Factors predicting the non-sentinel lymph node involvement in breast cancer patients with sentinel lymph node metastases

ObjectiveIn a significant proportion of patients, the sentinel lymph node (SLN) is the only involved axillary node. The goal of the present study was to identify predictive factors associated with a positive SLN and with a positive non-SLN in patients in whom axillary lymph node dissection (ALND) was performed.MethodsData was reviewed for patients with T1–2 invasive breast cancer who underwent SLN biopsy with or without axillary dissection in a single institution between July 2000 and May 2010. The SLNs were examined by serial sectioning and H&;E staining, and by cytokeratin immunostaining in suspicious cases.ResultsOf 332 patients with SLNB, 134 had SLN positivity, and 116 of them further underwent completion axillary dissection. Patients with T2 tumors (OR = 3.2; 95% CI, 1.74–5.58), or tumors with lymphovascular invasion (OR = 8.0; 95% CI, 4.44–14.27), or invasive ductal cancer (OR = 2.92; 95% CI, 1.1–8.0) were more likely to have a positive SLN. In patients with ALND, the non-SLN involvement rates were 10%, 11.5% and 50% in patients with isolated tumor cells (ITC), micrometastasis and macrometastasis, respectively. Finding of ITC or micrometastasis in SLNs (OR = 0.28; 95% CI, 0.08–0.99) or presence of extracapsular invasion (ECI) in SLN (OR = 0.24; 95% CI, 0.09–0.67) were the predictive factors of not having a non-SLN metastasis in logistic regression analysis.ConclusionsThese findings suggest further axillary surgery can be best omitted in patients with micrometastasis while validation of nomograms including factors such as ECI are still needed to be studied in patients with macrometastasis.     

Metachronous mediastinal lymph node metastasis from ascending colon cancer: A case report and literature review

IntroductionMetachronous mediastinal lymph node metastasis without pulmonary metastasis is extremely rare in colorectal cancer, which makes the clinical diagnosis difficult and treatment strategy unclear.Prsentation of caseA case was a 59-year-old man, who had undergone right hemicolectomy for ascending colon cancer 2 years and 8 months previously, presented with enlarged mediastinal lymph nodes. ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography revealed FDG was accumulated only into the mediastinal lymph nodes. Serum carcinoembryonic antigen (CEA) level was within the normal range. Six months later, the size and FDG uptake of the mediastinal lymph nodes had increased. We assumed a possibility that the mediastinal lymph nodes were metastasized from ascending colon cancer and so performed thoracoscopic-assisted resection of the mediastinal lymph nodes. Histopathological analysis revealed the resected lymph nodes were filled with moderately differentiated adenocarcinoma and a diagnosis of mediastinal lymph nodes metastasis from previously-resected ascending colon cancer was made. The patient was postoperatively followed for more than 1 year and 8 months without any sign of recurrence.DiscussionOnly 7 cases of metachronous mediastinal lymph node metastasis from colorectal cancer, including our case, have been reported in the English literature. It is difficult to clinically diagnose mediastinal lymph node metastasis.ConclusionWe report a rare case of metachronous mediastinal lymph node metastasis from ascending colon cancer with literature review. If the mediastinal lymph nodes are enlarged after colorectal cancer resection, we need to make a treatment strategy as well as a diagnostic approach considering the possibility of mediastinal lymph node metastasis.     

Solitary mediastinal lymph node recurrence after curative resection of colon cancer

We report two cases of solitary mediastinal lymph node recurrence after colon cancer resection. Both cases had para-aortic lymph node metastasis at the time of initial surgery and received adjuvant chemotherapy for 4 years in case 1 and 18 mo in case 2. The time to recurrence was more than 8 years in both cases. After resection of the recurrent tumor, the patient is doing well with no recurrence for 6 years in case 1 and 4 mo in case 2. Patients should be followed up after colon cancer surgery considering the possibility of solitary mediastinal lymph node recurrence if they had para-aortic node metastasis at the time of initial surgery.     

