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Angeline J, Siva Kailash A, Karthikeyan J, Karthika R, Saravanan V. Automated Prediction of Malignant Melanoma using Two-Stage Convolutional Neural Network. Arch Dermatol Res 2024; 316:275. [PMID: 38796546 DOI: 10.1007/s00403-024-03076-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 01/22/2024] [Accepted: 04/26/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE A skin lesion refers to an area of the skin that exhibits anomalous growth or distinctive visual characteristics compared to the surrounding skin. Benign skin lesions are noncancerous and generally pose no threat. These irregular skin growths can vary in appearance. On the other hand, malignant skin lesions correspond to skin cancer, which happens to be the most prevalent form of cancer in the United States. Skin cancer involves the unusual proliferation of skin cells anywhere on the body. The conventional method for detecting skin cancer is relatively more painful. METHODS This work involves the automated prediction of skin cancer and its types using two stage Convolutional Neural Network (CNN). The first stage of CNN extracts low level features and second stage extracts high level features. Feature selection is done using these two CNN and ABCD (Asymmetry, Border irregularity, Colour variation, and Diameter) technique. The features extracted from the two CNNs are fused with ABCD features and fed into classifiers for the final prediction. The classifiers employed in this work include ensemble learning methods such as gradient boosting and XG boost, as well as machine learning classifiers like decision trees and logistic regression. This methodology is evaluated using the International Skin Imaging Collaboration (ISIC) 2018 and 2019 dataset. RESULTS As a result, the first stage CNN which is used for creation of new dataset achieved an accuracy of 97.92%. Second stage CNN which is used for feature selection achieved an accuracy of 98.86%. Classification results are obtained for both with and without fusion of features. CONCLUSION Therefore, two stage prediction model achieved better results with feature fusion.
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Shukla MM, Tripathi BK, Dwivedi T, Tripathi A, Chaurasia BK. A hybrid CNN with transfer learning for skin cancer disease detection. Med Biol Eng Comput 2024:10.1007/s11517-024-03115-x. [PMID: 38760598 DOI: 10.1007/s11517-024-03115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/22/2024] [Indexed: 05/19/2024]
Abstract
The leading cause of cancer-related deaths worldwide is skin cancer. Effective therapy depends on the early diagnosis of skin cancer through the precise classification of skin lesions. However, dermatologists may find it difficult and time-consuming to accurately classify skin lesions. The use of transfer learning to boost skin cancer classification model precision is a promising strategy. In this work, we proposed a hybrid CNN with a transfer learning model and a random forest classifier for skin cancer disease detection. To evaluate the efficacy of the proposed model, it was verified over two datasets of benign skin moles and malignant skin moles. The proposed model is able to classify images with an accuracy of up to 90.11%. The empirical results and analysis assure the feasibility and effectiveness of the proposed model for skin cancer classification.
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Amante MF. Hepatic perivascular epithelioid cell tumors: Benign, malignant, and uncertain malignant potential. World J Gastroenterol 2024; 30:2374-2378. [PMID: 38764772 PMCID: PMC11099397 DOI: 10.3748/wjg.v30.i18.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/20/2024] [Accepted: 04/25/2024] [Indexed: 05/11/2024] Open
Abstract
In 2013, the World Health Organization defined perivascular epithelioid cell tumor (PEComa) as "a mesenchymal tumor which shows a local association with vessel walls and usually expresses melanocyte and smooth muscle markers." This generic definition seems to better fit the PEComa family, which includes angiomyolipoma, clear cell sugar tumor of the lung, lymphangioleiomyomatosis, and a group of histologically and immunophenotypically similar tumors that include primary extrapulmonary sugar tumor and clear cell myomelanocytic tumor. Clear cell tumors with this immunophenotypic pattern have also had their malignant variants described. When localizing to the liver, preoperative radiological diagnosis has proven to be very difficult, and most patients have been diagnosed with hepatocellular carcinoma, focal nodular hyperplasia, hemangioma, or hepatic adenoma based on imaging findings. Examples of a malignant variant of the liver have been described. Finally, reports of malignant variants of these lesions have increased in recent years. Therefore, we support the use of the Folpe criteria, which in 2005 established the criteria for categorizing a PEComa as benign, malignant, or of uncertain malignant potential. Although they are not considered ideal, they currently seem to be the best approach and could be used for the categorization of liver tumors.
