Breast paraffinoma: An obsolete but still important condition - Experience with 60 cases and the literature review.

BACKGROUND: Paraffin injections for breast augmentation has been abandoned by clinicians because of its serious long-term complications. The practice is still prevalent and long-term complications are still being encountered in clinical practice today. METHODS: Retrospective review was performed on patients with breast paraffinoma managed in Raja Isteri Pengiran Anak Saleha Hospital, Brunei Darussalam, between January 1, 2010 and August 31, 2020. Patients' demographics, presentations, investigations, treatment and follow-up outcomes were reviewed. A literature review on breast paraffinoma was also performed. RESULTS: We reviewed the data by combining our dataset of 60 patients with those extracted from the published articles, totaling 232 patients from 31 articles. The mean age at presentation was 48.8 (range 29-78) years with a preponderance of female patients. The most common presenting symptoms were painless lumps (65.5%), painful lumps (14.7%), ulcer (7.3%), skin discoloration (2.4%), sinus (1.7%) and abscess (1.0%). The most common imaging modality used was mammography (70.7%), MRI (52.6%) and ultrasonography (47.8%). Majority of the reported cases underwent surgical treatment; mastectomy was performed in 53.4% of the cases, excision of the paraffinoma in 17.7% of cases and 0.9% of cases had incision and drainage. A quarter of the patients (25%) did not require any further treatment. The mean follow-up was 4 (range 1-10) years with a mortality rate of 3.0%. CONCLUSIONS: Awareness of this condition will assist the clinicians in making the correct diagnosis and instituting the appropriate treatment. It is important to exclude co-existing breast cancer.

Fine-Needle Aspiration Cytology in the Diagnosis of Breast Paraffinoma.

INTRODUCTION: Paraffin injections for breast augmentation once a popular form of mammoplasty are now considered obsolete. It had been abandoned by clinicians because of its associated serious complications. The practice is however still available and is being practiced by nonmedically qualified people. Paraffin injection results in the formation of multiple foreign-body granulomas known as breast paraffinoma. The clinical features of breast paraffinoma can mimic and be mistaken for breast carcinoma or inflammatory breast carcinoma. The use of fine-needle aspiration cytology (FNAC) in the evaluation of patients with breast paraffinoma has not been fully evaluated. METHODS: Retrospective review was performed on 30 patients who presented with breast paraffinoma between June 1, 2010, and June 30, 2020, who also had FNAC as part of their breast lump evaluation. RESULTS: FNAC of 73.3% patients showed multinucleated giant cells and macrophages or histiocytes containing engulfed clear, empty intracytoplasmic vacuoles of varying sizes. In 13.3% of the patients, macrophages or histiocytes with engulfed clear intracytoplasmic vacuoles of varying sizes were seen. In 6.7% of patients, multinucleated giant cells containing engulfed vacuoles of varying sizes were seen, and in 6.7% of patients, hypocellular smears with large amount of clear spaces were seen. Oily droplets were seen in the background of all the smears, and there were no malignant cells seen. These features were compatible with breast paraffinoma. CONCLUSION: Most patients with breast paraffinoma can be managed conservatively and they do not require further treatment; FNAC with its characteristic features can provide the reliable diagnosis of breast paraffinoma and therefore sparing these patients from more invasive diagnostic procedures.

Combined pancreatic and gastric heterotopia in small intestine presenting as intussusception-A rare congenital anomaly.

Pancreatic and gastric heterotopias are rare congenital anomalies which have been reported throughout the length of the gastrointestinal tract. Combined gastric and pancreatic heterotopias, although very rare, have been described mainly in the duodenum followed by jejunum with ileum being a rare site. The reported incidence of this combined heterotopias is low, ranging from <1% to 13%. Extensive literature search has revealed that only Four cases of combined pancreatic and gastric heterotopias have been reported in the small intestine till date. Hence, we report this case for its rarity and unusual presentation as intussusception in a young male.

Paraneuronal pseudobranchial neurosecretory system in tank goby Glossogobius giuris with special reference to novel neurohaemal contact complex.

