Primary breast osteosarcoma: A case report and review of the literature.

Primary breast osteosarcoma (PBOS) is an extremely rare and poor prognostic malignancy that has not a definitive treatment guideline. Here, we presented a successfully treated case of PBOS and provided a comprehensive review of the literature which revealed the divergence of opinions regarding the histogenesis and management of this malignancy.

Premalignant Disorders of the Breast in Pregnancy and Lactation.

Papillomas, atypical hyperplasias, and lobular carcinoma in situ of the breast are not malignant tumors, but present serious management challenges when they are diagnosed in a breast biopsy . Upgrading after excision and increased possibility of future cancer are risks that accompany these lesions. While some features have been defined as high-risk for upgrading, many practitioners now recommend conservative non-surgical treatment and vacuum-assisted biopsy . However, the challenge gets worse when the patient is pregnant or breastfeeding because of the limitations in imaging and treatment in relation to the fetus. This chapter deals with these problems, although the best management strategy cannot be defined because of lack of evidence at present.

Imaging features of granulomatous mastitis in 36 patients with new sonographic signs.

PURPOSE: Idiopathic granulomatous mastitis is a rare relapsing benign inflammatory breast disease with unknown etiology. Its clinical features and imaging signs may mimic inflammatory breast cancer or some other inflammatory breast disease. This may interfere with correct and timely diagnosis and thus impose an additional burden on the costs of diagnosis and therapy, as well as patient anxiety. We aimed to characterize the imaging findings of this disease and introduce two new imaging signs. MATERIALS AND METHODS: This prospective study examined 36 patients with imaging and a clinical diagnosis of mastitis granulomatosis who were untreated and then confirmed by pathology. Demographic information, clinical data, imaging findings, and signs were recorded. RESULTS: The age range of the patients was 22-60 years with an average of 36 years. Most of the patients (78%) were at reproductive age. None of the patients had a family history of granulomatous mastitis. Most patients with granulomatous mastitis (89%) lived in regions with low socioeconomic status. For most patients, sonography indicated a heterogeneous hypoechoic mass with irregular shape and ill-defined margin (26 cases; 72.2%). Focal asymmetry (36%) and obscured mass (36%) were the most common mammographic findings. Two signs of duct ectasia containing secretion and high-flow pseudocyst appearance were described. CONCLUSION: Mammographic and ultrasound findings can highly suggest a diagnosis of granulomatous mastitis in an appropriate clinical context.

A Rare Case of Serous Papillary Ovarian Epithelial Type Carcinoma in Testis: A Rare Testicular Neoplasm.

Ovarian epithelial type carcinomas of testis are an extremely rare group of tumors, a few cases of which having been reported. We present the case of a 67-year-old man, presented with testicular mass and inflation, who underwent radical orchiectomy and pathological and immunohistochemical assessments revealed serous papillary carcinoma of ovarian epithelial type tumor of testis.

Evaluation of the risk of cervical cancer in patients with Multiple Sclerosis treated with cytotoxic agents: A cohort study.

Background: Since most patients with relapsing-remitting multiple sclerosis (RRMS) are women, the present study aimed to determine whether treatment of patients with MS by cytotoxic agents is associated with an increased risk of cervical dysplasia. Cancer screening is often neglected in the chronic diseases such as MS, so more attention in this field was needed. Decreasing morbidity and mortality due to cervical cancer is the most important goal of screening in female MS patients especially in child bearing age. Thus, it can be said that this is the first study which investigated this important issue. Methods: A total of 129 individuals participated in this cohort study. They were assigned into 3 groups including 43 patients with MS who were treated with cytotoxic drugs, 43 patients with MS on immunomodulators, and 43 normal healthy controls. Pap smears were performed following standard methods and the results obtained from the three groups were compared by statistical analysis. Demographic data, Expanded Disability Status Scale (EDSS), and Pap smear changes were analyzed by SPSS software. Results: The most commonly detected abnormality in all examined patients and healthy controls was inflammation. Five patients with MS who were treated with cytotoxic agents revealed benign cellular changes (BCC) in their Pap smear that were statistically significant in comparison with other groups (P = 0.03). Patients who took Mitoxantrone presented BCC more than other groups [Odds ratio (OR) = 9.44, 95% confidence interval (CI): 1.46-60.70]. There was no significant difference between mean duration of MS diagnosis (P = 0.12), mean duration of previous MS treatments (P = 0.25), and mean duration of current MS treatments (P = 0.21) in patients with BCC compared to normal healthy controls or inflammatory change. Conclusion: According to the results of present study, BCC is more frequently observed in patients with MS who were treated with cytotoxic agents with immunosuppressive effect. Since BCC is a 'premalignant condition', the authors suggest that mandatory annual Pap smear should be performed for patients with MS who are treated with cytotoxic agents irrespective of their age in order to detect early signs of malignancy.

