Final Histopathology Report Research Articles

Enbloc resection of primary oral cancer involving infratemporal fossa: A systematic “out to in and top to bottom” surgical approach and outcomes

Aim and introductionThe oral cavity Squamous Cell Carcinoma (OCSCC) involving infratemporal fossa (ITF) is considered as cT4b stage per AJCC 8th classification. The treatment of these group of patients is challenging due to the difficulty in achieving negative resection margin status. In this study we have highlighted our surgical technique with oncological outcome of enbloc resection of primary oral cancer involving ITF. Methodology- This was a single center retrospective study which included only patients with OCSCC extending into ITF. Our surgical technique of systematic “out to in and top to bottom” approach was detailed. The perioperative outcomes, histopathological details, survival outcomes were measured. Results- Over the period of 1 year a total of 340 patients with OCSCC reported to our outpatient department, out of which 120 patients belonged to cT4 category and 32 patients were cT4b stage with involvement of ITF. Amongst 32 patients, 2 patients had distant metastasis and were excluded from the study. The 5 patients received neoadjuvant chemotherapy followed by surgery and rest all patients were taken up for upfront curative surgery. There were no significant intraoperative and postoperative complications. None of the margins were found to be involved or close in the final histopathology report. The median DFS and OS were 31 months and 27 months respectively at a median follow up of 29 months. Conclusion- Our systematic approach of enbloc resection of primary oral cancer involving ITF is safe and easily reproducible with high rate of negative resection margin status.

Laparoscopic Distal Pancreatico-Splenectomy for Mucinous Cystic Neoplasm of Pancreas

Introduction: Mucinous cystic neoplasms are rare premalignant tumors of the pancreas and account for 1–2% of all pancreatic tumors. Surgical removal before invasive malignancy offers the best long-term outcome.1 Distal pancreatectomy with or without spleen preservation remains the standard procedure. Although an open technique is still the most commonly used approach, laparoscopy is associated with less pain, less blood loss, less morbidity, similar clinical outcomes, and an early return to activities.2,3 This video presents a laparoscopic distal pancreaticosplenectomy (LDPS) performed for a mucinous cystic neoplasm in the body of pancreas. Materials and Methods: A 30-year-old lady presented with a 2-year history of recurrent epigastric pain that had increased in severity over the past 2 months and required admission. Her physical examination was normal. A contrast-enhanced computed tomogram revealed a 3 × 3 cm well-defined cystic lesion in the tail of the pancreas adherent to the splenic vein. An endoscopic ultrasonography with fine needle aspirate revealed a complex cystic mucinous cystic neoplasm measuring 2.8 × 2.5 cm in the body of the pancreas. Owing to its premalignant potential and recurrent symptoms, an LDPS was performed for the mucinous cystic neoplasm of the body of pancreas. Vaccinations covering Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae were administered 2 weeks before surgery. The patient was placed in a French position with ports as shown in the video. Spleen preservation was not attempted because of the splenic vein involvement. The pancreas was divided using a stapler and the vessels were divided using sequential clips. The pancreas was separated from the spleen as it was a nonmalignant lesion and enabled easy removal from the port site without enlarging the incision or morcellation. Results: The operative time was 90 minutes with <10 mL of blood loss. The perioperative course was uneventful, and her diet was resumed on postoperative day 1. The drain was removed on postoperative day 3 after an insignificant drain amylase. The patient was discharged on postoperative day 4. Final histopathology report revealed a low-grade mucinous cystic neoplasm of the pancreas. The patient is asymptomatic at 3 months follow-up. Conclusion: LDPS is a safe and feasible approach for mucinous cystic neoplasms of pancreas. It provides less pain, lower blood loss, and early return to work to the patient while providing similar outcomes. The authors have no commercial associations resulting in conflict of interest with respect to the submitted video. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 9 mins 57 secs This video was presented and awarded third best video presentation at SURGICON 2022 (Annual conference of Association of Surgeons of India—Delhi Chapter) on November 13, 2022.

