The nuclear protein Ki-67 and Tumor infiltrating lymphocytes (TILs) have been introduced as prognostic factors in predicting both tumor progression and probable response to chemotherapy. The value of Ki-67 index and TILs in approach to heterogeneous tumors such as Breast cancer (BC) that is the most common cancer in women worldwide, has been highlighted in literature. Considering that estimation of both factors are dependent on professional pathologists’ observation and inter-individual variations may also exist, automated methods using machine learning, specifically approaches based on deep learning, have attracted attention. Yet, deep learning methods need considerable annotated data. In the absence of publicly available benchmarks for BC Ki-67 cell detection and further annotated classification of cells, In this study we propose SHIDC-BC-Ki-67 as a dataset for the aforementioned purpose. We also introduce a novel pipeline and backend, for estimation of Ki-67 expression and simultaneous determination of intratumoral TILs score in breast cancer cells. Further, we show that despite the challenges that our proposed model has encountered, our proposed backend, PathoNet, outperforms the state of the art methods proposed to date with regard to harmonic mean measure acquired. Dataset is publicly available in http://shiraz-hidc.com and all experiment codes are published in https://github.com/SHIDCenter/PathoNet.

Background Aneurysm formation of internal carotid arteries (ICA) in patients with mucormycosis is a scarce phenomenon. However, the prevalence of rhino-cerebral mucormycosis has been reported to increase after the coronavirus disease 2019 (COVID-19) pandemic. Methods Three patients with stroke and subarachnoid hemorrhage due to ICA aneurysm after the involvement of adjacent paranasal sinuses with mucormycosis were presented. All patients were recruited from Namazi and Khalili hospitals affiliated with Shiraz University of Medical Sciences in Iran from April 2021 to May 2021. Results They had a history of diabetes and corticosteroid use. Also, one of them was treated with imatinib. Two out of three patients were infected with SARS-CoV-2 infection before developing mucormycosis. Two patients had diagnostic angiography before endovascular intervention. One patient did not undergo any therapeutic intervention due to total artery occlusion, whereas the other patient experienced a successful parent artery occlusion by coiling, and only this patient survived. Although all patients received antifungal treatment and surgical debridement, two of them died. Conclusions In the patients with rhino-cerebral mucormycosis evolving of aneurysm should be promptly and meticulously investigated by magnetic resonance angiography (MRA) and computed tomography angiography (CTA). As this type of aneurysms was very fast-growing, as soon as the involvement of sphenoid sinus was detected, the possibility of ICA aneurysm formation should always be kept in mind. If the patient developed an aneurysm, prompt intensive antifungal therapy and therapeutic endovascular interventions such as stenting, coiling, or sacrificing should be considered as soon as possible to optimize outcomes.

Background: Reactive gliosis is a response of glial tissue to different types of injury such as brain abscess, trauma, hemorrhage, or even neoplastic process. In some circumstances, especially when the tissue biopsy is small, there may be difficulty to discriminate this reactive condition with low-grade diffuse astrocytoma (World Health Organization [WHO] grade II) by conventional hematoxylin and eosin (H&E) slides, so some immunohistochemical and molecular markers have been introduced for this differential diagnosis. One of the important aspects of updated WHO classification in 2016 has been dividing some of the glial tumor according to IDH1 (isocitrate dehydrogenase 1) mutation. Objectives: In this study, we tried to evaluate IDH1 and P53 mutation by immunohistochemistry as a simple and highly specific and sensitive method to differentiate low-grade astrocytoma and reactive gliosis. Material and methods: For 5 years (2013-2018), 50 cases of clinically documented reactive gliosis and 50 cases of low-grade astrocytoma were evaluated for the presence or absence of IDH1 and P53 mutation by immunohistochemistry. Results: Isocitrate dehydrogenase 1 was positive in 92% and 4% of the astrocytoma and reactive gliosis cases and P53 was positive in 90% and 4% of the cases with the final diagnosis of astrocytoma and reactive gliosis, respectively. Discussion and conclusion: Combination of P53 and IDH1 as an immunohistochemical panel showed specificity of 96% and sensitivity of 91% for differential diagnosis of reactive gliosis and low-grade astrocytoma. These 2 markers can be extremely helpful for this differential diagnosis.

Case ReportsFIG. 1. A, Preoperative clinical photo. B, Lacrimal mass. C, Postoperative clinical photo. D, Axial CT scan shows lacrimal gland mass with adjacent bone remodeling. E, Axial T2 sequence. Heterogeneous iso/hyperintense lacrimal gland mass with indentation of right globe.

Objective Hypothyroidism has a significant effect on the patients' voices. This study evaluated the histopathological characteristics of larynx following hypothyroidism in an experimental rabbit model. Methods Eleven male Dutch rabbits were included. Methimazole‐induced hypothyroidism was done for nine rabbits. The remaining two rabbits were assigned as controls. Six weeks after starting methimazole, a histological examination was performed with parameters of inflammation, ulceration, hemorrhage, and thickness of epithelium, Reinke's space, vocal ligament, thyroarytenoid muscle, collagen deposition, and periodic acid‐Schiff (PAS)‐positive materials, as well as confirmation of hypothyroidism by T4 measurement. Results Histologic examination showed a significant thickening of epithelium, Reinke's space, vocal ligament, and collagen PAS‐positive materials deposition in hypothyroid rabbits (p < .05). There was significant reduction in thyroarytenid muscle thickness (p < .05). Inflammation, ulceration, and bleeding were not significantly different between hypothyroid and control rabbits' laryngeal specimens. Conclusion Hypothyroidism causes significant changes in the laryngeal tissues. Thickening of epithelium, Reinke's space, vocal ligament, collagen, PAS‐positive materials, and reduced thickness of thyroarytenoid muscle are the major findings of this study.