Myxoma of parotid gland: report of a rare case

Myxomas of head and neck and especially parotid gland are rare. These insidious soft tissue tumours have obscured pathogenesis, can occur at any age, mostly located in the cheek, palate or floor of mouth. They often present with non- specific symptoms like painless slow growing localised swelling in the cheek or around the jaw. Complete excision remains the mainstay of treatment with rare recurrence, no distant metastases and excellent prognosis. Here we reported a case of right sided parotid gland myxoma in a 37 years old man. There were no specific clinical, laboratory or radiological features. Fine needle aspiration cytology was reported as adenoid cystic carcinoma of right parotid gland. Histopathological examination of the specimen confirmed the diagnosis of myxoma. Immunohistochemistry can be helpful, but not necessary to come to a diagnosis

Oral squamous cell carcinoma with clear cell change: a rare case report

Clear-cell variant of oral squamous cell carcinoma is an extremely rare entity. Clear-cell change can be seen in any of the neoplasms, but as pure form variant, it is difficult to find in head-and-neck SCC. We hereby present a case report of 71-year-old male who presented with a growth with erythematous patches on the lateral pharyngeal wall for the past 3 months. Histopathologic examination showed nests, islands and sheets of malignant squamous cells with vesicular nuclei and abundant clear cytoplasm. Neoplastic cells constituting majority of nests exhibited clear cell changes. Special stain was performed to identify the nature of clear cells. periodic acid Schiff-diastase (PAS-D) showed positivity in the clear cells. Immunohistochemical study using antibody for pan-cytokeratin revealed diffuse positivity in the tumor cells

Sinonasal teratocarcinosarcoma: a rare case report from a tertiary care centre of North East India

Sinonasal teratocarcinosarcoma is an extremely rare malignant tumour arising in the sinonasal tract, that may extend intracranially to complicate the treatment and further worsen its dismal prognosis. Diagnosis is challenging because of its rarity and morphologic heterogeneity. Here, we reported a case of a 55 years old male who presented with complaints of left sided nasal blockage and facial swelling. CECT showed a large sinonasal mass with epicentre in the left nasal cavity extending to post nasal space and nasopharynx, eroding the left medial orbital wall and cranially the cribriform plate. Histopathologically, malignant epithelial component comprising of squamous cell carcinoma, mesenchymal component comprising of fibrosarcoma with focal chondroid differentiation, primitive blastemal component with extensive necrosis was noted. Immunohistochemistry demonstrated positivity for synaptophysin, chromogranin, Pan-CK, EMA, CD99, focal p63 in areas of squamous metaplasia; stromal cells showed Desmin, S100, SOX 10 expression: Ki-67 was 30-40%. Immunohistochemistry confirmed the diagnosis of sinonasal teratocarcinosarcoma. Knowledge about this tumour is important because of its heterogenous morphology which often leads to a misdiagnosis, necessitating repeated biopsies and thorough examination of the surgical specimen

Carcinosarcoma of the vulva: a rare case report

Carcinosarcomas are rare and clinically aggressive neoplasms with poor outcome. A very few cases has been reported in the literature. We present a case of a 54 yrs woman with bleeding per vagina for 1.5 months. On per vaginal examination, a lump of size 3×2 cm was found over the left anterior region of vulva. CECT abdomen revealed a well-defined heterogeneously enhancing lesion with calcific foci involving both labia minora. MRI pelvis reveals carcinoma left vulva with involvement of lower 3rd of vaginal wall. Histopathological examination showed features suggestive of carcinosarcoma of the vulva. This was further confirmed by immunohistochemistry which showed positivity for CK, SMA, caldesmon and negative for S100, CD34, desmin, CD31, ERG and MyoD1. Because it is a very rare tumor with severe prognosis, we presented this case as this case report can be a useful addition to the literature.

CT-like MRI: a qualitative assessment of ZTE sequences for knee osseous abnormalities.

OBJECTIVE: To qualitatively evaluate the utility of zero echo-time (ZTE) MRI sequences in identifying osseous findings and to compare ZTE with optimized spoiled gradient echo (SPGR) sequences in detecting knee osseous abnormalities. MATERIALS AND METHODS: ZTE and standard knee MRI sequences were acquired at 3T in 100 consecutive patients. Three radiologists rated confidence in evaluating osseous abnormalities and image quality on a 5-grade Likert scale in ZTE compared to standard sequences. In a subset of knees (n = 57) SPGR sequences were also obtained, and diagnostic confidence in identifying osseous structures was assessed, comparing ZTE and SPGR sequences. Statistical significance of using ZTE over SPGR was characterized with a paired t-test. RESULTS: Image quality of the ZTE sequences was rated high by all reviewers with 278 out of 299 (100 studies, 3 radiologists) scores ≥ 4 on the Likert scale. Diagnostic confidence in using ZTE sequences was rated very high confidence in 97%, 85%, 71%, and 73% of the cases for osteophytosis, subchondral cysts, fractures, and soft tissue calcifications/ossifications, respectively. In 74% of cases with osseous findings, reviewer scores indicated confidence levels (score ≥ 3) that ZTE sequences improved diagnostic certainty over standard sequences. The diagnostic confidence in using ZTE over SPGR sequences for osseous structures as well as abnormalities was favorable and statistically significant (p < 0.01). CONCLUSION: Incorporating ZTE sequences in the standard knee MRI protocol was technically feasible and improved diagnostic confidence for osseous findings in relation to standard MR sequences. In comparison to SPGR sequences, ZTE improved assessment of osseous abnormalities

