Final Pathological Diagnosis Research Articles

Combined crystal-storing histiocytosis, light chain proximal tubulopathy, and light chain crystalline podocytopathy in a patient with multiple myeloma: a case report and literature review

Background Crystal-storing histiocytosis (CSH), light chain proximal tubulopathy (LCPT), and light chain crystalline podocytopathy (LCCP) are rare complications of multiple myeloma (MM) or monoclonal gammopathy of renal significance, and their diagnoses are challenging. Case presentation In this case, a 69-year-old Chinese woman presented with suspicious Fanconi syndrome with renal insufficiency. Immunofixation electrophoresis of both serum and urine revealed elevated immunoglobulin G kappa (IgGkappa) and kappa light chain. Bone marrow aspirate revealed 15% plasma cells with considerable cytoplasmic granular inclusions and needle-shaped crystals. Renal biopsy confirmed the final pathologic diagnosis of kappa-restricted CSH, combined LCPT and LCCP by immunoelectron microscopy. A number of special casts were present which could easily be misdiagnosed as light chain cast nephropathy. Immunofluorescence on frozen tissue presented false negative for kappa light chain, as ultimately proven by paraffin-embedded tissue after pronase digestion. MM and CSH were diagnosed, and two cycles of chemotherapy were given. The patient subsequently refused further chemotherapy, and her renal function remained relatively stable during a 2.5-year follow-up period. Conclusions In conclusion, we report a rare case of generalized kappa-restricted CSH involving bone marrow and kidney, combined with LCPT and LCCP, provide a comprehensive summary of renal CSH, and propose a new nomenclature of monoclonal immunoglobulin-induced crystalline nephrology. The presentation of monoclonal immunoglobulin and Fanconi syndrome should suggest the presence of monoclonal immunoglobulin-induced crystalline nephrology. Use of paraffin-embedded tissue after pronase digestion and immunoelectron microscopy is beneficial to improve the sensitivity of diagnosis.

Evaluation of breast lesions based on modified BI-RADS using high-resolution readout-segmented diffusion-weighted echo-planar imaging and T2/T1-weighted image

PurposeTo evaluate the diagnostic performance of a non-contrast magnetic resonance imaging (MRI) protocol combining high-resolution diffusion-weighted images (HR-DWI) using readout-segmented echo planar imaging, T1-weighted imaging (T1WI), and T2-weighted imaging (T2WI), using our modified Breast Imaging-Reporting and Data System (modified BI-RADS). MethodsTwo experienced radiologists, blinded to the final pathological diagnosis, categorized a total of 108 breast lesions (61 malignant and 47 benign) acquired with the above protocol using the modified BI-RADS with a diagnostic decision tree. The decision tree included subcategories of category 4, as in mammography (categories 2, 3, 4A, 4B, 4C, and 5). These results were compared with the pathological diagnoses. ResultsThe area under the ROC curve (AUC) was 0.89 (95% confidence interval [CI]: 0.83–0.95) for reader 1, and 0.89 (95% CI: 0.82–0.96) for reader 2. When categories 4C and above were classified as malignant, the sensitivity, specificity, and accuracy were 73.8%, 93.6%, and 82.4%, for reader 1; and 82.0%, 89.4%, and 85.2% for reader 2, respectively. ConclusionOur results suggest that using HR-DWI, T1WI/T2WI analyzed with a modified BI-RADS and a decision tree showed promising diagnostic performance in breast lesions, and is worthy of further study.

LESÕES CÍSTICAS DO PÂNCREAS: IMAGENS VERSUS ACHADOS ANATOMOPATOLÓGICOS. COMO MELHORAR A ACURÁCIA DIAGNÓSTICA?

