Visible Pancreatic Neuroendocrine Tumor after Water Intake and Position Change

Most pancreatic neuroendocrine tumors (NETs) are detected incidentally and arise in the endocrine tissues. NETs can secrete hormones and result in clinical syndromes. However, between 50 and 75 percent of pancreatic NETs are nonfunctioning. Ultrasonography shows a well-circumscribed mass with a smooth margin and round or oval hypoechoic shape. A 38-year-old woman visited our hospital with mild upper abdominal discomfort. We visualized an oval hypoechoic mass with inner hyperechogenicity after water intake in the stomach and position change. The patient underwent surgery, and the mass was diagnosed as pancreatic NET.

Evaluation of peripheral enhancement on contrast-enhanced CT and corresponding pathological findings in colorectal liver metastases after preoperative chemotherapy

Objective: To correlate peripheral enhancement on contrast-enhanced computed tomography (CE-CT) of post-chemotherapy colorectal liver metastases (CRLM) patients with the pathological findings. Methods: Forty-four patients with CRLM who underwent hepatic resection after preoperative chemotherapy between 2008 and 2013 were included. Two radiologists blinded to the histopathology findings performed a consensus categorization of the marginal contrast effects of CRLM on CE-CT as follows: Group 1, smooth margin without enhancement; Group 2, smooth margin with an enhanced rim; and Group 3, fuzzy margin with/without an enhanced rim. The Kruskal-Wallis test was used to compare the imaging findings with the histological findings. Results: The percentage of infarct-like necrosis was significantly higher in CRLM with smooth margins than in those with fuzzy margins (p<0.001, r=0.62). The percentage of viable cells was lowest in CRLM with smooth margins without enhancement (p<0.001, r=0.60). Conclusions: Our findings suggest that the type of necrosis is related to the nature of the margins, and the presence of residual cells are related to peripheral enhancement.

Euphorbia mbuinzauensis, a new succulent species in Kenya from the Synadenium group in Euphorbia sect. Monadenium (Euphorbiaceae)

Euphorbia mbuinzauensis, a succulent new species of the Synadenium group in Euphorbiaceae from Makueni County, Kenya, is described and illustrated. Morphologically, it is most similar to E. pseudomollis, but differs mainly by its shrubby habit (up to 4 m), abaxial leaves surfaces with densely stellate hairs, 2–4-forked cymes, smaller bracts (ca. 2.5 × 3.0 mm), smaller cyathia (6 mm wide), crimson glands without narrow smooth margin, smaller fruits (ca. 8 × 7 mm) and ovoid seeds (ca. 1.8 × 2.2 mm). Furthermore, we performed a molecular phylogenetic analysis of the Synadenium group in Euphorbia sect. Monadenium, based on complete nuclear ribosomal DNA (nrDNA) datasets. This phylogenetic inference also supports it to be a distinct species. The new species is assessed as Endangered using the IUCN criteria.

Stenotrophomonas maltophilia spondylodiscitis following lumbar microdiscectomy mimicking a cotton granuloma: A case report and literature review

Background: Vertebral osteomyelitis caused by Stenotrophomonas maltophilia is very rare. There are only two cases reported in literature. Here, we present a 48-year-old immunocompetent male who, following a lumbar microdiscectomy, developed postoperative spondylodiscitis due to S. maltophilia that mimicked a cotton granuloma. Case Report: Two months ago, a 48-year-old male underwent a lumbar L4-L5 microdiscectomy, he newly presented with the left thigh and leg pain of 4 weeks duration. Laboratory studies revealed a CRP of 26 mg/l, an ESR of 6 mm (1st h), and total leukocyte count of 7.85 thousand/ul. The MRI T2 images showed a focal hyperintense lesion in the left lateral recesses at the L4-L5 level; the accompanying hypointense-smooth margin resembled a cotton granuloma. At surgery, we found a localized epidural collection of pus; S. maltophilia was isolated from the culture. His symptoms gradually improved, and symptoms fully resolved with 3 months of subsequent antibiotic therapy. Conclusion: S. maltophilia causing vertebral osteomyelitis is extremely rare and can sometimes mimic a cotton granuloma. MR diagnosis, surgical decompression, and obtaining cultures are requisite to direct appropriate antibiotic therapy.

