Final Histological Examination Research Articles

Papillary Microcarcinoma: AN Epidemiological, Clinical, therapeutic and Prognostic Study of 35 Cases

Papillary microcarcinoma of the thyroid is defined as cancers having a diameter equal or inferior to 10 mm in the anatomopathological examination; The problematic of this pathology lies in its latent character, it is, thus, much more frequent than we thought or predicted. That is why, beyond specifying the epidemiological and clinical characteristics of papillary thyroid microcarcinoma, our ultimate goal was to determine the "gold standard" for the management of this entity.
 We carried out a descriptive retrospective study spread over 4 years including all cases of Papillary Microcarcinoma of the thyroid diagnosed within the department of ENT and Head and Neck Surgery of the medical center Mohammed VI in Marrakech; We collected 35 cases, and using their medical records we summarized their epidemiological, clinical and paraclinical data.
 None of our patients had a normal clinical examination, the palpation of our patients showed an isolated nodule in 20% of patients, the rest of our patients had clinically bilateral noticeable nodes. 80% of which were not clinically suspicious, and only three of our patients had palpable lymph nodes which was confirmed by the ultrasound, where the major suspicious character was their hypoechoic character ( 17 % were EU-TIRADS 5 ) With regard to surgical treatment, 28 of our patients (80%) underwent total thyroidectomy as a first step,4 patients underwent secondary totalization during the same operation after the extemporaneous examination came back positive for papillary microcarcinoma , 2 cases of remote loboisthmectomy after final histological examination showing papillary microcarcinoma , and one final case of totalization after extemporaneous examination of a superior right jugular lymph node with central necrosis. Neck dissection was performed in three cases. Postoperative outcomes were simple in all patients. Isotopic totalization by iodine 131 therapy was performed in four of our patients. Their indications were respectively: infiltrating tumor, extension to neighboring parenchyma, multifocality, lymph node metastasis. The survival rate of our series was 100%. The therapeutic protocol of papillary microcarcinoma is punctuated, to this day, with controversy, and faces a conservative attitude versus a radical one, it is the surgeon's duty to distinguish between the two attitudes.

Transmission of SARS-CoV-2 in Surgical Smoke during Laparoscopy: A Prospective, Proof-of-concept Study

Study ObjectiveThere are growing concerns regarding the potential risk of coronavirus disease transmission during surgery and in particular during minimally invasive procedures owing to the aerosolization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) particles. However, no study has demonstrated this hypothesis. Here, we aimed to investigate the presence of SARS-CoV-2 in surgical smoke.DesignA prospective pilot study.SettingA tertiary cancer center in northern Italy.PatientsOverall, 17 patients underwent laparoscopic procedures for the management of suspected or documented gynecologic malignancies. The median age was 57 years (range 26–77). The surgical indications included endometrial cancer (n = 11), borderline ovarian tumor (n = 3), early-stage ovarian cancer (n = 1), stage IA cervical cancer after diagnostic conization (n = 1), and an ovarian cyst that turned out to be benign at final histologic examination (n = 1).InterventionsWe evaluated all consecutive women scheduled to have laparoscopic procedures for suspected or documented gynecologic cancers. The patients underwent planned laparoscopic surgery. At the end of the laparoscopic procedures (after extubation), we performed reverse transcription–polymerase chain reaction (RT-PCR) tests for the detection of SARS-CoV-2 from both the endotracheal tube and the filter applied on the trocar valve.Measurements and Main ResultsIn 1 patient, both swab tests (endotracheal tube and trocar valve filter) showed amplification of the N gene on RT-PCR analysis. This case was considered to be a presumptive positive case. In another case, the RT-PCR analysis showed an amplification curve for the N gene only in the swab test performed on the filter. No ORF1ab amplification was detected.ConclusionOur study suggested the proof of principle that SARS-CoV-2 might be transmitted through surgical smoke and aerosolized native fluid from the abdominal cavity.

