Breast masses occur in men far less commonly than women. Papillary lesions of the male breast are rare and comprise a spectrum of lesions ranging from benign intraductal papilloma to intraductal papillary carcinoma and invasive papillary carcinoma. In this case report, a 78-year-old man presented with a subareolar painless mass. Fine needle aspiration cytology (FNAC) was performed. Cytologic examination revealed a cellular aspirate. A diagnosis of papillary lesion favoring papillary carcinoma was rendered. The patient underwent modified radical mastectomy, which showed invasive papillary carcinoma. As far as we know, only a few cases of invasive papillary carcinoma of the male breast have been published in the literature. To the best of our knowledge, this is the first case report of invasive papillary carcinoma of male breast in Malaysia. In this purview, we discuss papillary carcinoma of male breast with review of the relevant literature.
Intra-axial dermoid cysts are rare intracranial space occupying lesions, more so in the pediatric age group. Dermoid cysts account for about 0.2 to 1.8% of all intracranial tumors and are commonly located in the cisternal spaces, mainly in the cerebellopontine angle and parasellar cisterns. A purely intra-axial position as reported in this paper is quite exceptional.
Anaemia is the most common haematological abnormality in cancer patients, and unfortunately, it is often under-recognised and undertreated. The aetiopathology of anaemia in cancer patients is complex and is usually multifactorial. There is enough evidence suggesting that tumour hypoxia in anaemic patients has a negative impact on the treatment outcomes in cancer patients. The use of recombinant human erythropoietin is becoming a new standard of care in cancer patients. Various well-controlled studies have shown that the use of erythropoietin (EPO) increases the haemoglobin level, thereby decreasing the need for frequent transfusions and improving the tumour responses, cancer-free survival and quality-of-life parameters in cancer patients. However, a few recent clinical trials failed to replicate the survival benefit. Hence, a free unrestricted use of EPO is to be avoided. The past belief that anaemia does not matter in cancer patients is now considered invalid and is being seriously challenged. This article aims to present some recent findings on the impact of anaemia on outcomes, with discussion on the possible causes and effects. The benefits of the use of EPO analogues in cancer-related anaemia are also presented.
Pilomatricoma (PMC) is a relatively uncommon benign skin neoplasm arising from the skin adnexa. Since the first description of PMC in 1880, there has been a gradual increase in understanding of the morphologic features and clinical presentation of this tumor. However, difficulties still persist in making clinical and cytologic diagnosis. We report the clinical and histopathological findings of two cases of pilomatricoma. In case 1, a 10-year-old girl presented with a right upper back mass. In case 2, a nine-year-old girl presented with a left ear lobe mass. The clinical findings in both the cases were suggestive of epidermoid/dermoid cyst. However, subsequent histopathologic examination confirmed these cases as pilomatricoma. This report reveals that pilomatricoma is a frequently misdiagnosed entity in clinical practice. The purpose of this article is to create awareness among clinicians on the possibility of pilomatricoma as a cause of solitary skin nodules, especially those on the head, neck or upper extremities.
Follow-up of colorectal carcinoma after therapy is based on symptoms, tumor markers, and imaging studies. Clinicians sometimes face diagnostic dilemmas because of unusual presentations on the imaging modalities coupled with rising serum markers. We report a case of colorectal carcinoma that presented with gastrointestinal symptoms 14 months after completion of treatment. Investigations showed rise in carcinoembryonic antigen (CEA). Suspecting disease recurrence, complete radioimaging workup was performed; the only abnormality detected was a smooth, hypodense area in the posterior third of the spleen on contrast-enhanced computed tomography abdomen. In view of the previous diagnosis of carcinoma colon, the symptoms reported by the patient, the elevated CEA, and the atypical CECT appearance, a diagnosis of splenic metastasis was made. The patient was subjected to splenectomy as a curative treatment. However, the histopathological report revealed it to be a splenic infarct. The present case reemphasizes the limitations of radiological studies in the follow-up of carcinoma colon.
We report a case of a 48-year-old Indian male who presented with swelling and firmness in his left upper part of the abdomen of one month duration with anorexia and weight loss. Initial examination revealed an intra abdominal mass of around 16.8x11.0x24.5cm with minimal left sided pleural effusion. A biopsy from the mass confirmed the diagnosis of gastrointestinal stromal tumour (GISTs) as supported by immmunohistochemistry results which showed strong positivity for c-kit while stains for smooth muscle actin, desmin, myoglobin, S100 Protein and cytokerstin remained negative. The patient was not suitable for surgical intervention in view of advanced tumor, and Imatinib Mesylate 400mg daily was started with the aim of making the tumor operable. Such therapy lasted for twenty months and was tolerated well by the patient. It then resulted in gradual tumor regression, following which the patient underwent successful tumor resection. Post surgical resection patient had no radiological evidence of intra abdominal tumor but mild left sided pleural effusion with left lower lobe atelectasis. The patient had uneventful post operative recovery and he is currently on Imatinib mesylate and tolerating treatment well with mild skin rash. The experience with preoperative imatinib on surgical resection rates and post operative outcomes is limited especially with primary locally advanced GISTs. In our case successful surgical resection was possible for a huge locally advanced GIST with unusually prolonged treatment of twenty months with imatinib preoperatively.
Positron emission tomography (PET) has emerged as an important diagnostic tool in the management of lung cancers. Although PET is sensitive in detection of lung cancer, but FDG (2-deoxy-2- 18 fluro-D-glucose) is not tumor specific and may accumulate in a variety of nonmalignant conditions occasionally giving false positive result. Addition of CT to PET improves specificity foremost, but also sensitivity in tumor imaging. Thus, PET/CT fusion images are a more accurate test than either of its individual components and are probably also better than side-by-side viewing of images from both modalities. PET/CT fusion images are useful in differentiating between malignant and benign disease, fibrosis and recurrence, staging and in changing patient management to more appropriate therapy. With analysis and discussion it appears that PET/ CT fusion images have the potential to dramatically improve our ability to manage the patients with lung cancer and is contributing to our understanding of cancer cell biology and in development of new therapies.
Primary sarcomas of the breast are extremely rare comprising less than 1.0% of all malignant tumors of the breast. It is even rarer to be reported in a 25-year-old female. This can cause a diagnostic dilemma not only for the clinician but also for the cytopathologist. A 25-year-old woman presented with a well defined firm, mobile lump in her right breast. With fine needle aspiration cytology (FNAC) and ultrasonography a diagnosis of fibroadenoma was made. The patient underwent lumpectomy. Histopathologically it was diagnosed as myxoid liposarcoma. This case is reported to highlight the fact that, even though rare in young females but the possibility of a breast lump being a myxoid liposarcoma does exist. This report discusses a primary myxoid liposarcoma of female breast, considers cytologic differential diagnoses with review of the relevant literature.
Radiotherapy has an established role in reducing the local relapses in breast cancer patients. The objective of this review was to investigate whether radiotherapy or its omission after breast surgery has measurable consequences on local tumor recurrence and patient survival. The late excess of cardiac deaths has also been published in various reports but important advances in the delivery of radiotherapy have overcome this problem to the extent that, excess cardiac deaths do not appear to be occurring in more recent trials. In this article some recent data, suggesting that radiotherapy following mastectomy and/or breast conserving surgery has a beneficial effect on survival is reviewed. Omission of radiotherapy is associated with a large increase in risk of ipsilateral breast tumor recurrence and with a small increase in the risk of patient's mortality.