Intravascular large B-cell lymphoma (IVLBCL) is a rare, clinically aggressive lymphoma defined by the proliferation of atypical lymphoma cells in the lumen of all sized blood vessels, particularly capillaries. The reasons for this unusual neoplastic cell proliferation are still only partially understood. IVLBCL is considered stage IV lymphoma and manifests with a variety of nonspecific signs and symptoms. Patients with IVLBCL usually do not present with lymphadenopathy. The tumor cells invade the blood vessels of multiple organs such as the central nervous system, skin, lungs, kidneys, and bone marrow. Common presenting symptoms are based on the organ affected and include mental status changes and fever of unknown origin. Although immunochemotherapy has significantly improved the often-poor prognosis of this kind of lymphoma, a large percentage of patients’ relapse. We present a 63-year-old man who had been diagnosed with large B cell lymphoma in the bone marrow in March 2021 and was in remission state after completing six cycles of chemotherapy. There was no abnormal FDG uptake on a post-chemotherapy PET/CT scan. Patient presented to the emergency room (ER) two months later with fever and dyspnea. The entire workup was completed and showed pancytopenia and elevated ESR. While chest CT scan did not show lymphadenopathy or lesions, PET/CT scans revealed a widespread increase in FDG uptake in both the lungs and spleen. Lung biopsy revealed large, atypical cells within alveolar septae and vessels. Immunohistochemical stains demonstrated that these cells were positive for CD20 and PAX-5 and had high proliferation rate based on Ki67. IVLBCL has a low incidence rate with non-specific clinical presentation. The diagnosis can be easily missed in both clinical, radiological and the corresponding histopathological findings. Radiological finding and CT scan are not sensitive enough and may miss the lesion. Even though the PET/CT scan is more sensitive, the definitive diagnosis of IVLBCL relies mainly on histopathology and immunohistochemistry, at which point awareness of this entity by the pathologist is most necessary.

This editorial discusses the transformative potential of digital health literacy and the critical role of electronic medical records (EMRs) in promoting patient empowerment in the healthcare landscape of developing countries. It examines the impact of digital media in healthcare, noting its ability to both democratize access to information and services and pose risks of misinformation among populations with limited health literacy. The discussion includes an overview of key literacy components critical for effectively navigating the digital healthcare ecosystem. Our article highlights the critical role of EMR in facilitating a patient-centered care (PCC) model, with a special emphasis on making EMR systems accessible and user-friendly for vulnerable groups in developing countries. The core aim of our study is twofold: First, it sheds light on the significant challenges - be they technical, financial, or infrastructural - that obstruct the adoption of sophisticated EMR systems in these areas. Second, it explores the essential aspect of digital health literacy, advocating for its improvement as a vital step toward enabling patients to effectively engage with their medical records. By addressing these key issues, our study seeks to illustrate how enhancing digital health literacy, alongside increasing the accessibility of EMR systems, can empower patients in the developing world to actively participate in their healthcare processes. This dual focus aims to contribute to the broader discourse on improving healthcare outcomes through more inclusive and patient-centered approaches, particularly in settings that are currently underserved by modern healthcare technologies. In conclusion, the editorial advocates for a concerted effort toward creating a more inclusive and empowered healthcare paradigm. It suggests integrating PCC principles, tailoring EMR systems to diverse needs, and enhancing digital health literacy as strategies to harness digital health innovations for better healthcare outcomes and equity. It emphasizes the importance of ongoing investment in education, technology, and policy to fully leverage digital health solutions in the developing world.

Background: Human monkeypox (MPXV) virus infection, an emerging zoonotic disease caused by an orthopoxvirus, leads to smallpox-like disease. Human MPXV infection was first reported in 1970 in the Democratic Republic of Congo (DRC). Before April 2022, MPXV cases were endemic and seldom reported outside African regions; but recent global outbreaks of MPXV are concerning. We aimed to investigate the epidemiology of emerging human monkeypox virus infection including the number of suspected, confirmed, and fatal cases as well as risk factors for contracting monkeypox infection. Design: We performed a systematic review of peer-reviewed literature by following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. An electronic database search (PubMed, online Willey library, science direct) was undertaken. For monkeypox related studies, we included 25 peer-reviewed articles from 2018 and 2022 and data were extracted to inform current evidence on the cases and public health risk factors for developing infection, and public health advice. Results: Our reports show a rapid rise of MPVX cases in highly endemic African regions after the 1970s, spread to other countries, and increased median age from young children to young adults. Cessation of smallpox vaccination might be one of the factors responsible for the findings. Till 2022 genomic sequences of ten MPXV strains, associated with the recent countrywide outbreak, have been determined. While West African Clade is mostly implicated in the recent viral surge, data were insufficient to determine which mutation contributed to increased transmissibility. In DRC, sleeping on the floor was significantly (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.2-31.6) associated with contracting MPVX while eating or processing animal foods was not a significant risk factor . In the United States, cleaning cages, bedding sick animals (OR 5.3, 95% CI 1.4-20.7), or touching infected animals (OR 4.0, 95% CI 1.2-13.4), daily sick animal exposure (OR 4.0, 95% CI 1.2-13.4) were associated with contracting MPVX infection. Conclusion: Recent global outbreaks, the rising incidence in young adults and endemic zones might result from smallpox vaccine cessation. Increased risk with sick animal exposure or sleeping on the floor suggests high infectivity from animal excretions. Increasing awareness, strict surveillance, and contact tracing can contain global outbreaks. Ring vaccination approach to exposed people can also be a strategy. Future studies should investigate to determine measures for rapid laboratory diagnosis, maintaining lab safety, and also transmissibility.

