Low-grade myofibroblastic sarcoma (LGMS) is a rare spindle cell tumor with indolent course. Due to rarity and low-grade histologic features of LGMS, accurate diagnosis is challenging. We report a ...63-year-old female patient with a three-month history of a 3.1 cm×2.5 cm sized, firm, skin-colored, painless, protruding left back mass. Initial excisional biopsy was performed and the mass was diagnosed as nodular fasciitis. After 18 months after excision, the mass recurred with pain and grew larger. Considering the clinical manifestations, diagnostic impression was changed as dermatofibrosarcoma protuberans not nodular fasciitis. Second wide excision was performed and the histopathology revealed proliferative atypical spindle cells with moderate nuclear atypia and a distinctive whorling pattern, which is suggestive of low-grade sarcoma. Additional computed tomography and positron emission tomography revealed no metastasis and suspicious residual viable malignant tissue. To remove suspicious residual tumor, third wide excision were performed and the diagnosis confirmed as LGMS. A microscopically clear resection was achieved with deep and lateral safety margin 0.6 cm each. Despite of postoperative radiotherapy with 35 times, recurrence of the tumor and lung metastasis was found after 7 months later. LGMS rarely metastasizes and occurs most commonly in the head and neck region. Thus, we report a rare case of LGMS on back which repeated localized recurrence and regional lung metastasis occurred despite wide excision and adjuvant radiotherapy.
Sebaceous hyperplasia (SH) is a benign proliferation of the sebaceous glands. Ultraviolet radiation is known to be the cofactor for the pathogenesis of SH. Frequently reported adverse events of ...308-nm excimer laser are erythema, burning or pain, and itching sensation. However, the role of excimer laser as an aetiological factor of SH is rarely reported in the literature. A 59-year-old female presented with several elevated, umbilicated papules on the face. Papular eruption appeared abruptly after 11 weeks of treatment for vitiligo which includes 308-nm excimer laser therapy. The distribution of lesion was associated with the treated area. Total cumulative dose was 3,300 mJ/cm² over 16 sessions. Histopathologic findings showed enlarged sebaceous glands composed of numerous lobules around a centrally located, widened sebaceous duct. Chronic sun exposure clinically causes SH was proved in the previous animal studies. Thus, we introduce a rare case of eruptive SH in the patient treated with 308-nm excimer laser.
Extramammary Paget disease (EMPD) is a rare adenocarcinoma that usually occurs in areas of the body that are rich in apocrine sweat glands. Great depth of tumor invasion is a well-known risk factor ...for worse prognosis. Paget cells usually are limited to the epidermis, whereas invasive EMPD, which infiltrates the dermis, is relatively rare. It is even rarer for the tumor to spread beyond the dermis. Only 3.1% of patients with EMPD of the penis and scrotum have exhibited infiltration of the subcutaneous fat layer. We report a case of a 62-year-old male with EMPD that invaded the subcutaneous fat layer. He presented with a several-year history of a slowly expanding erythematous plaque with the hypopigmented area on the left penoscrotum. One month before presentation, the patient had undergone punch biopsy at another hospital and diagnosed with EMPD. He had no personal history of urogenital cancers. The patient was treated with Mohs micrographic surgery, and negative margins were achieved after four stages. The histopathologic findings revealed Paget cells scattered throughout the epidermis. At the hypopigmented area, Paget cells extended to the subcutaneous fat layer with lymphovascular invasion. There was no evidence of recurrence at seven months postoperatively. Herein, we describe a case of hypopigmented EMPD that infiltrated the subcutaneous layer, which rarely has been reported in Korea.
