Recognition of Colon Polyps (Tubular Adenoma, Villous Adenoma) and Normal Colon Epithelium Histomorphology with Transfer Learning.

BACKGROUND:  The use of artificial intelligence technology in medicine, which is remarkable with its increasing use in many areas recently, has allowed for rapid developments. This technology quantitatively solves many problems in medicine, such as increased workload, delayed diagnosis, and treatment processes. It has been seen in the literature that this technology, which has a wide range of applications in medicine, also has a place in medical pathology. The main purpose of this study is to provide a histomorphological classification of colon polyps in the medical pathology department with high accuracy in a short time. Besides accelerating the diagnosis and treatment process, it is desired to facilitate the workload of the pathology department. METHODS:  This study is based on the recognition of colon preparation images that come to the pathology department by using the image recognition techniques of artificial intelligence. VGG19, DenseNet201, and EfcientNetB7 models, which are convolutional neural networks (CNN) models, were used. A model based on a concatenation ensemble of 3 CNN architectures was also used in this study. RESULTS:  Within the scope of the study, a total of 515 preparation images, including normal epithelium, tubular adenoma and villous adenomas of the colon, were procured as data and introduced to artificial intelligence, and the diagnoses of these preparations were estimated histomorphologically by artificial intelligence. CONCLUSION:  As a result of the study, an accuracy rate of 94.17% was achieved.

An important finding for differential diagnosis in thymic cyst mimicking pericardial cyst: punctate calcification.

Mediastinal cysts are usually congenital but present in adulthood. A pericardial cyst is usually localized in the right cardiophrenic region. Thymic cysts are less common and are located in the cervical region or anterior mediastinal region. While thoracoscopic excision or aspiration can be applied in pericardial cysts, excision is recommended in thymic cysts. We present a case of a thymic cyst located in the localization of the pericardial cyst and radiologically containing wall punctate calcification.

Diagnostic value of FDG PET-CT in differentiating lung adenocarcinoma from squamous cell carcinoma.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths worldwide. The combination of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) and computed tomography (CT) has a major impact on the diagnosis, staging, treatment planning and follow-up of lung cancer patients. The maximum standardized uptake value (SUVmax) is an easily performed and most widely used semi-quantitative index for the analysis of FDG PET images and estimation of metabolic activity. This study aimed to investigate the role of PET/CT in differentiating adenocarcinoma (ADC), the most common lung cancer, from squamous cell carcinoma (SCC) by comparing FDG uptake measured as SUVmax. RESULTS: Between 2019 and 2022, 76 patients diagnosed with non-small cell lung cancer (NSCLC) at the Department of Pathology, Atatürk University Faculty of Medicine, with histopathologic evidence of adenocarcinoma or squamous cell carcinoma, underwent retrospective analysis using PET/CT scanning to measure PET parameters of the lesions and compare them with histopathology. Among 76 NSCLC patients included in the study, 43 (57%) were histopathologically diagnosed as ADC and 33 (43%) as SCC. SUVmax, SUVmean, metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values of lesions in patients with SCC were statistically significantly higher than those in patients with ADC (p values 0.007, 0.009, 0.003 and 0.04, respectively). CONCLUSIONS: Lung SCC has higher metabolic uptake values than ADC, and PET/CT can be used to differentiate them.

Ultrasonography-based staging of inflammatory granulomatous mastitis and estimation of steroid response.

OBJECTIVES: The aim of this study is to present novel diagnostic ultrasonography (USG)-based classification of inflammatory granulomatous mastitis (IGM) and to assess and compare dosage responses of locoregional steroid therapy. METHODS: From January 2017 through March 2023, total of 230 biopsy-proven IGM patients were reclassified (grades I, II, and III) according to USG-based morphological features. The injection applications were grouped in Group1 (40 mg/mL between years 2017 and 2019) versus Group2 (80 mg/mL between years 2019 and 2023), and effectiveness was analysed for each grade in between groups. RESULTS: The mean age was 31 years old (range: 19-60) with median follow-up period of 7 months. The most common clinical presentation was breast mass accompanying draining skin sinuses of the affected skin and hypoechogenic mass with tubular extensions was the most prevalent feature on USG examination. As per USG-based features, 79 (34.3%) patients were redefined as grade I, 64 (27.8%) as grade II, and 87 (37.8%) as grade III. All patients underwent locoregional steroid injection only. The average number of treatments in the first group was 6 (±3 SD) with an effective dose of 40 mg/mL in the first group, and 4 (±2 SD) with an effective dose of 80 mg/mL in the second group. The generalized linear mixed model was used to investigate effects between groups (P < .05). CONCLUSIONS: High-dose steroid treatment was effective in burnout lesions (grades II and III), and it was found to be statistically significant in lowering number of treatments irrespective of grade. ADVANCES IN KNOWLEDGE: This novel classification could be a convenient tool in terms of common language between radiologists and clinicians. In addition, our study is a pioneer in comparing steroid dosage with no relapse in IGM patients.

