Postoperative Histopathology Report Research Articles

Cine-MRI and T1TSE Sequence for Mediastinal Mass.

Background/Objectives: Contrast-enhanced computed tomography (CT) is the standard radiologic examination for evaluating the extent of mediastinal tumors. If tumor infiltration into the large central thoracic vessels, the pericardium, or the myocardium is suspected, cine magnetic resonance imaging (cine-MRI) can provide additional valuable information. Methods: We conducted a retrospective study of patients with mediastinal tumors who were staged with CT, cine-MRI, and a T1-weighted turbo spin echo (T1TSE) prior to surgical resection. Imaging was re-evaluated regarding tumor infiltration into the pericardium, myocardium, superior vena cava, aorta, pulmonary arteries, and atria and compared with intraoperative findings and postoperative histopathological reports (gold standard). Unclear CT findings were further investigated. Results: Forty-seven patients (29 female and 18 male patients; median age: 58 years) met the inclusion criteria. Cine-MRI was able to predict infiltration of the aorta in 86%, pulmonary arteries in 85%, and atria in 80% of unclear CT cases. Aortic tumor infiltration in unclear CT cases was significantly more often correctly diagnosed with cine-MRI than with T1TSE sequence. Conclusions: Additional cine-MRI is of crucial benefit in unclear CT cases. We recommend performing cine-MRI if infiltration into the large central vessels and atria is suspected. T1TSE sequence is of very limited additional value.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after 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 intra-operative 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 the 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. The 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 a 26 Fr sheath resectoscope. The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months 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.

Evaluation of Thyroid Nodules in Patients With Fine-Needle Aspiration Biopsy.

The incidence of thyroid nodules has increased in the last 50 years due to the widespread use of imaging methods and incidental detection of small thyroid nodules. Thyroid fine-needle aspiration biopsy (FNAB) is the most accurate, reliable, and cost-effective test to evaluate thyroid nodules. In this research, we aimed to elucidate thyroid fine-needle aspiration cytology (FNAC) to understand how suspicious cases predict malignancy. Within this research's scope, 411 patients over 16 years old who were evaluated in IzmirKatipCelebi University, Ataturk Training and Research Hospital Internal Medicine (Izmir, Turkey) outpatient clinic for thyroid nodules between2018 and 2022and underwent thyroid FNAC followed by thyroid surgery were analyzed retrospectively. The age, gender, thyroid FNAC, operation type, and histopathology of all the patients were reviewed. Individuals with a history of head and neck cancer were excluded from the analysis. No statistically significant relationship between the pathology results and demographic characteristics was found. A statistically significant correlation existed between the pathology and FNAB results (p<0.05). Although 84.5% of the patients were diagnosed as benign, 14.7% as suspicious, and 0.8% as malignant in FNAC, all of these cases were diagnosed as benign in final histopathology results. Similarly, 21.9% of the patients were diagnosed asbenign, 58.8% as suspicious, and 19.4% as malignant in FNAC and all of these cases were diagnosed as malignant in final histopathology results. A correlation was determined between the two measurements (Cohen's kappa(κ)=0.557; p<0.001). The test's sensitivity was 47%, and the specificity was 99.1%. According to the FNAC results, the rate of being diagnosed with malignancy (positive predictive value (PPV)) was 93.9%, and the rate of being diagnosed as benign (negative predictive value (NPV)) was 85.8% for the individuals initially diagnosed as benign. Although FNAB remains the most important diagnostic tool to identify benigncases with a high accuracy rate, the operation decision is not clear in suspicious atypia of undetermined significance/follicular lesions of undetermined significance (AUS/FLUS) cytology findings. In conclusion, this study highlights the importance of FNA results andhelps in surgical decision-making by emphasizing that the possibility of malignancy in the post-operative final histopathology report is higher, especially in the presence of suspicious FNAC results.

