Papillary Mass Research Articles

When cervical microglandular hyperplasia coincides with high-risk human papillomavirus infection: Diagnostic challenges and evidence

ABSTRACT Cervical microglandular hyperplasia (MGH) is a benign cervical lesion mimicking cervical malignancy, thereby making its pathogenesis diagnostically challenging for gynecologists and pathologists. While MGH is often associated with physiological or external hormonal factors, several cases remain unexplained. In this report, we present a case of a young primiparous woman without evident hormonal risk factors seeking gynecologic evaluation owing to abnormal vaginal discharge. During her clinical examination, we observed an irregular cervical lesion raising malignancy-related concerns and consequently planned a colposcopy. The human papillomavirus (HPV) polymerase chain reaction tested positive for two high-risk HPV genotypes (16 and 52), denoting that the patient did not have an HPV infection history. During colposcopy, we identified a friable papillary cervical mass at the transformation zone, bleeding significantly with minimal handling, from which we obtained multiple biopsies. Our subsequent histopathological examinations eventually confirmed the MGH diagnosis, ruling out malignancy. Intriguingly, a follow-up colposcopy 7 months later revealed the resolution of the initial cervical lesion, coinciding with negative HPV test and Pap smear cytology results. This case highlights the rare encounter of MGH concurrent with an initial high-risk HPV infection. Beyond a comprehensive review of related literature and clinical guidelines, we discuss the clinical and histopathological results in such a case.

Desmoplastic Fibroma: a benign neoplasm mimicking a malignancy

A four-year-old African male patient presented to our clinic with a two-month history of a fi rm, warm lesion involving the right side of his face. The lesion presented as a bleeding papillary mass in the 85/46 region that extended to the floor of the mouth, causing displacement of the tongue (Figure 1A-B). Upon cone-beam computed tomography (CBCT) examination, an expansile homogenous intermediate density lesion was noted with complete destruction of the bucco-lingual cortical bone. Discernible extensions were identified in the anteroposterior plane from the region of the 84 to the posterior mandible involving the right corpus, developing 46, angle and ramus but spared the condyle and coronoid processes. The lesion extended inferiorly below the epiglottis and showed a reduction of the hypopharynx. Marked bucco-lingual expansion with soft tissue swelling was noted (Figure 2A-D). An incisional biopsy was performed under general anaesthesia, and histological examination rendered a diagnosis of desmoplastic fi broma (DF).

Vascular and Myocardial Structure and Function in Adolescents with Type 1 Diabetes: The CARDEA Study

Introduction. Despite heightened risk of cardiovascular disease (CVD) among individuals with type 1 diabetes, few studies in this population have investigated the development of CVD using early markers in adolescence. We compared risk factors (blood pressure (BP) and dyslipidemia) and early markers of CVD between adolescents with and without type 1 diabetes and explored effect modification by sex. Methods. Cross-sectional study using data from the CARdiovascular Disease risk in pEdiatric type 1 diAbetes (CARDEA) study. We recruited 100 adolescents with type 1 diabetes at the Sainte-Justine University Hospital Center and 97 adolescents without diabetes (14–18 years). We measured arterial stiffness by carotid-femoral pulse wave velocity, endothelial function by brachial artery flow-mediated dilation test, as well as left ventricular (LV) mass, papillary mass, and wall thickness by cardiac MRI. We used multivariable linear regression models to assess the impact of type 1 diabetes on each outcome adjusting for age, sex, ethnicity, adiposity, and familial income. Results. Adolescents with type 1 diabetes had 0.21 standard deviations (SD) (95% CI: 0.04; 0.38) higher diastolic blood pressure z-score (zDBP), 0.21 mmol/L (95% CI: 0.02; 0.40) higher low-density lipoprotein cholesterol (LDL-c) levels, and 17% (95% CI: 4; 29) higher triglyceride levels and lower endothelial function based on acceleration (−77.4 cm/s2, 95% CI: −133.1; −21.6) compared with adolescents without diabetes. Girls with type 1 diabetes had higher systolic blood pressure z-score (zSBP), and boys with type 1 diabetes had lower LV mass and wall thickness compared to healthy peers. Conclusions. In addition to higher BP and abnormal lipid profiles, adolescents with type 1 diabetes present endothelial dysfunction and alterations in cardiac structure (in boys) compared to adolescents without diabetes, suggesting that CVD prevention should be incorporated into type 1 diabetes management early in the disease.

