Orthostatism, Constipation, and Early Satiety

A 65-year-old woman with a history of Graves disease, status post radioactive iodine therapy, and a biopsy-proven benign calcified breast nodule sought care for evaluation of multiple symptoms. She had constipation for 8 years, with prior fecal urgency, and intermittent diarrhea for the previous year. She was diagnosed with irritable bowel syndrome. Her weight remained stable until 1 1/2 years earlier, and she had lost 6.8 kg. For the previous 3 years, the patient had experienced multiple urinary symptoms including hesitancy, urgency, incontinence, and retention. She was diagnosed with a cystocele, the correction of which did not help. She had noted difficulty focusing her eyes when moving from a dark to a well-lit environment, or vice versa. She also reported orthostatic light-headedness for 1½years, which worsened on exposure to a hot environment. Neurologic examination showed abnormally dilated pupils with prominently sluggish constriction in response to light. Autonomic reflex screening indicated patchy postganglionic sympathetic sudomotor, marked cardiovagal, and cardiovascular adrenergic failure, with neurogenic orthostatic hypotension. Thermoregulatory sweat testing showed 82% anhidrosis. A nuclear medicine gastric-emptying study indicated delayed gastric emptying and colonic hypomotility. Serum testing was markedly positive for ganglionic (alpha 3) acetylcholine receptor autoantibodies. The patient was diagnosed with autoimmune autonomic ganglionopathy. The patient received intravenous immunoglobulin. She returned and reported 80% improvement in all symptoms, and neurologic examination showed normal pupillary response to light. Autonomic reflex screening indicated improvement of her adrenergic function, and thermoregulatory sweat testing showed an impressive improvement of her sudomotor function. Her postganglionic sympathetic sudomotor and cardiovagal function remained impaired. Gastric emptying remained mildly delayed. She was maintained on intravenous immunoglobulin, which was later tapered after azathioprine was started. Autoimmune autonomic ganglionopathy usually presents subacutely, much like other autoimmune neurologic diseases. Typical features of this disorder are the impaired pupillary reaction to light and prominent sicca symptoms, indicating prominent cranial parasympathetic (cholinergic) impairment. Also consistent with this diagnosis are the prominent gastrointestinal tract symptoms. Prominent cholinergic failure helps distinguish autoimmune autonomic ganglionopathy from peripheral autonomic neuropathy or neurodegenerative disorders such as pure autonomic failure.

A Case of Granulomatosis with Polyangiitis with Various Breast Lesions as the Initial Symptoms: A Case-Based Review

A 44-year-old woman presenting with pus-like discharge from the nipples visited our hospital for scleritis. Subcutaneous induration and ulceration were found on her breast. She was diagnosed with granulomatosis with polyangiitis (GPA) considering scleritis, sinusitis, cutaneous granuloma formation, and antiproteinase 3-antineutrophil cytoplasmic antibodies and was successfully treated with glucocorticoids. Fifteen months later, she developed pulmonary consolidation and a right breast nodule. Biopsies of the breast nodule showed granulomatous vasculitis, and she was treated with rituximab. While breast involvement in GPA is rare, unilateral breast mass is a typical clinical feature; thus, GPA should be considered in such cases.

Not a Coincidental Concurrence of Breast Carcinoma and Cardiac Myxoma: Case Report

Background: Myxoma has been considered to undergo a simple and benign process but not always so. Case presentation: A female patient was admitted for evaluation of left breast nodule. Physical examination showed facial pigmentation, left breast nodule and 3/6 diastolic murmur at the mitral valve area. Preoperative echocardiography revealed a massive mobile left atrial mass attaching to the interatrial septum causing obstruction to mitral orifice. Histopathologic investigation confirmed the left atrial mass to be myxoma and left breast nodule to be cancer. Carney complex was considered and lifelong follow-up was advised. Conclusion: Cardiac myxoma may present as a part of a systematic disease entity. In patients with a combination of breast nodule and facial pigmentation, transthoracic echocardiography examination is advised to guide decision-making.

Epidemiological and diagnostic profiles of mammary squamous cell carcinomas at the Joliot Curie Institute in Dakar

INTRODUCTION: Breast cancer is the first cancer in women and clearly constitutes a real public health problem. Although adenocarcinoma remains by far the most common histologic type, there are other types that vary in frequency. A particular form which is the squamous cell carcinoma holds our attention. MATERIALS AND METHODS: The clinical records of patient consultants at the Joliot Curie Institute in Dakar between January 1, 2016 and June 30, 2020 were reviewed. We have retained the cases of pure or mixed breast squamous cell carcinomas. RESULTS: Our study focused on three observations received and treated at the Joliot Curie Institute in Dakar. These patients were 48, 50 and 48 years old respectively. They did not have any particular medical history. They were all postmenopausal. They had consulted following a self-palpation of a breast nodule. The biopsy had concluded in a mammary squamous cell carcinoma. Two of the three patients were metastatic. CONCLUSION: At the end of our study, we recommend a larger scale study including several centers. The therapeutic sequences must be better evaluated and compared to the most frequent form, which is infiltrating ductal adenocarcinoma.

Unanticipated diagnosis- intraparenchymal leiomyoma of the breast: case report

Smooth muscle neoplasms are uncommon, particularly if we are talking about the mammary gland. We report a case a case of a 38-year-old female with an 11.6 mm right breast nodule. A wire-guided surgical excision was performed and the histopathologic and immunohistochemical studies revealed a leiomyoma. There are no radiological criteria to allow the diagnosis of smooth muscle neoplasm and histopathological evaluation is the definitive diagnostic method. Despite being a benign neoplasm, it may mimic malignancies and therefore present a diagnostic challenge.