Case Report: Gastric Carcinoma Diagnosed at the Second Trimester of Pregnancy

We report a rare case of gastric cancer in pregnancy. A 26-year-old woman presented at the 20th week of pregnancy complaining of nausea and vomiting. Although the patient considered the condition to be related with pregnancy and underestimated its importance, her complaints persisted over the following weeks and she was hospitalized for investigation. The diagnostic workup revealed a metastatic gastric cancer. Gastric cancer is very rare in pregnancy, and therefore it may be left out of differential diagnosis by physicians. Diagnosis may be further delayed because of overlapping symptoms occurring during normal pregnancy (nausea, vomiting, and fatigue). All these factors may contribute to a very high mortality of this malignancy during pregnancy

Prognostic value of aldehyde dehydrogenase 1 (ALDH1) in invasive breast carcinomas

Aldehyde dehydrogenase 1 (ALDH1) has been identified as a marker of cancer stem cells in breast cancer (BC). Recent studies showed that ALDH1 expression is correlated with poor prognostic parameters and worse clinical outcome in BC. We evaluated ALDH1 expression by immunohistochemistry in a series of 217 invasive BCs and investigated the correlation between ALDH1 expression and clinicopathological parameters, molecular subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 [HER2] type, and triple-negative BC [TNBC]), and patient survival. There was a significant association between ALDH1 expression and tumor grade (p < 0.001), i.e., the expression of ALDH1 was higher in high-grade tumors. ALDH1 expression was significantly associated with estrogen and progesterone receptor (ER and PR) negativity (p < 0.001) and HER2 positivity (p = 0.001). ALDH1 expression ratios were higher in HER2 type and TNBC. There was a statistically significant correlation between ALDH1 negativity and luminal A subtype (p < 0.001). The overall and disease free survival were shorter in ALDH1+ tumors, although without statistical significance. We confirm that ALDH1 is a potentially important, poor prognostic factor in BC, associated with high histological grade, ER/PR negativity and HER2 positivity. For more accurate results, ALDH1 expression should be evaluated in larger case series including various types/subtypes of BC

See and treat strategy by LEEP conization in patients with abnormal cervical cytology

Objectives: To determine the overtreatment and re-LEEP rates of see and treat strategy (S &amp; T) in women who underwent S &amp; T by LEEP and to identify the risk factors for overtreatment and surgical margin and/or endocervical curettage positivity. Material and methods: A total of 800 patients who underwent S &amp; T in Istanbul University Cerrahpasa Medical Faculty between June 2010 and June 2016 were retrospectively analyzed. Results: Overtreatment rate was found to be 46.6%, decreasing with higher grade of cervical smear abnormalities. Age more than 45, low grade of cervical cytologic abnormality and absence of glandular involvement were associated with higher overtreatment rates. The more advanced the histopathology, the more increased risk of surgical margin on LEEP and ECC positivity (p &lt; 0.0001, for both). Glandular involvement was associated with both surgical margin and ECC positivity. Conclusions: S &amp; T can be used in patients with high grade cytologic anomaly with an acceptable overtreatment rate. In addition, bigger pieces of specimens may need to be removed during LEEP in patients who have suspicious images of higher grade of abnormalities on colposcopy to reduce surgical margin or ECC positivity. When high rate of ECC positivity in patients with HSIL cytology is considered, we suggest performing ECC to every patients with HSIL

Reproducibility of endometrial intraepithelial neoplasia diagnosis is good, but influenced by the diagnostic style of pathologists

Endometrial intraepithelial neoplasia (EIN) applies specific diagnostic criteria to designate a monoclonal endometrial preinvasive glandular proliferation known from previous studies to confer a 45-fold increased risk for endometrial cancer. In this international study we estimate accuracy and precision of EIN diagnosis among 20 reviewing pathologists in different practice environments, and with differing levels of experience and training. Sixty-two endometrial biopsies diagnosed as benign, EIN, or adenocarcinoma by consensus of two expert subspecialty pathologists were used as a reference comparison to assess diagnostic accuracy of 20 reviewing pathologists. Interobserver reproducibility among the 20 reviewers provided a measure of diagnostic precision. Before evaluating cases, observers were self-trained by reviewing published textbook and/or online EIN diagnostic guidelines. Demographics of the reviewing pathologists, and their impressions regarding implementation of EIN terminology were recorded. Seventy-nine percent of the 20 reviewing pathologists' diagnoses were exactly concordant with the expert consensus (accuracy). The interobserver weighted kappa values of 3-class EIN scheme (benign, EIN, carcinoma) diagnoses between expert consensus and each of reviewing pathologists averaged 0.72 (reproducibility, or precision). Reviewing pathologists demonstrated one of three diagnostic styles, which varied in the repertoire of diagnoses commonly used, and their nonrandom response to potentially confounding diagnostic features such as endometrial polyp, altered differentiation, background hormonal effects, and technically poor preparations. EIN diagnostic strategies can be learned and implemented from standard teaching materials with a high degree of reproducibility, but is impacted by the personal diagnostic style of each pathologist in responding to potential diagnostic confounders

