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B Chaiwun

Publications and source records attributed to B Chaiwun.

At least 19 recordsLinked to original sources
PubMed2006

Metaplastic carcinoma of the breast: a clinicopathological review.

BACKGROUND: Mammary metaplastic carcinoma encompasses epithelial-only carcinoma (high-grade adenosquamous carcinoma or pure squamous cell carcinoma), biphasic epithelial and sarcomatoid carcinoma and monophasic spindle cell carcinoma. AIM: To evaluate the clinicopathological features of a large series of 34 metaplastic carcinomas. METHODS: 10 epithelial-only, 14 biphasic and 10 monophasic metaplastic carcinomas were assessed for nuclear grade, hormone receptor status, HER2/neu (cerbB2) oncogene expression, Ki-67 and p53, lymph node status and recurrence on follow-up. RESULTS: Intermediate to high nuclear grade were assessed in most (33/34) tumours. Oestrogen and progesterone receptors were negative in 8 of 10 epithelial-only, all 14 biphasic, and 9 of 10 monophasic tumours, cerbB2 was negative in 7 of 10 epithelial-only, all 14 biphasic and 8 of 10 monophasic tumours. Ki-67 was found to be positive in 6 of 10 epithelial-only, 6 of 14 biphasic, and 7 of 10 monophasic tumours, whereas p53 was positive in 6 of 10 epithelial-only, 7 of 14 biphasic, and 8 of 10 monophasic tumours. Lymph node metastases were seen in 7 of 7 epithelial-only, 7 of 11 biphasic, and 3 of 7 monophasic tumours. Recurrences were seen in 4 of 7 epithelial-only, 8 of 9 biphasic, and 4 of 9 monophasic tumours. CONCLUSIONS: All three subtypes of metaplastic carcinoma are known to behave aggressively, and should be differentiated from the low-grade fibromatosis-like metaplastic carcinoma, which does not metastasize. Oncological treatment options may be limited by the frequently negative status of hormonal receptor and cerbB2.

Adenocarcinoma↗
PubMed2006

Breast carcinomas: why are they missed?

INTRODUCTION: Mammography has proven to be an effective modality for the detection of early breast carcinoma. However, 4-34 percent of breast cancers may be missed at mammography. Delayed diagnosis of breast carcinoma results in an unfavourable prognosis. The objective of this study was to determine the causes and characteristics of breast carcinomas missed by mammography at our institution, with the aim of reducing the rate of missed carcinoma. METHODS: We reviewed the reports of 13,191 mammograms performed over a five-year period. Breast Imaging Reporting and Data Systems (BI-RADS) were used for the mammographical assessment, and reports were cross-referenced with the histological diagnosis of breast carcinoma. Causes of missed carcinomas were classified. RESULTS: Of 344 patients who had breast carcinoma and had mammograms done prior to surgery, 18 (5.2 percent) failed to be diagnosed by mammography. Of these, five were caused by dense breast parenchyma obscuring the lesions, 11 were due to perception and interpretation errors, and one each from unusual lesion characteristics and poor positioning. CONCLUSION: Several factors, including dense breast parenchyma obscuring a lesion, perception error, interpretation error, unusual lesion characteristics, and poor technique or positioning, are possible causes of missed breast cancers.

Aged↗
PubMed2005

Painless scrotal swelling: ultrasonographical features with pathological correlation.

Scrotal swelling may be due to extratesticular and intratesticular lesions. The majority of extratesticular lesions are benign while the majority of intratesticular lesions are malignant. Ultrasonography (US) is helpful in separating extra- from intratesticular lesions. US can show whether a mass is cystic, solid or complex, and also features such as associated calcifications, epididymal involvement, scrotal skin thickening and colour Doppler flow pattern. Extratesticular lesions include hydrocoele, spermatocoele, varicocoele, epididymal cyst, hernia and tumours of the epididymis and cord structures. Intratesticular lesions include primary tumour, metastases, lymphoma and leukaemia. Tuberculous epididymitis or epididymo-orchitis may also present with painless scrotal swelling. US features of these disease patterns, with pathological correlation, are presented in this pictorial essay.

