Nodular Fasciitis of the breast – An uncommon benign reactive proliferative lesion

Nodular fasciitis is rarely reported in breast. It is benign reactive proliferative lesion of fibroblast. A 65 year old female presented to surgical department for left breast mass since 2 months duration, rapidly enlarging without any regional lymphadenopathy. Mammography showed hyperdensity masses with irregular margin. On FNAC reported as benign spindle cell lesion. Left sided two breast masses measuring 4 x 3.3 x 2.5cm and 2.0 x 1.6 x 0.5cm were excised and on histopathology reported as Nodular Fasciitis of left breast. We are presenting this extremely rare case of nodular fasciitis of breast for its clinical, radiological and histopathological findings.

Case Report: Multimodality Imaging of Infectious Sacroiliitis and Retroperitoneal Abscess Causing Hindlimb Ataxia in a Young Dog

A 3-month-old intact male Labrador Retriever was presented for falling trauma and hindlimb ataxia. Radiography indicated radiolucent left sacroiliac joint with irregular margin. Computed tomography revealed thickened sublumbar muscles and hypoattenuated sacroiliac joint while magnetic resonance imaging demonstrated abscess at retroperitoneum and gluteal muscle. Ultrasonography showed lytic left sacroiliac joint with retroperitoneal fluid, and fine needle aspiration resulted Staphylococcus aureus. Hindlimb ataxia was attributed to infectious sacroiliitis and its secondary retroperitoneal abscess. As far as the authors' knowledge, this is the first report of multimodality imaging of infectious sacroiliitis with retroperitoneal abscess caused by S. aureus in a dog.

Can sonographic features of microcalcification predict thyroid nodule malignancy? a prospective observational study

Background The aim of this study was to investigate the diagnostic accuracy of microcalcification, as well as its associated sonographic features, for prediction of thyroid nodule malignancy. We prospectively assessed the patients with thyroid nodule, who underwent ultrasound-guided fine-needle aspiration during 2017–2020 in Babol, northern Iran. The ultrasonographic characteristics of the nodules, as well as their cytological results, were recorded. We used regression analysis to evaluate the relation between sonographic findings and nodule malignancy. A receiver operator characteristics (ROC) analysis was also used to estimate the ability of ultrasound to predict the characteristic features of malignancy, as estimated by the area under the curve (AUC). Results Overall, 1129 thyroid nodules were finally included in the study, of which 452 (40%) had microcalcification. A significant positive association was found between nodule malignancy and microcalcification in both univariate (OR=3.626, 95% CI 2.258–5.822) and multivariable regression analyses (OR=1.878, 95% CI 1.095–3.219). In the nodules with microcalcification, significant positive relations were seen between malignancy and hypoechogenicity (OR=3.833, 95% CI 1.032–14.238), >5 microcalcification number (OR=3.045, 95% CI 1.328–6.982), irregular margin (OR=3.341, 95% CI 1.078–10.352), and lobulated margin (OR=5.727, 95% CI 1.934–16.959). The ROC analysis indicated that AUC for hypoechogenicity, >5 microcalcification number, irregular margin, and lobulated margin were 60%, 62%, 55%, and 60%, respectively, in predicting malignant thyroid nodules. Conclusion The findings indicated that microcalcification can be a potential predictor of thyroid nodule malignancy. Also, the presence of irregular or lobulated margins, multiple intranodular microcalcification (>5 microcalcifications), and/or hypoechogenicity can improve the ability of microcalcification in distinguishing malignant from benign nodules.

Non-Thermal Biocompatible Plasma Jet Induction of Apoptosis in Brain Cancer Cells

Glioblastoma multiforme (GBM) is a highly malignant and rapidly advancing astrocytic brain tumor in adults. Current therapy possibilities are chemotherapy, surgical resection, and radiation. The complexity of drug release through the blood-brain barrier, tumor reaction to chemotherapy, and the inherent resistance of tumor cells present challenges. New therapies are needed for individual use or combination with conventional methods for more effective treatment and improved survival for patients. GBM is difficult to treat because it grows quickly, spreads finger-shaped tentacles, and creates an irregular margin of normal tissue surrounding the tumor. Non-thermal biocompatible plasma (NBP) has recently been shown to selectively target cancer cells with minimal effects on regular cells, acting by generating reactive oxygen species (ROS) and reactive nitrogen species (RNS). We applied a soft jet plasma device with a syringe shape to U87 MG cells and astrocytes. Our results show that NBP-J significantly inhibits cell proliferation and changes morphology, induces cell cycle arrest, inhibits the survival pathway, and induces apoptosis. Our results indicate that NBP-J may be an efficient and safe clinical device for brain cancer therapy.

