Surgical Pathology Research Articles (Page 1)

Circumferential rectal tumors treated with total neoadjuvant therapy have the potential to develop into a stricture. These strictures can make assessment of clinical response challenging and are considered a contraindication to non-operative management according to the National Comprehensive Cancer Network guidelines. However, the incidence of stricture formation and its likelihood of harboring occult residual disease remains poorly understood. To investigate which patients with locally advanced rectal cancer are at risk for stricture formation after total neoadjuvant therapy and assess residual tumor at the time of surgery. Retrospective study. Single tertiary care center. Stage II or III rectal cancer patients who underwent total neoadjuvant therapy with curative intent surgery. The rate of stricture formation after total neoadjuvant therapy and pathologic complete response rate after proctectomy at the primary tumor site. Total neoadjuvant therapy. Of the 69 patients included in the analysis, 18 patients (26%) had a circumferential rectal tumor. Four (22%) of these 18 patients developed a stricture at the primary tumor site. No other patients in the study developed a stricture. All four patients with a post-treatment rectal stricture underwent proctectomy due to the concern for residual disease within the stricture despite complete response on endoscopy and magnetic resonance imaging. Three (75%) of the four stricture patients had residual primary disease on final surgical pathology. Fourteen patients with circumferential tumors did not develop a stricture but underwent a proctectomy for incomplete response. Eleven out of 14 (79%) had a pathologic incomplete response. Limited sample size. Seventy-five percent of these patients with a stricture were found to have residual disease on surgical pathology despite classic findings of complete clinical response. This highlights the inherent difficulty in pursuing non-operative management in this patient population. See Video Abstract.

Objective This study aimed to assess the value of preoperative [ 68 Ga]Ga-FAPI-04 positron emission tomography (PET) for evaluating pathological complete response (pCR) in patients with gastrointestinal adenocarcinomas receiving neoadjuvant therapy (NAT). Materials and Methods A retrospective analysis was conducted on patients with gastrointestinal adenocarcinomas who received [ 68 Ga]Ga-FAPI-04 PET/MR scans between February 2021 and January 2024. The enrolled patients had completed preoperative NAT, undergone contemporary enhanced CT or MR scans, and received surgery within one month after PET imaging. Clinical data, imaging evaluations, PET parameters (standardized uptake values [SUVs], SUVs standardized by lean body mass [SUL], FAPI-positive tumor volume [FAPI-PTV], and total lesion burden [FAPI-TL]), and surgical pathology results were collected. Each parameter’s sensitivity, specificity, and diagnostic cutoff for predicting pCR were determined via receiver operating characteristic curve analysis. Logistic regression analysis identified independent predictors of pCR. Results Sixty-five patients were enrolled, and 22 patients achieved pCR according to surgical pathology. In visual evaluation, [ 68 Ga]Ga-FAPI-04 PET was limited in its ability to assess pCR, with 16 false positives and 1 false negative. The dichotomization using the FAPI-PTV cutoff value (<1.92 cm 3 ) improved the specificity for predicting pCR to 72.7%, while retaining a high sensitivity of 93.0%. Enhanced CT or MR scans had the sensitivity and specificity of 72.7% and 93.0% in predicting pCR, respectively. According to the logistic regression analysis, a FAPI-PTV<1.92 cm 3 was an independent predictor for patients who achieved a pCR ( p <0.05). Conclusion [ 68 Ga]Ga-FAPI-04 PET shows promise in predicting pCR among patients with gastrointestinal adenocarcinomas following NAT. FAPI-PTV derived from [ 68 Ga]Ga-FAPI-04 PET may provide an effective clinical tool for guiding further treatment.

