Atypical Lesions Research Articles

Serum Concentrations of Some Thelper1-Derived Cytokines in Generalized Erythema Multiforme

BACKGROUND: Erythema multiforme (EM) is an acute mucocutaneous syndrome characterized by typical and/or atypical target lesions on the skin. The etiology is still not clear, but EM may be related to infection or medication. Clinically, there are cases of EM with atypical target lesions with generalized distribution without, or with minimal, mucosal lesions. The causes remain unknown. However, T helper cells 1 (Th1) may play an important role in EM. AIMS: The aim of the study was to investigate serum concentrations of some Th1-derived cytokines in generalized EM or generalized EM -like eruptions. METHODS: This was a sectional and descriptive study conducted at the National Hospital of Dermatology and Venereology, in Hanoi, Vietnam, from April 2017 to August 2019. There were 33 EM patients, and 32 healthy controls (HCs) participated. Serum interleukin (IL)-2, interferon-gamma (IFN-γ), and tumor necrosis factor-alpha (TNF-α) levels were measured using the fluorescence covalent microbead immunosorbent assay (ProcartaPlex Immunoassay Panels kit, Thermo Fisher Scientific, USA). The Mann–Whitney U-test was used to compare the serum IL levels of the two groups. Differences were considered to be statistically significant at p < 0.05. RESULTS: The mean age of the EM patients was 42.2 ± 17.5 years, ranging from 19 to 76 years old. Men accounted for 30.3%, women accounted for 69.7%. There were 22 patients with <1 week of onset, accounting for 66.7%; 11 patients with 1 week and those with more than 1 week accounted for 33.3%. There were 60.6% of patients using drugs before the onset. Most patients had pruritus (97%), and all had diffusely distributed skin lesions. Only 15.2% of the patients had mucosal lesions. There are 30.3% of patients with fever. The serum IFN-γ concentration of the EM group was 5.35 ± 9.88 pg/mL, higher than that of the HCs group (0.35 ± 0.77 pg/mL), the difference was statistically significant with p = 0.01 (Mann–Whitney U). The concentrations of IL-2 and TNF-α of the HCs were 24.32 ± 27.94 pg/mL and 109.74 ± 126.73 pg/mL, respectively, higher than those of the EM group (3.37 ± 5.94 pg/mL and 5.86 ± 11.88 pg/mL, respectively). The difference was statistically significant with p < 0.001. Age did not correlate with serum concentrations of cytokines in the EM group. CONCLUSION: In generalized EM, serum concentrations of IFN-γ are statistically significantly higher than those of HCs but serum concentrations of IL-2 and TNF-α were lower. There is no correlation between age and serum concentrations of cytokines in generalized erythema multiform.

Relationship Between Clinical, Laboratory, and Radiological Symptoms with The Incidence of Active Pulmonary Tuberculosis in People with Type 2 Diabetes Mellitus

Background: Type 2 diabetes mellitus (DM) is an independent risk factor for TB that increases the risk of morbidity and mortality. Method: This research is an observational analytical study using a cross-sectional design, which was conducted at Prof. Ngoerah General Hospital Denpasar, Bali over a 3-year period (January 2019-March 2023). Results: There were 106 samples that met the inclusion criteria consisting of 53 DM-TB subjects and 53 non-TB DM subjects. The results of bivariate analysis showed that there was a significant relationship between cough (PR= 13.67, p= <0.001), weight loss (PR= 3.18, p= <0.001), night sweats (PR= 2.02, p= 0.001), NLR³ 4.76 (PR= 2.53, p= <0.001), MLR³ 0.44 (PR= 2.58, p= <0.001), anemia (PR= 2.26, p= <0.001), uncontrolled HbA1c (PR= 1.65, p= 0.042) with the incidence of active pulmonary TB in people with type 2 DM. The results of multivariate analysis showed that the independent variables consisted of cough (OR= 91.90, p= < 0.001), weight loss (OR= 11.32, p= < 0.001), night sweats (OR= 24.27, p = 0.008), atypical lesions (OR= 2183.74 p= 0.002), typical lesions (OR= 12273.19, p=0.033) affect the incidence of active pulmonary TB in people with type 2 DM. TB scoring results were obtained in people with type 2 DM if suggestive of pulmonary TB if major criteria by adding one or more minor criteria and non-suggestive TB if one or more minor criteria without major criteria. Conclusion: There is a relationship between coughing, night sweats, weight loss, increased NLR, MLR, HbA1c, anemia, typical lesions and atypical lesions with the incidence of active pulmonary TB in people with type 2 DM. TB scoring results were obtained in people with type 2 DM if suggestive of pulmonary TB if major criteria by adding one or more minor criteria and non-suggestive TB if one or more minor criteria without major criteria.

