A Rare Case of Myoid Hamartoma Masquerading As Invasive Breast Carcinoma

Breast Myoid Hamartoma (MH) is a rare type of neoplasm with a poorly understood pathogenesis. Very few literatures have reported such disease with an unclear prognosis and malignant potentiality. Some isolated studies have shown that breast Myoid Hamartoma (MH) may be genetically related to other types of tumours with the involvement of HMGA2 gene. We reported a case of a 64-year-old post-menopausal lady with an underlying chronic idiopathic axonal polyneuropathy (CIAP) that was referred to our centre for a suspected right breast tumour. Clinical and imaging proved the disease to be malignant, however, core biopsy results showed otherwise. Ultrasound of the right breast showed a solid mass with a hypoechoic heterogeneous echotexture and posterior shadowing. A Mammogram highlighted a dense lesion in the right breast with radiolucent halo and macrocalcification. It was reported as BIRADS 4 category. Managing breast Myoid Hamartoma (MH) is proved to be of great challenge to clinicians as meticulous clinical acumen is needed to strategize a proper plan and management, most importantly, not to overlook the disease as the malignant transformation has been reported before.

Immunohistochemical Analysis of Prostein Expression in Archived Prostatic Core Biopsies from Prostate Cancer Patients in Western Kenya

Background Prostate cancer is the leading cause of cancer-associated mortality in men. Most of the current biomarkers for detection of the disease have low sensitivity and specificity. Prostein is a newly reported prostate cancer biomarkers whose diagnostic utility can help in early detection of the disease. Nonetheless, previous studies have utilized limited number of samples to evaluate its immunohistochemistry (IHC) and reports on the African population are not available. The current study aimed to determine the prostein expression in archived prostatic core biopsies from prostate cancer patients in Western Kenya. Materials and Methods This was a retrospective study conducted on malignant and benign prostatic tissue core biopsies of 106 patients who underwent prostate core biopsy at Jaramogi Oginga Odinga Teaching and Referral Hospital and division of urology at Synergy Clinics, Kisumu between January 2018 to May 2021. Immunohistochemical technique was performed on each of the 106 samples and on the following non-prostatic male control biopsies; Testis, Penis, Liver and Esophagus. Cellular location of prostein staining was evaluated at X40, X100 and X400 magnification using a light microscope and was classified as cytoplasmic or nucleocytoplasmic. Intensity of prostein expression was assessed for each core biopsy at similar magnification and graded according the immunohistochemistry composite score. Results The biopsies had been obtained from men whose mean (SE) age was 72.00±0.93 years. 95.3% (101) of the biopsies were malignant and 4.7% (5) were benign. Four non-prostatic male tissues were included. 97% of malignant and all the benign prostate tissue stained positive for prostein whereas the four non-prostatic male tissues were negative. Staining intensities were weak (24.5%), Moderate (17.0%), strong (55.7%) and non-stained (2.8%). The staining was highly immunolocalized within the cytoplasm (95.1% cases) as compared to nucleocytoplasmic (2.0% cases). The mean immunoreactivity composite score was 1.91±0.96 (0.0-3.14). Strongly stained sections had a punctate plasma membrane staining pattern clustered within the cytoplasm in a perinuclear location whereas the weakly stained sections had faint and punctate coarse brown cytoplasmic granular appearing. Conclusion Prostein is exclusively expressed in benign and malignant prostate tissue with a higher cytoplasmic granular staining pattern in the present population. These findings suggest that prostein diagnostic utility is applicable in the current study population and routine IHC diagnosis of prostate cancer may be recommended.

TUMOR FILODES MAMÁRIO COM COMPONENTE DE CARCINOMA DUCTAL INVASOR: UMA RARA ASSOCIAÇÃO

Introdução: O tumor filodes (TF) corresponde a uma neoplasia caracterizada por um maior grau de pleomorfismo das células estromais, além do estroma ser mais abundante e mais celular do que o observado nos fibroadenomas. Trata-se de uma neoplasia fibroepitelial da glândula mamária pouco comum, representando cerca de 0,3% a 0,9% das neoplasias da mama, e 1% a 2,5% dos tumores epiteliais da mama. Pode, raramente, ocorrer em conjunto com carcinomas de mama in situ ou invasivos, sendo o TF na maioria das vezes maligno, e estando presente em 1 a 2% dos casos. A concomitância entre tumor filodes benigno e carcinoma ductal invasivo é ainda mais rara, o que justifica a importância deste estudo. Relato do caso: Assim sendo, relata-se um raro caso de uma paciente feminina, com nodulação palpável em quadrante superior lateral da mama esquerda, cuja punção aspirativa por agulha fina (PAAF), demonstrou quadro citológico hemorrágico intensamente hipocelular com irregularidades nucleares. A core-biopsy evidenciou proliferação bifásica estromatoglandular benigna sugestiva de fibroadenoma. A setorectomia diagnóstica evidenciou carcinoma ductal invasivo e tumor filodes benigno com infarto hemorrágico central, confirmados no anatomopatológico e pela imunohistoquímica. Conclusão: O objetivo, portanto, é descrever um caso pouco frequente de carcinoma ductal invasivo concomitante com tumor filodes benigno na mama, discorrendo sobre suas manifestaçõeses clínicas, diagnóstico e tratamento, auxiliando na abordagem de novos casos semelhantes.

Ultrasound-guided core biopsy in the diagnosis of parotid neoplasia: an overview and update with a review of the literature

Objective: Accurate diagnosis of parotid neoplasia is a key to determine the most appropriate patient management choice, including the need for surgery. This review provides an update of the literature on current practice and outcomes of parotid tissue sampling techniques, with an emphasis on ultrasound-guided core biopsy (USCB) and comparison with fine needle aspiration cytology (FNAC). Methods: A literature review of EMBASE, Medline, PubMed and Google Scholar was conducted. Results: USCB has higher sensitivity, specificity and lower non-diagnostic rates than optimized FNAC. It also has a significantly higher sensitivity for the detection of malignancy. Significant complications post-USCB are uncommon, with only one reported case of tumour seeding and no cases of permanent facial nerve dysfunction. The technique is less operator-dependent than FNAC, with less reported variation in results between institutions. Conclusions: USCB can be considered as the optimum tool of choice for the diagnosis of parotid neoplasia. This would particularly be the case in centres utilizing FNAC with high non-diagnostic rates or reduced diagnostic accuracy when compared to USCB published data, or in centres establishing a new service. Advances in knowledge: An update of the role and outcomes of USCB in the diagnosis of parotid gland pathologies. Research shows that USCB preforms better than FNAC, in terms of sensitivity and specificity, particularly in the case of malignant neoplasia. Complications following USCB were found to be higher than that of FNAC; however, no long-term major complications following either method have been reported in the literature.