Cm In Diameter Research Articles

The clinical effect of thoracoscopic segmentectomy in the treatment of lung malignancies less than 2CM in diameter

ObjectiveTo investigate the clinical effect of thoracoscopic segmentectomy in the treatment of lung malignancies less than 2CM in diameter.MethodsIn this retrospective study, a total of 103 patients with lung cancer who received outpatient or inpatient treatment from December 2020 to May 2022 were selected and divided into the lobectomy group (n = 48) and the segmentectomy group (n = 55) according to different surgical methods. The lobectomy group was treated with thoracoscopic lobectomy, while the segmentectomy group was treated with thoracoscopic segmentectomy. The prognostic effect, complications, blood gas level and respiratory function indexes of the two groups were observed and compared.ResultsThe general data of the two groups of patients, such as gender, age, course of disease, body mass index, lesion diameter, lesion site and pathological type, were analyzed by statistical software. There was no statistical significance in the operation time and the number of lymph node dissection between the two groups (P > 0.05), while the drainage volume and intraoperative blood loss in the segmentectomy group were lower than those in the lobectomy group, and the drainage time and hospital stay were shorter than those in the lobectomy group, with statistical significance (P < 0.05). Before treatment, there were no statistically significant differences in various lung function indexes between the two groups (P > 0.05). After treatment, the values of FVC, FEV1 and FEV1/FVC in each group had different amplitude changes, and the values of FVC, FEV1 and FEV1/FVC in the segmentectomy group were significantly higher than those in the lobectomy group, with statistical significance (P < 0.05). Thoracoscopic segmentectomy showed a lower incidence of respiratory complications (P = 0.042) and higher pulmonary air leak (P = 0.023) than thoracoscopic lobectomy. After propensity score-matched analysis, respiratory complications remained significantly higher in thoracoscopic segmentectomy (P = 0.017). However, the difference in the total complication rate between the two groups was not statistically significant (P > 0.05). There were no differences during the 2-year follow-up (median follow-up in months: 18.4; interquartile range, 14.8–21.3) in terms of overall survival (P = 0.49) and disease-free survival (P = 0.34) between groups (P > 0.05).ConclusionsFor patients with lung cancer less than 2 cm in diameter, thoracoscopic segmentectomy can achieve good short-term efficacy, with rapid postoperative recovery and little impact on lung function, which may be helpful to improve patients’ postoperative quality of life.

First report of Alternaria leaf spot caused by Alternaria brassicae on broccoli in North Carolina, United States.

In September 2023, broccoli (Brassica oleracea var. italica) 'Sweet Bunch' plants on an organic farm in Buncombe County, North Carolina (NC), displayed symptoms of Alternaria leaf spot. Disease affected 10 to 20% of leaf area on all (approximately 30) plants. Lesions were dark brown with chlorotic halos, irregular in shape, and ≤3 cm in diameter. Leaf samples were incubated in a humidity chamber for 24 h, and the pathogen was putatively identified as Alternaria brassicae based on conidial morphology (Rimmer et al. 2007; Supplemental Fig. 1). Leaf pieces (2 x 2 mm) spanning lesion edges were surface-disinfested (1% sodium hypochlorite solution) for 1 min, rinsed in sterile distilled water, embedded in potato dextrose agar, and incubated at 22°C with a 12-h photoperiod. A pure culture was obtained by transferring a hyphal tip onto 20% V8 juice agar and incubated as above. After 10 d, colonies consisted of concentric zones of white to brown mycelia with white, aerial mycelia. Within 7 d, conidia measuring 80 to 150 µm long with 0 to 3 longitudinal septa, 6 to 15 transverse septa, and a long beak were observed, and the isolate was putatively identified as A. brassicae (Rimmer et al. 2007). To confirm identification, DNA was extracted from mycelia and subjected to PCR using primers to amplify a portion of the internal transcribed spacer of rDNA (ITS: ITS1/ITS4) (White et al. 1990), the transcription elongation factor-1 (tef1: EF1-728F/EF1-986R) (Carbone and Kohn 1999), and the glyceraldehyde-3-phosphate dehydrogenase gene (GAPDH: gpd1/gpd2) (Berbee et al. 1999). Amplicons were sequenced at Eton Bioscience (Durham, NC) and subjected to BLAST analysis in NCBI GenBank. Sequences matched (99.5 to 100% identity) A. brassicae CBS 116528 accessions KC584185 (ITS), KC584641 (tef1), and KC584102 (GAPDH) (Woudenberg et al. 2013). All sequences were deposited in NCBI GenBank (accessions PP584506, PP584507, PP584508). To confirm pathogenicity on broccoli and kale (B. oleracea var. sabellica), 5-week-old plants of broccoli 'Sweet Bunch', 'Eastern Crown', and 'Green Magic' and kale 'Winterbor', 'Darkibor', and 'Oldenbor' grown in 10-cm-diameter pots were separated by crop type and arranged in four randomized complete blocks by cultivar. Each block contained single-plant replicates of each cultivar that were either inoculated or non-inoculated. Conidia of A. brassicae obtained from 10-d-old cultures (3.5 x 103 conidia/ml) were sprayed onto each inoculated plant until run-off. Non-inoculated plants were sprayed with distilled water. Plants were incubated in a humidity chamber alternated with ambient greenhouse conditions every 48 h for 10 d, with average greenhouse temperatures ranging from 15 to 28°C. The experiment was conducted twice. Dark brown to gray lesions measuring 1 to 3 mm in diameter were observed on leaves of all inoculated plants within 5 d of inoculation (Supplemental Fig. 2), and non-inoculated plants remained healthy. On broccoli plants, lesions expanded in concentric rings, and sporulation of the pathogen was observed on leaf tissue and petioles 10 d after inoculation. Lesions remained small (< 3 mm) on kale plants, and sporulation was not observed. Alternaria brassicae was re-isolated from leaf tissue of all inoculated cultivars using methods described above. Pathogen identity was confirmed via colony and conidial morphology. The larger impact of A. brassicae on brassicas is unknown, but finding this less common Alternaria species in the eastern United States could have implications for host resistance development and fungicide efficacy (Nieto-Lopez et al. 2023).

