Surgical Excisional Biopsy Research Articles

Ocular surface squamous neoplasia (OSSN) in an 84‐year‐old female patient

AbstractPurposeTo report a case of Ocular Surface Squamous Neoplasia, in an 84 years old woman. The patient referred 4 months of red vascularized elevated corneal lesion.MethodsOur proposal was an exportation of the conjunctival corneal neoformation and histological examination. During the surgical procedure, we found an elevated lesion with feeder vessels, the surgical excision biopsy was done and the specimen was sent for histopathological evaluation, which revealed an invasive, poorly differentiated carcinoma extending to subcutis. Immunohistochemical staining for p63 gave dubious results on the integrity of the basement membrane. These findings associated with the incomplete excision of the lesion did not allow us to express a possible invasiveness in the lateral margin affected.ResultsIn the post‐operative, we used Mitomycin C 0.04% topical treatment, 4 times a day for a week, then 3 weeks off for a total of 3 cycles. During this period the patient did not display any adverse systemic or ocular reactions. At the end of the treatment, we found a complete regression of the disease. During the control at 6 months and 1 year, the patient was asymptomatic.ConclusionsDiagnosis of invasive Squamous Cell Carcinoma mainly rests on the histopathological examination of the excised lesion. No serious ocular or systemic side effects were observed during the Mitomycin C 0.04% eye drops treatment. Mitomycin C 0.04% seems to be a safe and effective treatment for ocular surface squamous neoplasia.

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.

A Rare Case of Angiofibroma Mimicking Fibrous Epulis in Posterior Gingival Mucosa

Angiofibromas are highly vascular, locally aggressive but histologically benign tumors. A 40-year-old woman complaint of pedunculated mass in the right gingiva of the posterior region since 7 months earlier. Surgical excisional biopsy under general anesthesia was performed. Histopathological examination showed an angiofibroma. Angiofibromas are localized in the superficial soft tissue and the gingiva could have a similar clinical appearance as an epulis. Definitive diagnosis was determined through histopathological analysis.

Identification of Inguinal Sentinel Lymph Nodes in Recurrent Vulvar Melanoma

<h3>Study Objective</h3> To demonstrate the feasibility of inguinal sentinel lymph node detection in recurrent vulvar melanoma using ICG fluorescence technique. <h3>Design</h3> Radical local excision and sentinel lymph node biopsies for recurrent vulvar melanoma. The injection of ICG tracer was followed by visualization of sentinel lymph nodes using an Image1 S Rubina system (Karl Storz, Germany). <h3>Setting</h3> Tertiary hospital. <h3>Patients or Participants</h3> one patient, 17 months after primary surgical excision and sentinel lymph biopsy for vulvar malignant melanoma. <h3>Interventions</h3> Injection of ICG tracer around the border of the lesion. <h3>Measurements and Main Results</h3> Bilateral sentinel nodes were successfully identified and removed. <h3>Conclusion</h3> Detection of sentinel lymph nodes in recurrent vulvar melanoma is feasible. ICG tracer can be considered for sentinel mapping in recurrent vulvar cancer.

Audit on Intraductal Papilloma of the Breast: Upgrade Rate, Management Pitfalls, and Updated Guidelines in a Tertiary Health Care Center.