Deep learning for automated, interpretable classification of lumbar spinal stenosis and facet arthropathy from axial MRI.

OBJECTIVES: To evaluate a deep learning model for automated and interpretable classification of central canal stenosis, neural foraminal stenosis, and facet arthropathy from lumbar spine MRI. METHODS: T2-weighted axial MRI studies of the lumbar spine acquired between 2008 and 2019 were retrospectively selected (n = 200) and graded for central canal stenosis, neural foraminal stenosis, and facet arthropathy. Studies were partitioned into patient-level train (n = 150), validation (n = 20), and test (n = 30) splits. V-Net models were first trained to segment the dural sac and the intervertebral disk, and localize facet and foramen using geometric rules. Subsequently, Big Transfer (BiT) models were trained for downstream classification tasks. An interpretable model for central canal stenosis was also trained using a decision tree classifier. Evaluation metrics included linearly weighted Cohens kappa score for multi-grade classification and area under the receiver operator characteristic curve (AUROC) for binarized classification. RESULTS: Segmentation of the dural sac and intervertebral disk achieved Dice scores of 0.93 and 0.94. Localization of foramen and facet achieved intersection over union of 0.72 and 0.83. Multi-class grading of central canal stenosis achieved a kappa score of 0.54. The interpretable decision tree classifier had a kappa score of 0.80. Pairwise agreement between readers (R1, R2), (R1, R3), and (R2, R3) was 0.86, 0.80, and 0.74. Binary classification of neural foraminal stenosis and facet arthropathy achieved AUROCs of 0.92 and 0.93. CONCLUSION: Deep learning systems can be performant as well as interpretable for automated evaluation of lumbar spine MRI including classification of central canal stenosis, neural foraminal stenosis, and facet arthropathy. KEY POINTS: • Interpretable deep-learning systems can be developed for the evaluation of clinical lumbar spine MRI. Multi-grade classification of central canal stenosis with a kappa of 0.80 was comparable to inter-reader agreement scores (0.74, 0.80, 0.86). Binary classification of neural foraminal stenosis and facet arthropathy achieved favorable and accurate AUROCs of 0.92 and 0.93, respectively. • While existing deep-learning systems are opaque, leading to clinical deployment challenges, the proposed system is accurate as well as interpretable, providing valuable information to a radiologist in clinical practice

Ribosome-associated quality control mediates degradation of the premature translation termination product Orf1p of ODC antizyme mRNA

Decoding of OAZ1 (Ornithine decarboxylase AntiZyme 1) mRNA, which harbours two open reading frames (ORF1 and ORF2) interrupted by a naturally occurring Premature Termination Codon (PTC), produces an 8 kDa truncated polypeptide termed Orf1p, unless the PTC is bypassed by +1 ribosomal frameshifting. In this study, we identified Orf1p as an endogenous ubiquitin-dependent substrate of the 26S proteasome both in yeast and mammalian cells. Surprisingly, we found that the ribosome-associated quality control factor Rqc1 and the ubiquitin ligase Ltn1 are critical for Orf1p degradation. In addition, the cytosolic protein quality control chaperone system Hsp70/Hsp90 and their corresponding co-chaperones Sse1, Fes1, Sti1 and Cpr7 are also required for Orf1p proteolysis. Our study finds that Orf1p, which is naturally synthesized as a result of a premature translation termination event, requires the coordinated role of both ribosome-associated and cytosolic protein quality control factors for its degradation

Ribosome‐associated quality control mediates degradation of the premature translation termination product Orf1p of ODC antizyme mRNA

Decoding of OAZ1 (Ornithine decarboxylase AntiZyme 1) mRNA, which harbours two open reading frames (ORF1 and ORF2) interrupted by a naturally occurring Premature Termination Codon (PTC), produces an 8 kDa truncated polypeptide termed Orf1p, unless the PTC is bypassed by +1 ribosomal frameshifting. In this study, we identified Orf1p as an endogenous ubiquitin-dependent substrate of the 26S proteasome both in yeast and mammalian cells. Surprisingly, we found that the ribosome-associated quality control factor Rqc1 and the ubiquitin ligase Ltn1 are critical for Orf1p degradation. In addition, the cytosolic protein quality control chaperone system Hsp70/Hsp90 and their corresponding co-chaperones Sse1, Fes1, Sti1 and Cpr7 are also required for Orf1p proteolysis. Our study finds that Orf1p, which is naturally synthesized as a result of a premature translation termination event, requires the coordinated role of both ribosome-associated and cytosolic protein quality control factors for its degradation

Evaluation of 2 Novel Ratio-Based Metrics for Lumbar Spinal Stenosis.

