Pyoderma gangrenosum of the breast 17 years after breast cancer treatment.

We present a case of pyoderma gangrenosum (PG) affecting the breast of a 74-year-old woman, with a history of breast cancer treated with breast conserving surgery and adjuvant radiotherapy 17 years prior. She presented to the hospital with worsening breast ulceration, after a punch biopsy was performed at the site. She had surrounding cellulitis and concurrent infection to that breast which required antibiotics. The ulceration persisted even after treatment, and incisional biopsies of the area of ulceration confirmed the diagnosis of PG. Her condition was managed effectively with the use of immunosuppressive therapy, and she continued to display a good clinical response 2 months post discharge from the hospital.

Small Bowel Obstruction with Perforation Secondary to PillCam.

We present a case of a 63-year-old female who presented with small bowel obstruction and perforation secondary to a retained PillCam®. She initially presented with iron-deficiency anaemia (haemoglobin 44 g/L, ferritin 190 mcg/L). After unremarkable upper and lower gastrointestinal endoscopies and biopsies, she was referred for wireless capsule endoscopy (WCE). Four days afterwards she re-presented with small bowel obstruction and perforation related to the PillCam, which was confirmed on X-ray, on computed topography (CT), and at laparotomy.

Difficulties with defining lymphoedema after axillary dissection for breast cancer.

AIM: Axillary lymph node dissection(AND) is a common treatment for breast cancer. An important side effect of the surgery is lymphoedema (LO). The primary aims of this study were to assess the local prevalence of LO in patients who had undergone AND and how the subjective symptoms described by patients compare with objective measurements. Secondary aims were to investigate the relationship between risk factors and the prevalence of LO and to establish an easy and convenient way to detect LO patients in surgical clinics. METHOD: Eligible women after AND for breast cancer underwent three circumference measurements on the operated and non operated (control) arm. LO was defined as one or more measurements with an increase ≥7.5% than control after dominant arm correction. Questionnaires were used to assess severity of symptoms related to lymphoedema. 73 patients also had serial measurements in arms and change in arm volume in operated arm was calculated using Casley-Smith method and LO was defined as ≥20% increase in volume. RESULTS: 193 women with AND were analysed. Mean age was 61 years and mean time since surgery was 56 months. The overall prevalence of LO was 23.3%. LO prevalence by arm volume was 8.2%. Using volume as the standard, an arm circumference increase of ≥7.5% and ≥10% showed a sensitivity and specificity of 83% and 81%, and 66% and 89% respectively. Significant risk factors for LO were age, radiotherapy and infection to the operated arm CONCLUSION: Circumference measures are a simple office method of screening for LO. A patient history and ≥10% increase in any circumference is optimal for determining LO after AND.

Recurrent phyllodes tumor of the breast: defining the role for skin-sparing mastectomy and autologous reconstruction.

Phyllodes tumors (PTs) are uncommon fibroepithelial tumors of the breast, noteworthy for their difficult excisions and high recurrence rates. In the setting of recurrence, there is no consensus in the literature as to the extent of excision or the impact on reconstructive options. Breast-conserving surgery and simple mastectomy have each been described with mixed reports. Despite a shift toward the selective use of skin-sparing mastectomy and nipple-areola complex-sparing mastectomy in breast carcinoma, neither the role for these techniques nor the role for breast reconstruction in recurrent PT has been described. A case report is presented demonstrating the utility of skin-sparing mastectomy and autologous breast reconstruction for locally recurrent PT of the breast, with a literature review of management options in this setting presented. The case presented highlights an appropriate setting for autologous microsurgical reconstruction of the breast in recurrent PT. The literature review highlights a lack of any published management consensus, with only the role for mastectomy suggested for recurrent high-grade or malignant lesions. A potential management algorithm is thus presented. Skin-sparing mastectomy, particularly for intermediate-grade lesions, may allow wider resections while enabling aesthetically pleasing reconstructive options without affecting recurrence rates.