Clinicopathological Study of Uterine Leiomyomas – A Retrospective Study

Leiomyomas are benign tumors of the uterus affecting women of the reproductive age group. They are the most common gynaecologic neoplasms in women. The aim of our study was to analyse and correlate the histopathological findings of leiomyomas in 203 hysterectomy specimens received in the department of Pathology at Saveetha Medical College and to further delineate the associated changes and variants that were observed in the leiomyoma specimens. In this study we found that the dominant age group was 31-50 years of age with multiple leiomyomas being more common than solitary ones. The most commonly observed location was intramural. Majority of the hysterectomy specimens showed a proliferative pattern of endometrium. Degenerative changes were observed in 26 cases with hyaline degeneration being the most common secondary change. There were multiple uterine pathologies associated with the uterine leiomyomas of which ovarian cortical cysts were the most frequently noted. The histopathological study of leiomyomas is important as it helps to further ascertain the diagnosis and ensure optimal patient management.

Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach

Background: Current practice in cardiogenic shock is guided by expert opinion in guidelines and scientific statements from professional societies with limited high quality randomized trial data to inform optimal patient management. An international panel conducted a modified Delphi process with the intent of identifying aspects of cardiogenic shock care where there was uncertainty regarding optimal patient management. Methods: An 18-person multidisciplinary panel comprising international experts was convened. A modified RAND/University of California Los Angeles appropriateness methodology was used. A survey comprising 70 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9: 1 to 3 inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. A summary of the results was discussed as a group, and the survey was iterated and completed again before final analysis. Results: There was broad alignment with current international guidelines and consensus statements. Overall, 44 statements were rated as appropriate, 19 as uncertain, and 7 as inappropriate. There was no disagreement with a disagreement index <1 for all statements. Routine fluid administration was deemed to be inappropriate. Areas of uncertainty focused panel on pre-PCI interventions, the use of right heart catheterization to guide management, routine use of left ventricular unloading strategies, and markers of futility when considering escalation to mechanical circulatory support. Conclusions: While there was broad alignment with current guidance, an expert panel found several aspects of care where there was clinical equipoise, further highlighting the need for randomized controlled trials to better guide patient management and decision making in cardiogenic shock.

HISTOMORPHOLOGICAL VARIANTS AND SECONDARY CHANGES IN UTERINE LEIOMYOMA

BACKGROUND: Leiomyoma is one of the most common causes of Abnormal Uterine Bleeding. It occurs chiey in women during active reproductive years. It has a lot of morphological variants and secondary changes which may mimic malignancy clinically, radiologically and histologically. A few degenerative changes and variants like Atypical and Mitotically active Leiomyoma may be misdiagnosed as malignancy. It is imperative to have a good knowledge of Leiomyosarcoma as the treatment protocol varies. AIMS AND OBJECTIVES: To analyse the morphological variants and secondary changes in Leiomyoma and to study the associated changes in the endometrium. MATERIALS AND METHODS: 420 Hysterectomy specimens with Fibroid received at Govt. Kilpauk medical College, Chennai were studied from January 2018 to January 2020. RESULTS: Leiomyoma was seen in the reproductive age group and menorrhagia was the most common clinical presentation. Hyalinisation was the most common secondary change seen in Leiomyoma and cellular leiomyoma was the most common morphological variant. CONCLUSION:A good comprehensive and accurate knowledge of the morphological variants and secondary changes in Leiomyoma mandatory to avoid misdiagnosis and ensuring optimal patient management.

Injected Breast Materials: Review of Imaging Features and Characteristics

In the United States, silicone and saline breast implants with their familiar radiologic appearance are the mainstays of breast augmentation. However, less well-known sequelae of unconventional injected materials introduced for cosmetic and noncosmetic purposes may also be encountered on breast imaging—for example, free silicone, paraffin and/or oil, polyacrylamide gel, autologous fat, and hyaluronic acid, which are encountered in the setting of breast augmentation. Breast injection of go-yak is not cosmetic but also results in characteristic imaging findings. Breast changes due to extravasation of chemotherapy or interstitial brachytherapy can mimic the appearance of injected noncosmetic materials. Because many of these materials can mimic or obscure imaging findings of breast cancer, it is important to recognize their varied appearances and the limitations of imaging alone in delineating breast injection material from cancer. Given the relatively uncommon incidence of injected materials into the breast, this article aims to review the imaging appearance in order to aid radiologists in maximizing cancer detection and ensuring optimal patient management.

