Suspicion Of Malignancy Research Articles

Papillary Carcinoma in Thyroglossal Duct Cyst and Thyroid Gland with Hashimoto

The ectopic thyroid gland is a rare condition. In most cases, ectopic thyroid tissue is the only functioning thyroid tissue, but it may rarely be associated with a normal thyroid gland. Ectopic thyroid carcinoma within a thyroglossal duct cyst is a very rare entity, with controversial individual approaches. This encouraged us to present the case of a 31-year- old woman, with papillary thyroid carcinoma in the thyroid gland and in the thyroid ectopic tissue within the thyroglossal duct. After suspicion of thyroid malignancy in the ultrasonography of the neck, FNA-biopsy was performed on the thyroid nodule and the thyroglossal duct cyst. Since the pathological exam revealed a papillary carcinoma in the eutopic and ectopic thyroid tissues, the Sistrunk procedure and total thyroidectomy were done, followed by radioiodine ablation.

Interobserver variability in ultrasound assessment of thyroid nodules

The first diagnostic tool for thyroid disease management is ultrasound. Despite its importance, ultrasound is an extremely subjective procedure that requires a high level of performance skill. Few studies have assessed thyroid ultrasound performance and its effectiveness, particularly the variability between observers in the assessment of ultrasound images. This study evaluated the variability in ultrasound assessments and diagnoses of thyroid nodules between 2 radiologists. In this retrospective study, 75 thyroid nodules in 39 patients were reviewed by 2 experienced radiologists. The nodule composition, margin, shape, calcification, and vasculitis were determined using echogenicity. The study evaluation included these 5 assessments and the final diagnosis. Interobserver variation was determined using Cohen kappa statistics. The interobserver agreements in the interpretation of echogenicity, shape, and margin were fair (κ = 0.21–0.40), whereas there were substantial agreements for vascularity and calcification (κ = 0.62–0.78). The agreements between the observers for individual ultrasound features in this study were the highest for vascularity and the presence/absence of calcification. The interobserver reproducibility for thyroid nodule ultrasound reporting was adequate, but the diagnostic evaluation ability of the observers was inconsistent. The variability in the interpretation of sonographic features could influence the level of suspicion of thyroid malignancy. This study emphasizes the need for consistency in the training of sonographic interpretation of thyroid nodules, particularly for echogenicity, shape, and margin.

Learning curves and association of pathologist’s performance with the diagnostic accuracy of linear endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA): a cohort study in a tertiary care reference centre

ObjectivesWe aimed to assess the learning curves and the influence of the pathologist’s performance on the endobronchial ultrasound transbronchial needle aspiration’s (EBUS-TBNA’s) diagnostic accuracy in a real-world study.Design/settingCohort study conducted...

S2417 A Diagnosis That Is Difficult to Swallow: Digging Deeper for Answers

Introduction: Esophageal parakeratosis (EP) is an uncommon finding with largely unknown clinical implications and malignant potential. Here, we report a case of severe esophageal parakeratosis. Case Description/Methods: Patient is a 69-year-old African American male with history significant alcohol and cocaine abuse, prior tobacco abuse, keloids, gastroesophageal reflux, food impaction, and progressive dysphagia for 20 years with 40-pound weight loss. Patient’s first esophagogastroduodenoscopy (EGD) in 2000 revealed moderate esophagitis and a distal esophageal stricture with 9 mm lumen bougie dilated to 12 mm, but dysphagia persisted. Repeat EGDs between 2006 and 2016 showed whitish plaques with no evidence of fungal organisms. Given classic appearance of EOE, he was trialed on empiric fluticasone and budesonide with no improvement in dysphagia. In September 2021, he was hospitalized with severe dysphagia. EGD (Figure) at this time showed gray, yellow frondlike lesion replacing esophageal lumen from mid to distal esophagus with mucosal friability. His dysphagia transiently responded to repeat dilations, but continued to recur and worsen. Unfortunately, patient continued to have weight loss and dysphagia unresponsive to dilations. The patient was then started on gastric tube feedings. He was offered surgery due to the severity of his symptoms, but he declined. Most recently, the patient underwent endoscopic mucosal resection with deeper tissue samples revealing superficial fragments of laterally spreading squamous cell carcinoma of the esophagus. Discussion: In this case, there was a high clinical suspicion for malignancy, leading the endoscopist to obtain deeper tissue samples via endoscopic mucosal resection as superficial fragments of the esophagus only revealed parakeratosis. It is important to trust clinical judgment, especially if there is a high suspicion for malignancy. Tylosis also has a known association with EP and often presents with areas of thickened skin plaques on palms and feet. Tylosis has a strong association with head, neck, and esophageal squamous cell carcinoma. The patient had no family history of tylosis and no cutaneous features. Despite this, a careful inspection of the entire EP area with targeted biopsies should be obtained to evaluate for dysplasia. This case represents EP with years of no evidence of squamous cell cancer despite aggressively searching for it, which at least anecdotally suggests a precancerous potential for EP.Figure 1.: A. Initial EGD B. Recent EGD.

