Benign Changes Research Articles

RETROSPECTIVE ANALYSIS OF DISCORDANT RESULTS BETWEEN UROVYSION FISH AND URINE CYTOLOGY IN THE DETECTION OF HIGH-GRADE UROTHELIAL CARCINOMA (HGUC): A STUDY OF 118 PATIENTS

Abstract Introduction/Objective Accurate detection of high-grade urothelial carcinoma (HGUC) relies on multiple diagnostic modalities, including UroVysion FISH and urine cytology; however, discordant results between these diagnostic tools can present a challenge. We present this study, scrutinizing the discordant results between UroVysion FISH and urine cytology to explore the potential factors that could contribute to discrepancies. Methods/Case Report A cohort of 118 patients, who underwent both UroVysion FISH and urine cytology testing for evaluation of HGUC, was selected from our cytopathology archives. Results of both the modalities were compared, and a retrospective review of original slides was done by experienced cytopathologists. Results (if a Case Study enter NA) Among the 118 cases, Urovysion FISH yielded positive results in 14 cases and negative in 104. In contrast, urine cytology reported 1 case as positive, 102 as negative, 10 as atypical (8 atypical and 2 rare atypical), and 5 as suspicious. Discordant findings were observed in 20 cases, accounting for 17% of the cases. After retrospective review of original slides, few cases were reclassified. 2 cases as atypical (initially labeled as negative), 2 cases as negative (initially labeled as atypical), 3 cases as positive (initially labeled as atypical/suspicious), 3 cases as suspicious (initially labeled as negative/atypical). Conclusion This reclassification highlights complexity of cytological interpretation, including the challenges of distinguishing between benign cellular alterations, reactive changes, ambiguous findings, suspicious features and malignant cytological changes. Integrating molecular and morphological assessment is essential for evaluation of urothelial carcinoma. Discrepancy between the two is an area which is open to study and can be related to differences in sensitivity and specificity of the testing modalities, sampling methods, variation in interpretation, limitations of testing modality and varying tumor characteristics. Review of clinical history, imaging studies, cystoscopy, and repeat testing may be considered in such cases for diagnostic accuracy.

Early Detection of Residual/Recurrent Lung Malignancies on Post-Radiation FDG PET/CT

Positron Emission Tomography/Computed Tomography (PET/CT) using Fluorodeoxyglucose (FDG) is an important imaging modality for assessing treatment outcomes in patients with pulmonary malignant neoplasms undergoing radiation therapy. However, distinguishing between benign post-radiation changes and residual or recurrent malignancies on PET/CT images is challenging. Leveraging the potential of artificial intelligence (AI), we aimed to develop a hybrid fusion model integrating radiomics and Convolutional Neural Network (CNN) architectures to improve differentiation between benign post-radiation changes and residual or recurrent malignancies on PET/CT images. We retrospectively collected post-radiation PET/CTs with identified labels for benign changes or residual/recurrent malignant lesions from 95 lung cancer patients who received radiation therapy. Firstly, we developed separate radiomics and CNN models using handcrafted and self-learning features, respectively. Then, to build a more reliable model, we fused the probabilities from the two models through an evidential reasoning approach to derive the final prediction probability. Five-folder cross-validation was performed to evaluate the proposed radiomics, CNN, and fusion models. Overall, the hybrid fusion model outperformed the other two models in terms of sensitivity, specificity, accuracy, and the area under the curve (AUC) with values of 0.67, 0.72, 0.69, and 0.72, respectively. Evaluation results on the three AI models we developed suggest that handcrafted features and learned features may provide complementary information for residual or recurrent malignancy identification in PET/CT.