Clinico Virological Characterization of Hand, Foot and Mouth Disease in a Tertiary Care Hospital, South India.

Hand, foot, and mouth disease (HFMD) is a common childhood infectious disease, caused by enteroviruses (EVs) which can present with typical or atypical lesions. Although the disease is self-limiting, it can also lead to serious complications. In the era of polio eradication, it is important to understand the population dynamics of enteroviruses causing HFMD as one of the circulating strains may become dominant. It was a collaborative study carried out in the Department of Dermatology and Microbiology of a tertiary care teaching hospital. The throat swabs were collected from 132 suspected HFMD cases. Real-time polymerase chain reaction (PCR) was performed to detect the presence of pan enteroviruses, followed by genotype-specific PCR targeting Human Enterovirus 71 (HEV-71) and Coxsackie virus A16 (CVA-16) and CVA-6 for pan Enterovirus-positive samples. Follow-up samples were collected from 14 children in the 2nd week and subjected to molecular testing to detect enteroviruses. Among 132 children suspected to have HFMD, 44 were girls and 88 were boys, and the majority of them 76.5% (101/132) were under 2 years of age. A history of exposure to a similar clinical presentation was present in 15 children. Of 132 suspected cases, 60 samples (45.5%) were positive for pan Enterovirus. The predominantly circulating genotype was found to be CVA-6 (31.6% [19/60]). There were about 10 cases (16.6%) which had co-infection with both HEV71 and CVA-6. Rash with fever was the most common presentation (57%). In most of the cases with HEV 71, 92.3% (12/13) presented within 3 days of illness to the health-care facility. Of 60 positive cases, 25% (15/60) of children had the atypical distribution of rashes in the face, trunk, genitalia, thigh, neck, and axilla and 16.7% of children (10/60) had the atypical type of lesion either only papular lesions or erythema multiforme. Out of 14 follow-up samples, 13 were negative for EVs; one was positive for pan EV in the 2nd week, however, the patient lost to follow-up after that. HFMD outbreaks in our region were caused by various genotypes of enteroviruses. No severe complications were seen in the affected children. Nearly 30% had atypical presentation either in the form of lesion or site. Robust molecular epidemiological surveillance of HFMD is required to know the strain variations and other emerging genotypes in our setup.

The Impact of Systemic Diseases on Endodontic Treatment Outcomes

Endodontic treatment is vital for preserving teeth as it involves removing pulp tissue and sealing the root canal system. Individuals with compromised function may present with aggressive forms of periapical lesions, which can complicate treatment approaches. Strict infection control measures are crucial during procedures for immunocompromised patients due to the increased risk of infections. This review discusses the connection between diseases and endodontic treatment outcomes. It sheds light on how conditions like diabetes, cardiovascular diseases, immunocompromised states, and osteoporosis can affect manifestations and management strategies. The clinical landscape presents challenges, such as delayed healing and persistent lesions in diabetes due to compromised responses to tissue repair issues caused by vascular changes in cardiovascular diseases, atypical periapical lesions in immunocompromised states, and compromised bone healing in osteoporosis. Managing these conditions requires an approach that puts the patient at the center. It involves monitoring, infection control measures, collaborating with specialists, and making decisions together with the patient. These insights emphasize the importance of endodontic practitioners considering health factors when planning treatments to achieve outcomes.

