Irregular Borders Research Articles

Superpixel-based C-SVC for Brain Tissue Classification in MRI Scans

Accurate identification of brain tissue is an ill-posed problem due to the inhomogeneous intensity and the extremely complicated and irregular border between endocrine tissues. This study introduces a superpixel-based approach to brain tissue classification in MRI scans. The proposed approach starts with image smoothing and feature highlighting, followed by image splitting based on the SLIC superpixel and merging strategy. Then, distinct superpixel-based appearance and boundary features are extracted and refined by minimizing redundancy and maximizing relevance technique before sending to the C-support vector classifier. Finally, a refinement step is adopted based on morphological characteristics and the distance regularized level set evolution model to modify the matter contour. The proposed approach was evaluated and compared with ten existing algorithms using the publicly accessible IBSR dataset. The experimental results show the better efficiency of the proposed approach in delimiting the contour of each matter than the other approaches in the literature.

Primary Intraosseous Solitary Fibrous Tumor of the Mandible: Report of a Diagnostically Challenging Case with NAB2::STAT6 Fusion and Review of the Literature.

Solitary fibrous tumor (SFT) represents an uncommon mesenchymal neoplasm affecting primarily the extremities and deep soft tissues with, overall, benign but locally aggressive biologic behavior and an underlying pathognomonic NAB2::STAT6 fusion. Intraosseous SFTs are infrequent, and involvement of the jawbones is exceedingly rare. A 54-year-old woman presented with an asymptomatic, well-demarcated, multilocular radiolucency of the left posterior mandible featuring focally irregular borders, root resorption and lingual cortex perforation. The lesion had shown progressive growth over a 6-year period. Microscopically, a proliferation of predominantly ovoid and spindle-shaped cells with indistinct cell membrane borders, elongated, plump or tapered, hyperchromatic nuclei, and lightly eosinophilic cytoplasm was noted. Marked cytologic atypia, pleomorphism and mitoses were absent. A secondary population of epithelioid cells exhibiting ovoid or elongated vesicular nuclei, and abundant, pale eosinophilic or vacuolated cytoplasm was also present. The supporting stroma was densely fibrous with areas of marked hyalinization and variably-sized, ramifying, thin-walled vessels. By immunohistochemistry, lesional cells were strongly and diffusely positive for STAT6 and CD99, and focally immunoreactive for MDM2 and SATB2. Ki-67 was expressed in less than 5% of lesional cells, while most interspersed epithelioid cells were positive for the histiocyte marker, CD163. Molecular analysis disclosed a NAB2::STAT6 fusion confirming the diagnosis of SFT. The patient underwent segmental mandibulectomy. Herein, we report the first case of primary intraosseous SFT of the mandible with complete documentation of its characteristic immunohistochemical and molecular features. Diagnosis of such unusual presentations may be further complicated by the challenging histomorphologic diversity of SFT.

A Case Report on Maxillary Ameloblastic Fibroma in a 55-Year-Old Man

Ameloblastic Fibroma (AF) accounts for only 2% of all odontogenic tumors.1 It has been shown to be more common in males than females.2 A malignant transformation of this tumor is known as ameloblastic fibrosarcoma. To the best of our knowledge, there are no published reports on AF in the Philippines, with only one report of its malignant counterpart, ameloblastic fibrosarcoma.3 We present a rare case of AF with an unusual presentation and discuss its rarity, pathogenesis, histologic features and management. CASE REPORTA 55-year-old Filipino man consulted at our tertiary government hospital for a one-year history of a gradually enlarging maxillary alveolar ridge mass extending to the hard palate. Upon first noticing the mass a year prior, he consulted with a local dentist and an intraoral examination revealed a smooth swelling on the right maxillary alveolar ridge between the first and second maxillary premolar, approximately measuring 2 cm x 2 cm x 1 cm. The mass was noted to extend to the hard palate. (Figure 1A) He was advised consultation with an ENT surgeon for further evaluation and management but he did not comply. In the interim, the mass gradually enlarged. Upon first consultation at ITRMC, intraoral examination revealed a 6 cm x 4 cm x 2 cm soft, non-friable, ulcerative mass with irregular borders on the right maxillary alveolar ridge extending to the hard palate. (Figure 1B) The mass was malodorous, easily bled on manipulation and had violaceous areas. A punch biopsy revealed AF. Past medical history was unremarkable. A contrast-enhanced computed tomography (CECT) scan of the paranasal sinuses (PNS) revealed a 6.7 cm x 8.7 cm x 6.7 cm expansile, lobulated, mixed attenuating, heterogeneously enhancing mass in the midface. The bulk of the mass involved the right maxilla but extended to involve the entire hard palate and most of the left maxillary sinus. (Figure 2) The lesion was associated with osteolytic destruction and abutted the floor of the right orbit and bilateral zygomaticomaxillary buttresses. The inferior and posterior portions of the nasal septum were also eroded. (Figure 3) Given the clinical and radiographic features, odontogenic myxoma and ameloblastoma were considered as differential diagnoses as they may present as a painless, slow-growing, multiloculated mass with bony expansions.4,5 Oral cavity squamous cell carcinoma was also considered. The mass was excised via a right subtotal maxillectomy and left inferior maxillectomy using a Weber-Ferguson approach (Figure 4) and a temporary surgical obturator was fitted. Post-operative recovery was unremarkable and the patient was discharged after five days. Once the surgical site healed he was fitted with an acrylic surgical obturator. Final histopathological report was AF, compatible with the pre-operative biopsy result. (Figure 5) On follow up three months post-surgery, the patient was able to eat and speak with ease and no tumor recurrence was observed. One year and three weeks later, there was still no recurrence noted on inspection of the surgical defect, his speech was hypernasal but understandable, and he had no difficulty communicating and eating.

