Surgical Pathological Examination Research Articles

Analysis of BRAF Gene Mutation in Hashimoto's Thyroiditis With Multifocal Papillary Thyroid Carcinoma.

Thyroid cancer (TC) is a highly prevalent malignant tumor of the head and neck. Papillary thyroid carcinoma (PTC) is the primary pathological type of TC, accounting for more than 80% of all TCs. BRAF mutations are closely associated with PTC. However, the relationship among HT, PTC, and BRAF mutations has not yet been clarified. We aimed to investigate the BRAF mutation in Hashimoto's thyroiditis (HT) with PTC. A total of 72 patients with multifocal PTC were included and grouped based on surgical pathology examination. Group A (n = 32) had pure multifocal PTC and Group B (n = 40) had HT with multifocal PTC. Various features were compared: BRAF mutation, multifactorial analysis of BRAF mutations, pathological features in patients with HT and multifocal PTC, and multifactorial analysis of factors affecting HT with multifocal PTC. Significant differences were seen in thyroid peroxidase antibody levels, central lymph node metastasis, extra-thyroidal invasion, main and non-main lesion diameters, and BRAF mutation positivity (P < 0.05). Patients with the BRAF mutation had significantly higher rates of extra-thyroidal invasion and lymph node metastasis than those without the BRAF mutation (P < 0.05). Logistic regression analysis showed that BRAF mutation and main lesion nodule diameter were independent risk factors affecting extra-thyroidal invasion and central lymph node metastasis in patients with HT and multifocal PTC (P < 0.05). BRAF mutations were more prevalent and closely associated with extra-thyroidal invasion and central lymph node metastasis in patients with HT and multifocal PTC.

First incidence of extrarenal wilms tumor within the spinal canal in the adult population: a novel case report and literature review

BackgroundWilms tumor (WT), also known as nephroblastoma, is rare in adults, accounting for merely 3% of all nephroblastomas or 0.2 cases per million individuals. Extrarenal Wilms tumor (ERWT) emerges outside the renal boundaries and comprises 0.5 to 1% of all WT cases, with even rarer incidences in adults. Oncogenic mutations associated with ectopic nephrogenic rests (NR) may contribute to ERWT development. Diagnosis involves surgical resection and pathology examination. Due to scarce cases, adults often rely on pediatric guidelines. We thoroughly searched PubMed, Scopus, and Web of Science databases to establish our case’s uniqueness. To the best of our knowledge, this is the first documented incidence of extrarenal Wilms tumor within the spinal canal in the adult population.Case presentationA 22-year-old woman with a history of congenital lipo-myelomeningocele surgery as an infant presented with a 6-month history of back pain. This pain gradually resulted in limb weakness, paraparesis, and loss of bladder and bowel control. An MRI showed a 6 × 5 × 3 cm spinal canal mass at the L4-S1 level. Consequently, a laminectomy was performed at the L4-L5 level to remove the intramedullary tumor. Post-surgery histopathology and immunohistochemistry confirmed the tumor as ERWT with favorable histology without any teratomatous component.ConclusionThis report underscores the rarity of extrarenal Wilms tumor (ERWT) in adults, challenging conventional assumptions about its typical age of occurrence. It emphasizes the importance of clinical awareness regarding such uncommon cases. Moreover, the co-occurrence of spinal ERWTs and a history of spinal anomalies warrants further investigation.

Outcomes of Patients Undergoing Segmentectomy for Occult Node-Positive Clinical Stage IA Lung Cancer

BackgroundResults of recent clinical trials suggest that segmentectomy may be an acceptable alternative to lobectomy for selected patients with early-stage non-small cell lung cancer (NSCLC). Increased use of segmentectomy may result in a concomitant increase in occult node-positive (N+) disease on surgical pathology examination. The optimal management for such patients remains unknown. MethodsClinicopathologic data were abstracted from a prospective institutional database to identify patients with pathologic N+ disease after segmentectomy for cT1 N0 M0 NSCLC. Propensity score matching identified a comparable lobectomy cohort for assessment of cumulative incidence of recurrence and overall survival (OS). ResultsOf 759 included patients, 27 (4%) had nodal upstaging on the final pathology report. Of these 27 patients, 4 (15%) had skip metastasis to N2 stations, and 20 (74%) received adjuvant therapy; no completion lobectomies were performed. Ten patients (37%) had disease recurrence: 3 isolated locoregional (11%) and 7 distant (26%). The median time to recurrence among patients with recurrence was 1.8 years; OS after recurrence was 3.4 years. After 5:1 matching with 109 patients who underwent lobectomy, all variables were balanced between the groups, except pathologic N2 stage and open surgical approach. The 5-year cumulative incidence of recurrence was not significantly different between segmentectomy and lobectomy (42% vs 52%, respectively; Gray’s P = .1). The 5-year OS (63% and 50%) and rate of locoregional recurrence (12% vs 13%) were not statistically different between the groups. ConclusionsPatients with occult N+ disease after segmentectomy for cT1 N0 M0 NSCLC had limited isolated locoregional recurrences and outcomes similar to those in patients who underwent lobectomy. Lobectomy may not provide an advantage in these patients.

