OBJECTIVES

The increasing prevalence of Kawasaki disease in Southeast Asia (SEA) and its potential relation with Coronavirus Disease 2019 (COVID-19) infection resulted in heightened interest in KD in the region, thus, this paper aimed to determine the trend and the socioeconomic facilitators of scientific productivity of KD research within the region. Specifically, this article determined the number of publication and citations related to KD per country, institution, and journal. We also explored the networks of countries within the region to the rest of the world and the keywords mostly associated with KD research in the region. Lastly, correlation of these bibliometric indices with socioeconomic factors in the region was analyzed.

METHODS

A literature search of KD papers in SEA was performed using Scopus database. We obtained bibliographic data from the available literature and visualized network of existing collaborations and keywords using VOSviewer software.

RESULTS

A total of 196 papers were included in the study. Bibliometric analysis showed a rising trend in publication within the region, most of which were from institutions in Singapore and Thailand. The most common topics on KD studies included clinical features, complications, treatment, and comorbidities. 

Country characteristics such as gross domestic product (GDP) per capita, research and development (R&D) expenditure (% GDP), and number of physician and R&D researchers were positively correlated with bibliometric indices of KD research in SEA. Moreover, number of international linkages was significantly associated with KD research productivity in the region. 

CONCLUSION

In summary, we showed an increasing trend of KD research in SEA. Funding allocation and capacity building are necessary to strengthen research productivity within the region.

Asia ; Asia, Southeastern ; Bibliometrics ; Capacity Building ; Coronavirus ; Covid-19 ; Database ; Disease ; Efficiency ; Gross Domestic Product ; Guanosine Diphosphate ; Infection ; Infections ; Literature ; Mucocutaneous Lymph Node Syndrome ; Paper ; Physicians ; Prevalence ; Publications ; Research ; Research Personnel ; Rest ; Singapore ; Socioeconomic Factors ; Software ; Thailand ; Therapeutics

BACKGROUND

Early-stage endometrial cancer often presents with favorable survival rates, but high-risk factors, including TP53 mutations and high-grade serous pathology, can lead to recurrence and poor prognosis. The standard primary treatment for endometrial cancer is surgical staging, and lymph node metastases significantly impact adjuvant therapy decisions. The subgroup of p53-abnormal (p53abn) indicates the worst prognosis and potential benefits from adjuvant chemotherapy. Molecular classification, while recommended, faces practical challenges due to resource constraints.

OBJECTIVES

The study aimed to assess the incidence of p53 abnormal expression in clinical stage 1 endometrial cancer cases that underwent surgery at a government tertiary hospital, and assess its relationship with clinicopathologic factors and pelvic and paraaortic lymph node metastasis (LNM).

METHODS

A cross-sectional retrospective analysis was conducted on clinical early-stage endometrial cancer cases that underwent surgical primary treatment between January 2018 and December 2022. Patient records were reviewed to gather demographics, surgical information, and pathological evaluations. Preoperative clinical staging was determined through imaging, and surgical staging involved comprehensive lymphadenectomy. Immunohistochemistry studies for p53 were carried out on formalin-fixed paraffin-embedded tissue samples.

RESULTS

A total of 233 endometrial cancer cases were included. The mean age at diagnosis was 53.7 years. Common comorbidities included hypertension (47.2%) and dyslipidemia (20.6%). Most cases were endometrioid histology (82.8%) and low-grade tumors (85.8%). Tumor grade (p=0.010), myometrial invasion (p<0.001) and lymphovascular space invasion (p<0.001) significantly correlated with lymph node metastasis. However, tumor size and p53abn were not significantly associated with lymph node metastasis. p53abn overexpression was significantly associated with non-endometrioid histology at 33% and Grade 3 tumors at 23%. Preoperative grading demonstrated moderate reliability (0.51) with postoperative grading, with an agreement of 65.4%.

CONCLUSION

Tumor grade, myometrial invasion, and LVSI were all significantly associated with lymph node involvement. While p53 immunohistochemical stains show promise in predicting metastasis and has been associated with tumor aggressiveness, this should still be correlated with clinicopathological parameters to carry out a more accurate risk stratification of early-stage patients.

Therapeutics ; Survival Rate ; Risk Factors ; Recurrence ; Prognosis ; Pathology ; Endometrial Neoplasms ; Immunohistochemistry ; Tumor Suppressor Protein P53 ; Lymph Node Excision ; Risk Assessment

BACKGROUND

Penile squamous cell carcinoma (SCC) is rare in high-income regions but remains a significant oncologic burden worldwide. Nodal involvement is the most important prognostic factor, and early identification is critical.

