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Ugeskrift For Laeger Sep 2022With the introduction of screening mammography, the proportion of smaller, clinically recognised tumors has increased. In cases in which lesions cannot be palpated, a... (Review)
Review
With the introduction of screening mammography, the proportion of smaller, clinically recognised tumors has increased. In cases in which lesions cannot be palpated, a guidewire or a wireless marker is placed. Wire localization is associated with several limitations, despite its status as gold standard. Several wireless methods that meet these limitations have been developed. Methods that increase efficiency and patient satisfaction. This review provides an overview of the existing literature on intra-operative localization methods, and the risk of re-resection associated with excision of non-palpable mammary lesions.
Topics: Breast; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mastectomy, Segmental
PubMed: 36205159
DOI: No ID Found -
Indian Journal of Otolaryngology and... Dec 2022Styloid process is a long and slender osseous projection protruding downward, forward and slightly medially from the temporal bone and serves as an anchor point for...
Styloid process is a long and slender osseous projection protruding downward, forward and slightly medially from the temporal bone and serves as an anchor point for various muscles associated with the tongue and the larynx. The aim of the present study was to record the length and the angle of Styloid process on three dimensional computed tomography in patients with unilateral symptomatic and palpable styloid process and compare the length and the angle of styloid process of symptomatic side to asymptomatic side on three dimensional computed tomography. 3D-CT face reconstruction were perfomed in all 35 patients (17 females, 18 males of age range 25-69 years). The length of the styloid process and its angulation (transverse and sagittal angles) were measured by means of three dimensional and multiplanar reconstruction images. The length of styloid process on symptomatic side had a mean of 33.61 ± 5.08 mm while on asymptomatic side mean was 31.11 ± 5.02 mm. The mean transverse angle on symptomatic sides had a mean of 72.37° ± 4.48° while on asymptomatic side mean was 74.17° ± 4.48°. The mean sagittal angle seen on symptomatic side was 88.11° ± 5.21° while on asymptomatic side was 87.88° ± 5.03°. Symptomatic side has a longer styloid. Length of the styloid process has a statistical correlation with the symptoms and symptomatic side has a longer styloid. Though there was a difference in transverse and sagittal angulation in symptomatic versus asymptomatic side; but it was not statistically significant. On examination of the opposite asymptomatic side, 5 patients had a palpable styloid process therefore we infer that long styloid process may not always be associated with symptoms. Patients with cervicofacial pain should be evaluated for Eagle syndrome by palpation of styloid process in the tonsillar fossa and further by three dimensional computed tomography (3D-CT). 3D CT is an effective tool in evaluating patients with cervicofacial pain and making a diagnosis of Eagle's syndrome. Therefore, 3D CT should be performed while evaluating patients with these symptoms.
PubMed: 36742646
DOI: 10.1007/s12070-021-02901-5 -
World Journal of Clinical Cases Jun 2023Fibromatosis-like metaplastic carcinoma is classified as a rare type of metaplastic carcinoma of the breast by the 2012 WHO pathological and genetic classification...
BACKGROUND
Fibromatosis-like metaplastic carcinoma is classified as a rare type of metaplastic carcinoma of the breast by the 2012 WHO pathological and genetic classification criteria for breast tumors, which takes hyperplastic spindle cells as the main component and is often misdiagnosed as benign stromal proliferative lesions or benign mesenchymal tumors of the breast because of its mild morphology. Here, we collected the clinical data of 2 cases of fibromatosis-like metaplastic carcinoma of the breast and performed pathomorphological observation and immunohistochemical staining of the surgically resected specimens. According to the clinical features, imaging features, immunophenotype, diagnosis and differential diagnosis of 2 cases of fibromatosis-like metaplastic carcinoma of the breast, it was further differentiated.