Introduction: Gonococcal infective endocarditis (IE) is a rare but aggressive complication of disseminated gonococcal infection (DGI), occurring in only 1–2% of DGI cases. While DGI typically presents as a triad of arthralgia, tenosynovitis, and skin lesions, cardiac involvement is very uncommon and often easily missed. We report a unique case of gonococcal IE in a healthy young male without any genitourinary symptoms. Case Presentation: A 24-year-old male with no past medical history presented to the ED with dull, non-radiating substernal chest pain, worsened by rest and relieved by leaning forward. Vital signs revealed a temperature of 100.3°F and a heart rate of 120 bpm. Physical examination noted a grade 3/6 diastolic murmur, loudest at the left upper sternal border. He denied IV drug use but reported remote oral and vaginal sexual encounters. Transthoracic echocardiography (TTE) showed an ejection fraction of 58% with a mobile echodensity on the aortic valve, severe aortic regurgitation, and holo-diastolic flow reversal in the descending aorta. Transesophageal echocardiography (TEE) confirmed a 1.4 × 0.8 cm mobile echogenic mass consistent with vegetation, and an abscess in the right coronary part of the aortic annulus. The patient was started on broad-spectrum antibiotics, including vancomycin and ampicillin-sulbactam. Intraoperatively, vegetations were observed on the left and right coronary leaflets, with a small perivalvular abscess at the left-right coronary commissure. The aortic valve was reconstructed with a mechanical valve. Blood cultures and throat swabs were positive for Neisseria gonorrhoeae. Surgical pathology revealed moderate to severe acute and chronic inflammation, consistent with acute/subacute infective endocarditis, although tissue Gram stain was negative for definitive bacteria. Conclusion: Gonococcal IE is an exceedingly rare yet life-threatening entity, with reported mortality rates of 19–20%, likely due to rapid valvular destruction and large vegetations. Interestingly, valve cultures are often sterile, so diagnosis typically relies on blood or mucosal cultures. Given the potentially devastating consequences of delayed recognition, this case emphasizes the importance of considering gonococcal etiology in endocarditis, particularly in young, sexually active individuals without classic symptoms. Reporting such cases helps towards forming evidence-based treatment guidelines and strengthening awareness of this rare presentation.

Introduction. A fairly large number of cancer patients with surgical pathology enter a hospital with nutritional insufficiency of varying degrees. According to the international screening study Nutrition Day, weight loss is associated with a higher risk of inpatient death within 30 days in patients undergoing surgery as compared with patients who were not treated surgically. Pain syndrome in the postoperative period has a negative effect on all vital systems of the body, increases the wound healing period and creates a risk of adverse hemodynamic events, thromboembolic complications and chronic pain syndrome. Enhanced sympathetic stimulation inhibits peristalsis and enhances the smooth muscles tone of the intestine, which is fraught with the development of postoperative intestinal paresis. Opioid-associated adverse events such as respiratory depression, gastrointestinal disorders (nausea, vomiting, constipation), sleep, endocrinopathies, cognitive impairment, high risk of addiction and drug dependence impair the quality of care provided Aim. To compare the effectiveness and safety of the innovative Russian analgesic Tafalgin® and morphine in cancer patients with nutritional insufficiency in the early postoperative period. Materials and methods. The open-label randomized controlled trial included 80 patients who underwent abdominal surgery. Patients received multimodal analgesia with either tafalgina or morphine. Results. According to the data obtained during the study, tafalgin provides analgesia comparable to morphine, while contributing to earlier mobilization, reducing the length of hospital stay, reducing the incidence of postoperative complications, hypoxemia, nausea and vomiting. The drug was also associated with lower severity of sedation and daytime sleepiness. Conclusion. Tafalgin has demonstrated high analgesic potential and a better safety profile as compared to morphine allowing its use in multimodal analgesia in cancer patients with nutritional insufficiency after abdominal surgery.

Lesions of the parapharyngeal space (PPS) represent a challenging surgical pathology for resection, especially when critical structures like the parapharyngeal internal carotid artery (ppICA) are difficult to visualize and access. Current approaches provide inadequate visualization and incomplete access with significant morbidity. We investigate a novel approach, the intermaxillary-mandibular (IMM) approach, and compare this approach to traditional surgical approaches for visualization and access to the PPS and ppICA. A single-institution anatomical study with endoscopic IMM approach and transcervical/transparotid (TCTP) approach dissections was performed in two cadaver heads. The qualitative advantages and disadvantages of both the IMM and traditional TCTP approaches are described and compared. Using the IMM approach, the ppICA can be completely mobilized as it enters the skull base in the upper PPS (UPPS). Compared to traditional TCTPA approaches, the IMM approach provides greater visualization of the ppICA entering the skull base with less risk of facial nerve injury, and provides more direct access to the ppICA entering the skull base compared to the TCTPA with a surgical corridor length (SCL) of 50.2 versus 63.5 mm, p = 0.001. Achieving surgical access to the PPS for ppICA lesions is difficult due to the proximity of critical structures and the bony confines of the mandible, maxilla, and skull base. Lesions near or involving the ppICA require wide access to the ppICA including complete mobilization for optimal and safe surgical intervention. Our novel IMM approach allows access to the entire UPPS and mobilization of the ppICA. N/A.

