Acute abdomen due to primary omentitis: a case report

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Η αξιολόγηση της υποβοηθούμενης με αναρρόφηση βιοψίας στη μελέτη των μικροαποτιτανώσεων του μαστού

Οι μικροαποτιτανώσεις του μαστού είναι μικροσκοπικές (<1mm) εναποθέσεις αλάτων ασβεστίου στο μαζικό παρέγχυμα και αποτελούν μαστογραφικό εύρημα. Οι μικροαποτιτανώσεις είναι συνήθως καλοήθεις, αλλά είναι δυνατόν να αποτελούν το μόνο εύρημα ενός αρχόμενου καρκινώματος του μαστού. Η αξιολόγηση των μικροαποτιτανώσεων βασίζεται στο σύστημα BIRADS ( Breast Imaging Reporting and Data System) του Αμερικάνικου Κολλεγίου Ακτινολογίας και ταξινομεί τις μικροαποτιτανώσεις της μαστογραφίας σε 6 κατηγορίες ανάλογα με τη μορφολογία και τη κατανομή τους. Οι κατηγορίες 3, 4a, 4b και 4c έχουν αναλογικά αυξανόμενες πιθανότητες κακοήθειας, ενώ η κατηγορία 5 θεωρείται αντίστοιχη κακοήθειας και συνεπώς έχουν ανάγκη βιοψίας. Η κλασσική προσέγγιση για τη βιοψία των μικροαποτιτανώσεων είναι με την τοποθέτηση αγκίστρου με συρμάτινο οδηγό (hook wire localization) από τους ακτινολόγους και εν συνεχεία η χειρουργική εξαίρεση της σημανθείσας περιοχής. Τα τελευταία χρόνια, η στερεοτακτική με αναρρόφηση βιοψία του μαστού έχει εισέλθει με αυξανόμενη δυναμική στη διερεύνηση των μη ψηλαφητών βλαβών του μαστού, όπως είναι οι μικροαποτιτανώσεις. Η αξιολόγηση αυτής της διαγνωστικής προσέγγισης αποτελεί και το στόχο της παρούσας μελέτης. Στη Μονάδα Μαστού του Ιπποκράτειου Νοσοκομείου Αθηνών, από τον Ιανουάριο του 2005 μέχρι το Νοέμβριο του 2011, αντιμετωπίστηκαν 853 γυναίκες ασθενείς με μαστογραφικά ευρήματα ύποπτων μικροαποτιτανώσεων, κατηγοριών BIRADS 3, 4a, 4b, 4c και 5 . Αναλύθηκαν τα αποτελέσματα της στερεοτακτικής με αναρρόφηση βιοψίας του μαστού με τη χρήση του Μαμμοτόμου. Αποτελέσματα: Η ιστολογική εξέταση των δειγμάτων που λήφθηκαν με τη χρήση της στερεοτακτικής βιοψίας υπό αναρρόφηση ανέδειξε 594 καλοήθεις (69.6%), 66 βλάβες υψηλού κινδύνου (7.7%) και 164 κακοήθεις (19.2%) βλάβες. Είκοσι εννιά περιπτώσεις κατηγοριοποιήθηκαν ως μη διαγνωστικές, καθώς ένα περιστατικό (0,1%) το δείγμα κρίθηκε ακατάλληλο για ιστολογική εξέταση λόγω μηχανικών αλλοιώσεων και 28 (3,3%) περιπτώσεις, λόγω επιφανειακής εντόπισης των μικροαποτιτανώσεων, παραπέμφθηκαν για ανοικτή χειρουργική βιοψία. Ο συνολικός βαθμός υποεκτίμησης ήταν 4.6% και τα ψευδώς αρνητικά αποτελέσματα ανήλθαν σε 2.4%. Η ευαισθησία της μεθόδου έφθασε το 98.2%, η ειδικότητα ήταν 100%, η θετική προγνωστική αξία ήταν 100% και η αρνητική προγνωστική αξία έφτασε το 97.6%. Συμπέρασμα: Η στερεοτακτική με αναρρόφηση βιοψία του μαστού είναι μια ασφαλής και αξιόπιστη μέθοδος για την αξιολόγηση των ύποπτων μικροαποτιτανώσεων του μαστού και για τη διάγνωση του καρκίνου του μαστού σε πρώιμο στάδιο.Purpose: Vacuum Assisted Breast Biopsy (VABB) is a minimal invasive technique, in the diagnostic approach for non palpable lesions. The aim of this study was to evaluate the efficacy and accuracy of VABB in the investigation of breast microcalcifications, a significant mammographic sign of early breast cancer. The rate of histological underestimation and the false negative rate were assessed based on the follow up data and the histological examination of the surgical specimens. Methods: From January 2005 to November 2011, 853 women with mammographically detected microcalcifications, classified as BI-RADS 3-5, were referred to our Breast Unit for evaluation. During this 6-year period, 825 vacuum-assisted breast biopsies were performed, while 28 women (3.3%) were not submitted to VABB due to superficial location of microcalcifications. Results: VABB histology revealed 594 benign (69.6%), 66 high risk (7.7%) and 164 malignant (19.2%) lesions. Twenty-nine cases were classified as non diagnostic, as in one case (0.1%) the sample of the biopsy was maladjusted and not suitable to undergo histopathological examination due to mechanical alterations and in 28 (3,3%) cases microcalcifications were located in proximity to the skin and open surgical excision was performed. The overall documented underestimation rate was 4.6%, the false negative rate was 2.4%. The sensitivity of the method was 98.2%, specificity 100%, positive predictive value 100% and negative predictive value 97.6%. Conclusions: VABB is a safe and accurate method for the evaluation of suspicious microcalcifications and diagnosis of early breast cancer

