Diagnostic correlation of palpable breast masses by cytology and histopathology: A prospective study

Introduction: Fine needle aspiration cytology (FNAC) has revolutionized the approach to diagnosis and management of breast and various other lesions. Its accuracy in many situations avoids any unnecessary surgical procedures. The aim of this study was to analyze and correlate the diagnosis of breast lesions on cytology with histopathology. Materials and methods: This prospective study was done at Government Medical College, Nizamabad, and Telangana State (TS) during June 2016 to May 2018 and total numbers of cases included were 200. A detail clinical and family history was taken before the procedure of FNAC and examination of both the breast was done. Results: The study included 200 breast masses/ cases, which were diagnosed on cytology. The age group included in this study was between 16 years and 75 years. Most of the cases in this study were in the age group 16- 30 years (91 cases) followed by 31- 45 years group (66 cases), followed by 46-60 years (34 cases) and least numbers of cases were noted in 61-75 years age group (09 cases). In this study, most common diagnosis was Fibroadenoma and least common diagnosis given on cytological examination was tubular Adenoma. Conclusion: FNAC is an important diagnostic adjunct in the management of patient with a breast lump. Recently FNAC popularity has grown many folds and has become a most valuable tool in the diagnosis of palpable breast masses owing to its distinct advantages of being sensitive, specific, expedient, economical and safe. Lack of local or general anesthesia makes the procedure more comfortable for the patient and the pathologist.

Ampullary Adenoma Treated by Endoscopic Double-Snare Retracting Papillectomy

We report herein improved methods for the safe and successful completion of endoscopic papillectomy (EP). Between January 2008 and November 2011, 12 patients underwent double-snare retracting papillectomy for the treatment of lesions of the major duodenal papilla. The main outcomes were en bloc resection rates, pathological findings, and adverse events. All of the patients (mean age, 60.1 years; range, 38 to 80 years) were diagnosed with ampullary adenoma by endoscopic forceps biopsies prior to endoscopic snare papillectomy. En bloc resection by double-snare retracting papillectomy was successfully performed for all lesions (median size, 12.3 mm), comprising six tubular adenomas, one tubulovillous adenoma, three cases of epithelial atypia, one hamartomatous polyp, and one case of duodenitis with regenerative change. Significant hemorrhage and pancreatitis were observed in one case after EP. Adenoma recurrence occurred in three patients during follow-up (median, 28.5 months) at a mean interval of 2 months postoperatively (range, 1 to 3 months). No serious adverse events were observed. Double-snare retracting papillectomy is effective and feasible for treating lesions of the major duodenal papilla. Further treatment experience, including a single-arm phase II study, needs to be accumulated before conducting a randomized controlled study.

Diagnosis and treatment of tubular adenoma in the extrahepatic bile duct / 中华消化外科杂志

Objective To study the clinical manifestations,diagnosis and surgical treatment of tubular adenoma in the extrahepatic bile duct.Methods The clinical data of 3 patients with tubular adenoma in the extrahepatic bile duct who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from July 2010 to February 2012 were retrospectively analyzed.Results The tumors were located at the middle and lower part of the common bile duct.All the 3 patients received resection of the common bile duct and Roux-en-Y cholangioenterostomy,and recovered well.The results of pathological examination showed that all the patients were with tubular adenoma,and 2 patients had moderate atypical hyperplasia.Conclusions Tubular adenoma in the extrahepatic bile duct could be diagnosed by pathological examination.Radical resection and rerouting of the bile duct can get a better outcome.

A Case of Tubular Adenoma of the Common Hepatic Duct Accompanied with Gallbladder Carcinoma / 대한소화기내시경학회지

Biliary adenoma is rarely found in the biliary tract, and there are currently few reported cases of tubular adenoma. Biliary adenoma most often occurs on the duodenal ampulla and the next most common site is on the common bile duct. Because the clinical signs, symptoms and the laboratory findings of these lesions may be similar to malignant biliary diseases, it is difficult to differentiate benign biliary adenoma from malignancy. Therefore, the diagnosis of these tumors tends to be delayed and physicians usually make the pathologic confirmation after a surgical operation. We experienced a case of the simultaneous occurrence of tubular adenoma of the common hepatic duct and gallbladder carcinoma, and all this was diagnosed and treated with common hepatic duct resection and a Roux-en-Y hepaticojejunostomy operation. To the best of our knowledge, this is the first report of biliary tubular adenoma accompanied with gallbladder carcinoma arising from tubulovillous adenoma.

Colonic Carcinoma and Tubular Adenoma with High Grade Dysplasia Resembling Submucosal Tumor / 대한소화기내시경학회지

Colorectal carcinoma arises from the epithelium of the colorectal mucosa, and so it displays various macroscopic appearances with abnormal mucosal changes. But submucosal tumor-like colorectal carcinoma is very rare. We report here on two such cases along with a review of the relevant literature. The first case was submucosal tumor-like colorectal carcinoma that was initially diagnosed as rectal submucosal tumor, but the follow-up endoscopic exam revealed ulceroinfiltrative type adenocarcinoma. The second case was an endoscopically determined polypoid lesion combined with submucosal tumor, but it was found to be tubular adenoma with high grade dysplasia combined with a mucin pool collection in the submucosa after surgical resection.

