Histopathology Of Biopsy Research Articles

Concordance between Axillary Ultrasound and Sentinel Biopsy in Clinically Node-Negative Early Breast Cancer

Objective: To determine the sensitivity of axillary ultrasound in detecting axillary nodal metastasis in clinically and radiologically uninvolved axillary nodes in early carcinoma breast by comparing with sentinel node biopsy histopathology on frozen section. Study Design: Comparative cross-sectional study Place and Duration of Study: Breast Clinic, CMH, Rawalpindi Pakistan, from Aug 2020 to May 2021. Methodology: Patients included in the study presented with breast cancer lesions with clinically impalpable axillary lymph nodes aged 18-75. Patients with clinically impalpable nodes underwent an ultrasound of the axilla; if suspicious nodes were found, the patient had subsequent axillary node dissection. Sentinel node biopsy (SLNB) was performed on axillary ultrasound in all patients with no suspicious or benign-looking nodes. Histopathological reporting was taken as standard. Lymph nodal status on axillary ultrasound, SLN biopsy and axillary lymph node clearance were documented and analyzed. Results: Twenty-nine patients were included who had benign-looking lymph nodes on axillary ultrasound and underwent sentinel lymph node biopsy. The mean age of the patients was 54.03 ± 7.94. Out of 29 patients, 24(82.8%) patients had negative Sentinel lymph node biopsy, and 5(17.2%) had positive Sentinel lymph node biopsy, who then underwent axillary lymph node dissection. Conclusion: Sentinel lymph node biopsy is the gold standard to determine axillary lymph nodes involved in early carcinoma breast, which seem benign on pre-operative axillary ultrasound.

Prevalence of Skin Cancer in Chronic Arsenicosis in Chittagong Medical College Hospital, Bangladesh

A descriptive study was done in the Department of Dermatology and Venereology; Chittagong Medical College Hospital, Chittagong, during the period of July 2004 to June 2008, to find out the prevalence of skin cancer among various skin manifestations of chronic arsenicosis. All suspected patients of chronic arsenicosis coming from endemic zones of Bangladesh were the study population. A total number of 234 patients of chronic arsenicosis were included in this study. The patients were diagnosed by physical examination and by estimation of arsenic level of scalp hair. The majority of the patients came from Noakhali, Chitagong, Feni, Laxmipur, Comilla and Chandpur districts. The mean age of the patients was 27.80 years ± 10.22 SD (Range: 12-70 years). About 70% patients were around 30 years of age. The male & female ratio was 1.9: 1. Most of them came from average socio-economic status. About 28.6 % patients were students, while about 25% patients were daily labour. 94 % patients used tube well as drinking water source. 12.8o patients had family history of chronic arsenicosis and about 19% patients took alternative medicines (homeopathic /kobirajee) for treatment of the same or other illness. The cent percent patients presented with hypo and hipermelanosis (rain drop pigmentation), while 90,6 % patients were with hyperkeratosis in palms and soles. The measurement of arsenic in scalp hair was done. The mean arsenic level of scalp hair was found to be 2.63 1.39 SD (range: 2.0 - 17.6 mg/kg). Skin biopsy for histopathology was done for suspected patients and skin lesions of 21.4% patients were detected as arsenical keratosis. Among the total patients, 6 (six) patients were found to develop skin cancers (2.6 %). Among them, 3 patients developed Squamous Cell Carcinoma (SCC), 1 patient developed Basal Cell Carcinoma (BCC), while Bowen's disease and Melanoma was found in I patient each. Regarding treatment response, about 48% patients showed good response with topical ........

Immune Features of Disparate Liver Transplant Outcomes in Female Hispanics With Nonalcoholic Steatohepatitis.

