Avoiding misdiagnosis of multilocular thymic cysts as malignant tumors on computer tomography

This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tumor,resulting in an unnecessary surgical procedure.Both MTCs and thymic tumors are rare conditions that heavily rely on radiological imaging for accurate diagnosis.However,the similarity in their imaging presentations can lead to misinterpretation,resulting in unnecessary surgical procedures.Due to the ongoing lack of comprehensive knowledge about MTCs and thymic tumors,we offer a summary of diagnostic techniques documented in recent literature and examine potential causes of misdiagnosis.When computer tomography(CT)values surpass 20 Hounsfield units and display comparable morphology,there is a risk of misdiagnosing MTCs as thymic tumors.Employing various differential diagnostic methods like biopsy,molecular biology,multi-slice CT,CT functional imaging,positron emission tomography/CT molecular functional imaging,magnetic resonance imaging and radiomics,proves advantageous in reducing clinical misdiagnosis.A deeper understanding of these conditions requires increased attention and exploration by healthcare providers.Moreover,the continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.

Clinicopathological and molecular insights into odontogenic tumors associated with syndromes:A comprehensive review

The association between genetic syndromes and odontogenic tumors encompasses several entities,reflecting the intricate interplay between genetic factors and the development of these lesions.The present study aimed to comprehensively investigate the associations between genetic syndromes and odontogenic tumors.We delineated the diverse spectrum of syndromic connections,including key syndromes such as Gardner syndrome,Gorlin syndrome,Schimmelpenning syndrome,and others.Our findings underscore the clinical significance of recognizing odontogenic tumors associated with genetic syndromes as diagnostic indicators for early intervention.We advocate for multidisciplinary collaboration among clinicians,geneticists,and researchers to deepen our understanding of the underlying mechanisms driving these syndromic associations.In light of this,our study contributes to the growing body of knowledge in dentistry and medical genetics,offering insights that may inform clinical practice and enhance patient care for individuals affected by genetic syndromes and odontogenic tumors.

Misdiagnosis and Delayed Diagnosis for Ectopic and Heterotopic Pregnancies after In Vitro Fertilization and Embryo Transfer

This study examined the misdiagnosis and delayed diagnosis factors for ectopic pregnancy（EP） and heterotopic pregnancy（HP） after in vitro fertilization and embryo transfer（IVF-ET） in an attempt to reduce the diagnostic error. Clinical data of patients who underwent IVF-ET treatment and had clinical pregnancy from 12463 cycles were retrospectively analyzed. Their findings of serum β-hCG test and transvaginal ultrasonography were also obtained during follow-up. These patients were divided into two groups according to the diagnosis accuracy of EP/HP： early diagnosis and misdiagnosis/delayed diagnosis. The results showed that the incidence of EP and HP was 3.8%（125/3286） and 0.8%（27/3286） respectively for IVF/ICSI-ET cycle, and 3.8%（55/1431） and 0.7%（10/1431） respectively for frozen-thawed embryo transfer（FET） cycle. Ruptured EP occurred in 28 patients due to initial misdiagnosis or delayed diagnosis. Related factors fell in 3 categories：（1） clinician factors： misunderstanding of patients＇ medical history, insufficient training in ultrasonography and unawareness of EP and HP;（2） patient factors： noncompliance with medical orders and lack of communication with clinicians;（3） complicated conditions of EP： atypical symptoms, delayed elevation of serum β-hCG level, early rupture of cornual EP, asymptomatic in early gestation and pregnancy of unknown location. All the factors were interwoven, contributing to the occurrence of EP and HP. It was concluded that complicated conditions are more likely to affect the diagnosis accuracy of EP/HP after IVF-ET. Transvaginal ultrasonography should be performed at 5 weeks of gestation. Intensive follow-up including repeated ultrasonography and serial serum β-hCG tests should be performed in patients with a suspicious diagnosis at admission.

Two case reports and literature review for hepatic epithelioid angiomyolipoma: Pitfall of misdiagnosis

