Irregular Borders Research Articles

A region of interest focused Triple UNet architecture for skin lesion segmentation

AbstractSkin lesion segmentation is a crucial step for skin lesion analysis and subsequent treatment. However, it is still a challenging task due to the irregular and fuzzy lesion borders, and the diversity of skin lesions. In this article, we propose Triple‐UNet, an organic combination of three UNet architectures with suitable modules, to automatically segment skin lesions. To enhance the target object region of the image, we design a region of interest enhancement module (ROIE) that uses the predicted score map of the first UNet. The enhanced image and the features learned by the first UNet help the second UNet obtain a better score map. Finally, the results are fine‐tuned by the third UNet. We evaluate our algorithm on a publicly available dataset of skin lesion segmentation. Experiments have shown that TripleUNet achieves an accuracy of 92.5% on the ISIC‐2018 skin lesion segmentation benchmark, with Dice and mIoU of 0.909 and 0.836, respectively, which outperforms the state‐of‐the‐art algorithms.

The ringed residual u-net with non-natural regions feature for image splicing forgery detection and localization

Recently, with the emergence of many image editing tools (photoshop, Topaz studio, etc.), the authenticity of images has been severely challenged. However, the performance of some existing traditional feature extraction methods and detection methods based on convolutional neural network (CNN) is poor, and the information provided by the features extracted from the network is limited and single. In this paper, an end-to-end ringed residual U-Net is proposed to detect image splicing forgery by blending features of non-natural regions. Some regions with significant differences from the image background are defined as non-natural regions(such as the irregular border at the splicing of images). In this paper, a feature enhancement module for non-natural regions is constructed, which the image through the pooling of four different scales, and these features are then combined with the original image and input to the backbone network for processing, aiming to highlight regions of the image that differ significantly from the background. Therefore, after adding the feature enhancement module for non-natural regions to the end-to-end ring residual U-Net, more attention will be paid to the tampering regions in the feature extraction stage, image manipulation detection and localization will also become more accurate. Compared with some mainstream methods, this method achieves better performance on the three standard datasets(CASIA2.0, NIST2016, COLUMBIA). In addition, it has excellent robustness under JPEG compression attack and noise corruption attack.

Ultrasound features using MUSA terms and definitions in uterine sarcoma and leiomyoma: cohort study.

Timely and accurate preoperative diagnosis of uterine sarcoma will increase patient survival. The primary aim of this study was to describe the ultrasound features of uterine sarcoma compared with those of uterine leiomyoma based on the terms and definitions of the Morphological Uterus Sonographic Assessment (MUSA) group. A secondary aim was to assess the interobserver agreement for reporting on ultrasound features according to MUSA terminology. This was a retrospective cohort study of patients with uterine sarcoma or uterine leiomyoma treated in a single tertiary center during the periods 1997-2019 and 2016-2019, respectively. Demographic characteristics, presenting symptoms and surgical outcomes were extracted from patients' files. Ultrasound images were re-evaluated independently by two sonologists using MUSA terms and definitions. Descriptive statistics were calculated and interobserver agreement was assessed using Cohen's κ (with squared weights) or intraclass correlation coefficient, as appropriate. A total of 107 patients were included, of whom 16 had a uterine sarcoma and 91 had a uterine leiomyoma. Abnormal uterine bleeding was the most frequent presenting symptom (69/107 (64%)). Compared with leiomyoma cases, patients with uterine sarcoma were older (median age, 65 (interquartile range (IQR), 60-70) years vs 48 (IQR, 43-52) years) and more likely to be postmenopausal (13/16 (81%) vs 15/91 (16%)). In the uterine sarcoma cohort, leiomyosarcoma was the most frequent histological type (6/16 (38%)), followed by adenosarcoma (4/16 (25%)). On ultrasound evaluation, according to Observers 1 and 2, the tumor border was irregular in most sarcomas (11/16 (69%) and 13/16 (81%) cases, respectively), but regular in most leiomyomas (65/91 (71%) and 82/91 (90%) cases, respectively). Lesion echogenicity was classified as non-uniform in 68/91 (75%) and 51/91 (56%) leiomyomas by Observers 1 and 2, respectively, and 15/16 (94%) uterine sarcomas by both observers. More than 60% of the uterine sarcomas showed acoustic shadows (11/16 (69%) and 10/16 (63%) cases by Observers 1 and 2, respectively), whereas calcifications were reported in a small minority (0/16 (0%) and 2/16 (13%) cases by Observers 1 and 2, respectively). In uterine sarcomas, intralesional vascularity was reported as moderate to abundant in 13/16 (81%) cases by Observer 1 and 15/16 (94%) cases by Observer 2, while circumferential vascularity was scored as moderate to abundant in 6/16 (38%) by both observers. Interobserver agreement for the presence of cystic areas, calcifications, acoustic shadow, central necrosis, color score (overall, intralesional and circumferential) and maximum diameter of the lesion was moderate. The agreement for shape of lesion, tumor border and echogenicity was fair. A postmenopausal patient presenting with abnormal uterine bleeding and a new or growing mesenchymal mass with irregular tumor borders, moderate-to-abundant intralesional vascularity, cystic areas and an absence of calcifications on ultrasonography is at a higher risk of having a uterine sarcoma. Interobserver agreement for most MUSA terms and definitions is moderate. Future studies should validate the abovementioned clinical and ultrasound findings on uterine mesenchymal tumors in a prospective multicenter fashion. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Who is to blame? Stories of European Union migration governance in Italian, Maltese, and Spanish newspapers

