Isolated Port Site Metastases in Carcinoma Gallbladder: Does it Represent Better Prognosis?

Port site metastasis (PSM) is a known sequela of laparoscopic cholecystectomy in carcinoma gallbladder. While they are associated with poor prognosis, isolated PSM may represent a subset with better outcomes. We conducted a clinical audit of 33 cases of PSMs treated over a 6-year period. This included 26 cases of isolated PSM and 7 cases of PSM with systemic metastases. The mean time interval between index surgery and appearance of PSM was longer in the patients with isolated PSM (33.11 vs 25.5 months, p = 0.041). Isolated PSMs were treated with surgery and chemotherapy while the others were treated with palliative chemotherapy only. Two out of 27 cases (7 %) of isolated PSM had disease progression during therapy while 3 out of the 6 cases (50 %) of PSM with other sites of recurrences had disease progression while on treatment. Time to disease progression was significant more in cases of isolated PSM (17.14 vs 7.66 months, p = 0.034). The mean survival time too was significantly more in these cases (25.33 vs 15.66 months, p = 0.015). Isolated PSMs in case of gallbladder cancer may represent a distinct disease entity. Aggressive surgical management in addition to systemic chemotherapy may result in a reasonable survival advantage.

Indian Council of Medical Research consensus document for the management of gall bladder cancer.

The document is based on consensus among the experts and best available evidence pertaining to Indian population and is meant for practice in India.All postcholecystectomy gallbladder specimens should be opened and examined carefully by the operating surgeon and be sent for histopathological examination.All "incidental" gall bladder cancers (GBCs) picked up on histopathological examination should have an expert opinion.Evaluation of a patient with early GBC should include essential tests: A computed tomography (CT) scan (multi-detector or helical) of the abdomen and pelvis for staging with a CT chest or chest X-ray, and complete blood counts, renal and liver function tests. magnetic resonance imaging/positron emission tomography (PET)-CT are not recommended for all patients.For early stage disease (up to Stage IVA), surgery is recommended. The need for adjuvant treatment would be guided by the histopathological analysis of the resected specimen.Patients with Stage IVB/metastatic disease must be assessed for palliative e.g. endoscopic or radiological intervention, chemotherapy versus best supportive care on an individual basis. These patients do not require extensive workup outside of a clinical trial setting.There is an urgent need for multicenter trials from India covering various aspects of epidemiology (viz., identification of population at high-risk, organized follow-up), clinical management (viz., bile spill during surgery, excision of all port sites, adjuvant/neoadjuvant therapy) and basic research (viz., what causes GBC).

Limb salvage surgery in bone tumors: a retrospective study of 50 cases in a single center.

Modular segmental replacement system (MSRS) is one of the options for Limb conservation surgery in bone tumors. The study analyses a single center experience of use of MSRS for limb conservation in cases of primary bone tumors. Retrospective analysis was done for a series of cases of limb salvage procedures done over a five year period. All Patients with bone tumors who underwent limb salvage procedures utilising MSRS prosthesis were included in the study. The patients' record were perused for pre operative staging; neoadjuvant therapy used, if any; surgical procedure done; follow-up for prosthesis related complications and overall survival achieved. Total of 50 cases studied,included 28 males and 22 females . Median age at diagnosis of 28 (10-73) years. Tumor localized in lower limb in 38 patients, and upper limb in 12 patients. Tumors were malignant in 28 patients (56 %) and benign in 22 (44 %). The most common diagnosis was osteosarcoma (21 patients (42 %)) . The median resection length was 15 cm (range 6-25). High grade tumors (grade 2a and 2b) was found in 27 of 29 cases(93.1 %) . 14 patients had prosthesis related complications. The mean follow-up was 5 years (range: 3-7). 42 patients of 50 were alive with the endoprosthesis at the last follow-up. Survival rate of prosthesis is 84 %. The modular segmental-replacement system prosthesis favoured by us in limb sparing surgery for bone tumors results in satisfactory results in terms of tumor control and limb function.

Comparison of PET/CT with conventional imaging modalities (USG, CECT) in evaluation of N0 neck in head and neck squamous cell carcinoma.

BACKGROUND: Evaluation of a clinically N0 neck is mandatory in cases of squamous cell carcinoma of head and neck region in order to determine the need to address the neck. The study was designed to compare the accuracy of PET/CT scan with that of USG and CECT Neck in assessing clinically N0 neck in cases of squamous cell carcinoma of upper aerodigestive tract. METHODS: Single center, prospective, study over a 2 year period. All Cases of squamous cell carcinoma of upper aerodigestive tract with no palpable neck lymphadenopathy and who were scheduled for surgery were evaluated with USG, CECT and 18F-FDG PET/CT, of the neck. Post operative histopathology was correlated with pre-operative nodal status. Statistical analysis was done using the chi square test. RESULTS: In the 49 patients enrolled, 51 neck sides underwent dissections. Sensitivity of USG, CECT and PET-CT was 4.76%, 23.80% and 71.43% respectively while the specificity was 93.33%, 93.33% and 96.67% respectively. The positive predictive value (PPV) calculated for USG, CECT and PET-CT was 33.33%, 71%, 93.5% respectively while the negative predictive value (NPV) 58.33%, 63.63% and 82.85% respectively. CONCLUSIONS: In N0 neck in head and neck squamous cell carcinoma, though FDG-PET-CT is more accurate than either USG or CECT in staging of the neck, it is not accurate enough to alter the current treatment paradigm.

Percutaneous transfemoral repositioning of malpositioned central venous access device: a report of two cases.

Placement of long term central venous access devices (CVAD) such as chemo ports and Hickman's catheters are associated with a definite risk of catheter tip malpositioning. As such, malpositioning runs a risk of venous thrombosis and related complications; it is imperative to reposition the catheter. Percutaneous transfemoral venous approach has been described as a minimally invasive and safe method for the repositioning. We present two cases in which the CVAD implanted in one subclavian vein got malpositioned in contra lateral subclavian vein. A percutaneous transfemoral venous approach utilizing 5 Fr angiographic catheter was successful in repositioning of the catheters in both cases.

Primary mucinous carcinoma of eyelid: a rare clinical entity.

Primary cutaneous mucinous carcinoma of the eyelid, a rare pathologic entity, is an adenocarcinoma of the eccrine glands. Though it has low metastatic potential, it does have a significant recurrence rate. We present the occurrence, clinical and histological features, and management of this tumor in a 62-year-old male who presented with a recurrent, firm, nodular left lower lid lesion. He underwent excision with a 5 mm margin and the defect was repaired with a Mustarde's cheek rotation flap. A full oncological screening, including whole-body Positron Emission Tomography scan, excluded the presence of primary mucinous carcinoma elsewhere and any metastatic spread. This case underscores the importance of considering this tumor in recalcitrant eyelid lesions and highlights the pathology of this tumor.