Cm In Diameter Research Articles

Anatomopathological characterization of hepatocellular carcinoma in a jaguar (Panthera onca).

A 21-year-old jaguar (Panthera onca) with a low body score, pale ocular mucosa, severe dehydration, and decubitus eschar was referred to our veterinary hospital. The patient died and underwent a postmortem examination to establish a diagnosis. Macroscopic evaluation revealed a reddish-black, well-defined, focally extensive mass measuring 12cm in diameter on the visceral surface involving the left lateral lobe of the liver. The mass was surrounded by a capsule and exhibited diffuse hemorrhage, cystic areas, infiltrative zones on cross-section, and areas of morphologically compatible fatty liver degeneration. The primary differential diagnoses included adenoma, hepatocellular carcinoma, and cholangiocarcinoma. Microscopic analysis showed malignant hepatocytes forming irregular trabeculae of two or more cells, with vascular spaces between them, rudimentary acini, and neoplastic cell aggregates scattered throughout the parenchyma. Additional findings included coagulative necrosis, macrophage infiltration, hepatocyte cord formation, moderate pleomorphism, anisokaryosis, and the presence of discrete binucleated and multinucleated cells. To our knowledge, this is the first report of hepatocellular carcinoma in a jaguar. This information may aid veterinary pathologists in reporting hepatic alterations and characterizing anatomopathological findings in jaguars, representing a valuable contribution to the literature.

Robotic trachelectomy with sentinel lymph node biopsy for cervical cancer: a prospective study investigating minimally invasive radicality.

The importance of minimally invasive fertility-sparing surgery for cervical cancer is gaining increasing interest, both to achieve a cure and for future fertility. Procedures for robotic radical trachelectomy involving uterine reconstruction are not fully established. This study prospectively verified the feasibility and safety of robotic radical trachelectomy between February 2018 and May 2022. The criteria were almost identical to those for our standard abdominal radical trachelectomy. Larger tumors (> 2cm in diameter) were acceptable for surgery, provided a secure ≥ 1cm cancer-free space was identified between the tumor and internal os. Eight patients (median age, 32 y) were registered; the median body mass index was 21.8, and the median tumor size was 11.5mm (range 0-30mm). Robotic radical trachelectomy could be achieved in all patients with hybrid sentinel lymph node navigation surgery, confirming the precise cervical amputation line with a newer small knob ultrasonography probe, adequate cervical cerclage with non-absorbable monofilament stitches, and avoiding looseness between vaginal-uterine anastomosis with uninterrupted barbed U-shaped sutures. None of the cases were converted to laparotomy or radical hysterectomy, and there were no major complications. The median follow-up period was 49.5 mo (range 21-58 mo) and no patient had disease recurrence. Robotic radical trachelectomy is safe and feasible using newer technologies without reducing radicality; it is also less invasive. Procedures are consistently reproducible and have the potential to be generalized to minimally invasive approaches.

Preoperative high-precision three-dimensional reconstruction in laparoscopic splenectomy for supramassive splenomegaly: a case report and literature review

BackgroundMassive splenomegaly is considered to pose a high risk for laparoscopic splenectomy (LS). We report a case of supramassive splenomegaly wherein the patient successfully underwent LS guided by preoperative three-dimensional (3D) reconstruction.Case presentationA 35-year-old female had a history of autoimmune hepatitis spanning 4 years, accompanied by progressive splenomegaly. Her spleen had grown to a size of 27.3 cm in diameter, and a consistent decline in her blood cell counts had been noted over the same period. Considering the significant enlargement of the spleen and the technical challenges associated with LS in such instances, a preoperative 3D reconstruction was performed. This 3D model accurately delineated the splenic artery and depicted the positional relationships between the enlarged spleen and nearby organs, thus supporting detailed preoperative planning. Following the surgical route determined in the preoperative planning, 3D assistance enabled the safe ligation of the splenic artery and meticulous separation of the spleen from adjacent tissues. The patient’s postoperative recovery was smooth and free from complications.ConclusionMeticulous preoperative 3D planning may help overcome technical difficulties and enable successful LS even in patients with supramassive splenomegaly.

