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Abstract [Ru(5-FU)(PPh3)2(bipy)]PF6 (Ru/5-FU) is a novel ruthenium complex with 5-fluorouracil with promising potential against colorectal cancer (CRC). In the present study, we investigated the molecular mechanism of Ru/5-FU action in HCT116 CRC cells. Ru/5-FU exhibited potent cytotoxicity on a panel of cancer cell lines and on primary cancer cells and induced apoptosis in HCT116 CRC cells. Ru/5-FU reduced AKT1 gene transcripts, as well as the expression of Akt1 and Akt (pS473) and downstream Akt proteins mTOR (pS2448), S6 (pS235/pS236), 4EBP1 (pT36/pT45), GSK-3β (pS9) and NF-κB p65 (pS529), but not Akt upstream proteins Hsp90 and PI3K p85/p55 (pT458/pT199), indicating an inhibitory action of Akt/mTOR signaling. Ru/5-FU increased LC3B expression and reduced p62/SQSTM1 levels, indicating autophagy induction. Curiously, the autophagy inhibitors 3-methyladenine and chloroquine increased Ru/5-FU-induced cell death, indicating an induction of cytoprotective autophagy by this compound. Ru/5-FU also reduced clonogenic survival, as well as the percentage of CD133+ cells and colonosphere formation, indicating that Ru/5-FU can suppress stem cells in HCT116 cells. Ru/5-FU inhibited cell migration and invasion in wound healing assays and Transwell cell invasion assays, along with a reduction in vimentin expression and an increase in E-cadherin levels, indicating that Ru/5-FU can interfere with epithelial-mesenchymal transition. Ru/5-FU also inhibited in vivo HCT116 cell development and experimental lung metastases in mouse xenograft models. Altogether, these results indicate that Ru/5-FU is an anti-CRC chemotherapy drug candidate with the ability to suppress stemness in CRC cells by inhibiting Akt/mTOR signaling.

Abstract In this work, we describe a novel ruthenium-xanthoxylin complex, [Ru(phen)2(xant)](PF6) (RXC), that can eliminate colorectal cancer (CRC) stem cells by targeting the chaperone Hsp90. RXC exhibits potent cytotoxicity in cancer cell lines and primary cancer cells, causing apoptosis in HCT116 CRC cells, as observed by cell morphology, YO-PRO-1/PI staining, internucleosomal DNA fragmentation, mitochondrial depolarization, and PARP cleavage (Asp214). Additionally, RXC can downregulate the HSP90AA1 and HSP90B1 genes and the expression of HSP90 protein, as well as the expression levels of its downstream/client elements Akt1, Akt (pS473), mTOR (pS2448), 4EBP1 (pT36/pT45), GSK-3β (pS9), and NF-κB p65 (pS529), implying that these molecular chaperones can be molecular targets for RXC. Moreover, this compound inhibited clonogenic survival, the percentage of the CRC stem cell subpopulation, and colonosphere formation, indicating that RXC can eliminate CRC stem cells. RXC reduced cell migration and invasion, decreased vimentin and increased E-cadherin expression, and induced an autophagic process that appeared to be cytoprotective, as autophagy inhibitors enhanced RXC-induced cell death. In vivo studies showed that RXC inhibits tumor progression and experimental metastasis in mice with CRC HCT116 cell xenografts. Taken together, these results highlight the potential of the ruthenium complex RXC in CRC therapy with the ability to eliminate CRC stem cells by targeting the chaperone Hsp90.

Artificial intelligence (AI) is here to stay and will change health care as we know it. The availability of big data and the increasing numbers of AI algorithms approved by the US Food and Drug Administration together will help in improving the quality of care for patients and in overcoming human fatigue barriers. In oncology practice, patients and providers rely on the interpretation of radiologists when making clinical decisions; however, there is considerable variability among readers, and in particular for prostate imaging. AI represents an emerging solution to this problem, for which it can provide a much-needed form of standardization. The diagnostic performance of AI alone in comparison to a combination of an AI framework and radiologist assessment for evaluation of prostate imaging has yet to be explored. Here, we compare the performance of radiologists alone versus a combination of radiologists aided by a modern computer-aided diagnosis (CAD) AI system. We show that the radiologist-CAD combination demonstrates superior sensitivity and specificity in comparison to both radiologists alone and AI alone. Our findings demonstrate that a radiologist + AI combination could perform best for detection of prostate cancer lesions. A hybrid technology-human system could leverage the benefits of AI in improving radiologist performance while also reducing physician workload, minimizing burnout, and enhancing the quality of patient care. Patient summary: Our report demonstrates the potential of artificial intelligence (AI) for improving the interpretation of prostate scans. A combination of AI and evaluation by a radiologist has the best performance in determining the severity of prostate cancer. A hybrid system that uses both AI and radiologists could maximize the quality of care for patients while reducing physician workload and burnout.

