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Risperidone is the first line of treatment for bipolar disorder, atypical depression, and Schizophrenia. We present a 55-year-old male with a history of schizoaffective disorder with bipolar type I presented with aggressive behavior and suicidal ideation. Our patient was treated with low-dose Risperidone; after that, he gradually developed leg pain and edema. His leg pain hampers his ambulation, which is clinically improved after a week of medication discontinuation; however, his leg edema did not resolve completely. In addition, we evaluated our patient's compliance with an empathic verbal interview that shows edema and leg pain hampers his quality of life. We have found that not informing edema as one of the possible side effects increases medication non-compliance in our case. There are several case reports about the side effect of Risperidone (such as leg edema) in combination with other medications, but there is no recommendation about patient counseling of forthcoming leg edema and mobility issues.

Tertiary lymphoid structure (TLS) is an ectopic lymphoid organ found in some tumors. The presence of TLS is recently proposed as a predictive biomarker for immune checkpoint inhibitors (ICI) in mutation-driven tumors. It is also associated with prognosis in copy number-driven tumors, including high grade serous ovarian cancer (HGSOC), although the function of TLS and its interaction with copy-number alterations in HGSOC is not fully understood. In the current study, we comprehensively analyze immune profile, copy number profile and quantitative imaging profile from 242 HGSOC patients (HH cohort), and combine these with two public single cell RNA-sequencing datasets (Lambrechts cohorts; n=9, 29,999 cells). TLS-high HGSOC patients show significantly better progression free survival in both HH and TCGA cohorts. We show that presence of TLS in HGSOC tumors is associated with B-cell maturation, resulting in higher and more specific immunoglobulin production; TLS also leads to more cytotoxic tumor-specific T-cells activation and proliferation. Through integrated analysis of single cell RNA-sequencing and whole exome sequencing data, we reveal that the copy number loss of IL15 and CXCL10 may limit TLS formation in HGSOC; we also propose a list of genes that may dysregulate TLS function. A candidate gene, DCAF15, is found to confer resistance to NK-mediated cytotoxicity in HGSOC cell lines. Lastly, we develop a radiomics-based signature to predict presence of TLS, which independently predicts PFS in both HGSOC patients and ICI-treated NSCLC patients. Overall, we reveal that TLS coordinates intratumoral B-cell and T-cell response against HGSOC tumor, while cancer genome evolves to counteract TLS formation and function. Citation Format: Haonan Lu, Georg Wengert, Hantao Lou, Reema Paudel, Naina Patel, Saral Desai, Bill Crum, Kristofer Linton-Reid, Mitchell Chen, Dongyang Li, Jacey Ip, Francesco Mauri, David J. Pinato, Andrea Rockall, Susan J. Copley, Sadaf Ghaem-Maghami, Eric O. Aboagye. Tumour and local lymphoid tissue interaction determines prognosis in high grade serous ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 600.

Introduction: The prevalence of cannabis use disorder (CUD) has increased in the US especially following its legalization in various states. Few studies have reported that CUD has been associated with increased Acute Myocardial Infarction (AMI) especially in the younger population. There are limited epidemiological studies that estimate the recent trend of AMI among young patients with CUD. Hypothesis: To estimate the hospitalization trends of AMI with concurrent CUD and characteristics associated with it in the young population. Methods: Study cohort was derived from the National Inpatient Sample (NIS) for the years 2007-2018. Hospitalizations due to AMI among the age group of 18-49 and concurrent CUD were identified using previously validated ICD-9-CM/ICD-10-CM. We then utilized the Cochran Armitage trend test and multivariable survey logistic regression modeling to analyze temporal trends and predictors of CUD among AMI patients. Results: Out of a total 819,354 hospitalizations due to AMI among the age group of 18-49 years, 33,488 (4.1%) had concurrent CUD. Hospitalizations due to AMI with concurrent CUD increased from 1722 (2.4%) in 2007 to 4455 (6.7%) in 2018 with a 12% yearly rate (OR 1.1; 95%CI 1.1-1.1; p Conclusions: Our study highlights the increasing trend of AMI hospitalizations with concurrent CUD. Our study also identifies that 18-34 years of age, male gender, African American and psychiatric conditions were significant determinants of CUD in young AMI patients. This warrants additional research to prove causal association between CUD and AMI in the young population in the era of increased cannabis legalization.

