Tru-cut Biopsy Research Articles

Accuracy of Metabolic Imaging-guided Transthoracic Biopsy in Lung Cancer.

To compare the detection of transthoracic tru-cut biopsy performed on metabolically active areas in positron emission tomography (PET) for the diagnosis of lung cancer, compared to only CT scan-guided biopsy. Descriptive study. Department of Thoracic Surgery, Kayseri City Training and Research Hospital, Turkey, between December 2020 to June 2021. Patients of suspected lung cancer with pre-transthoracic biopsy chest computerised tomography and without positron emission tomography were included in Group A; while, patients with both and positron emission tomography chest computerised tomography were included in Group B. Based on the CT findings of the patients in Group A, a biopsy was obtained from the most appropriate place. The patients in Group B were evaluated by a nuclear medicine specialist and the place with the highest maximum standardised uptake value before the biopsy was marked and the area to be biopsied was determined. The malignancy detection rate was significantly higher in Group B (48/50 patients, 96%) than in Group A (36/50 patients, 72%, p=0.001). Two lesions in the Group B (4 %) and 14 lesions in the Group A (28 %) were found to give benign results (p=0.001). Biopsy was repeated in one patient of Group B, and in five patients of Group A due to an initial negative diagnosis. The sensitivity of PET/CT in predicting malignant tumor was 96%, with the positive predictive value (PPV) of 98.0%; while the sensitivity of CT was 74.5%, with PPV of 82%. Transthoracic biopsies taken by considering metabolically active areas of the mass in positron emission tomography-guided can both increase diagnosis rate and reduce the complication rate by preventing repeated biopsies. Key Words: Transthoracic biopsy, PET/CT, Metabolic active lesion, Malignant tumor.

Complications and diagnostic accuracy of CT-guided 18G tru-cut versus end-cut percutaneous core needle biopsy of solitary solid lung nodules.

Percutaneous biopsy has demonstrated high accuracy in diagnosis of lung nodules, but the technique is not innocuous and a yield decrease in lesions smaller than 20 mm has been reported. We carried out a prospective study to evaluate and compare the complications and efficacy of percutaneous core needle biopsy (CNB) of solitary solid lung nodules, which were performed with two types of automatic guns. 330 consecutive CT-guided CNB were included. Tru-cut or end-cut 18G devices were used alternatively. Nodules were categorized by their size: ≤10 mm, 11-20 mm and >20 mm. Incidence of complications such as pneumothorax or hemoptysis and factors influencing them (nodule size and depth within lung parenchyma) were evaluated. Diagnostic accuracy of CNB achieved in the three groups of nodules regarding the two different needles were calculated and statistically evaluated and compared. We performed 68 CNB in nodules ≤10 mm, 130 in 11-20 mm and 132 in >20 mm. Pneumothorax appeared in 24.2% of them, but only 5.7% required drainage. Hemoptysis was developed in 9.4% and abundant hemoptysis with hypoxemia was observed in only 4.2% of patients. Regarding appearance of complications between the two needle types, no significant differences were found. A higher risk of hemoptysis was observed in nodules ≤10 mm (OR = 3.87; 95% CI = 1.24-12.06, P = 0.019) and in those located deeper in pulmonary parenchyma (OR = 2.21; 95% CI = 1.04-4.69, P = 0.038). End-cut needles reached a diagnostic accuracy of 93.7%, 92.1% and 98.3%, in nodules sized ≤10 mm, 11-20 mm and >20 mm, respectively. Corresponding results for tru-cut were 84.7%, 88.5% and 92.1%. In spite of differences reaching up to 9% in smaller nodules, intra-group results were not significant. Both needles have similar complications rate. Despite not having observed statistically significant differences between the two types of needles, end-cut devices have demonstrated a higher diagnostic yield in the three groups of nodules and could be a more suitable option especially for CNB of nodules ≤10 mm.

