C2 Lesions Research Articles

Feasibility and Safety of Lateral and Posterolateral Percutaneous Vertebroplasty of Osteolytic C1–C2 Lesions under Computed Tomography Guidance and Local Anesthesia

PurposeTo evaluate the safety and effectiveness of lateral or posterolateral percutaneous vertebroplasty (PVP) of osteolytic C1–C2 lesions performed under computed tomography (CT) guidance and local anesthesia. Materials and methodsA retrospective study of 16 consecutive patients (11 females and 5 males; aged from 24 to 86 years; median age, 65.5 years) who underwent 17 lateral or posterolateral PVP was performed. Pain status was assessed using a visual analog scale (VAS). Patients were evaluated preoperatively as baseline and at 24 hours and 1, 6, and 12 months postoperatively, until death, or until loss to follow-up. The Oswestry Disability Index was used to evaluate the patients’ functional disability preoperatively. The adverse events were recorded using the Society of Interventional Radiology (SIR) classification. ResultsThe technical success was 100% (17/17) for a median Spinal Instability Neoplastic Score of 13.5 (interquartile range [IQR], 6.75, 20.25). Mean clinical follow-up was 10.1 months (range, 6–36 months; median, 19.5 months, IQR, 4, 35 months). Mean VAS score decreased significantly from 7.5 (SD ± 2.1) preoperatively to 1.6 (SD ± 1.5) 24 hours postoperatively, and 1.0 (SD ± 1.1), 1.5 (SD ± 1), and 0.5 (SD ± 1.5) at 1, 6, and 12 months, respectively (all P < .001). No severe adverse events were observed, but 3 cases of asymptomatic cement leakage were noted (SIR Grade 1; 17.6% [3/17]). ConclusionsLateral and posterolateral PVP performed under CT guidance and local anesthesia is safe and effective to treat symptomatic osteolytic C1–C2 lesions.

Clinical Implications of C2 Lesion in IgA Nephropathy: A Cohort Study

Introduction: In 2016, the Oxford Classification of IgA nephropathy (IgAN) updated its scoring system for the glomerular crescents. Despite this, the clinical significance of crescentic lesions in the updated Oxford classification is still unexplored through prospective cohort studies. Methods: 134 patients diagnosed with IgAN accompanied with C2 lesions at Peking University First Hospital were consecutively enrolled and prospectively followed up for analysis. Multivariate Cox regression in combination with LASSO regression was used to analyze risk factors associated with end-stage kidney disease (ESKD). Results: During biopsy, the mean estimated glomerular filtration rate (eGFR) was 39.3 mL/min/1.73 m2, and the mean proteinuria was 4.4 g/day. The proportion of kidney failure at 1 year, 2 years, and 3 years were 24%, 34%, and 47%, respectively. The results of LASSO in combination with Cox regression showed that mean arterial pressure (hazard ratio [HR] = 1.035, 95% confidence interval [95% CI] 1.013–1.056, p = 0.001), eGFR at biopsy (HR = 0.968, 95% CI [0.948–0.990], p < 0.004) and T2 lesions (HR = 2.490, 95% CI [1.179–5.259], p = 0.017) were independent risk factor associated with ESKD in patients with C2 lesions. Furthermore, based on univariate analyses, we found that patients with kidney function declined more than 50% within 3 months prior to biopsy or pathological findings indicated a proportion of crescents exceeding 50% were both associated with a poor kidney prognosis. Lastly, when the proportion of the crescent was less than 50%, patients receiving combined steroid and immunosuppressant treatment did not exhibit a better renal prognosis than those receiving steroid only. Conclusion: Patients diagnosed with IgAN and concurrent C2 lesions exhibited a poor clinical prognosis, necessitating more effective treatment strategies.

Exploring the role of the combination of FDG-PET plus whole body MRI for staging patients with high-risk smoldering myeloma: A prospective trial.