Different methods, different results? Threshold-based versus conventional contouring techniques in clinical practice

BackgroundThe quantitative differences of left and right ventricular (LV, RV) parameters of using different cardiac MRI (CMR) post-processing techniques and their clinical impact are less studied. We aimed to assess the differences and their clinical impact between the conventional contouring (CC) and the threshold-based (TB) methods using 70% and 50% thresholds in different hypertrabeculated conditions. MethodsThis retrospective study included 30 dilated cardiomyopathy, 30 left ventricular non-compaction (LVNC), 30 arrhythmogenic cardiomyopathy patients, 30 healthy athletes and 30 healthy volunteers. All participants underwent CMR imaging on 1.5 T. Cine sequences were used to derive measures of the cardiac volumes, function, total muscle mass (TMi) and trabeculae and papillary muscle mass (TPMi) using CC and TB segmentation methods. ResultsComparing the CC and the 70% and 50% threshold TB methods, the LV and RV volumes were significantly lower, the ejection fraction (EF) and the TMi were significantly higher with the TB methods. Between the two threshold setups, only TPMi was significantly higher with the 70% threshold. Regarding the clinical benefits, the LVNC was the only group in whom all the diagnostic and therapeutic decisions and risk stratification were influenced using the TB method. Diagnostic changes occurred in three-quarters of the population, and all the cardiomyopathy groups were affected regarding the decision-making about pharmaco- and device therapy. ConclusionsUsing the TB method, only TPMi was significantly higher with the 70% threshold than the 50% setup, and both of them differed significantly from the CC technique, with relevant clinical impacts in all patient groups.

Abstract P134: Dietary Intake and Vascular Function and Myocardial Structure in Canadian Youth With and Without Type 1 Diabetes: The Cardea Study

Introduction: People living with T1D are disproportionally more affected by CVD than the general population. As emerging evidence points to direct effects of diet on vascular function and cardiac structure, dietary interventions may be effective strategies to mitigate CVD risk early on. Hypothesis: We tested the hypothesis that specific dietary components and diet quality are associated with early markers of vascular and cardiac structure and function in youth with T1D. We compared these to associations in healthy controls. Methods: Cross-sectional study of 100 youth with T1D aged 14-18 yrs recruited at the Diabetes Clinic at Sainte-Justine Hospital University Center (Montreal, Canada) and 97 age and sex-matched healthy controls. Pulse-wave velocity (PWV) estimated arterial stiffness; velocity time integral (VTI) and acceleration during a flow-mediated dilation test assessed endothelial function. We measured left ventricular mass/height (LVMH), papillary mass, and wall thickness with cardiac MRI. Diet was measured with 3 x 24-h dietary recalls. Nutrients and foods were analyzed with the CANDAT software based on the Canadian Nutrient File. We assessed daily consumption of fruits, vegetables, fish, red meat, sugar-sweetened beverages and juices (SBJs), and sweets and chips. Food groups were all adjusted for total energy intake. We used the Diet Quality Index-International (DQI-I) to assess overall diet quality. We estimated linear regression models for each diet variable/outcome combination separately in youth with T1D and healthy controls adjusting for age, sex, ethnicity, parental education, physical activity and sedentary time (by accelerometer), and heart rate. Results: Girls comprised 48% of the sample; the mean age was 16.3 yrs (SD=1.3). The T1D group included more youth having overweight or obesity (43% vs. 20%), and was more ethnically diverse (White: 60% vs. 72%), compared to controls. Average glycated hemoglobin was 8.5% (SD=1.4) and median diabetes duration 6 yrs (IQR=3-10) in youth with T1D. In youth with T1D : Consuming more fruits was associated with lower PWV (beta [95% CI] per serving: -0.21 [-0.40; -0.02] m/s). Greater SBJ intake was paradoxically associated with higher VTI (per % total energy intake: 0.34 [0.04; 0.65] cm). DQI-I was related to a higher LVMH (per unit: 0.5 [0.1; 0.9] g/m). In controls : Eating more fruit was associated with a greater LVMH (per serving: 2.5 [0.1; 4.7] g/m). Higher SBJ intake was associated with a lower wall thickness (per % total energy intake: -0.10 [-0.20; -0.01] mm). Conclusions: Findings suggest that consuming more fruit could prevent arterial stiffening in youth with T1D. We previously reported that youth with T1D had lower LVMH than controls, and findings herein suggest that better diet quality could help compensate for this deficit. Overall, our results provide evidence on diet as a potential strategy to lower CVD risk in youth with T1D.