CASE SUMMARY
Case 1: A 56-year-old postmenopausal female was admitted due to "right breast mass for over 1 year and local ulceration for over 1 mo". Physical examination showed a mass with a diameter of 4.5 cm × 5.5 cm palpable at 2.5 cm from the nipple at 1 o'clock in the right breast. The skin on the surface of the mass ruptured about 3 cm, with a small amount of exudation and bleeding, less clear boundary, hard texture, fair activity, without obvious tenderness. No obvious abnormality was palpable in the left breast. No enlarged lymph nodes were palpable in the bilateral axillae and bilateral supraclavicular region. After removing the mass tissue, it was promptly sent to the pathology department for examination. Case 2: Female, 52-years-old, premenopausal, admitted due to "right breast mass for more than 3 mo". Physical examination showed a 4.0 cm × 4.0 cm diameter mass palpable at 2.0 cm of the nipple in the lower outer 7 o'clock direction of the right breast, with less clear boundary, hard texture, fair activity, no significant tenderness, no palpable significant abnormalities in the left breast, and no palpable enlarged lymph nodes in the bilateral axillae and bilateral supraclavicular region. The mass was resected and sent for pathological examination. Postoperative pathological examination revealed fibromatosis-like metaplastic carcinoma of the breast in both patient 1 and patient 2. No systemic therapy and local radiotherapy were performed after surgery, and no tumor recurrence or metastasis was observed.
CONCLUSION
Fibromatosis-like metaplastic carcinoma of the breast is a rare subtype of metaplastic carcinoma that is often misdiagnosed, and the diagnosis relies on medical history collection, complete sampling, and full use of immunohistochemical assessment. The risk of lymph node and distant metastasis is low, and the current treatment is based on complete surgical resection. The efficacy of systemic radiotherapy and chemotherapy is not clear.
PubMed: 37449215
DOI: 10.12998/wjcc.v11.i18.4384 -
Acta Otorhinolaryngologica Italica :... Dec 2023Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate...
OBJECTIVES
Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complications. We describe five cases of pre-operative USGW localisation of non-palpable head and neck lesions to facilitate surgical localisation and resection.
METHODS
All patients undergoing pre-operative USGW localisation for non-palpable tumours of the head and neck region at London Health and Sciences Center, London, Ontario, Canada, were included. All the USGW localisations were performed by the same interventional radiologist, and the surgeries were performed by fellowship trained head and neck surgeons.
RESULTS
Five patients were included. All patients were undergoing revision surgery for recurrent or persistent disease. All successfully underwent a pre-operative USGW localisation of the non-palpable lesion before revision surgery. All lesions were localised intra-operatively with no peri-operative complications.
CONCLUSIONS
USGW localisation is a safe and effective pre-operative technique for the identification of small non-palpable head and neck tumours.
Topics: Humans; Head and Neck Neoplasms; Neck; Preoperative Care; Ultrasonography, Interventional
PubMed: 37519136
DOI: 10.14639/0392-100X-N2280 -
Journal of the West African College of... 2023Presently, histology is the gold standard in definite diagnosis of breast masses. Ultrasound is a relatively cheap, non-invasive, and non-ionizing imaging modality which...
INTRODUCTION
Presently, histology is the gold standard in definite diagnosis of breast masses. Ultrasound is a relatively cheap, non-invasive, and non-ionizing imaging modality which is widely available in most hospitals. An assessment of its accuracy in diagnosing breast masses is necessary to minimize unwarranted biopsies.
AIM AND OBJECTIVES
This study aims to correlate the ultrasonographic and histopathologic findings in the diagnosis of patients with palpable breast masses.
MATERIALS AND METHODS
This was a cross-sectional hospital-based study, which involved 100 consecutive patients who presented with palpable breast masses in Zaria. This was carried out for a period of 7 months (November 2016-June 2017). They had a clinical breast examination to identify the mass, which was then imaged and biopsied via ultrasound-guided fine needle aspiration cytology.
RESULTS
The generated data were analysed using SPSS version 23.0 (Chicago, IL, USA). There were more benign masses (63%) than malignant masses (29%). On correlating the final diagnosis of ultrasound to that of histology, it was found to have a sensitivity of 89%; specificity of 94%; positive predictive value of 89%; negative predictive value of 94%; and accuracy of 92%.
CONCLUSION
This study shows that there was a correlation between ultrasound and histology findings in differentiating between benign and malignant masses. This proves that ultrasound has a significant role to play in evaluating and diagnosing clinically palpable breast masses.
PubMed: 36923804
DOI: 10.4103/jwas.jwas_218_22 -
Acta Medica Portuguesa 2001After reviewing the clinical, diagnostic and therapeutic attitude related to Benign Prostatic Hyperplasia, the authors present the guidelines for Generalists, in terms...
