Central Necrotic Area Research Articles

Imaging Gigantic Small Bowel Gastrointestinal Stromal Tumours Through Different Radiological Lenses: A Case Report

Gastrointestinal stromal tumours (GIST) account for 1–3% of all the gastrointestinal (GI) neoplasms. It is the most common mesenchymal tumour in the Gl tract. The majority of GISTs are KIT gene positive; however, it is necessary to diagnose them pre-operatively. Here, the authors report the case of a 65-year-old male who presented with pain and a lump in the umbilical region for the last 2 years. On abdominal ultrasound, there was a heterogeneously hypoechoic mass in the umbilical region, with lobulated margins and central necrotic areas. On small bowel series, the core of the mass showed faint contrast opacification. Contrast-enhanced CT of the abdomen showed a heterogeneously enhancing, lobulated exophytic lesion arising from the small bowel loops, the central core of the lesion demonstrating an air-contrast level. Under ultrasound guidance, the lesion was biopsied. Histopathological findings were suggestive of a spindle cell tumour. The sample was c-KIT positive. Hence, the diagnosis of GIST was confirmed. The patient was given imatinib after resection of the mass. Usually, a GIST of larger size has higher malignant and metastatic potential; however, this article shows a gigantic small bowel GIST with cavitation and heterogeneity in different imaging modality, and still has no metastasis on imaging or high mitotic activity, and nuclear atypia on histopathology. A radiologist should also know the imaging pattern on conventional imaging and ultrasound, apart from usual cross-sectional imaging.

P17 Hepatobiliary parasitic infestation: a case report

Abstract Background Hepatic parasitic lesions can present with multiple cystic lesions that may simulate inflammatory pseudo-tumour or malignancy in appropriate clinical settings. Here we present a known case of renal cell carcinoma with liver lesions that showed parasitic infestation on histology. Patient case A 70-year-old male with a history of right partial nephrectomy for clear cell renal cell carcinoma having an uneventful postoperative follow-up for 2 years underwent a surveillance CT scan. Multiple hepatic cystic lesions were identified, which on subsequent MRI and PET scan were suspicious for metastasis. Partial hepatectomy was performed for histological evaluation. Results Multiple discrete cystic hepatic lesions were noted on macroscopy. Histological examination revealed multiple necrotic hyalinized nodules with granulomatous inflammation within the liver and dense neutrophil infiltration with microabscess formation. Within the central necrotic area, there were non-viable parasite eggs and parts of worm, in keeping with parasitic infestation. On further expert opinion, this was diagnosed as Enterobius infestation of liver. Conclusions Hepatobiliary parasitic infestations may be encountered as clinically and biochemically asymptomatic lesions, especially in immunocompromised patients. Strong clinical history of travel and parasite serology screen is always helpful to clinch the diagnosis but may not be always available during histological examination. This case highlights the importance of thorough histological and microbiological examination as all nodular lesions in liver are not malignant and could be infective.

Myocardial Infiltration in Primary Mediastinal B-Cell Lymphoma Detected by Cardiac Magnetic Resonance Imaging

Introduction: Cardiac involvement, particularly myocardial infiltration in primary mediastinal lymphoma, is a rare occurrence with an incidence of only 9% in known cases of primary malignancy. Neoplasm infiltration into the myocardium manifests through direct invasion, hematogenous spread, transvenous invasion through the great veins, or lymphangitic spreading in the mediastinal. Myocardial infiltration in lymphoma presents a grim prognosis and its treatment may be associated with specific risks, such as myocardial rupture. Various imaging modalities may detect cardiac involvement, with cardiac magnetic resonance (CMR) imaging considered the gold standard. CMR enables clear delineation of myocardial infiltration, making it valuable for local staging, pretreatment planning, and evaluating treatment response. Case Presentation: : A 37-year-old woman patient was diagnosed with primary mediastinal large B-cell lymphoma. Mild chest discomfort and shortness of breath were observed 3 months before hospital admission. A thorax CT scan showed a heterogeneous contrast-enhancing mass with a central necrotic area in the anterior mediastinum. Following thoracotomy and tumor debulking, the patient complained of severe crushing chest pain radiating to her back, accompanied by new T wave inversion on ECG and elevated cardiac troponin levels a week after surgery. Coronary angiogram results showed a normal coronary artery. Subsequent cardiac MRI showed tumor infiltration into the anterior pericardial space, as well as the myocardium of the left and right ventricles. Chemotherapy was promptly initiated, resulting in a gradual improvement of symptoms. Conclusions: In this study, we discuss the use of 3D-CRT in the re-irradiation of NPC with its limitation on obtaining optimum dose sculpture compared to more sophisticated and widely spread modalities like IMRT. However, with careful planning, we can still obtain optimum tumor dose, minimize OAR dose, and subsequently late toxicities that come after. We hope that this study can bring hope to centers with limited facilities, and we suggest further studies on reirradiation, especially in OAR dose tolerance guidelines.

