Biopsy Examination Research Articles

How reliable is your diagnosis?

The effectiveness and justification of every therapy and other clinical decisions is based on a correct diagnosis. However, many types of test results can contain uncertainties that may lead to clinically incorrect decisions. The same applies to the reliability of expert opinions for legal disputes. Adequate communication of diagnostic and expert uncertainties in the examination report or expert opinion is therefore crucial for avoiding incorrect decisions. The liability of the person providing the service is also affected. However, uncertain or even erroneous findings can have various causes, only some of which are known to the examining or commissioning person. This article provides an overview of 3 different types of susceptibility to errors using the example of pathological biopsy and cytology examinations, which can also be transferred to other veterinary disciplines in a similar way. A solid understanding of the possible sources of error as well as adequate communication and discussion of case-specific, limited probabilities in investigation reports and expert opinions make a significant contribution to avoiding incorrect decisions. However, commonly used terms such as "highly probable", "suspected" or "cannot be ruled out" are sometimes interpreted in unclear or divergent ways, which are explained here with recommendations for uniform use. This is intended to enable the person making the decision, if necessary, to initiate further diagnostic tests or gather further evidence in the context of all other available data in order to reduce the risk of error as far as possible.

Morphology of endometrial inflammatory changes in foci of endometriosis and adenomyosis

The high prevalence of endometriosis, its impact on menstrual and reproductive functions, obstetric complications, and the quality of life of women in the reproductive age determines the urgency of the problem.The objective: to assess the prevalence of inflammatory changes in foci of heterotopic endometrium in patients with endometriosis and adenomyosis.Materials and methods. 92 women of reproductive age – from 21 to 46 years old – who applied for surgical treatment for symptomatic adenomyosis (47 women – 1st group) and ovarian endometriosis (45 patients – 2nd group), and 30 practically healthy women of the same age (control group) were examined.Histological examination of adenomyosis and ovarian endometriosis biopsies was performed using a light microscope at magnifications of 40 and 100. For immunohistochemical examination, primary and secondary antibodies were used to determine CD34, CD68, and CD138 markers.Results. In patients with adenomyosis and ovarian endometriosis the following concomitant gynecological pathologies as uterine fibroids, endometrial hyperplasia, chronic endometritis, chronic abnormal uterine bleeding, the frequency of which is significantly higher in adenomyosis, were diagnosed. This may indicate the pathogenetic role of chronic inflammation in the development of these pathological conditions.In patients with adenomyosis the positive expression of CD68 in the epithelial component of heterotopias was determined in 8 (17.0±5.6%) women, and in 4 (8.9±4.2%) women with ovarian endometriosis, which indicated a low phagocytic activity. During the assessment of CD34 expression in vessel walls and the stromal component of endometrioid heterotopias, a positive reaction was determined in 16 (34.0±6.9%) patients with adenomyosis and in 10 (22.2±6.2%) patients with ovarian endometriosis, which reflects the processes of neoangiogenesis and the activity of the pathological process.Positive expression of CD138 in endometrioid heterotopias prevailed in the group of patients with adenomyosis – 12 (25.5±6.4%) cases versus 4 (8.9±4.2%) cases in the group of patients with ovarian endometriosis (p<0.05). This confirmed the histological results and clinical data regarding the presence of chronic endometritis and isthmocele.Conclusions. The identified inflammatory changes, weak phagocytic activity and signs of neoangiogenesis in foci of heterotopic endometrium are more significant in patients with adenomyosis, which is confirmed by clinical and morphological data.

