Well-defined Borders Research Articles

S2735 Ectopic Hepatic Tissue Causing Mass Effect Presenting as Dysphagia

INTRODUCTION: Ectopic hepatic tissue (EHT) located in the posterior mediastinum is rare. The etiology of EHT is not well understood. We present a case of posterior mediastinal EHT causing mass effect in a middle-aged woman presenting with dysphagia. CASE DESCRIPTION/METHODS: A 50-year-old female presented to the ED with one year of intermittent dysphagia. Described as a “ball-like” sensation in the epigastrium. She denied abdominal pain, nausea, vomiting, hematemesis, early satiety, anorexia or weight loss. Her medical history was significant for peptic ulcer disease. She denied history of abdominal trauma or family history of malignancy. She was hemodynamically stable. Initial labs were nonrevealing. Physical exam was unremarkable. CT chest revealed a well-circumscribed posterior mediastinal mass measuring 3.9 × 3.4 × 3.2 cm. The mass was located to the right of the esophagus, homogeneous and measured 40 Hounsfield units. Her liver was noted to have a similar attenuation coefficient. Endoscopic evaluation revealed an area of mild extrinsic compression at the distal third of the esophagus (35 cm) which was easily traversed by the adult EGD scope. The Z line was seen at 36 cm from the incisors. The posterior mediastinal lesion was noted from 32 to 35 cm. It had an echogenic appearance of hepatic tissue and was noted to be continuous with the left lobe of the liver. This lesion was surrounded by a capsule with well-defined endosonographic borders. The mass was adjacent to the descending aorta and the ventricle. Mediastinal EHT was suspected to be the etiology of her symptoms. Fine needle biopsy was not performed due to proximity to the left ventricle. No other abnormalities were identified. A liver-spleen scan confirmed hepatic tissue in the posterior mediastinum. Outpatient evaluation with cardiothoracic surgery was planned. DISCUSSION: Although typically benign, ectopic hepatic tissue still warrants surgical evaluation and resection. Beyond exerting mass effect on surrounding structures, EHT may also undergo a malignant transformation to hepatocellular carcinoma (HCC). A review of recent medical literature disclosed many cases in which EHT preceded development of HCC, even when the remainder of the liver did not have HCC. Further studies are needed to determine the rate of malignant transformation.We urge consideration of EHT as a differential in the evaluation of posterior mediastinal masses. Given EHT’s propensity for malignant transformation, early recognition and close follow up is of vital importance.Figure 1.: CT Chest demonstrating posterior mediastinal mass continuous with the left lobe of the liver.Figure 2.: Mild extrinsic compression at the distal third of the esophagus approximately 35 cm from the incisors.Figure 3.: Ectopic Hepatic Tissue in the mediastinum.

Cytopathology of extra-renal perivascular epithelioid cell tumor (PEComa): a series of 7 cases and review of the literature

Perivascular epithelioid cell tumor (PEComa) is a family of rare mesenchymal tumors consisting of histologically and immunohistochemically distinctive perivascular epithelioid cells. Relatively little is known about the cytopathology of extra-renal PEComas. Because of a considerable range of morphology and their rarity, accurate cytologic classification can be challenging. We evaluated cytologic characteristics and diagnostic pitfalls of extra-renal PEComas on fine-needle aspiration (FNA). We performed a retrospective search in our cytopathology and surgical pathology database for cases diagnosed as PEComa that had corresponding cytology specimens from 3 medical institutions. All available cytopathology specimens were reviewed. We evaluated cytologic characteristics and recorded histologic diagnoses and immunohistochemical stains. Seven FNA specimens from 6 patients were identified, and cytologic diagnoses were made in all cases as follows: PEComa (4 cases), most consistent with PEComa (1 case), malignant neoplasm (1 case), and hepatocellular carcinoma (1 case). Most specimens were moderately to highly cellular. Cell distribution occurred as tissue fragments with background proliferating capillaries. Most smears were composed of epithelioid cells showing mild to moderate anisonucleosis, abundant eosinophilic cytoplasm, well-defined borders, intranuclear pseudoinclusions, and prominent nucleoli. A combination of myoid and melanocytic markers was expressed in 6 cases except 1 case, which was called hepatocellular carcinoma. This was the largest FNA series for extra-renal PEComas to date. Our study highlights some common cytomorphologic characteristics of PEComa with which cytopathologists should be familiar. In the right clinical and radiologic context, and with the aid of immunohistochemistry, a definitive diagnosis can be achieved.

