A Rare Case of Low-Grade Dedifferentiated Liposarcoma Presenting as a Pharyngeal Polyp: Avoiding a Pitfall With Significant Repercussions

Dedifferentiated liposarcoma is a nonlipogenic sarcoma of variable histological grade that frequently arises in association with a well-differentiated liposarcoma. Dedifferentiation occurs in approximately 10% of well-differentiated liposarcomas and is most commonly encountered in the retroperitoneum. Dedifferentiated liposarcoma of the upper respiratory tract is an extremely rare occurrence. Herein, we report a very rare case of low-grade dedifferentiated liposarcoma of the pharynx that presented as a polyp mimicking a benign process clinically and microscopically. We discuss the relevant molecular findings and review the current literature.

Acute Appendicitis with Neuronal Hyperplasia and Swelling: A Novel Histologic Mimic of Appendiceal Goblet Cell Adenocarcinoma and Signet-Ring Cell Adenocarcinoma

Goblet cell adenocarcinoma and signet-ring cell adenocarcinoma are well-known diagnostic pitfalls of routine appendectomy specimens. Here we present a case of acute appendicitis with prominent neuronal (ganglion cell) hyperplasia and swelling which histologically mimics goblet cell adenocarcinoma and signet-ring cell adenocarcinoma. Attention to the cytologic features of the lesional cells (absence of atypia, mitotic activity) and their close association with nerves and classic ganglion cells, along with the use of a limited panel of immunostains, ensures proper classification of this rare but striking benign process.

Sonographic and MRI Presentation of Geyser Sign in Rotator Cuff Tears

Limited cases of rotator cuff tears with acromioclavicular (AC) degeneration in association with cystic swelling or ganglion cyst have been described till date. The “geyser radiographic sign” was originally described by Craig in 1984. Its significance was to document a tear in the articular capsule of the AC joint in the setting of a chronic full-thickness tear of the rotator cuff, which gave the appearance of a geyser arising from the subacromial bursa as radiographic contrast tracked through the AC joint to project superiorly from the shoulder. An 82-year-old male presented with pain on rest in the left shoulder and with difficulty in overhead abduction from last few months. MRI showed near complete full-thickness tear of supraspinatus tendon with retraction of the tendon and reduced bulk of the supraspinatus muscle with associated superior subluxation of humerus with AC arthropathic changes causing ganglion cyst and incidental finding of superior labrum anterior and posterior tear. AC cysts are further divided into Type 1 and Type 2. Repeated aspirations of these masses are not advised, as they often recur and repeated attempts at aspiration may lead to formation of a draining fistula. MRI geyser sign is highly suggestive of a benign process, which suggests underlying rotator cuff pathology.

Not a Coincidental Concurrence of Breast Carcinoma and Cardiac Myxoma: Case Report

Background: Myxoma has been considered to undergo a simple and benign process but not always so. Case presentation: A female patient was admitted for evaluation of left breast nodule. Physical examination showed facial pigmentation, left breast nodule and 3/6 diastolic murmur at the mitral valve area. Preoperative echocardiography revealed a massive mobile left atrial mass attaching to the interatrial septum causing obstruction to mitral orifice. Histopathologic investigation confirmed the left atrial mass to be myxoma and left breast nodule to be cancer. Carney complex was considered and lifelong follow-up was advised. Conclusion: Cardiac myxoma may present as a part of a systematic disease entity. In patients with a combination of breast nodule and facial pigmentation, transthoracic echocardiography examination is advised to guide decision-making.

Pseudocystic Osteosarcoma: A Potential Diagnostic Pitfall – Case Report

Introduction: Pseudocystic osteosarcoma (OS) is an uncommon variant of conventional OS. Clinical and radiological features are presented as benign process with a non-rapid growth rate. Treatment may be adversely affected by the delay in diagnosis or an appropriate invasive procedure. Case Presentation: We report a rare case of pseudocystic OS of the distal femur in a 6-year-old boy. Imaging findings revealed an osteolytic intra-compartmental tumor, that suggested either simple bone cyst or subacute osteomyelitis. The patient was first operated by lateral approach for curettage but histopathology showed conventional OS. Treatment had been managed by standard current chemotherapy and trans-epiphyseal intercalary resection through lateral approach. Reconstruction was done by a non-vascularized autograft within the induced membrane technique. At 3 years of follow-up, the patient remained disease-free with good anatomical and functional results. Conclusion: conventional OS can be presented in rare cases as a benign bone cyst tumor. This type of pseudocystic OS should be included in the differential diagnosis of bone cyst tumors and pseudo-tumors. Keywords: Osteosarcoma, pseudocystic, surgery, reconstruction.

