Benign Condition Research Articles

The efficacy of the use of atropine in children with reflex anoxic syncope during pallid breath-holding spells: can cardiac pacemaker implantation be avoided?

Reflex anoxic syncope is the result of an overreaction of the vagal system, resulting in hypotension and bradycardia or brief cardiac arrest. Because of the benign character and the absence of complications in short or long term, treatment is only necessary in case of frequent or severe clinical presentation. Treatment options are anticholinergic drugs or cardiac pacemaker placement. We investigated atropine treatment and aimed to examine if pacemaker placement can be avoided. We retrospectively reviewed patients treated with atropine for severe reflex anoxic syncope in our centre from January 2017 until May 2023, and compared our results to those in the literature. The study population consisted of 10 children, 70% female, with an age ranging from 5 months to 3 years (mean 14.5 months) when atropine treatment was started (dose 17-50 microg/kg/day). All patient's parents reported adequate symptom management during atropine treatment, with complete resolution in 10%. Minor side effects were reported in 60% (dry mucosa in 40%, obstipation in 20%, and nausea or blurry vision in 10%). We consider atropine a safe and effective treatment to manage reflex anoxic syncope with similar success rate to pacemaker implantation. However, pacemaker implantation entails substantial risk for complications (up to 25%) such as infection or technical problems and morbidity such as scar formation. This might be considered redundant for a benign and temporary condition, certainly given the possibility of other efficient treatment options. Consequently, we recommend atropine treatment over implantation of a cardiac pacemaker in children with severe reflex anoxic syncope.

Incidence of Seromucous Otitis in Schools in Southern Algeria

Introduction: Seromucous otitis (SMO) is a very common pathology, affecting almost 50% of children. It is a benign condition, but should be investigated in adults for neoplasia of the nasopharynx. It is bilateral in 85% of cases, with an average age of 5 years. Although the evolution of this pathology is often favorable in children, with a tendency to spontaneous regression, in adulthood these ears can evolve into simple or dangerous chronic otitis. Aim: To assess the incidence of seromucous otitis in children in southern Algeria (Laghouat), where the hot season is longer than in temperate or cold regions, and to detect and treat chronic forms. Materials & Methods: This is a monocentric, prospective study involving all schoolchildren aged between 3 and 12, with no history of otitis (chronic otitis) or sensorineural hearing loss, over a 13- month period (October 2020 to October 2021). The diagnosis of sensorineural hearing loss is based on anamnesis and confirmed by clinical examination and functional hearing tests. Results: Of the 340 children examined over a one-year period, 28 presented with seromucous otitis, i.e. 8.2% of the sample size, with a peak in frequency between the ages of 4 and 6. There was also a slight male predominance. Promiscuity was the most frequent risk factor, observed in 64% of cases. Spontaneous regression of seromucous otitis was observed in 10 children (35.7%), and surgical treatment with a trans-tympanic aerator with or without adenoidectomy was instituted in 13 children. Conclusion: The natural evolution of SMO does not always lead to spontaneous regression, and many cases require early management and strict monitoring to prevent complications. It is therefore necessary to introduce screening as part of school hygiene in order to reduce the incidence of chronic otitis in adults.

Pubertal retroareolar cysts presenting as bluish lumps: New cases and literature review.

Retroareolar cysts (RCs) are a benign self-resolving condition primarily affecting pubertal individuals. However, their presentation as asymptomatic bluish areolar lumps remains underreported in the literature, with only six cases previously documented. This lack of awareness may lead to the oversight of RCs during diagnosis. To address this, we conducted a comprehensive literature review using PUBMED, and we further added three more cases. The mean time for clinical resolution was found to be 2.3 years. In light of these findings, we proposed a diagnostic and management algorithm to guide clinicians in their approach to RCs in pediatric patients. The algorithm involves thorough clinical examination, medical history assessment, and echographic investigation with color Doppler analysis. Regular follow-up visits are recommended until resolution of the lesions. Notably, due to the consistently favorable outcome of RCs, aggressive diagnostic interventions can be avoided, providing reassurance to patients and their families. It is crucial for paediatricians to stay updated on this underreported condition to ensure timely recognition and appropriate management. Dermatologists should be the first specialists to be consulted in cases of suspected RCs. Increasing awareness among healthcare professionals will contribute to improved diagnosis and management of this benign condition. In conclusion, RCs are a benign self-resolving condition commonly observed during puberty. Their presentation as asymptomatic bluish areolar lumps may often be overlooked. Through this study, we highlighted the importance of early recognition, proposed a diagnostic and management algorithm, and emphasized the favorable prognosis of RCs, which allows for a conservative approach to their management.

