Abordagens cirúrgicas para cisto dentígero: revisão de literatura / Surgical approaches for dentigerous cyst: literature review

O objetivo desta revisão integrativa foi elaborar uma avaliação qualitativa da literatura existente sobre as modalidades de tratamento utilizadas para cistos dentígeros em pacientes pediátricos. O presente estudo trata-se de uma revisão integrativa da literatura na qual utilizou-se as bases de dados PubMed, BVS (Biblioteca Virtual em Saúde), LILACS, e SciELO. Como critérios de inclusão estavam os artigos publicados na íntegra, relatos de caso clínico, revisões sistemáticas e de meta-análise publicados nos últimos 10 anos, disponível nos idiomas português ou inglês, que abordassem a temática. Os critérios de exclusão foram: resumos, anais, editoriais, cartas ao editor, reflexão, duplicidade, artigos com detalhamento incompleto. O cisto dentígero é o tipo mais comum dos cistos odontogênicos de desenvolvimento e o segundo mais frequente entre todos que ocorrem nos maxilares, representando cerca de 20% de todos os cistos revestidos por epitélio nos ossos gnáticos. Clinicamente pode estar associado a qualquer dente impactado, porém ele envolve com mais frequência os terceiros molares inferiores. Acomete pacientes entre 10 a 30 anos de idade, com predileção pelo sexo masculino, sendo na maioria dos casos detectados em exames radiográficos de rotina. O tratamento baseia-se nas técnicas de descompressão, marsupialização e enucleação. O prognóstico para os cistos dentígeros é altamente favorável e não há chance de recorrência após a remoção completa. Assim, a decisão terapêutica deve ser tomada de forma adequada para cada caso, levando em consideração a localização anatômica, extensão clínica, tamanho, idade, remoção do dente não irrompido e possibilidades de acompanhamento.

The aim of this integrative review was to carry out a qualitative assessment of the existing literature on the treatment modalities used for dentigerous cysts in pediatric patients. This study is an integrative literature review using the PubMed, VHL (Virtual Health Library), LILACS and SciELO databases. The inclusion criteria were articles published in full, clinical case reports, systematic reviews and meta-analysis published in the last 10 years, available in Portuguese or English, which addressed the subject. The exclusion criteria were: abstracts, annals, editorials, letters to the editor, reflection, duplication, articles with incomplete details. The dentigerous cyst is the most common type of developmental odontogenic cyst and the second most frequent of all those that occur in the jaws, accounting for around 20% of all epithelium-lined cysts in the gnathic bones. Clinically, it can be associated with any impacted tooth, but it most often involves the lower third molars. It affects patients between 10 and 30 years of age, with a predilection for males, and in most cases it is detected during routine radiographic examinations. Treatment is based on decompression, marsupialization and enucleation. The prognosis for dentigerous cysts is highly favorable and there is no chance of recurrence after complete removal. Therefore, the therapeutic decision must be made appropriately for each case, taking into account the anatomical location, clinical extension, size, age, removal of the unerupted tooth and follow-up possibilities.

Regenerating the ailing heart: Stem cell therapies for hypoplastic left heart syndrome.

Hypoplastic left heart syndrome (HLHS) is a complex congenital heart defect (CHD) characterized by a spectrum of underdeveloped left-sided cardiac structures. It is a serious defect and warrants either 3-staged surgical palliation or a heart transplant. Despite numerous surgical advancements, long-term outcomes remain challenging and still have significant morbidity and mortality. There have been notable advancements in stem cell therapy for HLHS, including developments in diverse stem cell origins and methods of administration. Clinical trials have shown safety and potential benefits, including improved ventricular function, reduced heart failure, and fewer adverse events. Younger myocardium seems particularly receptive to stem cell signals, suggesting the importance of early intervention. This review explores the potential of emerging stem cell-based therapies as an adjunctive approach to improve the outcomes for HLHS patients.

Mounting agents with low toxicity and with fast curing time for digital pathology in the intraoperative frozen section laboratory.

