No abstract

PURPOSE: Adjuvant therapy in patients with ductal carcinoma in situ who undergo partial mastectomy remains controversial, particularly for low-risk patients (60 years or older, estrogen-positive, tumor extent < 2.5 cm, grade 1 or 2, and margins ≥ 3 mm). We performed a cost-effectiveness analysis comparing three strategies: no adjuvant treatment after surgery, a five-fraction course of accelerated partial breast irradiation using intensity-modulated radiation therapy (accelerated partial breast irradiation [APBI]–alone), or APBI plus an aromatase inhibitor for 5 years. MATERIALS AND METHODS: Outcomes including local recurrence, distant metastases, and survival as well as toxicity data were modeled by a patient-level Markov microsimulation model, which were validated against trial data. Costs of treatment and possible adverse events were included from the societal perspective over a lifetime horizon, adjusted to 2019 US dollars and extracted from Medicare reimbursement data. Quality-adjusted life-years (QALYs) were calculated based on utilities extracted from the literature. RESULTS: No adjuvant therapy was the least costly approach ($5,744), followed by APBI-alone ($11,070); combined therapy was costliest ($16,052). Adjuvant therapy resulted in slightly higher QALYs (no adjuvant, 11.320; APBI-alone, 11.343; and combination, 11.381). In the base case, no treatment was the cost-effective strategy, with an incremental cost-effectiveness ratio of $239,109/QALY for APBI-alone and $171,718/QALY for combined therapy. The incremental cost-effectiveness ratio for combined therapy compared with APBI-alone was $131,949. Probabilistic sensitivity analyses found that no therapy was cost effective (defined as $100,000/QALY of lower) in 63% of trials, APBI-alone in 19%, and the combination in 18%. CONCLUSION: No adjuvant therapy represents the most cost-effective approach for postmenopausal women 60 years or older who receive partial mastectomy for low-risk ductal carcinoma in situ.

The adenomatoid odontogenic tumor (AOT) is a hamartomatous benign neoplasia of odontogenic origin. It appears to be, mostly prevalent in young female patients, mostly during the second decade of life. The maxillary region is most affected when compared to the mandible. Its presentation is slow-growing, asymptomatic, and quiet but not quite a lesion. It is related to canines which are unerupted. Here, we report a case of the AOT in the left maxillary region of a female patient aged 13 years. We approached with a surgical enucleation resulting in an excellent outcome.

No abstract

Malakoplakia is a rare chronic inflammatory disease that predominantly develops in the urogenital system. Although its clinical presentation can vary from asymptomatic to urgent depending on location, mass effect, and other factors, its gross appearance can be mistaken for malignancy. However, the histological identification of von Hansemann histiocytes and Michaelis-Gutmann bodies confirm the diagnosis of malakoplakia. We present a case of a female patient who sought medical care for acute pelvic discomfort attributed to urinary retention after urinary obstruction. Although the discovery of multiple masses within the vagina and pelvic cavity indicated a tumor, it was originally negative for malignancy. Histology of biopsy samples demonstrated Michaelis-Gutmann bodies mixed with lymphoid cells through immunohistochemical and periodic acid-Schiff stains, consistent with a diagnosis of malakoplakia. Despite negative cultures, multiple courses of antibiotics were given, but the mass progressed and caused urinary obstruction. After pelvic exenteration, lymphoma was diagnosed and treated. We review the current literature on malakoplakia in different body sites associated with infections and noninfectious diseases.