Histopathological Correlation Research Articles

Clinico-pathological spectrum of oral cavity lesions with their radiological, histopathological, and immuno-histochemistry correlation at a tertiary care teaching hospital: A study of 200 cases

: The oral cavity is vulnerable to different types of environmental insults and chemical injuries specifically with the use of tobacco. Among the various oral cavity lesions, oral squamous cell carcinoma (SCC) is a major burden in the developing countries. Diagnosis is done mainly by histopathological examination while few cases need immunohistochemistry (IHC). Some neoplastic lesions are small and deep-seated and need CT or MRI for further evaluation. This study was aimed at studying the spectrum of oral cavity lesions with respect to age, gender and location and to analyse their radiological and histopathological aspects.: The aim of this article is to study the spectrum (neoplastic and non-neoplastic) of the oral cavity lesions with respect to age, gender, and location/site distribution, to analyse the radiological aspect of the oral cavity lesions and to analyse the histopathological aspect of the oral cavity lesions.: This is a retrospective and prospective study of 200 cases over a period of one and a half years. The information like age, gender, etc. was recorded from the requisition forms and the departmental record and studied statistically. p63, CD45, CD19, CD20 IHC markers were done.: The most involved age group was 41 to 50 years. The male: female ratio was 2.27:1. Out of 200 studied cases, 102 (51%) were malignant lesions. In SCC, the buccal mucosa was the most common site with ulcero-proliferative presentation and association with tobacco consumption. : Histopathological examination is the gold standard for the diagnosis of oral cavity lesions. IHC is helpful to confirm an epithelial lineage. Prevention as well as early detection and treatment of oral SCC improves the lifestyle of affected individual and reduce the overall morbidity and mortality associated with oral SCC.

Soft-tissue tumor of myoepithelial origin in leg with secondary bone changes: A rare case report

Myoepithelial tumors in skin and soft tissue are uncommon, but have been increasingly characterized over the past decades. They equally affect men and women of all age groups. Lesions are more frequent in extremities and limb girdles. Due to presence of varied architectural and cytological features both within a lesion and between different tumors, immunohistochemistry may be required to diagnose these tumors. We report a rare case of myoepithelial tumor of soft tissue of lower extremity with secondary bone changes on radiographs, as well as magnetic resonance imaging and histopathological correlation. The tumor was initially noticed as a painless, deep soft-tissue mass in the left lower limb; thereafter, the patient started complaining about chronic left lower limb radicular pain. A core needle biopsy was then performed, which discloses nests of ovoid to plasmacytoid cells having monomorphic round nuclei, inconspicuous nucleoli, and clear cytoplasm. Immunohistochemically, the tumor cells were positive for AE1, P40, CK 5/6, and vimentin markers.

An Observational Study on The Role of Magnetic Resonance Imaging in The Evaluation of Soft Tissue Tumors with Histopathological Correlation at Tertiary Care Centre

Background: The primary aim of this study is to evaluate the role of magnetic resonance imaging (MRI) in the assessment of soft tissue tumors with histopathological correlation at a tertiary care center. Methods: An observational study was conducted on 75 patients (n = 75) in the Department of Radiodiagnosis over 18 months. The targeted population comprised patients who presented to the Radiodiagnosis Department for radiological imaging of soft tissue tumors. Results: Out of 75 cases, 20% were found to have benign tumors, while 80% were found to have malignant tumors. The most frequent benign tumor was fibromatosis, with n = 10 cases (13.33%), and the most common malignant tumor was synovial sarcoma, with n = 14 cases (18.66%). The benign age group ranged from 11 to 20 years. T2-weighted heterogeneous hyperintensity was noted more frequently in malignant lesions, demonstrating a high positive predictive value; that is, 83% of malignant tumors exhibited changes on diffusion-weighted imaging/ apparent diffusion co efficient (DWI/ADC). Low-grade malignant lesions showed no restrictions. Most benign lesions displayed restrictions, with a high positive predictive value of 98.14%, specificity of 93.33%, and sensitivity of 88.33%. Conclusions: Soft tissue tumors can be detected and locally staged using MRI; thus, this technique has proven its value. Intralesional hemorrhage and calcification are two parameters that have been shown to have no substantial association with cancer. Due to its high sensitivity, MRI is a viable option for evaluating soft tissue tumors.

