Omohyoid muscle syndrome

Omohyoid muscle syndrome is a rare cause of a bulging lateral neck mass that occurs on swallowing that often a worrisome observation because of the concern of malignancy and cosmetic deformity. The first case has been documented on 1969. A 12 years old male came to Surgical Oncology Outpatient Clinic with chief complaint a protruding right lateral neck mass during swallowing. He noticed this complaint since three months prior. He had no previous history of medical illness. He had history of multiple chokehold trauma when playing with his friend 6 months ago. He had no symptoms besides the mass occurring on his right neck. The patient went through the cervical radiograph and neck ultrasonography examination. There were inconclusive results. The patient was informed that the implication of these findings was strictly cosmetic and did not pose any risk of long-term consequence. Corrective cosmetic surgery was recommended as an option if he was concerned about the cosmetic appearance and conservative management was recommended to observe any pain or dysphagia he might experience in the near future. He denied surgery and did not seek further care for his condition. Omohyoid muscle syndrome is a rare condition that might occur after trauma such as chokehold to the neck. Imaging on this syndrome quite challenging especially when there were no other symptoms experienced. If it is proven to be strictly cosmetic, most patients will choose to have a conservative therapy

Case Report: A Simple Thoraco - Abdominal Flap to Reconstruct Wide Defect of Radical Mastectomy in Squamous Cell Carcinoma of Breast

BACKGROUND: Squamous cell carcinoma (SCC) of the breast is very unusual. Thoraco-abdominal (TA) flap is a simple flap, and it is a rotation advancement fasciocutaneous flap. Here, we present a case of using TA flap for chest wall reconstruction in quick in-quick outpatient. CASE PRESENTATION: A Russian woman 48 years old presented enlarging lump on her left breast for the last 5 years. She was diagnosed as stage IV low-differentiated breast cancer luminal B and had a history of 4 cycles chemotherapy. Patient getting worsening and no response to chemotherapy. We decided to perform palliative radical mastectomy to improve quality of life. Primary skin closure was not possible due to the wide defect of skin and soft tissue. We decided to use TA flap to cover the defect. Histopathology result was compatible with SCC. CONCLUSION: TA flap can be the choice in patients with a wide defect of skin and soft tissue after a radical mastectomy. Given its simplicity and shorter operative time, TA flap is an ideal option for quick in-quick outpatient

A Successful Tracheal Resection and Anastomosis in Papillary Thyroid Carcinoma with Tracheal Invasion

BACKGROUND: Well-differentiated thyroid carcinoma (DTC) can be locally aggressive, invading aerodigestive tract. The rationale for aggressive surgical resection in this clinical setting is supported by a long-term local control with a positive impact on survival. CASE REPORT: A 60-year-old male patient was consulted by a digestive surgeon of unaware thyroid enlargement. Physical and imaging examination showed a suspect of thyroid malignancy. During surgery, we found that a tumour had invaded the anterior side of the trachea. Resection of three tracheal rings was performed, with end-to-end anastomosis. Surgical outcome regarding nervous preservation and parathyroid glands was good as well as cosmetic aspect. During one-year follow-up, no indication of tumour recurrence was found. The management of locally invasive DTC has been controversial yielding the palliative surgery modalities. Advances in surgical technique have given a new perspective of resection in a difficult case. This case report was managed by sleeve resection with end-to-end anastomosis which showed a satisfactory outcome functionally and cosmetically. CONCLUSION: Sleeve resection with primary reconstruction of the trachea is a simple one-stage procedure which can adequately address the problem of tracheal invasion by thyroid cancer

Melanonychia striata: a case report

Melanonychia striata longitudinalis is a pigmented band in the long axis of the nail. The discoloration occured because of increase of melanin in the nail matrix. In most cases, especially in children, melanonychia striata is a benign condition. In this case report a 12-years-old male with melanonychia striata. Longitudinal excision was performed with histopathology examination to rule out malignancy and further management

Correlation of CD8+ Expression, Foxp3+ Expression, and CD8+/Foxp3+ Ratio with Triple Negative Breast Cancer Stage in Sanglah General Hospital