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Pappas TC, Roy Choudhury M, Chacko BK, Twiggs LB, Fritsche H, Elias KM, Phan RT. Neural network-derived multivariate index assay demonstrates effective clinical performance in longitudinal monitoring of ovarian cancer risk. Gynecol Oncol 2024; 187:21-29. [PMID: 38703674 DOI: 10.1016/j.ygyno.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/28/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE We recently characterized the clinical performance of a multivariate index assay (MIA3G) to assess ovarian cancer risk for adnexal masses at initial presentation. This study evaluated how MIA3G varies when applied longitudinally to monitor risk during clinical follow-up. METHOD The study evaluated women presenting with adnexal masses from eleven centers across the US. Patients received an initial blood draw at enrollment and at the standard-of-care follow-up visits. MIA3G was determined for all visits but physicians did not have access to MIA3G scores to determine clinical management. The primary outcome was the relative change value (RCV) of MIA3G over the period of clinical observation. RESULTS A total of 510 patients of 785 enrolled met study criteria. Of these, 30.8% had a second, 25.4% a third and 22.2% a fourth blood draw following initial collection. The median duration from initial draw was 131 d to second draw, 301.5 d to the third draw and 365.5 d to the fourth draw. MIA3G RCV of >50% was observed in 22-26% patients, whereas 70-75% patients had MIA3G RCV >5%. An empirical baseline RCV of 56% - transformed to 1 in logarithmic scale - was calculated from averaging RCVs of all patients who had no malignancy risk after 210 days. RCV > 1 log was associated with higher incidence of surgical intervention (29.6%) compared to RCV < 1 log (16.9%). CONCLUSIONS Variation in MI3AG does not change the accuracy of the test for excluding malignancy, while marked changes may be associated with a slightly higher likelihood of surgical intervention. In addition to MIA3G score itself, the MIA3G RCV may be important for clinical management.
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Kawaguchi M, Kato H, Furui T, Noda Y, Hyodo F, Miyazaki T, Matsuo M. MRI findings of malignant transformation arising from mature cystic teratoma of the ovary: comparison with benign mature cystic teratoma. Jpn J Radiol 2024; 42:500-507. [PMID: 38146022 PMCID: PMC11056338 DOI: 10.1007/s11604-023-01521-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of MRI findings to differentiate malignant transformation arising from mature cystic teratoma (MT-MCT) of the ovary from benign mature cystic teratoma (BMCT). MATERIALS AND METHODS This study included 11 patients with histopathologically proven MT-MCT and 50 with BMCT. Overall, 7 patients with MT-MCT and all 50 with BMCT underwent unenhanced and contrast-enhanced MRIs and 4 with MT-MCT only underwent unenhanced MRIs. The MRI findings were evaluated and compared between the two diseases. RESULTS The median age (55 vs. 38 years, p < 0.01) and maximum diameter (109 vs. 65 mm, p < 0.01) were higher in MT-MCT than in BMCT. Fat component occupancy was lower in MT-MCT than in BMCT (median, 5% vs. 63%, p < 0.01). Only MT-MCT exhibited irregular tumor margins (64%), peritoneal dissemination (18%), and abnormal ascites (27%). The solid components were more commonly observed in MT-MCT than in BMCT (100% vs. 32%, p < 0.01) on contrast-enhanced images. The maximum diameter of solid components in MT-MCT was larger than that in BMCT (median, 61 mm vs. 14 mm, p < 0.01). In MT-MCT, the common configuration of solid components was endophytic or exophytic sessile (85%), whereas in BMCT, it was endophytic papillary (88%). CONCLUSION Compared with BMCT, MT-MCT demonstrated a larger maximum diameter, lower occupancy rate of fat components, and sessile solid components. The characteristic configuration of solid components was endophytic or exophytic sessile in MT-MCT and endophytic papillary in BMCT.
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King HL, Benedetti GB, Keller JJ, DeLoughery TG, Shatzel JJ, Martens KL. Dermatologic manifestations of hematologic disorders. Ann Hematol 2024:10.1007/s00277-024-05761-5. [PMID: 38662204 DOI: 10.1007/s00277-024-05761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.
