Diagnostic dilemmas in intraductal papillomas of the breast - experience at Sultan Qaboos University Hospital in the Sultanate of Oman

The aim of this retrospective study was to correlate the significance and accuracy of the colour of nipple discharge and breast ultrasound imaging in the diagnosis of intraductal papilloma. This is a retrospective study of 34 patients who underwent 36 microdochectomies in Sultan Qaboos University Hospital [SQUH] in the Sultanate of Oman, over a 4 year period of January 2009 till December 2012. The confounders considered were patient age, physical examination findings, nipple discharge cytology result, ultrasound results and biopsy report following microdochectomy. Comparisons analysis, charts and graphs were made using the SPSS software [version 20]. The mean age of the patients was 44 [27-73] years old. Twenty-seven out 36 [75%] patients had presented with nipple discharge, 14 out 27 [52%] had blood stained nipple discharge and 13 [48%] with coloured discharge [yellow, brown and green], 9 patients had no discharge. The final histopathology showed intraductal papilloma 13 [36%], duct ectasia 18 [50%], DCIS 1 [2.7%], fibrocystic disease 3 [8.3%] and LCIS 1 [2.7%]. Thirteen out of 36 had intraductal papilloma on final histopathology. The correlation between blood stained discharge and final histopathology of intraductal papilloma was insignificant [p=0.44]. Nipple discharge is irrelevant to the diagnosis of intraductal papilloma. Spontaneous nipple discharge regardless of color is to be referred to breast surgeon and to be assessed with triple assessment. Surgery remains the mainstay of treatment

Mucinous breast cancer with solitary metastasis to humeral head: a case report

Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.

Eosinophilic cholecystitis: an infrequent cause of cholecystectomy

Eosinophilic cholecystitis is a rare condition with obscure etiology. They are diagnosed histopathologically on resected specimens. We report a similar case confirmed on histopathology of a 49 years old diabetic lady who underwent routine elective cholecystectomy for chronic cholecystitis due to gall stones. The rarity of the condition prompted us to report this entity

Left sided amyand's hernia

Appendicitis within an Amyand's hernia is a rare clinical entity in itself and becomes especially more rare if it occurs in the left inguinal region. We report this rare case of Amyand's hernia where the appendix was found along with gangrenous ceacum during surgery for strangulated left inguinal hernia in an adult, who underwent resection, anastomosis and simple repair for his hernia

Torsion of an epiploic appendix pretending as acute appendicitis

Torsion of an epiploic appendix is a rare surgical entity. Its unusual symptomatology, wide variation in physical findings and the absence of helpful laboratory and radiological studies makes it very difficult to diagnose pre-operatively. This is a report of this rare entity found in a patient upon diagnostic laparoscopy performed for suspected acute appendicitis

Sternal bronchogenic cyst: a rare condition

Bronchogenic cyst is a congenital developmental abnormality of the embryonic foregut usually formed as a result of an accessory lung bud becoming isolated from the rest of the tracheobroncheal tree. Usually a solitary extra pulmonary cyst, it's a benign condition, found most commonly in the mediastinum with rare occurrence on the skin or subcutaneous tissues.We report a case of cutaneous bronchogenic cyst that occurred in the skin over the manubrium sterni of four years old boy. The diagnosis was made by the histopathological findings which revealed ciliated and mucin-producing pseudo stratified columnar epithelium of respiratory type