7569 Background: According to IMWG criteria, Smoldering Multiple Myeloma (SMM) is an asymptomatic stage characterized by M-spike &lt; 3 g/dl serum and/or bone marrow plasma cells infiltration between 10-59% in absence of myeloma-defining events and organ damage. In SMM setting, it is really important to differntiate high risk SMM (HR-SMM), in which treatment could be available thanks to clinical trials. 2016 IMWG criteria state that detection of bone lesions is mandatory for diagnosis of multiple myeloma and essential for diagnosis of SMM. It is really important to clarify in SMM the best imaging analysis in order to perform a correct diagnosis, and particularly it is necessary to define if the combination of FDG-PET/TC and WB-MRI could improve the assessment of lytic lesions and so the discrimination between high risk SMM and symptomatic MM. Methods: In our Institution we conducted a prospective trial, based on integrated new generation imaging, aiming to improve patients’ stadiation and to define its prognostic implications. From January 2021 to January 2024, we performed a prospective trial enrolling 26 consecutive newly diagnosed high risk SMM, according to IMWG, in which WB-MRI was performed according to MY-RADS criteria in combination with FDG PET-CT (median age 56; range 36-85). Results: Our comparison between WB-MRI and FDG PET-CT, showed a discordance between the two imaging modalities in 4/26 (15%) cases. In particular, in 3/26 (12%) cases WB-MRI showed bone lesions that have lead to symptomatic MM diagnosis according to IMWG criteria, while PET-CT was negative. In one case, PET-CT showed a diffuse uptake, not diagnostic for MM, while WB-MRI was negative. WB-MRI showed a 100% of accuracy in detecting SMM and MM. Therefore, WB-MRI has lead to a modification of the prognosis and treatment approach (observation in SMM vs treatment in symptomatic MM) in 3/26 patients (11%) (i.e. Figure 1, with DWI of C2 lesion). Furthermore, in 5/23 (22%) cases of confirmed SMM WB-MRI showed a slight diffuse alteration pattern of bone marrow without any overt lytic bone lesion, which could be a potential prognostic evidence. Conclusions: Our results support a fundamental role of WB-MRI in combination with FDG PET/CT in the stadiation of patients with newly diagnosed high risk SMM, which could modify prognosis and treatment, improving the differentiation with symptomatic MM. In particular, combination of WB-MRI plus FDG PET/CT could be more accurate in the detection of bone lesions than FDG PET/CT alone, being able to anticipate symptomatic MM diagnosis and consequently its treatment. Moreover, a diffuse pattern of marrow involvement could be detected in some HR-SMM patients without any overt lytic lesions: it is questionable if this group of patients is associated with a rapid progression in lytic lesions and so in symptomatic MM diagnosis. Prospective data on evolution of these patients are pending.

#2631 Efficacy and safety of Telitacicept combined with low-dose mycophenolate mofetil in IgA nephropathy

Abstract Background and Aims Currently, there is no specific agent blocking for IgA nephropathy. The KDIGO guideline recommends basic treatment with renin-angiotensin-aldosterone system (RAAS) antagonists. MMF can be used for Chinese patients. Telitacicept is a fusion protein composed of transmembrane activator and calcium modulating cyclophilin ligand interactor and fragment crystallizable portion of immunoglobulin G (IgG), which neutralizes the B lymphocyte stimulator and a proliferation-inducing ligand. Telitacicept (240 mg qw ih) treatment led to a clinically meaningful reduction in proteinuria in patients with IgAN in the present phase 2 clinical trial. This study intends to observe the efficacy of Telitacicept (160 mg qw ih) combined with low-dose MMF in the treatment of IgA nephropathy. Method Retrospective analysis involving all biopsy proven IgA nephropathy patients with complete clinical data in our department. After RAAS inhibitor treatment for 3 months, the patient's urinary protein more than 0.75 g/24 h, he or she was given Telitacicept (160 mg qw) combined with Mycophenolate mofetil (1 g, twice a day) was treated for 6 months, and follow-up for 6-12 months. The quantification of 24-hour urinary protein and immunity functional, renal function was observed. Results 25 patients with IgA nephropathy confirmed by renal biopsy were enrolled, 14 males and 11 females, aged 34.32 ± 9.68 years’ old, 3 patients with Lee's grade II, Grade III 17 patients, Grade IV 3 patients, and Grade V 2 patients. For Oxford classification, there were 3 cases with M0, 22 cases with M1 lesions, 20 cases with E0, 5 cases with E1 lesions, 1 case with S0, 24 cases with S1 lesions, 10 cases with T0, 15 cases with T1 lesions, and 17 cases with C0, 8 cases with C1 lesions. The patient's urine protein quantification was 2.52 ± 1.82 g before treatment, after Telitacicept and MMF treatment for 2 months, the proteinuria was 1.05 ± 0.55 g (compared with that before treatment, P = 0.0004), and at 4 months, it was 0.71 ± 0.39 g (compared with that before treatment, P &amp;lt; 0.0001), 0.53 ± 0.31 g at 6 months (compared with than before treatment, P &amp;lt; 0.0001). And the 24-hour urine protein quantification of 13 patients was all lower than 0.5 g/24 hours. The renal function of all patients was stable during the observation period. The serum creatinine before treatment was 83.16 ± 21.85 μmol/L and it was 81.88 ± 19.48 μmol/L (P = 0.83) after 6 months. There were no patients with worsening renal function after treatment. Among them, the renal function of 3 patients was better than that after treatment. During follow-up period for 6- to 12-month, the patient did not develop any pulmonary infection requiring for hospitalization or other infections. Some patients experienced adverse reactions such as pain at the site of injection, but no patient discontinued treatment due to adverse reactions. Conclusion Telitacicept combined with low-dose mycophenolate mofetil is a alternative method for the treatment of IgA nephropathy. It is more effective than mycophenolate mofetil or Telitacicept use alone, and with fewer adverse reactions, especially with S or C lesions of Oxford classification. This is an observational retrospective study with a few cases, it's worthy further randomized clinical study to prove.

