Comparison of liquid-based cytology and cell blocks prepared from cell remnants for diagnosis of cervical pathology.

BACKGROUND: Cervical cancer is a global public health problem with high mortality. Advances in screening programs for cervical cancer are considered key to eliminate cervical cancer. We aimed to examine the contribution of cell block analysis to the detection of epithelial cell abnormalities in cervical smear samples. METHODS: A total of 559 patients with suspected cervical pathology were examined, and their samples were analyzed by both liquid-based cytology (LBC) and cell blocks. The biopsy results of 149 out of the 559 patients were obtained. RESULTS: Of the 50 patients who were identified as HSIL by biopsy, only 12 were diagnosed as HSIL by the LBC method, 22 as LSIL, 12 as ASCUS, and 4 as ASC-H (p < 0.001). With the cell block analysis, results for these patients were: 20 HSIL, 17 LSIL, 7 NILM, 4 'unsatisfactory', and 2 ASC cases (p < 0.001). LBC detected only 1 of the 10 patients with biopsy-diagnosed tumors, while 7 of these were defined as HSIL, 1 as ASCUS and 1 as AGC. The results of cell block analysis in patients with biopsy-diagnosed tumors were as follows: 7 HSIL, 1 tumor, 1 ASC and 1 LSIL. CONCLUSIONS: Cell block analysis might be superior to LBC in terms of diagnostic accuracy in cervical pathologies, particularly in the detection of HSIL. However, both methods were similarly poor in diagnosing tumors. Cell blocks may improve diagnostic accuracy and can be a complementary method to LBC, while having the advantage of revealing histological architecture.

Non-random adenomatoid tumours of the female genital system: A comparative clinicopathologic analysis of 14 cases.

The aim of this study was to evaluate adenomatoid tumours (AT) clinicopathologically in the female genital tract and compare the histomorphological features of ATs according to their uterine or tuba-ovarian location. Cases of AT were excised and collected from female genital tracts between the years of 2010-2017. Cases were evaluated depending on their clinical findings, localisation and pathological properties. There were 14 cases of AT. Ten cases were uterine, and 4 cases were adnexal tumours. The diagnostic ratio of uterine ATs was 64.3%, and of tuba-ovarian ATs was 21.4% (P > 0.05). The size of the largest tumour was 6 cm. Two of the uterine and one of the ovarian cases had a macrocyst; 2 uterine and one ovarian case had a microcyst; and 6 uterine had a combined microcystic/trabecular pattern. Uterine cases showed a higher number of smooth muscle component, signet-ring cells and infiltrative nature compared with other cases (P < 0.05). All uterine cases were infiltrative. Most of ATs of the female genital system were small in size and incidentally diagnosed in our cases but rarely detected as an adnexal mass forming lesion which mimics a malignancy. A comparative clinicopathologic analysis of these cases should be considered with the histomorphological and immunohistochemical features for an accurate differential diagnosis.

Aortic valve replacement for papillary fibroelastoma.

Surgery is indicated for symptomatic patients with papillary fibroelastomas (PFE) on the aortic valve. The valve is commonly spared during tumor excision. Rarely, aortic valve replacement (AVR) is needed. We present a case requiring AVR for an aortic valve PFE and review the literature to determine the risk factors for failure of aortic valve-sparing techniques in patients with PFE.

Use of Adipose-Derived Mesenchymal Stem Cells to Increase Viability of Composite Grafts.