Resumo Fundamento O pterostilbeno (PS), um composto polifenólico natural e antioxidante, surge como uma intervenção promissora para minimizar danos do infarto agudo do miocárdio (IAM). Objetivo Este estudo teve como objetivo avaliar o desempenho do PS na promoção da homeostase redox nos pulmões e no ventrículo direito (VD) de animais infartados. Métodos Ratos Wistar machos (60 dias de idade) foram randomizados em três grupos: SHAM, IAM (infarto) e IAM+PS (IAM + pterostilbeno). Sete dias após o procedimento de IAM, os ratos foram tratados com PS (100 mg/kg/dia) por gavagem por oito dias. Os animais foram depois sacrificados e os pulmões e VD foram coletados para análise do balanço redox (diferenças foram consideradas significativas quando p

The effects of the COVID-19 pandemic across various sectors are far-reaching, and the education sector is not an exemption. Approved and recognized vaccines are clinically proven to provide protection and have been considered one of the primary mitigations against the virus. Knowledge, attitude, and related practices (henceforth KAP) toward the virus is widely considered to be an essential cognitive key in public health for health intervention, prevention, and promotion. Previous studies revealed a positive correlation between knowledge and attitude. This study investigated the KAP and their relationship among the 857 college students in one state college in the Philippines using an online survey. Using descriptive statistics, the findings showed that the majority of the respondents have been fully vaccinated against COVID-19. Respondents were shown to be knowledgeable about COVID-19, specifically about its transmission, clinical symptoms, treatment, risk groups, isolation, prevention, and control. Positive attitudes toward individual and governmental mitigation and control of the virus were shown. Their scores on practices revealed that they always exhibit protective and preventive behavioral practices. Pearson correlation revealed a weak significant relationship between knowledge and practice, and a fair significant relationship between attitude and practice. No significant relationship is found between knowledge and attitude. This study hopes to find its place in the literature worthy of consideration as empirical support toward understanding a specific group's perceptive risk and preventive behavior toward the virus, policy making, and health intervention and promotion.

ABSTRACT Locomotor problems are a challenge for commercial poultry, but current methods used to assess the bone structure of chickens are few and laborious. The objective of this study is to present software for the automatic extraction of morphometric characteristics of broiler chicken’s locomotor bones throughout the life cycle, by applying computer vision techniques. 112 samples from the tibia and 112 from the femur of commercial chickens were used, subdivided by age (0, 7, 14, 21, 28, 35, and 42 days). The images were digitally processed to extract bone morphometric properties (area, length, and perimeter). New software was created, including the proposed processing and algorithms for obtaining the morphometric characteristics. Classification models (artificial neural networks, ANN, and k-nearest neighbors’ algorithm, KNN) were developed to classify bones according to age and type. The results of the software were satisfactory, the sample bank could be handled correctly, a high applicability to test images from other sources was determined. For the classification of bones, the ANN method was more accurate than KNN. The information obtained in this study opens new possibilities for evaluative studies of broiler locomotive systems.

English preposition is one of the hardest features to learn and master, especially by ‘nonnative’ speakers of the English language; hence, several Filipinos tend to interchange particle/preposition in phrasal verbs (PhVs) (e.g., fill up and fill out). As such, this study aimed to compare the semantic features and idiomatic status of selected same-verb different-particle PhVs, and describe their syntactic features utilizing the Philippine component of the International Corpus of English (ICE-PHI) and the Global Web-based English Corpus (GloWbE) Philippines. This study revealed evidence that clearly shows the interchange of particle/preposition for the same verb. A new meaning has been found for two PhVs. Most of the PhVs follow the type 2 (transitive) pattern, while others follow the type 1 (intransitive) pattern. They generally occur in the medial position, rarely in the beginning position, and very rarely in the final position. The study suggests that despite the interchange, Filipinos generally follow the American English (AmE) usage of PhVs. Also, despite the fact that PhV is not an inherent characteristic in the first language, Filipinos still show adequate knowledge and proficiency in the use of PhVs in their utterances. The interchange of particle/preposition may be considered as an emerging feature of Philippine English (PhE).