Upper Lip Nodule as the First Manifestation of Sarcoidosis: A Case Report

Introduction: Sarcoidosis is a chronic disorder characterized by the presence of multiple granules, which could affect different systems and tissues. These granules are histologically characterized by non-caseous granulomatous inflammation; however, their etiology is still unknown. Previous reports state that different antigens may be involved. Sarcoidosis has been rarely reported in the Brazilian population. The objective of this study was to report a clinical case of sarcoidosis presenting with oral manifestations as the first sign and symptom. Case Presentation: An 85-year-old, nonsmoking, white woman was referred to the Department of Stomatology of our clinic in 2019, complaining of a persistently growing nodule on the upper lip and in the right arm subcutaneous tissue lasting for three months. Both lesions were painless and non-mobile/cohesive nodules with borrachoid consistency on palpation, well-delimited margins, and overlying normal-colored mucosa/skin. The oral nodule was surgically excised and sent for routine histopathological analysis, revealing granulomatous inflammation, the presence of central lobules of activated macrophages, epithelioid histiocytes, multinucleated Langerhans cells, and a peripheral cuff of mononuclear cells (lymphocytes). There was no evidence of central necrotic areas; however, asteroid bodies (i.e., starry inclusions) were rarely interspersed within multinucleated Langerhans cells. Warthin-Starry, Fite, and PAS special staining did not show any evidence of granulomatous pathogens, which was compatible with non-infectious granulomatosis. Complementary tests revealed hypercalcemia and elevated serum levels of alkaline phosphatase and angiotensin-converting enzyme. Conclusions: Sarcoidosis can manifest itself in several ways, so the diagnostic process needs to be thorough and comprehensive to confirm the disease. In addition, disease progression should be regularly monitored in patients.

Comparison of Translocator Protein Expression Between Tumefactive Multiple Sclerosis and Glioblastoma.

This figure presents a comparison of molecular imaging of the translocator protein (TSPO) and contrast-enhanced MRI in 2 patients with tumefactive multiple sclerosis and glioblastoma, respectively. In the case of the tumefactive multiple sclerosis patient, TSPO uptake is primarily located centrally, while in the glioblastoma patient, TSPO uptake is predominantly situated peripherally to the central necrotic area. These findings suggest that TSPO imaging could be a noninvasive imaging technique for distinguishing between these 2 diagnoses.

Successful management of a rare case of gallbladder neuroendocrine carcinoma with tumor thrombi.

A gallbladder neuroendocrine neoplasm (GB‑NEN) is a bizarre heterogeneous neoplasm arising from neuroendocrine cells, which are present in minimal amounts on the GB mucosa either due to conversion of undifferentiated stem cells, chronic inflammation and resulting in pathological metaplasia or switching of GB adenocarcinoma to neuroendocrine one. Among all the GB malignancies, GB-NEN accounts for approximately 2.1%. A 41-year-old lady presented with right upper abdomen pain and distension for 2weeks. Contrast CT showed heterogeneously enhancing wall thickening involving fundus-body of the GB with large exophytic component involving segments IV/V of liver, peripheral enhancement and central low attenuating necrotic areas. Middle hepatic and left branch of portal vein was filled with enhancing lesion, tumor thrombi. She underwent left trisectionectomy followed by adjuvant chemotherapy. Postoperative biopsy reported as poorly differentiated unifocal small cell GB-neuroendocrine carcinomas (GB-NEC). Resected margins were free of tumor with periportal lymph nodes negative for tumor. Follow-up PET-CT after six months of treatment completion shows no tumor recurrence or metastases. She has completed 12months following the surgery and is asymptomatic. As the occurrence of GB-NEC is rare, there are little data regarding etiology, pathogenesis, treatment and prognosis of it. Even though metastasis is early and most frequent to lymph nodes, liver, lung and peritoneum, the presence of tumor thrombus in GB-NEC is rarely reported. Though most reports suggest very poor outcomes, radical surgery followed by adjuvant chemotherapy can yield good short-term results as seen in this case.

