Difficulties in the differential diagnosis of tumors in the female reproductive system

Introduction. Most pelvic tumors originate from reproductive organs. Even using the up-to-date imaging techniques, radiologists experience difficulties in determining the source of the lesion since a wide range of tumors look similar to each other on the distorted backdrop of pelvic anatomy, large invasive formations, and an active inflammatory reaction of the pelvic peritoneum.Aim: to evaluate “pitfalls” in the preoperative noninvasive diagnosis of female pelvic tumors by applying the clinical diagnostic tools.Materials and methods. Four rare clinical cases were analyzed; all of them posed difficulties in interpreting the diagnostic examination due to their atypical characteristics. There were 2 cases of ovarian cancer, initially identified by an experienced team of radiologists as benign pelvic pathology. Also, there were fibroids with degeneration, marked proliferative activity, and a massive inflammatory reaction of the peritoneum – that was diagnosed as a malignant ovarian tumor. Tumor biopsies were examined using morphological and immunohistochemical methods (with the р16, Ki-67, p53, CD 117, S 100, CD 34 markers). Immunohistochemical (IHC) studies were performed with formalin-fixed paraffin materials using the avidin-biotin-peroxidase method. Antibodies to estrogen receptor (ER), progesterone receptor (PR), cytokeratin 7 (CK7), cytokeratin 20 (CK20) and Wilms tumor protein 1 (WT1) were also used.Results. A thorough analysis of the clinical picture and a joint multidisciplinary discussion (gynecologist, oncologist, radiologist, etc.) made it possible to avoid diagnostic errors.Conclusion. These observations demonstrate the difficulties of differential diagnosis between ovarian metastases of uterine cancer and primary multiple ovarian and uterine cancer, as well between leiomyosarcoma and uterine myoma with high mitotic activity. Obviously, the change in diagnosis calls for a change in the treatment strategy.

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The desperate plea of women with the nutcracker syndrome

Phlebologie ◽

10.1055/s-0037-1622296 ◽

2010 ◽

Vol 39 (02) ◽

pp. 104-111

Author(s):

J. L. Villavicencio

Keyword(s):

Renal Vein ◽

Imaging Techniques ◽

Left Renal Vein ◽

Diagnostic Tools ◽

Nutcracker Syndrome ◽

Treatment Techniques ◽

Children And Young Adults ◽

Good Number ◽

Pelvic Congestion

Summary Objective: To increase awareness on the severe impact of the nutcracker syndrome in women with undiagnosed disease. Patients and methods: We reviewed the medical literature and analyzed six representative series with 73 patients with nutcracker syndrome. Women with left flank pain, dyspareunia, dysuria, dysmenorrhea, micro- or macrohaematuria and pelvic congestion symptoms, should be carefully investigated for evidence of meso aortic left renal vein compression. A good number of our colleagues do not believe in the existence of the nutcracker syndrome and send these patients in a long pilgrimage in search of someone who can help them to get relief to their pain. New and improved imaging techniques can assist in the diagnosis but retrograde reno-gonadal phlebography and renocaval gradient are the most reliable diagnostic tools. Results: Among an assortment of treatment techniques, renal vein transposition and endovenous stenting were the two most commonly used procedures. There are no long term studies on renal vein stenting in children and young adults. Its use in these cases should be carefully considered. The nutcracker syndrome may present with pelvic congestion symptoms and its diagnosis missed. The patient's age, severity of symptoms and haemo dynamic renal studies should guide the treatment. Conclusion: An increased awareness of the existence of the nutcracker syndrome may prevent many unfortunate undiagnosed women from spending many months and often years of suffering.

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PERANAN RADIOLOGI PADA KASUS TUMOR WILMS’

Jurnal Radiologi Indonesia ◽

10.33748/jradidn.v4i1.85 ◽

2020 ◽

Vol 4 (1) ◽

pp. 26-33

Author(s):

Galuh Ayu Treswari ◽

Bambang Soeprijanto ◽

Indrastuti Normahayu ◽

Lenny Violetta

Keyword(s):

Differential Diagnosis ◽

Distant Metastasis ◽

Wilms Tumor ◽

Diagnosis And Treatment ◽

Tumor Extension ◽

Abdominal Tumors ◽

Pathology Reports

Wilms’ tumor is the most frequent renal malignancy in childhood with the highest incidence per year, approximately 7,8 cases per 1.000.000in children under 15 years-old and frequently occurred in 2-5 years of age (highest incidences in 3 years-old). There are many differential diagnosis of intra-abdominal tumors and the correct differential diagnosis are detrimental to the prescribed treatments for the patients.Medical imaging along with pathology reports is a precise way to determine the appropriate diagnosis and treatment. Imaging gives information about tumor extension and distant metastasis, especially useful for indicating pre-operative chemotherapy.