BackgroundIntraductal papillomas (IDPs) are typically classified as B3 lesions in histology as they may show intralesional heterogeneity with a potential upgrade to malignancy. On core needle biopsy (CNB), a distinction between papilloma versus papillary ductal carcinoma in situ (DCIS) may be difficult. It is well known that otherwise benign papillomas may harbor foci of atypical ductal hyperplasia or DCIS. In this study, we aimed to calculate the radiological (mammogram and ultrasound) accuracy of IDP and to analyze the accuracy of CNB to diagnose IDP. Furthermore, we calculated the percentage of upgrade to malignancy after surgical excision. Any case that had a co-existing in-situ or invasive carcinoma during surgical excision was considered as an “upgrade” to malignancy. Finally, we analyzed the current management protocol for IDP in the institution and suggested changes, if needed.MethodologyThis is a retrospective cross-sectional study. A total of 112 cases diagnosed as IDP radiologically and/or by histopathology over a one-year time frame were included. A retrospective analysis of the accuracy of the radiological diagnosis was done by comparing it with CNB and/or surgical excision biopsy reports. The number of cases diagnosed with a co-existing in-situ or invasive carcinoma was calculated. This was considered as an “upgrade” from a B3 lesion in CNB to carcinoma in surgical excision. Current institutional management protocols were evaluated and compared with international benchmarks.ResultsOut of the 112 cases, 91 were suspected to be papilloma by imaging. The remaining 21 cases who were positive for papilloma on biopsy but were not diagnosed radiologically were also studied separately. Among the biopsied patients, eight were positive for IDP with atypia in CNB. Five out of these eight cases had an in-situ or invasive component during the surgical excision, with one invasive lobular carcinoma, three lobular carcinomas in situ, and one DCIS on surgical excision histopathology. The upgrade percentage was calculated to be 22.72%.ConclusionsDue to the large upgrade potential of IDP, it is recommended to biopsy every radiologically suspected lesion and excise pathology-proved lesions. If the biopsy shows papilloma without atypia, vacuum excision is sufficient; otherwise, surgical excision with a clearance of margins is advocated. Annual mammograms/surveillance is recommended for biopsy-proven cases. IDP has a high upgrade potential, and, hence, care should be taken to biopsy suspicious lesions. An excision of biopsy-proven lesions must be done.

Diagnostic accuracy and prognostic value of three-dimensional electrical impedance tomography imaging in patients with breast cancer.

Three-dimensional electrical impedance tomography (3D EIT) is a novel, non-invasive, radiation-free imaging technology for breast cancer screening. This study aimed to identify characteristics and classification of 3D EIT breast cancer imaging that could provide diagnostic accuracy and prognostic value for breast cancer patients. A total of 645 suspicious breast lesions [Breast Imaging Reporting and Data System (BI-RADS) III, IV, V] identified by mammography or ultrasound were examined with 3D EIT (MEIK, SIM-Technika, Yaroslavl, Russia). Breast tissue conductivity was quantified using MEIK 5.6 software. Diagnostic performance of visually interpreted 3D EIT was assessed using histology (surgical excision or vacuum core biopsy) and clinical follow-up. Kaplan-Meier analysis was used to calculate progression-free survival (PFS) and overall survival (OS) rates. Hazard ratio (HR) with a 95% confidence interval (95% CI) for various clinicopathological variables were determined using univariate and multivariate Cox regression models. Breast cancer was confirmed in 272 of 645 patients by histopathology and other diagnostic imaging modalities. Among the confirmed cases, 218 patients had positive 3D EIT findings. The sensitivity, specificity, accuracy, positive likelihood, and negative likelihood ratios of 3D EIT were 80.1%, 75.1%, 77.2%, 70.1%, and 83.8%. There were no significant differences in the diagnostic accuracy, sensitivity, or specificity between 3D EIT and mammography, ultrasound, or combined mammography and ultrasound. 3D EIT breast cancer images were classified into 3 different types, including Ia [non-complicated breast cancer (NCBC), 62 cases], Ib [complicated breast cancer (CBC), 131 cases], and Ic [edematous-infiltrative breast cancer (EIBC), 25 cases], which were associated with tumor size (P<0.001), TNM stage (P<0.001), and lymph node metastasis (P=0.012). At 5-year follow-up, multivariate analysis demonstrated that breast cancer 3D EIT imaging classification was an independent predictor for decreased OS (HR: 2.399, 95% CI: 1.035, 5.564, P=0.041) and PFS (HR: 2.836, 95% CI: 1.555, 5.172, P=0.012) in patients with breast cancer. 3D EIT breast cancer images were classified into 3 types based on different image characteristics. 3D EIT appeared to be useful in clinical diagnostic performance and prognostic evaluation in patients with breast cancer.

