Terminal Duct Research Articles

Modified techniques versus Hadfield\u2019s procedure in patients with periductal mastitis

BackgroundPeriductal mastitis (PM) is a rare disease characterized by chronic inflammation of the terminal mammary ducts. Complete removal of terminal lactiferous ducts with Hadfield procedure is a previously defined technique in treatment but carries various complications risks. This study aims to evaluate the effectiveness of modified techniques in the treatment of PM.MethodsTwenty women who underwent surgery due to PM between January 2012 and December 2019 were retrospectively analyzed. Types of PM were determined. All patients were operated on with three different incisions [Hadfield’s operation with periareolar incision (n:11), periareolar combined radial incision (n:7), and round block incision (n:2)].ResultsThe mean age was 37.5 ± 6.5 years (range: 24–49). Sixty percent of patients had type 3 PM. In Hadfield’s procedure, NAC retraction (n:2), seroma (n:1), and hematoma (n:1) were seen. In the periareolar incision combined radial incision group only one patient had complications (seroma) and none in the round block method. Follow-up was 12 ± 1.5 months and disease relapse occurred in two patients in the Hadfield group. Patients who underwent round block were more satisfied with the appearance of the nipple.ConclusionsIn the treatment of PM, the main principle of surgical treatment is the excision of the affected canal with a clear margin. Apart from the classical Hadfield procedure, the round block method and periareolar combined radial incision techniques can be performed in the treatment of PM.

Automated quantification of levels of breast terminal duct lobular (TDLU) involution using deep learning

Convolutional neural networks (CNNs) offer the potential to generate comprehensive quantitative analysis of histologic features. Diagnostic reporting of benign breast disease (BBD) biopsies is usually limited to subjective assessment of the most severe lesion in a sample, while ignoring the vast majority of tissue features, including involution of background terminal duct lobular units (TDLUs), the structures from which breast cancers arise. Studies indicate that increased levels of age-related TDLU involution in BBD biopsies predict lower breast cancer risk, and therefore its assessment may have potential value in risk assessment and management. However, assessment of TDLU involution is time-consuming and difficult to standardize and quantitate. Accordingly, we developed a CNN to enable automated quantitative measurement of TDLU involution and tested its performance in 174 specimens selected from the pathology archives at Mayo Clinic, Rochester, MN. The CNN was trained and tested on a subset of 33 biopsies, delineating important tissue types. Nine quantitative features were extracted from delineated TDLU regions. Our CNN reached an overall dice-score of 0.871 (±0.049) for tissue classes versus reference standard annotation. Consensus of four reviewers scoring 705 images for TDLU involution demonstrated substantial agreement with the CNN method (unweighted κappa = 0.747 ± 0.01). Quantitative involution measures showed anticipated associations with BBD histology, breast cancer risk, breast density, menopausal status, and breast cancer risk prediction scores (p < 0.05). Our work demonstrates the potential to improve risk prediction for women with BBD biopsies by applying CNN approaches to generate automated quantitative evaluation of TDLU involution.

Feasibility Study of a Variant Procedure of Radical Breast Ductectomy (Dolichectomy) with a Perinipple Incision.

Papillomatosis and recurrent duct ectasia could be treated with terminal lactiferous ducts excision. In this study we describe a modified miniinvasive procedure of terminal lactiferous ducts excision with a perinipple approach to the lower or upper half of the nipple. This technique avoids the much more extensive periareolar incision and has excellent aesthetic results.

ФУНКЦИОНАЛЬНО-АНАТОМИЧЕСКИЕ ОСОБЕННОСТИ ЛИМФОВЕНОЗНОГО СОУСТЬЯ

The article presents a general description of the lymphatic system and detailed characteristics of the structure of the terminal thoracic duct (TD) and lymphovenous junction (LVJ): their clinical and anatomical features, the role of LVJ in regulating lymph flow, and the separating two systems (circulatory and lymphatic). The presented data expand the concept of the structural and functional characteristics of the left central LVJ, its valves, and TD, and also provides information about the anatomical heterogeneity of the studied tissue complex. The morphological and functional characteristics of LVJ will help to better understand the logistics of the lymph flow and the mechanism of the LVJ valves’ work. Keywords: Lymphatic system, thoracic duct, lymphovenous junction, ostial valve.