Volume of blood suctioned during vacuum-assisted breast biopsy predicts later hematoma formation

<p>Abstract</p> <p>Background</p> <p>To evaluate whether the volume of blood suctioned during vacuum-assisted breast biopsy (VABB) is associated with hematoma formation and progression, patient's age and histology of the lesion.</p> <p>Findings</p> <p>177 women underwent VABB according to standardized protocol. The volume of blood suctioned and hematoma formation were noted at the end of the procedure, as did the subsequent development and progression of hematoma. First- and second-order logistic regression was performed, where appropriate. Cases with hematoma presented with greater volume of blood suctioned (63.8 ± 44.7 cc vs. 17.2 ± 32.9 cc; p < 0.001, Mann-Whitney-Wilcoxon test for independent samples, MWW); the likelihood of hematoma formation was increasing till a volume equal to 82.6 cc, at which the second-order approach predicts a maximum. The volume of blood suctioned was positively associated with the duration of the procedure (Spearman's rho = 0.417, p < 0.001); accordingly, hematoma formation was also positively associated with the latter (p = 0.004, MWW). The volume of blood suctioned was not associated with patients' age, menopausal status and histopathological diagnosis.</p> <p>Conclusion</p> <p>The likelihood of hematoma is increasing along with increasing amount of blood suctioned, reaching a plateau approximately at 80 cc of blood lost.</p

Decreased Hsp90 expression in infiltrative lobular carcinoma: an immunohistochemical study

Background: Elevated Hsp90 expression has been documented in breast ductal carcinomas, whereas decreased Hsp90 expression has been reported in precursor lobular lesions. This study aims to assess Hsp90 expression in infiltrative lobular carcinomas of the breast. Methods: Tissue specimens were taken from 32 patients with infiltrative lobular carcinoma. Immunohistochemical assessment of Hsp90 was performed both in the lesion and the adjacent normal breast ducts and lobules; the latter serving as control. Concerning Hsp90 assessment: i) the percentage of positive cells and ii) the intensity were separately analyzed. Subsequently, the Allred score was adopted and calculated. The intensity was treated as a

Gastrointestinal stromal tumor

<p>Abstract</p> <p>Background</p> <p>GISTs are a subset of mesenchymal tumors and represent the most common mesenchymal neoplasms of GI tract. However, GIST is a recently recognized tumor entity and the literature on these stromal tumors has rapidly expanded.</p> <p>Methods</p> <p>An extensive review of the literature was carried out in both online medical journals and through Athens University Medical library. An extensive literature search for papers published up to 2009 was performed, using as key words, GIST, Cajal's cells, treatment, Imatinib, KIT, review of each study were conducted, and data were abstracted.</p> <p>Results</p> <p>GIST has recently been suggested that is originated from the multipotential mesenchymal stem cells. It is estimated that the incidence of GIST is approximately 10-20 per million people, per year.</p> <p>Conclusion</p> <p>The clinical presentation of GIST is variable but the most usual symptoms include the presence of a mass or bleeding. Surgical resection of the local disease is the mainstay therapy. However, therapeutic agents, such as Imatinib have now been approved for the treatment of advanced GISTs and others, such as everolimus, rapamycin, heat shock protein 90 and IGF are in trial stage demonstrate promising results for the management of GISTs.</p

Primary melanoma of the gallbladder: Does it exist? Report of a case and review of the literature

With the occasion of a case of malignant melanoma of the gallbladder, which appeared to be primary we have reviewed the literature and the result of this research was that primary melanoma of the gallbladder remains a questionable medical entity. Only few cases of both primary and metastatic gallbladder melanoma have been reported so far, and the only agreement is that surgery is the mainstay treatment. The role of adjuvant chemotherapy, hormonotherapy or immunotherapy for both primary and metastatic disease remains undefined. (c) 2006 The WIG Press. All rights reserved