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Mucinous carcinoma is a rare histologic type of breast cancer that, when classified with favorable histology, can be treated with different therapeutic options. This study reviews the histologic findings of mucinous carcinoma that support or exclude favorable histology and emphasizes the necessity of an appropriate gross examination with radiologic findings for an accurate diagnosis. In addition, unusual findings such as micropapillary arrangements and lobular differentiation in mucinous carcinoma and their implications for prognosis and treatment are reviewed. Mucinous carcinoma involves upregulation of MUC2, a mucus-associated gene common in mucinous carcinoma of the breast as well as various other organs. In mucinous carcinoma, the fraction of genome altered and tumor mutation burden are lower than those of invasive carcinoma of no special type, the most common histology of breast cancer. In addition, the genetic alterations found in mucinous carcinoma are diverse, unlike the pathognomonic genetic alterations observed in other histologic types of breast cancer. These genetic features support the importance of conventional microscopic evaluations for the pathologic differential diagnosis of mucinous carcinoma of the breast in routine practice. A variety of breast lesions, including mucinous cystadenocarcinoma and mucocele-like lesions, as well as mucinous carcinoma from other organs, can mimic mucinous carcinoma of the breast. In order to obtain an accurate pathologic diagnosis, careful evaluation of the overall histopathologic characteristics and ancillary testing are required to provide information on appropriate treatment and prognosis.

Context.--Nonalcoholic fatty liver disease (NAFLD) encompasses steatosis and steatohepatitis. The cause may be multifactorial, and diagnosis requires correlation with clinical information and laboratory results. Objective.--To provide an overview of the status of histology diagnosis of steatosis, steatohepatitis, and associated conditions. Data Sources.--A literature search was performed using the PubMed search engine. The terms 'steatosis,' 'steatohepatitis,' 'nonalcoholic fatty liver disease (NAFLD),' 'nonalcoholic steatohepatitis (NASH),' 'alcoholic steatohepatitis (ASH),' 'type 2 diabetes (T2DM),' 'cryptogenic cirrhosis,' 'drug-induced liver injury (DILI),' 'immune checkpoint inhibitor therapy,' and 'COVID-19 and liver' were used. Conclusions.--Nonalcoholic fatty liver disease has become the most common chronic liver disease in the United States. NASH is the progressive form of nonalcoholic fatty liver disease. The hallmarks of steatohepatitis are steatosis, ballooned hepatocytes, and lobular inflammation. NASH and alcoholic steatohepatitis share similar histologic features, but some subtle differences may help their distinction. NASH is commonly seen in patients with metabolic dysfunction but can also be caused by other etiologies. Examples are medications including newly developed immune checkpoint inhibitors and viral infections such as coronavirus disease 2019 (COVID-19). NASH is also a common cause of cryptogenic cirrhosis but can be reversed. The results from recent clinical trials for NASH treatment are promising in reducing the severity of steatosis, ballooning, and fibrosis. (Arch Pathol Lab Med. 2022;146:940-946; doi: 10.5858/arpa.2021-0339-RA), Recent epidemiologic studies have shown that nonalcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in the US, with an estimated prevalence of 34% in the [...]

