Palpable Nodes Research Articles

EP496 - Metastatic Invasive Lobular Carcinoma of the Breast mimicking healed Gastric Ulcer: A Case Report

Abstract Introduction Breast cancer metastasizing to the stomach as a new presentation is highly unusual. We report a 77-year-old female with such presentation. Case Presentation A 77-year-old female investigated for significant weight loss. She denied any upper or lower gastrointestinal symptoms. She had bidirectional scopes. Colonoscopy showed only diverticulosis. Two gastroscopies revealed non-specific stellar shaped areas in the anterior antrum wall mimicking a healed gastric ulcer. Biopsies confirmed metastatic lobular carcinoma of the breast, ER+ve, HER2 negative. On further clinical examination she had large mass upper outer quadrant with palpable enlarged nodes. Staging CT scan showed couple of hyper enhancing foci in the right breast which may be potential candidates for primary tumour and enlarged right axillary nodes. Subsequently she had an ultrasound guided biopsy of the breast lesion confirmed invasive lobular cancer. Patient has been referred to the breast MDT for breast and lymph node biopsy. Discussion The incidence of GI metastatic disease from a primary breast cancer is less than 1%. It is more common to diagnose in patients with prior history and treatment for primary breast malignancy. However, occasionally it can be encountered prior to the diagnosis of the primary tumour. Hence, index of high suspicion is required as the endoscopic findings are non-specific.

Minimally Invasive Management of Inguinal Lymph Nodes in Penile Cancer: Recent Progress and Remaining Challenges.

The diagnosis of occult inguinal lymph node metastasis in clinically node-negative invasive penile squamous cell carcinoma (PSCC) has remained a challenge, with substantial perioperative complications. The recent refinements in the technique of dynamic sentinel lymph node biopsy (DSLNB) demonstrated high diagnostic accuracy with considerably lower morbidity compared to conventional open modified/superficial inguinal lymph node dissection (ILND). Although DSLNB, if available, has been endorsed as the preferred method for nodal staging in patients with invasive PSCC and no palpable inguinal lymphadenopathy in the recent penile cancer guidelines, its utilization has been quite limited so far. Laparoscopic and robotic-assisted ILND have emerged as alternatives for nodal staging in this patient population and are shown to improve the rate of wound infections and postoperative pain. For management of nodal metastasis in patients with clinically palpable inguinal lymph nodes, minimally invasive ILND has shown promising results as well. Nonetheless, given the rarity of PSCC and the absence of prospective studies and clinical trials, nodal staging and treatment of nodal metastasis in clinical practice will likely continue to vary across the medical centers in the following years. In this review, we first summarize the evolution of DSLNB and minimally invasive ILND and discuss the advantages and drawbacks of each management strategy. We further discuss the remaining challenges and future perspectives in the management of inguinal lymph nodes in patients with PSCC.

Primary Paraganglioma of the Prostate: A Systematic Review of the Literature for A Rare Entity.

Paragangliomas of the urinary tract are exceptionally uncommon, and sporadic case reports of primary paraganglioma of the prostate have been reported in the literature. Systematic research in PubMed/Medline and Scopus databases concerning primary prostatic paraganglioma was performed by two independent investigators. This analysis included 25 adult males, with a mean age of 49.8 ± 22.4 years. 32% of included patients had a history of hypertension. Problems during urination (52%), blood loss (44%), either as hematuria or hemospermia, and catecholamine-related symptoms (36%) comprised the most frequently reported clinical manifestations. Digital rectal examination found a palpable nodule in 36% of patients, while prostatic specific antigen (PSA) was normal in all tested patients. Abdominal ultrasound (44%), computed tomography (44%) and magnetic resonance imaging (28%) helped to identify the primary lesion. 24-hour urine epinephrine, norepinephrine and vanillylmandelic acid (VMA) levels were elevated in 90%, 80% and 90% of included patients. Open surgical excision of the mass was performed in 40%, transurethral resection in 8%, open radical prostatectomy in 24%, transurethral resection of the prostate in 16% and robot-assisted radical prostatectomy in 4% of included patients. Due to atypical clinical manifestation and scarcity of prostatic paraganglioma, urologists should be aware of this extremely rare entity.

