Mixed Lesions Research Articles

Abstract 2824: Establishing prostate cancer models for orthotopic and bone metastatic growth using the 22Rv1cell line

Abstract Prostate cancer is the second most common cancer in men with new cases diagnosed in 1.4 million men each year. Luckily the 5-year survival rates in developed countries are high reaching over 90%. However, approximately one third will develop a metastatic disease. In metastatic patients, prostate cancer almost always progresses despite the androgen deprivation therapy and is then referred to as “castration-resistant (mCRPC)”. Bone is involved in 80% of patients with metastasis, and the bone lesions are typically osteoblastic. The 22Rv1 human prostate carcinoma cell line is androgen sensitive and shown to express androgen receptor (AR). They also express low levels of prostate-specific membrane antigen (PSMA). The aim of this study was to establish orthotopic and intratibial preclinical in vivo prostate cancer models that can be used in drug development when targeting cancer cells and their local environment. Male athymic nude mice (5-6 weeks old) and NOG mice (over 20 weeks old) were used in the study. 2.5 × 105 22Rv1 cells (ATCC) were inoculated orthotopically into the prostate of NOG mice, and 5 × 105 cells were inoculated intratibially into the bone marrow cavity of athymic nude mice. Tumor growth was followed by PSA measurements every second week using Human PSA ELISA assay. In addition, in the intratibial model, tumor-induced bone changes were monitored by X-ray imaging of the hind limbs. Prostates and hind limbs were collected at sacrifice, fixed in 10% NBF, and processed to paraffin blocks for further histological analysis. Sections of prostate were stained with hematoxylin-eosin (HE) and AR. Tumor-bearing and contralateral (healthy) tibias were stained with HE - OrangeG, MGT, TRAP, and AR. The observed tumor take rate was 92% in the orthotopic and 100% in the intratibial models. Confirmed by IHC, tumors formed in both the orthotopic and intratibial models expressed AR. 22Rv1 cells formed osteoblastic - lytic mixed bone lesions in the intratibial model. Based on lesion areas, randomization of the tumor bearing mice in the intratibial model can be done after 2 weeks from cancer cell inoculation. Taken together, the 22Rv1 prostate cancer models are relatively fast growing, express AR and present good take rates. Furthermore, the intratibial model represents robust tumor-induced changes in bone with strong osteoblastic component. Thus, these models have several advantages in efficacy studies of novel drug candidates for prostate cancer. Citation Format: Justyna Zdrojewska, Katja Fagerlund, Jenni H. Mäki-Jouppila, Mari I. Suominen. Establishing prostate cancer models for orthotopic and bone metastatic growth using the 22Rv1cell line [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2824.

Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Ground-Glass Opacity Pulmonary Lesions without Fluoroscopic Guidance.

Diagnosing ground-glass opacity (GGO) pulmonary lesions poses challenges. This study evaluates the utility of radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) in diagnosing GGO pulmonary lesions. A total of 1651 RP-EBUS procedures were performed during the study period. This study analyzed 115 GGO lesions. The EBUS visualization yield was 80.1%. Of 115 lesions, 69 (60%) were successfully diagnosed. The average size of diagnosed lesions was significantly larger than that of undiagnosed lesions (21.9 ± 7.3 vs. 17.1 ± 6.6 mm, p < 0.001). Diagnostic yield varied by lesion size: 50.0% for lesions <20 mm, 65.1% for 20-30 mm lesions, and 85.7% for lesions >30 mm. The mixed blizzard sign on EBUS appeared in 60.6% of mixed GGO lesions, with no cases in pure GGO lesions. Multivariable analyses showed that lesion size (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.00-1.16; p < 0.001) and mixed blizzard sign on EBUS (OR, 20.92; CI, 7.50-58.31; p < 0.001) were significantly associated with diagnostic success. Pneumothorax and hemoptysis occurred in 1.7% and 2.6% of patients, respectively. RP-EBUS-TBLB without fluoroscopic guidance is a viable diagnostic approach for GGO pulmonary lesions with acceptable complications.

Automatic hepatic tumor segmentation in intra-operative ultrasound: a supervised deep-learning approach.

