Malignant Lesions Research Articles

Narrow band imaging: Important tool for early diagnosis, management, and improved outcomes in gastrointestinal lesions.

Narrow band imaging-magnifying endoscopy (NBI-ME) is used to identify changes in mucosal or vascular pattern observed on GI endoscopy in real time on the basis of optical image enhancement.It has a significant role in early detection of dysplasia, premalignant, and Malignant lesions along with its depth of invasion. Upper and lower GI endoscopy performed in 1742 patients who presented with gastrointestinal symptoms at this tertiary center over 5years out of which 1623 were evaluated with both NBI-ME and histopathology. Real time endoscopic assessment was performed. Targeted biopsies were taken for comparative analysis. Of the 1742 patients, 119 were excluded from the study. 807 underwent upper GI endoscopy and 816 underwent lower GI endoscopy. Mean age of presentation was 38 +/- 2.7years. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of NBI-ME for neoplastic esophageal lesions were 96.3%, 90.6%, 91.1%, 96.03%, respectively. For Barrett's esophagus it was 95.4%, 90.7%, 86.1%, and 90.7%; For gastric neoplastic lesions the values were 96.1%, 91.04%, 83.8%, and 97.9%. For colorectal it was 96.7%, 91.3%, 88.0%, and 97.7%. Overall sensitivity, specificity, PPV, andNPVof NBI-ME for neoplastic lesions (both upper and lower GI) were 96.2%, 91.0%, 96.2%, and 97.2%. Of the 1623 patients, 951 received medical management with regular surveillance and 672 patients with high-grade dysplasia, premalignant, and malignant conditions underwent interventions in form of either endoscopy or surgery. NBI-ME has a greater role and can be considered as an effective tool in making early diagnosis and guiding optimum treatment.

Benign Lobular Inner Nuclear Layer Proliferations of the retina.

Report the clinical and imaging findings of a patient with an intraretinal benign tumor that was documented as an unexpected clinical finding after an ischemic stroke in the context of mitral valve disease. This tumor must be distinguished from retinoblastoma and other malignant neoplasms. A patient with intraretinal tumor of the inner nuclear layer (INL) underwent a combination of ophthalmic examination, fundus photography, fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCT-A). A 64-year-old male patient with unilateral benign tumor lesions dependent on the internal retina, centered in the posterior pole, and multifocal. OCT showed that these lesions were centered within the INL at the edge of the inner plexiform layer and were not associated with other findings in the posterior pole. Benign Lobular Inner Nuclear Layer Proliferations (BLIP) of the Retina are recently described lesions that should be considered, given their distinctive characteristics that set them apart from other benign and malignant retinal lesions.

Discrimination Between Benign and Malignant Lesions With Restriction Spectrum Imaging MRI in an Enriched Breast Cancer Screening Cohort.

Breast cancer screening with dynamic contrast-enhanced MRI (DCE-MRI) is recommended for high-risk women but has limitations, including variable specificity and difficulty in distinguishing cancerous (CL) and high-risk benign lesions (HRBL) from average-risk benign lesions (ARBL). Complementary non-invasive imaging techniques would be useful to improve specificity. To evaluate the performance of a previously-developed breast-specific diffusion-weighted MRI (DW-MRI) model (BS-RSI3C) to improve discrimination between CL, HRBL, and ARBL in an enriched screening population. Prospective. Exactly 187 women, either with mammography screening recommending additional imaging (N = 49) or high-risk individuals undergoing routine breast MRI (N = 138), before the biopsy. Multishell DW-MRI echo planar imaging sequence with a reduced field of view at 3.0 T. A total of 72 women had at least one biopsied lesion, with 89 lesions categorized into ARBL, HRBL, CL, and combined CLs and HRBLs (CHRLs). DW-MRI data were processed to produce apparent diffusion coefficient (ADC) maps, and estimate signal contributions (C1, C2, and C3-restricted, hindered, and free diffusion, respectively) from the BS-RSI3C model. Lesion regions of interest (ROIs) were delineated on DW images based on suspicious DCE-MRI findings by two radiologists; control ROIs were drawn in the contralateral breast. One-way ANOVA and two-sided t-tests were used to assess differences in signal contributions and ADC values among groups. P-values were adjusted using the Bonferroni method for multiple testing, P = 0.05 was used for the significance level. Receiver operating characteristics (ROC) curves and intra-class correlations (ICC) were also evaluated. C1, √C1C2, and were significantly different in HRBLs compared with ARBLs (P-values < 0.05). The had the highest AUC (0.821) in differentiating CHRLs from ARBLs, performing better than ADC (0.696), especially in non-mass enhancement (0.776 vs. 0.517). This study demonstrated the BS-RSI3C could differentiate HRBLs from ARBLs in a screening population, and separate CHRLs from ARBLs better than ADC. 2.

