Breast Tumors Diagnosis Using Fuzzy Inference System and Fuzzy C-Means Clustering

Many of the researches have been successful in the field of computer-aided diagnosis because of the important results the intelligent computing approaches have achieved in this field. In this paper the robust classification method is presented, that attempts to classify the tissue suspicion region as normal or not normal by using a Fuzzy Inference System (FIS) using the Fuzzy C-Mean (FCM) clustering for fuzzification of the Gray-Level Co-Occurrence Matrix (GLCM) feature and a match shape function for fuzzification of matrix shape, then by using (T-norm) generate 729 rules (243 rules based on normal DB case, 243 rules based on benign case, 243 rules based on malignant case), after that the best Eighteen rules are selected (best 6 rules based on normal DB case, best 6 rules based on benign DB case, best 6 rules based on malignant DB case) by using genetic algorithm, then make summation for each group if the summation of 6 rules based on normal DB is greater than other summation of two group (best 6 rules based on benign DB case and best 6 rules based on malignant DB case) that mean resulted of the classification step is normal. The model approved efficiency classification rate of 97.5% of input dataset image.

Ovarian tumors in patients aged upto 20 years: a longitudinal study conducted in a tertiary care centre, West Bengal, India

Background: International treatment guidelines dedicated to children and adolescents are not yet established, hence need for such studies like ours is required to throw light on demographic variations of ovarian tumors and developing specific guidelines for their management.Methods: It was a descriptive longitudinal study undertaken in the Department of Obstetrics and Gynaecology from February 2018 to July 2019. According to prevalence in our setup, 50 cases of adolescent girls and children were taken for study and subjected to thorough clinical assessment and investigations. After proper diagnosis, surgery was performed in all cases and depending upon histopathology and cytology, adjuvant chemotherapy was given in selected cases. Patients were followed up till 6 months after discharge.Results: The most common symptom was found to be abdominal pain (42%), most common sign abdominal mass (38%). Out of 50 cases, 12% were found to be malignant, all of germ cell origin. Epithelial tumors were found to be the most common ovarian tumors (52%) up to 20 years of age, out of which benign tumors had 48% epithelial origin. However, up to 10 years of age, germ cell tumors were found to be the most common (75%). Only 1 malignant case expired, belonging to mixed germ cell variety of advanced stage.Conclusions: Ovarian neoplasm is highly challenging, especially in adolescents and children due to the need for fertility preservation. Early detection, optimal therapy and intense follow up with psychological support to patients and families are the mainstay of treatment.

Malignant perivascular epithelioid cell neoplasm in the liver: report of a pediatric case

Background Perivascular epithelioid cell neoplasm (PEComa) in a child is very rare. We herein report the first malignant case of PEComa developing in the liver of a pediatric patient. Case presentation A 10-year-old boy visited a private clinic with prolonged fever of unknown etiology. Abdominal ultrasonography was performed to evaluate the fever’s origin, revealing a large tumor in the liver. He was thus referred to a nearby hospital to investigate the tumor further. Enhanced computed tomography (CT) showed a 6.8 × 5.9 × 10.5-cm solid lesion on S4 and S5. On magnetic resonance imaging (MRI), the tumor had a low signal intensity on T1 imaging and high signal intensity on T2 imaging, with partial diffusion restriction. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) showed a marked uptake in the mass lesion with no evidence of metastasis. The patient was negative for all tumor markers, including AFP, CEA and PIVKA-II. The results of a needle biopsy suggested hepatocellular carcinoma. The tumor’s rapid growth suggested malignancy. Hepatic segmentectomy (S4 + S5 + S8) was performed. The tumor was resected en bloc with a margin. Microscopically, the tumor showed atypical spindle, polygonal or oval-shaped cells with a high nuclear grade, and vascular invasion. Immunohistochemistry was positive for alpha-smooth muscle antigen (α-SMA), human melanin black-45 (HMB-45) and melan A. The pathological diagnosis was malignant PEComa. In the 6 months after surgery, the patient complained of shoulder pain. MRI showed a dumbbell-shaped tumor at the 2nd thoracic vertebrae, which was confirmed to be bone metastasis of PEComa. After chemotherapy, including ifosfamide and doxorubicin, vertebrectomy was performed. Two years later, thoracoabdominal CT showed a 10-cm solid mass occupying the pelvis and a 15-mm nodule in the middle lobe of the right lung. Under a diagnosis of peritoneal and lung metastases, they were surgically removed and metastasis of PEComa was pathologically confirmed. Four months after the 2nd relapse, pelvic metastasis appeared again and mTOR (mammalian target of rapamycin) inhibitor was initiated. To our knowledge, this is the first report of malignant hepatic PEComa in a pediatric patient. Conclusion Although extremely rare, malignant hepatic PEComa can develop in a child.

