Unusual Cases Research Articles

Application of deep learning for semantic segmentation in robotic prostatectomy: Comparison of convolutional neural networks and visual transformers.

Semantic segmentation is a fundamental part of the surgical application of deep learning. Traditionally, segmentation in vision tasks has been performed using convolutional neural networks (CNNs), but the transformer architecture has recently been introduced and widely investigated. We aimed to investigate the performance of deep learning models in segmentation in robot-assisted radical prostatectomy (RARP) and identify which of the architectures is superior for segmentation in robotic surgery. Intraoperative images during RARP were obtained. The dataset was randomly split into training and validation data. Segmentation of the surgical instruments, bladder, prostate, vas and seminal vesicle was performed using three CNN models (DeepLabv3, MANet, and U-Net++) and three transformers (SegFormer, BEiT, and DPT), and their performances were analyzed. The overall segmentation performance during RARP varied across different model architectures. For the CNN models, DeepLabV3 achieved a mean Dice score of 0.938, MANet scored 0.944, and U-Net++ reached 0.930. For the transformer architectures, SegFormer attained a mean Dice score of 0.919, BEiT scored 0.916, and DPT achieved 0.940. The performance of CNN models was superior to that of transformer models in segmenting the prostate, vas, and seminal vesicle. Deep learning models provided accurate segmentation of the surgical instruments and anatomical structures observed during RARP. Both CNN and transformer models showed reliable predictions in the segmentation task; however, CNN models may be more suitable than transformer models for organ segmentation and may be more applicable in unusual cases. Further research with large datasets is needed.

Spectrum of Unusual Cytomorphology of Axillary Swellings: A Series of Four Cases

The axilla is a triangular area situated anatomically beneath the shoulder joint, between the upper arm and thorax. It contains lymph nodes and numerous non lymphatic tissues such as neurovascular structures, muscle, and fat. Axillary swellings can arise from any of these mesenchymal soft tissues. Fine Needle Aspiration Cytology (FNAC) is the first-line investigative technique widely used in evaluating axillary swellings, as it is a simple outpatient procedure that causes minimal complications, unlike core biopsy, which is invasive and carries a high-risk of bleeding. Hereby, the authors present a case series of four unusual cases: bilateral accessory breast tissue (32-year-old female), bilateral galactocele (28-year-old female), unilateral galactocele (24-year-old female), and fibroadenoma (35-year-old female) in the axilla, all of which were cytomorphologically diagnosed with the aid of FNAC. Axillary lumps can present with a variety of unusual lesions and can pose a significant diagnostic challenge to a clinicians. Although histopathology of the biopsy of the lesion remains the gold standard, clinical features along with imaging can aid in the diagnosis with better patient compliance.

Discovery of a Large-scale H i Plume in the NGC 7194 Group

We present the discovery of a new H i structure in the NGC 7194 group from the observations using the Karl G. Jansky Very Large Array. NGC 7194 group is a nearby (z ∼ 0.027) small galaxy group with five quiescent members. The observations reveal a 200 kpc long H i plume that spans the entire group with a total mass of M H I = 3.4 × 1010 M ⊙. The line-of-sight velocity of the H i gas gradually increases from south (7200 km s−1) to north (8200 km s−1), and the local velocity dispersion is up to 70 km s−1. The structure is not spatially coincident with any member galaxies but it shows close associations with a number of blue star-forming knots. Intragroup H i gas is not rare, but this particular structure is still one of the unusual cases in the sense that it does not show any clear connection with sizable galaxies in the group. We discuss the potential origins of this large-scale H i gas in the NGC 7194 group and its relation with the intergalactic star-forming knots. We propose that this H i feature could have originated from tidal interactions among group members or the infall of a late-type galaxy into the group. Alternatively, it might be leftover gas from flyby intruders.

