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INTRODUCTION: Breast cancer is the most common diagnosed cancer among women worldwide. Invasive ductal carcinoma (IDC) is the most common type, on the other hand, squamous cell carcinoma of the skin (SCC) overlying the breast is a rare tumor. The co-presence of two tumor types in one organ is even a rarer entity, termed as collision tumor. Only 3 known cases of collision tumor with breast invasive ductal and skin squamous carcinoma were reported in the literature. CASE PRESENTATION: An otherwise medically free 91-year-old, postmenopausal, female presented with left breast fungating mass for four months. Pre-operative core tissue biopsy and incisional skin biopsy revealed two distinct tumor subtypes of invasive ductal carcinoma, positive for progesterone, estrogen receptors and negative for human epidermal growth factor receptor 2, as well as skin squamous cell carcinoma, and axillary lymph node metastasis. Patient underwent left breast modified radical mastectomy and split skin grafting for wound closure. The final histopathology was consistent with grade 2 IDC. The nipple and areola complex were involved by moderately differentiated squamous cell carcinoma. Currently patient on adjuvant hormonal treatment. Follow up showed no local recurrence or distal metastasis. CONCLUSION: Collision tumors of the breast with IDC and SCC of the overlying skin is very rare. The surgeon has to be aware of of such entity as the proper peri-operative management should be tailored to target the most aggressive histologic subtype.
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Understanding the significance of cytopathological tests in evaluating various infectious processes have become very essential nowadays, as it is a safe, fast, and cost-effective procedure. We present a case of a 52-year-old male with Salmonella empyema where the causative organisms were initially identified on cytology, and subsequently confirmed by microbiological culture. Diff-Quik stained smears showed many colorless, slender, fat short bacilli, which were visualized against the blue-gray background of the smear. These bacilli were identified both intracellularly inside the histiocytes and neutrophils cytoplasm as well as extracellularly in the smear background. We consider that this negative image represents the organism and its capsule creating an area that did not take the Diff-Quik stain. The patient was treated accordingly with suitable antibiotics. A brief discussion of this interesting finding in such a rare infection with pertinent literature review is presented.