Immunosuppressant Agents as Add-On Therapy Failed to Improve the Outcome of Immunoglobulin A Nephropathy with Crescent Score C1

Introduction: The renoprotective benefits of adding immunosuppressant therapy to corticosteroid (CS) treatment for immunoglobulin A nephropathy (IgAN) patients with less than 25% crescent formation (C1) remain uncertain, warranting further research. Methods: A retrospective study was conducted on IgAN patients with crescent C1 lesions confirmed by renal biopsy at Xinqiao Hospital between May 1, 2017, and May 1, 2020. Patients were stratified into either the CS treatment group or the CS combined with an additional immunosuppressant therapy group. Follow-up assessments were conducted within 24 months. Propensity score analysis was used to match patients receiving CS and CS + immunosuppressant drug treatment in a 1:1 ratio. Primary outcomes included changes in estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR). Subgroup analyses were performed to evaluate the benefits of different populations. Composite endpoint outcomes comprised a 30% eGFR decrease, end-stage kidney disease (ESKD) necessitating dialysis or transplant, or kidney disease-related mortality. Adverse events were also compared between the two groups. Results: 296 IgAN patients with C1 lesions were included in the analysis. Baseline characteristics indicated that IgAN patients in the CS + immunosuppressant group exhibited poorer renal function and higher UACR levels. Propensity score analysis effectively minimized the influence of baseline clinical characteristics, including age, serum creatinine, initial eGFR, UACR, and 24-h proteinuria. Both treatment groups demonstrated continuous eGFR improvement and significant UACR reduction during follow-up, especially at 6 months. However, no significant differences in eGFR and UACR reduction rates were observed between the two groups throughout the entire follow-up period, both before and after matching. Subgroup analysis revealed improved eGFR in both treatment groups, notably among patients with an initial eGFR below 90 mL/min/1.73 m2. Conversely, IgAN patients with C1 lesions and a cellular crescent ratio exceeding 50% treated with CS and immunosuppressant therapy experienced a significant improvement in renal function and a decline in urinary protein creatinine ratio. Composite endpoint outcomes did not significantly differ between the two groups, while the incidence of adverse events was comparable. Conclusion: Our findings suggest that the addition of immunosuppressant therapy to corticosteroid monotherapy did not confer significant therapeutic advantages in patients with C1 lesions compared to CS monotherapy, although some specific patient populations appeared to derive modest benefits from this combined approach.

