Squamous cell carcinoma of the breast.

Patient: Female, 60 Final Diagnosis: Primary squamosus cell carcinoma of the breast Symptoms: - Medication: - Clinical Procedure: Mastectomy Specialty: Oncology. OBJECTIVE: Rare disease. BACKGROUND: Primary squamous cell carcinoma (SCC) is a very rare malignancy of the breast. It is a tumour of the elderly age group. Pure squamous cell carcinoma of the breast can deviate from epidermis, the nipple or the epithelium of deep-seated epidermoid cyst or squamous metaplasia on chronic inflammation background. CASE REPORT: Our case is a 60-year-old female patient who presented with a lump in her left breast. Left-side modified radical mastectomy was done. It was histopathologically diagnosed as squamous cell carcinoma of the breast (SCCB). There was no axillary node involvement. After one and half years, the patient presented with breathlessness and weakness. Investigations revealed lung metastasis with pleural effusion, and postoperative chemotherapy was given. The patient has attended regular follow-ups for the last 8 months. CONCLUSIONS: The prognosis of this disease is highly uncertain and the treatment options are unclear and controversial. There is inadequate literature and treatment guidelines are lacking.

Adenoid cystic carcinoma of female breast: A case report.

INTRODUCTION: Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm accounting for 0.1% of breast carcinomas. PRESENTATION OF CASE: A 30 year old female patient presented with multiple lumps in the right breast. Excision biopsy of a lump in the lower outer quadrant revealed adenoid cystic carcinoma. A right sided modified radical mastectomy (MRM) was performed, with axillary clearance. Histopathology revealed a fibroadenoma accounting for one mass and adenoid cystic carcinoma in another, confirmed on Periodic acid Schiff (PAS) staining. Three out of the eight excised axillary lymph nodes contained malignancy. There was no evidence of recurrence or distant spread at follow-up 6 months postoperatively. DISCUSSION: ACC of the breast is a rare neoplasm accounting for 0.1% of breast carcinomas and is of special interest because of its favourable prognosis and distinctive histological appearance. This tumor occurs predominantly in women in their sixth decade and usually presents as a tender breast mass, often in the subareolar area though in our case it was not tender and presented as multiple lumps in the right breast. The diagnosis can be made on fine needle aspiration cytology (FNAC), but in our case FNAC was inconclusive. We performed MRM with axillary clearance, and three out eight lymph nodes proved positive for malignancy. CONCLUSION: ACC is a rare malignant neoplasm. Surgical treatment is the mainstay with little role for radiotherapy and chemotherapy according to the published literature.

Primary angiosarcoma of breast: A case report.

INTRODUCTION: Primary breast angiosarcoma is a rare form of breast cancer, accounting for only 0.04% of all malignant breast tumours. PRESENTATION OF CASE: A 28-year-old woman presented with a progressive lump in the right breast for one month. Fine needle aspiration cytology (FNAC) was highly suspicious of angiosarcoma, and this diagnosis was confirmed on core needle biopsy. Modified radical mastectomy was performed as sole treatment. DISCUSSION: Primary breast angiosarcoma is a rare type of breast malignancy, usually occurring in the third to fourth decade and only reported in women. The histological features of angiosarcoma of the breast are conventionally graded I, II or III. Total mastectomy appears to be the only treatment conferring benefit, chemotherapy and radiation therapy being of little proven value to date. The 5-year disease-free survival for grade I tumours can be as high as 76%, and up to 70% for grade II tumours whereas for grade III tumours it is reportedly about 15%. CONCLUSION: Primary angiosarcoma of the breast is a rare malignancy with a poor prognosis, even after complete resection. Surgery is the mainstay of treatment with a limited role for chemotherapy and radiotherapy.

Acute appendicitis presenting as chest pain.

INTRODUCTION: Abdominal pain is the primary presenting complaint of patients with acute appendicitis. Acute appendicitis presenting as chest pain is extremely rare and according to our search such presentation due to herniation of appendix into thorax through congenital diaphragmatic defect has not yet been reported. PRESENTATION OF CASE: We present a case of a 12year old male child who presented with acute chest pain. ECG was suggestive of ischemic changes. Echocardiogram and cardiac enzymes were within normal limits. Chest X-ray and gastrograffin contrast study confirmed the diagnosis of congenital diaphragmatic hernia. On exploration inflamed appendix was found herniated through the diaphragm along with caecum, ascending colon and transverse colon. Histology confirmed the diagnosis of acute appendicitis. DISCUSSION: Acute appendicitis may sometimes have very varied and rare presentation. In late presenting CDH, the most important factor responsible for acute or chronic presentation seems to be the type of herniated viscera. CONCLUSION: This report presents a rare case of late-presenting CDH with herniated appendix along with caecum, ascending colon and transverse colon. Unusual presentation of chest pain was due to an attack of acute appendicitis. Late-presenting CDH is a very intriguing defect with a wide spectrum of clinical manifestations. It should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favorable with correct diagnosis and prompt surgical repair.

Apple-peel atresia presenting as foetal intestinal obstruction.

Apple-peel atresia or Type 3 jejuno-ileal atresia (JIA) is an uncommon cause of foetal intestinal obstruction. Bowel obstruction in the foetus is diagnosed on the prenatal ultrasonography only in 50% cases. We report a case in which foetal intestinal obstruction was diagnosed on prenatal ultrasonography. The child showed signs of intestinal obstruction on day one after birth, for which an exploratory laparotomy was performed. Type 3 JIA was found for which resection of atretic segments with jejuno-ascending colon anastomosis was preformed.

