Clinicopathological Features and Prognosis of Invasive Micropapillary Carcinoma Compared to Invasive Ductal Carcinoma-NOS: Worse or Better?

OBJECTIVE: To evaluate whether there are differences in invasive micropapillary carcinoma (IMPC) and invasive ductal carcinoma-NOS (IDC-NOS) according to the clinicopathological features and prognosis including molecular subtypes. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of Pathology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey, from 2003 to 2016. METHODOLOGY: Operated breast cancer cases (58 IMPC + 326 IDC-NOS), with long-term follow-up findings (cases followed up until 2020), were reviewed. The cases, whose other component was only IDC-NOS, were included in the mixed IMPC group. The clinical features, including clinical presentation, treatments, and follow-up information were obtained from the patient clinical database. The IMPC cases included in the study were re-examined, and micropapillary tumour components were confirmed based on the criteria set by the World Health Organisation (WHO). The clinicopathological findings, recurrence, and survival data of both groups were compared. In addition, IDC-NOS was divided into the molecular subgroups and compared with IMPC cases in terms of 5-year overall survival (OS). RESULTS: There was no significant difference between the two groups for the distribution of molecular subtypes. There was a statistically significant difference among the nuclear grade, tumour size, nodal status, lymphovascular, and perineural invasion. In the first 5-year period, the OS rate for IDC-NOS and IMPC was 90.8% and 86.2% (p<0.05). The 5-year OS rate of luminal A, luminal B, HER2, triple negative (TN), and IMPC patients was 97.6%, 91.3%, 90%, 70%, and 86.2%, respectively (p<0.05). The OS rate in patients with TN and IMPC was similar which was found significantly lower than the other groups (luminal A, luminal B, and HER2). The median OS was 51.3 months and 53.9 months for the patients with TN and IMPC, respectively (p<0.001). This difference disappeared in the 10th and 15th years of follow-up. CONCLUSION: The majority of the deaths in IMPC occurred within the first 5 years. The 5-year OS rates were similar in the TN and IMPC patients. The survival pattern of IMPC is parallel with TN, Therefore, clinical, therapeutic, and prognostic evaluation in IMPC can be done like TN. KEY WORDS: Invasive ductal carcinoma, Invasive micropapillary carcinoma, Survival.

How Accurately FNAC Reflects the Breast Papillary Lesions?

Context: Diagnosis of papillary lesions of the breast by fine needle aspiration cytology (FNAC) is problematic. For this reason, it is situated in the indeterminate zone in classification systems. Aims: To ascertain the accuracy of cytological diagnosis of papillary lesions in distinguishing papillary lesions from non-papillary lesions and to determine whether papillomas can be reliably distinguished from malignant papillary lesions by FNAC. Material and Methods: A total of 346 cases with the diagnoses of breast papillary lesions were selected among 5112 breast FNAC procedures performed in our center. One hundred and thirty-nine cases with excised lesions were included in this study, and their corresponding histology was reviewed. Results: Papillary lesion diagnosis was confirmed by histopathology in 103 (74.1%) of 139 patients. Cytology and histopathology results were not found to be compatible in 35 (25.2%) cases. The diagnostic accuracy of distinguishing papillary breast lesions as malignant or benign was assessed statistically. According to the cytology-histology comparison, one case was evaluated as false negative (FN) and twelve cases as false positive (FP). Overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC in distinguishing papillary lesions as benign or malignant were calculated as 87%, 97%, 83%, 72%, and 98%, respectively. Conclusions: The diagnostic accuracy of papillary breast lesions classified by FNAC might be improved by careful evaluation together with cytological, radiological, and clinical findings (triple test). Cell block may allow more accurate evaluation of the papillary lesion and can be applied to immunohistochemical examination. It may also facilitate the differentiation of benign/malignant papillary lesions.

Recurrent Left Atrial Botyroid Rhabdomyosarcoma.

Primary heart tumors are extremely rare and their frequency ranges from approximately 0.01-0.3% in autopsy series. Nearly one quarter of all primary cardiac tumors are malignant tumors such as sarcoma. Rhabdomyosarcoma is the second most common malignant primary tumor of the heart following angiosarcoma.Primary cardiac tumors present with one or more of the symptoms of the classic triad: cardiac symptoms and signs resulting from intracardiac obstruction; signs of systemic embolization; and systemic or constitutional symptoms. The prognosis after surgery is usually excellent in case of benign tumors, but is unfortunately still limited in localized malignant diseases [Butany 2005].In this case report we present a 45-year-old female patient operated three times in 9 years because of left atrial tumor.

Pattern of primary tumors and tumor-like lesions of bone in children: retrospective survey of biopsy results.