We propose a hybrid technique that employs artificial intelligence (AI)-based segmentation and machine learning classification using multiple features extracted from the foveal avascular zone (FAZ)-a ...retinal biomarker for Alzheimer's disease-to improve the disease diagnostic performance. Imaging data of optical coherence tomography angiography from 37 patients with Alzheimer's disease and 48 healthy controls were investigated. The presence or absence of brain amyloids was confirmed using amyloid positron emission tomography. In the superficial capillary plexus of the angiography scans, the FAZ was automatically segmented using an AI method to extract multiple biomarkers (area, solidity, compactness, roundness, and eccentricity), which were paired with clinical data (age and sex) as common correction variables. We used a light-gradient boosting machine (a light-gradient boosting machine is a machine learning algorithm based on trees utilizing gradient boosting) to diagnose Alzheimer's disease by integrating the corresponding multiple radiomic biomarkers. Fivefold cross-validation was applied for analysis, and the diagnostic performance for Alzheimer's disease was determined by the area under the curve. The proposed hybrid technique achieved an area under the curve of Formula: see text%, outperforming the existing single-feature (area) criteria by over 13%. Furthermore, in the holdout test set, the proposed technique exhibited a 14% improvement compared to single features, achieving an area under the curve of 72.0± 4.8%. Based on these facts, we have demonstrated the effectiveness of our technology in achieving significant performance improvements in FAZ-based Alzheimer's diagnosis research through the use of multiple radiomic biomarkers (area, solidity, compactness, roundness, and eccentricity).
Primary localized cutaneous amyloidosis (PLCA) is characterized by extracellular deposition of pathological fibril aggregation of proteins in the skin without systemic involvement. Macular ...amyloidosis, lichen (papular) amyloidosis, and nodular amyloidosis are three different subtypes of PLCA. Although the pathological mechanism of PLCA has not yet been clarified, it is assumed that a nucleus formation of amyloid fibril is formed due to repeated external stimulation, such as subcutaneous injection, which often poses diagnostic challenges. Herein, we present a 54-year-old Korean male patient with cutaneous localized amyloidosis which occurred after repeated local insulin injections, and discuss the relationship between insulin therapy in patients with diabetes mellitus and dermal amyloid deposition.
Abstract
This paper discusses an approach to augmented virtual reality (AVR) and 360-degree spatial visualization. The approach involves locating stereoscopic three-dimensional virtual objects into a ...real off-site panorama, supporting spatial remodel design decision-making through realistic comparisons. Previous studies have shown that in the design process, end-user engagement promotes the quality and satisfaction of design solutions. Immersive media such as virtual reality (VR) and augmented reality (AR) have increasingly been used as communication tools for user engagement in design, as they provide intuitive and realistic user experiences, particularly in comparing design plans. However, the dichotomous affordance of current VR and AR devices is limited in satisfying both the sense of realism and immersion that are essential for user engagement. To overcome this shortcoming, we propose an AVR-based design visualization approach that integrates the advantages of both media technologies to provide a high sense of realism and immersion off-site, responding to location and environmental stimuli, such as lighting, material, and other factors. To achieve this goal, we used 360-degree panorama data of the target space as a design visualization background, with content immersion experienced through VR hardware. Additionally, we developed software to demonstrate the actual use of the AVR-based approach, and various visualization-purposed file formats can be exported automatically using this software. The software supports the authoring of 360-degree spatial visualization videos for realistic design comparisons, which can be easily accessed by end-users using a head-mounted display or smartphone, even in real-time. We performed a demonstration of this approach using an actual remodel design project for the university library lobby, and this paper shows the usability and applicability of the AVR-based approach for user engagement.
Graphical Abstract
Graphical Abstract
The purpose of this study was to investigate the morphological and histological change of vocal folds (VFs) after steroid injection in a rabbit model.
Prospective animal study.
Tertiary academic ...medical center.
Twenty-four New Zealand white rabbits were used in this study. We randomly classified rabbits into the 3 groups and triamcinolone acetonide suspension was injected to the right VF with different concentrations. Left VF was injected with the same volume of phosphate-buffered saline as control. Endoscopic evaluation was performed to measure morphological changes. The larynges were collected for histological analysis, and the VFs were stained with hematoxylin-eosin for assessing inflammatory response, glandular atrophy, and muscular atrophy and with Masson's trichrome for assessing collagen deposition.
In morphological assessment, there were no differences in VF mass reduction, mucosal atrophy, and granulation formation between both VFs. Histological assessments showed no significant difference in inflammatory response, glandular atrophy, and collagen deposition between both VFs. However, there was a difference in muscular atrophy and epithelial layer thinning in steroid injected right VFs. Muscular atrophy had been completely recovered over time, but mild epithelial thinning was continued until 12 weeks. The longer exposure time and larger dose did not increase the intensity of muscular atrophy or epithelial thinning.
