Factors influencing the decision-making process for breast surgery in women likely to face breast cancer: a cross-sectional study.

Breast cancer (BC) is one of the main neoplasia affecting women worldwide. Breast conserving surgery (BCS) or modified radical mastectomy (Mx) are both applicable with no difference between patients treated by these surgeries in terms of quality of life, local recurrence rate, and overall survival. The surgical decision today favors the surgeon-patient dialog, in which the patient is involved in the therapeutic decision. Several factors influence the decision-making process. This study aims to investigate these factors in Lebanese women likely to face BC and before being operated on, unlike other studies that targeted patients who had already been operated on. Methods: The authors conducted a study to investigate the factors influencing the choice of breast surgery. To be eligible for this study, participants had to be Lebanese women, with no age limit and willing to participate voluntarily. A questionnaire form was used to collect data related to patient demographics, health, surgery, and relevant factors. Data analysis was performed by statistical tests using IBM SPSS Statistics software (version 25) and Microsoft Excel spreadsheet (Microsoft 365). Significant factors (defined as P<0.05) were than used to determine the factors that influenced women's decision-making. Results: Data from 380 participants were analyzed. The majority of participants were young (41.58% were between 19 and 30 years old), living in Lebanon (93.3%), and had a bachelor's degree or higher (83.95%). Almost half of the women (55.26%) are married and have children (48.95%). Among the participants, 97.89% had no personal history of BC, and 95.79% had not undergone any breast surgery. The majority of participants indicated that their primary care physician and surgeon influenced their decision on the type of surgery they take (56.32 and 61.58%, respectively). Only 18.16% of respondents said they had no preference for Mx over BCS. While the others listed their reasons and concerns for choosing Mx, including: concern about recurrence (40.26%), concern about residual cancer (31.05%). 17.89% of the participants justify the reason for choosing Mx rather than BCS, by the fact that they lack information on BCS. Most of the participants confirmed the importance of clarifying all information about BC and treatment options before being affected by a malignancy (71.84%) of which 92.28% preferred to participate in the next online lectures about this topic. The assumption of equal variance is assumed. Indeed, according to the Levene Test (F=1.354; P<0.05), there is a significant difference between the age categories of the group that prefers Mx (2.08) and the group that does not prefer Mx over BCS (1.77). Based on an independent samples t-test (t(380)=2.200; P<0.05). On the other hand, the preference of Mx over BCS is statistically dependent on the choice of contralateral prophylactic mastectomy. Indeed, according to the χ2-test, the relationship between the two variables is significant (χ2 (2)=8.345; P<0.05). The 'Phi' statistic measures the intensity of the relationship between the two variables in question (φ=0.148); therefore, the relationship between the preference of Mx rather than BCS and the asking of contralateral prophylactic Mx is strong and significant (P<0.05). However, there was no statistically significant dependence between the preference of Mx and the other factors studied (P>0.05). Conclusion: BC poses a problem for affected women, especially when they are asked to choose between a Mx or a BCS. Several complex factors affect and influence their decision and lead them to decide. Understanding these factors helps us to properly help these women choose. In this study, the authors demonstrated all the factors that can influence the choice of Lebanese women prospectively, and we stressed the need to explain all the modalities before being diagnosed.

Extra-Gastrointestinal Stromal Tumor (EGIST) in the Pelvis Mimicking Retroperitoneal Sarcoma.

Extra-gastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors accounting for less than 1% of total gastrointestinal tumors. They tend to be aggressive and have a poor prognosis. Unfortunately, there is a lack of data or controversial data due to its scarcity. Therefore, we report a case of pelvic EGIST misdiagnosed as retroperitoneal sarcoma. We opted for surgical management followed by adjuvant oral chemotherapy with imatinib.

Primary Breast Tuberculosis Mastitis Manifested as Nonhealing Abscess.

Primary breast tuberculosis (TB) is a rare extrapulmonary TB mainly affecting young women of childbearing age from endemic countries. Its incidence is increasing in immunocompromised and HIV-infected people and with the emergence of drug-resistant strains of Mycobacterium tuberculosis (MTB). There are no specific clinical signs suggestive of this disease, it often presents as a hard mass or breast abscess. There is an overlap of features with other inflammatory, infectious, benign lesions, fat necrosis and malignant neoplasms of the breast. The detection of MTB remains the gold standard for diagnosis. Several other diagnostic modalities are used, with varying lack of sensitivity and specificity, and with a range of false negatives. A quarter of cases were treated solely on the basis of clinical, imaging or histological suspicion, without confirmation of the diagnosis. Therefore, we report the case of a young Vietnamese woman, presented for a nonhealing breast abscess, and diagnosed with breast TB based on the patient's ethnicity, histological findings, lack of clinical response to conventional antibiotic therapy, and a good clinical response to anti-TB treatment.