Vocal dysfunction following thyroid surgery: a multidimensional subjective and objective study

Background and objectiveFollowing thyroid surgery, vocal changes are a common complication and well-known morbidity that may be linked to neuronal and non-neuronal voice breakdown. Nevertheless, their effects on different voice characteristics are not fully understood, and their bases are still poorly characterized. In order to determine the diagnostic indicators that address the nature of such post-thyroidectomy voice alternations, this study was designed to provide a multidimensional assessment of vocal function after thyroid surgery.MethodsThis research was a 1-year prospective cohort study conducted on 100 adult patients aged 40.19 (± 12.82) years who were recruited from the outpatient clinic of Phoniatric Unit, Assiut University Hospital, and scheduled to undergo thyroid surgery during the period from November 2020 to November 2021. All subjects underwent vocal assessment preoperatively and 15 days, 1 month, and 2 months postoperatively by filled in subjective evaluation of voice complaints via voice handicap index (VHI-30), auditory perceptual assessment (APA) of the voice, and videolaryngoscopy in addition to acoustic analysis using computerized speech lab (CSL). Statistical analysis was performed to compare multi-parameter voice assessment tools across different assessment time points.ResultsThe voice changes were significantly decreased from 51.0% after 15 days postoperatively to 33.0% after 2 months of follow-up. Among these cases, 35.0% cases developed vocal fold paralysis and complained of a breathy voice (27% developed unilateral vocal fold paralysis, and 8% developed bilateral focal fold lesions), and the remaining 16.0% cases had no paralytic manifestations. Also, only one case developed gross lesion “bilateral vocal fold nodules.” The subjective evaluation of voice outcome after thyroidectomy showed significant improvement in VHI subscales and total score from 15 days postoperatively to 2 months of follow-up (P < 0.001). All of the acoustic parameters except HNR showed a significant difference across the different assessment settings (P < 0.001).ConclusionThyroidectomy can result in significant vocal alterations, even in cases where the laryngeal nerve is unharmed. These changes should be taken into consideration in patient having thyroid surgery, especially a total thyroidectomy because of malignant lesions. More efforts are needed in order to determine the extent and pathophysiological reasons for the vocal alterations following thyroid surgery in order to reduce the morbidity associated with one of the most popular surgical procedures performed globally.

Usefulness of Combined Advanced Dynamic Contrast-Enhanced and Diffusion-Weighted MRI Over Ultrasonography in Differentiating Cancer From Benign Lesions in Dense Breasts.

Aim To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in characterizing suspicious lesions in dense breasts compared to ultrasonography (USG). Materials and methods Eighty-two consecutive female patients with suspicious lesions in dense breast parenchyma showing the American College of Radiology Breast Imaging Reporting And Data System (ACR BI-RADS) c/d composition on mammography underwent USG, where 63 lesions of 63 patients were suspicious. They underwent multiparametric MRI, followed by histopathological evaluation (HPE) of the lesions.Statistical analysis was done to calculate the sensitivity, specificity, and accuracy of USG and MRI in lesion characterization and the combined accuracy of DCE-MRI with DWI.The receiver operating characteristic (ROC) curve analysis provided the cut-off for the apparent diffusion coefficient (ADC) value. Results The sensitivity, specificity, and accuracy of USG were 91.7%, 63%, and 79.4%, respectively. Kinetic curve analysis on DCE-MRI showed a type I curve only in benign lesions. Malignant lesions predominantly showed a type III curve.The sensitivity, specificity, and accuracy of DCE-MRI were 95.8%, 78.5%, and 85.7%, respectively.The optimum cut-off ADC value was 1.05x10-3 mm2/s with sensitivity, specificity, and accuracy of 83.3 % each.The specificity and accuracy of combined DCE-MRI with DWI were 94.4% and 88.1%, respectively. Conclusion Advanced MRI, including a combination of DCE-MRI kinetics and DWI, would be more effective and accurate for lesion characterization in dense breasts and act as a superior problem-solving tool compared to USG in differentiating carcinoma from benign lesions.