Pancreatic cystic lesions are a group of pancreatic neoplasms with different behavior and risk of malignancy. Imaging diagnosis and differentiation of these lesions remain a challenge. The aim of this study was to evaluate the agreement between computed tomography and/or magnetic resonance imaging and post-operative pathologic diagnoses of Pancreatic cystic lesions in a University Hospital of São Paulo State. A total of 39 patients with surgically diagnosed Pancreatic cystic lesions were enrolled, as a study cohort from 2009 to 2019. Preoperative radiological and final pathological diagnosis was correlated to measure computed tomography and/or magnetic resonance imaging diagnostic. Pancreatic adenocarcinoma, choledochal pancreatic cyst, mucinous cystadenoma, serous cystadenoma, intraductal papillary mucinous neoplasms, and pancreatic pseudocyst were classified as neoplastic cysts. It was noted that 27 patients (69.23%) had preoperative computed tomography and magnetic resonance imaging, 11 patients (28.20%) had preoperative computed tomography only, and 1 patient had preoperative magnetic resonance imaging only. The values for diagnoses made only with computed tomography (p=0.47) and from the combination of computed tomography+magnetic resonance imaging (p=0.50) did also point to moderate agreement with the anatomopathological findings. The values pointed to a fair agreement for the diagnosis of mucinous cystadenoma (p=0.3), moderate agreement for intraductal papillary mucinous neoplasms (p= 0.41), good agreement for serous cystadenoma (p=0.79), and excellent agreement for choledochal pancreatic cyst (p=1), pancreatic pseudocyst (p=0.84), and Frantz tumor (p=1) (p<0.05). The findings of computed tomography and/or magnetic resonance imaging have an equivalent diagnostic agreement with an anatomopathological diagnosis for differentiating benign from malignant Pancreatic cystic lesions and in suggesting a specific diagnosis. There is no statistical difference between the use of computed tomography alone and computed tomography+magnetic resonance imaging in the improvement of diagnostic accuracy.

Laparoscopic Surgery for Atypical Endometrial Hyperplasia with Awareness Regarding the Possibility of Endometrial Cancer.

Although atypical endometrial hyperplasia (AEH) is considered a precancerous disease, the frequency with which AEH and endometrial cancer (EC) coexist is not low. Broadly, total laparoscopic hysterectomy (TLH) is performed for treating AEH; however, it is unclear what perioperative precautions need to be taken. This study aimed to clarify the points to be considered when performing TLH for AEH. We retrospectively identified 57 patients who underwent TLH for AEH in our hospitals. We extracted data on clinical characteristics, preoperative examinations (endometrial sampling and diagnostic imaging), surgical procedures, and final pathological diagnoses. Then, we statistically analyzed the difference in clinicopathological features and preoperative examinations between patients postoperatively diagnosed with EC and those diagnosed with AEH. Twenty patients (35%) who underwent TLH for AEH were diagnosed with EC postoperatively (16 [28%] with stage IA EC and four [7.0%] with stage IB EC). We found no significant differences in clinical characteristics and preoperative evaluations between patients postoperatively diagnosed with EC and those diagnosed with AEH. The group with stage IB EC had a significantly higher median age and a significantly higher proportion of postmenopausal patients and patients with adenomyosis. It is important to recognize the risk of coexisting EC when performing TLH for AEH. High-precision endometrial sampling and contrast-enhanced magnetic resonance imaging are recommended for diagnosing AEH. In addition, surgical procedures for AEH are required to prevent cancer spillage in consideration of its coexistence, such as tubal sealing before manipulator insertion or avoiding using manipulator.

Application of Dynamic Enhanced Magnetic Resonance Imaging Texture Analysis Combined with ADCs in Predicting Pelvic Lymph Metastasis of Prostate Cancer.