A Case of Advanced Unicentric Retroperitoneal Castleman's Disease, Associated With Psoriasis.

We present here a 32-year-old male with advanced lately diagnosed, right sided retroperitoneal mass, which had been already treated due to progressive muco-cutaneous lesions clinically consistent with psoriasis, during recent four years. The advanced retroperitoneal mass resected surgically and reported as hyaline-vascular castleman disease with a dense focus of coarse calcification, on histopathology. Association of psoriasis and castlman disease is discussed in this case report.

The Core Needle and Surgical Biopsy Concordance to Detect Estrogen, Progesterone, and Her-2 Receptors in Breast Cancer: A Comparative Study.

BACKGROUND &OBJECTIVES: Evaluation of estrogen receptor (ER), progesterone receptor (PR), and (human epidermal growth factor receptor-2) Her-2 on core needle biopsies (CNBs) is increasingly in use to diagnosis early breast cancer, but its concordance with surgical excision (SE) is not well documented. METHODS: The study included 100 formalin fixed, paraffin-embedded specimens of invasive breast carcinoma archived in Pathology Department of Cancer Institute, Tehran, Iran, from 2011 to 2014. Immunohistochemistry was applied to detect ER, PR, and Her-2. RESULTS: The current study findings indicated a significant correlation of 90% between CNB and SE specimens for ER expression. The correlation between CNB and SE specimens was estimated as 81% and 97.3% for PR and Her-2, respectively. DISCUSSION: CNB can be performed confidently to determine ER and Her-2. For PR, results obtained from CNB should be considered.

Bilateral Simultaneous Pseudoangiomatous Stromal Hyperplasia of the Breasts and Axillae: Imaging Findings with Pathological and Clinical Correlation.

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a pathology that is usually diagnosed by accident during pathological examination of other breast lesions. PASH is an uncommon and benign tumoral lesion of the mammary stroma that can be pathologically mistaken for other tumours, such as phyllodes, fibroadenoma, and sometimes even angiosarcoma. We report the case of a 45-year-old woman with complaints of huge bilateral breast enlargement. This is a rare case of PASH presenting with gigantomastia and involving bilateral breasts and axillae simultaneously. Mammography, ultrasonography, and MRI features are illustrated with histopathological correlation.

CD44 and CD74: The promising candidates for molecular targeted therapy in oral squamous cell carcinoma.

BACKGROUND: Considering molecular target therapy concept in the treatment of oral squamous cell carcinoma (OSCC), many attempts have been performed to introduce an effective molecular marker during recent years. Several investigations have emphasized on the role of CD44 in various cancers and few studies have mentioned CD24 and CD74. The purpose of this study was to investigate the relationship between CD44, CD24 and CD74 expressions and several clinical or histopathological factors in OSCC patients. MATERIALS AND METHODS: In our analytical cross-sectional study, forty primary OSCC specimens were immunohistochemically stained for CD44, CD24, and CD74 proteins. Then, the relationship between their expressions and age, sex, lymph node metastasis, and histopathologic grading was statistically analyzed using Mann-Whitney nonparametric and t-test. Furthermore, P < 0.05 was considered as significant. RESULTS: CD44 and CD74 proteins were significantly over-expressed in OSCC patients with high grade (P = 0.001 and P = 0.001) as compared to those with low grade. Furthermore, CD74 immunoreactivity showed significantly higher expression in patients with lower age (P = 0.039). Considering lymph node metastasis, we observed significant overexpression of CD74 in patients with no lymph node involvement (P = 0.033). CONCLUSION: Our observations support the significant role of membranous CD44 protein in progression of OSCC and also introduce CD74 protein as a probable interfering factor in different aspects of OSCC.

