Lump In Left Breast Research Articles

Male’s Primary Breast Lymphoma: Rare Entity of Breast Malignancy, Wad Madani Teaching Hospital, Gezira State, Sudan, August 2023

<i>Background</i>: Primary breast lymphoma is a malignant lymphoma primarily involving breast in absence of previously detected lymphoma localizations. <i>Method</i>: A male of forty years old admitted to Department of Surgery; Wad Madani Teaching Hospital; Gezira State; Sudan; complaining of left breast lump for three months. Condition observed as a painful swelling in left breast, increasing gradually in size, associated with continuous high-grade fever, no rigors and relieved by analgesia, no nipple discharges. Had significant weight loss, anorexia, fatigability, back pain, dry cough with no hemoptysis, no history of headache, and no past or family history of similar condition. Examination: patient looks ill, pale, and not jaundiced. Breast examination: Left breast was larger than right one. Left breast: no nipple destruction, nipple was directed downward medially, no skin changes or dimpling, and no ulceration. There was a mass in left upper outer quadrant, measuring 6*7 cm, smooth surface, hard in consistency with well-defined edges, and attached to muscles but not to skin. No palpable axillary lymph nodes. Right breast was normal. Chest and abdominal examination were unremarkable. Investigations: Fine needle aspiration cytology showed poorly differentiated carcinoma. Incisional biopsy revealed: high grade Non-Hodgkins Lymphomas (Diffuse Large B Cell Lymphoma). He was referred to oncological department for neoadjuvant chemoradiotherapy. Conclusion and <i>Recommendation</i>: Primarily breast lymphoma is extremely rare among male, showing features mimicking breast carcinoma. Incisional biopsy was recommended for investigation of breast lump especially among males.

Case study on 19-year-old female with Mc-Cune Albright syndrome

McCune-Albright syndrome is a genetic condition that affects your skin, bones and endocrine system (endocrine organs). It causes scars on bones, skin pigmentation and elevated function of growth-regulating hormonal glands. This can be mild in few people and quite severe to life-threatening in others. This syndrome can affect any age group of people like children, adults and old population due to some genetic mutations. These mutations can be sudden and unpredictable. We have come across a rare case called McCune-Albright syndrome where a 19-year-old female presented with chief complaints of lump in left breast associated with pus discharge sine a week. There have been changes in the skin and there is no history of retraction of nipple and any swelling in axilla, neck and opposite breast. Patient has gone to the doctor when she found a lump one month back, doctor has advised some of the diagnostic tests but she completely ignored and after one month she came to the hospital and has been admitted in the general ward. She was treated with vitamin supplements, antibiotics, antacids, NSAIDS.). The surgery procedure is simple mastectomy of left breast. This is done due to the fibro adenoma present in left breast. The patient was recovered in 10 days.

Secretory carcinoma of breast: No more a juvenile tumor

: Secretory breast carcinoma (SBC) is one of the rare breast neoplasm with an incidence rate of < 0.15% of all breast cancers. Previously it was described as juvenile breast carcinoma. Young children and adolescent girls are most commonly affected. It is characterized by balanced translocation t (12;15), ETV6-NTRK3 gene fusion. : A 45 -year-old female presented with palpable lump in left breast. FNAC was suggestive of mucinous carcinoma. The diagnosis of SBC was made through histopathology and Immunohistochemistry: Recent study report suggested that the disease may also occur at a later age group in contrast to the conventional thought of onset at juvenile age group. Long-term survival is good for these cases. In radiological studies of breast imaging it mimics a benign tumour Immuno-histochemistry and cytogenetic are of the tumour are the ancillary investigations for confirmation of diagnosis. : Although rare diagnosis of SBC can be confirmed by histopathological studies and IHC. It is slowly progressive but has a good prognosis.

Neurofibroma of breast- A rare case report

Neurofibroma are benign tumour of peripheral nerve sheath that are mostly sporadic. Solitary neurofibromas of breast are uncommon. In this study, a case of 21-year-old female was referred with complaint of hyper pigmented lump in left breast since birth with recent increase in size for 5 months. Ultrasonography revealed a well-defined hypoechoic Space occupying lesion in subcutaneous plane at 11’o clock position of left breast along with a large ill-defined hypoechoic area with normal vascularity noted extending from 11’o clock to 2’o clock areas in left breast. Microscopically, the underlying stroma showed proliferating spindle cells with interspersed collagen bundles. Spindle cells show bland serpentine (wavy dark) nuclei and scant cytoplasm.

