Ensemble Learning of Tissue Components for Prostate Histopathology Image Grading

Ensemble learning is an effective machine learning approach to improve the prediction performance by fusing several single classifier models. In computer-aided diagnosis system (CAD), machine learning has become one of the dominant solutions for tissue images diagnosis and grading. One problem in a single classifier model for multi-components of the tissue images combination to construct dense feature vectors is the overfitting. In this paper, an ensemble learning for multi-component tissue images classification approach is proposed. The prostate cancer Hematoxylin and Eosin (H&E) histopathology images from HUKM were used to test the proposed ensemble approach for diagnosing and Gleason grading. The experiments results of several prostate classification tasks, namely, benign vs. Grade 3, benign vs.Grade4, and Grade 3vs.Grade 4 show that the proposed ensemble significantly outperforms the previous typical CAD and the naïve approach that combines the texture features of all tissue component directly in dense feature vectors for a classifier

HBME-1 expression in differentiating benign and malignant thyroid lesions

Thyroid carcinomas are classically diagnosed based on specific morphological criteria. In some cases, a definitive diagnosis may be difficult when morphological features are equivocal. This study evaluated the utility of Hector Battifora Mesothelial-1 (HBME-1) as an immunohistochemical marker to differentiate malignant from benign thyroid lesions and to compare its expression in different types of thyroid lesions. The sensitivity and specificity of HBME-1 as a specific marker for thyroid carcinoma were also studied. A total of 54 malignant and 54 benign thyroid cases diagnosed were collected in Universiti Kebangsaan Malaysia Medical Centre for a period of seven years. All cases were stained with HBME-1 and evaluated by three independent observers. The cases were scored based on the proportion of staining and graded as 0 (less than 10%), 1+ (10-25%), 2+ (26-50%) or 3+ (more than 50%). In addition, the score of malignant cases was correlated with their pathological tumour stage. HBME-1 showed significantly higher expression in malignant compared to benign lesions (P<0.001) with papillary thyroid carcinoma (PTC) showed the highest expression among the carcinoma cases (87.1%). Benign lesions were mostly negative (96%), except for two follicular adenoma cases having focal positivity. HBME-1 had a sensitivity of 57% and specificity of 96% in thyroid carcinoma. There was no correlation between HBME-1 expression and TNM primary tumour stage (pT). HBME-1 might be a useful marker in distinguishing malignant from benign thyroid lesions, especially in PTC cases

Alveolar rhabdomyosarcoma of the neck in a two-months-old baby: diagnostic challenges

Rhabdomyosarcoma (RMS) is the most common soft tissue malignancy in children and adolescents. The rarity of its occurrence in infant poses a great difficulty in terms of diagnosis and management. Here, we report an aggressive case of alveolar rhabdomyosarcoma in an infant who presented with neck swelling and neurological complications. The Magnetic Resonance Imaging (MRI) revealed a soft tissue swelling of the neck with intraspinal extension and spinal cord compression, raising the possibility of a neurogenic or malignant nerve sheath tumour. Histopathological examination revealed a primitive, small round cell tumour with no rhabdoid differentiation. The clinical presentation, neurological symptoms, tumor location and the histopathologic features were highly suggestive of neuroblastoma. However, the tumour cells were positive for desmin with focal and weak nuclear positivity for myogenin and MyoD1; immunoexpressions which were in favour of rhabdomyosarcoma. Fluorescent in situ hybridization (FISH) confirmed the presence of a translocation t(2;13)(q35;q14), supporting the diagnosis of alveolar rhabdomyosarcoma. Despite chemotherapy, patient succumbed to death after two months due to septic shock. Rhabdomyosarcoma is highly aggressive mesenchymal neoplasm which may present with diagnostic difficulty. This case highlights the importance of molecular studies in making an accurate diagnosis so that appropriate chemotherapy may be instituted

Diffuse large B-cell lymphoma of the small intestine in a patient with refractory coeliac disease.