The application value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) texture analysis combined with apparent diffusion coefficient (ADC) in predicting pelvic lymph node metastasis of prostate cancer was explored. The clinical and imaging data of 151 patients with prostate cancer admitted to The Affiliated Tumor Hospital of Guizhou Medical University from November 2019 to November 2021 were retrospectively analysed. According to the final pathological diagnosis results, they were divided into two groups: Metastasis group (n = 63, pelvic lymph node metastasis) and non-metastasis group (n = 88, no pelvic lymph node metastasis). The DCE-MRI texture parameters and ADCs of the two groups were compared using Omni-Kinetics software and MADC software packages. The receiver operating characteristic (ROC) curve was used in evaluating the predictive value of each method and their combination, and Spearman rank correlation analysis was used in evaluating their correlation. The volume transfer (Ktrans) and interstitium-to-plasmarate rate constant (Kep) in the metastatic group were significantly higher than those in the non-metastatic group (p < 0.001). However, no significant difference in extravascular extracellular space volume fraction (Ve) was found between the groups (p > 0.05). The ADC of the metastatic group was lower (p < 0.001). The Ktrans and Kep values were positively correlated with pelvic lymph node metastasis of prostate cancer (r = 0.580, 0.684; p < 0.001), and the ADC was negatively correlated with pelvic lymph node metastasis of prostate cancer (r = -0.478; p < 0.001). The ROC curve showed that the area under the curve (AUC) of DCE-MRI texture analysis parameters Ktrans and Kep combined with ADC was large, and the prediction efficiency increased. The AUC, sensitivity and specificity were 0.974, 95.20% and 93.20% (p < 0.001), respectively. DCE-MRI texture analysis combined with ADC value can accurately predict pelvic lymphatic metastasis of prostate cancer, which is helpful for the selection and formulation of clinical treatment plans and has certain guiding value for the implementation of pelvic lymph node clearing in patients.

Presumed radiological diagnosis of solid pseudopapillary tumors: do we really know what we are watching?

ObjectivesLittle is known about the clinicians’ ability to ascertain the identity of a pancreatic lesion as solid pseudopapillary tumors (SPT)preoperatively. We led this retrospective study to figure out the disease spectrum that mimic SPT, the key features of SPT and the accuracy of CT and MRI in characterizing them. MethodsRadiological and clinical database at a tertiary pancreatic disease center (Peking Union Medical College Hospital) was searched for patients who received CT or MRI with a presumed radiological diagnosis of SPT. Those patients’ clinical information and final pathological diagnosis were collected. ResultsDuring 2018.10–2021.12, 200 patients had a presumed radiological diagnosis of SPT, and 132 of them had unambiguous pathological diagnosis. SPT were confirmed in only 63.6% (84/132), while the others had a variety of neoplastic and nonneoplastic lesions, including pancreatic neuroendocrine tumors (n = 15), pseudocysts (n = 4), mucinous cystic neoplasms (n = 4), serous cystadenomas (n = 3), neural sheath tumors (n = 3), lymphoepithelial cysts (n = 2), and several very rare pathologies (n = 17). Of note, 11.4% (15/132) of those were benign or nonneoplastic lesions, while 6.8% (9/132) were neoplasms with highly aggressive nature, or pancreatic metastases, which require systematic evaluation and staging instead of upfront surgery. Retrospective radiological analysis based on key imaging features, clinical history and laboratory findings had an improved diagnostic accuracy of 78.5% with CT and 77.8% with MRI. ConclusionsThere is a broad disease spectrum mimicking SPT at CT and MRI. Key imaging features, clinical information and laboratory findings must be integrated to improve the diagnostic accuracy.

A Case of Primary Epithelioid Sarcoma of the Pleura.

