The impact of vascular access type on survival in haemodialysis: time for a paradigm shift? A prospective cohort study.

INTRODUCTION: Although arteriovenous autologous fistula is the vascular access of choice due to better long-term outcome than central venous catheters, the use of central venous catheters is increasing. Our study aims to describe the survival and epidemiological features of a cohort of dialysis patients with a focus on the role of vascular access. METHODS: Our study comprises a follow-up period from 2001 to 2020 in a single center. Descriptive analysis was performed on baseline data. Moreover, we analysed predictive variables of death with univariable and multivariable logistic regressions. Predictors of survival were analysed by univariable and multivariable Cox regression. RESULTS: Our analysis includes 754 patients undergoing chronic haemodialysis. In the multivariable logistic regression, the use of tunnelled catheters resulted protective against death from any cause (Odds Ratio 0.43; p = 0.017). In the multivariable Cox analysis, being "late referral" was associated with decreased survival in the first 6 months since haemodialysis start (Hazard Ratio 3.79; p = 0.001). In the subgroup of elderly (age ≥ 75 years) patients (n = 201/472) with a follow up of 7-60 months, multivariable logistic regression showed that tunnelled catheters at the start of haemodialysis were associated with lower mortality (Odds Ratio, 0.25; p = 0.021), whereas vascular disease was found to be the main risk factor for death (Odds Ratio, 5.11; p = 0.000). Moreover, vascular disease was confirmed as the only independent risk factor by Cox analysis (Hazard Ratio, 1.58; p = 0.017). CONCLUSIONS: In our cohort, mortality was found to be more closely associated with comorbidities than with the type of vascular access. Tunnelled central venous catheters might be a viable option for haemodialysis patients.

Breast metastasis in a young pregnant woman affected by metastatic melanoma.

Metastasis to the breast from extramammary tumors are rare, and the most common cancer that metastasizes to this site is malignant melanoma (MM). Unfortunately, metastases from malignant melanoma reveal a widespread of the disease and a high likeliness of poor diagnosis. In this study, a case of left breast metastasis of MM in a young pregnant woman, with a fast progression of the mammary and systemic course of pathology and unfortunately poor prognosis is presented. Despite the role of pregnancy in MM has yet to be unraveled, our study encourages the theory that immunosuppression and hormonal changes due to pregnancy may aggravate melanoma prognosis.

Therapeutic Efficacy, Radiotoxicity and Abscopal Effect of BNCT at the RA-3 Nuclear Reactor Employing Oligo-Fucoidan and Glutamine as Adjuvants in an Ectopic Colon Cancer Model in Rats.

Boron neutron capture therapy (BNCT) is based on the preferential uptake of 10B compounds by tumors, followed by neutron irradiation. The aim of this study was to assess, in an ectopic colon cancer model, the therapeutic efficacy, radiotoxicity, abscopal effect and systemic immune response associated with (BPA/Borophenylalanine+GB-10/Decahydrodecaborate)-BNCT (Comb-BNCT) alone or in combination with Oligo-Fucoidan (O-Fuco) or Glutamine (GLN), compared to the "standard" BPA-BNCT protocol usually employed in clinical trials. All treatments were carried out at the RA-3 nuclear reactor. Boron biodistribution studies showed therapeutic values above 20 ppm 10B in tumors. At 7 weeks post-treatment, the ratio of tumor volume post-/pre-BNCT was significantly smaller for all BNCT groups vs. SHAM (p < 0.05). The parameter "incidence of tumors that underwent a reduction to ≤50% of initial tumor volume" exhibited values of 62% for Comb-BNCT alone, 82% for Comb-BNCT+GLN, 73% for Comb-BNCT+O-Fuco and only 30% for BPA-BNCT. For BPA-BNCT, the incidence of severe dermatitis was 100%, whereas it was significantly below 70% (p ≤ 0.05) for Comb-BNCT, Comb-BNCT+O-Fuco and Comb-BNCT+GLN. Considering tumors outside the treatment area, 77% of Comb-BNCT animals had a tumor volume lower than 50 mm3 vs. 30% for SHAM (p ≤ 0.005), suggesting an abscopal effect of Comb-BNCT. Inhibition of metastatic spread to lymph nodes was observed in all Comb-BNCT groups. Considering systemic aspects, CD8+ was elevated for Comb-BNCT+GLN vs. SHAM (p ≤ 0.01), and NK was elevated for Comb-BNCT vs. SHAM (p ≤ 0.05). Comb-BNCT improved therapeutic efficacy and reduced radiotoxicity compared to BPA-BNCT and induced an immune response and an abscopal effect.