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Puhlmann N, Olsson O, Kümmerer K. How data on transformation products can support the redesign of sulfonamides towards better biodegradability in the environment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 921:171027. [PMID: 38378053 DOI: 10.1016/j.scitotenv.2024.171027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 02/22/2024]
Abstract
Sulfonamide antibiotics (SUAs) released into the environment can affect environmental und human health, e.g., by accelerating the development and selection of antimicrobial resistant bacteria. Benign by Design (BbD) of SUAs is an effective risk prevention approach. BbD principles aim for fast and complete mineralization or at least deactivation of the SUA after release into the aquatic environment. Main objective was to test if mixtures of transformation products (TPs) generated via photolysis of SUAs can be used as an efficient way to screen for similarly effective but better biodegradable SUA alternatives. Six SUAs were photolyzed (Hg ultraviolet (UV) light), and generated UV-mixtures analysed by high performance liquid chromatography coupled to an UV and tandem mass spectrometry detector. UV-mixtures were screened for antibiotic activity (luminescence bacteria test, LBT, on luminescence and growth inhibition of Aliivibrio Fischeri) and environmental biodegradability (manometric respirometry test, MRT, OECD 301F) using untreated parent SUAs in comparison. Additionally, ready environmental biodegradability of three commercially available hydroxylated sulfanilamide derivatives was investigated. SUA-TPs contributed to acute and chronic bacterial luminescence inhibition by UV-mixtures. LBT's third endpoint, growth inhibition, was not significant for UV-mixtures. However, it cannot be excluded for tested TPs as concentrations were lower than parents' concentrations and inhibition by most parental concentrations tested was also not significant. HPLC analysis of MRT samples revealed that one third of SUA-TPs was reduced during incubation. Three of these TPs, likely OH-SIX, OH-SMX and OH-STZ, were of interest for BbD because the sulfonamide moiety is still present. However, hydroxylated sulfanilamide derivatives, tested to investigate the effect of hydroxylation on biodegradability, were not readily biodegraded. Thus, improving mineralization through hydroxylation as a general rule couldn't be confirmed, and no BbD candidate could be identified. This study fills data gaps on bioactivity and environmental biodegradability of SUAs' TP-mixtures. Findings may support new redesign approaches.
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Tuladhar S, Katwal S, Joshi HO. Benign pneumoperitoneum in a neonate receiving positive pressure ventilation: A case report and clinical insights. Radiol Case Rep 2024; 19:1629-1633. [PMID: 38327553 PMCID: PMC10847833 DOI: 10.1016/j.radcr.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
The presence of air in the peritoneal cavity demonstrated radiographically as the crescent of air under the diaphragm is termed pneumoperitoneum. The causative agents may be divided into spontaneous, traumatic, iatrogenic, and miscellaneous. The majority (∼ 90%) of cases are attributed to hollow viscus perforation which requires immediate surgical attention. Neonatal pneumoperitoneum is a surgical emergency unless proven otherwise. A distinct entity termed benign pneumoperitoneum occurs in the absence of clinical and paraclinical features of peritonitis. Benign pneumoperitoneum may be caused by various thoracic, abdominal, and gynecological conditions. In neonates with respiratory distress pneumoperitoneum is a frequent association especially when treated with mechanical ventilation. The air leak phenomenon leads to air tracking from the ruptured alveoli along the interstitium to the mediastinum then to the retroperitoneum and ultimately into the peritoneal cavity. Such patients usually do not require surgical intervention and are managed conservatively. Knowledge of the existence of benign pneumoperitoneum helps to avoid unnecessary surgery thereby reducing operative morbidity and mortality.
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Yip JA, Lee KK. Comedy, consensus, and conflict framework: Comedy as a norm violation can build consensus or escalate conflict in negotiations. Curr Opin Psychol 2024; 57:101814. [PMID: 38626690 DOI: 10.1016/j.copsyc.2024.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/18/2024]
Abstract
In this work, we propose that humor violates norms that can build consensus or escalate conflict in negotiations. Drawing on social identity theory, we propose that humor commits norm violations that are more likely to be perceived as benign among ingroup observers in negotiations, but perceived as offensive to outgroup observers in negotiations. We introduce the Comedy, Consensus, and Conflict Framework to shed light on the interpersonal effect of humor on negotiations. When humor is expressed to an ingroup observer, relative to neutral communication, humor is more likely to violate weak norms that govern social group membership resulting in the violation as being perceived as benign, which promotes cooperative behaviors in negotiations such as concessions and collaborative problem-solving. By contrast, when humor is expressed to an outgroup observer, relative to neutral communication, humor is more likely to violate strong norms that define social group membership resulting in the violation as being interpreted as offensive, which triggers competitive behaviors in negotiations such as aggressive offers and hardened positions. Furthermore, we suggest that humor not only generates appraisals of social identity threats, but also affective responses that influence negotiation behavior. Finally, we expand our theoretical model about humor to consider key relational factors that influence norm strength, which motivates whether negotiators appraise norm violations as offensive or benign.
