Mahmoud Haj

Inflammatory Pseudotumor of the Breast: Case Report and Literature Review

Abstract:   Inflammatory pseudotumor (IP) is a benign lesion that can affect any tissue in the body and which may be confused clinically and in imaging for malignancy. Despite the widespread performance of breast biopsy, the finding of inflammatory pseudotumor of the breast is exceedingly rare. Excision of the tumor is the treatment of choice, but there is a relatively high rate of recurrence. The aim of this report is to describe the clinical, imaging, and pathologic features in a case of breast IP, the first reported case in a postpartum woman still nursing her infant.

Effect of oxygen tension on activity of antioxidant enzymes and on renal function of the postischemic reperfused rat kidney.

The aim of the present study was to examine the effect of exposing animals to 100% oxygen instead of room air on renal function and endogenous antioxidant enzymes of the postischemic reperfused rat kidney. Superoxide dismutase (SOD), catalase and glutathione peroxidase (GPX) were determined in the homogenate of the left kidney after 45 min of ischemia, caused by clamping the left renal artery, 10 and 90 min after reperfusion while the animals breathed room air or 100% O2. The right kidney served as a control. The possible influence of trapped blood in the clamped kidney was also investigated by the use of a correction factor based on the Hb concentration in the homogenate. The results indicate that such correction is necessary as the blood adds significant antioxidant activity. The activities of all 3 enzymes after 45 min of ischemia decreased significantly in the left (ischemic) compared to the right (control) kidney, to 64% of the control levels for catalase, 58% for SOD and 49% for GPX. After 10 min of reflow, a further decrease in the activities of catalase (to 49%) and of GPX (to 29%) was found. SOD activity, however, increased to 64%. After 90 min of reperfusion, restoration toward normal levels was noticed (SOD activity increased to 70%, catalase to 76% and GPX to 58%). Breathing 100% O2 resulted in a significant decrease in all enzyme activities (to 38.6% for catalase, 45% for SOD and to 27.4% for GPX). This inactivation can be explained by increased reactive oxygen species (ROS) activity during hyperoxia.(ABSTRACT TRUNCATED AT 250 WORDS)

Gastrointestinal anastomosis with histoacryl glue in rats.

Technical difficulties in creating gastrointestinal anastomosis in infants and young children, because of the small lumen, are well known and may be complicated by a narrow passage, anastomotic obstruction, gastric stasis, recurrent vomiting, and failure to gain weight. The search for alternative easier technique was the basis for this study. The primary aim was to evaluate the safety of anastomosis between the stomach and a loop of the jejunum performed by using the tissue adhesive Histoacryl glue in comparison with the same anastomosis performed conventionally with absorbable sutures. We compared the results of gastrojejunal anastomosis in rats using either Histoacryl (n-butyl cyanoacrylate) glue or continuous, absorbable sutures. Sixty-four Sprague-Dawley rats were divided into 4 groups of 16 rats each. Gastroenterostomy was performed with either type of anastomosis with and without truncal vagotomy. The criteria of gastroenterostomy investigated included anastomotic leakage, stricture formation, adhesion formation, and histological examination. The pH of gastric secretion was measured with intact gastric innervation and after vagotmy in all rats. The time to complete each type of anastomosis was measured in minutes. Anastomotic stricture, leak, peritonitis, and death happened in three rats in each group with intact vagal innervation, in two rats after vagotomy and anastomosis with Histoacryl, and in one rat after vagotomy and anastomosis with sutures. The results showed no statistically significant differences between the various groups, except the shorter time for performing the glued anastomosis (5-7 min) compared to the conventional anastomosis (16-21 min). In conclusion, gastroenterostomy with Histoacryl in rats appears to be as safe as conventional suture anastomosis, saves operating time, and is not affected by gastric acidity.

Diabetic sclerosing lymphocytic lobulitis of the breast

Diabetic sclerosing lymphocytic lobulitis of the breast (SLLB) as a complication of long standing diabetes is a benign disease without known tendency to malignant evolution. Clinically, it is characterized by solitary or multiple rock-hard discrete lesion(s) in one or both breasts, usually in a subareolar site, but may appear equally in any part of the breast. Mammographically and morphologically, this lesion simulates cancer. The lesion may recur after excision in the same site or in another location of the ipsilateral or the contralateral breast. Awareness of this entity, establishment of the diagnosis by open biopsy or by core needle biopsy may spare the need for repeated wide excisions and the resulting distortion of the breast architecture. The aim of this review is to arouse the awareness of the physicians and surgeons to this possibility when they find a similar lesion in the breast of a diabetic patient.

Three years of experience with advanced breast biopsy instrumentation (ABBI).

