Oral Verrucous Hyperplasia with Dysplasia – A Case Report

Introduction: Verrucous Papillary Lesions (VPLs) clinically present themselves as an exophytic growth seen commonly as grey- white in color. A dominant part of the favorable VPLs have viral etiology and incorporate commonly occurring squamous papil- loma alongside verruca vulgaris, central epithelial hyperplasia, and condyloma. Current comprehension of possibly malignant VPLs is astounding and is basically ascribed to the utilization of confounding and unacceptable terminology. Verrucous Hyper- plasia (VH) of the oral mucosa is a relatively intricate entity possessing paradoxical features making it difficult to diagnose when compared to other verruco-papillary lesions such as Verrucous Carcinoma (VC). Case Presentation: This case report depicts the presentation of Oral verrucous hyperplasia along with dysplasia seen in buccal mucosa of a 46-year-old patient. Management and Prognosis: Surgical excision was performed and ensured that margins were included in the excision to avoid any recurrence of the lesion. Conclusion: The most dependable approach to isolate these substances on routine hematoxylin-eosin stained tissue areas is to perceive the exophytic growth patterns of oral verrucous hyperplasia from the combined exophytic and endophytic growth patterns related with verrucous carcinoma. Furthermore, investigations on this are required using Immunohistochemical meth- ods.

Evaluation of Role of Tru-Cut Biopsy in the Diagnosis of Clinically Palpable Breast Lumps

Many diseases affect the breast that range from inflammatory conditions, benign lesions to malignant lesions, most of which present as lumps in the breast. Breast lumps are one of the frequent complaints that we come across in surgical OPDs. Breast lumps not only create apprehension but also can cause unacceptable pain and impairment if they are found to be malignant. Fine Needle Aspiration Cytology (FNAC), Tru-Cut biopsy, incision biopsy and excision biopsy are the pathological investigations available for the diagnosis of breast lesions. This study is done to evaluate the role of Tru-Cut biopsy in diagnosing the breast lesions and compare it with FNAC and histopathology.METHODSThis prospective study is conducted in the Department of General Surgery at a tertiary care centre from September 2015 to November 2016 among patients attending surgical OPD and admitted in general surgical wards with clinically palpable breast lumps.RESULTSThe sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC were 86.36%, 93.75%, 90.47%, 90.90% and 90.74 % respectively. For Tru-Cut biopsy the values were 95.45%, 100%, 100%, 96.96 % and 98.14 % respectively.CONCLUSIONSTru-Cut biopsy has better efficacy over FNAC in our study. The superiority of Tru-Cut biopsy is particularly seen in Sclerosing, papillary, fibro-epithelial lesions and malignancies with inconclusive and suspicious FNAC results.

Breast papillary lesions: a retrospective analysis from oncology set up of Pakistan

Background: Papillary lesions of the breast are a heterogeneous group of breast lesions that are difficult to diagnose as benign or malignant. These lesions have varied morphologic features that carry differing prognostic implications for affected patients. Accurate diagnosis is required to ensure that effective treatment is achieved. Papillary lesions can have increased risk of carcinoma and recurrence, in these patients even for lesions yielding a benign concordant diagnosis of papilloma at percutaneous biopsy, surgical excision may be warranted. Malignant lesions are usually surgically treated. Depending on stage-adjuvant chemotherapy and/or radiation therapy is given.Methods: A retrospective study was conducted at Shaukat Khanum Memorial hospital and Research Centre Lahore Pakistan. We reviewed the electronic records of diagnostic and registered patients from January 2007 till December 2017 in women imaging section, in age range of 25 to 75 years. Total 150 diagnosed patients with benign or malignant breast papillary lesions were selected and their conventional breast imaging (mammography and ultrasound) and histopathology was retrospectively analyzed on SPSS.Results: Patients were predominantly asymptomatic or on follow-up to an abnormal mammogram. Of the 150 cases most of the patients had intra-ductal papilloma followed by invasive papillary carcinoma and intra cystic papillary carcinoma. Few patients had intra-ductal papillomatosis and invasive micro papillary carcinoma.Conclusions: Conventional breast imaging remains the first main stay and quite sensitive in detecting breast papillary lesions leading to early detection and management.