AbstractWhile scholars have investigated how media frame human mobility and securitize irregular border crossings, little research has been dedicated to how European Union (EU) actors are portrayed in media coverage of migration across the Mediterranean. By integrating framing into narrative analysis through the Narrative Policy Framework, our article fills this gap. Specifically, we provide a content analysis of Italian, Maltese, and Spanish newspapers and identify the key narratives underlying the portrayal of specific EU actors. We show that, overall, lack of EU solidarity is the prevalent issue in Italian, Maltese, and Spanish newspapers alike, followed by the alleged inefficiency of EU actors. Accordingly, the EU and its key actors are regularly narrated as either villains, responsible for the crisis and deserting member states in need of solidarity, or as weaklings unable to take effective action. These narratives appear remarkably consistent across countries, over time, and newspapers with different ideological orientation.

Ultrasonographic predictors of thyroid cancer in Bethesda III and IV thyroid nodules.

Bethesda III and IV thyroid nodules continue to be difficult to manage. Although molecular testing may assist in decision-making, it is expensive, not widely available, and not without pitfalls. The objective of this study is to assess whether certain thyroid ultrasonographic features may predict the risk of thyroid cancer in patients with Bethesda III and IV thyroid nodules and be used as additional decision-making tools to complement cytopathological results in deciding on diagnostic thyroidectomy. We retrospectively evaluated the ultrasonographic features of Bethesda categories III and IV thyroid nodules in patients who underwent subsequent thyroidectomy. We used the final histopathological examination of the surgical specimens as the gold-standard test and analyzed individual preoperative ultrasonographic features as predictors of malignancy. Of the 278 patients who were diagnosed with Bethesda III and IV thyroid nodules on fine needle aspiration cytology (FNAC), 111 (39.9%) had thyroid cancer, and 167 (59.9%) exhibited benign nodules. The malignancy rate was higher in patients with Bethesda IV nodules (28/50, 56%) than those with Bethesda III nodules (83/228, 36.4%; p=0.016). In univariate analysis, hypoechogenicity (55.6% in malignant vs. 35.3% in benign, p=0.006) and calcifications (54.5 in malignant vs. 35.4% in benign, p=0.008) were significantly different between the benign and malignant pathology groups, whereas the size of the dominant nodule, number of nodules, irregular borders, taller-than-wide shape, and the presence of lymph nodes were comparable between the two groups. These two ultrasonographic features (hypoechogenicity and calcifications) remained significantly associated with the risk of malignancy in multivariate logistic regression analysis (for hypoechogenicity, p=0.014, odds ratio: 2.1, 95% CI:1.0-3.7 and for calcifications, p=0.019, odds ratio: 1.98, 95% CI:1.12-3.50). The sensitivity, specificity, positive and negative predictive values, and accuracy were 31.5%, 83%, 55.6%,64.7%, and 62.6%, for hypoechogenicity, respectively and 32.4%, 82%, 54.5%, 67.8%, and 62%, for calcification, respectively. Hypoechogenicity and calcifications in Bethesda III and IV thyroid nodules are strong predictors of thyroid cancer and associated with a two-fold increased risk of malignancy.

