Atypical Vascularization Research Articles

Spatial transcriptomics of gastric cancer brain metastasis reveals atypical vasculature strategies with supportive immune profiles.

Gastric cancer brain metastasis (GCBM) represents a rare but highly aggressive malignancy. Metastatic cancer cells are highly heterogeneous and differentially remodels brain vasculature and immune microenvironments, which affects the treatment effectiveness and patient outcome. This study aimed to investigate the spatial interactions among different cell components, especially the vasculature system and the brain microenvironment of GCBM patients. We used digital spatial profiling to examine 140 regions composing tumor, immune, and brain tissues from three GCBM patients. Transcriptomic data with spatial information were analyzed for tissue areas related to different blood recruitment strategies. For validation, independent analysis of patient bulk transcriptomic data and in vivo single-cell transcriptomic data were performed. Angiogenesis and blood vessel co-option co-existed within the same GCBM lesion. Tumors with high epithelial-mesenchymal transition and an enhanced transcriptomic gene signature composed of CTNNB1, SPARC, VIM, SMAD3, SMAD4, TGFB1, TGFB2, and TGFB3 were more prone to adopt blood vessel co-option than angiogenesis. Enriched macrophage infiltration, angiogenic chemokines, and NAMPT were found in angiogenic areas, while increased T cells, T cell activating cytokines, and reduced NAMPT were found in vessel co-option regions. Spatially, angiogenesis was enriched at the tumor edge, which showed higher DMBT1 expression than the tumor center. This study mapped the orchestrated spatial characteristics of tumor and immunological compositions that support the conventional and atypical vascularization strategies in GCBM. Our data provided molecular insights for more effective combinations of anti-vascular and immune therapies.

Reliability and diagnostic performance of smartphone colposcopy.

To evaluate the interobserver and intraobserver reliability of smartphone colposcopy (SPC) versus conventional colposcopy and to determine diagnostic performance. A smartphone back camera was used to capture cervical images before and after application of acetic acid, and after application of lugol solution. Captured images were reviewed independently by two experienced colposcopists and findings were noted as per colposcopy. Smartphone-based diagnostic performance was calculated, and kappa statistics were used for measurement of agreement between SPC and conventional colposcopy findings. A total of 114 women were included in the study. The kappa statistic for intraobserver reliability was 0.77 for both normal colposcopic findings and the transformation zone, indicating substantial agreement. Kappa values were 0.54 for acetowhite epithelium, 0.51 for lugol staining, and 0.51-0.60 for atypical vascularization. Kappa values for interobserver reliability were 0.76 for normal colposcopic findings, 0.56 for acetowhite epithelium, and 0.60 for lugol staining. The sensitivity, specificity, PPV, and NPV of SPC for CIN2+ were 88.2 (95% CI, 72.5-96.7), 48.7 (95% CI, 37.4-60.2), 0.42 (95% CI, 0.36-0.48), and 0.91 (95% CI, 0.79-0.96), respectively. SPC showed substantial agreement between the histologic diagnoses based on the captured images and conventional colposcopic findings.

CERVICAL CYTOLOGIC AND COLPOSCOPIC CHANGES IN CASES USING IUDs FOR A LONG TIME

The present study aims to examine cervical cytologic and colposcopic changes in patients using IUDs for a long time. Our study is a cross-sectional study that enrolled 188 cases. 62 monogamous patients without a history of sexually transmitted infection, and using an IUD for 5 years or more were included in the study group (Group 1). 126 patients without a previous anamnesis of IUD use and patients in whom IUDs were not detected during the examination were enrolled in the control group (Group 2). All patients underwent a colposcopic examination and a smear was obtained. Patients with a history of HPV were excluded from the study. Smear test results and findings of colposcopic examination of the study and control groups were compared. Gravida, Parity, Number of Births, age at first coitus were determined through the patients’ histories. The mean age of the patients in Group 1 was 38.67, age at first coitus was 19.49, and the mean age in Group 2 was 39.11 and age at first coitus was 18.95 years. There was a significant difference detected in the comparison of Gravida (p=0.03), while parity and NSD parameters were not found significantly different (p=0.15, p=0.14). Rates of mild ectopy in Group 1 and Group 2 were 25.8% and 19.18%, moderate ectopy were 25.8%, 28.6%, severe ectopy were 11.3% and 23.8%, respectively. Polyp detection rate was found 16.7% in Group 1, while it was 40.9% in Group 2. On the other hand, leukoplakia detection rate was 8.3% in Group 1, while it was found 18.2% in Group 2. no statistically significant difference was detected between the two groups. F. Mosaic rate in patients using IUDs was found significantly lower ( χ² = 3.74 p= 0.05). As a result of our study, no significant difference could be shown in NTZ, ATZ, Asetowhite, C.Mosaic, F.Punction, C.Punction, Atypical Vascularization, and Schiller rates.

