Morphological and immunohistochemical profile of pancreatic neuroendocrine neoplasms

Publisher Copyright: © 2015, Versalius University Medical Publisher. All rights reserved.The study represents a comprehensive retrospective morphological and immunohistochemical profiling of pancreatic neuroendocrine neoplasms (PNENs) in order to reveal the associations between morphological and molecular parameters. The local tumour spread (T), presence of metastases in regional lymph nodes (N) and distant organs (M), tumour grade (G) and resection line status (R) by pathology findings (pTNMGR), mitotic activity, perineural, vascular and lymphatic invasion were assessed in 16 surgically resected PNENs. By immunohistochemistry, expression of Ki-67, p53, p27, p21, cyclin D1, Bcl-2, E-cadherin, CD44, vimentin, cyclooxygenase 2 (COX-2), microvascular density, and cytokeratin (CK) spectrum, along with neuroendocrine, intestinal and squamous markers were detected. Descriptive statistics, Chi-square test, Spearman’s rank correlation, Mann–Whitney and Kruskal–Wallis methods were applied; p < 0.05 was considered significant. Ki-67, CK19, p63, vimentin and COX-2 were significantly up-regulated in PNENs in comparison to benign pancreatic islets. A complex network of morphological and molecular associations was identified. Ki-67 correlated with PNEN size (p = 0.022), the World Health Organization 2004 and 2010 classification grades (p = 0.021 and p = 0.002), stage (p = 0.028) and mitotic count (p = 0.007) but among molecular markers – with CK19 (p = 0.033) and vimentin (p = 0.045). CK19 was significantly up-regulated in PNENs, having higher pT (p = 0.018), pR (p = 0.025), vascular (p = 0.020), perineural (p = 0.026) and lymphatic invasion (p = 0.043). In conclusion, proliferation activity (by Ki-67), E-cadherin, vimentin and CK19 are important molecular characteristics of PNENs due to significant associations with morphological tumour characteristics, pTNMGR and invasive growth.publishersversionPeer reviewe

Impact of the hypoechogenicity criteria on thyroid nodule malignancy risk stratification performance by different tirads systems

Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses /by/4.0/).Background: Various Thyroid Imaging and Reporting data systems (TIRADS) are used worldwide for risk stratification of thyroid nodules. Their sensitivity is high, while the specificity is suboptimal. The aim of the study was to compare several TIRADS systems and evaluate the effect of hypoechogenicity as a sign of risk of malignancy on the overall assessment of diagnostic accuracy. Methods: The prospective study includes 274 patients with 289 thyroid nodules to whom US and risk of malignancy were assessed according to four TIRADS systems—European (EU‐TIRADS), Korean (K‐TIRADS), TIRADS by American College of Radiology (ACR TIRADS), and modified Kwak et al. TIRADS (L‐TIRADS) systems, in which mild hypoechogenicity is not included in malignancy risk suggestive signs. For all thyroid nodules, a fine needle aspiration (FNA) biopsy was performed and evaluated according to the Bethesda system. For all systems, diagnostic accuracy was calculated. Results: Assessing the echogenicity of the thyroid nodules: from 81 of isoechogenic nodules, 2 were malignant (2.1%), from 151 mild hypoechogenic, 18 (12%) were malignant, and from 48 marked hypoechogenic nodules, 16 (33%) were malignant. In 80 thyroid nodules, mild hypoechogenicity was the only sign of malignancy and none appeared malignant. Assessing various TIRADS systems on the same cohort, sensitivity, specificity, PPV, NPV, and accuracy, firstly for EU‐TIRADS, they were 97.2%; 39.9%; 18.7%; 99.0%, and 73.3%, respectively; for K‐TIRADS they were 97.2%; 46.6%; 20.6%; 99.2%, and 53.9%; for ACR‐TIRADS they were 97.2%; 41.1%, 19.0%; 99.0%, and 48.0%, respectively; finally, for L‐TIRADS they were 80.6%; 72.7%; 29.6%; 96.3%, and 73.3%. Conclusions: This comparative research has highlighted that applying different TIRADS systems can alter the number of necessary biopsies by re‐categorization of the thyroid nodules. The main pattern that affected differences was inconsistent hypoechogenicity interpretation, giving the accuracy superiority to the systems that raise the malignancy risk with marked hypoechogenicity, at the same time with minor compensation for sensitivity.publishersversionPeer reviewe

