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Background: Category III (AUS; Atypia of Undetermined Significance) of The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was established to describe thyroid nodule features that are neither benign nor cancerous. OBJECTIVES: This study aims to evaluate the rate of thyroid malignancy in patients diagnosed with AUS at the Armed Forces Hospital Southern Region (AFHSR), Saudi Arabia. Method: The patients (508) diagnosed with AUS in their thyroid nodules underwent fine-needle aspiration cytology (FNAC). Data were collected through a chart-based approach, reviewing patients’ medical records and relevant information. Results: Among the cases, the majority were females (84.6%). Among the different age groups, individuals between 40 and 50 years had the highest prevalence of thyroid nodules (32.5%). Approximately 27% of patients exhibited tumor sizes larger than 4 cm. FNAC results revealed 16.5% benign, 26% AUS, and 22.4% follicular neoplasm cases. Histopathology indicated 54.1% of benign and 37.2% of malignant cases. Papillary carcinoma accounts for 80.4% of all malignant cases. A significant correlation was observed between FNAC and postoperative histopathology (P value < 0.05). Hypoechoic nodules exhibited 33.9% of malignant cases, and calcification was observed in 25% of the cases. A significant association was found between malignancy and echogenicity and between malignancy and calcification (P value = 0.003 and 0.001, respectively). Conclusion: The findings of this study identify malignancy in thyroid nodules with AUS cytopathology, particularly in the Southern region of Saudi Arabia. The correlation between pre-surgery FNAC and postoperative histopathology supports FNAC’s diagnostic value. Additionally, echogenicity and calcification can potentially contribute to predicting nodule malignancy.

Abstract The current primary treatment approach for malignant pelvic tumors involves hemipelvic prosthesis reconstruction following tumor resection. In cases of Enneking type II + III pelvic tumors, the prosthesis necessitates fixation to the remaining iliac bone. Prevailing methods for prosthesis fixation include the saddle prosthesis, ice cream prosthesis, modular hemipelvic prosthesis, and personalized prosthetics using three-dimensional printing. To prevent failure of hemipelvic arthroplasty protheses, a novel fixation method was designed and finite element analysis was conducted. In clinical cases, the third and fourth sacral screws broke, a phenomenon also observed in the results of finite element analysis. Based on the original surgical model, designs were created for auxiliary dorsal iliac, auxiliary iliac bottom, auxiliary sacral screw, and auxiliary pubic ramus fixation. A nonlinear quasi-static finite element analysis was then performed under the maximum load of the gait cycle, and the results indicated that assisted sacral dorsal fixation significantly reduces stress on the sacral screws and relative micromotion exceeding 28 μm. The fixation of the pubic ramus further increased the initial stability of the prosthesis and its interface osseointegration ability. Therefore, for hemipelvic prostheses, incorporating pubic ramus support and iliac back fixation is advisable, as it provides new options for the application of hemipelvic tumor prostheses.

Introduction: The ovaries, fallopian tubes, and the broad ligament make up the anatomical adnexa. Adnexal masses represent a commonly occurring issue in gynaecology. The majority of ovarian malignancies are detected at advanced stages. The clinical manifestations of adnexal masses vary, with many cancers either showing no symptoms or presenting with vague signs. In the reproductive age group, the most typical manifestation is a benign functional cyst. Aim: To conduct a clinico-pathological analysis of adnexal masses among women presenting at a tertiary healthcare centre. Materials and Methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology at Akash Institute of Medical Science and Research Centre, Devanahalli, Karnataka, India, from November 2022 to April 2024. The diagnosis of adnexal mass was based on clinical symptoms, abdominal examination, bimanual examination, and trans-abdominal ultrasound. The CA-125 and other tumour markers were sent depending on the risk of malignancy. All tissues were sent for histopathological examination. The data were collected and tabulated in a Microsoft excel sheet, and percentages were calculated. Results: This study included 38 cases, in which benign ovarian and para-ovarian cysts were the most common findings, observed in 21 cases (55.3%). There were six cases of benign serous cystadenoma (15.8%), three cases of teratoma (7.9%), two cases of high-grade serous carcinoma (5.3%), one case of germ cell tumour (2.6%), one case of mucinous cystadenoma (2.6%), two cases of endometriotic cysts (5.3%), one case of adnexal cystic degeneration of a fibroid (2.6%), and one rare case of primary fallopian tube carcinoma (2.6%). The most common presenting complaint was abdominal pain, reported in 21 cases (55.3%). Conclusion: Adnexal masses can present in a variety of forms, ranging from benign cysts to infections and cancers. A thorough history and clinical examination are essential for accurate diagnosis. Investigations support the diagnosis, and histology confirms it.

We report a case of nodular melanoma. A 46-year-old female presented with a brown papule on the medial side of the right upper arm for more than 40 years, with an increase in size for 2 months. Dermatological examination revealed a demarcated brown fungoid nodule with crusts, 1.3 cm in diameter, on the medial side of the right upper arm. The nodule was surrounded by light erythema, without ulceration. Histopathology showed exophytic nodular growth, involving both the epidermis (Paget's cells) and the reticular dermis. The tumor cells appeared in epithelioid or spindle shapes with abundant cytoplasm, vesicular nuclei of varying sizes, prominent nucleoli, and mitoses (4/HP), arranged in a nest pattern. Breslow thickness was 10 mm, and Clark level was Ⅳ. Immunohistochemistry demonstrated S-100 (diffuse+), Melan-A(+), HMB-45 (focal+), Ki-67 hot spot area(25%+), SOX-10 (diffuse+), and PRAME (diffuse+).The diagnosis of nodular melanoma was made. The patient underwent an extensive excision. The patient was recommended to seek medical care in other facility. The latest follow-up showed that surgery and chemotherapy were not given after evaluation by the oncology department at other hospital.

Sava&scedil; Gegin,1 Ahmet Cemal Pazarl&inodot;,2 Burcu Özdemir,1 Levent Özdemir,1 Esra Arslan Aksu3 1Samsun Training and Research Hospital, Pulmonology Clinic, Samsun, Türkiye; 2Tokat Gaziosmanpa&scedil;a University, Faculty of Medicine, Department of Pulmonary Diseases, Tokat, Türkiye; 3Samsun University Faculty of Medicine, Pulmonology Department, Samsun, TürkiyeCorrespondence: Ahmet Cemal Pazarl&inodot;, Tokat Gaziosmanpa&scedil;a University, Faculty of Medicine, Department of Pulmonary Diseases, Tokat, Türkiye, Tel +90 5053696860, Fax +03562129500, Email dracp60@gmail.comAim: In cases where standardized maximum uptake (SUVmax) values in positron emission tomography (PET-CT) were not sufficient to differentiate mediastinal lymphadenopathy and masses from malignant or benign, the contribution of Hounsfield unit (HU) values in thorax computed tomography to the diagnosis was evaluated.Material Method: The study was conducted by evaluating the data of 182 patients between 2019 and 2023. HU values on non-contrast thorax computed tomography and PET-CT SUVmax values of biopsied masses and lymph nodes were compared with histopathological diagnoses.Results: Patients, 58 females (31.9%) and 124 males (68.1%), who underwent EBUS were included in the study. Biopsies were taken from 233 stations (199 lymph nodes, 34 masses) from 182 patients. A total of 135 of the biopsies taken from 233 stations were histopathologically malignant and 98 were benign. While PET-CT SUVmax values of cases with benign histopathology were 4.5 ± 3.5, it was 7.6 ± 4.2 in patients with malignant pathology (p< 0.05). The HU value on non-contrast thorax tomography in patients with benign histopathology was 43.1 ± 15.7, and in patients with malignant histopathology it was 40.5 ± 13.7 (p> 0.05). When HU was compared according to lung cancer type, it was found to be significantly higher in non-small cell lung cancer (p=0.035). A weak (r=0.182) positive and significant relationship (p< 0.01) was found between PET-CT values and HU values in thorax computed tomography.Conclusion: While positron emission tomography maintains its importance in the differentiation of mediastinal lymphadenopathy and masses from malignant to non-malignant, it was concluded that HU values in computed tomography are not sufficient to distinguish malignant/non-malignant.Keywords: Hounsfield unit, positron emission tomography, SUVmax, benign, malignant, mediastinal lymphadenopathy