Evaluation of the efficacy and safety of ultrasound guided injection of carbon nanoparticles as a preoperative localizing tool of non-palpable breast cancer and sentinel lymph nodes detection

Objective This study aimed to measure the efficacy of using carbon nanoparticles in the preoperative localization of early breast cancer (BC) cases as well as in the detection of sentinel lymph nodes in Egypt. In addition, the purpose of the study was to determine whether the efficacy of carbon nanoparticles outweighs their high price and additional shipping fees. Material and methods The current pilot study enrolled 16 early BC patients, particularly those eligible for breast-conserving surgery. All patients underwent standardized injection techniques. The operating surgeons provided comprehensive intraoperative findings and postoperative histopathological reports of the excised tissues. Results After neoadjuvant chemotherapy (NAC), downstaging of the study subjects was achieved until reaching the TNM stage of T1N1M0 and T1N0M0 in 2 cases (12.5%) and 14 cases (87.5%), respectively. Ultrasound-guided injection of carbon nanoparticles was done, followed by surgical excision on the same day or the day after injection. Eleven patients had positive mass lesions preoperatively, with a mean tumoral size of less than 1 cm in maximum dimension. Moreover, 6 out of the 11 patients showed positive black staining intraoperatively with an accuracy of 68.75%. Postoperative histopathological examination (the gold standard) of axillary specimens revealed that 3 out of 16 of the study population have positive tumor-infiltrated lymph nodes. However, only 2 of these cases demonstrated intra-operative black staining, with the black dye’s positive and negative predictive values of staining being 100% and 92.2%, respectively. Conclusions Preoperative carbon nanoparticle suspension injection is a safe and effective method for adequate tumoral localization in BC patients. Nevertheless, this pilot study did not provide strong evidence for the adequacy of sentinel lymph node detection due to the small sample size, high cost, and extra shipping fees of the carbon nanoparticles.

Case report of spontaneous sino-cutaneous fistula in chronic rhinosinusitis

BackgroundChronic rhinosinusitis (CRS) is a common disease characterized by inflammation of the paranasal sinuses, with symptoms such as nasal blockage, facial pain, hyposmia, and headache. While these symptoms are often treated as a common cold, the disease can lead to serious complications if left untreated. We present an unusual case of CRS in which the patient presented to the ophthalmology department with persistent pus discharge from the left upper eyelid for 6 months, despite being treated with multiple courses of antibiotics and undergoing incision and drainage procedures.Case presentationA 69-year-old male patient presented with a 6-month history of persistent pus discharge from the left upper eyelid, despite being treated with multiple courses of oral antibiotics and three incision and drainage procedures. He also complained of yellowish nasal discharge and bilateral nasal blockage for the past year but did not seek medical attention for these symptoms. Physical examination revealed pus discharge from the left upper eyelid and widening of the nasomaxillary groove. Nasoendoscopic examination showed bilateral grade 3 nasal polyps with mucopus secretion. CT scan of the paranasal sinuses revealed that the odd presentation was due to the chronic inflammatory process in the paranasal sinuses, which had led to osteitis and hyperostosis. This patient underwent endoscopic sinus surgery (ESS) with left frontal trephination and fat obliteration of the left frontal sinus. The postoperative histopathological report confirmed the diagnosis of benign inflammatory nasal polyp with acute on chronic inflammation. The patient was asymptomatic at 3-month follow-up post-operation.ConclusionOur case report highlights the importance of considering CRS as a possible underlying cause of such unusual presentations, even when the symptoms may appear unrelated. Early diagnosis and treatment of CRS can prevent serious complications and improve patient outcomes. The inflammatory process of CRS leading to osteitis and hyperostosis of the paranasal sinuses complicates the clinical presentation, distorts the usual anatomical structures, and may complicate the operation. CT scan of the paranasal sinus is highly recommended before any sinus surgery. At times, ESS may not be sufficient to eradicate frontal sinus disease. In these cases, an external approach is necessary with or without obliteration of the sinus cavity.

Recurrent infected thyroglossal sinus: a unique case

Thyroglossal sinus are a frequent clinical entity in the pediatric population, mostly present in upper midline of the neck. It is the most common complication following thyroglossal duct cysts and is well known for recurrence, if inadequately excised or infected. A careful consideration of the magnetic resonance imaging (MRI) pre-operatively helps improve the outcomes and reduces complications. We present the case of a 12-year-old boy operated four times for recurrent thyroglossal sinus. The diagnosis was confirmed by pre-operative history, physical examination as well as post-operative histopathological report of the specimen. MRI neck was used for tract diagnosis.

