Fine-needle aspiration cytology in children with superficial lymphadenopathy.

Introduction: In pediatric population Fine-Needle Aspiration Citology (FNAC) is slowly gaining acceptance in clinical management of Superficial Lymphadenopathy (SL). Our experience adds some data about the usefulness of this technique in diagnosing the cause of a SL and therefore guiding further treatment. Patients and Methods: 238 FNAC were performed in 217 patients with SL, observed at our Institution from 2002 to 2006. The neck was the most frequent localization. The results were available within few hours. In cases of granulomatous findings, the samples were processed for microbiological and PCR test, in order to identify Mycobacteria. Results: 174 were reactive lesions, 38 granulomatous lymphadenopathies, 24 malignant lesions, 2 specimens inadequate for diagnosis. Among the 174 reactive SL, 22 required an incisional biopsy after 1 month follow-up. Among the granulomatous lymphadenopathies, 13 children with Cat-Scratch Disease recovered, 25 with Mycobacteria infection underwent surgical excision. For 24 malignant lesions, the diagnosis was confirmed by further biopsy. Two false negative and no false positive were detected (sensitivity 92%, specificity 100%). No complications were encountered. Conclusions: In our experience FNAC, performed by experienced cytopathologist, has revealed to be a fast, safe, non invasive and inexpensive method to achieve diagnosis in persistent SL. The use of FNAC gave us the possibility to select patients for further investigation and/or surgical treatment. Incisional biopsy remains necessary to confirm the diagnosis in case of malignancy or doubtful lesions

Innovation and Design in the Age of Artificial Intelligence

At the heart of any innovation process lies a fundamental practice: the way people create ideas and solve problems. This \u201cdecision making\u201d side of innovation is what scholars and practitioners refer to as \u201cdesign.\u201d Decisions in innovation processes have so far been taken by humans. What happens when they can be substituted by machines? Artificial Intelligence (AI) brings data and algorithms to the core of the innovation processes. What are the implications of this diffusion of AI for our understanding of design and innovation? Is AI just another digital technology that, akin to many others, will not significantly question what we know about design? Or will it create transformations in design that current theoretical frameworks cannot capture?. This paper proposes a framework for understanding the design and innovation in the age of AI. We discuss the implications for design and innovation theory. Specifically, we observe that, as creative problem-solving is significantly conducted by algorithms, human design increasingly becomes an activity of sensemaking, that is, understanding which problems should or could be addressed. This shift in focus calls for the new theories and brings design closer to leadership, which is, inherently, an activity of sensemaking. Our insights are derived from and illustrated with two cases at the frontier of AI\u2014Netflix and Airbnb (complemented with analyses of Microsoft and Tesla)\u2014which point to two directions for the evolution of design and innovation in firms. First, AI enables an organization to overcome many past limitations of human-intensive design processes, by improving the scalability of the process, broadening its scope across traditional boundaries, and enhancing its ability to learn and adapt on the fly. Second, and maybe more surprising, while removing these limitations, AI also appears to deeply enact several popular design principles. AI thus reinforces the principles of Design Thinking, namely: being people-centered, abductive, and iterative. In fact, AI enables the creation of solutions that are more highly user centered than human-based approaches (i.e., to an extreme level of granularity, designed for every single person); that are potentially more creative; and that are continuously updated through learning iterations across the entire product life cycle. In sum, while AI does not undermine the basic principles of design, it profoundly changes the practice of design. Problem-solving tasks, traditionally carried out by designers, are now automated into learning loops that operate without limitations of volume and speed. The algorithms embedded in these loops think in a radically different way than a designer who handles the complex problems holistically with a systemic perspective. Algorithms instead handle complexity through very simple tasks, which are iterated continuously. This paper discusses the implications of these insights for design and innovation management scholars and practitioners

Collecting duct carcinoma of kidney producing alpha-fetoprotein

A case of a collecting duct carcinoma (CDC) of the kidney alpha-fetoprotein producing is reported. Serum elevation of alpha-fetoprotein (AFP) is a common marker for hepatocellular carcinoma, although some extrahepatic carcinomas, also of the kidney, with elevated AFP levels have also been reported in the literature. CASE REPORT: A 62-year-old man with a collecting duct carcinoma of the kidney presenting as a mediastinal mass and supra-clavicular lymph node enlargement, and with a serum alpha-fetoprotein (AFP) level of 102.8 microg/L. RESULTS AND CONCLUSIONS: CDC of the kidney is associated with an aggressive course and extremely poor prognosis. There are no standard treatment regimens, and neither immunotherapy nor chemotherapy has been found to be effective. In the present case, nephrectomy followed by a chemotherapeutic association of carboplatin and gemcitabine gave promising results, with lessening of the patient's symptoms

When hardware matters: innovation strategies to integrate digital technologies in physical products

Notwithstanding AI adoption has been leading to critical jumps in the productivity of platform-based firms like Amazon, Netflix, Uber, or Airbnb, traditional manufacturing firms are often not capable to fully benefit from AI adoption. One of the reasons for this failure is that those firms’ value propositions are highly based on hardware, which clashes with AI. Contrary to AI, hardware suffers from low scalability and low adaptability inertias. In this paper, we investigate strategies to mitigate those inertias by adopting a multiple-case study methodology, drawing on the instances of four companies that innovatively redesign hardware to relax the constraints that the presence of hardware imposes on AI. This analysis identifies two strategic initiatives that can be undertaken by firms, which are the Minimum Valuable Hardware and the Anticipation strategies

