Papillary Squamous Cell Carcinoma of the Uterine Cervix: Biopsy Samples Frequently Underrepresent the Presence of Stromal Invasion.

Papillary squamous cell carcinoma is a rare variant of squamous cell carcinoma, histologically characterized by thin or broad papillae lined by epithelium showing the features of high-grade squamous intraepithelial lesion. Given the exophytic nature of these neoplasms, the diagnosis, assessment and quantification of invasion may be difficult in small biopsies. The goal of this study was to determine the presence and extent of cervical stromal invasion by comparing biopsy samples with excisional specimens in a cohort of patients diagnosed with papillary squamous cell carcinoma. Cases were identified from the surgical pathology files between the years 2003 and 2018 and only cases in which the patients underwent an excisional procedure following the diagnostic biopsy were included. Eighteen cases were identified. Patients age ranged 21 to 72 yr (mean: 46.2 yr). Review of the initial, presurgical biopsies showed that 17/18 (94%) patients had no evidence of stromal invasion. In the surgical excision specimens (2 cone biopsies, 1 loop electrosurgical excision procedure, and 15 hysterectomies), 13 cases (76.5%) showed invasive squamous cell carcinoma. Tumor sizes ranged 1.0 to 6.1 cm; stromal invasion ranged in depth 0.2 to 2.2 cm (median: 1.2), and in horizontal length 0.3 to 4.0 cm (median: 2.01). Papillary squamous cell carcinoma is a rare variant of squamous cell carcinoma of the cervix that may impose some diagnostic difficulties in small biopsies. Our findings demonstrated that the significant majority of cases might only show the presence of invasive cancer in excisional samples. Awareness of this data is important to guide proper management and avoid under-treatment.

Atypical vulvar lipoma - A case report and literature review.

Atypical spindle cell lipomatous tumors of the vulva are rare masses. We report a case of atypical spindle cell lipoma of the vulva and provide a succinct review of the current understanding of these benign masses. Specifically, this report describes a case of a 20-year-old nulligravid female who presented for evaluation of a labial mass that had been growing for one year. A pelvic MRI revealed a 7 cm fatty growth. The vulvar mass was surgically resected. This case report describes the pathologic staining pattern for these masses and reviews characteristics of these benign tumors such that they are not mistaken for malignancy.

A rare sweat gland tumor in an ovarian teratoma: Spiradenocylindroma case report.

Background: Spiradenocylindroma is a benign tumor of skin adnexal origin with overlapping features of two distinct neoplasms: spiradenoma and cylindroma. This cutaneous tumor typically presents on the head and neck and extracutaneous presentations are uncommon. The presentation described below involves a spiradenocylindroma within a mature ovarian teratoma is very rare. Aim: The aim of this article is to portray the diagnostic process of this unusual spiradenocylindroma presentation. Case presentation: A 65 year-old female with a left adnexal mass underwent ultrasonography and magnetic resonance imaging (MRI) which showed a left ovarian multiseptated lesion, with mural calcifications and projections into the mass. Excisional surgery was performed and histopathological examination revealed a spiradenocylindroma. Conclusion: Spiradenocylindroma is rare, hard to identify, and often misdiagnosed. Our study described the process of diagnosis and depicts the rare presentation of this lesion arising within a mature teratoma.

The Paris System "atypical urothelial cells" category: can the current criteria be improved?

