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PubMed2004

Becker muscular dystrophy in a patient with Hodgkin's disease.

Genetic disease often predisposes to neoplastic processes because of either alterations in both oncogenes and tumor suppressor genes or imbalances in the cell cycle. The authors present the case of a 15-year-old boy with Hodgkin's disease associated with Becker muscular dystrophy. Becker muscular dystrophy is an X-linked neuromuscular disease due to in-frame mutations in the dystrophin gene, and it is considered a milder variant of Duchenne muscular dystrophy. In most patients with Becker muscular dystrophy, the myopathic process affects the myocardium, leading to cardiomyopathy.

Adolescent↗
PubMed1999

Sinonasal undifferentiated carcinoma: a distinctive clinicopathologic entity.

The sinonasal undifferentiated carcinoma (SNUC) is an aggressive and rare neoplasm arising in the nasal cavity and the paranasal sinuses. To date, over 50 cases of histologically proven SNUCs have been reported since its original description in 1986. Presenting symptoms include facial pain, nasal obstruction, diplopia, epistaxis, proptosis, and periorbital swelling. The histologic features of this neoplasm include cohesive cells arranged in nests, ribbons, and trabeculae. The cells exhibit hyperchromatic nuclei and a high nuclear to cytoplasmic ratio. A brisk mitotic rate, tumor necrosis, and vascular invasion are prominent features. Confirming the diagnosis of SNUC at the light microscopic level can be challenging, since the microscopic differential diagnosis includes olfactory neuroblastoma, rhabdomyosarcoma, undifferentiated nasopharyngeal carcinoma (lymphoepithelioma), malignant lymphoma, malignant melanoma, and neuroendocrine (small cell undifferentiated; oat cell) carcinoma. Sinonasal undifferentiated carcinoma can be differentiated from these other neoplasms by correlating clinical, light microscopic, histochemical, immunohistochemical, and ultrastructural characteristics. Aggressive, multimodal therapy can provide the best opportunity for local control of this neoplastic process, but the optimal treatment has yet to be determined.

Diagnosis, Differential↗
PubMed2003

Adenomatous polyposis coli gene, beta-catenin, and E-cadherin expression in proximal and distal gastric cancers and precursor lesions: an immunohistochemical study using tissue microarrays.

The aims of this study were (1) to compare protein expression of adenomatous polyposis coli (APC) gene, beta-catenin, and E-cadherin between proximal and distal gastric adenocarcinomas and (2) to investigate their use as markers of cancer risk in intestinal metaplasia (IM). The epidemiology of proximal (cardia and gastroesophageal junction) and distal (antrum and corpus) gastric carcinomas is strikingly different despite similar morphologies. Carcinoma of the distal stomach is decreasing in incidence, whereas proximal carcinomas are increasing in incidence more than any other cancer in the Western world. This phenomenon has so far not been satisfactorily explained. IM is a well-established precursor for adenocarcinoma in the distal stomach but less so in the proximal stomach. However, its specificity as a predictor of gastric carcinoma is very low. Abnormalities of APC, beta-catenin, and E-cadherin are implicated in carcinogenesis of the stomach and may show aberrant expression at early stages of the neoplastic process. This study evaluated their immunoprofiles in 3 groups: biopsies showing normal mucosa (n = 108), biopsies showing IM (n = 99), and gastric cancer resections (n = 117). In the last group, carcinoma and noninvolved mucosa were studied. All groups included material from both proximal and distal locations. The results of this study showed that there were no differences between proximal and distal locations with regard to APC, beta-catenin, or E-cadherin expression. In both locations, high normal expression rates for all 3 molecules were present in biopsies showing normal gastric mucosa or IM and noninvolved mucosa from gastric cancer resections. In carcinomas, there was a significant decrease in both APC and E-cadherin expression, whereas beta-catenin showed abnormal cytoplasmic and nuclear staining. Diffuse-type cancers showed significantly lower E-cadherin expression than intestinal types. Noninvolved mucosa from cancer resections showed normal APC, beta-catenin, and E-cadherin expression regardless of adjacent tumor type and whether the mucosa was morphologically normal or showed IM. In conclusion, proximal and distal gastric carcinomas show no differences in expression of APC, beta-catenin, or E-cadherin; thus, the observed abnormalities do not seem to contribute to the observed epidemiologic differences between these tumors. Because loss of APC, decreased E-cadherin, or abnormal beta-catenin expression did not occur in IM, even when associated with carcinoma these immunostains are unlikely to be of value in the assessment of malignant potential in IM.