Nonalcoholic steatohepatitis (NASH) is a severe immune-mediated stage of nonalcoholic fatty liver disease that is rapidly becoming the most common etiology requiring liver transplantation (LT), with Hispanics bearing a disproportionate burden. This study aimed to uncover the underlying immune mechanisms of the disparities experienced by Hispanic patients undergoing LT for NASH. We enrolled 164 LT recipients in our institutional review board-approved study, 33 of whom presented with NASH as the primary etiology of LT (20%), with 16 self-reported as Hispanic (48%). We investigated the histopathology of prereperfusion and postreperfusion biopsies, clinical liver function tests, longitudinal soluble cytokines via 38-plex Luminex, and immune cell phenotypes generated by prereperfusion and postreperfusion blood using 14-color flow cytometry and enzyme-linked immunosorbent assay. Hispanic LT recipients transplanted for NASH were disproportionately female (81%) and disproportionately suffered poor outcomes in the first year posttransplant, including rejection (26%) and death (38%). Clinically, we observed increased pro-inflammatory and apoptotic histopathological features in biopsies, increased AST/international normalized ratio early posttransplantation, and a higher incidence of presensitization to mismatched HLA antigens expressed by the donor allograft. Experimental investigations revealed that blood from female Hispanic NASH patients showed significantly increased levels of leukocyte-attracting chemokines, innate-to-adaptive switching cytokines and growth factors, HMGB1 release, and TLR4/TLR8/TLR9/NOD1 activation, and produced a pro-inflammatory, pro-apoptotic macrophage phenotype with reduced CD14/CD68/CD66a/TIM-3 and increased CD16/CD11b/HLA-DR/CD80. A personalized approach to reducing immunological risk factors is urgently needed for this endotype in Hispanics with NASH requiring LT, particularly in females.

Prevalence and Clinicopathological Characteristics of NDRD in Type 2 DM Patients

The prevalence of non-diabetic renal disease (NDRD) in type 2 diabetes mellitus (DM) varies depending on selection criteria and populations studied. Renal biopsies are not routinely performed in diabetic patients, but are indicated when NDRD is suspected. This study evaluated kidney biopsy histopathology and its correlation with clinical and biochemical parameters. Patients with type 2 DM who underwent renal biopsy for suspected NDRD from January 2015 to May 2023 were selected. Data analysis included clinical, laboratory, and histopathology findings. Patients were grouped as follows: Group I (pure diabetic nephropathy [DN]), Group II (NDRD with underlying DN), and Group III (pure NDRD). 41 biopsies were performed on type 2 DM patients. Mean age: 48.07±11.9 years, mean diabetes duration: 8.23±7.4 years, mean proteinuria: 11.37±8.0 mg/mmol, and mean creatinine: 2.19±2.05 mg/dl. 46.3% were hypertensives, 46.34% had diabetic retinopathy and 34.14% had hematuria. Among the studied group, 12 patients (29.26%) had pure DN, 10 patients (24.39%) had NDRD with underlying DN, and 19 patients (46.34%) had pure NDRD. The most common NDRD findings were membranous nephropathy 5 cases (26.31%) and focal segmental glomerulosclerosis 4 cases (21.05%). This study found a 46.34% incidence of NDRD in diabetic patients. NDRD should be suspected in atypical diabetic presentations, as early diagnosis and treatment may slow kidney disease progression.

The role of CD24 as a potential biomarker for malignant pleural mesothelioma

Abstract Objectives Pleural mesothelioma is a rapidly progressing pleural neoplasm caused by asbestos exposure of a long latency around 30-40 years. Patients with mesothelioma are usually diagnosed at a late stage with poor outcomes in terms of morbidity and mortality with 6–12 months’ median survival. Despite the prohibited use of asbestos, malignant pleural mesothelioma is still increasingly being occurred in young age and female patients. Different un-standardized biomarkers have been used to diagnose MPM as mesothelin and febulin with controversial results, so we used CD 24 as a biomarker to diagnose and differentiate between different subtypes of malignant pleural mesothelioma. Materials and methods Our cohort study included total of fifty-nine patients with exudative pleural effusion. All patients underwent full history taking, clinical examination, blood tests (CBC, coagulation profile, liver and kidney functions), tapping of pleural effusion and to send pleural fluid investigations for LDH, albumin, total protein and albumin, then confirmed exudative pleural effusion patients were subjected to thoracic ultrasonography and medical thoracoscopy for the majority of cases or ultrasound guided biopsy in selected cases to obtain pleural biopsies for histopathology and then the examination of pleural biopsies for CD24 expression. Results Our study demonstrated the possibility of using CD24 as a biomarker in the immunostaining of pleural biopsies to differentiate between malignant pleural mesothelioma and pleural malignancy other than mesothelioma (18 mesothelioma cases versus 2 nonmesothelioma malignant cases) with high statistical significance P value < 0.001 and also it can discriminate between subtypes of mesothelioma as it showed marked significance in epithelioid subtype (12 epithelioid versus 1 sarcomatoid versus 5 biphasic subtypes) with more uptake by score +2 in epithelioid mesothelioma. Conclusions CD24 can be supposed to be a routine biomarker for immunohistochemistry of pleural tissue samples in diagnosis of mesothelioma and it can be used to differentiate between subtypes of malignant mesothelioma subtypes.

