Histology Imaging Research Articles

Thymoma-associated autoimmune enteropathy with colonic stricture: a diagnostic and histological challenge.

Thymoma-associated autoimmune enteropathy is a rare paraneoplastic syndrome that is characterized by severe chronic diarrhea, malabsorption, and specific histological findings. Because of its rarity, it is difficult to diagnose. We describe an adult patient with protracted diarrhea and weight loss that developed recurrent sepsis and progressive colonic stenosis due to thymoma-associated autoimmune enteropathy. Ultimately, the diagnosis thymoma-associated autoimmune enteropathy was established by characteristic intestinal histology, anti-enterocytes antibodies, and thorax imaging. Radical thymectomy was performed without improvement. Therapy with azathioprine and infliximab induced clinical remission with complete recovery of the colonic stenosis.

Frequency of synchronous malignant liver lesions initially detected by ultrasound in patients with newly diagnosed underlying non-hematologic malignant disease: a retrospective study in 434 patients.

This study described the frequency of malignant synchronous focal liver lesions (FLLs) in patients with newly diagnosed non-hematologic malignant disease. From June 2013 to January 2017, 434 patients with synchronous FLLs and newly diagnosed underlying malignant disease were included in the study. The diagnosis of the FLLs was made by histology and/or contrast-enhanced imaging. The final medical report was used for analysis in the study. Of the 434 liver lesions, 258 (59.4%) were malignant and 176 (40.6%) benign. All malignant lesions were metastases. The benign liver lesions were comprised of 93 cysts (21.4%), 52 hemangiomas (12.0%), 20 focal fatty sparing (4.6%), 4 focal nodular hyperplasia (0.9%), 3 unspecified benign lesions (0.7%), 2 regenerative nodules (0.5%), 1 calcification (0.2%), and 1 adenoma (0.2%). Diseases with the highest percentage frequency of synchronous malignant FLLs were cholangiocarcinoma with 86.7%, neuroendocrine tumor with 72.7%, and pancreatic carcinoma with 72.0%. Gastric carcinoma (33.3%), breast carcinoma (44.4%), and urothelial cell carcinoma (45.5%) were the diseases with the lowest percentage frequency of synchronous malignant FLLs. In total, the frequency of malignant synchronous FLLs in newly diagnosed non-hematologic malignant disease was 59.4%. In particular, cholangiocarcinoma, neuroendocrine tumor, and pancreatic carcinoma were the diseases with the highest rate of synchronous malignant FLLs.

Harnessing multimodal data integration to advance precision oncology.

Advances in quantitative biomarker development have accelerated new forms of data-driven insights for patients with cancer. However, most approaches are limited to a single mode of data, leaving integrated approaches across modalities relatively underdeveloped. Multimodal integration of advanced molecular diagnostics, radiological and histological imaging, and codified clinical data presents opportunities to advance precision oncology beyond genomics and standard molecular techniques. However, most medical datasets are still too sparse to be useful for the training of modern machine learning techniques, and significant challenges remain before this is remedied. Combined efforts of data engineering, computational methods for analysis of heterogeneous data and instantiation of synergistic data models in biomedical research are required for success. In this Perspective, we offer our opinions on synthesizing complementary modalities of data with emerging multimodal artificial intelligence methods. Advancing along this direction will result in a reimagined class of multimodal biomarkers to propel the field of precision oncology in the coming decade.

O02 Cancer, Covid and control of RA – a toxic combination?

