[A rare cause of swelling of the little finger]. / Een snelgroeiende zwelling van de top van de pink.

A 71-year-old man presented with a painful swelling of the tip of his little finger. Infection was considered, but antibiotics and incision did not give relief. Biopsy showed metastasis of anal carcinoma, for which he had been treated 7 years earlier with curative chemoradiotherapy. He underwent amputation of the finger.

Sentinel lymph node biopsy for cutaneous melanoma: results of 10 years' experience in two regional training hospitals in the Netherlands.

BACKGROUND AND OBJECTIVE: The Multicenter Selective Lymphadenectomy Trial (MSLT-I) demonstrated that the sentinel node (SN) status in cutaneous melanoma affects prognosis and that completion lymphadenectomy in SN-positive patients may improve survival. Our objective was to evaluate sentinel lymph node biopsy (SLNB) in two regional hospitals in the Netherlands. METHODS: Patients with localized melanoma were planned for wide excision and SLNB. Completion lymphadenectomy was recommended for positive SN status. Data were compared with the MSLT-I. RESULTS: A median of 2 (1-7) SNs were identified in 305 patients and complications occurred in 11%. Fifty-four patients (18%) demonstrated SN metastases and 45 underwent completion lymphadenectomy (20% additional metastases). Six patients with initially negative SN developed lymph node metastases (sensitivity 90%). Overall disease-free survival was 83% (SN-negative 91% vs. SN-positive 41%; p < 0.001) and melanoma-specific survival was 93% (SN-negative 97% vs. SN-positive 62%; p < 0.001). Multivariate regression analysis revealed the SN status to be the most significant predictor for recurrence and melanoma-related death. CONCLUSION: Our results of SLNB are comparable to data from high-volume centers participating in MSLT-I. From a patient perspective, the false-negative SN rate of 10% and complication rate of 11% should be weighed against being informed about prognosis and having a possible therapeutic benefit from completion lymphadenectomy.

[Malignant sacrococcygeal teratoma in an adult woman]. / Maligne sacrococcygeaal teratoom bij volwassen vrouw.

BACKGROUND: Sacrococcygeal teratomas are neoplasms that are ordinarily diagnosed intrauterinely. In case of complete or partial intrapelvic sacrococcygeal teratoma, it may happen that it is only ascertained at a later age. CASE DESCRIPTION: During a regular monitoring visit for breast cancer a 58-year-old female reported that she had discovered a swelling at the level of her coccyx. MRI imagery appeared to indicate an ectopic ovary. After resection, it appeared that it was a mature teratoma from which mucinous adenocarcinoma had developed. CONCLUSION: Given the risk of malignant deterioration, it is important that sacrococcygeal teratoma be recognized and treated by means of complete resection, including resection of the coccygeal bone.