Background Benign fibrous histiocytomas are among the most common soft tissue tumors and are made up of a mixture of fibroblasts, histiocytes, and chronic inflammatory cells. These are commonly found in skin and less commonly in deep soft tissues. There are reports of the presence of a malignant counterpart of fibrous histiocytoma in the breast; however, existence of benign fibrous histiocytoma in breast is a very rare occurrence. Case presentation We present here a case of benign fibrous histiocytoma at an uncommon location with a common presentation. This is a case of 45-year-old female patient, who complained of a painless focal area of hardness and itching in the left areolar region that developed gradually for 1 year, with recent onset of areolar skin thickening, erythema, and mastalgia on the left side. Physical examination revealed a focal area of nodular thickening in the areolar region on the left side with erythema and skin excoriation. No mass was palpable in either breast or axilla. A subsequent mammogram showed an area of focal thickening in the areolar region. Ultrasound also showed a similar finding of nodular skin thickening. Paget’s disease was suspected based on clinical and imaging findings. The contralateral breast was normal. Afterward, a core needle biopsy was done, but the histopathology report was inconclusive and showed only a spindle cell lesion. In due course, excisional biopsy was performed and on the basis of morphology and immune-histochemical markers, a diagnosis of benign fibrous histiocytoma was made. Conclusions Benign fibrous histiocytomas are varying soft tissue tumors that show wide variations in anatomic locations, biologic behavior, and pathologic features. Its diagnosis can be very challenging by imaging and even on histopathology. It must be based on the combination of morphological features and immunohistochemistry. Breast is an extremely uncommon location, and its presentation can mimic invasive carcinomas. A number of other benign and malignant skin lesions may be considered as probable differential diagnosis. It is worthwhile to keep these diverse entities in mind as differential diagnosis, with regards to this particular clinical presentation, which can be beneficial in dealing with challenging cases.

Background Axillary lymphadenopathy is a common clinical presentation of variety of benign and malignant diseases. However, majority of patients with unilateral axillary lymph node enlargement have an underlying malignancy in which association with breast carcinoma being the commonest one. In most of these patients there will be a discernible primary tumor, either clinically or radiologically. However, in axillary lymphadenopathy with negative mammogram is not very common, and in this case other malignant causes should also be considered in addition to occult breast cancer and these can be metastases from other primary tumors for, e.g., lung, genitourinary tract, gastrointestinal, ovarian, thyroid carcinomas and malignant melanoma. Axillary node is an uncommon site of metastases from Transitional cell carcinoma (TCC) of urinary bladder even from its muscle invasive form, and distant metastasis from low grade superficial tumors without muscle invasion or regional metastasis is a very rare occurrence. Here we present a case of axillary nodal metastases from non-muscle invasive (superficial) bladder cancer without history of local recurrence and regional metastases. Case presentation We present a case of female patient who complaint of hard swelling in right axilla and right breast enlargement. Patient had past history of non-muscle invasive transitional cell carcinoma of urinary bladder (pTa, grade II A) which had been treated accordingly. No recurrence of bladder growth had been observed on serial check cystoscopies. On clinical examination of breast and axilla, right breast appears enlarged and there were palpable hard fixed axillary lymph nodes. Ultrasound showed enlarged malignant looking lymph nodes. Occult breast carcinoma with metastatic axillary lymph nodes was our initial impression; however, subsequent biopsy of axillary lymph nodes showed Transitional cell carcinoma. Conclusions This patient’s case emphasizes the importance of having sound knowledge of natural behavior of primary tumor and common and uncommon sites of distant metastases. The causes of unilateral axillary lymphadenopathy include both benign and malignant disease.

Introduction: Whipple's disease (WD) is a rare multi-systemic disorder caused by actinomycetes, Tropheryma whipplei. It presents with weight loss, arthralgia, and diarrhea and may involve the heart, lung, or central nervous system. The use of immunosuppressive medications or underlying immunodeficiency states are associated risk factors. Six cases in transplant recipients have so far been reported worldwide. We describe our experience of WD in renal transplant recipients.Methods: All renal transplant recipients who presented with diarrhea and were diagnosed with WD on duodenal biopsy from 2016 till 2019 were included. Their data regarding duration since transplantation, immunosuppressive therapy, symptoms, treatment response, and outcome were analyzed.Results: Seven cases were diagnosed as WD based on duodenal biopsy, with histological findings of periodic acid Schiff-positive granules in macrophages. All were males. The most common symptoms were chronic diarrhea and weight loss. Average time since transplantation was 4.8 years. All patients were on azathioprine and everolimus. Clinical relapse or adverse effects was seen in five of seven patients treated with doxycycline and hydroxychloroquine which was discontinued. Trimethoprim/sulfamethoxazole for 1 year, with initial intravenous ceftriaxone in two patients, resulted in complete remission in all patients at a follow-up period averaging 1.5 years. Conclusion:WDs in renal transplant recipients most commonly presents as an intestinal disorder. Treatment of 1 year with trimethoprim/sulfamethoxazole has good response with complete remission at 1.5 years of follow up.