Anatomopathological Results Research Articles

Abstract PO2-17-10: Metaplastic breast cancer: description of 16 cases treated at a reference center and review of the literature

Abstract Background: Metaplastic breast carcinomas (MBC) are very rare and represent less than 1% of all invasive breast carcinomas. It is a heterogeneous neoplasm characterized by a mixture of adenocarcinoma with other histological elements such as squamous cells, spindle cells or other mesenchymal differentiation. Most MBC are hormone receptor and Her2 negative and tend to have a worse prognosis when compared to triple negative carcinomas. Clinically, they manifest as a rapidly growing palpable mass, without necessarily involving lymph nodes. According to the nomenclature of the WHO Classification of Tumors of the Breast (2012), tumors were classified into 4 variants: spindle cell, squamous cell, mesenchymal and mixed. Since publications on MBC are scarce in the literature, we studied the cases that were attended at Hospital Pérola Byington in the period 2010-2021. Methods: A retrospective study was carried out by reviewing the medical records of patients treated at the Reference Center for Women's Health - Pérola Byington Hospital, São Paulo, Brazil. Patients with breast cancer, with anatomopathological result confirming the diagnosis of metaplastic carcinoma were reviewed. Clinical data and histopathological characteristics were evaluated, as well as the type of treatment performed and the evolution. Results: A total of 16 female patients diagnosed with MBC were included. The median age was 56 years (ranging from 34 to 88). The mean initial size observed was 7 cm (ranging from 2 to 20 cm) and 94% of patients presented with a palpable mass. The initial clinical staging were I (12%), II (32%), III (50%) and IV (6%). The most common histological subtype was spindle cell (50%), of which 2 were squamous (12%), 3 mesenchymal (20%), 1 mixed spindle/squamous (6%) and 2 were not classified. Regarding immunohistochemistry, 14 patients (88%) had hormone negative and Her2 negative (triple negative). Of the 16 cases, 8 underwent mastectomy and 6 partial mastectomiy and 2 patients did not undergo surgical treatment because they died despite treatment with neoadjuvant chemotherapy. All operated patients underwent sentinel lymph node biopsy or axillary dissection and 85% of them did not have axillary lymph node involvement. Radiotherapy was indicated in 13 patients. Chemotherapy was performed in 10 patients, 6 of which were neoadjuvant (since the tumors were not resectable) and 4 received adjuvant chemotherapy. Of the 6 patients that underwent neoadjuvant chemotherapy, 2 had disease progression, 3 partial response and 1 complete pathological response. During follow-up, 4 (25%) evolved with locoregional recurrence and 5 (31%) with metastatic disease. Of these women, 44% (7) are still alive. We also found that 6 of the 16 cases (37%) did not receive a diagnosis of MBC in the initial biopsy, requiring revision, a new biopsy or study of the surgical specimen for confirmation. Conclusion: As verified in the literature, MBC is a very rare histological type and corresponded to 0.2% of all cases of breast cancer in the period described above. Most patients have an advanced tumor at the time of diagnosis and little axillary involvement. The most common histological classification is the spindle cell variant and almost all tumors are triple negative. The CMM has an aggressive behavior and little response to chemotherapy treatments. Therefore, radical surgical treatments are preferred. Due to the rarity of this entity there is little data published in the international literature. Citation Format: Andre Mattar, Marcelo Antonini, Marina Diogenes, Andressa Amorim, Francisco Pimentel Cavalcante, Luiz Henrique Gebrim. Metaplastic breast cancer: description of 16 cases treated at a reference center and review of the literature [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-17-10.

