Irregular Borders Research Articles

The effect of conditioned media on mouse oocytes ultrastructure following in vitro maturation

Optimizing the culture condition and vitrification process during in vitro maturation (IVM) of oocyte has been controversial. This study aimed to evaluate the effect conditioned medium (CM) enriched with human mesenchymal stem cells (hUCM) derived from bone marrow and umbilical cord blood on the ultrastructure of immature mouse oocytes during IVM. Three hundred ninety-two germinal vesicle (GV) oocytes were obtained from mouse ovaries. They were divided into fresh IVM (fIVM) and vitrified IVM (vIVM) groups and cultivated in either alpha Minimum Essential Medium (α-MEM) (control) or CMs supplemented with supernatants derived from cultures of bone marrow or umbilical cord mesenchyme stem cells (MSCs). Then the maturation rate was evaluated in the experimental groups. Twelve in vivo fresh mature oocytes were randomly obtained from uterine tubes as the control group. Finally, 43 matured IVM oocytes were randomly selected for ultra-structural evaluations using transmission electron microscopy (TEM). Oocyte maturation rates were significantly higher in fIVM than vIVM groups. The highest maturation rate was observed in the fIVM umbilical cord MSCs while the lowest rate was related to α-MEM vIVM (86.44% vs 72.72%). There was an increase in the number of mitochondria–vesicle (MV) complexes in IVM groups. Also, the distribution of cortical granules showed the highest decline in α-MEM vIVM groups. The highest aggregations of mitochondria–SER (M-SER) were observed in fIVM umbilical cords. Oolemma had an irregular border with small microvilli in vIVM groups. The Zona pellucida was darker in the vIVM than fIVM groups. In conclusion, umbilical cord MSCs showed a superior efficacy than bone marrow cells for supporting oocyte maturation and conserving its ultrastructure.

Efektivitas multi drug therapy pada transmisi morbus hansen transplasental

Introduction: The evidence of transplancental transmission of Morbus Hansen (MH) in animal models is a challenge for MH treatment in pregnancy because it brings anxiety for patients and their fetuses. Case: A 31-year-old pregnant woman, first trimester, came with complaints of reddish numbness rash on her hands since 2 years ago. Dermatological examination showed erythematous plaque, multiple, well-defined, irregular borders with hypoaesthesia. There were right and left ulnar nerve enlargement. Acid Fast Bacteria (AFB) from ear lobes and lesion revealed Bacterial Index +2 and Morphological Index 10%. Histopathological examination showed gren zone which indicate MH type BL. Patient was diagnosed with MH Multi Basiler (MB) on G3P2002Ab000 and given MDT MHMB. Postpartum IgM and IgG anti-PGL-1 examination of cord blood and infant blood, also PCR examination of cord blood and amnion showed negative results. Histopathological examination found no AFB on the umbilical cord and placenta. Conclusion: MDT is effective in preventing transplacental transmission of MH from mother to fetus.

Thyroid Multimodal Ultrasound Evaluation—Impact on Presurgical Diagnosis of Intermediate Cytology Cases

