Urinary Bladder Carcinoma in Females: A Clinico-Pathological Assessment.

BACKGROUND: Urinary bladder cancer is an uncommon cancer in females. Despite not being an infrequent encounter, female bladder cancer remains a poorly defined entity. There is a paucity of literature regarding bladder cancer in females, especially in North India. OBJECTIVE: This study aims to evaluate the clinico-pathological profile of bladder cancer in female patients managed at a single centre in north India. MATERIALS AND METHODS: This retrospective observational study was carried out in a tertiary care centre in North India. Medical records and a database of female patients with bladder cancer treated between January 2012 and January 2021 were retrieved. Data regarding age, duration of disease, associated comorbidity, histopathological variants, and outcomes were studied. RESULTS: Out of 56 female patients with bladder masses, 55 had transitional cell carcinoma (TCC), while one had pheochromocytoma. Painless hematuria (80.3%) was the commonest presentation. At the time of presentation, 5 patients (9.1%) had muscle-invasive bladder cancer (T2-T4), while 50 patients had non-muscle-invasive disease, out of which 31 (56.4%) patients had high-grade and 19 (34.5%) patients had low-grade papillary carcinoma. Twenty-three patients (41.8%) had a history of exposure to domestic chulha (open wood-burning cooking stove), and 11 patients (20%) were smokers; six patients (10.9%) were exposed to both risk factors. CONCLUSIONS: Female bladder cancer was most prevalent in the sixth decade of life, with the majority of patients having a high-grade but non-muscle-invasive disease. Of all the risk factors, chulha exposure was the main risk factor in the aetiology of female bladder cancer.

Application of Vesical Imaging-Reporting and Data System in Evaluation of Urinary Bladder Cancer Using Multiparametric Magnetic Resonance Imaging: A Hospital-Based Cross-Sectional Study.

Background Multiparametric magnetic resonance imaging (mp-MRI) of urinary bladder (UB) is a novel imaging to predict detrusor muscle invasion in Bladder cancer (BC). The Vesical Imaging-Reporting and Data System (VI-RADS) was introduced in 2018 to standardize the reporting of BC with mp-MRI and to diagnose muscle invasion. This study was performed to evaluate the role of mp-MRI using VI-RADS to predict muscle invasive BC. Methods This prospective study was carried from June 2020 to May 2021 in a tertiary care institute. Thirty-six patients with untreated BC underwent mp-MRI followed by transuretheral resection of the tumor (TURBT). Mp-MRI findings were evaluated by two radiologists and BC was categorized according to VI-RADS scoring system. Resected tumors along with separate biopsy from the base were reported by two pathologists. Histopathological findings were compared with VI-RADS score and the performance of VI-RADS for determining detrusor muscle invasion was analyzed. Results VI-RADS scores of 4 and 5 were assigned to 9 (25%) and 15 (41.7%) cases, respectively, while 4 (13.3%) cases had VI-RADS score 3 on mp-MRI. VI-RADS 1 and 2 lesions were observed in six (16.7%) and two (5.5%) cases, respectively. On histopathology, 23 cases (63.9%) had muscle-invasive cancer and 13 cases (36.1%) had non-muscle-invasive cancer. The sensitivity and diagnostic accuracy of mp-MRI in predicting muscle invasive BC was 95.6 and 80.6%, respectively. Conclusion Mp-MRI has high sensitivity and diagnostic accuracy in predicting muscle invasive BC and should be advocated for evaluation of BC prior to surgery.

Evaluation of clinically significant prostate cancer using biparametric magnetic resonance imaging: An evolving concept.