AIMS: In intraoperative frozen tissue section laboratories (FS laboratories) conventional practice for mounting coverslips on tissue slides involves the use of xylene-based mounting agents, such as Pertex. However, toxic vapours pose a risk to biomedical laboratory scientists (BLS) and pathologists who handle the wet slides to provide fast and urgent diagnostic results to surgeons during operations. Our study aims to evaluate non-toxic mounting agents to substitute Pertex, preferably with a fast curing time suitable for the demands of the new digital era in pathology. METHODS: Five non-toxic mounting agents were purchased and tested through six different protocols and compared to xylene-based Pertex as our gold standard. With light microscopy, tissue slides were quality assessed by BLS. Mounting agents, which were evaluated comparable to Pertex, were also evaluated by a pathologist, hence scanned digitally and re-evaluated. RESULTS: The protocols for Eukitt UV, Eukitt UV R-1 and Eukitt UV R-2 had significantly more artefacts (bubbles) compared to gold standard Pertex (p<0.0001, p=0.004 and p<0.0001, respectively) and assessed inadequate as replacements. Neo-Mount and Tissue Mount were assessed applicable regarding quality, but curing times were long. Tek Select UV showed promising results in both quality and fast curing time (protocol was <2 min). CONCLUSIONS: Toxic mounting agents need replacement to health guard professionals, and also digital pathology is revolutionising laboratories. A digitalized FS laboratory requires fast dry/cured slides for digital scanning. Therefore, a substitute for the FS laboratory should have the qualities of being non-toxic to handle and having a fast curing time, and a UV-based mounting agent may solve both requirements.

[In the face of climate change, is a relevant and sustainable eco-pathology in France possible?] / Face au changement climatique, un écosoin pertinent et sobre en anatomo-pathologie en France est-il possible ?

INTRODUCTION: The healthcare sector is a major contributor to greenhouse gas emissions, accounting for 8 % of annual French emissions. Eco-design in healthcare, which provides care with equal quality, safety, and relevance but with a lower environmental impact, is therefore a crucial lever for sustainable medical practice. This article explores the application of eco-design in anatomical and cytopathological practices (ACP) in France, in response to the country's decarbonization goals. OBJECTIVES: After demonstrating that decarbonization is possible through the chosen eco-design of care and practices in ACP, we describe the barriers to these changes and the potential real-world solutions. DISCUSSION: We examine the challenges and solutions for integrating eco-design principles into daily ACP practice, highlighting the importance of the relevance of medical procedures to reduce unnecessary practices. We discuss the technical and human barriers in ACP, as well as the solutions: raising awareness among laboratory personnel, industrial stakeholders, research and innovation, the involvement of scientific societies, and initiatives from the collective for Ecological Transformation in ACP (TEAP). Finally, we propose financial incentives to make eco-friendly practices economically viable in ACP. CONCLUSION: Eco-design in ACP practices is essential to address the climate challenge and ensure the sustainability of the healthcare system.

Deep learning links localized digital pathology phenotypes with transcriptional subtype and patient outcome in glioblastoma.

BACKGROUND: Deep learning has revolutionized medical image analysis in cancer pathology, where it had a substantial clinical impact by supporting the diagnosis and prognostic rating of cancer. Among the first available digital resources in the field of brain cancer is glioblastoma, the most common and fatal brain cancer. At the histologic level, glioblastoma is characterized by abundant phenotypic variability that is poorly linked with patient prognosis. At the transcriptional level, 3 molecular subtypes are distinguished with mesenchymal-subtype tumors being associated with increased immune cell infiltration and worse outcome. RESULTS: We address genotype-phenotype correlations by applying an Xception convolutional neural network to a discovery set of 276 digital hematozylin and eosin (H&E) slides with molecular subtype annotation and an independent The Cancer Genome Atlas-based validation cohort of 178 cases. Using this approach, we achieve high accuracy in H&E-based mapping of molecular subtypes (area under the curve for classical, mesenchymal, and proneural = 0.84, 0.81, and 0.71, respectively; P < 0.001) and regions associated with worse outcome (univariable survival model P < 0.001, multivariable P = 0.01). The latter were characterized by higher tumor cell density (P < 0.001), phenotypic variability of tumor cells (P < 0.001), and decreased T-cell infiltration (P = 0.017). CONCLUSIONS: We modify a well-known convolutional neural network architecture for glioblastoma digital slides to accurately map the spatial distribution of transcriptional subtypes and regions predictive of worse outcome, thereby showcasing the relevance of artificial intelligence-enabled image mining in brain cancer.

