Definitive Pathological Diagnosis Research Articles

Osteosarcoma/Ewing Sarcoma

Osteosarcoma/Ewing Sarcoma

An unusual presentation of chordoma as a pyloric ring submucosal tumor: The first case report of a primary gastrointestinal lesion in humans.

Introduction and importanceChordomas are rare malignant bone neoplasms that are presumed to arise from chordal remnants in the fetal stage and typically occur along the axial skeleton. The extra-skeletal chordomas reported to date include soft tissue of the extremities and nasopharynx. Chordoma arising from the gastrointestinal wall has not been previously described.Case presentationWe report on a 42-year-old man with primary chordoma presenting as a gastroduodenal submucosal tumor centered on the pyloric ring. The patient was consistently asymptomatic, and the tumor was an incidental finding. However, during a follow-up at approximately 1.6 years, an increase in tumor size was identified on computed tomography (CT), and surgical resection was performed without a definite pathologic diagnosis. The patient was successfully treated with distal gastrectomy, and the histological diagnosis was a conventional chordoma. The diagnosis was confirmed via immunohistochemical staining for brachyury, pan-cytokeratin, S-100, and SOX9. Postoperative CT and magnetic resonance imaging revealed no recurrence or metastasis during the 1.5-year follow-up period.Clinical discussionPrimary chordomas of the digestive tract are rare. Embryologic development of the notochord does not explain the existence of remnants in the gastrointestinal wall. Moreover, notochordal remnants, as precursors of chordoma, were not identified in the current case. The gastroduodenal chordoma may not have originated from embryonic notochordal remnants but through aberrant brachyury activation without a notochordal precursor.ConclusionWe report the first case of primary gastrointestinal chordoma in humans. The tumor was completely removed surgically, without postoperative recurrence.

New Challenges in the Differential Diagnosis of High-Grade Triple-Negative Breast Cancer and Serous Carcinoma.

While screening has improved early detection of primary breast cancers, it may also identify metastasis to the breast in rare instances. High-grade carcinomas identified on breast screening may have non-specific morphology and immunoprofiles, making distinction from metastasis problematic. High-grade carcinomas frequently lose expression of specific tumor markers. New evidence specifically challenges GATA3/PAX8 exclusivity in the differential diagnosis of high-grade triple-negative breast cancer and high-grade serous carcinoma of müllerian origin. This case series provides a careful and detailed review of immunohistochemistry interpretation, with focus on PAX8, and the potential pitfalls in making a definitive pathological diagnosis, which is essential in determining oncological treatment options.

Outcomes Following Surgical Lung Biopsy for Interstitial Lung Diseases: A Monocenter Experience.

Surgical lung biopsy (SLB) is considered in the investigation of interstitial lung diseases (ILDs) when a complete clinical evaluation and a multidisciplinary discussion (MDD) do not allow the clinician to make a confident diagnosis. Owing to the risk of the procedure, an appropriate assessment of the risk/benefit ratio prior to the intervention is recommended. We aimed to assess the postoperative outcomes and diagnostic yield of SLB for the investigation of ILD in a tertiary care institution. We conducted a retrospective cohort study of consecutive subjects who underwent a SLB for the investigation of ILD in our center from 2009 to 2020. The postoperative mortality and complications rates as well as the diagnostic yield of the procedure were assessed. Of the 1,805 patients newly investigated for ILD in our center from 2009 to 2020, 71 (3.93%) underwent a SLB. At days 30 and 90, the mortality rates were 0 and 2.8%, whereas 4.3 and 7.6% patients experienced an acute ILD exacerbation, respectively. In addition, 4 (5.8%) patients experienced infectious complications and 5 (7.0%) presented prolonged air leaks (all within 30 days). A definite pathological diagnosis was made in 47 (66.2%) patients. Following postoperative MDD, a confident diagnosis was made in 61 patients (85.9%) and resulted in a change of therapy in 49 (69.0%) patients. SLB for the diagnosis of unclassifiable ILDs is associated with low mortality but significant morbidity. However, it results in a confident diagnosis and a change in therapy in the majority of patients.

