Banoth Manilal

Outcomes of pectoralis major myocutaneous flap in female patients for oral cavity defect reconstruction.

PURPOSE Although much has been mentioned in the literature worldwide regarding the outcome of pectoralis major myocutaneous flaps (PMMFs), hardly any studies are available that mention the outcome of PMMFs in female patients. It has been presumed that complication rates after PMMF reconstruction in female patients are higher because of the presence of more adipose tissue in the flap. The objective of this study was to analyze our data regarding the outcomes of PMMFs in female patients with oral cancer undergoing reconstruction after tumor ablation. MATERIALS AND METHODS In this retrospective study from January 2008 to May 2012, performed in a single institution in south India, we have analyzed our data on PMMFs in 140 female patients with oral cancer. The operative technique used was essentially the same as that described originally by Ariyan. However, to preserve the deltopectoral flap area, the incision was appropriately modified in a manner as described by Schuller. RESULTS The mean age of the patients was 52.36 years, with a range from 30 to 76 years. They presented mostly with ulcers or ulceroproliferative lesions. Most of the patients had a history of tobacco and betel nut chewing. All of them underwent composite resection and reconstruction with PMMF under general anesthesia. Of the patients, 30 (21.4%) had complications, comprising infection (8), superficial flap necrosis (11), combined wound infection and superficial flap necrosis (3), total flap failure (2), and orocutaneous fistula (6). CONCLUSIONS PMMF reconstruction is a reliable and cosmetically acceptable method of reconstruction in female patients for oral cavity defects after tumor ablation.

Multiple primary cancers: An enigma.

Background: Incidence of multiple primary cancers though uncommon, is being frequently reported now-a-days owing to better diagnostic techniques, the prolonged life span and the increased incidence of long-term survival of cancer patients. Materials and Methods: This is a retrospective study. Cases of multiple malignancies diagnosed histopathologically were retrieved from the archives of department of surgical oncology. Clinical data were obtained from the medical records. They were categorized as synchronous malignancies if the interval between them was less or equal to 6 months and metachronous, if the interval was more than 6 months. Results: A total of 13 cases were encountered in the 5 year study period. Out of them two were in the metachronous category and the rest were synchronous as the 2nd malignancy was detected mostly during clinical evaluation of the patients for the primary malignancy. There was female predominance with age range being 43-68 years. Majority of the cases were in the 7th decade. The most common organ involved was breast, followed by cervix. Apart from bilateral breast malignancies, there were combinations like breast with uterine endometrial carcinoma, cervical carcinoma and even papillary thyroid carcinoma. Conclusion: Detection of multiple primary malignancies is becoming increasingly common in day-to-day practice. Greater awareness of this is required among both cancer patients and their treating clinicians.

A rare case of oropharyngeal melanoma: Case report and brief review of literature

Mucosal melanomas are rare compared with the cutaneous melanomas. They present with advanced stage and are known to have a poor outcome in comparison to their cutaneous counterparts. Mucosal melanomas constitute about 1.3% of all melanomas. The most common site of mucosal melanomas is the head and neck region. In oropharynx, 95% of all malignancies are squamous cell carcinomas. The melanomas of the oropharynx are very rare. Hereby, we are reporting a case of pedunculated mucosal melanoma of oropharynx.

Multiple endocrine neoplasia-2A-revisited

Multiple endocrine neoplasia-2A (MEN-2A) is a rare syndrome. MEN-2 is characterized by medullary thyroid carcinoma (MTC), pheochromocytoma, and hyperparathyroidism. MTC is the most consistent feature in all subtypes of MEN-2. In MEN-2A, approximately 70–95% of individuals develop MTC, 50% develop pheochromocytoma, and 15–30% develop hyperparathyroidism. Identification of a germline REarranged in transfection mutation or the identification of the clinical features of MEN-2A in other first-degree relatives is required to make the diagnosis, in those patients with only one or two clinical features. We present the case of a family with MEN-2A syndrome. Here, the patient was first operated for MTC and following further investigation was detected to have pheochromocytoma. In her family history, she had a daughter who was earlier operated for MTC. After 5 years of follow-up, she is doing well. This is an additional case of MEN-2A.