OBSERVATIONAL STUDY ON INCIDENCE OF INCIDENTAL MALIGNANCY IN MULTINODULAR GOITRE PATIENTS WHO UNDERWENT TOTAL THYROIDECTOMY AT A TERTIARY CARE CENTRE IN NORTH KERALA

Introduction: Incidental thyroid malignancy is the term applied to unsuspected cancer identied incidentally on pathologic examination of thyroid tissue removed for benign disease. Early detection and treatment of thyroid cancer helps in decreasing the morbidity and mortality of the patient. There have been very few studies related to incidental thyroid carcinoma in this part of the world. Therefore, this study can act as a baseline study for further research. Materials And Methods: From October 2020 to October 2022, 50 patients with multinodular goiter who fullled the inclusion criteria were selected. These patients were subjected to detailed history taking, clinical examination and preoperative workup. History, clinical examination ndings, investigations, operative and the post-operative ndings were recorded in detail in a proforma. Outcome measurement was done by comparing the nal histopathological report with clinical diagnosis and FNAC report. Results:Among the 50 patients with a female: male ratio of 4:1, majority (44%) belonged to 40-50 years of age group. Out of the 50 patients with preoperatively benign multinodular goiter, Postoperative histopathological report came as malignant among 7 patients (14 %), all of them were females. The commonest type of incidental thyroid malignancy among the studied population was micro papillary carcinoma, being present in 4 of the 7 cases (57.15%). Papillary carcinoma was found in 3 patients (42.85%). Conclusion: There is a trend towards rise in the incidence of incidental thyroid cancers. Total thyroidectomy as initial surgery for benign disorders reduces the morbidity of second surgery. Identifying incidental thyroid cancers early can help in planning denitive management early and thus achieving cure in the patients

IL-1β and IL-6 as predictors of ypN and early response to neoadjuvant chemotherapy in patients with locally advanced GC and GEJ cancer.

454 Background: Perioperative chemotherapy remains a standard of care in locally advanced gastric cancer. About 10-15% patients do not respond to such therapy and there are currently no biomarkers which could be used to predict early response to the neoadjuvant treatment. Methods: This prospective biomarker study aimed at identification of serum biomarkers of early response to neoadjuvant chemotherapy. Here we report only the results for serum cytokine assessments. It was an academic, nonrandomized, prospective study, conducted in MSCNRIO. Between January 2018 and November 2019 we analysed 42 patients aged 30-77 (median 63 years, 52.5% male and 47.5% female) with histologically confirmed GC or GEJ cancer qualified by MDT for perioperative FLOT. Exclusion criteria were: inflammatory and autoimmune diseases, other cancers, chronic steroid and immunosuppressive therapy. Blood sample was collected a.c. prior to the administration of cycle one (C1), two (C2) and three (C3) FLOT regimen. Serum levels of IL-1β and IL-6 were measured twice using ELISA. Results: All patients with pre-treatment IL-1β levels above 0.5 ng/ml on the postoperative histopathological report had positive lymph nodes (ypN+). There was a statistically significant difference in the level of IL-1β in the blood serum of patients before the start of treatment in the subgroups ypN0 vs ypN+ vs unresectable tumor (p = 0.003), ypN0 vs ypN+ (p = 0.002) as well as ypN+ vs unresectable tumor (p = 0.075). There was a trend for change in IL-1β level between cycles C1 and C3 in the ypN0 vs ypN+ subgroups (p = 0.056). The difference in IL-1β level before C1 between the groups TGR-G1-2/ypN0 vs TGR-G1-2/ypN+ vs TGR-G3/ypN0 vs TGR-G3/ypN+ was statistically significant (p = 0.017). The difference in IL-6 level between C3 and C1 in the subgroups TGR-G1-2/ypN0 vs TGR-G1-2 / ypN + vs TGR-G3 / ypN0 vs TGR-G3 / ypN + vs unresectable tumor was statistically significant (p = 0.009). Among the analyzed factors, only the difference in serum IL-6 level between C3 and C1 may be a predictor of ypN+ response to preoperative FLOT regimen. Among ypN0 patients, 76% had an IL-6 difference between C3 and C1&gt; 1.1, i.e. C3 greater than C1 by at least 1.1 (specificity), and among ypN+ patients 83% had an IL-6 difference between C3 and C1 &lt;1.1 (specificity). Conclusions: Low IL-1β levels before starting treatment is a prognostic factor while an early decrease in IL-6 could be considered a predictive marker of response to FLOT.