Background: Multiparametric magnetic resonance imaging (mp-MRI) of prostate involves a combination of T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced (DCE) scans. However, controversy exists in the literature regarding the true value of DCE in the detection of clinically significant (CS) prostate cancer (PCa). Aim: The aim of this study is to compare the role of biparametric MRI (bp-MRI) and mp-MRI in the detection of CS PCa. Materials and Methods: Thirty-six patients with raised serum prostate-specific antigen levels were included. Bp-MRI was performed in all patients, whereas mp-MRI was performed in 30 cases only. The findings were characterized on the basis of prostate imaging reporting and data system (PI-RADS) v2 grading. PI-RADS v2 score of 3 or more was considered CS PCa. All patients underwent transrectal ultrasound-guided biopsy. Gleason score >6 was considered CS. Statistical analysis was done using the SPSS software and results interpreted. Results: CS PCa was observed in 31 cases on histopathology. On bp-MRI, CS PCa was seen in 31 patients. Five cases of PI-RADS v2 score 3 were seen on bp-MRI and 3 of them were upgraded to PI-RADS 4 on DCE images. One case of PI-RADS 3 had low Gleason score on biopsy, whereas 1 case of PI-RADS 2 had CS PCa on biopsy. No significant difference was observed between bp-MRI and mp-MRI in the detection of CS PCa. Conclusions: Both bp-MRI and mp-MRI have high sensitivity, specificity, and diagnostic accuracy and were nearly identical in the detection of CS PCa with no significant advantage of DCE images.

Comparative evaluation of severity of COVID-19 pneumonia on computed tomography of the chest in vaccinated and non-vaccinated individuals: an observational study.

Purpose: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus causing an infectious disease, coronavirus disease 2019 (COVID-19). Computed tomography (CT) of the chest plays a significant role in the diagnosis and prognosis of COVID-19 using computed tomography severity scoring (CT-SS). Numerous vaccines are being made available in the world to lessen the effect of the COVID-19 pandemic. The purpose of the current study is to compare the severity of COVID-19 pneumonia using CT-SS in COVID-19-positive vaccinated (Covishield/Oxford-AstraZeneca) and non-vaccinated individuals and to compare the final outcome wherever possible. Material and methods: This observational study was carried out from March 2021 to April 2021. Forty vaccinated and 40 non-vaccinated RT-PCR-positive COVID-19 patients who underwent CT chest during the 4-12th day of illness formed the material of the study. Semi-quantitative scoring was used, and CT-SS was calculated based on the extent of lobar involvement in all the patients. CT-SS was then compared between the vaccinated and non-vaccinated groups and the results analysed. Results: CT scans were performed in 80 patients (40 patients each in the vaccinated and non-vaccinated groups). The majority of patients in the vaccinated group had mild (42.5%) and moderate (37.5%) CT-SS while the majority of patients in the non-vaccinated group had moderate (52.5%) and severe (27.5%) CT-SS score on chest CT. Also, no mortality was observed in the vaccinated group, with 2 deaths in the non-vaccinated group. Conclusions: Covishield vaccine administration reduces the severity of COVID-19 pneumonia as compared to the nonvaccinated group, with a marked reduction in mortality.

Correlation between Prostate Imaging Reporting and Data System Version 2, Prostate-Specific Antigen Levels, and Local Staging in Biopsy-Proven Carcinoma Prostate: A Retrospective Study.

BACKGROUND: Multi-parametric magnetic resonance imaging (mp-MRI) is a promising tool in the diagnosis of clinically significant prostate cancer. Morphologic assessment using T2-weighted (T2W) images and functional assessment with diffusion-weighted imaging is the cornerstone for the diagnosis of prostate cancer on mp-MRI. AIM/OBJECTIVES: The aim of this study is to evaluate the role of mp-MRI based prostate imaging reporting and data system version 2 (PI-RADS v2) for the assessment of prostate cancer and its correlation with serum prostate specific antigen (S.PSA) levels, local (T) staging on MRI and histopathology. MATERIALS AND METHODS: The study was carried out from June 2019 to February 2020. All patients with raised S.PSA levels and abnormal digital rectal examination who underwent mp-MRI of the prostate were included. MRI findings were characterized on the basis of PI-RADS v2 grading. All the patients underwent biopsy and histopathology. The score was correlated with S.PSA levels and the local stage of disease on MRI. Statistical analysis was performed, and results interpreted. RESULTS: Carcinoma prostate was reported in 32/33 cases on biopsy. A significant correlation was observed between PI-RADS v2 score and S.PSA Levels and between PI-RADS v2 score and T stage of disease in our study. MRI was highly sensitive (93.75%) and specific (100%) in the diagnosis of prostate cancer in our study. CONCLUSIONS: Significant correlation between lesion score on PI-RADS v2 with the local stage and S.PSA levels was seen, thus signifying the importance of mp-MRI in detecting clinically significant prostate cancer. Diffusion-weighted and T2W sequences were the primary diagnostic sequence for the prostate cancer with no additional role of dynamic contrast enhanced sequences.

