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• Double-section absorption heat pump is used for deep recovery of waste heat. • Heating output of 8666.4 kW and coefficient of performance of 1.77 are achieved. • The prototype is able to cool the waste hot water from 45.0 °C to 15.9 °C. • The stepped evaporation with gradient temperatures is the key for good performance. Absorption heat pump is an effective option for industrial waste heat recovery. However, significant conflict between low evaporation temperature and high efficiency exists in conventional absorption heat pump, which limits its application in deep recovery of low-grade waste heat recovery. To address this issue, this paper presents the use of double-section absorption heat pump for low-grade waste heat recovery. Both theoretical and experimental researches are carried out to analyze the features of double-section LiBr-water absorption heat pump. Driven by hot water with temperature of 120.1 °C, the experimental prototype was able to extract thermal energy from the waste hot water by reducing its temperature from 45.0 °C to 15.9 °C, realizing a large temperature decrease of 29.1 °C for waste hot water. Meanwhile, the experimental prototype could heat water up to 52.5 °C for domestic heating application with capacity of 8666.4 kW and high coefficient of performance of 1.77. The excellent performance is attributed to the stepped generation/evaporation processes with gradient temperatures, which makes the double-section absorption heat pump achieve both higher efficiency for internal circulation and reduced irreversible loss for external circulation comparing with the conventional single-section absorption heat pump. This makes the double-section absorption heat pump an efficient way to realize the deep recovery of low-grade waste heat. [ABSTRACT FROM AUTHOR]

• Solar trigeneration system by photovoltaic-thermal collector in subtropical cities. • Trigeneration system achieves 17% higher electricity saving than photovoltaic one. • The influence of solar field area and absorption chiller capacity is analyzed. • The lowest payback period is achieved in Zhuhai where solar irradiation is high. Solar trigeneration systems based on photovoltaic-thermal collectors can play a positive role in promoting renewable energy integration in buildings. Usually, low-grade solar heat produced by photovoltaic-thermal collectors does not meet the temperature requirement for driving absorption chillers, leading to unsatisfactory system performance. In this study, the solar absorption-subcooled compression hybrid cooling system, which is capable of utilizing heat at temperatures as low as 60 °C, is coupled with photovoltaic-thermal collectors to be a low-grade solar trigeneration system. In spite of heat recovery for heating and cooling, the electrical output of collectors decreases, due to the losses caused by the additional glass cover and elevated operating temperature. Therefore, through quasi-steady simulations based on annual meteorological data of three subtropical cities, this system is assessed from energy, economic and environmental viewpoints. The results show that in Guangzhou, the specific annual electricity saving of this system is up to 170.6 kWh/m2, which is 17.3% higher than that of a comparable photovoltaic system. The parametric analysis suggests that increasing the solar filed area gives rise to a shorter payback period. With the maximum available solar filed area of 600 m2, the minimum payback period and the maximum electricity saving can be achieved by the absorption subsystem capacities of around 40 kW and 180 kW, respectively. The most economically viable system is obtained in Zhuhai where annual solar irradiation is close to 1400 kWh/m2 and electricity prices are relatively high. This study is useful for the development of solar trigeneration systems based on photovoltaic-thermal collectors and energy saving in modern cities. [ABSTRACT FROM AUTHOR]

We report a case of low-grade follicular lymphoma presenting as a primary lesion in the intracranial dura. Based on the preoperative MRI, our patient was presumed to have meningioma. A surgical excision was performed and the histology showed features of a grade 1 follicular lymphoma predominately small-cleaved cell type. Postoperative investigations confirmed that it was the only site of involvement. The patient then received cranial radiotherapy and she is doing well with a follow up period of 18 months. To the best of our knowledge, it is the first case of a primary dural grade 1 follicular lymphoma, small-cleaved cell type. [ABSTRACT FROM AUTHOR]

