Excisional Biopsy Specimen Research Articles

Studying Edema Formation After Release of the Infraspinatus Muscle as an Experimental Model of Rotator Cuff Lesions in Sheep: A Histological Analysis

Background: Muscle edema formation and inflammatory processes are early manifestations of acute rotator cuff lesions in sheep. Histological analysis of affected muscles revealed edema formation, inflammatory changes, and muscle tissue disruption in MRs. Hypothesis: Edema contributes to inflammatory reactions and early muscle fiber degeneration before the onset of fatty infiltration. Study Design: Controlled laboratory study. Methods: Osteotomy of the greater tuberosity, including the insertion of the infraspinatus tendon, was performed on 14 sheep. These experimental animal models were divided into 2 groups: a nontrauma group with surgical muscle release alone (7 sheep) and a trauma group with standardized application of additional trauma to the musculotendinous unit (7 sheep). Excisional biopsy specimens of the infraspinatus muscle were taken at 0, 3, and 4 weeks. Results: Edema formation was histologically demonstrated in both groups and peaked at 3 weeks. At 3 weeks, signs of muscle fiber degeneration were observed. At 4 weeks, ingrowth of loose alveolar and fibrotic tissue between fibers was detected. Fatty tissue was absent. The diameter of muscle fibers increased in both groups, albeit to a lesser degree in the trauma group, and practically normalized at 4 weeks. Immunohistology revealed an increase in macrophage types 1 and 2, as well as inflammatory mediators such as prostaglandin E2 and nuclear factor kappa-light-chain-enhancer of activated B cells. Conclusion: Early muscle edema and concomitant inflammation precede muscle fiber degeneration and fibrosis. Edema formation results from tendon release alone and is only slightly intensified by additional trauma. Clinical Relevance: This study illustrates that early edema formation and inflammation elicit muscle fiber degeneration that precedes fatty infiltration. Should this phenomenon be applicable to human traumatic rotator cuff tears, then surgery should be performed as soon as possible, ideally within the first 21 days after injury.

Unusual Variant of Ameloblastoma with Calcifying Epithelial Odontogenic Tumor-like Areas in a Three-Year Old Child

The Calcifying Epithelial Odontogenic Tumor (CEOT) is a benign odontogenic tumor, comprising approximately 1% of all odontogenic tumors. It presents as a slow-growing tumor in posterior mandibular region. A three year-old female child from Multan, reported a swelling in right lower jaw progressively increasing in size eventually causing facial asymmetry. On intraoral examination, a protuberance was seen arising from posterior mandibular region and causing displacement of overlying teeth. The swelling was cystic on palpation and mildly tender. The patient underwent complete excision of lesion at a tertiary care center in her locality. The excision biopsy specimen was received at our lab which was intact and well preserved. A diagnosis of ameloblastoma with Calcifying epithelial odontogenic tumor-like areas was made. The patient was followed up after six months however no complaint of any recurrent swelling in the area of was recorded.

Presence of 10 transformation zone cells in endocervical curettage should not be required for adequacy.

In another publication, we concluded endocervical curettage (ECC) should have a minimum number of squamous cells for adequacy, similar to the requirements for adequate cervical Papanicolaou smears. Here, we investigate if also, similar to cervical Papanicolaou smears, the presence of at least 10 cells from the endocervical/transformation zone (EC/TZ) in ECCs should be used as a quality assurance measure or if, instead, at least 10 EC/TZ cells should be part of the adequacy criteria for ECC, with an emphasis on diagnosis of at least high-grade squamous dysplasia (HGD). All patients with at least HGD diagnosed on an excisional biopsy specimen (loop electrosurgical excision procedure [LEEP]) from May 1, 2018, to December 31, 2019, and an ECC in the preceding 6 months at our institution were included. Number of EC/TZ cells present in ECCs was counted visually and categorized as less than or greater than 10 TZ cells. A χ2 test was used to evaluate the proportion of ECCs with and without HGD and the presence or absence of at least 10 EC/TZ cells. Given our recent work encouraging at least 1000 squamous cells in an ECC to be considered adequate, we also evaluated only ECCs with greater than 1000 squamous cells with and without HGD and the presence or absence of at least 10 EC/TZ cells. P value was <.05. Fifty-one LEEPs with HGD and a preceding ECC in the previous 6 months were identified. Of the 51 ECCs, 6 had fewer than 10 EC/TZ cells and 45 had at least 10 EC/TZ cells. A similar proportion of the ECCs with HGD had at least 10 EC/TZ cells as those without HGD (93% vs 86%, P = .53). Using only ECCs with greater than 1000 squamous cells, we still found no statistical difference in the proportion of ECCs with HGD having greater than 10 EC/TZ cells compared to those without HGD (91% vs 100%, P = .49). We found that the presence of at least 10 EC/TZ cells does not increase the likelihood of finding HGD in an ECC performed in the 6 months prior to a LEEP with HGD. Similar to the use of the TZ component in cervical Papanicolaou smears, the presence or absence of at least 10 TZ cells in an ECC should only be considered a quality assurance measure and not be used as a criterion for adequacy of the specimen.