Primary invasive ductal carcinoma of axillary accessory breast.

Primary accessory breast cancer is an extremely rare pathology, representing less than 1 % of all breast cancers, and it is found in more than 90 % of cases in the axilla. The diagnosis of accessory axillary breast cancer (AABC) is often late and at an advanced stage with an average delay of 40.5 months. Histological sampling and immunohistochemical results confirm the diagnosis. Most patients are diagnosed with stage II disease or higher, so it is considered to have a poor prognosis. There is no specific management for AABC; it follows the guidelines for orthotopic pectoral breast cancer. We therefore report the case of a 50-year-old woman diagnosed with grade II invasive ductal carcinoma found in accessory axillary breast, treated by wide local resection and sentinel lymph node dissection.

A report of an unexpected complication of PORT-A-CATH insertion.

INTRODUCTION: Vascular access is essential in the management of patients, and sometimes poses a problem, especially in patients requiring chronic treatment. Surgical insertion of the port-a-cath solved this problem by providing easy access, but unfortunately, it's associated with some complications. CASE PRESENTATION: We present a case of 32 year-old woman, diagnosed with advanced breast cancer, admitted for insertion of a port-a-cath for neoadjuvant chemotherapy. A few hours after the operation, the patient developed hoarseness and a cough. A flexible laryngoscope showed the left vocal cord which was fixed in the middle position and did not move, while the other maintained normal motility. The patient was treated conservatively. CONCLUSION: This case demonstrated a rare and unexpected complication of the insertion of a port-a-cath, which is the result of an injury to the recurrent laryngeal nerve. We are reporting this case to encourage physicians to take note of this complication and know how to manage it.

Adult patient living 32 years with postduodenal remnant small bowel of only 35 cm in jejunocolic anastomosis type II weaned off parenteral nutrition. A case report.

INTRODUCTION: The small bowel is an essential organ for maintaining adequate nutrition. Decrease in length could be associated with malnutrition and may require that the patient receives parenteral nutritional support. We report a case of a 59-year-old man who survived32 years with a short bowel of 35 cm length without any parenteral nutrition. CASE PRESENTATION: A 59-year-old gentleman, with a history of hypercoagulable state, presented for severe abdominal pain and obstipation of one day's duration. Upon presentation, the patient was hemodynamically unstable, with abdominal guarding and tenderness upon physical examination. Laboratory studies showed metabolic acidosis with leukocytosis and electrolyte disturbances, and an abdominal CT scan showed thickening of the sigmoid and multiple air-fluid levels. The patient was operated urgently for suspicion of mesenteric ischemia, however, he was found intraoperatively to have a very short dilated small bowel with jejunotransverse anastomosis. DISCUSSION: The necessity for surgical resection of the small bowel can arise for a sum of reasons. However, the removal of a big amount of small bowel may not be adaptive and appropriate digestion will no more be possible. In the aftermath of the resection, patients require parenteral nutrition for a certain period after which they may switch to enteral and oral nutrition, and subsequently intestinal adaptation by thickening and growth of the remaining intestinal villi. CONCLUSION: Patients with a short bowel, particularly those surgically removed, can survive even with a very short remaining bowel length, as a result of intestinal adaptation, nutrition enhancement, and elimination of parenteral nutrition.

Rare presentation of community acquired pneumonia resulted in laparoscopic intervention in adult. Case Report.

INTRODUCTION: Community acquired pneumonia usually presents with typical clinical and radiological signs allowing for a quick diagnosis. Nevertheless, pneumonia can infrequently mimic acute abdominal pathologies, leading to invasive unnecessary procedures. PRESENTATION OF CASE: We report a case of a 44-year-old man, previously healthy, admitted with a diagnosis of a surgical abdomen, investigated with an exploratory laparoscopy after inconclusive imaging and failure of improvement. Clinical evolution revealed the diagnosis of pneumonia. DISCUSSION: Community acquired pneumonia is a frequently encountered condition. While its clinical presentation is usually related to the respiratory system, extrapulmonary manifestations, including abdominal pain in the pediatric population, are well documented. However, solely severe acute abdominal pain, being as the major presentation, without respiratory symptoms or radiological signs is very rarely reported. CONCLUSION: Community acquired pneumonia can sometimes be a challenging diagnosis. Acute abdominal pain mimicking a surgical abdomen is an infrequent presentation but can confuse physicians when no radiological or clinical signs of pneumonia are present.