Fine needle aspiration (FNA) is recommended as the final evaluation in diagnosing thyroid nodules. Intermediate cytology is observed in about 15%–25% of the FNA results and has divergent recommendations: follow-up or surgery, either hemi- or total thyroidectomy. The present study aimed to assess the benefit of multimodal ultrasound (US) evaluation in clarifying the attitude in cases with intermediate cytology on FNA. Sixty-four successive cases with Bethesda III or IV cytology results were evaluated using two-dimensional B-mode US (2B), qualitative strain elastography, as well as planar and volumetric (3D) color Doppler using both a linear multifrequency probe and a linear volumetric probe (Hitachi Preirus Machine, Hitachi Inc. Japan). The analyzed nodules were all categorized as low, intermediate, or high risk, based on the following US criteria: taller-than-wide shape, marked hypoechogenicity, irregular borders, inhomogeneity, microcalcifications, or the presence of suspicious adenopathy. Elastographic criteria included stiff lesions, while volumetric Doppler criteria included moderate and marked perinodular vascularization, as suspicious for malignancy. The gold standard for the analysis was the result of the pathology report after thyroidectomy. Our results showed that the prevalence of cancer was 25% (16 cases). In five cases, borderline follicular neoplasia was identified, group which requires watchful waiting. These lesions were also considered as malignant in the final analysis, with a total number of 21 neoplasm cases. Sixteen of the 21 malignant nodules presented with high stiffness, while 15/21 had increased perinodular vascularization. Eight of the 21 cases displayed both important stiffness and perinodular vascularization. Cancer prevalence increased both with severity of stiffness (9.0%–15.0%–66.6%–80.0%) and intensity of vascularization in the adjacent perinodular parenchyma (18.2%–27.7%–35.29%–50.0%). Combining the use of grayscale US, elastography, and 3D Doppler in the evaluation of intermediate cytology cases showed a sensitivity of 85.7%, a specificity of 88.3%, and an accuracy of 90.3% in detecting thyroid cancer cases. We can conclude that the identification of highly suspicious US characteristics observed in 2B, qualitative elastography, and volumetric Doppler increases the risk of malignancy.

MON-479 Acute Thyroid Edema: A Rare Complication of Thyroid Fine Needle Aspiration

Background: Acute thyroid swelling is a rare complication of thyroid fine needle aspiration (FNA). The first documented case was in 1982 and to date there are less than 20 cases currently reported in the literature (1). Case Presentation: A 66-year-old female with a history of non-ischemic cardiomyopathy and heart failure was admitted to hospital to expedite heart transplant evaluation. A neck ultrasound was performed due to voice hoarseness and concern for vocal cord nodules. The ultrasound showed a 1.3 cm hypoechoic nodule in the right thyroid lobe. Given that the nodule had irregular borders and microcalcifications, a thyroid FNA was recommended.The patient’s home warfarin had been held for at least three days prior to the biopsy and her INR on the procedure date was 1.4. Her heparin drip was held four hours prior to the thyroid FNA. Immediately following the procedure, a 3.2 cm hematoma formed inferior to the thyroid gland. The heparin drip was restarted 6 hours post-FNA as per radiology’s recommendation. Cytology of the nodule was benign.The patient recovered well post FNA and improvement in the hematoma was noted on exam. Her hemoglobin was stable and she was restarted on warfarin. On day two post thyroid FNA, she reported significant neck pain, with no corresponding increase in the extra-thyroidal hematoma. No stridor or other concerning features were present on exam. A repeat thyroid ultrasound was performed three days after the FNA. It demonstrated fluid filled ‘cracks’ within the thyroid parenchyma and tripling in the volume of the thyroid gland, concerning for diffuse edema. No heterogeneity or subcapsular thickening was seen to suggest hemorrhage, and the previously demonstrated 3.2 cm extra-thyroidal hematoma was not visualized.She was treated with ibuprofen 800 mg and prednisone 30 mg, and noted an improvement in her neck pain with these measures. A repeat ultrasound done three weeks after initial thyroid FNA showed marked improvement of the diffuse swelling. Conclusion: The phenomenon of diffuse thyroid edema after fine need aspiration has been termed acute thyroid swelling (ATS). Given how frequently thyroid fine needle aspirations are performed, ATS appears to be a very rare complication. The etiology of ATS remains unknown, but the use of blood thinners, such as in our patient, does not appear to be a risk factor (1). The radiological appearance of fluid filled ‘cracks’ within the thyroid parenchyma suggests a more diffuse process, rather than a localized reaction. While NSAIDs or steroids may help with symptoms, patients appear to improve irrespective of whether or not medications are given. This suggests that ATS is a self-limiting condition without long term complications. Reference: (1) Polyzos SA, Anastasilakis AD, Arsos. Acute transient thyroid swelling following needle biopsy: An update. Hormones. 2012;11(2);147-150