Abstract PO5-07-10: CONTRAST MAMMOGRAPHY FOR PREOPERATIVE STAGING OF PATIENTS WITH EARLY BREAST CANCER: PRELIMINARY RESULTS

Abstract a) Brief description of the objective(s) The aim of this study is to compare contrast-enhanced mammography (CM) with magnetic resonance imaging (MRI) for preoperative locoregional staging of patients with early-stage breast cancer. b) Material(s) and method(s) Prospective, single-center study, approved by the Research Ethics Committee, which included patients with a histological diagnosis of invasive breast carcinoma, candidates for initial medical treatment. Patients treated with neoadjuvant chemotherapy and those in whom the tumor was completely resected in the initial biopsy were excluded. CM and MRI were performed in the week before surgery and the anatomopathological result of the surgical specimen was considered the gold standard. Pearson's modification (r) was used to compare tumor size between different methods. c) Results and discussion Thirty-seven patients were included, with a mean age of 54.5±6.9 years (43-70 years). The mean size of the tumors in pathology was 2.9±1.4 cm (1.1-8.0 cm) and the most common histological type was invasive ductal carcinoma (n=34;87.2%). The clinical stage was IA for 14 patients (37.8%) and IIA for 23 patients (62.2%). The main tumor was identified in 33 cases (89.2%) on conventional mammography and in all cases (100%) on both CM and MRI. There was excellent elasticity between tumor size measured on CM and MRI (r=0.897;p< 0.01). When compared with tumor size in pathology, both methods were adopted in a good way (p< 0.01), however, MRI was functionally superior to CM (r=0.847 vs. 0.683), while mammography conventional showed no therapeutic effect (r=0.222;p=0.21). Multifocal lesions were observed on CM in 2 cases (5.4%) and on MRI in 6 cases (16.2%), with 1 case confirmed as multifocal and the others presenting DCIS associated with the surgical specimen. Suspicious additional lesions were seen in 4 patients (10.8%) on CM and in 3 patients (8.1%) on MRI, of which one was confirmed as malignant in the contralateral breast, which had not been identified in previous exams. d) Conclusions CM showed good adaptability with MRI for assessing tumor size and searching for additional lesions, and may be a cheaper and more accessible alternative for preoperative staging in patients at an early clinical stage. Citation Format: Andressa Amorim, Andre Mattar, Almir Bitencourt, Paula Moraes, Flora Finguerman. CONTRAST MAMMOGRAPHY FOR PREOPERATIVE STAGING OF PATIENTS WITH EARLY BREAST CANCER: PRELIMINARY RESULTS [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-07-10.

Amnion Rupture Sequence

The amnion rupture sequence is a rare condition occurring early in pregnancy, resulting in complex fetal anomalies by disrupting normal embryonic development. The prevalence of amnion rupture sequence is reported to be 1.16 in 10,000 live births. This article explores the uncommon case of early amnion rupture leading to fetal encephalocele, suspected in the first trimester. Despite the variable and intricate nature of anomalies associated with this condition, cranio-facial and abdominal defects are frequently observed. Genetic testing was conducted, with normal results supporting our theory of amnion rupture. The patient decided to terminate the pregnancy, and the anatomopathological results confirmed the findings. This article discusses the diagnostic challenges, emphasizing the importance of timely identification through advanced imaging techniques.

Body Stalk Anomaly.

Abdominal wall defects encompass three primary classifications: gastroschisis, omphalocele and anomalies resembling body stalk. Potential causative factors include early amnion rupture, amniotic bands, vascular disruptions or abnormal folding of the embryo. The prevalence of these defects stands at 1 in 14,000 live births. Body stalk anomaly is characterized by a substantial abdominal defect coupled with spine and limb anomalies, along with a very short or absent umbilical cord. We present a case of a rare abdominal defect known as body stalk anomaly, the most severe form of this spectrum of diseases. The diagnosis of this anomaly was established during the first trimester of pregnancy. Subsequently, the patient opted for pregnancy termination and chose not to undergo genetic testing. The anatomo-pathological results confirmed the findings. Body stalk anomaly is not compatible with life; therefore, early identification and understanding the clinical implications of this rare anomaly for informed decision-making in prenatal care are very important.