Tumeur du site d’implantation trophoblastique : quand la suspecter et quel traitement décider ?

Tumors of trophoblast implantation site TTSI are rare gestational tumors. This case highlights the diagnostic difficulties and treatment of tumors of trophoblastic implantation site early. Patient of 28 years with no medical history, G1P1 who gave birth 11 months ago presented bleeding with an HCG level of 73IU that led to the diagnosis of early miscarriage. Treatment of miscarriage by hysteroscopy and curettage is complicated leading to the realization of an abdominopelvic CT and pelvic ultrasound that show an atypical uterine vascularity and an intracavitary heterogeneous mass. The pelvic MRI performed evokes a TTSI stage I. A hysterectomy with bilateral salpingectomy and ovarian conservation is achieved. Despite the standard treatment with surgery the HCG levels do not normalize before seven months after surgery. This indicates an adjuvant chemotherapy, the patient refuses. The presented case illustrates the diagnostic difficulties of the disease. He noted the importance of the second reading network proposed by the specialized center in Lyon. It also raises the question of adjuvant chemotherapy in some cases of early stage TTSI. The challenge is to define cases requiring adjuvant therapy. Predictors of chemotherapy in early stages could be tumor size, degree of infiltration of the myometrium and mutation p53. Amenorrhea, bleeding associated with uterine atypical vascularization, and atypical development of HCG<1000IU and/or unusual complications of treatment of miscarriage should evoke a tumor site trophoblastic implantation. Hysterectomy is the first treatment in early stages. Tumor size, degree of infiltration of the myometrium and mutation p53 are predictors to assess in multicentre studies to define the indications of postoperative chemotherapy.

The role of doppler ultrasound and multislice spiral computed tomography angiography in the common form of stomach cancer diagnosis

Aim. To evaluate the results of Doppler ultrasound and multislice computed tomography angiography in patients with gastric cancer and the sensitivity of these diagnostic methods for the detection of the abdomen great vessels lesions.Methods. The study included 32 patients aged 37 to 82 years who had histologically confirmed gastric adenocarcinoma diagnosis. The control group consisted of 30 apparently healthy people of the same age. Transabdominal ultrasonography of the abdominal cavity organs and stomach in gray-scale mode (B-mode before and after the stomach filling with degassed liquid), Doppler ultrasound of the abdomen and the stomach wall vessels, multislice spiral computed tomography angiography were performed in all patients at the preoperative stage. The analysis of the study results and their comparison with intraoperative data were conducted.Results. In patients with gastric cancer a statistically significant increase in peak systolic velocity in the celiac trunk, superior mesenteric artery, left gastric artery and resistive index decrease in these blood vessels (p &lt;0.05) with the presence of atypical vascularization in the affected stomach walls were registered. The data obtained during the multislice spiral computed tomography angiography were analyzed. The sensitivity of Doppler ultrasound in the preoperative detection of abdominal cavity great vessels affection in patients with gastric cancer was 77.8%, multislice spiral computed tomography angiography - 88.9%, the combination of these two methods - 96.3%.Conclusion. The analysis of used diagnostic methods of examination of patients with stomach cancer showed that Doppler ultrasound should be included in the patients examination standard to assess the abdominal cavity great vessels condition, what is important in deciding on the possibility of operative intervention; the sensitivity of the combination of dopplerography and multislice spiral computed tomography angiography in the diagnosis of great vessels affection is 96.3%.

A Benign Ovarian Tumour developing an Endometrial Cancer? Sertoliform Ovarian Cystoadenoma getting together with an Endometrioid Adenocarcinoma

