Diagnosis Of Hyperplasia Research Articles

COWDEN SYNDROME DIAGNOSIS FROM ORAL MANIFESTATIONS: A CASE REPORT

Cowden syndrome (CS) is a rare condition, inherited with autosomal dominant trait, resulting from mutation in the Phosphatase and Tensin homolog gene on chromosome 10 and characterized mainly by multiple hamartomas and increased risk of malignant development. The report describes a case in a 43-year-old white male patient, complaining of a nodule on the tongue. In the anamnesis, a previous history of malignant neoplasms in the thyroid and testicles treated 20 years ago was been reported. Physical examination showed multiple small papules on the facial skin around eyes and mouth, multiple asymptomatic hamartomas in the labial mucosa, buccal mucosa, dorsal tongue and gingivae, and small superficial keratotic plaques in the dorsal surface of the hands. Three biopsies were performed in different oral sites with histopathological diagnosis of fibrous hyperplasia. Diagnosis of CS was confirmed by medical history, clinical, and histopathological characteristics. The patient is followed up in medical and dental care.

Abstract 1124: Discordance between gross and histologic findings in progestin-treated endometrial neoplasia

Abstract Introduction: Hysterectomy with or without lymphadenectomy remains the first line of therapy for endometrial cancer (EC). Rising levels of obesity coupled with a trend toward delayed childbearing has led to an increasing population of young women with EC who are poor surgical candidates due to obesity or desire fertility preservation. Accordingly, progestin-based therapy is gaining momentum nationally. Nevertheless, some patients ultimately undergo surgery. Progestin-treated EC can undergo marked stromal decidualization. We hypothesized that this treatment effect may create the false impression of a large residual endometrial tumor burden at the time of gross intra-operative tumor assessment (ITA). As ITA can guide the decision to pursue lymphadenectomy and/or oophorectomy, particularly in community hospitals, familiarity with the gross findings in this setting is essential in order to inform optimal patient management. Methods: 12 hysterectomy specimens with reported progestin-related changes following a diagnosis of atypical hyperplasia or FIGO grade 1-2 EC were identified over a 10-year period. Patient age, duration of progestin therapy, and gross tumor size were recorded. Tumors were histologically assessed for the extent to which decidualized stroma comprised grossly identified lesions and were categorized as having minimal (<10%), intermediate (10-50%), or extensive (>50%) stromal decidualization. Results: Patients' ages ranged from 28-59 years of age (median 41.5 years). 8 were premenopausal and 4 were postmenopausal. Indications for progestin therapy included fertility preservation and a bridge to surgery in patients not desiring fertility. Duration of therapy ranged from 17-332 days (median 80 days). Grossly visible lesions were described in all cases with a median size of 4.1 cm (range 1-8.2 cm). The decidual component was minimal in 3 cases, intermediate in 4 cases, and extensive in 5 cases. 2 cases with grossly visible lesions (2.2 & 7 cm in size) had only focal residual hyperplasia. Extensive decidualization was more common in premenopausal (median 65%, range 10-90%) than in postmenopausal women (median 18%, range 10-40%; p=0.06), irrespective of time on progestin therapy (102.5 vs. 80 days, p=0.87). Conclusions: Large mass lesions following progestin therapy may histologically consist primarily of decidualized stroma with little to no residual neoplastic disease. In these cases, the perceived tumor size does not reflect the actual residual tumor burden; this effect appears to be more pronounced in pre-menopausal patients. In the setting of intraoperative decision-making based on gross tumor assessment, this discrepancy between gross and histologic findings may lead to unnecessary lymphadenectomy and its associated morbidity. Citation Format: Yang Hu, Ahmed N. Al-Niaimi, Alain P. Cagaanan, Paul Weisman, Stephanie M. McGregor. Discordance between gross and histologic findings in progestin-treated endometrial neoplasia [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1124.

Diagnostic value of clinical parameters and parathyroid scintigraphy for asymptomatic primary hyperparathyroidism.

