The Odds of One-Year Mortality in Bedridden Geriatric Patients Discharged from Acute Rehabilitation Ward Are Increased Eightfold If the Patients Have Three or More Complications.

Low muscle strength, functional score at discharge, and complications during a ten-day rehabilitation hospital stay can affect mortality rates in bedridden geriatric patients. This was a prospective observational study in a cohort of 105 bedridden geriatric patients admitted to the Rehabilitation ward after a major illness or surgery. All participants had a severe dependency on another person (Barthel's Index < 60). The one-year mortality rate in this cohort was 15.2%, with further subdivision according to the number of complications: 61.5% in patients with ≥3 complications during hospitalization, 17.6% in patients with two complications, 9.5% with one complication, and 3% in patients with no complications. The Barthel Index at discharge (OR = 0.95; p = 0.003) and ≥3 medical complications (OR = 8.33; p = 0.005) during rehabilitation ward stay were significant predictors for one-year mortality. The odds of one-year mortality after discharge increased eightfold in patients with ≥3 medical complications. Sarcopenia, age, and sex were not significant predictors of mortality in this cohort. The 10-day acute rehabilitation was too short to achieve progress from severe to moderate independence in 60% of patients. The Barthel Index at discharge and a number of complications affect the mortality rate. These findings provide valuable insights into the complex dynamics of mortality and functional outcomes in bedridden geriatric patients.

Effect of Denosumab Therapy on Pain Level in Diffuse Sclerosing Osteomyelitis of the Mandible: a Case Report.

This is the first case report where two patients were under uniform denosumab administration protocol in diffuse sclerosing osteomyelitis (DSO) treatment and were closely monitored for 18 months. Objectives: This study aimed to describe the beneficial effects of denosumab in DSO treatment as well as pain relief and the significant lack of long-term use due to poorer outcomes after repeated use. DSO of the jaw is a poorly understood rare chronic disease the treatment of which is still very challenging despite a rapid development of medicine. Different medical treatments have been proposed without any significant long-lasting success. Bisphosphonates have offered substantial clinical benefit in DSO therapy, but due to harmful pharmacodynamic properties, denosumab therapy has been used to replace bisphosphonate therapy. Patients had a reduction in pain intensity with each subsequent application of denosumab but with less success than the first administration of denosumab. This case report has shown that denosumab could be a promising conservative treatment option for pain treatment in patients suffering from DSO.

Neck Disability Index Detects Higher Neck-Related Disability Levels among Physiotherapists and Family Medicine Specialists than among Dentists.

BACKGROUND: Healthcare workers who are in physical contact with patients are prone to work-related musculoskeletal disorders (WMSDs). Much is known about the prevalence of neck pain, but the extent of disability associated with neck pain among physical therapists (PTs), dentists, and family medicine specialists (FMs) is unknown. METHODS: The prevalence of neck pain and Neck Disability Index (NDI) data were collected from 239 PTs, 103 FMs, 113 dentists, and 112 controls from June to August 2022. RESULTS: The highest prevalence of neck pain was found in FMs (58.3%), followed by dentists (50.4%), PTs (48.5%) and controls (34.8%). The NDI% in PTs and FMs had higher values than controls: 14.6 ± 12.4, p = 0.02 for PTs, 14.9 ± 12.4, p = 0.01 for FMs vs. 10.1 ± 10.1 controls. The dentist group did not differ from controls (11.9 ± 10.2, p = 0.13). Mild, moderate, or severe forms of disability were more common in medical professionals than in controls (44.2%, 9.5%, and 1.5% vs. 37.5%, 7%, and 0%). Dentists were the youngest group with high functionality and the lowest degree of disability, comparable to the control population. Gender or age had no effect on NDI scores in this population. FMs, who represented the oldest group, showed age dependency (eleven years older in higher disability groups). Gender had no effect on NDI. In PTs, females predominated in all disability categories and PTs became five years older with increasing disability level. CONCLUSION: By using NDI in assessing neck-related WMSDs, we can detect medical professionals prone to more serious disability and potentially plan preventive actions.

Psychometric properties of the Croatian version of the Multiple Sclerosis Walking Scale (MSWS-12).