Evaluation of HER2/neu oncoprotein in serum and tissue samples of women with breast cancer: Correlation with clinicopathological parameters

BackgroundHER2/neu (HER2) is a proto-oncogen of the EGF Receptor family. The assessment of serum HER2 level is useful for predicting the patients’ response to chemotherapy or hormonal therapy and selection of proper patients for treatment with Herceptin.We aimed to compare serum HER2 levels with immunohistochemistry in tumoral tissues and investigate correlation between these levels and various prognostic factors.Materials and methodsThis cross-sectional study was conducted on 75 patients with breast carcinoma referred to surgical ward of Mashhad Imam Reza’s hospital from November 2008 to February 2009. Pre-operative serum samples were collected and stored in ?20 °C.Surgical samples were investigated for the type of carcinoma, tumor size, lymph node metastasis, stage as well as grade of the tumor. Tissue HER2 over-expression was evaluated by immunohistochemistry (IHC) staining and HER2 levels were studied by ELISA method. Statistical analysis was performed by SPSS software.ResultsSerum HER2 cut-off level was 18.4 ng/ml; 46.7% of patients were serum HER2-positive and 43% were IHC positive. There was a high statistical correlation between these two parameters (P = 0.018).Statistically, there was no significant correlation between serum HER2 and age, tumor size, stage, grade and metastatic lymph nodes (P > 0.05).ConclusionSerum HER2 level assay can be considered as a complementary method besides tissue methods.     

High-resolution ultrasonographic features of axillary lymph node metastasis in patients with breast cancer

To determine ultrasound (US) features that most accurately predict the presence of axillary lymph node metastasis, we retrospectively analysed the results of preoperative US breast examinations of axillary lymph nodes in 425 consecutive patients who subsequently underwent surgery for invasive breast cancer. We compared the US findings with pathologic results for axillary lymph node metastasis. US features included length of the longest (L) and shortest (S) axes, L/S ratio, cortical thickness, presence of hilum and shape. The results of multivariate logistic regression analysis revealed that cortical thickness greater than 3 mm was the most accurate indicator, with 4.14 times increased risk of the presence of an axillary lymph node metastasis as compared to cortical thickness less than 3 mm. The absence of a hilum showed the highest specificity for axillary lymph node metastasis (94.6%), but low sensitivity.     

Patient age and positive margins are predictive factors of residual tumor on mastectomy specimen after conservative treatment for breast cancer

AimsTo determine factors predictive of the presence of residual tumor on the specimen from mastectomy performed after conservative treatment for breast cancer in order to limit potentially unnecessary mastectomies (free of residual lesions).Materials and methods294 patients treated in 2 expert centers for breast cancer with breast-conserving therapy (BCT) followed by mastectomy, according to French recommendations, were investigated between January 1, 1998 and January 1, 2005. Patients with residual tumor on the mastectomy specimen were compared with patients whose mastectomy specimens did not reveal any residual tumor. All the clinical risk factors (age, previous history of breast cancer, tumor focality) and histological risk factors (tumor size, histological type, positive margins, estrogen and progesterone receptor expression, histological grade) for residual tumor after BCT were compared between the 2 patient groups.ResultsOf the 294 patients studied, 202 (68.71%) mastectomies had residual tumor and 92 (31.29%) were tumor-free. Four predictive factors for residual tumor were found in the univariate analysis: age under 45 years (p = 0.01), absence of estrogen receptor expression (p = 0.05), positive margins (p = 0.01), and presence of lymph node metastases (p = 0.05). The multivariate analysis revealed only 2 independent risk factors that were significantly associated with increased risk of residual tumor on the mastectomy specimen: age under 45 years (p = 0.05) and presence of positive margins on the lumpectomy specimen (p = 0.05).ConclusionYoung age of patients (under 45-years-old) and presence of positive margins on the operative specimen are independent risk factors of residual tumor after conservative treatment of breast cancer.     