INTRODUCTION: The Paris System (TPS) for reporting urine cytology was developed for standardization of diagnosis focusing on the detection of high-grade urothelial carcinoma (HGUC). Probably the most challenging task for TPS is to provide criteria for the atypical urothelial cell (AUC) category. The TPS criteria for AUC include increased nuclear/cytoplasmic (N/C) ratio (>0.5) and 1 of the 3 minor criteria including nuclear hyperchromasia (NH), coarse chromatin (CC) and irregular nuclear membrane (INM). We evaluated TPS-AUC diagnostic value and investigated whether other morphologic parameters can improve its criteria. MATERIALS AND METHODS: Urine samples with diagnoses of AUC collected during a 6-month period were re-reviewed. Data captured included N/C ratio >0.5, NH, CC, INM, and 2 additional criteria including enlarged nuclear size (ENS) and the presence of nucleolus (N). ENS was considered when the nucleus was 2 times larger than the urothelial cell or 3 times larger than lymphocyte. RESULTS: By applying the TPS-AUC criteria, the rate of atypia diagnosis reduced in comparison to Pre-TPS (9% versus 13%, P = 0.02). Among the AUC minor criteria, NH was the best criterion with the highest interobserver agreement (IOA) and correlation with HGUC (k = 0.342, r = 0.61, P < 0.001) and strong PPV (93.6%). ENS had the highest PPV (95.8%) and, after NH, had the highest IOA and correlation with HGUC (k = 0.29, r = 0.52, P < 0.001). CONCLUSION: TPS improves the diagnostic value of urine cytology, particularly in cases with atypia. ENS is a strong criterion for increasing the diagnostic value of AUC and potentially can improve TPS performance as a minor criterion.

Frozen section evaluation via dynamic real-time nonrobotic telepathology system in a university cancer center by resident/faculty cooperation team.

Frozen section telepathology interpretation experience has been largely limited to practices with locations significantly distant from one another with sporadic need for frozen section diagnosis. In 2010, we established a real-time nonrobotic telepathology system in a very active cancer center for daily frozen section service. Herein, we evaluate its accuracy compared to direct microscopic interpretation performed in the main hospital by the same faculty and its cost-efficiency over a 1-year period. From 643 (1,416 parts) cases requiring intraoperative consultation, 333 cases (690 parts) were examined by telepathology and 310 cases (726 parts) by direct microscopy. Corresponding discrepancy rates were 2.6% (18 cases: 6 [0.9%] sampling and 12 [1.7%] diagnostic errors) and 3.2% (23 cases: 8 [1.1%] sampling and 15 [2.1%] diagnostic errors), P = .63. The sensitivity and specificity of intraoperative frozen diagnosis were 0.92 and 0.99, respectively, in telepathology and 0.90 and 0.99, respectively, in direct microscopy. There was no correlation of error incidence with postgraduate year level of residents involved in the telepathology service. Cost analysis indicated that the time saved by telepathology was $19,691.00 over 1 year of the study period, whereas the capital cost for establishing the system was $8,924.00. Thus, real-time nonrobotic telepathology is a reliable and easy-to-use tool for frozen section evaluation in busy clinical settings, especially when frozen section service involves more than one hospital, and it is cost-efficient when travel is a component of the service.

Immunophenotypes of Chronic Myelomonocytic Leukemia (CMML) Subtypes by Flow Cytometry: A Comparison of CMML-1 vs CMML-2, Myeloproliferative vs Dysplastic, De Novo vs Therapy-Related, and CMML-Specific Cytogenetic Risk Subtypes.

OBJECTIVES: We sought to immunophenotype blasts, monocytes, and granulocytes in chronic myelomonocytic leukemias (CMMLs) and compare CMML subtypes, to identify if significant antigen expression differences existed. METHODS: Bone marrow blasts, monocytes, and granulocytes from CMML subgroups (n = 30; World Health Organization types 1/2, proliferative/dysplastic, therapy related/de novo, and low/intermediate/high cytogenetic risk) were immunophenotypically compared by flow cytometry with 10 nonneoplastic control marrows. RESULTS: Aberrancies were present in blasts of 26 (87%) of 30 CMMLs (26 diagnostic; four follow-up) and six (60%) of 10 controls (P = .089), monocytes of 28 (93%) of 30 CMMLs and six (60%) of 10 controls (P = .026), and granulocytes of eight (28%) of 29 CMMLs and zero of 10 controls (P = .166). Underexpression of CD14 and CD15 on monocytes was more common in CMMLs compared with controls (P = .008 and P = .043). Statistical analysis showed no significant difference in antigen expression between the CMML subgroups on blasts or monocytes; granulocytes demonstrated more common HLA-DR expression in CMML-2 vs CMML-1. CONCLUSIONS: These findings confirm heterogeneity within CMML subgroups and find no specific qualitative or quantitative findings characteristic of a subgroup.

