Irregular Borders Research Articles

Breast metastasis from an olfactory esthesioneuroblastoma: A case report and review of the literature

Metastases to the breast from an extra-mammary malignancy are extremely rare. Lymphomas and melanomas are the most commonly reported secondary tumors in the breast. Breast metastasis from an esthesioneuroblastoma is extremely rare and only 3 cases are described in the literature. We herein report another case of 31 year-old woman diagnosed with an esthesioneuroblastoma since two years, who presented to our hospital for a breast rapidly growing mass in the right upper inner quadrant. On physical examination, this mass measured 3cm, was firm with no skin retraction and no nipple discharge. Imaging features revealed multiples nodules with irregular border. A fine needed biopsy was performed. On pathological examination, the tumor was arranged in nests and lobules of monotonous tumor cells with round nuclei, indistinct nucleoli and scanty cytoplasm. On immunohistochemistry, the tumor cells were positive for chromogranin. Estrogen and progesterone receptors were negative as well as mammaglobin. Based on the pathological features and clinical history in conjunction with the immunohistochemical finding, the diagnosis of a metastasis of the esthesioneuroblastoma to the breast was made.Our case highlighted the importance of clinical history and imaging features when dealing with a breast lump.

A Probabilistic-Based Deep Learning Model for Skin Lesion Segmentation

The analysis and detection of skin cancer diseases from skin lesion have always been tedious when done manually. The complex nature of skin lesion images is one of the key reasons for this. The skin lesion images contain noise and artifacts such as hairs, oil and bubbles, blood vessels, and skin lines. They also have variegated colors, low contrast, and irregular borders. Various computational approaches have been designed in the past for aiding in the detection and diagnosis of skin cancer diseases using skin lesion images. The existing techniques have been limited due to the interference of the aforementioned features of skin lesion. Recently, machine learning techniques, in particular the deep learning techniques have been used for the detection of skin cancer. However, they are still limited to the fuzzy and irregular borders of skin lesion images coupled with the low contrast that exists between the diseased lesion and healthy tissues. In this paper, we utilized a probabilistic model for the enhancement of a fully convolutional network-based deep learning system to analyze and segment skin lesion images. The probabilistic model employs an efficient mean-field approximate probabilistic inference approach with a fully connected conditional random field that utilizes a Gaussian kernel. The probabilistic model further performs a refinement of skin lesion borders. The whole framework is tested and evaluated on publicly available skin lesion image datasets of ISBI 2017 and PH2. The system achieved a better performance, having an accuracy of 98%.

Infected Aortic Aneurysm Caused by Streptococcus zooepidemicus: A Case Report and Literature Review.

A 66-year-old Japanese male working at a stable developed abdominal pain and fever and was brought to the emergency department. The computed tomography scan revealed an aneurysm of approximately 70 mm in diameter, with an irregular border, at the infrarenal abdominal aorta. Emergency surgery was performed with a bifurcated Dacron graft. Streptococcus zooepidemicus was observed on the aneurysm wall. He was discharged in good condition and was prescribed oral amoxicillin/clavulanic acid for 4 months. He has remained well and did not develop inflammation. Evaluation of patient history and data, including the consumption of unpasteurized dairy food, occupation, and direct contact with animals, is important for an early diagnosis, a prompt surgery, and an appropriate antibiotic therapy.

Characteristics of Preferred Retinal Locus in Eyes with Central Vision Loss Secondary to Different Macular Lesions

