Schwannoma of the Appendix Mimicking a Metastatic Breast Cancer: A case report

Metastatic breast cancer (MBC) represents 5-10% of newly diagnosed breast cancer cases, referred to as de novo stage IV MBC. Distinguishing a distant lesion in breast cancer patients can be challenging. Therefore, obtaining a histopathological confirmation of a metastasis is advisable, as a suspicious metastatic lesion may turn out to be benign or exhibit different immunohistochemistry compared to the primary site. In this case, we describe a woman undergoing staging scans for newly diagnosed breast cancer, where radiological findings suggested appendix metastasis. However, subsequent laparoscopic appendicectomy revealed an appendicular schwannoma, confirmed through immunohistochemistry. The patient then received curative-intent breast cancer treatment. With the increasing use of advanced staging scans in breast cancer, clinicians should thoroughly investigate and confirm metastatic disease, especially in uncommon metastatic sites, before initiating treatment. Keywords: Schwannoma, metastasis, breast cancer, appendix

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

A rare case of hepatic sub capsular biloma after cholecystectomy treated by percutaneous drainage and endoscopic biliary stenting: A case report

Bilomas are localized collections of bile which usually happen post-operatively from an injured cystic or bile duct and most of the biloma collections are in the sub hepatic space. We describe a rare case of hepatic subcapsular biloma after open cholecystectomy which was successfully treated by percutaneous drainage.</p