Malignant Cases Research Articles

MM-111 A Complex Journey of Multiple Myeloma, a Devastating Metastatic Breast Cancer, Then Multiple Myeloma Again: A Double Malignancy Case Report

MM-111 A Complex Journey of Multiple Myeloma, a Devastating Metastatic Breast Cancer, Then Multiple Myeloma Again: A Double Malignancy Case Report

A multivariate analysis on characteristics of hand and wrist tumours: a multiethnic study.

Hand tumours are frequently encountered in clinical practice. However, large-scale epidemiological data of soft tissue tumours in the hand are infrequently published. Epidemiological data provide diagnostic cues to guide the workup and management of hand tumours. Assessing significant independent demographic factors and tumour characteristics associated with hand tumours is essential in health care. A retrospective review of patients who underwent excision of hand tumours in Singapore General Hospital between 2004 and 2015 was conducted. The data collected included age, gender, ethnicity, histological diagnosis, malignancy and location of tumour. Generalised linear latent and mixed models (GLLAMM) analyses were performed. A total of 4476 tumours were identified from 4226 patients with a mean age of 51.3 (range 8-101) years and male to female ratio of 1 to 1.15. Most patients were Chinese (75%), followed by Malay (9%), Indian (8%) and others (8%). The most common hand tumours excised were ganglions (43%) (majority in the wrist), followed by giant cell tumours (9%) (commonly in the digits). Most soft tissue tumours were benign (97%), with only 3% of malignant cases. The GLLAMM analyses revealed further potential factors on the status of malignancy, tumour origin and tumour location. Most soft tissue tumours in the hand and wrist are benign. This can guide workup and counselling of patients before the operation. While malignant tumours are uncommon, they have the potential for significant morbidity and mortality if not appropriately evaluated or treated. The application of GLLAMM analyses showed that age, ethnicity and gender were significant predictors of malignancy.

The clinical importance of IFN-γ and human epididymis protein 4 in Egyptian patients with epithelial ovarian cancer combined with HPV infection

BackgroundHigh-grade Epithelial Ovarian Cancer (HGEOC) is an aggressive disease that usually presents at an advanced stage. Thus, detecting the circulating cytokines (IFNγ and TNF-α) may serve as a biomarker to identify malignancy and manage therapeutic decisions. ObjectivesAssessing the clinical importance of inflammatory mediators and tumor markers in EOC Egyptian patients compared with benign cases. Moreover, identifying the distinct inflammatory mediators in EOC patients combined with HPV infection. MethodsThis study was conducted on 61 Egyptian patients, divided into 25 patients with HGEOC, 22 patients with LGEOC, and 14 benign ovarian tumor cases. Measurements of serum HE4, CA125, CEA, and CA19-9 were determined by Roche Elecsys immunoassays. Serum levels of TNF-α and IFN-γ were measured using quantitative sandwich ELISA. Quantitative genotyping of HPV DNA types 16, 18, and 45 was assessed for the HPV DNA-positive samples. ResultsHPV DNA was detected in 25.53 % of malignant cases, HPV 16 was detected in 50 % of HPV-positive cases, and only 1 case of HPV 18 was detected out of 12 positive cases. The Human Epididymis protein 4 (HE4) was statistically different between patients with EOC and benign cases (p-value = 0.007) and between HPV DNA positive and HPV DNA negative cases (p-value = 0.008). The serum levels of IFN- γ were statistically different between HGEOC and LGEOC (p-value < 0.001), while the serum levels of TNF-α didn’t differ statistically between the two groups. ConclusionIFN-γ could be used as a biomarker to discriminate HGEOC and LGEOC. Initial evidence for the possible association between HE4 and the progression of HPV-associated EOC was speculated.

Enhancing Melanoma Diagnosis with Advanced Deep Learning Models Focusing on Vision Transformer, Swin Transformer, and ConvNeXt.

