Lobular carcinoma of breast presenting with skin and stomach metastases

Background: Skin metastases occur in 1-5% of solid tumors and are rarely the presenting sign of internal malignancies. Certain features in skin lesions raise suspicion of metastasis from solid tumors. Case Presentation: In this article a 61-year-old woman is presented with erythematous skin nodules in upper abdomen and chest. Histopathological evaluation of lesions suggested metastatic carcinoma and a thorough search found stomach signet cell adenocarcinoma and breast lobular carcinoma. Immunohistochemical staining confirmed diagnosis of lobular carcinoma with metastasis developed in skin and stomach. Conclusions: Clinicians must be aware that malignancies can present by skin metastases. Since breast and stomach cancer can both metastasize to skin, immunohistochemistry evaluation is of great importance to diagnose the primary tumor

Anatomy of arterial supply of the soleus muscle

Soft tissue defects of the lower limb are a challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Various types of soleus muscle flap have been described, based mainly on the vascular supply. This study has been conducted as a descriptive study. The arterial blood supply of the soleus muscle was studied in 45 cadaveric lower limbs. The blood vessels and their branches to the muscle were dissected. The mean length of the soleus muscle was 37 +/- 2.2 Cm. In 66.7% of the limbs at least two branches arose from the popliteal artery trunk. The average distance of the first branch was 2.61 +/- 1.75 Cm distal to the fibular head. And the second branch was 3.88 +/- 0.7 Cm distal to the fibular head. The average number of branches to the soleus muscle from the posterior tibial trunk was 4.3 +/- 0.7. The average distance of the first branch was 9.4 +/- 2.3 Cm from medial malleolus and second branch was 15 +/- 3.4 Cm. The average number of branches to soleus arising from the proneal artery was 3.8 +/- 0.8. The proneal artery gave 2-5 branches to the soleus muscle in the limbs that in 95.6% of the limbs were found three branches from proneal artery trunk to soleus muscle. In this study have been shown, the distribution of the arteries entering the soleus muscle and how the information may be used in the design of soleus muscle flaps. However, clinical application of distal pedicle soleus muscle flaps in Iranian population is not beneficial and we do not recommend it to the surgeons