Simple Local Excision Research Articles

Ten-year trend analysis of breast cancer, oncoplastic, and reconstructive breast surgery in a single institution (2010-2019), what has not changed?

There has been a UK national directive to ensure that patients are offered reconstructive surgical options. We aimed to assess any change in oncoplastic practice over a 10-year period. The surgical management of 7019 breast cancers was retrospectively assessed at Nightingale Breast Centre, Manchester University UK, from 2010 to 2019. The procedures were categorised into breast conservative surgery (BCS) and mastectomy ± immediate reconstruction. The data were analysed using inclusion and exclusion criteria. The overall rates of BCS and mastectomy were 60.1% and 39.9% respectively. No statistically significant change in the overall rates of BCS or mastectomy was observed over the last decade (p = 0.08). The rate of simple wide local excision (WLE) decreased from 98.7% to 89.3% (p < 0.001), whilst the rate of therapeutic mammoplasty (TM) increased from 1.3% to 8% (p < 0.01). The rate of chest wall perforator flaps (CWPF) changed from zero to account for 2.7% of all BCS by 2019. The overall rate of immediate breast reconstruction (IBR) did not significantly change over the study period, but it consistently remained above the national average of 27%. The rate of implant-based IBR increased from 61.3% to 76.5% (p = 0.012), whilst the rate of Latissimus Dorsi (LD) reconstruction decreased from 26.7% to 5.1% (p < 0.05). Additionally, the rate of nipple-sparing mastectomy significantly increased from 5.2% to 24%. No significant changes in the overall rates of BCS was observed, the rates of advanced breast conservation techniques, nipple-sparing mastectomy, and implant-based IBR all have increased, whilst the use of LD reconstruction decreased.

Suspected Prostate Malignancy in Elderly Male Results in an Incidental Finding of Cellular Angiofibroma of the Male Pelvis

Cellular angiofibroma (CAF) is a rare benign mesenchymal tumor that affects both genders in the genitourinary region [1]. Nucci et al. first described this entity in the vulva in female in 1997 [2]. Cellular angiofibroma is generally a slow-growing and form asymptomatic mass that primarily arises in the vulvar-vaginal region in female and the inguinal region in males [3]. Although rare, cases have been reported in the pelvic and extra pelvic regions [4]. It mainly affects women mostly during the fifth decade of life [1]. “CAF” is the applied terminology of this tumor in accordance with World Health Organization [5]. It can easily be misdiagnosed as spontaneous perineal herniation in clinical practice [6]. Detailed pathological examination and correlation with immunohistochemistry workup are imperative to distinguish it from various soft tissue tumors which affect the pelvic regions. Differential diagnosis of this tumor includes both benign and malignant lesions such as spindle cell lipoma, solitary fibrous tumor, angiomyofibroblastoma, leiomyoma, and aggressive angiomyxoma [7]. Treatment with simple local excision is generally curable due to low local recurrence and no chance of metastasizing [8]. Cellular angiofibroma has a good prognosis [9]. However, preoperative distinction of cellular angiofibroma from malignant tumors can be challenging [10]. Periurethral CAF is rare with only two cases reported in the periurethral region [11, 12]. The current study presents a third rare case of cellular angiofibroma affecting the periurethral region in 69-year-old male that measured approximately 7 cm. This case was suspected a prostate malignancy with possible bladder invasion on the radiology imaging.

Pilonidal Sinus, Minimal Excision and Simple Direct Closure Versus Wide Local Excision and Flap Reconstruction