PURPOSE: Walking difficulties in people with multiple sclerosis (pwMS) are one of the most pronounced predictors affecting patients' quality of life. The study objective was to determine the psychometric properties of the Croatian version of the Multiple Sclerosis Walking Scale (MSWS-12) among pwMS in Croatia and to examine the association between MSWS-12 and Depression, Anxiety, and Stress Scale-21 (DASS-21), and Multiple Sclerosis Impact Scale-29 (MSIS-29). MATERIALS AND METHODS: A cross-sectional study included a sample of pwMS (N = 148). Psychometric properties were examined by estimating the validity and reliability of the MSWS-12. The predictive validity of MSWS-12 and demographic and disease-related factors were assessed by a hierarchical regression model using MSIS-29 and DASS-21 as criterion variables. RESULTS: Scale reliability was good for the MSWS-12 scale, expressed by Cronbach's alpha coefficient (α = 0.98). Correlations between MSWS-12 and DASS-21 (0.20-0.27) and between MSWS-12 and MSIS-29 subscales (0.47-0.83) provided initial support for the convergent validity. Factor analysis demonstrated the unidimensional structure of the MSWS-12. CONCLUSIONS: The Croatian version of the MSWS-12 is a reliable, valid, and clinically useful tool for assessing walking impairments in pwMS.Implications for rehabilitationWalking difficulties in people with multiple sclerosis (pwMS) are one of the most pronounced predictors affecting patients' quality of life.Multiple Sclerosis Walking Scale (MSWS-12) is a measure of the disease's impact on walking abilities from the patient's perspective.MSWS-12 is a reliable scale for assessing walking speed, endurance, and gait quality in multiple sclerosis and is validated in several languages (Korean, Italian, Brazilian, and Persian).The Croatian version of the MSWS-12 is a reliable, predictive, and valid tool for screening walking impairments in pwMS.

Lack of Objective Measurement in the Initial Screening and Follow-Up of Patients Who Report Whiplash Injury-Is Elastography of the Trapezius Muscle an Answer?

BACKGROUND: Painfully decreased cervical range of motion accompanied by muscle spasm is a common presentation of whiplash injury of the neck. Stiffness of the cervical muscles can be assessed by ultrasound shear wave elastography (SWE), expressed in kilopascals (kPa). THE HYPOTHESIS: SWE of the trapezius muscle is an objective measurement suitable for the initial screening and follow-up of patients who report whiplash injury. METHODS AND RESULTS: A total of 99 patients after whiplash injury were compared to 75 control participants. Mean trapezius stiffness was 82.24 ± 21.11 vs. 57.47 ± 13.82 for whiplash patients and controls, respectively. The cut-off value of SWE of 75.8 kPa showed 77% accuracy in correctly assigning patients to the whiplash or control group. To evaluate whether SWE can be used as a follow-up method of recovery after a whiplash injury, initial and endpoint SWE (after six months, n = 24) was carried out. Patients reporting no recovery showed similar SWE values as completely recovered patients. This finding refutes the second part of our hypothesis. CONCLUSIONS: SWE is a method that can be used for the initial screening of patients with whiplash injury, but we are still searching for an objective measurement that can be used in the follow-up of recovery.

Croatian version of the neck disability index can distinguish between acute, chronic and no neck pain : Results of a validation study.

OBJECTIVE: Longitudinal study to test the validity and reliability of the Croatian version of the neck disability index (NDI-CRO) for use in patients. METHODS: Three groups were given NDI-CRO on two occasions, 48 h apart: acute whiplash neck injury group (n = 30), hospital physiotherapists-professional chronic neck pain group (n = 56) and control group (n = 65). To test validity, correlation between NDI-CRO and the pain VAS and PHQ­9 questionnaire for depression was analyzed. Reliability testing was done using the test-retest experiment and item-total score correlation. RESULTS: Test-retest showed excellent correlation in all groups: whiplash 0.86, control 0.95 and physiotherapist 0.89 (Spearman r). Item-total score in the 3 analyzed groups showed positive correlation in all 10 categories, varying from 0.43-0.85. The NDI-CRO score showed significant difference between groups (median whiplash 38%, physiotherapist 12% and control 6%, p < 0.05). Validity testing showed positive correlation between NDI and pain VAS (control r = 0.63, physiotherapist r = 0.68 and whiplash r = 0.83, p < 0.05) and PHQ­9 (control r = 0.49, physiotherapist r = 0.71 and whiplash r = 0.69, p < 0.05). No correlation was found between NDI-CRO and age, gender or radiographic findings. In the whiplash injury group 75% of patients showed moderate to severe disability. The majority of physiotherapists showed mild to moderate disability due to neck pain while 40% showed no disability. In the control group two out of three people reported no disability. CONCLUSION: The NDI-CRO is a valid index for measuring the degree of neck disability in people with acute and chronic neck pain and in control group. It is strongly correlated with pain VAS and PHQ­9 index.