Role of magnetic resonance imaging in urinary bladder carcinoma: A tertiary care experience

Background: Bladder cancer is the most common malignancy of the urinary tract. Pre-operative tumour staging and grading play a significant role in treatment planning and prognosis estimation for bladder cancer. Aims and Objectives: This study aims to evaluate the utility of multiparametric-magnetic resonance imaging (mp-MRI) in detecting and staging bladder cancers and hence its role in final management. Materials and Methods: A total of 40 patients with documented urinary bladder mass undergoing mp-MRI before transurethral resection of bladder tumours for primary bladder cancer were identified and compared with post-operative histopathological reports. The data were collected and analysed using SPSS software. Results: The mean age in the study population was 53.68 ± 13.2 years, including 7 (17.5%) females and 33 (82.5%) males. Twenty-three (57.5%) of our patients had muscle invasion on the MRI pelvis. In muscle-invasive urothelial carcinoma, there were significantly more patients with Vesical Imaging-Reporting and Data System (VIRADS) 3, VIRADS 4 and VIRADS 5 than in non-muscle invasive urothelial carcinoma. The proportion of patients with VIRADS 1 and VIRADS 2 on MRI pelvis was significantly lower in muscle-invasive urothelial carcinoma than in non-muscle-invasive urothelial carcinoma (P = 0.0001). Histopathology and muscle invasion on the MRI pelvis agree well in the current study (κ = 0.742; P = 0.0001). There was an overall concordance rate of 87.5% and an overall discordance rate of 12.5% between histopathology and muscle invasion on the MRI pelvis. The sensitivity, specificity, area under the curve, positive predictive value, negative predictive value and diagnostic accuracy of the mp-MRI scan were 87.5%, 87.5%, 0.88, 91.3%, 82.35% and 87.50%, respectively. Conclusion: The mp-MRI and VIRADS scoring is an effective comprehensive tool with satisfactory sensitivity, specificity and diagnostic value for detecting muscle invasiveness of primary bladder cancer. We recommend VIRADS scoring for all bladder cancer patients for better pre-operative staging and overall management.

From diagnosis to treatment: Examining disparities in thyroid nodule evaluation and its impact on patient care

Controversy exists regarding the management of thyroid nodules because of conflicting information regarding the excessive occurrence of thyroid nodules, various occurrence of most cancers stated in the ones surgically excised and the frequency of loss of life from thyroid most cancers. The guidelines suggest an algorithm for evaluation of thyroid masses. 1Workup should start with history and physical examination, proceed to laboratory studies, and then to imaging. Even though FNAC is superior to USG, basically USG is used for evaluation of all thyroid masses initially, followed by FNAC. This study was done to know about the disparities between preoperative investigations and postoperative histopathology report of thyroid swelling. Methods: Study was done in 50 patients with thyroid masses which were subjected to FNAC, TFT and USG neck and their results were later correlated with histopathological examination report (HPR) whenever available. Results: Out of 50, 7 patients had disparities between preoperative and postoperative diagnosis, but it was statistically insignificant. Conclusion: FNAC stands at higher level with respect to P value and significance. Despite the fact is that, there are some patients whose preoperative and postoperative diagnoses were different. They either didn&#39;t want the first surgery or they want a second one. 2Detecting malignancy preoperatively allows total thyroidectomy in a single operation without the need for frozen section or a second operation for completion of a thyroidectomy if malignancy is found during the initial thyroid lobectomy. Among them, FNAC was more reliable compared to other investigations in diagnosing malignant conditions preoperatively. Both FNAC and USG over diagnosed colloid goitre.

Hyalinizing Clear Cell Carcinoma of the Mandible – A Rare Case Report

Hyalinizing clear cell carcinoma (HCCC), also known as clear cell carcinoma is a rare tumor constituting ≤1% of minor salivary gland tumors. We present here the case of a 48-year-old woman with complaints of pain in the left lower jaw with a surgical history of post-marginal mandibulectomy (lesion being benign). However, the postoperative histopathological reports confirmed clear cell carcinoma of the mandible. Due to delay in presenting, a whole-body positron emission tomography scan was performed and reports have shown no evidence of disease elsewhere in the body. Immunohistochemistry was performed and reports suggested HCCC of salivary gland origin. The patient underwent segmental resection of the mandible along with bilateral modified radical neck dissection and reconstruction of the defect with a free fibula flap. The postoperative period was uneventful. The clinical characteristics, differential diagnosis, surgery, histological, immunohistochemical, and treatment for HCCC were reviewed and discussed.

Utility of Whole Body 18F-FDG PET/CT in Comparison to Pelvic MRI in Evaluation of Local Staging of Early-Stage Carcinoma Cervix.