OBJECTIVE: Chondrocutaneous composite grafts figure among the reconstruction alternatives for alar rim defects resulting from tumor resection and trauma. The major problem with composite grafts is the limited graft survival area. In the present study, the authors aimed to increase the survival area of composite grafts by utilizing the ability of stem cells to promote neovascularization which is crucial in composite graft viability. METHODS: The study included 36 adult Wistar Albino rats, which were allocated to 6 groups. Groups 1, 2, and 3 were the groups in which the grafts were implanted immediately after the defect was formed, and Groups 4, 5, and 6 were those in which grafts were adapted 4 days after the defect was formed. Composite grafts of 1 × 1 cm containing both the cartilage and the skin were prepared from 1 ear, and after forming punctures and incisions on the cartilage, the grafts were adapted to the 1 × 1 cm defects on the back. The backs of the rats in groups 1 and 4 were injected with adipose-derived stem cell (ADSC), those in groups 2 and 5 with medium solution, while the rats in Groups 3 and 6 did not receive any injection. The procedures were followed by histopathological and scintigraphic evaluations. RESULTS: An evaluation of the statistical results showed that composite graft survival areas of the group treated with stem cells increased significantly, in comparison with control and medium groups. When scintigraphic evaluations were considered, it was seen that the group treated with stem cells had significantly higher radioactive substance retention than the control group. Histopathological examination demonstrated that microscopic survival rates in the stem cell group were higher than those in the control group. Green fluorescent protein (GFP) was used in the experiment to tag adipose tissue-derived stem cells. Immunofluorescence staining studies showed less apoptosis and fewer GFP (+) stem cells in the composite grafts of the stem cell group. However, apoptosis was more severe in the control and medium groups which also had decreased vascularity in the graft. DISCUSSION: As the authors have shown in the present study, ADSCs have favorable effects on the viability of composite grafts. They have increased the survival rate of the grafts to a considerable extent. As a clinical implication of this experimental study, the authors think that in the patient of auricular and nasal defects involving the cartilage and the skin, injection of the ADSC and the adaptation of composite grafts 4 days after the preparation of the receiving bed may increase the composite graft viability rates. Thus, it has been found that if the composite grafts are implanted 4 days after stem cell injection, the injection of adipose tissue-derived mesenchymal stem cells is useful in enhancing the survival of composite grafts.

Use of Adipose-Derived Mesenchymal Stem Cells to Accelerate Neovascularization in Interpolation Flaps.

OBJECTIVE: Interpolation flaps are commonly used in plastic surgery to cover wide and deep defects. The need to, wait for 2 to 3 weeks until the division of the pedicle still, however, poses a serious challenge, not only extending treatment and hospital stay, but also increasing hospital expenses. To solve this problem, we have aimed to use the angiogenic potential of stem cells to selectively accelerate neovascularization with a view to increasing the viability of interpolation flaps and achieving early pedicle removal. MATERIALS AND METHODS: A total of 32 rats were allocated to 2 groups as control (N = 16) and experiment (N = 16). The cranial flaps 6 × 5 cm in size located on the back of the rats were raised. Then, a total suspension containing 3 × 10(6) adipose-derived mesenchymal stem cells (ADSC) tagged with a green fluorescent protein (GFP) was injected diffusely into the distal part of the flap, receiving bed, and wound edges. In the control group, only a medium solution was injected into the same sites. After covering the 3 × 5 cm region in the proximal part of the area where the flap was removed, the distal part of the flap was adapted to the uncovered distal area. The pedicles of 4 rats in each group were divided on postoperative days 5, 8, 11, and 14. The areas were photographed 7 days after the pedicles were released. The photographs were processed using Adobe Acrobat 9 Pro software (San Jose, CA) to measure the flap survival area in millimeters and to compare groups. Seven days after the flap pedicle was divided, the rats were injected with 250 mCi Tc-99 mm (methoxy-isobutyl-isonitrie) from the penile vein, and scintigraphic images were obtained. The images obtained from each group were subjected to a numerical evaluation, which was then used in the comparison between groups. The flaps were then examined by histology to numerically compare the number of newly formed vessels. Neovascularization was also assessed by microangiography. In addition, radiographic images were obtained by mammography and evaluated quantitatively. RESULTS: An evaluation of statistical results revealed a significant increase in the flap survival area of the group on stem cell treatment in comparison to the control group. In scintigraphic examinations, the rate of radioactive substance retention was significantly higher in the stem cell group, relative to the control group. Histopathologic examination showed that the capillary density in the stem cell group was higher than that in the control group. Green fluorescent protein had been used to label ADSC in the experiment and it was found by immunofluorescence staining that endothelial samples of control animals did not have GFP (+) cells, whereas all the animals in the experiment group had GFP (+) cells. The comparison of microangiographic images of the experiment and control groups demonstrated significantly elevated vascularity in the former, relative to the latter. DISCUSSION: It has been established in the current study that ADSC injection worked well in speeding up the neovascularization of interpolated flaps and reducing the time of pedicle division. It seems possible to minimize the morbidity of interpolated skin flaps with mesenchymal stem cell therapy at an appropriate dose and for an appropriate length of time.

Perineural invasion in prostate biopsy specimens is associated with increased bone metastasis in prostate cancer.

