A Rare Case of Childhood Lipoblastoma presenting as Tongue Mass

Introduction Lipoblastoma is a rare benign tumour arising from embryonic white fat been commonly noted in limbs and trunk, but tongue involvement is rare and has not yet been reported. Case Report A child with tongue lipoblastoma is reported, whose imaging reported an encapsulated, well-delineated, fat-containing tumour. Surgical excision was performed with no post-operative morbidities.  Discussion Lipoblastoma is an uncommon childhood tumour, which rarely affects the tongue. It presents as a progressive painless swelling, rarely causing any symptom. MRI is helpful to assess the precise location and extent of the lesion. Although the ratio of fat to myxocollagenous tissue in the tumour is variable, the diagnosis can be suggested in most cases based on the imaging characteristics. Recommended treatment is complete surgical excision and confirmation of diagnosis by histopathological examination

Essentials of pathology

This manual was written in conformance with training program in Pathomorphology for higher educational establishments and based on European credit-transfer system principles. Its first part covers one module - general pathologic processes and tumors growth, second part covers systematic and infectious pathology. Notional modules include theoretical knowledge of pathologic processes macroscopic and microscopic manifestations. The aim of the book is clearly and easily assist student to acquire habits of synthetic generalization of pathologic processes demonstration and their interpretation in cause-effect correlations

Better Targeting of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease

Introduction: Inhaled corticosteroids (ICS) have long been a treatment option for Chronic Obstructive Pulmonary Disease (COPD). However, questions over their efficacy have persisted and recent changes to guidance have stated that further research is needed to predict the patient factors that indicate ICS responsiveness. The aim of this thesis was to investigate the effect of variables, including smoking status, asthma co-diagnosis and blood eosinophil counts, on the outcomes of COPD with ICS use. Method: Three methodologies were used to investigate the aims of this thesis. Systematic review: To examine the literature on the effect of smoking on outcomes with ICS use in COPD an electronic database search was conducted. Fully published randomised controlled trials, in the English language that stratified the participants by smoking status were included. The primary outcome measures were changes in lung function and yearly exacerbation rates. Random effects panel data model: The Clinical Practice Research Datalink with linkage to Hospital Episode Statistics and Office of National Statistics data were used. The cohort was identified based on a previously validated method by Quint et al (2014). The impact of patient variables on the outcomes of lung function, yearly exacerbations and deaths with COPD after three, five and ten years were investigated. Prospective cohort study: Patients in the cohort above were categorised by yearly ICS usage. Patients prescribed ICS were matched to those not using ICS based on propensity score. The outcomes measured were lung function, yearly exacerbations and deaths after three, five and ten years. Sub-group analysis was performed on the variables of smoking status, asthma co-diagnosis and blood eosinophil levels. Results: Systematic review: Eight studies were identified. Heavier or current smokers did not gain the same benefit from ICS use on lung function and exacerbation rates as lighter or ex-smokers do, however effect size may not be clinically important. Random effects panel data model: An asthma co-diagnosis in people with COPD resulted in a lower probability of death, better lung function and less hospital-treated exacerbations compared to no asthma co-diagnosis. Smoking resulted in reduced lung function and an increased probability of death compared to non-smokers. However, there was no overall effect on yearly exacerbations. Prospective cohort study: ICS use was associated with a greater decline in lung function and increased exacerbation rates but lower probability of death versus no-ICS use. In the sub-group analysis, smoking was associated with an additional 58ml decline in lung function at year five, an increase of 0.074 yearly exacerbations and 6.8% increased probability of mortality with ICS use than for non-smokers. An asthma co-diagnosis conferred decreased probability of mortality of up to 8.2% at year five for ICS users compared to those with no asthma co-diagnosis. ICS use in the high eosinophil group decreased the probability of mortality by 10% at year five compared to non-use. Conclusion: ICS are of some benefit in treating COPD in terms of lung function and exacerbation rates. If they are to be used, targeting them to people with a co-diagnosis of asthma, with high blood eosinophils or are not current smokers will produce the most benefit in terms of decreased probability of death