Training and evaluation of the performance of a supervised deep-learning model for the segmentation of hepatic tumors from intraoperative US (iUS) images, with the purpose of improving the accuracy of tumor margin assessment during liver surgeries and the detection of lesions during colorectal surgeries. In this retrospective study, a U-Net network was trained with the nnU-Net framework in different configurations for the segmentation of CRLM from iUS. The model was trained on B-mode intraoperative hepatic US images, hand-labeled by an expert clinician. The model was tested on an independent set of similar images. The average age of the study population was 61.9 ± 9.9 years. Ground truth for the test set was provided by a radiologist, and three extra delineation sets were used for the computation of inter-observer variability. The presented model achieved a DSC of 0.84 (), which is comparable to the expert human raters scores. The model segmented hypoechoic and mixed lesions more accurately (DSC of 0.89 and 0.88, respectively) than hyper- and isoechoic ones (DSC of 0.70 and 0.60, respectively) only missing isoechoic or >20mm in diameter (8% of the tumors) lesions. The inclusion of extra margins of probable tumor tissue around the lesions in the training ground truth resulted in lower DSCs of 0.75 (). The model can accurately segment hepatic tumors from iUS images and has the potential to speed up the resection margin definition during surgeries and the detection of lesion in screenings by automating iUS assessment.

Clinicomorphological patterns in an outbreak of paederus dermatitis in patients attending rural tertiary care hospital

Background: Paederus dermatitis (PD) is an acute irritant contact dermatitis caused by beetles belonging to the genus ‘Paederus’. The study aims to describe the clinical and morphological patterns and epidemiology of PD. Methods: A descriptive study was done on 80 patients with PD attending DVL OPD in a tertiary care hospital for 6 months i.e.; from March to August 2023. A detailed clinical history was taken and local and systemic examinations were done. Results: The mean age of the patients was 24.8 years. The percentage of females affected was 61.25% and males was 38.75%. Peak cases were noted during May (32.5%) followed by August (17.5%). Out of 80 patients, 61 had erythematous plaques (76.25%) along with other types of lesions (mixed lesions), 8 had post-inflammatory hyperpigmentation (10%), 5 had bullae (6.25%), 6 had erosions alone (7.5%). Out of 61 patients with erythematous plaques, 16 had vesicles and 15 had pustules. Common sites involved were face and neck (42.5%), trunk (35%), and upper extremity (30%), 51.2% of patients were sleeping with windows open, 73.7 % of patients complained of itching, 80% of patients were residing in areas with nearby vegetations. 60% of the patients affected were students residing at college hostels in rural areas with surrounding vegetation. Conclusions: PD can present in various forms and should be promptly differentiated from other conditions. Proper education of the general population and awareness about the paederus beetles should be given.

The Coexistence of Cervical Intraepithelial Neoplasia (CIN3) and Adenocarcinoma In Situ (AIS) in LEEP Excisions Performed for CIN3.

A sample of 414 women underwent LEEP for CIN3. The study sample consisted of 370 women with a CIN3 lesion alone and 44 women with a CIN3 lesion coexisting with AIS or adenocarcinoma. We studied the individual HR HPV genotypes and their frequency in the two groups under study. Furthermore, the therapeutic results and follow-ups for the population were studied on the entire study sample. In patients with a single CIN3 lesion, 11 high-risk genotypes were detected; in patients with CIN3 associated with AIS or AC, only 4 different genotypes were detected (16, 18, 45, 33). Overall, the frequency of HPV 18 was significantly higher in CIN3 coexisting with AIS compared to solitary CIN3 lesions, χ2 = 27.73 (p < 0.001), while the frequency of other high-risk genotypes was significantly higher in patients with a single CIN3 than in patients with CIN3 coexisting with AIS. In our study population, mixed lesions (CIN3 coexisting with AIS), unlike their squamous counterparts (single CIN3 lesions), were characterized by skip lesions, which demonstrate more aggressive behavior and a higher rate of viral persistence and recurrence. A relatively high rate (10.7%) of AIS-AC was found in women treated for CIN3. Our study confirms the multifocal biological nature of the CIN3 lesion coexisting with AIS compared to the single CIN3 lesion. All this justifies the different treatments to which CIN3 lesions coexisting with AIS are addressed; in fact, the latter are treated with hysterectomy, while CIN3 is treated with conization alone.