THE CASE

A 56-year-old circumcised male presented with a six-month history of a progressively enlarging, foul-smelling fungating penile mass and bilateral inguinal lymphadenopathy. Biopsy confirmed moderately differentiated SCC. Imaging showed large bilateral inguinal nodal disease without distant metastasis. Laboratory findings revealed leukocytosis, thrombocytosis, and mildly deranged coagulation parameters. The patient underwent total penectomy with perineali urethrostomy, followed by bilateral inguinal and pelvic lymph node dissection through single-curvilinear incisions. Frozen-section analysis confirmed extensive bilateral nodal metastasis. Postoperatively, a localized left inguinal surgical site infection was treated conservatively. He was discharged on postoperative day seven with drains in situ and was recommended adjuvant chemoradiotherapy in accordance with NCCN Guidelines.

CONCLUSION

This case highlights the challenges of managing advanced penile SCC with bulky bilateral inguinal metastasis and demonstrates the utility of single-curvilinear inguinal incisions for comprehensive lymphadenectomy. Early recognition, accurate staging, and guideline-based multimodal treatment remain essential for optimizing outcomes.

Human ; Male ; Middle Aged: 45-64 Yrs Old ; Carcinoma, Squamous Cell ; Lymph Node Excision

INTRODUCTION: Takayasu arteritis is the most common large-vessel vasculitis in childhood, but there is a lack of literature regarding childhood-onset Takayasu arteritis (c-TAK) in Southeast Asia. We aim to describe a c-TAK cohort in Singapore and highlight a unique subset that first presents with Kawasaki-like disease (KD). METHOD: A single-centre cohort study in Singapore of consecutive children diagnosed with c-TAK between 2002 and 2023 was performed. Demographic and clinical features, laboratory and angiographic findings, treatment, and outcomes were summarised. Disease activity was evaluated using the Paediatric Vasculitis Disease Activity Score and inflammatory markers. RESULTS: Twenty-three patients, fulfilling both the EULAR/ PRINTO/PReS and ACR/EULAR 2022 criteria, were recruited. The most common clinical features at diagnosis were fever (15, 65%) and neurological symptoms (11, 48%, half of which presented with stroke), while the most prevalent angiographic pattern by Hata's classification was Type V (21, 91%). Eight children (35%) initially presented with refractory KD, and these patients were significantly younger, more male-predominant, and had higher inflammatory markers at diagnosis; all of them had coronary artery involvement, but none had intracranial vascular findings. Of the entire cohort, 16 (70%) achieved inactive disease on medications with a median duration of 6 months (interquartile range [IQR]: 4-11), and 8 (35%) achieved remission off medications with a median duration of 43 months (IQR 35-60). CONCLUSION Our c-TAK cohort has high proportions of neurological involvement and stroke. This is also the first cohort study to describe a distinct group of patients who first presented with refractory KD.
Humans ; Takayasu Arteritis/complications* ; Singapore/epidemiology* ; Male ; Female ; Child ; Adolescent ; Age of Onset ; Mucocutaneous Lymph Node Syndrome/diagnosis* ; Cohort Studies ; Child, Preschool ; Fever/etiology* ; Stroke/epidemiology* ; Retrospective Studies

Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignant tumor with poor prognosis, and lymph node metastasis constitutes one of the critical risk factors contributing to unfavorable patient outcomes. Lymph node dissection holds significant value in accurately staging ICC, guiding prognostic evaluation, and determining adjuvant therapeutic strategies. In recent years, both domestic and international scholars have conducted extensive research on lymph node metastasis and dissection in ICC. However, discrepancies persist among various research findings and consensus guidelines domestically and internationally regarding the understanding and recommendations for lymph node dissection in ICC. Furthermore, substantial variations exist in the extent of lymph node dissection, the minimum number of lymph nodes required for retrieval, and surgical dissection techniques, which have consequently led to divergent research conclusions. To standardize the clinical practice of lymph node dissection for ICC in China and enhance the level of ICC diagnosis and treatment, the Branch of Biliary Surgery, Chinese Society of Surgery, Chinese Medical Association and Working Group of Biliary Surgeons, Chinese College of Surgeons, Chinese Medical Doctor Association, convened relevant experts to develop this expert consensus. This consensus document has been formulated based on the latest evidence-based medical research and accumulated clinical experience.
Humans ; Cholangiocarcinoma/pathology* ; Lymph Node Excision ; Bile Duct Neoplasms/pathology* ; Lymphatic Metastasis ; Consensus ; Prognosis

