Solid Mass Research Articles

Computed tomography–guided percutaneous transthoracic core needle biopsy for the diagnosis of mediastinal masses

Mediastinal masses encompass a wide spectrum of diseases; therefore, histopathological diagnosis is crucial for adequate surgical or medical treatments. Herein, we report six cases of mediastinal tumors that were definitively diagnosed by computed tomography (CT)-guided core needle biopsy. Case 1: A 35-year-old woman was found to have an anterior mediastinal mass on both a chest X-ray and a CT thorax. A CT-guided core needle biopsy of the mediastinal mass revealed type A thymoma. The patient underwent surgery and remained well 1 year of post-surgery. Case 2: A 47-year-old man was found to have a solid and cystic mass with areas of calcifications on a CT scan. A CT-guided core needle biopsy of the mediastinal mass revealed an immature teratoma. The patient is now under chemotherapy. Case 3: An 18-year-old boy was found to have a tumor in the anterior mediastinum on both a chest x-ray and CT scan. A CT-guided core needle biopsy of the mediastinal mass revealed a yolk sac tumor. The patient received only two cycles of chemotherapy and died. Case 4: A 26-year-old man was found to have a left anterior mediastinal mass with internal necrosis and calcification on a CT scan. A CT-guided core needle biopsy of the mediastinal mass revealed a malignant germ cell tumor. The patient is now under chemotherapy. Case 5: A 17-year-old boy was found to have an anterior mediastinal mass on both a chest X-ray and a CT scan. A CT-guided core needle biopsy of the mediastinal mass showed non-Hodgkin lymphoma. The patient received chemotherapy and remained well 6 months after the treatment. Case 6: An 8-year-old child was found to have an anterior mediastinal mass on a chest C-ray and a CT scan. A CT-guided core needle biopsy of the mediastinal mass revealed neuroblastoma. After six courses of chemotherapy the patient passed away. Percutaneous CT-guided core needle biopsy of mediastinal mass lesions is a safe, accurate, and cost-effective procedure.

Patellar-shaped Osteochondromatosis in Young Adults: A Rare Case

Introduction: Synovial chondromatosis is a rare, benign condition that affects the synovial lining of joints, bursae, and synovial sheaths. It commonly occurs in larger joints and presents as a metaplastic disorder affecting a single joint. This case report focuses on an unusual occurrence of synovial chondromatosis in young adults, specifically with a patellar-shaped presentation. Case Presentation: A 23-year-old male patient presented with a two-year history of right knee pain and the presence of a gradually enlarging lump. The lump, currently the size of a pingpong ball, has limited the patient's range of motion in his knee joint. An MRI scan revealed a solid mass in the hoffa's fat pad on the right knee joint suggestive of extraskeletal ossifying chondroma, as well as minimal fluid accumulation in the knee joint. The mass located in front of anterior meniscus and posterior of patellar tendon, it makes the pattelar tendon redundant and patellar alta (Insall-Salvati ratio 0.88), so we performed wide excision patellar tendon augmentation with tape (ultra high molecular weight polyethylene based) and imbrication of MPFL. Histopathological analysis confirmed osteochondromatosis measuring 6.5x5x3.5cm, resembling the shape of a patella. Post-operation x-ray examination showed no signs of ossification in the hoffa's fat area or any narrowing or sclerosis in knee joints. Furthermore, there were no visible fracture/dislocation lines or indications for osteomyelitis. The patient is now free from pain and can move without any limitations in range of motion. Discussion: Synovial Chondromatosis with pattelar-like shape mass is uncommon benign tumor that rarely affects young adults. Effective surgical treatments such as wide excision and patellar tendon augmentation using UHMWPE tape with imbrication of the medial patellofemoral ligament have demonstrated favorable outcomes for cases of osteochondromatosis that have reached a significant size and are impacting adjacent tendons.