Magnetic Resonance Imaging in Autism Spectrum Disorders: clinical and neuroradiological phenotypes.

BACKGROUND AND AIM: Autism Spectrum Disorders (ASDs) are a group of neurodevelopmental disorders that can severely compromise social and cognitive functions in childhood. Magnetic Resonance Imaging (MRI) currently represents the gold standard as an in vivo and non-invasive study of the human brain morphology. This work aims to search for possible links between clinical phenotypes and radiological anomalies that may be relevant and pathognomonic in the subsequent diagnosis of ASDs. METHODS: This is a retrospective study in which 132 patients (112 males and 20 females) with neurodevelopment disorders, including ASDs, were enrolled. The population study was divided into three groups considering their own pathological diagnosis. All patients included in this population underwent genetic screening and one or multiple 1.5T MRI scans were performed to evaluate potential anomalies of the corpus callosum, periventricular white matter, ventricular space, cerebellum, subarachnoid space and thalamus. RESULTS: Univariate analysis showed that the presence of MRI brain abnormalities was a significant variable in predicting the presence of ASDs.  Increased ventricular volume was one of the most replicated findings in ASDs patients since it was reported to be statistically significant both in uni- and multivariate analysis, resulting even as a potentially predictive factor of diagnosis. CONCLUSIONS: This study can represent a starting point for the research of new radiological evidence that might be important to early diagnose ASDs and for making a differential diagnosis with all those conditions that mimic autistic traits, but which are not clinically connected to the spectrum disorder itself.

Castleman disease: a rare case in a young woman.

Castleman disease is a rare lymphoproliferative disorder characterized by benign enlargement of lymph nodes. It is divided into unicentric disease, which involves a single enlarged lymph node, and multicentric disease, which affects multiple lymph node stations. In this report, we describe a rare case of a 28-year-old female patient with an unicentric Castleman disease. Computed tomography and magnetic resonance imaging revealed a well-circumscribed large mass in the left neck, characterized by intense homogenous enhancement and suspected for a malignant disease. The patient underwent an excisional biopsy for definitive diagnosis of unicentric Castleman disease and ruled out malignant conditions.

Extragonadal germ cell tumor: A rare case in dorsal region.

Extragonadal germ cell tumors (GCTs) are a rare group of neoplasms that account for 1%-5% of all GCTs. These tumors can present with an unpredictable behavior and clinical manifestations depending on different factors such as histological subtype, anatomical site, and clinical stage. We report the case of a 43-year-old male patient with a primitive extragonadal seminoma located in the paravertebral dorsal region, an extremely rare site. He presented to our emergency department with a 3-month history of back pain and a 1-week history of fever of unknown origin. Imaging techniques revealed a solid tissue arising from the vertebral bodies of D9-D11 and extending in the paravertebral space. After a bone marrow biopsy and exclusion of testicular seminoma, he was diagnosed with primitive extragonadal seminoma. The patient underwent five cycles of chemotherapy, and the follow-up CT examinations showed a reduction of the mass initially till a complete remission with no evidence of recurrence.

Two rare cases of pituitary apoplexy in adult females: a tricky diagnosis.

We reported two cases of women who suffered from a rare case of pituitary apoplexy, rare and potentially fatal clinical condition due to a hemorrhagic infarction of the pituitary gland due to a pre-existing macroadenoma. The onset of symptoms is often insidious and includes generic symptoms such as headache, vomiting, and visual disturbances. In this case report we discuss the typical CT and MRI imaging features of this rare clinical condition in order to help radiologists in the timely diagnosis for a more rapid and correct diagnostic framing.

Malignant odontogenic tumors. A report of a series of 30 cases and review of the literature.

