Bilateral Dissection Research Articles

Risk Factor Analysis for Central Lymph Node Metastasis in Papillary Thyroid Microcarcinoma.

PurposeAlthough the prognosis of papillary thyroid microcarcinoma (PTMC) is excellent, cervical lymph node metastasis (CLNM) is commonly observed in PTMC. This study aimed to investigate the incidence and risk factors for CLNM in PTMC.Patients and MethodsAltogether, 687 patients with PTMC who initially underwent unilateral thyroidectomy with unilateral central lymph node dissection or bilateral thyroidectomy with bilateral central lymph node dissection between January 2014 and June 2018 at our hospital were included. The patients were divided into two groups: PTMC with CLNM and PTMC with no CLNM. The clinicopathologic characteristics and ultrasound features were compared between the groups. Univariate and multivariate logistic regression analyses were used to identify the risk factors for CLNM.ResultsCLNM was observed in 121/687 (17.6%) patients with PTMC. PTMC patients aged <55 years exhibited a greater incidence of CLNM (87.6% vs 12.4%) than those aged ≥55 years. PTMC patients with CLNM were more likely to have capsular extension (24.0% vs 15.4%) and extension to the adjacent structures (9.9% vs 4.2%). Patients with microcalcification on ultrasound images were more likely to have CLNM (66.1% vs 47.9%). Multivariate logistic regression analysis revealed that microcalcification (odds ratio [OR]: 2.066, 95% confidence interval [CI]: 1.361–3.135, P<0.001), age <55 years (OR: 2.341, 95% CI: 1.309–4.187, P=0.004), capsular invasion (OR: 1.772, 95% CI: 1.082–2.879, P=0.023), and invasion of the adjacent tissues (OR: 2.872, 95% CI: 1.355–4.187, P=0.004) were significant risk factors for CLNM.ConclusionMicrocalcification, age <55 years, capsular invasion, and invasion of the adjacent tissues were significant risk factors for CLNM in PTMC.

Abstract 1122‐000200: Chiropractor Manipulation Leading to Bilateral Vertebral Artery Dissection and Acute Ischemic Stroke

Introduction : Traumatic cervical artery dissection is one of the leading causes of stroke in patients under the age of 45. Recent chiropractic neck manipulation is associated with risk of vertebral artery dissection (VAD). The V3 segment of the vertebral artery is highly susceptible to the bending forces during forced manipulation leading to intimal damage. Methods : N/A Results : This is a case presentation of a 44 year old male who was transferred from another emergency department for left homonymous inferior quadrantanopia noted on an optometrist visit. He reported sudden onset left homonymous hemianopia after receiving a high velocity cervical spine adjustment at a chiropractor appointment for chronic neck pain a few days prior. CT angiogram of the head and neck revealed bilateral vertebral artery dissection at left V2 and right V3 segments. MRI brain confirmed an acute infract in the right medial occipital lobe. His right PCA stroke was likely embolic from the injured right V3 but possibly from the left V2 as well. As the patient reported progression from a homonymous hemianopia to a quadrantanopia, he likely had a migrating embolus. Conclusions : Arterial dissection accounts for about 2% of all ischemic strokes, but may be between 8–25% in patients less than 45 years old. VAD can result from trauma of varying severities ‐ from sports, motor vehicle accidents, and chiropractor neck manipulations to violent coughing/sneezing. It is estimated that 1 in 20,000 spinal manipulation results in vertebral artery aneurysm/dissection. In the United States, patients who have multiple chronic conditions are reporting higher use of complementary or alternative medicine, including chiropractic manipulation. Education about the association of VAD and chiropractor maneuvers can be beneficial to the public as these are preventable acute ischemic strokes. In addition, vertebral artery dissection symptoms can be subtle and patients presenting to chiropractors may have distracting pain masking their deficits. Evaluating for appropriateness of cervical manipulation in high‐risk patients and detecting early clinical signs of VAD by chiropractors can be beneficial in preventing acute ischemic strokes in young patients.