Computed Tomography and PET/CT Features Of Pulmonary Hamartomas

Abstract: Background: In this study, we aimed to examine the Computed Tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) findings of the pulmonary hamartomas Methods: Histopathologically (after surgical excisional, transbronchial, or transthoracic biopsy) proven pulmonary hamartomas in our institute between 2007 and 2013 were reviewed retrospectively. The CT and PET/CT images were interpreted regarding the lesion diameter, number, location, components and standardized uptake values (SUVmax). Results: A total of 22 (2 endobronchial and 20 parenchymal) hamartomas detected in 21 (11 males and 10 females) patients (an endobronchial and a parenchymal lesion in the same patient). Right lung (63,7%) involvement was common than left lung (36,4%) and upper lobes (50%) involvement than lower lobes (25%). 54,5% of the lesions has smooth margins while 40,9% have lobulated contour and 4.5% had irregular margins. Fat density was observed in 54,5% and calcification in 40.9%. In 18.2% of the lesions neither fat density nor calcification was seen. There was no FDG uptake in 5 lesions. Mean SUVmax value was 1.6±1.0 (range between 0 and 3,2). A SUVmax value &gt; 2.5 was observed in 5 ones Conclusion: Our results were generally consistent with previous reports. But we found a higher female/male ratio and and more common upper lobes involvement of pulmonary hamartoma

Papillary Thyroid Carcinoma Within Thyroglossal Duct Cyst

A 55-year-old female with medical history of hypothyroidism and fibrocystic disease of the breast presented with complains of a painful anterior neck mass, difficulty swallowing and hoarseness of the voice. Symptoms had progressed over a period of 5 months. CT neck with contrast indicated the presence of an ectopic thyroid tissue anterior to the thyroid cartilage measuring approximately 1.7 x 1.2 x 3.1 cm, with indistinct inferior margins and internal calcifications. The hyoid bone or thyroid cartilage had no irregularities. The thyroid gland itself was unremarkable except for small complex thyroid nodules in both lobes. No masses within the pharynx or larynx were noted.Family history was significant for lymphoma in her father.On physical exam, a hard, mobile right anterior neck mass was appreciated. Labs showed normal TSH of 1.05 uIU/mL and normal free T4 of 1.2 ng/dL.Further evaluation with a dedicated neck US showed a right submandibular mass, superior to the thyroid, lobulated and heterogeneous measuring 2.0 x 1.0 x 2.3 cm with multiple areas of calcifications and internal Doppler flow. The thyroid gland had normal size and texture with bilateral sub centimeter non-concerning nodules.After ENT evaluation and an unremarkable flexible fiberoptic nasolaryngoscope, patient underwent surgical excisional biopsy of the neck mass. Pathology was consistent with thyroglossal duct cyst with the presence of thyroid follicles. An incidental finding of a 0.9 cm papillary microcarcinoma was noted, which was encapsulated with focal extracapsular follicular structures showing papillary nuclear features with no perineural or lymphovascular invasion. The tumor cells were immunoreactive for TTF-1 and PAX8.Development of papillary thyroid cancer within the thyroglossal duct cyst is a rare event, reportedly occurring in 1% of thyroglossal duct cysts. There are no well-established management guidelines.Current management strategies consist of monitoring with serial neck ultrasound versus total thyroidectomy with consideration of postsurgical I-131 treatment, based on pathology results. Our patient opted for undergoing total thyroidectomy.

Effectiveness of fine needle aspiration cytology versus excisional biopsy in cervical lymphadenopathy