SUN-491 A Diagnosis of Thyroid Cancer Reveals a Triple Threat

Introduction: The risk of secondary malignancies is increased in patients with papillary thyroid cancer (PTC). It is not completely clear if this risk is due to radioactive iodine treatment or due to other causes. We present a case of a patient diagnosed with papillary thyroid cancer (PTC) found to have lung cancer and small lymphocytic lymphoma which appear to be unrelated to radioactive iodine treatment.Case Presentation: A 72 yo woman with a history of Graves’ disease, atrial fibrillation, and hyperparathyroidism initially presented to care for weight loss. She was found to have hyperthyroidism and was treated with methimazole. Thyroid ultrasound revealed multiple nodules including a 17mm right lower pole nodule with irregular borders for which she underwent FNA. Pathology demonstrated atypical-cells of undetermined significance (AUS), but thyroseq revealed a BRAF V600E mutation. She underwent total thyroidectomy with pathology showing multifocal thyroid cancer, 12mm and 0.8mm with 3/11 involved lymph nodes and right parathyroid adenoma. Given a questionable lower left lung nodule on preop CXR, she underwent CT chest which revealed a 2cm lung nodule. She had video assisted thoracoscopic (VATS) left lower lobe wedge resection with completion left lower lobectomy for a 3 cm lung adenocarcinoma with negative margins and 33 negative lymph nodes. She was subsequently treated with RAI after recovery from VATS procedure. Pretreatment thyroglobulin was 0.8 ng/ml with negative thyroglobulin antibodies. One month after her RAI treatment, ultrasound of the neck revealed suspicious bilateral level IV lymph nodes which increased in size during short term follow up. Serum thyroglobulin was 0.3ng/ml with negative antibodies and TSH 0.29 mIU/L. Biopsy of right level IV lymph node was positive for PTC with thyroglobulin washout >5000 while left level IV lymph node was negative for PTC and Tg washout was 0.1. She subsequently underwent right-sided modified radical neck dissection, with lymph nodes revealing PTC also involved by small lymphocytic lymphoma. She had repeat RAI ablation for thyroid cancer and is being actively monitored for her small lymphocytic lymphoma and lung adenocarcinoma.Conclusion: We present a patient with no known history of malignancy who presented with 3 de novo primary malignancies. This case may demonstrate an increased risk of malignancy in patients with thyroid cancer not necessarily related to radioactive iodine treatment.

Acquired agminated melanocytic nevus in the acral area is a potential mimicker of acral lentiginous melanoma: A three-case series report and published work review.

Agminated nevus refers to a clustered group of melanocytic nevi confined to a localized area of the body. It rarely involves acral skin, but recognition of acquired agminated nevus (AAN) in the acral area is clinically important because it may mimic acral lentiginous melanoma (ALM). However, acral AAN has only been described in a few case reports and its clinical characteristics remain unclear. We report three additional cases of acral AAN to further analyze the differential points between ALM. Clinical images, including those of dermoscopy, of three cases of acral AAN were reviewed. The lesions were located on the sole or lateral border of the foot. All acral AAN were flat and large in size (>20mm in greatest dimension), and associated with asymmetry and irregular border. However, no parallel ridge pattern suggesting ALM was observed on dermoscopy. In two patients, the lesions on the sole were totally resected; microscopic evaluation of these two lesions confirmed junctional nests of banal melanocytes. AAN lesions on the sole with chronic mechanical pressure are slightly larger and more diffuse; thus, they may be more likely to be overdiagnosed as malignancy upon inspection than those in the non-acral area. Understanding the concept of the disease and careful dermoscopic evaluation leads to an accurate diagnosis.

MRI Lymph Node Evaluation for Prediction of Metastases in Rectal Cancer.