1269 A Rare Case of Bilateral Phyllodes Tumour of the Breast

Abstract Introduction Phyllodes tumours are rare breast fibroepithelial neoplasms. More rare presentations of these tumours include bilateral disease. Surgical excision with clear margins is the treatment of choice. Case Summary We report a case of a 60-year-old female with bilateral asynchronous breast Phyllodes. She initially underwent an excision of a left breast lump that revealed a borderline malignant Phyllodes. Six years later she presented with a lump in her right breast for three months and underwent a lumpectomy that revealed a malignant Phyllodes. Subsequently she had an excision of the inferior margin, and a staging computed tomography scan showed no evidence of metastasis. She was referred for genetic testing and adjuvant radiotherapy. Discussion In conclusion, bilateral representation of Phyllodes is rare and this is one of few cases reported in literature. In view of limited evidence available, the management of these patients is quite challenging. The indication of radiotherapy and chemotherapy in managing these tumours remains controversial and highlights the need for clear guidelines.

Breast metastasis as the first presentation of an anorectal melanoma diagnosed on fine needle aspiration cytology: a case report

BackgroundPrimary anorectal melanoma is a rare and aggressive disease accounting for approximately 1–3% of all colorectal and anal cancers.Case reportWe present a unique case of anorectal melanoma where the primary presentation was the metastatic breast lump which led to the detection of the primary tumor. A 70-year-old elderly postmenopausal female presented with complaint of left breast lump. On fine needle aspiration cytology, May Grunwald-Giemsa and Papanicolaou stained smears examined were highly cellular and showed sheets, clusters and singly scattered highly pleomorphic plasmacytoid cells having high nucleus to cytoplasmic ratio and scant to moderate cytoplasm with enlarged eccentric round to ovoid nuclei. Immunocytochemistry performed on cell block preparation showed tumor cells strongly positive for HMB-45, S-100 and negative for ER, PR, Her2neu, chromogranin, synaptophysin and Pan-CK. A thorough work up of the patient to look for the site of primary malignancy was done and radiological findings reveled presence of an ill-defined soft tissue mass in the anal canal. Biopsy from the anal mass confirmed the diagnosis of anal melanoma with metastasis to breast.ConclusionThe present case was reported to emphasize the importance of atypical presentation where the breast lump was the primary presentation of an anal melanoma. Therefore, we should have a strong index of suspicion for metastatic tumors in case of a breast lump especially when there is unusual morphology or unexpected immunophenotype, particularly if the neoplasm is triple-negative, in patients with a previous history of other malignancies.

Mastitis Tuberkulosis Primer

Objectives : Tuberculous (TB) mastitis is an uncommon presentation of TB even in countries where the incidence of pulmonary and extrapulmonary TB is high. It accounts for < 0.1% of all breast pathologies and <2% of all cases of tuberkulosis. Case presentation : A 25-year-old female presented a palpable lump in the upper-outer quadrant left breast, measuring about 3 cm and accompanied by retraction of the adjacent skin. Conclusion : Tuberculous mastitis is a rare and results from direct infection via the breast ducts opening to the nipple or from breast skin abrasions. Breast sonography and fine needle aspiration biopsy have been used for diagnostic of tuberculous mastitis.