Clinico-pathological Spectrum of Pyogenic Granuloma in Patients Presenting at Ayub Teaching Hospital, Abbottabad

Background: Oral Pyogenic Granuloma (OPG) is a type of oral mucosal lesion that is distinguished by its rapid development, friable nature, and vascular proliferation. Aim: To examine the demographic and histopathological features of patients diagnosed with oral pyogenic granuloma. Study design: The cross-sectional study. Methodology: This study was conducted in the Dentistry Department of Ayub Medical College, Abbottabad following the acquisition of a comprehensive medical history through a pre-established form, pertinent clinical information pertaining to the patients, including age and lesion location, was collected. All excisional biopsy specimens were collected. Following preservation in 10% neutral buffered formalin, the gathered specimens underwent preparation for paraffin embedding. The histopathological findings that were assessed and documented included the observation of ulceration, inflammatory cell infiltration, vascular proliferation, fibrosis, and epithelial alterations. Data was analyzed in SPSS. Results: The 51 patients who were a part of the research had a mean age of 31.14+SD and were all female. The bulk of the patients were between the ages of 26 and 35. Lesion diameters varied from 0.5 to 3 cm, with 1.1 to 2 cm being the most common size range. 78% of the cases involved pregnant females. The most common site was the gum mucosa, lips, tongue, and palate were the next most typical locations for OPG. The majority of patients had pseudoepitheliomatous hyperplasia, mild chronic inflammation, and fibrosis, in addition to lobules of capillary sized blood vessels according to histopathological examination. Conclusion: Oral Pyogenic Granuloma is predominantly seen in young females, and is mostly associated with pregnancy and most common site is gum mucosa. The histopathological findings demonstrate characteristic features such as pseudoepitheliomatous hyperplasia, chronic inflammation, and fibrosis. Understanding these features contributes to accurate diagnosis and management of this lesion. Keywords: Oral Pyogenic Granuloma, lobular capillary hemangioma, pseudoepitheliomatous hyperplasia.

Uncommon case of cytopathological features of sialadenoma papilliferum.

Sialadenoma papilliferum, a benign and rare salivary gland neoplasm, accounts for 0.4%-1.2% of all salivary gland tumors and occurs primarily in minor salivary glands of the oral cavity. Here, we report a case of sialadenoma papilliferum and its associated cytological findings. A papillary tumor was incidentally detected on the palate of an 86-year-old Japanese man. Conventional oral exfoliative cytology was performed; the cytology smear exhibited epithelial clusters composed of atypical epithelial cells with a high nuclear/cytoplasm ratio and arranged in sheet or small papillary-like projections. Cytoplasmic vacuoles were also observed in the papillae. It was difficult to make a definitive diagnosis due to the presence of uncommon cytological features. The excisional biopsy specimen revealed histological features characteristic of sialadenoma papilliferum. Mutational analysis detected BRAFV600E mutation, which confirmed the diagnosis of sialadenoma papilliferum. To the best of our knowledge, no prior cytomorphological evaluations of sialadenoma papilliferum have been reported in detail. Oral exfoliative cytology specimens from salivary gland tumors can demonstrate uncommon cytomorphological features. A differential diagnosis of sialadenoma papilliferum can be based on the observation of mildly atypical epithelial cells that form small papillary-like structures.

