Unveiling the Uncommon: Gastrointestinal Basidiobolomycosis of the Colon and its Distinctive Splendore-Hoeppli Phenomenon.

BACKGROUND: Basidiobolomycosis is a rare fungal infection caused by Basidiobolus ranarum. CASE PRESENTATION: A 53-year-old man from Saudi Arabia with a known history of diverticulosis presented with severe abdominal pain and diarrhea. A CT scan revealed circumferential wall thickening of the descending and sigmoid colon with surrounding fat stranding, suggesting a diagnosis of complicated diverticulitis. Additional thick fluid was observed around the affected area. Surgical excision was pursued. A gross examination of two received large bowel segments disclosed marked ulcerated mucosa and wall thickening with exudate-covered serosal surfaces and adhesions. Microscopic examination unveiled significant infiltration by eosinophils, polymorphonuclear leukocytes, and granulomatous inflammation. Thin-walled, broad fungal hyphae of Basidiobolus, surrounded by eosinophilic material, were identified. Granulomas displayed abundant multinucleated giant cells and palisading histiocytes around central necrosis or abscess formation. Thin-walled, broad fungal hyphae of Basidiobolus, with sparse septations, are surrounded by a radiating, intensely eosinophilic cuff (Splendore-Hoeppli phenomenon). These hyphae, visible with hematoxylin and eosin staining, were further highlighted with periodic acid-Schiff and Gomori methenamine silver staining. DISCUSSION: Basidiobolomycosis may mimic neoplastic lesions. Histologically, the characteristic features include broad, thin-walled septate hyphae surrounded by eosinophilic material, a finding that is accentuated by the Splendore-Hoeppli phenomenon. Microscopic examination, along with special stains such as periodic acid-Schiff (PAS) and Gomori methenamine silver, is essential for accurate diagnosis. CONCLUSION: Prompt recognition and appropriate antifungal therapy are vital for favorable patient outcomes. This report highlights the distinctive features of Basidiobolomycosis to raise awareness and understanding of this infrequent yet clinically significant fungal infection.

Utilizing Data Analytics And Business Intelligence Tools In Laboratory Workflow.

A business intelligence (BI) tool in a laboratory workflow offers various benefits, including data consolidation, real-time monitoring, process optimization, cost analysis, performance benchmarking (quality indicators), predictive analytics, compliance reporting, and decision support. These tools improve operational efficiency, quality control, inventory management, cost analysis, and clinical decision-making. This write up reveals the workflow process and implementation of BI in a private hospital laboratory. By identifying challenges and overcoming them, laboratories can utilize the power of BI and analytics solutions to accelerate healthcare performance, lower costs, and improve care quality. We used navify (Viewics) as a BI platform which relies on an infinity data warehouse for analytics and dashboards. We applied it for pre-analytic, analytic and post-analytic phases in laboratory. We conclude, digitalization is crucial for innovation and competitiveness, enhancing productivity, efficiency, and flexibility in future laboratories.

Lipoprotein Glomerulopathy With Complete Resolution With Fenofibrate: Report of First Case From Pakistan.

Background: Lipoprotein glomerulopathy is an infrequent glomerular disorder that culminates in nephrotic syndrome and often progresses to kidney failure. Whereas most patients have been reported in Japan and China, limited reports have been documented outside these regions. This patient represents the first report of lipoprotein glomerulopathy in Pakistan. Case Presentation: A 25-year-old male patient, hypertensive for 2 years, presented with progressive body edema, frothy urine, and fatigue. Examination revealed elevated blood pressure, bilateral pedal edema, and positive shifting dullness. Laboratory results showed significant proteinuria and elevated cholesterol and triglyceride levels. Renal biopsy revealed enlarged glomeruli with a dilated capillary lumen filled with pale-staining mesh-like material "lipoprotein thrombi." Mild tubular atrophy and interstitial inflammation were observed. No interstitial fibrosis was evident. Electron microscopy detailed the lipoprotein thrombi with lipid granules and vacuoles of various sizes. A diagnosis of lipoprotein glomerulopathy was rendered. Treatment with fenofibrate, rosuvastatin, and captopril led to notable improvements in symptoms, blood pressure, and lipid levels during a 6-month follow-up. Subsequent biopsy showed complete resolution of the lipoprotein thrombi and a significant reduction in subendothelial granular densities. However, the flocculent subendothelial material persisted to some extent despite the complete resolution of lipoprotein thrombi. Conclusion: This report underscores the rarity of lipoprotein glomerulopathy in Pakistan and contributes valuable insights into its histopathologic features and global epidemiology. This unique instance aims to raise awareness among healthcare professionals, aiding in improved recognition of this rare entity. The favorable response to fenofibrate treatment underscores its effectiveness in managing lipoprotein glomerulopathy.