Lesiones papilares malignas de la mama: nuestra experiencia / Malignant papillary lesions of the breast: our experience

Objetivo Este trabajo tiene como objetivo evaluar las características de las lesiones papilares malignas diagnosticadas en una obra social durante el período que abarca desde marzo de 2007 hasta agosto de 2015. Material y método Se realizó un análisis retrospectivo descriptivo de corte trasversal donde se incluyeron 56 pacientes con diagnóstico de Carcinoma ductal in situ papilar (cdis papilar), Carcinoma papilar encapsulado y Carcinoma papilar invasor. Se evaluaron las características clínicas, imagenológicas y anatomopatológicas. Conclusiones Las lesiones papilares malignas representan un desafío para el diagnóstico y manejo del equipo tratante dada su baja frecuencia y constante revisión de criterios diagnósticos y de manejo posterior

Objective The aim of the current study is to evaluate the characteristics of malignant papillary lesions diagnosed during march 2007 through agost 2015. Materials and method Retrospective and descriptive analysis has been made incluiding 56 patients with pathological diagnostic of papillary dcis, encapsulated carcinoma and invasive papillary carcinoma. We analyzed clinical characteristics, form of presentation in radiological features and pathological findings. Conclusions Papillary lesions of the breast represent a challenge for diagnostic an clinical management for clinicians involved, due to low frequency and a lack of clinical guidelines

Atypical papillary lesions after core needle biopsy and subsequent breast carcinoma.

Background: Papillary lesions of the breast cause diagnostic problem because papillary structures are found in benign and malignant processes. Core needle biopsy is important to make an initial diagnosis, but it still has potential pitfalls. Comparison between core needle biopsy and excisional biopsy can predict the possibility of malignant change in atypical papillary lesions. Objective: Evaluate the concordance between core needle biopsy and excisional results in atypical papillary lesions of the breast. Materials and methods: The pathology database of University of Texas Medical Branch at Galveston, USA was searched for patients with atypical papillary lesions at core needle biopsy who subsequently underwent surgical excision. Pathology reports from the excisional biopsies was also examined to assign each case to one of three categories, downgrade to benign papilloma, no change (remained atypical papillary lesion), and upgrade to carcinoma. The mammograms and ultrasounds were reviewed for each case. They characterized the lesions according to multiple imaging criteria. Results: Twenty-four patients with atypical papillomas at core biopsy subsequently underwent surgical excision. The lesions were downgraded to benign papilloma in 25%, remained atypical papillary lesion in 33%, and upgraded to carcinoma in 42%. On mammographic presentations (n = 23), masses were in 61%, architectural distortion in 4.3%, mass with calcifications in 9%, mass with architectural distortion and calcifications in 4.3%, calcifications alone in 17.4%, and architectural distortion and calcifications in 4.3%. On ultrasound findings (n = 21), solid masses were in 90%, intracystic masses in 10%, peripheral in locations in 81%, and subareolar in location in 19%. Conclusion: Due to the high upgrade rate of atypical papillary lesions to carcinoma (42%), excision of all atypical papillary lesions with wide excision margin is recommended for cases with pathologic diagnosis of atypical papillary lesion on core-needle biopsy.

Is Further Diagnostic Surgery Necessary for the Benign Papillary Lesions that Are Diagnosed by Large Volume Vacuum Assisted Breast Biopsy? / 한국유방암학회지

PURPOSE: There is ongoing controversy regarding the management of papillary lesions that are diagnosed by core needle biopsy (CNB). The development of vacuum assisted biopsy now permits non-operative removal of papillary breast lesions. Our aim was to evaluate whether the papillary lesions diagnosed by vacuum assisted breast biopsy (VABB) can be followed up without further diagnostic excision. METHODS: From January 2003 to July 2009, a total of 4,655 US-guided mammotome excision were performed in 3,714 patients at Kangnam CHA Hospital. Out of 4,655 lesions, 156 lesions were proved to be papillary lesions. Among these, 82 lesions that had histologic findings that were consistent with benign papillary lesions and that were followed up for more than 2 years without further diagnostic surgical excision were collected and retrospectively analyzed. Ultrasonographic follow-up was done at 3-6 month intervals to assess for recurrence. The mean follow up period was 49.6 months. RESULTS: The pathologic diagnoses for the 82 lesions obtained via VABB were benign intraductal papilloma and papillomatosis. Half of the lesions were palpable and 50.0% (41 cases) were nonpalpable. Twenty eight lesions (34.1%) were classified as BIRADS category 3, 50 lesions (61.0%) were category 4A, 3 lesions (3.7%) were category 4B and only 1 lesion (1.2%) was category 5 according to the ultrasound exams. No local recurrence developed during the follow up period that needed surgical re-excision or rebiopsy. None of those diagnosed as benign lesions at VABB were upgraded to a more advanced lesions. CONCLUSION: The benign papillary lesions that are diagnosed and excised by mammotome may not need further diagnostic surgical re-excision if surgeons are sure that the targeted lesions were excised completely.