Search Results (50)

Background: The aim of this study is to compare the concordance of Preoperative Magnetic Resonance Imaging (MRI) and Intraoperative Frozen Section Analysis, widely used worldwide for Endometrial Cancer (EC), with final pathology results, to calculate their sensitivity and specificity, and to evaluate their diagnostic agreement with final pathology results. Positive predictive values for both MRI and frozen section analysis will also be calculated. Methods: In this retrospective cohort study, patients diagnosed with Endometrioid-Type Endometrial Cancer at the Gynecologic Oncology Surgery Department of Akdeniz University Hospital between January 2020 and December 2023 underwent preoperative MRI to assess the depth of myometrial invasion and intraoperative frozen section examination for surgical staging. The results of both methods were compared with the final pathology reports. Results: A total of 88 patients were included in the study. Patient ages ranged from 34 to 80 years, with a mean age of 57.57 years (SD: 9.65), predominantly in the middle-aged and older population. In the assessment of myometrial invasion depth, MRI demonstrated a sensitivity of 81.6% and a specificity of 88%, while frozen section analysis showed a sensitivity of 73.7% and a specificity of 98.0%. Conclusions: In our study, preoperative MRI demonstrated similar sensitivity and specificity to intraoperative frozen section analysis in determining the depth of myometrial invasion in cases of Endometrioid-Type Endometrial Cancer. Therefore, when intraoperative frozen section analysis is not available, MRI findings may assist surgical planning, particularly in centers where frozen section is limited. Full article

Background: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is linked to metabolic syndrome, obesity, and type 2 diabetes. Omega-3 fatty acids, especially EPA and DHA from fish, may protect against hepatic steatosis. Methods: From 2015 to 2018, all participants were invited to the first follow-up, where 1426 (62% response rate) responded and underwent the same standardized protocol as at baseline. For this analysis, the study is a cross-sectional investigation focusing solely on follow-up data, which included 1297 adults. MASLD was diagnosed via standardized ultrasound, and dietary intake was assessed using the validated EPIC Food Frequency Questionnaire. Associations between total EPA and DHA intake and MASLD were examined using logistic regression models adjusted for age, sex, marital status, occupation, income, Mediterranean diet adherence, liver enzymes, and C-reactive protein. Results: Overall, 48.5% of participants had MASLD. Higher total EPA and DHA intake was associated with lower odds of MASLD (EPA highest vs. lowest quartile: OR = 0.572, 95% CI 0.400–0.818; DHA highest vs. lowest quartile: OR = 0.516, 95% CI 0.361–0.739). Intake of fatty fish contributed most strongly to this protective effect (EPA highest vs. lowest quartile: OR = 0.556, 95% CI 0.390–0.794; DHA highest vs. lowest quartile: OR = 0.575, 95% CI 0.403–0.820), whereas mollusks, crustaceans, and some processed/frozen fish showed weaker or no associations. A statistically significant trend of decreasing MASLD risk was observed across increasing quartiles of both EPA and DHA intake. Conclusions: Higher intake of EPA and DHA, especially from fatty fish, is linked to lower MASLD risk in this Mediterranean population, supporting recommendations for regular fish consumption to protect liver health. Full article

Introduction: Non-surgical biopsy is recommended for diagnosing solid pulmonary nodules measuring >8 mm when the probability of malignancy is low to moderate. However, currently available biopsy methods do not have a sufficient diagnostic yield for nodule size <20 mm. Previous work has shown that one-lung flooding (OLF) enables complete lung sonography and good demarcation of lung nodules. Therefore, here, we report the first experiences with ultrasound-guided transthoracic core needle biopsy (USgTTcNB) under OLF for the histological diagnosis of small pulmonary nodules. Methods: In two patients with small pulmonary nodules, a transbronchial/thoracic biopsy was not indicated due to the size and location of the nodules. Following nodule detection under OLF, the USgTTcNB was performed. The biopsy cylinder was immediately examined via the frozen section procedure. After liquid draining and re-ventilation, the patients were extubated in the operation room and monitored in the intermediate care unit. Results: In both patients, a histological diagnosis was achieved. In the case of malignancy, the patient underwent lobectomy during the same session. In the case of a benign diagnosis, a futile operation was avoided. In case two, a small apical pneumothorax occurred. The hemodynamic values during and after the intervention were in the normal range. Lung function on day 2 after the intervention increased compared with that before the intervention. Conclusions: USgTTcNB under OLF is feasible and enables a histological confirmation of small pulmonary nodules. Nevertheless, this new promising technique should be evaluated in a study with a larger cohort. Full article