Skin tumors, especially melanoma, which is highly aggressive and progresses quickly to other sites, are an issue in various parts of the world. Nevertheless, the one and only way to save lives is to detect it at its initial stages. This study explores the application of advanced deep learning models for classifying benign and malignant melanoma using dermoscopic images. The aim of the study is to enhance the accuracy and efficiency of melanoma diagnosis with the ConvNeXt, Vision Transformer (ViT) Base-16, and Swin Transformer V2 Small (Swin V2 S) deep learning models. The ConvNeXt model, which integrates principles of both convolutional neural networks and transformers, demonstrated superior performance, with balanced precision and recall metrics. The dataset, sourced from Kaggle, comprises 13,900 uniformly sized images, preprocessed to standardize the inputs for the models. Experimental results revealed that ConvNeXt achieved the highest diagnostic accuracy among the tested models. Experimental results revealed that ConvNeXt achieved an accuracy of 91.5%, with balanced precision and recall rates of 90.45% and 92.8% for benign cases, and 92.61% and 90.2% for malignant cases, respectively. The F1-scores for ConvNeXt were 91.61% for benign cases and 91.39% for malignant cases. This research points out the potential of hybrid deep learning architectures in medical image analysis, particularly for early melanoma detection.

Appropriate Statistical Methods to Assess Cross-study Diagnostic 23-Gene Expression Profile Test Performance for Cutaneous Melanocytic Neoplasms.

Comparing studies of molecular ancillary diagnostic tests for difficult-to-diagnose cutaneous melanocytic neoplasms presents a methodological challenge, given the disparate ways accuracy metrics are calculated. A recent report by Boothby-Shoemaker et al investigating the real-world accuracy of the 23-gene expression profile (23-GEP) test highlights this methodological difficulty, reporting lower accuracy than previously observed. However, their calculation method-with indeterminate test results defined as either false positive or false negative-was different than those used in previous studies. We corrected for these differences and recalculated their reported accuracy metrics in the same manner as the previous studies to enable appropriate comparison with previously published reports. This corrected analysis showed a sensitivity of 92.1% (95% confidence interval [CI], 82.1%-100%) and specificity of 94.4% (91.6%-96.9%). We then compared these results directly to previous studies with >25 benign and >25 malignant cases with outcomes and/or concordant histopathological diagnosis by ≥3 dermatopathologists. All studies assessed had enrollment imbalances of benign versus malignant patients (0.8-7.0 ratio), so balanced cohorts were resampled according to the lowest common denominator to calculate point estimates and CIs for accuracy metrics. Overall, we found no statistically significant differences in the ranges of 23-GEP sensitivity, 90.4%-96.3% (95% CI, 80.8%-100%), specificity, 87.3%-96.2% (78.2%-100%), positive predictive value, 88.5%-96.1% (81.5%-100%), or negative predictive value, 91.1%-96.3% (83.6%-100%) between previous studies and the cohort from Boothby-Shoemaker et al with this unified methodological approach. Rigorous standardization of calculation methods is necessary when the goal is direct cross-study comparability.

(Invited) Developing Optical Nanosensors for Biomedical Applications

Novel biomedical application technologies have been rapidly improved in the past few decades. Despite recent technological progress, significant challenges persist toward more accessible, precise, inexpensive, rapid, automated, and patient-facing methods. Optical spectroscopic and imaging technologies have multiple advantages to current practices, such as versatility, fast and robust signal, and noninvasive and nondestructive probing techniques that can be easily integrated into current medical devices such as catheters, endoscopes, or biopsy needle channels. Single-walled carbon nanotubes (SWCNTs) have been developed as near-infrared (NIR) fluorescent nanosensors and demonstrated in vitro and in vivo with great interest for using them in biological and clinical applications and the methods designed to probe them. The advantages of SWCNT include resistance to photobleaching and high sensitivity towards biological environments.Gynecologic cancers are challenging to diagnose. Patient prognosis and quality of life are affected substantially by this problem. In this talk, I will present recent work on developing new technologies to improve gynecological cancer detection and grant new research tools for understanding fundamental mechanisms in cancer development using liquid biopsy and in vitro and in vivo sensor approaches. With artificial intelligence algorithms, we harness SWCNTs' unique optical properties and sensitivity to develop intelligent optical sensors. We developed platforms to detect multiple gynecological cancer biomarkers as implantable devices in patient biofluids and the uterine cavity. Applying machine learning algorithms to analyze the optical response of the sensors enabled the precise detection of multiplexed biomarkers. In addition, when implanted in human uteri, the sensors detected the biomarkers and successfully differentiated between benign and malignant cases. These technologies will significantly improve diagnostics and cancer research, leading to robust, point-of-care technologies for early-stage diagnosis.