Childhood renal tumors: surgical treatment and results

Aim: Renal tumors in children are rare. Wilms’ tumor (WT) is the most common renal tumor in childhood. The aim of this study is to investigate the data on the demographic factors, treatment, and follow-up results of pediatric patients who were operated on for renal tumors and determine the factors affecting mortality.
 Material and Method: Patients who were operated for renal tumor in our clinic in 2005-2020 were evaluated retrospectively. Age at diagnosis, gender, complaint, localization of the involved kidney, additional anomalies, tumor size, tru-cut biopsy performed, tumor stage, distant metastasis, applied treatments, pathology, treatment complications, and follow-up period were examined. 
 Results: Of the 47 patients, 25 were female and 22 were male. The mean age was 45.46 (2–204) months. The tumor was located in the right in 21 cases, left in 23 cases and bilateral in three cases. The mean length of the tumor was 11.73 cm. At the time of diagnosis, there was metastasis in 15 cases (31.9%). While metastasis were the most common seen in lung (24.3%), bone-cell metastases were seen in clear cell carcinoma (33.3%) and brain metastases were seen in rhabdoid tumor (50%). Tru-cut biopsy was performed in 15 (31.9%) cases and biopsy was diagnostic in ten cases. Histopathologically, 41 cases had WT (87.23%), three cases were clear cell carcinoma (6.3%), two cases had anaplasia rhabdoid tumor (4.2%), and one case had metanephric adenoma. Relaps occured in nine cases (19.14%) during the follow-up period. Histopathologically, one case was a clear cell carcinoma, one case was a rhabdoid tumor, and seven cases were unilateral WT. The survival rate of our series was 89,4%. 
 Conclusion: The most common renal tumor in childhood was WT. Surgery have no effect on survival; the most important survival factors were detecting the existence of rhabdoid tumors and anaplasia histopathologically. Therefore, during the follow-up and treatment of renal tumors in childhood, pathological examination should be of primary importance and followed up with the pediatric oncologists.

Granulocytic sarcoma with unusual localizations (breast and stomach) without bone marrow involvement after the allogeneic transplantation

Granulocytic sarcoma (GS) is a rare extramedullary solid tumor composed of immature myeloid cell that is associated with acute myeloid leukemia or myelodysplastic syndrome. Espe­cially, the involvement of the breast as a pattern of relapse after allogeneic bone marrow transplantation ( allo SCT) is extremely rare. We report the case of a 57-year-old woman who palpated a painless lump in the superior quadrant of her right breast. Her past medical history was a myelodysplastic syndrome ( MDS) treated with bone marrow transplantation. Imaging work-up by mammogram and ultrasonography ( US ) showed solitary mass suspect of malignancy in breast. Tru-cut biopsy was performed from the suspect palpable mass of the right breast. Histologic findings were compatible with a granulocytic sarcoma in breast. While she was also evaluated for mass in the breast, also investigated by endoscopy for the symptoms of gastrointestinal system. The endoscopic biopsy showed diffuse neoplastic infiltration similar the pathology of the breast. GS of the breast is a rare extramedullary involvement of hematologic diseases. There are no the specific radyologic features in the presentation with GS of the breast. Our case also showed that careful histopathological review along with all panel of immunohistochemistry is extremely important for diagnose.

Granulocytic sarcoma with unusual localizations (breast and stomach) without bone marrow involvement after the allogeneic transplantation

Granulocytic sarcoma (GS) is a rare extramedullary solid tumor composed of immature myeloid cell that is associated with acute myeloid leukemia or myelodysplastic syndrome. Especially, the involvement of the breast as a pattern of relapse after allogeneic bone marrow transplantation (allo SCT) is extremely rare. We report the case of a 57-year-old woman who palpated a painless lump in the superior quadrant of her right breast. Her past medical history was a myelodysplastic syndrome (MDS) treated with bone marrow transplantation. Imaging work-up by mammogram and ultrasonography (US) showed solitary mass suspect of malignancy in breast. Trucut biopsy was performed from the suspect palpable mass of the right breast. Histologic findings were compatible with a granulocytic sarcoma in breast. While she was also evaluated for mass in the breast, also investigated by endoscopy for the symptoms of gastrointestinal system. The endoscopic biopsy showed diffuse neoplastic infiltration similar the pathology of the breast. GS of the breast is a rare extramedullary involvement of hematologic diseases. There are no the specific radyologic features in the presentation with GS of the breast. Our case also showed that careful histopathological review along with all panel of immunohistochemistry is extremely important for diagnose. Keywords: myelodysplastic syndrome; granulocytic sarcoma; allogeneic bone marrow transplantation.

