Paraneoplastic polymyositis presenting as a clinically occult breast cancer.

Paraneoplastic syndrome affects less than 1% of cancer patients. Diagnosis of paraneoplastic syndrome with neurological presentation requires screening for an underlying malignancy, including a complete history, physical examination and imaging studies. Treatment often results in symptom stability, rather than improvement. Paraneoplastic polymyositis can precede or instantaneously occur at diagnosis or treatment of a primary tumour, while neurological symptoms can persist even following cancer treatment. We report a rare case of metaplastic breast carcinoma with an unusual presentation of paraneoplastic polymyositis.

A case report on over-replacement of oral calcium supplements causing acute pancreatitis.

A 42-year-old female teetotaller presented via the accident and emergency department with a 2-day history of vomiting and upper abdominal pain. She was diagnosed with acute pancreatitis. The aetiology of the pancreatitis was identified as hypercalcaemia secondary to oral calcium supplementation. The hypercalcaemia was corrected by stopping calcium supplements and aggressive fluid resuscitation. A thorough literature search did not show any case reports in which the aetiology of pancreatitis was oral calcium supplement over-replacement.

Mucin lakes or perforation?

We are reporting two cases with similar appearances on post chemo radiotherapy MRI scan of the mucinous adenocarcinoma. There was high signal on T2-weighted sequences of the mucin pools within and beyond the rectal wall. Does this imply that wall tissues become less resistant to cancer pools intrusion after chemo radiation? Does the high intramural pressure have an impact on the protrusion of the cancer pools beyond the muscularis propria? Final histology reports differ from predicted MRI staging. It highlights the difficulty of the final MRI staging and outcome for mucinous adenocarcinomas. The presence of acellular mesothelial reaction, acellular mucin pools and inflammation extending to the serosal surface causes considerable confusion and may result in over staging or under staging of mucinous adenocarcinoma. Pathogenesis and prediction of the mucin lakes behaviour prior and post chemoradiotherapy is unclear and requires future study but may impact surgical management.