Background: Cannabis is one of the most extensively cultivated illicit drugs internationally. Its legalization and decriminalization in some states of the U.S. has increased its usage. Despite its widespread use, cannabinoid-related cerebrovascular disease is underreported. There are contradicting studies regarding the risk of Acute Ischemic Stroke (AIS) and its outcomes among cannabis users. Hypothesis: Our analysis estimates concurrent Cannabis Usage Disorder (CUD) trends among AIS patients and its impact on AIS outcomes. Methods: Study cohort was derived from the Nationwide Inpatient Sample (NIS) for the years 2007-2018. Hospitalizations due to AIS in the age group of 18-49 were identified using previously validated ICD-9-CM/ICD-10-CM codes. Cochran Armitage trend test and multivariable survey logistic regression modeling were then utilized to analyze temporal trends, predictors, and outcomes. Results: Out of a total 406,987 hospitalizations due to AIS from 2007-2018, 19,614 (4.82%) had concurrent CUD. AIS hospitalizations with concurrent CUD have increased from 3.3% in 2007 to 6.6% in 2018 with a yearly increase of 10% (OR 1.1; 95%CI 1.1-1.1; p Conclusion: Our results show that between 2007 and 2018, hospitalizations due to AIS with concurrent CUD has doubled. This association is significantly higher among 18-34 age group, males, African American, Western US and with concomitant psychiatric disorders. However, CUD was not associated with poor outcomes in AIS. Our study highlights underlying demographic trends and emphasizes the need for further studies to identify the causal association of cannabis use and AIS.

Although pica is commonly associated with nutritional deficiencies, it is also observed in psychiatric disorders such as obsessive-compulsive disorder and less commonly in schizophrenia. We describe a case of pica in a 34-year-old male with decompensated schizophrenia. Emergency medical services brought the patient from a state facility as he was scavenging and eating foreign objects. Upon initial evaluation, no notable nutritional deficiencies were noted. After surgical removal of foreign objects, he was started on antipsychotics. His pica was determined to be due to his active psychosis involving delusions, disorganized thought processes, and loosening of associations. His psychosis improved on paliperidone intramuscular injection and oral olanzapine, which coincided with reduction and resolution of pica. Our case highlights the need to understand further the exact psychopathology of pica that may not be limited to nutritional deficiencies.

Previous studies have suggested that some individuals experience neuropsychiatric symptoms following coronavirus disease 2019 (COVID-19) infection. We describe a case of new-onset psychosis following COVID-19 infection in a 55-year-old female with no prior psychiatric history. The patient started exhibiting symptoms of COVID-19 infection three weeks prior and was treated in the hospital with 4 L oxygen, dexamethasone 6 mg, and remdesivir therapy for seven days. Throughout her hospital stay, the patient had no neuropsychiatric symptoms. During her last week of stay, she was solely getting oxygen at home before presenting to the emergency department (ED) with severe psychosis. Her COVID-19 test in ED presentation was negative, and all potential etiologies for psychosis were ruled out. She was effectively treated for two weeks with 10 mg haloperidol and 1000 mg sodium valproate daily, followed by outpatient care. While variables such as a family history of bipolar disorder, psychosocial stressors, and steroid medication may have contributed to the patient's presentation, these circumstances alone did not result in neuropsychiatric symptoms in the past. COVID-19 infection may enhance the likelihood of developing neuropsychiatric problems on its own or amplify the effects of risk factors associated with an increased risk of psychosis. Neuropsychiatric consequences of COVID-19 infection may be under- or over-reported in individuals treated with steroids. Further research is necessary to identify individuals at risk of experiencing neuropsychiatric issues owing to COVID-19 infection and the prognosis.

Few case reports of catatonia associated with cannabis use are reported. Here, we describe a case of a 35-year-old African American male who developed malignant catatonia following heavy cannabis use. The patient was brought to the emergency department (ED) for altered mental status, hypertension, and erratic behavior. Before his ED presentation, he was smoking cannabis in heavy amounts, confirmed by positive urine toxicology in ED. Initial lab results showed leukocytosis, elevated creatine phosphokinase (CPK) levels. Head CT scans without contrast, including cerebrospinal fluid (CSF) analysis, were nonsignificant. In ED, the patient was agitated, combative, mute, and rigid. He was sedated using 2 mg of intramuscular (IM) midazolam. Psychiatric consultation services suspected catatonia, and the patient scored 12 points on Bush-Francis Catatonia Rating Scale (BFCRS). Although the patient’s symptoms responded to 2 mg of IM lorazepam, the patient later relapsed, became tachycardic with blood pressure fluctuations, and his repeat BFCRS score was 18. At this point, the patient was diagnosed as having malignant catatonia, and his lorazepam dosage was increased up to 6 mg IM per day. After a few days of waxing and waning of his symptoms, he finally started to show constant improvement and gradually reduced his symptoms. Our case highlights the first-ever reported case of malignant catatonia associated with cannabis use.