Performance of Ultrasound-Guided Core Biopsy Driven by FDG-avid Supraclavicular Lymph Nodes in Patients With Suspected Lung Cancer.

ObjectivesUltrasound-guided core biopsy (UGCB) for supraclavicular lymph nodes (SLNs) represents an attractive procedure to obtain tissues for lung cancer confirmation. The aim of the present study is to evaluate the performance of UGCB driven by FDG-avid SLNs, as performed by nuclear medicine physicians, in patients with suspected lung cancer.MethodsInstitutional database in our hospital was searched for eligible patients between September 2019 and March 2021. A 3-12 MHz linear probe was used to guide the biopsy process and to ensure that the needle tip was being directed at the metabolically active area that had been indicated by side-by-side PET/CT images. Diagnostic yield, malignancy rate, molecular testing results, and complications were reviewed.ResultsAmong the 54 patients included in this study, definite pathological diagnosis from UGCB specimens was achieved in 53 patients, reaching a diagnostic yield of 98.1% (53/54) and a malignancy rate of 96.2% (51/53). Among the 50 patients confirmed as lung cancer, thirty-eight were spared from further invasive procedures which had been planned. Molecular analyses were adequately performed on all the 38 specimens obtained from non-small cell lung cancer (NSCLS). The positive rate was 36.8% (14/38) for epidermal growth receptor (EGFR) mutation and 31.6% (12/38) for anaplastic lymphoma kinase (ALK) translocation. 28.9% (11/38) of the patients had a tumor proportion score (TPS) ≥ 50% for PD-L1 expression. No complication was observed and the average biopsy time was 15 min.ConclusionsNuclear medicine physicians-performed UGCB driven by FDG-avid SLNs in suspected lung cancer patients could produce a high performance in terms of diagnostic yield, malignancy rate, and molecular analysis, which may obliviate more invasive interventional procedures and lead to fast decisions on subsequent management.

IS REPEAT FNAB NECESSARY FOR THYROID NODULES WITH ND / UNS CYTOLOGY?

The standard approach is to perform repeat FNAB (rFNAB) in thyroid nodules with non-diagnostic (ND) / insufficient (UNS) cytology. However, due to the nature of these nodules, recurrent FNABs may also be insufficient. Therefore, by comparing the clinical-radiological-pathological parameters of nodules with a definite diagnosis of excision, we questioned the possibility of patient management without rFNAB. Clinical-radiological parameters of 275 nodules belonging to 264 patients in the ND/UNS aspiration group with definite pathological diagnosis after surgery were determined. Under the guidance of these parameters, those with and without rFNAB were compared. The incidence of malignancy was found to be significantly higher in nodules without rFNAB compared to nodules with rFNAB (p = 0.036). In addition, the incidence of malignancy in BC-1 nodules without rFNAB was significantly higher than in nodules with rFNAB result also BC-1 (p = 0.009). In all cases, nodule size smaller than 10 mm and border irregularity were found to be statistically significant for malignancy (p <0.020, p <0.002). When looking at the distribution of rFNAB results, a significant correlation was observed with female gender, solid component, hypoechogenicity, border irregularity and halo loss around the nodule in patients with BC-4,5,6 cytology results (respectively, 0.005 / 0.031 / 0.001 / 0.012 / 0.004). rFNAB did not show the expected effect in ND / UNS nodules. We recommend direct surgical excision without rFNAB for nodules with border irregularity, solid structure, halo loss and hypoechogenicity, which should be considered more important in female patients.

