Hard Nodules Research Articles

Miliary Osteoma Cutis, Report of A Case After Plant Injury

Osteoma cutis (OC) is a rare condition characterized by the presence of bone particles within the skin. One subtype of osteoma cutis is miliary osteoma cutis (MOC), which primarily affects middle-aged women and commonly occurs on the face. Clinical features of MOC include papules and skin-colored hard nodules, similar to milia. In this case, we present a 60-year-old woman with facial skin lesions resulting from a plant injury. The diagnosis was miliary osteoma cutis, and successful surgical treatment was performed

7387 A Rare Case Of Concomitant Intrathyroidal Parathyroid Carcinoma With Osteitis Fibrosa Cystica, Masquerading As Oncocytic Thyroid Carcinoma - A Post-operative Diagnosis

Abstract Disclosure: Y. Koh: None. D.E. Chew: None. T.P. Quek: None. Introduction: Parathyroid carcinoma is a rare form of malignancy. An intrathyroidal location of parathyroid carcinoma further complicates the diagnosis as it may be mistakenly presumed to be of thyroid origin instead. We present a case report of an intrathyroidal parathyroid carcinoma which was diagnosed post-total thyroidectomy. Clinical case: A 72-year-old lady was found to have an intrathyroidal mass after presenting with unintentional weight loss and chronic constipation. Ultrasound of the neck showed a 4.0 x 2.9cm markedly hypoechoic solid mass in the mid-lower right thyroid lobe. Fine needle aspiration of the mass was suspicious for an oncocytic neoplasm. She underwent total thyroidectomy with central neck dissection for concerns of oncocytic thyroid carcinoma. Intraoperatively, a 4cm right hard intrathyroidal nodule invading into the right recurrent laryngeal nerve was observed. All 4 parathyroids were identified and preserved. Post-operatively, routine biochemistry to monitor for hypocalcemia showed hypercalcemia instead. This quickly transitioned into hypocalcemia on post-operative day 4, with biochemistry supportive of hungry bone syndrome [adjusted calcium 2.05mmol/L [normal range (NR) 2.15-2.5], phosphate 0.6mmol/L (NR 0.8-1.4), PTH 8.2pmol/L (NR 0.8-6.8), 25-OH vitamin D 18ug/L (NR 30-100)]. She was started on oral calcium carbonate, calcitriol and cholecalciferol aiming for normocalcemia. Evidence for underlying primary hyperparathyroidism were sought for, which showed osteitis fibrosa cystica, severe osteoporosis and an ossifying fibroma of the mandible, suggesting underlying hyperparathyroidism-jaw tumour-syndrome. The intra-operative histology was reported as oncocytic carcinoma with angio- and perineural invasion, presumed to be thyroid in origin. Given our suspicion of underlying primary hyperparathyroidism, we requested our pathology colleagues to perform additional immunochemical stains, which stained diffusely positive for parathyroid hormone, GATA3 but were negative for thyroglobulin, thyroid transcriptor factor-1, confirming its parathyroid origin. Her hungry bone syndrome resolved 22 weeks post-operatively. Till present (14 months post-operatively), her calcium and PTH levels remain normal and ultrasound of the neck did not reveal any evidence of recurrence. She declined genetic screening. Clinical Lesson: A high index of suspicion is required for the diagnosis of parathyroid carcinoma. In a patient who presents with constitutional symptoms and a neck mass, it is imperative to consider parathyroid disease as a differential diagnosis. A lesion with oncocytic morphology may be of parathyroid or thyroid origin, and the use of immunochemical stains can help differentiate them. Effective communication between clinicians and pathologists is essential in clinching the correct cytopathological diagnosis. Presentation: 6/3/2024

Osteosarcoma with widespread metastasis in a 1-year-old crossbred rabbit.

A 14-month-old female spayed, small crossbred rabbit presented for assessment of a small, hard subcutaneous nodule in the right axilla. Serum biochemistry showed markedly increased serum ALP activity. A whole-body CT revealed an aggressive, monostotic osteolytic, and productive lesion within the left alveolar process of the maxilla, with erosion of the alveolar bone and secondary premolar depression. Innumerable metastatic osseous masses were present throughout the body, including cerebral, pulmonary, hepatic, subcutaneous, and skeletal muscular metastases. Postmortem findings confirmed widespread, metastatic osteosarcoma, with the primary lesion within the left maxilla.