Merkel cell carcinoma in pelvic lymph nodes after surgical staging for endometrial cancer: A case report and review of the literature

INTRODUCTIONMerkel cell carcinoma (MCC) is a rare malignant neuroendocrine tumor of the skin.PRESENTATION OF CASEWe present a case of MCC in pelvic lymph nodes, revealed after surgical staging for endometrial cancer. A 54-year-old Caucasian woman presented to our department with a three-month history of postmenopausal bleeding. After proper preoperative evaluation, the patient underwent total abdominal hysterectomy, bilateral salpingo-ophorectomy and pelvic lymph node dissection. The pathology report confirmed the presence of a small, grade I, endometrioid adenocarcinoma and MCC in the pelvic lymph nodes. Primary site of the disease could not been retrieved. The tumor board decided adjuvant chemotherapy (carboplatin and etoposide) and close follow-up every 2 months. Our patient is alive with no evidence of disease 12 months after surgery.DISCUSSIONIt is noteworthy that 19% of the patients with MCC had lymph node metastasis with no apparent primary lesion. The mechanism of this regression remains unclear, although a higher apoptotic activity has been observed in MCC than other skin tumors. In addition, other co-malignancies have also been linked to MCC patients. The explanation for the frequent occurrence of other primary neoplasms in patients with MCC is still unclear. However, a reasonable cause could be an altered genetic profile or an immuno-compromised situation in these patients.CONCLUSIONFurther analytic investigations are needed to clarify the role of various factors in the spontaneous regression or not of this neuroendocrine tumor as well as in the simultaneous genesis of other primary carcinomas.     

Contralateral ureteral metastasis 4 years after radical nephrectomy

IntroductionMetastasis of renal cell carcinoma to the contralateral ureter is extremely rare. To date, only 50 cases of metastatic RCC to the ureter have been reported, among whom 6 cases occur at the contralateral site. We herein report a rare case of metastatic RCC in the contralateral ureter 4 years after radical nephrectomy.Presentation of caseA 74-year-old man presented with gross, painless hematuria for one month. Computed tomography scan confirmed that a 1.5 cm × 0.5 cm tumor occurred in the contralateral distal ureter. A 3.5 cm segment of ureter was resected and a uretero-vesical anastomosis with psoas hitch was accomplished.DiscussionThe reappearance of hematuria after radical nephrectomy is the most common manifestation of the metastasis to the bladder or ureter. The mechanism of metastasis is not clear. In pathology, vimentin and cytokeratins might help to differentiate between metastatic clear cell renal cell carcinoma and clear cell transitional cell carcinoma.ConclusionMetastasis of renal cell carcinoma to the contralateral ureter is rare. Early recognition is extremely important in protecting the remaining renal function and prolonging life-expectancy for post-nephrectomy patients. Complete metastectomy suitable anastomosis have been shown to improve survival.     

Bone mineral density change: comparison between prostate cancer patients with or without metastases and healthy men (a North African ethnic group)

AimTo evaluate total body bone mineral density and regional bone mineral density in patients with prostate cancer with and without metastases, and to correlate them with bone scintigraphy findings.Patients and Methods135 patients with prostatic carcinoma and 50 healthy subjects were investigated with bone scintigraphy and dual-energy X-ray absorptiometry. The bone scintigraphic findings were classified as normal (score 0: n = 55), abnormal but not typical for metastases (score 1: n = 45), and typical pattern of metastases (score 2: n = 35).Results: The patients with bone metastases prostate cancer had significantly higher total bone minera1 density and regional bone mineral density of trunk and pelvis than healthy controls and prostate cancer patients without bone metastases. There was a significant positive correlation between bone scan score and total bone mineral density and regional bone mineral density of trunk and pelvis (r = 0.328; P < 0.05; r = 0.60; P < 0.001; r = 0.480; P < 0.001, respectively).ConclusionBone metastasis is a major cause of morbidity in prostatic cancer, bone loss during hormonal treatment is currently effective. Our results show that patients of prostate cancer with bone metastases have increased bone mineral density (BMD) in the pelvis and trunk, possibly because of a predominance of osteoblastic over osteolytic metastases demonstrated by ^99mTc MDP bone scan.     