Intra-tumoural lipid composition and lymphovascular invasion in breast cancer via non-invasive magnetic resonance spectroscopy

ObjectivesDespite improved survival due to new treatments, the 10-year survival rate in patients with breast cancer is approximately 75%. Lymphovascular invasion (LVI), a prognostic marker independent from histological grade and stage, can only be fully determined at final histological examination. Lipid composition is deregulated in tumour via de novo lipogenesis, with alteration in lipogenic genes in LVI. We hypothesise alteration in lipid composition derived from novel non-invasive spectroscopy method is associated with LVI positivity.MethodsThirty female patients (age 39–78) with invasive ductal carcinoma were enrolled, with 13 LVI negative and 17 LVI positive. Saturated, monounsaturated, polyunsaturated fatty acids and triglycerides (SFA, MUFA, PUFA and TRG) were quantified from ex vivo breast tumours freshly excised from patients on a 3 T clinical MRI scanner, and proliferative activity marker Ki-67 and serotonin derived histologically.ResultsThere were significantly lower MUFA (p = 0.0189) in LVI positive (median: 0.37, interquartile range (IQR): 0.25–0.64) than negative (0.63, 0.49–0.96). There were significantly lower TRG (p = 0.0226) in LVI positive (1.32, 0.95–2.43) than negative (2.5, 1.92–4.15). There was no significant difference in SFA (p = 0.6009) or PUFA (p = 0.1641). There was no significant correlation between lipid composition against Ki-67 or serotonin, apart from a borderline negative correlation between PUFA and serotonin (r = - 0.3616, p = 0.0496).ConclusionLipid composition might provide a biomarker to study lymphovascular invasion in breast cancer.Key Points• Monounsaturated fatty acids in lymphovascular invasion (LVI) positive invasive breast carcinoma were significantly lower than that in LVI negative.• Triglycerides in LVI positive invasive breast carcinoma were significantly lower than that in LVI negative.• Lipid composition from MR spectroscopy reflects the rate of de novo lipogenesis and provides a potential biomarker independent from histological grade and stage.

Malignancy Analyses of Thyroid Nodules in Patients Subjected to Surgery with Cytological- and Ultrasound-Based Risk Stratification Systems

The fine needle aspiration (FNA) cytology is the gold standard for the preoperative diagnosis of thyroid cancer. However, up to 30% of FNA examinations yield nondiagnostic or indeterminate results and this complicates patient management. Clinical features and ultrasound (US) patterns, including US risk stratification systems, could be useful in the preoperative diagnostic workup and prediction of malignancy, but the evidences are not univocal. Methods: 400 consecutive patients subjected to thyroid surgery were retrospectively enrolled at our institution in Calabria, Southern Italy. Preoperative US and FNA cytological descriptions, formulated according to the “Italian consensus for reporting thyroid fine-needle aspiration cytology” (ICCRTC) classification and three US risk stratification systems (those developed by the American Association of Clinical Endocrinologists, American College of Endocrinology and Associazione Medici Endocrinologi (AACE/ACE/AME), American Thyroid Association (ATA), and American College of Radiology (ACR-TIRADS)), were collected, along with histological results. Results: 147 thyroid cancer cases, in large majority papillary carcinomas, were detected on final histological examination. Almost two-thirds of patients subjected to thyroid surgery for either benign or malignant lesions were female. Patient’s age ≤20 years and between 21–30 years were clinical features associated with increased risk of thyroid cancer in logistic regression analyses. US features associated with thyroid cancer included irregular margins, solid composition, microcalcifications, and marked hypoechogenicity. The AACE/ACE/AME, ATA, and ACR-TIRADS risk categories, corresponding to specific US patterns, were strong predictors of malignancy in both genders, but not in nodules with indeterminate cytology. A measured difference between the longitudinal (L) and the anteroposterior (AP) diameter >5 mm, a proxy for a parallel-oriented oval shape of a nodule, emerged as a robust protective factor against thyroid cancer (OR 0.288 (95%CI 0.817–0.443); p < 0.001), regardless of cytological risk. Conclusions: Some, but not all, well-established predictors of TC have been confirmed in this study. Controversy surrounds the diagnostic performance of US risk stratification systems for the detection of thyroid cancer in the subgroup of nodules with indeterminate cytology, suggesting their use only to set the thresholds for FNA. A measured difference between L and AP diameters >5 mm may represent an additional and practical tool for ruling out malignancy in thyroid nodules, with the potential to reduce unnecessary surgical procedures.

