Impact of the COVID-19 pandemic on breast cancer pathological stage at diagnosis in Tunisian patients

BACKGROUND

Breast cancer (BC) patients' diagnosis and management was affected by a global reorganization after the Coronavirus disease 2019 (COVID-19). Our study aimed to assess the impact of the pandemic on the pathological stage of newly diagnosed patients with BC compared to pre-pandemic and to identify predictive factors of tumor advanced stage.

METHODS

Pathological records of all consecutive newly operated BC patients between March 2020 and December 2021 were reviewed retrospectively. Clinical and pathological prognostic factors of BC were collected and compared between pre-pandemic and pandemic periods. Then, predictive factors of tumor advanced stage were identified.

RESULTS

Of the 225 cases included in the analysis, 98.7% were females and 1.3% were males. The median time from first histological diagnosis to first surgical treatment was enlarged by 42 days with a significant difference between the two periods (p = 0.002). Newly diagnosed BC patients during the COVID-19 pandemic were operated at a more advanced stage (54.1% vs 36.2%, p = 0.007), had a greater lymphovascular invasion (p = 0.002), lymph node metastasis (p = 0.015) and are more commonly of IBC NST histological type (p = 0.005). Moreover, multivariate analyses showed that the pandemic period (AOR = 2.28; p = 0.016) and the lympho-vascular invasion (p < 0.001) were independently associated with advanced stage of tumors.

CONCLUSION

Our findings proved an increase in alarming rates of advanced stage BC associated with the COVID-19 crisis. These findings support recommendations for a quick restoration of BC screening at full capacity, with adequate prioritization strategies to mitigate harm.

Primary cystic echinococcosis of the peritoneum: a case report

BACKGROUND

Peritoneal cystic echinococcosis happens usually after traumatic rupture or after surgical treatment. Primary peritoneal cystic echinococcosis is a very rare case that constitutes a diagnostic and therapeutic challenge.

CASE REPORT

A 30-year-old Tunisian man was admitted for hypogastric pain since 4 months. He has a 10 cm hypogastric mass. Biological-tests were normal. A computed tomography Scan showed a cystic mass on the pelvis measuring 13 × 17 cm without echinococcosis cyst in the liver. The patient was operated and we found a cystic mass of 17 cm located on the Douglas cul-de-sac that suggest a pelvic hydatid cyst. We have performed an aspiration of the cyst confirms the diagnosis followed by injection of hypertonic solution, extarction of the germinal layer and a maximal reduction of the pericyst. The postoperative course was uneventful.

CONCLUSION

Trough our case, we try to focus on the diagnosis and therapeutic options of this rare entity that we should think of in front of a patient with isolated peritoneal cyst especially in endemic country.

ALK-Negative Inflammatory Myofibroblastic Tumor: A Challenging Case in a Premature Newborn

Inflammatory myofibroblastic tumors (IMT) are rare borderline tumors with a variable histological appearance that may mimic multiple mesenchymal tumors. We present a rare case of a challenging abdominal mass discovered in a premature newborn. The histopathology showed a bland myofibroblastic proliferation associated with an inflammatory infiltrate that was positive for smooth muscle actin and desmin but negative for anaplastic lymphoma kinase (ALK) protein. The diagnosis of an ALK-negative IMT was established. The tumor was partially resected. After six months of follow-up, the residual tumor remained stable, and the patient was asymptomatic. The correct diagnosis and subsequent treatment of ALK-negative IMT require appropriate histopathological, immunohistochemical, and sometimes genetic examination. Further research has to be conducted to help clinicians make an appropriate treatment plan.

Congenital Epulis Diagnosed Antenatally

Background: Congenital epulis is a benign gingival tumor whose differential diagnosis includes other oral-facial masses such as teratoma, hemangioma, lymphatic malformation and dermoid cysts. This tumor can cause obstruction of the airway or feeding problems in the newborn. Surgical excision is the treatment of choice. Case Report: We present a case of congenital epulis, diagnosed prenatally with ultrasonography. Conclusion: Although difficult, a defined prenatal image of congenital epulis is possible by means of accurate high-resolution ultrasonography. It facilitates the narrowing down of differential diagnosis. The confirmatory final diagnosis relies on histopathological examination.

