Soft Tissue Lesions Research Articles

Primary Hydatid Cysts in the Extremities: A Systematic Review of the Literature.

Primary hydatid cysts (PHCs) in the extremities are uncommon, presenting in the majority of cases with atypical clinical features. Radical surgical excision remains the mainstay of treatment. The aim of our study was to accumulate the already published data on PHCs in the extremities in terms of demographic, diagnostic, and therapeutic aspects. Three electronic databases were meticulously searched for articles published until 2024. A total of 85 studies comprising 118 patients were finally included in our review. Sixteen patients (13.5%) were diagnosed with a hydatid cyst in their upper extremity, 94 (79.7%) with a PHC in the lower extremity, and eight (6.8%) with an echinococcal cyst in the axilla. Pain and swelling were the most frequent symptoms, whereas only two patients were completely asymptomatic. The mean lesion size was 11.6 ± 7.1 cm.Preoperative serology investigation was reported in 82 out of 118 (69.5%) patients; among them, 33 (44.6%) cases had a positive preoperative serology test. The vast majority of patients (96.6%) were treated with an interventional procedure either surgical or radiological, and only seven experienced postoperative complications. No anaphylactic reaction was described perioperatively. Although preoperative diagnosis of PHCs is challenging, they should be considered in the differential diagnosis of soft tissue lesions. Treatment strategies should be individualized on a patient basis, while radical surgical excision remains the gold standard treatment.

Impact of extramedullary multiple myeloma on outcomes with idecabtagene vicleucel

Idecabtagene vicleucel (Ide-cel) has demonstrated excellent efficacy and durable responses in patients with relapsed/refractory multiple myeloma (RRMM). However, the outcomes with ide-cel in patients with extramedullary disease (EMD) remain incompletely characterized. We included patients with RRMM treated with ide-cel between May 2021 and April 2023 across 11 US academic institutions. Visceral or soft tissue lesions non-contiguous from bone was classified as EMD. Time-to-event analyses were performed from date of ide-cel infusion. Among 351 patients, 84 (24%) had EMD prior to infusion. The median follow-up from ide-cel infusion was 18.2 months (95% CI: 17-19.3). The day 90 overall response rates (ORR) were 52% vs. 82% for the EMD and non-EMD cohorts, respectively (p < 0.001). The median progression-free survival (PFS) was 5.3 months (95% CI: 4.1–6.9) for the EMD cohort vs. 11.1 months (95% CI: 9.2–12.6; p < 0.0001) for the non-EMD cohort. In a multivariable analysis, EMD was an independent predictor of inferior PFS [hazard ratio 1.5 (1.1–2.2), p = 0.02]. The median overall survival was 14.8 months [95% CI: 9-Not reached (NR)] vs. 26.9 months (26.3 vs. NR, p = 0.006) for the EMD and non-EMD cohorts, respectively. Extramedullary disease represents an independent predictor of inferior day 90 ORR and PFS among patients treated with ide-cel.

Coronoid fractures and complex elbow instability: current concepts.

Fractures of the coronoid process typically occur as part of more complex injury patterns, such as terrible triads, trans-olecranon fracture-dislocations, posteromedial rotatory injuries or Monteggia-like lesions. Each pattern is associated with a specific type of coronoid fracture with regard to shape and size and specific soft-tissue lesions. O' Driscoll classification incorporates those associations identifying three major types of fractures: tip, anteromedial facet, and basal fractures. The objective of this study is to review the most common types of complex elbow instability, identify the indications for coronoid fixation and guide the appropriate management. Tip fractures as those seen in terrible triads can conditionally left untreated provided that elbow stability has been restored after radial head fixation and ligaments repair. Anteromedial facet fractures benefit from a buttress plate, while large basilar fractures can be effectively secured with posteroanterior screws. Coronoid reconstruction with a graft should be considered in post-traumatic cases of chronic coronoid deficiency.

METRADS-P vs. RECIST/PCWG criteria to detect disease progression in metastatic castration-resistant prostate cancer (mCRPC).