BACKGROUND Epithelioid sarcoma is a rare tumor and that is extremely rare as a primary pleural neoplasm. On imaging, it may appear similar to malignant pleural mesothelioma; thus, it can be difficult to diagnose. CASE REPORT A 64-year-old Asian woman, who had a treatment history of cervix adenocarcinoma, was admitted with dyspnea and right massive pleural effusion. Chest drainage was performed, and malignant cells were found in the pleural effusion. The malignant cells were thought to be metastasized from previous cervical cancer. We continued pleural drainage; however, the volume of the pleural effusion did not decrease. On the 5th hospital day, the chest tube became occluded. Computed tomography showed structures similar to empyema. Pleural irrigation and fibrinolytic therapy did not improve her condition. Empyema curettage was performed on the 14th hospital day. The resected pleura was submitted for pathological examination and showed tumor lesion but not metastatic adenocarcinoma of the cervix. The intrathoracic tumor grew extremely rapidly, and the patient died of respiratory failure on postoperative day 8 (22nd hospital day) before a diagnosis could be made. The final pathological diagnosis obtained on the 34th hospital day was epithelioid sarcoma. CONCLUSIONS For patients who appear to have empyema complicated by neoplastic lesions, a histopathological examination should also be performed to ensure accurate diagnosis. In addition, if a tumorous lesion is detected and it is neither metastatic nor malignant pleural mesothelioma, pleural epithelioid sarcoma should be added to the differential diagnosis in the presence of a rapidly growing and histologically difficult-to-diagnose pleural tumor.

Uterine Smooth Muscle Tumor of Uncertain Malignant Potential (STUMP) Treated with Conservative Surgery: Systematic Review of Reproductive Outcomes

Background: Uterine smooth muscle tumors of uncertain malignant potential (STUMPs) are a rare tumor that represent a diagnostic challenge to both clinicians and pathologists. Hysterectomy is considered the definitive treatment in women who don’t desire to conceive anymore; while myomectomy is suggested in young women who desire to preserve their fertility. The aim of this review is to evaluate the reproductive outcomes in patients submitted to fertility sparing treatment and with a diagnosis of STUMP at the definitive pathological evaluation. Methods: We searched among electronic databases from inception of them through January 2022. The research was conducted using meshes created by the combination of relevant heading term, key words, and word variants for: “uterine smooth muscle tumor of uncertain malignant potential”, “fertility”, “pregnancy”. Results: Seven retrospective studies including 80 women desirous of conceiving after a diagnosis of STUMP were included in this systematic review. Among these, 33 (41.25%) women got pregnant at least once and we recorded a total number of pregnancies of thirty-nine. Almost all deliveries were performed by caesarean section. Two (6.1%) relapses were diagnosed. Patients were submitted to hysterectomy and STUMP was confirmed as the final pathological diagnosis. The median follow-up in patients who delivered live babies was 61 months after surgery. At the last follow-up, all patients were alive without evidence of disease. Conclusions: This review shows that pregnacy seems to be possible and safe after the diagnosis of STUMP. These women should undergo rigorous follow-up and consider hysterectomy after completion of their reproductive plan. This review could be a useful tool for the counseling and the management of women with STUMP who desire to keep their fertility.

Preliminary clinical application of multimodal imaging combined with frameless robotic stereotactic biopsy in the diagnosis of primary central nervous system lymphoma

ObjectiveTo evaluate the clinical application of multimodal imaging combined with frameless robotic stereotactic biopsy in the diagnosis of primary central nervous system lymphoma (PCNSL). MethodsWe retrospectively reviewed the clinical data of 8 patients who were considered suspected cases of PCNSL by multimodal imaging techniques. The final pathologic diagnosis were determined by the frameless robotic stereotactic biopsy. The postoperative related complications and pathological results were analyzed. ResultsAll patients underwent biopsies under general anesthesia with an average surgery time of 29.5 ± 4.5 min. The final pathological diagnostic accordant rate with the preoperative ones was 100%, and the pathologic examination of our patients showed features of diffuse large B-cell lymphoma. During the surgery, one patient suffered intratumoral hemorrhage without leading to serious cerebral edema, and conservative treatment was given. There was no death occurring during the study, and there were no significant differences in the Karnofsky Performance Scale Scores of all patients before and after surgery. Finally, they were transferred to the hematology department for standardized chemoradiotherapy according to the pathological results of PCNSL. ConclusionThis study shows that it may play a vital role in the early diagnosis of PCNSL with the technique of multimodal imaging. The technique of frameless robotic stereotactic biopsy for obtaining the pathology outcomes in suspected PCNSL patients has the advantages of safety, efficiency, and minimally invasiveness.