Pierre Fauchard's Contribution to Oral Medicine and Oral and Maxillofacial Pathology: An historical essay.

Pierre Fauchard, considered the father of dentistry, contributed to the development of different fields of dentistry that we know today. However, the contribution of this important individual to the fields of oral medicine and oral and maxillofacial pathology is unknown. This study aimed to identify Pierre Fauchard's contribution to these areas of dentistry. We focused on "Le Chirurgien Dentiste, or Traité des Dents" in both French and English, looking for information about the oral diseases diagnosed and treated by Fauchard. Information on patient history, disease description, treatment applied, and clinical follow-up was collected. A contemporary analysis of the diseases was performed, and the collected data were systematized, reported, and analyzed descriptively, according to the current literature on the addressed topics. Information on conditions such as scurvy, parulides, epulides, oral ulcers, dentoalveolar abscesses, dental alterations, and post-exodontia incidents were elucidated. Findings indicated that Pierre Fauchard described, diagnosed, and treated different soft and hard tissue diseases of great interest to the fields of oral medicine and oral and maxillofacial pathology.

Unveiling the role of long non-coding RNA MALAT1: a comprehensive review on myocardial infarction.

Myocardial infarction (MI) stands at top global causes of death in developed countries, owing mostly to atherosclerotic plaque growth and endothelial injury-induced reduction in coronary blood flow. While early reperfusion techniques have improved outcomes, long-term treatment continues to be difficult. The function of lncRNAs extends to regulating gene expression in various conditions, both physiological and pathological, such as cardiovascular diseases. The objective of this research is to extensively evaluate the significance of the lncRNA called Metastasis associated lung adenocarcinoma transcript 1 (MALAT1) in the development and management of MI. According to research, MALAT1 is implicated in processes such as autophagy, apoptosis, cell proliferation, and inflammation in the cardiovascular system. This investigation examines recent research examining the effects of MALAT1 on heart function and its potential as a mean of diagnosis and treatment for post- MI complications and ischemic reperfusion injury.

Case Series of 6 Fetuses With Osteogenesis Imperfecta Type II: A Retrospective Study of Heart Pathology.

INTRODUCTION: Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility. While skeletal manifestations are well documented, few studies have explored the effect of OI on the fetal heart. This retrospective case series investigates cardiac pathology in OI type II fetuses, aiming to address this gap. METHODS: Medical records and autopsy reports of 6 genetically confirmed OI type II cases were examined. Fetuses had pathogenic variants in COL1A1 or PPIB, inducing structural defects in collagen type I. In addition to hematoxylin and eosin and Elastic van Gieson staining, the expression of collagen type I, COL1A1 and COL1A2 chains was examined by immunohistochemistry. RESULTS: Immunohistochemistry confirmed robust expression of collagen type I throughout the heart. Five fetuses had normal heart weight, while 1 had a low heart weight in the context of generalized growth retardation. None displayed structural heart anomalies. CONCLUSION: This study reveals robust collagen type I expression in the hearts of OI type II fetuses without structural anomalies. We hypothesize that collagen type I abnormalities may not be causative factors for heart anomalies during early embryonic development. Instead, their impact may be conceivably related to an increased susceptibility to degenerative changes later in life.

SUMOylation at the crossroads of gut health: insights into physiology and pathology.