Non-Breast Implantable Medical Devices and Associated Malignancies: A Systematic Review.

Innovation in healthcare has led to the development of numerous implantable medical devices (IMDs). However, advances in our knowledge of breast implant-associated malignancies have raised questions about the prevalence, etiology and management of malignancies associated with non-breast IMDs. The objective of this study was to examine the prevalence and characteristics of malignancies associated with non-breast IMDs. An expert medical librarian developed the search strategy for this review. Databases included MEDLINE (National Library of Medicine, Bethesda, MD; date range of search: 1946 to June 21, 2023), EMBASE (Elsevier, Amsterdam, the Netherlands; date range of search: 1946 to June 21, 2023), and Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library, Wiley, Hoboken, NJ; date range of search: 1946 to June 21, 2023). In addition, grey literature sources were searched and relevant references from systematic reviews and meta-analyses were included. The PRISMA guideline was used to guide the review. Risk of bias was evaluated using the JBI Critical Appraisal tools. A total of 12,230 articles were reviewed with a total of 77 meeting inclusion criteria. Risk of bias was highest with case reports (moderate, average of 65.1% with range of 37.5 to 100%) and low for the remaining study types. In total, 616 cases of IMD-associated malignancies were identified. Malignancies associated with IMDs were reported in the head/neck (543, 88.1%), lower extremity (57, 9.6%), thorax (9, 1.4%), abdomen (3, 0.5%), and genitourinary system (2, 0.3%). The most common malignancy type in the lower extremity was sarcoma, in the head and neck was squamous cell carcinoma, and in the thorax was lymphoma. This study is the first comprehensive systematic review of its kind. Overall, the oncologic risk of IMDs is low. The discussion of malignancy is an important part to the overall consent process and malignancy should be considered with any new signs or symptoms in the anatomic area of an implant. More data is needed to better understand how primary malignancies occur around IMDs and how to reduce this risk.

Clinicopathologic features and new factors affecting constitution of eyelid neoplasms: a 10-year multicentre experience in southern coastal China

ObjectiveThis study aims to delineate the key characteristics of eyelid neoplasms in central and southern coastal China and to explore potential factors affecting tumour development. MethodsThis was a retrospective, multicentre observational study. In total, 1302 cases of eyelid neoplasms diagnosed in 2 tertiary hospitals were reviewed from January 2013 to May 2023. Histogenesis, pathologic diagnosis, and potential risk factors were investigated, and the findings were compared with data from various regions and countries. Age- and sex-specific incidence rates, time trends, distributions across age groups, and the relationship with the Sociodemographic Index, latitude, and altitude were calculated. ResultsThere were 1162 benign (89.2%) and 140 malignant (10.8%) cases, representing 63 pathologic types. The median age of benign cases (50 years) was significantly lower than that of malignant cases (72 years) (P < 0.05). The most common benign and malignant lesions were intradermal nevus (28.83%) and basal cell carcinoma (BCC) (74.29%). A relatively younger median age (68 years) for sebaceous gland carcinoma (SGC) was observed, with a male preponderance (sex ratio 2:1). Analyses of the proportions of BCC, SGC, and squamous cell carcinoma in eyelid malignancies revealed significant regression equations (P < 0.05). ConclusionsMost eyelid neoplasms are of epithelial and melanocytic origin, with benign tumours being predominant. The regions with greater Sociodemographic Index exhibit a greater incidence of BCC and a lower incidence of squamous cell carcinoma and SGC. BCC appears to have a greater incidence in regions located at higher latitudes.