FNAC as preoperative diagnostic tool for neoplastic and non-neoplastic breast lesions with special reference to IAC standardised reporting in Coastal population - A teaching hospital experience

Breast cancer is steadily increasing worldwide. This study is based on application of recently proposed International Academy of cytology (IAC) Yokohama categorisation system of Breast cytology from C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious &amp; C5-Malignant). We aim to categorize the breast lesions based on the above-mentioned categorization scheme (IAC, Yokohama 2016) along with histopathological correlation (wherever possible). This was a retrospective observational study conducted from January 2018 to December 2021 in the Department of Pathology of a tertiary care hospital involving coastal population. Ethical clearance was taken from institutional reviw committee. All patients with palpable breast lumps who had undergone FNAC were included in the study. Patient details and data were collected from the case records maintained in Department of Pathology. All quantitative parameters were described through descriptive statistics. Total scores were computed for all the risk factors. Sensitivity, specificity, Positive Predictive Value, Negative Predictive Value calculated. Risk of malignancy(ROM) was calculated for each category. A total 200 patients, with age group ranging from 17 - 67 years with breast lesions were included in the study. C1 lesions were found in 5 cases, C2 in 152 cases, C3 in 11 cases, C4 in 4 cases, and C5 in 28 cases. Cytohistological correlation obtained in 94 cases with concordance noted in 89 cases and discordance in 5 cases. Breast FNAC cytology categorization according to IAC Yokohama system increases accuracy of diagnosis and helps clinician in appropriate patient management.

A rare case of multifocal chordoma involving the lower clivus and multiple spine levels: illustrative case.

Chordomas are rare bone tumors originating from notochord remnants with a predilection for the median axis of the body, primarily in the sacrococcygeal spine, skull base, and cervical spine. This paper presents the first reported case of simultaneous multilevel chordomas with various enhancements. A 40-year-old woman presented with right-sided otalgia, headache, nasal obstruction, and facial pressure. The patient's head and spinal magnetic resonance imaging (MRI) demonstrated a midline lesion in the clivus, C2, and T1-5 spinal levels. All lesions were T1 isointense and T2 hyperintense, consistent with chordoma. Interestingly, the clivus lesion was enhancing, whereas the C2 lesion was only slightly enhancing, and the rest of the lesions showed no enhancement. The patient underwent endoscopic endonasal transclival approach surgery for the clival lesion, followed by radiation to the surgical bed and the C2 lesion. The remaining lesions were monitored. Follow-up imaging showed stable disease in the C2 lesion and other lower lesions. The patient's severe pain in the posterior cervical spine was managed with cervical fusion, pain management, and physical therapy. This case underscores the importance of comprehensive spinal MRI in patients with chordomas, as multiple concurrent primaries may be present. The article summarizes the fundamental distinctions between ecchordosis physaliphora and chordoma and casts doubt on the capacity to always differentiate them.

Is prostatic adenocarcinoma with cribriform architecture more difficult to detect on prostate MRI?

Cribriform (CBFM) pattern on prostate biopsy has been implicated as a predictor for high-risk features, potentially leading to adverse outcomes after definitive treatment. This study aims to investigate whether the CBFM pattern containing prostate cancers (PCa) were associated with false negativemagnetic resonance imaging (MRI) and determine the association between MRI and histopathological disease burden. Patients who underwent multiparametric magnetic resonance imaging (mpMRI), combined 12-core transrectal ultrasound (TRUS) guided systematic (SB) and MRI/US fusion-guided biopsy were retrospectively queried for the presence of CBFM pattern at biopsy. Biopsy cores and lesions were categorized as follows: C0 = benign, C1 = PCa with no CBFM pattern, C2 = PCa with CBFM pattern. Correlation between cancer core length (CCL) and measured MRI lesion dimension were assessed using a modified Pearson correlation test for clustered data. Differences between the biopsy core groups were assessed with the Wilcoxon-signed rank test with clustering. Between 2015 and 2022, a total of 131 consecutive patients with CBFM pattern on prostate biopsy and pre-biopsy mpMRI were included. Clinical feature analysis included 1572 systematic biopsy cores (1149 C0, 272 C1, 151 C2) and 736 MRI-targeted biopsy cores (253 C0, 272 C1, 211 C2). Of the 131 patients with confirmed CBFM pathology, targeted biopsy (TBx) alone identified CBFM in 76.3% (100/131) of patients and detected PCa in 97.7% (128/131) patients. SBx biopsy alone detected CBFM in 61.1% (80/131) of patients and PCa in 90.8% (119/131) patients. TBx and SBx had equivalent detection in patients with smaller prostates (p = 0.045). For both PCa lesion groups there was a positive and significant correlation between maximum MRI lesion dimension and CCL (C1 lesions: p < 0.01, C2 lesions: p < 0.001). There was a significant difference in CCL between C1 and C2 lesions for T2 scores of 3 and 5 (p ≤ 0.01, p ≤ 0.01, respectively) and PI-RADS 5 lesions (p ≤ 0.01), with C2 lesions having larger CCL, despite no significant difference in MRI lesion dimension. The extent of disease for CBFM-containing tumors is difficult to capture on mpMRI. When comparing MRI lesions of similar dimensions and PIRADS scores, CBFM-containing tumors appear to have larger cancer yield on biopsy. Proper staging and planning of therapeutic interventions is reliant on accurate mpMRI estimation. Special considerations should be taken for patients with CBFM pattern on prostate biopsy.