Inflammatory myofibroblastic tumor of right leg and calcified fibroadenoma of left breast removed from a postmenopausal-women: a rare case report and review of literature

Inflammatory myofibroblastic tumors are uncommon neoplasms; presentation of these tumors in the lower extremities is extremely rare. Treatment varies depending on type, location and patient factor. Here the case of 60-year-old female post-menopausal (P2L2) presented with swelling over anterior aspect of right leg which was exophytic in nature and left breast lump. Combined histopathology and immunohistochemistry findings favoured myofibroblastic tumor of borderline category- inflammatory myofibroblastic tumor. Mammography of left breast showed presence of fibroadenoma at 12 o’ clock position. Patient underwent wide local excision of right leg swelling followed by split thickness skin grafting and excision of left breast swelling (lumpectomy). Inflammatory myofibroblastic tumors are of varied biologic potentials. They are generally classified as tumours of intermediate biological activity with uncertain malignant potential. There are many factors which affect treatment and prognosis of the patient. Five types of standard treatment for sarcoma are used: surgery, radiation therapy, chemotherapy, targeted therapy, immunotherapy. Fibroadenomas are benign breast neoplasms, typically present in women from ages of 20-35 years old (premenopausal).

Primary mucinous cystadenocarcinoma of breast with sternal metastasis: A diagnostic challange

The WHO categorizes the breast tumors in various distinct histological types based on cell morphology and architecture. A widely accepted fact that the aggressive nature of the breast cancer can be determined by its histological type, grade, nodal status, and metastasis holds the ground even in the era of immunohistochemistry (IHC) and molecular. An extremely rare variant of primary breast carcinoma belongs to the family of mucin producing carcinoma sharing the same histology as the mucinous cystadenocarcinoma of the ovary and pancreas. The tumour typically occurs in postmenopausal women with a median patient age of 61 years. Due to the rarity of these tumors, there is an extreme paucity of literature on this topic. We report a case of 35 year old female with left breast lump and presternal swelling. Breast lumpectomy and total sternectomy was done and final diagnosis was given as Primary mucinous cystadenocarcinoma with sternal metastasis and Estrogen receptor (ER) and Progesterone receptors (PR) positivity.

CLINICO PATHOLOGICAL ANALYSIS ON PAPILLARY CARCINOMA BREAST

Background : Papillary carcinoma of breast is rare and account for approximately 1-2% of newly diagnosed cases of breast cancers. The common age group of presentation is 6-7th decade. These tumours usually present with a painless retroareolar swelling associated with bloody nipple discharge in 50% cases. Case 1) 57 year old most Cases : menopausal woman presented with huge ulcerative lump in right breast over a period of 1 year. After confirming diagnosis with incisional biopsy, patient was proceeded with Neoadjuvant Chemotherapy (NACT) followed by Right MRM with SSG. Case 2) 66 year old male patient came with complaints of bloody discharge from nipple for past 1 year. A small subcentimetric lump present in retroareolar region on left breast was present, on which USG guided CNB revealed Invasive Ductal Carcinoma. Patient was proceeded with Left MRM. Case 3) 65 year old male patient presented with painless lump in left breast for 3 months. Clinical examination revealed a 1*2 cm lump in left breast with a single mobile ipsilateral axillary node. Image guided CNB revealed Invasive Papillary carcinoma. Patient was taken up for upfront Left MRM. All 3 patients are on regular follow-up for more than a year, and no recurrence is noted on followup

A CASE OF BREAST MYOFIBROBLASTOMA - A RARE DIAGNOSIS ON HISTOPATHOLOGY

INTRODUCTION: Myofibroblastoma is a benign mesenchymal tumor originally described in the male breast but also occurring in the female breast. CASE REPORT: A 15 years old male present in surgery department with complain of left breast lump since 10 days. It was non tender and mobile. USG: Subcutaneous swelling. FNAC: fibrofatty tissue. DISCUSSION: Myofibroblastoma is a benign mesenchymal tumor originally described in the male breast but also occurring in the female breast.