Abstract PO5-07-08: A Serum Biomarker for the Early Detection of Breast cancer

Abstract Background: After decades of use, clinicians and medical societies are still debating on the clinical utility of mammography, the standard of care for breast cancer (BC) screening, because of its limitations such as subjective visual interpretation, high rate of false-positive and false-negative (in dense breast) and concerns over radiation exposure. There are 55 million women, and about 45% of them considered dense breast, in need of an accurate, easy to use test for the screening of BC regardless of breast tissue complexities to differentiate between BC and benign findings such as calcification and fibrosis. To this date there is no blood protein biomarker (BM) in clinical use for the early detection of BC. We have developed a novel BC specific protein biomarker -based blood test to detect patients with early-stage BC and established herein the diagnostic performance of our BM in discriminating BC patients from healthy individuals and benign breast cases. Methods: A total of 433 serum samples (318 primary BC, 32 benign breast and 83 normal breast) were obtained from the Cooperative Human Tissue Network and from the IRCCS San Raffaele Pisana Research Center (blind samples). 247 BC samples were provided as blind samples and were used to validate the screening utility. Serum samples were tested with our BC specific BM by sandwich ELISA. Receiver operating characteristic (ROC) curves were calculated to evaluate the diagnostic performance, by determining sensitivity (SE), specificity (SP), area under the curve (AUC), and confidence interval (CI). Statistical analysis, ROC curves and scatter plots were performed with GraphPad Prism 7.0. Results: BM elevation in early cancer cases (stage I-II, Ductal Carcinoma) was found to be statistically significant (p< 0.0001) as compared to healthy and benign cases. Our test discriminated early BC patients from non-cancer cases with 87.3% SE at 85.2% SP and was further validated in a blind set including 247 BC (Ductal & Lobular Carcinoma, stage I-III), 30 benign and 83 normal breast cases (88%SE, 86%SP). The sensitivity for early-stage (I-II) and late stage (III) BC was 86.8% and 94.3%, respectively. While lobular carcinoma is particularly not well detected by mammography with a sensitivity as low as 57% and much lower for women with dense breast, it was detected with high sensitivity (90%) in our test. 80% of fibrocystic changes (FCC), the most common form of benign breast disease in women over 50 years of age were negative with our test. Although it is a benign condition, FCC may be misdiagnosed as a malignant lesion by physical examination and imaging. Conclusion: Our results support the utility of our blood-based test for the early detection of breast cancer which presents improved features over mammography such as higher lobular cancer sensitivity, lower detection rate of common form of benign condition often misdiagnosed by imaging, absence of radiation and expected high compliance. Further testing is needed to confirm accuracy of our test in the dense breast population. Citation Format: Christine Chavany, Jeffrey Dea, Monica Guevara, Rafael Hernandez-Gonzalez, Patrizia Ferroni, Fiorella Guadagni, Rosaura Valle, Moncef Jendoubi. A Serum Biomarker for the Early Detection of Breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-07-08.

Kikuchi-Fujimoto disease, simultaneously diagnosed with systemic lupus erythematosus in an Arabic female: an agonizing combination.

Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign condition affecting young Oriental-Asian females. It is characterized by fever and tender cervical lymphadenopathy with an unclear aetiology, and in most longitudinal reviews, KFD occurs before systemic lupus erythematosus (SLE). Herein, the case of a 28-year-old Kuwaiti female without any relevant past medical history, who was simultaneously diagnosed with KFD and SLE following an Ebstein-Barr virus infection, is reported. The patient was treated with oral prednisolone, hydroxychloroquine, cyclosporin, and belimumab and her response was clinically and biochemically favourable. Although KFD is prevalent in Asian populations, it may affect all races. Early diagnosis of KFD is difficult, particularly when simultaneously diagnosed with SLE, but crucial to preventing inappropriate therapy. Clinicians need to know about this rare disease, especially when patients present with fever and swollen lymph nodes, due to a risk of misdiagnosis with tuberculosis or lymphoma, as these are more often thought to be the cause of such symptoms.

IS IT POSSIBLE TO PREDICT TUMOR PROGRESSION THROUGH GENOMIC CHARACTERIZATION OF MONOCLONAL GAMMOPATHY AND SMOLDERING MULTIPLE MYELOMA?

The study of monoclonal serum proteins has led to the generation of two major theories: one proposing that individuals who had monoclonal proteins without any symptoms or evidence of end-organ damage have a benign condition; the other one suggesting that some individuals with asymptomatic monoclonal proteins may progress to multiple myeloma and thus are affected by a monoclonal gammopathy of undetermined significance (MGUS). Longitudinal studies of subjects with MGUS have supported the second theory. Subsequent studies have characterized and defined the existence of another precursor of multiple myeloma, smoldering multiple myeloma (SMM), intermediate between MGUS and multiple myeloma. Primary molecular events, chromosome translocations, and chromosome number alterations resulting in hyperploidy, required for multiple myeloma development, are already observed in myeloma precursors. MGUS and SMM are heterogeneous conditions with the presence of tumors with distinct pathogenic phenotypes and clinical outcomes. The identification of MGUS and SMM patients with a molecularly defined high risk of progression to MM offers the unique opportunity of early intervention with a therapeutic approach on a low tumor burden.  

Management of Geographic Tongue with Individualized Homeopathy: An Evidence-Based Case Report

AbstractGeographic tongue, also known as benign migratory glossitis, is a common and benign condition characterized by distinct features on the tongue's surface. Typically, it affects the tip, lateral borders, and dorsum of the tongue, with occasional extension to the ventral surface. Indeed, geographic tongue commonly starts in childhood and has a global prevalence estimated at around 1 to 2.5% of the general population. In the pediatric population, the prevalence ranges from 0.37 to 14.3%, indicating that it can vary significantly among different age groups. The age group of 20 to 29 years seems to have the highest prevalence, with approximately 39.4% of individuals affected by geographic tongue. This suggests a peak incidence during early adulthood. This case report explores the potential benefits of homeopathic medicines in management of geographic tongue. A 17-year-old adolescent girl experiencing whitish discoloration of the tongue accompanied by intense burning sensation with history of recurrent tonsillitis and increased sweating in her palms and soles since early childhood presented in the OPD of Regional Research Institute for Homoeopathy, Shimla. Upon examination of her oral cavity, white patches were observed on her tongue, which did not resolve despite trying various medications. The primary diagnosis was geographic tongue, confirmed by physical examination. Following homeopathic treatment, the patient experienced marked improvement in symptomatology, including relief from the burning sensation, and the lesion from the tongue completely disappeared. This evidence-based case report highlights the potential beneficial role of homeopathy in the treatment of geographic tongue.

Multimodal Imaging and Follow-Up of a Nodule arising from Congenital Hypertrophy of the Retinal Pigment Epithelium

Congenital Hypertrophy of the Retinal Pigment Epithelium (CHRPE) is a benign ocular condition. Here, we present a rare case of a neoplasm arising from a CHRPE, diagnosed as retinal pigment epithelium (RPE) adenoma (epithelioma) or adenocarcinoma (malignant epithelioma). Utilizing multimodal imaging, we followed the lesion over a sixteen-month period, during which it showed stable size, absent exudation, and resolution of the overlying vitreous hemorrhage.

