Synchronous primary parotid tuberculosis and EBV-associated primary lymphoepithelial carcinoma.

ABSTRACT: A 48-year-old gentleman presented with complaints of neck swelling in the parotid region for 2 years. Diagnostic nasal endoscopy and video laryngeal stroboscopy were normal, and positron emission tomography scan showed no other primary lesion. The lesion with tail of parotid was excised and sent for histopathological examination. Part of the tissue was also sent for diagnosis of tuberculosis by polymerase chain reaction (PCR) as it is a very common disease in South Asian countries. At this point, differentials considered were undifferentiated primary carcinoma, metastatic undifferentiated nasopharyngeal carcinoma, and primary lymphoepithelial carcinoma. At the same time, PCR for tuberculosis came positive with rifampicin sensitive in drug resistance testing. EBV by ISH testing came out to be positive. Final diagnosis of primary lymphoepithelial carcinoma with co-existing tuberculosis of parotid was made. The patient was started on antitubercular therapy.

Evaluation of Diagnostic Accuracy and Impact of Preoperative Positron Emission Tomography/Computed Tomography in the Management of Early Operable Breast Cancers.

AIM: Our aim of this study was to evaluate the diagnostic accuracy of staging positron emission tomography/computed tomography (PET/CT) in early breast cancers (EBCs) and to assess its impact on disease management. PATIENTS AND METHODS: We retrospectively reviewed preoperative PET/CT scans of patients from January 2015 to December 2018 with Stage I/II, clinically T1-T2 N0-N1 breast cancers. The diagnostic performance of PET/CT for nodal (N) and distant metastases (M), its correlation with patient/tumor-specific factors, and its impact on disease management were analyzed using histopathology/clinical follow-up as standards of reference. RESULTS: Of 158 patients evaluated, 14% of patients were Stage I (T1N0), 60% were Stage IIA (T1N1, T2N0), and 26% were Stage IIB (T2N1). Sensitivity, specificity, and the diagnostic accuracy of PET/CT for axillary staging were 76%, 97%, and 84% and for distant metastasis evaluation were 100%, 98%, and 99%, respectively. The diagnostic accuracy of PET/CT for axillary staging was lower for low-grade, T1 tumors, postmenopausal group, and luminal A pathological subtype (77%, 84%, 81%, and 73%, respectively) compared to high-grade, T2 tumors, premenopausal group, and nonluminal A subtype (88%, 88%, 94%, and 87%, respectively). Distant metastases were detected on PET/CT in overall 16% (n = 25) of the patients (9% in Stage IIA and 27% in Stage IIB). PET/CT also incidentally identified clinically occult internal mammary nodes in 5% (n = 8) and organ-confined synchronous second malignancies in 5% (n = 8) of the patients. CONCLUSION: Preoperative PET/CT should be considered in all EBCs> 2 cm as it upstages the disease and alters management in about 24% of these patients. Given its high specificity for axillary staging PET/CT, patients with PET-positive axilla can be subjected to axillary dissection and those with PET-negative axilla to sentinel lymph node biopsy. The yield and diagnostic accuracy of PET/CT is less for low-grade tumors <2 cm and with luminal A subtype.