Orthorectification of Skin Nevi Images by Means of 3D Model of the Human Body

Melanoma is the most lethal form of skin cancer, and develops from mutation of pigment-producing cells. As it becomes malignant, it usually grows in size, changes proportions, and develops an irregular border. We introduce a system for early detection of such changes, which enables whole-body screening, especially useful in patients with atypical mole syndrome. The paper proposes a procedure to build a 3D model of the patient, relate the high-resolution skin images with the model, and orthorectify these images to enable detection of size and shape changes in nevi. The novelty is in the application of image encoding indices and barycentric coordinates of the mesh triangles. The proposed procedure was validated with a set of markers of a specified geometry. The markers were attached to the body of a volunteer and analyzed by the system. The results of quantitative comparison of original and corrected images confirm that the orthorectification allows for more accurate estimation of size and proportions of skin nevi.

Intra- and Interobserver Variability in Magnetic Resonance Imaging Measurements in Rectal Cancer Patients

Colorectal cancer is the second most common cancer in Europe, and accurate lymph node staging in rectal cancer patients is essential for the selection of their treatment. MRI lymph node staging is complex, and few studies have been published regarding its reproducibility. This study assesses the inter- and intraobserver variability in lymph node size, apparent diffusion coefficient (ADC) measurements, and morphological characterization among inexperienced and experienced radiologists. Four radiologists with different levels of experience in MRI rectal cancer staging analyzed 36 MRI scans of 36 patients with rectal adenocarcinoma. Inter- and intraobserver variation was calculated using interclass correlation coefficients and Cohens-kappa statistics, respectively. Inter- and intraobserver agreement for the length and width measurements was good to excellent, and for that of ADC it was fair to good. Interobserver agreement for the assessment of irregular border was moderate, heterogeneous signal was fair, round shape was fair to moderate, and extramesorectal lymph node location was moderate to almost perfect. Intraobserver agreement for the assessment of irregular border was fair to substantial, heterogeneous signal was fair to moderate, round shape was fair to moderate, and extramesorectal lymph node location was substantial to almost perfect. Our data indicate that subjective variables such as morphological characteristics are less reproducible than numerical variables, regardless of the level of experience of the observers.

EU-TIRADS-Based Omission of Fine-Needle Aspiration and Cytology from Thyroid Nodules Overlooks a Substantial Number of Follicular Thyroid Cancers

Background. The classification of nodules by Thyroid Imaging Reporting and Data Systems (TIRADS) is important in guiding management. Whether sensitivity in identifying thyroid cancers varies with thyroid cancer phenotype remains unclarified. Methods. The ultrasound (US) characteristics of nodules of 26,908 nodular goiter patients were recorded. Fine-needle aspiration cytology (FNA) was performed in all nodules >1 cm irrespective of US findings (n = 25,025) and in nodules between 5 mm and 10 mm with suspicious US characteristics (n = 1,883). Of the 3281 operated cases, 221, 30, and 23 were papillary (PTC), follicular (FTC), and medullary (MTC) cancers, respectively. The US-based indication of FNA, as defined by EU-TIRADS scores, combined with lesion size, was calculated. This study design is unique in avoiding the common selection bias when TIRADS’ sensitivity is tested in a cohort selected for FNA and surgery based on the same US characteristics on which TIRADS is based. Results. The EU-TIRADS score influences decision of FNA in the 10–20 mm range. In such nodules (n = 118), the number of suspicious features (marked hypoechogenicity, microcalcifications, irregular shape, and irregular border) per lesion was lower in FTC (0.7 ± 0.6) than in PTC (1.7 ± 1.0) or MTC (1.8 ± 0.7; p < 0.02 ), resulting in EU-TIRADS scores of 4.1 ± 0.6, 4.8 ± 0.3, and 4.9 ± 0.2, respectively ( p < 0.01 ). The EU-TIRADS-based FNA indication rate was lower in FTC (55.5%) compared to PTC (85.0%) and MTC (88.9%) ( p = 0.02 ). Conclusions. EU-TIRADS-defined suspicious US features are less common in FTC than in PTC and MTC. Therefore, a substantial number of FTCs in the 10–20 mm range escape surgery.

Post Natal Gross Anatomical Studies on the Harderian Gland of Pati Duck (Anas platyrhynchos domesticus) of Assam

Background: The agro-climatic condition of Assam is suitable for duck rearing. Duck rearing contributes a major part to uplift the socio-economic condition of the rural poor people of Assam as well as others states located in the coastal regions of India. The Pati duck (Anasplatyrhynchos domesticus) population constitutes a major indigenous non-descript economically important duck variety in the state of Assam. The Harderian gland acts as a part of the Head Associated Lymphoid Tissue (HALT) Olah et al. (1992) and provides local innate immunity to the upper respiratory system, to the eye and oral cavity. Since literature on the postnatal development of Harderian gland of Pati duck is scant, hence the present study was designed to establish the basic anatomical details on Harderian gland at different stages of postnatal development of Pati duck of Assam. Methods: The present study was conducted on total forty five (45) numbers Pati duck of Assam at different stages of postnatal development. The experimental birds were brought to the Department of Anatomy and Histology, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-22 and was sacrificed according to the method of Gracy (1986). After slaughter, the birds were placed on a clean dissecting table and skin and fascia were reflected carefully without disturbing the other organs of the head region. The Harderian gland was collected by opening the orbital cavity. Thereafter, length, breadth and thickness of the Harderian gland of all age group were recorded with the help of the Vernier Callipers (McCance, 1974) and topographical location of the gland was observed. The weight of the Harderian gland of all age group was also recorded with the help of electronic balance. Result: The Harderian gland of Pati duck (Anas platyrhynchos domesticus) was located within the orbit. The gland was flat, oval and coma shaped with irregular border. The gland had two surfaces i.e. the parietal and visceral surfaces, two borders and two blunt poles. The parietal surface was found convex and attached to fascia covered by the nasal bones and interorbital septa. The visceral surface was concave and it was attached loosely to the eye ball with fascia. The lobes of the Harderian gland became more prominent with the advancement of the age. The gland was light pink in colour. The arterial blood and the venus drainage was by provided by the ophthalmic artery and vein, respectively. The slender branch of oculomotor nerve innervated the Harderian gland. The result reflected an ascending trend from 0 week age group to 42 week age group in regard to all the gross parameters. There were slight difference between left and right glands for all the gross parameters but such variations were not statistically significant (P greater than 0.05). Each lobe of the Harderian Gland of Pati duck (Anas platyrhynchos domesticus) had a single short duct which opened into the conjunctival sac at the base of the 3rd eyelid.