BACKGROUND Cervical cancer ranks fourth globally among women's cancers. Squamous cell carcinoma constitutes 70% of cervical cancer cases, often metastasizing to lungs and paraaortic nodes. Uncommon sites include the brain, skin, spleen, and muscle, while pericardial fluid metastasis is highly rare. We report a case of squamous cell carcinoma of the uterine cervix that was metastatic to the pericardium and was detected on cytologic evaluation of pericardial fluid. CASE REPORT A 42-year-old woman who was previously treated for stage III squamous cell carcinoma of the cervix presented with symptoms of cough, fever, and shortness of breath for 8 days, and chest pain for 3 days. Clinical workup revealed pericardial effusion, with spread to the lungs and mediastinal and hilar lymph nodes. Cytological analysis of the fluid showed malignant cells, consistent with metastatic squamous cell carcinoma. Immunohistochemistry demonstrated cells positive for p63 and p40, while negative for GATA-3, D2-40, calretinin, and WT1. These findings in conjunction with patient's known history of cervical squamous cell carcinoma was consistent with a cytologic diagnosis of metastatic squamous cell carcinoma to pericardial fluid. CONCLUSIONS History and clinical correlation plays a vital role in determining the primary site causing malignant pericardial effusions. While the occurrence of cervical cancer metastasizing to the pericardium is uncommon, it should be considered, particularly in cases involving high-grade, invasive tumors, recurrences, or distant metastases. This possibility should be included in the list of potential diagnoses when encountering pericardial effusions with squamous cells in female patients.

Uterine leiomyosarcoma (ULMS) is the most common subtype of uterine sarcoma and constitutes 1% of all uterine malignancies. In some cases, distinguishing ULMS from endometrial stromal sarcoma (ESS) can be challenging because they may display histological and immunohistochemical overlaps. In such cases, molecular studies such as RNA sequencing to detect gene rearrangements can help arrive at a definitive diagnosis. We report a unique case of ULMS with a novel RAB2A-PLAG1 gene fusion. To our knowledge, this is the first reported case in English literature. Case Presentation: An 80-year-old woman presented to our hospital with a one-month history of pelvic pain and abnormal uterine bleeding. Imaging was notable for a large necrotic uterine mass, thickened endometrium, and uterine fibroids. Subsequent endometrial biopsy (EMB) revealed an unremarkable transformation zone of the epithelium. After four months, the patient presented with persistent symptoms. A solid mass within the endometrium was observed on the imaging. Endometrial curettage (EMC) revealed a malignant uterine mesenchymal neoplasm, with histological findings suggestive of ULMS and ESS. The patient underwent a total hysterectomy with bilateral salpingo-oophorectomy. Immunohistochemical analysis of the resected specimen was inconclusive. RNA sequencing revealed a novel RAB2A-PLAG1fusion, and ULMS was diagnosed. Conclusion: This is the first case of ULMS with a RAB2A-PLAG1 gene fusion. Pathologists should be aware of the extensive morphological and immunophenotypic overlap between the various uterine mesenchymal neoplasms. In challenging cases, molecular studies are crucial for pathologists to arrive at a final diagnosis.

Dermatofibrosarcoma protuberans (DFSP) is a superficial and locally aggressive cutaneous soft tissue sarcoma. In most patients, DFSP arises from the trunk and proximal extremities with breast being an uncommon location. Although they rarely metastasize (<5%), DFSP variants tend to recur locally. Most molecularly characterized cases have been defined by the translocation t(17;22)(q21.3;q13.1), which yields a fusion of the COL1A1 and PDGFB genes. In routine practice, dual fusion or break-apart fluorescence in situ hybridization (FISH) for the COL1A1-PDGFB fusion gene is the most widely used screening method for DFSP. However, in ~4% of typical DFSP cases, routine FISH screening is negative. In some of the DFSP cases negative for COL1A1-PDGFB fusion gene by FISH, RNA sequencing has identified two novel gene fusions, COL6A3-PDGFD and EMILIN2-PDGFD, with the former having a predilection for the female breast. We present a 32-year-old woman who underwent a biopsy for a 3.4 cm echogenic firm mass in her right breast. Histology showed a cytologically-uniform spindle cell neoplasm with fibroblastic morphology. The neoplastic cells displayed a storiform growth pattern and honeycomb-like infiltration of the adipose tissue. Immunohistochemically, the neoplastic cells expressed CD34 and vimentin and were negative for AE1/AE3, p63, S100, CD31, SMA, β-catenin, and STAT6. PDGFB break-apart FISH was negative. Based on the histologic and immunohistochemical findings, a diagnosis of DFSP was rendered. FISH for PDFGD rearrangements or RNA sequencing targeting PDGFD was not performed at this time. NA. Awareness is warranted for the rare variant of DSFP with a predilection for female breast, which is characterized by a novel gene fusion not detectable by routine FISH used for DFSP screening.