Metastatic lobular carcinoma of the breast found incidentally on pathology following cholecystectomy for chronic cholecystitis: A case report.

BACKGROUND: Traditional oncologic pattern of spread of breast cancer is metastasis to axillary lymph nodes, lung, liver and bone (Doval et al., 2006 [1]). Here we present a case of unknown synchronous breast cancer in a patient that was revealed on histopathologic assessment following elective cholecystectomy. CASE SUMMARY: A 57 year old female presented for an elective laparoscopic cholecystectomy secondary to biliary colic. Histopathologic assessment of the gallbladder revealed metastatic adenocarcinoma with signet ring features, consistent with metastatic lobular carcinoma. The patient went on to have a complete oncologic workup that revealed invasive ductal carcinoma with components of high grade ductal carcinoma in situ in the left breast, lobular carcinoma in the right breast, and metastatic lobular carcinoma to left and right axillary lymph nodes as well as diffuse osseous metastatic disease. CONCLUSIONS: Metastatic disease to the gallbladder found incidentally on elective cholecystectomy is a rare presentation of synchronous breast cancer.

Open surgical approach for infected mesenteric pseudocyst presenting as lifelong, migratory abdominal pain-A case report.

INTRODUCTION: Mesenteric psuedocysts are rare tumors of the gastrointestinal mesentery that are seldom symptomatic. Although these benign tumors are most commonly found incidentally during work-up for other pathology, they can be troublesome in select patients based off size, location and risk of malignant transformation. This case is reported in accordance with SCARE Criteria [1]. PRESENTATION OF CASE: A 24 year-old-male presents with life-long migratory abdominal pain presents with a one week history of acute pain associated with nausea. Computed tomography revealed free fluid in the pelvis and a thin-walled mesenteric cyst within the left, mid-abdominal mesentery measuring approximately 4.3 × 4.0 × 4.0 cm. The patient was admitted for resuscitation and planned delayed operative intervention. DISCUSSION: The patient underwent complete open enucleation secondary to location and in an attempt to limit injuries to or resection of small bowel. Pathological analysis revealed a mesenteric cyst with fluid culture positive for Propionibacterium acnes without true cystic wall consistent with an infected mesenteric pseudocyst. These lesions are difficult to diagnose secondary to varied presentation and lack of pathognomonic clinical, laboratory and imaging findings. Mesenteric pseudocyst have a low rate of recurrence after removal; however, surgical management is mandated due to risks of malignant transformation. CONCLUSION: This is a rare case of a mesenteric pseudocyst of small size presenting with lifelong abdominal pain secondary to its location near the root of the mesentery and inflammatory reaction secondary to infection. It is important to maintain a high index of suspicion for mesenteric cyst as many complications may result if misdiagnosed or without proper surgical management.

Biliary hyperkinesia, a new diagnosis or misunderstood pathophysiology of dyskinesia: A case report.

INTRODUCTION: Biliary colic, characterized by intermittent right upper quadrant abdominal pain is a common complaint in the United States population. Patients whose pain is undiagnosed by ultrasound generally undergo hepatobiliary iminodiacetic acid scan with cholecystokinin stimulation (HIDA-CCK) to assess function of the gallbladder and biliary tree. Traditionally, two outcomes are possible based on a measured ejection fraction of the gallbladder: either dyskinesia or normal function is diagnosed. Biliary dyskinesia, or hypokinesia of the gallbladder, is accepted as an ejection fraction less than 35%, while an accepted normal functioning gallbladder ejection fraction is greater than 35%. CASE: We report a case of a fifteen-year-old female who had functional gallbladder disease per Rome IV criteria due to intermittent biliary colic, with exception to the ejection fraction measurement which was elevated at 96.5%. She underwent laparoscopic cholecystectomy with complete symptom resolution. DISCUSSION: As demonstrated in the literature reviewed here, these subsets of patients, who present with normal to high ejection fractions, have undergone laparoscopic cholecystectomy with resolution of pain in several case studies. CONCLUSION: Many unknown variables still exist due to lack of prospective studies, most notably the pathophysiology and definitive indications for surgical treatment. As such, we propose that surgical options should not be limited to those who display the traditional findings of biliary dyskinesia, but also patients who demonstrate typical symptoms with normal to elevated ejection fraction, following work up to rule out the extensive differential diagnoses for right upper quadrant abdominal pain.

Traumatic Hemipelvectomy with a Contralateral Unstable Pelvis and Acetabular Fracture: A Case Report and Review of the Literature.

CASE: A traumatic hemipelvectomy (THP) is a rare life-threatening injury, with limited reports in the civilian population. We present the case of a patient who sustained a massive pelvic injury with an incomplete unilateral THP, a contralateral unstable pelvis, and a fracture of the acetabulum. CONCLUSION: With advancements in resuscitative techniques, carefully timed and planned surgical interventions, and a coordinated multidisciplinary approach, a greater number of patients may be able to survive a massive pelvic injury.