Primary tuberculosis of the breast from mankweng hospital

Object of study: To share our experience with a rare case of Primary Tuberculosis of Breast.
 The problem to be solved: Tuberculosis of the breast is a rare type of extrapulmonary tuberculosis and usually affects young lactating multiparous women. It accounts for less than 0.1 % of all breast pathologies. Tuberculosis of the breast is often misdiagnosed. Therefore, a high index of suspicion is needed when evaluating cases of breast abscesses, fistulae, or mass.
 Main scientific results: A case of a 27-year-old female with no known co-morbidities, HIV negative who presented to our Surgical Outpatient Department with a 1-year history of a painless left breast lump. No previous history of pulmonary tuberculosis was reported. Breasts ultrasonography indicated BIRADS (Breast Imaging-Reporting and Data System) V: lesion highly suspicious of malignancy. Histopathological analysis of the core biopsy showed features of a necrotizing granulomatous mastitis with adjacent fat necrosis. Ziehl-Neelsen stain was negative though histological results were worrisome of a mycobacterial infection. Patient responded well to antitubercular therapy as evidenced by lump regression, ulceration healed, peau d’orage currently resolved, and the overall size of the breast is going back to its normal state.
 The area of practical use of research results: Family medicine physicians, Primary health care center, District level or regional level hospital.
 An innovative technological product: a high index of suspicion tuberculosis is needed when evaluating cases of breast abscesses, fistulae, or mass. Awareness of this condition is important as it can clinically, and radiologically mimic breast carcinoma.
 Scope of application of an innovative technological product: Family medicine physicians, Primary health care center.

LEFT CA MAMMAE WITH FEBRILE NEUTROPENIA : A CASE REPORT

Introduction: Breast cancer is the most common cancer diagnosed, especially in women, accounting for more than 1 in 10 new cancer diagnoses each year. Physical examination, imaging and biopsy must be done to diagnose breast cancer.1,2 Staging is performed to define prognosis and guide treatment recommendations for patients with a similar prognosis. Chemotherapy, hormone therapy, and targeted therapy are the systemic therapies used in breast cancer management. The therapies option are has an side effect, especially chemotherapy. Chemotherapy induced neutropenia is a common toxicity caused by the administration of anticancer drugs. This side effect are life-threatening infections and alter the chemotherapy schedule.
 Case presentation: A female 50-years-old patient with left breast cancer on chemotherapy. She already has 3 times chemotherapy session and now had a fever with leucocyte result is 520 mg/dl and neutrophilia is 1.9 mg/dl. The patient has a history of painless lump in left breast since 11 months ago and growing proggresive. From physical examination, the lump with an ulcer with size 6x7x3cms and palpable hard consistency lump size is 8x8x5cms with irreguler edges and immobile. Patient had a biopsy examination with result invasive carcinoma ; high grade. From chest xray and USG Abdomen no finding sign of metastatic. Patient had an neo adjuvant chemotherapy
 Conclusion: Breast cancer is cancer of the breast tissue. Risk factors for breast cancer are divided into two, namely risk factors that cannot be changed (gender, age, genetic factors, previous cancer history, race and ethnicity, menstrual history and history of chest radiation) and those that can be changed (history of contraception, history of pregnancy, hormone therapy after menopause, breastfeeding, alcohol consumption, and obesity). Therapy for breast cancer is divided into five, namely surgical therapy, radiotherapy, chemotherapy, biologic therapy, and hormonal therapy. The goal of breast cancer therapy is to increase the survival rate and quality of life of patients.

A STUDY OF CORE-CUT BIOPSY AND FNAC FINDINGS IN A CLINICALLY PALPABLE BREAST LUMP

Aims And Objectives To nd the sensitivity and specicity of FNAC and Core-Cut biopsy. To study the efcacy of FNAC and Core-Cut biopsy with that of Histopathological (gross specimen) study in diagnosing a breast lump. To nd limitations of FNAC and Core-Cut biopsy Materials and Method: This is Hospital based Interventional study at Tertiary care centre in the department of General Surgery. All patients admitted during the period of 24 months with palpable breast lump coming under the eligibility criteria will be subjected for FNAC and Core-Cut biopsy after obtaining informed consents. Data Entry is done by using MS Excel and Analysis is done by using Suitable Statistical tests. Results: Our study of 70 patients, age incidence was ranged from 18 to 70 years. The age incidence for the benign lesions ranged from 18 years to 64 years (Mean age 38.5 years, SD= 12.56 years). The incidence for the malignant lesions ranged from 25 to 70 years (mean age 51.06 years, SD= 10.62 years). Out of total 70 patient, 49 patients had lump in right breast, 21 had lump in left breast. Our study True positive for FNAC was 38(54.28%) True negative was 26 (37.14%) and false positive was 0 and false negative were 6 (0.08%), which lead to the interpretation of sensitivity of 86 % for FNAC and specicity of 81.12% for FNAC. Our study True positive for Core-Cut biopsy was 42(60%) True negative was 26(38%) and False positive was 0(0%) and false negative was 02(2.85%), which lead to the interpretation of sensitivity of 95% for Core-Cut biopsy and specicity of 92.85 % for Core-cut biopsy. For Core-Cut biopsy in our study positive and negative predictive value was found to be 100% and 59.09% respectively Conclusion: As Both Sensitivity and Specify of Core-Cut biopsy is far superior than FNAC, and more number of False Negative reports in FNAC, where we can miss the Malignant breast Lump, we conclude that, Core-Cut Biopsy is far superior to FNAC in the diagnostic approach of breast cancer and, especially in cases of doubt, it is preferable to proceed directly with Core Cut biopsy.