The predictive value and response to immunosuppressive therapy of IgA nephropathy patients with crescents in a large retrospective Chinese cohort.

The prognostic value and response to immunosuppressive therapy (IST) of patients with crescents in the different backgrounds of pathological presentations in immunoglobulin A nephropathy (IgAN) is unclear. A total of 1262 IgAN patients were enrolled. Crescents (C, 0/1/2), fibrinoid necrosis (FN, 0/1) and endocapillary hypercellularity (E, 0/1) were integrated into different degrees of glomerular activity (0-4 points): mild (0), moderate (1-2) and severe (≥3). The effect of IST on patients with different glomerular activity scores and chronic tubular and interstitial lesions (T, 0/1/2) were analysed using Cox regression analysis. The kidney outcome was defined as an estimated glomerular filtration rate decrease ≥30% or end-stage kidney disease. C2 was an independent risk factor for kidney outcomes {overall cohort: hazard ratio [HR] 1.85 [95% confidence interval (CI) 1.03-3.31], P=.040; T0 patients: HR 6.52 [95% CI 2.92-14.54], P<.001; reference to C0} in those without IST, while the HR decreased to 0.83 (95% CI 0.54-1.27; P=.396) in the overall cohort and 2.39 (95% CI 1.00-5.67; P=.049) in T0 patients with IST. For patients with severe glomerular activity, IST decreased the risk of kidney outcomes by 70% in the overall cohort [HR 0.30 (95% CI 0.12-0.74), P=.009; reference to those without IST] and 86% in T0 patients [HR 0.14 (95% CI 0.04-0.54), P=0.005; reference to those without IST]. IST could reduce the risk for kidney outcomes in IgAN patients with C2 and T0 lesions together, as well as in those with crescents and at least one other active lesion, including FN and E1 lesions.

Assessment of cervical spinal cord volume in pediatric-onset multiple sclerosis

PurposeSeveral studies of adult-onset multiple sclerosis (AOMS) patients have demonstrated that spinal cord volume loss is associated with disease progression and clinical disability. However, complementary studies of young patients with pediatric-onset multiple sclerosis (POMS) are lacking. Our retrospective study aimed to assess spinal cord volume in POMS patients compared with that in healthy controls. MethodsCervical spinal cord magnetic resonance images were evaluated for 20 POMS patients and 20 age- and sex-matched controls. Cross-sectional areas (CSAs) were measured at C2 and C7, along with the spinal cord average segmental area (CASA). The POMS group was further subdivided based on the presence or absence of spinal cord lesions, specifically C2 lesions. Pairwise area and volume comparisons were made across the different groups. ResultsNo significant difference was found in CASA and CSA at C2 and C7 between POMS patients and comparative controls. However, CASA, CSA at C7, and estimated spinal cord volume were significantly lower in a small subset of POMS patients with C2 lesions (3 patients) than in controls (P = 0.001, 0.02, and 0.001, respectively). ConclusionNo significant difference was found in spinal cord areas and volumes between POMS patients and controls. This finding contrasts with spinal cord volume measurements in AOMS patients.