Advancing Electric Engineering Education through Immersive Virtual Reality: Deep Learning and Evolutionary Algorithms for Image Stitching and Rectification in Virtual Lab Environments

Virtual Reality (VR) technology has emerged as a transformative tool in education, offering immersive and interactive experiences that enhance learning outcomes. This paper delves into the application of image stitching and rectification techniques to create a VR lab environment, specifically tailored for electrical engineering education. The importance of VR technology in education is explored, highlighting its role in promoting active learning and providing experiential learning opportunities. The primary emphasis of this Paper lies in the smooth incorporation of image stitching algorithms for the creation of panoramic perspectives, along with the implementation of rectification techniques to correct irregular borders within the stitched images. By utilizing Convolutional Neural Networks (CNNs) and Genetic Algorithms (GAs), the proposed approach optimizes the rectification process, resulting in visually cohesive representations. Demonstrating the utilization of the VR lab across a range of situations, such as examining power transfer and creating control panels for water pumps in irrigation initiatives, the immersive setting enables students to delve into intricate systems. The performance of the proposed method was evaluated using various metrics, including mean squared error, peak signal to noise ratio (PSNR), structural similarity index (SSIM), and Fréchet inception distance (FID). the combination of deep learning algorithm specifically (CNN) and optimization algorithm specifically (Genetic algorithm (GA)) led to an increase in the accuracy of the rectified images where the average PSNR reached 23.98, SSIM was 0.8066, and FID was 18.72. Regarding the users’ opinion about the generated environment by stitching and rectifying images, participants demonstrated consistent positive sentiments, with mean scores ranging from 3.65 to 4.03, all above the scale midpoint, and moderate variability indicated by standard deviation values ranging from 1.070 to 1.251, suggesting general favorability with some variation in responses. This experience empowers the users to gain insights and cultivate essential problemsolving abilities at a heightened level. Collaborative learning is facilitated, enabling students to engage in collaborative projects regardless of their physical location. Through the synthesis of image processing techniques and VR technology, this research contributes to the enrichment of educational experiences and the advancement of electrical engineering education.

Dermatosurgical rounds: shark island pedicle flap for skin defect of the alar crease area after basal cell carcinoma removal

A 67-year-old female presented to the Dermatology Department with a tumor formation located on the left lateral side wall of the nose, measuring 1,5/1,2 cm in size, which had been slowly growing over the past few years. The tumor exhibited a shiny, pink-colored surface with a dome-shaped appearance, irregular borders, and superficial telangiectasias, raising clinical suspicion for basal cell carcinoma. Additionally, there was no reported history of skin cancer in any family member or painful sunburns during childhood. The patient was recommended surgical excision under local anesthesia for the suspected lesion.

