The Journal of Pathology

Introduction Conjunctival melanoma (CM) is a rare cancer with a potentially high recurrence rate. The mechanics of its progression, its relationship with neighboring tissues, and its molecular characteristics are largely unknown. Diagnosis currently requires a biopsy and the time and expertise of a pathologist. Methods Archived human biopsies containing CM were submitted to Xenium spatial transcriptomic analysis. Regions were graded by disease progression through histopathology. Differential expression (DE) and composition analysis were performed across disease states. Results From three patients, 12 formalin-fixed paraffin-embedded (FFPE) tissue specimens were recovered. Composition analysis showed that melanoma depletes fibroblast and epithelial cells while melanocytes proliferate. DE signatures specific to each state show a clear pattern of progression from inflammation, to cellular restructuring, and then to tumor progression and malignancy. Conclusion Spatial transcriptomics allows single-cell transcriptomics techniques to compare spatially relevant annotations that are difficult to separate by library. This study proposes disease progression biomarker candidates that may elucidate the mechanics of CM progression and function as objective diagnostic and prognostic tools in the future.

Introduction. TAC/SARIFA has been introduced as a new robust and easy-to-evaluate biomarker in several cancer entities, including colorectal cancer. It is defined by direct contact between at least five tumour cells and one adipocyte and is believed to indicate metabolic reprogramming associated with adverse outcome. However, the mechanism that leads to TAC/SARIFA positivity remains unclear. To investigate whether there is an individual component, we conducted a study on double and triple cancers, establishing a within patient design. Methods. We retrospectively analysed a total of 135 cases with 276 colorectal cancers from two academic medical centres. The TAC/SARIFA status was evaluated, as were the basic histopathological factors. The median follow-up time was 120 months. Results. Cases with any TAC/SARIFA positive tumours showed significantly reduced overall survival (62 vs. 88 months; p = 0.011). Analysing the entire cohort, the rates of concordant and discordant cases followed a random distribution. However, restricting the analysis to synchronous pT3/4 cases revealed a significant deviation from a random distribution (p = 0.016). Conclusion. This study reveals significant concordance of TAC/SARIFA status in synchronous locally advanced colorectal double/triple carcinomas, supporting the concept that tumour adipocyte interaction reflects a host related microenvironmental condition linked to metabolic reprogramming rather than a purely tumour intrinsic event.

Background: Single cell RNA sequencing provides a wealth of information to explore the complexities of the tumour microenvironment, but crucially the spatial topology of the tumour is lost and studying cellular interactions is limited. Spatial transcriptomics aims to address this however the technique remains cost prohibitive for the generation of data from meaningfully-sized clinical cohorts. In contrast, spatial proteomic profiling with multiplex immunofluorescence, preserves spatial interactions, is relatively cost accessible, and is scalable for large clinical cohorts to address powerful translational questions. Whilst multiplex approaches have advanced in recent years, we note that cancer-associated fibroblasts (CAFs) have been explored in less detail, potentially due to difficulties associated with CAF heterogeneity and the diversity of markers used to define them. Methods: We designed, optimised, and validated a multiplex immunofluorescence panel that combines four frequently used CAF markers; alpha smooth muscle actin (aSMA), fibroblast activation protein (FAP), podoplanin (PDPN) and platelet-derived growth factor receptor alpha (PDGFRa) with CD8 and pan-cytokeratin. Here we share our methodology and the practical considerations taken to inform the final panel design. We also highlight the benefits of robust optimisation experiments.

