Nodular mucinosis is an extraordinary stromal lesion of the breast. The usual clinical presentation is that of an oozing, slow-growing, soft, non-tender, lobulated mass in the subareolar region. Histologically, it is a non-encapsulated myxoid/mucinous lesion with a sparse infiltrate of spindle cells within a collagenized stroma. The histogenesis of nodular mucinosis is undetermined but the pattern of staining of the spindle cells suggests it might be of myofibroblastic origin. We herein report for the first time in the English literature a case of nodular mucinosis occurring in a supernumerary nipple. We also discuss the main differential diagnoses and review the literature of previously published cases of this entity.

What ' s known on the subject? and What does the study add? Pathological stage, lymph node metastasis and tumour grade have been established as prognostic factors for upper-tract urothelial carcinoma, but there are few studies to date assessing location within the ureter as a prognostic factor. There are also few studies comparing surgical approaches to radical nephroureterectomy (NU), partial ureterectomy and endoscopic resection (ENDO) with regard to oncological outcomes.This study did not fi nd any prognostic signifi cance for tumour location or surgical approach with regard to outcomes in patients with ureteric tumours. Although NU is the standard treatment for invasive ureteric tumours, partial ureterectomy and ENDO can safely be performed in selected patients. Despite the risk of a shorter time to recurrence, ENDO can be recommended in low grade, non-invasive ureteric tumours but only with close, thorough surveillance practices. OBJECTIVE• To assess the impact of tumour location within the ureter and the impact of surgical approach on recurrence-free survival (RFS) and cancer-specifi c survival (CSS) with regard to ureteric tumours. PATIENTS AND METHODS• Data were retrospectively reviewed from 60 patients with isolated primary ureteric tumours, treated at a single tertiary referral centre.• Patients were treated with radical nephroureterectomy (NU, n = 33), partial ureterectomy ( n = 17) or endoscopic resection (ENDO, n = 10).• Kaplan -Meier curves were used for the analysis of RFS and CSS after surgery, stratifi ed by tumour location and surgical approach. RESULTS• With a median follow-up of 29 months, tumour location was not associated with disease recurrence ( P = 0.423).• The ENDO group had shorter time to disease recurrence.• There were no signifi cant differences in the probability of CSS with regard to either tumour location or surgical approach ( P = 0.523 and P = 0.904, respectively). CONCLUSIONS• Tumour location or surgical approach were not signifi cant predictors of oncological outcomes in patients with ureteric tumours.• Although NU is standard treatment for invasive ureteric tumours, partial ureterectomy and ENDO can safely be performed in selected patients. Despite the risk of a shorter time to recurrence, ENDO can be recommended in low grade, non-invasive ureteric tumours.• All urothelium-preserving approaches require thorough surveillance. KEYWORDSureteric tumour , tumour location , surgical approach , recurrence-free survival , cancer-specifi c survival Study Type -Therapy (case series) Level of Evidence 4

Background: Cervical cancer remains a global health problem especially in remote areas of developing countries which have limited resources for cervical cancer screening. In this study, we evaluated the performance of a lowcost, smartphone attachable paper-based microscope when used for classifying images of cervical cytology. Methods: Cervical cytology samples included: 10 Normal, 10 Low-grade squamous intraepithelial lesion (LSIL), 10 High-grade squamous intraepithelial lesion (HSIL), and 10 Malignant Pap Smears. The agreement between conventional microscopy vs. Foldscope imaging was calculated using a weighted kappa coefficient. A confusion matrix was created with three classes: Normal, LSIL, and HSIL/malignant, to evaluate the performance of the Foldscope by calculating the accuracy, sensitivity, and specificity. Results: We observed a kappa statistic of 0.68 for the agreement. This translates into a substantial agreement between the cytological classifications by the Foldscope vs. conventional microscopy. The accuracy of the Foldscope was 80%, with a sensitivity and specificity of 85 and 90% for the HSIL/Mal category, 80 and 83.3%, for LSIL, and 70 and 96.7% for Normal. Conclusions: This study highlights the usefulness of the Foldscope in cervical cytology, demonstrating it has substantial agreement with conventional microscopy. Its use could improve cytologic interpretations in underserved areas and, thus, improve the quality of cervical cancer screening. Improvements in existing limitations of the device, such as ability to focus, could potentially increase its accuracy.

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Introduction: Medical students express frustration that they cannot assemble a comprehensive big picture of how the immune system responds to a microbe and that integration of basic science knowledge, especially across disciplines, with clinical knowledge is difficult. Yet medical student competency requires application of knowledge of immune mechanisms to inform diagnosis and treatment. Methods: A diagram for immune response to extracellular microbes was previously published by MedEdPORTAL in 2011. This diagram has been updated here as a narrated audiovisual module with integrated histopathology. It contains a self-assessment quiz that tests students' understanding of the module followed by a clinical vignette that tests students' ability to apply the concepts in a clinical context. The module was published and usage was tracked via our learning management system. An in-class survey was conducted to gauge students' perceptions of the module. Results: Eighty-two out of 102 (76%) first-year medical students used the module. Over 85% of survey participants felt that the module was a useful resource for learning and reviewing. More than 90% felt that the module helped them to understand the big picture and identify areas for further study. Discussion: This module assembles a big picture of the immunologic mechanisms involved in a bacterial infection. It was created in response to requests and suggestions by preclinical medical students and used for first-year students during the first few weeks of their training in the basic sciences. This approach integrates multiple disciplines and facilitates students' learning and application of difficult concepts in immunology and pathology.

Background: This study was conducted to evaluate the diagnostic utility of cell block material in fine needle aspiration (FNA) of thyroid nodules.Design: A total of 242 thyroid fine need aspirations (FNAs) were performed between January 2015 and December 2015. Of those, all consecutive thyroid FNA cases with cell blocks (n = 140) from 129 patients (age: 58.9 ± 12.8 years) are included in this study.Cytology slides and cell blocks are reviewed for adequacy assessment based on the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and then categorizing them into TBSRTC diagnostic categories. These cases are divided into two groups, combined cytology and cell block (C + CB) and cytology without cell block (C).Results: In the first group (C + CB), a total 140 cases are categorized in TBSRTC as follows: I: 13 (9.3%) cases, II: 78 (55.7%) cases, III: 7 (5%), IV: 16 (11.4%), V: 3(2.2%) and VI: 23 (16.4%). In the second group (C), the cases are classified in TBSRTC as follows: I: 23 (16.4%) cases, II: 70 (50%), III: 7 (5%), IV: 16 (11.4%), V: 3 (2.2%) and VI: 21 (15%). Nondiagnostic rate was 7.1% lower in the first group (C + CB) as compared with second group (C) (First group: 9.3% vs second group: 16.4%, P = .0764).Conclusions: Combined use of cytology slides and cell block decreases the nondiagnostic rate up to 7.1% as compared with cytology without cell block.

Osteoclast-like giant cells (OLGCs) are multinucleated cells of histiocytic lineage and have been identified in a wide array of neoplasms. In the uterus, they have most frequently been reported in association with leiomyosarcomas. This article describes a case of an osteoclast-like giant cell-rich uterine tumor that was essentially indistinguishable at the morphologic and immunophenotypic levels, from typical giant cell tumor of bone. This is the first example of such a case that has been reported in the uterus to the authors' knowledge.