After reviewing the clinical, diagnostic and therapeutic attitude related to Benign Prostatic Hyperplasia, the authors present the guidelines for Generalists, in terms of practical handling and when and how to refer their patients to the Urology consultation. Based on the criteria presented, Generalists must refer their patients to the Urology consultation in the presence of mild or severe symptoms, ages below 50 years, diabetes or neurological disturbances, disturbed voiding, palpable bladder, palpable nodule or a diffusely hardened or asymmetric gland revealed by digital rectal examination, hematuria, urinary tract infection, renal impairment or PSA above 4 nglml in patients aged below 70 years.
Topics: Algorithms; Clinical Protocols; Humans; Male; Prostatic Hyperplasia
PubMed: 11482317
DOI: No ID Found -
Breast Cancer Research and Treatment Nov 2022Screen-detected unilateral non-palpable breast cancer (NPBC) shows favorable prognosis, whereas bilateral breast cancer (BBC), especially synchronous BBC (SBBC)...
PURPOSE
Screen-detected unilateral non-palpable breast cancer (NPBC) shows favorable prognosis, whereas bilateral breast cancer (BBC), especially synchronous BBC (SBBC) manifests worse survival than unilateral breast cancer (BC). It remains unclear whether screen-detected bilateral NPBC has compromised survival and requires intensified treatment or favorable prognosis and needs de-escalating therapy.
METHODS
From 2003 to 2017, 1,075 consecutive NPBC patients were retrospectively reviewed. There were 988 patients with unilateral NPBC (UniNPBC), and 87 patients with ipsilateral NPBC + any contralateral BC [(N + AnyContra) PBC], including 32 patients with bilateral NPBC (BiNPBC) and 55 patients with ipsilateral NPBC + contralateral palpable cancer [(N + Contra) PBC]. Median follow-up time was 91 (48-227) months. Clinicopathological characteristics were compared between UniNPBC and BBC, whereas relapse-free survival (RFS) and overall survival (OS) among BBC subgroups. RFS and OS factors of BBC were identified.
RESULTS
Compared to UniNPBC, patients with screen-detected bilateral BC had more invasive (85.1%, 74.8%), ER negative (26.4%, 17.1%), PR negative (36.8%, 23.5%), triple-negative (21.6%, 8.5%) BC as well as less breast conserving surgery (17.2%, 32.4%), radiotherapy (13.8%, 32.0%) and endocrine therapy (71.3%, 83.9%). 10 year RFS and OS rates of (N + AnyContra) PBC (72.8%, 81.5%), (N + Contra) PBC (60.6%, 73.9%), and synchronous (N + Contra) PBC (58.1%, 70.1%) were significantly compromised compared to UniNPBC (91.0%, 97.2%). RFS factors of BBC included pN3 (p = 0.048), lymphovascular invasion (p = 0.008) and existence of contralateral palpable interval BC (p = 0.008), while the OS relevant factor was pN3 (p = 0.018).
CONCLUSION
Screen-detected bilateral NPBC including SynBiNPBC and MetaBiNPBC showed good prognosis as UniNPBC so that the therapy of BiNPBC could be de-escalated and optimized according to UniNPBC. Contrarily, screen-detected ipsilateral NPBC with contralateral palpable BC [(N + Contra) PBC] manifested unfavorable survival worse than UniNPBC and synchronous (N + Contra) PBC had the worst survival among all subgroups, implying that these were actually bilateral interval BC and required intensified treatment.
Topics: Humans; Female; Breast Neoplasms; Neoplasm Staging; Retrospective Studies; Neoplasm Recurrence, Local; Prognosis; Hospitals; China
PubMed: 36166112
DOI: 10.1007/s10549-022-06747-5 -
African Journal of Paediatric Surgery :... Apr 2024Bezoars are indigestible lumps which are usually found in stomach. Types of bezoar include phytobezoar, trichobezoar, lithobezoar, pharmacobezoar, plasticobezoar,... (Review)
Review
BACKGROUND
Bezoars are indigestible lumps which are usually found in stomach. Types of bezoar include phytobezoar, trichobezoar, lithobezoar, pharmacobezoar, plasticobezoar, lactobezoar and metal bezoar. Trichobezoars mostly affect females in 20s and 30s with a rarity in paediatrics. Unexplained complaints with a palpable mass are commonly found in these patients. Treatment involves retrieval of mass with searching for others. The purpose of this study was to present data and surgical management of cases with trichobezoars.
