First case report of bilateral breast necrosis following coronary artery bypass graft using left internal mammary artery.

Coronary artery bypass grafting (CABG) using internal mammary artery is a frequently performed procedure for the treatment of coronary artery disease nowadays. Ipsilateral breast necrosis is a rare and seldom reported complication that may mimic breast cancer on presentation. However, contralateral breast necrosis has not been reported to date. We are reporting the first case of bilateral breast necrosis after CABG using the left internal mammary artery. We discuss the different underlying mechanisms and possible co-factors behind the development of this rare complication, and we also share a successful management approach to conserve the breast and improve the patient's outcome.

A Case of Locally Advanced Breast Cancer in a 59-Year-Old Man Requiring a Modified Approach to Management.

BACKGROUND Male breast cancer is rare, accounting for approximately 1% of all malignancies in men. The lack of awareness of this rare cancer results in delayed diagnosis and its aggressive behavior can result in poor prognosis. This report is of a case of locally advanced, high-grade breast cancer in a 59-year-old man who was reluctant to undergo diagnostic procedures, and describes the approach to clinical management. CASE REPORT A 59-year-old man presented with a large left breast mass with enlarged axillary lymph nodes. The patient had ignored the mass and declined all diagnostic procedures. After modifying the diagnostic workup and involving a psychiatrist, the patient agreed to undergo a modified radical mastectomy. Histopathology showed a high-grade invasive ductal carcinoma with lymph node metastasis. The breast cancer was triple-positive for human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), and progesterone receptor (PR). Adjuvant treatment included herceptin, tamoxifen, and radiation therapy. CONCLUSIONS This case demonstrates the importance of raising public awareness of breast cancer in men, and to assess and overcome the factors leading to delay in accessing medical attention. In challenging cases, modifying the diagnostic workup and the treatment approach with the least deviation from the standard of care, including counseling may be required.

A rare complication resulting in a rare disease: radiation-induced male breast cancer.

The increase in survival after childhood radiation therapy for some blood malignancies has led to an increase in the diagnosis of radiation-induced secondary solid malignancies (SSM). We report a young man presenting with invasive breast cancer 19 years after receiving radiation therapy and bone marrow transplant for acute lymphocytic leukaemia in childhood. This latency period is longer than previously reported. Therefore, survivors of radiation-treated primary cancer should be closely monitored for SSM, including breast cancer, for the rest of their lives.