UNASSIGNED: To compare the ultrasonography and pathology features between children and adolescents with papillary thyroid carcinoma (PTC).
UNASSIGNED: A total of 53 patients who were surgically diagnosed with childhood or adolescent PTC between 2017 and 2022 were included in this study. The pre-operative ultrasonography, post-operative histology, and molecular and clinical characteristics were retrospectively analyzed.
UNASSIGNED: No differences were observed in composition, echogenicity, and shape using ultrasonography. Moreover, there was a significantly higher rate of extrathyroidal extension, punctate echogenic foci, and lymph node metastases in children compared to adolescents. The molecular analysis showed that BRAFV600E mutations are the most prevalent abnormality in adolescent PTC (12/20, 60.0%). However, they are less in childhood PTC (7/23, 30.4%). In addition, using next-generation sequencing, three cases with oncogenic fusion (one TRIM33-RET case, one CCDC6-RET case, and one STRN-ALK case) were identified in childhood PTC.
UNASSIGNED: The frequency of extrathyroidal extension, punctate echogenic foci, and lymph node metastases were higher in childhood PTC, while BRAFV600E mutations were higher in adolescent PTC.

Lingual thyroid is by far the most common presentation of ectopic thyroid. Though mostly asymptomatic it is associated with congenital hypothyroidism and importantly, absence of orthotopic thyroid making it the only functional thyroid tissue a patient has in many cases. It appears indistinguishable to orthotopic thyroid tissue on imaging, with avid homogeneous enhancement on contrast computed tomography. Here we report clinical presentation and imaging findings of lingual thyroid in a 38-year-old man.

UNASSIGNED: Differentiating Warthin tumor (WT) from pleomorphic adenoma (PA) is of primary importance due to differences in patient management, treatment and outcome. We sought to evaluate the performance of MRI-based radiomic features in discriminating PA from WT in the preoperative setting.
UNASSIGNED: We retrospectively evaluated 81 parotid gland lesions (48 PA and 33 WT) on T2-weighted (T2w) images and 52 of them on post-contrast fat-suppressed T1-weighted (pcfsT1w) images. All MRI examinations were carried out on a 1.5-Tesla MRI scanner, and images were segmented manually using the software ITK-SNAP (www.itk-snap.org).
UNASSIGNED: The most discriminative feature on pcfsT1w images was GLCM_InverseVariance, yielding area under the curve (AUC), sensitivity and specificity of 0.9, 86 % and 87 %, respectively. Skewness was the feature extracted from T2w images with the highest specificity (88 %) in discriminating WT from PA.
UNASSIGNED: Radiomic analysis could be an important tool to improve diagnostic accuracy in differentiating PA from WT.

Chest wall lesions can mimic masses on mammograms and can cause diagnostic difficulty in interpretation. Here, we report a case of an axillary and retro-pectoral vascular malformation visualized on mammography in a 67-year-old patient presenting with fullness in the right axilla and right supraclavicular region. Mammography, ultrasonography (US), and computed tomography (CT) angiography of the patient were done to make the final diagnosis.

IgG4-related diseases are rare multisystem disorders involving salivary glands, retroperitoneum, pancreas, biliary tract, and liver. Isolated biliary strictures and gall bladder involvement are rare in such patients, and presentation with cholangitis and weight loss can misguide the diagnosis toward malignancy. Here, we report an interesting case of IgG4-related biliary stricture with gall bladder involvement, presented with cholangitis and weight loss. The initial symptoms and imaging were guided toward the malignant possibilities of cholangiocarcinoma and pancreatic carcinoma. However, endosonography, serology, and histopathology clinched the diagnosis of IgG4-related disease. The patient was managed without any biliary intervention and with antibiotics, steroids, and steroid-sparing agents. There was a relapse of disease during the steroids taper that improved after hiking its doses. The disease responded with medical management on follow-up. We demonstrated the effectiveness of steroid-sparing agents to treat IgG4-related diseases, especially to avert the steroid-related adverse effects. This case highlights the possible mislead for the diagnosis and delayed management of IgG4 disease due to shared clinical features with hepatobiliary malignancies and the effectiveness of noninvasive measures of management.

