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Summary: Breast cancer is the most prevalent kind of tumor to occur in females and the primary cause of death for women. Early detection is perhaps the most successful strategy to minimize breast cancer mortality. Early diagnosis necessitates a consistent and efficient diagnostics method that allows doctors to differentiate benign from malignant breast cancers without a surgical sample. The goal of this endeavor is to develop a sophisticated breast cancer diagnosis method. The primary goal of the paper is to reduce the death rate among women by promoting early detection of breast cancer. First, pre‐processing techniques such as median filtering and contrast limiting adaptive histogram equalization are used to the obtained raw images. By doing this, the machine‐learning model's computational complexity is decreased and the image quality is enhanced. K‐means clustering is used to segregate the pre‐processed image. Additionally, features including the enhanced local vector pattern, grey‐level co‐occurrence matrix and local vector patterns are produced in the course of the feature extraction stage. Finally, an optimized deep belief network (DBN) is carrying out the classification process. To boosts the classification accuracy, activation function of DBN (tanh, softmax, ReLu) as well as its weight function is optimized by the proposed grey wolf updated whale optimization algorithm The accuracy of the greywolf updated whale optimization algorithm+DBN is above 93% for datasets 1 and 2 when compared to extant models. Finally, calculation of the performance validates the proposed model's performance. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to compare shear wave elastography (SWE) of benign and malignant breast lesions, evaluate the sensitivity and specificity of previously suggested thresholds for identifying malignant breast lesions, and compare SWE measures across histopathological type and grade. Methods: This single‐centre study included 303 patients, and 405 solid breast lesions were biopsied and evaluated by mammography, which may have included contrast‐enhanced mammography, conventional B‐mode ultrasound, and SWE. Following this, elastography mean (Emean), maximum (Emax), and ratio (Eratio) variables were calculated for elasticity in kilopascals (kPa) and speed in metres per second (m/s). Results: Malignant (n = 113) samples were significantly higher than benign (n = 267) across all SWE variables [median (interquartile range)]; Emean (kPa) [132.8 (34), vs. 41.9 (53.6), p <.001], Emean (m/s) [6.9 (1), vs. 3.7 (2.2), p <.001]. The highest combined sensitivity and specificity were for Emax (97%, 73%) at >80 kPa, and Emean (96%, 76%) at >5.2 m/s. Histopathological grade 3 (kPa), Emean [145.8 (22.5), p =.012], Emax [147.8 (19.4), p =.009], and Eratio [11.7 (6.6), p =.006] were significantly higher than grades 1 [129.2 (37.3), 133.2 (35.9), 7.53 (4.7)] and 2 [127.3 (36.4), 133.3 (34.2), 8.3 (6.1)]. Conclusion: Breast elastography is a sensitive complementary technique that can distinguish between malignant and benign lesions and help characterise histological profile and grade. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Malignant carotid body tumors (MCBT) are rare and diagnosed after detection of nodal or distant metastases. This systematic review (SR) focuses on MCBT initially approached by surgery. Preferred Reporting Items for SR and Meta‐Analysis (MA) guided the articles search from 2000 to 2023 on PubMed, Scopus, and Web of Science. Among 3548 papers, 132 (337 patients) were considered for SR; of these, 20 (158 patients) for MA. Malignancy rate was 7.3%, succinate dehydrogenase (SDH) mutation 17%, age at diagnosis between 4th and 6th decades, with a higher prevalence of females. MCBTs were mostly Shamblin III, with nodal and distant metastasis in 79.7% and 44.7%, respectively. Malignancy should be suspected if CBT >4 cm, Shamblin III, painful or otherwise symptomatic, at the extremes of age, bilateral, with multifocal disease, and SDHx mutations. Levels II–III clearance should be performed to exclude nodal metastases and adjuvant treatments considered on a case‐by‐case basis. [ABSTRACT FROM AUTHOR]

Skull lesions in pediatric population are common findings on imaging and sometimes with heterogeneous manifestations, constituting a diagnostic challenge. Some lesions can be misinterpreted for their aggressiveness, as with larger lesions eroding cortical bone, containing soft tissue components, leading to excessive and, in some cases, invasive inappropriate etiological investigation. In this review, we present multiple several conditions that may present as skull lesions or pseudolesions, organized by groups (anatomic variants, congenital and development disorders, traumatic injuries, vascular issues, infectious conditions, and tumoral processes). Anatomic variants are common imaging findings that must be recognized by the neuroradiologist. Congenital malformations are rare conditions, such as aplasia cutis congenita and sinus pericranii, usually seen at earlier ages, the majority of which are benign findings. In case of trauma, cephalohematoma, growing skull fractures, and posttraumatic lytic lesions should be considered. Osteomyelitis tends to be locally aggressive and may mimic malignancy, in which cases, the clinical history can be the key to diagnosis. Vascular (sickle cell disease) and tumoral (aneurismal bone cyst, eosinophilic granuloma, metastases) lesions are relatively rare lesions but should be considered in the differential diagnosis, in the presence of certain imaging findings. The main difficulty is the differentiation between the benign and malignant nature; therefore, the main objective of this pictorial essay is to review the main skull lytic lesions found in pediatric age, describing the main findings in different imaging modalities (CT and MRI), allowing the neuroradiologist greater confidence in establishing the differential diagnosis, through a systematic and simple characterization of the lesions. [ABSTRACT FROM AUTHOR]

Malignant peripheral nerve sheath tumors (MPNSTs) are neoplasms originating from or differentiating into nerve sheaths of peripheral nerves. Vaginal origin is rare, with only six vaginal primary cases reported to date. A 55‐year‐old woman presented to our hospital with a 7 cm vulvar mass. Tumor biopsy results were suspicious of sarcoma, and pelvic magnetic resonance imaging and hysterofiberscopy showed that the tumor originated from the lower vagina. The mass was transvaginally excised, and histological examination confirmed the diagnosis of a vaginal MPNST with negative surgical margins. The patient underwent radiotherapy because the risk of recurrence was high, owing to the large tumor size and high mitotic index. The patient remained recurrence‐free for 1 year after the primary treatment. This is the first case of a high‐risk vaginal MPNST that avoided early disease recurrence with additional radiotherapy after complete tumor resection. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the combined use of ultrasonography and clinical features for the differentiation of malignant peripheral nerve sheath tumors (MPNST) from benign peripheral nerve sheath tumors (BPNST) and to compare the efficacy of ultrasonography with that of magnetic resonance imaging (MRI). Methods: This retrospective study included 28 MPNSTs and a control group of 57 BPNSTs. All patients underwent an ultrasound scan using the Logiq E9 (GE Health Care, Milwaukee, WI) or EPIQ7 equipment (Philips Medical System, Bothell, WA). A 3.0‐T MRI machine (Ingenia; Philips Healthcare, Best, the Netherlands) was used for scanning, and conventional MRI was performed on different regions based on the patient's clinical situation. The following variables were evaluated: palpable mass, pain, nerve symptoms, maximum diameter, location, shape, boundary, encapsulation, echogenicity, echo homogeneity, presence of a cystic component, calcification, target sign, posterior echo, and intertumoral vascularity of the tumors. The diagnostic efficacy of ultrasonography and clinical factors was compared with that of MRI. Independent factors for predicting MPNST versus BPNST were also assessed. Results: The parameters of location, shape, boundary, encapsulation, and vascularity were significantly different between MPNSTs and BPNSTs. Multiple logistic regression analysis showed that shape, boundary, and vascularity were independent predictors of MPNSTs. The sensitivity, specificity, and Youden index of the three clinical and ultrasound factors (shape, boundary, and vascularity) were 0.89, 0.81, and 0.69, respectively, whereas those of MRI were 0.71, 0.89, and 0.61, respectively. No significant differences in the area under the curve (AUC) of the three combined clinical and ultrasound factors and those of MRI were found (P >.05). Conclusions: MRI was useful in the differential diagnosis between MPNSTs and BPNSTs. However, the combination of clinical and ultrasound diagnoses can achieve the same effect as MRI, including shape, boundary, and vasculature. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis is a systemic histiocytic proliferative disease with cutaneous manifestations which is well described in human medical literature and has relatively recently been reclassified as a neoplastic disorder. The diagnosis of canine Langerhans cell histiocytosis has been proposed in the veterinary literature to refer to a histiocytic proliferative disease in the dog with clinical and histopathologic features that mirror the human disease. However, reports that invoke this diagnosis are rare and often lack complete diagnostic characterization. This case report presents an extensive diagnostic investigation of a putative case of Langerhans cell histiocytosis in a 3‐year‐old male castrated Golden Retriever dog, including gross, cytologic, histopathologic, and immunohistochemical findings. Furthermore, we document that canine LCH may have positive immunolabeling for the transcription factor multiple myeloma oncogene 1/interferon regulatory factor 4 (MUM1/IRF4), which is classically used for the diagnosis of canine plasma cell neoplasms. [ABSTRACT FROM AUTHOR]

