Histological Specimens Research Articles

Appendicolith as a sign of complicated appendicitis - a myth or reality? A retrospective study.

Appendicolith can be incidentally detected on abdominal computer tomography (CT) without any signs of appendicitis. However, it has also been found to be a risk factor for failure of nonoperative management in acute appendicitis. The present retrospective study aimed to evaluate whether appendicolith predicts complicated appendicitis in patients with any appendicitis. A retrospective chart review was conducted for patients undergoing appendectomy from January 2016 to December 2018. Appendicolith was considered to be present when it was described in a CT scan. Of the 267 patients, appendicolith was found in 120 cases, while there were no in 147 cases in preoperative CT scans. In the case of complicated appendicitis (gangrenous or gangrenous perforated appendicitis), appendicolith was visible in CT scans in 57.7% of the patients. Of the patients with uncomplicated appendicitis, 38.3% had appendicolith in CT scan (p=0.002). In univariate logistic regression analysis, based on the finding of the histological specimen, appendicolith was associated with complicated appendicitis (OR 2.12; 95% CI 1.28-3.51 p=0.004). When adjusting for sex, age group (age ≤50 vs >50 years), and duration of symptoms (≤24 vs >24 hours), the odds ratio was 3.52 (95% CI 1.88-6.58; p<0.001). Our study found that appendicolith can be considered an independent risk factor for complicated appendicitis. Therefore, in the presence of appendicolith, surgical treatment should probably be preferred over non-surgical treatment in acute appendicitis.

Immune cells in thyroid adenoma and carcinoma: uncovering a hidden value of assessing tumor-host interplay and its potential application in thyroid cytopathology

IntroductionAlthough the role of tumor immune microenvironment (TIME) in thyroid cancer is well established, little data exists about the differences in immune cell presence in thyroid adenomas and carcinomas. We assume that immune cell density could be an additional diagnostic criterion for differentiating benign and malignant tumors in thyroid aspirates.AimThe current study compared the immune contexture of thyroid adenoma (TA) and thyroid carcinoma (TC) in histological and cytological specimens of III-V categories.Materials and methodsThis pilot study included 72 cases (36 of TA and 36 of TC) with verified histological diagnosis and pre-operative cytology corresponding to categories III, IV and V according to the Bethesda system for reporting thyroid cytology. The number of CD8+, CD68+ and CD163+ cells was assessed in histological samples of TA and TC with further comparison to cytological specimens. Besides, the expression of STAT6 and SMAD4 as potential regulators of TIME was evaluated in the study.ResultsTC demonstrated an immune-rich profile representing abundant tumor-associated CD8+ lymphocytes, CD68 and CD163+ macrophages. In contrast, TA represented mostly a low immune cell infiltration. The higher immunogenicity of TC was accompanied by the more profound expression of STAT6 and SMAD4 in tumor cells. The number of immune cells in cytological specimens correlated with CD8+ (r = 0.693; p &amp;lt; 0.001) and CD163+ cells (r = 0.559; p &amp;lt; 0.001) in histological samples, reflecting the differences in the tumor immune microenvironment between benign and malignant thyroid neoplasms.ConclusionTC demonstrated high immunogenicity compared to TA, which correlated to the number of immune cells in cytological specimens. The number of immune cells in thyroid cytology samples could be an additional criterion in cytological diagnostics for III-V Bethesda categories. Further investigations are needed to validate the findings of the study.

Charcot as a collector and critic of the arts: Relationship of the ‘founder of neurology’ with various aspects of art

ABSTRACT In his teaching, Charcot often used artistic representations from previous centuries to illustrate the historical developments of various conditions, particularly hysteria, mainly with the help of his pupil Paul Richer. Charcot liked to draw portraits and sketches of colleagues during boring faculty meetings and students’ examinations, including caricatures of himself and others, church sculptures, landscapes, soldiers, and so on. He also used this skill in his clinical and scientific work. He drew histological or anatomic specimens, as well as patients’ features and demeanor. His most daring artistic experiments were drawing under the influence of hashish. Charcot’s tastes in art were conservative; he displayed little interest for the avant-gardes of his time, including impressionism, or for contemporary musicians, such as César Franck or Hector Berlioz. The pamphleteer Léon Daudet described Charcot’s home as a pseudo-gothic kitsch accumulation of heteroclite pieces of furniture and materials. However, he taught medicine not only as a science but also as an art, a style that has now been almost universally forgotten.