Unusual uterine metastasis of invasive ductal carcinoma: A case report

Metastatic carcinoma of the uterus usually originates from other genital sites. Extragenital metastases such as breast are rare. A woman aged 34 years with a history of breast cancer was referred to the gynecology outpatient clinic for routine follow-up. Diagnostic tests and gynecologic examination revealed a uterine mass, which was removed with laparotomy. The pathologic investigation revealed metastasis of invasive lobular breast cancer. Chemotherapy was given and the patient has been under follow-up for 3 years with normal imaging on computerized tomographic examination and positron-emission tomography-computerized tomographic. It should be kept in mind that patients with breast cancer who have received tamoxifen may develop primary endometrial cancers, and may also demonstrate uterine metastases. With successful treatment these patients can obtain dis-ease-free survival

NIPPLE ADENOMA OF THE BREAST: RECONSTRUCTION OF NIPPLE FROM THE AREOLA

Although the nipple adenoma is a relatively rare condition, awareness of this disease is extremely important because its clinical features resemble Paget's disease or ductal carcinoma of the breast. A failure to recognise the pathology could therefore lead to misdiagnosis and consequent surgery which would cause serious damage to the patient. We report a case of erosive adenomatosis of the nipple. Physical examination revealed erosive tumor measuring 17x11 mm that was tender; swelled and indurated. There was a bloody discharge from the nipple. Cytological material from the nipple discharge showed a papillary cell cluster and punch biopsy revealed the nipple adenoma. We performed total nipple excision after pathological confirmation of diagnosis and reconstruction of the nipple with double opposing Z plasty

The Relationship of Ki-67 Over-expression with Clinicopathological Prognostic Parameters in Invasive Breast Carcinomas

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Epidermoid cyst of the cecum: A case report

Pure, benign epidermoid cysts of the abdominal viscera are rare. There have been only six reports of epidermoid cysts of the cecum in the literature. A 31-year-old female with a previous cesarean delivery was admitted to our hospital with inguinal pain. After admission to the hospital, she was operated with the initial diagnosis of adnexal mass. During the operation, no adnexal pathology was identified. A heterogeneous mass originated from the posterior surface of the cecum was observed. It had no connection with the lumen. The mass was then removed with dissection. Macroscopically, the mass was 9x7 cm in diameter and wall thickness was 0.1 cm. The inner and outer surfaces were smooth. It was filled with a dense yellow, thick-fatty material with no tooth, hair, bone, or calcification areas. On microscopic examination, the inner lining was composed of mature keratinized stratified squamous epithelium with a granular layer. In view of the later findings, the case was reported as epidermoid cyst of the cecum. Although epidermoid cysts are rarely seen in visceral organs, this case is the seventh case of cecum-originated epidermoid cyst that has been reported in the literature. The histogenesis of epidermoid cyst is unknown. These cysts are generally accepted to be sequestration cysts that may be either congenital or acquired. Acquired epidermoid cysts are believed to be traumatic or iatrogenic. The cesarean delivery may have been a cause of this condition in the present case. On ultrasonographic examination, these cysts can be misdiagnosed as ovarian cysts

Identification of PIK3CA aberrations associated with telomere length in breast cancer

PIK3CA (p110 alpha) mutations are the most common alterations in the phosphoinositide 3-kinase (PI3K) pathway, affecting about 27% of breast cancer (BCa) patients. Telomeres play crucial roles in chromosomal maintenance and stability. This study investigated the correlations between telomere length and PIK3CA mutations in BCa patients and compared these findings with the patients' clinical parameters