P001 - Defining the role of bilateral groin dissection for squamous cell carcinoma of the penis in South Africa

P001 - Defining the role of bilateral groin dissection for squamous cell carcinoma of the penis in South Africa

Characterization of A Rare Case of Vulvar Epithelioid Sarcoma with local recurrence and metastases

Abstract Introduction/Objective Epithelioid sarcoma (ES) is a rare, malignant mesenchymal neoplasm that has a known tendency for local recurrence, regional lymph node involvement, and distant metastases. Two histologic variants have been recognized: classic ES also known as the distal type, and proximal-type ES (PES). The classic ES is common in young adults. It occurs more frequently in the distal upper extremities followed by the distal lower limbs and has a male prevalence of 2:1. Conversely, PES commonly involves deep tissues in the pelvic region, including the genital area. It tends to occur in older patients and follows a more aggressive clinical course. In the female genital tract, PES occurs most frequently in the vulva. The incidence of primary sarcoma of the vulva accounts for 1.5-5% of all malignant tumors, making PES a very rare incidence. Methods/Case Report Here we report a 60-year-old female diagnosed with vulvar epithelioid sarcoma treated with a right radical vulvectomy and bilateral inguinal lymph node dissection in 2008. In 2017, further surgery and adjuvant radiation were given for local recurrence. In 2020, the patient developed left hip pain and was found to have an expansile lytic lesion in the left proximal femur. Extensive resection was performed. Grossly the vulvar lesion was nodular with diffuse hemorrhage, degeneration, and necrosis. Microscopically, the tumor cells had large vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Histologically, the morphology of the tumor cells are similar for the primary vulvar specimen and the bone metastases. Immunohistochemically, the tumor cells are positive for vimentin, GATA, FLI-1, SMA, SMHC, partially positive for CAM5.2, AE1/AE3, CD31, and CD163. Immunohistochemistry was negative for CDX2, CD56, S-100, TTF-1, CK5/6, CK20, P40, mammoglobin, MOC31, ER, CK7, CK903, HMB45, PAX8. A Ki-67 proliferative index was around 30-40%. NGS molecular testing detected a SMARCB1 mutation with loss of exons 1-3 and exons 7-9 supporting the diagnosis of epithelioid sarcoma. Results (if a Case Study enter NA) NA Conclusion In summary, we report a case of PES of the vulva in a 60 year old female. Grossly, the lesion was nodular with histology showing large vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. It showed loss of INI1/SMARCB1 nuclear expression. The patient is receiving further adjuvant treatment and shows no new metastases.

Thirty years' changes of the strategy of lateral lymph node dissection in low rectal cancer: treatment experience and prognostic analysis of 289 cases in one single center

Objective: The surgical indications, resection extent and management principle of lateral lymph node dissection (LLND) in lower rectal cancer have been controversial between Eastern and Western countries. This study aims to provide a theoretical basis for the rational implementation of LLND by reviewing the changes of LLND strategy over the past 30 years in a single-center, and analyzing prognostic factors for the survival outcomes of patients with lateral lymph node metastasis (LLNM). Methods: A retrospective observational study was performed. Clinical data of 289 patients with rectal cancer who received LLND at the Department of General Surgery of Peking University First Hospital from 1990 to 2019 were collected. Patients were divided into three groups based on decades. There were 89 cases in 1990-1999 group, 92 cases in the 2000-2009 group, and 108 cases in the 2010-2019 group. Data analyzed: (1) patient baseline data; (2) surgery and postoperative recovery; (3) lateral lymph node dissection; (4) postoperative survival and prognosis of patients with positive lateral lymph nodes. The surgical methods and pathological results of LLND were compared between groups, and the prognostic risk factors of patients with LLNM were analyzed. Results: A total of 289 patients underwent radical resection with LLND' accounting for 6.3% of the 4542 patients with rectal cancer during the same period in our hospital. Except decade-by-decade increase in tumors with distance from anal verge ≤ 7 cm, the proportion of ulcerated tumors, and the proportion of neoadjuvant radiochemotherapy, the differences in other baseline data were not statistically significant among 3 decade groups (all P>0.05). The proportion of LLND in the 3 groups decreased decade by decade [9.9% (89/898) vs. 8.0% (92/1154) vs. 4.3% (108/2490), χ(2)=40.159, P<0.001]. The proportion of laparoscopic surgery and unilateral LLND increased, while the mean operative time, intraoperative blood loss, surgical complications above grade III and postoperative hospital stay decreased decade by decade. These 289 patients completed a total of 483 lateral dissections, including 95 cases of the unilateral dissection and 194 cases of the bilateral dissection. The proportion of LLND in the 3 groups decreased decade by decade [9.9% (89/898) vs. 8.0% (92/1154) vs. 4.3% (108/2510), P<0.001]. The median number of dissected lymph nodes in the internal iliac artery and obturator regions increased (2 vs. 3 vs. 3, P<0.001), but those in the common iliac and external iliac regions decreased significantly (4 vs. 3 vs. 2, P=0.014). A total of 71 patients with LLNM were identified. The rate of LLNM in the 2010-2019 group was significantly higher than that in the previous two groups [37.0% (40/108) vs. 16.9% (15/89) vs. 17.4% (16/92), P=0.001]. The patients with LLNM showed a poorer overall survival (OS) and disease-free survival (DFS) compared with negative lateral lymph nodes (P<0.001). There were statistically significant differences in 5-year OS rate (30.9% vs. 27.2% vs. 0, P=0.028) and 5-year DFS rate (28.3% vs. 16.0% vs. 0, P=0.038) among patients with only internal iliac lymph node metastasis, patients with only obturator lymph node metastasis, and patients with external iliac or common iliac lymph node metastasis. Multivariate analysis of prognostic factors showed that external iliac or common iliac lymph node metastasis was an independent risk factor for OS (HR=1.649, 95%CI: 1.087-2.501) and DFS (HR=1.714, 95%CI: 1.173-2.504) in patients with LLNM (all P<0.05) . The OS and DFS were not significant different in patients with LLNM among 3 decade groups. Conclusions: In the past decade, the proportion of LLND in rectal cancer has decreased significantly. However, LLNM rate has been significantly increased due to preoperative imaging assessments focusing on suspicious LLNM without compromising the survival. Internal iliac artery and obturator lymph nodes can be regarded as regional lymph nodes with a satisfactory prognosis after LLND. For suspected external iliac or common iliac lymph node metastasis, the significance of LLND remains to be further evaluated.