Case Report: Giant bronchogenic cyst compressing the pericardium and the lung hilum

Introduction: The bronchogenic cyst is a congenital anomaly of the trachea and the bronchi resulting in a malformation that develop in the bronchial tree, most often in the middle mediastinum. It is a benign pathology, often asymptomatic, however in the case of a large bronchogenic cyst, signs of compression of the intra-thoracic organs appear and early surgery is necessary to avoid complications. Case presentation: A 49-year-old patient was referred to our department with dry cough, dyspnea and chest tightness progressing for six months. Radiological exploration concluded that a giant bronchogenic cyst, 90 mm in diameter, was very probable. Surgery was performed via a right posterolateral thoracotomy. Intraoperatively, there was a large cystic formation 100mm*80 mm of the middle mediastinum in intimate contact with the origin of the right pulmonary artery, the lower right pulmonary vein as well as the right atrium exerting a compressive effect on the bronchi. The lesion was firmly adhered to the pericardium. The cystic was ‘en bloc’ resected in totality. The postoperative course was uncomplicated. Histological examination confirmed diagnosis of a bronchogenic cyst. The patient was asymptomatic throughout the follow-up period. Clinical discussion: Apart from the possibility of malignant degeneration, a bronchogenic cyst can increase in size and become huge causing serious complications. Despite the predictive diagnostic value of imaging, definitive diagnosis of a bronchogenic cyst is confirmed by surgical excision and pathological examination. Conclusions: Surgery is almost obligatory especially if the cyst is above a certain size (about 60 mm) and in the case of giant bronchogenic cysts.

Value of early pregnancy ultrasound combined with ultrasound score in the evaluation of placenta accreta in scar uterus: A retrospective cohort study.

The objective of this study is to investigate the value of early pregnancy ultrasound combined with ultrasound score (USS) for the evaluation of placenta accreta (PA) in scar uteri. Thirty cases of PA in scar uteri diagnosed by ultrasound at our hospital between June 2021 and June 2022 were selected retrospectively (observation group). In addition, 30 patients had placenta attached to the anterior wall of the uterus and covered the internal orifice of the cervix; however, no PA was selected in the same period (control group). The results of surgical pathology and ultrasound examination in the first trimester of pregnancy (11-14 weeks of pregnancy, fetal top hip length 4.5-8.4 cm) were analyzed. Ultrasonic image characteristics of the 2 groups were scored using an ultrasonic scoring scale. The ultrasonic signs and ultrasonic scores of the 2 groups were analyzed. The diagnostic value of ultrasound and USS for PA in the scarred uterus alone and in combination was analyzed based on the gold standard of surgical and pathological results. The rich blood flow signal at the junction of the uterine serosa and bladder, the rate of blood flow in the cavity of the placental parenchyma, the thinning rate of the myometrium after placenta, and the abnormal rate of the low echo area after placenta in the observation group were significantly higher than those in the control group (P < .05). The USS of the observation group was significantly higher than that of the control group (P < .05). The sensitivity (93.33%) and accuracy (95.00%) of the combined examinations were significantly higher than those of ultrasound (70.00% and 83.33%, respectively) (P < .05). The sensitivity and accuracy of combined examination were slightly higher than those of USS examination (83.33% and 90.00%), but the difference was not statistically significant (P > .05). There was no significant difference between the specificity of combined examination (93.33%) and ultrasound (96.67%) and USS (96.67%) (P > .05). Early pregnancy ultrasound and USS evaluation have high application value in the diagnosis and evaluation of early scar uterine PA. The combination of the 2 methods can further improve the sensitivity and accuracy of diagnosis.