Purpose: Aims to provide an overview of the contemporary epidemiology of malignant orbital tumors by analyzing population-based incidence patterns across various regions worldwide. Methods: In this article, we retrieved orbital malignancy data from the MEDLINE database and analyzed the incidence and prevalence of orbital malignancies worldwide. We performed the literature search by searching on the Mesh terms for malignant orbital tumors (''orbital'', ''tumor'', ''lymphoma'', ''malignant'', ''cancer'', ''incidence'', and ''epidemiology''). All included studies were published between 1993 and 2023 and were written in English. Results: Ocular or ophthalmic lymphoma most frequently occurred in the orbit, with a prevalence ranging from 47% to 54%. The incidence of malignant orbital tumors was increasing in the USA (2.0 per million (1981–1993), Netherlands (0.86 (1981–1985) to 2.49 (2001–2005) per million) and South Korea (0.3–0.8 per million (1999–2016)), respectively. Ophthalmic lymphoma which includes orbit lymphoma was increasing in Canada (0.17–1.47 per million (1992–2010)), Denmark (0.86 per million (1981–1985) to 2.49 per million (2001–2005)), respectively. Conclusions: The predominant primary malignant orbital tumor in adults was lymphoma. Ocular or ophthalmic lymphoma most frequently occured in the orbit. The limited data available suggested an increasing trend in the incidence of malignant orbital tumors in each country included, which were mainly attributed to the increase in lymphoma. Generally, incidence rates were found to increase with advancing age, with no difference between males and females.

Abstract Background Malignant chest wall tumors need to be excised with wide resection to ensure tumor free margins, and the reconstruction method should be selected according to the depth and dimensions of the tumor. Vascularized tissue is needed to cover the superficial soft tissue defect or bone tissue defect. This study evaluated differences in complications according to reconstruction strategy. Methods Forty-five patients with 52 operations for resection of malignant tumors in the chest wall were retrospectively reviewed. Patients were categorized as having superficial tumors, comprising Group A with simple closure for small soft tissue defects and Group B with flap coverage for wide soft tissue defects, or deep tumors, comprising Group C with full-thickness resection with or without mesh reconstruction and Group D with full-thickness resection covered by flap with or without polymethyl methacrylate. Complications were evaluated for the 52 operations based on reconstruction strategy then risk factors for surgical and respiratory complications were elucidated. Results Total local recurrence-free survival rates in 45 patients who received first operation were 83.9% at 5 years and 70.6% at 10 years. The surgical complication rate was 11.5% (6/52), occurring only in cases with deep tumors, predominantly from Group D. Operations needing chest wall reconstruction (p = 0.0016) and flap transfer (p = 0.0112) were significantly associated with the incidence of complications. Operations involving complications showed significantly larger tumors, wider areas of bony chest wall resection and greater volumes of bleeding (p

الملخص: أهداف البحث: تمثل الحليمات الكمئية الملونة في اللسان آفة مصبوغة نادرة التواجد وغير موثقة بشكل كاف في الدراسات المنشورة، مما يشكل تحديات في التشخيص وخطط العلاج اللاحقة. تهدف الدراسة إلى تحليل معرفة وفهم وموقف أطباء الأسنان تجاه أشكال الحليمات الكمئية الملونة في اللسان لتحديد التشخيص وخطط العلاج اللاحقة. طرق البحث: أجريت دراسة مقطعية بين أطباء الأسنان في جاوة الشرقية باستخدام استبانة عبر الإنترنت. تم تقديم أربع صور سريرية للحليمات الكمئية الملونة في اللسان، مع سبعة أسئلة لتقييم معرفة أطباء الأسنان بها، بما في ذلك نوع الآفة، وهياكل اللسان المتضمنة، وتصنيف هولزوانقر، ونمط الآفة، والتشخيص المشتبه به، وطبيعة الآفة (حميدة أو خبيثة). تضمنت أسئلة إضافية تجارب مع الآفة في الممارسة، والتحول المحتمل إلى الورم الخبيث، والتحقيقات التشخيصية، والعلاج المطلوب لتقييم المواقف. تم تحليل الفروقات في المواقف المرتبطة بالمعرفة إحصائيا باستخدام اختبار مان-ويتني. النتائج: شارك ما مجموعه 117 طبيب أسنان، وكانت الغالبية من الإناث (69.23%) ومن الفئة العمرية 26-30 سنة (44.44%). أظهر أطباء الأسنان الذين تتراوح أعمارهم بين 41-50 عاما معرفة متفوقة مقارنة بأولئك الذين تتراوح أعمارهم بين 20-30 عاما. أظهر الممارسون الذين لديهم 1-5 سنوات من الخبرة فروقات كبيرة في المعرفة حول هذه الحالة. لم يلاحظ تباين كبير بين مستوى المعرفة والموقف، خاصة فيما يتعلق بالعلاج والتحقيق الداعم. ومع ذلك، كان لمواجهة حالات الحليمات الكمئية الملونة تأثير كبير على قرارات العلاج والتحقيقات الداعمة. الاستنتاجات: يمتلك معظم أطباء الأسنان المشاركين مستوى جيد من المعرفة حول حالات الحليمات الكمئية الملونة. تتأثر معرفة أطباء الأسنان، كما يتضح من مواقفهم تجاه التحقيق والعلاج، بشكل ملحوظ بتجاربهم مع هذه الحالات. Abstract: Objective: Pigmented fungiform papillae of the tongue (PFPT) are infrequently encountered and inadequately documented pigmented lesions that pose challenges in diagnosis and subsequent treatment planning. The study was aimed at analyzing dentists' knowledge and attitudes regarding PFPT morphologies, to determine diagnosis and subsequent treatment planning. Methods: A cross-sectional study was conducted among dentists in East Java through an online questionnaire. Four clinical photographs of PFPT were presented, accompanied by seven questions assessing dentists' knowledge of PFPT, including lesion types, tongue structure involvement, Holzwanger classification, lesion patterns, suspected diagnoses and the nature of the lesion (benign or malignant). Additional questions to evaluate attitudes included prior experience with PFPT in practice, potential malignant transformation, diagnostic investigation and required treatment. Knowledge-associated attitude differences were statistically analyzed with the Mann–Whitney test with a threshold of p 0.05). However, prior encounters with PFPT cases were significantly associated with treatment decisions and supporting investigations for diagnosis (p

Background: Neck swellings are frequently found and can present the vast pathological spectrum from simple benign to highly malignant, which sometimes can pose a diagnostic dilemma. They are broadly classified as developmental, inflammatory, and neoplastic on the basis of etiology. The aim of the study is to assess the distribution of neck swelling according to etiology and its relation to age groups, as well as to assess their clinicopathological correlation as benign and malignant. Materials and Methods: The study was conducted from January 2020 to February 2023 on the basis of retrospective and prospective sampling. All the patients with neck swellings, except thyroid, who had undergone an excisional or incisional biopsy, were included in this study. Data was collected from in-patient records for retrospective sampling, and fine-needle aspiration cytology (FNAC), radiological investigation, and excisional or incisional biopsy were performed for prospective sampling after proper history and examination. Cytological and pathological correlation was analyzed as benign and malignant. Sensitivity and specificity were calculated. (P value

Background & Aims: Ovarian cancers are increasing in incidence, and an accurate ultrasonographic diagnosis, along with a complete physical examination and history taking, is essential for prompt diagnosis and early reporting. In this study, we aimed to evaluate the efficacy of ultrasonography (USG) in identifying ovarian lesions using histopathology as the gold standard. Materials & Methods: This was a retrospective study conducted by evaluating the reports of patients in the menopausal age group who had undergone total hysterectomy or oophorectomy. Histopathological diagnoses were retrieved from the Department of Pathology, and ultrasonographic (USG) reports were obtained from the patients' medical records. Results: This study included the histopathological and ultrasonographic reports of 239 women, of which 95.4% of cases were benign, while borderline lesions and malignant lesions constituted 3.3% and 1.3%, respectively. USG showed sensitivities of 93.55%, 66.7%, and 33% in identifying benign, borderline, and malignant lesions, respectively. Specificities of 91.67%, 91.84%, and 99.46% were noted in classifying ovarian lesions as benign, borderline, and malignant, respectively. Conclusion: Ultrasonography (USG) remains an important imaging tool for the early diagnosis of ovarian lesions, and a standardized reporting protocol should be implemented in every institution to increase the accuracy of USG and to reduce the inter-observer variability commonly encountered in ultrasound.

