Background Pleomorphic lobular carcinoma in situ (PLCIS) of the breast is a distinctive entity, and yet its behavior and management are unclear. The purpose of this study was to review a relatively large number of cases and to evaluate the risk of recurrence. Methods Cases of PLCIS (n=47) over a 12 year-period were reviewed. The clinical, radiologic and pathologic findings were recorded. Immunohistochemistry for estrogen receptor (ER), progesterone receptor (PR) and HER2 were performed. Results Thirty-one patients had no concurrent or past history of breast cancer, six (19.4%) of which had local recurrence. All tumors (4 invasive carcinoma and two PLCIS) were ipsilateral. Younger age at presentation was a high risk factor for local recurrence with mean and range of 52.5 (44, 59) vs. 60.6 (40, 81) years (p=0.03). Three of 31 patients were treated with radiation therapy (RT), none of which developed local recurrence. PLCIS had an adverse ER/PR/HER2 molecular profile with at least 41.2% of the cases overexpressing HER2. Moreover, at least 11.7% of the cases were triple negative. Conclusions This study included the largest number of patients that had no past or concurrent history of breast cancer with the longest clinical follow-up, providing an insight to the management practices and risk of recurrence from PLCIS.

We describe a case of pustular dermatitis in a 15-year-old girl who had just returned from horseback riding camp. Based on gram staining, colony characteristics, biochemical reactions, and whole-cell fatty acid analysis, the causative agent was identified as Dermatophilus congolensis. The literature contains few reports of human infection with this organism. CASE REPORTA 15-year-old Caucasian girl with a history of recalcitrant verruca on both hands presented to the dermatology clinic with an eruption on her left inner thigh. The eruption began after the patient returned home from a 2-week session at a horseback riding camp in rural Michigan. The weather had been hot and humid, and the campers often rode bareback, wore shorts, and did not shower regularly. The eruption was slightly tender to touch but not painful or pruritic, and there was no burning or tingling in the area prior to the lesion's appearance. Examination of the skin revealed multiple erythematous papules and pustules over a large portion of the left medial thigh. A few other campers had similar lesions, but they were not as severe. Samples from the pustules were taken for bacterial and fungal cultures by swabbing the purulent discharge. Gram staining was not performed. The patient was placed on cephalexin at 500 mg four times a day for 10 days and was encouraged to wash with an antibacterial soap.An organism was isolated in pure culture. The organism grew readily on blood and chocolate agars (Remel, Lenexa, KS) after overnight incubation at 35°C in 5% CO 2 . Colonies were slightly beta-hemolytic, yellowish, irregular, hard, and adherent to the agar surface and produced pits in the agar medium. Gram staining of the colonies showed gram-positive coccoid forms and large, long, irregular, tapering filaments, many with transverse septa (Fig. 1). The organism was catalase positive and urease positive. Based on these characteristics, the organism was presumptively identified as Dermatophilus congolensis. Definitive identification was performed by the Michigan Department of Community Health based on a variety of biochemical reactions and whole-cell fatty acid analysis with the Sherlock Microbial Identification System (MIDI, Inc., Newark, DE). The organism hydrolyzed casein and starch but not xanthine or tyrosine (Becton Dickinson, Sparks, MD). Nitrates were reduced, urease was produced, and gelatin was liquefied slowly (Remel, Lenexa, KS). The organism produced an alkaline reaction with peptonization in litmus milk (Becton Dickinson, Sparks, MD; prepared at the Michigan Department of Community Health [MDCH]) and grew in standard nutrient broth (Becton Dickinson, Sparks, MD; prepared at MDCH) but not in the presence of 6% sodium chloride. With Purple Broth Base containing 1% carbohydrates (Becton Dickinson, Sparks, MD; prepared at MDCH), dextrose was weakly fermented but xylose, mannitol, lactose, sucrose, maltose, salicin, inositol, sorbitol, arabinose, raffinose, rhamnose, galactose, and glycerol were not fermented. The organism was not acid fast and gre...

Elastic staining is useful to evaluate the serosal invasion of CRC. Positive PELI is a significant predictive factor for lymph node metastasis and recurrence-free survival in patients with pT3 CRC. This indicates that pT3 tumors with PELI should be treated like pT4a tumors.

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Phyllodes tumors of the breast are rare breast tumors that resemble fibroadenoma. They are composed of two types of tissues: stromal and glandular tissues. Unlike fibroadenoma, they are commonly found in the third decade of life and they tend to grow more rapidly. Depending on the relative components of the cells and mitotic activity, they are classified into benign, borderline, and malignant. They are usually present as a lump in the breast. Phyllodes tumors are usually managed by wide excision. The excision should be wide enough to ensure a tumor-free margin. Recurrence rate is very high and most recurrences are usually local. Metastasis to the vulva has not been reported.