BACKGROUND Hepatic epithelioid angiomyolipoma(HEAML) is a rare liver disease and is easily misdiagnosed. Enhanced recognition of HEAML is beneficial to the differential diagnosis of rare liver diseases.CASE SUMMARY We presented two cases of HEAML in Changzheng Hospital, Naval Medical University, and then collected and analyzed all reports about HEAML recorded in PubMed, MEDLINE, China Science Periodical Database, and VIP database from January 2000 to March 2018. A total of 409 cases of HEAML in 97 reports were collected, with a ratio of men to women of 1:4.84 and an age range from 12 years to 80 years(median 44 years). Among the patients with clinical symptoms mentioned, 61.93%(205/331) were asymptomatic, 34.74%(115/331) showed upper or right upper quadrant abdomen discomfort, while a few of them showed abdominal mass, gastrointestinal symptoms, low fever, or weight loss. The misdiagnosis rate of HEAML was as high as 40.34%(165/409) due to its nonspecific imaging findings. Most of the tumors were solitary and round in morphology, with clear boundaries. Ultrasound scan indicated low echo with internal nonuniformity and rich blood supply in most cases. Computer tomography/magnetic resonance imaging enhanced scan showed varied characteristics. The ratio of fast wash-in and fast wash-out, fast wash-in and slow wash-out, and delayed enhancement was roughly 4:5:1. A definite diagnosis of HEAML depended on the pathological findings of the epithelioid cells in lesions and the expression of human melanoma black 45, smooth muscle actin,melanoma antigen, and actin by immunohistochemical staining. HEAML had a relatively low malignant rate of 3.91%. However, surgical resection was the main treatment for HEAML, due to the difficulty diagnosing before operation.CONCLUSION HEAML is a rare and easily misdiagnosed disease, and it should be diagnosed carefully, taking into account clinical course, imaging, pathological,and immunohistochemical findings.

Temporal trends in the misdiagnosis rates between Crohn's disease and intestinal tuberculosis

AIM To investigate the temporal trends in the misdiagnosis rate between Crohn's disease(CD) and intestinal tuberculosis(ITB) in South Korea. METHODS We retrospectively reviewed the medical records of patients managed for CD or ITB at Asan Medical Center, a tertiary referral hospital, Seoul, Korea between 1996 and 2014. The temporal trends in the misdiagnosis rates between the two diseases were analyzed. The demographic and clinical characteristics were compared between CD patients who were initially misdiagnosed as ITB(final CD group) and vice versa(final ITB group). Final diagnostic criteria for ITB and medication for CD before definite diagnosis of TB were also analyzed in final ITB group.RESULTS In total, 2760 patients were managed for CD and 772 patients for ITB between 1996 and 2014. As well, 494 of the 2760 CD patients(17.9%) were initially misdiagnosed as ITB and 83 of the 772 ITB patients(10.8%) as CD. The temporal trend in misdiagnosing CD as ITB showed a decrease(OR = 0.89, 95%CI: 0.87-0.91, P < 0.001), whereas the temporal trend in misdiagnosing ITB as CD showed an increase(OR = 1.06, 95%CI: 1.01-1.11, P = 0.013). Age at diagnosis, presenting symptoms, and proportion of patients with active/past perianal fistula and active/inactive pulmonary tuberculosis(TB) were significantly different between final CD group and final ITB group. Forty patients(48.2%) in final ITB group were diagnosed by favorable response to empirical anti-TB treatment. Seventeen patients(20.5%) in final ITB group had inappropriately received corticosteroids and/or thiopurines due to misdiagnosis as CD. However, there were no mortalities in both groups. CONCLUSION Cases of CD misdiagnosed as ITB have been decreasing, whereas cases of ITB misdiagnosed as CD have been increasing over the past two decades.

Workplace mistreatment: Health, working environment and social and economic factors

Objective: To explore patterns of workplace mistreatment, relationships with health and with selected workplace, economic and social factors in 34 countries. Methods: Secondary data analysis of the European Working Conditions Survey. Results: Patterns of ill treatment (across occupational groups, and sectors) were broadly consistent with smaller, less representative studies. Prevalence was lower than many studies but corresponds with estimates of serious mistreatment. Mistreatment increases the risk of both physical and mental ill health and is associated with a range of work environment factors. Mistreatment is more prevalent in countries with smaller gender gaps, better performance on the GINI index for income inequality and for countries with specific anti-bullying legislation. Conclusions: Mistreatment in work is complex, and interventions are required at the level of the organization. Implementation issues need to be addressed, as specific anti-bullying legislation does not appear to provide sufficient protection.

Twenty years of misdiagnosis of schizophrenia in a patient with Dandy-Walker variant syndrome

SUMMARY Various case reports of patients with Dandy-Walker variant syndrome mimicking schizophrenia have been published in the last 20 years, suggest!ng that this neurodevelopment disorder should be part of the differential diagnosis for every patient with a first episode of psychosis. In this report, it is presented that a patient who was diagnosed and treated as a paranoid schizophrenic for 20 years and had four bone fractures secondary to ataxic gait impairment, before performing a neuroimaging examination that revealed Dandy-Walker variant syndrome.