Epidemiological trends and treatment abandonment of paediatric solid tumours in a nigerian tertiary hospital: a seven-year review (2016–2022)

BackgroundPaediatric solid tumours, both benign and malignant, present significant health challenges, particularly in Sub-Saharan Africa where comprehensive data is limited. This study aims to elucidate the prevalence, distribution, and treatment outcomes of paediatric solid neoplasms in a tertiary hospital in South-East Nigeria over a seven-year period.MethodsA retrospective cohort study was conducted at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. Clinical details and histological slides of confirmed cases from January 2016 to December 2022 were reviewed. Data extraction focused on socio-demographic variables and treatment outcomes, analysed using statistical methods.ResultsThe study included 293 children diagnosed with solid tumours (58.1% malignant, 41.9% benign), with a female predominance (61.8%). The median age at diagnosis was 12 years. Fibroadenoma was the most common benign tumour (61.8% of benign cases), while non-Hodgkin lymphoma was the predominant malignant tumour (18.2% of malignant cases). Treatment abandonment rates differed significantly between benign (13.8%) and malignant (51.2%) tumours. Significant associations were found between treatment outcomes and factors such as gender (p = 0.0001 for benign tumours), age category (p = 0.0001 for benign tumours), and specific diagnoses (p = 0.0001 for both benign and malignant tumours).ConclusionThis study underscores the substantial burden of paediatric solid tumours in South-East Nigeria and highlights the critical need for improved treatment adherence strategies, particularly for malignant cases. The findings emphasize the importance of tailored interventions based on tumour type, age, and gender. These insights can inform future research, policy formulation, and healthcare strategies aimed at enhancing the management and outcomes of paediatric solid neoplasms in resource-limited settings.

Quality of Life and Clinical Outcomes of Endosonography-Guided Biliary Drainage in Patients with Malignant Biliary Obstruction: A Single-Center, Prospective Analysis.

Introduction: Endosonography-guided biliary drainage (EUS-BD) serves as a rescue treatment modality for patients with malignant biliary obstruction when endoscopic retrograde cholangiopancreatography (ERCP) fails. Objectives: This study explores the effects of EUS-BD on liver function and quality of life (QoL). Patients and Methods: Patients with malignant biliary obstruction and failed ERCP were enrolled to undergo EUS-BD. QoL, including pruritus severity, was evaluated using EQ-5D-5L and PSS-10 questionnaires before and after EUS-BD. Serum bilirubin and liver function tests were measured on the procedure day, two days, and at least 14 days post-procedure. Results: During a 20-month study period, 1755 ERCPs were performed, with 595 for malignant cases. Of these, 49 underwent EUS-BD following failed ERCP, and 37 (54% women, age range 34-87 years) completed the 14-day follow-up. Pancreatic cancer was the most common (49%) condition, and the median hospital stay was 4 days. Serum bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase significantly decreased 2 and 14 days after EUS-BD (all p < 0.001). Pruritus significantly improved, with an average reduction of 5.19 points on the PSS-10 scale two weeks post-procedure (p < 0.001). EUS-BD led to improvements in anxiety and depression according to the EQ-5D-5L (p = 0.013). Conversely, deteriorations were observed in the Mobility, Self-Care, and Usual Activities domains over time (all p < 0.05). Successful EUS-BD enabled the resumption of chemotherapy in 11 (30%) patients. The median post-procedure survival was 112 (range 27-1030) days. Conclusions: EUS-BD improves liver parameters and some aspects of life quality in patients with malignant biliary obstruction, thereby increasing their eligibility for optimal palliative care.

Comprehensive analysis of diagnosis and treatment in 99 cases of abdominal Schwannoma.