Transumbilical Single-Port Laparoscopic Cystectomy of Giant Ovarian Teratoma

Mature ovarian teratomas are benign germ cell tumors of the ovary, accounting for about 10 % -20 % of ovarian tumors and 95 % of ovarian teratomas. Mature ovarian teratomas are common in young women. They are usually unilateral, slow growing, cystic, mobile, smooth, with little or no ascites. Ovarian cystectomy for benign neoplasms instead of oophorectomy is mandatory for ovarian function preservation. We report a case of a large pelvic teratoma in a 19-year-old adolescent female, approximately 20.7cm×10.5cm in size. The patient's main clinical presentation was mild lower abdominal pain, After transumbilical single-port laparoscopic ovarian cystectomy, the final histopathological report was bilateral ovarian mature teratoma. This case report suggests that transumbilical single-port laparoscopic-assisted in vitro giant ovarian tumor ablation is a safe and feasible surgical approach for patients with benign large adrenal tumors. it effectively combines the advantages of open surgery and laparoscopic resection of large ovarian tumors, which not only protects ovarian function, but also avoids cyst fluid overflow and has significant postoperative cosmetic effects. Nevertheless, this study also had some limitations. First, this was a case report and not a multi-center randomized controlled trial. Second, it included a single patient and the short follow-up data precluded us from deriving any conclusions about the long-term efficacy and safety of this method.

A systematic review of Pilomatrix carcinoma arising from the previous scar site of Pilomatrixoma.

Pilomatrix carcinoma is a rare tumor arising from the hair follicle matrix cells most commonly seen in the head and neck region. Also known as "calcified epithelial carcinoma of Melherbe," it was first reported in 1980 by Lopansri and Mihm. Since then till date to the best of our knowledge only around 125 cases were reported in literature, of which only 11 cases were reported to arise from histologically proven areas of previous pilomatrixoma which is the benign variant. One such case is being reported here along with the review of literature. A 50-year-old man presented with a swelling in the nape of his neck since 6 months, which was gradually increasing in size. He had a history of similar swelling at the same site 18 months back for which he underwent a surgery at a center outside. Final histopathology report was suggestive of pilomatrixoma with negative margin. Wide local excision of the tumor with 3 cm margin, placement of surgical clips followed by a primary closure was done. The final histopathology report is suggestive of pilomatrix carcinoma. The patient has no recurrence in 6 months follow-up. The differential diagnosis of pilomatrix carcinoma should be considered in cases of recurrent skin tumors. Wide local excision is the preferred treatment. Re-excision should be done in margin positive cases and cases where simple excision was done due to improper preoperative diagnosis. Due to the rarity of the disease, adjuvant treatment is not properly defined.

Renal biopsy - indication and its implications in management of children admitted at a tertiary care hospital, Mangalore

Background: Percutaneous renal biopsy is an established diagnostic tool for identification of renal pathology required for diagnosis, treatment, and prognostication. The present study was conducted to know the common indications and histopathological findings of renal biopsy, impact of biopsy report on treatment, and complications of procedure. Methods: This was a retrospective observational study conducted in the paediatric ward of a tertiary care level hospital. Indications of renal biopsy as suggested by medical records were noted down. Any treatment changes happened after final histopathological report were recorded. Statistical analysis was made using statistical package for the social sciences (SPSS) version 20.0 (IBM, NY). Results: The mean age of patients at which biopsy was done was 9.83±5.31 years. Most common indications of renal biopsy were nephritic onset nephrotic syndrome (34.8%), steroid-resistant nephrotic syndrome (21.7%), steroid-dependent nephrotic syndrome requiring calcineurin inhibitors (CNI) (17.4%), lupus nephritis (8.7%), nephrotic syndrome with later age of onset (8.7%), acute kidney injury (AKI) stage 3 (4.3%) and for evidence of calcineurin inhibitor toxicity (4.3%). Focal segmental glomerulosclerosis (26.1%), minimal change disease (21.7%) and membranoproliferative glomerulonephrosis (17.4%) were the most common histopathological findings. Conclusions: This study reiterates the fact that renal biopsy is one of the decisive and diagnostic procedures and has good prognostic value in further management of medical renal disease.

