Metastatic aneurysmal fibrous histiocytoma in a 20-year-old woman: A rare case report with review of the literature and discussion of its genomic features.

Aneurysmal fibrous histiocytoma is an uncommon variant of cutaneous fibrous histiocytomas with a local recurrence rate of 19%. We present a case of aneurysmal fibrous histiocytoma in a 20-year-old female with a regional lymph node metastasis and subsequent satellite nodule. The patient initially presented with a 1-month history of two palpable nodules in left lower anterior shoulder and left axilla. Needle core biopsies from both lesions revealed an atypical spindle cell neoplasm with a differential diagnosis of aneurysmal fibrous histiocytoma and angiomatoid fibrous histiocytoma. The axillary dissection confirmed a metastatic deposit in 1 out of 22 lymph nodes. At 6 months a satellite nodule arose between the resection scar and the axilla histopathologically demonstrating a cellular spindle cell nodule at the dermis subcutaneous junction with large, blood-filled pseudovascular spaces lined by histiocytes. The periphery of the lesion showed collagen trapping without a lymphoplasmacytic infiltrate. The lesional cells were diffusely positive for CD10 and focally for CD68 and Illumina RNA fusion panel sequencing was negative. Herein we present this case of metastatic aneurysmal fibrous histiocytoma with review of the literature and discussion of biology, cytogenetic alterations, and differential diagnosis.

Death Certification in Northern Alberta: Error Occurrence Rate and Educational Intervention.

Errors in death certification can directly affect the decedent's survivors and the public register. We assessed the effectiveness of an educational seminar targeting frequent and important errors identified by local death certificate (DC) evaluation. Retrospective review of 1500 DCs categorized errors and physician specialty. A 60-minute didactic/case-based seminar was subsequently designed for family medicine physician (FAM) participants, with administration of presurvey, immediate post, and 2-month postsurveys. Most DCs were completed by FAM (73%), followed by internists (18%) and surgeons (3%). Error occurrence (EO) rate ranged between 32 and 75% across all specialities. Family medicine physician experienced in palliative care had the lowest EO rate (32%), significantly lower (P < 0.001) than FAM without interest in palliative care (62%), internal medicine (62%), and surgery (75%). Common errors were use of abbreviations (26%), mechanism as underlying cause of death (23%), and no underlying cause of death recorded (22%). Presurvey participants (n = 72) had an overall EO rate of 72% (64% excluding formatting errors). Immediate postsurvey (n = 75) and 2-month postsurvey (n = 24) participants demonstrated significantly lower overall EO (34% and 24%, respectively), compared with the Pre-S (P < 0.05). A 60-minute seminar on death certification reduced EO rate with perceived long-term effects.

Effect of trans-bullar gentamicin treatment on guinea pig angular and linear vestibulo-ocular reflexes.

This study provides the first systematic examination of the effects of intratympanic gentamicin instillation on vestibulo-ocular responses of guinea pigs during both Earth-vertical yaw axis and off-vertical axis rotation. A scleral search coil was sutured to the right eye of pigmented female guinea pigs prior to trans-bullar instillation of a 0.2-ml bolus of either 20 mg/ml or 40 mg/ml of gentamicin (1) into the right middle ear (unilateral treatment groups) or (2) into both ears (bilateral treatment groups). Two weeks later, eye movement responses were tested during yaw axis sinusoidal rotation at 7 frequencies (0.02, 0.05, 0.1, 0.2, 0.5, 1 and 2 Hz, 40 deg/s peak velocity) and during off-vertical axis rotation at five constant velocities (20, 40, 60, 80 and 100 deg/s), tilted 30 deg relative to the earth-vertical axis. The main result was that unilateral trans-bullar gentamicin instillation produced almost exclusively unidirectional deficits in horizontal angular vestibulocular reflex (HVOR) responses and modulation and bias responses to off-vertical axis rotation (OVAR). The HVOR gain was reduced during rotation toward the injected ear in a dose-dependent manner for frequencies of 1 Hz and lower, but there was no effect on responses during rotation toward the intact ear. Further, the modulation and bias responses to OVAR were reduced profoundly in a dose-dependent manner during rotation toward the treated ear. It is suggested that these effects indicate selective cytotoxic and/or physiologic effects of gentamicin intoxication in the inner ear or, possibly, the vestibular nerve and central nervous system.