Giant pilomatricoma with atypical features: report of a case of aggressive pilomatricoma in an adult

Abstract Introduction/Objective Pilomatricoma, also known as pilomatrixoma or calcifying epithelioma of Malherbe, is a relatively common, benign tumor of the hair matrix. It typically presents as a small (~1cm), dermal based mass in the head and neck region of children and young adults (under 20 years) with predominance for males, but can occur in any age. In contrast, malignant pilomatricoma is typically larger (1 to 10 cm) and occurs later in life (50-60 years). Aggressive pilomatricoma is a variant of pilomatricoma that tends to occur in children and demonstrates atypical features such as increased matrical cells and nuclear atypia, but insufficient for a classification as pilomatrical carcinoma. Here, we presented a case of a large (14.5 cm) aggressive/atypical pilomatricoma that occurred in an adult. Methods/Case Report A 45 year-old-female presented to the emergency department with a posterior neck mass which has been slowly enlarging for years. Recently, it became painful with sanguineous discharge which prompted her to seek medical attention. CT scan revealed a lobulated, pedunculated mass with fat and fluid components. An excision was performed. Gross examination revealed an ulcerated mass measured 14.5 cm in greatest dimension. Scattered calcifications were present. Microscopically, nests of basaloid cells with scattered shadow cells are present consistent with matrical differentiation. A multinodular growth pattern with central necrosis was evident. Nuclear atypia characterized by prominent nucleoli and nuclear overlapping was identified. Results (if a Case Study enter NA) NA Conclusion Histopathologic criteria to reliably differentiate between benign and malignant pilomatrical tumors are not well-established. Tumor ulceration, asymmetry, irregular borders, multinodular growth pattern, marked cytologic atypia, prominent necrosis, lymphovascular invasion, and perineural invasion may be used in favor of malignancy. Our case showed focal confluent necrosis, ulceration, multinodular growth pattern, and cellular atypia but lacked other features that indicative of unequivocal malignancy. The resection margins were negative for tumor. Clinical followup was negative for signs of recurrence or metastasis after two years. We presented this case to show the large size that aggressive pilomatricoma can reach and to emphasize the difficulty in differentiating benign from malignant pilomatrical tumors in borderline cases.

Dermoscopic Features of Cutaneous Hypopigmented Lesions

Abstract Background Pigmentation disorders are rather common in dark skin. In India, 11% of patients presenting to the dermatology outpatient department in Western India have pigmentary disorders. Recently, dermoscopy has been involved as an important tool in the diagnosis of various dermatological diseases. Aim of the Work The aim of this study was to describe the Dermoscopic features of some hypopigmented skin disorders that may be clinically overlapping in order to facilitate differentiation between these skin disorders. Patients and Methods This Cross section descriptive study included 104 patients who complained of patchy or macular hypopigmented lesions. Results The most common dermoscopic features of progressive vitiligo were; Perifollicular hyperpigmentation, diffuse white glowing areas, white vellus and terminal hairs. The most common dermoscopic features of repigmenting vitiligo were; perifollicular pigmentation, marginal hyperpigmentation and interfollicular pigmentation. The most common dermoscopic features of stable vitiligo were; starburst appearance and altered pigmentation, marginal hyperpigmentation and perifollicular pigmentation. The most common dermoscopic features of idiopathic guttate hypomelanosis were; multiple, shiny and porceilin like macules, most of the lesions were well- defined (amoeboid pattern), few lesions were ill-defined with irregular cloudy whitish pattern (nebuloid pattern) and hyperpigmented networks were seen on the surrounding skin of some lesions giving the appearance of the cloudy-sky pattern. The most common Dermoscopic features of nevus depigmentosus were; hypopigmented patch with irregular and serrated borders, faint reticular network in some patches, borders showed pseudopods pattern protruding into the normal skin, the surrounding skin was scaly on some lesions and hair was pigmented with no peri-follicular hyperpigmentation. The most common dermoscopic features of pityriasis alba were; fairly demarcated hypopigmented macules, fine scales and hair inside patches of normal color. Conclusion Dermoscopy can aid in the diagnosis of hypopigmented skin disorders and can help in assessing the activity of vitiligo, however in sometimes the condition may be challenging and difficult to differentiate even by dermoscopy and in such cases histopathological examination may be helpful.

Cervical stump leiomyomata after supracervical hysterectomy; a case report with review of literature