Comprehensive Analysis of Liver Biopsies in a Tertiary Care Hospital: A Retrospective Histopathological and Clinical Correlation Study

Liver biopsy (LB) served as a vital diagnostic tool for cases with notable alterations in liver function tests and for diagnosing a range of liver diseases, including chronic liver disease, cirrhosis, primary biliary cirrhosis, and hepatic neoplasms. Patients presenting with liver pathology often exhibited nonspecific symptoms, such as abdominal discomfort, nausea, vomiting, fever, indigestion, and flatulence. Based on patients' clinical history and radiological findings that suggested liver disease, a liver biopsy was frequently recommended, as it provided definitive diagnostic insights. Histopathological analysis of liver biopsies offered critical information on disease severity, grading, staging of liver tumors, and the presence of any coexisting hepatic conditions.This study retrospectively examined liver biopsies submitted to the Department of Pathology, correlating histopathological findings with clinical and radiological data. Through this integration, the research contributed to improved diagnosis, management, and follow-up of liver disease cases in a tertiary care setting.

Neuropathological Correlates of White Matter Hyperintensities in Cerebral Amyloid Angiopathy.

White matter hyperintensities (WMHs) are frequently observed on magnetic resonance imaging (MRI) in patients with cerebral amyloid angiopathy (CAA). The neuropathological substrates that underlie WMHs in CAA are unclear, and it remains largely unexplored whether the different WMH distribution patterns associated with CAA (posterior confluent and subcortical multispot) reflect alternative pathophysiological mechanisms. We performed a combined invivo MRI-ex vivo MRI-neuropathological study in patients with definite CAA. Formalin-fixed hemispheres from 19 patients with CAA, most of whom also had invivo MRI available, underwent 3T MRI, followed by standard neuropathological examination of the hemispheres and targeted neuropathological assessment of WMH patterns. Exvivo WMH volume was independently associated with CAA severity (P=0.046) but not with arteriolosclerosis (P=0.743). In targeted neuropathological examination, compared with normal-appearing white matter, posterior confluent WMHs were associated with activated microglia (P=0.043) and clasmatodendrosis (P=0.031), a form of astrocytic injury. Trends were found for an association with white matter rarefaction (P=0.074) and arteriolosclerosis (P=0.094). An exploratory descriptive analysis suggested that the histopathological correlates of WMH multispots were similar to those underlying posterior confluent WMHs. This study confirmed that vascular amyloid β severity in the cortex is significantly associated with WMH volume in patients with definite CAA. The histopathological substrates of both posterior confluent and WMH multispots were comparable, suggesting overlapping pathophysiological mechanisms, although these exploratory observations require confirmation in larger studies.

Bright Luminal Sign on High b-Value Diffusion-Weighted Magnetic Resonance Enterography Imaging as a New Biomarker to Predict Fibrotic Strictures in Crohn's Disease Patients: A Retrospective Preliminary Study.

A retrospective analysis was conducted to investigate how a bright luminal sign on high b-value diffusion-weighted imaging (DWI) could be considered as a new biomarker for identifying fibrotic strictures in Crohn's disease (CD). Fibrotic strictures, due to excessive deposition of extracellular matrix following chronic inflammatory processes, can be difficult to distinguish from inflammatory strictures using endoscopy. This study was performed on 65 patients with CD who underwent MRE, and among them 32 patients showed the bright luminal sign on high b-value DWI. DWI findings were compared to pre- and post-contrast MRE data. Luminal bright sign performance results were calculated using a confusion matrix, the relationship between categorical variables was assessed by the χ2 test of independence, and the Kruskal-Wallis test (ANOVA) was used for the assessment of statistical significance of differences between groups. The results indicated a high sensitivity (90%) and specificity (85%) of the bright luminal sign for fibro-stenotic CD and a significant correlation between DWI luminal brightness and markers such as the homogeneous enhancement pattern (p < 0.001), increase in enhancement percentage from 70 s to 7 min after gadolinium injection (p < 0.001), and submucosal fat penetration (p = 0.05). These findings indicate that DWI hyperintensity can be considered as a good non-invasive indicator for the detection of severe intestinal fibrosis and may provide an efficient and accurate method for assessing fibrotic strictures. This new non-invasive biomarker could allow an early diagnosis of fibrotic stricture, delaying the onset of complications and subsequent surgery. Moreover, further evaluations through larger prospective trials with histopathological correlation are needed to confirm these results and completely determine the clinical benefits of DWI in treating CD.