Adult↗
PubMed2006

Clinical significance of atypical glandular cells on cervical cytology.

OBJECTIVE: To evaluate the prevalence and histologic outcomes of patients with atypical glandular cells of undetermined significance (AGUS), diagnosed by Pap test, and concurrent risk factors. DATA SOURCES: A PubMed/MEDLINE/Ovid HealthStar search of the English literature was conducted from January 1988 through March 2004. METHODS OF STUDY SELECTION: The search criteria included the terms "atypical glandular cells of undetermined significance," "AGUS," or "AGC." All studies investigating the clinical significance of patients with an AGUS Pap test were included, except for those where consecutive Pap tests were not studied. Diagnostic outcomes were then determined. TABULATION, INTEGRATION, AND RESULTS: Of the 916 studies identified, 24 met our inclusion criteria. Of the 2,389,206 Pap tests included in these studies, 6,829 (0.29%) had AGUS. Follow-up was available for 3,890 tests. These data showed the following rates of pathology: 8.5% low-grade squamous intraepithelial lesions (LSIL), 11.1% high-grade squamous intraepithelial lesions (HSIL), 2.9% adenocarcinoma in situ, 1.4% endometrial hyperplasia, and 5.2% malignancy. The most common malignancies were endometrial adenocarcinoma (57.6%), cervical adenocarcinoma (23.6%), ovarian and fallopian tube carcinoma (6.4%), squamous cell carcinoma of the cervix (5.4%), and other (6.9%). Of the AGUS Pap tests, the remaining 71.0% corresponded to benign findings, including reactive changes, polyps, and normal histology. Patients with AGUS, which favors a neoplastic process, or with a concurrent ASCUS have a greater likelihood of disease. CONCLUSION: Histologic diagnosis showed that 29.0% of these Pap tests had findings requiring follow-up or therapeutic intervention, including a 5.2% rate of malignancy. Based on these findings, 99.6% of the diagnoses are within the region of surveillance when AGUS Pap tests are evaluated with colposcopy and directed biopsy, endocervical curettage, an endometrial biopsy in patients with risk factors for endometrial cancer, and pelvic examination.

Adenocarcinoma↗
PubMed2003

Validation of cDNA microarray analysis to distinguish tumor type ex vivo.

Tissue biopsy alone is diagnostic in less than 10% of cases of metastatic bone disease with an unknown primary tumor. Accordingly, to delineate the neoplastic process in cases of metastatic bone disease, where the primary tumor cannot be determined with conventional modalities, new tools are attractive. Complementary deoxyribonucleic acid cDNA microarrays may be such a tool. Verification and validation of this technology for analysis of specimens ex vivo is mandatory if it is to be used to analyze the complexity of heterogenous biologic tissues. To convey the issues involved in the clinical application of cDNA microarray analysis of tumor specimens ex vivo, a set of experiments analyzing surgically resected human specimens is presented. The specific aims of the analysis were to assess cDNA microarray reproducibility of serial tissue preparations of tumor samples and to confirm that heterogeneity within a given clinical tumor specimen does not preclude this technique as a tool to discern tumor types. Complementary deoxyribonucleic microarray analysis, as it applies to heterogeneous clinical tumor samples in limited numbers, based on preliminary data, seems to be an appropriate but still experimental method for distinguishing tumor types.

Adult↗
PubMed2004

Self-expanding polytetrafluoroethylene covered nitinol stents for the treatment of ureteral stenosis: preliminary report.

PURPOSE: We evaluated the treatment of ureteral stenosis using a self-expanding nitinol stent covered with expanded polytetrafluoroethylene (ePTFE). MATERIALS AND METHODS: Between January 2001 and April 2003, 37 ePTFE covered metal stents were implanted in 20 patients with a total of 29 ureteral stenoses due to various causes. In general the stents were introduced by using a retrograde approach under combined endoscopic and fluoroscopic guidance with patients under spinal block and sedation. Followup assessments in 18 patients, including urography, were done 3, 6, 12, 18 and 24 months after the procedure. Followup endoscopic examinations were performed at 6 and 12 months in 8 patients. RESULTS: Immediate ureteral patency was achieved during all insertion procedures and maintained in most patients. Four patients died of the neoplastic process 3 to 12 months after implantation. Four stent migrations occurred in 3 patients (22.2%), which was resolved by implanting a new stent. Nonobstructive mucous hyperplasia was observed in 5 patients (27.7%) at the end of the stent, although there was no internal calcification. In all cases the stents remained patent until the current time or until patient death. CONCLUSIONS: We found that ePTFE covered nitinol stents were safe and effective for ureteral stenosis. Their resistance to calcification was high with nonobstructive hyperplasia developing in only a few cases and only at the stent ends. The ideal material for covering stents would produce no mucous hyperplasia.