This article reports our experience using the advanced breast biopsy instrument (ABBI) system for excisional biopsy of mammographically visible nonpalpable breast lesions. Patients with nonpalpable mammographically detected breast lesions were evaluated as potential ABBI candidates. Selection criteria included noncystic lesions for which complete removal or large sampling was indicated, compressed thickness of the breast of more than 25 mm, and the patients ability to lie prone for at least 1 hour. During the period August 1997–April 2000 (33 months), 284 patients were found to be potential ABBI candidates. Sixteen patients were subsequently excluded. Biopsies using the ABBI system were performed in 268 cases, yielding an overall technical success rate of 94.4%. The mammographic abnormalities included mass in 125 cases (46.6%), mass with calcifications in 63 cases (23.5%), and microcalcifications without a mass in 80 cases (29.8%). Histologically 56 specimens (20.9%) were malignant (mass in 30 cases, mass with calcifications in 12, and microcalcifications in 14) and 212 (79.1%) were benign. Carcinoma in situ was found in 17 cases (30.4%), invasive carcinoma in 35 cases (62.5%), tubular carcinoma in 2 cases (3.6%), metastatic intramammary lymph node of previously unknown malignant melanoma in 1 case, and malignant lymphoma in 1 case. Open reexcision was performed in 54 cases with primary breast cancer. The histologic investigation revealed that in 26 (48.15%) cases the mammographic lesion was completely excised and in 28 (51.85%) cases the margins involved malignant residue and/or other foci of carcinoma. There were complications in 17 cases: wound infection in 2, ecchymosis in 9, seroma in 5, and a large immediate hematoma in 1 patient. Only the latter patient required immediate revision and drainage; the remainder underwent successful conservative treatment. Most nonpalpable breast lesions, if selected properly, are accessible for ABBI procedure. The biopsy causes minimal complications and minimal distortion of the breast architecture. Should relumpectomy be needed after the ABBI procedure, the tunnel of the cannula path is easily recognized, leaving no need for needle localization.

Pelvic Actinomycosis Presenting as Ureteric and Rectal Stricture

Background/Aims: Simultaneous ureteric and rectal stricture due to pelvic actinomycosis is very rare and only a few cases of either rectal or ureteric stricture have been reported. Our aim is to report a case of stricture of the rectum and the right ureter due to pelvic actinomycosis infection in a 63-year-old man. Methods: Explorative laparotomy and biopsies of the inflammatory pelvic mass were the only procedures that led to the definitive diagnosis of actinomycosis. Temporary diverting colostomy, drainage of the right ureter by a pigtail catheter and postoperative treatment with appropriate antibiotics were successful in eradicating the inflammatory process. Conclusions: Extensive pelvic masses involving pelvic viscera should be biopsied before undertaking any major surgery because of the possibility of pelvic actinomycosis.

Obstructing gastric heterotopic pancreas:Case report and literature review

Heterotopic pancreas (HP) is generally an asymptomatic lesion and is a rare cause of gastric outlet obstruction. We report such a case in which both upper gastrointestinal series and abdominal computerized tomography (CT) demonstrated an antral mass; surgical and histological results are also reported.

Membranous Fat Necrosis of the Breast: Diagnosis by Minimally Invasive Technique

Abstract:  Clinical and mammographic features of membranous fat necrosis (MFN) may simulate breast malignancy and tissue sampling is essential for accurate diagnosis. The aim of our study was to evaluate the clinical and imaging findings in these patients. Retrospective review of the records of breast biopsies (n = 1200) during the 5‐year period 1998 to 2002 revealed eight (0.67%) cases of histologically proven MFN. Seven of the eight patients had a history of breast trauma or surgery. Seven patients underwent mammography: normal in two, a mass with curvilinear calcifications in one, and heterogeneous calcifications in four. Four patients underwent surgical excision of a palpable mass, one patient had complete excision of calcifications with large core biopsy technique, and three patients had stereotactic vacuum‐assisted mammotome biopsy (VAMB). MFN should be included in the differential diagnosis of lesions in a breast with previous trauma or surgery. A minimally invasive diagnostic procedure should be considered in order to avoid excessive excisional surgery. 

Tubal anastomosis in the rat using the tissue adhesive cyanoacrylate (Histoacryl

n-Butyl-2-cyanoacrylate (Histoacryl) is said to be as effective as microsurgery for tubal anastomosis. In a prospective controlled study at the regional teaching hospital research laboratories, 40 female laboratory rats underwent laparotomy, with ligation of the uterine horns, and reanastomosis by microsurgery or cyanoacrylate tissue adhesive. Main outcome measures were patency of uterine horns following anastomosis, histologic examination of anastomotic sites and pregnancy rate following anastomosis by each of the two methods. Patency rates were 100% with both methods of anastomosis, although foreign-body granulomas were more prominent in horns anastomosed by microsurgery. When cyanoacrylate was used on one horn and the contralateral horn ligated, a 90% pregnancy rate was achieved; when microsurgery was used, the pregnancy rate was 80%. In microsurgically anastomosed tubes there was a longer narrow segment, resulting in a lower number of embryos per rat. Cyanoacrylate tissue adhesive is successful in tubal reanastomosis and has certain advantages over classical microsurgical techniques: fewer foreign-body granulomas occur; there is less narrowing of the uterine horn; less skill is required in its use.

Infarction of a Giant Breast Hamartoma in a Pregnant Patient Mimicking an Inflammatory Breast Cancer

A giant mass of the breast with discoloration of the overlying skin during pregnancy requires investigation to rule out the possibility of breast malignancy. The aim of this paper is to report a case of rapidly growing hamartoma in a pregnant patient mimicking advanced breast cancer and to discuss the usefulness of sonography and core needle biopsy in the diagnosis. Case Report: A 24-year-old woman in her 16th week of pregnancy presented with a very enlarged and painful breast. The overlying skin was edematous, brown to red, with severely dilated and congested veins. A huge mass was palpated and easily separated from the main breast. Results: Sonography and needle core biopsy were consistent with benign lesion but inadequate to exclude malignancy. At surgery, a giant (1,600 g) well-defined, ovoid mass was enucleated under general anesthesia. Gross and microscopic sections of this tumor were consistent with hamartoma with a central area of infarction. Clinical and histological features of this tumor are briefly discussed. Conclusion: Inability to exclude malignancy in case of symptomatic giant breast tumor during pregnancy should be an indication for early surgical excision.