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Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

Communication & Medicine ◽

10.1558/cam.v12i1.26851 ◽

2016 ◽

Vol 12 (1) ◽

pp. 13-24 ◽

Cited By ~ 7

Author(s):

Katie Ekberg ◽

Markus Reuber

Keyword(s):

Differential Diagnosis ◽

Correct Diagnosis ◽

Diagnostic Errors ◽

Epileptic Seizures ◽

Routine Clinical Setting ◽

Choice Of Treatment ◽

Transient Loss ◽

Factual Content ◽

Patient’S History ◽

Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

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Diagnostic Value of Real-Time Shear Wave Elastography in Diagnosing Thyroid Cancer

Revista de Chimie ◽

10.37358/rc.17.12.5985 ◽

2018 ◽

Vol 68 (12) ◽

pp. 2818-2822

Author(s):

Maria Cristina Oprea ◽

Mihaela Vlad ◽

Ioana Golu ◽

Ioan Sporea ◽

Lazar Fulger

Keyword(s):

Shear Wave ◽

Predictive Value ◽

Thyroid Nodules ◽

Imaging Techniques ◽

Area Under The Curve ◽

Thyroid Volume ◽

Shear Wave Elastography ◽

Maximum Diameter ◽

Diagnostic Tools ◽

Tissue Elasticity

Thyroid nodules are a common pathology found in 50 to 60% of otherwise healthy people. Diagnostic imaging techniques are help discriminating between benign and malignant nodules, while fine needle aspiration is still a gold standard. Shear wave elastography, a recent imaging technique, holds the promise to become reliable diagnostic tools and is currently used in combination with ultrasound. We here report data obtained in a series of 52 thyroid nodules analysed by means of elastography, as well as conventional and Doppler ultrasound. We found no differences in age, nodule and thyroid volume, length, width, thickness and maximum diameter between benign and malignant lesions. Several sonographic patterns are considered to be predictive of malignancy, out of which we only found the intranodular blood flow to be statistically significant. By the means of shear wave elastography we have first assessed tissue elasticities, which are shown in a range of colours, depending on tissue elasticity/stiffness. Then, we have measured and recorded four parameters automatically displayed by the system, namely SWE-mean, SWE-max, SWE-SD and SWE-ratio. Data analysis showed all these quantitative parameters had good sensitivity, specificity, positive predictive value, negative predictive value and area under the curve, as calculated by the ROC curve. As with these parameters, the cut-off points were lower than in literature, still able to indicate reliable diagnoses, which were confirmed by histopathological exam. Our conclusion is that shear wave elastography has great potential for reliably and accurately diagnosing thyroid malignancies.

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State-of-the-art MR Imaging of Fat-containing Focal Lesions of the Liver

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405614666171218154838 ◽

2019 ◽

Vol 15 (5) ◽

pp. 435-442

Author(s):

Joanna Podgorska ◽

Agnieszka Anysz-Grodzicka ◽

Andrzej Cieszanowski

Keyword(s):