Structural AbstractO_ST_ABSBackgroundC_ST_ABSTriple-negative breast cancer (TNBC) represents a major clinical challenge due to its aggressiveness, heterogeneity and limited availability of effective targeted therapy. We investigated whether LRP-1, a multifunctional cell-surface endocytic and signaling receptor, contributes to TNBC progression. MethodsUsing CRISPR-Cas9, LRP-1-deficient murine 4T1 and human HS578-T TNBC cells were used. Functional consequences were assessed through migration, invasion, and 3D spheroid assays, imaging of focal adhesions and actin organization, atomic force microscopy, and plasmin activity assays. Global molecular reprogramming was analyzed by label-free quantitative proteomics and secretomics. LRP-1-deficient or proficient 4T1 cells were implanted orthotopically in immunocompetent mice; tumor progression was monitored longitudinally while peritumoral collagen architecture and immune microenvironment composition were characterized by second harmonic generation imaging and immunohistochemistry. ResultsWe show that LRP-1 loss reduces TNBC aggressiveness, as reflected by decreased migration and invasive capacity, reduced spheroid evasion, and significant morphological changes in focal adhesion and actin structure. LRP-1-deficient cells became stiffer and showed lower LOXL-4 levels, while pericellular proteolytic activity remained unchanged, suggesting other proteases mechanism. Multi-omic analysis revealed alterations in extracellular matrix (ECM), epithelial-mesenchymal transition, and inflammatory pathways. In vivo, LRP-1-deficiency reduced tumor progression and peritumoral collagen deposition, while increasing CD8+ T and Natural Killer cell infiltration, together with a cytokine profiling compatible with a more immune-permissive microenvironment. ConclusionsLRP-1 act as a key contributor in TNBC progression through matrix remodeling, mechano-adaptation, and immune exclusion. Positioning it as a candidate biomarker for TNBC patients who are likely to benefit from stroma-targeting therapies. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=113 SRC="FIGDIR/small/732906v2_ufig1.gif" ALT="Figure 1"> View larger version (60K): org.highwire.dtl.DTLVardef@1b595c2org.highwire.dtl.DTLVardef@7b208aorg.highwire.dtl.DTLVardef@1956e54org.highwire.dtl.DTLVardef@17e55d0_HPS_FORMAT_FIGEXP M_FIG C_FIG

Pancreatic ductal adenocarcinoma (PDAC) is currently the third leading cause of cancer-related deaths in the United States. Intraductal papillary mucinous neoplasms (IPMNs) are neoplastic lesions of ductal origin that seed 10-25% of PDAC. There are currently no markers that distinguish between IPMN that will remain benign and those that will progress to cancer. A heterogenous population of secretory cells, including chemosensory tuft cells and hormone-expressing enteroendocrine cells (EECs), form during metaplasia and neoplastic progression in the pancreas, but the relevance of these populations as it relates to IPMN progression is not well characterized. Here, we performed spatial transcriptomics as well as multiplex immunostaining and spatial statistics on surgically resected IPMN from 60 patients to characterize these populations in all subtypes (gastric foveolar, intestinal, pancreatobiliary) and grades (low-grade, high-grade, invasive). We found that POU2F3+ tuft-like cells, CHGA+ EECs, and a subset of pancreatic endocrine cells ([a] and {gamma} cells) were present in all types of IPMN. Further, serotonin-expressing enterochromaffin cells made up the bulk of EECs in low-grade disease. Enterochromaffin, tuft-like, and glucagon-expressing alpha cells were not evenly distributed and instead were significantly enriched in a spatial manner, which is overlooked using conventional whole tissue quantification approaches. Tuft-like cell clusters were enriched with monocytes and resident memory T cells and anti-correlated to activated fibroblasts (myCAFs, iCAFs). Overall, these secretory cell clusters may reflect clonal expansion resulting in formation of distinct stromal niches with unknown consequences for disease progression.

