A Laparoscopic Radical Inguinal Lymphadenectomy Approach Partly Preserving Great Saphenous Vein Branches Can Benefit for Patients with Penile Carcinoma

Background: Inguinal lymphadenectomy (iLAD) is effective for penile carcinoma treatment, but usually results in many complications. This study aims to clinically evaluate the feasibility and clinical significance of a laparoscopic radical iLAD approach partly preserving great saphenous vein branches for penile carcinoma patients. Methods: A total of 48 patients with penile cancer who underwent laparoscopic radical iLAD with retention of the great saphenous vein in Henan Cancer Hospital from 2012 Jan to 2020 Dec was included in this study. Sixteen penile carcinoma patients who underwent laparoscopic radical iLAD preserving parts of superficial branches of the great saphenous vein were identified as the sparing group, and the matched 32 patients who incised those branches were identified as control group. This new procedure was performed by laparoscopy, preserving parts of superficial branches of the great saphenous vein, superficial lateral and medial femoral veins. Clinicopathological features and perioperative variables were recorded. Postoperative complications, including skin flap necrosis, lymphorrhagia, and lower extremity edema were analyzed retrospectively. Results: We found that the operative time of the sparing group is significantly longer than the control group (p = 0.011). There was no statistical difference in intraoperative blood loss, the lymph node number per side, average time to remove the drainage tube and postoperative hospital stay between the two groups. Compared to the control group, the sparing group showed a significantly decreased incidence of lower extremity edema (p = 0.018). The preservation of parts of superficial branches of the great saphenous vein was mainly decreased the incidence of edema below ankle (p = 0.034). Conclusions: This study demonstrated that the iLAD with preserving parts of superficial branches of the great saphenous vein, with a decreased incidence of postoperative complications, is a safe and feasible approach for penile cancer.

Micropapillary Carcinoma in a dog: Case report

Mammary neoplasms in female dogs present a high incidence. Several histological types are observed, among them, micropapillary carcinoma is considered one of the most aggressive because it is related to vascular invasion, metastases and low survival time. Aimed to describe a case of micropapillary breast carcinoma, with cutaneous metastasis, in a dog. A canine, female, 14 years old, 8kg, not defined breed, uncastrated, nulliparous, with pseudocyesis and no contraceptives administration history was attended at the Veterinary Reproduction and Obstetrics Service from "Governador Laudo Natel” Hospital, FCAV, UNESP, Jaboticabal, presenting a breast ulcerated nodule, with one month estimated evolution. After stabilization and preoperative exams, radical unilateral mastectomy and ipsilateral axillary and inguinal lymphadenectomy were performed. Histopathologic diagnosis revealed micropapillary carcinoma and free surgical margins from neoplasm, however, there were metastasis in both lymph nodes. The tutors did not adhere to antineoplastic chemotherapy. In 60th post-surgical day, there was inflammatory reaction in the surgical scar region, with small cutaneous ulceration, where the elastogram revealed rigidity and shear velocity of 7.84m/s. Skin biopsy revealed metastasis of micropapillary breast carcinoma. There was progression of ulcerations, compromising animal’s welfare and its physiological activities, when on the 110th post-surgical day, it was decided to euthanize the patient. The correct diagnosis and knowledge of tumor biological behavior are importants points to choose the correct treatment. The adjuvant chemotherapy treatment can impact on average survival time and ARFI elastography is an accurate predictor of rapid and non-invasive diagnosis of micropapillary carcinoma recurrence.