Differential Diagnosis ◽

Imaging Techniques ◽

Hepatobiliary Phase ◽

Focal Lesions ◽

Dysplastic Nodules ◽

Nodular Hyperplasia ◽

Specific Finding ◽

Magnetic Resonance Imaging Mri ◽

Adrenal Rest ◽

Mri Characteristics

Background: Fat can be identified in numerous liver lesions, and usually is not a specific finding. Distinguishing between different kinds of fatty deposits is an important part of differential diagnosis. Magnetic Resonance Imaging (MRI) is superior to other imaging techniques because it allows distinguishing intracellular from macroscopic fat. Discussion: Intracellular lipid may be found in focal hepatic steatosis, hepatic adenoma, hepatocellular carcinoma and, less commonly, in focal nodular hyperplasia as well as regenerative and dysplastic nodules. Macroscopic fat is seen in angiomyolipoma, lipoma, metastases from fatcontaining neoplasms, primary or metastatic liposarcoma, hydatid cyst, pseudolipoma of the Glisson capsule, pericaval fat collection, lipopeliosis, hepatic teratoma, focal hepatic extramedullary haematopoiesis and adrenal rest tumour. Conclusion: Liver nodules should be characterised with regard to underlying liver condition, MRI characteristics and contrast enhancement pattern, including hepatobiliary phase. In many cases, identification of fatty content may help narrowing the differential diagnosis.

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Potential predictors of severe cardiovascular involvement in Marfan syndrome: the emphasized role of genotype–phenotype correlations in improving risk stratification—a literature review

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01882-6 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Roland Stengl ◽

Bence Ágg ◽

Miklós Pólos ◽

Gábor Mátyás ◽

Gábor Szabó ◽

...

Keyword(s):

Risk Stratification ◽

Marfan Syndrome ◽

Current Knowledge ◽

Imaging Techniques ◽

Connective Tissue Disorder ◽

Main Body ◽

Wide Range ◽

Stratification System ◽

Genetically Determined ◽

Aortic Dissections

Abstract Background Marfan syndrome (MFS) is a genetically determined systemic connective tissue disorder, caused by a mutation in the FBN1 gene. In MFS mainly the cardiovascular, musculoskeletal and ocular systems are affected. The most dangerous manifestation of MFS is aortic dissection, which needs to be prevented by a prophylactic aortic root replacement. Main body The indication criteria for the prophylactic procedure is currently based on aortic diameter, however aortic dissections below the threshold defined in the guidelines have been reported, highlighting the need for a more accurate risk stratification system to predict the occurrence of aortic complications. The aim of this review is to present the current knowledge on the possible predictors of severe cardiovascular manifestations in MFS patients, demonstrating the wide range of molecular and radiological differences between people with MFS and healthy individuals, and more importantly between MFS patients with and without advanced aortic manifestations. These differences originating from the underlying common molecular pathological processes can be assessed by laboratory (e.g. genetic testing) and imaging techniques to serve as biomarkers of severe aortic involvement. In this review we paid special attention to the rapidly expanding field of genotype–phenotype correlations for aortic features as by collecting and presenting the ever growing number of correlations, future perspectives for risk stratification can be outlined. Conclusions Data on promising biomarkers of severe aortic complications of MFS have been accumulating steadily. However, more unifying studies are required to further evaluate the applicability of the discussed predictors with the aim of improving the risk stratification and therefore the life expectancy and quality of life of MFS patients.

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The 6C model for accurately capturing the patient’s medical history

Diagnosis ◽

10.1515/dx-2020-0126 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Taro Shimizu

Keyword(s):

Artificial Intelligence ◽

Differential Diagnosis ◽

Patient Safety ◽

Information Processing ◽

Safety Concern ◽

Data Gathering ◽

Diagnostic Errors ◽

Accurate Diagnosis ◽

History Taking ◽

Novel Approach

Abstract Diagnostic errors are an internationally recognized patient safety concern, and leading causes are faulty data gathering and faulty information processing. Obtaining a full and accurate history from the patient is the foundation for timely and accurate diagnosis. A key concept underlying ideal history acquisition is “history clarification,” meaning that the history is clarified to be depicted as clearly as a video, with the chronology being accurately reproduced. A novel approach is presented to improve history-taking, involving six dimensions: Courtesy, Control, Compassion, Curiosity, Clear mind, and Concentration, the ‘6 C’s’. We report a case that illustrates how the 6C approach can improve diagnosis, especially in relation to artificial intelligence tools that assist with differential diagnosis.

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A Structurally Variable Hinged Tetrahedron Framework from DNA Origami

Journal of Nucleic Acids ◽

10.4061/2011/360954 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 18

Author(s):

David M. Smith ◽

Verena Schüller ◽

Carsten Forthmann ◽

Robert Schreiber ◽

Philip Tinnefeld ◽

...

