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Artificial intelligence (AI) and its recent increasing healthcare integration has created both new opportunities and challenges in the practice of radiology and medical imaging. Recent advancements in AI technology have allowed for more workplace efficiency, higher diagnostic accuracy, and overall improvements in patient care. Limitations of AI such as data imbalances, the unclear nature of AI algorithms, and the challenges in detecting certain diseases make it difficult for its widespread adoption. This review article presents cases involving the use of AI models to diagnose intracranial hemorrhage, spinal fractures, and rib fractures, while discussing how certain factors like, type, location, size, presence of artifacts, calcification, and post-surgical changes, affect AI model performance and accuracy. While the use of artificial intelligence has the potential to improve the practice of emergency radiology, it is important to address its limitations to maximize its advantages while ensuring the safety of patients overall. A summary of most important contents reviewed in this paper. [ABSTRACT FROM AUTHOR]

Purpose: Fibroblast activation protein (FAP)-inhibitor (FAPI)-PET tracers allow imaging of the FAP-expressing cancer associated fibroblasts (CAF) and also the normal activated fibroblasts (NAF) involved in inflammation/fibrosis that may be present after invasive medical interventions. We evaluated [68Ga]Ga-FAPI-46 uptake patterns post-medical/invasive non-systemic interventions. Methods: This single-center retrospective analysis was conducted in 79 consecutive patients who underwent [68Ga]Ga-FAPI-46 PET/CT. Investigators reviewed prior patient medical/invasive interventions (surgery, endoscopy, biopsy, radiotherapy, foreign body placement (FBP) defined as implanted medical/surgical material present at time of scan) and characterized the anatomically corresponding FAPI uptake intensity both visually (positive if above surrounding background) and quantitatively (SUVmax). Interventions with missing data/images or confounders of [68Ga]Ga-FAPI-46 uptake (partial volume effect, other cause of increased uptake) were excluded. Available correlative FDG, DOTATATE and PSMA PET/CTs were analyzed when available. Results: 163 medical/invasive interventions (mostly surgeries (49%), endoscopies (18%) and non-surgical biopsies (10%)) in 60 subjects were included for analysis. 43/163 (26%) involved FBP. FAPI uptake occurred in 24/163 (15%) of interventions (average SUVmax 3.2 (mild), range 1.5–5.1). The median time-interval post-intervention to FAPI-PET was 47.5 months and was shorter when FAPI uptake was present (median 9.5 months) than when absent (median 60.1 months; p = 0.001). Cut-off time beyond which no FAPI uptake would be present post-intervention without FBP was 8.2 months, with a sensitivity, specificity, positive predictive value and negative predictive value of 82, 90, 99 and 31% respectively. No optimal cutoff point could be determined when considering interventions with FBP. No significant difference was detected between frequency of [68Ga]Ga-FAPI-46 and [18F]FDG uptake in intervention sites. Compared to [68Ga]Ga-PSMA-11, [68Ga]Ga-FAPI-46 revealed more frequent and intense post-interventional tracer uptake. Conclusion: [68Ga]Ga-FAPI-46 uptake from medical/invasive interventions without FBP appears to be time dependent, nearly always absent beyond 8 months post-intervention, but frequently present for years with FBP. [ABSTRACT FROM AUTHOR]

Melanoma, with its diverse histopathologic characteristics, can mimic both benign nevi and neoplasms of various cell lineages. Immunohistochemistry (IHC) can play a vital role in melanoma diagnosis, particularly when the cell lineage is unclear on hematoxylin and eosin sections. Commonly utilized IHC stains for melanoma diagnosis include SOX10, Melan‐A, and S100. A relatively novel stain, PReferentially expressed Antigen in MElanoma (PRAME), is also proving useful in accurate melanoma diagnosis. However, none of these stains are completely specific to melanocytes or melanoma, and misinterpretation can lead to incorrect diagnoses. This report presents a unique case of triple‐negative breast carcinoma (TNBC) metastatic to the skin exhibiting histopathologic characteristics similar to melanoma, including positivity for SOX10 and PRAME. Our aim is to highlight TNBC metastatic to the skin as a potential diagnostic pitfall. [ABSTRACT FROM AUTHOR]

Abstract Background This collection focuses on Navigation Surgery, we aim to explore the intersection of cutting-edge technology and musculoskeletal surgery. It covers recent advancements, challenges, and future directions in navigational techniques. Navigation devices reconstruct 3D surgical information on monitors, aiding in safer and more accurate operations across orthopedic surgeons. While beneficial, there are risks like misplaced implants, necessitating careful navigation usage. The collection encourages discussions on clinical applications and the ongoing evolution of navigation surgeries.

We presented a case of a 46-year-old woman from Saudi Arabia with a persistent buccal ulcer, measuring 0.4 × 0.4 × 0.3 cm. After surgical excision of the lesion was performed using both general and local anesthesia, its microscopic examination revealed keratinized squamous epithelium with surface ulcerations in the buccal mucosa. Beneath the epithelium, there was granulation tissue, scattered and clustered lymphoid tissue, and reactive germinal centers with tingible body microphages. These lymphoid clusters infiltrated the adjacent skeletal muscles and fat. The final diagnosis was ectopic oral tonsillar tissue overlaid by an inflammatory ulcer, most likely attributed to friction. Importantly, no evidence of malignancy were observed in the biopsy. The surgical removal of the lesion was performed to rule out malignancy. The surgical excision was performed using both general and local anesthesia. Following surgery and during follow-up visits, the indicated instructions were provided. Pain was effectively managed with acetaminophen, and the patient fully recovered in approximately ten days. Neither recurrence nor post-operative complications were hitherto reported. [ABSTRACT FROM AUTHOR]