Molecular identification and lipolytic potential of filamentous fungi isolated from residual cooking oil.

Filamentous fungi, microorganisms that develop and are located in different habitats, are considered important producers of enzymes and metabolites with potential for the biotechnology industry. The objective of this work was to isolate and identify filamentous fungi that grow in used oil. Two fungal species were characterised through their morphology and molecular identification. The DNA of each extracted strain was amplified by PCR using primers ITS1 and ITS4, obtaining sequences that were later in GenBank (NCBI). A white coloured strain (HB) with a cottony, white, hyaline morphology and irregular borders was observed; so too, a brown colony (HC) with a sandy surface, a well-defined border of beige colour in early growth until it became a dark brown colour. The identity result by homology of the sequences in the BLASTn database was 100% and 99.55%, indicating that they correspond to Cladosporiumtenuissimum and Fomitopsismeliae, respectively. Finally, the results in lipolytic activity show greater potential for Fomitopsismeliae with 0.61 U/l in residual oil. Thus, it is important to highlight the potential of this type of waste to favour the prospection of microorganisms for a sustainable alternative for future studies of biological conversion.

A rare case of liver regenerative and non-neoplastic lesion resembling a well-differentiated hepatocellular carcinoma

BackgroundNodular regenerative hyperplasia (NRH) is a rare disease that presents pathologically as diffuse hepatic nodules without fibrous septa. It is believed to be caused by vasculopathy against a background of various systemic diseases, such as hematologic, autoimmune, and drug-induced diseases, with various symptoms. In spite of the recent imaging advances, various atypical cases of nodular lesions are observed in daily clinical practice. Cases that do not completely meet these criteria are referred to as -like or -similar lesions in clinical situations, making it difficult to understand their pathogenesis. We present a case in which two hepatic nodular lesions were noted and difficult to differentiate from malignancy preoperatively. The lesions were laparoscopically resected and a pathological diagnosis with non-neoplastic liver regenerative nodules resembling NRH was made.Case presentationA 49-year-old man with no alcohol or drug intake and no past medical history was identified as having liver tumors on screening examination without any symptoms. Contrast-enhanced computed tomography (CT) showed two hepatic tumors; approximately 2-cm tumors at S7 and S8. Gadolinium-ethoxybenzyl-diethylenetriamine-pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) revealed fat inclusions in their contents. Ethoxybenzyl (EOB) uptake was also observed during the hepatobiliary phase. Based on preoperative examinations, we suspected well-differentiated hepatocellular carcinoma (HCC) and performed laparoscopic S7/8 partial resection for these lesions. Macroscopically, the resected specimens showed a non-cirrhotic yellowish-cut surface containing brownish, ill-defined lesions with irregular borders. Microscopically, these lesions showed zonal necrosis, congestion, and aggregation of hemosiderin-laden macrophages around the central vein. In these areas, the fatty deposition of hepatocytes was lower than that in the surrounding background hepatocytes. Histopathologically, neither neoplastic nor hyperplastic lesions were observed, and he was diagnosed as regenerative hepatic change with centrilobular necrosis.ConclusionsConsidering the pathological results, these lesions were thought to be a type of NRH-like lesion with possible hepatic vessel disorder. However, the lesion’s cause and classification was difficult to determine. The accumulation of these regenerative changes accompanying fatty liver is needed to clarify the mechanism and its clinical significance.

Ultrasound features and role of O-RADS classification in the diagnosis of ovarian tumors

