Indeterminate (B3) Breast Lesions and the Ongoing Role of Diagnostic Open Biopsy

Introduction. Due to their uncertain malignant potential, indeterminate breast lesions on core needle biopsy (CNB) require diagnostic open biopsy (DOB). This study evaluated DOB results given largely benign pathology. Lesions included are atypical papilloma, atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and radial scar/complex sclerosing lesions (RS/CSL). Methodology. A retrospective audit from 2010 to 2017 analysed patients with a screen-detected suspicious lesion and indeterminate (B3) CNB diagnosis. Primary outcome was the malignancy upgrade rate, with secondary evaluation of patient factors predictive of malignancy including age, symptoms, mammogram characteristics, lesion size, biopsy method, and past and family history. Results. 152 patients (median age 57 years) were included, with atypical papillomas being the largest subgroup (44.7%). On DOB histology, 99.34% were benign, resulting in a 0.66% malignancy upgrade rate. Patient characteristic analysis identified 86.84% of B3 lesions were in patients greater than 50 years old. 90.13% were asymptomatic, whilst 98.68% and 72.37% had a negative past and family history. Majority 46.71% of lesions had the mammogram characteristic of being a mass. However, with 57.89% of the lesion imaging size less than 4 mm, a corresponding 60.5% of core needle biopsies were performed stereotactically. The small malignant subgroup limited predictive factor evaluation. Conclusion. Albeit a low 0.66% malignancy upgrade rate in B3 lesions, no statistically significant patient predictive factors were identified. Until predictive factors and further assessment of vacuum-assisted excision (VAE) techniques evolve, DOB remains the standard of care.

Complications of invasive methods diagnosis of pulmonary dissemination syndrome, their prevention and treatment

Objective — to study the possible complications that arise when using invasive methods for the diagnosis of pulmonary dissemination syndrome, to develop measures aimed at their prevention and treatment. Materials and methods. Data from 216 patients who used invasive methods to diagnose pulmonary dissemination syndrome were analyzed. Patients were divided into 3 groups, depending on the type of biopsy: Group I — 143 patients who underwent VATS lung biopsy, Group II — 64 patients who underwent endobronchial ultrasound transbronchial biopsy lungs (EBUS TBBL); Group III — 9 patients who underwent open biopsy. Complications in I — 12 (8.4 %), II — 5 (7.8 %), III — 2 (22.2 %), total — 19 (8.8 %). These were lung tear, wound suppuration, disease progression, pneumothorax, hemoptysis, respiratory failure, intrapleural hemorrhage. Results and discussion. Based on the obtained data, we have proposed methods of prevention of complications: radiography of the thoracic cavity in the first day after biopsy; correction of antiplatelet therapy; careful selection of patients for biopsy taking into account age, concomitant pathology, taking drugs, history.Conclusions. Lung biopsy for pulmonary dissemination syndrome is a safe type of diagnosis with a low level of complications — 8.8 %.The least traumatic method is transbronchial lung biopsy under ultrasound control.If it is impossible to perform a transbronchial lung biopsy, or if the obtained material is uninformative, the next step is to use a video­assisted lung biopsy.An open biopsy should be considered last and only under strict indications.It is important to choose the right method of biopsy, taking into account age, history, drugs.

Hemangioma of the Rib Mimicking Chondrosarcoma: A Report of Two Cases and Literature Review

Cases. Case 1 was a 58-year-old man who presented with an incidentally detected, slowly growing mass in the right hypochondrium area. An imaging study showed the mass arising from the 11th rib, with ill-defined margins and cortical destruction. Differential diagnoses included chondrosarcoma and metastatic malignant tumor. Open biopsy was associated with moderate bleeding (300 mL) despite small incision. Microscopic findings showed numerous irregular, dilated, and thin-walled vessels, consistent with the diagnosis of hemangioma of bone, and en bloc excision was performed with no surgical complication. Case 2 was a 49-year-old man who presented with an incidentally detected 4th rib mass with calcification on computed tomography scan. Chondrosarcoma was suspected according to imaging features. An open biopsy was considered to have a risk of tumor seeding because the tumor was located behind the scapula. En bloc excision of the tumor without biopsy was performed. The pathological findings were consistent with hemangioma of bone. Conclusion. We reported two cases of rare hemangioma arising from the rib, which mimicked chondrosarcoma. The preoperative diagnosis was challenging, both clinically and radiologically. Because biopsy for hemangioma of the rib is associated with a bleeding risk, the en bloc excision without biopsy can be a practical treatment option.

Bilateral Primary Aneurysmal Bone Cyst of Proximal Femur: A Rare Case Report

Aneurysmal bone cysts (ABC) are blood-filled, locally destructive, expansile lesions of the bone. ABC of the proximal femur is usually unilateral in presentation. As far as the English literature is concerned, there is no case report of bilateral involvement of the proximal femur by primary ABC. We hereby present a rare case of bilateral primary ABC of the proximal femur with pathological fracture of the right femoral neck. The patient underwent right hip hemiarthroplasty and open biopsy and curettage of the left proximal femur. ABC is usually unilateral in location. Whenever there is a bilateral lesion in the proximal femur usually ABC is not suspected as a differential diagnosis, but ABC may have a bilateral presentation.

Primary diffuse large B-cell lymphoma of the bone mimicking osteomyelitis

In this article, we report a 34-year-old man who presented with progressive hip pain and osteolytic bone lesions . Primary workup included Core needle biopsies manifested as osteomyelitis; however as no sign of remission was observed, an open biopsy considered which revealed primary bone lymphoma.

Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection

The accurate preoperative diagnosis of periprosthetic joint infection (PJI) of total knee arthroplasty (TKA) can be difficult despite the use of a combination of serum and synovial markers. In such inconclusive cases, incisional open biopsy might be considered. This study investigates the usefulness of biopsies in patients with inconclusive diagnostic findings. We retrospectively identified 63 patients who underwent incisional biopsy for chronic PJI in the operation theatre following TKA revision between 2010 and 2018 after inconclusive preoperative diagnostics for PJI. In all cases, 5 independent biopsies were taken. Results from open biopsy for PJI were analyzed for diagnostic accuracy using the intraoperative results from following revision surgery as gold standard. 27 patients (43%) had a positive culture taken during biopsy. 15 cases (24%) met the diagnostic criteria for a chronic PJI. Most common organisms were Coagulase-negative staphylococci (67%) and Cutibacterium acnes (30%). Compared to the findings during revision surgery, biopsies showed a sensitivity of 47% and a specificity of 77% for PJI. Open incisional biopsy following inconclusive serum- and synovial diagnostics for low grade PJI may be considered for identification of microorganisms. Due to its low sensitivity and moderate specificity found in the present cohort, microbiological analysis should be combined with additional diagnostic markers and histological investigation.Level of Evidence. Retrospective cohort study (Level III).

Metastasis of Pulmonary Adenocarcinoma presenting as Multiple Cystic Lesions of the Brain: Importance of Differential Diagnosis

A 62-year-old otherwise healthy patient was admitted with severe headache for several weeks. Initial imaging studies revealed multiple cystic lesions in both hemispheres. Neuroparasitic infections were considered as primary differential diagnosis. Open biopsy of a right frontal cortical lesion was performed. Pathohistological revealed the diagnosis of cerebral metastasis of adenokarcinoma.