Newly Arising Contralateral Granular Cell Tumor after Wide Excision of Large Breast Granular Cell Tumor: A Case Report

Granular cell tumor (GCT) of the breast is a rare neoplasm that is usually benign in nature. The results of physical examination and ultrasonographic findings of GCT of the breast often mimic those of other malignancies. A 46-year-old woman underwent wide excision for removal of a large mass in the left breast (about 10 cm in diameter). The pathologic finding of the excised mass was benign GCT. A year after initial surgery, recurrence of the left breast mass was found along with a newly developed mass in the contralateral right breast, which was excised. In this study, we describe the case of a newly developed GCT in the contralateral breast 1 year after excision of a larger breast GCT.

Step-by-step Management and Treatment Outcome of Bleeding Control for Anastomosis Site after Low Anterior Resection with Double Stapling Technique

PURPOSE: This study reviews our experience with a step- by-step management approach of increasing aggressiveness and evaluates the treatment outcome for intraluminal hemorrhage. METHODS: The study group was comprised of patients who had experienced intraluminal hemorrhage after a low anterior resection with the double stapling technique from 1999 to 2003. The choice of management was selected according to our step-by-step management protocol, and the outcomes were evaluated for each step, lincluding mortality and complications. RESULTS: Nine patients (6 males and 3 females, mean age 55 years) were identified, the mean volume of packed RBC transfusion was 2 pints, and the mean distance of the anastomotic site from the anal verge was 6 cm. The median stapler size was 31 mm. The first step was cold saline irrigation and drainage; four of 9 patients were controlled. The second step was retention enema with topical hemostatics; one of remaining 5 patients stopped bleeding. The third step was colonoscopic hypertonic saline injection around the bleeding site with direct colonoscopic electrocauterization, two of remaining 4 patients were controlled. The last step was suturing the bleeding site through the anus, the remaining 2 patients stopped bleeding. One of the 9 patients developed leakage from the anastomotic site after the last step management, three of the 9 patients had long standing ileus, and one of the 9 patients developed acute renal failure after a massive transfusion. There were no postoperative deaths. CONCLUSIONS: It is safer and easier to control bleeding with step-by-step management system of increasing aggressiveness.