A157 ASSOCIATION OF SUBMUCOSAL INVASION WITH THE PARIS CLASSIFICATION OF POLYPS IN THE LOWER GASTROINTESTINAL TRACT

Abstract Background Endoscopic evaluation of the colorectum allows for diagnosis of colorectal cancer (CRC) and advanced polyps. In particular, polyps can be described in terms of gross morphology using the Paris classification. Previous work has demonstrated that submucosally invasive (SMI) cancer may correlate with the Paris classification subtypes. Aims To determine whether the Paris classification is associated with SMI in a Canadian setting. Methods We conducted a retrospective single-centre study using data from 2016 to 2023 of patients with colorectal lesions that were referred for endoscopic submucosal dissection (ESD). Using the Paris classification, we classified polyps as either protruding type (0-I) or flat type (0-IIa, 0-IIb, 0-IIc, 0-III) lesions. Protruding type lesions were further classified as sessile (0-Is), pedunculated (0-Ip) and pseudo-pedunculated (0-Isp) subtypes. Mixed lesions, with two concomitant subtypes, were categorized using the higher classification subtype. We categorized polyps as: protruded lesions, including any mixed lesions with a flat lesion; isolated flat elevated lesions; and flat lesions, both mixed and isolated lesions. We also recorded polyp location, prior endoscopic mucosal resection (EMR), previous biopsy, and polyp diameter (in cm), age, sex, and American Society of Anesthesiology (ASA) class. The primary outcome was SMI as identifed on histopathology. We used logistic regression with backward stepwise entry, Fisher exact test with relative risk (RR) and 95% confidence interval (95% CI), and independent samples t-test. Statistical tests were two-tailed and significant at Pampersand:003C0.05. Results In our sample of 130 patients, the mean age was 69.2 years (standard deviation [SD] 10.4), most were male (n=78, 60%), and typically had an ASA score of 3 (n=77, 59.2%). Most polyps occured in the rectum (n=65, 50%) with a mean length was 4.5 cm (SD 2.2 cm). The most common subtype was IIa (n=59, 45.4%). Starting with the covariates of age, sex, ASA, prior EMR, prior biopsy at the same, and length of polyp, the logistic regression model reduced them to three: prior EMR, prior biopsy at the same site, and length. Univariate analysis of these three variables found that there was no significant difference with polyp length and SMI (P=0.147) and no significant association with prior EMR on SMI (RR=0.8 [95% CI 0.3 to 1.9]. The presence of prior biopsies at the same site of the lesions was significantly associated with SMI (RR=2.4 [95% CI 1.2 to 4.7]) Conclusions We did not find that the Paris classification for type of polyp lesion did not correlate with the presence of submucosal invasion, nor did prior EMR, age, sex, or length of polyp. The presence of a prior biopsy, however, did in fact tend to predict submucosal invasion. Future work should aim to incorporate mortality data and response to treatment into the above analysis. Funding Agencies None

Characterization of bone marrow lesions in axial spondyloarthritis using quantitative T1 mapping MRI.

Conventional magnetic resonance imaging (MRI) uses T1-weighted and short-tau inversion recovery (STIR) sequences to characterize bone marrow in axial spondyloarthritis. However, quantification is restricted to estimating the extent of lesions because signal intensities are highly variable both within individuals and across patients and MRI scanners. This study evaluates the performance of quantitative T1 mapping for distinguishing different types of bone marrow lesions of the sacroiliac joints. In this prospective study, 62 patients underwent computed tomography (CT) and MRI of the sacroiliac joints including T1, STIR, and T1 mapping. Bone marrow lesions were characterized by three readers and assigned to one of four groups: sclerosis, osteitis, fat lesions, and mixed marrow lesions. Relaxation times on T1 maps were compared using generalized estimating equations and receiver operating characteristics (ROC) analysis. A total of 119 lesions were selected (sclerosis: 38, osteitis: 27, fat lesions: 40; mixed lesions: 14). T1 maps showed highly significant differences between the lesions with the lowest values for sclerosis (1516±220 ms), followed by osteitis (1909±75 ms), and fat lesions (2391±200 ms); p<0.001. T1 mapping differentiated lesions with areas under the ROC curve of 99% (sclerosis vs. osteitis) and 100% (other comparisons). T1 mapping allows accurate characterization of sclerosis, osteitis, and fat lesions at the sacroiliac joint but only for homogeneous, non-mixed lesions. Thus, further sequence development is needed before implementation in clinical routine.

