Tubular adenomas, also known as pure adenomas, are rare epithelial tumors of the breast. Only a few cases have been reported in the literature, especially in young women of reproductive age. Postmenopausal women are very rarely affected. We describe here a very rare case of tubular breast adenoma in a postmenopausal woman who presented with a gradually enlarging breast lump. Clinical examination and imaging studies revealed a non-tender well circumscribed left breast tumor suggestive of a fibroadenoma. Due to the history of progressive enlargement of the breast lump, a surgical excision was performed. Histological findings were suggestive of a tubular breast adenoma. We conclude that although tubular breast adenoma is rare, it should always be considered in the differential diagnosis in postmenopausal patients presenting with a gradually enlarging breast mass. Preoperative diagnosis is difficult because tubular adenoma is indistinguishable from a fibroadenoma on physical examination and breast imaging. Surgical excision is necessary to establish a definitive diagnosis. Clinical presentation and management of our patient are discussed along with a review of the literature.KeywordsTubular adenoma; Breast; Breast mass.

The association between breast cancer and type 1 neurofibromatosis (NF1) is a rare clinical entity. We herein present the case of a 59-year-old woman, with typical clinical manifestations of NF1, who presented with a painless lump in her right breast, which she had first noticed 8 months earlier. Clinical examination and diagnostic workup were suggestive of a breast carcinoma, and a modified radical mastectomy was performed. Histopathological examination revealed a poorly differentiated invasive ductal breast carcinoma and multiple neurofibromas. The pathological staging was pT2N1a according to TNM/UICC. Delayed presentation of the patient was the result of her mistakenly identifying the breast tumor as a manifestation of NF1 neurofibromatosis.

Dermoid cyst of the spermatic cord is a very rare clinical entity with only a few cases reported in the literature so far. We herein describe an extremely rare case of a large dermoid cyst of the spermatic cord measuring 8.5 x 5 x 5 cm in a young patient who presented with clinical manifestations of an incarcerated inguinal hernia. After the cyst excision, a diffuse direct hernia became apparent and a Lichtenstein polypropylene mesh repair was performed. Direct hernia was likely the result of chronic pressure on the inguinal floor maintained by the large cyst. We conclude that although very rare, dermoid cyst of the spermatic cord should be considered as a part of the differential diagnosis in patients presenting with an irreducible inguinal mass of a long course.

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Oncocytomas are benign tumors that infrequently involve ocular adnexa. We describe a case of oncocytoma of the lacrimal gland which was initially diagnosed by fine-needle aspiration cytology. An 83-year-old patient presented to the cytology laboratory with a peripunctal mass in the right eye. The tumor was aspirated. The cytoplasm of the tumor cells was rich in eosinophilic granules. The initial cytological diagnosis was oncocytoma. The tumor was then completely excised and the histological diagnosis confirmed the initial cytological one. Oncocytoma is a rare entity which must be considered in differential diagnosis of a peripunctal mass in elderly patients. The literature was reviewed confirming the rarity of such a presentation and the novelty of this case. Cytological criteria of malignancy are not yet established.

A primary mucinous cystadenocarcinoma of the appendix is a rare tumor, accounting for approximately 25% of all appendiceal adenocarcinomas. 1 Preoperative diagnosis is very difficult and is mainly based on computed tomography (CT) scan findings. Furthermore, in many cases difficulties in establishing an accurate intraoperative diagnosis have resulted in a two-stage surgical intervention. We present here a rare case of an appendiceal mucinous cystadenocarcinoma (AMC) in a patient who presented with an unusually large cystic mass in the right lower abdomen.A 67-year-old man with a past medical history remarkable for diabetes mellitus, presented with a 1-month history of lower abdominal discomfort and dull pain localized mainly to the right lower abdomen. The pain became progressively worse over the two days prior to his admission and was associated with nausea. No urinary dysfunction or changes in bowel habits were reported.On admission his blood pressure and body temperature were normal. A physical examination revealed a firm tender mass measuring approximately 15 cm with muscle rigidity in the right iliac fossa. There was no abdominal distension and his bowel sounds were normal, but his liver and spleen were not palpable. A rectal examination revealed no abnormalities. On laboratory investigation, his peripheral blood counts and biochemical markers were normal. The serum concentrations of carcinoembryonic antigen, carbohydrate antigen and alpha fetoprotein were within normal range as well.Contrast-enhanced CT scans of the abdomen revealed the presence of a thick-walled cystic mass with enhanced borders near the cecum. The mass, measuring 15 cm at maximum diameter, was associated with inflammatory changes at its periphery. A giant appendiceal mucocele and a mesenteric cyst were considered in the differential diagnosis.At an exploratory laparotomy performed through a midline incision a large cystic mass measuring 15 × 5 cm was found, involving the appendix. The mass was in contact with the anterior abdominal wall and extended into the urinary bladder, and loops of the small bowel adhered to its surface. The mass was resected and found to contain a thick gelatinous fluid and a number of papillary structures on its inner surface.A frozen section examination revealed malignancy. A right hemicolectomy with side-to-side ileocolic anastomosis was then performed. A histopathological examination of the resected specimen revealed a welldifferentiated AMC (Figs 1,2). No venous or lymphatic Figure 1. Cystically dilated carcinomatous structures with extracellular production of mucus (HE stain, original magnification 25×).

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To our knowledge, synchronous occurrence of neuroendocrine colon carcinoma and hairy cell leukemia has not been previously reported in the literature. Given the rare incidence of both entities in the general population, it is highly unlikely that they occurred together by chance. Further research is needed to determine what would be the optimal management options of patients with simultaneous hairy cell leukemia and a neuroendocrine colon cancer.