Novel use of ultrasound-guided high-intensity focused ultrasound (HIFU) may enable the neuroablation of the sacroiliac joint in a swine model: a feasibility study

BackgroundSacroiliac joint (SIJ) dysfunction accounts for the etiology of pain in 15%–30% of low back pain cases. Some patients with conservative treatment-refractory SIJ dysfunction undergo radiofrequency (RF) ablation of the...

Evaluation of the Value of Fine Needle Aspiration Cytology and Cell Morphology in Determining the Histogenesis of Pancreatic Lesions With Review of Literature, Overview and Cytological Experience of 25 Years: Original Research.

Benign lesions, inflammation, cysts and pseudocysts, as well as neoplasms of the exocrine and endocrine parts of the pancreas can be easily identified using cytological methods. The sensitivity and specificity can be increased with the help of additional examination methods. The sensitivity of intraoperative rapid cytology reaches about 99%. In the literature, the sensitivity reaches an average of about 85% for biopsies. The method is easy to use, has very low complication rates (1%-2%) and is safe for the patient. 1290 cytological samples from pancreatic lesions were processed in the institute of pathology at Hannover Medical School (MHH), as cytological smears and stained with Giemsa and PAS stains as conventional methods. They were compared with the histological specimens that were processed at the same institute. Immunocytochemistry and molecularpathology have been processed only in selected cases. In general, it is routine in the university that the patients give their written consent to participate in clinical studies. The local ethics committee has stated that there is no need for approval due to the retrospective nature of the study. In this work, we detected 20.077% malignant lesions, 63.333% benign findings and inflammation, 7.441% pseudocysts and cysts. About 9.147% samples were unrepresentative due to insufficient number of cells. This work will highlight the importance of fine aspiration cytology (FNAC) of suspicious pancreatic lesions, its possibilities and limitations in routine diagnostics with discussing the differential diagnoses, pointing to its great value and safety for patients. FNAC is the gold standard, its power is strongly associated with high specificity and sensitivity in the diagnosis of pancreatic lesions, and is very useful in the differential diagnosis between malignant and inflammatory lesions in pancreas.

CYTOLOGICAL CHARACTERISTICS OF THE WOUND HEALING PROCESS IN PATIENTS WITH CORONARY HEART DISEASE AT DIFFERENT STAGES OF THE POSTOPERATIVE PERIOD IN ODONTOGENIC PHLEGMON OF MAXILLOFACIAL LOCALIZATION

Odontogenic phlegmon of maxillofacial localisation is one of the most common diseases in the practice of a dental surgeon. The presence of comorbidities, such as coronary heart disease, can negatively impact the course of the underlying condition, complicate diagnosis and treatment, and delay patient recovery. This highlights the need to explore and improve treatment methods for odontogenic phlegmon in patients with coronary heart disease. The aim of this study was to examine the dynamics of regenerative processes in the wound at different stages of the postoperative period after using both classical and novel treatment methods for odontogenic phlegmon of maxillofacial localization in patients with coronary artery disease. Subjects and methods. The study included 80 patients with this pathology, divided into 4 groups. In the first group, quercetin was added to standard therapy, in the second group, quercetin and mexazol were used, and the third group received standard treatment. Patients in these three groups had a history of coronary heart disease. The fourth group (control) had only the underlying disease without comorbidities. Cytological examination was performed using the "surface biopsy" method. The material was collected on days 1, 3, 5, 7, and 9 of the postoperative period and stained using the Romanowsky-Giemsa method. Subsequently, histological specimens were examined. Results. On day 1, the main cellular elements across all groups were erythrocytes. By day 3, lymphocytes and single holonuclear cells were observed in the first group; precollagen fibers appeared in the second group; the third group showed a significant number of polymorphonuclear leukocytes; and the fourth group mainly had holonuclear cells. By day 5, the first group showed progressive development of regenerative processes, while the second group entered the final phase of regeneration. In the third and fourth groups, gradual development of the regenerative process was observed. On day 7, the first group showed signs of the final stage of wound healing, and the second group had completed this process. The third and fourth groups showed signs of the regenerative stage at this point. On day 9, no signs of inflammation were present in the third and fourth groups. Conclusion. The use of quercetin combined with intravenous mexazol injections as part of conservative therapy accelerates regenerative processes in the postoperative period and shortens the duration of the inflammatory reaction.