Background Although the relationship between sexual risk behaviors and substance use has been established, It remains to be studied if different types of substances have differences in the odds of sexual risk behaviors. Therefore, we aimed to identify the prevalence of sexual risk behaviors in high school students of the United States (US) and study the difference in the odds of sexual risk behaviors for various substances. Methods We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) data of 2019 that nationally represents US high school students in grades 9-12. We identified individuals with sexual risk behaviors as participants with four or more lifetime sexual partners and who did not use a condom during the last intercourse. Results Out of 11,191 participants, 463 (3.9%) engaged in sexual risk behaviors. The prevalence of substance use, including anabolic steroids (11.5 vs. 1.1%), cocaine (27.2 vs. 2.0%), marijuana (87.1 vs. 34.7%), alcohol (92.4 vs. 54.3%), e-cigarette (90.3 vs. 48.0%), and traditional cigarette (62.2 vs. 21.6%) was higher in participants with sexual risk behaviors compared to participants with no sexual risk behaviors (p

Few existing cases of closed-eye visual hallucinations have been reported. These rare perceptual disturbances are distinct from open-eye visual hallucinations, as observed in Charles Bonnet syndrome. This case report discusses a 35-year-old male who presented with closed-eye visual hallucinations 24 hours before severe alcohol withdrawal. On initial presentation, the patient denied auditory or visual hallucinations. The day before the onset of severe alcohol withdrawal, the patient reported vivid, colorful, and lifelike visual hallucinations with his eyes closed which disappeared with eyes open. The hallucinations consisted of cartoon characters such as Daffy Duck, a lifelike blond woman with curly hair, and a tree-covered landscape. The patient endorsed awareness that the hallucinations were not real. The next day, the patient became acutely delirious with rapid onset of agitation, space-time disorientation, open-eye visual hallucinations, and emotionally disturbing illusions. The patient was promptly transferred to the intensive care unit (ICU) to manage severe alcohol withdrawal, including administration of intravenous sedation. During follow-up evaluation, the patient retained a clear memory of the closed-eye hallucinations. However, he had no recollection of the ICU course. Several etiologies were considered, including alcohol withdrawal complicated by polysubstance withdrawal and acute hepatitis, which resolved following pharmacological treatment. To the best of our knowledge, this is the first case report of its kind. Additional research is required to elucidate the etiology, mechanism, and clinical implications of closed-eye visual hallucinations.

In this review, we first present a case of chronic myeloid leukemia with acute psychosis, and then we will discuss the incidence of cancer in patients with psychotic disorders, the manifestations of new-onset psychosis, and the prevalence of preexisting psychosis in cancer patients, coupled with their impact on the treatment, diagnosis, and prognosis of cancer. This was a case that presented with acute psychosis and was found to have an elevated white blood cell count upon admission to an inpatient psychiatric unit. He was diagnosed with chronic myeloid leukemia and successfully managed with imatinib/dasatinib therapy. Psychiatrically, he was stabilized on two long-acting injectable medications to help maintain adherence. We were able to eliminate his active psychotic symptoms and return him to normal functioning in affect and thinking, achieving sustained compliance with treatment. We identified multiple inconsistencies in screening for cancer of all types in these patients, masking of signs and symptoms that would typically clue physicians to the presence of cancers, underreporting of symptoms, and disparate access to healthcare resources in patients with mental disorders when compared to the general population. Treatment of cancer in these patients as compared to the general population has also been shown to be incongruent, which will be elaborated upon. Psychiatric interventions, as well as supportive measures, for treating patients who are facing challenges during active cancer treatment will be discussed.