Studying Edema Formation After Release of the Infraspinatus Tendon as an Experimental Model of Rotator Cuff Tears in Sheep: A Preliminary Imaging and Morphological Analysis

Background: The cause, extent, and role of muscle edema for muscle degeneration are unknown and not considered in the current literature. In vivo experiments were designed to prove muscle edema formation in the early period in a sheep model of acute rotator cuff tears. Hypothesis: Muscle edema occurs after tendon release with or without additional stretching trauma and may be associated with muscle retraction and subsequent muscle degeneration. Study Design: Controlled laboratory study. Methods: A sheep model with acute release of the infraspinatus tendon was used. An osteotomy of the greater tuberosity, including the insertion of the infraspinatus tendon, was performed in 14 sheep. To demonstrate presence of edema, magnetic resonance imaging scans were performed at 0, 2, and 4 weeks using T1-weighted, T2-weighted, proton density–weighted, and Dixon sequences. Excisional biopsy specimens were taken at 0, 3, and 4 weeks (histological results will be reported in a later publication). Two injury models were created: a nontrauma group that consisted of muscle release alone and a trauma group that included additional standardized traction to the musculotendinous unit. Evaluation of T1- and T2-weighted images included calculation of pennation angle, muscle fiber length, signal intensity (edema), and muscle volume. Muscle wet weight and volume were measured at sacrifice. Results: Edema formation was shown in all sheep and slightly more pronounced in the trauma group, where muscle intensity increased significantly between time point 0 (200 Grey Value (GV)) and weeks 2, 3, and 4 (300 GV). Edema formation started early after tendon release with a plateau between 3 and 4 weeks. Deterioration of muscle fiber bundles began also after tendon release with a peak at 4 weeks. Muscle volume decreased steadily over time. Conclusion: Muscle edema appeared early after rotator cuff tendon release, was more pronounced in the trauma group, and reached a plateau after 3 to 4 weeks. Muscle fatty content decreased within the short period of 4 weeks owing to a dilution effect. Muscle edema seems to be an essential factor in cuff tears and subsequent muscle retraction and degeneration. Clinical Relevance: This study demonstrates a new type of muscle edema of retraction and describes the characteristics of edema associated with a retracted rotator cuff tear.

HL-367 ASCT for Treatment-Resistant Mediastinal Gray Zone Lymphoma

Gray zone lymphoma (GZL) is a rare type of blood cancer with intermediate characteristics of diffuse large cell B lymphoma (DLCBL) and classical Hodgkin lymphoma (cHL). There is no universal approach to the management of GZL, and resistant cases often remain challenging. To describe a potential treatment for mediastinal GZL (MGZL) resistant to standard chemotherapy regimens based on a clinical case report. A 40-year-old woman was admitted to the hospital with recent onset of generalized itchiness, weakness, fevers, and night sweats. Upon initial standard workup, a CT scan demonstrated a 7 × 4 cm mediastinal mass with irregular borders and several enlarged paraaortic (2 cm), parasternal (4 cm), and aortic bifurcation (2 cm) lymph nodes. The excision biopsy specimen from the mass showed high expressivity of CD30 and moderate expressivity of CD20, CD3, MUM-1, Fascin, and CD79a, with Ki67 detected in 75%-80%. CD15, AE1/3, ALK, PAX-5, CD45, CD19, CD 23, CD68, BOB 1, and PD-1 were negative. The patient was diagnosed with stage IIB MGZL with intermediate features of DLCBL and cHL. Interventions and Main Outcomes: Initial treatment with the R-BEACOPP regimen resulted in some shrinkage in lymph node sizes; however, after the fourth cycle of chemotherapy, a PET-CT scan demonstrated disease progression with Ds5 metabolic activities in the left axillary, mediastinal, and bronchopulmonary nodes, along with left lung consolidation. Salvage therapy with 2 courses of R-DHAP regimen was administered without significant success, as the consequent CT scan demonstrated a tumor size of 9.4 × 5.9 × 7.6 cm with extension to the left lung. This was followed by 3 cycles of BV, resulting in 3-4 months of disease remission. Due to subsequent disease progression, 2 cycles of BvB and 2 cycles of BV-ICE were initiated, followed by autologous stem cell transplantation (ASCT). The procedure resulted in pancytopenia and oral mucositis, both of which were resolved with appropriate treatment. The patient is currently in the third week of follow-up for further management. ASCT may ultimately be a candidate for treatment-resistant MGZL. These findings should be validated in larger studies.