Histo-morphometric evaluation of post-augmentation bone tissue of the human mandible

The clinical challenge of today is to restore the biological structure of atrophied bone tissue by combining methods of complex clinical rehabilitation, that is, intraosseous implantation and augmentation, in its interimplant sites. The aim of the study was to perform a histo-morphometric assessment of post-augmentation bone tissue using a combined technique of controlled autocellular transplantation with the use of bone allograft filler on edentulous distal segments of the human mandible with varying degrees and forms of atrophy. Trepanbiopsy specimens were used as the study material, after microtomy processing of which histological slides were prepared, followed by the accelerated May-Grunwald staining-fixation technique (Sigma-Aldrich, St. Louis, USA). For the histomorphometric study, stained histological specimens of post-augmentation bone tissue were imaged with an optical microscope camera (Leica DMLB, Germany). The analysis was performed using the Fiji information software, with the formation of reconstructed mosaic digital micrographs for further histomorphometry. The results of the evaluation of controlled bone tissue formation (post-augmentation), which are the key tasks, novelty, and justification of modern and effective methods of rehabilitation of patients with acquired forms of atrophy in the edentulous distal segments of the human mandible, are illustrated by microphotographs and presented in detail in this paper by the percentage of the quality of cross-linking of the cortical layer. The ratio of the newly formed cortical layer of bone tissue to the total area of the post-augmentation tissue study was 61.30 %, with a lateral form of atrophy (according to J. Cawood and R. Howell: class IV), in the post-augmentation period – 4 months. The histo-morphometric assessment of the qualitatively formed cortical bone in the post-augmentation period of six months is 92.80 % of the total postoperative area. Therefore, it is biased to evaluate the quality of the formed bone in the mandible within the generally accepted average period of four months, although paraclinical densitometry shows positive values.

Histopathological Examination of 404 Sleeve Gastrectomy Specimens at a Large UK Center and Systematic Review of the Published Literature.

Laparoscopic sleeve gastrectomy (LSG) specimens are histologically analyzed to identify incidental pathologies. However, no guidelines recommend routine histology. This study evaluates the clinical utility of LSG sample analysis and if incidental diagnoses have a significant clinical impact. A single high-volume UK bariatric unit retrospectively gathered LSG data covering a 9-year period. All specimens were sent for histological analysis. Where incidental diagnoses were identified, patient records were reviewed to assess any clinical management alterations. A systematic review (2013-2023) was performed, exploring rates of incidental pathologies post-LSG. Publications were stratified into those performing routine pre-operative endoscopy, or not, and results compared to present data. From 01/06/2013 to 12/12/2022, 404 patients underwent LSG. 365/404 (90.4%) had no pathology on histopathological analysis. Seven (1.7%) appeared macroscopically abnormal, with histology identifying 3 polyposis and 1 each of GIST, pernicious anaemia, sarcoidosis and gastritis. Ten (2.48%) appeared macroscopically normal but had incidental pathology. All patient management remained unchanged. Twenty-two (5.44%) were H. pylori positive. Forty-eight publications within wider literature reviewed LSG specimen histology. Fifteen, including 9662 patients undergoing pre-operative endoscopy, found pathological diagnoses in 0.5% and 1 malignancy. Thirty-three studies reporting 17,008 patients without pre-operative endoscopy identified pathologies in 0.45% and 7 malignancies. There is little clinical utility in analyzing macroscopically normal gastric samples following LSG. The potential financial and environmental savings from limiting this practice are of great importance to worldwide bariatric teams. The authors recommend selectively sending LSG specimens only if abnormal gastric mucosa is identified when examining the extracted specimen.