Background: Ovarian tumors are a common condition in women, with 5% - 30% cases being malignant. Clinical symptoms are often nonspecific, causing difficulties in early diagnosis and detection. The O-RADS classification system provides a consistent way to interpret ovarian masses on ultrasound. Aim: The aim of this study is to (1) Describe the ultrasound characteristics of ovarian tumors according to the O-RADS classification. (2) Investigate the signs predicting malignancy in the O-RADS 3, 4, and 5 categories. Materials and Method: This cross-sectional study involved 188 patients who were examined and treated at the Hospital of Hue University of Medicine and Pharmacy, diagnosed with ovarian tumors, from April 2022 to September 2023. Results: 88.8% of ovarian tumors were found to be benign (88.8%), with serous tumors being the most common type in both benign and malignant groups. The distribution of ovarian tumors based on the O-RADS classification was as follows: O-RADS 1 (1.6%), O-RADS 2 (52.1%), O-RADS 3 (22.9%), O-RADS 4 (17.6%), O-RADS 5 (5.9%). Most ovarian tumors were monocystic masses, without solid components (65.4%), with diameters ranging from 50 - 100 mm (58.0%), and had smooth inner borders (79.3%). Papillary growth in inner borders and increased vascularity in Doppler ultrasound (color score: CS = 2 - 4) were found to be predictive factors for malignant ovarian tumors, with adjusted odds ratios (aOR) of 8.5 and 5.5, respectively. Conclusions: Monocystic mass with solid components, multicystic mass with solid components, mass with solid components, irregular inner borders, papillary growth in inner borders, and increased vascularity in Doppler ultrasound (CS = 2 - 4) were identified as predictive factors for malignant ovarian tumors. Key words: ovary tumors, O-RADS classification, ultrasound

Corymbiform cutaneous disorders in pediatric dermatology: Exploring this pattern of presentation beyond secondary syphilis.

"Corymbiform" is a term found in medical literature as early as 1876 to describe a central larger lesion with smaller surrounding lesions, leading to the appearance of an irregular border. While the term in current medical literature most often describes a possible morphology of secondary syphilis, the authors have noted this pattern presenting in other cutaneous conditions. We present a commentary on the corymbiform pattern in dermatology including a series of photographs of cutaneous disorders presenting in a corymbiform morphology in pediatric patients. While the term corymbiform is not commonly used in the present-day dermatologic literature, increased recognition and use of this term may aid in the recognition of various dermatologic diagnoses presenting in a less common morphology and may also lend to increased fluidity of dermatologic descriptions in the literature.

Reflectance Confocal Microscopy Combined with Dermoscopy and Histology in the Diagnostic Setting of Pigmented Eccrine Poroma: A Retrospective Study.

Pigmented eccrine poroma (PEP) is a unique variant of a benign adnexal tumor known as eccrine poroma. Distinguishing PEPs from other pigmented lesions can be challenging due to overlapping clinical and dermoscopic features. To provide a comprehensive analysis of the dermoscopic, confocal (RCM), and histological features of PEPs. We undertook a retrospective study of the clinical, dermoscopic, RCM and histopathological features of PEPs that were surgically excised and histopathologically recognized. Data on epidemiological, clinical, dermoscopic, RCM and histopathological features were collected from the databases of the Skin Cancer Unit, IRCCS Policlinico di Sant' Orsola, between January 2021 and May 2023. The study population consisted of 61 patients, including 34 females (55.7%) and 27 males (44.3%). Dermoscopic examination of 61 PEPs revealed the presence of irregular borders (55.7%), milia-like cysts (50.8%), brown pseudo-network (41%), cerebriform pattern (34.4%), comedo-like openings (29.5%), atypical vessels (26.2%), glomerular vessels (18%), fingerprint-like perifollicular structures (8.2%), dots (4.9%) and dotted vessels (4.9%). RCM imaging was collected from 11 cases and showed mostly well-defined tumor nests with small cells in 100% of cases, bright structures in the upper dermis representing melanocytes and melanophages (63.6%), dark round spaces within the tumor nests (54.5%), well-demarcated borders of the nest (45.5%) and dilated and prominent vessels in upper dermis (27.3%). Histopathological pattern analysis revealed PEP sensu stricto (PEPss) as the most frequent (54.1%). The distinctive dermoscopic patterns, along with the confocal features aid in the differentiation from other pigmented lesions.

