RESUMO
Hidradenitis suppurativa (HS) is a chronic skin condition characterised by recurrent abscesses, nodules, sinus tracts and fistulas. The condition has a known diagnostic delay and well-documented negative effect on the quality of life of patients. When affecting the periareolar region, there is a capacity for confusion with other more mainstream surgical conditions of the breast. We present a case of a 35-year-old woman who was diagnosed with an acutely painful breast nodule with periareolar erythema and induration who was repeatedly misdiagnosed due to cofounding features on clinical assessment. We present this case as a diagnostic dilemma to raise awareness of HS as a differential when assessing surgical breast patients.
RESUMO
Ipsilateral axillary lymph node metastasis is common, while contralateral axillary lymph node metastasis (CAM) is uncommon. This report is of a patient that presented with a recurrence of left breast cancer and synchronous CAM, with a distant history of left breast conserving surgery and axillary dissection for invasive carcinoma. The CAM was confirmed following a non-routine lymphoscintigraphy and sentinel lymph node biopsy. This highlights the possibility of CAM representing as locoregional disease rather than advanced stage IV disease.
Assuntos
Neoplasias da Mama , Axila/patologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Biópsia de Linfonodo SentinelaRESUMO
BACKGROUND: The incidence of gastrointestinal cancer increases with age, with approximately 20% of these cases in people over 80 years of age. Due to pre-existing comorbidities, this onco-geriatric population often presents diagnostic and therapeutic challenges. METHODS: A systematic review of articles on PubMed was performed to determine the predictive ability of screening tools and their components regarding the occurrence of adverse outcomes in elderly onco-surgical patients with gastrointestinal malignancies. RESULTS: Surgical procedures in this patient cohort, particularly complex resections, may result in increased morbidity and mortality. The decision to treat an elderly patient with curative intent requires sound clinical judgment based on knowledge, consideration of objective parameters, and experience. These patients could potentially be optimized for surgery with the improvement of nutritional and overall performance status as well as with stabilizing comorbidities. CONCLUSION: Various geriatric assessment and screening tools have been developed to identify risk factors to assist the surgeon and the interdisciplinary team in treatment planning, including the Frailty Assessment Score, Timed Up and Go test, nutritional status, and Activities of Daily Living test. It is important to emphasize that transparent and open communication between the treating surgeon and the patient is crucial in that the patient fully understands the implications of the treatment plan.
RESUMO
BACKGROUND: Recent data suggests that intradermal (ID) injection for sentinel lymph node (SLN) mapping and biopsy in breast cancer is as effective and reproducible as intraparenchymal (IP) injection. The aim of this study was to review our initial experience with IP and ID injection for SLN mapping and biopsy at our rural-based university medical center. METHODS: From January 4, 1999 to January 5, 2001, 113 of 165 patients with breast cancer underwent attempted SLN mapping and biopsy by either IP (n=63) or ID (n=50) injection. Selection of the IP versus ID injection route was non-randomized and based on surgeon preference. Success of SLN localization was examined. RESULTS: SLN localization was successful in 82% of IP and 100% of ID for radioisotope (p=0.001), 69% of IP and 92% of ID for blue dye (p=0.002), and 90% of IP and 100% of ID (p=0.024) for radioisotope and blue dye. Identical comparisons made after excluding the first 10 cases, 20 cases, and 30 cases from each injection group showed that the percentage of cases in each group in which the SLN localized changed minimally; however, some of the resultant p values eventually lost statistical significance. CONCLUSIONS: SLN localization was more successful by ID injection than by IP injection, thus favoring utilization of the ID injection route. The eventual loss of statistical power in some of the comparisons with increasing numbers of initial cases excluded may reflect differential learning curves of the two injection techniques; however, this may simply be a reflection of decreasing sample size used in each subsequent analysis. A prospective randomized trial comparing the IP and ID injection route may be warranted.