Objective: Current evidence suggests that intracranial dural arteriovenous fistulas (dAVFs) without cortical venous drainage (CVD) have a benign clinical course. However, no large study has evaluated the safety and efficacy of current treatments and their impact over the natural history of dAVFs without CVD., Methods: The authors conducted an analysis of the retrospectively collected multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database. Patient demographics and presenting symptoms, angiographic features of the dAVFs, and treatment outcomes of patients with Borden type I dAVFs were reviewed. Clinical and radiological follow-up information was assessed to determine rates of new intracranial hemorrhage (ICH) or nonhemorrhagic neurological deficit (NHND), worsening of venous hyperdynamic symptoms (VHSs), angiographic recurrence, and progression or spontaneous regression of dAVFs over time., Results: A total of 342 patients/Borden type I dAVFs were identified. The mean patient age was 58.1 ± 15.6 years, and 62% were women. The mean follow-up time was 37.7 ± 54.3 months. Of 230 (67.3%) treated dAVFs, 178 (77%) underwent mainly endovascular embolization, 11 (4.7%) radiosurgery alone, and 4 (1.7%) open surgery as the primary modality. After the first embolization, most dAVFs (47.2%) achieved only partial reduction in early venous filling. Multiple complementary interventions increased complete obliteration rates from 37.9% after first embolization to 46.7% after two or more embolizations, and 55.2% after combined radiosurgery and open surgery. Immediate postprocedural complications occurred in 35 dAVFs (15.2%) and 6 (2.6%) with permanent sequelae. Of 127 completely obliterated dAVFs by any therapeutic modality, 2 (1.6%) showed angiographic recurrence/recanalization at a mean of 34.2 months after treatment. Progression to Borden-Shucart type II or III was documented in 2.2% of patients and subsequent development of a new dAVF in 1.6%. Partial spontaneous regression was found in 22 (21.4%) of 103 nontreated dAVFs. Multivariate Cox regression analysis demonstrated that older age, NHND, or severe venous-hyperdynamic symptoms at presentation and infratentorial location were associated with worse prognosis. Kaplan-Meier curves showed no significant difference for stable/improved symptoms survival probability in treated versus nontreated dAVFs. However, estimated survival times showed better trends for treated dAVFs compared with nontreated dAVFs (288.1 months vs 151.1 months, log-rank p = 0.28). This difference was statistically significant for treated dAVFs with 100% occlusion (394 months, log-rank p < 0.001)., Conclusions: Current therapeutic modalities for management of dAVFs without CVD may provide better symptom control when complete angiographic occlusion is achieved.

Only 30% of patients with major depressive disorder (MDD) reach full recovery or remission. Treatment-resistant depression (TRD) is MDD that does not respond to adequate treatment attempts with at least two antidepressants. TRD is associated more with immune activation than with treatment responsive depression. The current retrospective population-based cross-sectional study, utilizing data from a large nation-wide health maintenance organization in Israel which provides services to estimated 725,000 members, aimed to assess the clinical signs and laboratory markers of autoimmune comorbidity and low-grade inflammation, in patients with TRD. Included were participants aged 18-70 years, diagnosed twice within one year with ICD-9-CM MDD and two control groups, MDD responders (MDD-r) consisting of people with MDD and no TRD and a non-MDD group that included people with no MDD or TRD. The case (570 subjects in TRD group) to control ratio in both control groups (2850 subjects in MDD-r and 2850 subjects in non-MDD control group) was 1:5. Compared to MDD-r, the overall proportion of allergic diseases was higher among the TRD than among the MDD-r [OR 1.52 (1.19-1.94); p ​< ​0.001]. Any systemic autoimmune disease was associated with increased likelihood of MDD-r [OR 1.52 (1.04-2.24); p ​= ​0.03] or TRD [OR 2.22 (1.30-3.78); p ​= ​0.003]. Higher rates of positive (>1:80) antinuclear antibodies [33 (5.79%)] were found among the TRD than among the MDD-r [98 (3.44%); p ​= ​0.011). More allergy and autoimmune comorbidities and presence of low-grade inflammation biomarkers, were found mainly in TRD., (© 2021 Published by Elsevier Inc.)

