Effect of Red-Beetroot-Supplemented Diet on Gut Microbiota Composition and Metabolite Profile of Weaned Pigs-A Pilot Study.

Red beetroot is a well-recognized and established source of bioactive compounds (e.g., betalains and polyphenols) with anti-inflammatory and antimicrobial properties. It is proposed as a potential alternative to zinc oxide with a focus on gut microbiota modulation and metabolite production. In this study, weaned pigs aged 28 days were fed either a control diet, a diet supplemented with zinc oxide (3000 mg/kg), or 2% and 4% pulverized whole red beetroot (CON, ZNO, RB2, and RB4; respectively) for 14 days. After pigs were euthanized, blood and digesta samples were collected for microbial composition and metabolite analyses. The results showed that the diet supplemented with red beetroot at 2% improved the gut microbial richness relative to other diets but marginally influenced the cecal microbial diversity compared to a zinc-oxide-supplemented diet. A further increase in red beetroot levels (4%-RB4) led to loss in cecal diversity and decreased short chain fatty acids and secondary bile acid concentrations. Also, an increased Proteobacteria abundance, presumably due to increased lactate/lactic-acid-producing bacteria was observed. In summary, red beetroot contains several components conceived to improve the gut microbiota and metabolite output of weaned pigs. Future studies investigating individual components of red beetroot will better elucidate their contributions to gut microbiota modulation and pig health.

Cross Inoculation of Rumen Fluid to Improve Dry Matter Disappearance and Its Effect on Bacterial Composition Using an in vitro Batch Culture Model.

Environmental pressures of ruminant production could be reduced by improving digestive efficiency. Previous in vivo attempts to manipulate the rumen microbial community have largely been unsuccessful probably due to the influencing effect of the host. Using an in vitro consecutive batch culture technique, the aim of this study was to determine whether manipulation was possible once the bacterial community was uncoupled from the host. Two cross inoculation experiments were performed. Rumen fluid was collected at time of slaughter from 11 Holstein-Friesian steers from the same herd for Experiment 1, and in Experiment 2 were collected from 11 Charolais cross steers sired by the same bull and raised on a forage only diet on the same farm from birth. The two fluids that differed most in their in vitro dry matter disappearance (IVDMD; "Good," "Bad") were selected for their respective experiment. The fluids were also mixed (1:1, "Mix") and used to inoculate the model. In Experiment 1, the mixed rumen fluid resulted in an IVDMD midway between that of the two rumen fluids from which it was made for the first 24 h batch culture (34, 29, 20 g per 100 g DM for the Good, Mix, and Bad, respectively, P < 0.001) which was reflected in fermentation parameters recorded. No effect of cross inoculation was seen for Experiment 2, where the Mix performed most similarly to the Bad. In both experiments, IVDMD increased with consecutive culturing as the microbial population adapted to the in vitro conditions and differences between the fluids were lost. The improved performance with each consecutive batch culture was associated with reduced bacterial diversity. Increases in the genus Pseudobutyrivibrio were identified, which may be, at least in part, responsible for the improved digestive efficiency observed, whilst Prevotella declined by 50% over the study period. It is likely that along with host factors, there are individual factors within each community that prevent other microbes from establishing. Whilst we were unable to manipulate the bacterial community, uncoupling the microbiota from the host resulted in changes in the community, becoming less diverse with time, likely due to environmental heterogeneity, and more efficient at digesting DM.

Efeito da radiação vermelha de baixa intensidade sobre o sêmen canino criopreservado / Effect of low intensity red light on the canine semen cryopreservation

O objetivo geral deste trabalho foi analisar o efeito da radiação vermelha de baixa intensidade sobre alguns parâmetros cinéticos do espermatozoide canino criopreservado. Ejaculados de oito cães adultos foram centrifugados, rediluídos em meio tris-gema de ovo com 6% de glicerol, e, posteriormente, fracionados em: T1: incidência de radiação vermelha (660 NM) (Fisioled - Mmoptics - 100mW) por 60 segundos, antes do resfriamento e após a descongelação; T2: incidência somente antes do resfriamento; T3: incidência somente após a descongelação; e T4: sem incidência. Após a descongelação, as amostras foram submetidas ao TTR utilizando-se Sperm Class Analyzer(r). No TTR0, TTR60 e TTR90, não houve diferença entre as variáveis analisadas pelo CASA. Somente no TTR30 os efeitos da incidência da radiação vermelha foram evidentes e significativos em T1 e T2; T1 resultou em baixa MT (12,5 + 10,6%) e T2 determinou o melhor resultado de MT 40,3 + 26,1%. De forma similar T1 apresentou maior número de espermatozoides estáticos (77,5±28,9%) em relação ao T2 (50,6±28%). Concluiu-se que a dupla incidência de radiação vermelha de baixa intensidade antes do resfriamento e após a descongelação teve efeito deletério sobre a motilidade do espermatozoide canino, expressa principalmente aos 30 minutos após descongelação.