The purpose of this study was to evaluate the diagnostic value of clinical parameters and parathyroid scintigraphy for asymptomatic primary hyperparathyroidism (aPHPT), including quantitative parameter of laboratory and semiquantitative parameters derived from technetium-99m- metoxyisobutylisonitrile (99mTc-MIBI) single photon emission computed tomography/computed tomography (SPECT/CT). Two hundred and fourteen patients who had been diagnosed as PHPT and underwent surgical treatment were enrolled in this study. All patients were divided into two groups: aPHPT and symptomatic PHPT (sPHPT). Dual tracer 99mTc pertechnetate/99mTc-MIBI, dual time point and tomography scintigraphy with 99mTc-MIBI SPECT/CT were performed. Clinical parameters included basic information, serum calcium (Ca), phosphorus (P), parathyroid hormone (PTH) and alkaline phosphatase (ALP) levels. Semiquantitative parameters of parathyroid scintigraphy included the average counts of early parathyroid (PT1), late parathyroid (PT2), early thyroid (T1) and late thyroid (T2), the ratio of PT1/ T1 (R1), the ratio of PT2/ T2 (R2), parathyroid washout (PTW=(PT1-PT2)/PT1) and retention index (RI=(R2-R1)/R1). P<0.05 was considered as statistically significant. A total of 167 aPHPT patients (46 males, 121 females) were studied. One hundred and seventy four One hundred and seventy four174 parathyroid glands were removed after operation: 146 (87.4%) lesions were adenoma, 12 (7.2%) lesions were hyperplasia and 1 (0.6%) lesion was adenocarcinoma. There were significant differences in previous history (P=0.000), echo of parathyroid (P=0.004), thyroid function (P=0.029), clinical course (Z=-3.422, P=0.001), 99mTc-pertechnetat thyroid uptake (TcTU) (Z=-2.126, P=0.033), serum Ca level (t=-2.926, P=0.004) and serum PTH level (Z=-3.028, P=0.002) between aPHPT and sPHPT. For patients with aPHPT, there were significant differences for serum Ca level (t=2.832, P=0.005), R2 (Z=-2.597, P= 0.009) and RI (Z=-2.100, P=0.036) between adenoma and hyperplasia, and serum Ca level in aPHPT patients with adenoma was significantly higher compared with patients with hyperplasia. The areas under the curve (AUC) of clinical course, TcTU, serum Ca and PTH levels were 0.662, 0.399, 0.642 and 0.645 respectively for differential diagnosis of aPHPT and sPHPT. The AUC of R2 and RI were 0.737 and 0.692 respectively for differential diagnosis of adenoma and hyperplasia in patients with aPHPT. The sensitivity, negative predictive value (NPV) and accuracy for diagnosing aPHPT combined 99mTc-MIBI SPECT/CT with ultrasound (US) were significantly higher than dual tracer, dual time point, 99mTc-MIBI SPECT/CT and US, which were 97.5%, 95.2% and 55.6% respectively. Laboratory inspection and semi-quantitative parameters of parathyroid scintigraphy had higher value for differential diagnoses of aPHPT and sPHPT, the same for adenoma and hyperplasia in patients with aPHPT. When combined 99mTc-MIBI SPECT/CT with US, the diagnostic efficiency would be significantly improved.

Action Algorithm for the Diagnosis of Prostate Hyperplasia in Dogs

In veterinary practice, at present, specialists often have to deal with pathology of the prostate gland in dogs. The reason for this is that the pathological process in the tissues of the prostate gland can occur asymptomatic and for a long period of time, subsequently leading to organ hypertrophy. An increase in the volume of the prostate gland most often has a benign character, which is generally accepted to be diagnosed as prostatic hyperplasia. The disease is often detected at a late stage, which complicates the treatment and worsens the prognosis. Hyperplasia, as a medical condition, is an indicative term used to describe the abnormal increase in the number of cells in any organ, in this case the prostate gland. This article describes the main symptoms, diagnostic methods and differential diagnosis proceeding from practical veterinary experience.

Rectal Tonsil as a Cause of Recurrent Rectal Prolapse.