Various putative oxygen chemosensory cells are reported to be present throughout the vertebrate body performing pivotal roles in respiration by initiating responses during acute hypoxia. Since air-breathing fishes often are exposed to the oxygen-deficient milieu, in such conditions various chemosensory cells operate in an orchestrated fashion. The Pseudobranchial neurosecretory system (PSNS) a newly discovered system, is one of these. It has been placed in the category of "Diffuse NE systems (DNES)". It is found in all the catfish species and in some other non-catfish group of teleosts. In catfishes, it is present in close association with the carotid labyrinth- a chemosensory structure, known in fish and amphibians. The presence of this system in Glossogobius giuris, in association with the pseudobranch, a structure considered to be precursor of carotid labyrinth, is a significant finding. In an attempt to study the structure and organization of the pseudobranchial neurosecretory system in a non-catfish species of teleost, the present investigation was undertaken on a goby G. giuris. The histological observations, using a neurosecretion-specific stain, revealed the presence of this system in G. giuris. The findings are discussed in the light of the association of PSNS with pseudobranch and the type of "neurohaemal contact complex" formed between this neurosecretory system and the elements of the circulatory system.

The paraneuronal gill neuroendocrine system in ocellated puffer fish Leiodon cutcutia.

Pseudobranchial neurosecretory system (PSNS) is the third Neuroendocrine (NE) system found in the gill region of fishes in close association with pseudobranch/carotid labyrinth/carotid gland and can suitably be placed under the category of "Diffused NE system (DNES)." The cells belonging to this system fall under the category of "Paraneurons," a concept proposed by Fujita and coworkers. It is found uniformly in all the catfish species and some other noncatfish group of teleosts as Atheriniformes, Channiformes, Perciformes, and Clupeiformes. The fishes, in which the PSNS is present, belong to different breathing habits. Most of these have the capacity to tolerate low O2 conditions. Leiodon cutcutia although not an air-breathing fish, is known to retain air in its stomach for varied periods when threatened. In an attempt to verify the veracity of this system in a fish of another peculiar breathing habit, ocellated puffer fish L. cutcutia (order Tetradontiformes) was investigated. The histological observations undertaken on L. cutcutia revealed the presence of a well-developed extrabranchial NE system. The findings are discussed in the light of the association of PSNS with chemosensory system and its evolution in fishes, especially in the view of the transition from aquatic to terrestrial life.

Tumour resection volumes and facial nerve outcomes for vestibular schwannomas.

The objective of this study is to correlate tumour volume relationship with surgical outcomes in subtotal resections and accepted nomenclature through a retrospective study at Charing Cross Hospital, London, a tertiary referral centre. The participants were 16 patients with vestibular schwannoma managed with subtotal resection between 2002 and 2011. The main outcome measures were surgical technique; tumour volume; recurrence and post-operative facial nerve function. Mean pre-operative and post-operative volumes for all patients were 14.7 and 3.7 cm(3) respectively. Tumour volumes do not correlate with diameter (p < 0.05). Mean reduction in volume of these subtotal resections was 75 %. Long term facial nerve outcome was good in the majority of patients: House-Brackmann Grade I/II in 12 (75 %), Grade III/IV in 2 (12.5 %) and Grade V/VI in 2 patients (12.5 %). Notably, two patients with Grade I/II House-Brackmann grading later developed Grade V/VI palsy following adjunctive radiotherapy. Seven of the 16 subtotal resections had subsequent radiotherapy or microsurgery. Mean follow up was 26.5 months. In conclusion, subtotal resections lead to good facial nerve outcomes but may require further treatments. Radiation treatment can worsen facial nerve function. There is no standardised use of tumour volumes or accepted guidelines for resection terminology. We propose the use of tumour volumes to define this further.

Nondestructive determination of curcuminoids from turmeric powder using FT-NIR.

Nondestructive method of measuring curcuminoid content of turmeric powder was developed by fourier transform near infrared (FT-NIR) spectrometer. Also, the calibration models describing the relationship between curcuminoid content and the NIR spectra of the turmeric powder were developed and evaluated. To develop the model, NIR reflectance spectra were acquired for each turmeric powder sample. Spectra were pre-processed by applying different spectra correction algorithms. The relationship between spectrometric curcuminoid content and FT-NIR spectra of turmeric powder was examined through partial least square (PLS) regression method in the wave number range of 6102 to 4246 cm(-1). The root mean square error of cross-validation and test set validation were 0.104 and 0.201 whereas the determination coefficient (R(2)) for both the validations were 97.64 and 87.53, respectively. A low value of root mean square error and high value of R(2) indicates a high correlation between the concentration and spectral data. Thus the FT-NIR offers a viable alternative to spectroscopic procedures as well as the method is time and cost effective for determination of curcuminoid content of turmeric.