Morphological Findings Research Articles

Novel PEG6000-Silica-MWCNTs Shape-Stabilized Composite Phase-Change Materials (ssCPCMs) for Thermal-Energy Storage.

This paper describes the preparation of new PEG6000-silica-MWCNTs composites as shape-stabilized phase change materials (ssPCMs) for application in latent heat storage. An innovative method was employed to obtain the new organic-inorganic hybrid materials, in which both a part of the PEG chains, used as the phase change material, and a part of the hydroxyl functionalized multiwall carbon nanotubes (MWCNTs-OH), used as thermo-conductive fillers, were covalently connected by newly formed urethane bonds to the in-situ-generated silica matrix. The study's main aim was to investigate the optimal amount of PEG6000 that can be added to the fixed sol-gel reaction mixture so that no leakage of PEG occurs after repeated heating-cooling cycles. The findings show that the optimum PEG6000/NCOTEOS molar ratio was 2/1 (~91.5% PEG6000), because both the connected and free PEG chains interacted strongly with the in-situ-generated silica matrix to form a shape-stabilized material while preserving high phase-transition enthalpies (~153 J/G). Morphological and structural findings obtained by SEM, X-ray and Raman techniques indicated a distribution of the silica component in the amorphous phase (~27% for the optimum composition) located among the crystalline lamellae built by the folded chains of the PEG component. This composite maintained good chemical stability after a 450-cycle thermal test and had a good storage efficiency (~84%).

Morphological placental findings in women infected with SARS-CoV-2 according to trimester of pregnancy and severity of disease

IntroductionPlacental morphology findings in SARS-CoV-2 infection are considered nonspecific, although the role of trimester and severity of infection are underreported. Therefore, we aimed to investigate abnormal placental morphology, according to these two criteria. MethodsThis is an ancillary analysis of a prospective cohort study of pregnant women with suspected SARS-CoV-2 infection, managed in one maternity, from March 2020 to October 2021. Charting of clinical/obstetric history, trimester and severity of COVID-19 infection, and maternal/perinatal outcomes were done. Placental morphological findings were classified into maternal and fetal circulatory injury and acute/chronic inflammation. We further compared findings with women with suspected disease which tested negative for COVID-19. Diseases’ trimester of infection and clinical severity guided the analysis of confirmed COVID-19 cases. ResultsNinety-one placental discs from 85 women were eligible as a COVID-19 group, and 42 discs from 41 women in negative COVID-19 group. SARS-CoV-2 infection occurred in 68.2% during third trimester, and 6.6% during first; 16.5% were asymptomatic, 61.5% non-severe and 22.0% severe symptomatic (two maternal deaths). Preterm birth occurred in 33.0% (one fetal death). Global maternal vascular malperfusion (MVM) were significant in COVID-19 group whether compared with negative COVID-19 tests group; however, fetal vascular malperfusion lesions and low-grade chronic villitis were not. Three placentas had COVID-19 placentitis. Decidual arteriopathy was associated with infection in first/mid trimester, and chorangiosis in asymptomatic infections. DiscussionPlacental abnormalities after an infection by COVID-19 were more frequent after first/mid-trimester infections. Extensive placental lesions are rare, although they may be more common upon underlying medical conditions.

Genetic and Immunohistochemical Profiling of Mammary Hidradenoma and Comparison to Mucoepidermoid Carcinoma