The Impact of Conservative Surgical Treatment of Adenomyosis on Fertility and Perinatal Outcomes.

Adenomyosis is a benign condition commonly encountered in patients with infertility. While the definitive surgical management is hysterectomy, conservative surgical management is gaining attention in patients desiring future fertility. This review explores whether the surgical treatment of adenomyosis affects fertility outcomes for patients trying to conceive. The PubMed and Medline databases were searched using the keywords: "adenomyosis", "surgery", "radiofrequency", "infertility", "pregnancy", "sterility", "conception", "miscarriage", and "endometrial receptivity". Abstracts were screened, and relevant articles were selected for review. This review reveals that surgery appears to improve fertility outcomes with or without medical therapy; however, the risk of uterine rupture remains high and the best technique to reduce this risk is still not known. More studies are needed to formulate the best surgical approach for preserving fertility in treating adenomyosis and to establish standardized guidelines.

P105 Healthcare use by women with Joint hypermobility and Ehlers-Danlos syndromes in Northumberland

Abstract Background/Aims In 2017, the diagnosis of Joint Hypermobility Syndrome was withdrawn and combined with hypermobile form of Ehlers-Danlos syndrome (hEDS). International Consortium on Ehlers-Danlos syndromes proposed new clinical criteria for hEDS and it recommended the concept of Hypermobility Spectrum Disorders (HSDs) when these criteria are not met. None of these three diagnostic terms JHS, HSD and hEDS fully explain the complexity of this heterogenous condition as the criteria do not take into account many co-morbidities such as anxiety, autism, ADHD, bowel and bladder issues, pregnancy complications, dysautonomia, allergies, and more. Health services are organised on the assumption that it is a benign musculoskeletal condition. Health burden from both joint hypermobility and the associated co-morbidities is not known as these patients are usually discharged after episodic care by most services that work in silos. Hence we sought to measure the pattern and costs of secondary NHS healthcare use in this patient group. Methods Using primary care clinical systems from 30 of 36 GP surgeries in Northumberland (approximately 300,000 total population), we determined the number of people with SNOMED codes synonymous to hypermobility; ‘Benign joint hypermobility’ or ‘Hypermobility syndrome’ was the code recorded in 90% of patients, with less than 10% coded as EDS or subtypes. For the purpose of statistical analysis, we grouped all under the newer diagnostic terms hEDS/HSD. RAIDR, the UK’s leading health intelligence tool, was used to compare secondary healthcare activity and costs between patients with and without hEDS/HSD in Northumberland. Results Prevalence of hEDS/HSD in GP records was 4.4 per 1000. Women of childbearing age are affected more than men (Male : Female ratio 3:1). Hospital admissions to General Medicine, Obstetrics & Gynaecology, Surgery, and Orthopaedics were significantly higher in women with hEDS/HSD. Outpatient attendances to Rheumatology, Physiotherapy, Orthopaedics, and Obstetrics & Gynaecology were also higher in women. Male patients with hEDS/HSD where younger than female patients; they presented more often to mental health, physiotherapy and paediatric outpatients compared to those without hEDS/HSD. The cost of secondary care treatment per patient with hEDS/HSD during 2022 was £932.37 compared to £731.88 in those without. For 1,302 patients with diagnoses synonymous with hEDS/HSD, the total additional cost for A&E, Acute Inpatient and Outpatients in 2022 was £261,037. This excludes mental healthcare costs, although there were around twice the number of appointments. Conclusion We found a diagnosed prevalence of hEDS/HSD of one in 227 people in Northumberland. These patients have a significantly higher usage of secondary care, and thereby a higher average healthcare utilisation cost. The next steps would be expansion of this study, along with more in-depth analysis of reasons for secondary healthcare usage. This should inform commissioning of appropriate integrated health services for people with these complex conditions. Disclosure V. Saravanan: None. E. Reinhold: None. J. Demmler: None. I. Loughran: None. B. Frankel: None.