Psychometric Properties of the HADS Measure of Anxiety and Depression Among Multiple Sclerosis Patients in Croatia.

Depression and anxiety are common complaints in patients with multiple sclerosis (MS). The study objective was to investigate the factor structure, internal consistency, and correlates of the Croatian version of the Hospital Anxiety and Depression Scale (HADS) in patients with MS. A total of 179 patients with MS and 999 controls were included in the online survey. All subjects completed the HADS and self-administered questionnaires capturing information of demographic, education level, disease-related variables, and the Multiple Sclerosis Impact Scale-29 (MSIS-29). Psychometric properties were examined by estimating the validity, reliability, and factor structure of the HADS in patients with MS. The two HADS subscales (anxiety and depression) had excellent internal consistencies (Cronbach's α value 0.82-0.83), and factor analysis confirmed a two-factor structure. The convergent validity of the HADS subscales appeared to be good due to the significant correlations between HADS and MSIS-29. Receiver operating characteristic (ROC) analysis indicates that the HADS subscales have a significant diagnostic validity for group differentiation. Hierarchical regression analysis using MSIS-29 subscales as criterion variables showed consistent evidence for the incremental validity of the HADS. The HADS is a reliable and valid self-assessment scale in patients with MS and is suggested to be used in clinical monitoring of the psychiatric and psychological status of patients with MS.

Psychometric properties of the Croatian version of the depression, anxiety, and stress scale-21 and multiple sclerosis impact scale-29 in multiple sclerosis patients.

OBJECTIVES: Depression, anxiety, stress, and physical disabilities are a common complaint in people with multiple sclerosis (MS), and monitoring of these symptoms are based on self-report questionnaires. The objective of this study was to determine psychometric properties of the Croatian version of the Depression, Anxiety, and Stress Scale-21 (DASS-21) and Multiple Sclerosis Impact Scale-29 (MSIS-29) in people with MS. MATERIALS AND METHODS: We included data on 163 people with MS registered in the Association of multiple sclerosis societies of Croatia (AMSSC). Patients' demographic information, education level, and disease-related variables were ascertained. DASS-21 was applied for assessing depression, anxiety, and stress, while MSIS-29 scale was used for assessment of the physical and psychological impact of MS disease. Psychometric properties were examined by estimating the validity and reliability of the DASS-21 and MSIS-29 scale. Predictive validity of DASS-21 subscales and relevant demographic and disease-related variables was examined by the hierarchical regression model. RESULTS: The Croatian version of the three DASS-21 subscales and two MSIS-29 subscales had excellent internal consistencies (Cronbach's alpha coefficients 0.88-0.93) and good convergent validity, as expressed by inter-correlations between DASS-21 and MSIS-29 subscales. Hierarchical regression analysis using MSIS-29 subscales as criterion variables showed consistent evidence for the predictive validity of depression, anxiety, and stress on psychological impact, and predictive validity of age, EDSS, and anxiety on physical impact. CONCLUSIONS: The Croatian versions of DASS-21 and MSIS-29 are reliable and valid scales in people with MS.

Can measuring passive neck muscle stiffness in whiplash injury patients help detect false whiplash claims?

BACKGROUND: Whiplash injury of the cervical spine is the most common injury after a car accident and in 25% of patients it progresses into chronic neck pain. AIM OF THE STUDY: To investigate the difference in neck muscle stiffness using shear wave ultrasound elastography between subjects who suffered an uncomplicated whiplash injury and a control group. Possible recognition of patients who insist on physical therapy in order to support their false whiplash injury claims. METHODS: This study included 75 whiplash injury patients and 75 control subjects. Trapezius, splenius capitis and sternocleidomastoid muscles were examined by ultrasound shear wave elastography. RESULTS: Increased muscle stiffness was noticed in trapezius muscle bilaterally in the whiplash group when compared to the control group (p < 0.001; right 57.47 ± 13.82 kPa vs. 87.84 ± 23.23 kPa; left 54.4 ± 12.68 kPa vs. 87.21 ± 26.47 kPa). Muscle stiffness in splenius capitis and sternocleidomastoid muscles was not suitable for analysis because of asymmetrical data distribution. Patients with less than 76 kPa of muscle stiffness in trapezius muscle are unlikely to belong in whiplash injury group (sensitivity 90% for right and 97% for left trapezius muscle, specificity 72% and 73%, respectively). CONCLUSION: Patients measuring below 76 kPa of muscle stiffness in the trapezius muscle might have no whiplash injury. Further follow-up of the patients measuring higher than cut-off value might be beneficial for detecting patients with prolonged neck muscle spasm that can lead to chronic cervical pain syndrome.