Giant Coronary Artery Aneurysm

Abstract Coronary artery aneurysm is seen in about 5% of the population undergoing coronary angiogram. However, giant aneurysms, defined as >2 cm in diameter, are rare. The diagnosis and management of giant coronary artery aneurysms are not well defined due to limited experience and rarity of cases. We present the case of a 49-year-old female who presented with a history of palpitations and chest pain on exertion for 1 year. She had undergone coronary angiogram, which showed dilated right coronary artery draining into a giant aneurysmal sac. Computed tomography showed dilated and tortuous right coronary artery with a giant aneurysm arising from posterior descending artery. The aneurysmal sac was excised and aneurysmorrhaphy done with ligation of proximal vascular communication.

Minimally Invasive Approach In The Treatment Of Lung Abscess: A Case Report

Background : Lung abscess is characterized by a localized collection of pus or necrotic tissue in the lung parenchyma, which develops into a cavity. Early diagnosis and appropriate management are essential to prevent further complications. Minimally invasive procedures can be performed on lesions larger than 6cm in diameter. Case Report : A 63-year-old man came with a chief complaint of progressive shortness of breath and coughing up blood. The cough had been present for 1 month, accompanied by night sweats, and weight loss. The patient's general condition appeared thin. Physical examination showed decreased fremitus and dull percussion in the left hemithorax. Laboratory results showed leukocytosis with increased neutrophils. Chest radiography showed air-fluid level in the inferior zone and the left parahilar cavity with infiltration suggest a suspected lung abscess. Based on the findings obtained, the patient underwent percutaneous drainage guided by ultrasound ( U S -guided drainage ) using a 14-gauge abbocath needle as a therapeutic procedure. The procedure was performed twice, evacuating 400 cc and 250 cc of purulent fluid. Thoracic radiology evaluation showed resolution of the lung abscess, along with significant clinical improvement in the patient. The patient received metronidazole antibiotic therapy combined with ceftriaxone. The patient underwent treatment for 5 days, before finally being allowed to go home. Discussion: In cases of lung abscess, if conservative therapy using antibiotics does not provide adequate improvement, then invasive intervention such as open surgical procedures is needed. Minimally invasive approaches such as ultrasound-guided percutaneous drainage are an alternative option in areas with limited resources and no computed tomography (CT) facilities. This approach is considered to provide shorter hospitalization and faster recovery. In this case, the percutaneous drainage procedure in cases of lung abscess showed good clinical improvement in the patient. Conclusion: Lung abscess is a serious condition that requires rapid diagnosis and intervention. Ultrasonography-guided percutaneous drainage has been shown to be effective as a therapeutic modality in treating lung abscess . Operator reliability in operating ultrasonography can reduce the risk of complications that may occur.

Effects of installation method on the behavior of driven piles and piles bored using a manual auger in tropical collapsible soil

Understanding the effects of installation method on a deep foundation is fundamental for analyzing load test results and improving foundation design based on soil profile characteristics. This study analyzed 40 load-displacement curves of driven piles and piles bored using a manual auger, measured 20 cm in diameter and 3 or 6 m in length. Piles were constructed at the Experimental Field of Geotechnical Engineering, State University of Londrina. The soil is classified as silty clay, exhibits collapsible behavior up to a depth of 7 m, and has low resistance in surface layers, according to the results of particle size analysis and the standard penetration test. Load tests were carried out under static conditions using mixed loads. Natural moisture conditions were used in the test, and pre-wetted conditions in the retest. For three bored piles, these conditions were reversed. Pre-wetted conditions resulted in loss of failure load, highlighting the collapsible nature of the soil. Conversely, piles tested under natural moisture conditions exhibited higher failure load. Load-displacement curves showed shapes consistent with the expected for the analyzed pile types. This consistency supports the discussion on the effect of the construction method on pile behavior, demonstrating that soil removal during excavation for pile boring mobilizes side friction, whereas, in driven piles, soil compaction enhances toe resistance, particularly for piles constructed by concrete pounding as compared with concrete casting.