Genital Diseases, Male↗
PubMed2005

Atypical and suspicious categories in fine needle aspiration cytology of the breast: histological and mammographical correlation and clinical significance.

INTRODUCTION: This study aims to correlate fine-needle aspiration specimens diagnosed as C3 (atypical, probably benign) and C4 (suspicious, probably malignant) with histology and mammography, and to evaluate these two cytology categories in terms of diagnostic usefulness and patient management. METHODS: All fine-needle aspiration (FNA) specimens in categories C3 or C4 at the Maharaj Nakorn Chiang Mai Hospital, Thailand between 2000-2004 were reviewed. Results were correlated with available histological and mammographical studies. RESULTS: 148 FNA specimens were identified, comprising 43 category C3 and 105 category C4. Histology was available in 90 cases. 14 (64 percent) C3 cases showed benign histology on biopsy and eight (36 percent) were malignant. 13 (19 percent) C4 cases were benign on biopsy, whereas 55 (81 percent) were malignant. Mammographical studies were available in 56 of the histologically-proven cases. All seven cases with benign mammograms had benign histology, and all 26 cases called "highly suggestive of malignancy" were malignant on histology (five C3 and 21 C4). Of the 23 cases called "suspicious abnormality" on mammography, 14 turned out to be malignant on biopsy (one C3 and 13 C4). CONCLUSION: Our study supports maintaining cytology categories C3 and C4. About two-thirds of C3 cases were benign on biopsy whereas 81 percent of C4 cases were malignant (p-value is less than 0.001). There was complete correlation between histological and mammographical studies except those with equivocal mammograms. Our study supports the combined use of clinical, mammographical and cytological findings for optimal patient management. This is especially important for patients with C3 aspiration results, in order to avoid unnecessary surgery for benign lesions.

Adult↗
PubMed2004

Malignant germ cell tumours of undescended testes: imaging features with pathological correlation.

AIM: To illustrate the imaging features of malignant germ cell tumours complicating undescended testes, emphasizing the importance of recognizing this condition and providing a correct diagnosis to facilitate appropriate management. METHODS: The clinical presentation, ultrasonography (US) and computed tomography (CT) features of eight consecutive patients with malignant germ cell tumours of undescended testes were reviewed. RESULTS: CT performed in seven patients showed well-circumscribed soft-tissue masses with inhomogeneous enhancement in all cases. US in four patients showed circumscribed masses with inhomogeneous echogenicity. On pathological examination, there were two cases of embryonal carcinoma and six cases of seminoma. All tumours showed necrosis that correlated to inhomogeneous areas on imaging. CONCLUSION: The radiologist has an important role as he may be the first physician to suggest the diagnosis.

Adult↗
PubMed2004

Role of mammography in diagnosis of axillary abnormalities in women with normal breast examination.

The mammograms of 43 patients presenting with palpable unilateral masses in the axilla and normal breasts on physical examination were retrospectively reviewed to determine the cause and imaging characteristics of axillary abnormalities, and the usefulness of mammography in detecting occult breast carcinoma. Cytological or histological confirmation was obtained in all patients. Forty of 43 patients had axillary lymphadenopathy while three had lipoma, fibroadenoma and haematoma, respectively. Causes of malignant lymphadenopathy (n = 22) were metastatic diseases from non-mammary primary malignancy (n = 8), occult ipsilateral breast carcinoma (n = 5), and previous contralateral breast carcinoma (n = 9). Causes of benign lymphadenopathy (n = 18) were reactive nodal hyperplasia (n = 6), collagen vascular diseases (n = 2), and acute bacterial (n = 2) and tuberculous (n = 8) lymphadenitis. Nodal size was not significantly different between benign and malignant lymph nodes. Benign and malignant nodal margins were variable. Intranodal microcalcifications were found in two cases of breast carcinoma metastasis. Intranodal macrocalcifications were found in three cases of tuberculous lymphadenitis. Occult primary breast carcinoma was detected on mammograms in four of five patients with axillary lymphadenopathy due to ipsilateral breast carcinoma. Mammographical features of benign and malignant lymphadenopathy may be indistinguishable, but presence of intranodal calcifications is helpful. Mammography is also valuable in depicting occult primary breast carcinoma.

