Periductal stromal tumor of the breast with synchronous bilateral breast cancer.

We report on a case of low-grade periductal stromal tumor of the breast with synchronous bilateral breast carcinoma. A 45-year-old woman came to our Hospital because of a palpable mass of the right breast. An approximately 5-cm mass was palpated in the upper right breast. The mammographic and sonographic findings of the palpable mass suggested the possibility of hamartoma. A 1.3-cm, irregular mass with microcalcifications was also detected in the upper outer quadrant of the right breast and a 1.3-cm irregular mass was detected in the upper outer quadrant of the left breast. Core-needle biopsy revealed bilateral breast carcinoma. The patient underwent bilateral breast-conserving surgery, including the excision of the large palpable mass in the right breast. The palpable mass in the right breast was confirmed as low-grade periductal stromal tumor and there were bilateral invasive ductal carcinomas in both upper outer breast quadrants. After surgery, the patient received adjuvant chemotherapy. At 16 months of follow-up, no recurrence was observed.

Atypia of undetermined significance on thyroid fine needle aspiration: surgical outcome and risk factors for malignancy.

PURPOSE: This study was performed to analyze the surgical pathology results of the "atypia of undetermined significance" (AUS) category from thyroid fine needle aspiration (FNA) and to describe the characteristics to distinguish a malignant from a benign nodule. METHODS: A retrospective analysis was done on 116 patients who underwent thyroid surgery from December 2008 to December 2012, following a diagnosis of AUS from preoperative thyroid FNA. We investigated the age, gender, size and site of the nodules, ultrasonographic criteria, cytological features, the number of atypia results after repeated FNAs, surgical method, and final pathologic results. RESULTS: Sixty-five out of 116 patients underwent total thyroidectomy and the rest had partial thyroidectomy. The final pathologic results were 41 malignancies (35.3%) and 75 benign diseases (64.7%). AUS was divided into group 1: 'cannot rule out malignancy' or group 2: 'cannot rule out follicular neoplasm'. After surgery, group 1 revealed papillary thyroid cancer in most cases and group 2 revealed follicular adenoma in most cases. Age over 40 years, ultrasonographic findings suggestive of malignancy, more than 2 results of atypia from repeated FNAs and nodules less than 2 centimeters were risk factors for malignancy on univariate analysis. Multivariate analysis showed that ultrasonographic findings suggestive of malignancy was a significant risk factor for malignancy. CONCLUSION: For proper evaluation of the risk for malignancy in thyroid AUS patients, the ultrasonographic criteria should be considered along with other clinicopathological findings such as age, nodule size, number of atypia, cytologic features.

Generalized peritonitis arising from small bowel metastasis in a lung cancer patient.

Symptomatic gastrointestinal metastasis from lung malignancy is rarely reported. In this report, we present a case of lung adenocarcinoma with acute abdominal pain from small bowel perforation. The patient underwent small bowel resection and the final diagnosis was metastatic adenocarcinoma originating from lung. Immunohistochemistry was positive for thyroid transcription factor-1 and cytokeratin 7 (CK7), and negative for CK20. We present this rare case and briefly review the literature.

Age and prognosis of papillary thyroid carcinoma: retrospective stratification into three groups.

PURPOSE: We investigated the prognosis according to age in papillary thyroid carcinoma (PTC) patients. METHODS: We retrospectively evaluated 2,890 patients who underwent thyroidectomy due to PTC between May 2004 and Aug 2008. We divided patients into 3 groups: young (≤35 years old), middle (between 35 and 54 years old), and old (≥55 years old). RESULTS: Median age was 47.0 years old (range, 15 to 82 years). Within a follow-up period median of 50 months, there were 148 (5.1%) locoregional recurrences, 6 (0.2%) PTC-related deaths, and 18 (0.6%) PTC-unrelated deaths. Outcomes were more favorable in the young group, with no PTC-related death despite the frequent locoregional recurrence. In the old group compared to the middle, there was a higher proportion of male, and more aggressive types as T3 or N1b, higher mean tumor number, more multiplicity, and bilaterality. The old group of ≥55 years did not show a significant difference in PTC-related deaths than other age groups in Cox analysis (OR, 0.9; P = 0.677), but a significant cutoff age in PTC-related deaths at 62.5 years was determined in ROC analysis (area under curve = 0.912). CONCLUSION: We showed that the ≤35 years group shows favorable prognosis despite the frequent locoregional recurrence and ≥62.5 years group shows a poor prognosis regardless of other factors such as male sex or tumor aggressiveness. Further multiinstitutional studies are needed to elucidate the prognosis according to patient's age.