Case Presentation where MRI shows Superiority as A Modality for Breast Cancer Screening

Background: Common modalities for breast cancer screening include regular clinical breast exams (73%), annual breast sonograms (73%) for high-risk groups, and mammograms (71.5%) recommended every 3 years for high-risk groups. Despite a higher sensitivity of 89.4%, MRI is underutilized, especially among high-risk groups with the means for the test. Kenyan guidelines recommend mammography for normal-risk populations, omitting MRI for routine screening in average-risk populations. This study explores an intriguing case of a 60-year-old post-menopausal lady, with no hormone replacement history, three parities, and a smoking habit. She presented with a left-sided benign cyst but revealed an ominous, undetected lesion on the right breast, emphasizing the limitations of conventional screening modalities. Method: The patient was admitted for abdominal pain due to gastroenteritis and a breast lump on the left breast for 3 months with a strong family history of breast cancer, so she requested screening for the same. In the process, we found axillary and mediastinal lymph nodes, but the left breast showed a simple harmless cystic lesion. The right breast confirmed a lesion with irregular borders that looked suspicious, and a biopsy confirmed ductal carcinoma of the right breast. Results: The right breast that had no symptoms or signs, and no abnormality on mammogram, ultrasound, or CT scan, had a grade 3a Ductal Cancer in its initial stage that was seen on a simultaneous MRI. Conclusion: MRI could be a better choice for screening early breast cancer in high-risk groups and in those who can afford the test.

International migration and illegal costs: Evidence from Africa-to-Europe smuggling routes

The 2011 Arab Spring marked the opening of the Central Mediterranean Route for irregular border crossings between Libya and Italy, which produced heterogeneous reductions of bilateral smuggling distances between country pairs in the Mediterranean region. We exploit this source of spatial and temporal variation in bilateral distance along land and sea routes to estimate the elasticity of irregular migration intentions for African and Near East countries. We estimate an elasticity of migration intentions to smuggling distances exceeding −3, mainly driven by countries with weak rule of law and high internet penetration. Our findings are consistent across irregular migration measures both at the aggregate and individual levels. We show that irregular migration elasticity is higher for youth, relatively skilled individuals and those with an informative advantage (having a social network abroad or a mobile phone).

Correlative Study of Ultrasound Scan, Fine-needle Aspiration Cytology and Histopathology of Thyroid Swellings

Abstract Introduction: Thyroid swellings are common clinical entities with a reported prevalence of about 10% of the adult population. As ultrasound technology is advancing, so is the detection of thyroid lesions, even if they are as small as a few millimetres in size. While fine-needle aspiration cytology (FNAC) is the standard procedure for thyroid nodule diagnosis; it involves risks and unnecessary costs. However, histopathological examination (HPE) is the gold standard for the classification of thyroid swellings. While individual characteristics of USS which increase the suspiciousness of malignancy, have been studied repeatedly but are inconclusive, we therefore need a comprehensive system of stratifying thyroid nodules and characterising them with confidence so that we can reduce the number of needless painful aspiration and biopsy procedures. Aim: This study aims to determine the diagnostic accuracy of ultrasound scans and FNAC in thyroid swellings by comparing them with HPE results. Materials and Methods: It was a prospective observational study conducted in a tertiary care centre over a period of 2 years. During this period, a total of 200 patients presented with palpable thyroid nodules in the surgery outpatient department out of which 160 patients were included in our study. All the patients underwent a triple assessment (clinical examination, sonogram and FNAC) and were later posted for surgery, the specimen obtained was sent for HPE. Data were collected and the results were analysed and compared. Results: One hundred and sixty cases with thyroid swellings were studied. Out of the 160 cases, 136 were female and 24 were male with female-to-male ratio of 5.6:1. Based on various ultrasound characteristics of thyroid nodules, each thyroid nodule was classified into ACR-TIRADS categories and then FNAC was done. On HPE diagnosis of 160 cases, 98 (61.3%) patients were benign and 62 (38.8%) patients were malignant. The results of histopathology were correlated with ultrasound features and statistical analysis was done calculating sensitivity, specificity, positive predictive value and negative predictive value for each feature. The sensitivity and specificity for irregular margin were 38.7% and 93.9%, for taller-than-wide were 21% and 100%, for punctate echogenic foci/microcalcification were 8.1% and 100%, for hypoechogenicity were 91.9% and 64.3% and for solid consistency were 69.4% and 76.5%. The risk of malignancy for TIRADS categories 2, 3, 4 and 5 in our study was 2.5%, 21%, 64% and 94%, respectively. In comparison with FNAC diagnosis and HPE, FNAC is 98.0% sensitive and 54.8% specificity in detecting benign lesions while 4.84% sensitivity and 97.96% specificity in detecting malignant lesions. Conclusion: ACR-TIRADS is a good predictor of malignancy. Individual characteristics such as solid composition, hypoechogenicity, irregular borders, taller-than-wide shape and microcalcifications were highly predictive of malignancy. FNAC is of greater help in the pre-operative diagnosis and should be treated as a first-line diagnostic test for thyroid swellings to guide the management though it is not a substitute for HPE.