Ruptured solitary fibrous tumor of the pleura with hemothorax: a case report

BackgroundThe majority of the patients with a solitary fibrous tumor (SFT) of the pleura are asymptomatic, and rupture of an SFT with hemothorax is rare.Case presentationA 48-year-old man was taken by ambulance to our hospital because of sudden onset of left chest pain. Two months before the referral, a tumor was detected in the left upper lobe of the lung by screening computed tomography at another hospital, and further observation was recommended, because the tumor was suspected to be benign. Our contrast-enhanced computed tomography analysis of the chest revealed a solid tumor (5 cm in diameter) with an irregular enhancement effect close to the pericardium and pleural effusion in the left thoracic cavity. Pleural effusion was not detected in the previous imaging analysis. CT number of the pleural effusion was 40 HU, and the pleural effusion was suspected to be hematogenous. Therefore, rupture of the tumor with bleeding was suspected as the cause of the effusion because of the sudden onset. Preoperative diagnosis was a mediastinal tumor, such as a teratoma, because the tumor was close to the pericardium. Thoracoscopic surgery was performed with the patient in the right lateral decubitus position; bloody pleural effusion was observed and drained. The tumor originated from the visceral pleura of the left upper lobe of the lung and was resected with a surgical stapler. Macroscopic analyses of the resected tumor indicated that bleeding were caused by the rupture of the tumor at the defect of the capsule wall. The operation took 63 min. The postoperative pathological diagnosis was a benign SFT. Hemorrhage was observed just under the capsule wall of the tumor. The postoperative course of the patient was uneventful, and he was discharged 2 days after surgery.ConclusionsEven when an SFT is neither huge nor malignant, rupture can occur, and resection should be considered regardless of the size or malignant characteristics. After an SFT rupture, careful follow-up is needed to monitor for the intrathoracic recurrence or dissemination of the tumor.

Histomorphometric analysis of excisional cutaneous wounds with different diameters in an animal model.

The skin wound model in rats is a fundamental stage in preclinical trials, but there is a lack of standardization in these trials regarding the initial wound area, making analysis and comparison between studies difficult. Therefore, this study evaluates the healing progression of excisional skin lesions of varying diameters in Wistar rats, aiming to identify the optimal wound size for monitoring treatment effects on wound healing. Excisions of 0.8, 1.5, 2.0 and 3.0 cm in diameter were made on the back of the animals. Thirty animals were used per treatment and evaluated on days 3, 7, 10, 14 and 21 after surgery. The lesions were cleaned daily with saline solution until they were completely closed. The 0.8 cm group showed complete repair on D14, while in the other groups, the wounds persisted until day 21, with a reddened surface and no complete epidermal coverage, but with greater keratinization and presence of appendages in the 1.5 cm lesions. Therefore, as a standardization model for creating skin wounds, we suggest using 1.5 or 2.0 cm excisions, considering that 0.8 cm wounds close very early and 3.0 cm wounds, although behaving similarly to 2.0 cm wounds, are more invasive for the animals. The 1.5 cm model proved to be suitable for closure within 21 days. When evaluating a product intended to accelerate wound healing, 2.0 cm lesions are recommended to assess the effectiveness of the treatment.

Type I Branchial Cyst of the Sedunda Cleft Uncommon presentation: Case Report

Introduction: The cyst branchial is a rare tumor as well known as cysts lymphoepithelial, are dysembryological rare and benign second cleft tumors. Tumors cystic that HE develop in the part anterolateral of the neck; represent he 2% of the tumors laterocervical of the neck [1]. Clinical Case: We present he clinical case of a patient male of 37 years, does not report personal pathological history, with a clinical picture of approximately 8 months of evolution approximately characterized by a laterocervical tumor right with progressive growth in size, not accompanied by any other symptoms. Upon examination Physical: A mobile, fluctuating tumor of approximately 5 cm in diameter is observed in the right cervical region III, with no changes in skin color. No symptoms of a sinus or fistulous tract are observed. Discussion: The cyst branchial is a rare tumor and benign second cleft tumors. Tumors cystic that HE develop in the part anterolateral of the neck, represent he 2% of the tumors laterocervical of the neck, proper physical examination determines its prompt diagnosis and surgical treatment [6]. Conclusion: In conclusion, despite their low incidence, third branchial cleft cysts should be included in the differential diagnosis of laterocervical tumors. An adequate history and physical examination, complemented by the indicated imaging tests, will allow establishing a presumptive diagnosis that should be confirmed histologically after surgical resection.

Importância da análise histopatológica no diagnóstico de sarcoma de tecidos moles

The present work aimed to inform the importance of diagnosis through histopathological analysis of a grade II soft tissue sarcoma in a mixed breed bitch. Soft tissue sarcoma (STS) is a type of malignant neoplasm that originates from mesenchymal tissues, affecting several species, but is more prevalent in medium and elderly dogs. Clinical signs are variable and depend on the location of the tumor, generally occurring in the pelvic limbs. In the present report, the patient in question had a history of a subcutaneous mass measuring 30 cm in diameter, weighing 5 kg, located on the right flank and pelvic limb. Therefore, the diagnosis was initiated through laboratory and cytopathological tests; however, definitive confirmation was obtained through histopathological analysis, confirming the diagnosis. That said, histopathological diagnosis is extremely important for determining the prognosis and choosing the most effective treatment, with surgical resection being the most indicated treatment for these cases. Although the prognosis is generally favorable after complete removal of the neoplastic mass, factors such as size, location and grade of the tumor significantly influence clinical results as in the case discussed. Reinforcing the need for a multidisciplinary approach in the diagnosis and treatment of STS, in order to promote quality of life for patients.

