Hidradenitis suppurativa of the breast: a diagnostic dilemma.

Hidradenitis suppurativa (HS) is a chronic skin condition characterised by recurrent abscesses, nodules, sinus tracts and fistulas. The condition has a known diagnostic delay and well-documented negative effect on the quality of life of patients. When affecting the periareolar region, there is a capacity for confusion with other more mainstream surgical conditions of the breast. We present a case of a 35-year-old woman who was diagnosed with an acutely painful breast nodule with periareolar erythema and induration who was repeatedly misdiagnosed due to cofounding features on clinical assessment. We present this case as a diagnostic dilemma to raise awareness of HS as a differential when assessing surgical breast patients.

Synchronous contralateral axillary lymph node metastasis in a recurrent breast cancer following previous axillary clearance.

Ipsilateral axillary lymph node metastasis is common, while contralateral axillary lymph node metastasis (CAM) is uncommon. This report is of a patient that presented with a recurrence of left breast cancer and synchronous CAM, with a distant history of left breast conserving surgery and axillary dissection for invasive carcinoma. The CAM was confirmed following a non-routine lymphoscintigraphy and sentinel lymph node biopsy. This highlights the possibility of CAM representing as locoregional disease rather than advanced stage IV disease.

Risk Factors for Adverse Outcome for Elderly Patients undergoing Curative Oncological Resection for Gastrointestinal Malignancies.

BACKGROUND: The incidence of gastrointestinal cancer increases with age, with approximately 20% of these cases in people over 80 years of age. Due to pre-existing comorbidities, this onco-geriatric population often presents diagnostic and therapeutic challenges. METHODS: A systematic review of articles on PubMed was performed to determine the predictive ability of screening tools and their components regarding the occurrence of adverse outcomes in elderly onco-surgical patients with gastrointestinal malignancies. RESULTS: Surgical procedures in this patient cohort, particularly complex resections, may result in increased morbidity and mortality. The decision to treat an elderly patient with curative intent requires sound clinical judgment based on knowledge, consideration of objective parameters, and experience. These patients could potentially be optimized for surgery with the improvement of nutritional and overall performance status as well as with stabilizing comorbidities. CONCLUSION: Various geriatric assessment and screening tools have been developed to identify risk factors to assist the surgeon and the interdisciplinary team in treatment planning, including the Frailty Assessment Score, Timed Up and Go test, nutritional status, and Activities of Daily Living test. It is important to emphasize that transparent and open communication between the treating surgeon and the patient is crucial in that the patient fully understands the implications of the treatment plan.

Sentinel lymph node mapping and biopsy for malignant melanoma at a rural-based university medical center.

Sentinel lymph node mapping and biopsy (SLNMB) is a standard of practice in the management of cutaneous malignant melanoma (CMM). Since there were no published articles reviewing the experience of a single-institution, rural-based university medial center, we compiled our results from the patients we treated from Nov. 11, 1998 to May 23, 2001. A total of 54 caucasian patients (35 males, 19 females) of a median age of 60 years (range 2-84) were surgically treated, including 29 cases on the extremities, 16 trunk cases, and nine of the head/neck. Median Breslow thickness was 1.50 mm (range 0.23-12.0). Median Clark's level was 4 (range 2-5). Forty-seven patients underwent sentinel lymph node (SLN) injection and preoperative lymphoscintigraphy. Preoperative lymphoscintigraphy revealed radiocolloid uptake in 53 regional lymph node basins (RLNB), including two separate RLNB in four patients and three separate RLNB in one patient. Intraoperatively, SLN localization of radiocolloid was shown in 53 RLNB and SLN localization of blue dye was demonstrated in 38 RLNB. SLNs were positive in six of 52 (11.5%) RLNB biopsied and six of 46 (13.0%) patients. Our initial experience with SLNMB was encouraging and holds promise for rural-based practices by sparing added morbidity and inconvenience of more extensive surgery.

Sentinel lymph node mapping and biopsy for breast cancer at a rural-based university medical center: initial experience with intraparenchymal and intradermal injection routes.

BACKGROUND: Recent data suggests that intradermal (ID) injection for sentinel lymph node (SLN) mapping and biopsy in breast cancer is as effective and reproducible as intraparenchymal (IP) injection. The aim of this study was to review our initial experience with IP and ID injection for SLN mapping and biopsy at our rural-based university medical center. METHODS: From January 4, 1999 to January 5, 2001, 113 of 165 patients with breast cancer underwent attempted SLN mapping and biopsy by either IP (n=63) or ID (n=50) injection. Selection of the IP versus ID injection route was non-randomized and based on surgeon preference. Success of SLN localization was examined. RESULTS: SLN localization was successful in 82% of IP and 100% of ID for radioisotope (p=0.001), 69% of IP and 92% of ID for blue dye (p=0.002), and 90% of IP and 100% of ID (p=0.024) for radioisotope and blue dye. Identical comparisons made after excluding the first 10 cases, 20 cases, and 30 cases from each injection group showed that the percentage of cases in each group in which the SLN localized changed minimally; however, some of the resultant p values eventually lost statistical significance. CONCLUSIONS: SLN localization was more successful by ID injection than by IP injection, thus favoring utilization of the ID injection route. The eventual loss of statistical power in some of the comparisons with increasing numbers of initial cases excluded may reflect differential learning curves of the two injection techniques; however, this may simply be a reflection of decreasing sample size used in each subsequent analysis. A prospective randomized trial comparing the IP and ID injection route may be warranted.