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"Hepatocellular adenoma is an extremely rare benign tumor of the liver which predominantly in young women. Its rare incidence with estimated 3-4 cases per 1.000.000 annually makes it a diagnostic challenge. Here we present a 30-year-old female patient with hepatocellular adenoma without classic risk factors. A series of work up tools have been performed in order to diagnose the condition. None but excision biopsy from segmental resection had been showed to increase diagnostic confidence. This case illustrates the role of immunohistochemical staining from excision biopsy as the best diagnostic modality of hepatocellular adenoma as well as therapeutic modality to prevent malignant transformation.

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Adenoma hepatoselular merupakan tumor jinak hati yang sangat jarang, dengan predominasi pada wanita usia muda. Estimasi insidens 3-4 kasus per 1.000.000 populasi setiap tahunnya menjadikan kondisi ini memiliki tantangan diagnostik tersendiri. Melalui naskah ini kami melaporkan seorang wanita berusia 30 tahun dengan adenoma hepatoselular tanpa faktor risiko klasik. Rangkaian metode diagnostik telah dikerjakan untuk dapat menegakkan diagnosis dan hanya biopsi eksisi dari reseksi segmental yang menunjukkan kemaknaan nilai diagnostik. Kasus ini mengilustrasikan peran dari pulasan imunohistokimia pada biopsi eksisi sebagai modalitas diagnostik terbaik untuk adenoma hepatoselular, sekaligus sebagai modalitas terapeutik untuk mencegah transformasi keganasan."

"AbstrakA 43-year old male presented with persistent discomfort and pain upper abdomen (epigastrium) more on left side associated with fever on and off, along with fatigue and loss of appetite for the last four months. Physical examination revealed mass on left hypochondrium extending to epigastrium with mild distension of the abdomen. Imaging studies of the patient showed dextrocardia on chest x-ray postero-anterior (PA) view, thoracic and abdominal CT scan showed situs inversus totalis with multiple SOL (space occupying lesion) in right lobe of liver with largest measuring 8x6 cm2 in the 4th segment. USG-guided FNAC of the mass showed features of hepatocellular carcinoma. Thereupon, hepatocellular carcinoma in situs inversus totalis was diagosed to this patient and was clinically staged as T3aN0M0. He was given sorafenib 400 mg orally twice daily with an advice to come for regular assessment every 4 week."

"ABSTRAKLatar belakang. Karsinoma medular sulit dibedakan secara histopatologik dan imunohistokimia dengan karsinoma invasif NST dengan gambaran medular derajat 3, karena beberapa gambaran yang tumpang tindih. Pembedaannya sangat penting terkait perbedaan tatalaksana dan prognosis. Karsinoma invasif NST dengan gambaran medular derajat 3 dianggap varian dari karsinoma invasif NST derajat 3, sehingga dapat mewakilinya. Karsinoma medular menunjukkan indeks apoptosis yang lebih tinggi dibandingkan karsinoma invasif NST derajat 3. Tujuan penelitian ini adalah mengetahui apakah indeks apoptosis dapat digunakan untuk mempertajam diagnosis karsinoma payudara medular secara obyektif menggunakan indeks apoptosis. Bahan dan Cara. Dilakukan penelitian retrospektif observasional analitik secara potong lintang terhadap 20 kasus karsinoma medular dan 20 kasus karsinoma invasif NST derajat 3. Dilakukan penilaian indeks apoptosis dengan metode TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate in situ nick endlabeling); selanjutnya membandingkan nilai keduanya dan menghitung titik potongnya. Dari titik potong yang didapat, selanjutnya dibandingkan indeks apoptosisnya pada sediaan simulasi core biopsy dan sediaan mastektomi/eksisinya pada kedua kasus. Hasil. Indeks apoptosis (IA) pada karsinoma medular lebih tinggi secara bermakna dibandingkan karsinoma invasif NST derajat 3 ( p 0,001). Berdasarkan kurva ROC, kami mendapatkan titik potong yang optimal pada IA 1.25. Uji kappa terhadap keselarasan sediaan core biopsy dan eksisi/mastektomi mendapatkan hasil 0,3. Kesimpulan. IA dapat digunakan untuk mempertajam diagnosis karsinoma meduler payudara pada sediaan eksisi/mastektomi. Didapatkan titik potong IA: dinyatakan ´medular´ apabila lebih besar/ sama dengan 1,25. IA potensial dapat membantu pada sediaan core biopsy jika >1.25 pada gambaran histopatologik yang memenuhi sebagian kriteria karsinoma medular.