Mixed malignant tumor of the submandibular gland.

A 70-year-old woman presented with chief complaints of swelling in the right side of her neck for 20 years, mainly in the submandibular region, with an increase in size 2 months prior, discharge of foul-smelling pus, ulceration of the overlying skin, and pain in the swelling for 15 days. Immunohistochemical studies reported the tumor to be a mixed malignant tumor arising from the submandibular gland. Wide excision of the tumor with deltopectoral flap was done.

Metastatic primitive neuroectodermal tumor involving testis.

A 40-year-old male patient presented with enlarging mass over left leg region. Incisional biopsy report revealed an undifferentiated malignant round cell sarcoma, for which above-knee amputation was done. One year later, the same patient presented with left testicular swelling which appeared to be malignant. A left high orchiedectomy was done. Biopsy report showed metastatic round cell tumor, which was confirmed by immunohistochemistry as primitive neuroectodermal tumor. Metastasis to testis is very uncommon.

Gastric carcinoid presented as gastric outlet obstruction.

Carcinoids are solid tumors of entero-chromaffin origin classified as neuroendocrine amine precursor uptake and decarboxylation (APUD) cell tumors and are found throughout the gastrointestinal tract from the stomach to the rectum, with a predilection for the ileum. These tumors rarely occur in the stomach, constituting only 2% of gastric tumors and 3.3% of all carcinoid tumors of the gastrointestinal tract. Localization of gastric tumors can be done by ultrasonography, computed tomography, and magnetic resonance imaging, but endoscopic biopsy is required for confirmation; demonstration of neurosecretory granules on microscopy is the most specific feature. Early resection is the treatment of choice. Prognosis of noninvasive tumors <2 cm in size in terms of 5-year survival rate is 100%. The 5-year survival rate declines and prognosis becomes poor with increase in size and with involvement of serosa, perineural infiltration, and lymph node metastasis.

Eosinophilic enteritis presenting as a rare cause for ileo-ileal intussusception.

Eosinophilic enteritis, a relatively rare entity, usually involves gastric antrum or proximal small bowel. Our case is rarer in its involvement of the distal small bowel and presents unusually as intussusception. The disease if diagnosed in the initial stages responds well to medical treatment but if associated with complications or misdiagnosed, surgical modality is the treatment of choice. In our case, the patient presented with acute intestinal obstruction due to intussusception and emergency laparotomy with ileoileal anastomosis was done. Histopathology confirmed the diagnosis as eosinophilic enteritis. This case with such a presentation is discussed here.

Pseudohermaphrodite presented as an irreducible inguinal hernia.

Absence of antimuellerian hormone or defective functioning of antimullerian hormone type II receptors give rise to a type of male pseudohermaphroditism known as 'persistent muellerian duct syndrome'. Such patients are phenotypically male with 46 XY karyotype and well developed muellerian duct derivatives which may be intra-abdominal or may herniate in inguinal region giving rise to a condition called as 'hernia uterine inguinale'. Cryptorchidism, transverse testicular ectopia and hypospadias are few anomalies associated with this syndrome. Though orchidopexy while leaving the uterus and fallopian tube in situ is an accepted surgical management, compromisation of blood surply to the testes or the vas may occur as vasa efferentia are embedded in the wall of uterus.

Adenoid cystic carcinoma of the male breast.

We present an 82-year-old male patient who presented with complaints of gradually an increasing ulcero-proliferative lesion with persistent mucinous discharge in the left breast. Left side-modified radical mastectomy was done. This was histopathologically diagnosed as an adenoid cystic carcinoma of the left breast. Periodic acid schiff (PAS) staining confirmed the diagnosis. Three of the five axillary lymph nodes excised were positive for malignancy. Although the patient was advised to have postoperative radiotherapy, he did not comply. After 2 years, the patient again presented with local recurrence of the disease. Wide excision of the recurrent malignant nodules over the anterior chest wall was done, and the defect was covered primarily with split thickness skin grafting. Postoperative radiation was given. For the past 9 months, the patient has maintained a regular follow-up on an outpatient basis. He does not have any evidence of recurrence of the tumor--neither locally nor distant metastasis.

Retroperitoneal para-aortic paraganglioma.

Paragangliomas or chemodectomas are neoplasms that arise from neural crest cells and histologically resemble their adrenal counterpart, the pheochromocytoma. Seventy-one percent of the extra-adrenal paragangliomas are located in the superior or inferior para-aortic area. This tumor usually presents as an abdominal mass producing back pain. Tumor localization has improved remarkably through the use of computed tomography and I131MIBG (metaiodobenzylguanidine) scintigraphy, particularly when tumors are hormonally active. Surgical excision remains the mainstay of treatment, although vascularity can at times make excision difficult.

Retroperitoneal para-aortic paraganglioma.

Paragangliomas or chemodectomas are neoplasms that arise from neural crest cells and histologically resemble their adrenal counterpart, the pheochromocytoma. Seventy-one percent of the extra-adrenal paragangliomas are located in the superior or inferior paraaortic area. This tumor usually presents as an abdominal mass producing back pain. Tumor localization has improved remarkably through the use of computed tomography and I131 metaiodobenzyl-guanidine scintigraphy, particularly when tumors are hormonally active. Surgical excision remains the mainstay of treatment, although vascularity can at times make excision difficult.