BackgroundDespite being a highly debated issue, subtotal or supracervical hysterectomy (SCH) is still considered a safe and effective treatment for women with benign gynecological lesions. Benign and malignant cervical diseases have been reported after SCH, with fibroids being the most frequently diagnosed lesions in the excised cervical stump. Recurrence of cervical disease after SCH usually presents with vaginal bleeding, pelvic mass, or abdominal pain; moreover, it may necessitate reoperation and resection of the cervical stump or trachelectomy. Trachelectomy is known to be a difficult surgical procedure that may be associated with significant intra- and post-operative morbidity.Case presentationWe presented here a case of a 41-year-old nulliparous woman with a pelvic mass related to the cervical stump presented 2 years after subtotal hysterectomy, performed due to interactable abnormal uterine bleeding, which was attributed to a multiple fibroid uterus. Six years ago, she complained of pelvic pain, excessive vaginal discharge, and spotting. A transvaginal sonography and magnetic resonance imaging with contrast were performed, which revealed a 10.2 × 7.6 × 6.5 cm heterogeneous pelvic mass with irregular borders and marked vascularity on color Doppler. Surgical exploration and resection of the mass with cervical stump excision were performed. Histopathology confirmed the diagnosis of cervical stump multiple benign leiomyomata with no atypical features.ConclusionRecurrence or De novo development of leiomyomata and other cervical lesions might occur after supracervical or subtotal hysterectomy; thus, thorough pre-operative counseling for women requesting a SCH regarding the pros and cons of the procedure compared with total hysterectomy should be optimized. Meticulous follow-up, including the continuation of routine cervical cytological smears, is mandatory for patients with a retained cervix.

Ectopic thyroid adenoma diagnosed in a Senegal seabream (Diplodus bellottii, Steindachner 1882): Towards an accurate diagnosis.

Thyroid tissue in teleosts is located mainly in the pharyngeal region, usually reaching other adjacent anatomical locations. Herein, a nodular lesion located in the left operculum of a Senegal seabream (Diplodus bellottii) was surgically excised and sent for microscopical evaluation. Microscopically, the lesion presented irregular borders and consisted in columnar epithelial cells arranged in a tubulopapillary pattern, surrounding a central lumen filled with acellular, acidophilic and homogeneous, material ('colloid'). To determine the lesion's histogenesis, immunohistochemistry was performed employing antibodies for AE1/AE3, CK7, thyroglobulin and vimentin. The neoplastic cells presented low mitotic index and positive immunolabelling for CK7 and thyroglobulin. Therefore, a diagnosis of ectopic thyroid adenoma was made. Herein, the successful employment of antibodies classically used in mammals for accurate diagnosis of thyroid disorders is described. Proliferation of thyroid tissue in fish may reflect environmental and physiological imbalances, making the study and correct diagnosis of these tumours in this species important.

A RARE CASE OF COEXISTING BLADDER SMALL CELL NEUROENDOCRINE CARCINOMA AND PROSTATE ADENOCARCINOMA: CASE REPORT AND LITERATURE REVIEW

Objective: We present a case of synchronous malignancies of rare bladder small cell neuroendocrine carcinoma (SCNC) and prostate adenocarcinoma and provide literature review of bladder SCNC. Case(s) presentation: A 72-year-old male smoker presented with 3 months history of gross hematuria. Ultrasonography showed a large hypoechoic mass in the right bladder. TURBT was performed and histopathology of the TURBT specimen showed a high-grade papillary urothelial carcinoma. Abdominal contrast-enhanced computed tomography (CECT) demonstrated an isodense heterogenous undefined mass, with irregular border at right anterolateral side of bladder wall. Radical cystoprostatectomy, bilateral radical lymph node dissection and bilateral ureterocutaneostomy was performed. Histopathology and immunohistochemical examination after radical cystoprostatectomy revealed bladder small cell neuroendocrine carcinoma coexisting with prostate adenocarcinoma (Gleason score 3+3=6, group 1). The patient eventually succumbed to disease after having symptomatic disease progression and metastatic disease five months after the surgery. Discussion: Bladder SCNC is a rare malignancy with an incidence of 1–9/1,000,000 reported. This tumor has an aggressive clinical course with high incidence of metastasis, and it tends to confer dismal prognosis. No specific clinical symptom exists. Histopathological recognition and immunohistochemistry is required to differentiate this rare entity. Conclusion: Clinicians and pathologists should be alert to the possibility of bladder SCNC despite extremely scarce incidence. Keywords: Bladder cancer, small cell neuroendocrine carcinoma, synchronous malignancy, case report.

The Diagnostic Value of Endobronchial Ultrasound-Guided Fine Needle Aspiration (EBUS-FNA) in Diagnosing FDG-PET-Avid Lymph Nodes in Extrapulmonary Malignancies.

