Benign Tumors Research Articles

Neurofibromatosis type1 adult surveillance form for Austria.

Neurofibromatosis type1 (NF1) is arare autosomal dominant tumor predisposition syndrome with abirth prevalence of approximately 1in 2000-3000 individuals. Management of both benign and malignant tumors arising in individuals with NF1 is demanding and tumors may be difficult to treat. Both standardized and individual surveillance programs are therefore highly important to prevent morbidity and mortality in patients with NF1. The guidelines for the clinical management of NF1 recently proposed by the European Reference Network for Genetic Tumor Risk Syndromes provide the cornerstone of the present surveillance form and were discussed through three rounds of voting and afinal consensus meeting involving experts from five Austrian and one German clinical NF1 centers for adults and one patient organization representative. Subsequently, 31items within 4categories were integrated into the proposed surveillance form for Austria. All recommendations, unless otherwise specified, pertain to primarily asymptomatic patients in routine follow-up. At healthcare transition from pediatric to adult surveillance or the initial visit in adulthood, we suggest athorough clinical, laboratory and radiological examination to obtain abaseline for future diagnostics. To comply with the general screening recommendations in Austria, we suggest extending the frequency of clinical visits from annual to biennial at 50years of age. In cases of clinical dynamics, early follow-up is recommended to facilitate early detection of potential complications. Particular emphasis should be placed on preventive patient education.

Laparoscopic enucleation of tumors embedded in the pancreatic head: Safety and feasibility

BackgroundSurgical treatment for a benign or low-grade malignant tumor in the pancreatic head remains a challenge at present. As an organ-sparing procedure, enucleation is ideal. However, it is still controversial whether laparoscopic enucleation (LapEN) can be safely performed for a pancreatic head tumor, especially a deeply embedded one. MethodsThe cases who underwent LapEN of a pancreatic tumor from January 2014 to September 2022 in our hospital were collected and analyzed. ResultsA total of 151 cases were collected. The incidence of pancreatic fistula (PF, grade B) was 21.9%. No patient developed PF (grade C) or died. Compared with enucleating a tumor in the distal pancreas (N = 98), enucleating a tumor in the pancreatic head (N = 53) showed a longer operation time and a higher incidence of conversion. The cases with a tumor in the pancreatic head were then divided into the group with a deeply embedded tumor (N = 32) and the group with a superficial tumor (N = 21). The embedded group had a smaller tumor size and a higher proportion of insulinoma. There were no statistical differences in the parameters of operation time, blood loss and incidence of complications between the two groups. The outcomes of enucleating a tumor deeply embedded in the proximal and distal pancreas were further analyzed, which indicated no statistical differences in clinical parameters between the two groups. ConclusionLapEN of a tumor in the pancreatic head is feasible and safe, even for a deeply embedded tumor.

Insulin-like growth factor-1 deficiency caused by hepatocellular adenoma leads to growth arrest, primary amenorrhea and metabolic syndrome: a case report and 4 years follow up

BackgroundHepatocellular adenoma (HCA) is a rare benign neoplasm, seldom ascribed as the cause of endocrine and metabolic derangement. We herein report a case of primary amenorrhea, growth arrest and metabolic syndrome. En bloc resection of the tumor normalized all the disturbances.Case presentationA 16-year-old girl complained of primary amenorrhea and growth arrest for the past 2 years. Her height and weight were at the 3rd percentile, whereas waist circumference was at the 90th percentile for chronological age. She was hypertensive on admission. Plasma cholesterol, triglyceride and uric acid were elevated. Evaluation of GH/IGF-1 axis showed extremely low IGF-1 concentration, which was unresponsive to hGH stimulation. Computer tomography identified a huge liver mass (18.2 cm×13.7 cm×21 cm). The patient underwent an uneventful open right hepatic lobectomy. The tumor was en bloc resected. Immunohistochemistry indicated an unclassified HCA, which was confirmed by genetic screening. IGF-1 concentration, blood pressure, lipid profile and ovarian function were all normalized after surgery, and the girl had reduction in waist circumference and gain in height during the follow up.ConclusionWe provide evidence that liver-derived IGF-1 has a direct effect on skeletal and pubertal development, blood pressure, visceral adiposity and dyslipidemia independent of insulin resistance and obesity in the circumstance of undernutrition. Though rare, we propose the need to look into HCA cases for the existence of IGF-1 deficiency and its impact on metabolic derangement.