Integration of radiomic and deep features to reliably differentiate benign renal lesions from renal cell carcinoma.

Integration of radiomic and deep features to reliably differentiate benign renal lesions from renal cell carcinoma.

Neuronal guanine nucleotide exchange factor promotes the axonal growth and cancer cell proliferation via Ephrin-A3/EphA2 axis in lung adenocarcinoma

BackgroundNeural infiltration has been found in various cancers and the infiltrating nerves influence tumor growth and dissemination. In non-small cell lung cancer, pan-neuronal marker PGP9.5 was detected by immunohistochemical staining and its high expression correlated with poor prognosis. However, the existence of nerve fibers and the mechanism driving neural infiltration remains unclear.MethodWe first used immunohistochemical staining to assess the density of nerve fibers in patients with lung adenocarcinoma of different tumor sizes. Following that, we performed differential expression analysis and univariate Cox prognostic analysis, using public datasets and cell experiments to identify the gene that triggers neural infiltration and is associated with cancer progression and unfavorable prognosis. Finally, molecular biology experiments and a subcutaneous tumor model were used to deeply analyze the mechanism that the gene regulates neural infiltration and tumor progression.ResultsIn lung adenocarcinoma patients, the density of PGP9.5 positive nerve fibers within tumors larger than 2 cm in diameter is significantly higher than that in tumors smaller than 2 cm. Bioinformatics analysis suggested NGEF, KIF4A, and PABPC1 could be the genes that trigger neural infiltration and are associated with cancer progression and unfavorable prognosis. Subsequent co-culture experiments with neurons showed that the increased expression of NGEF in lung cancer cells significantly enhanced axonal growth in neurons. Meanwhile, GSE30219 datasets indicated that patients exhibiting high levels of NGEF expression are associated with larger tumor sizes, higher lymph node involvement, and reduced overall survival rates. At the level of molecular mechanisms, the knockdown of Ephrin-A3 in ND7/23 neurons or the use of ALW-II-41-27 resulted in a significant decrease in neurite outgrowth when co-cultured with LA795 cells. In animal model, NGEF overexpression significantly promoted tumor growth and increased the density of nerve fibers, and these effects were inhibited by ALW-II-41-27.ConclusionsNGEF facilitates the infiltration of nerve and the growth of cancer cells in lung adenocarcinoma through the Ephrin-A3/EphA2 pathway, suggesting that NGEF is a promising target for disrupting interactions between nerves and tumors. Biomaterials that focus on NGEF are anticipated to be a potential treatment option for lung cancer.

First report of Rhizoctonia solani AG 5 causing stem lesion and root necrosis of mint in Idaho