Efficacy of collagenase Clostridium histolyticum combination therapies for Peyronie's disease: a systematic review and meta-analysis.

Peyronie's disease (PD) is a common penile disorder characterized by the formation of fibrous noncompliant hard nodules in the tunica albuginea of the penis. Collagenase Clostridium histolyticum (CCH) is an injectable drug that treats PD by enzymatically degrading plaque interstitial collagen. CCH has been used in patients with varying curvature, as well as in the acute and stable phases of the disease, through a variety of treatment regimens and combinations. We carried out a systematic review and meta-analysis to assess the efficacy of CCH combination therapies for PD. We selected 4 observational comparative studies and 3 randomized controlled trials including 532 participants from the PubMed, Embase, and Cochrane databases (until December 2023) to evaluate the efficacy of CCH combination therapies for PD. The primary outcome was clinical efficacy as evaluated by improvement in penile curvature and penile length, as well as by scores on the Peyronie's Disease Questionnaire (PDQ) for symptom bother, penile pain, and psychological symptoms. Continuous data were represented by mean difference (MD) and 95% CI. All data were analyzed by Review Manager version 5.3. For penile length (MD,0.81cm; 95% CI, 0.17-1.45; P = .01), PDQ symptom bother (MD,-1.02; 95% CI, -1.83 to -0.21; P = .01), and PDQ penile pain (MD,-0.93; 95% CI, -1.50 to -0.36; P = .001), CCH combination therapy showed significantly greater improvements vs CCH monotherapy. However, in the other indicators, penile curvature and PDQ psychological symptoms, there was no significant difference between the therapies. This meta-analysis supports that CCH combination therapies can partially increase penile length and ameliorate symptom bother and penile pain to some extent. However, CCH combination therapies still need to be evaluated through more high-quality research.

Increased cardiovascular risks and mortality in prurigo nodularis: a global cohort study

BackgroundPrurigo nodularis (PN) presents with intensely itchy hard nodules. Despite being limited to the skin, PN was noted to be associated with systemic diseases including diabetes and chronic renal failure. In previous smaller retrospective studies, several cardiac and vascular diseases were found more frequently in patients with PN. However, small cohort sizes, partially discrepant outcomes, missing data, and incomplete risk assessment limit these findings. MethodsElectronic health records (EHR)s of 64,801 patients (59.44% females) with PN and an equal sized propensity-matched control group were retrieved. In these cohorts, the risks to develop cardiac and vascular diseases and mortality following diagnosis of PN were determined. Sub-analyses included stratification for sex, ethnicity, and treatments. FindingsPN was associated with a higher risk for a broad range of acute cardiac events including heart failure and myocardial infarction. For example, the hazard ratio of myocardial infarction was 1.11 (95%-CI: 1.041-1.184, p=0.0015) following PN diagnosis. Also, all-cause mortality was higher in patients with PN. Further, chronic vascular as well as structural heart diseases, e.g., peripheral arterial disease, chronic ischaemic heart disease and valval disorders were found more frequently following a PN diagnosis. Risks were more pronounced in white and female patients. Having established an increased risk for death and cardiovascular disease, we next addressed if dupilumab that has been recently licenced for use in this indication can modulate these risks. The risk of death but not of any cardiovascular disease was slightly reduced in patients with PN treated with dupilumab as opposed to those treated with systemic therapies other than dupilumab. The study is limited by retrospective data collection and reliance on ICD10-disease classification. InterpretationPN is associated with higher mortality and an increased risk for the development of a wide range of cardiac and vascular diseases. Health care professionals should take this into account when managing patients with PN. FundingThis work was supported by the University of Lübeck, the Deutsche Forschungsgemeinschaft and the State of Schleswig-Holstein.