ABSTRACT Objective: Preferred retinal locus (PRL) training has been applied to low-vision rehabilitation for patients with central vision loss (CVL). This study aimed to explore the characteristics of a natural PRL in eyes with different macular lesions. The data may be useful in customizing training programs. Methods: A total of 72 eyes with CVL were included and assigned into two groups. In group A, 29 eyes diagnosed with macular holes featured relatively sharp borders and small areas of lesions. In group B, 44 eyes showed lesions characterized by irregular borders and large areas. The PRL location relative to a scotoma in the retina, fixation stability, and the average threshold surrounding the PRL were determined and compared between the two groups. Results: In group A, the PRL was located above in 48.28%, below in 27.59%, left in 62.07%, right in 31.03%, and inside in 3.45% of the eyes. In group B, the PRL was located above in 39.53%, below in 4.65%, left in 44.19%, right in 6.98%, and inside in 27.91% of eyes. The amount of retinal displacement occurring within 1° from an initial reference point (P< .05) and the 95% bivariate contour ellipse area (P< .05) in group A were respectively higher and lower than those in group B. However, the average thresholds around the PRLs in the two groups showed no significant difference (P > .05). Conclusions: A PRL to the left of or above a scotoma tends to develop to avoid the right and inferior field defect, regardless of the scale and boundary of lesions. Although light sensitivity around a PRL shows no relation to lesion features, fixation stability is worse in irregular and large lesions.

First report of Colletotrichum chrysophillum causing cassava anthracnose in Brazil.

Cassava (Manihot esculenta Crantz) has significant socioeconomic relevance in Brazil and other developing countries, as one of the main sources of carbohydrates for human and animal consumption (De Oliviera et al., 2011). Among the cassava crop diseases, anthracnose is one of the main limiting factors for production and may be caused by species like Colletotrichum plurivorum, C. karstii, C. fructicola, and C. siamense (Bragança et al., 2016; Liu et al., 2019; Oliveira et al., 2016; Sangpueak; Phansak; Buensanteai, 2018). Severity in the field is variable, depending on the resistance of the variety used and is also highly influenced by the climate, being the most severe disease under high humidity and high temperature. Under these conditions, it can cause losses of up to 100%. In 2019, cassava leaves presenting dark brown necrotic injuries of different sizes and irregular borders-typical anthracnose symptoms- were collected from commercial plantations in the states of Pará and Tocantins, Brazil. Symptomatic tissue fragments were superficially disinfected, placed in plates with potato dextrose agar (PDA), and incubated under 25 ± 2 °C for seven days. In the 56 isolates used in the morphological identification, the colonies were white and gray at the top and dark gray in the bottom with sector formation. The conidia were hyaline, cylindrical, and aseptic, 10.04 to 17.83 μm long × 3.29 to 5.75 μm wide. These phenotypical characteristics were similar to those of C. gloeosporioides lato sensu species (Weir et al., 2012). Genomic DNA was extracted from two representative isolates (UFT/Coll69, collected in the municipality of Casa de Tábua-PA; UFT/Coll82, collected in Pau Darco-PA) and the APN2 / MAT-IGS, DNA lyase (Apn2), and glyceraldehyde-3-phosphate dehydrogenase-IGS (GAP2-IG) intergenic spacers were amplified and sequenced. The nucleotide sequences were deposited in the GenBank (accession numbers: MT409462, MT396231, MT759633, MT396239, MT396232, MT800846). The BLASTn (Basic Local Alignment Search Tool) showed a 99 to 100% similarity with Colletotrichum chrysophillum. The maximum likelihood phylogenetic analysis grouped the isolates in the C. chrysophillum clade, with a high bootstrap value (98%). Based on morphocultural characteristics and the phylogenetic analysis, the isolates associated with M. esculenta anthracnose were identified as C. chrysophillum, with a frequency of 6.67% among Colletotrichum colonies isolated from cassava leaves. The inoculation of three isolates was carried out in three plants, three leaves for each plant, by spraying spore solution with a concentration of 1×106 conidia / ml, without wounding the leaves and placed in a humid chamber at 25 ° C for ten days. Control plants were inoculated with sterile distilled water. From the 2nd day after inoculation, small irregular necrotic lesions appeared that increased in size over time, while control plants remained asymptomatic. Both were pathogenic and the symptoms caused after inoculation were similar to each other and to those observed in the field. In Brazil, anthracnose by C. chrysophillum was reported in cashew (Veloso et al., 2018) and banana trees (Vieira et al., 2017). To our knowledge, this is the first report of cassava anthracnose disease by C. chrysophillum.