Interstitial lipoid pneumonia-A complication of intravenous administration of lipid emulsions in critically ill patients.

Lipoid pneumonia is a rare entity most often associated with inhalation of foreign material (i.e. "fire-eater's lung"), silicone injection, and severe trauma. We present the case of a 61-year old man who developed acute respiratory distress syndrome following endoscopic retrograde cholangiopancreatography (ERCP) for cholelithiasis. Intensive care supportive therapy included mechanical ventilation, dialysis, and total parenteral nutrition. Unresolved pneumothorax necessitated lobectomy. Histology of the lobectomy specimen demonstrated massive intra-alveolar haemorrhage and numerous alveolar septal macrophages with clear cytoplasmic vacuoles. These findings were diagnostic of interstitial lipoid pneumonia due to intravenous administration of lipid emulsions. The differential diagnosis is also discussed. Although rare, interstitial lipoid pneumonia should be considered in critically ill patients presenting with an interstitial pattern of lung disease after intravenous administration of lipid emulsions.

Change in hepatocyte nuclear-cytoplasmic ratio at nontuberculosis mycobacteria infection against the background of immunomodulator action

The study was targeted at the examination of the effect of the specific immunomodulator KIM-M2 on the morphostructure of liver cells of guinea pigs infected with nontuberculosis mycobacteria. The research was carried out in 15 guinea pigs selected by gender at the Diagnostic Research and Biotechnology Laboratory of the Department of Veterinary Medicine of the Omsk Agrarian Scientific Center. All animals were kept in a specialized animal keeping facilities according to standard housing and feeding regime. The experimental animals were subdivided into three groups of five animals in each: group 1 – challenge group (Mycobacterium scrofulaceum), group 2 – experimental group (Mycobacterium scrofulaceum and KIM-M2), group 3 – pure control group (saline solution). On day 30 after the start of the experiment, the animals were removed from the experiment, liver biopsy samples were collected and histologic specimens were prepared according to the classical method. During the experiment, it was found that KIM-M2 had a regenerative effect on the liver tissue of the guinea pigs infected with nontuberculosis mycobacteria, which was associated with 1.5-fold increase in the number of mononuclear hepatocytes, 3-fold increase in binuclear cells and 4.3-fold decrease in anucleate hepatocytes thus indicating the manifestation of compensatory reactions in the organ and increase in the depth of regenerative processes. As for animals in group 1; 1.8and 1.3-fold increase in the area of the nucleus and cytoplasm as compared with the individuals in group 2, and 2.7and 2-fold increase as compared with the animals in the control group, respectively, indicated the launch of the accumulation mechanisms of the potential reparative reserves and increase in their depth in the liver tissues.

Predicting epidermal growth factor receptor (EGFR) mutation status in non-small cell lung cancer (NSCLC) patients through logistic regression: a model incorporating clinical characteristics, computed tomography (CT) imaging features, and tumor marker levels.

Approximately 60% of Asian populations with non-small cell lung cancer (NSCLC) harbor epidermal growth factor receptor (EGFR) gene mutations, marking it as a pivotal target for genotype-directed therapies. Currently, determining EGFR mutation status relies on DNA sequencing of histological or cytological specimens. This study presents a predictive model integrating clinical parameters, computed tomography (CT) characteristics, and serum tumor markers to forecast EGFR mutation status in NSCLC patients. Retrospective data collection was conducted on NSCLC patients diagnosed between January 2018 and June 2019 at the First Affiliated Hospital of Zhengzhou University, with available molecular pathology results. Clinical information, CT imaging features, and serum tumor marker levels were compiled. Four distinct models were employed in constructing the diagnostic model. Model diagnostic efficacy was assessed through receiver operating characteristic (ROC) area under the curve (AUC) values and calibration curves. DeLong's test was administered to validate model robustness. Our study encompassed 748 participants. Logistic regression modeling, trained with the aforementioned variables, demonstrated remarkable predictive capability, achieving an AUC of 0.805 (95% confidence interval (CI) [0.766-0.844]) in the primary cohort and 0.753 (95% CI [0.687-0.818]) in the validation cohort. Calibration plots suggested a favorable fit of the model to the data. The developed logistic regression model emerges as a promising tool for forecasting EGFR mutation status. It holds potential to aid clinicians in more precisely identifying patients likely to benefit from EGFR molecular testing and facilitating targeted therapy decision-making, particularly in scenarios where molecular testing is impractical or inaccessible.