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Al-Janabi MH, Abdallah G, Deeb H, Melhem F, Salloum R. Extradigital glomus tumor: A rare case report. Int J Surg Case Rep 2024; 116:109466. [PMID: 38442675 PMCID: PMC10926113 DOI: 10.1016/j.ijscr.2024.109466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Glomus tumors are benign soft tissue tumors of the glomus body, most regularly found in the sublingual region of the digits, palms, and soles. Extra digital lesions are uncommon and might be difficult to diagnose. CASE PRESENTATION We report a rare case of a 38-year-old man who presented with a painful nodule on his right upper arm. A definite diagnosis was made by histopathological study. A complete surgical excision was performed to avoid recurrence. CLINICAL DISCUSSION Glomus tumors form less than 2 % of all soft tissue tumors. The tumor was first reported by Wood in 1812. It typically appears like a small blue-red solitary papule in the hand especially the digits, which are the most prevalent location for glomus tumors with an incidence rate of up to 75 %. The histopathology findings of glomus tumor, are three components: glomus cells, vasculature, and smooth muscle cells. The preferred method of treatment is total excision to prevent a recurrence. CONCLUSION Eventually, the glomus tumor is fairly a rare benign tumor that physicians should keep in mind as a deferential diagnosis when facing a subcutaneous nodule and don't rule out when the tumor is extradigital.
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Chang-Patel EJ, Wong JMK, Gould CH, Demirel S. The Effect of Transversus Abdominis Plane Block Timing on Milliequivalents of Opioid Use and Immediate Postoperative Pain Scores in Patients Undergoing Minimally Invasive Hysterectomy: A Retrospective Cohort Study. J Minim Invasive Gynecol 2024; 31:237-242. [PMID: 38151093 DOI: 10.1016/j.jmig.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
STUDY OBJECTIVE To examine the effect of transversus abdominis plane (TAP) block timing (preoperative or postoperative) on postoperative opioid use (quantified via morphine milligram equivalents; MME) and pain scores in patients undergoing minimally invasive hysterectomy for benign indications. DESIGN Retrospective, single-institution cohort study SETTING: Academic-affiliated community hospital PATIENTS: A total of 2982 patients were included who underwent a minimally invasive total hysterectomy between January 2018 and December 2022, excluding patients with a malignancy diagnosis, concurrent urogynecological procedure, vaginal hysterectomy, supracervical hysterectomy, or those with baseline narcotic use (opioid use within the 3 months before surgery). Patients were separated into 3 groups: no TAP blocks (n = 1966, 65.9%), preoperative TAP blocks (854, 28.6%), and postoperative TAP blocks (162, 5.4%). INTERVENTIONS Summary statistics and mixed-effects regression methods were used for data analysis. MEASUREMENTS AND MAIN RESULTS There was a statistically significant lower mean use of opioids (MME 43.2 vs 53.9, p = .002) among patients who received a TAP block (either pre or postoperatively) than those who did not receive a block. However, when comparing preoperative vs postoperative patients with TAP block, there was no statistically significant difference in mean opioid use (MME 43.4 vs 42.1, p = .752). There were no differences in postoperative pain scores between patients with and without a TAP block, however, more opioids were required in patients who did not receive a TAP block to achieve the same pain scores as those who did receive a TAP block. There was a statistically significant shorter time to discharge for TAP versus patients without TAP block(median 5.5 vs 6.3 hours, p ≤ .001) as well as preoperative versus postoperative patients with TAP block (median 5.3 vs 6.2 hours, p = .001). CONCLUSION While TAP block use at the time of minimally invasive hysterectomy reduced use of postoperative opioids, the timing of TAP block, either preoperatively or postoperatively, did not significantly affect opioid use. Preoperative compared with postoperative TAP block administration significantly shortened the time to discharge.