Malignant odontogenic tumors are rare entities and can arise de novo or from malignant transformation of pre-existing lesions. The aim of the present study was to report 30 cases of malignant odontogenic tumors diagnosed at a single diagnostic center over a 38-year period. MATERIALS AND METHODS: All cases of malignant odontogenic tumors diagnosed between 1980 and 2018 were retrieved from the files of the School of Dentistry, University of Buenos Aires; their frequency and clinical, radiographic, and histopathological features were analyzed. The obtained data were compared with the information reported in the literature. RESULTS: Malignant odontogenic tumors accounted for 2 % of odontogenic tumors and 0.05 % of all oral-maxillofacial diseases. Mean age was 43 years (8 to 87 years). No differences in sex distribution were observed. The most frequent location was the mandible, mostly the posterior mandibular body and the ramus. Odontogenic carcinomas were the most frequent tumors, and primary intraosseous carcinomas were the most common in this group. CONCLUSIONS: This is the largest case series of malignant odontogenic tumors diagnosed at a single center reported in the literature to date. Diagnosis of these tumors is challenging based on their rarity and complexity and relies on careful analysis of the histopathological, clinical, and radiographic features.

Cor triatriatum dexter: a rare incidentaloma.

Cor triatriatum dexter (CTD) is an extremely rare finding resulting from the persistence of the right valve of sinus venosus. It is a congenital cardiac anomaly defined by an abnormal septation of the atrium leading to inflow obstruction to the respective ventricle. Multimodal diagnostic modalities are necessary to characterize it for an optimal patient management. We report the case of a 68-year-old woman who presented to our clinic for further feedback of ventricular ectopic beats.

Lumbar malignant peripheral nerve sheath tumor: a rare case in a young patient.

Malignant peripheral nerve sheath tumor (MPNST) is a rare soft tissue sarcoma that originate from peripheral nerves or from cells associated with the nerve sheath. We report the case of a 30­year­old male patient with a history of neurofibromatosis type I (NF-1) and a MPNST located in the lumbar region. The mass was resecated but surgical margins weren't clear. Recurrence of disease was observed after few months. A close monitoring of subjects with NF-1 is crucial to diagnose MPNST at an earlier stage and allow a complete surgical resection.

Titanium dental implant-related pathologies: A retrospective histopathological study.

OBJECTIVES: To perform a retrospective, descriptive, histopathological study of peri-implant tissue pathologies associated with titanium dental implants (TDI), and to evaluate the presence of metallic particles in samples from a single diagnostic center. METHODS: Sixty-eight cases of TDI-associated lesions were retrieved from the Surgical Pathology Laboratory archives, School of Dentistry, University of Buenos Aires (UBA) (1990-2018). The study included re-examining the histopathological features of the biopsy samples, analyzing the inflammatory infiltrate, and examining the samples to detect metallic particles whose chemical composition was determined spectrophotometrically (EDS). Available clinical and radiographic data were also reviewed. RESULTS: The retrieved cases ranged from lesions of inflammatory origin to neoplastic lesions. Metallic particles were observed in 36 cases (52.9%), all of which showed inflammation. Particle length ranged from 2 to 85µm. EDS analysis of the particles/deposits observed in the tissues showed the presence of aluminum, titanium, iron, and nickel, among other elements. CONCLUSIONS: A significant number of TDI-associated lesions, including cases not reported to date and diagnosed at a single diagnostic center, are shown here. Cases showing particles exhibited an inflammatory response, irrespective of the histopathological diagnosis. The role of metallic particles in the development of TDI-associated lesion is yet to be established.

Postmenopausal osteoporosis: current status of bone densitometry.

Osteoporosis is the most common of all metabolic bone disorders characterized by loss of bone strength, due to modifications in bone turnover. It leads to bone fragility and increased fracture risk. Because of the increasing aging of the world population, the number of people affected by osteoporosis is continuously increasing. The WHO operational definition of osteoporosis, based on a measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), identifies patients at greatest risk of fracture. However, in the population overall a greater total number of fractures occurs in individuals with BMD values above threshold for osteoporosis diagnosis; for this reason, algorithms have been developed to improve the identification of individuals at high fracture risk, including clinical risk factors for fracture. The correct diagnosis of osteoporosis with an appropriate and accurate use of diagnostic imaging results in better management in terms of adequate treatment and follow-up. Moreover, screening strategies will improve identification of patients who are most likely to benefit from drug treatment to prevent fracture. All women after the age of 65 years previously untested and women after the age of 50 years with previous low trauma fractures should be screened by DXA. In fact, osteoporosis-related fractures cause a significant increase in morbidity and mortality, decreasing the quality of life, with an increasing social and economic burdens. For this reason, fracture risk assessment should be a high priority amongst health measures.

