Clear cell variant of diffuse large B-cell lymphoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Diffuse large B-cell lymphoma is a diffuse proliferation of large neoplastic B lymphoid cells with a nuclear size equal to or exceeding the normal macrophage nuclei. We report a case of a clear cell variant of diffuse large B-cell lymphoma involving a lymph node in the neck, which was clinically suspected of being metastatic carcinoma.</p> <p>Case presentation</p> <p>A 39-year-old Caucasian ethnic Albanian man from Kosovo presented with a rapidly enlarging lymph node in his neck, but he also disclosed B symptoms and fatigue. A cytological aspirate of the lymph node revealed pleomorphic features. Our patient underwent a cervical lymph node biopsy (large excision). The mass was homogeneously fish-flesh, pale white tissue replacing almost the whole structure of the lymph node. The lymph node biopsy showed a partial alveolar growth pattern, which raised clinical suspicion that it was an epithelial neoplasm. With regard to morphological and phenotypic features, we discovered large nodules in diffuse areas, comprising large cells with slightly irregular nuclei and clear cytoplasm admixed with a few mononuclear cells. In these areas, there was high mitotic activity, and in some areas there were macrophages with tangible bodies. Staining for cytokeratins was negative. These areas had the following phenotypes: cluster designation marker 20 (CD20) positive, B-cell lymphoma (Bcl)-2-positive, Bcl-6^-, CD5^-, CD3^-, CD21⁺(in alveolar patterns), prostate-specific antigen-negative, human melanoma black marker 45-negative, melanoma marker-negative, cytokeratin-7-negative and multiple myeloma marker 1-positive in about 30% of cells, and exhibited a high proliferation index marker (Ki-67, 80%).</p> <p>Conclusion</p> <p>According to the immunohistochemical findings, we concluded that this patient has a clear cell variant of diffuse large B-cell lymphoma of activated cell type, post-germinal center cell origin. Our patient is undergoing R-CHOP chemotherapy treatment.</p

Risk of breast cancer in women with cystic lesions

The aim of this study, was to diagnose breast cancer in women with breast cystic lesions using sonographic features of ultrasound and fine needle aspiration. Materials and methods: We examined 1560 patients with breast lesions, 87 patients had cystic breast masses. Most often symptoms was : a lump, breast pain, nipple discharge. The mean age of the patients was 45 years (range, 18–73 years). Diagnosis was determined with sonography with high frequency transducers 12 MHz and with fine- needle aspiration. Excision was performed for all malignant lesions. Cystic lesions were categorized as simple cysts, clustered cysts, cysts with thin septa, complicated cysts, cystic masses with a thick wall, and complex solid and cystic masses. Sonographic findings were compared with the pathologic results and were classified as benign and malignant masses. Results: Of 87 patients with cystic lesions, 12 (13.8%), were simple cysts, 8 (9.2%) were clustered cysts, 11 (12.6%) were cysts with thin septa, 17(19.5%) complicated cyst. All of cases were pathologically proven to be benign. Of 13 (15%) cases with cystic masses with a thick wall, 3 (23.1%) proved malignant, of 26 (29.9%) cases with complex solid and cystic masses, 11(42.3%) of them proved malignant. Conclusion: In our study sonographically detected and pathologically proved, simple cysts, clustered cysts and cysts with thin septa were all benign, so for this kind of cysts interventional treatment was not needed, just annual routine follow-up with sonography. Symptomatic complicated cysts should be follow-up by sonography and aspiration cytology and treated according to clinical symptoms. Cystic masses with a thick wall and complex solid and cystic masses should be examined by biopsy with pathologic confirmation

Të arriturat më të reja në trajtimin e kancerit metastatik të gjirit hormon receptor pozitiv dhe receptor të faktorit të rritjes epidermale humane 2 negativ me inhibitorët CDK4/6