Patient reported outcomes and short-term adjustment trajectories following gamma knife radiosurgery for benign brain tumor

Purpose Patient reported outcomes (PROs) in the context of Gamma Knife Stereotactic Radiosurgery (GKSRS) for benign brain tumor have been under-researched. This study examined changes in PROs and adjustment trajectories post-GKSRS. Method 50 adults (54% female) aged on average 53.18 (SD = 14.76) years with benign brain tumor were assessed 1 week before GKSRS, 1–2 weeks post-GKSRS, and at 3-month follow-up. Telephone-based questionnaires of anxiety and depressive symptoms, cognitive function, symptom burden, and health-related quality of life (HRQoL) were completed. Results Significant improvements in HRQoL, perceived cognitive ability, anxiety, and total brain tumor symptoms were evident between pre-GKSRS and 3-month follow-up. Conversely, there was a significant short-term increase in depressive symptoms at post-GKSRS; however, levels did not differ from pre-GKSRS at follow-up. No significant changes were evident on PROs of headaches or fatigue. About half of the participants (46–51%) experienced reliable improvement in global HRQoL, and one-third (31–34%) reported improved anxiety symptoms. Increased depressive symptoms was seen in 34% of participants post-GKSRS and 18% at follow-up. Conclusions At 3 months post-GKSRS, improvements in HRQoL, anxiety, perceived cognitive ability, and total brain tumor symptoms were evident. Routine monitoring and support for pre-GKSRS anxiety and depressive symptoms post-GKSRS is recommended.

Human intermediate prostate cancer stem cells contribute to the initiation and development of prostate adenocarcinoma

BackgroundIntermediate cells are present in the early stages of human prostate development and adenocarcinoma. While primary cells isolated from benign human prostate tissues or tumors exhibit an intermediate phenotype in vitro, they cannot form tumors in vivo unless genetically modified. It is unclear about the stem cell properties and tumorigenicity of intermediate cells.MethodsWe developed a customized medium to culture primary human intermediate prostate cells, which were transplanted into male immunodeficient NCG mice to examine tumorigenicity in vivo. We treated the cells with different concentrations of dihydrotestosterone (DHT) and enzalutamide in vitro and surgically castrated the mice after cell transplantation in vivo. Immunostaining, qRT-PCR, RNA sequencing, and western blotting were performed to characterize the cells in tissues and 2D and 3D cultures.ResultsWe found intermediate cells expressing AR+PSA+CK8+CK5+ in the luminal compartment of human prostate adenocarcinoma by immunostaining. We cultured the primary intermediate cells in vitro, which expressed luminal (AR+PSA+CK8+CK18+), basal (CK5+P63+), intermediate (IVL+), and stem cell (CK4+CK13+PSCA+SOX2+) markers. These cells resisted castration in vitro by upregulating the expression of AR, PSA, and proliferation markers KI67 and PCNA. The intermediate cells had high tumorigenicity in vivo, forming tumors in immunodeficient NCG mice in a month without any genetic modification or co-transplantation with embryonic urogenital sinus mesenchyme (UGSM) cells. We named these cells human castration-resistant intermediate prostate cancer stem cells or CriPCSCs and defined the xenograft model as patient primary cell-derived xenograft (PrDX). Human CriPCSCs resisted castration in vitro and in vivo by upregulating AR expression. Furthermore, human CriPCSCs differentiated into amplifying adenocarcinoma cells of luminal phenotype in PrDX tumors in vivo, which can dedifferentiate into CriPCSCs in vitro.ConclusionsOur study identified and established methods for culturing human CriPCSCs, which had high tumorigenicity in vivo without any genetic modification or UGSM co-transplantation. Human CriPCSCs differentiated into amplifying adenocarcinoma cells of luminal phenotype in the fast-growing tumors in vivo, which hold the potential to dedifferentiate into intermediate stem cells. These cells resisted castration by upregulating AR expression. The human CriPCSC and PrDX methods hold significant potential for advancing prostate cancer research and precision medicine.

Inflammatory fibroid polyp of the esophagus: a systematic review.