Thyroid fine-needle aspiration cytology: malignancy rate in the category of indeterminate significant atypia/indeterminate significant follicular lesion.

Fine needle aspiration cytology (FNAC) is a standard preoperative diagnostic modality for thyroid nodules. The Bethesda Thyroid Cytopathology Reporting System (TBSRTC) defines the FNAC atypia group as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS). Determine the risk of malignancy after surgical resection in patients with AUS/FLUS. Retrospective. Pathology department of a tertiary care center. All thyroid FNACs between 2015 and 2023 that were diagnosed as AUS/FLUS in Turkey. Patient demographics, preoperative ultrasonographic features, and follow-up data were collected. Relationship between AUS/FLUS diagnosis and final histopathological diagnosis. 562. In total, 562 thyroid nodules were diagnosed as AUS/FLUS, and 267 (47.5%) were surgically excised. A malignant histopathological diagnosis was given in 28 cases (10.4%). Malignancy risk sensitivity of AUS/FLUS diagnosis was 75.68% (95% CI=58.80-88.23%), specificity was 55.24% (95% CI=50.91-59.52%), positive predictive value was 10.49% (95% CI=8.71-12.58%), and negative predictive value was 97.04% (95% CI=94.86-98.31%). In the ultrasonographic data, having symptomatic nodules, nodule calcification, and irregular nodule borders were all statistically significant signs of cancer in a one-variable analysis (P<.01). The presence of a family history emerged as a statistically significant prognostic marker for malignancy (P=.012). Although not statistically significant, the malignancy rate for nodules with nuclear atypia was 11.9%, significantly higher than the rate of 8.3% for nodules with architectural atypia only (P=0.32). The diagnosis of AUS/FLUS has a high rate of predicting the risk of malignancy and should continue to be offered. In addition to cytopathological features, ultrasound data and family history should be taken into consideration when evaluating the case. Retrospective design and no molecular studies.

Cancer rates and characteristics of thyroid nodules with macrocalcification.

The aim of this study was to determine the malignant potential of thyroid nodules with macrocalcifications and to evaluate the role of other sonographic findings in the diagnosis of malignancy in thyroid nodules besides macrocalcifications. The findings of 8250 patients who applied to our outpatient clinic and underwent thyroid ultrasonography(US) between 2008 and 2021 were retrospectively reviewed. We included a total of 296 patients with 296 macrocalcified nodules (macrocalcification group) and an age- and sex matched group of 300 patients (control group) with the cytopathologic and/or histopathologic data of fine-needle aspiration biopsy (FNAB) of thyroid nodules without calcification. Demographic characteristics of these patients, US characteristics of the nodules, and thyroid function tests were recorded. Cytopathological data of FNAB were classified according to BETHESDA. The malignancy rate was 14.2% (42/296) in the macrocalcification group and 5.3% (16/300) in the control group (p < 0.001). There was no significant relationship between interrupted peripheral calcification and malignancy. Hypoechoic or markedly hypoechoic appearance, irregular border, solid structure, presence of accompanying pathological lymphadenopathy on sonographic examination and upper and middle zone localization were other sonographic features that increased the risk of malignancy of a nodule. The presence of autoimmunity was not found to be associated with the risk of malignancy. TSH and calcitonin levels of malignant nodules were higher than benign nodules. There was no significant difference between gender and malignancy. In the univariate analysis, it was found that the presence of macrocalcification increased the risk of malignancy 2.935 times. (OR:2.935, p < 0.001.95% CI for OR 1.611-5.349) In addition, being younger, being in the high TIRADS category, and being in the upper and middle zones were factors that increased the risk of malignancy. Gender, TSH level, nodule volume and structure were not associated with malignancy. However, after multivariate analysis, factors that significantly increased the risk of malignancy were younger age, higher TIRADS category, and nodule localization. In our study, the malignancy rate was higher in the macrocalcification group than in the control group. However, no correlation was found after multivariate analysis. In the multivariate analysis, younger age, higher TIRADS category, and nodules located in the upper and middle zone were other factors associated with malignancy. There was no association between peripheral interrupted calcification and malignancy risk.