Ultrasomics differentiation of malignant and benign focal liver lesions based on contrast-enhanced ultrasound

ObjectivesTo establish a nomogram for differentiating malignant and benign focal liver lesions (FLLs) using ultrasomics features derived from contrast-enhanced ultrasound (CEUS).Methods527 patients were retrospectively enrolled. On the training cohort, ultrasomics features were extracted from CEUS and b-mode ultrasound (BUS). Automatic feature selection and model development were performed using the Ultrasomics-Platform software, outputting the corresponding ultrasomics scores. A nomogram based on the ultrasomics scores from artery phase (AP), portal venous phase (PVP) and delayed phase (DP) of CEUS, and clinical factors were established. On the validation cohort, the diagnostic performance of the nomogram was assessed and compared with seniorexpert and resident radiologists.ResultsIn the training cohort, the AP, PVP and DP scores exhibited better differential performance than BUS score, with area under the curve (AUC) of 84.1-85.1% compared with the BUS (74.6%, P < 0.05). In the validation cohort, the AUC of combined nomogram and expert was significantly higher than that of the resident (91.4% vs. 89.5% vs. 79.3%, P < 0.05). The combined nomogram had a comparable sensitivity with the expert and resident (95.2% vs. 98.4% vs. 97.6%), while the expert had a higher specificity than the nomogram and the resident (80.6% vs. 72.2% vs. 61.1%, P = 0.205).ConclusionsA CEUS ultrasomics based nomogram had an expert level performance in FLL characterization.

The Role of Predictive and Prognostic Biomarkers in Lower Female Genital Tract Pathology: PD-L1, MMR, HER2, p16, p53, and Beyond.

Biomarkers play a crucial role in the diagnosis, treatment planning, and prognosis of premalignant and malignant lesions and are increasingly used in neoplasia of the lower female genital tract (LFGT) including the cervix, vagina, and vulva. This review will discuss key biomarkers routinely used in LFGT pathology, including programmed cell death ligand 1 (PD-L1), mismatch repair (MMR), and tumor mutational burden (TMB) testing, which are FDA-approved companion diagnostics for anti-PD-1 checkpoint inhibitors. Recent developments in HER2 testing as a marker for anti-HER2 therapies, and prognostic biomarkers such as p53 in HPV-independent vulvar intraepithelial lesions and carcinomas, are also reviewed.

Abstract A013: Advanced Gene Signatures for the Diagnosis and Personalized Treatment of Pancreatic Ductal Adenocarcinoma

Abstract Pancreatic ductal adenocarcinoma (PDA) is among the most lethal tumors, with limited treatment options. The absence of reliable screening and diagnostic tools (biomarkers or procedures) significantly contributes to its poor prognosis. Biomarkers that can diagnose PDA, select optimal therapy combinations, and predict the risk of occult metastases are crucial for enhancing treatment outcomes. Previously, we identified methylation signatures capable of predicting outcomes and diagnosing PDA, focusing on genes/proteins with preclinical evidence of influencing key drugs (gemcitabine [Gem], 5-fluorouracil [5FU], oxaliplatin, cisplatin, paclitaxel, and irinotecan) used in treatment. To make these findings more clinically applicable and propose a novel approach for personalized treatment selection between Gem-based (Gem/nab-paclitaxel) and 5FU-based (FOLFIRINOX) combinations, we explored the diagnostic value of genes associated specifically with Gem and 5FU. The objective was to develop a gene signature for diagnosing PDA and aiding in treatment selection. Based on recent literature, we updated our previous gene panels (from 55 to 93 for Gem, and from 20 to 28 for 5FU). We analyzed RNA and gene expression differences between normal (NT) and PDA tissues using TNMplot.com, a web tool that leverages data from the Gene Expression Omnibus (NCBI-GEO), Cancer Genome Atlas (TCGA), Therapeutically Applicable Research to Generate Effective Treatments (TARGET), and The Genotype-Tissue Expression (GTEx) repositories, employing Mann-Whitney or Kruskal-Wallis tests for statistical significance. For the Gem-specific gene panel, the combined RNA expression of 90 out of 93 genes was significantly higher in PDA compared to NT (2.59, p=6.48e-61), while the combined gene expression of 80 out of 93 genes was also significantly higher in PDA tissues (1.62, p=3.48e-29). For the 5FU-specific gene panel, the combined RNA expression of 27 out of 28 genes was significantly elevated in PDA (2.00, p=5.44e-57), and the combined gene expression of 23 out of 28 genes was significantly higher in PDA tissues (1.21, p=1.44e-7). Our preliminary findings suggest that this approach has the potential to serve as an effective tool for diagnosing PDA and guiding treatment selection. However, these results must be validated through larger prospective studies. Additionally, this application could serve as a screening tool for high-risk populations, such as individuals with potentially malignant lesions like intraductal papillary mucinous neoplasms, first-degree relatives of PDA patients, or those with concerning genetic risks (e.g., BRCA1 or BRCA2 mutations). Citation Format: Harshitha Puram, Deepak Sherpally, Sravan Jeepalyam, Ashish Manne. Advanced Gene Signatures for the Diagnosis and Personalized Treatment of Pancreatic Ductal Adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr A013.