Spontaneously formed gradient chemical compositional structures of niobium doped titanium dioxide nanoparticles enhance ultraviolet- and visible-light photocatalytic performance

Semiconductor photocatalysts showing excellent performance under irradiation of both ultraviolet (UV)- and visible (VIS)-light are highly demanded towards realization of sustainable energy systems. TiO2 is one of the most common photocatalysts and has been widely investigated as candidate showing UV/VIS responsive performance. In this study, we report synthesis of Nb doped TiO2 by environmentally benign mechanochemical reaction. Nb atoms were successfully incorporated into TiO2 lattice by applying mechanical energy. As synthesized Nb doped TiO2 were metastable phase and formed chemical compositional gradient structure of poorly Nb doped TiO2 core and highly Nb doped TiO2 surface after high temperature heat treatment. It was found that formed gradient chemical compositional heterojunctions effectively enhanced photocatalytic performance of Nb doped TiO2 under both of UV- and VIS-light irradiation, which is different trend compared with Nb doped TiO2 prepared through conventional methods. The approach shown here will be employed for versatile systems because of simple and environmentally benign process.

Development and usability testing of two arts-based knowledge translation tools for parents about pediatric fever

Fever is defined as an elevated body temperature greater or equal to 38 degrees celsius when measured via the ear canal. It is a common bodily response in children and is typically a benign process that is self-limiting. However, fever can be an anxiety provoking event for some parents because their child can look unwell and become irritable as a result. Past attempts at translating medical knowledge about fever and its management strategies into parent-friendly formats exist; however, parent misperceptions about definition and management persist despite these educational tools. Our research team employs patient engagement techniques to develop resources for parents to enhance the uptake of complex medical knowledge. First, our research group conducts qualitative interviews and knowledge synthesis of the literature. Following analysis, salient themes are used to develop a script and skeleton for our videos and infographics, respectively. Employing this same process, this paper discusses the development and usability testing of two digital tools for fever. Prototypes for the video and infographic were tested by parents in urban and remote emergency department (ED) waiting rooms. A total of 58 surveys were completed by parents. Overall, parents rated both the fever video and infographic favourably, suggesting that patient engaged research methods and digital formats are mediums that can facilitate knowledge transfer.

Depression and Intolerance of Uncertainty: Association with Decisional Conflict in Otolaryngology Patients

Objective: To determine if anxiety, stress, depression, worry, and intolerance of uncertainty were related to pre-operative decisional conflict (DC), shared decision making (SDM), or demographic variables in adult otolaryngology surgical patients. Methods: Consecutive adult patients meeting criteria for otolaryngological surgery were recruited and completed DC and SDM scales, Penn State Worry Questionnaire (PSWQ), Intolerance of Uncertainty Scale (IUS-12), and Depression, Anxiety and Stress Scale-21 (DASS-21). Results: The cohort included 118 patients, 61 (51.7%) males and 57 (48.3%) females. Surgery was planned for a benign process in 90 (76.3%) and 46 (39.3%) had previous otolaryngologic surgery. SDM and DC scores did not significantly differ across gender, age, education level, previous otolaryngologic surgery or whether or not surgery was for malignancy. Patients with no malignancy had significantly higher DASS-21 Stress scores (mean 12.94 vs 8.15, P < .05) and total IUS-12 scores (mean 28.63 vs 25.56, P = .004). Women had lower PSWQ scores (41.56 vs 50.87 for men, P = .006). IUS-12 and PSWQ declined with age. DC scores correlated positively with DASS-21 Depression ( r = .256, P = .008) and IUS-12 scores ( r = .214, P = .024). SDM correlated negatively with DASS-21 Depression ( r = −.208, P = .030). Linear regression model for DC scores revealed a significant relationship with DASS depression ( B = 0.674, P = .048). Conclusion: Preoperative decisional conflict is associated with increased depression and intolerance of uncertainty in adults undergoing otolaryngologic surgery. Screening for and management of depression, anxiety, and related concerns may improve surgical outcomes in this group.