Magnetic resonance imaging features of minimal-fat angiomyolipoma and causes of preoperative misdiagnosis

BACKGROUND Minimal-fat angiomyolipoma(mf-AML)is often misdiagnosed as renal cell carcinoma before surgery.AIM To analyze the magnetic resonance imaging(MRI)features of mf-AML and the causes of misdiagnosis by MRI before operation.METHODS A retrospective analysis was performed on ten patients with mf-AML confirmed by surgical pathology,all of whom underwent preoperative MRI examination to analyze the morphological characteristics and MRI signals of the tumor.RESULTS MRI revealed a circular-like mass in 4/10(40%)patients,an oval mass in 6/10 patients(60%),a mass with a capsule in 9/10 patients(90%),and a mass with a lipid component in 7/10 patients(70%).The diameter of the masses in all ten patients was from 11 to 47 mm;the diameter was between 11 mm and 40 mm in 8/10(80%)patients and between 40 mm and 47 mm in 2/10(20%)patients.CONCLUSION An oval morphological characteristic is strong evidence for the diagnosis of mf-AML,while a capsule and lipids are atypical manifestations of mf-AML.

Misdiagnosis of Left Supraclavicular Lymph Node Metastasis of Prostate Carcinoma: One Case Report and Literatures Review

IntroductionChina is a country with a low morbidity of prostate carcinoma. The incidence of prostate carcinoma in China is 1.6/100,000, which is much lower than the rate in the United States, i.e., 119.9/100,000. Due to changes of lifestyle and improved measurement of serum prostate specific antigen （PSA） over the past decades, the incidence of prostate carcinoma in China also showed a yearly increase. However, the misdiagnosis and mistreatment of this disease commonly occur. The aim of this study is to report the case of a patient with prostate carcinoma presenting asymptomatic but with left supraclavicular lymphadenopathy, and analyze the reasons of misdiagnosis and mistreatment.

Prevalence and predictive factors of elder mistreatment in Chinese migrant families

Objectives:To examine the prevalence of and identify the predictive factors for elder mistreatment(EM)in Chinese migrant families.Methods:This was a cross-sectional study.A total of 489 rural migrant elderly were recruited using multistage sampling technique from communities in Wenzhou city between June 2020 and October 2020.All par ticipants completed the Mini-Cog,and then data were collected in a survey using the 12-Item Shor t-Form Health Survey Questionnaire,Abuser’s Dependency Scale,the Friendship Scale(FS),Intergenerational Ambivalence Scale,Filial Piety Index,the Assessment Tool of Domestic Elder Abuse,and a demographic questionnaire.Descriptive statistics and multiple regression were carried out to analyze the data.Results:The prevalences of physical mistreatment,psychological mistreatment,neglect,economic mistreatment,and social mistreatment among the migrant elderly were 1.23%,20.65%,22.50%,0.61%,and 9.41%,respectively.Significant predictive factors were migrant elderlies’mental health status(β=–0.118,P<0.01),adult children’s filial piety(FP)(β=–0.245,P<0.001),and intergene rational ambivalence(β=0.365,P<0.001).Conclusions:EM was common among the migrant elderly.Predictive factors for EM in Chinese migrant families were identified.The findings could be useful in developing nursing interventions to promote migrant elderlies’mental health,uphold their children’s FP,and harmonize intergenerational relationship to avoid EM.

Echocardiography in the diagnosis of Shone’s complex and analysis of the causes for missed diagnosis and misdiagnosis

BACKGROUND Shone’s complex is a rare syndrome characterized by congenital left heart defects that can differ among the patients.AIM To use echocardiography in the diagnosis of Shone’s complex and analyze the causes of missed diagnosis and misdiagnosis.METHODS This was a retrospective study of patients who underwent echocardiography and repair surgery from February 14,2008,to November 22,2019.The patients were followed once a year at the outpatient clinic after surgery.RESULTS Sixty-six patients were included.The patients were 2.7(0.8-5.6)years of age,and 54.5%were male.Ten(15.2%)had a history of heart surgery.The most common heart defect was the Annulo-Leaflet mitral ring(ALMR)(50/66,75.8%),followed by coarctation of the aorta(CoA)(43/66,65.2%).The patients had a variety of combinations of defects.Only two(3.0%)patients had all four defects.None of the patients had a family history of congenital heart disease.The preoperative echocardiographic findings were examined against the intraoperative findings.Echocardiography missed an ALMR in 31 patients(47.0%),a parachute mitral valve(PMV)in one patient(1.5%),subaortic stenosis in one patient(1.5%),and CoA in two patients(3.0%).CONCLUSION Echocardiography is an effective method to diagnose the Shone’s complex.Due to this disease’s complexity and interindividual variability, Improving the understanding of thedisease can reduce misdiagnosis and missed diagnosis.