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ABSTRACTBackground. Difficulties are often faced to differentiate between medullary breast carcinoma and invasive carcinoma of no special type with medullary features grade 3, due to morphology and immunohistochemistry overlapping features. It is important to differentiate between them due to differences in the treatment and prognosis . Invasive carcinoma NST with medullary features grade 3 is considered a variant of invasive carcinoma NST grade 3 so it can represent it. Some study showed that apoptotic index in medullary breast carcinoma is higher than invasive carcinoma of no special type grade 3. The aim of this study is to investigate whether apoptotic index can be more definitive in diagnosing medullary breast carcinoma. Patients and methods. This is a retrospective-analytic cross-sectional study using 20 cases of medullary breast carcinoma and 20 cases of invasive carcinoma of no special type grade 3. Apoptotic cell were assessed by TUNEL and the apoptotic index (AI) was calculated. Results. AI in medullary breast carcinoma is significantly higher than invasive carcinoma of no special type grade 3 (p 0,001). The cut off point of AI between medullary carcinoma and invasive carcinoma NST grade 3 is 1.25. Kappa test was done to determine the concordance between core biopsy simulation AI with the related excision/mastectomy and the result is 0,3. Conclusion. The AI can be used to improve diagnostic accuracy of medullary breast carcinoma in excision/mastectomy. The cut off point of the apoptotic index between medullary carcinoma and invasive carcinoma NST grade 3 is 1.25. Only if AI >1.25 can potentially be used to support the diagnosis of medullary carcinoma in core biopsy in case showing some of the medullary carcinoma morphologic criteria."

"Although basal cell carcinoma (BCC) is a common skin tumor, very rare cases of BCC arising from upper vermilion mucosa of lip have been reported previously. This tumor basically, originates from pillar structures and the involvement of the vermilion lip contrasts this concept so it is devoid of hair follicles and sweat glands. The exact pathogenesis of vermilion lip BCC is not clear but it has been postulated that the neoplasm originates from the pluripotential epithelial cells of the oral mucosa and epidermis. On the other hand, some authors consider their origin from ectopic sebaceous glands. Herein, we report a 34- year-old man with an asymptomatic ulcerated lesion on the upper left lip vermilion mucosa. The diagnosis of BCC was confirmed with histopathological examination after incisional biopsy of the mucosal neoplasm. After surgery of lip lesion, no recurrency was seen after 3 months follow-up the patient.

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Meskipun karsinoma sel basal (KSB) merupakan tumor kulit yang umum dijumpai, tetapi kasus-kasus KSB yang berasal dari mukosa merah bibir di bibir atas sangat jarang dilaporkan sebelumnya. Tumor ini pada dasarnya berasal dari struktur jaringan pilar dan keterlibatan bagian merah bibir sangat bertentangan dengan konsep ini sehingga struktur tersebut kekurangan folikel rambut dan kelenjar keringat. Patogenesis terjadinya KSB pada bagian merah bibir yang tepat masih belum jelas, tetapi telah dipostulasikan bahwa neoplasma tersebut berasal dari sel-sel epitel pluripoten di mukosa mulut dan epidermis. Sebaliknya, beberapa penulis memperkirakan bahwa asalnya adalah kelenjar sebasea ektopik. Di sini, kami melaporkan seorang lelaki berusia 34 tahun dengan lesi ulkus asimptomatik pada bagian merah bibir di bibir atas kiri. Diagnosis KSB dipastikan dengan pemeriksaan histopatologik setelah biopsi insisi pada mukosa neoplasma dilakukan. Setelah dilakukan pembedahan lesi bibir tersebut, tidak ditemukan kekambuhan setelah pasien dievaluasi lanjut selama 3 bulan."