Wound Healing Activity of Two Honeys from the Southern Regions of Senegal (Casamance)

Aim: The aim of this study was to evaluate the healing activity of two honeys from Casamance (Senegal) in a second-degree experimental burn model in the Wistar strain rat. Methodology: Experimental burns were induced using a metal cylinder 3 cm in diameter and heated for 5 min. The cylinder was applied for 20 seconds, pressing lightly on the surface of the rats' shaved skin to induce second-degree burns. Results: The daily application of honey induces a healing dependent on concentration and typology. The healing rate is higher with AF, with a score of 0.60 ± 0.48 vs 1.00 ± 0.00 for MZ which induces almost complete tissue repair after 21 days of treatment. Conclusion: The results of this study demonstrate the use of traditional honey in wound healing and burns.

Rhizome Propagation Methods of Lowland Bamboo (Oxytenanthera abyssinica) in Central Tigray, Northern Ethiopia

Bamboo is a plant species that has a range of economic, environmental, and sociocultural importance. Bamboo can be propagated through sexual and asexual propagation methods. Both methods have their own advantages and disadvantages. This study aims to evaluate different rhizome cutting materials that are relatively suitable for large-scale plantations. The materials for propagating bamboo by vegetative means are whole or portions of the rhizomes, each with a single culm having two to six basal nodes, preferably 1- to 2-year-old culms from the peripheral portion of the clump having 2, 4, 6 basal nodes and 1.5-2 cm, 2-4 cm, and 4-6 cm in diameter. The design of the experiment is a split plot design with three replications and nine plots. This experiment is laid in 1029 m2 (21 m x 49 m). The size of each plot is 45 m2 (15 m by 5 m), and the distance between plots and plants in plots is 2 m. The number of nodes is assigned in the main plot, and the diameter of the planting material is assigned in the subplot. There are a total of 9 treatment combinations and a total of 108 planting materials. Significantly higher (P = 0.01) mean survival rate (59%) was observed in the planting material with two basal nodes and 2-4 cm diameter and the planting material with six nodes and 2-4 cm diameter. Further research is crucial to devise effective vegetative propagation methods for large scale plantations without compromising the survival capability of the planting materials.

Very pronounced bowel sparing during radiation therapy for anal carcinoma using a natural spacer (Myoma) – a case report

BackgroundUsing dose-painted intensity-modulated radiation therapy, specific dose volume constraints or implantation of tissue expanders prior to radiotherapy are validated options for reducing radiation dose on the bowel and therefore minimizing acute gastrointestinal toxicity during chemoradiation for anorectal malignancies. We describe the rare case of a female patient with a locally advanced anal carcinoma where a large myomatous uterus served as a natural spacer to protect the bowel during radiation therapy.Case presentationInitially the patient presented with anal pain, proctoscopy followed by an excisional biopsy confirmed the diagnosis of a squamous cell carcinoma of the anus. Imaging examination showed a locally advanced tumor and in addition a large uterus with typical leiomyomas up to 11.5 cm in diameter. The patient underwent chemoradiation; because of the large leiomyomas there was almost no dose burden for the small intestine and therefore practically no gastrointestinal toxicity.ConclusionAs we know, this report describes the situation that a large myomatous uterus served as a natural spacer during radiation therapy in a way that is unique to date.

ACUTE EOSINOPHILIC APPENDICITIS IN A CHILD WITH NORMAL TOTAL LEUKOCYTE COUNT AND ABSOLUTE EOSINOPHILIC COUNT

Abstract Introduction/Objective Eosinophilic appendicitis is a rare condition with a reported incidence of 0.03% to 1.2%, and often presents with clinical manifestations indistinguishable from acute appendicitis. Eosinophilic appendicitis may be associated with a localized allergic phenomenon. Methods/Case Report We present a 13-year-old male with ~24-hour history of constipation who was brought to the emergency department because of right lower quadrant abdominal pain, nausea, and vomiting. He was afebrile and had no antecedent of atopy or parasitic infestation. Laboratory investigation revealed an elevated C-reactive protein: 0.7 mg/dL [0.0-0.3]; mildly decreased hemoglobin: 12.2 g/dL [12.6 -16.8]; normal white blood cell count: 9.7 x10 3/mcL [3.2-10.6]; eosinophil count:1.7% [&amp;lt;5] and mildly elevated monocyte count: 0.9 x103/mcL [0.2-0.7]. Ultrasound examination revealed a non-compressible 7mm in diameter hyperemic appendix. The laparoscopic appendectomy specimen measured 9.5 cm long by 0.8 cm in diameter. The serosa was focally congested and there was mild mural thickening but no obvious sign of active appendicitis. Microscopic examination showed focally abundant mucosal eosinophils and a considerable sprinkling of eosinophils throughout the muscularis propria. No intraluminal parasite or neutrophilic associated mucosal damage was seen. The final diagnosis was: Acute Eosinophilic Appendicitis. Results (if a Case Study enter NA) N/A Conclusion Among the many and still intriguing causes of appendicitis is acute eosinophilic appendicitis. Eosinophils exert homeostatic roles in the normal host and pathological eosinophil-mediated processes over different tissues and their varied milieu. While this patient did not have any evidence of allergy, parasitic infestation, or elevated eosinophilic count in his work up, the presentation of acute appendicitis without an increase in total leukocytic count may alert for the possibility of an eosinophilic appendicitis. Conceivably, eosinophil mediators, such as IL-5, IL-33, granulocyte–macrophage colony-stimulating factor, thymic stromal lymphopoietin, and eotaxin-1 determine eosinophil behavior in a rarified appendix microenvironment.

