Entire Specimen Research Articles

On the relevance of histopathology results in oropharyngeal cancer with mandibular involvement and the necessary imaging

Planning of surgical procedures in patients suffering from oropharyngeal cancer requires appropriate imaging, particularly in consideration of the spatial relationship to the mandible. Resection of portions of the mandible (box, marginal, or segmental resection) is often necessary, while simultaneously avoiding overtreatment. Typically, acomputed tomography (CT) scan is initially performed. However, the question arises of whether CT alone is adequate for reliable assessment of mandibular involvement. Apatient cohort of 25individuals aged 44-79years (mean 62years) undergoing partial oropharyngeal resection with segmental mandibular resection was examined. The indication for segmental resection was based on the close relationship of the tumor to the mandible observed in imaging. Reconstruction was consistently carried out with areconstruction plate and free or pedicled flaps. Preoperative radiological findings were compared with histopathology results after decalcification of the mandibular bone. Cortical tumor infiltration was observed in the mandible in 9patients (36%). Preoperatively, clear bone infiltration had been identified in CT in only 2 of these 9patients; in the remaining 7, only direct tumor contact with the mandible was evident. Magnetic resonance imaging (MRI) revealed bone infiltration in 1 of these 7patients. Adhering to safety margins requires aradical surgical approach and reliable intraoperative frozen section analysis. However, at the bone level, intraoperative frozen section analysis is technically impractical due to the required decalcification. Only after decalcification can the entire specimen be assessed for tumor infiltration. In our cohort, asignificant discrepancy in terms of bone infiltration was noted between preoperative imaging assessments and postoperative histopathology. CT preoperatively identified bone infiltration in only 8% of our patients. In two thirds of the specimens, no bone infiltration was evident after decalcification and histopathological processing, retrospectively indicating overtreatment by segmental resection; box or marginal resections may have been sufficient in these cases. Therefore, when tumors are adjacent to the bone in CT, MRI should also be performed preoperatively to more reliably detect bone infiltration.

Congenital Appendiceal Atresia: An Extremely Rare Disorder Presenting with Acute Abdomen

Abstract Introduction/Objective Congenital malformations of the appendix are extremely rare and difficult to diagnose preoperatively. One of those anomalies include congenital appendiceal atresia (CAA) which mimics acute appendicitis and is usually ignored in the differentials of acute abdomen. Herein, we present a case study of congenital appendiceal atresia associated with periappendicitis. Methods/Case Report A 62-year-old female with past history of diverticulitis presented with complaints of crampy, diffuse and progressive lower abdominal pain and nausea for two days. She denied fevers, chills or change in bowel movements. Physical examination revealed vitally stable patient with soft, non-distended and tender abdomen in bilateral lower quadrants, worse on the right side and showing positive rebound test. Her complete blood count and chemistry were within normal limits. A computerized tomography arterial portography (CTAP) scan with contrast demonstrated inflammatory stranding around the appendix without abscess, concerning for acute appendicitis. She then underwent laparoscopic appendectomy. Grossly, the appendix consisted of a cylindrical portion of yellow-pink fatty tissue covered by peritoneum measuring 6.2 x 3.3 x 0.5 cm. The peritoneal surface displayed patchy fibrinous exudates. Sectioning revealed yellow adipose tissue with no identifiable appendix. Microscopically, the entire specimen demonstrated a poorly formed, mainly fatty appendix without a discernible lumen or submucosal lymphoid tissue. There were scattered sparsely distributed non-continuous bundles of smooth muscle (muscularis propria) at the periphery, which were highlighted by desmin and trichrome stains. This atretic appendix, mesoappendix and peritoneal covering were acutely inflamed. The final diagnosis was poorly formed, acutely inflamed fatty appendix consistent with congenital appendiceal atresia with accompanying acute periappendicitis. Results (if a Case Study enter NA) NA Conclusion This case would add to the very limited existing literature for congenital appendiceal anomalies and highlight the importance of thorough surgical intraoperative abdominal exploration and submission of the entire specimen for microscopic examination in order to render a definitive diagnosis.

