Hiba El Hage Chehade

Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients

BACKGROUND The use of sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC) in patients presenting with clinically positive lymph nodes remains controversial. METHODS A computer-aided search of the literature regarding SLNB in clinically node-positive breast cancer treated with NAC was carried out to identify the false negative rate (FNR), sentinel lymph node identification rate (IR), and axillary pathological complete response (pCR). RESULTS Nineteen articles were used in the analysis yielding 3,398 patients. The pooled estimate of the FNR was 13% and that of the IR was 91%. The adjusted pCR rate was 47%. A trend toward significance was observed with only clinical stage N1 (cN1) disease whereby clinical stage N1 was associated with an increased pCR rate when compared to N2 or N3 disease (P = .06). CONCLUSIONS SLNB after NAC in biopsy-proven node-positive patients results in reasonably acceptable FNR and IR, making it a valid alternative management strategy to axillary dissection. More refined patient selection and optimal techniques can improve the FNR and IR in this patient population.

What could happen if you insert a BioEnterics intragastric balloon after sleeve gastrectomy

A 49-year-old previously healthy female patient with a body mass index (BMI) of 41 kg/m had undergone an SG 3 years before presentation to our hospital. She had lost 30 kg but then regained 10 kg because of increased food intake, and she had failed to maintain all conservative measures. Her treating physician has decided to insert an intragastric balloon with a capacity of 300 mL until tension on the gastric wall could be observed. She was referred to us 2 hours later as she experienced abdominal pain, retching, and hematemesis. Her vital signs and abdominal examination were normal. Therefore, the balloon was removed; however, a gastric mucosal tear was observed, but it went unrecognized as a full-thickness tear at this time. The patient was admitted for observation. Two hours later, she developed tachycardia, (heart rate [HR] 1⁄4 110 beats/ min), hematemesis, and abdominal distention. A standing abdominal film revealed a huge amount of air under the diaphragm (Fig. 1). Thus, a decision was made to perform

Do online prognostication tools represent a valid alternative to genomic profiling in the context of adjuvant treatment of early breast cancer? A systematic review of the literature

INTRODUCTION Decision-making regarding adjuvant chemotherapy has been based on clinical and pathological features. However, such decisions are seldom consistent. Web-based predictive models have been developed using data from cancer registries to help determine the need for adjuvant therapy. More recently, with the recognition of the heterogenous nature of breast cancer, genomic assays have been developed to aid in the therapeutic decision-making. METHODS We have carried out a comprehensive literature review regarding online prognostication tools and genomic assays to assess whether online tools could be used as valid alternatives to genomic profiling in decision-making regarding adjuvant therapy in early breast cancer. RESULTS AND CONCLUSIONS Breast cancer has been recently recognized as a heterogenous disease based on variations in molecular characteristics. Online tools are valuable in guiding adjuvant treatment, especially in resource constrained countries. However, in the era of personalized therapy, molecular profiling appears to be superior in predicting clinical outcome and guiding therapy.

Highly Vascularized Primarily Inflammatory Pseudotumor of the Omentum in an Adult Male: A Case Report

Patient: Male, 38 Final Diagnosis: Inflammatory myofibroblastic tumor Symptoms: Abdominal pain • anorexia • weight loss Medication: — Clinical Procedure: Operation Specialty: Surgery Objective: Rare disease Background: Inflammatory pseudotumors can affect any organ, whereas primary omental tumors are very rare. A few cases have been reported in the literature, all affecting adult patients. They are usually difficult to diagnose preoperatively and pathology remains the criterion standard for diagnosis. Surgical resection is considered the first-line treatment in limited disease, whereas recurrent or metastatic disease is treated by re-excision. There is no role for chemo- or radio-therapy in limited disease. Here, we present a rare case of omental myofibroblastic tumor in an adult male. Case Report: A 38-year-old healthy man presented to our clinic complaining of lower abdominal pain associated with anorexia and low-grade fever, and he also reported weight loss. His initial hemoglobin was 9.7 g/dl. Magnetic resonance imaging (MRI) showed an enhancing solid mass in the lower abdomen, with close proximity to the appendix and the urinary bladder. The patient was treated successfully with laparotomy and excision of the tumor. Histopathology of the mass revealed spindle cells of vague fascicular pattern. Further immunohistochemical staining showed presence of reaction for CD68, CD34, and ALK. No omental infiltration was noted. No adjuvant treatment was applied and the patient was free of disease after 1-year follow-up. Conclusions: Omental pseudotumors are a rare pathology. They are usually slowly- growing, circumscribed tumors with a low malignant potential. They have a predilection for children. The overall mortality is reported to be 5–7% in cases with multiple recurrences.