Clinical, histological and receptor profiles of invasive breast cancer and ductal carcinoma in situ in females with germline pathogenic variants in PTEN and implications for germline testing

PTEN hamartoma tumour syndrome (PHTS) is an autosomal dominant hereditary cancer syndrome, caused mostly by germline pathogenic variants in PTEN. Female carriers have an up to 80% lifetime risk of breast cancer. Pathologic features of breast cancer in PHTS have seldom been reported.In a collaboration between all histopathology laboratories in our state and our statewide familial cancer service, we tracked the breast biopsies of 12 females with known PTEN pathogenic or likely pathogenic variants (Jan 1990 to Jan 2018). Two further cases were added by a Victorian cancer genetics unit.Breast cancer, inclusive of invasive cancer or ductal carcinoma in situ (DCIS), was diagnosed in 12 of 14 cases (85.7%). One case had a family history of PHTS and six a family history of breast cancer. The mean age at first breast cancer diagnosis was 41.6 years (range 27-63). Six cases developed more than one breast cancer. Five (42%) developed contralateral breast cancer. Ten of the 12 invasive cancers were of no special type, two were reported as lobular carcinomas. None were grade 1. When reported, all cancers were hormone receptor positive and HER2 negative. All were associated with DCIS. The DCIS spanned all grades.The two cases without breast cancer still required surgery for exuberant benign changes, including papillomas, fibroadenomatoid change, florid ductal epithelial hyperplasia, adenosis and stromal fibrosis.We note that the morphology and receptor profiles of breast cancer in individuals with P/LP PTEN variants are not distinctive. Contrary to prevalent beliefs, these cancers do not conform to the contemporary definition of apocrine breast carcinoma. Greater familiarity of healthcare professionals with the overall clinical and pathologic findings in PHTS and the validated Cleveland Clinic PTEN calculator (http://www.lerner.ccf.org/gmi/ccscore) would improve the recognition of female PHTS individuals with breast cancer. Earlier identification of their cancer predisposition syndrome would benefit these patients and their families who are at high risk of a range of cancers.

Prostate magnetic resonance imaging (MRI) in patients with hip implants-presetting a protocol using a phantom.

Metal structures are a source of artifacts that significantly complicate the interpretation of magnetic resonance imaging (MRI). The use of prostate MRI as a preliminary test in men with a suspicion on prostate cancer leads to an increased use of the test. The aim of this study was to solve a clinically significant problem: to ensure the reduction of artifacts from metal hip implants during prostate MRI. Another goal was to evaluate the impact of artifact reduction methods on quantitative measurements. The prostate gland (PG) phantom model was a cylinder filled with an aqueous solution of polyvinylpyrrolidone at the concentrations of 40%, 30%, and 20% [central zone (CZ), peripheral zone (PZ), and "lesion", respectively]. Phantom MRI study was conducted on Philips Ingenia 1.5T and Philips Ingenia 3T scanners. For 1.5 T, the reduction in the influence of artifacts inside region of interest (ROI) was observed, expressed in a decrease in the average apparent diffusion coefficient (ADC) (CZ, PZ, "lesion") for the manual artifact reduction (MAR) and ZOOM (title of software artifact reduction) techniques compared to the standard method. For 3T this effect was not detected. The same ADC results were obtained for Standard and MAR techniques, and increased ADC values for ZOOM. Despite the fact that the spread of ADC values on 3.0T scanners was minimal, there was a significant deviation of ADC values from the reference ones (up to 30.4%). Therefore, it is necessary to use a correction coefficient in the ADC calculation for the 3.0 T device. In the presented clinical case, high-quality tomograms were obtained without any artifacts, despite the presence of two hip replacement devices in the scanning area. The accurate prostate MRI in the presence of implants is essential for an accurate diagnosis. This approach allows to reduce artifacts from hip implants, to visualize PG and periprostatic tissue in the best way, and to detect malignant and benign changes.

HPV DNA status and clinical history of patients are supplements for accurate reporting of the cytological Pap smear