Adaptive stereotactic radiosurgery for cerebral metastases of non-small cell lung cancer: a retrospective study

INTRODUCTION: Non-small cell lung cancer (NSCLC) is a common cause of brain metastases (BM). Adaptive stereotactic radiosurgery (ASRS) may be a useful option in the treatment of patients with large unresectable brain metastases (BM), but to date there are only a limited number of studies evaluating the effectiveness of this method.OBJECTIVE: To analyze the effectiveness of ASRS in patients with large BM NSCLC not subject to surgical resection.MATERIAL AND METHODS: We retrospectively analyzed data from 37 patients suffering from NSCLC with 45 large (&gt;2 cm in diameter, volume &gt;4 cm3) unresectable BM treated with the Gamma Knife Perfexion model using two- and three-fraction ASRS. Of these, 14 foci (31.1%) were metastases of squamous cell lung cancer, 31 (68.9%) were metastases of adenocarcinoma. The median volume of lesions treated with ASRS was 9.8 (range 4.6–30.6 cm3). The dynamics of volume changes between fractions and the cumulative incidence of local relapses (CILR) were studied, and ROC analysis was performed for the tumor volume parameter. Intracranial progression-free survival (iPFS) and overall survival (OS) were assessed. Statistics: To establish statistical significance of differences for related variables, the Wilcoxon test for pairwise comparisons and the Friedman test for three or more groups were used. The Kaplan-Meier method was used to calculate local control, PFS, and OS rates. The log-rank test was used to compare survival data in two groups.RESULTS: The median follow-up period was 19.4 months. With two-fraction ASRS, the median volume of metastasis decreased by 28.6% by the second session, with three-fraction — by 40.0% by the third session. The 1-year and 2-year CILR rates were 8.6±6.1%, respectively; 26.1±12.3%. In ROC analysis, the area under the curve (AUC) for tumor volume was 0.80 (95% CI 0.6– 1.0) with an optimal cutoff of 18.5 cm3. The differences in CILR between the groups with metastasis volume &lt;18.5 cm3 and ≥18.5 cm3 were statistically significant (p&lt;0.001). Median iPFS was 8.3 (95% CI 5.9–10.7) months, 1-year iPFS was 33.5±8.1%;2-year — 7.8±5.2%. Median OS was 13.2 (95% CI 9.0–17.4) months; 1-year OS — 52.9±8.7%, 2-year — 22.4±8.8%.DISCUSSION: Using two- and three-fraction ASRS, we delivered doses to large BM sufficient for a high level of local control with an acceptable risk of neurotoxicity: 1-year local control was 91.4%; 2-year — 73.9%; the incidence of radionecrosis is 8.5%. A statistically significant effect of lesion volume ≥18.5 cm3 on the risk of local recurrence was found. The iPFS and OS indicators after ASRS can be considered satisfactory for this group of patients.CONCLUSION: ASRS is an effective and perhaps optimal strategy for the treatment of large unresectable BM in patients with NSCLC, but comparison with other modern radiotherapy modalities such as stereotactic hypofractionated radiotherapy and WBRT with simultaneous integrated boost is needed.

First Report of Colletotrichum siamense Causing Leaf Anthracnose on Jackfruit in Thailand.

Jackfruit (Artocarpus heterophyllus Lam.) is commonly grown in Thailand. In June 2023, leaf anthracnose on this plant was observed at a field in Chai Prakan District (19°42'24"N, 99°01'59"E), Chiang Mai Province, Thailand, with ~25% disease incidence in a 1000-m2 plantation area. The initial symptom had brown spots with a yellow halo, enlarged, elongated, 0.2 to 2 cm in diameter, irregular, sunken, brown, with a dark brown halo, and leaves withered and dried. Pale yellow conidiomata developed on the lesions in high humidity. Ten symptomatic leaves were used to isolate the fungal causal agents through a single spore isolation method (Tovar-Pedraza et al. 2020). Four fungal isolates (SDBR-CMU492 to SDBR-CMU495) with similar morphology were obtained. Colonies on potato dextrose agar (PDA) were 70 to 85 mm in diameter, white to grayish white with cottony mycelia, the reverse pale yellow after incubation at 25°C for 1 week. All isolates produced asexual structures. Setae were brown with 1 to 3 septa, 40 to 100 × 2.2 to 4.0 µm, a cylindrical base, and acuminate tip. Conidiophores were hyaline to pale brown, septate, and branched. Conidiogenous cells were hyaline to pale brown, cylindrical to ampulliform, 7.4 to 27.2 × 2.0 to 4.5 µm. Conidia were one celled, hyaline, smooth walled, cylindrical, ends rounded, guttulate, 11.1 to 15.7 × 3.4 to 6.1 µm. Appressoria were dark brown to black, oval to irregular, 8.8 to 24.9 × 3.6 to 10 µm. Morphologically, all isolates resembled the Colletotrichum gloeosporioides species complex (Weir et al. 2012). The internal transcribed spacer (ITS) region, actin (act), β-tubulin (tub2), calmodulin (CAL), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes were amplified using primer pairs ITS5/ITS4, ACT-512F/ACT-783R, T1/T22, CL1C/CL2C, and GDF1/GDR1, respectively (White et al. 1990; Weir et al. 2012). Sequences were deposited in GenBank (ITS: PP068858, PP068859, PP446789, PP446790; act: PP079636, PP079637, PP460760, PP460761; tub2: PP079638, PP079639, PP460762, PP460763; CAL: PP079634, PP079635, PP460758, PP460759; GAPDH: PP079632, PP079633, PP460756, PP460757). Maximum likelihood phylogenetic analyses of the concatenated five genes identified all isolates as C. siamense. To pathogenicity test, the mature leaves of a healthy plant were surface disinfested using 0.1% NaClO for 3 min, rinsed three times with sterile water, and wounded. Conidia suspensions (15 µl of 1 × 106 conidia/ml) of each isolate grown on PDA at 25°C for 2 weeks were used to inoculate wounded and unwounded samples by the attached method. Control leaves were mock inoculated with sterile distilled water. Ten replications were conducted for each treatment and repeated twice. Plants were placed in a greenhouse at 25 to 30°C and 80 to 90% relative humidity. After 7 days, all inoculated leaves displayed brown lesions, while control leaves had no symptoms. Colletotrichum siamense was reisolated from inoculated tissues on PDA to complete Koch's postulates. Prior to this study, C. fructicola and C. gloeosporioides caused leaf anthracnose on jackfruit worldwide (Sangchote et al. 2003; Chitambar 2016). Leaf anthracnose on jackfruit caused by C. siamense has been reported from Australia (James et al. 2014) and Bazil (Borges et al. 2023). In Thailand, Bhunjun et al. (2019) reported that C. artocarpicola causes leaf anthracnose in jackfruit. Therefore, this is first report of C. siamense causing leaf anthracnose on jackfruit in Thailand. The finding will inform epidemiological investigations and future approaches to managing this disease.