A comprehensive evaluation of bronchoscopy at a large urban public hospital in South Africa

ABSTRACT Background: A definitive diagnosis of respiratory pathology is often elusive without tissue biopsy. Bronchoscopy is indispensable to visualise and sample endobronchial lesions and lung parenchyma. Objectives: To describe the practise of fibreoptic bronchoscopy at Chris Hani Baragwanath Academic Hospital (CHBAH). Outcomes include patient demographics, as well as indications and findings of fibreoptic bronchoscopy. To define possible associations between demographic characteristics and final diagnosis. Methods: Retrospective record review of patients who had undergone fibreoptic bronchoscopy at CHBAH over a 8-year period (2011–2018). Results: Bronchoscopy records were retrieved for 830 patients. Two thirds of patients were male; the mean age of patients was 56.1 (+/−13.3) years. Human Immunodeficiency virus (HIV) status was reported in 74%. Twenty-two percent of this population was seropositive for HIV (median CD4 count 233 cells/mm3, IQR: 85–434 cells/mm3). Most were performed for suspected endobronchial lesions (52%), and 12% for pulmonary infiltrates. The most common final diagnosis was lung malignancy in 39% of patients. Squamous cell carcinoma was identified in 43%, followed by adenocarcinoma (31%). Women and HIV positive patients were less likely to be diagnosed with malignancy compared to men and HIV negative patients. The complication rate for bronchoscopy was 2%. Conclusion: Suspected endobronchial lesions were the most common indication for bronchoscopy, and the most common diagnosis was primary lung cancer. Bronchoscopy is a useful tool in the diagnosis of respiratory disease with a low complication rate.

Evaluation of demographic and rare clinical characteristics of patients with thoracic carcinoid tumor in Razi and Aria Hospitals of Rasht during 2006-2016.

Carcinoid tumors are malignant neoplasms of neuroendocrine cells. This study tended to evaluate the demographic and rare clinical characteristics of patients with thoracic carcinoid tumor during 2006-2016 at Razi and Aria Hospitals in Rasht. The present study was performed on records of 43 patients with lung carcinoid tumors referred to Razi and Aria Hospitals of Rasht during 2006-2016. Information on age, gender, rare clinical symptoms, smoking history, diagnosis tools, treatment, and outcome were analyzed. Of 43 patients treated with definitive diagnosis of carcinoid tumor pathology, 31 patients had typic carcinoid tumor and 12 patients with atypic carcinoma (mean age 43.14 ± 15.16 years). The most common clinical symptom was cough and hemoptysis. Two cases presented with cushing syndrome, The most common diagnostic method in this study was simultaneous use of both CT scans and bronchoscopy. In 95.3% of cases, the tumor was pulmonary and in 4.7% of cases, it was extrapulmonary. Right lower lobe was the most common site of tumors and most of the surgeries used were lobectomy. This study showed that the most common clinical sign of thoracic carcinoid is cough and the tumor is pulmonary in 95.3% of cases. Right lower lobe was the most common site of tumors and most of the surgeries used were lobectomy. outcome was good.

Value of intraoperative pathological diagnosis in decision-making regarding resection of well-differentiated retropharyngeal liposarcoma: A case report.

Introduction and importancePreoperative diagnosis of well-differentiated liposarcoma (WDLS) in the retropharyngeal space is challenging because of the difficulty in obtaining a biopsy tissue specimen that will yield the microscopic findings necessary for a definitive pathological diagnosis. This report describes a case of retropharyngeal WDLS that was successfully diagnosed intraoperatively, which allowed radical resection.Case presentationThe patient was a 60-year-old man suspected of having a lipomatous tumor in the retropharyngeal space. On imaging, the tumor contained linear septum-like structures that were prominent behind the larynx. Pathological examination was performed using fine-needle aspiration cytology and core needle biopsy specimens. However, no malignant features were found. Given that partial biopsy of the retropharyngeal tumor by puncture was anatomically limited, we decided to collect appropriate tissue specimens for intraoperative pathological examination. During the operation, we biopsied the tumor, including the hard portion behind the larynx, anticipating inclusion of the septum-like structures seen on imaging. A pathological diagnosis of WDLS was successfully made and the tumor was completely excised.Clinical discussionThe fibrous septum with induration is important for intraoperative diagnosis of WDLS. The fibrous septum within the tumor was palpable as a rubbery hard portion.ConclusionWDLS in the retropharyngeal space could be successfully resected surgically by making a rapid intraoperative pathological diagnosis using appropriately selected tissue sampled from a hard portion of the tumor.