Detection of asymptomatic lesions in jaws from patient visiting King Saud University (KSU) College of Dentistry: A retrospective study

The aim of this study was to evaluate the detection of asymptomatic lesions of jaws in retrospective two-year panoramic radiographs from patients’ record visiting for treatment in the College of Dentistry, King Saud University, and accidentally noticed while patients visited for other reasons. Ninety-two (92) cases were selected for the study to detect asymptomatic lesions among 907 patients varying in age of 18 to 72 years (mean 38 years) and who visited the Dentistry College. The information was collected on a designed proforma by two examiners and calculated average. Seventy-six (76) were male and sixteen (16) females, including 79 (85.9%) radiopaque, 11 (12%) radiolucent, and 2 (2.2%) with mixed lesions. These results showed no significant gender differences. The selected cases were divided into three age groups 18-30, 31-50, and 51-72 years to detect different lesions, but the groups did not differ significantly. In this study, location-wise frequency of lesions in the anterior region of jaws were 2 (28.6%) in maxilla and 5 (71.4%) in mandible, whereas in the posterior region 7 (9.7%) were in maxilla and 65 (90.3%) in mandible. However, the study concluded that most of asymptomatic radiopaque lesions were found in the posterior region of mandible and more incidence being in young age group.

Leukoplakia and erythroplakia in youngers versus older individuals: a clinicopathological retrospective study.

The incidence of oral cancer has exhibited a rise within the young population. Considering that oral potentially malignant disorders (OPMDs) can precede the development of oral cancer, it is imperative to conduct studies in this particular younger population. This study aimed to evaluate the frequency and conduct a comparative analysis of the clinical-demographic characteristics of OPMDs in two distinct age groups. A retrospective analysis was conducted with patients diagnosed with leukoplakia, erythroplakia, and leukoerythroplakia between 1965 and 2020. The individuals were categorized into two groups: those aged up to 40 years (Group Younger) and those aged 41 years and above (Group Older). A total of 640 lesions were subjected to analysis. Among these, patients aged up to 40 years constituted 10.63% of the sample, however, this proportion decreased significantly to 6.9% between 2010 and 2020. A predominant male representation was observed in both groups, with white lesions being the most common in both as well. However, the frequency of red or mixed lesions was significantly higher (p=0.034) in the older group, along with a higher prevalence of dysplastic lesions (26.9% versus 11.8%, p=0.01). Moreover, the older group exhibited a relatively higher percentage of smokers/ex-smokers (78.6%), compared to the younger group (61.5%, p=0.085) and alcohol consumers/ex-consumers (54.9% versus 22.7%, p=0.028). Elderly individuals exhibited an unfavorable progression (p=0.028). However, a logistic regression analysis identified as significant variables associated with malignant transformation, the presence of epithelial dysplasia, and red lesions diagnosed as erythroplakia. A declining frequency of OPMDs in young adults was observed over the years, whereas in older adults, these disorders exhibited an unfavorable progression.

Role of scheduled repeat CT scan in traumatic brain injuries: A prospective observational study.

Scheduled CT scan is a routine practice at many centers after traumatic brain injury (TBI), but it has been questioned by few authors. The majority of the studies are reported in mild TBI; however, no specific data exist for the same in moderate and severe TBI. This was a single-center and 1-year prospective study. All cases with TBI who underwent scheduled repeat scans were included in the study. Patients who underwent emergency surgery after first computed tomography (CT) and those who expired before repeat CT were excluded from the study. Data included demographics, Glasgow coma scale (GCS) score, initial head CT findings, findings of repeat CT, and the need for any intervention (medical/surgical). A total of 231 cases were analyzed. The mean time interval for the repeat CT was 7.8 h. One hundred and seventy-one patients underwent scheduled repeat CT (Group 1), 53 patients with GCS >13 were discharged from emergency before the repeat scan (Group 2), and seven cases underwent repeat CT before the scheduled time in view of clinical deterioration (Group 3). The mean age and gender did not vary significantly between the three groups. Mixed lesions predominated in all; however, the proportion significantly differed between groups. In Group 1, two patients required surgery; in Group 3, all patients required a significant change in treatment, whereas none deteriorated or required a repeat scan in Group 2. In our study, the yield of routine repeat CT scans requiring surgery was 3.5%. Based on the results of our study and the observations from previous studies, we have proposed a few general working statements regarding indications for repeat CT scans in TBI.