Adult↗
PubMed2004

Imaging of giant breast masses with pathological correlation.

Ultrasonography (US) and mammography are the two basic techniques for routine imaging in the diagnosis of breast diseases. A wide variety of breast conditions such as lipoma, hamartoma, cyst, fibroadenoma, phyllodes tumour, haematoma, abscess and carcinoma can result in solitary or multiple giant masses. These conditions may appear similar on physical examination. The clinical significance of these entities is that some lesions necessitate mastectomy but some lesions may require only local excision, aspiration or even conservative management. Imaging has enhanced our ability to characterise these lesions. The purpose of this pictorial review is to illustrate the causes of giant breast masses, and the role of US and mammography in diagnosis of these lesions.

Algorithms↗
PubMed2003

Breast cancer in women under 40 years: preoperative detection by mammography.

INTRODUCTION: This article assesses the diagnostic sensitivity of mammography in the preoperative detection of breast cancer in young women. MATERIALS AND METHODS: We retrospectively reviewed 1010 women with breast carcinoma between January 1996 and September 2002. The patients were identified from pathological reports. Of these, 237 women were below 40 years of age, accounting for 23.5% of all breast cancers. Only 76 of 237 patients had mammograms performed prior to surgery. Seventy-five of the 76 patients also had ultrasonography performed. Histological types were reviewed and the proportions of each type were compared with those found in a consecutive series of 773 breast carcinomas in women above 40 years of age seen during the same period in our hospital. The breast patterns, as seen on mammograms, were classified as follows: fatty, scattered fibroglandular, heterogeneously dense and homogeneously dense. Specific features of a mass, microcalcifications, architectural distortion and asymmetrical density were evaluated. RESULTS: Of the 76 patients who had mammograms performed prior to surgery, 81 cancers were found. The patients' age ranged from 25 to 40 years, with a mean of 36.4 years. The breast parenchymal patterns were homogeneously dense in 6.6%, heterogeneously dense in 67.1% and had scattered fibroglandular density in 26.3%. Abnormal mammographical findings were present in 93.8%. The most common mammographical findings were mass in 60% and microcalcifications, with or without associated breast abnormality, in 28.7%. The most frequent tumour (82.7%) was invasive ductal carcinoma, which is not significantly different to those found in older women (P = 0.895). Ultrasonography showed solid masses in 73 patients and was negative in the other 2 patients. CONCLUSION: Mammography is a useful imaging technique in providing preoperative detection and diagnosis of breast carcinoma in women below 40 years of age with clinical suspicion of malignancy. Mass and microcalcifications are the most common abnormal mammographical findings and invasive ductal carcinoma is the most common tumour found in our study.

Adult↗
PubMed2002

Mammographic features of tuberculous axillary lymphadenitis.

The clinical and mammographic findings of 10 patients with pathologically proven tuberculous axillary lymphadenitis were reviewed. The cases were identified from 10 173 mammograms performed over 6 years at Maharaj Nakorn Chiang Mai University Hospital. The 10 patients were aged 31-65 years. All cases were initially diagnosed to have breast carcinoma with axillary nodal metastases. Eight patients presented with axillary swelling, while two presented with breast enlargement. None of these cases had a palpable breast mass. Associated supraclavicular, cervical or groin nodes were found in seven cases, and two patients had evidence of pulmonary tuberculosis. All lesions were unilateral, affecting the right side in eight cases and left side in two cases. On mammogram, the axillary nodes were enlarged and homogeneously dense. The nodes were sized 2.5-5 cm. Nodal margins were variable. Some nodes were matted. Macrocalcifications were noted in three cases. Ipsilateral breast oedema without mass or microcalcifications was present in two cases. Patients with tuberculous axillary lymphadenitis have large homogeneously dense nodes with either well- or ill-defined margins. It is impossible to differentiate tuberculous from malignant nodes. The presence of macrocalcifications might suggest tuberculous axillary lynphadenitis. Biopsy of enlarged axillary nodes is necessary to determine its aetiology.