DIAGNOSIS, MANAGEMENT, AND OUTCOMES IN BIOPSY PROVEN BRONCHIOLITIS

TOPIC: Diffuse Lung Disease TYPE: Original Investigations PURPOSE: Bronchiolitis refers to a variety of inflammatory diseases affecting the small airways. Patients usually present with subtle symptoms including shortness of breath, cough or wheezing, often misdiagnosed as asthma. We performed a retrospective review to describe diagnostic characteristics, treatment patterns, and outcomes of biopsy-proven bronchiolitis METHODS: We searched the electronic medical records of the Advanced Lung Disease Clinic at Baylor University Medical Center. We examined charts of patients with VATS biopsy-proven bronchiolitis between Feb 2001 and February 2021. Cases that developed following bone-marrow or solid organ transplant were excluded RESULTS: Forty patients met criteria. The median age was 61(±9), and 90% were female. 45% of patients had a history of smoking. The most common presenting symptom was shortness of breath, followed by cough. More than half of the patients were treated for asthma prior to diagnosis of bronchiolitis. 50% of patients had airflow limitation noted on spirometry, defined as an FEV1/FVC < 0.7, 40% had FVC< 60%. Fifty percent of subjects had no positive connective tissue disease serologies; the remainder had positive rheumatoid factor (12), ANA (6), anti-RNP (3), anti-Scl-70 (2). ESR and CRP was elevated in 50% of the patients. High-resolution computed tomography was available in 36 patients. The most commonly identified abnormalities were: air trapping (80%), ground-glass opacities (22%), centrilobular nodules (32%), and pleural abnormalities (22%). Forty percent of patients underwent bronchoscopy with bronchoalveolar lavage. Lymphocytosis (defined as >15%) was noted in 5 patients (31%) and eosinophilia (defined as >1%) was noted in 4 patients (10%). Lung pathology revealed constrictive bronchiolitis in 33 patients (83%), follicular bronchiolitis in 7 (17%), organizing pneumonia in 7 (17%), and granulomas in 5 (10%) patients. Fourteen (35%) patients were treated with azithromycin, 6 (15%) with oral prednisone, 16 (40%) with mycophenolate mofetil (MMF), 1 (2.5%) with azathioprine, and 1 (2.5%) with rituximab. Seven (50%) patients on azithromycin and 8 (50%) patients on MMF had spirometric improvement (defined as > 10% improvement in FVC at 6-month follow-up spirometry). Two underwent lung transplantation, and three patients died. The rest of the patients were treated with inhaled bronchodilators or inhaled steroids. Most of the patients remained stable at 6 months follow up, one had decline in FVC by 10%. Follow-up PFTs were missing in five of the patients. CONCLUSIONS: Bronchiolitis is often misdiagnosed as asthma before a definitive pathologic diagnosis is made, and so a high index of suspicion is important in patients who do not respond to usual asthma therapies. The most common imaging finding was air trapping, and lung function testing most commonly indicated restriction or a mixed obstructive and restrictive pattern. The most common pathologic finding was constrictive bronchiolitis. No significant difference in outcome noted in patients on immunosuppression or macrolides compared to not on any treatment. Patients with follicular pathology tend to do better compared to constrictive pathology. CLINICAL IMPLICATIONS: Bronchiolitis is often misdiagnosed as asthma before a definitive pathologic diagnosis is made, and so a high index of suspicion is important in patients who do not respond to usual asthma therapies. DISCLOSURES: No relevant relationships by Susan Mathai, source=Web Response no disclosure on file for Mark Millard; No relevant relationships by Joon Yong Moon, source=Web Response No relevant relationships by Sofiya Rehman, source=Web Response No relevant relationships by Ciara Wisecup, source=Web Response