Telomerase Expression in Colorectal Tubular Adenoma Determined by Immunohistochemical Staining / 대한소화기학회지

BACKGROUND/AIMS: Telomeres are simple repeat elements located at each chromosome end of eukaryotic cells. The main function of telomeres is to cap the chromosome end and protect it from enzymatic attack. Telomerase that facilitates the synthesis of telomere has been detected in not only cancer but also precancerous lesion. In this study, we compared the telomerase expression between low grade and high grade colorectal tubular adenoma. METHODS: Among thissues from forty eight patients with colorectal tubular adenoma (23 low grade and 25 high grade colorectal dysplasia), telomerase expressions were evaluated by immunohistochemical staining. RESULTS: We classified 48 patients into two groups by the extent of nuclei staining pattern. High telomerase expression was a group which showed staining nucleus pattern above 50% in tubular adenoma. Low telomerase expression was a group which showed staining pattern nucleus below 50%. Twelve in 25 high grade colorectal dysplasia showed high telomerase expression (48%). Only one in 23 low grade colorectal dysplasia showed high telomerase expression (4%). Telomerase expression was much higher in the tissues from the patients with high grade than in those with low grade colorectal dysplasia (p<0.05). CONCLUSIONS: Activation of telomerase may be related to the malignant potential in colorectal epithelial cells. Further studies are needed to define the role of telomerase in colorectal tumorigenesis.

Expression of beta-catenin, hMLH1, p53, Bcl-2, Bax and COX-2 in Serrated Adenomas of Colon / 대한소화기내시경학회지

BACKGROUND/AIMS: Serrated adenoma of the colorectum is a recently proposed entity that is characterized by a saw-toothed structure of hyperplastic polyp and also the cytologic atypia of conventional adenoma. In contrast to conventional adenomas, the molecular features of serrated adenomas have been poorly studied. METHODS: The expression of beta-catenin and the DNA mismatch repair protein hMLH1, apoptosis regulating protein Bcl-2, Bax, p53 and COX-2 were analyzed in 28 serrated adenoma specimens and 28 tubular adenoma specimens. RESULTS: No differences were observed in the frequency of beta-catenin loss in the cell membrane between the serrated and tubular adenoma specimens. The frequency of hMLH1 loss was significantly higher in the serrated adenomas than in tubular adenomas (p 60 years old). In the tubular adenoma specimens, the frequency of p53 overexpression was increased in the dysplastic epithelium. CONCLUSIONS: The expressions of hMLH1, Bax and Bcl-2 were decreased in the serrated adenoma than in the tubular adenoma. Our data suggest that the serrated adenoma and tubular adenoma may have different pathway in their development. However, further studies including normal mucosa, hyperplastic polyp and cancer specimens are needed.

A Case of Gastritis Cystica Profunda Associated with Tubular Adenoma / 대한소화기내시경학회지

Gastritis cystica profunda (GCP) is a rare disease in which mature glandular epithelium extends into the muscularis mucosae or below. GCP lesions mainly develop at the gastroenterostomy stomas. These lesions show malignant histologic features such as metaplastic and even dysplastic alteration, however they usually exhibit benign behavior. We report a case of a patient with GCP who had not previously undergone gastric surgery. A 63-year-old woman visited our hospital for anorexia and epigastric discomfort. The esophagogastroduodenoscopy revealed two polyps on the anterior wall of the greater curvature, antrum. The polyps were removed by snare polypectomy and the histology findings showed the character of a tubular adenoma and a hyperplastic polyp with an associated GCP.

Tubular Adenoma of the Common Bile Duct: Endoscopic Diagnosis and Treatment / 대한소화기내시경학회지

Biliary adenoma of the common bile duct is a rare disease found in biliary tract encounterd in biliary mass lesion, and it is difficult to differentiate from their malignant counterparts. Symptoms and signs of these tumors can mimic choleliathiasis and malignant tumors. Therefore, this tumor is rarely diagnosed preoperatively. In addition, there has been no reported case of a tubular adenoma of the common bile duct in Korea, until recently. We experienced a case of tubular adenoma of the common bile duct, which was diagnosed and partially resected by percutaneous transhepatic cholangioscopy. The patient was a 84-year-old male who showed abnormal liver function test. Abdominal ultrasonography showed a dilated common bile duct, and a soft tissue was observed on endoscopic retrograde cholangiography. This was initially thought as a stone, but it became partially detachable from the common bile duct during an endoscopic retrograde cholangioscopic basket removal. The mass lesion was partially resected by a percutaneous transhepatic cholangioscopic snare. This resected tissue was confirmed as a tubular adenoma.