Serum prostate-specific antigen trends and prostate cancer detection on follow-up in men with a prior negative biopsy: A cohort study

ABSTRACT Introduction: Elevated serum prostate-specific antigen (PSA) is the most common trigger for a prostate biopsy. However, the range of normal PSA is poorly defined in many populations. Men with “elevated” PSA may not harbor cancer, and it is unclear if such men with a prior negative prostate biopsy should be biopsied again. We conducted a cohort study to assess the PSA trends and cancer detection rates in such men. Methods: In an Institutional Review Board-approved ambispective study, men who underwent prostate biopsy between January 2016 and December 2021 for PSA > 4 ng/mL were identified. Among them, those whose biopsy was negative for malignancy were contacted either telephonically or reviewed in person, and the most recent PSA and histopathology of any repeat prostate biopsy were determined. These were evaluated to assess the PSA trend, re-biopsy rate, and cancer detection rate. Results: During the study period, prostate biopsies were performed in a total of 1260 men; out of which 444 were negative for malignancy and 241 patients fulfilled the inclusion criteria. Their median prebiopsy PSA was 9.81 ng/mL (interquartile range [IQR]: 7.14–15.6), and the median follow-up PSA was 5.08 (IQR: 3.18–8.4). At a median follow-up of 53 months (range: 6–77 months), PSA had decreased in 177 (73.4%) patients, was static in 48 (19.9%) patients, and increased in only 16 (6.6%) patients. Repeat biopsy was performed on 20 patients; of whom seven had cancer (35%) with an overall positivity rate of 2.9% among the 241 patients. Although the positivity rate was higher in men with increased PSA, it was not statistically different from those with lower or similar PSA. No factors could be identified to predict a positive repeat biopsy. Conclusions: PSA, the sole trigger for a prostate biopsy, declined in nearly three-quarters of men with a negative first biopsy, and <3% of men were detected to have cancer on a repeat biopsy. This information could help appropriately counsel patients and allay anxiety after a negative biopsy.

Diagnosing the Dermatologic Blues: Systematic Review of the Rare Conundrum, Psychogenic Purpura.

Psychogenic purpura is an idiopathic psychodermatologic condition of recurrent, painful purpura precipitated by psychological stress, predominantly affecting young females. Little consensus exists on the diagnostic guidelines for this rare condition, often resulting in costly, unnecessary, and stressful investigations as well as prolonged hospital admissions. With this first up-to-date systematic review of 134 cases of psychogenic purpura in over a decade, we aim to thoroughly investigate the diagnostic strategy and treatment regimens used in the last decade. With a sooner diagnosis, patient stress and nosocomial ecchymoses can be minimized, and treatment can be expedited. We conducted a literature review of 4 databases (PubMed, Ovid Embase, Ovid MEDLINE, and Web of Science) on October 5, 2022 that yielded 46 full-text articles, which were reviewed and extracted by 2 independent reviewers. We analyzed a total of 134 cases, consisting largely of females (125/134, 93.3%) with purpura on the upper (103/134, 76.9%) or lower limbs (112/134, 83.6%). Apart from a paresthesia prodrome, patients commonly experienced headaches, malaise, and arthralgia or myalgia. Approximately 70% (95/134) of patients reported a physiological or psychological stressor or psychiatric diagnosis before the development of the purpura. Laboratory testing almost always revealed unremarkable results. The intradermal washed autoerythrocyte sensitization test was positive in 98% (42/43) of cases. Histopathology biopsy findings commonly revealed dermal erythrodiapedesis or hemorrhage (n=34) and perivascular inflammatory infiltrates (n=17). Approximately 42% (56/134) of patients received a novel psychiatric diagnosis, with depression being the most common (40/72, 56%). In both patients with and those without a novel psychiatric diagnosis, observation, counseling, treatment with antidepressants (ie, selective serotonin reuptake inhibitors), and psychotherapy (ie, cognitive behavioral therapy) prevailed in the resolution of the purpura. Due to the unclear etiology and infrequent presentation of this condition, it remains a diagnosis of exclusion based on clinical suspicion evaluating the presence of stressors or psychiatric comorbidities and exclusion of systemic conditions. Clinical confirmation can be sought through a positive autoerythrocyte sedimentation test, characteristic histopathology findings, and remission of purpura after psychiatric treatment.