Primary membranous glomerulonephritis with negative serum PLA2R in haemophilia A successfully managed with rituximab \u2013 case report and review of the literature

BackgroundHepatitis C virus (HCV) and human immunodeficiency virus (HIV) cause a wide range of glomerular pathologies. In people with haemophilia, transfusion-associated infections with these viruses are common and definitive pathological diagnosis in this population is complicated by the difficulty of safely obtaining a renal biopsy. Membranous nephropathy (MN) is a common cause of adult onset nephrotic syndrome occurring in both primary and secondary forms. Primary MN is associated with podocyte autoantibodies, predominantly against phospholipase A2 receptor (PLA2R). Secondary disease is often associated with viral infection; however, infrequently with HIV or HCV. Distinguishing these entities from each other and other viral glomerular disease is vital as treatment strategies are disparate.Case presentationWe present the case of a 48-year-old man with moderate haemophilia A and well-controlled transfusion-associated HCV and HIV coinfection who presented with sudden onset nephrotic range proteinuria. Renal biopsy demonstrated grade two membranous nephropathy with associated negative serum PLA2R testing. Light and electron microscopic appearances were indeterminant of a primary or secondary cause. Given his extremely stable co-morbidities, treatment with rituximab and subsequent angiotensin receptor blockade was initiated for suspected primary MN and the patient had sustained resolution in proteinuria over the following 18 months. Subsequent testing demonstrated PLA2R positive glomerular immunohistochemistry despite multiple negative serum results.ConclusionsPursuing histological diagnosis is important in complex cases of MN as the treatment strategies between primary and secondary vary significantly. Serum PLA2R testing alone may be insufficient in the presence of multiple potential causes of secondary MN.

Adult-onset perianal Langerhans cell histiocytosis presenting as pruritus ani: a case report and review of the literature

BackgroundLangerhans cells belong to the histiocytic system and give rise to two tumors: Langerhans cell histiocytosis and Langerhans cell sarcoma. Clinical aggressiveness and degree of atypia distinguish the two neoplasms. Langerhans cell histiocytosis can infiltrate a single or multiple organ systems and particularly affects bone, skin, and lymph nodes. Perianal cutaneous Langerhans cell histiocytosis is a rare condition in adults, with 15 cases reported in the literature.CaseWe present the case of a 50-year-old hispanic man who presented with a 9-month history of pruritus ani and a personal history of diabetes insipidus. Punch biopsy confirmed a lesion of Langerhans cells origin but could not exclude Langerhans cell sarcoma because of limited sample size. An additional biopsy was planned as well as a positron emission tomography scan to determine the extent of disease spread. While the patient failed to follow up for repeat biopsy, the positron emission tomography scan was performed and was negative for metastatic disease. A stable perianal lesion of Langerhans cell histiocytosis with benign clinical features in a 50-year-old male despite lack of treatment is extremely rare and has not been described in the literature so far. Here, we review the presentation and workup of patients with Langerhans cell histiocytosis, review the relevant literature, and discuss treatment planning.ConclusionPerianal Langerhans cell histiocytosis is rare, and there should be a high index of suspicion with chronic or new perianal lesions, especially in a patient with a history of diabetes insipidus. It is also important to consider the patient’s full clinical course when it is not possible to reach a definitive pathological diagnosis before management.

Preoperative Diagnostic Uncertainty in T2-T3 Rectal Adenomas and T1-T2 Adenocarcinomas and a Therapeutic Dilemma: Transanal Endoscopic Surgery, or Total Mesorectal Excision?