Malignant Para-Testicular Mesothelioma: A Rare Presentation in the Tunica Vaginalis of an Elderly Male With No Prior Asbestos Exposure.

Malignant mesothelioma of the tunica vaginalis is an extremely rare and aggressive tumor that is frequently encountered in elderly patients. The diagnosis of malignant mesothelioma of the tunica vaginalis poses a diagnostic challenge due to its infrequency and nonspecific clinical presentation. Histopathological examination and immunohistochemical staining are essential in differentiating this tumor from other para-testicular masses and establishing a definitive diagnosis. Early detection and comprehensive treatment planning are crucial for improving the prognosis and overall outcomes for patients with this rare malignancy. We present a report of malignant mesothelioma of the tunica vaginalis in a 78-year-old male patient with no history of asbestos exposure who presented with a large infiltrative left para-testicular mass. Histopathological examination revealed a biphasic proliferation composed of epithelioid and spindle cells with infiltrative features, foci of necrosis, and increased mitotic figures. Immunohistochemical staining exhibited positive staining for WT1, D2-40, and calretinin, supporting the mesothelial origin of the tumor. Notably, BerEP4 staining was negative, arguing against carcinoma. Immunostaining for keratin 5 was positive, supporting the mesothelial differentiation. The Ki67 proliferation index was high. The differential diagnosis included adenomatoid tumors, germ cell tumors, and pleomorphic sarcoma. We aim to discuss the clinical presentation, diagnostic approach, and therapeutic approaches of this rare entity.

Pseudoangiomatous Spindle Cell Lipoma: A Rare and Distinct Pattern of Lipomatous Tumors.

Pseudoangiomatous spindle cell lipoma is a rare pattern within the spindle cell lipoma spectrum that exhibits a remarkable histological pattern characterized by its resemblance to vascular lesions, creating a pseudoangiomatous appearance. Approximately 20 to 30 reports have been described in the literature. In this context, we present an intriguing report of pseudoangiomatous spindle cell lipoma showcasing a unique low-fat pseudo angiomatous pattern in a 61-year-old male patient presented with a 6-cm subcutaneous mass on his right arm, which was thoroughly investigated and subsequently excised. Microscopic examination revealed bland spindle cells infiltrates within a fibromyxoid stroma. Notably, the tumor exhibited distinctive branching and dilated vascular-like spaces that formed pseudopapillary (villiform) projections. Interestingly, the tumor displayed certain regions featuring mature adipose tissue components, alongside hyalinized blood vessels. No necrosis, atypical spindle cells, increased mitotic activity, or pleomorphic lipoblasts were observed. The immunohistochemical evaluation demonstrated diffuse positive staining for CD34 and negative staining for STAT6. This report of a low-fat pattern of pseudoangiomatous spindle cell lipoma underscores the importance of recognizing and characterizing rare entity subtype for accurate diagnosis and appropriate management. This report contributes to the expanding understanding of the diverse presentations of pseudo angiomatous spindle cell lipomas and underscores the significance of comprehensive histopathological assessment.

Role of therapeutic plasma exchange in the treatment of severe hypertriglyceridemia: an experience.