This prospective comparative study aimed to investigate the applied value of whole body 2-deoxy-2[fluorine-18]fluoro- D-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) in comparison to pelvic magnetic resonance imaging (MRI) in early cervical cancer patients. A prospective study was performed on 47 clinically early-stage cervical cancer patients evaluated with positron emission tomography/computed tomography (PET/CT) and MRI before surgery. The final postoperative histopathology report served as the reference standard. Both PET/CT and MRI images were analyzed and correlated with histopathologic findings concerning parametrial and lymph node involvement. Sensitivity, specificity, and negative predictive value (NPV) of PET/CT were 33.3%, 81.8%, and 94.7%, respectively, for parametrium assessment. And the corresponding values of pelvic MRI were 33.3%, 63.6%, and 93.3%, respectively (PET/CT versus MRI, p > 0.05). The positive predictive value (PPV) of PET/CT (11.1%) was higher than MRI (5.9%) for parametrial assessment (p < 0.05). The sensitivity, specificity, PPV, and NPV of PET/CT were 75%, 83.7%, 30%, and 97.3%, respectively, for lymph node assessment. And the corresponding values of MRI were 75%, 81.3%, 27.3%, and 97.2%, respectively (PET/CT versus MRI, p > 0.05). There was no significant difference between MRI and PET/CT concerning stage migration (p= 0.4276). The PET/CT had no additional utility (compared to MRI) in the evaluation of local staging of clinically early cervical carcinoma patients.

Multi-time point imaging in 99m Tc-pertechnetate scintigraphy of ectopic gastric mucosa in duplication cysts: value-added services.

The aim of our study was to describe the scintigraphic patterns of 99m Tc-pertechnetate uptake in patients who were referred to the department of nuclear medicine for evaluating and diagnosing ectopic gastric mucosa in foregut and midgut duplication cysts. This hospital-based, retrospective cum prospective research spans a period of 8 years from April 2014 to January 2022. Previous hospital medical records were analyzed and subsequently, a database was prepared which included the age, sex, clinical indication of a 99m Tc-pertechnetate scan, and the planar and SPECT-computed tomography (CT) imaging findings. Postoperative histopathological reports were available for 21 patients. Dynamic and planar static imaging was performed. We included SPECT-CT in suspected duplication cysts to increase the sensitivity and specificity which is a tradeoff for a small amount of additional radiation exposure. A total of 69 patients were subjected to a 99m Tc-pertechnetate scan for suspected foregut or midgut duplication cysts. All were subjected to dynamic planar and delayed static images up to 24 h or until focal uptake of radiotracer was noted which corroborated the anatomical findings, whichever was earlier. SPECT-CT was performed along with the planar study in 31 patients which confirmed the findings. Previously performed CT scans were used for anatomical correlation in the remaining ones. Duplication cysts were localized in a total of 28 patients (19 foregut duplication cysts and 12 small bowel duplications - 3 patients had dual duplication cysts, both foregut, and midgut). Forty-one patients had no scintigraphic evidence of ectopic gastric mucosa. Of these 69 patients, histopathological diagnosis was available for 21 patients (22 lesions). The report was concordant with the scan findings in 15 patients (16 lesions) and 6 patients showed discordance in histopathological diagnosis and scan findings. In conclusion, multi-time point imaging is the key to diagnosing ectopic gastric mucosa of various sizes and in various locations. An abnormal radiotracer uptake in dynamic sequences, even before the appearance of the stomach in the region of the small bowel is indicative of intestinal duplication, and delayed radiotracer visualization in the region of the thorax is characteristic of intrathoracic foregut duplication cyst.

Frequency of Skip Metastasis to the Cervical Lymph Nodes in Oral Squamous Cell Carcinoma

