Unexplained arterial thrombosis after pelvic oncologic surgery: a report of a new pathologic entity of postoperative thrombosis in grossly normal arteries

Acute arterial ischemia of the lower limb post pelvic surgery can be caused by different pathopyhsyiologic mechanisms which include; contusion thrombosis, ligation, spasm, thrombosis on top of atherosclerosis. Treatment is bypass or replacement. This report describes 4 cases of unexplained iliac arterial thrombosis post pelvic surgery without gross underlying pathology in the arterial wall, neither traumatic nor atherosclerotic. Patients were successfully managed by simple thrombectomy only without the need for vessel replacement or bypass. Establishment of flow across the previously thrombosed segment was achieved with no rethrombosis. Simple thrombectomy through the groin, alone can be used successfully to treat a selected group of patients with post operative iliac artery occlusion

In vivo sentinel lymphatic mapping in rectal cancer

Nearly 30% of patients with stage I, II rectal cancer with no evidence of nodal deposits develop systemic disease despite radical curative surgery. It is postulated that a subset group of patients do harbor nodal micrometastases not detected by the classic Hematoxylin and Eosin [H and E] staining. This prospective study aimed to assess the feasibility of in vivo sentinel lymphatic node [SLN] mapping and biopsy in accurate nodal staging and decision making. This might offer a reasonable clue to whether lateral lymph node metastases can be diagnosed by SLN mapping and so provide benefit to patients with advanced rectal cancer regarding consideration of more extensive resection. The study included 25 patients with mid and low rectal tumours. In mid rectal tumours blue dye was injected circumferentially in the peritumoral area in the subserosal plane. Similarly in low rectal tumours submucosal injection around the tumour through proctoscopy was performed. Immediate labeling and prompt dissection of blue stained nodes were followed by the standard radical resection. The sentinel nodes were separately sent for focused histopathological examination, the surgical specimen including other nodes for routine examination. H and E negative SLN were tested Immunohistochemically [IHC]. Sentinel Lymph Node [SLN] mapping was feasible in 24 out of 25 patients [96%] with a mean number of SLN 2.87 patient [0-3].Positive SLN were found in 9 patients [38%] while negative SLN were found in 15 patients [62%].The incidence of metastasis in SLN was 26%.Lateral positive nodes were found in 3 patients [13%].Upstaging of T2-3NO to T2-3N1 was done in 15% of cases. Skip lesions were present in one patient. Sentinel Lymph Node [SLN] In vivo mapping using blue dye is a promising and feasible technique with a short learning curve. Lateral node dissection was excluded in 87% of patients. Proper nodal Staging by SLN focused analysis leads to identification of a subset group of patients that could benefit from Adjuvant therapy

Bilharziasis and bladder cancer: a time trend analysis of 9843 patients

To explore any changes in bladder carcinoma during 37 years period, in regard to: its frequency, bilharzia association, histological profile and demographic data. This is a retrospective study on 9843 patients treated at the National Cancer Institute [NCI], Cairo University, during the years 1970-2007. Three groups were selected: series [A] included 3212 patients during 1970-1974, series [B] 3988 patients during 1985-1989 and series [C] 2643 patients during 2003-2007. For statistical analysis, data of series [A], [B] and [C] were compared to determine the significance of difference [p value 0.005]. A significant decline of the relative frequency of bladder cancer was observed from 27.63% in the old series to 11.7% in the recent series. Bilharzia association dropped from 82.4% to 55.3%. There was a significant rise of transitional cell carcinomas from 16.0% to 65.8%, becoming at present the most common tumor type, with a significant decrease in squamous cell carcinomas from 75.9% to 28.4%. There was an increase in the median age of patients from 47.4 years to 60.5 years and a decrease of male: female [M/F] ratio from 5.4 to 3.3. The decline in the relative frequency of bladder cancer is associated with a decline in bilharzia egg positivity in the specimen and is probably related to better control of bilharziasis in the rural population in Egypt. This was accompanied by a change in the histological profile of tumors, with significant predominance of transitional cell carcinoma and an increase in the age of patients, a pattern rather similar to that in western reports

Phyllodes tumors of the breast: surgical options and outcome

Surgical management of phyllodes tumors is not clearly defined in literatures and even controversial due to the unpredictable biological behavior of these neoplasms. The authors present a prospective cohort of patients who underwent a wide range of tumor excisions to evaluate the oncologic and long term results of these procedures. Starting at June 1990 through September 2004, 64 evaluable female patients were operated for the treatment of PT in our hospital. Patients had a median age of 38 years [16-74] and a median clinical tumor size of 8 cm [3-25]. Preoperative diagnosis was made by the usual triple assessment [clinical examination, mammography and/or ultrasonography and fine needle cytology]. Surgical options included local excision [36 patients], wide local resection [13 patients], simple mastectomy [7 patients], modified radical mastectomy [4 patients], and skin sparing mastectomy [4 patients]. The median follow-up period was 89 months [3-203], where patients were regularly investigated by the same triple assessment together with the metastatic work-up. Histological examination of the surgical specimens showed 39 benign, 10 borderline and 15 malignant phyllodes tumors. Surgical margin was jeopardized in 16/36 44%] after local excision in contrast to the other procedures and consequently local recurrence rate was high 22/36 [61%]. Benign and borderline tumors had less recurrence rate com-wed to malignant lesions [40% Vs. 60%]. Overall 5-year survival rate [73.4%] was not decreased by these high rates of local recurrence because most of them could be resected adequately and the risk of distant metastasis a as low [5 patients or 7.8%]. Tumor grade, tumor margin and age of the patients were significant prognostic factors whereas, tumor size was found non significant. Phyllodes tumor in general should be reacted widely if tumor size to breast size permits clear margins. We encourage re-excision of accidentally discovered tumors after local excision of what was thought as fibroadenomas. Skin sparing mastectomy is an excellent alternative to mastectomy for these tumors provided skin of the breast is intact and away of tumor margin