SUMOylation, a post-translational modification involving the covalent attachment of small ubiquitin-like modifier (SUMO) proteins to target substrates, plays a pivotal role at the intersection of gut health and disease, influencing various aspects of intestinal physiology and pathology. This review provides a comprehensive examination of SUMOylation's diverse roles within the gut microenvironment. We examine its critical roles in maintaining epithelial barrier integrity, regulating immune responses, and mediating host-microbe interactions, thereby highlighting the complex molecular mechanisms that underpin gut homeostasis. Furthermore, we explore the impact of SUMOylation dysregulation in various intestinal disorders, including inflammatory bowel diseases and colorectal cancer, highlighting its implications as a potential diagnostic biomarker and therapeutic target. By integrating current research findings, this review offers valuable insights into the dynamic interplay between SUMOylation and gut health, paving the way for novel therapeutic strategies aimed at restoring intestinal equilibrium and combating associated pathologies.

Weakly-supervised deep learning models enable HER2-low prediction from H &E stained slides.

BACKGROUND: Human epidermal growth factor receptor 2 (HER2)-low breast cancer has emerged as a new subtype of tumor, for which novel antibody-drug conjugates have shown beneficial effects. Assessment of HER2 requires several immunohistochemistry tests with an additional in situ hybridization test if a case is classified as HER2 2+. Therefore, novel cost-effective methods to speed up the HER2 assessment are highly desirable. METHODS: We used a self-supervised attention-based weakly supervised method to predict HER2-low directly from 1437 histopathological images from 1351 breast cancer patients. We built six distinct models to explore the ability of classifiers to distinguish between the HER2-negative, HER2-low, and HER2-high classes in different scenarios. The attention-based model was used to comprehend the decision-making process aimed at relevant tissue regions. RESULTS: Our results indicate that the effectiveness of classification models hinges on the consistency and dependability of assay-based tests for HER2, as the outcomes from these tests are utilized as the baseline truth for training our models. Through the use of explainable AI, we reveal histologic patterns associated with the HER2 subtypes. CONCLUSION: Our findings offer a demonstration of how deep learning technologies can be applied to identify HER2 subgroup statuses, potentially enriching the toolkit available for clinical decision-making in oncology.

Case report: A case of cutaneous gallstones.

Gallbladder spillage during laparoscopic cholecystectomy procedures is common but rarely leads to patient morbidity due to complications such as abscesses or fistulas. We present the case of a 52-year-old woman post cholecystectomy, who presented to our dermatology clinic with abdominal pain and an epigastric subcutaneous nodule. The nodule was removed, leading to a complete resolution of her pain. On histopathology, it was found to be a cutaneous cholelithiasis.

Linking Diabetic Retinopathy Severity to Coronary Artery Disease Risk Factors in Type 2 Diabetic Patients.

BACKGROUND: Diabetes mellitus (DM) is a common metabolic disorder characterized by hyperglycemia, leading to chronic complications, notably cardiovascular diseases such as coronary artery disease (CAD). Diabetic retinopathy (DR), a leading cause of blindness, may serve as a non-invasive marker for CAD. This study investigates the correlation between DR and CAD to explore its diagnostic potential in diabetic populations. METHODS: A cross-sectional study was conducted over one year in a general hospital, involving 100 type 2 DM patients with retinopathy. DR was classified as mild non-proliferative diabetic retinopathy (NPDR), moderate NPDR, severe NPDR, or proliferative retinopathy, based on fundus examinations. Data on age, duration of diabetes, cholesterol levels, glycated hemoglobin (HbA1C), and ECG (electrocardiography) findings were collected. Statistical analysis included frequency analysis, chi-square tests for association between categorical variables, and significance testing with p-values. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States). Descriptive statistics were characterized by categorical and continuous variables. The chi-square test determined associations between qualitative variables, with significance set at p<0.05. RESULTS: The mean age of patients was 57.13 ± 8.51 years. Age and duration of diabetes were significant predictors of retinopathy severity (p<0.001). Proliferative retinopathy was found exclusively in patients over 70 years. Lower cholesterol levels (<200 mg/dL) were significantly associated with less severe retinopathy (p=0.033), whereas higher cholesterol levels (>200 mg/dL) did not show a statistically significant association with retinopathy severity (p=0.772). Patients with HbA1C levels between 6.5% and 8.5% predominantly had milder forms of retinopathy, as indicated by the significant p-value (<0.001). In contrast, patients with HbA1C levels above 8.5% are more likely to have severe NPDR or proliferative diabetic retinopathy (PDR), but this association was not statistically significant (p=0.582). ECG abnormalities increased with retinopathy severity (p=0.002). Hypertension was significantly linked to cardiac changes in retinopathy patients (p<0.001), while smoking and family history of CAD were not significant factors. This study's cross-sectional design limits causality inference. The single-center sample of 100 patients may not be broadly generalizable. Reliance on self-reported data introduces potential recall bias, and confounding factors such as diet, physical activity, and additional comorbidities were not accounted for. The lack of a control group further limits comparative analysis. Future longitudinal studies with larger, diverse samples are needed. CONCLUSION: Retinopathy in DM patients is significantly associated with cardiac changes and other risk factors such as hypertension, dyslipidemia, and poor glycemic control. Aggressive management of these factors is essential. Retinopathy can serve as a predictor of CAD in diabetic patients.