DIAGNOSTIC EFFICACY OF FNAC IN THYROID LESIONS, CLASSIFIED ACCORDING TO BETHESDA SYSTEM WITH CYTOHISTOLOGICAL CORRELATION

Objective: The objective of the study is to estimate the diagnostic accuracy (DA) of fine needle aspiration cytology (FNAC) in thyroid lesions with cytohistological correlation. Methods: The study was a cross-sectional study which was conducted in the Department of Pathology, Rabindranath Tagore Medical College, M.B.G. Hospital, Udaipur, Rajasthan, from December 2022 to December 2023. A total of 201 thyroid aspirations were performed, and the smears were classified according to The Bethesda system. Cytological and histopathological findings were compared in 132 cases that proceeded to surgery. Sensitivity, specificity, negative predictive value (NPV), positive predictive value, and DA were calculated using standard statistical methods. Results: The distribution of thyroid lesions on cytology was as follows: Non-diagnostic (1%), benign (92%), atypia of unknown significance (1%), follicular neoplasia (3%), suspicious for malignancy (2%), and malignant (1%). The sensitivity, specificity, positive predictive value, NPV, and DA in our study were 78.94%, 100%, 100%, 96%, and 96.9%, respectively. Conclusion: FNAC’s cost-effectiveness, patient-friendly nature, swift results, and high sensitivity, specificity, and accuracy render it a primary diagnostic tool for assessing patients with thyroid swelling preoperatively. The Bethesda system categorizes thyroid lesions cytologically, aiding in their diagnosis and subsequent management. Histopathological correlation facilitates the assessment of DA and ensures quality assurance.

A Study of Small and Large Bowel Wall Thickness Using Computed Tomography and Its Histopathological Correlation.

Small bowel imaging presents significant challenges due to the bowel's length, narrow caliber, and complex looping. Accurate diagnosis of gastrointestinal disorders often requires detailed imaging to differentiate various pathologies, such as inflammatory bowel disease (IBD), infections, ischemic conditions, and neoplasms. The small bowel plays a crucial role in digestion and absorption and is susceptible to various pathologies. CT imaging is essential for diagnosing bowel wall thickening, which can indicate a range of conditions. Dual-energy CT (DECT) and CT enterography offer advanced imaging capabilities to address these diagnostic challenges. This study aims to evaluate the efficacy of CT in staging malignant lesions by correlating imaging findings with histopathology to enhance non-invasive diagnosis and treatment strategies. This cross-sectional study was conducted over two years at Era's Medical College and Hospital, Lucknow, India, with 60 subjects. Patients with abnormal bowel wall thickening (>5 mm) on ultrasound were included, while those with renal dysfunction or pregnancy were excluded. After informed consent, subjects consumed a mannitol solution before undergoing CT scans using a 384-slice Dual Energy CT scanner (Somatom Force, Siemens Healthcare, Erlangen, Germany). All images were post-processed on a workstation using Synovia software (Synovia Solution, Fort Worth, Texas), which allows for image analysis using three-material decomposition. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York). The majority of patients were young adults aged 20-39 years (63.33%), with a slight male predominance (53.33%). Abdominal pain was the most common complaint (35.00%). Mild wall thickening (<10 mm) was associated with IBD (48.28%), while marked thickening (>10 mm) was linked to neoplastic lesions (48.39%). Symmetrical thickening was common in infective and inflammatory conditions, whereas asymmetrical thickening was typical of neoplastic lesions. CT scans demonstrated high diagnostic accuracy, with 83.33% sensitivity, 95.24% specificity, 88.24% positive predictive value, and 93.02% negative predictive value, resulting in an overall accuracy of 91.67%. The study highlights that neoplastic lesions are associated with marked bowel wall thickening, while inflammatory conditions present with mild thickening. CT scans proved highly effective in diagnosing gastrointestinal disorders, with significant accuracy in distinguishing between benign and malignant lesions. This underscores the importance of advanced imaging techniques in clinical practice for improved patient outcomes.

