Breast Implant Capsule-Associated Squamous Cell Carcinoma: A Systematic Review and Case Presentation.

Breast implant capsule-associated squamous cell carcinoma is exceedingly rare, with only eleven previously published cases. The present study systematically reviews the current literature and describes an additional case in a 56-year-old patient who had undergone previous breast implant augmentation with textured silicone implants 22 years prior. Systematic review of the literature demonstrated a scarcity of reported cases, yielding only eleven other incidences. Symptomatology for this patient involved pain, swelling, and erythema of the right breast prior to eventual surgery. Magnetic resonance imaging reporting extensive oedema and a large periprosthetic effusion with lobulated changes. The patient proceeded with bilateral capsulectomies and histology demonstrated moderately differentiated squamous cell carcinoma, areas of squamous metaplasia, and a chronic inflammatory cell infiltrate. Postoperatively, a positron-emission tomography scan showed no concerning uptake of fluorodeoxyglucose and no evidence of metastatic disease. The patient proceeded to a right-sided total mastectomy and axillary lymph node biopsy. Final histology demonstrated remnant well-differentiated squamous cell carcinoma, whilst five lymph nodes were negative of disease. The patient received postoperative radiation therapy. A clinical history of swelling and pain appears to be a common presentation for this condition. Aspirations of periprosthetic collections containing squamous cells should be considered concerning for neoplasm. The presence of squamous metaplasia within the specimen provides some credence for transformation to invasive carcinoma mediated through chronic inflammation. The presence of perineural invasion would be worth reporting in future cases as it may confer similar risk characteristics as in cutaneous squamous cell carcinoma. A finding of remnant carcinoma during completion mastectomy provides support for an aggressive approach to surgical resection. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Idiopathic spontaneous intraperitoneal haemorrhage: A near fatal presentation of acute abdomen requiring prompt diagnosis.

INTRODUCTION AND IMPORTANCE: Idiopathic spontaneous intraperitoneal haemorrhage is a rare and life-threatening condition that results from non-traumatic visceral artery rupture in the latter half of pregnancy and within the postpartum period [1-3]. CASE PRESENTATION: A 32 -year-old woman presented to emergency department, 14 weeks post-partum, with sharp left sided abdominal pain, nausea, and vomiting. Initial computed tomography (CT) was suggestive of non-specific colitis from transverse to descending colon of unclear cause. Six hours into admission she became haemodynamically unstable with abdominal peritonism resulting in emergency laparotomy. Intra-operative findings showed large volume haemoperitoneum with an active bleed from the middle colic artery. CLINICAL DISCUSSION: Symptoms and clinical presentation of Idiopathic spontaneous intraperitoneal haemorrhage is variable and ranges from vague abdominal pain to haemorrhagic shock. A latent period of several hours may be followed by a rapid progression of symptoms owing to rapidity of extravasation[3]. Pathogenesis has been suggested to arise from the increased physiologic demands during the intrapartum period, wherein repeated distension of vessels and increased tortuosity leads to a predisposition for rupture [4]. CONCLUSION: Diagnosis of Idiopathic spontaneous intraperitoneal haemorrhage is difficult but should be a differential in those who are post-partum presenting with abdominal pain. Patients should be assessed with CT angiography and treatment focused around aggressive resuscitation, surgical exploration, and ligation [3].

Peritoneal inclusion cysts in a young male: A case report.

INTRODUCTION AND IMPORTANCE: Peritoneal inclusion cyst is a rare benign condition with low potential for malignant transformation but high recurrence rates. Debulking surgery is the recommended first line management for these patients, however, recurrence rates are up to 50 % (Padmanabhan et al., 2020; Chapel and Husain, 2021). CASE PRESENTATION: A 26-year-old male being worked up for non-specific abdominal pain with cross-sectional imaging showing multiple multicystic lesions in the abdomen and pelvis. There was a pre-operative suspicion of Pseudomyxoma Peritonei and decision was made for diagnostic laparoscopy and biopsy. Mucin and an abnormal small bowel mesentery was found intraoperatively and sampled leading to the diagnosis of peritoneal inclusion cyst. CLINICAL DISCUSSION: Treatment of peritoneal inclusion cyst range from surveillance to aggressive treatment with complete cytoreductive surgery with involved field peritonectomy and hyperthermic intra-peritoneal chemotherapy. CONCLUSION: First line management of peritoneal inclusion cysts is for debulking surgery. Arguments for less invasive and more aggressive management has been proposed, however, further data needs to be collected to determine gold standard of treatment.