Bloody nipple discharge in Carney complex: A case report.

Carney complex (CNC) is an extremely rare, autosomal dominant genetic syndrome consisting of pigmented skin and mucosal changes with multiple endocrine and nonendocrine tumors, including the breast. Breast tumors are typically multiple and benign and are most commonly reported as myxoid fibroadenomas and/or intraductal papillomas. We present a young female patient with known CNC who presented with copious bloody nipple discharge with multiple breast lumps and discuss the breast imaging features regarding this complex and often underrecognized genetic condition.

The Benefits and Pitfalls of Using an Autologous Dermal Flap in Immediate Implant-Based Reconstruction.

One of the challenges of implant breast reconstruction post-subcutaneous mastectomy is coverage of the inferior pole of the implant to provide a barrier between the implant and skin. Numerous biological and synthetic meshes are available on the market for this purpose; however, they are often very costly and carry all the risks of using a foreign body. In patients with large ptotic breast, the skin of the inferior mastectomy flap can be used instead. A number of techniques and variations have been developed over the last 40 years driven by the increasing cost of healthcare and acceptance of breast reconstruction as vital part of breast cancer care and survivorship. This review outline the benefits and pitfalls of using an autologous dermal flap in breast construction and the variations in published use.

Synchronous Acute Appendicitis and Cholecystitis in a Paediatric Patient with Salmonella Enteritis.

We present the case of a 13-year-old male who presented with right upper quadrant pain and diarrhoea after recently travelling from Bali, Indonesia. He had a normal white cell count of 8x10^9/L and elevated c-reactive protein (CRP) of 205 mg/L with normal liver function tests. Originally thought to be appendicitis, given the rarity of cholecystitis in a child, he was commenced on broad-spectrum antibiotics and was taken to the operating theatre based on his clinical presentation. Diagnostic laparoscopy revealed inflammatory change in both the gallbladder and appendix and a laparoscopic cholecystectomy and appendicectomy were performed simultaneously. Histopathology results confirmed cholecystitis and appendicitis and a stool culture confirmed the presence of Salmonella serotype B. Synchronous cholecystitis and appendicitis is an exceedingly rare phenomenon with only a handful of cases reported in the literature. This is the first case in the literature of this phenomenon occurring in the paediatric population; surgeons need to be aware of this rare possibility even in the paediatric population and especially in those patients with an atypical presentation or in recent travellers experiencing gastroenteritis.

The Prognostic Impact of Tumor Size in Papillary Thyroid Carcinoma is Modified by Age.

BACKGROUND: Although the importance of tumor size in papillary thyroid cancer (PTC) is well established, there is no research investigating whether age modifies the impact of tumor size, and there is conflicting evidence regarding optimal size thresholds for prognostic discrimination. We aimed to verify that tumor size is an independent prognostic factor in PTC, investigate the impact of patient age, and identify optimal size cutoffs for risk stratification using objective measures of model performance. METHODS: A retrospective analysis of 574 patients with PTC, using multivariate Cox regression models to test the impact of tumor size on recurrence-free survival (RFS). Subgroup analyses were performed in patients aged <55 and ≥55 years. Exploratory analyses to identify optimal size cutoffs for prognostic discrimination were performed using the proportion of variation explained (PVE) and Harrell's C-index. RESULTS: Tumor size predicted RFS on multivariate analysis in the overall study cohort (hazard ratio [HR] 1.16; [95% confidence interval (CI)1.01-1.34]; p = 0.038). In subgroup analysis, there was no association between tumor size and RFS in patients aged <55 years (HR 1.11; [CI 0.89-1.38]; p = 0.362). In contrast, size was an independent predictor of RFS in patients aged ≥55 years (HR 1.52; [CI 1.11-2.07]; p = 0.009). In this subgroup, an optimal size threshold of >2 cm versus ≤2 cm (HR 5.24; [CI 2.30-11.92]; p < 0.001; PVE: 36%; C-index: 0.66) provided the greatest prognostic discrimination. There was no incremental improvement in prognostic value by further stratification of size. CONCLUSION: In our PTC cohort, the impact of tumor size on RFS was limited to patients aged ≥55 years. A single size threshold of 2 cm maximized prognostic discrimination with tumors >2 cm associated with a five times higher risk of recurrence than those ≤2 cm. These findings need to be validated in independent large cohorts and the potential management and staging implications further studied.

An Analysis of The American Joint Committee on Cancer 8th Edition T Staging System for Papillary Thyroid Carcinoma.

Background: The American Joint Committee on Cancer (AJCC) removed microscopic extrathyroidal extension (ETE) from the 8th edition T staging for papillary thyroid cancer (PTC) based on increasing evidence that it is not an independent prognostic factor. Objectives: We compared the prognostic performance of AJCC 7th (pT7) and 8th (pT8) edition T stage systems, particularly in patients ≥55 years old without macroscopic ETE or distant metastases in whom T classification affects AJCC Tumor Node Metastasis (TNM) stage. Method: A retrospective analysis of disease-free survival (DFS) in 577 patients with PTC comparing pT8 vs pT7 using the Akaike information criterion (AIC), Harrell's C-index, and Proportion of Variation Explained (PVE). Results: Of 105 patients with AJCC7 T3 disease, 74 were down-staged. Overall, the prognostic performance of pT7 and pT8 was similar. However, in patients ≥55 years old without macroscopic ETE or distant metastases, pT8 was inferior to pT7 on the basis of higher AIC, lower C-index (0.67 vs 0.76), and lower PVE (30% vs 45%). In this subset, microscopic ETE was associated with multiple other adverse prognostic features and reduced DFS (hazard ratio, 2.8; 95% confidence interval, 1.5 to 5.2; P = 0.002), irrespective of tumor size. Discussion: In our cohort, pT8 was inferior to pT7 in patients ≥55 years old without macroscopic ETE or distant metastases in whom T classification affects TNM stage. Microscopic ETE was strongly associated with other adverse prognostic factors and reduced DFS in this patient subgroup and may be an effective surrogate for disease biology in PTC, irrespective of whether it is an independent prognostic factor.