MP46-08 DIAGNOSTIC PERFORMANCE OF PET-CT COMPARED TO CONVENTIONAL CT FOR LYMPH NODE STAGING IN BLADDER CANCER PATIENTS UNDERGOING RADICAL CYSTECTOMY AND BILATERAL PELVIC LYMPH NODE DISSECTION

You have accessJournal of UrologyCME1 Apr 2023MP46-08 DIAGNOSTIC PERFORMANCE OF PET-CT COMPARED TO CONVENTIONAL CT FOR LYMPH NODE STAGING IN BLADDER CANCER PATIENTS UNDERGOING RADICAL CYSTECTOMY AND BILATERAL PELVIC LYMPH NODE DISSECTION Mattia Longoni, Pietro Scilipoti, Mario De Angelis, Chiara Re, Alessandro Bertini, Giulio Avesani, Giuseppe Basile, Luigi Nocera, Giorgio Gandaglia, Andrea Salonia, Francesco Montorsi, Alberto Briganti, and Marco Moschini Mattia LongoniMattia Longoni More articles by this author , Pietro ScilipotiPietro Scilipoti More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Chiara ReChiara Re More articles by this author , Alessandro BertiniAlessandro Bertini More articles by this author , Giulio AvesaniGiulio Avesani More articles by this author , Giuseppe BasileGiuseppe Basile More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Andrea SaloniaAndrea Salonia More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , Alberto BrigantiAlberto Briganti More articles by this author , and Marco MoschiniMarco Moschini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003292.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Pre-operative lymph node (LN) staging has a pivotal role in the therapeutic pathway of bladder cancer (BC) patients undergoing radical cystectomy (RC) and bilateral pelvic lymph node dissection. Conventional imaging (i.e. CT-scan) has been proved to have low accuracy in LN staging. Therefore, we evaluated the diagnostic performance of of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET-CT). METHODS: 272 patients affected by BC who underwent RC between 2015 and 2022 in a high-volume center were retrospectively evaluated. Both pre-operative FDG-PET-scan and CT-scan were performed, evaluating pelvic LN invasion. All patients underwent pelvic lymph nodes dissection at RC. Sensitivity, specificity, positive (PPV), negative predictive value (NPV) and accuracy of both exams were determined with 95% CI, according to the presence of LN invasion at final histopathology reports obtained from RC. A sub-group analysis of patients who did not receive neoadjuvant chemotherapy (NAC) was also done. RESULTS: Overall, 222 (85%) patients had pT2 diseased at last TURBT. Open and robot-assisted RC were performed in 34% (n=92) and 66% (n=179) of the cases respectively. LN invasion at final pathology report was found in 63 patients (23%). On a per-patient analysis, conventional CT had 40% [29-53] sensitivity, 83% [77-88] specificity, 47% [34-60] PPV, 79% [73-85] NPV, whereas the corresponding figures for FDG-PET-CT were 44% [32-56], 88% [83-92], 57% [43-71], 81% [75, 0.86]. Accuracy for conventional CT and FDG-PET-CT was respectively 72% [66-77] and 76% [71-81]. In NAC-naïve patients (n=112), conventional CT showed 27% [12-48] sensitivity, 88% [80-94] specificity, 37% [16-62] PPV, 82% [74-89] NPV, 75% [67-83] accuracy, whereas the corresponding figures for FDG-PET-CT were 23% [9-44], 92% [85-96], 43% [18-71], 82% [74-89], 78% [70-85]. CONCLUSIONS: Our study showed that FDG-PET-CT had a general better diagnostic performance compared to conventional CT, although having a lower sensitivity and similar NPV in chemo-naïve patients. Thus, FDG-PET-CT could improve the management of BC patients before RC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e633 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mattia Longoni More articles by this author Pietro Scilipoti More articles by this author Mario De Angelis More articles by this author Chiara Re More articles by this author Alessandro Bertini More articles by this author Giulio Avesani More articles by this author Giuseppe Basile More articles by this author Luigi Nocera More articles by this author Giorgio Gandaglia More articles by this author Andrea Salonia More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Marco Moschini More articles by this author Expand All Advertisement PDF downloadLoading ...