The Potential Utility of RAS Q61R Immunohistochemistry as a Screening Tool in Pre-operative Fine Needle Aspirates of Medullary Thyroid Carcinoma.

Medullary thyroid carcinoma (MTC) can either be sporadic, often via mutually exclusive RET or RAS alterations, or inherited via a RET germline alteration. Germline testing is recommended for all patients diagnosed with MTC. RAS p.Q61R immunohistochemistry (RASQ61R-IHC) can identify a subset of RAS-mutated MTCs on resections, but whether this could be applied pre-operatively to cytology specimens remains unclear. Herein, we assessed RASQ61R-IHC in a tri-institutional cohort of cytologic and histologic MTC specimens with available molecular and germline data. Thirty-four fine needle aspirates with cell blocks were identified between three institutions from 2009 to 2024 with corresponding histology. Tumor sequencing and germline data were recorded, if available. RASQ61R-IHC was scored on staining intensity with documentation of membranous accentuation. Sensitivity, specificity, positive predictive (PPV), and negative predictive values (NPV) were calculated. Of the MTCs, 29% were germline-mutated, and 71% were sporadic. Among all sporadic MTCs (n = 22), 41% were RET-altered, 27% were RAS-altered, and 31.8% did not have available data. With any RASQ61R-IHC staining considered positive, sensitivity, specificity, PPV, and NPV for detecting RAS p.Q61R-mutated MTCs were 100%, 72.7%, 45.4%, and 100%, respectively. Requiring a stain score of > 1 and/or membranous accentuation for a true positive changed sensitivity, specificity, PPV, and NPV to 100%, 100%, 100%, and 100%, respectively. RASQ61R-IHC membranous staining was 100% predictive of RET-negative germline testing. RASQ61R-IHC, when requiring a score > 1 and/or membranous stain accentuation for true positive, had high sensitivity and specificity for RAS p.Q61R mutation in cytologic and surgical MTC specimens. Moreover, RASQ61R-IHC is a rapid and inexpensive modality that could potentially tailor which MTC patients undergo germline testing.

Histological Analysis of the Effect of a Vector Potential Generator on the Femur of a Hindlimb-Suspended Rat

Disuse osteoporosis occurs due to rest and reduced mechanical stimulation. Under these conditions, bone resorption exceeds bone formation, leading to a decrease in bone density. Vector potential (VP) generators have been developed, and their ability to maintain cartilage thickness has been reported. However, their effects on bone tissue remain unstudied. In this study, experiments were conducted to test the effects of VP on bones that had undergone weight reduction due to hindlimb suspension as a model of disuse osteoporosis. Methods: In this study, 7-week-old male Wistar rats (N = 6 each) were classified into control (CO), hindlimb suspension (HS), and VP energization intervention groups. The tail was used to suspend the HS and VP to remove the load applied to the hindlimbs. The VP conditions were as follows: voltage, 67 mV; frequency, 20 kHz, 0.12 mA; experimental intervention, 30 min/day, 5 days/week, for 3 weeks. At the end of the experimental period, the rats were euthanized with carbon dioxide gas, and histological specimens were fixed in 4% paraformaldehyde (PFA) in the femur and analyzed by electron microscopy, bone morphometry, immunohistology, bone fracture testing, and gene expression analysis. Results: HS decreased trabecular bone density and strength. However, VP maintained a significantly higher bone mass than HS, and VP did not differ from CO in bone strength; more osteoclasts were observed on the bone surface in HS, but they were suppressed in VP, and gene expression of CTSK and MMP-9 was decreased. Conclusions: VP suppressed bone resorption by osteoclasts, suggesting that VP is useful in the treatment of disuse osteoporosis.

Investigating the Role of Primary Cilia and Bone Morphogenetic Protein Signaling in Periodontal Ligament Response to Orthodontic Strain In Vivo and In Vitro: A Pilot Study.