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Addis NA, Yigzaw GS, Belay ST, Belay YA, Shiferaw EA, Alemu HT, Molla YD. Lipoma of the vulva: A case report. Case Rep Womens Health 2024; 41:e00588. [PMID: 38425709 PMCID: PMC10904153 DOI: 10.1016/j.crwh.2024.e00588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
The patient, a 20-year-old nulligravida, presented with a progressive swelling on the right side of her vulva over the past three years. She also reported dull, aching pain, particularly during long walks. Upon examination, the patient appeared comfortable, and her vital signs were within normal limits. Genitourinary examination revealed a right vulvar mass, 12 cm by 7 cm, which was movable, soft in consistency, and non-tender. Subsequent inguinovulvar ultrasonography confirmed the presence of a compressible soft-tissue mass measuring 10 × 7 × 4 cm, consistent with a diagnosis of lipoma. Surgical excision resulted in a significant improvement in the patient's condition and she was discharged from hospital.
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Lin CS, Lin SM, Rwei SP, Chen CW, Lan TY. Simple bone cysts of the proximal humerus presented with limb length discrepancy: A case report. World J Clin Cases 2024; 12:1130-1137. [PMID: 38464921 PMCID: PMC10921303 DOI: 10.12998/wjcc.v12.i6.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Simple bone cysts (SBC) are benign tumor-like bone lesions typically identified in children. While SBC may lead to growth disturbances or growth arrest, such cases are uncommon. The mechanisms behind these observations remain unclear. Additionally, research on the etiology of SBC remains inconclusive, and there has been no consensus on the appropriate timing and methodology for treatment. CASE SUMMARY Here, we present our experience in the successful surgical management of a 10-year-old girl with SBC, who presented with a pathological fracture complicated by malunion of the displaced fracture, varus deformity, and limb length discrepancy. We hypothesized two possible etiologies for the patient's growth arrest and subsequent humerus varus deformity: (1) Direct disruption of the physis by fluid from the cyst itself; and (2) damage to the epiphysis due to repetitive pathological fractures associated with SBC. In addressing this case, surgical intervention was undertaken to correct the proximal humerus varus deformity. This approach offered the advantages of simultaneously correcting angular abnormalities, achieving mild limb lengthening, providing definitive SBC treatment, and reducing the overall treatment duration. CONCLUSION As per current literature, acute correction of acute angular deformity in proximal humeral SBC is not well comprehended. However, in this specific case, acute correction was considered an optimal solution.
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Zheng T, Wang L, Wang H, Tang L, Xie X, Fu Q, Wu PY, Song B. Prediction model based on MRI morphological features for distinguishing benign and malignant thyroid nodules. BMC Cancer 2024; 24:256. [PMID: 38395783 PMCID: PMC10885392 DOI: 10.1186/s12885-024-11995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The low specificity of Thyroid Imaging Reporting and Data System (TI-RADS) for preoperative benign-malignant diagnosis leads to a large number of unnecessary biopsies. This study developed and validated a predictive model based on MRI morphological features to improve the specificity. METHODS A retrospective analysis was conducted on 825 thyroid nodules pathologically confirmed postoperatively. Univariate and multivariate logistic regression were used to obtain β coefficients, construct predictive models and nomogram incorporating MRI morphological features in the training cohort, and validated in the validation cohort. The discrimination, calibration, and decision curve analysis of the nomogram were performed. The diagnosis efficacy, area under the curve (AUC) and net reclassification index (NRI) were calculated and compared with TI-RADS. RESULTS 572 thyroid nodules were included (training cohort: n = 397, validation cohort: n = 175). Age, low signal intensity on T2WI, restricted diffusion, reversed halo sign in delay phase, cystic degeneration and wash-out pattern were independent predictors of malignancy. The nomogram demonstrated good discrimination and calibration both in the training cohort (AUC = 0.972) and the validation cohort (AUC = 0.968). The accuracy, sensitivity, specificity, PPV, NPV and AUC of MRI-based prediction were 94.4%, 96.0%, 93.4%, 89.9%, 96.5% and 0.947, respectively. The MRI-based prediction model exhibited enhanced accuracy (NRI>0) in comparison to TI-RADSs. CONCLUSIONS The prediction model for diagnosis of benign and malignant thyroid nodules demonstrated a more notable diagnostic efficacy than TI-RADS. Compared with the TI-RADSs, predictive model had better specificity along with a high sensitivity and can reduce overdiagnosis and unnecessary biopsies.