First report of Colletotrichum nymphaeae causing anthracnose on Hass avocados in Brazil.

The Hass cultivar is one of the most cultivated and distributed avocado varieties throughout the world, having high productivity, nutritional quality, market acceptance and adaptation to different climatic zones (Dreher and Davenport 2013). Anthracnose affects avocado production in tropical and subtropical regions, causing economic losses, especially post-harvest (Fuentes-Aragón et al. 2020). Correct identification of Colletotrichum species causing anthracnose is essential, as different species vary in important phenotypes such as virulence and sensitivity to fungicides (Chen et al. 2016). Twelve samples from batches of avocados with anthracnose were collected in Minas Gerais State, Brazil, in September 2023. The observed symptoms were brown to black depressed circular spots, ranging from a few millimeters to 3 cm in diameter on the epicarp of the fruits, covered in center by mucilaginous layers of pathogen sporulation. Isolation was performed directly from the spore masses and monoconidial isolates were cultured in PDA at 25°C for 7 days for morphological characterization and preserved in sterile water at 4°C. One of the morphotypes commonly recovered from lesions, represented by isolate UCBV 362 (Culture Collection COAD 3843), formed fast-growing colonies having white aerial mycelium and intense salmon-colored sporulation. The cylindrical conidia were 13 to 17.5 μm long and 4.5 to 7 μm wide (average 14.5 x 5.7 μm, N=100), produced on conidiophores dispersed in the aerial mycelium or aggregated on melanized conidiomata formed on the agar. The partial sequence of the second largest subunit of the RNA polymerase II gene (RPB2) from isolate UCBV 362 (GenBank: PQ034617, 1116 nt) showed 99% of coverage and 99.37% of nucleotide identity with the RPB2 sequence of the ex-epitype strain of Colletotrichum nymphaeae ICMP 17918 (=CBS 515.78) (GenBank: JN985506). In a Maximum Likelihood phylogenetic tree composed with RBP2 sequences from reference strains of the Colletotrichum acutatum species complex, the isolate UCBV 362 formed a highly supported clade with the ex-epitype and other reference strains of Colletotrichum nymphaeae, occupying the Clade 2 of the species complex together with C. scovillae and C. simmondsii (Damm et al. 2012). This result shows the reliability of RPB2 for phylogeny and species delimitation within Colletotrichum. To confirm pathogenicity, 10-mm discs from a 7-day-old colony were inoculated at 3 different points on healthy-looking avocado fruits and incubated at 28°C. Uninoculated fruits served as controls. The first symptoms appeared 5 days after inoculation and were similar to those observed in the original samples, while the fruits in the control group remained asymptomatic. The pathogen was reisolated from the lesions and identified morphologically, fulfilling Koch's postulates. Colletotrichum nymphaeae has been associated with avocado anthracnose in Mexico (Fuentes-Aragón et al. 2020). In Brazil, a study based on molecular phylogeny identified Colletotrichum siamense and C. karsti as etiological agents of this disease (Soares et al. 2021). This report expands the range of species that cause avocado anthracnose in Brazil and provides etiological information for the implementation and monitoring of control methods, especially chemical control.