Undifferentiated pleomorphic sarcoma in the anterior mediastinum with a rapidly progressive course: A case report.

A 77-year-old woman with heart failure was admitted to our hospital. Computed tomography (CT) of the chest revealed an anterior mediastinal tumor. CT-guided biopsy revealed a malignant nonepithelial tumor of unknown origin. She was not treated with chemotherapy or radiotherapy because of her poor clinical condition. She died 33 days after admission. Following autopsy, we confirmed that the mediastinal tumor had infiltrated the large blood vessels. After final histological examination, undifferentiated pleomorphic sarcoma was diagnosed. Primary mediastinal sarcomas are very rare; clinicians should be aware of their possibility because some cases may progress rapidly as evidenced in this case.

“Harms” Associated with Breast Cancer Screening and Reliability of Frozen Section in Older Women: In the Case of an 80 Year Old Woman

The objective of this paper is to present a rare case with negative final histologic examination despite abnormal findings of all previous exams indicating breast cancer in an 80 year old woman. Mammographic and magnetic resonance imaging findings were concordant with the frozen section biopsy result of DCIS. However, the final histologic diagnosis was radial scar (benign breast lesion that can radiologically mimic malignancy). As a conclusion, abnormal mammographic and magnetic resonance imaging findings with positive for DCIS frozen section reports are not always confirmed in the final histologic examination. Furthermore, considering that screening does not seem to be associated with a reduction in mortality due to breast cancer after the age of 75, breast cancer screening could be individualized in this age group.

Frozen section analysis for organ-conserving surgery in penile cancer: Assessing oncological outcomes and trends of local recurrence

Introduction and objectives: The local recurrence rate of penile cancer following surgical excision is reported in many series to be between 6 and 29%. Intra-operative frozen section (FS) is a useful tool to ensure safe microscopic margins in organ-sparing procedures in penile cancer. In this series, we assessed the rates of positive margins and patterns of local recurrence in a multicentre cohort of patients undergoing penile-preserving surgery assisted by intra-operative FS analysis. Materials and methods: We reviewed all those patients for whom intra-operative FS was employed during penile-preserving surgery in three tertiary referral centres between 2003 and 2016. We assessed whether the use of FS altered the surgical technique and what affect it had on positive margins and recurrence rates. Results: A total of 169 patients were identified. Of these, intra-operative FS examination of the surgical margin was positive in 21 (12%) cases. Final histological examination confirmed cancer-free margins in all but one patient (99.4%). Overall, 9 patients developed local recurrence (5.3%). Conclusions: In this series, intra-operative FS contributed to a very low rate (5.3%) of local recurrence. We noted an extremely low positive margin rate (0.6%) which highlights the benefit of incorporating FS analysis into organ-preserving surgery for penile cancer. Level of evidence: Not applicable for this multicentre audit.

Immediate outcomes of robotic resection for hilar cholangiocarcinoma. Initial experience evaluation

