Persistent median artery and communicating branch related to the superficial palmar arch.

Microvascular surgery, plastic and reconstructive hand surgery, and coronary artery bypass surgery call for a microanatomical study of the branching pattern of the superficial palmar arch (SPA). For the anatomical analysis, we used a group of 20 dissected human hands injected with 4% formaldehyde solution and a 10% mixture of melted gelatin and India ink. The morphometric study was performed on 40 human hands of adult persons injected with methyl-methacrylate fluid into the ulnar and radial arteries simultaneously and afterwards corroded in 40% KOH solution for the preparation of corrosion cast specimens. The mean diameter of the SPA, between the second and third common palmar digital arteries, was 1.86 ± 0.08 mm. We identified the persistent median artery (PMA) in 5% of hands. We distinguished the three main groups of the SPAs according to variations in morphology and branching of the arch: Type 1, the long SPA; Type 2, the middle length SPA; and Type 3, the short SPA found in 27.5% of specimens. The communicating branch (CB), a vessel interconnecting the SPA to the closest branch of the radial artery, is classified into two different morphological groups. The third type of incomplete short arterial arch is the most important of the three groups of SPAs. That short SPA is potentially inadequate for restoring circulation after occlusion or radial artery harvesting for coronary artery bypass.

[The importance of cytology in diagnosing rare breast carcinoma--two case reports].

INTRODUCTION: This paper presents two cases of very rare tumors of breast: breast sebaceos carcinoma, which has rarely been described in medical literature, and breast carcinosarcoma. Morphological characteristics and biological behavior of sebaceos carcinoma are still rather vague. Carcinosarcoma of the breast is a rare malignancy with distinct cell lines described as a breast carcinoma of ductal type with a sarcoma-like component. CASE REPORT: The first presented case is a 73-year-old female referred to our hospital in January 2008 with tumor of the right breast in the upper outer region of the breast and enlarged lymph nodes in the right axillary region. The second presented case is a 51-year-old female with carcinosarcoma, also a very rare primary breast tumor. She was admitted to our hospital in June 2011 with history of lump in the upper and lower outer quadrant of the left breast. In both cases, biopsy of tumor tissue was carried out with a thin needle, i.e. the aspiration cytology was applied as a diagnostic method, and during the operation the fast diagnostics of frozen sections and cytologic diagnostics were done. Although this methodology is important in diagnosis, in both cases it showed certain limitations in diagnosing such rare tumors. The final diagnosis was made after carefully synthesizing the histological findings and immunohistochemical phenotype. CONCLUSION: An accurate classification of breast tumors on cytological preparations is not possible in case of poorly differentiated and rare tumors. A careful and accurate classification of these tumors is necessary.