"ABSTRAKLatar Belakang: Kanker tiroid merupakan keganasan endokrin yang paling sering ditemukan dan insidennya semakin meningkat. Meskipun metode biopsi aspirasi jarum halus memiliki sensitivitas yang baik dalam mendiagnosis nodul tiroid, sebanyak 10-40 masih memberikan hasil inkonklusif dalam penentuan keganasan. Hal ini sering merugikan pasien karena harus mengalami re-operasi apabila terdapat keganasan pada hasil histopatologi.Tujuan Penelitian: Mengetahui proporsi dan mendapatkan nilai diagnostik dari pemeriksaan mutasi BRAF, NRAS, dan promoter TERT pada spesimen BAJAH untuk meningkatkan akurasi diagnosis kanker tiroid.Metode Penelitian: Studi retrospektif dengan mengikutsertakan 50 pasien nodul tiroid yang memerlukan pembedahan. Spesimen diambil pada saat proses BAJAH atau pasca operasi. Deteksi mutasi BRAF, NRAS, dan promoter TERT menggunakan metode DNA sekuensing Sanger . Hasil mutasi akan dibandingkan dengan pemeriksaan baku emas histopatologi.Hasil: Dari 50 kasus yang ikut dalam analisis, terdapat 39 kasus 78 merupakan keganasan tiroid. Nilai proporsi mutasi BRAF, NRAS, dan pTERT berturut-turut sebesar 31 , 18 , dan 13 . Uji diagnostik mutasi BRAF menghasilkan sensitivitas, spesifisitas, nilai duga positif, dan nilai duga negatif berturut-turut 31 , 100 , 100 , 29 terhadap kanker tiroid. Untuk mutasi NRAS sebesar 18 , 100 . 100 , 26 . Sedangkan untuk mutasi pTERT sebesar 13 , 100 , 100 , 24 . Jika ketiga mutasi tersebut dikombinasikan, maka nilainya akan meningkat menjadi 49 , 100 , 100 , 35 . Kesimpulan: Pemeriksaan mutasi BRAF, NRAS dan promoter TERT pada kanker tiroid masing-masing memiliki spesifisitas yang tinggi. Jika ketiganya dikombinasikan maka akan meningkatkan sensitivitas untuk membantu dalam meningkatkan akurasi diagnosis keganasan tiroid.

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ABSTRACTBackground Thyroid cancer is the most common endocrine malignancy and it rsquo s incidence is on the rise. Although the fine needle aspiration biopsy FNAB has a good sensitivity in the diagnosis of thyroid nodules, as much as 10 40 still gives inconclusive results in malignant determination. This is often detrimental to patients having to undergo re surgery if there is a malignancy in the histopathologic outcome.Aim To establish the proportion and diagnostic value of BRAF, NRAS, and TERT promoter mutation detection on FNAB specimens to improve the accuracy of thyroid cancer diagnosis.Methods The retrospective study by involving 50 patients with thyroid nodules surgery. Specimens were taken during the FNAB or postoperative process. Detection of BRAF, NRAS, and TERT promoter mutation using DNA sequencing method Sanger . The mutation results will be compared with the histopathologic gold standard examination.Resuts Of the 50 cases involved in the analysis, there were 39 cases 78 of thyroid malignancies. The proportion of BRAF, NRAS, and pTERT mutations was 31 , 18 , and 13 , respectively. BRAF mutation diagnostic test results in sensitivity, specificity, positive predictive value, and negative predictive value were 31 , 100 , 100 , 29 respectively. For NRAS mutation were 18 , 100 . 100 , 26 . As for pTERT mutation were 13 , 100 , 100 , 24 . If the three mutations are combined, then the value will increase to 45 , 100 , 100 , 35 .Conclusion Detection mutations of BRAF, NRAS and TERT promoters in thyroid cancer have a high specificity. If all three are combined it will increase the sensitivity to improve the accuracy of the diagnosis in thyroid malignancy."