Schwannoma is a rare mesenchymal tumor. In this study, we analyzed clinicopathologically 99 schwannomas.This retrospective study delves into the clinical, pathological, and immunohistochemical dimensions of abdominal schwannomas. A cohort of 99 cases, comprising 4 malignant and 95 benign schwannomas, was meticulously examined. Clinical analysis revealed a notable gender distribution (1:1.7, male to female) and an average age of 58.5 years. The majority of cases were asymptomatic. A cohort of 99 cases, comprising 4 malignant and 95 benign schwannomas, was meticulously examined. Clinical analysis revealed a notable gender distribution (1:1.7, male to female) and an average age of 58.5 years. The majority of cases were asymptomatic. Tumor sizes ranged from 0.5 to 30 cm, with distinct locations in the stomach for most benign cases and the abdomen/small intestine for malignancies. Initial misdiagnoses were frequent. Pathological evaluations revealed distinct features, including Antoni A and B patterns, spindle cells, and lymphatic sheath structures in benign schwannomas. Malignant cases exhibited atypical cells, ulcers, and invasive growth. Immunohistochemical markers, such as S100, SOX10, and vimentin, consistently demonstrated positivity by contributing to accurate diagnoses. Treatment outcomes indicated a poor prognosis in malignant cases, with overall survival ranging from 10 to 41 months. Conversely, benign cases displayed no recurrence or metastasis during follow-up, despite atypical behaviors. This study underscores the rarity of abdominal schwannomas and underscores the need for a comprehensive diagnostic morphology and immunohistochemistry. SOX10 emerges as a crucial and specific marker for accurate diagnosis. Further research is imperative to refine diagnostic protocols and enhance our understanding of the clinical behavior of abdominal schwannomas.

Evaluation of CTLA-4 and PD-L1 Expression in Thyroid Carcinoma and Its Prognostic Significance.

Introduction Immune checkpoint inhibitors (ICIs) targeting cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and programmed death-ligand 1 (PD-L1) have revolutionised treatment and improved outcomes in various malignancies. We aimed to evaluate CTLA-4 and PD-L1 immunoexpression in thyroid tumours and correlated them with clinicopathological parameters. Methods The study included 90 cases of thyroid malignancies comprising papillary thyroid carcinoma (PTC) (n = 64, 54.2%), follicular thyroid carcinoma (FTC) (n = 19, 16.1%), anaplastic thyroid carcinoma (ATC) (n = 3, 2.5%), and poorly differentiated carcinoma (n = 4, 3.4%), two cases (1.69%) of non-invasive follicular thyroid neoplasm with papillary-like nuclear features(NIFTP) along with 26 cases (22%) of benign thyroid lesions. CTLA-4 (UMAB249) and PD-L1 (SP263) expression were assessed in all the cases of thyroid tumours. Results were compared with clinicopathologic parameters and overall survival. Results PD-L1 was positive in all three cases of anaplastic thyroid carcinoma (ATC), 33% (n = 21) cases of PTC, and 16% (n = 3) cases of FTC. PD-L1 positivity was significantly associated at tumour proportion score (TPS) ≥1% with lymphovascular invasion and age ≤40 years and at TPS ≥50% with tumour necrosis and N-stage. Immune proportion score (IPS) did not correlate with any clinicopathological parameters except for the N-stage. CTLA-4 was positive in six cases of PTC (1-5%); five showed lymph node involvement (p = 0.032). IPS was positive in 14 cases, and a significant association was seen with lymph node metastasis, lymphocytic infiltration, and lymphovascular invasion. Three cases of PTC showed co-expression for PD-L1 and CTLA-4 in tumour cells. No significant association was seen between PD-L1 expression and survival. Conclusion The current data suggest that PD-L1 is expressed in differentiated thyroid carcinoma, mainly PTC and ATC, indicating higher responsiveness to immunotherapy. A subset of PTC showed co-expression of PD-L1 and CTLA-4. These findings suggest the need for further investigation to utilise combinational immunotherapy, including anti-PD-L1 and anti-CTLA-4.

Application of the International Endometrial Tumor Analysis (IETA) in Ultrasound Evaluation of Abnormal Uterine Bleeding.

Abnormal uterine bleeding (AUB) affects a significant proportion of women, particularly around the ages of menarche and menopause. While ultrasonography is a primary diagnostic tool for AUB, techniques like the International Endometrial Tumor Analysis (IETA) scoring system have enhanced diagnostic accuracy for endometrial abnormalities. IETA provides a standardized approach to evaluating endometrial features, which aids in distinguishing benign from malignant lesions. This study applied the IETA scoring system to the ultrasound evaluation of 50 women presenting with AUB. The study assessed various endometrial characteristics, including thickness, echogenicity, midline appearance, junction regularity, and vascular patterns. Data were analyzed to correlate IETA scores with histopathological findings and to compare the ultrasound features of benign and malignant lesions. The study found that non-uniform endometrial characteristics and irregular midline appearances were more common in malignant lesions. Specifically, interrupted or irregular endometrial-myometrial junctions, absence of the bright edge, higher color scores, and complex vascular patterns were significantly associated with malignancy. Mean endometrial thickness was notably higher in malignant cases compared to benign ones, with a statistically significant difference. The most frequent IETA scores were 7, 12, and 13. Integrating the IETA scoring system into ultrasound evaluation enhances the detection of endometrial abnormalities, improving the differentiation between benign and malignant lesions. This approach provides a reliable framework for diagnosing and managing AUB, potentially reducing the need for invasive procedures and facilitating better clinical decision-making.