Wunderlich syndrome: a rare case in a young woman.

We report the case of a 29-year-old woman with Wunderlich syndrome, a rare spontaneous renal hemorrhage into the subcapsular and perinephric space. She presented to our emergency department with a sudden and persistent right flank pain in the abscence of abdominal injury. The onset of the symptoms can be insidious and lead to hypovolemic shock. Computed Tomography helps both in the diagnosis, detecting the renal hemorrhage, and contributes to an optimal patient management. Selective arterial embolisation is an efficient technique to stop acute and potential life-threatening hemorrhage and preserve the renal parenchyma.

Phosphaturic mesenchymal tumors: radiological aspects and suggested imaging pathway.

Phosphaturic mesenchymal tumors (PMTs) are rare mesenchymal neoplasms of soft tissue or bone origin that can give rise to a challenge in diagnostic imaging. These tumors are frequently associated with tumor-induced osteomalacia, also called oncogenic osteomalacia, which is a rare paraneoplastic syndrome characterized by ectopic secretion of fibroblast growth factor 23, a hormone that regulates serum phosphate level. PMTs show polymorphic features on both radiological findings and histological examination, causing problems in diagnosis owing to their similarity with other mesenchymal tumors. Thus, this paper aims to describe radiological aspects of PMTs and suggest an imaging pathway for accurate diagnosis throughout the evidence from the literature review.

Quantitative analysis of KLF4 and SOX2 expression in oral carcinomas reveals independent association with oral tongue subsite location and histological grade.

BACKGROUND: Stemness factors associated with tumorigenesis in different types of cancers have not been specifically studied in oral tongue SCC (OTSSC). Here, we aimed to quantify expression levels and distribution of KLF4 and SOX2, two relevant stemness factors, in oral SCC including OTSCC samples from different subsites. METHODS AND RESULTS: We determined KLF4 and SOX2 expression levels by immunostaining 35 biopsies of OSCC. Stained wholeslide images were digitized and subjected to automatic cell detection and unbiased quantification using Qupath software. We found statistically significant reduction in KLF4 positive cells density (p= 0.024), and fraction (p= 0.022) in OTSCC from tongue borders compared with other tongue subsites. Instead, quantitative SOX2 analysis did not show differences in expression levels between OTSCC from the borders versus OTSCC developed in others subsites. Notably SOX2 expression was revealed increased in moderately and poorly differentiated OSCC compared with well differentiated ones (positive cells density p= 0.025, fraction p= 0.006). No significant correlation between KLF4 and SOX2 expression was observed, neither in OSCC nor in OTSCC. CONCLUSIONS: KLF4 and SOX2 exhibit opposite expression profiles regarding subsite localization and differentiation level in OSCC. Our study prompts future OTSCC prospective studies looking for clinical prognosis to incorporate detailed subsite information in the analysis.

Paget's disease of the jaws: Histopathological features of a series of 31 cases.

The aim of the present study was to analyze the histopathological features of Paget's disease of the jaws observed in a series comprising 31 cases. The study comprised all cases of Paget's disease of the jaws filed in the archives of the Surgical Pathology Laboratory of the Oral Pathology Department, School of Dentistry, University of Buenos Aires, between 1960 and 2018. Their microscopic features were evaluated, and available clinical data and radiographic studies were analyzed. Paget's disease of the jaws accounted for 0.05% of retrieved oral-maxillofacial pathologies. Microscopically, all cases showed lamellar bone trabeculae with the characteristic mosaic pattern. Twenty cases (64%) showed osteoblastic-osteoclastic activity, and all showed areas of necrosis. Cemento-osseous trabeculae were observed in 15 cases (48%), and cementicles were observed in 13 (42%). Osteomyelitis was seen in 11 cases (35%), all of which showed cemento-osseous trabeculae with a mosaic structure, sclerosis and necrosis, and chronic inflammation with abscess formation. Mean age was 61 years (44-85 years); 19 cases were women. Localization was the maxilla in 13 cases (42%), and the disease involved other skeletal bones in five cases. To our knowledge, this is the largest series of Paget's disease of the jaws reported to date. Paget's disease is infrequent in the jaws and has distinct histopathological features that not only differ from those observed at other skeletal sites but also require differential diagnosis from other pathologies affecting the jaws exclusively.