Rare case of coagulative necrosis of uterine leiomyoma: Case report

Coagulative tumor necrosis or tumor cell necrosis is a very rare type of fibroid degeneration, commonly occurs in 80% of leiomyosarcomas, but it is rare in benign uterine leiomyomas. Women with menorrhagia have increased levels of plasminogen activators in endometrium and use of anti-fibrinolytics can enhance the formation of thrombus in leiomyoma. Degeneration like red and hyaline in uterine leiomyomas may be associated with pregnancy and use of progestogen or OCP’s but degeneration associated with use of anti-fibrinolytics can occur in any part of reproductive life. Materials and Methods: We present the case of 28yr lady with heavy menstrual bleeding and severe dysmenorrhea since 2 years, diagnosed with fibroid uterus and was on anti-fibrinolytics (Tranexamic acid) on and off for 2years. Finally underwent a myomectomy, wherein we found a cheesy degenerative material with final histopathology report revealing as coagulative tumor necrosis without any atypical cells. Conclusion: Coagulative necrosis is usually seen in malignant condition. Infarct type necrosis and thrombus was observed in benign leiomyoma, possibly secondary to prolonged, repetitive use of Tranexamic acid.

A Rare Case of Extraosseous Osteosarcoma (EOS) of Parotid Gland.

Extraosseous osteosarcoma is a rare malignant soft tissue neoplasm, and extraosseous osteosarcoma of the parotid gland is very rare. It has a very aggressive course, and there are no standardized treatment guidelines.We report the case of a 20 year old male patient who presented with history of right neck swelling since 6 years for which he had undergone right parotid surgery 5 years ago. The final histopathological report indicated that the mass was a pleomorphic adenoma. One year after the first surgery, the patient experienced recurrence of swelling over the operated site, and the size of the swelling has been increasing gradually since then. He was evaluated clinically, and a large mass was noted over the upper aspect of the right upper neck, extending to the occipital and parotid regions. An MRI scan was done which showed a 12 × 10 × 8cm lesion centred in the right parotid gland, involving paraspinal muscles, C1-C2 vertebrae and extending into the parapharyngeal space. FNAC of the lesion showed features of pleomorphic adenoma. The patient underwent a complete excision of the tumour. The patient's post-operative period was uneventful. The final histopathological report of the patient was extraosseous osteosarcoma of the parotid gland. The patient was referred for adjuvant radiotherapy. He has been on regular follow-up for the past 6 months and has shown no sign of recurrence.EOS is an extremely rare tumour of the head and neck region which often requires extensive surgical resection with or without adjuvant radiotherapy. It has a high rate of local recurrence and a very low disease free survival. Such patients should be kept on a close follow-up.

A rare case of schwannoma of the nasal vestibule

BackgroundSchwannomas of the nose and paranasal are extremely rare. Few schwannomas arising from within the lateral wall of the nose have been reported to date.Case presentationA 32-year-old male presented to us with complaints of left-sided nasal obstruction and a mass in his nasal cavity. The evaluation revealed a benign spindle cell lesion arising from within the lateral wall nose which was excised. The final histopathology report revealed a nasal schwannoma.DiscussionSchwannomas are benign tumors arising from Schwann cells. Schwann cells are responsible for the formation of the myelin sheath. They are rare, slow-growing tumors. Twenty-five to 45% tumors arise in the head and neck, of which only 4% were arising from nasal cavity and paranasal sinuses.ConclusionTo generate awareness about the varying clinical presentations of Schwannomas in the nose and paranasal sinuses and their management.

Evaluation of the Role of Neck Dissection in Patients with Verrucous Squamous Cell Carcinoma of the Oral Cavity: A Cohort Study

