Postoperative Histopathological Examination Research Articles

Primary renal synovial sarcomas diagnosed by a novel fusion gene with the fusion site involving exons of SS18 and SSX2: a case report

Abstract Objectives Primary renal synovial sarcoma (PRSS) is an uncommon malignancy with diagnostic challenges and poor prognosis. Research on PRSS is limited, primarily based on case reports, leading to a lack of widely recognized effective treatment options. This article reports a case of primary renal synovial sarcoma diagnosed using a novel fusion gene with a fusion site involving the SS18 and SSX2 exons. Case presentation A 34-year-old male, presented with intermittent right upper abdominal pain. Abdominal CT revealed an isolated mass in the upper pole of the right kidney, which was initially diagnosed as renal cell carcinoma. The patient underwent radical right nephrectomy, and postoperative histopathological examination confirmed the diagnosis of synovial sarcoma, and immunohistochemistry supported the diagnosis. Further detection through RT-PCR and DNA sequencing confirmed the presence of the SS18-SSX2 fusion gene. Despite the recommendation for adjuvant therapy, the patient refused chemotherapy and other treatments and succumbed to systemic metastasis. Conclusions This case highlights the diagnostic challenges and aggressive nature of PRSS. The novel fusion gene with the fusion sites SS18: exon9 and SSX2: exon5 has important implications for the diagnosis of primary synovial sarcoma of the kidney. Further research is warranted to explore novel therapeutic strategies and improve patient outcomes in PRSS.

Surgical resection of double advanced pancreatic neuroendocrine tumors with multiple renal cell carcinoma associated with von Hippel-Lindau disease.

Von Hippel-Lindau (VHL) disease, an autosomal dominant genetic disorder caused by a germline mutation, is associated with non-functional and slow-growing pancreatic neuroendocrine tumor (PNET) and kidney cancer. We describe the case of a 46year-old man with a 35mm mass in the pancreatic head causing stricture of the bile duct and main pancreatic duct, a 55mm mass in the pancreatic tail causing obstruction of the splenic vein (SV), and multiple masses of > 36mm on both kidneys. We performed a two-stage resection. First, a total pancreatectomy with superior mesenteric vein (SMV) resection and reconstruction and retroperitoneoscopic right partial nephrectomy (NP) for five lesions was performed, followed by retroperitoneoscopic left partial NP of the five lesions 6months later. Postoperative histopathological examination revealed NET G2 in the pancreatic head with SMV invasion and somatostatin receptor type 2A (SSTR2A) positivity, NET G2 in the pancreatic tail showed SV invasion and negative SSTR2A, and multiple clear cell renal cell carcinomas (RCC) were also noted. Multiple liver recurrences occurred 22months after primary surgery. The patient remains alive 41months after primary surgery. Kidney cancer generally determines VHL prognosis; however, we experienced dual-advanced PNETs with a more defined prognosis than multiple RCC associated with VHL.

A Rare Case of Struma Ovarii in Afghanistan

Introduction: Struma ovarii is a rare ovarian tumor characterized by containing either entirely or predominantly thyroid tissue (> 50%). It accounts for less than 1% of all ovarian tumors and approximately 3% of ovarian teratomas. The condition was first described by Von Klden in 1895. Case Presentation: In this report, we described a 50-year-old Afghan menopausal woman who referred to our hospital with a 5-month history of weight loss, anorexia, hyperthyroidism, abdominal distension and sinus tachycardia. Abdominal radiological findings revealed left adnexal large multilocular cystic lesion and the patient’s CA-125 serum level was high. Preoperatively, the clinicians suggested a diagnosis of ovarian cancer based on the symptoms, radiological findings and high level of CA-125 serum. However, postoperatively, histopathological examination revealed the lesion to be a benign struma ovarii. Conclusions: Association of struma ovarii with CA-125 and hyperthyroidism is an extremely rare case and are usually misdiagnosed preoperatively due to nonspecific clinical manifestations, and indistinguishable imaging studies, and should be kept in the differential diagnosis of all ovarian cystic lesions. An exact diagnosis is only made by postoperative histopathological examination, and complete surgical resection of the lesion is considered the optimal treatment.

Serum Metabolites as Diagnostic Biomarkers in Patients with Endometriosis.