Large ileocecal submucosal lipoma presenting as hematochezia, a case report and review of literature

Highlights • Ileocecal lipomas present typically with intussusception.There are only few reported cases of ileocecal lipomas presenting as lower GI bleeding.• Histopathological evaluation remains the gold standard in precise diagnosis.• The treatment of colonic lipomas is debatable among specialists.

Rapid growth and local advance of an aggressive papillary thyroid cancer with anaplastic transformation in an elderly woman

A 71-year-old female was presented to our surgical department complaining of painful, erythematous and ulcerated neck mass causing bleeding (Figure 1). She also complained of shortness of breath and generalized fatigue. Her medical history included osteoporosis, hypertension and dyslipidemia. The history dates back to five years ago when she had noticed to have a cervical nodule during routine examination for elective cholecystectomy. Chest radiograph at that time noticed a well-defined nodule about 4x4 cm (Figure 2). That pathological findings was ignored by the patient till recently when that mass started to grow up, ulcerate and bleed. Patient underwent incisional biopsy of the mass which turned to be metastatic papillary carcinoma in cervical lymph node with extensive neoplastic infiltration of skin and sub-cutaneous tissue by anaplastic tumor, giant cell type. A whole body computed tomography scan showed multiple metastatic lung nodules. The rest of the body was free of metastasis. Multimodal therapeutic approaches were started including debulking surgery (R2 resection), radiation to a biologically equivalent dose and

Porcine acellular dermis-based breast reconstruction: complications and outcomes following adjuvant radiotherapy

Sir, We read the study by Ng and colleagues [1] with great interest. In their study, the authors report on the use of an acellular dermal matrix (ADM, StratticeTM, LifeCell, NJ, USA) in the setting of breast reconstruction and radiotherapy treatment. In their study, Ng and colleagues describe an overall complication rate of 32 % with no significant difference between those treated with radiotherapy before surgery and those treated postoperatively. They therefore conclude that implant-based reconstruction using StratticeTM should not be an absolute contraindication in preor post-radiotherapy patients, but that the increased risks are emphasised to patients in order to better manage patient expectations if complications arise. With up to one third of women opting for mastectomy [2], the use of ADMs in breast reconstruction is becoming increasingly popular, being described as the most significant innovation impacting prosthetic breast reconstruction in recent years [3]. We recently undertook a similar study, looking at the use of a bovine-derived ADM, SurgiMendTM (TEI Biosciences, MA, USA), in a prospective case series of 118 patients undergoing 164 skin sparing mastectomy and immediate reconstruction procedures. Thirty-two patients (27 %) in our series underwent radiotherapy, of whom 27 received postmastectomy radiotherapy and 5 received it prior to surgery. Fifty-two percent of the patients received chemotherapy. Despite this relatively high uptake rate of chemotherapy and radiotherapy, we found a relatively low complication rate. At a mean follow-up of 21 months, the explantation rate was 1.2 %, and 4 % of patients developed wound complications. This included one case of partial wound dehiscence requiring surgical debridement and implant replacement in a patient who had undergone both postmastectomy radiotherapy and chemotherapy. Another patient who also received radiotherapy prior to surgery developed capsular contracture after 2 years which required capsulotomy and fat transfer. Those who lost their implants were undergoing adjuvent chemotherapy. We also found that there was high patient satisfaction with the outcome of the procedure (9 out of 10). We therefore agree with the conclusions reached by Ng and colleagues: ADM-assisted breast reconstruction should not be an absolute contraindication in patients receiving radiotherapy. The difference between results may be explained by differences in surgical technique or the different ADMs used in each of the studies, as follow-up times were similar. Furthermore, other factors have been reported to affect complication rate, such as body mass and comorbidity status; therefore, patient selection may also play a role. As Ng rightly point out, it is important to ensure that patients have adequate * Kefah Mokbel kefahmokbel@hotmail.com

Simultaneous double ileoileal intussusception due to Burkitt's lymphoma in a young male.

Burkitts lymphoma is an uncommon cause of intussusception in adults. Double intussusceptions due to Burkitts lymphoma are extremely rare. We present a case of a 26-year-old man who presented with symptoms of intestinal obstruction and was diagnosed with double ileoileal intussusception at laparotomy. The pathology of the lead points turned out to be Burkitts lymphoma. This could be the first reported case in the literature.