To evaluate the efficacy of radiomics features extracted from preoperative high-resolution computed tomography (HRCT) scans in distinguishing benign and malignant pulmonary pure ground-glass nodules (pGGNs), a retrospective study of 395 patients from 2016 to 2020 was conducted. All nodules were randomly divided into the training and validation sets in the ratio of 7:3. Radiomics features were extracted using MaZda software (version 4.6), and the least absolute shrinkage and selection operator (LASSO) was employed for feature selection. Significant differences were observed in the training set between benign and malignant pGGNs in sex, mean CT value, margin, pleural retraction, tumor–lung interface, and internal vascular change, and then the mean CT value and the morphological features model were constructed. Fourteen radiomics features were selected by LASSO for the radiomics model. The combined model was developed by integrating all selected radiographic and radiomics features using logistic regression. The AUCs in the training set were 0.606 for the mean CT value, 0.718 for morphological features, 0.756 for radiomics features, and 0.808 for the combined model. In the validation set, AUCs were 0.601, 0.692, 0.696, and 0.738, respectively. The decision curves showed that the combined model demonstrated the highest net benefit.

Introduction: The thyroid gland is a crucial endocrine organ that can be susceptible to various pathological conditions, often necessitating total thyroidectomy or lobectomy. It is a common surgical procedure in Saudi Arabia. Thus, it is essential to recognize the impact of thyroid surgery on patients’ health-related quality of life (HRQoL). Aim: The aim of this study was to evaluate HRQoL among patients with benign and malignant thyroid diseases who underwent thyroidectomy in the eastern region of Saudi Arabia. Methods: This cross-sectional study was conducted at King Fahad Hospital of University in Khobar, Kingdom of Saudi Arabia from January 2018 to May 2018. The data collection method used was divided into two parts. Part I included the patients’ socio-demographic characteristics and the clinical characteristics of their thyroid surgery. Part II was a HRQoL questionnaire (SF-36, version 1.0). Results: The sample included 100 thyroidectomy patients ≥18 years. The study findings revealed that the overall scores for post-thyroidectomy patients showed a significant improvement in HRQoL, and HRQoL was not significantly associated with benign or malignant thyroid diseases. Conclusion: Especially when the surgery is performed by a high-volume endocrine surgeon, thyroidectomy may lead to significant improvements in HRQoL among patients, including the elderly and younger adults, with benign and malignant thyroid disorders. There was no difference in HRQoL between patients who underwent total thyroidectomy or thyroid lobectomy. Also, HRQol among thyroidectomy patients is associated with their educational and occupational statuses.

Introduction: Merkel cell carcinoma is a very rare malignant neoplasm which presents high aggressivity, high recurrence rate and has meta-static potential. Our purpose is to present the histological and immunohistochemical particularities of Merkel Cell Carcinoma while reviewing potential differential diagnoses and challenges that we can encounter in daily practice.

Background: Breast cancer presents a significant global health burden. An accurate differentiation between benign and malignant lesions is imperative for timely intervention. While dynamic contrast enhanced MRI (DCE-MRI) is highly sensitive, its specificity is limited. This has led to the exploration of diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions. Objectives: The study aimed to explore the diagnostic utility of DWI in distinguishing between benign and malignant breast lesions. Method: Assessment of 38 breast lesions using DWI with a b value of 800 s/mm2, performed with 3 Tesla MRI. The diagnostic performance of two different region of Interest (ROI) placement approaches was compared to obtain a feasible cut-off value of apparent diffusion coefficient (ADC) to differentiate between malignant and benign lesions. The histopathological reports were used as the gold standard. Results: ADC values of malignant lesions were significantly lower than those of benign lesions (0.84 × 10−3 mm2/s vs. 1.54 × 10−3 mm2/s). The average ADC measured using a small-sized 2D ROI including the darkest part in the ADC map, performed better than the large 2D ROI covering the entire lesion. Conclusion: Using a cut-off value of 0.98 × 10−3 mm2/s, ADC obtained high sensitivity (90%) and specificity (88.9%) in distinguishing between benign and malignant breast lesions. Contribution: Utilising quantitative analysis of DWI with ADC value measurement, reliably distinguished between benign and malignant breast lesions in this cohort, especially when employing a higher b value of 800 s/mm2.

IntroductionOral malignant melanoma (OMM) is the most common malignant oral neoplasm in dogs. Tumor recurrence, progression, and regional and distant metastasis remain major obstacles despite advanced therapy. Tumor size has been a consistent, key independent prognostic factor; however, other clinical and histopathologic features impact prognosis and likely influence optimal treatment strategies. Adoption of a risk stratification scheme for canine OMM that stratifies groups of dogs on defined clinicopathologic features may improve reproducible and comparable studies by improving homogeneity within groups of dogs. Moreover, it would aid in the generation of multidisciplinary prospective studies that seek to define optimal treatment paradigms based on defined clinicopathologic features.MethodsTo build a platform upon which to develop a risk stratification scheme, we performed a systematic review of clinicopathologic features of OMM, with particular attention to levels of evidence of published research and the quantitative prognostic effect of clinicopathologic features.ResultsTumor size and presence of bone lysis were repeatable features with the highest level of evidence for prognostic effects on survival. Overall, with strict inclusion criteria for paper review, the levels of evidence in support of other, previously proposed risk factors were low. Factors contributing to the challenge of defining clear prognostic features including inconsistencies in staging and reporting of prognostic variables, incomplete clinical outcome data, inhomogeneous treatment, and absence of randomized controlled studies.DiscussionTo overcome this in the future, we propose a risk stratification scheme that expands the TNM system to incorporate specific designations that highlight possible prognostic variables. The ability to capture key data simply from an expanded TNM description will aid in future efforts to form strong conclusions regarding prognostic variables and their influence (or lack thereof) on therapeutic decision-making and outcomes.

Solitary fibrous tumor (SFT) of the pleura is a rare mesenchymal tumor with

Introduction: The Papanicolaou Society of Cytopathology System for reporting Pancreaticobiliary Cytology (PSCPC) is a reliable method to classify pancreatic fine needle aspiration cytology (FNAC) smears. However, it is not without practical problems which can diminish the diagnostic accuracy of the cytological diagnosis. Aims and Objectives: To determine the diagnostic pitfalls while reporting cytomorphology of pancreatic lesions according to PSCPC on correlating FNAC findings with histopathology. Materials and Methods: Retrospective analysis of pancreatic FNAC smears received in the Department of Pathology of our tertiary care institute over a period of 2 years was done. The cytological diagnoses were classified according to the Papanicolaou Society of Cytopathology system of reporting pancreaticobiliary cytology and correlated with histopathology. The reasons of cyto-histological discordance were analyzed. Results: Out of 50 cases in which both FNAC and biopsy of pancreatic lesions were done, 34 cases were positive/malignant (Category VI), eight cases were suspicious for malignancy (Category V), three cases were neoplastic (Category IV), two cases were atypical (Category III), two cases were negative for malignancy (Category II), and one case was non-diagnostic (Category I). Out of 50 cases, histopathology was non-diagnostic due to inadequate material in six cases. The cytological diagnoses were compared with histopathology in the remaining 44 cases. Categories III, IV V, and VI were considered as positive for neoplastic pathology. The sensitivity of FNAC to predict neoplastic pathology was 97.5%, while the specificity was 25%. The positive predictive value was 92.9%. Two cases reported as atypical (Category III) turned out to be adenocarcinoma on histopathology. One case reported as neuroendocrine tumor and two cases reported as adenocarcinoma on cytology displayed features of chronic pancreatitis on histology. One case reported as neoplastic mucinous cyst (Category IV) turned out to be adenocarcinoma on histology (limited concordance). Conclusion: The cytopathologist needs to be wary of the potential pitfalls to improve the diagnostic accuracy of FNACs.

Abstract Background Sex cord-stromal tumors with annular tubules are a rare tumor accounting for less than 1% of all ovarian malignancies. However, they are characterized by very late recurrence, which can be as late as 30 years after diagnosis and treatment. Case presentation A 16-year-old female Caucasian patient was treated in our department for a stage IA ovarian sex cord-stromal tumors with annular tubules. She underwent a left salpingo-oophorectomy and ipsilateral pelvic node biopsy with no adjuvant treatment. She was seen for amenorrhea after being lost to follow up for 16 years. The diagnosis of recurrence was made by radiology and the elevation of serum inhibin B level. The patient underwent resection of the tumor, left segmental colectomy, and paraaortic lymphadenectomy because the mass was massively adherent to the left mesocolon. Histology confirmed the diagnosis with no metastatic lymph nodes. No adjuvant therapy was indicated. The patient was lost to follow-up again for 4 years and re-presented for amenorrhea. Serum inhibin B level was high. A second recurrence was suggested, and the patient underwent a laparoscopic surgery. We performed left pelvic and paraaortic lymphadenectomy, and 3 months after surgery the patient was pregnant. Conclusion Sex cord-stromal tumors with annular tubules is a slow-growing ovarian tumor with a high potential for recurrence and metastasis. Surgery is the mainstay of treatment. Due to the rarity of these tumors, they are often unsuspected and thus incompletely staged before primary surgery; the diagnosis is made by histological examination. The prognosis of these patients is unknown, and they require long-term follow-up.