Introduction: Sertoli cells tumours are neoplasms with a very low incidence, being sertoliform cystoadenomae extremely unusual. Its first description was made on 1982 by Young and Roth, with very few cases published after them. This is a neoplasm only described on postmenopausal women, with an average age of presentation of 68 year old, and they could suffer virilization symptoms in different degrees. Histologically, it is a well differentiated neoplasm, with a low malignancy degree, and good prognosis if it is confined to ovaries. In other way, the finding of this ovarian tumour getting together with an endometrioid adenocarcinoma is an extremely rare case. Medical Case: A 66 year old woman, who attended our office relating postmenopausal metrorrhage, is presented. The patient had a medical history of diabetes mellitus type II, arterial hypertension, dyslipidemia, liver steatosis, glaucoma and appendectomy. She got three deliveries and had her menopause at the age of 53. An outpatient hysteroscopy was carried on, finding three endometrial polyps, two of them appeared as normal, and the bigger one had a glandular appearance with atypical vascularization, taking biopsy of it that was informed as endometrioid type adenocarcinoma with mucus-secreting pattern. Ultrasoud scanning, magnetic resonance and serum Ca 125 were carried on, finding a 2,5cm left ovarian nodule with negative Ca 125. An abdominal total hysterectomy with double adnexectomy, was carried on, with intraoperative biopsy, informed as a borderline tumour. Due to this finding, the operation was completed with omentectomy, lymphadenectomy and peritoneal washing. Last histological analysis identifies the ovarian tumour as sertoliform adenoma from rete ovarii, with hepatocyte multifocal metaplasia. This tumour is suspected of being estrogenic functioning one, probably was the inductor of low degree and moderatedly differentiated G2 endometrioid adenocarcinoma. There was no lymphatic or omental metastases. FIGO staging IA, TNM staging T1aN0M0. Conclusions: Sertoliform cystoadenoma is a very rare finding, with only few cases reported. It could be an estrogenic functioning tumour and due to this characteristic could induce endometrial hyperplasia, and at last, could be the reason for appearance of low malignancy degree endometrial neoplasms.

Borderline ovarian tumors and diagnostic dilemma of intraoperative diagnosis: could preoperative He4 assay and ROMA score assessment increase the frozen section accuracy? A multicenter case-control study.

The aim of our study was to assess the value of a preoperative He4-serum-assay and ROMA-score assessment in improving the accuracy of frozen section histology in the diagnosis of borderline ovarian tumors (BOT). 113 women presenting with a unilateral ovarian mass diagnosed as serous/mucinous BOT at frozen-section-histology (FS) and/or confirmed on final pathology were recruited. Pathologists were informed of the results of preoperative clinical/instrumental assessment of all patients. For Group_A patients, additional information regarding He4, CA125, and ROMA score was available (in Group_B only CA125 was known). The comparison between Group A and Group B in terms of FS accuracy, demonstrated a consensual diagnosis in 62.8% versus 58.6% (P: n.s.), underdiagnosis in 25.6% versus 41.4% (P < 0.05), and overdiagnosis in 11.6% versus 0% (P < 0.01). Low FS diagnostic accuracy was associated with menopausal status (OR: 2.13), laparoscopic approach (OR: 2.18), mucinous histotype (OR: 2.23), low grading (OR: 1.30), and FIGO stage I (OR: 2.53). Ultrasound detection of papillae (OR: 0.29), septa (OR: 0.39), atypical vascularization (OR: 0.34), serum He4 assay (OR: 0.39), and ROMA score assessment (OR: 0.44) decreased the probability of underdiagnosis. A combined preoperative assessment through serum markers and ultrasonographic features may potentially reduce the risk of underdiagnosis of BOTs on FS while likely increasing the concomitant incidence of false-positive events.

The study of differences of antigenicity in rabbit intervertebral disc

Objective To reveal and compare the immunogenicity of glycoprotein from nucleus pulposus and collagen from anulus fibrosus in rabbit intervertebral disc. Methods According to the similarity principle of genome biology and the amount of nucleus pulposus in different intervertebral disc, Glycoprotein from nucleus pulposus was harvested from the intervertebral disc of 20 rabbits and placed into the psoas by anterolateral approach. Similar implantation of collagen from anulus fibrosus was performed in another 20 rabbits. The implantations of autologous muscle in rabbits serve as a control group.After one week,two weeks, four weeks, six weeks and eight weeks, the rabbits were killed, the tissue was harvested. HE staining was applied to detect the degree of vascularization and infiltration of lymphocytes. Immunohistochemistry were used for analysis of T-helper cells (CD4+) and cytotoxic T cells (CD8+) in the tissue. Results HE staining showed the infiltration of lymphocytes was found just one week after implantation and vascularization was seen at the 2nd week in the glycoprotein implanted group. However in collagen implant group,small amounts of lymphocytic and atypical vascularization were seen at the 4th week. Immunohistochemistry revealed that the proportion of activated T cells (CD4+ and CD8+) was significantly higher in the glycoproteinimplanted group at all time points, as compared with the collagen-implanted group and sham group. The proportion of activated T cells was higher in collagen-implated group than that of in sham group . Conclusion The glycoprotein in nucleus pulposus is easier to induce the differentiation and mature of T cell. The antigenicity of glycoprotein in nucleus pulposus was stronger than that of collagen in anulus fibrosus in rabbit intervertebral discs. Key words: Intervertebral disk; Autoimmunity; Antigens; Glycoproteins; Collagen