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Grit JL, Turner L, Essenburg CJ, Gallik KL, Dischinger PS, Shurlow ND, Pate MJ, Graveel CR, Steensma MR. Ex Vivo Patient-Derived Explant Model for Neurofibromatosis Type 1-Related Cutaneous Neurofibromas. J Invest Dermatol 2024:S0022-202X(24)00117-9. [PMID: 38395106 DOI: 10.1016/j.jid.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024]
Abstract
Cutaneous neurofibromas (CNFs) are benign tumors that occur in the dermis of individuals with the inherited tumor predisposition disorder, neurofibromatosis type 1. CNFs cause disfigurement, pain, burning, and itching, resulting in substantially reduced QOL in patients with neurofibromatosis type 1. CNFs are benign tumors that exhibit cellular and molecular heterogeneity, making it difficult to develop tractable in vitro or in vivo models. As a result, CNF research and drug discovery efforts have been limited. To address this need, we developed a reproducible patient-derived explant (PDE) ex vivo culture model using CNF tumors from patients with neurofibromatosis type 1. CNF PDEs remain viable in culture for over 9 days and recapitulate the cellular composition and molecular signaling of CNFs. Using CNF PDEs as a model system, we found that proliferation was associated with increased T-cell infiltration. Furthermore, we identified a pattern of reciprocal inflammatory signaling in CNF PDEs in which tumors rely on prostaglandin or leukotriene-mediated signaling pathways. As proof of principle, we show that ex vivo glucocorticoid treatment reduced the expression of proinflammatory genes, confirming that CNF PDEs are a useful model for both mechanistic studies and preclinical drug testing.
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Tsolaki F, Tagarakis GI, Tagarakis I. When to anatomically excise a benign lung tumor-correspondence regarding the article: "large mesenchymal cystic and chondroid pulmonary hamartoma mimicking lung cancer: case report". J Cardiothorac Surg 2024; 19:82. [PMID: 38336782 PMCID: PMC10858531 DOI: 10.1186/s13019-024-02554-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
The decision of whether to perform a large anatomic resection for a lung mass that is not definitely malignant comes often forward in the everyday practice of the thoracic surgeon. The general characteristics of the tumor as well as of the patient and the instinct and experience of the surgeon are the ones that dictate the final choice. Such a decision was made in the case of a large pulmonary hamartoma where a right middle lobectomy was performed with the postoperative course justifying the surgeons' choice.
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Siluvai Arulappan LA, Eleza BF. Remote Possibility of Post Aural Swelling as Nodular Hidradenoma: A Case Report. Indian J Otolaryngol Head Neck Surg 2024; 76:94-96. [PMID: 38440531 PMCID: PMC10908938 DOI: 10.1007/s12070-023-04089-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/13/2023] [Indexed: 03/06/2024] Open
Abstract
A 30-year-old female patient presented with swelling over the left post aural region of 6 months duration which gradually increased in size. Cutaneous examination: A solitary, non-tender, mobile swelling of variable consistency over the post aural region. Dermoscopic examination: Revealed white and red areas. Diagnosis of nodular hidradenoma was made by histopathological examination.
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Shenoy S V, Dhawan S, K.V A, Saha NN, Multani M. Myoepithelioma- An Uncommon Parotid Tumour in An Adolescent. Indian J Otolaryngol Head Neck Surg 2024; 76:1168-1173. [PMID: 38440509 PMCID: PMC10909051 DOI: 10.1007/s12070-023-04199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 08/28/2023] [Indexed: 03/06/2024] Open
Abstract
Myoepitheliomas are uncommon neoplasms of major and minor salivary glands. These tumours are encapsulated and slow growing in nature and are benign in majority of the cases. The mean age of presentation is 40 years and this entity is rarely reported in younger age groups. Here, we seek to report a rare case of a 10-year-old patient who presented with a swelling below the right ear. Clinical and radiological evaluation revealed a mass in the parotid gland. This patient was treated with a superficial parotidectomy and subsequent histopathological examination revealed it to be a myoepithelioma.
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Opango ADC, Nshimirimana B, Jaifi A, Belmaachi S, Fawzi S, Mansouri-Hattab N. Eccrine spiradenoma of nose: Surgical case report. Int J Surg Case Rep 2023; 113:109033. [PMID: 37976721 PMCID: PMC10684999 DOI: 10.1016/j.ijscr.2023.109033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Eccrine spiradenoma is a benign tumor of the eccrine sweat glands, preferentially affecting the scalp, face and trunk. Few cases are described in the literature, it is a fairly rare pathology. PRESENTATION OF THE CASE We present the case of a 64-year-old man who consulted for an ulcerative and nodular lesion of the left side of the nose for 5 years. He was treated in our department (excision and reconstruction). Pathological examination revealed a benign eccrine spiradenoma. CLINICAL DISCUSSION Eccrine spiradenoma is a relatively rare benign adnexal tumor. His diagnosis is based on histopathological examination. His treatment is surgical. In case of incomplete excision of the tumor, the risk of recurrence is always possible. The risk of malignant transformation exists, particularly for tumors with a long duration of evolution. CONCLUSION Benign eccrine spiradenoma is a rare adnexal tumor, but it is important to know about it. The main risk is malignant transformation.
