Comparison of Short-Term Results of Laparoscopy and Open Surgery for Colorectal Cancer: A Single-Center Experience

Objective: Although laparoscopic colon cancer surgeries have increased in recent years, their oncological competence is questioned. In our study, we aimed to evaluate oncological competence by comparing laparoscopic and open surgery. Material and Methods: The study was planned retrospectively. A total of 94 patients were included in the study, 42 of whom underwent laparoscopy, and 52 patients underwent open surgery. Both groups were compared in terms of demographic characteristics, staging, number of benign/malignant lymph nodes, histological findings and complications. Result: The final pathology report of all patients was adenocarcinoma. The median number of dissected lymph nodes was 20.9 in the open group (8-34) and 19.46 in the laparoscopy group (7-31) (p=0.639). The median number of dissected malignant lymph nodes was 1 (0-13) in the open surgery group and 3.1 (0-8) in the laparoscopy group (p=0.216). The laparoscopy group exhibited a longer operation time (281.2±54.2 and 221.0±51.5 min, respectively; P=0.036) than the open surgery group, but a shorter intensive care unit(ICU) discharge, quicker initiation oral feeding, and shorter length of hospital stay (4.0±0.9 vs. 5.7±2.0 days, respectively; P<0.001). Discussion: Laparoscopic surgery elicits many benefits such as less wound infection, lower requirement for blood transfusion, shorter hospitalization, quicker initiation of oral feeding and mobilization. Our study has shown that laparoscopic surgery provides quite adequate lymph node dissection when compared with oncological surgery, which is viewed with suspicion in the light of these benefits of laparoscopy.

Relationship Between Clustered Ring Nonmass Enhancement of Breast MRI and Prognostic Molecular Biomarkers in Breast Cancer

BackgroundClustered ring enhancement (CRE) of breast MRI is a lexicon of nonmass enhancement (NME) representing tendency of breast cancer and molecular biomarkers are predictors of response to therapy. The purpose of this study was to retrospectively determine the relationship between CRE NME and prognostic molecular biomarkers in breast cancer.MethodsRetrospective analysis of 58 breast lesions in 56 female patients between July 2013 and December 2018 was performed in our institution. Cases with MRI reporting NME in the text were collected via searching the report database. The patterns of enhancement including CRE on breast MRI were reviewed by a radiologist blinded to pathology report. The pathological results and expression of molecular biomarkers were collected. Univariate analysis was applied to evaluate the association between MRI NME imaging features, pathological and IHC stain findings.Results58 Breast lesions were pathologically proven breast carcinoma, and 31 lesions with CRE and 27 lesions without CRE on breast MRI. The expression of estrogen receptor (ER) (P=0.017) and progesterone receptor (PR) (P=0.017) was significantly lower in lesions with CRE compared with those without CRE. The expression of Ki-67 (≥ 25%) was significantly higher in lesions with CRE(P=0.046). The lesions with CRE have a lower expression ratio of ER (50.71 ± 45.39% vs. 74.26 ± 33.59%, p= 0.028).ConclusionOur results indicated that lesions with CRE may possess different features from those without CRE in molecular expression. They tend to bear a more aggressive biological behavior.

Painful catamenial vulvar lesions misleading gynecologist

Endometriosis usually presents as cyclical pain in the pelvis but may also present as painful cutaneous lesions. Many diseases may mimic hidradenitis suppurativa (HS) since HS, a chronic inflammatory painful skin disease, is a clinical diagnosis. A 32-year-old woman presented with painful lumps on her vulva and groin accompanied with bloody discharge during menstruation. She was followed up with preliminary diagnosis of endometriosis. Previous excision without definitive diagnosis resulted in temporary relief. She was prescribed oral contraceptive pills that alleviated her symptoms but quitted due to headache. Surgical excision was performed for definitive diagnosis and therapeutic relief. Pathology report revealed HS. She was prescribed oral doxycycline. She responded well to the therapy and has symptom-free for the last 2 years. She delivered one healthy girl via cesarian section 2 years after the treatment. Endometriosis and HS should be included in the differential diagnosis when women present with menstrual painful lesions around external genitalia for diagnosis and treatment.