Real-time ultrasound elastography in the diagnosis of newly identified thyroid nodules in adults: the ElaTION RCT.

Strain and shear wave elastography which is commonly used with concurrent real-time imaging known as real-time ultrasound shear/strain wave elastography is a new diagnostic technique that has been reported to be useful in the diagnosis of nodules in several organs. There is conflicting evidence regarding its benefit over ultrasound-guided fine-needle aspiration cytology alone in thyroid nodules. To determine if ultrasound strain and shear wave elastography in conjunction with fine-needle aspiration cytology will reduce the number of patients who have a non-diagnostic first fine-needle aspiration cytology results as compared to conventional ultrasound-only guided fine-needle aspiration cytology. A pragmatic, unblinded, multicentre randomised controlled trial. Eighteen centres with a radiology department across England. Adults who had not undergone previous fine-needle aspiration cytology with single or multiple nodules undergoing investigation. Ultrasound shear/strain wave elastography-ultrasound guided fine-needle aspiration cytology (intervention arm) - strain or shear wave elastography-guided fine-needle aspiration cytology. Ultrasound-only guided fine-needle aspiration cytology (control arm) - routine ultrasound-only guided fine-needle aspiration cytology (the current standard recommended by the British Thyroid Association guidelines). The proportion of patients who have a non-diagnostic cytology (Thy 1) result following the first fine-needle aspiration cytology. Patients were randomised at a 1 : 1 ratio to the interventional or control arms. A total of 982 participants (80% female) were randomised: 493 were randomised to ultrasound shear/strain wave elastography-ultrasound guided fine-needle aspiration cytology and 489 were randomised to ultrasound-only guided fine-needle aspiration cytology. There was no evidence of a difference between ultrasound shear/strain wave elastography and ultrasound in non-diagnostic cytology (Thy 1) rate following the first fine-needle aspiration cytology (19% vs. 16% respectively; risk difference: 0.030; 95% confidence interval -0.007 to 0.066; p = 0.11), the number of fine-needle aspiration cytologies needed (odds ratio: 1.10; 95% confidence interval 0.82 to 1.49; p = 0.53) or in the time to reach a definitive diagnosis (hazard ratio: 0.94; 95% confidence interval 0.81 to 1.10; p = 0.45). There was a small, non-significant reduction in the number of thyroid operations undertaken when ultrasound shear/strain wave elastography was used (37% vs. 40% respectively; risk difference: -0.02; 95% confidence interval -0.06 to 0.009; p = 0.15), but no difference in the number of operations yielding benign histology - 23% versus 24% respectively, p = 0.70 (i.e. no increase in identification of malignant cases) - or in the number of serious adverse events (2% vs. 1%). There was no difference in anxiety and depression, pain or quality of life between the two arms. The study was not powered to detect differences in malignancy. Ultrasound shear/strain wave elastography does not appear to have additional benefit over ultrasound-guided fine-needle aspiration cytology in the diagnosis of thyroid nodules. The findings of the ElaTION trial suggest that further research into the use of shear wave elastography in the diagnostic setting of thyroid nodules is unlikely to be warranted unless there are improvements in the technology. The diagnostic difficulty in distinguishing between benign and malignant lesions still persists. Future studies might examine the role of genomic testing on fine-needle aspiration samples. There is growing use of targeted panels of molecular markers, particularly aimed at improving the diagnostic accuracy of indeterminate (i.e. Thy3) cytology results. The application of these tests is not uniform, and their cost effectiveness has not been assessed in large-scale trials. This study is registered as ISRCTN (ISRCTN18261857). This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/19/04) and is published in full in Health Technology Assessment; Vol. 28, No. 46. See the NIHR Funding and Awards website for further award information.

