Primary Cardiac Sarcomas: Risk of Brain Metastases and Management.

Primary cardiac neoplasms are very rarely encountered, and the most common type of malignant tumours occurring primarily in the heart are sarcomas. These carry a lethal prognosis on account of their late presentation and aggressive spread. They have a high propensity for cerebral metastases. Such cases are exceptionally uncommon, and till date only a few examples are available. Currently, there is no standard protocol for the management of primary cardiac sarcoma with brain metastases.

Solitary Skull Langerhans Cell Histiocytosis Presenting With a Pus Draining Fistula: An Unusual Presentation and Review of Literature.

Langerhans cell histiocytosis (LCH) is a rare condition in adults, especially when it is limited to a single area of the skull, known as solitary calvarial involvement. In this case report, we present a unique instance of LCH affecting the parietal bone with a pus-draining fistula. This is a rare and unusual presentation at this location, which has been scarcely reported in medical literature. A 30-year-old woman with no prior comorbidity presented with complaints of headache that persisted for a year. She also had swelling on her scalp and a yellowish discharge for 3 weeks, but no neurological problems were observed. Radiology revealed thinning of the calvaria, with ragged margins along the inner table, multiple focal erosions, and involvement of overlying soft tissue and bony sequestrum. The patient underwent biparietal craniotomy and excision of the lesion. The histopathology report showed LCH. After 8 months of follow-up, there was no recurrence. The management of solitary calvarial involvement by LCH with masquerading presentation as a scalp infection can be achieved through complete excision of the lesions, resulting in a favorable outcome.

Delays In Breast Cancer Diagnosis At A Tertiary Care Facility In Karachi, Pakistan.

BACKGROUND: Diagnostic delay of breast cancer is linked to poor prognosis and survival. It can be caused by patients or healthcare providers. Since there is no quantification of provider delay and total delay in Pakistan, the general picture of breast cancer diagnostic delay is poorly understood. This study was conducted to quantify total delay, provider delay, and patient delay, along with the factors contributing to each type of delay in breast cancer management. METHODS: This was a descriptive study conducted over 3 years at a hospital in Karachi. Convenience sampling was used. Breast cancer patients undergoing treatment were interviewed. Values for diagnostic delays extracted from literature were >12 weeks in seeking care as patient delay and >4 weeks in treatment initiation as provider delay. RESULTS: A total of 334 patients were included in the analysis. Mean total delay was 56±52 weeks, the median (IQR) patient delay was 4 (0-22) weeks, and the median provider delay was 17 (9-52) weeks. Patient delay was found in 149 (44.6%), and provider delay was found in 269 (80.5%) patients. Believing symptoms to resolve on their own was the most common reason (24.9%) for patient delay. Seeking multiple opinions (43.7%) and misdiagnosis (43.4%) were the most common reasons for provider delay. CONCLUSIONS: Patients and providers both caused diagnostic delay in breast cancer treatment. There is a need to increase awareness in the general population and enhance the training of providers regarding timely recognition in all patients presenting with breast-related symptoms.