Adult↗
PubMed2002

Evaluation of the contralateral breast in patients with ipsilateral breast carcinoma: the role of mammography.

OBJECTIVE: To assess the value of mammography in the detection of cancer in the contralateral breast in women with ipsilateral breast carcinoma. MATERIALS AND METHODS: From February 1994 through May 2001, a total of 500 patients with unilateral mastectomy from breast carcinoma had mammograms performed for the first time following mastectomy. We retrospectively reviewed the clinical findings and mammograms of these patients. Four hundred and sixty-four patients were asymptomatic and 36 patients presented with palpable breast or axillary masses. Specific mammographic features of a mass, microcalcifications, architectural distortion and asymmetric density were evaluated. Diagnosis was confirmed by fine needle aspiration biopsy or surgical excision in all patients. RESULTS: Four hundred and sixty-four patients had screening mammograms and 36 patients had diagnostic mammograms. All 36 symptomatic patients had abnormal mammograms. Of these, 12 (33.33%) patients were found to have second primary breast carcinoma, 12 (33.33%) had metastases to the contralateral breast or axillary lymph nodes, six (16.66%) had fibroadenomas, two (5.55%) had abscesses, three (8.33%) had fibrocystic change, and one (2.77%) had axillary node reactive hyperplasia. Of the 464 asymptomatic patients, five (1.07%) had second primary breast carcinoma, five (1.07%) had fibrocystic change, and two (0.43%) had fibroadenomas. The mean age at the time of diagnosis of the first primary carcinoma in the symptomatic patients was 41.9 years (range 35-60 years), and was 43.4 years (range 36-56 years) in the screening group. The mean time interval between the two carcinomas was four years (range one to 13 years) in symptomatic group and 3.4 years (range one to four years) in screening group. The tumour stage in the screened group was in situ (n = 2), stage I (n = 3) and in the symptomatic group was stage I (n = 2), stage II (n = 5), stage III (n = 5). CONCLUSION: Patients who have ipsilateral breast carcinoma have a strong risk to develop a second primary carcinoma in the contralateral breast. Close follow-up of the second breast with careful clinical examination and mammography are necessary for the early detection of cancer.

Adenocarcinoma↗
PubMed2001

Multiple bilateral giant fibroadenomas associated with cyclosporine A therapy in a renal transplant recipient.

A 31-year-old woman developed a right breast mass following cyclosporine A therapy after a renal transplant. Several large breast masses continued to grow bilaterally. Mammography and ultrasonography showed features of giant fibroadenomas. The diagnosis was confirmed by biopsy of one of the masses. Awareness of the association between cyclosporine A therapy and fibroadenoma development in renal transplant recipients is highlighted.

Adult↗
PubMed2001

Fine needle aspiration of the thyroid gland.

Fine needle aspiration (FNA) has become a major diagnostic triage for clinical management of patients with a thyroid mass. Diagnostic accuracy of this procedure can be evaluated by cyto-histologic correlation. Out of 1,761 fine needle aspirates of thyroid glands performed from January 1996 to December 1999, 230 satisfactory specimens contained respective histologic correlates. Using histologic diagnoses as the gold standard, the overall accuracy, sensitivity and specificity for cytologic diagnoses of thyroid neoplasm were 90.4 per cent, 85.7 per cent, and 92.5 per cent respectively. The positive predictive value for diagnosing thyroid neoplasm was 83.3 per cent while the negative predictive value was 93.7 per cent. The common pairs of cyto-histological diagnostic discrepancy included adenomatous goiter vs follicular neoplasm, adenomatous goiter vs papillary carcinoma, and thyroiditis vs follicular neoplasm. In conclusion, FNA is a rapid, reliable and safe diagnostic tool to distinguish non-neoplastic from neoplastic lesions in patients with thyroid masses.

Biopsy, Needle↗
PubMed2001

Primary intraosseous glomus tumor: a case report.