P19.06.B T2/FLAIR MISMATCH, SPECIFIC RADIOGENOMIC MARKER FOR A DIFFUSE LOW GRADE ASTROCYTOMA

Abstract A 36-year-old woman presented with recurring episodes of generalized tonic clonic seizures. An MRI from an outside institution demonstrated an intra-axial brain mass suspicious for a primary brain tumor. Repeat conventional and advanced MRI imaging revealed a primary brain mass centred on the left postcentral gyrus involving cortex and subcortical white matter. The lesion was homogenously hyperintense on T2-weighted imaging, and centrally iso-to hypointense on FLAIR with a rim of hyperintense signal on the FLAIR sequence. There was no significant peritumoral edema or minimal effacement of the central sulcus. No abnormal enhancement was seen post-contrast. The lesion demonstrated no reduced diffusivity on diffusion-weighted imaging. MR perfusion showed no elevation in regional cerebral blood volume or flow. Findings are most compatible with a low grade glioma. Patient underwent total surgical resection and biopsy for histopathology. Genetic sequencing revealed an IDH mutant, non 1P,19q codeleted grade II astrocytoma. The diagnosis of adult infiltrating gliomas is predicted using imaging, and confirmed by histopathology, and molecular diagnostic methods. Regardless of grade the 1st phase in glioma diagnosis and management is IDH status. A multidisciplinary approach to the diagnosis of low grade and high grade glioma including genetic and molecular analysis is essential, as different genetic and molecular subtypes have different management and prognostic implications. Conventional MRI still represents a mandatory and extremely important step in the diagnostic workflow of neuro oncological patients for preoperative diagnosis, treatment planning, and subsequent follow up. The T2/FLAIR mismatch sign describes the MRI appearance of an IDH-mutant astrocytoma that is non 1p19q codeleted, and it is considered a preoperative novel specific MRI marker for this type of diffuse astrocytoma. In this case, the MRI findings were used preoperatively as a noninvasive tool to diagnose the patient`s low grade glioma which was confirmed by subsequent histological and genetic analysis. TEACHING POINTS1. T2/FLAIR mismatch allows for pre-operative diagnosis of IDH-mutant astrocytomas with a high level of specificity.2. It is particularly helpful in distinguishing diffuse astrocytoma from an oligodendroglioma3. Conventional MR sequences can suggest the diagnosis of IDH mutant gliomas which can assist neurosurgeons in presurgical planning and can help neuro-oncologists with treatment planning including potential clinical trials.

Sequential liquid-based cytology based on exfoliative cells of 18-gauge core needle groove to improve renal mass core needle biopsy yield: a real-world observational study.

