Histologic Examination of Mastectomy Scars during Breast Reconstruction: A Systematic Review.

Background: Breast reconstruction is a standard procedure in postmastectomy plastic surgery. The necessity of routine histological examinations for mastectomy scars during delayed reconstruction remains a topic of debate. We evaluated the need for histological examination of scars during delayed breast reconstruction. Methods: We conducted a systematic review using PubMed, TDnet, and Cochrane Central in August 2023. Inclusion criteria involved delayed breast reconstruction with histological scar analysis and malignancy reporting. Exclusion criteria encompassed noncancerous breast diseases, prophylactic mastectomies, articles lacking relevant information, case reports, technique descriptions, and reviews. We independently assessed articles. Differences in recurrence rates were determined using a Z-test for proportions. A linear regression model explored the relationship between reconstruction timing and pathological results. The number needed to treat was calculated based on the literature. The Wilcoxon test was used to compare mean reconstruction times and postreconstruction follow-up between groups. Results: Our analysis covered 11 retrospective observational studies published between 2003 and 2018, including 3754 mastectomy scars. The malignancy recurrence rate was 0.19%, consistent with previous reports, with a number needed to treat of 144.93-188.68 patients. The timing of breast reconstruction postmastectomy averaged 19.9 months, without statistically significant association between reconstruction timing and recurrence rates. Postreconstruction follow-up periods ranged from 60 to 87 months. The postreconstruction adverse outcomes ratio was 2.21%. Conclusions: Assessing the necessity of histological examination in breast reconstruction is complex. Based on the literature and this study, we do not recommend routine histological examination of mastectomy scars during delayed reconstruction. A selective approach based on risk factors may be beneficial, warranting further research.

Nipple Adenoma: Systematic Review of Literature.

Background: Nipple adenomas (NAs) are rare benign proliferative tumors presenting as palpable nodules, erosive lesions, or nipple discharge, mimicking other conditions. This systematic review categorizes cases into sole NA (ONA) or co-diagnoses with other conditions (CONA) to enhance clinical recognition, diagnosis, and treatment efficacy. Methods: Following PRISMA guidelines, a PubMed search was conducted for NA. Inclusion criteria covered original research, excluding reviews or other breast diseases. Bias risk was assessed through a thorough search, authors independently evaluated studies, and data were synthesized using varied measures. Subgroups ONA and CONA were formed. Analyses were conducted in Excel and R, complemented by a qualitative review due to case report predominance. Biases in case reports were transparently addressed. Results: Of the 86 studies, 387 cases were analyzed, showing 10.34% with co-diagnoses of malignant or premalignant conditions. Mean age was 44, with a female predominance (97%). ONA (347 cases) and CONA (40 cases) subgroups exhibited variations in symptoms, physical findings, and imaging. Treatment modalities included excision (51.39%), biopsy alone (11.1%), and mastectomy (8.6%). Mean follow-up of 56.73 months revealed recurrence (2.87%) and malignancy development (1.79%), notably in CONA cases (33.33%). Conclusions: This study provides insights into the broader age range of NA and its associations. Higher co-diagnosis rates were correlated with older age, highlighting the necessity for thorough investigation, with excision as the primary treatment. Follow-up emphasizes the significance of identifying and monitoring CONA cases, which pose a higher malignancy risk. Recurrence is presumed to be linked to proper lesion excision and co-diagnosis.

Combat-related Wartenberg Syndrome Due to Penetrating Shrapnel Injury: A Case Report.

Wartenberg syndrome, also known as Cheiralgia paresthetica, is an uncommon neuropathy affecting the superficial branch of the radial nerve. Typically caused by external compression, it manifests as paresthesia or pain in the radial side of the hand. We present a case of Wartenberg syndrome resulting from combat shrapnel injury, illustrating an uncommon etiology. A 21-year-old soldier was presented with allodynia and paresthesia after a shrapnel explosion, with positive clinical findings and radiographic evidence supporting the diagnosis. Nonoperative management led to significant improvement, highlighting the importance of conservative treatment in such cases. This report underscores the significance of considering unconventional causes in nerve entrapment syndromes post combat trauma, emphasizing adherence to established therapeutic guidelines.

Pubertal gynecomastia incidence among 530,000 boys: a cross sectional population based study.

Background: Adolescent gynecomastia, a benign proliferation of male breast tissue, can lead to psychological issues during adolescence. The prevalence varies widely (4%-69%). The incidence peaks are during neonatal, pubertal, and senescent periods. Its affect on emotional well-being necessitates understanding and occasional intervention. This study aimed to determine the incidence of gynecomastia among male adolescents aged 12-15 years. Methods: A retrospective cross-sectional study utilized the Clalit Health Care Services database (2008-2021) with a population of approximately 4.5 million. Participants aged 12-15 years were included if diagnosed with gynecomastia (International classification of diseases-9 code 611.1) and having a body mass index (BMI) measurement and no obesity diagnosis (ICD9 code 278.0). Data analysis included incidence rates and associations with ethnicity, age, BMI, and socioeconomic status. Results: 531,686 participants included with an incidence of 1.08%. Of all participants, 478,140 had a BMI ≤ 25 with an incidence of 0.7%, and 0.25%-0.35% yearly, and 70% of gynecomastia patients were aged 13-14 years. The prevalence of gynecomastia differed between Jews (1.28%) and Arabs (0.67%), but the disparity diminished when socioeconomic status was considered. Conclusions: This unprecedented Population study establishes a definitive rate of true pubertal gynecomastia, revealing a lower yearly incidence as compared to previous reports. The higher observed prevalence among Jewish adolescents, may be caused due to complex interactions between different influencing factors. Understanding these dynamics can aid in formulating more targeted interventions and policy strategies to address gynecomastia's affect on adolescent well-being.