We demonstrated that the VF steroid injection resulted in no significant changes in morphology and histology of rabbit VF. However, steroid injection may induce several VF histological changes and these results are needed to be considered when treating humans.
While a rushed operation can omit essential procedures, prolonged operative time results in higher morbidity. Nevertheless, the optimal operative time range remains uncertain. This study aimed to ...estimate the ideal operative time range and evaluate its applicability in laparoscopic cancer surgery.
A prospectively collected multicenter database of 397 patients who underwent laparoscopic distal gastrectomy were retrospectively reviewed. The ideal operative time range was statistically calculated by separately analyzing the operative time of uneventful surgeries. Finally, intraoperative and postoperative outcomes were compared among the shorter, ideal, and longer operative time groups.
The statistically calculated ideal operative time was 135.4-165.4 min. The longer operative time (LOT) group had a lower rate of uneventful, perfect surgery than the ideal or shorter operative time (IOT/SOT) group (2.8%
8.8% and 2.2%
13.4%, all P<0.05). Longer operative time increased bleeding, postoperative morbidities, and delayed diet and discharge (all P<0.05). Particularly, an uneventful, perfect surgery could not be achieved when the operative time exceeded 240 min. Regardless of ideal time range, SOT group achieved the highest percentage of uneventful surgery (13.4%), which was possible by surgeon's ability to retrieve a higher number of lymph nodes and perform ≥150 gastrectomies annually.
Operative time longer than the ideal time range (especially ≥240 min) should be avoided. If the essential operative procedure were faithfully conducted without compromising oncological safety, an operative time shorter than the ideal range leaded to a better prognosis. Efforts to minimize operative time should be attempted with sufficient surgical experience.
We validate the 7th American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system for gastric cancer and propose a new staging system that reflects the ...prognostic significances of each of T and N category.
Data from 5,957 patients who underwent curative gastrectomies from 2000 to 2007 at 4 university hospitals in Daegu Metropolitan city in Korea were analyzed for the validation of the 7th AJCC/UICC staging system for gastric cancer. The hazard ratios of the respective T and N categories were estimated and converted to weightings and summated to make prognostic score (P-score). Homogeneity and stage grouping were determined according to the P-scores.
In the 7th AJCC/UICC staging system for gastric cancer, poor discrimination was noted between stages IIB and IIIA (P = 0.152). In addition, heterogeneity in stage IIB (P = 0.021) and a small gap in 5-year survival rates (1.7%) between stages IA and IB were noted. A new proposed staging system was generated on the basis of P-scores and demonstrated more discrimination between stages and more homogeneity within stages. The new staging system reflects the different prognostic impacts of N3a and N3b.
Several controversial issues of the 7th AJCC/UICC staging system for gastric cancer were reconfirmed in the present analysis. The TNM system based on P-score appears to be more scientifically accurate than the 7th AJCC/UICC staging system for gastric cancer.
To investigate the relationships between lymph node metastasis (LNM) and expression of CD31, D2-40 and vascular endothelial growth factors (VEGF)-A and -C in patients with papillary thyroid cancer ...(PTC).
Paraffin-embedded thyroid tissues of 72 patients were evaluated, which included 25 patients with thyroid nodular hyperplasia (TNH), 24 PTC patients without LNM, and 23 PTC patients with LNM. Three pathologists, who were blinded to the patient's clinical information, assessed the immunohistochemical staining results. The amount of expression was scored as high (>25% of cells stained) or low (0-25%).
A higher level of VEGF-A expression was observed in the PTC groups regardless of LNM when compared to the group with TNH (91.3%, 79.2%, 4.0%, respectively). VEGF-C expression in the PTC with LNM group was significantly higher than the other two groups (P<0.05). No difference in microvessel density (MVD) scores was observed using CD31 among the three groups. The lymphatic vessel density (LVD) score using D2-40 was significantly higher in patients having PTC with LNM than the other groups (P<0.05).
VEGF-C and D2-40 were more highly expressed in patients having PTC with LNM than in patients having PTC without LNM or in those having TNH. Analysis of VEGF-C level and LVD using D2-40 may be helpful in the diagnosis of PTC and the evaluation of LNM potential in patients with PTC.
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