Background: Outcomes of robotic resection for perihilar cholangiocarcinoma is still controversial. Aim. Estimation of outcomes after robot-assisted resection for hilar cholangiocarcinoma. Methods. Data were collected for four years (2014-2016) in a single Russian high-volume centers. All patients underwent surgery with intention to treat for hilar cholangiocarcinoma. Diagnosis was based on medical history, CT, MRI and PTBD data. The standard procedure included major liver resection with segmentectomy 1, extrahepatic bile duct resection and Roux-en-Y biliary reconstruction with D2 lymphadenectomy. In case of insufficient (<40%) volume of FLR its hypertrophy was induced by modified variant of ALPPS (PRALPPS). Results: Twelve patients were treated. Major liver resection was performed in 11 patients. In one case of papillary tumor type I according to Bismuth-Corlette classification extrahepatic bile ducts were resected without liver resection. Final histological examination confirmed hilar cholangiocarcinoma in 9 patients with exception of 2 patients with benign strictures and gallbladder sarcoma in one patient. In two patients there was conversion to open procedure due to vascular invasion required vascular resection and reconstruction. The mean operation time was 710 (490-980) min for totally laparoscopic cases. After initial period of the first 4 procedures the mean time decreased from 858 (560-980) min to 612 (490-690) min without significant differences. Mean blood loss was 420 (50-950) mL. The rate of R0/R1 resection was 9/1 in patients with malignancy. The mean number of lymph nodes harvested was 8 (4-9). Severe complications (>2 according Clavien-Dindo classification) revealed in 9 patients. In six of them IIIa,b grade morbidity was observed. One patient died due to liver failure. The mean hospital stay was 22 (11-37) days. Conclusion: The initial experience of robot-assisted resection for hilar cholangiocarcinoma suggests that robotic approach may be validated in highly selected patients. Evaluation of long-term Results is needed to clarify oncological safety.

Predicting Patients Found to Have Malignancy at Nipple Duct Surgery

Introduction: The unexpected diagnosis of breast cancer following total duct excision is distressing for patients. Despite advances in radiology and the description of suspicious nipple discharge, pre-operative diagnosis of malignancy still evades us. The aim of this study was to review the pathological findings of total duct excision and microdochectomy with reference to pre-operative symptoms, ultrasound, or mammographic findings and identify features associated with increased likelihood of malignant disease. Methods: Data were collected retrospectively of all patients who underwent total duct excision surgery in a single centre (2011–2017). Pre-operative demographics, symptoms, and imaging findings were recorded and correlated with subsequent pathology. Results: 214 patients underwent total duct excision; data were available for 211. Median age was 53 years. 175/211 (82.9%) patients had benign pathology (duct ectasia, papilloma without atypia, fibrocystic change) on final histological examination, 21/211 (10%) had “risk” lesions (papilloma with atypia, atypical ductal hyperplasia), and 15/211 (7.1%) had malignancy (ductal carcinoma in situ). Of the 15 patients with malignant lesions, 6/15 (40%) had normal imaging (M1, U1). 71/211 (33.6%) had normal imaging (M1, U1): 60/71 (84.5%) had benign disease, 5/71 (7%) had “risk” lesions, and 6/71 (8.5%) had malignant lesions. 83/211 (39.3%) patients presented with bloody discharge: 64/83 (77.1%) had benign pathology, 9/83 (10.8%) risk, and 10/83 (12%) malignancy. 38/211 (18%) patients presented with non-bloody discharge: 32/38 (84.2%) had benign disease, 4/38 (10.5%) risk, and 2/38 (5.3%) malignant lesions. ­Conclusion: Neither imaging nor presenting symptoms correlate with the likelihood of malignant disease being present at final pathology. Even with advances in pre-operative diagnosis, total duct excision remains an essential diagnostic and therapeutic procedure.

The Feasibility of Cardiophrenic Lymphnode Assessment and Removal in Patients Requiring Diaphragmatic Resection During Interval Debulking Surgery for Ovarian Cancer