Introduction Familial Mediterranean fever (FMF) is the most common hereditary autoinflammatory disease with an increased risk for secondary amyloidosis. Since lifelong colchicine has been the treatment of choice that prevents renal amyloidosis, non-amyloid kidney diseases are more frequently considered in the differential diagnosis of proteinuria. Nutcracker syndrome (NCS) can be one of the confounding causes. This long-term retrospective study aimed to evaluate the causes of proteinuria in a pediatric cohort of patients with FMF and discuss changing trends in recent years. Methods Demographic, clinic, and laboratory data were extracted from electronic medical records of patients with FMF. All urine tests of the study population were reviewed. Patients were evaluated for persistent proteinuria and grouped according to the etiology of proteinuria. Results A total of 576 patients with FMF were identified with a mean follow-up of 6.3 years in the last 10 years; 8% had persistent proteinuria. The etiology was NCS in 67.5% of the patients with proteinuria, and renal amyloidosis was less commonly encountered (15%) without any new diagnosis for the last 8 years. Non-amyloid kidney diseases were also diagnosed in 17.5% of the patients. Patients with NCS had significantly lower BMI than other patients in the cohort and less subclinical inflammation, higher hemoglobin concentration, and milder levels of proteinuria with normal serum albumin and eGFR than other patients with proteinuria. Conclusion Nutcracker syndrome is the leading cause of proteinuria in children with FMF nowadays, and it should be kept in mind during the evaluation of proteinuria in these patients. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information., Author(s): Pinar Ozge Avar-Aydin [sup.1] , Zeynep Birsin Ozcakar [sup.1] , Nilgun Cakar [sup.1] , Suat Fitoz [sup.2] , Hatice Dilara Karakas [sup.1] , Fatos Yalcinkaya [sup.1] Author Affiliations: (1) [...]

Hyponatremia, especially if acute and severe, can be a life-threatening condition. Several conditions can trigger hyponatremia. In this review, we will discuss two conditions that can determine euvolemic hyponatremia: the cerebral/renal salt wasting (CRSW) syndrome and the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), including the two subtypes: reset osmostat (RO) and nephrogenic syndrome of inappropriate antidiuresis (NSIAD) and their differential diagnoses. Despite the passage of over 70 years since its first description, to date, the true etiopathogenesis of CRSW syndrome, a rare cause of hypovolemic/euvolemic hyponatremia, is almost unknown. SIADH, including RO and NSIAD, is sometimes difficult to differentiate from CRSW syndrome; in its differential diagnosis, the clinical approach based on the evaluation of the extracellular volume (ECV) was proven insufficient. We therefore suggest a simple diagnostic algorithm based on the assessment of the degree of hyponatremia, urinary osmolality, and the assessment of the fraction of urate excretion (FEUa) in conditions of hyponatremia and after serum sodium correction, to be applied in children over 1 year of life., Author(s): Flaminia Bardanzellu [sup.1] , Maria Antonietta Marcialis [sup.1] , Roberta Frassetto [sup.1] , Alice Melis [sup.1] , Vassilios Fanos [sup.1] Author Affiliations: (1) grid.7763.5, 0000 0004 1755 3242, Neonatal [...]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare 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.)

Introduction. Leiomyoma is a mesenchymal benign tumor that seldom manifests in the kidney. Typically, these tumors are small, asymptomatic, and often detected accidentally. Differentiating leiomyomas radiologically from other renal neoplasms, particularly renal cell carcinomas, poses a considerable challenge before surgical intervention. Moreover, the conclusive diagnosis of leiomyomas can only be established through histopathological and immunohistochemical evaluation following surgical intervention. Case Report. We present a case of a 44-year-old woman who was diagnosed with right kidney leiomyoma accidentally during a computed tomography examination following exploratory curettage by a gynecologist. An enhanced computed tomography scan revealed a 10 mm tumor located on the upper pole of the right kidney, extending beyond its boundaries. The imaging differential diagnosis was renal cell carcinoma of the right kidney. A laparoscopic partial nephrectomy was performed. Macroscopically, the tumor appeared subcapsular, well-defined, with a firm consistency and a tan-white whorled cut surface. The histological characteristics and the supporting immunohistochemical profile confirmed the diagnosis of renal leiomyoma. The postoperative course was uneventful, and the patient was discharged on the 3rd postoperative day. Conclusion. Leiomyomas are rare kidney tumors. A conclusive diagnosis is established through histopathological findings. The pre-operative differentiation of leiomyomas radiologically from other renal neoplasms, particularly renal cell carcinomas, poses a considerable challenge in radiological assessment. [ABSTRACT FROM AUTHOR]

China has the considerable disease burden of cervical cancer, with the mortality and morbidity of cervical cancer showing an increasing and younger trend. Facing to the critical situation of cervical cancer control, it is urgent to explore the new methods that suitable for different resource areas for the early detection and treatment of cervical cancer. Recently, great progress has been made in the field of AI image classification, and scientists have developed many algorithms to identify cervical lesions and conducted corresponding studies on their accuracy. Here, by reviewing the papers published at home and aboard, which studied the applications value of AI in cervical cytology screening, colposcopy examination, diagnosis and treatment of cervical cancer, we summarized and discussed the current progress and challenges for AI's application in the area of cervical cancer control, in order to provide solid evidence for the future use of AI in improving human health.