Simple SummaryEndorectal ultrasound and rectal magnetic resonance are sometimes unable to differentiate between stages T2 and T3 in rectal adenomas that are possible adenocarcinomas, and between stages T1 and T2 in rectal adenocarcinomas. These cases of diagnostic uncertainty raise a therapeutic dilemma: should they be treated with transanal endoscopic surgery (TES) or total mesorectal excision (TME)? We present an observational study of a cohort of 803 patients who underwent TES between 2004 and 2021. Five hundred and twenty-nine patients operated on for adenoma (group I) and 109 for low-grade adenocarcinoma (group II) were included. Diagnosis was uncertain in 113/529 patients (21.4%) in group I, and in 8/109 (7.3%) in group II. The definitive pathology diagnosis showed 17 cases in group I (15%) to be adenocarcinomas greater than T1, and two cases in group II. On the strength of these data, in cases of diagnostic uncertainty we recommend TES as the initial indication.Background: Endorectal ultrasound and rectal magnetic resonance are sometimes unable to differentiate between stages T2 and T3 in rectal adenomas that are possible adenocarcinomas, or between stages T1 and T2 in rectal adenocarcinomas. These cases of diagnostic uncertainty raise a therapeutic dilemma: transanal endoscopic surgery (TES) or total mesorectal excision (TME)? Methods: An observational study of a cohort of 803 patients who underwent TES from 2004 to 2021. Patients operated on for adenoma (group I) and low-grade T1 adenocarcinoma (group II) were included. The variables related to uncertain diagnosis, and to the definitive pathological diagnosis of adenocarcinoma stage higher than T1, were analyzed. Results: A total of 638 patients were included. Group I comprised 529 patients, 113 (21.4%) with uncertain diagnosis. Seventeen (15%) eventually had a pathological diagnosis of adenocarcinoma higher than T1. However, the variable diagnostic uncertainty was a risk factor for adenocarcinoma above T1 (OR 2.3, 95% CI 1.1–4.7). Group II included 109 patients, eight with uncertain diagnosis (7.3%). Two patients presented a definitive pathological diagnosis of adenocarcinoma above T1. Conclusions: On the strength of these data, we recommend TES as the initial indication in cases of diagnostic uncertainty. Multicenter studies with larger samples for both groups should now be performed to further assess this strategy of initiating treatment with TES.

Lack of definitive presurgical pathological diagnosis is associated with inadequate surgical margins in breast-conserving surgery

PurposeTo determine the impact of definitive presurgical diagnosis on surgical margins in breast-conserving surgery (BCS) for primary carcinomas; clinicopathological features were also analyzed. MethodsThis retrospective study included women who underwent BCS for primary carcinomas in 2016 and 2017. Definitive presurgical diagnosis was defined as having a presurgical core needle biopsy (CNB) and not being upstaged between biopsy and surgery. Biopsy data and imaging findings including breast density were retrieved. Inadequate surgical margins (IM) were defined per latest ASCO and ASTRO guidelines. Univariable and multivariable analyses were performed. Results360 women (median age, 66) met inclusion criteria with 1 having 2 cancers. 82.5% (298/361) were invasive cancers while 17.5% (63/361) were ductal carcinoma in situ (DCIS). Most biopsies were US-guided (284/346, 82.0%), followed by mammographic (60/346, 17.3%), and MRI-guided (2/346, 0.6%). US and mammographic CNB yielded median samples of 2 and 4, respectively, with a 14G needle. 15 patients (4.2%) lacked presurgical CNB. The IM rate was 30.0%. In multivariable analysis, large invasive cancers (>20 mm), dense breasts, and DCIS were associated with IM (p = 0.029, p = 0.010, and p = 0.013, respectively). Most importantly, lack of definitive presurgical diagnosis was a risk factor for IM (OR, 2.35; 95% CI: 1.23–4.51, p = 0.010). In contrast, neither patient age (<50) nor aggressive features (e.g., LVI) were associated with IM. ConclusionLack of a definitive presurgical diagnosis was associated with a two-fold increase of IM in BCS; other risk factors were dense breasts, large invasive cancers, and DCIS.