We aimed to evaluate the prevalence and trend of identifying as a sexual minority among the American adolescent population. Additionally, we aimed to evaluate the prevalence and odds of substance abuse, hopelessness, and suicidality among the sexual minority adolescents compared to their heterosexual peers.We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) data from 2015 to 2019. YRBSS divides "Sexual identity" into three groups: heterosexuals, sexual minorities (gay or lesbian or bisexual), and unsure. We identified "hopelessness and suicidality" using the survey questions exploring if participants felt sad or hopeless for2 weeks, considered suicide, made a suicide plan, and attempted suicide requiring medical care. Univariate and multivariable survey logistic regression analyses were performed to establish an association between hopelessness, suicidality, substance abuse, and identifying as a sexual minority.Out of 41,377 adolescents, 4055 (9.8%) identified as a sexual minority. An increasing percentage of adolescents identified themselves as a sexual minority between 2015 to 2019 (8% to 11.2%) (pTrend0.0001). The sexual minority had a higher prevalence of feeling sad and hopeless (63.4 vs. 28.6%), considering suicide (46 vs. 14.2%), planning suicide (38.9 vs. 11.5%), attempting suicide, and having injurious suicide attempts compared to heterosexuals. (p0.0001) Amongst sexual minorities, the prevalence of substance abuse was higher compared to their heterosexual peers, which includes cigarettes (15 vs 7.8%), e-cigarette (27.2 vs 23.2%), inhalants (14.1 vs 5.3%), cocaine (8.4 vs 3.9%), marijuana (31.2 vs 20.2%), alcohol (36.9 vs 30.3%), steroids (6.4 vs 2.2%), heroin (4.4 vs 1.2%), and injectable drugs (4.0 vs 1.1%) (p0.0001). In regression analysis, the sexual minority had higher odds of substance abuse, feeling sad and hopeless (aOR:4.6; 95%CI:4.0-5.2; p0.0001), considering suicide (3.2; 2.8-3.7; p0.0001), planning suicide (2.0; 1.7-2.3; p0.0001) compared to heterosexual.Sexual minorities not only have higher prevalence and odds of hopelessness and suicidality but also have higher prevalence and odds of substance abuse like cigarettes, marijuana, cocaine, heroin, inhalants, and steroids. Hence, early identification, risk stratification, and interventions to reduce mental health disparities are needed.

Background Although the relationship between risky sexual behaviors and substance use has been established, the interplay between different types of substances and risky sexual behaviors needs further exploration. We aimed to identify the prevalence of risky sexual behavior in US high school students and study the difference in the association of risky sexual behaviors with substance use mediated by the type of substances. Method We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) 2019 data that nationally represents US high school students in grades 9–12. We identified risky sexual behaviors as participants with four or more lifetime sexual partners who did not use a condom during intercourse. Results Out of 11,191 participants, 463 (3.9%) engaged in risky sexual behavior. 17- year old (37.1% vs. 23.0% ;p = 18-year old (26.0% vs. 12.8% ;p

A case of transfusion-dependent anemia in a simultaneous pancreas and kidney (SPK) transplant recipient that masqueraded as gastrointestinal bleeding (GIB) is described. The anemia was attributed to bleeding from the donor duodenal cuff based on balloon enteroscopy findings. The patient underwent multiple contrast-enhanced computed tomography scans and multiple endoscopies with confounding features until, eventually, the diagnosis was established. We discuss the diagnostic difficulties and the therapeutic dilemma, along with the pitfalls in ascertaining the final diagnosis.

The aim of our study was to evaluate chemopreventive efficacy and possible mechanism of most abundant polyphenolic fraction in black tea, polymeric black tea polyphenols (PBPs), in experimental lung carcinogenesis model. Effect of 1.5% black tea derived PBPs on benzo(a)pyrene [B(a)P] and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) induced lung lesions were studied over 28 wks. Chemopreventive efficacy was studied using decrease in tumor incidence and/or multiplicity and/or delay in the latency period in A/J mice. Histopathological analysis of lung was carried out post-carcinogen treatment weeks to analyze the microscopic lung lesions. Inflammation, cell proliferation, and apoptosis markers along with signaling kinases like p38, Akt, and their phosphorylated forms were studied using immunoblotting and immunohistochemistry at 4th, 10th, and 18th wk post-carcinogen treatment. Administration of PBPs throughout the treatment period significantly decreased the multiplicity of surface tumors as well as microscopic lung lesions, including adenomas. Although tumor incidence and latency period remains unaffected, histopathological evaluation of lung at 6, 10, and 18 wks post- carcinogen treatment period showed decrease in tumor multiplicity which was also correlated with different molecular markers. Anti- inflammatory action of PBPs was demonstrated by reduced Cox-2 expression. PBPs down-regulated the B(a)P and NNK-induced cell proliferation (diminished PCNA expression, proliferation index, and Bcl-2 expression) and enhanced apoptosis (increased Bax expression and apoptotic index) potentially through phosphorylation of p38 and Akt. PBPs, most abundant polyphenolic component in the black tea, have chemopreventive effect through inhibition of inflammation, cellular proliferation, and induction of apoptosis possibly via modulation of signaling kinases. © 2016 Wiley Periodicals, Inc.