MCQ corner

1. Selenocysteine is coded by UGA UAG UAA AUG Ans: A. UGA Explanation Selenocysteine (SeCys/SeC) is the 21st amino acid and is found in thioredoxin reductase, glutathione peroxidase, 5’-deiodinase, and selenoprotein P. It is an exceptional case where a stop codon codes for an amino acid. The other stop codons are UAA and UAG. The ability of the protein synthetic apparatus to identify a selenocysteine-specific UGA codon involves the selenocysteine insertion element, a stem-loop structure in the untranslated region of the mRNA.[1] 2. A child with diarrhea for 2 days came to your out-patient department (OPD). On examination, the signs of dehydration were marked and the child was treated with oral rehydration solution (ORS). Glucose absorption was facilitated by which receptors? SGLT1 SGLT2 GLUT4 Sodium–hydrogen antiporter Ans: A. SGLT1 Explanation Absorption of glucose from the intestinal lumen to intestinal cells is by the cotransport mechanism. It is an active transport system and can transport against the concentration gradient.[2] 3. Skeletal derivative of the second pharyngeal arch is Malleus Incus Stapes Maxilla Ans: C. Stapes Explanation Maxilla, malleus, and incus are derived from the first arch.[3] 4. Blastocyst makes contact with a uterus on <3 days 5–7 days 8–11 days 15–16 days Ans: B. 5–7 days Explanation Contact of the blastocyst with endometrium occurs at the time of implantation. Implantation occurs at around 5-7 days.[4] 5. The father of antiseptic surgery is Louis Pasteur Robert Koch Julius Petri Joseph Lister Ans. D. Joseph Lister Explanation Louis Pasteur – the father of microbiology, Robert Koch – the father of microbiology (with Louis Pasteur), and the father of medical bacteriology, Julius Petri – invented the Petri dish.[5] 6. Following were the findings in a Glucose tolerance test (GTT). Fasting blood glucose <75 mg/dl; all blood samples show low blood glucose; urine glucose – nil. The possible diagnosis is Alimentary glycosuria Diabetes mellitus Hypopituitarism Diabetes insipidus Ans. C. Hypopituitarism Explanation In alimentary glycosuria, there will be a peak in the first sample after glucose load and sugar will appear in urine. In diabetes mellitus, fasting and the next two samples will show higher values than the normal reference range and the sample does not return to baseline at the end of the test. In hypopituitarism, there is hypoglycemia and the patient feels fatigued and stressed. In diabetes insipidus, GTT is mostly unaffected.[6] 7. A 10-year-old boy with a history of atopy presented with seasonal recurrent bilateral conjunctivitis and complained of blurred vision for the past 1 week. On lid eversion, giant papillae were seen. All of the following could be seen by slit-lamp examination except: Vascular pannus and punctate epithelial erosions involving the superior cornea. An oval epithelial ulceration with underlying stromal opacification in the central cornea Limbal follicles Conjunctival symblepharon Ans. D. Conjunctival symblepharon Explanation A conjunctival symblepharon is seen in the case of autoimmune disorders such as Sjogren’s syndrome, sarcoidosis, lichen planus, granulomatosis with polyangiitis, etc.[7] 8. Which of the following breast lesion is a noninvasive malignancy? Tubular carcinoma and mucinous carcinoma Intraductal carcinoma of the comedo type Infiltrating ductal carcinoma and lobular carcinoma Medullary carcinoma, including atypical medullary lesions Ans. B. Intraductal carcinoma of the comedo type Explanation A comedo-type ductal carcinoma in situ (DCIS), also known as comedocarcinoma insitu, is the high-grade subtype of DCIS. It completely fills and dilates the ducts and lobules in terminal duct lobular units with plugs of high-grade tumor cells with central necrosis “comedonecrosis.”[8] 9. In patients who develop a documented episode of deep-vein thrombosis, the most significant long-term sequelae are: Claudication Recurrent foot infections Development of stasis ulcer Pulmonary embolization Ans. C-Development of stasis ulcer Explanation Chronic symptoms may occur after 6 weeks or beyond. Pulmonary embolization is the most common complication but is seen as an acute complication.[9] 10. Identify the test from the diagram. Rothera’s test Benedict’s test Barfoed’s test Seliwanoff’s test Ans. A. Rothera’s testFigure 1: Purple permanganate coloured ring [Ferro-penta cyanine complex] at the junction of two fluidsExplanation Rothera’s test was done to identify the presence of ketone bodies in a urine sample. Benedict’s test will contain a green/yellow/orange/brick red precipitate at the bottom. Barfoed’s test has a red scum at the top of the fluid and a little red precipitate at the bottom. Seliwanoff’s test will have a cherry red color.[10] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Calcinosis cutis in a patient with severe COVID-19 infection

Background: Atypical presentation of calcinosis cutis in the context of COVID-19 infection complicated by acute renal failure has not been described in literature. We report a case of severe COVID-19 infection and its associated uncommon skin manifestation. It is a rare condition and its association with different diseases has been established in the past. However, to the authors&amp;apos; knowledge, calcinosis cutis has not yet been described in relation to COVID-19 infection complicated by acute renal failure. Case Presentation: Here we describe a case of a 55-year-old gentleman admitted to the intensive care unit with severe COVID-19 infection whose hospital stay was complicated by acute renal failure and development of hypocalcemia which was treated with oral and intravenous calcium. Subsequently, he developed an atypical fleshy lesion on his left ankle during his in-patient stay which was histologically proven calcinosis cutis. It was successfully treated with topical medications. Conclusion: This case highlights the importance of considering a wide differential of skin lesions including calcinosis cutis in patients who are critically unwell with COVID-19 or any other severe infections and develop isolated skin lesions in the setting of impaired renal functions and abnormal calcium phosphate metabolism with calcium administration.

