Predicting malignant potential of solitary pulmonary nodules in patients with COVID-19 infection: a comprehensive analysis of CT imaging and tumor markers.

OBJECTIVE: To analyze the value of combining computed tomography (CT) with serum tumor markers in the differential diagnosis of benign and malignant solitary pulmonary nodules (SPNs). METHODS: The case data of 267 patients diagnosed with SPNs in the First Affiliated Hospital of Zhengzhou University from March 2020 to January 2023 were retrospectively analyzed. All individuals diagnosed with coronavirus disease 2019 (COVID-19) were confirmed via respiratory specimen viral nucleic acid testing. The included cases underwent CT, serum tumor marker testing and pathological examination. The diagnostic efficacy and clinical significance of CT, serum tumor marker testing and a combined test in identifying benign and malignant SPNs were analyzed using pathological histological findings as the gold standard. Finally, a nomogram mathematical model was established to predict the malignant probability of SPNs. RESULTS: Of the 267 patients with SPNs, 91 patients were not afflicted with COVID-19, 36 exhibited malignant characteristics, whereas 55 demonstrated benign features. Conversely, within the cohort of 176 COVID-19 patients presenting with SPNs, 62 were identified as having malignant SPNs, and the remaining 114 were diagnosed with benign SPNs. CT scans revealed statistically significant differences between the benign and malignant SPNs groups in terms of CT values (P<0.001), maximum nodule diameter (P<0.001), vascular convergence sign (P<0.001), vacuole sign (P = 0.0007), air bronchogram sign (P = 0.0005), and lobulation sign (P = 0.0005). Malignant SPNs were associated with significantly higher levels of carcinoembryonic antigen (CEA) and neuron-specific enolase (NSE) compared to benign SPNs (P < 0.05), while no significant difference was found in carbohydrate antigen 125 (CA125) levels (P = 0.054 for non-COVID-19; P = 0.072 for COVID-19). The sensitivity (95.83%), specificity (95.32%), and accuracy (95.51%) of the comprehensive diagnosis combining serum tumor markers and CT were significantly higher than those of CT alone (70.45%, 79.89%, 76.78%) or serum tumor marker testing alone (56.52%, 73.71%, 67.79%) (P < 0.05). A visual nomogram predictive model for malignant pulmonary nodules was constructed. CONCLUSION: Combining CT with testing for CEA, CA125, and NSE levels offers high diagnostic accuracy and sensitivity, enables precise differentiation between benign and malignant nodules, particularly in the context of COVID-19, thereby reducing the risk of unnecessary surgical interventions.

Solitary Experience and Problematic Social Media Use Among Young Adults: A Systematic Review with Recommendations for Future Research.

Objective: This study was conducted to summarize existing studies on the association between solitary experiences and problematic social media use (PSMU) among young adults. Method: A systematic review was performed according to the PRISMA guidelines, implemented in Scopus, Web of Science, PubMed and PsycINFO. We selected studies if they presented original data, assessed solitary experiences and PSMU in young adults (i.e., 18-30 age range), were published in peer reviewed journals between 2004 and 2023, and were written in English. Results: After duplicate removal, 1,841 eligible studies were found. From these, 12 articles were selected, encompassing 4,009 participants. Most studies showed a positive association between general loneliness and PSMU. Some of these suggested that this relationship varies based on the facets of loneliness, other potential variables, and the type of social media. No mediating factors were found. Few studies assessed solitary experiences other than general loneliness, highlighting the need for a multidimensional perspective on solitary experience in investigating PSMU. Conclusions: Implications and future research orientations are discussed.

Immunological Tumor Microenvironment of Solitary Fibrous Tumors-Associating Immune Infiltrate with Variables of Prognostic Significance.