Diagnostic Accuracy of FNAC for Detection of Malignancy in Palpable Breast Lump and its Comparison with Tru-Cut Biopsy

Breast cancer is the commonest malignancy in women worldwide and leading cause of cancer related deaths in women, almost half of these occurring in developing countries. Aim was to know the diagnostic accuracy of FNAC for detection of malignancy in palpable breast lump and its comparison with tru-cut biopsy Methodology: Six months following the publication of this report, researchers in the Surgical Department of Allied Hospital Faisalabad conducted this study. Starting on March 31st, 2019, and running all the way through September 30th, 2019. Allied Hospital Faisalabad's ethics council approved the study's summary, and patients who presented to the hospital's breast clinic with a palpable breast lump met the criteria for inclusion in the research. Across all patients, histopathology was performed on FNAC, tru-cut, and excisional biopsy specimens. H&amp;E staining was performed on both the tru-cut biopsy and tissue specimens from later excision procedures to examine the histological characteristics of the tumor tissue. Results: In our study, out of 190 cases, frequency of malignancy on was recorded in 28.42%(n=54), the diagnostic accuracy of Tru-cut biopsy for detection of malignancy in patients with palpable breast lump taking histopathology examination after excision biopsy (HPE) as gold standard was recorded as 80.33% sensitivity, 96.12% specificity, 90.74% positive predictive value,91.18% negative predictive value and 91.05% accuracy rate, likelihood ratio was calculated as 20.72 and diagnostic accuracy of FNAC biopsy for detection of malignancy in patients with palpable breast lump taking histopathology examination after excision biopsy (HPE) as gold standard was recorded as 70.49% sensitivity, 93.80% specificity, 84.31% positive predictive value, 87.05% negative predictive value and 86.32% accuracy rate, likelihood ratio was calculated as 11.37. Conclusion: As far as diagnostic accuracy for the diagnosis of malignancy in patients with palpable breast lumps, FNAC and Tru-cut biopsy are both good, although Tru-cut biopsy is more accurate than FNAC in terms of detecting the disease. Keywords: Palpable breast lump, malignancy, diagnosis, FNAC, Tru-cut biopsy, diagnostic accuracy

Pediatric Traumatic Neuroma of the Upper Lip - A Case Report

Traumatic neuroma (TN), represents a reactive proliferation of neural tissue following damage to an adjacent nerve. Clinically, patients usually present with inimitable pain, oral lesions appearing as nodule of size less than 2 cm with normal or greyish white smooth surface mostly involving the mental foramen, tongue or the lower lip. We report a rare case of an upper lip traumatic neuroma, in an uncommon age group and uncommon location, which was clinically thought to be hemangioma. Histopathologically, excision biopsy specimen showed haphazard proliferation of fascicles of nerve fibres. Immunohistochemical analysis revealed strong cytoplasmic positivity for S100 and was negative for SMA and CD34, affirming the neural origin of the lesion. TN could be considered as a differential in cases of soft tissue swelling from uncommon location in the oral region especially in the pediatric age group, where a clear trauma history cannot always be illustrated.

Unilateral Orbital Lipoma in Young Woman Occurred 5 Years after Autologous Fat-graft

Purpose: To report a case of unilateral orbital lipoma in a 22-year-old woman after an autologous fat graft.Case summary: A 22-year-old woman visited our clinic with the chief complaint of persistent ptosis of the left upper eyelid for 6 months. Five years prior, she had undergone double eyelid surgery on both eyes, in which autologous fat grafting was performed. She had experienced swelling of the left upper eyelid that began 6 months prior to her visit. Examinations of her visual acuity, intraocular pressure, pupil reflex, extraocular movement, and fundus revealed no abnormal findings. Sagittal images from orbital contrast computed tomography scans revealed a translucent lesion in the posterior space of the orbital septum of the left upper eyelid. Histological examination of excisional biopsy specimens showed mature adipose cells surrounded by a fibrous capsule. The patient remained disease-free at the 3-month follow-up.Conclusions: Lipoma can occur both during and after autologous fat grafting. It is important that the patient is well-informed of this issue before surgery and that the appropriate treatment is provided when it occurs.

Castleman disease and mimickers: Clinicopathological findings of atypical lymphoproliferative disorders associated with autoimmune disease.

