Primary Breast Angiosarcoma: Pathological and Radiological Diagnosis

Primary breast angiosarcoma is a very rare aggressive mesenchymal tumor, which may represent only 0.04% of all breast malignant tumors. We report a case of primary angiosarcoma in the breast of a 22-year-old woman who presented with a mass in her right breast. Ultrasonography revealed a large heterogeneous lobulated mass lesion consistent with a fibroadenoma or phyllodes tumor. After a period of six months, she presented with nipple retraction, so a core needle biopsy was performed. Histopathology revealed a well differentiated angiosarcoma (grade I/III), but in the mastectomy specimen, numerous neoplastic multinucleated giant cells were evident, which resembled those found in other sarcomas, such as malignant fibrous histiocytoma or extra skeletal osteogenic sarcoma, and this caused difficulty making the diagnosis. Using immunohistochemical (IHC) studies, neoplastic cells were positively stained for CD31, CD34, and factor VIII-related antigens, which confirmed that the tumor was a high grade, poorly differentiated angiosarcoma (grade III/III). In conclusion, angiosarcomas may have different grade patterns in the same tumor, and as a result it is necessary to examine the whole tumor for definite grading. Imaging findings in angiosarcomas are non-specific, therefore they may misdiagnosed, frequently by other benign lesions.

Bacterial contamination of expressed breast milk in neonatal intensive care unit

The milks expressed from the mothers' breast might be infected during squeeze, storage and/or transmission. The infection level has been reported as different in various studies up to 97 percent. The main purpose of this study is to determine the infection level and its relevant organisms as well as to specify drug allergy of the expressed milks from the mothers with their infant admitted to NICU ward. In this study, among the expressed milks from 80 mothers, were cultured each in an amount of 0.5-1cc and antibiotic discs selected for every strain was placed. The results indicate that 85 percent of samples were infected and dominant microorganisms were firstly Klebsiella [13.7%] and then S. epidermidis [12.5%]. In addition, 95% of Gram negative bacteria strains were susceptible to imipenem. The most effective antibiotic on isolated staphylococci was ceftizoxime [46.6% resistance]. The colony count in 32.4% gram negative bacteria and in 66.7% gram positive bacteria was between 10[4] to 10[5]CFU/ml and the remaining was above 10[5]CFU/ml [p=0.02]. Furthermore, there was no significant relationship between bacterial infection of the expressed milks with the site of milk expressing [house or hospital], mode of expressing[by pump or hand], storage duration and the mother's demographic characteristics including age and/or literacy. The studies show that infection prevalence in the milk samples was 85%; the most common infection factor was Klebsiella and then S. epidermidis that is indicative of high prevalence of hospital infection [nosocomial infection] in the infants ward

Lymphatic metastasis in head and neck squamous cell carcinoma

Squamous cell carcinoma is the common type of malignancy in head and neck area and it metastasis into the regional lymphnodes. The objective of this study was to evaluate the detection of this metastasis via lymphatic channels around the tumor or via newly formed lymphatics inside the tumor. This case series included twenty patients specimens with head and neck squamous cell carcinoma. They were evaluated for lymphangiogenesis by using Vascular Endothelial Growth Factor 3 and KI67 immunohistochemical markers and then the data was correlated with clinicopatological criterias. High intratumoral and peritumoral lymphatic densities were both found significantly associated with the poor histological differentiation [Exact test p= 0.023]. There was no association between intratumoral lymphatic density, peritumoral lymphatic density and the presence of lymph node metastasis, location of the tumor, age, and sex. There was however a significant association between intratumoral lymphatic density and peritumoral lymphatic density [Fisher exact test p=0.001]. This study reveals the existence of intratumoral and peritumoral proliferating lymphatics, but these lymphatics have no correlation with the lymph node metastasis in all the head and neck squamous cell carcinoma cases such as larynx and oral cavity

Histopathologic findings of lymph node biopsy cases in comparison with clinical features

To determine useful and important clinical signs and symptoms for evaluation of lymphadenopathy with consideration of histopathologic findings of biopsy. This retrospective case-series study was done on patients hospital folders who came with lymphadenopathy, Informations was collected about clinical signs, symptoms, age, gender and histopathologic findings. It was then analyzed by SPSS version 13 with chi-square test. There were 208 specimens, 98 women [47.1%] and 110 men [52.9%]. Mean age was 32.94 years. There were 45 cases [21.6%] of malignancy, 33 cases [15.9%] of infectious diseases and 130 cases [62.5%] of reactive lymphadenopathy. The most common histopathologic finding in all ages was reactive lymphadenopathy. Clinical signs and symptoms had significant relationship with pathologic findings. For a decision of lymph node biopsy attention to patients symptoms and signs especially B signs, size of the lymph node >2cm, generalized lymphadenopathy, mobility of lymph node and splenomegaly seems to be the useful guide lines for physician. In this study it seems that decision to take biopsy was correct in 75% of the cases

Pruritic urticarial papules and plaques of pregnancy with bullae formation: Report of an unusual case

Pruritic urticarial papules and plaques of pregnancy [PUPPP] is a pregnancy-specific dermatosis, which is a tremendously uncomfortable condition that effects primigravid women in their third trimester of pregnancy. The severe itching of PUPPP reduces sleep in the weeks prior to parturition. Erythematous urticarial papules and plaques with small vesicles are noted, but true bullae formation has not been reported. We present a 33-year-old woman with clinical findings of PUPPP with large bullae formation on her lower abdominal and periumbilical skin. Considering herpes gestationis as the first clinical diagnosis, a skin biopsy was performed. Histopathological findings confirmed the diagnosis of PUPPP