Objectives To evaluate the effect of spermatic vein ligation in patients over 30 years old and with low‐grade left varicocele, and thus help to establish whether such patients might benefit from surgery. Patients and methods A randomized study was conducted on 68 infertile patients (30–38 years old) with evidence of sperm abnormalities and who had low‐grade varicocele (grade I according to Hirsch), comparing left spermatic vein ligation with no treatment. The outcome was assessed by standard sperm analysis and eventual paternity. Results There was no improvement in sperm quality in either of the groups one year after surgery, and no significant difference in paternity. Conclusions Left spermatic vein ligation for low‐grade varicocele in patients more than 30 years old cannot be recommended. [ABSTRACT FROM AUTHOR]

Embryo quality is a key determinant of the success of IVF. Although the focus has been on selecting the best embryo for transfer, the classification of low-grade blastocysts (LGB) in existing scoring systems has received less attention. This is worrisome; embryo freezing allows optimal use of all created embryos, thus maximizing the cumulative live birth rate, which is arguably the most important outcome for infertile couples. A PubMed search was conducted in August 2020, using '((('poor-quality' OR 'poor quality') OR ('low-grade' OR 'low grade')) AND ('embryo' OR 'blastocyst')) AND ('pregnancy' OR 'live birth')'. This scoping review shows that LGB have similar euploidy and pregnancy success rates after implantation and have no adverse effects on pregnancy or perinatal outcomes. Evidence for pregnancy outcomes is lacking for different grades of LGB, with most studies clustering all LQB as one to compare with optimal blastocysts., (Copyright © 2021 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Low-grade endometrial stromal sarcoma (LGESS) is a rare malignant uterine tumor with the potential to metastasize years after the primary resection. There is a broad differential diagnosis for endometrial stromal sarcomas (ESS), including both benign and malignant entities. Herein, we present the case of a 64-year-old female with metastatic LGESS to the lung, diagnosed by cytology, 24 years after her initial presentation. This report discusses the cytomorphologic and histopathologic characteristics, and ancillary studies including immunohistochemical stains and recent advances in molecular diagnostics of ESS. Accurate diagnosis of spindle cell lesions in the lung can be challenging. As such, this case highlights the instrumental role of ancillary testing and molecular diagnostics to achieve a more definitive diagnosis., (© 2020 Wiley Periodicals LLC.)

Objective: Low-grade endometrial stromal sarcoma (LG-ESS) is a rare gynecological tumor. Whether adjuvant radiotherapy benefits survival in patients with resected early-stage ESS remains controversial. This study was designed to explore the role of adjuvant radiotherapy in stage I to II LG-ESS., Methods: We retrospectively reviewed patients with stage I to II LG-ESS in our center from Jan. 1998 to Feb. 2018. All patients underwent a total hysterectomy and postoperative radiotherapy was administrated based on clinical and pathological characteristics., Results: A total of 152 patients with stage I to II resected LG-ESS were included. Forty patients received adjuvant radiotherapy (RT group) while 112 patients did not receive adjuvant radiotherapy (no RT group). The baseline characteristics of the two groups were comparable, except that the proportion of stage II patients in the RT group was higher than that in the no RT group (32.5% vs. 11.6%, in RT vs. no RT groups, respectively; p = 0.003). For both patient groups, median overall survival was not reached. The median disease-free survival (DFS) was 144 months. Radiotherapy was associated with significantly improved DFS (92 months vs. not reached in RT vs. no RT groups, respectively; p = 0.008) and pelvic failure-free survival (PFFS) (92 months vs. not reached in RT vs. no RT groups, respectively; p=0.004). Subgroup analysis revealed that RT benefited survival most among patients with stage IB to IIB disease. Adjuvant radiotherapy significantly reduced the pelvic recurrence rate (10.0%, 4/40 vs. 28.6%, 32/112, p = 0.018). No radiotherapy-induced grade 4 to 5 toxicity was observed., Conclusion: For patients with stage I to II LG-ESS, adjuvant radiotherapy showed significant improvement in DFS and PFFS with tolerable adverse effects, especially in patients with stage IB to IIB disease., Competing Interests: The authors declare that this research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wang, Sun, Miao, Hou, Zhang and Hu.)

