Granulomatous mastitis in accessory breast tissue: A rare presentation and surgical management.

Granulomatous mastitis (GM) in accessory breast tissue is rare. The present study aimed to report a rare case of GM in accessory breast tissue. A 39-year-old female patient presented with right axillary discomfort and swelling for ~5 days. On clinical examination, a tender, firm lump was detected in the right axillary region. The ultrasound showed diffuse parenchymal heterogeneity and surrounding edema in the right accessory breast associated with reactive axillary lymph nodes. Following unresponsiveness to conservative treatment, a surgical procedure was performed in the form of an excisional biopsy and the lesion was diagnosed as GM. During the six-month follow-up, there were no recurrences. The exact cause of GM remains uncertain and the etiology within accessory breast tissue is even less understood. Proposed mechanisms suggest that it may result from an exaggerated immune response triggered by various factors, such as infection, autoimmunity or hormonal fluctuations. GM in accessory breast tissue is a rare and challenging clinical condition to be diagnosed. Due to the rarity of this condition, it highlights the importance of including GM in the differential diagnosis of axillary masses.

Unusual migration of implantable cardioverter defibrillator that clinically mimicking breast cancer: A case report.

Pacemaker and implantable cardioverter defibrillator migration to the breast are an extremely rare complication. The rarity of this phenomenon and its potential to mimic breast cancer emphasize the importance of reporting such cases. This study presents a rare migration of the device to the breast tissue that clinically mimicked breast cancer. This case underscores the need for comprehensive diagnostic approaches and individualized management strategies when faced with such clinical challenges. A 59-year-old female patient complained bilateral breast masses for a 3-month duration. She is a known case of diabetes mellitus and hypertension. In 2015, she underwent Implantable cardioverter defibrillator implantation for dilated cardiomyopathy and left ventricular failure. On examination, there was a skin dimpling in the left upper quadrant of her breast. The skin dimpling was clinically suspected to be breast cancer. Mammography showed an implantable cardiac device in the upper central part extending into the glandular parenchyma. A consultation with a cardiologist confirmed that the ICD was functioning properly, and as a result, no medical interventions were deemed required. Implantable cardioverter defibrillator migration to the breast is an extremely rare phenomenon and represent a complex clinical challenge that require a comprehensive diagnostic approach and individualized management strategies.

Non-operative management of umbilical pilonidal sinus: One more step towards ideal therapy.

There are controversies regarding the management of umbilical pilonidal sinuses. The current study aims to report on the efficacy of a non-operative, umbilical conserving procedure in the treatment of umbilical pilonidal sinus. This is a prospective, single cohort study. The cases were managed in a single private practice center. Patients were assessed and managed throughout the previous nine years (from January 2013 to June 2022). The required information was obtained from the center's medical database. The current study included 114 patients. There were 82 (71.9%) male patients. The patients' ages varied from 14 to 56 years (mean = 23.24). The umbilicus was retracted under local anesthesia. The sinuses were cleaned with povidone-iodine. Following the drying of the cavity, the mixture was put in the umbilicus, and the area was dressed. The amount of mixture was determined by the size of the cavity. Following treatment, the patients were directly discharged home with instructions to remove all hair from the chest and abdomen and keep the dressing dry for three days. After three days, the patients were advised to use a clean cotton swab to remove the injected mixture. Recurrence was reported in 5 cases (4.4%). The current technique might be used effectively in the treatment of umbilical pilonidal sinus. It is an umbilical preserving technique with a minimal recurrence rate.

Bilateral invasive ductal carcinoma of the breast; a case report with literature review.

