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Copyright of Journal of Taibah University Medical Sciences is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Current meta-analysis was performed to systematically evaluate the potential prognostic factors for overall survival among resected cases with gallbladder carcinoma. Methods: PubMed, EMBASE, and the Cochrane Library were systematically retrieved and hazard ratio (HR) and its 95% confidence interval were directly extracted from the original study or roughly estimated via Tierney's method. Standard Parmar modifications were used to determine pooled HRs. Results: A total of 36 studies with 11 502 cases were identified. Pooled results of univariate analyses indicated that advanced age (HR=1.02, P=0.00020), concurrent gallstone disease (HR= 1.22, P=0.00200), elevated preoperative CA199 level (HR=1.93, P<0.00001), advanced T stage (HR=3.09, P< 0.00001), lymph node metastasis (HR=2.78, P< 0.00001), peri-neural invasion (HR=2.20, P<0.00001), lymph-vascular invasion (HR= 2.37, P<0.00001), vascular invasion (HR=2.28, P<0.00001), poorly differentiated tumor (HR=3.22, P< 0.00001), hepatic side tumor (HR=1.85, P< 0.00001), proximal tumor (neck/cystic duct) (HR=1.78, P<0.00001), combined bile duct resection (HR=1.45, P<0.00001), and positive surgical margin (HR=2.90, P<0.00001) were well-established prognostic factors. Pathological subtypes (P =0.53000) and postoperative adjuvant chemotherapy (P=0.70000) were not prognostic factors. Pooled results of multivariate analyses indicated that age, gallstone disease, preoperative CA199, T stage, lymph node metastasis, peri-neural invasion, lymph-vascular invasion, tumor differentiation status, tumor location (peritoneal side vs hepatic side), surgical margin, combined bile duct resection, and postoperative adjuvant chemotherapy were independent prognostic factors. Conclusion: Various prognostic factors have been identified beyond the 8th AJCC staging system. By incorporating these factors into a prognostic model, a more individualized prognostication and treatment regime would be developed. Upcoming multinational studies are required for the further refine and validation. [ABSTRACT FROM AUTHOR]

The United Kingdom National Health Service Breast Screening Programme proposes five B categories for reporting breast screening needle core biopsies. The system is also recommended for symptomatic patients and diagnostic vacuum-assisted biopsies. Usually over 90% of biopsies are categorised as normal (B1), benign (B2) or malignant (B5). B3 is a heterogeneous group including atypical intraductal proliferations, classical lobular neoplasia, papillary lesions, radial scars, cellular fibroepithelial lesions and some rarer lesions. It is important to comment on the presence of epithelial atypia in B3 lesions as the risk of malignancy in the excision specimen is higher if atypia is present. Recent United Kingdom guidelines propose more thorough sampling with vacuum-assisted biopsy as an alternative to diagnostic surgical excision for some B3 lesions. B4 is used for lesions suspicious of malignancy. Further investigation is usually needed for B4 lesions. B5 is subdivided into B5a for DCIS and pleomorphic LCIS, B5b for invasive carcinoma, lymphoma, sarcoma, malignant phyllodes tumour and metastases from extramammary malignancies, and B5c for carcinomas that cannot be classified as in situ or invasive. The biopsy result must be discussed at the multidisciplinary meeting in combination with the clinical and radiological findings (the triple approach) to guide patient management. [ABSTRACT FROM AUTHOR]

Corruption is a global menace with some countries of the world notoriously deep in it. Nigeria, a developing country has been battling, however, unsuccessfully with the scourge of corruption despite measures put in place to curb it. This paper chronicles the antecedents of corruption in Nigeria. It reviews the anti-corruption strategies with a view to proffering a robust, aggressive, and productive engagement against the recalcitrant nature of corruption in the country. The theoretical framework of the study is anchored on Social Disorganization Theory (SDT) and Social Learning Theory (SLT). Among the varying recommendations made by this paper, is the need to rejig, reinvigorate, and re-awake consciously, conscientiously, and systematically, the traditional anti-corruption institutions such as the National Assembly, the Judiciary, the Police, offices of the Accountant General, Auditor General, among others, to the understanding of their paramount role and vanguard position in championing very effectively, the anti-corruption war. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos Brasileiros de Oftalmologia is the property of Arquivos Brasileiros de Oftalmologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose of the current study was to introduce a new detailed aesthetical subunit (ASU) involvement chart to localize the defect configuration on the eyelids, and, to evaluate the aesthetical and functional outcomes of the post-oncological full-thickness eyelid defect reconstruction surgery by using a modified aesthetical rating guideline. Medical records of subjects who were diagnosed with a primary malignant full thickness eyelid tumor involving the eyelid margin and underwent full-thickness eyelid defect reconstruction surgery between April 2016 and May 2022 were retrospectively reviewed. Age, sex, pathological diagnosis, follow-up time, the ASU of the eyelid involvement, and surgical methods used to reconstruct the anterior and posterior lamella were examined from medical records. The reconstructed eyelid photos were scored according to the modified aesthetical rating guideline to analyze the aesthetical and functional outcomes of the surgeries. A total of 31 subjects were included to the study, and the overall mean aesthetical score was 3.5. Seventeen subjects with aesthetical scores greater than 3.5 were included in the more aesthetically pleasing (AP) group, and 14 subjects with aesthetical score less than 3.5 were included in less AP group. Anterior lamella repair was mainly performed using myo-cutaneous flaps in the more AP group and multiple flap combinations in the less AP group (P: 0.13). Posterior lamella reconstruction was performed using tarso-conjunctival tissue in both groups. In more AP group, tissue scarring, lash line disruption, eyelid thickness, and retraction or ectropion scores were significantly higher when compared with less AP group (P:0.03, P:0.03, P:0.02, and P:0.01, respectively). Subjects with fair eyelash color were significantly more common in more AP group (P: 0.009). The ASU involvement chart and outcomes of the current study may aid novice surgeons to determine which method will provide the best result for an individual patient for full-thickness eyelid defect repair and may offer some insight into the different surgical techniques used for repairing similar wounds. [ABSTRACT FROM AUTHOR]

