Extending the Indications of 5-Aminolevulinic Acid for Fluorescence-Guided Surgery for Different Central Nervous System Tumors: A Series of 255 Cases in Latin America

Introduction Fluorescence guidance with 5-aminolevulinic acid (5-ALA) is a safe and reliable tool in total gross resection of intracranial tumors, especially malignant gliomas and cases of metastasis. In the present retrospective study, we have analyzed 5-ALA-induced fluorescence findings in different central nervous system (CNS) lesions to expand the indications of its use in differential diagnoses. Objectives To describe the indications and results of 5-ALA fluorescence in a series of 255 cases. Methods In 255 consecutive cases, we recorded age, gender, intraoperative 5-ALA fluorescence tumor response, and 5-ALA postresection status, as well the complications related to the method. Postresection was classified as ‘5-ALA free’ or ‘5-ALA residual’. The diagnosis of histopathological tumor was established according to the current classification of the World Health Organization (WHO). Results There were 195 (76.4%) 5-ALA positive cases, 124 (63.5%) of whom underwent the ‘5-ALA free’ resection. The findings in the positive cases were: 135 gliomas of all grades; 19 meningiomas; 4 hemangioblastomas; 1 solitary fibrous tumor; 27 metastases; 2 diffuse large B cell lymphomas; 2 cases of radionecrosis; 1 inflammatory disease; 2 cases of gliosis; 1 cysticercosis; and 1 immunoglobulin G4-related disease. Conclusion Fluorescence with 5-ALA can be observed in lesions other than malignant gliomas or metastases, including meningiomas, hemangioblastomas, pilocytic astrocytomas, and lymphomas. Although there is need for further evidence for the use of 5-ALA beyond high-grade gliomas, it may be a safe and reliable tool to improve resection in positive tumors or to guide the histopathologic analysis in biopsies.

Sub-chronic oral toxicity study of “Kien Nao Dan” tablets in experimental animal

“Kien nao dan” (KND) tablet is composed of 13 traditional medicines that may has preventive and effective treatment of cerebral ischemia. However, there are no scientific reports of its toxicological properties which guarantee of the safety its usage treatment. Therefore, the aim of this study was to investigate the sub-chronic toxicity of KND tablet on rats through oral administration. The sub-chronic toxicity was evaluated by the recommendation of WHO in Wistar rats at doses of 0.72 g/kg/day (equal to recommended human dose) and 2.16 g/kg/day (3 times as high as recommended human dose) for 8 consecutive weeks. In the evaluation of sub-chronic toxicity, there were no behavioral and physiological changes or signs of toxicity. The result of the hematological and biological parameters after administration of KND tablets showed no change. The histopathologic analysis of livers and kidneys indicated that no significant differences were observed between the exposed and unexposed rat groups. In conclusion, “Kien nao dan” tablets did not produce sub-chronic toxicity in Wistar rats.

Convolutional Neural Network-Based Diagnostic Model for a Solid, Indeterminate Solitary Pulmonary Nodule or Mass on Computed Tomography

PurposeTo establish a non-invasive diagnostic model based on convolutional neural networks (CNNs) to distinguish benign from malignant lesions manifesting as a solid, indeterminate solitary pulmonary nodule (SPN) or mass (SPM) on computed tomography (CT).MethodA total of 459 patients with solid indeterminate SPNs/SPMs on CT were ultimately included in this retrospective study and assigned to the train (n=366), validation (n=46), and test (n=47) sets. Histopathologic analysis was available for each patient. An end-to-end CNN model was proposed to predict the natural history of solid indeterminate SPN/SPMs on CT. Receiver operating characteristic curves were plotted to evaluate the predictive performance of the proposed CNN model. The accuracy, sensitivity, and specificity of diagnoses by radiologists alone were compared with those of diagnoses by radiologists by using the CNN model to assess its clinical utility.ResultsFor the CNN model, the AUC was 91% (95% confidence interval [CI]: 0.83–0.99) in the test set. The diagnostic accuracy of radiologists with the CNN model was significantly higher than that without the model (89 vs. 66%, P<0.01; 87 vs. 61%, P<0.01; 85 vs. 66%, P=0.03, in the train, validation, and test sets, respectively). In addition, while there was a slight increase in sensitivity, the specificity improved significantly by an average of 42% (the corresponding improvements in the three sets ranged from 43, 33, and 42% to 82, 78, and 84%, respectively; P<0.01 for all).ConclusionThe CNN model could be a valuable tool in non-invasively differentiating benign from malignant lesions manifesting as solid, indeterminate SPNs/SPMs on CT.

