Cervical mature teratoma 17 years after initial treatment of testicular teratocarcinoma: report of a late relapse

BACKGROUND: Late relapses of testicular germ cell tumor are uncommon. We report a case of cervical mature teratoma appeared 17 years after treatment of testicular teratocarcinoma. CASE PRESENTATION: A 20- year- old patient underwent left sided orchiectomy followed by systemic therapy and retroperitoneal residual mass resection in 1989. He remained in complete remission for 200 months. In 2005 a huge left supraclavicular neck mass with extension to anterior mediastinum appeared. Radical surgical resection of the mass was performed and pathologic examination revealed mature teratoma. CONCLUSION: This is one of the longest long-term reported intervals of a mature teratoma after treatment of a testicular nonseminoma germ cell tumor. This case emphasizes the necessity for follow up of testicular cancer throughout the patient's life

Inguinal sentinel lymph node biopsy with only blue dye in lower extremity malignant melanoma

Background: Sentinel lymph node (SLN) biopsy has become the standard of care in malignant melanoma, it is commonly identified by intradermal injection of both radiocolloid tracer and Patent Blue Dye (PBD) around the tumor. This study aims to evaluate the efficacy of PBD in identifying inguinal SLN and also the accuracy of SLN mapping performed by peritumoral injection of PBD without combined radioisotope in malignant melanoma of lower extremity.Methods: Thirty consecutive patients with primary melanoma of lower exteremity who were referred to Cancer Institute of Tehran University of Medical Science between March 2003 to March 2006 were enrolled in this study. All patients had a preoperative pathologic diagnosis of malignant melanoma, median breslow thickness (range 1-4 mm) and none had clinical or radiologic evidence of nodal involvement or distant metastases. At surgery PBD was injected around the lesion or scar of excisionl biopsy. Subsequently with a 5cm groin incision SLN Biopsy and complete lymph node dissection was done and all lymph nodes were sent for histopathologic examination. SLN examined by both hematoxylin-eosin and immunohistochemical staining.Results: SLN identification rate was 100%. No complication directly related to PBD injection was seen. Forty-eight sentinel lymph nodes and 195 non sentinel lymph nodes were harvested. Nineteen SLNS were found to be metastasic in 13 patients (47%). In these patients metastases were found in other inguinal lymph nodes.In the remaining 17 patients, both the SLN itself and the other removed nodes were negative for the metastatic involvement. Conclusions: Patent blue dye may be enough to identify superficial inguinal SLN in lower extremity melanoma

Ovarian metastasis in colorectal cancer: retrospective review of 180 cases

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Routine oophorectomy in women with colorectal cancer is under debate, the aim of this study is to determine incidence, clinicopathologic features and prognostic factors of ovarian involvement in primary colorectal cancer (CRC) and to clear the role of prophylactic oophorectomy."n"nMethods: Data from primary CRC women treated between years 1990 and 2004 were retrieved and clinical and pathologic features of those who had undergone oophorectomy during CRC surgery were reviewed."n"nResults: One hundred eighty cases (mean age 47.5 years) were included. In 120(66.6%), ovaries were preserved and 60(33.3%) cases underwent bilateral oophorectomy in addition to primary CRC resection. Reasons for oophorectomy were prophylactic in 22(36.6%), abnormal morphology in 35(58.3%), and undetermined in 3(5%) cases. There were five metastatic carcinomas, eight primary ovarian tumors and 47 normal ovaries in pathologic evaluation. No complication directly related to oophorectomy was noted. Patients with ovarian metastases had higher stages of tumor. Ovarian metastases were not related to menstrual status, CRC location, size, differentiation, and mucin production, as well as abnormal morphology of ovary. The global prevalence of ovarian metastasis in CRC was 2.7%, and isolated ovarian metastases occurred in less than half of them. Of 120 women that underwent colectomy alone, eight (6.6%) developed ovarian metastasis during two years of follow-up. Only three cased had isolated ovarian metastases. No patient with synchronous or metachronous ovarian metastases from CRC survived five years."n"nConclusion: Isolated ovarian metastases from primary CRC occur with a low frequency and this may partially explain the debate regarding prophylactic oophorectomy at the time of curative resection for primary CRC

