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"ABSTRACTHepatocellular 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."

"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."

"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."

"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. "

"ABSTRACTAlthough 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."

"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."

"Background: genitourinary tuberculosis (GUTB) refers to a Mycobacterium tuberculosis infection of the urinary tract with clinical manifestation masquerading as various urological diagnostic entities. With an incidence rate of 192-232 per 100,000 individuals, current diagnoses have fallen short in comparison to the total incidence. Combined with an atypical and non-specific manifestation, a high false negative rate of acid-fast bacilli (AFB) staining, and long AFB culture duration has made diagnosis difficult. We aim to gather current available evidence regarding the diagnostic performance of polymerase chain reaction (PCR) in the diagnosis of GUTB. Methods: a literature search was conducted in four different, well-known databases using a predetermined PICO, keywords, and Boolean operators. All included articles will be subjected to rigorous appraisal according the University of Oxford's Centre for Evidence-Based Medicine (CEBM) Diagnostic Variability Criteria. Review and meta-analysis will be subjected to the QFAITH appraisal checklist to assess its quality. Results: out of a total of 243 initial search results, 11 relevant studies were determined after title and abstract screening. Additionally, nine articles were excluded based on the predetermined criteria. Two fully appraised articles were included in the study: one systematic review article, revealing a heterogenous (I2 = unstated; p = unstated) result of sensitivity mean above 85% and specificity above 75%; and one cross-sectional diagnostic study that reported the use of two different PCR primers: IS6110-PCR and 16SrRNA-PCR primer with a sensitivity of 95.99% and 87.05% and specificity of 98.11% and 98.9%, respectively. Conclusion: current limited evidence showed that PCR could not be solely used for the diagnosis of GUTB, but its use is recommended to guide patient treatment and monitoring."

"In this paper, I describe four Indonesian aspect markers, sudah, telah, pernah, and sempat, showing that the main opposition between them relies not only on their aspectual meanings, but also on the various modalities they express. The opposition between the very frequent markers sudah and telah is analysed in detail. The syntactic and semantic survey shows that these two markers are not synonyms in most contexts."