Evaluating the performance of a low-cost mobile phone attachable microscope in cervical cytology.

BACKGROUND: Cervical cancer remains a global health problem especially in remote areas of developing countries which have limited resources for cervical cancer screening. In this study, we evaluated the performance of a low-cost, smartphone attachable paper-based microscope when used for classifying images of cervical cytology. METHODS: Cervical cytology samples included: 10 Normal, 10 Low-grade squamous intraepithelial lesion (LSIL), 10 High-grade squamous intraepithelial lesion (HSIL), and 10 Malignant Pap Smears. The agreement between conventional microscopy vs. Foldscope imaging was calculated using a weighted kappa coefficient. A confusion matrix was created with three classes: Normal, LSIL, and HSIL/malignant, to evaluate the performance of the Foldscope by calculating the accuracy, sensitivity, and specificity. RESULTS: We observed a kappa statistic of 0.68 for the agreement. This translates into a substantial agreement between the cytological classifications by the Foldscope vs. conventional microscopy. The accuracy of the Foldscope was 80%, with a sensitivity and specificity of 85 and 90% for the HSIL/Mal category, 80 and 83.3%, for LSIL, and 70 and 96.7% for Normal. CONCLUSIONS: This study highlights the usefulness of the Foldscope in cervical cytology, demonstrating it has substantial agreement with conventional microscopy. Its use could improve cytologic interpretations in underserved areas and, thus, improve the quality of cervical cancer screening. Improvements in existing limitations of the device, such as ability to focus, could potentially increase its accuracy.

Diagnostic utility of cell block in fine needle aspiration cytology of thyroid gland.

BACKGROUND: This study was conducted to evaluate the diagnostic utility of cell block material in fine needle aspiration (FNA) of thyroid nodules. DESIGN: A total of 242 thyroid fine need aspirations (FNAs) were performed between January 2015 and December 2015. Of those, all consecutive thyroid FNA cases with cell blocks (n = 140) from 129 patients (age: 58.9 ± 12.8 years) are included in this study. Cytology slides and cell blocks are reviewed for adequacy assessment based on the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and then categorizing them into TBSRTC diagnostic categories. These cases are divided into two groups, combined cytology and cell block (C + CB) and cytology without cell block (C). RESULTS: In the first group (C + CB), a total 140 cases are categorized in TBSRTC as follows: I: 13 (9.3%) cases, II: 78 (55.7%) cases, III: 7 (5%), IV: 16 (11.4%), V: 3(2.2%) and VI: 23 (16.4%). In the second group (C), the cases are classified in TBSRTC as follows: I: 23 (16.4%) cases, II: 70 (50%), III: 7 (5%), IV: 16 (11.4%), V: 3 (2.2%) and VI: 21 (15%). Nondiagnostic rate was 7.1% lower in the first group (C + CB) as compared with second group (C) (First group: 9.3% vs second group: 16.4%, P = .0764). CONCLUSIONS: Combined use of cytology slides and cell block decreases the nondiagnostic rate up to 7.1% as compared with cytology without cell block.

Thoracic Paraspinal Castleman Disease in a Young Mexican-American Man with Postcoital Hematuria.

BACKGROUND: Castleman disease (CD) is an uncommon disorder of deregulated lymphoproliferation with unicentric (UCD) and multicentric forms based on extent of nodal involvement. Gross resection with histopathologic analysis remains the gold standard for diagnosis of UCD and is curative in most cases. Symptomatic paraspinal UCD is a rare presentation with potentially dangerous complications, and its tendency to mimic more common spinal tumors presents a significant diagnostic challenge. CASE PRESENTATION: A 25-year-old Hispanic man with no past medical history was evaluated for a known left-sided paraspinal mass that was incidentally discovered during an emergency department work-up for hematuria. Computed tomography on initial presentation revealed a 5.3 cm × 3.3 cm × 4.8 cm heterogeneously enhancing left paraspinal mass adjacent to the T11 vertebral body with tonguelike extension into the T11-T12 neural foramen. Although he remained neurologically intact throughout most of the diagnostic work-up, an inconclusive biopsy, worsening hematuria, and late-onset radiculopathy with severe back pain prompted surgical intervention. Microscopic histomorphology was consistent with CD. He continued to have intermittent hematuria and dysuria postoperatively, but repeat computed tomography at 7 months confirmed no recurrence of the mass. CONCLUSIONS: Compared with previous reports, our case of postcoital hematuria and radiculopathy accompanying a paraspinal thoracic mass in a young Mexican-American man is a unique presentation. Awareness and early consideration of UCD in the work-up of a paraspinal mass may spare affected patients adverse and dangerous sequelae, such as spinal cord compression and excessive intraoperative hemorrhage.

