Benign Lesion Group Research Articles

Comparison of Frozen and Final Pathology Results in Patients Operated for Endometrial Hyperplasia

OBJECTIVE: Our study aimed to determine the frequency of endometrial cancer in patients undergoing surgery with a diagnosis of endometrial hyperplasia and to evaluate the concordance between preoperative diagnosis, frozen section examination, and final pathology results. STUDY DESIGN: The clinical findings, imaging results, and all pathology reports of patients who underwent total abdominal hysterectomy for endometrial hyperplasia (atypical or non-atypical) between January 2020 and January 2023 at our hospital were retrospectively evaluated. Demographic and clinical characteristics (age, menopausal status, parity, body mass index, presence of diabetes and hypertension) and pathology results were recorded from patient records. RESULTS: 144 patients diagnosed with endometrial hyperplasia were included in the study. The frozen section and final pathology results of all patients diagnosed with non-atypical endometrial hyperplasia were reported as benign lesions. In the atypia group, the intraoperative frozen section results of 80.7% of the patients were classified as benign lesions, while the results of 19.3% were reported as malignant pathology. A statistically significant difference was found between the benign and malignant lesion groups, which were classified based on the final pathology results, with respect to age, menopausal status, and average endometrial thickness before biopsy. CONCLUSION: In cases of endometrial hyperplasia with atypia, the possibility of cancer appearing in the final pathology results should be taken into consideration. In the preoperative evaluation of patients, characteristics such as endometrial thickness, age, and menopausal status may suggest the likelihood of encountering endometrial cancer during surgery in this patient group.

Development and validation of a prediction model for gastric cancer: a single-center prospective study.

This study aimed to develop and validate a novel nomogram for diagnosing gastric cancer (GC). In this prospective analysis, 146 patients of Wenzhou Central Hospital were recruited for a GC group and a benign lesion group and were divided into a training set and an internal validation set in a ratio of 7:3. Clinical and analytical characteristics were collected and analyzed by logistic regression analysis. The performance of the predictive model was evaluated using the receiver operating characteristic curve, calibration curve, and decision curve analysis. There were 5 variables, namely albumin, carcinoembryonic antigen, carbohydrate antigen 125, creatinine, and small proline-rich protein 2A, that were identified as the final parameters for the developed model. In the training and internal validation sets, the area under the curve of the model was 0.968 and 0.979, respectively, showing good diagnostic performance. This study developed and validated a new nomogram based on 5 parameters. This model shows good diagnostic performance in distinguishing GC from benign lesion groups and has certain significance in clinical application.

The diagnostic value of two-dimensional ultrasound score, contrast-enhanced ultrasound score and ultrasound elastography score in prostate cancer.

Prostate cancer (PCa) is a prevalent malignancy in men, with early diagnosis being crucial for treatment and prognosis. This study evaluates the diagnostic efficacy of two-dimensional ultrasound imaging score (2DUS), contrast-enhanced ultrasound score (CEUS), and ultrasound elastography score (UES) in PCa. The PCa group consisted of patients diagnosed with primary PCa who underwent radical prostatectomy at the second hospital of Shanxi Medical University between January 2022 and December 2023. The benign lesion group consisted of patients diagnosed with benign prostatic hyperplasia (BPH)through prostate biopsy during the same period. We compared ultrasound scores at PCa and BPH patients using receiver operating characteristic (ROC) curve analysis. The study collected comprehensive patient data and analyzed variations in 2DUS, CEUS, and UES to identify relationships between preoperative ultrasound findings and the pathological states of PCa patients. PCa patients exhibited significantly higher ultrasound scores (P<0.001). Optimal cut-offs were 2.110 for 2DUS, 3.235 for CEUS, and 2.790 for UES, yielding area under curves (AUC) of 0.789, 0.817, and 0.898. The combined score provided an AUC of 0.933, with 83.33% sensitivity and 90.70% specificity. In the form of that patients with tumor stage III-IV, pathological grade III, poor differentiation, and pelvic lymph node metastasis exhibited significantly higher scores in 2DUS, CEUS, and UES compared to those with tumor stages I-II, pathological grades I-II, moderate and high differentiation without pelvic lymph node metastasis, respectively (P<0.05). The combined use of 2DUS, CEUS, and UES scores is highly effective for early PCa detection, surpassing individual scores in accuracy, and is beneficial for staging and differentiation.