Introduction: Carcinoma of breast is a heterogeneous disease. Using their light microscopic appearance, the invasive forms are usually divided into three main types: infiltrating lobular carcinomas, infiltrating ductal carcinomas, and other infiltrating carcinomas. This paper aims to discuss and report a case of bilateral invasive ductal carcinoma of the breast. Case report: A 48-year-old female presented with bilateral breast masses of 5-month duration. On examination. she had bilateral palpable breast masses, which were hard, mobile, and irregular. On the right side, there was skin tethering and palpable axillary lymph nodes. Ultrasound examination showed a heterogeneous, irregular, ill-defined, mass-like lesion, seen in the upper outer quadrant of the right breast along with a hypoechoic. irregular mass 12*13mm in the upper outer quadrant of the left breast. FNA showed bilateral invasive ductal carcinoma. Right axillary lymph nodes were positive for adenocarcinoma. She received 4 sessions of NACT which was followed by right-side mastectomy with axillary lymph node dissection and left-side mastectomy with sentinel lymph node biopsy. Discussion: Bilateral breast carcinomas are very rare. They form 2-5% of all breast malignancies. About 2-11% of breast cancer patients develop cancer in the opposite breast in their lifetime with an incidence rate varying from 4 to 8 per 1000 people per year. Conclusion: Bilateral carcinoma of the breast is very rare. Microscopically, the findings usually reveal infiltrative ductal carcinoma. The treatment of choice is bilateral modified radical mastectomy.

Primary diffuse B-cell non-Hodgkin's breast lymphoma; A case report with a brief literature review.

INTRODUCTION: Primary non-Hodgkin's breast lymphoma is a very rare entity. The present study aims to report a case of primary diffuse B-cell non-Hodgkin's breast lymphoma. CASE PRESENTATION: A 55-year-old female presented with a right breast mass for a duration of 4 months. There was no history of cancer in her family. She has had umbilical hernial repair two years before this presentation. Examination revealed the presence of a suspicious mass in the right breast and multiple axillary lymph nodes. Ultrasound showed a rounded vascular mass (46*40mm) and pathological axillary lymph nodes, U5. Mammography showed a round, dense mass with an indistinct posterior margin and a few round axillary lymph nodes, M4. A Core needle biopsy was done which showed an invasive mammary carcinoma; the result of the FNA of the axillary lymph nodes was benign lymphoid tissue. Histopathological examination confirmed the presence of a tumor, sized 6.4cm, non-Hodgkin's lymphoma. Modified radical mastectomy was performed. The histopathological examination confirmed non-Hodgkin's lymphoma. CLINICAL DISCUSSION: There are two main groups of primary breast lymphoma. The bilateral diffuse-type affects the younger puerperal women associated with pregnancy or recent childbirth that may involve the CNS, ovaries, and gastrointestinal tract without lymph node involvement. The second type, the unilateral type, which appears in elderly women without extra mammary involvement. CONCLUSION: Primary breast non-Hodgkin's lymphoma is a rare disease. It mimics breast cancer, and hence, may lead to misdiagnosis. The common modalities of treatment include chemotherapy, radiotherapy, and surgery.

Paget's disease of the breast in male with underlying invasive ductal carcinoma: A case report with review of literature.

INTRODUCTION: Paget's disease of the breast is a rare cutaneous eczema-like condition that occurs in the nipple-areolar complex of the breast. The current study aims to report a rare case of Paget's disease of the breast associated with invasive ductal carcinoma in a male breast. CASE REPORT: A 54-year-old male presented with ulceration of the left nipple-areolar complex that has been progressing over the last 6 months. On examination; there was a palpable axillary lymph node. On ultrasound, a small hypoechoic heterogenous mass was seen beneath the areola (8*4 mm) with surrounding vascularity, and a few axillary lymph nodes with normal morphology and cortical thickness. The mammography revealed some points of calcification arranged in clusters. The patient underwent left side mastectomy and sentinel lymph node biopsy. The result of histopathological examination showed left side unifocal invasive ductal carcinoma. DISCUSSION: There are two main theories that explain the histogenesis of Paget's disease of the breast with and without underlying malignancy: epidermotropic theory, which suggests an epidermal infiltration of the nipple with Paget cells, and transformative theory, which proposes a malignant transformation of normal glandular cells of the epidermis. CONCLUSION: The clinical presentation of Paget's disease of the breast is characteristic and should always warn the surgeon of the possibility of underlying malignancy.