Introduction: Per- and poly-fluoroalkyl substances (PFASs) are a large, complex group of synthetic chemicals humans can be exposed to from occupational or environmental sources. In this systematic review and meta-analysis, we examined the association between PFAS exposure, particularly Perfluorooctanoic Acid (PFOA), and Perfluorooctane Sulfonic Acid (PFOS), and risk of kidney, liver, and testicular cancer. Methods: We systematically searched PubMed to identify cohort and case-control studies reported after the Monograph of the International Agency for Research on Cancer and the Toxicological Profile of the Agency for Toxic Substances and Disease Registry. We assessed the quality of the studies by using a modified version of the Newcastle-Ottawa Scale (NOS). Forest relative risk (RR) plots were constructed for liver, kidney, and testicular cancer. We conducted stratified analyses by geographic region, study design, quality score, outcome, years of publication, exposure source, and PFAS type. A random-effects model was used to address heterogeneity between studies. Results: Fifteen studies, including ten cohort studies, three case-control studies nested in a cohort, and two case-control studies were included after removing duplicate and irrelevant reports. We found an association between overall PFAS exposure and the risk of kidney cancers (RR=1.18, 95% CI =1.05-1.32; I =52.8%, 11 studies). Also, we showed an association between high-level exposure to PFAS and kidney cancer (RR=1.74, 95% CI =1.23-2.47; p=0.005) and testicular cancer (RR=2.22, 95% CI =1.12-4.39; p=0.057). There was no association with liver cancer. We found no heterogeneity by geographical region, PFAS type, study design, outcome, quality score, year of publication, or exposure source. Only two studies reported results among women. Conclusions: We detected an association between overall PFAS exposure and kidney cancer and high doses of PFAS with testicular cancer. However, bias and confounding cannot be excluded, precluding a conclusion in terms of causality. [ABSTRACT FROM AUTHOR]

Carcinoma breast is the commonest cancer among women. Various authors have studied breast cancer with Contrast-Enhanced Ultrasound (CEUS) with promising results. Despite promising results, the additional cost of post-processing software limits its availability. In this study, we evaluated the utility of CEUS in differentiating malignant from benign breast lesions on regular ultrasound equipment without the use of dedicated software. We performed CEUS in 121 women with 121 breast lesions. CEUS was done by creating a custom preset on existing ultrasound equipment with the help of an application specialist authorized by the vendor. Lesions were evaluated qualitatively without the use of any commercial software. The pattern of enhancement i.e. homogenous, heterogeneous, peripheral, or no enhancement, and the number of penetrating vessels i.e., few or multiple were recorded. Results were compared with histopathological diagnosis. There were a total of 121 breast lesions. The study showed sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 86.67 %, 54.10 %, 65 %, and 80.49% respectively for differentiating benign vs malignant lesions on the basis of the pattern of contrast enhancement. Using penetrating vessels for differentiating malignant lesions from benign lesions, the sensitivity, specificity, PPV, and NPV were found to be 64%, 67.86%, 78.05%, and 51.35% respectively. CEUS is useful in differentiating malignant from benign breast lesions. It can be easily performed by creating a custom preset on standard ultrasound equipment without the use of expensive software. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Chest computed tomography (CT) is increasingly being used to screen for lung cancer. Machine learning models could facilitate the distinction between benign and malignant pulmonary nodules. This study aimed to develop and validate a simple clinical prediction model to distinguish between benign and malignant lung nodules. PATIENTS AND METHODS: Patients who underwent a video thoracic-assisted lobectomy between January 2013 and December 2020 at a Chinese hospital were enrolled in the study. The clinical characteristics of the patients were extracted from their medical records. Univariate and multivariate analyses were used to identify the risk factors for malignancy. A decision tree model with 10-fold cross-validation was constructed to predict the malignancy of the nodules. The sensitivity, specificity, and area under the curve (AUC) of a receiver operatic characteristics curve were used to evaluate the model’s prediction accuracy in relation to the pathological gold standard. RESULTS: Out of the 1,199 patients with pulmonary nodules enrolled in the study, 890 were pathologically confirmed to have malignant lesions. The multivariate analysis identified satellite lesions as an independent predictor for benign pulmonary nodules. Conversely, the lobulated sign, burr sign, density, vascular convergence sign, and pleural indentation sign were identified as independent predictors for malignant pulmonary nodules. The decision tree analysis identified the density of the lesion, the burr sign, the vascular convergence sign, and the drinking history as predictors of malignancy. The area under the curve of the decision tree model was 0.746 (95% CI 0.705-0.778), while the sensitivity and specificity were 0.762 and 0.799, respectively. CONCLUSIONS: The decision tree model accurately characterized the pulmonary nodule and could be used to guide clinical decision-making. [ABSTRACT FROM AUTHOR]

Mesothelioma is a rare but highly aggressive malignancy with poor prognosis that frequently present with recurrent effusions. Establishing the diagnosis by cytology can lead to early diagnosis and treatment and consequently improve prognosis. This review examines the cytological diagnosis of mesothelioma in the context of its historical and morphologic evolution and provides an update of the current reporting systems. Clues to identify the mesothelial and malignant nature of the sample are detailed as well as the supporting ancillary tests. Cytologically, the samples are overwhelmingly cellular and malignancy is recognized by both architectural and cytological atypia. Numerous variably sized clusters and enlarged cells are easily identified, some with papillary architecture and collagen cores. Recognizing the mesothelial nature of the cells and supportive immunostains are essential to rule out the differential diagnosis of metastatic carcinomas and reactive mesothelium. Current ancillary tests such as homozygous deletion of CDKN2A, loss of BRCA1-associated protein, and methylthioadenosine phosphorylase expression can provide further support of malignancy. At this time with the aid of current ancillary tests and in the hands of cytopathologists with adequate experience with the interpretation of effusions, the diagnosis of mesothelioma can be established with accuracy in most cases. [ABSTRACT FROM AUTHOR]

Breast cancer is one of the deadly diseases prevailing in women. Earlier detection and diagnosis might prevent the death rate. Effective diagnosis of breast cancer remains a significant challenge, and early diagnosis is essential to avoid the most severe manifestations of the disease. The existing systems have computational complexity and classification accuracy problems over various breast cancer databases. In order to overcome the above-mentioned issues, this work introduces an efficient classification and segmentation process. Hence, there is a requirement for developing a fully automatic methodology for screening the cancer regions. This paper develops a fully automated method for breast cancer detection and segmentation utilizing Adaptive Neuro Fuzzy Inference System (ANFIS) classification technique. This proposed technique comprises preprocessing, feature extraction, classifications, and segmentation stages. Here, the wavelet-based enhancement method has been employed as the preprocessing method. The texture and statistical features have been extracted from the enhanced image. Then, the ANFIS classification algorithm is used to classify the mammogram image into normal, benign, and malignant cases. Then, morphological processing is performed on malignant mammogram images to segment cancer regions. Performance analysis and comparisons are made with conventional methods. The experimental result proves that the proposed ANFIS algorithm provides better classification performance in terms of higher accuracy than the existing algorithms. [ABSTRACT FROM AUTHOR]