Observational study of central metastases following thyroid lobectomy without a completion thyroidectomy for papillary carcinoma.

PURPOSE: There are no guidelines for the optimal timing of the decision of when to perform completion thyroidectomy, and controversy exists regarding how the timing of completion thyroidectomy impacts survival patterns. We investigated the legitimacy of an observational strategy in central node metastasis after thyroid lobectomy for papillary thyroid cancer (PTC). METHODS: We retrospectively evaluated 522 consecutive patients who underwent thyroid lobectomy. Of the 69 patients with central metastasis, 61 patients (88.4%) were included in an observational study under cautious evaluation with informed consent by the patients, and compared with an observation arm of 180 postlobectomy N0 (node negative proven) patients. RESULTS: Of the 522 patients, six (1.1%) thyroid, five (0.9%) central, and two (0.4%) lateral recurrences were observed. Lateral recurrences occurred in the immediate completion N0 and Nx groups but not in the N1a observation arms. There were two (3.3%) central recurrences without thyroid or lateral recurrence on the observation arm of N1a observation patients. But two (1.1%) thyroid and three (1.7%) central recurrences were on the observation arm of N0 patients. In Kaplan-Meier survival curves for central or lateral recurrences between observation arms for the N1a and N0 groups, no significant difference was found between the N1a and N0 observation arms (P = 0.365). CONCLUSION: The timing of when to perform completion thyroidectomy in central metastases-proven patients after lobectomy for PTC should be based on the patient's risk category.

Is it possible to predict hypothyroidism after thyroid lobectomy through thyrotropin, thyroglobulin, anti-thyroglobulin, and anti-microsomal antibody?

PURPOSE: We investigated the incidence and risk factors of hypothyroidism after thyroid lobectomy, and evaluated the possibility to predict hypothyroidism preoperatively with serologic markers, such as thyrotropin (TSH), thyroglobulin (TG), anti-thyroglobulin (ATA), and anti-microsomal antibody (AMA). METHODS: We enrolled 123 consecutive patients who underwent thyroid lobectomy due to benign conditions between May 2004 and April 2008. Only preoperative euthyroid patients were included. Patients were divided into two groups by postoperative thyroid function outcomes, into hypothyroid (n = 97) and euthyroid groups (n = 26), and analyzed specially for the preoperative levels of TSH, TG, ATA, and AMA. RESULTS: Twenty-six (21.1%) patients developed hypothyroidism following thyroid lobectomy within 35.7 months of follow-up. The proportion of post-lobectomy hypothyroidism was high in patients with high-normal preoperative TSH level, and the cut-off value was 2.0 mIU/L, with 67% sensitivity and 75% specificity. The quantitative titer of preoperative TG, ATA, and AMA was not significant, but the outcome of categorical analysis of two or more positivities on these three markers was significantly higher in hypothyroid patients than in euthyroid patients (28.6% vs. 3.9%, P = 0.024). The combined positivity of preoperative TSH and two or more positivities of TG, ATA, and AMA possess 100% positive predictive value and 81% negative predictive value. CONCLUSION: The incidence of hypothyroidism following thyroid lobectomy was 21.1%. High-normal preoperative TSH and two or more positivities for TG, ATA, and AMA are good pre-operative predictive markers. Such high-risk patients need close TSH monitoring before the onset of clinical hypothyroidism.

The role of lymphovascular invasion as a prognostic factor in patients with lymph node-positive operable invasive breast cancer.