Renal mass biopsy (RMB) has regained clinical interest in recent years due to the pursuit of individualized and precision medicine. Renal mass core needle biopsy (RMCNB) for histopathology (HP), with or without liquid-based cytology (LBC), has been used increasingly in our hospital. This study investigated factors influencing the HP diagnostic yield of RMCNB, and compared the diagnostic rate between HP alone and HP plus LBC. In this retrospective cross-sectional study, a total of 134 patients who underwent ultrasound-guided percutaneous RMCNB in the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2015 and May 2022 were enrolled. All biopsies were performed using an 18-gauge core needle biopsy gun, and the sampling tissues and exfoliative cells of 18-gauge core needle groove were delivered for HP and LBC diagnosis, respectively. The patient demographics, clinical indications, tumor characteristics, number of biopsies, final pathological diagnosis, and follow-up data were reviewed. Univariate and multivariate logistic regression analyses were performed to evaluate the association between variables and HP diagnostic yield of RMCNB. The diagnostic rate between HP and HP plus LBC was compared using McNemar's test and agreement was evaluated using the Kappa score. The most common indication of RMCNB was renal masses with a radiological diagnosis of locally advanced disease or distant metastasis (86.6%). The HP diagnostic yield was established in 88.1% (118/134) of cases, and the diagnostic rate of HP plus LBC was 94.0% (126/134). Logistic regression analyses revealed that non-enhanced area exceeding 50% [odds ratio (OR): 0.021, 95% confidence interval (CI): 0.003-0.134, P<0.001] and number of core biopsies (OR: 9.479, 95% CI: 1.528-58.794, P=0.016) were associated with the HP diagnostic yield of RMCNB. The diagnostic rate of HP plus LBC was significantly higher than that of HP alone (94.0% vs. 88.1%, P=0.008), and they showed substantial agreement (Kappa =0.638, P<0.001). Meanwhile, in the non-enhanced area ≥50% subgroup, the diagnostic rate between HP plus LBC and HP alone was significantly different (86.7% vs. 60%, P=0.008), and the agreement was fair (Kappa =0.375, P=0.009). RMCNB has a high diagnostic yield with a minimum of two high-quality core biopsies, LBC can improve the diagnostic yield of HP alone, especially in masses with large non-enhanced area.

Comparative analysis of accuracy between fine-needle aspiration biopsy and postoperative histopathology for detecting large thyroid nodules: A retrospective observational study.

To avoid unnecessary surgeries, ultrasound-guided fine-needle aspiration biopsy (FNAB) is an effective and reliable procedure for the preoperative evaluation of thyroid nodules. However, there have been only a limited number of studies exploring the ability of preoperative FNAB to distinguish malignancy compared to postoperative histopathology in thyroid nodules larger than 4 cm. The aim of this study was to investigate the diagnostic accuracy of FNAB compared to postoperative histopathology in distinguishing malignancy in thyroid nodules larger than 4 cm. A single-center retrospective observational study was conducted at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, between January 2014 and December 2018. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were calculated. A total of 83 patients were included in the study. The results showed that preoperative FNAB may have the ability to distinguish malignancy compared to postoperative histopathology. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 42.85%, 98.38%, 90.00%, 83.56%, and 84.33%, respectively. These data suggested that ultrasound-guided preoperative FNAB is a reliable diagnostic tool in the preoperative evaluation of thyroid nodules larger than 4 cm, but it has limited capability in distinguishing malignancies. In conclusion, although FNAB may be useful in reducing unnecessary surgeries, histopathology remains the preferred method for confirming malignancy in thyroid nodules.

Computer-Based Diagnosis of Celiac Disease by Quantitative Processing of Duodenal Endoscopy Images.

Celiac disease (CD) is a lifelong chronic autoimmune systemic disease that primarily affects the small bowel of genetically susceptible individuals. The diagnostics of adult CD currently rely on specific serology and the histological assessment of duodenal mucosa on samples taken by upper digestive endoscopy. Because of several pitfalls associated with duodenal biopsy sampling and histopathology, and considering the pediatric no-biopsy diagnostic criteria, a biopsy-avoiding strategy has been proposed for adult CD diagnosis also. Several endoscopic changes have been reported in the duodenum of CD patients, as markers of villous atrophy (VA), with good correlation with serology. In this setting, an opportunity lies in the automated detection of these endoscopic markers, during routine endoscopy examinations, as potential case-finding of unsuspected CD. We collected duodenal endoscopy images from 18 CD newly diagnosed CD patients and 16 non-CD controls and applied machine learning (ML) and deep learning (DL) algorithms on image patches for the detection of VA. Using histology as standard, high diagnostic accuracy was seen for all algorithms tested, with the layered convolutional neural network (CNN) having the best performance, with 99.67% sensitivity and 98.07% positive predictive value. In this pilot study, we provide an accurate algorithm for automated detection of mucosal changes associated with VA in CD patients, compared to normally appearing non-atrophic mucosa in non-CD controls, using histology as a reference.