Malignant testicular unclassified sex cord stromal tumor: a case report

BackgroundMost testicular tumors are germ cell tumors; sex cord stromal tumors are infrequent, accounting for only 3–5% of testicular tumors. Unclassified sex cord stromal tumors are extremely rare. Generally, 10% of sex cord stromal tumors are malignant. We report a case of malignant unclassified sex cord stromal tumor with retroperitoneal lymph node metastasis at first visit and a corresponding literature review.Case presentationA 72-year-old Japanese man visited our department primarily for indolent right scrotum enlargement in September 2020. Blood biochemistry examination, urinalysis, and tumor markers (alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase) showed no abnormal findings. Contrast-enhanced computed tomography showed enlarged para-aortic lymph node (18 × 16 and 10 × 102 mm); a 50 × 452 mm mass with uneven contents was found in the right testicle. The patient underwent inguinal orchiectomy in September 2020. As per immunohistochemistry, the tumor cells were diffusely positive for SF-1 and Ki-67, partially positive for inhibin, and negative for CAM5.2, CK7, CK20, C-KIT, CD30, LCA, GATA-3, TTF-1, and PAX8. Calretinin was expressed in approximately 5% of tumor cells; thus, sex cord/gonadal stroma components were considered to be involved. The final pathological diagnosis was unclassified malignant sex cord stromal tumor. The patient was diagnosed with pT1, N1, M0, S0, and tumor–node–metastasis stage IIA disease. The patient received postoperative chemotherapy with four courses of etoposide and cisplatin therapy from November 2020. Post-chemotherapeutic computed tomography showed new metastatic lesions including lung, liver, pancreas, and para-aortic lymphadenopathy, which increased in size. Disease progression was observed. Cancer genome research was performed using the OncoGuide National Cancer Center oncopanel system; however, no gene mutation for which the drug could be expected to be effective was found. The patient opted for best supportive care at a nearby hospital and died from cancer progression in January 2022.ConclusionWe encountered a case of malignant testicular unclassified sex cord stromal tumor pathologically diagnosed as testicular tumor with retroperitoneal lymph node metastasis in a patient who underwent inguinal orchiectomy. Future data collection is necessary to establish multimodality therapy for malignant testicular unclassified sex cord stromal tumor.

COMBINING REAL-TIME 3-D IMAGING AND AUGMENTED FLUOROSCOPY WITH ROBOTIC BRONCHOSCOPY FOR THE DIAGNOSIS OF PERIPHERAL LUNG NODULES

COMBINING REAL-TIME 3-D IMAGING AND AUGMENTED FLUOROSCOPY WITH ROBOTIC BRONCHOSCOPY FOR THE DIAGNOSIS OF PERIPHERAL LUNG NODULES

BENIGN PLEURAL SCHWANNOMA WITH PLEURAL EFFUSIONS AND NECROTIZING PNEUMONIA

BENIGN PLEURAL SCHWANNOMA WITH PLEURAL EFFUSIONS AND NECROTIZING PNEUMONIA

Clinicopathological Features of Patients with Vesiculobullous Diseases Referred to Dermatology Clinic of Afzalipour Hospital, Kerman, Iran

Background: Bullous diseases are classified as autoimmune blistering diseases, hereditary blistering disorders, and blistering diseases secondary to inflammation and physical trauma. This study evaluated clinicopathological features of patients with bullous diseases. Methods: This is a retrospective cross-sectional study of 88 patients with vesiculobullous diseases referred to the dermatology clinic of Afzalipour hospital in Kerman, Iran. Demographic features of the patients, type of lesions, differential diagnosis, and pathological features (site of skin biopsy, final pathological diagnosis, type of inflammatory cells, and direct immunofluorescence results) were recorded. Data were analyzed by chi-square test and independent t-test. Results: Eighty-eight patients (59.1% females and 40.9% males) were evaluated. The mean age of patients was 45.09 ± 20.48 years. Autoimmune blistering diseases, hereditary bullous diseases, and blisters secondary to inflammation and trauma were observed in 79.5%, 11.4%, 6.8%, and 2.3% of the cases, respectively. The most common diseases were pemphigus vulgaris (29.5%) and bullous pemphigoid (21.6%). There was a significant correlation between the type of the disease and the age of patients (P-value = 0.001) and the duration of the disease (0.047). Conclusions: The most common autoimmune blistering diseases, hereditary bullous diseases, and blisters secondary to inflammation and trauma were pemphigus vulgaris, epidermolysis bullosa, lichen planus, and diabetic bullae/friction blister, respectively.