BACKGROUND: Triple negative breast cancer (TNBC) is a breast cancer sub-type that lacks ER, PR and HER-2 expression. This type tends to be more aggressive than other types of breast cancer, with poor prognosis, distant metastases, higher recurrence rate, and lower overall survival. The TNBC is resistant to hormonal therapy, but generally very susceptible to chemotherapy. Expression of CD8+ and Foxp3+ were parts of the TIL, which often found in TNBC as an immune response to tumour antigens following antigens presenting cell (APC) stimulation. AIM: This study was conducted to find out whether the expression of CD8+, Foxp3+ and CD8+/Foxp3+ ratio was associated with the stage of TNBC. METHODS: This cross-sectional study was conducted from January 2014 until December 2016 at Sanglah Hospital with 46 research subjects. Two paraffin blocks were prepared for each sample to examine the CD8+ expression and Foxp3+ expression. Data were analysed using the Chi-Square test or Fisher's Exact tests as an alternative for bivariate analysis and logistic regression for multivariate analysis. RESULTS: On bivariate analysis, we found a low of CD8+ expression in advanced stage (p < 0.001 with OR 3.5; CI 1.611-7.727). Expression Foxp3+ in advanced stage (p = 0.482; OR 0.8; CI 0.497-1.374), while the ratio of CD8+/Foxp3+ (p = 0.213; OR 2.2; CI 0.650-7.132). On multivariate analysis, a low of CD8+ expression (adjusted OR 16.5; CI 3.735-7.370; p < 0.001) was obtained. CONCLUSION: Low expression of CD8+ was associated with the advanced stage of TNBC. The risk of becoming an advanced stage in TNBC patients with low CD8+ expression was 16.5 times higher than those with high of CD8+ expression. High expression of Foxp3+ was not associated with an advanced stage of TNBC. The low CD8+/Foxp3+ ratio was not associated with the advanced stage of TNBC

Immunocytochemistry Test of Protein BRAF Expression for Diagnosis of Well Differentiated Thyroid Carcinoma

Background: Thyroid carcinoma generally has a good prognosis. The main focus of current research on thyroid carcinoma is to increase the accuracy of preoperative diagnosis of thyroid nodules. When the result of fine needle aspiration biopsy (FNAB) is indeterminate, clinicians often have doubts in determining the surgical management. Objective: Protein BRAF expression analysis can help improve the accuracy of FNAB and optimize the management of differentiated thyroid carcinoma. Methods: This study is a diagnostic test performed from October 2016 at Sanglah General Hospital with 38 patients as subjects who fulfilled the inclusion criteria. Data is being presented in descriptive form before diagnostic test is done to determine sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of immunocytochemistry test for BRAF on indeterminate thyroid nodule. Results: Thirty-eight samples met the inclusion criteria during the study period. Three samples were male (7.9%) and 35 samples (92.1%) were female. The mean age of the sample was 45.21 years (SD ±10.910 years) with ages ranging from 23 to 66 years. Of the 12 samples undergoing isthmolobectomy, 7 samples (58.4%) were determined to be malignant from histopathological results. The sensitivity value of BRAF immunocytochemistry test is 45.45% with a specificity value of 81.25%, a positive predictive value of 76.92%, a negative predictive value of 52% and an accuracy of 60.50%. Analysis of the receiver operator (ROC) curve shows the area under the curve (AUC) of 63.4% with a confidence interval of 45.5–81.2%. Conclusion: Immunocytochemistry BRAF test have a reliable diagnostic value and can be taken into consideration in the preoperative diagnosis of thyroid malignancies

Potensi mikrosfer kombinasi fukoidan dan mirna-200c sebagai inovasi penatalaksanaan kanker payudara kemoresisten