Case report - IntroductionThis case highlights the dilemma of keeping rheumatoid arthritis disease under control in active cancer cases and establishing a consistent multidisciplinary dialogue during a pandemic and staffing crises.During chemotherapy and active cancer treatment, disease-modifying therapies (conventional and biologic) are often stopped. In some cases, the potential benefits versus risks of restarting usual therapies have to be balanced against risks of suppressing disease activity with high-dose steroids. Risks of infection (common and atypical) need to be considered.Case report - Case descriptionA is a 67-year-old female non-smoker diagnosed with seropositive rheumatoid arthritis (RF, anti –CCP positive) in 2008. Other conditions include type 2 diabetes, atrial fibrillation (on warfarin), hypothyroidism and obstructive sleep apnoea. Due to active disease, despite triple therapy (methotrexate, sulphasalazine and hydroxychloroquine), anti-TNF therapy (etanercept) commenced in 2009 with primary non-response. However, she responded well to B-cell therapy (rituximab) in conjunction with oral methotrexate (25mg weekly) receiving annual infusions from 2010 to 2016.In 2017, an elective sleeve gastrectomy procedure for high BMI was abandoned after peritoneal deposits of concern were noted. Histology and CT imaging were consistent with a primary peritoneal malignancy (Stage 3c low-grade serous adenocarcinoma). Treatment involved debulking surgery (total abdominal hysterectomy, bilateral salpinoophorectomy, omentectomy) and tamoxifen.Treatment for rheumatoid arthritis stalled during this period but as frequent steroids were required for active joint inflammation, in agreement with the oncologists, she had a rituximab cycle in 2018.Unfortunately, in 2019 she had signs of cancer progression (elevated tumour markers, CT imaging) and has subsequently started carboplatin chemotherapy. She has been unable to continue methotrexate or rituximab pending completion of the chemotherapy cycles (ongoing). However, her arthritis is now uncontrolled without increased steroids. Due to recurrent flares, her maintenance dose has been increased from 5mg to 7.5—10mg prednisolone daily until we can establish if it is safe and appropriate to recommence her usual arthritis regime.Even without disease-modifying therapy like methotrexate and rituximab, risk of infection (including atypical ones) is still significant with the combination of chemotherapy and steroids. Risk of progressive joint damage and adverse quality of life with active arthritis also needs to be considered. Staffing crises, exacerbated by COVID pandemic issues, have added to complexity of decision making and coordination of regular multidisciplinary discussions regarding treatment.Case report - DiscussionCancer is a known association in rheumatoid arthritis patients with a twofold higher risk of lymphoma compared to the general population. Whether condition or treatment affects risk remains unclear as immune dysregulation is relevant in both autoimmunity and cancer. Paraneoplastic, recent onset arthritis, chemotherapy- or immunotherapy-induced arthralgia/arthritis are also well documented. This case had a seropositive rheumatoid arthritis phenotype quite a few years prior to cancer diagnosis. Primary peritoneal cancer is uncommon, often presenting as in this case as an incidental finding. It is usually treated like ovarian cancerWhilst methotrexate has been implicated in lung cancer, melanoma and non-Hodgkin lymphoma, overall safety data suggest any risk is quite low (e.g., EBV-associated lymphoproliferative disorders usually resolve with drug discontinuation). It is also a known chemotherapeutic agent. Anti-TNF treatment algorithms generally exclude patients with recent cancer. Rituximab, originally developed as a cancer drug, is not thought to affect risk of cancer development or progression.Treatment with disease-modifying therapy (conventional and biologics) is often withheld in patients with active malignancy undergoing chemotherapy due to a theoretical risk of potentiated immunosuppression and toxicity, particularly cytopaenias. However, maintaining arthritis control with glucocorticoids also has short- and long-term risks. Combining chemotherapy agents like carboplatin with methotrexate has been used for urothelial carcinoma and can be well tolerated with close monitoring of haematological parameters.Thus, it could be argued this patient is at risk of infections whichever treatment approach is taken and regaining control of arthritis with recommencement of methotrexate and rituximab is much better for her quality of life.Regular multidisciplinary discussions are important to outline risks versus benefits of combined treatment. This may be difficult in practice during staffing crises. Covid risk in patients receiving rituximab and/or chemotherapy, timing and response to COVID vaccination are also important considerations.Case report - Key learning pointsPrimary peritoneal cancer is uncommon and can present as an incidental findingWhilst treatment for progressive cancer is important, withholding rheumatoid arthritis treatment can have a significant adverse impact on quality of lifeMorbidity and mortality risks of stopping treatment versus combined treatment (cancer therapy and disease-modifying therapy) ideally needs to be fully discussed and agreed with the patient and all care providers – lack of “named” providers, restructuring, redeployment, multi-specialty care and a global pandemic can make coordination of this difficult

Embotrap Extraction & Clot Evaluation & Lesion Evaluation for NeuroThrombectomy (EXCELLENT) Registry design and methods

BackgroundRelationships between occlusive clot histopathology, baseline characteristics, imaging findings, revascularization rates, and clinical outcomes of stroke patients with large vessel occlusion (LVO) are not well understood. This study will assess...