A 9-year-old boy presenting with recurrent rectal bleeding and prolapse refractory to therapy for constipation was referred for colonoscopy. Initial work-up (magnesium, thyroid function, food allergies, celiac disease, and stool cultures) was negative. Five large rectal polyps were evidenced just above dental line. Due to the location of the lesions, a combined endoscopic/surgical submucosal resection of the lesions was performed (Fig. 1). Postoperative course was uneventful. The patient's symptoms resolved quickly. Histological examination after complete resection ruled out a malignant process, particularly extranodal marginal zone B-cell lymphoma (1–4), and confirmed the diagnosis of atypical mantle zone hyperplasia, also known as rectal tonsil (RT) (Fig. 2).FIGURE 1: Endoscopy showing polypoid lesions of lower rectum.FIGURE 2: Histology. (A) Rectal submucosal resection specimen showing nodular lymphoid proliferation in the mucosa and submucosa. Hematoxylin and eosin staining. (B) Positive CD20 immunohistochemical (IHC) staining, showing prominent B-lymphocyte proliferation. (C) Positive CD3 IHC staining demonstrating small T lymphocytes surrounding B-lymphoid nodules; (D) Bcl2 IHC staining showing negative-stained and disorganized germinal center (asterisk).RT corresponds to prominent and localized lymphoid tissue hyperplasia. The incidence seems to be more frequent in young children and adolescent. RT is associated with viral and bacterial infections (Giardia lamblia, Helicobacter pylori), food allergies, immune deficiency (IgA deficiency), and refractory constipation (5). RT can be asymptomatic or present with rectal bleeding, abdominal pain, or intestinal obstruction (3). Identification of predisposing factors and their treatment usually allows spontaneous resolution of the symptoms and sometimes regression of the lesions. Occasionally, resection is necessary to treat some complications as described in this unusual case (6–8).

Comparison of cytomorphology and frozen section of endometrial aspiration with histopathology in abnormal uterine bleeding

Background: Endometrial aspiration cytology is the latest available modality for the study of endometrial diseases. A large range of diseases like atypia’s, malignancies, and infective changes can be diagnosed using a cytological examination. Aim and Objectives: To assess the adequacy of the aspirate of endometrium for cytological examination and correlating the diagnosing efficiency with frozen section and histopathology. Methods: A cross sectional study was conducted at department of pathology, tertiary care health center in Pondicherry. Endometrial aspiration and Curettage were done in 58 perimenopausal women with abnormal uterine bleeding. Endometrial aspiration sample were subjected for cytological examination by Papanicolaou staining and May- Grunewald- Gimesa staining, frozen section and histopathology examination with Hematoxalin & Eosin staining. Diagnostic accuracy was compared with gold standard histopathological examination. Sensitivity, specificity and predictive values were calculated. Results: Among 58 participants, the mean age was 45.02 ± 4.12 years. Majority (63.79%) of the participants had menorrhagia. High cellularity was seen in 58.62%. Sheets were the most commonly observed pattern on cytology (65.52%). The cytological diagnosis of simple hyperplasia had sensitivity of 100% and specificity was 94.44%in predicting HPE diagnosis. The frozen section of simple hyperplasia had sensitivity of 100%in predicting HPE diagnosis. Conclusion: Endometrial aspiration cytology and frozen section are useful and minimally invasive techniques that can be utilized for the diagnosis of endometrial pathologies at par with the efficiency of histopathological examination.

Atypical polypoid adenomyoma follow-up and management: Systematic review of case reports and series and meta-analysis.

Atypical polypoid adenomyoma (APA) is a rare uterine tumor typically found in fertile age and associated with infertility. Among young nullipara women, conservative treatment is proposed despite the high recurrence rate and the association with endometrial cancer.Our aim was to assess the risk of recurrence with different conservative treatments in fertile ages and the prevalence of malignant or pre-malignant associated lesions to better address an adequate patient counselling when treatment modalities are discussed. This study is a systematic review and meta-analysis of case reports and case series about APA management and follow-up. A literature search was carried from Medline and Scopus for studies published from January 1, 1980 to December 31, 2018. We included 46 observational studies and 296 cases in fertile women. The prevalence of APA relapse was 44% (CI.95 33-57%) and was lower in cases treated with operative hysteroscopy (22%; CI.95 11-39%) than in cases treated with blind curettage and polypectomy (38%; CI.95 15-67%). The prevalence of the concomitant or during the follow-up diagnosis of endometrial carcinoma was 16% (CI.95 9-29%). The risk of cancer development during follow-up was significantly less in cases treated with histeroscopy (10.56% new cumulative diagnosis at 5 years follow up; CI.95 0-23.7%) than blind curettage and polypectomy (35.5% new cumulative diagnosis at 5 years; CI.95 11.65-52.92%; P < .05). Medical treatment with medroxyprogesterone acetate after surgery does not reduce APA recurrence. Pregnancy was observed in 79% cases in which the desire was expressed. This review suggests that conservative treatment performed by operative hysteroscopy is the optimal choice because it lowers the risk of recurrence, improves the accuracy of concomitant carcinoma or hyperplasia diagnosis, and leaves the possibility of future pregnancies.