Bilateral maxillary odontogenic fibroma: a case of rare occurrence

Aim: To report the case of a patient diagnosed with bilateral odontogenic fibroma in the maxilla that was surgically removed. Clinical conduct: A 32-year-old female patient was referred to the Santa Casa de Montes Claros Hospital for the removal of a lesion in the maxilla. Intraoral examination revealed a mixed lesion in the maxilla, bilaterally, with a suspected odontogenic tumor. Cone beam computed tomography showed an expansive lesion in the posterior region of the right and left maxilla, extending to the palatine and zygomatic processes. An incisional biopsy was performed and revealed the proliferation of spindle cells amid collagenized stroma, with the presence of mitoses and foci of concentric calcification, accompanied by lacerated bone trabeculae and fibroconnective tissue with edema, which were compatible with the diagnosis of odontogenic fibroma. During removal, the lesion detached easily and it was necessary to remove a premolar corresponding to the area involved, which presented advanced mobility due to loss of support, followed by adequate cleaning of the surgical site. Results: After the surgery to remove the lesion, the patient remained under clinical follow-up to evaluate the evolution of the case as well as its possible complications. Conclusion: This case highlights the importance of a careful clinical, imaging, and histopathological approach to lesions in the maxilla, for correct diagnosis and referral of the patient for appropriate treatment.

MTOR Pathway Substrates Present High Activation in Vascular Malformations and Significantly Decrease with Age.

Vascular anomalies often result in aesthetic flaws, pain, and impair the quality of life. They require challenging treatments that frequently do not provide the desired results. The mammalian target of rapamycin (mTOR) is directly involved in the development of these malformations. However, the exact mechanism behind mTOR dysregulation has not been unambiguously defined. The purpose of this study is to investigate the activation of selected substrates of mTOR to partially assess its involvement in the disease process. We analyzed tissue samples collected from patients with vascular anomalies treated in our department. We included patients with histopathological diagnoses of lymphatic, venous, capillary malformations, mixed lesions, and a control group of healthy skin samples. We stained the samples using H and E and immunohistochemistry. We used primary antibodies against p70 S6 Kinase, 4EBP1, and p-4EBP1. We graded their color reactions. The statistical analyses were performed using the FactoMineR and factoextra R v.4.1 packages. p-values < 0.05 were considered statistically significant. The analysis of 82 patients showed that healthy tissue vessels expressed lower levels of tested mTOR pathway substrates compared to high activation in vascular malformations. Elevated substrate expression in a comparison between sexes revealed higher P-4EBP1 expression in the female malformation group. We observed a decrease in mTOR substrate expression with age. The higher expression of mTOR substrates in vascular malformations compared to healthy tissue confirms their involvement in abnormal vascular development. Age-related changes in mTOR substrate expression highlight the need for timely intervention. Our study contributes to the understanding of the mTOR signaling pathway in vascular malformations and highlights its potential as a therapeutic target, contributing to personalized medicine.

The effect of deep learning-based lesion segmentation on failure load calculations of metastatic femurs using finite element analysis