Sarcoidosis is a multisystemic disease and its diagnostic difficulties

The peculiarities of the clinical symptoms of sarcoidosis and complexity of its diagnosis have been considered on the clinical example of sarcoidosis manifestations in a young man. Sarcoidosis is a relatively rare multisystem inflammatory granulomatous disease of unknown etiology. The incidence of sarcoidosis varies according to different authors from 7.5 to 64 cases per 100.000 population. The clinical manifestations of sarcoidosis are determined by the number of affected organs, the degree of their structural and functional disorders, and the severity of general inflammatory symptoms. Mostly often, the process involves the intrathoracic lymph nodes, lungs, skin and eyes. Musculoskeletal involvement is rare; about 10 — 15 % of patients with sarcoidosis have associated arthropathy. In this article, special attention is paid to the importance of assessing the articular syndrome and visualization of the chest cavity organs, as well as assessing the dynamics of changes in the progression of the disease. The dynamic changes in laboratory parameters and instrumental diagnostic methods have been highlighted. The analysis of the literature data about sarcoidosis was carried out. The emphasis is stroked on the limitations of modern diagnostic methods, as well as the non‑specificity of clinical manifestations. A doctor can only rely on the results of histological studies or imaging using computed tomography or nuclear magnetic resonance imaging. It is noted that the symptom complex, known as Löfgren’s syndrome, manifests with a combination of skin manifestations, hilar lymphadenopathy and articular syndrome, and is very rare. In the presented clinical case, medrol 16 mg per day was used as a basic therapy. Therapy with glucocorticosteroids was associated with a good clinical and laboratory response, a decrease in the size of the mediastinal neoplasm, and an improvement in the patient’s well‑being.

A Transmural Path Model Improves the Definition of the Orthotropic Tissue Structure in Heart Simulations

In the past decades, the structure of the heart, human as well as other species, has been explored in a detailed way, e.g., via histological studies or diffusion tensor magnetic resonance imaging. Nevertheless, the assignment of the characteristic orthotropic structure in a patient-specific finite element model remains a challenging task. Various types of rule-based models, which define the local fiber and sheet orientation depending on the transmural depth, have been developed. However, the correct assessment of the transmural depth is not trivial. Its accuracy has a substantial influence on the overall mechanical and electrical properties in rule-based models. The main purpose of this study is the development of a finite element-based approach to accurately determine the transmural depth on a general unstructured grid. Instead of directly using the solution of the Laplace problem as the transmural depth, we make use of a well-established model for the assessment of the transmural thickness. It is based on two hyperbolic first-order partial differential equations for the definition of a transmural path, whereby the transmural thickness is defined as the arc length of this path. Subsequently, the transmural depth is determined based on the position on the transmural path. Originally, the partial differential equations were solved via finite differences on structured grids. In order to circumvent the need of two grids and mapping between the structured (to determine the transmural depth) and unstructured (electromechanical heart simulation) grids, we solve the equations directly on the same unstructured tetrahedral mesh. We propose a finite-element-based discontinuous Galerkin approach. Based on the accurate transmural depth, we assign the local material orientation of the orthotropic tissue structure in a usual fashion. We show that this approach leads to a more accurate definition of the transmural depth. Furthermore, for the left ventricle, we propose functions for the transmural fiber and sheet orientation by fitting them to literature-based diffusion tensor magnetic resonance imaging data. The proposed functions provide a distinct improvement compared to existing rules from the literature.

Therapeutic effectiveness and safety of sintilimab-dominated triple therapy in unresectable hepatocellular carcinoma