Anatomical Variation of the Cystic Duct: A Case Report

During a cholecystectomy, cystic duct anatomical variation mostly transpires might experience. Understanding the complex anatomy of the cystic duct and cholecystitis junction is crucial before undergoing biliary surgery to prevent severe ductal damage. This article highlights two unusual cases of irregular cystic duct, i.e., cystic duct narrow-wide and low lateral insertion. The first case was of a 66-year-old male patient having chronic cholecystitis and cholelithiasis. The aberrant cystic duct entry was thought to be rapid and heading into the correct hepatic duct during surgery. Multiple calculi were discovered after more investigation of the common and proper hepatic ducts. Following the completion of the cholecystectomy, the standard and right hepatic ducts were drained using T-tubes. The two T-tubes were found in the cystic and common hepatic ducts, respectively, according to postoperative T-tube cholangiography. The distal choledochus residual stones were removed six weeks later by cholangioscopy through the T-tube's sinus tract. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) in the second case of a 44-year-old woman exposed to a lengthy cystic duct with a small and bent-in lumen. The cholecystectomy was done openly on the patient. Both of the patients recovered. The approach described by the authors for identifying structural changes in the cystic duct is preoperative or MRCP or ERCP, as well as intraoperative cholangiography or cholangioscopy.

Plumbagin's molecular docking studies as a possible target for the SARS-CoV-2 spike receptor protein

Around the end of 2019, reports of unusual cases of pneumonia with specific symptoms started to arrive in Wuhan, China. Within a few weeks, the atypical pneumonia spread throughout China, and a few months after that, it became a global pandemic. The etiological agent of that pandemic, which is officially known as COVID-19, is Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In an attempt to find an efficient therapy to either fight the spread of COVID-19 or to cure infected people from its tissue damage, researchers around the world have been studying several plants, herbs, and natural products. Abundant studies have revealed that organic compounds can be very operative in averting virus-mediated infection. The purpose of this study was to accomplish molecular docking studies among plant-derived naphthoquinone (Plumbagin) and spike receptor (THR304) proteins of coronavirus. MGL virtual screening tool and Biovia Discovery Studio were utilized in the current molecular docking investigations. Outcomes of docking studies exposed that selected organic compounds have interacted with targeted spike receptor protein with binding energies in the range of -4.0 to -9.5 kcal, which means the binding energy of the target and ligand is -5.78. In summary, plumbagin seems to be a more effective primary protease inhibitor than the other chosen ligands for deactivating the SARS-Coronavirus.

Mechanical strength of the aircraft control chains in certain unusual cases

The paper focuses on certain specific occurrences involving sports aircraft and their mechanical flight control chains. Usually the flight controls and their control chains are subject of thorough checking procedures, but frequently such details are not observed or are easily ignored during the maintenance and airframe checking processes. The authors aim to provide information enabling proper training of flight crews, technical, and design staff/ personnel, allowing the avoidance of severe occurrences/ events caused by failures of the mechanical control chains. The analysis focuses on lighter aircraft, such as sports aircraft, which have full mechanical control chains.

51 Two unusual cases of infectious mimics of metastatic disease

51 Two unusual cases of infectious mimics of metastatic disease

“Case of the Week: The Value and Impact of Sharing Pathology Cases Online”

Abstract Introduction/Objective Social media has become a driving force in the field of pathology in a variety of ways, including aiding in recruitment efforts for residents, fellows, and faculty members; promoting both individual practitioners and institutional programs; sparking discussion; creating and growing community; and sharing resources. Large teaching hospitals see an expansive number of cases, some of which are rare or have unusual features. The sharing of unique pathology cases through social media has become a robust online conversation, resulting in connections to pathologists worldwide through shared educational resources, and as examples to potential trainees and faculty of the wide variety of cases the institution sees. Methods/Case Report In 2017, under guidance of our department chair, we began posting one case per week to our website and newly created Twitter account. These posts featured recent, in-house cases contributed by faculty and trainees with slide images and de-identified case descriptions. This content began garnering a following as we shared an increasing number of more unusual cases. In 2018, our department added communications team who standardized the weekly cases and worked with resident leaders to organize and plan a schedule to collect cases from department members. The team posts these cases every Monday on the department website and on our Twitter account, alongside a poll for users to vote on their suspected diagnosis. Each Friday, the team posts the final answer with an educational explanation of the case. Results (if a Case Study enter NA) NA Conclusion Our weekly cases have become the most popular content shared across our department’s social media channels, garnering hundreds of votes on Twitter, and now Instagram story polls, every week. Building on its popularity, in 2022 we added a second case of the week, specific to cytopathology, shared each Wednesday. We archive the cases on our website, and they are being accessed as a learning tool.