In August 2023, disease symptoms were noted on mint plants (Mentha arvensis) in two southwest Idaho fields with 10 to 30% of the plants exhibiting dark brown stem lesions and root necrosis. To identify the causal agent, isolations from symptomatic tissue were conducted. The surface of the disease material was treated with sodium hypochlorite (0.6%) for 1 minute and washed three times using sterile water. Approximately 2 mm³ tissue sections were cultured on water agar supplemented with 0.02% penicillin and 0.08% streptomycin and incubated at room temperature for 3-5 days. Fungal colonies were tentatively identified as Rhizoctonia from right-angle branching and septate hyphal structures, slight constriction and septum near the branch base. Single hyphal tips were transferred to potato dextrose agar (PDA) and grown at room temperature. Approximately five isolates with a consistent macromorphology were observed. These isolates had light brown mycelia and produced 1-10 mm light brown to dark irregularly shaped sclerotia after a month at ambient temperature with no exposure to continuous light. A representative isolate, designated 23D360 was selected for sequencing and pathogenicity testing. Isolate 23D360 mycelia were removed with a scalpel after 7 days of growth for DNA extraction (Synergy Kit, OPS Diagnostics, N.J., USA) and sequencing of the rDNA internal transcribed spacer (ITS) region and translation elongation factor 1α (tef1α) (Sharon et al. 2008). For ITS a 693 bp amplicon was generated and the sequence was submitted to GenBank (Accession PQ068734). NCBI-BLAST indicated this sequence was 100% identical to an isolate previously identified as R. solani AG 5 (Accession MW999177). For tef1α a 708 bp amplicon was generated and the sequence was submitted to Genbank (Accession PV021964). This tef1α sequence also had a 100% identical match to a previously characterized R. solani AG 5 strain (Accession OP832176). Final confirmation of 23D360 was done using an AG 5 specific real-time PCR assay which targets the beta-tubulin gene (Budge et al. 2009). Pathogenicity testing was performed twice on thirteen 1-week-old mint transplants cultivar ‘Black Mitcham Scottish’ grown in premium potting compost (Scotts) in greenhouse conditions (30°C, 12h daylight). Barley seeds soaked in water overnight were autoclaved twice, inoculated with a mycelial plug of isolate 23D360 and incubated for 2 weeks at ambient room temperature (25°C). Barley seed inoculum (5 g) was placed around each transplant at the root and stem convergence point. Thirteen 1-week-old transplants were mock-inoculated with autoclaved barley seeds as a control. Approximately 23% damping-off incidence was observed on inoculated transplants five days post-inoculation, while control transplants remained healthy. At 21 days post-inoculation, plants were assessed for visible stem lesions and root necrosis. The incidence of stem lesions occurred on 80% of seedlings, with all transplants with stem lesions ranging from 1-4 cm in diameter and root necrosis. No inoculated transplants were free of stem lesions and root necrosis. R. solani was re-isolated from symptomatic tissue, with a 90% isolation frequency, and rDNA ITS sequencing was used to confirm identity as AG 5, thus confirming Koch’s postulates. R. solani was reported in mint in Florida (Alfieri et al., 1984), Indiana (Green, 1961), North Carolina (Grand, 1985), the Pacific Northwest of Oregon (Horner, 1952), and Washington (Shaw, 1973) but not in Idaho. No information on anastomosis groupings was reported in previous literature. Nitzan et al. (2012) identified a new disease affecting Mentha longifolia, a species of mint produced and exported from Israel. Two isolates from symptomatic plants were identified as R. solani AG 1-IB and 4 HG-I. To our knowledge, the isolate 23D360 described here, is the first record of R. solani AG 5 in mint in Idaho. Idaho ranks second in U.S. peppermint production where much of the mint is concentrated in the southwest of the state, this report will create awareness among mint growers on the presence of this fungal disease.

Pembrolizumab (Keytruda)

Canada’s Drug Agency (CDA-AMC) recommends that Keytruda be reimbursed by public drug plans for the adjuvant treatment of adult patients with stage IB (with tumour[s] of 4 cm in diameter or larger), II, or IIIA non–small cell lung cancer (NSCLC) who have undergone complete resection and platinum-based chemotherapy and whose tumours have a PD-L1 tumour proportion score (TPS) of less than 50%, as determined by a validated test, if certain conditions are met. Keytruda should only be covered to treat patients aged 18 years or older who have a diagnosis of stage IB (with tumour[s] of 4 cm in diameter or larger), II, or IIIA NSCLC whose tumours have been completely surgically removed, who have received platinum-based chemotherapy, whose tumours have a PD-L1 TPS of less than 50% as determined by pathology testing, and who are in relatively good health (as measured by performance status). Keytruda should not be covered for patients who have received or planned to receive radiation therapy before or after surgery, and/or who are receiving other drugs before surgery to shrink a tumour or stop its spread. Also, Keytruda should not be covered to treat patients who have had previous treatment with drugs that change how the immune system works. Keytruda should only be reimbursed if it is prescribed by clinicians with expertise in managing lung cancer and the price of Keytruda is reduced.

