Improving the TIR3B oncological stratification: try to bridge the gap through a comprehensive presurgical algorithm.

PURPOSE: Indeterminate cytology still puzzles clinicians, due to its wide range of oncological risks. According to the Italian SIAPEC-IAP classification, TIR3B cytology holds up to 30% of thyroid cancer, which justifies the surgical indication, even if more than half of cases do not result in a positive histology. The study aim is to identify potential clinical, ultrasound or cytological features able to improve the surgical indication. METHODS: Retrospective analysis. A consecutive series of TIR3B nodules referred to the Endocrine Unit of Careggi Hospital from 1st May 2014 to 31st December 2021 was considered for the exploratory analysis (Phase 1). Thereafter, a smaller confirmatory sample of consecutive TIR3B diagnosed and referred to surgery from 1st January 2022 to 31st June 2022 was considered to verify the algorithm (Phase 2). The main clinical, ultrasound and cytological features have been collected. A comprehensive stepwise logistic regression was applied to build a prediction algorithm. The histological results represented the final outcome. RESULTS: Of 599 TIR3B nodules referred to surgery, 451 cases were included in the exploratory analysis. A final score > 14.5 corresponded to an OR = 4.98 (95% CI 3.24-7.65, p < 0.0001) and showed a PPV and NPV of 57% and 79%, respectively. The Phase 2 analysis on a confirmatory sample of 58 TIR3B cytology confirmed that a threshold of 14.5 points has a comparable PPV and NPV of 53% and 80%, respectively. CONCLUSIONS: A predictive algorithm which considers the main clinical, US and cytological features can significantly improve the oncological stratification of TIR3B cytology.

A unique presentation of a renal clear cell carcinoma with atypical metastases.

INTRODUCTION: Renal cancer is a relatively common neoplasia with renal clear cell carcinoma being the most frequent histological type. This tumor has a strong tendency to metastasize virtually to all organs. Today, new diagnostic tools allow physicians to distinguish between those patients with "incidental findings" and those with advanced metastatic disease. PRESENTATION OF CASE: A 70-year-old male with multiple indolent subcutaneous masses underwent colonoscopy after a positive fecal screening test for colorectal carcinoma. A rectal lesion was discovered but biopsy was negative. CT scan revealed advanced renal cancer involving the peritoneal cavity, retroperitoneum and lung. Biopsy of subcutaneous masses confirmed the suspected metastases. The patient underwent surgery (an open left nephrectomy with rectosigmoid resection and metastases debulking) because of a high risk of bowel obstruction and increasing anemia. After three years of multi-targeted therapy and follow-up, the patient is still asymptomatic and in good general condition. DISCUSSION: Treatment of metastatic renal cancer is still controversial even if more than 30% of patients have metastasis at the time of diagnosis. Recently introduced targeted therapies are encouraging but still present problems with side effects and an unlimited period of efficacy. Although there is no consensus, several studies and guidelines consider metastasectomy to be a valid option. CONCLUSION: Recent series highlight surgery as a key-point in the management of advanced renal clear cell carcinoma. Our case demonstrates the validity of a surgical strategy supported by a multidisciplinary approach.

Potential of Hymenopteran larval and egg parasitoids to control stored-product beetle and moth infestation in jute bags.

The control of stored-product moths in bagged commodities is difficult because the developmental stages of the moths are protected by the bagging material from control measures such as the application of contact insecticides. Studies were carried out to assess the ability of Hymenopteran parasitoids to locate their hosts inside jute bags in the laboratory. The ability of different parasitoids to penetrate jute bags containing rice was investigated in a controlled climate chamber. Few Habrobracon hebetor (Say) (Hymenoptera: Braconidae) passed through the jute material while a high percentage of Lariophagus distinguendus (Förster), Anisopteromalus calandrae (Howard) (Hymenoptera: Pteromalidae), Theocolax elegans (Westwood) (Hymenoptera: Pteromalidae) and Trichogramma evanescens Westwood (Hymenoptera: Trichogrammatidae) were able to enter the Petri-dishes. Significantly more L. distinguendus and T. elegans entered compared to H. hebetor. There was significant difference in the mean percentage parasitoids invading depending on species. Head capsules and/or thorax widths were measured in order to determine whether the opening in the jute material would be large enough for entry of the parasitoids. These morphometric data differed depending on parasitoid species and sex. The parasitoid Venturia canescens (Gravenhorst) (Hymenoptera: Ichneumonidae) did not enter the bags, but located host larvae inside the jute bags and parasitized rice moths Corcyra cephalonica larvae by stinging through the jute material. Venturia canescens significantly reduced the number of C. cephalonica adults emerging from the bagged rice; therefore, it could be released in storage rooms containing bagged rice for biological control of C. cephalonica. The use of parasitoids to suppress stored-product insect pests in bagged commodities could become a valuable supplement to the use of synthetic pesticides.