Mouse kidney transplantation model: Three novel methods.

The mouse kidney transplantation model presents challenges in terms of surgical difficulty and low success rate, making it difficult to master. This study aims to provide a crucial model for transplantation immunology research by modifying and developing novel techniques for mouse kidney transplantation. A total of 57 pairs of mice were used to establish and compare the modified and innovative surgical techniques for mouse kidney transplantation. Three different surgical models were established, including the abdominal suture technique for orthotopic kidney transplantation, the abdominal cuff technique for orthotopic kidney transplantation, and the cervical cuff technique for ectopic kidney transplantation. BALB/c or C57BL/6 male mice, aged 8 to 12 weeks and weighed 20 to 25 g with specified pathogen free-grade were served as the donor mice or the recipient mice. The surgical technique characteristics, key surgical times, complications, and pathological examination in the early postoperative period were summarized and compared. Three different surgical models of mouse kidney transplantation were successfully established. The comparison of warm ischemic time for the 3 groups of mice showed no statistical significance (P=0.510 4). The abdominal suture group had the shortest total operation time of the donor compared with the abdominal cuff group and the cervical cuff group [(18.3±3.6) min vs (26.2±4.7) min and (22.8±2.5) min; both P<0.000 1]. There was a significant difference in cold ischemia time among the 3 groups (all P<0.000 1), with (60.8±4.1) min in the cervical cuff group, (43.3±5.0) min in the abdominal suture group, and (88.8±6.7) min in the abdominal cuff group. Due to different anastomosis methods, the cervical cuff group had the shortest time [(17.6±2.7) min], whereas the abdominal cuff group had the longest time [(38.8±5.4) min]. The total operation time for the recipients showed significant differences (P<0.000 1), with the abdominal suture group having the shortest time [(44.0±6.9) min], followed by the cervical cuff group [(64.1±5.2) min], and the abdominal cuff group [(80.0±6.0) min] being the longest. In the 32 mice of the abdominal suture group, there were 6 with intraoperative bleeding, including 1 arterial intimal injury bleeding and 5 with bleeding after vessel opening. Six mice had ureteral complications, including ureteral bladder anastomotic stenosis, necrosis, and renal pelvis dilation. Two mice had postoperative abdominal infections. In the abdominal cuff group, there was no intraoperative bleeding, but 6 mice showed mild arterial stenosis and 5 showed venous stenosis, 4 arterial injury, 4 arterial thrombosis, and 2 ureteral complications. No postoperative infections occurred in the mice. In the cervical cuff group, no intraoperative bleeding, arterial intimal injury, arterial/venous stenosis, or thrombosis were found in 13 mice. Five mice had ureteral complications, including ureteral necrosis and infection, which were the main complications in the cervical cuff group. The renal function in mice of the 3 groups remained stable 7 days after surgery. Hematoxylin and eosin staining and periodic acid-Schiff staining showed no significant differences in terms of acute rejection among the 3 surgical methods (all P>0.05). All 3 surgical methods are able to successfully establish mouse kidney transplantation models, with no significant differences observed in the short-term graft survival and acute rejection. The modified abdominal suture technique and abdominal cuff technique have their respective advantages in research applications. The novel cervical cuff technique for ectopic kidney transplantation model is relatively simple to be prepared and causes less trauma to the mice, providing more options for studies involving xenotransplantation, secondary transplantation, and local lymphatic drainage. However, the difficulty in harvesting the donor kidney and the high incidence of ureteral infections need further validation in long-term survival. This study holds important reference value for choosing the type of mouse kidney transplantation model for different research needs.

Analysis of High-Resolution CT Diagnosis for Pulmonary Ground-Glass Nodules

Objective: To analyze the diagnostic value of high-resolution CT for pulmonary ground-glass nodules. Methods: 60 patients with pulmonary ground-glass nodules admitted from June 2021 to December 2022 were selected as research subjects. All patients underwent surgical pathological and high-resolution CT examinations, and the findings observed under high-resolution CT were recorded. The surgical pathology examination results were used as the benchmark in determining the size of the ground-glass nodules and analyzing the detection rate of various signs of benign and malignant lesions and the consistency of the diagnostic results. Results: After surgical pathological examination, 42 cases were determined to be malignant lesions, and 18 cases were benign lesions. The maximum diameter of pulmonary ground-glass nodules ranged from 5 to 35 mm (10.79 ± 0.71 mm). The detection rate of malignant lesions was higher than that of benign lesions. The consistency of the results of high-resolution CT examination for lesions was 88.33%, and the misdiagnosis rate was 11.67%. The accurate identification rate of malignant pulmonary ground-glass nodules was higher than that of benign pulmonary ground-glass nodules (P &lt; 0.05). Conclusion: High-resolution CT is highly accurate in diagnosing pulmonary ground-glass nodules, especially malignant ones.