ANALISIS INTERAKSI TANAH-GEOFOAM TERHADAP PARAMETER KUAT GESER TANAH

The ground in the Gedebage area of Bandung city consists of soft soil at a depth of approximately 30 meters. Construction on soft soil generally suffers from high settlement and low bearing capacity. To overcome the problem of soft soil, a lightweight material solution is needed that still has the necessary strength. This research uses geofoam, a synthetic material made of EPS (expanded polystyrene), as a geotechnical material. The interaction between soil and geofoam has not been widely studied, while the use of interface value software applications are always required for the geotechnical analysis process. This study aims to analyze the effect of geofoam layer on soil shear strength parameters in Gedebage area, Bandung and geofoam interaction. The soil samples used were undisturbed soil at a depth of 2.0-2.5 meters. The test conducted was the consolidated drained (CD) type direct shear test using geofoam of PT X with the type of Geofoam EPS with geofoam sample dimensions for testing 6 cm in diameter and 1 cm in height. The results showed that the Geofoam affected the shear strength parameters of the native soil. In the direct shear test of the native soil, the cohesion value (c) was found to be 0.0392 kgf/cm2 and the internal shear angle was 23.44 degree. While in the direct shear test of native soil with Geofoam, the cohesion value (c) was 0.5598 kgf/cm² and the internal shear angle was 7.02 degree. The Rinterface value of the interaction between soil and Geofoam is 0.284

Recurrent Giant Subcutaneous Tumor in Juvenile Hyaline Fibromatosis.

This case report presents a 5-year-old boy diagnosed with juvenile hyaline fibromatosis (JHF), an extremely rare autosomal recessive disorder characterized by the abnormal accumulation of collagen. The patient exhibited a recurrent giant subcutaneous tumor measuring 20cm in diameter, along with multiple tumors in the oral cavity, gingiva, and joints, leading to significant facial deformity and functional impairments. Previous surgeries at ages 1 and 2 for tumor removal resulted in recurrence. Surgical intervention was performed to excise the large tumor and alleviate symptoms. Pathologic analysis confirmed the diagnosis of JHF. This case highlights the challenges in managing JHF and the need for multidisciplinary approaches in treatment.

Magnetic Resonance Elastography of Invasive Breast Cancer: Evaluating Prognostic Factors and Treatment Response.

Objectives: To assess the elasticity values in breast tissues using magnetic resonance elastography (MRE) and examine the association between elasticity values of invasive breast cancer with prognostic factors and the pathologic response to neoadjuvant systemic therapy (NST). Methods: A total of 57 patients (mean age, 54.1 years) with invasive breast cancers larger than 2 cm in diameter on ultrasound were prospectively enrolled. The elasticity values (mean, minimum, and maximum) of invasive breast cancers, normal fibroglandular tissues, and normal fat tissues were measured via MRE using a commercially available acoustic driver and compared. Elasticity values of breast cancers were compared according to prognostic factors and pathologic responses in patients who received NST before surgery. Receiver operating curve analysis was performed to evaluate the predictive efficacy of elasticity values in terms of pathological response. Results: Among the 57 patients, the mean elasticity value of invasive breast cancers was significantly higher than that of normal fibroglandular tissue and normal fat tissue (7.90 ± 5.80 kPa vs. 2.54 ± 0.80 kPa vs. 1.32 ± 0.33 kPa, all ps < 0.001). Invasive breast cancers with a large diameter (>4 cm) exhibited significantly higher mean elasticity values relative to tumors with a small diameter (≤4 cm) (11.65 ± 7.22 kPa vs. 5.87 ± 3.58 kPa, p = 0.002). Among 24 patients who received NST, mean, minimum, and maximum elasticity values significantly differed between the pathologic complete response (pCR) and non-pCR groups (all ps < 0.05). For the mean elasticity value, the area under the curve value for distinguishing pCR and non-pCR groups was 0.880 (95% confidence interval, 0.682, 0.976; p < 0.001). Conclusions: The elasticity values of invasive breast cancers measured via breast MRE showed a positive correlation with tumor size and showed potential in predicting the therapeutic response in patients receiving NST.

Investigation of factors related to treatment planning of x-ray SBRT and scanning carbon-ion radiation therapy for early-stage lung cancer patients.