Quantitative Assessment of Polarization and Elastic Properties of Endometrial Tissue for Precancer/Cancer Diagnostics Using Multimodal Optical Coherence Tomography

Objectives: The most important phase in the endometrial pathologies diagnostics is the histological examination of tissue biopsies obtained under visual hysteroscopic control. However, the unclear visual diagnostics characteristics of subtle focal endometrial pathologies often lead to selection errors regarding suspicious endometrial lesions and to a subsequent false pathological diagnosis/underestimation of precancer or early-stage cancer. Methods: In this study, we investigate the potential of Multimodal Optical Coherence Tomography (MM OCT) to verify suspicious endometrial lesion regions before biopsy collection. We study the polarization (by cross-polarization OCT, CP OCT) and elastic (by compression OCT-elastography, C-OCE) properties of ex vivo endometrial tissue samples in normal conditions (proliferative and secretory phases to the menstrual cycle, atrophic endometrium) with endometrial hyperplasia (non-atypical and endometrial intraepithelial neoplasia) and endometrial cancer subtypes (low-grade, high-grade, clear cell and serous). Results: To the best of our knowledge, this is the first quantitative assessment of relevant OCT parameters (depth-resolved attenuation coefficient in co-[Att(co) values] and cross-[(Att(cross) values] polarizations and Young’s elastic modulus [stiffness values]) for the selection of the most objective criteria to identify the clinically significant endometrial pathologies: endometrial intraepithelial neoplasia and endometrial cancer. The study demonstrates the possibility of detecting endometrial pathologies and establishing optimal threshold values of MM OCT criteria for the identification of endometrial cancer using CP OCT (by Att(co) values = 3.69 mm−1, Sensitivity (Se) = 86.1%, Specificity (Sp) = 92.6%; by Att(cross) values = 2.27 mm−1, Se = 86.8%, Sp = 87.0%) and C-OCE (by stiffness values = 122 kPa, Se = 93.2%, Sp = 91.1%). The study also differentiates endometrial intraepithelial neoplasia from non-atypical endometrial hyperplasia and normal endometrium using C-OCE (by stiffness values = 95 kPa, Se = 87.2%, Sp = 90.1%). Conclusions: The results are indicative of the efficacy and potential of clinical implementation of in vivo hysteroscopic-like MM OCT in the diagnosis of endometrial pathologies.

Vasculitic involvement of the skeletal muscle and the peripheral nervous system: clinical and neuropathologic perspective

The peripheral nervous system is a classic target organ in systemic vasculitis. In addition, the skeletal muscle can also be affected. Myalgia, muscle weakness and sensory deficits are typical signs, which can lead to severe functional limitations and impaired of quality of life. Vasculitic involvement of the skeletal muscle (vasculitic myopathy [VM]) and peripheral nerves (vasculitic neuropathy [VN]) occurs predominantly in polyarteritis nodosa and small-vessel vasculitis. VM presents with elevated markers of inflammation and is typically characterized by immobilizing myalgia with normal creatine kinase activity and diffuse or patchy areas of hyperintensity on T2-weighted MRI ("MRI myositis without myositis"). In VN, sensor motor deficits predominantly affect the lower extremity in the area supplied by several peripheral nerves (e.g., mononeuritis multiplex) with acute to subacute history. The histopathological examination of nerve and muscle biopsies is the gold standard for the diagnosis of vasculitic manifestations and has a significant impact on the therapeutic approach.