BACKGROUND AND OBJECTIVES: Solitary fibrous tumors (SFTs) are morphologically heterogeneous tumors characterized by the NAB2::STAT6 gene fusion. Clinical outcomes may vary widely, and while most cases have favorable outcomes, some can progress to aggressive disease, manifesting as recurrence and metastasis, and ultimately resulting in patient death. Herein, we analyze the immunological tumor microenvironment (ITME) of SFTs, aiming to determine its prognostic value and correlation with established risk stratification systems (RSSs). METHODS: A retrospective observational multicenter study of 52 fusion-confirmed SFTs with clinical follow-up data. Immunohistochemical analysis including CD163, CD68, CD3, CD8, CD20, PDL-1, PD-1, and LAG1 were evaluated in tissue microarrays, using an analog scale with scores ranging from 0 to 3 (0 = ≤9, 1 = 10-49, 2 = 50-99, and 3 = >100 positive cells per 10 high-power fields). The expression of these markers was correlated with clinical outcomes, morphological characteristics previously evaluated in whole slide tissue sections (hypercellularity/hypocellularity, round-oval or spindle dominant constituent cell (DCC) morphology, and necrosis), Ki67, overall survival, and RSS. RESULTS: Only one of the fifty-two cases studied showed progression. In the multivariate analysis, neither the presence nor absence of immune cells (B-lymphocytes, T-lymphocytes, and macrophages) showed any association with the assessed RSSs (Demicco, Sugita, G-score, and Huang). Interestingly, the case that showed progression had high immune infiltrate with expression of CD68, CD163, CD8, and CD20 markers (score of 3). Round-oval cell morphology was associated with the presence of higher levels of CD163 macrophages. Lastly, the scant presence of CD20+ lymphocytes correlated with less necrosis, and cases with higher PDL-1 expression correlated with increased Ki67 values. All cases were negative for LAG-1 and PD-1. CONCLUSIONS: SFT ITME components correlated with independent variables with prognostic significance. Nevertheless, ITME did not correlate with RSS scores.

Case Report of Concomitant Diagnosis of Locally Advanced Intrahepatic Cholangiocarcinoma and Solitary Plasmacytoma of T11 Vertebra: Impact on Diagnostic and Clinical Management.

A solitary bone plasmacytoma is a rare tumor. Intrahepatic cholangiocarcinoma is the second most common primary liver cancer after hepatocellular carcinoma. We present the case of a 48-year-old female patient who consulted for recent back pain, with a final diagnosis of T10 solitary plasmacytoma and synchronous intrahepatic cholangiocarcinoma. Imaging suggested cholangiocarcinoma with bone metastasis. The patient underwent neurosurgical management with laminectomy, arthrodesis, and arthrectomy, with biopsies revealing monotypic kappa plasmacytic proliferation. Liver biopsies revealed an adenocarcinoma with expression of cytokeratin 19, cytokeratin 7, N-cadherin, and high expression of carbonic anydrase IX. The plasmacytoma was treated with external radiotherapy. The cholangiocarcinoma was treated with selective internal radiation therapy and concomitant systemic treatment with combinations of cisplatin and durvalumab, with capecitabine during radiotherapy, switched for gemcitabine after completion of irradiation. One year after initial management, imaging revealed a partial metabolic response of the intrahepatic cholangiocarcinoma, and a complete metabolic response of the plasmacytoma. This case illustrates the importance of not ignoring two primary tumors and the management of two concomitant treatments exploiting potential therapeutic synergies and limiting expected toxicities.

Extreme Latent Solitary Lung Metastasis of Endometrial Carcinoma 23 Years Following Radical Treatment: A Case Report.

Female genital tract tumors are an infrequent cause of secondary pulmonary metastases. Endometrial carcinoma (EC) has a propensity to cause metachronous lung metastasis with an average three-year interval of the radical treatment for EC. We present the case of a patient with hemoptysis who had an isolated right middle lobe lung metastatic adenocarcinoma of the endometrium 23 years following radical hysterectomy for International Federation of Gynecology and Obstetrics (FIGO) stage 1 EC.

A case of robotic distal pancreatectomy for solitary fibrous tumor of the pancreas.

Solitary fibrous tumor (SFT) is a spindle cell tumor driven by the NAB2-STAT6 fusion gene. While it can originate from any soft tissue, primary SFT of the pancreas is rare with limited reports. A 36-year-old man came to our department due to abdominal pain. Computed tomography revealed a circular mass with weak peripheral enhancement and an internal cyst in the pancreatic tail. Diagnosis was not confirmed through endoscopic ultrasound-guided biopsy, and differential diagnoses included acinar cell carcinoma and pancreatic neuroendocrine tumor. A robotic distal pancreatectomy with splenectomy was performed, and the patient was discharged 11 days postoperatively. Histopathological examination showed an irregular arrangement of spindle cells, and immunohistochemical staining was positive for CD34 and STAT6, confirming an SFT diagnosis with low metastatic risk. Robotic surgery effectively managed this tumor.

Orbital solitary fibrous tumor.

INTRODUCTION: Solitary fibrous tumor (SFT) is a rare borderline mesenchymal tumor typically arising in the pleura and involving the orbit as its most common extra-pleural location. CASE DESCRIPTION: We herein describe two cases of orbital SFT arising in both a 69-year-old woman presenting with progressive proptosis of the left eye and a 49-year-old woman presenting with binocular diplopia. The diagnoses relied on histopathological analysis of biopsy samples. Because of the poor local prognosis, we decided to perform an orbital exenteration in the first case. In the second case, a complete resection surgery was performed. CONCLUSION: SFT presents classics histological features and immunohistochemical markers that are essential to the diagnosis. SFT is classified as a benign tumor, but in some cases, it can show aggressive behavior with the potential for local tissue invasion and, more scarcely, distant metastasis. This is why complete resection remains the treatment of choice for SFT.