Hyperandrogenism, while one of the most common endocrine disorders in women, is relatively uncommon in the postmenopausal population. When present, it may be indicative of an underlying rare androgen-secreting ovarian tumor. Here, we report 2 cases: a 63-year-old woman with 2 years of male-pattern baldness and hirsutism and a 71-year-old female with 2 years of progression to complete scalp alopecia, hirsutism, and libido changes. Upon endocrine evaluation, testosterone concentrations were markedly elevated for both patients. In the first case, there was no radiologic evidence of ovarian mass on ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). In the second case, transvaginal ultrasound (TVUS) detected an ovarian lesion, which guided further radiologic workup; however, positron emission tomography (PET) and MRI were unremarkable. In case 1, surgical pathology upon total hysterectomy with bilateral salpingo-oophorectomy revealed bilateral Leydig cell hyperplasia. For case 2, surgical intervention revealed a right ovarian steroid cell tumor with contralateral stromal and hilus cell hyperplasia. In both patients, testosterone levels normalized immediately following total hysterectomy with bilateral salpingo-oophorectomy. In conjunction, these 2 cases highlight the importance of having a high clinical suspicion for steroid cell tumors or hyperplasia in postmenopausal women presenting with features of hyperandrogenism and elevated testosterone levels despite unrevealing radiographic findings.

Abstract Introduction Gout is a common crystal arthropathy that typically presents with acute monoarthritis of peripheral joints. Extra-articular tophaceous disease is rarely seen as the initial manifestation. We present an unusual case of a young man with a family history of gout who developed supraclavicular masses causing thoracic outlet syndrome (TOS). Initial surgical excision was undertaken due to concerns about malignancy. Only on recurrence and re-excision was the diagnosis of urate crystal deposition confirmed. This case highlights the importance of considering gout in atypical locations and the role of advanced imaging and surgical pathology in diagnosis. Case description A 30-year-old male with a known family history of gout (twin brother and uncle) presented with subacute onset of right shoulder and neck pain. Examination revealed a firm supraclavicular mass. Imaging confirmed compressive masses behind the right clavicle, raising concern for malignancy or a vascular anomaly. He underwent thoracic outlet decompression including 1st rib and pectoralis minor excision with subclavian vein bypass. Intraoperatively, chalky white material was noted. Histology suggested a granulomatous foreign body reaction, but no definitive diagnosis was made. The patient recovered but re-presented with recurrence of the mass six months later. A second surgery revealed similar chalky material and a fluid analysis confirmed monosodium urate crystals on polarised light microscopy. This was further confirmed with a dual-energy CT (DECT) scan showing multifocal urate deposition at the sternoclavicular and acromioclavicular joints (see attached DECT images – urate crystals denoted in green). Subsequently, he reported a new self-limiting attack of podagra. Serum urate was also elevated at 480 µmol/L. Allopurinol was initiated at 200 mg daily, with a repeat level of 328 µmol/L. The patient remains under rheumatology follow-up. Allopurinol was titrated to 400 mg to achieve a serum urate target <300 µmol/L as per BSR guidelines. Naproxen and gastroprotection were prescribed for future flares. The DECT scan of the right shoulder area shows the appearance of multifocal urate crystal deposition along the capsular attachments of the sternoclavicular and AC joints on the right side (green denotes urate crystals; purple can be ignored - cartilage). Discussion This case illustrates an unusual presentation of gout, masquerading initially as a sinister supraclavicular mass with compressive features mimicking TOS. The initial surgical exploration, although essential due to clinical suspicion, did not yield a diagnosis until the recurrence provided the opportunity for more targeted crystal analysis. The presence of chalky material intraoperatively should prompt consideration of gout, even in atypical locations. The patient had a suggestive family history and prior peripheral joint symptoms, but the rarity of axial gout meant this was not initially suspected. Serum urate was normal at first presentation, which likely contributed to diagnostic delay. This reflects the known limitation that serum urate can be normal during active disease. The diagnosis was ultimately confirmed using a combination of repeat histology and polarised microscopy, supported by DECT imaging which offered non-invasive localisation of urate deposits. The DECT findings were instrumental in guiding ongoing management and reassuring both patient and team regarding the nature of the recurrence. Treatment has focused on achieving urate lowering below target thresholds, consistent with BSR guidelines. Given prior surgical morbidity, a conservative approach is preferred for any recurrence. This case underscores the diagnostic challenge in atypical gout presentations and supports a lower threshold for crystal evaluation in unexplained masses. Questions for further discussion include: Should DECT be used earlier in diagnostic work-up for atypical soft tissue masses? What is the optimal surveillance strategy for extra-articular gout post-surgery? Key learning points • Gout can rarely present as a soft tissue mass in axial locations, mimicking malignancy or causing structural compression such as thoracic outlet syndrome. • DECT is a valuable diagnostic tool in atypical presentations, providing non-invasive localisation of urate deposits and confirming diagnosis where aspiration is not feasible.