The Predictive Value of Ultrasound, Alvarado Score, and C-Reactive Protein in Pediatric Appendectomy Outcomes

Aim: This retrospective study aimed to investigate the combined accuracy of appendix diameter, C reactive protein, and Alvarado score in classifying patients with negative appendectomy and acute appendicitis. Material and Methods: This descriptive observational cohort study research was conducted at the Emergency Department of a Training and Research Hospital between November 2017 and April 2019. We included the data of appendicitis cases aged under 18 years in this restrospective study and gathered data on patients’s demographics, preoperative laboratory values, signs, symptoms, and final pathological diagnosis, restrospectively. Then, cases were divided into acute appendicitis or negative appendectomy groups according to formal pathology reports. Results: The final study population consisted of 60 patients; the negative appendectomy rate was 25%. The diagnostic accuracy of the multivariate model`s involving CRP, Alvarado score, and appendix diameter was 93.3%, with a sensitivity and specificity of 93.3% for identifying acute appendicitis (+LR: 14 and -LR: 0.07). Applying the model could have prevented 93.3% of negative appendectomy cases (25% to 1.7%) from undergoing unnecessary surgery in our cohort. Conclusion: In conclusion, CRP, Alvarado score, or appendix diameter should not be used individually to diagnose AA in children. However, combining these variables can increase the accuracy of acute appendicitis diagnosis and may provide a significant reduction in negative appendectomy rates.

291. A CASE OF LAPAROSCOPIC AND THORACOSCOPIC ENUCLEATION FOR GIANT CIRCUMFERENTIAL ESOPHAGEAL LEIOMYOMA

Abstract Enucleation is surgically or endoscopically performed for submucosal tumors of the esophagus, especially for esophageal leiomyoma. Enucleation for large and circumferential tumors is technically challenging given a higher risk of mucosal injury and/or tumor rupture during procedure. We present a case of giant leiomyoma with a maximal diameter of 8 cm successfully enucleated by laparoscopic and thoracoscopic approaches. A 24-year-old man was referred to our hospital with a mediastinal tumor suspected on chest X-ray. He suffered from heartburn for more than 10 years and recently dysphagia. Endoscopic examination revealed esophageal submucosal tumors located at 30 cm to 35 cm from the incisor, involving whole luminal circumference. Boring biopsies were endoscopically performed of which pathological diagnosis was esophageal leiomyoma. CT showed wall thickening in the lower esophagus with a maximal esophageal diameter of 8 cm. Giant esophageal tumor enucleation with antireflux fundoplication was performed using both laparoscopy and thoracoscopy. The tumor expanded circumferential shape with the longitudinal extent of approximately 8 cm. After tumor enucleation, the esophageal mucosa was circumferentially exposed from the level of the azygos vein to the esophagogastric junction without the muscle layer. The esophageal mucosal injury occurred in 3 places, which were repaired by primary closure using absorbable threads. The operation time was 827 minutes and the loss of blood was 230 mL. The specimen was 160 g, and the final pathological diagnosis was leiomyoma. Postoperative course was not eventful. We experienced a case of enucleation for a giant esophageal circumferential submucosal tumor. Enucleation may be considered a possible treatment strategy to avoid esophagectomy even for a giant circumferential tumor especially in young patients.

Usefulness of intraoperative rapid immunohistochemistry in the surgical treatment of brain tumors.