BACKGROUND: We aimed to evaluate the relationship between perineural invasion (PNI) and bone metastasis in prostate cancer (PCa). METHODS: We retrospectively reviewed the data of 633 PCas who had whole-body bone scan (WBBS) between 2008 and 2014. We recorded the age, clinical T-stage, total PSA (tPSA) prior to biopsy, Gleason sum (GS), and PNI in transrectal ultrasound guided biopsy (TRUS-Bx) and digital rectal examination findings. Bone metastases were assessed with WBBS and magnetic resonance image if WBBS was suspicious. We divided the patients into two groups according to NCCN criteria: (Group 1) bone scan not indicated, (Group 2) bone scan indicated. RESULTS: There were 262 patients in Group 1 and 371 in 2. There is not significant relationship between PNI and bone metastasis in Group 1. However, there is very limited number of metastatic patients (n = 12) in this group. There is a strong relationship between PNI and bone metastasis in Group 2 (P = 0.001). Sensitivity, specificity and positive predictive value of PNI for bone metastasis were 72.4%, 81.7%, and 77.7%, respectively. In this group, tPSA, GS, positive DRE, and PNI were significant covariates for prediction of bone metastasis in univariate and multivariate analysis (except age). The most powerful predictor was PNI, and it increased the risk of bone metastasis 11-fold. CONCLUSIONS: PNI in the TRUS-Bx specimens is the most powerful predictive histopathological feature for bone metastasis, by increasing the risk of bone metastasis 11-fold in NCCN bone scan indicated patients (Group 2).

Minimum 6 mm core length is strongly predictive for the presence of glandular tissue in transrectal prostate biopsy.

INTRODUCTION: Prostate biopsy guidelines recommend that a prostate biopsy not containing glandular prostate tissue should be reported as inadequate. In the literature, there is a lack of any study that addresses the relationship between the length of biopsy cores and the absence of glandular prostate tissue. In this study, we aimed to determine whether a relationship exists between these parameters. MATERIALS AND METHODS: We retrospectively evaluated 1,712 consecutive initial transrectal 12-core prostate biopsies. Individual cores were histologically categorized as glandular (benign or malignant) and non-glandular (rectal mucosa, periprostatic adipose tissue, prostatic or periprostatic fibromuscular tissue). Total number of evaluable cores ≤9, highly fragmented, incorrectly numbered or dried biopsies, patients with 5-α reductase inhibitory treatment were excluded. RESULTS: We analyzed remaining 1,584 patients; 41.7 % had adenocarcinoma. A total of 19,144 cores were sampled. Non-glandular cores were found significantly shorter than glandular cores (p < 0.0001). The percentages of non-glandular cores were significantly higher at the base, apex and lateral biopsy sites (p < 0.0001). We found a 6-mm cutoff value for accurate prediction of glandular sampling with 80.2 % sensitivity and 78.7 % specificity. The risk of non-glandular sampling increased 15-fold in cores ≤6 mm (OR 14.91, 95% CI 13.20-16.83, p < 0.0001). CONCLUSIONS: Non-glandular sampling was directly associated with shorter core lengths. They were found significantly higher at the base, apex and lateral localizations. We found a 6-mm cutoff value for the prediction of non-glandular samples before the histologic evaluation. Below this value, the risk of non-glandular sampling increased 15-fold. We suggest it for prompt additional sampling during biopsy procedure.

The effect of memantine on functional recovery of the facial nerve after crush injury.

The objective of this study is to establish whether memantine is an alternative and effective treatment on facial nerve recovery after crush injury, and also to analyze the effective doses of this promising agent. This is a randomized controlled animal study. 40 rats underwent crush injury to left main trunk of the facial nerve, and divided into 4 groups; (1) control (saline treated), (2) 5-mg/kg memantine, (3) 10-mg/kg memantine, and (4) 20-mg/kg memantine group. Facial nerve functions were evaluated by eye reflex, and whisker movement compared to the unaffected side. They were scored on a 3-point scale. On day 28, the rats were sacrificed, and the facial nerves were dissected. The paraffin sections were studied with caspase-3 immunostaining. According to statistical data, the recovery in Group 4 began significantly earlier than the other groups on the basis of restoring eye blink reflexes and whisker movement. Groups 2 and 3 showed faster recovery than Group 1 on the basis of whisker movement. The caspase-3 positive staining was rarely detected in all groups. The Kruskal­Wallis test revealed that Group 4 showed fewer apoptotic cells than other groups; this was statistically significant. However, the Mann­Whitney U test with the Bonferroni correction did not reveal any significant difference between the groups. In conclusion, this study revealed that memantine acted to restore facial nerve functions, and accelerate recovery after facial nerve injury by inhibiting apoptosis.

