Clinicopathological spectrum of gynecological pelvic masses: a cross-sectional study

Background: Pelvic mass lesions are a commonly encountered entity in gynecological practice. These masses may be uterine or adnexal, benign or malignant. Clinicians have to be aware of their differential diagnosis to triage the patients and ensure optimum therapeutic approach. The objectives of this study were to study the diverse clinical spectrum of gynecological pelvic masses and to correlate the preoperative diagnosis based on clinical examination and ultrasonography with intraoperative surgical findings and histopathological examination.Methods: This was a cross sectional observational study on 114 patients with a diagnosis of pelvic mass who underwent laparotomy. All the patients were evaluated by a complete history, general abdominal and pelvic examination, followed by ultrasonography. These preoperative findings were then correlated with surgical findings and histopathological diagnosis.Results: 48% 0f the patients were in the age group of 41-50 years. The most common presenting complaint was lower abdominal/ pelvic pain seen in 78% of the patients. Uterine masses mostly presented as abdominal pain, abdominopelvic mass, menstrual complaints whereas ovarian masses presented with vague G. I symptoms or were asymptomatic. 37% of all masses were leiomyomas. There were 16 uterine malignancies and 14 ovarian cancer cases. Preoperative USG correlated well with histopathological diagnosis.Conclusions: A methodical approach consisting of a proper history, clinical examination, imaging studies and correct interpretation of diagnostic procedures is necessary for the triage and optimum management of gynecologic pelvic masses

Canine idiopathic chronic hepatitis

Canine idiopathic hepatitis is a common disease, categorized histologically by presence of hepatocellular apoptosis or necrosis, a variable mononuclear or mixed inflammatory cell infiltrate, regeneration and fibrosis. Clinical signs are vague and non-specific, but there are known breed, age and gender predispositions. Results of clinical pathology are non-specific, but usually include elevations in liver enzymes and function impairment; a liver biopsy is required for diagnosis. Management involves around the use of an anti-inflammatory dose of glucocorticoids and other supportive and symptomatic therapies including ursodeoxycholic acid, antioxidants, diuretics, and diet. The prognosis is variable, but there are known prognostic indicators, especially the presence of portal hypertensio

Loss of Secreted Frizzled-Related Protein 4 Correlates with an Aggressive Phenotype and Predicts Poor Outcome in Ovarian Cancer Patients

Background: Activation of the Wnt signaling pathway is implicated in aberrant cellular proliferation in various cancers. In 40% of endometrioid ovarian cancers, constitutive activation of the pathway is due to oncogenic mutations in β-catenin or other inactivating mutations in key negative regulators. Secreted frizzled-related protein 4 (SFRP4) has been proposed to have inhibitory activity through binding and sequestering Wnt ligands. Methodology/Principal Findings: We performed RT-qPCR and Western-blotting in primary cultures and ovarian cell lines for SFRP4 and its key downstream regulators activated β-catenin, β-catenin and GSK3β. SFRP4 was then examined by immunohistochemistry in a cohort of 721 patients and due to its proposed secretory function, in plasma, presenting the first ELISA for SFRP4. SFRP4 was most highly expressed in tubal epithelium and decreased with malignant transformation, both on RNA and on protein level, where it was even more profound in the membrane fraction (p<0.0001). SFRP4 was expressed on the protein level in all histotypes of ovarian cancer but was decreased from borderline tumors to cancers and with loss of cellular differentiation. Loss of membrane expression was an independent predictor of poor survival in ovarian cancer patients (p = 0.02 unadjusted; p = 0.089 adjusted), which increased the risk of a patient to die from this disease by the factor 1.8. Conclusions/Significance: Our results support a role for SFRP4 as a tumor suppressor gene in ovarian cancers via inhibition of the Wnt signaling pathway. This has not only predictive implications but could also facilitate a therapeutic role using epigenetic targets

Radiological manifestations of splenic tuberculosis: a 23-patient case series from India