Background Several studies have demonstrated the feasibility and role of bulky cardiophrenic lymph nodes (CPLNs) resection during primary debulking surgery (PDS) for stage IV ovarian cancer (OC). However, no studies, to date, investigated the accuracy and feasibility of CPLNs assessment and removal during interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). Material and Methods A retrospective analysis of consecutive stage IV OC patients who underwent NACT followed by IDS with CPLNs assessment and/or resection from July 2017 to June 2018. Bulky CPLNs were considered for excision when a full-thickness diaphragmatic resection was required in order to achieve complete tumour resection. Results A total of 21 ovarian cancer stage IV patients treated with NACT followed by IDS were identified. Seven (33.3%) patients underwent CPLNs resection due to bulky appearance of the CPLNs at the intraoperative palpation. The final histological examination of the CPLNs reported metastatic disease in four (57%) of seven patients. Complete cytoreduction without residual disease was achieved in five cases (71.4%) while in two case (28.6%) optimal cytoreduction was performed. Intra-operative surgical complications occurred in one patient. One patient had a major postoperative complication (Clavien-Dindo 3). Two cases of postoperative cardiac arrhythmia were observed. Conclusions CPLNs intraoperative assessment is less accurate during IDS compared to previous PDS studies. CPLNs removal during IDS after NACT for stage IV OC could be safely performed to achieve a complete resection.

Is axillary lymph node dissection necessary for positive preoperative aspiration cytology lymph node results?

IntroductionBased on international guidelines, axillary lymph node dissection (ALND) is recommended in cases of breast cancer if preoperative examinations confirm axillary metastasis. We examined which set of preoperative parameters might render ALND unnecessary. Patients and methodsPreoperative examinations (axillary ultrasound and aspiration cytology) confirmed axillary metastasis in 190 cases out of 2671 patients with breast cancer; primary ALN dissection was performed on these patients with or without prior neoadjuvant therapy. The clinicopathological results were analysed to determine which parameter might predict the presence of no more than 2 or 3 metastatic ALNs. ResultsThe final histological examination confirmed 1–3 metastatic lymph nodes in ALND samples in 116 cases and over 3 metastatic lymph nodes in 74 cases.For patients receiving neoadjuvant therapy (59 out of the 190 cases), if the size of the primary tumour was 2 cm or smaller and/or the metastatic ALN was 15 mm or smaller, then the patient was likely to have no more than 3 positive ALNs (stage N0–1 disease) (p < 0.001). If the patient did not receive neoadjuvant therapy, stage N2 or N3 disease was very likely. No correlation was found between other clinicopathological characteristics of the tumour and involvement of the ALNs. ConclusionAxillary lymph node dissection is not necessary for selected breast cancer patients with axillary metastasis receiving neoadjuvant therapy. In these cases, sentinel lymph node biopsy with or without radiation therapy and close follow-up may serve as adequate therapy.

Value of large loop excision of the transformation zone (LLETZ) without histological proof of high-grade cervical intraepithelial lesion: Results of a two-year continuous retrospective study

ObjectiveLarge loop excision of the transformation zone (LLETZ) conization has been associated with adverse obstetrical outcomes. In an approach to reduce the number of performed LLETZ procedures, we conducted this study to evaluate whether “diagnostic” LLETZ should still be performed, by analyzing their yield in terms of detection (and treatment) of real high-grade squamous intraepithelial lesion (HSIL). MethodsDuring a two-year study period, all patients who underwent a LLETZ procedure in our institution were retrospectively included. Study participants were divided into two groups according to LLETZ indication: a biopsy-proven HSIL group, and a non-biopsy-proven HSIL group. The results of the final histological examination were recorded, as well as excision margin status and specimen dimensions. ResultsDuring the two-year study period, 396 LLETZs were performed, 283 (71%) of which were indicated by biopsy-proven HSIL. In the non-biopsy-proven group, final histology showed 50 cases of HSIL (44%) and 4 cases of carcinoma (3.6%), versus respectively, in the biopsy-proven group, 221 (78%) HSIL and 28 (9.9%) carcinoma (p<0.001). Regarding margin status and specimen dimensions, no intergroup difference was observed between the two groups. ConclusionSo called “diagnostic” LLETZ allowed the detection of severe cervical lesions in almost half of cases, without increasing specimen dimensions in comparison with classical conization indications. Moreover, they also allowed an efficient treatment as showed by similar margins status. Our results therefore strengthen the idea that “diagnostic” LLETZ, when specific indications are respected, should not be overlooked as a major part of our therapeutic arsenal.

