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Αλέξανδρος Γ. Σφακιανάκης

Thursday, April 1, 2021

Sphenoid Sinus: Pneumatization and Septation Patterns in a Hispanic Population

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Introduction: Pneumatization of the sphenoid sinus (SS) varies widely among different ethnic groups. Information regarding the prevalence and significance of SS variants among Hispanic groups is limited. This study aims to describe and analyze pneumatization and septation patterns of the SS in a Hispanic population. Methods: A total of 160 paranasal sinus computed tomographies were reviewed by a head and neck-specialized radiologist and 2 otolaryngologists. R esults: The postsellar and sellar types were the most frequent patterns of pneumatization observed, with a prevalence of 52.5 and 40%, respectively. Accessory septations were present in 59.4% of the patients. Septa were inserting over the internal carotid artery (ICA) in 43.8% and over the optic nerve in 17.5% of the population. No significant association (p #x3e; 0.05) was observed when comparing the different accessory septation patterns among the types of the SS. The frequency of septa inserting on the ICA was significantly higher in postsellar types (p #x3c; 0.001). Pneumatization of the anterior clinoid process, pterygoid processes, and greater wing was present in 20, 17.5, and 45.9% of the sinuses, respectively. Onodi cells were encountered in 40% of the sinuses. There were no significant differences in any of the pneumatization and septation variables when compared by gender and age (p #x3e; 0.05). Discussion/Conclusion: Differences regarding anatomical variants and septations of the SS were observed in our study when compared with findings reported in other ethnic groups. Preoperative assessment of the anatomical variants of the SS in Mexican patients is imperative to select the most optimal surgical approach and prevent iatrogenic injuries to related neurovascular structures.
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Pragmatic Skills in Children with Hearing Loss: Comparison Between Cochlear Implants and Hearing Aids Users

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Abstract

Pragmatic language ability denotes the ability to use language in a social context. There is a lack of research that has compared children's pragmatic skills with hearing loss with those of hearing peers. This study questioned whether children with a cochlear implant would show better pragmatic skills than children with hearing aids. 52 children were included in three groups: cochlear implant (n = 16), hearing aid (n = 16), and normal hearing (n = 20). The participants' pragmatic skills were evaluated using the Persian version of the children's communication checklist. Of the 52 participants recruited, 22 (42.3%) were males, and 30 (57.7%) were females. The mean age of the CI, HA, and NH group participants was 75.19 ± 10.80, 72.19 ± 8.68, and 68.90 ± 6.78 months, respectively (P > 0.05). There was a significant difference between the mean scores of Speech Output and Syntax between the groups (CI, HA and NH) (P < 0.001). The hearing-impaired children show acceptable pragmatic skills in comparison with NH children. Specialists, such as teachers and clinicians, should be alert of the abilities and difficulties that the hearing-impaired children might be facing in the regular classroom.

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Atypical and bilateral pigmented villonodular synovitis of wrist in an adolescent patient: case report and literature review

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):383-388. eCollection 2021.

ABSTRACT

BACKGROUND: Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disorder of the synovium. It rarely occurs in adolescents, particularly in immature patients with bilateral manifestation.

CASE PRESENTATION: We present a case of atypical and bilateral PVNS of wrist in a 14-year-old boy. Initially, the patient presented with left wrist pain and swelling without the history of trauma. Physical examination revealed an obvious lesion in the dorsal part of left wrist. Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) showed multiple abnormal signal shadows and arthroedema in the left wrist. Arthroscopy operation was performed, and histologic examination suggested the diagnosis of PVNS. Only 10 months later, the patient presented with the similar symptoms and signs in the right wrist. But MIR and histologic examination were atypical. In this article, we also review and summarize 26 studies on 30 adolescent patients with PVNS.

CONCLUSIONS: This study provides an example of atypical and bilateral PVNS in adolescents.

PMID:33786156 | PMC:PMC7994141

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Primary bilateral tuberculous otitis media with peripheral facial paralysis: a case report and literature review

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):304-313. eCollection 2021.