A pilonidal sinus is a sinus that contains hair, primarily in the sacrococcygeal region, due to preferring conditions like: The presence of a profound natal split and the presence of hair inside the separated, perspiring, maceration, bacterial tainting, and entrance of hair. The point of this examination was to analyze between the results of insignificant extraction of pilonidal sinus lot with basic direct conclusion versus wide extraction with rotational rhomboid fold conclusion. This investigation included 50 patients experiencing 1ry non intermittent sacrococcygeal pilonidal sinus. They were arbitrarily partitioned into 2 gatherings. The primary gathering (25 patients) was exposed to negligible extraction of the pilonidal sinus plot and straightforward direct conclusion while patients of the subsequent gathering (25 patients) were exposed to wide neighborhood extraction and rotational rhomboid fold reproduction. there were no critical contrasts among the two gatherings as for age or sex conveyance. Likewise no critical distinction in contamination, seroma, disturbance and repeat rates yet insignificant extraction of the pilonidal sinus parcel and straightforward direct conclusion was altogether more limited in usable time, Post-employable clinic stay, recuperating time and early re-visitation of work. The natal separated in the rhomboid fold gathering can be leveled, and tissue can be approximated without strain. rhomboid fold procedure in pilonidal sinus medical procedure almost equivalent in the vast majority of static's to insignificant extraction of the pilonidal sinus plot and basic direct conclusion in1ry non repetitive sacrococcygeal pilonidal sinus.

Achieving margin clearance following oncoplastic breast surgery in comparison with simple wide local excision: a three-dimensional specimen assessment.

Pre-operative breast tumour radial dimensions often determine the choice between simple wide local excision (WLE) and oncoplastic breast surgery (OBS). We reviewed the three-dimensional interplay between tumour and surgical specimen dimensions in the two cohorts. Demographic, tumour and treatment data were collected for all patients undergoing OBS by a single surgeon and compared with a randomly selected cohort of WLE patients treated. The relationship between tumour and specimen medio-lateral, supero-inferior and antero-posterior dimensions were explored in both groups. Subgroup analyses were performed in the OBS cohort (parenchymal displacement versus replacement). We identified 60 OBS patients (63 breasts), comparing them with 60 WLE patients. Pre-operative tumour estimated size was significantly larger in the OBS cohort and concordant with macroscopic tumour radial dimensions and final microscopic tumour size. Surgical specimen weight was more than 3.5 times higher in the OBS group and its radial dimensions were almost double. No significant difference was observed for the antero-posterior dimensions. The rate of margin re-excisions and completion mastectomies were lower in the OBS cohort. WLE patients with positive margins had a lower tumour-to-specimen ratio, whereas, the requirement for further surgery in the OBS cohort was associated with larger tumour dimensions. Despite larger tumour dimensions, OBS is not inferior to WLE in providing clear surgical margins. Our analysis of the three-dimensional spatial relationship between cancer and surgical specimen, although not completely conclusive, can be helpful in the selection of the most appropriate surgical approach for every patient.

Simple Transanal Local Excision，Transanal Local Excision Following Radiotherapy Versus Total Mesorectum Excision for the Treatment of the Ultra-low T2N0M0 Rectal Cancer

Simple Transanal Local Excision，Transanal Local Excision Following Radiotherapy Versus Total Mesorectum Excision for the Treatment of the Ultra-low T2N0M0 Rectal Cancer

Dysplastic Lipoma: A Distinctive Atypical Lipomatous Neoplasm With Anisocytosis, Focal Nuclear Atypia, p53 Overexpression, and a Lack of MDM2 Gene Amplification by FISH; A Report of 66 Cases Demonstrating Occasional Multifocality and a Rare Association With Retinoblastoma.