Macrodystrophia lipomatosa (MDL) is a rare congenital disorder characterized by localized gigantism of one or several digits. It may involve the entire limb due to progressive overgrowth of all mesenchymal elements with an excessive increase in the fibro-adipose tissues. It occurs most commonly in the lower limbs. It comes to clinical attention for cosmetic reasons, mechanical problems secondary to degenerative joint disease, or the development of neurovascular compression. We report a case of MDL of the right foot with difficulty walking and wearing footwear. With a complete radio-clinical workup and history review, a provisional diagnosis of MDL was made, confirmed by histopathology and during surgery. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Background: The differential diagnosis of intrahepatic cholangiocarcinomas (iCCAs) from metastatic adenocarcinomas from organs adjacent to the liver (gallbladder, pancreas, and stomach) is difficult due to histopathological similarity and a lack of specific markers. This study aimed to develop a method to differentiate iCCA and adenocarcinomas originated from extrahepatic organs adjacent to the liver. Methods: We retrospectively enrolled surgically resected iCCA (n = 181) and adenocarcinomas from extrahepatic organs (n = 30, n = 28, and n = 38 from gallbladder, pancreas, and stomach, respectively) between 2007 and 2013. The albumin mRNA in situ hybridization (ISH) and immunohistochemistry (IHC) of filamin-A and cytokeratin 19 (CK19) were performed using tissue microarray. Using logistic regression analysis of three markers, iCCA-score was developed, and its diagnostic performance was evaluated. Results: The iCCAs were more frequently positive for albumin ISH (23.2% vs. 0%), filamin-A IHC (47.5% vs. 12.5%) and CK19 (68.5% vs. 40.6%) than extrahepatic adenocarcinomas (p < 0.001 for all). The iCCA-score consisting of these three markers was developed, and it showed higher diagnostic performance (area under the curve [AUC], 0.798 vs. 0.616, p < 0.001). Taking an iCCA-score of 2 or higher as the threshold for iCCA, the sensitivity was substantially higher than albumin ISH alone (45.9% and 23.2%, respectively; p < 0.001), but maintained high specificity (94.8% and 100%, respectively). Conclusion: Albumin ISH and IHC staining for filamin-A and CK19 showed distinct expression patterns between iCCA and extrahepatic adenocarcinomas from gallbladder, pancreas, and stomach. We developed iCCA-score that consisted of those three markers, and it showed better diagnostic performance than albumin ISH alone. [ABSTRACT FROM AUTHOR]

ß-thalassemia is a genetic disease characterized by the decrease or absence of the production of ß hemoglobin chains, which can be heterozygous, presenting asymptomatically or with mild microcytic and hypochromic anemia; or homozygous, with severe hemolytic anemia, leading to musculoskeletal and developmental disorders. The aim of the present study was to analyze the Mentzer Index as an adjuvant in the diagnosis of the thalassemia trait of beta-thalassemia, given that, in its homozygous form, beta thalassemia has a clinical setting that is distinct from iron deficiency anemia or even from the beta-thalassemia trait, culminating in a hemolytic anemia with symptoms of excessive hemolysis leading to splenomegaly, anemia with significant hemoglobin deficiency, bone marrow hyperplasia and, in some cases, imminent need for blood transfusion. This is an integrative review of the Mentzer index. A bibliographic review was carried out in the electronic databases PUBMED, SciELO and Periódicos CAPES between 2016 and 2021. 12 manuscripts to be reviewed were incorporated in the present study, which needed to relate the Mentzer index to the differentiation of beta-thalassemia trait from anemia ferropenic. After reading and analyzing the articles related to this study, it was shown that the Mentzer index can be recommended for differentiating between the two pathologies with good sensitivity and specificity for the trait related to beta-thalassemia, however, in case of doubts between anemia iron deficiency and beta-thalassemia, a study with hemoglobin electrophoresis should be performed. Therefore, it is concluded that in the absence of the possibility of carrying out hemoglobin electrophoresis or hemoglobin analysis by HPLC, the Mentzer index can be used to differentiate between iron deficiency anemia and the respective beta-thalassemia trait and start treatment, however, it is necessary to point out that in the absence of response to therapy, hemoglobin electrophoresis or hemoglobin analysis by HPLC becomes an indispensable test. [ABSTRACT FROM AUTHOR]