The spatial arrangement of immune cells in the tumor microenvironment (TME) varies widely, from dispersed to clustered and tumor excluded to infiltrating. Multiplexed spatial profiling is an effective means of characterizing tumor-infiltrating lymphocytes (TILs) and immune complexes such as tertiary lymphoid structures (TLS) in the TME. However, few approaches have been described for objectively parametrizing patterns of immune organization and assessing their association with biological or clinical variables. This makes it difficult to evaluate whether a set of tumors is relatively immunologically cold or hot. Here we describe an intuitive set of statistical tools (available in the R package, tlsR) for characterizing lymphocyte patterns in the TME of solid cancers. We apply tlsR to primary prostate cancer (PCa), which is often described as immunologically cold. Using a cohort of 29 radical prostatectomy specimens stratified into low Gleason-grade (LGG; n=15) and high Gleason-grades (HGG; n =14) we show that HGG PCa is significantly more infiltrated than LGG PCa with lymphocytes organized into B cell or T cell enriched immune clusters (BICs and TICs). A subset of these ICs have the B and T cell zonation and follicular dendritic cells characteristic of a bona fide TLS. HGGs are also enriched with ICs containing precursor exhausted T cells (Tpex) and proliferating B cells and their tumor compartments harbor granzyme-B+ cytotoxic T cells in contact with cancer cells. Thus, far from being cold, a subset of HGG PCa has features associated with active immune surveillance, a finding with implications for emerging PCa immunotherapies.

Pancreatic ductal adenocarcinoma (PDAC) exhibits extensive molecular and microenvironmental heterogeneity, yet how tumor lineage states interact with spatial immune organization in advanced disease remains poorly understood. Here, we performed multiplexed spatial proteomic profiling using tissue cyclic immunofluorescence (t-CyCIF) in 27 patients with advanced PDAC and integrated these analyses with spatial transcriptomic profiling of representative tumors. Tumors were classified into Classical, Hybrid, Basal, and Null epithelial states based on GATA6 and CK5 expression, revealing distinct immune architectures associated with clinical outcome. Classical and Hybrid tumors displayed immune-inflamed microenvironments enriched for lymphocytes, whereas Basal and Null tumors exhibited immune-excluded, macrophage-dominated landscapes characterized by increased M2 macrophages. Spatial transcriptomic analysis further revealed that Hybrid tumors were not homogeneous intermediate states but instead contained spatially segregated Hybrid_Classical and Hybrid_Basal regions with distinct transcriptional programs, immune niches, and cell-cell communication networks. Hybrid_Basal regions were associated with increased M2 macrophage enrichment and preferential activation of macrophage-derived SPP1-CD44 signaling, implicating localized immune-epithelial interactions in epithelial plasticity and lineage-state transitions. To quantify spatial immune organization, we developed a spatial immune score that captures the relative positioning of CD8 cytotoxic T cells with respect to CD4 helper T cells and CD163 M2 macrophages. Higher scores were associated with worse survival and provided stronger prognostic information than conventional immune cell abundance metrics. Integration of the spatial immune score with GATA6 expression achieved superior prognostic discrimination (AUC = 0.822) compared with either feature alone. Together, these findings demonstrate that tumor lineage state and spatial immune organization represent complementary dimensions of PDAC biology and highlight spatial tumor-immune interactions as determinants of clinical outcome in advanced pancreatic cancer. SummaryPancreatic ductal adenocarcinoma (PDAC) exhibits marked molecular and microenvironmental heterogeneity, yet how tumor lineage states interact with the spatial immune microenvironment in advanced disease remains poorly understood. Here, the authors apply multiplexed spatial proteomics and spatial transcriptomics to advanced PDAC and show that epithelial lineage states defined by GATA6 and CK5 are associated with distinct immune architectures and macrophage-enriched signaling niches. Hybrid tumors contain spatially segregated epithelial states with differential immune engagement and SPP1-CD44 signaling. The authors further identify a spatial immune score based on the relative positioning of CD8 T cells, CD4 T cells, and M2 macrophages that predicts patient survival. Integration of spatial immune organization with tumor lineage information improves prognostic stratification, highlighting the clinical relevance of spatial tumor-immune interactions in advanced PDAC.