Aims: Glomus tumours are neoplasms with perivascular smooth muscle differentiation, which rarely occur in the oesophagus and may behave aggressively in this site based upon prior case reports. This study describes the clinicopathologic features of three oesophageal glomus tumours diagnosed at two large academic institutions between 1984 and 2022. Methods and results: Three cases of oesophageal glomus tumours were identified. Patients included two females and one male, with an age range of 19–65 years. All three tumours behaved in a malignant fashion, with metastases to various sites (lymph nodes, lung, pericardium, pleura, diaphragm, scalp). One patient developed an aorto‐oesophageal fistula, resulting in a fatal haemorrhage. Tumours ranged in size from 4.5 to 8.1 cm. Histologically, all tumours had a multinodular, perivascular growth pattern. The neoplasms showed varying degrees of cytologic atypia and spindling, elevated mitotic activity (2–12 mitotic figures per 10 high‐power fields), and necrosis was seen in in two cases. All tumours expressed smooth muscle actin by immunohistochemistry, and harboured NOTCH gene alterations (MIR143::NOTCH2 fusion in two cases; NOTCH3 rearrangement and NOTCH1 point mutation in one case). An ATRX splicing mutation in exon 10 was also identified in one case. Conclusion: Oesophageal glomus tumours pose diagnostic challenges, given their rarity at this site, but can be recognised by their characteristic perivascular growth pattern, round central nuclei, and supportive ancillary studies. Given the propensity for aggressive behaviour in this location, we recommend management by a multidisciplinary sarcoma team for optimal outcome. [ABSTRACT FROM AUTHOR]

Aims: Ossifying fibromyxoid tumor (OFMT) is a rare enigmatic tumor of uncertain differentiation that can be classified as typical, atypical, and malignant subtypes based on cellularity, nuclear grade, and mitotic activity. The majority of OFMTs, regardless of the risk of malignancy, harbor genetic translocations. We report two malignant OFMTs, including one with evidence of dedifferentiation, with novel genefusions. Methods and Results: Case 1 was a 63‐year‐old male with a dedifferentiated OFMT arising in the right wrist, while case 2 was a 41‐year‐old male with a malignant OFMT presenting as a posterior mediastinal mass. Case 2 showed multifocal expression with EMA and synaptophysin, while desmin and S100 were absent in both tumors. NGS sequencing studies detected PHF1::FOXR1 and PHF1::FOXR2 gene fusions in cases 1 and 2, respectively. Despite aggressive regimens, both progressed with wide spread metastases resulting in death within six years of diagnosis. Conclusions: We expand the genetic spectrum of OFMTs with two novel gene fusions, PHF1::FOXR1 and PHF1::FOXR2. These cases confirm the previously reported tendencies for OFMTs with rare variant fusions to demonstrate malignant behavior, unusual morphology, and non‐specific immunophenotype. [ABSTRACT FROM AUTHOR]

Nevus sebaceus (NS) is a congenital hamartoma of skin structures including the epidermis, sweat sebaceous glands, and hair follicles. It is known that secondary tumors can occur in NS. However, secondary metastatic malignancies are rare. Basosquamous carcinoma (BSC) is an aggressive type of basal cell carcinoma (BCC) characterized by squamous differentiation. Herein, we report a case of metastatic BSC that developed in a 73‐year‐old male with NS. The clinical presentation of this patient was that of an ulcerative nodule developing in a longstanding plaque‐like lesion consistent with NS. Histopathological examination revealed characteristic features of BCC with some areas of squamous differentiation in addition to the structure of a typical NS. Immunohistochemical expression of Ber‐EP4, AE1/AE3, and epithelial membrane antigen helped to make the diagnosis of BSC. [ABSTRACT FROM AUTHOR]

Background and Purpose: Diagnosis of retroperitoneal schwannoma (RS), especially cystic RS, is frequently missed or delayed owing to its rarity, location, nonspecific symptoms, and similarities with other tumors on various imaging modalities. This study aimed to determine associations between clinical, radiological, and histopathologic features and outcome. Materials and Methods: Seventy‐nine patients with pathologically confirmed RS who underwent tumor resection between June 2010 and June 2020 were retrospectively reviewed and analyzed. Patients were stratified into three groups according to degree of tumoral cystic degeneration. Results: Cystic degeneration was significantly associated with multiple foci (p = 0.025), calcification (p = 0.012), and hemorrhage (p = 0.000), but not size (p = 0.08), high Ki‐67 (p = 0.094), malignancy (p = 0.115; prevalence of cystic degeneration in the benign and malignant groups were 53.9% vs 100%), rough margin (p = 0.162), or irregular shape (p = 0.369). Malignant RS was significantly associated with multiple lymph nodes enlargement (p = 0.034). Tumor size, margins, shape, or/and multiplicity did not significantly differ between benign and malignant tumors. No recurrence occurred in patients with benign RS (mean follow‐up, 45 months). All malignant tumors recurred; mean time to recurrence was 11.4 months (mean follow‐up, 33 months). Conclusion: Since RS is misdiagnosed mostly as malignancy and diagnosis is often delayed, a suspicion is necessary for diagnosis when atypical features are present. In RS, cystic degeneration was not associated with tumor size, Ki‐67, or malignancy; however, it was significantly associated with multiple foci, calcification, and hemorrhage. Cystic degeneration and related factors are useful for the diagnosis of RS. Malignant RS should be considered when a mass involves multiple lymph nodes. Margins, morphology, and size are not associated with malignancy. Pathological tumor type, tumor location, and adjacent anatomic structures are associated with outcome. [ABSTRACT FROM AUTHOR]

Background: Spitzoid melanocytic neoplasms are diagnostically challenging; criteria for malignancy continue to evolve. The ability to predict chromosomal abnormalities with immunohistochemistry (IHC) could help select cases requiring chromosomal evaluation. Methods: Fluorescence in situ hybridization (FISH)‐tested spitzoid neoplasms at our institution (2013–2021) were reviewed. p16, BRAF V600E, and preferentially expressed antigen in melanoma (PRAME) IHC results were correlated with FISH. Results: A total of 174 cases (1.9F:1M, median age 28 years; range, 5 months–74 years) were included; final diagnoses: Spitz nevus (11%), atypical Spitz tumor (47%), spitzoid dysplastic nevus (9%), and spitzoid melanoma (32%). Sixty (34%) were FISH positive, most commonly with absolute 6p25 gain (RREB1 > 2). Dermal mitotic count was the only clinicopathologic predictor of FISH. Among IHC‐stained cases, p16 was lost in 55 of 134 cases (41%); loss correlated with FISH positive (p < 0.001, Fisher exact test). BRAF V600E (14/88, 16%) and PRAME (15/56, 27%) expression did not correlate with FISH alone (p = 0.242 and p = 0.359, respectively, Fisher exact test). When examined together, however, p16‐retained/BRAF V600E‐negative lesions had low FISH‐positive rates (5/37, 14%; 4/37, 11% not counting isolated MYB loss); all other marker combinations had high rates (56%–75% of cases; p < 0.001). Conclusions: p16/BRAF V600E IHC predicts FISH results. "Low‐risk" lesions (p16+/BRAF V600E−) uncommonly have meaningful FISH abnormalities (11%). PRAME may have limited utility in this setting. [ABSTRACT FROM AUTHOR]

