Limited Adenocarcinoma of the Prostate on Needle Core Biopsy

Context.— Grading small foci of prostate cancer on a needle biopsy is often difficult, yet the clinical significance of accurate grading remains uncertain. Objective.— To assess if grading of limited adenocarcinoma on prostate biopsy specimen is critical. Design.— We studied 295 consecutive patients undergoing extended-sextant biopsy with only 1-core involvement of adenocarcinoma, followed by radical prostatectomy. Results.— The linear tumor lengths on these biopsy specimens were: less than 1 mm (n = 114); 1 mm or more or less than 2 mm (n = 82); 2 mm or more or less than 3 mm (n = 35); and 3 mm or more (n = 64). Longer length was strongly associated with higher Grade Group (GG) on biopsy or prostatectomy specimen, higher risk of extraprostatic extension/seminal vesicle invasion and positive surgical margin, and larger estimated tumor volume. When cases were compared based on biopsy specimen GG, higher grade was strongly associated with higher prostatectomy specimen GG, higher incidence of pT3/pT3b disease, and larger tumor volume. Outcome analysis further showed significantly higher risks for biochemical recurrence after radical prostatectomy in patients with 1 mm or more, 2 mm or more, 3 mm or more, GG2-4, GG3-4, GG4, less than 1 mm/GG2-4, less than 1 mm/GG3-4, less than 2 mm/GG3-4, 3 mm or more/GG2-4, or 3 mm or more/GG3-4 tumor on biopsy specimens, compared with respective control subgroups. In particular, 3 mm or more, GG3, and GG4 on biopsy specimens showed significance as independent prognosticators by multivariate analysis. Meanwhile, there were no significant differences in the rate of upgrading or downgrading after radical prostatectomy among those subgrouped by biopsy specimen tumor length (eg, <1 mm [44.7%] versus ≥1/<2 mm [41.5%] versus ≥2/<3 mm [45.7%] versus ≥3 mm [46.9%]). Conclusions.— These results indicate that pathologists still need to make maximum efforts to grade relatively small prostate cancer on biopsy specimens.

Comparison of bacteriologic culture results for skin wound swabs and skin wound biopsy specimens

OBJECTIVE To compare bacteriologic culture results for superficial swab and tissue biopsy specimens obtained from dogs with open skin wounds. ANIMALS 52 client-owned dogs. PROCEDURES For each dog, 1 wound underwent routine preparation prior to collection of 2 specimens, 1 by superficial swab (Levine) technique and 1 by tissue biopsy. Specimens were processed for bacteriologic culture. Two observers determined whether any detected difference in culture results for the 2 types of specimen would have resulted in differing treatment plans. RESULTS Culture results of swab and tissue biopsy specimens were identical in 11/52 (21.2%) cases. Tissue biopsy specimen and swab cultures yielded positive results for 44 (84.6%) and 40 (76.9%) wounds, respectively. With regard to mean recovery rates of bacteria from wounds with positive culture results, both the biopsy specimens and swabs yielded 3.4 bacterial species/wound. All wounds for which swab cultures yielded no growth also had negative culture results for biopsy specimens. Biopsy specimen and swab culture results were in agreement with regard to the most common bacteria cultured. In 7/52 (13%) wounds, the observers would have treated the patient differently on the basis of the results of the 2 cultures. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that culture of a swab collected by the Levine technique is an appropriate noninvasive alternative to culture of a tissue biopsy specimen. A negative result obtained from culture of a swab is likely to be reliable. Disagreement between the results of swab and tissue biopsy specimen cultures is likely of low clinical importance.

Pandora’s Box: Disseminated Coccidioidomycosis Associated with Self-Medication with an Unregulated Potent Corticosteroid Acquired in Mexico

Coccidioidomycosis (CM), caused by the dimorphic fungi Coccidioides immitis and C. posadasii, typically presents as acute or chronic pulmonary disease. However, disseminated disease occurs in about 1% of patients. Disseminated CM may affect multiple organ systems, including cutaneous, osteoarticular, and central nervous system sites. Here, we present a case of disseminated CM in a patient from a border city in Texas. The patient had a history of uncontrolled diabetes mellitus and was also taking an over-the-counter medication acquired in Mexico that contained a potent corticosteroid. The patient presented with seizures and was found to have a brain infarct, cavitary lung lesions, synovitis of the knee, multiple skin lesions, and chorioretinitis. The patient had a very high complement fixation titer for Coccidioides; fungal spherules were seen in a skin biopsy specimen, and Coccidioides grew in culture from a sample of synovial fluid and the skin biopsy specimen. This case illustrates the dissemination potential of Coccidioides, the danger of unregulated pharmaceuticals, the importance of thorough history taking, and recognizing risk factors that contribute to disseminated CM.