INTRODUCTION: Coeliac disease enteropathy is associated with an increased risk of lymphomas. Enteropathy-associated T-cell lymphoma is the principal malignancy related to coeliac disease. However, studies have shown that other types of lymphoma such as diffuse large B-cell lymphoma may also be associated with coeliac disease. CASE REPORT: We report a 54-year-old Caucasian man who presented with chronic diarrhoea and weight loss. He was diagnosed with coeliac disease based on positive serology results and duodenal, jejunal, and ileal biopsies that showed villous atrophy. Despite adherence to a gluten-free diet, there was no clinical remission and enteropathy-associated T cell lymphoma was suspected. Repeated endoscopic biopsy showed persistent mucosal disease but no evidence of lymphoma. Several weeks later he presented with a perforated jejunum. Histology of the resected jejunum showed diffuse infiltration of submucosa and muscularis propria by malignant lymphoid cells sparing the mucosa. The cells expressed CD20, CD79α, CD10 and BCL6 and ki67 of 80%, consistent with diffuse large B-cell lymphoma. DISCUSSION: It is suspected that the undetected lymphoma may have contributed to the persistent malabsorption syndrome rendering the patient unresponsive to treatment. Despite thorough clinical and endoscopic evaluation and multiple biopsies, histologic diagnosis of DLBCL was only confirmed following resection of the perforated jejunu

Intracystic haemorrhage in a non-endometriotic Mullerian vaginal cyst: an unexpected phenomenon

We report a case of rare, Mullerian vaginal cyst with intracystic haemorrhage in the absence of endometrial components. To date, this is the second case reported in the literature. A 51-year-old post-menopausal woman with history of anterior vaginal wall cyst was misdiagnosed to have cystocele. The cyst was excised and the content was old blood mixed with mucous. Histopathological examination revealed a Mullerian vaginal cyst without endometrial component. Thus, diagnosis and management of vaginal cyst was revisited and discussed

Diffuse large B-cell lymphoma of the small intestine in a refractory coeliac disease

Introduction: Coeliac disease (CD) is a chronic immune-mediated enteropathy induced by dietary gluten in genetically susceptible individuals. These patients have increased risk of lymphomas. Enteropathy-associated T-cell lymphoma (EATL) was previously thought to be the principal malignancy related to CD, however, recent studies show increased incidence of diffuse large B-cell lymphoma (DLBCL) among CD patients. Here, we report a case of concurrent small intestine DLBCL and CD. Clinical case: A 54-year-old Caucasian male who presented with weight loss and persistent diarrhoea was diagnosed as CD following enteroscopy and ileal biopsy. His symptoms however persisted after six months of gluten-free diet. Oesophagogastroduodenoscopy was then performed and showed generalised villous atrophy with scalloping of duodenal mucosa. MR enterography showed small bowel thickening at the proximal and mid-jejunum with mesenteric lymphadenopathies, suspicious of EATL. Repeat enteroscopy one month later showed thickened jejunal wall and biopsy confirmed mucosal disease consistent with refractory CD without features of EATL. A few weeks later, he presented with acute abdomen; laparotomy with small bowel resection was performed for a perforated jejunum. Pathological findings: His first biopsy from the terminal ileum showed severe mucosal flattening of villi with crypt destruction, hence, a diagnosis of CD was made. The second biopsy from duodenum showed severe active duodenitis with blunted villi. Under suspicion for EATL, the third biopsy taken from the jejunum showed villous blunting and flattening, consistent with refractory CD without features of EATL. Subsequently, small bowel resection was performed and gross examination of the perforated jejunum showed thickened wall and a small polypoidal structure. Microscopically, diffuse malignant lymphoid cells comprised of medium to large cells infiltrated the intestinal wall. Immunohistochemical studies showed that the malignant cells were positive towards CD20, CD79α, CD10 (weak), and BCL-6 with a high proliferative index (80%). These cells were negative for CD3, CD5, CD7, CD8, TIA-1, MUM 1, cyclin D1, and CD56; these features were consistent with a diagnosis of DLBCL. Conclusions: Non-responsive CD warrants thorough dietary review and further evaluation to exclude diseases associated with CD such as enteropathy-associated lymphoma or other alternative diagnosis