Hypertriglyceridemia of obesity, the metabolic syndrome, and type II diabetes mellitus are highly prevalent in Saudi Arabia. Severe hypertriglyceridemia is a rare but well known cause of acute pancreatitis. In treatment pancreatic rest, lifestyle changes, and lipid-lowering medications are essential, but the response is slow. Recently the role of therapeutic plasma exchange (TPE) has been stressed for fast and effective management in addition to insulin and heparin infusion. TPE for hypertriglyceridemic pancreatitis resulted in drastic improvements in clinical and laboratory findings and patient outcomes as suggested in our cases. However, this procedure is limited due to its high cost and availability only in specialized hospitals.

Squamous metaplasia on the breast implant capsule.

The development of squamous metaplasia or carcinoma is a rare occurrence in the setting of a ruptured or leaking silicone breast implant capsule. However, the oncogenic process in such a context is yet another intriguing example of how chronic inflammation plays an integral role in the tumorigenic process. Recent papers have shed light on how inflammation involving M2-tpe macrophages, lymphocytes, and other inflammatory cells at first provide the cytokines necessary to fend off an inciting foreign-body attack such as silicone from a ruptured or leaking implant. Although such a response is beneficial in keeping infection or foreign material in check, there are instances when the response may be exaggerated. It is thought that the extent and length of the response, the balance between pro-inflammatory/ anti-apoptotic and anti-inflammatory/pro-apoptotic, as well as genetic factors play important roles in determining the final result of an inflammatory insult.

Role of urinary NMP-22 combined with urine cytology in follow-up surveillance of recurring superficial bladder urothelial carcinoma.

OBJECTIVE: To determine efficacy and utility of NMP-22 in follow-up of bladder urothelial carcinoma (UC) and compare NMP-22 as a single evaluating test vs combination with cytology. STUDY DESIGN: Ninety-four consecutive urine cytology samples of bladder UC were identified. Patients received follow-up urine cytology, NMP-22 testing and cystoscopy with surgical biopsy. RESULTS: NMP-22 specificity was 100%, sensitivity 45%, positive predictive value (PPV) 100% and negative predictive value (NPV) 87%. NMP-22 showed lower sensitivity for high-grade lesions and higher for low-grade lesions. Cytologic diagnosis had a high inconclusive rate; when regarded as positive, it resulted in 75% sensitivity, 58% specificity, 33% PPV and 89% NPV. NMP-22 correctly classified 60% of false negative cases diagnosed by cytology with low-grade UC and clarified 27 inconclusive cytologic diagnoses. NMP-22 misclassified 9 cases as false negative, all with high-grade UC; all were correctly identified on cytology as true positive. Combined interpretation showed 90% sensitivity, 92% specificity, 75% PPV and 98% NPV. CONCLUSION: NMP-22 complements cytology by its higher sensitivity for low-grade lesions; its values are not affected by bacillus Calmette Guérin therapy changes, which are limiting in cytology. Combined interpretation of NMP-22 and cytology shows promise as an effective, noninvasive method for surveillance of UC.

Fine-needle aspiration of follicular adenoma versus parathyroid adenoma: the utility of multispectral imaging in differentiating lesions with subtle cytomorphologic differences.

BACKGROUND: Multispectral image analysis is an emerging tool that utilizes both spatial and spectral image information to classify images that can be used for the differentiation between benign versus malignant cells. The aim of the current study was to analyze the ability of this tool in differentiating subtle cytologic differences that cannot be appreciated by the human eye. Herein, the authors used fine-needle aspirations (FNAs) of follicular adenoma (FA) and parathyroid adenoma (PA) as a test case. METHODS: The Nuance platform was used to collect image stacks that were subsequently analyzed with CRI-MLS software, a neural network-based artificial intelligence system that can classify images using automatically "learned" spatial-spectral features. CRI-MLS was trained on random, well-preserved FA cells and PA cells from the training set (n = 45 cells each). An algorithmic solution was developed and then validated on an independent series comprised of 1904 FA cells from 5 FA cases and 690 PA cells from 5 PA cases. RESULTS: The solution from the CRI-MLS classifier showed 1876 FA cells (98.5%) as true FA and 28 FA cells (1.5%) as false PA, whereas 663 PA cells (96%) were true PA and 27 PA cells (4%) were false FA. The summary result of this solution was a sensitivity of 98.5%, a specificity of 96.1%, and a positive predictive value of 98.6%. CONCLUSIONS: The best spatial-spectral imaging solution was able to correctly classify 2534 of 2594 cells (98%) and misclassified only 55 of 2594 cells (2%). These data suggest that this technology may be valuable in a clinical setting to help differentiate and classify morphologically similar lesions.