First report of the histopathological effect of electrocautery using on the urethral taste rosea during glans penis injury by incision in rabbits.

Objective: Currently, electrocautery devices have frequently been used in penile surgical procedures. We hypothesized that electrocautery using during penile surgical procedures may harm the taste rosea and the dorsal nerve of the penis or clitoris. Methods: Eighteen young age male New Zealand rabbits were studied: five in the control (Group I, n=5), five in the penile surgery without using electrocautery (sham group, Group II, n=5), eight in the monopolar cautery (study group, Group III, n=8) groups under general anesthesia. The animals were followed for 3 weeks and sacrificed. Penile tissue-pudendal nerve root complexes and dorsal root ganglion of sacral 3 level were examined using stereological methods. The results were compared statistically. Results: The live and degenerated taste bud-like structures and degenerated neuron densities of pudendal ganglia (mean±standard deviation, n/mm3) were estimated as 198±24/mm3, 4±1/mm3, and 5±1/mm3 in Group I; 8±3/mm3, 174±21/mm3, and 24±7/mm3 in Group II; and 21±5/mm3, 137±14/mm3, and 95±12/mm3 in Group III, respectively. Neurodegeneration of taste buds and pudendal ganglia was significantly different between groups. Conclusion: Intact spinal cord and normal parasympathetic and thoracolumbar sympathetic networks are crucial for human sexual function. The present study indicates that the glans penis injury by using electrocautery may lead to pudendal ganglia degeneration. Iatrogenic damage to taste rosea and retrograde degeneration of the pudendal nerve may be the cause of sexual dysfunction responsible mechanism.

New Evidence for Regulatory Role of Trigeminal Ganglion on the Intraocular Pressure Following Subarachnoid Hemorrhage.

BACKGROUND: Increased intraocular pressure (IOP) likely secondary to an activated oculo-trigeminal reflex network is an important issue following subarachnoid hemorrhage (SAH). The relationship between the IOP and trigeminal ganglion (TGG) following experimental SAH was investigated in this study. METHODS: Twenty-three rabbits were used in this study. Five rabbits (n = 5) were used as the control group, another 5 as the sham group (n = 5), and the remaining 13 (n = 13) as the study group. The study group was further divided into two groups of animals with mild (n = 6) and severe (n = 7) TGG degeneration. The IOP values were recorded. After 2 weeks, the animals were decapitated. The mean degenerated neuron density of TGGs was estimated by stereological methods and analyzed statistically. RESULTS: The average IOP values were 11.85, 14.12, and 21.45 mm Hg in the control (n = 5), sham (n = 5), and study (n = 13) groups, respectively. The mean degenerated neuron density was 34, 237, and 3,165 mm3 in the control, sham, and study groups, respectively. CONCLUSION: According to the findings of this study, the experimental SAH leads to changes in IOP by affecting the TGG. By predicting and preventing IOP elevation in the setting of SAH, our findings will shed light on secondary sequelae such as glaucoma and irreversible blindness.

A retrospective analysis of practical benefits and caveats of the new WHO 2021 central nervous system tumor classification scheme in low-resource settings: "A perspective from low- and middle-income countries".

The revised classification of tumors of the central nervous system (CNS) by the World Health Organization (WHO) in 2021 was hailed as a major advance and improvement in the management of brain tumor patients. However, the increased reliance on sophisticated technology and molecular analysis posed a major challenge to healthcare systems in low- and middle-income countries. A few recent publications have drawn attention to the issue of the applicability of the new CNS WHO 2021 worldwide, but the exuberant enthusiasm observed in high-income countries seems to have stifled such a concern. In this study, we present data on the practical utility of the changes that occurred in CNS WHO 2021 in four institutions with limited resources. Our findings demonstrate no major alterations in patient management in low resource settings and significant added financial impact. While there is no doubt that the revised classification provides greater insight into tumor biology and molecular/genetic features of CNS tumors, its practical benefit and applicability in the majority of cases worldwide are limited, and attempts to improve its utility in low resource settings are warranted.

Clinicopathologic Features and Prognostic Significance of Immunohistochemistry and In Situ Hybridization Based Molecular Classification in Gastric Carcinoma.