Periodontal ligament (PDL) cells are crucial for mechanosensation and mechanotransduction within the PDL, yet the role of primary cilia in orthodontic force transmission has not been examined. While bone morphogenetic protein (BMP) signaling significantly influences ciliary function, its effect on cellular responses to mechanical stress has not been investigated. This study aims to investigate whether primary cilia and BMP signaling are involved in the periodontal ligament's response to orthodontic tooth movement and the resultant mechanical strain. To visualize primary cilia, human PDL cells were cultured on glass-bottom dishes for five days, with a subset fixed daily, followed by immunostaining with anti-acetylated α-tubulin and Alexa Fluor 568 and imaging using a fluorescence microscope under 405 nm and 561 nm laser excitation. Human PDL cells were grown on Bioflex® culture plates and subsequently exposed to static tensile strains of 2.5%, 5%, 10%, 20%, on a FX-6000T™ Tension System for 24 h. RT-qPCR was performed to evaluate changes in expression of primary cilia via Ift88 expression, mechanotransduction via Cox2 expression, and BMP signaling-related genes. Histological specimens from orthodontically loaded and control human premolars were investigated for primary cilia and BMP signaling using immunohistochemistry and confocal microscopy. Primary cilia were observed in PDL cells from day one, with their incidence and length increasing over time alongside cell density. BMP signaling components, including upregulated genes such as Bmp7 (10.99-14.97 fold), Alk2 (3.19-5.45 fold), and Bmpr2 (1.64-8.40 fold), consistently responded to strain, while Cox2 and Ift88 showed differential regulation depending on strain intensity. In vivo, orthodontic movement activated BMP signaling and increased primary cilium incidence in the PDL. These findings indicate the potential role of primary cilia and BMP signaling in the mechanosensitivity of PDL cells under orthodontic forces. Further studies are required to understand the complex mechanotransduction mechanisms and role of these components in cellular adaptation during orthodontic tooth movement.

Prognostic and predictive value of pathohistological features in gastric cancer and identification of SLITRK4 as a potential biomarker for gastric cancer

The aim of this study was to develop a quantitative feature-based model from histopathologic images to assess the prognosis of patients with gastric cancer. Whole slide image (WSI) images of H&E-stained histologic specimens of gastric cancer patients from The Cancer Genome Atlas were included and randomly assigned to training and test groups in a 7:3 ratio. A systematic preprocessing approach was employed as well as a non-overlapping segmentation method that combined patch-level prediction with a multi-instance learning approach to integrate features across the slide images. Subjects were categorized into high- or low-risk groups based on the median risk score derived from the model, and the significance of this stratification was assessed using a log-rank test. In addition, combining transcriptomic data from patients and data from other large cohort studies, we further searched for genes associated with pathological features and their prognostic value. A total of 165 gastric cancer patients were included for model training, and a total of 26 features were integrated through multi-instance learning, with each process generating 11 probabilistic features and 2 predictive labeling features. We applied a 10-fold Lasso-Cox regression model to achieve dimensionality reduction of these features. The predictive accuracy of the model was verified using Kaplan-Meyer (KM) curves for stratification with a consistency index of 0.741 for the training set and 0.585 for the test set. Deep learning-based resultant supervised pathohistological features have the potential for superior prognostic stratification of gastric cancer patients, transforming image pixels into an effective and labor-saving tool to optimize the clinical management of gastric cancer patients. Also, SLITRK4 was identified as a prognostic marker for gastric cancer.

Fresh Hemorrhages in Intestinal Resection Margins Are Associated with Unfavorable Clinical Outcomes in Preterm Infants with Necrotizing Enterocolitis with Surgical Intervention.