The management of retrorectal tumors - a single-center analysis of 21 cases and overview of the literature.

Retrorectal tumors are rare and heterogeneous. They are often asymptomatic or present with nonspecific symptoms, making management challenging. This study examines the diagnosis and treatment of retrorectal tumors. Between 2002 and 2022, 21 patients with retrorectal tumors were treated in our department. We analyzed patient characteristics, diagnosis and treatment modalities retrospectively. Additionally, a literature review (2002-2023, "retrorectal tumors" and "presacral tumors", 20 or more cases included) was performed. Of the 21 patients (median age 54 years, 62% female), 17 patients (81%) suffered from benign lesions and 4 (19%) from malignant lesions. Symptoms were mostly nonspecific, with pain being the most common (11/21 (52%)). Diagnosis was incidental in eight cases. Magnetic resonance imaging was performed in 20 (95%) and biopsy was obtained in 10 (48%). Twenty patients underwent surgery, mostly via a posterior approach (14/20 (70%)). At a mean follow-up of 42 months (median 10 months, range 1-166 months), the local recurrence rate was 19%. There was no mortality. Our Pubmed search identified 39 publications. Our data confirms the significant heterogeneity of retrorectal tumors, which poses a challenge to management, especially considering the often nonspecific symptoms. Regarding diagnosis and treatment, our data highlights the importance of MRI and surgical resection. In particular a malignancy rate of almost 20% warrants a surgical resection in case of the findings of a retrorectal tumour. A local recurrence rate of 19% supports the need for follow up.

Comprehensive Evaluation of Pulmonary Masses Using Multi-detector CT: Correlating Morphological Features With CT-Guided Histopathological Findings for Enhanced Diagnostic Accuracy.

Lung masses pose a significant diagnostic challenge due to their diverse causes, from benign hamartomas to malignant bronchogenic carcinoma. Multi-detector CT (MDCT) is essential in evaluating these masses, offering detailed morphological insights to help differentiate between benign and malignant lesions. However, a definitive diagnosis often requires histopathological confirmation. CT-guided biopsy is crucial, providing a minimally invasive method to obtain tissue samples and thus guiding clinical management and treatment decisions. The primary objective of this study was to assess the diagnostic accuracy of MDCT in differentiating between benign and malignant lung mass lesions. The study focused on evaluating the characteristic features of lung masses on MDCT that aid in this differentiation, correlating imaging findings with histopathological results from CT-guided biopsies, and determining the overall diagnostic utility of MDCT in thoracic lesions. This hospital-based observational study was conducted over a period of 17 months. The study included 52 patients with thoracic lesions, identified through imaging techniques such as chest radiographs and CT scans. These patients underwent CT-guided biopsy, with tissue samples sent for histopathological examination. Inclusion criteria involved patients with clinically and radiographically diagnosed lung masses, while exclusion criteria included those who did not consent, had contraindications to contrast media, or had conditions such as severe respiratory distress or coagulopathy. The data were analyzed using descriptive statistics, with efficacy measures such as yield and failure rates of CT-guided biopsies and validation measures like sensitivity, specificity, positive predictive value, and negative predictive value for MDCT. The study included 52 patients (50% male, 50% female), aged 16-80, with the most common age group being 51-60 years. Lesions were mainly in the lung parenchyma (65.38%), followed by the mediastinum (15.38%), hilar region (11.54%), and pleura (7.69%). MDCT evaluation classified 84.44% of the lesions as malignant, characterized by irregular contours, inhomogeneous texture, and contrast enhancement, while 15.55% were benign. Histopathology confirmed 42 malignant lesions, with squamous cell carcinoma being the most prevalent. Benign lesions included abscesses, tuberculosis, and pneumonitis. The study achieved a 100% success rate for CT-guided biopsy, with one minor complication (pneumothorax). The diagnostic accuracy of MDCT was notable, with a sensitivity of 100% for detecting malignancies, a specificity of 77.78%, a positive predictive value of 87.50%, and a negative predictive value of 100%, emphasizing its effectiveness in thoracic lesion evaluation. MDCT is a highly effective tool in the evaluation of lung masses, providing critical information that aids in distinguishing between benign and malignant lesions. When combined with CT-guided biopsy, it offers a reliable method for obtaining diagnostic tissue samples, with a high degree of accuracy and a low complication rate. The study underscores the importance of integrating imaging and histopathological findings in the management of thoracic lesions, ultimately enhancing diagnostic precision and informing appropriate clinical interventions.