Qëllimi i këtij punimi është të përshkruajë rolin dhe rëndësin e aplikimit të inhibitorëve CDK4/6 në trajtimin e pacientëve me kancer metastatik të gjirit hormon receptor pozitiv dhe receptor të faktorit të rritjes epidermale njerëzore 2 negativ (HR + / HER-2-). Kanceri i gjirit është një ndër karcinomat më të shpesht tek gratë, me më shumë se 276,000 raste të reja të vlerësuara në vitin 2020. Kanceri metastatik i gjirit përbën 6-10% të të gjithë pacientëve të diagnostikuar, është një sëmundje e pashërueshme dhe kërcënuese për jetën me mbijetesë 5 vjeçare afërsisht 25%. Fatkeqësisht, pavarësisht hapave të rëndësishëm në trajtimin e kancerit të gjirit, përsëritja e sëmundjes ndodh në 20-30% të pacientëve. Kanceri i gjirit me receptor hormonal pozitiv, i cili përbën më shumë se 70% të rasteve, është trajtuar me terapi endokrine me inhibitor selektivë të receptorëve të estrogjenit dhe me inhibitor të aromatazës. Megjithëse terapia endokrine mbetet shtylla kryesore e trajtimit të kancerit të gjirit me receptor hormonal pozitiv, rezistenca zhvillohet deri në 50% të pacientëve me kancer të avancuar të gjirit. Për të luftuar rezistencën, janë aprovuar terapi të cakut, tre inhibitor CDK4/6 palbociklib, ribociklib dhe abemaciklib si terapi për pacientët me kancer të avansuar ose metastatik të gjirit hormon receptor pozitiv dhe receptor të faktorit të rritjes epidermale humane 2 negativ (HR+, HER2–). Inhibitorët CDK4/6 (Cyclin-dependent kinase inhibitorët) janë klasa më e re e medikamenteve për trajtimin e kancerit të gjirit në stadin e avancuar. Efekti kryesor i inhibitorëve të CDK4 /6 është të zgjasin kohën e zhvillimit të rezistencës ndaj terapisë endokrine. Mbijetesa mesatare pa progresion të sëmundjes është rreth 20 muaj në vijën e parë të trajtimit ku inhibitorët CD4/6 u kombinuan me inhibitorët të aromatazës dhe rreth 10 muaj në vijën e dytë ku inhbitorët CD4/6 u kombinuan me fulvestrant. Zgjatja e kohës pa përparimin e sëmundjes e shtyn përdorimin e kimioterapisë dhe pacientëve ju sigurohet cilësia më mirë e jetës, pa efekte anësore të kimioterapisë, e cila ka një efekt sistemik në trup, duke shkaktuar nauze, te vjella, rrënie të flokëve dhe të ngjashme. Përfundimi: Inhibitorët CD4/6 në kombinim me terapinë endokrine janë një mundësi e re terapeutike, në trajtimin e kancerit metastatik të gjirit. Përdorimi i inhibitorëve CDK4/6 në trajtimin e kancerit metastatik të gjirit, hormon receptor pozitiv dhe HER-2 negativ, ka sjellë një përmirësim të dukshëm të kontrollit të sëmundjes, duke zgjatur në mënyrë të konsiderueshme mbijetesën pa progredim të sëmundjes, me një profil të pranueshëm të toksicitetit

Breast Hamartoma

Breast hamartoma is a benign, slow-growing tumor that can occur at any age. Breast hamartoma is also known as fibroadenolipoma, lipofibroadenoma or adenolipoma, depending on whether it is composed of glandular, fatty or fibrotic tissue. Breast hamartoma has an incidence of 0.1% to 0.7% of benign breast tumors. It is now more frequently diagnosed because of the breast diagnostic procedures such as ultrasound and mammography. In this study I present a case of 47 years female patient, with recent history of palpable right breast mass.. The patient was examined clinically, with ultrasound, mammography and core needle biopsy. With ultrasound were analyzed echosonographic features of the mass: shape, borders, echostructure, retrotumoral acoustic phenomen and tumor compressibility. Ultrasound showed in the lower inner quadrant of the right breast, well circumscribed mass 3.4 cm x 1.7cm, with heterogeneous hyperechoic internal echo texture with echogenic halo without retrotumor acoustic phenomen. This mass was easily compressed with a transducer. Mammography was done in the mediolateral oblique and craniocaudal view. Mammography showed a well circumscribed ovoid mass, around 3.4cm x 1.7cm with mixed, heterogeneous density (fat and soft tissue) with a mottled centre, with no evidence of microcalcification. We have also done spot magnification views, were we have seen lack of intrinsic density. Core needle biopsy of the mass was performed under ultrasound. The pathologist microscopically saw dysplastic glandular structures of the lobules and ducts, with a pronounced fibrotic stroma without neoplastic features. The histopathological analysis was hamartoma and the pathologist suggested to do excision of the mass. The patient refused the operation, and decided to follow- up. After 3 years of follow-up with ultrasound and mammography, the breast mass had the same size. Conclusion: Biopsy of the hamartoma and histological examination is necessary for a differential diagnosis to exclude malignancy. Breast hamartoma biopsy is recommended when the diagnosis is uncertain or the patient has complaints. In general, hamartoma has a good prognosis with or without surgical excision

Comparative Accuracy of Mammography and Ultrasound in Women with Breast Symptoms According to Age and Breast Density

Breast cancer is the most common cancer and the second most common cause of death from cancer in women.The aim of this studywas to determine which is more accurate imaging test mammography or ultrasound for diagnosis of breast cancer based on the women’s age and breast density. We examined 546 patients with breast symptoms, by clinical breast examination, mammography and ultrasound. A total of 546 breast lesions were examined by histopathology analyses. Histopathology results revealed the presence of 259 invasive cancers, and 287 benign lesions. Sensitivity varied significantly with age and breast density. In the 259 women who had both tests, ultrasound had a higher sensitivity than mammography in women younger than 45 years, whereas mammography had a higher sensitivity than ultrasound in women older than 60 years. The sensitivity according to age was 52,1% for mammography and 72,6% for ultrasound. The specificity according to age was 88, 5% for ultrasound and 73, 9% for mammography. Comparing the sensitivity of mammography and ultrasound according to the breast density indicates that mammographic sensitivity was 82,2% among women with predominantly fatty breast, but 23.7% in women with heterogeneous dense breasts, with the increase of fibro glandular density the level of sensitivity with mammography decreases, while ultrasonographic sensitivity was 71,1% among women with predominantly fatty breast and 57,0% for heterogeneous dense breasts. Our data indicate that sensitivity and specificity of ultrasound was statistically significantly greater than mammography in patients with breast symptoms for the detection of breast cancer and benign lesions particularly in dense breast and in young women