Prevalence of ductal carcinoma insitu of the breast in Tehran university medical centers: evaluation of 2244 cases

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Detection rate of Ductal Carcinoma Insitu of the breast (DCIS) have increased rapidly over the past decade, which is generally attributed to the widespread use of screening mammography. The aim of this study was to evaluate the prevalence of ductal carcinoma in situ in patients who had been referred to Tehran university medical centers."n"nMethods: In a retrospective study, medical records of the patients with diagnosis of breast cancer in 3 teaching hospitals of Tehran University of Medical Sciences (Cancer Institute, Sina and Shariati Hospitals between 1994-2003) were reviewed and records with ductal carcinoma in situ were selected and analyzed."n"nResults: Between 2244 medical records of breast cancer 23 patients had DCIS (1.02%). Mean age was 47.3 years just one patient had been detected by screening mammography and others had clinical symptoms. 48% of patients had mass with mean size of 3.3cm. All had undergone open biopsy (four incisional, 19 excisional). Treatment included 65.2% modified radical mastectomy, 30.4% lumpectomy with axillary dissections and 3.8% lumpectomy alone. Nine patients had radiotherapy after surgery and ten took tamoxifen as hormonal therapy. Two patients (8.6%) in lumpectomy group had recurrence in follow ups. Median follow up time was 84 months."n"nConclusion: This study shows that the Prevalence of early stages of breast cancer especially ductal carcinoma in situ is extremely low. (DCIS was 1.02 in comparison with 15-30% in western countries). These findings indicate the need for increasing public information about breast cancer in Iran and improving screening programs of breast cancer

Letter to the Editor – The impact of COVID-19 on cancer multidisciplinary teams’ meetings and tumor boards: what should we think about to overcome and amend?

On December 2019, a viral pneumonia known as corona virus disease 2019 (COVID-19) was reported in China and it has spread rapidly throughout the world. The first official announcement of the first case of death due to COVID-19 was made on February 2020 in Iran and in a short time, Iran became known as one of the countries with the highest incidence of this disease. Until 11 April 2020, about 68192 people have been infected by COVID-19 and 4232 people have died due to COVID-19 infection in Iran (1). As the pandemic progresses, many challenges have arisen for other patients referred to hospitals and routine activities of medical centers are affected due to this issue in cancer patients as a high-risk population. Since care of cancer is increasingly complex and often requires specialized expertise from multiple disciplines, tumor board (TB) reviews provide a multidisciplinary approach to treatment planning that involves health care providers from different specialties reviewing and discussing the medical condition and treatment of patients. In the Cancer Institute of Tehran University of Medical Sciences (Figure 1) as a referral hospital, different tumor boards have been established as an accepted part of the care of cancer patients for many years. A great number of trainees from various disciplines who are participating in cancer treatment like residents and fellows are attending in these TB regularly. Table 1 shows the details of the most active tumor board in this hospital. The negative impacts of COVID-19 pandemic on our TB sessions can be summarized as follows: Lack of expert opinion for patient management. Lack of treatment protocol documentation and the resulted legal consequences with regard to suboptimal decisions. Lack of a great pool of educational and research resource which reduced the educational outcome of tumor board on residents and fellows despite converting to virtual TB. Difficulties in convincing patients to accept complex procedures. Considering the following important points can help us to overcome part of these negative impacts during the COVID-19 pandemic to some extent. Institutional protocols and guidelines should be prepared and updated regularly for site specific cancer patients depending on the severity of the pandemic. It may be wise if one of the official managers of the hospital participates in designing and registration of these protocols. TB used to recommend the best practice (for example category A of NCCN) for patients under treatment. In COVID-19 era, however, we should reconsider this routine and sometimes choose other safe but normally considered weaker practices. Deferring treatment of cancer patients in COVID era will face all cancer centers and hospital with a huge burden of neglected and maybe advanced or even metastatic tumors in near future which need more complicated treatments. Hospitals should prepare for this in advance. Before the COVID-19 era, TB documentation support for cancer patients was an important issue. During this time, when we have no choice but to change our practice for some patients and move from the best practice to other acceptable ones, this legal documentation is of utmost importance. It is probable that we face some legal conflicts with our patients after COVID-19 ceasing. Documentation and registration of cases in TB can prevent those problems and protect medical staff. As the duration of pandemic and future conditions of Health Care Centers are not predictable, it is very important to draw a whole treatment plan for cancer patients when we are deciding on postponing or changing our routine practice. It necessitates that all the multidisciplinary team (MDT) members have an active role in describing the whole roadmap of the patient treatment. A comprehensive list of other cancer treatment teams who are working in other centers and cities and building up an effective network with them can help us to guide our patients and prevent some unnecessary travels for surgery and even post-operative visits. It is important to keep our residents and fellows informed about the logic behind the change of our practice from the best and standard to what we are doing under COVID-19 pandemic situation. For instance, when we are performing a stoma instead of primary anastomosis for a colorectal cancer or a mastectomy for a breast conserving (2), we have to make sure that our trainees do not mistake this temporary practice for a standard routine. After the elimination of the COVID-19 pandemic, we should analyze the effects of this inevitable change in our MDT and study our patients’ responses to this. The virtual MDT clinics, for instance, may turn out to be a tool to decrease the patients’ anxiety and stress that result from attending a meeting in front of different disciplines members. Since the beginning of COVID-19 storm, our head and neck TB began to hold the meetings by creating a virtual group in WhatsApp social network with 26 participants. Around 10 complex cases were introduced and discussed, and decisions were made. Besides, an application for online visits was introduced to patients by sending them a message. They can message their physicians and call them via this application when necessary. In some countries, development of mathematical models and technological applications have been employed to overcome the challenges posed by COVID-19 (3). In our Cancer Institute, to compensate more for the negative impact of COVID-19 on our session, we designed and launched MDT management software which has the capability of registering patients, uploading their medical documents, finalizing the decision and saving the final document of the MDT result. Using other virtual software like Webinars and etc. should also be considered. Finally, health care providers should know about the cost-benefits of a selection of different treatment modalities in cancer patients considering the risk of COVID-19 infection. Making these decisions is inconceivable without using MDT potentials. Therefore, we should do the maximum efforts not to permit COVID-19 to ruin MDT sessions