Synchronous Multifocal Early Gastric Cancer: How Important is A Meticulous Endoscopic Examination? A Case Report and Literature Review

Introduction: The incidence rate of synchronous early gastric cancer is reported to be 5% to 15%, and several risk factors that increase its incidence have already been identified. Synchronous lesions are reported to be neglected in 32.4% of early gastric neoplasia cases. Method: Case report of a 75-year-old woman, with mucosa atrophy, intestinal metaplasia, with early gastric adenocarcinoma in antrum, CT staging without alterations, underwent surgical treatment using endoscopic submucosal dissection (ESD). Results: The anatomopathological result demonstrated a lesion of 2 cm, a well-differentiated non-ulcerated adenocarcinoma, without lymphatic-vascular invasion, with a positive deep submucosal margin, eCURE C-2. A D1+ complementary laparoscopic partial gastrectomy was performed. The analyzes of the surgical specimens showed an ESD area of ulcer scar without tumor and another early gastric cancer (T1a) at 2.2 cm distance with normal mucosa between them. Thirty six lymph nodes were free of disease. Conclusion: In this case, the patient had 3 risk factors for synchronic injury, but it was only discovered during the salvage gastrectomy. Thorough endoscopy should be performed in all patients and even more so in patients with risk factors. Failure to recognize these lesions can result in evolution to advanced cancer

B-376 Performance of Pathological Anatomy Immunohistochemical Markers and Serum Tumor Markers in Prostate Cancer

Abstract Background The gold standard method for diagnosing prostate cancer is systematic prostate biopsy under ultrasound guidance and local anesthesia.Serum tumor marker tests (PSA, Free PSA and testosterone) and confirmatory or classificatory immunohistochemical (IHC) complement the conclusion of the patient’s report. The maximum amount of information regarding the pathological anatomy and markers provided to physicians favors assertive decision-making in the conduct of treatment. However, the results of prostate biopsies after treatment with prostatectomy can differ significantly in the course of the disease. In this context, the authors’ objectives were to analyze the performance of the dosages of these widely used serum markers against the IHC markers of biopsies, as well as their indicators of positive and negative predictive values (PPV and NPV) for prostatic neoplasms. The authors analyzed the level of agreement between pathological prostate biopsy results and immunohistochemical (IHC) testing for 34ßE12, p63, and alpha-methylacyl-CoA racemase (AMACR) to provide final pathological results for prostate cancer, as well as their relationship with data provided by biochemical tests for the markers PSA, Free PSA and Testosterone. Methods Descriptive, retrospective study with a qualitative and quantitative approach, based on data obtained through IHC exams and available in a database of a large laboratory in São Paulo—Brazil. Data collection was based on anatomopathological results of male patients diagnosed with prostate cancer, aged between 40 and 69 years between August 2021 and December 2022 with a total of 1403 analyzes for biopsies using IHC combined markers such as 34ßE12 , p63 and AMACR, and a total of 144 analyzes for combined prostatic serum markers (total PSA, free PSA and testosterone). All analyzes were conducted using the R software version 4.1.0 (R CORE TEAM, 2021) and considered a significance level (α) of 5%. Results The Mann-Whitney test indicated that the distribution of the PSA variable (ng/dL) does not differ statistically between the 34ßE12 groups (W = 822.0; P = 0.224; r = 0.139 , p63 (W = 826.0; P = 0.361 ; r = 0.103), and AMACR (W = 610.0; P = 0.351; r = -0.106). Likewise, the Free PSA marker (ng/dL) did not differ statistically between 34ßE12 (W = 309.5; P = 0.473 ; r = -0.097), p63 (W = 319.5; P = 0.488; r = - 0.093 and AMACR (W = 372.0; P = 0.725; r = 0.048). The results of the ROC curve with PSA (ng/dL) as predictor of the biopsy result with the marker 34ßE12, p63 and AMACR the mean positive predictive values (MPVP) were 0.623 , 0.635 and 0.615 respectively. For Free PSA (ng/dL) with the markers respectively, the VPPM were 0.743, 0.750 and 0.455. As for testosterone, our sample was very small. Conclusion Our findings showed that all markers are important indicators for the diagnosis and monitoring of prostate cancer and that they complement each other. Free PSA showed good PPV for 34ßE12 and p63 markers and low PPV for AMACR.

