CD56, p53, and Cyclin D1 detection in plasma cells (PC) can help to predict prognosis of multiple myeloma (MM). Clinical and biochemical prognostic parameters were analysed in a group of 122 patients with primary diagnosed MM in the period 2011–2015. Bone marrow biopsies were analysed with Cyclin D1, p53, CD56 antibodies. Statistical analysis was performed using Microsoft Excel 2010 and Graph Pad Prism 5. Lack of CD56 expression and p53-positivity were significantly correlated with a low glomerular filtration rate (GFR), low platelet count and haemoglobin level, as well as with high serum creatinine levels. Patients with Cyclin D1 expression in PC had a significantly higher serum calcium level and more common osteolytic lesion in bones. CD56-negative as well as p53, Cyclin D1-positive groups had advanced Salmon–Durie MM stages by and significantly higher ß2-microglobulin. Expression of p53, Cyclin D1 and lack of CD56 antigen in PC are negative predictive factors in cases of MM, as these patients were diagnosed as having late Salmon–Durie stage and higher ß2-microglobulin level. Expression of p53 and lack of CD56 antigen in PC is associated with an increased creatinine level in blood and decreased GFR; therefore, these are criteria for chronic renal failure progression and poorer prognosis of MM.
For many years, there has been a concern that inflammatory bowel disease carries an increased lymphoma risk. At the same time, patients with intestinal lymphomas are occasionally misdiag-nosed as having Crohn’s disease. We report a case of T-cell lymphoma of the bowel misdiag-nosed as Crohn’s disease, which illustrates the diagnostic challenges posed by peripheral extranodal lymphomas. A 68-year old female presented with clinical symptoms (diarrhoea, abdominal pain, poor appetite and significant weight loss), and colonoscopic and initial histological findings that were similar to inflammatory bowel disease. She was diagnosed with Crohn’s disease and received treatment with sulfasalazine with subsequent improvement of symptoms. Eight months after the initial diagnosis the patient experienced sudden abdominal pain. Laparotomy revealed necrosis in the small and large intestine and ileostomy was performed. On day 10 of a complicated postoperative period the patient died. Post-mortem histopathological examination of small and large intestine revealed highly malignant peripheral T-cell lymphoma, not otherwise specified. Differentiation of intestinal T-cell lymphoma from Crohn’s disease continues to be a challenge, because clinical, colonoscopic, radiological and histopathological findings can mimic Crohn’s disease. Careful multi-disciplinary assessment and knowledge of this rare disorder is crucial for timely diagnosis.
The aim of the study was to evaluate the role of ultrasound guided fine needle aspiration cytology (FNAC) in the restaging of node positive breast cancer after neoadjuvant chemotherapy (NAC). From January 2016 – October 2018, 90 node positive stage IIA-IIIC breast cancer cases undergoing NAC were included in the study. The largest, most superficial and the most caudal axillary node metastasis confirmed by fine needle aspiration cytology (FNAC) was marked with clip. After NAC, restaging of axilla was performed with ultrasound and FNAC of the marked and/or the most suspicious axillary node. Of the 90 cases, 58 with available ultrasound guided percutaneous needle biopsy data were further evaluated. Axilla conserving surgery was performed in 37 of 58 cases and axillary lymph node dissection (ALND) in 21 of 58 cases. False Positive Rate (FPR) of FNAC after NAC was 12%, False Negative Rate (FNR) — 58%, sensitivity — 54%, specificity — 82%, accuracy 62%. FNAC after NAC had low FPR and was found to be useful in predicting residual axillary disease and to streamline surgical decision making regarding ALND. However, FNR was unacceptably high and FNAC alone was not able to predict ypCR and omission of further axillary surgery.