Published data on male breast cancers (MBCs) are scare in Ghana. We report a case of breast cancer in a 79-year old man, who presented at the Tamale Teaching surgical unit with a clinically advanced stage of the disease. He had modifified mastectomy and an invasive intracystic papillary cancer was diagnosed histologically. Immunohistochemically, this tumour was ER+/PR+ /HER2-However, hormonal therapy could not be started, for the 79-year old before he died in the third week after being discharge from the hospital.

Background: Factor Xa inhibitors are widely used by the physicians to reduce the incidence of thrombosis in order to protect the cardiovascular function. Although complications of bleeding and spontaneous gastrointestinal sources have been reported before, there are very sporadic cases of spinal epidural haematoma causing neurological compromise.
Case presentation: We report a case of spontaneous spinal epidural haematoma (SSEH) in an 85-year-old female patient treated with Rivaroxaban, a new agent to prevent the incidence of thrombo-embolic events. Anticoagulant therapy is a recognised risk factor in the development of spontaneous bleeding and haematomas. The patient presented to the emergency department with sudden onset of severe back pain in the lumbar spine associated with paraplegia in the lower limbs. Magnetic resonance imaging (MRI) of the spine demonstrated a SSEH from T12 to L5 affecting the cauda equina. Rivaroxaban was discontinued and the patient was monitored as an inpatient. There was gradual improvement in the symptoms of the lower limbs.
Conclusion: This rare condition of incomplete cauda equina syndrome due to Rivaroxaban therapy has not been reported previously. Clinicians must have a high index of suspicion in patients on regular anti-coagulation regimen.

Pasteurella multocida, a gram-negative bacillus, is present in the oropharyngeal secretions of livestock, wild animals, and domesticated pets and can cause infection in humans. The most common route of entry has been shown to be via an animal bite, but a significant portion of cases of human infection lack evidence of such a wound. Review of the literature reveals that patients with a history of an animal bite tend to have a less aggressive clinical course than patients without an animal source of infection. We present a case, however, of Pasteurella multocida bacteremia which resulted in the death of an immunocompromised 80-year old woman in which the route of infection was found at autopsy to be a cat bite. This case highlights the importance of educating patients, particularly those with underlying immunocompromised conditions, of the possible lethal complications that can result from animal inflicted wounds and the importance of seeking medical assistance should a bite occur.

We present a rare case of a lipoleiomyoma which was discovered incidentally in a hysterectomy specimen of a 74-year old female patient who underwent surgery for a biopsy proven serous adenocarcinoma of the uterus. Lipoleiomyomas represent uncommon, usually benign soft-tissue tumors, generally found in obese menopausal as well as postmenopausal women aged 50 to 70 years. The reported incidence varies from 0.03% to 0.2%. The relationship between lipoleiomyomas and gynecologic malignancies has only been reported in a few cases. We report this case of lipoleiomyoma due to its rarity and its association with a serous adenocarcinoma in our patient.

Uterine adenolipoleiomyoma is a benign hamartomatous lesion of controversial origin, with descriptions of exceptional cases published in the literature. We present the case of a 65-year-old female patient who presented an adenolipoleiomyoma in an endometrial polyp incidentally found during a hysterectomy performed for a cervical lesion. The incidental finding consisted of müllerian type glands, smooth muscle and mature adipose tissue.

Erdheim Chester disease is a rare form of non-Langerhans histiocytosis with frequent BRAF V600E mutations. It is mainly characterized by multifocal osteosclerotic bone lesions with or without systemic involvement. The histologic image is consistent with a histiocytic proliferation of foamy cells in a polymorphic background. The main difference from the Langerhans histiocytosis is the immune profile with mainly S100, CD1a, and langerin negative. The overall prognosis is dependent on extraskeletal involvement. Herein, we present a typical presentation of Erdheim Chester disease with a review of the literature.

Juvenile respiratory papillomatosis is a rare pediatric disease in which benign papillomata develop in the respiratory tract, most commonly involving the larynx and tracheobronchial tree. Invasive pulmonary papillomatosis is an aggressive form in which the papillomata extend into the lung parenchyma. We report a case of a 22-year-old man with a long-standing juvenile respiratory tract papillomatosis, initially diagnosed at age 2, who subsequently developed invasive pulmonary papillomatosis and underwent partial surgical resection for his pulmonary disease. Hypercalcemia complicated the patient’s final hospitalizations. HPV typing performed on a laryngeal papilloma was positive for HPV 6/11. The lobectomy specimen revealed malignant transformation of invasive pulmonary papillomatosis characterized by the presence of microinvasive nests of squamous carcinoma. Immunohistochemical stain for parathyroid hormone on the invasive component was negative. Eventually, the patient succumbed to his disease and while the family refused post-mortem examination, Positron Emission Tomography (PET) performed during the patient’s terminal course suggested the possibility of metastasis to liver and periaortic lymph nodes. There was no evidence of bony metastasis.

