Incidence of phyllodes tumors of breast at a single centre in Allahabad, Uttar Pradesh, India

Background: Phyllodes tumor of breast is the rare fibro-epithelial tumor of breast constituting <1% of breast neoplasms. They are locally aggressive tumor and suddenly attain a big size. Fine needle aspiration cytology should have both stromal and epithelial component to make the diagnosis. Wide local excision of 1 to 2 cm margin of normal breast is the treatment of choice for tumour of <10 cm in size and simple mastectomy for tumor more than 10 cm. This study was conducted to evaluate the incidence and outcome after surgery for phyllodes tumor at our centre.Methods: Data of 15 patients at our centre was retrieved retrospectively from January 2011 to April 2016.Results: Out of these 15, 14 were female and 1 was male. 14 of them undergo wide local excision under general anesthesia while in one of the patients simple mastectomy was done. Based on tumor histology they are divided into 3 histotypes i. e. benign, borderline, and malignant. 12 patients were found to be benign, 3 borderline and none malignant. Out of 3 borderline disease patients 1 developed recurrence 8 months later to initial surgery. Wide local excision was done for total of 10 times and every time histopathology revealed borderline phyllodes but last report revealed sarcomatous changes. Patient also developed lung metastases and so was referred to oncology department and review histopathology revealed low grade spindle cell sarcoma. Full radiotherapy and complete course of MAID chemotherapy regimen was given but patient still developed local recurrence and metastasis to lungs. All patients in benign category were doing well and none of them developed recurrences in due course.Conclusions: Phyllodes tumor is an interesting entity for both surgeons as well as pathologists because of its rare occurrence and varied histological features. Rapidly growing nature of this tumor does not necessarily indicate malignant disease. No correlation was found between tumor size and recurrence

The accuracy of USG and USG guided FNAC axilla in predicting nodal metastasis in a clinically lymph node negative cancer breast patient

Background: Breast malignancies are the second most common cause of cancer-related mortality among women. As the size of the primary breast cancer increases, some cancer cells are shed into cellular spaces and transported via the lymphatic network of the breast to the regional lymph nodes, especially the axillary lymph nodes. Objective of the study was to determine the accuracy of USG and US-FNAC in detecting lymph node metastasis in a clinically lymph node negative CA Breast patient.Methods: This prospective study was conducted on 40 consecutive patients with biopsy proven breast cancer with clinically negative axilla, who had attending the OPD or IPD in our department of surgery, Swaroop Rani Nehru Hospital, Allahabad, during the period of 2014 to 2015. All of these patients were planned to undergo surgery (breast conservation or modified radical mastectomy with axillary clearance).Results: Sensitivity of the study = 97.77%, specificity = 25%, positive predictive value =92.01%, negative predictive value =50%, diagnostic accuracy =90%.Conclusions: Using axillary ultrasound and selective US-FNAC is a rapid, non-morbid method of staging the axilla in newly diagnosed breast cancer patients and should become a routine part of patient care because it can spare many patients particularly those who are undergoing axillary dissection

Outcome of substitutional urethroplasty by using dorsal onlay buccal mucosal graft: our experience of 10 years

Background: The term urethral stricture is anterior urethral disease, or a scarring process involving the spongy erectile tissue of the corpus spongiosum. Methods: Total 127 patients were included in the study. Patient selection criteria for urethroplasty by using buccal mucosal graft was length of stricture more than 2 cm, deep spongiofibrosis, failed optical urethrotomy for 3 times, adequate oral hygiene and proper buccal mucosa. Results: Length of stricture varied from 3.2 to 14 cm. In first postoperative week, 20.47% (n=26) patients developed minor wound infection culture negative seroma formation in stitch line in the skin. Donor site complications like eating and drinking difficulty, dysguesia, pain, sensitivity, speaking disorders were not found in any patient while oral tightness was noted in 43.30% (n=55) of patients. On postoperative follow-up mean peak urinary flow rate (Qmax) was 28.0 ml/sec (range 20.0-30.6 ml/sec). After a mean follow-up of 8.8 months range (1 month to 33 months) overall success rate was 90.55% (n=115). Conclusions: Buccal mucosa is an excellent graft material for substitution free graft urethroplasty in case of long anterior urethral stricture with excellent success rate. Success rate of dorsal onlay substitution free buccal mucosal graft urethroplasty is affected by length of stricture and aetiology of strictures. Lichen sclerosus having moderate success rate of urethroplasty and higher rate of complication and failure rate in 1-stage buccal mucosal urethroplasty and can be considered for two stage urethroplasty in case of very long stricture of anterior urethra of lichen sclerosus origin

Incidence of phyllodes tumors of breast at a single centre in Allahabad, Uttar Pradesh, India

Background: Phyllodes tumor of breast is the rare fibro-epithelial tumor of breast constituting &lt;1% of breast neoplasms. They are locally aggressive tumor and suddenly attain a big size. Fine needle aspiration cytology should have both stromal and epithelial component to make the diagnosis. Wide local excision of 1 to 2 cm margin of normal breast is the treatment of choice for tumour of &lt;10 cm in size and simple mastectomy for tumor more than 10 cm. This study was conducted to evaluate the incidence and outcome after surgery for phyllodes tumor at our centre.Methods: Data of 15 patients at our centre was retrieved retrospectively from January 2011 to April 2016.Results: Out of these 15, 14 were female and 1 was male. 14 of them undergo wide local excision under general anesthesia while in one of the patients simple mastectomy was done. Based on tumor histology they are divided into 3 histotypes i. e. benign, borderline, and malignant. 12 patients were found to be benign, 3 borderline and none malignant. Out of 3 borderline disease patients 1 developed recurrence 8 months later to initial surgery. Wide local excision was done for total of 10 times and every time histopathology revealed borderline phyllodes but last report revealed sarcomatous changes. Patient also developed lung metastases and so was referred to oncology department and review histopathology revealed low grade spindle cell sarcoma. Full radiotherapy and complete course of MAID chemotherapy regimen was given but patient still developed local recurrence and metastasis to lungs. All patients in benign category were doing well and none of them developed recurrences in due course.Conclusions: Phyllodes tumor is an interesting entity for both surgeons as well as pathologists because of its rare occurrence and varied histological features. Rapidly growing nature of this tumor does not necessarily indicate malignant disease. No correlation was found between tumor size and recurrence

The accuracy of USG and USG guided FNAC axilla in predicting nodal metastasis in a clinically lymph node negative cancer breast patient

Background: Breast malignancies are the second most common cause of cancer-related mortality among women. As the size of the primary breast cancer increases, some cancer cells are shed into cellular spaces and transported via the lymphatic network of the breast to the regional lymph nodes, especially the axillary lymph nodes. Objective of the study was to determine the accuracy of USG and US-FNAC in detecting lymph node metastasis in a clinically lymph node negative CA Breast patient.Methods: This prospective study was conducted on 40 consecutive patients with biopsy proven breast cancer with clinically negative axilla, who had attending the OPD or IPD in our department of surgery, Swaroop Rani Nehru Hospital, Allahabad, during the period of 2014 to 2015. All of these patients were planned to undergo surgery (breast conservation or modified radical mastectomy with axillary clearance).Results: Sensitivity of the study = 97.77%, specificity = 25%, positive predictive value =92.01%, negative predictive value =50%, diagnostic accuracy =90%.Conclusions: Using axillary ultrasound and selective US-FNAC is a rapid, non-morbid method of staging the axilla in newly diagnosed breast cancer patients and should become a routine part of patient care because it can spare many patients particularly those who are undergoing axillary dissection