Background: Cervical lymphadenopathy is a common cause of referral to the surgery department. In low-resource countries, fine-needle aspiration cytology (FNAC) has been advocated as an alternative to more expensive surgical excision biopsies. Although FNAC is a simple and effective procedure in many conditions, its sensitivity and specificity still remains a question.The primary aim of our study was to evaluate the sensitivity and specificity of FNAC of head-and-neck lymph nodes using histopathology as the gold standard.Methods: All patients clinically diagnosed with cervical lymphadenopathy were included in the study, and they underwent FNAC followed by surgical excision and histopathology. The results were tabulated and analyzed using IBM SPSS V.20.0 software. To test the statistical significance between benign and malignant groups, Chi-square test was used, and the difference in FNAC and histopathology were analyzed using McNemar's test.Results: The mean age group in our study of 86 patients was 45.20 ± 18.20 years with equal sex distribution. Among 23 male patients with age above 45 years, 15 patients (65.2%) had malignancy in the lymph node. Level V lymph nodes were most commonly involved (n = 31 [36%]), of which 13 were diagnosed as malignancy and 10 as tuberculosis (TB). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value of FNAC in comparison to histopathology for diagnosis of malignancy were found to be 79.4%, 98.1%, 96.4%, and 87.9%, respectively, and for TB was 77.8%, 87.5%, 87.5%, and 77.8%, respectively.Conclusion: FNAC of head-and-neck lymph nodes has comparable sensitivity and specificity with histopathological examination. It has a very high (96.4%) PPV in detecting malignancy and 100% for detecting metastatic disease in cervical lymph nodes. In patients with suspected lymphoproliferative disorder and in patients above 45 years of age, open biopsy is recommended. For younger patients and in level V cervical lymphadenopathy, irrespective of age, FNAC should be the first invasive diagnostic tool of choice.

Stereotactic breast biopsy: A review & applicability in the Indian context.

Stereotactic biopsy is used for sampling of suspicious non-palpable lesions identified on mammography or digital breast tomosynthesis which are not visible on ultrasound. Stereotactic biopsy is preferable to surgical excision biopsy and helps avoid surgery for benign lesions. Providing tissue diagnosis in patients with early breast cancer may help in formulating a management strategy. Stereotactic biopsy can be carried out using either a dedicated prone table with the patient lying prone or an upright mammographic add-on system with the patient in a sitting or lateral decubitus position. This review focuses on the advantages and disadvantages of both these systems, the indications, contraindications and the complications inherent with this technique. The important pitfalls and their management as well as ways to ensure quality assurance have also been elaborated upon. Data regarding uptake of stereotactic biopsy in other parts of the world have been discussed using evidence from existing registries and databases and attempts made to quantify the need of the technique in the Indian set-up. In the absence of a national breast screening programme and limited resources in India, a hub and spoke model has been proposed as a viable model for healthcare providers for providing stereotactic biopsy.

Assessment of Ultrasound -Guided Core Needle Biopsy as the First-Line Diagnostic Procedure for Cervical Lymphoma

Objective: This study was conducted to assess the effectiveness of Ultrasound-guided Core Needle Biopsy (US-CNB) to provide sufficient information for diagnosis and initiation of the treatment for head and neck lymphoma.Study Design: We carried out the prospective consecutive case series in a single- center study.Setting: The tertiary medical center setting.Patients and Methods: Totally, 72 patients were enrolled and the US-CNB of suspicious cervical lymph node was performed. Demographics, imaging and pathological data were collected for each patient and used to identify the factors that shape the diagnostic yield of US-CNB.Results: We observed among 72 CNBs 52 were fully diagnosed and 20 cases needed Excisional Surgical Biopsy for sub-classification. Then the factors influencing the results of the US-CNB, as the first-line diagnostic procedure for suspected cervical lymphadenopathy were discussed. The CNB results did not differ in terms of BMI, neck circumference and pathological subtype. Fully diagnosis CNB results demonstrated an association with higher mean tumor size and LAP in cervical zones 1 to 4 rather than posterior triangle.Conclusion: About 30% of the patients in the present study required ESB after US-CNB for fully diagnosis and this delayed their treatment. Therefore, the use of US-CNB as a primary method in assessment of cervical lymphadenopathy still needs more studies to investigate the factors influencing the results and shaping its diagnostic yield.

Image-guided core needle biopsy as the first-line diagnostic approach in lymphoproliferative disorders-A review of the current literature.