Thoraco-omphalopagus twins with complex biliary tree, pancreatic and intestinal anatomy: Planning behind successful separation, “the Santorini difference”

Here we report the separation of thoraco-omphalopagus twins at week 17th after birth, that are already 11-year-old and performing satisfactorily at the family, school, and social level. At birth, hearts shared a common pericardium and livers were fused along the anterior edge. Small bowel was common from duodenum down to the terminal ileum and invested by a dual mesentery. From the bifurcation bowels were normal. Bile and pancreatic ducts discharged into the duodenum but whether they were fused, or not, and details of the terminal ducts did not show up in the study. Vasculatures were independent. Teams -anesthesia, reconstructive, cardio-surgery, digestive, management-were formed and given specific tasks. Separation, programed for week 24, was performed at week 17 due to an emergency. In the intervention, the central step was the exploration of bile and pancreatic discharges. The duct of Santorini was searched for and identified; it discharged at the minor papilla in the duodenum prior to fusion. Both Wirsungs and the already fused common bile duct discharged in a single major papilla in a fused duodenum. The distance between papillae allowed for a duodenal transection between them. This scenario, considered during planning, commanded the separation. T1 kept the major papilla, while T2, the minor papilla complemented with a cholecystojejunostomy. Careful planning and management were keys to overcome both emergency and incomplete preoperative information.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ГИПЕРТЕНЗИОННО-ПРОТОКОВОГО ТИПА ХРОНИЧЕСКОГО ПАНКРЕАТИТА, В СОЧЕТАНИИ С СИНДРОМОМ БИЛИАРНОЙ ОБСТРУКЦИИ

Background. The frequency of chronic pancreatitis and its complications is steadily increasing, which makes the problem of treating this pathology one of the most urgent and significant. Objective. Improvement of the results of surgical treatment of patients with hypertension-ductal type of chronic pancreatitis with extended stricture of the intrapancreatic part of the common bile duct. Material and methods. During the period 2006–2021, 328 operations were performed in the Grodno University Clinic due to chronic pancreatitis with pathology of the ductal system in combination with pancreatic cysts. The total number of complications was 5,1%. 18 patients with chronic recurrent pancreatitis, ductal hypertension in combination with a cyst of the head pancreas, also with extended stricture of the terminal part common bile duct and mechanical jaundice were operated on according to the methods developed in the clinic: 12 patients underwent choledochopancreatoejunostomy, 5 patients underwent choledochocystopancreatoejunostomy, choledochocystoduodenostomy was performed in 1 case. Results. The developed methods make it possible to perform adequate internal drainage of the ductal system of the pancreas and bile ducts, as well as cystic formations. Conclusions. The application of the developed methods improves the results of surgical treatment complicated chronic pancreatitis.

Ceiling-fan-integrated air-conditioning: thermal comfort evaluations

Ceiling-fan-integrated air-conditioning (CFIAC) is a concept in which terminal supply ducts and diffusers are replaced by vents/nozzles that jet supply air into the vicinity of ceiling fans to be mixed and distributed within the room. CFIAC distributes the supply air within the room and convectively cools the occupants. This could allow raised thermostat set-points and reduced energy for the air-conditioning system’s supply fan and compressor. Previous work on CFIAC shows that the air temperature in the occupied zone is spatially uniform, but the air speed is not. This paper evaluates the thermal comfort performance of a CFIAC system under various ambient temperatures and fan operation modes. Human subject experiments and thermal manikin tests were conducted to characterize how subjects evaluate the thermal comfort performance across the room’s floorplate, and how CFIAC affects human body heat transfer. Despite the spatial variation in air speed across the floorplate, CFIAC created uniform thermal comfort perceptions. Comfort at 28°C was similar to that of 26°C for the overhead supply neutral reference condition. Human subjects preferred having the increased air movement over that of the reference condition. The paper evaluates thermal comfort indexes appropriate for evaluating and designing CFIAC. <em><strong>Practice relevance</strong></em> Despite the spatial variation in air speed across the floorplate, CFIAC created quite uniform thermal comfort perceptions. Conventional air-conditioning systems often create overcooling complaints because supply volumes through diffusers are kept overly high in order to disperse cold temperature dumping in the space. Ceiling fan circulation provides sufficient dispersion to eliminate this issue. However, it is important for standards writers and designers to understand that the room temperatures should not be so cold that the highest airspeeds caused by the ceiling fans will be uncomfortable for the occupants in the fan-cooling zone. To evaluate CFIAC systems, the standard effective temperature (SET) model is shown to be useful and the elevated air speed method in American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) Standard 55 also provides appropriate design guidance.