Heterotopic pancreas: the added value of endoscopic ultrasound with Computed Tomography for diagnosis

Aims: To investigate the added value of endoscopic ultrasound (EUS) with computed tomography (CT) in distinguishing heterotopic pancreas (HP) from other pathologies, when gastroduodenal subepithelial tumors (SETs) are suspected on an upper endoscopic examination.Material and methods: We retrospectively included 54 consecutive patients with gastroduodenal SETs who had undergone both abdominal CT and EUS within a 3-month interval. All EUS, endoscopy, and CT images were reviewed and evaluated in a blinded manner by an endoscopist and a radiologist, respectively. Univariate and multivariate analyses were performed to identify EUS/CT findings related to HP. Diagnostic performance of CT only and CT combined with EUS was compared for distinguishing HP from other SETs.Results: We included patients with HP (n=17; pathologically confirmed, n=6), gastrointestinal stromal tumor (GIST, n=24), and other pathologies (n=13). Multivariate logistic regression analyses revealed that irregular margin, origin from submucosal layer, internal microcystic-tubular structure, and oval shape were independent factors in diagnosing HP by EUS, whereas a micro-lobulating contour was the only significantly independent factor in CT. In assessments of diagnostic performance, CT combined with EUS showed significantly superior diagnostic performance in comparison with CT only (area under the curve, 0.961 vs. 0.833, p=0.028) in the consensus interpretation of an endoscopist and a radiologist.Conclusions: CT combined with EUS with a comprehensive and complementary interpretation showed significant added value compared to CT only in diagnosing gastroduodenal HP

Diagnostic features of the presumed focal viral retinitis: A case series

Introduction: Other than well-known herpetic retinopathies like acute retinal necrosis, progressive outer retinal necrosis and cytomegalovirus retinitis, there are few reports on atypical forms of viral retinitis caused by herpes virus from around the world. Cases: Presenting symptom was sudden onset of diminution of vision in all 6 cases. Mean duration of symptoms at presentation was 7.6 days. The mean age was 27.3 years (range 22-40 years). All were immunocompetent (4 females and 2 males), with unremarkable review of system. All had unilateral involvement. Presenting visual acuity ranged from CFCF to 6/60. Granulomatous anterior uveitis was present in 4 cases. All had focal retinitis with irregular margins, either juxtapapillary, macular or over one of the major vascular arcades. The diagnosis of focal viral retinitis was made solely based upon the clinical findings. All recovered after a course of oral acyclovir (one was given additional intravitreal acyclovir as well) and oral prednisolone, with final visual acuity of 6/6P to 6/9 in all except one. Conclusion: In case of focal retinitis with irregular margin, viral etiology should be borne in mind. Clinical features are typical enough to help in diagnosing without PCR test.

A Simplified Ultrasonographic Score for the Prediction of Cytologically Suspicious Thyroid Nodules

Purpose The major aim of ultrasound (US)-based risk stratification systems is to reduce unnecessary thyroid biopsies without losing the ability to recognize nodules with clinically significant malignancy. Each of the classic suspicious features of a thyroid nodule detected on US scan (hypoechoic pattern, microcalcifications, irregular margin, taller than wide shape, irregular vascularization) is significantly independently associated with the probability of malignancy, but none of them has good diagnostic accuracy. Thus, we evaluated the predictive value of a binary score simply based on the combination of these US features, regardless of the specific predictive value of each US feature, against the outcome of suspected malignancy at cytological diagnosis (TIR3 to TIR5 categories by SIAPEC-IAP [TIR+]). Materials and Methods 1009 thyroid nodules from 1081 patients were considered. The US features of suspicion of all nodules were categorized in 5 binary scores (U1 to U5), each including from 1 to 5 of those features. Results U2 (at least 2 US suspicious features) was the most balanced predictor of TIR+ (PPV 0.48, NPV 0.93, LR+ 3.05 and LR– 0.24). Weighting the predictivity of the single features did not improve the estimate. Using U2 as the criterion to send nodules to FNAC would have reduced the number of biopsies by 60 % (604 patients) and the false negatives would have only accounted for 41 cases out of 237 TIR+ (17 %) with 39 cases of TIR3 and 2 cases of TIR4, including only 6 malignant nodules on histological examination. U2 performed much better than the ATA recommendations for detecting those nodules, resulting in TIR+ at cytology. Conclusion This simple and reproducible sonographic score based on 2 US features of suspicion of malignancy has quite a good performance with respect to identifying thyroid lesions categorized by cytology as medium-high risk of malignancy and could allow us to reduce cytology costs for low-risk nodules.