Esophageal inflammatory fibroid polyp (IFP) is a rare benign tumor of the gastrointestinal tract with limited available data on clinicopathologic features and treatment strategies. A systematic review of the literature in PubMed/Medline and Scopus databases was performed for articles concerning esophageal IFP in adult population. A total of 16 studies were identified, involving 16 patients with a Male-Female Ratio of 3:1 and mean age of 50.38 years. Clinical presentation of esophageal IFP included progressive dysphagia in 56.3% of cases, with additional symptoms such as epigastric and retrosternal pain, weight loss, vomiting, and melena. Diagnostic modalities involved endoscopy in all cases, with endoscopic ultrasound (EUS) employed in 50% of cases and tissue biopsy performed during endoscopy in 87.5% of the patients. Therapeutic approach of esophageal IFP consisted of surgical resection in 75% of the patients and endoscopic resection in the remaining 25%, with various surgical procedures employed based on tumor location. Follow-up data, available for 11 patients over a median duration of 15.5 months, indicated two instances of recurrence following endoscopic resection, while the other nine patients remained asymptomatic with no evidence of recurrence. Esophageal IFP is a rare benign tumor of the gastrointestinal tract presenting with dysphagia, regurgitation, and heartburn. Resection, either endoscopic or surgical, is the primary treatment approach. Prognosis for esophageal IFP is favorable, with low recurrence rates. Further research is required to investigate potential risk factors and etiology for this lesion, and to explore novel therapeutic approaches that may improve patient outcomes.

CD26 Is Differentially Expressed throughout the Life Cycle of Infantile Hemangiomas and Characterizes the Proliferative Phase

Infantile hemangiomas (IHs) are benign vascular neoplasms of childhood (prevalence 5–10%) due to the abnormal proliferation of endothelial cells. IHs are characterized by a peculiar natural life cycle enclosing three phases: proliferative (≤12 months), involuting (≥13 months), and involuted (up to 4–7 years). The mechanisms underlying this neoplastic disease still remain uncovered. Twenty-seven IH tissue specimens (15 proliferative and 12 involuting) were subjected to hematoxylin and eosin staining and a panel of diagnostic markers by immunohistochemistry. WT1, nestin, CD133, and CD26 were also analyzed. Moreover, CD31pos/CD26pos proliferative hemangioma–derived endothelial cells (Hem-ECs) were freshly isolated, exposed to vildagliptin (a DPP-IV/CD26 inhibitor), and tested for cell survival and proliferation by MTT assay, FACS analysis, and Western blot assay. All IHs displayed positive CD31, GLUT1, WT1, and nestin immunostaining but were negative for D2-40. Increased endothelial cell proliferation in IH samples was documented by ki67 labeling. All endothelia of proliferative IHs were positive for CD26 (100%), while only 10 expressed CD133 (66.6%). Surprisingly, seven involuting IH samples (58.3%) exhibited coexisting proliferative and involuting aspects in the same hemangiomatous lesion. Importantly, proliferative areas were characterized by CD26 immunolabeling, at variance from involuting sites that were always CD26 negative. Finally, in vitro DPP-IV pharmacological inhibition by vildagliptin significantly reduced Hem-ECs proliferation through the modulation of ki67 and induced cell cycle arrest associated with the upregulation of p21 protein expression. Taken together, our findings suggest that CD26 might represent a reliable biomarker to detect proliferative sites and unveil non-regressive IHs after a 12-month life cycle.

Akurasi Biopsi Aspirasi Jarum Halus untuk Diagnostik Tumor Kelenjar Liur di RSUD DR Saiful Anwar Malang 2018-2022

Fine needle aspiration biopsy is accepted as a safe, reliable, minimally invasive, and cost-effective method. Fine needle aspiration biopsy aims to assist clinicians in handling patients. The purpose of this study is to evaluate the validity of fine needle aspiration biopsy as a diagnostic tool in salivary gland tumors compared to histopathological examination at Dr. Saiful Anwar Malang Hospital for the period of 2018-2022. Methods: Fine needle aspiration biopsy examination was performed before surgery, then compared with the results of histopathological examination after surgery as gold standard and retrospectively reviewed. Fine needle aspiration biopsy results and histopathological results are classified as neoplasm or non-neoplasm and benign or malignant. Validity is determined from sensitivity, specificity, positive conjecture value, negative conjecture value and accuracy. As a result, there were 33 cases of salivary gland tumors that met the inclusion criteria in the period 2018-2022 were reviewed, then classified into neoplasms or non-neoplasms and benign or malignant neoplasms. The sensitivity, specificity, accuracy, positive presumptive value, and negative presumptive value of cytological diagnosis of fine needle aspiration biopsy of salivary gland tumors for the neoplasm or non-neoplasm category were 93.1%, 100%, 93.9%, 100%, 66.7% and for the benign or malignant category 94.4%, 88.9%, 92.6%, 94.4%, 88.9%. This study shows that salivary gland fine needle aspiration biopsy cytology is a reliable and accurate diagnostic method for the diagnosis of salivary gland lesions. Conclusions: Fine needle aspiration biopsy is a useful method for diagnostics in salivary gland tumors but cannot replace histopathological examination as the gold standard for diagnostics.