Immune checkpoint inhibitor therapy has shown promising results in patients with unresectable hepatocellular carcinoma. This study aimed to evaluate the effectiveness and safety of sintilimab, a programmed cell death protein-1 (PD-1) blockade, combined with sorafenib and transhepatic arterial chemotherapy and embolization in this patient population, compared with sintilimab monotherapy and sintilimab-sorafenib duotherapy. This was a 22 months single center retrospective cohort study in China. 80 patients with unresectable hepatocellular carcinoma were included, with diagnosis confirmed by either histologic, cytologic or diagnostic imaging analysis. The patients were divided into three groups based on therapeutic regimen: sintilimab monotherapy (sintilimab group, n = 22), sintilimab-sorafenib duotherapy (duplex group, n = 23), sintilimab-sorafenib and transcatheter arterial chemoembolization combined therapy (triple group, n = 35). The principal evaluation criteria were overall survival and progression free survival in the population, assessed according to response evaluation criteria in solid tumors, version 1.1 (RECIST 1.1). Secondary evaluation criteria were safety, objective response rate and disease control rate. From March 1st, 2019 to December 31, 2020, 80 patients with unresectable hepatocellular carcinoma were included and divided into three treatment groups (22 received sintilimab monotherapy, 23 received sintilimab-sorafenib duotherapy, and 35 received sintilimab-sorafenib combined with transcatheter arterial chemoembolization). The median overall survival of all patients was 11.0 months (95% CI 7.7–14.3). Median overall survival was 13.0 months (95% CI NE–NE), 9.0 months(95% CI 6.3–11.7)and 3.0 months (95% CI 1.9–4.1, p < 0.0001) in the triple therapy, duplex and sintilimab groups respectively, while the corresponding median progression-free survival were 5.0 months (95% CI 2.9–7.1, p < 0.001), 4.0 months (95% CI 2.8–5.2) and 2.0 months (95% CI 1.7–2.3). Disease control and clinical benefits rates were higher in the triple therapy group (80%, 95% CI 63.1–91.6, p < 0.001; 54.3%, 95% CI 36.6–71.2, p < 0.01) compared to the sintilimab group. Median duration of disease control was 4.0 months (95% CI NE–NE, p < 0.01) in the triple therapy group, longer than that of the duplex group (2.0 months, 95% CI 0.9–3.1) and sintilimab group (2.0 months, 95% CI 0.8–3.2). Grade 3 or 4 treatment-related adverse events occurred in 26.3% of 80 patients with hypertension was the most common event observed (38, 47.5%), however, other severe toxic effects were infrequent. Sintilimab combined with sorafenib and transcatheter arterial chemoembolization might have more beneficial effects on overall and progression-free survival and on the duration of disease control outcomes than both sintilimab monotherapy and sintilimab-sorafenib duotherapy in patients with unresectable hepatocellular carcinoma. This triple therapy model might represent an innovative and effective option for inoperable liver cancer.

Machine learning for grading and prognosis of esophageal dysplasia using mass spectrometry and histological imaging

BackgroundBarrett's esophagus (BE) is a precursor lesion of esophageal adenocarcinoma and may progress from non-dysplastic through low-grade dysplasia (LGD) to high-grade dysplasia (HGD) and cancer. Grading BE is of crucial prognostic value and is currently based on the subjective evaluation of biopsies. This study aims to investigate the potential of machine learning (ML) using spatially resolved molecular data from mass spectrometry imaging (MSI) and histological data from microscopic hematoxylin and eosin (H&E)-stained imaging for computer-aided diagnosis and prognosis of BE. MethodsBiopsies from 57 patients were considered, divided into non-dysplastic (n = 15), LGD non-progressive (n = 14), LGD progressive (n = 14), and HGD (n = 14). MSI experiments were conducted at 50 × 50 μm spatial resolution per pixel corresponding to a tile size of 96x96 pixels in the co-registered H&E images, making a total of 144,823 tiles for the whole dataset. ResultsML models were trained to distinguish epithelial tissue from stroma with area-under-the-curve (AUC) values of 0.89 (MSI) and 0.95 (H&E)) and dysplastic grade (AUC of 0.97 (MSI) and 0.85 (H&E)) on a tile level, and low-grade progressors from non-progressors on a patient level (accuracies of 0.72 (MSI) and 0.48 (H&E)). ConclusionsIn summary, while the H&E-based classifier was best at distinguishing tissue types, the MSI-based model was more accurate at distinguishing dysplastic grades and patients at progression risk, which demonstrates the complementarity of both approaches. Data are available via ProteomeXchange with identifier PXD028949.