Pediatric Diffuse Lung Disease in Infants: Imaging Findings and Histopathologic Correlation.

Childhood interstitial lung disease (chILD) encompasses a diverse group of genetic, infectious, and inflammatory conditions affecting infants and children. The recognition and understanding of these entities have highlighted the necessity for more accurate classification. This group of rare heterogeneous diseases comprises more than 200 different conditions and has a combined estimated prevalence of less than one patient per 100 000 children. Hence, a systematic diagnostic approach is crucial. This article describes a diagnostic approach for pediatric diffuse lung diseases in infancy, including an analysis of clinical presentations and imaging and histologic features to effectively distinguish among various chILD entities. Although they often have overlapping and nonspecific radiologic features, some chILD entities may exhibit typical imaging findings, resulting in a CT diagnosis or aiding in narrowing the differential diagnosis, thus guiding the clinician to the appropriate genetic tests, potentially limiting unnecessary biopsies. This approach aims to enhance the understanding and diagnosis of chILD in infants, thereby facilitating improved patient care.

Study of clinical and histopathological correlation of abnormal uterine bleeding

Study of clinical and histopathological correlation of abnormal uterine bleeding

A Histopathologic Correlation Study Evaluating Glymphatic Function in Brain Tumors by Multiparametric MRI.

This study aimed to elucidate the impact of brain tumors on cerebral edema and glymphatic drainage by leveraging advanced MRI techniques to explore the relationships among tumor characteristics, glymphatic function, and aquaporin-4 (AQP4) expression levels. In a prospective cohort from March 2022 to April 2023, patients with glioblastoma, brain metastases, and aggressive meningiomas, alongside age- and sex-matched healthy controls, underwent 3.0T MRI, including diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index and multiparametric MRI for quantitative brain mapping. Tumor and peritumor tissues were analyzed for AQP4 expression levels via immunofluorescence. Correlations among MRI parameters, glymphatic function (DTI-ALPS index), and AQP4 expression levels were statistically assessed. Among 84 patients (mean age: 55 ± 12 years; 38 males) and 59 controls (mean age: 54 ± 8 years; 23 males), patients with brain tumor exhibited significantly reduced glymphatic function (DTI-ALPS index: 2.315 vs. 2.879; P = 0.001) and increased cerebrospinal fluid volume (201.376 cm³ vs. 115.957 cm³; P = 0.001). A negative correlation was observed between tumor volume and the DTI-ALPS index (r: -0.715, P < 0.001), whereas AQP4 expression levels correlated positively with peritumoral brain edema volume (r: 0.989, P < 0.001) and negatively with proton density in peritumoral brain edema areas (ρ: -0.506, P < 0.001). Our findings highlight the interplay among tumor-induced compression, glymphatic dysfunction, and altered fluid dynamics, demonstrating the utility of DTI-ALPS and multiparametric MRI in understanding the pathophysiology of tumor-related cerebral edema. These insights provide a radiological foundation for further neuro-oncological investigations into the glymphatic system. See related commentary by Surov and Borggrefe, p. 4813.

Dermoscopy of Lichen Planus Pigmentosus and Histopathological Correlation: A Case Series.