S2323 First Known Case of Esophageal Parakeratosis Associated With a Severe SARS-CoV-2 Infection

Introduction: Esophageal parakeratosis is a rare, benign condition that is associated with vitamin deficiencies as well as squamous cell carcinoma of the head and neck or upper gastrointestinal tract. Symptoms include dysphagia, odynophagia, and heartburn. Here we describe a patient diagnosed with esophageal parakeratosis in the setting of a recent, severe SARS-CoV-2 infection as his only associated condition. Case Description/Methods: A 79-year-old man presented for an outpatient endoscopy for history of a gastric mass. He had been worked up for this presumed gastrointestinal stromal tumor (GIST) with endoscopic and surgical biopsies that were unrevealing. During that time he developed a severe case of SARS-CoV-2 with prolonged hospitalization and was started on anticoagulation for bilateral pulmonary emboli. He developed hematemesis and endoscopy revealed a large ulcer at the same site of the previous noted mass instead of the previously. He was now presenting for endoscopic workup with EGD as an outpatient for follow up. Endoscopy revealed only chronic gastritis but no evidence of mass or ulcer. However, the entire esophageal mucosa was abnormal with diffuse sloughing. Brushings were taken and he was empirically started on antifungals for presumed candida esophagitis as well as proton pump inhibitor twice daily. Histology revealed esophageal parakeratosis without dysplasia without candida. He returned for a repeat EGD and was found to have a normal esophagus at that time. All vitamin levels checked were within normal range including zinc at 78 ug/dL. There were no other known active malignancies at the time and imaging revealed no residual evidence of mass. His only other association during this time was the recent, severe SARS-CoV-2 infection (Figure). Discussion: Esophageal parakeratosis needs to be differentiated from other conditions such as candida and eosinophilic esophagitis. It should raise suspicion for head and neck malignancies and has been found in the nearby esophageal mucosa of 90 percent of patients with esophageal cancer in one study. Other associated conditions with esophageal parakeratosis include tylosis and alcohol abuse. The temporal relationship of the severe SARS-CoV-2 infection likely causing some degree of immunosuppression in this patient could have been the precipitating factor that led to the development of his esophageal parakeratosis. More studies are needed to elucidate the relationship between the immunocompromised state during SARS-CoV-2 infection and esophageal parakeratosis.Figure 1.: Esophageal Parakeratosis.