Invertebrates play a critical role in beach ecosystems, and seasonal variation in their occurrence and abundance likely influences food webs. We examine and characterise seasonal patterns in invertebrate activity on a temperate, southern sandy dune and beach ecosystem at Venus Bay, Victoria, Australia. We index invertebrate abundance, diversity and assemblage composition at fixed-site pitfall traps which were deployed in four transects from the lower dunes to the beach. Seasonal differences occurred in assemblage composition (foredunes only), richness and abundance. Insects dominated assemblages in summer, spring and autumn; crustaceans dominated winter assemblages. Morphospecies richness was lowest in winter (139% higher in summer and 169% higher in autumn). Our results contrast with other studies from temperate beaches in that (1) richness was higher on beaches compared to in foredunes across all seasons and (2) abundance differed significantly such that winter abundance was higher than for all other seasons. Possible explanations include the exposed nature of the study foredunes, marine ecological subsides in the form of beach wrack in winter and/or between-site variations in such factors. Further studies would usefully examine between-beach variation in seasonality in invertebrate activity in foredunes and dunes. [ABSTRACT FROM AUTHOR]

68Gallium-PSMA positron emission tomography/computer tomography has been utilized recently for the diagnosis and staging of prostate cancer. PSMA is a transmembrane protein that is expressed not only in the prostate gland but also in other tissues. While some pitfalls have been addressed, there are still uncertainties. Herein, we report a 79-year-old male with prostate cancer who underwent a PSMA scan after coronary artery bypass graft surgery, revealing disease progression and PSMA-avid foci at the surgical stitch sites. This report discusses the immunohistochemical and molecular imaging mechanisms underlying PSMA expression in surgical scar tissues, providing critical insights for optimizing radiologic reporting in such situations. [ABSTRACT FROM AUTHOR]

Abstract Background A marked increase in PD1-positive TFH cells in nodal MZL cases (NMZL) was reported previously and could prompt suspicion for a diagnosis of peripheral T-cell lymphoma (PTCL), especially angioimmunoblastic T-cell lymphoma (AITL). Case presentation To demonstrate that the pitfall might exist not only in NMZL but also in transformed splenic MZL (tSMZL), two NMZL cases (70 y/o female with enlarged left cervical lymph node and 75 y/o male with generalized lymphadenopathy) and one case of tSMZL (47 y/o male with nodal and extranodal involvement) with obvious PD1-positive T-cell hyperplasia were described here. Although all their initial diagnoses were prompted to be AITL, they were comprehensively characterized by clinical features, morphologic, immunophenotypic, clonality, and targeted exosome sequencing (TES) findings. Case 1 and Case 2 were NMZL with increased PD1 + T cells in the “peripheral pattern” or “mixed peripheral and central pattern”, and Case 3 was SMZL with abundant PD1-positive T cells in the “nodular pattern” that transformed to tSMZL (DLBCL) with PD1-positive T cells distributed in the “diffuse pattern.” In addition to the monoclonal IG rearrangement and polyclonal TCR rearrangement results, TES demonstrated enriched and recurrent mutations in MZLs and failed to find aberrations described in AITL- or TFH-derived lymphomas. Conclusions It is important to realize that this pitfall can also occur in more diagnostically difficult tSMZL cases; the integration of histopathology with clonality and mutation studies is also highlighted.

This letter, published in the International Journal of Surgical Pathology, discusses a previously undescribed retraction artifact in ameloblastoma, a type of tumor that affects the jaw. The artifact can mimic vascular invasion or pseudoinvasion, leading to potential misdiagnosis of malignancy. The authors describe a case where an ameloblastoma nest appeared to be situated in a thick-walled muscular vessel, but further examination revealed that it was a retraction artifact. The letter emphasizes the importance of pathologists being aware of these pseudomalignant artifactual patterns to avoid misdiagnosis. [Extracted from the article]

We report a [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) scan of a 17-year-old male presenting increased focal glucose metabolism of a histologically proven solitary nodular fasciitis mimicking an extranodal manifestation of Hodgkin lymphoma. This interesting image should draw attention to considering nodular fasciitis as a possible pitfall in the staging of malignant diseases. [ABSTRACT FROM AUTHOR]

Background: A marked increase in PD1-positive TFH cells in nodal MZL cases (NMZL) was reported previously and could prompt suspicion for a diagnosis of peripheral T-cell lymphoma (PTCL), especially angioimmunoblastic T-cell lymphoma (AITL). Case presentation: To demonstrate that the pitfall might exist not only in NMZL but also in transformed splenic MZL (tSMZL), two NMZL cases (70 y/o female with enlarged left cervical lymph node and 75 y/o male with generalized lymphadenopathy) and one case of tSMZL (47 y/o male with nodal and extranodal involvement) with obvious PD1-positive T-cell hyperplasia were described here. Although all their initial diagnoses were prompted to be AITL, they were comprehensively characterized by clinical features, morphologic, immunophenotypic, clonality, and targeted exosome sequencing (TES) findings. Case 1 and Case 2 were NMZL with increased PD1 + T cells in the "peripheral pattern" or "mixed peripheral and central pattern", and Case 3 was SMZL with abundant PD1-positive T cells in the "nodular pattern" that transformed to tSMZL (DLBCL) with PD1-positive T cells distributed in the "diffuse pattern." In addition to the monoclonal IG rearrangement and polyclonal TCR rearrangement results, TES demonstrated enriched and recurrent mutations in MZLs and failed to find aberrations described in AITL- or TFH-derived lymphomas. Conclusions: It is important to realize that this pitfall can also occur in more diagnostically difficult tSMZL cases; the integration of histopathology with clonality and mutation studies is also highlighted. [ABSTRACT FROM AUTHOR]

Hodgkin Lymphoma (HL) is a malignancy involving lymph nodes and lymphatic system. [18F]F-FDG PET/CT (FDG-PET) imaging is routinely used for staging, to assess early chemotherapy response (interim FDG-PET), at the end of treatment (EoT FDG-PET) and for the identification of disease recurrence.We present a case of a 39-year-old man treated for HL. FDG-PET scans performed after first line therapy (both Interim PET and at the end of therapy) demonstrated a persistent and significant mediastinal FDG uptake. The patient was treated with a second line therapy but the FDG-PET uptake did not change. After board discussion a new surgical, thoracoscopy-guided biopsy was performed. Histopathology demonstrated a dense fibrous tissue with occasional chronic inflammatory infiltrates.Persistent FDG-PET positivity may suggest refractory or relapsed disease. However, occasionally, non-malignant conditions are responsible for a persistent FDG uptake, not related to primary disease. An accurate evaluation of clinical history and previous imaging exams is mandatory for clinicians and others experts to avoid misinterpretations of FDG-PET results. Nevertheless, in some cases, only a more invasive procedure, such as a biopsy, may finally lead to a definitive diagnosis.