The present study was aimed at showing the importance of HPV DNA status and the clinical history of the patients required by the cytologist for accurate reporting. A total of 1250 symptomatic women who attended the gynaecology outpatient department of the Mahavir Cancer Sansthan and Nalanda Medical College, Patna, for pap smear examinations were screened and recruited for the study. Due to highly clinical symptoms out of the negative with inflammatory smears reported, one hundred and ten patients were randomly advised for biopsy and HPV 16/18 DNA analysis by a gynaecologist to correlate negative smears included in the study. Pap smear reports revealed that 1178 (94.24%) were negative for intraepithelial lesions (NILM) with inflammatory smears, 23 (1.84%) smears showed low-grade squamous intraepithelial lesions (LSIL), 12 (0.96%) smears showed high-grade squamous intraepithelial lesions, and 37 (2.96%) smears showed an atypical squamous cell of undetermined significance (ASC-US). A biopsy of 110 out of 1178 (NILM) patients revealed that 15 (13.63%) women had cervical cancer, 29 women had CIN I, 17 women had CIN II + CIN III, 35 women had benign cervical changes, and 14 women had haemorrhages. On the other hand, HPV 16/18 DNA was detected as positive in 87 out of 110. The high positivity of HPV in biopsied cases where frank cervical cancer and at-risk cancer were also observed in the negative smear-screened patients reveals that the HPV status and clinical history of the patients will be quite helpful to the cytologist for accurate reporting, and suggests that a negative HPV DNA result may be a stronger predictor of cervical cancer risk than a negative Pap test.

Prospective Study of Supplemental Screening With Contrast-Enhanced Mammography in Women With Elevated Risk of Breast Cancer: Results of the Prevalence Round.

Contrast-enhanced mammography (CEM) and magnetic resonance imaging (MRI) have shown similar diagnostic performance in detection of breast cancer. Limited CEM data are available for high-risk breast cancer screening. The purpose of the study was to prospectively investigate the efficacy of supplemental screening CEM in elevated risk patients. A prospective, single-institution, institutional review board-approved observational study was conducted in asymptomatic elevated risk women age 35 years or older who had a negative conventional two-dimensional digital breast tomosynthesis screening mammography (MG) and no additional supplemental screening within the prior 12 months. Four hundred sixty women were enrolled from February 2019 to April 2021. The median age was 56.8 (range, 35.0-79.2) years; 408 of 460 (88.7%) were mammographically dense. Biopsy revealed benign changes in 22 women (22/37, 59%), high-risk lesions in four women (4/37, 11%), and breast cancer in 11 women (11/37, 30%). Fourteen cancers (10 invasive, tumor size range 4-15 mm, median 9 mm) were diagnosed in 11 women. The overall supplemental cancer detection rate was 23.9 per 1,000 patients, 95% CI (12.0 to 42.4). All cancers were grade 1 or 2, ER+ ERBB2-, and node negative. CEM imaging screening offered high specificity (0.875 [95% CI, 0.844 to 0.906]), high NPV (0.998 [95% CI, 0.993 to 1.000), moderate PPV1 (0.164 [95% CI, 0.076 to 0.253), moderate PPV3 (0.275 [95% CI, 0.137 to 0.413]), and high sensitivity (0.917 [95% CI, 0.760 to 1.000]). At least 1 year of imaging follow-up was available on all patients, and one interval cancer was detected on breast MRI 4 months after negative screening CEM. A pilot trial demonstrates a supplemental cancer detection rate of 23.9 per 1,000 in women at an elevated risk for breast cancer. Larger, multi-institutional, multiyear CEM trials in patients at elevated risk are needed for validation.

New trade theory converges to the old trade theory—An elementary theoretical perspective

AbstractWe introduce factor specificity to reflect the cost of adjustment of reallocating factors between technologies that determine fixed costs and variable costs in a typical Dixit–Stiglitz–Krugman (DSK) model of trade, retaining all other standard specifications of such a framework. We show that such an apparently benign change fundamentally alters the results of the DSK model. The number of varieties and output per variety depends entirely on full employment conditions. Thus, DSK and Heckscher–Ohlin–Samuelson (HOS) models, which represent the major workhorses of old trade theory, converge in the sense that now the number of varieties and outputs per variety are completely determined by factor endowments.

P037 Peripheral blood flow cytometry reveals heterogeneous but benign T-cell changes in patients with severe eczema undergoing dupilumab therapy

P037 Peripheral blood flow cytometry reveals heterogeneous but benign T-cell changes in patients with severe eczema undergoing dupilumab therapy

Halogenated Boroxine K2[B3O3F4OH] Modulates Metabolic Phenotype and Autophagy in Human Bladder Carcinoma 5637 Cell Line.

