Occult breast cancer (OBC) is a unique type of breast cancer that initially presents with metastasis to the axillary lymph nodes or other metastatic carcinoma, while no breast mass is palpable by finger examination and simultaneously undetectable by usual radiography. The morbidity of OBC is quite low, less than 1% among all types of breast cancers. However, OBC has only been described in case reports and retrospective studies with small samples. Hence, there is no consensus on a therapy due to lack of high quality randomized clinical trials. The aim of the present study was to review the literature from China and the PubMed/Medline database published prior to July, 2015. Key findings in the diagnosis and therapy of OBC are discussed and reviewed.

Exosomes are small membrane derived vesicles secreted by a variety of mammalian cells during normal and pathologic conditions which are actively involved in conferring intercellular signals. They are enriched with mRNA, micro RNA, lipids and other cellular proteins which can be isolated from various body fluids. Recently their role as potential biomarkers is gained a lot of attention. Exosomes can reveal the cell of origin and the condition of the cell as well. Their role as biomarkers in diseases like Alzheimer’s, brain tumors, chronic kidney disease, salivary gland diseases, breast cancer has been already established. Role of tumor derived exosomes in cancer progression, metastasis and drug resistance is widely discussed at present times. In contrast, exosomes from healthy cells of the immune system appear to have anti-tumor characteristics. Anti-tumor therapies based on exosomes, for example, by blocking the formation of tumor-derived exosomes or having exosomes release therapeutic agents at specific sites is being explored. The use of exosomes from dendritic cells in tumor vaccination, the safety of which has been demonstrated in phase I studies. Salivary exosomes can be relevant diagnostic, prognostic and predictive biomarkers in oral diseases especially oral cancer. Exosomes isolated from cells infected with various intracellular pathogens, including Mycobacterium tuberculosis and Toxoplasma gondii, have been shown to contain microbial components and can promote antigen presentation and macrophage activation, suggesting that exosomes may function in immune surveillance. Their role in forensic analysis is also being explored. On the other hand, exosome mediated drug expulsion has led to drug resistance thus hindering the therapy.

A 49 years old woman was diagnosed of bilateral and multicentric infiltrating ductal breast carcinoma with a luminal A phenotype (Figure 1) and blastic bone metastatic spread. She had a very good response to hormonotherapy and monthly zoledronic acid without visceral spread or bone events for three years. Then she consulted because of progressively asthenia, anorexia, nausea, dizziness, orthostatic, occasional abdominal pain, increased thirst and frequent urination and altered sleep-wake cycles. On physical examination, she appeared pallid without any other remarkable finding.

Nucleus reflects a cell’s biological potential and activity. Nuclei of normal healthy cells are usually single per cell in number, round to oval shaped, show even distribution of chromatin, display regular nuclear margin or membrane, one or two inconspicuous nucleoli and normal mitotic figures. During development of cancer, the nucleus undergoes numerous alterations of size, shape, number, nuclear membrane or margin, chromatin pattern, nucleoli, and organization of nuclear chromatin.

Introduction: Desmoid fibromatosis (DF) or Desmoid tumours are rare, benign musculoaponeurotic tumours. DF have no potential for metastatic spread but are locally aggressive and spread along fascial planes, leading to extensive patient morbidity. While germline Adenomatous Polyposis Coli (APC) mutations are associated with DF, it can also occur sporadically. Debate regarding the most appropriate treatment options exists in literature.

Case summary: A 38 year old lady presented with a left hypochondrial swelling, night sweats and weight loss to the General Surgical Outpatients Department at our institution. This was noticed after the birth of her second child. No relevant family history was noted. A pre-operative ultrasound demonstrated a fusiform nodule within the left anterior abdominal transversalis oblique muscle, which had a focal hypervascular nidus. Surgical excision of the mass was performed under general anaesthetic and histologically the tumour was found to contain spindled myofibroblastic cells arranged in fascicles with perivascular lymphoid infiltrates. The diagnosis was DF with a positive margin status. Given the high risk of recurrence of this tumour type, the decision was made to undertake a further resection.