Numerical simulation of mechanical properties and damage process of carbon nanotube concrete under triaxial compression and splitting conditions

To investigate the mechanical properties and failure processes of carbon nanotube concrete, a three-dimensional meso-scale finite element model of concrete was constructed. Using ABAQUS software, numerical simulations were conducted on concrete samples with different carbon nanotube concentrations under triaxial compression and splitting conditions. The results indicate that under splitting conditions, the failure of the specimens initially occurs along the loading direction from both ends, with few cracks and slow propagation. Subsequently, the cracks rapidly expand, penetrating the entire specimen, leading to the formation of a macro-fracture surface with a crack aligned with the loading direction. This failure mode manifests as a straight crack. At the same loading rate, the tensile strength of the specimens with different carbon nanotube concentrations increases to varying degrees during splitting failure, with a maximum increase of 45.10% to 4.15 MPa. nder triaxial compression conditions, the main failure mode of the specimens exhibits shear failure characteristics. As the confining pressure gradually increases, the failure angle of the specimens enlarges. Under low confining pressure, there are fewer wing-shaped tensile cracks at the shear failure surface of the specimens. As the confining pressure increases, irregular shear failures and multiple shear planes appear in the specimens, resulting in more complex failure modes. For specimens with the same carbon nanotube concentration, the triaxial compressive strength of carbon nanotube concrete specimens increases with increasing confining pressure. The triaxial compressive strengths of the specimens under confining pressures of 5 MPa, 10 MPa, 15 MPa, and 20 MPa are 90.48 MPa, 122.72 MPa, 137.22 MPa, and 172.65 MPa, with strength increases of 35.63%, 51.66%, and 90.81%, respectively.

MECHANICAL BEHAVIOUR OF ISTLE FIBRE COMPOSITE REINFORCED WITH EPOXY AND E-GLASS AT DIFFERENT FIBRE ORIENTATIONS

This paper was aimed to study the mechanical properties of Istle fibre composites. The process of fabrication was done by hand layup technique at three different fibre orientations i.e., unidirectional, bidirectional and 45 degrees inclined, and also its effect on tensile and flexural property that was studied in the Instron Testing Machine. The fibre volume ratio was kept uniform for the entire specimen as 50:50. The treatment of istle fibre was done with sodium hydroxide to increase the fibre matrix bonding. The effect of E-glass reinforcement has also been studied in both bending tests and flexural tests. The maximum tensile and bending modulus recorded were from unidirectional fibre specimen.

Entropy‐based method considering nonlinear hardening effect to predict the crack propagation life of superalloy GH4169 at elevated temperature

AbstractThis paper aims to determine the relationship between thermodynamic entropy generation and fatigue crack propagation life of superalloy GH4169 at 300–650°C. The entire specimen was considered as the thermodynamic system. The plastic energy dissipation in the crack tip was obtained by finite element simulation utilizing the Chaboche nonlinear hardening model. Then the cyclic entropy generation rate (CEGR) and the accumulated entropy generation are calculated by combining simulation and experimental methods. Results show that the CEGR is a power function of the stress intensity factor range, and it is almost a constant at fatigue failure. The fatigue fracture entropy (FFE) increases as fatigue cycles at failure increase at constant temperature, but it first decreases and then increases when temperature increases from 300 to 650°C. A fatigue life prediction model based on the thermodynamic damage parameter is established and verified by comparison with experimental results and available data in the literature.