Background &amp; Objective: Splenic tuberculosis (TB) is a less common but important manifestation of abdominal TB, especially in India and other developing countries. Its prevalence is increasing with the epidemic of HIV-TB co-infection and subsequent rise in extrapulmonary TB. The range of radiological manifestations of splenic TB is poorly described. Here, we review the ultrasonographic and computed tomographic (CT) images of 23 cases from two large tertiary care centers in India. Methods: Radiographic images, ultrasonographic in all cases and CT in selected cases, were retrospectively analyzed in a series of 23 patients presenting to two large tertiary care centers in India, with suspected TB and with splenomegaly on physical examination. Images were assessed at baseline and when available following anti-tuberculosis therapy. Results: The ultrasound and CT findings included, in order of most common: single or multiple hypoechoic focal lesions, splenic abscess, calcifications (on CT), and isolated splenomegaly. Five of the six patients with findings of isolated splenomegaly on ultrasound were found to have lesions on CT. Interpretation &amp; Conclusion: Ultrasonography of the spleen is an affordable, non-invasive imaging modality, which can be helpful in diagnosis of splenic TB and assessment of therapeutic response. Proper use of this imaging modality in splenic TB should help avoid unnecessary CT imaging or invasive procedures. However, this technique is operator-dependent, and, when extensive intraabdominal involvement is suspected, or the diagnosis is unclear, CT may be necessary

HURP Expression-Assisted Risk Scores Identify Prognosis Distinguishable Subgroups in Early Stage Liver Cancer

Hepatoma up-regulated protein (HURP) is a component of the chromatin-dependent pathway for spindle assembly. We examined the prognostic predictive value of HURP in human hepatocellular carcinoma (HCC).HURP expression was evaluated by immunocytochemistry of fine needle aspirated hepatoma cells in 97 HCC patients with Barcelona Clinic Liver Cancer (BCLC) stage A. Subsequently, these patients underwent partial hepatectomy (n = 18) or radiofrequency ablation (n = 79) and were followed for 2 to 35 months. The clinicopathological parameters were submitted for survival analysis.HURP expression in aspirated HCC cells was detected in 19.6% patients. Kaplan-Meier survival analysis showed that positive HURP expression (P = 0.023), cytological grading ≥3 (P = 0.008), AFP ≥35 ng/mL (P = 0.039), bilirubin ≥1.3 mg/dL (P = 0.010), AST ≥50 U/L (P = 0.003) and ALT ≥35 U/L (P = 0.005) were all associated with a shorter disease-free survival. A stepwise multivariate Cox proportional hazard model revealed that positive HURP expression (HR, 2.334; 95% CI, 1.165-4.679, P = 0.017), AST ≥50 U/L (HR, 3.697; 95% CI, 1.868-7.319, p<0.001), cytological grade ≥3 (HR, 4.249; 95% CI, 2.061-8.759, P<0.001) and tumor number >1 (HR, 2.633; 95% CI, 1.212-5.722, P = 0.014) were independent predictors for disease-free survival. By combining the 4 independent predictors, patients with different risk scores (RS) showed distinguishable disease-free survival (RS≤1 vs. RS = 2, P = 0.001; RS = 2 vs. RS = 3, P<0.001). In contrast, the patients cannot be separated into prognosis distinguishable subgroups by using AJCC/UICC TNM staging system.HCC patients with BCLC stage A can be separated into three prognosis-distinguishable groups by use of a risk score that is based upon HURP expression in aspirated HCC cells, ALT, cytological grade and tumor number

Clinico-radiological and histopathological study of ovarian masses at a tertiary care centre