Steroid Screening Tools Differentiating Nonclassical Congenital Adrenal Hyperplasia and Polycystic Ovary Syndrome

To analyze the performance of basal 17OH-progesterone (17OHP) levels versus the basal 17OHP/cortisol ratio in nonclassical congenital adrenal hyperplasia (NCAH) and polycystic ovary syndrome (PCOS) differential diagnosis. Basal 17OHP levels >10 ng/mL have been used to confirm NCAH diagnosis without the adrenocorticotropic hormone (ACTH) test; however, the optimal cutoff value is a matter of debate. A cross-sectional study was performed at the endocrinology and gynecological endocrinology outpatient clinics of a tertiary hospital. A total of 361 patients with PCOS (age 25.0 ± 5.3 years) and 113 (age 19.0 ± 13.6 years) patients with NCAH were enrolled. Basal and ACTH-17OHP levels were measured by radioimmunoassay, and CYP21A2 molecular analysis was performed to confirm hormonal NCAH diagnosis. Receiver operating characteristic curve analysis compared basal 17OHP levels and the 17OHP/cortisol ratio between NCAH and PCOS patients. Basal 17OHP levels were higher in NCAH patients than in those with PCOS (8.85 [4.20-17.30] vs 1.00 [0.70-1.50] ng/mL; P < 0.0001), along with 17OHP/cortisol ratio (0.86 [0.47-1.5]) vs 0.12 [0.07-0.19]; P < 0.0001, respectively). Basal 17OHP levels and the 17OHP/cortisol ratio were strongly correlated in both groups (rho = 0.82; P < 0.0001). Areas under the curves for basal 17OHP levels (0.9528) and the 17OHP/cortisol ratio (0.9455) were not different to discriminate NCAH and PCOS (P > 0.05). Basal 17OHP level >5.4 ng/mL and 17OHP/cortisol ratio >2.90 had 100% specificity to identify NCAH. Basal 17OHP levels >5.4 ng/mL can be used to perform differential diagnoses between NCAH and PCOS, dismissing the ACTH test. The basal 17OHP/cortisol ratio was not superior to basal 17OHP levels in this scenario.

Abstract A066: Performance of the prostate health index (PHI) assay in black men

Abstract Introduction: The low specificity of PSA in prostate cancer (PCa) screening has caused excessive biopsies and PCa over-detection. PHI is more specific for clinically significant (cs) PCa (i.e. Gleason &amp;gt;6 PCa) and includes serum PSA, [-2]proPSA, and free PSA in its formula. Validation studies in diverse populations have suggested that PHI should be used as a reflex test and the optimal cutoffs for PHI vary across ethnic groups, but have not been determined in Black men. We sought to 1) assess the distributions of PHI and PSA in healthy controls and men with high-grade PCa and 2) assess the accuracy of PHI vs. PSA for detection of csPCa in Black men with elevated PSA. Methods: The present study population consists of two biopsy-naïve cohorts. The first cohort serves as healthy controls and includes Black men with PHI and PSA drawn at community screening events through the social networks of eight lay Black male Citizen Scientists. The second PHI Biopsy Study cohort consists of Black men referred with elevated PSA and/or abnormal digital rectal exam (DRE) who had PHI drawn immediately before prostate biopsy. We excluded men with prior biopsies or known PCa. Distributions of PHI and PSA were compared across controls and men with negative biopsies, Gleason 6 PCa and csPCa. Among men with biopsy, we compared the area under the receiver operating characteristics curves (AUC) for PSA and PHI for detecting csPCa and assessed specificity at selected sensitivities as a proxy of avoided biopsies. We descriptively assessed theoretically avoided biopsies and missed csPCa at previously established PHI cut points [27.0, 28.6, 29.9, and 35.0]. Results: For the first objective, 139 men (42.5%) were included as controls from the Citizens Scientist Study and 188 (57.5%) were from the PHI Biopsy Study cohort, out of which 82 (43.6%) had a negative biopsy for PCa, 40 (21.1%) had low-grade PCa, and 66 (35.1%) had a Gleason &amp;gt;6 PCa. Compared to the healthy control group, the PHI Biopsy Study cohort was older (median age 61 vs. 55 years), with higher PSA levels (7.1ng/mL vs. 0.9ng/mL) and PHI scores (61.1 vs. 20.1), and more commonly had a family history of PCa (19.4% vs. 5.0%) and benign prostatic hyperplasia diagnosis (21.3% vs. 2.2%) (all p&amp;lt;0.001). Relative to PSA, PHI has a higher degree of overlap in the distribution between controls and csPCas (p &amp;lt;0.05), suggesting PHI would not perform well as a primary screening test in Blacks. In men with PSA between 4-10, PHI outperformed PSA in the detection of HGPCa with an AUC of 0.70 (95% CI: 0.59-0.81) compared to 0.57 (95% CI: 0.46-0.69). As a reflex test in men with PSA of 4-10ng/mL and normal DRE, a PHI cutoff of 35.0 would spare 20 (27.8%) low-risk men a biopsy while missing 2 (7.4%) csPCas. Conclusion: PHI should not be used for primary screening but has higher accuracy and specificity than PSA in Black men with PSA levels of 4-10ng/mL as a reflex test. At a cutoff of 35.0, 28% of low-risk men avoid biopsy while missing 7% of csPCas. Citation Format: Samuel Carbunaru, Oluwarotimi Nettey, Edward M Schaeffer, Peter H Gann, Michael Abern, Courtney M.P Hollowell, Karriem Watson, Tiffany McDowell, Rick A Kittles, Adam B Murphy. Performance of the prostate health index (PHI) assay in black men [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A066.