Atypical lymphoproliferative disorders (LPDs) related with autoimmune disease (AID) show marked clinicopathological diversity, which are defined as three distinct clinicopathological subtypes such as those resembling Castleman disease (CD), atypical paracortical hyperplasia with lymphoid follicles (APHLF), and atypical lymphoplasmacytic and immunoblastic proliferation (ALPIB). We studied excisional biopsy specimens from 31 patients with atypical LPDs associated with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and Sjögren syndrome (SjS). The lesions in these 31 cases were classified into 6 (19.4%) cases resembling CD, 14 (45.2%) cases of APHLF, and 11 (35.5%) cases of ALPIB. Five cases (83.3%) resembling CD were in the active stage with systemic symptoms and multicentric lymphadenopathy. Thirteen cases (92.9%) of APHLF showed systemic symptoms, multicentric lymphadenopathy and abnormal laboratory findings. Histologic findings for cases resembling CD were rare in patients with RA and SjS. In AID patients, histologic findings for cases resembling CD or APHLF findings correlated with disease activity and multicentric lymphadenopathy. Six cases (54.5%) of ALPIB were in the active phase with systemic symptoms and multicentric lymphadenopathy. ALPIB tended to be unrelated to AID activity, especially in the majority of patients with no abnormal laboratory findings. Atypical LPDs associated with AID is a group of diseases that may be overdiagnosed and overtreated. The diagnosis of atypical LPDs associated with AID requires an understanding of the histological findings as well as a comprehensive assessment of the presence of systemic symptoms, the distribution of lymphadenopathy, and abnormal laboratory findings.

Managing the Lesion and Counseling Patient Post–Breast Biopsy

AbstractBreast cancer is the leading cause of cancer deaths worldwide among women. Early diagnosis and prompt treatment offers a chance for cure and long-term survival among afflicted women. Triple assessment which includes clinical examination, radiological imaging and histopathological evaluation has become a standard of care in the evaluation of breast cancer. Radiological imaging involves mammography, ultrasound, and magnetic resonance imaging while pathological evaluation can be done on fine needle, core-needle, and surgical excision biopsy specimens with core needle biopsy being the workhorse for diagnosis. While triple assessment has increased the diagnostic yield and helps in the identification of early lesions, an increasing subset of patients present with a situation where the imaging and pathological characteristics of a lesion do not correlate with each other thereby causing diagnostic and therapeutic dilemma. Imaging and pathology concordance and discordance present distinctly under differing circumstances in the care of the patient. While those with concordant findings proceed to treatment or follow up directly and hence benefit from the early treatment, those with discordant findings are beset with a delay in the diagnosis and should be subjected to further evaluations for confirming or refuting a diagnosis. This article reviews the salient features of image-guided breast biopsy and the outcomes and management options in imaging and pathology concordance and discordance. We also discuss the role of a radiologist in the counselling of the patient before and after receiving the pathological report after biopsy.

S2397 First Reported Case of Kikuchi-Fujimoto Disease in a Crohn’s Disease Patient

Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare entity, mostly associated with autoimmune conditions such as SLE. It is benign, focal, self-limited, and despite abundant literature, its pathogenesis remains unknown. We report a unique case of KFD in a patient with coexisting Crohn’s disease. Case description/methods: A 23-year-old female with no medical history was evaluated for Iron deficiency anemia and anorexia. She underwent a colonoscopy which revealed normal colonic mucosa, however, an ulcerated and congested terminal ileum was seen. Biopsies were significant for acute cryptitis and granuloma. Serology was positive for anti–Saccharomyces cerevisiae antibody and fecal calprotectin was elevated. She was initially started on oral corticosteroids and later transitioned to azathioprine and Adalimumab, with a good response. 7 months later, she was planned for a repeat colonoscopy to check for endoscopic healing, however, at her pre-procedure COVID testing, she was noted to have rubbery painless LAD of the right neck. The procedure was postponed and she was immediately asked to discontinue her medications. She was referred to an oncologist. A CT chest was unremarkable and an excisional biopsy of the largest of the lymph node revealed necrotizing lymphadenitis, favoring KFD. Infectious workup was negative. Over the next 2 months, her LAD spontaneously resolved without the need for medications. A repeat colonoscopy was aborted due to poor prep. A follow-up MRE revealed long segment mid and distal Crohn's ileitis, and fecal calprotectin remained elevated. She was started on oral budesonide with plans to restart biological therapy after repeating a colonoscopy. Discussion: KFD may rarely involve the terminal ileum, potentially masquerading as Crohn’s disease. Our patient, however, had histological findings pathognomic for Crohn’s and her ileitis did not resolve with the resolution of LAD. Lymphoma remains a feared adverse outcome of both immunomodulators and Anti-TNF medications, thus necessitating their cessation upon signs of LAD. However negative EBV testing, an unrevealing chest CT, and a benign histological diagnosis of KFD may allow our patient to safely resume these medications to treat her Crohn's.Figure 1.: Excisional Lymph node biopsy specimen demonstrating necrotizing histiocytic lymphadenitis. No infectious organisms were identified (Negative PAS, Warthin-Starry stain, Tuberculosis, HSV 1/2 and EBV immunohistochemistry).