To explore whether the size and characteristics of the largest regional lymph node in patients with rectal cancer, based on magnetic resonance imaging (MRI), following neoadjuvant therapy and before surgery, is able to identify patients at high risk of developing metachronous metastases. A retrospective case-control study with data from the Swedish Colo-Rectal Cancer Registry. Forty patients were identified with metachronous metastases (M+), and 40 patients without metastases (M0) were matched as controls. Patients with M+ disease were more likely to have a regional lymph node measuring ≥5 mm than patients with M0. (87% vs. 65%, p=0.02). There was also a significant difference between the groups regarding the presence of an irregular border of the largest lymph node (68% vs. 40%, p=0.01). Lymph nodes measuring ≥5 mm with/without displaying irregular borders at MRI performed after neoadjuvant therapy emerged as risk factors for metachronous metastases in patients with rectal cancer. Intensified follow-up programmes may be indicated in these patients.

Efficacy of new fungicides against sheath blight disease management of rice caused by Rhizoctonia solani under field condition

Rice (Oryza sativa L.) is second most important cereal and the staple food for more than half of the world’s population. Sheath blight is one major biotic constraints that affects rice production in India and is considered economically important disease of rice in the world The disease is caused by Rhizoctonia solani Kuhn (Teleomorph: Thanetophorus cucumeris (Frank) Donk), a fungal pathogen of both rice and soyabeans. The yield loss due to this disease is reported to range from 5.2-50 per cent depending on the environmental conditions, crop stages at which the disease occurs, cultivation practices and cultivars used. The disease has been named as “sheath blight” because of primary infection on leaf sheath. The fungus attack the crop from tillering to heading stage and leaf blade symptoms also observed. Initial symptoms are noticed on leaf sheath near water level. As the spot enlarge, the centre become grayish with irregular brown blackish border. The fungus Rhizoctonia solani produced usually long cells of septate mycelium which are hyaline within young, yellowish brown. It produced large number of globose sclerotia which initially turn white, late turn brown to purplish brown. Sclerotia as a major source of primary inoculum.In the study an experiment was laid out in the field condition during 2017-18 at experimental field of IGKV, Raipur to control the sheath blight disease of rice by application of different doses of chemical fungicide, the treatment of Propiconazole 13% + Difenconazole 13.9% SC (Tespa), Propiconazole 25% EC (Tilt), Tebuconazole 50% +Trifloxystrobin 25% WG (Nativo), Azoxystrobin 23% EC (Amistar), Validamycin 5% L (Vamcin), Captan 70% + Hexaconazole, WB (Takat), Hexaconazole 5% EC (Contaf), Carbendazin 50 WP (Bavestin) where tested in field under artificial condition. The Hexaconaxoke 5% EC found highly effective in reducing the Sheath blight disease severity (11.11%) and increase the grain yield (5566 kg/ha). The maximum disease severity (20.77%) and lowest grain yield (2600 kg/ha) was recorded under control condition.

Skin malignancy initially misdiagnosed as a benign epidermal cyst

Skin cancer, which often occurs as a result of skin exposure to ultraviolet light radiation, usually presents with characteristic abnormal features, such as ulcerative lesions, irregular morphology, bleeding, and excessive growth. Therefore, skin cancer rarely resembles a benign tumor on visual inspection. Nonetheless, squamous cell carcinoma and basal cell carcinoma with nodular or polypoid features can have a similar appearance to that of benign tumors, meaning that they are sometimes misdiagnosed as benign. As benign and malignant tumors have some overlapping features, clinicians sometimes use additional imaging techniques such as ultrasonography to improve the accuracy of the diagnosis because even a malignant tumor that externally resembles a benign tumor generally has internal morphological features characteristic of malignancy, such as invasion and irregular borders. However, these imaging tools also have limitations, and punch or excisional biopsy can be needed if malignancy cannot be completely ruled out. Herein, we report a case of skin malignancy initially misdiagnosed as a benign epidermal cyst based on external visual inspection and ultrasonography.