Endometriosis diagnosis is usually delayed. The gold standard for diagnosing endometriosis is laparoscopy, which is invasive and accompanied by several risks. Currently, there are no effective non-invasive biomarkers for diagnosing endometriosis. Here, we investigated whether metabolites whose levels are altered in patients with endometriosis hold potential as diagnostic biomarkers for the disease. This case-control study involved 32 patients with endometriosis and 29 patients with other benign gynecological disease. The diagnosis of all patients was confirmed through postoperative histopathological examination, and the patients were divided into two groups: an endometriosis group (EM) and a control group. Fasting blood was collected and used for non-targeted metabolomic-based detection. The data were processed through principal component analysis, orthogonal partial least squares discriminant analysis, and significance analysis of microarrays. A univariate receiver operating characteristic curve was used to evaluate the diagnostic value of the metabolites. The metabolite profiles of patients with endometriosis were markedly different compared with those of the controls. In addition, several metabolic pathways, including biosynthesis of unsaturated fatty acids, arginine biosynthesis, and glutathione metabolism, were altered. Ornithine and medorinone showed better potential as biomarkers for endometriosis diagnosis than CA125. We analyzed the altered metabolic profiles in patients with endometriosis and found ornithine and medorinone as potential non-invasive biomarkers for endometriosis diagnosis, whereas the combined ornithine-medorinone diagnosis is more valuable. These findings may help advance research on non-invasive diagnostic biomarkers for endometriosis. Further research with an improved study design and a larger cohort should be performed to confirm the diagnostic potential and clinical application of these biomarkers.

Evaluation of the neoadjuvant chemotherapy response in osteosarcoma using the MRI DWI-based machine learning radiomics nomogram.

To evaluate the value of a nomogram combined MRI Diffusion Weighted Imaging (DWI) and clinical features to predict the treatment response of Neoadjuvant Chemotherapy (NAC) in patients with osteosarcoma. A retrospective analysis was conducted on 209 osteosarcoma patients admitted into two bone cancer treatment centers (133 males, 76females; mean age 16.31 ± 11.42 years) from January 2016 to January 2022. Patients were classified as pathological good responders (pGRs) if postoperative histopathological examination revealed ≥90% tumor necrosis, and non-pGRs if <90%. Their clinical features were subjected to univariate and multivariate analysis, and features with statistically significance were utilized to construct a clinical signature using machine learning algorithms. Apparent diffusion coefficient (ADC) values pre-NAC (ADC 0) and post two chemotherapy cycles (ADC 1) were recorded. Regions of interest (ROIs) were delineated from pre-treatment DWI images (b=1000 s/mm²) for radiomic features extraction. Variance thresholding, SelectKBest, and LASSO regression were used to select features with strong relevance, and three machine learning models (Logistic Regression, RandomForest and XGBoost) were used to construct radiomics signatures for predicting treatment response. Finally, the clinical and radiomics signatures were integrated to establish a comprehensive nomogram model. Predictive performance was assessed using ROC curve analysis, with model clinical utility appraised through AUC and decision curve analysis (DCA). Of the 209patients, 51 (24.4%) were pGRs, while 158 (75.6%) were non-pGRs. No significant ADC1 difference was observed between groups (P>0.05), but pGRs had a higher ADC 0 (P<0.01). ROC analysis indicated an AUC of 0.681 (95% CI: 0.482-0.862) for ADC 0 at the threshold of ≥1.37×10-3 mm²/s, achieving 74.7% sensitivity and 75.7% specificity. The clinical and radiomics models reached AUCs of 0.669 (95% CI: 0.401-0.826) and 0.768 (95% CI: 0.681-0.922) respectively in the test set. The combined nomogram displayed superior discrimination with an AUC of 0.848 (95% CI: 0.668-0.951) and 75.8% accuracy. The DCA suggested the clinical utility of the nomogram. The nomogram based on combined radiomics and clinical features outperformed standalone clinical or radiomics model, offering enhanced accuracy in evaluating NAC response in osteosarcoma. It held significant promise for clinical applications.

