Accuracy of MRI Versus PET/CT in the Prediction of Treatment Response to Neoadjuvant Chemotherapy in Breast Cancer.

Background Breast-conserving surgeries have significantly advanced breast cancer treatment, offering favorable oncological outcomes, enhanced cosmetic results, reduced postoperative morbidity, and better psychological acceptance compared to mastectomy. The introduction of neoadjuvant therapy has expanded the applicability of breast conservation surgery to include locally advanced tumors. Tumor response to neoadjuvant chemotherapy is evaluated using imaging modalities such as breast ultrasound, breast magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT). Accurate prediction of therapeutic response facilitates the planning of surgical and adjuvant treatments. This study aims to compare the diagnostic accuracy of MRI and PET/CT in predicting treatment response to neoadjuvant chemotherapy in breast cancer patients. Methods This retrospective study was conducted at a tertiary care center in Bahrain. A total of 138 patients with locally advanced breast cancer or human epidermal growth factor receptor-2 (HER2) positive, hormone receptor-negative cancers who underwent breast-conserving surgeries between June 2018 and December 2022 were included. The inclusion criteria focused on patients achieving a complete pathological response following neoadjuvant systemic therapy, ensuring a homogenous study population. Patients with hormone receptor-positive early breast cancers or metastatic tumors, ineligible for neoadjuvant chemotherapy, were excluded. Non-responders and partial responders were also excluded from the study. Statistical analysis was performed using IBM SPSS v26.0 (IBM Corp., Armonk, US). Response rates for the imaging modalities and histopathology results were assessed. Agreement between histology and imaging modalities was computed using kappa statistics. Diagnostic performance for predicting "no residual" disease was evaluated using the McNemar Test. All tests were two-tailed, with a p-value <0.05 considered statistically significant. Results The study included 138 patients, of whom 73 (52.9%) had an incomplete response or residual disease, while 65 (47.1%) had a complete response or no residual disease according to histology reports. There was slight agreement between post-neoadjuvant MRI and histology results (Cohen's kappa 0.172, p=0.010), while substantial agreement was observed between post-neoadjuvant PET/CT and histology results (Cohen's kappa 0.614, p=0.000). PET/CT demonstrated a higher sensitivity of 93.8% (p<0.001) and a specificity of 68.5%. Although MRI was more specific, the positive predictive value was comparable for both PET/CT and MRI. Conclusion PET/CT shows higher sensitivity and can serve as an early marker for predicting complete pathological response in post-neoadjuvant breast cancer patients. However, the prediction of residual disease is optimized by combining both MRI and PET/CT as diagnostic modalities.

An extremely rare case of malignant jejunal mesenteric inflammatory myofibroblastic tumor in a 61-year-old male patient: A case report and literature review.

Introduction: A mesenteric inflammatory myofibroblastic tumor (IMT) is a rare solid tumor of intermediate malignant potential that affects children, adolescents, and young adults predominantly. IMT is mostly encountered in the lung. We report a case of malignant jejunal mesenteric IMT in a 61-year-old male patient who presented with vague abdominal pain and generalized weakness. CT scan revealed a mesenteric mass displacing the attached jejunum. Surgical resection was curative. Discussion: An extensive literature review was performed to update and further analyze the already available data. A total of 35 cases with mesenteric IMT were reported previously. Only five cases of jejunal mesenteric IMT were reported. Mesenteric IMT demands vast effort to reveal the diagnosis due to its vagueness in the clinical presentation. Mesenteric IMT resembles each other in plenty of pathological and immunohistochemical characteristics. Conclusion: To the best of our knowledge, this is the first case of malignant jejunal mesenteric IMT in the elderly. Surgical resection was curative.

Schwannoma originating in the soft palate: A case report.

INTRODUCTION AND IMPORTANCE: Schwannomas are relatively uncommon, benign, slow-growing neoplasms, which are derived from schwann cells that can arise from any cranial, peripheral, or autonomic nerves. The involvement of the palate is a rare presentation and hardly reported in the literature. CASE PRESENTATION: Here, we report the case of a 39-year-old woman with a history of a foreign body sensation in the throat and difficult swallowing. CLINICAL FINDINGS AND INVESTIGATIONS: Oral examination showed a smooth, non-tender, right-sided, soft palate mass. Computed tomography (CT) scan revealed a well-defined, non-enhancing, homogenous pedunculated soft tissue mass arising from the posterior edge of the right side of the soft palate. INTERVENTIONS AND OUTCOME: The mass was excised completely under local anesthesia in the clinical setting using a CO2 surgical laser. The mass was sent for histologic analysis, which confirmed the diagnosis of a benign schwannoma. CONCLUSION: Eventually, upon follow-up at six months post excision, no evidence of recurrence was detected.

Efficacy of fine-needle aspiration biopsy in diagnosis of breast cancer: a retrospective study of 303 cases in Bahrain.

Breast cancer is a leading cause of death in many countries worldwide and breast lesions remain a common diagnostic dilemma. Fine-needle aspiration biopsy (FNAB) has been suggested as the most important, first line, minimally invasive measure in the management of patients with breast lesions. The aim of this study is to evaluate the efficacy of FNAB in patients with breast lesions by comparing the diagnostic accuracy of cytology results with that of the definitive histological examination outcome and also to investigate the added value of a single aspirator experience to the overall diagnostic precision and compared with the internationally published results. A retrospective study of 303 breast FNAB samples were carried out by a single experienced cytopathologist with complete comparison records.The prevalence of positive cytologic diagnosis for the breast cancer was determined to be 20.4%. The overall diagnostic accuracy of FNAB was 97.9%, with a specificity and sensitivity of 98.3 and 96.5%, respectively. The overall positive and negative predictive values were determined to be 93.2 and 99.2%, respectively. In addition, the sensitivity was comparable in cases that have been attempted by palpation-guided sampling compared with those aspirations that were carried out under US guidance.Results from this study confirm that FNAB biopsies performed and reported by a dedicated, single, skilled cytopathologist are highly effective in diagnosis of breast lesions and reliable in differentiating benign and malignant breast lesions with an overall high efficacy in a specialized laboratory-based FNAB clinic.

Inflammatory myofibroblastic tumor of paranasal sinuses.

Inflammatory myofibroblastic tumors IMTs are clinico-pathologically distinctive but biologically controversial entities; they rarely affect the head and neck region and usually follow a benign clinical course after radical excision. We reviewed the literatures of IMTs and present a rare case of IMT arising from the maxillary paranasal sinus of an 11-year-old girl. Moreover, we elaborate on the morpho-immunophenotypic characteristics of this lesion. Microscopic examination revealed a spindle cell proliferation set in a highly vascular stroma with numerous inflammatory cells. Tumor cells were immunoreactive for vimentin, and smooth muscle actin, negative for desmin, S-100, p53, Cyclin D1, and bcl-2. The potential neoplastic nature of this lesion was substantiated by the strong diffuse immuno-expression of ALK-1 protein, a marker that has been linked to neoplastic transformation. The lesion was excised completely by a CO2 LASER as a new treatment modality and the patient manifested no evidence of disease recurrence at 10-months recall.