Correlation of CT-scan findings of lung lesions and pathologic diagnosis

Background: we aimed to evaluate the features of lung nodules and masses in Ct scan that help to distinguish malignant lesions from benign ones. Method: The study was performed on 50 pulmonary lesions biopsied at the Shahid Faghih Hospital by an interventional radiologist. CT scan findings were evaluated by a radiologist and compared with pathologic outcomes. Data was entered into SPSS software and by Descriptive statistical methods of frequency and Roc curve analysis and Chi-squared test and T-test at the level of alpha 0.05 was analyzed. Results: The relationship between smoking and malignancy was determined in this study. There was no significance found in mean age and sex, lesion density and enhancement of benign and malignant nodules. Smooth border was mostly seen in benign lesions and lobulated and spiculated borders in malignant lesions. Popcorn calcification was in favor of benignity and calcification in periphery of lesion was in favor of malignancy. Cavity was mostly seen in benign lesions Conclusion: smoking and the spiculated or lobulated margins, calcification in the periphery of the lesion were associated with malignant lesions, and the smooth margin and popcorn calcification and cavity formation were mostly seen in benign lesions. Enhancement showed no significance.

Optimizing Burr Hole Placement for Craniotomy: A Technical Note

Objective Usually, burr holes are placed along the line of a craniotomy. We describe a novel technique of burr hole placement to obtain smooth and beveled bony margin without any troughs and crests. Dural separation is obtained by minimizing the number of burr holes required. Methods Fifty craniotomies of diameter ranging from 3.5 to 11.5 cm were accomplished by placing burr hole in the center of bone flap rather than along the craniotomy line permitting 360 degrees of dura separation dependent on the length of dura separator. Craniotomy < 9 cm in diameter was performed by placing a single burr hole and a larger size craniotomy was performed with two burr holes. Parasagittal craniotomy was performedby placing burr hole not > 2.5 cm away from expected craniotomy site, namely superior sagittal sinus area enabling separation of adhered dura and venous sinuses. The bone cutter was used in a particular fashion to create smooth margin and beveled edges. Results Craniotomy < 9 cm in diameter was possible with single burr hole in 34 cases. Craniotomy larger than 9 cm in size was performed in 16 cases with double burr hole by strategically placing burr in the center of the desired bone flap. The craniotomy was achieved in all cases without damaging dura and venous structures. Conclusions An optimally placed single burr hole is sufficient for small to moderately large size craniotomy. Larger size craniotomy is possible with minimum numbers of burr holes. This achieves good cosmesis and avoids sinking of the bone flap.

A new, overlooked species of Aiphanes (Arecaceae) from Santander, Colombia

The new species Aiphanes suaita, from the Eastern Cordillera of Colombia, is described and illustrated. Previous specimens of this species had been mistaken for Aiphanes simplex, but a molecular phylogeny revealed that it is actually more closely related to Aiphanes leiostachys, from the Central Cordillera, prompting a reexamination of the specimens. The new species differs in its solitary stem, lack of yellowish spines, pinnae strongly plicate along secondary veins, spicate inflorescences, staminate flowers with the axis perpendicular to the spike axis, and triad bracts short, with smooth margin. Based on IUCN criteria, it is categorized as Endangered.

Ultrasonography features of medullary thyroid cancer as predictors of its biological behavior