5070 Background: Radiographic Progression-free survival (rPFS) derived from Computer Tomography (CT) and Bone Scan (BS) using Prostate Cancer Working Group (PCWG) criteria is utilized as an intermediate clinical endpoint for overall survival (OS) benefit in mCRPC. Whole Body MRI (WBMRI) is emerging as a potentially superior response biomarker, allowing a more accurate assessment of bone marrow and soft tissue disease. We have now compared the performance of previously reported WBMRI criteria (MET-RADS-P) with PCWG criteria as a response biomarker for mCRPC, and this with overall survival (OS). Methods: We retrospectively analysed imaging data from mCRPC patients that 1) discontinued therapy based on PCWG criteria; 2) had contemporaneous WBMRI, CT, and BS at time-points according to PCWG. Soft tissue lesions were classified according to RECIST1.1 both on CT and WBMRI; bone lesions were classified on BS using PCWG criteria as non-PD (non-progressive disease), PD-U (PD unknown) &amp; PD (progressive disease) and on WBMRI using MET-RADS-P as non–PD (subclassified as partial response-PR &amp; stable disease-SD) &amp; PD, for each imaging time-point. We calculated % agreement between MET-RADS-P and PCWG across all time-points. Median PFS as per PCWG (rPFS) and METRADS-P (mPFS) and median OS according to METRADS-P response at 12 weeks was estimated by Kaplan Meier. Results: 100 cases (91 subjects received 100 lines of treatment, 100 baseline imaging &amp; 216 follow-up imaging assessments). For soft tissue disease, RECIST 1.1 and WBMRI assessments were concordant at 201 of 216 time-points (93.1%); the discordance was related to superior detection of local disease and liver metastases on WBMRI. Bone metastases assessments showed agreement in 37.5% time-points, with details as follows (% over BS category): 1) Negative BS (13 time-points): WBMRI 69.2% negative, 15.4% PR, 15.4% as PD; 2) Non-PD BS (154 time-points): WBMRI non-PD 51% (34.4% PR, 17.5% SD), 48.1% PD; 3) PD-U BS (40 time-points): WBMRI PD 90%; Non-PD 10% (1pt FLARE &amp; 3pt with subsequent concordant PD). At time of PD-U, 30 out of 40 pt (75%) discontinued treatment due to RECIST PD (24/40) &amp; clinical progression (6/40). 4) PD confirmatory BS (9 time-points) : WBMRI 100%PD. Median rPFS by PCWG was 4.9 months (m) (95%CI: 3.8-5.7); the median mPFS by MET-RADS-P was 2.8 months (2.6-3.9), with overall progression rate of 70% and 94% respectively. Non-PD by WBMRI at 12-weeks associated with longer OS when compared with PD by MRI (median OS: 17.9m (14.2-22.6) vs 14.4m (9.6-17.0) (crude log-rank test 0.0059). Conclusions: Regarding soft-tissue disease, MET-RADS-P detects progression earlier than RECIST in 4.2% time-points, while for bone metastases it detects progression earlier than PCWG at 51.9% of timepoints. WBMRI can better classify BS non-PD patients in PR, SD and PD. Response evaluation based on WBMRI is a prognostic factor in mCRPC.

Impact of extramedullary multiple myeloma on outcomes with idecabtagene vicleucel.

7508 Background: Idecabtagene vicleucel (Ide-cel) has demonstrated excellent efficacy in patients with relapsed/refractory multiple myeloma (RRMM). However, outcomes in patients with extramedullary disease (EMD) remain to be better characterized. Methods: We included patients from 11 US academic centers, who were evaluated for EMD and were infused with ide-cel between May 2021 and April 2023. Patients with soft tissue or visceral lesions non-contiguous from bony lesions were classified as having true EMD, with paraskeletal disease classified as non-EMD. Disease responses were evaluated using the IMWG criteria. Time-to-event analyses were performed from the date of ide-cel infusion. Results: Among 351 patients with RRMM treated with ide-cel, 84 (24%) had EMD prior to infusion. Median follow-up for the entire cohort was 18.2 months (95% CI: 17-19.3). Baseline characteristics at ide-cel infusion for EMD and non-EMD cohorts are depicted in the table. For the EMD and non-EMD cohorts, the Day 30 objective response rates (ORR) were 58% vs. 69% (p=0.1), Day 30 ≥complete response rates were 16% vs 24% (p=0.11), the Day 90 ORR were 52% vs 82% (p&lt;0.001), and best ORR were 58% vs 82%, respectively. The median progression-free survival (PFS) was 5.3 months (95% CI: 4.1-6.9) for the EMD cohort vs. 11.1 months (95% CI: 9.2-12.6; p&lt;0.0001) for the non-EMD cohort. The median duration of response for EMD among day 30 responders was 6.4 months (95% CI: 5.1-8.4). In a multivariable analysis, EMD was an independent predictor of inferior PFS [hazard ratio 1.8 (95% CI: 1.2-2.5), p&lt;0.001] after adjusting for ECOG status, revised ISS stage, penta-drug refractoriness, elevated ferritin, prior BCMA-directed therapy and use of bridging therapy. Pattern of progression in the EMD cohort (n=68/84) included EMD site only (21%), hematologic only (22%), or both (57%), with comparable PFS for type of progression (p=0.19). The median overall survival (OS) was 14.8 months [95% CI: 9-Not reached (NR)] for EMD and 26.9 months [95% CI: 26.3 vs NR, p=0.006)] for the non-EMD group. Rates of Grade ≥2 cytokine release syndrome or neurotoxicity syndrome were comparable between the two cohorts. Conclusions: Patients with EMD demonstrate significantly inferior Day 90 ORR and presence of EMD is an independent risk factor for inferior PFS. [Table: see text]