Diagnostic Value of Combined BCOR, Cyclin D1, and CD10 in Differentiating Endometrial Stromal Sarcoma From Other Uterine Spindle Cell Lesions.

Uterine spindle cell lesions share a dilemmatic overlapped features that needed to be addressed by the pathologist to reach a conclusive accurate diagnosis for its prognostic value and different management decisions. Usage of combined IHC panel can be an aiding guiding tool in this context. The aim of this study is to evaluate the diagnostic value of combined BCOR, Cyclin D1, and CD10 IHC panel in differentiating endometrial stromal sarcoma from other uterine spindle cell lesions. This study included 60 cases categorized into endometrial stromal sarcoma group (ESS) (12 cases high-grade endometrial stromal sarcoma [HGESS] and 18 cases low-grade endometrial stromal sarcoma [LGESS]), malignant uterine spindle cell lesions group (5 cases adenosarcoma [AS], 6 cases leiomyosarcoma [LS], 4 cases carcinosarcoma [CS]), and benign uterine lesions group (5 cases endometrial stromal nodule [ESN], 5 cases leiomyoma, and 5 cases adenomyosis). IHC staining procedure and evaluation for BCOR, Cyclin D1, and CD10 was performed on all studied cases. BCOR IHC staining was positive in all HGESS (12/12) of ESS group cases, with diffuse pattern in 75% of cases. BCOR-diffuse staining pattern was not recorded in any of LGESS (0/18), malignant mesenchymal lesions group (0/15), and also benign lesions group (0/15). Cyclin D1 positivity was observed only in HGESS cases, in parallel with positive-BCOR expression. On the contrary, CD10 was negatively expressed in all HGESS and positive in all LGESS, ESN, and adenomyosis cases. A specificity of 100% and sensitivity of 75% were recorded in differentiating HGESS from malignant mesenchymal lesions (including LMS, AS, and CS) and also HGESS from LGESS when using the combined panel BCOR +ve D /Cyclin D1 +ve / CD10 -ve , considering only the BCOR-diffuse staining pattern. In conclusion, BCOR +ve D /Cyclin D1 +ve /CD10 -ve as a combined panel is 100% specific and with lesser sensitivity in diagnosing HGESS as well as differentiating it from LGESS and other malignant uterine spindle cell lesions.

Human epididymis protein 4, a novel potential biomarker for diagnostic and prognosis monitoring of lung cancer.

This study aimed to explore the application value of human epididymis protein 4 (HE4) in diagnosing and monitoring the prognosis of lung cancer. First, TCGA (The Cancer Genome Atlas) databases were used to analyze whey-acidic-protein 4-disulfide bond core domain 2 (WFDC2) gene expression levels in lung cancer tissues. Then, a total of 160 individuals were enrolled, categorized into three groups: the lung cancer group (n = 80), the benign lesions group (n = 40), and the healthy controls group (n = 40). Serum HE4 levels and other biomarkers were quantified using an electro-chemiluminescent immunoassay. Additionally, the expression of HE4 in tissues was analyzed through immunohistochemistry (IHC). In vitro cultures of human airway epithelial (human bronchial epithelial [HBE]) cells and various lung cancer cell lines (SPC/PC9/A594/H520) were utilized to detect HE4 levels via western blot (WB). Analysis of the TCGA and UALCAN (The University of Alabama at Birmingham Cancer Data Analysis Portal) databases showed that WFDC2 gene expression levels were upregulated in lung cancer tissues (p < 0.01). Compared with the control group and the benign group, HE4 was significantly higher in the serum of patients with lung cancer (p < 0.001). Receiver operating characteristic (ROC) analysis confirmed that HE4 had better diagnostic efficacy than classical markers in the differential diagnosis of lung cancer and benign lesions and had the highest diagnostic value in lung adenocarcinoma (area under the ROC curve [AUC] = 0.826). HE4 increased in early lung cancer and positively correlated with poor prognosis (p < 0.001). Moreover, the results of WB and IHC revealed that the expression of HE4 was increased in lung cancer cells (SPC/A549/H520) and lung cancer tissues but decreased in PC9 cells with a lack of exon EGFR19 (p < 0.05). Serum HE4 emerges as a promising novel biomarker for the diagnosis and prognosis assessment of lung cancer.