Resultados da atratividade do perfil facial nas dimensões sagital e vertical utilizando previsão computadorizada / Facial profile attractiveness outcome in sagital and vertical dimensions, using computerized prediction

Aim: To assess the perception of facial attractiveness in profile digital images in the sagital and vertical plan. Methods: The facial profiles of 80 patients (20 Class II, 20 Class III, 20 open bite and 20 deep bite) male and female samples were evaluated. The lateral cephalometry radiographs of the all samples were digitized and systematically altered regarding the location of the mandible and maxilla in the sagital and vertical plan, using Dolphin Imaging software program (version 10.0). Five manipulated profile images together with the patients' own profile were presented to the raters including laypersons, orthodontists and surgeons. The facial attractiveness of the profile images were assessed using a 6-scaled (visual analogue scale). The data were analyzed using Kruskal Wallis and Mann Whitney U tests. Results: The most attractive facial profiles were normal images in both patients' groups as assessed by all judges Severe Class III facial profiles in both Class II and Class III patients' images and severe open bite facial profiles in both deep bite and open bite patients' images ranked as the least attractive. No significant differences were found in the overall rankings of male and female profile images between female and male raters. Conclusion: The profile attractiveness decreased with the more deviations from the normal profile proportions and more scattered ideas were shown by raters. Specialists can use the results of the beauty perception by the laypersons to modify the treatments and consequently increase the patients' satisfaction.

Objetivo: Avaliar a percepção da atratividade facial em imagens digitais de perfil no plano sagital e vertical. Método: Foram avaliados perfis faciais de 80 pacientes (20 Classe II, 20 Classe III, 20 mordida aberta e 20 mordida profunda), pertencentes ao sexo masculino e ao feminino. As radiografias cefalométricas de todos os indivíduos foram digitalizadas e sistematicamente alteradas em relação à localização da mandíbula e da maxila no plano sagital e vertical, usando o software Dolphin Imaging (versão 10.0). Cinco imagens de perfil, manipuladas em conjunto com o perfil dos próprios pacientes, foram apresentadas aos avaliadores, incluindo leigos, ortodontistas e cirurgiões. A atratividade facial das imagens de perfil foram avaliadas através de uma escala visual analógica. Os dados foram analisados pelo teste de Kruskal Wallis e Mann Whitney. Resultados: Os perfis faciais mais atrativos foram os de imagens normais, em ambos os grupos de pacientes, sendo considerado por todos os avaliadores perfis faciais graves os casos de Classe III. Tanto as imagens de pacientes graves Classe II e Classe III, como os perfis faciais de mordida aberta e mordida profunda, foram classificados como menos atraentes. Não foram encontradas diferenças significativas na classificação geral de imagens de perfil masculino e feminino entre avaliadores do sexo feminino e masculino. Conclusão: A atratividade do perfil diminuiu na medida em que maiores eram os desvios das proporções do perfil normal e opiniões mais divergentes foram emitidas pelos avaliadores. Especialistas podem usar os resultados da percepção da beleza pelos leigos para modificar os tratamentos e, consequentemente, aumentar a satisfação dos pacientes.

Introducing of the Novel Midsagittal Line for Diagnosis of Craniofacial Asymmetry With P. A Cephalometry Radiography / Introdução de uma Nova Linha Média Sagital para Diagnóstico de AssimetriaCraniofacial com Radiografia Cefalométrica P.A.