213 Can Styloid Process and Internal Carotid Artery Anatomy Be Used to Predict Carotid Artery Dissection?

Abstract Aim Carotid artery dissection is a common cause of stroke in the young. It has been related to the association of the carotid artery with fixed neighbouring anatomical structures. This study assesses the association between styloid process length, internal carotid artery position and cervical carotid artery dissection (CCAD). This information would provide potential predicative radiological measurements, which could prevent delays in CCAD diagnosis. Method Retrospective data was collected from two central London hospitals over five years. CCAD cases were identified from individuals who underwent computer topography angiography (CTA) of the neck for suspected CCAD. The following data was collected: evidence of CCAD; bilateral styloid process length and presence of styloid-hyoid ligament calcification; bilateral styloid process-internal carotid distance; calcification of carotid arteries and whether their position was aberrant. Cases were dissection-side, age and gender matched with two non-dissection controls. Results Three hundred and fifty-five individuals were identified. Fifty individuals had CCAD, of which 4 had bilateral dissection. In individuals with CCAD, average styloid process length was 27.5mm and styloid process-internal carotid distance was 5.14mm. There was no significant association between styloid process length or styloid process-internal carotid distance, and CCAD when compared with matched controls. Internal carotid artery aberrancy was significant for non-dissection. Conclusions In this study, there was no association between styloid process length and styloid process-internal carotid distance with CCAD. These measurements cannot be used to predict the possibility of a CCAD following trauma.

Selection of surgical strategies for vulvar Paget's disease.

Selection of surgical strategies for vulvar Paget's disease.

A hybrid technique of lap perineal pelvic lymphadenectomy after open radical perineal prostatectomy in localized carcinoma prostate: Our initial experience.

The major disadvantage of radical perineal prostatectomy (RPP) is the difficulty to perform pelvic lymphadenectomy via the same incision. Open retropubic, mini laparotomy, and transperitoneal laparoscopic pelvic lymphadenectomy as an adjunct to open RPP have been tried but need change in patient position and separate incision, thereby decreasing the acceptability of this procedure. Open RPP followed by a lap perineal pelvic lymphadenectomy via the same perineal incision is a hybrid technique that is aimed to decrease morbidity of lymphadenectomy. Patients of low and intermediate risk localized carcinoma prostate with a Partin score of >5% were taken for this procedure. After completing prostatectomy part of RPP, lap perineal pelvic lymphadenectomy was performed via same incision using single incision laparoscopic surgery port. We performed this new hybrid technique in eight patients. Bilateral lymph node dissection required an additional mean time of 35 minutes. A total of 68 nodes were retrieved from eight patients with a median number of eight nodes (range: 6-12). None of our cases had any complications related to lymphadenectomy. Bilateral lymph node dissection was feasible in seven patients, and in one patient, it could be done on one side only. Sandwiching lap perineal pelvic lymphadenectomy between prostatectomy part of RPP and urethra-vesical anastomosis (by open approach) is a safe, reproducible, and feasible approach to pelvic lymphadenectomy compared to lymphadenectomy from other routes with simultaneous reduction in the operative time, patient morbidity, and discomfort. Ease of doing lymphadenectomy from same incision can increase the acceptability of this excellent procedure.