Background: Oral Squamous Cell Carcinoma (OSCC) commonly spreads across regional lymph nodes. Presence or lack of metastasis to the cervical lymph nodes is an essential prognostic factor. The regional metastatic pattern to the cervical lymph nodes is defined as the orderly involvement of the successive anatomical lymph node levels. When the sequential order of involvement is lost and metastases are found at a lower level without involving the first echelon nodes or groups of intermediate nodes, then it is called skip metastases. Knowledge of Skip metastases will allow patients to prevent from receiving under and overt therapy. Current treatment of oral squamous cell carcinoma is primary resection followed by elective/therapeutic neck dissection. Regarding neck dissection, there is a dilemma that up to which level should be performed. Some prefer up to level III and some prefer up to level IV based on evidence of skip metastasis to level IV. This study conducted to find out the frequency of skip metastasis and its pattern according to the site, size and grading of primary oral squamous cell carcinoma.&#x0D; Materials and methods: This was a cross sectional study performed in between August 2018 to September 2019 among 58 patients having histologically proven oral squamous cell carcinoma of tongue, buccal mucosa and retro molar trigone undergoing elective and therapeutic neck dissection. Cervical lymph nodes along with fibro-fatty tissue from patients underwent neck dissection except super selective neck dissection were fixed with 10% formalin in separate containers. The containers were marked with nodal level and sent to pathology department for histopathological examination.&#x0D; Results: Out of 58 patients, 32 (55.2%) had cervical nodal metastasis on postoperative histopathology report, 26 (44.8%) patients had no nodal metastasis and 7 (12.1%) developed skip metastasis. Oral squamous cell carcinoma of tongue was found to be the most frequent site to develop skip metastasis to the cervical lymph node. Also, skip metastases were relatively higher in greater tumour grading and T-stages.&#x0D; Conclusion: Chances of skip metastasis should be considered during treatment planning, especially for oral squamous cell carcinoma of the tongue. For the majority of cases with N0 neck, elective neck dissection up to level III should be performed. In case of carcinoma of Tongue, high-grade tumour and advanced T-stages, elective neck dissection should be performed up to level IV.&#x0D; IAHS Medical Journal Vol 4(2), December 2021; 36-40

Comparative Study Between Karaman Score and Modified Alvarado Score for Predictability in Avoiding Negative Appendectomy in the Suspected Cases of Acute Appendicitis

Objective: To compare the diagnostic accuracy between the Karaman score and the Modified Alvarado score for predictability in avoiding a negative appendectomy in suspected cases of acute appendicitis. Material and methods: This comparative study was done at the general surgery department of JPMC Karachi, from February 2022 to August 2022. All the patients diagnosed as the cases of acute appendicitis undergoing surgical treatment, aged more than 14 years and of either gender, were included. Both the Karaman and the Alvarado scoring systems were implemented in order to assign points to each of the study subjects. The Alvarado score is comprised of eight different parameters, while the Karama score only makes use of six different parameters. After evaluating the patient on both scores, the decision to perform surgery was primarily based on the surgeon's clinical judgement after considering all clinical, laboratory, and radiological findings. Postoperative histopathology reports were collected, and the scores of both Alvarado and Karaman score were compared. Patients were operated and monitored throughout the stay in hospital up to discharge. Afterwards, for each score, sensitivity, specificity, and positive and negative predictive values were determined. All the data was collected via a study proforma, and SPSS version 26 was used for the data analysis. Results: In this study, 180 cases of appendicitis undergoing surgical treatment were studied, their mean age was 27.03 ± 10.12 years, and their mean BMI was 19.88 ± 3.43 kg/m2. Males accounted for 80.0% of all study participants. As per histological findings, acute appendicitis was found in 78.9% of the cases, 14.4% of the patients had gangrenous appendicitis, while 6.5% of the cases had a normal appendix. Histopathological evaluation was statistically significant according to the appendicitis identification by Karaman scoring system and Alvarado scoring system (p-0.001). Although both scoring systems showed almost similar diagnostic accuracy, the Karaman scoring system showed sensitivity (98%), specificity (75%), PPV (98%), NPV (75%), and accuracy (96%), while the Alvarado scoring system showed sensitivity (97%), specificity (58%), PPV (97%), NPV (63%), and accuracy (95%). Conclusion: In the study conclusion, the Karaman score and Alvarado scoring systems both were observed to be the good predictive to distinguishing acute appendicitis in avoiding the negative appendectomy. Both showed almost similar and high sensitivity and accuracy by taking histopathology is gold standard. Keywords: Appendicitis, Karaman score, Alvarado score, Accuracy

The role of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in determining the prognosis of patients with testicular cancer

Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), as systemic inflammatory response markers, have been shown to play a role in prognostic factors for patients with malignancies in recent years. However, their application as the prognostic factors of testicular cancer remains unknown. This study aims to evaluate the prognostic role of testicular malignancies using preoperative hematological parameters, NLR and PLR, and their pre-diagnostic role in the staging of testicular cancer. Methods: This was a cross-sectional retrospective study of thirty-nine patients who underwent radical orchiectomy due to testicular cancer at the Department of Urology Haji Adam Malik General Hospital between January 2014 and December 2018. For each patient, clinical features including age, sex, clinical stage, chemotherapy, radiology report, pre-treatment neutrophil count, lymphocyte count, platelet count, NLR, PLR, and postoperative histopathological report were collected. Then we analyzed the association between NLR, PLR and the testicular cancer metastasis incidence. Result: The mean age of the patients was 27.56 ± 17.47 years. Seventeen patients had seminoma (42.5%), 16 others were yolk sac type of cancer (40.0%), and the rest six patients were teratoma (3 patients), lymphoma (2 patients), and embryonal carcinoma (1 patient). More than half (66.48%) of the patients received chemotherapy after radical orchiectomy, with 48.70% in clinical stage III. PLR was associated with testicular cancer metastases (p=0.024), while NLR was not (p=0.729). Conclusion: High pre-treatment PLR levels are associated with the occurrence of metastasis in testicular cancer patients. Hematological parameters will become critical in the preoperative evaluation of such testicular cancer cases. The potential prognostic significance of NLR and PLR in testicular cancer should be tested with further studies.

Correlation Between Histopathology and Fnac in Thyroid Lesion Diagnosis

Background: FNAC is effective for the identification of benign and malignant thyroid lesions prior to surgery or therapy, which helps to limit the number of needless treatments. Thyroid swelling FNAC is a straightforward, quick, patient-friendly, and low-cost technique that may be repeated if samples are insufficient. It has the highest predictive value of any diagnostic method presently available. Objective: To confirm if the fine needle aspiration cytology (FNAC) and histopathology have any correlation in the diagnosis of thyroid lesions. Place and duration of research: The present study comprised 100 patients in the ENT department, Khyber teaching hospital from January 2019 to December 2020. Materials and Methods: Multiple neck swellings were presented to the ENT department in Khyber teaching hospital where they were clinically assessed after a thorough history was gathered. FNAC was administered to just those thyroid-swelling patients who were hospitalized to an indoor facility and ultimately had surgery, according to the findings of this study. Every patient had a preoperative FNAC as well as a postoperative histopathology report of thyroid lesions. Before each of the 100 surgeries, informed consent was obtained. Results: The histopathological diagnosis of thyroid lesions was associated with the FNAC diagnostic. There were 26 men and 78 women among the 104 patients. The male-to-female ratio was 1:3. The majority of the 104 patients were between the ages of 31 and 40. There were 9 false Cyto-diagnosis cases out of 104 FNAC patients. The overall accuracy rate was 91.35%. Conclusion: As a preoperative examination of thyroid gland swelling before surgery, FNAC is a reliable, safe, and somewhat accurate approach. FNAC is a reliable diagnostic test for evaluating thyroid swelling since it is more accurate in diagnosing thyroid gland cancer. Keywords: FNAC, histopathology, thyroid swelling

Prevalence of Positive Level IIb Lymph Nodes in Tongue Carcinoma: Experience From a Tertiary Care Center in North India.

IntroductionComplications during and after dissection of level IIb lymph nodes include spinal accessory nerve (SAN) dysfunction, which results in the limitation of shoulder movements and, thus, hurts the quality of life. The current study aims to know the occurrence of level IIb lymph node positivity in tongue carcinoma.MethodsThis cross-sectional study was conducted from January 2019 to December 2019 in a tertiary care center in North India. Adult cases with primary ulcer-proliferative growth over the lateral border of the tongue were included in the study. The level IIb lymph node positivity from the postoperative histopathology report was the primary outcome measure of this study. To investigate the potential association of tumor size on level IIb lymph node positivity, we compared the maximum tumor dimensions among the level IIb lymph node-positive and -negative groups. In addition, to analyze the impact of the tumor's invasive nature on level IIb lymph node positivity, we compared the depth of invasion and proportion of cases with muscle involvement among the level IIb lymph node-positive and -negative groups. Lastly, to investigate their concurrent occurrences, we compared the number of level IIb lymph node-positive cases among the level IIa lymph node-positive and -negative groups.ResultsA total of 39 patients fulfilling the inclusion criteria were included in the study. Only six had positive level-IIb lymph nodes. No significant associations of tumor size, invasion depth, muscle invasion, or involvement of level IIa lymph nodes with the positivity of level IIb lymph nodes were found. However, only three were level IIb lymph node-positive in 28 level IIa lymph node-negative cases.ConclusionConsidering the low risk of isolated level IIb lymph node positivity in level IIa lymph node-negative cases, the dissection of level IIb nodes could be omitted during the surgical excision of the tumor. However, radiological investigations detecting metabolic activity should be used in the preoperative period and postoperative follow-up to detect early lymph node involvement and disease recurrence.