Autoimmune hepatitis (AIH) is a chronic progressive liver disease that despite suggestive serum autoantibodies or plasma cell enrichment, remains functionally a diagnosis of exclusion. Whether the broader cellular composition of the liver might enable improved specificity of diagnosis has not been systematically tested. We prospectively recruited patients undergoing a clinically-indicated liver biopsy for suspected AIH and performed single-nucleus RNA sequencing (snRNA-seq) on biopsy tissue to map the cellular landscape of AIH and its diagnostic mimics. Unsupervised clustering on cell-type abundances alone largely separated AIH from non-AIH samples. Among individual populations, a subset of CD8 T-cells marked by high TOX and PD1 expression was the most discriminating feature: its enrichment perfectly distinguished AIH by both snRNA-seq and in situ density (AUC = 1.00), outperforming plasma cell abundance (AUC = 0.83). CD8TOX T-cell enrichment may therefore be the histologic lesion that marks the diagnosis of AIH.

Glandular architecture - the coordination of lumen-containing structures by an apical-basal polarised epithelium - is frequently maintained in colorectal cancer (CRC), yet whether it actively contributes to tumour progression or metastatic competence remains unclear. Here, we identify Podocalyxin (PODXL), a developmental regulator of epithelial lumen formation, as a key determinant of glandular tumour architecture in CRC. PODXL is upregulated in CRC, particularly in poor-prognosis Consensus Molecular Subtype 4 (CMS4) tumours, where high expression predicts reduced survival. Using genetically engineered mouse models, matched organoids, human cell lines and xenografts, we show that PODXL promotes organisation of CRC cells into gland-like, lumen-containing structures. Loss of PODXL disrupts glandular architecture in both primary tumours and liver metastases, reducing tumour growth and metastatic colonisation. Mechanistically, TGF-{beta} signalling drives PODXL upregulation. Together, these findings establish glandular architecture as an active determinant of CRC progression and identify PODXL as a functional contributor rather than merely a prognostic biomarker.

Purpose: To develop and validate a temporal deep learning framework for predicting geographic atrophy (GA) progression across multi-year horizons using longitudinal optical coherence tomography (OCT) sequences. Design: Retrospective longitudinal cohort study. Subjects, Participants, and/or Controls: A total of 91 patients with dry age-related macular degeneration (AMD) were identified from Wake Forest University School of Medicine (2013-2023), yielding 455 OCT volumes. Two prediction cohorts were defined: 32 patients with no GA (NGA) at baseline who subsequently developed GA, and 35 patients whose earliest GA manifestation was non-central GA (NCGA). Non-progressing patients served as negative controls. Methods: OCT B-scan volumes were encoded into visit-level feature representations using three pretrained architectures (ResNet-18, ResNet-50, ViT-B/16). Chronologically ordered visit embeddings, optionally augmented with inter-visit time intervals ({Delta}t), were processed through recurrent neural networks (RNN), long short-term memory networks (LSTM), and Transformer encoders to model longitudinal disease trajectories. Models were trained and evaluated independently for prediction horizons of 2, 3, 4, 5, and 6 years using patient-level stratified splits (80/20). Performance was assessed across five random seeds. Main Outcome Measures: Area under the receiver operating characteristic curve (ROC-AUC), F1-score, and accuracy for predicting two clinically critical transitions: NGA to GA onset and NCGA to central GA (CGA) involvement. Results: For NGA to GA prediction, models achieved ROC-AUC of 0.84-0.94 at 2-4 years and 1.00 at 5-6 years. For NCGA to CGA prediction, Transformer-based models achieved peak AUC of 0.95 at 4 years and 0.96 at 5 years. Longer input sequences (8 visits vs. 4 visits) consistently improved NCGA to CGA performance at extended horizons. Temporal interval encoding improved stability in several LSTM configurations.