Halogenated boroxine K2[B3O3F4OH] (HB), an inorganic derivative of cyclic anhydride of boronic acid, is patented as a boron-containing compound with potential for the treatment of both benign and malignant skin changes. HB has effectively inhibited the growth of several carcinoma cell lines. Because of the growing interest in autophagy induction as a therapeutic approach in bladder carcinoma (BC), we aimed to assess the effects of HB on metabolic phenotype and autophagy levels in 5637 human bladder carcinoma cells (BC). Cytotoxicity was evaluated using the alamar blue assay, and the degree of autophagy was determined microscopically. Mitochondrial respiration and glycolysis were measured simultaneously. The relative expression of autophagy-related genes BECN1, P62, BCL-2, and DRAM1 was determined by real-time PCR. HB affected cell growth, while starvation significantly increased the level of autophagy in the positive control compared to the basal level of autophagy in the untreated negative control. In HB-treated cultures, the degree of autophagy was higher compared to the basal level, and metabolic phenotypes were altered; both glycolysis and oxidative phosphorylation (OXPHOS) were decreased by HB at 0.2 and 0.4 mg/mL. Gene expression was deregulated towards autophagy induction and expansion. In conclusion, HB disrupted the bioenergetic metabolism and reduced the intracellular survival potential of BC cells. Further molecular studies are needed to confirm these findings and investigate their applicative potential.

Mimickers and diagnostic pitfalls of urinary bladder cancer

Urothelial carcinoma (UC) is by far the most common malignant neoplasm of the urinary bladder; however, there are both benign and malignant changes of the urothelium which morphologically resemble urothelial carcinomas or other carcinomas of the urinary bladder. Thus, these mimickers can cause problems in the histomorphological diagnosis. This article provides an overview of possible mimickers and pitfalls of bladder cancer as well as practical notes on the diagnostic procedure, partly using case studies.

Artificial intelligence as a negative predictive tool for breast cancer postoperative recurrence

BackgroundMammography alone is an ineffective method for breast cancer surveillance and diagnosing cancer recurrence. The aim was to evaluate the ability of artificial intelligence (AI) to read digital mammograms as an additive tool to exclude recurrence in the operative bed of known breast cancer patients following the different surgical procedures.MethodsWe used a retrospective cohort study of post-surgery mammograms (n = 577). Imaging was performed within 6 months after the surgery or more. The AI solution used to read mammograms (AI-MMG) provided a targeted heat map of the operative bed, which was supported by a decision likelihood score percentage of cancer recurrence. The reference for suspicious or malignant-looking abnormalities (n = 62, 12.3%) was diagnosed by biopsy. A clear operative bed and benign-looking changes (n = 442) were confirmed by ultrasound characterization patterns and one year of intermittent follow-up.ResultsThe AI scoring percentage for a clear operative bed ranged between 0 and 26%, with a mean of 15% ± 5.4%. Operative bed benign changes ranged from 10 to 88%, with a mean of 48.2% ± 21.2%, while malignancy recurrence ranged from 65 to 99%, with an average of 87.7% ± 10.5%. The “ROC: Receiver Operating Characteristic” curve for AI to predict cancer in the surgical bed on mammograms was 0.906. The optimum cutoff value to distinguish between benign postoperative alterations and malignancy recurrence was 56.5% (95%, CI 0.824–1.060, p value < 0.001).Excellent agreement between AI-MMG and pathology or ultrasound results was observed, and Kappa was 0.894, p value < 0.001.ConclusionsThe use of artificial intelligence has enhanced the diagnostic performance of the postoperative mammograms to rule out recurrent malignancies in breast cancer surveillance.

Risk factors for breast cancer in patients with benign breast diseases: a 10-year observational study

