Comments on the Atiyah-Patodi-Singer index theorem, domain wall, and Berry phase

It is known that the Atiyah-Patodi-Singer index can be reformulated as the eta invariant of the Dirac operators with a domain wall mass which plays a key role in the anomaly inflow of the topological insulator with boundary. In this paper, we give a conjecture that the reformulated version of the Atiyah-Patodi-Singer index can be given simply from the Berry phase associated with domain wall Dirac operators when adiabatic approximation is valid. We explicitly confirm this conjecture for a special case in two dimensions where an analytic calculation is possible. The Berry phase is divided into the bulk and the boundary contributions, each of which gives the bulk integration of the Chern character and the eta-invariant.

Clear Cell Carcinoma Arising from Abdominal Wall Endometriosis – A Report on Two Cases and Literature Review

Background: Malignant transformation of abdominal wall endometriosis is extremely rare. Clear cell carcinoma and endometrioid carcinoma are the two most prevalent histological subtypes of malignant endometriosis. To date, approximately thirty cases of clear cell carcinoma arising from abdominal wall endometriosis have been described worldwide.Case Presentation: We report two cases of clear cell carcinoma developing postoperatively in the anterior abdominal wall in women with a history of extensive endometriosis. Histopathology of the resected abdominal wall tumor demonstrated benign endometriosis contiguous with features of clear cell carcinoma. These histological features satisfied Sampson’s criteria which are required for diagnosing malignant endometriosis. Both patients were successfully managed with platinum-based adjuvant chemotherapy following cytoreductive surgery. Conclusion: Clear cell carcinoma arising from abdominal wall endometriosis is a rare, highly aggressive cancer with a propensity to recur or metastasize. Due to the limited publications on this clinical entity, there are no clearly established protocols regarding adjuvant treatment, and an evaluation of prognostic factors is lacking. Clinicians must have a high index of suspicion for malignant endometriosis of the abdominal wall, particularly in patients with an abdominal wall mass, prior abdominal surgery, and long-standing endometriosis. By presenting our case, we expect to raise awareness and study of this rare endometriosis-related neoplasm.

Fine-needle aspiration (FNA) of an abdominal wall mass malakoplakia mimicking malignancy: a case report

Introduction/Objective Malakoplakia is a granulomatous disease of infectious etiology that affects immunosuppressed individuals. It commonly involves the genitourinary tract, but the involvement of other systems and organs has been reported. Gram-negative bacterial infections are mostly the responsible agent, with Escherichia coli found in approximately 80% of cases. Malakoplakia can present clinically and radiologically as a malignancy. Methods/Case Report We present a case of a 16-year-old male with a history of acute liver failure requiring liver transplantation due to autoimmune hepatitis. He was admitted with concerns for rejection, and he was found to have an abdominal wall mass. MRI studies showed a lobulated, solid, and cystic mass measuring 11.0 x 4.9 x 1.9 cm in the right abdominal wall. The mass was extending through all the layers of the abdominal wall and protruding into the abdominal cavity with mass effect on the liver, encasing the common bile duct, hepatic artery and main portal vein, concerning for malignancy, versus a possible infectious process. Ultrasound-guided FNA and biopsy were performed. The Diff-Quik and Papanicolaou-stained smears showed abundant foamy macrophages with numerous granular intra- and extracellular slightly refractile inclusions (4-10 um), rare multinucleated giant cells, and fibroblasts. A Von Kossa stain highlighted the targetoid inclusions consistent with Michaelis-Gutman bodies. Additional stains were performed on the core needle biopsy, and the histiocytes were positive for CD68 and CD163. Stains for keratins, CD45, HSA, CD1A, and Langerin were negative. No acid-fast or fungal microorganisms were identified on AFB and GMS stains, respectively. The final diagnosis was malakoplakia, with no evidence of malignancy. Results (if a Case Study enter NA) NA Conclusion Fine-needle aspiration cytology is useful in establishing a fast diagnosis of malakoplakia and excluding malignancies.