Intraductal oncocytic papillary neoplasm arising in Peutz-Jeghers Syndrome bile duct: a unique case report

BackgroundPeutz-Jeghers syndrome (PJS) is a rare, autosomal dominant disorder caused by germline mutations of STK11/LKB1, with an increased risk of tumors at multiple sites. Intraductal oncocytic papillary neoplasm (IOPN) is a unique subtype of intraductal papillary neoplasm of the bile duct (IPNB) defined by a premalignant neoplasm with intraductal papillary or villous growth of biliary-type epithelium. IOPN has a distinct mutation profile compared with both IPNB and intraductal papillary mucinous neoplasm (IPMN).Case presentationWe herein describe the case of a 44-year-old woman who presented as polyps in the intestinal lumen of sigmoid colon and a 3.1 × 2.1 cm mass in the left lobe of liver. Gross feature revealed a cystic papillary mass and the neoplasm had a clear boundary with the surrounding liver tissue. Histology revealed complex papillary structures, a small amount of fine fibrovascular cores and immunohistochemistry showed extensive positive for MUC5AC, MUC6, CD117. Therefore, histological and immunohistochemical examination of the liver tumor suggested the diagnosis of IOPN. Next-generation sequencing (NGS) revealed other than STK11 germline mutation, the tumor also harbors GNAS somatic mutation at codon 478 and EGFR amplification.ConclusionTo our knowledge, this is the first report of IOPN arising in PJS. This case enlarges the spectrum of PJS related tumors and genetic rearrangements in IOPN.

A Blinding Glioma

A 12-year-old girl presented with no light perception in the right eye. Ultrawide-field retinal imaging (Fig A) revealed a grayish papillary mass expanding into the vitreous cavity, ghost retinal vessels, and deep retinal hemorrhages. Brain magnetic resonance imaging showed a left-sided parieto-occipital tumor crossing the midline (Fig B, arrows) with an enlarged right optic nerve (arrowhead). Pathologic examination found highly cellular glial and microvascular proliferation, palisading necrosis, numerous mitoses (Fig C, arrow) (Hemalun Phloxin Saffron staining, left), and diffuse expression of the mutation H3F3A G34R (right).

S1714 Diagnosis and Management of Intraductal Papillary Neoplasm of the Bile Duct via Endoscopic Ultrasound Evaluation

Introduction: Intrampullary papillary neoplasm (IAPN) is a rare tumor seen in women in their 60s, with an incidence of 0.025 per 100,000. The 5-year survival rate is 33%. It is distinct from an ampullary adenoma, which arises from the duodenal mucosa overlying the ampulla. It is unlikely to be cured by ampullectomy. Case Description/Methods: A 63-year-old woman with prior cholecystectomy was found to have abnormal liver tests (AST 104, AST 233, alkaline phosphatase 290) and mild hyperbilirubinemia (total bilirubin 1.7). Abdominal ultrasound showed diffuse biliary dilatation without obvious stones or stricture. MRCP showed multiple filling defects in the distal common bile duct (CBD). ERCP revealed a prominent ampulla. Digital cholangioscopy done for further investigation showed an exophytic papillary tumor in the distal CBD (Figure) along with excess luminal mucous (Figure). The endoscopic and cholangioscopic findings of a papillary intraluminal mass and mucobilia was suggestive of intraductal papillary neoplasm of the bile duct (IPNB). A 69-year-old woman with a complicated biliary history was seen by her PCP for jaundice and R shoulder pain and was found to have cholelithiasis and choledocholithiasis. She underwent laparoscopic cholecystectomy after MRI showed CBD stones. An ampullary prominence of 1 cm was concerning for an invasive carcinoma. ERCP showed multifocal frond like papillary projections at the left hilum and distal CBD and copious thick mucin through the examined extrahepatic duct and hilum; concerning for IPNB with progression to cholangiocarcinoma. Both patients underwent surgical evaluation. Discussion: IAPN is a rare tumor with poor prognosis. It is unclear if it is a variant of IPNB that also includes the ampulla or if it primarily arises within the ampullary channel and spreads proximally into the bile duct and the pancreatic duct. Diagnosis is established by cholangioscopy with biopsies. Endoscopic ultrasound of the ampulla and pancreas is essential. Cholangioscopy should be undertaken for tumor mapping. Pancreaticoduodenectomy should be treatment of choice for IAPN or IAPN with adenocarcinoma without distant metastases in order to achieve tumor free margins, as seen via pathology tissue. IAPN should be suspected based on endoscopic ampullary features such as a prominent ampulla, prolapse of papillary fronds on sphincterotomy, lack of resolution of cholestasis despite duct clearance. Cholangioscopy should be undertaken establish an early diagnosis.Figure 1.: Photo 1 (top): exophytic papillary tumor in the distal common bile duct; Photo 2 (bottom): excess luminal mucous in common bile duct.