Appearance of recurrent dermatofibrosarcoma protuberans in postoperative MRI follow-up

Purpose: To analyze the appearance of recurrent dermatofibrosarcoma protuberans (DFSP) in postoperative MRI follow-up and to assess the occurrence of postoperative soft tissue changes detected in MRI.Methods: A total of 464 MRI follow-up scans of 32 patients with histologically proven diagnosis of DFSP were analyzed. MR imaging was performed using a 1.5T MRI system. Recurrent DFSP was examined for signal intensity, contrast behavior, appearance, and extent in MRI.Results: The mean age of the patients was 44,5±17,1 years. Recurrences of DFSP occurred 26±23.3 months after primary tumor resection in the mean (Min.: 9, Max.: 60). In 25% of the patients (n = 8), recurrences of DFSP were detected. Recurrent DFSP most often showed a nodular and homogeneous configuration with well-defined borders and marked contrast enhancement, and a hyperintense signal in PD-weighted and turbo inversion recovery magnitude sequences. All recurrences were well detected in the follow-up MRIs regardless of the performed plastic surgery procedure. Lateral and depth margins had no significant impact on the local recurrence rate. In all, 88% of the patients developed subcutaneous tissue edema (p < 0.01), followed by muscle edema (34%, p = 0.02), and postoperative seroma (22%).Conclusion: Recurrent DFSP mainly appear uniform and clearly delimitable on MRI as nodular, homogeneous, and well-defined lesions with marked contrast enhancement. Therefore, MRI is a valuable tool for postsurgical follow-up. Nearly all patients develop subcutaneous edema after the resection of DFSP.

Swept-source optical coherence tomography angiography findings in choroidal and retinal tumors.

Toreport the swept-source optical coherence tomography angiography (SS-OCTA) findings in choroidal and retinal tumors. A retrospectivenoncomparative interventional case series of 60 eyes having various choroidal and retinal tumors imaged with SS-OCTA (Topcon DR1 Triton Plus, Tokyo, Japan) between September 2018 and February 2020was conducted. Inclusion criteria were tumor thickness <4 mm, tumor base diameter <10 mm, and tumor location at the posterior pole. Choroidal nevi usually demonstrated well-defined borders, hyperreflective internal structure, and no outer retinal involvement on SS-OCTA. Choroidal melanoma, in contrast to nevi, usually had ill-defined borders (p = 0.018), mixed hyperreflective-hyporeflective or hyperreflectiveinternal structure (p = 0.014), and demonstrated outer retinal involvement (p < 0.001). Circumscribed choroidal hemangioma usually presented with well-defined borders, a hyperreflective internal tumor structure with multiple dilated interconnected tumor vessels intermixed with signal void areas representing connective tissue. Optic disc melanocytomas showeda hyporeflective plexus related to blocking of signal by the pigment and an intact radial peripapillary capillary network. There was flow on the surface and slightly deeper within the lesion on B-scan angiography overlay. Retinal astrocytic hamartomas had well-defined borders and a hyperreflective vascular plexus in the superficial and deep retina. Outer retina and choriocapillaris showed hyporeflective change due to shadowing/masking from calcium or high blood flow in the lesion. Each of the different retinal and choroidal tumors studied in this series presented with different SS-OCTA features to aid in the differential diagnosis of these conditions. Good quality images are obtained in patients with good fixation and tumors <3 mm in thickness located at the posterior pole.