Aged↗
PubMedDate not supplied

The diagnosis and management of benign hepatic tumors.

Benign hepatic tumors include a broad spectrum of regenerative and true neoplastic processes. Because of advances in imaging studies such as computed tomography (CT) and magnetic resonance imaging (MRI) as well as progress in immunohistochemistry, accurate diagnosis can now be made in a large percentage of patients without surgical laparotomy or resection. This article will focus on the pathogenesis, diagnosis, and management of focal benign lesions of the liver. Many of these tumors present with typical features in various imaging studies. On occasions, biopsies are required and/or surgical removal is needed. The most common benign hepatic tumors include cavernous hemangioma, focal nodular hyperplasia, hepatic adenoma, and nodular regenerative hyperplasia. In the majority of cases of benign hepatic tumors, patients are asymptomatic, and no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation.

Adenoma, Liver Cell↗
PubMed2004

Mandibular reconstruction in 2004: an analysis of different techniques.

PURPOSE OF REVIEW: The field of mandibular reconstruction has evolved dramatically over the past fifty years. Numerous advances in microsurgical technique, plating technology and instrumentation, and an understanding of donor site angiosomes have made consistent and reliable mandibular reconstruction possible. Refinements in technique continue to improve the functional and aesthetic outcomes of oromandibular reconstruction. This review discusses the current state-of-the-art techniques for mandibular reconstruction and highlights the latest innovations in technique. RECENT FINDINGS: The most common indication for oromandibular reconstruction remains ablative surgery for advanced neoplastic processes of the oral cavity and oropharynx. Reconstruction of these complex three-dimensional composite bony and soft-tissue defects is paramount for rehabilitation of form and function. Vascularized osseous free tissue transfer is the state-of-the-art for mandibular reconstruction. The long-term excellent functional and aesthetic outcomes of this technique have recently been reported. The most commonly used free flaps for mandibular reconstruction are the fibula, iliac crest, and scapula. Each of these typically accepts endosseous implants improving functional outcomes. The use of mandibular reconstruction plates and coverage with a soft-tissue flap remains a reconstructive option for selected patients. The latest refinements in technique include temporary intraoperative external fixation, the use of periosteal free flaps, distraction osteogenesis, and development of biodegradable biopolymer scaffolds for mandibular defects. SUMMARY: Oromandibular reconstruction, although a challenge for the head and neck reconstructive surgeon, is now reliable and highly successful with excellent long-term functional and aesthetic outcomes.

Bone Transplantation↗
PubMed2003

S100A6 protein expression is different in Spitz nevi and melanomas.

The Spitz nevus is a benign melanocytic lesion that can be identified reliably in many cases by conventional histopathological criteria. However, there are subsets of Spitz nevi and of malignant melanoma that closely resemble each other and represent diagnostic challenges. S100 proteins are of interest because of their involvement in neoplastic processes and their genes are clustered in chromosome 1q21. Chromosome 1 contains mutations in several types of tumors, including melanomas. The expression of different S100 proteins (A2, A6 and A8/A9 or A12) was examined in 42 Spitz nevi, 105 melanomas, and 73 melanocytic nevi to test the hypothesis that their expression differs among these entities and may contribute to the distinction between these entities. The results showed an up-regulation of S100A6 protein in Spitz nevi, melanomas, and melanocytic nevi but with a different percentage of positivity and pattern of immunoreactivity. The differences between these three entities were statistically significant (P <.001). All 42 Spitz nevi (100%) showed strong and diffuse S100A6 protein expression, both in junctional and in dermal components of the nevi. Thirty-three percent of melanomas expressed S100A6 (35/105). The expression was mainly weak (30/35) and patchy in the dermal component and was negative or minimal in the junctional component. Fifty-six percent of different subtypes of melanocytic nevi (41/73) expressed S100A6, almost all of them weakly (40/41) and in the dermal component. Normal intraepidermal melanocytes were negative. The melanocytic cells in these three entities did not express S100A2, S100A8/A9 or A12. However, an up-regulation of S100A2 and S100A8/A9 or A12 proteins was observed in normal keratinocytes in the epidermis overlying Spitz nevi and melanomas, without differences. In summary, a simple immunohistochemical test for S100A6 protein differentiated between Spitz nevi, melanomas, and melanocytic nevi. This marker could be used when the distinction is very difficult or controversial in routine studies, especially when there is a junctional component. Further molecular analyses of the S100A6 protein and gene should be performed to study the underlying genetic bases for such differences.