Tailgut cyst, a type of retro‐rectal cyst, is a rare condition requiring evaluation for malignant transformation. We report a case of squamous cell carcinoma arising in the retro‐rectal cyst, in a 51‐year‐old female who underwent incomplete resection of the cyst and chemo‐radiotherapy, subsequently became locally recurred and metastatic. Malignant transformation of tailgut cysts should be detected. The treatments based on pathology include complete surgical excision with or without chemotherapy and radiotherapy. Our case had a poor outcome despite the multi‐modality treatments. [ABSTRACT FROM AUTHOR]

A 44‐year‐old female underwent cranioplasty 6 months after a malignant right MCA stroke. Three hours later, she became unresponsive, with new left‐gaze deviation and right‐side hemiparesis. CT head showed new right MCA hypodensity and diffuse edema. After aggressive medical management, she returned to baseline. A brain MRI showed no stroke. Malignant cerebral edema after uneventful cranioplasty is a rare and often fatal complication related to sudden intracranial negative pressure and altered cerebral autoregulation. This is a rare case in which a patient developed malignant cerebral edema and status epilepticus after cranioplasty and survived. [ABSTRACT FROM AUTHOR]

The classification of tumours into benign and malignant continues to date to be a very relevant and significant research topic in the cancer research domain. With the advent of Computer Vision and rapid developments in the fields of deep learning, as well as medical devices and instruments, researchers are therefore utilizing the state‐of‐the‐art deep learning architectures to discover patterns in the medical image data and thereby use this information to detect tumours and classify them as benign or malignant. In this paper, we propose a custom state‐of‐the‐art deep learning architecture, the Inception‐ResNet v2 for the classification of ovarian tumours into the two categories of benign and malignant based on a custom dataset with a validation accuracy of 97.5% and a test accuracy of 67%. Furthermore, a quantum convolutional neural network (QCNN) was also implemented with an accuracy of 92% on the validation dataset. [ABSTRACT FROM AUTHOR]

Medical image analysis and disease diagnosis have significantly improved with the use of AI and Machine Learning algorithms. Automated systems for medical image analysis will help the doctors and radiologists understand the anomaly in a short span of time and with better visualization. Such automated systems will help to reduce the time taken for diagnosis by experts. Recently, Computer Vision is industrialized with the advancements in algorithms and hardware. The proposed study aims to develop a computer vision solution for automatic segmentation and classification of ovarian tumours in discriminating between benign and malignant tumours by image‐to‐image translation approach using Conditional Generative Adversarial Network (cGAN). Our method uses a novel algorithm which segments and classifies the images in a single pipeline which makes the algorithm unique and useful. This research also aims to compare its diagnostic accuracy with that of an expert radiologist. The dataset used by in the present study is formulated with images obtained from a hospital and annotated by doctors from the hospital. The obtained results show the proposed study is promising for ovarian cancer segmentation and classification with an average segmentation score of 0.825 for benign and 0.765 for malignant and classification accuracy of 83% for benign and 79% for malignant, precision score of 85% for benign and 80% for malignant and F1 score of 81% for benign and 80.1% for malignant images. The proposed methodology is evaluated on the existing MRI images to perform segmentation and classification. The results obtained shows that the proposed methodology can perform well on other MRI images. In this study, proposed methodology is convenient as separate segmentation need not be done and is giving good result. The same MRI images are segmented using UNet and classified using RESNET 101 and results are compared with the proposed methodology. [ABSTRACT FROM AUTHOR]

Background: Previous studies on oral submucous fibrosis (OSF) mostly focused on the activation of fibroblasts and collagen metabolism, while little involved in the epithelium. As we have reported the role of differentiated embryo-chondrocyte expressed gene 1 (DEC1) in oral cancer and other precancerous lesions, this research aimed to explore its role in the OSF epithelium.Methods: Expression of DEC1 and other proteins were investigated in tissue array constructed with 33 OSF and 14 normal oral mucosa (NOM) tissues. Human oral keratinocytes treated with arecoline and/or hypoxia were used to simulate OSF epithelium and detected for morphological and protein alterations. Inhibition of DEC1 was used to explore its mediating role. Finally, animal models of OSF constructed by locally arecoline injecting in buccal mucosa were used to verify our findings.Results: DEC1 overexpression could be detected in the epithelium of OSF compared with that in NOM followed by phosphorylated FAK and Akt, and DEC1 showed a significant positive correlation with them. Cytology experiment revealed that OSF-like treatment could upregulate DEC1 expression followed by phosphorylated FAK, Akt, but inhibit E-cadherin, while knockdown of DEC1 could suppress the effects. In addition, OSF mice revealed higher expression of DEC1 in the epithelium of buccal mucosa, along with synchronized alterations of phosphorylated FAK and Akt.Conclusion: In the epithelium of OSF, overexpression of DEC1 induced activation of FAK/Akt signal axis, caused mesenchymal transition in epithelial cells, and may promote malignant transformation of OSF. Targeting DEC1 in OSF could be promising a new target for the diagnosis and treatment of this process. [ABSTRACT FROM AUTHOR]

Objective: To explore independent factors influencing the risk of lower extremity deep vein thrombosis during the postoperative period in patients with gynecological malignancies by constructing a predictive model. Methods: In our study, we collected 573 patients with gynecological malignancies in the postoperative period between September 2016 and September 2020, who were divided into a modeling (n = 402) and verification group (n = 171) according to a ratio of 7:3. Univariate and multivariate regression analyses were used to determine independent factors influencing deep vein thrombosis (DVT). A nomogram model was created and a risk score was calculated. Results: Multivariate regression analysis showed that the independent factors affecting DVT among these patients included age, hyperlipidemia, abnormal uterine bleeding, degree of anemia, D‐dimer, operation time, and intraoperative blood loss. By incorporating these factors into a nomogram, we determined that the C‐index and calibration curve of the two groups both showed that the model distinguishes and fits well. Further comparing between the high‐ and low‐risk groups, we found that the model has favorable predictive performance. Conclusion: The predictive nomogram for the risk of DVT in patients with gynecological malignancies in the postoperative period demonstrated good calibration and recognition accuracy. Further independent research is necessary to verify our results. The predictive nomogram showed good accuracy in predicting the risk of venous thromboembolism in postoperative patients with gynecological malignancy. [ABSTRACT FROM AUTHOR]

Background and Aims: Skin tumors are one of the most common complaints among patients due to their external location and esthetic reasons. Skin tumors have a wide spectrum from being benign, with only esthetic problems, to malignant, which can be fatal. This study aimed to describe the epidemiologic profile of skin tumors in the Philippine General Hospital Out‐patient Services. Methods: This is a cross‐sectional study that describes the epidemiologic profile of the different skin tumors among Filipinos who consulted at the Philippine General Hospital Out‐patient Services. Results: Benign skin tumors are more common than malignant ones. Benign skin tumors are commonly seen in middle‐aged adults, with a median age of 33 years. There was a higher proportion of benign tumors among females (n = 1256/1529, 82.15%) compared to males (n = 690/923, 74.76%). The site of predilection was the head and neck region. The most common benign skin tumor was the intradermal nevus. The older adult age group had a higher predilection for malignant tumors, with a median age of 57 years. Relatively, there was higher proportion of malignant tumors among males (n = 223/923, 25.24%) compared to females (n = 273/1529, 17.85%). The site of predilection is also the head and neck region. Among malignant skin tumors, basal cell carcinoma is the most common skin cancer. Conclusion: The epidemiologic profile of skin tumors from patients seen in the Philippine General Hospital in terms of median age at diagnosis, sex preponderance, site of predilection, and tumor classification was similar to various Asian countries located in relatively the same latitude as the Philippines. [ABSTRACT FROM AUTHOR]

