Locally Aggressive Rib Hemangioma With Glomeruloid and Papillary Features - Expanding the Clinicopathologic spectrum of Bone Hemangiomas.

Intra-osseous hemangiomas are uncommon tumors that can present diagnostic and treatment dilemmas. Bone hemangiomas with papillary and glomeruloid growth patterns are exceptionally rare. We present an example of an intra-osseous hemangioma of the rib displaying aggressive features on both radiology and histology. Morphologically, prominent papillary and glomeruloid architectural patterns were observed, in addition to features of cavernous and capillary hemangiomas. Extensive extra-osseous soft tissue involvement was seen. Awareness of the diverse histological features and locally aggressive behavior of bone hemangiomas is important in avoiding over-interpretation as a malignant lesion.

MicroRNA Landscape in Endometrial Carcinomas in an Asian population: Unraveling Subtype-Specific Signatures.

MicroRNAs (MiRNAs) are small, non-coding RNA molecules that function in RNA silencing and post-transcriptional regulation of gene expression. We analyzed the differential expression of miRNAs in 119 endometrial carcinomas, measuring their expression in histological subtypes, molecular subtypes, and tumors with CTNNB1 mutations. Tumors were subdivided into histological and molecular subtypes as defined by The Cancer Genome Atlas. The expression levels of 352 miRNAs were quantified using the PanoramiR panel. Mir-449a, mir-449b-5p, and mir-449c-5p were the top three miRNAs showing increased expression in both endometrioid and de-differentiated carcinomas but were not significantly increased in serous and clear cell carcinomas. The miRNAs with the most increased expression in serous and clear cell carcinomas were miR-9-3p and miR-375, respectively. We also identified 62 differentially expressed miRNAs among different molecular subtypes. Using sequential forward selection, we built subtype classification models for some molecular subtypes of endometrial carcinoma, comprising 5 miRNAs for MMR-deficient tumors, 10 miRNAs for p53-mutated tumors, and 3 miRNAs for CTNNB1-mutated tumors, with areas under curves of 0.75, 0.85, and 0.78, respectively. Our findings confirm the differential expression of miRNAs between various endometrial carcinoma subtypes and may have implications for the development of diagnostic and prognostic tools.

Oncocytic low-grade myoepithelial carcinoma ex pleomorphic adenoma - A rare case illustrating key learning points.

BACKGROUND: Oncocytic myoepithelial carcinoma ex pleomorphic adenoma neoplastic is a rare neoplastic event and may not display overt malignant radiological features. METHODS: Using routine histopathology and immunohistochemistry, we characterize a case of low-grade oncocytic carcinoma ex pleomorphic adenoma. RESULTS: The tumor arose in the left parotid gland in a 59 year old female. Computed tomography (CT) imaging demonstrated a well-defined, lobulated, enhancing lesion with relative central stellate hypoenhancement. Histologically, the tumor displayed a multi-nodular, non-destructive, invasive pattern, low mitotic activity (one mitotic figure per 10 high power fields) and a small remnant focus of pleomorphic adenoma. The neoplastic cells showed significant expression of cytokeratin 5/6, S-100 protein, smooth muscle actin and p63. CONCLUSION: Low-grade oncocytic carcinoma ex pleomorphic adenoma is a challenging histopathological diagnosis which can be established with use of immunohistochemistry, generous tumor sampling and recognition of the multi-nodular, non-destructive, pattern of invasion. In the absence of clear-cut tumor encroachment into external structures, its malignant nature may not be easily identified on pre-operative imaging.

Falls efficacy: Extending the understanding of self-efficacy in older adults towards managing falls.

Falls efficacy is a widely studied construct. The understanding of falls efficacy has evolved over time. Falls efficacy was initially perceived to be suitably used as a measure of fear of falling. However, further research suggested that falls efficacy and fear of falling are distinct constructs, and therefore, would be inappropriate to be used as a proxy. Instead, some researchers posited that falls efficacy is synonymous with balance confidence. Falls efficacy has been conventionally understood as the perceived ability of individuals to perform activities without losing balance or falling. A recently conducted systematic review by the authors on existing falls efficacy related measures had revealed a fresh perspective of recognising falls efficacy as a perceived ability to manage a threat of a fall. Falls efficacy, with a broadened interpreted construct, relates to the individual's perceived self-efficacy of performing necessary actions needed in different scenarios, including pre-fall, near-fall, fall-landing and completed fall. The conventional interpretation of falls efficacy needs a rethinking of perspective. An extended understanding of falls efficacy would provide an integral approach towards improving the agency of individual to deal with falls and would enhance person-centred care.

