Introduction and importance Phyllodes tumor is a biphasic fibroepithelial tumor which accounts for less than 1% of all breast neoplasms. We aim to raise awareness among clinicians that a male breast lump may be indicative of underlying sinister pathology and therefore, should be investigated thoroughly. Case presentation A 62 year old male presented in clinic with right beast lump for the last 6 weeks. A preoperative diagnosis of spindle cell tumor was made on core needle biopsy. Neoadjuvant chemotherapy was administered in order to downsize the tumor as it was inseparable from underlying muscle. A post-operative diagnosis of malignant phyllodes was made following mastectomy. As the tumor was 1 mm from the deep margin, adjuvant radiotherapy was administered. Clinical discussion Differential diagnoses of malignant phyllodes include metaplastic carcinomas metastatic/primary sarcomas and fibroadenomas. Metaplastic carcinomas are morphologically heterogeneous and include adenosquamous carcinoma, squamous cell carcinoma and spindle cell carcinoma. In some malignant phyllodes, extensive stromal proliferation can make detection of epithelial component very difficult. This highlights the limitation of core biopsy in establishing an accurate preoperative diagnosis. The standard treatment for phyllodes treatment is surgical resection with margins of 1 cm or more. Adjuvant radiotherapy is used in cases with threatened margins. Conclusion Malignant phyllodes tumor of breast can exist in men, and its accurate pre-operative diagnosis is difficult given the limitations of core biopsy. This case report draws attention to the challenges associated with the diagnosis of this rare condition and highlights the role of different treatment modalities in its management.
Introduction: An abdominal binder is an elastic or non-elastic belt applied to the abdomen in postoperative patients with abdominal surgery. These provide support and splintage to the operative wound, reducing incision site pain. The present work aims to investigate the institutional practices regarding the use of abdominal binders, gain insight into the expected benefits that these practices are targeted to achieve, and determine if current practices are in accordance with the available evidence. Materials and Methods: It is a survey-based questionnaire study conducted at the Department of Surgical Oncology at Shaukat Khanum Memorial Cancer Hospital & Research Center. Respondents were inquired about: designation, frequency of binder usage, reasons for prescribing/ not prescribing binders, duration of the prescription, clinical factors that influence the decision to use binders, and the estimated cost of the device. Results: The questionnaire was emailed to 85 surgeons working in the department of surgical oncology. Out of these, 34 responded, resulting in an overall response rate of 40%. 22 (64.7%) of the respondents used abdominal binders regularly in postoperative patients. 8 (22.5%) reported using it occasionally, while 4 (11.7%) did not use abdominal binders in their clinical practice. 67.8% and 50% of the respondents believed that it helped early mobilization and better pain control, respectively. About 60.7% of the respondents believed that binders prevent incisional hernia formation, while 46.4% were of the view that these prevented wound dehiscence. Up to 60% of the respondents reported using an abdominal binder for 1 week to 1 month after discharge, whereas 23.3% preferred using it only till discharge. Conclusion: This survey demonstrates a gap between the evidence and actual practice. These gaps are often overlooked because of busy clinical practice. Equally important is the issue of surgical conservatism and the intrinsic desire to resist change by continuing old practices.
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