The World Health Organization (WHO) and numerous expert guidelines for lymphoma diagnosis and subclassification advocate the use of histology from surgical nodal excision biopsy (SEB) over core needle biopsy (CNB) due to perceived higher diagnostic yield. CNB is associated with lower morbidity and is more cost-effective compared to SEB. Furthermore, current practice increasingly demonstrates material obtained from CNB can rapidly diagnose individuals with a clinical suspicion of lymphoma and allow initiation of treatment in the majority of patients. We performed a literature review to assess the suitability of CNB in lymphoma diagnosis given recent advances in radiological and histopathological techniques in obtaining and processing tissue. Additionally, expert international guidelines in lymphoma diagnosis were compared. We found that CNB demonstrated a diagnostic efficacy between 79% and 97% (median 91%) where the diagnostic outcome was conclusive with full lymphoma subclassification. Studies demonstrate that there is a high diagnostic reproducibility amongst haematopathologists (87%-93%) in lymphoma diagnoses with full subtyping from material obtained via CNB. Furthermore, CNB is a safe, rapid and reliable method of obtaining tissue from lymph nodes for histopathological analysis. These procedures are minimally invasive, well-tolerated and should be considered the first-line diagnostic approach in clinical practice in patients with suspected lymphoproliferative disorders.

Does Magnetic Resonance Imaging After Diagnostic Ultrasound for Soft Tissue Masses Change Clinical Management?

To evaluate whether a follow-up magnetic resonance imaging (MRI) scan performed after initial ultrasound (US) to evaluate soft tissue mass (STM) lesions of the musculoskeletal system provides additional radiologic diagnostic information and alters clinical management. A retrospective chart review was performed of patients undergoing initial US evaluations of STMs of the axial or appendicular skeleton between November 2012 and March 2019. Patients who underwent US examinations followed by MRI for the evaluation of STM lesions were identified. For inclusion, the subsequent pathologic correlation was required from either a surgical or image-guided biopsy. Imaging studies with pathologic correlations were then reviewed by 3 musculoskeletal radiologists, who were blinded to the pathologic diagnoses. The diagnostic utility of MRI was then assessed on the basis of a 5-point grading scale, and inter-reader agreements were determined by the Fleiss κ statistic. Ninety-two patients underwent MRI after US for STM evaluations. Final pathologic results were available in 42 cases. Samples were obtained by surgical excision or open biopsy (n=34) or US-guided core biopsy (n=8). The most common pathologic diagnoses were nerve sheath tumors (n=9), lipomas (n=5), and leiomyomas (n=5). Imaging review showed that the subsequent MRI did not change the working diagnosis in 73% of cases, and the subsequent MRI was not considered to narrow the differential diagnosis in 68% of cases. There was slight inter-reader agreement for the diagnostic utility of MRI among individual cases (κ=0.10) between the 3 readers. The recommendation of MRI to further evaluate STM lesions seen with US frequently fails to change the working diagnosis or provide significant diagnostic utility.

The diagnostic performance of ultrasound-guided core biopsy in the diagnosis of head and neck lymphoma: results in 226 patients

Many clinical guidelines for investigating lymphomas advise that surgical excision biopsy (SEB) should be performed for a confident diagnosis. It is increasingly recognized in clinical practice that ultrasound-guided core needle biopsy (USCNB) is a reliable diagnostic technique. We aimed to investigate the diagnostic efficacy of USCNB in head and neck lymphoma.A retrospective analysis of all diagnosed head and neck lymphomas between 2013 and 2018 was performed. Patient records, radiology and histopathology reports along with the biopsy technique: fine needle aspiration cytology (FNAC), USCNB, and SEB used were reviewed. The technique providing diagnosis and leading to initiation of treatment was identified.Two-hundred and thirty patients and 267 biopsy samples were included. A total of 226 patients underwent USCN. In 215 of 226 (95.1%) USCNB patients were fully diagnostic allowing for initiation of oncological treatment; 11 patients required a subsequent SEB to provide diagnosis. In four patients, SEB was the only investigation performed. Of the USCNB total number of procedures (number of patients n=230 is the same coincidentally as the number of USCNB procedures), 215 of 230 (93.5%) were fully diagnostic samples.In the majority of cases, USCNB provided a definitive diagnosis allowing initiation of oncological treatment, avoiding the need for SEB. USCNB should be considered the first-line diagnostic modality in appropriate cases, as it reduces time to initiate treatment, costs and avoids patients having to undergo unnecessary surgery and possible complications.