Analysis of the correlation between gut microbiome imbalance and the development of endometrial cancer based on metagenomics.

Endometrial cancer (EC) is the most prevalent gynecologic malignancy, with a higher risk in obese women, suggesting the potential involvement of gut microbiota in the progression of EC. However, there is no direct evidence of a connection between EC and the human gut microbiota. Using metagenomic sequencing, we investigated the relationship between gut microbiome imbalance and cancer development in patients with EC. In this prospective case-control study, we included 15 patients with EC based on endometrial biopsy in the case group and 15 women admitted to the hospital for female pelvic floor issues during the same time who did not have endometrial lesions from January 2023 to June 2023 in control group. The microbiota structure of EC cases and controls without benign or malignant endometrial lesions during the same time period was analyzed using metagenomic sequencing technology. We employed Alpha diversity analysis to reflect the richness and diversity of microbial communities. Statistical algorithm Bray-Curtis was utilized to calculate pairwise distances between samples, obtaining a beta diversity distance matrix. Subsequently, hierarchical clustering analysis was conducted based on the distance matrix. The results showed that the composition of bacterial colonies in both groups was dominated by Firmicutes, which had a higher proportion in the control group, followed by Bacteroidetes in the control group and Proteobacteria and Bacteroidetes in the case group. The abundance of Klebsiella (P = .02) was significantly higher, and the abundance of Alistipes (P = .04), Anearobutyricum (P = .01), and bacteria in Firmicutes such as Oscillospira and Catenibacterium was markedly lower in the case group than in the control group. These results demonstrated conclusively that a gut microbiome imbalance was associated with the development of EC.

Nephrogenic adenoma of the urinary bladder. Clinical features, long-term follow-up and recurrence predictors

ABSTRACT Objectives To review the clinical features of nephrogenic adenoma (NA) of the urinary bladder and assess the long-term recurrence rates. Material and methods A retrospective analysis of all diagnosed NA of the urinary bladder between 2000 and 2023 was done. All patients’ demographics, symptoms, history of previous bladder surgeries, macroscopic and microscopic features of NA and coincidental pathology were reviewed. The long-term recurrence rate including malignant recurrence was assessed. Univariate and multivariate analysis of predictor of recurrence was performed. Results We identified 24 patients diagnosed with NA with a mean (SD, range) age of 56 (16, 15–73) years. Eighteen (75%) patients had previous history of bladder surgeries. Macroscopic appearance on cystoscopy looked polypoidal, flat velvety, papillary and nodular in eight, seven, five, and four patients, respectively. At a median (range) follow-up of 35 (18–145) months, 15 (63%) patients developed one recurrence including NA, non-specific cystitis and urothelial carcinoma (UC) in nine, three and three patients, respectively. Of them, five had a second recurrence, and one patient had a third recurrence. Patients with malignant recurrence had previous history of UC and two of them required radical cystectomy and urinary diversion. Previous TURBT was the only independent predictor for recurrence [OR (95% CI) = 28 (2–37), p = 0.01]. Conclusion Nephrogenic adenoma is a benign disease that mimics malignant lesion clinically. It is associated with high recurrence rate. Previous resection of bladder lesion is the independent predictor of the recurrence.

