Concurrent Utero-Vaginal Prolapse with Cervical Angiomyofibroblastoma: A Rare Disease with Distinct Entity

We report the case of a rare, benign mesenchymal tumour arising from the cervix. A 53-year-old post-menopausal woman presented with mass per vagina. Examination revealed stage 2 utero-vaginal prolapse and multiple elongated polyps seen at the cervix. She underwent local excision. Histopathological examination findings and the immunohistochemical studies were consistent with Angiomyofibroblastoma.

Mammographic breast density and other risk factors in Malaysian women with breast cancer

Aim: This study was performed to: (i) determine the association of breast cancer with dense breasts, and (ii) determine the breast cancer association with early onset of menarche, nulliparity, late age at first childbirth, not breast-feeding, and family history of breast cancer. Methods: This was a retrospective hospital-based case-control study. The 231 cases were women diagnosed with breast cancer on histology during the study period from July 1998 to April 2005. The 231 controls were age-matched and randomly selected women who did not have breast cancer but had mammography performed during the same time interval. Tabar classification was used to classify the mammographic parenchymal pattern of the 462 samples. The same radiologist analysed the parenchymal pattern based on the craniocaudal and mediolateral oblique views. Statistical analysis was done using the SPSS package. Results: Majority of women with breast cancer (55%) had dense breasts (29% Type IB, 19% Type IC, 4% Type IV, 3% Type V). Majority of controls (58%) had dense breasts (22% Type IB, 26% Type IC, 6% Type IV, 4% Type V). The majority of women with breast cancer had menarche at 12 years or older (93%), were parous (89%), had the first childbirth before 35 years old (91%), had breast-fed (67%), and did not have family history of breast cancer (84%). For controls, the majority had menarche at 12 years or older (88%) were parous (87%), had the first childbirth before 35 years old (98%), had breast-fed (66%), and did not have family history of breast cancer (85%). All factors explored, including breast density, were not significantly associated with breast cancer. The odds ratio for breast cancer among those with dense breast compared to those with non-dense breast is 0.8 (95% CI=0.6, 1.2). Conclusion: This study found no association between breast cancer and dense breasts (p=0.398). There was also no association between breast cancer with early onset of menarche (p=0.174), nulliparity (p=0.448), older age at first childbirth (p=0.065), not breast-feeding (p=0.716) and family history of breast cancer (p=0.665).

Metaplastic Breast Carcinomas: A Report of Six Cases

Metaplastic breast carcinomas (MBCs) are rare primary breast malignancies characterized histologically by carcinoma of two epithelial types or co-existence of carcinoma with non-epithelial cellular elements. They are aggressive tumours that carry poor prognosis. We reviewed the pathologic features and clinical outcomes of MBCs seen in our institution between the years 2000 to 2007. Out of 471 breast cancer patients, six female patients were histologically-proven to have MBCs giving an incidence rate of 1.3%. The patients comprised four Malays and two Indians and their mean age was 51 years old. Five patients underwent mastectomy (four with axillary clearance and one without) and one had wide local excision with axillary clearance. Axillary lymph node involvement was seen in four patients (three with epithelial only type tumour and one with the biphasic tumour). In all the cases, the tumours were bigger than 5 cm in diameter (T3), grade 3 and estrogen receptor negative. Five patients received chemotherapy while one refused. All of the patients had tumour recurrence with a mean time of recurrence of 9 months. In conclusion, metaplastic breast carcinomas are rare and aggressive tumours usually affect the post menopausal age group. They present as aggressive, large sized, high grade tumours that are estrogen receptor negative. Tumour size and axillary lymph node involvement indicate poor prognosis. Despite treatment with chemotherapy and radiotherapy, these patients have high risk of local recurrence and distant metastases which are potentially fatal.

Fine Needle Aspiration (FNA) Cytology of the Thyroid: A Cyto-Histopathological Study of 361 Cases in Hospital Universiti Kebangsaan Malaysia

Thyroid nodules are common but thyroid malignancies are not. Fine needle aspiration (FNA) cytology is a diagnostic tool used to screen patients with thyroid nodules who require surgery. We study the diagnostic accuracy of FNA as the initial diagnostic modality in the clinical assessment of thyroid nodules. Between January 1995 until December 2000, 2131 FNA of thyroid nodules were performed. Four hundred and forty-one (20.7%) of these were unsatisfactory and 1690 (79.3%) cases were satisfactory for cytological evaluation. Histopathological diagnosis were available for 361 cases. Cyto-histopathological correlation was carried out for these cases. Our results showed a diagnostic accuracy of 96.2% with sensitivity and specificity rates of 87.7% and 98.4% respectively. Our positive predictive value is 93.4% and our negative predictive value is 96.8%. From this study, we conclude that fine needle aspiration is an important initial screening diagnostic tool for the investigation of thyroid nodules.