Toe Pain - Softball

HISTORY: An 18-year-old collegiate softball player started noticing right great toe pain in March of her freshmen season. Pain was unrelenting throughout the day but temporarily responded to anti-inflammatories. She denied fevers, chills, night sweats, or unexpected weight loss. She did not report her pain to the team physician. However, after seeing an outside physician for continued pain, she was placed in a walking boot and provided a bone stimulator. After an additional three weeks of pain despite these therapies, she presented to the training room for re-evaluation of her toe. PHYSICAL EXAMINATION: Examination revealed exquisite tenderness to palpation of the dorsal-fibular aspect of the proximal portion of the distal phalanx of the right first toe, with mild swelling but no plantar tenderness. There was full passive and active range of motion of the MTP and IP joints. Skin of the right foot was intact, without erythema or induration. Tendon function was intact. The foot was neurovascularly intact. DIFFERENTIAL DIAGNOSIS: 1. Stress Reaction of right first toe distal phalanx 2. Subacute/Chronic Osteomyelitis 3. Bony Tumor TEST AND RESULTS: Right toe AP, lateral, and oblique radiographs- bony alignment is unremarkable, no acute fracture; joint spaces well preserved. MRI of right foot without contrast - diffuse marrow edema throughout the first distal phalanx; no corresponding focal signal hyperintensity in the distal phalanx.Nuclear medicine bone marrow imaging - mild increased radiotracer uptake in the region of the distal first phalanx suggesting increased regional blood flow. The above studies were reviewed by the team physicians and there was a concern for bony mass of the proximal portion of the dorsal fibular distal phalanx. MRI with contrast confirmed this suspicion. CT right foot without contrast with 3D reconstruction - ill-defined sclerosis in the medial aspect of the base of the first distal phalanx measuring 7 mm x 4 mm x 5 mm with faint lucency proximal to the sclerosis. FINAL WORKING DIAGNOSIS:Osteoid Osteoma TREATMENT AND OUTCOMES: 1. Continued anti-inflammatories with COX2 inhibitors for symptomatic treatment. 2. Surgical curettage and excisional biopsy of the 7 mm x 4 mm x 5 mm nidus; deferment of radiofrequency ablation due to proximity to the joint. 3. Anticipated return to play in 4-6 weeks.

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.

Image-guided core needle biopsy in the diagnosis of malignant lymphoma: comparison with surgical excision biopsy

PurposeThis study aimed to compare the efficacy and safety of image-guided core needle biopsy (CNB) with those of surgical excision biopsy (SEB) for the diagnosis of lymphoma, and to clarify the indication of CNB in clinical practice. MethodThis retrospective study included 263 image-guided CNB cases and 108 SEB cases that were performed at our institution between January 2014 and December 2018. The rate of patients with performance status of grade 1–4 was higher in the CNB group than in the SEB group (43.7% vs. 24.1%, P < 0.01). Waiting time to biopsy and diagnosis was shorter for CNB group than for SEB group (4 days vs. 7 days, 13 days vs. 15 days, P < 0.01). The rate of biopsy at the deep sites was higher in the CNB group than in the SEB group (53.2% vs. 8.3%, P < 0.01). Successful biopsy and complication rates were compared between the 2 groups. ResultsThere were no significant differences between the CNB and SEB groups in successful biopsy rates (89.0% vs. 93.5%, P = 0.25). The grade 3 complication rate was significantly lower for CNB group than for SEB group (0% vs. 4.6%, P < 0.01), although there was no significant difference in overall complication rates (4.9% vs. 6.5%, respectively, P = 0.61). ConclusionsCNB showed high diagnostic yield comparable to SEB for suspected lymphoma. CNB was especially recommended to the cases with low-PS, lesions in the deep sites, and requiring early pathological diagnosis.