AML-034 Granulocytic Sarcoma Disguised as Lymphoblastic Lymphoma

Acute myeloid leukemia (AML) is a malignant clonal disease of hematopoietic stem cells affecting the blood and bone marrow. Granulocytic sarcoma (chloroma) is a rare disease characterized by an extramedullary myeloid cell mass with or without bone marrow infiltration. We report a case of AML presented with granulocytic sarcoma causing cord compression. An 18-year-old male presented in January 2022 with acute onset and progressive low backache and lower limb weakness with no history of associated trauma. The condition was followed one week later by urine and stool incontinence. Clinical examination revealed motor and sensory impairment with bladder and bowel dysfunction. Pan CT scan showed an anterior mediastinal amalgamated lymph node with central necrosis and heterogeneous enhancement measuring 3.5×6 cm. MRI study detected a dorso-lumbar intradural extramedullary lesion 5×8×6 cm and a heterogeneously enhancing pre-sacral soft tissue mass measuring 3.2×7×6 cm. Biopsy and pathological examination of the dorsal mass showed infiltration by sheets and aggregates of malignant round cell tumor with diffuse, positive reaction of the tumor cells by LCA, CD99, PAX5, and BCL2 and 80%-90% of the cells positively stained by Ki-67, a picture suggestive of B-cell lymphoblastic lymphoma. A complete blood count revealed the following: white blood cell count 6.5×109/l, absolute neutrophil count 2.4×109/l, hemoglobin 11.9 g/dl, mean corpuscular volume 88.6 fl, platelets 217×109/l. Along with further immunohistochemical assessment of the dorsal lumbar mass, bone marrow examination showed 70% of blast cells positively stained for MPO, CD117, CD33, CD34, HLADR, and CD58 and negatively stained for TdT, CD79, cCD3, CD22, CD19, CD10, and CD20 with further immune staining of the spinal mass. The picture was consistent with AML. Treatment commenced, and the patient achieved complete remission following 2 induction therapies with a "7+3" regimen. On the clinical level, the patient showed noticeable improvement in sensation and motor power and was under high-dose cytarabine while the article was written. Myeloid sarcoma is a rare tumor consisting of immature granulocytic cells and is frequently misdiagnosed particularly in the absence of clinical suspicion of myeloid malignancies. Competent diagnostic clinical, laboratory, and radiological imaging of granulocytic sarcoma are crucial for proper management.

S1741 Gelatinous Ascites and a Double Duct Sign: A Case of Pancreatic Adenocarcinoma

Introduction: Pseudomyxoma peritonei (PMP) is a rare disorder characterized by the accumulation of gelatinous material within the abdomen and pelvis. While usually appendiceal in origin, it can be seen with mucinous tumors arising from the ovary, GI tract, urachus, and pancreas. We describe a case of pancreatic adenocarcinoma diagnosed due to the clinical syndrome precipitated by pseudomyxoma peritonei. Case Description/Methods: A 59-year-old Hispanic male presented to the hospital for evaluation due to a 2 month history of poor oral intake and worsening abdominal fullness, distension, discomfort, and intermittent pain. The patient reported one prior hospitalization for pancreatitis of unclear etiology, 3 years ago. A CT abdomen & pelvis was obtained; findings reported include multiple hepatic subcapsular cystic liver lesions, abdominal omental caking, ascites, and extrahepatic biliary and pancreatic ductal dilatation without definitive evidence of a mass. CEA and CA 19-9 were found to be elevated at 49.4 and 416 respectively. CT chest revealed a left-sided pleural effusion. Upper endoscopy and colonoscopy were negative. Paracentesis yielded gelatinous ascites. Clinical suspicion for appendiceal malignancy was raised which required surgical exploration and biopsy to confirm. An MRI of the abdomen was obtained to assess for pancreatic mass given presence of double duct sign. MRI revealed 2.2 x 2.7 x 5 cm lesion in the body of the pancreas, pseudomyxoma peritonei with scalloping of the liver and extension into the right posterior mediastinum via the esophageal hiatus, metastatic deposits in the porta hepatis and peritoneal carcinomatosis. No apparent abnormality in the appendix was observed. EUS FNA was performed; splenic vessel invasion by the mass was noted. Cytopathology supported a diagnosis of pancreatic adenocarcinoma. The patient was initiated on palliative chemotherapy with gemcitabine and nab-paclitaxel which led to a significant reduction in ascites and pleural effusion and improvement in symptoms. Discussion: This case highlights the potential of malignancies such as pancreatic adenocarcinoma to cause pseudomyxoma peritonei despite it more commonly being associated with appendiceal origin. Knowledge of this can help guide diagnostic and therapeutic plans.