An unusual renal malignancy of childhood: unilateral teratoid Wilms's tumor.

Teratoid Wilms's tumor is a rare histologic variant of the classical Wilms's tumor, containing predominantly heterolougus tissues (adipose, glial, muscle, cartilage, or bone). We report an unusual variant of such tumor, which simulated renal teratoma because of abundant fat within the tumor. The child underwent radical excision; postoperatively, he was treated with chemotherapy, and now the child is well at 36 months after surgery. The behavior of this kind of tumor usually is not aggressive, and the outcome is good. Surgery should be the treatment of choice, because the efficacy of chemotherapy and radiotherapy is probably reduced by the high amount of differentiated and mature tissue that characterizes this neoplasm. Radiologic imaging and pathological features of this rare entity are described.

Analysis of urine cytology at a community hospital.

BACKGROUND: To review the pattern of urine cytology in our setting of a community hospital with age and gender distribution. Also to discuss the importance of this safe and inexpensive tool for diagnosing and screening urothelial cancers. We desire to encourage more wider and confident use of urine cytology in the routine practice. METHOD: We reviewed all the consecutive urine cytology specimens received at our institution during time frame of one year. The cytological diagnosis were grouped in four categories; 1: negative, benign or reactive cases; 2: cases showing acute inflammatory changes; 3: inconclusive cases and 4: malignant cases. Only the positive malignant cases were followed histologically to determine the accuracy and efficiency of urine cytological examination for positive cases. RESULTS: A total of 1957 consecutive urine cytology specimens were reviewed. Majority of the cases were negative for tumour (67.19%). The most common diagnostic category was acute inflammatory case (17.3%) while inconclusive cases constituted 11.39% of total. There were 23 (1.18%) positive cases that were diagnosed malignant on urine cytology. These 23 malignant cases were followed histologically and 22 (95.6%) cases turned out to be malignant. CONCLUSION: Urine cytological examination is an efficient tool that has a good diagnostic yield in detecting malignant urothelial lesions. It should be used routinely for diagnosing, screening and for follow-up of all malignant urothelial lesions.

Analysis of inconclusive fine-needle aspiration of thyroid follicular lesions.

To evaluate all inconclusive fine-needle aspiration biopsy (FNAB) specimens from thyroid follicular lesions with subsequent histologic diagnosis at St John Hospital and Medical Center, Detroit, MI. The criterion for specimen adequacy used in our institution was also reexamined to determine whether it was too stringent. We reviewed 45 inconclusive FNAB samples. Only cases that underwent surgical intervention were considered. Specimen adequacy was determined by the presence of at least 8-10 tissue fragments of well-preserved follicular epithelium on at least two slides; each tissue fragment should have a minimum of 8-10 cells. Different cytologic characteristics-cellularity, cellular architecture, nuclear pleomorphism, inclusion/grooves, chromatin, Hürthle cell change, lymphocytes, macrophages, colloid, and multinucleated giant cells-were scored and compared with final surgical diagnosis. The surgical procedure performed was also analyzed. Review of these 45 surgical specimens found 28 (62.2%) multinodular goiters, 14 (31.1%) nodular hyperplasias, 2 (4.4%) follicular adenomas, and one (2.2%) with invasive follicular carcinoma. Forty-three (95.6%) of these cases were female and 2 (4.4%) were male. Cytologic review showed 2 acellular samples, 10 cases containing macrophages only, 10 aspirates with macrophages and an inadequate number of follicular cells, and 23 specimens with an inadequate number of follicular cells. Twenty-three patients underwent total thyroidectomy; 20, lobectomy; and 2, isthumusectomy. Almost 98% of the patients with inconclusive FNAB had benign lesions. This finding encouraged us to continue using our criteria for adequacy because of the importance of a negative report. Patients in our series, who underwent thyroidectomy after an inconclusive or nondiagnostic aspirate, had a malignancy rate of 2.2%, which was no worse than patients with a benign preoperative diagnosis. A balanced approach with careful follow-up for nondiagnostic cytology is prudent.