Intraneural Nodular Fasciitis of the Dorsal Scapular Nerve: Case Report and Review of the Literature

Background Nodular fasciitis is a benign neoplasm occurring predominantly in the subcutaneous tissue. There have been nine intraneural occurrences described in the literature. Case report A 37-year-old woman presented with numbness and tenderness in her left shoulder and scapula and a slightly dropped left shoulder, without history of trauma. A magnetic resonance imaging (MRI) of the cervical spine showed a well-circumscribed oval mass deep to the levator scapula muscle. Due to persisting symptoms and an unknown nature of the process, surgical excision was performed, and histopathologic analysis confirmed diagnosis of a benign fibroblastic/myofibroblastic neoplasm, nodular fasciitis. The postoperative course was uneventful and the patient was without symptoms at 4 months of follow-up. Methods We reviewed the available literature (PubMed, Google Scholar), with nine published cases of intraneural nodular fasciitis. The reported clinical, radiologic, and histopathologic parameters were evaluated and compared. Discussion Most of the cases reported in the literature were symptomatic, with tenderness and palpability being the main symptoms. Six of the reported cases occurred in the forearm, whereas three were in the leg. To the best of our knowledge, ours is the first reported case of nodular fasciitis occurring in the trunk. Ours is the only case to display desmin positivity, which supports the reactive hypothesis of nodular fasciitis. Conclusion Intraneural nodular fasciitis is an extremely rare diagnosis. Due to its benign natural course, a multidisciplinary approach with this extremely rare diagnosis in mind is needed to avoid overtreatment.

Solitary Fibrous Tumor of Adrenal Gland and Review of the Literature

Solitary fibrous tumor (SFT) is a rare and still controversial entity. This type of tumor first appeared in the literature as a pleural lesion, but, over the last decades, it has been reported in many extrathoracic sites. As a tumor of the adrenal gland, SFT is still rare and very uncommon, thus extensive research among the English language literature has been performed. We present here a case report of an adrenal SFT which is compared to 11 other known cases. Our case report is from a patient with SFT on the left adrenal gland, followed by mild symptoms of abdominal discomfort and hypertension. Physical examination, laboratory, and radiological tests were performed. The patient underwent surgery and the material was sent for histopathologic analysis for a definite diagnosis. Regular follow up appointments were performed over the course of two years. No recurrence of the tumor has been detected. We explain the symptoms, diagnosis, treatment, and additionally we describe the results and implications of the findings reported in the literature. Correct diagnosis is mandatory for optimal management of solitary fibrous tumor patients.

Accuracy Of the Gynecology Imaging Reporting And Data System Based Upon Ultrasound Evaluation Of Adnexal Lesions

Background: Globally as growing occurrence ratio of ovarian cancer as well as efficacy of Gynecologic-Imaging Reporting-and-Data-System GI-RADS to diagnose pathologies like ovaries cancer, we designed for evaluating the presentation of diagnosis of this system to differentiate among the adnexal benign and malignant lesions. For routine gynecologic examinations, pelvic ultrasound is generally used, consequential in analysis of adnexal lesions, main stream of which are benign or functional. Though, because of probable difficulties including benign adnexal cyst (i.e. pelvic pain and adnexal torsion) as well as ultimate significance of initial analysis as well as cure of ovarian cancer, precise ultrasound analysis of adnexal lesions is important in clinical run through Methods: We searched google scholar and pubmed form 2000 to December 2019. Selection criteria reporting on the accuracy of GI-R-A-D-S system in ultrasound. Results: In this study, we evaluated 197 women with suspected appendicitis. The proportions of GI-RADS II, III, IV and V were 34.5 (69 cases), 38.0 (76 cases), 19.5 (39 cases) and 6.5 (13 cases). For the high-risk and low-risk GI-RADS subtypes, 72.5% were classified as GI-RADS II and III, and 26 were classified as GI-RADS IV and V, respectively. Conclusive histopathologic analysis was testified for 158 cases. Histopathologic assessment designated that 12(7.6%) of were malignant masses as well as 146(92.6%) were benign. Associating by histopathologic analysis, the GIRADS system specificity, sensitivity, negative predictive value and positive predictive value, as well as negative LR were 91.6, 80.82, 28.2, 99.1, 4.77, and 0.10, correspondingly. The accurateness of the scoring system was 81.64%. Conclusion: This systemic review concluded that by Gynecologic-Imaging-Reporting-Data System, we could measure the possibility of malignant stage through such an organized along with modest recording system thus that system could be valuable in clinician to perform a suitable clinical organization Keywords: Adnexal Diseases, Ovarian Neoplasms, Ultrasonography.

Animal Study of a Newly Designed Metal Airway Brachytherapy Stent Loaded with Radioactive 125I Seeds

Aim: To evaluate dynamic tissue changes after airway stenting (AS) with a newly designed metal brachytherapy stent (BS) loaded with radioactive 125I seeds in normal rabbits.Method: Forty-five normal New Zealand white rabbits were divided into three groups (Group A: stent without seeds; Group B: stent with 0.4 mCi active seeds; Group C: stent with 0.8 mCi active seeds) and underwent AS under C-arm guidance. Then, 5 rabbits were sacrificed from each group at 2, 4, and 8 weeks for further examination. Laboratory tests (including routine blood tests, liver function, kidney function, electrolytes and ROS levels), gross observations, and tissue changes of Masson/hematoxylin-eosin staining, plus immunohistochemistry of α-SMA, NOX4, and TGF-β were performed at each time point.Result: All animals underwent AS successfully without procedure-related death, but one animal died at 6 weeks due to severe pulmonary infection in Group C. Apart from a transient increase in white blood cells (P < 0.05) and a gradual increase in ROS levels (P < 0.05), other blood test items showed no significant changes (P > 0.05). The brachytherapy injury score increased with irradiation dose accumulation (P < 0.05), but tissue hyperplasia at the stent end in Group C was less severe than that in Groups A and B (P < 0.05). Airway lateral fibrosis was observed in all groups by histopathologic analysis; however, fibrosis in Group C was more severe than that in Groups A and B (P < 0.05).Conclusion: The brachytherapy injury score increased with irradiation dose accumulation, while granulation tissue hyperplasia at the stent end was inhibited by 125I brachytherapy within 8 weeks.