Merkel cell carcinoma (MCC) is a neuroendocrine skin tumor that is frequently driven by integration of Merkel cell polyomavirus (MCPyV). In MCC, the MCPyV genome is truncated, but expression of the viral tumor antigens, truncated large tumor antigen (LTT) and small tumor antigen (sT), is maintained and drives uncontrolled proliferation. We introduced constitutive expression of the MCPyV T antigens (TAs) into primary mouse dermal fibroblasts (MDFs) to determine whether these cells are susceptible to MCPyV-driven transformation. TA expression alone in MDFs induced key MCC markers, cytokeratin-20 (CK20) and Sry-box transcription factor 2 (SOX2), and promoted anchorage-independent growth indicative of cellular transformation. Subcutaneous implantation of TA-transformed fibroblasts produced high-grade MCC-like tumors that grew persistently in immunodeficient NSG mice but not in immunocompetent C57BL/6 mice. Serial in vivo passaging of the tumor cell line enhanced tumor growth, reduced expression of p53-target genes and MHC-1, and was accompanied by a shift in T antigen isoform expression, with decreased LTT and increased sT expression. Our data demonstrate that MCPyV-driven tumors acquire immune-evasive adaptions during tumor progression in vivo and suggest that the anti-tumor immune response exerts selective pressure in MCC that favors expression of sT rather than LTT. The model established in this study provides a unique platform for studying evolution of MCPyV-driven tumors under immune pressure and identifying mechanisms of immune evasion in MCC that could be used to develop new therapeutic strategies. Significance StatementMCPyV tumor antigen expression transforms mouse dermal fibroblasts to generate MCC-like tumors. Serial in vivo passaging reveals tumor evolution under immune pressure, providing a model to study immune evasion mechanisms in MCC.

Background: Ewing sarcoma (EwS) is a highly aggressive bone and soft tissue cancer mainly affecting children, adolescents, and young adults. The rarity of the disease, relatively small cohort sizes of prior studies, and overall low mutational burden of EwS have limited the ability to establish robust correlations of genomic findings and clinicopathological factors. Methods: To overcome these limitations, we integrated genomic and clinical data from the seven major sequencing studies encompassing 538 EwS patients. Mutational profiles (SNV, indels and CNVs), and their correlation with clinicopathological features in the aggregated cohort were systematically analyzed to provide an integrated view of the EwS genomic landscape. Results: This study compiles the largest EwS genomic dataset reported to date. In the aggregated cohort (n=538) bone tumors were more common (65.4%) than soft-tissue tumors (34.6%), the latter being more frequent in older male patients and associated with poorer outcomes. EWSR1::FLI1 was the most prevalent fusion (87.2%). No major clinicopathological differences were identified between fusion types. The mutational landscape was dominated by STAG2 (15.6%) and TP53 (7.1%) alterations, associated with younger or with older age at diagnosis and poor survival, respectively. Strikingly, the coexistence of STAG2 and TP53 mutations, although rare (n=12), was associated with lethal outcome in all cases. CDKN2A loss (9.1%) was associated with older age, poor survival, and linked to a higher frequency of TP53-mutations in soft tissue EwS. Among frequent CNVs, gain of chr1q (25.2%) and loss of chr16q (21.9%) were per se frequently associated with fatal outcome and their co-occurrence further increased the risk of lethality. Conclusions: We delineate recurrent genomic alterations with important clinicopathological associations, including a uniformly lethal STAG2/TP53 co-mutation and CNV signatures marking aggressive disease. This comprehensive pooled analysis of EwS genomic studies provides a foundation for refined biological risk-stratification.

Germline pathogenic or likely pathogenic variants (GPVs) in BRCA-1 Associated Protein 1 (BAP1) are associated with a spectrum of tumors, including uveal melanoma (UM). Currently, UM patients with BAP1 GPVs are treated as high-risk class 2 tumors based on mostly empiric data. In the current study, we examined the clinical phenotype of a cohort of 29 UM patients with BAP1 GPVs. We also carried out a systematic review of the literature of UM patients with BAP1 GPVs. We observed that UM patients with BAP1 GPVs have significantly lower median age of diagnosis compared to median age reported in UM patients in the Surveillance, Epidemiology, and End Results Program (SEERS) database. Metastatic risk and overall survival in the UM BAP1 GPVs cohort were statistically significant from those in patients with class 1 tumors, but were comparable to those observed in UM patients with class 2 tumors. In UM BAP1 GPVs treated with radiation (n=12), no secondary cancers were observed in the field of radiation in a median 26.5 months (range, 4-119 months) follow up period. One patient experienced a separate growth of UM at a distinct location within the same eye. These data support managing UM in patients with BAP1 GPVs as aggressive class 2 tumors, following the currently established standard of care for these high-risk tumors.