The diagnostic accuracy of cerebral amyloid angiopathy criteria between modified Boston criteria v1.5, Boston criteria v2.0, and simplified Edinburgh criteria – the first Thai cerebral amyloid angiopathy pathological confirmed cohort.

AbstractBackgroundThe gold standard of cerebral amyloid angiopathy (CAA) diagnosis are surgical pathology or postmortem examination, which are scarcely done in clinical practice. Thus, the current diagnostic criteria are mainly based on clinic‐radiological characteristics, including modified Boston criteria v1.5 [Linn J, et al. 2010] and Boston criteria v2.0 [Charidimou A, et al. 2022], which are magnetic resonance imaging (MRI)‐based, as well as simplified [Sembill JA, et al. 2022] and full [Rodrigues MA, et al. 2018] Edinburg criteria, which are computerized topography (CT)‐based. These criteria had been developed based on patients in western countries. Therefore, the application of these criteria in Asian population, especially in South‐East Asian, is limited. This study aimed to explore the clinico‐radiological characteristics and the accuracy of the current diagnostic criteria among Thai CAA patients.MethodCongo Red staining brain histopathological specimens in King Chulalongkorn Memorial Hospital, Thailand during 2011‐2021 were reviewed. Patients’ characteristics were gathered from the best available data in electronic medical records. Each clinical event was analyzed separately. Radiological biomarkers in brain CT and MRI which had been done closet to the pathological confirmed date were systematically rated by trained investigators. Level of diagnosis was assessed based on the modified Boston criteria v1.5, Boston criteria v2.0, and simplified Edinburg criteria.ResultEight patients had pathological‐confirmed CAA and 11 clinical events from these patients were reviewed. The clinico‐radiological characteristics are shown in Table 1. Comparisons of the level of diagnosis between the criteria are shown in Table 2 and the diagnostic accuracy of the criteria using the Boston criteria v1.5 and v2.0 as reference standards are summarized in Table 3. The Boston criteria v2.0 revealed the better sensitivity compared with v1.5 (probable CAA, 63.6% vs 54.4%), likely due to an inclusion of non‐hemorrhagic biomarkers; whereas the simplified Edinburgh criteria showed lower sensitivity compared with Boston criteria. The AUC of probable CAA in Boston criteria v1.5 using v2.0 as a reference standard was 0.93 (95%CI[0.76‐1.00], sensitivity 85.7%, and specificity 100%).ConclusionWe performed the application of most recent current diagnostic criteria in CAA Thai population. The larger and well‐designed confirmatory study in Asian cohort is needed.

SAT218 Refractory Hypocalcemia From Combined Autosomal Dominant Hypocalcemia Type 2 And Postsurgical Hypoparathyroidism