Case history: a nine-year-old male German Shepherd Dog presented with a history of progressively enlarged abdomen, shallow breathing and uncoordinated gait. A large abdominal mass, causing huge pressure on the surrounding organs and abdominal distension, was observed on physical examination. Imaging findings: contrast-enhanced computed tomography (CECT) showed two isoattenuating masses originating from the tail of the spleen, depicting hypoattenuating cystic areas with enhancement of solid structures on contrast administration: a characteristic finding of cavernous splenic haemangioma. The dog underwent a successful complete splenectomy and was followed up for next six months. Histopathology findings: haematoxylin and eosin staining showed vascular channels lined by well-differentiated endothelial cells with a low mitotic rate, suggestive of cavernous haemangioma. Immunohistochemical (IHC) staining was performed for CD34, vimentin, HMB-45, AE1/AE3 and epithelial membrane antigen; the expression of CD34 and vimentin endothelial markers confirmed the diagnosis of splenic haemangioma. Diagnosis: cavernous haemangioma of the spleen. Clinical relevance: it is rare to have a massive lesion on the spleen presenting as a giant abdominal mass in dogs. The location and nature of such a mass is difficult to diagnose by radiography and ultrasonography owing to its large size. CECT was found to be reliable to characterise the mass morphologically, and CT played a significant role in diagnosis and surgical management. The diagnosis was confirmed by IHC.

Background and Objective The rarity of Ewing sarcoma (ES) of the jaw coupled with the technical challenge of resection and associated functional and cosmetic impairment has resulted in deficient data on surgical management of these tumors. The purpose of this study is to describe the results of surgical excision and reconstruction of primary non-metastatic ES of the mandible and maxilla in children. Methods Consecutive patients (mandible = 6, maxilla = 5) treated with surgery from August 2005 to January 2013 were selected. All patients received induction chemotherapy and were selected for surgical resection based on the presence of specific criteria for operability. Results The median age was 11.5 years (range 5–16 years). Free fibular osteocutaneous flap was commonly used for reconstruction. There were no complications related to microvascular anastomosis or flap loss. Five patients had 100% tumor necrosis and did not receive radiotherapy. Teeth alignment, chewing, swallowing, and speech were normal in all and donor site morbidity occurred in one. The 5-year overall, event-free survival, and local control are 87.5%, 72.9%, and 90%, respectively. Conclusion In eligible patients, surgery with contemporary reconstruction results in optimal oncological and functional outcome. Surgery also has the added advantage of identifying patients who may not need radiotherapy. J. Surg. Oncol. 2014 110:689–695. © 2014 Wiley Periodicals, Inc.

Background: Periosteal osteosarcoma is an uncommon variant of osteosarcoma which constitutes less than 2% of all osteosarcomas. Whereas adequate surgical excision remains the cornerstone of treatment, the role of chemotherapy in this tumor is still unclear. Existing literature contains very few single center studies on the outcomes for periosteal osteosarcomas and any additional information will help in better understanding of these uncommon lesions. This study aims to evaluate the oncologic and functional outcomes of treatment of periosteal osteosarcoma treated at our institute. Materials and Methods: A retrospective analysis of 18 cases of periosteal osteosarcoma treated between January 2001 and December 2010 was carried out. There were 12 males and 6 females. The mean age at presentation was 16.3 years (range 5-26 years). Tibia and femur were the most common sites ( n = 8). 16 of 18 patients received chemotherapy, 16 had limb sparing resection, one had an amputation and one had rotationplasty. Of the 16 patients with limb salvage, conventional wide excision was done in 11 cases. In 5 cases tumor was excised with hemicortical excision. Of the 11 cases treated with wide excisions, 4 patients underwent an osteoarticular resection and in 7 patients a joint preserving segmental intercalary resection was done. Results: All patients were available for followup. Surgical margins were free in all patients. A good response to chemotherapy was seen in 4/11 cases and poor in 6/11 cases. In one case the histological response was not discernible due to predominant chondromyxoid nature of the tumor. The median followup was 61 months (range: 18-130 months). There were two local recurrences (11%) at 9 and 18 months postsurgery. Pulmonary metastasis subsequently occurred in 4 cases (22%). Fourteen patients are currently alive and continuously disease free. Disease free survival at 5 years was 77.8% and overall survival (OVS) was 83.3%. Patients without marrow involvement had a better OVS at 5 years when compared with patients with marrow involvement (90% vs. 75%) ( P = 0.23). Conclusion: Surgical excision remains the mainstay of treatment. Intramedullary involvement may suggest aggressive disease biology. The role of chemotherapy is still debatable and multicenter studies are needed to provide guidelines.