Abstract Purpose: To expand the clinical and mechanistic understanding of the +57C>T seed-region mutation in miR-184 causing EDICT (endothelial dystrophy, iris hypoplasia, congenital cataract, and stromal thinning) syndrome. Design: Cross-sectional analysis and laboratory confirmation Participants: 18 members of a four-generation family with known +57C>T miR-184 status Methods: We used optical biometry, corneal topography, and medical history to characterize the clinical phenotype. Carrier effects on ocular biometric measurements were estimated using polygenic linear mixed models incorporating a pedigree-derived kinship matrix, adjusted for age and sex. Patient-derived and control induced pluripotent stem cells (iPSCs) were generated and differentiated into corneal endothelial cells (CECs). Main Outcome Measures: Axial length, keratometry (in diopters), white-to-white corneal diameter, topography mapping, central and peripheral corneal thickness, and history of retinal detachment or corneal transplant were compared between mutation carriers and noncarriers, adjusting for age and sex. Cellular analysis was conducted with immunostaining (ZO-1, ATP1A1), morphometric quantification, qRT-PCR of endothelial markers, and transendothelial electrical resistance (TEER). Results: 10 of 18 family members were heterozygous for +57C>T, with retinal detachment occurring in 5/10 affected individuals compared to 0/8 unaffected individuals (p=0.04). Affected eyes had 2.2 mm shorter axial length (p=0.02), 9.3 D steeper mean keratometry (p=0.004), 1.6 mm smaller horizontal corneal diameter (p=0.0001), and 139-micrometer thinner central corneas (p=0.003). Mutant iPSC-derived CECs were associated with irregular borders, increased cell and nucleus area, widened intercellular gaps, disrupted ATP1A1 membrane localization, and reduced barrier function on TEER (all p<0.05). Gene expression analysis showed downregulation of COL4A1, COL4A3, and AQP1 with upregulation of COL8A1. Conclusions: The miR-184 +57C>T mutation produces a broad ocular phenotype that includes smaller, thinner corneas and microphthalmia. Mechanistically, it disrupts CEC junctional integrity, extracellular matrix and pump-related genes, supporting a role for miR-184 in coordinated anterior-posterior eye morphogenesis.

High-grade squamous intraepithelial lesions (HSIL) of the uterine cervix result from transformation by high-risk human papillomavirus (HR-HPV) and are considered precancerous lesions. Depending on the proportion of the epithelium occupied by dysplastic cells, commonly evidenced by a block-like p16INK4a staining pattern, HSIL are subdivided into CIN2 or CIN3. We used immunohistochemistry (IHC) and laser-capture microdissection (LCM) to further characterize these lesions. Broad suprabasal expression of S100A9, a component of the epidermal differentiation complex (EDC), which we had previously found to be up-regulated in genus-beta-HPV-positive skin lesions, was present in the normal exocervix and declined gradually with increasing CIN grade. In CIN2 in particular, the S100A9 staining pattern was nearly complementary to the block-like p16INK4a expression. However, it largely coincided with the expression of CD63, a marker showing strong expression in cervical crypts and in columnar cells within the normal transformation zone, also those overlying reserve cells. We then used LCM to analyze both the p16INK4a- and S100A9/CD63-positive compartments in HSIL separately. Notably, in all samples investigated, we detected the same HR-HPV type (either HPV16, 45 or 51) in both compartments of the same HSIL, while tissue samples dissected from normal exocervix or transformation zone were consistently HR-HPV-negative. Our data suggest that the upper, S100A9-positive maturing compartment of HSILs retaining weak CD63 expression may represent a residual, HR-HPV-infected columnar-cell-derived epithelium, rather than not-yet-transformed squamous epithelium that is progressively being replaced by dysplastic cells. The two-compartment architecture of these HSILs was reminiscent of the staining pattern in the normal transformation zone, where columnar cells overlie reserve cells, and compatible with HR-HPV infection of columnar-derived cells but transformation of reserve cells, the putative origin of cervical squamous cell carcinoma. Our findings have direct clinical implications. Since the upper and lower layers of HSIL appear to form distinct epithelial compartments, our study suggests that the extent and thickness of the HR-HPV-transformed lower compartment itself, rather than the proportion of the epithelium occupied by dysplastic layers, may be the decisive factor in determining the HSIL grade.

