Background: This study aimed to identify metabolic alterations in the tryptophan, arginine, and glutamine pathways in patients with head and neck carcinoma (HNC) that could provide diagnostic and prognostic biomarkers.

Materials and methods: Serum levels of tryptophan, kynurenine, arginine, putrescine, glutamate, and glutamine were measured using micellar electrokinetic chromatography with laser-induced fluorescence detection (MEKC-LIFD). The study cohort included five treatment-naïve HNC patients, four treated HNC patients, three patients with benign tumors, and seven healthy controls.

Results: Serum concentrations of tryptophan and kynurenine were significantly elevated in both untreated and treated HNC patients compared to controls (p = 0.01 and p = 0.002, respectively). While both metabolites remained elevated post-treatment compared to controls (p = 0.002 and p = 0.0003, respectively), tryptophan decreased significantly after treatment. Serum arginine was significantly higher in patient groups versus controls (p = 0.04 and p = 0.002) but did not change with treatment. In contrast, serum putrescine increased after treatment compared to both controls (p = 0.035) and untreated patients (p = 0.05). The arginine/putrescine ratio was significantly lower in untreated versus treated patients. Furthermore, untreated HNC patients exhibited a significant decrease in glutamine and a significant increase in glutamate, a finding not present in treated patients. Serum glutamate was also elevated in benign tumor patients (p = 0.04).

Conclusion: These findings reveal significant dysregulation of tryptophan metabolism in HNC and identify serum tryptophan and putrescine as potential markers for monitoring treatment efficacy. Altered arginine metabolism and a pronounced shift in the glutamine-glutamate axis, indicative of increased glutaminolysis, further characterize the metabolic profile of active HNC tumors.

Background: This work aims to evaluate the demographic profile, treatment patterns and survival outcomes of ovarian cancer (OC) patients at tertiary cancer centre in Bihar.

Materials and methods: A retrospective study of ovarian cancer patients who were treated at Buddha Cancer Centre, Patna, between January 2019–December 2023. Detailed clinical history, tumor pathology, treatment modalities and survival outcomes of the patients were reviewed from clinical records. Response evaluation was done using clinical examination and computed tomography scan. Overall survival (OS) and progression-free survival (PFS) were calculated from time of diagnosis to time of death and from time of diagnosis to the time of progression. The statistical analysis was performed using Microsoft Excel. Kaplan–Meier plots were presented.

Results: A total of (N = 437) histopathological confirmed OC cases data were reviewed retrospectively. Mean age ± SD (years): 55.7 ± 16.1 years (age range 18 years to over 60 years). Most cases were diagnosed at Stage III (n = 135; 30.89%) and Stage IV (n = 191; 43.71%) at the time of diagnosis. The most common histologic types were serous (52%) followed by mucinous (22%) and endometrioid (13%). The majority of patients had received chemotherapy and supportive regimen (n = 184; 42%), P value < 0.005. Mean OS ± SD (months) was 36.2 ± 31.9 and mean PFS ± SD (months) was 19.5 ± 24.5. Complete response was achieved in 19%, partial response in 16%, SD in 38%, and progressive disease in 43% of patients. Early-stage disease had a better survival rate (65.2%) while advanced stage had a poor outcome.

Conclusion: Most OCs recur within 1.5 years. Mortality rates were associated with late stage of the disease clinically. Surgery followed by chemotherapy was associated with improved survival outcomes.

Background: Sepsis is a critical illness arising from an infection, often accompanied by challenges in detection and treatment, particularly when the source of the infection is unknown or the patient’s condition progresses beyond expectations. Sometimes, clinically occult malignancies may either initiate or mimic sepsis, complicating diagnostic evaluation and management pathways.

Case presentation: A 67-year-old White Hispanic woman with no previously documented chronic medical conditions presented with bilateral lower-extremity swelling, progressive weakness, and worsening fatigue. Upon admission, she exhibited septic shock physiology with multi-organ dysfunction, including acute kidney injury, hyponatremia, and deep vein thrombosis, raising concern for severe infection or malignancy-associated systemic inflammatory response syndrome. Chest imaging demonstrated bilateral pulmonary infiltrates, pleural effusions, and a dominant pulmonary mass. Additional imaging revealed multiple hepatic lesions and a solitary brain metastasis. Despite initiation of broad-spectrum antimicrobial therapy, microbiologic cultures remained unrevealing, and the patient’s clinical condition progressively deteriorated. Histopathologic evaluation of a liver biopsy ultimately confirmed metastatic pulmonary adenocarcinoma consistent with non-small cell lung cancer. Due to continued clinical decline despite aggressive supportive management, multidisciplinary discussions were held, and care was transitioned to comfort-focused measures. The patient passed away one week after hospitalization.

Conclusion: This case highlights the challenges of maintaining an appropriate differential diagnosis in septic patients, especially when clinical findings are atypical or treatment responses are suboptimal. Optimizing outcomes and aligning management with patient goals requires early recognition of the underlying malignancy and timely involvement of palliative and specialty care teams.

We describe a case of locally advanced stage IIIB (T4N2) EGFR-mutated lung adenocarcinoma with invasion of the distal trachea and superior vena cava (SVC). Following two cycles of neoadjuvant platinum-based chemotherapy, the patient underwent a complex curative-intent resection. The procedure, planned with 3D modeling, consisted of a right upper double-sleeve bilobectomy, sleeve resection of the tracheal bifurcation with reconstruction of the airway, and replacement of the SVC with a xenopericardial conduit. Adjuvant treatment with an EGFR tyrosine kinase inhibitor resulted in a recurrence-free survival of 35 months.