This study aimed to compare the treatment plans of x-ray SBRT and scanning carbon ion radiation therapy (CIRT) for localized lung tumors, and to evaluate the dose dependence of tumor size tumor-to-heart distance. For phantom verification, we used a chest phantom with a spherical simulated tumor. Treatment plans for 3-dimensional conformal radiation therapy (3D-CRT), volumetric modulated arc therapy (VMAT), and CIRT were created. GTVs were created in sizes ranging from 0.5 to 5cm in diameter, and the dependence of the lung dose on GTV diameter was evaluated for each treatment plan. For patient validation, 30 cases of localized lung tumors were analyzed. 3D-CRT, VMAT, and CIRT treatment plans were developed, and DVH parameters were evaluated for each GTV size and GTV-to-heart distance. In both phantom and patient validations, the OAR doses were the lowest for CIRT. The lung dose increased with increasing GTV diameter for all three treatment plans. CIRT had the smallest ratio of lung dose increase to GTV diameter increase among the three treatment plans. Heart dose in CIRT was independent of GTV size and GTV-to-heart distance Conclusions: The results of the present study suggested that the use of scanning CIRT can reduce the OAR dose while guaranteeing the tumor dose compared to x-ray SBRT. In addition, it was suggested that CIRT can treat patients with large GTV sizes while maintaining low lung and heart dose.

Case Report: Giant Colonic Lipoma, a Rare Benign Tumor Mimicking Malignancy

Background and Clinical Significance: Colonic lipomas are benign tumors composed of adipose tissue, frequently asymptomatic and found incidentally on routine surveillance. Most lesions are smaller than 2 cm in diameter, while giant lipomas are characterized as over 4 cm. Giant colonic lipomas, though rare, may present with obstructive symptoms, gastrointestinal bleeding or intussusception and can mimic malignant lesions on imaging and endoscopic examination. Historically, the resection of these lesions has been limited to those that are larger or symptomatic. Recent observations indicate that lipomas may retain growth potential and can become symptomatic over time, though being inconsequential initially. Surgical resection is favored over endoscopic excision for lipomas above 2 cm to mitigate risks including haemorrhages and perforations. Case Presentation: We report a case of a 38-year-old female who exhibited non-specific gastrointestinal symptoms with a high suspicion of malignancy based on imaging and endoscopy but was ultimately diagnosed with a benign giant colonic lipoma. Conclusions: This case presents the challenges in diagnosing giant colonic lipomas, which, in certain cases, can mimic malignant lesions. Histopathological analysis remains the gold standard for confirming the diagnosis, especially in cases with atypical features.

MRI-Conditional Tissue Expanders in Breast Reconstruction: Clinical Outcomes and Radiation Therapy Implications.

MRI-conditional tissue expanders (MRI-CTEs) were developed to address imaging artifacts and challenges in radiation planning associated with traditional tissue expanders (TTEs). This study aims to compare the clinical outcomes and radiation protocol impacts of MRI-CTEs versus TTEs in postmastectomy breast reconstruction. A retrospective review was conducted on immediate breast reconstruction with MRI-CTEs or TTEs between 2021 and 2024. Outcomes such as seroma, infection, malposition, and expander loss were analyzed. A total of 867 tissue expanders were evaluated in 559 patients. The MRI-CTE cohort consisted of 103 patients (161 devices), and the TTE cohort included 456 patients (706 devices). Demographics, surgical details, and outcomes did not differ significantly including seroma (P=0.091), malposition (P=0.827), and mastectomy skin flap necrosis (P=0.251). Three cases (1.9%) in the MRI-CTE cohort required MRI evaluation but did not require explantation. The MRI-CTE group had a lower need for artifact management during radiation therapy and reduced imaging artifact size from 4 cm to 1 cm in diameter, allowing for a reduction in planning target volume margins from 20 mm to 5 mm, improving delineation accuracy by 75% and decreased irradiation of healthy tissue by up to 60%. MRI-CTEs may contribute to improved clinical outcomes with fewer surgical interventions and enhanced precision in radiation treatment planning. MRI-CTEs demonstrated similar surgical outcomes to TTEs but offered improved accuracy in radiation dose calculations. Reduced manual interventions for artifact adjustment decrease the potential for human error, enhancing the overall precision of radiation treatment delivery.