The aim of this study was to analyze the effect of low intensity red light on some kinetic parameters of cryopreserved canine sperm. Ejaculates from 08 adult dogs were centrifuged, diluted in Tris-egg yolk with 6% glycerol, and subsequently separated into: T1: incidence of red light (660 nm) (Fisioled -MMOptics - 100mW) for 60 seconds before the cooling and after thawing, T2: just before cooling, T3: only after thawing, and T4: no incidence. After thawing the samples were subjected to TTR using Sperm analyzer(r). In TTR0, TTR60 and TTR90 there were no differences between the variables analyzed by CASA. Only in TTR30 the effects of the incidence of red light were visible and significant in T1 and T2. T1 resulted in low MT (12.5 ±10.6%) and T2 determined the best result of MT 26.1%±40.3. Similarly T1 showed a higher number of static spermatozoa (77.5±28.9%) compared to T2 (50.6±28%). We concluded that the double incidence of low intensity red light, before cooling and after thawing, had a deleterious effect on canine sperm motility expressed at 30 minutes after thawing.

Comparative evaluation of three commercial systems for detection of high-risk human papillomavirus in cervical and vaginal ThinPrep PreservCyt samples and correlation with biopsy results.

Genital human papillomavirus (HPV) is the etiologic agent of more than 99% of all cervical cancers worldwide, with 14 genotypes being considered oncogenic or "high risk" because of their association with severe dysplasia and cervical carcinoma. Among these 14 high-risk types, HPV-16 and -18 account for approximately 70% of cervical cancers. The aim of this study was to evaluate three FDA-approved HPV nucleic acid-based tests for the ability to predict high-grade cervical intraepithelial neoplasias (CIN2 or worse) in corresponding tissue biopsy specimens. Residual specimens (total n = 793, cervical n = 743, vaginal n = 50) collected in ThinPrep PreservCyt medium with a cytologic result of ≥ atypical squamous cells of undetermined significance were tested by the Hybrid Capture 2 (HC2) assay (Qiagen, Gaithersburg, MD), the cobas HPV test (Roche Diagnostics, Indianapolis, IN), and the APTIMA HPV assay (Hologic, San Diego, CA). Genotyping for HPV-16 and HPV-18 was simultaneously performed by the cobas HPV test. Results were compared to cervical or vaginal biopsy findings, when they were available (n = 350). Among the 350 patients with corresponding biopsy results, 81 (23.1%) showed ≥ CIN2 by histopathology. The ≥ CIN2 detection sensitivity was 91.4% by the cobas and APTIMA assays and 97.5% by HC2 assay. The specificities of the cobas, APTIMA, and HC2 assays were 31.2, 42.0, and 27.1%, respectively. When considering only positive HPV-16 and/or HPV-18 genotype results, the cobas test showed a sensitivity and a specificity of 51.9 and 86.6%, respectively. While the HC2, cobas, and APTIMA assays showed similar sensitivities for the detection of ≥ CIN2 lesions, the specificities of the three tests varied, with the greatest specificity (86.6%) observed when the HPV-16 and/or HPV-18 genotypes were detected.

Caseinate protects stallion sperm during semen cooling and freezing.

Extenders with a defined composition containing only components with clearly protective effects on sperm during storage would be an advantage. The aims of the present work were to assess whether caseinate, improves cooled and frozen equine semen quality. Semen from six stallions were suspended with four different cooling extenders C1) Kenney extender; C2) 0.6 % caseinate; C3) 2.7 % caseinate ; and C4) C1 + 2.1 % caseinate, and frozen extenders: F1) INRA 82 extender; F2) 1.35 % caseinate; and F3) 2.7 % caseinate. Although there was no significant difference between the motility rate among the cooled (C1:45.0, C2:36.7, C3:38.3 and C4:48.3) and frozen extenders (F1:16.9, F2:21.1 and F3:18.6), significant higher values of sperm velocity variables were observed with the 1.35 % caseinate extender compared to the control (VSL: 40.8 x 18.9 and VAP: 46.8 x 25.0 µm/s), respectively. Caseinate seemed to be responsible for sperm protection during preservation and showed to be as efficient as milk.

