Comparison of lymphatic contrast-enhanced ultrasound and intravenous contrast-enhanced ultrasound in the preoperative diagnosis of axillary sentinel lymph node metastasis in patients with breast cancer

Objectives: This study aimed to compare diagnostic efficiency for axillary sentinel lymph node (SLN) metastasis between lymphatic contrast-enhanced ultrasound (LCEUS) and intravenous contrast-enhanced ultrasound (ICEUS) in patients with breast cancer. We also examined whether adding ICEUS to LCEUS could improve the diagnostic accuracy of LCEUS. Methods: Sixty-nine patients with breast cancer were recruited preoperatively. All patients underwent LCEUS followed by ICEUS, and the enhancement pattern of one SLN was analysed for each patient. The targeted SLN was marked with wire and excised during surgery. The imaging diagnosis was compared with the histopathological result. Diagnostic efficiency was compared among LCEUS, ICEUS, and the combination of LCEUS and ICEUS. Results: The sensitivity values for LCEUS, ICEUS, and the combination of LCEUS and ICEUS were 86.2%, 82.6%, and 93.1%, respectively. Specificity values for the three methods were 95.0%, 92.5%, and 87.5%, respectively. Accuracy values for the three methods were 91.3%, 88.4%, and 89.9%, respectively. The area under the receiver operating characteristic (ROC) curve for LCEUS was 0.906, and there was no significant difference among LCEUS, ICEUS, and the combination of LCEUS and ICEUS (p = 0.752). Conclusions: LCEUS may represent an accurate method for predicting SLN metastasis preoperatively. Our findings suggest that adding ICEUS to LCEUS for SLN evaluation in patients with breast cancer is unnecessary. Advances in knowledge: This is the first study in which both LCEUS and ICEUS were performed for the same lymph node and the first to compare the diagnostic efficiency of LCEUS, ICEUS, and the combination of LCEUS + ICEUS.

Diagnóstico de linfangioma cavernoso de face em paciente adulto: relato de caso clínico

The authors present a case of a 18 (eighteen) years old male patient, presenting a recurrent painless tumour on the left side of his face, growing both intra and extraorally- It caused progressive limitation of mandibular mobilitv. Histopathological result of cavernous lymphangioma differed from the previous findings seen on magnetic resonance imaging.

mRNA EXPRESSION OF PD-1, PD-L1, AND IMMUNOTHERAPY IN BLADDER CANCER

Objective: This study aims to investigate mRNA expression of PD-1 and PD-L1 in patients with bladder cancer. Material & Methods: In this study, we examined 30 samples from paraffin embedded tissue blocks, samples were divided into two groups, 15 were NIMBC, and 15 were MIBC according to their histopathological result. mRNA expression of PD-1 and PD-L1 were conducted using Real Time-Polymerase Chain Reaction (qRT-PCR) and statistical significance was set at a p-value < 0.05. Results: Statistical analysis using the Mann-Whitney test found a significant difference in mRNA expression of PD-1 and PD-L1 in NMIBC compared to MIBC groups. Conclusion: mRNA expression of PD-1 and PD-L1 were higher in MIBC compared to NMIBC. PD-1 and PD-L1 as immune checkpoints are potential immunotherapy for patients with advance stage bladder cancer. Immunotherapy could be a substitute or combined with other treatments such as chemotherapy or radiotherapy.

Late malignancy after 26 years of evolution on an untreated perianal fistula

Squamous cell carcinoma and basal cell carcinoma are two types of neoplasms that rarely affect the perianal region, and their etiology is still a matter for debate. We present the case of a 75 year old patient with a 26 year history of perianal fistula, who presents with purulent and fecal perianal discharge and swelling at this level. Physical examination and anoscopy detected low transsphincteric fistula. The biopsy revealed the diagnosis of squamous cell carcinoma, for which a local excision was performed followed by adjuvant radiotherapy. Two years after this event, the patient presented with another perianal lession, which according to the histopathological result was a basal cell carcinoma; local excision was the only treatment performed for this malignancy.