Meibomian Gland Dysfunction Causing Dry Eye Syndrome in Computer Users

Background: Meibomian glands are follicular glands that release lipid that shapes the tear film's superficial layer. A persistent, extensive terminal duct blockage and descriptive alterations in the secretory output indicate meibomian gland dysfunction. Digital eye strain is characterized by changes in ocular surface integrity, tear film function, blinking patterns, accommodation disorders, differences in fixation, dryness, weariness and discomfort while using digital gadgets. The COVID 19 pandemic have resulted in almost everything to be on digital platform.&#x0D; Objective: To conclude after reviewing various studies (between Jan 2016- Dec 2020) which were focused on how digital eye strain adversely affects the function of meibomian glands and adds to symptoms of dry eye in computer users.&#x0D; Study Design: Narrative review article&#x0D; Methodology: Various articles were reviewed which got published in between 2014-2020 in indexed journals. Meibomian gland dysfunction significantly affects the factors such as blink rate, tear break-up time (TBUT), tear evaporation rate, tear film composition as well as corneal staining, we will find its significant effect and relation to digital eye strain.&#x0D; Expected Results: Based on previous articles.&#x0D; Results: Digital eye strain significantly affects the function of meibomian gland, thus results in altered and poor tear film that finally results in dryness of eyes.&#x0D; Conclusion: Eyes with meibomian gland dysfunction, develop changes such as, reduced blink rate, shorter tear breakup time; altered tear film composition and disturbed ocular surface which adds on to symptoms of dry eye especially in chronic computer users.

Corrosion Cast and 3D Reconstruction of the Murine Biliary Tree After Biliary Obstruction: Quantitative Assessment and Comparison With 2D Histology

Obstructive cholestasis can lead to significant alterations of the biliary tree depending on the extent and duration of the biliary occlusion. Current experimental studies reported about advanced techniques for corrosion cast and 3D reconstruction (3D-reco) visualizing delicate microvascular structures in animals. We compared these two different techniques for visualization and quantitative assessment of the obstructed murine biliary tree with classical 2D histology. Male mice (n= 36) were allocated to 3 different experiments. In experiments 1 and 2, we injected two different media (Microfil© for 3D-reco, MV; Batson's No.17 for corrosion cast, CC) into the extrahepatic bile duct. In experiment 3 we sampled liver tissue for 2D histology (HE, BrdU). Time points of interest were days 1, 3, 5, 7, 14, and 28 after biliary occlusion. We used different types of software for quantification of the different samples: IMALYTICS Preclinical for 3D scans (MV); NDP.view2 for the digital photography of CC; HistoKat software for 2D histology. We achieved samples in 75% of the animals suitable for evaluation (MV and CC, each with9/12). Contrasting of terminal bile ducts (4th order of branches) was achieved with either technique. MV permitted a fast 3D-reco of the hierarchy of the biliary tree, including the 3rd and 4th order of branches in almost all samples (8/9 and 6/9). CC enabled focused evaluation of the hierarchy of the biliary tree, including the 4th to 5th order of branches in almost all samples (9/9 and 8/9). In addition, we detected dense meshes of the smallest bile ducts in almost all CC samples (8/9). MV and CC allowed a quantitative assessment of anatomical details of the 3rd and 4th order branches of almost every sample. The 2D histology identified different kinetics and areas of proliferation of hepatocytes and cholangiocytes. Complementary usage of 3D-reco, corrosion casting and 2D histology matched dense meshes of small bile ducts with areas of intensive proliferative activity of cholangiocytes as periportal proliferative areas of 4th and 5th order branches (∼terminal bile ducts and bile ductules) matched with its morphological information the matching assessment of areas with increased proliferative activity (BrdU) and a partial quantification of the characteristics of the 4th order branches of the biliary tree. The 3D-reco and corrosion casting of the murine biliary tree are feasibleand provide a straightforward, robust, and reliable (and more economical) procedure for the visualization and quantitative assessment of architectural alterations, in comparative usage with the 2D histology.