Protocolos de produção in vitro de embriões na raça Gir / In vitro embryo production protocols in Gir breed

Avaliaram-se os efeitos de dois protocolos de punção folicular na quantidade/qualidade dos oócitos e na produção in vitro de embriões, em vacas da raça Gir, não-lactantes. O ciclo estral foi sincronizado com cloprostenol e ao longo do experimento os animais receberam implantes auriculares de norgestomet, renovados a cada 14 dias. Os animais foram submetidos aos protocolos I (sem estimulação hormonal, com punção folicular duas vezes/semana) e II (pré-tratamento com 250 UI de FSH em doses decrescentes, três dias antes da punção folicular). Os oócitos recuperados foram levados ao laboratório em meio TALP-Hepes e submetidos à maturação. Na fecundação in vitro utilizou-se sêmen de touro Gir, previamente capacitado. Após 22 horas de fecundação, os prováveis zigotos foram co-cultivados com células da granulosa em CR2aa acrescido de 10 por cento de soro fetal bovino. A taxa de clivagem foi avaliada 72 horas pós-fecundação e a de blastocisto 192 horas pós-fecundação. O número total de folículos foi maior (P<0,05) no protocolo II, assim como o número de folículos grandes e médios (P<0,05) e o diâmetro do maior folículo (P<0,05), sendo o número de folículos pequenos (P<0,05) menor. O total de oócitos recuperados por sessão não foi diferente entre os protocolos I e II (P>0,05). O número de oócitos de grau I e a taxa de clivagem foram maiores (P<0,05) e o número de degenerados menor protocolo II. A pré-estimulação ovariana com FSH pode melhorar a qualidade e a taxa de clivagem dos oócitos recuperados por punção folicular em animais Gir.

The effect of two ovum pick-up protocols on amount/quality of oocytes retrived and on in vitro embryo production of Gyr cows was evaluated in non-lactating cycling cows with good body and reproductive conditions. Estrous cycles were synchronized with cloprostenol. During the experiment, animals received norgestomet ear implants, replaced every 14 days. Animals were submitted to protocol I (without hormonal estimulation) and protocol II (pre-stimulation with 250 IU of FSH three days before aspiration). Recovered oocytes were transported in Talp-Hepes to the laboratory, classified and maturated. Twenty two hours after fertilization, presumptive zygotes were co-culture with granulosa cells in CR2aa supplemented with 10 percent of fetal calf serum. Cleavage rate was assessed at 72 hours post-fertilization, and blastocyst production 192 hours post-fertilization. The total number of follicles, the number of large and medium follicles and the diameter of the largest follicle were higher (P<0.05) in protocol II, and the number of small follicles (P<0.05) was lower than in protocol I. No difference between protocols I and II was observed for oocytes recovered per aspiration section (P>0.05). The number of grade I oocytes and cleavage rate were higher (P<0.05) in protocol II and the number of degenerated oocytes was lower (P<0.05). The pre-stimulation with FSH can improve the quality and cleavage rate of oocytes recovered by ovum pick-up in zebu animals.

Cervical cancer screening, screening errors and reporting.

Screening for cervical carcinoma by cervicovaginal cytology has led to a marked reduction in the incidence of and mortality from this tumor over the last 50 years in essentially all countries with a functioning screening program. It is the most successful cancer prevention program of all times. Consequently, approximately 80% of the current incidence of and mortality from this disease occurs in geographic areas of underserved and underscreened women. Essential components of a successful program are a high coverage rate of the female population, screening at regular intervals, well-trained clinical and laboratory staff, and an efficient follow-up and treatment system. Deficiencies in any of these areas may lead to a failing screening system. Thus, the most important reason for the remaining mortality from cervical carcinoma in developed countries is lack of complete coverage. It is questionable if new and more expensive technologies will be able to renmedy the remaining failures of the system if no improvement in the coverage rate is achieved. Screening errors do occur but represent only a small fraction of screening failures. Currently, there are a number of terminology systems around the world; thus, a unified terminology is currently not a realistic goal.