Indolent B-Lineage Precursor Populations Identified by Flow Cytometry and Immunohistochemistry in Benign Lymph Nodes.

In this retrospective study, we report a series of benign lymph nodes showing small populations of normal B-cell precursors characterized by flow cytometry and immunohistochemistry. Ten cases identified during clinical flow cytometry practice were retrospectively reanalyzed with particular attention to hematogone categorization and enumeration. Immunohistochemical staining was performed on five excisional lymph node biopsy specimens to characterize the morphologic correlate. Populations of hematogones ranging from 0.13% to 1.86% (median, 0.51%) of all viable leukocytes were demonstrated in 10 benign lymph node samples from eight different patients ranging in age from 17 to 45 years (median, 37.5). These hematogones showed a characteristic immunophenotype (CD19+/CD10+) and maturational pattern by flow cytometry, with progression from stage 1 (median, 0.03%) to stage 2 (median, 0.19%) to stage 3 (median, 0.26%) seen in all cases. Immunohistochemical staining on five excisional biopsy specimens demonstrated a distinct perisinusoidal distribution of CD10+/CD20+ cells with a subset of TdT+ cells, providing a morphologic correlate. To our knowledge, this is the first study to characterize distinct hematogone populations within benign lymph nodes by both flow cytometry and immunohistochemistry. Recognizing these normal B-cell precursor populations is important to avoid their miscategorization as a CD10+ B-cell neoplasm.

Fine-Needle Aspiration Cytology versus Core-Needle Biopsy for Breast Lesions: A Dilemma of Superiority between the Two

Introduction: Core-needle biopsy (CNB) is a minimally invasive procedure used in preoperative diagnosis of breast lumps. It has been seen that in few years, the CNB seems to be replacing the fine-needle aspiration cytology (FNAC), although no study had yet conclusively proved a superiority of one over the other. Aims and Objectives: The aim of this study was to study the cytohistological spectrum of palpable breast lesions and to evaluate the diagnostic accuracy of FNAC versus CNB for breast lesions. Materials and Methods: The study was a cross-sectional study conducted in the Department of Pathology and Surgery, over a period of 1 year in 152 patients. All the patients were subjected to FNAC and CNB. Cytosmears were stained with May-Grunwald Giemsa and hematoxylin and eosin was done on CNB and excision biopsy (EB) specimens. Sensitivity and specificity were calculated in percentage with 95% confidence interval with reference to CNB/surgical specimens. Kappa statistics were used to compare the level of agreement between FNAC versus CNB and CNB versus surgical specimens. Results: A total of 152 patients were taken for FNAC and CNB. EB was performed in only 104 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FNAC verses CNB in correlation with subsequent histopathology were found to be (93.40 vs. 94.06%), (97.50 vs. 100.00%), (99.00 vs. 100.00%), (84.78 vs. 33.33%), and (94.52 vs. 94.23%), respectively. Conclusion: CNB has overcome the pitfall of FNAC but CNB cannot replace FNAC but both procedures are complementary to each other.