Current methods of postsurgical rehabilitation in benign brain tumor patients

Current methods of postsurgical rehabilitation in benign brain tumor patients

EP165 - It is not just a perianal wart! A rare case of perianal lesion

Abstract Perianal skin lesion is a common presentation with a wide range of differentials, including thrombosed external haemorrhoids, perianal abscess, perianal warts, lipoma and sebaceous cysts. Malignant lesions such as squamous cell carcinoma are uncommon but should be considered. Hereby, we present a diagnostically challenging case of a benign looking perianal lesion that ultimately revealed a rare condition. A 50-year old lady presented with a one-year history of perianal lump accompanied with intermittent pain, fresh bleeding and pus-like discharge. A digital rectal examination revealed a well-demarcated 4mm fleshy skin lesion, 2cm from anal verge at 7 o’clock position without surrounding area of inflammation. No lymph nodes were palpable on both groins. Differentials as mentioned above including an infected granuloma and fistula in-ano were considered. Pelvic MRI revealed a well-demarcated, benign-looking subcutaneous lesion. The lesion was excised under general anaesthesia and interestingly, the histopathology report revealed a diagnosis of Hidradenoma Papilliferum (HP) with no dysplasia or malignancy. Patient recovered well, reassured with the above findings and discharged home. HP is an uncommon, benign tumour that occurs in the anogenital region. It is more prevalent in Caucasian middle-aged females, as illustrated in our case. A definite diagnosis necessitates histopathological examination. The management includes a local excision of the lesion, and it is associated with good prognosis, with low chances of recurrence or malignant transformation. HP, although rare, should be included in the differentials of a perianal lump. A surgical excision or diagnostic biopsy should be performed at minimum.

Diagnostic and therapeutic strategies for an evolving large jugal lipoma: a comprehensive case study

Lipoma, the most common benign mesenchymal neoplasm in soft tissues, is characterized by the localized growth of fat cells. In the oral cavity, lipomas typically present as well-defined, slow-growing, solitary submucosal nodules that are painless. They are generally easily diagnosed clinically, although there is a possibility of confusion with other neoplasms in the oral cavity In the cervicofacial area, lipomas account for 13% to 20% of cases, with the posterior cervical region being the most frequently involved. A 45-year-old male patient with an unremarkable medical history presented with a slowly evolving left jugal swelling that had been persistent for eight years. CT scan performed without any sign of infiltration. Surgical excision was done and histopathological exam has confirmed a lipoma. Infiltrative lipomas require particular attention, and it is advisable to remove them with a margin of healthy tissue to prevent recurrence. This strategy aims to ensure complete removal of the tumor and reduce the risk of its return. Keywords: Lipoma, Case report, Benign, Unesthetic, Sub-Saharan Africa.

TERT promoter mutations and additional molecular alterations in thyroid fine-needle aspiration specimens: A multi-institutional study with histopathologic follow-up

