An unusual presentation of locally recurrent breast cancer: a case report

Recurrent breast carcinoma is usually detected by imaging studies and biopsy. We present a case with unusual clinical presentation and discuss the diagnosis and treatment. While core needle biopsy and fine-needle aspiration are important in the diagnosis of early-stage breast cancer, physical examination and close follow-up are important in the absence of a diagnosis.     

An unusual presentation of a ring injury

A case of chronic erosion of the soft tissues and bone of the proximal phalanx of the ring finger in a 62-year-old woman is presented. The patient's rings had eroded the skin, nerves, and tendons of the finger as well as the palmar aspect of the proximal phalanx; however, circulation was adequate. When the rings were removed, there was no improvement in sensibility or range of motion, but this was not bothersome to the patient.     

An unusual tumor presentation

Germ cell cancer is the most common malignancy in men 15-35 years of age; 5% of malignant germ cell tumors are of extragonadal origin. The key to diagnosis and management is tumor histology. This point is highlighted in this case review. It also reinforces that germ cell tumor markers should be done in all young patients diagnosed with malignancy. We describe the case of a 21-year-old man who was diagnosed as having inoperable cancer of the ascending colon, which turned out to be extragonadal germ cell tumor after studies. This patient has responded very well to bleomycin, etoposide, and cisplatin chemotherapy.     

An unusual presentation of a rectal duplication cyst

INTRODUCTIONIntestinal duplications are rare developmental anomalies that can occur anywhere along the gastrointestinal tract. Rectal duplication cysts account for approximately 4% of all duplication cysts. They usually present in childhood with symptoms of mass effect, local infection or more rarely with rectal bleeding from ectopic gastric mucosa.PRESENTATION OF CASEA 26 year old male presented with a history of bright red blood per rectum. On examination a mucosal defect with an associated cavity adjacent to the rectum was identified. This was confirmed with rigid proctoscopy and CT scan imaging. A complete transanal excision was performed.DISCUSSIONRectal duplication cysts are more common in pediatric patients. They more frequently present with symptoms of mass effect or local infection than with rectal bleeding. In adult patients they are a rare cause of rectal bleeding. Definitive treatment is with surgical excision. A transanal, transcoccygeal, posterior sagittal or a combined abdominoperineal approach may be used depending on anatomic characteristics of the duplication cyst.conclusionWe present a rare case of a rectal duplication cyst presenting in adulthood with rectal bleeding, managed with transanal excision.     

Jaundice: An unusual presentation of a brunneroma

We describe obstructive jaundice as the presenting feature in a 55‐year‐old male with a peri‐ampullary Brunner’s gland hamartoma. Duodenal obstruction and bleeding from such lesions have been noted previously, but obstructive jaundice has not yet been reported. This case is being described for its unconventional presentation and for consideration in the differential diagnosis of obstructive jaundice.      

An unusual presentation of a linear epidermal nevus

We report an unusual presentation of a linear epidermal nevus in an adolescent male. Epidermal nevi most commonly appear in infancy and early childhood. They often are found in association with other organ system anomalies. We describe a palmar linear epidermal nevus that caused impairment of the patient's use of his hand. Therapeutic management involved surgical excision of the nevus and reconstruction of the area with a full-thickness skin graft.     

An unusual hand infection in a child--remember herpes!

An unusual form of herpetic infection of the hand in a nine month old child is described. The diagnosis, mode of spread and management is discussed.     

An unusual presentation of a simple bone cyst in the scapula

A 38-year-old man presented with pain in the left shoulder following a fall. A rotator cuff tear was suspected but roentgenograms revealed a lytic, expanded, multiseptate lesion of the scapula adjacent to glenoid. This was compatible with a giant cell tumor, aneurysmal bone cyst or simple bone cyst. The MRI showed rim enhancement and clinched the diagnosis of simple bone cyst. An infraspinous approach to scapula was undertaken and open biopsy confirmed the diagnosis of simple bone cyst. Definitive treatment in the form of curettage and calcium phosphate cementation was carried out. The postoperative period was uneventful. Early mobilization was started. Patient remained well on follow-up and has returned to work in a physically demanding capacity.     

An unusual presentation in a patient with metachromatic leukodystrophy

A 2-year-old child was admitted with bilateral bronchopneumonia. During convalescence he sustained sudden respiratory arrest for which he required ventilatory support. He had undergone cholecystectomy 1 month prior to the above episode. The pathological examination of the gall bladder mass had revealed the features of metachromatic leukodystrophy. Gastro-oesophageal reflux, which is associated with this neurological disorder, was suspected to be the cause of this sudden respiratory arrest and its presence was confirmed by barium swallow examination.     

Renal artery graft-to-duodenum fistula: unusual presentation of a recurrent flank abscess

Perhaps the most devastating complication of a prosthetic vascular graft is the formation of an aortoenteric fistula. Most reports have dealt with fistulas between the aortic graft and the duodenum, although any revascularized vessel with prosthetic material can be the site of an enteric fistula. We report an unusual case in which a renal artery previously revascularized with a silk prosthetic graft developed a fistula to the duodenum 16 years later. Whether the prosthetic graft is in the aortic position or to a visceral vessel, when a fistula develops the only acceptable treatment is complete removal of the graft and revascularization with autogenous tissues, if necessary.     

An unusual hernia complication: a late presentation

A 67-year-old man presented with a 10-year history of intermittent right iliac fossa pain. His only significant past medical history was an inguinal hernia repair 10 years ago. After investigations, the patient underwent a laparotomy. He had a localised caecal perforation secondary to a misplaced prolene suture. A right hemicolectomy was performed.