SP8.1.8 Factors influencing the post-operative upgrade of ductal carcinoma in situ (DCIS) to invasive cancer

Aims Ductal carcinoma in situ (DCIS) can be upgraded on pathological histology to invasive cancer and require a subsequent sentinel node biopsy (SNB). This second procedure increases the morbidity and costs of treating DCIS. Our study aims to establish the proportion of preoperatively diagnosed DCIS that is upgraded and identify factors associated with this upgrading. Method A retrospective review was conducted of 122 consecutive patients undergoing surgery following diagnosis of DCIS on percutaneous biopsy at our institution, from 1st January 2017 to 30th November 2019. Histological upgrade was evaluated against clinical, radiological and pathological parameters. Results Of the 122 patients, 31 (25.4%) were upgraded, with 11 (9.1%) having microinvasive disease (T1mi) only. A third of the upgrade group (n = 11) did not have a SNB during the initial surgery. Upgraded patients were younger (median 54yrs v 62yrs P = 0.005), had a higher BMI (median 28.9 v 26 P = 0.02) and more likely to have a palpable lesion (41.9% v 14.9% P < 0.001). Multivariate logistic regression analysis showed that mass detected on ultrasound (OR 3.6 P = 0.04), a palpable lump (OR 5.2 P = 0.03) and finding high grade DCIS on percutaneous biopsy (OR 11.9 P < 0.001) were independently associated with final tumour upgrade. In contrast, patients undergoing vacuum assisted biopsy were less likely to be upgraded after surgery (OR 0.23 P < 0.001). Conclusion Patients that have a higher BMI, palpable lump, mass on ultrasound and percutaneous biopsy showing high grade DCIS are at increased risk of harbouring invasive cancer and should be considered for SNB at initial surgery.

Clinical and USG Findings of Patients Presented with Breast Pain

Introduction: Breast pain also known as mastalgia is the dull acne in the breast, cause is multifactorial. It can affect any age group. Breast cancer is the most common site-specific cancer in women and is the leading cause of death from cancer for women aged 20-59 years worldwide. In India, breast cancer has ranked number one cancer among females, with age adjusted incidence as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Objective: To find out the Clinical and USG Findings of Patients Presented with Breast Pain. Settings and Design: Prospective cross-sectional descriptive study. Materials and Methods: Patients with complaints of breast pain in the age group 15 to 60 years with clinically no palpable mass attending to the Dept. of Clinical Oncology, Enam Medical College & Hospital, Savar, Dhaka, Bangladesh between January 2020 to December 2020 were included in the study. Detailed history with particular reference to age, duration of symptoms, Size, menstruation, marital status, parity, lactation, Nipple discharge and tenderness are recorded. Pain intensity was evaluated as mild, moderate and severe. Ultrasound of the breast including the axilla was done for all cases and findings recorded to correlate with clinical features. Results: Out of 90 patients studied, majority was in the age group (21-30) years, (43%) followed by (31-40 years) (40%) respectively. 57(63%) were married and 33(43%) were single. 21 patients had 1 child, 18 had 2 children with 6 of them having no children. Out of 90 patients only 3 attained menopause, rest of them have their monthly cycles. 51 patients had cyclical breast pain and 39 had noncyclical breast pain, 39 had pain on right breast, 36 on left side and bilateral in 15 patients. Pain was mild in 15 patients, moderate in 27 patients and severe in 6 patients. Various USG findings of the affected breast were normal study in 48 patients followed by duct ectasia and hetrogenous ectogenicity fibroadenosis, small cystic lesion and enlarged axillary lymph nodes etc. Conclusion: The study results show that majority of patients with breast pain without clinically palpable lump had normal USG study. But it also detects other early changes in the breast tissue. It can be used as a baseline investigation for any breast pain without palpable lump.

Unusual intramuscular locations as a first presentation of hydatid cyst disease in children: a report of two cases

Background Hydatid disease is an endemic disease in many countries of the world including the Middle East. It mainly affects the liver and lungs. Intramuscular hydatid disease is rarely reported in children. Such uncommon localization of hydatid cyst may pose difficulties in the clinical and radiological diagnosis; hence affecting patient’s management and outcome even in endemic areas. Case presentation We herein describe intramuscular hydatid cysts in 2 different children. The first case is a 5-year-old boy who presented with a painless palpable lump over the right lumbar paraspinal region. His history was remarkable for sheep contact. His laboratory results revealed a mild increase in white blood cell (WBC) count and C-reactive protein. The lesion showed typical features of a hydatid cyst on ultrasound. Further imaging including ultrasound of the abdomen and CT of the chest, abdomen, and pelvis showed infestation of the liver and lung as well. The lesions were resected surgically without complications. The patient received Albendazole preoperatively and after surgery for 3 months. No evidence of recurrence was seen during follow-up. The second case is a 6-year-old girl who presented with an incidental palpable lump in her left thigh during her hospital admission for recurrent meningitis. Ultrasound and MRI imaging were performed demonstrating a unilocular cystic lesion in the left proximal rectus femoris muscle. A provisional diagnosis of hematoma vs. myxoma was given. Biopsy was performed and yielded blood products only. The lesion was resected surgically with a postoperative diagnosis of hydatid cyst. Blood tests performed afterward showed a positive titer for Echinococcus. The patient received Albendazole for 3 months. No evidence of recurrence was seen during follow-up. Conclusions Despite its rarity; skeletal muscle hydatid cyst should always be considered in the differential diagnosis of cystic muscle lesions in children in endemic areas even if imaging studies did not show any of the typical signs. This will improve patient outcome by preventing unnecessary cystic puncture which might lead to serious complications, such as anaphylaxis and local dissemination.