"Background: nowadays, radiofrequency ablation (RFA) is applied widely as an alternative therapy of resection in patient with hepatocellular carcinoma (HCC). Moreover, in single nodule with size of less than 2 cm, RFA may be the primary treatment. Although resection is the main treatment and one of the curative treatments in nodule meeting Milan criteria, it needs consideration of risk stratification for surgical resection. This report was aimed to search evidence of RFA compared with RFA in term of survival in patient with HCC single nodule size of more than 5 cm. Methods: the searching was done using PubMed, Scopus, Web of Science, dan CINAHL from EBSCO with keyword of “hepatocellular carcinoma”, “single nodule”, “radiofrequency ablation”, “resection”, and “survival”. The limitation of the article was English with clinical question of “In patient with HCC single nodule size of more than 5 cm, was RFA more superior in resection in term of survival?”. Results: there were three articles with retrospective studies. One of the article combined RFA and percutaneous ethanol injection in the analysis, meanwhile another article combined RFA and transarterial chemoembolization. These articles showed conflicting ata that showed absolute risk reduction of 33% till absolute risk increment of 60.6%. Conclusion: all studies used RFA as the alternative of resection when the the tumor was unresectable which means the severity was higher in RFA group. Hence, we can not solely conclude that RFA resulted in worse survival.

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Latar belakang: radiofrequency ablation (RFA) saat ini semakin luas dipergunakan sebagai terapi alternatif reseksi pada pasien dengan karsinoma sel hati (KHS). Bahkan pada ukuran nodul kurang dari 2 cm, RFA dapat menjadi lini utama pada kasus tersebut. Reseksi merupakan terapi utama dan salah satu terapi kuratif pada nodul dengan kriteria Milan, tetapi harus dipertimbangkan toleransi operasi pada pasien yang akan menjalani reseksi. Pada laporan kasus berdasar bukti ini kami bertujuan memperlihatkan efektivitas RFA dibandingkan reseksi dalam hal kesintasan, tetapi pada KHS nodul tunggal berukuran lebih dari 5 cm.

Metode: pencarian artikel dilakukan dengan menggunakan mesin pencari PubMed, Scopus, Web of Science, dan CINAHL dari EBSCO dengan kata kunci “hepatocellular carcinoma”, “single nodule”, “radiofrequency ablation”, “resection”, dan “survival”. Artikel dibatasi pada artikel berbahasa Inggris dengan pertanyaan klinis “Pada pasien dengan KHS nodul tunggal berukuran lebih dari 5 cm, apakah RFA lebih baik dibandingkan dengan reseksi untuk memperpanjang kesintasan?” Hasil: didapatkan tiga artikel penelitian retrospektif dengan satu artikel menggabungkan terapi RFA dan injeksi etanol dalam analisis dan satu penelitian menggabungkan RFA dengan transarterial chemoembolization (TACE) dalam analisisnya. Dari ketiga penelitian tersebut memperlihatkan penurunan risiko absolut 33% sampai peningkatan risiko absolut 60,6%. Kesimpulan: seluruh penelitian menjadikan RFA sebagai alternatif reseksi bila reseksi tidak dapat dilakukan yang berarti tingkat keparahan lebih tinggi pada RFA, sehingga sulit mengambil kesimpulan bahwa RFA memberikan kesintasan lebih buruk."

"Background: liver cancer is currently the second deadliest cancer in the world with hepatocelullar carcinoma (HCC) being the commonest form—accounting 90% of all its cases. With the current global alarming increase of obesity, there is hence an increase of fatty liver disease cases, which is one of the major non-viral etiology of cirrhosis in the world. The objective of this study is to evaluate whether obese HCC patients have worse survival outcome. Methods: PubMed, Cochrane, Scopus, ProQuest, and EBSCOhost were comprehensively searched for systematic review and cohort prognostic researches studying overall survival of HCC patients who are underweight and obesity according to their BMI. Three studies were selected and critically appraised. Data were then summarized descriptively. Results: the three studies included consist of one meta-analysis and two cohort studies. Meta-analysis study stated no association between overweight and obesity status with higher mortality rate in Asian race HCC patients (aHR, 1.10; 95% CI, 0.63-1.92). A cohort study from Japan reported while there was a significant difference of mortality rate in obese HCC patients in bivariate analysis, adjustment with other important prognostic factors with multivariate analysis found no significant correlation between obesity and HCC-related mortality rate (aHR, 1.00; 95% CI, 0.83-1.22). Another cohort study from China reported that HCC-related mortality rate in patients with higher BMI was lower than in patients with lower BMI (aHR, 0.347; 95% CI, 0.239-0.302). Conclusion:there is no association between higher BMI with HCC-related mortality in Asian race patients.

