Papillary carcinoma breast in male patient - A rare presentation

Introduction - Male breast carcinoma is rare, accounting for 1% of all malignancies in men and around 1% of all cases of breast carcinoma. Intracystic papillary carcinoma accounts for 0.5–1% of all breast cancers. It generally has good prognosis in women with almost 100% reported 10 year survival rate.Similar data for male patients is not available as the disease is extremely rare.Presentation of Case - A 52 year-old male patient presented with a swelling in his left breast. Swelling had gradually increased in size. On examination, a well-circumscribed swelling was palpable in retro aerolar region with nipple retraction. Mass was not fixed to underlying pectoralis muscle.A large mobile axillary lymph node was palpable. Fine needle aspiration was done, which reported “atypical ductal hyperplasia”. A core biopsy was done which displayed features of intracystic papillary carcinoma. A left modified radical mastectomy was carried out with axillary dissection. The biopsy report of the specimen confirmed the diagnosis of intracystic papillary carcinoma, tumor deposits were seen in lymph nodes. Adjuvant chemotherapy was given postoperatively. Patient recovered well.Conclusion - Intracystic papillary carcinoma is a rare malignancy of breast .It carries an excellent prognosis with upto 100% ten years survival rates reported in females.Surgery with chemotherapy has remained mainstay of treatment but due to rarity of the male breast cancer as such and Intracystic papillary carcinoma in particular, there are no clear guidelines for its management. Further analysis of this disease is needed for its better understanding and management.

Prevalence of multidrug-resistant tuberculosis among newly diagnosed cases of sputum-positive pulmonary tuberculosis

Background & Objectives: The prevalence of multidrug-resistant tuberculosis (MDR-TB) is increasing throughout the world. Although previous treatment for TB is the most important risk factor for development of MDR-TB, treatment-naove patients are also at risk due to either spontaneous mutations or transmission of drug-resistant strains. We sought to ascertain the prevalence of MDR-TB among new cases of sputum-positive pulmonary TB. Methods: This was a prospective, observational study involving newly diagnosed cases of sputum-positive pulmonary tuberculosis diagnosed between 2008 and 2009 carried out in New Delhi, India. All sputum-positive TB cases were subjected to mycobacterial culture and first-line drug-susceptibility testing (DST). MDR-TB was defined as TB caused by bacilli showing resistance to at least isoniazid and rifampicin. Results: A total of 218 cases of sputum-positive pulmonary tuberculosis were enrolled between 2008 and 2009. Of these, 41 cases had negative mycobacterial cultures and DST was carried out in 177 cases. The mean age of the patients was 27.8 ± 10.2 yr; 59 patients (27%) were female. All patients tested negative for HIV infection. Out of 177 cases, two cases of MDR-TB were detected. Thus, the prevalence of MDR-TB among newly diagnosed pulmonary tuberculosis patients was 1.1 per cent. Interpretation & Conclusions: MDR-TB prevalence is low among new cases of sputum-positive pulmonary TB treated at primary care level in Delhi. Nation-wide and State-wide representative data on prevalence of MDR-TB are lacking. Efforts should be directed towards continued surveillance for MDR-TB among newly diagnosed TB cases