Papillary meningioma with multifocal leptomeningeal spread in a dog

AbstractAn 11‐year‐old, English cocker spaniel was presented with subacute progressive signs of vestibular ataxia, tetraparesis, left‐sided proprioceptive deficits, positional ventrolateral strabismus of the right eye and a right‐sided menace deficit. Magnetic resonance imaging of the cranium and cranial cervical spinal cord revealed multifocal T2 hyper‐/T1‐hypointense intradural lesions with dural tail signs and intra‐axial and intramedullary extension. Medical treatment resulted in initial improvement before deterioration was noticed. Cytological examination results of computed tomography‐guided fine‐needle aspiration biopsy of the C1–C2 lesion were consistent with mesenchymal neoplasia. Three days later, after progressive clinical deterioration, euthanasia was performed. Postmortem examination and subsequent histological examination of the brainstem and spinal cord revealed multifocal, strongly infiltrative growth of neoplastic cells with areas of pseudo‐rosette formation by cylindrical neoplastic cells with moderately large, oval nuclei in addition to areas of spindle‐shaped neoplastic cells with meningothelial whorls. The final diagnosis was a papillary (grade III) meningioma with multifocal leptomeningeal spread.

ANALYSE AND CLASSIFY VARIOUS BREAST LESIONS ON FNAC WITH SPECIAL REFERENCE TO IAC STANDARDISED REPORTING SYSTEM: A RETROSPECTIVE ANALYSIS OF 300 CASES

Introduction: Breast lumps are the common manifestations in clinical practice. For uniform reporting, better diagnostic clarity and uniform patient management International Academy of Cytology (IAC) has classified reporting of breast Fine needle aspiration cytology (FNAC) into 5 tier yokohama reporting system (C1 to C5). Material and Methods: Present study is a retrospective study done in Department of Pathology, GSVM medical college, Kanpur over a period of 12 month (December 2020 to November 2021). Total 300 cases of FNAC breast smears were reviewed and classified according to IAC reporting system (C1 to C5). Results: In our study we had total 300 cases in 12 month period with female patients (285) out numbered male patients (15). On age wise distribution we get maximum no of cases in 2nd and 3rd decade. On categorization of breast lesions according to IAC Yokohama reporting system out of total 300 cases we get C1 lesions in 09(3.0%)cases , C2 lesions in 184(61.3%) cases, C3 lesions in 26(8.6%) cases, C4 lesions in 11(3.6%) cases and C5 lesions in 70(23.3%) cases. Conclusion: Use of FNAC method for evaluation of breast lump for preoperative management is quick, simple and cost effective, with IAC reporting system we can uniformily classify breast FNA cytology for better patient management and better guidance to clinician.

Effectiveness of nasotracheal intubation in anterior cervical surgery including C3 lesions

Objective Anterior approach cervical surgery is widely used for accessing C3 lesions. When operating with an anterior approach, the surgical field is obstructed by mandible. Neck extension is popular method to secure better surgical field but risk devastating neurological damage. To overcome this limited surgical field without neck extension, we adopted nasotracheal intubation and evaluated its efficiency. Methods We retrospectively analyzed 16 patients who underwent anterior cervical discectomy or corpectomy of C3 lesions via nasotracheal intubation. We enrolled an additional 29 patients who underwent anterior cervical discectomy or corpectomy of C3 lesions via orotracheal intubation as a control group. All patients had been diagnosed with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament. We measured the mandibular-cervical angle, which is the angle between the lower mandibular line and anterior vertebral line. Results The mandibular-cervical angle was increased by 7.3 with nasotracheal intubation compared to orotracheal intubation. Conclusions Nasotracheal intubation is an effective surgical option for securing the surgical field without neck extension in anterior cervical surgery including C3 lesions.

A Diverse Spectrum of Immune Complex– and Complement-Mediated Kidney Diseases Is Associated With Mantle Cell Lymphoma