Double trouble: Co-infection of Angiostrongylus vasorum and Dirofilaria immitis in golden jackal (Canis aureus) in Friuli Venezia Giulia, Italy.

This study reports the first co-infection of Angiostrongylus vasorum and Dirofilaria immitis, two nematodes affecting canid cardiopulmonary systems, in golden jackals (Canis aureus) in Italy. Data on golden jackal carcasses, recovered in Friuli Venezia Giulia (Italy) from 2020 to 2023, were recorded using InfoFaunaFVG wildlife monitoring network. Out of 60 necropsied golden jackals, 24 tested positive for either pathogen, with 3 animals displaying co-infection. Pathological findings included verminous pneumonia, abdominal and thoracic bleeding, and adult individuals in the heart and pulmonary arteries. The recent expansion of the golden jackal in northern Italy may favour the establishment and spread of these nematodes, posing challenges for disease containment and surveillance. Given the increasing prevalence of angiostrongylosis and cardiopulmonary dirofilariosis in Europe, health monitoring of wild canids is essential to reduce their potential impact.

Impact of Reclassification of Oncocytic and Follicular Thyroid Carcinoma by the 2022 WHO Classification.

BACKGROUND: The 2022 WHO Classification categorizes oncocytic (OTC) and follicular thyroid carcinoma (FTC) based on the degree of capsular and vascular invasion into minimally invasive (MI), encapsulated angioinvasive (EA) and widely invasive tumors (WI). While associations with clinical outcomes have been studied extensively in FTC, robust clinical data are lacking for OTC. We aimed to investigate the impact of the reclassification of OTC and FTC by the 2022 WHO Classification on clinical outcomes. METHODS: All adult OTC and FTC patients treated at the Erasmus MC (the Netherlands) between 2000 and 2016 were retrospectively included. All tumors were extensively revised by two independent pathologists, facilitated by Palga: Dutch Pathology Databank. Kaplan-Meier curves were used to study the association of the 2004 and 2022 WHO Classification with overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS) and radioactive iodine (RAI) refractory disease. RESULTS: Fifty-two OTC and 89 FTC patients were included, of which 15 (28.8%) OTC and 34 (38.2%) FTC tumors were reclassified as EAOTC or EAFTC. The 2022 WHO Classification substantially improved risk stratification in both subtypes for DSS, compared with the 2004 edition. Ten-year DSS rates were 100% for MIOTC, 92.9% for EAOTC and 56.5% for WIOTC, compared to 100% (MIOTC) and 64.2% (WIOTC) following the 2004 WHO Classification. For FTC and RAI-refractory disease, similar trends were observed. CONCLUSION: Classification of OTC and FTC into three subcategories as defined by the 2022 WHO Classification substantially improves discrimination between low, intermediate and high risk patients, especially for DSS and RAI-refractory disease.