Germline DNA repair gene variants in patients under active surveillance for low-grade bladder cancer: Implications for risk stratification.

849 Background: The growing interest in de-intensifying therapeutic strategies for low-grade bladder cancer (BC), including active surveillance (AS), highlights the imperative need for precise patient stratification criteria. The major clinical challenge is the identification of patients at risk for progression to high-grade disease. To address this unmet need, we investigated the role of germline pathogenic variants (PVs) and variants of unknown significance (VUS) in DNA repair genes (DRG) to refine patient selection for AS. Methods: This ongoing prospective study includes patients with bladder cancer who have been enrolled in an AS protocol for a minimum of 12 months. Whole-exome sequencing was performed to screen for PVs and VUS in DRG (including TM, ATR, MRE11A, BAP1, BARD1, BRCA1, NBN, BRCA2, PALB2, BRIP1, CHEK2, RAD51C, FAM175A, RAD51D, GEN1, XRCC1, and the mismatch repair genes MLH1, PMS2, MSH2, and MSH6). The inclusion criteria for AS include suspicious recurrence at follow-up cystoscopy following a histopathologically confirmed diagnosis of low-grade pTa/pT1a NMIBC, with a maximum of five suspicious lesions, each no larger than 1 cm in diameter, absence of gross hematuria, and negative urinary cytology (UC). The primary endpoint was to describe the prevalence of PVs and VUS in AS patients. Patients with high-grade NMIBC and muscle-invasive bladder cancer (MIBC) were included as positive controls and screened for the same set of genes. This study is funded by the Associazione Italiana per la Ricerca sul Cancro (AIRC) under Protocol ICH-2812, code IG 2020-ID-25027. Results: From January to June 2024, a total of 15 patients under AS were tested. The median duration of surveillance at the time of testing was 16 months. All patients had a history of low-grade bladder cancer, with a median interval of 23 months between initial diagnosis and entry into the active surveillance protocol. None of the patients in the AS cohort harbored pathogenic variants in the targeted genes analyzed. In the positive control group, consisting of 10 patients with HG-NMIBC and 16 with MIBC, a total of 18 variants were identified, including 17 VUS and 1 PV. The distribution of variants was as follows: ATM (N=4), ATR (N=3), BARD1 (N=3), PMS2 (N=2), with one variant each in BRCA2, MSH6, NBN, PALB2, and GEN1. The single risk variant was detected in the CHEK2 gene. Conclusions: Our study indicates that none of the patients under AS with NMIBC harbored PVs or VUS the targeted genes. On the contrary, in the positive control group (NMIBC and MIBC), multiple VUS and one risk variant were identified, suggesting that germline DNA repair gene analysis may be more relevant in higher-risk bladder cancer cohorts. These findings underscore the need for further investigation into the utility of genetic screening, which might play a crucial role in refining patient selection for AS protocols in the future.

Delayed dural graft breakdown and intracranial hypotension following posterior fossa decompression and duraplasty for Chiari malformation type I: illustrative case.

Chiari malformations type I are commonly encountered in pediatric patients. Posterior fossa decompression with or without duraplasty is recommended for patients with intractable symptoms, as well as those showing evidence of brainstem dysfunction. In this report, the authors describe the case of a 19-year-old female who presented to the neurosurgery clinic with delayed synthetic dural graft breakdown as well as associated pseudomeningocele and intracranial hypotension. She underwent exploration and revision of her duraplasty, where a dural defect measuring 1.5 cm in diameter was observed. The defect was not contiguous with peripheral sutures. The defect was repaired with a pericranium autograft and reinforced with dural sealants. Her postoperative course was complicated by scalp dysesthesia. To the authors' knowledge, this is the first reported case of a synthetic dural graft breakdown following posterior fossa decompression with duraplasty. https://thejns.org/doi/10.3171/CASE24715.