Background and objective The accurate diagnosis of extrapulmonary malignancies with mediastinal lymphadenopathy is crucial for effective patient management. Endobronchial ultrasound-guided fine-needle aspiration(EBUS-FNA)has emerged as a valuable tool in assessingfluorodeoxyglucose (FDG)-positron emission tomography(PET)-avid lymph nodes (LNs).In this study, we aimed to evaluate the diagnostic value of EBUS-FNA in patients with mediastinal lymphadenopathy in extrapulmonary malignancies and compare its efficacy with PET-CT. Methodology Thisretrospective, cross-sectional study was conducted at Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, from February 2018 to February 2023. It included patients with extrapulmonary malignancies with mediastinal lymphadenopathy displaying abnormal PET-CT uptake, with LN diameters ≥5 mm, excluding lung cancer cases. Data on demographics, malignancy type, LN involvement, PET-CT findings, and EBUS-FNA histopathology were collected. EBUS-FNA procedures involved a 22-gauge needle, and samples were analyzed cytologically and histologically. SPSS Statistics version 20 (IBM Corp., Armonk, NY) was used to perform the statistical analysis. Results The study analyzed a total of 216 patients. Males comprised 56.3% of the cohort, and females 43.7%. The most common malignancy was lymphoma (33.0%), followed by breast cancer (12.6%). EBUS-FNA exhibited a sensitivity of 90.9% compared to PET-CT's sensitivity of 72.7%. Lymph node morphology on EBUS showed low echogenicity and irregular borders in malignant cases. Subcarinaland right hilar were the most frequently sampled lymph nodes. The study found significant differences in lymph node characteristics between non-malignant and malignant groups, with EBUS-FNA effectively identifying malignancies. Conclusions EBUS-FNA demonstrates high sensitivity and diagnostic utility in identifying malignant lymph nodes in patients with extrapulmonary malignancies. Its effectiveness in detecting true positive cases highlights its importance as a complementary diagnostic tool to PET-CT in oncological diagnostics.

Predictors of malignancy for treatment direction in patients with nonfunctioning adrenal incidentaloma

BackgroundAdrenal incidentalomas (AI) are predominantly nonfunctional and benign, and their detection and differential diagnosis are aided by computed tomography (CT). A nonfunctioning adrenal incidentaloma (NFAI) usually requires regular follow-up; however, adrenalectomy may be necessary in certain patients. This study aimed to evaluate prognostic predictors to guide the treatment approach for AIs. MethodsThis retrospective, single-center study involved patients diagnosed with NFAI from January 2000 to December 2020. Patients were divided into surgery and observation groups. A subgroup analysis compared malignant and benign adenoma within the surgery group. ResultsA total of 307 patients were included, with 127 in the surgery group and 180 in the observation group. The surgery group displayed distinct morphological and malignant potential features in CT scans more frequently than the observational group did. The malignant subgroup exhibited more irregular borders on CT, and a higher number of patients with absolute washout under 60 % and relative washout under 40 % compared with the benign adenoma subgroup. Interestingly, within the surgery group, the mean tumor size was <4 cm for the both malignant and benign adenoma subgroups. ConclusionsCharacterizing NFAI is important for appropriate treatment, as not all AIs have a favorable prognosis. CT findings associated with malignant potential, such as Hounsfield unit and washout values, were useful in determining the need for surgical treatment. However, the conventional criterion of a 4-cm size threshold for surgery was not a reliable malignancy predictor. Surgical resection should be considered for specific patient groups to ensure proper treatment over mere observation.

Heterozygosity for loss-of-function variants in LZTR1 is associated with isolated multiple café-au-lait macules

PurposePathogenic LZTR1 variants cause schwannomatosis and dominant/recessive Noonan syndrome (NS). We aim to establish an association between heterozygous loss-of-function LZTR1 alleles and isolated multiple café-au-lait macules (CaLMs). MethodsA total of 849 unrelated participants with multiple CaLMs, lacking pathogenic/likely pathogenic NF1 and SPRED1 variants, underwent RASopathy gene panel sequencing. Data on 125 individuals with heterozygous LZTR1 variants were collected for characterizing their clinical features and the associated molecular spectrum. In vitro functional assessment was performed on a representative panel of missense variants and small in-frame deletions. ResultsAnalysis revealed heterozygous LZTR1 variants in 6.0% (51/849) of participants, exceeding the general population prevalence. LZTR1-related CaLMs varied in number, displayed sharp or irregular borders, and were generally isolated but occasionally associated with features recurring in RASopathies. In 2 families, CaLMs and schwannomas co-occurred. The molecular spectrum mainly consisted of truncating variants, indicating loss-of-function. These variants substantially overlapped with those occurring in schwannomatosis and recessive NS. Functional characterization showed accelerated protein degradation or mislocalization, and failure to downregulate mitogen-activated protein kinase signaling. ConclusionOur findings expand the phenotypic variability associated with LZTR1 variants, which, in addition to conferring susceptibility to schwannomatosis and causing dominant and recessive NS, occur in individuals with isolated multiple CaLMs.