Incorporation of Core Biopsy and FNAB in the Diagnostic Algorithm for Endophytic and Submucosal Laryngeal Malignancies: A Technical Note.

Endophytic and submucosal laryngeal tumours pose as diagnostic as well as management challenges to the head and neck surgeon. Identifying the tumour location and extent of disease is crucial for the surgeon to determine the treatment options and the potential outcomes. Persistent laryngeal edema following radiotherapy also presents with a diagnostic dilemma, as distinguishing between recurrent laryngeal carcinoma and radiotherapy sequels; which include fibrosis, oedema and soft tissue and cartilage necrosis, can be confusing and punch biopsies performed in such cases would more than often yield inadequate or superficial tissue. Using a core biopsy gun for acquiring biopsy specimen is known to have more cellular material, less damage to the surrounding structure depth control, immediate analysis with higher accuracy rates. Patients with suspected laryngeal malignancy are initially evaluated with flexible endoscopy with Narrow band imaging (NBI) and appropriate imaging. These patients are subjected to Microlaryngoscopic under general anaesthesia. A core biopsy gun is used to obtain samples from the suspicious area. Simultaneously, with the aid of microlaryngeal forceps, an FNAC is also done and sent for rapid processing. Trucut biopsy is a novel diagnostic tool that can be commonly used in early laryngeal malignancies especially in those cases where there is strong suspicion of malignancy and the lesion is found to be submucosal. we noted that a routine DL scopy and Biopsy in submucoal disease often results in a acquiring a non-representative sample as well as causing inadvertent trauma to the surrounding mucosa. We encourage Laryngeal surgeons to routinely use Core biopsies and FNAC during routine microlaryngeal Examination for better yield, faster diagnosis and faster planning of treatment protocols.

The Evaluation of PSA levels in Libyan Prostate Cancer Patients

Background: Prostate cancer is the second most frequent cancer and the fifth leading cause of cancer death in men with higher prevalence in the developed countries. The use of biomarkers for prostate cancer can improve the diagnosis of prostate cancer and clinical management of the patients. Prostate-specific antigen (PSA) is widely used to screen for prostate cancer and there is evidence that PSA testing reduces prostate cancer mortality. Objective: In this report we have studied the relationship between the Gleason score, age and PSA levels of prostate adenocarcinoma tissues from Libyan patients to evaluate the levels of PSA in prostate cancer patients. Materials and methods: The data was collected from medical files of 40 patients who underwent curative surgical prostatectomy or prostate true cut biopsy at National Cancer Institute (NCI)-Misurata, Libya during 2016 to 2018. The clinical and histopathological information included age, PSA levels, and Gleason score grade. Results: Our data showed that PSA level was statistically significant correlation with Gleason score grade (p- value = 0.007, <0.05). The increased serum PSA level was associated with the progression of prostate cancer. However, we found no statistically significant correlation between PSA and the age of patients (p- value = 0.435). Conclusion: Our data confirmed the association of high levels of PSA and the progress of prostate cancer.

Utility of tru-cut biopsy in diagnosis of palpable pediatric soft tissue neoplasms.

