Value of the Sentinel Node Procedure in Pediatric Extremity Rhabdomyosarcoma: A Systematic Review and Retrospective Cohort Study

Background Our aim is to show whether the sentinel node procedure (SNP) is recommendable for pediatric patients with extremity rhabdomyosarcoma (RMS). Lymph node metastases are an important prognostic factor in pediatric patients with extremity RMS. Accurate nodal staging is necessary to treat the patient accordingly. An alternative to the current recommended lymph node sampling is the sentinel node procedure (SNP). Methods A systematic review was performed summarizing all published cases of SNP in addition to 13 cases from our hospital and 8 cases from two other hospitals that have not been published before. Results For all patients (n = 55), at least one SLN was identified, but the SNP technique used was not uniform. The SNP changed the nodal classification of eight patients (17.0%) and had a false-negative rate of 10.5%. Conclusions The SNP is recommendable for pediatric patients with extremity RMS. It can change lymph node status and can be used to sample patients in a more targeted way than nodal sampling alone. Therefore, we recommend use of the SNP in addition to clinical and radiological nodal assessment for pediatric patients with extremity RMS.

Premalignant and malignant disease of the vulva and vagina

Vaginal intraepithelial neoplasia is a rare, premalignant condition of the vagina, which is caused by persistent infection with oncogenic strains of the human papillomavirus (HPV). It occurs either concurrently with intraepithelial neoplasia of other parts of the anogenital tract, or can develop after treatment of cervical lesions or pelvic irradiation. It can be difficult to diagnose and treat, due to the proximity of surrounding structures such as the bladder and rectum, and the need to preserve sexual function. Squamous carcinoma of the vulva is the most common vulval malignancy. It may arise from two distinct types of vulval intraepithelial neoplasia (VIN). Vulval extramammary Paget’s disease is a rare intraepithelial adenocarcinoma which accounts for less than 2% of primary vulval tumours. VIN and Paget’s disease are treated in order to relieve symptoms, such as severe pruritus, to exclude invasive disease, and to decrease the risk of developing cancer. Specialist follow-up in multidisciplinary clinics, with access to conservative surgery and reconstruction, as well as psychosexual support, are important in the management of women with vulval premalignant disease. Vulvar and vaginal cancer are rare gynaecological malignancies that occur predominantly in elderly women. Where the cornerstone of vulvar cancer treatment is surgery, radiotherapy is the most common treatment given in vaginal cancer. Vulvar cancer treatment has undergone significant modifications during the last decades, all with the aim to reduce treatment-related morbidity without compromising survival rates. The introduction of the sentinel node procedure has been a major advantage in the treatment of this disease.

DIEAP Flap Breast Reconstruction Followed by Local Recurrence of Breast Cancer

Local recurrence after an autologous breast reconstruction is uncommon. We describe 2 patients with local recurrence 3 and 9 years, respectively, after mastectomy with DIEAP (deep inferior epigastric artery perforator) flap breast reconstruction. Patients generally present with a palpable mass, pain, or other visible abnormalities. Various imaging techniques are helpful, always completed by biopsy to characterize the tumour. A repeated sentinel node procedure can be useful in staging. The treatment of the local recurrence needs to be determined in a multidisciplinary team consultation.