Non-neoplastic Causes Research Articles

Lobar collapse: what radiologists need to know

Radiologists have to diagnose lobar collapse routinely, so they should be familiar with the direct and indirect signs of lobar atelectasis and with uncommon findings, for being able to make early diagnosis. Atelectasis can be caused by several mechanisms: by obstruction (due to neoplastic or non-neoplastic causes), by loss of negative pressure in the pleural space and/or by compression of lung parenchyma (e.g., pneumothorax, hydrothorax, and pleural effusion) or by an increase in alveolar surface tension (e.g., acute respiratory distress syndrome and neonatal respiratory distress syndrome). Collapses, moreover, can be observed in several ways. Lobar atelectasis occurs when entire pulmonary lobe is collapsed. Linear atelectasis (previously “plate like” or “band like”) is a local collapse with linear, plate-like or band-like shape which usually parallels the hemidiaphragms. Rounded atelectasis is a consequence of chronic or recurrent pleural effusion, which could be related to asbestos disease, chronic cardiac or renal failure, and thoracic malignancies. It occurs as a rounded mass abutting the pleura with adjacent pleural thickening. Collapsed lobes can assume quite limited forms and radiologists require familiarity with radiographic findings for helping clinical physician in the diagnostic process.

Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy.

Pancreatobiliary lymphadenopathy (PBL) may be due to a number of benign or malignant causes. Tissue sampling of these lymph nodes (LN) can be possible with the help of endoscopic ultrasound (EUS). Aim of this study was to identify the etiology of the PBL, morphology, and factors predicting good yield of biopsy with EUS. All patients found to have pancreatobiliary lymph node (PBLN) enlargement (>10 mm) on abdominal imaging and referred for EUS-guided biopsy were included in this prospective observational study. The facility of rapid on-site evaluation (ROSE) was not available. Adequacy of the tissue specimen was assessed by the endoscopist with macroscopic on-site evaluation (MOSE) and then sent to histopathologist for final diagnosis. Factors predicting good yield of biopsy were then analyzed. Of the total 87 patients with PBL, 54 (62.1%) were males. Mean age of the patients was 52.0 (±13.4) and range 18-80 years. The commonest locations of PBL were porta hepatis 37 (42.5%), peripancreatic 24 (27.6%), celiac 16 (18.4%), and others 10 (11.5%). Histological reports showed: neoplastic tissue in 34 (39.1%), non-neoplastic in 20 (23%), normal lymphoid tissue (27.6%) and suboptimal in 9 (10.3%). Among the 34 neoplastic causes, 26 had metastatic adenocarcinoma, 5 had lymphoma, and 3 had metastatic neuroendocrine tumors. Among the 20 non-neoplastic causes, 10 had tuberculosis, 4 had anthracosis, and 6 had other findings. Factors predicting good yield of biopsy were a PBLN size ≥12 mm and satisfactory MOSE on both univariate [PBLN (p = 0.005); MOSE (p < 0.0001)] and multivariate [PBLN (p = 0.011); MOSE (p < 0.0001)] analysis. The commonest etiology of PBLN enlargement was metastatic adenocarcinoma among the neoplastic causes and tuberculosis among the non-neoplastic causes. The most common PBLNs approached by EUS were in portahepatis and peripancreatic regions. A good biopsy yield can be predicted with PBLN size of ≥12 mm and a satisfactory MOSE. Tasneem AA, Yaseen T, Laeeq SM, et al. Pancreatobiliary Lymphadenopathy: Etiology, Location, and Factors Predicting Good Yield of Endoscopic Ultrasound-guided Biopsy. Euroasian J Hepato-Gastroenterol 2024;14(1):40-43.

A Cross-sectional Study on the Aetiology and Predisposing Factors of Hoarseness of Voice.