ABSTRACT

Tuberculous otitis media (TOM) is a rare disease. This study presents our experience in the diagnosis and treatment of TOM. A 49-year-old female had repeated ear discharge, vertigo, and severe hearing loss for six years, and underwent mastoid surgery four times because she was misdiagnosed with chronic suppurative otitis media. The patient had left-sided facial paralysis for two weeks when she was admitted to our hospital and was managed with radical mastoidectomy and facial nerve decompression. After surgery, facial nerve function gradually improved from grade V to grade II, and the patient was diagnosed with an unusual primary bilateral TOM after tuberculosis smear culture, pathologic examination, and tuberculosis DNA testing by the PCR technique. After anti-tuberculosis therapy, the operative mastoid cavity in the patient was eventually epithelialized and dr y. Therefore, this study suggests that, TOM should be actively excluded in patients with uncontrollable ear leakage, massive white granulation tissue and dead bone formation in the ear. Surgical decompression is recommended to prevent permanent facial paralysis, since opening the facial nerve sheath effectively relieves facial nerve compression and edema due to the TOM-induced persistent inflammation and granulation tissue formation.

PMID:33786147 | PMC:PMC7994147

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Molecular classification predicts survival for breast cancer patients in Vietnam: a single institutional retrospective analysis

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):322-337. eCollection 2021.

ABSTRACT

BACKGROUND: The Bhagarva surrogate molecular subtype definitions classify invasive breast cancer into seven the different subgroups based on immunohistochemical (IHC) criteria according to expression levels of markers as ER, PR, HER2, EGFR and/or basal cytokeratin (CK5/6) which are different in prognosis and responsiveness to adjuvant therapy.

PURPOSE: The present study aimed to classify primary breast cancers and directly compares the prognostic significance of the intrinsic subtypes.

METHODS: The current study was conducted on 522 breast cancer patients who had surgery, but had not received neoadjuvant chemotherapy, from 2011 to 2014. The clinicopathologic characteristics were recorded. IHC staining was performed for ER, PR, HER2, Ki67, CK5/6, EGFR and D2-40 markers. All breast cancer patients were stratified according to Bhagarva criteria. The fo llowed-up patients' survival was analyzed by using Kaplan-Meier and Log-Rank models.

RESULTS: The luminal A (LUMA) was observed at the highest rate (32.5%). Non-basal-like triple negative phenotype (TNB-) and Luminal A HER2-Hybrid (LAHH) were the least common (3.3% in both). LUMA and luminal B (LUMB) were significantly associated with better prognostic features compared to HER2, basal-like triple negative phenotype (TNB+) and TNB-. Statistically significant differences were demonstrated between overall survival (OS), disease-free survival (DFS) and molecular subtypes (P<0.05), of which LUMB and LUMA had the highest rate of OS and DFS being 97.2 and 93.7%; and 97.2 and 90.5%, respectively. Conversely, HER2 revealed the worst prognosis with the lowest prevalence of OS and DFS (72.5 and 69.9%, respectively).

CONCLUSION: The molecular subtypes had a distinct OS and DFS. The intrinsic stratification displayed inversely to clinicopathological features in breast cancer.

< p>PMID:33786149 | PMC:PMC7994142

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Identification of long noncoding RNA TC0101441 as a novel biomarker for diagnosis and prognosis of gastric cancer

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):363-368. eCollection 2021.

ABSTRACT

The present work aimed to explore the prognostic values of lncRNA TC0101441 (TC0101441) in patients with gastric cancer (GC). The expression of TC0101441 in a total of 159 GC specimens and matched normal specimens was detected by quantitative RT-PCR. ROC assays were conducted to determine the diagnostic value of TC0101441 expression in GC patients. The association of TC0101441 expression with clinical characteristics of 159 patients was analyzed using chi-square test. Kaplan-Meier methods were employed to determine the prognostic value of TC0101441 expression in the survival rate of GC patients. Multivariate Cox regression assays were used to identify whether TC0101441 could be a prognostic biomarker for GC patients. We found that TC0101441 expression was significantly increased in GC specimens compared to that in the normal specimens (P < 0.01). High TC0101441 expression was correlated with lymphatic metastasis (P = 0.027) and TNM stage (P = 0.015). TC0101441 could distinguish GC specimens from adjacent normal gastric specimens with an area under the receiver operating characteristic curve (AUC) of 0.8082. Survival data revealed that patients with high TC0101441 expression had worse overall survival (P = 0.0009) and disease-free survival (P < 0.0001) rates than those with low TC0101441 expression. Multivariate assays showed that TC0101441 expression was an independent biomarker for GC patients. The present study suggested that TC0101441 expression was increased in GC and may be aprognostic and diagnostic biomarker for GC.