A Case of Gastritis Cystica Profunda Associated with High Grade Tubular Adenoma / 대한소화기학회지

Gastritis cystica profunda is usually characterized by hyperplastic and cystic dilatation of pseudopyloric gland with submucosal invasion. These lesions possess malignant histologic features as metaplastic and even dysplastic alteration can be observed, however they usually exhibit benign behavior. Macroscopically, gastritis cystica profunda may present as a submucosal tumor or as a polyp. In rare case, however, it can be found as a giant mucosal fold. The proposed pathogenesis of lesion relates to ischemia, chronic inflammation, and the presence of foreign body. Herein, we report a case of gastritis cystica profunda associated with high grade tubular adenoma in a patient without antecedent surgery.

The Expression of Melanoma-Antigen Gene A1-6 during the Carcinogenesis of the Colon / 대한소화기내시경학회지

BACKGROUND/AIMS: Melanoma antigen gene (MAGE)-A which have more than 12 subtypes is a gene family for tumor specific shared antigens, recognized by the cytotoxic T cell. Since these genes are expressed only in tumor cells and silent in normal adult tissues except in the male germ line, they may be used as diagnostic markers in detecting malignancy. During the carcinogenesis of gastrointestinal tract, the hyperplastic epithelium-adenoma-adenocarcinoma sequence is largely accepted and the molecular studies on each step have been issued. However, in the aspect of carcinogenesis in the gastrointestinal tract, MAGE genes have not studied yet. To explore the functional role and clinical significance of MAGE-A genes in the carcinogenesis of the colon, mRNA expression of MAGE-A1 to -A6 in the mucosal tissues obtained from the colonoscopy was investigated and the relationship between their expressions and clinicopathologic parameters was analysed. METHODS: We investigated the expression of MAGE 1~6 in 65 endoscopically biopsied samples of neoplastic and nonneoplastic tissues from the colon, using a MAGE common primer by the reverse transcription-nested polymerase chain reaction and DNA sequencing. RESULTS: Of the 31 colorectal adenocarcinoma specimens examined, MAGE genes were expressed in 11 cases (36%). In contrast, no expression of these genes was observed in any of the 12 samples of tubular adenoma and 12 of non-specific colitis and 5 cases of normal colonic tissues. There was no significant correlation between the expression of the MAGE genes and clinicopathologic factors, such as gender, disease stage, lymph node metastasis and perineural and vascular invasion in colonic carcinoma. CONCLUSIONS: It is postulated that the expression of MAGE genes could reflect the late event of oncogenesis of the colon because no MAGE expression was noticed in chronic inflamamtion and adenomas which might have the important role in the process of malignant transformation.

A Case of Papillary Tubular Adenoma (Tubulopapillary Hidradenoma)

Tubular apocrine adenoma and papillary eccrine adenoma are rare sweat gland neoplasms that appear as a small solitary lesion on the scalp or extremities, respectively. Although these lesions are thought to be distinct entities, there are enough similarities between them to group them under the term tubulopapillary hidradenoma or papillary tubular adenoma. We describe a case showing many tubular structures with papillary projection, syringocystadenoma-like structures, and eccrine hirocystoma-like structures in the axillary area. The term of papillary tubular adenoma or tubulopapillary hidradenoma may be prefered in this case.

A Case of Malignant Transformation of Gastric Tubular Adenoma Proven by 9-year Follow-Up / 대한소화기내시경학회지

The association of gastric tubular adenoma and adenocarcinoma is already well known. Then, are those two pathologic lesions merely incidentally coexisting or does the one evolve to the other? That is a longstanding controversy. Nowadays, as is the case with the colonic tubular adenoma, the hypothesis that gastric tubular adenoma may be a precancerous lesion is generally accepted. However the direct evidences are rare. We report a clear case proving the potential of direct malignant transformation of gastric tubular adenorna through the 9-year close endoscopic follow-up. The developed cancer is well differentiated, surrounded with background tubular adenoma and limited to the submucosal layer.

Squamous Metaplasia in Tubular Adenoma of Sigmoid Colon: A case report

The occurrence of squamous metaplasia(morule) in colorectal mucosa and adenocarcinoma, althrough rare, has been well documented. In contrast, very little mention has been given to mature squamous cells seen in colorectal polyps or adenomas. A 42-year-old woman presented with a 2-month history of diarrhea and melena. Proctosigmoidoscopy revealed a 4 cm-sized polypoid tumor 20 cm above the anal verge. Colonoscopic biopsy showed tubular adenoma, and a segmental resection of sigmoid colon was done. Microscopically, the tumor was c classical tubular adenoma containing multiple solid nests of squamous cells scattered only in the neoplasm; the squamous nests were generally small, and some showed direct continuity with adenomatous glands. The squamous cells were keratinizing and had regular nuclei with no mitotic activity. The importance of this phenomenon lies in its pathologic recognition, and the findings suggest that awareness of this rare occurrence in colorectal polyps should avert such overdiagnosis, and consequently prevents unnecessary radical surgery.