Abstract Background Multisystem childhood Langerhans cell histiocytosis (LCH) patients, especially those with risk organ (RO) involved, had not been satisfactorily treated under the international traditional schemes as high incidences of reactivation with late sequelae were largely reported. Over years, we have observed that LCH patients with varied clinical symptoms responded differently to different drugs, suggesting the current grouping strategies based only on the number of organs involved might be inadequate. LCH has been defined as an inflammatory myeloid tumor, thus this study has innovatively divided LCH pediatric patients into inflammatory or malignant symptoms group, and given different intensity treatment regimens to different groups. Aim This clinical study aimed to explore a more appropriate patient grouping system according to the LCH symptom presentations and examine the clinical outcomes of treatment strategies in different groups. Methods According to the clinical manifestations, 37 cases of children were divided into Group A (only inflammatory symptoms) and Group B (malignant symptoms with or without inflammatory symptoms). Patients in Group A and B were initially treated with vindesine (VDS) and methylprednisolone (PSL), and VDS, PSL, pirarubicin (THP) and cyclophosphamide (CTX), respectively. Treatment responses were evaluated six weeks after the induction therapy in all patients, and the criteria were disease status and clinical scores of symptoms. Results Pre- and post-treatment scores were 1.22 ± 0.547 and 0.00 ± 0.00 in Group A, and 14.79 ± 1.686 and 1.00 ± 1.563 in Group B, respectively. All patients had subsequentlly received maintenance therapy without progressive disease. The 4-year overall survival (OS) rate was 100% in both groups and the 4-year event-free survival (EFS) was 94.4% in Group A and 89.5% in Group B, respectively. There were no obvious adverse events (AE) in Group A, whereas the main AE in Group B were alopecia and non-lethal hematological toxicity. Conclusion Stratification according to patients’ clinical symptoms, with low-intensity treatment for inflammatory symptoms (mild manifestations) and intensive treatment with multiple drugs for malignant symptoms (severe manifestations), is a positive exploration that simplifies stratification method, achieves good long-term remission of the disease, and obtains a higher survival rate and quality of life, which seemed to be more appropriate for LCH patients.

Runqian Huang,1,&ast; Chunling Zheng,1,2,&ast; Guixiao Xu,1 Xuanwei Chen,1 Jingxian Shen,1 Siyue Mao1 1Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, People’s Republic of China; 2Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jingxian Shen; Siyue Mao, Department of Radiology, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Sun Yat-sen University, 651 Dongfeng Road East, Guangzhou, 510060, People’s Republic of China, Tel/Fax +86-20-87343217, Email shenjx@sysucc.org.cn; maosiy@sysucc.org.cnObjective: To identify imaging features that help distinguish between HCCs and non-HCC malignancies assigned to LI-RADS M (LR-M) and evaluate the diagnostic performance of a LI-RADS with targetoid criteria using thin-rim arterial phase hyperenhancement (APHE).Materials and Methods: This retrospective study included 381 patients (387 observations) at high-risk for HCC who underwent enhanced-MRI before surgery. Three radiologists reviewed images for LI-RADS categorization of hepatic observations. Univariate and multivariate analysis was conducted to determine reliable features to differentiate between HCC and non-HCC malignancies among the LR-M lesions. The thin-rim (< 30%) APHE was defined based on the thickest thickness of rim APHE compared with the tumor radius, and a modified LI-RADS emphasizing thin-rim APHE as a specific feature of LR-M was established. We compared the diagnostic performance of modified LR-M and LI-RADS 5 (LR-5) with the conventional one.Results: Thin-rim APHE and targetoid diffusion-weighted imaging (DWI) were found as independent predictive factors of non-HCC malignancies, while enhancing capsule, thick-rim APHE and peripheral washout were noted as independent variables significantly associated with HCC of LR-M (P< 0.05). The noticeable diagnostic performance of thin-rim APHE in distinguishing non-HCC malignancies from HCCs using the ROC curve. Emphasizing thin-rim APHE on targetoid features, the modified LR-M revealed significantly superior specificity and accuracy (89.4% vs 81.1%, P=0.004; and 87.9% vs 82.2%, P=0.027, respectively) while maintaining high sensitivity (82.2% vs 86.0%; P=0.529) compared with the LR-M. Meanwhile, the modified LR-5 achieved greater sensitivity and accuracy (88.6% vs 79.7%, P=0.004; and 85.8% vs 80.1%, P=0.036, respectively) for diagnosing HCC, without compromising specificity (78.3% vs.81.1%; P=0.608) compared with the LR-5.Conclusion: Thin-rim APHE may be the specific imaging feature for differentiating non-HCC malignancies from HCCs within LR-M. The modified targetoid criteria emphasizing thin-rim APHE can improve the diagnostic performance of LI-RADS for hepatic malignancies.Keywords: hepatic tumors, malignant, targetoid feature, Rim APHE, liver imaging reporting and data system

Daifeng Hu,1,&ast; Mengyue Miao,1,&ast; Hui Zhou,1 Xia Gu,1,2 Xuedan Wang,3 Alexander Tobias Teichmann,1 Qin Wang,1 Youzhe Yang1,2 1Sichuan Provincial Center for Gynaecology and Breast Diseases, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China; 2Academician (Expert) Workstation of Sichuan Province, Luzhou, 646000, People’s Republic of China; 3Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Qin Wang; Youzhe Yang, The Affiliated Hospital of Southwest Medical University, NO. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People’s Republic of China, Email wangq@swmu.edu.cn; yangyouzhe@swmu.edu.cnAbstract: Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors originating from perivascular epithelioid cells. In gynecological system, the uterus is one of the most common sites affected by PEComas. Most PEComas are benign, and patients usually have a good prognosis. However, malignant uterus PEComa is rare, and better comprehensive epidemiological investigations are needed. To date, there are a few reported cases of uterus PEComa. We herein report a rare case of malignant PEComa occurred in the uterine corpus and cervix, possibly accompanied by pulmonary lymphangioleiomyomatosis (PLAM). In addition, 55 cases of malignant uterus PEComa were picked out and collected in the data base of PubMed and Medline. On the one hand, the age of onset, population distribution, clinical manifestations, metastatic sites and routes of metastasis were analysed. On the other hand, a summary of the epidemiology, pathogenesis, diagnosis, and treatments of uterus PEComa was given.Keywords: perivascular epithelioid cell tumors, uterus, malignant, rare case, cervix

Synovial sarcoma is a rare and highly malignant soft tissue sarcoma. The inconspicuous and diversity of its early symptoms make it a highly misdiagnosed disease. The management of synovial sarcomas is challenging as they are rare and have a poor prognosis. Early and correct diagnosis and treatment are critical for clinical outcomes. Misdiagnosis or delayed diagnosis can have devastating consequences for the patient. The detection of SS18 gene rearrangement is considered a powerful tool in establishing the diagnosis of synovial sarcomas. Biopsies and testing for gene rearrangements are recommended for all patients in whom SS cannot be excluded. Surgery is the mainstay of treatment for synovial sarcomas. Neoadjuvant/adjuvant radiotherapy is recommended for patients with big tumors (>5 cm) or positive resection margins, and neoadjuvant/adjuvant chemotherapy is recommended for patients with high-risk tumors or advanced diseases. This article reviews synovial sarcomas from the perspectives of clinical and radiological presentation, histological and cytogenetic analysis, differential diagnosis, treatment, and prognosis.

