rakesh kumar gupta

Solitary fibrous tumors (SFT) are the rare mesenchymal tumors originally described in the pleura. SFT of breast is even rarer and to the best of our knowledge about 35 cases are reported to date, including only six malignant SFT cases.

Casepresentation: 

We report a case of a 52-year-old lady with a large left breast mass involving all the quadrants. The tumor was diagnosed as malignant SFT in a core needle biopsy which was later confirmed on the resection specimen.

Herein, we describe the approach and importance of optimal utilization of immunohistochemistry for diagnosing such rare tumors of the breast, particularly, when clinical presentation, radiology and fine needle aspiration cytology are incongruous.Copyright © 2024. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0International License,which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.INTRODUCTIONThe solitary fibrous tumor is one of the rare mesenchymal origin tumors with an incidence of <0.1/100,000 people.1,2 This tumor tends to pose diagnostic challenges due to similarity in clinical, radiological and histological features with several more common soft tissue tumors like synovial sarcoma, leiomyosarcoma, phyllodes, malignant peripheral nerve sheath tumor (MPNST), etc. The tumor was previously reported to primarily occur in pleura which is still the most common site accounting for 70% of the cases. However, now it is known to occur at any anatomical sites with a varying spectrum of histological features. Histologically, it ranges from hypocellular to hypercellular tumors to anaplastic SFT with sarcomatous transformation.3 Fibroblastic cell is considered as the cell of origin in these tumors. Historically, SFTs are sub-classified into three groups: i) Benign (local disease); ii) not otherwise specified (usually not metastatic); and iii) malignant.4The general criteria adopted for malignant SFTs include a large tumor size, mitotic rate of ≥4/10 high-power fields (HPFs), nuclear pleomorphism, and necrosis. Demiccoet al. proposed a modified four-variable risk stratification model for development of metastasis in solitary fibrous tumors based on age, tumor size, necrosis and mitotic count into three risk classes of low, intermediate, and high risk.5 The diagnosis as well as risk stratification of SFT at unusual sites like the breast are very demanding and not possible on clinical and radiological examination. Accurate diagnosis requires a combined evaluation of clinical, pathological, immunohistochemical and molecular features together. Herein, we report a case of malignant SFT in a 52 year-old lady with a focus on diagnosis.CASE PRESENTATION A 52-year-old lady presented with a progressively enlarging lump in the left breast over the last 12 Case ReportOpen Access

Mucoepidermoid carcinoma (MEC) breast is a very rare triple negative breast cancer with relatively better overall prognosis, with histomorphological and immunohistochemical features similar to the salivary gland MEC. The literature suggests that it also carries molecular characteristics similar to the salivary gland MEC.

A 73-years-old woman presented with complaints of painful, foul smelling pus discharging mass in the right breast. The patient underwent therapeutic incision and drainage along with diagnostic biopsy. On histopathology, the diagnosis made was high grade MEC.

Primary MEC is a very rare triple negative breast cancer (TNBC) usually with much better survival outcome in comparison to other TNBCs. However, the index case had locally advanced disease with unique presentation leading to an alternative initial management

The ongoing coronavirus disease pandemic caused by a novel genetically-mutated strain of coronavirus has posed a tremendous challenge to healthcare professionals, worldwide. This study aimed to explore the healthcare professionals' knowledge, attitudes, and practices (KAP) related to coronavirus disease in Western Uttar Pradesh and provide data to improve awareness about this disease and remove the knowledge gap, if any, by disseminating the updated information to the corona warriors.

A cross-sectional survey was conducted in the form of a structured 28-item online questionnaire using SurveyMonkey software. The qualitative data were coded numerically, and the KAP score was calculated. Pearson Chi-square test was used to study the association, among variables.

Of 509 respondents, 296 (58.19%) were males and 213 (41.81%) were females. The median age bracket of the sample was 20–40 years. By profession, 255 (50.10%) were doctors, 167 (32.74%) were medical students, 80 (15.78%) were other healthcare workers, and a minority 7 (1.38%) were the nursing staff. Educational status covered a range from secondary (2.01%) to senior secondary (17.51%) to bachelors and equivalent (29.18%) to masters and equivalent (51.31%). The average KAP scores were 54%, and the score was highest among doctors as compared to other healthcare professionals (P < 0.001).

In light of these study findings, we conclude that healthcare professionals are aware of coronavirus disease. However, the overall KAP score regarding its clinical course, preventive strategies, and judicious use of personal protective equipment was less than expected. There is a need to address all misconceptions and empower the corona warriors with the right information through effective mass media communication and reinforcement through seminars and workshops in the medical institutes and hospitals. The healthcare professionals are a cornerstone to prevent the nosocomial and community spread of this pandemic.

Pediatric bronchial asthma is associated with considerable morbidity. The study was carried out to examine the association of Human Leukocyte Antigen (HLA)- Class II with the disease as we found no similar study on Asian Indian population. To define the HLA-Class II antigens in Asian Indian pediatric patients with asthma. A total of 103 children with asthma and 152 controls were analysed for HLA Class II (DRB1, DQB1and DPB1) by PCR-SSP (Sequence Specific Primers) method. Total serum IgE levels were determined by ELISA assay. A positive family history was recorded in 59 patients (57%) and 13 8.5%) of healthy controls. Serum IgE levels were more than normal range in 72% of the patients and 33% of healthy subjects with mean values of 4877 and 627 IU/ml, respectively. DRB1*04 and DQB1*03 showed significant positive relations while DRB1*15 showed a negative association with asthma. DQB1*02 was more common in healthy individuals but was not statistically significant. A positive association of the DR4/DQB1*03 and a negative association of DRB1*15 was seen with extrinsic bronchial asthma. However, more studies are required on larger populations to confirm the association of HLA Class II alleles in Indians before a particular allele can be labeled as being protective or causative for asthma.

Rectovaginal fistula (RVF) is one of the intractable complications following chemoradiation and total mesorectal excision (TME) for rectal cancer. It is supposed that there is a strong possibility of this complication occurring in patients after radiation therapy and having underlying sepsis. We describe herein two female patients (73 and 40 years old) who developed RVF after chemoradiation and TME for rectal cancer, who were successfully managed by gracilis muscle transposition. Fecal diversion was done as a preliminary step to the fistula repair. Success was defined as healed fistula after stoma closure. The strategy in the present report is a useful option for RVF management in such patients as other successful modalities are very limited.