The thyroid storm is an emergency characterized by multiple organ failure due to severe thyrotoxicosis that is often triggered by other diseases. The diagnosis of thyroid storm is made clinically in a severe thyrotoxic patient with evidence of systemic decompensation. The Burch–Wartofsky Point Scale (BWPS) is a score that is widely used to diagnose thyroid storm, introduced by Burch and Wartofsky in 1993. In Burch–Wartofsky Point Scale, the thyroid storm diagnosis is made if there is clinically severe thyrotoxicosis with a score of 45 in a patient that has a previous history of elevated free fT3 (triiodothyronine) or fT4 (free thyroxine). But in a condition it cannot be distinguished whether a condition is caused by the effects of thyrotoxicosis or due to other diseases, then these symptoms are considered as a result of the effects of thyrotoxicosis. In the Burch–Wartofsky Point Scale, there is a pitfall. If we are accustomed to assuming a worsening of the condition in thyroid patients as a result of the effects of thyrotoxicosis, without trying to exclude the condition due to other conditions can lead to a misdiagnosis of thyroid storm. This article aims to remind us to be careful in applying diagnostic tools in diagnosing a thyroid storm.

PurposeReaders need to be informed about potential pitfalls of [68Ga]Ga-PSMA-11 PET interpretation.MethodsHere we report [68Ga]Ga-PSMA-11 PET findings discordant with the histopathology/composite reference standard in a recently published prospective trial on 635 patients with biochemically recurrent prostate cancer.ResultsConsensus reads were false positive in 20 regions of 17/217 (8%) patients with lesion validation. Majority of the false positive interpretations (13 of 20, 65%) occurred in the context of suspected prostate (bed) relapse (T) after radiotherapy (n = 11); other false positive findings were noted for prostate bed post prostatectomy (T, n = 2), pelvic nodes (N, n = 2), or extra pelvic lesions (M, n = 5). Major sources of false positive findings were PSMA-expressing residual adenocarcinoma with marked post-radiotherapy treatment effect. False negative interpretation occurred in 8 regions of 6/79 (8%) patients with histopathology validation, including prostate (bed) (n = 5), pelvic nodes (n = 1), and extra pelvic lesions (n = 2). Lesions were missed mostly due to small metastases or adjacent bladder/urine uptake.Conclusion[68Ga]Ga-PSMA-11 PET at biochemical recurrence resulted in less than 10% false positive interpretations. Post-radiotherapy prostate uptake was a major source of [68Ga]Ga-PSMA-11 PET false positivity. In few cases, PET correctly detects residual PSMA expression post-radiotherapy, originating however from treated, benign tissue or potentially indolent tumor remnants.Trial registration numberClinicalTrials.gov Identifiers: NCT02940262 and NCT03353740.

We report a [18F]fluorodeoxyglucose positron emission tomography/computed tomography ([18F]FDG PET/CT) scan of a 17-year-old male presenting increased focal glucose metabolism of a histologically proven solitary nodular fasciitis mimicking an extranodal manifestation of Hodgkin lymphoma. This interesting image should draw attention to considering nodular fasciitis as a possible pitfall in the staging of malignant diseases.

This letter is an unpretentious reflection on a decade of research in applied ethics and bioethics. Drawing on the experiential knowledge of the author, who has a background in occupational therapy and philosophy, this letter presents some of what has been learned over the years, which may help the current and future generation of bioethicists to navigate between theory and practice, and in so doing, value those confronted with ethical issues, demonstrate epistemic humility, while mobilizing ideas and theories capable of shedding light on the ethical dimensions of various experiences and practices. [ABSTRACT FROM AUTHOR]

Background: Augmented reality navigation is the one of the navigation technologies that allows computer-generated virtual images to be projected onto a real-world environment. Augmented reality navigation can be used in spinal tumor surgery. However, it is unknown if there are any pitfalls when using this technique. Case presentation: The patient in this report underwent complete resection of a cauda equina tumor at the L2-L3 level using microscope-based augmented reality navigation. Although the registration error of navigation was < 1 mm, we found a discrepancy between the augmented reality navigation images and the actual location of the tumor, which we have called "navigation mismatch". This mismatch, which was caused by the mobility of the spinal tumor in the dura mater, seems to be one of the pitfalls of augmented reality navigation for spinal tumors. Conclusions: Combined use of intraoperative ultrasound and augmented reality navigation seems advisable in such cases. [ABSTRACT FROM AUTHOR]

El estudio se realizó en el municipio de Suchiapa, Chiapas (16°36’08’’N y 93°05’53’’W) teniendo como objetivo evaluar la composición y diversidad de la macrofauna del suelo en un gradiente de diversidad, pastizal-SAF-Bosque, para determinar la influencia de la comunidad de invertebrados del suelo. Para lo anterior se realizó un muestreo general preseleccionando los sitios al azar, utilizando dos tipos de trampas, monolitos y pitfall; se hizo una colecta de muestras por cada trampa establecida para después realizar el análisis dentro del laboratorio, se utilizaron variables como, tipos de órdenes y gremios tróficos de los invertebrados del suelo para la base de datos. Del análisis realizado se observa que hay cambios en la composición y la abundancia de la macrofauna en respuesta a las prácticas realizadas dentro de esos paisajes. El análisis estadístico de los resultados muestra que los herbívoros son el grupo de mayor presencia en los diferentes paisajes, seguidos de los detritívoros; y los depredadores y nectarívoros fueron los que menos presencia tuvieron.