An Atypical Case of Intracardiac Myxoma Fed by Extracardiac Arteries

Myxoma is the most common type of primary benign heart tumor and is usually easily identified by echocardiography. Tumor vascularity is a rare finding in atrial myxomas and reported cases of the right atrial myxomas most frequently involve feeding vessels from the right coronary artery or, less frequently, from both coronary arteries. In this case report, an echocardiographic examination of a 74-year-old male, who was admitted to hospital with chest pain revealed an echogenic solid mass in the right atrium. A coronary angiography showed an arteriocavity fistula connecting the feeding artery to the cardiac chamber. In the computed tomography angiography examination performed, a mass was observed with intense vascularity, containing feeding vessels from the left circumflex artery, the right inferior phrenic artery, and the left hepatic artery; calcifications in the right atrium were also present. The mass was completely and successfully resected. Pathology results of the mass were compatible with cardiac myxoma. This was an atypical case of a right atrial myxoma due to the presence of intense vascularization and the feed from the cardiac and extracardiac arteries.

A comprehensive numerical procedure for high-intensity focused ultrasound ablation of breast tumour on an anatomically realistic breast phantom.

High-Intensity Focused Ultrasound (HIFU) as a promising and impactful modality for breast tumor ablation, entails the precise focalization of high-intensity ultrasonic waves onto the tumor site, culminating in the generation of extreme heat, thus ablation of malignant tissues. In this paper, a comprehensive three-dimensional (3D) Finite Element Method (FEM)-based numerical procedure is introduced, which provides exceptional capacity for simulating the intricate multiphysics phenomena associated with HIFU. Furthermore, the application of numerical procedures to an anatomically realistic breast phantom (ARBP) has not been explored before. The integrity of the present numerical procedure has been established through rigorous validation, incorporating comparative assessments with previous two-dimensional (2D) simulations and empirical data. For ARBP ablation, the administration of a 0.1 MPa pressure input pulse at a frequency of 1.5 MHz, sustained at the focal point for 10 seconds, manifests an ensuing temperature elevation to 80°C. It is noteworthy that, in contrast, the prior 2D simulation using a 2D phantom geometry reached just 72°C temperature under the identical treatment regimen, underscoring the insufficiency of 2D models, ascribed to their inherent limitations in spatially representing acoustic energy, which compromises their overall effectiveness. To underscore the versatility of this numerical platform, a simulation of a more clinically relevant HIFU therapy procedure has been conducted. This scenario involves the repositioning of the ultrasound focal point to three separate lesions, each spaced at 3 mm intervals, with ultrasound exposure durations of 6 seconds each and a 5-second interval for movement between focal points. This approach resulted in a more uniform high-temperature distribution at different areas of the tumour, leading to the ablation of almost all parts of the tumour, including its verges. In the end, the effects of different abnormal tissue shapes are investigated briefly as well. For solid mass tumors, 67.67% was successfully ablated with one lesion, while rim-enhancing tumors showed only 34.48% ablation and non-mass enhancement tumors exhibited 20.32% ablation, underscoring the need for multiple lesions and tailored treatment plans for more complex cases.

Klebsiella liver phlegmon mimicking a solid liver tumour.

This case examines the sonographic and clinical challenge of diagnosing a Klebsiella pnumoniae pyogenic liver abscess with systemic metastatic infection. The patient in this case study is an 81-year-old man who presented with intermittent rigors. Following radiological and clinical assessments, a Klebsiella pnumoniae pyogenic liver abscess, with evidence of systemic metastatic infection, was diagnosed. Sonographic features of the liver abscess were atypical for a cystic lesion and instead appeared as a solid mass, raising the possibility of malignancy. Treatment of intravenous ceftriaxone infusions resulted in full resolution of the liver lesion. The discussion criticises the terminology when describing hepatic lesions, which result from a Klebsiella pnumoniae infection. The term hepatic phlegmon is appropriate when a liver lesion caused by bacterial infection demonstrates a solid appearance on radiologic imaging. The term hepatic abscess is appropriate in cases where liver lesions caused by bacterial infection demonstrate a fluid filled core on radiologic imaging. Differentiation of these terms is important when treating the underlying lesion as a phlegmon, in contrast to an abscess, cannot be drained because it contains no pus. The variable sonographic appearances of Klebsiella pnumoniae pyogenic abscesses were also examined. Despite reported sonographic appearances in the literature, none are sufficient to distinguish a pyogenic liver abscess from malignancy without further investigation. Ultrasound operators should be aware of the variable sonographic appearances of a Klebsiella pnumoniae liver abscess and how these features, combined with non-homogenous terminology, can obfuscate the correct diagnosis.

