Metastatic progression of breast cancer along with decreased mitochondrial cell death priming of breast cancer cells: a case report.

Metastatic breast cancer remains to be a major cause of cancer-related deaths in women. Exploring the molecular mechanisms to identify targetable alterations in progressing breast cancer and developing functional tools to predict therapy response in these patients are needed. In this report, we present a case of breast cancer patient who progressed following surgery and adjuvant endocrine therapy. Radiological and pathological analyses revealed metastasis to liver and brain. Paired liquid biopsies demonstrated acquired ERBB2 mutations in addition to TP53 and PIK3CA mutations, which were also present before progression. BH3 profiling test demonstrated decreased mitochondrial cell death priming in CTCs of the patient after progression. In conclusion, novel personalized treatment strategies are needed to monitor metastatic breast cancer patients for better clinical benefit.

Metaplastic Carcinoma of the Breast: Analysis of 38 Cases from a Single Institute.

OBJECTIVE: To evaluate the pathological and radiological features, hormone profiles, surgery and treatment methods of metaplastic breast carcinoma cases diagnosed at our center in the light of current literature. MATERIAL AND METHOD: A total of 38 metaplastic breast cancer cases diagnosed between 2006-2018 at our center were included in the study. The patients were evaluated in terms of age, tumor size, localization, histological grade, hormone profiles (ER, PR, Her2-neu), American Joint Committee on Cancer (AJCC) Tumor, Lymph node status, Metastases (TNM) stage, progression, survival, radiological features, types of surgery and therapy modalities (chemotherapy and / or radiotherapy). RESULTS: The age of the patients ranged between 32 and 95 years. Pathological evaluation of cases showed that 14 were pure epithelial (IC-NST + squamous cell carcinoma) and 24 were metaplastic carcinomas with mesenchymal differentiation. Ductal carcinoma in situ (DCIS) was accompanying an invasive component in twenty cases. Seventeen patients had lymph node metastasis. Twelve patients developed distant metastasis. Thirty patients were triple negative for hormone receptors. The mean follow-up period of the patients was 34 months. The estimated life expectancy was 116 months. All of the patients received chemotherapy and 28 patients received adjuvant radiotherapy. There was no correlation between tumor size and lymph node or distant metastasis in our series. Our findings are consistent with the literature. CONCLUSION: Metaplastic breast carcinoma is a rare entity among breast carcinomas. Metaplastic carcinomas of the breast draw attention with the differences in their clinical course and the radiological and pathological heterogeneity.

Not Otherwise Specified-Type Sarcoma of Breast with CD10 Expression: Case Report.

Primary breast sarcomas are very rare and account less than 1% of invasive breast carcinomas. Primary sarcomas of breast are leiomyosarcoma, angiosarcoma, liposarcoma, fibrosarcoma, rhabdomyosarcoma, malignant peripheral nerve sheath tumor and pleomorphic sarcoma. Recently, a new CD10 positive group of sarcoma was identified. These tumors cannot be classified as a soft tissue sarcoma and show diffuse strong positive staining pattern with CD10 (NSCD10). Herein we report clinical and morphological characteristics of two cases diagnosed with not otherwise specified-type sarcoma with CD10 expression by histologically and immunohistochemical findings with the literature. NSCD10 shows similarity with leiomyosarcoma and sarcomatoid-type metaplastic carcinoma histomorphologically among specific sarcomas of breast. CD10 expression should be taken into consideration in the presence of not diagnosed and not specified tumors and CD10 should be added to the immunohistochemical panel.

What does the Data of 354,725 Patients from Turkey Tell Us About Cervical Smear Epithelial Cell Abnormalities? - The Epithelial Cell Abnormality Rate is Increasing - Quality Control Studies and Corrective Activity are Musts.

OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.

Seroma Cytology in Breast Cancer: An Underappreciated Issue.