Unusual neck masses encountered in remote areas of Sikkim

Neck masses are one of the most common presentations in the ENT practice and they are a challenge in the diagnosis and management. The masses may be of congenital, inflammatory, or neoplastic origin. An accurate clinical assessment conducted while taking into account pertinent anatomical and developmental viewpoints, accompanied by well-planned investigative parameters, may aid in making an early diagnosis. Our is a series of three cases where in which we have described the finding of all the three cases in detail, first case is of 70 years female with right sided neck swelling which ultimately turned out to be right venous aneurysm. Second being a case of a young kid misdiagnosed as other infections and treated for long time, which ultimately responded with ATT. Lastly, a young kid presenting with multinodular goitre. We need to be ready for surprise and be ready to deal with unusual cases with different management options.

Bilateral Staged Ureteral Stenosis Secondary to Wegener s Disease A Case report

Wegener's disease is a rare vasculitis characterized by inflammation of the endometrium of blood vessels. Ureteral stenosis is a rare manifestation of granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis). We report the case of a 38-year-old woman with acute renal failure in which bilateral hydronephrosis due to staged ureteral stenosis was the second manifestation of the disease after necrotico-inflammatory skin lesions. Our patient had high titers of anti-proteinase 3 c-ANCA, but no upper or lower respiratory tract damage was demonstrated. Hydronephrosis and renal function improved rapidly under immunosuppressive therapy with high dose of corticosteroids. We reviewed the literature and found only ten other reported cases of Wegener's granulomatosis and intrinsic ureteral stenosis: in two cases the presenting clinical manifestation was unilateral hydronephrosis and in only three others bilateral hydronephrosis. All of these complications have developed on disease relapse except in one case where the first manifestation of vasculitis is bilateral ureteral stenosis. This case highlights the importance of including ANCA-related vasculitis in the differential diagnosis of unusual cases of unilateral or bilateral ureteral stenosis.

Two Cases of Unusual Clinical Features of Keratoacanthoma

The Iraqi and the Yemeni dental literature lack documentation of keratoacanthoma (KA). It uncommonly appears at the mucocutanous junction and very rarely reported to arise in the mucous membrane. Nevertheless, it has such a chance; therefore, it is necessary to bring the attention of dental practitioners to this lesion. It is a benign epithelial tumor that frequently affects the face of old people. It usually, appears as an exophytic nodule with a central keratin plug that grows rapidly but with several poses. Clinically and microscopically KA is similar to squamous cell carcinoma (SCC) and can be occasionally misdiagnosed therefore it is important to be biopsied and carefully interpreted. This report presents two clinically unusual cases of KA.

A case of monorchidism in a domestic rabbit

Registered veterinary nurses are often involved in complex, unusual cases found in veterinary medicine and play a large role in aiding the veterinary surgeon to reach a diagnosis. Through academic writing and transfer of knowledge and experience, veterinary nurses should be encouraged by peers to report on unusual cases (that may be left unpublished otherwise), enabling a more significant contribution to the veterinary field and documentation of information that is useful to both veterinary surgeons and nurses alike. In this article, the case of a rabbit with monorchidism is reported, alongside documentation of diagnostic aids used by the veterinary surgeon and clinical outcome.

Phénomènes de réfraction atmosphérique terrestre

This article presents, almost without any analytical analysis, an orderly and illustrated presentation of the atmospheric—or terrestrial—refraction effects, i.e., affecting the vision of the apparent shape and position of objects located in the atmosphere, contrary to the case of astronomical refraction. The adopted classification, which is non-exhaustive as there are still mysterious atypical cases, is mostly based on the shape of the transfer curves and on the value of the refraction coefficient κ. Beginning with mirages, i.e. when an inverted image is formed, four main types are identified: inferior, superior, Nachspiegelung and mock-mirage, multiple mirage. Then comes the special case of Fata Morgana: their archetypal form is a transition case whose physical cause remains imperfectly understood, and their real forms are more complex and varied, although often linked to superior mirages. Finally remain the unusual cases without inverted image: stooping/stretching, sinking, looming, and finally hillingar effect—corresponding to a strong looming (κ>1) and giving the illusion that a flat horizontal surface, e.g., the sea, is concave.