The advancement in diagnostic techniques has resulted in increased incidence of occult second primary in cancer patients. Here, we report a case of symptomatic oesophageal carcinoma and synchronous asymptomatic colon carcinoma diagnosed through Positron Emission Tomography-Computed Tomography imaging.

Melanocytic nevi measuring or predicted to measure >20 cm by adulthood are called giant congenital melanocytic nevi (CMN). Giant CMN are uncommon birthmarks occurring in about one out of every 200,000– 500,000 births, with slight female preponderance. Such giant CMNs carry substantial risk of malignant change and are also associated with many serious conditions like neurocutaneous melanosis. Malignant melanoma is the most common malignancy arising within such nevi, and rhabdomyosarcoma is one of the rare but usually fatal malignancies arising within giant CMNs. We report a case of alveolar rhabdomyosarcoma arising in a giant CMN in an adult with fatal outcome, and review the literature.

Spontaneous coronary artery dissection is a rare cause of death seen largely in young women, with many cases occurring in the early postpartum period. Nine cases with this condition were examined from our histopathology records comprising 6 women and 3 men with an age range of 26 to 47 years. All deaths were sudden, and only one patient complained of chest pain and she was 8 weeks postpartum. All cases showed dissection macroscopically, though 4 of the 6 cases, which were sent for a second opinion, were described as having normal coronaries by the referring pathologists. One heart seemed to have postmortem coronary artery thrombus and dissection was difficult to discern on gross examination. All cases were examined histologically and confirmed acute dissection of the coronary arteries, with more than 2 arteries affected in 2 cases. Histologic features of myocardial ischemia/infarction were noted in 4 cases so the explanation for the sudden death in the other 4 cases remains a possible fatal arrhythmia. The macroscopic changes in the heart of acute coronary artery dissection can be difficult to detect and can be easily mistaken for postmortem clot or a thrombus overlying an atheromatous plaque. All such cases with thrombus in the arteries, even the normal-looking coronary arteries, in young adults should be examined microscopically for dissection

Primary leiomyosarcoma of bone is a rare and a diagnostically challenging tumor entity. Over a 7-year period, we identified 8 such cases that fulfilled the diagnostic criteria in 6 men and 2 women, with age ranging from 25 to 59 years (mean, 42.7 years). All cases were noted in the lower limbs, including femur and tibia as the commonly involved bones in 4 and 3 cases, respectively. On radiography, the most consistent feature was a solitary osteolytic lesion with cortical destruction, unassociated with matrix formation. On histopathology, all cases showed spindly sarcomatous cells, mostly arranged in fascicles and whorls. Of 8 cases, 6 (75%) were of high grade. Prominent vasculature was noted in 5 cases. Two cases displayed focal mineralization, including calcification and heterotropic woven bone formation in 1 case each, but lacked malignant osteoid or chondroid matrix. One case showed osteoclast-like giant cells. On immunohistochemistry, smooth muscle actin was diffusely positive in all cases (100%), desmin was positive in 6 (75%) of 8 cases, and h-caldesmon was positive in 5 (83.3%) of 6 cases. Five cases underwent surgery, including 3 amputations and 2 wide excisions. One case underwent chemotherapy. On follow-up, 5 cases developed metastasis, including 1 case with another, who died within 17 and 5 months. Leiomyosarcoma of bone is uncommon and diagnostically challenging. An index of suspicion is necessary for this diagnosis, especially in cases of lytic, destructive bone lesions, unassociated with matrix production, that show spindly sarcomatous cells on histopathology. Immunohistochemical analysis, including an optimum panel formed by smooth muscle actin (diffuse positivity), desmin, and h-caldesmon, is necessary for substantiating this diagnosis. Surgery forms the treatment mainstay. The prognosis appears to be dismal.

Pleuropulmonary synovial sarcoma is a rare malignancy that often presents like any other thoracic tumor with symptoms such as chest pain or cough. Here we describe 4 young adults who underwent surgery for apparently benign recurrent pneumothoraces and who, unexpectedly, were found upon histologic and molecular examination of the resection specimen to have cystic primary pleuropulmonary synovial sarcoma. These cases highlight (a) the importance of cytogenetic analysis in making the diagnosis, as confusion with other spindle cell sarcomas or cystic neoplasms can occur and (b) the importance of thorough examination of all resected tissue in cases of recurrent pneumothorax.