Adrenal vein sampling with continuous infusion of cosyntropin for identifying surgically curable cases of primary aldosteronism.

Background: Visceral artery aneurysm is an uncommon pathology with a potential risk of rupture and disastrous complications, especially during pregnancy. Sudden rupture is associated with higher fetal mortality. The exact etiology of splenic artery aneurysm remains unclear. However, intimomedial mucoid degeneration is a rare vascular disorder that can lead to aneurysms in young individuals. Case Presentation: In this case, we present a case of unexpected and sudden intra-abdominal hemorrhage in a 26-year-old woman in her first pregnancy (27th week) with fetal death but maternal survival. At the onset, blood pressure was 90/70 mmHg, and blood tests showed anemia. The transabdominal ultrasound showed fluid in the sub-hepatic area and a significantly slowed fetal heartbeat. Cesarean section was performed, and upon opening the abdomen, there was a massive hemoperitoneum, and the incision of the uterus led to the extraction of a dead fetus. Surgical pathology revealed an aneurysm of the splenic artery, and histological examination supported a diagnosis of intimomedial mucoid degeneration of the vessel. Conclusion: Abdominal pain in pregnancy is a frequent presentation in obstetric departments with a wide possibility of diagnosis. Clinicians face significant diagnostic challenges due to the wide range of potential causes of abdominal pain. The rarity of this pathology and the objective diagnostic difficulties make this condition obscure and unpredictable. Routine screening of the splenic artery with ultrasound and Doppler can be considered in pregnant women with predisposing factors. Timely surgical intervention is necessary to spare the life of the mother and the fetus.

Introduction: Lipomas represent the most frequent type of soft tissue tumor. A giant lipoma is typically defined as a lesion measuring ≥10 cm in at least one dimension or weighing more than 1000 g. While these tumors are often asymptomatic, they may occasionally produce compressive symptoms, including neuropathic pain or motor impairment, particularly when located in areas that affect gait or mobility. Presentation of case: We report the case of a 48-year-old woman with no relevant past medical history who presented with a nine-year history of a progressively enlarging, painless mass on the right thigh. The lesion had gradually increased in size, leading to discomfort and limitation of daily activities. Magnetic resonance imaging (MRI) revealed a well-defined intramuscular , adipose mass measuring 26.5 × 12.5 × 6 depending on the rectus femoris muscle, well defined and encapsulated, with the same signals as fat. Its lower pole reaches the myotendinous junction of the quadriceps, and its upper pole reaches the trochanteric massif.. Complete excision with clear margins was achieved while preserving the affected musculature. The postoperative course was uneventful, and the patient demonstrated a satisfactory functional recovery. Discussion: Lipomas are common benign tumors originating from adipose tissue. Their considerable size or deep extension can pose challenges in surgical management. Although malignant transformation is rare, careful excision is warranted. Close collaboration between radiologists and surgical pathologists is essential, particularly in assessing muscular involvement and identifying any infiltrative growth patterns. Conclusion: Giant lipomas should always prompt consideration of potential malignant transformation. Radiological assessment usually provides sufficient information to determine the necessity of a biopsy, thereby preventing unnecessary invasive procedures. During surgical excision, maintaining a margin of approximately 1 cm of healthy tissue is recommended to minimize the risk of local recurrence.

Bowel perforation represents a prevalent and life-threatening emergency within general surgical pathology. This study aims to evaluate clinical and biochemical parameters that predict mortality in cases of bowel perforation. A retrospective analysis was performed on 144 patients who underwent surgical intervention for bowel perforation between 2019 and 2024. Key variables assessed included the albumin/creatinine ratio, age, serum albumin levels, CRP, and history of COVID-19. Mortality-associated variables were analyzed using univariate and multivariate logistic regression, as well as receiver operating characteristic (ROC) analysis. The mean age of the patients was 60 years, with 84 patients (58.3%) being male. The overall mortality rate was 25%. Independent predictors of mortality identified in the study included an albumin/creatinine ratio <3.38 (odds ratio [OR]: 12.666, p<0.001), age >66 years (OR: 3.273, p=0.036), and serum albumin levels <3 g/dL (OR: 5.653, p=0.002). ROC analysis indicated that the area under the curve (AUC) for the albumin/creatinine ratio was 0.879, establishing it as the parameter with the highest predictive accuracy for mortality. Among patients with a history of COVID-19, ischemia was the predominant cause of perforation (87.5%), while malignancy was the leading cause (41.4%) in those without a COVID-19 history. This difference in etiology was statistically significant (p<0.001). In conclusion, the albumin/creatinine ratio, age, and serum albumin levels are robust parameters for predicting mortality in bowel perforation cases. Furthermore, a history of COVID-19 significantly increases the risk of bowel perforation due to ischemia.

