In experienced hands, ultrasonic shears had been found to be a useful tool in total thyroidectomy surgery as long as the safety precautions are adhered to closely. It has the advantage of minimising operating time and will eventually reduce the cost of surgery. A randomised controlled trial is thus suggested to further evaluate its efficacy.

Most breast cancer recurrences occur in the surgical scars or within other quadrants of the same breast. Isolated tumour recurrence occurring in the nipple after breast-conserving surgery and radiotherapy is extremely unusual. The reason for this is unknown, but is speculated to be due to involved surgical margins or an occult involvement of the nipple–areolar complex in a breast cancer of the same breast. We present a case of a 44-year-old Indian woman who had recurrent tumour over her right nipple after an ipsilateral breast-conserving surgery that was followed by adjuvant chemotherapy and radiotherapy. There was no typical malignancy features from the mammogram. However, histopathological study confirmed a malignant growth that infiltrated into the dermis and the underneath breast tissue. Completion mastectomy was then performed and the patient was later treated with Taxane-based chemotherapy. Nipple recurrence after breast-conserving surgery and adjuvant radiotherapy may be confused with other nipple conditions such as Paget’s disease of the breast. Comprehensive assessments, which include mammogram and biopsy, have proved that such recurrence do occur, as presented in this case. This warrants a specific management strategy.

Pheochromocytoma during pregnancy is potentially disastrous to the mother and fetus. Its ambiguous presentation is often mistaken for pre-eclampsia, although it may imitate other problems during pregnancy. Early diagnosis and timely, appropriate management reduces possible maternal and fetal complications. We identified a case of pheochromocytoma during pregnancy; the condition was initially diagnosed as pre-eclampsia complicated with gestational diabetes. Surgical intervention via left adrenalectomy was successfully performed in the second trimester. After surgery, all of the patient’s medical problems nearly subsided and she did not require further treatment. However, her fetus displayed restricted intrauterine growth, and the patient eventually had premature delivery via a caesarean section. A multidisciplinary team to identify and treat pheochromocytoma is mandatory to ensure optimal conditions for tumour removal and to anticipate any possible catastrophic events.

Papillary thyroid carcinoma (PTC) associated with familial adenomatous polyposis (FAP) is rare. It is usually associated with the cribriform-morular variant of PTC, with unusual patterns on detailed histology examination. This variant is known to have a good prognosis. Papillary thyroid carcinoma associated with FAP commonly occurs in females in their 30s and rarely in the elderly. We report a case of a 69-year-old female presenting with thyroid swelling and a history of FAP.

Chronic granulomatous mastitis is known as a benign and relatively rare disorder that is often difficult to differentiate from breast carcinoma. We highlight the case of a 34-year-old woman who had recurrent episodes of right breast swelling and abscess for 8 years. These were proven to be chronic granulomatous mastitis by tissue biopsies on 3 different occasions. Her condition improved on similar courses of antibiotics and high-dose prednisolone. However, she subsequently developed progressive loss of vision due to an orbital tumour. She then underwent a craniotomy and left orbital decompression with excision of the tumour, which proved to be a metastatic carcinoma. A trucut biopsy of the right breast was then done and showed features consistent with an infiltrating ductal carcinoma. This case illustrates the possibility that chronic granulomatous mastitis could be a precursor for malignancy and the difficulty in differentiating one from the other. The possible mechanisms of development and the implications for future management are also discussed.