A scoping review on the use of traditional medicine and oral health in Africa.

This review aimed to chart the landscape of literature concerning the precise applications of traditional medicine in managing specific oral diseases and, in doing so, to pinpoint knowledge gaps surrounding the use of traditional medicine for oral disease management in the African context. A systematic search of the literature was conducted on PubMed, Web of Science, Scopus, and CINAHL. The search was conducted from the inception of the database till September 2023. A search of related citations and references was also carried out. Only English language publications were included. A summary of studies that met the inclusion criteria was conducted. Of the 584 records identified, 11 were duplicates and 12 studies, published between 2006 and 2021, met the inclusion criteria. The studies were published from eight countries located in the five sub-regions on the continent. All the studies were either experimental designs or ethnobotanical surveys and they all utilized plant-based remedies. The five experimental studies aimed to assess the impact of whole plants or plant extracts on the three microorganisms responsible for dental caries and seven responsible for periodontal diseases. The number of plant species identified by the seven ethnobotanical surveys ranged from 29 to 62 while the number of plan families ranged from 15 to 29. The remedies were either topical applied, use as mouth rinses, gargled, or chewed. The systemic routes of administration identified were inhalation and drinking. The remedies were used for the treatment of hard such as dental caries and tooth sensitivity, to soft tissue lesions such as mouth ulcers, gingival bleeding, and mouth thrush. Other oral disorders managed include halitosis, jaw fracture, and oral cancer. Given the increasing prevalence of oral diseases within the region, the shortage of oral healthcare professionals and limited access to financial resources, it becomes imperative to support the generation of empirical evidence to enhance the provision of traditional medicine for oral healthcare in Africa.

Mullerianosis of the urinary bladder: A great mimicker

Mullerianosis is a rare benign lesion consisting of an admixture of two or more of the following tissues: endometriosis, endocervicosis, and endosalpingiosis. It most commonly affects the urinary bladder and females of reproductive age group. Müllerianosis of the bladder is an extremely rare entity with fewer than 30 cases reported. Herein we report one such rare case of mullerianosis of the urinary bladder in a 33-year-old female who had undergone cesarian section 2 years back, presented with painless hematuria associated with menstruation. USG revealed a soft tissue lesion measuring 23×11 mm abutting the wall of the urinary bladder and extending into it. These findings were suspicious for endometriosis. The patient was admitted to the hospital for transurethral resection of a bladder lesion (TURBT). Operative findings revealed a solid 2x2 cm mass in the posterior wall of the urinary bladder. Superficial and deep TURBT chips were sent for histopathological examination. On microscopic examination, there were variable-sized glands lined by endometrial, endocervical, or tubal epithelium embedded in the bladder wall. The case was diagnosed as mullerianosis of the urinary bladder. As this rare entity, since it mimics benign and malignant neoplasms clinically and radiologically, pathologists should be aware of this rare entity to avoid misdiagnosis, which has great therapeutic implications for the patient.

Peripheral giant cell granuloma of orbit: A case report

Giant cell reparative granuloma (GCRG) is a rare locally aggressive benign lesion of orbit with a total of less than 15 reported cases worldwide. A 35-year-old male presented with a left upper eyelid mass. Contrast-enhanced computed tomography orbit revealed a soft-tissue density lesion of the extraconal compartment of the left orbit. Wide local excision was done. Histopathology showed peripheral giant cell granuloma of the orbit with fibroosseous component. No recurrence has been seen after eight months. Definite diagnosis of GCRG is only possible by excision biopsy. Early intervention is important to differentiate from malignant lesion.