A caustic ingestion consequence mistaken for gastric cancer: A case report.

INTRODUCTION: This report is a case of a suicide attempt by bleach ingestion. mistaken for gastric cancer after oral contrast studies and esophagogastroduodenoscopy. We report this case to encourage physicians to take this etiology into consideration as part of differential diagnosis especially in front of a secretive patient. PRESENTATION OF CASE: We report a case of a 38-year-old lady admitted for an acute onset of symptoms leading to a diagnosis of antral stenosis. Further workup which included endoscopic and surgical biopsies failed to reveal an underlying malignancy. After 24 days of inconclusive inpatient investigations, and due to failure of conservative treatment, distal gastrectomy was performed. Final pathology also revealed an absence of any signs of malignancy, and reported only inflammatory changes. One month after discharge, the patient confessed that she had attempted suicide by ingestion of corrosive agents before the symptoms started and wanted to keep the incident as a secret. DISCUSSION: Gastric stenosis is seldom encountered in adult patients, however, it can occasionally result secondary to gastric ulcer disease, malignancies, foreign body ingestion, certain drugs or chemicals, or after endoscopic or surgical interventions. These etiologies do not usually cause acute gastric obstruction, and usually follow a more indolent course. Identification of an underlying etiology is mandatory to determine the proper medical or surgical treatment to relieve the obstructive symptoms. CONCLUSION: We report this bizarre case to encourage physicians to keep this etiology in mind in otherwise unexplained gastric stenosis.

Recurrent giant retroperitoneal liposarcoma with 10 years follow up. Case report and review of literature.

INTRODUCTION: This case is of a patient with a recurrent giant retroperitoneal liposarcoma, followed-up and operated multiple times over 10 years. We report this case because of its rarity and review all previous articles reporting "Giant Retroperitoneal Liposarcoma" in the English literature. CASE DESCRIPTION: A 70 years old man presented to our clinic for dizziness and fatigue. He was incidentally found to have a large retroperitoneal mass filling all the length of the abdominal cavity and shifting all intraabdominal viscera and kidney to the left side. En bloc excision of a 50 × 30 × 18 cm, 9 kg tumor was performed. Final pathology revealed a well-differentiated liposarcoma. Five years later, the patient was reoperated for recurrence and a well-differentiated liposarcoma was excised in 2 pieces (the biggest measuring 14 × 11 × 7 cm) along with the appendix. Four years later the patient was operated on again for a second recurrence, and again a well-differentiated liposarcoma (16 × 10 × 7 cm) extending into the right inguinal canal was excised. One year thereafter, the patient was diagnosed with a third recurrence (22 × 12 cm). DISCUSSION: Retroperitoneal Liposarcomas are rare tumors, presenting with different histological differentiation. They are diagnosed using multiple imaging modality, mainly CT scan, and it is confirmed by percutaneous large core needle biopsy. R0 Surgical excision remains the proper treatment for non-metastatic tumors, which may necessicate multiorgan resection. They rarely grow to reach a large size and be labled as "Giant Retroperitoneal Liposarcoma".

Left gastric artery pseudo-aneurysm post sleeve gastrectomy: A case report.

INTRODUCTION: Bleeding in the context of sleeve gastrectomy could be caused by a variety of diseases however pseudo-aneurysm is an overlooked complication. CASE: For instance, we present case of a 25 year-old Lebanese woman that undergone sleeve gastrectomy and presented 3 weeks later with a bleeding left gastric artery pseudo-aneurysm. CONCLUSION: Angiography followed by embolization is best for diagnosing and treating the pseudo-aneurysm by coiling. Serious outcomes could arise from such a complication. Hence, accurate diagnosis and treatment using the appropriate methods is essential to avoid life-threatening events.

Prepyloric gastric inflammatory fibroid polyp presenting as chronic epigastric discomfort in a 5th decade aged female: A case report.

INTRODUCTION: Inflammatory fibroid polyps is a rare entity that mostly occur in the stomach. Gastric type is usually asymptomatic or may show nonspecific symptoms. Diagnosis is mainly postoperative with limited roles of usual diagnostic techniques. PRESENTATION OF CASE: A 42 years old healthy female presenting with chronic symptoms for epigastric discomfort and mild nausea. Labs showed mild anemia. A gastric lesion was detected by Endoscopy and being studied by echo-endoscopy and needle aspirate. Gastric Inflammatory fibroid polyp was diagnosed after distal gastrectomy by histopathology and immunohistochemistry. CONCLUSION: Gastric inflammatory fibroid polyp is a preoperative diagnostic challenge of unclear pathogenesis. Histopathology and immunohistochemistry are the gold standard. Studies around this exact pathology are required for better management and prevention.