Cytomorphological Evaluation of Synovial Lesions in a Tertiary Care Centre in North India: A Retrospective Study.

BACKGROUND: Numerous pathological processes involve synovium and periarticular tissues that are characteristic and in some cases specific to a particular disease. Synovial fluid is a thick, stringy fluid found in the cavity of synovial joint. Examination of the synovium plays a key role in the diagnosis of many joint diseases. AIMS: The aim of this study was to study the spectrum of synovial lesions on fine needle aspiration cytology (FNAC) and to compare the cytological diagnosis with histopathological findings. MATERIAL AND METHODS: This retrospective diagnostic analytical study was carried out in the Department of Pathology. Sixty-six patients with suspected synovial lesions referred from other departments who underwent FNAC during 1 year from January 2017 to December 2017 were included in the study. The slides along with records of the patients were retrieved and findings recorded. Histopathological evaluation was performed wherever possible and compared with cytological diagnosis. RESULTS: Non-neoplastic lesions accounted for 80.3% cases followed by benign tumors (15.2%). Ganglion cyst was the commonest non-neoplastic lesion (60.6%, 40/66), while tenosynovial giant cell tumor was the commonest neoplasm (12.1%, 8/66) observed in our study. Solitary case of synovial sarcoma was also observed. Histopathological evaluation was performed in 14 cases and FNAC had overall diagnostic accuracy of 85.7% in diagnosis of these lesions. CONCLUSIONS: FNAC is a useful tool with high diagnostic accuracy in the evaluation of synovial lesions.

Management of Genitourinary Fistulas Following Benign Gynecological and Obstetric Procedures: A Single Surgeon Experience.

BACKGROUND: Genitourinary fistula results in lot of anxiety in the suffering females. Scant literature regarding the comprehensive management of genitourinary fistula i.e. VVF and UVF is available. OBJECTIVE: The aim of the study was to review a single surgeon experience in dealing with these complex situations. MATERIAL AND METHODS: We conducted a retrospective, institutional review board approved chart review of patients who underwent genitourinary fistula repair from Jan 2014 till Dec 2019. Of all the fistulas VVF accounted for 18 and UVF for 12 cases. Pre-operative diagnosis in these patients was based predominantly on the history, local examination and cystoscopy. Of the 18 VVF 12 were managed laparoscopically and 6 by open O'Connor's repair. Of the 12 UVF, 8 were managed laparoscopically and 4 by open ureteric reimplants. All were followed up for three months post operatively. RESULTS: A total of 30 patients were treated since 2014 till December 2019. Average age for the VVF was 54.72 ≤ 10.9 years and that for UVF repair was 59.9 ≤ 7.6 years. Hysterectomies for benign diseases accounted for 66.66% of VVF and 91.6% of UVF. Of the VVF patients one required a ureteric reimplantation, remaining were managed with O'Connors' repair. We had one failure which was successfully repaired after 6 weeks. None of our patients with UVF repairs had a failure at three months follow-up. CONCLUSION: Genitourinary fistulas are a debilitating problem in females but a comprehensive approach regarding diagnosis and treatment can cure these patients.

X-ray and computed tomography findings in macrodystrophia lipomatosa of the foot with secondary osteoarthritic changes diagnosed in an elderly female: a case report.

Macrodystrophia lipomatosa is a rare entity that is mostly diagnosed in children. It has been very rarely reported in adults. Here, we describe the X-ray and computed tomography findings in a case of macrodystrophia lipomatosa in an elderly female presenting with an enlarged second toe since birth and bony outgrowths causing pressure effects and cosmetic problems.

A macrodistrofia lipomatosa é uma entidade rara, principalmente diagnosticada em crianças, e pouquíssimo relatada em adultos. Descrevemos os achados de radiografia e tomografia computadorizada em um caso de macrodistrofia lipomatosa em uma mulher idosa que apresentava um segundo dedo do pé aumentado desde o nascimento e crescimentos ósseos que causavam efeitos de pressão e problemas cosméticos.