Ewing’s sarcoma/PNET are small round cell tumors showing a varying degree of neuroectodermal differentiation. They are one of the commonest tumors of childhood and occur in bone and within soft tissues. Traditionally, light microscopy with the aid of immunohistochemical stains was suitable for diagnosis. But now translocation analyses are being used not only for the diagnosis and classification of small round cell tumors, but to ascertain their prognostic significance, detect micrometastasis, and monitor minimal residual disease, with potential for targeted therapy. This article analyzes the pathology, biology, and molecular aspects of Ewing’s sarcoma/PNET and discusses their clinical and therapeutic implications.

Desai S, Dusmet M, Ladas G, Pomplun S, Padley S P G, Griffin N, Badreddine J, Goldstraw P & Nicholson A G (2010) Histopathology 57, 121–127 Secondary vascular changes in pulmonary sequestrations Aims: Whilst parenchymal changes in pulmonary sequestrations are well described, there are comparatively little data on associated vascular changes and their extent. The aim of this study was to retrospectively review morphological changes within sequestrations, concentrating on vascular changes and associations with clinical parameters. Methods and results: Twenty-seven resected cases of sequestrations (intralobar n = 20, extralobar n = 7) showed a male predominance (n = 16) and an age range of 2 months–60 years (average 13 years). Plexogenic vascular changes (medial hypertrophy and intimal fibrosis) were seen in 15 of 27 cases, as well as plexiform lesions in seven cases. Patients with plexogenic changes had a higher mean age compared with those lacking vascular changes (19 versus 6 years) and were more commonly female. Respiratory tract infections were associated solely with intralobar sequestrations. No other associations between presenting symptoms and histopathological parameters were identified. Adjacent lung showed lesser plexogenic changes in six of 22 intralobar cases. There were features of type 2 congenital cystic adenomatoid lesions in 63% of cases. Dissection of the supplying systemic artery (n = 1), intralesional aspergilloma (n = 1) and coexistent lymphangiomatosis (n = 1) were also identified. Conclusions: Hypertensive vascular changes are not uncommon in both intrapulmonary and extrapulmonary sequestrations, although their relative severity seems unrelated to presenting symptoms.

Objective: To characterise the demographics and aetiology of sudden cardiac death (SCD) in athletes referred to a tertiary cardiac pathology centre in the UK. Design: Retrospective non-case controlled analysis. Setting: Cardiac pathology centre at the National Heart and Lung Institute and Royal Brompton Hospital. Subjects: Between 1996 and 2008, the hearts of 118 athletes were referred for pathological assessment to ascertain the precise aetiology of SCD. Results: The majority of athletes (n = 113; 96%) were male and most (107; 91%) were amateurs participating predominantly in football, rugby and running. The mean (SD) age of death was 28 (12) years (range 7–59); 75% athletes were aged ⩽35 years. Most deaths (81%) occurred during or immediately after exercise. Antecedent symptoms of cardiac disease were reported in 21 (18%) subjects, and 20 (17%) had a family history of premature cardiovascular disease and/or SCD. 25 (21%) athletes had relevant past medical history which included a known history of cardiac disease. Cardiomyopathy was the commonest cause of death and accounted for 62% of all the SCDs. A significantly high proportion of athletes (23%) exhibited a morphologically normal heart. Atherosclerotic coronary disease accounted for only 3% of cases and was confined to athletes aged >35 years. Conclusions: SCD in sport is largely due to clinically silent cardiomyopathies or primary electrical disorders (morphologically normal heart). Antecedent symptoms and family history are absent in over 80% of cases, and therefore clinical screening with health questionnaires will fail to identify most athletes with potentially sinister cardiac disorders.

The aim of our study was to evaluate chemopreventive efficacy and possible mechanism of most abundant polyphenolic fraction in black tea, polymeric black tea polyphenols (PBPs), in experimental lung carcinogenesis model. Effect of 1.5% black tea derived PBPs on benzo(a)pyrene [B(a)P] and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) induced lung lesions were studied over 28 wks. Chemopreventive efficacy was studied using decrease in tumor incidence and/or multiplicity and/or delay in the latency period in A/J mice. Histopathological analysis of lung was carried out post-carcinogen treatment weeks to analyze the microscopic lung lesions. Inflammation, cell proliferation, and apoptosis markers along with signaling kinases like p38, Akt, and their phosphorylated forms were studied using immunoblotting and immunohistochemistry at 4th, 10th, and 18th wk post-carcinogen treatment. Administration of PBPs throughout the treatment period significantly decreased the multiplicity of surface tumors as well as microscopic lung lesions, including adenomas. Although tumor incidence and latency period remains unaffected, histopathological evaluation of lung at 6, 10, and 18 wks post- carcinogen treatment period showed decrease in tumor multiplicity which was also correlated with different molecular markers. Anti- inflammatory action of PBPs was demonstrated by reduced Cox-2 expression. PBPs down-regulated the B(a)P and NNK-induced cell proliferation (diminished PCNA expression, proliferation index, and Bcl-2 expression) and enhanced apoptosis (increased Bax expression and apoptotic index) potentially through phosphorylation of p38 and Akt. PBPs, most abundant polyphenolic component in the black tea, have chemopreventive effect through inhibition of inflammation, cellular proliferation, and induction of apoptosis possibly via modulation of signaling kinases. © 2016 Wiley Periodicals, Inc.