Immune Response in Allergic Contact Dermatitis: An Integrated Learning Module.

Introduction: Medical students are introduced to skin rashes during their preclinical years and often express difficulty in differentiating the underlying mechanisms. The preclinical lessons regarding immunologically mediated skin rashes are largely forgotten by the time the students begin diagnosing and treating skin rashes during clinical rotations. This module aims to enhance student understanding of immunologic concepts by integrating material across disciplines, contextualizing within a clinical scenario, and providing opportunity for self-testing. Methods: A diagram illustrating immune responses in allergic contact dermatitis was used in the Texas Tech University Paul L. Foster School of Medicine preclinical curriculum. This diagram was updated as an audiovisual learning module that traced the immune mechanisms and pathogenesis of contact dermatitis from allergen exposure to skin-rash development. A self-assessment quiz and a clinical vignette with questions were included in the module. Student usage was monitored, and an in-class survey evaluating student perception was administered. Results: Sixty-four (58%) first-year medical students used this module. Twenty-eight students completed the in-class survey. Over 95% of respondents felt that the module helped them learn the new material, identify areas of weakness, and both understand the underlying pathology and big picture for this immune response. Discussion: Student survey results indicate the module is clinically relevant and enhances learning. The module may be used as a component of self-directed learning in any immunology curriculum or may be used in any basic immunology course to exemplify the role of the immune system in disease.

Innate and Adaptive Immune Response to a Virus: An Integrated Learning Module.

Introduction: Medical schools must expand their teaching strategies to address a new generation of medical students and ensure their growth into lifelong, self-directed learners. Integration across basic science disciplines packaged together with clinical medicine produces learning materials that better enable medical students to achieve these goals. Methods: We created a narrated audiovisual learning module illustrating the foundational sciences and clinical presentation surrounding immune responses to viral infections. We integrated immunology, microbiology, histology, pathology, and clinical medicine and included a self-assessment quiz and clinical vignette with questions to test students' understanding of the material. We published the module on our school's learning management system and tracked student usage, which was followed by an in-class survey to assess student perceptions of the usefulness of the module. Results: Sixty-four (59%) of the first-year medical students used the module. Thirty-seven students completed the in-class survey assessing their perceptions of the module. Over 95% of responders reported that the module helped them learn the new material, identify areas of weakness, understand the big picture for this immune response, and apply the material in a clinical context. Discussion: This module illustrates an approach to integrating basic science disciplines in order to facilitate students' understanding of the mechanisms underlying patients' clinical presentations. Survey results indicated that students valued the module as a self-directed learning component that integrated essential clinical concepts. The module was a helpful tool for students to evaluate their comprehension of immunology in a clinical context and can be used as required or optional material.

Immune Response to Bacteria: An Integrated Learning Module to Enhance Preclinical Students' Competency in Immunology.

INTRODUCTION: Medical students express frustration that they cannot assemble a comprehensive big picture of how the immune system responds to a microbe and that integration of basic science knowledge, especially across disciplines, with clinical knowledge is difficult. Yet medical student competency requires application of knowledge of immune mechanisms to inform diagnosis and treatment. METHODS: A diagram for immune response to extracellular microbes was previously published by MedEdPORTAL in 2011. This diagram has been updated here as a narrated audiovisual module with integrated histopathology. It contains a self-assessment quiz that tests students' understanding of the module followed by a clinical vignette that tests students' ability to apply the concepts in a clinical context. The module was published and usage was tracked via our learning management system. An in-class survey was conducted to gauge students' perceptions of the module. RESULTS: Eighty-two out of 102 (76%) first-year medical students used the module. Over 85% of survey participants felt that the module was a useful resource for learning and reviewing. More than 90% felt that the module helped them to understand the big picture and identify areas for further study. DISCUSSION: This module assembles a big picture of the immunologic mechanisms involved in a bacterial infection. It was created in response to requests and suggestions by preclinical medical students and used for first-year students during the first few weeks of their training in the basic sciences. This approach integrates multiple disciplines and facilitates students' learning and application of difficult concepts in immunology and pathology.

Aortic intimal sarcoma: report of two cases with immunohistochemical analysis for pathogenesis.

