Adamantinoma of Bone: A Structured Narrative Review of Clinical Outcomes, Recurrence Patterns, and Metastatic Behaviour

Haemorrhoidal Disease Across the Care Continuum: A Critical Narrative Review of Pathophysiological Mechanisms, Clinical Classification and Evidence-based Management

Haemorrhoidal disease is among the most frequently encountered anorectal conditions in general practice, gastroenterology and colorectal surgery, yet the field remains unusually resistant to the forms of evidential consolidation achieved in comparable benign surgical domains. This critical narrative review examines the state of knowledge across the full care continuum, from mechanistic accounts of disease initiation through diagnostic classification to the comparative performance of conservative, office-based, ablative and operative interventions. Literature was identified through structured searching of MEDLINE via PubMed, Crossref Metadata Search and Semantic Scholar, supplemented by targeted retrieval of individual trials, consensus documents and guidelines named within retrieved sources, with a final search date of 9 June 2026. The synthesis is organised around mechanisms, measurement and management rather than around individual studies. Three interlocking problems are identified. First, the dominant sliding-anal-cushion model, although anatomically coherent and now supported by genetic evidence implicating smooth muscle, epithelial and connective tissue biology, has limited power to explain why symptomatic disease develops in some individuals and not others, and it has generated few testable predictions relevant to treatment selection. Second, the Goligher classification continues to serve simultaneously as a descriptive scheme, an eligibility criterion and an outcome, despite documented interobserver variability and weak correspondence with symptom burden, and the validated symptom scores and patient-reported outcome measures developed to replace it have not yet been consistently adopted in comparative trials. Third, the comparative evidence base is extensive but structurally weak, with recurrence defined inconsistently, follow-up frequently truncated before the interval at which prolapse recurs, and newer energy-based and endovascular techniques supported largely by uncontrolled series. Recurring findings that appear robust include the efficacy of fibre supplementation for bleeding, the trade-off between procedural invasiveness and durability, and the higher long-term recurrence of stapled haemorrhoidopexy relative to excisional surgery. Priorities for research include outcome standardisation, mechanistic stratification of patients, and adequately powered randomised comparison of the newer minimally invasive techniques against established office-based treatment.

Clinicopathological characteristics, diagnostic challenges, and systemic implications of metastatic tumors to the eyelid: a systematic review.

BACKGROUND Metastatic tumors to the eyelid are rare but clinically significant, often indicating advanced systemic malignancy or presenting as the first sign of an occult primary. Histopathology is the diagnostic cornerstone, yet the spectrum of clinicopathological patterns, immunohistochemistry, and common diagnostic pitfalls has not been systematically synthesized at the patient level. METHODS We conducted a PRISMA 2020-compliant systematic review (protocol registered on the Open Science Framework). PubMed/MEDLINE, Embase, and Scopus were searched on 7 March 2026 without date restrictions, supplemented by Google Scholar citation tracking. Case reports and case series of histopathologically confirmed eyelid metastases were eligible. We performed a descriptive case-level systematic synthesis; proportions are reported with 95% Wilson confidence intervals. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports. RESULTS Seventy-three studies (95 patients; 52/95, 54.7% female; median age 61 years, range 21-92) were included. Breast carcinoma was the most frequent primary site (39/95; 41.1%), followed by gastrointestinal tumors (15/95; 15.8%), renal cell carcinoma (9/95; 9.5%), and lung carcinoma (8/95; 8.4%). Metachronous presentation predominated (58/92; 63.0%; median interval 36 months, range 2-288), followed by synchronous (27/92; 29.3%) and occult presentation (7/92; 7.6%). Among 62 patients with documented preoperative impressions, 41/62 (66.1%) received a benign misdiagnosis; pyogenic granuloma was the most frequent mimic. Immunohistochemistry was reported in 61/73 studies (83.6%). BAP1 loss was observed in 2 of 3 evaluable uveal melanoma cases and was intact in all 6 cutaneous melanoma cases [18, 20]. Overall, 61/89 (68.5%; 95% CI 58.6-77.0%) had synchronous distant organ metastases at eyelid biopsy; eyelid biopsy identified an occult primary in 11/95 (11.6%) and altered oncologic management in 13/95 (13.7%). CONCLUSIONS Eyelid metastases commonly mimic benign conditions, supporting a low threshold for biopsy of atypical or refractory lesions. Site-directed immunohistochemistry, including BAP1 for melanoma subtype attribution, can be diagnostically informative and should inform staging and management decisions.