S3660 Prolapsed Gastric Polyp Causing Gastric Outlet Obstruction

Introduction: Gastric polyps are epithelial and subepithelial lesions that encompass various pathological conditions. While largely asymptomatic, some may present with bleeding or obstruction. Our case demonstrates a rare presentation of a gastric polyp leading to mechanical complications. Case Description/Methods: A 64 year old female presented with progressively worsening nausea and vomiting associated with a 20 lbs weight loss since the last 5 weeks. The patient reported vomiting of undigested food shortly after her meals and occasionally during her meals. She denied abdominal pain, dysphagia, odynophagia, alteration of taste, constipation or loss of appetite. She denied similar symptoms with liquids. Upon evaluation, the patient appeared well and was hemodynamically stable. Labs were unremarkable. An abdominal CT scan showed nodular thickening of distal pylorus and distal duodenal bulb which raised suspicion for malignancy considering the patient’s reported weight loss. An EGD was performed which revealed a bilobed pedunculated gastric antral polyp (approximately 8 mm each lobe) prolapsed into the duodenal bulb with multiple papules and nodules in the antrum and inflamed gastric mucosa. The pedunculated gastric polyp was thought to be the cause of the patient's symptoms and was resected. Biopsy results revealed inflamed hyperplastic polyps with mildly active H. pylori gastritis, negative for intestinal metaplasia and dysplasia with some evidence of reactive foveolar hyperplasia. The patient had complete resolution of her symptoms post polypectomy. She was discharged with HP treatment and outpatient follow up care (Figure 1). Discussion: The patient’s symptomatic relief confirmed that the pedunculated antral polyp prolapsed into the duodenal bulb causing gastric outlet obstruction (GOO). Polyps in the stomach are usually small, asymptomatic and discovered incidentally on upper endoscopy. Several risk factors are associated with hyperplastic polyps including HP infection, bile reflux, and autoimmune gastritis. Rarely, large lesions greater than >2 cm in size that are more prone to surface erosion and can cause chronic blood loss and/or GOO. Endoscopic resection of symptomatic polyps and hyperplastic polyps >5 mm is currently recommended. Gastric polypectomy is considered a safe and easy procedure however, the risk of bleeding and perforation increases with the polyp size. Studies have found that eradication of HP resulted in regression of the existing polyps and prevented new polyp development.Figure 1.: Pylorus with bilobed gastric polyp manually pulled back into the stomach.

Radiological evaluation of ovarian mass by contrast-enhanced computed tomography abdomen with clinicopathological correlation in Eastern Indian population

Background: Adenexal masses present diagnostic challenges. After identification of the ovarian mass, the most critical step is to determine the degree of suspicion for malignancy. It is mainly based on imaging modalities and clinicopathological correlation. Aims and Objectives: This radiological study was designed to differentiate benign and malignant ovarian masses by contrast enhanced-computed tomography (CECT) of abdomen and correlation of the radiological findings with histopathological report. Materials and Methods: This was a hospital-based prospective study conducted in Department of Radiodiagnosis, Nilratan Sircar Medical College and Hospital, Kolkata during January 2019–June 2020. The study was done on clinically suspected 50 patients of 15–50 years with ovarian mass having CECT diagnosed solid/complex solid cystic mass. Results: Among 50 cases under study, 37(74.0%) were benign which was significantly higher than that of malignant cases (26.0%). Malignancy was significantly associated with wall irregularity, solid-cystic composition, presence of thick septations, septal enhancement, presence of both septal, and solid enhancement pattern in CECT. Conclusion: Based on the results of the present study, multi-detector contrast-enhanced CT could be a rapid non-invasive and cost-effective step in the evaluation of ovarian masses.