Improving Interdisciplinary Communication and Pathology Reporting for Head and Neck Cancer Resections: 3D Visualizations and Margin Reconciliation.

PURPOSE: Surgical pathology reports play an integral role in postoperative management of head and neck cancer patients. Pathology reports of complex head and neck resections must convey critical information to all involved clinicians. Previously, we demonstrated the utility of 3D specimen and defect scanning for communicating margin status and documenting the location of supplemental margins. We introduce a newly designed permanent pathology report which improves documentation of intraoperative margin mapping and extent of corresponding supplemental margins harvested. METHODS: We test the hypothesis that gaps in understanding exist for head and neck resection pathology reports across providers. A cross-sectional exploratory study using human-centered design was implemented to evaluate the existing permanent pathology report with respect to understanding margin status. Pathologists, surgeons, radiation oncologists, and medical oncologists from United States-based medical institutions were surveyed. The results supported a redesign of our surgical pathology template, incorporating 3D specimen / defect scans and annotated radiographic images indicating the location of inadequate margins requiring supplemental margins, or indicating frankly positive margins discovered on permanent section. RESULTS: Forty-seven physicians completed our survey. Analyzing surgical pathology reports, 28/47 (60%) respondents reported confusion whether re-excised supplemental margins reflected clear margins, 20/47 (43%) reported uncertainty regarding final margin status, and 20/47 (43%) reported the need for clarity regarding the extent of supplemental margins harvested intraoperatively. From this feedback, we designed a new pathology report template; 61 permanent pathology reports were compiled with this new template over a 12-month period. CONCLUSION: Feedback from survey respondents led to a redesigned permanent pathology report that offers detailed visual anatomic information regarding intraoperative margin findings and exact location/size of harvested supplemental margins. This newly designed report reconciles frozen and permanent section results and includes annotated radiographic images such that clinicians can discern precise actions taken by surgeons to address inadequate margins, as well as to understand the location of areas of concern that may influence adjuvant radiation planning.

A Proliferating Trichilemmal Tumor at an Uncommon Site Treated With Radical Excision: A Case Report and Literature Review.

A proliferating trichilemmal tumor (PTT) is a rare, benign, exophytic tumor originating from the isthmus region of the outer root sheath of the hair follicle. Clinically, PTTs manifest as isolated, exophytic, firm nodules that have the potential to ulcerate. These tumors may occasionally originate from a pre-existing trichilemmal cyst, or they can emerge spontaneously. Most exclusively these lesions are seen on the scalp. However, rarely these tumors can be found in other anatomical areas. Our patient had a protruding mass in her shoulder for 20 years, and this is a rare site for the occurrence of these lesions; it could be the first case to document such a site, as far as we found in the literature. The mainstay treatment of the PTT is surgical excision of the tumor, assessing the histological margins to ensure sufficient resection was made, close monitoring, and follow-up with the patient.

Distant Multilevel Spinal Metastasis Secondary to Hypopharyngeal Squamous Cell Carcinoma.

Head and neck squamous cell carcinomas account for most head and neck malignancies. While multi-modality treatment may be offered for locally advanced cancer, distant metastasis still occurs in a significant number of patients. This paper aims to present a rare case of a patient who developed bony metastases in the cervical spine from a primary hypopharyngeal malignancy status post-laryngopharyngectomy. We report a case of a male patient presenting with acute-on-chronic hypercapnic and hypoxic respiratory failure with two months of dysphagia and weight loss. On arrival, a barium swallow revealed mucosal irregularity of the upper thoracic esophagus as well as narrowing and stenosis. A direct laryngoscopy with biopsy revealed squamous cell carcinoma of the hypopharynx. CT neck and chest were obtained for staging. He underwent a total laryngopharyngectomy, bilateral neck dissections, and a free flap. His final staging was pT4aN2c cM0. Three months post-admission, during inpatient radiation therapy, the patient reported midline neck pain with focal bone tenderness, and an MRI was obtained of his cervical and thoracic spine with a report concerning spinal metastasis.A subsequent bone biopsy showed findings consistent with osseous metastasis from a primary hypopharyngeal squamous cell carcinoma. After multidisciplinary goals of care discussions, the patient ultimately decided to be discharged to inpatient hospice. This report highlights a rare case of hypopharyngeal carcinoma metastasis to the cervical spine. Despite its rarity and poor prognosis, such a metastasis should be considered in the differential diagnosis of patients with a history of hypopharyngeal squamous cell carcinoma and localizing symptoms.

