Lymphedema. A significant health problem for women with breast cancer in Jordan.

OBJECTIVE: To investigate the frequency of breast cancer related lymphedema in our region, and to heighten its awareness among health workers. METHODS: This is a cross-sectional study of patients treated with breast cancer at King Hussein Cancer Center, Amman, Jordan, between January 2004 and December 2009. We excluded patients with bilateral breast cancer. A total of 515 patients were included. We asked the patients to complete questionnaires that included questions related to arm symptoms. Lymphedema was defined as 2 cm or more difference between the 2 upper limbs' girths. RESULTS: The incidence of lymphedema was 21.1%. The subjective evaluation by the patients overestimated the figure (35%). Most patients (75.3%) had limb symptoms, such as pain, numbness, and limitation of movement. In most patients with lymphedema, the symptoms were mild, but in 17 patients (15.6%) the effects were severe. CONCLUSION: Lymphedema continues to be a common health problem in our region. Most patients have mild lymphedema, but in some patients the effects on daily activities are severe. It is important for health workers to understand the significance of this problem and its associated morbidity.

Popliteal lymph node dissection for metastatic squamous cell carcinoma: a case report of an uncommon procedure for an uncommon presentation.

Lymph node metastasis from cutaneous squamous cell carcinoma is uncommon. The popliteal fossa is rarely involved with metastasis. Popliteal lymph node dissection is uncommonly performed and not frequently discussed in the literature. We present a case of squamous cell carcinoma of the heel with popliteal and inguinal metastasis. This is followed by a description of the relevant anatomy of the popliteal fossa and the technique of popliteal lymphadenectomy.

A large gastrointestinal stromal tumor of the duodenum: a case report.

INTRODUCTION: Gastrointestinal stromal tumors of the duodenum are uncommon. They can reach a large size. Diagnosis can be elusive and managing them can be difficult. Our case report aims to increase awareness and highlight some issues related to the diagnosis and management of duodenal gastrointestinal stromal tumors. CASE PRESENTATION: We present the case of a 38-year-old Middle Eastern woman with a large, slowly-growing gastrointestinal stromal tumor of the duodenum. Her complaints were minor epigastric discomfort and swelling. A pancreaticoduodenectomy with complete tumor excision was performed. She was doing very well with no evidence of disease recurrence when she was last seen 34 months after her operation. CONCLUSION: Gastrointestinal stromal tumors of the duodenum should be suspected in any patient with a duodenal wall mass. Extramural growth and central ulceration with or without bleeding should alert the endoscopist to the possibility of a duodenal gastrointestinal stromal tumor diagnosis. There is more than one surgical approach available; however, complete surgical excision, with negative margins, is the absolute requirement. Preoperative imatinib mesylate can be considered in unresectable or borderline resectable cases.

Metastasis to the popliteal lymph nodes in lower extremity melanoma and their management.

Melanomas located anywhere below the knee can drain to the popliteal fossa. Sentinel nodes in the popliteal fossa are found in 1-9.6% of cases. The positivity rate in these nodes is 12.5-30%, which is comparable to rates in conventional nodal basins. Formal dissection of the popliteal fossa for a positive sentinel node is indicated. Inguinal dissection based only on the presence of involved popliteal lymph nodes is not warranted.