Deep learning enables ultraviolet photoacoustic microscopy based histological imaging with near real-time virtual staining

Histological images can reveal rich cellular information of tissue sections, which are widely used by pathologists in disease diagnosis. However, the gold standard for histopathological examination is based on thin sections on slides, which involves inevitable time-consuming and labor-intensive tissue processing steps, hindering the possibility of intraoperative pathological assessment of the precious patient specimens. Here, by incorporating ultraviolet photoacoustic microscopy (UV-PAM) with deep learning, we show a rapid and label-free histological imaging method that can generate virtually stained histological images (termed Deep-PAM) for both thin sections and thick fresh tissue specimens. With the tissue non-destructive nature of UV-PAM, the imaged intact specimens can be reused for other ancillary tests. We demonstrated Deep-PAM on various tissue preparation protocols, including formalin-fixation and paraffin-embedding sections (7-µm thick) and frozen sections (7-µm thick) in traditional histology, and rapid assessment of intact fresh tissue (~ 2-mm thick, within 15 min for a tissue with a surface area of 5 mm × 5 mm). Deep-PAM potentially serves as a comprehensive histological imaging method that can be simultaneously applied in preoperative, intraoperative, and postoperative disease diagnosis.

S1736 A Case of Primary Signet Ring Cell Carcinoma in a Colon Polyp on Routine Colonoscopy

Introduction: Colon polyp size contributes significantly to the assigned surveillance interval for prevention of colorectal carcinoma (CRC). Polyps ≤5-mm generally have a negligible risk of malignancy and colonic invasion (< 1%) and are often amenable to standard endoscopic resection. We present a patient undergoing her index average risk screening colonoscopy found to have rare colorectal primary signet ring cell carcinoma (SRCC) in a 5-mm polyp, necessitating surgery. Case Description/Methods: A 52-year-old Hispanic female with hypertension presented for her first routine screening colonoscopy. She denied a family history of gastrointestinal malignancy and was otherwise asymptomatic. A 5-mm, Paris Is sessile polyp was noted in the sigmoid colon (Image 1a) and was resected en-bloc with a cold snare. Histology showed poorly differentiated, invasive adenocarcinoma with signet ring cells (Image 1d). A staging abdominopelvic CT scan did not reveal pathologic lymphadenopathy or distant metastatic disease. Based on the histological findings and imaging, the patient returned for a flexible sigmoidoscopy to tattoo the lesion, and then underwent robotic-assisted laparoscopic sigmoid colectomy. There was no evidence of malignancy in the surgical pathology specimen. Discussion: SRCC is an epithelial malignancy with prominent intracytoplasmic mucin typically found in gastric glandular cells. Colorectal primary SRCC is a rare clinical entity accounting for 1% of all CRCs. It is often detected at an advanced stage, and therefore its overall prognosis is worse than other types of CRC. Risk factors for lymph node metastasis in pT1 polyps invading the submucosa include deep submucosal invasion for sessile lesions, poor differentiation, lymphovascular invasion, rectal location, tumor budding/mucinous tumors and the presence of either positive or indeterminate resection margins. The decision regarding surgical intervention after endoscopic resection of pT1 colorectal polyps is a complex one and depends upon the risk of residual cancer in the bowel wall and metastatic spread to adjacent or remote lymph nodes. Studies suggest that endoscopic resection before surgical resection of a high-risk pT1 CRC has no adverse effects on morbidity and mortality. In SRCC, factors such as advanced age, higher tumor grading and size, primary tumor location and nodal involvement are significantly correlated with a poor prognosis, thus, as seen in our patient, immediate colectomy provides the highest chance of survival.Figure 1.: A computed tomography scan of the abdomen exhibited diffuse fluid-filled dilatation of the colon with wall thickening and peri-colonic haziness, most prominent in the sigmoid colon and rectum. Chronic bilateral hydronephrosis and chronic cystitis were present as well.

Functional and histologic imaging of urinary bladder wall after exposure to psychological stress and protamine sulfate

To quantify the urinary bladder wall T1 relaxation time (T1) before and after the instillation contrast mixture in rats previously subjected to water avoidance stress (WAS) and/or acute exposure to protamine sulfate (PS). Female Wistar rats were randomized to receive either sham (control) or 1 h of WAS for ten consecutive days before the evaluation of nocturnal urination pattern in metabolic cages. T1 mapping of urinary bladder wall at 9.4 T was performed pre- and post- instillation of 4 mM Gadobutrol in a mixture with 5 mM Ferumoxytol. Subsequently, either T1 mapping was repeated after brief intravesical PS exposure or the animals were sacrificed for histology and analyzing the mucosal levels of mRNA. Compared to the control group, WAS exposure decreased the single void urine volume and shortened the post-contrast T1 relaxation time of mucosa- used to compute relatively higher ingress of instilled Gadobutrol. Compromised permeability in WAS group was corroborated by the urothelial denudation, edema and ZO-1 downregulation. PS exposure doubled the baseline ingress of Gadobutrol in both groups. These findings confirm that psychological stress compromises the paracellular permeability of bladder mucosa and its non-invasive assay with MRI was validated by PS exposure.