In clinical practice, the distinction between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) can be challenging, leaving patients with "ambiguous" diabetes type. Insulin-treated patients (n=115) previously diagnosed with T2DM had to be re-classified based on clinical phenotype and laboratory results, and were operationally defined as having an ambiguous diabetes type. They were compared against patients with definite T1DM and T2DM regarding 12 clinical and laboratory features typically different between diabetes types. Characteristics of patients with ambiguous diabetes type, representing approximately 6% of all patients with T1DM or T2DM seen at our specialized clinic, fell in between those of patients with definite T1DM and T2DM, both regarding individual features and with respect to a novel classification based on multi-variable regression analysis (P<0.0001). In conclusion, a substantial proportion of diabetes patients in a tertiary care centre presented with an "ambiguous" diabetes type. Their clinical characteristics fall in between those of definite T1DM or T2DM patients. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Gastroenterología del Perú is the property of Sociedad de Gastroenterologia del Peru 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.)

We present the case of a 60-year-old man with a history of severe tophaceous gout with polyarticular involvement who came to the emergency room due to direct trauma to the right forearm and knee. The knee X-ray and CT scan showed a lateral tibial plateau fracture characterized by the presence of a lytic bone lesion. The presence of a solid neoplasm was ruled out and a CT-guided biopsy was performed. Histological evaluation revealed findings typical for an advanced intraosseous gout. As there was no significant risk of progression of the lytic lesion, the fracture site was treated conservatively. This case is unique in the literature in terms of location and should be considered as an atypical site of intraosseous gout. Proper differentiation of a pathological fracture on an intraosseous gout location from a neoplastic lesion is essential to choose the correct therapy.

BackgroundThe 2020 Chinese guidelines for ultrasound malignancy risk stratification of thyroid nodules: the C-TIRADS (C-TIRADS for short) put forward a method for stratifying the malignancy risk of thyroid nodules, but there are few studies about its value in differentiating benign and malignant thyroid nodules.ObjectiveTo compare the value of ultrasound-based thyroid nodule malignancy risk stratification in differentiating malignant and benign thyroid nodule between C-TIRADS and 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: the American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer (ATA guidelines for short) .MethodsA total of 336 inpatients who underwent surgery and ultrasound examination in Bozhou People's Hospital from January 2019 to May 2021 were selected as participants. Four ultrasonologists with a title higher than attending physician were equally randomized into groups A and B for evaluating ultrasonic examination results according to ultrasound-based thyroid nodule malignancy risk stratification in C-TIRADS and ATA guidelines, respectively. The accuracies of ultrasound-based thyroid nodule malignancy stratification in the two guidelines in differentiating malignant and benign thyroid nodules were assessed using intraoperative or postoperative pathological findings (gold standard for diagnosis) , and were further analyzed using ROC analysis.ResultsAccording to intraoperative or postoperative pathological findings, the participants had 367 thyroid nodules in total, including 253 benign nodules and 114 malignant nodules. The nodules were classified as follows according to the TI-RADS in the C-TIRADS by ultrasonologists in group A: (1) 253 benign nodules: 2 were in TI-RADS 5 category, 23, 30, and 80 were in categories 4c, 4b, and 4a, respectively, 103 were in 3 category, and 15 were in 2 category; (2) 114 malignant nodules: 24 were in TI-RADS 5 category, 59 were in 4c category, 22 were in 4b category, 6 were in 4a category and 3 were in 3 category. And the classification of nodules according to the ATA guideline by ultrasonologists in group B was: (1) 253 benign nodules: 13, 53, 47, 118 were high, intermediate, low, and very low suspicion pattern for malignancy, respectively, and 22 were benign pattern; (2) 114 malignant nodules: 76, 24, 8, 6 were high, intermediate, low, and very low suspicion pattern for malignancy, respectively. ROC analysis showed that, AUCs of ultrasound-based thyroid nodule malignancy risk stratification in differentiating malignant and benign thyroid nodules between C-TIRADS and ATA guidelines were 0.890〔95%CI (0.815, 0.918) 〕and 0.780〔95%CI (0.750, 0.876) 〕, with significant difference (Z=13.62, P