Low-grade serous carcinoma of the ovary is an uncommon lesion, composing approximately 3% of ovarian neoplasms. It typically arises in association with a serous borderline tumor and is most often at an advanced stage upon diagnosis. Gene mutations in BRAF and KRAS are characteristic. Various histologic architectural patterns are known, such as papillary, micropapillary, inverted micropapillary, glandular and nested. We report a case of low-grade serous carcinoma arising years after a serous borderline tumor and contralateral teratoma; the low-grade serous carcinoma showed two patterns: micropapillary growth and a previously unreported form of solid pattern manifesting as large tumor islands without slit-like spaces. This unusual solid morphology raises the differential diagnosis of high-grade serous carcinoma, which would result in different clinical management. The presence of areas with classic micropapillary architecture, in addition to the absence of high-grade cytonuclear atypia and marked pleomorphism, support the diagnosis of low-grade serous carcinoma. Immunohistochemical stains for p53 and p16 failed to show abnormal patterns characteristic of high-grade serous carcinoma. The patient declined chemotherapy and is on letrozole; she has had recurrent right pleural effusions over six months of follow-up after surgery. [ABSTRACT FROM AUTHOR]

Malignant or aggressive primary musculoskeletal tumors are rare and encompass a wide variety of bone and soft tissue tumors. Given the most common site for metastasis from these primary musculoskeletal tumors is to the lung, chest imaging is integral in both staging and surveillance. Extrapulmonary metastases are rarely encountered with only a few exceptions. Following primary tumor resection, surveillance of the primary tumor site is generally recommended. Local surveillance imaging recommendations differ between primary tumors of bone origin versus soft tissue origin. This document consolidates the current evidence and expert opinion for the imaging staging and surveillance of these tumors into five clinical scenarios. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Background: Incidental indeterminate solitary solid pulmonary nodule is a progressively common finding on CT worldwide. Once detected, there are a number of imaging modalities that can be done to help in nodule characterization and differentiating benign from malignant nodules. Through these imaging modalities, there are PET CT, SPECT and dynamic CE-CT. Dynamic CE-CT is a functional test that help in assessment of the vascularity of the nodule which reverb the degree of angiogenesis of that nodule so can help in differentiating benign from malignant pulmonary nodules. The purpose of this study was to evaluate the role of Dynamic CE-CT in characterization of solitary pulmonary nodules. Detect what are the important parameters on dynamic CE-CT to differentiate benign from malignant nodules and detect their cutoff values. Results: The pre-enhancement value shows cutoff point of 26.50 HU with sensitivity 93.8% and specificity 75% with accuracy rate 90% in differentiating benign from malignant pulmonary nodules. Peak enhancement value (at 2 min) shows cutoff point of 40.00 HU with sensitivity 96.9% and specificity 87.5% with accuracy rate 95% in differentiating benign from malignant pulmonary nodules. Net enhancement value shows cutoff point of 19.00 HU with sensitivity 96.9% and specificity 87.5% with accuracy rate 95% in differentiating benign from malignant pulmonary nodules. Conclusion: Dynamic CE-CT is a useful tool in differentiating benign from malignant pulmonary nodules. Peak and net enhancement values are important parameters with high sensitivity and specificity in differentiating benign from malignant pulmonary nodules. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the process of diagnosing patients with malignant pleural mesothelioma (MPM) at a tertiary care hospital. Methods: This was a retrospective study involving patients referred to a tertiary-care cancer center in Brazil between 2009 and 2020. The diagnostic process was divided into four steps: onset of symptoms, referral to a specialist visit, histopathological diagnosis, and beginning of treatment. The intervals between each phase and the factors for delays were evaluated. Data including clinical status, radiological examinations, staging, treatment modalities, and survival outcomes were collected. Results: During the study period, 66 patients (mean age = 64 years) were diagnosed with MPM and underwent treatment. Only 27 (41%) of the patients had knowledge of prior exposure to asbestos. The median number of months (IQR) between the onset of symptoms and the first specialist visit, between the specialist visit and histopathological characterization, and between definite diagnosis and beginning of treatment was, respectively, 6.5 (2.0-11.4), 1.5 (0.6-2.1), and 1.7 (1.2-3.4). The knowledge of prior asbestos exposure was associated with a shorter time to referral to a specialist (median: 214 vs. 120 days; p = 0.04). A substantial number of nondiagnostic procedures and false-negative biopsy results (the majority of which involved the use of Cope needle biopsy) were found to be decisive factors for the length of waiting time. The mean overall survival was 11.9 months. Conclusions: The unfamiliarity of health professionals with MPM and the patient's lack of knowledge of prior asbestos exposure were the major factors to cause a long time interval between the onset of symptoms and beginning of treatment. An overall survival shorter than 1 year is likely to have been due to the aforementioned delays. [ABSTRACT FROM AUTHOR]

Copyright of Cukurova Medical Journal / Çukurova Üniversitesi Tip Fakültesi Dergisi is the property of Cukurova University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the medical field, the detection of breast cancer may be a mysterious task. Physicians must deduce a conclusion from a significantly vague knowledge base. A mammogram can offer early diagnosis at a low cost if the breasts' satisfactory mammogram images are analyzed. A multi-decision Intuitionistic Fuzzy Evidential Reasoning (IFER) approach is introduced in this paper to deal with imprecise mammogram classification efficiently. The proposed IFER approach combines intuitionistic trapezoidal fuzzy numbers and inclusion measures to improve representation and reasoning accuracy. The results of the proposed technique are approved through simulation. The simulation is created utilizing MATLAB software. The screening results are classified and finally grouped into three categories: normal, malignant, and benign. Simulation results show that this IFER method performs classification with accuracy almost 95% compared to the already existing algorithms. The IFER mammography provides high accuracy in providing early diagnosis, and it is a convenient diagnostic tool for physicians. [ABSTRACT FROM AUTHOR]

Background: The sinonasal region is affected by a variety of neoplasms. A differentiation between benign and malignant masses is essential both for management and prognostication. Morphological analysis often does not allow this differentiation. Objectives: This article aims to assess the value of advanced MRI (diffusion [DWI] and dynamic contrast enhanced MRI [DCE-MRI]) in differentiation of benign and malignant sinonasal masses. Methods: This prospective study included 40 patients with sinonasal masses who underwent advanced MR on 3T MR scanner. The lesions were analyzed based on morphological characteristics, qualitative, quantitative diffusion parameters, and time signal intensity curves. Apparent diffusion coefficient (ADC) values were acquired using b values of 50 and 1000 s/mm2. The accuracy of DWI, DCE-MRI, and combined DWI/DCE-MRI in differentiating benign from malignant sinonasal masses were analyzed. Results: Perineural extension and growth pattern of the tumor were the best morphological discriminators. Mean ADC values for benign and malignant lesions were 1.675 ± 0.561 and 0.903 ± 0.405 × 10−3 mm2/sec,,respectively. ROC revealed that ADC cutoff value of 1.005 × 10−3 mm2/sec provided an accuracy of 92.5% in differentiating benign from malignant masses (P value <.01). On excluding the benign vascular masses (Juvenile Nasopharyngeal Angiofibroma and hemangioma), the time signal intensity curve showed 78% accuracy (P value <.001). The highest diagnostic performance was achieved by combining DWI and DCE-MRI (95% accuracy). Conclusion: DWI has higher accuracy than DCE-MRI. Quantitative DWI is preferable over qualitative DWI. Accuracy of DCE-MRI can be increased by excluding vascular masses with characteristic imaging features. DWI and DCE-MRI have the highest accuracy when used in combination than either of them alone in differentiating benign from malignant sinonasal masses. [ABSTRACT FROM AUTHOR]