Purpose DICER1-mutant primary intracranial sarcoma (PIS-DICER1) is a rare, recently defined high-grade intracranial tumor. This systematic review and meta-analysis aimed to comprehensively investigate its imaging characteristics to improve preoperative diagnostic accuracy and facilitate differential diagnosis. Methods A systematic literature search was conducted in PubMed and Web of Science for studies published up to December 31, 2025. Original studies with pathologically and molecularly confirmed PIS-DICER1 and detailed imaging data were included. Imaging features, including tumor location, margin definition, meningeal contact, intratumoral hemorrhage, enhancement pattern, cystic components, peritumoral edema, and advanced imaging findings (SWI, DWI, MRS, PWI), were extracted and analyzed. Pooled proportions with 95% confidence intervals (CIs) were calculated using a random-effects model. Results Twenty-four studies comprising 110 patients with detailed imaging data were included. The pooled mean age was 18.6 years (95% CI: 15.2-22.0), with a slight female predominance (53.3%, 96/180). Tumors were predominantly supratentorial (87%, 95% CI: 80%-93%). Substantial heterogeneity was observed across studies for location (I2 = 78%). Intratumoral hemorrhage was observed in 85% (95% CI: 78%-91%). Contrast-enhanced MRI demonstrated heterogeneous enhancement in all cases (100%, 95% CI: 96%-100%). Due to sparse data, advanced MRI features could not be quantitatively synthesized, underscoring a critical knowledge gap. Conclusion PIS-DICER1 exhibits imaging features including supratentorial location, intratumoral hemorrhage, heterogeneous enhancement, well-defined margins, and meningeal involvement. These features, particularly in children and young adults with hemorrhagic supratentorial masses, should prompt differential diagnosis. Definitive diagnosis requires molecular confirmation, but recognition of these characteristics facilitates diagnosis and preoperative planning.

Analyses of human breast carcinomas (BCs) and premalignant breast lesions show that the loss of RASSF1A is an early event in the development of ER+ BCs, which correlates linearly with malignant progression. This observation suggests that RASSF1A inhibition is important for the development and progression of ER+ BCs. In addition to RASSF1A, concurrent caveolin-1 (Cav-1) inhibition may further promote ER+ breast carcinogenesis. In the present study, transgenic Rassf1a-/- and Cav-1(-/-) single as well as Rassf1a-/-, Cav-1(-/-) double knockout mice were used to investigate the impact of single or combined Rassf1a and Cav-1 inactivation on BC initiation. Loss of either one or both proteins led to different, pre-malignant histopathological alterations within the mammary glands of the mice, but not to fully developed BC, confirming that Rassf1a and Cav-1 are both important for maintaining the integrity of mammary gland epithelial structure, but suggesting that further intracellular changes or extracellular factors are required for the development of luminal BC when both genes are lost.