The primary objective of the study was to find out the aetiology of hoarseness and analyse people with hoarseness based on socio-demographic profile like age, gender, occupation and socio-economic status. Secondary objective was to find out the predisposing factors of hoarseness and to see their association between benign and malignant causes of hoarseness. The study was conducted for a period of one and half years in 178 patients who were above the age of 18 years of age and presented with hoarseness lasting for more than 2 weeks to the Department of Otorhinolaryngology. After obtaining a written informed consent, history was taken using a structured proforma and a proper clinical examination was done including indirect laryngoscopy. Nasopharyngolarygoscopy was done where indirect laryngoscopy was difficult. In a sample of 178 patients with hoarseness, 159 patients had structural lesions and 19 patients had movement disorders. Of the structural lesions, 86 patients were due to malignancy, 64 due to non-neoplastic causes, and 9 were due to premalignant causes. The most common malignant cause for hoarseness was Malignancy glottis, which had a male predilection. Smoking and alcoholism were found to be the main predisposing factors. The most common non neoplastic cause were vocal cord nodule and vocal cord polyp. The main predisposing factor was vocal abuse and was seen mostly in females. Vocal cord palsy was found to be the most common movement disorder. Hoarseness as a symptom if taken lightly can lead to serious consequences. Therefore it is important to avoid predisposing factors like smoking, alcoholism and also to educate the people regarding the proper use of voice.

Diagnostic Accuracy of Ultrasound to Differentiate Neoplastic and Non-Neoplastic causes of Cervical Lymphadenopathy taking Histopathology as the Gold Standard

Objective: To evaluate the efficacy of high-resolution ultrasound and colour Doppler in differentiating neoplastic and nonneoplastic causes of cervical lymphadenopathy compared to histopathological diagnosis.&#x0D; Study Design: Cross-Sectional study.&#x0D; Place and Duration of Study: Pakistan Institute of Medical Sciences, Islamabad Pakistan, from Jan to Jun 2019.&#x0D; Methodology: The study included 110 patients with palpable cervical lymph nodes undergoing neck ultrasound and Fine needle aspiration cytology/Biopsy. Certain important sonological features were considered to categorize them into nonneoplastic and neoplastic groups. Colour Doppler imaging was employed along with grey-scale imaging. The histopathology results were compared with sonographic findings to determine the diagnostic accuracy of ultrasound in differentiating neoplastic from non-neoplastic causes of enlarged cervical lymph nodes.&#x0D; Results: Our study revealed that High-resolution sonography has 94.4% sensitivity and 88.8% specificity, differentiating between neoplastic and non-neoplastic causes of cervical lymphadenopathy. At the same time, the overall accuracy of ultrasound is 90.9%. The most consistent grey-scale feature in the non-neoplastic nodal group was preserved central fatty hilum, while its loss was significantly associated with neoplastic etiologies.Conclusion: Due to high sensitivity and negative predictive value, high-resolution sonography can be deployed as a first-line investigating tool for enlarged lymph nodes, and invasive procedures like Fine needle aspiration cytology (FNAC) can be abandoned in non-neoplastic lymphadenopathies.

Differential Diagnosis of Tumor-like Brain Lesions.

Tumor-like brain lesions are rare and commonly suggest a neoplastic etiology. Failure to rapidly identify non-neoplastic causes can lead to increased morbidity and mortality. In this review, we describe 10 patients who presented with atypical, non-neoplastic tumor-like brain lesions in which brain biopsy was essential for a correct diagnosis and treatment. There has been increasing recognition of autoimmune conditions affecting the nervous system, and many of those diseases can cause tumor-like brain lesions. Currently available reports of non-neoplastic tumor-like brain lesions are scarce. Most case series focus on tumefactive demyelinating lesions, and a comprehensive review including other neuroimmunological conditions such as CNS vasculitis, neurosarcoidosis, histiocytic and infectious etiologies is lacking. We review the literature on tumor-like brain lesions intending to increase the awareness and differential diagnosis of non-neoplastic brain tumor mimics. We advocate for earlier brain biopsies, which, in our case series, significantly changed diagnosis, management, and outcomes.

Détection automatisée de la dysplasie cellulaire en hématologie : où en sommes-nous ?