Diagnostic Challenges of Rosai-Dorfman Disease Presenting as Pachymeningitis and Meningiomatosis: A Report of Two Unusual Cases Involving the Spinal Cord

Rosai-Dorfman disease (RDD) is an exceptionally rare medical condition, with spinal cord involvement even more infrequent. It is frequently misidentified as another malignancy or infectious disease. In this report, we present two cases of RDD with spinal cord involvement. Each patient presented with spinal intradural extramedullary masses within the thoracic and cervical levels, respectively. The differential diagnoses remained uncertain, with the potential for pachymeningitis and meningiomatosis due to the shared nature of nonspecific imaging findings and clinical symptoms in both conditions. Given the presence of neurologic symptoms and spinal cord compression, the individual lesions were surgically excised. Subsequent pathological analysis definitively confirmed the diagnosis of RDD. As an adjunctive therapeutic measure, both patients were orally administered prednisolone. Both patients exhibited favorable neurologic improvement. These cases highlight the diagnostic challenges of RDD when solely relying on imaging studies. Surgical intervention, in conjunction with a meticulous pathologic examination, is imperative for a precise diagnosis and guides appropriate treatment strategies. The multifaceted spatial manifestation of this disease further underscores the potential for multifocal occurrences within the central nervous system, providing an avenue for improved comprehension of the underlying mechanisms contributing to its dissemination.

FRI531 IgG4 Related Mass -forming Thyroid Disease: Two Case Reports

Abstract Disclosure: R.S. Braham: None. C. Droumaguet: None. M. Vitellius: None. J. Tran-van-nhieu: None. E. Béquignon: None. P. Desgranges: None. N. Limal: None. M. Mahevas: None. B. Godeau: None. IgG4 thyroiditis is an invasive fibrotic process involving the thyroid in a systemic disease. It is a rare inflammatory autoimmune disease with insidious presentation and nonspecific symptoms.We describe two unusual cases of mass forming IgG4 thyroiditis that were diagnosed recently in our department. The first case is about a 42-year-old woman who has a history of Hashimoto thyroiditis with hypothyroidism presenting with a rapid goiter growth, neck pain, dysphagia and hoarseness. A lymphoma was suspected. Ultrasonography shows heterogeneous hypoechoic lesions that may infiltrate the perithyroid muscles. Fine-needle aspiration (FNA) was suspicious of IgG4 infiltrative disease which was confirmed by microbiopsy. Only the thyroid was hypermetabolic on fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) Scan. No improvement under corticosteroid treatment and Rituximab. Surgery was planified to relieve pressure symptoms. The thyroid surgery was very difficult because of the extensive fibrosis and only a biopsy was performed, confirming the diagnosis and excluding malignancy. The second case is about a 68-year-old woman with a history of hypertension and Graves disease presented with a neck right mass that was suspected to be a paraganglioma, hypermetabolic on FDG PET scan with no other localisation. This mass was surrounding the right primitive carotid artery, associated with thrombi of the internal jugular vein. FNA and microbiopsy found a fibrotic non specific tissue. Thyroidectomy and surgical biopsy of the neck mass were performed with histopathology confirming IgG4 disease on the thyroid gland with fibrosis. There were no hypocalcemia in the two cases and no other localisation. IgG4 related mass-forming thyroiditis is an extremely rare disease. It is now a recognizable pattern of IgG4 thyroiditis, and has as differential diagnosis Hashimoto’s thyroiditis, Graves disease and thyroidal carcinoma.We will discuss through these cases the different clinical presentation of this rare disease, the diagnostic tools, the treatment and the long term follow up. Presentation: Friday, June 16, 2023

S4306 Two Unusual Cases of Isolated Immune Checkpoint Inhibitor-Induced Gastritis

S4306 Two Unusual Cases of Isolated Immune Checkpoint Inhibitor-Induced Gastritis

Hypermethylation of DNA Methylation Markers in Non-Cirrhotic Hepatocellular Carcinoma.