Introduction: The incidence of pancreatic neuroendocrine tumors (PNETs) is increasing over the past few decades. Surgery for low-grade and small PNETs of less than 2cm and N0M0 is still debated. The purpose of this study is to examine the association between surgical resection and survival in patients with low-grade nonfunctioning PNETs., Materials and Methods: Patients diagnosed with PNETs between 2004 and 2015 were extracted from SEER. Kaplan-Meier methods and Cox proportional hazard models were used to estimate independent predictors in PNETs patients., Results: A total of 2637 patients (2147 underwent surgical resection and 490 did not undergo surgery) with histologically confirmed low-grade PNETs in this cohort study. Overall survival (OS) and cancer-specific survival (CSS) of patients with surgery was better than those without surgery (log rank test P OS <0.001, P CSS <0.001). Multivariate Cox regression analysis showed that surgical status was an independent prognostic factor associated with OS (HR 3.257, 95%CI: 2.635, 4.026) and CSS (HR 3.546, 95%CI: 2.798, 4.493). Subgroup analysis suggested the patients receiving surgery apparently had better OS and CSS regardless of tumor size (all log rank test P OS <0.001, all log rank test P CSS <0.001) and SEER stage (all log rank test P OS <0.001, all log rank test P CSS <0.001), compared to patients without removal of the primary tumor., Conclusions: Surgical resection of primary tumor may have a significant benefit on survival for patients with low-grade nonfunctioning PNETs. To determine the optimal management, grade, stage and tumor size should be considered comprehensively., (Copyright © 2020 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Background: Maximal, aggressive resection of diffuse low-grade gliomas (DLGG) is well established as the standard of care in neuro-oncology. The role of repeat resection for tumor progression is unclear., Objective: To assess the role of repeated operation for DLGG, and the effect on malignant transformation and survival., Methods: We conducted a historical cohort study in which all patients undergoing multiple resections of DLGG between the years 1995-2019 were evaluated for overall survival (OS) and time to transformation (TTT). We then compared the outcome of this group with that of a matched control group comprised of patients who underwent only one operation despite being eligible for repeat surgery at tumor progression, but had received non-surgical oncological therapy or declined additional treatment., Results: Of 607 patients in our departmental DLGG database, 93 patients underwent 2 or more surgeries and had sufficient follow-up and imaging data to be included in the study group. Thirty-eight patients were included in the matched control group. Early (less than 1 year) progression was associated with decreased survival and shorter TTT in the study group. Patients undergoing multiple resections had significantly longer TTT and OS compared to patients who underwent a single surgery. This effect was especially noted in patients who had radiological evidence of tumor transformation., Conclusions: Repeated resections of LGG are safe and offer survival benefit in select patients. Early progression following resection is associated with worse prognosis. Patients with evidence of radiological transformation may benefit the most from re-resection., Competing Interests: Declaration of competing interest All authors declare no conflict of interest., (Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background: Whilst the resection margin is an established factor predictive of local control of soft-tissue sarcomas (STSs), the adequacy of margin width for low-grade STSs has been rarely described. We aimed to investigate the margin adequacy and its prognostic relevance in low-grade STSs., Methods: 109 patients who underwent surgical treatment for a low-grade STS were studied. The prognostic value of margin status was evaluated according to the R-, R+1-classification, and width in millimetres., Results: The 10-year local recurrence (LR) rates were 6%, 27%, 54% in R0, R1, and R2, respectively (p < 0.001), according to the R-classification. The R+1-classification resulted in a decreased LR rate in R1, but no major differences in LR rates in R0 and R2; 7%, 14%, 54% in R0, R1, and R2, respectively (p < 0.001). When classified by metric distance, 10-year LR rates were 0%, 8%, and 38% by ≥ 2.0 mm, 0.1-1.9 mm, and 0 mm margins, respectively (p < 0.001). Patients with close margins (0.1-1.9 mm) who received adjuvant radiotherapy had a trend toward lower LR risk than those without radiotherapy (10-year, 4% vs. 12%; p = 0.406). The 5 and 10-year disease-specific mortality was 9% and 13%, respectively; margin width was not associated with disease-specific mortality but LR was a poor prognostic factor for survival (p = 0.003)., Conclusion: Whilst negative margin provided local control over 90%, excellent local control was achieved with microscopic margins ≥2 mm. The role of margins is more important than radiotherapy in local control. Margins do not determine survival, but LR is associated with a poor prognosis., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: This review aims to analyze the pathological aspects, diagnosis and treatment of rare mesenchymal uterine tumors., Methods: On August 2019, a systematic review of the literature was done on Pubmed, MEDLINE, Scopus, and Google Scholar search engines. The systematic review was carried out in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes statement (PRISMA). The following words and key phrases have been searched: "endometrial stromal sarcoma", "low-grade endometrial stromal sarcoma", "high-grade endometrial stromal sarcoma", "uterine sarcoma", "mesenchymal uterine tumors" and "uterine stromal sarcoma". Across these platforms and research studies, five main aspects were analyzed: the biological characteristics of the neoplasms, the number of cases, the different therapeutic approaches used, the follow-up and the oncological outcomes., Results: Of the 94 studies initially identified, 55 were chosen selecting articles focusing on endometrial stromal sarcoma. Of these fifty-five studies, 46 were retrospective in design, 7 were reviews and 2 randomized phases III trials., Conclusion: Endometrial stromal sarcomas are rare mesenchymal uterine neoplasms and surgery represents the standard treatment. For uterus-limited disease, the remove en bloc with an intact resection of the tumor (without the use of morcellation) is strongly recommended. For advanced-stage disease, the standard surgical treatment is adequate cytoreduction with metastatectomy. Pelvic and para-aortic lymphadenectomy is not recommended in patients with Low-grade Endometrial Stromal Sarcoma (ESS), while is not clear whether cytoreduction of advanced tumors improves patient survival in High-grade ESS. Administration of adjuvant radiotherapy or chemotherapy is not routinely used and its role is still debated., (© 2020 Japan Society of Obstetrics and Gynecology.)

