fluorouracil (Carac, microsponge)

Carbon Dioxide Laser Debulking With Immediate Intralesional 5-Fluorouracil and Triamcinolone for Recurrent Auricular Keloids.

Rebollo Caballero Blanca B, Ruiz Martínez Javier J, Gómez-Olit Pérez Manuel M, Romera Pallarés Juan C JC

Design, Synthesis, and Evaluation of Halo-Substituted Flavonols Against Melanoma A375 Cells.

Sheng Tzu-Yun TY, Huang Kuan-Ying KY, Su Yu-Jui YJ, Li Sin-Min SM et al.

Malignant melanoma is one of the most aggressive forms of skin cancer. Despite advances in targeted therapy and immunotherapy, the emergence of drug resistance and limited therapeutic efficacy in advanced stages remain major clinical challenges. In this study, a series of novel flavonols were synthesized and evaluated for their cytotoxic activity against human malignant melanoma A375 cells. Among the tested compounds, compound 4j exhibited the most potent inhibitory effect, with an IC50 value of 25.07 ± 2.24 μM, outperforming 5-fluorouracil (5-FU) used as a positive control. Furthermore, Western blot analysis revealed that compound 4j modulated the expression of key apoptotic regulators: it downregulated the anti-apoptotic protein Bcl-2, upregulated the pro-apoptotic protein Bax, and activated caspase-3, indicating induction of apoptosis via a caspase-dependent mitochondrial pathway. Molecular docking analysis further showed that the halogenated derivatives exhibited distinct interaction patterns within the Bcl-2 binding groove, supporting the observed positional structure-activity relationship. These findings demonstrate that compound 4j possesses promising anticancer activity against malignant melanoma cells. They support flavonols as valuable scaffolds for the development of new anti-melanoma agents, with compound 4j emerging as a particularly compelling lead candidate.

Beyond the Threatened Limb: Acute Limb Ischemia as a Diagnostic Attractor.

Smith Antoine A, Zahir Soheil S

Acute limb ischemia is a time-sensitive vascular emergency, but in older patients with active cancer and multimorbidity, the threatened limb can become a diagnostic attractor: a correct specialized diagnosis that narrows attention before whole-patient physiology is integrated. We report an 81-year-old man with metastatic cecal adenocarcinoma receiving folinic acid, fluorouracil, and oxaliplatin (FOLFOX) who presented on day one with three days of progressive left lower limb claudication, coldness, discoloration, absent pulses, preserved motor and sensory function, and no rest pain. The presentation was clinically compatible with Rutherford I-IIa acute limb ischemia; bedside Doppler signals were not documented, precluding a definitive retrospective distinction between these categories. Concurrent findings included new atrial fibrillation, basal crackles, peripheral edema, markedly elevated N-terminal pro-B-type natriuretic peptide and troponin, bilateral pleural effusions, and radiological concern for low cardiac output. Computed tomography angiography (CTA) showed severe distal superficial femoral artery stenosis, long popliteal occlusion, slow distal flow, and limited runoff, favoring an acute-on-chronic ischemic process. On day two, a 6 mm x 60 mm covered stent was placed across the distal superficial femoral artery lesion. The treated lesion had a satisfactory technical result, but distal runoff remained severely compromised. Therapeutic anticoagulation initiated on day one was not maintained; discharge treatment on day three included prophylactic-dose enoxaparin and aspirin, with no rationale for the change documented in the available record. He returned on day five with recurrent coldness and toe necrosis despite normal lactate. No repeat vascular imaging was available to define the mechanism. Care became palliative on day 13, and he died on day 58. This case illustrates that a correct vascular diagnosis should not terminate integrative emergency reasoning. We propose that a vascular-plus-physiology cross-check may help preserve attention to systemic physiology and goals of care, but it is an educational framework rather than a validated clinical algorithm.

Tumor-to-tumor metastasis of colorectal adenocarcinoma within a gonadotroph pituitary adenoma.

Murasawa Shingo S, Isozaki Fumiya F, Fukasawa-Maeda Miku M, Takayasu Shinobu S et al.

Pituitary metastases are uncommon, and most cases originate from breast or lung cancer. Tumor-to-tumor metastasis, in which one neoplasm metastasizes into another, is particularly rare in the sellar region. We report a 66-year-old man with metastatic sigmoid colon adenocarcinoma treated with modified FOLFOX6 (5-fluorouracil, L-leucovorin, and oxaliplatin) plus panitumumab; extracranial disease was controlled, whereas a sellar mass initially suspected as a pituitary adenoma slowly enlarged over 2 years. Endocrine testing showed anterior hypopituitarism without arginine vasopressin deficiency. Endoscopic transsphenoidal surgery was performed for continued enlargement and diagnostic uncertainty. Histopathology demonstrated a gonadotroph pituitary adenoma infiltrated by colorectal adenocarcinoma, with extensive intermingling of the 2 components rather than discrete nests, favoring tumor-to-tumor metastasis over a collision tumor. The metastatic component consisted of viable tumor cells without necrosis or convincing treatment effect despite prolonged chemotherapy. This case underscores that metastatic tumor within a pituitary adenoma may enlarge despite favorable systemic therapy outcomes. Metastasis should therefore remain a key differential diagnosis for a sellar mass radiologically suggestive of a pituitary adenoma.