N Kathiresan

Radical neck dissection: preserving the distal spinal accessory nerve based on its cervical plexus contribution.

In an effort to overcome shoulder morbidity from the classical radical neck dissection, modifications preserving the entire spinal accessory nerve, were described. When there are metastatic upper jugular nodes with potential extracapsular spread, modifications that preserve the entire XI nerve may be oncologically unsafe. We describe a technique wherein the XI nerve is preserved based on the contribution from the cervical plexus, while allowing resection of the proximal part of the nerve en bloc with the specimen. This modification may preserve useful trapezius function without compromising oncological safety. J. Surg. Oncol. 2008;98:200–201.

Oral cavity metastasis: An unusual presentation of carcinoma prostate

Oral cavity cancers form the third most common cancers among men in south India. The oral cavity is a very rare site for metastases and has been described in various cancers, particularly lung, breast, kidney and colon carcinoma. Here a very rare case of a buccal metastasis from prostate carcinoma that was originally evaluated as a primary oral cavity malignancy is presented. Histopathological examination of a biopsy of the lesion revealed papillary adenocarcinoma Grade II, nuclear Grade II, which initiated the evaluation of prostate. On evaluation diagnosis of carcinoma prostate was made which was confirmed by immunohistochemistry for PSA.

Role of dynamic sentinel node biopsy in carcinoma penis with or without palpable nodes

Introduction: We aimed to evaluate the role of dynamic sentinel node biopsy (DSLNB) in patients diagnosed with carcinoma penis and clinically N0 disease using superficial inguinal dissection as the standard staging modality. Materials and Methods: Twenty consecutive men (40 groins) with carcinoma penis having clinically N0 status were enrolled in the study. Patients underwent DSLNB if fine needle aspiration cytology from the groin nodes was negative, followed by injection of radiocolloid and blue dye. The sentinel lymph node(s) were harvested. The inguinal incision was then extended and a modified superficial inguinal dissection was performed and all nodes were labeled separately and sent for frozen section. A completion deep inguinal with pelvic dissection was performed if any of the nodes were reported positive for malignancy. Results: The median age of the patients was 52.5 years. Ten patients were smokers. Phimosis was present in five patients. Lesions were present over the glans penis and shaft in 18 and two patients, respectively. Wide local excision, partial penectomy and total penectomy were performed in one, 15 and four patients, respectively. Clinically palpable nodes were found in 19 groins. Median follow-up was 26 months. Nodes were positive in 10 groins. DSLNB missed the sentinel node in one groin. The accuracy and false-negative rate of DSLNB was 97.5% and 10%, respectively. Conclusion: DSLNB is a useful and reliable technique to identify the involved node(s) in patients diagnosed as having carcinoma penis with clinical N0 status (with or without palpable nodes). It helps to avoid the morbidity associated with a staging inguinal dissection in these patients.

Bleomycin induced urethral stricture in Hodgkin's disease

Bleomycin is a glycoprotein that is extensively used in combination with other anti-cancer agents because of its relative lack of hematological and gastrointestinal toxicity. However, pulmonary toxicity is common with bleomycin and limits its therapeutic utility. Urethral stricture as a result of bleomycin toxicity has not been reported in literature. In this case report, a young male patient who developed urethral stricture after bleomycin-based chemotherapy is described and the possible effects of bleomycin on the urethra are discussed.

Ganglioneuroma of the retroperitoneum presenting as a pediatric renal mass.

Ganglioneuroma is the benign representative of peripheral neuroblastic tumors, with localized and predominant thoracic presentations in older children. They often have an excellent outcome with surgery alone. A 12-year-old girl presented with an incidentally detected abdominal mass, which was clinicoradiologically a renal mass. Laparotomy revealed a mass adherent to the anterior surface of the right kidney. The mass was carefully dissected out, sacrificing a portion of the inferior vena cava. Histopathological diagnosis was that of a ganglioneuroma. She was kept under follow up.

Ruptured Retroperitoneal Node Presenting as Hemoperitoneum—An Unusual Presentation of testicular tumour

Herewith we are reporting an unusual presentation of testicular tumour. The patient is a 37 years old gentleman diagnosed with Stage III seminoma post orchidectomy on chemotherapy and had spontaneous rupture of retroperitoneal nodal mass and presented with hemoperitoneum and hypovolemic shock. He was successfully salvaged by aggressive resuscitation, emergency laparotomy and resection of ruptured nodal mass and is presently disease free. This article is aimed at highlighting this unusual presentation and complication of advanced testicular tumour and the need for aggressive surgery even in the so called hopeless situations. The need for multidisciplinary care in the cure of advanced testicular care is once again reemphasized

Postoperative renal failure following inferior vena caval tumor resection with right nephrectomy: A case report and review of literature

Tumors arising from the inferior vena cava are rare. The commonest histological type among these rare tumors is leiomyosarcoma. Complete resection of the tumor is the mainstay of management. Concomitant right nephrectomy during resection may be required. As the collateral circulation of the left renal veins is extensive and well-developed, reconstruction of left renal vein is not required generally. This case report provides a situation, which may warrant the reconstruction of the left renal vein as the patient developed postoperative renal failure. Authors recommend the reconstruction of the left renal vein in a similar situation disregarding the collateral circulation.