Multislice Computed Tomography Imaging of Diverticultis Complication: Colovenous Fistula

Acute colon pathology as diverticulitis is a frequent and important gastrointestinal disease, but the clinical diagnosis is often difficult to state. Several radiological studies have been used to assist in the diagnosis of acute diverticulitis (e.g. barium enema, ultrasound, and computed tomography (CT). Colovenous fistula is a rare complication of diverticulitis. We have analyzed MSCT imaging role in evaluation of such complicated form of diverticular disease.publishersversionPeer reviewe

Non‐Marked Hypoechogenic Nodules : Multicenter Study on the Thyroid Malignancy Risk Stratification and Accuracy Based on TIRADS Systems Comparison

Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Background and Objectives: The aim of the study was to evaluate the predictive value of the ultrasound criterion “non‐marked hypoechogenicity” for malignancy and to determine whether classification of these nodules as TIRADS 3 could improve the overall accuracy of consequently adjusted M‐TIRADS score. Materials and Methods: A total of 767 patients with 795 thyroid nodules were subject to ultrasonography examination and ultrasound‐guided fine needle aspiration biopsy. Nodules were classified by Kwak TIRADS and modified (M‐TIRADS) categories 4A, 4B, and 5 according to number of suspicious US features (marked hypoechogenicity, microlobulated or irregular margins, microcalcifications, taller‐than‐wide shape, metastatic lymph nodes). Non‐marked hypoechoic nodules were classified as TIRADS 3. Results: Thyroid nodules were classified as TIRADS 2, 3, 4A, 4B, and 5 in 14.5, 57.5, 14.2, 8.1, and 5.7%, respectively. Only histopathologic results (125 nodules underwent surgery) and highly specific cytology results (Bethesda II, VI) were accepted as a standard of reference, forming a sub‐cohort of 562/795 nodules (70.7%). Malignancy was found in 7.7%. Overall, M‐TIRADS showed sensitivity/specificity of 93.02/81.31%, and for PPV/NPV, these were 29.2/99.29%, respectively (OR—18.62). Irregular margins showed the highest sensitivity and specificity (75.68/93.74%, respectively). In TIRADS 3 category, 37.2% nodules were isoechoic, 6.6% hyperechoic, and 52.2% hypoechoic (there was no difference of malignancy risk in hypoechoic nodules between M‐TIRADS and Kwak systems—0.9 vs. 0.8, respectively). Accuracy of M‐TIRADS classification in this cohort was 78.26% vs. 48.11% for Kwak. Conclusions: The non‐marked hypoechoic nodule pattern correlated with low risk of malignancy; classification of these nodules as TIRADS 3 significantly improved the predictive value and overall accuracy of the proposed M‐TIRADS scoring with malignancy risk increase in TIRADS 4 categories by 20%; and no significant alteration of malignancy risk in TIRADS 3 could contribute to reducing overdiagnosis, obviating the need for FNA.publishersversionPeer reviewe