Background: Due to their low prevalence and variable clinical presentation, oral metastatic tumours present a diagnostic challenge to the clinician. This case describes the presentation of a mandibular metastatic tumour in an apparently healthy patient, initially managed as dento‐alveolar infection by her general dental practitioner (GDP). Case description: A 56‐year‐old female attended her GDP with a small intraoral swelling buccal and lingual to the lower left incisors, canine and first premolar. Radiographic examination revealed gross caries in the lower left anterior dentition and periapical bone loss in the region. A week's course of antibiotics had no effect. The swelling increased rapidly and the involved teeth were extracted by the GDP before referral to Oral Surgery. The patient offered no history of weight loss, febrility or breathlessness. Her medical history was unremarkable. She smoked and did not consume alcohol. Histological examination revealed a poorly differentiated metastatic carcinoma. A computerized tomography scan of the neck showed a 4 cm mass in the left anterior mandible with adjacent bony destruction. There was bilateral cervical lymphadenopathy and a large right‐sided upper lobe lung mass with metastasis to the contralateral upper lobe of the lung, the right adrenal gland and brain. A diagnosis of poorly differentiated non‐small cell carcinoma of the lung was made, staged T4 N3 M1c. Nine weeks after her initial presentation to the GDP, the patient suffered a seizure and passed away. Conclusion: This case demonstrates an uncommon presentation of mandibular metastatic tumour as the first indicator of advanced malignant disease. The presentation of such tumours can often mimic more common, benign processes, making diagnosis challenging. At a time of increased remote assessment of patients due to the COVID‐19 pandemic, it is particularly important for clinicians to consider the possibility of malignancy when faced with any unusual case of swelling. [ABSTRACT FROM AUTHOR]

BACKGROUND: The international system for reporting serous fluid cytopathology (TIS) recommends submitting at least 50‐75 mL of serous fluid to decrease false‐negative results. However, prior studies did not agree on specific volume requirements or consensus adequacy criteria. Our study aims to assess whether fluid volume affects the adequacy rate and to assess the minimum volume necessary for optimal adequacy in pleural and peritoneal fluids. METHODS: A total of 8530 serous fluid cytology cases were identified in the laboratory information system. Differences in mean fluid volume received in the laboratory were compared using an ANOVA Games‐Howell test based on TIS category. The percentage of malignant diagnoses across the volume ranges of 0 to 5 mL, 5 to 10 mL, 10 to 25 mL, 25 to 50 mL, 50 to 75 mL, 75 to 100 mL, 100 to 150 mL, 150 to 250 mL, 250 to 500 mL, 500 to 2000 mL was compared in pleural and peritoneal fluids using a chi‐square test, and a SiZer analysis was performed. RESULTS: Mean fluid volume in inadequate, atypical, and negative cases was significantly lower compared to positive cases. A SiZer analysis showed a positive relationship between the malignancy fraction of pleural and peritoneal fluids and fluid volume. The percentage of malignant diagnoses in pleural and peritoneal fluid samples increased significantly up to a volume range of 75‐100 mL. CONCLUSIONS: There is a significant relationship between fluid volume, adequacy and detection of malignancy in serous effusion cytopathology. The malignancy fraction increases with larger fluid volumes but at least 75‐100 mL of fluid should be submitted for optimal diagnosis of malignancy in pleural and peritoneal fluids.; [ABSTRACT FROM AUTHOR]

Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is a mucin‐producing tumor that develops from the epithelial lining of the main pancreatic duct or branch pancreatic ducts. Here, we assessed the feasibility and safety of various robotic pancreatectomy approaches to treating IPMN, and short‐ and long‐term outcomes of robotic IPMN resection. Methods: Data from patients who underwent robotic pancreatectomy for IPMN between 2012 and 2019 at our hospital were retrospectively analyzed. The survival outcomes for patients were compared using the Kaplan‐Meier method and Cox regression analysis. Results: Of the 174 patients who underwent robotic pancreatectomy, 120 and 54 patients had benign or malignant tumors, respectively. Patients with malignant IPMN had lost more weight in the 6 months prior to surgery (P =.008), and a higher serum level of CA19‐9 (P <.001) and CEA (P <.001). Postoperative pancreatic or biliary fistula occurred in 17 or 6 patients overall, respectively. The pathology of the IPMN (P =.030), tumor diameter (P =.016), mural nodule (P =.023), tumor capsule (P =.003) and CA19‐9 (P =.024) values were all independent risk factors for survival. The median OS time after surgical resection for the malignant IPMN group was 29.0 months (range, 21.6‐36.4). The OS was significantly different in patients with IPMN according to their different pathology, tumor capsule, mural nodule group, CA19‐9 level, or tumor diameter. Conclusions: This large‐scale survey of 174 patients indicated that various robotic pancreatectomy approaches were feasible and safe for IPMN. Patients had an acceptable prognosis, indicating that robotic pancreatectomy represents a feasible potential therapeutic strategy for IPMN. [ABSTRACT FROM AUTHOR]

Steroid cell tumors not otherwise specified are one of the rare virilizing ovarian tumors. Most of the tumors are benign. This case report illustrates the challenge in managing steroid cell tumor not otherwise specified, which starts from determining its malignant potential, surveillance, and adjuvant treatment option. [ABSTRACT FROM AUTHOR]

Background: Stenting against recurrent biliary obstruction (RBO) after placement of covered metal stent (CMS) for distal malignant biliary obstruction (MBO) is still challenging. This study investigated the feasibility of a novel laser‐cut fully CMS with anti‐reflux valve in patients with distal MBO refractory to conventional CMS. Methods: Patients who underwent Duckbill‐type metal stent (DMS) placement between June 2019 and May 2020 were included. Early complications, causes of RBO including non‐occlusion cholangitis, and time to RBO (TRBO) were evaluated. TRBO of DMS was also compared with that of previous CMS. Results: Thirty patients were included: pancreatic cancer/metastatic lymph nodes in 29 patients/one patient; duodenal stenosis in 13 patients. Technical and functional success were achieved in all patients. Mild cholangitis and mild pancreatitis developed in each one. Median follow‐up period was 167 days (range, 23‐527 days). RBO occurred in nine patients (30%): sludge formation in four patients, hemobilia in one patient, symptomatic distal stent migration in three patients, and non‐occlusion cholangitis in one patient. TRBO of DMS was significantly longer than that of previous CMS (median 224 days vs median 120 days, P =.0025). DMS was successfully removed in all of six patients when re‐intervention was needed. Conclusions: Duckbill‐type metal stent might be safe and effective in patients with distal MBO refractory to conventional CMS. [ABSTRACT FROM AUTHOR]