BACKGROUND: Although primary bone tumors are relatively uncommon, they constitute the most important tumors in patients less than 20 years. We aimed to determine the frequencies of primary bone tumors and tumor-like lesions of bone and the anatomical sites of their occurrence. METHODS: A retrospective review of histopathology reports of all bone specimens received in a private pathology laboratory in Istanbul between 2009 and 2015. RESULTS: A total of 57 patients (aged 5 to 18 years) with a mean of 13.12 years were studied. Thirty five patients (61.4%) were males and 22 (38.6%) were females. Fifty five (94.4%) of the tumors were benign. Osteochondroma was the commonest tumor accounting for 31 cases (54.3%) followed by osteoid osteoma, 9 cases (15.7%). Chondrosarcoma observed in two patients and Ewing sarcoma in one patient as malignant tumors. Of the 57 bone tumors 13 (22.8%) occurred in the upper extremities, while 44 (77.2%) were in the lower extremities. Proximal humerus was the most commonly involved site in upper extremity tumors, with osteochondromas representing the most frequent type of tumor (4 patients; 7%). In the lower extremities again osteochondromas were the most common type of tumor (8 cases, 14%), with the femur being the most common site of involvement (18 patients, 31.5%). Of the patients with tumor-like lesions; four patients had fibrous dysplasia, 4 patients had non-ossified fibromas, 4 patients had simple bone cysts and 3 had aneurismal bone cyst. CONCLUSION: This study showed that primary bone tumors were mainly benign, settled predominantly in the lower extremities mostly in the femur with a male preponderance. Osteochondroma was the most common benign bone tumor. We didn't observed osteosarcoma, which is the most frequent malignant bone tumor.

Diagnostic value of fine needle aspiration biopsy in non-thyroidal head and neck lesions: a retrospective study of 866 aspiration materials.

AIM: We aimed to investigate the diagnostic value of fine needle aspiration biopsy (FNAB) and compared our FNAB results of non-thyroidal head and neck lesions with excisional biopsy results. MATERIALS AND METHODS: A total of 866 aspiration material taken from different parts of head and neck region out of thyroid were evaluated at Haydarpasa Numune Training and Research Hospital Pathology Laboratory, between January 2002 and May 2013 and 248 of which has histopathologic response were included in the study. Patients depending on origin of the masses were divided into three categories as; salivary gland, lymph nodes and soft tissue/cystic lesions. The sensitivity, specificity, diagnostic accuracy values of fine needle aspiration biopsies have been investigated for all the series and individually for each category. FINDINGS: Diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive values of non-thyroidal head and neck masses were respectively; For all of the series; 94.6%, 97.9%, 96.7%, 95.9%, 97.2%, Salivary gland: 88.9%, 100%, 98.8%, 100%, 98.7%, Lymph nodes: 94.7%, 89.3%, 92.9%, 94.7%, 89.2%, Soft tissue/cystic lesions: 100%, 100%, 100%, 100%, 100%. For all of the series; there were 4 false negative (FN) cases; and 3 false positive (FP) cases. CONCLUSION: FNAB in the diagnosis of head and neck masses; it is an easy, cheap and usefull procedure.

Evaluation of peripheral lymphadenopathy with excisional biopsy: six-year experience.

BACKGROUND: Lymphadenopathy (LAP) may be the first symptom of many diseases. We aimed to investigate peripheral LAP results taken by excisional biopsy. METHODS: Histopathological examination of 185 lymph node biopsy specimens were evaluated between January 2009 and April 2015 in Istanbul Private Ekin Pathology Laboratory, retrospectively. RESULTS: The average age of patients ranged from 1 to 86 was 41.01 ± 20.62 years. 87 of were female, 98 of male. 62 (33.5%) of excisional biopsy materials were benign lesions and 123 (66.5%) of malignant. Benign lesions were consisted of reactive hyperplasia, cat-scratch disease, toxoplasmosis, necrotizing/non-necrotizing granulomatous. Of these patients, 40 had nodes with reactive hyperplasia (15 female/25 male, mean age: 27.35 y), 14 had necrotizing granulomatous disease (9 female/5 male, mean age: 39.86 y), 2 non-necrotizing granulomatous disease (1 female/1 male mean age: 43 y), 4 had cat-scratch disease (1 female/3 male mean age: 54.25 y), 1 toxoplasmosis (26 y, female), 1 Kikuchi disease (25 y, female). In the evaluation of malign lesions; 38 were Hodgkin lymphoma (HL) (20.5%, 17 female/21 male, mean age: 34.89 y) 77 had non-Hodgkin lymphoma (NHL) (41.6%, 37 female/40 male, mean age: 52.26 y), 8 metastasis (4.3%, 5 female/3 male, mean age: 53.5 y). Reactive LAP observed most common in cervical region, NHL in axillary-abdomen-inguinal-mediastinum and HL in the supraclavicular region. CONCLUSION: Excisional biopsy can be applied safely with minimal morbidity and mortality and a gold standard diagnostic method for LAP. Although LAP is mostly related with benign lesions, malignancy should be kept in mind in differential diagnosis.

A different type of branchial fistula as part of a branchiootorenal syndrome.

We describe an extremely rare case of a complete fistula, a combination of the first 2 branchial arches as a component of branchiootorenal syndrome. A 13-year-old girl presented with the complaint of intermittent drainage from bilateral preauricular and right lower neck external openings. A contrast fistulogram revealed a complete fistula. Diagnostic features and surgical techniques are discussed in detail.