Large Parathyroid Tumor 8 Years after Thyroid Surgery : A Case Report

Funding Information: This case report was funded by the Fundamental and Useful Research Project (FLPP) within the project “Multiparametric ultrasound correlation with morphology in patients with primary hyperparathyroidism [Nr. lzp-2020/2-0297].” The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2022 S. Karger AG. All rights reserved.This report represents an unusually large parathyroid carcinoma (PC) mimicking thyroid nodule recurrence after hemithyroidectomy. PC is a rare endocrine malignancy accounting for less than 1% of hyperparathyroidism cases. This is the first case report where contrast-enhanced ultrasound (CEUS) was performed on a PC. A 63-year-old female presented with an enlarged mass on the left side of the neck. In 2012, left-side hemithyroidectomy was done due to a benign goiter. In 2020, laboratory analysis showed markedly elevated parathyroid hormone and calcium. Multiparametric neck ultrasonography was performed including B-mode, color Doppler, shear wave elastography, and CEUS. Computed tomography revealed an irregular mass in proximity to the trachea, esophagus, and dislocation of the common carotid artery. Perifocal fatty tissue appeared normal. Scintigraphy displayed a suspected parathyroid tumor or a suspected left lobe nodule of thyroid. Based on the biochemical diagnosis of primary hyperparathyroidism and radiological examinations, a suspected parathyroid tumor was considered. Intraoperative findings demonstrated an unusually large 9 × 6 cm tumor (84 g) adjacent to the common carotid artery anterolaterally and the recurrent laryngeal nerve medially. Pathohistological examination revealed a tumor solid in structure, with focal necrosis penetrating the capsule. Immunohistochemical analysis was positive for chromogranin, CD56, and Ki-67 (8–10%) and negative for CK20 and CK7. The morphological and immunohistochemical results correspond to PC. PC is a challenging diagnosis requiring a multidisciplinary approach, especially in the case of previous neck surgery. The only curative treatment for PC is radical surgery. Lifelong monitoring of PCs is mandatory due to the high recurrence rate.publishersversionPeer reviewe

Update on the role of ultrasound guided radiofrequency ablation for thyroid nodule treatment

Publisher Copyright: © 2017 IJS Publishing Group LtdThyroid nodules can be frequently detected in general population, most of them are benign, however malignant cases are rising in the past decades. Ultrasound (US) is the most common imaging modality to assess thyroid nodular lesions, plan patient work-up and guide minimally invasive treatment. The present review paper has been researched to evaluate the current status of radiofrequency ablation (RFA) treatment in order to evaluate indications, techniques, complications, limitations and outcome assessment in benign solid, partially cystic nodules and recurrent malignant nodules. RFA comparison with other ablation techniques has been provided as well. US guided Radiofrequency ablation has been proved to be effective and safe in cases of benign thyroid nodules and a promising treatment method alternative to surgery for patients with recurrent papillary thyroid cancer. It's major role lies in significant reduction of thyroid nodule mean volume and improvement of the patient symptoms. However, future multicenter studies are warranted to better clarify the multi-parametric patient selection criteria and evaluate RFA technique efficacy, advantages and limitations in the variety of thyroid nodular disease.publishersversionPeer reviewe

Power Measurement and Data Logger with High-Resolution for Industrial DC-Grid Application

Power and energy measurement and monitoring is a key factor for many industries in terms of energy and cost efficiency evaluation. Due to trends of Smart Grid concept application in industrial environment, including decentralized DC-Grid implementation, for precise evaluation – faster and low-cost measurement equipment is needed. Manufacturing industry widely uses industrial robots that have dynamic load characteristics for which faster measurement equipment is needed

Power Measurement and Data Logger Device with High-Resolution for Industrial DC-Grid Application

Abstract – power and energy measurement and monitoring is a key leading factor for many industries in terms of energy and cost efficiency evaluation. Due to trends of Smart Grid concept application in industrial environment, including decentralized DC-Grid implementation, for precise evaluation - faster and lower cost measurement equipment is needed. Manufacturing industry use lot of industrial robots that have dynamic load characteristics, and to know their consumption faster measurement equipment is needed. This paper gives brief description of developed power measurement equipment, its structure and interconnection to industrial PROFInet network. Further as a testing method steady state and dynamic loads are selected and analyzed. For testing, specially created industrial DC-Grid testing environment and equipment has been used. Testing results shows that selected method and idea is working, and it is able to measure dynamic loads with high resolution. For other industrial load types, discussion rises, about how detailed resolution is needed in industrial SmartGrids, as energy forecast is a new trend in robotic industry, and manufacturing planning