In the treatment of primary central nervous system lymphoma (PCNSL), intraoperative rapid pathological diagnosis can dramatically change the surgical strategy, and more accurate diagnostic methods are required. In April 2020, we adopted intraoperative rapid immunohistochemistry (IHC) in addition to conventional rapid intraoperative diagnosis based on morphological assessment, mainly for patients with PCNSL. Here, we investigate the usefulness and significance of intraoperative rapid IHC based on our initial experience. We performed intraoperative rapid IHC using antibodies for cluster of differentiation (CD)20, CD3, leukocyte common antigen (LCA) and glial fibrillary acidic protein (GFAP) using enzyme-labeled antibody methods in 25 patients, including PCNSL patients, from April 2020 to July 2022. We examined the utility of this approach in determining treatment strategies for brain tumors. Postoperative final pathological diagnoses from paraffin-embedded sections were as follows: diffuse large B-cell lymphoma, 16 cases; glioblastoma, six cases; pilocytic astrocytoma, one case; adenocarcinoma, one case; and inflammatory disorder, one case. The entire process took 32 min and staining for CD20, CD3, LCA, and GFAP was comparable to that using paraffin-embedded sections. In all cases, the results of intraoperative rapid IHC were consistent with final pathological diagnoses from paraffin-embedded sections. In addition, in two cases, the results of conventional intraoperative rapid pathological diagnosis based on morphological assessments using frozen sections were drastically changed by adding intraoperative rapid IHC. Intraoperative rapid IHC contributes to deciding appropriate treatment strategies and facilitating early initiation of chemotherapy for PCNSL. This may allow new therapeutic strategies not only for PCNSL but also for other brain tumors.

Classification of pancreatic cystic neoplasms using radiomic feature analysis is equivalent to an experienced academic radiologist: a step toward computer-augmented diagnostics for radiologists.

A wide array of benign and malignant lesions of the pancreas can be cystic and these cystic lesions can have overlapping imaging appearances. The purpose of this study is to compare the diagnostic accuracy of a radiomics-based pancreatic cyst classifier to an experienced academic radiologist. In this IRB-approved retrospective single-institution study, patients with surgically resected pancreatic cysts who underwent preoperative abdominal CT from 2003 to 2016 were identified. Pancreatic cyst(s) and background pancreas were manually segmented, and 488 radiomics features were extracted. Random forest classification based on radiomics features, age, and gender was evaluated with fourfold cross-validation. An academic radiologist blinded to the final pathologic diagnosis reviewed each case and provided the most likely diagnosis. 214 patients were included (64 intraductal papillary mucinous neoplasms, 33 mucinous cystic neoplasms, 60 serous cystadenomas, 24 solid pseudopapillary neoplasms, and 33 cystic neuroendocrine tumors). The radiomics-based machine learning approach showed AUC of 0.940 in pancreatic cyst classification, compared with AUC of 0.895 for the radiologist. Radiomics-based machine learning achieved equivalent performance as an experienced academic radiologist in the classification of pancreatic cysts. The high diagnostic accuracy can potentially maximize the efficiency of healthcare utilization by maximizing detection of high-risk lesions.

Evaluation of TP53 and HER-2/neu Genes Expression Levels in Gestational Trophoblastic Diseases Cases and Determining Their Predictive Value in Diagnosis of Malignancy and Disease Progression