In our routine and consultative pathology practices, we have repeatedly encountered an unusual subcutaneous fatty tumor with notable anisocytosis, single-cell fat necrosis, and patchy, often mild, adipocytic nuclear atypia. Because of the focal atypia, consultative cases have most often been received with concern for a diagnosis of atypical lipomatous tumor. Similar tumors have been described in small series under the designations "subcutaneous minimally atypical lipomatous tumors" and "anisometric cell lipoma." Sixty-six cases of this tumor type were collected and reviewed. Immunohistochemistry for p53, MDM2, CDK4, Retinoblastoma 1 (RB1) protein, CD34, S100, and CD163 was performed. Cases were tested for MDM2 gene amplification and RB1 gene deletion with fluorescence in situ hybridization (FISH) and for TP53 mutations by Sanger sequencing. Next-generation sequencing analysis using a panel of 271 cancer-related genes, including TP53, RB1, and MDM2, was also carried out. Our patient cohort included 57 male patients, 8 female patients, and 1 patient of unstated sex, who ranged in age from 22 to 87 years (mean: 51.2 y). All tumors were subcutaneous, with most examples occurring on the upper back, shoulders, or posterior neck (86.4%). Ten patients had multiple (2 to 5) lipomatous tumors, and the histology was confirmed to be similar in the different sites in 4 of them, including 1 patient who had a retinoblastoma diagnosed at age 1. The tumors were generally well circumscribed. At low magnification, there was notable adipocytic size variation with single-cell fat necrosis in the background associated with reactive histiocytes. Adipocytic nuclear atypia was typically patchy and characterized by chromatin coarsening, nuclear enlargement, and focal binucleation or multinucleation. Focal Lochkern change was frequent. In most instances, the degree of atypia was judged to be mild, but in 3 instances, it was more pronounced. Spindle cells were sparse or absent, and when present, cytologically bland. Thick ropy collagen bundles were absent. In all cases, p53 immunoexpression was noted (range: 2% to 20% of adipocytic nuclei), characteristically highlighting the most atypical cells. Twenty of 50 cases had MDM2 immunoreactivity, usually in <1% of the neoplastic cells, but in 4 cases, up to 10% of the cells were positive. Of 32 cases tested, 22 showed a near total loss of RB1 immunoexpression, and the remainder showed partial loss. Three of 13 cases showed RB1 gene deletion in >45% of the cells by FISH (our threshold value for reporting a positive result) with an additional 3 cases being very close to the required cutoff value. MDM2 gene amplification was absent in all 60 cases tested, including those with the greatest MDM2 immunoexpression and most pronounced atypia. All 5 tested cases showed no TP53 mutation with Sanger sequencing. Because of material quality issues, next-generation sequencing analysis could be performed in only 3 cases, and this did not reveal any recurrent mutations. All tumors were managed by simple local excision. Follow-up was available for 47 patients (range: 1 to 192 mo; mean: 27 mo) and revealed 2 local recurrences and no metastases. Dysplastic lipoma is a distinctive atypical fatty tumor variant that has p53 overexpression and RB1 gene abnormalities and lacks MDM2 gene amplification by FISH. These tumors have a strong male predominance and a notable tendency to involve the subcutaneous tissue of the shoulders, upper back and posterior neck. Multifocality is frequent (18.9% of patients with follow-up information), and there is a rare association with retinoblastoma. This tumor warrants separation from ordinary lipoma with fat necrosis, fat-rich spindle cell lipoma and the conventional form of atypical lipomatous tumor that features MDM2 gene amplification.

Wide Local Excision Versus Oncoplastic Breast Surgery: Differences in Surgical Outcome for an Assumed Margin (0, 1, or 2 mm) Distance

IntroductionOncoplastic breast surgery (OBS) can be applied in larger tumors or in patients with high tumor-to-breast ratio without compromising oncologic safety. Inherent larger excisions may increase the probability of clear margins. We compare postoperative outcomes between simple wide local excision (WLE) and OBS assuming 3 different margin distances. Patients and MethodsSingle oncoplastic surgeon data between April 2014 and September 2016, including tumor and treatment details, for WLE or OBS were reviewed. Relative incidence of margin positivity at 3 assumed distinct margin distances (2, 1, and 0 mm) and reexcision rates were compared. Statistical comparisons were performed by the Student t and chi-square tests. ResultsAvailable data from 201 patients revealed similar patient age and respective tumor phenotypes between 2 cohorts (166 WLE and 35 OBS). Though both the preoperative (30 vs. 16 mm, P < .001) and postoperative tumor (30 vs. 19 mm, P = .001) sizes were greater in the OBS group, margin positivity rates were significantly lower, at 1 mm (5.7% vs. 20.8%, P = .036). Though similar rates of reexcision were observed, completion mastectomies were required in 5.4% of WLE versus 0 OBS. Similar rates of margin positivity and reexcision were observed between mammoplasties and chest wall perforator flaps. ConclusionOBS is not inferior to standard WLE at providing a safe and clear oncologic margin regardless of margin distance (up to 2 mm) despite larger tumor size. The additional benefit of improved cosmesis, particularly in patients with larger tumor-to-breast ratio, offers a suitable and safe alternative, thus increasing patient choice and reducing the incidence of reexcision and completion mastectomy.