874 Solitary Fibrous Tumours of the Pleura: Immunohistochemistry

Aim To evaluate immunohistopathology markers of solitary fibrous tumours of the pleura (SFTP), including markers of benign and malignant variants. Method Retrospective review of immunohistopathology reports on 4 patients diagnosed with SFTP between January-October 2020 at the Golden Jubilee National Hospital. Data was collated on markers tested or detected. Benign and malignant cases were compared. A literature review was conducted to summarise the current evidence. Results Ki-67, Anti-bcl-2, CD99, STAT6, Desmin, AE1/3, Calretinin and S100 were tested in 100% (4/4) cases. CD34, EMA and CD117 were tested in 75% (3/4). Betacatenin and Vimentin were tested in 25% (1/4). Of those tested, Ki-67 was present in 100% (4/4), Anti-bcl-2 and CD99 in 75% (3/4), STAT6 in 50% (2/4), Desmin in 25% (1/4), AE1/3 in 25% (1/4), Calretinin in 25% (1/4), S100 in 0% (0/4), CD34 in 67% (2/3), EMA in 0% (0/3), CD117 in 0% (0/3), Betacatenin in 100% (1/1) and Vimentin in 100% (1/1). One out of 4 cases were malignant based on clinical presentation. Of the markers tested in all cases, Desmin was only detected in the malignant case, AE1/3 and Calretinin only in the benign cases, and the other markers in both benign and malignant cases. Anti-bcl-2 and Ki-67 intensity did not correlate with tumour diameter or malignant potential. Immunohistopathology could not confirm SFTP diagnosis in 50% (2/4) cases; it could not determine malignant potential or SFTP-subtype in 100% (4/4) cases. Conclusions A better understanding of SFTP immunohistopathology is needed for investigating SFTP, including benign and malignant tumour variants.

Detection of Architectural Distorted Region in Mammogram Images Using Hybrid Classification Approaches

The architectural distorted regions in mammogram images are detected and segmented using computer aided hybrid classification approach in this paper. The main importance of this research work is to provide a computer aided methodology for screening the distorted regions in mammogram images. In present approach, the classification accuracy of the conventional methods is not suitable for further diagnosis process such as malignant and benign. Hence, the main objective of this paper is to develop an efficient architectural region detection method using soft computing method with high classification accuracy for further diagnosis purpose. This proposed method has two stages of the proposed flow as architectural distorted detected mammogram image and segmentation of architectural distorted regions in mammogram images. The first stage of this proposed method uses Random Forest (RF) classification method which classifies the source mammogram image into either normal or abnormal. In second stage of the proposed method, the abnormal image is further classified into either Benign or Malignant using Adaptive Neuro Fuzzy Inference System (ANFIS) classification approach. The proposed methodology for architectural distorted region detection is tested on the publicly available mammogram datasets Mammographic Image Analysis Society (MIAS) and Digital Database for Screening Mammography (DDSM) respectively. In this paper, the mammogram images from MIAS dataset are grouped into normal case (156 images), benign case (122 images) and malignant case (98 images). The mammogram images from DDSM dataset are grouped into normal case (144 images), benign case (112 images) and malignant case (145 images). The overall average detection rate of the proposed system on the mammogram images in MIAS dataset is about 98.7%. The overall average detection rate of the proposed system on the mammogram images in DDSM dataset is about 98.3%. The extensive simulations are carried out on the mammogram images which are obtained from these dataset and the results are compared with stated of art methods.