Soft tissue neoplasms are infrequent in children with sarcomas accounting for approximately 7% of all pediatric malignancies. Morphologic diagnosis is challenging due to overlapping features. Subtyping and categorization of these lesions are difficult on fine-needle aspiration cytology (FNAC) alone owing to tumor heterogeneity and limited material in some cases. Tru-cut biopsies obtain adequate tumor tissue for ancillary studies besides conventional histology. The study aims to explore the role of tru-cut biopsy to arrive at a definitive diagnosis. The study also highlights the correlation between FNAC and histopathology on tru-cut biopsy besides explaining the significance of a panel of immunohistochemistry (IHC) markers for histological categorization and subtyping. A total of 61 children from infancy to 18 years were included in the study. Closed biopsy procedures like FNAC and tru-cut biopsy were performed, and the tru-cut biopsy specimen was subjected to a panel of immunohistochemical markers. Fisher's exact test for sensitivity and specificity towards detection of malignancy was 83% and 86%, respectively for FNAC. For tru-cut biopsy, sensitivity was 94% and specificity was 91%. The two-sided P value (<0.0001) was extremely significant. Cohen's Kappa coefficient value for tru-cut biopsy was 0.772 suggesting a substantial strength of agreement. Tru-cut with IHC had a Kappa value of 0.866 suggesting greater agreement with histopathology. Tru-cut biopsy is a simple, safe, and reliable adjunct to the FNAC. Instead, immunohistochemistry enhances the diagnostic accuracy.

Diagnostic yield of one-pore versus two-pore ultrasound-guided tru-cut needle pleural biopsy

Background Ultrasound (US)-guided tru-cut pleural biopsy is a rapid technique that is cheap, has low complication, provides real-time visualization of the biopsy needle, and is without radiation. Aim To increase diagnostic yield of US-guided tru-cut pleural biopsy by taking biopsy from two different sites and to study factors increasing this yield for an effective, safe, and noninvasive substitute of thoracoscopy. Patients and methods Randomly chosen 80 patients with undiagnosed pleural effusion were scanned by US and classified into two groups: one-pore group where tru-cut US-guided pleural biopsy was done using one opening in the most safe, accessible, thick nodular pleura and the other group is the two-pore group, taking the biopsy from two different site, making two pores instead of one. Results The two groups were comparable to each other in diagnostic yield, with no significant difference, and the factors affecting this yield were the more thickness of pleura, presence of nodularity or masses, and the caliber of the cutting needle. Conclusion There is no need for more than one pore for taking US-guided tru-cut pleural biopsy, and diagnostic yield depends on more needle caliber and the thickness of the pleura.

Audit of prostatic diseases diagnosed from Tru-Cut biopsies in Nnamdi Azikiwe University Teaching Hospital, Nnewi, using the P63 immunohistochemical marker

Background: There is growing literature on the burden of prostatic lesions: both benign and malignant among men of West African ancestry. There are also some studies on the prostate in Anambra State and South-East Nigeria, but these are mainly on patterns and prevalence, without the use of immunohistochemistry. Aims and Objectives: The aim of this study is to determine the histological pattern of prostatic diseases diagnosed from Tru-Cut biopsies in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, South-East Nigeria, using the p63 immunohistochemical marker. This will be a pioneer study in both the state and the geopolitical zone. Materials and Methods: This is a 2-year (January 2019 to December 2020) retrospective study of the immunohistochemical expression of p63 on the haematoxylin and eosin-diagnosed Tru-Cut biopsies of the prostate in the archives of the histopathology laboratory in NAUTH, Nnewi. A Purposive sampling method was used with a sample size of 151. Sections were made from the blocks, reviewed and stained using the p63 immunohistochemical marker. Results: There were 191 cases of prostate diseases histologically diagnosed, of which 151 met the inclusion criteria for the study. Of the 151 cases, 97 (64.2%) were diagnosed as benign and 54 (35.8%) were diagnosed as malignant. Following p63 immunohistochemistry, 97 cases were accurately diagnosed as benign and 54 cases accurately diagnosed as malignant with no misdiagnoses. The age of the patients ranged from 50 years to 90 years; however, the predominant population was in the sixth decade (31.8%) and seventh decade (35.1%), with a mean age of 75.3 years. There is no significant difference noted in the mean age of the non-neoplastic and neoplastic groups. Conclusion: This study shows that morphology alone is sufficient for the diagnosis of both Benign and prostatic lesions, as shown by the accuracy level (100%) in the haematoxylin and Eosin results. This is particularly important in resource-poor settings such as ours.