PO-04-054 FIRST REPORTED HUMAN CASE OF ELECTRICAL STORM TREATED WITH THE NEW HIGH-POWER-SHORT-DURATION TACTIFLEXTMABLATION CATHETER.

In the last decade, standard-power-long-duration radiofrequency delivery systems were the standard care to treat ventricular arrhythmias. Recently, high-power-short-duration radiofrequency delivery systems are available and TactiFlexTM Ablation Catheter is the most recent one. we present the first worldwide case of electrical storm catheter ablation using the new TactiFlexTM. N/A A 78 years old female was admitted to the emergency department because of arrhythmic storm. Thirty days earlier she had been hospitalized for acute coronary syndrome. On initial assessment, she appeared soporous, arterial blood pressure was 80/50 mmHg and ECG revealed sustained monomorphic ventricular tachycardia, regular cycle length, left bundle branch morphology, negative concordance in precordial lead. Patient therapy included metoprolol, mexiletine and cordarone; intravenous lidocaine and procainamide were added, with poor results in controlling arrhythmia; then, we decide to perform VT catheter ablation. Left ventricle mapping was performed with TactiFlexTM and AdvisorTM HDGrid Mapping Catether supported by the new EnsiteX V2 electro-anatomical mapping system and Omnipolar Technology. During voltage substrate mapping we found a central necrotic core area surrounded by a low voltage area in the mild-apical posterior-lateral wall. During late potential mapping the same area showed late and multi-fragmented potentials. Clinical tachycardia was easily induced during programmed ventricular pacing. VT activation map was performed and no meso-diastolic potentials or "early meets late" areas were found, probably signifying a possible epicardial regions involvement in the VT circuitry: it was not possible to reconstruct the entire arrhythmia circuit. Activation velocity map was performed and VT slowed in the same regions of low voltage and fragmented potentials. High-power radiofrequency energy (35W-25seconds or 40W-20seconds pulses) was delivered in the mid-basal posterior-septal wall obtaining VT termination. Subsequently, substrate homogenization, which include late and fragmented potentials elimination, was performed. No ventricle arrhythmias were inducible during programmed ventricular pacing. No procedure-related complications occurred. TactiFlexTM appears safe and effective to control left VT. Further reports and studies are needed to evaluate the most appropriate Watts and seconds to perform effective and safe human left ventricle injuries.

An Unusual FDG-PET/CT Documentation in Aleukemic Leukemia Cutis: Atypical Penile, Scrotal, and Leg Muscles Involvement.

Aleukemic leukemia cutis (ALC) is a rare condition with a relatively poor prognosis, clinically presenting as skin and subcutaneous nodules commonly involving head and neck region with discrete atypical leukemic cells infiltrating in the skin on histopathology. The lesions on the genital area skin are seldom reported. A 49-year-old male presented with joint pains and multiple subcutaneous nodules clinically with biopsy proving it as leukemia cutis. Bone marrow aspiration and biopsy were suggestive of normocellular myeloid preponderant bone marrow with mild increase in eosinophils. The 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 F-FDG PET/CT) revealed metabolically active FDG avid ill-defined soft tissue attenuation involving the entire length of penile shaft with central necrotic area, diffuse scrota skin thickening, and lateral compartment muscles of left leg, in addition to multiple hypermetabolic metastatic lymph nodes, and diffuse hypermetabolic marrow in humerii and femora. Despite prompt investigations and initiation of management, the patient succumbed in 15 days post-FDG PET/CT. The present report depicts an atypical case of ALC, with FDG PET-CT showing extensive and unusual sites of disease involvement, emphasizing its potential role in ALC.