Lung cancer mimickers - a case series of seven patients and review of the literature.

Background: Lung is the third most frequent identified site of malignancy and lung cancer is the most lethal type of cancer in the world. Several benign lung diseases or proliferations may mimic lung carcinoma in its clinical, pathological, and radiological presentation, which makes the differential diagnosis life changing. This case series was designed to describe the main diagnosis encountered in a multidisciplinary emergency hospital during the last years in Romania. Results: The most challenging cases encountered during the recent years were those of lung hamartoma associated with eosinophilic pneumonia because of the multicentricity of the disease and the suspicion for metastasis in the clinical setting, pulmonary aspergillosis that presented as a cystic lesion with a 9 mm mural nodule, actinomycosis discovered as firm nodule showing aspects of false pleural invasion, cryptococcosis – a hilar mass for which a pneumectomy was prepared, pulmonary parasitosis that presented as a nodule with irregular borders, causing pleural retraction, one case of inflammatory myofibroblastic tumor of the lung, one case of tumorlet type neuroendocrine lesion in a patient with history of melanoma and renal oncocytoma, admitted under the suspicion of lung metastasis. Conclusions: These are some of the main mimickers of primary or secondary lung cancers and one must be aware of these similitudes to avoid higher cost procedures, psychological stress for the patient and higher mortality.

ASCU-Net: Attention Gate, Spatial and Channel Attention U-Net for Skin Lesion Segmentation.

Segmentation of skin lesions is a challenging task because of the wide range of skin lesion shapes, sizes, colors, and texture types. In the past few years, deep learning networks such as U-Net have been successfully applied to medical image segmentation and exhibited faster and more accurate performance. In this paper, we propose an extended version of U-Net for the segmentation of skin lesions using the concept of the triple attention mechanism. We first selected regions using attention coefficients computed by the attention gate and contextual information. Second, a dual attention decoding module consisting of spatial attention and channel attention was used to capture the spatial correlation between features and improve segmentation performance. The combination of the three attentional mechanisms helped the network to focus on a more relevant field of view of the target. The proposed model was evaluated using three datasets, ISIC-2016, ISIC-2017, and PH2. The experimental results demonstrated the effectiveness of our method with strong robustness to the presence of irregular borders, lesion and skin smooth transitions, noise, and artifacts.

High-frequency ultrasound in the diagnosis of the spectrum of cutaneous squamous cell carcinoma: Noninvasively distinguishing actinic keratosis, Bowen's Disease, and invasive squamous cell carcinoma.

To evaluate high-frequency ultrasound (HFUS) features for diagnosing cutaneous squamous cell carcinoma (cSCC) as a spectrum of progressively advanced malignancies, including precursor actinic keratosis (AK), Bowen's disease (BD), and invasive squamous cell carcinoma (iSCC). In this retrospective study, 160 skin lesions diagnosed histopathologically (54 AK, 54 BD, and 52 iSCC) in 160 patients were included. The HFUS features of AK, BD, and iSCC were analyzed. The obtained data were evaluated using univariate and forward multivariate logistic regression analyses. The most significant HFUS features in AK were regular surface (odds ratio [OR], 8.42) and irregular basal border (OR, 6.36). The most significant HFUS features in BD were crumpled surface (OR, 19.62) and layer involvement confined to the epidermis (OR, 3.96). The most significant HFUS features in iSCC were concave surface (OR, 27.06), stratum corneum (SC) detachment (OR, 14.41), irregular basal border (OR, 4.01), and convex surface (OR, 3.73). The characteristics of surface features, basal border, and layer involvement could be valuable HFUS clues in the discrimination of AK, BD, and iSCC. High-frequency ultrasound is valuable for the differentiation of AK, BD, and iSCC, which may allow dynamic and noninvasive monitoring in the spectrum of cSCC.

