Taylor Strange

Mesonephric-like adenocarcinoma is a rare uterine neoplasm recognized in the fifth edition of the World Health Organization Classification of Female Genital Tumors and poses diagnostic challenges due to its morphologic and immunophenotypic overlap with other endometrial carcinomas. We retrospectively reviewed three cases diagnosed at our institution, evaluating clinical presentation, histologic features, immunohistochemical profile, and available molecular findings, and performed a literature review of approximately 200 reported cases with emphasis on comorbidities and potential predisposing factors. All three patients presented with abnormal uterine bleeding and had hypothyroidism, and one patient had Down syndrome, representing the first reported case in this population. Tumors consistently expressed thyroid transcription factor 1, showed variable GATA3 expression, and demonstrated limited or absent hormone receptor expression. Literature review revealed frequent association with Müllerian-type lesions and recurrent KRAS mutations, while thyroid disease was not identified as a consistent comorbidity. These findings support a Müllerian origin for mesonephric-like adenocarcinoma and suggest that hypothyroidism is unlikely to represent a defining association. The occurrence in a patient with Down syndrome raises the possibility of an underlying genetic susceptibility that warrants further investigation.

Background: Focal nodular hyperplasia (FNH) is a benign hepatic lesion that rarely presents as an exophytic mass attached by a fibrous stalk (termed pedunculated FNH). This variation poses a challenge to clinicians, with atypical symptoms and imaging. Case presentation: We describe a 33-year-old female who underwent excision of a pedunculated FNH. On gross examination, the lesion was lobular and vascular with homogenous tan-brown surfaces. Histological examination showed loss of normal liver architecture, abnormal intervening fibrous tracts, dysplastic arteries, and focal steatosis. Immunohistochemical staining with glutamine synthetase resulted in a branching, or “map-like” pattern. These findings were consistent with focal nodular hyperplasia. One of the most sensitive imaging techniques for diagnosing this lesion involves magnetic resonance imaging (MRI) with contrast, which discloses a homogenous mass that is hyperintense during the arterial phase with gradual decrease in intensity during the venous and equilibrium phases. The central stellate scar will often remain hyperintense for a prolonged period of time. On histology, normal hepatic architecture is lost to abnormal fibrotic bands and a characteristic stellate scar. Immunohistochemistry with glutamine synthetase uniquely highlights a map-like pattern that is not seen in other liver lesions. Conclusions: Due to its atypical presentation and increased risk of complications compared to its intrahepatic counterpart, pedunculated FNH brings unique challenges for diagnosis and therapy. Proper identification of pedunculated FNH is critical for appropriate treatment. Our case highlights the importance of radiological and histopathological studies to accurately identify this lesion, as well as the benefits of surgical removal to prevent serious complications.

Lung cancer is the leading cause of cancer deaths in men and women in the United States. Accurate staging is needed to determine prognosis and devise effective treatment plans. The International Association for the Study of Lung Cancer (IASLC) has made multiple revisions to the tumor, node, metastasis (TNM) staging system used by the Union for International Cancer Control and the American Joint Committee on Cancer to stage lung cancer. The eighth edition of this staging system includes modifications to the T classification with cut points of 1 cm increments in tumor size, grouping of lung cancers associated with partial or complete lung atelectasis or pneumonitis, grouping of tumors with involvement of a main bronchus regardless of distance from the carina, and upstaging of diaphragmatic invasion to T4. The N classification describes the spread to regional lymph nodes and no changes were proposed for TNM-8. In the M classification, metastatic disease is divided into intra- versus extrathoracic metastasis, and single versus multiple metastases. In order to optimize patient outcomes, it is important to understand the nuances of the TNM staging system, the strengths and weaknesses of various imaging modalities used in lung cancer staging, and potential pitfalls in image interpretation.

Radiation therapy using conventional or newer high-precision dose techniques, including three-dimensional conformal radiotherapy, intensity-modulated radiation therapy, stereotactic body radiation therapy, four-dimensional conformational radiotherapy, and proton therapy, is an important component of treating patients with lung cancer. Knowledge of the radiation technique used and the expected temporal evolution of radiation-induced lung injury, as well as patient-specific parameters such as previous radiotherapy, concurrent chemoradiotherapy, or immunotherapy, is important in image interpretation. This review discusses factors that affect the development and severity of radiation-induced lung injury and its radiological manifestations, as well as the differences between conventional and high-precision dose radiotherapy techniques.

Chronic conditions like type II diabetes (T2DM) have long been known to exacerbate many infectious diseases. For many arboviruses, including Zika virus (ZIKV), severe outcomes, morbidity and mortality usually only occur in patients with such pre-existing conditions. However, the effects of T2DM and other pre-existing conditions on human blood (e.g., hypo/hyperinsulinemia, hyperglycemia and hyperlipidemia) that may impact infectivity of arboviruses for vectors is largely unexplored. We investigated whether the susceptibility of Aedes aegypti mosquitoes was affected when the mosquitoes fed on “diabetic” bloodmeals, such as bloodmeals composed of artificially glycosylated erythrocytes or those from viremic, diabetic mice (LEPRDB/DB). Increasing glycosylation of erythrocytes from hemoglobin A1c (HgbA1c) values of 5.5–5.9 to 6.2 increased the infection rate of a Galveston, Texas strain of Ae. aegypti to ZIKV strain PRVABC59 at a bloodmeal titer of 4.14 log10 FFU/mL from 0.0 to 40.9 and 42.9%, respectively. ZIKV was present in the blood of viremic LEPRDB/DB mice at similar levels as isogenic control C57BL/6J mice (3.3 log10 FFU/mL and 3.6 log10 FFU/mL, respectively. When mice sustained a higher ZIKV viremia of 4.6 log10 FFU/mL, LEPRDB/DB mice infected 36.3% of mosquitoes while control C57BL/6J mice with a viremia of 4.2 log10 FFU/mL infected only 4.1%. Additionally, when highly susceptible Ae. aegypti Rockefeller mosquitoes fed on homozygous LEPRDB/DB, heterozygous LEPRWT/DB, and control C57BL/6J mice with viremias of ≈ 4 log10 FFU/mL, 54%, 15%, and 33% were infected, respectively. In total, these data suggest that the prevalence of T2DM in a population may have a significant impact on ZIKV transmission and indicates the need for further investigation of the impacts of pre-existing metabolic conditions on arbovirus transmission.