Gynecomastia: A systematic review of pharmacological treatments.

Background: Pubertal gynecomastia (PG), a benign condition with varied reported prevalence, typically appears at 13-14 years-old and is mostly idiopathic and self-limited. Psychologic impairments are common among adolescents with gynecomastia. Surgical intervention is reserved to severe cases and is offered towards the end of puberty. Pharmacological treatment is seldom given by clinicians mainly due to insufficient published data. We conducted this systematic literature review to assess the efficacy, safety, side effects, and complications of pharmacological treatments published. Methods: MEDLINE, Embase, and Cochrane CENTRAL were searched for the terms "gynecomastia", "pubertal", and "adolescent" in conjunction with medications from the Selective Estrogen Receptor Modulator (SERM), aromatase inhibitors (AI), and androgens groups in different combinations to optimize the search results. Exclusion criteria included: studies based on expert opinion, similar evidence-based medicine levels studies, and studies which discuss gynecomastia in adults. Selected articles were assessed by two authors. Data collected included: the level of evidence, population size, treatment regimen, follow-up, outcomes, complications, and side effects. Results: Of 1,425 published studies found and examined meticulously by the authors, only 24 publications met all the study research goals. These were divided into 16 publications of patients treated with SERM, of whom four had AI and four androgens. In general, the data regarding pharmacologic therapy for PG is partial, with insufficient evidence-based research. Tamoxifen and SERM drugs have long been used as treatments for PG. Tamoxifen was the chosen drug of treatment in most of the reviewed studies and found to be effective, safe, and with minimal side effects. Conclusions: Pharmacological treatment as a new standard of care has an advantage in relieving behavioral and psychological distress. Although high quality publications are lacking, pharmacological intervention with tamoxifen is appropriate in select patients. Conduction large-scale high-quality studies are warranted with various drugs.

Severe Postoperative Bleeding Following Minor-to-Moderate Abdominal and Flank Liposuction Performed at a Day Surgery Center: A Case Report.

BACKGROUND Liposuction is a one of the most common aesthetic procedures. The super-wet and tumescent techniques are used most frequently. Both serve to reduce collateral blood loss, facilitate the suctioning procedure, and providing local anesthesia. Overall, liposuction is considered safe and effective, with minor adverse effects such as swelling, minute bleeding, contour irregularities, and seroma. Serious complication such as life-threatening bleeding are rare. In this case report, we present a patient with significant postoperative bleeding following minor-to-moderate liposuction performed at a day surgery center. CASE REPORT A 51-year-old healthy man, 4 days after 1600-cc aspirate tumescent liposuction performed in a day surgery center, was admitted to our ward with tachycardia, weakness, abdominal pain and disseminated hematoma. On admission, laboratory testing showed hematocrit of 20.9% and hemoglobin of 6.9 gr/dl. Immediate abdominal CT angiography was performed to exclude active bleeding, showing diffused hematoma in the subcutaneous fat all over the abdomen and scrotum, with some edema without active bleeding. The patient was treated with blood transfusion to facilitate fast home discharge during the peak of the COVID-19 epidemic that time. CONCLUSIONS We discuss the common work-up and treatment of postoperative hemorrhage. Blood transfusion following minor-to-moderate liposuction is unusual but during the COVID-19 pandemic it can facilitate quick discharge of a patient with postoperative hemorrhage with no active bleeding. Improper patient selection, an inexperienced surgeon, and inadequate operating locale can all result in postoperative complications. We call for the formulation of more detailed guidelines for liposuction setting.

Desmoplastic Neurotropic Melanoma Presenting as Pilonidal Sinus: A Rare Clinical Association.

BACKGROUND Pilonidal Sinus (PNS) is a small cutaneous orifice in the intergluteal region; symptoms include pain and swelling. Disparately, desmoplastic neurotropic melanoma (DNM) accounts for 1% of all melanomas and mostly occurs in the head and neck region. Because its appearance is generally benign, it typically comes to surgical attention only at an advanced stage or after recurrence. A perineural involvement occurs in 30-40% of the cases and is accompanied by symptoms such as paresthesia, paresis, and/or paralysis. To the best of our knowledge, the association between PNS and DNM has not been described in the literature before. Here, we present a patient with PNS that was diagnosed with DNM. CASE REPORT A 31-year-old healthy man presented with coccydynia and sacral cyst that had been present for about a year. While the initial diagnosis was of a PNS, after excision and biopsy, the pathology changed to PNS with DNM. The patient underwent a work-up for distant metastasis, which was negative. Wide local excision (WLE) with sentinel lymph node biopsy (SLNB) was also performed. CONCLUSIONS Due to the malignant potential of PNS, we support the routine of pathological examination of excised specimens. Once DNM is diagnosed, work-up for distant metastasis and further treatment with WLE as well as SLNB are recommended. The current report describes an association between PNS and DNM. While coccydynia may have been caused by the PNS or the melanoma, the presence of the PNS helped with an earlier diagnosis of the melanoma. Further research on the possible causative relationship between the conditions is required.