Incidence of Celiac Disease in Children with Down’s Syndrome

Aim: Incidence of celiac disease among children with down’s syndrome Setting: Pediatrics department, Khyber Teaching Hospital, Peshawar Study design: Cross sectional study Study duration: 20/7/2019 to 20/1/2020 Methodology: A total of 241 subjects were selected. Five ml of venous blood was obtained from all patients to detect the Anti-tTG Ab. Among those patients who are positive for the antibody, endoscopy and biopsy specimen from duodenum were sent to hospital laboratory to confirm the presence of villus atrophy. Results: Mean age was 8 ± 4.57. 44% children were male and 56% children were female. More over 4% children had celiac disease and 96% children didn’t have celiac disease. Conclusion: The frequency of celiac disease was 4% among children presenting with Down syndrome. Keywords: Celiac disease, Down’s syndrome.

ADAPTATION OF MACHINE LEARNING TECHNIQUES WITH ITS CHALLENGES IN THE FIELD OF MEDICINE

An affected person notices an effortless rash over his shoulder but does not get treatment. His spouse suggests he visit the hospital for a physician after few months, who will provide treatment a seborrhea keratosis. Afterward, when the patient went through a colonoscopy screening, a black shaded macule on his shoulder was noticed by a nurse and advises him to evaluate it. Then he takes it to a dermatologist after one month and takes a biopsy specimen for the lesion. Through which they find out a non-dangerous near to cancer but not cancer symptoms. A second reading of the biopsy specimen was suggested by the dermatologist. After that, they started to do the treatment by systematic chemotherapy. One friend who was a physician told the patient why he is not giving a try to immunotherapy.

Challenge of Interpreting Cytoplasmic CD20 Stain in Diffuse Large B Cell Lymphoma Biopsy Specimen of Patients with Steroid Usage

Lymphoma work-up involves immunohistochemical stains to help reach the diagnosis. It is imperative to have clinical information and sound knowledge of staining pattern of antibodies to avoid misinterpretation of results. We describe two cases in which pre-biopsy steroid hindered antigenic profile, leading to “cytoplasmic granular staining” and causing delay.

Celiac disease: non-carious lesions of the teeth

The high prevalence of non-carious manifestations in patients with celiac disease is described by numerous authors, who are considered as a diagnostic key to atypical forms of celiac disease. The manifestations closely associated with celiac disease include: defects in tooth enamel, pathological tooth abrasion, as a violation of the mineralization of dental crowns, and morphofunctional defects in the hard tissues of the teeth.Materials and methods. We examined 45 patients aged 23 to 36 years with a diagnosis of celiac disease, established on the basis of the results of clinical anamnestic, genetic, instrumental studies, morphological study of a biopsy specimen of the intestinal mucosa.Result. Examination of the dentition of the patients showed that 100% of the examined had pathological abrasion of tooth enamel. Crowded teeth were found in 32 patients. Partial symmetric congenital adentia was diagnosed in 5 patients.Conclusion. The revealed dentoalveolar anomalies can be attributed to oral manifestations of celiac disease, which is a diagnostic criterion for suspected disease.

Eyelid Lipoma

Purpose: To report a rare case of eyelid lipoma. Case summary: A 41-year-old female presented with a palpable mass in her left upper eyelid. Diffuse hard mass was palpable at preaponeurotic fat layer of left upper eyelid, and there was no inflammatory sign. Under local anesthesia, a left upper eyelid mass partial excision was performed and a biopsy specimen was collected. The mass was yellower and harder than surrounding normal eyelid fat. A lipoma was diagnosed based on histopathological findings such as proliferation of mature adipocytes. Conclusions: Lipoma is a benign tumor commonly found around trunk and limbs, but rarely occurs at eyelid. Eyelid lipoma should be considered as a differential diagnosis of diffuse mass at eyelid fat layer. Diagnosis and treatment can be achieved by partial excision and histopathological examination.