Peroxidasin Enhances Basal Phenotype and Inhibits Branching Morphogenesis in Breast Epithelial Progenitor Cell Line D492

The human breast is composed of terminal duct lobular units (TDLUs) that are surrounded by stroma. In the TDLUs, basement membrane separates the stroma from the epithelial compartment, which is divided into an inner layer of luminal epithelial cells and an outer layer of myoepithelial cells. Stem cells and progenitor cells also reside within the epithelium and drive a continuous cycle of gland remodelling that occurs throughout the reproductive period. D492 is an epithelial cell line originally isolated from the stem cell population of the breast and generates both luminal and myoepithelial cells in culture. When D492 cells are embedded into 3D reconstituted basement membrane matrix (3D-rBM) they form branching colonies mimicking the TDLUs of the breast, thereby providing a well-suited in vitro model for studies on branching morphogenesis and breast development. Peroxidasin (PXDN) is a heme-containing peroxidase that crosslinks collagen IV with the formation of sulfilimine bonds. Previous studies indicate that PXDN plays an integral role in basement membrane stabilisation by crosslinking collagen IV and as such contributes to epithelial integrity. Although PXDN has been linked to fibrosis and cancer in some organs there is limited information on its role in development, including in the breast. In this study, we demonstrate expression of PXDN in breast epithelium and stroma and apply the D492 cell line to investigate the role of PXDN in cell differentiation and branching morphogenesis in the human breast. Overexpression of PXDN induced basal phenotype in D492 cells, loss of plasticity and inhibition of epithelial-to-mesenchymal transition as is displayed by complete inhibition of branching morphogenesis in 3D culture. This is supported by results from RNA-sequencing which show significant enrichment in genes involved in epithelial differentiation along with significant negative enrichment of EMT factors. Taken together, we provide evidence for a novel role of PXDN in breast epithelial differentiation and mammary gland development.

HISTOGENESIS AND MOLECULAR PECULIARITIES OF TERMINAL DUCT IN THE WOMAN'S MAMMARY GLANDS

The development of a woman's mammary glands occurs during the fertile age. It is during this period that the glands are subject to morpho-functional changes in the form of proliferation and differentiation of the epithelium in the parenchyma and elements of the stroma as response to the action of many stimulating physiological factors of the body. There changes have a tendency to be repeated several times during the woman's reproductive age. There is enough in-depth knowledge about the object of the cyclic effect of sex hormones in the woman's mammary glands. This study will expand knowledge about the important morphological state of the terminal ducts of the mammary glands before pregnancy and childbirth that can be of great importance in determining the histogenesis of possible pathomorphological changes in the gland of a dyshormonal and neoplastic nature. The aim of the study was to investigate the molecular characteristics of the parenchyma of the terminal ducts of the mammary glands of a non-pregnant woman of reproductive age. The study was carried out on autopsy material of 192 micro-incisions of breast tissue samples from 8 women who died of infectious diseases. Karyometry with the definition of the logarithm of the volume of the nuclei of the parenchymal elements in the structures of the terminal ducts was performed; histological, histochemical and immunohistochemical research methods were applied. The study identified histogenetic series of the epithelial lining in the parenchyma of the terminal ducts of the mammary gland; applying immunohistochemical markers enabled cytotyping of the epithelial elements of these ducts, as well revealing certain functions of the terminal ducts of the mammary glands before pregnancy and childbirth.