Mesenteric panniculitis associated with non-alcoholic fatty liver disease: a case series

Mesenteric panniculitis (MP) is a benign inflammatory condition of the abdominal mesentery which presents with a wide variety of symptoms. It is diagnosed non-invasively through computed tomography (CT) scan, whereas biopsy is still considered the gold standard. Steroids are the first line of treatment. Here, we report four cases who presented with abdominal pain. These patients were overweight and the CT scan findings were suggestive of mesenteric panniculitis. Three cases had concomitant non-alcoholic steatohepatitis with elevated alanine transaminase levels, dyslipidaemia, and insulin resistance. FibroScan showed moderate to severe steatosis. PNPLA3 rs738409 genotype was homozygous positive (GG) in one patient, whereas two patients were heterozygous positive (CG). This association has not been well-described so far and warrants further investigation. There may be some common predisposing factors. Key words: Mesenteric panniculitis, Non-alcoholic steatohepatitis, Dyslipidaemia, Insulin resistance.

Real-world data evaluating Guy’s rapid diagnostic clinic as an alternate pathway for patients with FIT levels below 10

ObjectiveTo analyse the effectiveness of rapid diagnostic clinics (RDCs) as an alternative pathway for patients with concerning symptoms and a faecal immunochemical test (FIT) result <10. Our primary endpoint was...

Effect of Piracetam and Iron Treatment on Heart Rate Variability in Patients With Breath-Holding Spell

BackgroundBreath-holding spells are a benign condition primarily seen in 3% to 5% of healthy children aged between six months and five years. Although no specific treatment is recommended due to its benign nature, iron and piracetam are used in severe or recurrent cases. We planned to compare the heart rate variability (HRV) before and after treatment with 24-hour Holter monitoring in patients receiving iron and piracetam treatment and investigate the treatment's effectiveness. MethodsTwenty-five patients who applied to the outpatient clinic between 2013 and 2015 due to breath-holding spells were included in the study. The patients who received piracetam and iron therapy and underwent 24-hour rhythm Holter monitoring were evaluated retrospectively. ResultsFourteen (56%) of these patients were evaluated as having cyanotic-type and 11 (44%) patients were assessed as having pale-type breath-holding spells. A significant difference was found only between hourly peak heart rate and total power in the group receiving iron treatment. Significant differences were also found among the minimum heart rate, mean heart rate, the standard deviation of RR intervals, the mean square root of the sum of the squares of their difference between adjacent RR intervals, spectpow, and low frequency before and after the treatment in the patients who started piracetam treatment (P < 0.05). ConclusionsOur study is critical as it is the first to investigate the effects of treatment options on various HRV in patients with breath-holding spells. There were statistically significant changes in HRV parameters in patients receiving piracetam, and the number of attacks decreased significantly. Piracetam treatment contributes positively to the breath-holding spell with regard to efficacy and HRV, therefore it can be used to treat breath-holding spells.

Use of a vessel-sealing device compared with Jaboulay's technique for adult hydrocelectomy surgery: a retrospective cohort study.

Hydrocele is a common benign scrotal condition affecting adult men. The gold standard of treatment includes hydrocelectomy, with the use of Winkelman's/Jaboulay's technique or Lord's procedure. The vessel-sealing device (VSD) is a blood vessel-sealing system, known to enhance patient's postoperative outcomes in multiple different surgeries. The aim of this study was to compare the procedural and postoperative outcomes of a novel hydrocelectomy method using a VSD to the conventional hydrocelectomy using the Jaboulay's technique. We performed A retrospective review for all adult cases who underwent surgical hydrocelectomy at Hillel Yaffe Medical Center between 2011 and 2022. Study cases were grouped into one of two groups, patients undergoing conventional hydrocelectomy, or patients undergoing hydrocelectomy with the use of a VSD. Patients operated using other techniques were excluded. Data collected included demographic data and operative and postoperative parameters. Among 102 patients, 47 underwent Jaboulay's technique and 55 underwent hydrocelectomy using a VSD. We observed significantly shorter duration of hospitalization (1.18 vs 1.53, P = 0.038) and shorter surgery time (31.87 vs 37.4, P = 0.003) when using the VSD during a hydrocelectomy compared to conventional surgical hydrocelectomy. Both techniques indicated low complication rates and no recurrent hydrocele was observed in either group. We report our experience with a novel surgical technique that includes hydrocelectomy with the use of VSD. Our findings demonstrated shorter surgery time and length of hospitalizations, which may indicate improved patient's postoperative outcomes with the use of the VSD for hydrocelectomy.