Ultrasound features as predictive markers of BRAFV600E mutation in thyroid cancer: a systematic review and meta-analysis.

Conflicting evidence exists on the predictive value of ultrasound characteristics for BRAFV600E gene expression in thyroid cancer. This study aimed to determine the predictive value of ultrasound features for BRAFV600E gene expression status in thyroid cancer. A systematic review of studies published before December 31, 2023, was conducted in the PubMed, Web of Science, and Cochrane Library databases. Studies evaluating the ultrasonographic features for predicting BRAFV600E gene mutations in thyroid cancer were included. The relevant data were extracted, and the quality of eligible studies was independently assessed by two reviewers. Statistical analysis was performed using RevMan 5.4 and Stata 12.0 software. The meta-analysis included 13 studies involving a total of 2,250 thyroid cancer patients. Ultrasound features significantly associated with BRAFV600E gene expression status in thyroid cancer (P<0.05) comprised hypoechogenicity, absence of halo, irregular borders, and vertical orientation. Contrastingly, no significant differences were observed in solid composition, irregular shape, and microcalcifications (P>0.05). Among the seven ultrasound features, the ones with superior combined sensitivity for nodules were hypoechogenicity, solid composition, absence of halo, and irregular borders, with sensitivities of 0.93 [95% confidence interval (CI): 0.87-0.96], 0.93 (95% CI: 0.86-0.97), 0.83 (95% CI: 0.72-0.91), and 0.74 (95% CI: 0.64-0.83), respectively. Finally, the areas under the summary receiver operating characteristic (SROC) curve with the highest diagnostic performance were the absence of halo and hypoechogenicity, with area under the curve (AUC) of 0.84 (95% CI: 0.80-0.87) and 0.81 (95% CI: 0.77-0.84), respectively. The expression status of the BRAFV600E gene in thyroid cancer correlates with nodules exhibiting hypoechogenicity, absence of halo, irregular borders, and taller-than-wide shape. Notably, the absence of a halo and hypoechogenicity were identified as the most predictive ultrasonic features. However, due to the limited sample size, there may be bias in the meta-analysis results, and more extensive research is necessary.

Melanoma Detection and Classification using Deep Learning

Melanoma is a type of carcinoma with a notably high mortality rate. Accurate diagnosis of this aggressive cancer is crucial due to its severe implications. Key diagnostic indicators include asymmetrical shape, heterogeneous color, diameter greater than 6 mm, and irregular borders, which dermatologists typically identify through visual examination. The conventional method for carcinoma detection is biopsy, involving the removal or scraping of skin samples for extensive laboratory testing. This process is both painful and time- consuming. To improve patient experience and enhance diagnostic efficiency, computer-based detection using image processing techniques and deep learning algorithms, specifically Convolutional Neural Networks (CNNs), has been developed to accurately identify melanoma. Keywords: Deep learning, CNN, Computer- based detection

Diffuse large B-cell lymphoma in the uterus with unexpected manifestations: a case report

BackgroundLymphoid neoplasm is a common disease, arising from lymphoid cells. It is divided into Hodgkin lymphoma and non-Hodgkin lymphoma. Non-Hodgkin lymphoma can be intranodular or extranodular, which happens in 25% of primary cases. The most common locations of extranodular non-Hodgkin lymphoma are the skin and gastrointestinal tract. The genital tract is a rare location; most lymphomas arise from the cervix and vagina, while the uterine corpus is an extremely rare location. In our case, the patient was diagnosed with primary extranodular non-Hodgkin lymphoma in different locations of her genital tract.Case presentationA 48-year-old nonparous Syrian woman complained of diffuse abdominal pain, fatigue, debility, high fever, vomiting, and urinary retention for a week. The last menstrual period of the patient was 5 years previously. The physical examination showed periodic abdominal pain with severe fatigue and increased abdominal size. The laboratory investigations were within normal limits except for a low level of hemoglobin and a high level of cancer antigen 125. The radiological investigations showed a uterine sizable lobulated mass with irregular borders and high and heterogeneous density, extending to the right and left ovaries, enlargement lymph nodes around the abdominal aortic and right iliac vessels, and severe right pleural effusion with right inferior lobe atelectasis. A total hysterectomy and oophorectomy were done. The histopathological examination showed that the patient had non-Hodgkin lymphoma (primary tumor).ConclusionPrimary non-Hodgkin lymphoma in the female genital tract is an extremely rare disease. Fast diagnosis and treatment can improve the outcomes, so this differential diagnosis should be in our minds even in the absence of systematic manifestations of lymphoma. More studies are needed to explain the pathology of this disease and to put guidelines that determine the perfect methods for diagnosis and treatment.