We reported a rare case of a primary intraosseous glomus tumor in a 53-year-old woman who had a small lytic lesion in the distal phalanx of her left index finger. The radiologic appearance showed a well circumscribed osteolytic lesion without sclerotic rim. Histologic examination revealed solid nests or sheets of polygonal cells surrounding branching vasculatures consistent with a glomus tumor. Curettage resulted in complete removal of the tumor as well as pain alleviation. The patient was well without evidence of recurrent disease following an 18 month follow-up. Despite its rarity, intraosseous glomus tumor should be included in the differential diagnosis of bone lesions in which plain radiography showed a well circumscribed punch-out lesion without sclerotic rim especially those arising in the finger.

Female↗
PubMed1999

Role of immunohistochemical detection of lymph-node metastases in management of breast cancer. International Breast Cancer Study Group.

BACKGROUND: This study was designed to ascertain whether immunohistochemical methods could improve the detection of metastases in primary breast-cancer patients whose axillary lymph nodes were classified, by conventional methods, as disease free. METHODS: Ipsilateral lymph nodes (negative for metastases by routine histology) from 736 patients (participants in Trial V of the International [Ludwig] Breast Cancer Study) were examined by serial sectioning and staining with haematoxylin and eosin (two sections from each of six levels) and by immunohistochemistry of a single section (with two anticytokeratins AE-1 and CAM 5.2). After median follow-up of 12 years, disease-free and overall survival were estimated by Kaplan-Meier methods. FINDINGS: Occult nodal metastases were detected by serial sectioning and haematoxylin and eosin in 52 (7%) of 736 patients and by immunohistochemistry in 148 (20%). Only two (3%) of 64 invasive lobular or mixed invasive lobular and ductal cancers had node micrometastases, detected by haematoxylin and eosin, compared with 25 (39%) by immunohistochemistry. Occult metastases, detected by either method, were associated with significantly poor disease-free and overall survival in postmenopausal but not in premenopausal patients. Immunohistochemically detected occult lymph-node metastases remained an independent and highly significant predictor of recurrence even after control for tumour grade, tumour size, oestrogen-receptor status, vascular invasion, and treatment assignment (hazard ratio 1.79 [95% CI 1.17-2.74], p=0.007). INTERPRETATION: The immunohistochemical examination of ipsilateral axillary lymph nodes is a reliable, prognostically valuable, and simple method for the detection of occult nodal metastases. Immunohistochemistry is recommended as a standard method of node examination in postmenopausal patients.

Adult↗
PubMed1999

Fine-needle aspiration cytology of adrenal myelolipoma: case report and review of the literature.

Adrenal myelolipoma is a rare nonfunctioning tumor consisting histologically of an admixture of adipose tissue and extramedullary hemopoietic elements within the adrenal glands. Less than 300 cases have been reported in the literature and only 15 case reports have described cytological findings of this tumor obtained by fine-needle aspiration (FNA). We report a case of a 48-year-old male who had had anaplastic large cell carcinoma of the right lung. The left adrenal mass was encountered during a staging workup that led to a clinical suspicion of metastatic disease to the adrenal gland. FNA under computed tomography (CT) guidance was performed obtaining cytological material from which diagnosis of myelolipoma was made. The findings reemphasized an important role of FNA in investigation of adrenal mass. The literature on FNA cytology of adrenal myelolipoma is reviewed. Diagn. Cytopathol. 1999;21:409-412.

Adrenal Gland Neoplasms↗
PubMed1998

Detection of occult metastases in lung carcinomas: progress and implications for lung cancer staging.

The ability to detect occult regional and systemic metastases in patients with operable lung carcinoma could have a significant impact on the management of the disease. Here, we review the literature, including studies from our own laboratory, regarding the clinical significance of the presence of occult metastases in patients with lung cancer. The accumulated evidence strongly suggests that the detection of occult regional and systemic metastases is an important predictor of disease progression. The use of this method should be considered in the future design of lung cancer clinical trials, at the very least. The detection of occult metastases should have an impact on lung cancer management; to reflect this, we propose a change in the TNM staging system to indicate the presence or absence of occult regional (lymph node) and systemic (bone marrow) metastases. The proposed change is TNnMm, where n and m are occult nodal and bone marrow metastases status.

Bone Marrow Neoplasms↗