Solitary luteinized follicle cyst of pregnancy and puerperium

We report a huge ovarian solitary luteinized follicle cyst (SLFC) that contained 17 liters of fluid. Computed tomography scan revealed a 32 x 32 x 20 cm right simple cystic ovarian mass without calcification or septation. The fluid was removed, and the collapsed unilocular cyst was examined pathologically. No solid or papillary areas were identified. The cyst wall lining was composed of multiple layers of luteinized cells of variable size and shape with abundant eosinophilic cytoplasm and focally enlarged, pleomorphic, and hyperchromatic nuclei. Nests of luteinized cells were embedded within the fibrous tissue of the cyst wall. These findings are characteristic of solitary luteinized follicle cyst of pregnancy. Even though less than 15 cysts of this kind have been recorded, one should consider this uncommon, benign, non-neoplastic cystic ovarian lesion in the differential diagnosis of other cystic ovarian lesions.     

Diagnostic accuracy of contrast-enhanced digital mammography in breast cancer detection in comparison to tomosynthesis,synthetic 2D mammography and tomosynthesis combined with ultrasound in women with dense breast

Objective:To assess the diagnostic efficacy of contrast-enhanced digital mammography (CEDM) in breast cancer detection in comparison to synthetic two-dimensional mammography (s2D MG), digital breast tomosynthesis (DBT) alone and DBT supplemented with ultrasound examination in females with dense breast with histopathology as the gold-standard.Methods:It was a prospective study, where consecutive females presenting to symptomatic breast clinic between April 2019 and June 2020 were evaluated with DBT. Females who were found to have heterogeneously dense (ACR type C) or extremely dense (ACR type D) breast composition detected on s2D MG were further evaluated with high-resolution breast ultrasound and thereafter with CEDM, but before the core biopsy or surgical excision, were included in the study. s2D MG was derived from post-processing reconstruction of DBT data set. Females with pregnancy, renal insufficiency or prior allergic reaction to iodinated contrast agent were excluded from the study. Image interpretation was done by two experienced breast radiologists and both were blinded to histological diagnosis.Results:This study included 166 breast lesions in130 patients with mean age of 45 ± 12 years (age range 24–72 years). There were 87 (52.4%) malignant and 79 (47.6%) benign lesions. The sensitivity of CEDM was 96.5%, significantly higher than synthetic 2D MG (75.6%, p < 0.0001), DBT alone (82.8%, p < 0.0001) and DBT + ultrasound (88.5%, p = 0.0057); specificity of CEDM was 81%, significantly higher than s2D MG (63.3%, p = 0.0002) and comparable to DBT alone (84.4%, p = 0.3586) and DBT + ultrasound (79.7%, p = 0.4135). In receiver operating characteristic curve analysis, the area under the curve was of 0.896 for CEDM, 0.841 for DBT + ultrasound, 0.769 for DBT alone and 0.729 for s2D MG.Conclusion:CEDM is an accurate diagnostic technique for cancer detection in dense breast. CEDM allowed a significantly higher number of breast cancer detection than the s2D MG, DBT alone and DBT supplemented with ultrasonography in females with dense breast.Advances in knowledge:CEDM is a promising novel technology with higher sensitivity and negative predictive value for breast cancer detection in females with dense breast in comparison to DBT alone or DBT supplemented with ultrasound.     

Mesenchymal Stem Cells Promote Pancreatic Tumor Growth by Inducing Alternative Polarization of Macrophages

Pancreatic cancer is characterized by an extensive desmoplastic stroma, the functional relevance of which is poorly understood. Activated fibroblasts are a prevalent component of the stroma, and traditionally, these cells have been considered as a homogenous population derived from pancreatic stellate cells. In this study, we highlight a previously unappreciated heterogeneity of the fibroblast population within the stroma. In particular, a subset of stromal fibroblasts has characteristics of mesenchymal stem cells (MSCs). MSCs are present in the normal pancreas as well as in the carcinomatous pancreas (CA-MSCs). Here, we determine that CA-MSCs have increased tumor-promoting function compared with MSCs in normal pancreas. This ability to promote tumor growth is associated with CA-MSCs’ unique ability to promote alternative macrophage polarization. Thus, our study identifies a previously uncharacterized cell population within the stroma and sheds light on tumor-promoting interactions between different components of the stroma.

Significance

Targeting the stroma is emerging as a new paradigm in pancreatic cancer; however, efforts to that effect are hampered by our limited understanding of the nature and function of stromal components. Here, we uncover previously unappreciated heterogeneity within the stroma and identify interactions among stromal components that promote tumor growth and could be targeted therapeutically.     

Evaluation of the effect of impaction on the mineralization of mandibular third molars and forensic age estimation in a sample of south Indian children

Assessment of third molar mineralization is a basic forensic odontological method available for age estimation in children and adolescents. Due to their protracted development into the late adolescence, their development has become the subject of interest and acquired great forensic importance. It is clearly evident in the literature that impaction factor has an influence on the rate of maturation of the third molars. In this regard, the present study was undertaken to test the relationship between impaction and its concomitant effect on the mineralization of the third molar and forensic age estimation. A total of 520 digital orthopantomograms (OPG) of 260 males and 260 females of south Indian origin were assessed retrospectively. Maturation of the third molars (I3M) was assessed using the method of Cameriere et al. (Int J Leg Med 122 (6):493–497, 2008). Impaction status was determined according to the position of lower right and left third molars in relation to the long axis of the second molars. Out of the total sample, 68.1% of lower left third molars and 71.2% of lower right molars were impacted. Statistical measures for I3M were calculated in the males and females for both impacted and non-impacted third molars. It was ascertained that the mean age and I3M values were higher in impacted third molars, indicating the slower rate of maturation than non-impacted ones. The sensitivity and specificity of the test (I3M < 0.08) was 96.2% and 72.4% for non-impacted third molars and 46.2% and 87% for impacted third molars, respectively. Our findings indicate that the cut-off value of I3M < 0.08 resulted in greater number of age misclassifications (false negatives) for impacted molars, highlighting the need for new cut-off value of I3M to meet the legal standards. It was concluded that the mineralization of impacted third molars was slower compared to non-impacted ones in south Indian males and females. Further studies are warranted to validate these findings among a larger and more diverse sample.