Incidence of atypical breast lesions in reduction mammoplasty for macromastia associated with benign mammary dysplasia

Incidence of atypical breast lesions in reduction mammoplasty for macromastia associated with benign mammary dysplasia

Caracterização de coccidiose e avaliação de casos sugestivos de enterite necrótica subclínica em frangos de corte

ABSTRACT: This study performed the characterization of coccidiosis in broilers and evaluated the occurrence of suggestive cases of necrotic enteritis (NE), seeking if there is an association between the diseases in Brazilian flocks. Two hundred and fifty-six birds from 32 flocks were evaluated. Macroscopic and histopathological lesions were graduated for coccidiosis and NE. Intestinal content was investigated by polymerase chain reaction (PCR) for seven species of Eimeria and by selective anaerobic culture for Clostridium perfringens and identification of the NetB gene. Flocks positive for coccidiosis represented 93.8%. Macroscopic lesions of coccidiosis were Grade 1 for E. acervulina (27%); E. tenella (9.7%) and E. maxima (8.9%). Histopathological evaluation showed Grade 1 in duodenum (38.2%); jejunum (21.4%); cecum (9.3%) and ileum (5%). PCR demonstrated positivity for E. tenella (21.9%), E. maxima (18.8%), and E. acervulina (3.1%). Suggestive macroscopic lesions of necrotic enteritis ranged from Grade 1 (16%), 2 (23%) and 3 (10,9%). Histopathology indicated the absence of necrosis, showing only hemorrhage in the mucosa and submucosa, with the presence of Eimeria spp. Clostridium perfringens type A netB+ was not isolated, demonstrating that macroscopic lesions found mostly in the jejunum did not characterize NE, based on histopathology and negativity of the NetB gene. The study suggests that, due to the high occurrence of coccidiosis, many macroscopic findings suggestive of NE are, in fact, attributed to atypical lesions caused by the reproduction of Eimeria spp.

Fine Needle Aspiration Cytology of Thyroid Lesions Using Bethesda Classification and Histopathological Correlation

ABSTRACT Background: To keep uniformity and to achieve standardization of thyroid cytopathology reporting National Cancer Institute proposed six tier diagnostic classification system named The Bethesda system for reporting thyroid cytopathology (TBSRTC) that represents a major step toward standardization, reproducibility, and ultimately improved clinical significance, usefulness, and predictive value of thyroid Fine-needle aspiration cytology (FNAC). The guidelines were formulated in 2007 and revised in 2017. Material and Methods: The present study was performed at between January 2015 and June 2019, on thyroid FNA classifying them according to TBSRTC. Cytology and histopathology correlation were done where ever available. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of TBSRTC were calculated considering histopathology as gold standard. The malignancy risk for each category was calculated and the result was tabulated. Results: In the present study, total of 1248 cytology cases of thyroid were studied, out of them 1% were non diagnostic, 91.3% were benign, 1.5% were atypical lesions of undetermined significance (AUS). About 4% were follicular neoplasm (FN), 0.4 was suspicious for malignancy (SM), and 1.8% were malignant. A total of 179 cases were available for cytology and histopathology correlation and risk of malignancy (ROM) was calculated. No histopathology cases were available in category I for correlation, ROM was 4.7% in benign category, 46.2% in AUS category, 50% in SFN/FN, 100% in SM, and 85.7% in malignant category. TBSRTC showed sensitivity of 66.7%, specificity of 90.9%, PPV of 64.8%, NPV of 91.5%, and accuracy of 86.03%. Conclusion: TBSRTC improves perceptions of diagnostic terminology between cytopathologists and clinicians, prevent over diagnosis and helps in better patient management approaches. It should be included in all FNAC of thyroid reporting system.

Infantile Kaposiform hemangioendothelioma in a female patient complicated with severe obstructed jaundice: a case report

BackgroundKaposiform hemangioendothelioma (KHE) is a rare locally aggressive vascular neoplasm that occurs mainly in the pediatric population. KHE usually originates just underneath the skin and affects deeper tissues through infiltrative growth; however, visceral tissue involvement is quite rare.Case presentationAn 8-month-old girl with jaundice and acholic stool was referred to our hospital for further evaluation of a hepatoduodenal ligament tumor. A blood examination revealed high bilirubin and liver enzyme levels, but no signs of coagulopathy. The first attempt at a diagnostic surgical procedure did not provide sufficient diagnostic information. However, the histopathological diagnosis of the cystic duct excised in the second surgery indicated KHE. Therefore, in our case, KHE was considered a cause of obstructive jaundice. Sirolimus (rapamycin) was initiated, and the patient was discharged 7 months after admission.ConclusionsIn cases of atypical hypervascular lesions in the abdominal cavity, especially in the pediatric population, it is important to consider the possibility of KHE, and surgical intervention with proper strategies is required for diagnosis, followed sequentially by promising treatments.