An Unusual Presentation of Choriocarcinoma: A Case Report with a Long Latent Period

Introduction: Choriocarcinoma (CC) is a rare malignant tumor of trophoblastic tissue. This tends to invade rapidly to the vasculature and metastasis to the lung, vagina, brain, and liver. CC can present with a variety of manifestations, such as hemoptysis, gastrointestinal (GI) bleeding, and abnormal uterine bleeding. Commonly, the latent period to the development of CC is not more than 1 year after the antecedent molar or normal pregnancy. In this report, the patient developed CC about 32 months after her previous known pregnancy. We reported a rare case of gestational CC that occurred about 32 months after her antecedent pregnancy. Case Presentation: A 21-year-old admitted in shock with abnormal uterine bleeding, pain, and lower abdominal pain. The patient had one previous cesarean section 32 months prior to admission. The vaginal examination demonstrated a fused solid cervical mass with an irregular border measuring about 7 × 7 cm. In further workup, there was evidence of a 103 × 94 × 89 mm mass with the hemorrhagic area and central necrosis in the middle and lower segments of the uterus and cervix. The patient underwent a total abdominal hysterectomy and left side salpingo-oophorectomy. The diagnosis of CC was made after microscopic examination. Conclusions: There are few case reports of choriocarcinoma with more than a year latent period after antecedent pregnancy. The strongest hypothesis is having asymptomatic pregnancy during the period between the last pregnancy and the development of CC. However, the possibility of non-gestational choriocarcinoma in such cases should be considered. Treatment with a single- or multiple-agent chemotherapy regimen should be immediately initiated after diagnosis in these cases.

Pulmonary aspergilloma on transthoracic ultrasound

PurposePulmonary aspergilloma affects immunocompromised patients but is also a recurrent condition in patients previously treated for pulmonary tuberculosis.Methods and ResultsWe report the case of a 45-year-old patient with a history of cured pulmonary tuberculosis 15 years earlier in whom we visualized pulmonary aspergilloma by transthoracic lung sonography. Sonography of pulmonary aspergilloma demonstrated an oval cavity with hypoechoic contents and an irregular border, measuring a diameter of 4.7 cm; inside the lesion, a roundish structure with an anechoic rim was discernable.ConclusionsThe sonographic findings corresponded to chest X-ray and computed tomography imaging in this patient and to previously reported sonographic characteristics of mycotic abscesses in other organs. Lung ultrasound may be a tool to identify pulmonary aspergilloma, especially as a point-of-care imaging tool and where other imaging modalities are inaccessible.

Clinicopathological features of basal cell layer type high-grade squamous dysplasia of the esophagus

Objective: To investigate the clinicopathological features of basal cell layer type high-grade squamous dysplasia of the esophagus. Methods: Fifty-two cases of basal cell layer type high-grade squamous dysplasia of the esophagus were collected at PLA Joint Logistics Support Force 989 Hospital (34 cases) and Beijing Chaoyang Hospital (18 cases) from 2009 to 2019. The clinical, histological and immunohistochemical features were characterized. Related literature was also reviewed. Results: The median age of the 52 patients was 64 years (range 43-72 years). There were 35 men and 17 women, with a male to female ratio of 2.1∶1.0. There were 8 cases in the upper esophagus, 41 in the middle esophagus and 3 in the lower esophagus. According to the Paris Classification, 24 cases were 0-Ⅱb and 28 cases were 0-Ⅱc. Endoscopic examination showed that the color of the lesions was red and the edge was irregular. The narrow band imaging showed that the lesions were brown, and the microvascular abnormalities on the mucosal surface were observed with high magnification. Iodine staining of the lesions showed no or light staining and irregular border. Histologically, the basal layer of squamous epithelium was hypercellular, with large and hyperchromatic nuclei, and disordered cell arrangement. A high proportion of the cases showed a down-growth pattern and associated invasive squamous cell carcinoma. The immunohistochemical staining of 37 cases showed that the mutation rate of p53 was 48.6% (18/37), the median of Ki-67 labeling index was 60% (range 20%-90%), the median of Ki-67 labeling index of the basal tumor cells was 26/HPF (range 5-70/HPF), and the rate of abnormal Ki-67 distribution pattern was 37(100.0%). According to the initial pathological diagnosis, there were 8 cases of low-grade intraepithelial neoplasia, 2 cases of atypical epithelial cells and 42 cases of high-grade intraepithelial neoplasia. Conclusions: The basal cell layer type high-grade squamous dysplasia of the esophagus has a unique morphology. The dysplasia is mainly limited to the lower half part of the squamous epithelium. With marked cytological atypia and prominent invasiveness pattern, it is likely to develop into invasive squamous cell carcinoma at an early stage of the disease. The rate of pathologic misdiagnosis (such as low-grade lesion) is high. The p53 mutation and Ki-67 abnormal distribution pattern are helpful features for confirming the diagnosis of such high-grade dysplasia.

