Dyspnea attack due to hysteria after general anesthesia

A 30-year-old female was scheduled for an expander insertion of the breast under local anesthesia. Thirty minutes after infiltration anesthesia with lidocaine and bupivacaine mixture, she suffered from dyspnea. She was intubated and transferred to our hospital. As her vital signs were stable and consciousness was clear, she was extubated in the emergency room. However, she was reintubated at night and ventilated mechanically for two days. Three months later, breast expander insertion was performed under general anesthesia. After extubation, dyspnea attack occurred and midazolam was injected. Seven months later, the reconstruction of TRAM flap was performed under general anesthesia and continuous subcutaneous injection of morphine was used for the postoperative analgesia. After extubation, she was sedated deeply and dyspnea attack did not occur. A month later, she was scheduled for the debridment and the resuture. Then, dyspnea attack occurred in the ward at night. The apnea monitor was attached to her in recovery room after extubation following the operation of debridment and resuture. Dyspnea attack appeared and was diminished with midazolam injection. We diagnosed her as hysteria with CMI and MMPI psychologic tests.     

Radiation-induced squamous cell carcinoma of the chest wall seven years after adjuvant radiotherapy following the surgery of breast cancer: a case report

A 54-year-old woman, who had underwent an adjuvant radiotherapy following the modified radical mastectomy in the left primary breast cancer in June 1988. She underwent second surgery and adjuvant radiotherapy (electronic radiotherapy) for recurrent breast cancer in the major pectoral muscle and received chemoimmunotherapy in May 1989. In May 1996 she complained of two ulcers of the chest wall. The ulcer biopsy findings was squamous cell carcinoma, and we diagnosed she fell the radiation-induced skin cancer. She underwent chest wall resection and reconstruction with vertical rectal abdominal musculocutaneous flap (VRAM). However two months later her chest wall resection, she again got the recurrent squamous cell carcinoma in the right axillary lymph nodes and left pleura. The third radiotherapy and the chemotherapy with pepleomycin were uneffective on her recurrent cancer. And she died in March 1997.     

A case of melioidosis of the breast present at screening mammography

A previously well 54-year-old woman presented for screening mammography with a 3-day history of an inflamed lump in her right breast. She was subsequently admitted to hospital with acute melioidosis where right breast abscesses were drained. Following recovery and discharge, she was reviewed at the mammographic screening unit where her previous abnormal mammogram was found to be due to melioidosis. To our knowledge this is the first reported case of melioidosis of the breast and its appearance on mammography and ultrasound are described.     

Massive arm necrosis as a result of a subclavian artery occlusion after mastectomy and radiotherapy

A 60-year-old woman with a severe necrosis caused by a blunt trauma of her right upper arm is described. She had a history of ablation and radiotherapy of her right breast followed by a diagnosis of breast cancer 34 years previously. An angiogram revealed a complete occlusion of the right subclavian artery. After the reperfusion of the right arm, the necrosis at the upper arm was resected. After further operations, the wound could finally be closed with a skin graft. Today, the patient is able to complete all her activities of daily living. Despite a restriction in her range of motion, she complains about intermittent pain. Arterial occlusion of the ipsilateral limb is a rare event decades after mastectomy and radiation. A related necrosis in these dimensions and successful limb-saving treatment has not been previously described.     

Breast cancer associated with pregnancy

Two cases of breast cancer associated with pregnancy were reported and the immunological assessment was performed in the second case. Case 1: A 36 year-old woman in the first trimester of pregnancy and having a large axillary mass and breast lump was admitted. She was diagnosed as having Stage IIIb breast cancer. After interruption of pregnancy, she received an extended radical mastectomy and radiotherapy. However, she died nine months after surgery for brain and liver metastases. Case 2: A 30 year-old woman in her second trimester of pregnancy was admitted for a large breast mass. She was diagnosed as having Stage IIIa breast cancer. Interruption of pregnancy was again necessary to perform surgery followed by chemotherapy. After an extended radical mastectomy she was placed on a combination chemotherapy regimen with cyclophosphamide, adriamycin and 5-FU. In both cases tumors began to develop rapidly at pregnancy. Immunological studies in Case 2 showed a depression of T-lymphocyte function and NK cell activity. Our study suggests that the depression of cell-mediated immunity during pregnancy may promote tumor growth.     