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Kaur J, Aggarwal A, Yadav V, Bhagat S, Sharma D. A Case Report of Chondromyxoid Fibroma of the Nasal Cavity. Indian J Otolaryngol Head Neck Surg 2023; 75:3975-3979. [PMID: 37974817 PMCID: PMC10645689 DOI: 10.1007/s12070-023-03981-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 11/19/2023] Open
Abstract
The chondromyxoid fibroma is a benign osseocartilaginous tumor histopathologically characterized by chondroid, fibrous, and myxoid tissues (Nazeer et al. in Skeltal Radiol 25:779-78, 1996). Its occurrence is quite rare, accounting for less than 0.5% of all bone tumors, with 1-5% of cases reported in the head and neck region. We report an unusual case of 25 years old male who presented with progressive swelling over dorsum of nose with bilateral nasal obstruction over 1 year. The histopathological examination was suggestive of chondromyxoid fibroma. The tumor was completely excised via open approach. We report this case owing to the rarity of the disease, sometimes masquerading as invasive/malignant pathology.
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Szathmari A, Vasiljevic A, Di Rocco F, Beuriat PA, Mottolese C. Pineal cysts in children: a paediatric series treated over the last twenty years in Lyon. Childs Nerv Syst 2023; 39:3467-3474. [PMID: 37898987 DOI: 10.1007/s00381-023-06181-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/10/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Pineal cysts are a rare lesion of the pineal gland. Pineal cysts are benign lesions, generally asymptomatic, and are usually an incidental discovery on MRI performed for other problems. The management of pineal cysts in children remains a matter for debate. Here, we report our own retrospective paediatric cases that have been surgically treated and review the paediatric literature on this topic. METHODS This is a retrospective monocentric study. All patients operated by the senior author (CM) for a benign pineal cyst from 2000 to 2021 were included. All other pineal region cystic lesions were excluded. Medical and surgical data were extracted from the hospital medical database. RESULTS Twelve patients were included. The clinical symptomatology was characterized by headaches in seven patients, visual troubles in two patients, precocious puberty in one patient, signs of intracranial hypertension in two patients, seizures associated with headache in one patient, and headaches associated with behavioural troubles in another patient. No major post-operative complications were observed in this series. It is to noted that surgery was performed because a suspicion of a true pineal parenchymal tumour has been made. Histopathological study came back with the diagnosis of pineal cyst. CONCLUSIONS Pineal cyst is rare. If the radiological diagnosis is clear, no surgery is advocated except in cases associated with hydrocephalus and rapid growth. In case of a suspicion of a true pineal parenchymal tumour, a surgery may be needed to confirm the diagnosis. Lastly, we stress that only cystic lesions of the pineal gland itself should be considered as pineal cyst.
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van Olmen JP, Beerthuizen AWJ, Bekers EM, Viegen I, Drukker CA, Vrancken Peeters MJTFD, Bartels SAL, van Duijnhoven FH. Management of Benign Phyllodes Tumors: A Dutch Population-Based Retrospective Cohort Between 1989 and 2022. Ann Surg Oncol 2023; 30:8344-8352. [PMID: 37639031 DOI: 10.1245/s10434-023-14128-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Phyllodes tumors (PTs) are rare tumors of the breast. The current National Comprehensive Cancer Network (NCCN) guidelines recommend excision of benign PTs, accepting close or positive margins. Controversy about the optimal treatment for benign PTs remains, especially regarding the preferred margin width after surgical excision and the need for follow-up evaluation. METHODS A nationwide retrospective study analyzed the Dutch population from 1989 to 2022. All patients with a diagnosis of benign PT were identified through a search in the Dutch nationwide pathology databank (Palga). Information on age, year of diagnosis, size of the primary tumor, surgical treatment, surgical margin status, and local recurrence was collected. RESULTS The study enrolled 1908 patients with benign PT. The median age at diagnosis was 43 years (interquartile range [IQR], 34-52 years), and the median tumor size was 30 mm (IQR, 19-40 mm). Most of the patients (95%) were treated with breast-conserving surgery (BCS). The overall local recurrence rate was 6.2%, and the median time to local recurrence was 31 months (IQR, 15-61 months). Local recurrence was associated with bilaterality of the tumor (odds ratio [OR], 4.91; 95% confidence interval [CI], 2.95-28.30) and positive margin status (OR, 2.51; 95% CI 1.36-4.63). The local recurrence rate was 8.9% for the patients with positive excision margins and 4.0% for the patients with negative excision margins. Notably, for 27 patients (22.6%) who experienced a local recurrence, histologic upgrading of the recurrent tumor was reported, 7 (5.9%) of whom had recurrence as malignant lesions. CONCLUSIONS This nationwide series of 1908 patients showed a low local recurrence rate of 6.2% for benign PT, with higher recurrence rates following positive margins.