BackgroundThe treatment scheme for papillary thyroid carcinoma (PTC) patients is related to whether lymph node metastasis is prevalent or not. The routine ultrasound indicator used alone has proven to have a low sensitivity to predict the presence of lymph node metastasis in PTC.ObjectiveTo explore the value of combined use of ultrasonographic indicators in predicting central lymph node metastasis in PTC.MethodsClinical data of PTC patients (n=446) with thyroid surgery and central neck dissection were collected retrospectively from the First Affiliated Hospital of Shihezi University School of Medicine from March 2013 to May 2020, involving sex, age, and ultrasonographic features 〔diameter of nodule, number of nodules, location of single and multiple nodules, internal composition, internal echo, boundary, margin, micro calcification, anteroposterior and transverse diameter (A/T) ratio, posterior echo attenuation, capsular invasion〕. Postoperative pathological results confirmed that 159 cases (35.65%) with central lymph node metastasis and other 287 (64.35%) without. Unconditional stepwise binary Logistic regression was used to explore the factors associated with central lymph node metastasis. Receiver operating characteristic (ROC) analysis was performed to estimate the predictive value of each indicator for central lymph node metastasis.ResultsPatients with and without central lymph node metastasis had significant differences in sex ratio, distribution of age, thyroid nodule diameter, margin conditions, and A/T ratio, as well as prevalence of micro calcification and capsular invasion (P10 mm 〔OR=2.385, 95%CI (1.544, 3.684) 〕, and capsular invasion 〔OR=1.773, 95%CI (1.153, 2.724) 〕 were independently associated with increased risk of central lymph node metastasis (P10 mm, and capsular invasion were independent risk factors for central lymph node metastasis in PTC, and the value of combined use of them had a higher predictive value for central lymph node metastasis.

BackgroundIt is necessary to differentiate high-risk human papillomavirus (HR-HPV) infection and cervical lesions during pregnancy using an effective measure, so as to guide personalized diagnosis and treatment and to reduce unnecessary invasive examinations during pregnancy.ObjectiveTo assess the value of HR-HPV E6/E7 mRNA detection in differentiating HR-HPV infection and cervical lesions during pregnancy by comparing efficacy between it and HR-HPV DNA testing.MethodsParticipants were healthy women with singleton pregnancy (20-45-years old) selected from Department of Obstetrics and Gynecology of Capital Medical University Xuanwu Hospital during January 2016 to January 2019. All had file creation and underwent regular prenatal examination, and those with abnormal liquid-based cytology and HR-HPV DNA testing results further underwent colposcopy with biopsy taken for pathological examination (serving as a gold standard) , and performed HR-HPV E6/E7 mRNA detection in cervical exfoliated cells collected as samples. Pathologically detected CIN Ⅱand Ⅲ were defined as high-grade cervical lesions.ResultsOf the 1 058 participants, 118 had cytological abnormalities and/or HPV 16 and 18 infections, and 84 of them consented to perform colposcopy with biopsy pathological results successfully obtained. The prevalence of HR-HPV E6/E7 mRNA positivity was lower than that of HR-HPV DNA positivity in women with CINⅠ, normal cervical epithelium or cervicitis detected by pathological examination (P0.05) . In predicting CINⅡ and Ⅲ, the HR-HPV DNA testing had a sensitivity of 89.7% (26/29) , a specificity of 21.8% (12/55) , a positive predictive value of 37.1% (26/69) , and a negative predictive value of 75.0% (12/29) , and the HR-HPV E6/E7 mRNA detection had a sensitivity of 65.5% (19/29) , a specificity of 54.5% (25/55) , a positive predictive value of 43.0% (19/44) , and a negative predictive value 75.0% (25/40) . McNemar's test revealed that HR-HPV E6/E7 mRNA detection had a lower sensitivity but a higher specificity than HR-HPV DNA testing in diagnosing CINⅡ and Ⅲ (P