Primary vascular neoplasms are rare entities. They were first described as arising spontaneously in the aorta and other vessels. However, in the past several decades, a number of systemic artery-derived vascular neoplasms, mostly sarcomas, have been reported as arising in intimate association with synthetic grafts. We describe two additional cases of intimal sarcoma seen at our institution. The first is an invasive intimal sarcoma detected in a thoracoabdominal aortic aneurysm at the time of surgical intervention. The second is a superficial spreading intimal sarcoma associated with a Dacron-coated graft, in place for 9 years, detected when the graft was replaced. When the patient died 3 months later, a metastatic subcutaneous sarcomatous lesion was detected at autopsy. In these cases, we studied selective molecular pathways that may be involved in the transformation of benign endothelium to malignant endothelium, with implications for possible therapeutic targets. These cases are presented in order to contribute additional data to the literature involving these vascular neoplasms and to potentially provide a spectrum of disease seen in the vasculature tissues that may arise spontaneously or after placement of a synthetic graft.

Impact of tumour location and surgical approach on recurrence-free and cancer-specific survival analysis in patients with ureteric tumours.

UNLABELLED: What's known on the subject? and What does the study add? Pathological stage, lymph node metastasis and tumour grade have been established as prognostic factors for upper-tract urothelial carcinoma, but there are few studies to date assessing location within the ureter as a prognostic factor. There are also few studies comparing surgical approaches to radical nephroureterectomy (NU), partial ureterectomy and endoscopic resection (ENDO) with regard to oncological outcomes. This study did not find any prognostic significance for tumour location or surgical approach with regard to outcomes in patients with ureteric tumours. Although NU is the standard treatment for invasive ureteric tumours, partial ureterectomy and ENDO can safely be performed in selected patients. Despite the risk of a shorter time to recurrence, ENDO can be recommended in low grade, non-invasive ureteric tumours but only with close, thorough surveillance practices. OBJECTIVE: • To assess the impact of tumour location within the ureter and the impact of surgical approach on recurrence-free survival (RFS) and cancer-specific survival (CSS) with regard to ureteric tumours. PATIENTS AND METHODS: • Data were retrospectively reviewed from 60 patients with isolated primary ureteric tumours, treated at a single tertiary referral centre. • Patients were treated with radical nephroureterectomy (NU, n= 33), partial ureterectomy (n= 17) or endoscopic resection (ENDO, n= 10). • Kaplan-Meier curves were used for the analysis of RFS and CSS after surgery, stratified by tumour location and surgical approach. RESULTS: • With a median follow-up of 29 months, tumour location was not associated with disease recurrence (P= 0.423). • The ENDO group had shorter time to disease recurrence. • There were no significant differences in the probability of CSS with regard to either tumour location or surgical approach (P= 0.523 and P= 0.904, respectively). CONCLUSIONS: • Tumour location or surgical approach were not significant predictors of oncological outcomes in patients with ureteric tumours. • Although NU is standard treatment for invasive ureteric tumours, partial ureterectomy and ENDO can safely be performed in selected patients. Despite the risk of a shorter time to recurrence, ENDO can be recommended in low grade, non-invasive ureteric tumours. • All urothelium-preserving approaches require thorough surveillance.

Giant cell tumor of uterus resembling osseous giant cell tumor: case report and review of literature.

Osteoclast-like giant cells (OLGCs) are multinucleated cells of histiocytic lineage and have been identified in a wide array of neoplasms. In the uterus, they have most frequently been reported in association with leiomyosarcomas. This article describes a case of an osteoclast-like giant cell-rich uterine tumor that was essentially indistinguishable at the morphologic and immunophenotypic levels, from typical giant cell tumor of bone. This is the first example of such a case that has been reported in the uterus to the authors' knowledge.

Nodular mucinosis of the breast in a supernumerary nipple: case report and review of the literature.

Nodular mucinosis is an extraordinary stromal lesion of the breast. The usual clinical presentation is that of an oozing, slow-growing, soft, non-tender, lobulated mass in the subareolar region. Histologically, it is a non-encapsulated myxoid/mucinous lesion with a sparse infiltrate of spindle cells within a collagenized stroma. The histogenesis of nodular mucinosis is undetermined but the pattern of staining of the spindle cells suggests it might be of myofibroblastic origin. We herein report for the first time in the English literature a case of nodular mucinosis occurring in a supernumerary nipple. We also discuss the main differential diagnoses and review the literature of previously published cases of this entity.