Misdiagnosis of Sexually Transmitted Diseases in Hong Kong Outpatient Private Healthcare

Background and objective: Early and accurate diagnosis is one of the critical requirements for successful management of all diseases. Yet, delayed diagnosis and misdiagnosis remain as vital problems, consequently impose adverse effects on patient treatment. Sexually transmitted disease (STD) is one of the most common infectious diseases, and more than one million of STD cases are acquired every day globally. Misdiagnosis of STD inevitably exists, therefore should not be overlooked. Being a medical diagnostic laboratory providing various STDs diagnosing service in Hong Kong, we aimed to determine the misdiagnosis rate of STDs and investigate the possible underlying cause. Methods: Specimens were collected for STD diagnosis from multiple clinics during 1 June 2021 to 20 October 2021 from different clinics and hospitals were included in the study. DNA extraction was performed using magnetic bead based method;then the extracted DNA was tested using the DiagCor GenoFlowTM STD Array kit to detect the existence of any targeted pathogens. Results: 1459 specimens were collected and included during the designated time period, with 643 specimens found to be positive with at least one targeted STD pathogen. 494 of these were found to be aligned with test ordered by physicians, and the remaining 149 positive cases had at least one pathogen detected but not requested to be tested by the physicians resulting in misdiagnosis. The overall misdiagnosis rate was determined to be 23.2% (149/643), with high frequency of misdiagnosis occurred to tests ordered for one to three pathogens detection. Also, Ureaplasma urealyticum and/or Ureaplasma parvum (UU/UP) was the commonest pathogen detected in this study. Conclusion: The findings suggested incorrect test selection made by physicians was one of the major reasons of STDs misdiagnosis in outpatient settings. To reduce diagnostic errors in STD diagnosis, physicians are encouraged to select and request test that allow detection of multiple pathogens, as co-infection of multiple pathogens in STD patients is commonly observed. The correct selection of test would not only benefit the patient, but also the public health.

Simultaneously metastatic cholangiocarcinoma and small intestine cancer from breast cancer misdiagnosed as primary cholangiocarcinoma:A case report

BACKGROUND Cholangiocarcinoma and small intestine cancer are common clinical malignancies,but metastatic cholangiocarcinoma and small intestine cancer are rare,especially simultaneous metastatic cholangiocarcinoma and small intestine cancer from breast cancer.Since the clinical presentation of metastatic cholangiocarcinoma and small intestine cancer does not differ from primary tumor,it may lead to misdiagnosis preoperatively.CASE SUMMARY A 66-year-old woman was admitted to our hospital for further treatment due to abdominal pain and jaundice.Abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography showed an occupying lesion of the bile duct,considering a high possibility of primary bile duct tumor.Therefore,we performed a radical bile duct cancer surgery and cholecystectomy,and multiple tumors in the small intestine were found and removed during the surgery process.Postoperative pathology showed metastatic bile duct cancer and small intestine cancer from tumors in other parts.The patient underwent a right total mastectomy and axillary lymph node dissection because of right breast cancer 2 years ago.Combining with the immunohistochemical results,the patient was finally diagnosed as metastatic cholangiocarcinoma and metastatic small intestine cancer from breast cancer.Postoperatively,the patient received four cycles of chemotherapy and targeted therapy with docetaxel,capecitabine and trastuzumab.Unfortunately,the patient eventually died from tumor progression,thoracoabdominal infection,and sepsis 5 mo after surgery.CONCLUSION Simultaneous metastatic cholangiocarcinoma and small intestine cancer from breast cancer are rare and the prognosis is extremely poor.Improving preoperative diagnostic accuracy is beneficial to avoid excessive surgical treatment.Treatment should be aimed at relieving biliary obstruction and abdominal pain,and then supplemented with chemotherapy and targeted therapy to control tumor progression and prolong the patient’s life.

急诊猝死相关疑难病诊治的新近认识

本文介绍11种急诊猝死相关的疑难疾病,有心脏震荡、胸腺淋巴体质、青壮年猝死综合征、小心脏综合征、浅水昏迷、小麦依赖运动诱发的严重过敏反应、Kounis综合征、双相过敏反应、血液净化过滤器过敏、McKittrick-Wheelock综合征和Mendelson综合征等。急诊临床医师应认识这些比较疑难、实际上并不少见的疾病,以提高急诊临床诊治水平,最大限度地避免误诊误治。

Challenges and limitations of synthetic minority oversampling techniques in machine learning

Oversampling is the most utilized approach to deal with class-imbalanced datasets,as seen by the plethora of oversampling methods developed in the last two decades.We argue in the following editorial the issues with oversampling that stem from the possibility of overfitting and the generation of synthetic cases that might not accurately represent the minority class.These limitations should be considered when using oversampling techniques.We also propose several alternate strategies for dealing with imbalanced data,as well as a future work perspective.