BAP1-Inactivated Melanoma Arising From BAP1-Inactivated Melanocytic Tumor in a Patient With BAP1 Germline Mutation: A Case Report and Review of the Literature.

BAP1-inactivated melanocytic tumors represent a subset of epithelioid melanocytic neoplasms resulting from biallelic inactivation of the BAP1 gene and by a driver mutation that activate the MAP kinase pathway, most commonly BRAFV600E. They occur sporadically or, less common, in the setting of BAP1 tumor predisposition syndrome caused by a BAP1 germline mutation that predisposes to several malignancies including cutaneous and uveal melanoma. To date, only few cases of BAP1-inactivated melanomas have been reported. We present a case of a 35-year-old woman presented with a melanocytic lesion microscopically composed of 3 distinct melanocytic populations, suggesting a stepwise progression model to melanoma from a conventional nevus through a melanocytoma stage. This progression was also supported from a molecular viewpoint given BRAFV600E, BAP1, and TERT-p hot spot mutations detected by targeted mutational analysis. Four atypical melanocytic lesions were removed from the patient's back, and the same A BAP1 c.856A>T, p.(Lys286Ter) mutation was detected on either tumoral or normal tissue samples. To the best of our knowledge, this is the first case of BAP1-inactivated melanoma with a documented TERT-p hot spot mutation manifesting as the first presentation of BAP1 tumor predisposition syndrome.

Clear (Pale ) Cell Acanthoma

A 36-year-old gentleman presented to the Dermatology and Venereology outpatient clinic with a painless nodule of the volar aspect of the left forearm for six months (Panel A). On examination, there was a single, non-tender, smooth surface, and dome-shaped nodule. It was shiny with a reddish rim at its periphery. The nodule was excised completely as a treatment and for histopathological examination that shows it as a clear cell acanthoma (CCA) [panel B (H/E-4X) and C (H/E-10X)]. CCA is a rare benign cutaneous tumor of unknown cause. It is mostly presented as a painless, solitary, slowly growing, and pink-brown or red nodule that is seen mostly on the distal lower extremities of middle-aged and elderly patients. Multiple lesions and different morphologies such as polypoid, giant, atypical, pigmented, and cystic lesions can be seen. Other sites like the abdomen, areola, face, and scrotum can be affected. CCA has specific dermoscopic features in which the blood vessels are arranged in a string-like appearance, but the diagnosis is rarely done without biopsy. Histopathological examination reveals epidermal acanthosis with a psoriasiform pattern of pale keratinocytes and spongiosis in association with dilated blood vessels of the edematous dermal papillae. CCA is treated by surgery such as excision, CO2 laser, or cryosurgery. With a weekly regular follow-up of the patient for two months, the lesion was completely cured.

Upgrade Rate and Predictive Factors Associated With Breast Papillary Lesions on Core Biopsy: A Canadian Experience.

Background: Papillary lesions of the breast are a heterogeneous group, encompassing a wide range of lesions. The histologic distinction between papillary breast lesions remains challenging, especially on core biopsy specimens. Aim: This study aimed to determine the rate of upgrade to atypia or malignancy of biopsy-proven papillary lesions on surgical follow-up and to assess for factors associated with an upgrade in Greater Vancouver, BC, Canada. Materials and Methods: This is a retrospective population-based study of all breast papillary lesions diagnosed on core biopsy between 2017 and 2019 in the Fraser Health Authority in Greater Vancouver, Canada. Patients were retrieved from the laboratory information system. Patient demographics, histopathologic, and radiologic findings were analyzed. Results: A total of 269 specimens from 269 patients (mean 61.1 years), including 265 female and 4 male patients, were included in the study. Of the 269 specimens, 129 (48%) were intraductal papillomas and 140 (52%) were atypical papillary lesions. The overall upgrade rate among papillomas was 11.6% (15 of 129) on final excision. The mean age of patients diagnosed with papilloma on core biopsy was significantly younger than those with atypical papillary lesions (55.6 vs 66.1 years, P < .0001). Lesion size in patients with papillomas on core biopsy was significantly smaller than those with atypical papillary lesions (11.1 vs 15.1 mm, P = .001). The upgrade rates in patients <55 and ≥55 years were 4.9% and 13.2%. Size (P = .004) and atypia on core biopsy (P = .009) were significantly associated with upgrade. Older age (>55 years) (OR = 5.3, 95% CI: 1.04-27.08) was an independent predictor of upgrade among papillomas. Size, location, and Breast Imaging-Reporting and Data System (BI-RADS) radiologic categories in our study were not associated with predicting the upgrade of papillomas. Conclusion: Our data suggest that the risk of upgrade to atypia or malignancy is sufficient to warrant the excision of benign papillomas of any size in patients aged ≥55 years. In patients younger than 55 years, observation with close clinical and radiological follow-up without surgery may be sufficient. Our findings also support surgical excision of papillomas diagnosed on core biopsy when associated with atypia.