The effect of respiration and body position on terminal thoracic duct diameter and the lymphovenous junction: An exploratory ultrasound study.

The thoracic duct (TD) drains most of the body's lymph back to the venous system via its lymphovenous junction (LVJ), playing a pivotal role in fluid homeostasis, fat absorption and the systemic immune response. The respiratory cycle is thought to assist with lymph flow, but the precise mechanism underpinning terminal TD lymph flow into the central veins is not well understood. The aim of this study was to use ultrasonography (US) to explore the relationship between terminal TD lymph flow, the respiratory cycle, and gravity. The left supraclavicular fossa was scanned in healthy non-fasted volunteers using high-resolution (13-5 MHz) US to identify the terminal TD and the presence of a lymphovenous valve (LVV). The TD's internal diameter was measured in relation to respiration (inspiration vs. expiration) and body positioning (supine vs. Trendelenburg). The terminal TD was visualized in 20/33 (61%) healthy volunteers. An LVV was visualized in only 4/20 (20%) cases. The mean terminal TD diameter in the supine position was 1.7 mm (range 0.8-3.1 mm); this increased in full inspiration (mean 1.8 mm, range 0.9-3.2 mm, p< 0.05), and in the Trendelenburg position (mean 1.8 mm, range 1.2-3.1 mm, p< 0.05). The smallest mean terminal TD diameter occurred in full expiration (1.6 mm, range 0.7-3.1 mm, p< 0.05). Respiration and gravity impact the terminal TD diameter. Due to the challenges of visualizing the TD and LVJ, other techniques such as dynamic magnetic resonance imaging will be required to fully understand the factors governing TD lymph flow.

The Protective role of Nigella sativa versus Lepidium sativum on the submandibular salivary gland in hypercholesterolemic albino rat (Histological and Immunohistochemical study)

Abstract Background: Direct relation between hypercholesterolemia and hyposalivation was suggested. Phytosterols of herbal origin have been used as prophylactic or curative agents against many disorders. Objectives: Evaluate the protective role of Nigella sativa (Ns) versus Lepidium sativum (Ls) on the histological picture of submandibular salivary glands in hypercholesterolemic albino rat; and its immunomodulatory role of nuclear factor kappa B cell (NF-κB) and alpha smooth muscle actin (α-SMA) expression on the tissues. Materials and method: This study was performed with forty male albino rats, divided into four equal groups as follow: Group 1 (n=10): served as negative control, Group 2 (n=10): were fed with hypercholesteremic supplement (HCS) for 8 weeks. Group 3 (n=10): were fed HCS with oral administration of (Ns) seeds for 8 weeks. Group 4 (n=10): were fed HCS with oral administration of (Ls) seeds suspension for 8 weeks. Results: Histological results of submandibular salivary gland in group 2 revealed severe atrophic and degenerative changes in the secretory terminal portions & ducts. In group 3, the tissues appeared with nearly normal histological structures which reflect the beneficial effects of Ns. In group 4, a lesser degree of improvement was noticed with Ls. Quantitative analysis for α-SMA and NF-κB revealed highly statistically significant decrease in group 3 and 4 in comparison with group 2. Conclusion: The immunohistochemical finding confirmed the histological results of the present study that proved the superior protective effects of Ns rather than Ls seeds against hypercholesterolemia on the submandibular salivary glands of albino rats.

Comparative Analysis of Eosin-based Fluorescence Microscopy of Non-neoplastic Breast Tissue and Fibroadenoma