386. ROLE OF RECURRENT NERVE LYMPHADENECTOMY THROUGH MINIMALLY INVASIVE SURGERY IN THE TREATMENT OF OESOPHAGEAL CANCER

Abstract Background With the development of neoadjuvant therapy protocols and the advances in minimally invasive surgery, an increasing number of patients are undergoing surgery of oesophageal cancer. Lymphatic involvement is one of the most important independent prognostic factors. There is enough evidence to support that the greater the lymphadenectomy, the better survival rates. Our aim is to present the results of our series, in which partial or total recurrent nerve lymphadenectomy was performed during oncological oesophagectomies. Methods Retrospective observational study that includes all patients that were operated on for oesophageal cancer from January 2019 to January 2023. All surgeries were performed by the same specialized team. Quantitative variables are described as mean and standard deviation, and qualitative variables as absolute number and percentage. The univariate methods used were Pearson’s X2 or Student’s t test for independent samples. We used logistic regression models to study prognostic factors influencing survival. The IBM SPSS Statistics 22 programme was chosen for data analysis. Results 59 patients were operated during this period through minimally invasive approach, including recurrent nerve lymphadenectomy. Anatomopathological results showed 6 (10.2%) patients with recurrent lymph node involvement, 2 (3.4%) with right-sided positive nodes, 3 (5.1%) with left-sided ones and 1 (1.7%) with bilateral invasion. Analysis by subgroups showed that 20% of tumours larger than T2 had recurrent nerve lymph node metastasis. There were 18 (30.5%) recurrent nerve injuries, all of which were transient except for 3 (5.1%) that required scheduled surgery. A statistically significant relationship was found between the number of affected nodes and disease-free survival time (p-value = 0.045). Conclusions Mediastinal and recurrent nerve lymphadenectomy in oesophageal cancer increases the number of total positive lymph nodes obtained after surgery, allowing for a better adequacy of adjuvant treatment and corelating positively with disease-free survival time. Complications derived from these procedures are similar in number to standard lymphadenectomy and most of them can be managed by conservative treatment.

Endometrioma Detected on Recombinant TSH-Stimulated 18F-FDG-PET/CT

A 43-year-old female patient diagnosed with high-grade follicular thyroid neoplasm in October 2022, treated with total thyroidectomy + left laterocervical lymphadenectomy in February 2023 with stage T4N0M0. A study with 18F-FDG PET/CT stimulated with Recombinant Thyroid-Stimulating Hormone (rTSH) was requested prior to performing ablative treatment with radioactive iodine (131I) on the same day. Two days prior to the PET/CT study, a subcutaneous injection of rTSH (Thyrogen®) was administered, presenting, immediately after, pain in the right iliac fossa that did not subside with anti-inflammatories. The PET/CT image shows tumor remains in the anterior cervical region and a pelvic mass dependent on the right adnexa, not previously known, of a cystic nature, septated with FDG uptake, with an SUVmax of 15,3, which partially compresses the ipsilateral ureter. Treatment with 131I was postponed due to acute abdominal pain and it was decided to take him to the operating room where an oopherectomy + right adnexectomy was performed with an anatomopathological result of endometrioid cystadenoma. Due to structural similarities and cross-reactivity between hormones, and the presence of TSH receptors in endometrioid tissue, we propose that the growth of the tumor lesion in this case was precipitated by rTSH administration.

Abstract P2-14-11: Oncological outcomes in patients undergoing targeted axillary dissection with carbon marker