Kanker payudara adalah penyakit tidak menular dan juga masalah kesehatan utama di dunia. Berdasarkan data WHO pada 2012, kejadian kanker payudara dilaporkan sebanyak 1,67 juta kasus. Salah satu penyebab morbiditas dan mortalitas tertinggi pada kanker payudara adalah kemoresisten. Tujuan: Untuk menggambarkan potensi kombinasi mikrosfer fukoidan dan miRNA-200c sebagai terapi untuk kanker payudara kemoresisten. Metode: Dilakukan telaah pada literatur tervalidasi seperti jurnal dan website. Kata kunci yang digunakan yaitu “Fucoidan” dan “Chemoresistant breast cancer and miRNA-200c” pada search engine www.pubmed.com dan scholar.google.com. Dari 77 jurnal yang ditelaah, 55 jurnal ditemukan sesuai dengan topik bahasan dan digunakan sebagai referensi karya ini. Hasil: Kombinasi mikrosfer ini akan membawa sel target spesifik dalam kemoresistensi kanker payudara. Fukoidan sebagai agen pro-apoptosis mempengaruhi banyak sel target (multi-target) untuk menginduksi apoptosis. Sementara itu, ekspresi miRNA-200c menginduksi Mesenchymal Epithelial Transition (MET) dengan menghambat ZEB1, ZEB2 dan TGF-β2 sebagai anti-metastasis pada chemoresistance kanker payudara. Simpulan: Kombinasi mikrosfer fukoidan dan miRNA-200c memiliki potensi yang menjanjikan sebagai pengobatan baru untuk kemoresistensi kanker payudara, karena sifat proapoptotik dan anti metastasis yang manjur. Namun, belum ada penelitian yang mengevaluasi kombinasi ini. Jadi studi lebih lanjut diperlukan untuk mengkonfirmasi potensi sebenarnya dari kombinasi mikrosfer fukoidan dan miRNA-200c

Pretreatment Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio as a Stage Determination in Breast Cancer

BACKGROUND: Breast cancer tends to respond differently to treatments, which are usually determined by clinicopathological characteristics. Several studies evaluated the role of the peripheral blood test as diagnostic and prognostic markers in several types of solid cancer and neutrophil-to-lymphocyte ratio (NLR) and platelet-tolymphocyte ratio (PLR) are two of them which already tested. However, the evidence in breast cancer is still lacking. AIM: Therefore, the study aimed to investigate the value of NLR and PLR as biomarkers concerning breast cancer stage. METHODS: A retrospective study was conducted using breast cancer patients’ medical records from 2014 to 2019 at Sanglah General Hospital. The histopathological records and complete blood counts of the patients were collected and analyzed risk analysis model, receiver operator characteristics analysis, and correlation of NLR and PLR with cancer staging analysis used correlation test. RESULT: One hundred five patients data were used in this study, with 35 subjects had early-stage breast cancer while 70 subjects had an advanced stage. Breast cancer staging with NLR and PLR showed significant associations (p < 0.001). Both NLR and PLR had area under the curve >0.7 (p < 0.001). The cutoff, sensitivity, and specificity values of NLR and PLR were 2.504 (71%; 70%) and 157.1 (73%; 70%). Advanced stage of breast cancer was mostly found in high NLR and PLR value with (OR: 4.231; CI = 1.791-9.995, p < 0.001) and (OR: 3.949; 95% CI = 1.679–9.287; p < 0.001). CONCLUSION: From this preliminary study, pretreatment NLR and PLR values might determine the breast cancer stage. Further research is needed to evaluate the association between grade and patient survival

Successful Limb-Sparing Wide Excision of a Giant Lipofibromatosis in a 5-Year-Old Girl

A 5-year-old girl presented with a big painless mass, sized 24 × 37 × 35 cm, in her lower left limb. MRI revealed a huge heterogeneous mass splaying from the left distal femur to the calcaneal region without bony erosion but compressing the arteries and causing bowing of the left tibia and fibula bones. The difficulty was to determine the best course of action taken which would either be limb salvation or amputation. Considering that only a few muscles could be saved, the author initially recommended amputation but still considered a limb-sparing procedure. After a double set-up examination in the operating room, the author ultimately decided to save the affected limb. The salvaged limb was found to be viable after the surgery, and there was no further recurrence over a subsequent 6-month follow-up period. The careful surgical decision is vital in giving the best possible care to the patient