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Aim. The aim of our study was to assess the accuracy of a combination of digital mammography and breast ultrasonography in the prediction of response to neoadjuvant systemic treatment in breast cancer patients with different tumor subtypes. Methods. The study was designed as a retrospective diagnostic accuracy study. Stage I-III female breast cancer patients who received any type of neoadjuvant systemic treatment with radiological response assessment by both mammography and breast ultrasound and followed by surgical treatment in the breast and axilla were included in the study. The primary outcome was the diagnostic accuracy of combined modalities of mammography and breast ultrasonography for predicting the pathological complete response. On mammography and breast ultrasonography, the radiological response was categorized into complete response and non-complete response. Pathological complete response on surgical specimens was described based on current guidelines. True and false positive cases as well as true and false negative cases were counted and compared among patients with 4 different molecular subtypes. The diagnostic accuracy of combined imaging modalities was analyzed for positive and negative predictive values, sensitivity, and specificity rates. All rates were calculated according to the previously described formulas. Results. Eighty-one breast cancer cases were included in the study. Positive predictive values of imaging were 100%, 75%, 100%, and 83%, whereas negative predictive values were 67%, 75%, 100%, and 100% in patients with HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2- tumors, respectively. Sensitivity rates were found to be 98%, 90%, 100%, and 100%, whereas specificity rates were 100%, 50%, 100%, and 67% in patients with HR+/HER2-, HR+/HER2+, HR-/HER2+ and HR-/HER2- tumors, respectively. Conclusion. Digital mammography and breast ultrasonography as a combined modality seem to show the pathological complete response after neoadjuvant systemic treatment in HR+/HER2- breast cancer patients with a very high specificity rate. Therefore, these conventional tools may help surgeons to select patients who might benefit from loco-regional treatment de-escalation with higher accuracy. [ABSTRACT FROM AUTHOR]

Background: Chromophobe Renal Cell Carcinoma is the 3rd most common subtype of RCC. It is most frequently sporadic however, several familial cases, associated with Birt-Hogg Dubé syndrome, have been described. Material and Methods: A 68 year-old male which on CT examination, presents in the left hepatic lobe a focal lesion of 93 mm, well delimited with contrast socket. Liver biopsy is performed. Microscopic examination shows a tumor proliferation with a pseudoglandular- pseudo-accinar pattern with the delimitation of numerous vascular spaces. Immunohistochemical tumor cells are positive for CTK7 and CTK8 / 18 and negative for CEA, CTK19, CTK20 and CDX2 immunolabeling. Based on the immunohistochemical profile and morphological aspect, the diagnosis was malignant hepatic tumor possible hepatocellular carcinoma but a gastric metastasis of a carcinom with hepatoid pattern cannot be excluded. One week later it was found that the patient had a history of renal tumor, whose histopathological diagnosis was of chromophobe renal cell carcinoma. The immunohistochemical panel was supplemented with the reaction to CD117 in which the tumor cells were diffused positive and thus the definitive diagnosis of hepatic metastasis of renal carcinoma with chromophobic cells was established. Conclusion: In order to establish the primary origin of a liver metastasis, all the clinical information and all the pathological history of the patient are required. [ABSTRACT FROM AUTHOR]

Duodenal neuroendocrine tumors (NETs) are rare tumors, consisting of five different types of tumors. In many cases, they may be asymptomatic, leading to delay in diagnosis. Clinical symptoms are related to local tumor growth and mucosal ulceration. We report a 38-year old man with duodenal gangliocytic paraganglioma causing overt upper gastrointestinal bleeding and anemia. We describe specific clinical and histopathological features of the tumor, and review the diagnostic and therapeutic strategy. Gangliocytic paragangliomas are regarded as benign tumors. However, the disease recurrence and the malignant potential of the tumor have also been reported. [ABSTRACT FROM AUTHOR]