Background and Objectives: Adamantinomas are primary, low-grade malignant tumors of the bone that have metastatic potential to the lungs, lymph nodes, and other regions. The rarity of this disease and its nonspecific symptoms complicate diagnosis., Materials and Methods: Records for 20 patients who underwent treatment for adamantinoma from 1975 to 2018 were reviewed for demographic, clinical, and pathological data, treatment details, postoperative complications, and outcomes., Results: Patients presented at a median age of 22 years (1-79 years): 14 patients had a localized primary tumor, three presented with local recurrence, and three with metastatic disease. Median tumor size was 5.7 cm (0.5-15.5 cm). Wide excision was performed primarily in 15 cases; the remaining five patients underwent intralesional curettage. At a median follow-up of 7.3 years, 14 patients had no evidence of disease; two patients were alive with disease, and four patients died from the disease. Local recurrence and distant metastasis occurred at a median of 11.4 years (6 month-19 years) and 15.8 years (4 month-23 years) after diagnosis., Conclusions: Adequate histopathological diagnosis is crucial to avoid misdiagnosis of this rare tumor. Local and distant recuAbs&#95;Para&#95;meprrence can occur more than 20 years after the initial diagnosis. Life-long follow-up with clinical examination and imaging is required., (© 2020 Wiley Periodicals, Inc.)