Papillary thyroid microcarcinoma: distinct form or cancer growth stage?

Background. Over the past decades an increase in the incidence of papillary thyroid microcarcinoma (PTMC) has been observed throughout the world owing to the improved diagnostics. There are many different opinions about the aggressiveness degree of this group of tumors, as well as about the tactics of managing patients with PTMC.Aim of the study is the identification of the prognostic factors responsible for the features of the clinical course, including the more aggressive one.Materials and methods. A study was carried out with a detailed analysis of a group of patients with papillary thyroid cancer ≤1 cm in size and the existing clinical data of regional and distant metastases. All patients underwent thyroidectomy with bilateral central cervical lymph node dissection. Factors such as gender, patient age, bilaterality, extrathyroid extension, the presence or absence of a capsule around the tumor node, the absence or presence of metastases in the central part were assessed. In 26.6% histological examination revealed metastatic lesions of the central group lymph nodes. Latent metastases were detected in 24.2% of women and 43% of men, in 36.7% of patients &lt;55 and in 14.3% of patients ≥ 55 years, in 29.5% with the absence of the node capsule and in 19.3% with encapsulated tumors, in 48.1% with multicentric growth and in 19.5% with a solitary neoplasm, in 21.7% with a tumor size ≤0.5 cm and in 27.9% with a node of 0.6–1 cm, in 24% with the absence of invasion of the thyroid capsule and in 31% with the presence of extrathyroid invasion, in 21% of patients with typical, in 26% with follicular and 43% with mixed papillary cancer. 95 patients received radioiodine therapy. No additional metastases were found in them.Results. When conducting univariate analysis, the main signs influencing the development of metastases in the central zone were age up to 55 years (p = 0.009, χ2 = 6.919) and multicentric neoplasm (p = 0.004, χ2 = 8.530); in multivariate analysis, similarly, age younger 55 years (p = 0.000, Exp B = 0.011, CI 95.0% 0.001–0.106) and multifocality (p = 0.027, Exp B = 2.686, CI 95.0% 1.119–6.448).Conclusion. PTMC is not a separate group or tumor morphotype, and the determination of treatment tactics for this group of patients should be based not only on the size of the tumor, but on the clinical and biological parameters of the tumor.

Pathological Level VI Lymph Node Metastasis in Clinical N3b Pyriform Sinus Squamous Cell Carcinoma.

The frequency of metastasis to level VI lymph nodes in advanced pyriform sinus squamous cell carcinoma (PSSCC) is unknown. We intended to analyze the clinical features and pathological presence or absence of level VI lymph node metastasis in patients with PSSCC. The data of 270 patients with previously untreated hypopharyngeal squamous cell carcinoma from 2006 to 2016 were obtained. Patients who underwent pharyngolaryngectomy for the pyriform sinus subsite with a curative intent with level VI dissection were included. We retrospectively analyzed the clinical Tumor-Node (TN) status (TNM classification of malignant tumors, eighth edition) and the presence or absence of pathological level VI lymph node metastasis. A total of 34 patients were included. Eight patients (24%) had pathological level VI lymph node metastasis. The rate of pathological level VI lymph node metastasis was directly proportional to the clinical N status (P = .0002, Chi-square test for trend). In all, 5 patients with cN2b- 3 were classified as cN3b. Ipsilateral pathological level VI lymph node metastasis was observed in 1 patient, and bilateral metastasis was observed in 3 patients. There was no association between clinical T status or pyriform sinus apex invasion and pathological level VI metastasis (both P > .99, Fisher's exact test). PSSCC with cN3b is prone to bilateral level VI metastasis. We recommend that patients with PSSCC with cN3b should undergo bilateral level VI lymph node dissection.