Progression of Atrophy and Visual Outcomes in Extensive Macular Atrophy with Pseudodrusen-like Appearance.

PurposeTo report visual outcomes and rate of retinal pigment epithelium (RPE) atrophy progression in patients with extensive macular atrophy with pseudodrusen-like appearance (EMAP).DesignRetrospective, observational study.ParticipantsPatients with EMAP and symptom onset before 55 years of age, at least 12 months of follow-up using Spectralis blue-light fundus autofluorescence (BAF) and OCT and with no other ocular or systemic conditions.MethodsBest-corrected visual acuity (BCVA), BAF, and OCT images were reviewed at baseline and at each annual visit until the last available follow-up. Atrophy was measured by 2 graders using the region finder software on Heidelberg Explorer and confirmed using OCT scans covering the entire atrophic lesion. The following imaging biomarkers were analyzed at each visit: foveal atrophy, vitreomacular traction, outer retinal tubulations, choroidal caverns and subfoveal choroidal thickness, border autofluorescence pattern (hyper-autofluorescent or iso-autofluorescent), and border irregularity as expressed by circularity index (CI).Main Outcome MeasuresPrimary outcomes were annual rate of atrophy enlargement and BCVA loss in EMAP patients. Secondary outcomes included the assessment of potential factors able to predict disease progression.ResultsThirty-six eyes from 18 patients with EMAP (6 men [33%]; mean age at symptom onset, 48.1 ± 1.7 years) were included. Mean follow-up lasted 32.8 ± 14.3 months. RPE atrophy increased from 10.8 ± 6.3 mm2 at baseline to 18.1 ± 8.3 mm2 at the end of follow-up, with a rate of 2.91 ± 1.09 mm2/year. Faster progression was associated with smaller CI at baseline (P = 0.02) and with iso-autofluorescent lesion borders (P = 0.01). Visual acuity declined progressively at a rate of 7.4 ± 5.8 letters per year, with 57% of eyes showing vision of 20/200 Snellen or worse at the 4-year follow-up. Worse visual outcomes were observed in patients with early foveal involvement at baseline (P = 0.02).ConclusionsPatients affected by EMAP present a rapid expansion of RPE atrophy that is comparable with the diffuse-trickling form of geographic atrophy. More irregular and iso-autofluorescent lesion borders seem to predict faster progression. Our findings may provide relevant information for patient counseling and future interventional approaches to select the best candidates and proper clinical outcomes.