Abstract To illustrate the surgical technique and explore clinical outcomes of the reconstruction for the malignant and metastatic bone tumour of proximal femur with metallic modular intercalary prosthesis. Sixteen patients who underwent modular intercalary prosthetic reconstruction after tumour resection were included from April 2012 and October 2020. Prosthesis and screws parameters, resected bone length and residual bone length, clinical outcomes and survivorship were analyzed. All patients were followed up for an average of 19 months (range 1–74). In our series, 12 patients died of the progression of the primary disease at the final follow-up. The cumulative survivorship since the treatment of proximal femoral metastasis was 78.6% (11 patients) at 6 months and 38.5% (5 patients) at 1 year. The mean MSTS score was 22.25 ± 4.55 among all patients. There were no cases of loosening or breakage of the prostheses, plates or screws, despite the various measurements of prostheses and residual bones. Modular intercalary prosthetic reconstruction was an effective method for malignant tumour of the proximal femur, including the advantages of providing early pain relief, quickly restoring postoperative function, required a short operation time, and preserving the adjacent joints.

The term dermatoglyphics was first used in 1926 by anatomist Cummins. Dermatoglyphic is a term that refers to “a skin carving.” The unique carve present on the skin surface of humans and other living beings is referred to as dermatoglyphics. This research was conducted to understand the variations in patterns and assess the usefulness of dermatoglyphics among individuals diagnosed with potentially malignant diseases and mouth cancer. Three hundred subjects were selected. The study consisted of three groups. Patients were divided into the following groups: Group I: oral submucous fibrosis (OSMF) (100), Group II: ORAL LEUKOPLAKIA (100), and Group III: Healthy Individuals (100). Our research study indicates a difference in dermatoglyphic patterns between patients and healthy individuals. Specifically, there is a lower percentage of loop patterns and an increase in arch patterns in OSMF and leukoplakia patients. These findings suggest that dermatoglyphics may have relevance in understanding or identifying certain health conditions.

Phyllodes tumours or cystosarcoma phyllodes are fibroepithelial tumours of the breast and represent 1% of breast tumours. A 20-year-old nullipara presented with an enlarging left breast mass over 6 months. Although widely excised, it was reported to be a 12 × 10 × 5.5-cm borderline phyllodes tumour with involvement of the superior and inferior margins. Seven months later, she presented with a new ipsilateral breast lump measuring 8.5 × 7.5 × 4.6 cm. She underwent a left mastectomy, a three-rib resection with titanic rods for the thoracic cage reconstruction, and a latissimus dorsi flap wound closure. Histopathology revealed a high-grade malignant phyllodes tumour with features of osteoid differentiation with the nearest deep margin measuring 3 mm. She developed metastasis to the ipsilateral axillary lymph nodes and contralateral lung 2 months postoperatively. She was given palliative radiotherapy 60 Gy in 30 fractions to the left axilla. She developed sudden lower-limb weakness due to spinal metastases. The symptoms resolved with radiotherapy to the thoracic spine (T4–T8). As the lesion continued to grow rapidly from the anterior chest wall encircling towards the back, it was deemed unresectable. She was given palliative chemotherapy (doxorubicin six cycles, followed by ifosfamide one cycle) but had disease progression. She passed away 3 months later. The mainstay of treatment for phyllodes tumour is excision with a minimal margin of 1 cm. Although margins were involved after the first surgery, she was followed up as the pathology was a borderline phyllodes. When the lump recurred and had transformed, despite extensive surgery, it returned shortly and progressed. A borderline phyllodes should be excised to obtain a minimal margin of 1 cm, even if it means performing a mastectomy, to minimise recurrence. A recurrence may undergo malignant transformation which is largely chemotherapy and radiotherapy resistant. This will result in a poor outcome and decreased survival.

ObjectiveThis study aimed to construct a machine learning model using clinical variables and ultrasound radiomics features for the prediction of the benign or malignant nature of pancreatic tumors.Methods242 pancreatic tumor patients who were hospitalized at the First Affiliated Hospital of Guangxi Medical University between January 2020 and June 2023 were included in this retrospective study. The patients were randomly divided into a training cohort (n=169) and a test cohort (n=73). We collected 28 clinical features from the patients. Concurrently, 306 radiomics features were extracted from the ultrasound images of the patients’ tumors. Initially, a clinical model was constructed using the logistic regression algorithm. Subsequently, radiomics models were built using SVM, random forest, XGBoost, and KNN algorithms. Finally, we combined clinical features with a new feature RAD prob calculated by applying radiomics model to construct a fusion model, and developed a nomogram based on the fusion model.ResultsThe performance of the fusion model surpassed that of both the clinical and radiomics models. In the training cohort, the fusion model achieved an AUC of 0.978 (95% CI: 0.96–0.99) during 5-fold cross-validation and an AUC of 0.925 (95% CI: 0.86–0.98) in the test cohort. Calibration curve and decision curve analyses demonstrated that the nomogram constructed from the fusion model has high accuracy and clinical utility.ConclusionThe fusion model containing clinical and ultrasound radiomics features showed excellent performance in predicting the benign or malignant nature of pancreatic tumors.

Neuroleptic Malignant Syndrome (NMS) and Serotonin Syndrome (SS) are life-threatening conditions caused by adverse reactions to neuroleptics and antidepressant medications. The overlap of both syndromes is rare but has been described previously. Differentiating between both entities based on the clinical presentation can be difficult. We present a case of a young male patient with history of schizophrenia, admitted to the Medical Intensive Care Unit (MICU) for septic shock, who developed NMS and SS with oculomotor dysfunction following the abrupt cessation of clozapine while still being on an antidepressant.

Abstract Background The low specificity of Thyroid Imaging Reporting and Data System (TI-RADS) for preoperative benign-malignant diagnosis leads to a large number of unnecessary biopsies. This study developed and validated a predictive model based on MRI morphological features to improve the specificity. Methods A retrospective analysis was conducted on 825 thyroid nodules pathologically confirmed postoperatively. Univariate and multivariate logistic regression were used to obtain β coefficients, construct predictive models and nomogram incorporating MRI morphological features in the training cohort, and validated in the validation cohort. The discrimination, calibration, and decision curve analysis of the nomogram were performed. The diagnosis efficacy, area under the curve (AUC) and net reclassification index (NRI) were calculated and compared with TI-RADS. Results 572 thyroid nodules were included (training cohort: n = 397, validation cohort: n = 175). Age, low signal intensity on T2WI, restricted diffusion, reversed halo sign in delay phase, cystic degeneration and wash-out pattern were independent predictors of malignancy. The nomogram demonstrated good discrimination and calibration both in the training cohort (AUC = 0.972) and the validation cohort (AUC = 0.968). The accuracy, sensitivity, specificity, PPV, NPV and AUC of MRI-based prediction were 94.4%, 96.0%, 93.4%, 89.9%, 96.5% and 0.947, respectively. The MRI-based prediction model exhibited enhanced accuracy (NRI>0) in comparison to TI-RADSs. Conclusions The prediction model for diagnosis of benign and malignant thyroid nodules demonstrated a more notable diagnostic efficacy than TI-RADS. Compared with the TI-RADSs, predictive model had better specificity along with a high sensitivity and can reduce overdiagnosis and unnecessary biopsies.

Abstract Aim The current study aims to evaluate interrater reliability of ovarian–adnexal reporting and data system (O-RADS) magnetic resonance imaging (MRI) in interpretation of adnexal and ovarian lesions. Material and methods Retrospective analysis of 131 ovarian lesions was as done for 106 consecutive female patients with adnexal and/or ovarian lesions that underwent MR imaging of the pelvis. Images interpretation was accomplished by two-blinded independent raters for cystic and solid parts of ovarian lesions. The score was 5 types classified pursuant to O-RADS. Results A perfect interrater agreement regarding overall O-RADS [Kappa: 0.874, P: 0.001]. There was a perfect interrater agreement of the solid component (Kappa: 0.979, 95% confidence interval (CI) 0.938–1.0, P: 0.001), enhancement degree relative to myometrium (Kappa: 0.876, 95% CI 0.781–0.971, P: 0.001) and entirely solid lesions (Kappa: 1.0, 95% CI 1.0–1.0, P: 0.001). A perfect interrater agreement for ORADS 1 (Kappa: 0.937, P: 0.001), ORADS 2 (Kappa: 0.983, P: 0.001), ORADS 3 (Kappa: 0.834, P: 0.001), ORADS 4 (Kappa: 0.827, P: 0.001) and ORADS 5 (Kappa: 0.963, P: 0.001) was present. Conclusions The O-RADS MRI scoring system has better characterization of adnexal masses with high interrater agreement. Overcoming limitations of this study, O-RADS, may be suggested as a basic system in assessment of adnexal masses.