Small-sized magnesium cylinders influence subchondral bone quality in osteoarthritic rabbits - an in vivo pilot study.

No optimal therapy exists to stop or cure chondral degeneration in osteoarthritis (OA). While the pathogenesis is unclear, there is consensus on the etiological involvement of both articular cartilage and subchondral bone. Compared to original bone, the substance of sclerotic bone is mechanically less solid. The osteoproliferative effect of Mg has been shown repeatedly during development of Mg-based osteosynthesis implants. The aim of the present study was to examine the influence of implanted high-purity Mg cylinders on subchondral bone quality in a rabbit OA model. 10 New Zealand White rabbits received into the knee either 20 empty drill holes or 20 drill holes, which were additionally filled with one Mg cylinder each. Follow-up was at 8 weeks. Micro-computed tomography (µCT) was performed. After euthanasia, cartilage condition was determined, bone samples were collected and processed for histological evaluation and elemental imaging by micro-X-ray fluorescence spectrometry (µXRF). Articular cartilage collected post-mortem showed different stages of lesions, from mild alterations up to exposed subchondral bone, which tended to be slightly lower in animals with implanted Mg cylinders. µCT showed significantly increased bone volume in the Mg group. Also, histological evaluation revealed distinct differences. While right, operated limbs did not show any significant difference, left, non-operated controls showed significantly less changes in articular cartilage in the Mg group. A distinct influence of implanted cylinders of pure Mg on subchondral bone of osteoarthritic rabbits was shown. Subsequent evaluations, including other time points and alternative alloys, will show if this could alter OA progression.

The Effects of Borax (NA2B4O710H2O) on Histopathology of Wistar Rats’ Cerebrum (Rattus norvegicus)

The present study aimed to determine the effects of borax (Na2B4O7.10H2O) addition on the changes of histological cerebrum imaging in the brains of white mice (Rattus norvegicus). The current research was an experimental study with randomization of 24 white mice that were divided into four treatment groups with five replications. Borax was dissolved for each treatment with a dose of 19 mg/mouse/day, 26 mg/mouse/day, and 37 mg/mouse/day, and it was administered orally for 14 days. Then, it was analyzed statistically using the Kruskal-Wallis test. The statistical analysis results suggested that there were significantly different results in each treatment group. The control treatment with an administration dose of 26 mg/rat/day had a significantly different result in the worst cloudy swelling degeneration of cerebrum in histopathology imaging on Wistar rats (Rattus norvegicus). Using the Mann-Whitney test, it was found that the dose of borax at 37 mg/rat/day led to significant difference, compared to the other treatment groups, which means that 37 mg/rat/day of borax caused the worst pyramidal cell necrosis in histopathology imaging of the cerebrum on white mice. Borax exposure on Wistar rats (Rattus norvegicus) can cause cloudy swelling at a dose of 26mg/head/day, and pyramidal cell necrosis at a dose of 37 mg/head/day.

Non-small-cell lung cancer classification via RNA-Seq and histology imaging probability fusion

BackgroundAdenocarcinoma and squamous cell carcinoma are the two most prevalent lung cancer types, and their distinction requires different screenings, such as the visual inspection of histology slides by an expert pathologist, the analysis of gene expression or computer tomography scans, among others. In recent years, there has been an increasing gathering of biological data for decision support systems in the diagnosis (e.g. histology imaging, next-generation sequencing technologies data, clinical information, etc.). Using all these sources to design integrative classification approaches may improve the final diagnosis of a patient, in the same way that doctors can use multiple types of screenings to reach a final decision on the diagnosis. In this work, we present a late fusion classification model using histology and RNA-Seq data for adenocarcinoma, squamous-cell carcinoma and healthy lung tissue.ResultsThe classification model improves results over using each source of information separately, being able to reduce the diagnosis error rate up to a 64% over the isolate histology classifier and a 24% over the isolate gene expression classifier, reaching a mean F1-Score of 95.19% and a mean AUC of 0.991.ConclusionsThese findings suggest that a classification model using a late fusion methodology can considerably help clinicians in the diagnosis between the aforementioned lung cancer cancer subtypes over using each source of information separately. This approach can also be applied to any cancer type or disease with heterogeneous sources of information.