Intraoperative Nodal Palpation is a Mandatory Component of Sentinel Lymph Node Biopsy for Breast Cancer

Background: In the era of Z-0011, it is mandatory to decrease not only the false negative rate (FNR) of sentinel lymph node (SLN) biopsy but also the risk of residual metastatic nodes after SLN biopsy. Method: SLN biopsy with intraoperative nodal palpation (INP) was performed in patients with clinically node-negative (cN0) breast cancer. All identified blue and hot nodes were removed as blue/hot SLNs, and any suspicious palpable nodes were removed as palpable SLNs. Nodes that were incidentally removed with neighboring the blue/hot SLNs were classified as para-SLNs. Patients with positive SLNs on frozen section underwent axillary lymph node dissection (ALND) except for patients who met the Z-0011 and AMAROS criteria for exemption. Results: Palpable SLNs and para-SLNs were identified in 202 patients. Of 200 patients, excluding 2 patients only with palpable SLNs, 46 patients had involvements of blue/hot SLNs, and 14 had palpable and para-SLNs harboring additional metastasis. When false negative rate (FNR) was calculated based on blue/hot SLNs and palpable SLNs, the additional use of INP resulted in a FNR of 45.2%. Subsequently, ALND was performed in 43 patients with positive blue/hot or palpable SLNs. Residual nodal involvement was found in 28 (65%) of 43 patients after removing blue/hot SLNs. However, after removing palpable SLNs, the rate of residual nodal metastases significantly decreased from 65% (28/43) to 36% (13/36) (p=0.0133). Conclusion: INP decreased both the FNR of SLN biopsy and the risk of residual metastatic nodes after SLN biopsy.

Clinical prediction model for pediatric lymphadenopathy: enhancing diagnostic precision and treatment decision making.

Lymph node enlargement is common in children, with 90% of physiologically palpable lymph nodes. This study aimed to develop a predictive model based on clinical characteristics to enhance the diagnosis of pediatric lymphadenopathy and provide insights into biopsy outcomes. A clinical prediction rule was developed using a retrospective, cross-sectional design for patients under 15years who underwent lymph node biopsy from 2012 to 2022. Multivariable risk regression was used to analyze benign and malignant lesions, presenting results through risk difference and AUROC for each group. Predicted probabilities were applied in a logistic regression equation to classify patients' lymphadenopathy as reactive hyperplasia, benign, or malignant. Of 188 children, 70 (37.2%) had benign lymphadenopathy beyond reactive hyperplasia, and 27 (14.4%) had malignant lymphadenopathy. The predictive model included 12 characteristics such as size, location, duration, associated symptoms, and lymph node examination. Predictive accuracy was 92.2% for benign cases (AUROC = 0.92; 95% CI 0.87-0.96) and 98.6% for malignancy (AUROC = 0.98; 95% CI 0.94-0.99). Overall accuracy for predicting both benign and malignant tumors was 68.3%. The model demonstrated reasonably accurate predictions for the clinical characteristics of pediatric lymphadenopathy. It tended to overestimate malignancy but did not miss diagnoses, aiding in reducing unnecessary lymph node biopsies in benign cases.

Should Palpable Nodes Be Exclusionary in Patients Who Are Otherwise Candidates for ACOSOG Z0011-Type Trials?