X-ray and computed tomography findings in macrodystrophia lipomatosa of the foot with secondary osteoarthritic changes diagnosed in an elderly female: a case report / Achados de raios X e tomografia computadorizada na macrodistrofia lipomatosa do pé com alterações osteoartríticas secundárias diagnosticadas em mulher idosa: relato de caso

Abstract Macrodystrophia lipomatosa is a rare entity that is mostly diagnosed in children. It has been very rarely reported in adults. Here, we describe the X-ray and computed tomography findings in a case of macrodystrophia lipomatosa in an elderly female presenting with an enlarged second toe since birth and bony outgrowths causing pressure effects and cosmetic problems.

Resumo A macrodistrofia lipomatosa é uma entidade rara, principalmente diagnosticada em crianças, e pouquíssimo relatada em adultos. Descrevemos os achados de radiografia e tomografia computadorizada em um caso de macrodistrofia lipomatosa em uma mulher idosa que apresentava um segundo dedo do pé aumentado desde o nascimento e crescimentos ósseos que causavam efeitos de pressão e problemas cosméticos.

Giant nontraumatic intradiploic arachnoid cyst in a young male.

Intradiploic arachnoid cysts have scarcely been reported in the literature, most reported cases being secondary to trauma. Nontraumatic arachnoid cysts are quite rare and have been reported mostly in adults. Here, we report the case of a 16-year-old male presenting with a slowly growing mass in the occipital region and intermittent headaches. On the basis of the findings of X-rays, computed tomography scans, and magnetic resonance imaging scans of the head, the mass was diagnosed as a giant intradiploic arachnoid cyst.

Cistos aracnóideos intradiploicos foram raramente relatados na literatura, sendo a maior parte desses casos decorrente de traumas. Cistos aracnóideos não traumáticos são muito raros e têm sido relatados principalmente em adultos. Aqui, relatamos o caso de um jovem de 16 anos de idade apresentando uma massa de crescimento lento na região occipital e dores de cabeça intermitentes. Com base nos resultados de radiografia, tomografia computadorizada e ressonância magnética da cabeça, a massa foi diagnosticada como um cisto aracnóideo intradiploico gigante.

Giant nontraumatic intradiploic arachnoid cyst in a young male / Cisto aracnóideo intradiploico gigante não traumático em jovem do sexo masculino

Abstract Intradiploic arachnoid cysts have scarcely been reported in the literature, most reported cases being secondary to trauma. Nontraumatic arachnoid cysts are quite rare and have been reported mostly in adults. Here, we report the case of a 16-year-old male presenting with a slowly growing mass in the occipital region and intermittent headaches. On the basis of the findings of X-rays, computed tomography scans, and magnetic resonance imaging scans of the head, the mass was diagnosed as a giant intradiploic arachnoid cyst.

Resumo Cistos aracnóideos intradiploicos foram raramente relatados na literatura, sendo a maior parte desses casos decorrente de traumas. Cistos aracnóideos não traumáticos são muito raros e têm sido relatados principalmente em adultos. Aqui, relatamos o caso de um jovem de 16 anos de idade apresentando uma massa de crescimento lento na região occipital e dores de cabeça intermitentes. Com base nos resultados de radiografia, tomografia computadorizada e ressonância magnética da cabeça, a massa foi diagnosticada como um cisto aracnóideo intradiploico gigante.

Intact thumb reflex in areflexic Guillain Barré syndrome: A novel phenomenon.

INTRODUCTION: Areflexia is one of the cardinal clinical features for the diagnosis of Guillain Barré syndrome. However, some patients may have sluggish proximal muscle stretch reflexes. Presence of thumb reflex, a distal stretch muscle reflex has not been documented in Guillain Barré syndrome. MATERIALS AND METHODS: We prospectively evaluated thumb reflex in Guillain Barré syndrome patients and age matched controls from April to September 2013. RESULTS: There were 31 patients with Guillain Barré syndrome in whom thumb reflex could be elicited in all (24 brisk, 7 sluggish), whereas all the other muscle stretch reflexes were absent in 29 patients at presentation and the remaining two had sluggish biceps and quadriceps reflexes (P = 0.001). Serial examination revealed gradual diminution of the thumb reflex (P < 0.001). Rapid progression of weakness was associated with early loss of the thumb reflex. CONCLUSION: Thumb reflex, a distal stretch reflex is preserved in the early phase of Guillain Barré syndrome.