ABSTRACT
Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, typically characterized by their benign nature. We present a unique case of a 29-year-old Pakistani female who initially presented with a benign PT in her left breast. Despite undergoing multiple surgical resections over the course of a decade, the tumor exhibited a remarkable transformation in biology, progressing from a benign phenotype to malignancy. Subsequent recurrences manifested with increasing aggressiveness, ultimately culminating in distant metastasis to the bones, axillary nodes, chest wall, and abdominal wall. This case underscores the unpredictable nature of PTs and highlights the challenges in managing recurrent cases with malignant transformation. The clinical course described herein emphasizes the importance of vigilant monitoring and individualized treatment strategies in such cases.
ABSTRACT
Introduction Emergencies such as appendicitis, peritonitis, road traffic accidents and gunshots require immediate surgical intervention. Patients are first resuscitated at the emergency department and then shifted to the casualty operation theater (COT). COT is a state-of-the-art operation theater that is open 24/7 and ready to deal with any surgical crisis. Once surgery is performed, the patients are admitted to the surgical ward for post-operative care. Jinnah Postgraduate Medical Centre (JPMC) is the largest tertiary care hospital in Karachi. There is very limited data on the cases that are dealt with on regular basis at the COT in JPMC. Here we break the mold and analyze the various aspects of surgical emergencies treated at the COT over the course of last six months. Objectives To evaluate the demographics and mortality rates of emergencies treated at the COT in the last six months. Methods This was a retrospective study, held for six months (July 1st 2019 to December 31st 2019). Data was obtained from the Records and Administration section, Surgical Unit IV (ward 21), Jinnah Postgraduate Medical Centre. Results Three hundred and fifty-five patients were inducted into the study, predominantly male. Majority (71.54%) of the referrals were made from within the city. The mean age of the patients was 48.57 ± 14.92 years. Appendicitis was the most common emergency treated at the COT. The overall mortality rate was 23.94%. Peritonitis and road traffic accidents contributed significantly to the mortality rate. Conclusion Surgical emergencies treated at the COT have a high mortality rate at one week. Prompt recognition, early referrals and intervention can help reduce mortality in the future.
