PTGS2 and neoplasm: Primarily, ADSCs engage in bidirectional crosstalk with tumor cells via paracrine signaling, exemplified by the TSG-6/COX-2 axis: Tumor necrosis factor alpha-stimulated gene/protein 6 (TSG-6) upregulates cyclooxygenase-2 (COX-2) expression, fostering prostaglandin E2 (PGE2)-mediated angiogenesis, immunosuppression, and apoptosis evasion, a mechanism validated by the abrogation of chemoresistance upon TSG-6 silencing in ADSCs (60–63).