IntroductionThere are limited reports on kidney biopsy findings in patients with mantle cell lymphoma (MCL).MethodsWe initiated a multi-institutional, retrospective review of kidney biopsy findings in patients with active and treated MCL.ResultsA total of 30 patients with MCL and kidney biopsies were identified, with a median age of 67 (range 48–87) years, 73% of whom were men. A total of 20 patients had active MCL at the time of biopsy, of whom 14 (70%) presented with acute kidney injury (AKI), proteinuria and/or hematuria, and biopsy findings potentially attributable to lymphoma. Of the 14, 11 had immune complex (IC) or complement-mediated (C3) disease including proliferative glomerulonephritis (GN) with monotypic Ig deposits (PGNMID [2]), C3GN, (2), secondary membranous nephropathy (MN [3]), tubular basement membrane (TBM) deposits (2), and modest lupus-like GN (2). Lymphomatous infiltration was present in 8 of the 20 patients, 5 with coincident IC or C3 lesions. A total of 6 patients with available follow-up were treated for MCL, all with clinical remission of GN (2 PGNMID, 2 C3GN, and 2 MN).ConclusionMCL is associated with diverse monoclonal and polyclonal glomerular and extra-glomerular IC and C3 disease. For patients with active MCL and kidney dysfunction requiring biopsy, 70% had findings due or potentially due to lymphoma, including 55% with IC or C3 disease and 40% had lymphomatous kidney infiltration. IC and C3GN in the setting of active MCL was responsive to lymphoma-directed therapy.

Upper cervical spine instability due to pyogenic infection successfully treated by one stage posterior debridement and stabilization: Case Report and literature review

Pyogenic osteomyelitis of the upper cervical spine is a rare condition associated with different clinical symptoms and signs. Previous studies have stressed the difficulties in making the diagnosis due to its unusual location and relatively rare occurrence. We hereby describe a case of a 65-year-old man with pyogenic infection of the craniocervical junction up to the axis with severe instability managed by posterior fusion from occiput to C6, an open biopsy from C1–C2 lesions and irrigation and debridement. On follow-up visit at two years, our patient had recovered completely. We present this case to show that the posterior approach without the anterior transoral approach is a valid surgical option in such cases. Additionally, we emphasize the importance of stabilization to successfully treat spine osteomyelitis and summarize the literature available discussing upper cervical spine infection treatment options.

A Re-evaluation of Whether Non-monosynaptic Homonymous H Reflex Facilitation Tests Propriospinal Circuits.

The C3–C4 propriospinal system is an important pathway mediating movement in cats; it contributes to movements in primates (including humans), and may have a role in recovery after lesion. Validated clinical tests of this system would find many applications, therefore we sought to test whether non-monosynaptic homonymous facilitation of the forearm flexor H reflex is mediated solely via a C3–C4 propriospinal pathway. In one anesthetized macaque monkey, median nerve stimulation elicited an H reflex in the flexor carpi radialis (FCR). Median nerve conditioning stimuli at sub-threshold intensities facilitated the H reflex, for inter-stimulus intervals up to 30 ms. Successive spinal surgical hemisections were then made. C2 lesion left the homonymous facilitation intact, suggesting mediation by spinal, not supraspinal pathways. Facilitation also remained after a second lesion at C5, indicating a major role for segmental (C7–C8) rather than propriospinal (C3–C4) interneurons. In separate experiments in five healthy human subjects, a threshold tracking approach assessed changes in peripheral axon excitability after conditioning stimulation. This was found to be enhanced up to 20 ms after the conditioning stimulus, and could partly, although not completely, underlie the H reflex facilitation seen. We conclude that homonymous facilitation of the H reflex in FCR can be produced by segmental spinal mechanisms, as well as by a supranormal period of nerve excitability. Unfortunately, this straightforward test cannot therefore be used for selective assessment of propriospinal circuits.

Comparison between Sonography-based and Surgical Extent of Deep Endometriosis Using the Enzian Classification - A Prospective Diagnostic Accuracy Study