Evaluation of breast symptoms with mammography and ultrasonography

Introduction: Aim of the study was to discern which are more frequent symptoms presented in malign and benign masses diagnosed by mammography and ultrasonography. Methods: Our study group consisted of 546 female patients, with breast symptoms such as palpable lumps (40.8%), pain in the breast (26%), localized lumpiness or nodularity (13.7%), nipple retraction (11.2%), nipple bloody discharge (5.1%) and redness and swelling of the breast (3.1%). All 546 patients were examined by ultrasonography and mammography. Biopsy was performed according to the findings of mammography and ultrasonography. Results: In breast cancer detection ultrasonography showed an efficiency of 79.4% compared to 55.0% for mammography in detecting breast lump, in the case of nipple retraction mammography showed an efficiency of 89.1% compared to 80.4% for ultrasound, while the lowest efficiency for mammography was in the cases with localized lumpiness or nodularity 17.1% compared to 45.7% for ultrasound. In detecting fibrocystic changes where the most common symptoms was pain, ultrasonography showed an efficiency of 99.3 % compared to 84.2 % for mammography. Conclusions: Our study confirmed that breast lumps are detectable in the majority of patients with breast cancer. The most frequent symptoms in patient with benign lesions were pain or localized discomfort. The diagnostic accuracy for carcinomas of the breast and for benign lesions according to symptoms was higher for ultrasound than for mammography

Analysis of the relation between intelligence and criminal behavior

Introduction: One of the cognitive aspects of personality is intelligence. A large number of previous studies have shown that the intelligence within the criminal population is decreased, particularly in its verbal aspect. The aim of this study is to determine whether there is a link between intelligence and criminal behavior and how it is manifested. Methods: The research involved criminal inmates of the Correctional institutes of Republic of Srpska and Court Department of Psychiatry Clinic Sokolac who committed homicide and various non-homicide acts. The test group consisted of 60 inmates who have committed homicide (homicide offenders) and a control group of 60 inmates who did not commit homicide (non-homicide offenders). The study was controlled, transverse or cross-sectional study. Results: Average intelligence of inmates (homicidal and non-homicidal) was IQ 95.7. Intelligence of homicide inmates was IQ 97.4 and non-homicide IQ 94.09. Intelligence coeffi cients for non-homicide inmate subgroups were as follows - subgroup consisting of robbery offenders (IQ 96.9), subgroup consisting of theft perpetrators (IQ 93.83), subgroups consisting of other criminal offenders (IQ 92.8). Verbal intellectual ability – IQw of homicide inmates was 91.22, and 91.10 IQw of non-homicide inmates. Intellectual abilities in nonverbal or manipulative part were average, but they were higher in homicide inmates group (IQm 103.65) than in the group of non-homicide inmates (IQm 97.08). Conclusion: Average intelligence of investigated inmates (homicide and non-homicide) is lower than in the general population and corresponds to low average. Verbal part of intelligence is lowered while nonverbal part is within the average range

Prognostic Values of Thyroid Tumours

Thyroid cancer accounts for approximately 1% of total cancer cases in developed countries. The aim of this study has been to analyze the histopathological variants of thyroid tumours with regard to gender and age. Despite their relative rarity in our material, they exhibit a wide range of morphological patterns and biological behaviour During the period from 2001-2007, 138 biopsy cases of thyroid tumours, which were fixed in buffered neutral formalin and embedded in paraffin, have been reviewed. Tissue sections ^m thick) were cut and stained with hematoxylin and eosin (H&E). Follicular adenomas have been found in 39, 1% of cases, thyroid carcinomas in 60, 12%, whereas thyroid secondary carcinomas have been found in 0, 72% of cases. As far as histological variants of thyroid carcinomas are concerned, most frequently found were papillary carcinomas in 39,85% of cases; followed by follicular carcinomas in 9,42% of cases; follicular variants of papillary carcinomas in 5,79% of cases; medullary carcinomas in 3,62% of cases, while anaplastic and Hurthle cell carcinomas have been found in 0,72% of cases each. All histological variants of thyroid tumours occurred more frequently in women than in men. Papillary carcinoma has been found in 80% of female cases. Thyroid tumours in our material mainly occurred in the third, the fourth and the fifth decade of life. Our data indicate that apart from the fact that papillary carcinomas, well differentiated, and characterised by relatively good prognosis, were most frequent variants, certain morphological variants of it were associated with poor prognosis