What to do when nothing else is left to be done - metastatic non-HPV vulvar squamous cell carcinoma with multiple lines of chemotherapy

Recurrent vulvar squamous cell carcinoma with multiple site metastases is a rare entity – (up to 14.2% of the total number of recurrences), with a poor prognosis (only 15% of the patients alive at 5 years). Due to its “hard to find” character, there are no standardized guidelines available and the treatment is extrapolated from advanced cervical carcinoma, anal carcinoma and other squamous cell carcinomas. Immunotherapy has shown some positive results in vulvar carcinoma with PD-L1 positive, high TMB, high MSI or with MMR deficiency. An alternative for selected cases without therapeutic resources could be the HPV vaccine. We present the case of a 64-year-old woman diagnosed in 2014 with vulvar squamous cell carcinoma stage II for which she underwent radical vulvectomy with bilateral inguinal lymphadenectomy followed by external radiotherapy. In 2019 she developed local recurrence associated with lung, pleural, lymph nodes and subcutaneous metastasis, treated with three lines of chemotherapy: paclitaxel/carboplatin followed by cisplatin/5-fluorouracil and carboplatin/gemcitabine. The patient’s general health status altered progressively, and she died after the 4th cycle of carboplatin/gemcitabine. This case’s management could be a starting point for the vulvar carcinoma cases where the standard therapeutical options do not represent a choice anymore, providing the necessary example on how to approach it.

ANTIMICROBIAL THERAPY DURING CANCER TREATMENT: A CASE REPORT

Introduction. Penile cancer (pc) is a rare cancer. The standardized incidence rate of pc in russia is 0.82 cases per 100,000 males. On average, 58 % of patients (20–96 %) with pc have a local infection process: tumor decay, the presence of erosion, tumor ulceration, inflammatory changes in regional lymph nodes, etc. During hospitalization nosocomial pathogens may be possible causes of infection in ulcerative lesions.The aim of the study was to present the results of the treatment of tumor ulcer in a patient with penile cancer infected with multiresistant acinetobacter baumannii and klebsiella pneumoniae.Material and methods. We present a clinical observation of 54-year-old patient diagnosed with penile cancer pt4n3m0, with ulceration of the tumor, localized at the root of the penis and ulceration of metastatic lymph nodes in the left inguinal region and subsequent infection with highly resistant nosocomial microorganisms.Results. The patient received 6 courses of paclitaxel, ifosfamide and cisplatin with clinical effect, such as significant reduction of the tumor and therapeutic pathomorphosis of 3-rd degree. Then ileo-inguinal lymphadenectomy was performed on the left. A few months later the tumor continued to grow in the left groin area. During the 2nd line of chemotherapy (cisplatin, docetaxel and capecitabine), the patient had grade iii–iv neutropenia, febrile neutropenia. High fever and localized infection in the area of tumor ulceration with multiresistant hospital microorganisms was detected. Combined antibiotic therapy had temporary effect. After isolation of multiresistant carbapenemresistant k. Pneumoniae from the ulcer, the patient was prescribed ceftazidim/avibactam 2.5 g 3 times a day. Clinical effect, such as defervescence and significant reduction of the ulceration zone was seen subsequently.Conclusion. Etiotropic antibacterial therapy of the infected tumor ulcer resulted in a significant reduction in the manifestation of the infection process, allowing antitumor therapy to be continued, as well as surgery to be performed.

Salvage Robotic-Assisted Seminal Vesiculectomy for Merkel Cell Carcinoma Metastasis

A 71-year-old male presented with Merkel cell carcinoma along with inguinal lymph node involvement (stage III). The patient was proposed for systemic treatment followed by inguinal lymphadenectomy and adjuvant radiotherapy. During the follow-up period, recurrences were documented (lymphatic and visceral) and were treated with salvage surgery and radiotherapy. On the fifth year of follow-up the patient was diagnosed with a metastasis in the right seminal vesicle and underwent stereotactic body radiation therapy. Two-years later, tumor recurrence in the right seminal vesicle was managed with salvage robotic assisted seminal vesiculectomy. Advanced stages of Merkel cell carcinoma have a poor outcome and salvage treatments should be tailored to each patient. A multidisciplinary approach was crucial in achieving successful outcomes. The patient is still recurrence free twenty-four months after surgery. To the best of our knowledge, this is the first publication reporting a seminal vesical Merkel cell metastasis.