Imaging features of hepatic angiosarcoma: retrospective analysis of two centers

PurposeIdentifying primary hepatic angiosarcoma (PHA) preoperatively is challenging, often relying on postoperative pathology. Invasive biopsy increases bleeding risk, emphasizing the importance of early PHA diagnosis through imaging. However, comprehensive summaries of ultrasound, abdominal computed tomography (CT), magnetic resonance imaging (MRI), and whole- body positron emission tomography-CT (PET-CT) in this context are lacking. This study aimed to investigate the comprehensive imaging characteristics of PHA.Patients and methodsImaging data were collected from 7 patients diagnosed with PHA via pathology between January 2000 and December 2019 in two provincial grade III hospitals. All patients underwent routine color ultrasound examinations before surgery, with 3 patients receiving contrast-enhanced ultrasound (CEUS).CT scans, both plain and enhanced, were performed on 5 patients, and whole-body PET-CT examinations were conducted on 2 patients.ResultsAmong the 7 patients with PHA, 4 presented with a single solid intrahepatic mass (2 of which were large), 1 with a single exophytic macroblock type, 1 with a mixed type featuring multiple masses and nodules, and 1 with a multiple nodule type. Conventional ultrasound of PHA showed uneven echoes within the tumor, potentially accompanied by septal zone echoes, and a blood flow grade of 0-I. CEUS displayed early-stage circular high enhancement, a central non-enhancement area, and a "vascular sign" around the tumor. CT scans revealed low-density shadows in the plain scan stage, high peripheral ring enhancement, and punctate nodular enhancement in the arterial phase, with varying intensities and the presence of a "vascular sign." During the portal vein stage, the interior of the tumor was consistently unfilled and exhibited structural disorder. PET-CT showed low-density lesions in the liver and low fluorodeoxyglucose metabolism.ConclusionsImaging diagnosis plays a crucial role in PHA diagnosis. When liver tumor imaging matches the above characteristics, consider PHA.

Inflammatory spindle cell PEComa of the lung with YAP1::TFE3 fusion: a report of two cases and a potential relationship with clear cell stromal tumour.

The PEComa family of tumours is defined by spindle/epithelioid cells with myomelanocytic differentiation. A small subset harbours TFE3 fusion; however, YAP1::TEE3 has not been reported. Clear cell stromal tumour of the lung (CCST-L) is an emerging entity characterized by spindle to epithelioid cells with focal cytoplasmic clearing, inflammatory infiltrates, no myomelanocytic differentiation, and YAP1::TFE3 fusion. Herein, we report two cases of lung tumours with myomelanocytic differentiation that showed inflammatory spindle cell histology, focal epithelioid clear cells, as well as YAP1::TFE3 fusion. The patients were both men, aged 61 and 68 years. The tumours in both cases presented as well-circumscribed solid masses involving the lung hilum. After lobectomy, no recurrence was observed at 7 and 32 months. Both tumours shared storiform to short fascicular growth of long spindle cells, with a minor component of epithelioid cells showing clear cytoplasm in the background of substantial intratumoral chronic inflammation and dilated blood vessels. One tumour showed focal melanin deposition. Both tumours were immunohistochemically positive for HMB45, Melan A, and h-caldesmon. Fluorescence in situ hybridization assays indicated the presence of YAP1::TFE3 fusions, which was confirmed by RNA sequencing in one case tested, and by immunohistochemical TFE3 expression and loss of YAP1 C-terminus staining. We present two cases of inflammatory spindle to epithelioid cell tumours of the lungs with myomelanocytic differentiation and YAP1::TFE3 fusion. This unique morphology and gene fusion suggest that these tumours may constitute a distinct subset of lung PEComa. Furthermore, morphological and molecular overlap with CCST-L gives rise to a hypothesis of a potential inherent relationship between PEComa and CCST-L.

Submandibular gland pleomorphic adenoma masquerading as a multinodular goitre: a case report

Tumors of the salivary gland comprise of a small percentage of all head and neck tumors, of which nearly 80% are benign. The submandibular gland tumors constitute only 5-10% of this group, of which pleomorphic adenoma is the commonest type. They can weigh several kilograms and grow to ludicrous sizes. If left untreated, they may result in facial deformity and airway compromise. We describe a case of a big pleomorphic adenoma arising from submandibular salivary gland that developed in a 65 years old female presenting as a swelling in right side of neck since 15 years. The dimensions of the lesion were roughly around 8×12×11 cm. During surgical examination, a solid mass that originated from the right submandibular gland was discovered to be linked to both the skin and the soft tissue beneath it. Pleomorphic adenoma was confirmed by histopathological examination. Review and discussion of the relevant literature was conducted. This article's emphasis is on the fact that, although the pleomorphic adenoma is a well-reported entity, they can attain very large sizes involving the neck region and can misrepresent itself leading to diagnostic dilemma due to many possible differential diagnoses of neck swellings.