Thermal ablation has proven an effective treatment modality for certain thyroid diseases. However, its indications remain the subject of significant debate both domestically and internationally. Over recent years, several international academic organizations have issued consensus statements, position papers, and guidelines concerning thyroid thermal ablation. In China, the Chinese College of Interventionalists (CCI), in collaboration with other relevant academic organizations, released the "Expert consensus on thermal ablation for thyroid benign nodes, microcarcinoma and metastatic cervical lymph nodes (2018 edition)". This consensus statement received widespread recognition within the field and contributed significantly to the standardization of thyroid thermal ablation therapy in China. With the continuous accumulation of evidence-based medical data, the need for a more stringent and standardized approach to thyroid thermal ablation has become evident. Accordingly, the Interventional Ultrasound Committee of the CCI, in collaboration with multiple academic organizations and experts, conducted extensive discussions and multiple revisions before finalizing the "Multidisciplinary expert consensus on thermal ablation for benign thyroid diseases, low-risk thyroid carcinoma, and metastatic cervical lymph nodes (2025 edition)". This updated consensus builds on the framework of the 2018 edition, refining indications and contraindications, emphasizing standardized treatment, and outlining future directions for research and clinical applications of thyroid thermal ablation technology.
Humans ; Thyroid Neoplasms/surgery* ; Consensus ; Lymphatic Metastasis ; Lymph Nodes/pathology* ; Thyroid Diseases/surgery*

Objective To investigate the value of the novel lymphatic contrast-enhanced ultrasound(LCEUS)and conventional venous contrast-enhanced ultrasound(VCEUS)in the differential diagnosis of benign and malignant cervical lymph nodes in patients with thyroid cancer. Methods Patients with suspected thyroid cancer underwent conventional ultrasound,VCEUS,and LCEUS examinations of cervical lymph nodes before biopsy.The diagnostic abilities of conventional ultrasound,VCEUS,and LCEUS were compared with pathological results as the golden standard. Results Forty-four patients with 52 lymph nodes were included in the final data.Thirty-eight metastatic lymph nodes were confirmed by pathological results,and 14 were benign.The diagnostic sensitivity,specificity,and accuracy were 97.37%,71.43%,and 90.38% for LCEUS,92.11%,35.71%,and 76.92% for VCEUS,and 94.74%,21.43%,and 75.00% for conventional ultrasound,respectively.The area under the curve of LCEUS analyzed by the receiver operating characteristic curve was greater than that of VCEUS(P=0.020)and conventional ultrasound(P<0.001). Conclusion LCEUS could significantly improve the differential diagnosis of cervical lymph node metastasis in the patients with thyroid cancer,providing a basis for precise clinical treatment.
Humans ; Thyroid Neoplasms/diagnostic imaging* ; Lymphatic Metastasis/diagnostic imaging* ; Diagnosis, Differential ; Female ; Male ; Middle Aged ; Ultrasonography ; Adult ; Lymph Nodes/pathology* ; Contrast Media ; Neck ; Aged ; Young Adult ; Adolescent ; Sensitivity and Specificity

Objective To investigate the value of ultrasonographic features combined with immunohistochemistry in predicting axillary lymph node metastasis in middle-aged women with breast cancer.Methods A retrospective analysis was conducted on 827 middle-aged female breast cancer patients who underwent surgical treatment at the Affiliated Hospital of Chengde Medical University from June 2017 to June 2023.Ultrasonographic and immunohistochemical information was collected,and the patients were randomly allocated into a training set(579 patients)and a validation set(248 patients).Univariate and multivariate Logistic regression analyses were performed to identify ultrasonographic and immunohistochemical risk factors associated with axillary lymph node metastasis in these patients,and a nomogram model was developed.Receiver operating characteristic curves and calibration curves were established to evaluate the performance of the nomogram model,and clinical decision curves were built to assess the clinical value of the model.Results The maximum diameter,morphology,boundary,calcification,and expression of human epidermal growth facor receptor 2 and Ki-67 in breast cancer lesions were identified as risk factors for predicting axillary lymph node metastasis in middle-aged women.The areas under the curve of the nomogram model on the training and validation sets were 0.747(0.707-0.787)and 0.714(0.647-0.780),respectively.Calibration curves and clinical decision curves indicated good consistency and performance of the model.Conclusion The nomogram model constructed based on ultrasonographic features and immunohistochemistry of the primary breast cancer lesion demonstrates high value in predicting axillary lymph node metastasis in middle-aged women with breast cancer.
Humans ; Female ; Breast Neoplasms/diagnostic imaging* ; Middle Aged ; Lymphatic Metastasis/diagnostic imaging* ; Axilla ; Retrospective Studies ; Nomograms ; Ultrasonography ; Immunohistochemistry ; Lymph Nodes/diagnostic imaging* ; Risk Factors ; Ki-67 Antigen

Nodal marginal zone B-cell lymphoma(NMZL),the least common subtype of marginal zone lymphoma,represents a low-grade malignancy arising from the marginal zone of lymph node follicles,composed of small B-cells with an inert non-Hodgkin lymphoma nature.It accounts for 1.5% to 1.8% of all non-Hodgkin lymphomas and 10% of all marginal zone lymphomas.The low incidence and lack of typical clinical and pathological features pose a challenge to the diagnosis and clinical management of NMZL.In this article,we reported the diagnosis and treatment of a case of NMZL located in the parapharyngeal space of the left neck and reviewed the relevant literature from both domestic and international sources.We summarized the clinical manifestations,histopathological features,immunohistochemical characteristics,imaging features,diagnosis and treatment modalities,and prognosis of NMZL.
Humans ; Lymphoma, B-Cell, Marginal Zone/pathology* ; Lymph Nodes/pathology* ; Neck/pathology* ; Male