Discordance in receptor status between primary and metastatic breast cancer and overall survival: A single-center analysis

BACKGROUND

The tumor phenotype may change between primary and metastatic breast cancer. We compared the expression of estrogen receptor (ER), progesterone receptor (PR), and HER2 in a series of primary breast carcinomas (PBC) with their metastatic relapses and analyzed the impact of any changes on survival.

MATERIALS AND METHODS

It was a single-center retrospective study, collecting consecutive cases of metastatic breast carcinoma diagnosed in the pathology and medical oncology departments at Habib Bourguiba University Hospital in Sfax, Tunisia. An immunohistochemical study was used to assess ER, PR, and HER2 expression. Overall survival (OS) and post-metastasis survival (PMS) were evaluated using multivariable Cox regression analysis.

RESULTS

Our study included 68 patients. ER and PR status changed in 29.4 % and 39.7 % of cases, respectively. Conversions were mainly from positive to negative status (22 % and 23.5 % for ER and PR, respectively). Differences in HER2 status were observed in 19.6 % of cases, with loss of overexpression in 6 patients (10.7 %). Adjuvant trastuzumab therapy and PBC molecular subtype (HR-, HER2+) were associated with HER2 status discordance (p = 0.02 and 0.03, respectively). On multivariable analysis, HR-negative conversion tumors were significantly associated with a worse OS (p = 0.042) and PMS (p < 0.001), compared to HR-concordant positive tumors.

CONCLUSION

This study establishes that HR and HER2 status discordance between primary and metastatic breast carcinoma has a prognostic impact on patient outcome. Analyzing these receptors' status in all newly diagnosed cases of metastatic breast carcinoma is strongly recommended and would provide information for changing treatment strategies.

Small cell osteosarcoma of the rib: An exceptional localization

Small cell osteosarcoma is a rare sub‐type of osteogenic malignant tumors. Rib localization is uncommon. Histological examination is an important step to make the difference with similar tumors like Ewing's sarcoma. Surgical resection is the unique curative treatment. The prognosis remains poor even with adjuvant treatment.

An orange peel‐like nodule on the back: A case of Wells syndrome

Wells syndrome is a rare eosinophilic syndrome, associating inflammatory lesions, suggestive histological images and frequent eosinophilia. Wells syndrome is characterized by multiplicity of anatomoclinical forms. Clinically, lesions may be urticarial, annular, papulonodular, papulovesicular or bullous. On histopathology, the flame aspect is by no means specific and late.

Liver injury in COVID-19: pathological findings

Hepatic injuries have been reported in patients with Coronavirus disease 2019 infection, particularly in those with moderate to severe illness. To date, pathological changes caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in liver tissue are unclear. Moreover, the mechanisms involved in liver injury in Coronavirus disease 2019 infection are not yet established. In this paper, we summarize the spectrum of pathologic findings of liver injury in patients infected by SARS-CoV-2 and we discuss the clinicopathological correlation and the mechanisms of liver damage in Coronavirus disease 2019 infection.

Concomitant primary angiosarcoma and invasive carcinoma of the breast: a case report

Collision tumor is a rare entity composed of two different tumors that occur in close to one another and maintain distinct borders. Only few cases have been reported in the breast. We report the first case of concomitant and adjacent primary angiosarcoma (PBAS) and invasive carcinoma of the breast (IBC), in a 45-year-old patient which presented with a lump in her right breast. Biopsy revealed PBAS. She underwent mastectomy. Gross examination showed a hemorrhagic and spongy tumor in contact with a second small grayish-white mass. Histologically, the hemorrhagic tumor was consistent with a high grade (HG) PBAS; the second mass was consistent with an IBC with no images of histological admixture. The diagnosis of a collision tumor composed of HG PBAS and IBC was established. During follow-up, the patient developed ovarian angiosarcomatous metastasis. The diagnosis of breast collision tumor is very uncommon and hence is challenging for pathologist. Careful gross and microscopic examinations help in establishing the appropriate diagnosis.

