Desmoid type fibromatosis of the breast is a rare stromal tumor that accounts for <0.2% of all breast tumors. Although benign, this tumor is locally aggressive with frequent recurrence in up to almost one-third of the cases (1). Bilateral and multicentric lesions are extremely rare, found in only 4% of patients, with only less than ten cases reported in the literature (1, 2). Imaging features of aggressive fibromatosis can frequently mimic invasive breast cancer, resulting in exhaustive clinical and surgical workups.
Case PresentationA 19-year-old woman, with a familial history of breast cancer (paternal aunt diagnosed with it at age 30), presented with bilateral breast lumps that were increasing in size and associated with nipple retraction for one year. Physical examination revealed bilateral retracted nipples. There was a 4 cm × 5 cm firm, ill-defined, mobile retroareolar mass in her right breast and a 3 cm × 3 cm firm, ill-defined, mobile mass in the upper outer quadrant of her left breast. There were no skin changes and fixation to the chest wall or skin. Axillary, supraclavicular, and infraclavicular lymph nodes were not palpable. Breast ultrasound showed bilateral ill-defined hypoechoic masses (two on the right, one on the left) with irregular margins and posterior shadowing (Figure 1).
ContextNumerous studies have shown that gratitude can reduce stress and improve quality of life.ObjectiveOur study aimed to examine the effect of mindful gratitude journaling on suffering, psychological distress and quality of life of patients with advanced cancer.MethodsWe conducted a parallel-group, blinded, randomised controlled trial at the University of Malaya Medical Centre, Malaysia. Ninety-two adult patients with advanced cancer, and an overall suffering score ≥4/10 based on the Suffering Pictogram were recruited and randomly assigned to either a mindful gratitude journaling group (N=49) or a routine journaling group (N=43).ResultsAfter 1 week, there were significant reductions in the overall suffering score from the baseline in both the intervention group (mean difference in overall suffering score=−2.0, 95% CI=−2.7 to −1.4, t=−6.125, p=0.000) and the control group (mean difference in overall suffering score=−1.6, 95% CI=−2.3 to −0.8, t=−4.106, p=0.037). There were also significant improvements in the total Hospital Anxiety and Depression Scale score (mean difference=−3.4, 95% CI=−5.3 to −1.5, t=−3.525, p=0.000) and the total Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being score (mean difference=7.3, 95% CI=1.5 to 13.1, t=2.460, p=0.014) in the intervention group after 7 days, but not in the control group.ConclusionThe results provide evidence that 7 days of mindful gratitude journaling could positively affect the state of suffering, psychological distress and quality of life of patients with advanced cancer.Trial registration numberThe trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN1261800172191) and conducted in accordance with the Declaration of Helsinki.
Shiitake mushroom is a common ingredient in East Asian cuisines. Food processing/preparation can cause the mushroom to be soft and slimy, leading to accidental swallowing. Due to its high insoluble fibre content, it remains the same size and shape in the intestinal tract. We present two cases of small bowel obstruction caused by shiitake mushroom requiring surgical intervention. Preoperative imaging showed dilated small bowel with a suspicious mass in the ileum. However, the exact cause was unclear. For both cases, exploratory laparotomy and enterotomy were then performed and undigested shiitake mushroom was found. Both patients recovered well from the surgery.
HighlightsGastrointestinal (GI) tract metastasis in breast cancer is rare and occurs more commonly in invasive lobular carcinoma.The interval between the index breast cancer and GI tract spread may be as long as 30 years.20% of patients with GI tract metastasis are asymptomatic, and detection may rely on physical examination and imaging.Management follows the principles of treatment in systemic disease in breast cancer, with consideration for surgery in obstruction, perforation or bleeding.
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