Background: Fibroadenoma (FA) is one of the most frequently diagnosed benign neoplasm in women. Various researches have reported increased risk of breast cancer in females with FA. It stems from the proliferation of epithelial and stromal contents of the terminal duct lobular units (TDLU`S) of breast tissue, that are the primary sites for the histopathologic assessment which is the gold standard for the diagnosis of disease. However, this method is subjective and possess interobserver variability. Therefore, new quantitative methods are required to aid in diagnosis. Hence we evaluated fluorescence light intensity and its use in histopatholgic evaluation.&#x0D; Aim: The goal of this research was to compare and quantify red and green fluorescence light intensities of ductal cells and stroma of non-neoplastic breast tissue with fibroadenomatous tissue.&#x0D; Method: A cross-sectional study was done in the Cell biology and histology lab of Ziauddin University. 44 slides of normal breast tissue and 44 slides of diagnosed fibroadenomatous tissue were taken from Dr Ziauddin Hospital, North Campus. Hematoxylin and eosin (H&amp;E) staining of the slides were done following standard protocols. On microscopic examination, the changes in light intensities of ductal cells and stroma of normal breast tissue and fibroadenoma were quantified using dual channel fluorescence microscopy using Nikon NIS imaging software.&#x0D; Results: The results demonstrated statistically significant increase (p-value &lt;0.05) in mean red (37.22±5.9) and green (22.47±6.6) light intensity of stroma in FA when compared with red (32.71± 6.7) and green (17.01±4.3) light intensity of normal breast tissue. Whereas, R/G ratio for normal tissue was higher (1.95±0.11) than R/G for FA (1.74±0.37) with a p value of &lt;0.05. Similarly, for ductal cells; statistically significant (p value &lt;0.05) increase in mean red (38.86±5.4) and green (15.54±2.51) light intensity for FA was found when compared with red (29.62±1.89) and green (12.60±1.67) intensity of normal tissue. R/G ratio for FA (2.5±0.24) was compared to be higher than normal tissue (2.36±0.3) with a p value of &lt;0.05.&#x0D; Conclusion: The study suggests that fluorescence microscopy combined with quantitative assessment fluorescence light intensities may may be a helpful tool for histomorphic evaluation of the breast tissue.

Expression of LGR5 in mammary myoepithelial cells and in triple-negative breast cancers

Lineage tracing in mice indicates that LGR5 is an adult stem cell marker in multiple organs, such as the intestine, stomach, hair follicles, ovary, and mammary glands. Despite many studies exploring the presence of LGR5 cells in human tissues, little is known about its expression profile in either human mammary tissue or pathological lesions. In this study we aim to investigate LGR5 expression in normal, benign, and malignant lesions of the human breast using RNA in situ hybridization. LGR5 expression has not been observed in normal lactiferous ducts and terminal duct lobular units, whereas LGR5-positive cells have been specifically observed in the basal myoepithelium of ducts in the regenerative tissues, ductal carcinoma in situ, and in ducts surrounded by invasive cancer cells. These findings suggest LGR5 marks facultative stem cells that are involved in post injury regeneration instead of homeostatic stem cells. LGR5 positivity was found in 3% (9 of 278 cases) of invasive breast cancers (BC), and it showed positive associations with higher histologic grades (P = 0.001) and T stages (P < 0.001), while having negative correlations with estrogen receptor (P < 0.001) and progesterone receptor (P < 0.001) expression. Remarkably, all LGR5-positive BC, except one, belong to triple-negative BC (TNBC), representing 24% (9 of 38 cases) of all of them. LGR5 histoscores have no correlations with EGFR, CK5/6, Ki-67, or P53 expression. Additionally, no β-catenin nuclear localization was observed in LGR5-positive BC, indicating that canonical Wnt pathway activation is less likely involved in LGR5 expression in BC. Our results demonstrate that LGR5 expression is induced in regenerative conditions in the myoepithelium of human mammary ducts and that its expression is only observed in TNBC subtype among all invasive BC. Further studies regarding the functional and prognostic impact of LGR5 in TNBC are warranted.

Developing ovine mammary terminal duct lobular units have a dynamic mucosal and stromal immune microenvironment

The human breast and ovine mammary gland undergo striking levels of postnatal development, leading to formation of terminal duct lobular units (TDLUs). Here we interrogate aspects of sheep TDLU growth as a model of breast development and to increase understanding of ovine mammogenesis. The distributions of epithelial nuclear Ki67 positivity differ significantly between younger and older lambs. Ki67 expression is polarised to the leading edge of the developing TDLUs. Intraepithelial ductal macrophages exhibit periodicity and considerably increased density in lambs approaching puberty. Stromal macrophages are more abundant centrally than peripherally. Intraepithelial T lymphocytes are more numerous in older lambs. Stromal hotspots of Ki67 expression colocalize with immune cell aggregates that exhibit distinct organisation consistent with tertiary lymphoid structures. The lamb mammary gland thus exhibits a dynamic mucosal and stromal immune microenvironment and constitutes a valuable model system that provides new insights into postnatal breast development.