Background Acute appendicitis is a leading cause of surgical emergencies in children, with ultrasound (US) emerging as a preferred diagnostic tool due to its lack of radiation and cost-effectiveness. However, the accuracy of US is highly operator-dependent and may vary between general referring emergency departments (EDs) and specialized pediatric EDs. Objective To compare the diagnostic sensitivity and specificity of US performed at referring EDs vs. a pediatric ED in identifying acute appendicitis. Methods A retrospective study analyzed pediatric patients aged &amp;lt;18 years who underwent US at referring EDs and were transferred to a pediatric ED for repeat imaging between July 2018 and July 2023. Data collected included US findings, surgical pathology, white blood cell count, and patient disposition. Sensitivities of the US were calculated and compared between settings. Results Among 64 children included, the US at the pediatric ED demonstrated higher sensitivity (85.2%) compared to referring EDs (51.9%) ( p = 0.018). Pediatric ED US resulted in fewer non-visualized appendices (a 34.4% reduction) and equivocal findings (a 30.5% reduction). Patients with positive surgical pathology exhibited higher white blood cell counts (mean 17.1) and neutrophil percentages (mean 81.0%). False positive rates were low (6.9%), aligning with published benchmarks. Conclusion US performed at pediatric EDs exhibited superior diagnostic accuracy for appendicitis compared to referring EDs, likely due to operator expertise and enhanced imaging protocols. Efforts to standardize training and improve resources at referring EDs may reduce diagnostic disparities and unnecessary interventions.

Fine-needle aspiration cytology (FNAC) is a preferred method for evaluation of thyroid nodules. Under The Bethesda System for Reporting Thyroid Cytopathology, approximately 15%-30% of FNAC results fall into an indeterminate category: atypia of undetermined significance (AUS), follicular neoplasm (FN), and suspicious for malignancy (SFM), Bethesda classes III, IV, and V respectively. Molecular testing of indeterminate nodules helps evaluate the risk of malignancy and guide management decisions. This retrospective study assesses the impact of molecular testing on thyroid nodule classification in our institution, with an emphasis on indeterminate results. A 9-year retrospective analysis (January 2015-December 2023) was conducted at the University of North Carolina Health System. FNAC cases were classified per The Bethesda System. Molecular testing results and, when available, surgical pathology outcomes were reviewed. The study compared pre- and post-implementation data of routine reflex molecular testing of thyroid nodule diagnosis. A total of 3992 thyroid aspirates were evaluated: 490 (12.3%) nondiagnostic (class I), 2096 (52.5%) benign (class II), 1041 (26.1%) AUS (class III), 136 (3.4%) FN (class IV), 89 (2.2%) SFM (class V), and 140 (3.5%) malignant (class VI). Indeterminate cytology (classes III-V) accounted for 32% of all aspirates (n=1266). Before molecular testing, the AUS rate was 19.8% with an AUS:malignant ratio of 5.4. Post-implementation, the AUS rate rose to 30.1%, with a ratio of 8.9. This increase was statistically significant (p=.029). Implementation of molecular testing was associated with a significant rise in indeterminate cytologic diagnoses, particularly AUS.

Introduction . In the modern armed conflict, limb injuries have a high proportion in the structure of combat surgical pathology. In this case, injuries to the arteries of the limbs are often accompanied by massive external bleeding and/or acute ischemia, which is one of the main causes of death. The use of adjuvant therapeutic stimulation of angiogenesis in combat vascular pathology seems promising. Objective. To investigate the influence and dynamics of angiogenesis regulation and determine the role of VEGF in the pathogenesis of limb artery injuries in an experimental model of acute hind limb ischemia (AHLI) in laboratory animals. Materials and methods . An experimental model of acute hind limb ischemia (AHLI) was developed, dynamic observation and evaluation of the effect of drug-induced angiogenesis and systemic administration of antiangiogenic antibodies in laboratory animals (male White Giant rabbits) of one batch weighing 3673±113 g (n=36). Results . In Group Ia (drug-induced angiogenesis), there was a long-term positive survival rate of up to 24 days of the experimental study, in contrast to the other 3 groups. The survival data in Group Ia correlates with the quantitative determination of VEGF in blood serum, which by day 30 is 87.08±2.44 pg/ml (p&lt;0.001). By 30 day of the experimental study, the level of tissue perfusion after ligation of the femoral artery was 81.75±4.2% (p&lt;0.05). Conclusions . Gene and cellular technologies can become one of the most important methods for restoring perfusion in ischemic tissues due to the formation and growth of the microvascular network, which subsequently significantly reduces the number of amputations performed and improves the final result of treatment for this pathology. The results obtained indicate the effectiveness of adjuvant stimulation of angiogenesis, which also affected the survival of laboratory animals.