Impacto de la obesidad en las características anatomopatológicas de los tumores colorrectales. Estudio observacional

BackgroundTo asses the influence of body mass index on the tumour characteristics of patients subjected to colorectal cancer surgery.Materials and methodsRetrospective observational study. Patients subjected to curative elective colorectal cancer surgery at Hospital Josep Trueta de Girona (Spain), from 1990 to 2001.Univariate and bivariate analyses were performed to evaluate differences in tumour characteristics with regard to body mass index.ResultsA total of 369 patients with colorectal cancer were included into the study, 213 (57.7%) with colon cancer, and 156 (42.3%) with rectal cancer. For colon cancer patients, when the BMI was higher than 25 kg/m², the tumour grade was worst (P=0.011), and when BMI was above 30 kg/m² there were more lymph node metastasis. For rectal tumours, the higher the BMI, the more lymph node metastasis (P=0.041), and higher tumour stage (P=0.023).ConclusionsPatients with a higher BMI have more lymph node metastasis when submitted to elective colorectal cancer surgery. In the case of colon cancer they also have worst tumour grades, and in the case of rectal cancer, a more advanced tumour stage.     

Computed tomography of the parathyroids: the value of density measurements to distinguish between parathyroid adenomas of the lymph nodes and the thyroid parenchyma

PurposeTo compare the densities of parathyroid adenomas, lymph nodes and the thyroid parenchyma during multi-phase cervico-thoracic computed tomography to determine the differentiating threshold values.Materials and methodsThis study comprises 30 patients operated for a parathyroid adenoma after computed tomography without injection and then 45 and 70 seconds after the injection of an iodine based contrast product (350 mgI/mL, 150 mL, 3 mL/s). The density of the adenomas, lymph nodes and thyroid was measured during the three phases (D0, D45, D70). The relative enhancement (RE) at 45 seconds was calculated: RE = (D45 – D0) / D0.ResultsA significant difference was found in the spontaneous density of the parathyroid adenomas of the thyroid (P < 0.01) with a threshold value of 75 HU. A significant difference is found in the enhancement after injection of the adenomas and lymph nodes (P < 0.01). The adenomas present an enhancement peak at 45 seconds while the maximum enhancement of the lymph nodes is at 70 seconds. At 45 seconds, a threshold value of 114 HU and an RE 125% allows them to be distinguished (sensitivity and specificity 0.96).ConclusionMeasurement of the densities can differentiate between the parathyroid adenomas, lymph nodes and thyroid.     

A case of long-term survival after pulmonary resection for metachronous pulmonary metastasis of basaloid squamous cell carcinoma of the esophagus

INTRODUCTIONBasaloid squamous cell carcinoma of the esophagus (BSCE) is a rare malignancy among esophageal cancers. We reported a case of 63-year-old woman with metachronous pulmonary metastasis of BSCE, successfully treated by metastasectomy of the left lung.PRESENTATION OF CASEBiopsy specimens of upper gastrointestinal fiberscopy led to diagnosis of poorly differentiated squamous cell carcinoma of the esophagus. Computed tomography revealed metastatic lymph nodes surrounding the bilateral recurrent laryngeal nerve and no evidence of metastasis to distant organs. Curative esophagectomy with three-field lymph node dissection was performed through thoracoscopic approach. Pathological examination of the resected specimens led to diagnosis of BSCE with invasion into the submucosal layer of the esophageal wall. Two years later, a solitary oval-shaped pulmonary lesion of approximately 10 mm was detected in the left lung. Wedge resection of the left upper lobe was performed via thoracoscopic approach. The postoperative course was uneventful. Histologically, the pulmonary lesion was diagnosed as metastatic BSCE. Follow-up indicated no recurrence 9 years after the initial surgery.DISCUSSIONSurgical intervention was acceptable on this case of solitary pulmonary metastasis. However, data are lacking about the efficacy of pulmonary resection for metachronous pulmonary metastasis of BSCE because the postoperative outcome is usually poor. The efficacy of surgical intervention for metastatic lesions of BSCE is debatable and requires further examination.CONCLUSIONAlthough the usefulness of surgical intervention for metastatic lesions from BSCE is controversial, the patients with metachronous solitary metastasis to the lung and without extrapulmonary metastasis would be good candidate for pulmonary resection.     