Abstract PS14-09: The impact of non-classic LCIS on the natural history of DCIS

Abstract Background: Classic lobular carcinoma in situ (C-LCIS) and non-classic LCIS (NC-LCIS) are histologically and biologically distinct types of lobular neoplasia. Little is known about the impact of NC-LCIS on risk of recurrence when found in association with concomitant malignancy. We sought to assess oncologic outcomes in patients with DCIS and concomitant NC-LCIS as compared to DCIS with concomitant C-LCIS treated with breast conservation. Methods: Upon IRB approval, an institutional database was accessed to identify patients with a diagnosis of C-LCIS + DCIS or NC-LCIS+DCIS in the same core biopsy and/or excisional biopsy specimen. All pathology slides relevant to the diagnosis were confirmed by internal review. Patients with prior or concurrent ipsilateral invasive breast cancer and/or prior ipsilateral DCIS were excluded. Use of adjuvant therapies and the incidence of ipsilateral and contralateral DCIS and invasive breast cancer were compared in the 2 groups. Statistical analysis was performed using the chi-square test. Results: Among patients diagnosed with DCIS between 1996 and 2015 and treated with breast conserving surgery, 69 also had C-LCIS and 13 also had NC-LCIS (the diagnosis of NC-LCIS was not encountered until 2000). Median patient age was 55 years (range 40-88), 42 (51%) had a family history of breast cancer and 5 (6%) had a prior diagnosis of atypical proliferative breast lesions; these factors did not differ between patients with C-LCIS+DCIS and NC-LCIS+DCIS. Patients with NC-LCIS+DCIS were more likely to present with mammographic distortion (25% vs 6%, p=0.03), to have been diagnosed by core biopsy, and less likely to have ER positive (67% vs 91%, p=0.03) or PR positive (50% vs78%, p=0.014) DCIS. In 78% of the patient cohort, final excision margins were negative, and these proportions were not different between the 2 groups The median number of surgeries performed to obtain clear surgical margins which was 2 (range 1-4) for the entire cohort and for C-LCIS+DCIS and NC-LCIS+DCIS, individually. 78.% of C-LCIS+DCIS patients and 54% of NC-LCIS+DCIS patients received adjuvant radiation (p=0.064), and 45% of C-LCIS+DCIS patients took adjuvant hormonal therapy, while none of the NC-LCIS+DCIS patients did (p=0.002). At median follow-up of 78 (1-260) months for C-LCIS+DCIS and 60 (1-197) months for NC-LCIS+DCIS, there were no differences observed in the incidence of ipsilateral and contralateral breast cancer (10.1% vs 7.7% , p=0.19, and 10.1% vs 0%, respectively, p=0.78). One of 13 patients (7.7%) with NC-LCIS+DCIS, who developed an ipsilateral invasive carcinoma, was subsequently diagnosed with bone metastasis. Conclusions: Patients with NC-LCIS+DCIS were more likely to have ER and/or PR negative DCIS and only 54% of this cohort received radiation, yet local-regional recurrence rates were low and not different between NC-LCIS +DCIS and C-LCIS+DCIS patients. Despite the more aggressive histologic features of NC-LCIS, these data do not suggest that NC-LCIS associated with DCIS portends a different prognosis that C-LCIS associated with DCIS. Larger studies are needed to confirm these findings. Citation Format: Faina Nakhlis, Fisher Katlin, Samantha Grossmith, Ashley DiPasquale, Beth Harrison, Tari King. The impact of non-classic LCIS on the natural history of DCIS [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS14-09.

Nora’s lesion of Upper and Lower limb bones- A series of 8 cases

Introduction: Bizarre parosteal osteochondromatous proliferation (BPOP) presents as painless bony swelling and also known as Nora’s lesion. It is a benign surface osteocartilaginous lesion. This condition is seen most commonly in hands followed by feet. Long bone involvement is rare. Materials and Methods: This is a retrospective study of the patients who had visited the orthopedic OPD of our institute from January 2011 to December 2019. The diagnosis of BPOP was made by radiological evaluation and confirmed by histopathological evaluation. Results: There were 8 cases included in this study. Out of them, 4 cases (50%) were female, and 4 cases (50%) male. The age distribution of patients was 14 years to 36 years. The duration of the history of present illness was 6 months to 3 years. There were 6 cases (75%) of the upper limb and 2 cases (25%) of the lower limb. 4 cases (50%) had a history of trauma. All cases were operated on after pre-operative evaluation and the excisional biopsy specimen was sent for histopathological evaluation for confirmation. On follow up 2 cases (25%) had recurrence for which re-operation was done. Conclusion: BPOP involving long bones is exceedingly rare. The local recurrence rate after surgical resection of the lesion is high. En bloc resection of the lesion along with decortication of the underlying cortical bone was done to reduce the possibility of recurrence. Two patients in our series had a recurrence for which re-operation was done. Keywords: Nora’s lesion, BPOP, Bony swelling, Osteochondramatous proliferation.