Assuntos
Neoplasias da Mama/patologia , Linfonodos/patologia , Biópsia de Linfonodo Sentinela/métodos , Coloide de Enxofre Marcado com Tecnécio Tc 99m , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Feminino , Humanos , Injeções Intradérmicas , Injeções Intralesionais , Metástase Linfática , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , População Rural , Sensibilidade e EspecificidadeRESUMO
Sentinel lymph node mapping and biopsy (SLNMB) is a standard of practice in the management of cutaneous malignant melanoma (CMM). Since there were no published articles reviewing the experience of a single-institution, rural-based university medial center, we compiled our results from the patients we treated from Nov. 11, 1998 to May 23, 2001. A total of 54 caucasian patients (35 males, 19 females) of a median age of 60 years (range 2-84) were surgically treated, including 29 cases on the extremities, 16 trunk cases, and nine of the head/neck. Median Breslow thickness was 1.50 mm (range 0.23-12.0). Median Clark's level was 4 (range 2-5). Forty-seven patients underwent sentinel lymph node (SLN) injection and preoperative lymphoscintigraphy. Preoperative lymphoscintigraphy revealed radiocolloid uptake in 53 regional lymph node basins (RLNB), including two separate RLNB in four patients and three separate RLNB in one patient. Intraoperatively, SLN localization of radiocolloid was shown in 53 RLNB and SLN localization of blue dye was demonstrated in 38 RLNB. SLNs were positive in six of 52 (11.5%) RLNB biopsied and six of 46 (13.0%) patients. Our initial experience with SLNMB was encouraging and holds promise for rural-based practices by sparing added morbidity and inconvenience of more extensive surgery.
Assuntos
Melanoma/patologia , Biópsia de Linfonodo Sentinela , Neoplasias Cutâneas/patologia , Centros Médicos Acadêmicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Cutâneas/cirurgia , West VirginiaRESUMO
Reduction mammoplasty is one of the most commonly performed procedures in plastic surgery. Occasionally, there are findings reported by pathologists that are unfamiliar to the treating surgeon. The aim of the present study was to determine the types of pathologies encountered in reduction mammoplasty specimens. From this list of diagnoses, a best practice guideline for management will be organized to better assist plastic surgeons in the management of patients with incidental findings on pathology reports. A total of 441 pathology reports from patients who underwent bilateral or unilateral reduction mammoplasty in the past three years were identified. A list of 21 different pathologies was generated from the pathology reports, along with supplemental data from recent texts and articles. Occult carcinomas were encountered in two cases (0.45%) and high-risk lesions were found in three cases (0.68%) at the authors' institution. An algorithm was then constructed to organize the pathologies according to risk of malignancy and assign them to a management guideline. There are many different lesions encountered incidentally in reduction mammoplasty specimens that may or may not confer some cancer risk. It is important for plastic surgeons to know which lesions need closer follow-up to provide the best care for their patients.
Les réductions mammaires font partie des interventions les plus exécutées en chirurgie plastique. Il arrive que le médecin traitant ne soit pas familier avec les observations du pathologiste. La présente étude visait à déterminer le type de pathologies observées dans des prélèvements de réductions mammaires. À partir de cette liste de diagnostics, des directives de pratiques exemplaires de prise en charge sont exposées pour mieux aider le plasticien à prendre en charge les patients présentant des observations fortuites dans le rapport de pathologie. Au total, les chercheurs ont trouvé 441 rapports de pathologie de patients qui ont subi une réduction mammaire bilatérale ou unilatérale depuis trois ans. Ils ont dressé une liste de 21 pathologies différentes à partir des rapports de pathologie, de même que d'autres, tirées de textes et articles récents. Dans l'établissement des auteurs, on a observé deux cas de carcinomes occultes (0,45 %) et trois cas de lésions à haut risque (0,68 %). Un algorithme a ensuite été construit pour classer les pathologies d'après le risque de malignité et leur accoler une directive de prise en charge. Il existe de nombreuses lésions observées fortuitement dans les échantillons de réductions mammaires qui peuvent ou non s'associer à un risque de cancer. Il est important pour le plasticien de savoir quelles lésions doivent faire l'objet d'un suivi plus étroit pour dispenser les meilleurs soins aux patients.