Basal Cell Carcinoma of the Female Breast Masquerading as Invasive Primary Breast Carcinoma: An Uncommon Presentation Site

Skin cancer as a single entity is the most common malignancy in North America, accounting for half of all human cancers. It comprises two types: melanoma and nonmelanoma skin cancers. Of the nonmelanomas, basal cell carcinoma (BCC) constitutes about 80% of the cancers diagnosed every year. BCC usually occurs in sun-exposed areas such as the face and extremities. Occurrence in the nipple areolar complex is very rare. We present a case of a Caucasian woman who presented with what was initially thought to be invasive carcinoma of the breast involving the nipple areolar complex (NAC); however, the diagnosis was revealed to be a basal cell carcinoma after histopathological examination. The tumor was treated with modified radical mastectomy, with negative margins. The importance of this case lies in the rare site of presentation of basal cell carcinoma and the importance of early detection

‘Acute leukemia in congenital methehemoglobinemia - an enigma to explore’

Congenital methemoglobinemia is a rare disease, resulting in increased oxygen affinity and impaired oxygen delivery to the tissues. While there have been studies that have linked acquired methemoglobinemia in almost 79% of leukemia patients, to the best of our knowledge, this is the first case of leukemia development in a patient with congenital methemoglobinemia. Chronic deprivation of oxygen to metabolically active bone marrow can theoretically lead to hematopoietic disorders. It would be interesting to further investigate if presence of congenital methemoglobinemia is a risk factor for developing acute leukemia

Gastrointestinal Bleed from Erosive Gastritis and Duodenitis: A Sentinel Event of Invasive Lobular Carcinoma of the Breast and a Diagnostic Dilemma

Metastasis from breast cancer to the gastrointestinal (GI) tract is uncommon, and such events presenting as GI bleeding are exceedingly rare. In some individuals, the absence of classical findings of primary breast cancer coupled with the non-specific nature of GI symptoms may make early detection and diagnosis challenging. Our patient is a 75-year-old female who presented with symptomatic anemia manifesting as progressive dizziness, weakness, and early satiety that developed eight days after right knee arthroplasty. She had a remote history of acid reflux disease and reported regular use of non-steroidal anti-inflammatory drugs (NSAIDs). Physical examination was notable for pallor and tachycardia the cardiopulmonary examination was otherwise unremarkable and the abdominal examination was normal. A fecal occult blood test was positive. Subsequent esophagogastroduodenoscopy demonstrated significant erosive gastritis and duodenitis that was initially attributed to the patient's NSAID use. However, biopsy showed signet ring carcinoma. No gastric primary tumor was identified on work up. Extensive evaluation ultimately revealed invasive lobular carcinoma of the breast. Notably, no primary breast lesion had been detected on physical examination or breast mammography or magnetic resonance imaging (MRI). Therapy for invasive lobular carcinoma of the breast is substantially different from gastric carcinoma and thus it is important to accurately diagnose the condition early in its course to optimize patient outcomes