Management Outcome Assessment of Obstructive Jaundice and Associated Factor from Yekatit 12 Hospital Medical College Addis Ababa, Ethiopia

Background: Obstructive jaundice is common problem in daily clinical practice and among the most challenging conditions for planning current and future management. The causes are varied, but it is most commonly due to choledocholithiasis; benign strictures of the biliary tract, pancreaticobiliary malignancies, and metastatic disease. Surgery in patients with obstructive jaundice is generally considered to be associated with a higher incidence of complication and mortality. Objective: The purpose of the study was to assess outcome of obstructive jaundice and associated factors at Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia. Methods: A longitudinal study design was used to conduct the study and all patients admitted to the surgical wards for whom surgery was done for obstructive jaundice from May 1, 2022 to April 30, 2023 G.C were included. Chi square fisher’s exact test was used to see the association between obstructive jaundice outcome and independent variables, significance was determined by p-value &lt;0.05. Results: In these study 31 patients were enrolled and the mean age was 49.03 SD±16.16 years. Of patients diagnosed to have obstructive jaundice majority are due to benign causes. Common bile duct stones are the commonest benign condition accounting 88.2% and peri-ampullary cancers are the most frequent (48.4%) cause of obstructive jaundice from malignant condition. Among patients operated 38.7% were underwent bypass procedures. Post-operative complications occurred in 9 (24.3. %) of patients, with surgical site infection being commonest (55.5%). Significant association was identified between types of post-operative complication and management outcome (P=0.034). Conclusion: The most common cause of obstructive jaundice was bile duct stone. Post-operative complications were significantly associated with management outcome of obstructive jaundice.

Mitral annular disjunction and mitral valve prolapse extrapolating adult data to an adolescent cohort?

The aim of this study is to provide an update on mitral valve prolapse (MVP) and mitral annular disjunction (MAD) and who may be at risk for ventricular arrhythmias and sudden cardiac death. MVP is generally considered a benign condition. However, a small subset of patients may be at risk for life-threatening ventricular arrhythmias. Among the risk factors identified in adults include patients with bileaflet mitral valves, myxomatous changes, myocardial fibrosis, and the presence of MAD. Advances in multimodal imaging have allowed for improved identification of fibrosis, anatomical valve derangements, and the amount of MAD. Recent guidelines have suggested that patients with MVP with or without MAD may be at risk for life-threatening arrhythmias if they have had prior ventricular arrhythmias, ventricular dysfunction, or unexplained syncope. Yet, extrapolation of adult data to a pediatric cohort with similar MVP and MAD at this juncture is challenging. There is, however, early evidence that some pediatric patients with significant myocardial fibrosis or abnormal tissue Doppler may be at risk for ventricular tachycardia. Mitral valve prolapse and mitral annular disjunction at times coexist and at other times can be seen as isolated entities. While the incidence of arrhythmic MVP is quite rare, there is increasing evidence that certain select adults with MVP may be at risk for ventricular tachycardia and sudden cardiac death. Future multicenter studies are needed to better understand the natural history of arrhythmic mitral valve disease and how early disease manifestation in children may impact findings now being reported in young adults.