High-fidelity detection, subtyping, and localization of five skin neoplasms using supervised and semi-supervised learning

BackgroundSkin cancers are the most common malignancies diagnosed worldwide. While the early detection and treatment of pre-cancerous and cancerous skin lesions can dramatically improve outcomes, factors such as a global shortage of pathologists, increased workloads, and high rates of diagnostic discordance underscore the need for techniques that improve pathology workflows. Although AI models are now being used to classify lesions from whole slide images (WSIs), diagnostic performance rarely surpasses that of expert pathologists. ObjectivesThe objective of the present study was to create an AI model to detect and classify skin lesions with a higher degree of sensitivity than previously demonstrated, with potential to match and eventually surpass expert pathologists to improve clinical workflows. MethodsWe combined supervised learning (SL) with semi-supervised learning (SSL) to produce an end-to-end multi-level skin detection system that not only detects 5 main types of skin lesions with high sensitivity and specificity, but also subtypes, localizes, and provides margin status to evaluate the proximity of the lesion to non-epidermal margins. The Supervised Training Subset consisted of 2188 random WSIs collected by the PathologyWatch (PW) laboratory between 2013 and 2018, while the Weakly Supervised Subset consisted of 5161 WSIs from daily case specimens. The Validation Set consisted of 250 curated daily case WSIs obtained from the PW tissue archives and included 50 “mimickers”. The Testing Set (3821 WSIs) was composed of non-curated daily case specimens collected from July 20, 2021 to August 20, 2021 from PW laboratories. ResultsThe performance characteristics of our AI model (i.e., Mihm) were assessed retrospectively by running the Testing Set through the Mihm Evaluation Pipeline. Our results show that the sensitivity of Mihm in classifying melanocytic lesions, basal cell carcinoma, and atypical squamous lesions, verruca vulgaris, and seborrheic keratosis was 98.91% (95% CI: 98.27%, 99.55%), 97.24% (95% CI: 96.15%, 98.33%), 95.26% (95% CI: 93.79%, 96.73%), 93.50% (95% CI: 89.14%, 97.86%), and 86.91% (95% CI: 82.13%, 91.69%), respectively. Additionally, our multi-level (i.e., patch-level, ROI-level, and WSI-level) detection algorithm includes a qualitative feature that subtypes lesions, an AI overlay in the front-end digital display that localizes diagnostic ROIs, and reports on margin status by detecting overlap between lesions and non-epidermal tissue margins. ConclusionsOur AI model, developed in collaboration with dermatopathologists, detects 5 skin lesion types with higher sensitivity than previously published AI models, and provides end users with information such as subtyping, localization, and margin status in a front-end digital display. Our end-to-end system has the potential to improve pathology workflows by increasing diagnostic accuracy, expediting the course of patient care, and ultimately improving patient outcomes.

Reflectance confocal microscopy in paediatric patients: Applications and limits.

Reflectance confocal microscopy (RCM) is a non-invasive diagnostic tool extensively studied for adult patients. In this retrospective case series conducted at the Dermatology Unit of the University of Campania, Naples, Italy, all patients under 19 years old who were submitted to RCM from January 2011 to December 2021 where evaluated. The aim of the study was to review the most usual indications and possible benefits that it might add for children. Data collection included 215 patients (86 males and 129 females, mean age: 12). Most of the exams (n=85; 39.5%) were performed for lesions clinically compatible with Spitz nevi, congenital nevi (n=50 23,2%) and atypical melanocytic lesions (n=46; 21%) among which two melanomas were detected. RCM can be an useful instrument when evaluating paediatric patients and may help avoid unnecessary biopsy in most cases, representing an additional instrument to improve diagnostic accuracy.

