Versatility of Rectus Abdominis Myocutaneous Flap in Primary Reconstruction of Defects in Surgical Oncology.

With the advent of microvascular surgery, the choice of reconstruction following resection of the primary has an important bearing on the final functional and cosmetic outcome in surgical oncology. The vertical rectus abdominis myocutaneous (VRAM) flap is arguably the most widely used and versatile flap in reconstructive surgery. All patients undergoing a VRAM flap reconstruction following resection of their tumor in the Surgical Oncology Department of a tertiary cancer center from 2012 to 2019 were included in the study. Defects ranged from the breast (40), head and neck (10), groin (3), and perineum (5). The primary outcome measure was incidence of complete and partial flap necrosis, while incidence of hematoma, seroma, incisional hernia, wound dehiscence, and infection were secondary outcomes measured. The patients were followed up for a minimum period of 1 year. The incidence of complete flap necrosis was 5.1% (3) and partial loss 12% (7). Incidence of minor complications such as seroma was 13.7% (8), hematoma 6.8% (4), wound dehiscence 10.3% (6), and wound infection 5.1% (3). Incisional hernia and donor site wound-related complications were not seen in any. On binary regression analysis, the presence of diabetes mellitus, smoking, and the use of adjuvant treatment were associated significantly with increased odds of flap loss. This study demonstrates the versatility and reliability of the VRAM flap in primary reconstruction of defects in surgical oncology. Optimization of risk factors such as diabetes, smoking, and weight gain can reduce flap loss and improve outcomes.

Metachronous Synchronous Sternal and Colonic Metastasis with Asymptomatic Colo-colic Fistula from Carcinoma Ovary Rare Presentation of Ovarian Cancer.

Ovarian cancer is one of the most common gynecological cancers worldwide. It is the third leading cause of cancer among women in India. Metastatic disease to the visceral organs from ovarian cancer occurs as a terminal event in the natural history of the disease. In particular, spread to the bone and large bowel is infrequently described. The risk of distant metastasis increases in a recurrent setting. We describe a case of a 77-year-old lady, who was diagnosed for ovarian carcinoma in 2007 and underwent primary cytoreductive surgery, stage IIIc. She presented to us with asymptomatic rising cancer antigen (CA) 125 levels during follow-up. On evaluation she was found to have sternal and colonic deposits. She underwent left hemicolectomy and biopsy of sternal deposit. Histopathology revealed metastasis from the carcinoma ovary to the colon and sternum. This case report highlights the rare synchronous metastatic disease in a metachronous setting from ovarian carcinoma.

Diagnostic Dilemma in a Thyroid Incidentaloma: Second Primary versus Metastatic Nodule?

With the increasing use of 18F-Fluro-Deoxyglucose (FDG) Positron Emission Tomography (PET) the number of thyroid incidentalomas is on the rise. Focal thyroid incidentalomas identified by FDG-PET have been reported to have a high incidence of malignancy. Neuroendocrine tumours of the thyroid are rare entities. The most common neuroendocrine tumour of the thyroid is medullary carcinoma. A thyroid nodule in a patient with a known neuroendocrine tumour must be differentiated from a primary medullary carcinoma which can present as a diagnostic challenge to the clinician. A 65-year-old female patient was referred for thyroidectomy for a FNAC diagnosed follicular neoplasm of the left lobe of the thyroid, detected on FDG PET follow up. She was a known case of neuroendocrine tumour of the pancreas with no features suggestive of familial Multiple Endocrine Neoplasia (MEN) syndrome. The patient had undergone Whipple's procedure elsewhere, 5 years back. Following total thyroidectomy, the final histopathology report was suggestive of a primary neuroendocrine tumour. We present this case to highlight the clinical dilemma in diagnosing a thyroid incidentaloma as a second primary neuroendocrine tumour versus a solitary metastatic nodule in the background of metastatic gastroentero pancreatic neuroendocrine tumour. Although clinically, a metastatic nodule should have been the obvious diagnosis, the histopathological and immunohistochemical features were in favour of a primary non-medullary Neuroendocrine Tumor (NET) of the thyroid.