Operative resection is a viable treatment of macrodactyly of the foot caused by lipofibromatous hamartoma: a case study with 5 year follow-up.

UNLABELLED: Lipofibromatous hamartoma (LFH) is a benign tumour of nervous tissue that most commonly involves the median nerve. Only a few cases of LFH in the foot have been described. In these cases growth of bone and other tissue causing macrodactyly, a condition known as macrodystrophia lipomatosa, is often observed. Conservative treatment of LFH is usually preferred because of the potential loss of neurological function after surgery. Here we present a rare case of a 44-year old patient with LFH causing macrodactyly of the second ray of the left foot whose symptoms did not improve after conservative treatment. We describe the diagnostic process and the operative resection that was performed and show the follow-up results 5 years after surgery. All the symptoms experienced by our patient had disappeared. This case demonstrates that operative treatment of LFH in the foot is a viable option in patients with persistent symptoms following conservative treatment. LEVEL OF EVIDENCE: Level V.

Axillary staging by ultrasound-guided fine-needle aspiration cytology in breast cancer patients. Still up to date?

To investigate whether clinicopathological features of breast cancer patients could predict the likelihood of lymph node metastases and the likelihood of false-negative results of ultrasound-guided fine-needle aspiration cytology of suspicious lymph nodes (US+FNAC). Between 2004 and 2009, US+FNAC was performed in 1,150 axillae (18 bilateral breast carcinomas). Based on final histologic diagnosis, the true- and false-negative group of US+FNAC were defined. Subsequently, 11 clinicopathological factors were compared between these two groups. These factors were also compared between patients with and patients without lymph node metastases. Of 1,150 axillae, 429 had lymph node metastases at final histology. US+FNAC indicated metastases in 107 axillae. 1,043 axillae were negative by US+FNAC. Final histology showed metastases in 323 of these 1,043 axillae, resulting in a false-negative group of US+FNAC of 31%. Both age <60 years and a cT2/cT3 breast carcinoma were significantly associated with lymph node metastases and with false-negative results of US+FNAC. Lymph node metastases were found in 59.6% of patients <60 years with a cT2/cT3 breast carcinoma. In these patients, 52.3% of the negative US+FNAC results were falsely negative. In patients <60 years with a cT2/cT3 breast carcinoma, we recommend to omit US+FNAC preoperatively and perform a SNB directly, because lymph node metastases were found in 59.6% of these patients and 52.3% of negative US+FNAC results were falsely negative.