An unusual self-inflicted injury of the breast

A self-inflicted injury of the breast can present difficult diagnostic problems as is illustrated by the case report. A young woman had excoriated her left nipple causing profuse haemorrhage. Following excision of the nipple and a breast biopsy, the patient presented 1 month later with an abscess caused by the introduction of stones and gravel into the biopsy wound.     

An unusual case of adrenal cortical carcinoma

We describe a case of non-functioning adrenal cortical carcinoma, which recurred 16 years after surgical adrenalectomy. In addition, the patient was successfully treated for two anatomically separate and histologically different, primary malignant tumours. This case highlights the importance of lifelong follow-up after apparently curative surgical excision of an adrenal tumour.     

Isolated trigeminal neuropathy. An unusual complication of carcinoma of the lung.

The occurrence of isolated metastasis to the trigeminal nerve or ganglion form a distant, solid tumor is rare. This communication describes a patient with carcinoma of the lung; an isolated trigeminal neuropathy developed and at autopsy proved to be secondary to metastasis to the trigeminal ganglion. The appearance of a trigeminal neuropathy in a patient with an active solid tumor elsewhere in the body is most likely due to metastasis.     

An unusual beta-cell adenoma.

An unusual case of insulinoma in a 51-year-old man demonstrates the difficulties in diagnosing and treating hypoglycemia. From the many laboratory tests and procedures performed, the only findings typical of insulinoma were inappropriate values of plasma immunoreactive insulin in relation to the corresponding values of blood glucose, and these were sporadic. A small beta-cell adenoma in the pancreatic head was the cause of the hypoglycemia.     

Annual cancer symposium in Regina reviews carcinoma of the breast.

At the 19th annual cancer symposium held in Regina, Canada during May 1975, the major topic was breast cancer. The comment following a film on radical mastectomy shown by Dr. J.W. Baker was that this represented an outmoded form of therapy. The film was followed by a statement of the magnitude of the problem--one new breast cancer patient each hour in Canada. Dr. T.H.C. Barlay discussed the problems of the etiology and prognostic factors. Dr. R.D. James focused a the "poor man's thermography"--a technique involving cooling of the breast by ethyl chloride sprayed onto a sponge and observing for a "blush" during recovery. In 58 patients with no blush, 48 showed a final diagnosis of malignant breast disease. P.J. Waight discussed the function of bone scans in the diagnosis of breast carcinoma. Dr. N.J. Belliveau made the point that in Montreal the classical Halsted approach of radical mastectomy has been discontinued. Additional attention was directed to radiation results, immunological response, consumer viewpoint and breast carcinoma management. Regarding oral contraceptives, Dr. Black noted that in his patients under age 55 there appears to be no alteration in the incidence of breast carcinoma, and in patients over age 55 there appears to be a negative correlation between long-term medication with contraceptive steroids and the incidence of breast carcinoma.     

An unusual cause of dementia.

Gliomatosis cerebri is a rare cerebral tumour that presents with personality and mental state changes. Diagnosis can be very difficult and many times is made at post mortem. We describe a 63-year-old man who presented initially with depression that merged into a schizophrenia-like illness, and who developed progressive dementia prior to his death. Two computed tomography (CT) scans of the brain were normal and the diagnosis of gliomatosis cerebri was made at post mortem. The progressively changing mental state was suggestive of an organic cause of his illness. Since this tumour may not be detected by a CT scan, a magnetic resonance imaging scan with T2-weighted images with spin echo sequences of the brain should be performed. Prognosis is very poor but diagnosis is important to plan terminal care. The patient described was unusual because he was older than most people with this tumour, and he presented with psychiatric symptoms which were thought to be non-organic for almost two years.