MATERIALS AND METHODS
We documented a retrospective review of trichobezoars done in our hospital between 2016 and 2022. All demographic data collected included gender and age of cases, composition and extent of bezoar, clinical presentation, imaging modalities, endoscopic trial, surgical approach and outcome.
RESULTS
Five cases of gastrointestinal tract (GIT) trichobezoars underwent surgery. All cases were females between (13 and 16 years). Trichobezoars were three gastric, one ileal and one of combined gastric and colonic. Complaints were abdominal pain, vomiting, weight loss and halitosis. Three cases had a palpable abdominal mass. Different radiological modalities were performed. Endoscopic retrieval was tried in one patient and the laparoscopic approach in another one, but the first route failed. Laparotomy followed by gastrotomy, enterotomy and colotomy was done without complications.
CONCLUSIONS
Trichobezoars should be suspected in any child with unexplained abdominal complaints or with a palpable abdominal mass, especially in girls. Imaging can be done in different modalities for diagnosis. Endoscopic retrieval could be tried; however, its failure is common, necessitating laparotomy, which has an excellent outcome.
Topics: Female; Humans; Abdominal Pain; Bezoars; Ileum; Stomach; Vomiting; Adolescent
PubMed: 38546247
DOI: 10.4103/ajps.ajps_104_22 -
Translational Andrology and Urology Dec 2014The use of laparoscopic surgery has grown dramatically in recent years in most all types of surgery. Historically, the early use of laparoscopic surgery was for pelvic... (Review)
Review
The use of laparoscopic surgery has grown dramatically in recent years in most all types of surgery. Historically, the early use of laparoscopic surgery was for pelvic and groin problems. In this article we review the current technique, indications, benefits and complications of laparoscopy in diagnosis and management of various groin problems in children including undescended testes (non-palpable and palpable) and inguinal hernia.
PubMed: 26816798
DOI: 10.3978/j.issn.2223-4683.2014.12.11 -
World Journal of Surgical Oncology Sep 2018The utilization of intraoperative ultrasound (IOUS) in breast cancer surgery is a relatively new concept in surgical oncology. Over the last few decades, the field of... (Review)
Review
BACKGROUND
The utilization of intraoperative ultrasound (IOUS) in breast cancer surgery is a relatively new concept in surgical oncology. Over the last few decades, the field of breast cancer surgery has been striving for a more rational approach, directing its efforts towards removing the tumor entirely yet sparing tissue and structures not infiltrated by tumor cells. Further progress in objectivity and optimization of breast cancer excision is possible if we make the tumor and surrounding tissue visible and measurable in real time, during the course of the operation; IOUS seems to be the optimal solution to this complex requirement. IOUS was introduced into clinical practice as a device for visualization of non-palpable tumors, and compared to wire-guided localization (WGL), IOUS was always at least a viable, or much better alternative, in terms of both precision in identification and resection and for patients' and surgeons' comfort. In recent years, intraoperative ultrasound has been used in the surgery of palpable tumors to optimize resection procedures and overcome the disadvantages of classic palpation guided surgery.
OBJECTIVE
The aim of this review is to show the role of IOUS in contemporary breast cancer surgery and its changes over time.
METHODS
A PubMed database comprehensive search was conducted to identify all relevant articles according to assigned key words.
CONCLUSION
Over time, the use of IOUS has been transformed from being the means of localizing non-palpable lesions to an instrument yielding a reduced number of positive resection margins, with a smaller volume of healthy breast tissue excided around tumor, by making the excision of the tumor optimal and objectively measurable.
Topics: Biopsy; Breast; Breast Neoplasms; Female; Humans; Intraoperative Care; Margins of Excision; Mastectomy; Mastectomy, Segmental; Prognosis; Ultrasonography, Mammary
PubMed: 30205823
DOI: 10.1186/s12957-018-1488-1