Distribution and incidence of atypical glandular lesions in cervical cytology focusing on the association with high-risk human papillomavirus subtypes.

Adenocarcinoma in situ (AIS) is considered a precursor of adenocarcinoma. Cervical adenocarcinoma has been associated with human papillomavirus (HPV), while other subtypes of AIS and endocervical adenocarcinoma have no precursor lesions and are not associated with HPV. Cervical cytology and HPV genotyping are important in the detection of these different subtypes. Notably, endometrial lesions and infiltration with secondary adenocarcinoma may lead to misdiagnosis of endocervical lesions. The aim of the present study was to avoid misdiagnosis of squamous cell changes and endometrial lesions as endocervical lesions in cervical screening. A total of 210,510 female cytological samples were analyzed between the beginning of January 2020 and the beginning of January 2021. The samples were processed for conventional cytological techniques, and for molecular detection and subtyping of high-risk HPV (HPV-HR) according to the advice and measurements of BD Biosciences (117,765 samples) and the PapilloCheck® HPV test (5,579 samples). The present study was carried out in Germany using the Munich classification III. II-g (Bethesda classification: atypical glandular cells not otherwise specified) was detected in 0.12% of cases under the age of 35 years. Another peak was noticed within the 41-60-years age group (0.11%). In the 41-50-years age group, a peak for II-e (Bethesda classification: Endometrial cells) (1.5%) was identified. An association was revealed between HPV16, HPV18 and HPV45 with cervical intraepithelial neoplasia III, AIS, endocervical adenocarcinoma and squamous cell carcinoma, in addition to other HPV-HR subtypes, such as HPV33/58, as well as 52, 56/59/66 in the different age groups. In patients aged <35 years, 0.03% of cases were vaccinated cases against HPV. In the 35-40-years age group, there was only one vaccinated case (0.0045%); in the 41-50-years age group, there were 11 vaccinated cases (0.031%); and in the 51-60-years age group, there was one vaccinated case (0.002%). No patients aged >60 years were vaccinated against HPV in the analyzed cohort. In conclusion, most cases of HPV-associated glandular dysplastic changes and neoplasia occurred in sexually active women aged between 35 and 60 years. In addition, endocervical adenocarcinoma may occur at any age with or without an HPV infection.

Liposarcoma of the scalp mimicking a lipoma: a case report

BackgroundLiposarcomas are malignant tumours of adipocytic differentiation and their occurrence within the head and neck region is very uncommon. Lipomas are the most common types of benign mesenchymal tumours. The clinical, histological and imaging features of well-differentiated liposarcoma may resemble that of lipoma, causing challenges in the diagnosis. The management and prognosis of benign lipomas and well-differentiated liposarcoma are different.Case presentationA 73-year-old man presented with a painless soft mass in the left temporal region for 15 years with recent rapid growth. The scalp mass was clinically diagnosed as lipoma, while MRI suspected an atypical lipomatous lesion. Complete surgical resection was performed, and histopathological examination confirmed a well-differentiated liposarcoma.The patient recovered completely and will be followed up with long-term surveillance.ConclusionThis report is to highlight that clinicians must have a high index of suspicion for this rare entity when dealing with scalp masses and suspicious radiological findings, which can affect the overall management and prognosis.

Diagnosis of Endometriosis: The Surgeon's Eye Compared to Histopathology

<h3>Study Objective</h3> Evaluate the intraoperative visual detection of endometriosis compared to final histopathologic diagnosis based on lesion type. <h3>Design</h3> Prospective clinical study. <h3>Setting</h3> Tertiary-care, academic medical center. <h3>Patients or Participants</h3> Seventy-seven patients underwent surgical evaluation for suspected endometriosis by high-volume endometriosis surgeons. <h3>Interventions</h3> Minimally invasive complete pelvic peritonectomy with documentation of visual presence or absence of endometriosis and lesion type. Powder burn lesions were defined as typical lesions. White scarring, clear vesicles, red flame, and peritoneal pockets were defined as atypical lesions. <h3>Measurements and Main Results</h3> A total of 1,069 peritoneal specimens were obtained with visual detection of endometriosis reported for 352 specimens (32.93%). Endometriosis was confirmed on histopathologic evaluation in 65.8% powder burn lesions, 51.6% white scarring, 45.7% clear vesicles, 39.1% red flame, and 28.9% peritoneal pockets (p=0.003). Additionally, 11.3% of specimens with no visible endometriosis demonstrated a positive histopathologic diagnosis. Overall sensitivity was 68.36%, specificity was 78.15%, positive predictive value was 49.72%, and negative predictive value was 88.66% for visual detection of endometriosis. White scarring was the lesion type with the highest sensitivity at 44.14% while the lowest sensitivity was for red flame lesions at 10.0%. All lesion types had a high specificity (powder burn 96.20%, white scarring 91.34%, clear vesicles 92.54%, red flame 97.84%, peritoneal pocket 95.91%). The positive predictive value varied depending on lesion type (powder burn 65.75%, white scarring 51.61 %, clear vesicles 45.74%, red flame 39.13%, peritoneal pocket 28.95%). <h3>Conclusion</h3> There is poor reliability for the visual detection of endometriosis at the time of surgical evaluation for endometriosis. Typical and atypical lesions have similar sensitivity, specificity, and positive predictive value for accurate visual detection of endometriosis. Specimens with no visible endometriosis are found to have histopathologic disease in 11.3% of specimens. This potential for atypical appearance and disease not macroscopically visible suggests a role for complete pelvic peritonectomy.