Establishment and validation of multiclassification prediction models for pulmonary nodules based on machine learning.

Lung cancer is the leading cause of cancer-related death worldwide. This study aimed to establish novel multiclassification prediction models based on machine learning (ML) to predict the probability of malignancy in pulmonary nodules (PNs) and to compare with three published models. Nine hundred fourteen patients with PNs were collected from four medical institutions (A, B, C and D), which were organized into tables containing clinical features, radiologic features and laboratory test features. Patients were divided into benign lesion (BL), precursor lesion (PL) and malignant lesion (ML) groups according to pathological diagnosis. Approximately 80% of patients in A (total/male: 632/269, age: 57.73 ± 11.06) were randomly selected as a training set; the remaining 20% were used as an internal test set; and the patients in B (total/male: 94/53, age: 60.04 ± 11.22), C (total/male: 94/47, age: 59.30 ±9.86) and D (total/male: 94/61, age: 62.0± 11.09) were used as an external validation set. Logical regression (LR), decision tree (DT), random forest (RF) and support vector machine (SVM) were used to establish prediction models. Finally, the Mayo model, Peking University People's Hospital (PKUPH) model and Brock model were externally validated in our patients. The AUC values of RF model for MLs, PLs and BLs were 0.80 (95% CI: 0.73-0.88), 0.90 (95% CI: 0.82-0.99) and 0.75 (95% CI: 0.67-0.88), respectively. The weighted average AUC value of the RF model for the external validation set was 0.71 (95% CI: 0.67-0.73), and its AUC values for MLs, PLs and BLs were 0.71 (95% CI: 0.68-0.79), 0.98 (95% CI: 0.88-1.07) and 0.68 (95% CI: 0.61-0.74), respectively. The AUC values of the Mayo model, PKUPH model and Brock model were 0.68 (95% CI: 0.62-0.74), 0.64 (95% CI: 0.58-0.70) and 0.57 (95% CI: 0.49-0.65), respectively. The RF model performed best, and its predictive performance was better than that of the three published models, which may provide a new noninvasive method for the risk assessment of PNs.

Differential diagnosis of gastric low- and high grade dysplasia using C6orf15 protein

ObjectiveTo investigate the expression of C6orf15 protein in gastric endoscopic biopsy specimens and its usage as an ancillary diagnostic biomarker in determining the grade of gastric dysplasia. MethodsWe selected 102 patients with gastric endoscopic biopsy specimens from Jinling Hospital. These were divided into four groups: 22 cases of gastric mucosal benign lesions, 28 with low-grade dysplasia (LGD, intestinal-type: 21 cases，foveolar-type: 7cases), 28 with high-grade dysplasia (HGD, intestinal-type: 20 cases，foveolar-type: 8 cases), and 24 cases of gastric adenocarcinoma. We examined the expressions of C6orf15, P53, and Ki67 in 102 gastric endoscopic biopsy specimens, including 47 cases with accompanying endoscopic submucosal dissection (ESD) specimens, using immunohistochemistry. ResultsIn gastric HGD and gastric adenocarcinoma, the c6orf15 protein exhibits diffuse and strong cytoplasmic expression in tumor cells. Conversely, in gastric LGD and benign gastric mucosal lesions, the c6orf15 protein shows negative or faint yellow cytoplasmic staining. The expression rate of C6orf15 in high-grade gastric dysplasia (HGD, 93 %) and gastric adenocarcinoma (100 %) was significantly higher than in the gastric mucosal benign lesion group (0 %) and the low-grade dysplasia (LGD, 7 %) group (P < 0.001). ConclusionThe detection of C6orf15 protein expression could serve as a valuable adjunctive diagnostic tool for distinguishing between gastric HGD, LGD, and benign lesions. The combined assessment of C6orf15, P53, and Ki67 expressions may be beneficial in determining the grade of gastric dysplasia and evaluating the risk of progression in gastric mucosal lesions in clinical practice.