The impact of adipose fat tissue on pathogenesis of crypto-glandular anal fistula

Background: Cryptoglandular perianal fistula represents a prevalent benign anorectal condition, primarily addressed through surgical interventions, occasionally posing considerable therapeutic challenges. The associated decline in patient quality of life underscores the significance of effective management. However, the lack of a fully understood pathogenesis complicates the treatment approach. Recent research has proposed the involvement of adipose fat tissue in the inflammatory response and pathogenesis of cryptoglandular anal fistula.Methods: This study involved the characterization of serum levels of inflammatory cytokines and adipose tissue hormones. A total of 35 samples from both simple and complex cryptoglandular perianal fistula cases were collected during surgical procedures.Results: Serum levels of leptin, resistin, IL-1 and IL-8were significantly elevated in patients operated due to complex cryptoglandular perianal fistula when compared to patients with simple fistula. Adiponectin was significantly lowered in samples from complex perianal fistula in comparison to simple fistula. Conclusions: Complex perianal cryptoglandular fistula have a reduced level of antiinflammatory adipokines adiponectin and increase the level of proinflammatory resistin, leptin, IL-1 and IL-8.

Sudden Cardiac Arrest as first Manifestation of Malignant Mitral Valve Prolapse in a Young Patient: A Case Report and Review of the Literature.

Malignant MVP may be associated with life-threatening arrhythmias and sudden cardiac death.MVP is not always a benign condition, and physicians should be aware of the diagnostic criteria for malignant MVP.Echocardiography and cardiac magnetic resonance are crucial diagnostic methods to detect signs suggestive of malignant MVP.

Exploring the inhibitory impact of Mongolian medicinal He-Zi-3 soup on mammary gland hyperplasia in rats induced by estrogen and progestogen

Ethnopharmacological relevanceMammary gland hyperplasia, a prevalent benign breast condition, often serves as a precursor to various other breast diseases. He-Zi-3 soup (HZ-3), a traditional Mongolian remedy, is utilized for treating this condition. Aim of the studyTo explore the effect and underlying mechanism of HZ-3, a Mongolian medicinal preparation, on mammary gland hyperplasia. Materials and methodsThis study aimed to assess the impact of different doses of HZ-3 in a rat model of mammary hyperplasia. The active components within HZ-3 drug serum were identified and analyzed through network pharmacology and target prediction. To elucidate the underlying mechanism of HZ-3 in addressing mammary hyperplasia, we conducted a series of investigations on estradiol-induced mammary hyperplasia in model rates. Assessments included measurements of papilla width and height, hematoxylin and eosin staining, Masson staining, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), Western blot, and immunohistochemistry. ResultsOur investigation revealed the identification of 21 compounds, primarily terpenoids, through serum medicinal chemistry screening. Utilizing network pharmacological analysis, we observed predominant regulation through the estrogen pathway, closely associated with key genes including esr1,esr2, ncoa1, krt 19, ctsd, ebag 9, and bcl-2. Assessments encompassing nipple height and width, histological examination, immunohistochemical analysis, and serum hormone levels via enzyme-linked immunosorbent assay demonstrated the inhibitory effect of HZ-3 on mammary hyperplasia in rat models. RT-qPCR and Western blot analyses corroborated these findings, affirming the suppression of mammary hyperplasia by HZ-3 through the activation of estrogen pathway signaling.

Pigmented fungiform papillae in a middle-aged Saudi female

Pigmented fungiform papillae are a rare benign condition. It is commonly considered a diagnosis dilemma as it could be a clinical sign of a serious condition. Our patient was a middle-aged Saudi female presenting with hyperpigmentation along the lateral and anterior aspects of her tongue and was not associated with other cutaneous or mucocutaneous manifestation. Her medical history was significant for iron deficiency anemia, hepatic hemangioma, cervical and lumbar intervertebral disc herniation, and gastroesophageal reflux disease. Upon inspection, she had a longitudinal hyperpigmented tan-brown patch on the lateral aspects of her tongue and pinpoint discoloration evenly distributed on the papillae of the anterior tongue. The examination by mucoscopy revealed a cobblestone appearance along the mentioned distribution. The patient refused to have the biopsy done, but she was reassured about her condition and instructed to visit the clinic if she has any further issues.