Unusual presentation of Burkitt lymphoma with late onset secondaries

The diagnosis of endemic Burkitt lymphoma was made in this 16 year old Sudanese boy by kidney biopsy histopathology (Figure 1) and touch imprint (Figure 2) as the bone and bone marrow biopsies

Anti-Ficolin-2 Antibody: Could It Be a Predictor of Proliferative Lupus Nephritis in Lupus Patients?

Abstract Background Nephritis is a challenging domain of systemic lupus erythematosus (SLE). There is a growing need for identification of a non-invasive marker for diagnosing and monitoring nephritis. Objective To explore the relevance of using anti-ficolin-2 antibody (Anti-FCN2) as a biomarker for detecting lupus nephritis (LN), and its relation to renal biopsy histopathology and disease activity. Patients and Methods Sixty SLE patients were compared to 30 apparently healthy individuals. Thirty of the patients were LN patients (documented by a recent renal biopsy). Full history, examination and laboratory investigations were done. Activity was assessed by SLE disease activity index (SLEDAI) score, and Anti-FCN2 titer was measured by enzyme-linked immunosorbent assay technique (ELISA). Results Forty-four of our SLE patients were in disease activity by SLEDAI score. Anti-FCN2 titer was significantly higher among SLE patients compared to control group (p value &amp;lt;0.001). It was also higher among patients with high disease activity compared to those with low disease activity and cutoff value was at 37 ng/ml (p value is &amp;lt; 0.001). AntiFCN2 titer was significantly higher among patients with LN compared to those without LN (p value is &amp;lt; 0.001) with best cutoff value at 72.50 ng/ml. Regarding LN patients, it was significantly higher among patients with proliferative changes than LN patients with non-proliferative changes (p value is 0.05) with best cutoff value at 155 ng/ml. Conclusion Anti-FCN2 shows promising results as a biomarker for lupus disease activity, especially regarding LN and proliferative changes. Further longitudinal studies on larger samples are needed to confirm.

ThTP2.5 Diagnosis of intestinal metaplasia (IM) in the surveillance of Barrett’s oesophagus – a comparison between Cytosponge and endoscopic biopsy

Abstract Introduction Regular endoscopy with oesophageal biopsies is recommended for the surveillance of Barrett’s oesophagus. Intestinal metaplasia (of all subtypes) carries the highest risk of progression to dysplasia and adenocarcinoma; thus, it is important for diagnosis of Barrett’s. Concerns exist about the accuracy of endoscopic diagnosis when obtaining biopsies and in ‘missing’ metaplasia between biopsies. Cytosponge is a novel, minimally invasive oesophageal cytology sampling device; this study assessed the correlation between endoscopic biopsies and Cytosponge cytology in the diagnosis of IM. Methods 192 patients with endoscopic Barrett’s oesophagus who were due for surveillance endoscopy in 2022 were identified and screened for suitability for Cytosponge. If suitable, patients were offered a Cytosponge. Cytosponge cytology results were compared with previous histopathological biopsy results. Results 127 patients (66%) had IM from original endoscopic biopsies. Many of these patients did not have images available for review to assess accuracy of original endoscopic diagnosis. Cytosponge detected IM in 88 cases (45%). Sensitivity was 67.77% (95% CI, 58.67%-75.98%) and specificity of 91.55% (95% CI, 82.51%-96.84%). The positive predictive value was 93.18% (95%CI, 86%-96%) and negative predictive value of 62.50% (95% CI, 56.04%-68.54%). Conclusion The accuracy of cytosponge is favourable and comparable to screening endoscopy. Cytosponge can be used as a screening tool and, potentially, as an alternative to endoscopy to identify IM. Further work is needed to determine accuracy of endoscopic diagnosis, given the high proportion (over one-third) of patients who are currently on a Barrett’s surveillance programme but do not have any histological diagnosis of IM.