Differentiating necrotizing soft tissue infections from cellulitis by soft tissue infectious fluid analysis: a pilot study

Background We conducted this study to evaluate the characteristics of the infectious fluid in soft tissue infection and investigate the utility of the biochemical tests and Gram stain smear of the infectious fluid in distinguishing necrotizing soft tissue infection (NSTI) from cellulitis. Methods This retrospective cohort study was conducted in a tertiary care hospital in Taiwan. From April 2019 to October 2020, patients who were clinically suspected of NSTI with infectious fluid accumulation along the deep fascia and received successful ultrasound-guided aspiration were enrolled. Based on the final discharge diagnosis, the patients were divided into NSTI group, which was supported by the surgical pathology report, or cellulitis group. The t test method and Fisher’s exact test were used to compare the difference between two groups. The receiver–operator characteristic (ROC) curves and area under the ROC curve (AUC) were used to evaluate the discriminating ability. Results Total twenty-five patients were enrolled, with 13 patients in NSTI group and 12 patients in cellulitis group. The statistical analysis showed lactate in fluid (AUC = 0.937) and LDH in fluid (AUC = 0.929) had outstanding discrimination. The optimal cut-off value of fluid in lactate was 69.6 mg/dL with corresponding sensitivity of 100% and specificity of 76.9%. The optimal cut-off value of fluid in LDH was 566 U/L with corresponding sensitivity of 83.3% and a specificity of 92.3%. In addition, albumin in fluid (AUC = 0.821), TP in fluid (AUC = 0.878) and pH in fluid (AUC = 0.858) also had excellent diagnostic accuracy for NSTI. The Gram stain smear revealed 50% bacteria present in NSTI group and all the following infectious fluid culture showed bacteria growth. Conclusions The analysis of infectious fluid along the deep fascia might provide high diagnostic accuracy to differentiate NSTI from cellulitis.

Malignant Phyllodes Tumor of the Breast and Pregnancy: A Rare Case Report and Literature Review

Phyllodes Tumor (PT) is a rare fibroepithelial breast tumor that can behave differently depending on its biologic features. Traditionally, PTs are classified by their histologic features into benign, borderline, and malignant. In most cases that were reported, all PTs may recur, but only the borderline and malignant PT can metastasize. PT usually occurs as a breast lump or accidental finding on ultrasound (US) examination. The clinical features include a well-defined breast mass, regular or lobulated. The diagnosis is based on the integration of morphology features, but remains challenging, particularly in the distinction from fibroadenomas. We report a case of a 36-year-old patient who presented for a voluminous breast mass, rapidly growing in the past 3–4 months. At presentation, the patient was 19 weeks pregnant. The breast tumor had the clinical and US aspect of PT. A core needle biopsy was obtained, confirming a benign PT, and local excision was performed with no postoperative complications. The final pathology report showed a borderline PT with close resection margins of 1 mm. Immunohistochemistry (IHC) established the diagnosis of malignant PT with heterologous sarcomatous differentiation. The case was discussed in the multidisciplinary tumor board (MDT) and mastectomy was recommended. The patient fully consented but refused surgery at 25 weeks’ gestation, fearing premature delivery. The right breast was closely monitored by US, and at 9 weeks after the first surgery, signs of local recurrence were detected. At 35 weeks’ gestation, right mastectomy was performed, with no perioperative complications. The pregnancy was closely followed up and no complication were found. The final pathology report describes multiples PT recurrences with heterologous sarcomatous differentiation. The pregnancy outcome was uneventful, and the patient delivered a healthy child vaginally at term with no peripartum complication. Postpartum, a computer tomography (CT) examination of the head, thorax, abdomen and pelvis was performed, with no evidence of metastases. Adjuvant chemotherapy and radiotherapy completed the treatment. The follow-up and CT scan showed no metastases or further recurrence 4 years after diagnosis. In conclusion, diagnosis of PT can be difficult, especially because of the easy confusion with fibroadenoma of the breast. There are rare cases when a pathology exam needs further assessment and IHC is recommended for accurate diagnosis. Although malignant PT is rare and accounts for <1% of all breast cancers, the diagnosis and treatment that are recommended are based on the reported cases. Moreover, when complete surgical excision is achieved, the rates of recurrence and distant metastases are low, and adjuvant therapy might not be necessary.