Geographic Stomatitis with Multiple Areas Involvement of Oral Cavity: A Case Report and Review of Literatures

Background: Geographic stomatitis is an uncommon migratory benign lesion of oral mucosa with unknown etiology. It can affect all the areas of the oral mucosa, but the dorsum and lateral borders of the tongue are the most commonly involved areas called geographic tongue. The clinical appearance of this condition is the oval or circular erythematous areas with irregular elevated keratotic borders. These characteristic features of geographic stomatitis are diagnostic for all clinicians when appearing on the dorsum of the tongue, despite other affected areas of oral mucosa that can confuse clinicians. This condition may be associated with some diseases such as psoriasis, Reiter’s syndrome, and atopic conditions, so the clinicians should rule out these diseases and diagnose the geographic stomatitis. Case Report: A 17-year-old male attended to our department for a routine dentistry checkup. During the intraoral examination, we found multiple erythematous areas surrounded by a thin white border on different surfaces of his oral cavity. His extraoral examinations were completely normal. Conclusion: Due to the rarity of this lesion on the other sites of oral mucosa rather than dorsum and lateral borders of the tongue such as labial mucosa, buccal mucosa, the floor of the mouth, ventral surface of the tongue, and palate, it is necessary to report, study and evaluate each case of this condition that clinicopathologic findings have confirmed this diagnosis, to treat and advice these patients on the best approach. [GMJ.2021;10:e2071]

Traumatic Ulcer Associated with Iatrogenic Trauma After Basal Cell Adenoma Surgery

Traumatic ulcer is an oral cavity lesion characterized by loss of epithelial lining, reaching the lamina propria. This condition presents a single lesion with irregular borders, surrounded by diffuse erythema, and covered with pseudo-membrane. In specific case, the traumatic ulcer was caused by iatrogenic trauma after basal cell adenoma surgery. This case report aimed to discuss the causes of traumatic ulcer. A 39-year-old female was referred to the Oral Medicine Clinic from the Ear, Nose, and Throat Department, complaining of pain in the oral mucosa after basal cell adenoma surgery. On extraoral examination, the facial symmetry was intact along with dry and exfoliative lips. A solitary, oval, yellowish-white intraoral ulcer covered with pseudomembrane, irregular borders surrounded by diffuse erythema on the palate, left buccal mucosa and upper labial mucosa was present. The patient was diagnosed with traumatic ulcer due to iatrogenic trauma after surgery for basal cell adenoma located within the parotid gland that extended to the left palate. The treatment administered comprised instructions to clean the oral cavity using gauze and a cotton stick soaked in 0.2% chlorhexidine gluconate. Additionally, compressing the affected areas with gauze soaked in 0.9% NaCl and applying a thin coating of Vaseline album on the lips were part of the therapeutic measures. Given the iatrogenic nature of traumatic cancer, comprehensive therapy was considered essential to prevent secondary infection and address issues related to speech, appearance, and masticatory functions.

Identification and isolation of Campylobacter jejuni and C. upsaliensis from bovine local milk, milk products, and human stool samples by molecular technique in Karbala province

This study aimed to determine the prevalence of Campylobacter species in milk and its product samples in Karbala province and detect the antibiotic sensitivity of these isolates. One hundred samples were aseptically collected as follows: 50 samples of bovine raw milk and 50 samples of bovine milk products from different local shops and farms distributed in Karbala province, in addition to, 100 samples from children suffering diarrhea, fever, and abdominal pain from Kerbala (Iraq) General Children's Hospital. The pathogen was found using biochemical testing after samples were immediately inoculated into enriched and sub-cultured on selected media. Campylobacter spp. At 24 to 48 hours, colonies on the plate are small, often grayish in appearance, although some have to be creamy grey, slightly raised and moist, and often generated separate colonies of bacteria, flat with irregular borders, and non-hemolytic. This was confirmed by using the polymerase chain reaction method, 11 isolates (5.5%) of 200 samples were determined to be Campylobacter species. The 11 isolates were subjected to sequencing to detect the species of Campylobacter which found two species (C. jejuni and C. upsaliensis). Results showed that Campylobacter spp. 11 positive isolates, C. jejuni recorded 9 (81,8%) positive results while C. upsaliensis recorded 2 (18.18%) positive results. Antibiotic_ susceptibility_ test was cultured by using disk diffusion assay, campylobacter spp. showed complete sensitive to ciprofloxaci , gentamycin, and Imipenem.