AbstractMyelodysplastic syndromes (MDS) are clonal hematopoietic diseases of the elderly, characterized by chronic cytopenia, ineffective and dysplastic hematopoiesis, recurrent genetic abnormalities and increased risk of progression to acute myeloid leukemia. Diagnosis on a Complete Blood Count (CBC) can be challenging due to numerous other non-neoplastic causes of cytopenias. New generations of hematology analyzers provide many Cell Population Data (CPD) that can be exploited to reliably detect MDS from a routine CBC. In this review, we first describe the different technologies used to obtain CPD. We then give an overview of the currently available data regarding the performance of CPD for each lineage in the diagnostic workup of MDS. Adequate exploitation of CPD can yield very strong diagnostic performances allowing for faster diagnosis and reduction of time-consuming slide reviews in the hematology laboratory.

Genomics of myelodysplastic/myeloproliferative neoplasm.

Myelodysplastic/ Myeloproliferative neoplasms (MDS/MPN) demonstrate overlapping pathologic and molecular features of myelodysplastic (MDS) and myeloproliferative (MPN) neoplasms. Diagnosis is difficult based on morphology alone, requiring exclusion of various non-neoplastic causes for CBC abnormalities and morphologic findings and other myeloid neoplasms. Identifying a clonal abnormality by cytogenetics or molecular studies has vastly improved our ability to diagnose MDS/MPN and has been incorporated in the different classification schemas. Currently two separate classification systems are in use- The 5th edition WHO and international consensus classification. The two competing classifications emphasize genetic work-up and are similar on many levels; however, they do introduce diagnostic dilemma when diagnosing certain entities such as chronic myelomonocytic leukemia in the presence of NPM1 mutations. The genetic profile overlaps among different subentities; however, the combination and the incidence of mutations; together with the clinical features and morphology helps in further subclassification. In this review, we discuss the advances in molecular characterization of MDS/MPN. We attempt to summarize the differences between the various classification schemes, and highlight the changes made in the diagnostic criteria.

Percutaneous Image-guided Cryoneurolysis: Applications and Techniques.

The expansion and dissemination of interventional cryoneurolysis in recent years has been fueled by the integration of advanced imaging guidance, the evolution of our understanding of neuropathologic processes after exposure of nerves to cold, and opportunities for its use beyond pain management. The clinical translation of cryoneurolysis through interventional radiology requires consideration of many factors, including (a) the supply and composition of target nerves, (b) the value of diagnostic injection with imaging guidance for confirmation, (c) the integration of advanced imaging guidance that allows safe ablation, (d) the difference between neoplastic and nonneoplastic causes of pain, (e) the phenomenon of percutaneously induced neuroregeneration, (f) the potential to manage conditions other than pain, (g) the consideration of protocols, (h) the limitations of current technology, and (i) the potential complications and adverse effects. Cryoneurolysis has societal and legislative endorsement as an effective nonopioid option for pain palliation. The Centers for Medicare and Medicaid Services (CMS) approved three new category III Current Procedural Terminology (CPT) codes specifically for the cryoablation of nerves with advanced imaging guidance. Interventional radiologists who are aware of nerve-directed strategies see eligible patients in their daily practice and have opportunities to bundle procedures (eg, celiac plexus block at the time of a biliary drain for pancreatic cancer with low bile duct obstruction), offering an avenue to serve the patient, reduce opioid dependence, allow faster discharge, and establish name recognition of interventional radiologists. Also, the ability to use CT to target deep structures accurately and swiftly, often with only local anesthesia, compared with the usual monitored anesthesia care in a surgical setting, may provide another avenue to build a cryoneurolysis practice. ©RSNA, 2022.