Goblet cell adenocarcinomas (GCAs) are an exceedingly rare subtype of tumors, almost exclusively occurring in the appendix, and characterized by features overlapping both adenocarcinomas and neuroendocrine tumors (NETs), which has historically led to confusion and varied nomenclature. This study presents a comprehensive review of the literature highlighting particularities of this type of malignancy, starting from a rare case of a 54-year-old female operated on in our clinic for an appendiceal tumor, initially suspected to be a mucinous neoplasm based on colonoscopic biopsy, which was ultimately confirmed to be goblet cell adenocarcinoma on both intraoperative frozen section and definitive pathological examination. Exhibiting signs and symptoms associated with an abdominal mass, she underwent a right hemicolectomy with partial omentectomy for locally advanced, high-grade, invasive goblet cell adenocarcinoma of the appendix with lymphatic macro metastases and epiploic invasion, categorized as AJCC stage IVb carcinomatosis. The patient received FOLFOX adjuvant. Six months later, she required reoperation due to the progression of carcinomatosis, which was again confirmed histopathologically. A second-line oncological protocol comprising irinotecan, capecitabine, and bevacizumab was initiated. Given the rarity of GCAs and the absence of a consensus on nomenclature, classification, and diagnostic criteria, we conducted a comprehensive literature review to highlight current trends related to this entity, including its classification within different systems (Tang, Yozu, WHO, AJCC), as well as the therapeutic surgical approaches—ranging from simple appendectomy to extensive multiorgan resection, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), and the use of systemic therapy. Adhering to these recommendations will enhance communication among pathologists, surgeons, and oncologists regarding the natural history and prognosis of this rare malignancy. Full article

Operating under septic conditions poses significant challenges in vascular surgery. Infection is a serious risk when handling synthetic vessel prostheses and is one of the most dreaded complications. In the event of graft infection, an infection-resistant alternative is necessary. Cryopreserved vascular allografts offer a suitable alternative to replace an infected vessel or a section of a synthetic graft. However, there are no international guidelines for the preparation, storage, and thawing of such vessel grafts. Here, we aimed to investigate the mechanical properties of human cryopreserved arteries across multiple scales, ranging from nanonewton to newton forces and identify the optimal cryogenic storage duration. Human arterial allograft samples were frozen in a slow, controlled process and stored at −80 °C. One native and four cryopreserved samples were examined during a six-month-long period. Dimethyl-sulphoxide was used as a cryoprotectant. The mechanical properties of fresh and stored samples were explored in uniaxial ring tests and nanoindentation. We found no significant changes in the multi-scale mechanical properties during the examination period. Our results indicate that the cryopreserved vascular allografts are mechanically stable for up to six months under cryogenic conditions; hence, they represent ideal samples in vascular surgery. Full article

Background/Objectives: Lung cancer is the second most prevalent cancer in the general population and the third most prevalent among women. STAS (Spread Through Air Spaces) is a term used in pathology, particularly in lung cancer. It refers to the spread of tumor cells through air spaces in the lung tissue. The aim of this study was to evaluate the utility of STAS as a predictive and prognostic factor, as well as to assess the impact of STAS detection on subsequent surgical and pharmacological treatment decisions. Methods: A comprehensive literature search was performed on PubMed, PMC, and Google Scholar between June and September 2024. Search terms included ‘STAS’, ‘lung cancer’, ‘NSCLC’, ‘SCLC’, ‘PET and STAS’, ‘histopathological STAS’, ‘treatment methods for STAS’, and ‘STAS prognosis’. A diverse range of study designs was included in our analysis—encompassing meta-analyses, case-control studies, literature reviews, cross-sectional studies, and prospective longitudinal studies. Results: Lobectomy remains standard, whereas sublobar resection significantly increases recurrence risk in STAS-positive patients. CT, PET/CT, and frozen section analysis offer emerging, reliable predictive markers, supporting optimized treatment selection; however, histopathological examination continues to serve as the standard method for confirming STAS. Conclusions: One of the most significant limitations of our work is the limited number of available studies addressing the topic of STAS, which is the reason why statistical analysis was not provided. To conclude, the presence of STAS is identified as a negative prognostic factor amongst patients with NSCLC; however further research is needed to establish specific treatment guidelines when STAS is identified. Full article