Necrotizing enterocolitis (NEC) is a common disease in premature infants. If conservative treatment does not respond, surgical removal of the necrotic section of bowel is common practice. This study investigates whether there is a correlation between the histopathological findings and the postoperative clinical course of the children who have undergone surgery. To date, only a few detailed studies on a possible correlation have been published. The surgical specimens of 49 infants diagnosed with NEC in the years 2010-2019 were re-evaluated. The histologic specimens were examined for tissue viability and hemorrhage of the resection margins, peritonitis or perforation of the central resection segment. The groups were divided according to the clinical outcome: death, postoperative complications and patients without complications. 5 of 49 (10.2%) children died, 22 children (44.9%) required reoperation, while 22 (44.9%) had no complications. Univariate and multivariate analyses showed a significant association between fresh hemorrhage in the resection margins and postoperative outcome. In our data, correlation between the vitality of the resection margins or the extent of necrosis and the postoperative course was not seen. This retrospective study shows a significant correlation between a fresh hematoma in the tissue of the resection margin and the clinical prognosis. Fresh bleeding in the resection margins was associated with increased morbidity with stenosis and possibly another surgical intervention. In contrast, no further correlation was found between the vitality of the tunica mucosae, the tunica muscularis or peritonitis in the resection margin or central part of the NEC specimen and the clinical course. In summary, it can be said that the presence of a fresh hematoma at the resection margin is significantly linked to a poorer clinical outcome for the infants with NEC surgery. Other histopathological findings of the surgical specimen with regard to the clinical course show now significant correlation and, therefore, the histological examination mainly serves the medico-legal documentation and quality assurance of the NEC operation.

Clinical validation on role of cancer diagnostic probe in detecting the involved cavity margins missed in permanent pathology of tumor side in breast cancer surgery

Cancer diagnostic probe (CDP) as a newly entered tool in real-time breast cavity margin evaluation showed great improvement in smart margin shaving intra-operatively. This system increased the rate of involved margin detection to 30% with respect to frozen section. In this study for the first time we showed the independent role of CDP in finding the involved cavity side margins which were not diagnosed by permananet pathology of their tumor side interface. Among 147 detected margins by CDP, 23 lesions with invasive component and ductal carcinoma in-situ/ductal cancerization weren’t reported as involved margins in permanent pathology of tumor side. Our gold standard was the histology of cavity margin specimen had been scored as involved lesion by CDP. It seems that even when the permanent pathology of surgical margins is used for final declaration, role of CDP is irreplaceable. This distinguished achievement has been obtained intra-operatively in real-time by CDP while involved report in permanent pathology of tumor margins induce re-surgery for the patient.

Acute myeloid leukemia with peripheral lymph node involvement in dogs: A retrospective study of 23 cases.

Acute myeloid leukemia (AML) can infiltrate extramedullary tissues, such as the liver, spleen, and lymph nodes and can be difficult to differentiate from lymphoma in cytologic and histologic specimens. Our goal was to identify cytologic features that would support a diagnosis of AML in peripheral lymph node aspirates, for which we used the term extramedullary AML (eAML). Medical records of 23 dogs with a diagnosis of AML and archived lymph node aspirate smears from 2016 to 2024 were reviewed across 4 institutions. Inclusion criteria included ≥50% myeloid blasts plus differentiating myeloid cells in lymph node smears, confirmation of myeloid lineage by flow cytometric analysis, and complete medical records. Peripheral lymphadenopathy was the reason for presentation (9/23, 39%) or was found incidentally on physical examination (14/23, 61%). Most dogs were bi- or pancytopenic (18/23, 78%), with blasts identified in blood smears of 18 dogs (78%). Initial lymph node aspirate interpretations included hematopoietic neoplasia (8/21, 38%), AML (6/21, 29%), lymphoma (5/21, 24%), lymphoid hyperplasia (1/21, 5%), and granulocytic precursor infiltrates (1/21, 5%). On lymph node smear review, cytologic features supporting an eAML were differentiating granulocytes, blasts with myeloid features or promonocytes, dysplastic changes in myeloid cells, and retention of residual lymphocytes. The median survival was 22 days (range = 1-360 days), and 69% of 16 dogs given chemotherapy or glucocorticoids lived for 30 days or more. Our study highlights the importance of hemogram results and lymph node aspirate smear examination for morphologic features of myeloid differentiation to help diagnose eAML in lymph node smears.