DECOMPRESSION FOLLOWED BY CRYOSURGERY FOR TREATMENT OF A GLANDULAR ODONTOGENIC CYST

The glandular odontogenic cyst (GOC) is a rare developmental cyst. Clinically, there is a slow growth without symptoms; radiographically, it is usually characterized as a radiolucent lesion, unilocular or multilocular, with well-defined borders, and an aggressive behavior. This clinical case aims to report on a woman, 50 years old, who presented herself with a history of 5 months’ of volume increase in the right side of her mandible, without pain. Radiographically, we observed a radiolucent area between tooth 41 to 45. An incisional biopsy was performed with inconclusive histopathologic diagnosis. In a second exam, we installed a drain for decompression. The histopathologic diagnosis was a GOC demonstrating epithelium and structures similar to ducts. After 6 months, the cyst diminished and distanced itself from the mental nerve. The lesion was enucleated, and the patient underwent a cryosurgery on the remaining walls to avoid relapse. There is no signal of recurrence after 2 years. The glandular odontogenic cyst (GOC) is a rare developmental cyst. Clinically, there is a slow growth without symptoms; radiographically, it is usually characterized as a radiolucent lesion, unilocular or multilocular, with well-defined borders, and an aggressive behavior. This clinical case aims to report on a woman, 50 years old, who presented herself with a history of 5 months’ of volume increase in the right side of her mandible, without pain. Radiographically, we observed a radiolucent area between tooth 41 to 45. An incisional biopsy was performed with inconclusive histopathologic diagnosis. In a second exam, we installed a drain for decompression. The histopathologic diagnosis was a GOC demonstrating epithelium and structures similar to ducts. After 6 months, the cyst diminished and distanced itself from the mental nerve. The lesion was enucleated, and the patient underwent a cryosurgery on the remaining walls to avoid relapse. There is no signal of recurrence after 2 years.

ADULT RHABDOMYOMA OF THE ORAL CAVITY

This report describes a case of adult rhabdomyoma (AR) in the oral cavity. A 47-year-old male was referred for diagnosis of a painless lesion located in floor of the mouth, with 2 years of duration. Intra-orally, the lesion appeared as a large, well-delimited swelling mass measuring about 5.0 cm, projecting the tongue superiorly and posteriorly. On computerized tomography examination, there was a well-delimited, solid, hypodense mass. The main hypothesis of diagnosis was a salivary gland tumor. The patient was submitted to surgical excision. Microscopically, the nodule was composed by large polygonal cells with well-defined borders, which exhibited abundant, eosinophilic, and granular cytoplasm. Cross-striation in the cytoplasm was also observed, and there were no atypia or mitoses. The cells were positive for muscle-specific actin, desmin, and α-sarcomeric actin. Calponin, h-caldesmon, and myogenin were negative. Based on these features, the diagnosis of AR was established. No recurrence was observed after 24 months.

MEDIAN RHOMBOID GLOSSITIS HISTOLOGICALLY MIMICKING ORAL SQUAMOUS CELL CARCINOMA ON THE DORSUM OF THE TONGUE: CASE REPORT

Median rhomboid glossitis could present histologic features of pseudoepitheliomatous hyperplasia (PEH). An 82-year-old white man presented with a wound in the tongue dorsum. The lesion presented an erythroleukoplakia appearance, well-defined borders, and ardency symptom. An incisional biopsy was performed based on the clinical diagnosis of oral squamous cell carcinoma (OSCC). Microscopic analysis showed a hyperplastic benign epithelium, few mitotic figures, and keratin pearls. Absence of vascular, lymphatic, and perineural invasion was noted. Because PEH resembles systemic diseases, systemic conditions were excluded by laboratory tests. The immunohistochemistry analyses by ki-67 revealed nuclear positivity limited to basal cells. The histopathological features were compatible with median rhomboid glossitis. The patient was treated with oral hygiene instruction and topical antifungal. The patient remains in a follow-up of 7 months. In conclusion, the distinction between PEH and OSCC is necessary to avoid inappropriate therapy and to reach a correct histologic and clinical diagnosis.

EXTRAFOLLICULAR ODONTOGENIC ADENOMATOID TUMOR: CLINICAL AND EPIDEMIOLOGIC PROFILE

Objectives: The odontogenic adenomatoid tumor (AOT) has a prevalence of 3% to 7% among odontogenic tumors. There are 3 variants of AOT: follicular, extrafollicular, and peripheral. The present study aims to trace the clinical and epidemiologic profile of extrafollicular AOT, based on a review of case reports. Study Design: Using the adenomatoid and extrafollicular descriptors, a search was performed in the PubMed database. Fifty-one articles were obtained as a result. The following exclusion criteria were adopted: by title, by case report, by the summary, and by the series of cases. At the end, 10 articles were used as sources for the present study. Results: Ten cases were published between 2009 and 2019, with the following most prevalent characteristics: Asian ethnicity (90%), no gender preference, and mandible location (60%). Imaging presentation included well-defined borders (80%); root displacement (50%); presence of cortical perforation (30%); and root resorption (30%). The mean time of the cases was 4 months, with a maximum of 2 years, and no recurrence was observed in any of the cases. Conclusion: Extrafollicular odontogenic adenomatoid tumor is uncommon. It does not present a predominant profile, exhibiting a diversity of clinical manifestations, with slow to fast and locally aggressive growth.