Convolutional neural network-based magnetic resonance image differentiation of filum terminale ependymomas from schwannomas

PurposePreoperative diagnosis of filum terminale ependymomas (FTEs) versus schwannomas is difficult but essential for surgical planning and prognostic assessment. With the advancement of deep-learning approaches based on convolutional neural networks (CNNs), the aim of this study was to determine whether CNN-based interpretation of magnetic resonance (MR) images of these two tumours could be achieved.MethodsContrast-enhanced MRI data from 50 patients with primary FTE and 50 schwannomas in the lumbosacral spinal canal were retrospectively collected and used as training and internal validation datasets. The diagnostic accuracy of MRI was determined by consistency with postoperative histopathological examination. T1-weighted (T1-WI), T2-weighted (T2-WI) and contrast-enhanced T1-weighted (CE-T1) MR images of the sagittal plane containing the tumour mass were selected for analysis. For each sequence, patient MRI data were randomly allocated to 5 groups that further underwent fivefold cross-validation to evaluate the diagnostic efficacy of the CNN models. An additional 34 pairs of cases were used as an external test dataset to validate the CNN classifiers.ResultsAfter comparing multiple backbone CNN models, we developed a diagnostic system using Inception-v3. In the external test dataset, the per-examination combined sensitivities were 0.78 (0.71–0.84, 95% CI) based on T1-weighted images, 0.79 (0.72–0.84, 95% CI) for T2-weighted images, 0.88 (0.83–0.92, 95% CI) for CE-T1 images, and 0.88 (0.83–0.92, 95% CI) for all weighted images. The combined specificities were 0.72 based on T1-WI (0.66–0.78, 95% CI), 0.84 (0.78–0.89, 95% CI) based on T2-WI, 0.74 (0.67–0.80, 95% CI) for CE-T1, and 0.81 (0.76–0.86, 95% CI) for all weighted images. After all three MRI modalities were merged, the receiver operating characteristic (ROC) curve was calculated, and the area under the curve (AUC) was 0.93, with an accuracy of 0.87.ConclusionsCNN based MRI analysis has the potential to accurately differentiate ependymomas from schwannomas in the lumbar segment.

Ectopic epipericardial fat necrosis: a case report

BackgroundEpipericardial fat necrosis (EFN) is a rare disease in which local inflammation and necrosis occur in the adipose tissue surrounding the heart, particularly epicardial fat. Few cases of EFN in which surgical resection was performed have been reported. We report a case of EFN after surgical resection of a right extrapulmonary tumor, in which a malignant disease could not be excluded.Case presentationA 75-year-old male patient presented with fever and chest pain. A contrast-enhanced computed tomography scan of the chest revealed a lesion, 53 × 48 mm in size, with mixed fatty density spanning the middle and lower lobes of the right lung. Thoracic magnetic resonance imaging (MRI) revealed a mass with mixed fat and soft tissue density in the same area; the lesion was contiguous with pericardial fatty tissue. The tumor was diagnosed as a liposarcoma or teratocarcinoma based on imaging results; however, the possibility of lung cancer could not be excluded. Finally, EFN was diagnosed based on the postoperative histopathological examination. The patient underwent surgical resection of the suspected right extrapulmonary tumor. The intraoperative findings revealed a mediastinal mass contiguous with pericardial fat located between the middle and lower lobes. Intraoperative pathological examination of the lesion was performed using a needle biopsy; however, no definitive diagnosis was made. The tumor may have invaded the middle lobe of the right lung, and partial resection of the right lower lobe was performed in addition to resection of the middle lobe of the right lung. The patient was followed up every 3 months without adjuvant therapy. No recurrence was reported at 1 year after surgery.ConclusionEFN should be considered in the differential diagnosis of an extrapulmonary tumor when continuity with the pericardial space is observed on MRI or other imaging studies. Surgical resection is useful in the diagnosis and treatment of EFNs. Preoperative three-dimensional reconstructive imaging and MRI should be used to identify vascular structures and confirm the continuity of the lesion with the surrounding tissues to ensure safe and rapid tumor removal.

