Factors Predicting Microinvasion in Ductal Carcinoma in situ

Background: Whether sentinel lymph node biopsy (SLNB) should be performed in patients with pure ductal carcinoma in situ (DCIS) of the breast has been a question of debate over the last decade. The aim of this study was to identify factors associated with microinvasive disease and determine the criteria for performing SLNB in patients with DCIS. Materials and Methods: 125 patients with DCIS who underwent surgery between January 2000 and December 2008 were reviewed to identify factors associated with DCIS and DCIS with microinvasion (DCISM). Results: 88 patients (70.4%) had pure DCIS and 37 (29.6%) had DCISM. Among 33 DCIS patients who underwent SLNB, one patient (3.3%) was found to have isolated tumor cells in her biopsy, whereas 1 of 14 (37.8%) patients with DCISM had micrometastasis (7.1%). Similarly, of 16 patients (18.2%) with pure DCIS and axillary lymph node dissection (ALND) without SLNB, none had lymph node metastasis. Furthermore, of 20 patients with DCISM and ALND, only one (5%) had metastasis. In multivariate analysis, the presence of comedo necrosis [relative risk (RR)=4.1, 95% confidence interval (CI)=1.6-10.6, P=0.004], and hormone receptor (ER or PR) negativity (RR=4.0, 95% CI=1.5-11, P=0.007), were found to be significantly associated with microinvasion. Conclusions: Our findings suggest patients presenting with a preoperative diagnosis of DCIS associated with comedo necrosis or hormone receptor negativity are more likely to have a microinvasive component in definitive pathology following surgery, and should be considered for SLNB procedure along with patients who will undergo mastectomy due to DCIS

Laparoscopic management of chronic gastric volvulus: A case report

Gastric volvulus (GV) is a rare pathological entity, which is difficult to diagnose, may rapidly progress to infarction and necrosis of the stomach, and can be fatal. A 68-year-old woman presented to the surgical outpatient clinic of Istanbul University, Istanbul Faculty of Medicine, in August, 2006, with a 3-month history of nausea, vomiting, and recurrent abdominal pain. Physical examination revealed epigastric tenderness, but otherwise within normal limits. An urgent abdominal computed tomographic examination revealed only a paraesophageal hernia. A mesenteroaxial gastric volvulus with a large paraesophageal hernia was found on laparoscopy. The surgical procedure involved derotation of the stomach and closure of the paraesophageal hernia with a dual V-shaped graft gastropexy to the triangular ligament of liver; in addition, a laparoscopic cholecystectomy was performed. We found that derotation of stomach and gastropexy to the triangular ligament is technically easy to perform and is a safe procedure in the treatment of gastric volvulus

Videoendoscopic Single-Port Nipple-Sparing Mastectomy and Immediate Reconstruction

Purpose: Single-incision videoendoscopic surgery has recently become popular as a result of the ongoing search for less invasive procedures. The aim of this study was to evaluate the safety and efficacy of endoscopic single-port nipple-sparing mastectomy, axillary lymphadenectomy, and immediate reconstruction in patients with breast cancer. Patients and Methods: From May 14, 2012 through January 23, 2013, 10 patients underwent videoendoscopic single-port nipple-sparing mastectomy and axillary dissection via a single, limited incision and immediate prosthetic reconstruction. Patient charts were reviewed, and demographic data, operative time, complications and pathology results were analyzed. Results: In all patients, videoendoscopic surgery was performed successfully. Of 10 patients, 7 were diagnosed as having invasive ductal carcinoma, 2 had a ductal carcinoma in situ, and 1 underwent bilateral prophylactic mastectomy. The weight of the resected gland was 300-650g, with a mean of 420g. There were no operative complications, and the mean operative time was 250 minutes (range, 160-330 minutes). One-stage reconstruction with implants was performed on 4 patients, whereas expanders were placed in the remaining 6. Surgical margins of all cases were pathologically negative, and there were no recurrences observed during the early follow-up period. Conclusions: Videoendoscopic single-port nipple-sparing mastectomy is technically feasible even in larger breasts, enabling immediate reconstruction with good cosmetic outcomes. However, further studies with larger clinical series and long-term follow-up are required to compare the safety and efficacy of the technique with those of the standard nipple-sparing mastectomy

NODULAR PSEUDOANGIOMATOUS STROMAL HYPERPLASIA OF THE BREAST: A CASE REPORT

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a rare benign tumoral lesion of mammary stroma containing complex anastomosing spaces. This uncommon proliferative lesion is in differential diagnosis with angiosarcoma in histopathological examinations. A 38 year-old woman was admitted to our clinic with a complaint to of mastalgia and a mass in her right breast since six years. Ultrasonographic examinations revealed 4 cm mass with a diagnosis of fibroadenoma. Total excision of the mass was performed without any complications. Histopathologic examimation revealed pseudoangiomatous stromal hyperplasia

SURGICAL-TREATMENT OF HEPATIC HYDATID-DISEASE

The results of surgery in 38 patients with hepatic hydatid disease are described. Cystectomy was done in four patients with small peripheral cysts. For them the mean postoperative stay was 8.2 days. Partial cystectomy, introflexion and omentoplasty were performed in 28 patients with uncomplicated large cysts. The mean postoperative stay for these patients was 8.6 days. One patient in this group died of massive hemorrhage and disseminated intravascular coagulation. Exploration of the common bile duct and choledochoduodenostomy were required in three patients who had large cysts complicated by rupture into the biliary tree. This complication resulted in a mean postoperative stay of 11.5 days. Three patients who had cysts complicated by pyogenic infection were treated with tube drainage. They were discharged with their tubes in place after a mean hospital stay of 26.5 days

Primary ovarian cancer presenting with axillary lymph node metastases: A report of two cases

Background: Axillary lymph node metastasis of primary ovarian cancer is rare

OSTEORADIONECROSIS ON THE CHESTWALL DUE TO RADIOTHERAPY

Osteoradionecrosis is a rare, but severe complication of radiation therapy in patients with breast cancer. Radionecrosis developed in a 40-year-old patient 10 months after radiation therapy for breast cancer. The patient was hospitalized and operated on for chest wall necrosis. The results of the treatment were evaluated and discussed under the light of the literature