Bimodal distribution of inter-individual distance in free-ranging narrow-ridged finless porpoises.

Inter-individual distance (IID) is an important indicator of social organisation because solitary species are spatially intolerant towards conspecifics, whereas group-living species are usually gregarious with collective behaviour. Therefore, by examining the relationship between the distribution of IIDs and the active space of cues or signals, and behaviours, we can predict their social organisation. The narrow-ridged finless porpoises (NRFPs) have been described as a solitary species; however, recent studies described NRFPs tend to live in groups more than alone. To resolve the inconsistency, the present study investigated IIDs, the active spaces of sounds, and behaviours. The distribution of IIDs measured using drone was classified into three distributions. The close and intermediate distributions were significantly shorter than the distribution predicted by the angle of drone camera, whereas the far distributions were not. The far distributions were thus a random distribution within the limited angle of the camera. The close distributions were shorter than the active space, exhibiting a high proportion of collective behaviours, while intermediate distributions did not. These results suggest that NRFPs have both solitary- and group-living characteristics. Specifically, the intermediate distribution suggests a solitary aspect to maintain IIDs from others, while the close distribution indicates a group-living aspect with social interactions.

The Kir channel in the nucleus tractus solitarius integrates the chemosensory system with REM sleep executive machinery for homeostatic balance.

The locus coeruleus (LC), nucleus tractus solitarius (NTS), and retrotrapezoid nucleus (RTN) are critical chemosensory regions in the brainstem. In the LC, acid-sensing ion channels and proton pumps serve as H+ sensors and facilitate the transition from non-rapid eye movement (NREM) to rapid eye movement (REM) sleep. Interestingly, the potassium inward rectifier (KIR) channels in the LC, NTS, and RTN also act as H+-sensors and are a primary target for improving sleep in obstructive sleep apnea and Rett syndrome patients. However, the role of Kir channels in NREM to REM sleep transition for H+ homeostasis is not known. Male Wistar rats were surgically prepared for chronic sleep-wake recording and drug delivery into the LC, NTS, and RTN. In different animal cohorts, microinjections of the Kir channel inhibitor, barium chloride (BaCl2), at concentrations of 1 mM (low dose) and 2 mM (high dose) in the LC and RTN significantly increased wakefulness and decreased NREM sleep. However, BaCl2 microinjection into the LC notably reduced REM sleep, whereas it didn't change in the RTN-injected group. Interestingly, BaCl2 microinjections into the NTS significantly decreased wakefulness and increased the percent amount of NREM and REM sleep. Additionally, with the infusion of BaCl2 into the NTS, the mean REM sleep episode numbers significantly increased, but the length of the REM sleep episode didn't change. These findings suggest that the Kir channels in the NTS, but not in the LC and RTN, modulate state transition from NREM to REM sleep.

Uncommon Presentation of Solitary Plasmacytoma in the Nasal Cavity: Diagnostic and Therapeutic Challenges.

Extramedullary solitary plasmacytoma (SP) is an uncommon tumor and is even rare in the head and neck locations. Here, we report the case of an 82-year-old man admitted to our department for the management of nasal cavity SP. Radiological investigation showed a locally advanced tumor making the patient a non-candidate for surgery. The patient had undergone radiotherapy alone to a total dose of 50 Gy, with 2 Gy per fraction five days a week. After a follow-up of nine months, the tumor recurred, and the patient was managed in the internal medicine department. He received palliative chemotherapy with the cyclophosphamide, dexamethasone, and thalidomide protocol which resulted in a good response. This case illustrates the diagnostic challenges and treatment complexities of SP, particularly in rare locations such as the nasal cavity.

Case report: A rare case of malignant solitary fibrous tumor in an adult with an epithelioid pattern in the occipital region.

We illustrated a rare case of malignant solitary fibrous tumor (MSFT) with epithelioid morphology in the occipital region of a 59-year-old female, in which a rare NAB2ex7-STAT6 exon15/16 double fusion subtype was detected by the Next-generation sequencing (NGS) and STAT6 immunohistochemistry (IHC) was diffusely and strongly positively expressed, without recurrence after 20 months of postoperative follow-up. The morphological and molecular genetic aspects and the differential diagnosis are described, and the relevant literature was assessed in order to broaden our understanding and diagnostic capability of this malignancy.