Background Although there are many well-known prognostic predictors of medullary thyroid carcinoma (MTC), the ultrasonography (US) findings of MTC have not been sufficiently validated in this regard. Purpose To investigate the US findings of MTC and their relationship with the biological behavior of MTC. Material and Methods The US findings and clinical and pathology records of 123 MTC nodules from 108 patients were retrospectively analyzed at two tertiary referral hospitals. MTCs were classified according to US findings, i.e. MTC with benign (B-MTC) and malignant US findings (M-MTC). We then compared the clinical and pathology findings between the two groups. Results Eighty-two M-MTCs (66.7%) and 41 B-MTCs (33.3%) were identified. M-MTCs showed a significantly higher prevalence of lateral lymph node metastases as well as extrathyroidal and extranodal extension (all P < 0.05). M-MTCs larger than 1 cm showed a significantly higher prevalence of multifocality, recurrence, extrathyroidal and extranodal extension than B-MTCs larger than 1 cm in the largest dimension (all P < 0.05). Tumors > 1 cm were more likely to be B-MTC and one-third of all MTCs had benign US features. The common findings of B-MTC included a solid, ovoid to round shape, with a smooth margin, hypoechogenicity, and without calcification. Conclusion The biological behavior of M-MTCs results in poorer outcomes than that of B-MTCs.

Descriptions of species of Stegelleta Thorne, 1938 (Nematoda, Rhabditida, Cephalobidae) from California, New Zealand and Senegal, and a revision of the genus

Populations of Stegelleta are described from California, New Zealand and Senegal. An amphimictic population from California is identified as belonging to S. incisa and compared with type specimens from Utah and an amphimictic population from Italy. One population from New Zealand is close to S. incisa but considered to represent a new species, Stegelleta laterocornuta sp. nov. It is particularly characterised by a 379–512 μm long body in females and 365–476 μm in males; cuticle divided into 16 rows of blocks at midbody (excluding lateral field); lateral field with four incisures; three pairs of asymmetrical lips, U-shaped primary axils without guarding processes, each lip asymmetrically rectangular with a smooth margin, only lateral lips have slender acute tines; three labial probolae, bifurcated at half of their length; vulva without flap; spermatheca 17–31 μm long; postuterine sac 7–24 μm long; spicules 21.5–23.5 μm long. Other specimens from New Zealand are identified as belonging to S. tuarua. A parthenogenetic population from Senegal is identified as belonging to S. ophioglossa and compared with type specimens from Mongolia and records of several other populations of S. ophioglossa. The generic diagnosis is emended and a key to the species of Stegelleta is provided.

Can excisional biopsy be avoided for papillary breast lesions with typical benign sonographic features and concordant core needle biopsy (CNB)?

26 Background: The role of surgical excision in the management of papillary lesions remains controversial. Some studies have documented upgrade rates to malignancy or atypia as high as 17%. However, due to the inclusion of atypia or malignancy at percutaneous and other differences in methodology, these rates may have been over-estimated. This study was designed to determine sonographic features that can help to decide if a lesion warrants excision or standard follow-up. Methods: With institutional review board approval, we retrospectively reviewed 113 benign papillomas without atypia that were diagnosed at US-guided CNB at Foothills Medical Centre from 2005 to 2010. Surgical pathology for 62 of these lesions were assessed. Two radiologists who were blinded to the diagnosis reviewed the sonographic images to determine the likelihood of benignity. Statistical analysis was performed using chi-square and z-score tests. Results: In our study, 5.3% of benign papillomas were upgraded. The sonographic features associated with a higher likelihood of upgrade were intracystic type [LR+ 5.67, 95% CI (1.47,12)], non-periareolar location [LR+ 2.30, 95% CI (1.04,5.06)], complex echogenic pattern [LR+ 3.10, 95% CI (1.00,9.63)], and radiologist’s impression of unlikely benign (final BiRADS) [LR+ 1.48, 95% CI (1.01,1.90)]. Although no feature was statistically significant for greater likelihood of benignity, the sonographic features that may better predict benign pathology at excision include lesions <1cm in size [LR- 0.52], homogeneously solid [LR- 0.63], smooth margin [LR- 0.69] and periareolar location [LR- 0.47]. Conclusions: The management of benign papillomas diagnosed with CNB remains controversial with a lack of agreement among published articles. Our study identifies characteristic sonographic features that are associated with higher likelihood of malignancy, warranting surgical excision. Conversely, it may not be unreasonable to place patients with lesions that are stratified as low risk into standard radiographic follow-up. As the confidence intervals span 1.00 for latter, further study is necessary to confidently recommend follow-up in place of excision.