Large-scale energetic coherent structures and their effects on wall mass transfer rate behind orifice in round pipe

This paper first uses a low-speed stereoscopic particle image velocimetry (SPIV) system to measure the convergent statistical quantities of the flow field and then simultaneously measure the time-resolved flow field and the wall mass transfer rate by a high-speed SPIV system and an electrochemical system, respectively. We measure the flow field and wall mass transfer rate under upstream pipe Reynolds numbers between 25 000 and 55 000 at three specific locations behind the orifice plate. Moreover, we apply proper orthogonal decomposition (POD), stochastic estimation and spectral analysis to study the properties of the flow field and the wall mass transfer rate. More importantly, we investigate the large-scale coherent structures’ effects on the wall mass transfer rate. The collapse of the wall mass transfer rates’ spectra by the corresponding time scales at the three specific positions of orifice flow suggest that the physics of low-frequency wall mass transfer rates are probably the same, although the flow fields away from the wall are quite different. Furthermore, the spectra of the velocity reconstructed by the most energetic eigenmodes agree well with the wall mass transfer rate in the low-frequency region, suggesting that the first several energetic eigenmodes capture the flow dynamics relevant to the low-frequency variation of the wall mass transfer. Stochastic estimation results of the velocity field associated with large wall mass transfer rate at all three specific locations further reveal that the most energetic coherent structures are correlated with the wall mass transfer rate.

Scrotal wall leiomyosarcoma: a case report and review of the literature

Background Up to 30% of all scrotal masses are sarcomas. Leiomyosarcoma of the scrotal wall is rare, and its clinical significance and prognosis have not been well defined, since the most reported cases have little or no follow-up. Case presentation We report a 45-year-old Caucasian man who was admitted with a firm, nontender, mobile scrotal wall mass from 15 months ago. Laboratory data including testicular tumor markers were within normal range, and transscrotal ultrasonography revealed an oval-shaped, hypoechogenic, solid mass with blood flow and well-defined border. Histopathologic examination and immunohistochemistry staining, following surgical excision, were in favor of malignant leiomyosarcoma. Conclusion Here we describe the morphological features and immunohistochemical presentations of the tumor and the patient’s relatively long-term follow-up.

Disseminated Coccidioidomycosis Following COVID-19 Mimicking Metastatic Thoracic Relapse of Well-Differentiated Liposarcoma: A Case Report

Introduction: COVID-19 is associated with immune dysregulation which may increase susceptibility to atypical infectious diseases, particularly in the vulnerable cancer patient population. Coccidioidomycosis is an endemic fungal infection which presents with mild-to-moderate pneumonia in most cases.Case Presentation: The presented case is a 67-year-old woman living in the southwestern United States who is under close observation for well-differentiated liposarcoma of the abdominal wall. She presented with persistent cough and fatigue following COVID-19 infection. Imaging revealed new pulmonary nodules, a chest wall mass and bone lesions. The imaging appearance of these lesions was consistent with metastatic disease, although distant metastasis is not typical in well-differentiated liposarcoma. Biopsy of the chest wall mass revealed granulomatous fungal infection and serology was positive for coccidioidomycosis. At the time of diagnosis, the patient was lymphopenic, possibly a sequela of recent COVID-19 infection and which may have contributed to the development of her atypical disseminated form of coccidioidomycosis. Patient was treated with fluconazole for the coccidioidomycosis and continued observation for mild progression of the liposarcoma. On follow-up imaging, the chest wall mass and lung nodules have decreased in size and the patient remains on antifungal treatment. There has been no further increase in the liposarcoma mass.Conclusion: COVID-19 may be associated with increased risk of atypical forms of infectious diseases in cancer patients, which physicians should be aware of before giving systemic treatments for cancer. In endemic regions, co-infection by coccidioidomycosis should be suspected in cases of persistent symptoms after COVID-19 infection.

1150 A Painless Anterior Chest Wall Mass Post Coronary Artery Bypass Grafting Surgery

Aim We aim to present here a case of a painless anterior chest wall mass which was first noted during routine follow up post coronary artery bypass graft surgery Case presentation An 80-year-old male developed an asymptomatic slow growing pronounced swelling over the right anterior chest wall post CABG. His other past medical history includes chronic obstructive pulmonary disease, pulmonary fibrosis, ischaemic heart disease, an AICD for complete heart block, hypertension, hyperlipidaemia and osteoarthritis. A CT scan demonstrated a 10 x 12 x 6.5 cm subcutaneous lesion at the mid-line of the lower chest wall adjacent to the xiphisternum and the previous sternotomy site. On clinical examination there was a large non-tender cystic swelling with peripheral calcifications, but overlying skin was normal. Fluid was aspirated from the lesion and cytology showed a paucicellular specimen with features in keeping with seroma. Due to the progressive increase in size patient underwent surgical resection. A gelatinous bloody fluid was aspirated from the lesion and it was then resected enbloc. The tumour base appeared to arise from 6/7th costal cartilage and tumour was shaved away. The mass was confirmed histologically to be chondrosarcoma. Conclusions Given the uncommon prevalence of malignant primary chest wall tumours this case highlights the importance of high clinical suspicion even after developing post CABG.