A Rare Case of Metastatic Uterine Leiomyosarcoma to the Thyroid Gland.

Uterine leiomyosarcomas are malignant tumors that have a grim prognosis. These neoplasms have a high metastatic potential. Limited literature exists on leiomyosarcoma metastasizing to the thyroid. This case emphasizes the importance of considering metastasis as a possible cause for thyroid swelling in patients with a history of malignancy.

A proposed Clino-radio-pathological Risk Scoring System (CRiSS) for prediction and management of inguinal lymph-nodes metastasis in squamous cell carcinoma of the penis.

OBJECTIVE: To develop a risk scoring system for prediction of inguinal lymph-node involvement and to suggest a management strategy according to the risk groups based on clinical, radiological and pathological parameters in squamous cell carcinoma (SCC) of penis. MATERIALS AND METHODS: A retrospective analysis of all patients of SCC penis from 2014 to 2020 at our institute was done. The patients were divided into derivation cohort (2014 to 2019) and validation cohort (2019 to 2020). A total of 10 predictors were analysed in univariate analysis and those found significant were further subjected to multivariate analysis to derive regression coefficient for each. CRiSS scores were assigned based on the coefficients and three groups were created which were correlated with nodal metastasis. The predictive accuracy of the model was assessed by ROC analysis of the derivation cohort and validation cohort. RESULTS: A total of 102 patients were identified in derivation cohort and 23 patients in validation cohort. Size of the primary >3cm, ulceroinfiltrative growth, involving shaft, ultrasound size of lymph-nodes >1cm, loss of fatty hila, moderate and poor differentiation, and lypmphovascular/perineural invasion were independent predictors of inguinal lymphnode metastasis in multivariate analysis. CRiSS could achieve AUROC of .910 and .887 in derivation and validation cohort respectively. The rate of metastatic lymphadenopathy was 0%, 41.4%, and 89.5% in low, intermediate, and high-risk groups respectively. CONCLUSIONS: CRiSS can effectively predict inguinal lymph-node metastasis in SCC penis. We suggest a management strategy based on risk groups that will avoid morbidity of groin dissection in many patients.

Retrospective Audit of Various Surgical Modalities Adopted for Giant Cell Tumor in a Rural Tertiary Cancer Center.

Giant cell tumor of bone (GCTB) is a rare tumor with a spectrum of clinical behavior. Standard treatment modalities include surgical curettage to wide resection, and varying oncological and functional results have been reported. The aim of this study was to evaluate the functional outcome and recurrence rates of patients who underwent surgery for giant cell tumor in a rural tertiary cancer center from June 2009 to December 2016. A retrospective review of 12 patients (7 males and 5 females) with GCT of the extremity bones treated in the institution between the period of June 2009 and December 2016 was performed to study the oncological and functional outcomes. All patients were evaluated by clinical examination, plain X-ray of local parts, X-ray of the chest, and MRI of local parts. A biopsy was taken in all cases to confirm the diagnosis. All patients underwent surgical treatment including curettage combined with cryosurgery and bone cement or wide resection and reconstruction. Selection of the surgical technique was based on the site and size of the lesion, soft tissue involvement (intra- or extra-compartmental), and if recurrent or not. The patients were followed up to April 2018. The mean age of the patients was 31.3 years. The tumor sites were distal femur in 3 cases, proximal tibia in 6, ischial bone in 1, distal radius in 1, and 1 in the metacarpal bone. Campanacci radiographic grading was grade1 in 3 cases, grade 2 in 2 cases, and grade 3 in 7 cases. Out of 12 patients, local recurrence was noted in 2 patients (16.7%). Functional evaluation was performed according to the Musculoskeletal Tumor Society Scoring (MSTS) system. Mean MSTS score was 25. To preserve the good function of the extremities and avoid local recurrence, we consider that curettage with adjunctive therapy such as polymethylmethacrylate (PMMA) and liquid nitrogen should be employed for the treatment of benign GCT of bone. Wide excision should be considered for large tumors where achieving oncological results with functional preservation would be difficult with curettage procedure.

Age-adjusted charlson comorbidity index and 30-day morbidity in pelvic surgeries.

INTRODUCTION: Charlson comorbidity index (CCI) is a validated tool enabling clinicians for prediction of adverse events posttherapy. In this study, we planned to estimate the predictive value of age-adjusted CCI (ACCI) in assessing the perioperative complication in oncological patients undergoing major pelvic surgeries. METHODS: This was a single arm, prospective, observational study, in which adult patients with pelvic malignancies undergoing pelvic surgeries were selected. The relationship between the ACCI and Grade 3-5 adverse events were tested using Fisher's test. RESULTS: The rate of Grade 3-5 adverse event rate was 16.7% (11 patients, n = 66). Among the whole cohort, 11 patients (16.7%) had high score on ACCI. The rate of Grade 3-5 adverse events was higher in the cohort of patients with high ACCI score (45.5% vs. 10.9%, P = 0.014). The sensitivity, specificity and negative and positive predictive values were 45.5%, 89.1%, 89.1%, and 45.5%, respectively. CONCLUSION: ACCI can predict for postsurgical adverse events. It has a high negative predictive value for nonoccurrence of adverse events.