Inflammatory and Infectious Diseases of the Breast: Clinical Presentation, Imaging Features and Management Strategies

Background: Mucormycosis is a rare but aggressive opportunistic fungal infection that predominantly affects immunocompromised individuals, particularly patients with diabetes mellitus. Poor glycemic control creates a favorable environment for fungal proliferation, leading to rapid disease progression and high mortality. The rising incidence of mucormycosis among diabetic patients highlights the need for a detailed evaluation of its clinical presentation, management strategies, and outcomes. Objective: To assess the clinical features, diagnostic approaches, management strategies, and treatment outcomes of mucormycosis among diabetic patients presenting to the Department of ENT, Hayatabad Medical Complex, Peshawar. Methodology: A retrospective observational cohort study was conducted involving 250 diabetic patients diagnosed with mucormycosis between June 2023 and June 2024. Data were collected from medical records, including demographic characteristics, clinical presentation, diagnostic modalities, treatment strategies, and outcomes. A prospective follow-up of six months was performed to evaluate recovery and mortality. Statistical analysis was carried out using SPSS version 25.0, with significance set at p < 0.05. Results: The rhino-orbital-cerebral form was the most common clinical presentation, affecting 72% of patients. Pulmonary, cutaneous, and disseminated forms were less frequent. Complete recovery was observed in 40%, partial recovery in 36%, while 24% of patients died. Uncontrolled diabetes showed a statistically significant association with increased disease severity and mortality. Conclusion: Mucormycosis represents a serious and often fatal complication among diabetic patients, particularly those with poor glycemic control. Early diagnosis, aggressive antifungal therapy, timely surgical intervention, and stringent diabetes management are critical to improving patient outcomes. These findings provide valuable insight for optimizing clinical management strategies in resource-limited settings. Keywords: Diabetes Mellitus, Glycemic Control, Mucormycosis, Rhino-Orbital-Cerebral, Treatment Outcomes.

Background: Nontraumatic perforation of the ileum is still a difficult surgical emergency, which remains an important issue in regions where infectious diseases and chronic inflammatory conditions are prevalent. Moreover, patients commonly seek medical attention when symptoms have advanced with little time for delay. Untimely diagnosis or operative intervention may result in rapid deterioration of the clinical course and increased morbidity and mortality. It is important to gain a better insight into the way in which these patients present together with the conditions leading to preperforation and the intraoperative findings. These insights can help in the early detection and better decision-making of management. Objective: The aim of this study was to outline the clinical features, etiological factors, surgical approaches and postoperative outcomes in individuals treated for non-traumatic ileal perforation at a tertiary care centre. Methods: This ambispective observational study was conducted in the Department of General Surgery of a tertiary teaching hospital and included 157 patients in whom non-traumatic perforation of the ileum was confirmed during surgery. The cohort comprised both retrospectively identified cases and prospectively recruited participants. Information was collected on demographic characteristics, symptom duration, findings on clinical examination, laboratory results, imaging features, operative details, procedure undertaken, postoperative course and histopathological reports. All collected data were entered into a statistical database and analysed using SPSS software. Continuous variables were summarised using means with standard deviations or medians with interquartile ranges, based on distribution. Comparative analyses were performed to explore associations between factors such as time to hospital presentation, underlying aetiology, severity of peritoneal contamination and postoperative complications or death. Chi-square or Fisher’s exact tests were used for categorical variables, while independent t-tests or Mann-Whitney U tests were applied for continuous variables. Statistical significance was set at p < 0.05. Results: All patients had acute abdominal pain with either localized or widespread tenderness and several had pneumoperitoneum on imaging. There was significant variance in the time between the beginning of symptoms and operation and longer delays were substantially linked to more problems. The majority of patients had one or more ileal perforations with fecal or purulent contamination. While resection with anastomosis or stoma formation was reserved for gangrene, multiple perforations, cancer or tuberculous disease, primary closure was the most common technique. The most common postoperative complications were enterocutaneous fistula, surgical site infection and anastomotic leak. The most frequent causes were found to be cancer and typhoid illness. Higher complication rates were observed in patients with late presentation, severe contamination and malignant or tuberculous pathology. Mortality was linked to older age, septic shock and significant delays in operative management. Conclusion: The diagnosis and treatment of non-traumatic ileal perforation remain extremely difficult. Improving survival still requires prompt detection, vigorous resuscitation and early surgical surgery. While primary closure is adequate for straightforward perforations, complex etiologies often demand resection-based procedures. Routine histopathological assessment is crucial for defining the underlying cause and directing further management.