PURPOSE: Lymphovascular invasion (LVI) is an important prognostic factor in patients with lymph node-negative patients with invasive breast cancer. However, the prognostic value of LVI it is unclear and controversial about its prognostic value in patients with lymph node-positive breast cancer patients. So, we report the an analysis of the prognostic significance of LVI in a large cohort study of patients with lymph node-positive patients with invasive breast cancer. METHODS: We retrospectively reviewed 967 patients with invasive breast cancer that had undergone surgical treatment at our hospital, from January 2004 to December 2007. Among these thempatients, 349 patients with lymph node-positive breast cancer patients are were included in this study. We evaluated clinical and pathological data in these patients, we compared with 5-year overall survival and disease-free survival between an LVI-present group and an LVI-absent group. RESULTS: The median follow-up was 48 months (range, 12-78 months), and the mean age of the patients was 48 years (range, 23-78 years). LVI was present in 192 patients (55%) of with tumors and was associated with age ≤40 years (p=0.009), high histologichistological grade (p=0.007), estrogen receptor status (p=0.001), tumor size ≥2 cm (p<0.001), and number of involved lymph nodes (p<0.001), but not with progesterone receptor status, HER2 status, p53 status, or tumor multiplicity. LVI was a significant independent prognostic factor for disease-free survival (p<0.001) and overall survival (p=0.006). By multivariate analysis revealed that LVI (p=0.003), number of involved lymph nodes (≥4; p=0.005), and high histological grade (II and III; p=0.02) was were an independent significant predictors of disease-free survival and overall survival in the whole group of patients. CONCLUSION: In this case, we demonstrated that LVI is a significant predictor of poor prognosis in patients with lymph node-positive patients with primary invasive breast cancer, LVI is a significant predictive predictor value of poor prognosis. So, LVI should be considered in the therapeutic strategy as a decision making tool in the adjuvant chemotherapy setting.

Primary papillary carcinoma originated from a branchial cleft cyst.

Although branchial cleft cysts are common, papillary carcinomas arising from them are rare. Here we report a 41-year-old woman with papillary carcinoma originating from a right lateral branchial cleft cyst without any evidence of a papillary carcinoma in the thyroid gland. The patient underwent right lateral neck dissection followed by total thyroidectomy. We then confirmed papillary carcinoma arising from the branchial cleft cyst through microscopic and immunohistochemical staining with thyroglobulin (TG), thyroid-associated transcription factor-1 (TTF-1) and p63. It is the 10th case worldwide describing papillary carcinoma in a branchial cleft cyst with a review of the literature on the features of the disease and discussion of the role of immunohistochemical staining with TG, TTF -1 and p63. In conclusion, it should be emphasized that the surgeon must be cautioned of the possibility of primary papillary carcinoma in the branchial cleft cyst.

Analysis of infections occurring in breast cancer patients after breast conserving surgery using mesh.

PURPOSE: Breast conserving surgery using mesh can effectively fill the defective space, but there is the risk of infection. METHODS: From June 2007 to August 2010, 243 patients who underwent breast conserving surgery with polyglactin 910 mesh insert for breast cancer at our institution were retrospectively studied. RESULTS: Infection occurred in 25 (10.3%) of 243 patients. When comparing the infection and non-infection groups in multivariate analysis, there was no significant difference in age, underlying disease, preoperative biopsy methods, mass location, axillary lymph node dissection, operative methods, neoadjuvant or adjuvant chemotherapy use, mass size and removed breast volume. The infection appeared more common only in patients with body mass index (BMI) greater than 25. Infection symptoms occurred, on average, 119.5 days after surgery, and the average duration of the required treatment was 34.4 days. Out of 25 patients with postoperative infection complications, 16 (64%) patients underwent incision and drainage with mesh removal, whereas the remaining 9 (36%) only required conservative treatment. CONCLUSION: During breast conserving surgery, the risk of infection is increased in patients with high BMI, and should be taken into account when considering insertion of a polyglactin 910 mesh. Patient's age, underlying disease and perioperative treatment methods were not significant risk factors for developing mesh infection. Given that most infections seem to develop symptoms one month after surgery, a long enough observation period should be initiated. Early detection and appropriate conservative treatments may effectively address infections, thus reducing the need for more invasive therapies.