Shadan Ali

Denovo malignant fibrous histiocytoma of breast: Report of a case and review of literature

Sarcomas are rare histological types of malignancy found in the breast. While angiosarcoma is the most common type of sarcoma found here, malignant fibrous histiocytoma (MFH) arising de novo is one of the rare varieties. We recently cared for a middle aged lady with a locally advanced fungating growth in her right breast. The patient underwent right modified radical mastectomy (MRM) as her fine needle aspiration cytology report was suggestive of malignancy. The histopathological report revealed the tumour to be MFH. The patient had an uneventful postoperative recovery and is subjected to adjuvant radiotherapy.

Squamous cell carcinoma arising in epidermal inclusion cyst of breast: A diagnostic dilemma

Epidermal, or inclusion, cysts are frequently seen benign lesions that are lined with stratified squamous epithelium. Malignant transformation of these is rare, occurring in 0.011% to 0.045% cases [1]. We herein report an unusual case of squamous cell carcinoma occurring in an epidermal cyst of the breast in a middle aged lady.

Primary neuroendocrine carcinoma breast: Our experience

OBJECTIVES This retrospective study was designed to present the clinical characteristics and histopathological features of Primary neuroendocrine carcinoma (PNEC) of breast, and to evaluate the impact on outcome following its management on the line of more common primary adenocarcinoma of breast. MATERIALS AND METHODS Records of four patients diagnosed with PNEC of breast were retrospectively reviewed. Data were obtained from medical record from January 2008 to December 2012. Diagnosis of PNEC was confirmed by histopathological examination (HPE) and immunohistochemical (IHC) staining of tissue obtained from Trucut biopsy of the breast lump in all four patients. PNEC of breast was defined by the presence of more than 50% of invasive tumor cells with cytoplasmic immunoreaction for neuroendocrine (NE) markers synaptophysin, chromogranin or neuron specific enolase as per WHO classification. All patients were treated with Modified Radical Mastectomy (MRM), six cycle of Cyclophosphamide, Adriamycin and 5-Flurouracil (CAF) based adjuvant chemotherapy, radiotherapy and hormonal therapy. RESULTS There were four female patients. The mean age was 58~years (50-65 years). Breast lump was the presenting complaint in all patients. The result of HPE showed tumor size ranging from 4 to 6.5 cm in diameter. Axillary lymph node metastasis was detected in three (75%) patients. ER and PR expression was positive in four (100%) and three patients (75%) respectively. None of the patients expressed Her-2-neu. IHC staining was positive for NE markers chromogranin in three (75%) patients, synoptophysin in two patients (50%) and Neuron specific enolase three (75%) patients. The mean follow-up time was 27.7 months (range 48-9). All four patients survived without any loco-regional or metastatic recurrence with one patient developing lymphedema of arm. CONCLUSIONS Breast lump is the most common presentation of PNEC of the breast with characteristic expression of NE markers by the tumor. Management of this rare tumor may include surgery, chemotherapy, radiotherapy and hormonal therapy depending on the size of the tumor, lymph node and hormone receptor status. However, most appropriate treatment plan has yet to be established.

Clinico-epidemiological profile of breast cancer patients and the retrospective application of Gail model 2: An Indian perspective.

AIM To study the clinical and epidemiological profile of patients of breast cancer presenting at our center at New Delhi, India and to evaluate the applicability of Gail model 2 as a means of measuring 5-year and lifetime risk in our already diagnosed cases of breast cancer. METHODS This was a retrospective study conducted at Lady Hardinge Medical College Hospital in New Delhi, India, between January 2011 and July 2014. Two hundred and twenty two diagnosed cases of breast cancer were included. Information was collected retrospectively on a Performa from the medical record section and the Pathology department of the hospital.The predicted five-year and lifetime risk was calculated using GM2 prediction model from the NCIs breast cancer risk assessment tool website. RESULTS AND CONCLUSIONS Breast cancer in India is a far more biologically aggressive disease than in the west with a widely different spectrum of presentation and behavior and late presentation in an advanced stage. The accepted risk factors routinely associated with breast cancer in western literature do not appear to be relevant in the Indian population. Accepted western models do not seem to apply in the Indian scenario.

Short and hypertrophic ligament of treitz: a rare cause of superior mesentric artery syndrome.

Superior mesenteric artery syndrome (SMAS) is a rare form of upper intestinal obstruction in which the third part of the duodenum is compressed between the superior mesenteric artery and the aorta, secondary to any condition decreasing the angle between these two arteries. We recently cared for a young male who came with features of proximal small bowel obstruction. On investigation, there was extrinsic duodenal obstruction. Exploratory laparotomy was done which revealed a short and hypertrophic ligament of treitz leading to compression of 3(rd) part of duodenum. Release of the ligament with doudenojejunostomy was done. Postoperatively, patient recovered well. This case report highlights the occurrence and importance of hypertrophic and contracted ligament of treitz as a rare cause of SMAS.