Categorization of fibroepithelial breast tumors according to ultrasound BI-RADS classification

Among breast masses, the most common are fibroadenomas (FA), which belongs to the group of a fibroepithelial tumors. Simple pericanalicular FA ordinarily shows the ultrasound signs of a benign mass. Long-standing pericanalicular FA and intracanalicular FA as they grow acquire some ultrasound features uncommon for benign lesions, which requires differential diagnosis with malignant breast masses. The group of fibroepithelial breast tumors also includes phyllodes tumors with frequency of malignant variants of 20–30%. Differential diagnosis of phyllodes tumor and fibroadenomas is difficult, due to the lack of the clear radiologic diagnostic criteria (incl. ultrasound). All breast masses that shows suspicious or atypical features should be selected for biopsy, with the use of BI-RADS classification for the biopsy need indication.Objective: to reveal the rules for fibroepithelial breast tumors categorization according to BI-RADS depending on the ultrasound features.Material and methods. A total of 86 breast masses in 79 women were assessed by ultrasound in B-mode and Color Doppler (CDI). Of these, 22 masses in 15 women showed the typical ultrasound pattern of FA up to 2.0 cm in size with no necessary of morphological evaluation (the average age of the patients was 24.2 ± 5.1 years). Surgery performed for 64 lesions ≥2.0 cm in size, postsurgery morphological examination revealed pericanalicular FA – 38, intracanalicular FA –19 and phyllodes tumors (benign) – 7.Results. The majority of atypical pericanalicular FA (84.2%) were categorized as BI-RADS 4а (a low risk of cancer), 94.7% of intracanalicular fibroadenomas and all phyllodes tumors – as BI-RADS 4b and BI-RADS 4c (а high risk of cancer). The identification of suspicious ultrasound signs led to an increase in the BI-RADS category with indications to the morphological evaluation of the mass.Conclusion. As the suspicious ultrasound signs in B-mode should be considered the irregular shape and borders, vertical orientation and inhomogeneous acoustic shadowing in the absence of macrocalcifications, in Color Doppler – diffuse or focal mass hypervascularity or abnormal vascular pattern. The atypical ultrasound pattern commonly presents in large breast fibroadenomas (&gt;3.0 cm in size), requires differential diagnosis with phyllodes tumors and breast cancer and indicates the need of morphological evaluation and categorizing them as not lower than BI-RADS4.

A pregnant lady (G3P2A0) with fetal distress and brain tumor

Intracranial tumors or brain tumors are one of the most feared diseases because the brain is an important central organ. Brain tumors share several pathophysiologic features and may present with a variety of signs and symptom.&#x0D; A 39-year-old female patient, G3P2A0 of 28 weeks gestation complained of frequent throbbing headaches for the last 2 y. On physical examination, she had decreased consciousness, fever and anisocor pupil. Laboratory tests found leukocytosis. Cerebral multi-slice computed tomography (MSCT) found heterodense lesion at intraaxial supratentorial region with irregular border, necrotic components and bleeding in the right basal ganglia to the right temporal lobe. There were signs of fetal distress on cardiotocography (CTG).&#x0D; Management during pregnancy depends on the nature of the tumor. There may be some conflict between maternal and fetal interests in the patient with increased ICP. The patient was diagnosed with brain tumor in the right basal ganglia and undergoing treatment in the ICU. As a 28-week pregnant patient with fetal distress diagnosed with brain tumor, she needed to be observed and periodically evaluated. However, the patient's prognosis was dubia ad malam.&#x0D; Key words: Brain Tumor; Fetal Distress; Pregnancy&#x0D; Citation: Arianto AT, Heryadi MI. A pregnant lady (G3P2A0) with fetal distress and brain tumor. Anaesth. pain intensive care 2023;27(6):772−775; DOI: 10.35975/apic.v27i6.2233&#x0D; Received: May 22, 2923; Revised: August 08, 2023; Accepted: October 22, 2023