Testing remote feedback using a virtual semi-automated educational tool for the detection of pancreatic tumour-vessel contact on staging CT.

The third edition of the Bethesda system for reporting thyroid cytopathology recommends a simplified two-tiered subclassification of atypia of undetermined significance (AUS), dividing cases into AUS with nuclear atypia (AUS-Nuclear) and other atypia (AUS-Other). This study aims to evaluate the performance of these subcategories in estimating the risk of malignancy (ROM) in a setting without routine molecular testing. A retrospective review was conducted on consecutive thyroid fine-needle aspiration (FNA) cases diagnosed as AUS between 2018 and 2023. Surgical pathology reports were matched with the FNA-targeted nodules to enable cyto-histologic correlation. ROM and risk of neoplasm (RON) were calculated for all AUS cases and for each subcategory. Among 16,030 thyroid FNA cases, 617 (3.8%) were diagnosed as AUS. Histologic follow-up was available in 190 cases. Final diagnoses included non-neoplastic lesions (42.6%), benign neoplasms (17.4%), low-risk neoplasms (5.3%), and malignant neoplasms (34.7%). The ROM for AUS-Nuclear was significantly higher at 54.7%, compared to 14.7% for AUS-Other (p < 0.001). Similarly, the RON was significantly higher in the AUS-Nuclear group (67.4%) than in the AUS-Other group (47.4%) (p = 0.005). AUS-Nuclear carries a substantially higher ROM than AUS-Other, with a ROM (54.7%) comparable to the reported positive predictive values of molecular assays such as Afirma GSC (47%, 95% CI: 36%-58%) and ThyroSeq v3 (66%, 95% CI: 56%-75%). These findings support the clinical utility of the two-tiered AUS subclassification in enhancing risk stratification, particularly in settings where molecular testing is not routinely available.

PurposeTo investigate the incidence and clinical characteristic of preoperative anemia and its impacts on perioperative outcomes in gynecological inpatients.Patients and MethodsWe retrospectively collected data from surgical patients admitted to the Department of Gynecology at Peking University People’s Hospital between April 2023 and January 2024. The data included demographic information, preoperative laboratory tests, diagnoses, surgery records, and hospitalization information. Preoperative anemia was defined as hemoglobin (Hb) concentration less than 120 g/L according to the last blood test before surgery. The primary outcomes of this study were perioperative complications, including infection, heart failure, thromboembolic events, intestinal obstruction, and transfer to the intensive care unit (ICU). Secondary outcomes included perioperative RBC transfusion, length of stay (LOS) and hospitalization costs. Outcomes were compared between the anemic group and non-anemic group, and logistic regression analyses were used to identify risk factors associated with the study outcomes.ResultsThis study included a total of 2,519 patients, and the incidence of preoperative anemia was 30.8%. Compared with the non-anemic group, those in anemic group had younger age (44 vs 47, P < 0.001) and lower body mass index (BMI) (23.2 vs 23.9, P < 0.001); however, higher incidences of perioperative RBC transfusion (10.7% vs 1.7%, P < 0.001) and complications (4.4% vs 0.9%, P < 0.001), higher hospitalization costs (14531 vs 13681, P = 0.044) and longer LOS (6 vs 5, P < 0.001). According to multivariate analyses, lower BMI (aOR = 0.893, P = 0.016), having comorbidity (aOR = 4.422, P < 0.001), preoperative anemia (aOR = 6.259, P < 0.001), gynecological malignancy (aOR = 4.376, P < 0.001), longer surgery duration (aOR = 1.010, P < 0.001) and increased blood loss (aOR = 1.002, P < 0.001) were associated with higher incidences of perioperative complications. Based on final surgical pathology, we divided surgical patients into gynecologic malignancy and non-malignancy groups. Similar results were obtained in both groups, preoperative anemia remained a facilitating factor of perioperative RBC transfusion and complication. Additionally, we investigated whether patient blood management (PBM) before surgery could improve perioperative outcomes. The results revealed that preoperative RBC transfusion was a protective factor against perioperative complication (aOR = 0.032, P = 0.017), while the relationship between iron supplementation and perioperative complication remained unclear (aOR = 0.628, P = 0.502).ConclusionPreoperative anemia was related to higher incidence of perioperative RBC transfusion and complication, and it increased hospitalization costs and prolonged LOS in gynecological inpatients. PBM before surgery could help improve perioperative outcomes. These findings emphasized the importance of early identification and active management of anemia, which might help reduce transfusion needs, minimize complications, and ultimately enhance gynecological inpatients’ outcomes.