PMD18 DIAGNOSTIC AND TREATMENT PATTERNS FOR WOMEN UNDERGOING ENDOMETRIAL BIOPSY AFTER A DIAGNOSIS OF POSTMENOPAUSAL BLEEDING

This goal of this study was to use insurance claims in a real-world setting to describe common diagnostic and treatment patterns and associated cost burden for women who received an endometrial biopsy after being diagnosed with postmenopausal bleeding. The IBM MarketScan Commercial and Medicare Supplemental Databases were used to identify women with continuous enrolment for at least 2 years following a diagnosis of postmenopausal bleeding (ICD-9 code 627.1, ICD-10 code N950) during 2012-2017. Outcomes of interest were receipt of endometrial biopsy, repeat endometrial biopsy, and transvaginal ultrasound and diagnosis of endometrial hyperplasia and/or endometrial cancer. Healthcare resource utilization and costs were estimated for various diagnostic and treatment pathways. 61,186 women (mean age 57) with postmenopausal bleeding were identified in the database. Of these, 27,032 (44%) had evidence of an endometrial biopsy and 11,464 (19%) had 2-years continuous enrolment following the biopsy. 6% of women were diagnosed with endometrial hyperplasia and 3% were diagnosed with endometrial cancer within 90 days of their initial biopsy. Approximately 10% of women received an additional endometrial biopsy within 2 years of their initial biopsy (median time to the second biopsy was 312 days). Among women receiving two biopsies, 19% were diagnosed with endometrial hyperplasia and 2% were diagnosed with endometrial cancer within 90 days of their second biopsy. On average, women had 6.9 physician visits and incurred $12,912 in total healthcare costs ($2527 in pharmacy costs) in the period between their two biopsies. 62% of women received a transvaginal ultrasound during the period between their two biopsies. Approximately 10% of women receive multiple endometrial biopsies following a diagnosis of postmenopausal bleeding with significant healthcare utilization between biopsies. Approximately 2% of women with two biopsies are diagnosed with endometrial cancer within 90 days of their second biopsy.

Comparison of aspirating pipettes and hysteroscopy with curettage.

In this prospective study, endometrial biopsy by pipette was compared with hysteroscopy with curettage in patients with an abnormal uterine bleeding (ABU) (hypermenorrhea, intermediate bleeding, continuous bleeding, postmenopausal bleeding) and patients with a sonographically abnormal endometrium. 176 patients were included. The pipette samples were taken during the usual planned procedure under general anaesthesia. Thereafter, the planned hysteroscopy with curettage was completed. The study was performed as a double-blind study. The obtained histologies (of pipelle and curettage) were sent separately to the same pathologist. The pipelle material was encoded by a specific number without any patient data. In 97% of the cases using the biopsy with pipette were obtained an adequate sample. The biopsy with pipette had a sensitivity and specificity of 100% in the diagnosis of endometrial carcinoma and atypical hyperplasia. Pipette showed a significantly lower accuracy with a sensitivity of 28% in the diagnosis of endometrial hyperplasia without atypia. Pipette showed the lowest sensitivity for polyps, myomas and atrophic endometrium. The study shows that pipette sampling is a safe, accurate, low-cost ambulatory procedure with high sensitivity for the detection of atypical endometrial hyperplasia and endometrial carcinoma. In the case of sonographically definable findings (polyp, myoma), hysteroscopy with curettage is preferred.