Challenges in diagnostics and management of a dysgerminoma in a young female

Introduction: A rare case of dysgerminoma led to the prolonged and complex diagnostic journey of a young woman. Methods: The diagnostic process involved various imaging modalities, including ultrasound, FDG-PET/CT scan and MRI, alongside diagnostic laparoscopy. Additionally, methotrexate was administered based on provisional diagnosis to manage the patient’s condition. Results: Initial investigations suggested pregnancy of unknown location due to inconclusive ultrasound findings. Subsequent imaging with FDG-PET/CT initially appeared normal, but was followed by MRI, which revealed a solid mass on the right ovary. The definitive diagnosis of dysgerminoma was made during a repeat laparoscopy. The patient received oncologic treatment and recovered fully. Conclusion: This case emphasizes the challenges in diagnosing rare conditions, which may mimic common clinical diseases, as well as the importance of a comprehensive diagnostic approach.

A Case Study of a High-Grade Serous Carcinoma of the Fallopian Tube Transformed into Carcinosarcoma at the Site of Peritoneal Dissemination With Immunohistological Evidence of an Epithelial-Mesenchymal Transition.

We report a patient in whom a primary high-grade serous carcinoma (HGSC) of the fallopian tube transformed into a carcinosarcoma at the site of peritoneal dissemination, and immunohistological analysis suggested the involvement of an epithelial-mesenchymal transition (EMT). The patient, a 70-year-old woman, had an abdominal mass palpated on admission, and a laparotomy was performed after a close examination. The resected right fallopian tube was cystically dilated, and a solid mass was observed in its lumen. The histological diagnosis was HGSC of the right fallopian tube with a papillary or complex tubular structure composed of tumor cells with marked nuclear irregularities. p53 was overexpressed, and no mesenchymal tumor component was observed. The resected left-sided abdominal mass of the omentum was a solid with a long diameter of 100 mm. Microscopically, the tumor exhibited a mixture of HGSC and high-grade sarcoma with nonspecific differentiation. Furthermore, a heterologous chondrosarcoma was subsequently observed from the high-grade sarcoma. The HGSC component was E-cadherin positive. The high-grade sarcoma component was positive for EMT-related proteins such as zinc finger E-box-binding homeobox 1 (ZEB1) and twist family bHLH transcription factor 1 (TWIST1). The chondrosarcoma component was ZEB1 positive and TWIST1 negative. p53 overexpression was found in all 3 components. The tumor of the omentum suggested that an EMT phenomenon was involved in the tumorigenesis. In this scenario, the primary HGSC of the fallopian tube with obvious invasion demonstrated that the conversion from carcinoma to sarcoma by EMT occurs only with peritoneal dissemination.

Hemangioendothelioma of the spleen and liver in a 1-year-old child.

Concurrent occurrence of hemangioendothelioma in the spleen and liver of a 1-year-old child is a rare clinical case.She had a history of good health. Laboratory tests showed elevated inflammatory markers, but all other parameters were within normal range.In this article, we exhibit the typical clinical presentation and Pathology imaging features of this disease.CT imaging revealed a 9.8 cm×8.6 cm mass in the spleen, with areas of non-enhancing liquefactive necrosis. The mass exhibited heterogeneous enhancement during the arterial phase and progressive enhancement during the venous phase. Multiple nodules were observed in liver segments S2 and S4, the largest being approximately 3.7 cm×3.5 mm, with enhancement patterns similar to the splenic lesion. The patient underwent splenectomy, left hemihepatectomy, and cholecystectomy. Intraoperatively, the splenic mass exhibited some areas appearing spongy. Multiple nodules were observed in the left liver, presenting as gray-brown solid masses with a spongy texture. Pathology confirmed a diagnosis of hemangioendothelioma, supported by positive immunohistochemical staining for CD31, CD34, ERG, and FLI-1.