Application of Immunohistochemistry in the Pathological Diagnosis of Liver Tumors

Although radiological diagnostics have been progressing, pathological diagnosis remains the most reliable method for diagnosing liver tumors. In some cases, definite pathological diagnosis cannot be obtained by histological evaluation alone, especially when the sample is a small biopsy; in such cases, immunohistochemical staining is very useful. Immunohistochemistry is the most frequently used technique for molecular pathological diagnosis due to its broad application, ease of performance and evaluation, and reasonable cost. The results occasionally reflect specific genetic mutations. The immunohistochemical markers of hepatocellular carcinoma include those of hepatocellular differentiation—such as hepatocyte paraffin 1 and arginase-1—and those of malignant hepatocytes—such as glypican-3, heat shock protein 70, and glutamine synthetase (GS). To classify the subtypes of hepatocellular adenoma, examination of several immunohistochemical markers, such as liver fatty acid-binding protein, GS, and serum amyloid A, is indispensable. Immunohistochemical staining for GS is also important for the diagnosis of focal nodular hyperplasia. The representative immunohistochemical markers of intrahepatic cholangiocarcinoma include cytokeratin (CK) 7 and CK19. In this article, we provide an overview of the application of immunohistochemistry in the pathological diagnosis of liver tumors referring to the association with genetic alterations. Furthermore, we aimed to explain the practical points in the differential diagnosis of liver tumors by immunohistochemical staining.

Clinical characteristics of 288 cases of pathologically confirmed benign pulmonary nodules post-surgery

Objective: To analyze retrospectively the clinical characteristics of pathologically confirmed benign pulmonary nodules post-surgery, and therefore to provide evidence for the diagnosis of benign pulmonary nodules. Methods: 288 cases of pulmonary nodules were selected in the Ruijin Hospital from 1st January 2017 to 31st October 2019. All the lesions of these patients were confirmed by surgery and had definite pathological diagnosis. The clinical data were collected, including demography, clinical data, radiological features. Features that indicated benign pulmonary nodules were summarized. Results: The main etiologies of benign pulmonary nodules were granulomas, hamartomas, cryptococcus infection, organizing pneumonia and non-specific inflammation. In our cohort, we found that the radiological characteristics of benign nodules were single, solid, less than 10 mm in average diameter, with well-defined margins, absence of vacuole sign or vascular convergence , and negative functional imaging. Conclusion: The most common etiologies of post-surgical benign nodules were granulomas, hamartomas, and cryptococcus infection, characterized by being single, solid and with well-defined margins. Caution should be taken before considering surgery for such nodules.

Examination of endobronchial ultrasound-guided transbronchial needle aspiration using a puncture needle with a side trap

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is useful for diagnosing hilar and mediastinal lymph node enlargement; however, specimens obtained are often small and inadequate for pathologic diagnosis. In June 2017, EchoTip ProCore, a puncture needle with a side trap, was launched in Japan. In this single-center prospective interventional study, 57 patients with lymph nodes, intrapulmonary tumor or pleural mass were diagnosed using EBUS-TBNA with EchoTip ProCore between June 2017 and February 2020. EBUS-TBNA was performed for 57 patients and 53 patients had sufficient specimen for histologic diagnosis. The following pathologic subtypes were diagnosed: non-small cell lung cancer, 22; small cell lung cancer, 8; cancer of unknown primary, 2; neuroendocrine tumor (G2) recurrence, 1; lymphoma, 2; metastatic renal cell carcinoma, 3; thymoma recurrence, 1; sarcoidosis, 4; tuberculosis, 1; and non-malignancy, 9. In addition, the cytology showed Class V in 31 out of 57 cases (54.4%). In total, a definitive pathological diagnosis was obtained in 50 out of 57 cases (87.7%). The only complication was pneumonia caused by BAL simultaneously combined with EBUS-TBNA in one patient. Among 13 patients with inadequate specimens or without malignancy, only one patient was subsequently diagnosed with malignancy, and the median follow-up period was 300 days. EBUS-TBNA using EchoTip ProCore can obtain a sufficient specimen size for pathologic diagnosis.