Analytical Modeling of Breast Elastography

The purpose of the research is to develop a method for assessing the level of nonspecific protection of the body. Тhe purpose of the research. Тo develop an analytical method based on micromechanics to determine the location, size and modulus of elasticity of a tumor mass embedded in symmetrical double-dimensional breast tissue and obtain a closed solution for deformation elastograms.Methods. Changes in tissue elasticity usually correlate with pathological phenomena. Many cancers, such as scirrhous carcinoma of the breast, appear as extremely hard nodules that result from increased stromal density. Other diseases include deposits that increase or decrease tissue elasticity. Complex fluid-filled cysts may not be visible on standard ultrasound, but may be much softer than the embedded tissue. Тhe elastic moduli of tumors change during their pathological evolution. Еlastographic imaging has the potential to detect and characterize cancers by mapping tissue stiffness distribution. Тhe work developed a model of the mammary gland in the form of a two-dimensional layer of unit thickness with a round tumor, taking into account boundary conditions. Local elastic responses were obtained when an acoustic field was applied.Results. Тo evaluate the possibilities of determining the quantitative values of the elastic modules of the medium, we proposed a model of the process of deformation of heterogeneity under the conditions of ultrasonic static elastography and investigated the influence of elastic moduli and deformation of heterogeneity in the direction of applied pressure. Conclusion. Тhe developed technique made it possible to obtain an analytical solution for the field of deformations and stresses of two-dimensional models of mammary glands containing inhomogeneities. Тhe model makes it possible to use the developed methodology for constructing medical elastographic devices and conducting research in the field of elastography.

Mastitis granulomatosa

Granulomatous mastitis is a chronic, benign and inflammatory disease of the breasts from idiopatic etiology. It usually appears in women until 5 years after giving birth. The main hypothesis explains an autoimmune phenomenon as a result of expelled antigens from the breast-feeding period.Its clinical expression varies a lot, ranging from mastitis, fistulas or nodules. Usually it is seen as a hard nodule in any of the breast quadrants.Due to the fact that granulomatous mastitis clinically resembles inflammatory breast cancer, the diagnosis becomes challenging, needing different radiological tests as well as histiopatological samples for the final diagnosis. The treatment is not well established, and the two main options are complete escision of the breast or corticoesteroids with methotrexate. Even with this treatment, in half of cases the disease chronifies.

Clinical Efficacy Analysis of Circumferential Upper Arm Liposuction with Double Incision: A Study of 496 Cases.

In cases where the upper arm exhibits an irregular cylindrical appearance with subcutaneous fat concentrated primarily in the posterior lateral aspect, traditional localized fat suction techniques may lead to uneven or disharmonious results when addressing this concern. Many practitioners have turned to circumferential fat suction methods using multi-incision approaches to ensure effective results and fat removal. However, these methods often involve numerous incisions and complex procedures, necessitating the development of new, more efficient surgical techniques. We collected and screened patients who underwent upper arm circumferential liposuction with a double incision technique at our hospital from October 2020 to February 2023. A total of 496 cases were included in our retrospective analysis, in which we examined factors such as the length of surgery, arm circumference before and after surgery, subcutaneous tissue thickness before and after surgery, fat suction volume, postoperative satisfaction, and postoperative complications of the patients. The average length of surgery was 71.7min. 458 cases (92.3%) showed significant improvement, 23 cases (4.6%) reported satisfaction, and 10 cases (2.0%) were essentially satisfied. Additionally, 339 cases (68.3%) experienced an improvement in skin laxity. Four cases (0.8%) developed localized hard nodules with slight tenderness in the early postoperative period, which resolved without special treatment after observation and follow-up for 1-3months. Three cases (0.6%) reported localized pain or numbness, and they were given oral medication. Their symptoms disappeared after 1-3months of observation and follow-up. Three cases (0.6%) had localized pain or numbness, and their symptoms disappeared. All of these cases improved and resolved after onemonth of taking mecobalamin tablets. There were also three cases (0.6%) with mild pigmentation of the incision and two cases (0.4%) with mild limitation of unilateral upper arm abduction movement. However, upper arm activities were not affected after threemonths to oneyear of follow-up. No serious complications were reported, resulting in an overall satisfaction rate of 99.0%. The double incision upper arm liposuction is safe, effective, time-saving, with high satisfaction and fewer complications, and is worthy of clinical popularization and application. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .

Fibrosis Management Algorithm in Secondary Liposculpture.

Liposuction is considered one of the most common procedures in plastic surgery. However, major postoperative complications such as visceral injury, fluid overload, and necrotizing fasciitis still occur. Likewise, minor complications such as ecchymosis, seromas, infections, and contour irregularities that do not threaten the life of the patient do generate significant dissatisfaction. Current evidence regarding the management of fibrosis after previous liposuction remains limited. The objective of this article is to standardize a management algorithm based on the extensive experience and successful results of the primary author (G.M.). Patients who underwent secondary liposculpture between August 2022 and May 2023 were evaluated prospectively. Inclusion criteria comprised females between 18 and 60 years old, nonsmokers, with a BMI < 35 kg/m2 and a history of previous body contouring surgeries. Identification of the patient's skin condition and subcutaneous lesions in the adipose tissue were obtained in detail. Statistical analysis of preoperative and postoperative medical photographs was also performed with the Fiji Biological image analyzer. Photographic analysis of preoperative and postoperative photographs showed a statistically significant difference between the areas affected by fibrosis (P < .001). The most frequent clinical findings were depressions in 99% of the females (74), followed by soft nodules in 95% (70), hard nodules in 81% (61), adhesions in 47% (35), and finally cutaneous bursas in 4%. Our classification system and management algorithm for fibrosis and contour irregularities is a safe and reliable tool. Results were objectively verified, yielding statistically significant outcomes.

Isolated Tubercular Epididymitis: A 10-Year Series

Introduction: Genitourinary tuberculosis (TB) is considered a common form of extrapulmonary TB, being second only to lymph node tuberculosis, which is the most common site. Isolated TB of the epididymis is rare, and diagnosis of epididymal TB can be challenging. In this study, we report our series of isolated TB of the epididymis. Materials &amp; Methods: We retrospectively collected the outpatient and inpatient records of histologically confirmed epididymal tuberculosis. Data including age, clinical presentation, examination findings, and diagnostic tests were reviewed and analyzed. Results: A total of 56 patients were diagnosed to have isolated tuberculosis of the epididymis during the 10-year study period. The mean age was 33 years. The clinical presentation included a hard nodule in the epididymis (100%), hydrocele in 16 (28.5%), posterior scrotal sinus in 6 (10.7%), and sensitivity in 14 (25%) and fever in 3 (5.3%). Four (7.1%) patients had bilateral epididymal nodules, 30 (53.5%) had left-sided, and 22 (39.2%) had right-sided involvement. Scrotal exploration and epididymal biopsy were performed in 16 (28.5%), and unilateral epididymectomy was performed in 40 (71.4%). The histopathological examination revealed a typical tubercular granuloma in all these patients. All patients were put on anti-TB drugs. Conclusions: Isolated TB of the epididymis is a rare disease. Treatment with anti-TB drugs remains the first-line intervention in all cases. Surgery is indicated in cases of failure of pharmacological treatment or the development of complications.

Cutaneous Nodules - A Challenging Presenting Sign in Breast Neoplasm

Dr Mihalcea (Internal Medicine): A 77-year-old woman was admitted to the hospital because of dyspnea at rest, fatigability, unproductive cough (debuted 6 months prior to admission, with no improvement from common cough medication), and the onset, reportedly during the previous two months, of painful, erythematous, hard nodules distributed diffusely all over her body. She had a history of rheumatic heart disease, with severe mitralvalve stenosis, atrial fibrillation, and heart failure with reduced ejection fraction. Two months earlier she was admitted for a routine check-up at the Cardiology Ward of the hospital where she was being monitored for her cardiovascular pathology, and no nodules were reported.

Use of ultrasonographic shear wave measurements to diagnose thyroid metastasis from breast carcinoma.