Papillary Cholangiocarcinoma Located in the Distal Common Bile Duct

Papillary tumors are the rarest form of cholangiocarcinoma, usually present as intraductal masses in the common bile duct (CBD), which cause obstructive jaundice early in the course of the disease. A 66-year-old female had jaundice for one month. Abdominal ultrasonography revealed a 2-cm-sized hypoechoic mass located in the distal CBD with upstream biliary tree dilatation. Computed tomography and magnetic resonance imaging suggested the possibility of extrahepatic cholangiocarcinoma. We performed endoscopic retrograde cholangiopancreatography with intraductal ultrasonography, revealing a papillary mass without definitive bile duct invasion located in the distal CBD. The patient underwent successful surgery and was diagnosed with stage T1N0M0 papillary adenocarcinoma. The patient is currently, one year after the surgery, under follow-up without recurrence.

Cardiac myxomas: A narrative review

Cardiac myxomas are common primary neoplasms of the heart. They are biologically benign but “functionally malignant” because of the potential for embolization. They arise most commonly from the left atrium, but no chambers of the heart are immune. They may be sporadic in the majority but also familial as a part of the Carney complex. Two morphological forms exist: polypoid and papillary. Polypoid myxomas often present with obstructive features, while the papillary forms are more prone to embolization. Histogenesis is still controversial; the current view centres around origin from the primitive pluripotent mesenchymal cells. They may be of giant proportion, be calcified or get infected. Clinical presentation typically involves the triad of intracardiac obstruction, embolic events and constitutional symptoms. Precordial examination findings may simulate those of mitral or tricuspid stenosis. The presence of tumour plop and change of the physical findings with changing position may help differentiation between the two. Echocardiography is the investigation of choice. Echogenic polypoid or papillary mobile mass within the atrial cavity remaining attached to the interatrial septum through a stalk are the tell-tale echocardiographic features. Cardiac magnetic resonance and computed tomographic scanning may have incremental diagnostic value. Histopathological examination reveals abundant loose myxoid stroma with scattered round, polygonal or stellate cells with dense irregular nuclei. Genetic testing may detect mutations in the PRKAR1A gene in the familial form of cardiac myxoma, i.e. the Carney complex. Surgical excision is the mainstay of treatment with low operative mortality, excellent postoperative survival and low recurrence rate. The current trend favours minimal-access surgery with or without robotic assistance. Physicians should have appropriate preparedness to make a timely diagnosis and enthusiastic treatment to avoid potentially fatal complications.