Background: A group of international experts in breast fine needle aspiration biopsy (FNAB) cytopathology, supported by the International Academy of Cytology (IAC), drafted a comprehensive system for reporting breast FNAB cytopathology in 2017‐2018. The editorial team produced a survey to assess the international response to the proposed category structure, definitions, and management recommendations in this draft. Methods: A web‐based survey of 186 questions was generated using the Qualtrics software package (Provo, Utah) supported by the Division of Information Technology at the University of Wisconsin–Madison. The survey was advertised widely—including through the IAC, American Society of Cytopathology, Japanese Society of Clinical Cytology, Papanicolaou Society of Cytopathology, and Australian Society of Cytology and to audiences at national and international meetings—and was available from April to June 2018. The data obtained from the 265 respondents was assessed by the editorial team. Results: The survey provided a snapshot of the current role and use of breast FNAB and the international variations. Demographic questions were followed by specific questions based on the draft category definitions and statements and focused on issues that had generated discussion among the authors, including the FNAB diagnosis of ductal carcinoma in situ. Conclusion: The survey results strongly supported the development of the IAC Yokohama System and informed subsequent discussions among the authors regarding the final text. The responses to the online survey of the late‐stage drafts of the International Academy of Cytology Yokohama System for Reporting Breast Fine Needle Aspiration Biopsy (FNAB) Cytopathology supported the structure, definitions, approach to diagnosis, and management recommendations of the system; led to several minor changes in the final text; and highlighted specific contentious issues that require further investigation. This analysis and discussion of this detailed survey will help refine the development of new FNAB reporting systems. [ABSTRACT FROM AUTHOR]

Background: The management of malignant colorectal polyps removed at endoscopy remains controversial with patients either undergoing surgical resection or regular endoscopic surveillance. Lymph node (LN) metastases occur in 6–16% of patients with malignant polyps. This study assessed the rate of LN metastases in patients undergoing surgical resection for malignant polyps removed endoscopically to determine if there is a difference in the rate of LN metastases between colonic and rectal polyps. Methods: A retrospective review of a prospectively maintained database was performed from 2010 to 2018. All patients who underwent surgical resection following endoscopic removal of a malignant colorectal polyp were reviewed. Clinical data including patient demographics and tumour characteristics were examined. Results: A total of 177 patients underwent surgical resection in the study period. The median age at diagnosis was 65 years (range 22–88 years) with females comprising 52% of the patient cohort (n = 92/177). Polyps were located in the colon in 60.5% of cases with the remainder located in the rectum. The median number of LN harvested was 14 (range 0–44) with malignant LN (including a mesenteric tumour deposit) identified in 8.5% of resection specimens (n = 15/177). Malignant LNs were retrieved in 5.5% of right-sided tumours, 5.6% of left-sided tumours and 12.9% of rectal tumours (P = 0.090). Conclusion: A small proportion of patients with malignant polyps removed endoscopically will have LN metastases. The results of this study suggest that the tumour location might be a useful predictive marker; however, a further study with increased patient numbers is required to properly establish this finding. [ABSTRACT FROM AUTHOR]

Background: Central airway obstruction and fistula are treated with a tracheobronchial Y stent. In the currently used self‐expandable metal Y stents, the delivery system is 8 mm in diameter and requires either a 9 mm tracheal tube or rigid bronchoscope to enable airway control during insertion. In this study we present a novel technique of laryngeal mask airway (LMA) assisted Y stent insertion, enabling airway control during deployment of the Y stent. Methods: All procedures using LMA in assisting Y stent insertions between 2014–2020 were reviewed. Data collected included demographics, clinical diagnosis and disease characteristics, indication, procedural success rates, clinical outcome and survival. Results: A total of 10 patients with a median age of 61.5 years (range 37–73) underwent LMA assisted Y stent insertion. Indications for stent insertion were malignant disease with central airway obstruction or fistula. In all cases airway patency was achieved leading to improvement of symptoms and performance status. No procedural complications were reported. The median survival was 4.5 weeks (range: 2–26). Conclusions: LMA assisted Y stent insertion enables airway control during the procedure. In comparison to silicone Y stent insertion, the procedure is less cumbersome, shorter in duration and does not require the use of general anesthesia or rigid bronchoscopy. Key points: Significant findings of the study: LMA assisted Y stent insertion enables airway control during the implantation of metallic self‐expanding Y stent. The procedure does not require the use of general anesthesia or rigid bronchoscopy. What this study adds: In this study we present the technique and outcomes of LMA assisted Y stent insertion. This method of Y stent insertion provides an additional treatment option for patients with central airway obstruction and fistula. [ABSTRACT FROM AUTHOR]

Background: Oral potentially malignant disorders are a clinical conundrum as there are no reliable methods to predict their behaviour. We combine conventional oral epithelial dysplasia grading with DNA ploidy analysis to examine the validity of this approach to risk assessment in a cohort of patients with known clinical outcomes. Methods: Sections from diagnostic biopsies were assessed for oral epithelial dysplasia using the WHO grading system, and DNA ploidy analysis was performed using established methods. Patients reviewed for a minimum of 5 years who did not develop oral squamous cell carcinoma were classified as "non‐transforming" cases. Patients that developed oral squamous cell carcinoma ≥ 6 months after the initial diagnostic biopsy were classified as having "malignant transformation." Results: Ninety cases were included in the study. Seventy cases yielded informative DNA ploidy results. Of these 70 cases, 31 progressed to cancer. Oral epithelial dysplasia grading and DNA ploidy status were both significantly associated with clinical outcome (P < 0.05). Severe dysplasia had a hazard ratio of 3.50 (CI: 1.46, 8.45; P = 0.005) compared to cases with mild dysplasia. Aneuploidy had a hazard ratio of 2.09 (CI: 1.01, 4.32; P = 0.046) compared to cases with a diploid/tetraploid status. Receiver operating characteristic analysis gave an area under the curve of 0.617 for DNA ploidy status and 0.688 when DNA ploidy status was combined with dysplasia grading. Conclusion: Our findings suggest that combining dysplasia grading with DNA ploidy status has clinical utility which could be used to develop novel management algorithms. [ABSTRACT FROM AUTHOR]

Aim: The optimal management strategy for patients with endoscopically resected malignant colorectal polyps (MCP) has yet to be defined. The aim of this study was to validate a published decision‐making tool, termed the Scottish Polyp Cancer Study (SPOCS) algorithm, on a large international population. Methods: The SPOCS algorithm allocates patients to risk groups based on just two variables: the polyp resection margin and the presence of lymphovascular invasion (LVI). The risk groups are termed low (clear margin, LVI absent), medium (clear margin, LVI present) or high (involved/non‐assessable margin). The International Polyp Cancer Collaborative was formed to validate the algorithm on data from Australia, Denmark, UK and New Zealand. Results: In total, 1423 patients were included in the final dataset. 680/1423 (47.8%) underwent surgical resection and 108/680 (15.9%) had residual disease (luminal disease 8.8%, lymph node metastases 8.8%). The SPOCS algorithm classified 602 patients as low risk (in which 1.5% had residual disease), 198 patients as medium risk (in which 7.1% had residual disease) and 484 as high risk (in which 14.5% had residual disease) (P < 0.001, χ2 test). Receiver operating characteristic curve analysis demonstrated good accuracy of the algorithm in predicting residual disease (area under the curve 0.732, 95% CI 0.687–0.778, P < 0.001). When patients were designated as low risk, the negative predictive value was 98.5%. Conclusion: The SPOCS algorithm can be used to predict the risk of residual disease in patients with endoscopically resected MCPs. Surgery can be safely avoided in patients who have a clear margin of excision and no evidence of LVI. This study, a collaboration between Scotland, Australia, New Zealand and Denmark aimed to define the optimal management strategy for patients with malignant colorectal polyps. The results confirmed the SPOCS algorithm (margin & LVI) can be used to accurately predict the risk of residual disease. [ABSTRACT FROM AUTHOR]