Abstract Background: The use of axillary marking before neoadjuvant systemic therapy (NST) is the standard of care in patients with positive lymph nodes (LN). Several methods have been tested leading to reduced false negative rate compared to sentinel lymph node biopsy (SLNB). With the increase in therapies in patients with residual disease, it is necessary to improve the accuracy of the axillary assessment. The aim of this study was to evaluate oncological outcomes in patients undergoing targeted axillary dissection with positive LN pre-NST marked with 4% carbon marker, the secondary objective was to evaluate the association between SLNB and pre-NST marked lymph node. Methods: A prospective study was performed in patients with cT1-T4, cN1-N2 breast cancer who underwent NST. An ultrasound-guided 4% carbon marking was performed before proposed treatment. After NST, the carbon marked lymph node (CMLN) was identified and resected associated with SLNB. When at least one lymph node was positive, axillary dissection was performed. The oncological outcomes registered were overall survival (OS), specific survival (SS), disease-free survival (DFS), axillary recurrence (AR) and local recurrence (LR). Results: 176 patients operated between July 2014 and January 2019 were included in the analysis. The CMLN were identified in 168/176 (95.4%) and the SLNB 145/176 (82.3%) operations. SLNB and CMLN were coincident in 93/176 (52.8%) cases. The LNs were not coincident in 44/176 (25%) cases and at least one of the methods were not identified in 39/176 (22.1%). When condensing the lymph nodes not found as positive lymph node, the sample agreement was 148/176 (81.4%) [Kappa = 0.67 (95%CI: 0.56 – 0.78)], when separating the positive lymph nodes from the lymph nodes not found, the agreement was 133/176 (75.6%) [Kappa = 0.56 (95%CI: 0.46 – 0.66)] (Table 1). With a mean follow-up of 49 months, 168 patients were included in the analysis of oncologic outcomes. Among the patients analyzed, 7/168 (4,1%) had LR, 5/168 (2,9%) had AR, 28/168 (16.6%) had distant recurrences [DFS = 83.3%]. There were 10/168 (5,9%) deaths [OS = 94%], with 5 confirmed by breast cancer and 4 of undetermined cause. There was a significant association between axillary dissection and axillary recurrence (0 versus 6% p = 0.012). OS for clinical stages 2B, 3A and 3B were 97, 88 and 87.5% respectively. Conclusions: The use of 4% carbon marker is a feasible and cheap method for targeted axillary dissection. The oncological outcomes are compatible with the survival curves of the American Joint Committee on Cancer 8th edition, therefore, a safe tool to spare women cN+ from axillary dissection when there is a complete axillary response to NST. The concordance rate between the CMLN and the SLNB was moderate when we took into account the failure of some method, noting the need for a supplementary method to the SLNB after NST. Frequency and percentages of anatomopathological results and methods of lymph node identification. SLNB = sentinel lymph node biopsy; CMLN = carbon marked lymph node Occurrence of oncological outcomes Citation Format: Lucas R. Budel, Cleverton C. Spautz, Maria Helena Louveira, Teresa Cristina S. Cavalcanti, Alessandra C. Fornazari, Plinio Gasperin, Leonardo P. Nissen, Vinicius M. Budel. Oncological outcomes in patients undergoing targeted axillary dissection with carbon marker [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-11.

Darier Ferrand Mammary Dermatofibrosarcoma Simulating a Breast-Type Myofibroblastoma: A Case Report

Myofibroblastoma and Darier Ferrand’s dermatofibrosarcoma are rare entities that are similar both in terms of clinical morphological characteristics and histological characteristics. We report the case of a 49-year-old non-menopausal woman with a history of right breast lumpectomy. Supported by the Chompret criteria, an oncogenetic consultation was performed. Clinical examination revealed a firm 25 mm mass on the medial part of the left breast with skin involvement. A biopsy was performed and analysis result came back in favor of a cellular type myofibroblastoma showing a fibrous component consisting of spindle cells with a herringbone arrangement. Anatomopathological results concluded to a dermatofibrosarcoma of Darier Ferrand while immunohistochemistry stated a tumor population strongly positive for CD34 expression. The search for a rearrangement of the collagen type I alpha 1 gene (COL1A1) by fluorescence in situ hybridization (FISH) was positive. The diagnosis of Dermatofibrosarcoma of Darier Ferrand can be suspected on imaging and confirmed by histology. Surgical treatment of Darier Ferrand dermatofibrosarcoma consists of wide excision of the lesions with margins greater than 2 cm, on which the prognosis mainly depends. Micrographic surgery and oncoplastic breast surgery are of major interest in this location.