Introduction: Verrucous Carcinoma (VC), a well-differentiated Squamous Cell Carcinoma (SCC), commonly presents in the oral cavity, accounting for 2-16% of oral carcinomas. Though rare, it poses a challenge in establishing a pathological diagnosis, even in adequate biopsies, as 20% of Oral Cavity Verrucous Carcinoma (OVC) contains concomitant SCC. VC is primarily treated by surgery, similar to oral SCC. The role of neck dissection in oral SCC is well-established, but there is limited data on VC. Aim: To evaluate the role of neck dissection in the management of OVC. It also aimed to evaluate the clinicopathological demographics of OVC and identify predictors for survival outcomes. Materials and Methods: A retrospective cohort study was conducted using medical records of 2312 patients with oral carcinoma treated from January 2010 to December 2020 at Department of Surgical Oncology, Malabar Cancer Centre, Kannur, Thalassery, Kerala, India, a tertiary cancer centre under the Government of Kerala. Among 116 patients identified with VC, 49 patients met the inclusion criteria. The collected data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0. The primary outcomes were overall survival rate and disease-free survival rate. Kaplan-Meier curves were constructed based on the survival data and compared using the log-rank test. Results: The mean age of the entire population was 62.8 years, with an age range of 40-90 years. Among the 2312 patients who underwent surgery for oral carcinoma, 49 (2.11%) patients were diagnosed with VC based on the final histopathology report. The majority of patients were diagnosed with early-stage disease on histopathological examination 36/49 (73.5%). A total of 34 patients received neck dissections, of which 13 patients (38.3%) had palpable nodes on presentation. All patients were node negative (PN0). On univariate analysis, neck dissection was not found to be a predictor of mortality or locoregional recurrence. There was no significant difference in overall survival rate (p=0.160) or disease-free survival rate (p=0.67) when comparing patients who underwent primary resection with neck dissection to those whose necks were kept under observation. Conclusion: The OVC has an excellent prognosis, and surgery remains the mainstay of treatment. The decision on neck dissection and the extent of neck dissection should be judiciously made based on the surgical approach and the procedure’s morbidity.

Early Outcomes of the Surgical Treatment of Sacrococcygeal Tumors in a Tertiary Level Government Hospital.

Sacrococcygeal teratomas (SCT) are the most common extragonadal tumors of early childhood. Their clinical characteristics and outcomes of patients with sacrococcygeal tumors who underwent excision in the Philippines has never been described, while numerous retrospective studies have been conducted in other countries. This was a retrospective, descriptive study over a four-year period (December 2014 to November 2018). The study described the patients' demographic data, manner of delivery, clinical presentation, prenatal diagnosis of tumor, Altman classification, and alpha fetoprotein levels. These information were obtained from the medical records of the patients. Additional data from the operative technique include the surgical approach, size of the mass, and gross involvement of adjacent structures and the final histopathologic results. Outcomes include the 30-day mortality and morbidity, and tumor recurrence. A total of 29 patients were included in the study with 22 females (75.86%) and seven males (24.14%). Twenty-five out of the 29 (86.21%) had a sacral or gluteal mass at birth while other presenting factors include a palpable abdominal mass (1), constipation (1), difficulty in urination (1), and an elevated AFP in one postoperative patient. Even if 27 out of the 29 patients underwent a maternal ultrasound, only three patients (10.34%) had a correct ultrasound interpretation of sacrococcygeal teratoma. Age at presentation was problematic, with 12 presenting at greater than one year of age while 10 were brought for consultation at greater than one month old. Only seven presented at the neonatal period. CT scan was the most common imaging tool utilized (37.93%), followed by ultrasound (27.59%). AFP was elevated in ten patients (34.48%). Six of the patients with elevated AFP had mature teratoma, two had yolk sac tumor, one had fibroepithelial polyp, and one was post chemotherapy but had mature teratoma based on the final histopathology report. Fifteen out of the 29 patients had Altman type I tumors (51.72%), seven (24.14%) had type II tumors, six (20.69%) had type III tumors, and only one patient had type IV tumor. Sacral approach in the excision of the sacrococcygeal tumor was performed in 25 patients (86.21%). There was no reported perioperative mortality for patients who underwent surgery for SCT during the study period. Twelve out of the 29 had postop morbidities, three with surgical site infection and three with rectal or vaginal perforation. Five patients had tumor recurrence occurring from two months to three years postoperatively. Early detection of sacrococcygeal teratomas even in the prenatal period is the norm in certain areas of the world, but in our country, prenatal detection is still a challenge. Even if the majority of the patients presented with a gluteal mass at birth, less than a third were brought to our tertiary government hospital in neonatal life. The sacral approach for SCT excision was employed for the great majority of our patients, but due to the advanced age at diagnosis and locally advanced disease, morbidities occurred in about a third of the patients. Therefore, early detection prenatally and early referral to a pediatric surgical center should be achievable goals for physicians dealing with these patients.