BACKGROUND: The presence of malignant cells in postoperative seroma has been ignored in current breast cancer treatment. We aimed to assess the presence of malignant seroma cytology and to evaluate its relationship with the known prognostic factors for breast cancer. PATIENTS AND METHODS: The solution from irrigation of the operation field and postoperative drainage fluid from 68 patients were prospectively collected and examined for malignant cytology. The results were evaluated according to the tumor characteristics and patient demographics. RESULTS: Malignant cytology was found in none of the intraoperative samples but was found in the postoperative samples from 4 patients. Of these 4 patients, 3 were free of axillary metastasis. None of the common risk factors for breast cancer was associated with the finding of malignant cytology. CONCLUSION: Malignant cells can be seen in the drainage fluids from breast cancer patients independent of any contamination occurring during surgery, even in those without axillary metastasis.

Huge Neck Masses Causing Respiratory Distress in Neonates: Two Cases of Congenital Cervical Teratoma.

Congenital cervical teratomas are rare and usually large enough to cause respiratory distress in the neonatal period. We present two cases of congenital huge cystic neck masses in which distinguishing cervical cystic hygroma and congenital cystic teratoma was not possible through radiologic imaging techniques. Experience with the first case, which was initially diagnosed and treated as cystic hygroma by injection sclerotherapy, led to early suspicion and surgery in the second case. The masses were excised completely and histopathologic diagnoses were congenital teratoma in both patients. Our aim is to review congenital huge neck masses causing respiratory distress in early neonatal life to highlight this dilemma briefly with these interesting cases.

Durable clinical benefit to trastuzumab and chemotherapy in a patient with metastatic colon adenocarcinoma harboring ERBB2 amplification.

Somatic ERBB2 amplification or activating mutations occur in approximately 2-5% of metastatic colorectal adenocarcinomas and are presumed to be oncogenic drivers, but limited evidence exists to suggest these lesions are sensitive to targeted monotherapy in patients. Here we present the case of a patient with advanced CRC with pulmonary metastases, who had progressed on both standard of care cytotoxic chemotherapy and anti-EGFR targeted therapy. Comprehensive genomic profiling (FoundationOne(®)) identified amplification of ERBB2 and a TP53 mutation in the metastatic lesion. Treatment with trastuzumab with a chemotherapy backbone elicited stable disease/minor response in the patient over a one year course of therapy, reducing tumor burden and significantly improving quality of life. This report demonstrates the application of personalized targeted therapy guided by comprehensive genomic profiling in metastatic colorectal adenocarcinoma.

A Comparative Study of Conservative versus Surgical Treatment Protocols for 77 Patients with Idiopathic Granulomatous Mastitis.

The purpose of this study was to analyze the clinical features and demographic data of patients with idiopathic granulomatous mastitis (IGM) and to compare the results of conservative versus surgical treatment protocols. The demographic data, clinical findings, microbiological and pathologic features, scanning and treatment methods, recurrence, and recovery rates of 77 patients were analyzed retrospectively. The patients were divided into two groups based on the type of treatment received. Core biopsies were used to diagnose 37 patients: 26 using incisional biopsies and 14 using excisional biopsies. Of the patient population with IGM, 31 were treated with surgical excision, one with a simple mastectomy, and one with a subcutaneous mastectomy combined with a breast implant, whereas 44 were treated with steroids. The recovery rates of the 44 patients who were treated conservatively were 6 (1-15) months while for the 33 patients who were treated surgically, it was 1 (1-5) month (p = 0.001). Nine patients from the conservative treatment group experienced a recurrence while there were no recurrences in the surgically treated group (p = 0.009). Among all patients, the recurrence rate was 11.7% (9/77) while the average follow-up period was 16.57 ± 18.57 months. As a comparative study between conservative treatment protocols and surgical ones for patients with idiopathic granulomatous mastitis (IGM), this study is the largest to date. A wide surgical excision is the preferred approach for treating patients with IGM because of the low recurrence rate.

Myofibroblastoma of the Breast.

This study aimed presenting a case of a 64-year-old woman with a rare diagnosis of myofibroblastoma (MFB). MFB is one of the rare, benign, spindle-like stromal tumors arising from the connective tissue of the breast. MFBs are often confused with fibroadenomas and hamartomas because of their benign characteristic appearance on breast imaging and are diagnosed after excisional biopsies. Their differential diagnosis with malignant neoplasia of the breast is important because of their wide morphological spectrum. Our case also demonstrated a breast mass with benign imaging characteristics and a needle core biopsy revealing a benign, spindle-like stromal tumor. The pathological examination performed after the excision of the lump demonstrated a collagenous-/fibrous-type MFB. This case report emphasizes the rare but important place of MFB variants of the breast in the differential diagnosis of breast mass.