Background and aim. The purpose of breast-conserving surgery (BCS) for women with cancer is to perform an oncological radical procedure with disease-free margins at the final histological assessment and with the best aesthetic result possible. Intraoperative resected specimen ultrasound and intraoperative resected specimen mammography may reduce the rates of positive margins and reexcision among patients undergoing conserving therapy. Our objective is to compare the two methods with the histopathological results for a preset cut off and asses which parameters can influence the positive margin status. Method. A prospective study was performed on 83 patients who underwent breast conservation surgery for early breast cancer (pT1-3a pN0-1 M0) between 2014 and 2016. After excision the specimen was oriented in the operating room by the surgeon. Metallic clips and threads were placed on margins: one clip and the long thread at 12 o'clock, two clips and the short threads at 9 o'clock. The next step was intraoperative ultrasound assessment of the specimen. For the margins under 2 mm we performed selective margin shaving, followed by mammography to identify and document the lesion and finally histopathological examination of the specimen with reporting the gross and microscopic margins. The positive margins required re-excision or boost of radiation at the posterior or anterior margins, depending on the case. Results. We set a cut-off at 2 mm. The sensitivity and specificity of the intraoperative margin assessment via the ultrasound method were 90.91% (95% CI 70.84-98.88%) and 67.21% (95% CI 54-78.69%) respectively. The sensitivity and specificity of the intraoperative margin assessment via the mammographic procedure were 45.45% (95% CI 24.39-67.79%) and 85.25% (95% CI 73.83-93.02%) respectively. There was positive correlation between the histopathological and intraoperative ultrasound exam (p=0.018) and negative correlation between the histopathological exam and the post-operative mammographic exam (p=0.68). We found a positive correlation between the positive margin status and age (<40), preoperative chemotherapy, intraductal carcinoma, inflammatory process around the tumor, and the immunohistochemical triple negative profile. Conclusions. According to our results, the intraoperative ultrasound of the breast specimen for a cutt-off at 2 mm can decrease the rates of margin positivity compared to the mammographic procedure and has the potential to diminish the number of subsequent undesired re-excisions. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 45-year-old patient who was presented with a history of HIV (human immunodeficiency virus) infection associated with fever, weigh loss and pain in the right breast. The patient was performed with clinical examination and palpation which revealed a painful large mass at the right breast. The examination reported on a development of a primary infiltrating squamous cell carcinoma with Basal‐HER2 phenotype of the breast.

Background: Gastric and colorectal cancers are major causes of morbidity and mortality worldwide. Rectal cancer is the second most common cancer in the large intestine. Gastric cancer usually has a slow evolution, this type of cancer is difficult to diagnose because most patients typically don't present any symptoms in the earlier stages. Objective: The aim of this case presentation is to describe the case management of a 74 years old female patient with gastrointestinal stromal tumor (GIST) and rectal adenocarcinoma. Histopathological examinations present a gastrointestinal stromal tumor with low malignancy and intermediate risk of tumor progression, which infiltrated the gastric wall and a well-delimited adenocarcinoma that infiltrates the wall of the rectum to the level of the mucosa. Material and methods: Our case is about a female patient, 74 years old, who presented to the Surgical Department of the Mures County Clinical Hospital, accusing the following symptoms: rectal bleeding, motility disorder and abdominal pain. The patient performed a CT scan, which marked two tumors, first at the rectal level and a second one at the level of the posterior gastric wall. The purpose of the operation was a complete tumor excision, by performing rectosigmoid resection with L-T mechanical colorectal anastomosis DIXON and resection of the gastric area affected by tumor with a GIA stapler. Results: The immediate postoperative evolution wasn't favorable, the patient presented melenic stools on the third day after the operation, and on the fourth day she received a blood transfusion. Later evolution was favorable and on the 11th postoperative day the patient was discharged. Conclusions: Synchronous tumors require a multidisciplinary approach in order to be able to manage the case for the benefit of the patient. [ABSTRACT FROM AUTHOR]

The article presents case study of a 42-year-old patient suffering from areolar metastases of skin malignant melanoma. Topics discussed include surgical removal of the interscapular region; observation of edematous and enlarged left breast parenchyma associated with multiple hypoechoic nodules by performing ultrasound and mammographic examination; and observation of multiple brown and round nodules in the left breast.