Influence of neodymium substitution on structural, magnetic and spectroscopic properties of Ni-Zn-Al nano-ferrites

Ni0.6Zn0.4Al0.5Fe1.5-x Nd x O4 ferrite samples, with x = 0.00, 0.05, 0.075 and 0.1, were synthesized using the sol-gel method. The effects of Nd3+ doping on the structural, magnetic and spectroscopic properties were investigated. XRD Rietveld refinement carried out using the FULLPROF program shows that the Ni-Zn ferrite retains its pure single phase cubic structure with Fd3̄m space group. An increase in lattice constant and porosity happens with increasing Nd3+ concentration. FTIR spectra present the two prominent absorption bands in the range of 400 to 600 cm-1 which are the fingerprint region of all ferrites. The change in Raman modes in the synthesized ferrite system were observed with Nd3+ substitution. The magnetization curves show a typical transition, at the Curie temperature T C, from a low temperature ferrimagnetic state to a high temperature paramagnetic state. The saturation magnetization, coercivity and remanence magnetization are found to be decreasing with increasing the Nd3+ concentration.

Incidental Finding of Bilateral Ovarian Adrenal Rest Tumor in a Patient With Congenital Adrenal Hyperplasia: A Case Report and Brief Review

Ovarian adrenal rest tumors (OART) are tumors that develop in females with congenital adrenal hyperplasia (CAH). In contrast to their counterpart in testicles, they are exceptional and few cases have been reported in the literature. In this report, we present clinicopathological findings of a female patient with CAH due to 21-hydroxylase deficiency who was incidentally diagnosed with OART with a review of the literature. The 14-year-old patient, who was raised as a boy, developed a virilizing syndrome with high testosterone levels that were attributed to non adherence to her replacement corticosteroid therapy. She consulted for sex reassignment surgery. Pelvic ultrasound was normal. She underwent hysterectomy and bilateral adnexectomy. No abnormalities were noticed during the operation. Grossly, both ovaries were variegated with well circumscribed and lobulated, brownish-yellow nodules. Histologically, the nodules were composed of nests of large polygonal cells with centrally located nuclei and prominent nucleoli. There was mild atypia and no crystals of Reinke. Thus, the findings of the histopathological examination were consistent with bilateral OART. Histological differential diagnosis of OART can be challenging particularly with leydig cell tumor, stromal luteoma and steroid cell tumors, not otherwise specified. OART must be considered in women with CAH and persistent virilizing symptoms despite negative imaging results.

Prognostic significance of E-cadherin and Cox 2 expression in Tunisian patients with colorectal mucinous adenocarcinoma

INTRODUCTION

Mucinous colorectal carcinoma (MC) is a rare subtype of colorectal adenocarcinoma known to be associated with bad prognosis. Lately, research has turned to identify new prognostic markers allowing the use of targeted therapy. The aim of our study is to evaluate the prognostic impact of E-cadherin and Cox-2expression in MC.

MATERIALS AND METHOD

A total of 40 formalin-fixed, paraffin-embedded MC specimens were collected within a period of 13 years and were studied for the expression of the two proteins. We used SPSS 22 software to study associations with clinicopathological parameters and overall survival (OS).

RESULTS

A reduced or absent E-cadherin expression was noted in 52.5% of cases. It was associated with distant metastases (p = 0.049) and venous invasion (p = 0.049). Cox-2 was overexpressed in 17.5% of cases. It was associated with negative lymph node status (p = 0.020) and with early stage tumor (p = 0.020). A significant association between the two proteins was also noted (p = 0.04). No significant association with OS was found; However, there was an improvement in the survival of patients overexpressing Cox-2 (p = 0.16).

CONCLUSION

Our findings link the loss of E-cadherin expression with spread and aggressiveness in MC and Cox-2 overexpression with better prognosis and survival. Because MC has a distinct genetic pathway we encourage the analysis of MSI and Cox-2 expression in all MC. Cox-2 inhibitors may not be effective chemopreventative agents in the setting of defective DNA mismatch repair. More molecular studies are needed to better understand the role of these markers and their prognostic significance in MC.