Ultrasound and Contrast-enhanced Ultrasound Patterns of Primary Psoas Major Muscle Diffuse Large B-cell Lymphoma: A Case Report

Diffuse large B-cell lymphoma involving skeletal muscle is rare and accounts for less than 0.1%, most frequently affecting the lower extremities. A 63-year-old man complained of a persistent fever, accompanied by waist discomfort. Computed tomography and ultrasound detected an ill-defined solid mass in the right psoas major muscle. Contrast-enhanced ultrasound showed that peripheral inhomogeneous hyper-enhancement with nonenhancing central necrotic area was seen in the mass. Then, ultrasound-guided biopsy was performed and revealed diffuse large B-cell lymphoma. This is the first case report demonstrated the primary psoas major muscle lymphoma and analyzed the ultrasound and contrast-enhanced ultrasound features of the tumor.

Multicentric epithelioid hemangioendothelioma of humerus and scapula

Epithelioid hemangioendothelioma (EH) is a rare malignant vascular tumor occurring mainly in the liver and lungs, with bones being a rare site and primarily seen in the adult population. We present a rare case of multicentric EH in the right humerus in an adolescent male, who presented with complaints of pain and swelling in the right shoulder. Radiographs and Computed tomography showed a large expansile lytic lesion in the proximal end of the right humerus with areas of cortical destruction and matrix calcification. On Magnetic resonance imaging, the lesion was predominantly isointense on T1-weighted image, hyperintense on T2-weighted, and Short Tau Inversion Recovery images with prominent flow voids within. On post-contrast sequences, the lesion showed intense heterogenous enhancement with a non-enhancing central necrotic area. Multiple smaller lytic lesions with similar imaging characteristics were also found in the mid and distal shaft of the right humerus and the right coracoid process. Differentials of Telangiectatic osteosarcoma, Giant cell tumor, brown tumors of hyperparathyroidism, and metastasis were considered. Core biopsy revealed that the lesion was an EH. Though the imaging features of EH are non-specific, it may be considered in the differential diagnosis of an expansile lytic bone lesion with no periosteal reaction, showing cortical break and soft tissue component, especially if it is multifocal and multicentric.

Expression of Platelet Derived Growth Factor a, Its Receptor, and Integrin Subunit Alpha V in Feline Injection-Site Sarcomas

Abstract Injection-site sarcomas are considered an important entity in veterinary oncology, especially in cats. The current study investigated the immunohistochemical expression of platelet-derived growth factor A (PDGFA), platelet-derived growth factor receptor-α (PDGFR-α), and integrin alpha subunit v in feline injection-site sarcomas (FISS). A total of 14 paraffin-embedded tissue samples previously diagnosed as soft tissue sarcomas were selected from the departmental archive and sectioned at 5µm using a microtome. Tissue sections were stained with Hematoxylin & Eosin, Alcian blue-Periodic Acid Schiff (AB-PAS), Masson’s Trichrome, and immunohistochemically for PDGFA, PDGR-α, and integrin alpha v. The majority of the tumors were fibrosarcomas (n=13/14), except one case of myxoid liposarcoma. The tumors occurred at sites commonly used for injections or vaccine administration. Histologically, tumors were characterized by peripheral infiltration of mononuclear cells mainly lymphocytes, variable sized central necrotic areas, and many multinucleated tumor giant cells. AB-PAS staining revealed the presence of myxoid or mucinous areas in (8/14) tumors while trichrome staining demonstrated a variable amount of collagenous stroma in 12/14 tumors. Vimentin immunoreactivity was observed in all the tumors while smooth muscle actin and muscle actin staining was noticed in four and two cases, respectively. PDGFA and PDGFR-α immunoexpression was observed in all 14 cases while integrin alpha v in 13/14 cases. The results of the current study indicate that fibrosarcoma is the major morphologic phenotype of FISS. The PDGFA, its receptor, and integrin alpha v immunoexpression are increased in these tumors in cats which elucidates their role in the pathogenesis of FISS.

Pathology of Aspergilosis in ducks and its clinical management

The present study was carried out to investigate the pathology of Aspergillosis in ducks. A total of 10 cases were recorded during the months of June & July, 2019. The diagnosis was made on the basis of clinical signs, gross & microscopic alterations and isolation of the fungus. The clinical signs observed in the affected ducks include respiratory distress, dyspnoea, gasping and accelerated breathing associated with loss of appetite, stunted growth, lethargy and increased thirst. Grossly, there were presence of white-yellowish caseous nodules in the lung, airsacs, gizzard, liver, thoracic wall and abdominal serosa. Histopathological examination revealed the presence of focal granulomatous lesions in the lungs characterized by central necrotic area with infiltration of heterophils, macrophages, epithelioid cells and formation of giant cells. Similar type of lesions were also recorded in liver and gizzard. Invasion of fungal hyphae at the peri-bronchiolar and interstitial tissue and haemorrhages were also noticed. On the 5th day post incubation, there were presence of blackish green colonies in the SDA plates.

