High-grade mucoepidermoid carcinoma in thyroglossal cyst: Post-surgical histological surprise and dilemmas

Occurrence of malignancy in the TG cyst has been rarely reported, though rare, and papillary carcinoma predominates the common type but squamous cell carcinomas, anaplastic carcinoma, and medullary have been reported rarely. Mucoepidermoid carcinomas are most commonly seen in salivary glands, and as per the available literature, there was only two cases reported in thyroglossal cyst. We are presenting a 67-year-old lady presented with a 6×8 cm hard swelling below symphysis menti with no thyromegaly and moving on protrusion of tongue, and on MRI, it was found to be thyroglossal cyst with infiltration of strap muscles. Cytological investigation revealed it to be a TG cyst malignancy. The patient underwent total thyroidectomy and radical Sistrunk’s operation. Histopathological and immunohistochemistry revealed it to be a histological examination revealed a low-grade mucoepidermoid carcinoma consistent with origin in a thyroglossal duct remnant it invaded the hyoid bone and adjacent strap muscles. Various diagnostic and treatment dilemmas in the treatment of TG cyst malignancy are discussed with reference to mucoepidermoid carcinoma. We are reporting an usual histological surprise in a thyroglossal cyst malignancy being the only second reported case of TG cyst mucoepidermoid carcinoma this case highlights the importance of removal of thyroglossal duct cysts at an early stage and aggressive surgical approach in high-grade tumors.

Looking for a strategy in treating peritoneal gastric cancer carcinomatosis: an Italian multicenter Gastric Cancer Research group’s analysis

Background The present study provides a snapshot of Italian patients with peritoneal metastasis from gastric cancer treated by surgery in Italian centers belonging to the Italian Research Group on Gastric Cancer. Prognostic factors affecting survival in such cohort of patients were evaluated with the final aim to identify patients who may benefit from radical intent surgery. Methods It is a multicentric retrospective study based on a prospectively collected database including demographics, clinical, surgical, pathological, and follow-up data of patients with gastric cancer and synchronous macroscopic peritoneal metastases. Patients were surgically treated from January 2005 to January 2017. We focused on patients with macroscopic peritoneal carcinomatosis (PC) treated with upfront surgery in order to provide homogeneous evidences. Results Our results show that patients with peritoneal carcinomatosis cannot be considered all lost. Strictly selected cases (R0/R1 and P1 patients) could benefit from an aggressive surgical approach performing an extended lymphadenectomy and HIPEC treatment. Conclusion The main result of the study is that GC patients with limited peritoneal involvement can have a survival benefit from a surgery with “radical oncological intent”, that means extended lymphadenectomy and R0 resection. The retrospective nature of this study is an important bias, and for this reason, we have started a prospective multicentric study including Italian stage IV patients that hopefully will give us more answers.

Preoperative Ultrasonography in the Evaluation of Suspected Familial Non-Medullary Thyroid Cancer: Are We Able to Predict Multifocality and Extrathyroidal Extension?

Family history of thyroid cancer increases the risk of harboring thyroid malignancies that end up having extrathyroidal extension (ETE) and multifocality on histology; some authors suggest a more aggressive surgical approach. Their pre-operative identification could allow more conservative surgical procedures if none of these features are suspected. Our aim was to assess if neck ultrasonography could identify or exclude multifocality or ETE in these patients to tailor the extent of surgery. This retrospective study included patients with previous thyroid surgery, ≥1 first-grade relative with thyroid cancer, and who had undergone pre-surgical ultrasound. ETE was suspected in the case of thyroid border interruption or gross invasion of perithyroidal tissues. Multiple suspicious nodules were defined as suspicion of multifocal cancer. The cohort consisted of 45 patients (median age 49 years, 40 with thyroid cancer, 30 females). The positive predictive value of ultrasonography in predicting multifocality and ETE was 57.14% (25.25–84.03) and 41.67% (21.5–65.1%), respectively, while the negative predictive values were 63.2% (56.4–69.4%) and 72.7% (63.3–80.5%). Pre-operative ultrasound examination is unable to reliably identify or exclude multifocal disease or extrathyroidal extension. In patients scheduled for surgery and with a first-degree relative affected by DTC, a “negative” pre-operative US report does not exclude the potential finding of multifocality and ETE at final histopathology.