Aim. To assess risk factors for breast cancer in a large population of women with benign breast dysplasia (BBD) followed up for a long time.Materials and methods. This retrospective study included 504 women with BBD followed up for 10 years. Study participants were divided into two groups: 1) BBD patients who did not develop breast cancer within 10 years (n = 261); 2) BBD patients who developed breast cancer within 10 years (n = 243). We conducted comprehensive retrospective analysis of demographic, clinical, and laboratory characteristics, as well as treatment details for BBD. Patient age varied between 39 and 49 years. The ten-year follow-up interval was chosen to perform adequate comparison of the groups. The differences were considered significant at p &lt;0.05.Results. The main difference between the two groups was related to conservative treatment for BBD and its duration. Almost all (93.4 %) patients in the group without breast cancer received some conservative treatment for BBD for 78.0 ± 1.7 months, whereas among those who developed breast cancer, only 37.4 % received conservative therapy for 15.0 ± 0.8 months (p &lt;0.001). Other significant risk factors for breast cancer in group 2 included obesity, gynecological pathology, long-term stress, and no surgical treatment for benign breast changes (p &lt;0.001). The analysis of laboratory parameters demonstrated significantly higher levels of prolactin in patients who developed breast cancer (31 % versus 13 %; p &lt;0.001).Conclusion. Potential risk factors for breast cancer in BBD patients include overweight, benign gynecological diseases, elevated prolactin, and long-term stress. Timely diagnosis and treatment of BBD and elimination of the abovementioned factors can significantly reduce the probability of breast cancer.

Efficacy of the minimal-invasive vacuum-assisted biopsy under direct visualization with ultrasound for impalpable breast lesions in Taiwanese female: A retrospective case-control study

Abstract Background Although surgical excisional biopsy provides robust diagnostic results, the ultrasound-assisted vacuum-assisted biopsy (VABB) offers an alternative for Asian candidates with dense breasts and lesions which cannot be approached by stereotactic biopsy. The study aims to investigate the efficacy of the ultrasound-assisted VABB for impalpable mammographic-detected lesions. Methods A retrospective case-control study is conducted in a group of Taiwanese female patients who have impalpable breast lesions such as microcalcifications at screening mammography that are limited to BI-RADS category 4. Specifically, the lesions are categorized into three groups: 4a, 4b, 4c, and the histology from B2 through B5. The cases underwent ultrasound-assisted VABB and the controls had lumpectomies. The diagnostic accuracy, rate of discordance, excited tumor size, and the proportion of cancer cases is evaluated and compared using Fisher’s Exact test, Cohen’s kappa test, Chi-Square test, and the use of IBM SPSS statistical programs. Results The histology of the majorities of the collected specimen are B2 benign fibrocystic changes (60-70%). In cases of patients who are diagnosed with breast cancer, most are ductal carcinoma in situ and early-stage diseases. The cancer risks for lesions categorized under BI-RADS 4a, 4b, 4c respectively are consistent with clinical practice. Meanwhile, the diagnostic accuracy of VABB is similar to lumpectomy, as the histologic discordance rate did not differ significantly. Conclusions Ultrasound-assisted VABB does offer an option for patients who are not candidates for stereotactic biopsy, as it has shown to have non-inferior diagnostic values and cosmetic benefits when compared to surgical excision. The use of sonography monitors the biopsy process and guides the needle insertion thus is capable of obtaining samples from multiple directions, without risking the pectoralis muscles underneath. However, VABB may be intended for biopsies in lower-risk findings such as BI-RADS category 4a because doubts persist as complete excisional rates are operator-dependent.

Cervical CUP Syndrome: Diagnosis and Therapy

In CUP syndrome (CUP = cancer of unknown primary) there are 1 or more metastases of a primary tumor that cannot be localized despite extensive diagnostics. CUP syndrome accounts for 5% of all human malignancies, making it one of the 10 most common forms of cancer. In addition to inflammatory lymph node enlargement and benign changes such as cervical cysts, lymph node metastases are among the most common cervical masses. Cervical CUP syndrome is a histologically confirmed cervical lymph node metastasis with an unknown primary tumor. In addition to anamnesis, clinical examination and histological confirmation, diagnostics include radiological imaging using PET-CT and panendoscopy with histological primary tumor search. Treatment options include surgical therapy with neck dissection and chemoradiotherapy.

Skin Care in Pregnancy and the Postnatal Period

A great deal of advice around maintaining health is focused on nutrition and exercise – in particular what to do and what not to do. Little focus is on the importance of skin care. Just like the heart and lungs, the skin is an organ of the body. In fact it is the largest of all of the organs. It has many functions, many of which support us to maintain health and wellbeing through a complex eco system of the microbiome where it provides protections against pathogens, supports vitamin synthesis, metabolism and immune development.1 In pregnancy, the body’s organs undergo a myriad of physiological changes affecting each system differently.2 There are three categories of skin conditions in pregnancy, benign hormone-related changes such as hyperpigmentation and striae gravidarum, pre-existing skin conditions, such as acne and psoriasis, and pregnancy-specific disorders such as atopic eruption of pregnancy.3 Each will require different treatment or care to minimise discomfort or irritation.