HPV DNA integration site as proof of the origin of ovarian metastasis from endocervical adenocarcinoma: three case reports

BackgroundMost endocervical adenocarcinomas are human papillomavirus (HPV)-related cancers associated with p16 immunostaining. Ovarian metastasis from cervical cancer is a rare phenomenon, the mechanism of dissemination remains unclear. The diagnosis of metastasis may be difficult to establish when the ovarian neoplasm presents features consistent with primary tumor. Immunohistochemical expression of p16 in ovarian tumors can guide the diagnosis of metastasis from HPV-related cervical cancer, but p16 positivity is nonspecific. Identical HPV genotype in the paired endocervical and ovarian tumors is a better marker for cervical origin, which may also be confirmed by identical HPV integration site.Case presentationTwo women presented with HPV18 cervical adenocarcinoma. No signs of disease were visible on MRI after treatment. After several years of follow-up, mucinous ovarian tumors were discovered in both patients. Molecular analyses showed that the ovarian lesions were HPV18-positive; indicating a primary cervical origin. A third woman was diagnosed with grade 1 ovarian endometrioid carcinoma with no peritoneal carcinomatosis. Final histological examination and HPV genotyping revealed HPV18-related in situ endometrioid adenocarcinoma in the endocervix and HPV18-related invasive endometrioid adenocarcinoma in the endometrium and both ovaries. Additional molecular analyses performed in two patients identified the same HPV integration sites in both the ovarian and cervical tumors, confirming that the ovarian mass was a metastasis from the cervical adenocarcinoma.ConclusionWe report three new cases of ovarian neoplasia in which the diagnosis of metastasis from cervical cancer was supported by the same HPV genotype and the same integration site in the paired cervical and ovarian tumors. To our knowledge, this is the first report of molecular evidence of the cervical origin of an ovarian metastasis. HPV screening should be performed in ovarian tumors for all patients with history of cervical neoplasia.

Early outcomes of robotic-assisted resection for perihilar cholangiocarcinoma

Introduction: Minimally invasive approach for radical treatment of perihilar cholangiocarcinoma is not validated option and outcomes of robotic procedures are only starting to be evaluated. Method: Data were collected for four years (2014-2016) in a single Russian high-volume centers. All patients underwent surgery with intention to treat for hilar cholangiocarcinoma. The standard procedure included major liver resection with segmentectomy 1, extrahepatic bile duct resection and Roux-en-Y biliary reconstruction with D2 lymphadenectomy. In case of insufficient (<40%) volume of FLR its hypertrophy was induced by modified variant of ALPPS (PRALPPS). Result: Thirteen patients were treated. Major liver resection was performed in 12 patients. Final histological examination confirmed hilar cholangiocarcinoma in 10 patients with exception of 2 patients with benign strictures and gallbladder sarcoma in one patient. In two patients there was conversion to open procedure due to vascular invasion required vascular resection and reconstruction. The mean operation time was 699 (490-980) min for totally laparoscopic cases. After initial period of the first 4 procedures the mean time decreased from 858 (560-980) min to 608 (490-690) min without significant differences. Mean blood loss was 392 (50-950) mL. The rate of R0/R1 resection was 10/1 in patients with malignancy. The mean number of lymph nodes harvested was 8 (4-9). Severe complications (>2, Clavien-Dindo) revealed in 10 patients. In seven of them IIIa,b grade morbidity was observed. One patient died due to liver failure. The mean hospital stay was 22 (11-37) days. The mean follow up time was 8 (1-19) months. One patient died due to tumor progression 18 months after procedure. Conclusion: The initial experience of robot-assisted resection for hilar cholangiocarcinoma suggests that robotic approach may be validated in highly selected patients. Further evaluation is needed to clarify the surgical and oncological safety.

