Benign osseous metaplasia of the breast: Case report

INTRODUCTION

Benign Osseous metaplasia of the breast is rare, with only a few cases reported in the literature. Here we present a case of benign osseous metaplasia of the breast presenting as a breast lump.

CASE PRESENTATION

38-year-old previously well woman presented with a one-year history of bilateral breast pain and a left-sided breast lump. Ultrasound and mammography suggested calcified fibroadenoma. An ultrasound-guided true cut biopsy revealed fibrous tissue containing foci of adenosis in the presence of a myoepithelial cell layer. Excision biopsy was performed, and histopathological examination showed bone matrix deposition occupying most of the nodule with peripheral hyalinized tissue but no evidence of malignancy. A diagnosis of benign osseous metaplasia of the breast was made, and the patient recovered well without recurrence after lump excision.

DISCUSSION

Only a few cases of osseous metaplasia are reported in the literature. Most reported cases are malignant, such as in fibrosarcoma, malignant mesenchymoma, osteoid sarcoma, osteogenic sarcoma, and osteochondrosarcoma.Very few cases of osseous sarcoma are reported in benign lesions such as fibroadenoma, pleomorphic adenoma, benign mesenchymoma, phyllodes tumor, and amyloid tumor of the breast. Joshi et al. first reported a case of benign osseous metaplasia of the breast presenting as breast lump in an HIV-positive patient [18]. We, therefore, consider this case to be the second case report of benign osseous metaplasia of the breast presenting as a breast lump, but the patient had no chronic illness.

CONCLUSION

A breast lump can be the first presentation of benign osseous metaplasia.

Primary Diffuse B-Cell Thyroid Lymphoma: Case Report and Literature Review

Background

Primary thyroid lymphoma (PTL) is a rare disease, accounting for 5% of all thyroid malignancies. Diffuse B-cell lymphoma (DBCL) is the most common type of PTL. The diagnosis of PTL depends on biopsy results, and its management depends on the histological type.

Case Presentation

A 66-year-old female complained of a huge neck mass on the right side that had started growing 3 months previously and was associated with compressive and B symptoms. She had undergone left hemithyroidectomy 20 years previously. On examination, a huge neck mass measuring 10 × 6 cm was detected on the right side that had shifted the trachea to the contralateral side. CT scanning revealed a huge soft tissue mass in the neck with compressive signs. Fine-needle aspiration (FNA) showed variably sized lymphocytes and large epithelial cells with occasional atypical cells. Tissue biopsy revealed DBCL, which is suggestive of PTL.

Discussion

PTL affects only the thyroid gland and the regional lymph nodes. Most PTL originate from B cells, especially DBCL, which accounts for 50–80% of all PTL. FNA may have limited capability to differentiate between anaplastic carcinoma of the thyroid and thyroid lymphoma. If FNA fails to determine PTL tissue, it should be determined using biopsy. A multidisciplinary approach is the best management technique for PTL. Radiotherapy, surgery, or both can be used for local control, while chemotherapy can be used for disseminated or hidden disease.

Conclusion

Tissue biopsy is needed to exclude other differential diagnoses, whereas a multidisciplinary approach is needed to manage PTL.

Changes in the Presentation and Severity of Acute Appendicitis: A Comparison of the COVID-19 Pandemic and Post-Pandemic Eras

BACKGROUND

The restrictions during the COVID-19 pandemic, along with people's avoidance of hospital exposure, led to a reduction in medical consultations and delays in care seeking. Numerous reports have shown a decrease in the number of appendectomies performed and an increased incidence of complicated appendicitis during the pandemic. We aimed to investigate these findings during and after the cessation of COVID-19-related restrictions.

METHODS

This retrospective cohort study was conducted in a single centre, including consecutive adult patients who underwent appendectomy for acute appendicitis during three different periods: the pandemic cohort (7 March-30 June 2020), the post-pandemic cohort (7 March-30 June 2022) and the pre-pandemic control cohort (7 March-30 June 2019). A total of 103 patients were included and divided into the three cohorts. The patients' demographics, clinical presentation, investigations, and operative data were compared.

RESULTS

The three groups did not differ significantly regarding demographics, clinical characteristics, or the number of appendectomies. However, a duration of symptoms at presentation of less than 2 days was significantly more frequent in the pre-pandemic and post-pandemic groups than the pandemic group (p = 0.001). The interval between admission and operation was significantly shorter in the post-pandemic group than in the pandemic group. The pandemic group also showed a higher incidence of complicated appendicitis compared to the others (p = 0.025).

CONCLUSIONS

The termination of the COVID-19 pandemic and its related restrictions promoted the earlier presentation of acute appendicitis cases and lowered the incidence of complicated appendicitis. This emphasises the impact of the COVID-19 pandemic on acute appendicitis.