Mucoepidermoid carcinoma (MEC) is exceedingly rare in the breast, with <45 cases reported in the literature. Although estrogen receptor/progesterone receptor/human epidermal growth factor 2 triple-negative, MEC is characterized as a special subtype of breast carcinoma with significantly better prognosis than conventional basal-type tumors. Cutaneous hidradenoma (HA) is considered a benign adnexal neoplasm showing histomorphologic overlap with MEC. Rare cases of HA have also been reported in the breast, but these are relatively uncharacterized. In this study, we examined the clinicopathologic, immunohistochemical (IHC), and genetic features of 8 breast HAs, in comparison to 3 mammary MECs. All cases were positive for MAML2 break-apart fluorescence in situ hybridization. Eight cases demonstrated a CRTC1::MAML2 fusion, and one MEC harbored a CRTC3::MAML2 fusion; the latter is a novel finding in the breast. Mutational burden was very low, with only one HA exhibiting a MAP3K1 pathogenic alteration. By IHC, both MEC and HA demonstrated cell type–dependent expression of high- and low-molecular-weight keratins and p63, as well as negative to low-positive estrogen receptor and androgen receptor. Smooth muscle myosin and calponin highlighted an in situ component in the 3 cases of MEC; expression of these myoepithelial markers was negative in HAs. Additional distinguishing characteristics included the growth pattern and tumor architecture, the presence of glandular/luminal cells in HA, and overall higher IHC expression of SOX10, S100 protein, MUC4, and mammaglobin in MEC. Morphologic findings were also compared to a series of 27 cutaneous nonmammary HAs. Mucinous and glandular/luminal cells were identified in significantly more mammary HAs than nonmammary lesions. The findings provide insight into the pathogenesis of MAML2-rearranged neoplasms of the breast, underscore the overlapping genetic features of MEC and HA, and highlight similarities to their extramammary counterparts.

Microvascular damage in autoimmune connective tissue diseases: a capillaroscopic analysis from 20 years of experience in a EULAR training and research referral centre for imaging

ObjectiveNailfold videocapillaroscopy (NVC) allows the detection of microvascular damage in autoimmune connective tissue diseases (CTDs). The prevalence of the morphological capillary findings was retrospectively evaluated in a wide cohort of...

Morphological description of the pancreas in male and female swan geese

One of the organs that can be found in the abdominal cavity is called the pancreas. It is a vital component in the process by which the food we eat is transformed into fuel for the cells of the body. For investigation of morphological description of the pancreas, the study was performed on twenty adult swan geese (10 males and 10 females). According to the morphological findings, the pancreas of geese was located on the right side of their abdominal cavity. It possessed four lobes—dorsal, splenic, ventral, and third and a distinctive duodenal papilla. It was between the ascending and descending duodenal loops. The goose pancreas has a thin covering of connective tissue over its mesothelium. The pancreatic parenchyma was divided by connective tissue septa, into numerous lobules, and these lobules extended outward from the pancreatic capsule. There was a wide range of diameters for the blood vessels. It consists of significant blood arteries, which can be identified by their oval or circular, bright nuclei. They have oval or circular, brilliant nuclei with the nucleolus. In the swan goose, serous acini and islets of Langerhans made up most of the pancreatic parenchyma. Exocrine cells had pyramidal shapes, acidophilic granules, and serous acini. In conclusion, the pancreas of geese like the most bird and is different from domestic animals.

Nonalbuminuric diabetic kidney disease: what is known? Literature review

Urinal albumin excretion is widely used in clinical practice as an indicator of diabetic renal injury. In accordance with a classical conception of diabetic nephropathy clinical course, an albuminuria usually precedes a reduction of renal function.&#x0D; The review is devoted to discussion of an actual problem of contemporary nephrology, nonalbuminuric diabetic kidney disease (NADKD), its prevalence increasingly grows in population of patients with type 2 diabetes mellitus due to efficacy of glucose lowering, hypotensive, hypolipidemic therapy and smoking cessation. NADKD is more frequently revealed among females; it is associated with arterial hypertension and ischemic heart disease. Renal changes in patients with NADKD are heterogenous compared with albuminuric diabetic patients and interstitial changes as well as atherosclerosis can turn out to be the main morphological finding in the absence of glomerulopathy signs. Some modern pathophysiological mechanisms proposed today for understanding of NADKD such as vascular, inflammatory, acute renal injury and use of pharmacological agents with renoprotective properties are elucidated. Contemporary data about clinical characteristics of NADKD, as well as its prognostic value, diagnostics and monitoring and its association with cardiovascular risk are given. A prognostic significance of NADKD should be defined more precisely. NADKD is shown to increase a risk of myocardial infarction and stroke development as well as a death from cardiovascular causes in patients with diabetes mellitus. An importance of the search for alternative diagnostic markers for detecting renal injury in the absence of albuminuria is emphasized. The evaluations of the markers of tubular damage and interstitial fibrosis, as well as proteomic approaches, are considered today as perspective diagnostic and prognostic options in NADKD. The study of pathogenesis, pathomorphology, clinical course of NADKD, as well as the development of approaches for an early diagnostics and treatment of this complication of diabetes mellitus are determined as the tasks for future research.&#x0D;

