Atrial papillary fibroelastoma: A stranger in a strange place

Papillary fibroelastoma (PFE) is the most common primary tumor of cardiac valves and predominantly located on the left side. Its origin from non-valvular endocardium is extremely rare. We describe a case of an 81-year-old Caucasian male who presented with a mobile right atrial mass at the junction of right atrial wall and superior vena cava (SVC). Initially it was thought to be a thrombus and the patient was treated with anti-coagulation therapy without any change in size of the mass. Surgical excision was performed to establish the diagnosis and histopathology confirmed the diagnosis of PFE. In conclusion, this case is unique due to location of the tumor and its attachment with superior vena cava. Physicians should consider this unusual location of PFE in the differential diagnoses of an intra-atrial mass.

Beta-defensin index: A functional biomarker for oral cancer detection

There is an unmet clinical need for a non-invasive and cost-effective test for oral squamous cell carcinoma (OSCC) that informs clinicians when a biopsy is warranted. Human beta-defensin 3 (hBD-3), an epithelial cell-derived anti-microbial peptide, is pro-tumorigenic and overexpressed in early-stage OSCC compared to hBD-2. We validate this expression dichotomy in carcinoma in situ and OSCC lesions using immunofluorescence microscopy and flow cytometry. The proportion of hBD-3/hBD-2 levels in non-invasively collected lesional cells compared to contralateral normal cells, obtained by ELISA, generates the beta-defensin index (BDI). Proof-of-principle and blinded discovery studies demonstrate that BDI discriminates OSCC from benign lesions. A multi-center validation study shows sensitivity and specificity values of 98.2% (95% confidence interval [CI] 90.3-99.9) and 82.6% (95% CI 68.6-92.2), respectively. A proof-of-principle study shows that BDI is adaptable to a point-of-care assay using microfluidics. We propose that BDI may fulfill a major unmet need in low-socioeconomic countries where pathology services are lacking.

Monitoring the Use of Telemonitor: A Resident-run Quality Improvement Initiative Decreases Inappropriate Use of Telemonitor in a Community Hospital

Background Cardiac telemetry is an important tool to detect life-threatening conditions in hospitalized patients but is used widely and inappropriately. We sought to assess current usage and improve the appropriate use of telemetry in a community hospital. Methods We conducted a quality improvement project on patients who were admitted on telemetry floors between January and March 2017 (pre-intervention). The indication(s) and duration of telemonitor use, event(s) recorded on telemonitor and outcome of the event(s) were documented. A six-month educational intervention was undertaken and the effect of intervention was assessed among patients admitted between December 2017 and February 2018 (post-intervention). Results In the pre-intervention group, 329 patients qualified for the study, with a median age of 78 years. The post-intervention group had 383 qualified patients with a median age of 77 years. Mean duration of telemonitor use was four days in both groups. In the pre-intervention group, 54% had class I, 32% had class II, and 14% had class III indications. In post-intervention group, 46% had class I, 42% had class II, and 12% had class III indications. The educational intervention resulted in a trend towards less inappropriate use of telemetry, particularly in teaching service. Telemonitor events were recorded in 22 (7%) of the pre-intervention patients and 13 (4%) of the post-intervention group. Two patients died in the pre-intervention group and one in the post-intervention group from non-cardiac causes. Conclusion Our results highlight that change in practice requires sustained education interventions.

A retrospective comparison of the characteristics and recurrence outcome of triple-negative and triple-positive breast cancer

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Background: Triple-negative (estrogen/progesterone-receptors negative and HER2-negative; TNBC) and Triple-positive (estrogen/progesterone-receptors positive and HER2-positive; TPBC) breast cancers are very distinctive in terms of tumor behavior as well as disease management. Due to lack of an effective targeted therapy, the treatment options are limited for TNBC. We conducted a retrospective review to compare various characteristics and recurrence outcome in TNBC and TPBC. Methods: Over 3000 non-consecutive female breast cancer patients (diagnosed between 2000-2012) were reviewed. Of these, 406 patients (206 TNBC, 200 TPBC) were included. The following data at diagnosis were studied: age, tumor size, stage, grade, lymph node involvement, distant metastases and smoking history. Analyses are performed using R statistical software (Version 2.15.2). Numeric data are summarized by median and quartile with comparisons between groups performed by Wilcoxon Rank Sum Tests. Categorical data are summarized by frequency and percentage and comparisons between groups are performed by chi-square tests. Statistical significance is determined by a p-value ≤ 0.05. Results: Both TNBC and TPBC were diagnosed at similar median ages of 56.5 and 55 years respectively (p= 0.059). TNBC were more likely to have poorly differentiated histology (75.63%) whereas TPBC were more often moderately differentiated (54.79%) (p< 0.001). At diagnosis, Triple-Positive (TP) tumors were larger (median 2.4 cm) compared to Triple-Negative (TN) tumors (median 2 cm) (p= 0.013). However, there were no significant differences with respect to lymph node involvement and distant metastases in the two groups. Importantly, recurrences were more common in TNBC 33.85% (65/192) compared to TPBC 4.21% (8/190) (p < 0.001) and there was no association found with smoking history or active smoking status. Conclusions: TN tumors although smaller in size compared to TP were more likely to have poorly differentiated histology, showed higher recurrence rates and therefore were more aggressive in behavior. Both TNBC and TPBC were diagnosed at similar median age and exhibited no recurrence association with smoking history.