Primary squamous cell carcinoma of the breast: a case report and review of the literature.

Primary squamous cell carcinoma of the breast is a rare tumor. The prognosis is poor, and hence there is a clinical trend to offer multi-modal treatment options of surgery, chemotherapy, and radiation therapy. There is no consensus on treatment options due to the paucity of available data. We are reporting the case of a 68-year-old lady who presented with a right breast mass. Upon core biopsy and further workup, she was noted to have primary squamous cell carcinoma of the breast. She was successfully treated with surgical therapy alone without disease recurrence at 36 months. Primary squamous cell carcinoma of the breast can be treated successfully with surgical therapy alone. The role of adjuvant chemotherapy, radiation therapy, and anti-estrogen therapy should be questioned as these modalities can lead to significant treatment-related morbidities and might not be contributing to disease-free interval or overall survival from this unusual tumor subtype.

Lymphoma of the breast: a mimic of inflammatory breast cancer.

BACKGROUND: Unusual presentation of breast lymphoma with signs and symptoms suggestive of inflammatory breast cancer. DISCUSSION: Lymphoma of the breast is uncommon whether it is primary or secondary. Most breast lymphomas are of B cell origin. The most frequent mode of presentation is a painless breast mass. The clinical presentation of localized left breast erythema and edema with an associated left breast mass is common for an inflammatory breast cancer but highly unusual for lymphoma of the breast. CONCLUSION: In patients with a left breast mass associated with erythema and edema, the differential diagnosis should include breast lymphoma in addition.

Intra-ocular melanoma metastatic to an axillary lymph node: a case report.

BACKGROUND: Unusual metastatic presentation of intra-ocular melanoma. STUDY DESIGN: Case report. DISCUSSION: Extra-regional lymphatic spread of intra-ocular melanoma has not been reported previously in the literature. The usual pattern of metastasis for intra-ocular melanoma is hematogenous. There are few reports of regional spread to the maxillofacial bones. We report an interesting case of a 51 year old female with prior history of right eye melanoma, now presenting with metastasis to the left axilla, which is an extra-regional nodal basin. CONCLUSION: In female patients presenting with an isolated axillary mass, with a negative breast work up and known prior history of melanoma, the differential diagnosis should include possible metastatic melanoma. Core biopsy will confirm the diagnosis and tailor subsequent management.

NOTES(®) stapled cystgastrostomy: a novel approach for surgical management of pancreatic pseudocysts.

BACKGROUND: Traditional approach for surgical management of mature pancreatic pseudocysts is by internal surgical drainage. Endoscopic drainage procedures have also been described. We describe Natural Orifice Translumenal Endoscopic Surgery (NOTES(®)) stapled cystgastrostomy as a less invasive surgical procedure. STUDY DESIGN: Case series. METHODS: NOTES(®) cystgastrostomy was performed in six patients with mature pseudocysts from June 2007 to July 2009 under institutional review board (IRB) protocol. The size of the pseudocysts varied from 8 to 23 cm, and all of the pseudocysts were considered complex pseudocysts. The operative team included two general surgeons and a gastroenterologist. The procedure included endoscopic ultrasound (EUS)-guided puncture of the stomach just below the gastroesophageal (GE) junction to gain access to the pseudocyst, guidewire placement, and then dilatation with a balloon to 18-20 mm. Endoscopic necrosectomy and debridement were performed when possible, followed by transoral surgical anastomosis under endoscopic visualization with the SurgAssist™ SLC 55 (Power Medical Interventions, Langhorne, PA) 4.8-mm stapler. Anastomotic length varied from 5.5 to 8 cm. In one patient, diagnostic laparoscopy was performed after the procedure due to inadvertent pneumoperitoneum; no leak or perforation was identified. RESULTS: Length of stay varied between 2 and 14 days. All patients had routine esophagogastroduodenoscopy (EGD) at 1 and 6 weeks postoperatively to evaluate patency; computed tomography (CT) scan was done at 2-3 months to demonstrate resolution of the pseudocyst. All patients had significant decrease in pseudocyst size with patent anastomosis on postoperative EGD, although one patient required endoscopic anastomotic dilatation due to continued symptoms 6 weeks after the operation. Her pseudocyst completely resolved 4 months postoperatively. An additional patient required subsequent distal pancreatectomy due to recurrent symptoms of chronic pancreatitis. CONCLUSION: NOTES(®) cystgastrostomy is comparable to previously described surgical approaches, yet is as minimally invasive as endoscopic drainage procedures previously described for management of pseudocysts. It is less invasive than laparoscopic or open cystgastrostomy, yet provides definitive treatment.

Inferior vena cava duplication and deep venous thrombosis: case report and review of literature.

Duplications of the inferior vena cava (IVC) are seen with an incidence of 0.2% to 3.0%. Duplications causing symptoms are rare, with only six reported cases of IVC duplication associated with a deep venous thrombosis. We present a 78-year-old caucasian woman with an IVC duplication who developed a deep venous thrombosis. The etiologies of IVC duplication include failure of anastomosis between the primitive cardinal veins and failure of regression of the left supracardinal vein. When asymptomatic, treatment includes observation, placing filters in both systems, or coil-embolization of the duplicated segment plus placing a filter in the right IVC. For our patient, we chose to coil-embolize the communication to the duplicated segment as well as place a filter in the main right IVC system.