Golden bullet-denosumab: early rapid response of metastatic giant cell tumor of the bone.

Giant cell tumor of the bone (GCTB) is usually a benign, locally aggressive tumor with metastatic potential. Histogenesis of GCTB is unknown and a correlation has not been found between histologic and clinical course. For this reason, many authors consider its prognosis unpredictable. Lung metastasis after GCTB treatment is well known and generally has unfavorable outcome, despite varied chemotherapy regimens. Denosumab, which inhibits RANK-RANKL interaction, is a new, promising actor among targeted therapeutic agents for GCTB. In this report, we emphasize on early rapid response to denosumab in metastatic GCTB.

[Sinonasal teratocarcinosarcoma]. / Sinonazal teratokarsinosarkom.

Sinonasal teratocarcinosarcoma is an extremely rare malignant neoplasm presenting with the characteristics of a malignant teratoma and carcinosarcoma. The most common sites of origin of teratocarcinosarcomas are the nasal cavity and paranasal sinuses. The clinical presentation is usually with nasal obstruction and episodes of epistaxis. Teratocarcinosarcomas are aggressive and rapidly growing tumors with a poor prognosis. The incidence of sinonasal teratocarcinomas is higher in men than women. Treatment is primarily surgery, followed by radiotherapy. In this article, we report a 46-year-old male case of sinonasal teratocarcinosarcoma who was admitted with complaints of pain and swelling around the right eye and treated surgically followed by radiotherapy.

Preoperative evaluation of myometrial invasion in endometrial carcinoma: diagnostic performance of 3T MRI.

PURPOSE: To evaluate the diagnostic accuracy of 3T MRI in preoperative staging of myometrial invasion. METHODS: Twenty-eight women with histological diagnosis of endometrial carcinoma were included in this prospective study. After T2-W SS-TSE and DWI, dynamic series of T1-W THRIVE images were obtained (0-180 s) followed by a T1-W THRIVE sequence in the late phase (5th min). For detection of deep myometrial infiltration: sensitivity, specificity, PPV, NPV, and accuracy were calculated on T2-W, postcontrast early arterial and late phase T1-W, and DWI. For the quantitative analysis of DWI, ADC values of the tumor were calculated and correlated with histologic grade. For the quantitative evaluation of dynamic series, SI-time curves were obtained and the maximum relative enhancement, wash-in rate, time-to-peak, and wash-out rate of masses and myometrium were compared. RESULTS: T2-W and early phase contrast-enhanced sequences obtained sensitivity 100 %, specificity 76 %, PPV 58 %, NPV 100 %, and accuracy 82 %; late-phase contrast-enhanced images obtained sensitivity 100 %, specificity 81 %, PPV 64 %, NPV 100 %, and accuracy 86 %; DWI obtained lower accuracy [sensitivity 71 %, specificity 62 %, PPV 38 %, NPV 87 %, and accuary 57 %] than T2-W and postcontrast images. The MRE of carcinomas were significantly lower than those of the myometrium. This analysis showed a significant improvement in tumor versus myometrium contrast during the late phase. On DWI, the mean ADC value of tumor was 1.02 ± 0.48 × 10(-3). There was no statistically significant correlation between tumor grades and ADCs. CONCLUSIONS: As the 3T MRI scanner allows high-resolution images, accurate assessment of myometrial infiltration can be done especially with postcontrast late phase images.

Ovotesticular disorder of sexual development and a rare 46,XX/47,XXY karyotype.

Ovotesticular disorder of sexual development (DSD) is characterized by the presence of both ovarian and testicular tissues in the same individual. The most common karyotype is 46,XX. Here, we report the case of a boy with a 46,XX/47,XXY karyotype diagnosed as ovotesticular DSD by gonadal biopsy. A 5-month-old boy presented with hypospadias, unilateral cryptorchidism, and a micropenis. Pelvic magnetic resonance imaging revealed a suspicious gonad tissue that is solid in structure in the right scrotum and a suspicious gonad that is cystic in structure in the left inguinal canal. He underwent a diagnostic laparoscopy. Cytogenetic analysis of peripheral blood revealed a 46,XX/47,XXY karyotype. Histopathologic examination of the left gonad showed ovarian tissue containing primordial follicles with ipsilateral undifferentiated tuba uterina. The right gonad showed immature testis tissue. He underwent left gonadectomy and hypospadias repair, and was raised as a male. Through this rare case, we highlight the importance of histological and cytogenetic investigation in DSD.