Hepatic Angiosarcomas With Sinusoidal Growth Patterns.

Hepatic angiosarcomas are aggressive malignant tumors of the liver with variable morphology. One of the rare morphologies is that of the sinusoidal growth pattern, which is challenging to diagnose because of its subtle imaging and morphologic findings. This retrospective study characterizes the clinical, histologic, and immunohistochemical features of sinusoidal hepatic angiosarcomas. Thirteen cases were included in the study, comprising 12 (92.3%) needle core biopsies and 1 wedge biopsy; one of the needle biopsies also had a subsequent resection specimen available for review. Multiple biopsies were needed to make the diagnosis in 4 cases. At least moderate sinusoidal dilatation was seen in 53.8% of cases. Increased cellularity within the sinusoids was seen at both low-power and high-power magnification (69.2% and 84.6%, respectively). Cytologic atypia ranged from mild to marked. Multinucleated tumor cells were present in most cases (10/13 cases) but were often sparse. Mitotic activity was identified in 5/13 cases. ERG immunostains were more reliable than CD31 and CD34 in identifying the tumor cells. Ki-67 proliferative index ranged from 5% to 30%. p53 immunostains were available in 9 cases and c-MYC in 7 cases; they were positive in 62.5% and 33.3% of cases, respectively and had a mutually exclusive staining pattern. In summary, this rare pattern of hepatic angiosarcoma is challenging to diagnose but has distinctive morphologic findings that can be supplemented with immunostains to establish the diagnosis.

Ultrasonic elastographic and morphological features of fatty hepatosis

BACKGROUND: Non-alcoholic fatty liver disease is a common chronic liver condition characterized by pathological accumulation of fatty droplets, which is not associated with alcohol consumption. The main reason in the development of complications and adverse outcomes of the disease is fibrotic changes in the liver, leading to cirrhosis.&#x0D; AIM: To determ the informative value of two-dimensional shear wave elastography in hepatosis by a comparative analysis of morphological and ultrasound elastometric findings.&#x0D; METHODS: The study included 40 patients aged 3560 years. The control group consisted of 25 healthy people with a body mass index of 2426. Among 40 patients, F1, F2 and F3 stages were detected in 15 (37.5%), 20 (50%), and 5 (12.5%) cases, respectively. The diagnosis was based on clinical, laboratory, and ultrasound examinations conducted with a Mindray Consona N9 device using a convex transducer at 2.03.5 MHz. In the absence of contraindications, all patients underwent puncture biopsy under ultrasound navigation in compliance with aseptic and antiseptic requirements.&#x0D; RESULTS: At the first (F1) stage of hepatic fibrosis (n=15), the elastometry index averaged 5.4 (4.86.2) kPa, and the shear wave velocity was 1.10.2 m/s. Histomorphological examination in this group revealed mild fatty liver dystrophy, with liver tissue having varying degrees of dystrophic changes. In the second (F2) stage of fibrosis (n=20), the mean elastometry values were 6.9 (6.37.9) kPa, while the shear wave velocity increased to 1.50.2 m/s. In patients of this group, histological examination showed that moderate to large fatty dystrophy developed in hepatocytes. In the F3 stage (n=5), the elastometry index averaged 8.3 (8.113.5) kPa, and the shear wave velocity reached 1.70.2 m/s. In this case, hepatocytes with fatty dystrophy in the focus surrounded by a cluster of lipophages were determined. Coincidence of fibrosis stage determined by elastometry data with morphological examination of liver biopsy specimen was observed in 36 (90%) patients with fatty hepatosis.&#x0D; CONCLUSIONS: Comparison of the results of two-dimensional shear wave elastography and morphological changes of liver parenchyma in hepatosis showed high (90%) correlation with the data of the above examinations. If puncture biopsy is contraindicated, shear wave elastography may serve as a valuable diagnostic method to clarify the stage of fibrosis in hepatosis.