Leiomyomatosis: A Rare Case of Mistaken Identity

Abstract: Diffuse uterine leiomyomatosis (DUL) is a rare benign uterine pathology that is often misdiagnosed as uterine leiomyomas. We present a case of a woman with abnormal uterine bleeding treated with multiple medical therapies without symptomatic relief. She underwent two surgeries, almost a year apart, with the histopathologic diagnosis of leiomyomas. After numerous failed attempts at medical and surgical treatments, the patient requested definitive surgery and underwent a robotic-assisted laparoscopic hysterectomy. Histopathologic analysis of the entire uterine specimen confirmed diffuse uterine leiomyomatosis. Case Report: A 31-year-old female was referred to our office with a history of abnormal uterine bleeding and heavy menstrual bleeding who failed hormonal therapies. Levonorgestrel-releasing intrauterine devices were inserted at two different times and were expelled due to heavy menses. Pelvic magnetic resonance imaging reported leiomyomas. The patient underwent hysteroscopy and a robotic-assisted myomectomy. Pathology revealed leiomyomas. Seven months after her first surgery, her bleeding recurred, and the patient became severely anemic, requiring hospitalization and transfusion of 2 units of packed RBCs. Over a year later, the patient underwent a second hysteroscopic and robotic myomectomy after failed medical therapies of tranexamic acid, progesterone medication, and gonadotropin-releasing hormone antagonist with minimal symptom relief. Her quality of life suffered tremendously due to ongoing AUB-HMB. After seven months, the patient requested definitive surgical therapy and underwent a robotic-assisted laparoscopic hysterectomy. Pathology reported diffuse uterine leiomyomatosis. Diffuse uterine leiomyomatosis is a rare benign uterine pathology that is often misdiagnosed as uterine leiomyomas. Early diagnosis of DUL is challenging and often inconclusive. Less than 50 diffuse uterine leiomyomatosis cases have been reported in the literature. The myometrium in DUL is almost entirely replaced by numerous ill-defined benign smooth muscle tumors. MRI offers mapping of the size, site, and distribution of leiomyomas, but findings are difficult to differentiate from DUL. The pathophysiology of DUL development remains poorly understood, with patients frequently complaining of abnormal uterine bleeding, heavy menstrual bleeding, fertility issues, and dysmenorrhea. DUL is often misdiagnosed as leiomyomas or adenomyosis clinically, given the similarity in manifestations. Leiomyomatosis is histologically characterized by the proliferation of smooth muscle cells forming fascicles and nodules, which blend with normal myometrium tissue. Hysterectomy is the definitive treatment of DUL, with this case report demonstrating the close similarity between the two.

Inhomogeneity in mechanical properties of ductile iron pipes: A comprehensive analysis

Ductile iron pipes are widely used in pipe manufacturing for water and sewage transmission and distribution. In pipeline standards such as EN545, the pipe material is assumed isotropic and its mechanical properties are determined by tensile testing of round bars extracted along the longitudinal direction. This study experimentally examined the mechanical properties of centrifugal casting ductile iron pipes, focusing on the effects of sampling orientation, location, preparation, and test methodology. A ring hoop tension test (RHTT) was designed to evaluate circumferential properties. Force analysis of RHTT was performed and theoretical equation was derived to quantify the friction coefficient that existed between the coupon specimen and the loading fixture. A numerical study was conducted to further validate the effectiveness of the proposed theory. The test results indicated that the pipe mechanical property was inhomogeneous across the wall thickness, being inferior in the internal section and superior in the middle and external sections. This inferior layer would develop crack first and lead to subsequent outward propagation. This phenomenon led to a substantial degradation in the overall mechanical performance of the entire specimens, in comparison to the material in the middle portion. The material exhibited better performance in the circumferential direction compared to the longitudinal direction in terms of its mechanical properties, such as tensile strength and ductility. Flattened specimens showed enhanced strength and reduced ductility compared to the base pipe material. Fractographic and metallographic analyses revealed the existence of casting defects of porosity and agglomerated graphite in the internal section, which were the primary cause of material inhomogeneity. The round bars suggested per EN545 tended to overestimate the actual mechanical behaviour of ductile iron pipes, and may not be a true representation of the finished product of pipes. Flattened specimens as per ASTM E8/E8M were not recommended for ductile iron pipe material assessment, as the flattening process altered the stress–strain characteristics significantly.

A case report of sinonasal glomangiopericytoma: An important reminder to always collect specimen.

To present a case report of sinonasal glomangiopericytoma (GPC) in a female patient in her thirties and to highlight the importance of collecting pathology specimens even in routine sinus surgery cases. A case report detailing the diagnosis of GPC in a female in her thirties, including her initial presentation, treatment, and follow-up, along with a brief review of the literature. Pathology of the collected specimen revealed sinonasal GPC along with chronic rhinosinusitis. Immunohistochemistry was positive for SMA, beta-catenin, and cyclin D1; and negative for STAT6, ERG, pankeratin, SOX10, and S100. This diagnosis expands the knowledge around the demographic profile of GPC patients. GPC should be included in the differential diagnosis of sinonasal masses, even in younger patients. The case highlights the importance of collecting the entire pathology specimen in all cases, even of ones that seem routine and benign.