Radical or Not-So-Radical Prostatectomy: Do Surgical Margins Matter?

Prostate cancer is the second most common malignancy in men, and prostatectomy is the treatment of choice for most patients with at least low risk of progression. The presence of positive margins in the radical prostatectomy specimen is considered an adverse pathologic feature, and may prompt additional therapeutic intervention in the patients. The absence of a distinct capsule around the prostate and intraoperative manipulations that aim to minimize postoperative adverse effects, complicate its wide removal. Proper handling of the specimen during the gross processing is essential for accurate determination of the status of margins or resection. Positive margins, defined as the presence of neoplastic glands in the highlighted-with-ink margin of resection, range from 6–38%. The surgical technique, surgeon’s expertise and tumor (i.e., grade and stage) and patients’ (i.e., BMI) characteristics affect the rate of margin positivity. Extensive or multifocal and nonanterior/nonapical positive margins are linked with higher recurrence rates, especially in organ-confined disease, underscoring the need for treating these patients more aggressively. In summary, detailed description of the status of the margins should be performed in every pathology report to determine patients’ prognosis and the most appropriate therapeutic plan.

Utilidad del recuento de plaquetas en el diagnóstico del cáncer de ovario

Objective: To evaluate the usefulness of the platelet count and CA-125 in the discrimination between malignant and bening ovarian tumors at the Hospital Universitario de Los Andes, in a period of 5 years. Methods: Retrospective observational research. 419 patient medical stories coded as ovarian tumors were reviewed. The definitive pathology report was used as the gold standard test. Multiple statistical parameters of diagnostic performance were calculated from 2x2 tables and receiver operating characteristic (ROC) curves were plotted. Results: The mean platelet count: with invasive malignant ovarian tumors was 386/nl (CI 95 % 362-409), in benign tumors it 243/nl (CI 95 % 235-251) and in borderline tumors 237/nl (CI 95 % 198-276). Although the area under the curve receiver operating characteristic was higher for platelet count compared to CA125 levels (0.880 vs 0.790) this difference was not statistically significant. Among the mucinous tumors, the malignant ones did not present an elevated CA-125, but an elevated platelet count. Highest PPV of the platelet count was 95.6 % for > 350 / nl in postmenopausal women and 100 % for > 400/nl (p <0.001). Conclusion: The platelet count seems to have a similar utility to CA-125 to discriminate malignant from benign tumors and could improve diagnostic performance when both preoperative values are combined. Keywords: Platelets, Thrombocytosis, Ovary, Tumor, Cancer, CA-125, Diagnostic accuracy, Menopause.

Data Set for Reporting Carcinoma of the Stomach in Gastrectomy

Context.— A standardized detailed surgical pathology report is the cornerstone of gastric cancer management. Objective.— To guide management and prognostication for patients with gastric carcinomas globally, the International Collaboration on Cancer Reporting aimed to produce an evidence-based international pathology reporting data set with a panel of globally recognized expert pathologists and clinicians. Design.— Based on published guidelines/data sets for gastric carcinomas, a working draft was developed by the chair of the expert panel of pathologists and clinicians. The draft was then circulated to the panel and discussed in a series of teleconferences and email communications until consensus was achieved. The draft data set was uploaded on the International Collaboration on Cancer Reporting Web site for public comment. The data set was reviewed in consideration of the feedback, and a final version was approved by the panel. Results.— This data set was developed for gastrectomy specimens for primary gastric carcinomas, including neuroendocrine carcinomas and mixed neuroendocrine-nonneuroendocrine neoplasms. Well-differentiated neuroendocrine tumors, nonepithelial malignancies, and secondary tumors were excluded from this data set. The final data set contains 15 core (required) elements and 8 noncore (recommended) elements. A commentary is provided for each element. Conclusions.— The International Collaboration on Cancer Reporting has published freely available, evidence-based data sets for gastric cancer reporting. Standardized reporting has been shown to improve patient care and facilitates data exchange and analysis for quality assurance, cancer epidemiology, and clinical and basic research.