Increased risk of upstage when combinations of breast lesions of uncertain malignant potential are found on core needle biopsy: The need for surgical excision.

BACKGROUND: Management of breast lesions of uncertain malignant potential diagnosed at core needle biopsy (CNB) is controversial due to variable upstage rate (UR) with surgical excision (SE). METHODS: We performed an IRB-approved retrospective analysis of adult women who underwent CNB demonstrating atypical ductal hyperplasia (ADH), flat epithelial atypia, radial scar, or intraductal papilloma then SE between 2010 and 2022. We evaluated CNB pathology for combination diagnoses (CD), defined as multiple primary lesions or primary with lobular neoplasia (LN), and surgical pathology for upstage. RESULTS: 719 patients were included. UR was 12.2% (88/719). CD experienced higher UR than pure (17.7% (45/254) vs. 9.2% (43/465), p â€‹= â€‹0.001). ADH/LN had the highest UR of all CD (34.6% (9/26), p â€‹= â€‹0.001). Increased size (15.6 vs. 10.5 â€‹mm, p â€‹< â€‹0.001), distance from nipple (79 vs. 66 â€‹mm, p â€‹< â€‹0.001), and personal history of breast cancer (p â€‹= â€‹0.04) were associated with UR. CONCLUSIONS: CD was associated with increased UR. ADH/LN had the highest UR.

Actinomyces Infection Mimicking Esophageal Cancer.

Actinomycosis is a bacterial infection, which rarely affects the esophagus. Our patient presented with persistent acute blood loss anemia and epigastric pain despite previously negative upper endoscopy. He underwent repeat endoscopy a few months later showing what was thought to be malignant esophageal cancer at the gastroesophageal junction; however, the biopsy report revealed chronic inflammation with actinomycosis. This report will discuss the evaluation and management of actinomyces infections as it is important to distinguish infection from malignancy. It is crucial for physicians to be aware of the unusual presentation and ability to mimic malignancy to aid in proper diagnosis and management and therefore the prevention of unnecessary procedures including resection.

A conserved role for syndecan family members in the regulation of whole-body energy metabolism.

Syndecans are a family of type-I transmembrane proteins that are involved in cell-matrix adhesion, migration, neuronal development, and inflammation. Previous quantitative genetic studies pinpointed Drosophila Syndecan (dSdc) as a positional candidate gene affecting variation in fat storage between two Drosophila melanogaster strains. Here, we first used quantitative complementation tests with dSdc mutants to confirm that natural variation in this gene affects variability in Drosophila fat storage. Next, we examined the effects of a viable dSdc mutant on Drosophila whole-body energy metabolism and associated traits. We observed that young flies homozygous for the dSdc mutation had reduced fat storage and slept longer than homozygous wild-type flies. They also displayed significantly reduced metabolic rate, lower expression of spargel (the Drosophila homologue of PGC-1), and reduced mitochondrial respiration. Compared to control flies, dSdc mutants had lower expression of brain insulin-like peptides, were less fecund, more sensitive to starvation, and had reduced life span. Finally, we tested for association between single nucleotide polymorphisms (SNPs) in the human SDC4 gene and variation in body composition, metabolism, glucose homeostasis, and sleep traits in a cohort of healthy early pubertal children. We found that SNP rs4599 was significantly associated with resting energy expenditure (P = 0.001 after Bonferroni correction) and nominally associated with fasting glucose levels (P = 0.01) and sleep duration (P = 0.044). On average, children homozygous for the minor allele had lower levels of glucose, higher resting energy expenditure, and slept shorter than children homozygous for the common allele. We also observed that SNP rs1981429 was nominally associated with lean tissue mass (P = 0.035) and intra-abdominal fat (P = 0.049), and SNP rs2267871 with insulin sensitivity (P = 0.037). Collectively, our results in Drosophila and humans argue that syndecan family members play a key role in the regulation of body metabolism.