Vascular Resection in Perihilar Cholangiocarcinoma

Perihilar cholangiocarcinoma (phCC) is the most common type of cholangiocarcinoma, accounting for approximately 60 % of cases, followed by the distal and then the intrahepatic forms. There is not a staging system that allows comparation of all series and extract some conclusions to increase the long-survival rate in this dismal disease. The extension of the resection, which theoretically dependes on the type of phCC, is not closed subject. As surgery is the only known way to achieve a cure, many aggressive approachs have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, the surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions.

Current Surgical Management of Peri-Hilar and Intra-Hepatic Cholangiocarcinoma

Cholangiocarcinoma accounts for approximately 10% of all hepatobiliary tumors and represents 3% of all new-diagnosed malignancies worldwide. Intrahepatic cholangiocarcinoma (i-CCA) accounts for 10% of all cases, perihilar (h-CCA) cholangiocarcinoma represents two-thirds of the cases, while distal cholangiocarcinoma accounts for the remaining quarter. Originally described by Klatskin in 1965, h-CCA represents one of the most challenging tumors for hepatobiliary surgeons, mainly because of the anatomical vascular relationships of the biliary confluence at the hepatic hilum. Surgery is the only curative option, with the goal of a radical, margin-negative (R0) tumor resection. Continuous efforts have been made by hepatobiliary surgeons in order to achieve R0 resections, leading to the progressive development of aggressive approaches that include extended hepatectomies, associating liver partition, and portal vein ligation for staged hepatectomy, pre-operative portal vein embolization, and vascular resections. i-CCA is an aggressive biliary cancer that arises from the biliary epithelium proximal to the second-degree bile ducts. The incidence of i-CCA is dramatically increasing worldwide, and surgical resection is the only potentially curative therapy. An aggressive surgical approach, including extended liver resection and vascular reconstruction, and a greater application of systemic therapy and locoregional treatments could lead to an increase in the resection rate and the overall survival in selected i-CCA patients. Improvements achieved over the last two decades and the encouraging results recently reported have led to liver transplantation now being considered an appropriate indication for CCA patients.

Is total pelvic exenteration suitable for elderly patients with locally advanced or recurrent rectal cancer?

Locally advanced and relapsed rectal cancer represent one of the most commonly reported indications for total pelvic exenteration especially in men, while in women the surgical procedure might be limited to a posterior exenteration. This procedure is still associated with high risks of postoperative complications and high rates of perioperative mortality, therefore careful selection of the cases is mandatory. However, in the last decades improvement in the field of oncology treatment leaded to the increase of the lifespan of patients diagnosed with rectal cancer; in this respect, it is easy to be understood the fact that an increased number of cases will develop at a certain moment of their evolution pelvic recurrences which need more extended surgical procedures at a more advanced age. Therefore, extended procedures such as pelvic exenterations are needed in these cases; the aim of this paper is to study whether pelvic exenteration is suitable for elderly patients and which cases could benefit most from this aggressive surgical approach.

A case of recurrent chondroblastic osteosarcoma mandible

<p class="abstract">Osteosarcoma is an uncommon primary malignant tumor of bone. Craniofacial osteosarcomas constitute only about 6.5–7% of all osteosarcomas. The most common histopathologic type is chondroblastic type in head and neck group and osteoblastic in extremity group. We present a case report of 21 year old male patient with chondroblastic osteosarcoma with two episodes of recurrence. The tumour was dealt with left hemimandibulectomy followed by radiochemotherapy. After first recurrence he underwent right hemimandibulectomy. During second recurrence excision of growth followed by radiochemotherapy was done. Thus an aggressive multi-modality approach was adopted for treatment. Osteosarcoma is an uncommon primary malignant tumor of bone. Craniofacial Osteosarcomas are considered a separate category in view of their low histologic grade, less frequent metastases and better prognosis. The most common presentation is local swelling with or without pain. Aggressive surgical approach with post-surgical radiochemotherapy can be an effective tool.</p>