Use of tensor fascia lata flap for reconstruction of the defect created following inguinal block dissection in a case of carcinoma penis: a case report and brief review of literature

Tensor fascia lata (TFL) flap is a versatile myofasciocutaneous flap. It has varied usages as both free and pedicled flap. As a pedicled flap, it is a good option for reconstructing soft tissue defects after tumor ablation. The TFL perforator flap is a good alternative for anterolateral thigh (ALT) flap. The advantages of TFL flap are that dissection can be made through the same incision, without impairment of other donor sites. The reconstructive plan remains same as that of ALT flap. TFL flap offers a good volume of skin and can be made thin removing variable portions of muscle. The present case is a 63-year-old patient with a carcinoma penis who underwent left ilioinguinal block dissection resulting in a defect of 8 cm × 8 cm in the left inguinal region. TFL flap was raised with U-shaped incision and used for closure of the defect with good result.

Sclerosing stromal tumor of ovary in a young female: A case report and brief review of literature

Sclerosing stromal tumor (SST) is a rare benign sex cord-stromal ovarian tumor typically encountered in young females. These tumors are hormonally inactive and usually present with nonspecific symptoms. Histopathology is essential in the diagnosis of this uncommon tumor. We present a case of SST in a young female with a review of current literature. This patient presented with abdominal pain. She underwent right salpingo-oophorectomy. The histopathological examination and immunohistochemistry of the tumor was consistent with the diagnosis of SST.

Tubulovillous adenoma of stomach: A cause for intussusception - Report of an unusual case with brief literature review

In the stomach, benign tumors are not common. Even when they do occur, they are usually considered as premalignant lesions with a risk of transformation to malignant ones. Tubulovillous adenomas of the stomach are rare. However, these tumors are being diagnosed with increasing frequency due to more widespread use of endoscopy. We present an unusual case of a large tubulovillous adenoma of the stomach. The partial gastrectomy specimen showed a large polypoidal growth at the greater curvature of the stomach. The patient is symptom-free, after 2 years of follow-up.

Oral Cavity Cancers -Level v Metastasis.

Sir, We read with interest the article” Significance of level v lymph node dissection in clinically node positive oral cavity squamous cell carcinoma and evaluation of potential risk factors for level v lymph node metastasis. “ by Parikh etal. [1] In this context, we would like to share our experience regarding the lymph node positivity in patients with oral cavity cancers. We had analyzed our data from a tertiary care center in south India where our patients had undergone neck dissection along with surgical ablation of the tumor. [2] According to our data, of 218 operated cases, 68 were cN0. Of them 7 cases showed metastasis histopathologically. Out of 150 clinically positive nodes, histopathologically 59 were positive. [2] In two of our cases, level V lymph nodes were positive. In one case, the primary was retromolar trigone and in the other case it was gingivo-buccal sulcus. Histopathologically, lymphovascular invasion was present in both the cases. [2] Also both these cases showed lymph nodal involvement in other levels. In our study of female predominant patients, these two patients had undergone reconstruction with pectoralis major myocutaneous flap along with neck dissection (modified radical neck dissection type −2). [3] We agree with the authors that level V lymph node dissection should be a part of surgery for proper staging and post-operative subsequent treatment and follow-up.

Use of fillet flap in a case of soft-tissue sarcoma of the hand

Soft-tissue sarcoma of the hand is a rare entity. Hand sarcomas are more challenging to manage than those in other sites, due to a variety of factors including highly specialized, intricate anatomy, and absence of redundant soft-tissue. Hand-sparing surgery is now the most common option for sarcomas of the hand. We present our experience of hand sparring surgery in a patient with sarcoma of a thumb. We present a rare case of clear cell sarcoma of the thenar region of the right hand, managed by hand preserving wide excision of the primary tumor and amputation of the thumb at the metacarpal level. The wide defect created after excision of the tumor was effectively covered by a fillet flap. Limb sparing, function preserving surgeries are the standard of care wherever possible. An effective technique, the fillet flap, which was pragmatic in providing a working hand for our patient can be valuable in a select group of patients in a low resource setting.