Histopathological findings of gastric specimens of patients undergoing sleeve gastrectomy

Sleeve gastrectomy is the most preferred surgical procedure in obese patients. In the literature, the necessity of pathological examination of the specimen is emphasized because of malignant case reports. In this study, we aimed to present the histopathological findings of the specimens of our patients who underwent sleeve gastrectomy due to obesity in the light of the literature. Patients who underwent sleeve gastrectomy due to obesity between 2014-2019 in our clinic were retrospectively screened. Endoscopy was not performed in patients with no symptoms. After the obesity committee, the patients were operated and the specimens were sent for routine histopathological examination. Patients' age, gender, body mass index, surgical procedure information, and histopathological features of resected gastric specimens were analyzed. A total of 411 patients were included in the study and there were 309 (75.2%) female patients. The overall mean age was 35 ± 10.3 and the mean body mass index was 44.7 ± 5.2 kg / m2. The pathology of 85 (20.7%) of the patients were reported as completely normal. Abnormal pathological findings were detected in 326 (79.3%) patients. No malignant finding was found in the specimen pathology results. The necessity of endoscopic examination before sleeve gastrectomy is controversial. Even if no malignant pathological result was detected in our study, we believe that routine pathological examination is required for medicolegal reasons.

Malignant Ciliated Muconodular Papillary Tumors of the Lung: A Case Report

Ciliated muconodular papillary tumors (CMPTs) are rare peripheral lung lesions, characterized by papillary architecture and ciliated columnar cells admixed with mucous cells and basal cells. Only about 50 cases have been reported to date and is categorized as a benign neoplasm. In this article, we report an extremely rare case of 79-year-old man with a CMPT that developed in his right upper lobe. The central region of the tumor showed features of classic CMPT, while marginal area of the tumor showed the characteristics of invasive lung cancer. In central classic CMPT region, the ciliated, basal, and mucous cells were positive for thyroid transcription factor-1, cytokeratin 7 (CK7), and NapsinA. Basal cells were positive for CK5/6 and p40. Mucous cells were weakly positive for MUC2 and MUC5AC. However, CK5/6 and p40 were negative in the peripheral malignant area. Both of the benign and malignant regions had an EGFR driver mutation in exon 21. We concluded that this tumor was an extremely rare malignant case of CMPT.

Parapharyngeal Tumours: Our Experience in a Tertiary Care Hospital

Introduction Tumours of parapharyngeal space are rare. Surgical excision is the mainstay of its management. However, approach to the space is rather difficult. The transcervical approach is most commonly practiced as opposed to the transoral approach, due to fear of complications. The present study aims to study the two approaches with respect to treatment outcomes and complications. Materials and Methods A prospective study was conducted from July 2018 to December 2019 (1.5 years) at the Department of ENT in a tertiary care Hospital. A total of 10 cases of parapharyngeal tumours were selected; 5 of involving the prestyloid compartment underwent transoral surgery and the other 5 involving the post styloid compartment underwent transcervical surgery. The results of surgery and complications were studied. Results The mean age of presentation was 36.5 yrs. Male: Female ratio was 3:2. There were 9 benign and 1 malignant case in the study. The most common presentation was an asymptomatic oropharyngeal mass (80%). The most common pathological type was pleomorphic adenoma of the salivary gland (50%). Conclusion We found that the transoral approach is as effective as transcervical approach in surgical cureand contrary to the popular belief, it is associated with fewer complications.Hence, carefully selected cases can be safely managed by this approach.

A study on the correlation of clinical and ultrasonography diagnosis with histopathological outcome in cases of hysterectomy

Background: Hysterectomy is the most commonly performed gynaecological operation throughout the world due to different causes of pelvic pathology. Fewer studies have been performed describing the relationship between preoperative clinical, ultrasonological diagnosis and histopathological outcome.Methods: Authors report 100 cases with benign gynecological disorders who underwent hysterectomy. Authors excluded malignant cases from the study. A preoperative diagnosis was formed based on clinical and ultrasound examination and it was compared with the histopathological report of the hysterectomy specimen.Results: In this study the most common preoperative diagnosis for hysterectomy was fibroid uterus (39%) among which 94.87% showed positive correlation with HPE. Correlation for adenomyosis was 100% between preoperative diagnosis and HPE outcome. Correlation for DUB was poor. 57.14% of the preoperatively diagnosed DUB cases showed adenomyosis on HPE. One case of fibroid showed adenocarcinoma of endometrium on HPE.Conclusions: The study fulfills the aim of finding the efficacy of clinical and USG findings in diagnosing gynecological disorders accurately. Clinical examination is not always adequate. USG is the most important, simple and easily accessible investigation. There is one missed malignant case in this study which is a major shortcoming of clinical evaluation.