Palpable nodes were exclusionary in American College of Surgeons Oncology Group (ACOSOG) Z0011, while SINODAR-ONE excluded those with positive axillary nodes by palpation and ultrasound. To determine whether clinical nodal status should be exclusionary in those fulfilling pathologic criteria for ACOSOG Z0011 and similar trials, this study analyzed the accuracy and implications of clinical nodal positivity. Patients ≥ 18years old with cT1-T2, cN0-cN1, M0 breast cancer were identified in the National Cancer Database between 2004 and 2019. Subset characteristics of cN1 and cN0 were compared with respect to final pathologic nodal status and overall survival (OS). Of 57,823 patients identified, 77.0% were cT1 and 23.0% were cT2. Of the 93.9% of patients who were staged as cN0, 16.7% were pN1; of the remaining 6.1% staged as cN1, 9.6% were found to be pN0. Among cN1/pN0 patients, 14.9% underwent axillary dissection without sentinel node biopsy. There was no difference in adjusted OS for patients staged as cN0 versus cN1 who were found to be pN1 (HR 1.13, 95% CI 0.93-1.37, p = 0.22), a finding that persisted on subset analysis in those with two positive nodes (HR 0.91, 95% CI 0.62-1.33, p = 0.63). Clinical nodal stage does not affect OS in pN1 patients. Clinical nodal assessment can both overstage patients and result in unnecessary axillary surgery. These data suggest that cN1 patients who are otherwise candidates for a Z0011-like paradigm should still be considered eligible. Their final candidacy should be determined by surgical lymph node pathology and not preoperative clinical status.

INCIDENTALLY VS. NON-INCIDENTALLY DIAGNOSED PAPILLARY THYROID CARCINOMA: ARE THERE DIFFERENCES?

Compare incidental vs. non-incidental TC (ITC vs. NITC) regarding demographic, clinical, histological data and 5-year clinical outcomes. Retrospective analysis of 225 papillary TC (PTC) cases that completed a 5-year follow-up. Created 2 groups: ITC (including the incidentalomas) and NITC (cases of palpable or visible nodules or with thyroid compressive complaints). Included 225 PTC (122 were ITC). There were 95 women in ITC and 78 in NITC. ITC patients were significantly older (53.3±14.8 vs 47.2±17.7, p=0.006). Groups had no differences in family history of TC. ITC mean tumour size was smaller (19.1±9.2 vs 28.6±16.2, p<0.01). Tumours >20mm comprised 36.1% of ITC and 58.2% of NITC. We found no differences in tumour multifocality, histological thyroiditis, aggressive PTC subtypes, capsule or lymph-vascular invasion and gross extrathyroidal extension. There were no differences regarding the number of patients submitted to RAI or in RAI activity. pTMN staging showed higher prevalence of T3a and T4 cases (p<0.01), and M1 status (p=0.025) in NITC. There were no differences in the rates of persistence of disease. Logistic regression showed that the diagnostic modality had no impact on the 5-year clinical outcome. ITC patients were older and had smaller tumours. NITC showed no worst histological features or 5-year clinical outcome. Approximately, one third of ITC had diameters >20mm. As even large tumours can be ITC, overdiagnosis can be the most likely cause for the TC increasing incidence.

A study on the correlation of Doppler ultrasound in the diagnosis of cervical lymph nodes in patients with laryngeal and hypopharyngeal cancers: An observational study.

The objective was to assess the diagnostic efficacy of Doppler ultrasound in detecting cervical lymph nodes in patients diagnosed with laryngeal and hypopharyngeal cancers. Patients undergoing surgery for laryngeal and hypopharyngeal cancers in the Otolaryngology Department from January 2021 to January 2023 were included. Two groups, with equal numbers, underwent ultrasound examination and intensive CT examination in the experimental and control groups, respectively, along with routine cervical lymph node dissection. A resident with over 6 years of clinical experience in the otolaryngology department performed routine bilateral cervical lymph node palpation. Sensitivity, specificity, and validity were compared among different examination methods. The McNemar test assessed specificity and sensitivity between palpation, color Doppler ultrasonography, and enhanced CT, while the Kappa concordance test evaluated the concordance between the 2 examination methods. Data were statistically analyzed using SPSS 23.0. Palpation showed a diagnostic sensitivity (DS) of 52.83% and specificity of 91.11% for all patients with cervical lymph node metastasis. Ultrasonography demonstrated a DS of 77.78% and specificity of 81.82% in patients with cervical lymph node metastasis, while intensive CT had a DS of 75.86% and specificity of 60.00%. Statistical significance (P < .05) was observed in the sensitivity between palpation and ultrasonography, and between palpation and enhanced CT. The specificity between enhanced CT and ultrasonography (P = .021) and between palpation and enhanced CT scan (P = .003) both showed statistical significance (P < .05). Doppler ultrasound yields diagnostic results highly consistent with pathological diagnoses in patients with laryngeal and hypopharyngeal cancers. Utilizing Doppler ultrasound can enhance the accuracy of diagnosing these cancers, aiding physicians in devising more suitable treatment plans for patients.