Does hospice have a role in nursing home care at the end of life?

OBJECTIVES: To assess the possible benefits and challenges of hospice involvement in nursing home care by comparing the survival and needs for palliative care of hospice patients in long-term care facilities with those living in the community. DESIGN: Retrospective review of computerized clinical care records. SETTING: A metropolitan nonprofit hospice. PARTICIPANTS: The records of 1,692 patients were searched, and 1,142 patients age 65 and older were identified. Of these, 167 lived in nursing homes and 975 lived in the community. MEASUREMENTS: Patient characteristics, needs for palliative care, and survival. RESULTS: At the time of enrollment, nursing home residents were more likely to have a Do Not Resuscitate order (90% vs 73%; P < .001) and a durable power of attorney for health care (22% vs 10%; P < .001) than were those living in the community. Nursing home residents also had different admitting diagnoses, most notably a lower prevalence of cancer (44% vs 74%; P < .032). Several needs for palliative care were less common among nursing home residents, including constipation (1% vs 5%; P = .02), pain (25% vs 41%; P < .001), and anticipatory grief (1% vs 9%; P < .001). Overall, nursing home residents had fewer needs for care (median 0, range 0-3 vs median 1, range 0-5; rank sum test P < .001). Nursing home residents had a significantly shorter survival (median 11 vs 19 days; log rank test of survivor functions P < .001) and were less likely to withdraw from hospice voluntarily (8% vs 14%; P = .03). However, there was no difference in the likelihood of becoming ineligible during hospice enrollment (6% for both groups). CONCLUSIONS: These results suggest that hospices identify needs for palliative care in a substantial proportion of nursing home residents who are referred to hospice, although nursing home residents may have fewer identifiable needs for care than do community-dwelling older people. However, the finding that nursing home residents' survival is shorter may be of concern to hospices that are considering partnerships with nursing homes. An increased emphasis on hospice care in nursing homes should be accompanied by targeted educational efforts to encourage early referral.

Real-time measurements of DNA hybridization on microparticles with fluorescence resonance energy transfer.

When capture oligonucleotides are tethered on planar surfaces, mass transport limitations influence the kinetics of solid-phase nucleic acid hybridizations. By diffusion theory, however, hybridization of oligonucleotides on microparticles should be reaction-rate limited. In an initial effort to understand the kinetics of microparticle hybridization reactions, we developed a fluorescence resonance energy transfer method for monitoring oligonucleotide hybridization on microparticles. Microparticles were coated with a fluoresceinated oligomer at surface densities of 20, 40, and 80% saturation, hybridized to a complementary oligonucleotide labeled with tetramethylrhodamine, and monitored over time for quenching of the fluorescein signal as hybridization occurred on the particle surface. Association rate constants were compared for microparticle-based hybridization and solution-phase hybridization. Rate constants for hybridizations on the particle surface were about an order of magnitude less than those for hybridization in solution, but decreasing the surface density of the capture oligonucleotide to 20% saturation improved particle hybridization rates. Although a bimolecular reaction model adequately described solution-phase hybridization kinetics, oligonucleotide hybridization on microparticles did not fit this model but exhibited biphasic reaction kinetics. Based on two different lines of reasoning, we argue that microparticle-based oligonucleotide hybridization was indeed reaction-rate limited in our system and not diffusion-rate limited.

Colposcopy in pregnancy: directed brush cytology compared with cervical biopsy.