Extraction of polyphenols from Apocynum venetum leaves using customized deep eutectic solvents: Process optimization and antioxidant evaluation

To encourage the commercial utilization of A. venetum polyphenols as bio-colorant on textile, five different combinations of deep eutectic solvents (DESs) were evaluated using a single-factor approach and the extraction of polyphenols from A. venetum leaves by ultrasound-assisted DESs was optimized. At the same time, the antioxidant activity of polyphenols prepared were investigated. The DESs composed of choline chloride and glycerol with a molar ratio of 1:2 and a water content of 20 % showed higher extraction performance than other DESs and traditional solvents (water, 60 % ethanol and 60 % methanol). With the most effective solvent the maximum yield 8.24 % of polyphenols was obtained under the optimal extraction conditions were as follows: the ratio of liquid volume (mL) to solid mass (g) is 49:1, extraction temperature of 77 ℃, and extraction time of 55 min. In addition, the polyphenols that have been separated and purified from the DESs extract exhibited antioxidant activities in three kinds of assays including 2,2-diphenyl-1-picrylhydrazyl stable free radical (DPPH), 2,2’-azino-bis-(3-ethylbenzothiazoline-6-sulfonic) acid free radicals (ABTS) and hydroxyl radical (•OH) scavenging activity. Therefore, this paper demonstrates that DESs are effective and environmentally friendly solvents extraction of antioxidant polyphenols pigments from the leaves of A. venetum.

Utility of Ultrasound-Guided Attenuation Parameter (UGAP) in Renal Angiomyolipoma (AML): First Results.

Angiomyolipoma (AML) are the most common benign solid renal mass. Differentiation from malignant tumours is essential. Imaging features in ultrasound may overlap between malignant lesions, especially between renal cell carcinoma (RCC) and AML. So far, sectional imaging has been necessary for reliable differentiation. The aim of this study is to evaluate the use of the ultrasound-guided attenuation parameter (UGAP), a recently established tool for assessing hepatic steatosis, in the differentiation of AMLs from other renal masses. Therefore, 27 patients with unknown solid renal masses were examined by ultrasound including UGAP. The attenuation was assessed qualitatively by attenuation map and quantitatively in comparison to the surrounding renal tissue. UGAP was applicable in 26/27 patients. Findings were compared with CT/MRI as the current imaging standard. A total of 18 AML and 9 other renal tumours were found. The diagnostic performance of B-Mode (hyperechogenic lesion) ultrasound was 77.8% in identifying AML. The diagnostic performance of the attenuation map showed a diagnostic performance of 92.6%, whereby UGAP measurements were successful in 76.9% of cases. Quantitatively, we found a significant difference (p < 0.034) in mean measured attenuation between AML (0.764 ± 0.162 dB/cm/MHz) vs. other renal tumours (0.658 ± 0.155 dB/cm/MHz). The best performance was found by a combined parameter of a hyperechogenic lesion with a positive attenuation map with an accuracy of 95.0%. In conclusion, UGAP may represent a possibility for differentiating solid renal lesions more accurately by ultrasound, especially classic hyperechoic AMLs from other renal lesions. Further studies are needed to increase the diagnostic reliability further.

Synchronous Bilateral Ovarian Carcinomas With Right Mesonephric-like Adenocarcinoma and Left High-grade Serous Carcinoma: A Case Report and Review of the Literature.

Mesonephric-like adenocarcinomas (MLAs) are rare neoplasms of the uterus corpus and ovary, while high-grade serous carcinoma (HGSC) is the most common and lethal epithelial ovarian malignancy. We report a case of a 56-yr-old woman who presented with bilateral solid and cystic ovarian masses. She underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, lymphadenectomy, omentectomy, and peritoneal biopsies. Histopathologic examination of the bilateral ovarian masses revealed 1 ovary with MLA, and the other ovary showed HGSC in association with serous tubal intraepithelial carcinoma. The morphology, immunophenotypes, and molecular profiling of the HGSC and the MLA were distinct and as expected for the different tumor types: HGSC was diffusely positive for WT-1, estrogen receptor, and p53 (mutant pattern), while negative for GATA-3 and TTF-1; MLA was positive for GATA-3 and TTF-1, while negative for WT1, estrogen receptor, and p53 (wild-type pattern); both tumors were diffusely positive for PAX-8. The HGSC revealed a TP53 c.659A>G (p.Y220C) mutation, and the MLA revealed a KRAS c. 34G>T (p. G12C) mutation and a PIK3CA c. 1034A>T (p. N345I) mutation. To the best of our knowledge, this is the first reported case of synchronous bilateral ovarian carcinomas with MLA and contralateral ovarian HGSC.