Laryngeal schwannoma is a rare type of neurogenous tumour with a non-specific presentation. We present a case of a middle-aged man with issues of hoarseness, globus sensation and intermittent episodes...

Bipartite medial cuneiform bone (BMC) is located at the Lisfranc joint of the midfoot, and it represents a rare variant involving two separate ossification centers in the medial cuneiform bone. Although BMC is typically asymptomatic, it can become clinically relevant under conditions of trauma or chronic stress, affecting foot stability. The current imaging report describes a 48-year-old female presenting with chronic dorsal midfoot pain, worsened by extended standing and ambulation. Physical examination indicated mild tenderness without swelling or ecchymosis. Magnetic resonance imaging (MRI) revealed a BMC with degenerative changes around the synchondrosis, indicating abnormal weight-bearing stress across the cuneiform segments. The patient underwent conservative management with nonsteroidal anti-inflammatory drugs (NSAIDs) and restricted weight-bearing, leading to a reduction in pain over four weeks. Surgical options, including excision and fusion, were discussed but reserved for potential recurrence and persistence. The present report further explores BMC's anatomical features, including its differentiation from fractures through imaging. BMC's horizontal cleavage plane, well-corticated edges, and distinct articulations differentiate it from a traumatic fracture. Current literature on managing symptomatic BMC is limited, with treatment options varying from conservative approaches to surgical interventions for persistent symptoms. The present case highlights the importance of considering BMC in the differential diagnosis of midfoot pain or instability. Additionally, it enhances our understanding of the anatomical aspects of BMC and offers valuable insights into its clinical presentation, imaging characteristics, and management strategies.

Background: Cardiovascular toxicity is a common complication of fluoropyrimidine therapy, with angina from coronary vasospasm being the most frequent adverse effect. Despite its prevalence, risk factors and management strategies remain poorly defined, leading to inconsistent clinical approaches among different institutions. This study aims to characterize the clinical features, management, and outcomes of patients who developed fluoropyrimidine-induced angina at the Cleveland Clinic. Methods: We conducted a retrospective, single-center study of patients who developed angina during fluoropyrimidine therapy between 2017 and 2023. Patients with clear non-cardiac chest pain were excluded. Clinical presentation, management strategies, and treatment outcomes were collected. Logistic regression was used to identify predictors of chest pain recurrence among patients who were re-challenged following first angina. Results: A total of 137 patients were included. Mean age was 62.4 years, and 50.4% were male. The majority had colorectal cancer (54%). Among those, 61.3% received IV 5-fluorouracil, while 38.7% received oral capecitabine. Most events occurred during the first four treatment cycles (75.2%). At presentation, 43.3% had new ischemic changes on electrocardiogram, and 39% of those who underwent echocardiography had new abnormalities. Left heart catheterization was performed in 24.1% of cases, with most revealing normal or only mild coronary artery disease. Fluoropyrimidine therapy was discontinued in 35.9% of patients, while 64.1% were re-challenged. Among re-challenged patients, 35.7% experienced recurrence of chest pain. No clinical, oncologic, or treatment-related variables were significantly associated with recurrence. Conclusion: This study highlights our experience in managing fluoropyrimidine-induced angina. While re-challenge is frequently pursued, recurrence of chest pain remains common and unpredictable, with no clear clinical or treatment-related predictors identified. These findings highlight the need for better risk stratification and standardized management strategies in a common toxicity in a high-risk population.