Numerical investigation of gas migration behaviour in saturated bentonite with consideration of temperature

AbstractGas migration behaviour in saturated, compacted bentonite, especially under rigid-boundary conditions, is controversial. Gas breakthrough phenomena, observed under higher pressure gradient conditions in laboratory experiments, are described in literatures by adopting visco-capillary or dilatancy-controlled flow concept. Since, under rigid-boundary conditions, volumetric expansion is restricted and/or water dissipation is not detected, these concepts cannot be implemented satisfactorily. Instead, a diffusion and solubility-controlled (DSC) flow concept was previously found to be adequate for describing the behaviours at lower temperatures (20 °C). The DSC concept describes gas breakthrough as a function of gas solubility. Breakthrough occurs when concentration of dissolved gas reaches or surpasses the solubility limit in the entire specimen. In this work, the DSC flow concept is applied to validate gas migration and breakthrough experiments conducted at higher temperatures, e.g. 40 and 60 °C. Good agreements are observed between the experimental and predicted results, suggesting that the DSC flow concept can be applied to describe gas migration behaviour satisfactorily in rigidly confined saturated bentonites (under constant volume conditions) for various temperature regimes. Results also show that helium dissolution and diffusion processes in saturated bentonite are sensitive to test temperature and pressure conditions. The processes become more stable with increasing gas injection pressure and ambient temperature.

DL-EDOF: Novel Multi-Focus Image Data Set and Deep Learning-Based Approach for More Accurate and Specimen-Free Extended Depth of Focus.

Depth of focus (DOF) is defined as the axial range in which the specimen stage moves without losing focus while the imaging apparatus remains stable. It may not be possible to capture an image that includes the entire specimen in focus due to the narrow DOF in microscopic systems. Extended depth of focus (EDOF) is used to overcome this limitation in microscopic systems. Although the researchers have developed so many EDOF microscope approaches, this research field still has some crucial shortcomings such as high computational costs, complexity and execution time, requiring additional equipment, low precise characterization of curves, and edges in images, varying performance depending on the specimen and microscope, using only gray levels of input images to acquire the pixel's focus values. In order to minimize these shortcomings and comprehensively analyze the performance of EDOF approaches, a novel multi-focus image data set is generated, and a deep learning-based EDOF microscope approach is proposed in this study. When compared with the state-of-art EDOF approaches, our study provides various crucial contributions such as the first EDOF approach based on unsupervised deep learning, providing more accurate and specimen-free EDOF, generating a novel multi-focus image data, not requiring any pre- or post-processing technique and acquiring the pixel's focus degrees using deep features. In order to evaluate the effectiveness of the suggested approach, 20 different EDOF approaches are applied to a multi-focus image data set containing 9 image collections (4 synthetic and 5 microscope image collections) in total. Performance analysis metrics with and without requiring a reference image are preferred to identify which EDOF microscope approach can extract more essential details from the multi-focus images for the synthetic and microscope image collections, which are Root Mean Square Error (RMSE), Peak Signal Noise Ratio (PSNR), Universal Quality Index (UQI), Correlation Coefficient (CC), Perception-based Image Quality Evaluator (PIQE), Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE), Extension of Universal Quality Index for N Images (UQIN), and Naturalness Image Quality Evaluator (NIQE). Objective and subjective analysis of this study demonstrates that unsupervised deep learning model is more efficient to transmit crucial details from multi-focus images. Moreover, the suggested EDOF microscope approach with highest PSNR, UQI, CC, UQIN and lowest RMSE, PIQE, BRISQUE, NIQE produces higher performance than the state-of-art approaches.

Experimental study of the effect of crack distribution on the failure mechanism of sandstone specimens based on inclination angles and number of parallel flaws