Retrorectal Cystic Hamartoma: A Problematic ‘Tail’

The retrorectal space is an uncommon seat for neoplastic masses. Retrorectal hamartoma or tailgut cyst (TGC) is an uncommon developmental cystic lesion occurring in this space which mostly occurs in middle-aged females. We recently cared for a 16-year-old girl who presented with vague lower abdominal pain and occasional constipation. Per rectal examination revealed an extraluminal mass bulging from posterior rectal wall. Preoperative radiological investigations revealed by suggested it to be a mature cystic teratoma. The patient underwent exploratory laprotomy with en masse excision of the cyst. Histopathological examination of the specimen showed it to be a TGC. This case highlights the possibility of a TGC as a differential for retrorectal cystic lesions and the need to completely excise them given the possibility of future malignant transformation.

Appendicular perforation in dengue fever: our experience

Abstract Dengue viral infections have become one of major emerging infectious diseases in the tropics. Acute abdomen occurring in dengue viral infection is not uncommon. The spectrums of acute surgical emergencies which raise suspicion of an abdominal catastrophe in patients presenting with dengue fever include acute pancreatitis, acute acalculous cholecystitis, non-specific peritonitis and very rarely acute appendicitis. The presence of low white cell count and platelet count can raise suspicion of a diagnosis of dengue in a patient presenting with acute abdominal pain, during a dengue epidemic. We herein report three patients with dengue fever who had appendicular perforation during the course of their viral fever.

Biliary Ascariasis: Our Experience and Review of Literature

Background/Aim: Ascariasis is endemic in the tropics especially amongst those living in poor sanitary conditions. Although most commonly it infests the small intestine, it can sometimes migrate to the biliary tract. We herein aimed to study the clinical manifestations, complications, diagnostic modalities and the most appropriate treatment modality for this condition. Materials and Methods: Fifteen cases of hepatobiliary ascariasis presenting over a period of 1.5 years were studied. All the patients were adults and presented to the emergency with acute biliary symptoms. Results: In this study, biliary ascariasis was found to be more common in middle aged females. The common presentations included upper abdominal pain and jaundice. Complications observed included acute pancreatitis and cholangitis. Ultrasonography could establish the diagnosis in 86.67% cases. Medical management could successfully treat 86.67% patients with ERCP being required in the remainder. Conclusion: In endemic countries, ascariasis should be considered as a differential diagnosis in patients presenting with acute biliary symptoms. Ultrasonography is a useful non invasive test to diagnose the condition and medical management remains a reasonable first line treatment option. Case Study Suhani et al.; IJTDH, 6(3): 102-107, 2015; Article no.IJTDH.2015.045 103

Bilateral extensive tubercular iliopsoas abscess: An uncommon manifestation of Pott's spine

Bilateral iliopsoas abscess is an uncommon presentation of Pott′s spine. We recently cared for a young, immunocompetent male who presented with a right paravertebral swelling. He had been on antitubercular therapy (ATT) for 6 months for pulmonary tuberculosis. On computerized tomography (CT), the patient was found to have Pott′s spine as the primary pathology with extensive iliopsoas abscesses bilaterally. The aspirate from the swelling grew Mycobacterium tuberculosis, which was resistant to isoniazid and rifampicin. He was then started on appropriate drugs according to sensitivity reports. Our patient was a rare case of a young, immunocompetent male who presented with large bilateral psoas involvement due to Pott′s spine. This was not associated with any neurological deficit. The organisms were multidrug-resistant, even though the pulmonary lesions had resolved after being on ATT for 6 months. To conclude, for any tubercular patient presenting with paravertebral abscess or back pain, Pott′s spine should be considered among the differential diagnoses, especially in endemic regions. Tubercular culture and sensitivity should be done in all such cases due to the widespread prevalence of drug-resistant forms.

Giant Retroperitoneal Lymphangioma: a Rare Entity

Retroperitoneal lymphangiomas are rare benign tumors, and the exact incidence of which is not well known. They usually arise from the developmental abnormalities of retroperitoneal lymphatics or their traumatic rupture. Confusion with other cystic tumors of the retroperitoneum including those arising from the kidney and pancreas is common. They usually lack specific symptoms and are mostly detected accidentally, while very rarely, some may present with complications such as rupture, torsion, hemorrhage, or infection. We report a case of a 22-year-old female in whom preoperative diagnosis of retroperitoneal lymphangioma was made on the basis of radiological investigations. On exploration, a large lymphangioma arising retroperitoneally was identified and excised. Postoperative recovery was uneventful.