A metastatic thyroid tumor (MTT) arising from breast carcinoma (BC) is rare and sometimes difficult to diagnose. We present a case of MTT from BC; we suspected anaplastic thyroid carcinoma at initial presentation. The patient was a 58-year-old female with a hard nodule in the right anterior neck and a history of breast cancer. Computed tomography indicated tumors on both thyroid lobes, and ultrasonography (US) with shear wave measurement (SWM) showed malignant features. We performed fine needle aspiration cytology (FNAC), the results of which led us to strongly suspect MTT from BC. The surgically resected specimen was evaluated histopathologically, including by immunohistochemistry (IHC), and the diagnosis was confirmed. In addition to FNAC and IHC, SWM is useful to diagnose MTT from BC.

Evaluation of elastosonography and fine-needle aspiration biopsy results in the diagnosis of thyroid nodules

Objective The aim of our study is to investigate the importance of strain sonoelastography (SSE) in the diagnosis of thyroid nodules and in the selection of indications for fine-needle aspiration biopsy (FNAB). Materials and methods We included 481 patients who visited our clinic between 2019–2022 with thyroid nodules in the study and used a stepwise diagnostic approach to choose patients to perform surgery on and follow-up. All patients were ranked into 2 groups: Group 1 included 135 (28,1%) patients were assessed as SSE along with traditional examinations. The 2nd group included 346 (71.9%) patients who underwent ultrasound examination using SE, only the hard nodule or hard regions of the nodule detected by SSE were obtained with FNAB. We followed up on nodules with benign FNAB results, and nodules with suspicious or malignant results underwent thyroidectomy. Histopathology results of surgically removed nodules were compared with SSE and FNAB results. AUROC was the primary, while sensitivity, specificity, PPV and NPV were the secondary outcome. Results Out of 481 patients, 420 (87.3%) were female, 61 (12.7%) were male, and the age range was 17–83 (CI=45.57±25.9). The mean nodule size was 23.33±16.7 mm. After evaluating elastography results, FNAB was performed on 346 (71.9%) nodules. Surgical treatment was performed in 114 (group 1) (84.4%) of 135 patients, benign tumors were diagnosed in 107 (93.8%), and malignant tumors in 7 (6.2%). Surgical treatment in group 2 was performed in 146 (42.2%) of 346 patients, benign tumors were detected in 105 (71.9%) patients, and malignant in 41 (28.9%). The combined use of the sonoelastography and fine-needle aspiration biopsy contributed to a significant increase in the frequency of detection of thyroid nodules of malignant structure, which amounted to 28.9% in patients of the main group (versus 6.2% in patients of the control group) and a decrease in the frequency of surgical interventions by more than 2 times in patients of the second group. The area of the ROC curve for SSE was S=0.851±0.029; 95% CI (0.794 to 0.908); P=0.000. It is a statistically significant marker in the diagnosis of thyroid nodules. The most important marker in the diagnosis of thyroid nodules was the FNAB test: S=0.874±0.034; 95% CI (0.807 to 0.940); P =0.000. Sensitivity, specificity, PPV, and NPV of elastosonography of the I group were 42.9±18.7%, 96.3±1.8%, 42.9%, 96.3; of II group 68.3±7.3%, 87.6±3.2%, 68.3%, 87.6%; FNAB 90.2±4.6%, 90.5±2.9%, 76.2%, 91.3%, respectively. Conclusion Combined use of SE and Bethesda system was able to detect malignancy in the early stages and to reduce the number of operations.

437 Appedicular Endometriosis – a Rare Intra-Operative Finding

Abstract Endometriosis is a known gynaecological condition in young women of reproductive age group. It presents with many different symptom complexes, most common presentation being pain abdomen especially during menstruation. Pelvis is the most common site for endometrial deposits. Gastrointestinal endometriosis is rare, appendicular endometriosis is rarer. There have been only a few case reports of endometriosis causing appendicitis. We came across a case of perforation peritonitis in a young girl with a background history of endometriosis. Patient presented with sign and symptoms of acute appendicitis and on USS was found to have inflamed appendix. During diagnostic laparoscopy she was found to have gangrenous perforated appendix and a hard nodule, which on histopathology revealed endometriosis. Another important fact revealed on histopathology was bleeding into the endometrial tissue. This patient underwent laparoscopic right hemicolectomy. Postoperative recovery was uneventful. Patient was discharged from the hospital on 5th postoperative day. We did literature research to find out that there have been only two cases reported in the literature of appendicular perforation caused by endometriosis.