PMID:337 86153 | PMC:PMC7994149

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Results of endoscopy in 35,525 patients with precancerous diseases of the gastrointestinal tract

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):348-354. eCollection 2021.

ABSTRACT

BACKGROUND: To explore the need for the high-risk and general population to undergo endoscopy and the best age for these two groups to do so.

MATERIAL AND METHODS: Data on 35,525 patients who underwent endoscopy in the Endoscopic Center of Shanxi Cancer Hospital and associated medical group hospitals from January 2016 to December 2019 were collected. Two aspects of the high-risk and general population were analyzed retrospectively: 1. The detection rate of precancerous diseases. 2. The difference and distribution of the detection rate in different genders, different ages, and different pathologic types.

RESULTS: A total of 35,525 patients, 24,185 in the general population and 11,340 in the high-risk population, were examined by electronic gastroscopy and colonoscopy simultaneously. Of these, 20,659 were men and 14,866 were women. The detection rate of gastric diseases (gastric cancer, gastric polyp, gastric ulcer, chronic atrophic gastritis) in the general population was 9.27%, and that in the high-risk population was 25.18%. The detection rate of colonic polyps was 53.76% in the general population and 56.77% in the high-risk population.

CONCLUSION: Both the high-risk and the general population should consider gastroscopy and colonoscopy as routine physical examination items. Routine gastroscopy is highly recommended for the high-risk population. The general population should pay close attention to their colonoscopy results. The best screening age for both populations is 40 years old and above.

PMID:33786151 | PMC:PMC7994146

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Myxomatous liposarcoma in giant pleural cavity: case report and literature review

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):369-374. eCollection 2021.

ABSTRACT

Liposarcoma was mainly occurring in the lower extremities and deep retroperitoneal soft tissues, but rarely occurred in the thoracic cavity. Most cases were reported in the literature, and most of them were middle-aged and elderly people. It was even more rare in adolescents with tumors occupying the entire thoracic cavity. Recently, one case of myxomatous liposarcoma was admitted and treated in our hospital. This paper reports this case and discusses the diagnostic method, pathological type and treatment of giant liposarcoma in the chest, in order to provide a reference for the clinical diagnosis and treatment of this rare tumor.

PMID:33786154 | PMC:PMC7994144

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Conversion therapy combined with individualized surgical treatment strategy improves survival in patients with colorectal cancer liver metastases

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):314-321. eCollection 2021.

ABSTRACT

OBJECTIVE: To explore surgical treatment strategies for patients with liver metastases from colorectal cancer (CRLM), and analyze the prognosis and influencing factors.

METHODS: The clinical data of 156 inpatients with CRLM admitted to our hospital from January 2009 to June 2019 were retrospectively analyzed. Patients were divided into initially resectable group (80 cases) and initially unresectable group (76 cases). For patients with initially unresectable CRLM, conversion therapy (chemotherapy plus targeted therapy) combined with individualized surgical treatment strategy was used. The individualized surgical treatment strategy mainly included hepatectomy combined with ablation. Portal vein ligation and staged resection were adopted according to the patients' specific conditions. All patients were followed up until death. The Kaplan-Meier method and Log -rank test were used for survival analysis.

RESULTS: Median overall survival (OS) time of patients in the initially resectable group and initially unresectable group were 36 months and 17 months, respectively (P = 0.001). Median OS time of 24 patients who underwent surgical resection after successful conversion therapy was significantly longer than that of 52 patients with unsuccessful conversion therapy (20 months versus 15 months, respectively, P = 0.034). Univariate analysis showed that a maximum diameter of liver metastases < 6 cm and a number of metastases ≤ 4 were independent factors associated with successful conversion therapy. According to patients' specific conditions, 6 cases accepted hepatectomy combined with ablation, and 1 case accepted portal vein ligation and staged resection.