Becker’s Nevus in a 24-Year-Old Female Patient with Rheumatoid Arthritis: A Case Report of a Laser Therapy Without Recurrence

Introduction: Becker’s nevus is a type of cutaneous hamartoma that occurs as a brown hyperpigmented patch with irregular borders. The exact pathogenesis of Becker’s nevus is not clear, but hormonal disturbances might play a triggering role. Q-switched lasers have demonstrated favorable effects on improving hyperpigmentation lesions; however, following using a Q-switched laser, the nevus usually reoccurs. Case Presentation: In this study, we described a 24-year-old female patient with Becker’s nevus treated with Q-switched ruby laser (694 nm) whose lesion recovered without any complications or recurrence. The patient had rheumatoid arthritis and has been taking oral methotrexate, hydroxychloroquine, and prednisolone for ten years. Conclusions: Although hyperpigmentation has reported following laser therapy, our patient did not develop any pigmentation, and the lesion did not recur, which can be due to her concurrent drugs, suggesting the role of the immune system in recurrence of Backer’s nevus.

Animating characters in Chinese painting using two-dimensional skeleton-based deformation

Chinese painting is always a kind of resource to explore ancient Chinese dynasties and the ideology of painters. Nowadays, more and more Chinese-antique museums have created corresponding animations from Chinese painting for representing daily life of ancient Chinese and providing immersive experience to attract visitors. However, it is not easy to produce animation sequences directly from Chinese paintings. It is laborious and time-consuming to build every motion of animated characters in Chinese painting. Since the irregular borders of characters in Chinese painting are torn and the connectivity of stroke line will be lost while implementing deformation. This research therefore presents a procedure of generating Chinese painting animation sequences to overcome these problems. It focuses on two technical issues: sample point processing and animation generation. Sample point distribution and allocation are the major tasks in sample pint processing. A point distribution method is proposed to preserve connectivity of stroke line of object and a weight scheme is implemented to decide control bone of individual sample points. For the stage of animation, the skeleton-based deformation is firstly used to generate key frames through user-provided skeleton. Then an interpolation method is exploited to create smooth animations. The proposed scheme could also be applied to multiple-character and multiple-skeleton animations.

Differentiating between glioblastomas with and without isocitrate dehydrogenase gene mutation by findings on conventional magnetic resonance images

Various studies using advanced techniques have estimated the isocitrate dehydrogenase (IDH) gene mutation status in glioblastoma (GBM) from preoperative images. However, it is important to be able to predict mutation status using conventional MRI, which is more widely used in clinical practice. In this study, we examined the features of GBM with and without IDH gene mutation on conventional MRI. Twenty-three patients with GBM in whom IDH gene mutation status had been pathologically and molecularly confirmed in tumor specimens were included. The cases were divided into an IDH-wildtype group (n = 17) and an IDH-mutant group (n = 6). We retrospectively compared the following imaging parameters between the two groups: tumor location (superficial or deep), borders on T2-weighted images (regular or irregular), borders of enhancing lesions (regular or irregular), number of lesions showing contrast enhancement (solitary or multiple), presence or absence of intralesional bleeding, and presence or absence of a low-grade glioma in the background around the enhancing lesion. IDH-wildtype tumors were significantly more likely to be superficial than were IDH-mutant tumors (p < 0.05). Enhancing lesions in the IDH-wildtype group were less likely to have an irregular border (p = 0.059). Low-grade glioma was a background lesion in 5 patients (83.3%) in the IDH-mutant group and 9 (52.9%) in the IDH-wildtype group. The IDH mutation status is likely to be wildtype in patients with superficial GBM in which the enhancing lesion has a regular border and when low-grade glioma is not found as a background lesion on MRI.

Spontaneous Splenic Rupture Case Report: an Approach to Anatomy Importance for Radiological Correlation