Differential and prognostic value of cardiovascular magnetic resonance derived scoring algorithm in cardiac tumors

ObjectivesTo establish a scoring algorithm based on cardiovascular magnetic resonance (CMR) parameters for differentiating between benign and malignant cardiac tumors and for predicting outcome. MethodsPatients referred for CMR for suspected cardiac tumors were prospectively enrolled. Tumors were categorized as benign or malignant based on pathology, imaging, and clinical information. The CMR protocol included cine, T1-weighted, T2-weighted, first-pass perfusion, and late gadolinium enhancement (LGE) sequences. Variables independently associated with malignancy in the multivariable logistic analysis were used to construct the scoring algorithm, and receiver operating characteristic analyses were used to assess the ability to discriminate malignant from benign tumors. The ability of the score to predict outcome (all-cause mortality) was also assessed by Kaplan–Meier survival analysis. ResultsAmong the 105 enrolled patients, 74 had benign and 31 had malignant tumors. In multivariable analysis, the independent predictors of malignant tumors were invasiveness (odds ratio, OR = 11.4, 2 points), irregular border (OR = 5.8, 1 point), and heterogenous LGE (OR 10.6, 2 points). The area under curves (AUC) of the scoring algorithm was 0.912 (cut-off score of 5) and showed significantly higher AUCs than individual variables (all P < 0.05) in differentiating benign and malignant tumors. After median follow-up of 18.2 months, mortality was significantly higher in patients with a score of 5 than in patients with score ≤ 4. ConclusionsThe scoring algorithm based on CMR-detected invasiveness, irregularity of border, and heterogenous LGE is an effective method for differentiating malignant from benign cardiac tumors and for predicting outcome.

Sonography as a Prognostic Indicator of Breslow Depth: Primary Malignant Melanoma of the Auricular Helix

Malignant melanoma is a cellular cancer that produces pigmentation of the skin. The tendency toward melanoma may be inherited, and risk factors are increased with overexposure to the sun and ultraviolet radiation. Melanomas commonly present as a dark, asymmetrical, mole-like spot that spreads, with an irregular border. It is uncommon to find a melanoma in the auricular regions and even rarer for it to be a primary malignancy of the auricles. Utilizing sonography to evaluate melanoma lesions could serve as a prognostic indicator, regarding Breslow’s depth, an aide in staging, as well as surgical planning. However, utilizing multiple diagnostic imaging modalities is essential in the proper evaluation and staging of a melanoma. Currently there are revolutionary, effective systemic therapies available for patients with a metastatic melanoma. Current therapies are focused on immunotherapy and checkpoint inhibitors. These treatment options provide an opportunity for selected metastatic melanoma patients to achieve healthy long-term success.

Preliminary results of simultaneous integrated boost intensity-modulated radiation therapy based neoadjuvant chemoradiotherapy on locally advanced rectal cancer with clinically suspected positive lateral pelvic lymph nodes.

BackgroundLateral pelvic lymph node (LPLN) is approximately 11–14% and always associated with poorer prognosis. This study investigated the efficacy and safety of simultaneous integrated boost intensity-modulated radiation therapy (SIB-IMRT) based on neoadjuvant chemoradiotherapy (NCRT) on locally advanced rectal cancer (LARC) patients with clinically suspected positive LPLNs.MethodsWe retrospectively screened distal LARC patients with NCRT in our center from May 2016 and June 2019. The diagnostic criteria of positive LPLN were nodes of over 7 mm in short axis and irregular border or mixed-signal intensity. All patients with clinically suspected positive LPLN received 56–60 Gy SIB-IMRT in the LPLN area. Concurrent chemotherapy regimens were capecitabine as monotherapy treatment or in combination with oxaliplatin. The toxicities, local-regional recurrence (LRR), and disease-free survival (DFS) were investigated.ResultsFifty-two eligible patients with clinically suspected positive LPLN were screened and analyzed. The median distance from the distal tumor to the anal verge was 4 cm (range, 0–8 cm), while magnetic resonance imaging (MRI) analysis revealed the median short diameter of the pelvic LPLN to be 8 mm (range, 7–20 mm). There were 28 (53.8%) mesorectal fascia (MRF) positive and 22 (42.3%) extramural venous invasion (EMVI) positive patients. A radiotherapy dose of 41.8 Gy was administered to the pelvic area, while the LPLN received a median SIB dose of 60.0 Gy (range, 56–60 Gy) across 22 fractions. Synchronous capecitabine with or without oxaliplatin was administered during radiotherapy. In summary, 15 (28.8%) patients displayed grade 2–3 radiation-related toxicity, 8 (15.4%) patients underwent additional LPLN dissection, and positive nodes (26 nodes in total) were not observed. One patient suffered a LLR in the presacral region. The median follow-up duration was 21.2 months (range, 4.7–45.0 months), while the duration of 1- and 2-year DFS were 89.9% and 74.6%, respectively. Patients did not display LPLN recurrence.ConclusionsThe safety and efficacy of SIB-IMRT on clinically suspected positive LPLN of LARC patients were deemed acceptable. Patients did not exhibit in-field LPLN recurrence after NCRT combined with single total mesorectal excision (TME).