The Role of Video Thoracoscopy in the Diagnosis of Sarcoidosis

Sarcoidosis is a systemic autoimmune disease associated with the development of non-caseous granulomas. Early and accurate diagnosis of sarcoidosis is an important and difficult task, since the initial manifestations are diverse, nonspecific, and many patients are asymptomatic. Objective — to study the role of video thoracoscopy and to present our own experience of invasive diagnosis of sarcoidosis. Materials and methods. Patients included in the study were divided into 2 clinical groups depending on whether the diagnosis at admission coincided with the final diagnosis established after the morphological examination of lung biopsies or not. Group I — 74 patients with PDS and ML (41.6 %), whose diagnosis at admission coincided with the final clinical diagnosis (established on the basis of morphological examination of lung biopsies). Group II — 104 patients with PDS and ML (58.4 %), whose diagnosis upon admission did not coincide with the final clinical diagnosis. Results and discussion. Insufficient diagnosis of lung cancer (lung carcinomatosis) — 3 (2.9 %) cases at admission and 31 (29.8 %) cases after lung biopsy. The small percentage of diagnosis of interstitial, granulomatous lesions of the lungs or pneumonitis with systemic connective tissue pathology is also noteworthy - 3 (2.9 %) cases before lung biopsy and 19 (18.3 %) after. In patients who were diagnosed with pulmonary sarcoidosis without histological confirmation, such a pathology as tuberculosis was found in 14 (13.5 %), oncological lesion — 23 (22.1 %), interstitial or granulomatous lesion together with pneumonia in systemic pathology — 17 (16.3 %) and «other» — 20 (19.2 %) cases. We performed 178 VATS biopsies, among which lung biopsy prevailed — 67 (37.6 %) cases, pleural biopsy was the least performed — 18 (10.1 %) cases. Intraoperative complications were recorded in 2 (1.1 %) cases, in the form of bleeding from a lymph node, the elimination of which required the use of electrocoagulation, the use of local and systemic hemostatic agents. Postoperative complications were observed in 5 (2.8 %) cases and were caused by the lack of lung tightness and the resulting long-term discharge of air through the drainage. Conclusions. Manifestations of sarcoidosis often simulate other disseminated processes, so its invasive diagnosis is an effective and safe way of establishing the diagnosis, especially in complex cases and atypical clinical and radiological picture. Among invasive methods, preference should be given to mini-invasive methods, therefore, the optimal choice is VATS, which has high informativeness and a low percentage of postoperative complications and allows to evaluate a wide range of tissues such as the pleura, lymph nodes and lungs.

An Unusual Case of Blastomycosis Presenting as "Punched Out" Ulcerations

Background: Cutaneous blastomycosis commonly presents as verrucous, hyperkeratotic nodules or plaques. Less commonly, it presents as ulcerations with accompanying scale crusting or verrucous features. Case Report: A healthy 34-year-old incarcerated male with a history of drug abuse presented with several, well-defined (punched out), deep ulcerating cutaneous lesions with undermined borders. There was no crusting, or verrucous features. The clinical differential diagnoses included pyoderma, vasculitic ulcers, and pyoderma gangrenosum. The histopathology from a gluteal ulceration demonstrated pseudoepitheliomatous hyperplasia with acute, chronic, and granulomatous inflammation. PAS stain of the specimen exhibited thick-walled yeast demonstrating broad-based budding typical of blastomycosis and tissue cultures grew Blastomyces dermatitidis after one month. Conclusion: Ulceration without verrucous features can portend cutaneous blastomycosis. Diagnosis using fungal culture of the wound or tissue takes weeks to result. A prompt biopsy and histopathologic examination or broad-range PCR testing of a wound swab, tissue or urine specimen can lead to a prompt diagnosis.

Children and adolescents assisted in a referral oral medicine diagnostic service: 20 years of experience in Brazil.

Several lesions can affect the oral and maxillofacial region, with trends influenced by lifestyle and age. To investigate the occurrence of oral and maxillofacial lesions in paediatric patients assisted in an oral medicine diagnostic service in Brazil over 20 years. A retrospective cross-sectional study was performed in an oral medicine diagnostic service (1999-2019). Data included sex, age, anatomic site, and diagnosis from clinical records of children (0-9 years) and adolescents (10-19 years). Lesions were diagnosed through clinical examination. Biopsy and histopathologic examination were performed when necessary. Among 10 530 records, 702 (6.67%) were from patients aged 0-19 years diagnosed with oral or maxillofacial lesions. A high frequency of females was observed (58.1%). Reactive/inflammatory lesions were the most common group of lesions (45.2%), followed by abnormalities of teeth/developmental defects (17.8%) and pulpal and periapical diseases (8.5%). Mucocele/ranula was the most common lesion in children (29.3%) and adolescents (25.3%). Lips were the most affected anatomic sites. Most lesions were benign, and mucocele/ranula was the most frequent. Our results did not differ from those of histopathological-based studies, but they provided information on the occurrence of oral and maxillofacial lesions to dentists and paediatricians.