Disclosure: S.A. Marowa: None. S. Hossain: None. J. Delshad: None. T. Saikia: None. H. Liao: None. D. Rosenthal: None. S.C. Kumar: None.Background: The most common form of thyroid cancer is primary thyroid cancer, which includes: papillary, follicular, oncocytic (hurthle cell), anaplastic and medullary thyroid cancer. Among these, papillary thyroid cancer is the most common and metastatic disease to the thyroid is rare. Breast cancer, although one of the most commonly diagnosed malignancies, rarely metastasizes to the thyroid. The incidence of thyroid metastases identified through fine needle aspiration (FNA) is less than 0.2% (1). In this report, we present a case of metastatic mammary carcinoma to the thyroid that was initially misdiagnosed as papillary thyroid cancer in the FNA. Case Presentation: A 68 years old female with history of metastatic invasive ductal carcinoma of breast and lung cancer presented to the endocrinology clinic for evaluation of an incidental thyroid nodule identified on a chest CT scan. An ultrasound of the thyroid identified two nodules. Both categorized as TI-RADS category 2 (TR2). Typically, TR2 nodules are not considered suspicious and do not necessitate a biopsy; however, due to the size of the dominant nodule measuring 3.5 x 2.4 x 2.9 cm and the presence of underlying metastatic breast and lung cancer, further evaluation was warranted. A FNA was performed on the dominant nodule and the pathology report resulted as Bethesda category 5, indicating it was suspicious for papillary thyroid carcinoma. Following this, she was referred for total thyroidectomy. However, surgical pathology revealed metastatic mammary carcinoma. Immunohistochemical staining showed neoplastic cells that were positive for Gata-3, CK7, estrogen receptor, AE1/3, and CEA, while negative for calcitonin, TTF-1, thyroglobulin, P63, synaptophysin, and NSE. After surgery, patient was resumed on hormonal therapy and continued to be monitored by her oncology team. Conclusion: This case illustrates a significant discrepancy in outcomes between FNA and surgical pathology report where the initial FNA suggested primary thyroid cancer but surgical pathology confirmed metastatic mammary carcinoma. This indicates that a more comprehensive approach is needed regarding interpretation of FNA results in patients with complex oncological histories. Further genetic and molecular studies may provide additional insights into the behavior of such tumors and guide future management strategies. Additionally, TI-RADS may misclassify nodules that are metastatic to the thyroid rather than originating from thyroid cells, highlighting the need for clinicians to exercise caution when relying on TI-RADS in patients with known or suspected malignancies. Reference: 1.Wang Y,Zhou S,Y B,et al.Case Report and Review of Literature:Thyroid Metastases From Breast Carcinoma.Frontiers in Endocrinology.2021;12:631894.DOI: 10.3389/fendo.2021.631894.PMID: 33776925; PMCID: PMC7994513Presentation: Sunday, July 13, 2025