Background: Counselling and rapid referral to a specialised facility might be improved with the use of a scoring system that could diagnose ovarian cancer. The relative simplicity of the Risk of Malignancy Index (RMI) scoring technique and the ease with which it may be applied make it a strong candidate to use as a primary diagnostic tool for individuals with pelvic masses. Methods: Prospective observations study conducted on women diagnosed with ovarian mass by clinical examination and confirmed by ultrasonography, undergoing surgery at RL Jalappa Hospital, Kolar from January 2021 to December 2022. Histopathological report was considered as Primary outcome parameter. Age group, Parity, Menstrual history, Risk Malignancy Index, etc., were considered as explanatory parameters. Results: A total of 40 subjects are included among which 22.50% are aged ≤40 years and 77.50% are aged &gt;40 years. Using a cut off of 25, majority (88.2%) of those with malignancy had RMI≥25 and in benign histopathology report 56.5% had ≥25 RMI. Histopathology report, there was a statistically significant (p&lt;0.05) difference in RMI values. The RMI had a sensitivity of 88.24% in predicting malignancy with specificity 43.48%, positive predictive value 53.57%, negative predictive value 83.33% with a total diagnostic accuracy of 62.50%. Conclusions: Results from RMI and histopathology correlate positively. The results of this research show that RMI is a reliable and practicable method for assessing patients with pelvic masses at the commencement of therapy and identifying those who are good candidates for centralised surgical treatment

The Potential Role of Intraoperative Ultrasonography in the Surgical Treatment of Hilar Cholangiocarci noma

The role of intraoperative ultrasonography (IOU) in the surgical treatment of hilar cholangiocarcinoma was explored in twenty-two patients, 17 males and 5 females. The mean age was 55 years (range 36-78 years). Preoperative imaging studies included abdominal ultra-sonography and/or CT scan, and visceral angiography. Operations performed were segment III bypass in 18 patients, local resection of tumour in 2 and resection of tumour en bloc with left hepatectomy in 2. Interpretation of IOU in terms of vascular involvement by the tumour (as compared to angiography or operative findings) was correct in 21 patients; no vascular invasion in 20 and portal vein invasion in the remainder. One false negative result occurred in a patient whose IOU failed to show right hepatic artery encasement by the tumour. When compared to postoperative cholangiography or surgical specimen, IOU correctly demon-strated location and extent of the tumours in all but one patient who had incomplete tumour resection. IOU was also helpful in locating segment III duct for biliary bypass. The mean time used for IOU was 15.1 min (range 10-20 min.), and there was no procedure-related com-plication. When supplemented with operative exploration, IOU seems to be very useful in the assessment of the resectability of hilar cholangiocarcinoma

Prediction of portal pressure from intraoperative ultrasonography

BackgroundPortal hypertension is a major risk factor for hepatic failure or bleeding in patients who have undergone hepatectomy, but it cannot be measured indirectly. We attempted to evaluate the intraoperative ultrasonography parameters that correlate with portal pressure (PP) in patients undergoing hepatectomy.MethodsWe examined 30 patients in whom PP was directly measured during surgery. The background liver conditions included chronic viral liver disease in seven patients, chemotherapy-associated steatohepatitis in four patients, fatty liver in one patient, hepatolithiasis in one patient, obstructive jaundice in one patient, and a normal liver in 16 patients. A multivariate logistic analysis and linear regression analysis were conducted to develop a predictive formula for PP.ResultsThe mean PP was 10.4 ± 4.1 mm Hg. The PP tended to be increased in patients with chronic viral hepatitis. A univariate analysis identified the association of the six following parameters with PP: the platelet count and the maximum (max), minimum (min), endo-diastolic, peak-systolic, and mean velocity in the portal vein (PV) flow. Using multiple linear regression analysis, the predictive formula using the PV max and min was as follows: Y (estimated PP) = 18.235?0.120 × (PV max.[m/s])?0.364 × (PV min). The calculated PP (10.44 ± 2.61 mm Hg) was nearly the same as the actual PP (10.43 ± 4.07 mm Hg). However, there was no significant relationship between the calculated PP and the intraoperative blood loss and post hepatectomy morbidity.ConclusionsThis formula, which uses ultrasonographic Doppler flow parameters, appears to be useful for predicting PP