A Case Report of Wire-localised Excision of Impalpable Recurrent Papillary Thyroid Carcinoma and Discussion of Wire-guided Excision in the Head and Neck Pathology.

INTRODUCTION/BACKGROUND: Wire localisation techniques are used widely for precision surgery in many specialities. This convenient technique has not yet become mainstream in the field of head and neck surgery. With limited space and many vital structures coursing through the head and neck region, pathological nodes that are difficult to palpate can be a challenge for clinicians. CASE PRESENTATION: A patient with a history of papillary thyroid cancer treated with surgery and radioactive iodine had a single pathological node detected on ultrasound surveillance. An isolated recurrence of papillary thyroid carcinoma was confirmed. An excisional biopsy was performed using ultrasound wire guidance to successfully remove the diseased node with minimal morbidity. CONCLUSION: Wire-guided lymph node excision biopsy is a safe and effective method that can be applied to multiple pathologies. As of yet, it is not routine practice to employ this technique. Larger studies would increase the generalisability and safety profile of this technique in the head and neck region.

Musculoskeletal manifestations of lymphoma: a case series.

Lymphomas are a heterogenous group of cancers of the lymphatic system in which disease primarily arises in lymph nodes. Extranodal disease is common; however, musculoskeletal involvement is rare. Imaging plays an important role in the diagnosis and staging of all lymphomas. In this case series, we present examples of musculoskeletal involvement of lymphoma encountered at our institution. We outline the clinical presentation and imaging findings of each and use these cases to review the features that can help to differentiate lymphoma from other musculoskeletal lesions.

A normal screening ultrasound does not provide complete reassurance in infants at risk of hip dysplasia; further follow-up is required.

BACKGROUND: Screening for developmental hip dysplasia (DDH) continues to evolve with the use of ultrasound (US) in either selective or universal screening methods. The possibility of delayed evidence of DDH, and thus the need for radiographic follow-up at a later stage of development have been suggested by some authors. AIMS: The aim of this review was to evaluate the number of patients in our hospital network with a normal screening US at 6 weeks with evidence of DDH at the time of radiographic review at 6 months. Secondary aim; to determine the outcomes for these patients. METHODS: A retrospective review was done to infants undergoing DDH ultrasound screening between January and December 2015. Initial US and radiographs at 6 months were reviewed. Patients with normal screening US who had subsequent radiographs were included for analysis. RESULTS: In total, there were 829 patients included for analysis. Sixty-three patients (8%) had evidence of DDH at 6 months, representing 34% of all DDH diagnoses for the study period. Five of the 63 patients were lost to follow-up. The remaining 58 babies were treated in Boston bracing. Four patients with evidence of persistent DDH were referred for tertiary review. The osteotomy rate in the radiograph diagnosed group was 2%, versus 6% and 3% in the unstable and US diagnosed groups, respectively. CONCLUSION: Eight percent of patients with a normal screening US had evidence of DDH at time of radiograph at 6 months, reflecting 34% of all our DDH cases for the year. Based on these findings, patients in our hospital network undergo radiographic evaluation at 6 months even if the initial screening US is normal.

Factors Affecting Concordance between Radiological and Histological Findings in Invasive Lobular Carcinoma - Experience from a National Cancer Centre.

BACKGROUND: Invasive lobular carcinoma (ILC) is characterized by an infiltrative discohesive growth pattern, making it difficult to accurately assess both clinically and by imaging studies. Despite favourable biological characteristics, challenges remain in the surgical treatment of ILC. We aimed to evaluate radiology/histology concordance and identify histological and biological parameters on core biopsies that may predict final tumour histology and guide surgical treatment decisions. PATIENTS AND METHODS: The radiology and histology reports for all newly diagnosed cases of ILC were analysed. The biopsy and resection histological slides for all the surgical cases were reviewed. RESULTS: 75 new cases of ILC were diagnosed over a 2-year period. 48 patients underwent surgery of whom 25% had 2 or more operations. There was discordance between radiological and histological tumour focality and tumour size in 35 and 40%, respectively. The correlation between radiology/histology discordance and E-cadherin expression was statistically significant. However, the correlation between radiology/histology discordance and menopausal status, breast density, pattern of invasion, presence of lobular intraepithelial neoplasia (LIN), hormonal status, and Ki67 were not statistically significant. CONCLUSION: Histological and biological factors in ILC, with the exception of E-cadherin expression, do not seem to play a significant role in radiology/histology discordance. However, larger studies are needed to further corroborate these findings.