Evaluation of shoulder function after repairing head and neck defects with supraclavicular flap

Objective: To evaluate the shoulder function in patients after repair of head and neck defects with supraclavicular flap. Methods: A retrospective analysis was performed on 56 patients (54 males, 2 females, aged 35-74 years old) who received the repair of head and neck defects with supraclavicular flaps at Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital, Capital Medical University in January 2013-December 2020. The areas and types of flaps, disruption or infections of the incision at the donor sites and other postoperative complications were recorded. Quick disabilities of the arm, shoulder and hand (Quick-DASH) was used for evaluating the shoulder functions in 43 patients conforming to the standard for evaluation of the clinical functions of shoulders and upper limbs, to compare the postoperative upper limb functions between patients treated with clavicular flaps and patients with acromion flaps. Meanwhile, 30 patients who received bilateral neck lymph node dissection over the same period of time were selected for a comparative evaluation of the donor sides (observation group) and the opposite sides (control group). Data were processed with SPSS 22.0. Results: The areas of obtained supraclavicular flaps were (4-10) cm × (10-18) cm. Three patients (5%) showed the defect widths of 8-10 cm at the donor sites, which couldn't be sutured directly, received the repair of their shoulder defects with partial flaps. Defects in other patients were sutured directly. After surgery, 3 patients (5%) suffered from disruption of the acromion incision, which healed after 2 weeks of local dressing. The follow-up time was 6-43 (27±14) months. All patients expressed no dissatisfaction with the appearance. Among 43 patients, 28 (65%) were clavicular type and 15 (35%) were acromion type. The acromion type showed average motor ability and Quick-DASH scores higher than the clavicular type [(average motor ability: (14.4±4.7) vs. (11.8±3.1), t=2.105, P=0.048; Quick-DASH: (16.9±11.6) vs. (12.2±7.1), t=2.284, P=0.033]. Among 30 patients who received bilateral neck lymph node dissection over the same period of time, the observation group showed higher average motor ability, local symptoms and Quick-DASH scores than the control group [average motor ability: (13.4±5.8) vs. (9.8±4.2), t=3.024, P=0.004; average local symptoms: (4.1±1.0) vs. (3.4±1.0), t=2.537, P=0.014; Quick-DASH: (15.6±14.7) vs. (5.2±11.1), t=3.106, P=0.003]. Conclusion: Shoulder dysfunction exists after treatment with supraclavicular flap, which is related to the flap type.

Is There a Regular Pattern in the Recovery of Parathyroid Function After Thyroid Cancer Surgery?

PurposeTo investigate whether there is a pattern of recovery of parathyroid function after thyroid cancer surgery.Patients and MethodsThe study included 183 patients with papillary thyroid cancer (PTC) who underwent “total thyroidectomy (TT)” plus “unilateral central lymph node dissection (UCLND)” or “bilateral central lymph node dissection (BCLND)”. The intact parathyroid hormone (iPTH) and serum calcium (sCa) were analyzed several times within 1 month after surgery to explore the recovery pattern of parathyroid gland function. Then, these 183 cases were divided into group A (97 cases) with UCLND and group B (86 cases) with BCLND to analyze whether the impairment and recovery of parathyroid function were different between the two subgroups.ResultsPostoperative hypoparathyroidism was seen in 115 out of 183 cases. iPTH values decreased significantly on postoperative day (POD) 1 compared with preoperative values, dropped to the lowest point on POD 3, showed an increasing trend on POD 5 and 14, and increased to 85.0% of preoperative values at POD30, whereas changes in sCa differ from changes in iPTH, which showed the lowest sCa value on POD1, and rebounded on the POD3 with the intervention of calcium supplementation, and continued to rise on the POD5 and POD14, and the sCa value reached 96.6% of the preoperative level at POD30. Subgroup analysis showed that temporary hypoparathyroidism was more pronounced in group B than in group A. SCa and iPTH levels in both subgroups showed the same trend of first decrease and then increase.ConclusionThe recovery of hypocalcemia and hypo-iPTHemia in the first month after thyroid cancer surgery shows a trend of decreasing and then increasing, and knowing the recovery of parathyroid function at different time points is of great value to surgeons and patients alike.