Abstract One of the main purposes of the addition of fibers to the concrete is the control of the plastic shrinkage cracking in the fresh state and the increase of the post-crack resistance in the hardened state. The cementitious matrix is one of the factors that influences the performance of fiber reinforced concrete, interfering in the fluidity of the mixture and in the adhesion between fiber and matrix. In this context, the present paper evaluates the behavior of two concrete, one of conventional strength and another of high-strength, without fiber and with a content of 1%, by volume, of fiber, being used steel fiber and macro-polymeric fiber. For this, the mechanical properties of the concrete were evaluated in the hardened state by the tests of compressive strength, Barcelona, flexure of prisms and punching of plates. From the experimental results, statistically analyzed, there were significant changes in toughness and residual strength due to change in the cementitious matrix. Finally, an equivalence of performance between the fibers as to the toughness was observed, with the change of the cementitious matrix.

Background: Preserving the genetic diversity of wild fish is an important consideration for restocking programs, as inbreeding can compromise progeny survival as well as impact the resilience of natural populations. Objective: To evaluate the influence of spawning method: semi-natural (SN) or strip-spawning (ST), and the number of breeders (1♀:3♂ and 2♀:6♂) on the reproductive efficiency and genetic diversity of B. orbignyanus progeny destined for restoration of wild stocks. Methods: Rates of fertilization, hatching and broodfish mortality were recorded. For genetic evaluations (allele frequency, observed and expected heterozygosity, Shannon index, inbreeding coefficient, molecular variance analysis, and genetic differentiation), breeders (n=24), and their progenies (90 larvae/treatment) were sampled and analyzed using eight microsatellite markers. Results: Higher fertilization and hatching rates, and lower broodfish mortality were observed for the SN method (p0.05). Interaction between spawning method and number of breeders was not significant (p>0.05). The amplified microsatellite loci produced a total of 30 alleles, with sizes between 80 and 225 bp and their frequencies indicated an increase (p0.05). Conclusion: The spawning methods and number of breeders tested increased equally the genetic diversity of the progeny, with low genetic differentiation between treatments. In contrast, rates of fertilization, hatching and brood fish mortality revealed that the SN method resulted in the best reproductive efficiency due to the handling stress and injuries caused by ST. Thus, SN proves to be the most suitable spawning-method for B. orbignyanus in restocking programs.

Abstract Background Even though mesenchymal stromal cells (MSCs) mitigate lung and distal organ damage in experimental polymicrobial sepsis, mortality remains high. We investigated whether preconditioning with eicosapentaenoic acid (EPA) would potentiate MSC actions in experimental sepsis by further decreasing lung and distal organ injury, thereby improving survival. Methods In C57BL/6 mice, sepsis was induced by cecal hligation and puncture (CLP); sham-operated animals were used as control. Twenty-four hours after surgery, CLP mice were further randomized to receive saline, adipose tissue-derived (AD)-MSCs (105, nonpreconditioned), or AD-MSCs preconditioned with EPA for 6 h (105, EPA-preconditioned MSCs) intravenously. After 24 h, survival rate, sepsis severity score, lung mechanics and histology, protein level of selected biomarkers in lung tissue, cellularity in blood, distal organ damage, and MSC distribution (by technetium-99m tagging) were analyzed. Additionally, the effects of EPA on the secretion of resolvin-D1 (RvD1), prostaglandin E2 (PGE2), interleukin (IL)-10, and transforming growth factor (TGF)-β1 by MSCs were evaluated in vitro. Results Nonpreconditioned and EPA-preconditioned AD-MSCs exhibited similar viability and differentiation capacity, accumulated mainly in the lungs and kidneys following systemic administration. Compared to nonpreconditioned AD-MSCs, EPA-preconditioned AD-MSCs further reduced static lung elastance, alveolar collapse, interstitial edema, alveolar septal inflammation, collagen fiber content, neutrophil cell count as well as protein levels of interleukin-1β and keratinocyte chemoattractant in lung tissue, and morphological abnormalities in the heart (cardiac myocyte architecture), liver (hepatocyte disarrangement and Kupffer cell hyperplasia), kidney (acute tubular necrosis), spleen (increased number of megakaryocytes and lymphocytes), and small bowel (villi architecture disorganization). EPA preconditioning of MSCs resulted in increased secretion of pro-resolution and anti-inflammatory mediators (RvD1, PGE2, IL-10, and TGF-β). Conclusions Compared to nonpreconditioned cells, EPA-preconditioned AD-MSCs yielded further reductions in the lung and distal organ injury, resulting in greater improvement in sepsis severity score and higher survival rate in CLP-induced experimental sepsis. This may be a promising therapeutic approach to improve outcome in septic patients.