Concurrent and future risk of endometrial cancer in women with endometrial hyperplasia: Asystematic review and meta-analysis.

To inform treatment decisions in women diagnosed with endometrial hyperplasia, quantification of the potential for concurrent endometrial cancer and the future risk of progression to cancer is required. We identified studies up to September 2018 that reported on the prevalence of concurrent cancer (within three months of endometrial hyperplasia diagnosis), or the incidence of cancer, identified at least three months after hyperplasia diagnosis. Random-effects meta-analyses produced pooled estimates and 95% confidence intervals (CIs). A total of 36 articles were identified; 15 investigating concurrent and 21 progression to cancer. In pooled analysis of 11 studies of atypical hyperplasia, the pooled prevalence of concurrent endometrial cancer was 32.6% (95% CI: 24.1%, 42.4%) while no studies evaluated concurrent cancer in non-atypical hyperplasia. The risk of progression to cancer was high in atypical hyperplasia (n = 5 studies, annual incidence rate = 8.2%, 95% CI 3.9%, 17.3%) and only one study reported on non-atypical hyperplasia (annual incidence rate = 2.6%, 95% CI: 0.6%, 10.6%). Overall, a third of women with atypical hyperplasia had concurrent endometrial cancer, although the number of studies, especially population-based, is small. Progression to cancer in atypical hyperplasia was high, but few studies were identified. Population-based estimates are required, in both atypical and non-atypical hyperplasia patients to better inform treatment strategies.

Оптическая когерентная томография в дифференциальной диагностике остаточной меланомы и гиперплазии пигментного эпителия после транспупиллярной термотерапии

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

Can Magnetic Resonance Imaging Predict Pathologic Findings for Endometrioid Endometrial Cancer?

This pilot study aimed to assess the feasibility of precisely measuring tumor diameter and myometrial invasion in patients with endometrioid endometrial cancer (EEC) using preoperative contrast-enhanced magnetic resonance imaging (MRI). Adult patients with confirmed diagnosis of complex hyperplasia with atypia or EEC were included. Three radiologists separately measured tumor diameter and myometrial invasion. Basic descriptive statistics were used to describe patient characteristics and to compare radiology- and pathology-measured tumor diameter and myometrial invasion. Using the pathology results for tumor diameter as the gold standard for comparison, at least 1 radiologist was able to predict largest tumor diameter within 5 mm for 41.7% of patients. Similarly, based on pathology results for myometrial invasion, at least 1 radiologist was able to predict myometrial invasion within 5% for 50% of patients. All radiologists were able to predict superficial (<50%) or deep (≥50%) myometrial invasion for 75% of patients, with greater sensitivity, specificity, and accuracy for deep myometrial invasion. Given variation among radiologic measurements, it is difficult to recommend preoperative MRI as a basis for measuring tumor diameter and myometrial invasion. Even so, the ability to predict superficial versus deep myometrial invasion may benefit patients with EEC for whom surgery is not a viable option or for those seeking fertility-sparing treatment options.

Evaluation of the possibilities of shear wave elastography for differentiation of lymphomatous and reactive changes of superficial lymph nodes

Objective: to evaluate the possibilities of ultrasound elastography for differentiation of reactive and lymphomatous superficial lymph nodes (LN).Materials and methods. The prospective study included 138 patients with enlarged superficial LN. Based on a previous histological examination, patients were divided into two groups: 1st group (n = 108) – patients with non-Hodgkin’s lymphomas and Hodgkin’s lymphoma; 2nd (n = 30) – patients with reactive (inflammatory) changes in superficial LN. All patients underwent ultrasound elastography of the enlarged LN using ARFI technology.Results. According to the results of ultrasound elastography, the average, minimum, and maximum shear wave velocities for enlarged LN in lymphoma (1st group) were 2.616 ± 0.684; 1.980 ± 0.557 and 3.351 ± 0.987 m / s, respectively; for LN with reactive changes (2nd group) – 1.704 ± 0.223; 1.414 ± 0.209 and 2.027 ± 0.261 m / s, respectively. Thus, the average, minimum, and maximum values of shear wave velocities significantly different between the groups (p ˂0.001). The cut off values of the average shear wave velocity in the differential diagnosis of lymphoma and hyperplasia are determined at the level of 2.05 m / s, with a sensitivity of 88.5 %, specificity of 100 %, and AUC of 0.942 (p ˂0.001).Conclusion. Ultrasound elastography demonstrated statistically significant differences in shear wave velocity in the enlarged superficial LN in lymphoma and in inflammatory processes that can be used as a preliminary non-invasive differential diagnosis of enlarged superficial LN in these conditions.

