Kimura Disease of the Breast - A Previously Undescribed Entity.

Kimura disease (KD) is a rare chronic inflammatory disorder of unknown etiology, primarily seen in young Asian males. The disease is characterized by a triad of painless subcutaneous masses in the head and neck region, blood and tissue eosinophilia, and elevated serum immunoglobulin E levels. We report an unusual case of a 40-year-old woman found to have KD of the breast which presented clinically as carcinoma, leading to a diagnostic dilemma. To the best of our knowledge, this is the first case of KD in the breast to be documented in the literature. The patient also had scabies, which may have provided the stimulus for hypersensitivity, which is considered to be the pathogenetic mechanism responsible for development of KD.

Pulmonary metastasectomy: review of experience at a tertiary cancer care center.

BACKGROUND: Thirty to 40% of all extra thoracic cancers lead to secondary pulmonary lesions and approximately 20% of these cases feature metastases that are confined to the lungs. There is benefit of pulmonary metastasectomy in a select subset of patients. AIMS: The goal of this study was to evaluate the patient profile, treatment patterns, and outcomes following surgical treatment of lung metastasis and to identify prognostic factors for long-term survival. MATERIALS AND METHODS: Retrospective analysis of a prospectively maintained computerized database at a tertiary cancer care centre was done. 36 patients underwent curative resection for isolated pulmonary metastasis from January 1999 to December 2009. All metastasis were detected by non-contrast CT scan of the chest. Lung function tests were performed in all patients. Posterolateral thoracotomy was performed for resection of pulmonary metastasis by lung sparing procedures. A routine protocol of complete resection of all visible and palpable lung metastasis with a margin of 0.5 to 10 mm was followed in all patients. Staged thoracotomy was done for bilateral metastases. All palpable nodules were resected by wedge resection except in one case where pneumonectomy was done to achieve R0 resection. All patients underwent complete resection. CONCLUSIONS: Disease-free interval of more than 1 year along with less than 2 malignant nodules in patients with non-visceral pulmonary metastasis are variables identified in the present study which have enabled pulmonary metastasectomy to be offered as a safe therapeutic lifeline to patients.

Locally advanced sebaceous cell carcinoma (T3) of eyelid: incidence and pattern of nodal metastases and combined modality management approach.

BACKGROUND: Sebaceous carcinoma (SbCC) is a rare malignancy that often mimics benign conditions. Lymphatic involvement, large T3 tumors herald a dismal survival for patients. We present our series of 13 cases of locally advanced SbCC of the eyelid treated at a surgical oncology unit and describe the clinical profile, patterns of nodal spread and recurrence pattern in this subset of SbCC. METHODS: A retrospective analysis of case records was carried out for patients presenting with orbital tumors between January 1997 and April 2010 in the department of Surgical Oncology, AIIMS, New Delhi, India. All patients underwent orbital exenteration and superficial parotidectomy with neck dissection was added to patients with clinically significant lymphadenopathy. All patients who underwent OE after 2002 were advised radiotherapy as adjuvant therapy. The end point was development of recurrence or end of two year follow up period which ever occurred earlier. RESULTS: Thirteen patients underwent orbital exenteration. Eleven patients had clinically palpable lymphadenopathy. Ten patients (76.9%) had pathologically confirmed metastatic nodes. Parotid lymph node involvement was present in all patients (100%); two of these ten patients also had level II b cervical lymph node involvement. Recurrence was observed in seven patients (53.8%). All recurrences were loco-regional only and no systemic metastases was seen. There were only two recurrences in the group that received PORT. CONCLUSIONS: Eyelid SbCC is a loco-regionally aggressive malignancy and adequate disease control can be achieved with combined modality approach of radical surgery followed by post operative radiotherapy.

Are We Over-treating Neck in Buccal & Alveolo-buccal Cancers: Experience from a Tertiary Cancer Care Center.

Oral cancer is one of the most common types of cancer seen in India with buccal and alveolo buccal regions being the most frequent subsites. A retrospective analysis of buccal and alveolo buccal cancer patients undergoing neck dissection from 1995 to 2009 was performed to analyze the profile of neck dissections and patterns of nodal involvement in these patients. Total 310 neck dissections were done for buccal and alveolo-buccal cancer including 41 (13.2 %) RND, 231(74.5 %) MND and 38 (12.2 %) Supraomohyoid neck dissection (SOHND). Clinically palpable nodes were present in 75.9 % patients but only 117 (38 %) were pathologically node positive. 20 % had occult positive nodes in N0 group. Level I was most commonly involved with 35 % having positive nodes in more than one level. There were no patients with isolated involvement of level IV or V with only 3.9 % patients with involvement of level III. Current guidelines recommend neck dissection in all clinically node positive patients. However, our experience shows that neck is over treated in majority of patients and there is a need to optimize surgical management of neck in these patients.