Discontinuous joints are prevalent in engineered rock masses and play a significant role in the stability of the rock mass. This study aims to analyze the impact of the inclination angle and number of prefabricated flaws on the crack evolution and failure pattern of sandstone specimens. Uniaxial compression tests, along with acoustic emission technology and digital image technology, were employed to monitor and analyze the effects. The findings indicate that: (1) With the increase in the flaw inclination angle, the damage mode of the specimen transitions from tensile to compressive-shear failure. The localized high-strain region on the surface of the specimen predicts the propagation path for the formation of macroscopic cracks. (2) When the number of prefabricated flaws is small, the flaws mainly expand through tensile wing cracks. As the number of flaws increases, the inner flaw tip does not produce cracks. Instead, the failure of the entire specimen occurs along the direction of the outer flaw's tensile wing crack, with the inner flaw running through it. (3) The winged tensile crack is the first crack to appear in all rock samples, regardless of the flaw initiation angles. Finally, the stress intensity factor at the crack tip under uniaxial compression conditions, without considering the closure effect, was expressed based on fracture mechanics theory. The crack initiation angle was then calculated. The results of the theoretical calculation of the initiation angle were found to be consistent with the test results. These research findings can serve as theoretical references and provide insights into the failure mechanisms of cracked rocks and the development of disaster control methods in rock engineering.

In Situ Metallic Coating of Atom Probe Specimen for Enhanced Yield, Performance, and Increased Field-of-View.

Atom probe tomography requires needle-shaped specimens with a diameter typically below 100 nm, making them both very fragile and reactive, and defects (notches at grain boundaries or precipitates) are known to affect the yield and data quality. The use of a conformal coating directly on the sharpened specimen has been proposed to increase yield and reduce background. However, to date, these coatings have been applied ex situ and mostly are not uniform. Here, we report on the controlled focused-ion beam in situ deposition of a thin metal film on specimens immediately after specimen preparation. Different metallic targets e.g. Cr were attached to a micromanipulator via a conventional lift-out method and sputtered using Ga or Xe ions. We showcase the many advantages of coating specimens from metallic to nonmetallic materials. We have identified an increase in data quality and yield, an improvement of the mass resolution, as well as an increase in the effective field-of-view. This wider field-of-view enables visualization of the entire original specimen, allowing to detect the complete surface oxide layer around the specimen. The ease of implementation of the approach makes it very attractive for generalizing its use across a very wide range of atom probe analyses.

Evaluation of electromagnetic characteristics of 3D-printed radar absorbing structures based on three-dimensional period pattern surface

This paper aims to assess the electromagnetic (EM) characteristics of 3D-printed radar absorbing structures (RASs) based on three-dimensional period pattern surface (3D PPS) within the X-band frequency range (8.2–12.4 GHz). The assessment is validated through HFSS software, a 3D printer (Markforged, X7), and a scanning free-space measurement (SFM) system. Firstly, the analysis indicates that the EM characteristics of RASs based on 3D PPS are impacted by impedance matching in the thickness direction and the scattering of EM waves at the edges. The utilization of Onyx (Chopped carbon fiber/Nylon) reveals variations in resonance frequencies and EM wave absorption performance contingent upon the surface shape. Furthermore, significant differences in the variations of EM characteristics are observed even for RASs with the same surface shape but different materials. Secondly, the measurement results of 3D-printed RAS specimens based on PPS using Onyx exhibit similar trends to the analysis results obtained with the SFM system. Ensuring precise measurement results requires specific measurement conditions tailored to each surface shape, along with an examination of the EM characteristic distribution across the entire specimen area. This is crucial due to variations in the size, number, and range of reflected EM waves in the time domain. The analysis and measurement techniques presented in this study hold applicability in designing 3D-printed RASs that demand high EM wave absorption performance, whether under normal or oblique incident EM waves.

Multifocality and Detectability of Prostate Cancer with 3‐Tesla Multiparametric Magnetic Resonance Imaging: Correlation with Radical Prostatectomy Mapping Histopathology