Disseminated Extranodal NK/T-Cell lymphoma, Presenting as an Orbital Mass.

An 84-year-old male patient presented with decreased vision of 20/300 in the right eye, with additional painless upper eyelid fullness, hypoglobus, severe limitation of ocular motility, and conjunctival chemosis of the right eye for several months duration (panel A). He was referred after failing to respond to a trial of oral corticosteroids for presumed orbital myositis. MRI revealed an enlarged enhancing lacrimal gland (arrow), extraocular muscles, and mucosal thickening of the ethmoid sinus (arrowhead) on the right side (panel B). Lacrimal gland biopsy demonstrated medium-sized atypical lymphocytes with irregular nuclear contours, scant-to-moderate amounts of cytoplasm, and brisk mitotic figures (arrow) (panel C, hematoxylin-eosin, ×630), which expressed cytotoxic and natural killer-cell markers CD56 (panel D, ×400), perforin, and T-cell intracellular antigen 1, and were CD4-positive and CD8-negative. Neoplastic cells were positive for Epstein–Barr virus-encoded RNA by in situ hybridization (panel E, ×400). Clinical, morphologic, and immunophenotypic findings were compatible with extranodal natural killer/T-cell lymphoma (natural killer/T-cell lymphoma, nasal type). Optical coherence tomography revealed diffuse choroidal thickening with an undulating anterior border (sea-sick choroid) (arrow), compatible with choroidal involvement by lymphoma (panel F). Positron emission tomography scan showed significantly increased activity in the regional and distal lymph nodes and in multiple bones, compatible with disseminated disease. The patient succumbed to disease shortly after diagnosis. This case highlights the importance of prompt and accurate diagnosis of natural killer/T-cell lymphoma, nasal type, which can present with orbital and ocular involvement simulating an inflammatory process.FIG

Co-occurring mutations in ASXL1, SRSF2, and SETBP1 define a subset of myelodysplastic/ myeloproliferative neoplasm with neutrophilia

Identification of genomic signatures with consistent clinicopathological features in myelodysplastic/myeloproliferative neoplasm (MDS/MPN) is critical for improved diagnosis, elucidation of biology, inclusion in clinical trials, and development of therapies. We describe clinical and pathological features with co-existence of mutations in ASXL1 (missense or nonsense), SRSF2, and SKI homologous region of SETBP1, in 18 patients. Median age was 68 years with a male predominance (83%). Leukocytosis and neutrophilia were common at presentation. Marrow features included hypercellularity, granulocytic hyperplasia with megakaryocytic atypia, while the majority had myeloid hyperplasia and/or erythroid hypoplasia, myeloid dysplasia, and aberrant CD7 expression on blasts. Mutations in growth signaling pathways (RAS or JAK2) were noted at diagnosis or acquired during the disease course in 83% of patients. Two patients progressed upon acquisition of FLT3-TKD (acute myeloid leukemia) or KIT (aggressive systemic mastocytosis) mutations. The prognosis is poor with only two long-term survivors, thus far, who underwent blood or marrow transplantation. We propose that the presence of co-occurring ASXL1, SRSF2, and SETBP1 mutations can be diagnostic of a subtype of MDS/MPN with neutrophilia if clinical and morphological findings align. Our report underscores the association between genotype and phenotype within MDS/MPN and that genomic signatures should guide categorization of these entities.