Prediction of the likely histopathological diagnosis of canine splenic masses can guide appropriate decision‐making. This study explores the predictive effect of breed and clinical presentation on the diagnosis of a canine splenic mass. Records from the Royal Veterinary College, United Kingdom (2007‐2017) were reviewed. Dogs with a histopathologic or cytologic diagnosis from a splenic mass, or imaging findings consistent with disseminated metastatic disease, were included. Signalment, physical examination, haematology results, imaging findings and pathology reports were recorded. Breeds were grouped according to several permutations of their phenotype and then by clustering of breeds based on single nucleotide polymorphism analysis. Binary logistic regression was performed to identify predictors of malignancy and haemangiosarcoma. Two hundred and eighty‐eight dogs were identified: 27% female and 63% male, 21% entire and 79% neutered; German Shepherd was the most common breed (11%). Median age was 10 years and median bodyweight 25 kg. Thirty‐eight percent of dogs presented with haemoabdomen; a splenic mass was found incidentally in 28%. Sixty percent had a malignant tumour of which haemangiosarcoma comprised 66%. On multivariable analysis, genotype‐based breed group (P =.004), haemoabdomen (P <.001) and neutrophil count (P =.025) predicted malignancy, and genotype‐based breed group (P <.001) and haemoabdomen (P <.001) predicted haemangiosarcoma. Genotype‐based breed group and occurrence of haemoabdomen may have predictive value to diagnose malignant splenic masses and more specifically haemangiosarcoma. The effect of genotype‐based breed grouping was a superior predictor of the diagnosis of a canine splenic mass lesion compared with all phenotype‐based groupings tested. [ABSTRACT FROM AUTHOR]

Background and purpose: Malignant middle cerebral artery infarction (MMI) is a severe complication of acute ischaemic stroke (AIS). The aim of our study was to assess whether successful reperfusion after endovascular therapy (EVT) in AIS with clinical and imaging predictors of MMI decreased its occurrence. Methods: Data were collected between January 2014 and July 2018 in a monocentric prospective AIS registry of patients treated with EVT. Patients selected were <65 years old with severe anterior circulation AIS with a National Institutes of Health Stroke Scale score >15, baseline Diffusion‐Weighted Imaging‐Alberta Stroke Program Early Computed Tomography Score ≤ 6 and baseline diffusion‐weighted imaging lesion volume >82 mL within 6 h of symptom onset. Successful reperfusion was defined as a Thrombolysis in Cerebral Ischemia score ≥ 2b. Occurrence of MMI was the primary endpoint. Results: A total of 66 EVT‐treated patients were included in our study. MMI occurred in 27 patients (41%). In unadjusted analysis, successful reperfusion was associated with fewer MMIs (31.8% vs. 65.0%; P = 0.015) and with more favorable outcome at 3 months (50% vs. 20%; P = 0.023). In multivariate analysis, successful reperfusion was associated with an adjusted odds ratio (95% confidence intervals) of 0.35 (0.10–1.12) for MMI and 2.77 (0.84–10.43) for 3‐month favorable outcome occurrence. Conclusions: Early successful reperfusion performed in patients with AIS with clinical and imaging predictors of MMI was associated with decreased MMI occurrence. Reperfusion status might be considered in evaluating the need for craniectomy in patients with early predictors of MMI. [ABSTRACT FROM AUTHOR]

Background: The management of ground‐glass opacities (GGOs) depends mainly on personal experience. In clinical practice, benign GGOs are not rare in resected specimens, for which operations may be avoided. We retrospectively compared the clinical features of resected GGOs to identify differential diagnostic characteristics. Methods: Among 1456 patients with suspected malignant GGOs who underwent surgical resection, 105 patients (35 with benign GGOs and 70 matched controls with malignant GGOs) were included. Clinical characteristics, including demographics and radiologic, surgical and pathologic characteristics, were collected. Results: The smoking index (P = 0.044), frequency of coughing (P = 0.026), GGO size (P = 0.003), size change during follow‐up (P = 0.011), location (P = 0.022), presence of air bronchogram sign (P = 0.004), distance to the pleura (P = 0.021) and positron emission tomography/computed tomography (PET/CT) appearance (P = 0.003) showed significant differences between the benign and malignant groups. Pathologically, the resected benign GGOs included focal fibrosis (17), inflammation or infection (seven), lymphoproliferative disorder (one), hamartoma (three), inflammatory myofibroblastic tumor (two), hemangioma or vascular malformation (two), endometriosis (two) and pulmonary cyst (one). Conclusions: A higher smoking index, coughing, larger size, similar or increased size during follow‐up, location in the upper and middle lobes, air bronchogram sign on CT, lesion margin to pleura distance over 1 cm, and malignant tendency on PET/CT reports were associated with malignant GGOs. Relatively active surgical interventions could be considered for GGOs highly suspected of malignancy. [ABSTRACT FROM AUTHOR]

In this paper, we discuss a unique manifestation of malignant pheochromocytoma, which presented with ocular pain. The histopathological study pointed to a possible pheochromocytoma origin. Subsequently, the patient underwent thorough imaging and paraclinical evaluations, which confirmed the diagnosis of pheochromocytoma. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to integrate the available data published on radiation‐induced sarcoma of the oral cavity into an analysis of its clinical features, treatment modalities and prognostic factors. Methods: An electronic search was undertaken in September 2019. The eligibility criteria included publications that had enough clinical and histological information to confirm the diagnosis. Results: Forty‐two publications with 122 radiation‐induced sarcoma of the oral cavities (RISOCs) were included. The mean latency period was 114 months and mean radiation total dose was 62.5 Gy. The tumors were more prevalent in males between 50 and 60 years old and the mandible was the most affected site. Osteosarcoma was the most prevalent histological type and patients were mostly treated with radical surgery. Conclusions: RISOC showed a poor survival rate of 15.1% in 5‐year follow‐up. Gender and histological type were independently associated with survival. [ABSTRACT FROM AUTHOR]

Importance: Cancer is the main cause of death by disease in children. Children experience the highest incidence of cancer in the first year of life. However, there is no comprehensive registration system for children with tumors in China. Objective: To summarize the diagnosis and treatment of infant cancer and analyze the status of standardized diagnosis and management among several treatment centers in Beijing, China, thereby providing evidence to guide further clinical research. Methods: From January 1, 2010 to December 31, 2019, patients with newly diagnosed infantile malignant solid tumors were admitted to six large tertiary pediatric solid tumor diagnosis and treatment centers in Beijing. The epidemiology, clinical features, and therapeutic effects of tumors in these patients were analyzed retrospectively. All patients were followed up until March 31, 2020. Results: In total, 938 patients were enrolled in this study. There were 530 boys (56.5%) and 408 girls (43.5%); the median age was 6.0 months (range, 0–12.0 months). The three most common tumors were retinoblastoma in 366 patients (39.0%), neuroblastoma in 266 patients (28.4%), hepatoblastoma in 133 patients (14.2%), and central nervous system tumors in 52 patients (5.5%). The estimated 5‐year overall survival rate was 81.3% ± 1.8%, and the 5‐year event‐free survival rate was 71.8% ± 2.9%. The 5‐year overall survival rates of non‐rhabdomyosarcoma soft tissue sarcoma, neuroblastoma, and retinoblastoma were 100%, 88% ± 2.2%, and 86.9% ±2.1%, respectively. The 5‐year event‐free survival rates were 81.1% ± 2.7% for neuroblastoma, 81.6% ± 9.8% for non‐rhabdomyosarcoma soft tissue sarcoma, and 72.7% ± 14.1% for extracranial malignant germ cell tumors. Interpretation: The three most common infantile malignant solid tumors were retinoblastoma, neuroblastoma, and hepatoblastoma. Multidisciplinary combined diagnosis and treatment is needed for infantile tumors. [ABSTRACT FROM AUTHOR]