Background. We aimed to determine the multifocality and detectability of prostate cancer (Pca) with 3‐Tesla (3T) multiparametric magnetic resonance imaging (mpMRI). Methods. The data of the patients who underwent radical prostatectomy in our institution between April 2020 and April 2021 were analyzed. Patients were included in the study at the stage of radical prostatectomy. Demographic and histopathological data were retrospectively collected, and then MRIs of eligible patients were re‐evaluated for the study. Suspicious regions of interest (ROIs) were evaluated by a radiologist with 4 years of experience in uroradiology and scored based on Prostate Imaging Reporting and Data System (PIRADS) v2.1. The reader was blinded to the pathological outcomes of any biopsy specimen. Lesions with a PIRADS score ≥3 were considered positive and included in the study. All cases were evaluated histopathologically by a pathologist with ten years of experience in uropathology. We utilized the mapping method which provided exactly the same information as the whole‐mount histopathology along with processing the entire prostatectomy specimen. Results. A total of 142 histopathologic tumoral lesions were detected among 70 patients. In relation to postoperative histopathology, tumor multifocality was established in 78.6% (n = 55), and 52.1% (n = 74) of 142 foci recognized were clinically significant. By detecting a total of 67 lesions, mpMRI showed an overall sensitivity of 47%. Whilst the sensitivity was 73% (54/74) in clinically significant lesions, the sensitivity was only 17.6% (12/68) in clinically insignificant lesions. For the group with detected tumors, the mean prostate‐specific antigen (PSA) and PSA density were higher, there were more high‐grade lesions, and the rate of the extraprostatic extension was significantly greater (p < 0.05, respectively). According to the multivariate analysis, only tumor size and Gleason Score (GS) were independent predictors regarding the ability of mpMRI to detect tumor foci within the prostate (p < 0.0001). Conclusion. mpMRI exhibited an acceptable sensitivity in detecting high‐risk and large Pca foci. The diagnostic accuracy is observed to be markedly diminished in small, low GS, and nonindex tumors. A considerable percentage of missed lesions are clinically significant.

Histological and neuroimaging comparison of SMART syndrome versus focal neuronal gigantism.

Two of the rarest radiation-induced adverse effects are focal neuronal gigantism (FNG) and SMART syndrome (stroke-like migraine attacks after radiation therapy). Both conditions develop years, and sometimes decades, after receipt of therapeutic radiation to the brain. To date, there are only 3 previously reported cases of FNG, all of which describe cortical thickening, enlarged "hypertrophic" neurons, and neuronal cytological changes. No detailed studies exist of histological features of SMART or the comparison between FNG and SMART. In this study, we contrast histological and neuroimaging features of 3 FNG vs. 4 SMART cases, the latter diagnosed by a neuroradiologist, neurooncologist, and/or neurosurgeon. We confirm the cortical thickening, dyslamination, neuronal cytomegaly, and gliosis in FNG vs. cortical architectural preservation and normal neuronal cytology in SMART, although both showed gliosis, scattered neurons with cytoplasmic accumulation of tau and neurofibrillary protein and variable co-existence of other radiation-induced lesions. Both conditions lacked significant inflammation or consistent small vessel hyalinization throughout the entire resection specimen. The absence of pathognomonic histologic alterations in SMART cases suggests underlying vascular dysregulation. Despite differing histology, some overlap may exist in neuroimaging features. Molecular assessment conducted in 2 cases of FNG was negative for significant alterations including in the MAPK pathway.

Evaluation of non-uniformity of sandy soil specimens compacted in the field and laboratory using triaxial tests

The strength and deformation characteristics of compacted soils are typically evaluated using triaxial compression tests on specimens that are compacted relatively uniformly in a laboratory. Soil compacted in the field using vibration rollers is nonuniform in the vertical depth direction; this is because the gradient of the dry density and saturation degree in the depth direction of each compaction layer is large, owing to the distribution of the load transmitted from the contact surface. As a quality control method for earth-filling works, nondestructive inspection indices—such as the soil stiffness index—are applied in some cases, and the average value of the nonuniform compaction layers is measured. Further, unsaturated specimens, which were retrieved from the test fill yielded during field compaction tests, and specimens obtained via compaction using the same soil as that in the laboratory were prepared, and then triaxial compression tests were performed. Local displacement transducers were installed to obtain local deformation characteristics, based on the vertical depth of the specimen, which were then compared with the average deformation characteristics of the entire specimen. The results show that the local low-stiffness section significantly affects the overall average; this makes it non-negligible because the specimen compacted in the field is nonuniform. However, because field-compacted soil has a local lowstiffness section near the surface layer compared with laboratory-compacted soil, evaluations based on the nondestructive inspection of the surface layer may result in underestimations.