Surgical outcomes of total duct excision in the diagnosis and management of nipple discharge.

Total duct excision (TDE) is performed for the diagnosis and management of nipple discharge. The Association of Breast Surgery's recent guidelines recommend considering diagnostic surgery for single-duct, blood-stained or clear nipple discharge, and for symptomatic management. We retrospectively reviewed the diagnostic and surgical outcomes of all cases of TDE between January 2013 and November 2019. In total, 259 TDEs were carried out: 219 for nipple discharge, 29 for recurrent mastitis, 3 for screening abnormalities and 8 for breast lumps. Of the nipple discharge group, 121 had blood-stained discharge. Mean patient age was 52 years (range 19-81). Median follow-up time was 45 months (interquartile range 24-63). The following cases were identified on histopathology: 236 benign breast changes, 10 atypical ductal hyperplasia, 4 lobular carcinoma in situ, 2 low-grade ductal carcinoma in situ (DCIS), 3 intermediate-grade DCIS, 2 high-grade DCIS and 2 invasive ductal carcinomas. In total, 3.5% of patients who underwent TDE had a diagnosis of DCIS or invasive carcinoma. Blood-stained discharge was associated with a significant increase in risk of DCIS or carcinoma compared with other nipple discharge colours (p = 0.043). The most common complications of TDE were infection, poor wound healing and haematoma. Nipple discharge recurred in 14.2% of cases. TDE can be considered for the diagnostics and management of nipple discharge. Blood-stained nipple discharge increases the risk of DCIS or malignancy, but the majority of the time TDE reveals benign breast pathology.

Mueller matrix polarization interferometry of optically anisotropic architectonics of biological tissue object fields: the fundamental and applied aspects

The presented results concern the diagnostic application of vector-parameter polarization mapping and polarization-interference phase scanning applied to layered azimuths and ellipticity polarization maps obtained with the help of digital holographic reproduction for phase-inhomogeneous tissue layers in the female reproductive system. The differential diagnosis of the pathological changes in optically anisotropic polycrystalline tissue components, specifically “benign (fibroids) and precancerous (endometriosis),” was investigated. All studies within the representative groups of the histological samples were conducted using circularly polarized laser radiation, ensuring azimuthal invariance and polarization measurement reliability. Integral and layered maps and polarization azimuths and ellipticity random variable distribution histograms were obtained from the microscopic images of histological sections from the female reproductive system tumors. Systematized tables present statistical moments which characterize azimuths and ellipticity polarization maps for fibroids and endometriosis tissues. It is shown that the statistical parameters (diagnostic markers) are the most sensitive to benign and precancerous changes in the female reproductive system tissues. The results of information analysis, including the accuracy determination of the diagnostic vector-parameter polarization and polarization-interference methods for detecting and differentiating the samples of fibroids and precancerous endometriosis tissues in the female reproductive system, are presented.

Characteristic hysteroscopy appearance considerations for detecting uterine endometrial malignancies.

The effectiveness of hysteroscopy in diagnosing endometrial lesions has been demonstrated, showing high diagnostic accuracy for malignant endometrial lesions. Although the characteristic appearances of atypical and malignant endometria have been reported, they are not definitive and sometimes complicated. This study aimed to identify a small number of characteristic features to detect endometrial abnormalities using a simple judgment system and analyze the diagnostic characteristics and their accuracy in endometrial malignancy diagnosis. We performed a retrospective analysis of hysteroscopy video data of 250 patients, of which we selected for analysis based on pathology examination 152 cases with benign changes, 16 with atypical endometrium, and 18 with carcinoma in situ or endometrial cancer. Endometrial characteristics assessed included protrusion, desquamation, extended vessel, atypical vessel, and white/yellow lesion. Multivariable analysis revealed that desquamation (p = 0.001, odds ratio [OR] 5.28), atypical vessels (p < 0.001, OR 8.50), and white/yellow lesions (p = 0.011, OR 1.37) were significant predictors for endometrial malignancy. From their contribution status, scoring points of 4, 6, and 1 were settled according to the odds ratio proportions. When scores ≥5 (at least both desquamation and white/yellow lesions or only atypical vessels) were used to define endometrial malignancy, sensitivity and specificity were 100% and 92%, respectively. When detecting cancer, atypical, and benign cases, sensitivity and specificity were 88% and 90%, respectively. Our characteristics hysteroscopic findings showed a higher predictive ability in detecting endometrial malignancies. However, further examination with more cases would be needed to accurately diagnose endometrial malignancy by hysteroscopy.