OBJECTIVE: To evaluate colposcopically directed brush cytology as a substitute for directed biopsy of acetowhite lesions identified during pregnancy. METHODS: Pregnant patients eligible for the study were referred for colposcopic evaluation for either newly diagnosed abnormal cervical cytology or follow-up of a previously diagnosed squamous intraepithelial lesion (SIL). All patients with acetowhite lesions underwent colposcopically directed brush cytology followed by directed biopsy. RESULTS: Of 81 pregnant patients referred, 50 paired samples of colposcopically directed brush cytology and directed biopsies were evaluated from 49 patients. One patient was sampled in the first and third trimesters and one patient's brush cytology was unsatisfactory for interpretation because of clumping artifact, leaving 49 brush-biopsy pairs that were satisfactory for examination. One patient in the study group had an intrauterine fetal death of uncertain cause, remote from the time of biopsy. Compared with the corresponding biopsy, the directed brush caused significantly less blood loss (P < .001). For all diagnostic categories, directed cytology demonstrated a good degree of correlation with biopsy (kappa = 0.73). The brush technique correctly identified 12 of 14 cases (86%) of biopsy-proved cervical intraepithelial neoplasia II-III as high-grade SIL. If one considers "atypical squamous cells, favor human papillomavirus effect" as a true positive, brush sensitivity was 88 +/- 9% and specificity was 74 +/- 12%, with an accuracy of 80%. CONCLUSION: In the absence of lesions suspicious for carcinoma, colposcopically directed brush cytology is a safe substitute for directed biopsy in pregnant patients.

DNA hybridization on microparticles: determining capture-probe density and equilibrium dissociation constants.

Many DNA-probe assays utilize oligonucleotide-coated microparticles for capture of complementary nucleic acids from solution. During development of these assays, as well as in other particle-based nucleic acid applications, it is useful to know both the amount of duplex formation expected under various experimental conditions and the coating density of the capture oligonucleotide on the particle surface. We examined the simplest form of a DNA-probe microparticle assay: hybridization of a particle-bound capture oligonucleotide to its solution-phase complement. Fluorescein-labeled solution-phase oligonucleotide was hybridized to varying amounts of particles, and the amount of labeled oligonucleotide remaining in solution at equilibrium was measured. We present a simple two-state, all-or-none model for bimolecular hybridization of non-self-complementary sequences that can be used to calculate the equilibrium dissociation constant ( Kd ) from hybridization data. With experimental conditions where both the Kd value and the concentration of capture probe in the reaction are small relative to the concentration of labeled complementary oligonucleotide in the reaction, density of the capture probe on the particle's surface can also be determined. Kd values for particle-based hybridization were different from those obtained from solution-phase thermodynamic parameters. At higher temperatures, hybridization on particles was more efficient than hybridization in solution.

Efeitos da rufiaçäo e da manipulaçäo do sistema genital sobre a fertilidade de éguas inseminadas / Effects of teasing and genital manipulation upon the fertility of inseminated mares

Estudaram-se os efeitos da rufiaçäo e da manipulaçäo do sistema genital (estocadas) sobre a fertilidade de éguas inseminadas com sêmen fresco (exp. 1) e resfriado/transportado a 14ºC/3,6 horas (exp. 2). No experimento 1 utilizaram-se 42 ciclos de 29 éguas, e no experimento 2, 148 ciclos de 100 éguas, distribuídos aleatoriamente em quatro grupos experimentais definidos por um esquema fatorial 2 x 2, com número desigual de repetiçöes, de acordo com o tipo de rufiaçäo utilizado (éguas rufiadas e näo rufiadas) e o tipo de manipulaçäo do sistema genital da fêmea no momento da inseminaçäo (estocadas e näo estocadas). Em ambos os experimentos näo se observou efeito da estimulaçäo sexual da égua sobre a fertilidade. No experimento 2 näo se observou efeito da estimulaçäo sexual sobre a dinâmica de crescimento folicular e ovulaçäo

Renal medullary carcinoma: report of a case with positive urinary cytology.

Renal medullary carcinoma is an aggressive neoplasm of the renal pelvis arising in patients with a history of sickle-cell trait. The authors report a case of renal medullary carcinoma with positive urinary cytology. Due to the location of the tumor in the renal pelvis and the loosely cohesive nature of poorly differentiated neoplasms, the presence of renal medullary carcinoma in a urinary cytology specimen is not surprising. The cytologic characteristics as well as the ultrastructural features are described.

Glandular cells derived from direct sampling of the lower uterine segment in patients status post-cervical cone biopsy. A diagnostic dilemma.

Direct sampling of the lower uterine segment endometrium (LUS) may mimic atypical glandular lesions or resemble the cells of high grade squamous intraepithelial lesion. This study was done to further characterize the cytologic features of LUS and to determine the incidence of these cells in patients who have previously undergone cone biopsies. Cervical smears from 64 patients who had had a previous cervical cone biopsy were reviewed and compared to pre-cone cervical smears and any post-cone cervical biopsies or endocervical curettage specimens. Twelve smears from 63 patients (19%) were found to have fragments of LUS. Cytologic features of LUS included large groups with gland openings, branched glands, and nuclear palisading within the fragments. The fragments often were accompanied by endometrial stroma. Smaller fragments were frequently encountered. These were densely cellular but contained nuclear palisading.