7952 Controlled Ovarian Stimulation with LNG-Ius in Situ in Women with Atypical Endometrial Lesions, Undergoing Fertility-Sparing Treatment

<h3>Study Objective</h3> to demonstrate safety of ovarian stimulation with 52mg Levonorgestrel Intrauterine System (LNG-IUS) <i>in situ</i> in patients conservatively treated for atypical endometrial lesions <h3>Design</h3> prospective observational study. <h3>Setting</h3> <b>G</b>ynecology department of University Federico II, Naples, Italy. <h3>Patients or Participants</h3> young women with atypical endometrial hyperplasia (AEH),or FIGO IA G1-G2 endometrial cancer(EC-G1,EC-G2),who underwent fertility-sparing treatment and ovarian stimulation with LNG-IUS <i>in situ.</i> <h3>Interventions</h3> combined fertility-sparing treatment was performed:EC-G1 and EC-G2 were treated by three steps hysteroscopic technique, AEH by superficial endometrial resection. LNG-IUS was inserted after surgery. Hysteroscopic endometrial biopsies were performed at 3 and 6 months. If complete response (CR) was achieved, controlled ovarian stimulation with LNG-IUS <i>in situ</i> was started, oocytes retrieval performed, and mature oocytes cryopreserved. After removal of LNG-IUS, embryo transfer was performed. <h3>Measurements and Main Results</h3> 23 young women with AEH(n=17), EC-G1(n=3), or EC-G2(n=3) were enrolled. CR was achieved in 14/16(87.5%) of AEH, 2/2(100%) of EC-G1 and 2/3(66.7%) of EC-G2 at 3-month follow up and in 11/14(78.6%) of AEH, 2/2(100%) of EC-G1 and 2/2(100%) of EC-G2 at 6-month follow up. 10 patients underwent ovarian stimulation with LNG-IUS <i>in situ</i> (experimental group) and compared with 10 infertile patients undergoing ovarian stimulation in absence of LNG-IUS (control group). The mean number of oocytes retrieved and mature oocytes was 8.10(± 2.77 SD) and 7.00(± 2.11 SD) in experimental group, compared with 6.30(± 3.3 SD) and 4.88(± 2.68 SD) in control group. There were no statistically significant differences in oocytes retrieved(p=0.19) and mature oocytes(p=0.05) between the two groups. Reproductive outcome (pregnancies and live birth rate) was also assessed. Pregnancy rate was 50%, live birth rate 37.5% and miscarriage rate 12.5%; 50% of patients experienced implantation failure. <h3>Conclusion</h3> presence of LNG-IUS during ovarian stimulation has no negative effects on oocyte quality, balancing the potentially dangerous effect of hyperestrogenism on patients with atypical endometrial lesions. The combined approach confirmed as a safe and effective fertility-sparing approach. Promising pregnancy outcomes can be expected.

Combined central and peripheral demyelination: a case report

Overlapping central nervous system (CNS) and peripheral nervous system (PNS) demyelination is a rare clinical entity, more frequently seen in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and multiple sclerosis (MS). This case report showcases a patient with atypical CIDP and CNS demyelination lesions. Demographic data, disease course, treatment responsiveness, neurological examination, laboratory tests, nerve conduction studies (NCS), and brain and spinal cord MRI were registered. The case highlights the difficulty of diagnosis establishment and treatment selection, given the atypical course of the disease and limited answers to the indicated therapies. The data from our report suggest that specific and widely available immunological targets are necessary for diagnosing combined central and peripheral demyelination cases appropriately. The association of different immunotherapeutic agents may be necessary to induce and maintain disease remission.