OBJECTIVE: Hepatitis B virus (HBV) infection is a major public health problem globally. Northeast India is home to indigenous tribes with different ethnicity and high rates of drug abuse and HIV infection. The study was designed to estimate the burden of HBV infection across various spectrums of liver diseases from this region. HBV genotypes and subgenotypes play a role in the chronicity of disease, response to treatment and its progression. As very limited data are available from this region, we tried to elucidate the role of HBV genotypes, HBV mutants and their phylogenetic analysis.
METHODS: We designed a prospective multicentric study, and included 7464 liver disease cases, 7432 blood donors and 650 health care workers, who were screened for HBV infection. HBV DNA positive patients were genotyped and subjected to surface protein, precore and core mutation and phylogenetic analysis.
RESULTS: The prevalence of HBV infection with respect to different types of liver diseases, blood donors and health care workers was 9.9% (1550/15,546). 49.5% (768/1550) cases were found to be HBV DNA positive. The most common genotype was found to be genotype D 74.2% (570/768), followed by genotype C 6.5% (50/768), A 4.4% (34/768) and I 0.9% (7/768).
CONCLUSIONS: This study highlights the high hepatitis B burden in Northeast India, reflecting lacunae in health care needs of the region. Also, the different genotype distribution and presence of mutations may translate into different rates of liver disease progression, prognosis and ultimately, clinical significance. However, further prospective cohort study from Northeast India is warranted, to elucidate the clinical significance of multiple genotypes and mutation in this unique population.

UNASSIGNED: Radiofrequency ablation (RFA) is a standard treatment for small inoperable hepatocellular carcinoma (HCC). Studies on mid- and long-term outcome of RFA as first-line therapy for HCC from India are limited.
UNASSIGNED: We evaluated consecutive HCC patients who underwent RFA as primary treatment modality at our institute between July 2009 and April 2016. The median follow-up period was 26 months, range 1-84 months. We evaluated post-RFA tumor response, disease-free survival (DFS), overall survival (OS), and local tumor progression (LTP). Prognostic factors were also analyzed.
UNASSIGNED: In 147 patients (male:female = 121:26; mean age, 59.2 years), 209 RFA sessions were done for 228 lesions (mean size of 21.5 ± 8.3 mm, range 10-50 mm). Primary success rate was 94.2%. The estimated cumulative proportion survival at 1, 3, and 5 years was 90.2%, 63.8%, and 60.2%, respectively. The cumulative incidence of LTP estimated at 1, 3, and 5 years was 13.1%, 19.7%, and 20.1%, respectively. The mean estimate of LTP-free survival was 53.6 months (95% confidence interval: 0.49-0.58) which is 58.2 months in <3 cm lesions and 20.4 months in >3 cm lesions (P < 0.01). There was no significant difference in LTP rates between lesions in perivascular versus nonperivascular location (P = 0.71) and surface versus parenchymal lesions (P = 0.66). The mean DFS was 30.3 months (95% CI: 25.6-35.0). For OS, age and Child-Turcotte-Pugh class B were significant factors while for LTP, tumor size >3 cm was significant. Higher baseline alpha-fetoprotein level and LTP were poor predictors for DFS. Complication rate per RFA session was 7/209 (3.3%).
UNASSIGNED: RFA is a safe and effective curative modality for first-line treatment of HCC < 3 cm.