Terahertz transmission imaging of inhomogeneous polymer multilayers: theory and experiment

We extend an interferential multilayer model used in optics in the terahertz domain to be able to simulate the mapping of the transmissivity of a multilayer structure of polymers. In particular, we are interested in extracting the thickness gradient of a glue layer within an assembly of polymers. We developed an iterative procedure which we validated by terahertz imaging.

Microcystic transitional cell carcinoma: a rare tumor of the urinary bladder

Microcystic urothelial carcinoma is a rare variant of invasive transitional cell carcinoma recognized by the WHO classification. It is characterized by its deceptively benign appearance. The clinical course of this uncommon variety of carcinoma is not well known and their histological and immunohistological features are not well defined. We report a case of a 37-year-old man with a microcystic transitional cell carcinoma of the urinary bladder. He was diagnosed 4 years ago with cystitis glandularis lesions and nephrogenic adenoma. Through this observation we will try to define the clinical and pathological features of this uncommon tumor which must be differentiated from a number of proliferative lesions of the urothelium. The poor prognosis and aggressiveness of this tumor seems to be related to a higher stage and grade at diagnosis.

Low-Grade Sinonasal Sarcoma With Neural and Myogenic Features: A Recently Discovered Entity With Unique Features and Diagnostic Challenge

Low-grade sinonasal sarcoma with neural and myogenic features is an entity recently described in the literature. Little is known about its etiopathogenesis, natural history, or optimal treatment. In fact, it has relatively unique findings: it has a distinctive cytogenetic signature, and it expresses both smooth muscle actin and S100 protein. However, its diagnosis is challenging on biopsies showing negative staining for these 2 markers. The differential diagnoses include fibrosarcoma, malignant peripheral nerve sheath tumors, and other benign and malignant lesions. A complete resection, with or without radiotherapy, is required because this lesion appears to be locally aggressive. However, the clinical outcome seems to be good. Low-grade sinonasal sarcoma with neural and myogenic features merits classification as an independent tumor in the next World Health Organization classification of head and neck tumors. Reports of additional cases are required to support its unique classification.

Oxalosis in a Patient with Livedo Reticularis

A 27-year-old man with terminal renal failure requiring peritoneal dialysis for the past 2 years was referred to the dermatologist for evaluation of red violaceous macular skin lesions consistent with livedo reticularis. These lesions had appeared suddenly on his legs (Figure 1). He had first experienced recurrent nephrolithiasis at the age of 14. Results from urine analysis and abdominal ultrasound revealed chronic kidney failure. Because the patient had a sister with similar findings, primary hyperoxaluria (PH) was suspected and genetic testing was performed in all members of his family. The results confirmed PH type 1 (PH1) in both our patient and his sister, who had died 8 years after the establishment of the diagnosis. A biopsy of the livedo reticularis lesions revealed deposits of a yellowish brown crystalline material within the lumen and the media of medium vessels in the hypodermis associated with a histiocytic giant cell reaction (Figure 2a). There was no evidence of extravascular calcium deposition in the sections examined. The deposits were intensely birefringent under polarized light, and classic speculated crystals of oxalate salts were observed (Figure 2b). No focal epidermal or superficial dermal necrosis was seen. On the basis of the histopathologic findings, the diagnosis of oxalate crystal-induced vascular disease was established. The patient subsequently developed complications including pancreatitis and peritonitis. He underwent hemodialysis until a combined liver-kidney transplant could be performed.