Retrospective Study for Evaluation of TIRAD Scoring System Irrespective of FNAC in Decision Making Outcomes in Thyroidectomy

Abstract Background Thyroid nodules present a common clinical problem. Palpable nodules are present in about 5% of the population, and are noted incidentally on ultrasound in up to 70% of people, with increased prevalence in older patients. The incidence of thyroid nodules has increased due to exposure to medical radiation, iodine intake, obesity, insulin resistance, genetics and inorganic phosphates. With a 300% increase in the annual thyroid cancer rate. Aim of the Work The aim of this study is to evaluate the value of Ultrasound and TIRAD scoring system for decision making outcomes in thyroidectomy done for thyroid nodules. Patients and Methods This Retrospective cohort study was conducted at (General surgery department), Ain Shams University Hospitals and Ain shams University specialized Hospitals and was conducted over a period of six months starting from date of approval of the protocol. Results In our study, Conventional sonography has 66.66% sensitivity and 92.5% specificity as it suspected malignancy (positive suspecting findings) in 14 patients; eight of them were proved to be malignant and six of them were benign by histopathology accounting for low positive predictive value (57.14%) and it suspected benignity (negative suspecting findings) in 78 patients; 74 of them were perfectly correlated with the histopathology accounting for high negative predictive value (94.87%). In our study, the rate of detecting patients with thyroid cancer (sensitivity) was calculated as 80%, the rate of distinguishing healthy individuals (specificity) was 88.88%, the Positive Predictive Value (PPV) was 57.14% and the negative predictive value (NPV) was 96% for FNAC. In our study, the sensitivity and the specificity of FNAC in detecting cancer was near to the literature but the (PPV) was lower than the literature and was non diagnostic in fourty patients (40%), we think that this discrepancy depends on many factors including radiology, pathology, and the materials used in FNAC method, and patients with multiple nodules. Conclusion Neck US and FNAC have proven low sensitivity in differentiating malignant from benign thyroid nodules

Incidence of Thyroid Carcinoma in Multinodular Goiter versus Solitary Thyroid Nodule: Meta-Analysis

Abstract Background Thyroid carcinoma (TC) is a relatively rare tumour, but it represents the most frequent form of cancer of the endocrine glands. It represents 1% of human neoplasias. Thyroid nodules are common. Palpable Thyroid nodules are found in 5% of persons aged an average of 60 years. Objective To determine the incidence of thyroid carcinoma in multinodular goiter versus solitary thyroid nodule. Patients and Methods Recent clinical trials or cluster trials, prospective and retrospective comparative cohort studies. Search results were uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart was introduced on the search results and the inclusion/exclusion criteria. Results Initially, 1240 observational studies were identified through the literature search. When the duplicates were removed, 1087 remained. Eight studies fulfilled the inclusion criteria and included in the meta- analysis. The study included five retrospective studies, two prospective and one Cross- sectional comparative study. The frequency of thyroid cancer among them varied from 13.7 9 to 41.4%. Conclusion To conclude, the current meta-analysis revealed that there is no difference between thyroid carcinoma in multinodular goiter and thyroid carcinoma in solitary thyroid nodule although malignancy in follicular thyroid carcinoma is higher in MNG than STN.

Frequency and involvement of lymph nodes in squamous cell carcinoma of oral cavity in cross sectional population.