Mucocele of the Apendix - A Case Report and Review of the References

Abstract Mucocele of the apendix is a rare clinical and pathological entity with a higher incidence in the female population, and non-specific symptomatology that includes more diagnoses including neoplastic and non-neoplastic causes of the apendix dilation and mucin proliferation. With obtained numerous variations in symptomatology, clinical picture, intraoperative presentation, surgical treatment and histopathological findings, the aim of this paper is an inspection into current knowledge of this disease, its histopathological characteristics, differential diagnosis and current treatment modalities. We present a patient with a clinical picture of the acute abdomen and numerous comorbidities. Ultrasound diagnostics indicated the presence of thin-walled dilatation of the small intestine, especially in the lower right quadrant, as well as the presence of free fluid in the peritoneal cavity. Apendectomy and removal of the mucocele and resection of the gangrenous sigmoid colon according to Hartmann were done. A definitive histopathological finding suggests ischemic colitis and retention mucocele of the apendix with normal mucosa. Histopathologically, four types of mucocele apendixes are distinguished, namely the retention mucinous cyst, mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. Surgical treatment is the method of choice in treating these tumors, either open or laparoscopic. Imperative is the preservation of the integrity of the entire mucocele, due to the possible dissemination of contents of the cyst and the subsequent development of pseudomyxoma peritonei.

Causes of Mortality and Profile of Spontaneous Tumors in Young CD-1 Mice.

A retrospective study was performed to establish the causes of mortality and incidence patterns of tumors in young (<50 weeks) control CD-1® mice from Charles River Laboratories. Tumor incidences (fatal and nonfatal) and nonneoplastic causes of death observed during the first 50 weeks of the study were collected from 48 thirteen-week toxicity studies conducted between 2009 and 2018 and from 43 carcinogenicity studies conducted between 2005 and 2018. Thirteen-week studies had a mortality rate of 8/620 (1.3%) in males and 4/620 (0.65%) in females. The major factors contributing to death were integument lesions in males (3/8) and experimental procedure-related injuries in females (3/4). All tumors recorded were nonfatal. Bronchiolo-alveolar adenoma was the commonest tumor with the same incidence in both males and females (4/620, 0.65%); a single lymphoma (0.16%) and uterine leiomyosarcoma (1/620 0.16%) were reported in females. The mortality rates of males and females that died or were euthanized during the first 50 weeks in carcinogenicity studies were 192/2830 (6.8%) and 198/2830 (7%), respectively. The most common fatal tumor in this age group was lymphoma in both sexes, with an incidence of 18/192 (9.3%) and 41/198 (20.7%) in males and females, respectively. In males tumors were responsible for fewer deaths than in females (17% vs. 32.3%). The major nonneoplastic causes of death or moribundity were cutaneous lesions (44/192, 22.9%), and obstructive uropathy (39/192, 20.3%) in males, and chronic progressive nephropathy (40/198, 20.2%) in females. Only minor differences were evident compared to a similar study performed 15 years ago; these might reflect changes in terminology and diagnostic criteria, and stricter animal welfare endpoints.

Automated Detection of Dysplasia: Data Mining from Our Hematology Analyzers.

Myelodysplastic syndromes (MDSs) are clonal hematopoietic diseases of the elderly, characterized by chronic cytopenia, ineffective and dysplastic hematopoiesis, recurrent genetic abnormalities and increased risk of progression to acute myeloid leukemia. Diagnosis on a complete blood count (CBC) can be challenging due to numerous other non-neoplastic causes of cytopenias. New generations of hematology analyzers provide cell population data (CPD) that can be exploited to reliably detect MDSs from a routine CBC. In this review, we first describe the different technologies used to obtain CPD. We then give an overview of the currently available data regarding the performance of CPD for each lineage in the diagnostic workup of MDSs. Adequate exploitation of CPD can yield very strong diagnostic performances allowing for faster diagnosis and reduction of time-consuming slide reviews in the hematology laboratory.

