IntroductionAdrenocortical cancer (ACC) is a rare malignant tumor that originates in the adrenal cortex. Despite extensive molecular-genetic, pathomorphological, and clinical research, assessing the malignant potential of adrenal neoplasms in clinical practice remains a daunting task in histological diagnosis. Although the Weiss score is the most prevalent method for diagnosing ACC, its limitations necessitate additional algorithms for specific histological variants. Unequal diagnostic value, subjectivity in evaluation, and interpretation challenges contribute to a gray zone where the reliable assessment of a tumor’s malignant potential is unattainable. In this study, we introduce a universal mathematical model for the differential diagnosis of all morphological types of ACC in adults.MethodsThis model was developed by analyzing a retrospective sample of data from 143 patients who underwent histological and immunohistochemical examinations of surgically removed adrenal neoplasms. Statistical analysis was carried out on Python 3.1 in the Google Colab environment. The cutting point was chosen according to Youden’s index. Scikit-learn 1.0.2 was used for building the multidimensional model for Python. Logistical regression analysis was executed with L1-regularization, which is an effective method for extracting the most significant features of the model.ResultsThe new system we have developed is a diagnostically meaningful set of indicators that takes into account a smaller number of criteria from the currently used Weiss scale. To validate the obtained model, we divided the initial sample set into training and test sets in a 9:1 ratio, respectively. The diagnostic algorithm is highly accurate [overall accuracy 100% (95% CI: 96%-100%)].DiscussionOur method involves determining eight diagnostically significant indicators that enable the calculation of ACC development probability using specified formulas. This approach may potentially enhance diagnostic precision and facilitate improved clinical outcomes in ACC management.
Objective: to conduct a comparative morphological analysis of helicobacter pylori (H. pylori) and autoimmune gastritis and to determine the significant morphological criteria for differential diagnosis.Materials and methods. 30 cases of chronic atrophic helicobacter gastritis and 30 cases of chronic atrophic autoimmune gastritis were retrospectively selected for the study. In all cases of helicobacter gastritis, the presence of H. pylori was confirmed by morphological diagnostic methods using Giemsa staining or additionally using immunohistochemistry. All cases of autoimmune gastritis were additionally confirmed by clinical and laboratory diagnostic methods, some patients had a long history of follow-up and biopsy material was taken from them repeatedly. A prerequisite was taking at least 5 biopsies according to the Sydney Protocol.Results. The main differential diagnostic feature in our study was the detection of H. pylori, as well as the localization of the lesion in the stomach body characteristic of autoimmune gastritis and in the antrum in helicobacter gastritis. The study groups differed by gender (the predominance of females in the group of autoimmune gastritis), the prevalence and activity of inflammation (all cases of helicobacter gastritis had signs of inflammation activity). When studying the content of neuroendo-crine cells in cases of helicobacter gastritis in the stomach body, simple hyperplasia of neuroendocrine cells was noted, in cases of au-toimmune gastritis, the appearance of chains and nodules was noted, which corresponded to linear and nodular hyperplasia of neuro-endocrine cells.Conclusion. The morphological criteria obtained in the study make it possible to make a differential diagnosis between helicobacter and autoimmune gastritis. This is extremely important because of the differences in treatment approaches and dynamic monitoring tactics in these variants of chronic gastritis.
The analysis of the tumor microenvironment, especially tumor-infiltrated immune cells, is essential for predicting tumor prognosis, clinical outcomes, and therapy strategies. Adrenocortical cancer is a rare nonimmunogenic malignancy in which the importance of the presence of immune cells is not well understood. In our study, we made the first attempt to understand the interplay between the histology of adrenocortical cancer and its immune landscape using cases from The Cancer Genome Atlas database and the Endocrinology Research Centre collection (Moscow, Russia). We showed that the oncocytic variant of adrenocortical cancer is characterized by intensive immune infiltration and better survival, and it is crucial to analyze the effect of immune infiltration independently for each histological variant.
Harvey Cushing is one of the greatest surgeons of the early 20th century. The young doctor was trained in the best medical universities; parents, teachers and colleagues always noted his thirst for knowledge. Cushing opened a new page in the study of neurosurgery, endocrinology, anesthesiology, and neurology. Thanks to the improvement of surgical techniques, the great doctor has achieved a reduction in mortality in surgical interventions, and new diagnostic methods have given life to more than one person. Cushing’s versatility amazed his contemporaries and still surprises the world. His books won the Pulitzer prize, one of the most prestigious literary prizes, he was repeatedly nominated for the Nobel prize, and the American Association of neurosurgeons is named in honor of the greatest doctor.
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