A Case of Solitary Amyloid Lung Nodule Treated With Surgery.

Primary or light-chain (AL) (lambda) amyloidosis is a rare systemic disorder that is characterized by the misfolding of autologous proteins and the extracellular deposition of abnormally folded proteins composed of immunoglobulin light chains, often caused by plasma cell dyscrasias. We present a unique case of a 57-year-old female with multiple comorbidities, including extensive smoking history and chronic kidney disease, who was incidentally discovered to have a left upper lobe lung nodule on a chest X-ray prompted by complaints of shortness of breath. The patient underwent biopsy of the lung nodule, and by utilizing the gold standard diagnostic technique of a Congo red stain, positive test results confirmed the diagnosis of AL amyloidosis. However, additional investigations, including bone marrow and fat pad biopsies, were negative for plasma cell dyscrasias. The patient subsequently underwent a wedge resection of the nodule, and a follow-up positron emission tomography-computed tomography (PET-CT) scan showed only post-surgical changes in the left upper lobe of the lung without evidence of disease progression or systemic involvement. Given the asymptomatic and multisystem symptomology of most cases, treatment options for AL amyloidosis are individualized. This case discusses pulmonary nodular AL amyloidosis and highlights the diagnostic and treatment options for this disorder.

[Solitary fibrous tumor in a thyroid follicular adenoma]. / Solitär fibröser Tumor in einem follikulären Adenom der Schilddrüse.

A 28-year-old female patient developed a 5.5 cm progressive thyroid nodule that was surgically removed due to local symptoms. Histologically, a solitary fibrous tumor (SFT) in a thyroid adenoma was diagnosed. The tumor had a specific NAB2-STAT6 fusion.Solitary fibrous tumors rarely occur in the thyroid gland and are described as both primary and secondary manifestations. The diagnosis, prognosis assessment and treatment decision are carried out analogously to SFT of other localizations.

Arthroscopic Excision of a Solitary Intra-articular Osteochondroma Manifesting as a Loose Body: A Presentation of an Extremely Rare Medical Condition.

Osteochondroma typically has extra-articular growths at the metaphysis. Intra-articular osteochondroma is extremely uncommon. We report a case of a 55-year-old woman who had been experiencing right knee pain for the past 12 months. An arthroscopy revealed a medial meniscus tear with a loose body in the right knee. It was removed arthroscopically. Histopathology identified it as an osteochondroma. Therefore, intra-articular osteochondroma can be regarded as an uncommon cause of loose bodies in adult patients.

A case of lumbar spinal solitary fibrous tumor or hemangiopericytomas.

Background: Solitary fibrous tumors (SFTs) account for 3.7% of all soft-tissue sarcomas, with an annual incidence of 0.35/100,000 individuals. Notably, although 20% involve the central nervous system, only one in 10 occurs in the spine versus the brain. Case Description: A 46-year-old female presented with 18 months of left lower extremity sciatica. On examination, she had a 60° limitation of straight leg raising but was otherwise neurologically intact. The lumbar magnetic resonance revealed a dumbbell tumor at the L4-L5 level filing the canal, causing cauda equina compression and extending into the left L45 foramen. The patient successfully underwent a L4 left hemi-laminectomy for tumor resection. The postoperative World Health Organization (WHO) histopathology was consistent with a SFT/WHO Grade I hemangiopericytoma (HPC). Conclusion: A 46-year-old female with a lumbar L4 SFT with the left L45 foraminal extension successfully underwent a left hemilaminectomy for GTR of an SFT/WHO Grade I HPC.

Solitary fibrous tumor: A case report of this multifaceted tumor.

BACKGROUND: Solitary fibrous tumor (SFT) is a remarkably uncommon mesenchymal tumor. STAT6 level and a combination of clinical, pathological, and molecular features are required to arrive at a proper diagnosis. CASE SUMMARY: In this report, we present an intriguing case involving a 43-year-old woman who initially exhibited symptoms of a bleeding retroperitoneal tumor, initially resembling a gastrointestinal stromal tumor, but later confirmed as an SFT. However, a year later, what was initially believed to be a recurrence of her SFT was instead identified as a desmoid tumor. CONCLUSION: Distinguishing SFT from other tumors was pivotal. Correcting misdiagnoses of tumor type initially and of recurrence later was necessary for appropriate treatment of the correct desmoid type.

Solitary Fibrous Tumors: A Rare Tumor Arising from Ubiquitous Anatomical Locations.