Arthroscopic Management of Complex Knee Pathologies in a 45-Year-Old Male: A Case Report.

Knee disorders can present in various forms, often involving complex pathologies. The diagnosis and management of these conditions can be challenging, particularly in the absence of associated trauma. A 45-year-old male with a history of chronic right knee pain and clicking presented after failure of conservative treatment modalities. Imaging of the right knee identified multiple pathologies, including a ligament sprain, bone marrow edema, lateral maltracking of the patella, and advanced chondromalacia patella. Following these findings, the patient underwent arthroscopic surgery. A rare lateral meniscal cyst in the anterior horn was found during the surgery. Debridement, irrigation, and excision of the cyst were performed. Following the surgery, the patient experienced successful symptom resolution. Opting for arthroscopic surgery post other method failures can enhance patient outcomes.

An Uncommon Cause of Recurrent Dysphagia and Chest Pain in an Adolescent Boy.

An 11-year-old boy was brought to the emergency department with a week-long history of widespread pain in his upper abdomen that worsened with deep breathing and eating, sialorrhea, food impaction sensation, and a recent fever. Ten months prior, he had similar symptoms and was diagnosed with a pharyngeal phlegmon. He was treated with antibiotics and dexamethasone. In the current episode, he presented with mild elevation of inflammatory markers, a slight deviation of the trachea on chest X-ray, and a tubular esophageal duplication was identified on a thoracic CT, with its opening observed during the endoscopic study. The patient was admitted for further treatment with fluids, analgesia, and antibiotics, and showed improvement over the next seven days with no significant incidents. Esophageal duplications are a rare congenital anomaly and their exact cause is unknown. Typically found in the posterior mediastinum and lower esophagus, they can cause symptoms such as pain, dysphagia, regurgitation, and malnutrition. Surgical or endoscopic resection can be a treatment option for these malformations.

Glomerular Diameter Measurements on Light Microscopy: A New Parameter Available to Pathologists and its Utility in IgA Nephropathy.

Background: With the availability of whole slide digital scanners, fairly accurate glomerular diameter (GD) measurements are now possible on light microscopy. The value of these measurements in prognosis and diagnosis of immunoglobulin A nephropathy (IgAN) have not been studied widely. IgAN is a major cause of end-stage renal disease (ESRD) worldwide, and its progression is currently assessed using Oxford scores, serum creatinine, and 24-h urinary protein. We aimed to correlate the mean and maximum GDs with serum creatinine, 24-h urinary protein, and Oxford scores in patients with IgAN. Materials and Methods: One hundred biopsies of IgAN with a minimum of eight viable glomeruli were collected along with data of their 24-h proteinuria, serum creatinine, and Oxford scores. The slides were scanned using the Philips IntelliSite Pathology Solution-Ultra Fast Scanner. Mean GD of each glomerulus was calculated as the mean of two measurements, that is, the maximal diameter of the glomerulus and the maximal chord perpendicular to the maximal diameter. Maximum GD was also recorded for each case. The Spearman rho/Pearson R correlation coefficient was used to make this correlation. P-values <0.05 were considered statistically significant. Results: The mean age of the patients was 34.67 ± 12.03 years, and they showed a male preponderance. The overall mean GD was 151.82 ± 28.69 µm, and maximum GD was 205.40 ± 32.76 µm. No statistically significant correlation was observed between the mean or maximum GD and the 24-h proteinuria, serum creatinine levels, and Oxford scores. Conclusion: GD in IgAN does not correlate with proteinuria, serum creatinine, or Oxford scores.