Increased needle passes for comparable diagnostic yield in endoscopic ultrasound-guided tissue acquisition for pancreatic stiff lesions measured by elastography

Background/objectivesPancreatic cancer is characterized by tissue stiffness due to the high concentration of cancer-associated fibroblasts and extracellular matrix. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) is performed to diagnose pancreatic cancer but yields false-negative results attributed to inadequate specimens. EUS-elastography is a real-time assessment method to pancreatic tissue stiffness. This study aims to investigate the correlation between diagnostic yield and the number of needle passes based on the stiffness measured by elastography. MethodsPatients who underwent EUS-TA for pancreatic solid mass were retrospectively reviewed and included in this study. The number of needle passes during EUS-TA was determined based on macroscopic on-site evaluation. Tissue stiffness measurements were taken using EUS-elastography. The primary study outcome was the diagnostic yield. The secondary outcome included the number of needle passes required for a diagnosis. ResultsA total of 652 patients were included. The average stiffness differed depending on the location of the tumor, and high-stiffness group had more malignant lesions. Although the diagnostic yield was not significantly different between groups, the number of needle passes was significantly higher in the high-stiffness group (3.6 ± 1.0 vs. 3.2 ± 0.9, p < 0.001). ConclusionsThe higher the stiffness of the pancreatic mass in EUS-elastography, the more needle passes are required to achieve a comparable diagnostic yield.

Feasibility and Reproducibility of T2 Mapping Compared with Diffusion-Weighted Imaging in Solid Renal Masses.

Accurate prediction of renal mass subtypes, along with the WHO/ISUP grade and pathological T (pT) stage of clear cell renal cell carcinoma (ccRCC), is crucial for optimal decision making. Our study aimed to investigate the feasibility and reproducibility of motion-robust radial T2 mapping in differentiating lipid-poor angiomyolipoma (MFAML) from RCC and characterizing the WHO/ISUP grade and pT stage of ccRCC. Finally, 92 patients undergoing renal radial T2 mapping and ZOOMit DWI were recruited. The T2 values and apparent diffusion coefficient (ADC) were analyzed. Correlation coefficients were calculated between ADC and T2 values. Notably, ccRCC exhibited higher T2 and ADC values than MFAML (p < 0.05). T2 values were lower in the higher WHO/ISUP grade and pT stage of ccRCC (all p < 0.05). ADC showed no significant difference for pT stage (p = 0.056). T2 values revealed a higher area under the curve (AUC) in evaluating the WHO/ISUP grade compared to ADC (0.936 vs. 0.817, p = 0.027). T2 values moderately positively correlated with ADC (r = 0.675, p < 0.001). In conclusion, quantitative motion-robust radial T2 mapping is feasible for characterizing solid renal masses and could provide additional value for multiparametric imaging in predicting WHO/ISUP grade and pT stage of ccRCC.

Endoscopic ultrasound (EUS) elastography-guided fine-needle aspiration cytology (FNAC) versus conventional EUS FNAC for solid pancreatic lesions: A pilot randomized trial.