ELP1, the Gene Mutated in Familial Dysautonomia, Is Required for Normal Enteric Nervous System Development and Maintenance and for Gut Epithelium Homeostasis.

Familial dysautonomia (FD) is a rare sensory and autonomic neuropathy that results from a mutation in the ELP1 gene. Virtually all patients report gastrointestinal (GI) dysfunction and we have recently shown that FD patients have a dysbiotic gut microbiome and altered metabolome. These findings were recapitulated in an FD mouse model and moreover, the FD mice had reduced intestinal motility, as did patients. To understand the cellular basis for impaired GI function in FD, the enteric nervous system (ENS; both female and male mice) from FD mouse models was analyzed during embryonic development and adulthood. We show here that not only is Elp1 required for the normal formation of the ENS, but it is also required in adulthood for the regulation of both neuronal and non-neuronal cells and for target innervation in both the mucosa and in intestinal smooth muscle. In particular, CGRP innervation was significantly reduced as was the number of dopaminergic neurons. Examination of an FD patient's gastric biopsy also revealed reduced and disoriented axons in the mucosa. Finally, using an FD mouse model in which Elp1 was deleted exclusively from neurons, we found significant changes to the colon epithelium including reduced E-cadherin expression, perturbed mucus layer organization, and infiltration of bacteria into the mucosa. The fact that deletion of Elp1 exclusively in neurons is sufficient to alter the intestinal epithelium and perturb the intestinal epithelial barrier highlights a critical role for neurons in regulating GI epithelium homeostasis.

Transportable hyperspectral imaging setup based on fast, high-density spectral scanning for in situ quantitative biochemical mapping of fresh tissue biopsies.

Histopathological examination of surgical biopsies, such as in glioma and glioblastoma resection, is hindered in current clinical practice by the long time required for the laboratory analysis and pathological screening, typically taking several days or even weeks to be completed. We propose here a transportable, high-density, spectral scanning-based hyperspectral imaging (HSI) setup, named HyperProbe1, that can provide in situ, fast biochemical analysis, and mapping of fresh surgical tissue samples, right after excision, and without the need for fixing, staining nor compromising the integrity of the tissue properties. HyperProbe1 is based on spectral scanning via supercontinuum laser illumination filtered with acousto-optic tunable filters. Such methodology allows the user to select any number and type of wavelength bands in the visible and near-infrared range between 510 and 900nm (up to a maximum of 79) and to reconstruct 3D hypercubes composed of high-resolution (4 to ), widefield images ( ) of the surgical samples, where each pixel is associated with a complete spectrum. The HyperProbe1 setup is here presented and characterized. The system is applied to 11 fresh surgical biopsies of glioma from routine patients, including different grades of tumor classification. Quantitative analysis of the composition of the tissue is performed via fast spectral unmixing to reconstruct the mapping of major biomarkers, such as oxy-( ) and deoxyhemoglobin (HHb), as well as cytochrome-c-oxidase (CCO). We also provided a preliminary attempt to infer tumor classification based on differences in composition in the samples, suggesting the possibility of using lipid content and differential CCO concentrations to distinguish between lower and higher-grade gliomas. A proof of concept of the performances of HyperProbe1 for quantitative, biochemical mapping of surgical biopsies is demonstrated, paving the way for improving current post-surgical, histopathological practice via non-destructive, in situ streamlined screening of fresh tissue samples in a matter of minutes after excision.

Akurasi Biopsi Aspirasi Jarum Halus untuk Diagnostik Tumor Kelenjar Liur di RSUD DR Saiful Anwar Malang 2018-2022