[NON-PHARMACOLOGICAL PAIN MANAGEMENT OF RHEUMATIC DISEASES].

Rheumatic diseases are a leading cause of chronic painful conditions, which, if not recognized and treated in a timely manner, cause inability and consequently reduce the quality of life of individuals. Chronic pain in rheumatic patients has a multifactorial background. Therefore, it is oft en accompanied by sleep and mood disturbances, fatigue, and reduced functional capacity of joints and the spine. Recent studies suggest that rheumatic pain is not exclusively nociceptive, and that in a large number of patients it may have the characteristics of neuropathic and central pain. Thus, the current approach to the treatment of rheumatic pain oft en had very modest results. For these reasons, rheumatic pain can no longer be treated only as a symptom, but should rather be viewed as a separate disease. Effective treatment of rheumatic pain requires a multidisciplinary, biopsychosocial approach taking into account the cause and nature of the pain, the disease characteristics, lifestyle, and psychological ability of an individual to deal with painful conditions. Careful selection of different modes of non-pharmacological treatment should be the fi rst step in the treatment of rheumatic pain with the use of available pharmacological interventions. A small number of systematic reviews, which included only a small number of causes and treatments for rheumatic pain with questionable quality of evidence, indicates the need to develop new high-quality randomized controlled trials, in order to enable real insight into the effectiveness of non-pharmacological methods for the treatment of rheumatic pain.

Expression pattern of RAGE and IGF-1 in the human fetal ovary and ovarian serous carcinoma.

The expression pattern of RAGE and IGF-1 proteins in different ovarian cell lineages was histologically analyzed in six fetal, nine adult human ovaries, and nine serous ovarian carcinomas (OSC) using immunohistochemical methods. Mild expression of IGF-1 in ovarian surface epithelium (Ose) and oocytes in the 15-week human ovaries increased to moderate or strong in the stromal cells, oocytes and follicular cells in week 22. Occasional mild RAGE expression was observed in Ose during week 15, while strong expression characterized primordial follicles in week 22. In the reproductive human ovary, IGF-1 was mildly to moderately expressed in all ovarian cell lineages except in theca cells of the tertiary follicle where IGF-1 was negative. RAGE was strongly positive in the granulosa cells and some theca cells of the tertiary follicle, while negative to mildly positive in all cells of the secondary follicle. In the postmenopausal human ovary IGF-1 and RAGE were mildly expressed in Ose and stroma. In OSC, cells were strongly positive to IGF-1 and RAGE, except for some negative stromal cells. Different levels of IGF-1 and RAGE co-expression characterized fetal ovarian cells during development. In reproductive ovaries, IGF-1 and RAGE were co-localized in the granulosa and theca interna cells of tertiary follicles, while in postmenopausal ovaries and OSC, IGF-1 and RAGE were co-localized in Ose and OSC cells respectively. Our results indicate that intracellular levels of IGF-1 and RAGE protein might regulate the final destiny of the ovarian cell populations prior and during folliculogenesis, possibly controlling the metastatic potential of OSC as well.

Apoptotic pathways in ovarian surface epithelium of human embryos during embryogenesis and carcinogenesis: close relationship of developmental plasticity and neoplasm.