Comparative Study of Diagnostic Accuracy of Ultrasonography Vs Histopathology in patients Undergoing Hysterectomy due to Uterine Pathologies

Background: Accurate diagnosis of uterine pathologies has become a core part when referring patients for hysterectomy. A variety of modalities can be used for the diagnosis of uterine abnormalities. Aims: To evaluate the accuracy of ultrasound in diagnosing various uterine pathologies and to compare histopathological findings with ultrasonographical findings. Methods: A cross-sectional study was conducted on 80 females who met the inclusion criteria at Department of Gynaecology, University of Lahore Teaching Hospitalover a period of 9 months from November 2020 to August 2021. The study was started after the approval of ethical committee at the University of Lahore. All the patients were enrolled in this study after signing the informed consent form. Patients preop ultra-sonographic findings and post-operative histopathology reports of the hysterectomy was analyzed and sensitivity, specificity and diagnostic accuracy of ultrasonography for uterine pathologies was calculated. Results: Majority of the patients were in 40’s age group. Most common sonographical indication for hysterectomy was fibroids, followed byadenomyosis and endometrial hyperplasia. The overall sensitivity, specificity and diagnostic accuracy values for ultrasonography in the diagnosis of uterine abnormality was satisfactory. The diagnostic accuracy of ultrasonography in detection of uterine fibroids and adenomyosis was 96.25% and 98.75%. Conclusion: Histo-pathological analysis correlates well with the pre-operative sonographical diagnosis. The diagnostic accuracy of ultrasound in detecting intrauterine pathology urges us to utilize ultrasonography as a first-line investigation in gynaecological patients. It is a valuable adjunctive to histopatholoogy with high accuracy for identification and characterization of uterine pathologies. Keywords: Ultrasound, Menorrhagia, Fibroids, Adenomyosis, Endometrial hyperplasia.

Identification of Effective Model for Prediction of Ovarian Malignancy Risk using Models like Risk of Malignancy Index, Logistic Regression, International Ovarian Tumour Analysis- Simple Rules

Introduction: Ovarian tumour is not a single entity it is a spectrum of neoplasm involving variety of histological tissues. Use of mathematical formula as malignancy index which is based on logistic model, menopausal status, serum levels of Cancer Antigen 125 (CA-125) and ultrasound findings in a score system is not so popular which can be a useful predictor for diagnosing and monitoring the progression of ovarian malignancy. Aim: To determine the effectiveness of the three models i.e., Risk of Malignancy Index (RMI-1,2,3 and 4), Logistic Regression 2 (LR-2), International Ovarian Tumour Analysis (IOTA) - simple rules in predicting ovarian malignancy. Materials and Methods: This prospective cohort observational study was conducted in Department of Obstetrics and Gynaecology at Saveetha Medical College and Hospital, Tamil Nadu, India, from June 2017 to July 2018. The study included a total of 70 female subjects with ovarian mass. Information obtained by investigations, ultrasound was used to predict the risk of malignancy by using the three models {Risk of Malignancy Index (RMI-1,2,3 and 4), Logistic Regression 2 (LR-2), International Ovarian Tumour Analysis (IOTA)- simple rules}. CA-125 level was considered as primary outcome variable. Study group histopathology impression (malignant Vs benign) was considered as primary explanatory variable. The result from the above models was compared with the postoperative histopathological report. The sensitivity and specificity of each model was also identified. Results: Majority of the study participants 49 (70%) were in premenopausal status and only 21 (30%) were in menopausal status. The mean CA-125 level was 108.82±233.13 in the study population (95% CI: 53.23-164.41). Among the 70 study subjects, 53 (75.70%) patients were RMI-1 benign and only 17 (24.30%) were RMI-1 malignant. Majority of the study participants 42 (60%) were IOTA impression benign and only 28 (40%) were IOTA malignant. The difference in the proportion of IOTA-simple rules between histopathology impression was statistically significant (p-value &lt;0.001). The sensitivity of IOTA-simple rules in predicting malignant histopathology was 92%, Specificity was 90.48%, diagnostic accuracy was 91.04%. Conclusion: For early risk stratification of adnexal masses, IOTAsimple rules can be used as a screening tool due to its high sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy.