Personalized synthetic MR imaging with deep learning enhancements.

PURPOSE: Personalized synthetic MRI (syn-MRI) uses MR images of an individual subject acquired at a few design parameters (echo time, repetition time, flip angle) to obtain underlying parametric ( ρ , T 1 , T 2 ) $$ \left(\rho, {\mathrm{T}}_1,{\mathrm{T}}_2\right) $$ maps, from where MR images of that individual at other design parameter settings are synthesized. However, classical methods that use least-squares (LS) or maximum likelihood estimators (MLE) are unsatisfactory at higher noise levels because the underlying inverse problem is ill-posed. This article provides a pipeline to enhance the synthesis of such images in three-dimensional (3D) using a deep learning (DL) neural network architecture for spatial regularization in a personalized setting where having more than a few training images is impractical. METHODS: Our DL enhancements employ a Deep Image Prior (DIP) with a U-net type denoising architecture that includes situations with minimal training data, such as personalized syn-MRI. We provide a general workflow for syn-MRI from three or more training images. Our workflow, called DIPsyn-MRI, uses DIP to enhance training images, then obtains parametric images using LS or MLE before synthesizing images at desired design parameter settings. DIPsyn-MRI is implemented in our publicly available Python package DeepSynMRI available at: https://github.com/StatPal/DeepSynMRI. RESULTS: We demonstrate feasibility and improved performance of DIPsyn-MRI on 3D datasets acquired using the Brainweb interface for spin-echo and FLASH imaging sequences, at different noise levels. Our DL enhancements improve syn-MRI in the presence of different intensity nonuniformity levels of the magnetic field, for all but very low noise levels. CONCLUSION: This article provides recipes and software to realistically facilitate DL-enhanced personalized syn-MRI.

Early Assessment of Chemotherapy Response in Advanced Non-Small Cell Lung Cancer with Circulating Tumor DNA.

Monitoring treatment efficacy early during therapy could enable a change in treatment to improve patient outcomes. We report an early assessment of response to treatment in advanced NSCLC using a plasma-only strategy to measure changes in ctDNA levels after one cycle of chemotherapy. Plasma samples were collected from 92 patients with Stage IIIB-IV NSCLC treated with first-line chemo- or chemoradiation therapies in an observational, prospective study. Retrospective ctDNA analysis was performed using next-generation sequencing with a targeted 198-kb panel designed for lung cancer surveillance and monitoring. We assessed whether changes in ctDNA levels after one or two cycles of treatment were associated with clinical outcomes. Subjects with ≤50% decrease in ctDNA level after one cycle of chemotherapy had a lower 6-month progression-free survival rate (33% vs. 58%, HR 2.3, 95% CI 1.2 to 4.2, log-rank p = 0.009) and a lower 12-month overall survival rate (25% vs. 70%, HR 4.3, 95% CI 2.2 to 9.7, log-rank p < 0.001). Subjects with ≤50% decrease in ctDNA level after two cycles of chemotherapy also had shorter survival. Using non-invasive liquid biopsies to measure early changes in ctDNA levels in response to chemotherapy may help identify non-responders before standard-of-care imaging in advanced NSCLC.

Calvarial metastasis from adenocarcinoma of lung: An uncommon initial presentation diagnosed by cytology.

Bone metastasis from lung primary is not uncommon and about one-third of bone metastases originate from lung. However, skull bone metastasis is uncommon from lung carcinoma. Metastasis to skull bone and scalp as an initial presentation of lung carcinoma is a very rare phenomenon. We have diagnosed a case of calvarial metastasis with scalp swelling as an initial presentation of adenocarcinoma of lung by fine-needle aspiration cytology in an aged female. Radiologically, it was suggested as tuberculous lesion but cytology gave the correct diagnosis. Here, we present a rare case of calvarial metastasis as a presentation of adenocarcinoma of lung in an elderly female.

Simple Fabrication of PVA-ZnS Composite Films with Superior Photocatalytic Performance: Enhanced Luminescence Property, Morphology, and Thermal Stability.

Poly(vinyl alcohol) (PVA)-ZnS composite films were prepared by varying the composition of PVA ranging from 1-5 wt % through a simple solvent casting method. The photocatalytic enactment of the composites was evaluated along with the investigations of their photoluminescence (PL), optical transparency, morphology, and thermal properties. The firm interaction between the ZnS and PVA was confirmed by Fourier transform infrared, UV-vis, and PL spectroscopies. PVA-ZnS composites showed enhanced luminescence property than PVA. The composites exhibited very good optical transparency regardless of the amount of PVA addition. The thermogravimetric analysis data indeed exhibited better thermal stability of the composites. The glass transition temperature (T g), melting temperature (T m), enthalpy of melting (ΔH m), and crystallinity were evaluated for such composites. The composites demonstrated morphological variations depending on the amount of PVA addition, although the particle size of ZnS remained similar in the nanometer range (50-120 nm) for all composite samples. The prepared composite films exhibited superior photocatalytic performance in the degradation of methylene blue compared with the bare ZnS and PVA. This study may give a new insight into the fabrication of PVA-ZnS photocatalysts for the treatment of organic pollutants.

Fine needle aspiration cytology of minor salivary gland tumors: A retrospective 5-year study of 42 cases in a tertiary care hospital.

BACKGROUND: Minor salivary gland tumors (MSGTs) are less common than major salivary glands and involve only 15-20% of all salivary gland tumors. Most of the cases originate at intra- and peri-oral region. Minor salivary gland lesion cytology has been studied rarely in India. AIMS: This present study was performed to evaluate the role of fine needle aspiration cytology (FNAC) in diagnosis of MSGTs and to explore the cases of cytohistological discrepancies in the study. MATERIALS AND METHODS: This retrospective study was conducted over a 5-year period on 42 cases of MSGTs. In all the cases, cytology was correlated with histology and cytohistological discrepancies were searched. Sensitivity, specificity, and diagnostic efficacy were calculated using histopathology as gold standard. RESULTS: We diagnosed 27 malignant (64.28%) and 15 benign (35.71%) MSGTs in cytological evaluation. We found two false negative and one false positive case in cytology. Sensitivity, specificity, and diagnostic accuracy of the study were 92.59%, 93.33%, and 92.85%, respectively. CONCLUSION: FNAC is a minimally invasive and cost-effective procedure with high accuracy (92.85%) in the assessment of MSGTs and helps in the management of benign and malignant tumors.

Cytological findings of microfilariae in different sites: A retrospective review of 22 cases from endemic region.

BACKGROUND: Filariasis is a major health problem in India. Despite the high prevalence, microfilariae are rarely found in cytology smears. Most of the cases are incidentally found, solely or in association with other pathologies. AIMS AND OBJECTIVES: The study was undertaken to analyze the prevalence and cytology findings of cases of incidentally found microfilariae in cytology smears (fine-needle aspiration cytology [FNAC]/body fluids) from different body parts. MATERIALS AND METHODS: This was a retrospective study over 5 years, where the cases of microfilariae in aspirates from swelling of different locations and body fluids were reviewed, and clinic-pathological data were analyzed. RESULTS AND ANALYSIS: Out of 16,738 cases of FNAC and 882 cases of fluid cytology, 22 cases (0.124%) of incidental finding of microfilaria were documented in cytology smears. The cases were diagnosed from lymph nodes (5 cases), skin and soft tissue (4 cases), scrotal (4 cases), breast (3 cases), thyroid (2 cases), and pleural fluid (2 cases). We found eosinophilia in 15 cases (68.18%) of filarial lesions. We found two cases of incidental findings of microfilariae in association with malignant lesions. CONCLUSION: Filariasis should be considered as differential diagnosis of swelling of lymph nodes, skin, soft tissue, inguinoscrotal region, and other sites as well. Careful screening of cytology smears may help in detection of incidental cases in the association of other pathologies.