Pleuroscopy Early Experience in the Exudative Pleural Effusion of Unknown Etiology

Background: Pleuroscopy (medical thoracoscopy) is a minimally invasive procedure to inspect and perform a biopsy of the pleural space as well as to perform therapeutic interventions; pleural fluid drainage and pleurodesis. Material and Methods: In a retrospective study in Kasra Hospital, Tehran,Iran, the patients with exudative pleural effusion of unknown etiology who underwent pleuroscopy, were evaluated. These patients had negative smears and cultures for infective agents. Also, the cytological review was negative for malignancy. Results: 62 patients had undergone pleuroscopy, of which 29 (46.7) were men. After the final evaluation, 47 patients (75.8%) had a definite pathologic diagnosis, of which 39 patients (82.9%) had cancer. Through these 39 cases, 18 cases (46.1%) had a history of the previously confirmed cancer, in which pleural pathology was consistent with the initial diagnosis. In 21 cases (53.9%), metastatic cancers were detected without a previous history. From a total of 47 cases with definite pathologic diagnosis, 8 cases (17%) had histopathologic evidence of granulomatous lesions consistent with tuberculosis, and 15 patients (24%) showed non-specific inflammatory lesions. There was no morbidity and mortality among these patients. Discussion: Considering that pleuroscopy is a safe procedure with high diagnostic accuracy, malignancy is the most common finding in the exudative pleural effusion of unknown etiology, which increases the importance of this procedure in these cases to prevent wasting time and smear-negative anti-TB treatment.

Nerve biopsy: Current indications and decision tools.

After initial investigation of patients presenting with symptoms suggestive of neuropathy, a clinical decision is made for a minority of patients to undergo further assessment with nerve biopsy. Many nerve biopsies do not demonstrate a definitive pathological diagnosis and there is considerable cost and morbidity associated with the procedure. This highlights the need for appropriate selection of patients, nerves and neuropathology techniques. Additionally, concomitant muscle and skin biopsies may improve the diagnostic yield in some cases. Several advances have been made in diagnostics in recent years, particularly in genomics. The indications for nerve biopsy have consequently changed over time. This review explores the current indications for nerve biopsies and some of the issues surrounding its use. Also included are comments on alternative diagnostic modalities that may help to supplant or reduce the use of nerve biopsy as a diagnostic test. These primarily include extraneural biopsy and neuroimaging techniques such as magnetic resonance neurography and nerve ultrasound. Finally, we propose an algorithm to assist in deciding when to perform nerve biopsies.

Application of Radiomics Analysis Based on CT Combined With Machine Learning in Diagnostic of Pancreatic Neuroendocrine Tumors Patient’s Pathological Grades

PurposeTo evaluate the value of multiple machine learning methods in classifying pathological grades (G1,G2, and G3), and to provide the best machine learning method for the identification of pathological grades of pancreatic neuroendocrine tumors (PNETs) based on radiomics.Materials and MethodsA retrospective study was conducted on 82 patients with Pancreatic Neuroendocrine tumors. All patients had definite pathological diagnosis and grading results. Using Lifex software to extract the radiomics features from CT images manually. The sensitivity, specificity, area under the curve (AUC) and accuracy were used to evaluate the performance of the classification model.ResultOur analysis shows that the CT based radiomics features combined with multi algorithm machine learning method has a strong ability to identify the pathological grades of pancreatic neuroendocrine tumors. DC + AdaBoost, DC + GBDT, and Xgboost+RF were very valuable for the differential diagnosis of three pathological grades of PNET. They showed a strong ability to identify the pathological grade of pancreatic neuroendocrine tumors. The validation set AUC of DC + AdaBoost is 0.82 (G1 vs G2), 0.70 (G2 vs G3), and 0.85 (G1 vs G3), respectively.ConclusionIn conclusion, based on enhanced CT radiomics features could differentiate between different pathological grades of pancreatic neuroendocrine tumors. Feature selection method Distance Correlation + classifier method Adaptive Boosting show a good application prospect.