Intravascular papillary endothelial hyperplasia of the vulva: report of a patient with Masson tumor of the vulva and literature review

Intravascular papillary endothelial hyperplasia -- also known as Masson tumor -- is a rare, benign vascular condition that manifests on the skin as a firm, blue-black colored nodule or papule. Lesions range in size from 0.25 to 5 centimeters in diameter and may be tender or painless. In some individuals, nodules appear red colored, mimicking hemangioma or pyogenic granuloma. Histologically, intravascular papillary endothelial hyperplasia is characterized by the presence of an organizing thrombus in the vascular lumen with accompanying hyperplastic endothelial cell proliferation. Common sites of presentation include the head, neck, and extremities. However, albeit rarely, lesions may also appear in the genital region. We describe the clinical and pathologic findings of a woman who developed intravascular papillary endothelial hyperplasia of the vulva. We also review the characteristics of other patients with intravascular papillary endothelial hyperplasia of the vulva and summarize the differential diagnosis and treatment options for this condition. The features of a woman with intravascular papillary endothelial hyperplasia of the vulva are presented. Using PubMed, the following terms were searched and relevant citations assessed: intravascular papillary endothelial hyperplasia, IPEH, labia majora, Masson hemangioma, Masson pseudoangiosarcoma, Masson tumor, and vulva. In addition, the literature on intravascular papillary endothelial hyperplasia is reviewed. A 32-year-old woman presented with a 3 x 2 millimeter painless, black colored submucosal papule on her left labia majora. The lesion was removed by excisional biopsy. Microscopic examination revealed a re-canalizing thrombus and a proliferation of erythrocytes within a dilated vascular structure. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of intravascular papillary endothelial hyperplasia was established. The patient applied mupirocin 2% ointment to the biopsy site, which subsequently healed without complication or recurrence. Intravascular papillary endothelial hyperplasia -- also known as Masson tumor -- is a rare, benign vascular eruption. Cutaneous lesions typically present as red colored or blue-black colored nodules ranging in size from 0.25 to 5 centimeters in diameter. The most common sites of presentation include the head, neck, and extremities. However, albeit rarely, lesions may also appear in the genital region. The histologic hallmark of intravascular papillary endothelial hyperplasia is an organizing thrombus in the vascular lumen with associated hyperplastic endothelial cell proliferation. Lesions often appears similar to other neoplastic and non-neoplastic cutaneous tumors, including hemangiomas, pyogenic granulomas, and cutaneous angiosarcomas. Therefore, pathologic examination is required to confirm the suspected diagnosis and exclude malignancy. The condition can usually be treated with simple local excision.

A Giant Vulvar Mass: A Case Study of Cellular Angiofibroma.

Cellular angiofibroma is a mesenchymal tumor that affects both genders. Nucci et al. first described it in 1997. Cellular angiofibroma is generally a small and asymptomatic mass that primarily arises in the vulvar-vaginal region, although rare cases have been reported in the pelvic and extrapelvic regions. It affects women most often during the fifth decade of life. The treatment requires simple local excision due to low local recurrence and no chance of metastasization. The current study presents a case of angiofibroma in the vulvar region that measured approximately 20 cm.

Cellular-type neurothekeoma over the chest wall of a woman

A 33-year-old woman with no underlying systemic disease visited our hospital with a tender, hyperpigmented skin tumor over the right lateral chest wall for 6 months. Initially, the lesion was a small hemorrhagic cutaneous papule. Perifocal hyperpigmentation developed progressively and the lesion gradually enlarged to 2 cm at its greatest diameter. On physical examination, a painful illdefined mass-like lesion was palpated over the right lateral chest wall. It was a 1 2 cm2 ovoid hyperpigmented skin patch with a 0.3-cm papule in the center (Fig. 1A). A simple excision was performed. After the operation, the patient recovered uneventfully and has had no local recurrence. The histological examination revealed lobulated solid nests and strands of large epithelioid cells with vesicular nuclei, minimal nuclear atypia, pale cytoplasm, and rare mitoses, with infiltration into the dermis (Fig. 1B). Immunohistochemically, the tumor cells were positive for vimentin and CD57 and negative for CD34, epithelial membrane antigen (EMA), human melanoma black 45, estrogen receptor, S-100, and cytokeratin. These features were consistent with a cellular variant of neurothekeoma. Neurothekeoma is a type of benign nerve sheath neoplasm and presumably arises from small cutaneous nerves [1,2]. Neurothekeomas have been classified as myxoid, cellular, or mixed type. However, myxoid-type neurothekeomas have a relatively high local recurrence rate when managed by simple local excision and appear to be unrelated to cellular and mixed-type neurothekeomas.