A gastrointestinal stromal tumor (GIST) with signet ring cell features is a rare variant of epithelioid GIST. The current case demonstrates a 35-year-old woman with a 22.0 cm stomach mass. Tomography-guided core biopsy of the mass showed an undifferentiated tumor with abundant signet ring cells in a myxoid background. A preliminary diagnosis of adenocarcinoma was considered based on histomorphologic features; however, by immunohistochemistry studies the tumor cells were negative for cytokeratins and intensely positive for CD117/c-kit and CD34. Therefore a diagnosis of GIST with signet ring-like cells features was rendered. Making a diagnosis in a small biopsy specimen is always challenging, due to the variable histomorphological features of these tumors.

Pilomatricoma is a relatively uncommon benign tumor derived from the matrix of hair follicles. Multiple pilomatricomas may arise sporadically or in association with other disease entities. These entities include myotonic dystrophy type-1, a multisystem disorder that confers increased susceptibility to developing neoplasms, as well as familial adenomatous polyposis-related syndromes (including Gardner syndrome) and others. Here we present two case reports of multiple pilomatricomas that were initially misidentified clinically. We discuss pilomatricoma as a differential diagnosis of multiple skin nodules, its association with myotonic dystrophy in one of two patients, and describe its distinguishing microscopic features. We emphasize the importance of screening patients with multiple pilomatricomas for various syndromes that predispose to malignancy.

Objective: To study the clinical and pathological manifestations in a case of hepatic carinosarcoma with rhabdomyosarcoma differentiation (HCSR).
Methods: A case of HCSR was clinically and pathologically evaluated by macroscopy, microscopy, immunohistochemistry (IHC) and electron microscopy, along with thorough review of related literatures.
Results: HCSR tends to occur in elder patients without gender skew. This disease initially presented as an epigastric illness, with elevated serum Alpha-fetoprotein (AFP) and a mass on the right liver discovered through radiography. The patient in this report carried both hepatic carcinoma and variously differentiated forms of sarcoma components, with identifiable rhabdomyosarcoma. Immunohistochemistry staining showed that the hepatic carcinosarcoma was positive for epithelial markers; the mesenchymatous component was diffuse-like positive for Vimentin and mosaic-like positive for SDHB, CD117; and the rhabdomyosarcoma was positive for the muscular markers, respectively. Transmission electron microscopy images showed the tumor had both epithelial and rhabdomyosarcoma ultra-microstructures.
Conclusion: HCSR are malignant tumor associated with poor prognosis, and is difficult to diagnose due to its unique and varied clinical manifestations. In this case study, we used a combination of methods including assessing histomorphology, immunohistochemistry, and ultra-microscope observations to further determine criteria for differential diagnosis.

Breast tall cell carcinoma with reversed polarity (TCCRP) is rare and previously referred to as solid papillary carcinoma with reverse polarity. This low grade tumor commonly exhibits IDH2 p.Arg172 mutation, however is not completely understood at the molecular level. We present a case of TCCRP in a 55 year old woman with a 0.7 cm left breast mass. A core biopsy was performed with immunohistochemistry. Lumpectomy and sentinel lymph node biopsy were completed two months later. MammaPrint^® and BluePrint^® gene expression profilers were performed on an excision block. Microscopically, the tumor was composed of circumscribed nests of columnar cells, with focal papillary architecture. Tumor cells had apically located nuclei with grooves and rare inclusions. Tumor cells were positive for CK5, IDH1/2, and calretinin, and myoepithelial cells were absent. BluePrint^® subtyped the tumor as basaloid. MammaPrint^® classified the tumor as high risk for metastasis. TCCRP presents a diagnostic challenge. Although these rare breast carcinomas are generally reported to have an indolent clinical course, molecular analysis by gene expression profiling classified this tumor as high risk of recurrence with a basaloid type. Therefore, molecular analysis of this tumor may lead to conflicting data regarding prognosis and treatment considerations. Clinicians and patients should weigh published data and individual prognostic information for treatment planning. Our patient and clinical team opted for radiation without chemotherapy. More cases of TCCRP need to be studied to better understand its molecular profile.