Fine-needle aspiration cytology of leishmanial lymphadenitis in an HIV-reactive patient: Report of a rare case.

Lymphatic leishmaniasis is a rare parasitic disease even in endemic region. It is usually associated with visceral and post-kala-azar dermal leishmaniasis. Leishmaniasis is being increasingly recognized in association with immunodeficient patients (HIV/AIDS). However, leishmanial lymphadenitis has been rarely diagnosed by fine-needle aspiration cytology (FNAC) of epitrochlear lymph node in an HIV patient. Cytological features of leishmanial lymphadenitis in an HIV-reactive patient have been rarely addressed in previous literature. We present the FNAC of a case of leishmanial lymphadenitis in epitrochlear lymph node in the case of an HIV-reactive patient with visceral leishmaniasis.

Well differentiated papillary mesothelioma of abdomen- a rare case with diagnostic dilemma.

Well-differentiated papillary mesothelioma is a rare tumor occurring predominantly in the peritoneum of young women, a few with history of asbestos exposure. A 28-year-old woman presented with ascites and pain abdomen. Ultrasonography and computed tomography scan of the abdomen revealed a mass in the retroperitoneum measuring 15 cm × 12 cm. Histopathological examination along with immunohistochemistry (IHC) confirmed it to be a papillary mesothelioma in the peritoneum. It is difficult to differentiate from more common malignant mesothelioma and papillary adenocarcinoma, which also have poorer prognosis. The difficulty can be resolved by clinico-radiological correlation along with histopathological examination and IHC.

Fine Needle Aspiration Cytology of Basal Cell Adenoma of Parotid Simulating Adenoid Cystic Carcinoma.

Basal cell adenoma is a rare type of monomorphic salivary adenoma most commonly involving the parotid gland. Cytology of basal cell adenoma closely mimics many other benign and malignant basaloid neoplasms. Cytological features of membranous basal cell adenoma simulate adenoid cystic carcinoma in fine needle aspiration cytology (FNAC) smears. Here, we are presenting a rare case of cytodiagnosis of membranous basal cell adenoma of parotid gland in an elderly lady, which mimicked adenoid cystic carcinoma on FNAC. We discuss the cytomorphology of this rare case with an emphasis on cytological difference between membranous basal cell carcinoma and adenoid cystic carcinoma as well as other basaloid neoplasms.

Fine-needle aspiration cytology of granulocytic sarcoma presenting as a breast lump - Report of a rare case with a comprehensive literature search.

Myeloid sarcoma is a neoplasm of myeloid cells that can arise before or concurrent with or may follow acute myeloid leukemia. Very rarely, it can present as an isolated breast lump. We have diagnosed a case of myeloid sarcoma by fine-needle aspiration cytology (FNAC), in a 52-year-old woman who presented with the right-sided breast lump. FNAC showed hypercellular smears with immature myeloid cells few neutrophils and many large round cells with high nuclear-cytoplasmic ratio, prominent nucleoli and a moderate amount of granular cytoplasm. The blast cells were myeloperoxidase positive and complete blood count, and peripheral blood examination were normal. We report this case for its rarity and as a note of caution to a pathologist to consider myeloid sarcoma in the differential diagnosis of breast lump to provide the correct diagnosis and avoid incorrect treatment of a curable disease.

Cytodiagnosis of Eccrine Porocarcinoma of the Scalp.

Eccrine porocarcinoma is a rare, malignant adnexal tumor of the duct of eccrine sweat gland. Cytology of eccrine porocarcinoma has been described in very few previous literature. Here, we present a case of fine needle aspiration cytology (FNAC) of eccrine porocarcinoma of the scalp, which is subsequently confirmed by histology. Accurate diagnosis of eccrine porocarcinoma by FNAC is very difficult, but determining the malignant nature of the lesion is crucial for curative surgery. FNAC can be a convenient, safe, and effective approach to solve difficult diagnostic dilemma.