Abstract Disclosure: M. Sonmez Ince: None. F. Hannan: None. N. Esfandiari: None. M. Hussain: None. M.R. Haymart: None. R.V. Thakker: None. G.A. Clines: None. Background: Autosomal dominant hypocalcemia type 2 (ADH2), due to activating mutations in GNA11, is a rare disorder that causes hypocalcemia with low or inappropriately normal PTH. Postsurgical hypoparathyroidism (PSHP) is the most common etiology for hypoparathyroidism. The patient described was afflicted by both conditions and had persistent hypocalcemia despite aggressive management. Clinical Case: A 50-year-old female was found to have an enlarged thyroid on exam and subsequently diagnosed with papillary thyroid cancer (PTC). She underwent a total thyroidectomy without parathyroid autotransplantation since parathyroid glands were not identified during intraoperative pathologic survey. Surgical pathologic examination confirmed PTC with the identification of a single and small intrathyroidal parathyroid gland. Due to the patient’s low risk (T1N0M0), radioactive iodine ablation was not performed. Before thyroidectomy, serum corrected calcium was 6.4-8.5 mg/dL (8.6-10.3 mg/dL) and PTH was 9-21 pg/mL (10-65 pg/mL) during the previous 20 years. Following thyroidectomy, the patient had multiple emergency department visits due to hypocalcemia, hand cramping, and paresthesias. The patient was diagnosed with postsurgical hypoparathyroidism: corrected calcium 5.6-6.7 mg/dL, 24-hour urine calcium 112 mg (100-300 mg/24hour), magnesium 1.4-1.9 mg/dL (1.6-2.6 mg/dL), phosphorus 3-8.2 mg/dL (2.7-4.6 mg/dL). PTH remained &amp;lt;6 pg/mL. The patient was then referred to an academic endocrinology. TSH, AM cortisol, 25-vitamin D, iron, ceruloplasmin, copper, and 21-hydroxylase antibody concentrations were normal. Genetic testing revealed a pathogenic GNA11 variant (c.178C&amp;gt;T, p.(Arg60Cys)); no mutations were identified with CASR or AP2S1. Despite aggressive management with total daily oral calcitriol up to 12 mcg daily, calcium 8 grams, and chlorthalidone, the patient required calcium infusions thrice weekly. Despite the addition of teriparatide 20 mcg BID, the patient remained dependent on calcium infusions, with improvement after the addition of IV calcitriol. Recently, continuous teriparatide delivery was started using an Omnipod insulin pump that has significantly reduced the patient’s dependence on calcium infusions with serum calcium that are now 8-9 mg/dL. Conclusion: ADH2, due to gain-of-function mutations of GNA11, that encodes the Gα11 protein, causes life-long hypocalcemia that is often asymptomatic and undiagnosed. We report here the first documented case of combined ADH2 and PSHP. This case highlights that patients with ADH2 likely have hypoplastic parathyroid glands and that caution is required with procedures that may disrupt parathyroid gland function. Furthermore, the refractory nature of this patient’s hypocalcemia may suggest that GNA11 mutations in the kidney and skeleton reduce the effectiveness of standard hypocalcemia treatments. Presentation: Saturday, June 17, 2023

Apical pulmonary hydatid cyst: About a rare cause of Pancoast syndrome

Objectives: Our purpose is to illustrate the radiological aspects of an apical hydatid cyst as a rare cause of Pancoast Tobias syndrome. Material: We report the case of a 35 years-old man, who was admitted to our department with a Pancoast tobias syndrome. Results: The patient presented to our department with a history of shoulder and right chest pain radiating downward toward the ulnar side of his homolateral arm. He also reported hemoptysis and hydatidemesis (hydatid cysts and membranes in the vomitus). Radiological investigations suggested the diagnosis of hydatid cyst of the left lung apex which was confirmed by surgical excision and pathological examination of the lesion. This case highlights an uncommon etiology of Pancoast syndrome which might mislead physicians in their practice. Conclusion: In conclusion, a primary hydatid cyst should be considered in the differential diagnosis of Pancoast's syndrome especially in endemic regions. Unlike Pancoast tumors, this benign lesion has a very favourable prognosis and good surgical results.

Serum CA-125 as a predictor in the early diagnosis of ectopic pregnancy in Vietnam – A case-control study

IntroductionThis study aimed to determine the predictive value of cancer antigen-125 (CA-125) in combination with serum beta-human chorionic gonadotropin (β-hCG) and progesterone in the early detection of ectopic pregnancy (EP). MethodsBetween May 2019 and May 2020, the cross-sectional study recruited 42 cases of EP and 42 cases of IUP at the same gestational age who visited the Department of Obstetrics and Gynecology, Hospital of Hue University of Medicine and Pharmacy. EP was diagnosed based on surgical (laparoscopy) and postoperative pathology examination. ResultsThere were significant differences of mean level of β-hCG (2570 mUI/mL vs. 18357.7 mUI/mL), progesterone (10.79 ± 8.16 ng/ml vs. 27.42 ± 4.17 ng/ml) and CA-125 (26.90 ± 10.26 U/mL vs. 70.61 ± 20.89 U/mL) between the EP and the IUP groups (p < 0.001). In the prediction of early diagnosis of EP, the cut-off value of CA-125 at 30.94 U/mL has a sensitivity of 89.3% and a specificity of 87,9%; the cut-off value of β hCG at 2750mIU/ml has the sensitivity of 75%, specificity of 78,8%; the cut-off value of progesterone at 10.24 ng/mL has the sensitivity of 85.7%, specificity of 81.8%. A combination of CA-125, β hCG, and progesterone had a sensitivity of 92.8% and a specificity of 90.9% in early diagnosis of EP. DiscussionSerum CA-125 levels can be used independently or in combination with other markers in the early diagnosis of EP.

