality. Multivariate Cox regression showed that sAXL > 40.26 ng/mL remained associated with 6-month mortality (hazard ratio 2.42, bootstrap 95% CI 1.15–5.65, p = 0.020), independent of high tumour grade (hazard ratio 4.02, bootstrap 95% CI 1.68–13.2, p = 0.002). These findings suggest that a preoperative blood test (sAXL) has utility for predicting futile surgery beyond the current standard, CA19-9, and can be incorporated into larger models to assist in risk stratification and follow-up planning.

Mucoid impaction of the bronchi is an uncommon benign condition that can closely mimic pulmonary malignancy on imaging. A woman in her 50s with a remote history of chest wall chondrosarcoma presented with chest pain and was found to have a new pulmonary mass with satellite nodules. Computed tomography (CT) and fluorodeoxyglucose positron emission tomography (FDG-PET) findings raised concern for metastatic disease or primary lung cancer. Given the radiological suspicion and the patient’s oncological history, surgical resection was undertaken. Intraoperative lymph node sampling was negative for malignancy. Histopathological examination of the lung specimen demonstrated dense mucoid impaction with eosinophils and Charcot–Leyden crystals, with no evidence of neoplasia. This case highlights the limitations of imaging alone in differentiating benign from malignant pulmonary lesions and reinforces the importance of histopathological confirmation before definitive oncological management.