An Unusual Presentation of Choriocarcinoma: A Case Report with a Long Latent Period

Introduction: Choriocarcinoma (CC) is a rare malignant tumor of trophoblastic tissue. This tends to invade rapidly to the vasculature and metastasis to the lung, vagina, brain, and liver. CC can present with a variety of manifestations, such as hemoptysis, gastrointestinal (GI) bleeding, and abnormal uterine bleeding. Commonly, the latent period to the development of CC is not more than 1 year after the antecedent molar or normal pregnancy. In this report, the patient developed CC about 32 months after her previous known pregnancy. We reported a rare case of gestational CC that occurred about 32 months after her antecedent pregnancy. Case Presentation: A 21-year-old admitted in shock with abnormal uterine bleeding, pain, and lower abdominal pain. The patient had one previous cesarean section 32 months prior to admission. The vaginal examination demonstrated a fused solid cervical mass with an irregular border measuring about 7 × 7 cm. In further workup, there was evidence of a 103 × 94 × 89 mm mass with the hemorrhagic area and central necrosis in the middle and lower segments of the uterus and cervix. The patient underwent a total abdominal hysterectomy and left side salpingo-oophorectomy. The diagnosis of CC was made after microscopic examination. Conclusions: There are few case reports of choriocarcinoma with more than a year latent period after antecedent pregnancy. The strongest hypothesis is having asymptomatic pregnancy during the period between the last pregnancy and the development of CC. However, the possibility of non-gestational choriocarcinoma in such cases should be considered. Treatment with a single- or multiple-agent chemotherapy regimen should be immediately initiated after diagnosis in these cases.

Pulmonary aspergilloma on transthoracic ultrasound

Purpose Pulmonary aspergilloma affects immunocompromised patients but is also a recurrent condition in patients previously treated for pulmonary tuberculosis. Methods and Results We report the case of a 45-year-old patient with a history of cured pulmonary tuberculosis 15 years earlier in whom we visualized pulmonary aspergilloma by transthoracic lung sonography. Sonography of pulmonary aspergilloma demonstrated an oval cavity with hypoechoic contents and an irregular border, measuring a diameter of 4.7 cm; inside the lesion, a roundish structure with an anechoic rim was discernable. Conclusions The sonographic findings corresponded to chest X-ray and computed tomography imaging in this patient and to previously reported sonographic characteristics of mycotic abscesses in other organs. Lung ultrasound may be a tool to identify pulmonary aspergilloma, especially as a point-of-care imaging tool and where other imaging modalities are inaccessible.

Sonography as a Prognostic Indicator of Breslow Depth: Primary Malignant Melanoma of the Auricular Helix

Malignant melanoma is a cellular cancer that produces pigmentation of the skin. The tendency toward melanoma may be inherited, and risk factors are increased with overexposure to the sun and ultraviolet radiation. Melanomas commonly present as a dark, asymmetrical, mole-like spot that spreads, with an irregular border. It is uncommon to find a melanoma in the auricular regions and even rarer for it to be a primary malignancy of the auricles. Utilizing sonography to evaluate melanoma lesions could serve as a prognostic indicator, regarding Breslow’s depth, an aide in staging, as well as surgical planning. However, utilizing multiple diagnostic imaging modalities is essential in the proper evaluation and staging of a melanoma. Currently there are revolutionary, effective systemic therapies available for patients with a metastatic melanoma. Current therapies are focused on immunotherapy and checkpoint inhibitors. These treatment options provide an opportunity for selected metastatic melanoma patients to achieve healthy long-term success.

Thyroid Hürthle Cell Carcinoma: Clinical, Pathological, and Molecular Features

Hürthle cell carcinoma (HCC) represents 3–4% of thyroid carcinoma cases. It is considered to be more aggressive than non-oncocytic thyroid carcinomas. However, due to its rarity, the pathological characteristics and biological behavior of HCC remain to be elucidated. The Hürthle cell is characterized cytologically as a large cell with abundant eosinophilic, granular cytoplasm, and a large hyperchromatic nucleus with a prominent nucleolus. Cytoplasmic granularity is due to the presence of numerous mitochondria. These mitochondria display packed stacking cristae and are arranged in the center. HCC is more often observed in females in their 50–60s. Preoperative diagnosis is challenging, but indicators of malignancy are male, older age, tumor size > 4 cm, a solid nodule with an irregular border, or the presence of psammoma calcifications according to ultrasound. Thyroid lobectomy alone is sufficient treatment for small, unifocal, intrathyroidal carcinomas, or clinically detectable cervical nodal metastases, but total thyroidectomy is recommended for tumors larger than 4 cm. The effectiveness of radioactive iodine is still debated. Molecular changes involve cellular signaling pathways and mitochondria-related DNA. Current knowledge of Hürthle cell carcinoma, including clinical, pathological, and molecular features, with the aim of improving clinical management, is reviewed.