Unlocking Rare Cerebral Hydatid Cysts in 8-Year-Old Girl

Brief medical history: An 8 year old girl, previously healthy, presented to ER with 20 days h/o blurred vision + right eye progressively increasing in size. Intermittent headache mainly on the right side of head, but no history of fever, vomiting, neurological deficit, urinary retention or incontinence. On examination she was found to have Papilledema. Diagnostic hypothesis: When formulating a differential diagnosis for an enlarging eye size it is important to know if the sinuses are involved, optic nerve, ocular muscle, cavernous sinus and the brain parenchyma. Radiological findings with clinical outcome: A CT scan performed and it showed a large left frontal intra-axial cystic lesion measuring 9 x 9 cm with multiple peripheral solid nodules and mass effect on the brain parenchyma. Differential diagnosis: The differential diagnosis of enlarging globe size and blurred vision includes Orbital cellulitis as it shows soft tissue swelling, diffuse edema and abscess formation. Optic neuritis will show optic nerve enhancement on MRI with gadolinium contrast. Orbital tumors as it will cause mass effect in the orbits displacing the optic nerve. Thyroid eye disease as it shows enlarged extra ocular muscle with no tendon involvement. Cavernous sinus thrombosis as it shows non-opacification of cavernous sinus with venous congestion. Brain tumor with mass effect are involved in the differentials. Outcome, with definitive pathological diagnosis: Based on radiology finding the pathway was leading toward cerebral hydatid cyst with mass effect pushing the globe forward. The patient subsequently underwent surgical excision of the mass and the surgical specimen was sent to the pathology department. Axial contrast-enhanced CT scan demonstrates a large left frontal intra-axial cystic lesion measuring 9 x 9 cm with multiple peripheral solid nodules. Illustrative images of macroscopic and/or microscopic should be inserted, such as specimen photograph The cyst is large around 15 to 16 cm in diameter encapsulated in a transparent plastic bag, roughly spherical, and has a milky, translucent appearance. It likely represents a cyst formed by the parasitic infection of *Echinococcus*. The surface appears smooth and glossy, typical of the outer pericyst layer. There are also visible pale or whitish circular spots, which represent internal brood capsules or daughter cysts. Gross appearance of a hydatid cyst after it has been surgically opened. The cyst membrane is visible and has a translucent, gelatinous appearance. This likely represents the *laminated layer*, which is part of the cyst's outer wall. There are whitish nodules or masses within the cyst, which are likely protoscoleces or brood capsules. These are the larval stages of *Echinococcus*. The opened membrane has a thin, floppy appearance. Conclusion: Hydatid cysts present as well- circumscribed, fluid-filled, round lesions that may cause mass effect and compression of the surrounding parenchyma particularly the brain and orbit. Hydatid cysts are non enhancing, homogenous appearing cyst. Early detection is crucial to prevent complication, as cyst rupture or expansion can lead to severe outcomes such as increase intracranial pressure or secondary infection.

A novel scoring system proposal to guide treatment of dogs with hepatoid gland tumors.

Hepatoid perianal gland tumors are relatively common in dogs, accounting for 25% of all skin tumors. However, the specific factors involved in their development are still not completely clear. It has been established that hormonal influences can impact the formation of these tumors. The prognosis for dogs with perianal tumors depends largely on histology (benign vs. malignant) and, in case of malignancy, it has been suggested that the stage of the disease is important, with a more favorable outcome in dogs having small (under 5 cm in diameter), non-metastatic adenocarcinomas which are surgically removed with non-infiltrated margins. Nevertheless, there is a paucity of studies which thoroughly relate hepatoid gland histotypes to their prognosis; therefore, it is possible that a well-differentiated adenocarcinoma could be misclassified. Based on a retrospective review of 76 dogs with hepatoid gland tumors having clinical follow-up, the aims of this study were (1) to establish a histological grading system capable of potentially predicting prognosis and (2) to explore the role of Ki67 as a potential prognostic marker. Based on histopathological features only, the proposed grading system effectively differentiated tumors with a favorable prognosis from those with a worse prognosis to support histological diagnosis. The evaluation of the Ki67 index was not useful to predict prognosis in this study.