Medical, Environmental, and Social Determinants Associated With Periocular Cutaneous Malignancies in the United States Using the All of Us National Database.

To identify common factors associated with periocular cutaneous malignancies using the National Institutes of Health (NIH) All of Us database. In this case-control study, we extracted electronic health records and sociodemographic data for 385 cases of periocular cutaneous malignancies from the All of Us nationwide database. Controls (N = 1540) were matched to the demographic characteristics of the 2020 United States Census. Bivariate analyses and multivariable logistic regression determined variables significantly associated with increased odds of periocular cutaneous malignancies. We analyzed medical, environmental, and social determinants to evaluate which factors were associated with increased odds of periocular cutaneous malignancies. Among the cases, the mean (standard deviation) age was 66.8 (11.2) years at the time of diagnosis. The majority were male (207, 54%) and white (361, 94%). Periocular cutaneous malignancy was significantly more likely among individuals with high sun exposure (odds ratio [OR] 14.79, 95% confidence interval [CI] 3.35-85.73, P= 0.001), those identifying as white race (OR 3.88, 95% CI 1.06-25.33, P= 0.079), and those with higher socioeconomic status, including higher annual income (OR 1.35, 95% CI 1.25-1.46, P< 0.001). This study demonstrates similar risk factors for periocular cutaneous malignancies, echoing prior research that showed increased associations with lighter-pigmented skin and higher socioeconomic status. It also sheds light on the positive impact of physician surveillance and health utilization factors in the early detection and treatment of these malignancies, aspects less explored in prior analyses.

ESR Essentials: diagnostic work-up in patients with symptomatic breast disease-practice recommendations by the European Society of Breast Imaging.

Breast complaints are frequent reasons for consultations in primary care or breast clinics. Breast pain, breast lumps, and nipple discharge are the most common complaints. Less common symptoms such as skin changes and axillary abnormalities also require specific diagnostic approaches. Imaging the symptomatic breast should be performed by appropriately trained breast radiologists following the best practice guidelines and quality standards. Full-field digital mammography (FFDM), digital breast tomosynthesis (DBT), and breast ultrasound (US) are the main modalities used in this primary setting. The choice depends on the patient's age and symptoms. Women younger than 30-years-old are first imaged byUS, whereas women over 40-years-old usually require both FFDM or DBT and US. For women between 30-years-old and 40-years-old, the US is the modality of choice, whereas FFDM or DBT might also be performed if needed. Pregnant or lactating women with palpable lesions or nipple discharge are imaged with US as the first method; FFDM or DBT can also be performed depending on the degree of suspicion as the dose to the fetus is minimal, and shielding may even further reduce the dose. More advanced techniques such as breast magnetic resonance imaging or contrast-enhanced mammography are not indicated in this first diagnostic setting and are reserved for cases of established malignancy (local staging) or rare cases of equivocal findings not otherwise resolved or inflammatory breast cancer. Last, but not least, male breast symptoms should also be addressed with US and/or FFDM. CLINICAL RELEVANCE STATEMENT: It is equally important to correctly diagnose an underlying malignancy and to avoid false positives that would lead to unnecessary biopsies, increased costs, and anxiety for the patient. Proper use of imaging modalities ensures optimal diagnostic approach and minimizes false negatives. KEY POINTS: Ultrasound, full-field digital mammography, or digital breast tomosynthesis are the main imaging modalities in the diagnostic setting, while MRI or contrast-enhanced mammography should be reserved to selected cases. Initial imaging modality includes ultrasound combined with mammography or digital breast tomosynthesis depending on women's age and the presence (or not) of inconclusive findings. A negative imaging evaluation should not deter biopsy when a highly suspicious finding is found on physical examination.