Pathological assessment of follicular loss in laparoscopic endometrioma excision: effects of cyst size and surgeon's experience.

AIM: We planned to histologically demonstrate unintentional ovarian harm caused by excision of endometriomas. METHODS: One hundred and seven patients with 135 endometriomas had laparoscopic excision of endometriomas at a tertiary health-care clinic over a 6-year period. Records were obtained retrospectively and pathological specimens were reevaluated to demonstrate follicular loss. Tissue damage was scored morphologically and compared according to surgeons' experience and endometrioma size. RESULTS: Ovarian follicles were detected in 80% of endometrioma specimens near the cyst wall. Morphological scores of ovarian follicles were not affected by the surgeon's experience or endometrioma size. CONCLUSION: Surgical excision of endometriomas causes inevitable ovarian follicular loss. As observed in our study, this loss rate could not be traced to surgical experience or ovarian size.

Clitoris metastasis from a retroperitoneal leiomyosarcoma: A case report.

Leiomyosarcoma is a rare form of cancer commonly found in the retroperitoneum, uterus, stomach, small intestine and vascular tissue. Surgery with a wide margin of resection is the most effective treatment. Nevertheless, metastasis is common and generally occurs within the first 3 years. The liver and lungs are the most common sites of metastasis in leiomyosarcoma. Other sites of metastasis include bone, spleen, soft tissues and brain. Metastatic tumours of the clitoris are extremely rare. As cited in the literature, the most common cancers that metastasize to the clitoris are breast, bladder, renal and gastric. Here, we report a case of a clitoral mass in a 64-year-old woman who received an operation for retroperitoneal leiomyosarcoma 4 years prior. Mass resection was performed. The pathological diagnosis was a leiomyosarcoma metastasis. The patient also presented with brain and lung metastases at the time of the clitoral metastasis. This is the first case of clitoral and brain metastases originating from a retroperitoneal leiomyosarcoma.

Surgical treatment of the solid breast masses in female adolescents.

STUDY OBJECTIVE: To evaluate the histopathologic results of the excised solid breast masses in our clinic and to draw attention to breast masses in adolescents. DESIGN: A retrospective chart review study and review of the literature. SETTING: This study was conducted in Baskent University Adana Research Center between March 2003 and May 2011. PARTICIPANTS: Patients included 10 adolescent girls admitted to pediatric surgery clinic with the complaint of palpable breast mass who underwent surgical excision of the breast mass. MAIN OUTCOME MEASURES: The necessity of surgery in breast masses of female adolescents. RESULTS: 10 female patients with an average age of 14 years were operated on for breast masses. A palpable mass in the breast and social anxiety were the cardinal complaints. Two patients had a family history of breast carcinoma. One patient had a history of neuroblastoma in remission. Histopathologic examination revealed 3 juvenile fibroadenomas, 1 conventional fibroadenoma, 3 tubular adenomas, and 3 phyllodes tumors. CONCLUSIONS: Palpable breast masses in adolescents are uncommon and are usually benign. The low malignancy risk and rarity of breast masses in childhood create a controversy as how to manage breast masses. Ultrasonography is the initial imaging modality to define the characteristics of the breast mass. Excisional biopsy and histopathologic examination is essential to rule out rare, but probable malignant, lesions in adolescents in selected patients such as maternal history of breast carcinoma, previous malignancy history in the patient, big size of the mass, and no regression on follow-up.

Unusual malignant breast lesions: imaging-pathological correlations.

This pictorial essay presents the common radiological (mammography and/or ultrasonography) and pathological findings observed in unusual malignant breast lesions, which include well-differentiated subtypes of invasive ductal carcinoma not otherwise specified (tubular, mucinous, papillary, and medullary carcinomas), metaplastic carcinoma, and metastases. This study also includes unusual ultrasonographic appearances of a plasmacytoma.