Salivary gland tumor: atypical presentation of breast cancer

Breast cancer is a heterogeneous disease with various histological and molecular subtypes. Among them, salivary gland tumors are rare and can be divided into three groups: pure myoepithelial differentiation, pure epithelial differentiation and myoepithelial with mixed epithelial differentiation. In the last group, adenoid cystic carcinoma stands out, a rare entity with low malignant potential. It represents less than 0.1–3% of breast cancer cases and has the most frequent clinical presentation as a palpable mass. The diagnosis is confirmed by histology and immunohistochemistry. Classically, they are low-aggressive triple-negative tumors, with overall survival and specific cancer survival at five and ten years greater than 95%. However, there are rare reports of aggressive variants with a risk of distant metastasis and death. Treatment is based on surgical resection with margins. Lymphatic dissemination is rare, and there is no consensus regarding the indication of an axillary approach. Adjuvant radiotherapy is indicated in cases of conservative surgery and should be discussed in other cases. The benefit of chemotherapy remains uncertain, as most tumors are indolent. We report a case that required individualized decisions based on its peculiarities of presentation, diagnosed in an asymptomatic elderly patient during screening, in which mammography showed heterogeneous gross calcifications clustered covering 1.6 cm. Stereotacticguided vacuum-assisted biopsy was performed, and the area was marked with a clip. The anatomopathological examination led to a diagnosis of salivary gland-type carcinoma, triple-negative. The patient underwent segmental resection of the right breast and sentinel lymph node biopsy. The final anatomopathological result was similar to that of the biopsy, with an immunohistochemical profile of the adenoid cystic type and two sentinel lymph nodes free of neoplasia. Considering age and histological subtype, adjuvant therapy was not indicated. Follow-up for three years showed no evidence of disease.

Lingual location of Sweet's syndrome: A case report

Context: Sweet's syndrome is a rare acute febrile neutrophilic dermatosis and idiopathic in two-thirds of cases. The pathophysiological mechanisms of Sweet's syndrome are poorly understood. Observation: A 35 yr old female patient has been referred from the Dermatology Department to the Oral and Surgery Department, University Hospital Center of Oran (Algeria), for a lingual nodule. For medical history, the patient had a Sweet's syndrome diagnosed 1 yr ago and a rheumatoid arthritis treated with corticosteroids. An excisional biopsy of the lingual nodule was performed and the anatomopathological result revealed a pyogenic granuloma associated with polymorphonuclear neutrophilic vasculitis in the context of Sweet's syndrome. Discussion and conclusion: Sweet's syndrome is characterized by a constellation of clinical symptoms, biological and histological abnormalities and is manifested by the sudden appearance of painful skin lesions in the form of asymmetric erythematous papules, nodules or plaques. In the context of Sweet's syndrome, faced with an oral with cutaneous lesions a correlation and/or manifestation of neutrophilic dermatosis must be suspected.

P9.06: Liver Transplantation for Treatment of Acute Liver Failure After COVID-19 Infection and Anatomopathological Results

P9.06: Liver Transplantation for Treatment of Acute Liver Failure After COVID-19 Infection and Anatomopathological Results

OSTEOPLASTY AND PERIODONTAL PLASTIC IN PATIENT WITH GENGIVAL FIBROMATOSIS AND FIBROUS DYSPLASIA

Fibrous dysplasia is a bone development disorder prevalent in young adults characterized by the replacement of normal bone by fibrous connective tissue with bone trabeculae. Gingival fibromatosis is a rare condition in which there is a genetic predisposition, characterized by continuous and progressive gingival growth. These entities rarely appear together. Patient underwent osteoplasty in the right maxilla when she was 10 years old, with a diagnosis of fibrous dysplasia, confirmed by anatomopathologic examination. She returned at 23 years old with gingival and bone increase in the maxilla (vestibular, lingual, and tuberosity) and mandible (vestibular) for a second surgical correction. Osteoplasty and gingivoplasty were performed, and thinning of the flap in the maxillary palatal region was also necessary. The last anatomopathologic result was gingival fibromatosis and fibrous dysplasia. The surgical result was satisfactory, and the patient was referred to an orthodontist for correction of diastemas and inclination of the occlusal plane.