Better Targeting of Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease

Introduction: Inhaled corticosteroids (ICS) have long been a treatment option for Chronic Obstructive Pulmonary Disease (COPD). However, questions over their efficacy have persisted and recent changes to guidance have stated that further research is needed to predict the patient factors that indicate ICS responsiveness. The aim of this thesis was to investigate the effect of variables, including smoking status, asthma co-diagnosis and blood eosinophil counts, on the outcomes of COPD with ICS use. Method: Three methodologies were used to investigate the aims of this thesis. Systematic review: To examine the literature on the effect of smoking on outcomes with ICS use in COPD an electronic database search was conducted. Fully published randomised controlled trials, in the English language that stratified the participants by smoking status were included. The primary outcome measures were changes in lung function and yearly exacerbation rates. Random effects panel data model: The Clinical Practice Research Datalink with linkage to Hospital Episode Statistics and Office of National Statistics data were used. The cohort was identified based on a previously validated method by Quint et al (2014). The impact of patient variables on the outcomes of lung function, yearly exacerbations and deaths with COPD after three, five and ten years were investigated. Prospective cohort study: Patients in the cohort above were categorised by yearly ICS usage. Patients prescribed ICS were matched to those not using ICS based on propensity score. The outcomes measured were lung function, yearly exacerbations and deaths after three, five and ten years. Sub-group analysis was performed on the variables of smoking status, asthma co-diagnosis and blood eosinophil levels. Results: Systematic review: Eight studies were identified. Heavier or current smokers did not gain the same benefit from ICS use on lung function and exacerbation rates as lighter or ex-smokers do, however effect size may not be clinically important. Random effects panel data model: An asthma co-diagnosis in people with COPD resulted in a lower probability of death, better lung function and less hospital-treated exacerbations compared to no asthma co-diagnosis. Smoking resulted in reduced lung function and an increased probability of death compared to non-smokers. However, there was no overall effect on yearly exacerbations. Prospective cohort study: ICS use was associated with a greater decline in lung function and increased exacerbation rates but lower probability of death versus no-ICS use. In the sub-group analysis, smoking was associated with an additional 58ml decline in lung function at year five, an increase of 0.074 yearly exacerbations and 6.8% increased probability of mortality with ICS use than for non-smokers. An asthma co-diagnosis conferred decreased probability of mortality of up to 8.2% at year five for ICS users compared to those with no asthma co-diagnosis. ICS use in the high eosinophil group decreased the probability of mortality by 10% at year five compared to non-use. Conclusion: ICS are of some benefit in treating COPD in terms of lung function and exacerbation rates. If they are to be used, targeting them to people with a co-diagnosis of asthma, with high blood eosinophils or are not current smokers will produce the most benefit in terms of decreased probability of death

Hibernoma – two patients with a rare lipoid soft-tissue tumour

Background: Hibernomas are rare benign soft-tissue tumours arising from brown fat tissue. Although imaging characteristics are not specific certain imaging features, common locations and patient demographics may suggest hibernoma as a differential diagnosis. Case presentation: We report on two 48-year-old male patients with hibernoma. The tumour presented with local swelling of the inguinal region in the first patient and was an incidental imaging finding in the second patient. Imaging included magnetic resonance imaging in both patients and computed tomography as well as 18 F-fluorodeoxyglucose positron emission tomography-computed tomography in the second patient. In both cases histological diagnosis was initially based on excisional and needle core biopsy, respectively. Complete surgical resection confirmed the diagnosis of hibernoma thereafter. Conclusion: In soft tissue tumours with fatty components hibernoma may be included into the differential diagnosis. Because of the risk of sampling errors in hibernoma-like tissue components of myxoid and well-differentiated liposarcoma, complete resection is mandatory. This article also reviews the current imaging literature of hibernomas