Spectrum of blue nevus-like lesions, including blue nevus, pigmented epithelioid melanocytoma & animal-type melanoma

Blue nevus-like lesions constitute a category of melanocytic lesions clinically identified by their blue coloration. Histologically, they exhibit two primary features: a dermal location and intense pigmentation. The latest World Health Organization (WHO) classification categorizes blue melanocytic lesions into benign entities (dermal melanocytoses, blue nevus, and deep penetrating nevus), melanocytic tumors with low to intermediate malignant potential (pigmented epithelioid melanocytoma, PEM), and malignant lesions (blue nevus-like melanoma and melanoma arising in blue nevus).Clinically, blue nevi are enduring and stable lesions, displaying a structureless blue pigmentation both clinically and dermatoscopically, with a straightforward histologic diagnosis. Conversely, lesions with recent onset and/or rapid growth are more commonly associated with diagnoses falling within the intermediate part of the spectrum or with melanoma. These lesions often present with a blue color along with additional features such as black blotches, irregular vessels, and irregular pigmented globules. They typically emerge de novo without recognizable precursors, they pose significant challenges for patient management.Melanoma on a blue nevus is an exceedingly rare entity with only a few cases described to date. Histologically, differentiating between lesions with intermediate malignant potential and melanoma is always challenging, necessitating a comprehensive evaluation of all morphologic findings of the lesion.

Histopathological spectrum of uterine lesions in hysterectomy specimens of patients with abnormal uterine bleeding

Background: Abnormal uterine bleeding (AUB) is an overarching term that reflects any departure from normal menstruation or regular menstrual cycle patterns. Treatment depends upon the cause. Hysterectomy being a definite treatment for structural uterine pathology. Methods: This cross-sectional observational study was conducted in department of pathology, Netaji Subhash Chandra Bose medical college Jabalpur (M.P.). The study comprised of 140 hysterectomy specimens with or without salpingo-oophorectomy obtained from AUB patients and submitted for histopathological examination in our department during study period of 18 months. The relevant data of the patients was collected and analyzed as per designed proforma. Results: Out of 140 cases, majority of the patients were in 41-50 years age group 63 cases (45%), followed by 31-40 years age group 59 cases (42.14%). Most common clinical presentation was heavy menstrual bleeding in 83 cases (59.28%), followed by intermenstrual bleeding and pain in abdomen in 66 cases (47.14%) each. Commonest lesion found was leiomyoma, 83 cases (59.28%), second being dual pathology of adenomyosis with leiomyoma 23 cases (16.42%) followed by adenomyosis, 19 cases (13.57%). Four cases (2.85%) of benign endometrial polyp and endometrial carcinoma each and 1 case of adenomyoma, simple endometrial hyperplasia and endometrial stromal sarcoma, each, were reported. Conclusions: A wide spectrum of histopathological findings, ranging from normal cyclic endometrium to benign pathology and malignancy were seen. In some patients, dual pathologies, incidental findings and occult malignant lesions, which were missed clinically or radiologically, was diagnosed on histopathological examination, thus making it a gold standard for definite diagnosis.

Association of benign and malignant neoplastic lesions of the eyelid with systemic inflammatory markers

ABSTRACT Clinical relevance The role and prognostic significance of systemic inflammatory markers in various malignancies have been the subject of investigation. The role of these inflammatory markers in eyelid lesions remains to be elucidated. Background Benign and malignant lesions of the eyelid are common presentations in eye clinics. Systemic inflammatory markers derived from a complete blood count may provide insight into the benign-malignant differentiation of the lesion. Methods This study included 134 patients who underwent surgery for eyelid lesions between 2021–2023. The lesions were evaluated by oculoplastic surgeons and operated on with a preliminary diagnosis of benign or malignant. According to the histopathological diagnosis, benign lesions were included in Group 1 and malignant lesions in Group 2. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII) (NxP/L) based on neutrophil, lymphocyte, and platelet counts were calculated from the preoperative complete blood count of all patients. Results Eighty-eight patients were included in Group 1 and 46 patients in Group 2. There were 41/47 (Female/Male) in Group 1 and 19/27 (F/M) males in Group 2 (p = 0.345). The mean age was 62.91 ± 9.04 years in Group 1 and 65.41 ± 8.76 years in Group 2 (p = 0.127). The preliminary diagnosis and histopathological diagnosis were incompatible in 5 cases in both groups. In Group 1: NLR = 1.82 ± 0.72, PLR = 124.50 ± 45.19 and SII = 454.51 ± 220.20, in Group 2: NLR = 2.48 ± 0.89, PLR = 128.12 ± 49.58 and SII = 590.22 ± 271.09. NLR and SII differences between groups were statistically significant, while PLR was similar (p < 0.001, p = .002, p = .671). ROC curve analysis showed that the optimal cut-off values for NLR, PLR, and SII were 1.99, 119.16, and 475.21, respectively. Conclusion High levels of NLR and SII in eyelid tumours can be used as an adjunct to examination findings in the preliminary diagnosis of the lesion as benign or malignant and may influence surgical planning.