MUCUS OR MELANOMA? A CASE REPORT

MUCUS OR MELANOMA? A CASE REPORT

THROMBOEMBOLISM AS THE INITIAL MANIFESTATION OF CHRONIC LYMPHOCYTIC LEUKEMIA

THROMBOEMBOLISM AS THE INITIAL MANIFESTATION OF CHRONIC LYMPHOCYTIC LEUKEMIA

AN UNUSUAL OCULAR LYMPHOMA, PRIMARY INTRAVITREAL LYMPHOMA DIAGNOSED INCIDENTALLY

Ocular lymphoma involvement can be either secondary during systemic lymphoma or primary. Diagnosis can be troublesome due to insidious disease onset. Uveitis is the main differential diagnosis. The prognosis is poor. A 62-year-old male patient was evaluated during a periodical check-up for hypertensive retinopathy. The unexpected good vision quality with severe left vitreous infiltration and not associated macular edema contributed to malignancy suspicion. A diagnostic procedure was performed bilaterally. Both of the vitreal tissue revealed atypical lymphoid cells with B-Cell phenotype. Cranial MRI, PET-CT, and CSF analysis documented the case as primary vitreoretinal lymphoma (VRL). First-line treatment was with intravitreal methotrexate (MTX). After 10 courses, high-dose cytarabine-based treatment was given as consolidation. Considering high recurrence rates, stem cells were mobilized and cryopreserved for future use for autologous stem cell transplantation (ASCT). Follow-up was 3 monthly. After 10 months of remission period, retinal disease relapse was spotted. After 5 cycles bilateral intravitreal MTX, disease progressed as leukemic invasion of left optic nerve. High dose chemotherapy followed by ASCT was performed. Diagnosis of IVL is challenging due to late onset macular edema. Related with high relapse rates withhigh mortality, high-dose chemotherapy is the recommended management type currently.

Lymphocytic Mastopathy - Entity with Diagnostic Dilemma: A Case Report

Lymphocytic mastopathy is a condition that affects the breasts of people who have had diabetes for a long time. It frequently manifests as huge hard lumps, raising cancer risk and necessitating unnecessary surgery. Histopathologically, it is characterized by sclerosing lymphocytic mastitis. A nulliparous woman appeared with a firm, palpable breast lump. Malignancy was the clinical impression. They conducted imaging tests, which confirmed a malignancy suspicion. Histopathology revealed sclerosing fibrosis with keloid-like characteristics and abundant per lobular and intralobular lymphocytic infiltrates. Most of these instances will be resolved by clinicopathological correlation, which will help to avoid invasive surgical operations. However, imaging studies may not be appropriate in many situations. Understanding this pathology's proclivity is crucial because it shares many clinical and radiological features with breast cancer. Here we report a unique case study of Lymphocytic mastopathy in a 44-year-old female patient with complaints of pain in the right breast for 15 days. Ultrasonograms and histopathological studies have been conducted, which evidenced lymphocytic mastopathy.

A Rare Interesting Case of Brunner’s Gland Hyperplasia Causing Gastrointestinal Tract Obstruction

Brunner glands are exocrine glands that secrete mucus to protect against acid secretion. Brunner gland hyperplasia is an expansion in size and shape of glands due to excess mucus secretion which occurs in cases where acid is secreted in excess notably duodenal ulcer or gastritis. Usually asymptomatic as Brunner gland hyperplasia appears as small nodular growth noticed during endoscopic examination. Some Brunner gland hyperplasia causes gastric outlet symptoms that are seen in our case study, as we present a rare and interesting case of Brunner gland hyperplasia causing blockage of the gastric outlet (rare symptom). Although endoscopic removal was done in suspicion of malignancy and turned out to be benign Brunner gland hyperplasia which we are discussing in our case as an elaborate discussion. The importance of considering Brunner gland hyperplasia as a differential diagnosis for gastric outlet blockage, as well as the use of endoscopic biopsy for ruling out cancer, are reviewed in depth. There have been many reports in the adult literature of Brunner's gland hyperplasia causing the bleeding, blockage, or forming intestinal or duodenal folds. Similar cases of Brunner gland hyperplasia impeding stomach outflow are highly uncommon and should be reported.In cases of gastric outlet blockage, Brunner gland hyperplasia should be considered as a distinguishing a particular disease or condition from others that present with similar clinical features, and endoscopic assessment with histopathological microscopy may be a valuable tool in preventing needless surgical intervention. This case report research adds to the necessity of endoscopic biopsy.