Excitonic complexes in GaN/(Al,Ga)N quantum dots

Here we report a theoretical investigation of excitonic complexes in polar GaN/(Al,Ga)N quantum dots (QDs). A sum rule between the binding energies of charged excitons is used to calculate the biexciton binding energy. The binding energies of excitonic complexes in GaN/AlN are shown to be strongly correlated to the QD size. Due to the large hole localization, the positively charged exciton energy is found to be always blueshifted compared to the exciton one. The negatively charged exciton and the biexciton energy can be blueshifted or redshifted according to the QD size. Increasing the size of GaN/AlN QDs makes the identification of charged excitons difficult, and the use of an Al_0.5Ga_0.5N barrier can be advantageous for clear identification. Our theoretical results for the binding energy of exciton complexes are also confronted with values deduced experimentally for InAs/GaAs QDs, confirming our theoretical prediction for charged excitonic complexes in GaN/(Al,Ga)N QDs. Finally, we realize that the trends of excitonic complexes in QDs are significantly related to competition between the local charge separation (whatever its origin) and the correlation effect. Following our findings, entangled photons pairs can be produced in QDs with careful control of their size in order to obtain zero exciton-biexciton energy separation.

Dendriform pulmonary ossification in a patient with mucoepidermoid carcinoma

Dendriform pulmonary ossification is a chronic process characterized by the presence of heterotopic bone within the interstitium and alveolar walls. It usually occurs in the setting of chronic inflammation. We report an unusual case of a 54-year-old man with a history of relapsing Hodgkin lymphoma who was diagnosed with concomitant mucoepidermoid pulmonary carcinoma and dendriform ossifications. The radiological features were initially misinterpreted as post-radiation pulmonary fibrosis and bronchiectasis. The diagnosis was finally established after considering both the radiological and pathological findings. Dendriform pulmonary ossification is an under-recognized disease that should be considered in the differential diagnosis of lung chronic diseases.

A-site-deficiency effect on critical behavior in the Pr0.6Sr0.4MnO3 compound

We present the effect of vacancy in Pr0.6Sr0.4MnO3via dc magnetisation measurements. Using various techniques such as modified Arrott plots, the Kouvel-Fisher method, and Widom scaling relationship the values of TC (ferromagnetic transition temperature), as well as the β, γ and δ (critical exponents) are estimated. Critical exponents for the stoichiometric sample and the strontium deficient sample match well with those predicted for the tricritical mean field model. The vacancy in Pr0.5□0.1Sr0.4MnO3 changes the universal class. The estimated critical exponents of the praseodymium deficient sample are close to those found out by the 3D-Ising model.

Distributed feedback GaSb based laser diodes with buried grating: a new field of single-frequency sources from 2 to 3 µm for gas sensing applications

We report on the growth, fabrication, experimental study and application in an absorption gas setup of distributed feed-back antimonide diode lasers with buried grating. First, half laser structures were grown by molecular beam epitaxy on GaSb substrates and stopped at the top of the waveguide. A second order Bragg grating was then defined by interferometric lithography on the top of the structure and dry etched by Reactive Ion Etching. The grating was, afterwards, buried thanks to an epitaxial regrowth of the top cladding layer. Finally, the wafer was processed using standard photolithography and wet etched into 10 µm-wide laser ridges. A single frequency laser emission around 2.3 µm was recorded, a maximum output power of 25 mW and a total continuous tuning range reaching 4.2 nm at fixed temperature. A device has been used to detect methane gas and shows strong potential for gas spectroscopy. This process was also replicated for a target of 3 µm laser emission. These devices showed an output power of 2.5 mW and a SMSR of at least 23 dB, with a 2.5 nm continuous tuning range at fixed temperature.

[Tuberculosis prevention]

Tuberculosis prevention is classically based on early detection of potential contagious cases and their effective treatment. But due to new parameters such as migration flows around the world, the emergence of Mycobacterium tuberculosis resistant strains and the increase of the population at risk, screening should be more active and target those who are more vulnerable to developing the disease. Traditional screening methods such as chest X-ray and tuberculin skin test, due to their high sensitivity and low cost, remain valid especially in populations with a high prevalence of the disease. The interferon-gamma release assays (IGRAs) seem to be very useful in immunodeficient patients with prior BCG vaccination. The treatment of subjects at high risk of developing active tuberculosis with a daily isoniazid self-administrated dosage for a period of 9 months is a prevention measure not only at the individual level but also at the collective one. All prevention interventions should be part of a national program concordant with the guidelines of the WHO Stop TB program that recommend a universal access to quality diagnosis and treatment focused on the patient.