Breast cancer arising de novo in recipients of kidney allograft

Immunosuppressive therapy is not only an etiologic factor of de novo malignant disease but is also accelerates progression of the already developed malignant disease in immunosuppressed recipients. Two cases of de novo breast cancer arising in kidney transplant recipients are reported herein. A 25 year-old woman, transplanted one haploidentical kidney transplant 4 years and 9 months ago, developed a left breast tumor. Within one month the tumor had rapidly enlarged from 3.5 cm to 8 cm in diameter by the time she underwent a radical mastectomy. Nine axillary lymph nodes were positive for metastasis. Although her graft function had been poor due to chronic rejection, she was treated with standard immunosuppressive therapy, but not adjuvant therapy. Since local recurrent disease appeared two months postoperatively, the immunosuppressive therapy was ceased and 60Co therapy started. Recurrent disease progressed rapidly, however, and she died 7 months after her operation. A 27 year-old woman, having allograft from an identical sibling, noted a right breast tumor, 8 years and 7 months later. Again the tumor had grown rapidly from 1.8 cm to 3 cm in diameter within one month. She underwent a standard radical mastectomy. One axillary lymph nodes was positive for metastasis. She has been treated with standard immunosuppressive therapy and adjuvant endocrinochemotherapy. Presently, she is alive with a well functioning graft and no disease.     

Breast cancer associated with Recklinghausen's disease: report of a case.

A 49-year-old woman with Recklinghausen's disease presented to our department for investigation of a left breast lump, measuring 60 mm x 50 mm, which she had first noticed 6 months earlier, but had disregarded, believing it to be another manifestation of her Recklinghausen's disease. The lump was suspected to be malignant based on physical examination and ultrasonography. Biopsy and frozen sections subsequently confirmed a diagnosis of scirrhous carcinoma. A standard radical mastectomy was performed, followed by postoperative chemoendocrine therapy. However, lungs, liver, and bone metastasis, as well as a contralateral breast tumor, developed and she died 4 months after surgery.     

Breast cancer arisingde novo in recipients of kidney allograft

Immunosuppressive therapy is not only an etiologic factor ofde novo malignant disease but it also accelerates progression of the already developed malignant disease in immunosuppressed recipients. Two cases ofde novo breast cancer arising in kidney transplant recipients are reported herein. A 25 year-old woman, transplanted one haploidentical kidney transplant 4 years and 9 months ago, developed a left breast tumor. Within one month the tumor had rapidly enlarged from 3.5 cm to 8 cm in diameter by the time she underwent a radical mastectomy. Nine axillary lymph nodes were positive for metastasis. Although her graft function had been poor due to chronic rejection, she was treated with standard immunosuppressive therapy, but not adjuvant therapy. Since local recurrent disease appeared two months postoperatively, the immunosuppressive therapy was ceased and⁶⁰Co therapy started. Recurrent disease progressed rapidly, however, and she died 7 months after her operation. A 27 year-old woman, having allograft from an identical sibling, noted a right breast tumor, 8 years and 7 months later. Again the tumor had grown rapidly from 1.8 cm to 3 cm in diameter within one month. She underwent a standard radical mastectomy. One axillary lymph nodes was positive for metastasis. She has been treated with standard immunosuppressive therapy and adjuvant endocrinochemotherapy. Presently, she is alive with a well functioning graft and no disease.     

An Uncommon Complication of Secondary Augmentation Mammoplasty:Bilaterally Massive Engorgement of Breasts After Pregnancy Attributable to Postinfection and Blockage of Mammary Ducts

Augmentation mammoplasty is one of the most frequently performed aesthetic operations. Galactorrhea and galactocele formation after augmentation mammoplasty, while the patient is experiencing the hormonal effects, is rarely seen. The cause remains unknown. However, postoperative fibrosis and blockage of the mammary ducts after augmentation mammoplasty is a probable cause of this formation in some patients. In the reported case, the patient described painful massive engorgement of both breasts during the last month of pregnancy and inability to breast-feed after delivery. In her history, she had undergone breast augmentation via the semicircular periareolar transglandular approach. She had experienced an infection at an early stage of her postoperative period and had needed to have both prostheses removed. A second breast augmentation mammoplasty was performed 1 year after the first operation via the same incision. She was content with the result of her second augmentation mammoplasty, up until her third pregnancy, at which time she reported inability to breast-feed after her delivery. At our examination, it was determined that there was massive painful breast engorgement, hyperemia, and inflammation of both breasts attributable to a bilateral galactocele formation. She refused to take any medication (bromocriptine), but approved antibiotic treatment. The patient responded to the antibiotics, and the prostheses therefore were left in place without further complications.     

Multiple miliary osteoma cutis of the face after initiation of alendronate therapy for osteoporosis

A 62-year-old Asian woman presented with multiple small, rock-hard papular lesions on her face (Figure). She had no previous history of acne vulgaris or cutaneous malignancy. She had been diagnosed with breast cancer in 1995 and was treated with left lumpectomy followed by combination chemotherapy consisting of cyclophosphamide, 5-fluorouracil, and methotrexate. In 1995, at age 50, she also began therapy with systemic alendronate to treat osteoporosis. Within 1 year, she noticed the development of asymptomatic indurated dermal papules on her cheeks. Topical treatment with 12% lactic acid lotion did not improve her condition. Clinical examination revealed numerous 1- to 2-mm, brown dermal nodules on the malar cheeks bilaterally. Normal laboratory data included complete blood cell count, alkaline phosphatase, serum calcium, and serum phosphate. A lesional punch biopsy from the left cheek revealed lamellar bone within the dermis. Correlation of the clinical presentation, laboratory data, and pathology established the diagnosis of multiple miliary osteoma cutis of the face.     

