RESUMO
BACKGROUND: The efficacy and safety of cell salvage for musculoskeletal sarcoma surgery have not been reported, and concerns over re-infusion of tumour cells remain. This study aims to i) describe the intra-operative blood loss and cell salvage reinfusion volumes for lower limb sarcoma and pelvic sarcoma procedures ii) and explore whether there is evidence of tumour cells in reinfused blood. METHODS: Retrospective analysis of 109 consecutive surgical procedures for biopsy-proven sarcoma or bone metastasis performed between 1 July 2015 and 30 October 2019. Salvaged blood was processed and reinfused when intraoperative blood loss exceeded 500 ml. Primary bone tumour (n = 86(79%)) and metastasis (n = 23(21%) constituted the study group and surgeries were classified under hemipelvectomy (n = 43(39%)), lower limb endoprosthesis replacement (LLE) (n = 50(46%)) and wide excision surgery (WE) (n = 16(15%)). Microscopic examination of imprint cytology of leuco-depletion(LD) filters, and peripheral smear examination was performed for reinfused blood. RESULTS: Median (IQR) intra-operative blood loss was 1750 (600-3000) ml for hemipelvectomy, 850 (600-1200) ml for LLE, and 1000 (550-2000) ml for WE. Salvaged blood was re-infused in 102 of 109 (94%) patients. The mean (SD) volume of re-infusion was 445(4 2 5) ml for hemipelvectomy, 206(1 3 1) ml for LLE, and 184(1 0 6) ml for WE. In total, 64 of 109 (59%) patients received an allogeneic red blood transfusion within 72 h of surgery. Cytology analysis of imprints taken from the filtered blood available in 95(87%) patients and peripheral smear examination of reinfused blood available in 32(29%) patients did not reveal evidence of tumour cells on microscopic examination of any samples. CONCLUSION: Our study demonstrates that musculoskeletal sarcoma surgery is associated with significant blood loss, and cell salvage permits reinfusion of autologous blood in most patients. The cytological analysis did not reveal evidence of tumour cells in reinfused blood, consistent with other studies where cell salvage is used for cancer surgery.
RESUMO
Ectopic breast tissue (EBT) is an uncommon entity that occurs in about 6% of the population, more frequently in Asian people. It manifests as a nonspecific soft tissue mass that can develop in any location along the "milk-line," with the axilla being the most frequently reported location. As with normal breast tissue, both benign and malignant processes can arise from EBT. Therefore, imaging plays an important role in the adequate assessment of these soft tissue lesions, characterizing its shape, borders, internal components, and vascularity, as well as its relationship with the deep fascia and adjacent structures. Here we present a case of a 33-year-old female Indian patient with an 8 cm soft tissue mass in the upper left abdominal quadrant with a recent increase in size. Clinical and imagiological evaluation were nonspecific but established the nonaggressive behavior of the lesion. To ultimately exclude malignancy, an ultrasound-guided biopsy was performed providing the histological diagnosis of EBT. This case report illustrates the value of clinical, radiological, and histological correlation in the approach of indeterminate soft-tissue tumors, with special focus on lesions in close proximity to the native breasts, where EBT should not be forgotten amongst differentials.