The impact of malignant nipple discharge cytology (NDc) in surgical management of breast cancer patients

BACKGROUND: The role of nipple discharge cytology (NDc) in the surgical management of breast cancer patients is unclear. We aimed: (i) to evaluate the effect of malignant NDc on the surgical approach to the nipple-areola complex, and (ii) to verify the association between malignant NDc and nipple malignancy. METHODS: We retrospectively analyzed a case series of 139 patients with NDc who underwent breast surgery. The clinical and histological findings, types of surgery with emphasis on nipple-areola complex amputation, immunohistochemical phenotypes of the carcinomas and measurements of the tumor-nipple distance were recorded. Additionally, in patients who showed HER2-positive lesions on definitive surgery, we evaluated the HER2 immunocytochemistry of the NDc smears. RESULTS: Thirty-two malignant and 107 benign/borderline NDc diagnoses were identified. All 32 malignant-NDc cases were histologically confirmed as malignant. Thirty borderline/benign-NDc cases were histologically diagnosed as malignant (sensitivity 58%). The majority of the patients with malignant NDc were treated with nipple-areola complex amputations in both the mastectomy and conservative surgery groups (P<0.001, chi251.77). Nipple involvement was strongly associated with HER2-positive ductal carcinoma in-situ (P<0.001, chi211.98). HER2 immunocytochemistry on the NDc revealed a 100% correlation with the immunocytochemistry performed on the surgical tissues. CONCLUSIONS: Malignant NDc influenced surgical management. The association of malignant NDc with nipple involvement is highly related to ductal carcinoma in-situ with HER2 overexpression. In case of HER2 positive NDc, nipple-areola complex involvement is more likely than in HER2 negative cases

Aspectos clinicos y subclinicos de brucelosis canina en San Juan

La Brucelosis es una enfermedad zoonótica de distribución mundial, que afecta a animales domésticos y se relaciona con salud ocupacional y tenencia de mascotas infectadas. El presente estudio de tipo observacional, con muestreo no probabilístico se realizó en el Dpto de Santa Lucía (Provincia de San Juan). Se estudiaron 100 perros que asistieron al quirófano municipal y 27 canes derivados de clínicas privadas durante 2017. Se realizó extracción de sangre por punción venosa en venas cefálicas. Las técnicas serológicas realizadas fueron: prueba de aglutinación con antígeno tamponado (BPA), prueba de aglutinación rápida en portaobjeto (RSAT) con 2-ME, ELISA indirecto (iELISA) y hemocultivo. Los resultados obtenidos sobre 127 animales analizados, fueron 37 machos y 90 hembras con un promedio de 4,5 años y el 66 % eran mestizos. En el examen clínico, 119 perros (94%) estaban clínicamente sanos, mientras que 8 (6%) presentaba algún signo clínico: cuadros oculares (20%), locomotores (30%), Reproductivos (40%) e Inespecíficos (10%). Solo se observaron 3 machos con orquitis, discoespondilitis y signos inespecíficos (5%). Los 127 animales fueron negativos a la prueba de BPA, descartando la infección con especies lisas del género Brucella. Mediante la técnica de RSAT con 2- ME detectó 10% (13/127) de animales positivos. Paralelamente se utilizó el kit VETLIS Brucella iELISA Caninos indirecto para la detección de anticuerpos específicos contra el lipopolisacárido rugoso (LPSr) de B. canis. Se analizaron 45 muestras de suero, de las cuales 10 correspondían a animales con signos compatibles con brucelosis, pero negativas a RSAT, 13 eran positivas o dudosas a RSAT y el resto de las muestras negativas fueron seleccionadas al azar. Los resultados obtenidos fueron 33 Negativos, 9 Positivos y 3 Sospechosos. La detección de anticuerpos anti Brucella canis, mediante las pruebas RSAT, ME-RSAT, e iELISA, permitieron detectar varios animales sin manifestaciones clínicas. Pese a que el hemocultivo es considerado la ?técnica de oro?, para la confirmación de la enfermedad, en todos los perros serológicamente positivos a tres técnicas diferentes, el aislamiento fue negativo, posiblemente debido a la cronicidad de la enfermedad donde la bacteriemia es intermitente. A partir del presente estudio, se pretende alertar no solo al Municipio, sino también a los propietarios sobre una realidad epidemiológica compleja, que requiere urgentes medidas preventivas y de control sobre la población a riesgo.Fil: Carrillo Moreno, Maria Virginia. Universidad Nacional de San Juan; ArgentinaFil: Elena, Sebastián. Ministerio de Agricultura, Ganadería, Pesca y Alimento. Servicio Nacional de Sanidad y Calidad Agroalimentaria; ArgentinaFil: Vissio, Claudina. Universidad Nacional de Río Cuarto. Instituto para el Desarrollo Agroindustrial y de la Salud. - Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto para el Desarrollo Agroindustrial y de la Salud; Argentina. Universidad Nacional de Río Cuarto. Facultad de Agronomía y Veterinaria. Departamento de Patología Animal; ArgentinaFil: Martin, Vivian Adriana. Universidad Nacional de Río Cuarto. Facultad de Agronomía y Veterinaria. Departamento de Patología Animal; ArgentinaXIX Simposio Internacional sobre Enfermedades DesatendidasBuenos AiresArgentinaFundación Mundo San

The adverse impact of the COVID-19 pandemic on abdominal emergencies: A retrospective clinico-pathological analysis