Spontaneous splenic rupture (SSR) is a rare entity 1, usually associated with hematologic malignancies, infectious processes or inflammatory diseases. Timely diagnosis by ultrasound and/or computed tomography 1 allows early clinical and/or surgical management 2, reducing the mortality 1.Our aim is to expose, through a clinical case of SSR, the importance of anatomy knowledge and its radiological correlation in medical education.A 26‐year‐old man, diagnosed with chronic myeloid leukemia (CML) without chemotherapy treatment, attends to the emergency department for 10/10 (VAS) colic pain in the right inferior abdominal quadrant, irradiated to the ipsilateral inguinal region, associated with non‐emetic nauseas, abdominal distention and dysuria. At presentation, heart rate was 80 beats/minute, respiratory rate 18 breaths/minute, blood pressure 123/71 mmHg, temperature 36.0 ° C and SatO2 87%.Initial workup positive findings were leukocytosis (270.000/mm3), low hemoglobin (11.2 g/dL) and hematocrit (33.3%), thrombocytosis (925.000 platelets), and Hypokalemia (2,96 mEq/L). Abdominal computed tomography showed hepato‐splenomegaly and a poorly defined lesion with irregular borders, infiltration and vascular tracts on the spleen inferior segment. Considerable accumulation of free liquid in the abdominal cavity was present.After 2 hours the patient reported an increase in pain, associated to abdominal guarding and rebound tenderness. Heart rate of 134 beats/minute, respiratory rate 30 breaths/minute, blood pressure 150/70 mmHg, SatO2 84% and metabolic acidosis (pH 7.0).Based on the suspicion of hypovolemic shock, an emergency xipho‐pubic laparotomy was performed, finding a 1500cc hemoperitoneum, active bleeding, clots and splenic segments. Complete splenectomy was selected obtaining a surgical specimen (spleen) of 2 Kg, 32 cm in cephalo‐caudal length, and a lower pole rupture. Patient’s postoperative evolution was satisfactory, specific treatment for CML was initiated and he was discharged 14 days after the surgical procedure.An early diagnosis is crucial for the reduction of morbidity and mortality in patients suffering a SSR. This is carried out through the proper interpretation of diagnostic images. This clinical approach requires a broad body anatomy knowledge, and the capacity to extrapolate it to a bidimensional representation. Several researchers confirm that the inclusion of diagnostic‐images in the anatomy curriculum leads to an early exposure of medical student to these tools, which improves their imaging interpretation and diagnostical skills 2. Finally, the implementation of these diagnostic tools in the anatomy program could lead to better medical practice and, as seen in this case, to a reduction on mortality.

Penile necrosis due to calciphylaxis in peritoneal dyalisis patient: a case report

Introduction: Calciphylaxis (or calcific uremic arteriolopathy) is a life-threatening condition that affects 1–4% of patients with end-stage renal disease (ESRD). Penile necrosis is one of the complications of calciphylaxis that occur in ESRD patients undergone haemodialysis. Although rarely happen, this condition is potentially life-threatening and usually has a poor prognosis. It is associated with diabetes mellitus (DM), cholesterol embolism. The treatment varies, from surgical to conservative, and is usually depends on patient’s general condition.Case presentation: A 41-years-old male, known to have ESRD and underwent hemodialysis for 1 year in 2014, but has been switched to peritoneal dialysis ever since, presented with complaints of severe pain, purulent and progressive necrosis of glans penis within the last two months, and history of long-term DM and hypertension. Physical examination showed that the patient was alert, with blood pressure of 141/80 mmHg, pulse rate of 88 bpm, respiration rate of 20 times per minute, and temperature of 36.8ºC. A yellow purulent tissue was noticed over the glans penis, foul-smelling discharge was observed from urethra and undersurface of penile lesion. Laboratory examination showed elevated calcium level of 7.3 mg/dL. Ultrasound revealed multiple calcifications at the base of penis, hypoechoic lesion, nearly circular, irregular border, likely sac with thin wall, attached to the gland penis, and filled with exudate. Doppler confirmation showed avascular area. The patient was treated with partial penectomy, debridement, and antibiotic.Conclusion: Calciphylaxis in peritoneal dialysis patients as reported in this case was rarely found. Although the treatment is still debatable, however, we decided to impose surgical approach in this patient along with antibiotics. Despite its poor prognosis, the patient in this case showed improvement after the procedure.