To compare a preoperative evaluation of deep endometriosis (DE) by transvaginal sonography (TVS) according to the Enzian classification with the intraoperatively assessed extent of DE using the Enzian system. Prospective diagnostic accuracy study. Tertiary referral center for endometriosis. Women undergoing TVS and surgery for DE between 2017 and 2019 (N = 195). Evaluation of DE lesion sizes according to the Enzian classification as evaluated by preoperative TVS compared with surgical findings. The rate of exact concordances between preoperative TVS-based predictions of DE lesion sizes and intraoperatively assessed lesion sizes according to the Enzian classification varied depending on anatomic localizations, that is, Enzian compartments, and evaluated lesion size. The highest rate of exact concordances was found in Enzian compartment C (rectosigmoid) in which 86% of all TVS C3 lesions were confirmed as such at surgery. Enzian compartment A (vagina, rectovaginal septum) showed similar results. The rates of exact concordances were slightly lower in Enzian compartment B (uterosacral ligaments, parametria), with confirmation at surgery of 71% of TVS B2 lesions. In most cases of discordant findings, an underestimation of the lesion size by 1 severity grade was observed compared with the intraoperative findings. In Enzian compartment FB (urinary bladder), 91% of the lesions seen at TVS and 98% of cases without any lesion at TVS were confirmed surgically. TVS could detect DE preoperatively in compartments A, B, C, and FB with an overall sensitivity of 84%, 91%, 92%, and 88%, respectively, and a specificity of 85%, 73%, 95%, and 99%, respectively. TVS provides a valuable preoperative estimation of DE localization and lesion size using the Enzian classification, especially for Enzian compartments A, C, and FB. For Enzian compartment B, the exact assessment of the lesion size using the Enzian system seems to be less precise than for the other compartments.

Minimally invasive percutaneous C1–C2 transarticular screw fixation as a palliative management option in C2 metastases

Bone metastasis in patients with esophageal carcinoma is rare but serious, often resulting in structural complications of the spine such as atlantoaxial instability and C2 metastases. Atlantoaxial instability is usually managed surgically using screw-rod constructs; however, in patients undergoing radiotherapy, surgical wound healing is a concern. We present a technical note involving a terminally ill patient diagnosed with esophageal carcinoma who suffered from a metastatic lytic lesion of C2 and mechanical neck pain. Due to the patient starting palliative radiotherapy, a percutaneous approach and transarticular screws were used to achieve atlantoaxial fixation and minimize the surgical wound while maintaining the midline tension band. Significant clinical improvement was found. Our patient was able to begin palliative radiotherapy within 1 week of surgery, without surgical and wound complications. This report provides unique insight into the utilization of a minimally invasive approach for pain management and stabilization of the cervical spine for oncology patients.

Can C2 Vertebroplasty Restore Alignment in Pathologic Odontoid Fracture?

Background and Importance: Plasmacytoma is more likely to involve the spine with up to 50%, most commonly in the thoracic spine. Case Presentation: This study examined a patient with solitary plasmacytoma with neck pain and abnormal C1-C2 range of motion, which happened to have an osteolytic C2 lesion on CT scanning. The patient underwent a fluoroscopically guided anterior percutaneous C2 vertebroplasty without posterior fusion, leading to management of pain, maintenance of normal motions, and restoration of cervical alignment. Conclusion: This case represents fluoroscopically guided anterior percutaneous C2 vertebroplasty as an effective treatment for C2 osteolytic lesions with an abnormal range of motion, which can be considered in selected cases as an alternative approach for demanding open surgical approaches to this challenging region.

FNAC of Breast Lesions with Special Reference to IAC Standardized Reporting and Comparative Study of Cytohistological Grading of Breast Carcinoma.

Background:International Academy of Cytology (IAC) has established a process to produce comprehensive and standardized approach to fine-needle aspiration cytology (FNAC) reporting. They have categorized the breast lesions in C1 to C5. (C1-Insufficient material, C2-Benign, C3- Atypical, C4-Suspicious & C5-Malignant).Aims and Objectives:The aim of study is to classify various breast lesions (C1 to C5) and to grade breast carcinoma on FNAC using Robinson's grading system which is then correlated with modified Bloom–Richardson grading.Materials and Methods:All routine FNAC for breast lump were included in the study during the period from Jan 2016 to Jan 2017. The study was conducted in the Department of pathology and lab medicine of a tertiary care hospital in central India.Results:A total 225 female patients were included in the study, with an age group ranging from 15 - 79 years, with lesions in breast were taken. C1 lesions were found in 3 cases, C2 in 186 cases, C3 in 13 cases, C4 in 4 cases, and C5 in 19 cases. Correlation of cytohistological grading was obtained in 108 cases.Conclusion:Cytological categorization based on IAC structured reporting will enhance the reproducibility of reports among pathologist & clinicians. With the comparison between cytohistological nuclear grading, the cytoprognostic scores will help in evaluating the aggressiveness of tumor, predicts histological grade and prognosis. It could be a useful parameter for selecting neo-adjuvant chemotherapy.