Stratified application of gene expression in diagnosis of thyroid nodules

Objective: To investigate the value of BRAF V600E and multigene detection and stratified application for the diagnosis of thyroid nodules. Methods: A total of 1 117 patients with thyroid nodules resection at Nanjing Gulou Hospital from December 2020 to July 2022 were enrolled in the study. Fine needle aspiration (FNA) and core biopsy samplings were performed for cytopathologic examination and genetic testings; the findings were combined with BSRTC classification. The diagnostic performance of BRAF V600E and multigene detection were compared. Results: Among the 1, 117 patients who underwent thyroid nodules resection, 285 were male and 832 were female, with a median age of 46 years (range: 24-76 years). Postoperative histopathologic examination confirmed 1 040 cases of thyroid cancer and 77 cases of benign nodules. The sensitivity (87.0% vs. 80.8%, P<0.01) and diagnostic accuracy (87.9% vs. 82.1%, P<0.01) of multigene detection were significantly higher than those of BRAF V600E detection. The result of multigene detection showed that BRAF V600E mutation was the most common finding, followed by CCDC6-RET (E1-E12) fusion, ETV6-NTRK3 fusion, and KRAS mutation. Multigene detection had a higher sensitivity (81.9% vs. 72.8%, P<0.01) and lower cancer risk in wild-type (47.6% vs. 57.7%, P=0.069) than BRAF V600E detection in BSRTCⅠ-Ⅴ lesions. Compared with BRAF V600E detection, multigene had no significant difference of sensitivity in BSRTC Ⅰ lesions, but significantly higher sensitivity (86.3% vs 74.0%, P<0.01) in BSRTC Ⅲ lesions. Conclusions: Genetic detection can be used as an effective tool for the diagnosis of thyroid nodules. A stratified application of molecular markers in the diagnosis of thyroid nodules is proposed. Combined with FNA, single gene or multigene detection both can effectively assist in the diagnosis of thyroid nodules. Moreover, multigene detection is superior to single gene detection. For BSRTC Ⅲ lesion with wild-type BRAF, multigene detection can be considered with a repeated FNA.

Tailgut Duplication Cyst: A Rare Cause of Refractory Low Back Pain in a Teenage Girl

Abstract Tailgut cyst, or retrorectal cystic hamartoma, is a rare congenital malformation originating from retrorectal or presacral space. It stands as an embryonic vestige of the hindgut’s postnatal component. Owing to its rarity, undiagnosed asymptomatic cases and diverse array of clinical presentations that potentially mimic other diseases, correct diagnosis is often delayed. It can present at any age but is most prevalent in middle-aged females, often remaining asymptomatic and eluding detection during digital rectal examinations. Postoperative histopathological examination is the definitive diagnostic method. This case report highlights an unusual presentation of a tailgut cyst as an underlying etiology for lower back pain in a 17-year-old female patient, emphasizing the importance of considering it as a potential differential diagnosis for intractable lower back pain, especially in young females. Timely recognition of this condition is pivotal for precise management and better patient outcomes.

Prospective randomized study correlating intraoperative urethral mucosal injury with early post transurethral resection of the prostate stricture urethra: A novel concept

ObjectiveTo investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate (TURP) and correlate its incidence with intraoperative urethral mucosal injury during TURP. Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as prospective randomized study. MethodsOne hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant. Prostate size, operative time, intra-operative mucosal rupture, catheter time, catheter traction duration, uroflowmetry, and post-operative stricture rate were compared. ResultsA total of 150 patients underwent TURP, including 74 patients undergoing monopolar TURP (one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate) and 75 patients undergoing bipolar-TURP, all of which were performed using 26 Fr sheath resectoscope. The average International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 and 6 months were comparable between the groups. Out of 149 patients, nine patients (6.0%) developed urethral stricture. The severity of the injury (urethral mucosal injury) correlated with the likelihood of developing a subsequent complication (stricture urethra). Patients with stricture had significantly larger prostate volume than patients without stricture (65.0 mL vs. 50.0 mL; p=0.030). Patients with stricture had longer operative time than patients without stricture (55.0 min vs. 40.0 min; p=0.002). In both procedures, formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury. ConclusionIntra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Wilms tumour in a two day old neonate: A rare and challenging case