To evaluate the proportions of canine mammary gland lesions submitted to a New Zealand diagnostic laboratory, that were neoplastic vs. non-neoplastic and, among neoplasms, malignant vs. benign, and to determine whether age, reproductive status or breed of dog, or size of the mammary mass were associated with the histological diagnosis. Canine mammary gland biopsies submitted between the start of 2012 and the end of 2016 were selected from the surgical biopsy database of IDEXX Laboratories, NZ. For each case, details on age, breed, and reproductive status of the patient were registered as reported by the submitting veterinarians, along with the size (classified as small, medium or large) of the lesion and the histological diagnosis reported by the pathologists. χ2 tests and independent sample t-tests were performed to evaluate associations. Samples (n = 895) were submitted from 797 dogs, of which 673 had mammary neoplasms while 124 had non-neoplastic lesions. Neoplasms composed of a single nodule were found in 591/673 (87.8%) dogs, while 82/673 (12.2%) dogs had multiple nodules. Of the total 771 neoplasms, 432 (56.0%) were histologically malignant, while 339 (44.0%) were benign. Among malignancies, the most common histological sub-types were simple carcinoma (160/771; 20.8%), complex carcinoma (54/771; 7%), and ductal carcinoma (32/771; 4.2%), while benign mixed mammary tumour (128/771, 16.6%) and complex adenoma (105/771; 13.6%) were the most frequently reported benign mammary neoplasms. There was no evidence of a difference in age (p = 0.09) or reproductive status (p = 0.79) of the dog or the size of the mass (p = 0.21) between neoplastic and non-neoplastic lesions. However, neoplastic mammary gland lesions were more frequent in purebred dogs (612/671; 91.2%) than crossbred dogs (61/126; 48.4%; p < 0.001). There was no evidence of a difference in age (p = 0.15) reproductive status (p = 0.36) or breed (p = 0.45) of dog between malignant and benign neoplasms. There was an association between size and histological benign or malignant status of a neoplasm (φ = 0.65, p < 0.001). Most canine mammary gland samples submitted for examination were neoplastic with slightly more malignant than benign lesions. Masses submitted from purebred dogs were more likely to be neoplastic, while large neoplasms were more likely to be malignant. The present findings provide the first description of the distribution of mammary gland lesions in a relatively large number of dogs in New Zealand, representing a preliminary investigation of canine mammary gland diseases in this country. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the most common life-threatening cancer in women worldwide. A high number of women are going through biopsy procedures for characterization of breast masses every day and yet 75% of the pathological results prove these masses to be benign. Ultrasound (US) elastography is a non-invasive technique that measures tissue stiffness. It is convenient for differentiating benign from malignant breast tumors. Our study aims to evaluate the role of qualitative ultrasound elastography scoring (ES), quantitative mass strain ratio (SR), and shear wave elasticity ratio (SWER) in differentiation between benign and malignant breast lesions. Results: Among 51 female patients with 77 histopathologically proved breast lesions, 57 breast masses were malignant and 20 were benign. All patients were examined by B-mode ultrasound then strain and shear wave elastographic examinations using ultrasound machine (Logiq E9, GE Medical Systems) with 8.5–12 MHz high-frequency probes. Our study showed that ES best cut-off point > 3 with sensitivity, specificity, PPV, NPP, accuracy was 94.7%, 85%, 94.7%, 85%, 90.9%, respectively, and AUC = 0.926 at P < 0.001, mass SR the best cut-off point > 4.6 with sensitivity, specificity, PPV, NPP, accuracy was 96.5%, 80%, 93.2%, 88.9%, 92.2%, respectively, and AUC = 0.860 at P < 0.001, SWER the best cut-off value > 4.9 with sensitivity, specificity, PPV, NPP and accuracy was 91.2%, 80%, 92.9%, 76.2%, 93.5%, respectively, and AUC = 0.890 at P < 0.001. The mean mass strain ratio for malignant lesions is 10.1 ± 3.7 SD and for solid benign lesions 4.7 ± 4.3 SD (p value 0.001). The mean shear wave elasticity ratio for malignant lesions is 10.6 ± 5.4 SD and for benign (solid and cystic) lesions 3.6 ± 4.2 SD. Using ROC curve and Youden index, the difference in diagnostic performance between ES, SR and SWER was not significant in differentiation between benign and malignant breast lesions and also was non-significant difference when comparing them with conventional US alone. Conclusion: ES, SR, and SWER have a high diagnostic performance in differentiating malignant from benign breast lesions with no statistically significant difference between them. [ABSTRACT FROM AUTHOR]

Breast cancer is one of the most fatal diseases leading to the death of several women across the world. But early diagnosis of breast cancer can help to reduce the mortality rate. So an efficient multi-task learning approach is proposed in this work for the automatic segmentation and classification of breast tumors from ultrasound images. The proposed learning approach consists of an encoder, decoder, and bridge blocks for segmentation and a dense branch for the classification of tumors. For efficient classification, multi-scale features from different levels of the network are used. Experimental results show that the proposed approach is able to enhance the accuracy and recall of segmentation by 1.08%, 4.13%, and classification by 1.16%, 2.34%, respectively than the methods available in the literature. [ABSTRACT FROM AUTHOR]

In the world, lung cancer is the third most dreadful cancer. Thus, detection of lung cancer cells at early stage is a challenge. The symptoms of lung cancer do not appear in earlier stages which causes high death rates when compared with other types of cancer. In lung cancer detection, image processing algorithms have shown great performance in various high-end tasks. In this paper, different classification methodologies used for the prediction of lung cancer in its early stage are explained. Machine learning techniques are used to identify whether lung tumors are malignant or benign. Machine learning approaches such as: Convolutional neural network (CNN), Support vector machine (SVM), Artificial neural network (ANN), Multi-Layer Perceptron (MLP), K-Nearest Neighbor (KNN), Entropy degradation method (EDM) and Random Forest (RF) are discussed in detail and their performance is evaluated in terms of accuracy, sensitivity and specificity. In this analysis, CNN approach using small dataset shows best result with 96% accuracy compared to other methodologies and EDM shows the worst accuracy of 77.8%. [ABSTRACT FROM AUTHOR]