Neoplastic and Non-neoplastic Soft Tissue Lesions Around the Knee.

Neoplastic and non-neoplastic soft tissue masses around the knee are often incidental findings. Most of these lesions are benign with typical imaging characteristics that allow a confident diagnosis. However, some of these incidental neoplastic masses are characterized by morbidity and potential mortality. This review highlights the typical aspects of these lesions, facilitating a correct diagnosis.

Examining the Histopathological Effect of Er,Cr:YSGG Laser in the Treatment of Oral Benign Soft Tissue Lesion

Examining the Histopathological Effect of Er,Cr:YSGG Laser in the Treatment of Oral Benign Soft Tissue Lesion

THE ROLE OF DOCETAXEL AS FIRST-LINE CHEMOTHERAPY ON PSA LEVEL AND QOL IN CRPC PATIENTS

Objective: Prostate cancer is the second most common cancer in men and the fifth leading cause of death worldwide. 10-20% of cases can progress to a more aggressive stage called castration-resistant prostate cancer (CRPC) with a higher death rate. Clinical guidelines recommend docetaxel as first-line chemotherapy and evaluated using the PSA test. This study aims to investigate the effect of docetaxel chemotherapy on PSA levels in CRPC. Material &amp; Methods: A retrospective study was conducted from January 2016 until August 2022 according to the medical records database Saiful Anwar Hospital. There were 16 patients who met the inclusion criteria, including male patients with a diagnosis of CRPC who received castration therapy and found an increase in PSA 3 times of nadir or found 2 or more bone metastatic lesions or soft tissue lesions &gt; 2 cm, received 6 series of docetaxel chemotherapy, and have a PSA data was performed before and after chemotherapy. Statistical analysis was performed using a differential T-test. Results: The results, obtained were significantly different (p&lt;0.05) on the average PSA (log) pre-post chemotherapy, visual analog scale (VAS), and quality of life, and not significantly different on BMI pre-post chemotherapy. Conclusion: 6 cycles of docetaxel chemotherapy resulted in a decrease in PSA levels of CRPC significantly. It showed an excellent response to docetaxel chemotherapy in managing CRPC patients. Limitations of this study were specifically the retrospective cohort study model and the ability to reduce PSA levels in assessing the prognosis of CRPC. Keywords: Castration-resistant prostate cancer, chemotherapy, docetaxel, prostate-specific antigen.

Assessing Response to PSMA Radiopharmaceutical Therapies with Single SPECT Imaging at 24 Hours After Injection.

Understanding the relationship between lesion-absorbed dose and tumor response in 177Lu-PSMA-617 radiopharmaceutical therapies (RPTs) remains complex. We aimed to investigate whether baseline lesion-absorbed dose can predict lesion-based responses and to explore the connection between lesion-absorbed dose and prostate-specific antigen (PSA) response. Methods: In this retrospective study, we evaluated 50 patients with 335 index lesions undergoing 177Lu-PSMA-617 RPT, who had dosimetry analysis performed on SPECT/CT at 24 h after cycles 1 and 2. First, we identified the index lesions for each patient and measured the lesion-based absorbed doses. Lesion-based response was calculated after cycle 2. Additionally, PSA50 response (a decline of 50% from baseline PSA) after cycle 2 was also calculated. The respective responses for mean and maximum absorbed doses and prostate-specific membrane antigen (PSMA) volumetric intensity product (VIP-PSMA) at cycles 1 and 2 were termed SPECTmean, SPECTmaximum, and SPECTVIP-PSMA, respectively. Results: Of the 50 patients reviewed, 46% achieved a PSA50 response after cycle 2. Of the 335 index lesions, 58% were osseous, 32% were lymph nodes, and 10% were soft-tissue metastatic lesions. The SPECT lesion-based responses were higher in PSA responders than in nonresponders (SPECTmean response of 46.8% ± 26.1% vs. 26.2% ± 24.5%, P = 0.007; SPECTmaximum response of 45% ± 25.1% vs. 19% ± 27.0%, P = 0.001; SPECTVIP-PSMA response of 49.2% ± 30.3% vs. 14% ± 34.7%, P = 0.0005). An association was observed between PSA response and SPECTVIP-PSMA response (R 2 = 0.40 and P < 0.0001). A limited relationship was found between baseline absorbed dose measured with a 24-h single time point and SPECT lesion-based response (R 2 = 0.05, P = 0.001, and R 2 = 0.03, P = 0.007, for mean and maximum absorbed doses, respectively). Conclusion: In this retrospective study, quantitative lesion-based response correlated with patient-level PSA response. We observed a limited relationship between baseline absorbed dose and lesion-based responses. Most of the variance in response remains unexplained solely by baseline absorbed dose. Establishment of a dose-response relationship in RPT with a single time point at 24 h presented some limitations.