El objetivo del presente trabajo fue analizar las características histopatológicas de la enfermedad de Paget en los maxilares en una serie de 31 casos. El estudio comprendió todos los casos de enfermedad de Paget de los maxilares provenientes del Laboratorio de Patología Quirúrgica de la Cátedra de Anatomía Patológica de la Facultad de Odontología de la Universidad de Buenos Aires, entre 1960 y 2018. Se evaluaron las características microscópicas y se analizaron los datos clínicos y estudios radiográficos disponibles. La enfermedad de Paget en los maxilares representó el 0,05% de las patologías buco-maxilofaciales. Microscópicamente, todos los casos mostraron trabéculas óseas laminares con el característico patrón en mosaico. Veinte casos (64%) mostraron actividad osteoblástica-clástica y todos los casos mostraron necrosis focal. En 15 casos (48%) las trabéculas presentaron aspecto cemento-óseo y en 13 casos (42%) se observaron cementículos. Once casos (35%) presentaron cuadros osteomielíticos y todos ellos mostraron trabéculas cemento-óseas con estructura en mosaico, esclerosis y necrosis, e infiltrado inflamatorio crónico con formación de abscesos. La media de edad fue 61 años (44-85 años), y 19 fueron mujeres. Trece casos (42%) se localizaron en maxilar superior y 5 casos presentaron compromiso de otros huesos. A nuestro entender, esta es la serie más grande de enfermedad de Paget en los maxilares reportada hasta la fecha. La enfermedad de Paget es poco frecuente en los maxilares y presenta características histopatológicas que además de ser diferentes a las observadas en otros sitios del esqueleto plantean el diagnóstico diferencial con otras entidades que se presentan exclusivamente en los maxilares.

Paget's disease of the jaws: Histopathological features of a series of 31 cases / Enfermedad de Paget en los maxilares. Características histopatológicas de una serie de 31 casos

ABSTRACT The aim of the present study was to analyze the histopathological features of Paget's disease of the jaws observed in a series comprising 31 cases. The study comprised all cases of Paget's disease of the jaws filed in the archives of the Surgical Pathology Laboratory of the Oral Pathology Department, School of Dentistry, University of Buenos Aires, between 1960 and 2018. Their microscopic features were evaluated, and available clinical data and radiographic studies were analyzed. Paget's disease of the jaws accounted for 0.05% of retrieved oral-maxillofacial pathologies. Microscopically, all cases showed lamellar bone trabeculae with the characteristic mosaic pattern. Twenty cases (64%) showed osteoblastic-osteoclastic activity, and all showed areas of necrosis. Cemento-osseous trabeculae were observed in 15 cases (48%), and cementicles were observed in 13 (42%). Osteomyelitis was seen in 11 cases (35%), all of which showed cemento-osseous trabeculae with a mosaic structure, sclerosis and necrosis, and chronic inflammation with abscess formation. Mean age was 61 years (44-85 years); 19 cases were women. Localization was the maxilla in 13 cases (42%), and the disease involved other skeletal bones in five cases. To our knowledge, this is the largest series of Paget's disease of the jaws reported to date. Paget's disease is infrequent in the jaws and has distinct histopathological features that not only differ from those observed at other skeletal sites but also require differential diagnosis from other pathologies affecting the jaws exclusively.