Lichen planus pigmentosus (LPP) is an acquired pigmentary disorder affecting the dark-skinned population. There is a wide range of differentials, with substantial clinicopathological overlap. Dermoscopy may contribute to the better characterization of this dermatosis. This study aimed to describe dermoscopic features of LPP with a histopathological correlation. LPP lesions of 23 patients were studied using a polarized dermoscopy, followed by histological evaluation. The most common dermoscopic finding was dots and/or globules (n=23) in different patterns: speckled (n=4), dotted (n=2), reticular (n=4), diffuse (n=9), hem-like (n=1), and circular (n=2). Other patterns were exaggerated pseudo-reticular pattern (n=12), sparing of follicular openings (n=23), targetoid appearance (n=3), blue-white veil (n=5), rosettes (n=5), erythema (n=4), and telangiectasia (n=7). Histological findings included pigment incontinence (n=23), the severity being mild (n=8) and severe (n=15). We found a statistically significant association between the intensity of pigmentary incontinence on the histological examination and the presence of blotches in dermoscopy (P=0.046) and between blue-white veil and rosettes in flexural areas (P=0.01). Also, a statistical relationship was found between severe pigment density (reticulated and diffused patterns) and short disease duration (P=0.016). We describe LPP dermoscopic changes according to disease progression. We found that blotches are indicative of long-duration disease and could be specific dermoscopic features of LPP. We demonstrate that a blue-white veil associated with rosettes could be pathognomonic features of LPP inversus.

Histopathological Correlation Between High Endothelial Venule Neogenesis and the Tumor Microenvironment in Lung Adenocarcinoma.

The dynamic interplay between cancer cells and the microenvironment involves a wide range of intricate relationships that evolve during different stages of tumor progression. Recent attention has focused on high endothelial venules (HEVs), specialized endothelial cells in tumors with a unique cuboidal shape similar to those in lymph nodes. Previous animal studies have shown that normalization of tumor angiogenesis through anti-VEGFR2 therapy promotes HEV formation. However, few reports exist regarding the relationship between HEVs and preexisting blood vessels or interstitial fibers. In this study, we histologically examined whether tumor vascular structure correlates with HEV neogenesis. A total of 109 patients with pathological stage I lung adenocarcinoma who had undergone curative lung resection at our Institute between 2012 and 2016 were included. HEVs were identified by anti-peripheral node addressin (PNAd) staining. Immunostaining and Elastica-Masson-Goldner staining were performed on tumor sections and quantified. PNAd-positive cells were identified in 102 (93.6%) patients. Nearly all PNAd-positive cells were located within or near immune cell clusters. We investigated the correlation between microvessel structures or interstitial fibers and the number/density of PNAd-positive vessels, but no significant correlation was found. Since PNAd-positive cells were concentrated in immune cell aggregates, we focused our analysis specifically on these regions. Immune cell aggregates with abundant PNAd-positive vessels had a greater microvessel density along with by rich collagen fiber production, and displayed a more mature morphological phenotype of HEVs. The generation of PNAd-positive cells in tumors is governed by an angiogenetic mechanism distinct from that of broader tumor microenvironment. Furthermore, the accumulation of immune cells is associated with increased HEV maturation.

OSSN in South India: Clinical presentation, treatment outcomes, and histopathologic correlations.

This study aimed to analyze the clinical presentation, treatment outcomes, and histopathology features of ocular surface squamous neoplasia (OSSN) in a South Indian population and correlate the area of lesions to the histopathological grade/severity of carcinoma in situ (CIN) and squamous cell carcinoma (SqCC) invasive and noninvasive tumors. The study was a retrospective cross-sectional study. The study reviewed electronic medical records (EMRs) of 99 eyes of 99 South Indian patients who underwent en bloc excision and biopsy for tumors in the corneal and conjunctival epithelium with suspicion of OSSN over 1 year from January 2019 to December 2019. Postoperatively, patients were treated with three cycles of topical 0.04% mitomycin C eye drops. Sixty-three had requisite EMR data with a follow-up period of 1 year. Patients had equal gender distribution with an age range of 28-83 years. The most common clinical variant was leukoplakic lesion, and the area of the lesion was the only predicting factor for SqCC and CIN. Bigger (T2) lesions should be strongly suspected for OSSN and promptly excised. Histopathologic analysis should be performed, and post-op topical mitomycin C or interferon alpha 2b is administered to avoid recurrence. In this study, by correlating the area of the lesion, we introduce a new variable that may aid in clinical prognostication alongside the AJCC classification.

