Borderline phyllodes tumor arising in accessory breast tissue at the axilla.

Accessory breast tissue is an anatomical variation which occurs during embryogenic development. It appears most frequently at the axilla. Benign and malignant processes in general breast tissue can occur in accessory breast tissue. We report a case of 76-year-old female presented with palpable, huge mass at the right axilla which pathology of the mass was borderline phyllodes tumor. Phyllodes tumors arising in accessory breast tissue is an extremely rare condition. And this case study showed more detail on phyllodes tumor which would encourage the advance in management of the disease.

Preoperative clinical characteristics between uterine sarcoma and leiomyoma in patients with uterine mass, a case-control study.

OBJECTIVES: To determine the preoperative clinical characteristics associated with uterine sarcoma in patients with uterine mass. STUDY DESIGN: We retrospectively reviewed medical records of patients who presented with uterine mass undergoing surgery at Ramathibodi Hospital, with a pathologically confirmed diagnosis, from April 1, 2000 to October 31, 2019. The cases are patients with uterine sarcoma, whereas the controls are patients with leiomyoma diagnosed in the same year, with a proportion of 1 case per 4 controls. The association between preoperative clinical characteristics and uterine sarcoma were analyzed. RESULTS: There were 18,218 patients with uterine mass undergoing surgery at Ramathibodi Hospital during the study period. Uterine sarcoma was diagnosed in 68 patients. Thus, the incidence of uterine sarcoma was 0.37%. Following multivariate regression analysis, the following factors seemed to be independently associated with increased risk of uterine sarcoma. Patients with uterine mass, age ≥ 40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, recognition of rapid growing mass, and with single uterine mass identified by ultrasonography were more likely to be diagnosed with uterine sarcoma with adjusted odds ratio (95% confidence interval) of 3.30 (1.29-8.43), 8.57 (2.38-30.82), 35.35 (2.94-425.13), 3.39 (1.40-8.23), 4.50 (1.78-11.36), 6.91 (2.08-22.91) and 4.70 (1.91-11.60), respectively. CONCLUSIONS: Clinical characteristics, ie, age ≥ 40 years old, postmenopause, postmenopausal bleeding, abnormal uterine bleeding, palpable mass, mass with rapid growth, or single uterine nodule identified by ultrasonography were considered the independently strong association with uterine sarcoma in women who presented with uterine mass.

Circulating Exosomal miRNAs as Biomarkers in Epithelial Ovarian Cancer.

Failure to detect early-stage epithelial ovarian cancer (EOC) is a major contributing factor to its low survival rate. Increasing evidence suggests that different subtypes of EOC may behave as distinct diseases due to their different cells of origins, histology and treatment responses. Therefore, the identification of EOC subtype-specific biomarkers that can early detect the disease should be clinically beneficial. Exosomes are extracellular vesicles secreted by different types of cells and carry biological molecules, which play important roles in cell-cell communication and regulation of various biological processes. Multiple studies have proposed that exosomal miRNAs present in the circulation are good biomarkers for non-invasive early detection of cancer. In this review, the potential use of exosomal miRNAs as early detection biomarkers for EOCs and their accuracy are discussed. We also review the differential expression of circulating exosomal miRNAs and cell-free miRNAs between different biofluid sources, i.e., plasma and serum, and touch on the issue of endogenous reference miRNA selection. Additionally, the current clinical trials using miRNAs for detecting EOCs are summarized. In conclusion, circulating exosomal miRNAs as the non-invasive biomarkers have a high potential for early detection of EOC and its subtypes, and are likely to be clinically important in the future.

Serum CA19-9, CA-125 and CEA as tumor markers for mucinous ovarian tumors.

AIM: To analyze the use of serum cancer antigen 19-9 (CA19-9), cancer antigen 125 (CA-125) and carcinoembryogenic antigen (CEA) in predicting the malignant potential of mucinous ovarian tumor, and to assess the clinical factors associated with these tumors. METHODS: This retrospective study collected the data from 314 patients who were diagnosed with mucinous ovarian tumor. These patients had preoperative serum CA19-9, CA-125, CEA available and underwent surgery at Ramathibodi Hospital between January 2010 and December 2016. The diagnostic performance of CA19-9, CA-125 and CEA was analyzed using the receiver operator characteristic curve. The associations between clinicopathological factors and serum CA19-9, CA-125 and CEA level were also analyzed. RESULTS: A total of 314 patients were recruited in this study. They consisted of 221 patients with benign mucinous ovarian tumor (70.38%), 65 patients with borderline mucinous ovarian tumor (20.70%) and 28 patients with mucinous ovarian carcinoma (8.92%). Multivariate analysis revealed that the tumor size, elevated serum CA19-9, CA-125 and CEA influenced the tumor pathology. The mucinous ovarian tumor with large tumor size, elevated serum CA19-9, CA-125 and CEA more than the cut off values showed a positive correlation with the risk ratio of 1.60 (95% CI = 1.13-2.28; P = 0.005), 1.74 (95% CI = 1.22-2.47; P = 0.002), 1.90 (95% CI = 1.34-2.70; P < 0.001), 1.58 (95% CI = 1.10-2.29; P = 0.020), respectively. CA-125 provided the highest diagnostic performance, with an area under receiver operator characteristic curve of 0.745, to differentiate between borderline, malignant or benign mucinous ovarian tumor. CONCLUSION: Preoperative elevation of the serum CA19-9, CA-125, CEA and tumor size are useful predictors to differentiate between benign, borderline and malignant mucinous ovarian tumor. The best predictor is CA-125, followed by CA19-9 and CEA.

A large abdominal desmoid tumor associated with pregnancy.

Desmoid tumors are rare, benign tumors with locally aggressive behavior which originate from fascial or musculoaponeurotic structure. They are more common in young women than young man. The etiology of desmoid tumors are uncertain but may be related to operation, trauma or hormonal factors. The authors report a 17-year old woman, gravida 1, para 1 with a mass at her lower abdominal wall during the fifth month of gestation. She was biopsied during delivery in another hospital but was not given a definite diagnosis. The mass had grown rapidly after biopsy and delivery. The tumor measured 28 x 21 x 18 centimeters in size and 4,900 g in weight. Complete surgical excision was performed The pathological report was desmoid tumor (aggressive fibromatosis). She had no post-operative complication and no recurrent tumor in the 8 months after operation.