Bone ranks as the third most frequent tissue affected by cancer metastases, following the lung and liver. Bone metastases are often painful and may result in pathological fracture, which is a major cause of morbidity and mortality in cancer patients. To quantify fracture risk, finite element (FE) analysis has shown to be a promising tool, but metastatic lesions are typically not specifically segmented and therefore their mechanical properties may not be represented adequately. Deep learning methods potentially provide the opportunity to automatically segment these lesions and change the mechanical properties more adequately. In this study, our primary focus was to gain insight into the performance of an automatic segmentation algorithm for femoral metastatic lesions using deep learning methods and the subsequent effects on FE outcomes. The aims were to determine the similarity between manual segmentation and automatic segmentation; the differences in predicted failure load between FE models with automatically segmented osteolytic and mixed lesions and the models with CT-based lesion values (the gold standard); and the effect on the BOne Strength (BOS) score (failure load adjusted for body weight) and subsequent fracture risk assessments.From two patient cohorts, a total number of 50 femurs with osteolytic and mixed metastatic lesions were included in this study. The femurs were segmented from CT images and transferred into FE meshes. The material behavior was implemented as non-linear isotropic. These FE models were considered as gold standard (Finite Element no Segmented Lesion: FE-no-SL), whereby the local calcium equivalent density of both femur and metastatic lesion was extracted from CT-values. Lesions in the femur were manually segmented by two biomechanical experts after which final lesion segmentation for each femur was obtained based on consensus of opinions between two observers. Subsequently, a self-configuring variant of the popular deep learning model U-Net known as nnU-Net was used to automatically segment metastatic lesions within the femur. For these models with segmented lesions (Finite Element with Segmented Lesion: FE-with-SL), the calcium equivalent density within the metastatic lesions was set to zero after being segmented by the neural network, simulating absence of load-bearing capacity of these lesions. The models (either with or without automatically segmented lesions) were loaded incrementally in axial direction until failure was simulated. Dice coefficient was used to evaluate the similarity of the manual and automatic segmentation. Mean calcium equivalent density values within the automatically segmented lesions were calculated. Failure loads and patterns were determined. Furthermore, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both groups by comparing the predictions to the occurrence or absence of actual fracture within the patient cohorts.The automatic segmentation algorithm performed in a none-robust manner. Dice coefficients describing the similarity between consented manual and automatic segmentations were relatively low (mean 0.45 ± standard deviation 0.33, median 0.54). Failure load difference between the FE-no-SL and FE-with-SL groups varied from 0 % to 48 % (mean 6.6 %). Correlation analysis of failure loads between the two groups showed a strong relationship (R2 > 0.9). From the 50 cases, four cases showed clear deviations for which models with automatic lesion segmentation (FE-with-SL) showed considerably lower failure loads. In the whole database including osteolytic and mixed lesions, sensitivity and NPV remained the same, but specificity and PPV decreased from 94 % to 83 %, and from 78 % to 54 % respectively from FE-no-SL to FE-with-SL.This study indicates that the nnU-Net yielded none-robust outcomes in femoral lesion segmentation and that other segmentation algorithms should be considered. However, the difference in failure pattern and failure load between FE models with automatically segmented osteolytic and mixed lesions were relatively small in most cases with a few exceptions. On the other hand, the accuracy of fracture risk assessment using the BOS score was lower compared to the FE-no-SL. In conclusion, this study showed that automatic lesion segmentation is a none-solved issue and therefore, quantifying lesion characteristics and the subsequent effect on the fracture risk using deep learning will remain challenging.

CBCT In Imaging Radiopaque and Mixed Lesions of The Jaw

Radiolucent lesion in jawbone more than radiopaque and mixed lesion, this appears in any lesion (odontogenic, non-odontogenic). However, this group include benign and malignant bone tumor. this lesion appears rarely in crown of tooth and more than in apex tooth.

The Prevalence and Clinicopathological Spectrum of Nondiabetic Renal Disease in Patients with Diabetes in a Tertiary Care Center.

Diabetic nephropathy (DN) is a major complication of diabetes mellitus (DM), leading to end-stage renal disease. A wide spectrum of nondiabetic renal diseases (NDRDs) is reported in type 2 DM. We retrospectively reviewed the medical records of patients with type 2 DM who underwent a kidney biopsy from September 2019 to November 2021 at our center. Patients were grouped as having isolated DN, isolated NDRD, or mixed NDRD with underlying DN. According to the 379 renal biopsies performed during the study period, 57 patients had DM. The prevalence of DN, isolated NDRD, and combined pathologies was 36.8%, 35.1%, and 28.1%, respectively. The most common NDRD was infection-related glomerulonephritis (IRGN) (50.0%), followed by membranous nephropathy (3.0%), focal segmental glomerulosclerosis (10%), pyelonephritis (10%), minimal change disease (1.8%), fibrillary glomerulonephritis (1.8%), and ANCA-associated vasculitis (1.8%). The most common pathological finding of NDRD in the mixed group was IRGN (56.3%), followed by acute tubular injury (31.3%). The duration of DM was significantly shorter (4.8 ± 2.3 years vs. 9.7 ± 3.3 years, P = 0.035) in NDRD patients compared with patients with DN. NDRD was observed in 15% and mixed lesions in 25% of patients, with concomitant diabetic retinopathy (P = 0.029). We conclude that with increasing evidence of NDRD even in patients with DN, careful application of renal biopsies in diabetic patients would assist in the early diagnosis and institution of specific therapy for NDRD to ensure better patient and renal survival.