Cell differentiation and different pathways of cell death were immunohistochemically analyzed in ovaries of six human embryos, 20 serous borderline tumors (SBT) and ovarian serous carcinomas (OSC) using markers for apoptosis (caspase-3, AIF, TUNEL) and stemness (Oct-4). In the 5-8-week ovaries, caspase-3 was absent in the ovarian surface epithelium (ose) and mildly positive in the ovarian stroma (os), AIF was expressed moderately, while Oct-4 expression gradually decreased during that period. Some ovarian cells expressed only caspase-3 or AIF together with TUNEL, while both caspase-3 and AIF were co-expressed in other ovarian cells. Mild expression of Oct-4 and caspase-3 characterized some cells of SBT, while their expression varied from mild to strong in OSC. AIF displayed mild to strong expression in ose of SBT and moderate to strong expression in OSC, while no expression of AIF was observed in os of both tumors. In the ose of both SBT and OSC, caspase-3 and AIF were co-expressed only occasionally, while AIF and Oct-4 were co-expressed strongly. Our study showed the presence of stemness cells and different pathways of cell death (caspase-3 and AIF-mediated) in the ovarian tissue during development and carcinogenesis, indicating the correlation between developmental plasticity in human embryonic ovaries and OSC.

Physical and rehabilitation medicine training center in Split, Croatia: striving to achieve excellence in education of a rehabilitation team.

PURPOSE: The aim of this manuscript is to describe recent changes in rehabilitation medicine education in Croatia, and to highlight the effort that was made at University of Split School of Medicine, as well as at University Hospital Split in order to improve training in rehabilitation medicine. METHOD: Critical collection and study of pertinent data on evolvement and present state of physical and rehabilitation medicine (PRM) education in Croatia. RESULTS: Education in physical medicine and rehabilitation in Croatia was mainly focused on rheumatology rather than rehabilitation. In order to satisfy the new standards set for quality of rehabilitation medicine national curriculum reform was made for medical students, specialist and physiotherapists and new rehabilitation medicine training centers were established throughout the country. CONCLUSIONS: Academic setting such as PRM training center Split enables education for different health professionals at the same place and time, which provides opportunities for learning about competencies of other team members and development of future collaboration. Also, a uniform approach to education in rehabilitation medicine is provided for all health professionals. All of this sets a solid foundation for education of integrated rehabilitation team and achieving excellence in contemporary Croatian PRM. Implications for Rehabilitation In order to achieve high quality rehabilitation it is necessary to make education accessible to all rehabilitation team members. Implementation of rehabilitation principles in undergraduate education sets a good foundation for the development of postgraduate and specialty training in rehabilitation medicine. Academic setting such as physical and rehabilitation medicine training center Split provides a uniform approach to education in rehabilitation medicine for all health professionals.

The expression patterns of pro-apoptotic and anti-apoptotic factors in human fetal and adult ovary.

The influence of pro-apoptotic Bax and anti-apoptotic Bcl-2 proteins on the cell death (caspase-3, TUNEL) of different ovarian cell lineages was immunohistochemically analyzed in six fetal and five adult human ovaries in order to disclose possible mechanisms of cell number control. Mild to moderate expression of Bcl-2 characterized ovarian surface epithelium, follicular cells and oocytes of 15 and 22 week human ovaries, while expression of Bax and caspase-3 gradually increased in all ovarian cell populations, except caspase-3 in the ovarian surface epithelium. Different levels of Bax and Bcl-2 proteins co-expression characterized fetal ovarian cells, while TUNEL and caspase-3 co-expression was found only in some of them. In adult ovaries, Bcl-2 was moderately and Bax strongly expressed in the surface ovarian epithelium and stroma. Bcl-2 and Bax expression in granulosa and theca interna cells varied depending on the stage of follicular atresia. Caspase-3 apoptotic cells characterized granulosa cells of adult atretic follicles. Our results indicate that intracellular levels of Bcl-2 and Bax protein might regulate the final destiny of developing germ cells. Caspase-3 dependent apoptosis seems to be the most important, but not the only cell death pathway in ovaries. In adult ovaries, caspase-dependent cell death characterized granulosa cells, but not the germ cells.

Awareness and use of evidence-based medicine databases and Cochrane Library among physicians in Croatia.

AIM: To assess awareness and use of evidence-based medicine (EBM) databases and The Cochrane Library among physicians in Croatia. METHODS: A cross-sectional study with a telephone survey was performed among 573 physicians (88.6% response rate from 647 contacted physicians) from family practice and 4 major university hospital centers in Croatia. The main outcome measures were physicians' awareness of The Cochrane Collaboration, awareness and use of The Cochrane Library, access to EBM databases, and access to internet at work. RESULTS: Overall, 54% of respondents said they had access to EBM databases, but when asked which databases they used, they named mostly non-EBM databases. The question on the highest level of evidence in EBM was correctly answered by 53% respondents, 30% heard of The Cochrane Collaboration, and 34% heard about The Cochrane Library. They obtained information about The Cochrane Library mostly from colleagues and research articles, whereas the information about EBM was gained mainly during continuous medical education. There were more respondents who thought The Cochrane Library could help them in practice (58%) than those who heard about The Cochrane Library (30%). Only 20% of the respondents heard about the initiative for the establishment of the Croatian branch of The Cochrane Collaboration. Family physicians had significantly lower level of awareness, knowledge, and use of EBM and The Cochrane Library than physicians from university hospitals. CONCLUSION: There is low awareness about EBM and The Cochrane Library among physicians in Croatia, which creates a need for educational interventions about EBM for the benefit of health care in Croatia.