We recently developed a combination of four chemiluminescence-based assays for selective detection of different nitric oxide (NO) metabolites, including nitrite, S-nitrosothiols (SNOs), heme-nitrosyl (heme-NO), and dinitrosyl iron complexes (DNICs). However, these NO species (NOx) may be under dynamic equilibria during sample handling, which affects the final determination made from the readout of assays. Using fetal and maternal sheep from low and high altitudes (300 and 3801 m, respectively) as models of different NOx levels and compositions, we tested the hypothesis that sample handling introduces artifacts in chemiluminescence assays of NOx. Here, we demonstrate the following: (1) room temperature placement is associated with an increase and decrease in NOx in plasma and whole blood samples, respectively; (2) snap freezing and thawing lead to the interconversion of different NOx in plasma; (3) snap freezing and homogenization in liquid nitrogen eliminate a significant fraction of NOx in the aorta of stressed animals; (4) A "stop solution" commonly used to preserve nitrite and SNOs leads to the interconversion of different NOx in blood, while deproteinization results in a significant increase in detectable NOx; (5) some reagents widely used in sample pretreatments, such as mercury chloride, acid sulfanilamide, N-ethylmaleimide, ferricyanide, and anticoagulant ethylenediaminetetraacetic acid, have unintended effects that destabilize SNO, DNICs, and/or heme-NO; (6) blood, including the residual blood clot left in the washed purge vessel, quenches the signal of nitrite when using ascorbic acid and acetic acid as the purge vessel reagent; and (7) new limitations to the four chemiluminescence-based assays. This study points out the need for re-evaluation of previous chemiluminescence measurements of NOx, and calls for special attention to be paid to sample handling, as it can introduce significant artifacts into NOx assays. [ABSTRACT FROM AUTHOR]

Abstract Background Sinonasal mucosal melanoma (SNMM) is a rare malignant melanoma originating from melanocytes derived from multipotent neural crest cells. Its incidence accounts for less than 1 % of all malignant melanomas, with five-year survival rate about 25 %. Occasionally, it is incredibly formidable to make a compelling diagnosis when malignant melanoma with other diverse differentiation. Case presentation Herein, we presented a 54-year-old male case of SNMM with smooth muscle differentiation, defined by histopathology and positive immunostaining for the smooth muscle specific markers of a-SMA, H-caldesmon, calponin and Desmin, as well as specific melanocyte markers of HMB-45, Melan-A, SOX10, and PNL2. Conclusions Mucosal melanoma with smooth muscle differentiation is remarkably infrequent, and reported only 4 cases to date. It would be a potential pathological diagnostic pitfall. It is important to understand this variation of malignant melanoma for avoiding misdiagnosis.

Hodgkin Lymphoma (HL) is a malignancy involving lymph nodes and lymphatic system. [18F]F-FDG PET/CT (FDG-PET) imaging is routinely used for staging, to assess early chemotherapy response (interim FDG-PET), at the end of treatment (EoT FDG-PET) and for the identification of disease recurrence. We present a case of a 39-year-old man treated for HL. FDG-PET scans performed after first line therapy (both Interim PET and at the end of therapy) demonstrated a persistent and significant mediastinal FDG uptake. The patient was treated with a second line therapy but the FDG-PET uptake did not change. After board discussion a new surgical, thoracoscopy-guided biopsy was performed. Histopathology demonstrated a dense fibrous tissue with occasional chronic inflammatory infiltrates. Persistent FDG-PET positivity may suggest refractory or relapsed disease. However, occasionally, non-malignant conditions are responsible for a persistent FDG uptake, not related to primary disease. An accurate evaluation of clinical history and previous imaging exams is mandatory for clinicians and others experts to avoid misinterpretations of FDG-PET results. Nevertheless, in some cases, only a more invasive procedure, such as a biopsy, may finally lead to a definitive diagnosis. [ABSTRACT FROM AUTHOR]

Diffusion-weighted imaging (DWI) with an apparent diffusion coefficient (ADC) value is a relatively new magnetic resonance imaging (MRI) sequence that provides functional information on the lesion by measuring the microscopic movement of water molecules. While numerous studies have evaluated the promising role of DWI in musculoskeletal radiology, most have focused on tumorous diseases related to cellularity. This review article aims to summarize DWI-acquisition techniques, considering pitfalls such as T2 shine-through and T2 black-out, and their usefulness in interpreting musculoskeletal diseases with imaging. DWI is based on the Brownian motion of water molecules within the tissue, achieved by applying diffusion-sensitizing gradients. Regardless of the cellularity of the lesion, several pitfalls must be considered when interpreting DWI with ADC values in musculoskeletal radiology. This review discusses the application of DWI in musculoskeletal diseases, including tumor and tumor mimickers, as well as non-tumorous diseases, with a focus on lesions demonstrating T2 shine-through and T2 black-out effects. Understanding these pitfalls of DWI can provide clinically useful information, increase diagnostic accuracy, and improve patient management when added to conventional MRI in musculoskeletal diseases. [ABSTRACT FROM AUTHOR]

Circulating cell-free microRNAs (miRNAs) represent a major reservoir for biomarker discovery. Unfortunately, their implementation in clinical practice is limited due to a profound lack of reproducibility. The great technical variability linked to major pre-analytical and analytical caveats makes the interpretation of circulating cell-free miRNA data challenging and leads to inconsistent findings. Additional efforts directed to standardization are fundamental. Several well-established protocols are currently used by independent groups worldwide. Nonetheless, there are some specific aspects in specimen collection and processing, sample handling, miRNA quantification, and data analysis that should be considered to ensure reproducibility of results. Here, we have addressed this challenge using an alternative approach. We have highlighted and discussed common pitfalls that negatively impact the robustness of circulating miRNA quantification and their application for clinical decision-making. Furthermore, we provide a checklist usable by investigators to facilitate and ensure the control of the whole miRNA quantification and analytical process. We expect that these recommendations improve the reproducibility of findings, and ultimately, facilitate the incorporation of circulating miRNA profiles into clinical practice as the next generation of disease biomarkers. [ABSTRACT FROM AUTHOR]

Ground beetles (Carabidae, Coleoptera) are one of the most species-rich and well-studied insect families. However, the number of published datasets is disproportionately low against the biodiversity of this group. According to GBIF, only a fifth of the percentage of all published data covers ground beetles. This article describes a sampling-event dataset providing primary data on ground beetles collected in urban and suburban habitats in Kaluga, a typical central Russian city. We surveyed habitats of different land-use types and the extent and intensity of anthropogenic influence: yards, gardens, quarries, small urban woodlands, grasslands and riparian habitats. Carabids were collected by pitfall traps during most of the vegetative season (mostly from late April - early May to at least early October) for 13 seasons between 1994 and 2015. In total, the dataset contains 189 carabid species and 79,091 specimens. The dataset provides information about species composition and abundance, habitat distribution, seasonal and long-term dynamics of carabid beetles in environments of different degrees of urbanisation.This dataset is the first sampling-event dataset about carabids in various urban habitats published through GBIF.