Oral glomus tumor: A systematic review highlighting clinical and histopathological characteristics of a time-reclassified entity

Oral glomus tumors are exceptionally rare perivascular neoplasms that are frequently misdiagnosed due to their nonspecific clinical presentation. Their rarity has historically resulted in inconsistent terminology and a limited understanding of their biological behavior. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and registered in the International Prospective Register of Systematic Reviews (ID 1175198). A comprehensive literature search of PubMed, Scopus, and Web of Science (1954–2024) was performed to identify English-language case reports and case series describing histologically confirmed oral glomus tumors. Extracted data included demographics, tumor location and size, histopathological features, treatment modalities, recurrence, and follow-up. A total of 740 records were identified, of which 31 studies met the inclusion criteria, yielding 34 confirmed cases of oral glomus tumor. Patients ranged from 8 to 85 years, with a slight male predominance. The most frequently affected site was the lip, followed by the tongue, palatal mucosa, and other intraoral soft tissues. Tumor size varied from 0.3 to 4.5 cm. Classic glomus tumor was the most common subtype, with occasional reports of glomangiomyoma and one case of glomangiosarcoma. Surgical excision was curative in most patients. Recurrence occurred in a minority of cases, but metastasis was not reported in the only case of glomangiosarcoma. Oral glomus tumors are predominantly benign, well-circumscribed lesions with excellent prognosis following complete surgical excision. Accurate diagnosis relies on thorough histopathological and immunohistochemical evaluation, given the potential overlap with other mesenchymal tumors. This review provides the most updated synthesis of clinical, pathological, and outcome features of oral glomus tumors.

Current Evidence Across the Treatment Spectrum of Adrenocortical Carcinoma: A Comprehensive Scoping Review

Adrenocortical carcinoma is a rare and aggressive malignancy for which high-quality evidence to guide clinical decision-making remains limited. This scoping review aimed to map and synthesise the extent, nature, and direction of evidence across five therapeutic domains in the management of adrenocortical carcinoma. Following Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance, MEDLINE, Embase, and the Cochrane Library were searched without date restrictions. Eligible sources included clinical trials, observational studies, systematic reviews, and clinical guidelines addressing any treatment modality for adrenocortical carcinoma. Data were extracted using a standardised form and synthesised narratively across domains. Evidence visualisations, and an intervention-by-domain matrix, were developed to identify areas of consistency, uncertainty, and research gaps. Forty-nine studies met the inclusion criteria. Complete tumour resection with negative margins consistently emerged as the strongest prognostic factor. Minimally invasive adrenalectomy showed comparable outcomes only in carefully selected low-risk patients. Adjuvant mitotane demonstrated potential benefit in high-risk disease but not in low- to intermediate-risk patients. In metastatic disease, multimodal management incorporating etoposide, doxorubicin, cisplatin, and mitotane, together with metastasectomy and local therapies, was associated with improved outcomes in selected cases. Recurrence was frequent and often occurred early, particularly in large or invasive tumours. Cortisol-secreting tumours were associated with higher postoperative morbidity and earlier recurrence. Although the available evidence is predominantly retrospective and heterogeneous, consistent patterns emerge that can inform clinical management. This review provides a structured evidence base for future consensus development and highlights priorities for further research.

Spinal intramedullary melanocytoma: systematic review & clinical management considerations

Skull Base Osteomyelitis: Contemporary Concepts in Diagnosis and Management with a Neurosurgical Perspective

Abstract Skull base osteomyelitis (SBO) is an uncommon but potentially fatal infection of elderly, diabetic, or otherwise immunocompromised patients that poses major diagnostic and therapeutic challenges. Typical SBO arises as an extension of necrotizing external otitis involving the temporal bone, whereas atypical or central SBO involves the clivus and central skull base in the absence of overt otologic disease and frequently mimics malignancy. This systematic review synthesizes contemporary evidence on SBO, with particular emphasis on central disease and on issues relevant to Asian neurosurgical practice, where the burden of diabetes, tuberculosis, and invasive fungal infection is substantial. PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched from inception to October 2025 for case reports, case series, observational studies, and clinical trials reporting clinical, microbiological, imaging, management, or outcome data in radiologically or histologically confirmed SBO; a narrative synthesis was undertaken because of heterogeneity in study design, definitions, and outcome reporting. SBO predominantly affects older males in the fifth to eighth decades, with diabetes mellitus and other conditions impairing microvascular perfusion and immune function as major risk factors. Typical SBO remains largely Pseudomonas aeruginosa–driven, whereas central SBO shows a broader spectrum dominated by Staphylococcus aureus, Pseudomonas, and an increasing proportion of mucormycosis and Aspergillus infection, with culture–negative disease in up to one–third of cases. High–resolution CT and contrast–enhanced MRI are complementary for early detection and disease mapping, while fluorodeoxyglucose positron emission tomography (PET)/CT or PET/MRI, documented in only a subset of predominantly recent series, has emerged as a sensitive tool for diagnosis and treatment monitoring. Long–course, high–dose antimicrobial therapy (6–20 weeks, including at least 6–8 weeks of parenteral therapy) is the cornerstone of treatment; surgery is mainly reserved for diagnostic biopsy, drainage, and debridement, and extensive debridement has not consistently improved cure rates. Mortality has fallen but remains up to 20 to 30% in some cohorts, and many survivors have persistent cranial neuropathies. Early multidisciplinary assessment, protocol–driven imaging, culture–directed prolonged therapy, and PET–guided decisions on treatment cessation are likely to reduce relapse and improve long–term outcomes.