BACKGROUND: Gallbladder cancer (GC) is a relatively rare disease. To date, there are no studies describing the epidemiology of this disease in Qatar.
OBJECTIVE: To study the epidemiology of Gallbladder Cancer in Qatar.
METHODS: A retrospective analysis of the cases of GC in Hamad General Hospital in Qatar from 2009 to 2016.
RESULTS: Thirty-five patients presented with GC during the study period, 10 females (28.6%) and 25 males (71.4%). Fourteen patients (40%) were diagnosed incidentally after laparoscopic cholecystectomy, 16 (48.6%) were diagnosed pathologically, and 4 (11.4%) were diagnosed radiologically. The median age at diagnosis was 54 years (31-78). 74.3% of the disease occurred in patients less than 60 years old. Metastatic disease was discovered in 25 patients (71.4%) versus no metastasis in 10 patients (28.6%). The most common sites for metastasis were the liver (42.9%), peritoneum (25.7%), and lymph nodes (25.7%). Curative central hepatic resection was done in 8 patients (22.9%). Pathology showed adenocarcinoma in 27 patients (77.1%), neuroendocrine tumor in 3 patients (8.6%) and high-grade dysplasia in 1 patient (2.9%). No histopathology was available for 4 patients (11.4%). Twenty-eight patients (80.0%) had regular follow up, with 22 (62.9%) still alive. Six patients (17.1%) died during follow up with survival after diagnosis ranging from 42 days to 6.8 years.
CONCLUSIONS: In Qatar, due to the unique demographics, GC is more common in males and younger age groups. Most of the patients present late with metastasis, but curative resection is associated with long-term survival.

Primary hepatic leiomyosarcoma is a rare primary mesenchymal tumor of the liver requiring exclusion of any other primary site of origin and histological and immunohistochemical exclusion of other hepatic/extrahepatic tumors with spindle cell morphology. Only about 70 cases are reported in the English literature and many of these tumors have predisposing conditions in the form of immunosuppression or associated malignancies. The occurrence of this tumor in the immunocompetent individual is also known. Histomorphology of this tumor shows a spindle cell lesion which needs to be distinguished from other spindle cell lesions of this region. The main diagnostic challenge of this tumor lies in its rarity, lack of awareness and morphological mimickers in the given site. A complete range of immunohistochemical markers is required to distinguish the lesion from its close morphological mimickers. Here, we discuss a case of primary hepatic leiomyosarcoma in an adult female patient with detailed histomorphological differentials and respective immunoprofiles.

BACKGROUND: Interferon-based antiviral therapy is offered only to those HCV patients who have either chronic hepatitis or early cirrhosis. Advanced cirrhotics do not tolerate interferon-based therapy. Since HCV is asymptomatic in early stages and usually presents late, the eligibility for interferon-based therapy is thus limited. There are scarce studies from India, which looked specifically the eligibility of interferon-based therapy in HCV patients.
OBJECTIVE: To study the spectrum of presentation of HCV infection, determine their eligibility for interferon-based therapy, and follow for SVR.
METHODS: The records of all consecutive patients of HCV, >14 years age, who presented to our department between 2008 and 2014, were analyzed for categorization into chronic hepatitis, cirrhosis and hepatocellular carcinoma. Patients with detectable HCV RNA who have chronic hepatitis or Child A cirrhosis were considered eligible for Peg-interferon and ribavirin. Patients who received treatment were followed for SVR.
RESULTS: 777 patients (median age 49 [range 15-95] years, males 69%) were included. Cirrhosis was the most common presentation (56%, 439/777) followed by chronic hepatitis (37%, 287/777) and HCC (7%, 51/777). Of patients who had cirrhosis (including those with HCC), 36% (174/490) were Child A; 51% (250/490) were Child B and 14% (66/490) were Child C. Only 347/777 (45%) were eligible for Peg-interferon-alpha and Ribavirin. Among the remaining 430 patients, in 326 (76%) the disease was far too advanced. Of eligible patients only 54% actually received Peg-interferon-alpha and Ribavirin and 81% patients could complete the course. Of them only 70% could achieve SVR.
CONCLUSIONS: Most HCV patients in India present late and only about 45% are eligible for Interferon-based antiviral treatment. At presentation 56% patients already have cirrhosis and 7% have HCC. Since HCV is usually asymptomatic in early stages, awareness about screening should be increased so that more patients are diagnosed early before they develop cirrhosis or HCC.