EXTENSIVE MAXILLARY ODONTOGENIC CALCIFYING CYST: CASE REPORT

Calcifying odontogenic cyst is considered rare and is characterized by painless swelling, which can cause tooth displacement and root resorption. This entity has been defined as a simple cyst lined with ameloblastoma‐like epithelium containing focal ghost cells. A 22-year-old male patient reported with right maxillary swelling for 1 year. Diagnosis of odontogenic abscess and tooth 16 extraction was performed by another dentist; however, there was no regression of the increased volume and mobility of teeth 15 and 17 was present. Facial computed tomography scan, aspiration puncture, and marsupialization were performed. The anatomopathologic result was compatible with calcifying odontogenic cyst. Marsupialization was performed 3 more times because of the patient's rapid healing, the last with the aid of a device. One month after the last marsupialization, enucleation of the lesion was performed in an operating room. After 2 months, teeth 17 and 15 showed reduced mobility. The 4-month follow-up was uneventful.

Mesotelioma peritoneal em onça-pintada (Panthera onca – Linnaeus, 1758)

Mesotheliomas are malignant neoplasms and cause severe and extensive lesions in the peritoneum, pleura, pericardium and adjacent organs. The present case study discusses the death of a jaguar (Panthera onca) kept under human care in a zoo in the state of São Paulo, Brazil, with an estimated age of 19-years-old. He presented increased abdominal volume, ascites, decreased displacement by the enclosure, inappetence and polydipsia. The patient underwent clinical, laboratory and diagnostic imaging tests and died after a short period of time. The anatomopathological results indicated the diagnosis of peritoneal mesothelioma, with metastasis in the mesenteric lymph node.

Biliary Tract Rhabdomyosarcoma: A Challenging Diagnosis

Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. It is located mainly in the head and neck, extremities and trunk, rarely achieving the biliary tract (1%). The clinical presentation is characterized by obstructive jaundice, abdominal pain and palpable mass. The prognosis is favourable when being early diagnosed. The main differential diagnosis is the choledochal cyst. We bring a case report about a patient with biliary tract rhabdomyosarcoma, diagnosed and treated for 1 year as choledochal cyst, presenting obstructive jaundice for one year. A hepatic biopsy was done, showing hepatic fibrosis. He presented clinical worsening and was referred for liver transplant. An exploratory laparotomy was done before planning the transplant, which showed a biliary tract mass, followed by a biopsy. The anatomopathological result was RMS. Biliary tract RMS is a rare entity that should be included in the differential diagnosis of obstructive jaundice in children. Because of its similarity with choledochal cyst, pediatricians and surgeons should consider this hypothesis, for adequate investigation and treatment.

Dermatomiositis amiopática como primera manifestación de cáncer de uréter

Resumen Descripción del caso clínico: Varón de 79 años, consultó por episodio de angioedema facial sin otra sintomatología. A la exploración física presentaba eritema en cara y cuello, angioedema peripalpebral y máculas eritematosas en el dorso de las manos. Se realizó biopsia de lesión cutánea compatible con pápula de Gottron y para descartar enfermedad sistémica urografía por tomografía computarizada observando ureterohidronefrosis izquierda grado III por posible neoplasia ureteral. Estudio de extensión negativo. Se realizó nefroureterectomía izquierda laparoscópica e instilación endovesical de Mitomicina C, con resultados anatomo-patológicos de carcinoma papilar urotelial de alto grado multifocal. El paciente presentó una evolución posquirúrgica favorable, con mejoría de las lesiones dérmicas, pero a los 7 meses desarrolló múltiples metástasis siendo éxitus. Relevancia: La asociación de dermatomiositis con neoplasias es bien conocida, pero son pocos los casos descritos con malignidad urológica. El cáncer ureteral con dermatomiositis amiopática es extremadamente raro. Implicaciones clínicas: Es importante realizar un tamizaje de cáncer en pacientes que cursan con dermatomiositis para así tratarlos y mejorar su pronóstico. Conclusión: La dermatomiositis es un síndrome paraneoplásico raro que se asocia al cáncer ureteral de manera muy infrecuente. El tamizaje de cáncer en estos pacientes es muy importante para mejorar el pronóstico. El tratamiento quirúrgico de este tumor supuso la desaparición de las alteraciones cutáneas.