MR -specific characteristics of left ventricular noncompaction and dilated cardiomyopathy

BackgroundThe differentiation of dilated cardiomyopathy (DCM) and left ventricular noncompaction (LVNC) is a recurring issue during cardiac imaging processes; thus, we aimed to compare the left ventricular (LV) cardiac MRI characteristics of these patients. MethodsThirty-one nonischemic DCM patients, 42 LVNC patients with reduced ejection fraction and 42 healthy controls were included in this retrospective study. LV volumetric, functional and myocardial mass parameters were measured with a threshold-based technique, while global and segmental strain values and rotational patterns were analyzed with feature-tracking strain analysis. ResultsOf the LV volumetric and myocardial mass parameters, only the trabeculated and papillary muscle mass (TPMi) values differed significantly between the patient groups and were higher in the LVNC group (DCM vs LVNC: 43.2 ± 8.9 vs 51.6 ± 13.6 g/m2, p < 0.002). The global longitudinal and circumferential strains were similar between the patient groups and significantly worse than those of the controls. In comparing the segmental strains between the patient groups, only the circumferential apical strain was significantly lower in the LVNC group (DCM vs LVNC: −30.5 ± 13.5 vs −24.5 ± 12.0%, p < 0.05). There was no difference in the rotational pattern between the patient groups, and both healthy and patient populations showed heterogeneous rotational patterns. ConclusionsDespite the similarities between DCM and LVNC in volumetric, global strain parameters, and rotational patterns, we found some differences between the patient groups, as the TPMi was higher and the apical circumferential strains were significantly lower in LVNC. These minor alterations might be due to the morphological characteristics of LVNC with a trabeculated apical region.

Sex- and age- specific normal values with threshold-based trabeculae quantification

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ÚNKP-19-3-II New National Excellence Program of the Ministry for Innovation and Technology National Research, Development and Innovation Office of Hungary (NKFIA; NVKP_16-1-2016-0017 National Heart Program) Thematic Excellence Program (Tématerületi Kiválósági Program 2020-4.1.1-TKP2020) The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method. Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18-29, Group B: 30-39, Group C: 40-49, Group D: &amp;gt;50 years). The calculated parameters were indexed to body surface area (i). The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age. Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.

A Case of Incidental Detection of Asymptomatic Bladder Cancer by Transvaginal Ultrasound

We report a case of an incidental diagnosis of early asymptomatic bladder cancer using transvaginal ultrasonography. The patient was a 68-year-old female without urinary symptoms. Transvaginal ultrasonography revealed a 2-cm papillary mass in the bladder mucosa. Urine cytology revealed the presence of atypical cells indicative of malignancy. Cystoscopy revealed a stalked papillary tumor at the apex of the posterior wall of the bladder. Transurethral resection of the bladder tumor was performed, and a 2-cm papillary tumor was resected. A pathological diagnosis of non-muscle-invasive bladder cancer was made.

Abstract 10371: Trajectories of Glycemic Control and Early Markers of Cardiovascular Disease in Canadian Adolescents with Type 1 Diabetes: The Cardea Study

Introduction: Adequate glycemic control can prevent or delay complications of diabetes. Little is known about the role of glycemic control trajectories on early markers of CVD in youth. Hypothesis: Poor glycemic control trajectory will be associated with increased vascular ageing and altered myocardial structure. Methods: Cross-sectional study of 100 youth with T1D recruited at Sainte-Justine Hospital, Canada. Trajectories of glycated hemoglobin (Hb A1c ) were estimated with group-based trajectory modelling, using 3 to 6 values retrieved from patients’ medical records over the preceding year. Vessel stiffness was assessed by pulse-wave velocity (PWV) and distensibility by velocity time integral (VTI) and acceleration during a brachial flow-mediated dilation test. Cardiac magnetic resonance assessed ejection fraction, left ventricular mass indexed by height (LVMH), papillary mass and wall thickness. Linear regression models were estimated between Hb A1c trajectory group and each CVD marker, with age, sex, ethnicity and duration of diabetes at baseline as covariates. Results: Mean age was 16.4 yrs (SD=1.3) and median diabetes duration 6.1 yrs (IQR=3.4-10.4). Forty-eight percent were girls, 63% were White and 43% had overweight/obesity. Three trajectories of Hb A1c were identified ( Figure ). Compared with the optimal trajectory, belonging to the high Hb A1c trajectory was associated with a lower ejection fraction (beta [95% CI]: -2.1% [-6.2; 2.0]), LVMH (-6.3 g/m [-15.4; 2.8]) and papillary mass (-1.2 g [-2.2; -0.2]). Youth in the high Hb A1c trajectory displayed higher PWV (0.2 m/s [-0.4; 0.8]) and lower VTI (-2.9 cm/s 2 [-8.4; 2.7]) and acceleration (-63.6 cm/s 2 [-188.7; 61.5]) compared with the optimal trajectory group. Conclusions: Poor glycemic control is linked to increased vascular ageing and a lower myocardial mass in youth with T1D, which is consistent with our prior finding that youth with T1D exhibit a lower myocardial mass than healthy controls.