Keyword(s):

Self Assembly ◽

Gel Electrophoresis ◽

Imaging Techniques ◽

Building Blocks ◽

Dna Origami ◽

Microscopy Technique ◽

Wire Frame ◽

Wide Range ◽

Potential Applications ◽

Linker Molecules

Nanometer-sized polyhedral wire-frame objects hold a wide range of potential applications both as structural scaffolds as well as a basis for synthetic nanocontainers. The utilization of DNA as basic building blocks for such structures allows the exploitation of bottom-up self-assembly in order to achieve molecular programmability through the pairing of complementary bases. In this work, we report on a hollow but rigid tetrahedron framework of 75 nm strut length constructed with the DNA origami method. Flexible hinges at each of their four joints provide a means for structural variability of the object. Through the opening of gaps along the struts, four variants can be created as confirmed by both gel electrophoresis and direct imaging techniques. The intrinsic site addressability provided by this technique allows the unique targeted attachment of dye and/or linker molecules at any point on the structure's surface, which we prove through the superresolution fluorescence microscopy technique DNA PAINT.

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MEDICAL FILMS

PEDIATRICS ◽

10.1542/peds.30.6.1018 ◽

1962 ◽

Vol 30 (6) ◽

pp. 1018-1018

Keyword(s):

Cystic Fibrosis ◽

New York ◽

New York City ◽

Differential Diagnosis ◽

Correct Diagnosis ◽

Diagnostic Tools ◽

Single Test ◽

Presenting Symptoms ◽

The Many ◽

Therapy And Diagnosis

Cystic Fibrosis—NCFRF. 16 mm., color, sound, showing time 32 minutes. Produced in 1961 by Samuel L. Schulman for the National Cystic Fibrosis Research Foundation, medical supervision by Giulio J. Barbero, M.D. Philadelphia. Procurable on purchase from National Cystic Fibrosis Research Foundation, 521 Fifth Avenue, New York City 17. Procurable on loan from American Medical Association, Motion Picture Library, 535 N. Dearborn Street, Chicago 10. This film has been prepared to aid physicians in making a correct diagnosis and to instruct them in the techniques currently being used to prolong life in cases of cystic fibrosis. Following the introductoy remarks there is a good discussion of the presenting symptoms, the differential diagnosis, the multiple system involvement, hereditary aspects, therapy, and prognosis. The film brings out well the panexocrine involvement, the clinical variability, and the fact that the disease is not an all or none phenomenon but rather a disease of all grades of severity and is a disease in which no single test is applicable to the exclusion of others. The diagrams and patient demonstrations are good. Perhaps too much review of older methods of therapy and diagnosis is given, but this serves as a background for the newer recommended procedures. More emphasis could have been given to the tremendous burden, both financial and emotional, this disease is on parents. This is an excellent instructive film and it emphasizes the many problems of cystic fibrosis as related to the diagnostic tools available and to forms of therapy. The photography and sound are satisfactory. It is recommended for pediatricians, general practitioners, house staff, and medical students.

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Clinical case of recurrent vomiting in a child: diagnostic search from functional gastrointestinal disorders to piloid astrocytoma

Practical medicine ◽

10.32000/2072-1757-2021-1-78-81 ◽

2021 ◽

Vol 19 (1) ◽

pp. 78-81

Author(s):

E. N. Voronina ◽

◽

D. V. Pechkurov ◽

A. A. Tyazheva ◽

E. V. Kozarez ◽

...

Keyword(s):

Differential Diagnosis ◽

Nutritional Status ◽

Clinical Case ◽

Anxiety Symptom ◽

Functional Gastrointestinal Disorders ◽

Integrated Approach ◽

Gastrointestinal Disorders ◽

Wide Range ◽

High Prevalence ◽

Recurrent Vomiting

The urgency of the problem of recurrent vomiting in children is due not only to the high prevalence of this syndrome, but also to a wide range of reasons for its development. The article presents a clinical case of observation of a child with recurrent vomiting syndrome. It shows the dynamics of the disease, the importance of identifying such «anxiety symptom» as the nutritional status violation. In this case, the cause of vomiting of central genesis was not immediately taken into account, although differential diagnosis presupposes an integrated approach, and doctors' oncological alertness should be constantly preserved even in pediatrics.

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