iDermatoPath - a novel software tool for mitosis detection in H&E-stained tissue sections of malignant melanoma

BACKGROUND

Malignant Melanoma (MM) is characterized by a growing incidence and a high malignant potential. Besides well-defined prognostic factors such as tumour thickness and ulceration, the Mitotic Rate (MR) was included in the AJCC recommendations for diagnosis and treatment of MM. In daily routine, the identification of a single mitosis can be difficult on haematoxylin and eosin slides alone. Several studies showed a big inter- and intra-individual variability in detecting the MR in MM even by very experienced investigators, thus raising the question for a computer-assisted method.

OBJECTIVE

The objective was to develop a software system for mitosis detection in MM on H&E slides based on machine learning for diagnostic support.

METHODS

We developed a computer-aided staging support system based on image analysis and machine learning on the basis of 59 MM specimens. Our approach automatically detects tumour regions, identifies mitotic nuclei and classifies them with respect to their diagnostic relevance. A convenient user interface enables the investigator to browse through the proposed mitoses for fast and efficient diagnosing.

RESULTS

A quantitative evaluation on manually labelled ground truth data revealed that the tumour region detection yields a medium spatial overlap index (dice coefficient) of 0.72. For the mitosis detection, we obtained high accuracies of above 83%.

CONCLUSION

On the technical side, the developed iDermatoPath software tool provides a novel approach for mitosis detection in MM, which can be further improved using more training data such as dermatopathologist annotations. On the practical side, a first evaluation of the clinical utility was positive, albeit this approach provides most benefit for difficult cases in a research setting. Assuming all slides to be digitally processed and reported in the near future, this method could become a helpful additional tool for the pathologist.

Cadmium uptake by cocoa trees in agroforestry and monoculture systems under conventional and organic management

Cadmium (Cd) uptake by cocoa has recently attracted attention, after the European Union (EU) decided to establish values for tolerable Cd concentrations in cocoa products. Bean Cd concentrations from some cocoa provenances, especially from Latin America, were found to exceed these values. Cadmium uptake by cocoa is expected not only to depend on a variety of soil factors, but also on plant and management factors. In this study, we investigated the influence of different production systems on Cd uptake by cocoa in a long-term field trial in the Alto Beni Region of Bolivia, where cocoa trees are grown in monocultures and in agroforestry systems, both under organic and conventional management. Leaf, fruits and roots of two cultivars were sampled from each production system along with soil samples collected around these trees. Leaf, pod husk and bean samples were analysed for Cd, iron (Fe) and zinc (Zn), the roots for mycorrhizal abundance and the soil samples for 'total' and 'available' Cd, Fe and Zn as well as DGT-available Cd and Zn, pH, organic matter, texture, 'available' phosphorus (P) and potassium (K). Only a small part of the variance in bean and pod husk Cd was explained by management, soil and plant factors. Furthermore, the production systems and cultivars alone had no significant influence on leaf Cd. However, we found lower Cd leaf contents in agroforestry systems than in monocultures when analysed in combination with DGT-available soil Cd, cocoa cultivar and soil organic matter. Overall, this model explained 60% of the variance of the leaf Cd concentrations. We explain lower leaf Cd concentrations in agroforestry systems by competition for Cd uptake with other plants. The cultivar effect may be explained by cultivar specific uptake capacities or by a growth effect translating into different uptake rates, as the cultivars were of different size.

[Cheilitis granulomatosa and Melkersson-Rosenthal syndrome. Intralymphatic histiocytosis as valuable diagnostic indication]

Intravascular and/or intralymphatic cell aggregations can occur in malignant tumors as well as in benign reactive conditions, such as chronic inflammatory diseases. This article discusses the valuable histomorphological aspects of intralymphatic histiocytosis (or granuloma) in the differential diagnostics to other entities exemplified by a case report on juvenile cheilitis granulomatosa. In addition other benign entities sometimes presenting with the phenomenon of intravascular histiocytosis (e.g. rheumatoid arthritis, orthopedic metal implants and Rosai-Dorfman disease) are discussed.

Post-processing in cardiovascular computed tomography: performance of a client server solution versus a stand-alone solution

PURPOSE

To compare the performance of server-based (CSS) versus stand-alone post-processing software (ES) for the evaluation of cardiovascular CT examinations (cvCT) and to determine the crucial steps.

MATERIALS AND METHODS

Data of 40 patients (20 patients for coronary artery evaluation and 20 patients prior to transcatheter aortic valve implantation [TAVI]) were evaluated by 5 radiologists with CSS and ES. Data acquisition was performed using a dual-source 128-row CT unit (SOMATOM Definition Flash, Siemens, Erlangen, Germany) and a 64-row CT unit (Brilliance 64, Philips, Hamburg, Germany). The following workflow was evaluated: Data loading, aorta and coronary segmentation, curved multiplanar reconstruction (cMPR) and 3 D volume rendering technique (3D-VRT), measuring of coronary artery stenosis and planimetry of the aortic annulus. The time requirement and subjective quality for the workflow were evaluated.

RESULTS

The coronary arteries as well as the TAVI data could be evaluated significantly faster with CSS (5.5  ±  2.9  min and 8.2  ±  4.0  min, respectively) than with ES (13.9  ±  5.2  min and 15.2  ±  10.9  min, respectively, p ≤  0.01). Segmentation of the aorta (CSS: 1.9 ±  2.0  min, ES: 3.7  ±  3.3  min), generating cMPR of coronaries (CSS: 0.5  ±  0.2  min, ES: 5.1  ±  2.6  min), aorta and iliac vessels (CSS: 0.5  ±  0.4  min and 0.4  ±  0.4  min, respectively, ES: 1.6  ±  0.7  min and 2.8  ±  3  min, respectively) could be performed significantly faster with CSS than with ES with higher quality of cMPR, measuring of coronary stenosis and 3D-VRT (p < 0.05).