Cell Count↗
PubMed2005

Intracranial plasma cell granuloma: case report and treatment of recurrence with methotrexate and 6-mercaptopurine.

Plasma cell granulomas are a rare form of idiopathic inflammatory pseudotumors often characterized by non-neoplastic proliferation of plasma cells, clinically mimicking a neoplastic process. Pseudotumors of the central nervous system, however, are exceptional and rare. The authors describe a 14-year-old girl with a mass lesion extending medially along the cavernous sinus into the right middle cranial fossa and pterygopalatine and infratemporal fossae. The authors review the current literature and discuss successful treatment with methotrexate and 6-mercaptopurine after recurrence of disease following radiation therapy and steroids.

Adolescent↗
PubMed2006

Pulmonary extranodal marginal zone lymphoma with massive crystal storing histiocytosis.

We present an incidentally discovered, unusual case of pulmonary bronchial mucosa-associated lymphoid tissue lymphoma associated with massive crystal storing histiocytosis in a 69-year-old woman. The neoplastic process was masked by large numbers of epithelioid and spindled histiocytes containing crystalline material. Histochemical stains showed intracytoplasmic crystals and immunoperoxidase staining confirmed the histiocytic nature of the swollen cells. Electron microscopy demonstrated the characteristic appearance of immunoglobulin crystals. Lymphoepithelial lesions were identified on immunohistochemical staining, compounding suspicions of an underlying lymphoid neoplasm. Molecular studies later revealed a monoclonal B-cell population. The patient had no systemic evidence of a paraproteinemia. Crystal storing histiocytosis is a rare phenomenon in which macrophages accumulate light chain or immunoglobulin crystalline inclusions. The disease may be systemic, or localized as in this case. It is usually associated with the excess production of a monoclonal immunoglobulin, although there have been many case reports without this feature. An overview of crystal storing histiocytosis is given.

Aged↗
PubMed2006

Evaluation of the nonneoplastic pathology in tumor nephrectomy specimens: predicting the risk of progressive renal failure.

Pathologic changes in nonneoplastic renal parenchyma of nephrectomy specimens for renal tumors and the significance of these changes with regard to the outcome of contralateral kidney function have not been studied previously. We examined the nonneoplastic renal parenchymal changes in 110 consecutive tumor nephrectomy specimens, and we correlated our findings with patients' clinical information. The material was examined for the presence of any glomerular, tubulointerstitial, or vascular pathology. In our analysis, only about 10% of cases had unremarkable renal parenchyma and vasculature. A further 28% of cases had unremarkable parenchyma, but some degree of vascular sclerosis was noted. The remaining cases (>60%) had evident pathologic abnormalities, most commonly related to vascular disease or diabetes mellitus. Regardless of the type of renal cancer they have, the majority of our cases can be placed in one of three principal groups: 1) unremarkable kidney parenchyma, with or without vascular sclerosis (38%); 2) parenchymal scarring and marked vascular changes, including cases of atheroembolic disease, and chronic thrombotic microangiopathy (28%); and 3) changes related to diabetes mellitus, such as glomerular hypertrophy, mesangial expansion, and diffuse glomerulosclerosis (24%). Follow-up data on serum creatinine 6 months postoperatively were available in a third of our patients. Patients with severe histopathologic findings (parenchymal scarring with >20% global glomerulosclerosis and advanced diffuse diabetic glomerulosclerosis) showed a significant change in serum creatinine from the preoperative period to 6 months after radical nephrectomy (P=0.001), indicative of progressive worsening of renal function; this change is significantly greater than that seen in patients with unremarkable renal parenchyma (P=0.01). We conclude that adequate examination of nonneoplastic renal parenchyma is an important tool in recognizing patients at risk for progressive renal disease after nephrectomy and could be an essential step in providing early preventive and treatment measures and better medical care of patients undergoing nephrectomy for neoplastic processes.