Pancreatic ductal adenocarcinoma (PDAC) exhibits a desmoplastic stroma with context-dependent tumor-restraining and tumor-promoting functions, highlighting the need to selectively reprogram stromal states. Although intratumoral coagulation activity is frequently observed, its role in driving these states remains unclear. Here, we identify extravascular coagulation as a tumor-amplified regulatory module that stabilizes pro-fibrotic stromal states via tumor-intrinsic protease-activated receptor-1 (PAR1) signaling. To establish clinical relevance and enable mechanistic interrogation, we combined human tumor bioinformatics with a cross-scale experimental workflow integrating microphysiological tumor-stroma (MPTS) models and in vivo systems to define and test this regulatory axis. Analysis of The Cancer Genome Atlas (TCGA) revealed heterogeneous F2R (PAR1) expression across tumors, with elevated expression associated with fibrotic transcriptional programs and reduced survival. Consistently, thrombin induced coordinated pro-fibrotic programs in tumor cells and cancer-associated fibroblasts (CAFs), which were recapitulated in microphysiological models where tumor-intrinsic PAR1 was required for amplification of extracellular matrix deposition and CAF activation. Mechanistically, PAR1 signaling amplified tumor-stroma communication, in part through induction of TGF-{beta}1-dependent pathways, establishing a reinforcing feedback loop that stabilizes fibrotic remodeling. Pharmacologic inhibition of PAR1 suppressed pro-fibrotic CAF states, reprogrammed stromal states and attenuated tumor progression across microphysiological and in vivo models. These findings establish extravascular coagulation as a systems-level regulator of stromal state architecture in PDAC and define a cross-scale framework for targeting tumor-stroma regulatory circuits.

Objective: To investigate the performance of anterior segment (AS) OCT quantitative imaging of anterior chamber inflammation in uveitis patients with diverse demographics. Design: Prospective cross-sectional study. Participants: 144 adult patients managed at a tertiary care service in the UK Methods: Repeated swept-source ASOCT imaging was performed pre- and post-pupil dilation (i.e. 4 scan sets). Inflammation was quantified using a validated human in the loop automated image analysis pipeline, Minuscule Cell Detection (MCD), which identified and counted putative inflammatory cells on AS-OCT. Main Outcome Measures: Test-retest variability of ASOCT and diagnostic accuracy of various ASOCT derived measurands (minimum, maximum, median counts per cross sectional image, and total counts across volume image sets per eye or MINCC, MAXCC, MEDCC and TOTCC) versus Standardization of Uveitis Nomenclature (SUN) grading system as assessed by a uveitis specialist. Results: A total of 281 eyes were included in the analysis. Median age was 48 years (IQR 36 to 64). Strong test-retest measurand reliability was demonstrated, with a 95% tolerance interval ratio 0.3 to 3.0. The best diagnostic performances for SUN activity were observed with the MINCC threshold of 3 particles (negative predictive value for clinical activity of 89.8%, 95% CI 83.0 to 94.1). Associations between ASOCT measurands and patient age (adjusted coefficient 7.5 additional particles, 95% CI 0.5 to 14.6, p<0.04 for age over 60 years versus under 44), and pigment load (52.8, 11.8 to 92.9, p<0.01 in eyes with AC pigment versus without) were noted. Conclusions: ASOCT assessment of anterior chamber inflammation in uveitis meets current recommendations for quantitative imaging biomarkers, demonstrating strong repeatability, linearity with clinical assessment scores and stability with pupil dilation and patient characteristics of ethnicity and lens status. The absence of variability in diagnostic indices across derived measurands suggests similar performance across different acquisition protocols. Further longitudinal cross-platform studies are needed to determine limitations of use.

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a dense, desmoplastic microenvironment that drives disease progression, yet conventional models fail to capture this complex tumor-stroma coevolution. Here, we utilize the chick chorioallantoic membrane (CAM) platform to investigate tumor-stroma interactions using murine PDAC cell lines and patient-derived organoids (PDOs). Integrating single-cell RNA sequencing and spatial transcriptomics, we show that the CAM microenvironment supports the emergence of complex tumor ecosystems while preserving patient-specific characteristics. Within five days, in ovo tumors faithfully recapitulated the structural and molecular features of parental tumors. Histological analysis revealed the rapid recruitment and spatial organization of heterogeneous host cancer-associated fibroblast (CAF) populations, showcasing distinct myofibroblastic and inflammatory stromal states. Crucially, the model preserved intrinsic tumor heterogeneity and permitted functional interrogation of subtype-specific extracellular matrix remodeling and metastatic dissemination. Together, our findings demonstrate that the CAM provides a highly permissive niche for tumor-stroma coevolution. As a rapid, scalable, and biologically relevant platform, this in ovo model offers a powerful approach for studying stromal composition, metastatic progression, and patient-specific tumor biology in pancreatic cancer.