CONCLUSION

Evaluation of cvCT can be accomplished significantly faster and better with CSS than with ES.  The segmentation remains the most time-consuming workflow step, so optimization of segmentation algorithms could improve performance even further.

Role of preprocedural computed tomography in transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is currently considered an acceptable alternative for the treatment of patients with severe aortic stenosis and a high perioperative risk or a contraindication for open surgery. The benefit of TAVI significantly outweighs the risk of the procedure in patients requiring treatment that are not suitable for open surgery, and leads to a lower mortality in the one-year follow-up. The absence of a direct view of the aortic root and valve remains a challenge for the transcatheter approach. While direct inspection of the aortic valve during open surgery allows an adequate prosthesis choice, it is crucial for TAVI to know the individual anatomical details prior to the procedure in order to assure adequate planning of the procedure and proper prosthesis choice and patient selection. Among the imaging modalities available for the evaluation of patients prior to TAVI, computed tomography (CT) plays a central role in patient selection. CT reliably visualizes the dimensions of the aortic root and allows a proper choice of the prosthesis size. The morphology of the access path and relevant comorbidities can be assessed. The present review summarizes the current state of knowledge regarding the value of CT in the evaluation of patients prior to TAVI. CT plays a central role in patient selection and planning prior to TAVI. CT reliably detects the dimensions of the aortic root including the size of the aortic annulus, the degree of valve calcification and the morphology of the access routes.

KEY POINTS

CT plays a central role in patient selection and planning prior to TAVI. CT reliably detects the dimensions of the aortic root including the size of the aortic annulus, the degree of valve calcification and the morphology of the access routes. CT provides a more accurate measurement of the aortic annulus than 2D TEE and CT is the only imaging modality that allows a risk assessment for paravalvular leakages based on the calcification of the aortic valve.

Gabra5-gene haplotype block associated with behavioral properties of the full agonist benzodiazepine chlordiazepoxide

The gabra5 gene is associated with pharmacological properties (myorelaxant, amnesic, anxiolytic) of benzodiazepines. It is tightly located (0.5 cM) close to the pink-eyed dilution (p) locus which encodes for fur color on mouse chromosome 7. We tested the putative role of the gabra5 gene in pharmacological properties of the full non specific agonist chlordiazepoxide (CDP), using behavioral and molecular approaches in mutated p/p mice and wild type F2 from crosses between two multiple markers inbred strain ABP/Le and C57BL/6By strain. From our results, using rotarod, light-dark box, elevated maze and radial arm maze tests, we demonstrate that p/p mice are more sensitive than WT to the sensory motor, anxiolytic and amnesic effect of CDP. This is associated with the presence of a haplotypic block on the murine chromosome 7 and with an up regulation of gabra5 mRNAs in hippocampi of p/p F2 mice.

Histological, immunohistological, and clinical features of merkel cell carcinoma in correlation to merkel cell polyomavirus status

Merkel cell carcinoma is a rare, but highly malignant tumor of the skin with high rates of metastasis and poor survival. Its incidence rate rises and is currently about 0.6/100000/year. Clinical differential diagnoses include basal cell carcinoma, cyst, amelanotic melanoma, lymphoma and atypical fibroxanthoma. In this review article clinical, histopathological and immunhistochemical features of Merkel cell carcinoma are reported. In addition, the role of Merkel cell polyomavirus is discussed.

Respiratory onset in an ALS family with L144F SOD1 mutation

Familial amyotrophic lateral sclerosis (FALS) cases linked to SOD1 mutations may sometimes present with unusual clinical features such as pure lower motor neuron involvement or sensory signs. The authors describe a FALS pedigree with the L144F SOD1 mutation in which all cases had respiratory involvement as a first symptom. Although atypical clinical features are not rare in ALS families, this is the first pedigree with respiratory-onset in three affected members. This unusual presentation led to delayed diagnosis in the proband and highlights the fact that respiratory-onset can occur in familial ALS cases carrying SOD1 mutation.

Antisense anti IGF-I cellular therapy of malignant tumours: immune response in cancer patients

The treatment of cancer by antisense anti-IGF-I cellular therapy inducing immune response has evoked interest among many promising strategies. Here, we reported some results obtained from patients with cancer, mainly glioblastoma treated by this strategy, which was also extended to patients with colon carcinoma, ovary cystadenocarcinoma and prostate adenocarcinoma. It was shown that, in the phase I of clinical trial, patients vaccinated with their own tumour cells treated by antisense IGF-I presented a slight increase of temperature. Their peripheral blood lymphocytes showed a shift in the percentage of CD8 effector cells as judged by expression of cell surface markers CD8+ CD28+. Particularly, in two treated patients with glioblastoma, the survival time was 19 and 24 months respectively in comparison to the range of 12 to 15 months observed in the case of classical treatment such as surgery, radiation or chemotherapy. These results, although preliminary, gave indication that the reported strategy could deserve consideration owing to its safety. Furthermore, the increase in the percentage of peripheral blood monomorphonucleated cells (PBMNCs) with effector phenotype, i.e., CD8+ CD28+ in vaccinated patients might explain their prolonged survival time.