Computer skills among medical learners: a survey at King Abdul Aziz University, Jeddah.

BACKGROUND: We conducted a survey at King Abdul Aziz University to assess computer and Internet related activities, needs, and attitudes of our medical students towards computer assisted medical learning. METHODS: A questionnaire containing 16 questions was distributed among medical students. The question form was prepared to assess the computer skills among students and their involvement in computer and Internet assisted medical and clinical learning activities. Each question was followed by a four or five points containing Likert-type multiple choice answer. RESULTS: A total of 303 medical member of the university filled the forms. Among them majorities were medical students constituting 247 (81.5%), 10 (3.3%) were interns, 9 (3%) residents and 36 (11.9%) were senior residents. 55% of the responders were male and 45% were females. The most important points with their brief responses are: Computer skills: 6.3% Not aware; 93.7% Aware. Purpose of using computer: Personal 62.5%; Professional 15%; Academic 21.9%. Software(s) used: MS office 9.4%; MS Office and Internet 31.3%; MS Office, Internet and any medical software 37%; No software 21%. Connecting to Internet or Email: Not at all 18%; Rarely 18%; Once a week 15%; Every alternate day 25%; Daily 12.5%; Multiple times a day 9.4%. Use of Internet for medical learning: Not at all 22%; Very rarely 22%; Some times 41%; Regularly 15%. Computers and Internet can improve studies and professional skills: No not at all 6%; Yes, to some extent 41%; Yes, too much 53%. CONCLUSION: The use of modern computer and Internet technology will result in more effective medical education. Expansion of computer-assisted learning requires careful strategic planning, resource sharing, staff incentives, and active promotion of multidisciplinary working and effective quality control.

Experience of liver disease at a University Hospital in Western Saudi Arabia.

OBJECTIVE: The aim of this retrospective study is to review the pattern of hepatic diseases seen in our setting at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia and to assist us in appreciating the hepatic prototype in our region. METHODS: Our study consisted of 246 consecutive liver biopsies. Lesions were studied considering histological type, age and gender of the patients and anatomic location. Distribution of hepatic lesions were classified into 4 categories as 1. Chronic inflammatory lesions, 2. Cirrhotic lesions, 3. Neoplastic hepatic lesions and 4. Pediatric and hereditary hepatic lesions. RESULTS: Chronic inflammatory lesions comprised of 123 (50%) cases (mean age 38.1), most commonly reported being chronic hepatitis 82 cases (33.3%, mean age 42). Among these patients with chronic hepatitis, 59 cases were positive for hepatitis C virus (HCV), 21 cases were positive for hepatitis B virus (HBV) and 2 cases had both HCV and HBV. Twenty cases were diagnosed with cirrhosis (mean age 38.2). Among these cirrhotic lesions 16 cases were positive for HCV, 4 cases were positive for HBV. Neoplastic lesions were mostly malignant and comprised of 41 (15.5%) cases (mean age 44.7), with only one benign lesion diagnosed as benign hemangioma (age 48 years). Among malignant lesions, the majority were metastatic lesions, 18 were adenocarcinoma metastasis, all with primary from the gastrointestinal tract (mean age 46.6) and 12 with lymphomatous metastasis (mean age 41.2). There were 10 cases of hepatocellular carcinoma (mean age 43). Pediatric hepatic lesions comprised of 35 (14.2%) cases with the most common lesion being extrahepatic bile duct obstruction in 6 cases (mean age 2 months). CONCLUSION: Chronic active hepatitis was the most common inflammatory lesion, metastatic carcinoma was the most common neoplastic lesion and extrahepatic bile duct obstruction was the most common pediatric lesion of the liver.