Diagnostic yield, safety, and impact of transbronchial lung biopsy in mechanically ventilated, critically ill patients: a retrospective study

Background Pulmonary infiltrates of variable etiology are one of the main reasons for hypoxemic respiratory failure leading to invasive mechanical ventilation. If pulmonary infiltrates remain unexplained or progress despite treatment, the histopathological result of a lung biopsy could have significant impact on change in therapy. Surgical lung biopsy is the commonly used technique, but due to its considerable morbidity and mortality, less invasive bronchoscopic transbronchial lung biopsy (TBLB) may be a valuable alternative. Methods Retrospective, monocentric, observational study in mechanically ventilated, critically ill patients, subjected to TBLB due to unexplained pulmonary infiltrates in the period January 2014 to July 2019. Patients’ medical records were reviewed to obtain data on baseline clinical characteristics, modality and adverse events (AE) of the TBLB, and impact of the histopathological results on treatment decisions. A multivariable binary logistic regression analysis was performed to identify predictors of AE and hospital mortality, and survival curves were generated using the Kaplan-Meier method. Results Forty-two patients with in total 42 TBLB procedures after a median of 12 days of mechanical ventilation were analyzed, of which 16.7% were immunosuppressed, but there was no patient with prior lung transplantation. Diagnostic yield of TBLB was 88.1%, with AE occurring in 11.9% (most common pneumothorax and minor bleeding). 92.9% of the procedures were performed as a forceps biopsy, with organizing pneumonia (OP) as the most common histological diagnosis (54.8%). Variables independently associated with hospital mortality were age (odds ratio 1.070, 95%CI 1.006–1.138; p = 0.031) and the presence of OP (0.182, [0.036–0.926]; p = 0.040), the latter being confirmed in the survival analysis (log-rank p = 0.040). In contrast, a change in therapy based on histopathology alone occurred in 40.5%, and there was no evidence of improved survival in those patients. Conclusions Transbronchial lung biopsy remains a valuable alternative to surgical lung biopsy in mechanically ventilated critically ill patients. However, the high diagnostic yield must be weighed against potential adverse events and limited consequence of the histopathological result regarding treatment decisions in such patients.

A different technique in gasless, laparoendoscopic, single-site myomectomy

Background The aim of this study was to introduce a novel technique for gasless, laparoendoscopic, single-site (GLESS) myomectomy and to evaluate its feasibility and safety. Methods A retrospective observational study was performed at a hospital from Sep 2017 to Nov 2018. 15 patients with symptomatic subserosal or intramural myomas underwent GLESS myomectomy. Results The mean age and body mass index were 41.73 ± 8.58 years and 22.72 ± 2.27 kg/m2, respectively. 5 patients had a history of abdominal surgery, including four caesarean deliveries and one myomectomy. The mean operative duration, blood loss volume, time to specimen removal, time of bowel activity and postoperative hospitalization duration were 156.47 ± 62.19 min, 57.33 ± 72.35 ml, 29.87 ± 13.6 min, 27.67 ± 10.06 h, and 3.4 ± 0.74 days, respectively. The operation was successful in all patients, there were no surgical or wound complications in any patient, and the histopathological result was leiomyoma in all 15 patients. Conclusion The procedure is feasible and safe in selected patients with symptomatic myomas.

Paranasal sinus mucoceles, therapeutic solution through external surgical approach

Mucoceles are benign, expansive, cystic tumors, affecting especially the adult, with development in the paranasal sinuses. Clinical symptoms are not specific. These are rare conditions that originate within the sinusal mucosa, favoured by the obstruction of the sinus ostium. Due to the inflammation and the expansive character of the tumor, with the erosion of the bony walls, combined forms can develop, with the involvement of two or more sinuses, most frequently with fronto-ethmoidal localization.The authors carry out a clinical retrospective study on 25 cases of mucoceles of the paranasal sinuses, diagnosed and treated in the ENT Clinic of the “Sfantul Spiridon” Emergency Clinical Hospital Iasi, during 2015-2019. The authors insist on aspects related to clinical and radiological diagnosis (CT scanner), as well as surgical treatment by external approach.The postoperative evolution is generally simple, with full recovery, without complications or recurrences.The diagnosis of the mucoceles of the paranasal sinuses consists in radiologic techniques by preoperative CT scan examination, intraoperative macroscopic aspect and histopathological result.Surgical approach with complete excision of the tumor and creating a new sinusal drainage path prevents the occurrence of recurrences.