The impact of COVID-19 in breast cancer diagnosis: a casuistic from our center

Background: The COVID-19 pandemic has posed significant pressures on healthcare system resources and treatment decisions at the provider and patient level. Regarding breast imaging, several articles demonstrated sizable decreases in imaging volumes, particularly in mammography examinations, due to lockdown recommendations by governments, concerns of patients for the potential virus exposure at hospitals and delaying non-mandatory screening examinations in most facilities. So, how did the COVID-19 affect our center? Materials and Methods: We performed a retrospective study, comparing the group of patients admitted in our hospital with breast cancer diagnosis, older than 18 years, between march and december 2019, with the same group of patients admitted between march and december of 2020.We analyzed the data regarding time periods between the first appointment and the different imaging tests. Results: 212 patients were included in our study, 122 from 2019 and 90 from 2020, and 135 patients excluded.The time between the first appointment and the biopsy increased 27.6 days from 2019 to 2020. Conversely, there was a reduction of the time between the biopsy and the anatomopathological result (13.3 days).As for the different imaging tests, we reported an increase from the first appointment to axillary ultrasound, MRI, and bone scintigraphy, in 11.9, 20.2 and 25.2 days, respectively. Conclusions: As we would expect, we observed a delayed response from the imageology department during the pandemic period. This was probably due to a redistribution of human and technical resources, which resulted in less availability for elective exams.On the other hand, the anatomopathological response was faster during this period, perhaps associated with a decrease in work volume, directly related to a reduction in elective surgeries and benign pathologies.The COVID-19 pandemic significantly affected the healthcare system resources, as we can confirm with this study. However, the true impact is yet to be seen, with delays in screening and diagnosis, which will probably result in thousands of excess cancer deaths over the next several years.

Elévation du taux de PSA sérique : Corrélation histologique avec les biopsies des tumeurs prostatiques au Togo

INTRODUCTION : Le but de ce travail est de déterminer la corrélation entre le taux sérique de PSA et les résultats anatomopathologiques des biopsies prostatiques dans notre pratique. MATERIELS ET METHODES : Il s’agit d’une étude rétrospective et descriptive allant du 1er janvier 2016 au 31 décembre 2020 (cinq ans) dans les services d’Urologie, les laboratoires d’Anatomie et Cytologie Pathologiques du Centre Hospitalier Universitaire Sylvanus Olympio (CHUSO) et de la clinique Autel d’Élie. Ont été inclus tous les dossiers de patients présentant une tumeur prostatique ayant reçu une biopsie et enregistrés dans les dit-services durant la période d’étude. RESULTATS : Deux cent huit dossiers de biopsie pour tumeurs prostatiques ont été colligés. L’âge moyen des patients était de 66,37 ± 9,85 ans. La tranche d’âge la plus représenté était celle de [60 – 70[ ans. Le taux moyen de PSA des patients était de 793,53 ng/ml. Des 208 biopsies prostatiques réalisées, les adénocarcinomes (ADC) représentaient 64,4% (n=134). Les patients ayant un adénocarcinome avaient un taux moyen de PSA de 1.209,37 ng/ml. Pour les adénomyomes, le taux moyen était de 40,52 ng/ml. Soixante-et-neuf patients ayant un adénocarcinome (33,2%) avaient un taux de PSA ≥100 ng/ml. CONCLUSION : Nous avions noté une relation statistiquement significative entre le taux de PSA total et la découverte de cancer. Ainsi toutes élévation du taux de PSA doit conduire à la réalisation de biopsie pour une confrontation histologique. Cependant, il n’existait pas de relation statistiquement significative entre l’élévation du PSA total et le grade histologique.