Serum mRNA levels of cytokeratin-19 and vascular endothelial growth factor in oral squamous cell carcinoma and oral potentially malignant disorders using RT-PCR

BackgroundOral cancers, which include tumors of the oral cavity, salivary glands, and pharynx, are becoming increasingly prevalent worldwide. Squamous cell carcinoma accounts for over 90% of malignant oral lesions, with oral squamous cell carcinoma (OSCC) being notably common in the Indian subcontinent and other regions of Asia. This is especially true in South-Central Asia, including Sri Lanka, where it is particularly prevalent among men. This study aims to evaluate the levels of Vascular Endothelial Growth Factor-A (VEGF-A) and Cytokeratin-19 (CK-19) mRNAs in whole blood as a potential method for the early detection of OSCC.MethodsThe study included 40 patients (each from OSCC, Oral Submucous Fibrosis (OSF), Oral Leukoplakia (OLK), Oral Lichen Planus (OLP), and 10 healthy controls. The expression levels of VEGF-A and CK-19 mRNAs were measured from extracellular RNA extracted from whole blood samples using real-time reverse transcription polymerase chain reaction (RT-PCR) with sequence-specific primers. Receiver operating characteristic (ROC) curve analysis was used to evaluate the effectiveness of these biomarkers in detecting OSCC.ResultsThe results demonstrated a significant increase in blood transcripts of the candidate mRNAs CK-19 and VEGF-A in patients with OSCC, OSF, OLK, and OLP. The Wilcoxon signed-rank test revealed a p-value of 0.002 for each specific comparison between diseased patients and healthy controls (i.e., OSCC vs. HC, OSF vs. HC, OLP vs. HC, OLK vs. HC) for both CK-19 and VEGF-A. When these two biomarkers were used together, they provided a 60% predictive probability for patients with OSCC (p = 0.023).ConclusionThis study highlights the efficacy of blood mRNA transcriptome diagnostics in detecting OSCC. This innovative clinical approach has the potential to be a robust, efficient, and reliable tool for early cancer detection. Blood-based transcriptomes could be further explored for their effectiveness in various health contexts and for routine health monitoring.

Unexpectedly Good Results from Advanced Invasive Cervical Cancer: Palliative Surgery

Presentation with a highly infiltrated malignant lesion often leads to unfavorable outcomes. This woman exhibited an advanced form of cervical cancer that had spread to the surrounding tissue, which might involve the urinary bladder. Due to the Sudan War in 2023, there was a lack of oncological therapy. In response, we implemented palliative surgery, which yielded positive results.

Utility of Ultrasound-Guided Attenuation Parameter (UGAP) in Renal Angiomyolipoma (AML): First Results.

Angiomyolipoma (AML) are the most common benign solid renal mass. Differentiation from malignant tumours is essential. Imaging features in ultrasound may overlap between malignant lesions, especially between renal cell carcinoma (RCC) and AML. So far, sectional imaging has been necessary for reliable differentiation. The aim of this study is to evaluate the use of the ultrasound-guided attenuation parameter (UGAP), a recently established tool for assessing hepatic steatosis, in the differentiation of AMLs from other renal masses. Therefore, 27 patients with unknown solid renal masses were examined by ultrasound including UGAP. The attenuation was assessed qualitatively by attenuation map and quantitatively in comparison to the surrounding renal tissue. UGAP was applicable in 26/27 patients. Findings were compared with CT/MRI as the current imaging standard. A total of 18 AML and 9 other renal tumours were found. The diagnostic performance of B-Mode (hyperechogenic lesion) ultrasound was 77.8% in identifying AML. The diagnostic performance of the attenuation map showed a diagnostic performance of 92.6%, whereby UGAP measurements were successful in 76.9% of cases. Quantitatively, we found a significant difference (p < 0.034) in mean measured attenuation between AML (0.764 ± 0.162 dB/cm/MHz) vs. other renal tumours (0.658 ± 0.155 dB/cm/MHz). The best performance was found by a combined parameter of a hyperechogenic lesion with a positive attenuation map with an accuracy of 95.0%. In conclusion, UGAP may represent a possibility for differentiating solid renal lesions more accurately by ultrasound, especially classic hyperechoic AMLs from other renal lesions. Further studies are needed to increase the diagnostic reliability further.