Background: In pediatric patients, soft tissue masses encompass a wide heterogeneous group of benign and malignant lesions. MRI is a powerful diagnostic tool in the workup of soft tissue tumors in children, and it helps in characterization of lesion and evaluation of the extent of the lesion. However, conventional MRI techniques are not specific in differentiating benign from malignant lesions. So to improve characterization of tumors, DWI was added to MRI techniques as it increases sensitivity and specificity by detecting the micro-diffusion changes of water into intra- and extracellular spaces. The aim of this work was to highlight the diagnostic value of DWI in detection and characterization of different musculoskeletal soft tissue masses in pediatrics. Results: There was a statistically significant difference regarding the mean ADC value of benign and malignant masses (P value = 0.001*). The mean ADC value for all benign masses (n = 41) was 1.495 ± 0.55 SD × 10–3 mm2/s, while the mean ADC value for all malignant masses (n = 21) was 0.449 ± 0.27 SD × 10–3 mm2/s. The cutoff ADC value between benign and malignant masses was 0.88 × 10–3 mm2/s. This cutoff ADC value has sensitivity of 100.0%, specificity of 92.3%, PPV of 66.7%, NPV of 100.0% and diagnostic accuracy of 93.3%. Conclusion: In pediatric patients, DWI is an innovative valuable noninvasive imaging technique for characterization of musculoskeletal soft tissue masses and discrimination between benign and malignant masses. [ABSTRACT FROM AUTHOR]

Background: The incidence of the thyroid nodules and its detection is increasing rapidly. The most precise method for diagnosis of the nodules of the thyroid is FNAC. But, about 10–20% of specimens of FNAC are indeterminate and non-diagnostic. Therefore, there is a demand for another diagnostic method for evaluating thyroid nodules. Thyroid ultrasound elastography may improve the ability to differentiate malignant from benign thyroid nodules. Few articles were published about the results of DW MRI in thyroid nodules, with its results confirmed that malignant nodules have lower mean ADC values than benign nodules. This study aims to investigate and compare the accuracy of B-mode ultrasound, ultrasound elastography and diffusion-weighted MRI in characterization of the nodules of the thyroid. Results: The study included 56 patients with thyroid nodules (36 benign and 20 malignant). Thyroid ultrasound, ultrasound elastography and DWI were done for all patients. Ultrasound-guided FNA Cytological examination (as the gold standard) was done for 48 patients and surgical histopathology was done to 8 patients with non-diagnostic FNAC. The results showed: TIRADS score had sensitivity 90%, specificity 77.8% and accuracy of 82.14%. The elastography score had sensitivity 80%, specificity 88.9% and accuracy 85.7%. The use of the strain ratio had 80% sensitivity, 94.4% specificity and 89.3% accuracy. DWI and ADC value had 100% sensitivity and 94.4% specificity and the accuracy was 96.4% for differentiating malignant from benign thyroid nodules. Multi-parametric analysis by TIRADS and ADC had 100% accuracy. Conclusion: Ultrasound elastography add valuable data over ultrasound TIRADS. But, diffusion weighted MRI and ADC value has more accuracy in differentiating malignant from benign thyroid nodules. The best performance was achieved by the combination of ACR-TIRADS and ADC value. [ABSTRACT FROM AUTHOR]

Background: Malignant lymphoma accounts for nearly 20% of all mediastinal neoplasms in adults and 50% in children. Hodgkin's disease is the most common primary mediastinal lymphoma. In non-Hodgkin's lymphoma, the two most common forms of primary mediastinal lymphoma are lymphoblastic lymphoma and diffuse large B-cell lymphoma. The aim of this study is to implement diffusion MRI in the algorithm of diagnosis of mediastinal lymphoma, differentiating Hodgkin's from non-Hodgkin's lymphoma and assessment of post therapeutic response. Results: Using Diffusion weighted magnetic resonance imaging DWI-MRI, there were statistic significant difference between ADC values in lymph nodes and mediastinal masses in Hodgkin and non-Hodgkin lymphomas. ADC range in non-treated Hodgkin lymphoma cases was 0.774 to 1.4, while ADC range in in non-treated non-Hodgkin lymphoma was 0.476 to 0.668. In this study, there was statistically significant difference of ADC values in lymphoma cases presented by mediastinal masses with and without chemotherapy. Conclusions: Diffusion weighted magnetic resonance imaging DWI-MRI is a promising functional technique in diagnosis of Hodgkin's and non-Hodgkin's lymphoma and assessment of response to treatment with no need for special preparation, contrast injection or radiation exposure. [ABSTRACT FROM AUTHOR]

Pheochromocytomas are rare catecholamine-secreting tumors with a high potential for recurrence post-surgery, necessitating prolonged follow-up. This case highlights the diagnostic and therapeutic challenges in managing recurrent pheochromocytoma. A 25-year-old female, with a history of left pheochromocytoma treated with adrenalectomy a decade earlier, presented with a right adrenal mass. Despite controlled hypertension, elevated urine metanephrines suggested recurrence. Imaging showed a right adrenal mass and suspicious left paraaortic lymph nodes, confirming the diagnosis of recurrent malignant pheochromocytoma in the left adrenal bed and right adrenal gland, with metastasis to the paraaortic lymph nodes. The patient underwent right adrenalectomy coupled with cytoreductive surgery (CRS) in the form of excision of left-sided adrenal bed recurrence and left paraaortic lymph node dissection, intraoperative radiation therapy (IORT), and hyperthermic intraperitoneal chemotherapy (HIPEC). On follow-up six years later, the patient remains free from recurrence. This case illustrates the importance of continued surveillance in pheochromocytoma patients, even those with a low-risk profile. The recurrence in this case, despite a smaller initial tumor size and no genetic predispositions, underscores the unpredictable nature of pheochromocytomas. The successful management with CRS, IORT, and HIPEC emphasizes the need for a personalized and multifaceted treatment approach. Pheochromocytoma patients, including those initially considered low risk, require long-term monitoring due to the risk of recurrence. The utilization of CRS, IORT, and HIPEC in this case was pivotal in managing the recurrent and metastatic malignant disease effectively, demonstrating the significance of a comprehensive, multidisciplinary treatment strategy in such complex cases. • Low risk pheochromocytoma patients require at least a 10-year follow-up. • Malignant pheochromocytoma is defined by the presence of extra-adrenal metastasis. • Recurrence of pheochromocytoma can be masked by controlled hypertension. • CRS, HIPEC, and IORT, a novel approach, was successful in treating pheochromocytoma. • HIPEC and IORT help achieve better local control and limit peritoneal spread. [ABSTRACT FROM AUTHOR]