Intrathoracic migration of preoperative breast localization wire: a rare case report

Objective: Preoperative needle localization under ultrasound or stereotactic guidance is an integral part of breast cancer surgery. Procedure related complications are rare, and migration of the localization wire is extremely rare. Herein, we present a case of wire migration from the breast to the lung apex in a 49-year-old woman, who refused the therapeutic removal of wire for one year after migration. Case presentation: Preoperative wire localization under ultrasound was performed in a patient with a non-palpable breast cancer. The wire could not be found during lumpectomy and it had been proven to be in thoracic cavity in recovery room. The patient refused any intervention for wire removal; accordingly, she underwent external radiation therapy following breast-conserving surgery. The computed tomography (CT) scan confirmed the fixed wire position at 3, 6, 9, and 12 months after wire migration. Despite frequent explanations about the possible late complications, she refused wire removal until one year. During this period, she was closely followed-up for the wire position via imaging. Finally, after 12 months, the patient accepted wire removal by video-assisted thoracoscopic surgery (VATS) which was performed without complication. Conclusions: Although preoperative wire localization for occult breast lesion is effective and safe, rare complications like migration have been reported and need early intervention

Congestive Heart Failure versus Inflammatory Carcinoma in Breast

Inflammatory breast cancer is a rare highly malignant form of breast cancer. Clinical signs and symptoms with histologic examination usually confirm the diagnosis. There are rare reports of breast edema of congestive heart failure which were difficult to differentiate from inflammatory carcinoma. The differential becomes more difficult when congestive heart failure is associated with unilateral breast edema. We present a case of a 70-year-old woman with congestive heart failure associated with unilateral breast edema and skin thickening simulating inflammatory breast carcinoma on mammography

TRANSMURAL MIGRATION OF SURGICAL SPONGE INTO CECUM: A RARE CASE REPORT

Retained foreign body in the abdominal cavity following surgery is a continuing problem. We report a case of an 18 year old man who was referred with abdominal pain and cecal mass. Clinical exam, computed tomography scan and colonoscopy were suggestive of cecal tumor. Laparotomy confirmed a retained surgical sponge which had migrated from peritoneal cavity into cecum