Objetivo: Determinação da linha de referência sagital mediana (LRSM), para avaliação de assimetrias craniofaciais, traçando uma linha paralela da crista galli à linha vertical verdadeira, em cefalometria PA, utilizando a técnica da posição natural da cabeça (PNC).Metodologia: 60 indivíduos (30 homens e 30 mulheres, com idade variando de 9 a 13 anos, de uma população iraniana), com oclusão normal Classe I sem história de tratamento ortodôntico ou cirurgia mandibular, foram selecionados no Departamento de Ortodontia, Universidade de Shahid Beheshti, MC Faculdade de Odontologia, Teerã, Irã, 2009-2010. Os pacientes não portavam supranumerários ou ausência dentária, nem anormalidade esquelética. Radiografias cefelométricas PA foram obtidas para todas as amostras pela técnica da posição natural da cabeça (PNC). A linha sagital mediana também foitraçada paralelamente da corrente pendurada à referência intracraniana selecionada (crista galli). Esta linha é a linha vertical verdadeira. A linha horizontal verdadeira foi traçada perpendicularmente à corrente pendurada da crista galli (Cg). Mensurou-se a assimetria craniofacial com medições linear, angular e trigonométrica por meio de radiografias cefalométricas PA pela técnica da posição natural da cabeça (PNC), usando as verdadeiras linhas vertical e horizontal. As diferenças médias entre as medidas acima nos lados direito e esquerdo foram analisadas pelo teste t.Resultados: Cada variável foi avaliada independentemente; os valores da média e desvio padrão foram calculados separadamente. Ademais, relações transversais foram preparadas na nossa amostra (faixa etária de 9 a 13 anos). Todos os pacientes eram descendentes iranianos.

Para a validação da linha media sagital (LMS), foi medida a distância entre a espinha nasal anterior (ENA) e o Mento (Me).Conclusão: Os achados deste estudo evidenciam que a cefalometria PA com a técnica da posição natural da cabeça (PNC) pode medir a assimetria facial com o nível de 96% de intervalo de confiança. Contudo, a introdução da linha média sagital pelo uso da técnica da posição natural da cabeça (PNC) poderia fornecer a capacidade de diagnosticar assimetrias faciais

Objective: Determination of midsagittal reference line (MSL) for craniofacial asymmetries assessment by drawing a line from crista gali parallel to true vertical line in PA cephalometry , using NHP technique. Method: 60 samples (30 males and 30 females, within the age range of 9-13 years old Iranian population) were selected with normal Class I occlusion without any history of orthodontic or jaw surgery treatments in Department of Orthodontics, Shahid Beheshti University, Tehran. Iran, 2009-2010. Patients had no supernumerary or missing teeth and any skeletal anomaly. PA cephalometry radiographs were taken from all samples with NHP technique. The midsagittal line was also traced parallel to the hanging chain from our selected intracranial reference point (Crista gali). This line is a true vertical line. True horizontal line traced perpendicular to the hanging chain from Crista gali (Cg). We assessed craniofacial symmetry with linear, angular and trigonometrical measurements in PA cephalometric radiographs by NHP technique, using true vertical and horizontal lines. The mean differences of above measurements in left and right sides were analyzed by T- test.Results: Each variable was measured independently; then the mean values and S.D was calculated separately. Also, transverse ratios were prepared in our samples (age range of 9-13 years). All patients were from Iranian decent. For midsagittal line (MSL) validity, the ANS (Anterior Nasal Spine) distance in the middle third and Me (Menton) distance in lower third from MSL was measured.Conclusion: Findings of this study showed that P.A.cephalometry with NHP technique could assess the facial symmetry with the rate 96% confidence interval. Therefore, the introduced midsagittal line by using NHP Technique, could prove the ability for diagnosis of facial asymmetries

Comparação Entre os Prognósticos do Planejamento Cirúrgico Manual ou porSoftware em Cirurgia Ortognática / Comparison between manual and software surgical planning predictions in orthognathic surgery

Objetivo: Avaliar comparativamente o prognostico do planejamento cirurgico por software com o metodo manual. Metodo: Radiografias laterais cefalometricas e modelos de estudo pre e pos-cirurgia de vinte pacientes Classe III (12 mulheres e 8 homens, media de idade: 22,5 ± 2,3) que tinham se submetidos a cirurgia no Departamento de Ortodontia. Para o planejamento manual, com combinacao de oclusogramas pre e pos-cirurgia com radiografias cefalometricas laterais de cada paciente, foram feitas analises tridimensionais. Prognosticos da movimentacao esqueletica foram elaborados. Em seguida, mensurou-se tridimensionalmente a movimentacao esqueletica. Quinze variaveis angulares e lineares foram avaliadas e os resultados analisados estatisticamente. Para cada paciente, o prognostico manual e por software antes e apos a cirurgia foram comparados entre si. O teste t pareado foi usado para verificar possiveis diferencas (p<0,05). Resultados: Nao foram observadas diferencas entre os metodos. Conclusao: O Software Dolphin Imaging (versao 10) tem boa acuracia para a predicao do resultado pre e pos-cirurgico de cirurgias ortognaticas.