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Latar belakang: saat ini kanker hati adalah kanker paling mematikan kedua di dunia yang umumnya dengan karsinoma hepatocelullar (HCC) - terhitung 90% dari semua kasusnya. Dengan peningkatan obesitas global yang cukup mengkhawatirkan, maka ada peningkatan kasus penyakit hati berlemak, yang merupakan salah satu etiologi utama sirosis virus di dunia. Tujuan dari penelitian ini adalah untuk mengevaluasi apakah pasien HCC obesitas memiliki hasil kelangsungan hidup yang lebih buruk.

Metode: PubMed, Cochrane, Scopus, ProQuest, dan EBSCOhost secara komprehensif mencari ulasan sistematis dan penelitian prognostik kohort dengan mempelajari kelangsungan hidup keseluruhan pasien HCC yang kekurangan berat badan dan obesitas menurut indeks massa tubuh (IMT) mereka. Tiga studi dipilih dan dinilai secara kritis. Data kemudian dirangkum secara deskriptif.

Hasil: tiga studi terdiri dari satu meta-analisis dan dua studi kohort. Studi meta-analisis menyatakan tidak ada hubungan antara kelebihan berat badan dan status obesitas dengan tingkat kematian yang lebih tinggi pada ,92). Sebuah studi kohort dari Jepang melaporkan sementara ada perbedaan yang signifikan dari tingkat kematian pada pasien HCC obesitas dalam analisis bivariat, penyesuaian dengan faktor prognostik penting lainnya berdasarkan analisis multivariat tidak ditemukan korelasi signifikan antara obesitas dan tingkat kematian terkait HCC (aHR, 1,00; 95 % CI, 0,83-1,22). Studi kohort lain dari Cina melaporkan bahwa tingkat kematian terkait HCC pada pasien dengan IMT tinggi, lebih rendah daripada pasien dengan IMT rendah (aHR, 0,347; 95% CI, 0,239-0,302).

Kesimpulan: tidak ada hubungan antara BMI yang lebih tinggi dengan mortalitas terkait HCC pada pasien ras Asia"

"The lateral periodontal lateral cyst (LPC) is an uncommon developmental odontogenic cyst defined as a radiolucent lesion which develops along the lateral aspect of an erupted vital tooth. LPC represents approximately 0.8% to 2% of all odontogenic cysts. The most frequently reported location of a lateral periodontal cyst is the mandibular caninepremolar area, followed by the anterior region of the maxilla. The lateral periodontal cyst is usually asymptomatic and presents as a round, oval or teardrop-like well-circumscribed inter-radicular radiolucent area, usually with a sclerotic margin lying between the apex and cervical margin of the teeth. The lateral periodontal cyst usually is seen in the fifth to sixth decade of life with a male preponderance. This paper reports an atypical case of an inter-radicular radiolucent cystic lesion in located between the mandibular central incisor and the canine area in an 87-year-old female patient mimicking clinically and radiographically as a residual cyst but histopathologicallyconfirmed as a lateral periodontal cyst. "

"Nevus of Ota is a dermal melanocytic nevus which is characterized by benign hamartomatous hyperpigmentation.Clinically it presents as a congenital or acquired blue or gray patch on the face and is distributed on the ophthalmic,maxillary, and mandibular branches of the trigeminal nerve. It is most commonly found in Japanese populationsand is rare in the Indian subcontinent. It affects only 0.014 – 0.034% of the Asian population and is less commonin the male population, with a male to female ratio of 1.4:8. The involvement of pigmentation over the pinna of theear and the oral mucosa is extremely rare with very few cases reported in scientific literature. The case reportedhere is a case of nevus of Ota, with a rare intraoral presentation on the hard palate, crossing the midline."