Aberrant DNA methylation changes have been reported to be associated with carcinogenesis in cirrhotic HCC, but DNA methylation patterns for these non-cirrhotic HCC cases were not examined. Therefore, we sought to investigate DNA methylation changes on non-cirrhotic HCC using reported promising DNA methylation markers (DMMs), including HOXA1, CLEC11A, AK055957, and TSPYL5, on 146 liver tissues using quantitative methylation-specific PCR and methylated DNA sequencing. We observed a high frequency of aberrant methylation changes in the four DMMs through both techniques in non-cirrhotic HCC compared to cirrhosis, hepatitis, and benign lesions (p < 0.05), suggesting that hypermethylation of these DMMs is specific to non-cirrhotic HCC development. Also, the combination of the four DMMs exhibited 78% sensitivity at 80% specificity with an AUC of 0.85 in discriminating non-cirrhotic HCC from hepatitis and benign lesions. In addition, HOXA1 showed a higher aberrant methylation percentage in non-cirrhotic HCC compared to cirrhotic HCC (43.3% versus 13.3%, p = 0.039), which was confirmed using multivariate linear regression (p < 0.05). In summary, we identified aberrant hypermethylation changes in HOXA1, CLEC11A, AK055957, and TSPYL5 in non-cirrhotic HCC tissues compared to cirrhosis, hepatitis, and benign lesions, providing information that could be used as potentially detectable biomarkers for these unusual HCC cases in clinical practice.

P25 TB or not TB? An unusual case of inflammatory arthritis in an anti-CCP positive patient

P25 TB or not TB? An unusual case of inflammatory arthritis in an anti-CCP positive patient

Primary cutaneous acral CD8-positive T-cell lymphoproliferative disorder: A clinical and histologic retrospective cohort study

Clonally restricted, non-epidermotropic, low-grade, CD8-positive T-cell infiltrates of the skin was recognized as a unique form of indolent CD8-positive lymphoproliferative disease in 2007 when it was first called primary cutaneous indolent CD8-positive lymphoid proliferation. More recently, the designation of primary cutaneous acral CD8-positive T-cell lymphoproliferative disorder has been used. It is unique as a cutaneous lymphoproliferative disorder because of relative uniformity in its clinical presentation and histomorphology. It has been recognized as having an interesting predilection for the ear and acral sites, characteristically presenting as a solitary lesion. The basic morphology is one characterized by a non-epidermotropic, tumefactive infiltrate of well-differentiated, noncerebriform, atypical, small- to intermediate-sized lymphocytes that exhibit a specific phenotype characterized by CD8 and TIA positivity in concert with a distinct perinuclear Golgi staining pattern for CD68. The typical presentation is in the context of a solitary lesion, which can be treated surgically or with local irradiation. We describe in detail two very unusual cases that expand the clinical spectrum of this condition given the non-acral localization, the multiplicity of lesions to involve the trunk and extremities, and, in one case, the stable but recalcitrant course over 30 years. In addition, the second patient developed paraneoplastic dermatomyositis. We also retrospectively review our database for other cases that represent the entity of primary cutaneous acral CD8-positive T-cell lymphoproliferative disorder and review the literature focusing on non-acral cases. Nomenclature evolution from its first recognition in 2007 to the present is discussed.

Unusual dynamics and nonlinear thermal self‐focusing of initially focused magnetoacoustic beams in a plasma

AbstractUnusual thermal self‐focusing of two‐dimensional beams in plasma which axis is parallel to the equilibrium straight magnetic field is considered. The equilibrium parameters of plasma determine scenario of a beam divergence (usual or unusual) which is stronger as compared with a flow without magnetic field. Nonlinear thermal self‐action of a magnetosonic beam behaves differently in the ordinary and unusual cases. Damping of wave perturbations and normal defocusing in gases leads to reduction of the magnitude of initially planar perturbations at the axis of a beam. Additional thermal self‐focusing nonspecific for gases occurs in plasma under some condition which counteracts this reduction. The theory and numerical examples concern thermal self‐action of initially focused (defocused) magnetosonic beam. Dynamics of perturbations in a beam is determined by dimensionless parameters responsible for diffraction, damping of the wave perturbations, initial radius of a beam's front curvature, and the ratio of viscous to thermal damping coefficients.