Designing anatomy program in modern medical curriculum: matter of balance.

AIM: To evaluate the structure of the anatomy program in the first year medical curriculum of University of Split School of Medicine by comparing it with the recommendations by the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) and the Terminologia Anatomica (TA); we also quantitatively evaluated the organization of teaching material in contemporary topographical anatomy textbooks and matched them with the AACA recommendations, TA, and the curriculum of the anatomy course taught at Medical School in Split, Croatia. METHODS: TA, official recommendations of the AACA, 6 contemporary anatomy textbooks, and the structure of the anatomy course were analyzed for the proportion of the terms or text devoted to standard topographical regions of the body. The findings were correlated using Spearman rho test. RESULTS: The curriculum outline correlated both with the AACA recommendations (Spearman rho=0.83, P=0.015) and TA (Spearman rho=0.73, P=0.046). Textbooks contained 8 distinct sections, 7 allocated to topographic anatomy regions and 1 to general anatomy concepts and principles. The structure of all textbooks correlated significantly with the course curriculum. However, 4 out of 6 textbooks did not correlate with TA and only a single textbook showed significant correlation with the AACA recommendations. CONCLUSION: Anatomy textbooks vary in the amount of text dedicated to different parts of topographical anatomy and are not quite concordant with curriculum recommendations and standard anatomical terminology. Planning the structure of an anatomy course should not be based on a single book or recommendation but on evidence.

Daily mini quizzes as means for improving student performance in anatomy course.

AIM: To evaluate daily-written 10-question quizzes in a medical anatomy course as a way to integrate assessment into the course and to evaluate their effect on the course success. METHODS: Students answering correctly 8/10 or more questions were awarded 0.5 points per quiz. There were 34 quizzes with a maximum point score 17. Measurable outcomes of academic progress in anatomy course (pass rates on 4 examination terms, total pass rate, and average marks) were calculated, and 2007/08 academic year was compared with the previous academic year in which daily written quizzes were not a part of the course. The relationship between cumulative points on daily quizzes and 3 components of the final examination (written, practical, and oral) for 2007/08 academic year was assessed by non-parametric correlation testing. RESULTS: Individual scores on quizzes ranged from 1.5 to 13.5 points. There was a positive correlation between scores on quizzes and grades on 3 components of the final examination: written (Spearman rho=0.784, P<0.001, n=79), practical (Spearman rho=0.342, P<0.002, n=79), and oral (Spearman rho=0.683, P<0.001, n=79) part. Compared with students in the previous academic year, students attending the course with daily quizzes significantly improved their academic achievement, expressed as the pass rate at the first examination term (39% vs 62%, respectively, chi(2) test, P=0.006, ) and the average course grade (2.71+/-1.08 vs 3.38+/-1.26, respectively; t test, P<0.001). CONCLUSION: Despite their frequency and possible associated stress, daily quizzes were associated with better academic success in the anatomy course.

Apocrine adenoma of the breast coexistent with invasive carcinoma.

We describe a case of apocrine adenoma with simultaneous occurrence of invasive ductal carcinoma in the breast of a 53-year-old woman. Apocrine adenoma affecting the breast is very rare. The lesion is composed of back-to-back ducts and papillary fronds covered with apocrine cells, and it is sharply demarcated from the surrounding breast tissue. The patient presented with a palpable nodule with skin retraction in her right breast, where ultrasound examination identified a 5-mm hypoechogenic nodule. The ultrasound also revealed in the surrounding breast parenchyma an additional abnormal finding suggestive of carcinoma. Histologic examination of the excised specimen showed that the hypoechogenic nodule represented an apocrine adenoma in proximity to the invasive ductal breast carcinoma. This is the first report that describes the simultaneous occurrence of these two lesions in the same breast.