Clinical value of endoscopic ultrasound sound speed in differential diagnosis of pancreatic solid lesion and prognosis of pancreatic cancer.

Differential diagnosis of pancreatic solid lesion (PSL) and prognosis of pancreatic cancer (PC) is a clinical challenge. We aimed to explore the differential diagnostic value of sound speed (SS) obtained from endoscopic ultrasonography (EUS) in PSL and the prognostic value of SS in PC. Patients with PSL in The Third Xiangya Hospital of Central South University from March 2019 to October 2019 were prospectively enrolled, who obtained SS from PSL. Patients were divided into the PC group and the pancreatic benign lesion (PBL) group. SS1 is the SS of lesions and SS2 is the SS of normal tissues adjacent to lesions. Ratio1 is equal to SS1 divided by SS2 of PSL (ratio1 = SS1/SS2). Eighty patients were enrolled (24 PBL patients, 56 PC patients). SS1 and ratio1 in PC group were higher compared with PBL group (SS1:1568.00 vs. 1550.00, Z = -2.066, p = 0.039; ratio1: 1.0110 vs. 1.0051, Z = -3.391, p = 0.001). The SS1 in PC (Z = -6.503, p < 0.001) was higher compared to SS2. In the nonsurgical group of PC, low ratio1 predicted high overall survival (OS) (7.000 months vs. 4.000 months; p = 0.039). In the surgical group of PC, low SS1 was associated with low median OS (4.000 months vs. 12.000 months; p = 0.033). SS plays a vital role in distinguishing between PBL and PC. Higher SS1 and ratio1 obtained by EUS are more related to PC than PBL. In PC patients, high SS1 may predict pancreatic lesions. In the nonsurgical group of PC, low ratio1 may predict high OS. However, in the surgical group of PC, low SS1 may predict low OS.

To assess the quantitative features of focal liver lesions in gadoxetic acid enhanced MRI and to determine whether these features can accurately differentiate benign form malignant lesions

PurposeThe study aims at assessing the quantitative features which distinguish focal liver lesions (FLLs) in gadoxetic acid (GA) enhanced liver MRI and at determining whether these features can accurately differentiate benign from malignant lesions. Material and methods107 patients with 180 unequivocal FLLs in previous examinations were included in a single-center retrospective study. All patients underwent a MRI test of the liver with GA. 99 benign and 74 malignant lesions were included. The group of benign lesions consisted of 60 focal nodular hyperplasias (FNH), 22 hemangiomas (HMG), 6 hepatic adenomas (HA), and 11 other benign lesions (1 angiomyolipioma, 6 lesions histopathology diagnoses as benign without further specification, or ones lacking features of malignancy, and 4 lesions radiologically diagnosed as benign which remained stable in the follow-up studies). The group of malignant lesions consisted of primary 51 hepatocellular carcinomas, 12 metastases, and 11 metastases from melanoma malignum (MM meta). 7 FLLs were excluded (4 cases of uncertain histopathological diagnosis, 2 cholangiocarcinomas, and 1 regenerative nodule). For the included lesions ROI (region of interest) measurements were taken by two observers in the T2-w, ADC (apparent diffusion coefficient) and in the T1-w sequence in the hepatobiliary phase (HBP). The interobserver agreement was evaluated with the Wilcoxon test. The Kruskal – Wallis, Mann – Whitney U and post hoc Dunn’s tests were applied to assess if there were any significant differences in the ROI values between individual lesions.The variables with the p values of < 0.05 were considered statistically significant. ResultsWe found significant differences in the ROI values between lesions with p < 0.0001. Strikingly high ROI values in the T2-w sequence were found for HMG. The lowest ADC values were encountered for metastases and MM metastases. The highest ROI values in the HBP were found for FNH, and the lowest for metastases.We also found statistically significant differences in the ROI values between benign and malignant lesions with benign lesions presenting statistically higher ROI values compared to malignant lesions. ConclusionsThere were significant differences in the ROI values among different types of FLLs. The predominant quantitative feature in the T2-w sequence was a strikingly high ROI value for HMG. Benign lesions presented statistically higher ROI values in the T2-w, ADC, and HBP sequences compared to malignant lesions. This was true for all lesions except for HA.