Surgical Management of Granular Cell Tumor of the Orbit: Case Report and Literature Review

Introduction:Granular Cell Tumors (GCTs) of the orbit are rare-entity soft-tissue tumors, and few reports have been published in the literature. The treatment of the choice is total excision. Early diagnosis prior to surgery is valuable for the distinction of malignant from benign tumor.Case presentation:We report a case of a 55-year-old woman with a solitary slow-growing mass in the right orbit with the involvement of the rectus inferior muscle, and present a review of the recent literature. The lesion had a diameter of 1 cm and was noticed 2 years before the examination. Excisional biopsy confirmed the diagnosis of GCT. The tumor was resected through a retroseptal transconjunctival approach. The final histological examination revealed findings characteristic of GCT, including positive reaction for protein S-100, SOX10, and calcitonin and negative reaction for desmin, myogenin, Smooth Muscle Antigen (SMA), Melan-A, and HMB-45. There were no signs of malignancy in this sample. Disturbance of motility was not noted by the patient after surgery.Conclusion:GCT should be included in the differential diagnosis of intraorbital lesions, particularly those that involve the orbit muscles. A biopsy is recommended before surgical resection, to exclude malignancy and prevent radical resection.

The Prevalence of Thyroid Malignancy in Multinodular Goiter in Erbil Governorate

Background and objectives:thyroid malignancy is relatively a rare tumor, but it represents the most common form of malignancy of endocrine glands. The common scenario in multinodular goiter is finding of incidental thyroid carcinoma after histopathological evaluation of specimens for assumed benign thyroid lesions. The objective of the study was to estimate the prevalence and types of malignancy in multinodular goiter in Erbil governorate, in order to choose the best surgical options for their treatment. Methods:This prospective cross-sectional study has been conducted from 1st March 2017 to 1st March 2018 on 72 patients with multinodular goiter in Rizgary teaching hospital and private hospitals in Erbil city. All patients evaluated preoperatively by history, clinical examination, thyroid function test, ultrasound study, fine needle aspiration cytology. Then, offered operative treatment for compressive symptoms, thyrotoxicosis, cosmetic concerns, undetermined cytology, suspicious or proved malignancy by fine needle aspirationcytology Results: Among 72 cases, 90.3% were females and 9.7% were males, with mean age distribution at the time of surgery was 41.6 ± 12.6 years. 8.3% of patients found to have malignancy on final histological examination and papillar carcinoma constituted 83.3% of cases. Conclusions:-we recommend near-total or total thyroidectomy to eliminate the need for re-operation in case of thyroid cancer.

Preoperative Staging in Women with Known Breast Cancer: Comparison between Digital Breast Tomosynthesis (DBT) and Magnetic Resonance Imaging (MRI)

Objectives&#x0D; &#x0D; To prospectively evaluate the accuracy in tumor extent and size assessment of Digital Breast Tomosynthesis (DBT) and Magnetic Resonance Imaging (MRI) in women with known breast cancer, with pathological size as the gold standard.&#x0D; &#x0D; Methods&#x0D; &#x0D; From May 2014 to April 2016, 50 patients with known breast cancer were enrolled in our prospective study. All patients underwent MRI on a 3T magnet and DBT projections. Two radiologists, with 15 and 7 years of experience in breast imaging respectively, evaluated in consensus each imaging set unaware of the final histological examination. MR and DBT sensitivity, PPV and accuracy were calculated, using histology as the gold standard. McNemar test was used to compare MR and DBT sensitivity. Correlation and regression analyses were used to evaluate MRI vs Histology, DBT vs Histology and MRI vs DBT lesions tumor size agreement to histological results. &#x0D; &#x0D; Results&#x0D; &#x0D; On histological examination 70 lesions were detected. MRI showed 100% sensitivity, 96% PPV and 96% accuracy; DBT sensitivity was 81%, PPV 92% and accuracy 77%. McNemar test p-value was 0.0003. Lesions size Pearson correlation coefficient was 0.97 for MRI vs Histology, 0.92 for DBT vs Histology, (p-value&amp;lt;0.0001). MRI vs DBT regression coefficient was 0.83.&#x0D; &#x0D; Conclusions&#x0D; &#x0D; MRI confirmed to be the most accurate imaging technique in preoperative staging of breast cancer. However, DBT showed very good accuracy, sensitivity and tumor size assessment and could be a valid tool for preoperative staging when MRI is contraindicated.

