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Introduction There are multiple management modalities for idiopathic granulomatous mastitis, but the treatment of choice is still under debate. This study aims to evaluate the diagnosis and outcomes of different management modalities in patients with idiopathic granulomatous mastitis and to identify the risk factors associated with recurrence. Method This is a single-group cohort study that included those patients who had idiopathic granulomatous mastitis. Ultrasonography was conducted for all of the cases using LOGIQ E9 with an ML6-15 transducer (5-15 MHz). A core needle biopsy was conducted to take samples from the cases for histopathological examination. The patients were put on steroid therapy. Whenever the cases did not respond to the steroid therapy, treatment with a combination of low-dose steroids and methotrexate was started. In the lack of response to conservative treatments, surgical interventions were started. Results Sixty-three cases with a confirmed histopathological diagnosis of granulomatous mastitis were included. The mean age of patients was 35.7 years. The history of more than one childbirth was positive in a large portion of the cases (82.5%). The lesion side was unilateral in 58.7% of the cases. A large proportion of the lesions were classified as BI-RADS category 2. The best treatment outcome was yielded by a combination of low-dose steroids and incision and drainage. The factors of age, lesion area (cm2), skin thickening, and white blood cell count enhanced the chance of recurrence. Conclusion Incision and drainage in combination with a low dose of steroids can give an acceptable outcome with a low rate of recurrence.

Highlights • Hydatid disease is an infestation by Echinococci species in the endemic areas. • Liver and lungs are the main two affected organs. • Hydatid disease of thyroid is an extreme rare variant of the condition • In this report, the details of thyroid hydatid disease occurring in a middle age female with brief literature review, Introduction Although hydatid cysts can affect any organ in the body, reports regarding affection of thyroid gland are scanty in the literature. This report aims to present a case of thyroid hydatid disease with literature review. Case report A 48-year-old female presented with painless anterior neck mass of about 2 year duration. There was an ill-defined, central anterior neck mass, with a smooth surface and mobile with deglutition. Ultrasound of the thyroid gland revealed an enlarged left lobe of thyroid gland due to well defined thick wall cystic nodule. The patient underwent left thyroid lobectomy under general anesthesia, the pathology report revealed hydatid cyst of thyroid gland. Discussion Liver and lungs are often the end destination for hydatid cysts, while other places like mediastinum, diaphragm, cardiac, smooth and skeletal muscles, abdominal and chest walls are rarely involved. In this case, the cyst affected even a rarer organ which was the left lobe of thyroid gland. Most of the time the disease is asymptomatic and is found accidentally, yet depending on the site and size of the cysts, symptoms can occur. Conclusion Hydatid disease of thyroid gland is an extremely rare condition. The main presenting symptom is swelling. Operation under general anesthesia is the only modality of treatment.

Introduction and importance The thymus is a primary lymphatic organ within the mediastinum that plays an essential role in developing and maintaining cell-mediated immunity. The current study aims to report a case of intra-tumoral osseous metaplasia of the thymus gland, which is an infrequent phenomenon. Case presentation A 43-year-old male presented with weakness and easy fatigability for 2 months. The patient had an elevated anti-acetylcholinesterase antibody (19.5 nmole/L). Magnetic resonance imaging showed a round, capsulated, enhanced mass in the anterior mediastinum measuring 5.5 × 3.5 cm, suspecting thymoma. The patient underwent plasmapheresis three times in one week, under general anesthesia, in a supine position, sternotomy was performed, and the thymoma was totally resected. Discussion Thymomas are known to occur in all age groups with the peak of nearly between 35 and 70 years with the median age of 54 years. The sex distribution of thymoma is approximately equal with slight predilection of women in old age groups. However, among all reported cases of thymomas with osseous metaplasia, the majorities are female. The significance of this ossification is still to be clarified. Conclusion Although it is rare, secondary changes in thymoma may occur including calcification and ossification., Highlights • The thymus is dedicated to the growth of the immunocompetent T-cells. • Thymoma is an uncommon tumor of the thymic epithelium. • Thymoma with osseous metaplasia is a sporadic condition.

Introduction and importance Lymph node metastasis is the most prominent prognostic factor in breast cancer. The aim of this paper is to report a case of contralateral axillary lymph node metastasis (CAM) which look like metachronous initially, but histopathologicaly confirmed as synchronous CAM. Case presentation A-44-year old female was a known case of left breast cancer five years prior to this presentation (T2,N2,M0, grade III, Triple negative, multifocal invasive ductal carcinoma). On follow up, multiple contralateral axillary suspicious lymph nodes were discovered. Fine Needle Aspiration Cytology from the lesion revealed grade III, Triple negative, invasive ductal carcinoma consistent with metastasis from the left invasive ductal carcinoma. Bilateral mastectomy and right axillary dissection were performed. The histopathological examination and immunohistochemistry showed left breast recurrent 0.5 cm grade III, Triple negative invasive ductal carcinoma. Discussion If a cancer is found in the contralateral axilla, three main potential sources should be considered: contralateral spread from the original breast tumor, metastasis from an occult primary in the ipsilateral breast, and metastasis from an extramammary site. Conclusion Although CAM in patients with breast cancer is an uncommon condition, it is still possible to occur. There is a controversy regarding the appropriate management., Highlights • Lymph node metastasis is the most prominent prognostic factor in breast cancer. • Ipsilateral axillary lymphnode metastasis is the most common site of involvement. • Contralateral axillary lymphnode metastasis is an unusual finding. • In this paper, a case of synchronous contralateral axillary lymph node metastasis has been discussed.