Histopathological Evaluation of Somatostatin Receptor 2 Expression in Myocarditis-Rationale for the Diagnostic Use of Somatostatin Receptor Imaging.

Myocarditis is an inflammatory disease of the myocardium and remains to this day a challenging diagnosis. A promising novel imaging method uses the expression of somatostatin receptors (SSTRs) on inflammatory cells to visualize myocardial inflammation. However, little is known about the histopathological correlate of SSTR imaging in different forms of myocarditis. In the present retrospective histopathological study, we systematically analysed the expression of SSTR subtype 2 (SSTR2) on inflammatory cells of 33 patients with biopsy- or explant-proven myocarditis (lymphocytic myocarditis (n = 5), giant-cell myocarditis (n = 11), and cardiac sarcoidosis (n = 17)), and in eight controls (multi-organ donors) without signs of myocardial inflammation and/or scars. In all patients, immunohistochemical staining for SSTR2 was positive in areas with CD68-positive macrophages and multinucleated giant cells. Staining for SSTR2 was most prominent in the presence of multinucleated giant cells. The colocalization of both SSTR2 and CD68 on the same cell could be confirmed using immunofluorescence microscopy. Western blotting confirmed the upregulated expression of SSTR2 in cases of granulomatous inflammation (sarcoidosis) of the skeletal and heart muscle, in comparison with controls. In conclusion, our findings demonstrate the expression of SSTR2 on the protein level on CD68-positive macrophages and multinucleated giant cells in various forms of myocarditis, which provides a clear rationale for the diagnostic use of SSTR imaging in this patient group.

Magnetic Resonance Imaging Evaluation of Carcinoma of the Cervix With Histopathological Correlation in a Tertiary Care Center: Emphasizing the Rise of Adenocarcinoma in the Indian Context.

Background and objectives Adenocarcinoma is increasingly being described in the histological profile of cervical cancer, which is a significant alteration in the disease's profile. This study, which highlights the rising incidence of adenocarcinoma in India, attempts to evaluate the relationship between magnetic resonance imaging (MRI) and histological findings in cervical cancer. The goal is to assess the utility of MRI in tumor staging and its consequences for the management of this evolving histological trend. Methods Forty-five patients with cervical cancer were included in a retrospective analysis; they had MRI scans and then histological examinations. We compared the MRI results for tumor size, lymph node involvement, and local invasion with histology, the gold standard for diagnosis. Correlation was evaluated using statistical analysis, which included chi-square tests; a p-value of less than 0.05 was considered significant. Results Magnetic resonance imaging showed good agreement with histology (p = 0.03) and was accurate in detecting lesions restricted to the cervix and parametrial infiltration. On the other hand, there were differences in the diagnosis of pelvic lymphadenopathy, which MRI underreported. Magnetic resonance imaging sensitivity was high for detecting parametrial invasion (88.24%) and for tumor extent (81.82%), but lower for lymph node involvement (56.25%). Compared to 47.06% of squamous cell carcinoma (SCC) cases, the study found a considerable increase in the number of instances of adenocarcinoma, with 54.55% of cases presenting in advanced stages. This pattern became statistically significant (p < 0.05), emphasizing the tendency of adenocarcinomas to manifest in their later stages. Conclusions When it comes to evaluating local tumor invasion, MRI is a dependable method for staging cervical cancer. However, other diagnostic techniques are required due to their limits in detecting lymphadenopathy. The need for better screening methods specific to this subtype is highlighted by the rising incidence of adenocarcinoma and its propensity for late-stage diagnosis. This will enable early detection and intervention.

