Diagnostic Difficulties and Complexities in the Management of Dermatofibrosarcoma Protuberans in the Breast: A Case Report and Review of the Literature.

Dermatofibrosarcoma protuberans (DFSP) is an extremely rare sarcoma with an incidence between 0.8-5.0 cases per one million persons per year. DFSP accounts for less than 0.1% of all malignancies and approximately 1-6% of all soft tissue sarcomas. Only a few cases of DFSP have been found within the breast tissue. We report a case of DFSP in a 30-year-old female within the left breast. The sarcoma presented as a painless, rubbery, mobile lump that gradually increased in size. It was initially identified on an ultrasound scan and subsequently confirmed with MRI and core biopsy. DFSP is a rare condition and treatment guidelines are not well established. The current recommendation is for surgical excision with 2-cm margins. Mastectomy may be considered in some circumstances. In our case, the aim was for surgical resection with 2-cm margins at both breast tissue and skin, but insufficient margins were taken. The recommendation for re-excision of the inadequate margins was declined. It is uncertain what the implications of this are given the lack of research on DFSP in the breast. Therefore, close surgical surveillance will be imperative. We present this case to highlight the difficulties associated with the diagnosis, treatment, and management of DFSP due to the lack of literature on this disease.

Idiopathic Portal Vein Thrombosis in a Non-cirrhotic Patient: A Discussion of Management and a Review of Literature.

Portal vein thrombosis (PVT) is most commonly seen in people with predisposing conditions such as cirrhosis, hepatobiliary malignancies, infectious or inflammatory abdominal disease, or haematologic disorders. However, the incidence of idiopathic portal vein thrombosis in non-cirrhotic people is low and approximately 25% of existing cases have no identifiable cause. If untreated, complications can include portal hypertension, a cavernous transformation of the portal vein, varices, septic thrombosis, or intestinal ischemia. We report the case of a 27-year-old female who presented to her general practitioner with two weeks of epigastric pain. She was referred for an upper abdominal USG and CT imaging, which identified portal vein thrombosis with a normal appearance of the gallbladder, liver, and spleen. Thrombophilia screen was negative for Factor V Leiden and prothrombin mutations and lupus anticoagulant. The tumour markers alpha-fetoprotein and carcinoembryonic antigen were also within normal limits. The patient was started on rivaroxaban indefinitely following advice from a vascular surgeon and haematologist. Subsequent follow-up imaging also revealed cavernous transformation of the portal vein. We present this case to discuss the diagnosis, management and treatment of this patient and to review the current evidence available in managing idiopathic portal vein thrombosis in non-cirrhotic patients, especially the role of anticoagulation in chronic cases.

Habitat transitions alter the adaptive landscape and shape phenotypic evolution in needlefishes (Belonidae).

Habitat occupancy can have a profound influence on macroevolutionary dynamics, and a switch in major habitat type may alter the evolutionary trajectory of a lineage. In this study, we investigate how evolutionary transitions between marine and freshwater habitats affect macroevolutionary adaptive landscapes, using needlefishes (Belonidae) as a model system. We examined the evolution of body shape and size in marine and freshwater needlefishes and tested for phenotypic change in response to transitions between habitats. Using micro-computed tomographic (µCT) scanning and geometric morphometrics, we quantified body shape, size, and vertebral counts of 31 belonid species. We then examined the pattern and tempo of body shape and size evolution using phylogenetic comparative methods. Our results show that transitions from marine to freshwater habitats have altered the adaptive landscape for needlefishes and expanded morphospace relative to marine taxa. We provide further evidence that freshwater taxa attain reduced sizes either through dwarfism (as inferred from axial skeletal reduction) or through developmental truncation (as inferred from axial skeletal loss). We propose that transitions to freshwater habitats produce morphological novelty in response to novel prey resources and changes in locomotor demands. We find that repeated invasions of different habitats have prompted predictable changes in morphology.

Leptomeningeal Metastases in Hormone Refractory Prostate Cancer.

Leptomeningeal metastases from the prostate are extremely rare, with few cases described in the medical literature (antemortem prevalence of less than 0.03%). Prostatic leptomeningeal metastases harbour a poor prognosis with a median survival after diagnosis of 15.7 weeks. We present the case of an 82-year-old male with a history of hormone-refractory prostate cancer who presented to the emergency department with neurological symptoms.