Endoscopic ultrasound guided fine-needle aspiration (EUS FNA) is the first-line modality to diagnose suspected solid pancreatic malignant lesions. Elastography-guided FNA has been shown to improve the diagnostic yield of EUS FNA but prospective studies are limited. The aim of the study was to compare diagnostic accuracy, sensitivity and specificity of conventional and elastography-guided EUS FNA in patients with suspected malignant pancreatic solid masses. Patients with suspected malignant solid pancreatic lesions presenting to our institute from July 2021 to January 2023 were recruited and randomized to conventional and elastography-guided EUS FNA using a 22-G EUS FNA needle. Diagnostic accuracy, sensitivity, specificity and positive and negative predictive values were calculated. Total 48 patients were initially screened for inclusion in the study, of which six were excluded and 42 patients underwent randomization. Finally, 20 patients in each group underwent the assigned intervention and were analyzed further. Baseline patient characteristics were similar in conventional FNA and elastography-guided FNA group with median age 52 (range 29-74) years and 51.8 (range 31-72) years, respectively, males being 70% and 75%, respectively. Median size of the lesion was 34mm (range 14-48mm) and 37 (range 18 to 50mm), respectively, for both conventional and elastography arm. The average size of the lesion was 35.7mm. Overall, the diagnosis of adenocarcinoma was made in 65% of cases. In the remaining cases, diagnoses were inflammatory mass, Castleman's disease, solid pseudopapillary epithelial neoplasm (SPEN), diffuse large B-cell lymphoma (DLBCL), pancreatic gastrointestinal stromal tumor (GIST) and metastasis. Conventional EUS FNA had diagnostic accuracy, sensitivity, specificity and positive and negative predictive values of 90%, 87.5%, 100%, 100% and 62.92%, respectively, and elastography-guided EUS FNA had diagnostic accuracy, sensitivity, specificity and positive and negative predictive values of 85%, 100%, 100% and 54.59%, respectively. No severe adverse events were noted. There is no significant difference between conventional and elastography-guided EUS FNA in terms of diagnostic accuracy, sensitivity, specificity and positive and negative predictive values. Both techniques appear safe and effective for characterizing solid pancreatic masses and elastography did not score numerically over the conventional arm.

Critical revision of check dams hydraulic design criteria

This paper addresses the problem of sizing the spillway of a closed check dam. Check dams are structures designed to control the solid transport and morphology of mountain streams. Paradoxically, however, their spillways are typically sized in clear-water conditions. The paper first analyses the behaviour of a check dam under clear water and then under live-bed conditions which is by far the most frequent operating condition. The theoretical approach is based on the conservation equations of solid mass, total mass, momentum and energy of the flow. The results of the theory are then compared with the results of some experiments in a laboratory channel equipped with a closed circuit for solid and liquid flow rates. The comparison between experiments and theory shows the validity of the approach. As expected, in some conditions that are far from rare, the design made in the clear-water condition is not safe.

The CT and pathological features of intestinal inflammatory myofibroblastic tumor

AbstractTo explore computed tomography (CT) findings and pathological features of intestinal inflammatory myofibroblastic tumors (IMT). A retrospective review was conducted on the CT features of five patients with pathologically confirmed IMT, which were then compared with the corresponding pathological findings. The study included four female and one male patients. The tumors were located in the rectum (n = 1), small intestine (n = 2), or cecum (n = 2). One patient exhibited a cystic solid mass with exophytic growth and the solid components showed moderate enhancement. Additionally, flaky low‐density, marginal line‐like calcified shadows were observed around the lesions. Two cases presented as solid masses within the lumen of the intestinal tract, showing obvious non‐uniform enhancement along with visible enhancement shadows of small blood vessels. One patient had a metastasis. In two other cases, solid masses grew outside the lumen of the intestinal tract, demonstrating progressive and delayed enhancement on enhanced scans, as well as local nodular enhancement and ring enhancement. These two cases also exhibited focal sarcomatoid lesions, along with their respective IMTs. Histologically, these tumors mainly consist of proliferating spindle myofibroblast cells accompanied by variable infiltration by interstitial inflammatory cells, such as fibroblasts. Immunohistochemical analysis revealed positive staining for smooth muscle actin (SMA) in ~80% of the cells tested, while vimentin staining was positive in ~60% of the cells. Intestinal IMT is an extremely rare tumor with imaging features that can reflect the underlying pathological characteristics to some extent, thus aiding diagnosis.

Focal myositis: a literature review of clinical and immunopathological aspects.

Focal myositis (FM) is a rare and restricted skeletal muscle inflammation, presenting as a solid mass with a typical lower leg localization and benign prognosis. In most cases the process solves spontaneously or after immunosuppressant therapy, but sometimes it recurs or progresses to a systemic inflammation. The basis of the disease are mostly unknown. Hence, we provide an update of histopathological features of FM, in order to better define the underlying pathomechanisms of this disorder. A PubMed literature search was focused on the case reports published in English from July 1977 to December 2023. FM and other myositis may show similar morphological features. Emerging studies on MMP molecules and future eventual research on microRNAs (miRNAs) could help in differential diagnosis. Clinical, laboratory, neurophysiological and imaging findings can allow a correct diagnosis. However, muscle biopsy seems to be the only diagnostic tool to differentiate among FM and other localized soft tissue masses.