Paraganglioma of the urinary bladder is a rare neuroendocrine tumor which originates from the chromaffin tissue of the sympathetic nervous system. It only accounts for about 0.05% of all vesical tumors. Bladder paraganglioma may also present with non-specific symptoms which could easily lead to misdiagnosis. In this report, emphasis on the histomorphology and immunohistochemical profile of the tumor is stressed as the morphological findings could overlap with relatively more common urothelial neoplasms. Distinction from other tumors is of utter importance because of different therapeutic options. Here, we present a case of a 52 year-old, filipino, male, previously diagnosed with colonic tubulovillous adenoma, presenting with dysuria and hematuria who, after undergoing CT Stonogram revealed an incidental finding of a lobulated mass measuring 5.7 cm located at the anteroinferior portion of the urinary bladder wall.

Background: Sinonasal mucosal melanoma (SNMM) is a rare malignant melanoma originating from melanocytes derived from multipotent neural crest cells. Its incidence accounts for less than 1 % of all malignant melanomas, with five-year survival rate about 25 %. Occasionally, it is incredibly formidable to make a compelling diagnosis when malignant melanoma with other diverse differentiation. Case presentation: Herein, we presented a 54-year-old male case of SNMM with smooth muscle differentiation, defined by histopathology and positive immunostaining for the smooth muscle specific markers of a-SMA, H-caldesmon, calponin and Desmin, as well as specific melanocyte markers of HMB-45, Melan-A, SOX10, and PNL2. Conclusions: Mucosal melanoma with smooth muscle differentiation is remarkably infrequent, and reported only 4 cases to date. It would be a potential pathological diagnostic pitfall. It is important to understand this variation of malignant melanoma for avoiding misdiagnosis. [ABSTRACT FROM AUTHOR]

The course of the vertebral artery from its subclavian artery origin up to its termination at the vertebrobasilar junction is divided into four segments (V1–V4). This segmentation, based on schemes that have evolved since the late nineteenth century, should be a consistent and reproducible anatomical concept. However, the current literature offers conflicting definitions of that scheme, not infrequently within a single article or monograph. The principal inconsistency found in modern publications concerns the termination of the V2 segment, which is either set at the C2 or C1 transverse foramen depending on the scheme considered. Consequently, the portion of the vertebral artery extending between C2 and C1—a frequent site of pathological involvement—either belongs to the V2 or V3 segment. This discrepancy can affect the validity of studies evaluating the diagnosis and management of vertebral artery disorders. A V3 segment extending from the transverse foramen of C2 to the posterior atlanto-occipital membrane and subdivided into vertical, horizontal, and oblique subsegments—a pattern suggested by Barbieri in 1867 and adopted in some modern publications—would provide a simple, precise, and reliable solution without significantly altering the widely accepted division of the vertebral artery into four segments (V1–V4). [ABSTRACT FROM AUTHOR]

Objective: We present a case with prenatal diagnosis of submucous cleft palate (SMCP) which was described using 2- and 3-dimensional (3D) ultrasonography in utero. Case Report: A 25-year-old pregnant woman was referred to our department for fetal ultrasound screening. After the detection of cardiac and spinal malformations of fetal, further detailed examination detected SMCP, which showed a gap within the hard palate on axial transversal view with the soft palate visible on sagittal view. The imaging of a defective hard palate in prenatal 3D ultrasonography is similar to that in postmortem 3D computed tomography reconstruction. Conclusion: A gap within the hard palate and verification of the visibility of the soft palate should be key points in the prenatal diagnosis of SMCP. Three-dimensional ultrasonic imaging is helpful for displaying the shape and extent of the bony defect in SMCP. [ABSTRACT FROM AUTHOR]

(1) Background: In treating medial unicompartmental gonarthrosis, medial open wedge high tibial osteotomy (mOWHTO) reduces pain and is intended to delay a possible indication for joint replacement by relieving the affected compartment. This study aimed to investigate the influence of the osteotomy height with different hinge points in HTO in genu varum on the leg axis. (2) Methods: Fifty-five patients with varus lower leg alignment obtained full-weight bearing long-leg radiographs were analyzed. Different simulations were performed: Osteotomy height was selected at 3 and 4 cm distal to the tibial articular surface, and the hinge points were selected at 0.5 cm, 1 cm, and 1.5 cm medial to the fibular head, respectively. The target of each correction was 55% of the tibial plateau measured from the medial. Then, the width of the opening wedge was measured. Intraobserver and interobserver reliability were calculated. (3) Results: Statistically significant differences in wedge width were seen at an osteotomy height of 3 cm below the tibial plateau when the distance of the hinge from the fibular head was 0.5 cm to 1.5 cm (3 cm and 0.5 cm: 8.9 +/− 3.88 vs. 3 cm and 1.5 cm: 11.6 +/− 4.39 p = 0.012). Statistically significant differences were also found concerning the wedge width between the distances 0.5 to 1.5 cm from the fibular head at the osteotomy height of 4 cm below the tibial plateau. (4 cm and 0.5 cm: 9.0 +/− 3.76 vs. 4 cm and 1.5 cm: 11.4 +/− 4.27 p = 0.026). (4) Conclusion: A change of the lateral hinge position of 1 cm results in a change in wedge width of approximately 2 mm. If hinge positions are chosen differently in preoperative planning and intraoperatively, the result can lead to over- or under-correction. [ABSTRACT FROM AUTHOR]