VALUE OF LUNG ULTRASOUND IN ASSESSMENT OF PEDIATRIC PATIENTS WITH PNEUMONIA VERSUS CHEST PLAIN X- RAY

Community acquired pneumonia (CAP) is defined as an infectious pneumonia that is acquired outside or inside the hospital in children without immune damage.Radiographic findings:Chest X-ray (CXR) has been the main modality in the investigation of chest infection since it has been invented in the late 19th century.CXR has certain restrictions such as radiation exposure risks, high inter-observer and intra- observer variations, and little impact on the clinical outcomes. Children in comparison to adults have 3 to 5 times higher morbidity and mortality risk from radiation exposure. A call for new imaging modality which is “lung ultrasonography”:LUS findings were classified as a normal pattern, defined as normal lung sliding with or without A-lines or having the following according to the following Ultrasonographic signs of pneumonia: 1. Presence of subpleural lung Alveolar consolidations: subpleural echo-poor regions or tissue-like region, with blurred margins irregular borders “shred sign” in nontranslobar consolidation, or lung hepatization in translobar consolidation. 2. Air bronchogram: branching hyperechoic structures in the consolidation. Lentiform or punctiform air bronchogram were not counted as separate signs and were considered as part of the consolidation. 3. Presence of B-lines. 4. Pleural line abnormalities, defined as irregularities in the pleural line. 5. Pleural effusion defined as anechoic or hypoechoic fluid with or without floating debris.

Unwanted and Uninvited: Canadian Exceptionalism in Migration and the 2017-2020 Irregular Border Crossings

ABSTRACT This paper focuses on the irregular migration flow from the United States to Canada from 2017 to 2020. This irregular migration, defined as unauthorized border crossings, challenges a central tenet of the perceived exceptionalism of Canadian immigration policy by illustrating that while legal migration remains publicly popular and receives political support, the public rejects unwanted, irregular, or illegal migration, demanding strong response from the Canadian government. The 2017–2020 irregular migration of refugee claimants from the United States generated discord in a number of public and political settings. Debates existed over the terminology for unauthorized border crossings, public opinion was divided, and prior to the 2019 Canadian federal election, political parties developed different and opposing positions. Disagreement over costs and funding for the settlement of irregular migrants emerged at city, provincial, and federal levels. The federal government subsequently amended immigration legislation and increased budgets for border control activities.

Thyroid Nodule: Alpha Score 2.0 Classification for FNAB Selection, Multicentric Study in Latin America