Multi-Organ Morphological Findings in a Humanized Murine Model of Sickle Cell Trait.

Sickle cell disease (SCD) is caused by the homozygous beta-globin gene mutation that can lead to ischemic multi-organ damage and consequently reduce life expectancy. On the other hand, sickle cell trait (SCT), the heterozygous beta-globin gene mutation, is still considered a benign condition. Although the mechanisms are not well understood, clinical evidence has recently shown that specific pathological symptoms can also be recognized in SCT carriers. So far, there are still scant data regarding the morphological modifications referable to possible multi-organ damage in the SCT condition. Therefore, after genotypic and hematological characterization, by conventional light microscopy and transmission electron microscopy (TEM), we investigated the presence of tissue alterations in 13 heterozygous Townes mice, one of the best-known animal models that, up to now, was used only for the study of the homozygous condition. We found that endothelial alterations, as among which the thickening of vessel basal lamina, are ubiquitous in the lung, liver, kidney, and spleen of SCT carrier mice. The lung shows the most significant alterations, with a distortion of the general tissue architecture, while the heart is the least affected. Collectively, our findings contribute novel data to the histopathological modifications at microscopic and ultrastructural levels, underlying the heterozygous beta-globin gene mutation, and indicate the translational suitability of the Townes model to characterize the features of multiple organ involvement in the SCT carriers.

Molecular and Clinical Characterization of CNGA3 and CNGB3 Genes in Brazilian Patients Affected with Achromatopsia.

Achromatopsia (ACHM) is a congenital cone photoreceptor disorder characterized by reduced visual acuity, nystagmus, photophobia, and very poor or absent color vision. Pathogenic variants in six genes encoding proteins composing the cone phototransduction cascade (CNGA3, CNGB3, PDE6C, PDE6H, GNAT2) and of the unfolded protein response (ATF6) have been related to ACHM cases, while CNGA3 and CNGB3 alone are responsible for most cases. Herein, we provide a clinical and molecular overview of 42 Brazilian patients from 38 families affected with ACHM related to biallelic pathogenic variants in the CNGA3 and CNGB3 genes. Patients' genotype and phenotype were retrospectively evaluated. The majority of CNGA3 variants were missense, and the most prevalent CNGB3 variant was c.1148delC (p.Thr383Ilefs*13), resulting in a frameshift and premature stop codon, which is compatible with previous publications in the literature. A novel variant c.1893T>A (p.Tyr631*) in the CNGB3 gene is reported for the first time in this study. A great variability in morphologic findings was observed in our patients, although no consistent correlation with age and disease stage in OCT foveal morphology was found. The better understanding of the genetic variants landscape in the Brazilian population will help in the diagnosis of this disease.

Optimal timing of late gadolinium enhancement imaging in patients undergoing CMR for suspected pericarditis: the later the better?