Purpose: The cranial epidural space (ES) is a potential space and is not generally recognized unless there is underlying pathology. With MRI in newborns, we have frequently observed T2 hyperintense thickening of the ES posterior to the confluence of sinuses, also referred to as "torcular pseudomass" (TP). We aim to identify the frequency of TP and possible associations with delivery. Methods: Retrospectively, brain MRIs of 194 neonates obtained within the first 2 weeks of life were evaluated. If TP was present, imaging characteristics and thickness were assessed by two observers, using fat-suppressed T2WI/FLAIR, T1WI, and SWI. Exclusion criteria were motion artifact, lack of sagittal T2WI, and lack of clinical data. Medical records were evaluated for demographic and clinical data. Follow-up exams were evaluated if available. Patients with TP and without were compared using Student t and chi-square tests. Results: TP was present in 64/158 (40%). No difference was found between the groups regarding sex, gestational age, birth weight, delivery type, fetal presentation during delivery, birth difficulty, and neurological sequelae (p > 0.05). Eight patients with TP underwent follow-up imaging, and in 6/8, TP completely resolved. Two patients showed persistent TP, improving from 3.2 to 1 mm in one child and from 3.2 to 2.8 mm in the other within a week. Conclusion: TP frequently occurs in early newborns. TP does not appear to be associated with factors related to delivery, shows complete resolution in most cases with a follow-up, and is likely of no clinical importance. [ABSTRACT FROM AUTHOR]

68 Gallium-Fibroblast activation protein inhibitor ( 68 Ga-FAPI) positron emission tomography/computed tomography (PET/CT) is increasingly used for evaluating various epithelial neoplasms. Despite addressing some pitfalls, many remain unacknowledged. This report details a 77-year-old man with suspected pancreatic malignancy who underwent a 68 Ga-FAPI PET/CT scan post-gastroduodenal coil embolization for upper gastrointestinal bleeding. The scan revealed intense 68 Ga-FAPI uptake in the pancreatic body and tail malignancy and around the embolized gastroduodenal artery, indicating a healing process. This highlights the importance of understanding FAPI expression in recent surgical sites for accurate radiologic interpretation., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Abdominal actinomycosis, a rare and often misdiagnosed condition caused by Actinomyces israelii , typically a commensal organism in the oral cavity and gastrointestinal tract, can become pathogenic, leading to chronic granulomatous infections that mimic various abdominal pathologies, including malignancies. We present a case of a 59-year-old male with coronary artery disease and type 2 diabetes who presented with severe abdominal pain, initially diagnosed as acute appendicitis. During exploratory laparotomy, an ileocecal band mimicking a congenital anomaly was discovered. Histopathological examination confirmed abdominal actinomycosis, revealing clusters of Actinomyces bacteria surrounded by acute inflammatory cells. The patient was successfully treated with surgical intervention and prolonged penicillin therapy, with no recurrence during a four-month follow-up. This case highlights the diagnostic challenges posed by abdominal actinomycosis and emphasizes the importance of considering it in the differential diagnosis of abdominal masses and appendicitis-like symptoms., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Erbagci et al.)

Abstract The release of gamebirds for recreational shooting exerts a series of effects on the ecosystems into which they are placed. Pheasants (Phasianus colchicus) are omnivorous and eat invertebrates, especially when young or, if females, when breeding. Consequently, the release of large numbers of pheasants into woodland release pens may affect local invertebrate populations. Previous studies have reported mixed evidence. We conducted pitfall trapping at 13 sites (49 pens) in central England over 2 years (totaling 65 pen measures), comprising three surveys annually, immediately prior to releases in mid‐summer, 4 weeks later when most birds were still in the pens, and another 5 weeks later when most birds had dispersed. We compared traps inside and 25 m outside pens in the same wood. We considered release densities and whether the birds had prior experience of eating invertebrates. While accounting for overall seasonal declines in invertebrates trapped, we detected changes for total invertebrate biomass and total counts indicative of released pheasants causing local decreases inside pens, either directly by predation or indirectly by modifying vegetation. There were also relative decreases outside pens when the pheasants start to disperse, suggesting that the released pheasants may be affecting invertebrates in those nearby areas or that their earlier effects inside the pen, modifying vegetation or increasing invertebrate activity, increased the relative susceptibility of invertebrates there to trapping. However, these effects were not seen for specific invertebrate groups believed to be especially susceptible to pheasants. For slugs and detritivores, we detected small population increases inside pens. Across the study period, decreases for most measures were greater outside pens than inside them. We conclude that any effects pheasants have on invertebrate communities at release sites in woodlands are complex and that long‐term and taxon‐specific studies should be considered to understand the local net ecological effects of gamebird releases on invertebrates.

Dedifferentiated melanoma is a particular form of malignant melanoma with a progressive worsening of the patient’s clinical outcome. It is well known that melanoma can assume different histo-morphological patterns, to which specific genetic signatures correspond, sometimes but not always. In this review we address the diagnostic difficulties in correctly recognizing this entity, discuss the major differential diagnoses of interest to the dermatopathologist, and conduct a review of the literature with particular attention and emphasis on the latest molecular discoveries regarding the dedifferentiation/undifferentiation mechanism and more advanced therapeutic approaches.

We recently developed a combination of four chemiluminescence-based assays for selective detection of different nitric oxide (NO) metabolites, including nitrite, S-nitrosothiols (SNOs), heme-nitrosyl (heme-NO), and dinitrosyl iron complexes (DNICs). However, these NO species (NOx) may be under dynamic equilibria during sample handling, which affects the final determination made from the readout of assays. Using fetal and maternal sheep from low and high altitudes (300 and 3801 m, respectively) as models of different NOx levels and compositions, we tested the hypothesis that sample handling introduces artifacts in chemiluminescence assays of NOx. Here, we demonstrate the following: (1) room temperature placement is associated with an increase and decrease in NOx in plasma and whole blood samples, respectively; (2) snap freezing and thawing lead to the interconversion of different NOx in plasma; (3) snap freezing and homogenization in liquid nitrogen eliminate a significant fraction of NOx in the aorta of stressed animals; (4) A “stop solution” commonly used to preserve nitrite and SNOs leads to the interconversion of different NOx in blood, while deproteinization results in a significant increase in detectable NOx; (5) some reagents widely used in sample pretreatments, such as mercury chloride, acid sulfanilamide, N-ethylmaleimide, ferricyanide, and anticoagulant ethylenediaminetetraacetic acid, have unintended effects that destabilize SNO, DNICs, and/or heme-NO; (6) blood, including the residual blood clot left in the washed purge vessel, quenches the signal of nitrite when using ascorbic acid and acetic acid as the purge vessel reagent; and (7) new limitations to the four chemiluminescence-based assays. This study points out the need for re-evaluation of previous chemiluminescence measurements of NOx, and calls for special attention to be paid to sample handling, as it can introduce significant artifacts into NOx assays.