Abstract Objectives TERT promoter mutations are not infrequently encountered in thyroid carcinomas; however, it is unclear if additional molecular alterations may play a role in determining tumor behavior. Methods Fine-needle aspiration (FNA) specimens from 32 patients with TERT promoter mutations detected by ThyroSeq v3 from 4 institutions were included in the study. FNA diagnoses, molecular results, and surgical follow-up were retrospectively reviewed and analyzed. Results There were 5 benign and 27 malignant neoplasms, including 7 high-grade thyroid carcinomas (HGCs) on histopathologic follow-up. Of 4 cases with an isolated TERT mutation, 3 (75%) cases were malignant. Of 17 cases harboring a co-occurring TERT mutation with 1 additional molecular alteration, 13 (76%) displayed malignancy on histopathologic follow-up. All 11 cases with TERT mutations plus 2 or more additional molecular alterations were malignant on follow-up. Furthermore, HGC was not seen in cases with an isolated TERT mutation, while 80% of cases harboring TERT mutations plus 3 additional molecular alterations showed HGC. Conclusions TERT promoter mutations are commonly associated with malignancy, particularly HGCs, when multiple co-occurring molecular alterations are present. However, TERT promoter mutations may occasionally be detected in benign thyroid neoplasms when encountered in isolation or with fewer than 2 additional molecular alterations.

The alternative value of thyroid stimulating hormone instead of thyroglobulin in differentiation of follicular thyroid neoplasm in Hashimoto’s thyroiditis

PurposesTo provide novel aspects for the preoperative diagnosis and appropriate differentiation strategies for follicular thyroid carcinoma (FTC) and follicular thyroid adenoma (FTA).MethodsAmong 25,765 cases, a total of 326 patients with follicular thyroid neoplasms between 2013 and 2019 were enrolled. Patient demographics, perioperative parameters, surgical profiles and oncologic outcomes were collected and analyzed.ResultsThere were no significant differences in preoperative ultrasound findings between FTA and FTC patients. The true positive rate (sensitivity) and true negative rate (specificity) of fine needle aspiration (FNA) for FTA patients were 0.6956 and 0.5000, respectively, and those for FTC patients were 0.0714 and 0.9348, respectively. Patients with FTC presented significantly higher serum thyroglobulin (TG) levels than patients with FTA. Preoperative TG level was positively related to tumor invasiveness and recurrence or distant metastases in FTC patients. There were 55 patients with Hashimoto’s thyroiditis (HT), accounting for 16.87% of enrolled patients. HT patients had significantly lower serum TG concentrations than antibody-negative patients. Among HT patients, no significant differences were observed in TG levels between the FTA and FTC groups. Instead, FTA patients had significantly higher serum thyroid stimulating hormone (TSH) levels and lower serum T3 (Triiodothyronine) levels compared to FTC patients. Serum TSH level >1.736U/L was associated with benign follicular neoplasms in HT patients according to the receiver operating characteristic (ROC) curve.ConclusionDistinguishing FTC from FTA remains a challenge for ultrasonography and FNA. Serum TG should be measured as a risk factor of FTC. However, in HT patients, serum TSH levels can serve as a more reliable indicator for differentiating FTC from FTA preoperatively.

Diagnostic accuracy of AI for bpMRI screening of prostate cancer: a systematic review and meta-analysis

The primary objective of this systematic literature review and meta-analysis is to evaluate the quality of prognostic models created for screening of prostate cancer (PCa). Methods: The systematic search of publications from January 2019 to September 2023 in the electronic databases ELibrary, PubMed, Google Scholar, Web of Science and Research Gate was used in accordance with the PRISMA protocol. Two authors independently assessed the need for inclusion or exclusion of the relevant studies Results: This meta-analysis included 21 studies. In total, 3,630 patients, of which 47% were with prostate cancer and 53% with benign prostate tumors. The average age of patients was 67.1 (mainly from 36 to 90 years). Eighty one percent (81%) of studies were based on T2-weighted imaging (T2-WI), 57% on diffusion-weighted imaging (DWI), and 76% on the apparent diffusion coefficients imaging (ADC). Forty three percent (43%) of studies were devoted to a malignancy formation in the transitional zone (TZ), 33% to the peripheral zone (PZ) of the prostate gland. Fifty two percent (52%) of authors conducted research on the entire organ, without dividing it into zones. The analysis showed that the researchers used machine learning (ML) algorithms: MLR (multiple logistic regression, in 76%), SVM (support vector machine, in 38%) and RF (random forest, in 24%). According to a meta-analysis of ROC-AUC assessment in 73 prognostic models described in the publications we studied, using methodological random effects, a final ROC-AUC value of 0.793 [95%CI 0.768; 0.818], I2 = 86.71%, p0.001. The most predictive models are based on T2-WI + ADC protocol: 0.860 [95%CI 0.813; 0.907], and those models that were created according to the “white box” principle (0.834 [95%CI 0.806; 0.861]). For comparison the values for “black box” are (0.733 [95%CI 0.695; 0.771]). Models using MRI and physiological features were slightly more accurate than the MRI parameters alone (0.869 [95% CI 0.844, 0.895] vs. 0.779 [95% CI 0.751, 0.807]). Model accuracy was virtually the same across PZ and/or TZ studies. Conclusion: The results reveal the most promising AI models. However, the clinical applicability may require more rigorous institutional validation and evaluation of efficacy in the prospective studies.