BACKGROUND/AIM: Gastric carcinoma (GC) is a highly heterogeneous disease with many subtypes that have different morphologic and molecular characteristics. In the current study, we analyzed immunohistochemical (IHC) and in situ hybridization (ISH) features of GCs and evaluated their association with prognosis and clinicopathological features. MATERIALS AND METHODS: Three hundred cases analyzed by IHC and ISH for microsatellite stability, p53, e-cadherin, HER2, PD-L1 expression, and Epstein-Barr virus (EBV) status. Cases were classified into five subgroups based on expression profile. The relationships between subgroups, clinicopathological features, and survival were determined. RESULTS: Ten (3.3%) cases were classified as EBV-associated, 45 (15%) as microsatellite instable (MSI), 73 (24.3%) as EBV-/microsatellite-stable (MSS)/epithelial-mesenchymal-transformation (EMT)-like, 75 (25%) as EBV-/MSS/ non-EMT-like/p53+, and 97 (32.3%) as EBV-/MSS/non-EMT-like/p53-. The MSI subtype had the best overall survival (OS). In contrast, the EBV-/MSS/EMT-like subtype had the poorest OS. The MSI subtype was also related with old age of the patient and antrum-corpus localized tumors, whereas the EBV-/MSS/EMT-like was associated with young age, larger tumor size, and advanced stage presentation. PD-L1 positivity is highly correlated with MSI and EBV-associated subtypes. CONCLUSION: Our data demonstrated a link between IHC/ISH characteristics of GC and clinical outcomes. IHC/ISH based molecular classification may be helpful in predicting the survival.

Nasopharyngeal Synovial Sarcoma; Report of A Rare Case.

Synovial sarcoma is a soft tissue tumor originating from mesenchymal precursor stem cells. It is usually seen in young males and lower extremities. It is only seen in 10% of head and neck region and nasopharynx which is a very unexpected location. We report a rare case treated with radiotherapy and chemotherapy.

The effects of intrauterine device on cervico-vaginal smears with liquid-based cytology technique: A North-Eastern Anatolia region study in Turkey.

Intrauterine device (IUD), is one of the most efficient methods of contraception. The aim of study to investigate the effects of intrauterine device in cervicovaginal smears with liquid based cytology technique in our patient population. Cervicovaginal smears of 5492 patients who sought the services of the pathology department in a sixmonth period were reviewed retrospectively. Samples were prepared with liquid based cytology technique. The patients using IUD as contraceptive method (n= 562 cases) were included in the study. The samples taken with the conventional method were excluded from the study. The results were categorized according to the Bethesda system. The age range of the patients was 18-61 years (mean age: 34.6). The most common diagnosis was "negative for intraepithelial lesion or malignancy" (97.2%). In 307 patients (54.6%) there were infection and only in 93 out of them (30.2%) a specific agent was detected. Actinomyces (11%) were recorded as the most common infectious agent, followed by Gardnerella vaginalis (2.8%) and Candida species (2.4%). There were reactive changes in 134 cases (23.8%). In 13 cases (2.3%) epithelial cell abnormalities were detected. The most common cytopathologic diagnosis was ASC-US (atypical squamous cells of undetermined significance) in patients who had epithelial cell abnormalities (2.1%). In conclusion, IUDs increase the frequency of genital infection by disrupting the genital flora. In our study the most frequent agent was Actinomyces, and this rate was higher than some studies. This high rate for Actinomyces may be associated with IUDs that are frequently used for contraception in Erzurum province with long term uses.

Clinical, Histopathological, Imaging, and Treatment Perspectives of Inflammatory Granulomatous Mastitis: Review of the Literature.

Inflammatory granulomatous mastitis is a benign inflammatory disease of the breast mostly presenting in puerperal women. The disease is characterized by recurrent bouts of mastitis with clinical picture of hyperemia, breast mass, and swelling of the breast with or without purulent discharge depending on the severity of the underlying inflammatory process. Although no true prevalence and incidence have been reported in the literature, there are several reported studies setting forth a predilection in specific ethnic groups and/ or geographical areas. Due to the intricate nature of the disease, quite often inflammatory granulomatous mastitis may be mistaken for malignant processes of the breast and even so, there are no pathognomonic imaging appearances to differentiate one from another. The histopathological analysis is a definite way of diagnosis. In this article, we review the imaging manifestations and clinical and histopathological findings along with current trends of available treatment options in the literature and briefly discussed our institutional perspective regarding grading of inflammatory granulomatous mastitis based on ultrasonographic appearances.

Dual energy CT in necrotizing enterocolitis; a novel diagnostic approach.