Neonicotinoids are pesticides widely used for pest control in agriculture with undesirable effects on pollinators. However, other beneficial insects are exposed to insecticides that are not lethal to them but may accumulate and affect their vital characteristics. The objective of this study was to determine neonicotinoid residues in two types of beneficial soil organisms. The first group includes ground beetles (family: Carabidae, order: Coleoptera). They are important in the food web within existing ecosystems, especially in agricultural areas. The second group includes earthworms (family: Lumbricidae, order: Opisthopora) as humifiers, important members of the soil fauna. Fauna was collected at two sugar beet growing areas in Croatia under intensive sugar beet management. Ground beetles were collected from six plots of sugar beet fields treated with imidacloprid and thiamethoxam or left untreated with neonicotinoids. Earthworms were collected from the eight fields involved in four-year sugar beet crop rotation (sugar beet, maize, soybean, oilseed rape). Detection of neonicotinoid residues was performed by LC-MS/MS, SPE-QuEChERS method. The limit of quantification (LOQ) was 0.001 mg/kg. In ground beetles, the highest concentration of imidacloprid was detected at 0.027 mg/kg, while the residues of thiamethoxam and clothianidin were below LOQ. The highest concentration of imidacloprid in earthworms was 0.2141 mg/kg, while residues of thiamethoxam did not exceed 0.0008 mg/kg. This is the first study of this kind on Croatian territory and provides a valuable first insight into the ecotoxicological status of beneficial soil fauna. More comprehensive studies are needed to assess the extent of accumulation in and to take further steps regarding conservation programs for beneficial soil organisms. [ABSTRACT FROM AUTHOR]

Sertoli-Leydig cells tumors are rare ovarian neoplasms that can be managed with conservative resection given their generally excellent prognosis. Here we report a case of Sertoli-Leydig cell tumor mistakenly diagnosed as an invasive mucinous adenocarcinoma at time of intraoperative consultation because of its blue-mucinous appearance in the frozen section material. The patient subsequently underwent an extensive staging procedure revealing unilateral, ovarian confined disease. The mucinous features seen on frozen section were lost on the slides prepared from formalin fixed tissues. Immunohistochemical work up confirmed the diagnosis of a pure Sertoli-Leydig cell tumor. No heterologous elements were identified in this tumor. This case illustrates a hitherto unrecognized frozen section pitfall in evaluation of ovarian neoplasms. To the best of our knowledge, this is the first well documented case of pure Sertoli-Leydig cells tumor which resembled a well differentiated mucinous adenocarcinoma during frozen section.

Despite the College of American Pathologists’ recommendation against diagnosing “fat invasion” in urinary bladder biopsies and transurethral resection of bladder tumor specimens (TURBT), some pathologists still consider this scenario as pathologic stage T3. However, a formal evaluation of fat in biopsies/TURBT has not been performed. Material obtained from TURBT is considered as clinical staging (cT) and that obtained from cystectomy is true pathologic staging (pT). Herein, we analyze adipose tissue incidence/distribution, cancer involving fat, staging ramifications, and clinical outcomes in a large series of biopsies/TURBT. Among 366 biopsies/TURBT specimens, data on adipose tissue presence, location, and quantity were analyzed. An initial analysis of 200 consecutive biopsies/TURBT specimens (including benign/cancer), adipose tissue was identified in 37% of 200 specimens (22% biopsies, 78% TURBT), primarily in the lamina propria (57%) or both lamina propria/muscularis propria (32%). A subsequent analysis of 183 invasive cancer (cT1/cT2) biopsies/TURBT revealed adipose tissue in 40% of specimens, predominantly within both the lamina propria and muscularis propria. Among all cT1/cT2 specimens, 26% (23/88) had cancer involving fat. Clinical follow-up on these putative “cT3” specimens revealed 10 patients who underwent radical cystectomy of which only 1 of 10 remained pT3/pT4 (although 8 patients had neoadjuvant chemotherapy). Adipose tissue is commonly found in biopsies/TURBT, predominantly localized in the lamina propria and sometimes extending into the muscularis propria. Importantly, the presence of tumor “invading” fat on biopsies/TURBT does not necessarily indicate pT3 disease. This underscores the need for standardized reporting practices, emphasizing the importance of reserving pathologic staging for cystectomy specimens. [ABSTRACT FROM AUTHOR]

Diffusion-weighted imaging (DWI) with an apparent diffusion coefficient (ADC) value is a relatively new magnetic resonance imaging (MRI) sequence that provides functional information on the lesion by measuring the microscopic movement of water molecules. While numerous studies have evaluated the promising role of DWI in musculoskeletal radiology, most have focused on tumorous diseases related to cellularity. This review article aims to summarize DWI-acquisition techniques, considering pitfalls such as T2 shine-through and T2 black-out, and their usefulness in interpreting musculoskeletal diseases with imaging. DWI is based on the Brownian motion of water molecules within the tissue, achieved by applying diffusion-sensitizing gradients. Regardless of the cellularity of the lesion, several pitfalls must be considered when interpreting DWI with ADC values in musculoskeletal radiology. This review discusses the application of DWI in musculoskeletal diseases, including tumor and tumor mimickers, as well as non-tumorous diseases, with a focus on lesions demonstrating T2 shine-through and T2 black-out effects. Understanding these pitfalls of DWI can provide clinically useful information, increase diagnostic accuracy, and improve patient management when added to conventional MRI in musculoskeletal diseases.