Types and Clinical Profile of Unilateral Sinonasal Masses

Background: Unilateral mass in the sinonasal region is a common problem facing the otolaryngologist in daily clinical practice. There are various benign and malignant conditions originating in this area with different clinical features depending on their nature and extent.Objectives: To evaluate the types and clinical profile of unilateral sinonasal masses.Materials and methods: This study includes 60 patients who attended the outpatient clinic at Alyarmook Teaching Hospital, Baghdad, Iraq, between January 2017 and April 2018. A thourough history from each patient was taken. Moreover, the clinical examination was done according to standard clinical practice. The imaging results of the nose and paranasal sinuses were documented. Then biopsy was taken from the mass at the operating room under local or general anesthesia if indicated. The specimen was sent for histopathological examination and the results were documented on the data collection sheet. The patients were divided into two groups: non-neoplastic and neoplastic according to the histopathological results.Results: Out of 60 patients, there were 36 (60%) males. The age of our cases was ranged from 6 to 79 years with a mean age of 34.20 ± 18.126 years. Non-neoplastic causes were (n=38, 63.3%) more than the neoplastic group, and the majority of them were unilateral simple polyp (n=23, 38.3%). Inverted papilloma was the most common benign tumor (n=8, 13.3%), while, squamous cell carcinoma was the commonest malignant neoplasm (n=2, 3.3%). Non-neoplastic causes were more in both sexes. The most affected age group was 20-49 years (n=31, 51.7%). The non-neoplastic causes were mostly seen in the age group 20-49 years (n=22, 36.7%). There was no statistically significant difference between the age and gender and the causes of unilateral sinonasal lesions (P-value > 0.05). Nasal obstruction, nasal discharge, and hyposmia were more in non-neoplastic than neoplastic group. While epistaxis and facial pain were found to be higher in the neoplastic group.Conclusion: Non-neoplastic masses outnumber neoplastic ones. Among non-neoplastic lesions, inflammatory polyps were the most common. Benign neoplasms outnumber the malignant neoplasms with inverted papilloma and squamous cell carcinoma were the most common respectively.

Clinical experience of transbronchoscopic laser ablation for central airway stenosis using a high-power diode laser-ten years' experience at a single institute.

High-power diode (GaAlAs) laser systems have been used for transbronchoscopic laser ablation for central airway stenosis. Such diode laser systems show a similar clinical effect to a conventional Nd-YAG laser, but the instrument is more compact with easier handling. We use a high-power diode laser system with a non-contact probe for endobronchial ablative therapy. The present study reviewed our experience with transbronchoscopic laser ablation to explore a better clinical approach for managing central airway lesions. We retrospectively reviewed the patients who were treated for central airway lesions by transbronchial laser ablation using the non-contact-type probe from January 2005 to December 2015 at Chiba University Hospital. We investigated the cause of stenosis, number of treatments, laser setting, total amount of energy, complications, and simultaneously performed modality. Thirty-three patients underwent treatment a total of 72 times. There were 23 males, with an average age of 60.3 years old (range, 18-80 years old). The primary causes of the central airway stenosis were neoplastic disease in 22 (16 malignant tumors, 6 benign tumors) and non-neoplastic disease in 11. Among malignant tumors, there were eight tracheal cancer and five lung cancer patients as well as three patients with esophageal cancer. Among benign tumors, there were three hamartomas and one patient each with papilloma, smooth muscle tumor, and glomus tumor. The non-neoplastic causes of airway stenosis were intubation or tracheotomy in four patients, tuberculosis and granulation in two each, and trauma, burn, and surgery in one each. The numbers of treatments were 30 times (1.36 times/patient) for neoplastic diseases and 42 times (3.82 times/patient) for non-neoplastic disease. The total amount of energy was 1,936 J on average (1,674 J for neoplastic diseases and 2,098 J for non-neoplastic disease). There were no major complications related to transbronchial laser ablation therapy. Transbronchoscopic laser ablation using a diode laser system with a non-contact probe can be safely performed and is useful for endobronchial treatment of both neoplastic and non-neoplastic central airway lesions.

Imaging findings of spontaneous intraabdominal hemorrhage: neoplastic and non-neoplastic causes.

Contrary to traumatic and iatrogenic intraabdominal hemorrhages, spontaneous intraabdominal hemorrhage is a challenging clinical situation. A variety of neoplastic and non-neoplastic conditions may cause spontaneous intraabdominal bleeding. Imaging findings vary depending on the source of bleeding and the underlying cause. In this article, we aim to increase the awareness of imagers to the most common causes of spontaneous intraabdominal hemorrhage by using representative cases.