Thyroid Ultrasound Reports: Deficiencies and Recommendations

Objective: Thyroid ultrasound plays a major role in the clinical management of patients with thyroid nodules. Comprehensive reporting enables malignant risk stratification and biopsy decisions. In this study, we aimed at a systematic evaluation of the content and completeness of thyroid radiology reports. Methods: A retrospective study was undertaken. A total of 200 thyroid ultrasound reports of examinations performed over a 1-year period were reviewed. After excluding 18 reports, the remaining 182 were evaluated for the inclusion of the following nodule characteristics: size, 3-axis dimensions, location, presence or absence of five signs suspicious of malignancy, namely microcalcification, hypoechogenecity, irregular margin, height-to-width ratio, and intranodular vascularity. Results: While all reported nodules could be stratified easily as being more or less than 1 cm in size, only 23.6% of these nodules were reported in 3 dimensions, and 33.5% of the nodules were specifically localized. For any described nodule, the frequency of reporting on echogenicity was 50%, on vascularity 19.2%, on margin 10.4%, on calcifications 9.3%, and no report contained a description of the height-to-width ratio. The cumulative frequency of reporting on one characteristic per nodule was 84%, of two characteristics 27%, three characteristics 4.4%, and no report included ≥4 characteristics per nodule. Conclusion: Despite easily accessible templates, reporting of thyroid nodule sonogram continues to be incomplete and inconsistent. This in turn constitutes a waste of a significant tool that could otherwise help in making timely informed medical decisions and in providing a significant platform for patients’ future follow-up.

KESESUAIAN CT SCAN LEHER DENGAN HASIL BIOPSI ASPIRASI JARUM HALUS DALAM MENGIDENTIFIKASI KEGANASAN LIMFADENOPATI LEHER

Limfadenopati dapat disebabkan oleh berbagai kondisi mulai dari keganasan, infeksi, autoimun, dan iatrogenik. Limfadenopati pada usia anak dan dewasa yang ukurannya tidak bertambah besar dalam kurun waktu kurang dari dua minggu atau lebih dari 12 bulan tidak bersifat neoplastik. Penelitian ini bertujuan mengetahui kesesuaian gambaran CT Scan leher dengan hasil biopsi aspirasi jarum halus (BAJAH) untuk membedakan limfadenopati leher yang jinak dan ganas. Penelitian ini dilaksanakan di Departemen Radiologi RS. Dr. Wahidin Sudirohusodo dan RS Universitas Hasanuddin Makassar mulai bulan Desember 2017 sampai Mei 2018. Sampel sebanyak 61 orang dengan rentang usia 4 - 82 tahun. Metode yang digunakan adalah observasional analitik dengan pendekatan cross sectional. Hasil penelitian menunjukkan gambaran keganasan limfadenopati leher pada CT Scan yang sesuai dengan BAJAH yaitu penyebaran ekstrakapsular, nekrosis sentral, bentuk bulat/lobulated dan margin irregular, sedangkan kalsifikasi dan ukuran tidak sesuai. Gambaran CT Scan limfadenopati leher yang jinak sesuai dengan hasil BAJAH yaitu tidak ada penyebaran ekstrakapsular, tidak ada nekrosis sentral, bentuk oval dan margin regular, sedangkan kalsifikasi dan ukuran tidak sesuai. Lymphadenopathy can be caused by various conditions that were malignancy, infection, autoimmunity, and iatrogenic. In adults and children, lymphadenopathy whose duration is less than two weeks or more than 12 months but its size does not increase, that is not a neoplastic. The study aims to determine the relationship between CT Scan of neck image and the result of fine needle aspiration biopsy (FNAB) in distinguishing benign and malignant cervical lymphadenopathies. The research was conducted in Radiology Department of Dr. Wahidin Sudirohusodo and Universitas Hasanuddin Hospital Makassar from December to May 2018. The sample were 61 people aged form 4 – 82 years old. The observational analytic with cross sectional analytic were used in this study. The result revealed that image of malignant lymphadenopathies in CT Scan of neck were significantly related with FNAB results; extracapsular spread; central necrosis, lobulated or rounded forms with irregular margin, while calcification and size were not related. The image of benign lymphadenopathies in CT Scan of neck was related with FNAB results; no extracapsular spread, no central necrosis, oval formed with regular margin, while calcification and size were not related.

Epidemiological and pathological study of cutaneous leishmaniasis in hilla and Diwanya/Iraq

Cutaneous leishmaniasis is an endemic diease in the middle and south of Iraq. distribution of infection was studied in two governorates (diwanya and hilla), total number of patients attended to the dermatology center in three months (December 2016, January, February 2017) in diwanyia was 1940, 132 were cutaneous leihmaniasis (10.7%) while in hilla 1757 patients were attended to the dermatology center at the asme months, cutaneous leihmaniasis cases were 42 (2.4%). total number of cutaneous leishmaniasis was 208, 132 for diwanya 76% while for hilla was 42, 24%.infected males were higer than females in both cities 74.3%,25.7% respectibely. Age variations reveal all infected cases were in all ages but high percent were in age of ten years old and below 35.6%. no cases were recorded during summer months and the peak of this sisease was in January 28.5%, February 30.9%. pathological lesions were classified grossly as follows, papule (redness and swelling ) pustule (redness with crusts sometimes with pus)ulcer (it was no crusts with shallow ulceration irregular margin)scar formation. Hematological study revealed increase in number of erythrocytes and variation in size (poikilocytosis). Treatment were mostly, systemic injection with topical treatment, several types of ointment.