Inflammatory myofibroblastic tumor (IMT) of the bladder is a rare sight, which can be distinguished by the proliferation of spindle cells and the presence of a persistent chronic inflammatory infiltrate. IMT is usually benign, but in a few cases it has a tendency for malignant transformation and metastases. A 30-year-old male with a history of recurrent hematuria. His initial symptoms was unfrequent painless hematuria. Abdomen multislice computerized tomography (MSCT) with contrast shows an enhancing solid mass with necrotized center measuring +/− 12.9 × 16.5 × 18.9 cm and extending from cavum pelvis to cavum abdomen. Cystectomy and bilateral ureterocutaneostomy were performed. The histology report found an IMT with mitotic cells, a necrotic region, and a positive ki67, which suggest the tumor's malignant transformation. Unfortunately, the patient's overall condition continued to deteriorate, and he passed away seven days after hospital discharge. IMT is comprised of spindel cells and inflammatory cells. IMT might become aggressive locally, recurring, or progress to malignancy. Fifty percent of IMTs are caused by rearrangements of the anaplastic lymphoma kinase (ALK) gene on chromosome 2p23, resulting in ALK-1 overexpression. A change from uniform spindled cells to atypical polygonal cells or plump cells with oval vesicular nuclei, prominent nucleoli, and mitoses is indicative of malignant transformation. This case emphasizes the importance of continuous monitoring and raising awareness about the possibility of malignant transformation of IMT. Understanding the characteristics of the findings could result in better decision-making and outcomes. • IMT is usually benign, it can show local recurrence in a few cases and has an aggressive course. • Clinical manifestation of IMT was painless haematuria, dysuria, frequency issues, pelvic pain, or urinary retention symptoms may be present. • Fifty percent of IMTs are caused by rearrangements of the anaplastic lymphoma kinase (ALK). • A change from uniform spindled cells to atypical polygonal cells or plump cells with oval vesicular nuclei, prominent nucleoli. • Ki67 has been found to be a useful tool to be a marker of malignant transformation of soft tissue lesions. [ABSTRACT FROM AUTHOR]

A calcifying epithelial odontogenic tumor (CEOT) is a relatively rare benign odontogenic tumor, which was described by Pindborg in 1955. Although benign, CEOT are locally infiltrative tumors with a tendency to invade adjacent bone. We report a case of calcifying epithelial odontogenic tumor with malignant transformation after two recurrences. The patient was a 78-year-old man. He had swelling of the mandibular anterior, and he was referred to our department in July 2015. The panoramic X-ray film showed a radiolucent image in the anterior mandible, and found a lesion-like calcification inside. In November 2015, the patient underwent tumorectomy of the mandible under general anesthesia. The histopathological diagnosis was CEOT. After the first surgery, the tumor recurred twice within 2 years and 5 months. In April 2018, we found swelling of the excised lingual gingiva, and an MRI scan showed a mass-like lesion. Diagnosis of recurrence, we performed marginal mandibulectomy in May 2018. Recurrent tumors had malignant features, such as increased nuclear pleomorphism with frequent mitotic figures, as well as increased proliferative activity assessed by immunostaining for Ki-67. Histopathological examination diagnosed transformation to malignancy. There have been no signs of recurrence or metastasis during follow-up as of 2 years and 3 months after re-operation. [ABSTRACT FROM AUTHOR]

Benign embryonal nephromas have been documented in rabbits. However, only one case of nephroblastoma with concurrent metastasis (pulmonary), a postmortem incidental finding, has been published. A 3-year-old neutered male Dutch rabbit (Oryctolagus cuniculus) was referred for assessment of a firm mass located in the mid-dorsal abdomen. Abdominal ultrasonography confirmed a large soft tissue mass of suspected renal origin. A left-sided nephrectomy was performed via a ventral midline approach. Multiple white macular lesions, hyperemia, and petechiae were observed in the mesenteric fat surrounding the spleen. Histopathological examination of the abnormal kidney and the mesenteric fat revealed microscopic findings consistent with an embryonal nephroma exhibiting distinct features of malignancy. At 6- and 12-month postsurgery, ultrasonographic evidence of tumor recurrence was not observed. This is the first report of successful treatment of an embryonal nephroma showing malignant behavior and metastasis to the surrounding adipose tissue with a minimum postoperative survival time of 12 months and no ultrasonographic evidence of local recurrence. [ABSTRACT FROM AUTHOR]

One of the ways to reduce oral cancer mortality rate is diagnosing oral lesions at initial stages to classify them as precancerous or normal lesions. During routine oral examination, oral lesions are normally screened manually. In a low resource setting area where there is lack of medical facilities and also medical expertise, an automated mechanism for oral cancer screening is required. The present work is an attempt towards developing an automated system for diagnosing oral lesions using deep learning techniques. An ensemble deep learning model that combines the benefits of Resnet-50 and VGG-16 has been developed. This model has been trained with an augmented dataset of oral lesion images. The model outperforms other popularly used deep learning models in performing the classification of oral images. An accuracy of 96.2%, 98.14% sensitivity and 94.23% specificity was achieved with the ensemble deep learning model. [ABSTRACT FROM AUTHOR]

One of the most prevalent forms of cancer worldwide is oral cancer which has a high rate of mortality. Diagnosis and treatment of oral premalignant lesions at an early stage reduces the death rate. The objective of this work is to detect malignancies by analyzing color features of digital true color oral images. A dataset of around 433 oral lesion images has been created that includes benign, premalignant and malignant lesions. The proposed method was experimented on this dataset. Different classifiers have been trained using various color features. The neural network classifier detects abnormalities with an accuracy of 94.82%. Results indicate that the color features have better potential in identifying benign and malignant oral lesions. [ABSTRACT FROM AUTHOR]

• Multiple primary malignancies can occur and could be classified into Synchronous and Metachronous. • Synchronous occurrence of oral malignant melanoma and Dermatofibrosarcoma protuberans is rare with paucity of data on it in the literature. • These lesions can be treated successfully with surgery alone or in combination with chemo-radiotherapy. • The role of general system examination for oral and maxillofacial surgery patients cannot be overemphasized. The simultaneous occurrence of multiple primary malignancies in a patient has been widely reported. Oral mucosal malignant melanoma is a rare lesion of the oral cavity. The occurrence of this lesion with a very rare skin sarcoma at the same time has never to the best of our knowledge been reported previously. A 64 year-old Nigerian woman with a 27-year history of a dark lesion in the right maxillary buccal and palatal mucosa with an anterior abdominal swelling of 24 years which was discovered on systemic examination. Both lesions were later discovered to be malignant melanoma and dermatofibrosarcoma protuberans respectively. She had a right hemimaxillectomy for the maxillary lesion and wide excision of the abdominal wall lesion, followed by six courses of chemotherapy. She has been undergoing regular reviews for the past 5 years and remains free of all malignancy; however, she died shortly after noticing the reappearance of both lesions. While evaluating patients with a tumor, it will be rewarding to rule out other similar swellings in the body. This is important to avoid metastasis or multiple primary malignancies, which can help prolong patient life. The synchronous occurrence of two different neoplastic lesions is rare. Our literature search revealed no previous report of such occurrence of oral malignant melanoma and DFSP at the same time in one patient. The importance of thorough examination of patients cannot be overemphasized as concurrent lesions may be missed. [ABSTRACT FROM AUTHOR]