Simple SummaryOrbital metastases may significantly worsen the functional status of oncological patients, leading to debilitating visual impairments. Surgical resection, orbital exenteration, and complementary therapies may result in heterogeneous clinical outcomes. In this systematic review, we aimed to comprehensively analyze the current literature on orbital metastases, describing clinical and imaging features, available management, and treatment outcomes. We found that most orbital metastases occur at later stages after primary tumors, frequently showing diffuse location within the orbit and rarely invading intracranial structures. Biopsy-only techniques were more frequently preferred in view of the less invasive approaches, but surgical resection and orbital radiotherapy were related to improved clinical outcomes. Although patients with primary breast cancer and patients undergoing resection showed superior prognoses, overall survival rates were generally poor, suggesting the need to better understand orbital metastases’ microenvironments for devising optimal systemic treatment strategies.Background: Orbital metastases often lead to severe functional impairment. The role of resection, orbital exenteration, and complementary treatments is still debated. We systematically reviewed the literature on orbital metastases. Methods: PubMed, Scopus, Web-of-Science, and Cochrane were searched upon PRISMA guidelines to identify studies on orbital metastases. Clinical characteristics, management strategies, and survival were analyzed. Results: We included 262 studies comprising 873 patients. Median age was 59 years. The most frequent primary tumors were breast (36.3%), melanoma (10.1%), and prostate (8.5%) cancers, with median time interval of 12 months (range, 0–420). The most common symptoms were proptosis (52.3%) and relative-afferent-pupillary-defect (38.7%). Most metastases showed a diffuse location within the orbit (19%), with preferential infiltration of orbital soft tissues (40.2%). In 47 cases (5.4%), tumors extended intracranially. Incisional biopsy (63.7%) was preferred over fine-needle aspiration (10.2%), with partial resection (16.6%) preferred over complete (9.5%). Orbital exenteration was pursued in 26 patients (3%). A total of 305 patients (39.4%) received chemotherapy, and 506 (58%) received orbital radiotherapy. Post-treatment symptom improvement was significantly superior after resection (p = 0.005) and orbital radiotherapy (p = 0.032). Mean follow-up was 14.3 months, and median overall survival was 6 months. Fifteen cases (1.7%) demonstrated recurrence with median local control of six months. Overall survival was statistically increased in patients with breast cancer (p < 0.001) and in patients undergoing resection (p = 0.024) but was not correlated with orbital location (p = 0.174), intracranial extension (p = 0.073), biopsy approach (p = 0.344), extent-of-resection (p = 0.429), or orbital exenteration (p = 0.153). Conclusions: Orbital metastases severely impair patient quality of life. Surgical resection safely provides symptom and survival benefit compared to biopsy, while orbital radiotherapy significantly improves symptoms compared to not receiving radiotherapy.

Background: Parathyroid cysts (PCs) are rare lesions that often resemble other cervical cystic conditions, making preoperative diagnosis challenging, especially in resource-limited settings. Methods: We report a case of a parathyroid cyst diagnosed and treated at Chongqing University Fuling Hospital in 2020. Clinical presentation, imaging, cytological features, pathological findings, differential diagnosis and management strategies were analyzed in conjunction with an updated review of the literature. Conclusion: PCs represent a rare subset of parathyroid lesions and are most often non-functioning. Their imaging and cytological characteristics frequently resemble those of thyroid cysts, which may lead to misdiagnosis. Measurement of parathyroid hormone levels in aspirated cyst fluid is essential when a PC is suspected. Surgical excision remains the definitive treatment. This case underscores the diagnostic challenges and highlights the importance of heightened clinical awareness, particularly in primary and rural healthcare settings.

Nerve sheath myxoma (NSM) is a rare benign tumor originating from peripheral nerves. We present a case of NSM in the upper extremity. A 67-year-old female presented with painful nodular bulging in the elbow. Magnetic resonance imaging and ultrasonography revealed diagnostic features. Surgical excision was performed and histopathological examination confirmed the diagnosis. Our case contributes to the understanding of NSM's clinical presentation, imaging characteristics, and management strategies of NSM.

Background:Coronary artery disease is the leading cause of mortality in India. There is scarcity of data on demographic profile and outcomes of acute coronary syndrome (ACS) in low socioeconomic status (SES) population of India.Objectives:This study was undertaken to determine the clinical presentation, management strategies, and in-hospital outcomes of ACS in low SES population.Methods:We conducted 1-year prospective observational cohort study of ACS patients admitted at Employees State Insurance Corporation unit of our tertiary care cardiac center. Clinical parameters, management strategies, and in-hospital outcomes of 621 patients enrolled during the study period from February 2015 to January 2016 were studied.Results:Mean age of patients was 56.06 ± 11.29 years. Majority (62%) of the patients had ST elevation myocardial infarction (STEMI), whereas Non-ST elevation acute coronary syndrome (NSTE-ACS) was seen in 38% of the patients. Median time from symptom onset to hospital admission was 285 min with wide range from 105 to 1765 min. Coronary angiography was performed in 81% of patient population. Single-vessel disease (SVD) was the most common pattern (seen in 43.3%) of coronary artery involvement with left anterior descending coronary artery (LAD) being the most frequently involved vessel (62.8%). Pharmaco-invasive approach was the preferred strategy. Overall percutaneous coronary intervention (PCI) rates were 59.1% (62.1% in STEMI and 54.2% in NSTE-ACS). Overall in-hospital mortality was 3.2%, being significantly higher in STEMI (4.2%) as compared with NSTE-ACS (1.7%).Conclusions:With implementation of evidence-based pharmacotherapy and interventions, outcomes comparable with developed countries can be achieved even in low SES populations of developing world.

