This response to the letter expands the discussion on the evolving demands of peer review for systematic reviews and meta-analyses. We emphasize that the main concern surrounding artificial intelligence is not its limited and disclosed use for language support, but undisclosed application and insufficient human verification, which may compromise citation accuracy, interpretation, and overall trustworthiness. We also argue that similarity reports should be interpreted contextually, particularly in evidence syntheses where standardized methodological language is unavoidable, and that low similarity does not necessarily exclude manuscript manipulation. Finally, we highlight reference verification as a central research-integrity challenge that should not rest on peer reviewers alone. Preserving the credibility of evidence synthesis requires shared responsibility across authors, reviewers, editors, and publishers.

BACKGROUND Hyponatremia is a common postoperative electrolyte disturbance in neurosurgical patients and may present with nonspecific neurocognitive symptoms that overlap with intracranial complications. Carbamazepine (CBZ), frequently used for seizure prophylaxis and pain syndromes, is a recognized cause of drug-induced hyponatremia with a syndrome of inappropriate antidiuretic hormone secretion (SIADH)-like profile. CASE SUMMARY A 62-year-old woman underwent elective left supraorbital craniotomy and microsurgical resection of a left anterior skull-base meningioma. Postoperatively, CBZ 400 mg was initiated twice daily for antiseizure prophylaxis. On postoperative day (POD) 2, she developed somnolence and cognitive slowing with serum sodium 131 mmol/L, which progressed to 123 mmol/L (POD 3) and 119 mmol/L (POD 7) despite isotonic saline and increased dietary sodium. Hypertonic saline (3% NaCl) was introduced with partial correction. Evaluation confirmed hypotonic hyponatremia (serum osmolality 254 mOsm/kg) with inappropriately concentrated urine (urine osmolality 560 mOsm/kg) and elevated urine sodium (68 mmol/L) in a clinically euvolemic patient; thyroid and adrenal functions were normal. Given the temporal association and SIADH-like pathophysiology, CBZ-induced hyponatremia was considered the most likely etiology. CBZ was discontinued and replaced with levetiracetam (titrated to 500 mg twice daily), followed by clinical improvement and steady sodium normalization (132 mmol/L at discharge; 136 mmol/L by POD 19), remaining normal at three-month follow-up. We searched PubMed and Google Scholar to for relevant literature review. CONCLUSION This case highlights CBZ as a potentially reversible cause of significant postoperative hyponatremia after meningioma surgery. Early sodium monitoring after CBZ initiation and prompt substitution with alternative antiseizure therapy should be considered when euvolemic hypotonic hyponatremia develops in the postoperative period.

Immunotherapy with immune checkpoint inhibitors (ICI) has become a transformative pillar in cancer treatment, offering significant improvements in survival and reducing treatment-related side effects compared to traditional therapies. In gynecologic cancers, ICIs have transformed the treatment of endometrial (EC) and cervical cancers, whereas they have not demonstrated clinical benefit in ovarian cancer. This review examines the current state of ICI advancements in EC. Given the unique immunological characteristics of EC, a comprehensive understanding of advancements is crucial for optimizing decision-making and patient outcomes. While ICIs have demonstrated robust and durable efficacy in dMMR/MSI-H EC, the magnitude of benefit in pMMR disease remains modest. Additionally, we examine promising future directions, including personalized immunotherapy approaches and novel combination therapies (e.g. antibody-drug conjugates, PARP inhibitors, antiangiogenic drugs).