PARa-aOrtic LymphAdenectomy in locally advanced cervical cancer (PAROLA trial): a GINECO, ENGOT, and GCIG study

BackgroundPositron emission tomography/computed tomography (PET/CT) fails to detect approximately 25% of aortic lymph node metastasis in patients with PET/CT stage IIIC1 cervical cancer. Surgical staging could lead to treatment modification...

Large cell acanthoma in a 10-year-old child: A case report

Introduction: Large cell acanthoma (LCA) is a rare benign tumor of epidermal origin. It is mainly seen on sun-exposed areas such as the head and extremities of older patients. Histopathologically, LCA is characterized by acanthosis and keratinocytes that are twice as large as normal cells. We herein report a case involving a child diagnosed with LCA on an unexposed area of skin. Case presentation: A 10-year-old boy presented with a rough, painless light brown papule on his right chest that had been present for 11 months. He underwent surgical resection and pathological examination, and the histopathological findings were consistent with LCA. Discussion: LCA is common in adults but rare in children. It is difficult to differentiate from solar lentigo, actinic keratosis, or seborrheic keratosis because of its atypical clinical presentation. Dermoscopy, reflectance confocal microscopy, and cellular-resolution full-field optical coherence tomography can be used as auxiliary examinations, but pathological biopsy is still required to confirm the diagnosis. Conclusion: LCA is not limited to adults and exposed areas. This case reminds us that LCA may occur in children and that close attention is required for its identification.

18F FDG-PET/CT analysis of spread through air spaces (STAS) in clinical stage I lung adenocarcinoma.

The purpose of this retrospective study was to investigate the utility of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG-PET/CT) to predict spread through air spaces (STAS) in clinical stage I lung adenocarcinoma. Between April 2020 and January 2022, 52 patients (55 lesions) who underwent surgery for clinical stage I lung adenocarcinoma were enrolled. The lesions were divided into two groups according to the presence of STAS. 18F FDG-PET/CT parameters, specifically the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), were calculated. The SUVmax, MTV, and TLG were compared between the two groups upon surgical pathological examination. Receiver operating characteristic (ROC) curve analysis was performed to identify a cut-off value. Nineteen lesions (35%) were positive for STAS and 36 lesions were negative for STAS. According to the presence of STAS, significant differences were detected in the SUVmax (5.21 [range 1.52-16.50] vs. 2.42 [range 0.74-11.80], p = 0.0040) but not MTV (3.44 [range 0.65-24.36] vs. 2.95 [0.00-20.07], p = 0.20) and TLG (7.92 [range 0.93-47.82] vs. 5.63 [0.00-58.66], p = 0.14). SUVmax had an AUC value of 0.74 (95% CI 0.61-0.87) with a sensitivity of 89.5% and specificity of 52.8% at a cut-off of 2.48. SUVmax rather than MTV and TLG were shown to be valuable indices for the prediction of STAS in clinical stage I lung adenocarcinoma.

The value of ACR-TIRADS and C-TIRADS in the diagnosis of nodular Hashimoto thyroiditis and papillary thyroid carcinoma with Hashimoto thyroiditis