RESUMEN El objetivo del presente trabajo fue analizar las características histopatológicas de la enfermedad de Paget en los maxilares en una serie de 31 casos. El estudio comprendió todos los casos de enfermedad de Paget de los maxilares provenientes del Laboratorio de Patología Quirúrgica de la Cátedra de Anatomía Patológica de la Facultad de Odontología de la Universidad de Buenos Aires, entre 1960 y 2018. Se evaluaron las características microscópicas y se analizaron los datos clínicos y estudios radiográficos disponibles. La enfermedad de Paget en los maxilares representó el 0,05% de las patologías buco-maxilofaciales. Microscópicamente, todos los casos mostraron trabéculas óseas laminares con el característico patrón en mosaico. Veinte casos (64%) mostraron actividad osteoblástica-clástica y todos los casos mostraron necrosis focal. En 15 casos (48%) las trabéculas presentaron aspecto cemento-óseo y en 13 casos (42%) se observaron cementículos. Once casos (35%) presentaron cuadros osteomielíticos y todos ellos mostraron trabéculas cemento-óseas con estructura en mosaico, esclerosis y necrosis, e infiltrado inflamatorio crónico con formación de abscesos. La media de edad fue 61 años (44- 85 años), y 19 fueron mujeres. Trece casos (42%) se localizaron en maxilar superior y 5 casos presentaron compromiso de otros huesos. A nuestro entender, esta es la serie más grande de enfermedad de Paget en los maxilares reportada hasta la fecha. La enfermedad de Paget es poco frecuente en los maxilares y presenta características histopatológicas que además de ser diferentes a las observadas en otros sitios del esqueleto plantean el diagnóstico diferencial con otras entidades que se presentan exclusivamente en los maxilares.

Incidencia de patologías bucomaxilares en un período de aislamiento social preventivo y obligatorio de la pandemia COVID-19 / Incidence of buccomaxillofacial pathologies in a period of preventive and mandatory social isolation due to the COVID-19 pandemic

La urgencia en la práctica odontológica incluye no solo la atención de pacientes con dolor e infección, sino también la atención de pacientes que presentan patologías con presunción diagnóstica de agresividad y/o malignidad. El objetivo de este estudio fue analizar la incidencia de las patologías bucomaxilares biopsiadas en el Servicio de Urgencias y Orientación de Pacientes (SUyOP), y diagnosticadas en el Laboratorio de Patología Quirúrgica de la Cátedra de Anatomía Patológica (LPQ-CAP) de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA), en un período del Aislamiento Social Preventivo y Obligatorio de la pandemia COVID-19. Se realizó un estudio observacional, descriptivo y retrospectivo de pacientes que se presentaron para la atención odontológica en el período de tiempo comprendido entre el 20 de marzo al 21 de junio de 2020. Se registraron los pacientes que presentaron lesiones bucales con indicación de biopsia. Del total de pacientes evaluados (4854), 48 presentaron patologías con presunción diagnóstica de agresividad y/o malignidad. Las patologías más frecuentes fueron las neoplasias malignas (21 casos), siendo la entidad prevalente el carcinoma de células escamosas. Para el LPQ-CAP, las muestras biópsicas remitidas por el SUyOP representaron el 44% del total de las muestras recibidas. Si bien la incidencia de patologías bucomaxilares biopsiadas y diagnosticadas fue baja (1%) es de destacar que el diagnóstico histopatológico correspondió, en la mayoría de los casos, a patologías neoplásicas. De allí la importancia de la atención de urgencia a pacientes que presentan lesiones con presunción diagnóstica de malignidad/agresividad (AU)

Histopathological features of malignant craniopharyngioma: Case report and literature review.

Malignant transformation in craniopharyngiomas is a very uncommon event and scarcely mentioned in the World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS). So far, there are only 34 reported cases. AIMS: We report an additional case in a 63-year-old woman who was diagnosed with craniopharyngioma 47 years ago. We reviewed the literature in order to define the histological features of malignant craniopharyngioma and its overlap with odontogenic tumors. RESULTS: Our case presented morphology of mixed odontogenic ghost cell/ameloblastic carcinoma. Analyzing all reported cases, 18 of them presented malignization as squamous cell carcinoma (SCC), 1 as odontogenic ghost cell carcinoma, 2 as ameloblastic carcinoma, and 10 cases were mentioned just as malignant craniopharyngiomas. CONCLUSION: We concluded that SCC represented only half of the malignant cases, while the morphology of ~ 11% of them was comparable with ameloblastic or odontogenic ghost cell carcinomas and 28% lacked a specific histological diagnosis. Most cases were fatal, which makes it necessary to include the entity of malignant craniopharyngioma in the WHO Classification of Tumors of the CNS as a high-grade tumor defining its histological variability.