Hyalinizing Clear Cell Carcinoma of Base of the Tongue – Case Report and Review of Literature

Abstract Hyalinizing clear cell carcinoma (HCCC) is a type of salivary gland carcinoma which is a low grade epithelial tumor and follows an indolent course. The main modality of treatment is surgical excision with or without adjuvant radiotherapy. A 33-year-old female patient presented to us with dysphagia, change in voice, and right ear ache. Clinical examination revealed an 8 cm × 6 cm submucosal growth over the right side base of the tongue crossing midline and also extending to anterior two-third of the tongue. Magnetic resonance imaging and positron emission tomography scan revealed tumor involving bilateral base of the tongue as well as anterior tongue. Biopsy from the lesion revealed HCCC with Ewing sarcoma breakpoint region 1 gene arrangement. Upfront tracheostomy followed by intraoral surgery was performed and the specimen was removed in toto and wound closed primarily. Postoperatively, she was decannulated within a week and started full oral diet within 10 days. The final histopathology report indicated HCCC. The patient underwent 30 fractions of adjuvant RT and is on regular monthly follow-up with no signs of residual disease. HCCC is a low-grade epithelial tumor with an indolent course and rarely seen in the head-and-neck region. The ideal treatment modality is excision of the lesion with adequate margins with or without adjuvant treatment.

Multi-parametric MRI without artificial erection for preoperative assessment of primary penile carcinoma: A pilot study on the correlation between imaging and histopathological findings

PurposeWe aimed to evaluate the diagnostic potential of non-erectile multi-parametric magnetic resonance imaging (mpMRI) for preoperative assessment of primary penile squamous cell carcinoma (SCC). MethodTwenty-five patients who underwent surgery for penile SCC were included. Preoperative mpMRI without artificial erection was performed in all patients. The preoperative MRI protocol consisted of high-resolution morphological and functional sequences (diffusion-weighted imaging and dynamic contrast-enhanced MRI perfusion) covering the penis and lower pelvis. T and N staging, according to the 8th edition of the Union for International Cancer Control TNM classification, as well as the largest diameter and thickness/infiltration depth of the primary lesions were determined in all patients. Imaging data were retrospectively collected and compared with the final histopathology reports. ResultsVery good agreement was observed between MRI and histopathology for the involvement of corpus spongiosum (p = 0.002) and good agreement was observed for the involvement of penile urethra and tunica albuginea/corpus cavernosum (p < 0.001 and p = 0.007, respectively). Good agreement was observed between MRI and histopathology for overall T staging and weaker, but still good agreement was observed for N staging (p < 0.001 and p = 0.002, respectively). A strong and significant correlation was observed between MRI and histopathology for the largest diameter and thickness/infiltration depth of the primary lesions (p < 0.001). ConclusionsGood concordance was observed between MRI and histopathological findings. Our initial findings indicate that non-erectile mpMRI is useful in preoperative assessment of primary penile SCC.

Assessment of Pathological Complete Response Using Vacuum-Assisted Biopsy in Breast Cancer Patients Who Have Clinical and Radiological Complete Response After Neo-Adjuvant Chemotherapy.

