Diagnostic value of fine-needle aspiration biopsy for breast mass: a systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Fine-needle aspiration biopsy (FNAB) of the breast is a minimally invasive yet maximally diagnostic method. However, the clinical use of FNAB has been questioned. The purpose of our study was to establish the overall value of FNAC in the diagnosis of breast lesions.</p> <p>Methods</p> <p>After a review and quality assessment of 46 studies, sensitivity, specificity and other measures of accuracy of FNAB for evaluating breast lesions were pooled using random-effects models. Summary receiver operating characteristic curves were used to summarize overall accuracy. The sensitivity and specificity for the studies data (included unsatisfactory samples) and underestimation rate of unsatisfactory samples were also calculated.</p> <p>Results</p> <p>The summary estimates for FNAB in diagnosis of breast carcinoma were as follows (unsatisfactory samples was temporarily exluded): sensitivity, 0.927 (95% confidence interval [CI], 0.921 to 0.933); specificity, 0.948 (95% CI, 0.943 to 0.952); positive likelihood ratio, 25.72 (95% CI, 17.35 to 28.13); negative likelihood ratio, 0.08 (95% CI, 0.06 to 0.11); diagnostic odds ratio, 429.73 (95% CI, 241.75 to 763.87); The pooled sensitivity and specificity for 11 studies, which reported unsatisfactory samples (unsatisfactory samples was considered to be positive in this classification) were 0.920 (95% CI, 0.906 to 0.933) and 0.768 (95% CI, 0.751 to 0.784) respectively. The pooled proportion of unsatisfactory samples that were subsequently upgraded to various grade cancers was 27.5% (95% CI, 0.221 to 0.296).</p> <p>Conclusions</p> <p>FNAB is an accurate biopsy for evaluating breast malignancy if rigorous criteria are used. With regard to unsatisfactory samples, futher invasive procedures are required in order to minimize the chance of a missed diagnosis of breast cancer.</p

Expression of Ki-67, Bcl-2 and Bax in the first trimester abortion materials

Objective: The aim of this study was to investigate possible similar or different mechanisms in recurrent and spontaneous abortion by evaluating immunohistochemical correlation between proliferation marker Ki-67, and apoptosis markers Bcl-2 and Bax in the fetal trophoblasts and maternal deciduas from abortion material. Material and Method: Eighty samples of curettage materials from 65 abortion patients histopathologically diagnosed "decidua showing Arias-Stella reaction and chorionic villi" or only "decidua showing Arias-Stella reaction" were included in the study. Hematoxylin&Eosin stained sections from all cases were re-evaluated and further stained immunohistochemically using antibodies against Ki-67, Bcl-2 and Bax. Results: Proliferation rate evaluated by Ki-67 expression both in the cytotrophoblastic cells and decidua was found to be significantly lower in spontaneous and recurrent abortions compared to evacuation abortion. The extent of Bcl-2 expression in syncytiotrophoblastic cells covering villous stroma was also decreased in spontaneous abortion. There were no significant differences between spontaneous and recurrent abortions in terms of Bcl-2 expression in syncytiotrophoblasts and Ki-67 proliferation index in cytotrophoblastic cells or decidua. Bax staining showed minimal decidual expression in a few spontaneous and recurrent abortions. Conclusion: We concluded that proliferation rate was decreased in fetal villous cytotrophoblasts and maternal deciduas in spontaneous and recurrent abortions. We also proposed that loss of Bcl-2 expression in syncytiotrophoblasts may cause abortion in a subset of cases. However, the data from spontaneous and recurrent abortions did not not support the presence of different mechanisms in both groups

Expression of Ki-67, Bcl-2 and Bax in the first trimester abortion materials

Objective: The aim of this study was to investigate possible similar or different mechanisms in recurrent and spontaneous abortion by evaluating immunohistochemical correlation between proliferation marker Ki-67, and apoptosis markers Bcl-2 and Bax in the fetal trophoblasts and maternal deciduas from abortion material. Material and Method: Eighty samples of curettage materials from 65 abortion patients histopathologically diagnosed "decidua showing Arias-Stella reaction and chorionic villi" or only "decidua showing Arias-Stella reaction" were included in the study. Hematoxylin&Eosin stained sections from all cases were re-evaluated and further stained immunohistochemically using antibodies against Ki-67, Bcl-2 and Bax. Results: Proliferation rate evaluated by Ki-67 expression both in the cytotrophoblastic cells and decidua was found to be significantly lower in spontaneous and recurrent abortions compared to evacuation abortion. The extent of Bcl-2 expression in syncytiotrophoblastic cells covering villous stroma was also decreased in spontaneous abortion. There were no significant differences between spontaneous and recurrent abortions in terms of Bcl-2 expression in syncytiotrophoblasts and Ki-67 proliferation index in cytotrophoblastic cells or decidua. Bax staining showed minimal decidual expression in a few spontaneous and recurrent abortions. Conclusion: We concluded that proliferation rate was decreased in fetal villous cytotrophoblasts and maternal deciduas in spontaneous and recurrent abortions. We also proposed that loss of Bcl-2 expression in syncytiotrophoblasts may cause abortion in a subset of cases. However, the data from spontaneous and recurrent abortions did not not support the presence of different mechanisms in both groups