ROBOTIC-ASSISTED LIVING DONOR HYSTERECTOMY - TECHNIQUE AND OUTCOME (DALLAS UTERUS TRANSPLANT STUDY)

To share our experience in performing the first series of robotic-assisted living donor hysterectomies with transvaginal extraction of the uterine graft in the world. Our institution has performed 19 living donor hysterectomies for uterus transplantation with the first 13 cases performed with an open laparotomy technique and the last 6 cases performed with a robotic-assisted technique. This video uses footage from a robotic-assisted living donor hysterectomy to review the essential steps and techniques involved. These steps include bilateral vascular dissection of the uterine arteries from the anterior branch of the internal iliac artery, the inferior uterine veins from the uterus to the inlet in the internal iliac veins, and the superior uterine veins without compromising the outflow of the ovaries. For the procedure, a da Vinci Xi robotic platform in a 4-arm configuration, alternating between a 0° and a 30° scope was used. Bilateral ureteral stents were placed allowing for indocyanine green dye injection (retrograde injection via the Foley catheter), which facilitates the identification of the ureters during surgery. A uterine manipulator (Rumi II Koh-Efficient Uterine Manipulator; CooperSurgical, Trumbull, CT) was used for retraction of the uterus. We also review donor complications, and graft and recipient outcomes. Uterus transplantation is a proven treatment for absolute uterine factor infertility. Proof of concept was achieved with both uteri from both living and deceased donors.

VNOTES Lateral Window Approach to Hysterectomy in a Case with Previous History of Multiple Surgeries Resulting in Keloid Scars and Enlarged Uterus with Dense Bladder Adhesions

To demonstrate transvaginal natural orifice transluminal endoscopic surgery (vNOTES) lateral window approach to hysterectomy in a case with a history of multiple surgeries resulting in keloid scars and enlarged uterus with dense bladder adhesions. Stepwise demonstration of the technique with narrated video. A minimally invasive gynecologic surgery department of tertiary care private hospital. A 43-year-old female presented with menorrhagia and dysmenorrhea in the last 8 months. She had a history of undergoing cesarean section twice and an open appendectomy. These surgeries had resulted in keloid scar formation. She was very anxious about keloid formation and desired to avoid abdominal scars. Examination and transvaginal ultrasound revealed enlarged uterus with multiple fibroids. The largest intramural fibroid measured 11×9.4 cm. vNOTES hysterectomy with the following key strategies was performed: (1) anterior colpotomy with bilateral lateral window dissection, (2) posterior colpotomy with opening of posterior peritoneal pouch, (3) application of wound retractor and vNOTES glove port, (4) continued dissection of lateral window aiding to the completion of hysterectomy, (5) uterine rotation maneuver aiding to bladder adhesiolysis, and (6) transvaginal retrieval of specimen and closure of colpotomy. vNOTES is a feasible method of approaching lateral window dissection in scarred uteri. It allows safe dissection and bladder adhesiolysis. It allows excellent visualization of all pedicles and safe hysterectomy for large uteri. Hysterectomy for adherent uteri can be performed by vNOTES.

Папиллярная микрокарцинома щитовидной железы: отдельная нозология или одна из стадий развития рака?

Background. Over the past decades an increase in the incidence of papillary thyroid microcarcinoma (PTMC) has been observed throughout the world owing to the improved diagnostics. There are many different opinions about the aggressiveness degree of this group of tumors, as well as about the tactics of managing patients with PTMC. Aim of the study is the identification of the prognostic factors responsible for the features of the clinical course, including the more aggressive one. Materials and methods. A study was carried out with a detailed analysis of a group of patients with papillary thyroid cancer ≤1 cm in size and the existing clinical data of regional and distant metastases. All patients underwent thyroidectomy with bilateral central cervical lymph node dissection. Factors such as gender, patient age, bilaterality, extrathyroid extension, the presence or absence of a capsule around the tumor node, the absence or presence of metastases in the central part were assessed. In 26.6% histological examination revealed metastatic lesions of the central group lymph nodes. Latent metastases were detected in 24.2% of women and 43% of men, in 36.7% of patients <55 and in 14.3% of patients ≥ 55 years, in 29.5% with the absence of the node capsule and in 19.3% with encapsulated tumors, in 48.1% with multicentric growth and in 19.5% with a solitary neoplasm, in 21.7% with a tumor size ≤0.5 cm and in 27.9% with a node of 0.6–1 cm, in 24% with the absence of invasion of the thyroid capsule and in 31% with the presence of extrathyroid invasion, in 21% of patients with typical, in 26% with follicular and 43% with mixed papillary cancer. 95 patients received radioiodine therapy. No additional metastases were found in them. Results. When conducting univariate analysis, the main signs influencing the development of metastases in the central zone were age up to 55 years (p = 0.009, χ2 = 6.919) and multicentric neoplasm (p = 0.004, χ2 = 8.530); in multivariate analysis, similarly, age younger 55 years (p = 0.000, Exp B = 0.011, CI 95.0% 0.001–0.106) and multifocality (p = 0.027, Exp B = 2.686, CI 95.0% 1.119–6.448). Conclusion. PTMC is not a separate group or tumor morphotype, and the determination of treatment tactics for this group of patients should be based not only on the size of the tumor, but on the clinical and biological parameters of the tumor.

