Surgical oncology
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Case Reports
Patients blue on patent blue: an adverse reaction during four sentinel node procedures.
Patent blue V is a well-known dye for visualisation of the lymph nodes in a sentinel lymph node biopsy in breast carcinoma. We present four cases of an adverse reaction to patent blue V, one of which was an anaphylactic shock. The adverse reactions to patent blue and isosulphan blue as found in the literature are discussed and an alternative is suggested.
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Review Case Reports
Hepatoid malignancy of unknown origin--a diagnostic conundrum: review of literature and case report of collision with adenocarcinoma.
Hepatoid carcinomas are a group of neoplasms with features resembling hepatocellular carcinomas. Although rare, more cases have been noted to arise from various organs within the last decade. Differentiating these tumors is not only a challenge but also critical, since treatment modalities and operative strategies are dependent upon the exact nature of the hepatoid cancer. Based on a review of literature, we discuss the guidelines for differentiating these tumors and utilize these criteria to differentiate these tumors irrespective of their primary tissue of origin. We also describe an unusual case of hepatoid variant of primary peritoneal yolk sac tumor presenting with extensive carcinomatosis and as a collision with two synchronous primary colonic adenocarcinomas, neither of which has been reported to our knowledge to date, thereby falsely mimicking metastatic dedifferentiated colonic adenocarcinoma. ⋯ The most likely explanation in our case is that the hepatoid tumor either originated from microscopic remnant ovarian tissue left behind or primarily from the peritoneum. With no evidence of yolk sac component within the colonic tumor or in the draining lymphatics, this essentially excludes the commonly observed metastatic dedifferentiation (opisthoplasia) of adenocarcinoma to primitive forms (also known as combination tumors). Based on analysis of various factors, including tumor behavior and response to chemotherapy, we conclude that our case was a hepatoid variant of yolk sac tumor presenting in an elderly woman with carcinomatosis. This unusual presentation of two entirely different primary malignancies in close proximity is defined as "collision tumor". This is the first reported case of collision tumors involving dual colonic and primary peritoneal hepatoid-YST. Identifying the exact type still remains to be the most challenging aspect in the diagnosis of hepatoid tumors.
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Surgical resection remains the mainstay of therapy for early stage non-small cell lung cancer (NSCLC). Unfortunately, many patients present with advanced stage disease, and many with resectable early stage disease are unable to tolerate pulmonary resection because of compromised cardiopulmonary function. This article reviews the standard and some alternative therapies that are being introduced into clinical practice for early stage NSCLC. New therapies such as sublobar resection with brachytherapy, radiofrequency ablation and stereotactic radiosurgery offer some hope for those patients who are deemed poor candidates for curative resection.
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Meta Analysis
Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models.
To review two predictive models, based on the American Society of Anaesthesiologists (ASA) and the Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (POSSUM)-used for estimating postoperative mortality in patients, undergoing surgery for colorectal disease, in the UK. ⋯ Prediction of postoperative death can be made by the clinician using simple, numerical, tables derived from the ACPGBI CRC, MBO and CR-POSSUM models. The models can be used in everyday practice for pre-operative counselling of patients and their carers, as a part of the process of informed consent. They may also be used to compare the outcomes between multidisciplinary CRC teams.
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Increasing numbers of women are using hormone replacement therapy (HRT) in their 50s and 60s. Oestrogen alone or oestrogen and progestogen combined given in this age group increase breast density and this has the effect of reducing both the sensitivity and specificity of breast screening in HRT users. HRT significantly increases the risk of developing breast cancer with combinations of oestrogen and progestogens increasing the risk to a greater degree than oestrogen alone. ⋯ Prospective randomised trials are underway but are unlikely to include sufficient numbers to exclude a small adverse influence of HRT on breast cancer mortality. Tibolone, a gonadomemetic agent which has been used to control menopausal symptoms, appears to have less direct effects on the breast and is being evaluated as an alternative to oestrogen in breast cancer survivors who develop significant menopausal symptoms resistant to non-hormonal therapies. There is clear evidence that HRT causes breast cancer and the challenge for the physician is to control the menopausal symptoms using HRT or alternatives while at the same time limiting the risks associated with this treatment.