The COVID-19 pandemic has caused a worldwide significant drop of admissions to the emergency department (ED). The aim of the study was to retrospectively investigate the pandemic impact on ED admissions, management, and severity of three abdominal emergencies (appendicitis, diverticulitis, and cholecystitis) during the COVID-19 pandemic using 2017–2019 data as a control. The difference in clinical and pathological disease severity was the primary outcome measure while differences in (i) ED admissions, (ii) triage urgency codes, and (iii) surgical rates were the second ones. Overall, ED admissions for the selected conditions decreased by 34.9% during the pandemic (control: 996, 2020: 648) and lower triage urgency codes were assigned for cholecystitis (control: 170/556, 2020: 66/356, p p = 0.031). Less surgical procedures were performed in 2020 (control: 447, 2020: 309), but the surgical rate was stable (47.7% in 2020 vs. 44.8% in 2017–2019). Considering the clinical and pathological assessments, a higher percentage of severe cases was observed in the four pandemic peak months of 2020 (control: 98/192, 2020: 87/109; p p < 0.001). For the first time in this study, pathological findings objectively demonstrated an increased disease severity of the analyzed conditions during the early COVID-19 pandemic

Eccrine spiradenoma of the nipple: Case report, differential diagnosis and literature review

Eccrine spiradenoma is a rare lesion originating from eccrine sweat glands, with only few cases reported in breast tissue: we here describe for the first time, an eccrine spiradenoma arising in the nipple. An 84 year-old woman with a lesion enlarging her right nipple, showing ulcerations and eczema-like changes of the covering skin, was admitted to our hospital. Surgical excision of the central quadrant with nipple-areola complex was performed, followed by histopathological evaluation which revealed an adenoma with predominantly basaloid epithelial cells. The lesion was composed of tightly packed small and large groups of cells, arranged in diffuse alveolar/pseudorosette formations. The small cells expressed p63 and calponin, while a positive expression of CK7 and CD117 was detected in large cells. After careful and detailed examination, excluding various similar entities, a diagnosis of eccrine spiradenoma has been rendered. Although extremely rare, eccrine spiradenoma should be taken into account in the differential diagnosis of subcutaneous primary breast tumors

How to Preserve Steatotic Liver Grafts for Transplantation

Liver allograft steatosis is a significant risk factor for postoperative graft dysfunction and has been associated with inferior patient and graft survival, particularly in the case of moderate or severe macrovesicular steatosis. In recent years, the increasing incidence of obesity and fatty liver disease in the population has led to a higher proportion of steatotic liver grafts being used for transplantation, making the optimization of their preservation an urgent necessity. This review discusses the mechanisms behind the increased susceptibility of fatty livers to ischemia-reperfusion injury and provides an overview of the available strategies to improve their utilization for transplantation, with a focus on preclinical and clinical evidence supporting donor interventions, novel preservation solutions, and machine perfusion techniques

Topography of Prostate Cancer Recurrence: A Single-centre Analysis of Salvage Radical Prostatectomy Specimens and Implications for Focal Salvage Treatments

Background: Most prostate cancer (PCa) recurrences after nonsurgical first-line treatment are managed with androgen deprivation therapy (ADT). When local treatment is indicated, salvage focal treatment (FT) may achieve outcomes similar to those after salvage radical prostatectomy (sRP), with lower morbidity. However, descriptions of the topography of PCa recurrence are scarce. Objective: To describe the characteristics and topography of recurrent PCa at sRP. Design, setting, and participants: We performed a review of the final pathology for consecutive men undergoing sRP at a single centre between 2007 and 2021. Outcome measurements and statistical analysis: Clinical and pathological outcomes and recurrence localisation (standardised map) were recorded. Suitability for salvage FT was evaluated using criteria defined a priori. Results and limitations: We included 41 men who underwent sRP after whole-gland treatment (82.9% primary radiotherapy). Of these, 68.3% had grade group ≥3 and 46.3% had pT3 disease, including nine men (22%) with seminal vesicle involvement >1 cm. The pN+ rate was 29.3%. Surgical margins were positive in 39% (mostly at the apex, 21.9%). PCa was located at <3 mm from the apex in 68% of cases. The segment most frequently involved was the mid-gland (93%). The median prostate and index lesion (IL) volume was 31.4 cm3 (interquartile range [IQR] 23–37) and 2 cm3 (IQR 0.5–6), respectively. A solitary IL was present in 63.4% of cases, while 7.3% had whole-gland PCa involvement. Overall, 56% of the men (n = 23) were deemed suitable for salvage FT (although seven had pN+ disease). The sample size, single-centre retrospective design, and unavailability of magnetic resonance imaging data are the main limitations. Conclusions: According to sRP pathology, radiorecurrent PCa is an aggressive disease, frequently showing extraprostatic extension, positive margins, and apical involvement. The majority of cases still harbour a solitary index lesion and a consistent proportion may be suitable for a gland-preserving strategy. Patient summary: In this report we looked at the location of prostate cancer recurrence within the prostate gland after radiotherapy or ablation, in which energy (such as heat, cold, or laser energy) is used to kill cells. We found that although these recurrences are often high-grade locally advanced disease, around half of cases might be suitable for a gland-preserving salvage treatment

Exceptional Clinical Response to Alectinib in Pancreatic Acinar Cell Carcinoma With a Novel ALK-KANK4 Gene Fusion

This case report corroborates the indication for patients affected by these rare tumors to be treated in higher- volume cancer centers to provide patients with more ex- perience and access to NGS diagnostic resources. Most importantly, it raises enthusiasm and hope toward precision medicine and tailored treatments for patients with PACC