Introduction. Mucormycosis is a life-threatening opportunistic infection whose incidence has significantly risen during the last two decades. The gastrointestinal form is very rare, with the stomach as the most common site of infection, followed by the colon and ileum. Risk factors include uncontrolled diabetes mellitus, corticosteroid use, and organ transplantation. We report a patient with a history of rheumatoid arthritis who has developed gastrointestinal mucormycosis. To the best of our knowledge, this is the first such case reported in the literature. Case report. A 53-year-old female patient with a prior medical history of rheumatoid arthritis was admitted to the hospital due to persisting diarrhea. Physical examination revealed diffuse abdominal tenderness to palpation without meteorism and peritoneal signs. Laboratory results demonstrated systemic inflammation, so antibiotic therapy was administered. Abdominal computed tomography findings revealed inflammation of the rectum and the left colon. Colonoscopy findings were indicative of Crohn’s disease. Additionally, the patient had developed profuse rectal bleeding and consequently underwent emergency surgery. Subtotal colectomy with ileostomy and partial gastrectomy was performed. The patient’s condition rapidly worsened after the operation, and she died due to multi-organ failure. Histologic findings of resection specimens discovered chronic active colitis and extensive gastric necrosis associated with dense mixed inflammatory infiltration and numerous non-septate and 90-degree branching hyphae. Diagnosis of invasive gastric mucormycosis was obtained, but unfortunately, several days after the patient’s death. Conclusion. It is very important to obtain high awareness among clinicians of this deadly infection to achieve a prompt diagnosis and effective therapy.

Introduction. Development of malignancy in chronic burn scars is described i n 2 % of cases, with cutaneous squamous cell carcinoma (cSCC) being the most frequent. It develops several years after the burn injury, as a consequence of malignant transformation in chronically in-flamed tissue. Melanoma in a burn scar is, however, quite rare; in several cases, a synchronous or metachronous appearance of melanoma and cSCC was noted. Based on the previous rare reports, melanoma and cSCC can concurrently arise on thermal burn scars, as well as on the areas treated with skin grafts. Case report. We reported a case of a 6 7-year-old male who was accidentally scalded by boiling water at the age of 14. The patient subsequently developed melanoma at the age of 60, according to clinical and dermoscopic examination at the site of the burn scar, and after excision and histopathological analysis, the diagnosis of melanoma was confirmed (superficial spreading melanoma, Breslow 0.87 mm, with ulceration, pT1b). Complete surgical excision was done, and the diagnosis was confirmed with histopathological analysis. After the diagnosis of melanoma, regular follow-up every six months was scheduled, and three years later, cSCC was suspected and confirmed after surgical excision and histo-pathologic analysis. Conclusion. This case highlights the importance of long-term dermatological follow-up after burn injuries and early detection and treatment of skin cancer that can lead to better outcomes in these patients.