Rapid multi-catheter segmentation for magnetic resonance image-guided catheter-based interventions.

Magnetic resonance imaging (MRI) is the gold standard for delineating cancerous lesions in soft tissue. Catheter-based interventions require the accurate placement of multiple long, flexible catheters at the target site. The manual segmentation of catheters in MR images is a challenging and time-consuming task. There is a need for automated catheter segmentation to improve the efficiency of MR-guided procedures. To develop and assess a machine learning algorithm for the detection of multiple catheters in magnetic resonance images used during catheter-based interventions. In this work, a 3D U-Net was trained to retrospectively segment catheters in scans acquired during clinical MR-guided high dose rate (HDR) prostate brachytherapy cases. To assess confidence in segmentation, multiple AI models were trained. On clinical test cases, average segmentation results were used to plan the brachytherapy delivery. Dosimetric parameters were compared to the original clinical plan. Data was obtained from 35 patients who underwent HDR prostate brachytherapy for focal disease with a total of 214 image volumes. 185 image volumes from 30 patients were used for training using a five-fold cross validation split to divide the data for training and validation. To generate confidence measures of segmentation accuracy, five trained models were generated. The remaining five patients (29 volumes) were used to test the performance of the trained model by comparison to manual segmentations of three independent observers and assessment of dosimetric impact on the final clinical brachytherapy plans. The network successfully identified 95% of catheters in the test set at a rate of 0.89s per volume. The multi-model method identified the small number of cases where AI segmentation of individual catheters was poor, flagging the need for user input. AI-based segmentation performed as well as segmentations by independent observers. Plan dosimetry using AI-segmented catheters was comparable to the original plan. The vast majority of catheters were accurately identified by AI segmentation, with minimal impact on plan outcomes. The use of multiple AI models provided confidence in the segmentation accuracy and identified catheter segmentations that required further manual assessment. Real-time AI catheter segmentation can be used during MR-guided insertions to assess deflections and for rapid planning of prostate brachytherapy.

Unusual soft tissue metastases in a patient with chondrosarcoma: a case report.

Chondrosarcoma (CS) is the second most frequent primary malignant bone tumour, characterized by production of non-osteoid cartilage matrix. Up to more than 30% of patients with CS present distant metastases, and the lungs represent the preferred site. Hence, CS soft tissue metastases and superficial cutaneous lesions are extremely rare. We report the case of a female who developed unusual multiple soft tissue CS metastases. This patient underwent left hindquarter amputation for recurrent grade 3 chondrosarcoma of the femoral neck with extension to the pelvis approximately 4years after internal fixation with an intramedullary nail for pathological fracture of left proximal femur and subsequent total proximal femoral endoprosthetic replacement for grade 1-2 chondrosarcoma. In the following years, she underwent metastasectomy for several grade 2 pulmonary metastatic chondrosarcomas. More than 14years after the amputation, she presented with multiple unusual superficial cutaneous lesions, and a whole-body magnetic resonance imaging demonstrated multiple soft tissue foci of metastatic disease. The histology of multiple soft tissue lesions excised confirmed metastatic chondrosarcoma. Then, she underwent marginal excision of further multifocal soft tissue metastatic high-grade chondrosarcoma. Unlike the poor survival from the onset of these metastases in the other cases reported in the literature, our patient is still alive 2years after the first multiple soft tissue excision of metastatic chondrosarcoma, and approximately 20years after the diagnosis of chondrosarcoma. Soft tissue CS metastases are a rare entity with few cases described in literature. This study aims to make the reader aware of this lesser-known CS manifestation.