Differentiation of renal masses with multi-parametric MRI: the de Silva St George classification scheme

PurposeTo develop a system for multi-parametric MRI to differentiate benign from malignant solid renal masses and assess its accuracy compared to the gold standard of histopathological diagnosis.MethodsThis is a retrospective analysis of patients who underwent 3 Tesla mpMRI for further assessment of small renal tumours with specific scanning and reporting protocol incorporating T2 HASTE signal intensity, contrast enhancement ratios, apparent diffusion coefficient and presence of microscopic/macroscopic fat. All MRIs were reported prior to comparison with histopathologic diagnosis and a reporting scheme was developed. 2 × 2 contingency table analysis (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)), Fisher Exact test were used to assess the association between suspicion of malignancy on mpMRI and histopathology, and descriptive statistics were performed.Results67 patients were included over a 5-year period with a total of 75 renal masses. 70 masses were confirmed on histopathology (five had pathognomonic findings for angiomyolipomas; biopsy was therefore considered unethical, so these were included without histopathology). Three patients were excluded due to a non-diagnostic result, non-standardised imaging and one found to be an organising haematoma rather than a mass. Therefore 72 cases were included in analysis (in 64 patients, with seven patients having multiple tumours). Unless otherwise specified, all further statistics refer to individual tumours rather than patients. 52 (72.2%) were deemed ‘suspicious or malignant’ and 20 (27.8%) were deemed ‘benign’ on mpMRI. 51 cases (70.8%) had renal cell carcinoma confirmed. The sensitivity, NPV, specificity and PPV for MRI for detecting malignancy were 96.1%, 90%, 85.7% and 94.2% respectively, Fisher’s exact test demonstrated p < 0.0001 for the association between suspicion of malignancy on MRI and histopathology.ConclusionThe de Silva St George classification scheme performed well in differentiating benign from malignant solid renal masses, and may be useful in predicting the likelihood of malignancy to determine the need for biopsy/excision. Further validation is required before this reporting system can be recommended for clinical use.

Easy Scheme Outlining the Various Morphological and Vascular Abnormalities of the Lymph Node Structure Associated with Recent COVID-19 Vaccination, Each with a Different Clinical/Diagnostic Management.

Throughout this recent ongoing SARS-CoV-2 pandemic, the European Society of Breast Imaging have surely contributed in improving the management of unilateral axillary adenopathy appearance homolaterally to the side of vaccine inoculation. After considering the patient’s COVID-19 history of vaccination, our group produced a day-to-day scheme that evaluates meticulously the probability of mammary malignancy, according to the lymph node characteristics including vascular abnormalities. It comprises of a UN (ultrasound node) score ranging from 2 to 5, that increases with the suspicion of malignancy. In this setting and in view of the additional incoming COVID-19 boost-dose vaccinations, we believe our model could be of great utility to radiologist when assessing patients whom do not have a straight forward diagnosis, in order to reduce breast cancer missed diagnosis, avoid delaying vaccinations, reduce rescheduling of breast imaging examinations and lastly avoid unnecessary lymph node biopsies.

What could this dark lesion on a woman’s eyelid be?

What could this dark lesion on a woman’s eyelid be?

309 Sonograhic Appearances of Hobnail Thyroid Carcinoma: A Rare Tumour

Abstract Background Hobnail papillary thyroid carcinoma is a rare, recently described papillary thyroid carcinoma variant, with potential for a more aggressive clinical course of disease and poorer prognosis1. The ultrasound features of papillary thyroid carcinoma variants can differ from known traditional features1 and the specific sonographic findings of the hobnail variant itself have not been previously described in the literature. Case report A 53-year-old man presented with a left thyroid mass. The ultrasound features of this mass included a predominantly cystic appearance with mobile internal echoes, vascularised internal septations, and murally based solid material. These ultrasound features were deemed benign by classification standards, which led to the patient being managed with active surveillance and interval imaging. However, the mass grew quickly, and the patient underwent diagnostic hemithyroidectomy which led to hobnail variant papillary thyroid carcinoma being found on pathology. Given that papillary thyroid carcinoma variants can lead to aggressive disease, the patient underwent completion thyroidectomy and level VI lymph node clearance, on multidisciplinary team recommendation. Discussion The ultrasound features of the hobnail variant of papillary thyroid carcinoma have not been previously described in detail in the literature and, in this case, are features that would be deemed benign by classification standards. The rapid growth of the mass is what led to clinical suspicion of malignancy and resulted in diagnosis. Therefore, careful clinical correlation is advised in order to discern this difficult diagnosis and to facilitate appropriate treatment.