Wilms tumor or nephroblastoma is the second most common renal tumor occurring in the neonatal age group next to congenital mesoblastic nephroma. The most common age group of presentation of Wilms tumor is between 3 and 4 years of age. Here, we report a case of right-sided Wilms tumor in a 2-day-old neonate. A term-born female baby presented on day 2 of birth with abdominal distension and physical examination revealed a large palpable mass in the right lumbar region crossing the midline. Imaging features were suggestive of a retroperitoneal mass of probable right renal origin. The patient was taken up for right radical nephroureterectomy and Per-operatively, there was anticipated tumor spillage. Post-operative histopathological examination was suggestive of a triphasic Wilms tumor with no anaplasia and favorable histology. The patient was diagnosed with Wilms tumor of the right kidney, COG stage III, SIOP (“International Society of Pediatric Oncology”) intermediate risk loss of heterozygosity testing for 1p and 16q was negative. She was started on chemotherapy with a DDA4 regimen. She completed whole abdominal radiotherapy and tolerated treatment well. The child is disease free and is under regular follow-up. This case of neonatal Wilms tumor was indeed a challenge to the pediatric surgeons and the oncologists but the final results were worth the challenge that was faced.

TIRADS and BETHESDA correlation to histopathological results of thyroid nodules: a case series at Dr. Sardjito General Hospital, Yogyakarta

Early diagnosis of thyroid nodules is necessary to identify malignancy before surgery. Fine needle aspiration (FNA) and ultrasonography (USG) are supporting examinations for diagnosing thyroid tumors. There have been several previous studies related to the sensitivity of each investigation compared to postoperative biopsy findings. Both have different diagnostic values, and it is hoped that if these two diagnostic methods are applied before surgery, they will have a higher sensitivity value in determining the type of thyroid nodule compared to a single examination. A single-center retrospective case series study. Socio-demographic and clinical data were obtained from hospital records. This study included six thyroid nodule cases, consisting of three (50%) women and three (50%) men. Patients had the appearance and clinical symptoms of swelling in the neck (100%), of which 50% had symptoms of difficulty swallowing and 16% had symptoms of shortness of breath. Three (50%) patients underwent isthmolobectomy, and 3 (50%) patients underwent total thyroidectomy. Three (50%) patients suspected of approaching malignancy based on TIRADS and BETHESDA underwent total thyroidectomy with postoperative histopathological results of non-malignancy. Three (50%) patients with suspected benign nodules based on TIRADS and BETHESDA underwent isthmolobectomy, with postoperative histopathological results indicating non-malignancy. The concordance of the results of the ultrasound examination (TIRADS) and histopathology of thyroid nodules before surgery (BETHESDA) compared with the results of the postoperative histopathological examination was 50%.

Comparison of Fine-Needle Aspiration Cytopathology with Histopathological Examination of the Thyroid Gland in Patients Undergoing Elective Thyroid Surgery: Do We Still Need Fine-Needle Aspiration Cytopathology?

Background: The thyroid gland is responsible for various functions, but it is susceptible to pathologies. The gold standard for preliminarily diagnosing thyroid abnormalities is fine-needle aspiration cytology (FNAC), although it has some limitations; thus, postoperative histopathological examination confirms the diagnosis. The aim of the present study was to compare preoperative FNAC results with postoperative histopathological examination. Methods: This study is a retrospective study based on FNAC and postoperative histopathology examination, which were compared and analyzed. Results: This study included 344 patients between 18 and 86 years old (mean age: 53.06 ± 13.89), comprising 274 females and 70 males (mean ages 52.72 ± 13.86 and 54.39 ± 14.05, respectively) with a 3.9:1 female-to-male ratio. Statistical significance between the FNAC and histopathology results was observed (p = 0.0000), and 86 (25.00%) patients were found to have been diagnosed incorrectly based on FNAC. The sensitivity of FNAC was 92.31%, and its specificity was 82.08%, with positive and negative predictive values of 68.57% and 96.08%, respectively. Conclusions: Due to many factors, FNAC may lead to over- or under-diagnosis, increasing the chances of complications associated with the selected treatment. However, we do not have any other more accurate tools; therefore, FNAC should still remain as the gold standard of preliminary examination.

The Role of Trans Oral Robotic Surgery in the Carcinoma of Unknown Primary: A New Evidence in the Horizon?