Comparison of E-selectin and the other inflammatory markers in lumbar disc herniation: a new promising therapeutical window for radicular pain.

STUDY DESIGN: Histopathologic and immunohistochemical analysis of the herniated disc specimens obtained from 50 patients who had unilateral persistent radicular pain or unilateral radicular motor paresis. OBJECTIVE: The aim of this study was to investigate the prevalence of inflammatory cells in lumbar disc herniations (LDH) and compare the prevalence of leukocyte adhesion protein "E-selectin" with other inflammatory cells such as T cells, B cells, and macrophages. SUMMARY OF BACKGROUND: Studies on inflammatory cells and biochemical mediators of inflammation have suggested that these factors may play an important role in pathophysiology of radicular pain, and the medical therapy was formed against to block these cells and inflammatory cytokines. METHODS: The herniated disc specimens obtained from 50 patients who had unilateral persistent radicular pain or unilateral radicular motor paresis were microscopically examined after staining with monoclonal antibodies of CD20, CD45, CD68, and E-selectin. Relative risk assessment of the straight-leg raising (SLR) test positivity or negativity with CD20, CD45, CD68, and E-selectin staining was investigated. RESULTS: Our data emphasize that, the cases with positive SLR test had higher rates of immunostaining with E-selectin and CD45. There were no statistically significant relationship between SLR positivity and CD20 and CD68. CONCLUSIONS: We suggest that E-selectin is as valuable as the other well-known inflammatory markers in the pathogenesis of LDH. In our opinion, beside the well-known nonsteroidal anti-inflammatory drugs, antagonists targeting E-selectin can be potentially effective therapeutics for controlling inflammation in LDH.

Solitary polyps of the uncinate process.

Cases of a solitary polyp of the nasal cavity are much less common than cases of massive polyposis. The most important factor in the formation of solitary polyps is the anatomic variations that result in mucosal contacts. We report the case of a patient who had bilateral solitary polyps of the uncinate process. Radiologic and clinical examinations revealed a medially bent uncinate process in the right nasal cavity and a bifid uncinate process in the left nasal cavity. These structures were the origins of the polyps.

[A case of cervical lymphoepithelial cyst]. / Servikal lenfoepitelyal kist: Olgu sunumu.

Lymphoepithelial cysts are usually benign lesions of unknown etiopathogenesis. They develop in the lateral aspect of the neck and their diagnosis is mainly made with histopathologic examination. Total excision is the primary method for treatment. A 43-year-old woman presented with a swelling on the left side of her neck. Computed tomography of the neck showed a cystic lesion. Fine needle aspiration cytology yielded a diagnosis of benign epithelial cyst. The lesion was totally excised. Histopathologic examination of the specimen was reported as lymphoepithelial cyst. No complications were encountered in the postoperative period.

Nasoalveolar cysts: review of 3 cases.

Nasoalveolar cysts, also known as nasolabial cysts or Klestadt's cysts, are rare, nonodontogenic, soft-tissue lesions that arise during development of the maxilla. They occur lateral to the midline in the region of the maxillary lip and alar base. In this case report clinical features and treatment options of three patients with nasoalveolar cysts are discussed.

Can E-selectin be a reliable marker of inflammation in lumbar disc disease?

The cause of sciatica and low back pain associating with lumbar disc herniation has not been clearly identified until now. Inflammation has been shown to occur via immunohistochemical and biochemical methods in herniated disc tissues. The important prognostic role of E-selectin has recently been substantiated by other studies in early rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). The important role of adhesion molecules in the initiation and progression of the inflammatory response is well known for infectious diseases and autoimmune disorders. In our study, we aimed to show the role of E-selectin as an inflammatory marker and the correlation of inflammation with straight-leg raise (SLR) test findings and subtype of disc herniation. We found that the cases with positive SLR test had higher rates of immunostaining with E-selectin. This led us to think that E-selectin might play an important role in the activity status of the disease, meaning patients with more limited movement capacity might benefit from E-selectin antagonist therapy. Among the many studies performed to identify the relationship between the inflammation markers and activity of lumbar disc herniation, this is the first investigation held with E-selectin.