Objective:To explore the diagnostic value of American Society of Radiology Thyroid Imaging Reporting and Data System（ACR-TIRADS） and Chinese Thyroid Nodule Ultrasound Malignant Risk Stratification（C-TIRADS） in nodular Hashimoto thyroiditis and papillary thyroid carcinoma with Hashimoto thyroiditis. Methods:This retrospective analysis included 144 patients（204 thyroid nodules） accompanied by nodular Hashimoto thyroiditis or papillary thyroid carcinoma under the background of Hashimoto thyroiditis confirmed by surgical pathology examination in the First Affiliated Hospital of Hebei North University from August 2018 to May 2021, all nodules were examined by ultrasound, and 204 nodules were scored and graded according to the classification standards of ACR-TIRADS and C-TIRADS. The surgical pathological results were the gold standard. The receiver operating characteristic curve of ACR-TIRADS and C-TIRADS was constructed to evaluate and compare the diagnostic performance of the two guideline. Results:①Ultrasound feature results showed that nodular Hashimoto thyroiditis and Papillary thyroid carcinoma had statistically significant differences in the location, echogenicity, calcifications and margins（P<0.001）, but there is no significant difference in structure and aspect ratio between the two kinds of nodular（P=0.141, P=0.240）; nodular Hashimoto thyroiditis were mostly absent focal echogenicity and hyperechogenicity, while papillary thyroid carcinoma was mostly manifested as focal echogenicity and extrinsic thyroid invasion. ②The sensitivity and negative predictive value of C-TIRADS were 91.7% and 83.1%, respectively, which were higher than those of ACR-TIRADS, and the difference was statistically significant（P=0.021, P=0.013）; The specificity and positive predictive value of C-TIRADS T were 98.3% and 99.2%, both of which were slightly higher than ACR-TIRADS, althought the difference was not statistically significant（P=0.157, P=0.062）. The area under the curve of the ACR-TIRADS and C-TIRADS were 0.806 and 0.941, respectively, and the difference was statistically significant（P=0.031）. ③The unnecessary FNAB rate of C-TIRADS was 10.3%, which was lower than ACR-TIRADS. Conclusion:C-TI-RADS has a better diagnostic value of nodular Hashimoto thyroiditis and thyroid papillary carcinoma under the background of Hashimoto thyroiditis, which is helpful for clinical evaluation of such nodules.

Sonography of Primary Cervical Neuroblastoma in the Infant

A palpable neck mass in a newborn or young child is overwhelmingly benign but can require additional evaluation to exclude the rare malignant etiology. We present a 10-month-old female with a non-tender, non-erythematous firm nodule in the left neck initially suspected to be enlarged lymph nodes. Sonographic imaging was concerning for a diagnosis of neuroblastoma confirmed by surgical resection and pathologic examination. The sonographic characteristics associated with neuroblastoma are important to recognize to accurately diagnose the neoplasm and improve patient management.

The “rail sign”: an ultrasound finding in placenta accreta spectrum indicating deep villous invasion and adverse outcomes

Ultrasound has demonstrated a high accuracy in the prenatal diagnosis of placenta accreta spectrum. However, it is not known whether ultrasound findings can pinpoint the depths of villous invasion, recommend surgical strategies, and predict clinical outcomes. We described an ultrasound descriptor for the placenta accreta spectrum and investigated whether it can predict the severity of villous invasion and clinical outcomes. The patients with placenta accreta spectrum in this retrospective cross-sectional study were diagnosed and managed in our hospital from 2002 to 2017. The placenta, with overlying myometrium and bladder, was mapped with color Doppler sonography while the patient's bladder was full. A "rail sign" was defined as 2 parallel neovascularizations depicted by color Doppler sonography over the uterovesical junction and bladder mucosa, with interconnecting bridging vessels perpendicular to both. The patients received serial ultrasound examinations and surgery at our hospital. An unpaired t test and Pearson chi-square test compared the pathology subtypes, surgical strategies, and clinical outcomes in patients with or without a rail sign. We enrolled 133 consecutive cases of placenta accreta spectrum confirmed either by surgical inspection or pathology examination. Patients with a rail sign had a significantly higher risk of an abnormally invasive placenta (placenta increta or placenta percreta) than those patients without a rail sign (83.3% [60 of 72] vs 27.9% [17 of 61]; odds ratio, 12.94; P<.001). In addition, patients with a rail sign had a higher probability of perioperative approaches, including preoperative vascular control (58.3% [42 of 72] vs 21.3% [13 of 61]; odds ratio, 5.17; P<.001) and uterine artery embolization (34.7% [25 of 72] vs 11.5% [7 of 61]; odds ratio, 4.1; P=.0002]. Furthermore, patients with a rail sign carried a higher risk of adverse clinical outcomes than patients without a rail sign, such as blood transfusion (80.6% [58 of 72] vs 36.1% [22 of 61]; odds ratio, 7.34; P<.001], admission to the intensive care unit (33.3% [24 of 72] vs 16.4% [10 of 61]; odds ratio, 2.55; P=.026), hysterectomy (75% [54 of 72] vs 24.6% [15 of 61]; odds ratio, 9.2; P<.001), and bladder invasion (16.7% [12 of 72] vs 4.9% [3 of 61]; odds ratio, 3.86; P=.033). Notably, the negative predictive value of bladder invasion was 95.1%, indicating a high confidence to reject bladder invasion while the rail sign was negative. When the rail sign was used as a screening test, the positive likelihood ratio of predicting deep villous invasion was 3.64 and correlated with an increased probability of 20% to 25%. Patients with a rail sign also had a greater blood loss (2944±2748 mL vs 1530±1895 mL; P<.001) and a longer hospital stay (11.9±10.9 days vs 8.6±7.1 days; P=.036) than patients without a rail sign. A "rail sign" depicted by color Doppler sonography correlates with deeper villous invasion, additional perioperative approaches, and more adverse outcomes.