Objective: To find out the frequent site of squamous cell carcinoma of oral cavity and pattern of neck node involvement in cross sectional population. Study Design: Prospective Study. Setting: Department of Otorhinolaryngology Head and Neck Surgery, Abbasi Shaheed Hospital Karachi and Karachi Medical and Dental College. Period: 01-06-2023 to 31-12-2023. Methods: Patients who biopsy proven squamous cell carcinoma of oral cavity visited ENT department Abbasi Shaheed Hospital were include in this study. Proforma was made in which detail history and examination were noted. Oral cavity examined to see the size and site of tumor. Neck was palpated to see palpable cervical lymph node. CT scan head and neck with contrast was done. Those patients who fulfilled the inclusion and exclusion criteria included in this. Result: 56 patients were selected in this study who fulfill the inclusion criteria. Male were 37 (66%). Maximum number of patients were between the 41-50 years of age, 24 patients (42.8%). Most common site of carcinoma was buccal mucosa 27 (48.2%). Highest number of patients presented with T3 stage 22 patients (39.2%). The frequency of lymph node involvement noted in 35 (62.5%) patients while 21 (37.5%) came with no lymph node. Level I was the most frequent level involved, it was involved in 28 patients (50%). Conclusion: Oral squamous cell carcinoma usually reported late. Early referral to otorhinolaryngologist and educate patient to consult Otorhinolaryngologist as earliest for early diagnosis and appropriate treatment plan.

Non-keratinizing squamous cell carcinoma – A rare variant of sinonasal tract malignancy invading orbit: A case report and review of literature

This case report presents a rare case of orbital invasion from non-keratinizing squamous cell carcinoma (NKCa) of paranasal sinuses. A male patient presented with painful bleeding from a mass near the left eye, blood-stained discharge from the left nostril, fatigue, and weight loss. There was a heterogenous lesion inferomedial to the left eye, inside the left nostril, and in the oral cavity. Palpable neck lymph nodes, computed tomography scan showing a bone-eroding lesion, histopathology, and immunohistochemistry findings suggested malignancy of the NKCa variant. Immediate chemotherapy showed improvement after the first cycle, and the patient is under regular follow-up.

Disseminated Multiple Organ Lymphoma Presented as Vulvar Lesion Diagnosed by [18F]FDG PET/CT

We would like to present a 49-year-old female patient who was presented with a vulva lesion and palpable inguinal lymph nodes who were diagnosed with disseminated multiorgan involvement of high grade diffuse large B-cell lymphoma. The 18F-fluorodeoxyglucose positron emission tomography computerized tomography imaging showed multiple cervical, axillary, and abdominal lymph nodes, pulmonary nodules as well as gross hypermetabolic vulvar lesion.

Clinical characteristics of tension headache in occlusive disorders

Relevance. Common physiological human suffering is headache. The prevalence of headache ranks third after back pain and joint pain in the structure of muscle-fascial pain syndromes. However, headaches and facial pains associated with muscle-fascial trigger points are much more common than headaches and facial pains caused by other causes. An extremely irritated area of skeletal muscle associated with an oversensitive palpable node located in a compacted bundle is the muscle–fascial trigger points. In the pathogenesis of headaches, a major role belongs to dysfunction or disease of the temporomandibular joint, age-related changes in the masticatory muscles, jaws and teeth and all elements of the TMJ occuring during a person’s life. In some cases, minor changes in the occlusion of teeth and jaws, as well as a stressful situation, lead to a painful spasm of the masticatory muscles. Goal. To analyze the clinical characteristics of tension headache in patients with occlusive disorders (OD) and physiological occlusion (PO). Material and methods. The study covered 210 patients with occlusion disorders and 92 patients with the signs of physiological occlusion. 141 patients from the first group and 32 patients from the second group complained of a headache. Occlusal relationships of teeth were analyzed in the position of central and dynamic occlusion. The destruction of the hard tissues of the teeth and partial adentia, as well as anomalies and deformities of the dentition were determined as the disorder of occlusion. The study of the muscles of the maxillofacial region and neck was carried out using the techniques described in the book by Travell J.G., Simons D.G. (2005). A visual-analogue pain assessment scale and a Russified McGill’s questionnaire on the nature of pain were used to identify the nature of the pain syndrome, the severity of pain. The assessment was carried out at a consultative appointment, the localization, nature, duration and intensity of pain, as well as the specificities of the pain syndrome being taken into account. When examining muscles, to quantify the data obtained the muscle syndrome index (IMS) was evaluated. The analysis of the research results was carried out using nonparametric criteria. Results. According to the severity of the pain syndrome, the use of a visual analogue scale (VAS) of pain allowed us to divide all patients into 3 groups: with mild pain, with moderate and with severe pain. According to the international classification of headaches, episodic and chronic headaches were distinguished. In patients with OD, the headache becomes chronic more often and is felt more intense than in patients with PO. Among the patients complaining of a headache, in patients with OD the IMS is higher than the IMS of the muscles of the masticatory complex, and in patients with PO the IMS is higher than the IMS of the neck muscles. Conclusions. Female patients with OD and PO suffer from tension headache more often than male patients. In patients with OD, musculo-fascial headaches are twice as common, have a more pronounced character and become chronic more often than in patients with PO. The severity of the IMS of the masticatory muscles in patients with OD is 2.5 times higher than in patients with PO.