Solitary Fibrous Tumors (SFTs) are uncommon mesenchymal tumors of fibroblastic/myofibroblastic origin that stem from various anatomical sites. Most SFTs are asymptomatic and noticed incidentally by various imaging modalities. Although SFTs were initially identified in the pleura and erroneously considered to originate solely from serosal layers, extrapleural SFTs have been reported more commonly than their pleural counterparts. Imaging features are similar in different anatomical locations and are mainly related to the tumor's size and collagen content, characteristically displaying low signal intensity on Magnetic Resonance Imaging (MRI). Smaller tumors typically exhibit uniform enhancement, yet necrotic regions may become evident as the tumor size increases, resulting in heterogeneous enhancement. Less than 30% of SFTs demonstrate unfavorable clinical outcomes regardless of their histological features, warranting surgery as the preferred treatment with long-term follow-up. In this article, we have reviewed the clinical manifestations and imaging features of SFTs, discussed their differential diagnosis based on anatomical site, and provided diagnostic pearls.

Total En Bloc Spondylectomy in a Case of Solitary Metastatic Breast Carcinoma With Intact Neurology: A Case Report.

The management of spinal metastasis varies from patient to patient, depending on the type of lesion, stage of the disease, extension into the spinal canal, associated fractures, and life expectancy. We present a case of solitary metastasis with intact neurology in a 48-year-old lady who underwent a radical mastectomy for T2 N3 M0 breast carcinoma 34 months ago. Total en bloc spondylectomy in a neurologically intact patient is a challenging one. In all posterior approaches, there is a high chance of postoperative neurodeficiency. In our case, a combined approach seems to be a much safer procedure with easy accessibility to remove the total D8 vertebra.

SolBeePopecotox: A Population Model for Pesticide Risk Assessments of Solitary Bees.

In agricultural landscapes, solitary bees occur in a large diversity of species and are important for crop and wildflower pollination. They are distinguished from honey bees and bumble bees by their solitary lifestyle as well as different nesting strategies, phenologies, and floral preferences. Their ecological traits and presence in agricultural landscapes imply potential exposure to pesticides and suggest a need to conduct ecological risk assessments for solitary bees. However, assessing risks to the large diversity of managed and wild bees across landscapes and regions poses a formidable challenge. Population models provide tools to estimate potential population-level effects of pesticide exposures, can support field study design and interpretation, and can be applied to expand study data to untested conditions. We present a population model for solitary bees, SolBeePopecotox, developed for use in the context of ecological risk assessments. The trait-based model extends a previous version with the explicit representation of exposures to pesticides from relevant routes. Effects are implemented in the model using a simplified toxicokinetic-toxicodynamic model, BeeGUTS (GUTS = generalized unified threshold model for survival), adapted specifically for bees. We evaluated the model with data from semifield studies conducted with the red mason bee, Osmia bicornis, in which bees were foraging in tunnels over control and insecticide-treated oilseed rape fields. We extended the simulations to capture hypothetical semifield studies with two soil-nesting species, Nomia melanderi and Eucera pruinosa, which are difficult to test in empirical studies. The model provides a versatile tool for higher-tier risk assessments, for instance, to estimate effects of potential exposures, expanding available study data to untested species, environmental conditions, or exposure scenarios. Environ Toxicol Chem 2024;00:1-17. © 2024 SETAC.

Renal Solitary Fibrous Tumor With Müllerian Cysts: A Novel Differential Diagnosis for Biphasic Renal Neoplasms.

Solitary fibrous tumor is an uncommon mesenchymal neoplasm, initially described in the pleura and infrequently found in the kidney. It is characterized by haphazardly arranged spindle cells, staghorn vasculature, coexpression of CD34 and signal transducer and activator of transcription 6 (STAT6), and a NAB2::STAT6 gene fusion. We report a 64-year-old woman who presented with a 2.5 cm multilocular cystic renal mass. On microscopic examination, the tumor consisted of a spindle cell component closely intermingled with ciliated and hemorrhagic epithelial cysts. The spindle cell component was positive for CD34, B-cell lymphoma 2 (BCL2), and STAT6, confirming the diagnosis of a solitary fibrous tumor. The epithelial cysts expressed keratin 7, PAX8, BCL2, estrogen receptor 1, and progesterone receptor, indicative of Müllerian cysts. The occurrence of solitary fibrous tumor in the kidney is extremely rare, and its association with Müllerian cysts has not been previously reported in the kidney. This morphologic variant has a striking similarity with biphasic renal neoplasms, especially with mixed epithelial and stromal tumors and angiomyolipoma with epithelial cysts. This report describes a novel renal solitary fibrous tumor subtype within this differential and underscores clinical and pathological distinctions of biphasic renal neoplasms.