INTRODUCTION

Kawasaki Disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) are two related conditions that primarily affect pediatric patients. The overlap in clinical symptoms, physical findings, and laboratory results between MIS-C and KD complicates diagnosis and treatment, as children with MIS-C may fulfill the criteria for KD. Early recognition of distinguishing clinical, laboratory, and echocardiographic findings is crucial for timely diagnosis and appropriate treatment, which can mitigate the risk of severe cardiovascular, gastrointestinal, and neurological complications.

OBJECTIVE

This study aims to compare the clinical profile, laboratory profile, 2-D echocardiographic findings, treatment, and outcome ofchildren with KD vs MIS-C at a tertiary hospital in the Philippines.

METHODOLOGY

A retrospective, analytic cohort study was done to differentiate the clinical profiles, laboratory profile, treatments, and outcomesof pediatric patients aged less than 19 years old, admitted with a diagnosis of KD, from January 2016 to December 2019 (pre-COVID-19 pandemic), and MIS-C cases admitted from January 2020 to December 2023, in a private, urban, tertiary hospital. Descriptive statistics (frequency and proportion, mean and standard deviation, median and inter-quartile range) were used to summarize the general and clinical characteristics of the participants. Independent T-test, Mann-Whitney U test and Fisher’s Exact/Chi-square test were used to determine the difference of mean, median and frequency of laboratory parameters among groups.

RESULTS

The study included 87 patients, with 60 categorized in the KD group (13 diagnosed with complete KD and 47 with incomplete KD) and 27 in the MIS-C group. MIS-C patients were more likely to be older (p = 0.023), present with GI symptoms such as vomiting (48.2% in MIS-C vs. 12.8% in KD) and abdominal pain (40.7% vs. 6.4%), respiratory symptoms such as shortness of breath (29.6% vs 0%) and wheezing (14.8% vs 0%), have lower WBC (6.30 in MIS-C vs. 13.07 in complete KD and 10.18 in incomplete KD, p < 0.001), ANC (5,940 in MIS-C vs. 13,660 in complete KD and 10,432 in incomplete KD, p = 0.002), and platelet count (280 in MIS-C vs. 368 incomplete KD and 364 in incomplete KD, p = 0.13), and experience more complications such as myocarditis (14.81% vs. 0%), hypotension (18.52% vs. 0%), shock (14.81% vs. 0%), and pneumonia (40.74% vs. 17.02% for incomplete KD and 7.69% for complete KD). In contrast, key features of KD, including conjunctival injection (100% in KD vs. 25.9% in MIS-C), rash (100% vs 59.3%), oral changes (92.3% vs. 22.2%), and cervical lymphadenopathy (92.3% vs. 29.6%), elevated laboratory results of CRP (12.89 in MIS-C vs. 46.53 incomplete KD and 111.15 in incomplete KD, p < 0.001), ESR (41.91 in MIS-C vs. 61.73 in complete KD and 82.49 in incomplete KD, p= 0.003), and AST/ALT ratios (0.42 in MIS-C vs. 1.88 in complete KD and 0.62 in incomplete KD, p = 0.034) were more frequently observed in KD patients. Combination therapy involving intravenous immunoglobulin (IVIG), methylprednisolone, and acetylsalicylic acid (ASA) was more common in MIS-C patients than in KD patients (48.15% in MIS-C vs. 7.69% for complete KD and 2.13% forincomplete KD), who mainly received IVIG and ASA alone (84.62% in complete KD and 93.62% in incomplete KD vs 3.7% in MIS-C).

CONCLUSIONS

This study highlights key clinical and laboratory differences between MIS-C and KD in a private tertiary hospital setting. MIS-C patients were generally older, exhibited more GI and respiratory symptoms, and had a higher risk of serious complications. In contrast, KD cases more often presented with classic mucocutaneous signs and elevated inflammatory markers. These findings underscore the importance of early differentiation, as MIS-C often requires more intensive management. The study also identifies practical diagnostic indicators including CBC parameters such as WBC, ANC, and platelet count that may aid clinicians, particularly in resource-limited settings. Further multicenter research involving both public and private hospitals is needed to validate and enhance the diagnostic criteria.

Human ; Kawasaki Disease ; Mucocutaneous Lymph Node Syndrome ; Multisystem Inflammatory Syndrome In Children ; Pediatric Multisystem Inflammatory Disease, Covid-19 Related ; Covid-19