Malign cylindroma of the scalp with multiple cervical lymph node metastasis—A case report

INTRODUCTIONCylindromas are usually benign tumors as small, solitary, slow-growing nodules of the scalp, face and trunk. Multiple cylindromas may form a “turban tumors” in the autosomal dominant Brooke–Spiegler syndrome. Malignant dermal cylindromas are very rare. There are few cases of malignant transformation of dermal cylindromas in the literature. We present an unusual case of malign cylindroma of the scalp with multiple metastasis to cervical lymph nodules and also this case is the only case that has the most lymph node metastasis.PRESENTATION OF CASEA 52-year-old man initially presented to our clinic with hyperemic plaque located on his scalp. Measures of the plaque was 20 cm × 10 cm with bilateral, multiple palpable submandibulary lymph nodes. Entire scalp was removed reaching in depth the periostal level and bilateral modified radical neck dissection was performed. The histopathological examination of the scalp specimen was malignant skin ecrine tumor, cylindroma and on the neck dissection specimen, 55 lymph nodes were reported as metastatic out of 79. The patient was treated with chemotherapy and radiotherapy. No recurrence or metastasis was observed during a 5 year follow-up period.DISCUSSIONMalign cylindroma of the scalp rarely presents with multiple cervical lymph node metastasis, however it is important to be aware of this possibility.CONCLUSIONThe case reported below is outstanding in literature for being the only case that has the most lymph node metastasis. Although malign transformation of dermal cylindromas is rare, aggressive surgery should be considered with locoregional metastasis of the tumor.     

Lymphatic mapping after previous breast surgery

BackgroundTo assess the feasibility of lymphatic mapping and determine the lymphatic drainage pathways in patients previously treated with breast conserving therapy (BCT).MethodsWe included patients without current breast cancer that previously received BCT with sentinel node biopsy (SNB) and/or axillary lymph node dissection (ALND) for primary breast cancer. The study population consisted of 44 patients and was divided into two groups according to previous surgical treatment of the axilla: 22 patients after previous SNB and 22 patients after previous ALND. Standard lymphatic mapping was performed and the lymphatic drainage pattern was registered. Drainage located outside the ipsilateral axilla was recorded as aberrant.ResultsLymphoscintigraphy revealed a drainage pattern in 17 of 44 patients (39%). The identification rate in the SNB-group was 41% and 36% in the ALND-group (P = 0.760). 8 patients (18%) showed aberrant drainage, which tended to be more frequent in the ALND-group than in the SNB-group (27% versus 9%, P = 0.122). Lymphatic drainage to the contralateral axilla was observed in 2 patients, both previously treated with ALND.ConclusionsLymphatic mapping seems feasible after previous BCT with axillary treatment, in spite of a relatively low identification rate. Aberrant drainage tends to be more frequent after previous treatment with ALND.     

La relación albúmina/globulina preoperatoria como factor pronóstico en pacientes con cáncer testicular

Introduction and objectivesIn recent years, the incidence of testicular cancer has increased, but mortality rates have decreased thanks to the improvements in treatment. Although primary tumor characteristics and serum tumor markers are associated with metastasis and relapse, their predictive value is not reliable. Therefore, there is a need for new biomarkers that predict prognosis. In this study, we aimed to investigate the role of preoperative albumin to globulin ratio (AGR) in predicting retroperitoneal lymph node (RPLN) involvement, distant metastasis and prognosis in testicular cancer.Material and methodsWe retrospectively analyzed the medical records of all patients that underwent radical inguinal orchiectomy at our hospital between 2007 and 2018. AGR was calculated using the equation: AGR = serum albumin / (serum total protein − serum albumin). The predictive value of AGR for RPLN involvement and distant metastasis was evaluated using receiver operating characteristic analysis and its prognostic value was evaluated using Kaplan-Meier survival analysis.ResultsA total of 115 patients with a mean age of 33.4 ± 7.7 years were included in the study. In multivariate analysis, AGR less than 1.47 and the presence of lymphovascular invasion were detected as the factors predicting RPLN involvement and distant metastasis. The AGR of patients who had died was significantly lower than AGR of those who were alive, 1 ± 0.2 versus 1.6 ± 0.3 (P = .001). In Kaplan-Meier survival analysis, the mean survival of patients with higher AGR (> 1.47) was found longer than patients with lower AGR (< 1.47).ConclusionsPreoperative AGR is a biomarker that may be used in predicting RPLN involvement, distant metastasis and prognosis in testicular cancer.     