Predictive Factors for Submandibular Gland Involvement in Oral Cavity Squamous Cell Carcinoma-a Prospective Study from a Tertiary Cancer Center.

The oncological necessity of submandibular gland removal during neck dissection for oral cavity squamous cell carcinoma surgery has remained controversial. This study was aimed to determine the rate of SMG involvement and assess the feasibility of submandibular gland (SMG) preservation. We present a prospective study conducted at a tertiary cancer center from June 2017 to May 2019. All patients of oral squamous cell carcinoma who underwent primary surgery with neck dissection were included and analyzed for incidence and predictive factors for incidence of level IB nodal and SMG involvement as per CAP guidelines. A total of 60 patients were inducted in the study, wherein 63 neck dissections were performed including bilateral dissection in three cases. There was involvement of SMG in 6 patients with two cases each in floor of mouth cancer, gingivo-buccal, and alveolar lesions. The SMG was involved by direct contiguous spread from the primary lesion in two cases, extra-capsular extension from level IB lymph nodes in one and by both mode of spread in three glands. Perineural invasion was seen in 83.33% (n = 5) patients with SMG involvement (p- < 0.001), while 66.67% (4/6) patients had lympho vascular invasion (p-0.006) and all the cases with SMG involvement had extra-capsular extension (p < 0.001), suggesting PNI, LVI, and ECE as the strongest predictors of SMG involvement. This study demonstrates that oral cavity squamous cell carcinoma has low potential to metastasize to the SMG; however, high-risk factors include primary tumor site in floor of mouth or tongue, heavy level IB nodal burden, presence of LVI, PNI, and ECE. In the absence of these high-risk factors, SMG preservation with complete nodal clearance in level IB is a promising technique for reducing future complications.

Revision of the morphology of longissimus capitis, longissimus atlantis, longissimus cervicis, and the cranial part of longissimus thoracis in the domestic goat (Capra hircus): a cadaveric study.

Veterinary anatomical texts have generally described the longissimus muscle only in terms of its attachment in the ox as the basic species and have not thoroughly addressed its morphology in small ruminants. Hence, the present study was designed to present the anatomical features of longissimus capitis, longissimus atlantis, longissimus cervicis, and the cranial part of longissimus thoracis of domestic goats by comparing them with the existing descriptions of these muscles in the ox. Bilateral dissections of the neck and the cranial thoracic regions of 10 domestic adult goats of both sexes were carried out. The longissimus capitis and longissimus atlantis consisted of about 5 muscle slips originating from the articular processes of C3-C7 (including their bony ridges) or T1 and the transverse process of T2. In 7 (37%) of the 19 muscles dissected, the last slips in the longissimus capitis and longissimus atlantis or in one of them showed no attachment to the vertebrae. Rather, the thoracolumbar fascia in the cranial part of the thoracic region, the cranial edge or the deep face of longissimus thoracis, and the deep face of longissimus cervicis served as the origins of the muscles. The attachment sites of the longissimus cervicis and the cranial part of the longissimus thoracis in the goat demonstrated no remarkable differences with those of the ox. Whether the attachment sites of these variants should be considered as normal or anomalous needs to be evaluated with a larger number of animals of different breeds.