Clinicopathological spectrum of Keratinocytic tumors of skin in a tertiary care centre

Introduction: Skin is the largest organ in the body and tumors can arise from any part of the skin. Skin cancer represents the most common form of malignant disease in the world.1 In India, malignant skin tumors constitute about 1-2% of all cancers. National Cancer Registry Programme, Indian council of medical research- Consolidated report of the Population based cancer registries reported cumulative incidence of skin cancer varying from 0.5 to 2 per 100000 population.2 Non melanoma skin cancers are associated with substantial morbidity, including loss of function and disfigurement and their treatment is costly. Early diagnosis can reduce morbidity and cost. There is a definite role of pathologists in the management of tumors. Aim: To study the different Clinicopathological features of Keratinocytic skin tumors and analyze the tumors according to age, sex, site and incidence. Materials and Methods: This is a prospective study from June 2015 to August 2017 for a period of 26 months. Excision biopsy specimens and skin punch biopsies sent for histopathological evaluation to the Department of Pathology, Dr. B. R. Ambedkar Medical College, were studied. Results: Out of the 140 skin tumors studied, 130 were benign and 10 were malignant. Incidence of benign tumors was most common in the younger age groups. Premalignant tumors were more common in the 4th decade. These tumors showed an overall male preponderance. However, malignant tumors were found to be more common in females and in the older age groups. The sun exposed areas were the most common site of both benign and malignant Keratinocytic tumors. Squamous cell carcinoma was found to be more common than Basal cell carcinoma.| Conclusion: We studied, 140 cases of Keratinocytic tumors of skin. 87.2% were benign, 5.7% were Pre-Malignant and 7.1% were malignant. Most common benign tumor in our institution was verruca vulgaris and the most common malignant tumor in our institution was squamous cell carcinoma. Although m

Role of FNA with core biopsy or cell block in patients with nodular lymphocyte-predominant Hodgkin lymphoma.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) represents a diagnostic challenge on surgical excisional or incisional biopsy. Classification is further challenging on fine needle aspiration (FNA) material accompanied by needle core and/or cell block biopsy (FNA+core/CB). The authors studied all FNA+core/CB and surgical excisional or incisional biopsies to evaluate for lymphoma in patients who had a prior history of NLPHL or subsequent diagnosis of NLPHL over a 5-year period from 2012 through 2016. Patients who ultimately were diagnosed with NLPHL represented <0.5% of those who underwent FNA+core/CB for an initial suspicion of lymphoma. FNA+core/CB resulted in a definitive diagnosis in 7 of 13 cases, and surgical excisional or incisional biopsy specimens resulted in a definitive diagnosis in 13 of 13 cases (chi-square statistic, 9.6; P=.002). At initial diagnosis, FNA+core/CB was negative in 2 cases and atypical or suspicious in 3 cases; all 5 of those patients required surgical excisional or incisional biopsy for a definitive lymphoma diagnosis. By contrast, patients who underwent FNA+core/CB for recurrent lymphoma required surgical excisional or incisional biopsy in only 1 of 8 cases (chi-square statistic, 9.5; P=.002). Flow cytometry was positive for a light-chain-restricted B-cell population in only 1 of 11 biopsies that were involved by lymphoma. Surgical excisional or incisional biopsy remains the gold standard for NLPHL diagnosis and for distinguishing progression to a T-cell/histiocyte-rich large B-cell lymphoma pattern. At a tertiary cancer center with routine collaborative diagnosis of lymphoma on FNA+core/CB by cytopathologists and hematopathologists, FNA+core/CB performs well to assess for recurrent or transformed NLPHL, rarely requiring subsequent surgical excisional or incisional biopsy. FNA+core/CB has limited sensitivity in the initial diagnosis setting.

Strategies for Reducing Final Surgical Defect Sizes in the Treatment of Lentigo Maligna.

Lentigo maligna (LM) is associated with disproportionately high surgical morbidity. The authors report on 2 strategies to reduce the surgical morbidity associated with LM. Forty LM lesions were removed with excisional biopsies without margins and closed with purse-string sutures. Invasive cases underwent staged excisions with 10-mm margins. Cases without invasion were treated with neoadjuvant topical imiquimod 5% cream (5 d/wk × 8 weeks) followed by conservative staged excisions with 2-mm margins using radial sections stained with hematoxylin and eosin and immunostaining with Mart-1, with or without SOX10. Invasion was detected in 12/40 (30%) of the excisional biopsy specimens (average depth 0.45 mm). No invasion was detected in 28/40 (70%). All 24 patients who completed neoadjuvant topical imiquimod 5% cream before staged excisions had negative first-stage margins at 2 mm. Compared with average published margins for LM, this represents a 71.4% reduction in the required margin and an average reduction in the final surgical defect by 74%. LM treatment by excisional biopsies with a purse-string closure enables accurate tumor staging and contracts the tumor footprint to its minimal size. Subsequent neoadjuvant imiquimod followed by a conservative staged excision with 2-mm margins allows for removal of LM with decreased surgical morbidity.