Sclerosing microcystic adenocarcinoma of the parotid gland - The first recorded case with histo-cytopathologic correlation and a brief review of the literature.

We present a case of a 1.0 cm primary tumor of the left parotid gland that meets the histological criteria for the recently described entity sclerosing microcystic adenocarcinoma. The patient was a 73-year-old man with a concurrent tonsillar squamous cell carcinoma, and a history of nasopharyngeal carcinoma treated with radiotherapy 23 years prior. Fine needle aspiration cytology demonstrated low-grade biphasic basaloid neoplastic cells arranged in branching sheets and clusters with minimal nuclear pleomorphism. A biphasic appearance was apparent and some of the cell clusters were bordered by a layer of flattened cells with ovoid bland nuclei. On histology, the tumor comprised small bilayered infiltrative tubules, nests, cords, and microcysts. On immunohistochemistry, EMA, SOX-10, P63, and S-100 protein highlighted a dual cell population of luminal and abluminal cells. The cells were negative for CD117, and the Ki-67 proliferation index was low (<5%).

The use of cone beam CT in achieving unipedicular spinal augmentation.

OBJECTIVE: To assess the feasibility of cone beam CT (CBCT) in achieving unipedicular access during spinal cement augmentation. METHODS: A retrospective review of all patients who underwent CBCT-guided unipedicular spinal augmentation procedures between 1 January 2012 and 15 June 2015 was performed. 59 patients (43 females 16 males; mean-age, 74.0 years; range, 52-90 years) underwent unipedicular spinal augmentation in 78 vertebral levels (T5-T9, n = 14; T10-L2, n = 42; L3-L5, n = 22). Degree of cross-over in contralateral hemivertebral body, complications and 30-day mortality were recorded. RESULTS: 97% (76/78) of procedures were technically successful. Two procedures failed owing to vertebral sclerosis. For vertebroplasty, all cases (6/6) demonstrated cross-over filling of cement and 50% (3/6) showed cement cross-over >50% of contralateral half of the vertebral body. For kyphoplasty, 13 out of 15 procedures demonstrated balloon and cement cross-over >50% of contralateral half of the vertebral body. Two kyphoplasty procedures required the second pedicle after midline cross-over of cement failed. Of the kyphoplasty procedures that were successfully performed with the unipedicular approach, 76.9% (10/13) showed cement cross-over >50% of contralateral half of the vertebral body. For stentoplasty, all cases (55/55) showed midline stent-cement complex cross-over and 78.2% (43/55) exhibited stent-cement complex cross-over >50% of contralateral half of the vertebral body. There was no major complication or mortality. Minor complications included asymptomatic cement extravasation (6.4%, n = 5) and self-limiting haematoma (1.3%, n = 1). CONCLUSION: Unipedicular access for spinal augmentation procedures is achieved at a high success rate with the use of CBCT. ADVANCES IN KNOWLEDGE: This article describes the novel use of CBCT to achieve unipedicular spinal augmentation. Unipedicular spinal augmentation has the potential to reduce risk, duration, radiation and cost while achieving similar results.

Burden of illness for an employed population with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) affects approximately 7% of Americans. COPD impacts productivity and forces 1 in 5 employees ages 45-65 years old to retire prematurely. Our objective was to quantify the direct and indirect costs of COPD in an employed population in the United States. A retrospective analysis using Thomson Reuters MarketScan commercial claims and Health and Productivity (HPM) databases (2000-2007) identified employees (ages 18-65 years) with ≥ 1 COPD medical claim, ≥ 6 month insurance eligibility pre and ≥ 12 months post diagnosis, and ≥ 12 months HPM data post diagnosis. COPD subjects were matched to non-COPD subjects using propensity scores to create a comparison group with similar characteristics. Differences in medical and pharmacy utilization and productivity (absence and short-term disability [STD] days) were examined using negative binomial regression, and cost differences using Heckman selection models. A total of 27,612 COPD patients were matched in a 1:1 ratio to 825,884 non-COPD patients; 80% were ages 36-65 years, and 59% were male. COPD employees had about twice the rate of emergency department visits and hospitalizations compared to non-COPD employees (P<0.0001). The rate of absence and STD days was approximately 1.5 times higher (P<0.0001) compared to non-COPD employees. Yearly direct and indirect expenditures were higher ($3609 and $909, respectively; P<0.0001) for COPD versus non-COPD employees. Excess utilization and associated costs of COPD to employers was quantified. By understanding these costs, employers may evaluate disease management programs and treatment to improve outcomes for employees with COPD. Improved treatment options may reduce the direct and indirect costs of COPD.