Contemporary Grading of Prostate Cancer: The Impact of Grading Criteria and the Significance of the Amount of Intraductal Carcinoma

(1) Background: Prognostic grade group (PGG) is an important prognostic parameter in prostate cancer that guides therapeutic decisions. The cribriform pattern and intraductal carcinoma (IDC) are two histological patterns, that have additional prognostic significance. However, discrepancies exist regarding the handling of IDC according to the guidelines published by two international genitourinary pathology societies. Furthermore, whether, in addition to its presence, the amount of IDC is also of importance has not been studied before. Lastly, the handling of tertiary patterns has also been a matter of debate in the literature. (2) Methods: A total of 129 prostatectomy cases were retrieved and a detailed histopathologic analysis was performed. (3) Results: Two cases (1.6%) upgraded their PGG, when IDC was incorporated in the grading system. The presence and the amount of IDC, as well as the presence of cribriform carcinoma were associated with adverse pathologic characteristics. Interestingly, in six cases (4.7%) there was a difference in PGG when using the different guidelines regarding the handling of tertiary patterns. In total, 6.2% of the cases would be assigned a different grade depending on the guidelines followed. (4) Conclusions: These findings highlight a potential area of confusion among pathologists and clinicians and underscore the need for a consensus grading system.

Severe and delayed-onset acneiform eruptions as an adverse reaction to regorafenib

Regorafenib is an oral multikinase inhibitor targeting several tyrosine kinase receptors including BRAF and epidermal growth factor receptor (EGFR), and is approved as a third-line treatment for metastatic gastrointestinal stromal tumor (GIST). While acneiform eruptions have been observed in patients receiving other BRAF and EGFR inhibitors, the commonly reported adverse reactions to regorafenib are fatigue and palmar-plantar erythrodysesthesia. Herein, we report, to the best of our knowledge, the first case who presented with a severe acneiform eruption 24 months after beginning regorafenib for the treatment of GIST. A 61-year-old woman developed GIST with multiple liver metastases, and she was treated with imatinib and sunitinib. However, these therapies were discontinued, and regorafenib was administered. Twenty-four months after beginning regorafenib, she developed an acneiform eruption on her back. Histopathologic analysis of a skin biopsy from the back revealed neutrophilic suppurative folliculitis. Therefore, she postponed regorafenib administration for 2 months and was treated with topical application of clindamycin phosphate hydrate, which was effective. Consistent with reported evidence that the presence of acneiform eruption and the efficacy of EGFR inhibitors are positively associated, regorafenib had good anticancer activity in our patient. Ultimately, we found that although regorafenib-associated skin toxicities usually appear within 1 month of treatment, patients potentially can present with delayed-onset acneiform eruptions even 24 months later.

Histopathological Findings in the Gastrointestinal Tract of Patients with COVID-19

Introduction/Objective Amidst the SARS-CoV-2 pandemic, we have learned that other organs, aside from the lungs, are affected by the virus. Tissue damage has been documented both clinically and histologically in multiple systems including the gastrointestinal tract. Clinical symptoms of gastrointestinal distress may be correlated with histopathologic findings. Studies have shown direct infection of epithelial cells in the GI tract in patients with the disease. The objective of this study is to identify specific histologic alterations that are present in patients with COVID-19. Methods/Case Report At our institution, a retrospective analysis was conducted to evaluate all COVID-positive patients who underwent any gastrointestinal procedure within 30 days after their positive test. The time frame included January 1, 2020 to December 31, 2020. Chart reviews were performed to document radiographic studies, endoscopic findings, histopathologic analysis, and clinical symptoms. Results (if a Case Study enter NA) A total of 26 patients met our criteria for inclusion in the study. The cohort consisted of 10 males and 16 females ranging in age from 13 to 78 years. Tissue was sent for histologic analysis in 19 of these individuals. Tubular adenomas (13), chronic gastritis (11), and prominent intestinal lymphoid aggregates (7) were the most common pathologic findings (Table 1). Conclusion These findings suggest that the histopathologic findings rendered from GI procedures of patients with COVID-19 may be non-specific and may not reveal any morphologic correlate to the clinical signs and symptoms. We propose that histopathological abnormalities identified from GI samples of SARS-CoV-2 positive patients must be correlated with clinical symptoms, endoscopic findings, and imaging when available.