Correlation Between Endometrial Thickness By Ultrasonography and Histopathology in Abnormal Uterine Bleeding

Background : Abnormal uterine bleeding (AUB) is the most common presenting complaint of patients in Gynaecology Outpatient department. Early diagnosis of endometrial hyperplasia through ultrasongraphic measurement of endometrial thickness and definite diagnosis by histopathologic examination will help the clinicians to give appropriate treatment to the patients. The objective of this study was to correlate the histopathology findings in abnormal uterine bleeding with endometrial thickness by ultrasonography. Methods : This was a prospective study done from Nov 2016 to June 2018.A total of 382 cases of AUB presenting above 40 years of age were included. Endometrial thickness was measured by ultrasonography. Histopathological findings were studied and compared with the endometrial thickness. Statistical analysis were done using chi square test. Results : A total of 382 cases were analysed. Maximum number of cases were from peri menopausal age group (68.32%). Majority of the cases were due to non organic causes(85.34%). 46.86% of patients had endometrial thickness of 5-10mm followed by endometrial thickness of 11-15mm in 39.01%. Disordered proliferative endometrium was the most common pattern (38.34%) in our study followed by secretory endometrium (35.58%) and menstrual endometrium (18.71%). These findings were found to be statistically significant. Conclusion : A thorough histopathological work up and clinical correlation is mandatory in cases of abnormal uterine bleeding above 40 years to find out organic lesions. Careful screening can detect precursor lesions like endometrial hyperplasia and early cases of endometrial carcinoma which has excellent prognosis and it will help in further management.

Clinicomorphological correlation of psoriasis and psoriasiform dermatitis

Introduction: Psoriasis is a chronic inflammatory skin disorder. Psoriasiform dermatitis on other hand is a frequently encountered terminology in a variety of inflammatory dermatoses. It often poses challenges to both dermatologists and pathologists alike. Clinical features when considered alone may not be reliable to differentiate psoriasis from psoriasiform dermatitis. Aims: (a)To correlate the clinicomorphological features of psoriasis and psoriasiform dermatitis. (b)To identify determinants that may contribute to the diagnosis of psoriasis and psoriasiform dermatitis. Methods: This is a prospective study of 40 cases. Cases clinically diagnosed as psoriasis and psoriasiform dermatitis were screened microscopically and as per morphological criterias 20 cases from each entity were selected and included in the study. Detailed histopathological analysis and correlation was done. Results: The clinical features of typical scales (p= 0.0012) and Auspitz's sign (p = 0.058) morphological evidence of regular acanthosis (p= 0.0005), absent granular layer (p = 0.0001) and presence of micromunros abscess (p=0.0001) were found to be statistically highly significant contributors to the diagnosis of psoriasis in comparison to psoriasiform hyperplasia. Other morphological features like suprapapillary thinning (p= 0.051) was also found to be morphologically significant. Vertical orientation of collagen bundles (p = 0.002) was found to be significantly associated with diagnosis of psoriasiform hyperplasia when compared to psoriasis. Conclusion: The present study reconfirms the diagnostic accuracy of scales, Auspitz’s sign as clinically reliable signs of psoriasis. However, in their absence, morphological presence of regular acanthosis, absent granular layer and Munro microabscess may contribute to the diagnosis of psoriasis. Similarly, vertical orientation of collagen bundles points toward a diagnosis of psoriasiform dermatitis. This may help clinicians not to miss the diagnosis of clinically insignificant psoriasis in order to start early treatment and prevent the poor prognosis in these patients.

Clinical application of red cell distribution width, mean platelet volume, and cancer antigen 125 detection in endometrial cancer.