SOLID AMELOBLASTOMA IN MANDIBULAR REGION: A CASE REPORT

Solid ameloblastoma is an odontogenic epithelial benign neoplasia, but it is aggressive and affects mainly young adults between their third and seventh decade of life, with no predilection for sex. It is clinically characterized as a slow-growing tumor, asymptomatic and with a high recurrence rate. Radiographically, it may present as unilocular or multilocular radiolucent lesions, usually with well-defined borders similar to soap bubbles or honeycombs. This study aims to report a case of solid ameloblastoma that occurred in a 29-year-old patient, submitted to treatment of segmental mandibular resection, presenting a satisfactory result. It is fundamental to know the characteristics of the lesion and to request complementary examinations for a correct diagnosis of this pathology.

Ossifying Fibroma pada mandibula pasien anak

Objectives: To view a case report of mandibular ossifying fibroma (OF) in pediatric male. &#x0D; Case Report: A 12 year old child came to RSHS with a panoramic radiograph with the chief complaint of swelling in the right mandible. Panoramic radiograph shows well-defined mixed lesions with radiolucent content and snowflake-like opaque. MDCT shows a superior-inferior and bucco-lingual extension of the lesion. The suspicion of this case leads to Ossifying Fibroma with differential diagnosis of Adenomatoid Odontogenic Tumor (AOT) and Calcifiying Ephitelial Odontogenic Tumor (CEOT). &#x0D; Conclusion: OF cases in children, especially mandibular, are very rare, where the characteristics of the lesion can be well defined through the help of panoramic radiographs and MDCT. OF is a lesion that has benign characteristics with well-defined borders, and the most important lies in the presence of wrapping capsules and mixed internal structures accompanied by snowflake-like calcification.

Mixed Method Study of International Students’ Cross-Cultural Adjustment and Assignment Satisfaction

Emotional stability and sense of coherence are both predictors of global quality of life, general life perception, psychological and physiological health. However, previous studies found those two concepts to overlap and called for researchers to find more well-defined borders and study them in different contexts together. The present study addresses this issue using a complex mixed-method approach. The conceptual framework was pretested including relationships between defined variables through the interviews conducted with 21 international students. The variables were then measured via a quantitative survey and 214 data rows obtained constituted the basis for the final statistical analysis. Drawing on the qualitative findings, study participants found emotional stability and sense of coherence as both enhancing cross-cultural adjustment process and influencing assignment satisfaction. Later, the latter two were quantitatively assessed in terms of moderating role of cross-cultural motivation. Complementary qualitative information not only supported the study hypotheses but also brought a certain degree of subjectiveness in the findings. Thus, it has illustrated how important these qualities for the acculturation are and how they can influence the assignment satisfaction, the key HEI performance criterion.

A review with an additional case: amelanotic malignant melanoma at mandibular gingiva.

The purpose of this review with an additional case is to evaluate the clinical, ultrasonographic and histopathological features of a rare case of Amelanotic Malignant Melanoma (AMM) at mandibular gingiva and to compare our case with other published AMMs at mandibular gingiva. A 52-year-old male patient with no systemic diseases was referred to our clinic with a soft tissue lesion at mandibular gingiva. Ultrasonographic examination was performed and a lesion with malignant features was observed. A periapical radiograph was taken toinvestigate bone destruction and biopsy was planned. Histopathological examination revealed AMM and a literature search was performed to congregate reports which were indexed in PubMed, ScienceDirect, and ResearchGate. Three AMM cases at mandibular gingiva were found. DopplerUltrasound examination suggested bone destruction and a 1.8cm × 0.6cm soft tissue mass with well-defined borders and increased vascularity. Due to its hypervascularity, depth of invasion and destruction at the bone, the lesion was prediagnosed as a malignancy. Lack of melanin pigmentation caused the large immunohistochemical panel study. The tumour cells showed HMB45 and S100 positivity and they were negative with SMA, Desmin, CK1.3, and CK20. Routine ultrasound examination of all soft tissue lesions is very important for assessing features such as vascularity, bone destruction and depth of invasion to detect malignancy. Melanocytic-associated immunohistochemical markers are crucial for AMM diagnosis.