Giant pilomatricoma with coexisting angiomyxoid stroma histopathology: a case report

Introduction: Pilomatricoma, also known as benign calcifying epithelioma of Malherbe, is a follicular tumor originating from cells in the hair follicle matrix. It usually manifests as a firm subcutaneous mass up to 3 cm in size. Less commonly, it may measure >5 cm and in such cases is called giant pilomatricoma. We herein present a case of a subcutaneous lesion that was characterized by aggressive biological behavior and initially thought to be malignant but subsequently found to be a rare angiomyxoid variant of giant pilomatricoma. Case presentation: This case involved a young, healthy woman with a rapidly growing subcutaneous lesion on the distal lateral side of her right arm. An incisional biopsy was performed, and the lesion was diagnosed as hyperplasia of the epidermis and subcutaneous tissue, likely of reactive nature. After radical excision, analysis of the entire specimen led the pathologist to diagnose a rare variant of giant pilomatricoma with angiomyxoid stroma. Discussion: Classic pilomatricoma is an indolent, slow-growing lesion that is well defined and not fixed to the underlying tissue planes. However, after showing no signs of enlargement for 6 months, the lesion in the present case began to grow in a very unusual and concerning manner, suggesting a skin malignancy. The patient’s young age and the rapid development and large dimensions of the lesion led us to suspect a sarcoma. Conclusion: This case highlights the importance of cooperation between the dermatosurgeon and the pathologist to ensure thorough evaluation of such misleading cases. Such cooperation will guide appropriate management decisions and avoid overtreatment of benign lesions.

A highly efficient computational approach for fast scan-resolved simulations of metal additive manufacturing processes on the scale of real parts

This article proposes a novel high-performance computing approach for the prediction of the temperature field in powder bed fusion (PBF) additive manufacturing (AM) processes. In contrast to many existing approaches to part-scale simulations, the underlying computational model consistently resolves physical scan tracks without additional heat source scaling, agglomeration strategies or any other heuristic modeling assumptions. A growing, adaptively refined mesh accurately captures all details of the laser beam motion. Critically, the fine spatial resolution required for resolved scan tracks in combination with the high scan velocities underlying these processes mandates the use of comparatively small time steps to resolve the underlying physics. Explicit time integration schemes are well-suited for this setting, while unconditionally stable implicit time integration schemes are employed for the interlayer cool down phase governed by significantly larger time scales. These two schemes are combined and implemented in an efficient fast operator evaluation framework providing significant performance gains and optimization opportunities. The capabilities of the novel framework are demonstrated through realistic AM examples on the centimeter scale including the first scan-resolved simulation of the entire NIST AM Benchmark cantilever specimen, with a computation time of less than one day. Apart from physical insights gained through these simulation examples, also numerical aspects are thoroughly studied on basis of weak and strong parallel scaling tests. As potential applications, the proposed thermal PBF simulation approach can serve as a basis for microstructure and thermo-mechanical predictions on the part-scale, but also to assess the influence of scan pattern and part geometry on melt pool shape and temperature, which are important indicators for well-known process instabilities.

High Ki67 Index Is Associated with Shorter Progression Free Survival in Follicular Lymphoma Patients Treated with Frontline Immunochemotherapy