Gadollium Nanoparticles Delivery for Low Intensity Focused Ultrasound Diagnosis Ablation of Thyroid Cancer Therapy

Chemotherapeutic efficacy can be significantly developed nanotheranostics systems of drug delivery in tumor cells. In this work, we have demonstrated that the self-assembled by C225 conjugates Gd-PFH-NPs (C-Gd-PFH-NPs) for low intensity focused ultrasound diagnosis ablation of thyroid cancer treatment. C-Gd-PFH-NPs have shown excellent stability in PBS. Transmission electron microscopy (TEM) images also exposed the effective construction of C-Gd-PFH-NPs with commonly spherical sized assemblies. The incubation of the C625 thyroid carcinoma with C-Gd-PFH-NPs triggers apoptosis, which was confirmed by the flowcytometry analysis. The C-Gd-PFH-NPs, with remarkably displays the potent antitumor efficacy in a human C625 thyroid carcinoma xenografts. A histopathological result reveals that precisely achieved to additional confirm these outcomes. Further, we successfully examined the efficiency of C-Gd-PFH-NPs when used the thyroid carcinoma low intensity focused ultrasound diagnosis imaging (LIFUS) in vivo. These findings clearable for LIFUS agents with high performing image and different therapeutic purpose will have extensive possible for the future biomedical purposes.

Analysis of Conization Results in Patients undergoing Hysterectomy for Uterine Adenocarcinoma

Objective To observe if the histopathological result of a conization performed after cervical adenocarcinoma in situ diagnosis is compatible with the histopathological analysis of a subsequent hysterectomy. Methods The present descriptive and observational research consisted of the analysis of the medical records of 42 patients who were diagnosed with in situ adenocarcinoma postconization. The analysis consisted of whether there was compatibility between the histopathological reports of conization and hysterectomy and if there was an association between adenocarcinoma in situ and another neoplasia (squamous disease). Interpretation of any immunohistochemistry reports obtained was also performed. In addition, clinical and epidemiological data were also analyzed. Results A total of 42 conizations were performed, 33 (79%) were cold knife conizations and 9 (21%) were loop electrosurgical excision procedures (LEEPs). Of the patients analyzed, 5 (10%) chose not to undergo subsequent hysterectomy to preserve fertility or were < 25 years old. Out of the 37 patients with adenocarcinoma in situ who underwent subsequent hysterectomy, 6 (16%) presented with residual disease. This finding proved incompatible with the finding of the conizations, which had ruled out invasive cancer. Conclusion The prevalence of adenocarcinoma in situ increased in the past years. There is still a large part of the medical literature that advocates the use of conservative treatment for this disease, even though it is common knowledge that it is a multifocal disease. However, the majority of studies advocate that hysterectomy should remain the preferred treatment for women who have already completed their reproductive purpose.

Primary Tracheal Papilloma: A Case Report

Solitary papilloma in the respiratory tract is a rare benign epithelial tumor which is complete surgical excision of the current standard treatment for this type of tumor. Here a case of solitary tracheal papilloma treated by surgical resection is reported. Due to rarity and non-specific symptoms, tracheal papilloma always subjected to misdiagnosed and suffer from delayed treatment. In this case, a forty two years male has been presented with a recurrent non-productive irritative cough, a progressive shortness of breath, expiratory stridor and occasional hemoptysis. The patient was previously diagnosed as a case of bronchial asthma by a Pulmonologist and wrongly treated as well. CT scan revealed an intraluminal tracheal mass arises from the right side of the tracheal wall opposite c6-c7 vertebrae. The tumour was removed by endoscopic excision. The histopathological result confirms the diagnosis of squamous cell papilloma. No complications occur during surgery and no recurrence was observed in six months after surgery on followup. Bangladesh Med J. 2020 May; 49(2) : 44-47