Sporadic oncocytic tumors with features intermediate between oncocytoma and chromophobe renal cell carcinoma: comprehensive clinicopathological and genomic profiling

Morphology, clinical behavior, and genomic profiles of renal oncocytoma (RO) and its malignant counterpart chromophobe renal cell carcinoma (ChRCC) are distinctly different. However, there is a substantial group of sporadic oncocytic tumors with peculiar hybrid phenotypes as well as a perplexing degree of morphologic and immunohistochemical overlap between classic RO and ChRCC with eosinophilic cytoplasm. The aim of this study is to provide detailed characterization of these hybrid tumors.Thirty-eight sporadic oncocytic neoplasms with ambiguous morphology from two institutions were reviewed by 4 pathologists. CKIT positivity was used as a selection criterion. We correlated CK7 and S100A1 immunostaining and detailed morphologic features with cytogenetic profiles. DNA from the formalin-fixed paraffin-embedded tissues was extracted and analyzed using cytogenomic microarray analysis (CMA) to evaluate copy number alterations (CNA) and ploidy. CMA categorized cases into 3 groups: RO (N=21), RO variant (N=7), and ChRCC (N=10). Cytogenetic RO had either no CNA (48%) or loss of chromosome 1p, X, or Y (52%). RO variant had additional chromosomal losses [-9q, -14 (n=2), -13] and chromosomal gains [+1q (n=2), +4, +7 (n=2), +13, +19, +20, and +22]. ChRCCs were either hypodiploid with numerous monosomies (40%) or hypotetraploid with multiple relative losses (60%). RO, RO variant, and ChRCC groups differed significantly in tumor architecture (p<0.01), stroma (p=0.013), presence of nuclear wrinkling, perinuclear halos, and well-defined cell borders in >5% of cells (p<0.01), focal cell clearing (p=0.048) and CK7 expression (p<0.02). Pathologic prediction of the cytogenetic subtype using only two categories (benign RO or malignant ChRCC) would overcall or undercall up to 40% of tumors that were ChRCC based on cytogenetics. This finding provides the rationale for an intermediate diagnostic category of the so-called hybrid tumors (hybrid oncocytic/chromophobe tumor [HOCT]). HOCT was a heterogeneous group enriched for cytogenetic RO variant. Other HOCTs have a profile of either RO or ChRCC. The genomic profile allows classification of oncocytic tumors with ambiguous morphology into RO, RO variant, and ChRCC. Several architectural and cytologic features combined with CK7 expression are significantly associated with cytogenetic RO, RO variant, or ChRCC tumors. Doubled hypodiploidy by whole-genome endoduplication is a common phenomenon in eosinophilic ChRCC.

Investigation of the effectiveness of CBCT and gray scale values in the differential diagnosis of apical cysts and granulomas.

The aim of this study was to investigate the effectiveness of cone-beam CT (CBCT) findings and gray scale values (GSV) in the differential diagnosis of apical cysts and granulomas. Two independent researchers retrospectively analyzed the CBCT images of 21 teeth and histopathologically diagnosed them as having radicular cysts or apical granulomas. In the CBCT images, apical lesions were evaluated and categorized according to 7 criteria. These criteria were determined as relationship of lesions with dental roots, periphery of the lesion, shape, darker focus in the center, root resorption, displacement in related teeth, and cortical bone perforation. In addition, the minimum and maximum gray scale values of the lesions were measured and compared. There was a statistically significant relationship between histopathological (HP) diagnosis and well-defined cortical border and lesion shape (p = 0.003, p = 0.014, respectively). According to the HP diagnosis, no statistically significant difference was found among other variables (p > 0.05) CONCLUSION: The presence of a well-defined cortical border or partial cortical border is a distinctive criterion for cysts. Additionally, the shape of the lesion was found to be a significant criterion for the separation of the two lesions. The shape of cystic lesions was circular and apical granulomas had a more curved shape. There was no relationship between the histopathological diagnosis of lesions and CBCT gray scale values.