Archived, frozen tongues of 56 bobcats (Lynx rufus) from Oklahoma, USA, were tested for parasites. Testing for Sarcocystis infections included microscopic examination of unstained muscle squashes, histological sections of paraffin-embedded tissues, and molecular characterization. By a combination of both compression methods and histology, sarcocysts were found in 28 (50.0%) of 56 bobcats. In compression preparations, the sarcocyst wall appeared thin and protrusions were not clear. Histologically, tissues were degraded and, in most tongues, only a few sarcocysts were found, except bobcat #35. Multilocus genotyping utilizing 18S rRNA, 28S rRNA, and cox1 genes yielded sequences exhibiting 98–100% identity with both Sarcocystis arctica and Sarcocystis caninum isolates available in the NCBI database. Hepatozoon rufi-like meronts were found in two tongues and is the first report of Hepatozoon infections in bobcats in Oklahoma. Full article

The purpose of this study was to evaluate in vitro whether the type of tooth preservation before treatment with the Tooth Transformer^® (TT) device affects the osteoinductive characteristics of the extracted tooth. Forty extracted teeth from healthy non-smoking patients were selected. All teeth were cleaned of caries, tartar, and filling material and then roughly sectioned and divided into four experimental groups according to storage type: room-temperature (RT) tooth samples, frozen tooth samples, RIPA tooth samples, and fresh tooth samples. Each sample was minced, demineralized, and disinfected using the TT device. The Enzyme-Linked ImmunoSorbent Assay (ELISA) test revealed the presence of bone morphogenetic protein-2 (BMP-2) and collagen type-I (COL-I) in all of the samples, demonstrating that the fresh teeth retained the most significant amount of osteoinductive protein. In contrast, the tooth samples stored at room temperature (RT) showed the most important loss of BMP-2 and COL-I. A Western Blot analysis demonstrated the presence of the Mineralization Protein LIM-1 (LMP-1) and Transforming Growth Factor-β (TGF-β) in all of the dental samples analyzed. The fresh and frozen dental samples showed significantly higher levels of LMP-1 than those in the other samples. In contrast, the levels of TGF-β were similar in all of the dental samples examined, regardless of the type of storage. These experimental results suggest that an extracted tooth should be treated with the TT device as soon as possible to maximize its osteoinductive potential in surgical bone preservation and regeneration procedures. Full article

Introduction: With around 25 different salivary gland tumor entities described by the World Health Organization, the correct preoperative identification of masses as benign or malignant remains a challenge. If preoperative needle biopsy is inconclusive, frozen section analysis is a possible alternative for accurate histological identification. The purpose of our study was to evaluate the diagnostic effectiveness of frozen section performed for primary submandibular gland masses. Methods: In addition to acquiring epidemiological data from patients who underwent submandibular gland excision over a 20-year period, we analyzed the diagnostic effectiveness of frozen section performed for submandibular gland masses. We also examined the impact of frozen section on overall survival. Furthermore, we investigated whether there was an impact on the surgical revision rate for malignant submandibular gland masses that required additional neck dissection within the submandibular triangle. Results: Frozen section was performed for 54 submandibular gland tumors, with a specificity of 100% and a sensitivity of 81.3%. Frozen section was conducted in 12 cases of primary salivary gland malignancies, of which 9 cases were identified correctly. In three cases, the frozen section results were inconclusive. We calculated a relative risk reduction of 27% for revision surgery by performing frozen section. There was no significant association between frozen section results and overall survival. Conclusions: Frozen section demonstrates a significant reduction in the need for revision surgery. With a specificity of 100%, frozen section is especially suited to identifying benign masses. It is a valid diagnostic tool when preoperative sampling is not possible or is inconclusive. Full article