The classification of the distinct group of mesenchymal neoplasms, first described as 'Xp11 translocation perivascular epithelioid cell tumor (PEComa)' and for which the term 'melanotic Xp11 neoplasm' or 'Xp11 neoplasm with melanocytic differentiation' has recently been proposed, remains challenging and controversial. We collected 27 melanotic Xp11 neoplasms, the largest series to date, for a comprehensive evaluation. Fourteen of the cases, together with eight alveolar soft part sarcomas (ASPS), nine conventional PEComas and a control group of seven normal tissues were submitted to RNA sequencing. Follow‐up available in 22 patients showed 5‐year overall survival and 5‐year disease‐free survival of 47.6 and 35.7%, respectively, which were similar to ASPS and significantly worse than conventional PEComa. Univariate analysis of location (occurring in the kidney versus not kidney), infiltrative growth pattern, nuclear pleomorphism, mitotic activity ≥2/50 high‐power fields (HPF), necrosis and lymphovascular invasion were found to be associated with overall survival and/or disease‐free survival. Multivariate analysis identified that location was the only factor found to independently correlate with disease‐free survival. More importantly, RNA sequencing‐based clustering analysis segregated melanotic Xp11 neoplasm and ASPS from other tumors, including conventional PEComa and Xp11 translocation renal cell carcinoma, and formed a compact cluster representative of the largely similar expression signature. Here we clearly define the true biologic nature of melanotic Xp11 neoplasms which are distinctive malignant mesenchymal tumors, rather than simply PEComa variants with occasionally unpredictable behavior. Meanwhile, melanotic Xp11 neoplasm and ASPS more likely represent phenotypic variants of the same entity, which is distinct from conventional PEComa and Xp11 translocation renal cell carcinoma. Based on these important findings, melanotic Xp11 neoplasm might be reclassified into a distinctive entity together with ASPS, independent from PEComa, in future revisions of the current WHO categories of tumors of soft tissue and bone for the improved reclassification. © 2020 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background/Objectives: Malignant rhabdoid tumors (MRT) are highly aggressive tumors with a predilection for the kidney, central nervous system, and soft tissues that usually affect young children under three years of age. Primary presentation in the skin is rarely reported, and features of the cutaneous manifestations are not well described. We report six cases of metastatic MRT that first manifested with congenital nodules and masses in the skin. Methods: Retrospective case series. Results: The cutaneous presentation of MRT may be heterogeneous and can present with solitary or multifocal skin lesions. Congenital polypoidal and papillomatous plaques, including those with histologic features of neurovascular hamartoma, appear to be a unique presentation of MRT in the infant. Conclusions: Malignant rhabdoid tumor should be considered in the differential diagnosis of unusual skin tumors in neonates and infants. [ABSTRACT FROM AUTHOR]

In this study, abnormalities in medical images are analysed using three classifiers, and the results are compared. Breast cancer remains a major public health problem among women worldwide. Recently, many algorithms have evolved for the investigation of breast cancer diagnosis through medical imaging. A computer‐aided microcalcification detection method is proposed to categorise the nature of breast cancer as either benign or malignant from input mammogram images. The standard mammogram image corpus, the Mammogram Image Analysis Society database is utilised, and feature extraction is performed using five different wavelet families at level 4 and level 6 decomposition. The work is accomplished through firefly algorithm (FA), extreme learning machine (ELM) and least‐square‐based non‐linear regression (LSNLR) classifiers. The performance of the classifiers is compared by benchmark metrics, such as total error rate, specificity, sensitivity, area under the receiver operating characteristic curve, precision, F1 score and the Matthews correlation coefficient. As validation of the classifier results, a kappa analysis is included to determine the agreement among classifiers. The LSNLR classifier attains a 3% to 7% improvement in average accuracy compared with the average classification accuracy of the FA (86.75%) and ELM (90.836%) classifiers. [ABSTRACT FROM AUTHOR]

Background and objective: Analysis of programmed death ligand‐1 (PD‐L1) in tumour samples is necessary to identify candidates for anti‐PD‐L1/PD‐L1 therapy. Because PD‐L1 is evaluated by immunohistochemistry (IHC), an adequate amount of tumour tissue is a prerequisite for PD‐L1 testing. To examine whether pleural fluid might be an alternative to biopsy/resection specimens for IHC evaluation of PD‐L1 in patients with non‐small cell lung carcinoma (NSCLC), we compared PD‐L1 by IHC between histological specimens and matched pleural fluid. Methods: A retrospective cohort study of patients with NSCLC who underwent core biopsy of a lung mass/surgical resection with PD‐L1 IHC and had a pleural fluid cell block (CB) available for PD‐L1 staining was conducted. PD‐L1 was categorized as negative (PD‐L1 in <1% of tumour cells), moderately positive (PD‐L1 in ≥1% to <50%), strongly positive (PD‐L1 ≥ 50) or inadequate for PD‐L1 testing (<100 tumour cells in the CB). Weighted Cohen's kappa was calculated to evaluate the agreement between PD‐L1 on biopsy/resection specimen and pleural fluid for variables with more than two categories. Results: Of the 115 patients included in this study, 82 (71.3%) had at least 100 tumour cells and were included in the analysis. Of these, 80 (97.6%) had adenocarcinoma. For PD‐L1 of histological specimens versus pleural fluid categorized as negative, moderately positive or strongly positive, the weighted kappa statistic was 0.76 (95% CI: 0.64–0.88), and the concordance was 0.78 (95% CI: 0.68–0.86). Conclusion: Correlation and concordance are high between PD‐L1 in histological specimens and matched pleural fluid. Evaluation of PD‐L1 in pleural fluid should be considered in patients unable to undergo histological biopsies. Programmed death ligand‐1 (PD‐L1) expression in pleural fluid is reliable with fairly good correlation and concordance with PD‐L1 expression in surgical biopsy/resection specimens and should be considered in patients who are unable to undergo histological biopsies. [ABSTRACT FROM AUTHOR]

Objective: To determine the accurate age‐adjusted incidence of prostate small cell carcinoma (SCC), update the clinical and pathological characteristics, as well as survival data of prostate SCC from Surveillance, Epidemiology, and End Results (SEER) datasets. Methods: A total of 260 patients with prostate SCC were selected from the SEER database of the National Cancer Institute between 2004 and 2015. Age‐adjusted incidence (AAI) rates, the observed and relative survival rates were evaluated over time by the SEER*Stat Software version 8.3.5. Overall survival (OS) rates that stratified by summary stage and treatment effects were evaluated by Kaplan‐Meier method. The significant differences were assessed in a log‐rank test. Univariate and multivariate cox hazard regression analysis were performed to determine independent predictors of OS. Results: The incidence of prostate SCC has increased over time. The average age of prostate SCC patients was 70.25 years. More than 90% of tumors were poorly differentiated or undifferentiated. The majority of prostate SCC (77.7%) was at stage IV. 49% of patients had lymph node metastases and 68% of patients presented distant metastases (Compared with 60.5% of patients with distant metastases between 1973‐2003). Interestingly only 23.5% patients had high level PSA (>10 ng/mL). 58.8% of patients underwent chemotherapy, 25.4% of patients were treated by surgery, and 31.9% of patients were treated by radiotherapy. The observed survival rates of 1‐year, 2‐year, and 5‐year were 42.1%, 22.1%, and 12.5%, respectively (Compared with 47.9%, 27.5%, and 14.3%, respectively, between 1973 and 2003). Chemotherapy prolonged the OS of patients with regional (distant) metastases from 3 months (2 months) to 12 months (9 months). Multivariate cox regression analysis showed age, race, and stage were independent prognostic factors for prostate SCC patients. Conclusion: Prostate SCC is a highly malignant cancer and our analysis of recent data has shown its incidence is increasing. Incidence rate of metastatic prostate SCC has increased and the survival rates have worsened in recent years. However, chemotherapy shows some survival benefit for prostate SCC patients with regional and distant metastasis over other treatment methods. Further work is needed to understand the reason prognosis of this type prostate cancer is worsening. [ABSTRACT FROM AUTHOR]