Angiogenesis in endometrial cancer: clinical and biological significance

Objective: to summarize the available data on the features of vascularization of endometrioid adenocarcinoma (EAC). Material and Methods. The search for relevant sources was performed in the “PubMed” database using the keywords “endometrium + cancer + angiogenesis”, “endometrium + cancer + angiogenesis + lymph”. Of the selected sources, 78 were included in this review. Results. Angiogenesis is an important and necessary stage in the pathogenesis of the appearance, progression and metastasis of EAC and, thus, the study of tumor vascularization provides an opportunity to improve diagnosis and personalized approach to treatment. Vascular density correlates with advanced stage of EAC, high grade of malignancy, myometrial invasion, cervical and adnexal lesions, vascular invasion, metastases to lymph nodes (LN), the presence of cancer cells in the peritoneal fluid, low overall survival and survival without tumor progression. There are publications that deny the connection of vascularization with the histological type of tumor, its grade, lymphovascular invasion, lymph node metastases, the depth of myometrial invasion, and these publications even prove that microvessel density is not an independent prognostic factor. So, there is still no consensus and final opinion, as evidenced by low or high vascularization of EAC. Recently, there are many drugs that affect both the processes of angiogenesis directly and the inducers and factors that control vascular growth. Unfortunately, all such drugs have a fairly high toxicity, and resistance to them very quickly develops. Conclusion. Despite numerous results of studies devoted to the study of the formation of blood vessels and isolated data on lymphangiogenesis in EAC, there is no data in the literature on studying changes in the vascularization of LN in gynecological cancer. However, proangiogenic and antiangiogenic factors are disseminated throughout the body and must exert their effects in distant organs and tissues. Based on changes in the vascularization of LN, it will apparently become possible to predict the activity of angiogenesis in the primary tumor, assess the prognosis of the disease, and the effectiveness of the treatment. In addition, significant expression of the vascular network in an enlarged lymph node biopsied for diagnosis may be a symptom of the development of a malignant tumor in the lymph collection region, even in the absence of metastases.

Understanding the Malignancy Potential of Cutaneous/Subcutaneous Lesions: Insight from 9,202 Day-Surgery Procedures

Abstract Objectives: Cutaneous and subcutaneous lesions often go unnoticed or disregarded, yet they can harbor malignant potential. These seemingly innocuous bumps and lumps vary in size and nature, necessitating thorough evaluation by health care professionals. In this study encompassing 9,202 day-surgery procedures, we sought to elucidate the malignancy risk associated with cutaneous/subcutaneous lesions. Materials and Methods: Conducted as a descriptive case-control investigation, our study enrolled patients undergoing excision for such lesions from 2009 to 2018. Patients were stratified into study (malignancy confirmed by histopathology) and control groups. Comprehensive data collection included demographic profiles, pathology reports, surgical details, and follow-up outcomes. Results: Analysis of 9,202 excision procedures involving 8,962 patients revealed epidermal/tricholemmal cyst as the most prevalent lesion type (34.5%), followed by lipomas (21.8%). Malignancies were identified in 1.1% of cases, predominantly affecting older individuals (mean age: 60.3 ± 16.2 years). While malignancy incidence correlated with advancing age, no significant gender disparity was observed (p &lt; 0.001 and p = 0.353, respectively). Conclusion: Our findings underscore the imperative of vigilance toward cutaneous and subcutaneous lesions, as they may harbor malignancy. Timely assessment by health care providers is paramount to promptly identify and manage potentially malignant lesions. With malignancy detected in over 1% of cases, our study emphasizes the necessity for meticulous evaluation and appropriate intervention strategies to mitigate associated risks effectively.