Rural hospital outcomes versus non-rural hospital outcomes following emergency laparotomy: A Scottish retrospective cohort study

Rural hospital outcomes versus non-rural hospital outcomes following emergency laparotomy: A Scottish retrospective cohort study

Patients treated with oncoplastic breast conservation require more postoperative radiological imaging, consequent biopsy and outpatient clinic visit than patients treated with simple wide local excision

Patients treated with oncoplastic breast conservation require more postoperative radiological imaging, consequent biopsy and outpatient clinic visit than patients treated with simple wide local excision

Cellular angiofibroma in women: a review of the literature.

Cellular Angiofibroma (CA) represents a quite recently described mesenchymal tumour that occurs in both genders, in particular in the vulvo-vaginal region in women and in the inguino-scrotal area in men. The first description of this tumour dates from Nucci et al. article in 1997; since then, the literature reports different reviews and case report of this tumour in both genders, but no article specifically addressing CA treatment and follow-up in women. In this review we collected all 79 published female CA cases, analyzing the clinical, pathological and immunohistochemical features of the tumour.CA affects women mostly during the fifth decade of life, it is generally a small and asymptomatic mass that mainly arises in the vulvo-vaginal region, although there are reported pelvic and extra-pelvic cases. The treatment requires a simple local excision due to an extremely low ability to recurrent locally and no chance to metastasize. Throughout the immunohistochemical and pathological findings it is also easily possible a differential diagnosis from the other soft tissue tumours which affect the vulvo-vaginal area, such as spindle cell lipoma, solitary fibrous tumour, angiomyofibroblastoma and aggressive angiomyxoma.

P065. Comparison of radial margins in therapeutic mammoplasty and wide local excisions for invasive breast cancer

P065. Comparison of radial margins in therapeutic mammoplasty and wide local excisions for invasive breast cancer

P138. Do patients diagnosed with phyllodes breast tumours need long term follow up?

P138. Do patients diagnosed with phyllodes breast tumours need long term follow up?

Fibroepithelial Polyps of the Vagina in Pregnancy.

A 25-year-old primigravida mother at 36 weeks pregnancy presented with mass descending per vaginum for last one month. In the antenatal history she had regular antenatal visits without any pregnancy complication. General and systemic examination revealed no abnormality. On local examination of external genitalia, there was a large pedunculated polyp [Table/Fig-1] of the vagina which measured 8 x 6 cm with multiple large atypical polyps found inside the vagina. Cervix was healthy and os was closed. An excisional biopsy of the largest polyp was done and histopathology revealed benign fibroepithelial polyps. So decision was taken to allow spontaneous vaginal delivery. Since operative vaginal delivery should be avoided in such cases to reduce the risk of trauma and haemorrhage [1]. Her pregnancy continued well and she went in to spontaneous labour at 40+2 weeks. But caesarean section was done for intrapartum fetal distress. On follow up after 6 weeks, the patient is asymptomatic and the polyps were reduced in size and number which proved their hormone dependant nature [Table/Fig-2]. [Table/Fig-1]: Large pedunculated polyp with multiple fibroepithelial polyps of vagina [Table/Fig-2]: After 6 weeks polyps reduced in size and numbers Fibroepithelial polyps of the vagina (FEPV) are mucosal polypoid lesions with a connective tissue core covered by a benign squamous epithelium [2]. They are thought to be rare as few cases are reported in literature and the cases are compared with the present case in [Table/Fig-3]. [Table/Fig-3]: Comparison of reported cases in literature with the present case The aetiology of FEPV may be as a result of a granulation tissue reaction after some local injury of the vaginal mucosa. It is because of delayed differentiation of myofibroblastic stromal cells which explains why granulation tissue sometimes does not contract properly but turns into polyps [2]. But during pregnancy hormonal factors may modulate the growth of FEPVs. Hartmann CA et al., reported after examination with immunohistochemistry that FEPV expressed vimentin, desmin, and receptors for estrogen and progesterone which indicates the hormone dependant nature of these polyps [3]. Although benign, it can be confused with malignant connective tissue lesions because of its bizarre histology. The differential diagnoses are sarcoma botryoides, rhabdomyosarcoma and mixed mesodermal tumour [4]. Histopatholgy confirms the diagnosis. The other terminologies of FEPV reported in literature are Pseudosarcoma botryoides, Cellular pseudosarcomatous fibroepithelial stromal polyps and Polyposis vaginalis [5,6]. Treatment of FEPV is simple local excision [7,8]. It can be performed after pregnancy as an interval procedure when the vaginal vascularity has returned to normal. Recurrence is extremely uncommon [9]. Nucci MR et al., studied 65 cases of FEPV and reported that awareness of the spectrum of histopathologic features that these lesions can exhibit and is crucial in their accurate diagnosis thus avoiding potential overtreatment [5]. FEPV in pregnancy is a rare lesion. Although benign, it can be confused with some malignant tumours. Histopathology confirms the diagnosis. Treatment is simple local excision and recurrence is uncommon. Hence knowledge of clinical and histopathological features of these lesions is important for accurate diagnosis for avoiding potential overtreatment.