Takayasu Artiritis, Peyronie’s Disease and Dupuytren’s Disease: A Non-Fortuitous Association

Background: Peyronie’s disease (PD), Dupuytren’s disease (DD) and Ledderhose disease (LD) are three localized fibrosis. Its pathophysiology is still controversial. Many factors as genetic predisposition, trauma and inflammation could be related. These disorders are commonly associated to environmental factors, diabetes and microtrauma. Until now, there is not a study reporting an association between PD, DD and large vessel vasculitis particularly takayasu’s arteritis. Case Report: It is about a 52-year-old man weaned from smoking since 15 years, with a history of takayasu’s arteritis for 10 years. At the CT angiography, he had a stenosis of the left subclavian artery, left carotid artery and left renal artery with a functional right kidney. At the physical examination, the penis size was normal but curved and deviated to the right side with palpable nodules. A penile ultrasonography was performed showing hyeperchogenic thickening of the tunica albuginea. The upper limbs examination showed nodules in the palm, fourth and fifth fingers in two hands but more pronounced in the left hand, with contractures related to DD and absence pulses in the left subclavian, humeral and radial arteries. Conclusion: To the best of our knowledge, there are no studies or cases reporting the association between a vasculitis of large artery and DD and PD. The presence of a PD on an occluded renal artery and a DD on a stenosed left subclavian artery, could be explain this theory.

Decision-making concordance: A comparative analysis between a multidisciplinary tumor board and a large language model (ChatGPT) in breast cancer management.

e13648 Background: Advances in breast cancer management have led to more tailored therapies, increasing the complexity of decision-making. Establishing multidisciplinary tumor boards (MTB) is crucial for optimizing patient care, challenging healthcare teams intellectually. The integration of expertise, deep understanding, and clinical judgment is crucial. Artificial intelligence (AI), particularly through rapid developments and Large Language Models (LLM) offers opportunities to revolutionize healthcare by processing complex ideas and integrating medical evidence into decisions. This study evaluates ChatGPT-4 concordance with a Breast MTB. Methods: This study included 124 patients discussed at our Tumor Board from March 2023 to January 2024, treatment decisions from ChatGPT-4 were compared with those made by the MTB. Results: The median age was 52 years (24-85), with 98% female and 51% premenopausal. In 36% of the patients, the diagnosis followed a screening, while 64% were diagnosed due to symptoms like a palpable nodule or skin changes. 33% of patients meet the NCCN criteria for a family history of cancer. The distribution of clinical stages at diagnosis was 0 (15%), I (35%), II (31%), III (10%), and IV (8%). Most cases were left-sided (52%), followed by right-sided (43%), and bilateral in 5%. The phenotype was Luminal A-like (35%), Luminal B-like HER2 positive (23%), Luminal B-like HER2 negative (15%), and triple negative (10%). The overall concordance between the LLM and MTB rate achieved was 80.65% in patient profiles, including ductal carcinoma in situ. Concordance rates for treatment option indications were high: surgery (96%), radiotherapy (98%), chemotherapy (97%) and endocrine therapy (100%). For additional evaluations (PET/CT or oncogeriatric assessment), the concordance rate was 99%, for indicating genomic signatures was 96%, and for referrals for genetic evaluation, it was 93%. The lowest concordance was observed in type of anti HER2 therapy at 68%. Overall management concordance for patients in stage IV was 50%. Conclusions: AI is seeking ways to integrate into clinical routines by identifying individualized and personalized therapy option for our patients. We explore the concordance and feasibility of employing the LLM ChatGPT-4 in executing one of the most complex tasks in patient care, achieving high rates of concordance. Currently, AI is not capable of replacing medical professionals, but the use of LLM such as ChatGPT as an assistance and support tool for clinicians is likely to expand and evolve. Its capabilities could make it a valuable support tool for therapeutic management in the near future. All authors confirm that this abstract was not thought of or written by ChatGPT.