Background/Aim. Functional imaging, including diffusion-weighted magnetic resonance imaging (DWI MRI) and apparent diffusion coefficient (ADC) map, provides promising results in discrimination benign from malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. The aim of the study was to assess diagnostic performances of DWI in differentiation between benign and malignant pelvic and inguinal lymph nodes in patients with gynecological malignancies. Methods. The prospective clinical study was conducted at the Clinical Center of Vojvodina, Serbia, from 2013 to 2016, comprising 80 patients with malignant gynecological tumors. Preoperatively, all patients underwent MRI examination, followed by standard surgical treatment with complete pelvic and/or inguinal lymphadenectomy. A combination of ADC value criteria and size-based criteria yields MRI the following diagnostic performances in discrimination between benign and malignant lymph nodes: sensitivity 95%, specificity 92%, overall accuracy 92.5%, positive predictive value 46%, and negative predictive value 99.6%. Histopathological examination of surgically removed material and lymph nodes separated in pelvic and inguinal anatomic groups was performed after the surgery. Results. A total of 2,320 lymph nodes were mapped and histopathologically examined in 80 patients included in the study. Metastases in lymph nodes were histopathologically confirmed in 28 (35%) patients. Measured ADC values were significantly lower in metastatic (mean ± standard deviation (SD), ADC: 0.8725 × 10-3 ± 0.0125 × 10-3 mm2/s) than benign lymph nodes (mean ± SD, ADC: 1.116 × 10-3 ± 0.1848 × 10-3 mm2/s; p = 0.001). If ADC value of 0.860 × 10-3 mm2/s was determined as a cut-off value for discrimination between benign and malignant lymph nodes, DWI sensitivity was 89%, specificity 85%, and overall accuracy was 86%, positive predictive values 30%, and negative predictive value 99%. Conclusion. DWI MRI sequence is a fast, simple, non-invasive method that aids significantly to MRI diagnostic performances in dis-crimination between benign and malignant pelvic and inguinal lymph nodes.

Introduction: Low-grade fibromyxoid sarcoma (LGFMS) is a rare special subtype of fibrosarcoma, it is more common in the trunk and proximal limbs. First described by Evans in 1987, this tumor is also named Evans tumor. Diagnosis of LGFMS may be quite challenging, either due to the low suspicion rate of the tumor or low specificity of its morphological pattern and immunohistochemical profile, a phenomenon that is magnified when tumor location is less usual, such as in the chest wall. The present article presents a challenging case of LGFMS of the chest wall. Case report: Female, 58-year-old patient was referred to the oncology referral clinic with a breast tumor. Diagnostic investigation included imaging tests (breast US and chest CT scan) and core needle biopsy. CT scan revealed the epicenter of the tumor in the left anterior thoracic wall. Biopsy to evaluate the histologic type of tumor was carried out and the result was inconclusive. Therefore, surgical excision of the tumor was performed. Histopathology and immunohistochemistry studies of the surgical specimen confirmed the diagnosis of LGFMS of the chest wall. Currently, after 36 months of the surgical excision, the patient is still doing well and continues under clinical follow-up. Conclusion: Although the diagnosis of LGFMS of the chest wall is challenging, it should be done correctly, since these cases require a long and thorough clinical follow-up.