Conidiobolomycosis in goats

ABSTRACT: The present article presents cases of conidiobolomycosis in adult goats with clinical signs characterized by serous nasal discharge, dyspnea, apathy, and weight loss. Two goats were necropsied. Necropsy displayed increased volume on the sagittal section of the head and an ulcerated surface containing a yellow friable mass with irregular and granular consistency in the nasal septum and in the ventral nasal turbinate. One goat also presented lesions on the ear’s skin and the right pelvic limb. Microscopically, lesions were characterized by multifocal granulomas with a central necrotic area containing non-stained fungal hyphae images surrounded by a granulomatous infiltrate. Samples of the lesions examined by immunohistochemistry and polymerase chain reaction were positive for Conidiobolus lamprauges. This is the first report of conidiobolomycosis in goats, and the disease should be considered in the differential diagnoses for rhinitis and dermatitis in goats.

FDG PET/CT and CT Findings of Renal Cell Carcinoma With Sarcomatoid Differentiation.

OBJECTIVE. The purpose of this article is to investigate the value of 18F-FDG PET/CT and enhanced CT in the diagnosis of renal cell carcinoma (RCC) with sarcomatoid differentiation and the differential diagnosis of clear cell renal cell carcinoma (ccRCC). MATERIALS AND METHODS. Among patients with renal tumors confirmed by pathologic examination from September 2010 to August 2019, 29 patients with RCC with sarcomatoid differentiation and 82 patients with ccRCC who underwent FDG PET/CT, renal contrast-enhanced CT examination, or both, before surgery were studied. Features of the two groups on CT and PET/CT were retrospectively reviewed. RESULTS. The tumor size of RCC with sarcomatoid differentiation was larger than that of ccRCC (p = 0.0086). Cystic necrosis, peritumoral neovascularity, and metastasis were more common in RCC with sarcomatoid differentiation (p = 0.0052, p = 0.0008, p < 0.0001, respectively). The ratio of necrotic area to tumor diameter of RCC with sarcomatoid differentiation was statistically significantly larger than that of ccRCC (p = 0.0032). Three cases of RCC with sarcomatoid differentiation showed a large central necrotic area and dense intratu-moral neovascularity in the surrounding parenchyma, defined as the ring-of-fire sign, which was not found in ccRCC. The maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and peak standardized uptake value (SUVpeak) of RCC with sarcomatoid differentiation were statistically significantly higher than those for ccRCC (all p < 0.0001), and the SUVmax, SUVmean, and SUVpeak cutoff values of 5.4, 4.2, and 5.0, respectively, were helpful for discrimination. CONCLUSION. Imaging features including higher SUVmax, SUVmean, and SUVpeak; a larger ratio of necrotic area to tumor diameter; the presence of peritumoral neovascularity; and metastasis are more commonly associated with RCC with sarcomatoid differentiation than with ccRCC. The ring-of-fire sign and SUVmax, SUVmean, SUVpeak cutoff values of 5.4, 4.2, 5.0, respectively, may be helpful to indicate RCC with sarcomatoid differentiation.

Metachronous extraskeletal (soft tissue) epithelioid osteogenic sarcoma: a case report