Background/Objectives: The porcine mammary anatomy is poorly characterized, and structures are difficult to differentiate macroscopically, unlike human mammary tissue. The objective of this exploratory study was to describe the Yucatan porcine breast tissue morphology and identify the basic differences and similarities to human breast tissue. Methods: Samples from an adult, non-parous female Yucatan pig were prepared utilizing various methods: freezing at −80 °F (−26.67 °C) with a thickness of 0.5 cm/post-fixation in formalin; freezing at −20 °F (−6.67 °C) with a thickness of 0.5 cm/post-fixation in formalin; or formalin fixed and incised at ~0.8 cm. A descriptive comparison of the gross and microscopic images of the porcine breast morphology to the previously described human breast anatomy was performed. Results: As examined grossly, frozen sections allowed narrower serial cross-sectioning and better visualization of the structures and relationships. The mammary glands were poorly demarcated with extensive interspersed adipose tissue throughout the periphery. The mammary tissue appeared grossly as pigmented tissue and extended within ~0.5 cm from the skin surface, ~2.0 cm deep (within ~0.5 cm of the deep muscle layer), and ~6.5 cm laterally (centered on a teat). There were a number of similarities between Yucatan porcine and human breast tissue, yet there were several inherent structural differences. In contrast to human mammary tissue, porcine mammary glands consist of more diffuse acinar tissue, less well demarcated by defined fascial, lamellar, and ligamentous structures. Conclusions: The Yucatan porcine mammary morphology and similarities to the human mammary region allow for the use of this animal model to guide those developing relevant technologies or performing local surgical interventions in the preclinical setting. Full article

Intestinal lymphoma is characterized by a malignant lymphoid neoplasm with multifactorial causes, variable clinical symptoms, and, in some cases, rapid progression. This article describes a case of intestinal lymphoma in a dog that had a history of diarrhea lasting two months, accompanied by episodes of hematochezia, which was treated using the CHOP 19 protocol. A seven-year-old male Golden Retriever presented to a veterinary clinic with clinical signs of diarrhea, prostration, and the presence of bloody feces, as reported by the owner. Initial examinations, including hematology, serum biochemistry, and imaging, revealed an abnormal structure in the intestinal region. Considering the circumstances, a surgical procedure was conducted with the aid of a trans-surgical frozen section biopsy. This biopsy aimed to verify the presence of the neoplasm, assess the suspected diagnosis, evaluate the viability of the surgical margins, and determine the possibility of expanding the surgical area. An enterectomy with enteroanastomosis and trans-surgical biopsy was performed, leading to an initial diagnosis of intestinal lymphoma. The tissue fragment was sent for immunohistochemistry, which ultimately confirmed the diagnosis of intestinal T-cell lymphoma. The patient underwent the CHOP protocol for 19 weeks, but during the maintenance phase, abdominal ultrasound examination findings indicated tumor recurrence. Despite being informed of the potential benefits of further chemotherapy, the owner opted not to continue treatment for the animal. Frozen section biopsy can help with diagnosis during surgery, avoiding more invasive procedures and the removal of lymph nodes, since in some cases, the systemic treatment of the disease is recommended. Full article

Background: This systematic review examines the clinical presentations and prevalence of scapulohumeral periarthritis (SP) by synthesizing the relevant literature from open-access articles from international databases (Medline, Pedro, and EBSCO). Methods: Keywords guiding the review included ‘scapulohumeral periarthritis’, ‘clinical forms’, ‘incidence’, ‘impingement syndrome, ‘calcifying tendinitis’, ‘bicipital tendonitis’, ‘shoulder bursitis’, ‘adhesive capsulitis or frozen shoulder’, ‘rotator cuff tears’, ‘functional assessment’, and ‘clinical trials’. Eligible studies included randomized controlled trials, nonrandomized controlled trials, cross-sectional studies, and review articles published between 1972 and 2024. Results: Our screening identified 2481 initial articles, of which 621 were further reviewed for eligibility resulting in 107 articles that met the relevance criteria. The findings highlight six distinct clinical forms of SP, such as partial rotator cuff tears and calcific tendinitis, each characterized by specific pathological features and prevalence patterns. Key factors contributing to SP include injuries, scapular instability, acromion deformities, and degenerative rotator cuff changes. Functional assessments, including the Neer, Hawkins, Pain Arc, and Yocum tests, demonstrated diagnostic value in distinguishing SP from other shoulder conditions. Conclusions: By comprehensively analyzing the clinical forms, functional assessment methods, and prevalent lesions of SP, functional testing can improve early diagnosis and guide personalized physiotherapy protocols for optimal rehabilitation in the physiotherapist’s practice. Full article