Pilonidal sinus disease may occur in the hand, the presentation and management of which is not well studied, the aim of this review is to highlight the presentation and management of pilonidal sinus disease of hand. Google scholar engine, Cochrane library, PubMed and Web of Science have been searched for the keywords. After exclusion of the unrelated papers, the search found 26 articles. The cases were presented and discussed collectively as the number of patients included in each study was few. The search found 31 patients complaining from pilonidal sinus of interdigital areas. Twenty-six (83.9%) cases were male, 5 (16.1%) cases were females, 23 (74.2%) patients were barbers; other 8 (25.8%) patients were animal groomers. Right hand was affected in 22 (67.7%) cases and in left hand in 10(32.3%) cases. Chronic painful discharging sinus was the most common presenting symptom occurring in 16 (51.6%) patients. Abscess and cystic-like lesions were found in 10 (32.3%) patients. Excision and daily dressing was done for 28 (90.3%) cases, incision and drainage were performed in 2 (6.4%) cases. Recurrence occurred in 5(16.1%) cases. Hand pilonidal sinus is an occupational disease solely affects those individuals who work with hair including barbers and hairy animal groomers. The main presenting symptoms are similar to the pilonidal sinus disease of other areas. Surgical excision with daily dressing is the main line of therapy.

Highlights • Cystic duct variation is quite common. • Duplication of cystic duct is an extreme rare variant. • We report a case of a young female who had two separate cystic ducts exiting from a single gallbladder., Introduction Although cystic duct variation is quite common, duplication of cystic duct is an extreme rare variant. We report a case of double cystic duct with literature review. A 33-year old female presented with right upper quadrant pain of three day duration, associated with nausea and poor appetite. The patient reported previous three attacks of right upper quadrant pain within the last two years. On examination: Murphy's sign was positive and the right upper quadrant was tender. Abdominal ultrasound showed multiple gall stones. Oesophago-gastro- duodenoscopy was normal. Under general anesthesia, four port formal laparoscopy was done, double cystic duct was found. Histopathological examination showed features of chronic cholecystitis. Conclusion double cystic duct is a very rare variant of the cystic duct anomaly. Identification pre or intraoperatively is very important to prevent ductal injury.

Background porocarcinoma is a rare sort of skin cancer developing from sweat glands. Its clinical course and management are not well understood. Objectives the current meta-analysis is to address the presentation and management of porocarcinoma. Data sources Web of Science, PubMed, MEDLINE on OVID and Google scholar were searched for English-language studies published before December 1, 2016. Results The review of literature revealed 453 cases. From which 222 (49%) cases were male and female were 231 (51%). The mean age was 67.57 years. The mean duration of presentation was 5.57 years ranging from 4 days to 60 years of age. The most common site of affection is the head and neck (39.9%) followed by lower extremity (33.9%). Mass and nodule are the most common modes of presentation. Metastasis occurred at presentation in 110 (31%) cases. The most common organ to which porocarcinoma metastizes is the nearby lymph node (57.7%). Conclusions Porocarcinoma is an aggressive skin cancer. Surgery is the main modality of treatment. Systematic review registration number reviewregistry233., Highlights • Porocarcinoma is a rare sort of skin cancer developing from sweat glands. • Because of rarity of the problem, there is controversy regarding both presentation and management. • The aim of the current meta-analysis is to summarize all data regarding the disease.

Highlights • Metaplastic breast carcinoma is a rare type of breast cancer. • Osseous differentiation is a very rare subtype. • We report a case of metaplastic breast carcinoma with osseous differentiation., Introduction Metaplastic breast carcinoma (MBC) is a rare type of breast cancer. Osseous differentiation is a very rare subtype. Reporting this kind of case is important because its clinical course and line of management are poorly mentioned in the literatures. We present a very rare case of MBC with osseous differentiation. A 48-year-old female presented with painless hard mass of the left breast. Examination and investigations showed MBC with osseous differentiation. She was managed by operation with adjuvant chemotherapy. Conclusion MBC with osseous differentiation is a very rare type of breast carcinoma presenting with hard mass and managed by mastectomy, axillary lymph node sampling and adjuvant chemotherapy.