BackgroundMetachronous osteosarcoma is a rare form of osteosarcoma. The occurrence of metachronous tumor in soft tissue is exceedingly rare. The pathogenesis of metachronous osteosarcoma, as to whether it represents multiple true primaries or metastatic disease, is still obscure.Case presentationA 49-year-old Indian man presented with progressively increasing swelling in his left hand of 2 months’ duration. An X-ray showed a soft tissue lesion. Contrast-enhanced computed tomography showed a soft tissue mass lesion, with peripheral enhancement and central necrotic areas in radial palmar soft tissue overlying second metacarpophalangeal region with no obvious bony osteolysis. Possibilities of acute abscess, resolving hematoma, or aggressive soft tissue mass lesion were suggested. An incision biopsy showed morphological features of epithelioid osteosarcoma, which was confirmed on immunohistochemistry. A detailed history revealed that our patient was diagnosed as having osteosarcoma of his right leg 3 years previously. Based on history, radiology, morphology, and immunohistochemistry, a final diagnosis of extraskeletal (soft tissue) epithelioid osteogenic sarcoma of the left hand occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg was given.ConclusionThis is probably the first reported case of extraskeletal (soft tissue) epithelioid osteosarcoma occurring as a metachronous tumor 3 years after diagnosis of primary osteosarcoma in the right leg. The prognosis of metachronous skeletal osteosarcoma is poor as compared to that of relapse limited to lungs. In late metachronous osteosarcoma, combined-modality therapy comprising surgery and aggressive chemotherapy may affect long-term survival. Lifelong follow-up of surviving patients with osteosarcoma is necessary and if metachronous osteosarcoma is discovered, it should be treated with curative intent.

MON-389 Normotensive Pheochromocytoma

Background: Pheochromocytoma is a rare neuroendocrine tumour arising from chromaffin cells of the adrenal medulla that produce catecholamines and their metabolites. It accounts for up to 5-9% of adrenal incidentalomas (AI). Lack of hemodynamic features including hypertension has been reported in 13.5% to 55% of incidental pheochromocytoma series. It is postulated that normotensive pheochromocytoma (NP) silent presentation might be caused by reduction in secretion of catecholamines. Adrenalectomy is the treatment of choice for normotensive pheochromocytoma. Pre-operative pharmacological blockade for NP is still controversial. Clinical case: A 39 years old lady Admitted with perforated Appendix was referred to the endocrine service for incidentally discovered left adrenal mass .Patient has no history suggestive of adrenal hyper functioning. No family history of endocrine disorders. Physical examination showed blood pressure of 90/60 mmHg with no signs of adrenal hyper functioning. CT scan showed, left adrenal mass measuring 6 X 4.1 x 4.7 cm with multiple central necrotic areas and heterogenous enhancement. MIBG scan showed a large focus of uptake in the left adrenal area. Laboratory investigations showed normal DST. Plasma metanephrines were 1850 ng/l (normal less than 90 ng/l) and normetanephrines were 3050 ng/l (normal less than 129 ng/ml). 24 hours urine adrenaline was more than 213 nmol/24 h (normal less than 147), metanephrines was more than 17.7 umol/l (normal is less than 2.04) and normetanephrine more than 15.79 umol/l (normal is less than 4.40). Patient had left laparoscopic adrenalectomy with no complications. She did not receive any pre-operative pharmacological blockade as she couldn't tolerate any. Histopathology showed pheochromocytoma 7 cm in diameter with no central necrosis, mitotic count was 1% per HPF, no Atypical mitosis, no vascular or capsular invasion, no extension. Genetic screen was negative. Conclusions: Screening for pheochromocytoma is mandatory for all adrenal incidentaloma even in the absence of hypertension as Lack of hemodynamic features has been reported in 13.5% to 55% of incidental pheochromocytoma series.

Depletion of Lipid Efflux Pump ABCG1 Triggers the Intracellular Accumulation of Extracellular Vesicles and Reduces Aggregation and Tumorigenesis of Metastatic Cancer Cells.

The ATP-binding cassette transporter G1 (ABCG1) is a cholesterol lipid efflux pump whose role in tumor growth has been largely unknown. Our transcriptomics revealed that ABCG1 was powerfully expressed in rapidly metastatic, aggregative colon cancer cells, in all the ABC transporter family members. Coincidently, genetic amplification of ABCG1 is found in 10–35% of clinical samples of metastatic cancer cases. Expression of ABCG1 was further elevated in three-dimensional tumoroids (tumor organoids) within stemness-enhancing tumor milieu, whereas depletion of ABCG1 lowered cellular aggregation and tumoroid growth in vitro as well as hypoxia-inducible factor 1α in cancer cells around the central necrotic areas in tumors in vivo. Notably, depletion of ABCG1 triggered the intracellular accumulation of extracellular vesicles (EVs) and regression of tumoroids. Collectively, these data suggest that ABCG1 plays a crucial role in tumorigenesis in metastatic cancer and that depletion of ABCG1 triggers tumor regression with the accumulation of EVs and their derivatives and cargos, implicating a novel ABCG1-targeting therapeutic strategy by which redundant and toxic substances may be accumulated in tumors leading to their regression.