手指鲍恩病误诊3例

报告3例手指鲍恩病。例1.患者男,80岁。右手无名指红斑、丘疹及脱屑2余年,疼痛2个月,误诊为乳房外Paget病。例2.患者男,88岁。左手中指红斑、斑块及糜烂10余年,误诊为基底细胞癌。例3.患者男,37岁。右手示指红斑、斑块、糜烂伴瘙痒2年,误诊为湿疹。3例患者皮损组织病理检查均表现为表皮角化过度伴角化不全,表皮全层细胞极性紊乱,可见核大深染的细胞,病理性核分裂象增多;真皮浅层可见不等量淋巴细胞及组织细胞浸润。3例患者均诊断为手指鲍恩病。

误诊为炎性脊髓病的硬脊膜动静脉瘘临床分析

目的 探讨硬脊膜动静脉瘘(SDAVF)的临床表现、影像学特点、诊治方法和误诊原因、防范措施。方法 对2016年3月-2018年3月收治的被误诊为炎性脊髓病的SDAVF 2例的临床资料进行回顾性分析。结果 2例分别因渐进性双下肢麻木、力弱伴尿便障碍5月余,以及行走不稳50 d、加重伴颈痛、呕吐45 d入院。均误诊为炎性脊髓病,误诊时间分别为5月余及50 d。后经仔细阅片发现磁共振影像上可见髓周流空信号影,完善脊髓血管造影后确诊为SDAVF。1例于等待院外介入治疗过程中死亡,1例行介入治疗后院外死亡。结论 SDAVF临床表现不典型,易误诊,仔细询问病史、查体,认真阅影像片,必要时行脊髓血管造影是避免该病误诊的关键。

前列腺癌多参数MRI诊断及误诊原因分析

目的 探讨前列腺癌临床特点、多参数MRI表现,总结其误诊原因及防范措施。方法 对2020年4月—2022年2月收治的多参数MRI检查后误诊为膀胱癌、前列腺增生的前列腺癌10例的临床资料进行回顾性分析。结果 10例年龄54~73岁。6例因尿急、尿频、尿潴留、排尿困难就诊,直肠指诊示前列腺肥大,查血清前列腺特异性抗原升高,多参数MRI及前列腺穿刺活组织病理检查未发现前列腺肿瘤证据,误诊为前列腺增生,后经术后病理检查确诊T1期前列腺癌。4例以尿痛、血尿、排尿困难就诊,经多参数MRI检查误诊为膀胱癌,查血清前列腺特异性抗原升高,直肠指诊发现前列腺肥大,再次行多参数MRI和前列腺组织穿刺活组织病理检查证实为前列腺癌累及膀胱。误诊时间4~10 d。误诊为前列腺增生6例接受根治性手术,误诊为膀胱癌4例予内分泌和放射治疗,随访至今病情控制尚可。结论 临床接诊以尿急、尿频、尿潴留、排尿困难等症状就诊的中老年男性患者时应考虑到前列腺癌可能。加强对前列腺癌影像学特征认识,行多参数MRI检查时重点观察前列腺结构、包膜完整与否、膀胱壁连续性等重要特征,必要时可行前列腺穿刺活组织病理检查,以提高该病术前诊断正确率。

子宫假性动脉瘤误诊分析

目的 探讨子宫假性动脉瘤(uterine artery pseudoaneurysm, UAP)超声特征并分析误诊原因。方法 回顾性选取2016年1月至2023年4月首都医科大学附属北京妇产医院UAP患者35例,收集其超声图像及临床资料,分析其误诊原因。结果 UAP灰阶超声呈肌层或同时累及宫腔及肌层的含有液性无回声区团块状病变,彩色多普勒超声可见一条或多条载瘤动脉血流射入假腔,频谱多普勒超声呈高速低阻血流;部分可伴发动静脉瘘(uterine arteriovenous fistula,UAVF),表现为与子宫静脉同方向的粗大血流,频谱呈与心动周期一致的搏动性频谱。UAP误诊率为71.4%(25/35),被误诊的疾病包括与滋养细胞相关疾病的富血供征象(12例)、UAVF(9例)、滋养细胞疾病(3例)、胚物残留(1例)。结论减少UAP误诊首先需提高对该病的认识,超声检查过程中要注意调节仪器的条件设置以获得更佳图像帮助诊断。