425 Appendicular Endometriosis- A rare presentation

Abstract Endometriosis is a known gynaecological condition in young women of reproductive age group. It presents with many different symptom complexes, most common presentation being pain abdomen especially during menstruation. Pelvis is the most common site for endometrial deposits. Gastrointestinal endometriosis is rare. Appendicular endometriosis is rarer. There have been only a few case reports of endometriosis causing appendicitis. We came across a case of perforation peritonitis in a young girl with a background history of endometriosis. Patient presented with sign and symptoms of acute appendicitis and on USS was found to have inflamed appendix. During diagnostic laparoscopy she was found to have gangrenous perforated appendix and a hard caecal nodule, which on histopathology revealed endometriosis. Another important fact revealed on histopathology is bleeding into the endometrial tissue. This patient underwent laparoscopic right hemicolectomy. Post – operative recovery was well and uneventful. Patient was discharged from the hospital on 5th day post operation. We did a literature research to find out that there have been only two cases of perforated appendicitis mentioned in literature. While endometriosis is a common disease and may lead to appendicitis but it is not very common for it to present it as perforation peritonitis.

"Sack of Marbles" Appearance of a Scalp Teratoma.

HomeRadiologyVol. 307, No. 5 PreviousNext Reviews and CommentaryFree AccessImages in Radiology“Sack of Marbles” Appearance of a Scalp TeratomaSumit Thakar , Pavan VasoyaSumit Thakar , Pavan VasoyaAuthor AffiliationsFrom the Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, ITPL Rd, EPIP Area, Whitefield, Bangalore 560066, India.Address correspondence to S.T. (email: [email protected]).Sumit Thakar Pavan VasoyaPublished Online:May 30 2023https://doi.org/10.1148/radiol.230033MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 52-year-old woman presented with a painless, gradually enlarging scalp swelling that had been present since childhood. At examination, there was a 15 × 10 × 12–cm mass in the parieto-occipital region. MRI scan showed a large cystic lesion in the subgaleal plane of the scalp. It was hypointense with T1-weighted images and hyperintense with T2-weighted images and contained multiple nodules of varying sizes floating in the cyst, giving it a “sack of marbles” appearance (Figure). The nodules had thick outer rims that were iso- to hyperintense with T1-weighted sequences and hypointense with T2-weighted sequences and thin inner cores that were hypointense with T1-weighted sequences and hyperintense with T2-weighted sequences. The nodules demonstrated restricted diffusion (Figure) and had low apparent diffusion coefficient values. After completing surgical excision, the cyst was found to contain sebum-like material, hard spherules, and multiple strands of hair (Figure). Histopathologic examination confirmed the diagnosis of a mature cystic teratoma, with elements from all three germ layers. There was no recurrence after 6 months of follow-up.Images in a 52-year-old woman presenting with a scalp mass show a large cystic lesion in the subgaleal plane of the scalp with a “sack of marbles” appearance. (A) Sagittal unenhanced T1-weighted MRI scan shows a smooth-walled hypointense cyst with multiple spherical nodules that had isointense to hyperintense rims and thin hypointense cores. (B) Diffusion MRI scan shows the nodules demonstrating restricted diffusion. (C) Photograph of the gross specimen shows a sebum-like material within the cyst, hard spherical nodules, and strands of hair.Download as PowerPointOpen in Image Viewer Mature cystic teratomas are commonly found in the gonadal tissues and in the head and neck region. In the head, they have a predilection for the orbit and scalp. The “marbles” are spherical aggregates of keratin, fat, sebaceous material, fibrin, and hair floating within the fluid matrix of the cyst. Though uncommon, the “sack of marbles” sign is considered pathognomonic of mature cystic teratomas in the head and neck (1–3).Disclosures of conflicts of interest: S.T. No relevant relationships. P.V. No relevant relationships.