Sinonasal Myxoma Extending into the Orbit in a 4-Year Old: A Case Presentation

Background: Sinonasal myxomas are exceptionally rare benign tumors in pediatric patients. This report presents the case of a 4-year-old boy diagnosed with a sinonasal myxoma extending into the right orbit. Case presentation: The patient’s clinical presentation included moderate-angle esotropia and ocular torticollis. Advanced imaging revealed an expansile lesion in the right posterior ethmoid cavity with orbital involvement. The differential diagnosis considered included malignancies such as rhabdomyosarcoma and lymphoma, as well as benign neoplasms and inflammatory changes. A biopsy confirmed the diagnosis of sinonasal myxoma. The patient underwent a wide local resection performed by a multidisciplinary team, leading to a confirmed histopathological diagnosis of sinonasal myxoma. Conclusion: This case highlights the diagnostic challenges and the importance of thorough clinical and radiologic evaluation in pediatric patients with unusual ocular symptoms. The report underscores the need for a multidisciplinary approach in managing rare neoplasms such as sinonasal myxomas.

DIAGNOSTIC VALUE OF MAGNETIC RESONANCE IMAGING WITH DYNAMIC CONTRASTING IN ASSESSING THE CONDITION OF BREAST SCARS AFTER INTERVENTIONS FOR BENIGN PATHOLOGY

The lifetime probability of surgical interventions on mammary glands for benign pathology is approximately 4.8%, i.e. approximately they are performed in every 20th woman. At this, it is known that surgical interventions on organs containing an epithelial component significantly increase the risk of epithelial malignant tumors developing in them. The aim of the study was to assess the diagnostic value of magnetic resonance imaging (MRI) of the mammary glands with dynamic contrasting in identifying malignant transformation of breast scars after surgical interventions on it for benign pathology. Materials and methods. The study involved 63 patients aged 47.35±7.33 years who underwent breast surgery for benign pathology 1.5 years – 30 years before breast MRI was performed. Breast MRI with dynamic contrasting was performed using a Siemens Amira system (Germany) with a magnetic field intensity of 1.5 T. Study results. Morphological analysis: four types of morphological changes were identified during MRI in the area of previously performed intervention: 1) type 1 (thin-walled cavity / seroma; 5 out of 63; 7.94%; 0 cases of breast cancer); 2) type 2 (thin linear scar; 27 out of 63; 42.86%; 2 cases of breast cancer); 3) type 3 (mass lesion; 5 out of 63; 7.94%; 3 cases of breast cancer); 4) type 4 (fat necrosis; 26 out of 63; 41.30%; 1 case of breast cancer). Contrasting dynamics: 36 (57.14%) of 63 patients were noted to have contrast accumulation in the scar area. ACR type I of the kinetic curve (slow gradual accumulation of contrast) was observed in 10 out of 28 cases (35.71%) and in all cases corresponded to benign changes. ACR type II (rapid initial contrasting and plateau in the delayed phase) occurred in 10 out of 36 (27.78%) patients, of whom 2 had breast cancer. ACR type III (rapid initial contrasting and washout in the delayed phase) occurred in 13 of 36 (36.11%) patients, of whom 3 had breast cancer verified. Conclusions. The overall sensitivity of MRI with dynamic contrasting in detecting malignant transformation of scars in the mammary gland was 80%, specificity was 85.9%, the prognostic value of a positive result was 30.8%, the prognostic value of a negative result was 98.2%.