Inadvertent coexistence of atrial myxoma and mitral stenosis

A 59-year-old woman was referred for evaluation of shortness of breath. Physical examination was remarkable for a faint apical mid-diastolic murmur. Transthoracic echocardiography (TTE) demonstrated moderate rheumatic mitral valve stenosis with valve area of 1.3 cm 2 by both planimetry and pressure half time. A mass lesion with a broad base was seen attached to the interatrial septum (IAS) inside the left atrium (Fig. 1, Movie 1). Transoesophageal echocardiography (TEE) revealed that the mass (23 x 33 mm) was encapsulated, heterogeneous with cystic degeneration, attached with a broad base to the lower portion of the IAS and extended to the anterior mitral leaflet consistent with left atrial myxoma (LAM). The mass was fixed and did not show any independent mobility or sliding through the mitral valve orifice (Fig. 2, Movie 2). Colour Doppler echocardiography showed that the mass was partially vascularized (Fig. 3, Movie 3). Coronary angiography ruled out significant coronary artery disease and uncovered atypical vascularization of the mass from both right and left coronary arteries (Movies 4 and 5). Cardiovascular magnetic resonance imaging was consistent with LAM. The patient was referred for cardiac surgery. The mass was excised, followed by mitral valve replacement due to encroachment on the anterior mitral leaflet. Gross appearance and histology showed typical features of myxoma (Figs. 4 and 5). The discrimination between LAM and atrial thrombi presents a diagnostic challenge in the presence of mitral stenosis. Usually, LAM arises from the IAS at the level of fossa ovalis. Atrial thrombi classically reside in an atrial appendage, but can also form in the LA body.

Lhermitte-Duclos disease with atypical vascularization – case report and review of the literature

A case of Lhermitte-Duclos disease (LDD, dysplastic gangliocytoma) with atypical vascularization is reported. LDD is a rare cerebellar mass lesion which may be associated with Cowden's syndrome and the PTEN germline mutation. A 61-year-old male presented 15 years before with a transient episode of unspecific gait disturbance. Initial magnetic resonance (MR) imaging revealed a right-sided, diffuse, nonenhancing cerebellar mass lesion. No definitive diagnosis was made at that time, and the symptoms resolved spontaneously. 15 years later, the patient presented with acute onset of vomiting associated with headache and ataxic gait. MR imaging showed a progression of the lesion with occlusive hydrocephalus. The lesion depicted a striated pattern characteristic for LDD with T1-hypointense and T2-hyperintense bands, nonenhancing with contrast. After resection of the mass lesion, the cerebellar and hydrocephalic symptoms improved rapidly. The pathological examination confirmed the diagnosis of dysplastic gangliocytoma (WHO Grade I) with enlarged granular and molecular cell layers, reactive gliosis and dysplastic blood vessels. No other clinical features associated with Cowden's syndrome were present. This case illustrates that LDD with atypical vascularization is a slow-growing posterior fossa mass lesion which may remain asymptomatic for many years. Timing of surgical treatment and extent of resection in patients with LDD is controversial. The typical features on standard T1-/T2-weighted MR imaging allow a diagnosis without surgery in most cases. The authors believe that the decision to treat in these cases should be based on clinical deterioration.

Giant Parathyroid Adenoma With Atypical Ultrasonographic Image

A 49-year-old woman with slightly increased serum calcium levels on random biochemical blood tests was found by Tc-99m MIBI scintigraphy to have a giant parathyroid adenoma with an atypical ultrasonographic image showing a homogenous mass with atypical vascularization. Surgical excision was carried out. The size of the adenoma did not correlate with the blood calcium levels.

Noninvasive Characterization of Left Atrial Mass

A 75-year-old woman presented for workup of a systolic murmur and recurring episodes of atrial fibrillation. Transthoracic and transesophageal echocardiography revealed biatrial dilatation, severe mitral valve stenosis, and a large left atrial mass attached to the atrial septum (IAS) (Figure 1). Thus, the patient was referred to us for presurgical cardiac catheterization. Coronary angiography ruled out coronary artery disease and demonstrated atypical vascularization of the left atrium, indicating additional perfusion and leaking of contrast media in the area where the mass was attached to the IAS (Figure 2). Movie I and Movie II show fully animated versions of Figure 1 and Figure 2, respectively. From the results of echocardiography and cardiac catheterization, the most likely diagnosis appeared to be left atrial myxoma. In patients with mitral valve stenosis, however, chronic atrial thrombus remains an important differential diagnosis. Therefore, the patient underwent cardiovascular MRI (CMR) for additional …

Macular-foveal capillaries in human retina.

Summary The occurrence of atypical vascularization of the macular-foveal zone in 20 eyes of 17 patients is described. The significance of this fluorescein stereoangiographic finding is discussed.