28596 Efficacy of laser CO2 treatment for lymphedema secondary to gynecologic cancer therapy

Genital lymphedema is a debilitating possible side effect of gynecologic and pelvic malignancies. With a prevalence of 2-3 million cases in the US, lymphedema is a common chronic inflammatory condition due to lymphatic insufficiency often occurring secondary to surgery, tumor burden, trauma or radiation. Studies estimate 1 in 5 breast cancer patients will experience chronic upper extremity edema; however, other malignancies are less explored. Genital lymphedema may significantly affect quality of life with sequela of lymphorrhea, swelling, and urinary retention. Suggested first line care is non-surgical management; however, no standard recommendations exist. We present a 62-year-old woman with stage IIB grade 3 cervical cancer presenting to dermatologic surgery for evaluation of chronic vulvar lymphedema after total abdominal hysterectomy with bilateral salpingoopherectomy and lymph node dissection with subsequent chemotherapy and pelvic radiation. She developed painful bilateral lower extremity, anterior pelvis and mons pubis lymphedema within two months of treatment. The patient experienced emotional distress due to seven episodes of cellulitis, admissions to the hospital, impaired ability to exercise and decreased aesthetic satisfaction. After failing traditional management with chronic antibiotic therapy, compression stockings and massage therapy and having been rendered a poor surgical candidate for lymph node transfer, she visited dermatology. Six sessions of fractional CO2 laser [Lumenis Deep Fx Fractional CO2 laser, Coherent USA] therapy have been performed with success in decreasing lymphorrhea, edema, and cellulitis episodes allowing stoppage of prophylactic antibiotics. This case explores and highlights the use of fractional CO2 laser therapy for treatment of lymphedema and its sequela.

Cervicocranial arterial dissection. Experience in 57 patients

Cervicocranial arterial dissection (CIAD) is an important cause of stroke. To describe the clinical and imaging characteristics of patients with CIAD. An anonymous registry was made including all patients admitted to a private hospital with a diagnosis of CIAD. Patients were subdivided as having an anterior or posterior circulation dissection (ACD or PCD, respectively). Fifty-seven patients aged 40 ± 8 years (60% women) were included in the study, 39 with PCD and 18 with ACD. Cervical pain was the most common symptom. CIAD was diagnosed with no clinical or imaging signs of stroke in 49% of patients. Fifty one percent of patients had focal neurological deficits and 72% had a NIH stroke score below five. No significant differences between patients with ACD or PCD were found. Fifty patients received antiplatelet therapy (simple or dual), seven patients were anticoagulated and 13 were subjected to stenting due to progression of stenosis with hemodynamic involvement or bilateral dissection with scarce collaterals. The lesion was located in V3 segment in 27 patients and cervical segment of the internal carotid in 16 cases. A favorable Modified Rankin Scale (0-2) was achieved in 85.9%, with a trend towards achieving better functional prognosis in PCD. Due to the greater availability of non-invasive imaging methods, 50% of these patients with CIAD did not have a stroke. Thus, an earlier and more timely management is feasible.

Carcinoma Ex Pleomorphic Adenoma of the Uvula - Case Report

Introduction: Carcinoma Ex Pleomorphic Adenoma (CEPA) results from the malignant transformation of a benign tumor of the Salivary Glands (SG), the Pleomorphic Adenoma (PA). PA is considered the most common salivary tumor with a 5% risk of malignant transformation and its excision is recommended. CEPA is a rare tumor, corresponding to 3.6% of all salivary tumors and 11.6% of all GS carcinomas. About 18% of CEPAs affect minor SG, with the palate being the most common location. The present work serves to describe a case of a CEPA of the Uvula Minor SG (UMSG). Case Report: We present a case report of a 57-year-old patient, with no relevant medical history, referred to the ENT consultation due to the appearance and progressive growth of a painless uvula lesion. The objective ENT examination showed a 15 mm ulcerative-vegetating lesion with apparent origin on the posterior face of the uvula. The lesion was biopsied and histopathological examination identified the presence of a neoplasm of the minor SG, probably NOS adenocarcinoma. The patient underwent Computed Tomography (CT) scan that showed an irregularity of the uvula, with no signs of invasion of the remaining soft palate, without other significant pharyngo-laryngeal changes. The patient underwent partial pharyngectomy and bilateral selective cervical ganglion dissection, and the histopathology of the surgical specimen confirmed that it was an invasive CEPA, the malignant component of the tumor corresponding to a NOS adenocarcinoma of the UMSG. The patient has been followed up in the ENT consultation, with no signs so far of loco-regional recurrence. Discussion/Conclusion: In the presented case, the patient probably developed an undiagnosed PA that had become malignant over time. Given that it is a poor prognosis neoplasm, it’s essential that the ENT specialists are aware of this disease, in order to facilitate and anticipate the diagnosis and treatment as much as possible.