Can be Seroma a normal event in Breast Surgery? Analysis from Survey in Plastic Surgery Safety Conference

Introduction: Merkel Cell Carcinoma (MCC) is a rare and aggressive neuroendocrine tumor of the skin. The main characteristics are frequent local recurrences and disseminations to regional lymph nodes and distant organs. MCC within the lymph nodes in the absence of a primary site is rare and few cases have been reported by the literature.

Case Report: We report a case of MCC presenting as a painless mass in the left inguinal area for 6 months in a 48-year-old women. The histopathology of the excised lesion revealed a poorly differentiated basophilic small cell tumor. The immunohistochemical study finding the diagnosis of a metastatic MCC. Despite extensive clinical and radiological investigation, we failed to identify the origin of the tumor.

Conclusion: Rare cases of MCC confined to a lymph node without an apparent primary site have been reported. We report a new case of MCC in the inguinal lymph node without identification of the primary site.

Background: The US Preventive Services Task Force (USPSTF) recommends screening for smokers based on age, pack-years of smoking, and years since past smokers quit (quit-time). Previous studies determined low dose computerized tomography (LDCT) to be the best method, but have not identified the population at highest risk. This study sought the percentage of lung cancer patients that would have been excluded by USPSTF criteria.

Method: A retrospective chart review identified 170past and present smokers who had undergone lung cancer resection at Hackensack Meridian Health (HMH) hospitals between September 15, 2014 and 2016. Data was collected from the Society of Thoracic Surgeons database. Descriptive statistics and Wilcoxon Rank-Sum tests were used to analyze differences between included and excluded patients.

Results: The percentage of patients that would have been excluded by screening criteria was 46.5% (95% CI: 38.8-54.3%). The difference between ages of included and excluded patients was not quite significant (p=0.051), with only17.1% (95% CI: 11.7-23.6%) of all patients excluded by age. Pack-years of included patients were significantly higher than of the excluded (p<0.001), and 25.3% (95% CI: 18.9-32.6%) had insufficient pack years. Quit-time was also a significant variable (p<0.001) and excluded 37.9% (95% CI: 29.1-49.4%) of past smokers. The percentage included by USPSTF criteria increased from 53.5% to 59.4% when quit-time was set to 25 years, and61.2% when extended to 30 years.

Conclusion: USPSTF criteria would have excluded almost half of the ever-smokers with surgically resectable lung cancers. Age would not have excluded a significant percentage, but inclusion criteria should account for smokers with less than 30 pack-years or who quit over 15 years ago. Future reviews should examine screening efficacy in larger databases. Prospective studies should investigate correlation between age and smoking history, and look to include secondhand smoking and occupational exposure as risk factors for screening.

Thyroglobulin levels ≥50 μg/L following thyroidectomy and I131 ablation correlate with poor prognosis in patients with high risk Differentiated Thyroid Cancer (DTC). We describe a case of a 54 year old woman with differentiated thyroid cancer and high thyroglobulin up to 220 μg/L following thyroidectomy and I131 ablation who demonstrated marked response to a novel immunotherapy involving autologous tumor cell transfected with a GMCSF/bi-shRNA furin expressive plasmid (Vigil). Activity is highlighted by four year disease free survival in correlation with immune activation as measured by ELISPOT assay of peripheral blood mononuclear cell reaction to autologous tumor. Further investigation with Vigil in differentiated thyroid cancer is warranted.

In spite of the good organ preservation strategies available for locally advanced Head and Neck Squamous Cell Carcinoma (HNSCC), failure rates have been reported to be as high as 35-50%. There has been an increasing interest in predicting response to treatment, to aid early intervention and better outcomes. FDG-PET is a standard modality for post treatment evaluation, however it is still under utilized as a pre-treatment investigative modality. Several articles have described quantitative parameters in pre-treatment FDG-PET to prognosticate patients and determine likelihood of response to treatment however they are still not used commonly. This article was a review of the literature available on pre-treatment FDG PET quantitative parameters and their value in predicting failure. A thorough review of literature from MEDLINE and EMBASE was performed on pre treatment quantitative parameters in HNSCC. Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) were reliable parameters to predict response to organ preservation therapy, disease free and overall survival. SUVmax was an inconsistent parameter. MTV and TLG may help predict poor response to organ preservation to initiate early surgical salvage or modify therapeutic decisions to optimize clinical outcomes. Routine incorporation into PET reporting may provide additional information over SUVmax alone.

Introduction: Gallbladder carcinoma is the most frequent tumor of the bile system and has a poor prognosis. The main proportion of tumors diagnosed coincidentally after gallbladder removal for various reasons. In these cases, an incomplete removal of the tumors occurs frequently. The adequate treatment of these patients is still under discussion. We present our experience with different procedures.

Patients and Methods: Between 1990 and 2015, we identified 20 patients which were presented at our University Hospital after incomplete removal of gallbladder cancer (R1, R2, RX) as incidental findings after cholecystectomy. The prospectively collected data including surgery, adjuvant treatment, histopathological examinations of the specimens and follow-up data were analyzed retrospectively.

Results: The median age of patients was 72 years (range 47-89 years), 90 % (18/20) were female. The median follow-up period was 10 months (range 0-109 months). The median survival of all patients was 11 months (95 % confidence interval: 5-17 months). The median survival of patients who received staged surgery and chemo radiation after incomplete gallbladder removal was significantly increased (median 32 months; range 4-109 months) vs. patients who received chemo radiation without surgery (median 13 months; range 8-51 months) or chemotherapy alone (median 2.5 months (range 0-40 months)) (p = 0.005).

