Breast and Axillary Lymph Nodes Metastasis five years after Radical Nephrectomy for Renal Cell Carcinoma A Case Report and Review of the Literature

Breast is an uncommon and rare site for metastasis. Primary and secondary tumors of the breast need to be differentiated as management is different. We present a 67 year old female patient with two breast lumps and an axillary lymph node, 5 years after nephrectomy for Renal Cell Carcinoma (RCC). Mammogram report showed a dense spiculated mass at right upper outer quadrant and a retroareolar mass associated with clustered micro calcifications. Fine Needle Cytology and trucut biopsy were inconclusive. Computer Topography (CT) abdomen did not show evidence of RCC recurrence. After discussion with the patient, she underwent mastectomy with axillary clearance and the final histopathology report was consistent with metastasis from RCC. The management of this case is discussed

Metaplastic breast carcinomas: a report of six cases

Metaplastic breast carcinomas (MBCs) are rare primary breast malignancies characterized histologically by carcinoma of two epithelial types or co-existence of carcinoma with non-epithelial cellular elements. They are aggressive tumours that carry poor prognosis. We reviewed the pathologic features and clinical outcomes of MBCs seen in our institution between the years 2000 to 2007. Out of 471 breast cancer patients, six female patients were histologically-proven to have MBCs giving an incidence rate of 1.3%. The patients comprised four Malays and two Indians and their mean age was 51 years old. Five patients underwent mastectomy (four with axillary clearance and one without) and one had wide local excision with axillary clearance. Axillary lymph node involvement was seen in four patients (three with epithelial only type tumour and one with the biphasic tumour). In all the cases, the tumours were bigger than 5 cm in diameter (T3), grade 3 and estrogen receptor negative. Five patients received chemotherapy while one refused. All of the patients had tumour recurrence with a mean time of recurrence of 9 months. In conclusion, metaplastic breast carcinomas are rare and aggressive tumours usually affect the post menopausal age group. They present as aggressive, large sized, high grade tumours that are estrogen receptor negative. Tumour size and axillary lymph node involvement indicate poor prognosis. Despite treatment with chemotherapy and radiotherapy, these patients have high risk of local recurrence and distant metastases which are potentially fatal

Fine Needle Aspiration (FNA) cytology of the thyroid: A Cyto-Histopathological study of 361 cases in Hospital Universiti Kebangsaan Malaysia

Thyroid nodules are common but thyroid malignancies are not. Fine needle aspiration (FNA) cytology is a diagnostic tool used to screen patients with thyroid nodules who require surgery. We study the diagnostic accuracy of FNA as the initial diagnostic modality in the clinical assessment of thyroid nodules. Between January 1995 until December 2000, 2131 FNA of thyroid nodules were performed. Four hundred and forty-one (20.7%) of these were unsatisfactory and 1690 (79.3%) cases were satisfactory for cytological evaluation. Histopathological diagnosis were available for 361 cases. Cyto-histopathological correlation was carried out for these cases. Our results showed a diagnostic accuracy of 96.2% with sensitivity and specificity rates of 87.7% and 98.4% respectively. Our positive predictive value is 93.4% and our negative predictive value is 96.8%. From this study, we conclude that fine needle aspiration is an important initial screening diagnostic tool for the investigation of thyroid nodule

Preemptive Ropivacaine Local Anaesthetic Infiltration Versus Postoperative Ropivacaine Wound Infiltration in Mastectomy: Postoperative Pain and Drain Outputs

The aim of this study was to investigate if preemptive local infiltration (PLA) with ropivacaine could improve postoperative pain and determine its effect on drain output postmastectomy with axillary dissection. Methods: This was a prospective, randomized trial comprising 30 women allocated to two groups: one to receive postoperative wound infiltration (POW) of 20 mL of 0.2% (40 mg) ropivacaine (Naropin(r)) versus PLA with 20 mL of 0.2% ropivacaine (Naropin(r)) diluted with 80 mL of 0.9% saline, total volume 100 mL. A visual analogue scale (0-100 mm) and angle of shoulder abduction were used for evaluation of pain. Postoperatively, all patients received oral ibuprofen 400 mg tds. Results: There was no significant difference in postoperative pain for the first 3 days between the two groups. There were wider shoulder abduction angles in the 1st and 3rd postoperative days in the PLA group, but this was not significant. Operative time was significantly shorter in the PLA group than in the POW group (69.34 ± 59.37 minutes vs. 109.67 ± 26.96 minutes; p = 0.02). The axillary drain was removed earlier in the preemptive group, 5.4 ± 1.55 days versus 6.8 ± 2.04 days in the postoperative group (p = 0.04). Conclusion: We found no difference in postoperative pain between preemptive tumescent ropiva-caine infiltration and postoperative ropivacaine wound infiltration