Relationship of vitamin D deficiency with mammographic breast density and triple-negative breast cancer: A cross-sectional study

BACKGROUND As breast epithelium is affected by vitamin D, it may have a direct effect on breast density and the risk of breast cancer. Our aim was to study the serum levels of vitamin D in patients with malignant and benign breast disease, and to study the association, if any, between vitamin D levels, mammographic breast density (MD) and molecular subtypes of breast cancer. METHODS In this cross-sectional, observational study, we enrolled 162 consecutive adult women with benign and malignant breast masses subjected to mammography and core-needle biopsy. Serum levels of vitamin D were estimated and correlated with MD and with immunohistochemical subtyping of breast cancer. RESULTS The mean vitamin D level in these 162 patients was 12.44 (5.88) ng/ml, with vitamin D deficiency seen in 98%. The mean (SD) vitamin D level in MD type 1 was 16.19 (4.62) ng/ml and it decreased to 7.54 (2.58) ng/ml in MD type 4. High MD was associated with significantly lower vitamin D levels. The mean vitamin D level in patients with benign breast disease (n=102) was 13.73 (5.68) ng/ml, while it was significantly lower in patients with breast cancer (n=60) at 10.26 (5.61) ng/ml. Among patients with breast cancer, the good prognosis luminal A molecular subtype had mean vitamin D level of 12.94 (6.16) ng/ml, whereas the poor prognosis triple-negative subtype had a significantly lower value of 7.68 (3.42) ng/ml. CONCLUSION Our study shows that vitamin D deficiency has a significant relationship with breast cancer (v. benign breast disease), high MD (showing increased breast cancer risk) and poor prognosis triple-negative breast cancer. Vitamin D deficiency could be an important, potentially modifiable, risk factor for the prevention of breast cancer in susceptible populations.

Submental nodal metastasis in papillary carcinoma of the thyroid

Papillary carcinoma of thyroid (PCT) commonly shows metastasis to central and lateral cervical compartment neck nodes. Submental nodes are rarely involved by PCT. Thus, its management is not clear. We report two young men who presented with submental nodal metastasis from PCT. Both underwent total thyroidectomy with central compartment neck dissection and modified radical neck dissection (MRND). Probable factors which might influence submental nodal metastasis are analyzed. We conclude that physicians should be aware of the possibility of submental nodal metastasis from PCT. A selective approach for neck dissection can be an alternative to MRND, reducing the morbidity in management of such cases.

Role of Polylactic-Polyglycolic Acid (Plga Co-Polymer) In Maintaining Alveolar Height and Width Following Extraction of Teeth

Background: This study was undertaken to consider the successful use of biodegradable osteosynthetic graft material polylactic- polyglycolic acid sponge as biodegradable root replicas which is placed as immediate implants in extraction socket to preserve the dimensions of alveolar process. Methods:A split mouth study was conducted on 20 patients who were selecte for orthodontic extraction of 1st and 2nd premolar teeth in the outpatient department of Oral and Maxillofacial Surgery, Peoples College of Dental Sciences and Research Centre, Bhopal from 1st January 2010 to 31st December 2010. One socket in each patient was randomly selected as test site (T) in which polylactic-polyglycolic acid sponge (Alvelac®) was inserted and the contralateral socket was taken as control site (C), which was allowed to heal naturally. Results: The test and control sites were evaluated preoperatively and postoperatively. Measurements recorded with regards to clinical (bucco-palatal width and height of the alveolus) and radiologically (mesio-buccal, mid buccal, disto-buccal). Clinical and radiological measurements shows there is a statistically significant decrease in bucco-palatal width and height of the alveolus on the control site as compared to that of the test site. Analysis of CT SCAN shows greater bone density on test site. Conclusion: The use of PLGA scaffolds (Alvelac®) significantly reduces the bone resorption both in height and width of the extracted socket. The quality of bone preserved when PLGA scaffolds is used, is of good quality to retain implants.

Validation of CK-19 and HBME-1 Expression Pattern in FNACs to Supplement Morphological Evaluation for Preoperative Diagnosis of Thyroid Lesions.

Aim: Fine Needle Aspiration Cytology is the cost effective, quick and minimally invasive method for the initial evaluation of thyroid nodule. But it poses a diagnostic challenge in differentiating benign follicular adenoma from follicular carcinoma and follicular variant of papillary carcinoma as they have similar cytological appearance. Present study focused on the identification of a biological marker for the differential diagnosis of thyroid malignancy in indeterminate cases. Place and Duration of the Study: Division of cancer Research, Regional Cancer Centre, Kerala, India, between August 2009 to September 2014. Methodology: Immunohistochemistry was performed using Ret (Rearranged during transfection), Hector Battifora Mesothelial Cell Antigen-1 (HBME-1), Cytokeratin-19 (CK-19), Keratan sulphate (KS), Thyroid peroxidase (TPO), Estrogen receptor (ER) and Progesterone receptor (PR) on cell block prepared from FNA material and corresponding tissue sections on 153 samples. Western blot analysis of ER and PR was performed in surgically excised fresh tissue specimens. Results: The present study found that HBME-1 is highly significant (P < .001) for the differential diagnosis with a diagnostic accuracy of 95.96%. Ret immunostaining may serve as good indicator of PTC whereas its sensitivity is very low in other lesions. The diagnostic accuracy of CK-19 was 90.91%. Intense positive staining of TPO was noted in majority of follicular epithelial cells of benign lesions (42.42%). Females had an increased prevalence in our study population so we examined the estrogen and progesterone receptors status in thyroid lesions. The specificity of KS, ER and PR are very low for the differentiation of adenoma from carcinomas of the thyroid. Conclusion: Present study found that the combination of two markers may give a more accurate way in the differentiation of thyroid nodules in problematic cases. So we suggest morphological evaluation along with immunocytochemistry of HBME-1 and CK19 can help the differential diagnosis of thyroid lesions in FNAs.