The statuses of HER2 expression and mismatch repair in endometrial clear cell carcinoma.

High-grade endometrial carcinomas (HGEC) are difficult to classify. With the current use of HER2-based therapy in serous carcinoma, a diagnosis of clear cell carcinoma (CCC) has the potential to exclude patients from receiving therapy. Therefore, we examined HER2 expression in our CCC patients. The preparations of 8 patients with CCC who underwent hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection were re-evaluated. Patients did not have any prior treatment. Histopathologic parameters that were evaluated include cytoplasmic clearing, nuclear atypia, mitotic activity, hobnail architecture, hyalinized cores, hyaline globules, stratification of epithelial lining papillae, or glandular structures, and highly atypical cell layers. Immunohistochemically, HER2, ER, PR, HNF1ß, Napsin A, MLH1, MSH2, MSH6 and PMS2 were applied. HER2 staining pattern, ASCO/CAP protocol used for endometrial carcinom was used. HER2 was positive in 3 of our 8 CCC patients (37.5%). While all of our HER2 + cases were Napsin A and HNF1ß positive, MMR proteins were intact and ER and PR were negative. Two patients had wild type p53 and 1 patient had aberrant p53 staining. Considering that there is not always a consensus between SC and CCC, even among gynecopathologists, tumor heterogeneity and different tumor components may exist, and while patients may be diagnosed with CCC and benefit from HER2 therapy, there is also a possibility that they may not benefit from the treatment. The fact that 37.5% of our CCC cases were HER2 + is a finding with strong implications for the therapeutic approach. As a result of our study, in patients with CCC, if MMR is intact and ER-PR is negative, regardless of the p53 staining pattern, HER2 testing may be an objective screening method for patients who are likely to benefit from HER-targeted therapy. Consequently, patients with a diagnosis of CCC can be candidates for future clinical trials of HER2-targeted therapy.

Classification of Cervical Precursor Lesions via Local Histogram and Cell Morphometric Features.

Cervical squamous intra-epithelial lesions (SIL) are precursor cancer lesions and their diagnosis is important because patients have a chance to be cured before cancer develops. In the diagnosis of the disease, pathologists decide by considering the cell distribution from the basal to the upper membrane. The idea, inspired by the pathologists' point of view, is based on the fact that cell amounts differ in the basal, central, and upper regions of tissue according to the level of Cervical Intraepithelial Neoplasia (CIN). Therefore, histogram information can be used for tissue classification so that the model can be explainable. In this study, two different classification schemes are proposed to show that the local histogram is a useful feature for the classification of cervical tissues. The first classifier is Kullback Leibler divergence-based, and the second one is the classification of the histogram by combining the embedding feature vector from morphometric features. These algorithms have been tested on a public dataset.The method we propose in the study achieved an accuracy performance of 78.69% in a data set where morphology-based methods were 69.07% and Convolutional Neural Network (CNN) patch-based algorithms were 75.77%. The proposed statistical features are robust for tackling real-life problems as they operate independently of the lesions manifold.

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists.

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted κ values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders.

Determining prostate cancer-specific death through quantification of stromogenic carcinoma area in prostatectomy specimens.

We previously reported that reactive stroma grading in prostate cancer (PCa) is predictive of biochemical recurrence in prostatectomies and biopsies. In this study, we tested whether quantifying the percentage of reactive stromal grade 3 (RSG 3; stromogenic carcinoma pattern) in the entire tumor is predictive of PCa-specific death. Whole-mount prostatectomies operated by a single surgeon obtained between 1983 and 1998 were reviewed. Reactive stroma was evaluated as described previously, and areas of RSG 3 in the entire tumor were registered as percentages of total tumor. Statistical analysis was performed using Spearman, Kaplan-Meier, and Cox analyses. In all, 872 cases were evaluable. Quantification of RSG 3 percentage was an independent predictor of biochemical recurrence, analyzed as a continuous or grouped variable. Patients with higher RSG 3 percentages (larger tumor areas with RSG 3) had a significantly decreased biochemical recurrence-free survival than those with a lower RSG 3 percentage, even within the Gleason score 7 subset of patients. A nomogram introduced this new variable to the model. Furthermore, quantification of RSG 3 percentage was significantly predictive of PCa-specific death. Quantification of the RSG 3 (stromogenic carcinoma) area in PCa provides additional novel information on prognosis. These data substantiate the concept that the tumor microenvironment holds significant predictive information, as well as biological significance.