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare lymphoma primarily linked to textured breast implants. Symptoms are often non-specific (e.g., breast swelling, pain, or fluid collection). When imaging detects fluid around the implant, cytological examination is the first diagnostic approach. However, this method has limited sensitivity and may yield false-negative results. In this case, a 41-year-old woman presented with swelling, pain, and itching in her left breast six years after bilateral textured breast implant placement. Ultrasonography (US) revealed peri-implant fluid collection around the left implant. A following magnetic resonance imaging (MRI) scan ruled out an implant rupture. Due to persistent pain and the peri-implant effusion on the left side, open surgery was performed. During implant removal, the seroma was drained, and multiple suspicious masses were found on the left side. The cytology of the seroma fluid was negative and intraoperative frozen sections of the excised masses were inconclusive. A complete capsulectomy was conducted due to the suspicion of malignancy. Histological examination ultimately confirmed the diagnosis of BIA-ALCL. This case highlights the diagnostic challenges associated with this rare condition. Therefore, BIA-ALCL should always be considered in the differential diagnosis of breast implant-associated seroma. Full article

Ex vivo fusion confocal microscopy (EVFCM) enables the rapid examination of breast tissue and has the potential to reduce the surgical margins and the necessity for further surgeries. Traditional methods, such as frozen section analysis, are limited by the distortion of tissue and artefacts, leading to false negatives and the need for additional surgeries. This study on observational diagnostic accuracy evaluated the ability of EVFCM to detect breast cancer. A total of 36 breast tissue samples, comprising 20 non-neoplastic and 16 neoplastic cases, were analysed using EVFCM and compared to the results obtained from routine histopathology. A Mohs surgeon experienced in EVFCM (evaluator A) and two breast pathologists unfamiliar with EVFCM (evaluators B and C) performed blinded analyses. EVFCM showed high concordance with the histopathology and the detection of neoplasia, with significant kappa values (p < 0.001). Evaluator A achieved 100% sensitivity and specificity. Evaluators B and C achieved a sensitivity of >87%, a specificity of >94%, positive predictive values of >95%, and negative predictive values of 81% and 94%, respectively. EVFCM therefore offers a promising technique for the assessment of margins in breast-conserving surgery. Its widespread adoption could significantly reduce re-excisions, lower healthcare costs, and improve cosmetic and oncological outcomes. Full article

Background: Intraoperative frozen sections (FS) are frequently used to establish the diagnosis of lung cancer when preoperative examinations are not conclusive. The downside of FS is its resource-intensive nature and the risk of tissue depletion when small lesions are assessed. Ex vivo fluorescence confocal microscopy (FCM) is a novel microimaging method for loss-free examinations of native materials. We tested its suitability for the intraoperative diagnosis of lung tumors. Methods: Samples from 59 lung resection specimens containing 45 carcinomas were examined in the FCM. The diagnostic performance in the evaluation of malignancy and histological typing of lung tumors was evaluated in comparison with FS and the final diagnosis. Results: A total of 44/45 (98%) carcinomas were correctly identified as malignant in the FCM. A total of 33/44 (75%) carcinomas were correctly subtyped, which was comparable with the results of FS and conventional histology. Our tests documented the excellent visualization of cytological features of normal tissues and tumors. Compared to FS, FCM was technically less demanding and less personnel intensive. Conclusions: The ex vivo FCM is a fast, effective, and safe method for diagnosing and subtyping lung cancer and is, therefore, a promising alternative to FS. The method preserves the tissue without loss for subsequent examinations, which is an advantage in the diagnosis of small tumors and for biobanking. Full article