Robot-assisted inguinal lymphadenectomy to treat penile and vulvar cancers: a scoping review.

Inguinal lymph nodes dissection (ILND) is recommended in patients presenting with high-risk penile (PC) or vulvar cancers (VC). Though, this surgical procedure is underused because of its anticipated morbidity. Minimally invasive approaches were proposed to minimize complications associated with open surgery. In this review, we analyze current available data exploring intra and perioperative outcomes of robot-assisted ILND (RAIL). On April 9th, 2023, a literature search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: ("robotic assisted" OR "robot-assisted" OR "robotic") AND ("inguinal lymph node dissection" OR "lymphadenectomy") AND ("penile cancer" OR "vulvar cancer"). Out of the 404 identified articles, 18 were used for the present scoping review and their results were reported according to the PRISMA statement. Data on 171 patients, ranging in age from 32 to 85 years, were obtained. Most of them (90.6%) harbored a penile squamous cell carcinoma and presented with no palpable nodes (85%). Operation time (OT) ranged between 45 and 300 min. Estimated blood loss varied from 10 to 300 mL. One single intra-operative complication was reported and one conversion to open was recorded. The lymph nodes (LNs) count spanned from 3 to 26 per groin, with 17 studies reporting a median yield >7 nodes. Hospital stay was 1-7 days, while the duration of drainage ranged from 4 to 72 days. Post-operative complications included lymphocele (22.2%; 0-100%), lymphedema (13.4%; 0-40%), cellulitis (11.1%; 0-25%), skin necrosis (8.7%; 0-15.4%). seroma (3.5%; 0-20%) and wound breakdown/wound infection (2.9%; 0-10%). Out of the included studies, 7 provided at least a 12-month follow-up, with recurrence-free rates ranging from 50% to 100% in patients affected by penile cancer and from 92% to 100% in vulvar cancer patients. The available evidence on RAIL for the treatment of PC and VC is limited. The approach appears to be safe and effective, as it provides an adequate lymph node yield while ensuring a minimally morbid postoperative course and a short hospital stay.

Post operative care for patients with transoral endoscopic thyroidectomy vestibular at Hanoi Medical University Hospital