Fine needle aspiration biopsy is accepted as a safe, reliable, minimally invasive, and cost-effective method. Fine needle aspiration biopsy aims to assist clinicians in handling patients. The purpose of this study is to evaluate the validity of fine needle aspiration biopsy as a diagnostic tool in salivary gland tumors compared to histopathological examination at Dr. Saiful Anwar Malang Hospital for the period of 2018-2022. Methods: Fine needle aspiration biopsy examination was performed before surgery, then compared with the results of histopathological examination after surgery as gold standard and retrospectively reviewed. Fine needle aspiration biopsy results and histopathological results are classified as neoplasm or non-neoplasm and benign or malignant. Validity is determined from sensitivity, specificity, positive conjecture value, negative conjecture value and accuracy. As a result, there were 33 cases of salivary gland tumors that met the inclusion criteria in the period 2018-2022 were reviewed, then classified into neoplasms or non-neoplasms and benign or malignant neoplasms. The sensitivity, specificity, accuracy, positive presumptive value, and negative presumptive value of cytological diagnosis of fine needle aspiration biopsy of salivary gland tumors for the neoplasm or non-neoplasm category were 93.1%, 100%, 93.9%, 100%, 66.7% and for the benign or malignant category 94.4%, 88.9%, 92.6%, 94.4%, 88.9%. This study shows that salivary gland fine needle aspiration biopsy cytology is a reliable and accurate diagnostic method for the diagnosis of salivary gland lesions. Conclusions: Fine needle aspiration biopsy is a useful method for diagnostics in salivary gland tumors but cannot replace histopathological examination as the gold standard for diagnostics.

Evaluation of Serum Levels of CK-MB in Heart Transplant Patients and Their Relationship with Graft Rejection Grades

Background: Heart transplant rejection is a multifactorial phenomenon routinely assessed using endomyocardial biopsy. Recently, efforts have been made to identify less invasive and cost-effective biomarkers for predicting graft rejection. Objectives: This study evaluated serum CK-MB levels in heart transplant patients and examined their relationship with the grading of graft rejection. Methods: In a prospective cohort study, 92 biopsy specimens from heart transplant patients were analyzed at Tehran's Rajaie Cardiovascular Medical and Research Center during 2022. Rejection grades, plasma CK-MB levels, and their relationship were investigated. Results: The mean age (standard deviation) of the patients was 36.70 (9.59) years, with 60.9% being male. Regarding graft rejection grades, 16.3% were grade 0R, 46.7% had Quilty effect (QE), 32.6% were grade 1R, and 4.3% were grade 2R. The mean (standard deviation) serum CK-MB levels for grades 0R, QE, 1R, and 2R were 17.14 (16.46), 12.39 (7.52), 26.77 (22.97), and 29.50 (7.94) ng/L, respectively (P = 0.046). The sensitivity of CK-MB for detecting grade 1R and 2R graft rejection was 56.7% and 75%, respectively, while its specificity for detecting grade 0R was 80%. A significant correlation was observed between increased serum CK-MB levels and transplant rejection grades (P < 0.001). Most cases of grade 0R had negative CK-MB serum levels (< 24 IU/L), with a higher frequency of positive CK-MB in grade 1R compared to grade 0R and in grade 2R compared to grade 1R. Conclusions: While elevated serum CK-MB levels in heart transplant patients may indicate graft rejection, the inconsistency of CK-MB levels with graft rejection grades suggests that endomyocardial biopsy and histopathological examination remain the gold standard for determining graft rejection grades.

Mandibular Rhabdomyosarcoma in an Eniente Woman: About a Case

Introduction: Rhabdomyosarcoma is the most common soft tissue sarcoma in patients under 25 years of age. The occurrence of mandibular rhabdomyosarcoma in a pregnant woman is rare with an incidence of 0.07 to 0.1 and the literature describes one case per 1000 deliveries. Only biopsy and histological examination make a definitive diagnosis. Treatment is based on a combination of chemoradiation and surgery. Objectives: To describe the diagnostic and therapeutic aspects of mandibular rhabdomyosarcoma in pregnant women. Observation: It was a 19-year-old patient who had consulted for left mandibular swelling evolving over 28 weeks. A morphological assessment had been requested but being almost full-term, the patient chose to let her pregnancy progress. She was seen again after delivery with a swelling that had tripled in volume with abundant bleeding on the alteration of the general condition. The imaging concluded that there was a large osteolytic mass of the mandible. The biopsy performed came back in favor of an infiltrating pleomorphic rhabdomyosarcoma. Treatment consisted of radiation therapy followed by surgery. The evolution was marked by the death of the patient after 01 month of radiotherapy. Conclusion: Rhabdomyosarcoma is an aggressive malignant tumor that most often affects subjects under 25 years of age and its appearance in pregnant women is rare.