Conclusion: DF is known to be a locally aggressive benign tumour of mesenchymal origin. The benefits and disadvantages of treatment options are debated within literature. Surgery is reported to have better or similar local control rates to radiotherapy but without radiation related complications. Given that DF is known to be locally aggressive, affecting young people and with a female preponderance, we believe that surgical excision with clear margins is the most appropriate treatment of choice.

The diagnosis of neoplastic pleurisies remains difficult because of frequent false negative cytological analysis. Thoracoscopy remains the gold standard to distinguish benign from malignant pleural effusion, but it is invasive and not suitable for all patients.

Microparticles (MPs) are promising potential biomarkers and could represent a new approach to identify patients with malignant pleural effusions.

We have recently reported the presence of EpCAM-positive-MPs (EpCAM+MPs) in malignant pleurisies that could be routinely used as a complementary tool with cytology for the diagnosis of pleural malignancy.

Here we describe three cases of pleural cancer patients negative for cancer cells but positive for EpCAM+MPs in the pleural fluid.

This study confirmed the possibility to apply in clinical practice recent data about EpCAM+MPs, detected in pleural fluid, as a non-invasive pleural biomarker useful to increase sensitivity of cytology. In particular, we suggest in patients with a strong suspicion of pleural cancer to search pleural EpCAM+-MPs as a complementary diagnostic tool in case of negative cytological analysis of pleural fluid.

This is case of a 40-year-old otherwise healthy and physically active gentleman noted the onset of palpitations while running upstairs the day of admission to the emergency room. On arrival to the emergency room, his heart rate was noted to be 250 beats-per-minute (bpm) and electrocardiogram (ECG) demonstrated ventricular tachycardia (VT). Synchronized electrical cardioversion was performed to sinus bradycardia. He was stabilized and admitted to the hospital. There was demonstration of right ventricular VT with an inferior axis, T-wave inversions in the right precordial leads with a right bundle branch block (RBBB) pattern, epsilon waves, and bidirectional premature ventricular contractions (PVC).

Purpose: The ability of miRNAs for biomarker tools was further built by recent research showing that cancerspecific miRNAs are traceable in cell-free blood fluids such as plasma and serum. In this study, the levels of miR-221 and miR146b in human’s peripheral blood as tumor markers for early detection of Papillary Thyroid Carcinoma [PTC] were investigated.

Methods: A stem-loop quantitative reverse transcription-polymerase chain reaction [qRT-PCR] method was performed to determine the serum levels of miR-221 and miR-146b from 25 healthy controls, 25 PTC patients the day before thyroidectomy, 25 patients with benign nodules and 25 patients after thyroidectomy during the scheduled medical examinations.

Results: There was statistical difference in the serum levels for miR-221 and miR-146b between the controls and the PTC patients. It also showed no statistical difference for miR-221 and miR-146b between controls and thyroidectomy patients.

Conclusion: The overexpression of miR-221 and miR-146b could be potentially served as serum indicator biomarkers in the approach for Thyroid Papillary Carcinoma detection from benign nodules.

Background: The major histocompatibility complex class I-related chain A (MICA) molecules play a pivotal role in the modulation of anti-tumor immune responses. A polymorphic change from methionine (Met) to valine (Val) at amino acid position 129 of the alpha 2 heavy-chain categorize MICA alleles into strong and weak binders for the NKG2D receptor. We investigated here whether MICA-129 alleles are associated with gastro-intestinal tract (GItract) carcinomas in Tunisian affected patients as compared to healthy controls (HC).

Material and methods: 181 patients affected by colorectal cancer (CRC) and 61 patients affected by gastric cancer (GC) along with 203 healthy controls (HC) were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) procedure.

Results: We found that the MICA-129 Val/Val genotype was statistically more prevalent in patients affected both by CRC and GC as compared to HC. After stratification with poor prognostic parameters, we observed that MICA- 129 Val/Val genotype is significantly associated with advanced tumor extension (T3-T4), lymph node metastasis (N+), and distance metastasis (M+). In both cases, the MICA-129 Val/Val genotype seems to behave as a risk genotype and a poor prognostic biomarker in our population.

Conclusion: Our findings suggest a potential tumor escape possibly due to an inability to activate NK cells and/ or to stimulate specific T lymphocytes subsets particularly active in the GI-tract.