The detection of the primary site in Carcinoma of Unknown Primary (CUP) is a challenging task which can significantly alter the course of management and also prognosis. Various modalities have been assessed with varying sensitivity and specificity. Imaging and cytological diagnosis have formed a key part of the diagnostic algorithm of CUP. Trans Oral Robotic Surgery offers the advantage of being both diagnostic as well as therapeutic with promising sensitivity and specificity and can form an integral part in the management of CUP. A prospective study was carried out at a tertiary care centre over a period of one year. Patients with unilateral neck swelling which was histopathologically proven squamous cell carcinoma neck metastasis were included in the study. They were evaluated with endoscopy and radiology according to the standard algorithm. When these failed to detect the primary, the patients underwent ipsilateral radical tonsillectomy and tongue base mucosal wedge biopsy via TORS. Post-operative histopathological examination was done on the resected specimens to detect the primary site. Transoral Robotic Surgery was able to localise primary in 50% of the patients enrolled in the study. Out of the primary site identified by TORS; 55.56% were located in the tonsil and 44.4% in the tongue base. TORS can offer promising detection rates of the occult primary in CUP and should form an integral part of the diagnostic algorithm.

Pathological Portrait of a Submandibular Gland Lymphoepithelial Cyst in a Non HIV Patient: A Case Report

Lymphoepithelial Cysts (LEC) manifest as benign, unilocular to multilocular lesions predominantly in the head and neck areas. LEC typically localise in the salivary glands, with the parotid gland being more common and the submandibular gland being a rare occurrence. Additionally, they may be observed in the oral cavity, with a particular affinity for the floor of the mouth. It manifests as a painless, solitary cystic mass situated close to or within the salivary gland. It predominantly occurs in individuals infected with Human Immunodeficiency Virus (HIV). It typically arises as a consequence of lymphocyte-induced dilation of the cystic duct, and in accordance with index case, the definitive diagnosis is consistently confirmed through postoperative histopathological examination. They are infrequently observed in immunocompetent individuals and may have a connection to Sjögren’s syndrome. Numerous contemporary investigative methods are at our disposal, with Fine Needle Aspiration Cytology (FNAC) emerging as a swift diagnostic tool for promptly confirming a LEC. Additional diagnostic modalities encompass Ultrasonography (USG) and Computed Tomography (CT). The primary treatment for an LEC continues to be surgical intervention. Understanding the characteristics and behaviour of such cysts in non HIV patients is critical for accurate diagnosis, appropriate therapy, and, perhaps, enhancing the understanding of the spectrum of conditions associated with these cyst formations. Investigating LEC occurring in the rare location of the submandibular salivary gland, this work is distinctive in that it involves an immunocompetent individual. The present case is of a 42-year-old woman who elucidates the diagnostic pathway, encompassing both FNAC and histopathology.

A Case Series of Idiopathic Granulomatous Mastitis: Surgical Intervention is not the Only Option

Idiopathic Granulomatous Mastitis (IGM) is a benign inflammatory disease of the breast that is difficult to treat, as there is no definitive protocol for management and it has a higher recurrence rate. The present case series presents five patients who exhibited clinical symptoms such as breast swelling, pain and nipple discharge, and were diagnosed with IGM. They were treated with a multimodality approach (surgical and/or conservative management) based on their symptoms. All patients were successfully treated for IGM using the multimodality approach. While a recurrence was observed in one out of five patients, it was further successfully treated with additional conservative management. The proposed multimodality treatment is effective in treating IGM. It eliminates the risk associated with surgical intervention among patients clinically diagnosed with IGM. It also eliminates the risk of corticosteroid side-effects among patients whose initial clinical diagnosis and postoperative histopathological examination is negative for IGM.

The presence of cribriform pattern in prostate biopsy and radical prostatectomy is associated with negative postoperative pathological features.

Prostate cancer is the second most common male cancer worldwide. Its rising incidence and high overtreatment rate drive the search for new prognostic factors. Histopathological variants, such as cribriform pattern (CP), are associated with poorer oncologic outcome. The aim of this study was to assess the correlation between CP in prostate biopsy and radical prostatectomy (RP) and postoperative pathological features. In this retrospective, single-centre study we analysed the reviewed medical records of 100 men who underwent minimally invasive RP in the years 2017-2019. RP histopathological examination was performed by a single expert pathologist, and preoperative biopsies were assessed by various professionals from different referral centres. 48% of men underwent endoscopic RP with limited lymphadenectomy, whereas 52% underwent laparoscopic RP with extended lymphadenectomy. CP in biopsy was present in 6 patients: 3 in each of both groups (6.3% and 5.8%, respectively). Lymph node metastases were present in 50% and 10% of patients with and without CP in biopsy, respectively (p = 0.028). Postoperative histopathological examination revealed CP in 65%. CP in RP was associated with higher International Society of Urological Pathology (ISUP) (p < 0.001), extraprostatic extension (EPE) (p = 0.001), seminal vesicle invasion (SVI) (p = 0.001), and positive surgical margin (PSM) (p = 0.004). Thirteen (20%) of the patients with CP in the RP specimen had lymph node metastasis, and none of the patients without CP in the RP specimen had regional LN metastasis. The presence of CP in a biopsy specimen and RP is associated with negative postoperative features. Therefore, efforts should be made to increase CP reporting in biopsies because its identification could trigger a more radical surgical approach with extended lymphadenectomy.