MFRP variations cause nanophthalmos in five Chinese families with distinct phenotypic diversity.

Nanophthalmos is a congenital ocular structural anomaly that can cause significant visual loss in children. The early diagnosis and then taking appropriate clinical and surgical treatment remains a challenge for many ophthalmologists because of genetic and phenotypic heterogeneity. The objective of this study is to identify the genetic cause of nanophthalmos in the affected families and analyze the clinical phenotype of nanophthalmos with MFRP gene variation (Microphthalmia, isolated; OMIM#611040 and Nanophthalmos 2; OMIM#609549, respectively). Comprehensive ophthalmic examinations were performed on participants to confirm the phenotype. The genotype was identified using whole exome sequencing, and further verified the results among other family members by Sanger sequencing. The normal protein structure was constructed using Alphafold. Mutant proteins were visualized using pymol software. Pathogenicity of identified variant was determined by in silico analysis and the guidelines of American College of Medical Genetics and Genomics (ACMG). The relationship between genetic variants and clinical features was analyzed. Five nanophthalmos families were autosomal recessive, of which four families carried homozygous variants and one family had compound heterozygous variants in the MFRP gene. Both family one and family three carried the homozygous missense variant c.1486G>A (p.Glu496Lys) in the MFRP gene (Clinvar:SCV005060845), which is a novel variant and evaluated as likely pathogenic according to the ACMG guidelines and in silico analysis. The proband of family one presented papilloedema in both eyes, irregular borders, thickened retinas at the posterior pole, tortuous and dilated retinal vessels, and indistinguishable arteries and veins, while the proband of family three presented uveal effusion syndrome-like changes in the right eye. In families one and 3, despite carrying the same gene variant, the probands had completely different clinical phenotypes. The homozygous nonsense variant c.271C>T (p.Gln91Ter) (Clinvar:SCV005060846) of the MFRP gene was detected in family 2, presenting shallow anterior chamber in both eyes, pigmentation of peripheral retina 360° from the equator to the serrated rim showing a clear demarcation from the normal retina in the form of strips. Family four proband carried the homozygous missense variant c.1411G>A (p.Val471Met) in the MFRP gene (Clinvar:SCV005060847), family five proband carried compound heterozygous missense variants c.1486G>A (p.Glu496Lys) and c.602G>T (p.Arg201Leu) in the MFRP gene (Clinvar:SCV005060848), which is a novel variant and evaluated as likely pathogenic according to the ACMG guidelines and in silico analysis, and they all presented clinically with binocular angle-closure glaucoma, family four also had retinal vein occlusion in the right eye during the follow-up. In this study, pathogenic variants of the MFRP gene were detected in five nanophthalmos families, including two novel variants. It also revealed a distinct phenotypic diversity among five probands harboring variants in the MFRP gene. Our findings extend the phenotype associated with MFRP variants and is helpful for ophthalmologists in early diagnosis and making effective treatment and rehabilitation strategies.

Accuracy of ultrasound-guided fine-needle aspiration cytology in evaluation of thyroid nodules using different ultrasonographic and cytological features.

Fine-needle aspiration cytology (FNAC) is a reliable method for preoperative evaluation of thyroid nodules particularly if ultrasound-guided (USG-FNAC). The main purpose of this study is to evaluate the efficacy of USG-FNAC and its accuracy. We retrospectively studied 212 thyroidectomy cases with preoperative ultrasonography and FNAC data during the period 2015-2022 using TI-RADS for final ultrasound diagnosis and Bethesda system for cytological diagnosis. The studied cases were 200 females and 12 males. Thyroid cancer was more prevalent under 20 years old (78.5%). Papillary thyroid carcinoma comprises 84% of all cancer cases. Significant ultrasound features (p-value <0.05) favour malignancy were hypoechogenicity (66%), mixed echogenicity (84%), irregular border (61%), microcalcification (68%) and rim halo (63.6%). Malignancy was found in 21% of TI-RADS-2, 65% of TI-RADS-4 and 100% of TI-RADS-5. There is a significant difference between different categories of Bethesda system. All cases in Cat-VI were malignant (100%). Malignancy was also found in 81% of Cat-V, 20% of Cat-IV, 33% of Cat-III, 16% of Cat-II and 43% of Cat-I. Cytological features consistent with malignancy were as follows: grooving (94%), nuclear irregularities (89%), nuclear pseudoinclusion (89%) and little colloid (82%). In our study, USG-FNAC sensitivity was 83%, specificity 85%, PPV 85%, NPV 83% and accuracy 84%. Ultrasound features in favour of malignancy in thyroid nodules are hypoechoic or complex echogenicity, irregular border, punctuate calcification and presence of rim halo. Cytological features in favour of malignancy are grooving, nuclear irregularities, nuclear pseudoinclusion and little or absent colloid.