Craniotomy Tumor Removal for Brain Metastases of Hepatocellular Carcinoma : A Case Report

Introduction: Brain metastases (BM) are the most frequent type of brain tumors in adults and are the leading source of neurological issues related to systemic cancers. Case Description: Female, 49 years old, presented with decreased consciousness that occurred since 1 month before admission. Weakness of the right limbs is found. CT scan abdomen with contrast show hepatic segment VIII infarction. histopathological examination of hepatic tissue biopsy with the results of hepatocellular carcinoma MRI brain shows multiple lesions suggestive of brain metastasis. Discussion: Patient was diagnosed with space occupying lesion on the frontotemporal dd brain metastasis dd orbital roof meningioma + multiple space occupying lesion intracranial on the left parietooccipital ec. brain metastasis + hepatocellular segment V, VI, VII, and VIII. Patients underwent craniotomy tumor removal to remove intracranial masses. The patient's postoperative condition showed improvement in the level of consciousness with GCS E4M5V3. Conclusion. Craniotomy tumor removal provides several advantages for managing patients with brain metastases of hepatocellular carcinoma. Keyword: Craniotomy, Brain Metastases, Hepatocellular Carcinoma

Effectiveness of serological markers of gastric mucosal atrophy in the gastric precancer screening and in cancer prevention.

New markers are needed to improve the effectiveness of serological screening for atrophic gastritis. To develop a cost-effective method for serological screening of atrophic gastritis with a high level of sensitivity. Of the 169 patients with atrophic gastritis, selected by the visual endoscopic Kimura-Takemoto method, 165 showed histological mucosal atrophy using the updated Kimura-Takemoto method. All 169 patients were examined for postprandial levels of gastrin-17 (G17) and pepsinogen-1 (PG1) using GastroPanel® (Biohit Plc, Helsinki, Finland). We used the histological standard of five biopsies of the gastric mucosa, in accordance with the Kimura-Takemoto classification system to assess the sensitivity of G17 in detecting gastric mucosal atrophy. We also compared the morpho-functional relationships between the detected histological degree of gastric mucosal atrophy and the serological levels of G17 and PG1, as the markers of atrophic gastritis. The sensitivity of postprandial G17 was 62.2% for serological levels of G17 (range: 0-4 pmol/L) and 100% for serological G17 (range: 0-10 pmol/L) for the detection of monofocal severe atrophic gastritis. No strong correlation was found between the levels of PG1 and degree of histological atrophy determined by the Kimura-Takemoto classification system to identify the severity of mucosal atrophy of the gastric corpus. In the presented clinical case of a 63-year-old man with multifocal atrophic gastritis, there is a pronounced positive long-term dynamics of the serological marker of atrophy - postprandial G17, after five months of rennet replacement therapy. Serological screening of multifocal atrophic gastritis by assessment of postprandial G17 is a cost-effective method with high sensitivity. Postprandial G17 is an earlier marker of regression of atrophic gastritis than a morphological examination of a gastric biopsy in accordance with the Sydney system. Therefore, postprandial G17 is recommended for dynamic monitoring of atrophic gastritis after treatment.

Atypical gouty tophus masquerading as a foreign body granuloma

Subcutaneous nodular lesions in a patient with significantly elevated inflammatory markers always raise the possibility of infectious diagnoses such as atypical infection, pyogenic abscess, mycobacterial infection, and malignancy. Definitive diagnosis requires tissue biopsy and histopathologic examination. The atypical presentation of a foreign body granuloma with concurrent intraoperative findings supports the diagnosis of gouty arthritis.We report a case of a 67-year-old man who presented with an inflammatory nodular lesion on the left elbow that was initially suspected to have an infectious cause. Histopathologic examination of the nodular tissue later revealed that the patient had a foreign body granuloma due to urate crystal deposition. The atypical appearance of the gouty arthritis, the low serum urate level, the negative crystal identification in the synovial fluid, and the markedly elevated inflammatory markers, which did not respond to the previous antibiotic and steroid therapy, raised the suspicion of atypical infection in this case.