Fine-needle aspiration cytology in children with superficial lymphadenopathy

Introduction: In pediatric population Fine-Needle Aspiration Citology (FNAC) is slowly gaining acceptance in clinical management of Superficial Lymphadenopathy (SL). Our experience adds some data about the usefulness of this technique in diagnosing the cause of a SL and therefore guiding further treatment. Patients and Methods: 238 FNAC were performed in 217 patients with SL, observed at our Institution from 2002 to 2006. The neck was the most frequent localization. The results were available within few hours. In cases of granulomatous findings, the samples were processed for microbiological and PCR test, in order to identify Mycobacteria. Results: 174 were reactive lesions, 38 granulomatous lymphadenopathies, 24 malignant lesions, 2 specimens inadequate for diagnosis. Among the 174 reactive SL, 22 required an incisional biopsy after 1 month follow-up. Among the granulomatous lymphadenopathies, 13 children with Cat-Scratch Disease recovered, 25 with Mycobacteria infection underwent surgical excision. For 24 malignant lesions, the diagnosis was confirmed by further biopsy. Two false negative and no false positive were detected (sensitivity 92%, specificity 100%). No complications were encountered. Conclusions: In our experience FNAC, performed by experienced cytopathologist, has revealed to be a fast, safe, non invasive and inexpensive method to achieve diagnosis in persistent SL. The use of FNAC gave us the possibility to select patients for further investigation and/or surgical treatment. Incisional biopsy remains necessary to confirm the diagnosis in case of malignancy or doubtful lesions

Fine-needle cytology of cutaneous juvenile xanthogranuloma and langerhans cell histiocytosis.

BACKGROUND: In pediatric patients, a cutaneous nodule is usually diagnosed by performing an excisional biopsy, but fine-needle cytology (FNC) is a safer and noninvasive diagnostic method widely used to obtain diagnostic specimens with little stress to the patient. The authors compared the ability of FNC and biopsy to differentiate Langerhans cell histiocytosis (LCH) from juvenile xanthogranuloma (JXG). METHODS: Correlating cytological results with histological findings, the authors reviewed 27 patients (15 males and 12 females; mean age, 37 months; range, 1 month to 14 years) admitted to the University of Padua Department of Pediatrics from 1998 to 2010. RESULTS: Cytology smears were adequate in all 27 (100%) patients: 14 (52%) were classified as having JXG, 12 (44%) as having LCH, and 1 (4%) as having a doubtful finding. A biopsy was also performed in 20 of these patients, and in all but 1, the 2 methods were completely concordant. CONCLUSIONS: FNC is safe and useful in the diagnostic workup of pediatric patients with cutaneous nodules and has no contraindications to its use as the initial diagnostic procedure. Cancer (Cancer Cytopathol) 2011;119:134-40. (C) 2010 American Cancer Society

Lung metastasis from TTF-1 positive sigmoid adenocarcinoma. pitfalls and management.

The lung is a frequent site of metastatic involvement, and in many cases the differential diagnosis between a metastasis and a primary carcinoma is a substantial question. TTF-1 is considered as a reliable marker for differential diagnosis in distinguishing primary lung carcinoma and metastasis, especially when dealing with an adenocarcinoma or a large-cell carcinoma. It was generally thought that adenocarcinomas arising in the gastrointestinal tract do not express TTF-1. Recently, it has been reported that a small percentage (1.8%-5.8%) of intestinal adenocarcinoma TTF-1 positive show differences in sensitivity/specificity depending on the antibody clones. We report a case of lung localization of a TTF-1 positive adenocarcinoma in a patient with a history of colon adenocarcinoma. Based on the current results and previous reports, we propose the following criteria for diagnosing lung metastasis from TTF-1 positive intestinal adenocarcinoma. 1) Clinical features and anamnestic history are diagnostic milestones, and provide very important information as a prognostic parameter of primary carcinoma and the time interval between the two localizations (primary and metastasis). 2) The histologic features are compatible with an enteric differentiation. 3) TTF-1 must be tested in the primary carcinoma. 4) In lung lesions, in association with TTF-1, it could be useful to test other immunohistochemical markers such as CDX-2 and NapsinA. 5) Testing other immunohistochemical or molecular markers in either lesion is not very useful. Heterogeneity between primary and metastatic lesions has been reported in the literature. Application of the above-mentioned criteria would simplify diagnosis of lung metastases from TTF-1 positive intestinal adenocarcinoma

Rhabdoid Carcinoma of the Colon: A Distinct Entity With A Very Aggressive Behavior: A Case Report Associated With a Polyposis Coli and Review of the Literature

Rhabdoid colon tumors (RCTs) are rare lesions whose existence as an independent distinct entity remains controversial. To date, 6 RCTs have been reported. This study reports a novel case associated with polyposis coli in a 73-year-old woman. Histologically, the neoplasia was heterogeneous consisting of an adenocarcinoma associated with rhabdoid features. In rhabdoid component, an intense expression of MSH2 was noted but MLH1 was negative. A BRAF V600E mutation and no KRAS mutations were identified. The promoter regions of subset of genes highly specific to characterize the CIMP status (NEUROG1, IGF2, RUNX3, SOCS1, including MLH1) were hypermethylated, suggesting the presence of CIMP+ and MSI high tumor. In conclusion, all RCTs have similar clinical features. The presence of polyposis and adenocarcinoma component as well as the expression of mesenchymal marker suggests a sarcomatous dedifferentiation. It is argued that RCT could be a very aggressive entity of colon, which could benefit from new biological colonic treatments