Systemic diseases can manifest in many ways and subtle clues to these processes can often declare themselves in the maxillofacial region. This report highlights one usual and rare presentation of such case. A 64- year-old woman, presented to her general practitioner with worsening right-sided jaw pain and trismus. She was referred to the local maxillofacial services and her mouth opening was measured at 1cm at presentation. An orthopantomogram (OPG) taken was unremarkable. She underwent an MRI of the head and neck that showed a soft tissue mass invading the right lateral and medial pterygoid muscles and plate with involvement of the ramus of the mandible. A staging CT was performed that revealed a mass of the proximal sigmoid colon. A colonoscopy performed with biopsy revealed a poorly differentiated squamous cell carcinoma with extensive metastasis, including the right masticatory space. She was presented at the multi-disciplinary meeting where it was decided to treat her palliatively and she died 6 weeks after her diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: High‐fluorescent cells (HFCs) that are detected with an automated hematology analyzer may be useful for the detection of tumor cells; however, the diagnostic ability of HFCs for differentiating malignant pleural effusion is limited. The aim of this study was to investigate the diagnostic value of the combined detection of HFCs with the tumor marker carcinoembryonic antigen (CEA) for the identification of malignant hydrothorax. Methods: A total of 115 pleural effusions were collected. HFCs, including the relative counts (HF‐BF%) and absolute counts (HF‐BF#), were analyzed using the BF mode of a Sysmex XN9000 hematology analyzer. Simultaneously, the CEA level from the same patient was measured by an electrochemiluminescence method. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic accuracy of HFCs separately or combined with CEA analysis for malignant diseases. Results: The levels of HF‐BF#, HF‐BF%, and CEA in the malignant effusion group were significantly higher than those in the benign control group. The diagnostic value of the HF‐BF# and HF‐BF% for malignant pleural effusion was low to moderate, and the area under the curve (AUC) was 0.663 and 0.715, respectively. The CEA detection showed a moderate diagnostic ability, and the AUC was 0.832. The AUC for the combined methods was 0.860 and 0.890, respectively. The cutoff levels of the HF‐BF#, HF‐BF%, and CEA levels were 29.5 × 106/L, 5.6/100 WBC, and 4.795 ng/mL, respectively. Conclusions: The combined detection of high‐fluorescent cells with the BF mode and CEA testing may be a good indication for malignancy. [ABSTRACT FROM AUTHOR]

Background: Metastatic paragangliomas are rare neuroendocrine tumors. Bony metastases most commonly occur in the ribs, vertebrae, and pelvis. Few cases of mandibular metastases have been reported. Methods: A 75‐year‐old female presented with a 6‐month history of an enlarging mandibular mass. A biopsy was consistent with a paraganglioma. Results: Staging workup with 18F‐fluorodeoxyglucose positron emission tomography demonstrated 2 hypermetabolic intra‐abdominal lesions adjacent to the inferior vena cava. These were confirmed as paraganglioma by biopsy and presumed as the primary lesions. The patient underwent left segmental mandibulectomy and neck dissection with osteocutaneous fibula free tissue reconstruction. Conclusion: A rare case of malignant paraganglioma presenting as a mandibular metastasis is described. Nuclear medicine studies for paraganglioma are reviewed. [ABSTRACT FROM AUTHOR]

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6‐tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fine‐needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs. Methods: Submandibular gland FNA cytology specimens from 15 international institutions (2013‐2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow‐up was performed, and the ROM was calculated for each MSRSGC diagnostic category. Results: The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%‐50%); nonneoplastic, 24.2% (9.1%‐53.6%); AUS, 6.7% (0%‐14.3%); benign neoplasm, 18.3% (0%‐52.5%); SUMP, 12% (0%‐37.7%); SM, 3.5% (0%‐12.5%); and malignant, 13.9% (2%‐31.3%). The histopathologic follow‐up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. Conclusions: This multi‐institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA. In this retrospective, international, multi‐institutional study, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been applied to a cohort of 734 submandibular fine‐needle aspirates, and the risk of malignancy (ROM) has been calculated for each diagnostic category. The aspirates have been reclassified as follows: nondiagnostic, 21.4% (0%‐50%); nonneoplastic, 24.2% (9.1%‐53.6%); atypia of undetermined significance (AUS), 6.7% (0%‐14.3%); benign neoplasm, 18.3% (0%‐52.5%); salivary gland neoplasm of uncertain malignant potential (SUMP), 12% (0%‐37.7%); suspicious for malignancy (SM), 3.5% (0%‐12.5%); and malignant, 13.9% (2%‐31.3%). The histopathologic follow‐up is available for 333 cases (45.4%). The ROMs are as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. This study confirms that the MSRSGC can be reliably applied in reporting submandibular gland fine‐needle aspiration. [ABSTRACT FROM AUTHOR]

Accessory pathway (AP) ablation failure may be related to multiple pathways which go unrecognized at the time of electrophysiology study. We present a patient who had two adjacent APs based on different preexcitation patterns as well as effective refractory periods (ERPs) which have not been previously described. Apart from leading to recurrent supraventricular tachycardia (SVT), multiple pathways are important to recognize as they more frequently predispose to malignant atrial arrhythmias. [ABSTRACT FROM AUTHOR]

In a few areas, these small epithelial cells displayed an abrupt transition to larger polygonal cells with abundant eosinophilic cytoplasm that were surrounding aggregates of keratinized luminal ghost cells. GLO:50IQ/01dec19:vcp12785-fig-0001.jpg PHOTO (COLOR): Photomicrographs of a smear prepared from a fine-needle aspirate of a lytic bone lesion in the distal ulna in a dog. B, The lytic bone lesion was composed of a similar population of polygonal epithelial cells with central areas of keratinization and ghost cell formation gl. [Extracted from the article]

ABSTRACT: Abnormal growth of cells in brain leads to the formation of tumors, which are categorized into benign and malignant. In this article, Co‐Active Adaptive Neuro Fuzzy Inference System (CANFIS) classification based brain tumor detection and its grading system is proposed. It has two phases as brain tumor segmentation and brain tissue segmentation. In brain tumor segmentation, CANFIS classifier is used to classify the test brain image into benign or malignant. Then, morphological operations are applied over the malignant image in order to segment the tumor regions in brain image. The K‐means classifier is used to classify the brain tissues into Grey Matter (GM), White Matter (WM) and Cerebro Spinal Fluid (CSF) regions as three different classes. Next, the segmented tumor is graded as mild, moderate or severe based on the presence of segmented tumor region in brain tissues. [ABSTRACT FROM AUTHOR]

Abstract: Background: Sorafenib has shown survival benefits in patients with advanced HCC; however, limited data are available on its role in OLT recipients with advanced HCC in the explant. Aim: Evaluate the role of preemptive sorafenib therapy on HCC recurrence and survival after OLT with advanced HCC on explant pathology. Methods: We retrospectively reviewed the outcome after OLT of all HCC recipients with advanced HCC in the explant pathology from 04/2006 to 12/2012 based on preemptive treatment with sorafenib. Results: During the observation period, 217 HCC recipients underwent OLT; 50 explants revealed advanced HCC. After exclusion of 5 patients who were lost to follow‐up, 45 LT recipients were finally included for analysis. Recipients were grouped as sorafenib Gr (N = 25) and nonsorafenib Gr (N = 20). Both recurrence‐free survival (RFS) (P = .67) and overall survival were similar between groups (P = .53) on Kaplan‐Meier analysis. Additionally, sorafenib use was neither associated with HCC recurrence‐free survival (HR 0.74, 95% CI [0.32‐1.70]; P = .48) nor overall survival (HR 0.92, 95% CI [0.39‐2.15], P = .84) on multivariate Cox proportional hazard model with sorafenib use as time‐varying covariates. Conclusion: Preemptive treatment with sorafenib in OLT recipients with high‐risk features in explant does not improve HCC recurrence‐free or overall survival. [ABSTRACT FROM AUTHOR]