This study aimed to investigate Brazilian consumers’ perception concerning foods processed by ultraviolet (UV) radiation and ultrasound (US) and define consumer segments considering their socioeconomic characteristics and eating habits towards industrialized products through free word association tasks answered by 1004 participants via an online platform. UV- and US-treated foods were more frequently related to unfamiliar words/terms (21.51 and 36.95%) and negative associations (36.25 and 26.70%) than positive ones (29.89 and 24.20%), respectively. Unfamiliarity and health risk concerns were more reported for US-treated foods by women aged 18–25 and ≥46 with low income, and low and frequent industrialized products consumption, as well as for UV-treated foods by consumers ≤35 years old with low and medium income, and low and frequent industrialized products consumption. This indicates that more clear and trustworthy information is needed before introducing these products in the Brazilian market, mainly for potential target consumer groups identified in this study.

Brugada syndrome (BrS) has been described as an arrhythmic disorder characterized by ST elevation with successive negative T wave in the right precordial leads. Patients are at risk for sudden cardiac death (SCD) due to ventricular fibrillation (VF). This specific electrocardiogram (ECG) pattern can sometimes be confused with ST elevation myocardial ischemia. This report shows a patient who presented with chest pain and had an ECG compatible with Brugada. An ischemic workup was performed, and acute coronary syndrome was ruled out. He had a final diagnosis of BrS and was discharged home after the placement of an automatic defibrillator.

BACKGROUND Chagas disease, which is caused by the protozoan Trypanosoma cruzi, is endemic to Latin America and mainly affects low-income populations. Chemotherapy is based on two nitrocompounds, but their reduced efficacy encourages the continuous search for alternative drugs. Our group has characterised the trypanocidal effect of naphthoquinones and their derivatives, with naphthoimidazoles derived from β-lapachone (N1, N2 and N3) being the most active in vitro. OBJECTIVES In the present work, the effects of N1, N2 and N3 on acutely infected mice were investigated. METHODS in vivo activity of the compounds was assessed by parasitological, biochemical, histopathological, immunophenotypical, electrocardiographic (ECG) and behavioral analyses. FINDINGS Naphthoimidazoles led to a decrease in parasitaemia (8 dpi) by reducing the number of bloodstream trypomastigotes by 25-50% but not by reducing mortality. N1 protected mice from heart injury (15 dpi) by decreasing inflammation. Bradycardia was also partially reversed after treatment with N1 and N2. Furthermore, the three compounds did not reverse hepatic and renal lesions or promote the improvement of other evaluated parameters. MAIN CONCLUSION N1 showed moderate trypanocidal and promising immunomodulatory activities, and its use in combination with benznidazole and/or anti-arrhythmic drugs as well as the efficacy of its alternative formulations must be investigated in the near future.

O presente artigo tem por objetivo verificar se dois diferentes tradutores para o inglês aproximam-se ou distanciam-se da construção poética de “A terceira margem do rio” de Guimarães Rosa e como o fazem. Para tanto, cotejamos o conto e suas traduções: a primeira, feita por Barbara Shelby, publicada em 1968, e a segunda, por David Treece, com primeira edição em 2001, analisando as traduções como formas de leitura e interpretação de um tipo de texto que chamamos – de acordo com Massaud Moisés – de conto poético e desvendar, nas linhas e entrelinhas de seus textos, a proximidade ou não da construção poética. Tal comparação não tem por finalidade apontar qual dos dois textos é o que melhor corresponde ao texto de partida pois acreditamos que traduções consistem em textos outros, novas obras literárias, elaboradas em contextos específicos. Nosso entendimento é que a tradução dos contos de Guimarães Rosa deve ser elaborada nos moldes da tradução de poesia, uma vez que, se realizada em forma de prosa, o plano da expressão é totalmente perdido e o que resta é apenas o plano do conteúdo, ou seja, o que o autor considera como sendo apenas o pano de fundo para as verdades maiores que ele gostaria de expressar. O embasamento teórico do trabalho é composto por estudos sobre a obra rosiana de modo geral, sobre o conto escolhido para análise, em particular, e os estudos sobre tradução literária realizados por Antoine Berman, Mario Laranjeira, Paulo Henriques Britto e Ana Cristina César.