Liposarcoma of the testis: A case report

Liposarcoma of the testis is a rare genitourinary tumor. Liposarcoma commonly arises in the spermatic cord and rarely arises in the testis. We describe the case of a 60-year-old man who presented with complaints of swelling, associated with pain, in the right testicular region for 3 weeks. The scrotal ultrasound showed a heterogenous, hyperechoic lesion measuring 10 × 7 cm on the right. The testicular lesion appeared irregularly marginated with heterogeneous echotexture, with a central hyperechoic area and peripheral hypoechogenicity. Contrast-enhanced computed tomography of the abdomen showed no intra-abdominal mass or lymphadenopathy. Tumor markers including alpha-fetoprotein, human chorionic gonadotropin, and lactate dehydrogenase were normal. A right high inguinal orchiectomy was performed, and the postoperative histopathologic examination showed features of liposarcoma of the testis with components of myxoid liposarcoma and well-differentiated liposarcoma. There was no evidence of recurrence up to 4 years post-surgery. Thus, misdiagnosis is common in liposarcoma testis due to the rarity and vague presentation. Ultrasound and tumor makers are often negative. A high index of suspicion is required in cases of tumor marker-negative testicular masses. The treatment of choice is high inguinal orchiectomy; evidence for the utility of chemotherapy and radiotherapy is limited.

Upper abdominal pain in a young woman treated by endoscopic submucosal dissection.

A previously healthy 39-year-old woman was hospitalized with upper abdominal pain for 1-month duration. A semipedunculated protrusion with smooth surface was found at the gastric angle measuring 2.0 × 2.5-cm by gastroscopy. Endoscopic ultrasound (EUS) showed a hypoechoic mass originated from the mucosal layer. Abdominal computed tomography (CT) revealed a circular pedunculated and slightly low-density mass with mild enhancement in the stomach cavity. Endoscopic submucosal dissection (ESD) was performed. Postoperative histopathology examination revealed the tumor was composed of proliferated spindle cells with eosinophil infiltration which were around small blood vessels and mucosal glands arranged in an "onion-skin" appearance. Immunohistochemical analysis of the spindle cells showed CD34 was positive and CD117, S100, DOG-1, SMA, Desmin were negative. The patient was diagnosed as gastric inflammatory fibroid polyp (IFP) and no symptoms was observed in 12 months follow-up.

Colonic basidiobolomycosis masquerading as colon cancer with liver metastasis: A case report and review of literature

AbstractBasidiobolomycosis is a rare subcutaneous fungal infection caused by Basidiobolus ranarum. Gastrointestinal Basidiobolomycosis GIB has been increasingly reported in the literature.We present a case of a 50-year-old male patient who presented by abdominal pain and weight loss. Imaging showed a left colon mass with a small liver lesion. Provisional diagnosis of colon cancer with liver metastasis was made. Endoscopic stenting and biopsy were done, and the results of the biopsy were not conclusive. The condition was complicated by perforation, and emergency laparotomy was done. The diagnosis of colon Basidiobolomycosis was reached from surgical histopathology. Unfortunately, the patient's condition deteriorated post operatively and the patient passed away a few days after surgery.GIB is a rare fungal infection commonly presenting as a colonic neoplastic mass or inflammatory bowel disease. The endoscopy biopsy usually fails to provide definitive diagnosis. Post-operative histopathological examination with or without culture provides a definite diagnosis. Treatment of GIB includes surgical resection with appropriate antifungal therapy which revealed dramatic response in most of the cases. However, delayed diagnosis and treatment lead to dissemination of the disease which is life-threatening condition.