An Unusual Presentation of Synchronous Breast Cancer and Skin Malignancy in a Patient with Lynch Syndrome: A Case Report and Review of the Literature.

BACKGROUND: Lynch syndrome is an autosomal dominant condition that leads to an increased risk of many neoplasms. In the United Kingdom, NICE recommends that patients with colorectal and endometrial cancer should be tested for Lynch syndrome. There is conflicting evidence in the literature on the link between breast cancer and Lynch syndrome. CASE PRESENTATION: A 54-year-old woman presented with a lump in her right breast with a background of locally advanced colorectal cancer and Lynch syndrome due to a MLH1 gene mutation. A core biopsy showed a grade 3, invasive, triple-negative NST carcinoma. The tumour was triple-negative with patchy positivity for CK14 and CK5/6. Simultaneously, a cystic skin lesion in the contralateral breast was noted, which comprised lesional cells with a proliferation of clear cells and bland basaloid cells. The lesion had evidence of sebaceous differentiation with AR, podoplanin and p63 positivity. MSH1 and PMS2 deficiency was found in the breast and skin lesions. CONCLUSIONS: In Lynch syndrome, it is vital to be aware of the increased risk of various types of cancer. This case adds to the body of evidence of the spectrum of malignancies that can be encountered in patients with Lynch syndrome.

A Prospective Analysis of Screen-Detected Cancers Recalled and Not Recalled by Artificial Intelligence.

OBJECTIVE: The use of artificial intelligence has potential in assisting many aspects of imaging interpretation. We undertook a prospective service evaluation from March to October 2022 of Mammography Intelligent Assessment (MIA) operating "silently" within our Breast Screening Service, with a view to establishing its performance in the local population and setting. This evaluation addressed the performance of standalone MIA vs conventional double human reading of mammograms. METHODS: MIA analyzed 8779 screening events over an 8-month period. The MIA outcome did not influence the decisions made on the clinical pathway. Cases were reviewed approximately 6 weeks after the screen reading decision when human reading and/or MIA indicated a recall. RESULTS: There were 146 women with positive concordance between human reading and MIA (human reader and MIA recalled) in whom 58 breast cancers were detected. There were 270 women with negative discordance (MIA no recall, human reader recall) for whom 19 breast cancers and 1 breast lymphoma were detected, with 1 cancer being an incidental finding at assessment. Six hundred and four women had positive discordance (MIA recall, human reader no recall) in whom 2 breast cancers were detected at review. The breast cancers demonstrated a wide spectrum of mammographic features, sites, sizes, and pathologies, with no statistically significant difference in features between the negative discordant and positive concordant cases. CONCLUSION: Of 79 breast cancers identified by human readers, 18 were not identified by MIA, and these had no specific features or site to suggest a systematic error for MIA analysis of 2D screening mammograms.

Is there any difference in carotid stenosis between male and female patients undergoing coronary artery bypass grafting?

Cardiovascular diseases are among the leading causes of death in women. Significant gender differences have been reported among patients with symptomatic carotid artery disease. The aim of this study is to examine if the female sex is a predisposing factor for carotid stenosis in coronary artery bypass grafting (CABG) patients. We studied 965 CABG patients, 796 males and 169 females. We combined the gender with risk factors predicting carotid disease as a history of cerebrovascular accident (CVA), peripheral vascular disease (PVD), left main (LM) disease and advanced age. We compared the incidence of carotid disease for each gender against known risk factors, which are history of CVA, PVD, LM and advanced age. In our study, there was not a statistically significant difference for the presence of carotid disease between males and females undergoing CABG. However, patients with a history of CVA, with PVD and older age were at greater risk for carotid stenosis. We conclude that the female sex is not a predictive factor for carotid stenosis in CABG patients.

Non-toxic megacolon due to transverse and sigmoid colon volvulus in a patient with ulcerative colitis.

Intestinal volvulus in patients with inflammatory bowel disease is rare. A 83-year-old woman diagnosed with ulcerative colitis five years ago was referred to our hospital due to abdominal distension. The patient had been diagnosed with pancolitis and dolichocolon and was started on mesalazine 1.5 g/day treatment resulting in long-term remission. Physical examination showed abdominal distention with no rebound; however on auscultation abdominal sounds were absent. Patient had no signs of toxicity. Temperature was 38.2 °C, heart rate was 82 bpm and respirations were 16/min. Laboratory investigation showed elevated white blood cell count (20,000/mm(3)) with hemoglobin at 13.2 g/dl and C-reactive protein at 310 mg/dl. Radiology was suggestive of megacolon and volvulus. Patient underwent endoscopy, which revealed normal rectal mucosa; there were however present areas of bowel gangrene. Urgent laparotomy was performed which revealed double transverse and sigmoid colon volvulus. A left hemicolectomy and transversectomy were performed. A case of a patient with ulcerative colitis is being presented here, exhibiting a non-toxic megacolon, resulting from a double transverse and sigmoid volvulus probably stemming from congenital dolichocolon. This case is stressing the importance of prompt differential diagnosis in such cases of megacolon as any symptom misinterpretation may result in unfavorable outcomes.