Breast carcinoma in pregnancy: a clinical case

Breast cancer is a rare, but frequently hidden pathology. A woman, 36 years old, during the early months of pregnancy found a little tumor in her right breast. A fine needle biopsy was negative for cancer. Despite this, the tumor rose and two months after delivery (the patient breast-fed her daughter for a month), she had pain in the right axillary region and the tumors involved all superior dials of the right breast. A Madden mastectomy was performed. The histopathological report was: ductal invasive breast cancer 3 of 19 lymph nodes involved, stage IIIA, TNM pT3N2M0, ER -, PgR +--. Chemotherapeutic regimens were: at first ADM 75 mg/m2 for 5 cycles, and after CMF 1-8 for 6 cycles. After six months the woman had a cutaneous recurrence in the scar of mastectomy, treated with surgery and RT. Thirteen months after, she had lung MTS and then brain MTS. The patient died thirty months after the mastectomy. The surgeons have to discover the women high-risk for the breast cancer before and during the pregnancy. Excisional biopsy is the diagnostic procedure of choice for breast lump during pregnancy. When a breast cancer develops during a pregnancy, the surgeon has to operate immediately the tumors. Chemotherapeutic regimens should be delayed until the second o third trimester or after delivery.     

Isolated cervical metastasis of breast cancer: a case report and literature review

Metastasis of distant malignancies to the cervix is a rare event. Patients usually present with abnormal bleeding, pain, and dyspareunia. A smaller number of patients are asymptomatic, and their tumors can be diagnosed early by Pap smears. We present 56-year-old woman with a history of intraductal breast cancer that presented with vaginal bleeding. Colposcopic pathology and fractional curettage revealed a lesion similar to her primary breast cancer. She underwent an extensive workup and hysterectomy that revealed no other lesions. Currently, she is alive and well. Cervical metastasis should be considered in women with a history of breast cancer who present with vaginal bleeding. Aggressive treatment of isolated cervical metastasis from breast cancer is warranted in appropriate patients.     

HSV-1 mastitis in a 30-year-old woman

A young woman presented with worsening bilateral periareolar mastitis associated with skin necrosis and delayed vesical formation after oral nipple manipulation by her sexual partner. After multiple failed antibiotic regimens, she was diagnosed with herpes simplex virus 1 (HSV-1) infection. This case demonstrates an uncommon etiology of breast mastitis. We highlight the importance of a timely diagnosis and early administration of antiviral therapy.     

Ultrasound demonstration of clip migration to Skin within 6 weeks of 11-gauge vacuum-assisted stereotactic breast biopsy

A 39-year-old woman underwent 11-gauge vacuum-assisted stereotactic biopsy of a cluster of calcifications at the 5 o'clock location in the left breast. Initial clip placement was confirmed by mammograms to be at the biopsy site. The patient experienced episodic minimal bleeding at the skin entry site when she went home. The patient presented 6 weeks later with a history of progressive discomfort and lump at the stereotactic breast biopsy scar site. Ultrasound confirmed clip migration to the skin incision site. The clip was removed percutaneously by the radiologist, relieving the patient of her symptoms.     

An apical left ventricular aneurysm rupture presenting as left breast mass 11 years after surgical repair

Left ventricular (LV) pseudoaneurysm is a rare entity and, consequently, there is limited knowledge of the condition’s natural history. The most frequent mode of presentation for LV pseudoaneurysm is heart failure with chest pain. However, the variable presentation of this condition requires a high index of suspicion for diagnosis.We report the case of a 75-year-old woman who had suffered an acute myocardial infarction 23 years previously, which resulted in a calcified LV apical aneurysm. Three weeks prior to being referred to our hospital, she was noted by her general practitioner to have a left-sided breast mass although mammography was negative. One week later, she attended the accident and emergency department; she was haemodynamically unstable but was resuscitated successfully. Contrast enhanced computed tomography showed a large haematoma located in the left chest wall communicating with the left ventricle. She underwent emergency cardiac surgical repair. On arrival at the intensive care unit following surgery, her haemodynamic status was unstable, and she deteriorated rapidly and died.With this report, we aim to raise the level of awareness for an apical LV pulsatile mass that could anatomically expand and present as a breast mass or tumour. An early diagnosis and timely surgical intervention is essential in order to achieve better outcomes and avoid detrimental complications.     