Radiofrequency ablation for thyroid nodules in Ecuador: a cross-sectional study

ObjectivesTo describe the demographic characteristics and clinical outcomes following the first cohort of patients with Bening Thyroid Nodule (BTN) and (Papillary Thyroid Microcarcinoma) (PTMC) treated with Radiofrequency Ablation (RFA)in Ecuador.MethodsSingle-center, cross-sectional study. We included adults undergoing RFA for BTN and PTMC between July 2019 and May 2022. Descriptive statistics and the Wilcoxon signed-rank test were used to compare some pre- and post-intervention outcomes.ResultsWe included 44 patients with 36 BTNs and eight PTMCs. The median age was 45.80 years (IQR 16–79 years), and most patients had normal thyroid function (72.72%). The median follow-up time was 7.80 months (IQR1.0-34.0). Nodules were primarily solid (43.21%) or predominantly solid (56.81%). The pre-RFA median volume in the benign lesions group was 10.30 ml (IQR 1.86–18.97). After ablation, the 1-month, 3-month, 6-month, and 12-month median volumes were 6.90 (IQR 0.48–10.15; p < 0.01) mL, 5.72 (IQR 0.77–7.25; p = 0.045); 0.98 (IQR 0.25–3.64; p < 0.01), and 0.11 (IQR 0.07–11.26; p = 0.026), respectively. The volume rate reduction was 47.20%, 72.20%, 74.00%, and 96.20% at 1, 3, 6, and 12-month follow-ups, respectively. The pre-RFA median volume in the PTMC group was 0.25 ml (IQR 0.19–0.48). After ablation, the 1-month, 3-month, and 6-month mean volumes were 0.19 (range 0.12–0.31; p = 0.120) mL, 0.10 (IQR 0.05–0.15; p = 0.13), and 0.01 (IQR 0.005–0.04; p = 0.364), respectively.ConclusionsIn this first report from Ecuador, we found that RFA may be a feasible alternative for treating benign and malignant thyroid nodules in the short term. Long-term data are needed to evaluate oncologic outcomes in PTMC patients.

A comparative study of tumor markers and dynamic contrast-enhanced CT and their combined evaluation in the diagnosis of renal cancer patients

The objectives of this study were to investigate the diagnostic efficacy of dynamic contrast-enhanced Computed Tomography (CT) and tumor markers and their combined evaluation in renal cancer patients. A total of eighty male patients with solid renal lesions were selected from our hospital and categorized into two groups based on pathological examination findings: renal cancer group and benign lesion group. A comparison was made between the findings of dynamic contrast-enhanced CT and tumor markers and the diagnostic efficacy of either mono or combined evaluation were compared. Receiver operating characteristic curves were plotted to better analyze and compare different diagnostic techniques. The serum concentrations of carcinoembryonic antigen (CEA), Cytokeratin 19 fragment (CYFRA21-1), midkine (MK) and matrix metalloproteinase 9 (MMP-9) in renal cancer patients were significantly higher than those with benign lesions (p &lt; 0.05). The Receiver Operating Characteristic (ROC) curve analysis demonstrated that the combination of dynamic contrast-enhanced CT and tumor markers had the highest area under the curve. This difference was statistically significant (p &lt; 0.05). The analysis of the overall model quality results revealed that the model values for both single and combination indicators exceeded 0.5, with the combined indicators having the highest value of (0.84). The diagnostic efficacy of dynamic contrast-enhanced CT combined with tumor markers for renal cancer is significantly higher than either the dynamic contrast-enhanced CT or tumor markers alone. The combination of dynamic contrast-enhanced CT and tumor markers has a significant therapeutic benefit in diagnosing renal cancer. We envisage that, this approach can offer valuable guidance for the clinical diagnosis and treatment of renal cancer.

