Double blind randomized controlled trial of efficacy of ormeloxifene for the treatment of fibroadenoma (The FIBROCENT study).

BACKGROUND: We evaluated the effectiveness of Ormeloxifene (Centchroman) on regression of Fibroadenoma in a double-blind randomized controlled trial. METHODS: Patients with biopsy proven Fibroadenoma were enrolled between March 2023 and October 2023 and divided in two arms- Ormeloxifene group and Placebo group. Effectiveness of the treatment was evaluated using USG. No residual mass was defined as complete regression and more than 30% decrease in size was considered as partial regression. RESULTS: A total of 130 consecutive patients with Fibroadenoma were randomized to Ormeloxifene group (n = 65) and Placebo Group (n = 65). Complete regression was observed in 9% (6/65) patients in Ormeloxifene group and 10.8% (7/65) in Placebo Group at the end of 12 weeks (p = 0.49). Twenty one patients taking Ormeloxifene reported adverse events as compared to none in the other group. CONCLUSION: In our study Ormeloxifene was not found to be effective in treatment of fibroadenoma and had concerning side effects.

Hydatid cyst of the infraspinatus muscle.

Muscle hydatidosis is rare accounting only for 3%-5% of cases. Until now, only one case of muscular hydatidosis involving the infraspinatus muscle has been recorded. Hereby, we present a case report of primary hydatidosis of infraspinatus muscle in a 32-year-old woman from Central India who presented with painful soft-tissue swelling. Ultrasonography appearance was consistent with that of hydatid cyst; while serology was negative, pericystectomy was performed, and the diagnosis was confirmed. The patient was followed up for a period of 6 months, and no recurrence was noted. Hydatid cysts should be considered in the differential diagnosis of soft-tissue swellings, particularly in endemic regions.

Validation sentinel lymph node biopsy study in cN0 axilla using low-cost dual dye technique: potential solution for resource poor settings.

BACKGROUND: Sentinel lymph node biopsy (SLNB) using radio-pharmaceutical and a blue dye is gold standard for axillary staging in clinically node-negative breast cancer. High costs and limited availability of radio-pharmaceutical and/or gamma probe are major deterrents in performing SLNB in developing countries. In this study, we evaluated feasibility of SLN identification (SLN-IR) of fluorescein-guided (FG) SLNB in combination with methylene blue dye (MBD). METHODS: This was a prospective cross-sectional non-randomized validation study in patients with clinically node-negative axilla. Patients underwent validation SLNB using fluorescein (and blue LED light) and MBD. Axillary dissection was performed irrespective of SLNB histology. SLIN-IR and False Negative Rate (FNR) were assessed for both groups. RESULTS: The SLNs were identified in 29 (96.6%) pre-chemotherapy patients and 23 (82%) post Neoadjuvant Chemotherapy (NACT) patients. The median number of sentinel lymph nodes identified was 3 (range of 1-5) in pre-chemotherapy patients and 1 (range of 1-3) in post NACT patients. The SLN-IR using MBD was 90%, FD was 86.7% and combined MBD FD was 96.7% in pre-chemotherapy patients. The SLN-IR using MBD was 82%, FD was 71% and combined MBD FD was 82% in in post NACT patients. The false negative rate (FNR) in pre-chemotherapy group was 8.0% (MBD), 8.3% (FD) and 7.4% (MBD + FD). The FNR in post NACT group was 8.7% (MBD), 10% (FD) and 8.7% (MBD + FD). CONCLUSION: This prospective validation study showed adequate SLN-IR and FNR using low-cost dual dyes in early breast cancer patients and can be used in low resource settings. However, SLNB in post NACT axilla though viable along with a satisfactory FNR, is associated with low identification rate and needs further evaluation.

Primary hyperparathyroidism misdiagnosed as metastatic disease, with trans-oral endoscopic surgical management.

Primary hyperparathyroidism is not so uncommon a disease. In high-income countries, with the introduction of routine biochemical testing in 1980s, it is diagnosed early, and the majority are seen as asymptomatic disease. However, in India, a severe symptomatic form is still seen, and many times patients are undiagnosed, thus continuing to suffer debilitating disease. Here, we report such a patient who was being treated as having bony metastases from an unknown primary source, when in fact he had osteitis fibrosa cystica due to primary hyperparathyroidism and was cured after surgery.

Axillary staging should be routine in primary rhabdomyosarcoma of breast: A rare case report and review of literature.

INTRODUCTION: Primary rhabdomyosarcoma (RMS) of breast is an uncommon entity and axillary lymph node (ALN) involvement is exceedingly rare. METHODS: Herein, we are reporting a case of RMS of breast with ALN metastasis in an adolescent girl. We searched Pubmed and Cochrane databases with keywords rhabdomyosarcoma and breast. All studies published in English language literature were included. Articles describing metastatic involvement of breast with RMS were excluded. RESULT: The initial search yielded a total of 8468 studies, out of which 03 were found to be duplicate. 8420 studies were excluded based on title and abstract as they did not fulfill inclusion criteria. Full text of the remaining 48 studies was screened. After full text screening, 26 case reports describing primary breast RMS were included. Overall 21% patients had axillary lymph node metastasis. CONCLUSION: Axillary staging should be considered in every patient undergoing surgery for breast RMS. However, it's impact on recurrence and survival could not be determined based on current review.