Collision metastasis of breast and thyroid carcinoma to a single cervical lymph node: report of a case

We herein report a rare case of collision lymph node metastases of breast and thyroid carcinomas. A 49-year-old female had undergone an extensively radical mastectomy of the right breast for inflammatory breast cancer at our hospital. Eleven months later, she presented with enlarged lymph nodes in her right lateral neck and multiple nodules in bilateral thyroid lobes. The patient underwent total thyroidectomy and radical dissection of the bilateral cervical lymph nodes. A histological examination showed multiple foci of papillary thyroid carcinoma (PTC) in the bilateral lobes. Surprisingly, concurrent metastases of breast carcinoma and PTC were shown in one of the lymph nodes from the right jugular region. This rare case of collision metastasis and the related literature are discussed.     

Toward Understanding Women Who Request Removal of Silicone Breast Implants

▪ Abstract: Fifty-five women were surveyed prior to explantation of their silicone breast implants regarding their reasons for having implants and their reasons for wanting them removed. Open-ended questions were used and content analysis was done to identify themes in their responses. Most of the women had implants for cosmetic reasons, with 28% having them for breast reconstruction after mastectomy. About one-third were actively or passively encouraged by their male partners, while nearly the same number reported they were influenced primarily by female friends or relatives. Regarding reasons for removal, the most commonly cited reasons were breast health problems (implants ruptured, painful or uncomfortable) cited by 59%, general health problems (48%), diagnosed with connective tissue disease (25%), and concern about long-term effects of silicone (18%). Some women blamed a broad array of health problems on the implants, and a few were angry about being given bland reassurances about the safety of the devices. However, the majority were uncertain about the role of silicone in their overall health but were hopeful that removal would restore their health and end their worries about long-term effects. The average subject was 34 years old when she had the implants to feel more attractive. Now she is 44 and more concerned about her health and her family than her physical appearance. ▪     

Ethics in practice. Terminating the physician-patient relationship

A.G. is a thirty-six-year-old reading teacher who presented to an orthopaedic surgeon with patellofemoral pain. After an appropriate evaluation, the physician suggested a course of physical therapy and anti-inflammatory medication. The patient asked for and received time off from her work, stating that her job required her to climb stairs. At multiple follow-up visits, A.G. was found to be poorly compliant with physical therapy and home-exercise programs. Her only interest appeared to be in securing the doctor's letter of support for an extended medical leave. At each visit, she demanded that the physician write a letter stating that she was unable to work as a reading teacher due to knee pain. At one point, she became belligerent with the medical office staff when the letter was not prepared. When her physician tried to elicit information about whether there were any unaddressed obstacles to rehabilitation treatment, A.G. did not answer the questions. Instead, she explained that her job required her to climb stairs and that she was unable to return to work because of the continued knee pain. The physician explained that, on the basis of his examination and assessment, he expected that her pain would improve if she complied with the treatment plan. After multiple visits, the orthopaedic surgeon counseled the patient that he did not see that his attempts to help her were providing any benefit and that perhaps it would be best for her to seek help from another physician. A.G. replied that she did not want to start going to another doctor. She stated emphatically that he was her doctor, that she was paying him, and that she wanted a letter saying that she should be granted an extended medical leave from work because of her inability to climb stairs. After this encounter, the surgeon thought it best to terminate the professional relationship.     

Distichiasis in association with entropion in metastatic HER2‐positive breast cancer treated by pertuzumab,trastuzumab, and docetaxel combination chemotherapy

We report the first case of distichiasis combined with entropion in a HER2‐positive metastatic breast cancer patient treated by pertuzumab, trastuzumab, and docetaxel combination therapy. After 7 months, she had ocular complaints including pain, irritation, burning, dryness, and redness in her both eyes. Ophthalmologic examination revealed distichiasis and a mild entropion involving her lower eyelids bilaterally. She remained free of symptom and in complete response to maintenance chemotherapy.     

Gigantomastia induced by bucillamine

Drug-induced mammary hyperplasias have been reported as rare complications of D-penicillamine and Neothetazone. The authors report the first case of bucillamine-induced giant mammary hyperplasia. Bucillamine is used as an antirheumatic drug that is structurally analogous to D-penicillamine. A 25-year-old woman with rheumatoid arthritis for the past 5 years started to develop gradual enlargement of her breasts 15 months before presentation. She had been on a combined treatment of steroid and lobenzarit disodium for the first 3 years, and then continued with a combined treatment of steroid and bucillamine for the following years until she was found to have pulmonary tuberculosis, at which time the steroid was suspended 10 months before she visited the authors' clinic. An almost total breast reduction was performed; 5 kg of right breast tissue and 7 kg of left breast tissue were excised. Retrospectively, bucillamine was believed to be the cause of the giant hypertrophy because of its structural similarity to D-penicillamine, which was the subject of an abundance of reports of mammary hyperplasia.