Low-grade endometrial stromal sarcoma with sex cord-like differentiation metastatic to the thoracic spines.

We report a case of monostotic low-grade stromal sarcoma (ESS) with sex cord-like elements metastatic to the thoracic spines, which to the best of our knowledge has not previously been documented. A 48-year-old female who had undergone total abdominal hysterectomy for low-grade endometrial stromal sarcoma 7 years previously presented with insidious onset of severe back pain of 2 months' duration. Magnetic resonance image (MRI) showed involvement of the eleventh and twelfth thoracic vertebral bodies. Decompression at the level of T10-12 was performed. Histologically, the laminae of thoracic vertebrae 11 and 12 were replaced by sheets of ovoid cells with plump nuclei intermixed with anastomosing trabeculae, cords and small nests, reminiscent of a sex-cord stromal tumor pattern. The tumor cells showed diffuse nuclear immunostaining for estrogen receptors (ER) and progesterone receptors (PR), as well as membranous immunostaining for CD10. The immunostaining for smooth muscle actin was focal and sparse. These findings confirmed the diagnosis of metastatic low-grade ESS with sex cord-like differentiation. Low-grade ESS with sex cord-like differentiation is an uncommon tumor which rarely metastasizes to the bone, and use of a panel of ER, PR, CD10, actin, cytokeratin and inhibin immunostains is essential to establish the diagnosis.

The use of a vacuum-assisted biopsy device (Mammotome) in the early detection of breast cancer in the United Arab Emirates.

Stereotactic core needle biopsy has proven to be an accurate technique for evaluation of mammographically detected microcalcification. The development of the Mammotome biopsy system has led many medical centers to use this vacuum-assisted device for the sampling of microcalcifications in mammographically detected nonpalpable breast lesions. Ninety-six women underwent 101 stereotactic Mammotome core biopsies for mammographic calcifications over a 32-month period in the Department of Surgery at Tawam Hospital, the national referral oncology center in the UAE. The stereotactic procedure was performed by surgeons using the Mammotome biopsy system. Microcalcifications were evident on specimen radiographs and microscopic sections in 96% and 87% of the cases, respectively. Excisional biopsy was recommended for diagnoses of atypical ductal hyperplasia or carcinoma. Patients with benign diagnoses underwent mammographic follow-up. Eighty-one lesions were benign, 5 atypical ductal hyperplasias and 14 carcinomas were diagnosed (2 invasive lobular carcinoma, 4 invasive ductal carcinoma, and 8 intraductal carcinomas in situ: 1 comedo, 1 cribriform, 6 mixed cribriform and micropapillary). Surgical excision in four patients with atypia on Mammotome biopsy (one was lost to follow-up) showed atypical ductal hyperplasia. Surgical excision in seven patients diagnosed with intraductal carcinoma in situ (one patient lost to follow-up) showed intraductal carcinoma with no evidence of microinvasion. Similar diagnoses were made in all the invasive ductal and lobular carcinomas in both Mammotome and excisional biopsies. A diagnosis of atypia on Mammotome biopsy warranted excision of the atypical area, yet the underestimation rate for the presence of carcinoma remained low. The likelihood of an invasive component at excision was negligible for microcalcification diagnosed as intraductal carcinoma in situ on Mammotome biopsy. Mammotome biopsy proved to be an accurate technique for the sampling, diagnosis, and early detection of breast cancer.