Subcutaneous basidiobolomycosis: An unusual fungus in immuno-competent children, vindicating longer duration of anti-fungal treatment

Subcutaneous Basidiobolomycosis is a rare fungal infection caused by environmental saprophyte Basidiobolus ranarum. The disease is seen among immunocompetent individuals of age 18 months to 80 years, being more common in children. We report a case of Subcutaneous Basidiobolomycosis in a 10-year-old immunocompetent male child from Ahmednagar, Maharashtra who presented with complaints of right gluteal non tender, diffuse swelling, which was gradually progressive involving inner and back of thigh. The overlying skin was hyperpigmented with scaling at places. It was associated with complaints of difficulty in walking and voiding of urine. Patient was prescribed multiple medicines with no records available. All primary investigations were done along with a deep incisional biopsy for histopathology. MRI was suggestive of? lymphangioma? vascular malformation. Histopathology revealed panniculitis with dense collections of eosinophils. Few broad, aseptate fungal hyphae were seen camouflaged within the inflammatory infiltrate, surrounded by Splendore-Hoeppli phenomenon. The patient was treated with oral fluconazole for a period of one year with complete resolution of the symptoms. After one year of follow-up, the patient is clinically well. Clinically, this lesion presented as induration of skin and subcutaneous tissue thus mimicking a soft tissue sarcoma. However, histopathological examination clinched the diagnosis. Fungal infections are common in immuno-suppressed patients, and extremely uncommon in children. Since this is an exceptional rare fungal infection seen in immuno-competent children and young adults, it is often disregarded as a differential diagnosis.

Identification of lymph node metastasis in pre-operation cervical cancer patients by weakly supervised deep learning from histopathological whole-slide biopsy images.

Lymph node metastasis (LNM) significantly impacts the prognosis of individuals diagnosed with cervical cancer, as it is closely linked to disease recurrence and mortality, thereby impacting therapeutic schedule choices for patients. However, accurately predicting LNM prior to treatment remains challenging. Consequently, this study seeks to utilize digital pathological features extracted from histopathological slides of primary cervical cancer patients to preoperatively predict the presence of LNM. A deep learning (DL) model was trained using the Vision transformer (ViT) and recurrent neural network (RNN) frameworks to predict LNM. This prediction was based on the analysis of 554 histopathological whole-slide images (WSIs) obtained from Qilu Hospital of Shandong University. To validate the model's performance, an external test was conducted using 336 WSIs from four other hospitals. Additionally, the efficiency of the DL model was evaluated using 190 cervical biopsies WSIs in a prospective set. In the internal test set, our DL model achieved an area under the curve (AUC) of 0.919, with sensitivity and specificity values of 0.923 and 0.905, respectively, and an accuracy (ACC) of 0.909. The performance of the DL model remained strong in the external test set. In the prospective cohort, the AUC was 0.91, and the ACC was 0.895. Additionally, the DL model exhibited higher accuracy compared to imaging examination in the evaluation of LNM. By utilizing the transformer visualization method, we generated a heatmap that illustrates the local pathological features in primary lesions relevant to LNM. DL-based image analysis has demonstrated efficiency in predicting LNM in early operable cervical cancer through the utilization of biopsies WSI. This approach has the potential to enhance therapeutic decision-making for patients diagnosed with cervical cancer.

Relationship between testosterone and male bladder cancer

Researches had proven that the occurrence of bladder cancer (BC) is much higher in men than those in women, which induced us to explore whether androgen plays a role in BC. A total of 147 patients who were diagnosed with primary BC by histopathological biopsy were included. Meanwhile 154 non-tumor patients were matched as the control group. The continuous variables were expressed as median (interquartile range, IQR) and compared by Mann–Whitney U test, for the reason that the data were not matched the requirementsthe of normal test. A Chi-square test was used to compare the categorical variables, which were expressed as frequency (percentage). Meanwhile univariate and multivariate logistic regression was done to further evaluating the potential independent factor of BC. P < 0.05 was considered statistically significant. Univariate multivariate analyse showed significant difference between two groups in hemoglobin (OR 0.979, 95% CI 0.968–0.991, P < 0.001), hypertension (OR 3.026, 95% CI 1.731–5.288, P < 0.001), diabetes (OR 4.294, 95% CI 1.887–9.771, P = 0.001) and smoking (OR 1.729, 95% CI 1.096–2.729, P = 0.019). Furthermore, multivariate logistic regression analysis was conducted to eliminate the interference of confounding factors, which showed that testosterone seems to be great correlated with the BC (OR 1.002, 95% CI 1.000–1.003, P = 0.017). Similar results were also found in hemoglobin (OR 0.981, 95% CI 0.968–0.993, P = 0.002), hypertension (OR 2.780, 95% CI 1.509–5.120, P = 0.001), diabetes (OR 3.313 95% CI 1.373–7.991, P = 0.008) and smoking (OR 1.938, 95% CI 1.184–3.174, P = 0.009). As a conclusion, our study showed that there was significant correlation between serum total testosterone levels and the occurrence of BC, similar results were shown in hemoglobin, hypertension, diabetes and smoking.