Disclosure: R.D. Paparodis: None. E. Karvounis: None. G. Simeakis: None. I. Androulakis: None. D.P. Askitis: None. S. Livadas: None. A. Rizoulis: None. V. Papanikos: None. N. Mastronikolis: None. D. Zianni: None. C. Massouras: None. I. Perogamvros: None. A. Boniakos: None. N.G. Angelopoulos: None. D. Bantouna: None. A. Kapezanou: None. O. Aporelli: None. S. Imam: None. J.C. Jaume: None.Introduction: Thyroid cancer has been associated with all forms of diabetes in some studies, but others contradicted these findings. Given that the metabolic perturbations that lead to type 2 diabetes (DM2) and the autoimmunity-mediated inflammation present in type 1 diabetes and LADA (DM1) both seem to affect the risk for cancers in several other organs, we designed the present study to assess their effects on thyroid cancer development and aggressiveness. Methods: We performed a retrospective data analysis of patients undergoing thyroidectomy over 10 years in 2 centers in the US and 13 in Greece. We collected data on gender, pre-existing DM, TSH, and surgical pathology. Patients were split in those with DM2, autoimmune diabetes (type 1 + LADA = DM1) and unaffected individuals (controls=CON). Results: We reviewed n=9461 consecutive thyroidectomy cases and enrolled n= 3459 patients; n=980 males (28.3%). These included DM2 n=361, DM1 n=11 and CON n=3087, all with similar preoperative serum TSH (p>0.05). There were more males in the DM subgroups compared to CON. Overall, n=1766 thyroid cancers were identified: Papillary n=1667, Follicular n=23, Hürthle cell n=28, Medullary n=38, Poorly differentiated n=6, Anaplastic n=1, Lymphoma n=1, Other n=2. The incidence of thyroid cancer by surgical pathology was not different between DM and non-DM patients, and the same holds true for the different histological subtypes’ ratios. Microscopic extrathyroidal extension (ETE) and capsular invasion was less common in DM1 and DM2, but gross ETE was more common in DM2 compared to CON (p<0.05). Tumor recurrence was more common in CON compared to DM patients (p<0.05). Lymph node involvement, distant metastasis and the number of I-131 treatments required, were equally distributed among all groups (p>0.05). Background lymphocytic thyroiditis was more common in DM1, and significantly less common in DM2 patients compared to controls (p<0.001). Conclusions: Diabetes does not seem to increase the risk for thyroid cancer in our international, multicenter cohort. Patients with diabetes tend to have lower risk of thyroid cancer extension beyond the gland’s capsule, though DM2 patients develop more aggressive extensions when these are present. Tumor aggressiveness with regard to lymph node or distant metastasis does not appear to be affected by the presence of diabetes.Presentation: Saturday, July 12, 2025

Disclosure: Y. Ahmed: None. S.M. Saad-Omer: None. R.M. Castro: None. M. Rivera: None. M.N. Stan: None.Background: Fine-needle aspiration (FNA) is a cornerstone in the evaluation of thyroid nodules. Its accuracy during long term follow up is not well established though. Our project aims to address that. Objective: To assess long-term accuracy of FNA results at Mayo Clinic Rochester including diagnostic classifications, procedural and cytologic variables, and concordance with surgical pathology. Methods: We conducted a retrospective cohort study of patients who underwent thyroid FNA at Mayo Clinic Rochester in 2014, to allow for the long-term follow-up. Descriptive statistics summarized patient demographics, nodule characteristics, and procedural factors. Cross-tabulation was used to evaluate concordance between FNA cytology and surgical pathology. This is an interim analysis. Results: Among 199 patients (from 741 FNAs that year), the mean age was 58.6 ± 14.1 years, and 73.7% were female. The average BMI was 29.6 ± 6.4 kg/m². Most had non-toxic multinodular goiter (69.3%) or non-toxic solitary nodules (27.6%). Nodules were 45% solid, 8% cystic, and 47% mixed, with a mean size of 2.3 cm. FNA results were predominantly benign (Bethesda II, 80%), followed by malignant (Bethesda VI, 8%), suspicious for follicular neoplasm (Bethesda IV, 7.5% ), non-diagnostic (Bethesda I, 3%), and suspicious for malignancy (Bethesda V,1%). There were no cases read as Bethesda III (AUS) in 2014. Of the 16 Bethesda VI cases, 15 had surgery; 14 were confirmed malignant, and 1 was benign (Hurthle cell adenoma). Both Bethesda V cases that underwent surgery were benign. Of the 15 Bethesda IV cases, 12 had surgery; 11 were benign and 1 was malignant and 3 had long term follow up (2 benign, and one malignant based on the available data). Overall the malignancy rate for Bethesda IV was 13.3%. Surgery was performed in 12 Bethesda II cases, with final pathology available for 11; 9 were confirmed benign, while 2 were malignant. In the other 147 cases of benign FNAs that didn’t undergo surgery we have not identified any indication of necessity for surgery during the mean of 9 years of follow-up, presumably indicating their benign character. Overall malignancy rate for this group was 1.3%. We had only 6 non diagnostic FNAs (Bethesda I), with all of them during follow up proven benign (2 by surgery, 2 by repeat FNA and 2 by long term follow up). Conclusion: Long term follow up data (over 9 years) support the continued reliability of Bethesda II and VI , while conversely raising questions about the significance of the Bethesda V classification. The malignancy rate in Bethesda IV (likely including the Bethesda III category at the time) is consistent with our institutional data, although it remains lower than that reported by other institutions. We’re currently enriching our cohort to verify and strengthen our conclusions.Presentation: Monday, July 14, 2025