OUTLOOK

New methods of detection based on gene amplification would better suit to detect tuberculosis in immunodeficient patients and identify treatment-resistant strains. The development of the third part of the Stop TB project would reduce the morbidity and mortality of this disease by 2025.

CONCLUSION

The prevention of tuberculosis has been a major epidemiological challenge around the world and is continuously improving to adapt to the evolving disease.

Effects of emulsion gels containing bioactive compounds on sensorial, technological, and structural properties of frankfurters

Emulsion gels prepared with olive oil, chia, and cold gelling agents (transglutaminase, alginate, or gelatin) were used as fat replacers in reduced-fat frankfurter formulation. Nutritional advantages, sensory analysis, technological properties, and microbiological populations of frankfurters were evaluated along with their lipid structural characteristics over chilled storage. Frankfurters with emulsion gels showed significant improvements in fat content (lower saturated fatty acid, higher mono- and polyunsaturated fatty acid contents) and had good fat and water-binding properties. The presence of an emulsion gel reduced lightness and redness, but increased yellowness. Textural behavior of samples was significantly affected by the presence of emulsion gels and by storage. Sensory properties were not affected by the incorporation of emulsion gels, and all frankfurters were judged acceptable. Attenuated total reflectance–Fourier transform infrared spectroscopy results showed that samples with emulsion gels involve more lipid–protein interactions. Frankfurters with emulsion gels showed good stability to oxidation during storage and contained lower levels of microorganism than reduced-fat control at 85 days.

Quartz-enhanced photoacoustic spectroscopy sensor for ethylene detection with a 3.32 μm distributed feedback laser diode

An antimonide distributed feedback quantum wells diode laser operating at 3.32 μm at near room temperature in the continuous wave regime has been used to perform ethylene detection based on quartz enhanced photoacoustic spectroscopy. An absorption line centered at 3007.52 cm(-1) was investigated and a normalized noise equivalent absorption coefficient (1σ) of 3.09 10(-7) cm(-1) W Hz(-1/2) was obtained. The linearity and the stability of the detection have been evaluated. Biological samples' respiration has been measured to validate the feasibility of the detection setup in an agronomic environment, especially on ripening apples.

Properties of reformulated hot dog sausage without added nitrites during chilled storage

The aim of this study was to assess the effect of a complete nitrite replacement strategy using celery, carmine, sodium lactate and orange dietary fibre combined with vitamins C and E, on the quality characteristics (technological, sensorial and safety properties) of hot dog sausages (five samples) during chilled storage (2 ± 1℃ 60 days). Nitrite replacers (combined with vitamins C and E) presented antioxidant activity, reducing lipid oxidation in reformulated samples. At the end of storage redness ( a*) was similar in the control sample (with added nitrite) and in the sample without added nitrite. Sensory evaluation detected no significant difference between samples with and without added nitrite. All the reformulated samples were judged acceptable by the panellists. At the end of storage, the control sample contained more than four times as much residual nitrite as the reformulated samples. Growth of presumptive Clostridium perfringens was not observed in any of the samples. Samples without added nitrite had longer shelf-lives than control sausage. Samples containing 0.1% vitamin C registered the lowest microbiological levels. This strategy could be a good alternative to reduce and/or eliminate added nitrite in hot dog sausages.

Nitrite-free Asian hot dog sausages reformulated with nitrite replacers

This research deals with the application of a global strategy designed to produce a nitrite-free Asian hot dog. Different ingredients such as annatto, cochineal, orange dietary fibre, vitamins E and C, lactate and celery were combined in order to study the appearance (colour), lipid oxidation stability and microbial stability of the nitrite-free formulations. The control sample contained much more (P < 0.05) residual nitrite (88.7 mg/kg) than the samples without added nitrite (23-24 mg/kg). Generally, no formulation-dependent variations were observed in fat and water binding properties. Control sample had the highest L* and a* values, while the product with annatto (RA) had the lowest a* values. Lipid oxidation levels were similar irrespective of formulation. The hot dog reformulated with cochineal (RC) scored higher for overall acceptability than RA, mainly due to its colour.