Characterization of vascular stains associated with high flow

High-flow vascular stains (HFVS) arelesions that have the appearance of capillary malformations/port wine stains but are associated with increased arterial flow. To identify features of HFVS that differentiate them from typical "slow-flow" port wine stains. Retrospective multicenter cohort study of HFVS evaluated across 7 centers was conducted. HFVS were characterized by clinical features (warmth, thrill, rapid capillary refill), radiologic findings (fast flow), or mutations associated with capillary malformation-arteriovenous malformation syndrome. Investigators reviewed photographs. The study reviewed 70 patients with HFVS (47 multifocal and 23 solitary). Most were flat (77%), warm to the touch (60%), and red or pink-red in color (35%), with heterogeneous color saturation (73%) and well-defined borders (71%). Regional soft tissue swelling/overgrowth was common (47%). Head and neck location was most common (38%). Among 34 HFVS with photographic review over time, all demonstrated changes in appearance. Retrospective design, recall bias, lack of standardized time points or visual analog scale, and image variability. Heterogeneity of stain color saturation, warmth to touch, peripheral pallor, and overgrowth/soft tissue swelling help distinguish HFVS from port wine stains. Darkening of color and increased border demarcation may develop over time. These findings raise suspicion for HFVS and provide an indication to assess for extracutaneous involvement.

Ultrasound features of the subungual glomus tumor and squamous cell carcinomas.

Nail tumors often pose a significant challenge for the clinician, as they are burdened by a high delay in diagnosis and paucity of clinical signs in the early stage. In most cases, the onset of pain or nail plate dystrophy leads to imaging investigations such as plain radiography, magnetic resonance imaging, and ultrasonography (US) when surgery is pending. A 2-year monocentric study evaluated the histologically confirmed cases of subungual glomus tumor (GT) and squamous cell carcinoma (SCC) with a pre-surgical US assessment, and reviewed their sonography features. A total of 7 digital GTs and 6 SCCs of the nail were collected. GT and SCC are easily distinguishable on US. Compared to SCC, GT was positively associated with an ovoid shape, well-defined borders, bone cup-scalloping without cortical erosion, and a rich intralesional vascular pattern (P < 0.05). Vice versa, SCC was significantly correlated with irregular shape, ill-circumscribed margins, an infiltrative growth pattern with peripheral hypoechoic foci, posterior acoustic shadow, cortical erosion, and a highly vascular multipolar peripheral pattern (P < 0.05). The rapid assessment of GT and SCC sonographic features may contribute to reduce diagnostic delay, expedite management, and decrease the risk of surgical relapse.

First Report of Stem Necrosis and Leaf Spot of Tomato Caused by Albifimbria verrucaria in Italy

First Report of Stem Necrosis and Leaf Spot of Tomato Caused by <i>Albifimbria verrucaria</i> in Italy

Hepatic Angiomyolipoma

To investigate whether quantitative contrast-enhanced ultrasound (CEUS) analysis and magnetic resonance imaging (MRI) can differentiate hepatic angiomyolipoma (AML) from hepatocellular carcinoma (HCC) and hepatic epithelial angiomyolipoma (EAML) from nonepithelial AML. Retrospective analysis of 26 CEUS lesions pathologically confirmed as AML and 60 patients with confirmed HCC. Clinical and ultrasound (US) features of AML versus HCC and EAML versus nonepithelial AML were analyzed. Quantitative parameters, including arrival time, ascending slope, time to peak, peak intensity (PI), fall time (FT), and mean transit time (MTT), were analyzed. Diagnostic performance of MRI and CEUS was compared. Angiomyolipoma was significantly different from HCC in US findings of solitary tumor (P < .001), well-defined border (P = .025), and hyperechogenicity (P < .001). Tumor types were significantly different in US findings of centripetal filling pattern (P < .001), less hypoenhancement in the CEUS delayed phase (P = .04), high PI (P = .007) and ascending slope (P = .006), and short FT (P = .001) and MTT (P < .05). The sensitivity and specificity of quantitative parameters were 61.5% to 96.2% and 55.0% to 71.7% (area under the curve, 0.642-0.773). An early draining vein and tumor vessels, intratumor fat, absence of pseudocapsules, mild signal intensity on diffusion-weighted imaging, and hypointensity in the MRI delayed phase were helpful for differentiation of AML from HCC (P < .05). The positive predictive values of CEUS and MRI were 46.3% to 100% and 42.9% to 75%, with no significant difference (P > .05). Epithelial AML was more likely to be hypoechoic with a centripetal filling pattern than nonepithelial AML (P < .05). The MTT and FT of EAML were shorter than those of nonepithelial AML (P < .05). The PI of EAML was significantly stronger than that of nonepithelial AML (P < .01). The sensitivity and specificity of quantitative parameters were 68.7% to 100.0% and 60.0% to 100.0% (area under the curve, 0.825-0.941). Less intratumor fat was helpful for differentiation of EAML from nonepithelial AML (P < .05). The positive predictive values of CEUS and MRI were 77.8% to 100% and 85.7%, with a significant difference (P < .05). Quantitative CEUS findings could be valuable in differentiating EAML from HCC.