Atypical Breast CarcinomaA Series of Six Cases

Breast cancer comprises 10.4% of all cancer among women world and it the second most common type of cancer. Increased public awareness and screening have led to earlier diagnosis at different stages. Surgical resection can be done earlier and complete cure of the disease can be achieved. As a result survival rates for breast cancer in young women have improved significantly. Six unusual type of breast carcinoma, presented to the Surgery Outpatient Department were referred to Pathology Department for further investigations. Patient age and sex, clinical characteristics of the tumour, the duration of the lesion, the size, radiological investigation, Fine Needle Aspiration Cytology (FNAC), trucut biopsy and histopathological examination were noted. Immunohistochemical examination also done in all the cases. Out of the six cases of breast carcinoma, one was the mucinous carcinoma of breast, two invasive papillary breast carcinoma, one apocrine carcinoma, one invasive Pleomorphic Lobular Carcinoma (PLC) of breast and one was fibromatosis like metaplastic carcinoma of breast. All the patients were female except, a 71-year-old male who presented with invasive papillary carcinoma. All the female patients were presented at postmenopausal age group. After careful examination of the cytology and histopathological slides the final diagnosis was made which helped the clinician for further treatment. Rare breast cancers do not differ from other types of breast cancer in their presentation. But they vary by treatment regimens and outcomes. So, proper diagnosis with imaging, FNAC, trucut biopsy and histopathological examination is a combined tool for proper diagnosis and treatment.

Ewing’s sarcoma of the mandibular condyle in a young adult: a rare case report

Introduction: Ewing’s sarcoma is a malignant, small, round, blue-cell tumour with metastatic potential that usually occurs in older children and young adults. Its occurrence in the jawbones is exceedingly rare and even rarer the in mandibular condyle. This case is being reported due to the extreme unique imaging finding of Ewing’s sarcoma arising in the mandible in a young male. Observation: A 22-year-old healthy male presented with a complaint of a progressive swelling in his right preauricular region. Magnetic resonance imaging showed a hyperintense lesion with the right ramus with loss of fat planes. True cut biopsy and histopathological examination of the lesion was suggestive of Ewing’s Sarcoma. Immunohistochemical analysis confirmed the diagnosis. Discussion: The most common presenting symptom of Ewing’s sarcoma in the head and neck region is a rapidly growing expansile mass along with pain, paraesthesia, and visual disturbances often mimicking odontogenic infections. Higher imaging modalities play a major role in the evaluation of the extent of the lesion and diagnosis. Conclusion: Prompt and pertinent treatment planning is critical for appropriate and timely management.

Giant Lactant Adenoma: About a Case

Affecting young women, lactating adenoma is a rare benign tumor of the breast. It is seen mainly in the third trimester of pregnancy and in the postpartum period. Clinically, it is a solid mass, mobile typically benign but its character of rapid evolution is reminiscent of phyllodes tumors, sarcomas and galactoceles. The definitive diagnosis is histological. We report a case of lactating adenoma in a 26-year-old lactating woman, third procedure, second pare, with a history of tumor resection of the outer quadrants of the left breast, 9 months ago, whose histology evoked a fibrotic disease, cystic breast associating non-specific subacute mastitis with suppuration. Received for recurrence of a tumor in the left breast which was the site of a polylobed mass of about 10/5 cm occupying 3/4 of the breast with mobile ipsilateral axillary adenopathies. A micro tru-cut biopsy was performed and the histology was in favor of a lactating breast adenoma with no signs of malignancy. She underwent surgical excision, the consequences of which were simple.

Soluble B7H3 level in breast cancer and its relationship with clinicopathological variables and T cell infiltration.