Study of cases of obstructive jaundice due to biliary and pancreatic tumors

Obstructive jaundice has recently become more common, particularly among malignant cases. The aim was to study, evaluate and compare various operative managements for obstructive jaundice due to biliary and pancreatic tumors. This prospective study was conducted by random selection of 20 cases presenting with obstructive jaundice due to biliary and pancreatic tumors at a tertiary care hospital affiliated with Smt. N.H.L. Municipal Medical College. Majority of patients were in age group 51-60 years (35%) and 61-70 years (20%). Males (70%) were found to be in higher proportion compared to females (30%). Most comm on presenting symptom was jaundice (90%). Most common cause was periampullary carcinoma (60%). It was found that the most common complication following Whipple’s procedure and Triple Bypass Surgery was pancreatic fistula.

A rare combination of double primary malignancies; mixed germ cell tumor of testis with papillary carcinoma of thyroid: a case report

Double malignancy occurring in multiple organs is relatively rare yet possible. The second primary lesion is identified either simultaneously with the primary lesion (synchronous) or after a while (metachronous). We report a case of synchronous double malignancy in a patient who had two separate carcinomas, a non-seminomatous germ cell tumor (NSGCT) and a papillary carcinoma of thyroid. These types of synchronous double malignancies can be dealt as independent carcinomas. This existence of two carcinomas at anatomically dissimilar sites with distinct histopathologies, being a rare combination, led us to report the case.

Ki-67 expression and its correlation with clinicopathological parameters in Iraqi breast cancer patients

Breast cancer is the most common cancer worldwide and the major cause of cancer-related death among women in both developed and developing countries. In Iraq, breast cancer accounted for 37.9% of all malignant cases in 2020 and 15.3% of cancer-related fatalities. Relevant biomarkers play an important role in predicting prognosis and deciding the most effective therapy for each patient to delay metastases and reduce mortality. Objective: This study aimed to assess the significance of Ki-67 expression as a prognostic biomarker in breast cancer patients as well as investigate the correlations between Ki-67 and their clinicopathological features. Methods: The case-control study comprised sixty newly diagnosed breast cancer patients and ten women with benign breast tumors who served as controls. We assessed the tissue expression level of Ki-67 protein using the immunohistochemistry technique. Results: Our results showed that the median immunohistochemical expression scores of Ki-67 in the newly diagnosed breast cancer group were higher than those of the control group; the difference was significant (p &lt; 0.001). The Ki-67 expression score in breast cancer cells increases with tumor size and grade. Ki-67 expression showed a substantial negative correlation with estrogen receptor expression and a significant positive correlation with HER2 expression.

Comprehensive analysis of clinical data and radiomic features from contrast enhanced CT for differentiating benign and malignant pancreatic intraductal papillary mucinous neoplasms

The primary aim of this investigation was to leverage radiomics features derived from contrast-enhanced abdominal computed tomography (CT) scans to devise a predictive model to discern the benign and malignant nature of intraductal papillary mucinous neoplasms (IPMNs). Radiomic signatures were meticulously crafted to delineate benign from malignant IPMNs by extracting pertinent features from contrast-enhanced CT images within a designated training cohort (n = 84). Subsequent validation was conducted with data from an independent test cohort (n = 37). The discriminative ability of the model was quantitatively evaluated through receiver operating characteristic (ROC) curve analysis, with the integration of carefully selected clinical features to improve the comparative analysis. Arterial-phase images were utilized to construct a model comprising 8 features for distinguishing between benign and malignant cases. The model achieved an accuracy of 0.891 [95% confidence interval (95% CI), 0.816–0.996] in the cross-validation set and 0.553 (95% CI 0.360–0.745) in the test set. Conversely, employing 9 features from the venous-phase resulted in a model with a cross-validation accuracy of 0.862 (95%CI 0.777–0.946) and a test set accuracy of 0.801 (95% CI 0.653–0.950).Integrating the identified clinical features with imaging features yielded a model with a cross-validation accuracy of 0.934 (95% CI 0.879–0.990) and a test set accuracy of 0.904 (95% CI 0.808–0.999), thereby further improving its discriminatory ability. Our findings distinctly illustrate that venous-phase radiomics features eclipse arterial-phase radiomic features in terms of predictive accuracy regarding the nature of IPMNs. Furthermore, the synthesis and meticulous screening of clinical features with radiomic data significantly increased the diagnostic efficacy of our model, underscoring the pivotal importance of a comprehensive and integrated approach for accurate risk stratification in IPMN management.