The Use of ESEM-EDX as an Innovative Tool to Analyze the Mineral Structure of Peri-Implant Human Bone.

This study aimed to investigate the mineralization and chemical composition of the bone–implant interface and peri-implant tissues on human histological samples using an environmental scanning electron microscope as well as energy-dispersive x-ray spectroscopy (ESEM-EDX) as an innovative method. Eight unloaded implants with marginal bone tissue were retrieved after four months from eight patients and were histologically processed and analyzed. Histological samples were observed under optical microscopy (OM) to identify the microarchitecture of the sample and bone morphology. Then, all samples were observed under ESEM-EDX from the coronal to the most apical portion of the implant at 500x magnification. A region of interest with bone tissue of size 750 × 500 microns was selected to correspond to the first coronal and the last apical thread (ROI). EDX microanalysis was used to assess the elemental composition of the bone tissue along the thread interface and the ROI. Atomic percentages of Ca, P, N, and Ti, and the Ca/N, P/N and Ca/P ratios were measured in the ROI. Four major bone mineralization areas were identified based on the different chemical composition and ratios of the ROI. Area 1: A well-defined area with low Ca/N, P/N, and Ca/P was identified as low-density bone. Area 2: A defined area with higher Ca/N, P/N, and Ca/P, identified as new bone tissue, or bone remodeling areas. Area 3: A well-defined area with high Ca/N, /P/N, and Ca/P ratios, identified as bone tissue or bone chips. Area 4: An area with high Ca/N, P/N, and Ca/P ratios, which was identified as mature old cortical bone. Bone Area 2 was the most represented area along the bone–implant interface, while Bone Area 4 was identified only at sites approximately 1.5 mm from the interface. All areas were identified around implant biopsies, creating a mosaic-shaped distribution with well-defined borders. ESEM-EDX in combination with OM allowed to perform a microchemical analysis and offered new important information on the organic and inorganic content of the bone tissue around implants.

Choroidal Manifestation of Systemic Non-Tuberculous Mycobacterial Infection: A Case Series.

To describe choroidal findings associated with disseminated systemic non-mycobacterial infection. A retrospective observational case series included two patients (four eyes) with non-tuberculous mycobacterial disease. The activity of choroidal lesions was assessed by clinical examination, supported by colour fundus photography, fundus autofluorescence imaging, indocyanine green angiography, fluorescence angiography, and optical coherence tomography (OCT) angiography. The relationships between clinical symptomatology, choroidal findings, and systemic disease activity were evaluated. One subject diagnosed with aortic graft infection showed positive cultures for Mycobacterium chimaera. One HIV-positive subject showed a positive saliva culture for Mycobacterium avium. At presentation, all subjects showed chorioretinal manifestation. In one patient, the lesions were active and in the other patient, the lesions appeared inactive. With activity of disseminated chorioretinitis, the lesions had indistinct, blurred borders on fluorescence angiography and indocyanine green angiography and were hyporeflective with well-defined borders on OCT imaging. Multimodal imaging enables distinction between active and inactive lesions, thus supporting therapeutic management. Choroidal presentation of active disseminated mycobacterium infection indicates activity of systemic disease. Thus, even if the patient is not immunocompromised, an underlying systemic involvement should be ruled out.