Objective: To summarize the clinical and molecular pathological characteristics of malignant pulmonary nodules and improve understanding of the disease. Methods: Patients who underwent surgical resection of small pulmonary nodules in Cardiothoracic Surgery of Jiangsu Province Hospital of Chinese Medicine from March 2018 to December 2021 and were pathologically confirmed to be malignant were taken as the research objects. Retrospective analysis of clinical data and molecular pathological features of surgical specimens was conducted. Results: A total of 371 patients were enrolled, including 39 cases of carcinoma in situ (CIS), 164 cases of microinvasive adenocarcinoma (MIA) and 168 cases were invasive adenocarcinoma (IA); 69.8% were females, 30.2% were males, with a majority of females. 87.6% of patients did not smoke; The upper lobe of the right lung had the most malignant nodules (37.5%), followed by the lower lobe of the left lung (18.6%). In comparison among different pathological types, the ages of CIS, MIA and IA were (54.1±10.9), (52.2±12.6) and (59.1±9.9) years (F=16.05, P＜0.01), the smoking rates were 10.3%, 3.7% and 21.4% (X2=24.31, P＜0.01), the median tumor diameter was 0.55, 0.60 and 0.80 cm (H=76.13, P＜0.01), respectively, with IA all being the highest, and the differences were statistically significant. The mutation frequency of exons 21 of epidermal growth factor receptor (EGFR), and tumor suppressor protein p53 (TP53) in IA were higher than those in CIS and MIA (P＜0.05), while the mutation frequency of human epidermal growth factor receptor 2 (HER2) exon 20ins, mitogen-activated protein kinase (MAP2K1) and serine/threonine protein kinase (BRAF) were lower than those in CIS and MIA, and the differences were statistically significant (P＜0.05). Conclusion: Patients with malignant pulmonary nodules may have the following characteristics: more common in women, non-smoking, located in the upper lobe of the right lung. There are differences in age, smoking rate, tumor diameter and driving gene mutation frequency among the three pathological types of malignant nodules.

Primary cardiac tumours are uncommon, and approximately 90% of them, in both children and adults, are benign. Primary tumours are less prevalent than secondary malignancies that spread to the heart. The subtle and non specific nature of the clinical signs could cause a delay in diagnosis, as well as surgical treatment. Although epidemiology and multimodality imaging approaches are helpful, the definitive diagnosis often necessitates histologic evaluation, and histological characterisation continues to be the gold standard in diagnostics. Herein the authors described four (two males and two females) cases of intriguing primary cardiac tumours. All the cases were diagnosed to have a cardiac mass/clot by Echocardiography (Echo), and the cases underwent tumour excision. Histopathological analysis revealed three benign cases diagnosed as atrial myomas, and one malignant case diagnosed as high-grade spindle cell sarcoma, specifically rhabdomyosarcoma. Immunohistochemistry (IHC) was required for the definitive diagnosis of the malignant patient. All the patients were followed-up for a period of one year. All benign cases were symptom-free, while the patient who had rhabdomyosarcoma expired. The aim of the present case series was to highlight the importance of histopathological examination, as well as the prognosis of cardiac tumours.

Background: Skin disorders are common as skin is constantly exposed to various chemicals, ultraviolet rays, climate, etc., making it prone to damage leading to various diseases. The spectrum of skin disorder lesions varies according to geographical distribution, gender, and age. A large number of skin lesions can be diagnosed clinically, but histopathological examination is necessary for accurate diagnosis and proper management. Literature shows few such studies in India, but no such study could be found for the Indian Armed Forces population. The aim of our study was to understand the pattern of skin diseases in Armed Forces population. Materials and Methods: All skin biopsies received between January 2022 and December 2022 were included in the study. Two hundred skin biopsies received were examined for various skin ailments. The skin biopsies were processed, sectioned, and stained with hematoxylin and eosin and wherever required special stains like modified Ziehl–Neelsen stain. The histopathological data were retrieved and reviewed. The data were collected and entered into SPSS 20.0 for statistical analysis. Results: Out of the two hundred cases studied, the most common group of disorders were of noninfectious nonneoplastic category (55%), followed by benign neoplasms (25%) and infectious category (18%), with least cases belonging to malignant category (2%). Commonly involved site in the body was upper limbs. The most common disorder found in males was psoriasis and in females was lobular capillary hemangioma. Conclusion: Understanding spectrum of histopathological spectrum of skin disorders will aid in identifying and managing different disorders, effectively providing high-quality care to the patient.

Malignant melanoma originates from melanoma cells, which derive from the neuroectoderm of the ectodermal mucosa. The chameleonic presentation of malignant melanoma, its often asymptomatic nature, the rarity of the lesion, the grim prognosis, and the imperative for highly specialized treatment are critical factors that merit careful consideration. Herein, we report a compilation of five cases of malignant melanomas occurring at unusual anatomical locations, which were initially misdiagnosed, which on careful analysis with the use of immuno-histochemical stains were correctly diagnosed as malignant melanoma.

Background/Aim: Endometrial abnormalities represent a diagnostic challenge due to overlapping imaging features with normal endometrium. Aim of this study was to assess accuracy of dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging (MRI) in evaluation of endometrial lesions in comparison with T2 and to assess local staging validity and degree of myometrial invasion in malignancy. Methods: Forty patients with abnormal vaginal bleeding or sonographic thickened endometrial were recruited. MRI examination of pelvis was per-formed using 1.5 T scanner with a pelvic array coil. Conventional T1-and T2, dynamic contrast-enhanced (DCE) sequences and diffusion-weighted image (DWI) were performed. Results: Mean age of patients was 53.2 years and 60 % of patients COM-plained of post-menopausal bleeding. Irregular margin, type III enhancement curve, a high signal in T2WI and DWI and low signal of apparent diffusion coefficient (ADC) were significantly associated with malignancy. The optimum ADC threshold value for distinguishing benign from malignant endometrial lesions was 0.905 × 10 -3 mm 2 /S, with 95.5 % sensitivity and 92.9 % specificity. DWI was most sensitive to malignant endometrial lesions, followed by DCE (89.6 %, 98.4 %) and T2 (86.7 %, 91.4 %). DWI and DCE staging correlated with FIGO staging (p = 0.0001 and p = 0.019, respectively). DWI had the best sensitivity for myometrial invasion (95.6 %), followed by DCE (91.9 %) and T2WI (90.1 %). All three sequences had 89.7 % specificity. Conclusion: DWI and DCE MRI were superior to conventional MRI at distinguishing malignant from benign endometrial lesions and can improve myometrial invasion depth evaluation and therapy planning when COM-bined with morphological T2WI. ADC cutoff at a high b value improved MRI diagnostic sensitivity and specificity.

Abstract Breast cancer stands as a paramount public health concern worldwide, underscoring an imperative necessity within the research sphere for precision-driven and efficacious methodologies facilitating accurate detection. The existing diagnostic approaches in breast cancer often suffer from limitations in accuracy and efficiency, leading to delayed detection and subsequent challenges in personalized treatment planning. The primary focus of this research is to overcome these shortcomings by harnessing the power of advanced deep learning techniques, thereby revolutionizing the precision and reliability of breast cancer classification. This research addresses the critical need for improved breast cancer diagnostics by introducing a novel Convolutional Neural Network (CNN) model integrated with an Early Stopping callback and ReduceLROnPlateau callback. By enhancing the precision and reliability of breast cancer classification, the study aims to overcome the limitations of existing diagnostic methods, ultimately leading to better patient outcomes and reduced mortality rates. The comprehensive methodology includes diverse datasets, meticulous image preprocessing, robust model training, and validation strategies, emphasizing the model's adaptability and reliability in varied clinical contexts. The findings showcase the CNN model's exceptional performance, achieving a 95.2% accuracy rate in distinguishing cancerous and non-cancerous breast tissue in the integrated dataset, thereby demonstrating its potential for enhancing clinical decision-making and fostering the development of AI-driven diagnostic solutions.