Adult↗
PubMed2006

Pseudosarcomatous myofibroblastic proliferations of the bladder: a clinicopathologic study of 42 cases.

Inflammatory pseudotumor or pseudosarcomatous fibromyxoid tumor and postoperative spindle cell nodule of the bladder are unusual lesions of uncertain pathogenesis which share overlapping, if not identical, histologic features. We present our experience with 42 cases, the largest series to date, to study the etio-pathogenesis, histologic features, biologic behavior and relationship to "inflammatory myofibroblastic tumor" of childhood. Patients ranged in age from 7 to 77 years (mean 47 y) and males predominated (3.2:1). Most patients presented with hematuria (31/42). Common associations were smoking (10/30) and previous instrumentation or surgery (9/42). The clinicopathologic features of patients having or not having prior instrumentation were identical. Grossly the lesions were polypoid or nodular and involved any portion of bladder wall, most commonly the dome (9/27) and measured 1 to 10 cm (mean 4 cm). They were composed of spindled and stellate cells arranged in a myxoid background with numerous inflammatory cells. Myxoid hypocellular areas were more pronounced near the mucosal surface with greater cellularity and a fascicular arrangement in the deep aspect of the lesion. "Atypical" features included mitotic activity (0 to 20/10 HPF; mean 2/10 HPF; median 1/10 HPF; none atypical), necrosis (22/42), and extension into muscularis propria (28/32) or perivesicular fat (3/8). Lesions were positive for cytokeratin (31/33), SMA (23/34), desmin (21/35), and Alk-1 protein (12/26). FISH confirmed the Alk-1 translocation in 4/6 cases. Treatment included transurethral resection (30/42), partial cystectomy (9/42), and total cystectomy (3/42). Initial diagnostic error resulted in radiotherapy and chemotherapy in 3 patients. Follow-up was available in 28 patients. (range 3 to 93 mo; median 25 mo). Three patients developed recurrences, but none had metastases. Because the clinicopathologic features of lesions associated with and without instrumentation were similar and inseparable, we believe they are essentially the same entity, and propose the term pseudosarcomatous myofibroblastic proliferation. The preponderance of evidence which includes the extravesical growth, local recurrence, and Alk-1 gene translocation in some cases suggests perhaps a neoplastic process with limited growth potential. Even in the face of atypical histologic features (muscle invasion and necrosis) the prognosis is excellent. Despite the Alk-1 gene translocation, there continues to be sufficient evidence for regarding these as distinct from the so-called inflammatory myofibroblastic tumor of childhood.

Adolescent↗
PubMed2003

Talc pleurodesis mimics pleural metastases: differentiation with positron emission tomography/computed tomography.

Talc pleurodesis is a technique used in the treatment of patients with persistent pleural effusions or pneumothorax not amenable to other treatment. These are commonly seen in patients with malignant thoracic neoplasms. Radiographic abnormalities resulting from prior talc pleurodesis could be confused with progression of the underlying neoplastic process. Positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET) might be unable to distinguish between malignant and benign inflammatory processes. This report demonstrates the use of combined positron emission tomography/computed tomography (PET/CT) in a patient with a history of both malignant neoplasm and a prior talc pleurodesis. Fusion of PET and CT studies could add information that CT and PET alone cannot. This could alter the diagnostic and therapeutic course for patients with a history of both thoracic neoplasm and talc pleurodesis.

Chylothorax↗
PubMed2004

MR imaging of brachial plexus.

The brachial plexus is a complex anatomic component originating from ventral rami of the lower cervical nerve roots from C5 to C8 and upper thoracic spinal nerve roots from T1, providing sensory and motor innervation to the upper extremities. As it is inaccessible to palpation, clinical evaluation of the brachial plexus is very challenging and localizing lesions along its course is very difficult. The gamut of pathologic conditions involving the brachial plexus includes primary tumor, direct extension of adjacent tumor, metastasis, trauma, or an inflammatory condition. MR imaging provides superior diagnostic ability due to its ability of multiplanar imaging and greater soft tissue contrast. This article discusses MR imaging findings in a variety of pathologic conditions, with special emphasis on neoplastic process.