196. Extended rotational flap for closing defects of upper-lateral segment of the breast. The useful trick in oncoplastic breast conserving surgery

Background: Breast tumors occur mostly in the upper-lateral quadrants. Simple wide local excision leads to deformities. Rotational flap (RF) is effective, leads often to the decrease of the breast size, although it saves breast shape. But asymmetry requires additional operation. We believe that optimal oncoplastic technique allows saving shape and size of the breast. It can be achieved by volume replacement from the axillary region – lateral thoracical flaps (LTF), which are reliable (Holmstrom 1986, Munhoz 2006). However, such flaps also can lead to deformities.

Patients treated with oncoplastic breast conservation require more postoperative radiological imaging, consequent biopsy and outpatient clinic visit than patients treated with simple wide local excision

Patients treated with oncoplastic breast conservation require more postoperative radiological imaging, consequent biopsy and outpatient clinic visit than patients treated with simple wide local excision

Patients treated with oncoplastic breast conservation require more postoperative radiological imaging, consequent biopsy and outpatient clinic visit than patients who had simple wide local excision – A controlled study

Patients treated with oncoplastic breast conservation require more postoperative radiological imaging, consequent biopsy and outpatient clinic visit than patients who had simple wide local excision – A controlled study

Oncoplastic breast conservation does not lead to a delay in the commencement of adjuvant chemotherapy in breast cancer patients

There is hardly any evidence that oncoplastic breast conservation surgery (OBCS) does not lead to a delay in the commencement of adjuvant chemotherapy. Although this is an integral part of overall oncological safety, no controlled studies have been published so far. Therefore, our aim was to determine whether OBCS led to a delay when compared to simple wide local excision (WLE), mastectomy (Ms) or mastectomy with immediate reconstruction (MsIR). Breast cancer patients who required adjuvant chemotherapy after OBCS, WLE, Ms and MsIR were identified from prospectively maintained institutional databases. Time between multidisciplinary team decision to offer chemotherapy and delivery of first cycle of chemotherapy was measured and compared among the four groups of patients. time to chemotherapy of breast cancer patients (n=169) treated with OBCS (n=31) were 29 [16-58] days, while it was 29.5 [15-105] days after WLE (n=66), 29 [15-57] days after Ms (n=56) and 31 [15-58] days after MsIR (n=16). A combined analysis involving all four groups demonstrated no statistically significant difference (p=0.524). Similarly, inter-group analysis revealed no significant differences in between patients treated with OBCS compared to any of the three control groups (OBCS to WLE: p=0.433; OBCS to Ms: p=0.800; OBCS to MsIR: p=0.405). OBCS seems as safe as WLE, Ms or MsIR in terms of delivery of adjuvant chemotherapy, and, therefore, should not adversely affect breast cancer outcome in this respect.