Role of Contrast Perfusion Weighted Magnetic Resonance Imaging in Grading of Brain Tumors with Histopathological Correlation

Background: Traditional MRI sequences provide precise anatomical information about brain tumors. But these sequences can’t quantitatively evaluate vascular physiology, or capture tumor biology at the molecular level; which is important for tumor grading, therapeutic assessment, and prognostication. Furthermore, non-enhancing parts of the tumor affected brain, which generally indicates peri-tumoral brain edema with infiltrative tumor cells, is not visible on conventional MRI sequences. Perfusion weighted Magnetic Resonance Imaging (PW-MRI) techniques such as Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) and Dynamic Susceptibility Contrast Magnetic Resonance Imaging (DSC-MRI) have shown promise as imaging biomarkers for glioma therapy, since these new sequences can also provide information about vascular hemodynamics. Our study was first prospective study from Himalayan belt of India, wherein we tried to assess the role of PW-MRI in the grading of brain tumors, with histopathological correlation. Aim and Objective: To compare tumor perfusion and histopathological tumor grading, in evaluation of brain tumor especially gliomas. Material and Method: 40 patients who were referred to Department of Radiodiagnosis for evaluation of brain tumor, and who gave informed consent, were included in this prospective study, done over a period of 18 months. All patients underwent MRI, followed by surgical resection. Observation and Result: In our study, diagnostic accuracy was 90% for mean rCBV (lesion) (cut off: 7 by ROC), mean rCBF (lesion) (cut off: 13.9 by ROC), and rCBF ratio (cut off: 2.9 by ROC); for differentiating benign versus malignant brain tumor. rCBF ratio was found to be best diagnostic parameter with sensitivity of 96%, specificity of 80%, positive predictive value of 89%, negative predictive value of 92%, diagnostic accuracy of 90%, area under ROC curve=0.909, and p value&lt;0.001. Conclusion: We come to conclusion that high grade brain tumor display higher CBF, than do low grade brain tumor. Three parameters showed good diagnostic accuracy, which includes rCBF ratio, mean rCBF (lesion), and mean rCBV (lesion). These parameters can be used to predict the grade of the brain tumor, with good diagnostic accuracy.

Assessment of a fully-automated diagnostic AI software in prostate MRI: Clinical evaluation and histopathological correlation

ObjectiveThis study aims to evaluate the diagnostic performance of a commercial, fully-automated, artificial intelligence (AI) driven software tool in identifying and grading prostate lesions in prostate MRI, using histopathological findings as the reference standard, while contextualizing its performance within the framework of PI-RADS v2.1 criteria. Material and methodsThis retrospective study analyzed 123 patients who underwent multiparametric prostate MRI followed by systematic and targeted biopsies. MRI protocols adhered to international guidelines and included T2-weighted, diffusion-weighted, T1-weighted, and dynamic contrast-enhanced imaging. The AI software tool mdprostate was integrated into the Picture Archiving and Communication System to automatically segment the prostate, calculate prostate volume, and classify lesions according to PI-RADS scores using biparametric T2-weighted and diffusion-weighted imaging. Histopathological analysis of biopsy cores served as the reference standard. Diagnostic performance metrics including sensitivity, specificity, positive and negative predictive value (PPV, NPV), and area under the ROC curve (AUC) were calculated. Resultsmdprostate demonstrated 100 % sensitivity at a PI-RADS ≥ 2 cutoff, effectively ruling out both clinically significant and non-significant prostate cancers for lesions remaining below this threshold. For detecting clinically significant prostate cancer (csPCa) using a PI-RADS ≥ 4 cutoff, mdprostate achieved a sensitivity of 85.5 % and a specificity of 63.2 %. The AUC for detecting cancers of any grade was 0.803. The performance metrics of mdprostate were comparable to those reported in two meta-analyses of PI-RADS v2.1, with no significant differences in sensitivity and specificity (p > 0.05). ConclusionThe evaluated AI tool demonstrated high diagnostic performance in identifying and grading prostate lesions, with results comparable to those reported in meta-analyses of expert readers using PI-RADS v2.1. Its ability to standardize evaluations and potentially reduce variability underscores its potential as a valuable adjunct in the prostate cancer diagnostic pathway. The high accuracy of mdprostate, particularly in ruling out prostate cancers, highlights its clinical utility by reducing workload and enhancing patient outcomes.