Thyroid nodules, including both benign and malignant lesions, are the most common endocrine neoplasms. Most thyroid tumours are benign, with slow progresssion over time. Although surgery is the primary treatment method for benign thyroid nodules, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has recently gained popularity due to its higher probability of concealing scarThe study was conducted using a prospective descriptive method, with a convenient sample size. The study subjects were patients with transoral endoscopic thyroidectomy vestibular approach at the Department of Oncology and Palliative care, Hanoi Medical University Hospital from February to November 2023. Average age was 38.2 ± 9.0 years old; female accounts for 98.8%; the most common symptom in the study was neck tumour (64.2%); 92.6% of patients had palpable nodules clinically. Ultrasound showed 72.8% of patients with one tumour with an average tumour size of 26.9±11.6mm; the majority of patients have nodules ranked TIRADS 3 (69.1%). 64.2% of patients have moderate pain on the first day after surgery and 92.6% of patients had no pain on the 7th day post surgery,; complications included 5 cases of laryngeal nerve damage, 2 cases of hypoparathyroidism and 1 case of mental nerve damage; 8 patients had skin numbness in the surgical area, 3 patients had limited swallowing. The average hospital stay was 5.2 ± 1.7 days; 80.2% of patients were satisfied with post-operative care. Research shows that TOETVA is a safe method with a small percentage of postoperative complications and brings satisfaction in the postoperative process.

Prostate cancer patients with lymphatic node involvement detected by immunohistochemistry. Is the effort worthwhile?

IntroductionLymph node (LN) status is one of the main prognostic factors in localized prostate cancer (CaP) patients after surgery. Examining palpable lymph nodes with hematoxylin and eosin (HE) is the most common approach in clinical practice; however, immunohistochemistry (IHC) has been reported to increase the LN detection rate. We reviewed the oncological results of patients with LN metastasis detected by IHC. MethodsRetrospective study of CaP patients who underwent lymphadenectomy at the time of the prostatectomy. Extended lymphadenectomy was performed with complementary indocyanine green (ICG) guidance. Three groups were considered according to LN status. Definition of the pN+ group was made if LNs were detected by HE, occulted lymph node-positive (OLN+) was considered when ≥ 1 LN was identified with IHC and occulted lymph node-negative (OLN-) if no metastatic nodes were found. Oncological outcomes were reported regarding PSA kinetics, biochemical recurrence (BCR), need for secondary treatments and metastasis-free survival (MFS). ResultsA total of 283 patients with a median follow-up of 69 months were included in the study. Immunohistochemical assessment revealed metastatic LNs in 8.9% of patients. The rate of locally advanced disease and positive surgical margins was higher in the OLN + and pN + groups vs the OLN – group (P < 0.05). At the end of follow-up, 19%, 44% and 52% of patients from the OLN -, OLN + and pN + groups experienced BCR (P < 0.001), respectively. Additionally, 2.6%, 17% and 22% of patients developed metastatic progression from the OLN -, OLN + and pN+ group (P < 0.001), respectively. In the multivariate analysis, the OLN + group had a higher risk HR: 12 (95% CI, 2.4-56; P = 0.002) of metastatic progression in comparison with OLN – patients. This difference was not observed in the risk of biochemical recurrence HR 1.8 (95% CI, 0.9-3.8; P = 0.09). ConclusionConventional HE histological analysis underdiagnosed nearly 10% of patients. IHC-detected patients were at higher risk of metastasis development than OLN - patients. This report highlights the importance of optimizing the anatomopathological analysis properly.

A case report of vaginal fibromyoma in a bitch

A 5-year-old, intact female Caucasian Shepherd dog was brought to our clinic with complaints of ongoing vaginal bleeding, weakness, loss of appetite, and a vaginal mass for a month. According to the anamnesis, the vaginal mass had rapidly increased in size over the last month, and there was ulceration and bleeding on the mass. In the examination, it was determined that the mass originated from the ventrolateral surface of the vagina, and an abscess-like structure was also found cranially to this mass. The mucous membranes were light pink, the palpable lymph nodes were of average size, the furs were matte, and the vaginal area was dirty with blood. The dog’s hemogram and biochemical test results were found to be within normal reference ranges; hence, it was decided to treat the dog surgically. The tissue obtained after vaginal mass excision was examined microbiologically and histopathologically. The mass, initially thought to be an abscess based on its smaller size and macroscopic examination, was determined to have a sterile content and to be an inflammatory infiltration rather than an abscess. It was concluded that detailed clinical examination and histopathological analysis can establish the diagnosis of all tumoral cases like this, and successful treatment can be achieved through surgical intervention.