Benign breast cyst in a young male patient diagnosed on cytopathology: Report of a rare case

Abstract Fine needle aspiration cytology (FNAC) is a widely accepted procedure for evaluating breast masses. Cystic lesions in female breasts are common. However, they are incredibly uncommon in male breasts, especially in cytology. Here, we report a rare benign breast cyst diagnosis on FNAC in a 26-year-old male patient without associated gynecomastia. A 26-year-old male patient presented to surgery outpatient department with left breast swelling for 3 months. He had no history of pain, nipple discharge, or fever. The patient, however, was on antitubercular treatment for pulmonary tuberculosis. On physical examination, a small diffuse 5–6 mm lump was palpable in the left breast. Ultrasound revealed a soft small tissue lesion in the superior aspect of the left areola with the suspicious flow on color flow Doppler following which FNAC was advised. Aspiration yielded scanty fluid. On microscopy, smears showed low cellularity comprising few monolayered sheets and small aggregates of benign ductal epithelial cells admixed with a fair number of cystic macrophages in a fluid background. There was no evidence of malignancy. Thus, a cytologic diagnosis of a benign breast cyst was rendered. This is the first case report describing the cytology of a benign breast cyst diagnosed in a male patient as young as 26 without associated gynecomastia. We report this case because of the rarity of this condition and to create awareness that breast cysts should also be kept in mind when dealing with male breast masses, thus avoiding unnecessary surgery, especially in a young men.

Tuberculosis of the breast: A case report in a tertiary health institution, South-South Nigeria

Tuberculosis (TB) of the breast is a rare disease that typically affects women of reproductive age, mainly between 15 and 25 years of age. TB of the breast has a non-specific clinical presentation and may present as a breast lump, abscess, or sinus, and it may sometimes mimic breast cancer. Histological diagnosis is necessary to avoid mismanagement of potentially curable breast disease. We present a case of an 18-year-old female with a left upper quadrant breast lump of 1-year duration. The fine-needle aspiration cytology of the breast lump was negative for malignancy. However, histological diagnosis of the excised breast lump confirmed TB of the breast.

Multiple Myeloma: A Rare Presentation as Breast Lump

Introduction: Multiple myeloma is a monoclonal immunoproliferative neoplasm of B lymphoid cells. Secondary extramedullary plasmacytoma is usually involved in advanced stages. Here we report an unusual presentation of multiple myeloma relapsing as a breast lump focusing on important findings and treatment given. Case Details: A 40-year-old woman with a past history of isolated plasmacytoma of 5th thoracic vertebra, treated with radical radiotherapy 45 Gray in 23 fractions now presented with left breast lump of 2 months duration measuring 2 x 1 cm involving the central quadrant. Ultrasonogram showed a BIRADS V lesion. A core biopsy with IHC was reported as plasmacytoma. Following this multiple myeloma work up was done. Bone marrow study showed 10% plasma cells, serum electrophoresis showed M band, raised ESR with anemia. Patient was diagnosed with Multiple Myeloma – International staging system stage III. Results: Patient was started on combination chemotherapy with 6 cycles of Bortezomib, Lenalidomide and Dexamethasone .Following treatment showed only a partial response following which the patient was started on carfilzomib. However, her disease progressed and the patient succumbed to the disease. Conclusion: Extramedullary presentation of multiple myeloma as a breast lump which itself is a rare entity despite treatment has an unfavourable course. Any patient presenting with breast lump should be evaluated carefully mostly if they have a previous history of plasmacytoma/ multiple myeloma. A proper identification of tumour pathology can evade patient from unwanted extensive surgery and thus a delay in definitive systemic treatment.