A commercial biorepository of tumor samples with associated clinical data is crucial for discovering and validating biomarkers and advancing all stages of cancer research. Although oncogenic fusions are highly specific and attractive drug targets, the progress is limited by their diversity and low (1-4%) prevalence in solid tumors, outside prostate adenocarcinoma (>30% with a characteristic TMPRSS2::ERG fusion). Systematic, cost effective evaluation of banked tumor samples for the oncogenic fusions could accelerate such research efforts. We examined formalin-fixed paraffin-embedded tumor samples from a commercial biorepository (Reference Medicine, Phoenix, AZ) using a workflow which included expert pathology review, whole slide scanning, construction of multi-tumor tissue microarrays (TMA) immunohistochemistry (IHC) and genomic profiling with commercially available next generation sequencing (NGS) panels. More than 500 tumors were reviewed by board-certified pathologists; selected cases were then cored for TMAs. Immunohistochemistry for ALK and ROS1 proteins' expression were performed on TMAs. IHC for ALK and ROS1 identified two positive cases, one for ROS1 and one for ALK. Thirty eight tumors underwent NGS and both IHC-positive cases were confirmed to harbor gene fusions (EML4::ALK and EZR::ROS1, respectively). All other cases were fusion-negative, concordant with the IHC result. Properly characterized tissue samples are essential for image analysis, biomarker detection and genomic profiling. Rigorous pathologic review helps avoid archiving of poorly preserved samples. IHC screening of TMAs provides a cost-effective approach for identification of fusion events, particularly in non-small cell lung carcinomas, while preserving material for multiple downstream applications. Zoran Gatalica, Inga Rose, Semir Vranic. Detection of fusion oncogenes in routinely collected biorepository samples [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Fusion-Positive Cancer: From Discovery to Therapy; 2026 Jan 13-15; Philadelphia PA. Philadelphia (PA): AACR; Cancer Res 2026;86(1_Suppl):Abstract nr A005.

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer mortality worldwide; however, precision oncology has fundamentally transformed its treatment landscape. In 2025, seven approvals by the U.S. Food and Drug Administration (FDA) further accelerated biomarker-driven care across critical molecular subsets. These include MET-directed and trophoblast cell-surface antigen-2 (TROP-2) antibody-drug conjugates (ADCs), expanded strategies targeting epidermal growth factor receptor (EGFR), notably those addressing exon 20 insertion mutations, a ROS proto-oncogene 1 (ROS1) inhibitor, and various human epidermal growth factor receptor 2 (HER2) options that encompass both tumor-agnostic and mutation-selected approaches. These advancements underscore the necessity for integrated diagnostics-such as next-generation sequencing (NGS), fluorescence in situ hybridization (FISH), and immunohistochemistry (IHC)-while also emphasizing ongoing challenges in biomarker selection, therapeutic sequencing, and equitable global implementation.

We report an infrequent case of a full-term male neonate presenting with a large congenital hernia of the umbilical cord (6 cm × 6 cm) containing only the entire left lobe of the liver. Prenatal ultrasonography suggested an omphalocele; however, the definitive postnatal diagnosis was established based on the presence of a narrow rim of normal skin encircling the umbilical ring and the proximal umbilical cord. Primary closure of the fascial defect was achieved successfully, with no intraoperative or postoperative complications observed. The patient recovered well postoperatively and was discharged in stable condition. Accurate differentiation from an omphalocele is crucial for appropriate management. Unlike omphaloceles, congenital hernias of the umbilical cord (CHUC) typically do not require extensive genetic or cardiac evaluation, and their surgical repair is generally less complex. However, awareness of atypical presentations of CHUC can aid in timely diagnosis, guide surgical planning, and improve clinical outcomes.

Abstract Objective. To report two additional cases of glycogen-rich clear cell carcinoma (GRCC) of the breast – detailing their clinicopathologic features, immunophenotypes, and follow-up – and to provide an updated literature review since 2020. Case Reports. Two patients (66 and 52 years old) had GRCC confirmed morphologically and histochemically. Case 1 was ER-positive/HER2-positive (luminal B/HER2-positive) and was managed with surgery, followed by adjuvant chemotherapy, endocrine therapy, and anti-HER2 therapy (trastuzumab). Case 2 was triple-negative and received neoadjuvant chemoimmunotherapy (pembrolizumab-based) with marked pathologic tumor regression at resection. Both patients were disease-free at one and 12 months, respectively. Conclusions. GRCC is heterogeneous and should not be regarded as a single clinicopathologic entity within invasive breast carcinoma of no special type or assumed to have a uniform prognosis. Management should be biomarker-guided, as illustrated by these cases. The role of targeted and immune therapies in GRCC warrants multi-institutional studies.