The neuroblastoma: A case report and review

The neuroblastoma: A case report and review - IJMPO- Print ISSN No: - 2581-4699 Online ISSN No:- 2581-4702 Article DOI No:- 10.18231/j.ijmpo.2019.032, IP International Journal of Medical Paediatrics and Oncology-IP Int J Med Paediatr Oncol

AVALIAÇÃO DAS CARACTERÍSTICAS SUPERFICIAIS DOS INSTRUMENTOS RECIPROC, RECIPROC BLUE E XP-ENDO SHAPER

Introduction: The quality control of endodontic instruments is extremely important since defects and failures on their surface, during their manufacturing process, can compromise the preparation of root canal. Objective: this study evaluated the presence of defects and failures in the manufacturing process on the surface of Reciproc (R25), Reciproc Blue (RB25) and XP endo-shaper (XP) instruments by means of scanning electron microscopy (SEM). Materials and Methods: In total, sixty nickel titanium instruments (n=20): R25, RB25 and XP were evaluated in the scanning electron microscope in three regions: 0mm (tip of the instrument), 4mm and 7mm of the tip, with a magnification of 100x. The images were evaluated in relation to the number of manufacturing faults (irregular border, groove, microcavity and burr) and by a system of scores, from 1 to 4, where 1 is no defective area and 4, more than five areas with defects on the surface. The data were submitted to statistical analysis using Kruskal-Wallis and Mann-Whitney tests (p<0.05). Results: Regarding the analysis by regions, significant differences were identified in most of the instruments. Comparing the different instruments, no significant difference was observed for microcavity (p=0.76), irregular border (p=0.98) and burr (p=0.40). The R25 instrument showed a greater number of grooves compared to the others (p=0.0000*). RB25 showed higher scores than the R25 (p=0.0002) and XP (p=0.01) instruments. Conclusion: All evaluated instruments showed defects/failures in the manufacturing process.

P1345 Tumors metastatic to the heart :Echo, CT, CMR Imaging

Abstract Background The frequency of secondary metastatic tumors has increased over years attributable to increased life expectancy in oncologic patients. Imaging with different methods: echo, CMR, CT and PET can provide noninvasive characterization of cardiac masses. We present 3 cases of cardiac metastasis, different for localization in the heart, pathways of dissemination and relation with neighboring structures. Case 1: a 62-years-old male was admitted to Cardiology department for chest pain and epistaxis. Patient’s medical history was negative for cardiovascular disease. The routine TTE detected a rounded,immobile,intra-myocardial mass (Panel A, fig.1) a the level of the interventricular septum protruding in the LV cavity. The mass was characterized by several anecogenic cavities and echo-contrast showed slight late hyperenhancement of the mass confirming vascularity (fig. 2).CMR gadolinium imaging confirmed late enhancement at the level of the edges of the cavities and in the external border (fig.4). In the suspicion of neuroendocrine tumor, a Gallium-68 dotatate PET/CT was performed with detection of pathological uptake at the abdominal and cardiac level (fig.3). Case 2: a 64-years-old woman presented with shortness of breath, fatigue and weight loss in the past three months. History of smoke was present and diagnosis of non-small cell lung cancer was made. PET-CT demonstrated pathological uptake at pulmonary, limph-nodes, adrenal, hepatic, bone, muscular and pericardial level (Panel B, fig.1).CMR clearly revealed a massive lesion (7x3x3.5 cm) at the level of the LV antero-lateral wall (fig.2) and TTE SAX view (fig.3) confirmed the presence of a large infiltrative immobile mass in the antero-lateral wall. In the same region the pericardium was irregular and thickened suggestive of pericardial tumor involvement. Some degree of pericardial effusion was also present. The ECG was consistent with ST-T elevation in D1 and aVL in absence of ischemic symptoms (fig.4).Case 3: a 78-years-old man known for non-small cell lung cancer underwent transthoracic echo for monitoring cardiotoxicity.Two–chamber TTE showed a intra-myocardial mass in the inferior wall of LV and another rounded mass at the left atrial level (Panel C, fig.1). Chest CT showed the pulmonary mass with irregular borders, intravascular invasion of left lower pulmonary vein (LLPV) and extension into the left atrium (fig.2).2D/3D TEE well demonstrated the atrial invasion by the mass composed by one more echogenic part inside the llpv and outside in the left atrium a rounded head with several region of cystic colliquation (fig.3). Attached to the rounded head irregular protuberances was noted (thrombus?, fig.4). Conclusion: metastasis to the heart and pericardium are much more common than primary cardiac tumors and occur late in the course of malignant disease. Echo is the initial diagnostic test to evaluate for the presence of cardiac metastases. Abstract P1345 Figure. Different cases of cardiac metastasis