Rhabdoid Meningioma of Brain - A Rare Aggressive Tumor.

Rhabdoid meningioma is a rare aggressive variant of meningioma, regarded as WHO Grade III type. Histologically and cytologically, it is distinctive type having abundant eosinophilic cytoplasm, cytoplasmic inclusion with eccentrically placed vesicular nuclei and prominent nucleoli. High recurrence rate and poor outcome are important features. Here, we are presenting a rare case of rhabdoid meningioma found in a recurrent meningioma of the posterior fossa in a middle-aged female. We emphasized the squash cytology and histology finding of the rare neoplasm.

Fine needle aspiration cytology of primary cutaneous mucinous carcinoma of axilla-report of a rare case.

Primary mucinous eccrine carcinoma is a rare malignant adnexal tumor of older patients. The histopathological features of this tumor are well-established but the cytomorphology of this neoplasm has only been documented in a few cases. The cytology and histology of this tumor may mimic metastatic mucinous carcinoma and may cause a diagnostic dilemma, especially when the tumor is located at axilla. A correct diagnosis is important because the prognosis is better than that of a metastatic mucinous carcinoma. Here we report the cytological and histological features of a case of primary cutaneous mucinous carcinoma of axilla in an elderly male patient.

Microfilaria in pleural fluid cytology: A rare finding.

Lymphatic filariasis is endemic in India and Southeast Asia. Detection of microfilaria is infrequently reported during cytological evaluation of various lesions or body cavity fluids. Presence of microfilaria in pleural fluid cytology is very rare finding even in endemic areas. Few cases of accidental finding of microfilaria have been reported in association with malignant pleural effusion. But pleural effusion of filarial origin is extremely rare manifestation. Here we report a classical case of microfilaria in pleural fluid cytology.

Placental Mesenchymal Dysplasia With Normal Fetus: A Rare Case Report.

Placental mesenchymal dysplasia (PMD) is a rare benign placental abnormality. It is characterized by hydropic degeneration of stem villi, placentomegaly, and increased maternal serum alpha-fetoprotein (AFP). It can be associated with different congenital abnormalities, karyotype abnormalities, and feto-maternal morbidities. It is difficult to differentiate PMDfrom partial mole, complete mole with twin pregnancy in ultrasound, and in macroscopic examination. The current paper presentsa rare case of placental mesenchymal dysplasia in a young primigravida mother who delivered a normal fetus withnormal karyotype.

Severely calcified leiomyoma of broad ligament in a postmenopausal woman: Report of a rare case.

Calcified broad ligament leiomyoma is a rare benign lesion in postmenopausal age group. It causes diagnostic confusion with solid calcified adnexal mass and large bladder calculi at the pelvic region. Clinical and radiological diagnoses were confirmed by histopathology of the hysterectomy specimen. We hereby present a case of heavily calcified broad ligament fibroid in a postmenopausal woman.

Fine needle aspiration cytology of cylindroma of scalp: A case report.

Cylindromas are uncommon benign adnexal tumor. Multiple cylindromas are commonly genetically inherited and also known as "turban tumor." Cytology of dermal cylindroma is rarely discussed in previous literature. We have diagnosed a case of dermal cylindroma of scalp in an elderly female patient by fine needle aspiration cytology of the lesion and further confirmation was done by histopathology. Cytology consists of many clusters of small round to oval basaloid cells surrounded and attached with magenta coloured acellular hyaline material. The cells have very scanty cytoplasm and dark, round to oval hyperchromatic nuclei without any nuclear membrane irregularity. Histopathology revealed nests of tumor cells separated by dense pink, PAS positive basement membrane material with a jigsaw puzzle appearance. Cytology of cylindroma should be differentiated from adenoid cystic carcinoma and other benign adnexal tumor like spiradenoma. We have discussed the case of cylindroma of scalp diagnosed by cytology and confirmed by histopathology. Diagn. Cytopathol. 2016;44:1082-1084. © 2016 Wiley Periodicals, Inc.