125: A Case Report and Review of the Literature

Uterus-like ovarian mass is a rare benign entity with controversial etiopathogenesis. A 37-year-old woman, gravida 2, pars 2, presented with the complaint of pain in right lower abdominal quadrant. Physical evaluation revealed tenderness in this area and the ultrasonographic examination showed a right adnexial mass. Biochemical blood tests showed minimal leucocytosis and elevated serum levels of both CA 19-9: 117.79 mIU/mL (N: 0-37) and CA 125: 41.4 u/mL (N: 0-35). To exclude a malignancy, the specimen was examined with frozen sections and was subsequently diagnosed as endometriosis. Therefore, the surgical procedure was limited to right salpingo-oophorectomy. The right ovary was 6 x 4 x 2.5 cm in size and the dissected surface of ovary resembled a miniature uterus. Histologic sections as well as immunohistochemistry (smooth muscle actin, caldesmon and CD10) were consistent with the endometrial mucosal tissue that surrounded the bundles of smooth muscle

Primary malignant fibrous histiocytoma of the kidney: Report of a case

Primary renal malignant fibrous histiocytoma is extremely rare. The prognosis is generally poor because of the high rate of local recurrence even if radical surgery is performed. We report a case of primary renal malignant fibrous histiocytoma in a 43-year-old woman. A well-defined renal mass (10x9x7cm) with lobulated contour was revealed by abdominal ultrasonography and computerized tomography in our patient who presented with left-flank pain. The contralateral kidney and renal functions were normal. No other primary tumor focus was detected by screening performed to exclude a metastasis to the kidney. However, a nodule consistent with metastasis was identified in the liver. The patient underwent left radical nephrectomy. A huge, yellowish-white, partly necrotic neoplasm infiltrating the renal parenchyma, perirenal fat and adrenal tissue was revealed by gross examination. Microscopically, the tumor was composed of pleomorphic spindle to polygonal cells arranged in fascicles and storiform structures with extensive necrosis. Twelve mitotic figures were noted in 10 high power fields. Immunohistochemical staining for vimentin and CD68 were positive whereas pan-cytokeratin, smooth muscle actin, S-100, HMB-45 and desmin were negative. "A pleomorphic type of malignant fibrous histiocytoma" was diagnosed based on both the microscopic and immunohistochemical findings. The patient presented with multiple bilateral lung metastasis three years after nephrectomy. Histopathological examination is essential since malignant fibrous histiocytoma cannot be differentiated clinically and radiologically from other lesions with kidney involvement. The overall prognosis is unfavorable with a recurrence rate of more than 50% and the 5-year-survival rate is only 14%

Ectopic pancreas of the gastric antrum contiguous to a gastrointestinal stromal tumor manifesting as upper gastrointestinal bleeding: report of a case.

A 54-year-old woman was referred to us for investigation of recurrent episodes of melena. Gastroduodenal endoscopic examination revealed a hemorrhagic, polypoid tumor, about 3 cm in diameter, in the posterior wall of the gastric antrum, near the greater curvature. The lesion had a smooth surface with ulceration, and was fixed to the sublying planes. The source of the bleeding was the mucosa overlying the tumor. We performed a distal subtotal gastrectomy with Roux-en-Y anastomosis. Histopathological examination of the resected specimen revealed an ectopic pancreas and a gastrointestinal stromal tumor contiguous to the ectopic pancreatic tissue in the gastric antrum. The patient was discharged after an uneventful postoperative course and has not experienced any recurrence of symptoms since

Primary peritoneal serous psammocarcinoma with recurrent disease and metastasis: a case report and review of the literature.

BACKGROUND: Psammocarcinoma is a rare variant of serous carcinoma arising from either ovary or peritoneum. Although behavior of tumor is uncertain, it has been suggested to be similar to serous carcinomas of low malignant potential. CASE: A 67-year-old woman was admitted with an abnormal vaginal bleeding and abdomino-pelvic pain. Computed tomography showed a heavily calcified rectovaginal mass that was histologically characterized by numerous psammoma bodies and low-grade cytological features. Following the primary surgery, the patient received 9 cycles of chemotherapy. Five years later, she presented with diffuse recurrence and 1 year later, with metastasis to the vertebra. CONCLUSION: Although psammocarcinoma is known to behave in a more indolent course, clinicians should be aware that patients with this disease may have a clinically aggressive, recurrent, and metastatic tumor that necessitated systemic therapy