Idiopathic Calcinosis Cutis Presenting As Multiple Sebaceous Cysts - A Case Study and Review of Literature

We report a case of 41 years old male, medically free presenting with multiple hard nodules of varying sizes in the scrotum for last 18 years. The diagnosis of sebaceous cysts was made initially. The patient underwent day care surgery for the removal of nodules. The diagnosis of scrotal calcinosis was made on histopathological examination of the specimen.

Prevalence of Trapezius Trigger Points in Young Healthy Individuals

MTrPs are labelled as hard, discrete, and palpable nodules in a taut band of skeletal muscle. It can be further divided into 2 forms, if it is spontaneously painful (i.e., active trigger points) or painful only on compression (i.e., latent trigger points). Objectives: To determine the frequency of active and latent trigger points of trapezius in healthy individuals and to find out its association with gender. Methods: A cross sectional survey was conducted from April 2018-August 2018 after getting approval from the ethical committee of Riphah College of Rehabilitation Sciences. The sample size was 323 which were selected by non-probability (convenient sampling) technique. Data were collected through self-structured questionnaire which also included trigger points assessment form. The data were analyzed using SPSS 24. Results: The mean age of participants was 23.60±4.6years with 60(19.8%) males and 243(80.2%) females. The trapezius trigger point 2 was found more active on right side (TT2Rt side) in 91(30%) and left side (TT2Lt side) 57(18.8%). While the same was more latent in 75(24.8%) on right side (TT2Rt side) and 86(28.4%) on left side (TT2Rt side) among the participants. There was no significant association between active trigger points and gender (p&gt;0.245), as well as the association between latent trigger point and gender was not significant (p&gt;0.740). Conclusions: The frequency of trapezius trigger point is less in healthy individuals whereas the majority of the young individuals have at least one or two active or latent trigger points. There was no significant association of both active and latent trigger points with gender.

Decorin inhibits the formation of hard nodules after microwave ablation by inhibiting the TGF-β1/SMAD and MAPK signaling pathways: in a Bama miniature pig model of mammary gland hyperplasia

Background Benign breast lesions are often associated with hard nodule formation after microwave ablation (MWA), which persists for a long time and causes problems in patients. The aim of this study was to evaluate the efficacy of decorin in the treatment of hard nodule formation and its potential mechanism of action. Methods Using a Bama miniature pig model of mammary gland hyperplasia, immunohistochemistry, Masson’s trichrome and western blotting were firstly applied to compare the extent of fibrosis and activation of key members of the TGF-β1/SMAD and MAPK signaling pathways of hard nodule in the control and MWA groups, and then the extent of fibrosis and expression of signaling pathways in hard nodule were examined after application of decorin. Results The results showed that the MWA group had increased levels of TGF-β1, p-SMAD2/3, p-ERK1/2, and collagen I proteins and increased fibrosis at 2 weeks, 4 weeks, and 3 months after MWA. After decorin treatment, the expression levels of each protein were significantly downregulated, and the degree of fibrosis was reduced at 2 weeks, 4 weeks, and 3 months after MWA compared with the MWA group. Conclusion In conclusion, these results suggest that activation of TGF-β1 may play an important role in hard nodule formation and that decorin may reduce hard nodule formation after MWA in a model of mammary gland hyperplasia by inhibiting the TGF-β1/SMAD and MAPK signaling pathways.

Small Cell Neuroendocrine Carcinoma of Cervix: A Rare Case Report

Neuroendocrine neoplasms (NEN) are derived from endocrine cells and are very rarely seen in gynecological practice. Here we report a case of small cell neuroendocrine carcinoma (SCNEC) of cervix in a 45 year old married female who presented with history of menorrhagia. On gynecological examination, she had bulky uterus with a palpable non tender, hard nodule on posterior wall of cervix. Ultrasonogram of pelvis was reported as bulky ? adenomyotic uterus with 2.7x2.4x1.0cm well defined collection in fundal region of endometrium. She underwent total abdominal hysterectomy for abnormal uterine bleeding. Histopathology with immunohistochemical markers was reported as small cell neuroendocrine carcinoma (SCNEC) of cervix. This case is reported here for its rarity.