BN SO24 - Predicting incidental gallbladder cancer: A protocol for identifying predictive factors of incidentally detected gallbladder cancer and prospective validation of a scoring system to allow selective histological analysis of the gallbladder

Abstract Background Incidental Gallbladder Cancer (iGBC) is a rare complication of cholecystectomy, with a UK incidence of 0.14-0.3%. Despite its rarity, most gallbladder specimens are analysed histologically. Some comparable countries undertake Selective Histological Analysis (SHA), selecting high-risk specimens for histology based on clinical judgement or postoperative inspection. However, evidence suggests a third of diagnoses can be missed with these approaches. Swedish and Dutch diagnostic scores incorporate few risk factors and are not generalisable to the UK. We present a protocol for a UK study aiming to develop a detailed diagnostic score for iGBC to reliably stratify patients by their risk of iGBC. Method This UK multicentre, cross-sectional, trainee-led study includes adult patients undergoing cholecystectomy for benign indications. It incorporates a feasibility study and an adaptive design, and has been submitted for ethical review. A parallel qualitative study will explore attitudes towards the risk of iGBC and the acceptability of SHA among patients and healthcare professionals. The feasibility phase will include 500 patients over six months, collecting data on patient risk factors for iGBC, preoperative investigations, operative findings, and histology results. Exclusion criteria include cholecystectomy as a secondary procedure, polyps over 5mm, and conditions known to increase the risk of biliary tract cancers. Results Following the feasibility phase, the recruitment rate and data completeness will be evaluated. Outcomes will be assessed against anticipated values, and collaborators will be surveyed to identify challenges with data collection. Necessary adjustments to the electronic case record form or overall protocol will be made, and the recruitment target will be recalculated based on an updated sample size calculation. When the study meets specified progression criteria, additional sites will be recruited, and data collection will continue to meet the required sample size. A detailed statistical analysis plan will be provided at a later date. Conclusion This protocol describes a UK diagnostic modelling study aimed at developing a risk-stratification score for iGBC in patients undergoing routine cholecystectomy, identifying high-risk patients and facilitating SHA.

Epineural Scarring Visualization and Noninvasive Quantification of a Severe Posttraumatic Complication: An Experimental Magnetic Resonance Neurography Study.

Peripheral nerve scarring is a severe yet common complication following nerve injury or surgery that can lead to impaired nerve function, including chronic pain and sensory or motor deficits. In this study, we aimed to establish high-resolution magnetic resonance neurography (MRN) to accurately visualize and monitor de novo-formed epineural fibrotic adhesions (EFAs) of the sciatic nerve in a rat nerve injury model. Employing an established model to induce overshooting EFA, the study included 3 experimental groups of animals (n = 6 each): a positive control group (PC), an intervention group (IG), and a sham group. All groups underwent surgical nerve exposure: both PC and IG received an application of 10 μL 2.5% glutaraldehyde to induce EFA, but only IG received an additional preventive wrapping of the nerve with a collagen-containing matrix. Magnetic resonance imaging was performed 6, 8, and 12 weeks postoperatively using a standardized protocol including T2w and T1w without and with contrast media. Motor function and nerve regeneration was assessed using the visual static sciatic index. Histological specimens were obtained 12 weeks postoperatively and correlated with imaging. On high-resolution MRN, prominently contrast-enhancing epineural sleeves were present in vivo, which corresponded to histologically confirmed EFA (ratio of EFA to nerve area MRN 1.512 ± 0.106 vs histological ratio 1.459 ± 0.208, nonsignificant). As expected, average EFA in IG (0.310 ± 0.118 mm2) was smaller than in PC (0.909 ± 0.212 mm2, P < 0.01). Also, the average EFA in sham (0.386 ± 0.030 mm2) was less pronounced than in PC (P < 0.01). There was no significant difference in the average EFA between IG und sham. The EFA correlated with the functional outcome, which was measured by visual static sciatic index (correlation coefficient -0.59, P < 0.05). The results of the present study for the first time confirm the clinical observation that epineural thickening on contrast-enhanced T1w imaging following manipulation to a nerve indeed corresponds to overshooting epineural scarring, which may be linked to impaired nerve function. This can be followed noninvasively in vivo over time providing an important basis for clinical decision-making in cases where further invasive therapies may be necessary.