8774 An Uncommon Presentation Of A Large Silent Pheochromocytoma

Abstract Disclosure: M. Lozano: None. A. Pinero-Pilona: None. Background: The reported estimated incidence of pheochromocytoma is approximately 2-8 cases per 1 million people per year. Of those, silent pheochromocytomas will make up about 8%. Thus, biochemically silent and non-secreting pheochromocytomas are a very rare phenomenon. Clinical Case: A 74-year-old Caucasian female with significant past medical history of primary hypothyroidism, hypercholesterolemia, and nasal sinus carcinoma s/p surgery (in remission) presented to the clinic for endocrine evaluation of a right adrenal mass. The patient was asymptomatic and denied headaches, tachycardia, sweating, severe hypertension, diabetes, muscle weakness, easy bruising, or striae. The mass was initially diagnosed as an incidental finding after a contrast CT scan of the abdomen was performed for diverticulitis. The right adrenal enhancing mass was 2.3 x 3.9 x 4.1 cm in diameter. Subsequent MRI abdomen with and without contrast ordered by the referring physician showed that the adrenal mass had grown to 4.9 x 3.8 x 5.4 cm and was hyperenhancing in nature with central T2 hyperintense signal. Notably, multiple “parasitized and arborealized” vessels were detected within the mass. Such findings led us to suspect metastatic versus primary adrenal neoplasm such as cortical carcinoma as a working diagnosis. Other laboratory studies including plasma free metanephrines (&amp;lt;10 pg/mL, normal 0-88 pg/mL), plasma normetanephrines (29.2 pg/mL, normal 0-285.2 pg/mL) and 24-hour urine collections (24 hr urine epinephrine - 3 ug/24 hr [normal 0-20 ug/24 hr]; 24 hr urine norepinephrine - 75 ug/24 hr [normal 0-135 ug/24 hr]; 24 hr urine VMA - 3 mg/24 hr [normal 0-7.5 mg/24 hr]) were negative for pheochromocytoma. As her mass was greater than 4 cm in diameter, surgical referral was then recommended to the patient. Right adrenalectomy was performed. Pathology report was consistent with pheochromocytoma as supported by immunohistochemistry. Ki-67 proliferation index was 0-10% (average 3-4%, rare hotspots 10%). Atrophy and vascular ectasia were present in residual non-neoplastic adrenal cortex and medulla. Histology showed a nested growth pattern, absence of composite tumor elements, absence of necrosis, and no atypical mitoses. The incidence of non-secreting pheochromocytomas has been quoted to be 0.000064% (1). Conclusion: The case illustrates an uncommon presentation of a large, silent pheochromocytoma with negative plasma metanephrines accompanied by negative urine studies, which have a negative predictive value close to 100% in ruling out a pheochromocytoma. Our case emphasizes the importance of considering pheochromocytoma on the differential of adrenal masses with high attenuation or high enhancement even when biochemical studies suggest otherwise. Reference: (1) Radojkovic, D., et al. "CLINICALLY" SILENT GIANT PHEOCHROMOCYTOMA. CASE REPORT." Acta Endocrinologica (1841-0987) 9.1 (2013). Presentation: 6/1/2024

7859 Primary Hyperaldosteronism And Mild Autonomous Cortisol Secretion (MACS) In Adrenal Incidentaloma

Abstract Disclosure: K. Chanturishvili: None. Q. Gvazava: None. N. Zavrashvili: None. An adrenal incidentaloma is a mass lesion greater than 1 cm in diameter, discovered by radiologic examination, performed for another reason. Widespread use of imaging studies in everyday clinical practice has led to the increased rates of adrenal incidentalomas. Two main questions arise after discovering adrenal mass: is it malignant or benign, and is the mass hormonally active?We present a case of a 55 years old male, with a history of obesity (BMI 35).He had no significant past medical history and was not taking any medications.He presented to our clinic with an upper respiratory tract infection and shortness of breath. Chest CT was done to evaluate for possible pneumonia, where 46 x 30 cm adrenal incidentaloma with -5 HU was discovered.He was referred to our department for endocrine evaluation.Initial assessment revealed previously unknown hypertension with left ventricular hypertrophy. Laboratory workup revealed high aldosterone, suppressed renin, low normal ACTH and DHEA-S, positive 1-mg overnight dexamethasone suppression test (DST- 2.66 ug/dL) and 8-mg DST (2.26 ug/dL).Additionally, the metabolic panel showed prediabetes and hyperlipidemia.Diagnosis of adrenal macroadenoma with cortisol and aldosterone co-secretion was made.Unilateral adrenalectomy was planned. Possible postoperative adrenal insufficiency has been established. Recommendation for proper glucocorticoid coverage was given.In conclusion, evaluation of the functional status of adrenal tumors is essential to uncover hidden medical issues, as s well as to properly guide the patient for intra and postoperative management, avoiding the risks of adrenal insufficiency with proper glucocorticoid coverage. Surgical management of hormonally active adrenal incidentalomas, especially larger &amp;gt;2.4 cm, has potential benefit of improving and preventing metabolic abnormalities: hyperglycemia, dyslipidemia as well as comorbidities such as obesity, hypertension and osteoporosis. Presentation: 6/1/2024

7085 Myoclonus Seizure with Pseudo-Adrenal Insufficiency as the Clinical Manifestations Leading to the Diagnosed Multi-focal Insulinomas that Mimic Multiple Endocrine Neoplasia Type 1 Syndrome

Abstract Disclosure: P. Kiatpanabhikul: None. Background: Insulinoma is a rare disease that presents with varying symptoms and can be sporadic or associated with hereditary syndromes (1). These rare points of views of insulinoma-patient on clinical manifestations, hormonal responses and surgical pathology result for final diagnosis and management. Clinical Case: A 59-year-old woman presented with myoclonic seizure of right arm with consciousness duration 5-10 minutes every midday twice a week for 6 months and generalized convulsion for 20 minutes ago. She had a low FPG level (59 mg/dL; n 70-100) and was admitted to doing 72-hour fasting test that revealed hypoglycemia at 12-hour of fasting with a nadir glucose level of 55 mg/dL, insulin 3.7 uIU/mL (cutoff &amp;gt; 5), C-peptide 0.4 ng/mL (cutoff &amp;gt; 0.6), cortisol 6.22 mcg/dL (n 5-25) and normal morning ACTH level (29.8 pg/mL; n 10-65). These were appropriated response of endogenous insulinemia with inappropriate response of serum cortisol level in hypoglycemic feature. MRI pituitary gland was considered to evaluate secondary hypocortisolism which showed a small less enhancing lesion left anterior lobe 0.3x0.45-cm without any pituitary hormonal abnormalities that were considered non-functioning pituitary microadenoma which could not explain inappropriate response of cortisol level to hypoglycemic period in this patient. Five months later, she presented at the emergency room with myoclonic seizure on her extremities, blurred consciousness and slurred speech after having lunch for 1-2 hour and revealed CPG 30 mg%, severe hypoglycemia (26 mg/dL), hypocortisolism (4.49 mcg/dL), with endogenous hyperinsulinemia (insulin 55.2 uIU/mL, C-peptide 2.5 ng/mL). 250-mcg ACTH stimulation test was done and showed normal response of her HPA-axis function (serum cortisol level at 0, 30, 60 min was 9.12, 17.87, 18.61 mcg/dL). CT pancreatic protocol showed several arterial enhancing nodules scattering at pancreatic tails isoattenuation to pancreatic parenchyma on portovenous phase up to 1.7*1.6 cm. She was operated on to distal pancreatectomy with intraoperative insulin/glucose ratio monitoring. Surgical pathology confirmed 4-well-differentiated pancreatic neuroendocrine tumors with insulin-producing, sizes 0.5-1.7 cm in diameter. Her final diagnosis was multi-focal insulinomas with non-functioning pituitary microadenoma that mimic MEN-1 syndrome without secondary adrenal insufficiency. She underwent successful surgical resection with complete resolution of symptoms during 4 years of followed-up with no recurrence and no having any hypercalcemia and hyperprolactinemia. Conclusion: Multi-focal insulinomas can be presented as sporadic, more severe hypoglycemia and endogenous hyperinsulinemia during period after meal with myoclonic seizure and pseudo-adrenal insufficiency in older-aged, non-diabetes person without recurrence after treatment for 4-year of followed-up. Presentation: 6/2/2024

