Surgical oncology
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Case Reports
Patients blue on patent blue: an adverse reaction during four sentinel node procedures.
Patent blue V is a well-known dye for visualisation of the lymph nodes in a sentinel lymph node biopsy in breast carcinoma. We present four cases of an adverse reaction to patent blue V, one of which was an anaphylactic shock. The adverse reactions to patent blue and isosulphan blue as found in the literature are discussed and an alternative is suggested.
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Review Case Reports
Hepatoid malignancy of unknown origin--a diagnostic conundrum: review of literature and case report of collision with adenocarcinoma.
Hepatoid carcinomas are a group of neoplasms with features resembling hepatocellular carcinomas. Although rare, more cases have been noted to arise from various organs within the last decade. Differentiating these tumors is not only a challenge but also critical, since treatment modalities and operative strategies are dependent upon the exact nature of the hepatoid cancer. Based on a review of literature, we discuss the guidelines for differentiating these tumors and utilize these criteria to differentiate these tumors irrespective of their primary tissue of origin. We also describe an unusual case of hepatoid variant of primary peritoneal yolk sac tumor presenting with extensive carcinomatosis and as a collision with two synchronous primary colonic adenocarcinomas, neither of which has been reported to our knowledge to date, thereby falsely mimicking metastatic dedifferentiated colonic adenocarcinoma. ⋯ The most likely explanation in our case is that the hepatoid tumor either originated from microscopic remnant ovarian tissue left behind or primarily from the peritoneum. With no evidence of yolk sac component within the colonic tumor or in the draining lymphatics, this essentially excludes the commonly observed metastatic dedifferentiation (opisthoplasia) of adenocarcinoma to primitive forms (also known as combination tumors). Based on analysis of various factors, including tumor behavior and response to chemotherapy, we conclude that our case was a hepatoid variant of yolk sac tumor presenting in an elderly woman with carcinomatosis. This unusual presentation of two entirely different primary malignancies in close proximity is defined as "collision tumor". This is the first reported case of collision tumors involving dual colonic and primary peritoneal hepatoid-YST. Identifying the exact type still remains to be the most challenging aspect in the diagnosis of hepatoid tumors.
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Surgical resection remains the mainstay of therapy for early stage non-small cell lung cancer (NSCLC). Unfortunately, many patients present with advanced stage disease, and many with resectable early stage disease are unable to tolerate pulmonary resection because of compromised cardiopulmonary function. This article reviews the standard and some alternative therapies that are being introduced into clinical practice for early stage NSCLC. New therapies such as sublobar resection with brachytherapy, radiofrequency ablation and stereotactic radiosurgery offer some hope for those patients who are deemed poor candidates for curative resection.
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Meta Analysis
Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models.
To review two predictive models, based on the American Society of Anaesthesiologists (ASA) and the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM)-used for estimating postoperative mortality in patients, undergoing surgery for colorectal disease, in the UK. ⋯ Prediction of postoperative death can be made by the clinician using simple, numerical, tables derived from the ACPGBI CRC, MBO and CR-POSSUM models. The models can be used in everyday practice for pre-operative counselling of patients and their carers, as a part of the process of informed consent. They may also be used to compare the outcomes between multidisciplinary CRC teams.
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Review Comparative Study
Optimal management of ductal carcinoma in situ of the breast.
Ductal carcinoma in situ (DCIS) represents a breast lesion that is diagnosed with increasing frequency, mainly due to the wide use of screening mammography. Today, DCIS comprises 15-25% of all breast cancers detected at population screening programs. Consequently, the concepts of properly managing such patients assume a greater importance in everyday practice. ⋯ Nearly all patients who develop a non-invasive recurrence following breast-sparing surgery are cured with mastectomy, and approximately 75% of those with an invasive recurrence are salvaged. Selected patients initially treated by lumpectomy alone may also undergo breast-conservation therapy at the time of relapse according to the same strict guidelines of tumor margin clearance required for the primary lesion; radiation therapy should be given following local excision. The use of systemic therapy in patients with invasive recurrence should be based on standard criteria for invasive breast cancer.