Biaxial mechanics of thermally denaturing skin - Part 1: Experiments

The mechanics of collagenous soft tissues, such as skin, are sensitive to heat. Thus, quantifying and modeling thermo-mechanical coupling of skin is critical to our understanding of skin’s physiology, pathophysiology, and its treatment. However, key gaps persist in our knowledge about skin’s coupled thermo-mechanics. Among them, we haven’t quantified the role of skin’s microstructural organization in its response to superphysiological loading. To fill this gap, we conducted a comprehensive set of experiments in which we combined biaxial mechanical testing with histology and two-photon imaging under liquid heat treatment at temperatures ranging from 37∘C to 95∘C lasting between 2 seconds and 5 minutes. Among other observations, we found that unconstrained skin, when exposed to high temperatures, shrinks anisotropically with the principal direction of shrinkage being aligned with collagen’s principal orientation. Additionally, we found that when skin is isometrically constrained, it produces significant forces during denaturation that are also anisotropic. Finally, we found that denaturation significantly alters the mechanical behavior of skin. For short exposure times, this alteration is reflected in a reduction of stiffness at high strains. At long exposure times, the tissue softened to a point where it became untestable. We supplemented our findings with confirmation of collagen denaturation in skin via loss of birefringence and second harmonic generation. Finally, we captured all time-, temperature-, and direction-dependent experimental findings in a hypothetical model. Thus, this work fills a fundamental gap in our current understanding of skin thermo-mechanics and will support future developments in thermal injury prevention, thermal injury management, and thermal therapeutics of skin. Statement of significanceOur work experimentally explores how skin reacts to being heated. That is, it measures how much skin shrinks, what forces it produces, and how its mechanical properties change; all as a function of temperature, but also of direction and time. Additionally, our work connects these measurements to changes in skin’s microscopic make-up. This knowledge is important to our understanding of skin’s function and dysfunction, especially during burn injuries or heat-dependent treatments.

Breast hamartoma: reassessment of an under-recognised breast lesion.

Breast hamartomas are an under-recognised lesion because they lack a distinctive microscopic appearance. Microscopic diagnosis can often conclude 'no significant lesion' or 'normal breast tissue', leading to repeated biopsies and diagnostic delay. We describe the histological, immunohistochemical and radiological features of breast hamartomas with the aim of identifying specific signs to facilitate their diagnosis and to differentiate them from normal breast and fibroepithelial lesions. Forty-seven breast hamartomas were reassessed (histological diagnosis and imaging features). An immunohistochemical study [oestrogen receptor (ER), progesterone receptor (PR), CD34, high-mobility group A2 (HMGA2)] was performed. On breast imaging, hamartomas most often presented as probably benign solid masses with circumscribed margins and variable densities. Histologically, breast hamartomas resembled normal breast, although their stromal component was predominant, separating randomly scattered epithelial elements with areas of pure collagenous stroma. Pseudoangiomatous stromal hyperplasia (PASH) was present in 93.6% of cases and CD34 antibody highlighted intralobular, perilobular and interlobular distribution of CD34-positive fibroblasts. By comparison, CD34 was mainly expressed in the intralobular normal breast tissue stroma. Hamartoma stromal cells expressed HMGA2, ER and PR in 79%, 66% and 76.3% of our cases, respectively, compared to 7.7%, 23% and 19% in normal breast tissue, respectively (P < 0.0001; P = 0.0005; P < 0.0001). After ascertaining that core needle biopsy is effectively intralesional, breast hamartomas can be diagnosed with confidence by taking into account the presence of stromal changes, PASH, interlobular distribution of CD34-positive fibroblasts, HMGA2 and hormonal receptor stromal expression.

Deep-learning-assisted microscopy with ultraviolet surface excitation for rapid slide-free histological imaging.