Cytologic diagnosis of cholesterol granuloma. A case report.

Cholesterol granuloma is a rare lesion of the orbit occurring in adults and must be distinguished from epidermoid cholesteatoma and other mass lesions of the orbit. We report the case of a 31-year-old man who presented to our institution with right eye proptosis secondary to a soft tissue mass. At surgery, cyst fluid from the lesion was sent for cytologic evaluation. The fluid was remarkable for numerous inflammatory cells, blood breakdown products, multinucleate giant cells and cholesterol crystals. The absence of squamous- or respiratory-type epithelium led to a diagnosis of cholesterol granuloma. This was confirmed by histologic examination of the tissue submitted. The differential diagnosis and cytologic features of orbital lesions are discussed.

Atypical cervical cytology. Colposcopic follow-up using the Bethesda System.

Patients with a cytologic diagnosis of either atypical squamous cells of undetermined significance (squamous ACUS) (191), atypical squamous cells suggestive of papillomavirus (ACPV) (79), low grade squamous intraepithelial lesion (LSIL) (184) or atypical glandular cells of undetermined significance (glandular ACUS) (30) obtained over an 18-month period were evaluated colposcopically at the National Naval Medical Center. The diagnosis of squamous atypia rendered using the Bethesda System was reduced when compared to the diagnosis of atypia rendered using traditional cytologic terms (1.9% versus 7.2%). Results from colposcopic evaluations of patients with squamous ACUS demonstrated similar rates of underlying dysplasia as in studies using older terminology (low grade dysplasia in 14% and high grade in 6% of the referrals). Colposcopic evaluation of patients with a referral diagnosis of squamous ACPV demonstrated rates of underlying low grade dysplasia double that of the diagnosis of squamous ACUS but half that of a diagnosis of LSIL (25% versus 14%, and 48%, respectively). Colposcopic evaluation of glandular ACUS rendered a diagnosis of high grade dysplasia more than three times (20%) as often as of squamous ACUS (6%). While the Bethesda System reduces inconsistencies in the diagnosis of atypical cytologic changes, a separate category (ACUS) appears to be useful in identifying underlying, unsuspected low grade dysplasias in our laboratory. In addition, glandular atypias herald a significant rate of underlying high grade dysplasias and warrant immediate colposcopic investigation.

Chlamydia trachomatis in routine cervical smears. A microscopic and ultrastructural analysis.

This study examined cervical smears for cytologic evidence of Chlamydia trachomatis in 380 women seen for routine gynecologic examination or follow-up for an abnormal cervical smear. Cervical smears and Chlamydiazyme samples were obtained. Fifteen patients tested Chlamydiazyme positive and were considered to be Chlamydia positive. Cellular samples meeting the screening criteria were examined carefully for evidence of Chlamydia, including type II (central target inclusions) and type III (granular inclusions or nebular inclusions). Electron microscopy was performed on representative inclusions from both Chlamydia-positive and -negative patients. Inclusions were identified in 6 of the Chlamydia-positive and 31 of the -negative patients. Electron microscopy of type II and III inclusions, from both positive and negative patients, revealed chlamydial organisms to be present only in nebular inclusions. Intracytoplasmic inclusions, other than nebular inclusions, result from inflammatory changes and, as such, may be induced by a chlamydial infection but are not specific to Chlamydia.

Fine needle aspiration of proliferative fasciitis. A case report.

The cytologic findings of a fine needle aspiration (FNA) biopsy from a patient with proliferative fasciitis, a benign, reactive process involving the subcutaneous tissue, are presented. Proliferative fasciitis is defined histologically as a spindle-cell lesion containing basophilic giant cells that resemble ganglion cells; the FNA smears from this patient's lesion were cellular and contained spindle cells as well as numerous large cells with abundant cytoplasm, one to two eccentric nuclei and macronucleoli. The large cells seen on the aspiration smears correspond well with the classic ganglionlike cells seen on histologic sections. Care must be taken so that this distinctive lesion is not misdiagnosed as a malignant soft tissue neoplasm.