Basal Cell Adenoma – A Report of a Rarity in a Relatively Rare Site

Basal cell adenoma is a rare benign neoplasm of the salivary gland. It preferentially occurs in the parotid glandand upper lip during the sixth and seventh decades of life. The clinical presentation most frequently seenis a slow-growing, asymptomatic, movable, round or oval, normally coloured submucosal mass measuringless than 3.0 cm in diameter, encapsulated and well circumscribed. Histologically, the tumor consists of aproliferation of the terminal duct epithelial cells forming islands and sheets with sparse of fibrous stroma,and numbers of small myoepithelial cells are present . Here is a report of a rare case of basal cell adenomain a relatively rare site of palate presented to our department.

Genetic Disorders of Bile Acid Transport.

Genetic Disorders of Bile Acid Transport.

Imaging of Noncalcified Ductal Carcinoma In Situ.

Ductal carcinoma in situ (DCIS) is a commonly encountered malignancy, accounting for approximately 20% of new breast cancer diagnoses in the United States. DCIS is characterized by a proliferation of tumor cells within the terminal duct lobular unit with preservation of the basement membrane. Typically nonpalpable and asymptomatic, DCIS is most often detected as calcifications on screening mammography. However, DCIS may also be noncalcified. When compared to calcified DCIS, noncalcified DCIS is more likely to be symptomatic, with patients most often presenting with nipple discharge or a palpable mass. Diagnosing noncalcified DCIS is challenging since it may be occult or subtle on mammography, and ultrasound findings can be nonspecific and may be interpreted as benign fibrocystic changes. In cases with a calcified component of DCIS, the extent of DCIS may be underestimated by mammography because not all involved areas may calcify. Breast magnetic resonance imaging (MRI), although less readily available than mammography and ultrasound, is advantageous in detecting noncalcified DCIS, especially high grade DCIS, which may not develop microcalcifications. MRI relies on abnormal contrast uptake due to tumor vascularity and changes in vessel density and permeability. This pictoral review presents the spectrum of imaging findings of noncalcified DCIS to assist radiologists in accurately detecting and describing its key imaging findings. Utilizing different modalities, we review the differential diagnoses for noncalcified DCIS, show illustrative cases of noncalcified DCIS, and discuss the importance of this entity.

English

BACKGROUND Meibomian gland dysfunction (MGD) is one of the causes of evaporative dry eye disease. It is the terminal duct obstruction of the Meibomian gland and is associated with glandular secretion changes. These changes lead to decreased amount of lipids secretion which accounts for instability of tear film leading to evaporative dry eye disease. Chronic smoking also causes irritative, burning eyes along with unstable tear film. We wanted to study the corelation of chronic smoking with Meibomian gland dysfunction. METHODS This is a hospital based observational cross-sectional study that enrolled a total of 100 subjects having Meibomian gland disease (MGD), out of whom 61 were smokers and 39 were non-smokers. All enrolled subjects underwent tear film breakup time (TBUT), Schirmer I test (SIT) and slit-lamp microscope examination of lid margin abnormalities, Meibomian gland expression as well as meibum. RESULTS Our study found that the patients with Meibomian gland dysfunction with the history of chronic smoking had a remarkably decreased value of tear film break up time (TBUT), Schirmer’s 1 Test which explains the dry eye symptoms as compared to MGD patients without smoking. No significant differences were seen in lid margin irregularity and meibum secretion. Meibomitis is found in 29 smokers with MGD and 5 non-smokers with MGD which is not significant. CONCLUSIONS Chronic smoking is associated with MGD. KEY WORDS Cigarette Smoking, Meibomian Gland Dysfunction, Tear Film Tests