Liver damage while Covid-19: problems of pathogenesis and treatment

The purpose of the review is to present an analysis of the current literature data on the pathogenesis and therapy of liver damage in Covid-19. Liver damage in COVID-19 patients can be caused by the direct cytopathogenic effect of SARS-CoV-2, an uncontrolled immune response, sepsis, severe hypoxia, or drug damage. In addition, COVID-19 can exacerbate and decompensate previously formed chronic liver diseases with the development of acute liver failure. Physicians should carefully assess the initial state of the liver, and after prescribing therapy, intensify monitoring of its functional state, especially in patients with severe COVID-19. In each clinical case, the doctor needs to establish the possible mechanisms of organ damage in order to select the most optimal patient management tactics, which would take into account all aspects of the COVID-19 course and liver damage. Currently, additional scientific information is required to uncover the features of liver damage during SARS-CoV-2 infection and in the postcovid period. Patients who have undergone COVID-19 need further monitoring to assess the long-term effects of the disease.

P160 Can the Lemann index at diagnosis predict the risk of early surgery in Crohn’s disease?

Background Identifying patients with Crohn’s disease (CD) with rapid disease progression or at high risk for early surgery is a crucial pillar in the treatment decision to ensure optimal patient management. The objective of this study was to assess the correlation between the Lemann index at the time of diagnosis and abdominal surgery in the first year after diagnosis of Crohn’s disease and to find the risk factors for early surgery. Methods This is a retrospective study of all patients with CD followed in our center over a period of 4 years (January 2016- January 2020), and who were evaluated by endoscopy and MRI at baseline. The Lemann Index is a score that measures cumulative damage to digestive tissue from entero-MRI and endoscopy data. It was calculated by noting the previous surgery, the location and extension of the disease and any intestinal complications. The sociodemographic and clinical characteristics of the patients were studied. Hypothesis tests were applied to identify associations. Results 112 patients with CD were included in this study, of which 53.6% were female. The mean age at diagnosis was 33.29 years [15–63]. Active smoking was found in 34 patients (30.4%). Regarding the localization of CD, it was ileal (L1 according to the Montreal classification), colonic (L2), and ileocolonic (L3) in respectively 16.1%, 42.9% and 41%. The disease phenotype was inflammatory (B1) in 60.7%, stricturing (B2) in 21.42%, and penetrating (B3) in 17.85%. Anoperineal manifestations were noted in 24 patients. An upper digestive tract was present in 19.6% of patients. The initial flare was judged to be severe in 33.9% of cases, moderate in 55.4% of cases and mild in 10.7% of cases, with a mean CDAI of 305.21 [115–493]. During the first year after diagnosis of CD, 19.6% of patients (n = 22) required surgical treatment. The indications for surgery were: the presence of an intra-abdominal collection (27.3%), severe acute corticosteroid-resistant colitis (18.2%); ileocaecal stenosis resistant to medical treatment (27.3%) or acute bowel obstruction (27.3%). The LI at diagnosis was much higher in the early surgery group: 5.22 +/- 2.65 vs. 2.63 +/- 1.88; with a statistically significant difference (p = 0.01). A severe initial flare as well as a penetrating phenotype were predictors of early abdominal surgery (p = 0.022, p = 0.024, respectively). Conclusion According to our study, a high Lemann score at diagnosis correlates well with the risk of early surgery in Crohn’s disease. Further, larger-scale studies would be needed to establish the reliability of this test in predicting this risk.

Nontuberculous mycobacteria and bronchiectasis

Nontuberculous mycobacterial pulmonary disease is an emerging multidisciplinary problem during the last decades, despite the lack of epidemiological data in most countries, including the Republic of Moldova. An increasing interest has been observed in evaluating nontuberculous mycobacteria (NTM) in patients with bronchiectasis, although the dilemma of which of these diseases comes first remains unresolved. This paper reviews several aspects of the correlations between NTM and bronchiectasis including pathogenesis, radiological features, diagnosis and management, emphasizing the necessity for clinicians to have sufficient familiarity of the mycobacteria types to provide optimal patient management.

Recurrent, refractory hypokalemia as a diagnostic clue to thyrotoxic periodic paralysis in a patient with acute kidney injury and suspected Guillain-Barre syndrome.

Hypokalemia can be multifactorial. When the primary driver of hypokalemia is obvious it is easy to miss other contributing causes that could be vital to optimal patient management and outcomes. Our case report highlights the importance of recognizing recurrent, refractory hypokalemia as a diagnostic clue to thyrotoxic periodic paralysis.

Are radiologists ready to evaluate true response to immunotherapy?

Background Standardized response criteria for evaluating patients radiological imaging have an essential role in oncological management. Immunotherapy, using immune checkpoint inhibitors (ICIs), including drugs targeting cytotoxic T-lymphocyte-associated antigen 4 and programmed cell death protein 1 or its ligand, promise a new role that has demonstrated improvement management in cancers resistant to chemotherapy. This article reviews the literature to understand the most useful response evaluation criteria for optimal patient management under immunotherapy treatment. Areas that warrant further research are described. Conclusion In conclusion, ICIs have become more widely accepted and used by medical oncologists. Radiologists face challenges in assessing tumor response and becoming more involved in the management of treatment. The latest published immune-RECIST criteria can be used in response assessment, but further prospective evaluation is needed with registration clinical trials to be definitively validated.