“A Study of Clinical and Ultrasonographic Findings of Patients Presented With Breast Pain”

Introduction: Breast pain also known as mastalgia is the dull acne in the breast, cause is multifactorial. It can affect any age group. Breast cancer is the most common site-specific cancer in women and is the leading cause of death from cancer for women aged 20-59 years worldwide. In India, breast cancer has ranked number one cancer among females, with age adjusted incidence as high as 25.8 per 100,000 women and mortality 12.7 per 100,000 women. Objective: To find out the Clinical and USG Findings of Patients Presented with Breast Pain. Settings and Design: Prospective cross-sectional descriptive study. Materials and Methods: Patients with complaints of breast pain in the age group 15 to 60 years with clinically no palpable mass attending to the Dept. of General Surgery, Chuadanga Sadar Hospital, Chuadanga, Bangladesh between January 2020 to December 2020 were included in the study. Detailed history with particular reference to age, duration of symptoms, Size, menstruation, marital status, parity, lactation, Nipple discharge and tenderness are recorded. Pain intensity was evaluated as mild, moderate and severe. Ultrasound of the breast including the axilla was done for all cases and findings recorded to correlate with clinical features. Results: Out of 90 patients studied, majority was in the age group (21-30) years, (43%) followed by (31-40 years) (40%) respectively. 57(63%) were married and 33(43%) were single. 21 patients had 1 child, 18 had 2 children with 6 of them having no children. Out of 90 patients only 3 attained menopause, rest of them have their monthly cycles. 51 patients had cyclical breast pain and 39 had noncyclical breast pain, 39 had pain on right breast, 36 on left side and bilateral in 15 patients. Pain was mild in 15 patients, moderate in 27 patients and severe in 6 patients. Various USG findings of the affected breast were normal study in 48 patients followed by duct ectasia and hetrogenous ectogenicity fibroadenosis, small cystic lesion and enlarged axillary lymph nodes etc. Conclusion: The study results show that majority of patients with breast pain without clinically palpable lump had normal USG study. But it also detects other early changes in the breast tissue. It can be used as a baseline investigation for any breast pain without palpable lump.

Inflammatory Myofibroblastic Tumor of the Breast: A Case Report

Inflammatory myofibroblastic tumors (IMTs) of the breast are extremely uncommon lesions, usually labelled as a subgroup of inflammatory pseudotumors. They are composed of inflammatory cells and bland spindle cells without nuclear atypia. Nearly half of all IMTs of the breast include clonal translocation of the anaplastic lymphoma kinase (ALK) gene, located at the chromosome band 2p23, and generally present with a palpable lump, swelling, and pain. Herein, we present a 66-year-old female patient with pain, swelling and a palpable lump in her right breast. A 40×26 mm sized T1A hypointense and T2A hyperintense mass with slightly lobulated margins was detected at breast magnetic resonance imaging. A mass associated with an intramammary lymph node was evaluated in the upper inner quadrant of the right breast via mammography. The results were considered as BI-RADS 3. Breast-conserving surgery with sentinel lymph node biopsy was performed. During pathological evaluation, cytoplasm with poorly-defined margins, and large-nucleoli tumor cells with benign ducts between these tumor cells, were observed. Intensive inflammatory cell infiltration and sclerotic changes in different areas were also noted. The lesion stained positive for caldesmon, smooth muscle actin, vimentin, CD10, and S100; however, it was negative for ALK on immunohistochemistry. The patient remained disease-free after the surgical procedure.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 305-308

Unusual pseudocyst in a wandering spleen

Pseudocysts of the spleen are rare, generally asymptomatic lesions developing secondary to trauma, infection or infarction. When symptomatic, they typically present as non-specific pain in the left hypochondrium, with or without a palpable lump on clinical examination. However, these conventions fail when they occur in a wandering spleen, making imaging critically important. This report describes an unusual case of a 50-year-old who presented with a large cystic mass in a pelvic spleen; imaging facilitated a successful splenectomy and subsequent histopathology revealed a pseudocyst in a wandering spleen.

Diffuse steatonecrosis - presenting as an obscure abdominal mass - a diagnostic dilemma

Diffuse steatonecrosis secondary to acute / gangrenous pancreatitis presenting as vague abdominal mass is difficult to diagnose and requires special method / techniques for demonstration of fatty acid crystalloids. We report a case of acute abdomen with palpable lump. On emergency exploratory laprotomy a large thick jumbled up omental mass was revealed adhered to parietal wall along with complete pancreatic necrosis. Biopsy show diffuse fat necrosis of pericolic fat, omentum / mesentry with involvement of gut submucosa and birefringent saponified fatty acid crystalloids were demonstrated. Steatonecrosis may cause diagnostic dilemma and should be considered as differential diagnosis in appropriate clinical setting.