Background Adamantinoma is a rare tumor of long bones that can be mistaken for a carcinoma, and numerous other lesions such as myoepithelial tumor, malignant mixed tumor of bone, fibrous dysplasia/osteofibrous dysplasia, and vascular tumors. Methods The histology and clinical features of 12 cases accrued from the surgical pathology files over a period of 23 years were analyzed. Results Of the 12 cases, 4 were men and 8 women, with a mean age of 30 years. Radiologically the tumor presented as a lytic, eccentric, intracortical lesion in the tibia. The histology revealed epithelial islands with basaloid, spindle, and squamous features on a background of fibrotic stroma. Three patients came back with local recurrences, and one of them developed pulmonary metastasis. Discussion In this article, an attempt is made to study the morphology, biology, and the differential diagnoses of adamantinoma of long bones. J. Surg. Oncol. 2006;93:429–433. © 2006 Wiley-Liss, Inc.

Primary musculoskeletal myoepithelial tumors (METs) are distinctly rare tumors and are being increasingly recognized as a result of improved diagnostic criteria and objective confirmation with immunohistochemical markers, including epithelial markers. Recent studies have unraveled distinct molecular mechanisms underlying these tumors. Herein, we present our second diagnosed case of an intraosseous MET that occurred in the tibia of a 37-year-old lady. The case is discussed with regards to current clinicopathological perspectives on these rather uncommon tumors, including our personal experience.

Giant cell tumors of bone are known for their unpredictable behavior characterized occasionally even by metastases. Most metastases lodge in the lungs but other rare sites are regional lymph nodes, mediastinum, skin, scalp and the pelvis. In this case report we document a case of giant cell tumor of the patella in which, associated with local recurrence, there were simultaneous metastases to lymph nodes and lungs.

Chondromyxoid fibroma (CMF) can be confused with a malignant tumor because of its potential for recurrence and occasional nuclear atypia. This study of 10 cases of CMF comprises 6 men and 4 women, with a mean age of 24.3 years. Tibia was the preferred site of involvement. The histology showed lobulated chondromyxoid matrix with peripheral fibrosis. Two cases had local recurrences following intralesional excision. The study emphasizes that despite nuclear atypia and recurrences, CMF is a benign disease.

Pulmonary adenofibroma is a rare benign biphasic tumor of the lung composed of epithelial and stromal components. We report 3 cases of this unusual lesion of lung in a male (25 years old) and 2 female (40 and 55 years old) patients. Breathlessness on exertion and mild left-sided chest pain of 1 month's duration were the main concerns in 2 patients, whereas the third had cough and hemoptysis for 3 months. Chest radiograph and computed tomography scan revealed a well-circumscribed, subpleural homogenous mass in left lower chest fields in 2 cases and solid-cystic lesion in left upper lobe in the third patient. All 3 patients underwent lobectomy, following biopsy in 2 cases. Histology revealed a well-circumscribed lesion composed of complex glandlike spaces lined by cuboidal to columnar epithelium surrounded by a hyalinized spindle-cell fibroblastic proliferation reminiscent of adenofibroma of the female genital tract or fibroadenoma of the breast. Immunohistochemical examination supported the diagnosis of a benign pulmonary adenofibroma. All 3 patients were are alive and doing well with no evidence of recurrent or metastatic disease. Diagnosis on biopsy can be challenging and may be misinterpreted as well-differentiated adenocarcinoma with extensive fibrosis or low-grade sarcoma. Frozen-section consultation will be a valuable adjunct in planning for limited lung resection of this benign lung lesion. Although we described 3 cases of pulmonary adenofibroma, still this is the largest published series of this rare entity till date. The possible histogenesis and various differential diagnoses are discussed along with literature review.