A Typical Features of Fibroadenoma, Correlation between Ultrasound and Pathology

Abstract Background Fibroadenomas (FAD) are benign tumors composed of stromal and epithelial elements. These tumors are commonly seen in young women. Multiple or complex fibroadenomas may indicate a slightly increased risk for breast cancer. Aim of the Work To assess the diagnostic accuracy of ultrasound in atypical fibroadenoma. Materials and Methods This retrospective study was approved by Ain Shams radiology department. On the basis of results of core needle or excisional surgical biopsy, we retrospectively identified 40 consecutive patients between October 2017 and October 2018 with the diagnosis of fibroadenoma. Results In our study, we found that The mean age in the simple fibroadenoma group was 29 years (range 18-49), and in the complex fibroadenoma group, it was 38 years (range 17-62) which represents statistically significant difference between the two groups (P =.021). Conclusion Complex fibroadenomas showed some characteristics that could help in differentiating them from their simple counterparts, namely, an irregular shape, noncircumscribed contours, a complex echo structure. The awareness of these distinguishing features could help radiologists decide which fibroadenomas should be sampled.

CD163+ Foamy Macrophages Are Associated with the Morphogenesis of Oral Verruciform Xanthoma through Angiogenesis by VEGF Expression: An Immunohistochemical Study.

Oral verruciform xanthoma (OVX) is an uncommon benign lesion that is characterized histologically by the accumulation of several foamy macrophages in the lamina propria papillae. The pathogenesis of OVX has not been completely elucidated, although the significance of macrophage polarization (M1, tumor suppression; and M2, tumor promotion) and the contribution of M2 macrophages to angiogenesis are well established. This study investigated the role of foamy macrophages in OVX, with a focus on angiogenesis. Four patients who underwent surgical excision or total excisional biopsy for OVXs were enrolled in this study. We evaluated the expression of the macrophage markers CD68 (broad) and CD163 (M2) and the CD34-positive microvessel density (MVD) of OVXs. The foamy macrophages of all patients exhibited positivity to CD68 and CD163. We evaluated the MVD and the expression of the vascular endothelial growth factor (VEGF) based on histological architecture. The MVD of all OVX cases was significantly higher than that of the corresponding normal epithelia. Interestingly, the MVD of verrucous-type OVX cases was higher than that of the other type. VEGF was expressed on foamy macrophages in all cases. Overall, the foamy macrophages expressing CD163 were associated with the morphogenesis of OVX through the process of angiogenesis by VEGF expression.

Ultrasound Features and Rate of Upgrade to Malignancy in Atypical Apocrine Lesions of the Breast.

To evaluate the ultrasound (US) features and rate of upgrade to malignancy in atypical apocrine lesions (AALs) of the breast, diagnosed on percutaneous needle biopsy. This retrospective study included 17 AALs diagnosed by needle biopsy in 15 patients. For 16 of the 17 AALs, subsequent surgical excision (n = 14) or 8-gauge vacuum-assisted biopsy (n = 2) was performed. Ultrasound features were retrospectively analyzed according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. Of 17 AALs, 13 (76.5%) were atypical apocrine hyperplasia; 3 (17.6%) were atypical apocrine adenosis; and 1 (5.9%) was combined atypical apocrine hyperplasia and atypical apocrine adenosis on needle biopsy. Subsequently, 4 of 16 AALs (25%) were upgraded to malignancy at surgical excision. On US imaging, all 17 lesions presented as masses, which were mainly irregular and noncircumscribed (n = 8) or oval/round and noncircumscribed (n = 7) with isoechogenicity or hypoechogenicity. Rarely, an AAL would show complex cystic and solid echogenicity (n = 1) or appear as a hypoechoic mass with oval shape and a circumscribed margin (n = 1). Atypical apocrine lesions of the breast often showed suspicious malignant features on US imaging. Given the high upgrade rate (25%), the diagnosis of an AAL by needle biopsy warrants subsequent surgical excision.