Aim of the studyAlthough early diagnosis of breast cancer (BC) is often associated with a good prognosis, there is currently no biomarker with high sensitivity serving this purpose. B7H3, a recently identified member of the B7 family, appears to inhibit antitumor immunity. We investigated the soluble B7H3 (sB7H3) level in BC and its relationship with clinicopathological variables and stromal tumor-infiltrating lymphocytes (sTILs).Material and methodsThe study, which was designed as a cross-sectional trial between January 2020 and September 2021, included 93 BC patients, 20 patients with benign breast disease (BBD) and 14 healthy volunteers as the control group. Serum sB7H3 levels were measured using the ELISA (enzyme-linked immunosorbent assay) method and sTILs were measured by immunohistochemistry using Tru-cut biopsy materials.ResultssB7H3 levels in BC patients were significantly higher than those in patients with BBD and healthy volunteers. Receiver operating characteristic curve analysis results showed that sB7H3 level may be a potential biomarker for distinguishing patients with BC from those with BBD (AUC: 0.807; sensitivity: 0.786; specificity: 0.706) and from healthy volunteers (AUC: 0.731; sensitivity: 0.700; specificity: 0.692).ConclusionsTo the best of our knowledge, the present study is the first to investigate the relationship between sB7H3 and disease parameters in BC. We found that sB7H3 may be a clinically practical and meaningful biomarker in differentiating BC from BBD. In order to evaluate the relationship of B7H3 with clinical variables in BC, and especially with sTILs, tissue-based studies with higher numbers of patients are needed.

The diagnostic contribution of magnetic resonance imaging in the detection of axillary metastasis after neoadjuvant chemotherapy.

Sentinel lymph node dissection (SLND) is a reliable method that provides axillary staging in clinical node-negative (cN0) breast cancer patients before neoadjuvant chemotherapy (NACT). However, it is not a standard method on its own due to the high false-negative rates (FNR) reported in initially clinical node-positive patients (cN1-cN3). The contribution of magnetic resonance imaging (MRI) to SLND after chemotherapy is not well understood. In our study, we aimed to investigate the contribution of post-NACT MRI to SLND in breast cancer patients receiving NACT. Between January 2014 and December 2020, patients who had MRI images including the axilla after NACT and had axillary lymph nodes evaluation performed simultaneously with SLND were included in the study. MRI images of all patients were re-evaluated by 2 experienced clinicians. MRI and SLND results were analyzed to detect axillary lymph node metastasis. 117 patients were included in the study. The median age of the patients was 49 years. Before chemotherapy, 108 patients (92.3%) had tumor metastases in their axilla pathologically confirmed by tru-cut biopsy. Axillary downstage was obtained in 48.1% (n=52) of the patients after NACT. Of the 56 patients with axillary node positivity, 3 patients had no metastasis in the SLND evaluation (FNR=5.4%). The sensitivity of post-NACT MRI in detecting node positivity was 69.6%, the specificity was 90.2%, the positive predictive value (PPV) was 86.7% and the negative predictive value (NPV) was 76.4. SLND together with MRI predicted all node-positive patients (FNR=0%). In summary, SLND may not detect a group of patients with residual axillary lymph node metastases after NACT. We have shown that MRI can contribute to identifying these patients. If no metastases are detected by both methods (SLND and MRI), avoidance of axillary dissection may be an acceptable choice.

Sentinel Lymph Node in Breast Cancer, Our First Experience at Nicaragua. Case Report

Morton introduced cutaneous lymphoscintigraphy in melanoma. His results permitted to reproduce sentinel lymph nodes(SLN) in other areas. Krag and Weaver implemented portable gamma radiation detectors in breast cancer. The aim of this article is to describe the first expertise in our hospital using nuclear medicine in breast cancer and the methodological aspects of SLN and reviewing the international literature. Case Report: Female 54 years, no family history of breast cancer. Medical exam detected a mass of 3x2 cm in the upper outer quadrant of the left breast, there is no axillary mass. The Ultrasound: BIRADS IV A. Mammography: BI-RADS V Preoperative Classification: T2N0M0 Tru Cut Biopsy: Invasive carcinoma no type determined. Triple negative. Extension studies were negative. The lymphoscintigraphy done according to international protocol. Methylene blue was used in conjunction with the radiotracer; a periareolar sub dermal injection was given in the operating room. The Surgery performed on the day marked. After localized the scintigraphic hot spots in vivo with the gamma probe Nuclear Lab DGC II. The intraoperative frozen section analysis used with Haematoxylin and Eosin staining. Two SLN reported as metastases Negative. The axillary dissection was deferred. There were no complications. Post-surgical pathologic report showed invasive carcinoma no type determined size 35 x 30 x 28 mm, unifocal. In situ ductal carcinoma and in situ lobular carcinoma unidentified and lympho-vascular unidentified invasion. There is no tumoral extension to the skin. All margins were reported negative.pT2pN0. Conclusion: Each time that a new therapeutic tool is within reach of the oncologic patients, principally when his effectiveness have been demonstrated to long time. It to make true in low income country increase the challenge for her implementation. However, the multidisciplinary effort of the human resources and the help of the technology development of our institutions permeated to jump the hard barrier that this entails, achieving a great achievement to the patients with breast cancer in our country. This first effort is not distant from the reported in the international literature.