Eccrine poroma (EP) is a rare benign adnexal tumor that may mimic benign or malignant tumors and differential diagnosis may be difficult under clinical and dermoscopic examination. Reflectance confocal microscopy (RCM) examination may add important information to diagnosis and subsequent management of solitary lesions for which dermoscopy can be challenging. The aim of the present study was to investigate features of EP at RCM in order to detect the characteristics that might aid in the differential diagnosis of EP versus other solitary lesions (benign or malignant). Secondary objective was to correlate the resulting features with histopathological findings. This monocentric retrospective observational case–control study included all EPs registered with RCM between January 2007 and May 2018. Control cases were benign or malignant lesions similar in clinical appearance, morphology, and dermoscopic features to EPs. RCM evaluators were blinded to clinical‐dermoscopic images and to final histopathological diagnoses. Finally, RCM‐histopathological correlation was performed. A total of 11 EPs and 33 controls were included in the present study. Among RCM parameters, "cords without palisading," "dark holes," "prominent vascularization" and "abundant stroma" resulted positively associated with EP in univariate analysis. RCM features correspond to the histopathological diagnosis of EP in 97% of cases, as illustrated by the cluster analysis. An excellent correlation between diagnostic features of conventional histopathology and RCM was observed. RCM assists in the differential diagnosis of solitary lesions, allowing to reach a correct diagnosis of EP through the identification of its four characteristics. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the diagnostic performance of Kaiser score (KS) adjusted with the apparent diffusion coefficient (ADC) (KS+) and machine learning (ML) modeling. Methods: A dataset of 402 malignant and 257 benign lesions was identified. Two radiologists assigned the KS. If a lesion with KS > 4 had ADC > 1.4 × 10−3 mm2/s, the KS was reduced by 4 to become KS+. In order to consider the full spectrum of ADC as a continuous variable, the KS and ADC values were used to train diagnostic models using 5 ML algorithms. The performance was evaluated using the ROC analysis, compared by the DeLong test. The sensitivity, specificity, and accuracy achieved using the threshold of KS > 4, KS+ > 4, and ADC ≤ 1.4 × 10−3 mm2/s were obtained and compared by the McNemar test. Results: The ROC curves of KS, KS+, and all ML models had comparable AUC in the range of 0.883–0.921, significantly higher than that of ADC (0.837, p < 0.0001). The KS had sensitivity = 97.3% and specificity = 59.1%; and the KS+ had sensitivity = 95.5% with significantly improved specificity to 68.5% (p < 0.0001). However, when setting at the same sensitivity of 97.3%, KS+ could not improve specificity. In ML analysis, the logistic regression model had the best performance. At sensitivity = 97.3% and specificity = 65.3%, i.e., compared to KS, 16 false-positives may be avoided without affecting true cancer diagnosis (p = 0.0015). Conclusion: Using dichotomized ADC to modify KS to KS+ can improve specificity, but at the price of lowered sensitivity. Machine learning algorithms may be applied to consider the ADC as a continuous variable to build more accurate diagnostic models. Key Points: • When using ADC to modify the Kaiser score to KS+, the diagnostic specificity according to the results of two independent readers was improved by 9.4–9.7%, at the price of slightly degraded sensitivity by 1.5–1.8%, and overall had improved accuracy by 2.6–2.9%. • When the KS and the continuous ADC values were combined to train models by machine learning algorithms, the diagnostic specificity achieved by the logistic regression model could be significantly improved from 59.1 to 65.3% (p = 0.0015), while maintaining at the high sensitivity of KS = 97.3%, and thus, the results demonstrated the potential of ML modeling to further evaluate the contribution of ADC. • When setting the sensitivity at the same levels, the modified KS+ and the original KS have comparable specificity; therefore, KS+ with consideration of ADC may not offer much practical help, and the original KS without ADC remains as an excellent robust diagnostic method. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: A convolutional neural network (CNN) model for the diagnosis of active pulmonary tuberculosis (APTB) and community-acquired pneumonia (CAP) using chest radiographs (CRs) was constructed and verified based on transfer learning.Materials and Methods: CRs of 1247 APTB cases, 1488 CAP cases and 1247 normal cases were collected. All CRs were randomly divided into training set (1992 cases), validation set (1194 cases) and test set (796 cases) by stratified sampling in 5:3:2 radio. After normalization of CRs, the convolution base of pre-trained CNN (VGG16) model on ImageNet dataset was used to extract features, and the grid search was used to determine the optimal classifier module, which was added to the convolution base for transfer learning. After the training, the model with the highest accuracy of the validation set was selected as the optimal model to verify in the test set and calculate the accuracy of the model.Results: The accuracy of validation set in the 63rd epochs was the highest, which was 0.9430, and the corresponding Categorical crossentropy was 0.1742. The accuracy of the training set was 0.9428, and the Categorical crossentropy was 0.1545. When the optimal model was applied to the test set, the accuracy was 0.9447, and the Categorical crossentropy was 0.1929.Conclusion: The transfer learning-based CNN model has good classification performance in the diagnosis of APTB, CAP and normal patients using CRs. [ABSTRACT FROM AUTHOR]