Well-circumscribed intra-axial CNS tumors encompass a wide variety of gliomas and glioneuronal tumors, usually corresponding to WHO grades I and II. Nonetheless, sometimes high-grade 'diffuse' gliomas such as gliosarcoma and giant cell glioblastoma can be relatively circumscribed but are often found to have foci of diffuse infiltration on careful examination, harboring distinct molecular alterations. These tumors are excluded from the discussion in this chapter with the current review emphasizing on lower-grade entities to include a brief description of their histology and associated molecular findings. Like elsewhere in brain biopsy evaluation, imaging is crucial and acts as a surrogate to gross examination. Given the circumscribed nature of these tumors, surgery alone is the mainstay treatment in most entities., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is often used to treat low-grade isthmic spondylolisthesis (IS). No studies have compared surgical outcomes for grade I and II IS following MIS-TLIF. Therefore, the objective of the current study was to compare outcomes between patients with grade I and II IS following MIS-TLIF., Methods: A retrospective cohort analysis was performed on a prospectively maintained database of patients who underwent a primary 1-level MIS-TLIF for treatment of IS between 2007 and 2015. Grade I patients underwent a unilateral tubular approach with a single interbody cage and bilateral pedicle screw instrumentation. Grade II patients underwent a bilateral tubular approach with bilateral interbody cage and pedicle screw placement. Baseline patient demographics and characteristics were compared using Student t test and χ 2 analysis. Differences in peri- and postoperative outcomes were assessed using Poisson regression with robust error variance or linear regression adjusted for perioperative variables., Results: A total of 58 patients with IS underwent MIS-TLIF; 21 (36.2%) were grade I and 37 (63.8%) were grade II. The grade I cohort was younger (42.2 versus 50.6 years, P = .029); no other differences in preoperative variables were observed. No significant differences in operative time, estimated blood loss, length of hospital stay, postoperative visual analogue scale scores, or complication and revision rates were demonstrated between cohorts. Arthrodesis rate was lower in the grade I cohort, though not statistically significant., Conclusions: Despite the grade I cohort being younger with less-severe diagnoses, the grade II cohort experienced similar outcomes. This finding may be due to the grade II cohort receiving bilateral cages, potentially providing a better fusion environment., Clinical Relevance: These results suggest that MIS-TLIF provides sufficient stabilization and fusion for treatment of grade II IS despite increased vertebral body displacement. In addition, MIS-TLIF with bilateral approach and interbody cage placement should be examined for treatment of high-grade IS cases., Competing Interests: Disclosures and COI: No funds were received in support of this work. No benefits in any form have been or will be received from any commercial party related directly or indirectly to the subject of this manuscript., (©International Society for the Advancement of Spine Surgery 2020.)

Background: Chondrosarcoma is the second most frequent malignant bone tumor. Grade I chondrosarcoma (syn.: atypical cartilaginous tumor) is classified as an intermediately and locally aggressive neoplasm and typically is treated less aggressively (i.e., by intralesional curettage). Does the data regarding local recurrence (LR) and metastatic disease justify this? Methods: From 1982 to 2014, 37 consecutive patients with G1 chondrosarcoma had been resected or curetted. The margin was defined as R0 (wide resection) or R1 (marginal resection). All patients were followed for evidence of local recurrence or metastatic disease. Overall and recurrence-free survival were calculated, and various potentially prognostic factors were evaluated. Results: In 23 patients (62%), the tumor was widely (R0) resected, whereas in 14 patients, (38%) the resection was marginal (R1). Overall survival was 97% after 5 years, 92% after 10 years, and 67% after 20 years. Five-year local recurrence-free survival was 96%. Ten-year local recurrence-free survival was 83%. Local recurrence-free survival showed a significant correlation to margin status but no correlation to location or age. None of the patients with local recurrence died during the follow-up. One patient had metastatic disease at initial presentation, and a further five patients developed metastatic disease during follow-up. Metastatic disease proofed to be a highly significant factor for survival but was not correlated to local recurrence. Conclusions: There was no significant correlation between the outcome and the primary tumor location. Marginal resection was a risk factor for LR, but there was no significant difference in the overall survival in patients with or without LR. Metastatic disease (16%) was more common than expected from the literature and a significant predictor for poor overall survival. [ABSTRACT FROM AUTHOR]