BACKGROUND: Necrotizing enterocolitis (NEC) is one of the most important causes of morbidity and mortality in premature infants. Although there are no specific diagnostic tools, the main factors affecting prognosis are clinical and laboratory findings, and early diagnosis and treatment. In this study, we demonstrate the importance of dual-energy computed tomography (DECT) in confirming intestinal ischemia in neonates with NEC. METHODS: Patients diagnosed with NEC in a neonatal intensive care unit were staged according to modified Bell's classification, and DECT was performed on patients with NEC stages 2-A, 2-B and 3-A. According to their DECT reports, these patients were then separated into two groups: those with intestinal ischemia and those without intestinal ischemia. The patients with intestinal ischemia were evaluated using surgical reports, and the other patients were evaluated using clinical findings. RESULTS: DECT was performed in 21 patients with NEC stages 2-A, 2-B and 3-A. Twelve patients (57.1%) without ischemia were followed up without surgery. Nine patients (42.9%) with ischemia on DECT were operated on, and resection and anastomosis or ileostomy and colostomy were performed. DISCUSSION: In patients with NEC, DECT significantly increases overall diagnostic confidence in assessing intestinal necrosis when compared with traditional diagnostic methods.

Toward the first definition of taste rosea in female breasts: histological analysis / La primera definición del sabor rosea en mamas femeninas: análisis histológico

Although various neuropsychochemical theories have been established about why breastfeeding mothers feel hedonic sensation, the underlying neural mechanism has not been adequately clarified. We aimed to investigate if there is hedonic sensation-initiated taste-bud like structures stimulated by sugars in the milk-secreting lactiferous ducts of mammary glands of breastfeeding female rats. In this study, twenty-two female rats were chosen which six of the virgin (n=6), six of pregnant (n=6) and ten of breastfeeding (n=10). We examined lactiferous ducts/nipples of mammary glands of all animals. They were sacrificed following intracardiac formalin injection, and their breast tissues were removed with covering tissues and fixed with 10 % of formalin solution. After current histological procedures, the tissues were examined by light microscope to assess taste-bud like structures, and their numerical densities were calculated by using stereological methods. Results were analyzed statistically. Taste-buds like structures with neuron-like appendages at the apical ends were discovered in lactiferous ducts. The taste rosea numbers were estimated as 3±1/mm3 in virgins, 167±27/mm3 in pregnant and 375±63/mm3 in breastfeeding animals. The taste rosea numbers were greater in breastfeeding rats than those of virgins and pregnant rats. They named as taste rosea resembling flower bucket which has not been mentioned in the literature so far.

Existen varias teorías neuropsicoquímicas, referente a la sensación hedónica que sienten las mujeres al amamantar, y el mecanismo neural subyacente. No obstante, estas aún no se aclaran adecuadamente. El objetivo de este estudio, fue investigar si existen estructuras hedónicas iniciadas por la sensación gustativa estimuladas por los azúcares en los conductos mamarios secretores de leche, de las glándulas mamarias de las ratas durante el período de lactancia. En este estudio, se eligieron 22 ratas hembras, seis de estas no preñadas como grupo control, seis preñadas y diez en período de lactancia. Examinamos los conductos lactíferos / pezones de las glándulas mamarias de los tres grupos. Los animales fueron sacrificados por medio de inyección intracardíaca de formalina. El tejido mamario se fijó en solución de formalina al 10 %. La muestras histólogicas fueron examinadas a través microscopía óptica con la finalidad de evaluar estructuras con características morfológicas similares a las papilas gustativas. Su densidad de número se calculó utilizando métodos estereológicos. Los resultados fueron analizados estadísticamente. En los conductos mamarios se observaron dos estructuras con con características morfológicas tipo papilas gustativas con apéndices neuronales en los extremos apicales. Los números se estimaron en 3±1/mm3 en el grupo control, 167±27/mm3 en gestantes y 375±63/mm3 en animales lactantes. El número de estructuras características morfológicas similares a las papilas gustativas fue mayor en las ratas amamantando que en el grupo control y que en las ratas preñadas. Conocido como sabor rosea debido a que se asemeja a un ramo de flores, lo que hasta ahora no se ha mencionado en la literatura.

Water-Filled Vesicles of Choroid Plexus Tumors.

OBJECTIVE: Choroid plexus cysts are the most common neuro-epithelial cysts. METHODS: The authors describe 2 cases. The first case is a 1-year-old child presenting with hydrocephalus and cyst of the choroid plexus. The child was treated with endoscopic fenestration of the cysts. RESULTS: The histological examination of the cyst wall was consistent with choroid epithelium and water-filled vesicles. The second case is a 63 year old male with a highly vascularized tumor extending to choroid plexus. A quaductus Silvius was obstructed by the tumor. The histopathologic examination of choroid plexus showed a low number, water-vesicles. CONCLUSIONS: According to our knowledge, there are no previous reports of water-filled vesicles with choroid plexus cyst causing hydrocephalus. The first case is a good example of over secretion of cerebrospinal fluid (CSF) with the water-filled vesicle. The second case with low number of water filled vesicle shows that the cause of hydrocephalus is not over production of CSF, it is blockage of the CSF pathway in Aquaductus Silvius by the tumor itself. These 2 cases are illustrative and more importantly highlight the need to study for water-filled vesicles in these kind of cases.