PATH-06. HISTOPATHOLOGICAL CHARACTERISTICS OF TREATMENT-INDUCED EFFECTS VERSUS PROGRESSION IN 180 RE-RESECTION SAMPLES FROM IRRADIATED GLIOMAS GRADE 2-4

Abstract Histopathological studies of re-resected glioma tissue are considered the gold standard to distinguish actual tumor progression (TP) and treatment-induced effects (TIE) after radiotherapy. The objectives of this mono-center, retrospective cohort study were to provide detailed histopathological characterization of re-resected glioma tissue, and to correlate pathological findings with survival (data driven). Consecutive adults with a diffuse glioma (WHO grade 2-4), previously treated with (chemo-)radiation and progressive lesion were reviewed. New histological slides from the recurrent-resected tissue were prepared and stained with routine and exploratory immunohistochemical (IHC) stains. Two neuropathologists used a scoring sheet to independently assess 33 items on standard H&amp;E and IHC stains. We included 180 samples, from 165 patients. Of these, 159 samples (88.3%) originated from a second resection (first re-resection). TIE were diagnosed in 34 (19%), a mixed TIE and TP lesion in 91 (51%), and TP in 55 (31%). Median survival after first re-resection for the groups TIE, mixed and TP were respectively 14.4 (interquartile range (IQR)=8.7-42.4), 7.6 (IQR=4-12.9) and 11.5 months (IQR=7.2-25.4). A diagnosis of TIE was associated with histological findings of hyalinization, endothelial thickening, cortical infiltration, (radio)necrosis, thrombosis, lymphocytic infiltration (CD3, CD8 positive), and positivity for CD34. Percentage of viable tumor and PTBP1 stain correlated negatively with TIE. Survival in the group TIE was significantly longer than in the groups with any viable tumor (p-value of log-rank test 0.008). In multivariable Cox regression analysis, hemorrhage and higher PTBP1 positivity were associated with a poor overall survival after re-resection. Dystrophic calcifications, IDH mutations, and a higher KPS correlated with improved survival. In conclusion, we confirm the previously described characteristics of treatment-induced effects in a large consecutive cohort of re-resected diffuse gliomas. However, none of these characteristics correlated with survival. PTBP1 could be a promising marker to differentiate TIE from TP in treated glioma samples.

Hemodynamic assessment of pci using ultrasonic flow ratio in multivessel cad

Abstract Background Ultrasonic flow ratio (UFR) is a novel method for fast computation of fractional flow reserve (FFR) from intravascular ultrasound. Recently studies have shown the feasibility of morphofunctional computational methods to reliably estimate coronary physiology stemming from intravascular ultrasound images. Purpose The objective of the study was to evaluate the reasons for suboptimal physiological results after PCI using the UFR. Methods The study population comprised 150 consecutive patients (283 vessels) who underwent intravascular ultrasound for optimization of PCI in three-vessel-disease as mandated in the ongoing MULTIVESSEL TALENT trial (NCT04390672). The UFR analysis of final IVUS pullback was performed at the CORRIB Core Lab by an analyst who was blinded to the clinical data using a prototype software package (IvusPlus prototype, Shanghai Pulse Medical, Shanghai, China). Suboptimal physiological results were defined as post PCI UFR value of &amp;lt;0.91. UFR drop of ≥0.05 (gradient) was taken as a significant drop either intra or outside of the stent. Based on the definition of the HAWKEYE study, Focal lesions were defined as UFR drop of ≥0.05 in 10mm, diffuse lesions were defined as progressive decline of UFR of ≥0.05 without any clear evidence of focal drop, and mixed lesions were defined as the combination of focal and diffuse lesions. Results The median UFR with IQR among 283 vessels was 0.94 (0.91-0.97). Sixty-four (22.61%) of the 283 vessels had a UFR less than 0.91. We measured gradients using the UFR pull back curve intra-stent and outside of stent (Figure 1) in vessels with UFR &amp;lt;0.91. Significant "intra stent gradient", "out of stent gradient", combined "intra stent "and "out of stent" gradients were seen in 28 (44%), 18 (28%), and 10 (16%) vessels respectively. No clearly defined gradients were found in 8 (12%) vessels. Out of the 28 "out of stent" gradients, 20 were diffuse lesions, 5 were focal lesions and 3 was a mixed lesion. Conclusion IVUS has been widely used in optimization of PCI especially in scenarios with complex multi vessel disease. Combination of IVUS and FFR enable the operator to conform to the highest standards in PCI. This study has demonstrated that using UFR it is possible to identify the cause(s) of suboptimal PCI results and thereby to further optimize PCI results.