Discussion: There is no standardized treatment for residual tumor after incomplete gallbladder cancer resection. Our data demonstrate that staged surgery with prior chemo radiation may improve patient´s outcome. Surgery can be performed with low morbidity and mortality.

Introduction: Hyperthermic Isolated Limb Perfusion (HILP) is a surgical procedure for the regional delivery of heat and high doses of chemotherapy and biologic agents to the extremity. The procedure is employed as a limb salvage technique for locally advanced primary malignancies or recurrent cancers that are unresectable and confined to the extremity

Methods: From 1987-2016, 247 patients with unresectable recurrent melanoma (95%), sarcoma or Merkel Cell Carcinoma underwent HILP for limb salvage of the affected extremity after staging was negative for Stage IV disease and disease was confirmed to be confined to the extremity.

Results: All patients had limb salvage with this protocol. All patients were clinically negative in their regional basin at the time of perfusion, although 40% of the patients had evidence of regional nodal disease following nodal dissections. Immediate responses (within 3 months) on the extremity to the HILP were as follows: complete response (CR) of 66%, partial response (PR) of 20%, 10% stable disease and 4% progressive disease. With a mean follow-up period of 5 years, 61.5% of the patients have recurred with 68.4% of the recurrences being systemic, 21% regional nodal, 7.2% in-transit and 3.3% local-regional soft tissue.

Conclusions: HILP is an effective strategy for limb salvage in patients with unresectable, locally advanced cancers confined to the extremity. The treatment was associated with a high rate of complete responses on the extremity. Most patients recurred with distant metastases emphasizing the need for better systemic therapies for these malignancies.

Synopsis: Patients with recurrent, unresectable melanoma, other cutaneous malignancies and sarcoma confined to an extremity are problematic for clinicians since recurrence rates show that most will have occult systemic disease. An aggressive amputation approach does not make sense and the fact that these patients have active disease makes them ineligible for approved adjuvant therapies. In addition since their clinically apparent active disease is confined to the local/regional soft tissues making them Stage 3 disease, they are not eligible for Stage IV protocols. In these situations Hyperthermic Isolated Limb Perfusion (HILP) effectively treats the extremity with high response rates and a 100% limb salvage rate.

Background and purpose: Wide resection in pelvis delivers important drawbacks not only physically but also mentally lowering the functional status and self-related quality of life (SRQL) of these patients. Our aim is to show functional results and SRQL in patients with wide resections in pelvis due to musculoskeletal tumours.

Patients and Methods: It is a retrospective study in patients with wide resections in pelvis due to musculoskeletal tumours and we focus on: demographical data, preoperative and pathology studies, type of resection and reconstruction, functional results (MSTS score) and SRQL (SF-12). We have performed 15 external hemipelvectomies (EH), 57 internal hemipelvectomies with pelvic ring stability reconstruction (IHPR), 10 internal hemipelvectomies without reconstruction of the pelvic stability (IHWR). There were 10 patients with soft tissue sarcomas and benign but aggressive tumours that we do not include in the study as they did not need hemipelvectomy.

Results: We found there is a tendency to better functional results in IHPR, though it shows no statistical differences between the three types of reconstruction. According to SRQL we observed light score loss in mental status related to general population. On the other hand, physical status showed strong score deviation from general population. Functional results seem to be similar to literature.

Interpretation: The severe loss of function and physical status in these patients underline the type reconstruction and avoiding complications as critical steps. The light score deviation in mental status may represent an adaptive pattern and social support of patients with this severe disease and its complications.

Alveolar soft part sarcoma (ASPS) is a rare neoplasm occurring most frequently in the soft tissues of both children and adults, which has a tendency for an indolent course and late metastasis. It is characterized by an unbalanced translocation, der(17)t(X:17)(p11;p25), producing a fusion protein which has recently been shown to play a role in promoting cell proliferation and angiogenesis and may provide a potential target for molecular therapy. We present a case of ASPS and discuss the histology, diagnostic considerations, cytogenetics, treatment, and prognosis.

Development of a second primary cancer in patients under follow-up because of metastasis is rare. We presented a 58-year-old man with neuroendocrine cancer of vater ampulla and distal common bile duct as a second primary cancer. The patient had been diagnosed with rectal adenocarcinoma and lung metastasis who underwent total mesorectal excision, lung lobectomy, and adjuvant therapy with an interval of 5 years. This article emphasizes on the importance of early detection of second primary cancer and treating it as the primary one

Chordomas are rare, malignant bone tumors with a typically unfavorable prognosis that develop slowly and aggressively along the skull base and axial skeleton from remnants of the primitive notochord. Grossly, chordomas classically present as lobular nodules with thick fibrous tissue; histologically, those fibrous tissues can be seen separating chords of tumor cells in a myxoid stroma. Its characteristic local aggressiveness and indolent growth makes timely detection difficult and local recurrence likely, especially since surgical resection and radiation are the only affective treatment options. Local recurrence currently serves as a significant predictor of metastatic progression which most commonly involves the lungs, liver, bone, and lymph nodes. We report a case of metastatic chordoma to the lung, and discuss the diagnostic features, differential diagnosis, molecular changes, treatment, and prognosis.