Biopsy with Side-Cutting Coaxial Needle—Knowing the “Cutting Length” and “Throw Length”

Image-guided Trucut biopsy is a well-established procedure. The length of the side notch in the stylet is the “cutting length,” which entraps the tissue sample and contributes to the yield. The total distance by which the inner stylet protrudes from the outer cannula with the cutting notch open is the “throw length.” It is inevitably longer than the cutting length does not add to the yield of the sample, but potentially to the complication of the procedure. The authors highlight the importance of knowing this distinction to minimize complications during the procedure.

Trucut biopsy as a first line diagnostic modality for equivocal or suspicious breast masses: an experience from a teaching hospital in Khyber Pukhtunkhwa

<p><strong>Background and Objective:</strong> Trucut biopsy (TCB) is a commonly used technique for histopathological diagnosis of a clinically and radiologically equivocal or suspicious breast mass. This study aimed to determine the sensitivity and specificity of TCB in the diagnosis of equivocal or suspicious breast masses at local tertiary care hospital in Khyber Pukhtunkhwa.</p> <p><strong>Methods:</strong> This descriptive cross-sectional study was conducted at the surgical unit of Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan. The study included 80 patients who presented with equivocal or suspicious breast masses from September, 2015 to December, 2020. The patients underwent TCB and after the histopathology report, they were followed by a definitive surgical procedure. The histopathology diagnosis following TCB was compared with the histopathology report of postsurgical specimen to determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TCB taking post-surgery histopathology as a gold standard for diagnosis.</p> <p><strong>Results:</strong> Out of the 80 patients, 68 (85%) were found to have a primary breast malignancy, while 12 (15%) patients were diagnosed with non-malignant lesions. There were only two false negative cases. The specificity and PPV of TCB were found to be 100%, while a sensitivity of 97% and a NPV of 85.7% was calculated.</p> <p><strong>Conclusion:</strong> TCB is a valid, reliable, and simple first line minimally invasive method to determine the diagnosis of breast masses that are clinically and radiologically (breast imaging-reporting and data system 3 to 5) equivocal or suspicious.</p>

A RARE CASE REPORT OF PRIMARY NEUROENDOCRINE CARCINOMA OF BREAST

we report a case of 51 year old lady, presented with complaints of hard lump in the right breast.On clinical examination lump of size 4x3cms in outer lower quadrant was noted. Ultrasonographic imaging showed evidence of 3x2cms ill dened hypoechoic lesion with spiculated margins and microcalcications. Trucut biopsy was done and histopathological report was given as Suspicious for malignancy which was followed by modied radical mastectomy with axillary clearance. Histopathological examination and Immunohistochemistry(IHC) was done.

A CASE REPORT ON ATYPICAL PRESENTATION OF ACTINOMYCOSIS

Actinomycetes israelii is a gram positive bacteria,causing chronic spreading suppurative and granulomatous disease, 1 which forms sulphur granules discharging sinuses. A CASE REPORT : 55 year old female P/W swelling in lower abdomen since 6 months and associated pain, known Diabetic and Hypertensive . O/E - 8x4x2 cms elliptical,rm,mildly tender swelling with illdened margins,smooth surface,skin over the swelling normal , immobile ,becoming prominent on leg raising is palpated in the right iliac fossa , extending partly into the hypogastrium. The clinically palpable mass on TRUCUT biopsy showed collection of acute on chronic inammatory cells and basophilic lamentous bacterial colonies showing Splendore-Hoeppli phenomenon S/O Actinomycosis.Upon Rx with Inj Gentamicin 60mg/IV/TID x 10d and Tab Doxycycline 100mg/BD x 30d ,patient responded with resultant decrease in discharge from the sinus.

Metaplastic Breast Cancer with Chondroid Differentiation

Background: Metaplastic breast cancer (MBC) cancer is a rare subtype of breast carcinoma and carries a worse prognosis. Chondroid differentiation is the rarest among all its histologic subtypes. We report a case of MBC with chondroid differentiation and review its clinicopathological details, genetic basis, and management.Case presentation: A 56-year female presented with right-sided large breast lump. She noticed this lump 4 months before presenting. Trucut biopsy was suggestive of invasive ductal carcinoma. She underwent breast conservation surgery and histology was consistent with MBC with chondroid differentiation, pT2N3aM0. Tumour was triple-negative for ER, PR, and Her-2- neu receptors. Adjuvant treatment with chemotherapy followed by radiotherapy was given and she has been doing fine during 11 months of follow-up.Conclusion: The MBC is an uncommon subtype with heterogeneity in biological and morphological features and its knowledge is paramount while evaluating a breast lump. Understanding the pathologic and molecular basis is imperative in developing the targeted therapy to improve outcomes.

Primary Hepatic Leiomyoma in a Healthy Middle-Aged Woman: Literature Review and Case Report

Introduction: Primary hepatic leiomyoma (PHL) is a rare benign hepatic tumor with unclear pathogenesis. It more commonly occurs in immunosuppressed patients, while only 24 cases have been described among immunocompetent individuals. To date, only one successful preoperative diagnosis of PHL has been achieved.Case Presentation: Here we report a case of PHL in a middle-aged woman with no history of immunosuppression. Preoperative diagnosis of PHL was established using ultrasound-guided fine needle trucut biopsy (FNTB). Nevertheless, due to the growing nature of tumor and patient's symptoms, we proceeded with surgical resection, which confirmed the diagnosis of PHL. At 6-month follow up, the patient is in good condition with no evidence of tumor recurrence.Conclusions: PHL is an uncommon tumor that should be considered in the differential diagnosis of rare liver tumors. Image guided FNTB appears to be effective in achieving preoperative diagnosis of PHL. Surgical resection, however, remains both diagnostic and curative in the management of PHL.

Primary signet ring carcinoma of the rectum: a rare entity

Signet ring cell carcinoma constitute an uncommon histological type of rectal cancer with less than 1% of all rectal neoplasms. It usually behaves aggressively and has an inferior prognosis. Herein, we present a rare case in young male diagnosed by trucut biopsy.

Adrenal extramedullary haematopoiesis: an unusual incidentaloma

We report a case of adrenal extramedullary haematopoiesis in a 24-year-old women who presented with pallor and weakness. Ultrasonography of the abdomen detected moderate hepatosplenomegaly with multiple lesions in the spleen and an incidental right adrenal mass. There was no ascites or lymphadenopathy. CT scan revealed a heterogeneous right adrenal mass with multiple non-enhancing lesions in the spleen. Ultrasound guided trucut biopsy was performed after excluding a functioning tumour, which confirmed the diagnosis. Later, she was diagnosed to have haemoglobin E/beta thalassaemia and was put on hydroxyurea trial.

A Rare Presentation of Ewing Sarcoma as Supraclavicular Swelling in an Adolescent Male – A Case Report

Supraclavicular swellings can have numerous differential diagnosis ranging from infections to malignancy, in almost all age groups. Here we present a case of 15 year old boy who presented with left supraclavicular swelling and clinically diagnosed as a case of Tuberculosis, underwent FNAC which was suggestive of Small Round Blue Cell Tumor favouring Ewing sarcoma. Later, trucut biopsy of the swelling confirmed the diagnosis of Ewing sarcoma. Ewing sarcoma is one of the most common primary malignancy of bone in children but can also arise from extraskeletal region like soft tissue.