Any treatment protocol that leads to complete elimination of surgery may lead to a better patient acceptance of breast cancer treatments. We conducted this study to assess the feasibility of preoperative vacuum-assisted biopsies in identifying pathological complete response (pCR) and its accuracy in correlation to final histopathology report (HPR), in an Indian setting. This was a prospective study conducted between October 1, 2019, and March 31, 2021. Patients with early breast cancer, estrogen and progesterone receptors negative and either Her2 positive or negative, and who were fit to undergo marker placement at the centre of the tumour and to receive third-generation chemotherapy (4 cycles of 3 weekly doxorubicin and cyclophosphamide followed by 4 cycles of 3 weekly docetaxel) were included in the study. Following the enrolment, a tissue marker was placed at the centre of the tumour and appropriate chemotherapy was started. Patients who achieved clinical complete response were subjected to ultrasound-guided vacuum-assisted biopsy (VAB) from the tumour bed before surgery. Pathology results of the VAB and resected specimen were then compared. Descriptive statistics were used in the study. Eighteen patients were enrolled in the study, with a mean age of 43.6 ± 9.8 years. However, only 10 were eligible for VAB procedure, and sensitivity and specificity were calculated based on the results of these 10 patients only. Vacuum-assisted biopsy showed sensitivity of 50% and specificity of 100% in identifying pCR. Combination of mammography, ultrasonography, and VAB showed sensitivity of 77.8% and specificity of 66.7% in identifying pCR. Vacuum-assisted biopsy of tumour bed may not be sensitive enough to eliminate surgery even in patients who have had exceptional response to neo-adjuvant chemotherapy.

Parotid Metastasis in a Case of Papillary Thyroid Carcinoma: Case Report and Review of Literature.

Papillary thyroid carcinoma (PTC) is the most common differentiated thyroid neoplasm. Common sites of regional and distant metastasis includes lymph nodes, lungs and bone. 51year old female patient who was a known case of PTC with a history of multiple surgeries, radioactive iodine therapy (RAI) and oral chemotherapy presented with a painful right parotid mass. PET scan demonstrated FDG avid lesions in the right parotid gland, cervical lymph nodes and other distant sites. Cytology report showed features of metastatic PTC. Patient underwent extended total parotidectomy with facial nerve resection, skin and masseter muscle resection and extended radical neck dissection. Final histopathology (HPE) report showed metastatic papillary carcinoma thyroid. Patient is currently on oral chemotherapy and on regular follow up. PTC rarely metastasizes to parotid gland and such cases have to be treated with surgery alone or with a combination of surgery and RAI based on tumour burden.

Non-Recurrent Laryngeal Nerve (NRLN): A rare anatomical anomaly of the recurrent laryngeal nerve

A 34-year young lady with a right-sided euthyroid nodule of 3x5 cm size for one year visited our clinic for surgery. FNAC was reported as colloid goiter. The right hemi-thyroidectomy surgery was planned. Intraoperatively while dissecting the right thyroid lobe, we could not find the right recurrent laryngeal nerve in its normal course, but we found a cord white-like structure running transversely &amp; entering the larynx at the level of the cricothyroid muscle. We dissected it till its origin from the right vagus nerve in the neck. So, this was Non-recurrent laryngeal nerve (NRLN) which is a rare anatomical anomaly of the Recurrent Laryngeal Nerve (RLN) which arises higher in the neck and runs a course directly to the larynx as the NRLN without looping around the vessels in the chest. This intraoperative image is showing right-sided neck structures after removal of the right thyroid lobe &amp; isthmus. The labeled structures in the image from right to left are the common carotid artery (CCA), Vagus Nerve (VN), Non-recurrent laryngeal nerve (NRLN), trachea &amp; left lobe of the thyroid gland. Her post-operative recovery was good without any voice change. The final histopathology report was suggestive of colloid goitre.

Utility of Whole Body 18F-FDG PET/CT in Comparison to Pelvic MRI in Evaluation of Local Staging of Early-Stage Carcinoma Cervix.

This prospective comparative study aimed to investigate the applied value of whole body 2-deoxy-2[fluorine-18]fluoro- D-glucose positron emission tomography integrated with computed tomography (18F-FDG PET/CT) in comparison to pelvic magnetic resonance imaging (MRI) in early cervical cancer patients. A prospective study was performed on 47 clinically early-stage cervical cancer patients evaluated with positron emission tomography/computed tomography (PET/CT) and MRI before surgery. The final postoperative histopathology report served as the reference standard. Both PET/CT and MRI images were analyzed and correlated with histopathologic findings concerning parametrial and lymph node involvement. Sensitivity, specificity, and negative predictive value (NPV) of PET/CT were 33.3%, 81.8%, and 94.7%, respectively, for parametrium assessment. And the corresponding values of pelvic MRI were 33.3%, 63.6%, and 93.3%, respectively (PET/CT versus MRI, p > 0.05). The positive predictive value (PPV) of PET/CT (11.1%) was higher than MRI (5.9%) for parametrial assessment (p < 0.05). The sensitivity, specificity, PPV, and NPV of PET/CT were 75%, 83.7%, 30%, and 97.3%, respectively, for lymph node assessment. And the corresponding values of MRI were 75%, 81.3%, 27.3%, and 97.2%, respectively (PET/CT versus MRI, p > 0.05). There was no significant difference between MRI and PET/CT concerning stage migration (p= 0.4276). The PET/CT had no additional utility (compared to MRI) in the evaluation of local staging of clinically early cervical carcinoma patients.