Glycogen Rich Clear Cell Carcinoma (GRCC) of the breast may not have a poor prognosis

IntroductionGlycogen Rich Clear Cell Carcinoma (GRCC) is a rare variant of breast carcinomas and believed to be linked with a poor prognosis.Case summaryWe are presenting a 60-year-old Saudi lady with a 2 cm GRCC carcinoma associated with clear cell ductal carcinoma in situ (DCIS) and no axillary lymph node involvement. The tumor was Estrogen and Progesterone receptors (ER & PR) positive and HER 2-neu negative. She underwent mastectomy with sentinel lymph node biopsy followed by hormonal therapy. She is alive and free of disease for 35 months.ConclusionThe prognosis of GRCC may not be different from other types of invasive breast cancer.     

Analysis of radiation exposure to the orthopaedic trauma patient during their inpatient hospitalisation

PurposeThere has been considerable concern regarding radiation exposure to both the patient and treating surgeon and the possible risk of resulting malignancy. We sought to analyse the total effective dose of radiation that a cohort of orthopaedic trauma patients are exposed to during their inpatient hospitalisation and determine risk factors for greater exposure levels.MethodsFollowing approval from the Institution Review Board, a search was conducted of a level I trauma centre database for radiation exposures to patients over a 1 year period. Patients were included if they had an ICD-9 code from 805 to 828, indicating a fracture involving the trunk (805–811) or extremities (812–828). We compared the total effective radiation dose in various injury patterns as well as those considered to be polytrauma patients to those who were not according to their injury severity score (ISS).ResultsThe records of 1357 trauma patients were available for review. The average patient age was 40.6 years and the mean ISS was 14.1. The average effective radiation dose for all patients during their hospitalisation was 31.6 mSv. There was a statistically significant difference in radiation exposure between patients with an ISS greater than 16 (48.6 mSv) versus those with an ISS equal to or less than 16 (23.5 mSv), p < 0.001. Patients with spine trauma can be expected to get more than 15 mSv more radiation than non-spine patients, p < 0.001. Extremity injuries received the least amount of radiation, spine only patients were next, then finally spine and extremity injury patients had the greatest exposures. Having a spine fracture, a pelvic fracture, a chest wall injury, or a long bone fracture were all risk factors for having more than 20 mSv of effective dose exposure. Patients under the age of 18 years did receive less radiation than the remainder of the cohort, p < 0.001.ConclusionsThe average orthopaedic patient receives a total effective radiation dose of more than 30 mSv, much greater than is considered acceptable as a recommended permissible annual dose by the International Commission on Radiological Protection (20 mSv). These findings indicate that the average trauma patient (in particular those with polytrauma or fractures involving the spine, pelvis, chest wall, or long bones) is exposed to high levels of radiation during their inpatient hospitalisation. The treating physicians of such patients should take into consideration the large amounts of radiation their patients receive just during their initial hospitalisation, and be prudent with the ordering of imaging studies involving radiation exposure.     