The escalating incidence of thyroid cancer over the past decade underscores the imperative for effective classification and early detection of thyroid nodules. An automated system for this purpose could significantly aid physicians, particularly in expediting diagnostic processes. However, attaining this objective has proven challenging, primarily attributed to the constrained dataset size for medical images and the laborious process of feature extraction. This research addresses these challenges by thoroughly exploring the importance of extracting meaningful features for tumor detection and introducing a quantum-based convolutional neural network. The proposed approach employs a quantum filter transformation for intricate feature extraction, coupled with a classical neural network for the classification of thyroid nodules in ultrasound images. The classification process involves two distinct categorizations: distinguishing between nodules that are benign or malignant, and identifying the specific suspicious class to which the nodule is attributed. The amalgamation of both classifiers yields a comprehensive characterization of thyroid nodules, showcasing notable accuracy. For tumor classification, the model achieves an accuracy of 97.63%, precision of 97.72%, and recall of 97.64% on a test dataset containing 127 images. Similarly, for suspicious level classification, the model attains an accuracy of 93.87%, precision of 94.58%, and recall of 93.88% on a test dataset containing 98 images. These results surpass the performance of existing models, marking a significant advancement in the field of thyroid nodule classification. The proposed model represents a promising and innovative methodology that could offer valuable support mechanisms in clinical settings, facilitating the rapid classification and diagnosis of thyroid cancer.

Background: Touch imprint cytology of image guided core needle biopsy implies gentle rolling of core needle biopsy obtained with the aid of imaging modality from various organs. The aim of the study was to measure the diagnostic accuracy of touch imprint cytology of image guided core needle biopsy in comparison to histopathological diagnosis. Materials and Methods: A prospective descriptive cross-sectional study was conducted among 47 touch imprint cytology of image guided core needle biopsy in the department of pathology of a tertiary care centre between 1st October 2021 to 30th September 2022 after receiving ethical approval from the institutional review committee. The Papanicolaou and Giemsa-stained slides of touch imprint smear and haematoxylin - eosin-stained slides of core needle biopsy was analysed for adequacy and categorization as non-neoplastic, benign, atypical and malignant. Convenience sampling was done. Results: The most frequent site of image guided core needle biopsy was lung (40.4%). The adequacy rate of touch imprint cytology of image guided core needle biopsy was 85.1%. Among 40 cases of adequate touch imprint smear, 28 cases (70%) were categorized as malignant. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of touch imprint cytology for categorizing a malignant lesion was 91.18%, 95.45%, 96.88%, 87.5% and 92.86% respectively. Conclusion: The touch imprint cytology of image guided core needle biopsy is a useful modality for the rapid preliminary diagnosis of lesions of various organs with decreased turnaround time for diagnostic workup and ancillary studies.

The subject matter of this study is breast tumor prediction and feature importance score finding using machine learning algorithms. The goal of this study was to develop an accurate predictive model for identifying breast tumors and determining the importance of various features in the prediction process. The tasks undertaken included collecting and preprocessing the Wisconsin Breast Cancer original dataset (WBCD). Dividing the dataset into training and testing sets, training using machine learning algorithms such as Random Forest, Decision Tree (DT), Logistic Regression, Multi-Layer Perceptron, Gradient Boosting Classifier, Gradient Boosting Classifier (GBC), and K-Nearest Neighbors, evaluating the models using performance metrics, and calculating feature importance scores. The methods used involve data collection, preprocessing, model training, and evaluation. The outcomes showed that the Random Forest model is the most reliable predictor with 98.56 % accuracy. A total of 699 instances were found, and 461 instances were reached using data optimization methods. In addition, we ranked the top features from the dataset by feature importance scores to determine how they affect the classification models. Furthermore, it was subjected to a 10-fold cross-validation process for performance analysis and comparison. The conclusions drawn from this study highlight the effectiveness of machine learning algorithms in breast tumor prediction, achieving high accuracy and robust performance metrics. In addition, the analysis of feature importance scores provides valuable insights into the key indicators of breast cancer development. These findings contribute to the field of breast cancer diagnosis and prediction by enhancing early detection and personalized treatment strategies and improving patient outcomes.

Objective: Ovarian cancer is the sixth most common cancer in Thailand. Given the absence of a computed tomography (CT) score for differentiating between benign and malignant ovarian tumors, this study aimed to develop a CT scoring system for differentiating between benign and malignant ovarian tumors using pathologic findings as the reference standard. Material and Methods: This retrospective study included all female patients having undergone abdominal/pelvic CT scans for evaluation of ovarian masses at our institute, from January 2011 to December 2021. Two radiologists independently reviewed CT features and obtained a CT score for each tumor. Comparison of the differentiation performance of the CT score, with reference to the pathologic findings, was performed using Fisher’s exact or chi-squared test. The diagnostic performance of the CT score was evaluated. Results: A total of 144 patients with 191 ovarian masses were enrolled. Tumor component characteristics, septate thickness, ascites, and metastasis significantly differed between benign and malignant tumors (p-value

Key Clinical Message Urachal anomalies are rare congenital lesions of the genitourinary tract and are important causes of pediatric and adolescent hospital presentations. It can mimic many other causes of intraabdominal pathology and fever, and pose diagnostic challenges, often aided by imaging, is crucial to prevent complications such as infection and calculus formation. Surgical intervention, preferably laparoscopic, is the primary treatment, with complete excision necessary to avoid potential malignant transformation.

Malignant glomus tumor (MGT) is a rare mesenchymal neoplasm. It is rarely located in the breast. We present a case of a 57-year-old female patient presenting with complaints of a progressively growing mass found in her left breast. Though multiple imaging examinations have been performed, especially multimodal ultrasound examinations, an accurate diagnosis still cannot be determined. Finally, the lesion was confirmed to be a MGT of the breast by postoperative pathological diagnosis. In conclusion, MGT originating from breast is extremely rare. No such case has ever been described before. This study demonstrates the imaging characteristics of a patient with MGT of the breast in order to provide more extensive insights to consider the differential diagnosis of breast lesions.

Objective: To study the outcomes of endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using lumenapposing metal stent (LAMS) in patients with benign and malignant gastric outlet obstruction (GOO). Materials and Methods: This single-center study retrospectively reviewed the medical records of benign and malignant GOO patients who underwent EUS-GE between May 2019 and September 2023. We evaluated the technical success, adverse events related to the techniques used, clinical success, and recurrence and reintervention rates. Results: A total of twelve patients who underwent three different EUS-GE techniques were included in this study. The first method was the direct over-the-guidewire technique, the second was the wireless-freehand method, and the third was modified endoscopic ultrasound-guided double-balloon occluded gastroenterostomy bypass (M-EPASS). All 3 techniques used preloaded oroenteral catheters in combination. Technical success was achieved in 83.3% (10/12) of patients, and there were 16.6% (2/12) failures due to misdeployment. One (8.3%) severe adverse event occurred resulting in peritonitis during the direct over-the-guidewire method. The second failure, which ensued after use of the wireless-freehand technique, achieved successful stent deployment at the second attempt without any complications. Clinical success was 100% (11/11), and mean follow up was 6.2 months. There was one (9.1 %) incidence of recurrence at 12-month follow up. Conclusion: EUS-GE is effective in the management of GOO, and the wireless-freehand and M-EPASS techniques in combination with oroenteral catheters should be the technique of choice in term of safety and efficacy.

Rationale and objectivesTo construct a predictive model for benign and malignant peripheral pulmonary lesions (PPLs) using a random forest algorithm based on grayscale ultrasound and ultrasound contrast, and to evaluate its diagnostic value.Materials and methodsWe selected 254 patients with PPLs detected using chest lung computed tomography between October 2021 and July 2023, including 161 malignant and 93 benign lesions. Relevant variables for judging benign and malignant PPLs were screened using logistic regression analysis. A model was constructed using the random forest algorithm, and the test set was verified. Correlations between these relevant variables and the diagnosis of benign and malignant PPLs were evaluated.ResultsAge, lesion shape, size, angle between the lesion border and chest wall, boundary clarity, edge regularity, air bronchogram, vascular signs, enhancement patterns, enhancement intensity, homogeneity of enhancement, number of non-enhancing regions, non-enhancing region type, arrival time (AT) of the lesion, lesion-lung AT difference, AT difference ratio, and time to peak were the relevant variables for judging benign and malignant PPLs. Consequently, a model and receiver operating characteristic curve were constructed with an AUC of 0.92 and an accuracy of 88.2%. The test set results showed that the model had good predictive ability. The index with the highest correlation for judging benign and malignant PPLs was the AT difference ratio. Other important factors were lesion size, patient age, and lesion morphology.ConclusionThe random forest algorithm model constructed based on clinical data and ultrasound imaging features has clinical application value for predicting benign and malignant PPLs.