Squamous cell carcinoma arising from mature cystic teratoma of the ovary: A challenging question for gynecologic oncologists.

Mature cystic teratomas of the ovary have an incidence of 1.2-14.2 cases per 100.000 people per year. Malignant transformation occurs in approximately 2% of the cases, and usually consists of squamous cell carcinoma. The preoperative detection is difficult and the diagnostic accuracy of ultrasound, magnetic resonance imaging, and computed tomography is debated. The diagnosis is frequently made in the operating room or on final histological examination. Standard treatment consists of bilateral salpingo-oophorectomy, total hysterectomy and comprehensive surgical staging in early disease and optimal cytoreductive surgery in advanced disease. Paclitaxel/carboplatin- based chemotherapy is the most used adjuvant treatment, whereas more aggressive regimens can be adopted in patients with high tumor burden or recurrent disease. The efficacy of radiotherapy is still unproven. The prognosis is poor when the tumor has spread beyond the ovary. There are few information to provide commonly accepted guidelines for this malignancy.

Merkel cell carcinoma of the upper extremity

Merkel cell carcinoma is a rare, aggressive skin cancer which is usually characterized by lymph node involvement, distant metastases, and disease relapse. It is commonly seen in elder people and it affects the head, neck, and extremities. It can be difficult to differentiate macroscopically Merkel cell carcinoma from other small cells neoplasms. Herein is the case of a 66-year-old male patient, admitted in our department for a local recurrence of Merkel cell carcinoma on the posterolateral side of the proximal third right forearm. The surgical treatment included wide local excision with 2 cm safety margins, sentinel lymph node biopsy and grafting the residual defect using split-thickness skin. Postoperative no local or general complications were encountered. The final histological examination revealed Merkel cell carcinoma with all the excisional margins free of tumor and two positive sentinel lymph nodes. The patient has performed postoperative radiotherapy with monthly clinical examination. Six months after the last surgery and after undergoing radiotherapy, there were no local or distant signs of recurrence. Due to high rates of recurrence, close surveillance is demanded.

A binational analysis of 252 pancreatic resections for chronic pancreatitis with regard to incidental carcinoma sequence and overall postoperative outcome

Introduction: Therapeutic treatment algorithms for patients with chronic pancreatitis remain to be debated controversially until today. Especially surgical therapy is often only considered after long-term conservative treatment. The aim of this study was a binational analysis of patients who underwent pancreatic resections for suspected chronic pancreatitis at an austrian and german high-volume center with regard to incidental carcinoma sequence and overall postoperative outcome. Patients and methods: An overall of 252 consecutive pancreatic resections for suspected chronic pancreatitis were performed at both institutions between 2005 and 2015. In a binational retrospective analysis both postoperative results as well as histopathological findings were analyzed. Results: Pancreatic resections were performed in 193 male (76.6%) and 59 female patients (23.4%) with a median age of 53.2 years. A total of 175 pancreatic head resections (69.4%), 37 distal pancreatectomies (14.7%), 23 total pancreatectomies (9.1%) and 18 other pancreatic resections (7.1%) were performed within our study period. Postoperative complications > Clavien II occurred in 94 patients (37.3%). 21 patients (8.3%) developed clinically relevant postoperative pancreatic fistula (grade B and C), while postoperative mortality occurred in 5 patients (2.0%). Final histological examination of the operation specimen revealed an incidental pancreatic adenocarcinoma in 18 out of the 252 patients (7.1%). Conclusion: The results of our study demonstrate that pancreatic resections for chronic pancreatitis may nowadays be considered as technically feasible and safe. Especially the high incidence of incidental pancreatic adenocarcinoma underlines the necessity for an early surgical therapy approach in these patients.