Striated duct adenoma: The cytological description of a rareentity.

Striated duct adenoma is a benign salivary gland tumour recently recognized by the World Health Organization. To date, no report has described the cytological features of this entity. We report the case of a 60-year-old woman with a tumour in the right parotid gland with a diameter greater than 2.4 cm confirmed by imaging tests. Two fine-needle aspiration cytologies (FNAC) were performed with inconclusive results, reporting epithelioid and spindle-shaped cellularity, with little stroma, and nuclei with abundant pseudoinclusions. Myoepithelioma and Schwannoma were proposed as differential diagnoses. An immunocytochemical panel was performed, showing positivity for S-100, SOX10, CK7 and vimentin, and negativity for both myoepithelial (p63 and calponin) and thyroid markers. In the absence of a conclusive diagnosis, the patient accepted surgery. The biopsy results confirmed diagnosis of striated duct adenoma, with immunohistochemical features superimposable to cytology. Little information is available in the literature, both on biopsy and, more strikingly, on cytology of this neoplasm. The aim of this work is to provide cytological characteristics that allow diagnosis of this entity with FNAC and thus avoid unnecessary surgeries.

Cardiac Hemangioma Located in the Interatrial Septum: A Case Report and Literature Review

Cardiac hemangiomas are extremely rare benign tumors that can occur in any part of the heart. We report the case of an adult female with no history of structural heart disease or symptoms of discomfort. Cardiac ultrasound showed a mass on the right atrial surface of the atrial septum. Intraoperatively, the mass was identified within the atrial septum, at the junction of the inferior vena cava and the ostium of the coronary sinus. The mass did not enter the left or right atrial cavities. The mass was successfully removed, and cardiac hemangioma was confirmed by postoperative pathology. This report discusses the clinical manifestations, diagnostic approaches, and treatment options for cardiac hemangiomas based on an analysis of previously reported cases. Owing to the risk of arrhythmia in patients with hemangiomas in the atrial or ventricular septum, surgical resection is recommended.

Breast Ultrasound Computer-Aided Diagnosis System Based on Mass Irregularity Features in Frequency Domain

Our study develops a computer-aided diagnosis (CAD) system for breast ultrasound by presenting an innovative frequency domain technique for extracting mass irregularity features, thereby significantly boosting tumor classification accuracy. The experimental data consists of 5252 ultrasound breast tumor images, including 2745 benign tumors and 2507 malignant tumors. A Support Vector Machine was employed to classify the tumor as either benign or malignant, and the effectiveness of the proposed features set in distinguishing malignant masses from benign ones was validated. For the constructed CAD system, the performance indices’ accuracy, sensitivity, specificity, PPV, and NPV were 92.91%, 89.94%, 91.38%, 90.29%, and 91.45%, respectively, and the area index in the ROC analysis (AUC) was 0.924, demonstrating our method’s superiority over traditional spatial gray level dependence (SGLD), the ratio of depth to width, the count of depressions, and orientation features. Therefore, the constructed CAD system with the proposed features will be able to provide a precise and quick distinction between benign and malignant breast tumors with minimal training time in clinical settings.

Diffusion-weighted MR image analysis based on gamma distribution model for differentiating benign and malignant brain tumors.