Effects of botulinum toxin A on fracture healing in rats: an experimental study.

INTRODUCTION: Fracture healing is a complex process influenced by intrinsic and extrinsic factors. The aim of the present study was to evaluate the effects of botulinum toxin (BTX) A on fracture healing. MATERIALS AND METHODS: Following the induction of bilateral standard closed femoral fractures and relative fixation in 18 Wistar albino rats, 8 IU of BTX A were injected into the right femoral region. After 28 days, all of the rats were sacrificed, the diameter of the callus was measured, and fracture healing was assessed by biomechanical and histopathologic evaluation. RESULTS: While an increase in biomechanical and histopathologic healing was noted on the side injected with BTX A, a decrease in callus diameter was observed. CONCLUSION: Botulinum toxin A administration increases the healing power in a relatively fixated fracture and decreases the callus diameter, just as if rigid fixation had been performed. The beneficial effect of BTX A on fracture healing might be associated with increased fixation rigidity.

A rare tumor of nasal bone in a child: osteoblastoma.

Benign osteoblastoma is an uncommon bone tumor, representing 1% of all benign tumors and 3% of all primary bone tumors. Intranasal or paranasal osteoblastoma is particularly rare. Osteoblastoma occurs more frequently in males, at a peak age between 10 and 20 years. We report an osteoblastoma of the nasal septum in an 11-year-old boy who presented with swelling of the nasal septum. The diagnosis and management of this unusual lesion, as well as the histopathology and imaging characteristics, are reviewed. Magnetic resonance imaging (MRI) revealed a solid midline nasal mass originating from the septum with intense contrast enhancement. There was no evidence of osteoid or chondroid matrix mineralization on computed tomography (CT). Biopsy was performed. Histologically, the tumor contained abundant plump osteoblast-like cells, with eosinophilic cytoplasm and large nuclei that were frequently juxtaposed to the newly formed osteoid. Conservative excision was performed. The literature concerning occurrence of osteoblastoma in this unusual location is reviewed.

A whole-slide image grading benchmark and tissue classification for cervical cancer precursor lesions with inter-observer variability.

The cervical cancer developing from the precancerous lesions caused by the human papillomavirus (HPV) has been one of the preventable cancers with the help of periodic screening. Cervical intraepithelial neoplasia (CIN) and squamous intraepithelial lesion (SIL) are two types of grading conventions widely accepted by pathologists. On the other hand, inter-observer variability is an important issue for final diagnosis. In this paper, a whole-slide image grading benchmark for cervical cancer precursor lesions is created and the "Uterine Cervical Cancer Database" introduced in this article is the first publicly available cervical tissue microscopy image dataset. In addition, a morphological feature representing the angle between the basal membrane (BM) and the major axis of each nucleus in the tissue is proposed. The presence of papillae of the cervical epithelium and overlapping cell problems are also discussed. Besides that, the inter-observer variability is also evaluated by thorough comparisons among decisions of pathologists, as well as the final diagnosis.

Malignant struma ovarii: a case report.

We present a case of a 40-yr-old woman diagnosed with a primary malignant struma ovarii. The patient was admitted with the complaint of pelvic pain and a large pelvic mass in the mid-portion of lower abdomen on gynecological examination. Pre-operative tumor markers and routine biochemistry were unremarkable. She was treated with total abdominal hysterectomy and right salpingo-oopherectomy. Post-operatively, she was diagnosed with a malignant struma ovarii through the usage of histopathological criteria similar to the guidelines for primary thyroid gland disease. The patient was subsequently performed left salpingo-oopherectomy and retroperitoneal pelvic lympadenectomy for re-staging. Although, left ovary and lymph nodes were histopathologically normal, she was offered thyroidectomy but she refused to accept the offer. Thyroglobulin level was monitored in the post-operative period. She is free of the disease for 18 months.