Mesenteric panniculitis on 18F-FDG-PET/CT caused by G-CSF therapy mimicking recurrence of lymphoma

We present the case of a 55-year-old woman with Follicular Lymphoma, with basal 18F-FDG-PET/TC showing supra and infradiaphragmatic lymphatic, pleural and bone involvement. Treatment with Epcoritamab + Lenalidomide + Rituximab was iniciated with complete metabolic response (CR). Due to neutropenia, granulocyte colony-stimulating factor (G-CSF) was indicated on 02/22/23 for 5 days. A control PET/CT was performed on 02/23/23 with a pathological increase in metabolism in new-appearing mesenteric soft tissue lesions, suggestive of disease relapse. QT continued without changes and a PET/CT performed on 04/12/23 showed disappearance of the hypermetabolic mesenteric lesions. This suggests that it was a mesenteric panniculitis probably due to the use of G-CSF.

Biochemical Response of

BackgroundIn a subset of patients with oligorecurrent prostate cancer (PCa), salvage surgery with prostate-specific membrane antigen (PSMA) radioguided surgery (PSMA-RGS) seems to be of value. ObjectiveTo evaluate whether a lower level of postoperative prostate-specific antigen (PSA; <0.1 ng/ml) is predictive of therapy-free survival (TFS) following salvage PSMA-RGS. Design, setting, and participantsThis cohort study evaluated patients with biochemical recurrence after radical prostatectomy and oligorecurrent PCa on PSMA positron emission tomography treated with PSMA-RGS in three tertiary care centers (2014–2022). InterventionPSMA-RGS. Outcome measurements and statistical analysisPostsalvage surgery PSA response was categorized as <0.1, 0.1–<0.2, or >0.2 ng/ml. Kaplan-Meier and multivariable Cox regression models evaluated TFS according to PSA response. Results and limitationsAmong 553 patients assessed, 522 (94%) had metastatic soft tissue lesions removed during PSMA-RGS. At 2–16 wk after PSMA-RGS, 192, 62, and 190 patients achieved PSA levels of <0.1, 0.1–<0.2, and >0.2 ng/ml, respectively. At 2 yr of follow-up, TFS rate was 81.1% versus 56.1% versus 43.1% (p < 0.001) for patients with PSA <0.1 versus 0.1–<0.2 versus >0.2 ng/ml. In multivariable analyses, PSA levels of 0.1–0.2 ng/ml (hazard ratio [HR]: 1.9, confidence interval [CI]: 1.1–3.1) and ≥0.2 ng/ml (HR: 3.2, CI: 2.2–4.6, p < 0.001) independently predicted the need for additional therapy after PSMA-RGS. The main limitation is the lack of a control group. ConclusionsFor patients after salvage PSMA-RGS, a lower biochemical response (PSA <0.1 ng/ml) seems to predict longer TFS. This insight may help in counseling patients postoperatively as well as guiding the timely selection of additional therapy. Patient summaryWe studied what happened to prostate cancer patients in three European centers who had salvage surgery using a special method called prostate-specific membrane antigen–targeted radioguidance. We found that patients who had low prostate-specific antigen levels soon after surgery were less likely to need further treatment for a longer time.

Histological and imaging features of myoepithelial carcinoma of the bone and soft tissue.

To depict histological and imaging features of myoepithelial carcinoma of the bone and soft tissue. We retrospectively examined histological features in 22 patients with myoepithelial carcinoma of the bone (4 patients) and soft tissue (18 patients) at a single institution. Imaging analysis of 15 patients (bone, 3 patients; soft tissue, 12 patients;) with preoperative images involved classifying lytic bone lesions via the modified Lodwick-Madewell classification; the growth patterns of soft tissue lesions were classified as well-defined, focally invasive, or diffusely invasive. Local recurrence occurred in eight out of 22 patients (36.3%). Four of 22 patients (18.2%) had metastasis at presentation, whereas 11 of 22 patients (50.0%) had distant metastasis during follow-up. Severe cytological pleomorphism was observed in 14 of 22 patients (63.6%), and 10 of 22 tumors (45.5%) showed ≥ 10 mitoses/10 high-power fields. Vascular invasion was observed in 10 of 22 patients (45.5%). Extracapsular/extraskeletal infiltration into the surrounding tissues was assessed in 20 patients, with 14 of them (70%) showing infiltration beyond the tumor border. Regarding imaging of bone lesions, two patients had Ludwick type IIIB, whereas one patient had type II. The growth pattern of soft tissue lesions was well-defined in two patients (16.7%), focally invasive in seven patients (58.3%), and diffusely invasive in three (25.0%) out of 12 patients. Myoepithelial carcinoma of the bone and soft tissue presents high risk of local recurrence and distant metastasis. Histological and imaging features might be important to understand the aggressive behavior of the tumor.