Abstract Funding Acknowledgements Type of funding sources: None. Background Pericarditis is frequently encountered in daily clinical practice and accounts for about 5% of chest pain hospital admissions [1]. Although the diagnosis of pericarditis can be established by clinical criteria, cardiovascular magnetic resonance (CMR) imaging is increasingly used to evaluate concomitant myocardial involvement and/or to exclude other disease entities. Besides well-known morphologic findings like pericardial effusion, thickening or adhesion, pericardial late gadolinium enhancement (LGE) imaging has been demonstrated to be the most sensitive surrogate of pericarditis [2]. Purpose While there is a lot of data regarding the optimal timing of LGE for the detection of myocardial damage, optimal timing of LGE for the detection of pericarditis is unknown. In the recent advent of rapid high-throughput CMR protocols, high diagnostic accuracy needs to be maintained not only for myocardial diseases, but also for the assessment of the pericardium. Methods We present a case series comparing pericardial contrast enhancement in rapid routine LGE images versus LGE images acquired following a longer waiting time after Gadolinium injection (gadoteridol). Results After a longer than rapid clinical routine waiting time, we observed more prominent pericardial signal enhancement in the setting of pericarditis. This effect is most likely explained by different pericardial Gadolinium distribution kinetics compared to the myocardium. Conclusion Consequently, this observation should be taken into account when imaging patients with suspected pericarditis and may warrant further evaluation. Figure: Routine LGE timing (top row) versus delayed LGE timing (bottom row) in 4 patients with pericarditis undergoing CMR Exemplary LGE images in the top row were acquired routinely after ∼10 min. from contrast administration (0,15mmol/Kg), whereas same LGE slices in the bottom row were additionally acquired after a delayed waiting time (∼20 min.) from contrast injection (0,15mmol/Kg). Pericardial LGE was more prominent in delayed LGE imaging compared to routine LGE imaging.

A Comparison of Bone Marrow Morphology and Peripheral Blood Findings in Low and High Level JAK2 V617F Allele Burden.

Cases with low level JAK2 V617F mutations are increasingly detected; however, the clinical interpretation of the low allele JAK2 burden may be challenging. The aim of this study is to analyze and compare the bone marrow morphology and peripheral blood findings in the low level JAK2 V617F allele burden (≤15% of JAK2) and high JAK2 V617F mutation burden patients (>15% JAK2). In total, 122 JAK2 V617F positive cases with concomitant bone marrow biopsies and peripheral blood findings were re-evaluated (62 low and 60 high level JAK2 V617F positive). Within the low burden group, normal looking megakaryocytes (p = 0.0005) were more frequently found, compared with those with no atypia (p = 0.0003), their number was more frequently not increased (p = 0.009), and they did not form clusters (p = 0.001). We found statistically significant difference in the number of platelet (p = 0.0003) and hematocrit levels (p = 0.032) when comparing the JAK2 V617F <3% and ≥3% mutation burden. In the high-level burden, the megakaryocytes were more frequently atypical (p = 0.054), and more frequently formed clusters (p = 0.053) with nuclei with maturation defects (p ≤ 0.0001). In conclusion, the JAK2 V617F mutation burden is reflected by morphological changes in the bone marrow and careful follow up of each and every patient with a low JAK2 V617F positivity is mandatory.

Appearance of retinal arterial macroaneurysms in patients using swept-source optical coherence tomographic angiography

BackgroundRetinal arterial macroaneurysm (RAM) is a common clinical disease leading to vision loss in elderly individuals. The appropriate interpretation of swept-source optical coherence tomographic angiography (SS-OCTA), a noninvasive examination, is easy and convenient for detecting the status of RAMs and guiding treatment.MethodsThe objectives of this study were to describe the morphologic characteristics of RAMs using SS-OCTA and to observe whether there are differences in the morphologies of RAMs between SS-OCTA and fundus fluorescein angiography (FFA), before and after treatment. We retrospectively evaluated twenty-two eyes of 22 patients who were diagnosed with RAMs. All patients underwent a complete ophthalmologic examination, including a review of medical records, best-corrected visual acuity (BCVA), fundus photography, FFA and SS-OCTA. RAMs were recorded by SS-OCTA before any treatment or observation decisions were made. The morphologic findings of the RAMs on SS-OCTA were investigated.ResultsOn SS-OCTA, RAMs can show local dilatation or an irregular linear blood flow signal, and the dilated cystic lumen may show thrombosis with a low reflection signal. After treatment, the shape of the RAMs will show reactive changes. The findings on SS-OCTA are not very consistent with those on FFA.ConclusionsThe same RAM may have different manifestations on OCTA and FFA, and OCTA can more conveniently reflect the changes in blood flow signals and treatment response of RAMs.

Magnetic resonance imaging evaluation of the disc morphology of temporomandibular joint in patients with severe hemophilia.

This study aimed to assess the morphological differences in the articular disc (AD) between hemophilic patients and healthy individuals of the control group for further association with signs and symptoms. Fourteen severe hemophilic patients had their AD evaluated by magnetic resonance imaging (MRI). The morphological findings were compared to those of a control group consisting of 14 healthy individuals. MRI was used to evaluate all the components of the temporomandibular (TMJ), including the AD, resulting in sequential T1-weighted parasagittal images. All the images were acquired with teeth in maximum intercuspation position. Morphological alterations showed significant statistical differences (P-value = 0.0068), whereas no statistical differences were found in the other variables, including TMJ pain, headache, bruxism and mouth opening limitation. In the group of non-hemophilic individuals, only two (14.29%) presented AD with non-biconcave features, whereas in the group of hemophilic patients, nine (64.29%) presented AD with a morphology other than biconcave. In patients with severe hemophilia, there seems to be a pattern of morphological alterations in the articular disc over time. The standard biconcave morphology of AD tends to change into other ones, particularly biplanar, hemiconvex and folded.

Rectovaginal endometriosis with nodular smooth muscle metaplasia diagnosed via transrectal ultrasound-guided fine-needle aspiration cytology: An underused minimally invasive diagnostic technique?

Rectovaginal endometriosis is a severe variant of deeply infiltrating endometriosis. Laparoscopic assessment with tissue sampling remains the gold standard for diagnosis of endometriosis. However, transvaginal (TVUS) and transrectal ultrasound (TRUS) have been shown to be especially helpful in the diagnosis of deep endometriosis. We present the case of a 49-year-old female with menorrhagia, dysmenorrhea, and constipation. Upon pelvic examination, an incidental mass was palpated. A computed tomography (CT) scan revealed an anterior rectal wall mass and colonoscopy was non-diagnostic. Further work-up with MRI showed a 3.9 cm mass centered within the upper rectovaginal septum. TRUS guided fine-needle aspiration (TRUS-FNA) revealed cohesive epithelial cell groups without significant cytologic atypia and a second population of bland spindle cells. Cell block slides showed glandular epithelium with associated stroma that exhibited endometrial morphology and immunophenotype. Nodular fragments of spindle cells with smooth muscle immunophenotype and fibrosis were also present. The overall morphologic findings were consistent with rectovaginal endometriosis with nodular smooth muscle metaplasia. Medical management with nonsteroidal aromatase inhibitor with radiologic follow-up was selected. Rectovaginal endometriosis represents a type of deep endometriosis usually associated with severe pelvic symptoms. Metaplastic smooth muscle cells are a frequent component of endometriosis in the rectovaginal pouch with nodular growth and may present diagnostic challenges. TRUS-FNA is a minimally invasive procedure that can provide an accurate diagnosis of endometriosis, even in this variant of deep infiltrating disease.

ADENOID CYSTIC CARCINOMA WITH BONE AND PLEURAL METASTASIS: A CASE REPORT

A 52 year-old male patient, who was referred for a diagnosis of palatal swelling. He underwent an incisional biopsy of a palatal swelling in the right maxilla, approximately 5 cm, pink in color, resistant palpation, with bleeding ulceration to the touch in the posterior region. The teeth involved in the lesion were mobile. An anatomopathological examination confirmed the morphological and immunohistochemical findings for locally advanced ACC, being positive for CK7, p40, SOX10, and EMA markers. After complementary tests, bone and pleural metastasis were diagnosed. Subsequently, the therapeutic approach chosen was for pain control, including five sessions of radiotherapy with a dose of 5 × 4Gy, and palliative chemotherapy with Carboplatin AUC 5 + Paclitaxel 175 mg/m². The patient is alive at the last follow-up. Therefore, confirmation with anatomopathological examination is essential for the diagnosis of palate lesions, even if they do not have clinical features of malignancy. A 52 year-old male patient, who was referred for a diagnosis of palatal swelling. He underwent an incisional biopsy of a palatal swelling in the right maxilla, approximately 5 cm, pink in color, resistant palpation, with bleeding ulceration to the touch in the posterior region. The teeth involved in the lesion were mobile. An anatomopathological examination confirmed the morphological and immunohistochemical findings for locally advanced ACC, being positive for CK7, p40, SOX10, and EMA markers. After complementary tests, bone and pleural metastasis were diagnosed. Subsequently, the therapeutic approach chosen was for pain control, including five sessions of radiotherapy with a dose of 5 × 4Gy, and palliative chemotherapy with Carboplatin AUC 5 + Paclitaxel 175 mg/m². The patient is alive at the last follow-up. Therefore, confirmation with anatomopathological examination is essential for the diagnosis of palate lesions, even if they do not have clinical features of malignancy.