Background: Metastatic tumors to the pancreas are uncommon, accounting for approximately 2% of pancreatic malignancies. The most common primary tumors to give rise to pancreatic metastases are carcinomas. Case presentation: A 50-year old female patient was investigated for a cause of abdominal discomfort. She had a 2-year history of menorrhagia and dysmenorrhea which was ascribed to a fibroid uterus. On imaging, she was found to have a large solid and cystic mass in the tail of the pancreas. Imaging also confirmed a fibroid uterus. A distal pancreatectomy and splenectomy showed a 9 cm circumscribed mass within, and grossly confined to, the parenchyma of the pancreatic tail. Microscopically, the pancreatic lesion was lobulated, and well-circumscribed, but focally infiltrative. It comprised sheets of uniform spindled to epithelioid cells with round to oval nuclei, coarse to vesicular chromatin, visible nucleoli, nuclear grooves and clear to eosinophilic cytoplasm. Prominent arterioles were identified. The stroma was collagenized in areas. Occasional hemosiderin-laden macrophages were seen, and focal cystic change was present. There was no evidence of nuclear pleomorphism, mitotic activity or necrosis, and there was no evidence of endometriosis despite multiple sections being taken. Immunohistochemistry showed that the tumor cells were positive for CD10, estrogen receptor (ER), progesterone receptor (PR), Wilms tumor-1 (WT-1) and smooth muscle actin (SMA). RNA sequencing detected a PHF1 rearrangement. The morphological, immunohistochemical and molecular features were of a low-grade endometrial stromal sarcoma (LG-ESS). Subsequent total hysterectomy and bilateral salpingo-oophorectomy 3 months later, showed uterine fibroids and a 5 cm low-grade endometrial stromal sarcoma confined to the uterus, with lymphatic invasion. Conclusions: To the best of our knowledge, this is the first documented case of metastatic endometrial stromal sarcoma of uterus presenting as a primary pancreatic neoplasm. An unexpected extra-uterine location and unusual presentation of ESS may make the diagnosis challenging, despite classic histological features. Morphological, immunohistochemical and molecular findings must be combined to render the correct diagnosis. [ABSTRACT FROM AUTHOR]

This article presents a case of low-grade cribriform cystadenocarcinomas (LGCCC), a rare salivary gland tumor manifesting in the infratemporal fossa (ITF). The lesion in this case is unique in its location, histopathology, and management in that the tumor resection was performed using an exclusively endoscopic, endonasal approach. This case highlights the expanding application of endoscopic skull base techniques to address an indolent, slow-growing malignancy of the ITF., Competing Interests: Kibwei A. McKinney is a part of the Speakers Bureau for Intersect ENT., (© 2020 The Authors.)

Background: The diagnosis of low-grade periprosthetic joint infections (PJIs) is challenging, because patients may present with unspecific symptoms, false-negative cultures, or marginally elevated values of serum biomarkers like C-reactive protein (CRP). This may lead to the unintended implantation of a revision prosthesis into an infected surgical site with a repeat risk of short-term failure. Conversely, false diagnosis of joint infection may result in multistage revision procedures, which expose the patient to unnecessary surgical procedures and inappropriate antibiotic treatment. Here, we investigated whether synovial biomarkers can preoperatively distinguish between aseptic prosthesis loosening and low-grade joint infection and the most accurate biomarker combinations., Methods: Inclusion criteria for the study were indication for revision arthroplasty due to aseptic implant failure, acute high-grade infection, or (suspected) low-grade infection. We prospectively collected synovial fluid of patients undergoing revision arthroplasty for quantitative measurement of alpha defensin, CRP, interleukin (IL-6), IL-10, and lipopolysaccharide binding protein (LBP)., Results: The classification tree method revealed alpha defensin and CRP as the most suitable biomarker combination to distinguish between aseptic loosening and low-grade joint infection. The combination of CRP > 2.0 mg/L and alpha defensin > 90.000 pg/mL correctly identified nine  of 11 patients with low-grade infection., Conclusions: Alpha defensin plus CRP seems to be the most helpful combination for pre-operative discrimination of aseptic loosening vs. low-grade joint infection.