Introduction The Follicular Lymphoma International Prognostic Index (FLIPI) is a commonly used prognostic tool in follicular lymphoma (FL). However, there is a need for better risk stratification to predict risk of progression after frontline chemoimmunotherapy. Ki67 proliferation index has prognostic value in many lymphomas and is widely available in clinical laboratories. However, the impact of Ki67 on outcomes in FL have not been conclusive. Studies have been limited by the method of quantifying Ki67 (entire specimen or intrafollicular [IF]), heterogeneous treatments, or small single institution studies. Moreover, the impact of Ki67 on predicting disease progression at 24 months (POD24) is unknown. We sought to study the predictive value of Ki67 on PFS in FL treated with Bendamustine Rituximab (BR) or RCHOP with or without Rituximab maintenance (RM) as first line therapy at 2 tertiary care centers. Methods This study was conducted with approval by the Wake Forest University Health Sciences IRB. We retrospectively analyzed 122 patients with FL (grade 1-3A) from 2010 to 2021 at Atrium Health (AH) Levine Cancer Institute (n=72) and AH Wake Forest Baptist Medical Center (n=50) who underwent first line therapy with BR or RCHOP and had tissue/slides available for analysis. Clinical data was collected through electronic medical record review. Archival slides and paraffin-embedded blocks were retrieved. Ki67 immunohistochemistry (IHC) (SP6, Cell Marque, Rocklin, CA), was performed if it was not available from the original work-up (8 cases). CD21 IHC (1F8, Dako, Denmark) was performed in select cases to confirm the presence of follicles in order to assess IF Ki67. Diagnosis, grade, and Ki67 stains were evaluated by 2 hematopathologists. The IF Ki67 index was determined by visual estimate to the nearest 10%. All cases with scores between 20-40% were re-reviewed to achieve a consensus score. Ki67 controls were exchanged between the two centers to ensure equivalent staining. Comparisons of patient characteristics were done by Kruskal-Wallis test for continuous variables (age) or Chi-square tests (categorical variables). Survival analysis was performed using Kaplan-Meier estimation and log-rank testing. Cox proportional hazards modeling was used for multivariable progression free survival (PFS) analysis. Results The clinical and pathologic characteristics are shown in Table 1. No differences in demographics [age, stage, cytologic grade, FLIPI, IF Ki67 status (<30 or ≥30) and treatment selection] were seen between the two centers. 100 cases were grade 1-2 (82.0%) and 22 were grade 3A (18.0%). Consistent with expected treatment patterns in FL, more patients were treated with BR (70.5%) compared to RCHOP (29.5%) and RCHOP was more frequently used in grade 3A compared to grade 1-2 FL patients. As expected, low FLIPI score (0-1) was associated with favorable PFS (P=0.02, Figure 1A), but not OS. However, treatment regimen (BR vs RCHOP), use of RM, and cytologic grade (grade 1-2 vs 3A) were not associated with PFS or OS. The IF Ki67 index was elevated (≥30%) in 46 cases (38%) and high IF Ki67 was associated with shorter PFS (P=0.002, Figure 1B), but was not associated with OS (P=0.11). When stratified by treatment regimen and IF Ki67, these results were maintained ( Figure 1C). There was no association between FLIPI and IF Ki67 (P=0.10). In a multivariable regression analysis, IF Ki67 ≥30 was associated with a significantly higher risk of progression (HR= 2.3, 95% CI 1.3 to 4, P=0.005) after accounting for the effect of FLIPI. In an exploratory analysis, a FLIPI/Ki67 (FKi) score was devised in which one point was given for either FLIPI ≥ 2 or IF Ki67 ≥ 30% giving a possible score of 0, 1 or 2. The FKi score was associated with PFS (P=0.0005, Figure 1D). Moreover, IF Ki67 ≥ 30 was associated with a higher risk of POD 24 (P=0.037). FLIPI ≥2 was also associated with POD24 (P=0.005). Conclusion Intrafollicular Ki67 ≥ 30% predicts for increased risk of progression independent of FLIPI in patients with FL treated with frontline immunochemotherapy. Addition of Ki67 to FLIPI is strongly associated with PFS in FL. Ki67 stains were done over an 11 year period in different laboratories, demonstrating the wide applicability and robustness of the Ki67 IHC technique. Larger studies incorporating IF Ki67 in risk stratification models are warranted in FL.

Influence of an oxygen-enriched layer on the tensile properties of an alpha titanium alloy

The manuscript focuses on establishing the role of an oxygen-enriched layer (OEL) on the tensile properties of an alpha titanium alloy, Ti-Al-Zr. The samples were heat-treated in the inert and air atmosphere for different durations up to 700 h. The air oxidation led to the formation of the OEL near the surface of the specimen. The specimens were characterized by different metallurgical techniques like a stereo microscope, optical microscopy, micro-hardness measurement and grain size measurement. The oxygen profiling was done by the glow discharge optical emission spectroscopy technique. The tensile testing was done at room temperature at a strain rate of 2.5 × 10−4 s−1. The fracture surface was examined under scanning electron microscopy. The tensile properties-yield strength and ultimate tensile strength were in the same range for the specimens oxidized in the inert and air atmosphere. However, the specimens oxidized in the air atmosphere showed a drastic decrease in ductility with increasing oxidation duration. The entire specimens oxidized in the inert atmosphere showed dimples features, typical of a ductile failure. The specimens oxidized in the air atmosphere showed fracture features like intercrystalline fracture, slip bands and cleavage facets in addition to dimples features. The OEL showed brittle failure and the regions other than OEL showed ductile failure. The role of oxygen on the tensile properties and the development of different fracture features during air oxidation are discussed.