The role of nanomagnetic beads in diagnosis of early breast cancer by ductoscopy combined with CEA expression of tumor marker

In this study, nipple discharge patients were selected as subjects to evaluate the diagnostic value of ductoscopy and the tumor marker CEA expression in early occulted breast cancer. A retrospective analysis was performed on 121 pathological nipple discharge patients who received treatment in our hospital. Thirty-two parturients who delivered normally in our hospital during the same period were randomly selected to be included in the control group. Samples of the subjects’ milk and nipple discharge were collected. The contents of tumor markers CEA, CA153, and CA125 were measured in the nipple discharge and milk using nanomagnetic beads combined with chemiluminescence immunoassay (CLIA). The findings from ductoscopy were documented and compared to the pathological results obtained after surgery. Nanomagnetic beads combined with CLIA can enhance the efficiency and stability of detection. CEA and CA125 levels increased in the group with breast lesions, and reached their highest levels in the group with malignant breast diseases. The positive prediction rates of CA153 and CEA in breast cancer were significantly higher than in the benign lesion group (P &lt; 0005). Univariate analysis showed that bloody nipple discharge or III ∼ IV breast duct lesions identified as high-risk factors associated with breast cancer. The sensitivity of endoscopy for diagnosing malignant lesions was 90.70%, while the sensitivity of CEA+ endoscopy was 95.35%. Ductoscopy has high sensitivity in the diagnosis of early occult breast cancer. The sensitivity and specificity of diagnosis could be significantly improved by combining tumor marker CEA expression with ductoscopy.

Angiolymphoid hyperplasia with eosinophilia of the tongue – A case report

Angiolymphoid lymphoid hyperplasia with eosinophilia (ALHE) represents a heterogenous group of benign vascular lesions that is characterized by proliferation of small to medium sized vascular structures lined by plump epitheloid (histiocytoid)endothelial cells surrounded by mixed inflammatory infiltrate predominantly eosinophils. Intraoral lesions of ALHE are uncommon and tongue involvement is extremely rare. Here we report a case of ALHE of tongue in a 60 yr old female diagnosed on histopathology and confirmed by IHC.

Imaging signs and the qualitative diagnosis of solitary rib lesions using 99mtechnetium-methylene diphosphonate whole-body bone imaging in patients with a malignant tumor.

The aim of this study was to summarize the valuable information for qualitative diagnosis by investigating the imaging signs from the whole-body bone imaging of solitary rib lesions. A retrospective analysis was conducted of the data from 313 patients with malignant tumors and solitary rib lesions identified using whole-body bone imaging in Department of Nuclear Medicine of Central South University Xiangya School Affiliated Haikou Hospital between January 2015 and December 2017. Based on the final comprehensive diagnosis of the rib lesions, the patients were divided into a bone metastasis group, fracture group, other benign lesions group, and an uncertain group, and the characteristic imaging changes in rib lesions in each group were explored. (I) Significant differences were identified among the 4 groups (P<0.001) in the distribution of lesions in the anterior, posterior, and lateral ribs and proximal costal cartilage. The fracture group had the highest proportion of lesions in the anterior ribs (99/121, 81.8%) and proximal costal cartilage (74.4%, 90/121). (II) Significant differences were detected in morphology, concentration, boundaries, and radioactivity distribution among the 4 groups of patients (P<0.001). The bone metastasis group had the highest proportion of lesions appearing as stripes (35/67, 52.2%), and the fracture group had the highest proportion of lesions appearing as spots (94.2%, 114/121) and the lowest proportion appearing as stripes (3/121, 2.5%). (III) Significant differences were found in the longitudinal diameter, transverse diameter, aspect ratio, and tumor-to-normal tissue ratio between the 4 groups (P<0.001). The longitudinal diameter (27.8±16.0 mm) and aspect ratio (1.9±1.0) of the bone metastasis group were the highest, whereas the longitudinal diameter (15.2±3.9 mm) and aspect ratio (1.0±0.2) of the fracture group were the smallest. This study revealed that different types of solitary rib lesions had relatively characteristic imaging signs in whole-body bone imaging.

Clinical implications of the concentration of alveolar nitric oxide in non-small cell lung cancer.

Clinical implications of the concentration of alveolar nitric oxide in non-small cell lung cancer.