Although mesenchymal stromal cells (MSCs) have demonstrated beneficial effects on experimental acute respiratory distress syndrome (ARDS), preconditioning may be required to potentiate their therapeutic effects. Additionally, administration of cell-free products, such as extracellular vesicles (EVs) obtained from MSC-conditioned media, might be as effective as MSCs. In this study, we comparatively evaluated the effects of MSCs, preconditioned or not with serum collected from mice with pulmonary or extrapulmonary ARDS (ARDSp and ARDSexp, respectively), and the EVs derived from these cells on lung inflammation and remodeling in ARDSp and ARDSexp mice. Administration of MSCs (preconditioned or not), but not their EVs, reduced static lung elastance, interstitial edema, and collagen fiber content in both ARDSp and ARDSexp. Although MSCs and EVs reduced alveolar collapse and neutrophil cell counts in lung tissue, therapeutic responses were superior in mice receiving MSCs, regardless of preconditioning. Despite higher total cell, macrophage, and neutrophil counts in bronchoalveolar lavage fluid in ARDSp than ARDSexp, MSCs and EVs (preconditioned or not) led to a similar decrease. In ARDSp, both MSCs and EVs, regardless of preconditioning, reduced levels of tumor necrosis factor- (TNF-) α, interleukin-6, keratinocyte chemoattractant (KC), vascular endothelial growth factor (VEGF), and transforming growth factor- (TGF-) β in lung homogenates. In ARDSexp, TNF-α, interleukin-6, and KC levels were reduced by MSCs and EVs, preconditioned or not; only MSCs reduced VEGF levels, while TGF-β levels were similarly increased in ARDSexp treated either with saline, MSCs, or EVs, regardless of preconditioning. In conclusion, MSCs yielded greater overall improvement in ARDS in comparison to EVs derived from the same number of cells and regardless of the preconditioning status. However, the effects of MSCs and EVs differed according to ARDS etiology.

This study investigated the rifting mechanism that preceded the prolonged subsidence of the Paleozoic Parnaíba basin in Brazil and shed light on the tectonic evolution of this large cratonic basin in the South American platform. From the analysis of aeromagnetic, aerogravity, seismic reflection and borehole data, we concluded the following: (1) large pseudo-gravity and gravity lows mimic graben structures but are associated with linear supracrustal strips in the basement. (2) Seismic data indicate that 120–200 km wide and up to 300 km long rift zones occur in other parts of the basins. These rift zones mark the early stage of the 3.5 km thick sag basin. (3) The rifting phase occurred in the early Paleozoic and had a subsidence rate of 47 m Myr−1. (4) This rifting phase was followed by a long period of sag basin subsidence at a rate of 9.5 m Myr−1 between the Silurian and the late Cretaceous, during which rift faults propagated and influenced deposition. These data interpretations support the following succession of events: (1) after the Brasiliano orogeny (740–580 Ma), brittle reactivation of ductile basement shear zones led to normal and dextral oblique-slip faulting concentrated along the Transbrasiliano Lineament, a continental-scale shear zone that marks the boundary between basement crustal blocks. (2) The post-orogenic tectonic brittle reactivation of the ductile basement shear zones led to normal faulting associated with dextral oblique-slip crustal extension. In the west, pure-shear extension induced the formation of rift zones that crosscut metamorphic foliations and shear zones within the Parnaíba block. (3) The rift faults experienced multiple reactivation phases. (4) Similar processes may have occurred in coeval basins in the Laurentia and Central African blocks of Gondwana.