MED 12 gene mutation in a case of bilateral giant juvenile fibroadenoma

Giant juvenile fibroadenoma is a rare variant of more common benign lesion, fibro adenoma observed in younger population. They present with rapidly enlarging single or multiple breast masses in one or both the breast. A 10-year-old pre-pubertal girl presented with large lump in left breast followed by right breast lump. FNAC was suggestive of fibroadenoma, and histopathology confirmed the diagnosis. To understand the genetic basis of common entity like fibroadenoma with a rare presentation in very young age, the tissue block was subjected to gene sequencing and identified MED 12 gene mutation. It leads us to the possibility of new treatment modalities of targeting the causative gene and thus sparing the patient from invasive procedures.

Abstract 14105: Stent Ahoy: Ventricular Tachycardia Due to Stent Migration Into the Right Ventricle

Case: A 46-year-old female with PMHx of ESRD on dialysis and prothrombin gene mutation presented with acute onset of left breast swelling, redness and pain for nearly 24 hours. She was found to have SVC occlusion and underwent successful SVC recanalization and stent placement with an uncovered 14x40 mm nitinol stent. She presented 4 days later with complaints of chest pain and shortness of breath. Initial vitals were notable for tachypnea with oxygen saturations of nearly 70%, and a blood pressure of 114/71 mmHg. Physical exam demonstrated an obese female in distress. Shortly after arrival in the emergency department, she developed a non-sustained episode of ventricular tachycardia (NSVT). Amiodarone and lidocaine were started, however, she continued to have runs of NSVT. Initial CXR found no acute process but failed to demonstrate the previously placed SVC stent. ECG demonstrated normal sinus rhythm with frequent PVCs and runs of NSVT. A limited echo demonstrated a free edge of an endovascular stent within the right ventricle. TEE demonstrated the stent appeared to be tethered to the septal leaflet of the tricuspid valve with the leading edge free within the right ventricle. Endovascular retrieval was proposed but given the degree of entanglement within the tricuspid leaflets, large stent size, and recurrent NSVT, was deemed an unsuitable therapeutic strategy. Urgent open-heart surgery was performed for removal. The patient tolerated the procedure well and had no further recurrence of NSVT. Discussion: Stent migration is a rare but feared complication of venous stent deployment, with only 32 reported cases over the past 30 years. While NSVT is often attributed to the RVOT, the etiology being the result of migrated stents has been rarely reported. This is the first case to our knowledge of SVC stent migration leading to runs of NSVT. Conclusion: Clinicians must remain cognizant of the risk for venous stent migration and unusual clinical presentations resulting from migration.

Correlation of proliferative index with various clinicopathologic prognostic parameters in breast carcinoma

Introduction: Breast cancer (BC) is the most common cancer and the second most common cause of death in women. Prognostic factors are essential in BC diagnosis as they allow the identification of high-risk patients, for whom, an adjuvant therapy can improve prognosis. Interest in Ki-67 has recently increased as Ki-67 is a potential marker for predicting the responsiveness to chemotherapy. Materials and Methods: The study was conducted on 75 consecutive cases of primary breast carcinoma undergoing radical or modified radical mastectomy specimen. Histopathological diagnosis was established on routine hematoxylin and eosin stain and various histologic prognostic parameters including histologic type, histologic grade, and lymph node metastases were assessed. All biopsy proven carcinoma breast were included in this study. Results: Among presenting compliant, 47 (62.66%) had lump in right breast and 28 (37.33%) had lump in left breast. Most patients in the study population presented with a lump of duration 3-6 months (54.6%). Out of 75 participants, 41 (62.66%) participants were diagnosed with carcinoma right beast and 28 (37.33%) with carcinoma left breast. On staging the disease among the study population, most of them diagnosed with breast cancer were of stage IIIB (48%) followed by IIA (25.33%).