Prevalence of precursor lesions (P53 signature, SCOUT, STIL, STIC) in fallopian tubes resected for non-neoplastic causes.

High-grade pelvic serous carcinoma is a common cause of death in women worldwide and India. Recent evidence has clearly implicated the changes in the mucosa of the fimbrial end of the fallopian tube in its pathogenesis. 1) To study histopathology features of surgically resected specimens of fallopian tubes received with non-neoplastic lesions of the uterus and ovary for the presence of any precursor lesions [secretory cell outgrowth (SCOUT), serous tubal intraepithelial lesion (STIL), p53 signatures, and serous tubal intraepithelial carcinoma (STIC)]. 2) To confirm the findings with immunohistochemistry. 3) To correlate the prevalence of precursor lesions with clinical parameters and benign lesions of the uterus and ovaries. Assessment of histopathological changes in 100 specimens of distal fallopian tubes was done using the sectioning and extensive examination of the fimbrial end (SEE-FIM) protocol. H and E stain followed by immunohistochemistry for Bcl-2, p53, and Ki-67. The statistical significance of the difference in the mean values of precursor areas was evaluated by an unpaired t-test. Among 100 specimens taken on H and E, precursor lesions were suspected in 49% of the cases. SCOUT, suspicious for STIC, suspicious for STIC with areas of SCOUT, and unequivocal for STIC with areas of SCOUT were seen in 8%, 4%, 33%, and 4% of the cases, respectively. However, on IHC, SCOUTS were confirmed in 45% of the cases, p53 signature in 2%, STIL in 9%, and STIC in 4% of the cases. Sectioning and extensive examination of the fimbrial end (SEE-FIM) should be routinely done as it provides the opportunity to detect the early malignant changes. It may help in evolving the strategies for early detection, management, and reducing mortality.

A huge appendiceal mucocele

Appendiceal mucoceles occur when there is an abnormal accumulation of mucin causing abnormal distention of the vermiform appendix due to various neoplastic or non-neoplastic causes. The prevalence at appendectomy is 0.2-0.3%. They affect the middle-aged individuals, considering the epidemiology of the mucinous neoplasms. Though carcinoid tumor is the most common primary appendiceal neoplasm in surgical pathology series, mucoceles due to neoplasms are the most common appendiceal tumors detected on imaging. We report the case of a 54-year-old patient with no pathological history, who arrived at the emergency department presenting an appendicular syndrome evolving for a week with fever and vomiting, without transit disorders or urinary signs. Physical examination found tenderness of the right iliac fossa. An ultrasound was performed urgently and showed an appearance of a superinfected appendicular mucocele. The patient was admitted to surgery room 2 hours later. Surgical exploration objectived the presence of a very long appendix measuring 15cmx2cm with an unthickened ceaco appendicular junction. The rest of the peritoneal cavity was unremarkable. Appendicectomy was performed. The anatomopathological examination objectived a ruptured chronic appendicular mucocele low grade mucinous neoplasia (LAMN).

