Bilateral breast fibromatosis: case report and review of the literature.

Fibromatosis or desmoid tumor is a benign, slow-growing fibroblastic neoplasm originating from musculoaponeurotic stromal elements. These tumors are characterized by an infiltrative and locally aggressive growth pattern, frequent recurrences, but no metastatic potential. The etiology is unknown, but these tumors have been associated with trauma and genetic disorders. Breast fibromatosis is exceedingly rare and often misdiagnosed, comprising only 0.2% of breast tumors. Clinically, it might mimic other breast lesions, such as carcinoma. Only approximately 6 case series and 100 case reports of this disorder affecting the breast are documented, and only 5 cases of bilateral breast fibromatosis have been reported. We describe the case of a 20-year-old woman who presented to our institution with firm, nontender masses palpable in both breasts. Prior ultrasound was suspicious for carcinoma, and breast core biopsies were suggestive of phyllodes tumor. An excisional biopsy was necessary to establish the diagnosis of breast fibromatosis for both masses. A review of articles published on desmoid tumors and breast fibromatosis was performed with emphasis on articles published in the last 10 years. Fibromatosis should be considered in the differential diagnosis of patients presenting with hard breast lumps suspicious of other diseases.

A system of multiple biopsy forceps.

AIM: A new system of flexible endoscopic biopsy forceps is described. These forceps are simple, cheap to produce, and disposable. DESIGN: These forceps take larger and less traumatized biopsies than do existing single biopsy forceps. The principle involves that of a central wire with a barbed spike at one end, to which sliding sprung steel jaws are attached. An outer plastic sleeve surrounds the central wire, and conventional-type handles activate the jaws. FUNCTION: The device is passed along the biopsy channel of a fiberoptic endoscope, and the tissue to undergo biopsy is visualized. Opening and closing of the forceps occurs when the outer sleeve slides on the inner wire allowing the sprung steel jaws to open and close. With the jaws open, the barb is pushed into the tissue to undergo biopsy. The fishhook-like barb pulls back the tissue into the jaws, which bite the tissue at an optimal angle and can thus obtain cleaner and bigger biopsies. For the second biopsy, the jaws are simply reopened, and as the barbed spike again pierces the tissue, the first specimen is pushed along the central wire. Up to 6 biopsies are to be stored in this way, in a predictable order, with a single passage of the biopsy forceps through the endoscope.

End-stage cardiac failure in a morbidly obese patient treated by biliopancreatic diversion and cardiac transplantation.

A 57-year-old 132-kg female (BMI 48.6) with end-stage cardiac failure is presented. Because of a progressive cardiomyopathy, the patient required a heart transplant. However, before receiving the transplant, major weight loss was deemed to be mandatory. Supervised dieting had manifestly failed, and thus a highly effective weight-reducing operation, biliopancreatic diversion, was performed. This resulted in a weight loss of 50.4 kg in 9 months. She then underwent successful cardiac transplantation, and progressed well for several months. She then developed severe psychiatric depression, withheld her medications and developed a lethal acute rejection phenomenon.