Breast cancer with scalp metastases: a case report.

BACKGROUND: While breast cancer is the most common cancer in women, cutaneous metastases are rare in breast cancer. Additionally, scalp involvement in breast cancer metastasis is extremely rare. That being said, scalp lesions should always be thoroughly investigated to distinguish metastatic lesions from other neoplasms. CASE PRESENTATION: A 47-year-old female Middle-Eastern patient presented with metastatic breast cancer in the lungs, bone, liver, and brain with no signs of multiple organ failure, in addition to cutaneous metastases, including the scalp. Between 2017 and 2022, she was managed through modified radical mastectomy, radiotherapy, and several lines of chemotherapy. She presented in September of 2022 with enlarging scalp nodules, which started developing 2 months prior to her presentation. Physical examination revealed firm, non-tender, and immobile skin lesions. Magnetic resonance imaging scan of the head showed soft tissue nodules in different sequences. A punch biopsy was taken from the largest scalp lesion and showed metastatic invasive ductal carcinoma. A panel of immunohistochemistry stains was applied, because a single specific marker for differentiating primary cutaneous adnexal tumors or other malignant neoplasms from breast cancer has not yet been identified. The panel showed positive estrogen receptor 95%, progesterone receptor 5%, negative human epidermal growth factor receptor 2, positive GATA binding protein 3, positive cytokeratin-7, negative P63, and negative KIT (CD117). CONCLUSION: Breast cancer metastases to the scalp are extremely uncommon. When a scalp metastasis is present, it might be the only symptomatic sign of disease progression or widespread metastatic lesions. However, such lesions warrant a comprehensive radiologic and pathologic workup to rule out other possibilities of skin pathologies, such as sebaceous skin adenocarcinoma as it effects the management plan.

Pain Management in Breast Cancer Patients: A Multidisciplinary Approach.

Pain is a significant problem and is one of the most invalidating symptoms in breast cancer (BC) patients that would negatively affect the functional status and the Quality of Life (QoL). Pain management in BC patients requires thorough patient evaluation and critical assessment of pain. The actual cause for the pain must be recognized, so management can be tailored to each patient. This review aims to discuss various treatment modalities employed for effectively managing pain in BC patients. Pharmacotherapy makes up the cornerstone of the management of pain in BC patients. Both opioid and non-opioid analgesics are utilized. The WHO recommends a method called "by the ladder" for managing pain in BC patients where analgesics are used in ascending order. In comprehensive pain management (CPM), non-pharmacologic therapies are gaining wide acceptance and popularity, including complementary and alternative medicine (CAM), procedural and psychosocial interventions. Procedural interventions are usually used in case of severe pain refractory to pharmacological therapy. Techniques, such as radiotherapy, neurectomy, and nerve blocks, are effective in managing cancer pain. However, CAM therapies in BC pain management need to be guided by enough scientific evidence, decision-making, and medical judgment of regulatory bodies. BC pain management is based on careful routine pain assessments and appropriate patient evaluation both physically and psychologically. Pain control is one of the methods to improve the QoL of BC patients. Both pharmacological and non-pharmacological therapies are accessible to patients today, but they should be used with caution to minimize toxicity and increase effectiveness. The use of any pain management intervention should be based on proper scientific evidence and collective medical judgment.

Prevalence and severity of traumatic dental injuries among young amateur soccer players: A screening investigation.

BACKGROUND/AIMS: Traumatic dental injuries (TDI) are prevalent among soccer players. In Kuwait, no studies of TDI among soccer players have been carried out. The aim of this study was to investigate the prevalence, type and causes of soccer-related traumatic dental injuries among 7-18-year-old amateur soccer players. METHODS: All amateur soccer players who were registered in the 14 sports clubs in the country were invited to participate in this screening study. Players who were present in the club on the assigned examination day were included. The players were examined by two trained and calibrated paediatric dentists for signs of injury to the oral tissues. Injury diagnosis was made according to the Andreasen (2007) epidemiological dental injury classification. The history of any dental injury present at the time of examination was recorded. The timing and nature of any dental advice or treatment sought was also noted. RESULTS: Six hundred sixty-seven (48% inclusion rate) male players were included (mean age of 13.4 ± 2.6 years). In total, 213 injured teeth were observed among 169 (25%) players. The prevalence of soccer-related injuries was 11%, and a greater number of injuries were observed in older players. Maxillary central incisors were the most frequently injured teeth (91%), and enamel-only fractures represented 60% of all injured teeth. Slightly more TDIs were soccer-related (44%) compared to non-soccer-related injuries (39%), and a large number of TDIs (39%) occurred inside the sports clubs. The prevalence of reported soft-tissue injuries was 18%. The majority of the players (75%) did not receive dental care for their injuries. CONCLUSIONS: A significant number of young Kuwaiti amateur soccer players suffered TDIs. In addition, a high percentage of traumatic injuries were not treated, and there was a lack of the use of protective mouthguards.