Objective: To evaluate the proximity of computer imaging soft ware surgical planning prediction methods, with standard manual methods. Method: Lateral cephalometry radiographs and study cast records of pre and post surgery of twenty longface Cl III patients (12 Females and 8 Males, mean age: 22.5 ± 2.3), that had been undergone surgery in Department of Orthodontics. For manual prediction, with combination of pre and post surgical occlusograms with lateral cephalometric radiograph tracings of each samples, three dimensional analysis was done. Predictions of skeletal movement with tacing overlay method, has prepared. Finally, measured the rate of skeletal movements at in three dimensional of spaces. Fifteen angular and linear variables were measured, and the results, analyzed using the statistical soft ware statistics. For each patient, the manual and computer soft ware prediction before and after surgery were compared with each other. The paired t-test was used to evaluate possible differences between manual and computer soft ware prediction (p<0.05). Results: The difference of the variables of the soft ware prediction in the pre and postsurgical stages in comparison with standard manual prediction method was insignificant. Conclusion: Dolphin Imaging software (version 10.0) has a good accuracy for prediction of pre and postsurgical outcome of orthognathic samples.

Comparison between manual and software surgical planning predictions in orthognathic surgery / Comparação entre os prognósticos do planejamento cirúrgico manual ou porSoftware em cirurgia ortognótica

Objetivo: Avaliar comparativamente o prognostico do planejamento cirurgico por software com o metodo manual. Metodo: Radiografias laterais cefalometricas e modelos de estudo pre e pos-cirurgia de vinte pacientes Classe III (12 mulheres e 8 homens, media de idade: 22,5 ñ 2,3) que tinham se submetidos a cirurgia no Departamento de Ortodontia. Para o planejamento manual, com combinacao de oclusogramas pre e pos-cirurgia com radiografias cefalometricas laterais de cada paciente, foram feitas analises tridimensionais. Prognosticos da movimentacao esqueletica foram elaborados. Em seguida, mensurou-se tridimensionalmente a movimentacao esqueletica. Quinze variaveis angulares e lineares foram avaliadas e os resultados analisados estatisticamente. Para cada paciente, o prognostico manual e por software antes e apos a cirurgia foram comparados entre si. O teste t pareado foi usado para verificar possiveis diferencas (p<0,05). Resultados: Nao foram observadas diferencas entre os metodos. Conclusao: O Software Dolphin Imaging (versao 10) tem boa acuracia para a predicao do resultado pre e pos-cirurgico de cirurgias ortognaticas.

Objective: To evaluate the proximity of computer imaging soft ware surgical planning prediction methods, with standard manual methods. Method: Lateral cephalometry radiographs and study cast records of pre and post surgery of twenty longface Cl III patients (12 Females and 8 Males, mean age: 22.5 ñ 2.3), that had been undergone surgery in Department of Orthodontics. For manual prediction, with combination of pre and post surgical occlusograms with lateral cephalometric radiograph tracings of each samples, three dimensional analysis was done. Predictions of skeletal movement with tacing overlay method, has prepared. Finally, measured the rate of skeletal movements at in three dimensional of spaces. Fifteen angular and linear variables were measured, and the results, analyzed using the statistical soft ware statistics. For each patient, the manual and computer soft ware prediction before and after surgery were compared with each other. The paired t-test was used to evaluate possible differences between manual and computer soft ware prediction (p<0.05). Results: The difference of the variables of the soft ware prediction in the pre and postsurgical stages in comparison with standard manual prediction method was insignificant. Conclusion: Dolphin Imaging software (version 10.0) has a good accuracy for prediction of pre and postsurgical outcome of orthognathic samples.