Immunomorphological insights into clinical variants of bullous pemphigoid in Moscow Region patients

Bullous pemphigoid is an autoimmune blistering dermatosis in which the pathogenesis is primarily characterized by the production of autoantibodies IgG and IgE against hemidesmosomal proteins (BP180 and BP230) and the disruption of T-cell immune response regulation. The classical understanding of the clinical course of bullous pemphigoid has undergone significant transformation in recent years due to the identification of numerous conditions that do not exhibit typical clinical presentations but are diagnosed as bullous pemphigoid based on immunofluorescence’s results. Often, when an atypical clinical form of bullous pemphigoid develops, a specialist physician may not have grounds to include bullous pemphigoid in the differential diagnosis. Consequently, specific diagnostic tests (such as immunomorphological examinations of skin biopsies) that would allow for the verification of this blistering dermatosis are not performed for the patient. Clearly, due to the absence of an accurate diagnosis, patients do not receive the necessary therapy. There is currently no information in the world literature regarding the frequency of atypical forms of bullous pemphigoid. However, it is known that bullous pemphigoid is a relatively common blistering dermatosis in the population of European countries, with a prevalence ranging from 2.4 to 66 cases per million people, depending on the region.

Case Report: Radical Vulvectomy V-Y Flap Surgical Procedure in a Woman with Vulva Cancer

Introduction: Vulva cancer is one of the relatively rare malignancies, accounting for only 4% of all malignancies in gynecologic organs. Vulva cancer is often asymptomatic. Surgery is the basic management in patients with earliest-stage vulvar cancer and frequently requires a combined radical vulvectomy followed by inguinal LN dissection through a separate incision. Therefore, the author hopes this case can add insight into the knowledge related to early detection and comprehensive management of vulva cancer. Case Presentation: A woman, 67 years old, referred from Gambiran General Hospital Kediri with a vaginal biopsy result of vulva cancer, came to the Saiful Anwar General Hospital oncology clinic. The patient complained of pain in the pubic area accompanied by tissue growth around the pubic area since August 2023. History of weight loss (+) 10 kg in the past year. History of menopause since 18 years ago. The examination results obtained vital signs: BP 132/79 mmHg, pulse 128x/min, RR 20x/min, temperature 36.5C, height 155 cm, weight 40kg, and BMI 16.64 kg / m2 (underweight). Physical examination of external genitalia revealed a 12x8 cm mass on the right vulva, odour (+). The results of the vulvar biopsy examination on 25/08/2023 were found to be squamous cell carcinoma, well differentiated. The patient is planned for elective-wide excision. The management performed was radical vulvectomy with V-Y flap reconstruction surgery. Conclusion: In this case, it can be concluded vulva cancer is a relatively rare malignancy. The subtype often found is SCC (90-95%). This patient planned for radical vulvectomy using the V-Y flap reconstruction technique with SAB.

Agreement Between Clinical and Histopathological Diagnoses of Oral and Maxillofacial Lesions and Influencing Factors: A Five-Year Retrospective Study.