Pulmonary Amyloidoma: A Case Report and Brief Review of the Literature.

We report the case of a 59-year-old female patient, a former smoker, who was diagnosed with bilateral pulmonary nodules. Extensive medical investigations were conducted, including a surgical lung biopsy, which led to the diagnosis of pulmonary amyloidoma. The diagnostic process was guided by the presence of a persistent, polymorphic, and nonspecific clinical picture, strengthened by imaging findings characterized by mixed nodular lesions and the addition of interstitial involvement, along with partial deterioration of the pulmonary parenchyma architecture. Although it is recognized as a benign tumor, pulmonary amyloidoma requires special care in order to rule out systemic involvement, association with lymphomas, or systemic amyloidosis. This case highlights the comprehensive investigations required in the presence of multiple pulmonary nodules and the wide range of possible diagnoses. It underscores the pivotal role of surgical lung biopsy and histopathological examination. The case is instructive, addressing a rare pathology, on the border between specialties, while also emphasizing potential evolving challenges and providing further insights into the clinical course of this disease.

Un-resolving frozen shoulder: Are we really treating it?

To perform ultrasound examination in un-resolving frozen shoulder disorder, in Pakistani cohort visiting rheumatology clinic. This cross sectional study was carried out at Department of Rheumatology, Indus Medical College Tando Mohhamad Khan, from 16th March 2022 to 30th October 2022. Patients diagnosed as unilateral frozen shoulder on clinical grounds and received intra-articular injection (s) in last six months, never been investigated, still persisting with pain and restricted range of shoulder motion were enrolled. After the demographic details and shoulder examination, ultrasound examination of both shoulder joints was performed by senior musculoskeletal radiologist, to know the exact diagnosis. In 138 cases on ultrasound examination following injuries were noted: rotator cuff tendinopathy (RCT) (61%), adhesive capsulitis (21%), mixed lesion (rotator cuff tendinopathy and adhesive capsulitis) (14%).In age group < 50 years rotator cuff tendinopathy was the major lesion, while in cases >50 years age group: adhesive capsulitis (AC) was predominant lesion (p-0.05).Rotator cuff tendinopathy had significant association with supraspinatus tears (p<0.5). In Un-resolving frozen shoulder pain, ultrasound examination of involved joint helps in reaching the exact cause which may differ from the existing diagnosis and guides to further management.

Occurrence of radiopaque and mixed lesions at periapical region in patients with rheumatoid arthritis and ankylosing spondylitis: a retrospective study

BackgroundRheumatoid arthritis (RA) and ankylosing spondylitis (AS) have different effects on bones, cartilage and joints, sometimes destroying the spine and joints, and other times causing new bone formation. This study aimed to evaluate the effects of RA and AS on the types (radiolucent, radiopaque and mixed) of periapical lesions in jaw bones.MethodsThis study included 708 individuals (97 with AS, 327 with RA and 284 healthy controls (C)) and a total of 17,118 teeth (AS: 2,442; RA: 7,638; C: 7,038). The number of teeth, extracted teeth and teeth with root canal treatment and the presence of radiopaque, radiolucent and mixed periapical lesions were recorded from dental panoramic radiographs. Kruskal–Wallis and chi-square tests were used for statistical analysis.ResultsThe frequency of radiopaque lesions in the AS and RA groups was similar (p > 0.05) and significantly higher than in the C group (p < 0.05) (AS: 13.4%; RA: 6.1%; C: 2%). Mixed lesions (AS: 3.1%; RA: 4.0%; C: 0.4%) were statistically significantly higher for the RA group compared to the C group (p < 0.05), while the AS–C and AS–RA groups were similar (p > 0.05). There was no significant difference in terms of radiolucent lesions among groups (p > 0.05).ConclusionRadiopaque apical lesions were frequent in RA and AS patients, while mixed lesions were significantly higher in RA patients.