BACKGROUND AND PURPOSE: Quantitative metrics of the dural sac such as the cross-sectional area are commonly used to evaluate central canal stenosis. The aim of this study was to analyze 2 new metrics to measure spinal stenosis on the basis of the ratio between the dural sac and disc cross-sectional areas (DDRCA) and the dural sac and disc anterior-posterior diameters (DDRDIA) and compare them with established quantitative metrics of the dural sac. MATERIALS AND METHODS: T2-weighted axial MR images (n = 260 patients) were retrospectively evaluated, graded for central canal stenosis as normal (no stenosis), mild, moderate, or severe from L1/L2 through L5/S1 with 1 grade per spinal level and annotated to measure the DDRCA and DDRDIA. Thresholds were obtained using a decision tree classifier on a subset of patients (n = 130) and evaluated on the remaining patients (n = 130) for accuracy and consistency across demographics, anatomic variation, and clinical outcomes. RESULTS: DDRCA and DDRDIA had areas under the receiver operating characteristic curve of 98.6 (97.4-99.3) and 98.0 (96.7-98.9) compared with dural sac cross-sectional area at 96.5 (95.0-97.7) for binary classification. DDRDIA and DDRCA had κ scores of 0.75 (0.71-0.79) and 0.80 (0.75-0.83) compared with dural sac cross-sectional area at 0.62 (0.57-0.66) for multigrade classification. No significant differences (P > .1) in the area under the receiver operating characteristic curve were observed for the DDRDIA across variations in the body mass index. The DDRDIA also had the highest area under the receiver operating characteristic curve among symptomatic patients (visual analog scale ≥ 7) or patients who underwent surgery. CONCLUSIONS: Ratio-based metrics (DDRDIA and DDRCA) are accurate and robust to anatomic and demographic variability compared with quantitative metrics of the dural sac and better correlated with symptomatology and surgical outcomes

Clinical and radiologic outcomes in patients with meniscal root tears.

BACKGROUND: Meniscal root tears can lead to early knee osteoarthritis and pain. This study aimed (1) to compare clinical and radiological outcomes between patients who underwent arthroscopic meniscal root repair after meniscal root tears and those who received non-surgical treatment, and (2) to identify whether baseline MRI findings could be potential predictors for future treatment strategies. METHODS: Patients with meniscal root tears were identified from our picture archiving and communication system from 2016 to 2020. Two radiologists reviewed radiographs and MRI studies using Kellgren-Lawrence (KL) grading and a modified Whole Organ MRI Scoring (WORMS) at baseline and follow-up. The median (interquartile range [IQR]) of follow-up radiographs and MRI studies were 134 (44-443) days and 502 (260-1176) days, respectively. MR images were assessed for root tear-related findings. Pain scores using visual analogue scale (VAS) and management strategies (non-surgical vs. arthroscopic root repair) were also collected. Chi-squared tests and independent t-tests were used to assess differences regarding clinical and imaging variables between treatment groups. Logistic regression analyses were performed to evaluate the associations between baseline MRI findings and each future treatment. RESULTS: Ninety patients were included. VAS pain scores were significantly (p < 0.01) lower after arthroscopic repair compared to conservative treatment (1.27±0.38vs.4±0.52) at the last follow-up visit with median (IQR) of 325 (180-1391) days. Increased meniscal extrusion (mm) was associated with higher odds of receiving non-surgical treatment (OR = 1.65, 95%CI 1.02-2.69, p = 0.04). The odds of having arthroscopic repair increased by 19% for every 1 mm increase in the distance of the tear from the root attachment (OR = 1.19, 95% CI: 1.05-1.36, p < 0.01). The odds of undergoing arthroscopic repair were reduced by 49% for every 1 mm increase in the extent of meniscal extrusion (OR = 0.51, 95% CI: 0.29-0.91, p = 0.02) as observed in the baseline MRI. CONCLUSIONS: Patients who underwent arthroscopic repair had lower pain scores than patients with conservative treatment in the follow-up. Distance of the torn meniscus to the root attachment and the extent of meniscal extrusion were significant predictors for arthroscopic repair in the next three weeks (time from the baseline MRI to the surgery date)