Diagnostic dilemmas in intraductal papillomas of the breast - experience at Sultan Qaboos University Hospital in the Sultanate of Oman

The aim of this retrospective study was to correlate the significance and accuracy of the colour of nipple discharge and breast ultrasound imaging in the diagnosis of intraductal papilloma. This is a retrospective study of 34 patients who underwent 36 microdochectomies in Sultan Qaboos University Hospital [SQUH] in the Sultanate of Oman, over a 4 year period of January 2009 till December 2012. The confounders considered were patient age, physical examination findings, nipple discharge cytology result, ultrasound results and biopsy report following microdochectomy. Comparisons analysis, charts and graphs were made using the SPSS software [version 20]. The mean age of the patients was 44 [27-73] years old. Twenty-seven out 36 [75%] patients had presented with nipple discharge, 14 out 27 [52%] had blood stained nipple discharge and 13 [48%] with coloured discharge [yellow, brown and green], 9 patients had no discharge. The final histopathology showed intraductal papilloma 13 [36%], duct ectasia 18 [50%], DCIS 1 [2.7%], fibrocystic disease 3 [8.3%] and LCIS 1 [2.7%]. Thirteen out of 36 had intraductal papilloma on final histopathology. The correlation between blood stained discharge and final histopathology of intraductal papilloma was insignificant [p=0.44]. Nipple discharge is irrelevant to the diagnosis of intraductal papilloma. Spontaneous nipple discharge regardless of color is to be referred to breast surgeon and to be assessed with triple assessment. Surgery remains the mainstay of treatment

Mucinous breast cancer with solitary metastasis to humeral head: a case report

Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.

Breast Pseudoangiomatous Stromal Hyperplasia challenges

Pseudoangiomatous stromal hyperplasia [PASH] is a rare proliferative breast disease. It is characterized by fibrosis of the mammary stroma surrounding breast ducts and lobules with formation of anatomizing capillary-like spaces lined by myofibroblastic cells. Commonly, patients present with a palpable breast mass or continuous breast enlargement. We report a case of a 25 year old lady who presented with painless unilateral swelling of her right breast. Ultrasonography showed heterogeneous, hypoechoic benign appearing breast tissue. Histopathology revealed dense collagenous stroma separated by slit like spaces that were lined by bland spindle cells showing no cytological atypia. With immunohistochemistry, these cells were positive for CD-34 and SMA and negative for the endothelial marker CD-31. Some of these cells were also positive for ER and PR.