Diagnosing oral and maxillofacial lesions is a multi-step, multidisciplinary process. If a clinical diagnosis is achievable, then a histopathological diagnosis is indicated to support and confirm the diagnosis. Histopathological examination of tissue biopsies is therefore an essential part of the diagnosis and/or treatment plan. The purpose of this study was to investigate the agreement between the clinical and histopathological diagnoses of oral and maxillofacial lesions and the patient, lesion, and healthcare provider factors that may affect this agreement. This was an observational, cross-sectional study of all patients who had been referred to the Oral Pathology Central Laboratory at the Faculty of Dentistry and University Dental Hospital at King Abdulaziz University in Jeddah, Saudi Arabia, between 2018 and 2022 for diagnosis of oral and maxillofacial lesions. Data extracted included information about the referring dental provider such as their clinical experience (number of years), specialty, certification, and education. Agreement between the clinical and histopathological diagnoses was evaluated, and logistic regression was used to assess provider characteristics associated with the accuracy of diagnosis. The clinical and pathological diagnoses were concordant in 44.1% (n=378) of cases, and concordance was highest for odontogenic tumors (72.7%, n=24), significantly higher than for inflammatory lesions (37.3%, n=111). The anatomical locations with the highest diagnostic accuracy were the ventral surface of the tongue (71.4%, n=5), followed by the lips (52.6%, n=20). Patient age and sex and the dentist's years of experience were not associated with diagnostic agreement (p=0.2, p=0.9, and p=0.08, respectively). However, concordant diagnoses were significantly associated with the dentist's rank (p=0.02) and specialty (p=0.01). Clinical diagnoses made by oral surgeons at the time of biopsy were 1.6-times more likely (p=0.01) to agree with the pathological diagnosis compared with those made by other specialties when controlling for education, certification, and years of experience. These data are a reminder that a clinical diagnosis alone is not sufficient to secure the final diagnosis and to plan treatment. Histopathological examination remains essential for most oral and maxillofacial lesions.

Lymphocytic Variant of Triple-Negative Breast Cancer Carcinoma Erysipeloides: A Rare Case of Carcinoma Erysipeloides Following TNBC Mastectomy

Background: Carcinoma erysipeloides (CE) is a rare but significant cutaneous manifestation of metastatic breast cancer, often misdiagnosed due to its rarity and nonspecific presentation. This is particularly true in patients with triple-negative breast cancer (TNBC), where the disease may progress undetected by conventional imaging modalities. This manuscript aims to elucidate the challenges and implications of diagnosing CE in breast cancer survivors, emphasizing the insufficiency of PET scans in detecting such cutaneous metastases and the potential for mismanagement due to diagnostic oversight. Case Presentation: We present a detailed case study of a 43-year-old female with a history of metastatic TNBC, who developed suspicious skin lesions post-treatment. Despite initial negative PET scan results, further investigations revealed CE through histopathological examination of skin biopsies. The case highlights the critical need for biopsy in the presence of new skin lesions in breast cancer survivors, irrespective of imaging results. It also underscores the possibility of lymphatic spread of CE, which could lead to life-threatening complications if not properly managed. Conclusion: The diagnosis of carcinoma erysipeloides must be considered in patients with breast cancer presenting with unusual skin lesions. Increased vigilance and dermatological assessment should be integral to the post-cancer follow-up regimen. The findings advocate for revising current treatment protocols and guidelines to better manage and potentially prevent the complications associated with this diagnosis. Enhanced surveillance for dermatological changes and a more aggressive approach to the biopsy of new skin lesions in cancer patients are recommended to improve outcomes and prevent the misdiagnosis of CE.

Histopathological features of reversal reactions in Morbus Hansen

The reversal reaction on Morbus Hansen is a type IV hypersensitivity reaction to M. leprae antigens. The clinical symptoms of a reversal reaction are that some or all of the existing lesions become more numerous and active in a short time. Hypopigmented lesions become more erythematous, erythematous lesions become increasingly erythematous, macular lesions become infiltrating, and old lesions increase in size. The histopathological feature of the reversal reaction showing dermal edema, stretching of the granulomas followed by loss of the well form granuloma arrangement, and predominance of lymphocytes are described as the hallmarks of a reversal reaction. Several additional characteristics were obtained in the form of an increase in the number of Langhans giant cells, as well as pyknosis/shrinkage of the lymphocyte nucleus. Although not a diagnostic criterion for a reversal reaction, histopathological examination of a lesion biopsy is needed to differentiate a reversal reaction in Morbus Hansen from other differential diagnoses.