Imidacloprid‐associated toxicity in the midgut of Sarcophaga ruficornis: Exploring histopathological, ultrastructural and biochemical alterations

AbstractThis study investigates the impact of imidacloprid insecticide, on the flesh fly Sarcophaga ruficornis, (Diptera: Sarcophagidae), a medically and veterinary significant species associated with myiasis. Lethal (0.02%) and sub‐lethal (0.004%) doses were administered over 24 and 48 h, focusing on midgut histopathological, ultrastructural and biochemical alterations. Imidacloprid‐induced disruptions in physiological and metabolic functions, leading to adult fly mortality. Histological and cytological analyses revealed significant cellular changes, including cell degeneration, cytoplasmic vacuolization, chromatin condensation, irregular epithelial borders, disrupted peritrophic membrane and the release of cell components into the midgut lumen. Biochemical analyses demonstrated a decrease in total protein, carbohydrate and lipid contents, correlating with insecticide concentration and duration. Antioxidant enzymes, particularly glutathione S‐transferase (GST) and superoxide dismutase (SOD), resulted in a significant increase compared to the control, proportional to time and concentration. This research provides a comprehensive understanding of imidacloprid‐induced toxicity in the midgut of Sarcophaga ruficornis, emphasizing its potential for effective pest population management.

Performance of O-RADS MRI Score in Differentiating Benign From Malignant Ovarian Teratomas: MR Feature Analysis for Differentiating O-RADS 4 From O-RADS 2.

The aim of the study is to evaluate the performance of the ovarian-adnexal reporting and data system magnetic resonance imaging (O-RADS MRI) score and perform individual MRI feature analysis for differentiating between benign and malignant ovarian teratomas. In this institutional review board-approved retrospective study, consecutive patients with a pathology-proven fat-containing ovarian mass imaged with contrast-enhanced MRI (1.5T or 3T) from 2013 to 2022 were included. Two blinded radiologists independently evaluated masses per the O-RADS MRI lexicon, including having a "characteristic" or "large" Rokitansky nodule (RN). Additional features analyzed included the following: nodule size/percentage volume relative to total teratoma volume, presence of bulk/intravoxel fat in the nodule, diffusion restriction in the nodule, angular interface, nodule extension through the teratoma border, presence/type of nodule enhancement pattern (solid versus peripheral), and evidence for metastatic disease. An overall O-RADS MRI score was assigned. Patient and lesion features associated with malignancy were evaluated and used to create a malignant teratoma score. χ 2 , Fisher's exact tests, receiver operating characteristic curve, and κ analysis was performed. One hundred thirty-seven women (median age 34, range 9-84 years) with 123 benign and 14 malignant lesions were included. Mean teratoma size was 7.3 cm (malignant: 14.4 cm, benign: 6.5 cm). 18/123 (14.6%) of benign teratomas were assigned an O-RADS 4 based on the presence of a "large" (11/18) or "noncharacteristic" (12/18) RN. 12/14 malignant nodules occupied >25% of the total teratoma volume ( P = 0.09). Features associated with malignancy included the following: age <18 years, an enhancing noncharacteristic RN, teratoma size >12 cm, irregular cystic border, and extralesional extension; these were incorporated into a malignant teratoma score, with a score of 2 or more associated with area under the curve of 0.991 for reviewer 1 and 0.993 for reviewer 2. Peripheral enhancement in a RN was never seen with malignancy (64/123 benign, 0/14 malignant) and would have appropriated downgraded 9/18 overcalled O-RADS 4 benign teratomas. O-RADS MRI overcalled 15% (18/123) benign teratomas as O-RADS 4 but correctly captured all malignant teratomas. We propose defining a "characteristic" RN as an intravoxel or bulk fat-containing nodule. Observation of a peripheral rim of enhancement in a noncharacteristic RN allowed more accurate prediction of benignity and should be added to the MRI lexicon for improved O-RADS performance.