Splenic epithelial cyst

Cysts of spleen are rare entities. Congenital splenic cysts are even more uncommon comprising of only 10% of benign non-parasitic cysts. We report a case of 22 years old female who presented with history of 2 years abdominal pain and gradual distension. Ultrasound and computed tomography [CT] both were suggestive of splenic cyst. Laboratory tests show thrombocytopenia with platelets count of 97000 per cubic millimeter and anemia with hemoglobin 8.7 gram per deciliter. Serological tests were negative for parasitic infection. Splenectomy was done and the weight of the spleen was found to be 1.5 kilogram. Histopathological findings were consistent with splenic epithelial cyst. The aetiology, diagnostic modalities and treatment options are discussed in the case report

Sensitivity and specificity of bi-rads scoring system in carcinoma of breast

To find out the sensitivity and specificity of mammogram according to BI-RADS scoring, in correlation with pathological findings so as to develop protocol for biopsy in patients presenting with clinically palpable breast lump or nipple discharge. Cross sectional study. Jinnah Postgraduate Medical Centre, Surgical unit 1 [Ward 3] Karachi, from July 2007 to June 2008. Female patients who presented with clinically palpable breast lumps or nipple discharge in general surgical OPD were examined and referred for mammography. Ultrasound examination was also done where considered necessary. The final diagnosis regarding the lump or nipple discharge as shown in the mammography was made and patients sent for biopsy [FNAC/ Trucut/ excision biopsy]. The mammographic diagnosis was compared with the histopathological report. Fifty patients were examined of whom 47 clinically suspected patients had confirmation of diagnosis on biopsy while 3 were found negative. Forty one suspected cases on BI-RADS mammogram were true positive that revealed 87.2% sensitivity of BI-RADS mammogram while 6 cases were false negative. All three cases of negative on biopsy were true negative that revealed hundred percent specificity. In this way positive predictive value was also hundred percent with negative predictive value of 33.3%. Overall diagnostic accuracy of mammogram was 88% when compared with histopathological diagnosis. Mammography can be used as an important diagnostic tool for the diagnosis of breast diseases and where there is doubt, diagnosis should be made by means of triple assessment i.e. clinical examination, mammography, and histopathology

Tuberculous mastitis

To find out the different clinical presentations of breast tuberculosis and its treatment outcome. Design: An observational study. Surgical ward 3 of Jinnah Postgraduate Medical Centre, Karachi from June 2001 to November 2003. Fifty consecutive female patients above 13 years presenting with breast lump, multiple sinuses, axillary lymphadenopathy, and cold abscess were included in the study. Medical records of the patients presented were reviewed and analyzed. Data was collected regarding the patient's name, age and marital and lactational status. Clinical Examinations and investigations were carried out by triple assessment i.e. clinical, radiological and histological / cytological evaluation. The commonest presentation was a solitary breast lump in 30 [60%] patients, breast lump with axillary lymphadenopathy in 13 [26%]. Four [8%] patients presented with generalized breast swelling [edema] with ipsilateral axillary lymphadenopathy. Two [4%] presented with breast abscess and axillary lymphadenopathy and one [2%] with axillary sinus and breast lump. Upper outer quadrant was most frequently involved in 29 [58%] of patients. Thirty two [64%] cases were secondary to tuberculosis in other sites, mostly [40%] from tuberculous axillary lymphadenitis. Forty eight [96%] patients responded well to one year antituberculous treatment with complete disappearance of the lumps except 2 patients who had shrinkage of lump size only, underwent excision of lump. Solitary lump and enlarged lymph nodes are the commonest presentation of mammary tuberculosis. Early diagnosis and treatment is necessary to prevent disfigurement of breast. Antituberculous therapy is the treatment of choice. Surgery should be reserved for unresponsive lumps

Dermatofibrosarcoma protuberans

Dermatofibrosarcoma protuberans is a rare, locally aggressive, rarely metastatic skin tumor which tends to recur. A 45-year-old female presented with dermatofibrosarcoma protuberans on her breast as a recurrent nodule after excision. Lump was re-excised with wide margins and irradiated. Follow-up was done monthly for two years, with no recurrence

Treatment of breast abscess with ultrasound guided percutaneous needle drainage

A study was conducted from August 2003 to July 2004 on 22 consecutive females with uncomplicated breast abscess in the breast clinical of ward-03 JPMC. Percutaneous aspiration of the abscesses was done under ultrasound control instead of more traditional incision and drainage. The highest number of patients had abscess in the lower outer quadrant. Minimum age was 14 and maximum 44 years. Out of 22 patients I 1 were cured on first aspiration, 7 responded on re- aspiration and 4 had incision drainage and tissue biopsy to exclude malignancy. Ultrasound guided needle aspiration is a good method to treat small breast abscess with no skin changes

Comparison of trucut biopsy with fine needle aspiration cytology in diagnosis of palpable breast lesions

A comparative study was conducted on 25 consecutive female patients with clinically palpable breast lumps from July 2003 to April 2004 in the barest clinical of Surgery ward-03 JPMC. All the patients underwent fine needle aspiration cytology and trucut biopsy simultaneously. Mean age was 45.28 years with minimum age of 32 and maximum 66 years. Most frequent site involved was upper outer quadrant [32%]. The most common lesion diagnosed on FNAC was malignancy in 60% of cases, whereas on trucut 64% of the lumps were diagnosed as malignant. Trucut biopsy defined the type of lesions more accurately than FNAC. The sensitivity of FNAC and trucut was 88% and 96%. Trucut biopsy is a valuable tool for breast lumps diagnosis and provides better characterization of benign and malignant lesions