Improved detection of metastases by step sectioning and immuno-histochemical staining of axillary sentinel nodes in patients with breast carcinoma.

BACKGROUND: The object of this study was to examine whether a new protocol including step-sectioning and immunohistochemistry (IHC) staining of axillary sentinel nodes (SN) would lead to detection of more metastases in patients with breast cancer. MATERIALS AND METHODS: Sixty-nine tumor free sentinel lymph nodes were examined. Step frozen sectioning was performed on formalin fixed SN and stained both by hematoxylin and eosin (H and E) and cytokeratin markers using IHC. Any tumoral cell in IHC stained slides were considered as a positive result. Metastases up to 0.2 mm were considered as isolated tumor cells and 0.2 up to 2 mm as micrometastasis. RESULTS: Mean age of the patients was 48.7±12.2 years. Step sectioning of the SN revealed 11 involved by metastasis which was statistically significant (p<0.001). Furthermore, 15 (21.7%) of the patients revealed positive results in IHC staining for pan-CK marker and this was also statistically significant (p=0.001). Ten patients had tumoral involvement in lymph nodes harvested from axillary dissection and 4 out of 15 lymph nodes with positive result for CK marker were isolated tumor cells. However, 4 of 10 patients with tumor positive lymph nodes in axillary dissection were negative for CK marker and in contrast 6 of the pan-CK positive SN were in patients with tumor-free axillary lymph nodes. CONCLUSIONS: Both IHC and step sectioning improve the detection rate of metastases. Considering the similar power of these two methods, we recommend using either IHC staining or step sectioning for better evaluation of harvested SNs.

Fine-needle aspiration cytology and flow cytometric immunophenotyping in diagnosis and classification of non-Hodgkin lymphoma in comparison to histopathology.

This prospective study aimed to compare the value of fine needle aspiration (FNA) cytology (FNAC) and flow cytometric immunophenotyping (FCI) with histopatopathology (HP) in the diagnosis and classification of non-Hodgkin lymphoma (NHL). Twenty-nine excised lymph nodes suspected of NHL were evaluated using FNAC, FCI, and HP. Specimens were divided into two equal parts; one for HP and the other for FNAC and FCI. Results were compared in terms of diagnosis (malignant, benign or reactive, and metastatic) and NHL class. With combined FNAC/FCI, 11 (37.9%) cases were diagnosed as NHL, 11 cases (37.9%) as reactive lymph node, six cases (20.6%) as Hodgkin's lymphoma, and one case (3.4%) as metastasis. HP revealed nine cases (31%) of NHL, five cases (17.2%) of reactive lymph nodes and all the diagnosed metastatic and Hodgkin's lymphoma. Considering histology as a gold standard method in diagnosis, the sensitivity, specificity, PPV and NPV of FNAC/FCI in differentiate malignant and benign lesion were 73.9%, 83.3%, 94.4%, and 45.5%, respectively and in differentiate NHL from others were 75%, 93.8%, 90%, and 83.3%, respectively. Cytology and HP in addition to FCI and HP are significantly different from determination of NHL lesions point of view (P = 0.001 and P < 0.0001, respectively). However, FCI can be considered as an adjunctive method for Cytology especially because Cytology is not competent enough to differentiate between benign lesions and Lymphoma. Additionally, FCI is shown to be an accurate method in classifying NHL.

Synovial sarcoma of the mandible.

Synovial sarcoma (SS) is a relatively common soft tissue tumor but only 6%-7% of cases are diagnosed in the head and neck region. It typically occurs in young adults and is slightly more common in males. The most common sites in the head and neck region are hypopharynx and parapharyngeal spaces. However, SS can also occur in tonsils, tongue, and orofacial soft tissues. It is not difficult to diagnose SS microscopically with its classic biphasic appearance, but the diagnosis of monophasic forms is more challenging especially in unusual locations. In this article, we report a rare case of monophasic SS of the mandible. The clinical, histopathological, and immunohistochemical features are discussed and compared with previously reported cases in the literature. To our knowledge, only six primary involvements have been reported in the jaws. Therefore, our case represents the seventh reported case of SS in the area.

Accuracy of immunohistochemistry in evaluation of malignant pleural and peritoneal effusions.