Morphological Changes and Pathological Findings in the Achilles Tendons of Diabetic Patients: A Meta-Analysis of Comparative Clinical Studies

Morphological Changes and Pathological Findings in the Achilles Tendons of Diabetic Patients: A Meta-Analysis of Comparative Clinical Studies

Head-to-Head Comparison of [68Ga]Ga-DOTA.SA.FAPi and [68Ga]Ga-DOTANOC Positron Emission Tomography/Computed Tomography Imaging for the Follow-Up Surveillance of Patients with Medullary Thyroid Cancer.

Background: A theranostic probe for accurate staging and treatment is crucial for the management of medullary thyroid cancers (MTCs). The abundance of stroma in most of thyroid cancers, including MTC, opens new avenues for selecting cancer-associated fibroblasts (CAFs) as new molecular imaging and therapeutic targets. [68Ga]Ga-labeled fibroblast activation protein inhibitor (FAPi) molecules have gained importance as alternative molecular imaging agents in the imaging of thyroid cancers. The purpose of this study was to compare the detection efficiency of primary and metastatic lesions of MTCs between [68Ga]Ga-DOTA.SA.FAPi and [68Ga]Ga-DOTANOC positron emission tomography (PET) radiotracers. Materials and Methods: In this retrospective study, [68Ga]Ga-DOTANOC and [68Ga]Ga-DOTA.SA.FAPi PET/CT (computed tomography) images were compared using patient-based and lesion-based analysis in patients with MTC for follow-up assessment. The quantitative assessment included comparing standardized uptake values corrected for lean body mass (SULpeak) and tumor-to-background ratios (TBR). The findings on both scans were validated with the morphological findings of the diagnostic CT. Results: Twenty-seven patients (21 males and 6 females) with a mean age of 42.4 ± 13.2 years (range 14-66 years) were included in the study. [68Ga]Ga-DOTA.SA.FAPi had similar sensitivities as that of [68Ga]Ga-DOTANOC PET/CT for detecting primary tumors (100% [18 of 18] vs. 94.4% [17 of 18], p = 0.979) involved lymph nodes (98.3% [118 of 120] vs. 95% [114 of 120], p = 0.288), and brain metastases (100%). [68Ga]Ga-DOTA.SA.FAPi demonstrated significantly higher sensitivities than [68Ga]Ga-DOTANOC PET/CT for detecting lung nodules (93.5% [87 of 93] vs. 68.9% [64 of 93], p < 0.0001), liver (100% [105 of 105] vs. 46.4% [49 of 105], p < 0.0001), bone (92.4% [110 of 119] vs. 76.5% [91 of 119], p = 0.001), and pleural metastases 98.2% versus 0%. Higher uptake values and TBR values were reported with [68Ga]Ga-DOTA.SA.FAPi compared with that of [68Ga]Ga-DOTANOC. Conclusion: [68Ga]Ga-DOTA.SA.FAPi outperformed [68Ga]Ga-DOTANOC PET/CT in the detection of distant metastases with both patient-based and lesion-based analysis in MTCs.