Background: Gestational trophoblastic disease (GTD) is a general term that includes several types of pathologically different diseases, which range from hydatidiform mole to choriocarcinoma. Early differentiation of these types is important to determine treatment strategy and prognosis. Objectives: Genetic markers such as TP53 and HER-2/neu expression are recently shown to have diagnostic and prognostic values. The aim of this study was to evaluate its significance. Methods: We enrolled 62 patients diagnosed with GTD referred to Imam Hossein Hospital in Tehran, Iran between 2012 and 2017. Endometrial pathologic specimens were stained, using the immunohistochemistry (IHC) method for the expression of TP53 and HER-2/neu genes. Expression levels determined by IHC were compared between final pathologic diagnoses, using one-way ANOVA test (analysis of variances), which detects significant differences between the means of 3 or more independent groups. Results: Out of 62 participants, 32 and 24 cases were diagnosed as partial and complete hydatidiform mole, respectively. Four cases had invasive hydatidiform mole and only 2 cases were diagnosed as choriocarcinoma. Analysis using ANOVA demonstrated that expression levels of both TP53 and HER-2/neu genes are significantly higher among patients with invasive form and choriocarcinoma compared with non-invasive hydatidiform mole (P &lt; 0.05 for both genes). The receiver operating characteristic (ROC) curve for each gene showed that more than 55% positive staining for the TP53 gene can differentiate non-invasive hydatidiform mole from invasive form and choriocarcinoma with 100% sensitivity, and 92.9% specificity. Conclusions: TP53 expression might serve as a potential diagnostic aid to differentiate benign and malignant GTDs and a future target for adjusting treatment based on the expression levels.

Impact of COVID-19 Pandemic on Thyroid Surgery in a University Hospital in South Korea.

Simple SummaryThe COVID-19 pandemic has changed healthcare systems around the world. Medical staff focused on managing infectious diseases and other treatments were postponed. We analyzed any changes in the treatment of thyroid cancer during the corona pandemic. Since the outbreak of COVID-19, the number of annual outpatients has significantly decreased, both for new patients and for follow-up patients, and the number of days from the first visit to surgery has increased significantly. After the onset of COVID-19, poor prognostic factors for thyroid cancer increased, and the size of follicular tumors increased.The COVID-19 pandemic has changed healthcare systems around the world. Medical personnel concentrated on infectious disease management and treatments for non-emergency diseases and scheduled surgeries were delayed. We aimed to investigate the change in the severity of thyroid cancer before and after the outbreak of COVID-19 in Korea. We collected three years of data (2019, 2020, and 2021) on patients who received thyroid surgery in a university hospital in South Korea and grouped them as “Before COVID-19”, “After COVID-19 1-year” and “After COVID-19 2-years”. The total number of annual outpatients declined significantly after the outbreak of COVID-19 in both new (1303, 939, and 1098 patients) and follow-up patients (5584, 4609, and 4739 patients). Clinical characteristics, including age, sex, BMI, preoperative cytology results, surgical extent, and final pathologic diagnosis, were not significantly changed after the outbreak of COVID-19. However, the number of days from the first visit to surgery was significantly increased (38.3 ± 32.2, 58.3 ± 105.2, 47.8 ± 124.7 days, p = 0.027). Papillary thyroid carcinoma (PTC) patients showed increased proportions of extrathyroidal extension, lymphatic invasion, vascular invasion, and cervical lymph node metastasis. Increased tumor size was observed in patients with follicular tumor (3.5 ± 2.2, 4.0 ± 1.9, 4.3 ± 2.3 cm, p = 0.019). After the COVID-19 outbreak, poor prognostic factors for thyroid cancer increased, and an increase in the size of follicular tumors was observed. Due to our study being confined to a single tertiary institution in Incheon city, Korea, nationwide studies that include primary clinics should be required to identify the actual impact of COVID-19 on thyroid disease treatment.

Ectopic Pancreatic tissue of Stomach: Pathology, Endoscopy, Endoscopic Ultrasonogram and Abdominal CT Findings

&lt;p&gt;We present an intresting case of heterotopic pancreas(HP) of the stomach in the posterior wall of antrum in a 60-years old female. The endoscopy, endoscopic ultrasonogram (EUS) and abdominal CT showed typical characteristics and with some vaiable appearances of this gastric lesion. The preoperation differential diagnosis includes gastrointestinal stromal tumor, leiomyoma, schwannoma and ectopic pancreatic tissue. The patient underwent laparoscopic wedge rsection. The frozen section and final pathologic diagnosis all confirmed ectopic pancreatic tissue. We also discuss the characteristics in correlation of the pathology with endoscopy, EUS and abdominal CT findings.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;