Cowper glands recognition remains one of the key histoanatomic benign mimics of prostatic adenocarcinoma. In most instances, these can be identified based on the dimorphic population of lobulated acini and duct(s). However, in the prostate biopsy setting with incomplete/distorted cores, this may not be immediately apparent and may warrant use of immunohistochemistry to argue against prostatic adenocarcinoma. Although immunohistochemical pitfalls in Cowper glands have been described, to our knowledge a comprehensive evaluation of both traditional and purportedly prostate-specific novel markers in Cowper glands has not been previously performed. Herein, we studied the clinicopathological and immunohistochemical features of 21 male patients (age range 39-81 years; mean = 63 years), including 15 prostate biopsies (7 of which also had prostate cancer in the same specimen set and 2 of which had both prostate cancer and Cowper glands in the same biopsy core). Immunohistochemistry showed the following results in Cowper glands: 100% positive for NKX3.1, 100% positive (basal cells) for both high molecular weight keratin and p63, 57% positive for PSAP, 25% positive for PSMA, 5% positive for AMACR, and 0% positive for PSA. In conclusion, for specimens lacking appreciable dimorphic morphology, caution should be rendered when using prostate-specific markers (PSA, PSAP, PSMA, and NKX3.1) as these can show considerable staining in Cowper glands and be a pitfall. Instead, findings from this cohort indicate relying on basal markers (high molecular weight keratin/p63; either individually or in a “cocktail” approach) and PSA are most useful in distinguishing Cowper glands (retained basal cell markers staining) from prostatic adenocarcinoma. [ABSTRACT FROM AUTHOR]

While the presence of adipose tissue and its involvement by prostatic cancer (extraprostatic extension) is well-recognized in prostate biopsies, adipose tissue in transurethral resections of the prostate (TURP) is largely unexplored. Herein, 200 consecutive TURPs and related specimens were reviewed, including a separate 3-year analysis of specimens containing prostatic cancer, with the following data collected: presence of fat, presence of cancer within fat, and quantity of fat. For specimens with both fat and prostatic cancer, specimen weight and tumor volume were recorded. Within the 200 consecutive TURPs and related specimens, adipose tissue was identified in 20%; 55% had 2.5 mm of adipose tissue; the number of fragments with adipose tissue ranged from 1 to 14. No correlation between specimen weight and measured extent of adipose tissue or number of fragments with adipose tissue was identified. Of all the specimens with prostatic cancer, 15/56 (27%) involved adipose tissue, with two specimens with large cancer volume (>90%) demonstrating extensive involvement of adipose tissue. Adipose tissue is frequently present within TURP and related specimens with variability in extent. The etiology behind encountering adipose tissue is uncertain, and it could represent resection into peri-prostatic fat, intraprostatic fat, or bladder neck fat sampling. Although encountering adipose tissue involved by cancer in TURP and related specimens may imply extraprostatic extension (pT3a), further studies are needed to corroborate these findings as well as to determine if these should be included in reported synoptics. [ABSTRACT FROM AUTHOR]

Abstract Background Trauma is a major cause of death among the working population. Many countries have now adopted a structured approach to trauma management in which ultrasound is used as a primary evaluation tool. While its use has direct therapeutic benefits, many artifacts and pitfalls are inherent to the technique. Knowledge of the most frequently encountered pitfalls in practice could thus help reduce the risk of error and lead to more accurate trauma assessments. Objective This study evaluates a potential pitfall caused by seminal vesicles during focused assessment with sonography for trauma examinations of the male pelvis performed by an emergency physician with experience in point-of-care ultrasound. Methods We took five static and five dynamic (3-s loops) transverse ultrasound images of the pelvis in five healthy males. The images and videos were then incorporated into an online survey and emailed through the World Interactive Network Focused On Critical UltraSound (WINFOCUS) in France and the Ultrasound and Emergency Medicine (UEM) Organization in Belgium. A questionnaire asked anonymous participants to assess the presence of free fluid in the static and dynamic images and to share information about their training and experience in point-of-care ultrasound. To validate the static and dynamic images, the survey was sent to three external radiologists for independent verification. Results A total of 191 individuals responded fully or partially to the survey, 114 of whom completed it. Among the 114 participants who completed the survey, the misinterpretation rate was 0.55 (95CI 0.51–0.60) for all static and dynamic ultrasound transverse pelvic views. The misinterpretation rate was 0.61 (95CI 0.55–0.66) and 0.50 (95CI 0.45–0.55) for static and dynamic ultrasound transverse pelvic views, respectively. The three external radiologists answered the questionnaire correctly without misinterpreting the survey ultrasound views. Conclusions Seminal vesicles are a potential pitfall when interpreting transverse ultrasound images of the male pelvis in the context of point-of-care ultrasound.

Prostate-specific membrane antigen (PSMA) PET/CT is a well-acclaimed imaging modality for prostate cancer (PCa). However, many reports have highlighted PSMA radioligand uptake in a variety of benign tumors and lesions. We report a case of PCa in which 68 Ga-PSMA-11 uptake was noted in the tracheal lumen. However, 18F-PSMA-1007 PET/CT was done on a subsequent day, which demonstrated no abnormal radiotracer uptake or morphological lesion within the tracheal lumen. This case highlights an uncommon finding of PSMA ligand uptake in a tracheal mucus plug (non-prostatic benign uptake), which may be misinterpreted as a false-positive finding. [ABSTRACT FROM AUTHOR]

We provide a list for the ants collected in the leaf litter, soil and vegetation of the Parque Estadual São Camilo, an important conservation unit of Atlantic Forest in Paraná, Brazil, and one of the oldest in the state. We report 108 species, of which eight species and two genera represent new records for Southern Brazil. Seven species are reported for the first time in Paraná. Our work is the first ant list for the western limit of the state, and reveals a surprisingly high number of species considering the extension of the study area. We highlight the importance of integrating different sampling techniques to explore ant diversity, and to conduct baseline studies in protected areas to document biodiversity. [ABSTRACT FROM AUTHOR]