Biliary Ascariasis: Our Experience and Review of Literature.

Background/Aim: Ascariasis is endemic in the tropics especially amongst those living in poor sanitary conditions. Although most commonly it infests the small intestine, it can sometimes migrate to the biliary tract. We herein aimed to study the clinical manifestations, complications, diagnostic modalities and the most appropriate treatment modality for this condition. Materials and Methods: Fifteen cases of hepatobiliary ascariasis presenting over a period of 1.5 years were studied. All the patients were adults and presented to the emergency with acute biliary symptoms. Results: In this study, biliary ascariasis was found to be more common in middle aged females. The common presentations included upper abdominal pain and jaundice. Complications observed included acute pancreatitis and cholangitis. Ultrasonography could establish the diagnosis in 86.67% cases. Medical management could successfully treat 86.67% patients with ERCP being required in the remainder. Conclusion: In endemic countries, ascariasis should be considered as a differential diagnosis in patients presenting with acute biliary symptoms. Ultrasonography is a useful non invasive test to diagnose the condition and medical management remains a reasonable first line treatment option.

Uncommon presentation of common disease.

Tuberculosis is a chronic, granulomatous disease. Primary lesion usually occurs in the lung. Extra pulmonary infection commonly involves head, neck and abdomen. In the absence of typical features of tuberculosis, tuberculous cellulitis mimicking oral infection may pose a challenge for diagnosis. In an attempt to highlight an uncommon presentation, we document a case of extra pulmonary tuberculosis in the parotid gland (tuberculous parotitis), without evidence of pulmonary tuberculosis and HIV. A 30 year old female from low socio-economic status reported with pain in front of the left ear and difficulty in opening her mouth. Swelling was present on left side of the face without evidence of intraoral focus of infection. She was diagnosed to be having tuberculosis of parotid gland after fine needle aspiration cytology (FNAC), Ultrasonography (USG) and histopathological examination and was treated medically and surgically.

Osteomyelitis of the mandible due to Aggregatibacter (Actinobacillus) actinomycetemcomitans.

Aggregatibacter (Actinobacillus) actinomycetemcomitans is a capnoic gram negative coccobacilli known to produce juvenile periodontitis. This organism was isolated in pure culture from an unusual case of osteomyelitis of the mandible. The patient was treated with tetracycline, which is the drug of choice for A. actinomycetemcomitans and the clinical response improved. From our limited review of the literature, it appears that this is the first case of osteomyelitis due to A.actinomycetemcomitans reported in India.

Epithelial myoepitheial carcinoma of minor salivary gland--low grade malignant tumor presenting with nodal metastasis.

Epithelial myoepithelial carcinoma (EMC) is a rare low grade malignant salivary gland neoplasm that most commonly occurs in the parotid gland but can also arise in minor salivary glands. We report a case of primary epithelial myoepithelial carcinoma of minor salivary gland in a 25 year old women who presented with swelling left cheek of one year duration and bilateral submandibular lymphadenopathy. A mass causing erosion of mandible, thyroid cartilage and masseter muscle was identified on CT scan. This was excised and histological examination revealed a mixture of ductal structures consisting of inner dark cells and outer clear cells seen in solid sheets. Immunohistochemical analysis showed the clear cells to be weakly positive for S100 and smooth muscle actin (SMA) and ductal cells to be positive for cytokeratin (CK) and epithelial membrane antigen (EMA). The characteristic morphological and immunohistochemical features aided in the diagnosis of epithelial myoepithelial carcinoma.

Randomized, double-blind trial comparing topical nitroglycerine with xylocaine and Proctosedyl in idiopathic chronic anal fissure.

OBJECTIVE: To compare symptomatic relief, healing, and changes in maximal anal resting pressure with the use of topical formulations in patients with chronic anal fissure. METHODS: Sixty-four consecutive patients with chronic anal fissure were randomized into 4 groups that received, in a double-blind manner, a topical ointment that contained 0.2% nitroglycerine (GTN), 5% xylocaine, Proctosedyl (hydrocortisone acetate, heparin, framycetin sulfate, esculoside, ethoform, butoform) or petroleum jelly (Vaseline), to be applied twice daily. Patients were reviewed at 2-week intervals for 6 weeks. Anal manometry was done before, and 20 minutes after, the first application of the ointment. RESULTS: There was significant (p < 0.0001) reduction in mean anal resting pressure after application of GTN, but not any other ointment. Of 16 patients receiving GTN, complete pain relief occurred in 6 and 15 patients after 2 and 4 weeks of treatment, respectively; this was more frequent than in the other 3 groups. At 6 weeks also, complete pain relief occurred more often with GTN than with Vaseline or xylocaine. After 4 weeks of treatment, 3 patients on GTN had complete healing of fissure as compared to one each in the xylocaine and Proctosedyl groups and none in the Vaseline group. At 6 weeks, healing of fissure had occurred in 15 of 16 patients receiving GTN as compared to 4 receiving Vaseline, 11 receiving xylocaine, and 12 on Proctosedyl. CONCLUSIONS: Topical nitroglycerine produces 'chemical sphincterotomy' with reduction in mean anal resting pressure. Pain relief and healing of fissure occurred earlier with GTN than with other treatments. GTN should be considered as the treatment of choice for the non-surgical management of patients with chronic anal fissure.