Background/Introduction Pulmonary embolism (PE) is caused by blockage of pulmonary arteries by thrombus. The sources of thrombus are thought to be mostly veins in lower extremities, whereas deep vein thrombosis (DVT) in upper extremities rarely occurs spontaneously. Recent studies reported that DVT in upper extremities might have significant complications, and DVT in upper extremities could be increasing. However, there is a paucity of data on patients with DVT in upper extremities, leading to uncertainty in optimal treatment strategies including anticoagulation therapy. Purpose We sought to evaluate the clinical characteristics, management strategies, and long-term outcomes of patients with DVT in upper extremities in a large observational database in Japan. Methods The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic venous thromboembolism (VTE) objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. The current study population consisted of 2498 patients with DVT in upper or lower extremities, after excluding 381 patients with PE only, 144 patients who had thrombus in locations other than upper or lower extremities, and 4 patients with DVT in both upper and lower extremities. The study patients were divided into 2 groups: patients with DVT in upper extremities and patients with DVT in lower extremities. We compared the clinical characteristics, management strategies and long-term outcomes between the 2 groups. Results There were 74 patients (3.0%) with upper extremities DVT and 2498 patients (97%) with lower extremities DVT. Patients with upper extremities DVT more often had active cancer at diagnosis (58%) and central venous catheter use (22%). The proportion of concomitant PE at diagnosis was lower in patients with upper extremities DVT than in those with lower extremities DVT (14% and 51%, P&lt;0.001). Discontinuation of anticoagulation therapy was more frequent in patients with upper extremities DVT (63.8% and 29.8% at 1-year, P&lt;0.001). The cumulative 3-year incidence of recurrent VTE was not different between the 2 groups (9.8% and 7.4%, P=0.43) (Figure). After adjusting confounders, the risks of upper extremities DVT relative to lower extremities DVT for recurrent VTE remained insignificant (HR 0.94, 95% CI 0.36–2.01, P=0.89). Kaplan-Meier event curves for recurrence Conclusions The prevalence of patients with DVT in upper extremities was 3.0% in the current large-scale real-world registry. Patients with DVT in upper extremities more often had active cancer at diagnosis and central venous catheter use as a transient risk factor for VTE, and less often had concomitant PE. Patients with DVT in upper extremities had similar long-term risk for recurrent VTE as those with DVT in lower extremities despite shorter duration of anticoagulation. Acknowledgement/Funding Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

BackgroundWomen with ST-segment elevation myocardial infarction (STEMI) had worse outcomes than men prior to the COVID-19 pandemic. Although concomitant COVID-19 infection increases mortality risk in STEMI patients, no studies have evaluated sex differences in this context.MethodsThe North American COVID-19 STEMI registry is a prospective, multicenter registry of hospitalized STEMI patients with COVID-19 infection. We compared sex differences in clinical characteristics, presentation, management strategies, and in-hospital mortality.ResultsAmong 585 patients with STEMI and COVID-19 infection, 154 (26.3%) were women. Compared to men, women were significantly older, had a higher prevalence of diabetes and stroke/transient ischemic attack, and were more likely to be on statins on presentation. Men more frequently presented with chest pain, whereas women presented with dyspnea. Women more often had STEMI without an identified culprit lesion than men (33% vs 18%, P < .001). The use of percutaneous coronary intervention was significantly higher in men, whereas medical therapy was higher in women. In-hospital mortality was 33% for women and 27% for men (P = .22).ConclusionsIn patients presenting with STEMI in the context of COVID-19, the in-hospital mortality rate was 30% and similar for men and women. Lack of an identifiable culprit lesion was common in the setting of COVID-19 for both sexes but more likely in women (1/3 of women vs 1/5 of men). Evaluation of specific underlying etiologies is underway to better define the full impact of COVID-19 on STEMI outcomes and better understand the observed sex differences.

Background: Granulosa cell tumors (GCTs) are rare neoplasms with predominantly low malignant potential, primarily affecting peri-menopausal individuals. This case series investigates six patients diagnosed with GCT, emphasizing clinical features, prognostic markers, and treatment strategies. Methods: This retrospective analysis focuses on patients diagnosed with GCT at Safdarjung Hospital between June 2022 and June 2023. Data collection included demographics, clinical presentations, diagnostic findings, treatment modalities, and follow-up outcomes. Results: The case series comprised various presentations, ranging from asymptomatic masses to complications such as ovarian torsion and tumor rupture. Most patients presented with hormonally active tumors, predominantly producing estrogen. Surgical management, including unilateral salpingo-oophorectomy or total abdominal hysterectomy with bilateral salpingo-oophorectomy, was the primary treatment modality. Prognostic factors such as tumor size, stage, and mitotic index were identified, guiding clinical decision-making. Close surveillance post-surgery was essential due to the potential for late recurrences. Conclusion: This case series enhances understanding of ovarian GCTs, providing insights into their clinical management and prognosis. Early detection, prognostic marker assessment, and vigilant surveillance are crucial for optimizing patient outcomes