Nitroimidazoles exhibit high microbicidal activity, but mutagenic, genotoxic and cytotoxic properties have been attributed to the presence of the nitro group. However, we synthesised nitroimidazoles with activity against the trypomastigotes of Trypanosoma cruzi, but that were not genotoxic. Herein, nitroimidazoles (11-19) bearing different substituent groups were investigated for their potential induction of genotoxicity (comet assay) and mutagenicity (Salmonella/Microsome assay) and the correlations of these effects with their trypanocidal effect and with megazol were investigated. The compounds were designed to analyse the role played by the position of the nitro group in the imidazole nucleus (C-4 or C-5) and the presence of oxidisable groups at N-1 as an anion receptor group and the role of a methyl group at C-2. Nitroimidazoles bearing NO2 at C-4 and CH3 at C-2 were not genotoxic compared to those bearing NO2 at C-5. However, when there was a CH3 at C-2, the position of the NO2 group had no influence on the genotoxic activity. Fluorinated compounds exhibited higher genotoxicity regardless of the presence of CH3 at C-2 or NO2 at C-4 or C-5. However, in compounds 11 (2-CH3; 4-NO2; N-CH2OHCH2Cl) and 12 (2-CH3; 4-NO2; N-CH2OHCH2F), the fluorine atom had no influence on genotoxicity. This study contributes to the future search for new and safer prototypes and provide.

The transform shearing between South American and African plates in the Cretaceous generated a series of sedimentary basins on both plate margins. In this study, we use gravity, aeromagnetic, and resistivity surveys to identify architecture of fault systems and to analyze the evolution of the eastern equatorial margin of Brazil. Our study area is the southern onshore termination of the Potiguar rift, which is an aborted NE-trending rift arm developed during the breakup of Pangea. The basin is located along the NNE margin of South America that faces the main transform zone that separates the North and the South Atlantic. The Potiguar rift is a Neocomian structure located at the intersection of the equatorial and western South Atlantic and is composed of a series of NE-trending horsts and grabens. This study reveals new grabens in the Potiguar rift and indicates that stretching in the southern rift termination created a WNW-trending, 10 km wide, and ~ 40 km long right-lateral strike-slip fault zone. This zone encompasses at least eight depocenters, which are bounded by a left-stepping, en echelon system of NW–SE- to NS-striking normal faults. These depocenters form grabens up to 1200 m deep with a rhomb-shaped geometry, which are filled with rift sedimentary units and capped by postrift sedimentary sequences. The evolution of the rift termination is consistent with the right-lateral shearing of the equatorial margin in the Cretaceous and occurs not only at the rift termination but also as isolated structures away from the main rift. This study indicates that the strike-slip shearing between two plates propagated to the interior of one of these plates, where faults with similar orientation, kinematics, geometry, and timing of the major transform are observed. These faults also influence rift geometry.

Un tratamiento correcto de la obesidad ha de comporta un programa de modificación de hábitos independientemente de la técnica que se indique, en especial si es mínimamente invasiva como el Balón Intragástrico (BIG). Se cifra la adherencia terapéutica de los pacientes obesos en menos del 50% a medio largo y plazo respecto a las medidas higiénico-dietéticas aconsejadas. Dado que los resultados obtenidos mediante la técnica de Balón Intragástrico han de verse influidos por la adherencia al programa de modificación de hábitos, revisamos las series publicadas en atención al programa propuesto junto al BIG y a su cumplimiento. Se observa que las series publicadas hasta la fecha ofrecen pocos detalles sobre los Programas Terapéuticos utilizados así como la adherencia de los pacientes a los mismos, y menos aún respecto al Plan de Seguimiento y la fidelidad del paciente. Concluimos la conveniencia de consensuar una estrategia de seguimiento, al menos durante los 6 meses que permanece colocado el BIG.

Oral squamous cell carcinoma (OSCC) is the most common oral malignant neoplasm, mainly affecting individuals over 50 years old with a history of tobacco and alcohol use. The occurrence of this oral cancer in individuals under 40 years old is unusual and, when it does occur, shows a weaker relation to those risk factors and a more aggressive clinical course. Due to the paucity of reports in this population, it is difficult to prove its increasing trend. A case of oral squamous cell carcinoma in a 39-year-old woman with no history of tobacco or alcohol use is reported. Clinical and histopathological findings, aetiology, and treatment are discussed. The increasing trend of oral squamous cell carcinoma in young women without known risk factors highlights the need for clinicians to be prepared to diagnose this lesion quickly and precisely, providing a better prognosis, chance of survival, and quality of life for the patient.