Syringomatous Adenoma of the Nipple with Associated Invasive Carcinoma: A Case Report.

Syringomatous adenoma of the nipple is a rare benign infiltrative neoplasm that was first described in 1983. At the time of this writing, a literature search revealed no cases of syringomatous adenoma of the nipple in association with invasive carcinoma of the breast. We report a case of syringomatous adenoma of the nipple in a 40-year old female who also had bilateral invasive ductal carcinoma and ductal carcinoma in situ of the breasts. Syringomatous adenomas of the nipple have been postulated to originate from eccrine structures of the nipple due to their microscopic similarity to other tumors of eccrine origin, such as syringomatous carcinoma. However, their exact origin is uncertain. Despite their benign behavior, they usually demonstrate an infiltrative and expansile proliferation into adjacent nipple and breast tissue. They have been confused with tubular carcinoma and low-grade adenosquamous carcinoma of the breast, both clinically and histologically. Complete excision is the therapy of choice, and only incompletely excised lesions have shown recurrence. We present this case to raise awareness that syringomatous adenoma of the nipple may present in patients with a simultaneous invasive carcinoma of the breast.

Sebaceous Adenocarcinoma in Parotid Gland of a 65-Year-Old.

Sebaceous adenocarcinoma of the parotid gland is a rare, malignant epithelial neoplasm with focal areas of sebaceous differentiation. A literature search revealed only 34 cases as of December 2020. Our case brings this total to 35. It is characterized as a partially encapsulated neoplasm with predominant areas of basaloid or squamous cells, and variable degrees of sebaceous differentiation. The sebocytes display an immunohistochemical staining pattern of EMA (cytoplasmic vesicles), CD15, lactoferrin, GCDFP-2, and androgen receptor positivity in the sebocytes. Bimodal peaks occur in the third and seventh decades of life. We present a case of sebaceous adenocarcinoma in a 65-year-old male who initially presented in the emergency department with hypertensive urgency and vertigo. MRI and CT scans showed a heterogeneous mass with a solid component and cystic areas, including calcifications that measured approximately 2.7 x 2.1 x 4.1 cm, predominantly in the deep part of the left parotid gland and extending upward to the adjacent sternocleidomastoid muscle and possibly infiltrating or abutting the muscle. Further questioning of the patient revealed a seven month history of a painless, slow-growing mass and increased sensation of fullness on the left side of his neck. Patient underwent a left total parotidectomy with flap reconstruction and left neck dissection, revealing a 6.0 x 4.4 x 2.2 cm left parotid gland with a 2.4 x 2.2 x 1.6 cm, well-circumscribed, multiloculated cystic mass that released red-brown serous fluid and thick yellow material and appeared to abut multiple resection margins. Microscopic examination showed nests of basaloid cells at the periphery and areas of distinct sebaceous differentiation, separated by bands of extensive hyalinization. The tumor also displayed an average of 2 mitotic figures per 10 high power fields, and less nuclear atypia and less invasiveness into the surrounding glandular tissue than what has been described in sebaceous adenocarcinomas. This is an unusual case because of the rarity of the tumor as well as the lack of nuclear atypia and invasiveness compared to what is described of sebaceous adenocarcinoma in the literature.

Patient Dissatisfaction Following Total Knee Arthroplasty: A Systematic Review of the Literature.

BACKGROUND: Dissatisfaction following total knee arthroplasty (TKA) is common. Approximately 20% of patients report dissatisfaction following primary TKA. This systematic literature review explores key factors affecting patient dissatisfaction following TKA. METHODS: Six literature databases published between 2005 and 1 January 2016 were searched using 3 key search phrases. Papers were included if the study investigated patient dissatisfaction in primary unilateral or bilateral TKA. Information from each article was categorized to the domains of socioeconomic, preoperative, intraoperative, and postoperative factors affecting patient dissatisfaction. RESULTS: This review found that patient dissatisfaction pertains to several key factors. Patient expectations prior to surgery, the degree of improvement in knee function, and pain relief following surgery were commonly cited in the literature. Fewer associations were found in the socioeconomic and surgical domains. CONCLUSION: Identifying who may be dissatisfied after their TKA is mystifying; however, we note several strategies that target factors whereby an association exists. Further research is needed to better quantify dissatisfaction, so that the causal links underpinning dissatisfaction can be more fully appreciated and strategies employed to target them.