7305 Pheochromocytoma Presenting With Resistant Hyperglycemia

Abstract Disclosure: M. Economou: None. A. Devine: None. Background: Pheochromocytoma is a rare catecholamine producing tumor arising from the adrenal gland. Impaired glucose tolerance is a well-recognized hormonal and metabolic manifestation of pheochromocytoma caused by catecholamine excess [1]. Insulin resistance requiring very high doses of insulin in association with pheochromocytoma is, however, rare. Here we report a case of pheochromocytoma in a woman with diabetes mellitus that proved difficult to control despite high-dose insulin therapy. Case presentation: A 72-year-old woman with a longstanding history of type 2 diabetes mellitus, uncontrolled hypertension, hyperlipidemia and CVA presented to the hospital after she was found to have a hemoglobin of 7.0 ng/mL on routine labs. Notably, over the past 4 years, her insulin requirement gradually increased from 20 units/day to 50 units/day despite an A1c level of 6.1%. On presentation, our patient was hypertensive to 170/90 with limited response to multiple antihypertensive medications. Additionally, her glucose was severely uncontrolled, fluctuating between 200-500 mg/dL. Within days, the patient’s total daily insulin requirement increased tremendously to as much as 300 units/day. As part of her anemia workup, she underwent a contrast-enhanced CT abdomen &amp; pelvis which identified a left adrenal mass measuring 2.2 x 2.8 x 2.9 cm. Further evaluation with MRI confirmed an adrenal mass suspicious for pheochromocytoma. Evaluation of plasma hormone levels revealed an elevated normetanephrine level of 7.10 nmol/L (normal: less than 0.89 nmol/L). Furthermore, the 24-h urinary normetanephrine level and chromogranin A levels were elevated to 145 mcg/day and 1203 ng/mL, respectively. Initial treatment with alpha and beta blockade improved blood pressure but glucose levels remained persistently elevated. The patient underwent left laparoscopic adrenalectomy and pathology revealed pheochromocytoma, measuring, 3.2 cm in diameter, with stains positive for CD56, synaptophysin and chromogranin. Surgical resection margins were negative for tumor. Postoperatively, insulin requirements returned to roughly that of her baseline, 40 units/day. Conclusion: Impaired glucose tolerance is a known phenomenon associated with pheochromocytoma. Despite this, it is unusual to see an insulin requirement rise as abruptly and drastically as seen in this case. Our patient, with relatively controlled diabetes had an enormous increase in her insulin requirement during her hospital course as evidenced by her insulin regimen which increased sixfold. This case highlights the importance of maintaining a high degree of suspicion for pheochromocytoma in patients with a sudden rise in insulin requirement and uncontrolled hypertension. Reference: (1) Ronen JA, Gavin M, Ruppert MD, Peiris AN. Glycemic Disturbances in Pheochromocytoma and Paraganglioma. Cureus. 2019 Apr 27;11(4): e4551. Presentation: 6/3/2024