Community social responsibility of continued and appropriate use of silver amalgam as dental restorative material in southern India: A cross-sectional study

Background For more than 150 years, dental amalgam (DA) has been popular as a dental restorative material. Many organizations oppose its use due to perceived toxicity and environmental concerns. Hence, this study aimed to explore the continued use of DA from a South Indian dental practitioners’ perspective. Methods This cross-sectional study was conducted among fifty-two private and public dental practitioners of Udupi district in Southern India. A self‑administered questionnaire was distributed, that involved assessment of their preferences, continuation of use and concerns of using DA as a restorative material. The percentage contribution of each variable was calculated. Preferences for continuation of use of silver amalgam based upon the age, experience and mercury toxicity as a risk factor were analyzed using Students-t test and Chi-square test. Results Most dentists were satisfied (87%) with the results of the DA, found minimal failures (96%) and found DA more economical (89%). More than half (54%) of the participants reported that they would not continue the use of DA owing to mercury toxicity and environmental concerns. Dentists with higher age and longer clinical experience preferred continuation of DA. Conclusions Despite satisfaction with DA for its minimal failure, longevity and affordability, the authors found that most practitioners did not prefer its continued usage. This highlights their concerns over mercury toxicity and soft tissue lesions and accentuates their community social responsibility. There is also an urgent need to educate dentists on mercury hygiene, mercury waste management and disposal.

A Rare Case of a Malignant Epithelioid Neoplasm With an Underlying Novel EWSR1::ZBT44 Fusion, Identified on Next-Generation Sequencing (NGS).

The clinicopathological spectrum of undifferentiated round cell sarcomas of bone and soft tissues is expanding after the 5th edition of the WHO classification. A 23-year-old male patient presented with a lump in his left thigh of 3 months' duration. Radiological examination revealed a well-defined, solid-cystic lobulated, soft tissue lesion in the proximal medial region of his left thigh, measuring 7.7 cm in the largest dimension. The referring diagnosis was an epithelioid sarcoma. Histopathological review of the tumor sections revealed a cellular tumor composed of malignant epithelioid to focally "rhabdoid-like" cells in a variable hyalinized and myxoid stroma with geographic areas of necrosis. In addition, there were areas reminiscent of hemangiopericytomatous vasculature. By immunohistochemistry, the tumor cells were diffusely positive for CD34, focally and distinctly for pan keratin (AE1/AE3). INI1/SMARCB1 and SMARCA4 (BRG1) were diffusely positive (normal). Next-generation sequencing with a wide sarcoma panel revealed EWSR1exon8::ZBT44exon4 fusion. The present example constitutes the first malignant epithelioid tumor with a hemangiopericytomatous growth pattern, exhibiting this rare fusion. The differential diagnoses of this tumor and their corresponding immunohistochemical profile are discussed. This example highlights the value of NGS in unraveling rare fusions and in differentiating these tumors from their several mimics.

Pre-prosthetic atraumatic laser-assisted mandibular rehabilitation: Er,Cr:YSGG 2780 nm for alveoloplasty and mucocele removal. A case report

Lasers are a popular technology in many areas of dentistry due to their low invasiveness, quick tissue response, and rapid healing time. Mucoceles develop from minor salivary glands, whereas bony exostosis is a prosthodontic challenge that prevents optimal prosthetic management. Scarring, pain, and discomfort are common drawbacks of traditional surgical approaches, which are followed by prolonged postoperative healing. Laser-assisted mandibular rehabilitation is a promising approach with predictable results. The patient complained of severe pain during denture fabrication, as well as a small, painless swelling on the inner aspect of the lower lip. The patient was able to receive the planned complete dentures after undergoing atraumatic laser-assisted removal of mucocele and bone exostosis with an Er,Cr:YSGG (Erbium, chromium-doped, yttrium, scandium, gallium, and garnet) laser treatment at 2780 nm. Both procedures were completed quickly, and there were no postoperative complications to report. Blanching overlying both lesions quickly faded after healing and was replaced by a healthy pink mucosal color; both lesions were monitored until complete healing. The Er,Cr:YSGG effectively ablated and removed both soft and hard tissue lesions with minimal bleeding and pain.