Lymphome cutané métamérique mimant un pyoderma gangrenosum Metameric cutaneous lymphoma mimicking a pyoderma gangrenosum

Primary cutaneous lymphomas are malignant lymphocyte proliferations starting from the skin. Their clinical presentation is often stereotyped. We report the case of a 73-year-old woman who has been presenting, for the past 06 months, deep ulcerations with irregular borders, sanious and purulent bottom, located on the left upper leg with a metameric disposition mimicking a pyoderma gangrenosum. Nonetheless, the skin biopsy confirms the diagnosis of cutaneous anaplastic large cell lymphoma CD30 +. The assessment did not show extracutaneous involvement. This case illustrates the particularity of cutaneous lymphomas that can take different clinical forms, sometimes responsible for a diagnostic delay. The prognosis of CD30 + anaplastic cutaneous lymphoma remains good despite its often disturbing clinical presentation. However, the multicentric involvement associated with an atypical presentation seems to make its evolution less innocuous and requires a rigorous follow-up.

Visual Vignette

Case Presentation: A 40-year-old female without significant past medical history initially presented to primary care with 12 months of left-sided neck pain with point tenderness in the lower neck and minimal improvement in pain despite several weeks of physical therapy for presumed musculoskeletal pathology. She noted recent hoarseness but no dysphagia, dyspnea, and no changes to her weight or heat/cold tolerance. On exam, a discrete left-sided thyroid nodule was palpated. Thyroid ultrasonography was performed, revealing a 1.0 × 1.0 × 1.5 cm solid, hypoechoic, taller-than-wide nodule with irregular borders in the left thyroid lobe (Fig.

Intra-Operative Dermoscopy in Assessment of Melanonychia and as a Guide for Biopsy.

Background and Aims:Melanonychia can be a manifestation of benign or malignant pathology and often poses a diagnostic challenge on clinical examination. Even with distinguishing dermoscopic features (nail plate), it can be quite difficult to determine the nature of pigmentation as complete assessment of nail bed and matrix is still not possible. Intraoperative dermoscopy (IOD) can serve as a useful tool to appreciate the bed and matrix changes. The aim here is to study the intraoperative dermoscopic features in patients with melanonychia and correlate with histopathology.Methods:20 consecutive patients with melanonychia were recruited. Inclusion criteria was melanonychia of sudden onset, progressive nature, irregular width/color/symmetry on dermoscopy, positive Hutchinson sign, solitary nail involvement or associated nail dystrophy. Preoperative dermoscopy was performed and recorded. Patients were planned for nail matrix biopsy, during which IOD was performed over nail matrix and bed after removal of the nail plate. Images were recorded and analyzed and correlated with the histopathology.Results:Out of 20 patients, 12 were females and 8 males. On IOD-histopathological correlation, 2 patients were found to have melanoma of the nail unit, 5had nail lichen planus, 9 had benign melanocytic nevi, and 4 had fungal melanonychia. IOD revealed fine, parallel and regular lines of pigmentation localized to proximal nail bed and matrix in all patients with benign melanonychia, while dark thick bands with irregular borders, dots, globules, streaks and structureless areas in the two patients with melanoma. Fungal melanonychia revealed an unremarkable nail bed and matrix on IOD.Conclusion:Intraoperative dermoscopycan help in determining the nature of melanonychia and obviate the need to perform biopsy in certain cases. It can also aid in delineating the most suitable site for biopsy, along with grossly assessing the extent of involvement in case of malignancy.