Brachial Plexus↗
PubMed2006

Multispectral quantitative magnetic resonance imaging of brain iron stores: a theoretical perspective.

OBJECTIVES: To review published magnetic resonance imaging (MRI) iron quantification techniques in the context of quantitative MRI and MR relaxation theories. To analyze comparatively and as a function of age the simultaneous measurements of the proton density (PD), the relaxation times (T1 and T2), and the longitudinal to transverse relaxation times ratio (T1/T2) of brain regions known to accumulate iron preferentially. METHODS: Twenty-seven human subjects were scanned with the mixed turbo spin echo pulse sequence, which is multispectral in PD, T1, and T2. Quantitative MRI (Q-MRI) maps of PD, T1, T2, and T1/T2 were generated, and region of interest measurements were performed in 5 brain regions, namely, frontal white matter (WM), genu of corpus callosum, caudate nucleus, putamen, and globus pallidus. RESULTS: Relaxation time measurements are consistent with results of others and provide further confirmation to our basic understanding of the relaxation effects of iron stores in the brain. Specifically, we found that the iron-rich globus pallidus exhibits enhanced T1 and T2 relaxation relative the iron poorer gray matter tissues (caudate nucleus and putamen) and also relative to the WM matter tissues (frontal WM and genu of the corpus callosum). We also observe that under riding this hypothesis-because we do not have independent confirmation-that iron caused relaxation enhancement, are the normal brain aging patterns, which suggest that the brain tissues become wetter with increasing age. Also noted is the virtual removal of age dependence observed for the T1/T2 ratio of WM tissues, further suggesting that this ratio may become of clinical significance in the diagnosis of neoplastic processes as well as for quantifying iron in tissue. CONCLUSIONS: The theoretical underpinnings of published brain iron Q-MRI techniques have been reviewed. We also examined MR relaxation theory essentials in relation to H-proton relaxation phenomena in diamagnetic tissues as well as theoretical extensions to describe relaxation effects in tissues containing iron deposits with a focus on ferritin. Also reported are in vivo Q-MRI results of 27 human brains obtained with a multispectral technique that uses the mixed turbo spin echo pulse sequence and a model conforming Q-MRI algorithms.

Brain↗
PubMed2003

The soft-tissue shaving procedure for deformity management of chronic tophaceous gout.

Gout is a condition characterized by the deposition of monosodium urate crystals in the joints or soft tissue. A gouty tophus occasionally mimics an infectious or neoplastic process. However, the conventional enucleating procedure might cause complications. In severe cases, skin necrosis and tendon or joint exposure can occur after debridements. In this series, the soft-tissue shaver is used for deformity management of the chronic tophaceous patients and the results are encouraging. From November 2000 to August 2002, 17 patients with chronic tophaceous gout were treated by the shaver technique. Suction and irrigation were performed simultaneously while the shaver was operating, and chalky deposits of sodium urate could be removed efficiently. Skin necrosis was minimized by means of proper incision planning. Also, bedside debridements and wound wet dressing were helpful for improving the outcomes. The families and patients were satisfied with the results. In conclusion, severe chronic tophaceous gout can be a surgical challenge. The soft-tissue shaving technique can be useful for cosmetic debulking of large tophi in patients with advanced chronic tophaceous gouty arthritis.

Adult↗
PubMed2006

Collision tumor: invasive ductal carcinoma in association with mucosa-associated lymphoid tissue (MALT) lymphoma in the same breast.

Synchronous occurrence of multiple neoplastic processes is uncommon and the relationship between breast cancer with lymphoproliferative diseases is unusual as well. Furthermore, breast involvement by malignant lymphoma is a rare event and primary breast mucosa-associated lymphoid tissue (MALT) lymphoma is even rarer. We report a patient with synchronous occurrence of malignant lymphoma of MALT type and ductal carcinoma of the breast, presenting as "collision tumor," invading each other and occurring as a single mass in the breast. Involvement of the sentinel lymph node by MALT lymphoma was demonstrated with no evidence of metastatic carcinoma. Staging bone marrow biopsy did not show involvement by malignant lymphoma or carcinoma. Our patient was treated with chemotherapy for the lymphoma. She also received radiotherapy and aromatase inhibitor as adjuvant therapy for the breast carcinoma.

Biopsy↗