A Clinico-Pathological Study on Cervical Lymphadenopathy

Background: The analysis of lymph node enlargement in the neck is not an easy task. It is a challenge for surgeon to assess its clinical behaviour and come to a final diagnosis. Those diseases which can be neoplastic also demands correct diagnosis for further management. The study intends to find out systematically the various pathological conditions presenting with enlarged lymph nodes in the neck, also the various modes of clinical presentation and behaviour of these conditions. Relevant investigations have also been studied. Methods: The study population consisted of patients above 12 years presenting with cervical lymph node enlargement. The proforma which was drafted is used. Patient was examined systematically giving utmost importance to local examination. After making a clinical diagnosis, further relevant investigations were done to confirm the diagnosis. Treatment was instituted appropriately and patients were followed up. Results: Majority of the cases in this study had non-neoplastic causes for cervical lymphadenopathy in which tuberculosis is most common. Male to female ratio of 1.38:1 is noted with most cases between 20 and 40 years. Posterior triangle group of lymph nodes was most commonly affected in tuberculosis. In lymphomas level 2 group of lymph nodes is most commonly involved. Variable results were noted among the groups of lesions, with regard to local characteristics like number, laterality, mobility and involvement of other group of lymph nodes, etc. FNAC by virtue of it being inexpensive, quick in getting the results and easy to perform, is one of the important and essential diagnostic procedures. Conclusion: Clinical symptoms in cervical lymphadenopathy is of limited significance because clinical behaviour can be highly variable and mostly non-specific. As cervical lymphadenopathy is an important condition, which always calls for meticulous attention, analysis and treatment. FNAC is found to be a frontline investigation of choice with ......

Spectrum of Second Primary Malignancies and Cause-Specific Mortality Among Patients with Hairy Cell Leukemia in the United States: A Population-Based Study

BACKGROUNDHairy cell leukemia (HCL) is a rare lymphoid neoplasm with an incidence of 1,000 new cases per year and accounting for 2% of all leukemias in the United States. There is a lack of data on the spectrum of second primary malignancies (SPMs) and cause-specific mortality in the era of targeted therapies (anti-CD20, anti-CD22, and BRAF-inhibitors). We undertook this study to address the gaps in knowledge using a national registry from the United States. METHODSWe estimated the incidence of SPMs and cause-specific mortality among two-month survivors of hairy cell leukemia (HCL) using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-18 registries. We included patients from 2003-2018 with ICD-O-3 code 9940/3 from the registry. We calculated the risk of SPMs using standardized incidence ratios (SIRs), and cause-specific mortality by standardized mortality ratios (SMRs) and absolute excess risk (AER)/10,000 population. We also reported survival analysis using relative survival rates (RSRs). RSR was calculated as ratio of observed to expected survival compared to the 2000 US standard population and adjusted for age, sex, and race. Overall survival (OS) analysis was reported using Kaplan-Meier (KM) method. RESULTSWe included a total of 4,261 patients with Hairy cell leukemia in this study. The median age at diagnosis was 59 yrs (range 21-85). The median follow-up duration for entire cohort was 68 months (range 0-191 mo). A total of 538 (12.6%) patients developed SPMs at last follow-up, of which 75% were solid organ malignancies, and 25% were hematologic neoplasms. The SPM risk for cohort was significantly elevated (SIR 1.33, 95% confidence interval [CI] 1.22 - 1.45) compared with the general population. The median latency period for SPM development was 3 yrs (range 1-15 yrs). The SPM risk was statistically higher than general population among Whites with HCL (SIR 1.33, 95% CI 1.22 - 1.45), but not significant among Blacks (SIR 1.31, 95% CI 0.76 - 2.09). The SIR was slightly higher in females (SIR 1.39, 95% CI 1.12 - 1.71) when compared to males (SIR 1.32, 95% CI 1.20 - 1.45). The SIR according to age groups were as follows: age < 65 years (SIR 1.36, 95% CI 1.21 - 1.52), age > 65 years (SIR 1.31, 95% CI 1.15 - 1.48). The risk for hematopoietic SPMs was higher (SIR 2.82, 95% CI 2.31 - 3.41) compared with solid organ tumors (SIR 1.16, 95% CI 1.05 - 1.28). Specific SPMs with highest risk included non-epithelial skin cancers (SIR 5.20, 95% CI 2.59 - 9.30), Hodgkin lymphoma (SIR 4.68, 95% CI 1.52 - 10.91), non-Hodgkin lymphoma [NHL] (SIR 3.91, 95% CI 3.04 - 4.95), myeloid and monocytic leukemia (SIR 2.23, 95% CI 1.15 - 3.90), melanoma (SIR 1.60, 95% CI 1.12 - 2.20), and prostate cancer (SIR 1.45, 95% CI 1.21 - 1.72). Although the risk of developing secondary NHL was significantly high throughout the follow-up period, risk for Hodgkin lymphoma was only significant >10 yr of follow-up (SIR 9.71, 95% CI 1.18 - 35). 5-year RSR for the cohort was 94.6%. On KM analysis, the mean OS for entire cohort was 11.8 yr, but the median OS was not reached (Figure 1). At last follow-up, 770 (18%) patients had died, of which 49% were due to malignant neoplasms. There was statistically significant risk of mortality due to all malignant cancers combined (SMR 2.41, 95% CI 2.17 - 2.66), largely due to mortality from leukemia (SMR 32.62, 95% CI 28.41 - 37.25, AER 70.2) and NHL (SMR 5.49, 95% CI 3.78 - 7.71, AER 9.01) (Table 1). Interestingly, risk of mortality from non-neoplastic causes was lower than general population: cardiovascular disease (SMR 0.70, 95% CI 0.58 - 0.83), pulmonary diseases (SMR 0.44, 95% CI 0.26 to 0.70), and infectious diseases (SMR 1.27, 95% CI 0.55 - 2.51). The risk of death from leukemia was highest within first year of diagnosis of HCL and continued to slowly decline thereafter, although remained statistically significantly elevated more than other causes of death (SMR 1yr 112, AER 214; SMR 1-5 yrs 36, AER 72; SMR 5-10 yrs 20, AER 43; SMR >10 yrs 17, AER 43). CONCLUSIONOur study reveals that despite therapeutic advances in HCL, hematologic neoplasms (including leukemia) remain the leading cause of death in last two decades. Additionally, the risk of developing SPMs remains elevated in patients with HCL, and is significantly high in Whites compared with Blacks. Further studies are needed to better define the healthcare needs of HCL patients beyond initial treatment to reduce the burden of mortality from HCL and other SPMs. [Display omitted] DisclosuresNarkhede: Gilead: Research Funding; Genentech/Roche: Research Funding; Genmab: Other: Medical writing support, Research Funding; TG Therapeautics: Research Funding.