Review of a 25-Year Experience in the Management of Ovarian Masses in Neonates, Children and Adolescents: From Laparoscopy to Robotics and Indocyanine Green Fluorescence Technology.

Background: Ovarian masses in pediatric populations are the most common abdominal masses in young girls. In neonates, the majority of masses are benign while in children and teen-agers the risk of malignancy exists. The aim of this study is to perform a 25-year experience retrospective analysis of clinical and therapeutic aspects of ovarian tumors in girls, in order to show how the development of minimally invasive technology has changed the management of this pathology. Methods: The records of patients under the age of 18 who were operated in three pediatric surgical units due to ovarian mass, in the last 25 years, were reviewed retrospectively. The study group comprised 147 patients operated between 1996 and 2021 with a diagnosis of ovarian masses. Data involved were demographical, surgical, follow-up and final diagnosis. We analyzed the type of surgical technique, intra-operative data (operative time, the use of different technologies), complications, length of stay and long-term follow-up. Based on these data, we assessed how the surgical approach to ovarian masses has changed in the last 25 years in newborns and young girls. Results: The patients ages ranged between 7 days and 15 years (median, 59 days). All the procedures were completed in laparoscopy or robotics without conversion in open surgery. One-hundred and eleven patients were neonates; they all had follicular cysts and they were all managed in laparoscopy using 1 or 3 trocars. In 80/111 patients (72%), a small part of ovarian parenchyma was saved; in 31/111 patients (28%), in which the ovarian parenchyma was not available, an ovariectomy was performed. Patients in which we saved a small part of ovary, at long term follow-up (minimum follow-up of 12 years) (29/80, 36%), developed a normal ovary at US control. Thirty-six were older patients. They had a histological diagnosis of benign (30) or malign (6) tumors. All the patients (8/36) with a pre-operative suspicion of ovarian malignancy received an ovariectomy and an adnexectomy using sealing devices. In the last 10 years in all the children, except neonates, we adopted sealing devices and, in the last 4 years, in 20 cases, we always adopted ICG fluorescence technology to check ovarian vascularization in case of torsion or to check lympho-nodes condition in case of malignancy. Conclusions: In neonatal ovarian cysts, surgical management remained unchanged and an ovarian sparing procedure is always indicated and the long-term follow-ups confirm this hypothesis. The principal innovation in this age period is the use of ICG fluorescence technology to check ovarian vascularization in case of torsion. In teenagers, the decision-making strategy is based on the tumoral markers and on the morphological aspects of the mass. Robotics cystectomy or ovariectomy now-days represents the safer and faster way to perform this. Sealing devices are essential tools for dissection and resection to avoid bleeding. ICG fluorescence technology in all ages is fundamental to check ovary vascularization after detorsion or to check lympho-node status in case of malignancy. All the suspected lesions have to be removed with an endo-bag.

Malignant Adenomyoepithelial Tumour of the Breast - a Rare Diagnosis - Case Report.

Breast adenomyoepithelioma is an unusual tumour characterized by a biphasic proliferation of epithelial and myoepithelial cells. Most of the breast adenomyoepitheliomas are considered to be benign and characterized by propensity for local recurrence. Malignant change can occur rarely in one or both cellular components. We here present a case of a 70-year-old previously healthy female who initially presented with a painless breast lump. The patient underwent wide local excision in view of suspicion of malignancy and sent for frozen section regarding the diagnosis and margins which surprisingly came as adenomyoepithelioma. Final histopathology came as low-grade malignant adenomyoepithelioma. The patient shows no sign of tumour recurrence in the follow up.