Heaviness in the chest and Hodgkin Lymphoma: An unusual presentation

Hodgkin lymphoma (HL) usually presents as nodal disease and may involve extranodal sites during the progression of the disease. Here we report a unusual case of Hodgkin’s lymphoma (HL) in an otherwise healthy 26 year old young male who came to the Pulmonology OPD with heaviness in the chest . An ultrasound shows mediastinal enlargement. The diagnosis of Hodgkin’s lymphoma was made on a trucut biopsy of mediastinal swelling.

AKCİĞERİN NADİR PRİMER MALİGN TÜMÖRLERİNDE KLİNİK VE RADYOLOJİK DEĞERLENDİRME

Objective&#x0D; The most common primary malignant tumors of the&#x0D; lung are squamous cell carcinoma, small cell carcinoma&#x0D; and adenocarcinoma. However, some rare malignant&#x0D; primary lung tumors can also affect the lung&#x0D; and cause difficulties in diagnosis and treatment.&#x0D; Conventional imaging methods do not help the diagnosis&#x0D; in most cases, and moreover, preoperative&#x0D; tissue samples may fail to establish a diagnosis. In&#x0D; cases with endobronchial lesions, small samples or&#x0D; lack of transthoracic biopsy in central tumors without&#x0D; endobronchial lesions can make diagnosis difficult.&#x0D; The definitive diagnosis can only be made after larger&#x0D; examinations with larger tissue samples taken after&#x0D; the operation. In addition, failure to differentiate benign-&#x0D; malignant in frozen examination may negatively&#x0D; affect the resection of the surgeon. It can cause incomplete&#x0D; or unnecessary resection.&#x0D; The aim of this study was to evaluate the clinical radiological&#x0D; and histopathological features of these tumors,&#x0D; which have been rarely reported in the literature,&#x0D; and to contribute to the diagnosis and treatment of&#x0D; these tumors.&#x0D; Material and Methods&#x0D; The study included 10 patients with rare malignant&#x0D; primary lung tumor who were operated on in our clinic&#x0D; between 2010 and 2019. All patients were retrospectively&#x0D; evaluated in respect of age, gender, symptoms,&#x0D; preoperative imaging methods and invasive diagnostic&#x0D; methods. Tumor localization, tumor size, type of&#x0D; surgical operation and survival were recorded.&#x0D; Results&#x0D; The 10 patients included in the study comprised 6&#x0D; males and 4 females. Postoperative histopathological&#x0D; diagnoses of the patients were reported as 2 carcinosarcomas,&#x0D; 2 large cell carcinomas, 2 epithelioid&#x0D; hemangioendothelioma, 1 glomangiosarcoma, 1 primary&#x0D; pulmonary leiomyosarcoma, 1 mucoepidermoid&#x0D; carcinoma, and 1 synovial sarcoma.&#x0D; Conclusion&#x0D; It can be difficult to diagnose in rare primary malignant&#x0D; lung tumors by preoperative imaging and preoperative&#x0D; invasive diagnostic methods. CT-guided fine needle&#x0D; biopsy and tru-cut biopsy, endobronchial biopsy&#x0D; and frozen samples performed before surgery may be&#x0D; insufficient in diagnosis, which may mislead the surgeon&#x0D; about lung resection.