Sex- and age- specific normal values of left ventricular functional and myocardial mass parameters using threshold-based trabeculae quantification.

The threshold-based (TB) trabeculated and papillary muscle mass (TPM) quantification method for cardiac MRI (CMR) calculates different values than conventional contouring techniques. We aimed to identify the sex- and age-related normal reference ranges for left ventricular (LV) myocardial mass values, volumetric and functional parameters and the correspondence of these parameters using the TB method. Healthy European adults (n = 200, age: 39.4 ± 12 years, males: 100) were examined with CMR and evaluated with a TB postprocessing method. They were stratified by sex and age (Group A: 18-29, Group B: 30-39, Group C: 40-49, Group D: >50 years). The calculated parameters were indexed to body surface area (i). The normal reference ranges for the studied parameters were assessed in each age group. Significant biometric differences in LV parameters and mass-to-volume ratios were found between males and females, and the left ventricular compacted myocardial mass (LVCMi) and TPMi differences remained significant after stratification by age. Unlike other LV volumetric and functional parameters and mass-to-volume ratios, the TPMi, the LVCMi and the TPMi-to-LVCMi ratio did not differ among age groups in males or females. This finding was strengthened by the lack of correlation between TPMi and age. Age- and sex-related normal reference ranges for LV volumetric and functional parameters and LVCMi and TPMi values were established using a TB postprocessing method. TPMi, LVCMi and their ratio did not change over time. The TPMi-to-LVCMi and the mass-to-volume ratios might have clinical utility in the differential diagnosis of conditions with LV hypertrabeculation.

S1 Machine Learning for Classification of Indeterminate Biliary Strictures During Cholangioscopy

Introduction: Indeterminate biliary strictures remain a diagnostic challenge despite advancements in radiologic, endoscopic, and laboratory testing. More than 25% of patients presumed to have malignant strictures during cholangioscopy show benign pathology after major surgical intervention. Interpretation of the visual findings during cholangioscopy remains challenging even for experienced endoscopists. We therefore aimed to develop a software tool that classifies indeterminate biliary strictures as benign or malignant using both cholangioscopy images and clinical data. Methods: Our dataset included cholangioscopy images and clinical data from a retrospective cohort of patients undergoing cholangioscopy for evaluation of indeterminate biliary strictures. We annotated images for abnormal features suggestive of malignancy, including papillary mass, dilated and tortuous vessels and ulceration. We trained a convolutional neural network (CNN) based on ResNet-18 to detect presence of abnormal image features and tested it in patients of independent centers (external validation). We used multiple outputation to analyze the patient as the unit of analysis and estimated accuracy, sensitivity, specificity, positive and negative predictive values (PPV and NPV), and area under the receiver operating characteristic curve (AUC). Results: A total of 1,371,605 cholangioscopy images were obtained from 528 patients at 25 centers (13 North America, 7 Asia, 2 Europe, 2 Australia, 1 South America). Our training set included data from 254 patients at 14 centers, and the test set included data from 95 patients at 8 other independent centers. Table 1 shows the proportion of patients with abnormal cholangioscopy image features according to their final diagnosis. For detection of abnormal image features, the CNN showed a sensitivity of 0.81 (95% confidence interval: 0.72 to 0.91); specificity 0.91 (0.86 to 0.97); PPV 0.93 (0.88 to 0.98); NPV 0.77 (0.66 to 0.88); and AUC 0.86 (0.80 to 0.92). Conclusion: Using data from a large cohort of patients across the world, we trained and externally validated a CNN that can detect key cholangioscopy image features suggestive of malignancy and thus support intra-procedural decision-making. Our next step is to enhance the CNN with clinical data and evaluate it for diagnosing and predicting malignancy in indeterminate biliary strictures. This can improve clinical outcomes through accurate diagnosis of disease and prevention of unwarranted surgical intervention.Table 1.: Proportion of patients with cholangioscopy images showing abnormal features (suggestive of malignancy) according to their final diagnosis.