CONCLUSION: Treatment of patients with CRLM should follow the principles of standardization and individualization. For patients with initially unresectable CRLM, successful conversion therapy should be pursued whenever possible. The maximum size and number of liver metastases were significantly associated with successful conversion therapy. Surgical resection-based comprehensive treatment is key.

PMID:33786148 | PMC:PMC7994140

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Primary hepatic mucosa-associated lymphoid tissue lymphoma: case report and literature review

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):375-382. eCollection 2021.

ABSTRACT

BACKGROUND: The prevalence of primary hepatic mucosa-associated lymphoid tissue (MALT) lymphomas is extremely low. Here, we describe a case of this disease misdiagnosed as hepatocellular carcinoma (HCC) and review relevant literature to prevent future misdiagnoses.

CASE PRESENTATION: a 58-year-old woman complained about abdominal pain for more than four months. About two months prior, she came to our hospital with elevated levels of HBV DNA and positive HBsAg and HBcAb. After two months of entecavir treatment, HBV DNA decreased to a normal level. She returned to the hospital with worsened abdominal pain for over a month. Magnetic resonance imaging and systemic positron emission tomography-computed tomography identified two nodes in the liver, and she was diagnosed with HCC. The patient then underwent a laparoscopic hepatectomy. Microscopic examination sho wed a diffuse infiltrate of small-to-medium-sized lymphocytes and lymphoepithelial lesions. Immunohistochemical staining showed that most of the lymphoid cells were strongly positive for CD20, CD79a, BCL2, IgM and weakly positive for IgD, while negative for CD3, CD10, BCL6, MUM1, CD43, CD5, cyclin D1, CD23, CD30, and PD1. The Ki-67 index of lymphoid cells was 5%. Further pathologic analysis confirmed the diagnosis of primary hepatic MALT lymphoma. The patient received antiviral treatment and recovered well with no sign of relapse for 17 months.

CONCLUSIONS: Primary hepatic MALT lymphoma is an uncommon disease that is difficult to diagnose and has no widely accepted treatment. Surgical resection is a good choice for both diagnosis and local therapy, and strict follow-up of the patient is essential.

PMID:33786155 | PMC:PMC7994143

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Metaplastic breast carcinoma: a retrospective study of 26 cases

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Int J Clin Exp Pathol. 2021 Mar 1;14(3):355-362. eCollection 2021.

ABSTRACT

Metaplastic breast carcinoma is a rare invasive breast cancer. Metaplastic breast carcinoma is mainly characterized by an epithelial or mesenchymal cell population mixed with adenocarcinoma. We collected 26 cases of metaplastic breast carcinoma in the First Affiliated Hospital of Bengbu Medical College from 2008 to 2014. Tumor size, tumor grade, vascular invasion, ER/PR status, histologic classification, and HER2/neu status were assessed for all cases and the literature was reviewed. Clinicopathologic characteristics of patients diagnosed with metaplastic breast carcinomas and its key points of differential diagnosis were discussed. All patients were female, with the median age of 50 years. The mean tumor size was 3.2 cm. 4 subtypes of metaplastic breast carcinomas were documented. Fibromatosis-like metaplastic carcinomas are typically characterized by wavy, in tertwined, gentle spindle cells. When the tumor components are almost squamous cell carcinoma components and the primary squamous cell carcinoma of other organs and tissues are excluded, we can diagnose breast squamous cell carcinoma. In spindle cell carcinoma, atypical spindle cells are arranged in many ways and are usually accompanied by inflammatory cell infiltrate. Cancer with interstitial differentiation has mixed malignant epithelial and mesenchymal differentiation, and the mesenchymal components are diverse. Most tumors are triple negative. At present, surgical resection combined with chemotherapy or radiation therapy is the most effective and acceptable method for treating metaplastic breast carcinoma.

PMID: 33786152 | PMC:PMC7994148

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