Purpose: Histiocytic and dendritic cell neoplasms are rare hematologic tumors. This study aimed to describe the epidemiologic features of the entire spectrum of histiocytic and dendritic cell neoplasms, including clinicopathological variables and patient outcomes. Materials and Methods: We comprehensively reviewed 274 patients who were diagnosed with histiocytic and dendritic neoplasms at Severance Hospital, Seoul, South Korea between 1995 and 2018. Results: The most common neoplasm was Langerhans cell histiocytosis (LCH), followed by dermal xanthogranuloma. Among non-LCH sarcomas, histiocytic sarcoma (HS) showed a relatively high prevalence, followed by follicular dendritic cell sarcoma (FDCS). Disseminated juvenile xanthogranuloma (DJG), Erdheim-Chester disease (ECD), indeterminate dendritic cell tumor (IDCT), and interdigitating dendritic cell sarcoma (IDCS) rarely occurred. Generally, these tumors presented in childhood, although the non-LCH sarcoma (HS/FDCS/IDCS/IDCT) group of tumors and ECD occurred in late adulthood. Multiorgan involvement and advanced Ann-Arbor stage, as well as recurrence and death of disease, were not uncommon. The non-LCH sarcoma group had the worst overall survival, compared to the DJG, ECD, and LCH groups. Conclusion: Our findings indicate that histiocytic and dendritic cell neoplasms exhibit heterogeneous epidemiologic characteristics and that some patients may have unfavorable outcomes, especially those with non-LCH sarcoma. [ABSTRACT FROM AUTHOR]

Malignant hyperthermia (MH) is a life-threatening condition characterized by signs of hypermetabolism during general anaesthesia. There is a wide variability in the magnitude of these signs. Early recognition and immediate management are essential in preventing morbidity and mortality. A MH crisis is a rare reaction caused by abnormal calcium movement within the skeletal muscle cells on exposure to volatile anaesthetic agents and/or succinylcholine. Diagnosing this condition preoperatively can be a challenge as a history of an uneventful exposure to the triggering agents does not exclude the possibility of developing the reaction. Despite the autosomal dominant pattern of inheritance, genetic testing is not a definitive diagnostic tool. The gold standard diagnostic test is the in-vitro contracture test (IVCT) that is usually performed in specialist MH centres using fresh muscle biopsies. A MH crisis can be fatal if mismanaged. Dantrolene is the only specific treatment available; it is crucial to ensure its availability in areas where triggering agents are administered. This article summarizes the pathophysiology and the safe perioperative approach in managing patients with MH. Both the European Malignant Hyperthermia Group (EMHG) and the Association of Anaesthetists have published comprehensive guidelines on the safe management of this condition. [ABSTRACT FROM AUTHOR]

Everyone remembers the adage beloved of medical school professors 'when you hear hooves, think horses not zebras' (i.e. most presentations have a common cause) and usually it is good advice. Fever is a very common paediatric presentation and usually has an identifiable infectious aetiology. However, for the child with prolonged fever it is sometimes necessary to look beyond the usual suspects and consider the 'zebra' diagnoses. This article addresses when to consider rarer and potentially life-threatening infective, autoimmune or malignant causes of prolonged fever and their immediate management. [ABSTRACT FROM AUTHOR]

Background: Focal liver lesions are considered a major problem during abdominal examinations. Shear wave sono-elastography (SWE) has been demonstrated to be helpful in assessment of liver fibrosis degree. The purpose of this study was to evaluate the role of SWE in characterization of benign and malignant hepatic focal lesions. Results: Seventy-five (75) patients with variable focal liver lesions (52 malignant and 23 benign) were analyzed by SWE. The stiffness values of surrounding hepatic parenchyma were also measured as a reference for readings of the focal lesion stiffness values. Final diagnosis was achieved by core needle biopsy (in 1 benign and 38 malignant cases) and contrast enhanced CT and MRI (in all cases). Cholangiocarcinoma (CCC) was the stiffest malignant lesion with median stiffness value (35.9 kPa). Focal nodular hyperplasia (FNH) was the stiffest benign lesion (26.7 kPa). The median stiffness value of malignant focal lesions (20.22 kPa) was significantly higher than that of benign focal lesions (10.68 kPa) (P value < 0.001). ROC curve of SWE median stiffness values for differentiation of benign from malignant hepatic focal lesions had AUC = 0.834, and using cut of value 14.165 kPa, yielding 98.1% sensitivity, 78.3% specificity, and 92% accuracy. Conclusion: SWE has high accuracy in differentiating benign form malignant liver focal lesions with promising results in individual characterization of some malignant (HCC and CCC) and benign hepatic focal lesion (FNH from other benign lesions). [ABSTRACT FROM AUTHOR]

Renal interstitial cell tumors are benign tumors of renomedullary origin; however, malignant features have not been reported in dogs, to our knowledge. A 17-y-old spayed female Maltese dog was presented to a local animal hospital with a mass in the right abdomen. Clinicopathologic findings prior to surgery revealed renal insufficiency and anemia. Imaging revealed that the right kidney was enlarged by an amorphous mass with opaque areas, indicative of mineralization. Upon histologic examination, the mass was comprised of malignant mesenchymal cells that produced mucinous matrix. The tumor cells were positive for vimentin and COX-2, but negative for pancytokeratin; the matrix stained positively with alcian blue. Therefore, the mass was diagnosed as a renal interstitial cell tumor, with malignant features. COX-2 may be useful in the diagnosis of canine renal interstitial cell tumors, similar to its diagnostic role in humans. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid carcinoma is classically diagnosed based on certain histological criteria. In some cases, definitive diagnoses may be challenging when morphological features are equivocal. This study evaluated the usefulness of Cytokeratin 19 (CK 19) as an immunohistochemical marker to differentiate the different histological types of malignant thyroid neoplasms, particularly papillary thyroid carcinoma (PTC) from benign thyroid lesions. Materials and Methods: We collected 54 malignant and 65 benign thyroid lesions diagnosed by histology in Universiti Kebangsaan Malaysia Medical Centre between January 2010 and December 2015. All cases were immunohistochemically stained with CK 19 and evaluated by 3 independent observers. The immunostaining patterns were scored based on the intensity and proportion of staining and finally graded as negative, weak positive, moderate positive or strong positive. In addition, the immunostaining scores of the malignant cases were correlated with their TNM pathological tumour stages. Results: Cytokeratin 19 staining expression was higher in malignant than benign thyroid lesions (p < 0.001) which was most prominent among classical PTC. The four PTC cases that showed negative or weak staining were all follicular variant of PTC. Benign conditions were mostly negative or showed weak positivity. There was no correlation between CK 19 expression and TNM primary tumour stage (pT). Conclusion: Cytokeratin 19 is a useful marker in differentiating malignant from benign thyroid conditions particularly the classical PTC, provided its interpretation is by correlation with morphology and takes into consideration the intensity and proportion of positive staining. [ABSTRACT FROM AUTHOR]