Background. Burden of disease estimation allows analyses to be carried out integrally, including cause and effect assessment. the rate of life years lost due to premature mortality is part of the burden of disease analysis. given that the burden of cancer is steadily increasing, analysis of the number of years lost makes it possible to identify new strategic directions, as well as to adjust decisions already made, in the health care of cancer patients.Purpose: to estimate the loss of life expectancy as a result of premature mortality from cancer in the population of the Russian Federation.Material and Methods. the analysis was carried out using international statistical databases for disease burden estimation, databases of the Federal state statistics service (Rosstat). to determine the target groups of priority reduction of mortality from neoplasms in the Russian Federation, an estimation of the lost years of life expectancy as a result of premature mortality in the form of the e† (e-dagger) indicator was carried out. the analyzed period of the study was 2010–2019.Results. the Russian Federation is characterized by the smallest share of losses from cancer in the structure of losses from all causes of death compared to the analyzed countries (Japan, France, germany, latvia, lithuania, estonia). However, the share of losses has been intensively increasing for 10 years (in 2010 – 14.79 %, in 2019 – 17.54 %). in comparison with the analyzed countries, Russia is more characterised by losses from cancer at a younger age, with the highest value of life years lost in the age group 60–64 years. the age-standardized number of years lost in men in Russia is 67.1 % higher than in women. in the age group from 25 to 49 years of age, the loss of life expectancy due to cancer in women is higher and accounts for 0.4 years (or 19 %) of all losses, which is not typical of other age groups in which losses in men prevail. A significant regional differentiation of mortality in the constituent entities of the Russian Federation has been revealed, which is also reflected in the number of years lost.Conclusion. the potential of preventive strategies in the Russian Federation has not been fully realized – the loss of life years in young and middle age requires the correction of measures to improve preventive services and oncological care. the revealed regional differentiation allows us to identify regions with high losses for priority solutions.

The incidence rate of melanoma is dramatically increasing worldwide, raising it to the fifth most common cancer in men and the sixth in women currently. Resistance generally occurs to the agents used in chemotherapy; besides their high toxicity destroys the normal cells. This study reviewed a detailed summary of the structure, advantages, and disadvantages of nanotechnology-based drug delivery systems in the treatment of melanoma, as well as some nanocarrier applications in animal models or clinical studies. Respective databases were searched for the target keywords and 93 articles were reviewed and discussed. A close study of the liposomes, niosomes, transferosomes, ethosomes, transethosomes, cubosomes, dendrimers, cyclodextrins, solid lipid nanoparticles, and carbon nanotubes (CNTs) was conducted. It was found that these nanocarriers could inhibit metastasis and migration of melanoma cells and decrease cell viability. Conclusively, some nanocarriers like liposomes, niosomes, and transferosomes have been discussed as superior to conventional therapies for melanoma treatment.

Premature Ventricular Complexes (PVCs) refer to electrical activity arising from ventricles resulting in ventricular contraction independent of the native rhythm. PVCs by themselves are common in the general population but based on the origin of the PVCs, either related to anatomical or electrical substrate, the disease process has a widely varied presentation and prognosis. The clinical presentation of symptoms may vary from being extremely benign, or very severe (malignant). Benign PVCs include those that are asymptomatic or induce very mild symptoms including palpitations, lightheadedness, chest discomfort, or the sensation of skipped beats. The middle range of PVCs present as heart failure or heart failure complicated by PVCs. The malignant variety may present as syncope, or sudden cardiac death. In this review we describe the multiple facets of PVC presentation and strategies of clinical management.

Background: Globally, oral cavity lesions are a serious public health issue. Premalignant lesions of the oral cavity, such as leukoplakia, erythroplakia, and oral submucous fibrosis, are common in India and are strongly associated with tobacco and betel nut use. These lesions have the potential to transform into malignancies, with squamous cell carcinoma (SCC) being the predominant type of oral cancer. Early detection and effective management of early malignant lesions are crucial to improving the prognosis for patients. Histopathological examination is a standard procedure used to identify these lesions. Aims and Objectives: The objective of this study is to examine the histopathology of premalignant and malignant lesions of the oral cavity, taking into account age, sex, site distribution, and their association with tobacco consumption. Materials and Methods: The study was a prospective, observational study carried out over a period of 3 years on patients with lesions of the oral cavity in a Government Medical College of Northern Odisha. Biopsies were obtained, fixed, and routinely processed. Sections were stained with Hematoxylin and Eosin. The final diagnosis was based on clinical, gross, and microscopic findings. The data was collected and analyzed. Results: Out of a total of 197 oral biopsies, 79 cases were malignant lesions, and 35 cases were pre-malignant lesions. The highest incidence of both pre-malignant and malignant lesions was observed in the age group of 51–60 years, with a male predominance. The buccal mucosa was the most affected site. The most frequent type of malignant lesion was well-differentiated SCC, while hyperkeratosis without dysplasia was the most common type of pre-malignant lesion. Conclusion: Cancers of the oral cavity are surface malignancies whose signs and symptoms can be recognized early. The most common subsite of cancer is the gingivobuccal complex, and site-specific carcinoma is often due to the use of tobacco and betel quid, as they are typically placed in the gingivobuccal sulcus. The occurrence of carcinoma can be minimized by creating public awareness regarding high-risk habits.

Objective: In the last years, robotic surgery was introduced in several different settings with good perioperative results. However, its role in the management of adrenal masses is still debated. In order to provide a contribution to this field, we described our step-by-step technique for robotic adrenalectomy (RA) and related modifications according to the type of adrenal mass treated. Methods: We retrospectively analyzed 27 consecutive patients who underwent RA at Onze-Lieve-Vrouw hospital (Aalst, Belgium) between January 2009 and October 2022. Demographic, intra- and post-operative, and pathological data were retrieved from our prospectively maintained institutional database. Continuous variables are summarized as median and interquartile range (IQR). Categorical variables are reported as frequencies (percentages). Results: Twenty-seven patients underwent RA were included in the study. Median age, body mass index, and Charlson's comorbidity index were 61 (IQR: 49–71) years, 26 (IQR: 24–29) kg/m2, and 2 (IQR: 0–3), respectively, and 16 (59.3%) patients were male. Median tumor size at computed tomography scan was 6.0 (IQR: 3.5–8.0) cm. Median operative time and blood loss were 105 (IQR: 82–120) min and 175 (IQR: 94–250) mL, respectively. No intraoperative complications were recorded. Overall postoperative complications rate was 11.1%, with a postoperative transfusion rate of 3.7%. A total of 10 (37.0%) patients harbored malignant adrenal masses. Among them, 3 (11.1%) had adrenocortical carcinoma, 6 (22.2%) secondary metastasis, and 1 (3.7%) malignant pheochromocytoma on final pathological exam. Only 1 (10.0%) patient had positive surgical margins. Conclusion: We described our step-by-step technique for RA, which can be safely performed even in case of high challenging settings as malignant tumors, pheochromocytoma, and large masses. The standardization of perioperative protocol should be encouraged to maximize the outcomes of this complex surgical procedure.

Background: Considering the high prevalence of breast masses and the importance of screening and follow-up for malignancies in women, and since age and hormonal changes during menopause play a role in determining the type of pathology and prognosis of the masses, the purpose of this study is to determine the relationship between menopause and mass pathology. Methods: This was a cross-sectional-analytical study that was conducted in order to investigate the types of pathology of breast masses and their relationship with the age of menopause in women referred to Shahid Beheshti Hospital in Qom between April 2013 and April 2019. The inclusion criteria include: having sufficient file information and having a contact number to complete personal information, no history of cancer in other parts of the body and simultaneous malignancies, and the exclusion criteria also include: samples that were taken by cellular aspiration sampling, There were women who had a history of first-degree breast malignancy and were previously diagnosed with breast cancer and there was a possibility that the new mass under study was metastatic. Finally, the patients' information was extracted from the files and recorded in pre-prepared checklists. And the supplementary information of the incomplete files was asked and completed using the contact information of the patients. After collecting the information, using SPSS software version 26 and with chi-square and t-test statistical tests and considering the significance level of 0.05 the data was analyzed. Results: He prevalence of malignancy in postmenopausal women was higher than in premenopausal women. Also, a significant difference was found between tumor size, the presence or absence of metastasis, and menopause (P0.05). Conclusion: Breast malignancies (invasive ductal carcinoma, invasive mixed carcinoma, mucinous, medullary, and papillary carcinoma) were more common in postmenopausal women than non-menopausal women. In both groups, ductal dilatation and chronic inflammation were the most benign findings, and fibroadenoma was found at a much lower rate in menopausal women than in non-menopausal.