Introduction: To perform a Latin-American multicentric study for the prediction of benign and malignant thyroid nodules using Alpha Score, and to compare it with ACR TIRADS® and Bethesda®. Materials and Methods: A prospective multicentric study in 10 radiological hospitals and institutions of Latin America was performed and 818 thyroid nodules were analyzed by ultrasound and classified by using both ACR TIRADS® and Alpha Score; fine-needle aspiration biopsy was performed when needed and classified with Bethesda. The relationships between predictors were analyzed by using binary logistic regression, statistical significance was defined by a p-value of 0.05, with an error margin of 4% and 95% confidence intervals. Results: Alpha Score 2.0 establishes five types of malignant predictors: microcalcifications, irregular borders, taller-than-wide shape, predominant solid texture and hypoechogenicity; a diameter equal to or greater than 1.5 cm adds an extra point to the final score. Resulting classification divides TNs into 4 categories: benign (1.9%), low suspicion (8.7%), mild suspicion (13.6%) and high suspicion (75.7%) of malignancy probability; sensitivity of 82%, specificity of 74%, the positive predictive value of 94%, the negative predictive value of 51%, the statistical accuracy of 81%, odds ratio of 108.89 and correlation with ACR TIRADS of 0.77 and Bethesda of 0.91. Conclusions: Alpha Score 2.0 has superior diagnostic accuracy and performance compared to the previously published Alpha Score and is able to classify a benign TN in a precise, safe and accurate way, avoiding unnecessary FNABs or determining the necessity of FNAB in cases of moderate to high suspicion of malignancy.

Recent Advances of TIRADS Classification of Thyroid Nodules by Ultrasound

Background: Thyroid nodules are abnormal growths of thyroid tissue which commonly arise within an otherwise normal thyroid gland. They may be hyperplasia or a thyroid neoplasm, but only a small percentage of the latter are thyroid cancers. Objectives: To improve the management of the patients and to reduce cost-effectiveness by decreasing number of unnecessary fine needle aspiration cytology (FNAC). Patients and Methods: This study was conducted on 50 patients known or clinically suspected to have solitary thyroid nodule or multiple nodules, referred to Radiodiagnosis Department, Ain Shams University Hospitals. The cases included 33 females and 17 males (age between 41-50 years). Results: All the nodules with TIRADS 1 were benign. In TIRADS 2 there were 10 benign and 1 malignant nodules. In TIRADS 3 there were 4 benign and 1 malignant nodules. In TIRADS 4 there were 2 benign nodules and 4 benign nodules while in TIRADS 5 there were 2 benign and 4 malignant nodules. There was a statistically significant difference between the two groups. There was a statistically significant difference between the two groups with benign and malignant nodules regarding the texture of the nodules. Solid texture was higher in the malignant nodules and spongiform texture was common in the benign nodules while the cystic and mixed texture were comparable between the two groups. Conclusion: The major ultrasound features seen associated with malignancy were microcalcifications, taller than wider shape of the nodule, hypoechoic and marked hypoechoic echopattern of the nodule, irregular borders and presence of suspicious cervical lymph nodes.

Congenital cutaneous neurofibromas in neurofibromatosis type1: Clinicopathological features in early infancy.

Clinicopathological features of cutaneous neurofibromas presenting as large irregularly shaped congenital café-au-lait macules (CALM) in Neurofibromatosis type1 (NF1) patients have not been well characterized. We aimed to analyze the histopathological findings of large "atypical" CALM in children with NF1. In this retrospective observational study we analyzed histopathological and immunostaining features of 21 biopsy specimens from 18 large hyperpigmented macules with irregular borders with or without hypertrichosis present during the first months of life in NF1 diagnosed children. Of the 21 biopsies, ten showed a diffuse neurofibroma pattern and four exhibited characteristics of plexiform neurofibroma (PNF). In twelve specimens we observed groups of fusiform cells arranged linearly mimicking a small caliber nerve trunk with abnormal morphology. Repeated biopsies from two of these lesions performed at different ages showed transformation to a plexiform pattern. An increased interstitial cellularity was observed in 17 samples that was more evident around eccrine glands in 16 or accompanying hair follicles and vascular structures in twelve samples. All these cells had immunoreactivity for S100-protein, CD68 and were Melan-A positive in 15 samples. Clinicopathological findings of congenital cutaneous neurofibromas provide early diagnostic clues of NF1 with high relevance for monitoring of these patients.