Adenomyoepithelioma of the breast: a rare diagnosis complicated by surgical emergency and diagnostic uncertainty.

A woman in her 80s was referred as an emergency case with a large oedematous and ulcerating lesion of the right breast. There was a 5-month history of increasing breast volume with new onset skin breakdown and discharge. Imaging revealed an extensive heterogeneous mass requiring drainage. No diagnosis was received from multiple biopsies and immediate surgical resection of the breast and axillary sampling was prioritised given the deteriorating patient condition. Postoperative histology identified a biphasic Adenomyoepithelioma of low malignant potential, a rare presentation compounding the complexity of management. The diagnostic uncertainty of this case highlighted the importance of MDT collaboration and the flexibility of current management pathways when dealing with cases requiring urgent surgical intervention. Axillary sampling in the context of unsuccessful preoperative biopsy represented a comprehensive means for assessing the need for further surgical or systemic management in the context of unconfirmed malignancy in a deteriorating patient.

Biosynthesis and Cellular Functions of Tartaric Acid in Grapevines.

Tartaric acid (TA) is an obscure end point to the catabolism of ascorbic acid (Asc). Here, it is proposed as a "specialized primary metabolite", originating from carbohydrate metabolism but with restricted distribution within the plant kingdom and lack of known function in primary metabolic pathways. Grapes fall into the list of high TA-accumulators, with biosynthesis occurring in both leaf and berry. Very little is known of the TA biosynthetic pathway enzymes in any plant species, although recently some progress has been made in this space. New technologies in grapevine research such as the development of global co-expression network analysis tools and genome-wide association studies, should enable more rapid progress. There is also a lack of information regarding roles for this organic acid in plant metabolism. Therefore this review aims to briefly summarize current knowledge about the key intermediates and enzymes of TA biosynthesis in grapes and the regulation of its precursor, ascorbate, followed by speculative discussion around the potential roles of TA based on current knowledge of Asc metabolism, TA biosynthetic enzymes and other aspects of fruit metabolism.