Considering the invasiveness of the biopsy method, we attempted to evaluate the ability of the gamma distribution model using magnetic resonance imaging images to stage and grade benign and malignant brain tumors. A total of 42 patients with malignant brain tumors (including glioma, lymphoma, and choroid plexus papilloma) and 24 patients with benign brain tumors (meningioma) underwent diffusion-weighted imaging using five b-values ranging from 0 to 2000 s/mm2 with a 1.5 T scanner. The gamma distribution model is expected to demonstrate the probability of water molecule distribution based on the apparent diffusion coefficient. For all tumors, the apparent diffusion coefficient, shape parameter (κ), and scale parameter (θ) were calculated for each b-value. In the staging step, the fractions (ƒ1, ƒ2, ƒ3) expected to reflect the intracellular, and extracellular diffusion and perfusion were investigated. Diffusion <1 × 10-4 mm2/s (ƒ1), 1 × 10-4 mm2/s < Diffusion > 3 × 10-4 mm2/s (ƒ2), and Diffusion >3 × 10-4 mm2/s (ƒ3); in the grading step, fractions were determined to check heavily restricted diffusion. Diffusion lower than 0.3 × 10-4 mm2/s (ƒ11). Diffusion lower than 0.5 × 10-4 mm2/s (ƒ12). Diffusion lower than 0.8 × 10-4 mm2/s (ƒ13). The findings were analyzed using nonparametric statistics and receiver operating characteristic curve diagnostic performance. Gamma model parameters (κ, ƒ1, ƒ2, ƒ3) showed a satisfactory difference in differentiating meningioma from glioma. For b value = 2000 s/mm2, ƒ1 had a better diagnostic performance than κ and apparent diffusion coefficient (sensitivity, 88%; specificity, 68%; P < .001). The best diagnostic performance was related to ƒ3 in b = 2000 s/mm2 (area under the curve = 0.891, sensitivity = 83%, specificity = 80%, P < .001). In the grading step, ƒ12 (area under the curve = 0.870, sensitivity = 92%, specificity = 72%, P < .001) had the best diagnostic performance in differentiating high-grade from low-grade gliomas with b = 2000 s/mm2. The findings of our study highlight the potential of using a gamma distribution model with diffusion-weighted imaging based on multiple b-values for grading and staging brain tumors. Its potential integration into routine clinical practice could advance neurooncology and improve patient outcomes through more accurate diagnosis and treatment planning.

Revision arthrodesis in a failed knee arthrodesis for a giant cell tumor excision of distal femur: a case report

Giant cell tumor is a benign tumor with locally aggressive behaviour. It is common in 20–40 years of age group. Common location of the tumor includes distal end of femur, proximal end of tibia. It is slightly more common in females than males. We present a case of forty-four years-old lady with a persistent swelling over her left knee and was diagnosed with a distal femur giant cell tumor. After a wide excision, dual free fibula grafting and arthrodesis of the knee with a long nail was performed. However, she experienced pain and progressive deformity three years after surgery. X-rays revealed the failure of union of the free fibula graft to the residual femur and the breakage of the nail at that site. A revision arthrodesis was performed with removal of implant and stabilizing the non-united ends with dual plating with bone grafting from lateral tibial condyle and bone graft substitutes. She was discharged with left side non weight bearing mobilization with walker support and was started on full weight-bearing mobilization after one year with satisfactory union on X-rays.

An RNA binding regulatory cascade controls the switch from proliferation to differentiation in the Drosophila male germ line stem cell lineage.

The switch from precursor cell proliferation to onset of differentiation in adult stem cell lineages must be carefully regulated to produce sufficient progeny to maintain and repair tissues, yet prevent overproliferation that may enable oncogenesis. In the Drosophila male germ cell lineage, spermatogonia produced by germ line stem cells undergo a limited number of transit amplifying mitotic divisions before switching to the spermatocyte program that sets up meiosis and eventual spermatid differentiation. The number of transit amplifying divisions is set by accumulation of the bag-of-marbles (Bam) protein to a critical threshold. In bam mutants, spermatogonia proliferate through several extra rounds of mitosis then die without becoming spermatocytes. Here we show that the key role of Bam for the mitosis to differentiation switch is repressing expression of Held Out Wings ( how ), homolog of mammalian Quaking. Knock down of how in germ cells was sufficient to allow spermatogonia mutant for bam or its partner benign gonial cell neoplasm ( bgcn ) to differentiate, while forced expression of nuclear-targeted How protein in spermatogonia wild-type for bam resulted in continued proliferation at the expense of differentiation. Our findings suggest that Bam targets how RNA for degradation by acting as an adapter to recruit the CCR4-NOT deadenylation complex via binding its subunit, Caf40. As How is itself an RNA binding protein with roles in RNA processing, our findings reveal that the switch from proliferation to meiosis and differentiation in the Drosophila male germ line adult stem cell lineage is regulated by a cascade of RNA-binding proteins.