The Clinical, Diagnostic, and Therapeutic Characteristics of 22 Male Patients with Breast Cancer.

Aim: The aim of this study is to evaluate the clinicopathological, diagnostic, and therapeutic features of male breast cancer. Study Design: This is a retrospective clinical study. Methodology: Twenty-two male patients who underwent surgery for breast cancer in a tertiary reference hospital in Ankara between 2010 and 2015 were included in this retrospective study. Patient characteristics, clinical findings, diagnostic and therapeutic features were recorded. Results: Among the 22 patients with a mean age of 59.6 years, 3 (13.6%) had a family history of BC. Painless breast mass was the most common (95.5%) presenting symptom. Hypoechoic breast mass with irregulary margins was the most frequent sonographic finding (90.9%) while mammography revealed asymmetric density or poorly defined mass in the majority of cases (75%). Modified radical mastectomy was the most performed surgical type (n= 21, 95.5%). In one patient, simple mastectomy was performed for a diagnosis of ductal carcinoma in situ. Twelve (54.5%) patients received adjuvant chemotherapy while 3 (13.6%) cases had radiation therapy. Hormonal therapy was given to 17 (77.2%) patients with receptor positivity. Median follow-up time of the patients was 31.2 months, and 3 recurrences was observed. Conclusion: The incidence of male breast cancer has been increased in the recent years. Since the management of male breast cancer is still based on the rules of female breast cancer, large scale clinical studies are urgently needed to develop an international guideline for of this rare cancer.

Laparoscopic Cholecystectomy Performed Immediately after Cesarean Section without Additional Incisions: A New Method.

Aim: To describe a new technique in which laparoscopic cholecystectomy can be performed through trocar cannulas inserted directly through the same incision used for the cesarean section, without the need for additional incisions elsewhere. Presentation of Case: A 30-year-old pregnant woman presented with symptomatic cholelithiasis. Laboratory and radiological investigations revealed no signs of cholecystitis or pancreatitis. She had previously undergone cesarean section, so this was planned for the current birth as well, to be followed immediately by laparoscopic cholecystectomy. In week 38 of gestation, under general anesthesia and with a standard Pfannenstiel incision, a cesarean section was successfully performed. Thereafter, a laparoscopic cholecystectomy was performed through the same incision. The patient was discharged without any problem. Discussion: For patients with symptomatic gallbladder stones who undergo cesarean section, treatment options include laparoscopic cholecystectomy performed immediately after cesarean section during the same operative session, either with the standard technique or with the use of the cesarean incision in addition to other incisions. Technical difficulties of laparoscopic cholecystectomy performed through Pfannenstiel incision is the main concern of this method; however, the laxity of the abdominal wall due to enlarged uterus and hormonal changes during pregnancy facilitate laparoscopic maneuvers. Conclusion: Our technique, by making use of the cesarean incision alone, provides for easy gallbladder removal while also minimizing the risk of port related injury, reducing postoperative pain and providing better cosmetic results due to the absence of additional incisions; therefore can be considered in selected patients.

Can mastalgia be another somatic symptom in fibromyalgia syndrome?

OBJECTIVE: The purposes of this study were to determine the coexistence of mastalgia and fibromyalgia, to investigate the effects of this combination on pain patterns, and to discuss the status of breast pain in the diagnostic algorithm of fibromyalgia syndrome. METHODS: Sixty-one female patients reporting breast pain during the last three months and 53 female patients diagnosed with fibromyalgia syndrome were enrolled in this study. The Breast Pain Questionnaire was administered to all participants in the mastalgia group and to those in the fibromyalgia syndrome group who had experienced mastalgia during the past three months. The patients in the fibromyalgia syndrome group were evaluated using the 2010 preliminary American College of Rheumatology classification criteria. All of the patients in the mastalgia group were evaluated for the diagnosis of fibromyalgia syndrome by a single physiatrist. The coexistence and pain patterns of mastalgia and fibromyalgia were assessed statistically. RESULTS: Approximately half of the patients with fibromyalgia syndrome (47.2%) reported having mastalgia at the time of admission and 37.7% of the patients with mastalgia met the diagnostic criteria for fibromyalgia syndrome. The patients with mastalgia in the fibromyalgia syndrome group had significantly higher total breast pain scores compared with the women in the mastalgia group. In addition, the patients with fibromyalgia syndrome in the mastalgia group had significantly higher Widespread Pain Index and Symptom Severity Scale scores than the patients with fibromyalgia syndrome. CONCLUSIONS: We suggest that mastalgia can be an aspect of the central sensitivity syndrome and can be added to the somatic symptoms of fibromyalgia.