Imaging characteristics of multiple unusual urogenital abnormalities in an incontinent dog

AbstractA 10‐month‐old, female, neutered Rottweiler was referred for further investigation of lifelong urinary incontinence. On abdominal ultrasonography, the urinary bladder was empty with asymmetrical wall thickening. Cystoscopy revealed a wide and short tubular connection from the vestibule to a poorly distensible bladder, with no distinct identifiable urethral papilla or urethra. The ureters were observed opening into what was thought to be the bladder trigone, but a third opening was additionally noted cranial to the ureterovesical junctions. A hypoplastic urethra and a stenotic vaginal opening were found on a fluoroscopic retrograde vaginourethrocystogram. Histopathology of bladder wall biopsies revealed mild neutrophilic inflammation. The urinary incontinence was attributed to a combination of severe anatomic abnormalities. No treatment was pursued.

Extracardiac findings with increased perfusion during clinical O-15-H2O PET/CT myocardial perfusion imaging: A case series

BackgroundCoincidental extracardiac findings with increased perfusion were reported during myocardial perfusion imaging (MPI) with various retention radiotracers. Clinical parametric O-15-H2O PET MPI yielding quantitative measures of myocardial blood flow (MBF) was recently implemented at our facility. We aim to explore whether similar extracardiac findings are observed using O-15-H2O. Methods and resultsAll patients (2963) were scanned with O-15-H2O PET MPI according to international guidelines and extracardiac findings were collected. In contrast to parametric O-15-H2O MBF images, extracardiac perfusion was assessed using summed images. Biopsy histopathology and other imaging modalities served as reference standards. Various malignant lesions with increased perfusion were detected, including lymphomas, large-celled neuroendocrine tumour, breast, and lung cancer plus metastases from colonic and renal cell carcinomas. Furthermore, inflammatory and hyperplastic benign conditions with increased perfusion were observed: rib fractures, gynecomastia, atelectasis, sarcoidosis, pneumonia, chronic lung inflammation and fibrosis, benign lung nodule, chronic diffuse lung infiltrates, pleural plaques and COVID-19 infiltrates. ConclusionsMalignant and benign extracardiac coincidental findings with increased perfusion are readily visible and frequently seen on O-15-H2O PET MPI. We recommend evaluating the summed O-15-H2O PET images in addition to the low-dose CT attenuation images.

Histopathology of Endoscopic Biopsies of Gastrointestinal Tract Lesions with Clinical Correlation

Introduction: Because of limited anatomical space and certain unusual clinicopathological features, gastrointestinal tract lesions causes problem in their diagnosis, prognosis, and management. The primary objective of the study is to know the utility of endoscopic biopsy in diagnosing gastrointestinal lesions, and the secondary objective is to correlate the histopathological findings with the clinical symptoms and endoscopic appearance of the lesions. Materials and Methods: The present study is a simple retrospective observational study. Upper and lower gastrointestinal lesions in the form of ulcer, polyp, and growth were biopsied by biopsy forceps using flexible fiberoptic endoscopes. Only adequate biopsies were included in the study. The exact site of the biopsy with clinical data was provided by the endoscopist. Routine histopathological examination was done on the specimens submitted in 10% formalin. The use of special stains was done wherever needed. Results: A total of 100 cases were categorized as nonneoplastic and neoplastic. Friedman and Osborn classification was used for nonneoplastic lesions. The maximum number of cases was seen in 5th–6th decade with male predominance with equal distribution of cases as far as anatomical site is concerned. Conclusion: Targeted biopsies are possible with definitive diagnosis in 90% of cases with safe use of endoscopy. 17% of cases diagnosed on endoscopy were confirmed on histopathology. In 73% of cases, histopathology was essential for further subtyping. Histopathology was mandatory in 8% of the cases. Recommended combined use of endoscopy and histopathology can offer a definitive diagnosis in 98% of cases.