BackgroundRed cell distribution width (RDW) and mean platelet volume (MPV) are considered to be associated with tumors. We investigated the diagnostic value of RDW, MPV, and cancer antigen 125 (CA125), alone or in combination, in the diagnosis of endometrial cancer and endometrial hyperplasia.MethodsThis study included 144 patients with endometrial cancer (stage I: 32; II: 42; III: 48; and IV: 22), 104 patients with endometrial hyperplasia, and 80 healthy control subjects. The whole blood cell parameters were analyzed by a Mindray Blood Cell Analyzer (CAL8000), whereas CA125 was analyzed using an Architect i2000 Analyzer (Abbott).ResultsSignificant differences in RDW, MPV, and CA125 level were observed in the endometrial cancer, endometrial hyperplasia, and control groups (P < .05). Red cell distribution width was positively correlated (r = .735) whereas MPV was negatively correlated with (r = −.736) endometrial cancer staging. The area under the receiver operating characteristic curve of the combined diagnosis of endometrial cancer based on RDW, MPV, and CA125 was 0.924 (95% CI: 0.881‐0.955). The sensitivity and specificity of the combined diagnosis were larger than those of the independent detections involving RDW, MPV, and CA125.ConclusionsThe combination of RDW, MPV, and CA125 can improve the differential diagnosis of endometrial cancer and endometrial hyperplasia.

88: Assessing the risk of concurrent endometrial cancer among women with endometrial hyperplasia

To identify the independent risk factors of concurrent endometrial cancer among women with endometrial hyperplasia and build the clinical prediction model incorporating the clinical and pathological markers. This cross-sectional retrospective observational study included data from 379 women who had a hysterectomy at the two institutes, Sisters of Charity Hospital and Roswell Park Cancer Institute, of Buffalo, New York from January 2005 to December 2016 following a diagnosis of endometrial hyperplasia with or without atypia. All women with a diagnosis of endometrial hyperplasia who subsequently received hysterectomy with or without staging operation were included in the study and analyzed. Women with a preoperative diagnosis of endometrial cancer prior to hysterectomy were excluded from the study. The variables chosen for the multivariable logistic regression analysis were ‘endometrial hyperplasia (with atypia vs. without atypia), age (≤ 53 vs. > 53), BMI (≤ 35 vs. > 35), the length of endometrial cavity (< 7cm vs. ≥ 7cm), the progestin treatment before hysterectomy (yes vs. no), smoking, diabetes, hypertension, and hyperlipidemia. Then, a stepwise backward regression model to determine the predictors of endometrial cancer was performed. The performance of predictive models was assessed with receiver operating characteristic (ROC) curve and Hosmer-Lemeshow test. Fifty-five (14.51%) of a total of 379 women with endometrial hyperplasia was diagnosed with endometrial cancer after hysterectomy. In bivariate regression analysis, the risk factors significantly associated with concurrent endometrial cancer were atypical endometrial hyperplasia, age ≥ 50, postmenopausal bleeding, the use of progestin, diabetes mellitus, hypertension, and hyperlipidemia. In adjusted multivariate logistic regression analysis, the presence of atypical endometrial hyperplasia was associated with a significant increase in the risk of being diagnosed with concurrent endometrial cancer in the final pathology of hysterectomy specimen (OR, 56.708, 95% CI 7.601-423.056). Using a stepwise backward multivariate regression (alpha set at 0.1) analysis, the model with atypical endometrial hyperplasia, hypertension, smoking, and postmenopausal bleeding was constructed. This model predicted the risk of being diagnosed as endometrial cancer better, in comparison to the model with atypical endometrial hyperplasia alone or the model controlling simultaneously for the variables selected in the bivariate analyses indicated above (stepwise backward regression model, AUC=0.8749; the model with atypical endometrial hyperplasia, AUC=0.7983; multivariate regression model, AUC=0.8696, p-value = 0.0001). The addition of postmenopausal bleeding, hypertension, and smoking to atypical endometrial hyperplasia in the risk prediction model improves the risk assessment of concurrent endometrial cancer.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Urinary Transcriptome as a Source of Biomarkers for Prostate Cancer.

Prostate cancer (PCa) is the second most common cancer of men and is typically slow-growing and asymptomatic. The use of blood PSA as a screening method has greatly improved PCa diagnosis, but high levels of false positives has raised much interest in alternative biomarkers. We used next-generation sequencing (NGS) to elucidate the urinary transcriptome of whole urine collected from high-stage and low-stage PCa patients as well as from patients with the confounding diagnosis of benign hyperplasia (BPH). We identified and validated five differentially expressed protein-coding genes (FTH1 BRPF1, OSBP, PHC3, and UACA) in an independent validation cohort of small-volume (1 mL) centrifuged urine (n = 94) and non-centrifuged urine (n = 84) by droplet digital (dd)PCR. These biomarkers were able to discriminate between BPH and PCa patients and healthy controls using either centrifuged or non-centrifuged whole urine samples, suggesting that the urinary transcriptome is a valuable source of non-invasive biomarkers for PCa that warrants further investigation.