BACKGROUND: The aim was to evaluate the accuracy of immunohistochemistry in diagnosis of the source of malignancies in pleural and peritoneal fluids in comparison to histopathology as the gold standard. MATERIAL AND METHODS: Retrospectively, the cell block specimen and past medical data files of patients who had undergone serosal fluid aspiration and had a histopathology report corresponding to underlying disease were retrieved. Three mesothelial antibodies (D2-40, calretinin and WT-1) and two non-mesothelial antibodies (MOC-31 and EMA) were set to be applied for evaluating malignant cells and benign cells within serous fluids. RESULTS: Seventy-one patients, 12 men and 59 women, were found to have a thorough information package needed, including cell blocks with appropriate cellularity on which ICC was applicable and the corresponding histopathology report. As mesothelial markers, calretinin and WT-1 were found to have sensitivity and specificity of 90%, 96.7% and 100%, 42.6%, respectively. Sensitivity and specificity of D2-40 both reached 100%. In addition, as non-mesothelial markers, MOC-31 and EMA were demonstrated to have sensitivity and specificity of 95.08%, 90% and 93.4%, 70%, respectively. CONCLUSION: D2-40 was reconfirmed to act as an accurate marker in distinguishing between cells of mesothelial and non-mesothelial origin. However, WT-1 is not specific enough to be considered as accurate as D2-40. Considering the sensitivity and specificity of calretinin and MOC-31, they can be considered as safe but not as much as D2-40. EMA is not recommended as an ancillary marker due to its low specificity and challenging results.

Intraoperative frozen sections for assessment of female cancers.

Frozen sections offer an important and helpful adjunct to intraoperative diagnosis and its use has greatly impacted on the care of gynecological oncology patients. Frozen section diagnosis is a reliable method for surgical management of gynecology oncology patients. Sensitivity of frozen section is acceptable and its specificity is almost perfect. False negative rate is low and false positive rate is negligible. Diagnostic problems can occur due to technical limitations especially in mucinous and borderline tumors. A good communication established between clinicians and pathologists is necessary to obtain more accurate results and to minimize the number of deferred cases.

Prevalence of human papillomavirus genotypes in women with normal and abnormal cervical cytology in Iran.

INTRODUCTION: HPV infection has a prime etiologic role in development and progression of cervical cancer, one of the most frequent forms of cancer among women in developing countries. This study was designed to determine the most prevalent HPV genotypes in women with normal and abnormal cervical cytology in Iran. MATERIALS AND METHODS: Samples from134 patients, including 127 who attended gynecology clinics and 7 with solid cervical tumors were used. All 127 patients underwent routine Pap tests for cytological evaluation and at the same visit a sample of cervical epithelial cells was obtained by scraping the cervix osteum. In each case HPV infection was primarily evaluated by PCR using GP 5/6 primers and then subtyping was performed in proved infected samples with specific primers for HPV 16, 18, 31, 33, 11 and 6. After cytological evaluation, 50 patients with abnormal Pap tests were categorized as the abnormal group and the remaining 77 patients as the normal group. RESULTS: In the normal group, HPV infection was established in 10 cases (13% infection rate), while 30 HPV positive cases were discovered in the abnormal group (60% infected). The most prevalent genotypes among the infected samples were HPV 16 (76%), HPV18 (12.7%) and HPV11/6 (8.5%). Moreover, all 7 tumor samples were positive for HPV general primers of which, 5 samples were infected with HPV 16, two were co-infected with HPV16,18 and HPV16,31 genotypes and one was infected with HPV 18. CONCLUSIONS: Infection with HPV 16 was found to be significantly higher in abnormal group in comparison with normal group (42% vs. 11.6%, P value <0.005), likewise HPV18 genotypes were proved to be more prevalent in abnormal group (8% vs. 0%, P value <0.05). No significant relation between other HPV genotypes and pathologic cervical changes was obtained. According to our study high rates of infection with HPV genotypes in sexually active Iranian women makes molecular investigation for HPV16 and 18 very essential in clinical approaches to patients with proven dysplasia in their screening tests and also for those patients with borderline (i.e. ASCUS) or incongruous pathology reports. Larger studies are required to determine the most appropriate vaccine with highest protection in Iranian women.