Vaginosonography versus MRI in Pre-Treatment Evaluation of Early-Stage Cervical Cancer: An Old Tool for a New Precision Approach?

This study aims to analyze the sensitivity of vaginosonography (VGS) and magnetic resonance imaging (MRI) in the preoperative local evaluation of early-stage cervical cancers and to assess their accuracy in the detection of tumors, size of the lesions and stromal invasion by comparing them with the final histopathology report. This single-center study included 56 consecutive patients with cervical cancer who underwent VGS and MRI from November 2012 to January 2021. VGS significantly overestimated the lesion size by 2.7 mm (p = 0.002), and MRI underestimated it by 1.9 mm (p = 0.11). Both MRI and VGS had a good concordance with the pathology report (Cohen's kappa of 0.73 and 0.81, respectively). However, MRI had a false-negative rate (38.1%) that was greater than VGS (0%) in cases of cervical tumor size &lt;2 cm. We found a good concordance between histology and VGS in the stromal infiltration assessment, with 89% sensitivity (95% CI 0.44-0.83) and 89% specificity (95% CI 0.52-0.86). VGS is a simple, inexpensive, widely available, and fast execution method that can complement ultrasound in particular cases and show a good correlation with MRI in the assessment of tumor dimensions, with a better performance in detecting small tumors (&lt;2 cm).

Trichoblastic carcinoma of the penile shaft: A case report of a rare condition

Trichoblastic carcinoma is a sporadic malignant tumor. It usually arises in the scalp, trunk, and extremities. However, its occurrence in the base of the penis is highly uncommon. To our knowledge, there were no similar cases reported in the literature. Case Presentation. A 65-year-old Tunisian man with no significant medical history consulted our department with a 10 cm ulcerative lesion on the base of the penis. The lesion biopsy was concordant with the diagnosis of basal cell carcinoma. The patient underwent a wide local excision. The tissue defect was reconstructed by an anterolateral pedicled flap of the thigh. The final histopathology report was concordant with the diagnosis of a trichoblastic carcinoma. Conclusion. There is no treatment consensus due to the few reported cases of trichoblastic carcinoma in the literature. Surgical excision with free margins remains the cornerstone of the treatment.

A masquerading ovarian mass

A 23 years old lady presented with lower abdominal vague pain and fullness for 6 months. Physical examination revealed a lump in the left lumbar region extending into the pelvis. The upper border was palpable, but the lower limit was not palpable. Computerized tomography of the abdomen revealed a multiloculated cystic lesion with minimal enhancement probably arising from the left adnexa. The right adnexa, uterus, pancreas, spleen appeared normal. Serum tumor markers: CA- 125, alpha-fetoprotein, beta HCG, LDH, and CA-19.9 were within normal limits. Diagnosis of left adnexal complex cystic was made and planned for Fertility preserving staging laparotomy. Intraoperatively, bilateral adnexa and uterus were normal. A large soft multicystic lesion measuring 15 x 10 x 7 cm was noted arising from the tail of the pancreas (Figure 1). No other lesions were noted in the peritoneal cavity. Distal pancreatectomy with splenectomy was performed to achieve R-0 resection. The post-operative hospital stay was uneventful, and the patient was discharged on POD-5. The final histopathological report revealed a multiloculated cyst showing irregular lymphovascular spaces lined by flattened, bland cells within fibroblastic and collagenous stroma suggestive of consistent with cystic lymphangioma of the pancreas. On follow-up, the patient is doing well after 1 year of the surgical excision.