Breast Imaging Reporting and Data System Classification for Central-Type Intra-Ductal Papillary Masses: Current Problems and Evaluation of Modified Parameters

The Breast Imaging Reporting and Data System (BI-RADS) standards have limitations regarding classifying and managing central intra-ductal papillary masses. Changes to the standards are necessary to provide early and effective treatment. To summarize the ultrasonographic imaging features of central mammary ductal papillary masses, this retrospective study included 56 participants. In identifying benign versus malignant lesions, the most significant indicators were angular edges and the long diameter of the tumor parallel to the duct. In the comparison of diagnostic efficacy for central mammary ductal tumors, the post-operative pathologic malignant upgrade rate of BI-RADS was 33.3%, and that of the new standard criteria was 14.2%. The angle of the wall of the tumor relative to the duct was most helpful. When BI-RADS is used to evaluate a papillary mass in a central duct, it is more accurate when the tumor is parallel to the duct than parallel to the skin.

Cutaneous papilloma and multicentric squamous cell carcinoma in four-toed hedgehogs (Atelerix albiventris).

Skin lesions possibly caused by Papillomavirus infections in two four-toed hedgehogs are described. In case 1, there was a papillary mass on the right hind limb. Histologically, the mass was consistent with a viral papilloma. In the other case, multifocal papillary masses with erosions and ulcers were found throughout the body, mainly on the extremities. Histology showed continuative lesions composed of acanthosis, Bowenoid in situ carcinoma, and squamous cell carcinoma, with abrupt transitions between the lesions. In both cases, keratinocytes in the granular layer infrequently had features of koilocytes and intranuclear inclusion bodies, and immunohistochemical staining was positive for anti-human papillomavirus antibody. To the best of the authors’ knowledge, this is the first pathological documentation of possibly papillomavirus-associated skin lesions in four-toed hedgehogs.

Common bile duct lesions - how cholangioscopy helps rule out intraductal papillary neoplasms of the bile duct: A case report

BACKGROUNDIntraductal papillary neoplasm of the bile duct (IPNB) is a rare variant of bile duct tumors, characterized by an exophytic growth exhibiting a papillary mass within the bile duct lumen and it can be localized anywhere along the biliary tree, with morphological variations and occasional invasion.CASE SUMMARYWe present a patient with obstructive jaundice who was diagnosed with IPNB using cholangioscopy during endoscopic retrograde cholangio-pancreatography. Using the SpyGlass DS II technology, we were able to define tumor extension and obtain targeted Spy-byte biopsies. After multidisciplinary evaluation, the patient was scheduled for surgical resection of the tumor, which was radically removed.CONCLUSIONCholangioscopy appears to be crucial for the rapid and clear diagnosis of lesions in the bile duct to achieve radical surgical resection.

A comparison of outcomes in patients with intracholecystic papillary neoplasms or conventional adenocarcinomas of the gallbladder

BackgroundIntracholecystic papillary neoplasm (ICPN) of the gallbladder (GB) is an exophytic intraepithelial neoplasm. This study aimed to investigate clinicopathologic findings, prognosis and recurrence patterns of patients with ICPN as compared to those patients with conventional adenocarcinoma of the gallbladder (GBC). MethodsPatients who underwent surgical resection for suspected GB cancer between 2000 and 2018 were included. ICPN was defined as an exophytic papillary mass within the GB lumen with a size ≥1.0 cm. ResultsOf 607 patients, 241 patients (40%) were pathologically diagnosed with ICPN. Of the 241 patients with ICPNs, 110 (46%) were T1 or less. Following T stage-matched analysis, the rate of lymph node metastases were comparable (50 [52%] vs. 37 [49%], P = 0.581). The five-year survival rate was higher in ICPN, but after T stage-matching, they were comparable (69.1 vs. 63.2%, P = 0.171). Overall recurrence rates were also comparable, with the exception of lower peritoneal seeding in patients with ICPN. ConclusionPatients with ICPN who underwent resection were more likely to have an earlier T stage. There was no significant difference in prognosis and recurrence between ICPN and conventional GBC after stage matching. Therefore, the treatment strategy for ICPN should follow the same protocols used for conventional GBC.