Histopathological examination of tissue sections is the gold standard for disease diagnosis. However, the conventional histopathology workflow requires lengthy and laborious sample preparation to obtain thin tissue slices, causing about a one-week delay to generate an accurate diagnostic report. Recently, microscopy with ultraviolet surface excitation (MUSE), a rapid and slide-free imaging technique, has been developed to image fresh and thick tissues with specific molecular contrast. Here, we propose to apply an unsupervised generative adversarial network framework to translate colorful MUSE images into Deep-MUSE images that highly resemble hematoxylin and eosin staining, allowing easy adaptation by pathologists. By eliminating the needs of all sample processing steps (except staining), a MUSE image with subcellular resolution for a typical brain biopsy (5 mm × 5 mm) can be acquired in 5 minutes, which is further translated into a Deep-MUSE image in 40 seconds, simplifying the standard histopathology workflow dramatically and providing histological images intraoperatively.

Bone microstructure and bone mineral density are not systemically different in Antarctic icefishes and related Antarctic notothenioids.

Ancestors of the Antarctic icefishes (family Channichthyidae) were benthic and had no swim bladder, making it energetically expensive to rise from the ocean floor. To exploit the water column, benthopelagic icefishes were hypothesized to have evolved a skeleton with “reduced bone,” which gross anatomical data supported. Here, we tested the hypothesis that changes to icefish bones also occurred below the level of gross anatomy. Histology and micro‐CT imaging of representative craniofacial bones (i.e., ceratohyal, frontal, dentary, and articular) of extant Antarctic fish species specifically evaluated two features that might cause the appearance of “reduced bone”: bone microstructure (e.g., bone volume fraction and structure linear density) and bone mineral density (BMD, or mass of mineral per volume of bone). Measures of bone microstructure were not consistently different in bones from the icefishes Chaenocephalus aceratus and Champsocephalus gunnari, compared to the related benthic notothenioids Notothenia coriiceps and Gobionotothen gibberifrons. Some quantitative measures, such as bone volume fraction and structure linear density, were significantly increased in some icefish bones compared to homologous bones of non‐icefish. However, such differences were rare, and no microstructural measures were consistently different in icefishes across all bones and species analyzed. Furthermore, BMD was similar among homologous bones of icefish and non‐icefish Antarctic notothenioids. In summary, “reduced bone” in icefishes was not due to systemic changes in bone microstructure or BMD, raising the prospect that “reduced bone” in icefish occurs only at the gross anatomic level (i.e., smaller or fewer bones). Given that icefishes exhibit delayed skeletal development compared to non‐icefish Antarctic fishes, combining these phenotypic data with genomic data might clarify genetic changes driving skeletal heterochrony.

A multicontrast MR atlas of the Wistar rat brain

Abstract We describe a multi-contrast, multi-dimensional atlas of the Wistar rat acquired at microscopic spatial resolution using magnetic resonance histology (MRH). Diffusion weighted images, and associated scalar images were acquired of a single specimen with a fully sampled Fourier reconstruction, 61 angles and b=3000 s/mm2 yielding 50 um isotropic spatial resolution. The higher angular sampling allows use of the GQI algorithm improving the angular invariance of the scalar images and yielding an orientation distribution function to assist in delineating subtle boundaries where there are crossing fibers and track density images providing insight into local fiber architecture. A multigradient echo image of the same specimen was acquired at 25 um isotropic spatial resolution. A quantitative susceptibility map enhances fiber architecture relative to the magnitude images. An accompanying multi-specimen atlas (n=6) was acquired with compressed sensing with the same diffusion protocol as used for the single specimen atlas. An average was created using diffeomorphic mapping. Scalar volumes from the diffusion data, a T2* weighted volume, a quantitative susceptibility map, and a track density volume, all registered to the same space provide multiple contrasts to assist in anatomic delineation. The new template provides significantly increased contrast in the scalar DTI images when compared to previous atlases. A compact interactive viewer based on 3D Slicer is provided to facilitate comparison among the contrasts in the multiple volumes. The single volume and average atlas with multiple 3D volumes provide an improved template for anatomic interrogation of the Wistar rat brain. The improved contrast to noise in the scalar DTI images and the addition of other volumes (eg. QA,QSM,TDI ) will facilitate automated label registration for MR histology and preclinical imaging.