Establishment and Verification of Benign and Malignant Prediction Model of Subcentimeter Pulmonary Ground Glass Nodules Based on HRCT

Pre-operative accuracy of subcentimeter ground glass nodules (SGGNs) is a difficult problem in clinical practice, but there are few clinical studies on the benign and malignant prediction model of SGGNs. The aim of this study was to help identify benign and malignant lesions of SGGNs based on the imaging features of high resolution computed tomography (HRCT) and the general clinical data of patients, and to build a risk prediction model. This study retrospectively analyzed the clinical data of 483 patients with SGGNs who underwent surgical resection and were confirmed by histology from the First Affiliated Hospital of University of Science and Technology of China from August 2020 to December 2021. The patients were divided into the training set (n=338) and the validation set (n=145) according to 7:3 random assignment. According to the postoperative histology, they were divided into adenocarcinoma group and benign lesion group. The independent risk factors and models were analyzed by univariate analysis and multivariate Logistic regression. The receiver operator characteristic (ROC) curve was constructed to evaluate the model differentiation, and the calibration curve was used to evaluate the model consistency. The clinical application value of the decision curve analysis (DCA) evaluation model was drawn, and the validation set data was substituted for external verification. Multivariate Logistic analysis screened out patients' age, vascular sign, lobular sign, nodule volume and mean-CT value as independent risk factors for SGGNs. Based on the results of multivariate analysis, Nomogram prediction model was constructed, and the area under ROC curve was 0.836 (95%CI: 0.794-0.879). The critical value corresponding to the maximum approximate entry index was 0.483. The sensitivity was 76.6%, and the specificity was 80.1%. The positive predictive value was 86.5%, and the negative predictive value was 68.7%. The benign and malignant risk of SGGNs predicted by the calibration curve was highly consistent with the actual occurrence risk after sampling 1,000 times using Bootstrap method. DCA showed that patients showed a positive net benefit when the predictive probability of the predicted model probability was 0.2 to 0.9. Based on preoperative medical history and preoperative HRCT examination indicators, the benign and malignant risk prediction model of SGGNs was established to have good predictive efficacy and clinical application value. The visualization of Nomogram can help to screen out high-risk groups of SGGNs, providing support for clinical decision-making.

Laparoscopic Management of Benign Cystic Lesions of the Liver

Background: Benign cystic lesions of the liver are rare conditions. Owing to the improvement in investigation modalities like ultrasound and CT scan these lesions are found frequently today. A safe and effective method of laparoscopic management for hepatic hydatid cysts, simple liver cysts and liver abscess is described along with a review of the relevant literature. Objectives: To report our experience in laparoscopic management of hepatic hydatid cysts, simple liver cysts and liver abscess with the outcome, feasibility and complications of the procedure. Methods: This was a prospective observational study held at BSMMU, BIRDEM, DMCH, ShMCH and some private hospital in Dhaka city from July 2014 to December 2014. Total sample size was thirty cases. All patients diagnosed on ultrasound and CT scan and who have ful-filed the inclusion and exclusions criteria were included in the study. Laparoscopic unroofing, evacuation inocleation and aspiration were done. Operative procedure, operation time, conversion to laparotomy, complications, and mortality and recurrence rates were analysed. Results: There were three groups of benign cystic lesions: hepatic hydatid cysts (n=18), simple liver cysts (n=8) and liver abscess (n=4). Mean age of the patients were 43.6 years with hydatid cysts, 46.7 years with simple liver cysts, and 59.6 years in patients with liver abscess. Minimum age was 17 years and maximum age was 69 years. Male patients were 10 in hydatid cysts group, 3 in simple liver cysts group and 3 in liver abscess group. Most of the patients presented with pain, 72.22% in hydatid cysts, 62.5% in simple liver cysts and 100% in liver abscess. Most of the lesions were single and they were located in the right lobe of the liver in majority of cases. Benign cystic lesions were successfully treated laparoscopcally in 29 cases. Open surgery conversion was needed in one case 3.33%, with hepatic hydatid cysts. Complications included port site infection in 2 (6.67%), one in .....

Radiologic staging of peritoneal and retroperitoneal disease.