8787 A Case of Indolent Medullary Thyroid Cancer with Sporadic HRAS Mutation and Prolonged Stability

Abstract Disclosure: M. Lozano: None. A. Pinero-Pilona: None. Background: Medullary thyroid cancer (MTC) is a rare neuroendocrine tumor that is derived from calcitonin-producing C-cells that accounts for the smallest portion (&amp;lt;5%) of thyroid cancer. Most of these cases are attributed to mutations in the RET oncogene. Of the remainder, approximately 70% of MTC cases without a RET mutation have been attributed to RAS gene mutations. We report a case of a patient who presented with a thyroid nodule present and stable for years and was found to have MTC with a HRAS mutation. Clinical Case: A 73-year-old Caucasian male with a history of metastatic squamous cell carcinoma (SCC) of the neck, orthostatic hypotension, pacemaker implantation, and coronary artery disease with prior stenting presented to the clinic for evaluation after an abnormal thyroid biopsy. His SCC was diagnosed 16 years ago and was treated with surgery and cetuximab. It was a poorly differentiated squamous cell carcinoma with 2 of 7 lymph nodes positive for malignancy. Fifteen years ago, as part of the evaluation for his SCC, the patient had CAT and PET scans that showed a small nodule with increased uptake in the right lower neck in the thyroid bed (2.7 SUVs) measuring about 1.4 cm in diameter. No further interventions were done back then, and the patient was unaware of the mass until his records were reviewed. The patient was more recently noted to have the incidental thyroid nodule 2 months prior to clinic evaluation after routine carotid ultrasound. The gland was described to be homogeneous; in the mid to inferior portion of the right lobe, there was a 1.2 cm TR5 nodule of which biopsy was recommended. Fine needle aspiration biopsy showed a follicular lesion of unknown significance Bethesda category 3 using AFIRMA GCS RNA molecular analysis. Subsequently, gene sequencing classification was performed and abnormal: results were positive for HRAS mutation. Sonography in the office showed a right-sided, slightly hypoechoic, taller-than-wide vascular nodule with well-preserved borders and intermediate risk of malignancy. No abnormal lymphadenopathy was observed regionally in the central or lateral neck. The patient then underwent total thyroidectomy with modified right level 3 dissection. The right mid-superior nodule was consistent with MTC without tumor necrosis and without lymphatic, perineural, or extrathyroidal extension, but there was angioinvasion of at least 3 vessels. Preoperative calcitonin was elevated at 71 pg/mL and the level was undetectable (&amp;lt;2 pg/mL) 8 weeks post operatively (n&amp;lt;=10 pg/mL). The patient was deemed cured based on these biochemical studies and is recovering uneventfully on supplemental levothyroxine. Conclusion: Given the predominant association of MTC with RET, it is worth noting this case of a sporadic HRAS mutation in a patient with prior SCC. This case illustrates an indolent MTC without aggressive behavior that stayed stable in size and without metastasis for 15 years. Presentation: 6/1/2024

12450 Beyond the Surface: A Deep Dive into Pancreatic Insulinoma

Abstract Disclosure: S. Bhandari: None. R. Elhag: None. J. Singh: None. N. Rastogi: None. Background: Pancreatic neuroendocrine tumors (NET) are rare lesions that are typically sporadic, solitary and usually &amp;lt;2cm in diameter, with reported incidence of 4 cases per 1 million patients per year[1]. The most common hormone secreting NET are insulinomas. The hallmark of insulinomas is hypersecretion of insulin, leading to neuroglycopenic symptoms and uncontrolled sympathoadrenal activity. Clinical case: 51 years old female with no significant past medical history was referred to endocrine clinic by her primary care physician for hypoglycemia with a blood glucose level of 48 mg/dl. She reported an increased frequency of headaches and dizziness which began with intermittent fasting (10-12 hours) for past 6 months. These symptoms improved upon increasing meal frequency. Initial laboratory investigations revealed glucose of 54 mg/dl, normal HbA1c, and negative sulfonylurea panel. The patient had normal liver and kidney function with no malnutrition or malabsorption issues. Further work up showed C-peptide level 1.56 ng/ml (n 0.80-3.85ng/ml), insulin level 7.9 uIU/mL (n &amp;lt;18.4 uIU/mL), pro-insulin level significantly elevated at 77.6 pmol/L (n &amp;lt;/= 18.8pmol/L) and beta hydroxybutyrate of 0.12 mmol/l (n 0.02-0.27mmol/l). Insulin like growth factor was normal. Insulin antibodies were negative, and pituitary hormones were within normal limits. Pancreatic ultrasound was normal. CT abdomen/pelvis showed a 0.8x1.1 cm homogenously hypervascular anterior pancreatic body soft tissue lesion consistent with NET. Patient was started on diazoxide and continuous glucose monitoring (CGM). She was referred to general surgery and underwent successful tumor resection. Insulinoma is suggested by Whipple's triad, which is presence of hypoglycemic symptoms, documented hypoglycemia and resolution of hypoglycemic symptoms after glucose administration. As clinical manifestations are non-specific, diagnosing an insulinoma is challenging and depends on collateral history and a high index of suspicion. The gold standard of diagnosis is supervised 72-hour fasting test with plasma glucose, insulin, C-peptide, and proinsulin level measurements. Medical management of insulinoma includes the use of diazoxide, calcium channel blockers, propranolol, and glucocorticoids. Surgery is definitive treatment for insulinomas, with cure rates ranging from 77 to 100%. Conclusion: Insulinomas are benign and curable in most cases but can be fatal if misdiagnosed. Incidental findings of hypoglycemia should warrant thorough diagnostic workup to facilitate timely diagnosis and management.

Dosimetric impact of variable air cavity within PTV for rectum cancer.

The aim of this study is to determine the impact of rectal air volume changes on treatment plan quality, and subsequently inform daily cone-beam computed tomography (CBCT) evaluation constraints, in terms of acceptable rectal air volume during treatment. Twelve rectal cancer patients who exhibited rectal air within the PTV on their planning CT were selected. A study was conducted to evaluate the deterioration in plan quality due to expanding air volume. For each case, the air cavity volume was isotropically expanded in three dimensions using predefined margins of 3, 5, 7, and 10mm, while deforming bladder and rectum contours. A constraint was applied to the bony anatomy to restrict the deformation. Treatment plans were then generated for all twelve patients by recalculating the reference plan with the expanded air cavity volume. As the air cavity expanded, the maximum relative change in D98% coverage, compared to the reference plan, decreased by 10.8%±3.5%, while the D2% increased by 3.5%±0.9%. The positioning of the air cavity notably influenced the D98% variability with the 3mm expansion. D98% coverage falls below 95% when the air cavity volume exceeds 17 cm3. On average, D2% coverage increased by 0.5% with each expansion. At the largest expansion, extensive coverage of 102% and 105% isodoses was observed compared to the reference plan. Air cavity volumes above 17 cm3 can potentially degrade the high-dose PTV coverage while increasing the regions covered by the 102% and 105% isodoses. Clinical CBCT guidelines were deduced, recommending a maximum threshold of 3.2cm in diameter in any direction.