ONYCHOMATRICOMA, A RARE NAIL TUMOR

Abstract Introduction/Objective Nail apparatus tumors are rare and can pose diagnostic challenges. Onychomatricoma (also called onychomatrixoma) is a rare tumor first described in 1992. It is a benign biphasic fibroepithelial tumor of the nail. It has been reported in Caucasians, often in females with a peak incidence in the fifth decade of life. Rare cases are also reported in children. The common location is in the fingernail (75%), presenting with yellowing of the nail plate (xanthonychia) and thick longitudinal band. Cutaneous horn, melanonychia, nail bleeding, and nail deformity with or without bony extension can also be seen. Histologic findings show increased nail thickness surrounded by a layer of Malpighian epithelium. The fibroepithelial tumor shows hyperplasia of two components including onychogenic epithelium and mesenchymal stroma. Methods/Case Report A 65-year-old Vietnamese female presented with longstanding dark yellowish ridging discoloration, thickening and nail plate deformity of the left fourth fingernail with appearance of onychomycosis. However, KOH mount and fungal cultures of the nail plate were negative for fungal microorganisms. There was no history of pain, trauma, or prior treatment. Microscopic analysis of transverse and longitudinal sections of the nail shows a biphasic neoplasm that penetrates the nail plate with multiple digitations. There was deep finger-like epithelial cell strands that form anastomosis as well as invaginations into the dermis. Characteristic filiform projections are lined by onychogenic epithelium composed mostly of basal and supra-basal cells that lack granular and corneum layers. The stroma was hypercellular and fibrillary with spindle-shaped fibroblastic cells, and a deep layer with dense collagen. Immunohistochemical stains of the lesion show diffuse expression for CD10 and CD34 in the stroma and negativity for Periodic Acid Schiff staining. Results (if a Case Study enter NA) N/A Conclusion While most of the literature on onychomatricoma has been reported in Caucasian population, little is known about this tumor in non-Caucasians. This case report of onychomatricoma in a Vietnamese woman contributes to the emerging literature of this rare nail apparatus tumor in non-Caucasian population. Clinical and histopathologic correlation is important to achieve prompt and correct diagnosis since delay would result in nail dystrophy and deformity.

Unusual Presentation of Tuberculosis in the Lungs and Lymph Nodes

Abstract Introduction/Objective Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis mainly affecting the lungs. Despite treatment advancements, TB remains a major cause of morbidity. This report presents a patient with active pulmonary and lymph node TB. Methods/Case Report The patient is a 41-year-old male from Bangladesh admitted for worsening cough and shortness of breath. Earlier, he had a cough and right cervical lymphadenopathy with lymph node biopsy demonstrating noncaseating granuloma and a positive Quantiferon-Gold. Outpatient workup included negative sputum TB PCR with negative cultures. The patient was febrile, tachycardic, and oxygenating normally. D-dimer was 1484. CT angiography was negative for emboli and showed mediastinal and right hilar lymphadenopathy. Imaging was otherwise non-indicative of active TB. We started rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy with bronchoalveolar lavage for additional sputum sampling and excisional lymph node biopsy to rule out malignancy. Workup for autoimmune disease and sarcoidosis was negative. An acid-fast bacilli stain of the biopsy was positive, indicating active TB. The patient was discharged on RIPE with outpatient follow-up. Results (if a Case Study enter NA) NA Conclusion Histological findings of TB demonstrate caseating granulomatous lesions. Sarcoidosis can be considered in patients with hilar or mediastinal lymphadenopathy with noncaseating granulomatous lesions. However, both active and inactive TB should be considered in the differential diagnosis with biopsy results indicating noncaseating granuloma, as infected tissues can lack the central necrosis to produce caseation. Common chest radiographic findings in TB include pulmonary consolidation, hilar and mediastinal lymphadenopathy, disseminated miliary disease, and a normal chest radiograph. Our patient had just hilar and mediastinal lymphadenopathy. While a common finding in tuberculosis, this is also present in other inflammatory pathologies, emphasizing the importance of keeping a broad differential even in settings where initial biopsy and imaging results may indicate latent infection or other diagnoses. We utilized the expertise of pathologists to identify lymph nodes with active TB infection in a patient who previously had inconsistent pathological and radiological findings. Without the help of the pathologists in this case, diagnosing and treating this patient would not have been possible, showing the necessity of histopathological correlation with clinical and radiologic findings.