Peritoneal and retroperitoneal tumors consist of a heterogenous group of benign and malignant lesions of different origin. Due to often complex multidisciplinary treatment concepts in patients with peritoneal surface malignancies radiological imaging plays a pivotal role regarding the therapeutic options. Moreover, tumor entity, abdominal tumor distribution and common as well as rare differential diagnoses have to be taken into account. Using different radiological modalities non-invasive pretherapeutic diagnostics might be significantly improved. KEY POINTS:: · Diagnostic CT is a valuable part of the initial diagnostic approach to peritoneal surface malignancies.. · Sensitivity might be increased by the additional use of dwMRI and PET/CT considering tumor entity and individual diagnostic issues.. · The Peritoneal Cancer Index (PCI) should be determined independent of radiologic modality.. CITATION FORMAT: · Glockzin G, Helmberger T. Radiologic staging of peritoneal and retroperitoneal disease. Fortschr Röntgenstr 2023; 195: 377 - 384.

Relationship between Clinicohistomorphology Profile of Atypical Prostate Gland and Diagnosis Benign Lesion or Prostate Adenocarcinoma

BackgroundAtypical prostate gland especially atypical small acinar proliferation (ASAP) is a histopathological diagnosis that requires a follow-up biopsy 3-6 months after the first biopsy, because 17-60% of cases potentially to be malignant. The varied clinical and histomorphological characteristics of the atypical prostate gland make it difficult to confirm the final diagnosis as a benign lesion or prostate adenocarcinoma. This study aims to describe clinicohistomorphological cases of atypical prostate gland at Anatomical Pathology Department FKUI/RSCM and to identify histomorphological features of the atypical prostate gland as benign lesions or prostate adenocarcinoma on immunohistochemistry diagnosis.MethodsA histopathological investigation of prostate gland cases with atypical nuclei was carried out in 2011-2021 from archives of Anatomical Pathology Department FKUI/RSCM. Clinical and histomorphological characteristics were assessed and categorized into benign lesions or prostate adenocarcinoma based on immunohistochemistry appearance.ResultsThere were 109 cases of atypical prostate gland, 49 of which met the inclusion and exclusion criteria and could be analyzed. Corpora amylacea was found in 11 cases (84.6%) in the benign lesion group, statistically significant (p-value 0.005). Intraluminal crystalloids were found in 4 cases (100%) in the prostate adenocarcinoma group with p-value 0.050, close to significant. Other clinicohistomorphological characteristics did not show a significant relationship both in benign lesions and prostate adenocarcinoma groups (p-value 0.05).Conclusion On histopathological examination of the atypical prostate gland that is difficult to re-biopsy, the discovery of corpora amylacea may lead to the diagnosis of a benign lesion, while the discovery of intraluminal crystalloids may lead to the diagnosis of prostate adenocarcinoma. The diagnosis must be supported by immunohistochemistry characteristics.

The 2022 WHO Classification of thyroid tumors: novel concepts in nomenclature and grading.

The 5th edition of the Classification of Endocrine and Neuroendocrine Tumors has been released by the World Health Organization (WHO). This timely publication integrates several changes to the nomenclature of non-neoplastic and neoplastic thyroid diseases, as well as novel concepts that are essential for patient management. The heterogeneous group of non-neoplastic and benign neoplastic lesions are now collectively termed "thyroid follicular nodular disease" to better reflect the clonal and non-clonal proliferations which clinically present as multinodular goiter. Thyroid neoplasms originating from follicular-cell derived are distinctly divided into benign, low-risk and malignant neoplasms. The new classification scheme stresses that papillary thyroid carcinoma (PTC) should be subtyped based on histomorphologic features irrespective of tumor size to avoid treating all sub-centimeter/small lesions as low-risk disease. Formerly known as the cribriform-morular variant of PTC is redefined as cribriform-morular thyroid carcinoma since this tumor is now considered as a distinct malignant thyroid neoplasm of uncertain histogenesis. The "differentiated high-grade thyroid carcinoma" is a new diagnostic category including PTCs, follicular thyroid carcinomas and oncocytic carcinomas with high-grade features associated with poorer prognosis similar to the traditionally defined poorly differentiated thyroid carcinoma as per Turin criteria. In addition, squamous cell carcinoma of the thyroid is now considered a morphologic pattern/subtype of anaplastic thyroid carcinoma. In this review, we will highlight the key changes in the newly devised 5th edition of WHO classification scheme of thyroid tumors with reflections on its applicability in patient management and future directions in this field.