Wandering spleen with acute torsion mimicking an adnexal mass.

Wandering spleen manifests when the splenic ligaments are underdeveloped, or become lax, thereby allowing the spleen to relocate from its anatomical site to more distant areas. During such movements, torsion of the long splenic peduncle is common, which can lead to symptoms of acute abdomen and further complications such as infarction. It is typically seen in children and young females. Our report presents a case of a 22-year-old female presenting to the ER with complaints of severe pain in the abdominal region. On ultrasound, there was suspicion of an adnexal mass, which was later confirmed to be a misplaced spleen in the lower abdomen, with torsion, fat stranding, and splenic vein thrombosis, as revealed by enhanced CT abdomen and pelvic MRI. It was followed by an emergency splenectomy. As wandering spleen presents nonspecifically and is a rare condition, it is important to consider wandering spleen when patients present similarly to this case, to prevent misdiagnosis and to deliver surgical treatment quickly to preserve the spleen.

Clinicopathological features of dysembryoplastic neuroepithelial tumor: a case series.

BACKGROUND: Dysembryoplastic neuroepithelial tumors are rare benign supratentotrial epilepsy-associated glioneuronal tumors of children and young adults. Patients have a long history of seizures. Proper surgical resection achieves long term seizure control. We describe the clinicopathological features of dysembryoplastic neuroepithelial tumor cases reported in our practice and review the published literature. METHODS: All cases of Pakistani ethnicity were diagnosed between 2015 and 2021 were included. Slides were reviewed and clinicopathological features were recorded. Follow-up was obtained. Extensive literature review was conducted. RESULTS: Fourteen cases were reported. There were 12 males and 2 females. Age range was 9-45 years (mean 19 years). Majority were located in the temporal and frontal lobes. Duration of seizures prior to resection ranged from 2 months to 9 years with mean and median duration of 3.2 and 3 years, respectively. Histologically, all cases demonstrated a multinodular pattern, specific glioneuronal component, and floating neurons. Simple and complex forms comprised seven cases each. No significant nuclear atypia, mitotic activity, or necrosis was seen. Ki-67 proliferative index was very low. Cortical dysplasia was noted in adjacent glial tissue in four cases. Follow-up ranged from 20 to 94 months. Seizures continued following resection in all but one case but were reduced in frequency and intensity. In one case, seizures stopped completely following surgery. CONCLUSION: Clinicopathological features were similar to those in published literature. However, a marked male predominance was noted in our series. Seizures continued following resection in all but one case but were reduced in frequency and intensity. This series will help raise awareness among clinicians and pathologists in our part of the world about this seizure-associated tumor of children and young adults.

Sonographic Characteristics and Pathology Correlation of Breast Imaging Reporting and Data System (BI-RADS) Category 4 Lesions.

INTRODUCTION: The Breast Imaging-Reporting and Database System (BI-RADS) category 4 is designated for breast lumps that do not display the typical features of malignancy but still raise enough suspicion to warrant a recommendation for a biopsy, as malignancy cannot be ruled out through imaging alone. The main objective of this study was to investigate the sonographic characteristics and pathology correlation of BI-RADS 4 breast lesions and determine the positive predictive rate of BI-RADS 4 lesions in diagnosing breast cancer, using histopathology as the gold standard. METHODS: This was a cross-sectional study conducted at the Department of Radiology, Aga Khan University Hospital in Karachi, spanning from May 2021 to August 2022, with a duration of 15 months. The study focused on female patients over the age of 18 who presented with suspicious breast lesions on ultrasound. Both mammography and ultrasound-guided core needle biopsy were performed on these patients, followed by a detailed histopathological evaluation of the biopsy specimens. To calculate the positive predictive value (PPV), true positive cases were identified through both histopathology and ultrasonography. RESULTS: A total of 227 cases were categorized as BI-RADS 4 lesions, with the patients' mean age being 47.8 ± 14.3 years (range: 17 - 88). Among the biopsied lesions, 101 cases were confirmed to be true positive for breast malignancies, resulting in a PPV for malignancy of 44.9%. Conversely, there were 124 false positive cases out of the 227 BI-RADS 4 category lesions (54.63%). The primary indication for presentation was a breast lump, and out of the 101 confirmed malignant cases, 70 (69.3%) were associated with malignancy. CONCLUSION: BI-RADS 4 can be utilized to assess suspicious breast lumps; however, for more reliable results and to avoid false negatives, histopathological confirmation should complement the imaging findings.

Preoperative Ultrasound-guided Core Biopsy of Axillary Nodes for Staging of Clinically Negative Axilla in Breast Cancer Patients - A Pilot Study.

Objective The aim of the current study is to determine the feasibility and accuracy of ultrasound-guided core biopsy for staging the axilla in clinically node-negative patients with invasive breast cancer. Introduction Historically, in breast cancer patients, axillary lymph node dissection was performed to stage axilla. Because of the high morbidity of axillary lymph node dissection, sentinel lymph node biopsy (SLNB) became the standard of care in patients with clinically node-negative breast cancer. However, SLNB is expensive, time consuming, can cause morbidity and can be complicated by seroma formation, sensory nerve injury, lymphedema, etc. Many centers rely on the availability of frozen section on sentinel lymph nodes to avoid a second procedure with the accuracy of procedure ranging from 73 to 96%, however, the availability of frozen section is limited in our part of the world. Pre-operative identification of axillary node positivity in patients with clinically negative nodes by ultrasound imaging of the axilla would allow one-stage axillary clearance and can decrease the need for SLNB from 21% to 70%. The aim of the present study is to determine the accuracy and feasibility of ultrasound-guided core biopsy to stage the axilla in clinically node-negative breast cancer patients, comparing with final histopathology as gold standard. Material & methods This was a non-randomized, prospective interventional study, done at Radiology Department of Aga Khan University Hospital. All patients diagnosed with breast cancer (histologically proven) with clinically negative axilla and ipsilateral positive axillary ultrasound were included. These patients underwent axillary lymph node core biopsy. If the result was negative they were subjected to SLNB. Histopathology result was taken as gold standard. Results The sensitivity of ultrasound-guided core biopsy was 88%, specificity 100%, positive predictive values (PPV) 100%, negative predictive values (NPV) 89.28%, diagnostic accuracy 94%. Conclusion In conclusion, the present study demonstrated high accuracy of ultrasound-guided axillary lymph node core biopsy in breast cancer patients with clinically node-negative axilla. Positive core biopsy results can thus obviate the need for sentinel lymph node biopsy and allow breast surgeons to directly proceed to axillary lymph node dissection.