Gastric carcinoma with osteoblastic differentiation

INTRODUCTIONCarcinosarcoma is a rare malignant biphasic tumor which has sarcomatous and carcinomatous components. Stomach localization is very rare. We discuss the diagnosis, follow-up and treatment of patients diagnosed with gastric carcinosarcoma in company with the literature review.PRESENTATION OF CASEA 73-year-old white male patient applied to hospital with dyspeptic complaints lasting for 2 months. His endoscopic examination revealed an ulcero-vegetating mass in the cardiac region of his stomach. Total gastrectomy and D2 lymph node dissection were performed for the patient. In the pathologic evaluation, the tumor was found consistent with Stage IIA stomach adenocarcinoma in accordance with AJCC (7edt, 2010) classification. Pathologic specimen was reevaluated by an expert pathologist for the patient with progression and liver metastasis under adjuvant chemotherapy and concomitant radiotherapy. The new pathology was consistent with gastric carcinosarcoma, and 90% of the tumor was identified as osteosarcoma whereas 10% was identified as carcinoma. Cisplatin doxorubicine-based chemotherapy was given considering the fact that sarcomatous component was dominant.¹ The patient was given 3 courses of chemotherapy. However, as the patient showed progression under therapy, he died after 14 months of the diagnosis.DISCUSSIONGastric carcinosarcoma is a very rare and clinically aggressive malignancy. Recurrence is likely to occur with a rate of more than 50% in patients who have undergone resection within the first year following surgery, and overall survival time is 10–15 months.CONCLUSIONIn refractory gastric carcinoma cases with rapid progression, we suggest that gastric carcinosarcoma with biphasic component should be taken into consideration and the pathological evaluation should be performed by an expert pathologist.     

Invasive micropapillary carcinoma of the breast in a male patient: Report of a case

INTRODUCTIONWe report a rare case of invasive micropapillary carcinoma in the male breast.PRESENTATION OF CASEA 63-year-old man was referred to our hospital for investigation of a left breast tumor, which could be palpated in the upper lateral quadrant of the left nipple-areola complex. The tumor invaded the areola skin. Ultrasonography showed a 14.8 × 15.0 × 12.4 mm low echoic mass, with an irregular lobulated border. Core needle biopsy indicated invasive ductal carcinoma, but the subtype could not be accurately determined. Mastectomy with axillary lymph node dissection was performed. Pathological examination indicated invasive micropapillary carcinoma, no lymph node metastasis, and a nuclear grade of 2. Immunohistochemical examination showed positive staining for estrogen and progesterone receptors, but negative staining for HER2. The Ki67 index was 5%. Tamoxifen was administered, and recurrence has not been noted for 1 year.DISCUSSIONWomen's IMPC generally shows a high HER2 positivity rate. However, HER2 positivity was noted in only 1 male patient with IMPC (14%) according to our literature review. Furthermore, in all cases of the mixed type that were reviewed, IMPC was associated with papillotubular carcinoma. These findings may be specific to IMPC in male patients.CONCLUSIONIMPC is associated with a high rate of lymph node metastasis or recurrence and advanced vessel invasion, aggressive adjuvant chemotherapy following surgical resection should be selected for patients with IMPC.     

Ganglio centinela en la metástasis ganglionar por cáncer papilar de tiroides: validez diagnóstica y aplicación en la práctica clínica

IntroductionThe presence of lymph nodes metastasis in papillary thyroid cancer modifies the type of surgical resection as well as the indication of the treatment with ¹³¹I in the postoperative period. This therapeutic approach is based on the results of the diagnostic tests, like the cervical ultrasonography. Currently other methods of diagnostic are tested as selective sentinel lymph node biopsy (SLNB). It can complement to the ultrasound results. The aim was to validate the SLNB for use in the diagnosis of lymph node metastasis by papillary thyroid cancer.MethodsObservational prospective cohort study of 55 patients who underwent papillary thyroid cancer without suspicion of lymph node involvement clinical or radiological, since February 2012 through February 2015, with a follow-up between 6 and 8 years. It was used ⁹⁹Tc with intratumoral nanocoloid and a portable tube of the gamma camera for the detection of the sentinel node. Variables: age, gender, histological, analytical and preoperative and postoperative staging. The sensitivity, specificity and predictive values of technique was calculated. The validation was determined by calculating the detectability and the false negative results of the test.ResultsIn 53 of the 55 patients (96.36%) there was the sentinel node detection. The false negative were 4 patients (7.5%). Of the rest, after applying the SLNB, 24 (48.9%) were kept as N0, 14 (28.5%) became N1a and 11 (22.4%) were classified as N1b. The differences observed in the study were significant (P < .05). The sensitivity was 86.21%, the specificity of 100%, the PPV was 100% and the NPV of 85.71%. The diagnostic accuracy was 92.45%.ConclusionsThe SLNB is a valid technique for use in patients suffering from papillary thyroid cancer with a high diagnostic accuracy.