English

BACKGROUND Breast diseases have been known to mankind since ancient times. However, earlier it was a matter of taboo and embarrassment that meant detection and diagnosis were rare. But the involvement of more women and actively bringing out the disease into open is a recent phenomenon. Various types of lesions from inflammation to carcinoma can affect the breast. Lump in breast is the commonest complaint which the patient presents to the surgeon. Different aetiologies of breast lump need different lines of management. We wanted to study the clinical profile of patients up to 40 years presenting with a discrete breast lump, diagnose different pathological conditions causing them and also study different investigations used for diagnosis. METHODS The study was done from October 2013 to December 2015 on a total of 305 consenting patients attending surgery outpatient department and those patients admitted in wards at government medical college, Nagpur were up to 40 years of age with a complaint of a breast lump. Clinical profiles of patients up to 40 years of age presenting with breast lumps were studied along with different investigations for diagnosis and different treatment modalities. RESULTS The highest incidence noted was fibroadenoma (178) in 58.36 % of cases and the lowest incidence was of duct ectasia (3) in 0.98 % of cases. The incidence of fibroadenoma in married women was 46.06 % and in unmarried was 53.93 %. The lowest number of breast lump cases was found in the 10-20 yrs (59) age group and a maximum number of breast lump cases was found in the 21-30 yrs age group (140). Total 74 patients diagnosed with malignancy were the most commonly affected patients in the age group of 31 – 40 yrs. Out of 305 patients with a history of self detected lump 87 i.e. 28.52 % had mastalgia and 16 patients presented with nipple discharge. Ultrasound showed only their benign breast disease characteristic and the definitive diagnosis was not possible in them. CONCLUSIONS Rate of benign pathologies is comparatively much higher than malignant ones in young females; however, increasing trends of malignancy in this age group cannot be neglected. With the global trend towards an increase in the incidence of breast malignancy, for every patient with a breast lump, cytological / tissue diagnosis by an expert pathologist must be established, before a further line of treatment can be planned. KEY WORDS Fibroadenoma, Malignancy (CA Breast), OPD (Outpatient Department), Trucut Biopsy.

Presentation of Acute Lymphoblastic Lymphoma and Colorectal Carcinoma in the Context of Constitutional Mismatch Repair Deficiency Syndrome: A Case Report with Literature Review.

Constitutional mismatch repair deficiency (CMMRD) is a rare autosomal recessive disease carrying an increased risk of cancers (paediatric tumours of central nervous system, haematolymphoid malignancies along with gastrointestinal (GI) cancer(s), which are usually seen in the second and third decades), leading to syndromic presentation. Causal mutations are detected in DNA mismatch repair (MMR) genes, including MLH1, PMS2, MSH2 and MSH6 that are also known for their established role in Lynch syndrome. We describe a case of CMMRD with an earlier (first decade of life) presentation of mediastinal acute lymphoblastic lymphoma and colorectal malignancy. A 5-year-old boy presented with respiratory complaints, bilateral cervical lymphadenopathy, multiple café-au-lait macules (CALMs) on the lower back and history of parental consanguinity with the death of three sisters due to brain tumour within 6 months of diagnosis. Computerised tomographic scan chest revealed a huge mediastinal mass. The patient underwent a trucut biopsy of the mass. The results were significant for a pre-T-cell acute lymphoblastic lymphoma. Suspicion of CMMRD was raised based on a combination of factors described above. A panel of MMR proteins was applied on the biopsy tissue that revealed loss of nuclear expression of MLH1 and PMS2 immunostaining in tumour cells with positive external controls. While on maintenance therapy for lymphoma, about a year later, the patient developed subacute intestinal obstruction due to a stenosing polypoidal circumferential tumour in the mid-sigmoid colon found on flexible sigmoidoscopy that was followed by endoscopic biopsies and insertion of a fully covered self-expanding metallic adult biliary stent with a diameter of 10 mm and length of 6 cm leading to immediate relief of obstruction. Biopsies revealed adenocarcinoma with neuroendocrine differentiation. Metastatic tumour deposits were seen in the omentum, anterior abdominal wall and the left peritoneal wall. Earlier (first decade) presentation of GI malignancy warrants that an earlier screening through radiological scans for any possible tumours and MMR protein expression analysis (loss in tumour plus normal non-tumour cells) are essential in patients having CALMs and family history of paediatric tumours.