A giant mesenteric fibromatosis adherent to the appendix and colonic wall, case report.

BACKGROUND: Mesenteric fibromatosis, is a rare neoplasm arising usually from the bowel mesentery, with intermediate behavior and local invasion potential. They can be sporadic or related to multiple factors contributions. They usually presents as an asymptomatic growth of intraabdominal mass, and can reach a large diameter before symptoms appearance. Surgical excision is the definitive treatment when achievable. CASE PRESENTATION: In this case we present a case of 34 years old gentleman, presenting for painless abdominal distension, and found to have a giant mesenteric fibromatosis of 23 cm diameter and 4.5 kg arising from the appendix and colonic mesentery. Treated surgically, and was free of recurrence after 1 year follow up. CONCLUSION: We report this rare case to encourage physicians to keep this etiology in mind as part of the differential diagnosis of unspecific abdominal mass.

Breast adenomyoepithelioma, a case report.

BACKGROUND: Adenomyoepithelioma is a rare tumor of the breast characterized by a dual/biphasic proliferation of two cell populations: the epithelial cells and the myoepithelial cells. The first case was reported in 1970. The majority of the cases are benign, but few malignant cases were reported in literature. CASE PRESENTATION: A case of a 66-year-old lady presenting with an asymptomatic breast mass, of 18 × 17 × 15 mm size with irregular borders and negative metastatic workup. The patient was operated for wide local excision of the tumor, with a confirmed negative margins intraoperatively. The final pathology was Adenomyoepithelioma. CONCLUSION: We report this rare case to encourage physicians to keep this etiology in mind as part of the differential diagnosis of breast mass.

Splenoptosis in young female, case report.

BACKGROUND: Splenoptosis is an uncommon disorder defined as the dislodgment of the spleen from its anatomical location in the left hypochondrium to another location in the intraabdominal cavity. This migration is the result of laxity or absence of the ligaments that fix the spleen to surrounding structures. Splenoptosis is either diagnosed after it causes symptoms, or incidentally using different imaging modalities. Surgery is the definite treatment either by splenopexy or splenectomy. CASE PRESENTATION: In the case presented here, we discuss a 17 years old female patient who presented to our institution for acute onset of abdominal pain, mainly suprapubic, occurring for 4 days. Ultrasound showed a suspicious right pelvic mass, which was found to be a wandering spleen with pedicle torsion. The patient was treated surgically by splenectomy. CONCLUSION: We report this rare case to encourage physicians to keep this etiology in mind as part of the differential diagnosis of unspecific abdominal pain.

Bilateral inguinal masses or hernias in a female teenager with delayed menarche: Think of Complete Androgen Insensitivity Syndrome (CAIS), a case report.

INTRODUCTION: Complete Androgen Insensitivity Syndrome (CAIS) is a rare sexual development disorder with X-linked recessive inheritance. It is prevalent in 1:20400 to 1:99000 of female phenotypes, yet characterized by an XY genotype. Cases of CAIS usually present with primary amenorrhea together with unilateral/bilateral inguinal hernias. CASE PRESENTATION: A previously healthy 19 year old sexually inactive girl presents to our clinics for delay in menarche and bilateral palpable inguinal masses 3 years ago. She has normal female habitus, tanner stage 3 and external female genetalia with sparse pubic hair. She has a family history of 2 aunts (mother side) having infertility with Bilateral inguinal hernias surgery. Hormonal tests showed male range testosterone levels. MRI showed bilateral inguinal masses with Mullerian structures agenesis and a misdiagnosis of Mayer-Rokitansky-Küster-Hauser syndrome (MRHKS) was interpreted. While karyotype showed XY genotype. She is then planned for bilateral orchiectomy. Final pathology of the 2 specimens taken showed testicular tissue correlating with CAIS. DISCUSSION: CAIS patients presents with near normal female external genetalia, absence of Mullerian structures, taller status than regular females and testosterone levels equal or higher than male levels. Different imaging types together with karyotyping are crucial in diagnosing and differentiating CAIS from other entities such as MRHKS and Swyer syndrome. Treatment debates include prepubertal or postpubertal gonadectomy correlating with the age related malignancy rate and site of testis followed by Hormonal replacement therapy. CAIS management needs a multidisciplinary approach and decisions by the patient or his family sometimes. CONCLUSION: CAIS must be suspected in any case of young females with bilateral inguinal hernias as in our case, and precise diagnostics tests such as MRI and Karyotyping must be done followed by biopsy or excision for diagnosis and then adequate treatment. Hormonal therapy must be continued after gonadectomy that is best to be postpubertal.