Cholecystectomy in 23 cats (2005-2021).

To describe the clinical presentation, treatments, and long-term outcomes following cholecystectomy in cats. Clinical retrospective study. Twenty-three client-owned cats. Medical records of all cats undergoing cholecystectomy between 2005 and 2021 at a single referral hospital were retrospectively reviewed. No cats were excluded. An owner questionnaire assessed long-term outcomes. Vomiting, jaundice, and abdominal pain were the most common clinical signs; median duration of signs was 4 days (range 1-21). Cholelithiasis was the major indication for cholecystectomy followed by cholecystitis. Intraoperative hypotension and postoperative anemia were commonly encountered. Nine cats required a postoperative blood product transfusion. Cardiopulmonary arrest and death occurred in five cats. Eighteen cats (78.3%) survived to discharge. Long-term follow up (>60 days) was available for 16 cats at a median of 1003 days (range 81-4995). Fifteen cats survived over 6 months with eight cats (44.4%) surviving over 3 years. The most common short-term and long-term postoperative complication was vomiting. Owners assessed postoperative outcome as excellent in all cats and quality of life as excellent or good. The most common indication for cholecystectomy was cholelithiasis. Perioperative complications were commonly encountered. Perioperative mortality rate was 21.7%. Long-term owner evaluation of clinical outcome was considered excellent. Cats undergoing cholecystectomy for non-neoplastic causes can have a favorable prognosis for recovery and quality of life. Concurrent extrahepatic biliary duct obstruction is not a contraindication for cholecystectomy provided that patency of the common bile duct is restored.

Horner's syndrome due to Hashimoto's thyroiditis

Horner's syndrome is characterized by ptosis, ipsilateral miosis, anhidrosis and occasionally apparent enophthalmos. Amongst the diverse neoplastic and non-neoplastic causes of acquired Horner's in children, thyroid disease is rare. We present a case in which Horner's syndrome was a consequence of the mass effect from a substantially sized goiter due to Hashimoto's thyroiditis.