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Amrami KK, Chebrolu VV, Felmlee JP, Frick MA, Powell GM, Marek T, Howe BM, Fagan AJ, Kollasch PD, Spinner RJ. 7T for clinical imaging of benign peripheral nerve tumors: preliminary results. Acta Neurochir (Wien) 2023; 165:3549-3558. [PMID: 37464202 DOI: 10.1007/s00701-023-05724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE MRI has become an essential diagnostic imaging modality for peripheral nerve pathology. Early MR imaging for peripheral nerve depended on inferred nerve involvement by visualizing downstream effects such as denervation muscular atrophy; improvements in MRI technology have made possible direct visualization of the nerves. In this paper, we share our early clinical experience with 7T for benign neurogenic tumors. MATERIALS Patients with benign neurogenic tumors and 7T MRI examinations available were reviewed. Cases of individual benign peripheral nerve tumors were included to demonstrate 7T MRI imaging characteristics. All exams were performed on a 7T MRI MAGNETOM Terra using a 28-channel receive, single-channel transmit knee coil. RESULTS Five cases of four pathologies were selected from 38 patients to depict characteristic imaging features in different benign nerve tumors and lesions using 7T MRI. CONCLUSION The primary advantage of 7T over 3T is an increase in signal-to-noise ratio which allows higher in plane resolution so that the smallest neural structures can be seen and characterized. This improvement in MR imaging provides the opportunity for more accurate diagnosis and surgical planning in selected cases. As this technology continues to evolve for clinical purposes, we anticipate increasing applications and improved patient care using 7T MRI for the diagnosis of peripheral nerve masses.
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Prisco AR, Castro JR, Roukoz H, Tholakanahalli VN. Premature Ventricular Complexes: Benign versus Malignant - How to approach? Indian Pacing Electrophysiol J 2023; 23:189-195. [PMID: 37714513 PMCID: PMC10685167 DOI: 10.1016/j.ipej.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/22/2023] [Accepted: 09/12/2023] [Indexed: 09/17/2023] Open
Abstract
Premature Ventricular Complexes (PVCs) refer to electrical activity arising from ventricles resulting in ventricular contraction independent of the native rhythm. PVCs by themselves are common in the general population but based on the origin of the PVCs, either related to anatomical or electrical substrate, the disease process has a widely varied presentation and prognosis. The clinical presentation of symptoms may vary from being extremely benign, or very severe (malignant). Benign PVCs include those that are asymptomatic or induce very mild symptoms including palpitations, lightheadedness, chest discomfort, or the sensation of skipped beats. The middle range of PVCs present as heart failure or heart failure complicated by PVCs. The malignant variety may present as syncope, or sudden cardiac death. In this review we describe the multiple facets of PVC presentation and strategies of clinical management.
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Kelsey E, Holmes A, Tissot S, Campbell P, McLeod K. Management of recurrent localised bladder amyloid, has methotrexate helped? Urol Case Rep 2023; 51:102577. [PMID: 37811541 PMCID: PMC10551828 DOI: 10.1016/j.eucr.2023.102577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
Background Amyloidosis of the bladder is a benign condition which can present with a multitude of symptoms including bladder mass, irritative voiding symptoms and haematuria. Case presentation We report on the investigation and management of a patient with recurrent localised amyloidosis of the bladder, which appears to have been managed fortuitously by concurrent methotrexate prescribed for another indication. Conclusion We provide further assessment and management with a focus on the possible benefit of methotrexate for management of localised bladder amyloidosis.
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