• Pre-sacral mass presenting with right thigh shooting pain in the setting of Von Recklinghausen. • Radiological imaging was crucial in providing a road map pre-op. • Mass abutting the internal iliac artery and possibly pressing on the sacral nerve roots. Malignant peripheral nerve sheath tumors (MPNST) are rare, aggressive sarcomatous tumors that arise from peripheral nerve sheaths and show schwann cell differentiation (Thangadurai, 2017) [ 1 ]. They commonly arise among patients with neurofibromatosis I and following radiation therapy (Farid et al., 2014). High resolution PET scans confirm the diagnosis and the definitive treatment is surgical excision. Post operative radiotherapy plays an important role in disease free survival rates. Chemotherapy is offered to people who have a systemic disease. This case report is on a 47 year old lady, a known case of Von Recklinghausen, who complained of a vague mass in the pelvis with recent history of pain to her right thigh. Pelvic examination revealed a vague mass on the right side of her pelvis. She was planned for excision of the mass. Intraoperative findings were consistent with the clinical and radiological findings. She is currently on regular follow-up and disease free. MPNSTs are rare tumours that arise in patients with neurofibromatosis I. Mutations at the genetic level is responsible for the development of MPNST. Early presentation, radiological confirmation, aggressive margin free surgery followed by chemoradiation helps in near complete cure of the disease. MPNST are difficult to manage because of their aggressive nature and the limitations in early diagnosis and management. In patients with Von Recklinghausens disease, malignancy must be suspected when a patient presents with the complaints as mentioned in this case report. [ABSTRACT FROM AUTHOR]

Background The prevalence of malignant wounds (MWs) is currently unknown. However, it is estimated that around 5%-10% of breast cancer cases, sarcomas and melanomas result in MWs. Aim This study aimed to identify and analyse the scientific evidence on the use of topical treatments for controlling odour from MWs. Methods We used a PRISMA checklist to systematically review articles in the following databases: PubMed, ProQuest, Science Direct, CINAHL, Wiley, Springer, CANCERLIT and Google Scholar, published from 2011 to 2018. We structured the research questions with the use of PICO elements. Although 111 articles were obtained from the search, only eight articles met the inclusion criteria. We analysed these articles with the aid of a CASP checklist and classified them based on the levels of evidence and recommendation grade. Results Among the eight shortlisted articles, four were intervention studies (three RCTs and one non-controlled study), three were case studies and one was a cohort study. The MWs in these articles were predominantly located on the breast, head/neck, cervix, vulva/ vagina, groin, spine, lower limbs, penis and rectum/ anus. Wound odour was measured using the verbal rating scale (VRS). Six products were used as topical therapies to manage wound odour: Polyhexamethylene biguanide, metronidazole, green tea, Manuka honey, nanocrystalline silver nanoparticles and charcoal dressing. These were associated with level of evidence 2b and recommendation grade B. Further, the charcoal dressing was associated with level of evidence 4 and recommendation grade C. Conclusions The following topical therapeutic products for control or management of MW Fodour were of recommendation grade B: polyhexamethylene biguanide, metronidazole, green tea, manuka honey and nanocrystalline silver nanoparticles. Implications for clinical practice The topical products discussed in this review can be used for controlling MW odour. Six interventions in the form of topical therapies were identified to reduce wound odour, namely Polyhexamethylene biguanide, metronidazole, green tea, manuka honey and nanocrystalline silver nanoparticles with level of evidence 2b and recommendation grade B. The use of oral metronidazole as topical therapy in wounds is not recommended, because it shows poor results. It is better to use metronidazole gel proved to be effective and safe for reduce bad odour. [ABSTRACT FROM AUTHOR]

Leydig cell tumors are rare sex cord-stromal tumors that account for less than 1% of all testicular tumors. Less than 10% of these tumors show metastatic malignant behavior. Herein we present a case of metastatic malignant Leydig cell tumor in an iliac lymph node diagnosed on fine-needle aspiration (FNA) in a 70-year-old man. The patient was referred from an outside institution with lymphadenopathy and had a past medical history of lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia and past surgical history of orchiectomy. An iliac lymph node FNA was performed demonstrating large discohesive plasmacytoid cells with indistinct cell borders; abundant and finely granular cytoplasm; round, eccentric nuclei with evenly distributed chromatin; and prominent nucleoli. The tumor cells were positive for inhibin and negative for calretinin and keratin leading to the diagnosis of metastatic malignant Leydig cell tumor. Review of the patient's history and of previous pathologic material, careful evaluation of cytomorphologic features, and the judicious use of immunohistochemistry can allow an accurate diagnosis of metastatic Leydig cell tumor. [ABSTRACT FROM AUTHOR]

Glioblastoma (GBM) is one of the most aggressive malignant glioma in central nervous system. The malignant transformation of GBM results from DNA mutations and alterations in gene expression levels. In this work, we used a bioinformatics approach to investigate the molecular mechanisms of GBM. The gene expression profile of normal genomes was used as a control. The analysis of gene expression revealed important alterations in genes involved in biological processes and metabolic pathways. We also identified some small molecules capable of reversing the altered gene expression in GBM; these molecules could provide a basis for future therapies for the treatment of this disease [ABSTRACT FROM AUTHOR]

• Cutaneous cystic lesion have wide clinical differentials. • A high index of suspicion should be maintained when any cutaneous lesion shows aggressive behavior. • A prompt investigation should be carried before surgical resection, and histopathology provides a final diagnosis. • We report a rare case of cystic poorly differentiated SCC of scalp operated as a sebaceous cyst. Cutaneous cystic lesions have broad differentials ranging from common benign entity to rare malignant lesions. Clinical evaluation of the lesion is the key to differentiation, as some rare malignant entities may simulate benign lesions. A high index of suspicion should be maintained for any aggressive behavior, which may require more thorough evaluation, including histopathology and radiographic imaging studies. We report a rare case of cystic poorly differentiated squamous cell carcinoma (CPDSCC) of the scalp. We report a case of a 37-year-old Filipino expatriate male who presented with a scalp swelling which had been gradually increasing in size for four months and was operated upon with a working diagnosis of sebaceous cyst. On post-op excisional biopsy, it turned out to be poorly differentiated cystic squamous cell carcinoma of the scalp. On further workup, no metastasis or other primary was found. Complete re-excision of the lesion with no evidence of residual tumor was achieved. Long-term follow-up was lost, as the patient left for his native country. Though cystic cutaneous lesions are very commonly encountered in clinical practice, high suspicion for malignancy should be maintained if the lesion shows any aggressive behavior. Prompt investigation should be done before surgery to determine the nature of the disease and the most effective management for the patient. Poorly differentiated cystic squamous cell carcinoma should also be considered in the differential diagnosis of cystic cutaneous lesions show aggressive behavior. [ABSTRACT FROM AUTHOR]