Heterogeneous mutations in dentin sialophosphoprotein (DSPP) gene, which is located on autosome 4, are associated with hereditary dentin developmental disorders. According to the new classification proposed by de La Dure-Molla et al, diseases caused by DSPP gene mutations mainly manifested as abnormal dentin development are collectively referred to as dentinogenesis imperfecta (DI), including dentin dysplasia type Ⅱ (DD-Ⅱ), dentinogenesis imperfecta type Ⅱ (DGI-Ⅱ) and dentinogenesis imperfecta type Ⅲ (DGI-Ⅲ) in Shields classification. And dentin dysplasia type Ⅰ (DD-Ⅰ) in Shields classification is redesignated as radicular dentin dysplasia. In this paper, progress in the classification, clinical characteristics and genetic mechanisms of DI are reviewed. This paper also provides clinical management and treatment strategies for patients suffering DI.

Coccidioidomycosis and histoplasmosis are endemic mycoses caused by the Coccidioides species and Histoplasma capsulatum, respectively. While these fungal infections are often associated with immunocompromised individuals, they pose significant risks to immunocompetent hosts. This review comprehensively analyzes these infections in immunocompetent individuals, focusing on clinical features, diagnostic approaches, and management strategies. The current understanding of coccidioidomycosis and histoplasmosis in immunocompetent individuals includes their clinical presentations, diagnostic methodologies, and treatment options. A literature review encompassed recent studies, clinical guidelines, and expert opinions. Data were analyzed to highlight critical aspects of the clinical manifestations, diagnostic processes, and management of these infections in immunocompetent patients. Coccidioidomycosis typically presents with pulmonary symptoms that may range from mild to severe and can include chronic and disseminated forms. Histoplasmosis also presents a spectrum of pulmonary symptoms with the potential for extrapulmonary dissemination. Diagnostic approaches for both infections involve clinical evaluation, serological tests, culture, and imaging studies. Management strategies include antifungal therapies such as fluconazole and itraconazole for coccidioidomycosis and itraconazole and amphotericin B for histoplasmosis, with treatment duration and monitoring tailored to the severity of the infection. Coccidioidomycosis and histoplasmosis can significantly affect immunocompetent individuals, with clinical presentations varying widely from mild to severe. Accurate diagnosis and appropriate management are crucial for optimal outcomes. This review underscores the importance of awareness and timely intervention in managing these endemic mycoses and highlights the need for continued research into better diagnostic and therapeutic approaches.

Isolated cecal necrosis (ICN) represents a rare yet clinically significant variant of ischemic colitis, characterized by ischemic injury to the cecal region due to prolonged disruption of intestinal blood flow. While ICN can arise from various causes, including atherothrombotic occlusions in cecal arteries and non-occlusive factors such as shock or chronic diseases, its pathogenesis remains multifactorial. Clinical presentation often mirrors acute appendicitis, with patients typically presenting with sudden right lower quadrant abdominal pain. Prompt diagnosis and surgical intervention are paramount to mitigate the risk of cecal perforation and improve patient outcomes. However, preoperative diagnosis can be challenging due to non-specific radiological findings, necessitating urgent surgical resection of the affected intestine. Despite documented cases in the literature, knowledge regarding ICN remains limited, underscoring the importance of detailed case reporting to enhance disease understanding and refine diagnostic and therapeutic approaches. Here, we present a retrospective analysis of 7 ICN cases diagnosed in our hospital between 2019 and 2024, aiming to contribute insights into the clinical spectrum, management strategies, and outcomes associated with ICN. Our study revealed a diverse array of clinical presentations, radiological features, surgical interventions, and pathological findings among ICN patients. Hypertension and diabetes mellitus emerged as common comorbidities, with acute abdomen and abdominal pain being predominant symptoms. Radiologically, cecal wall thickening was frequently observed. Surgical management predominantly involved right hemicolectomy, with varying techniques employed. Pathological examination unveiled histological alterations indicative of ischemic necrosis, inflammation, and perforation. Our findings underscore the importance of considering ICN in the differential diagnosis of acute abdominal pain, particularly in elderly patients with predisposing risk factors. Further research efforts are warranted to elucidate its pathophysiological mechanisms and optimize therapeutic approaches.