Colored Doppler Ultrasound Diagnosis and Pathological Analysis of Superficial Organ and Vascular Diseases

This paper proposes a fully digital signal processing scheme for ultrasonic Doppler endoscope imaging. 200 patients with superficial tissue lumps were randomly divided into two groups: the control group and the experimental group. These two groups used conventional ultrasound examination and colored Doppler ultrasound imaging technology, respectively, to observe and compare the test method and the surgical pathological examination results. Compared with the results of the two groups, the diagnostic compliance rate of the patients in the experimental group was 99.0% significantly higher than the diagnostic compliance rate of 86.0%. At the same time, 300 patients with surgery and pathologically confirmed superficial organ lesions were selected in the hospital, and all patients were diagnosed by ultrasound to observe the diagnosis. The clinical effects of colored Doppler ultrasound to diagnose vascular lesions in the lower extremities of diabetes were discussed. The rate of arteriosclerosis in the lower extremities of the observation group was 92.32%. The more than 50% vascular stenosis rate was 45.16%. The vascular blocking rate was 16. 13% and thrombosis rate 6.45% were significantly higher than the control group 12.90%, 8.06%, 0.00%, 0.00%. In the diagnosis of superficial tissue lesions, the resolution of colored Doppler ultrasound imaging technology is relatively high, which can significantly improve the clinical diagnosis rate and has clinical application value.

Risk factors for the development of tubo-ovarian abscesses in women with ovarian endometriosis: a retrospective matched case\u2013control study

BackgroundThe purpose of this study was to assess the risk factors associated with the development of tubo-ovarian abscesses in women with ovarian endometriosis cysts.MethodsThis retrospective single-center study included 176 women: 44 with tubo-ovarian abscesses associated with ovarian endometriosis and 132 age-matched (1:3) patients with ovarian endometriosis but without tubo-ovarian abscesses. Diagnoses were made via surgical exploration and pathological examination. The potential risk factors of tubo-ovarian abscesses associated with ovarian endometriosis were evaluated using univariate analysis. The results (p ≤ 0.05) of these parameters were analyzed using a multivariate model.ResultsFive factors were included in the multivariate conditional logistic regression model, including in vitro fertilization, presence of an intrauterine device, lower genital tract infection, spontaneous rupture of ovarian endometriosis cysts, and diabetes mellitus. The presence of a lower genital tract infection (odds ratio 5.462, 95% CI 1.772–16.839) and spontaneous rupture of ovarian endometriosis cysts (odds ratio 2.572, 95% CI 1.071–6.174) were found to be statistically significant risk factors for tubo-ovarian abscesses associated with ovarian endometriosis.ConclusionsAmong the factors investigated, genital tract infections and spontaneous rupture of ovarian endometriosis cysts were found to be involved in the occurrence of tubo-ovarian abscesses associated with ovarian endometriosis. Our findings indicate that tubo-ovarian abscesses associated with ovarian endometriosis may not be linked to in vitro fertilization as previously thought.

A Case Report of Lupus Panniculitis in a Hemodialysis Patient with Lupus Nephritis

Background: Systemic lupus erythematosus and lupus nephritis are relatively common autoimmune diseases that can cause damage to multiple systems. Aim: To investigate the lupus activity of patients with lupus nephritis on hemodialysis and the combined occurrence of lupus panniculitis. Case introduction: A patient with lupus nephritis on regular hemodialysis had a symmetrical hard mass under the skin of his abdomen. After surgical resection and pathological examination, she was diagnosed with lupus panniculitis and was treated with glucocorticoids and hydroxychloroquine. After that, no new subcutaneous masses appeared, and the unresectable part of the masses did not increase. Conclusion: 1) Lupus activities in patients with lupus nephritis entering end-stage renal disease still need to be paid attention to. 2) Lupus panniculitis can occur on the skin of the abdomen, and it needs to be differentiated from connective tissue panniculitis, sclerosing panniculitis and other diseases.