Gross, histopathology and molecular diagnosis of oesophagostomosis in sheep.

A total of 120 tissue samples (Rumen, reticulum, omasum, abomasum, small intestine and large intestine) were collected from slaughter houses in Chennai, Kanchipuram and Tiruvallur districts and five samples from necropsy room at Department of Veterinary Pathology, Madras Veterinary College, Chennai, Tamil Nadu. Overall prevalence of GI parasites was 52.00%. Among the positive samples, single infection was found to be more (53.84%) than themixed infection (46.15%). Out of which, oesophagostomosis was 17.00% and found as single infection. In oesophagostomosis, significant gross lesions observed in the small and large intestine were multiple small to large, round to irregular, hard, fibrotic, raised nodules. The wall of the large intestine was greatly thickened and oedematous and the nodules were seen projecting into the lumen and mucosal surface was intact. On histopathological examination, ileum of sheep showed parasitic nodules with central baso-eosinophilic necrotic area, larval stages in the necrotic area, surrounded by layers of inflammatory cells and finally encapsulated in a thick fibrous connective tissue capsule. Immunohistochemistry (IHC) with Vimentin showed intense cytoplasmic positive signals DAB Brown. PCR was carried out targeting ITS2 regions of the O. columbianum and O. venulosum. DNA isolated from both the faecal eggs and adult worms showed good amplification.

Single 15-Min Protocol Yields the Same Cryoablation Size and Margin as the Conventional 10–8–10-Min Protocol: Results of Kidney and Liver Swine Experiment

The objective was to determine the ablation size of a single 15-min freeze and compare it with the conventional 10-min freeze-8-min thaw-10-min freeze protocol. Secondary objectives were to determine the ablation margin and to ascertain whether islands of viable tissue remain within the ablation zone. Five adult swine under general anesthesia were used. After surgical abdominal exposure, two ablations were performed in liver and two in kidney. One ablation utilized the 15-min and the second the 10-8-10-min protocol. At maximum ice-ball, tissue ink was infused via an angiographic catheter in hepatic or renal artery to stain the non-frozen tissue. Animals were euthanized and organs examined macro- and microscopically. Three histological regions were observed: (A) a viable/stained region representing the tissue outside the ice-ball, (B) a central necrotic area representing the ablated region within the ice-ball and (C) an unstained but viable margin representing the non-lethal margin within ice-ball. Ablation size did not vary with protocol but did for tissue type. Renal ablation was approximately 5 × 4cm with both protocols, whereas liver ablation was approximately 6.7 × 4.4cm. Ablation margin was measured at 1mm irrespective of ablation protocol or tissue. No islands of viable tissue were identified within the ablation zone. Fifteen-minute cryoablation yielded an ablation size and margin identical to that of the conventional 10-8-10-min protocol. Within the ablated region, cell death was uniform. The only difference was a larger cryoablation zone in hepatic tissue compared to renal tissue, likely attributable to differences in blood perfusion.

Unusual Necrotizing Uterine Adenocarcinoma in a Dog

A 2-year-old female Maltese dog was admitted with a history of pyometra and resulting peritonitis and septicemia. Uterine specimen sampled by ovariohysterectomy was processed routinely for histopathological observation. Grossly, the uterine mucosa was covered with necrotic debris and on the cut surface, lesion extended into the uterine wall. Microscopically, severe necrosis was observed throughout thickened mucosa, submucosa, and wall of uterus. Tumorous lesions composed of anaplastic cells with bizarre nuclei or tubular structures of cuboidal to short columnar cells were infrequently observed around the necrotic lesions and muscular layer far from necrotic areas. Immunohistochemically, central necrotic area with ambiguous cell and tissue structures, peri-necrotic tumor lesions, and muscular layer were strongly positive for cytokeratin. Since huge necrosis of adenocarcinoma lesions in this case made it difficult to diagnose, immunohistochemical results enable to diagnose as a severe necrotizing adenocarcinoma. Thus, histopathological and immunohistochemical findings in this case may serve as an important knowledge to diagnose uterine adenocarcinoma with huge necrosis in the veterinary field.