Metastatic breast cancer spread to peripancreatic lymph nodes causing biliary obstruction.

Metastases to the pancreas and peripancreatic lymph nodes (PPLN) are unusual. Metastatic involvement of the PPLN without biliary obstruction, from a primary breast cancer has been published in only a single case in literature. We report the first metastatic breast cancer patient with PPLN deposit, presenting with obstructive jaundice.

Presence of Helicobacter pylori in betel chewers and non betel chewers with and without oral cancers.

BACKGROUND: Betel chewing has been shown to predispose to periodontal disease and oral cancer. Studies show that people with gum disease are more likely to test positive for Helicobacter pylori (H. pylori). It is not known if the lesions produced by betel quid and the resulting, chemical changes predispose to colonization by H. pylori. Further the role of this organism in oral cancer is not known. Our objective was to determine the presence of H. pylori in oral lesions of thirty oral cancer patients and to determine the presence of IgG antibodies to H. pylori in oral cancer patients who are betel chewers and non betel chewers, healthy betel chewers and healthy non-betel chewers and to compare the presence of H. pylori in these four groups. This case control study was conducted at the Cancer Institute Maharagama and the Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura. METHODS: One hundred and seventy three subjects, of whom fifty three were patients presenting with oral cancer to the Cancer Institute Maharagama, sixty healthy betel chewers and sixty healthy non-betel chewers from the Religious and Welfare Service Centre Maharagama were tested for H. pylori by serology. Thirty oral biopsies from oral cancer patients were cultured under microaerophilic condition to isolate H. pylori. The statistic used was Chi-square test. RESULTS: Of the fifty-three oral cancer patients, forty-four were betel chewers. Among the 53 oral cancer patients examined, ten of forty-four (10/44 = 22.7%) patients who are betel chewers and four of nine (4/9 = 44.4%) patients who are non-betel chewers were detected positive for IgG antibody against H. pylori. In the healthy group (betel chewers and non betel chewers) ten (16.7%) of the healthy betel chewers tested positive for H. pylori by serology. None of the healthy non-betel chewers tested positive for H. pyloriFourteen [26.4%] of oral cancer patients tested positive for H. pylori by serology, of which two were also culture positive (Only thirty samples were cultured). The presence of H. pylori in betel chewers (with or without cancer) compared to non-betel chewers was statistically significant. (Chi-square test p < 0.05) The use of tobacco and areca nut in betel chewers was significant with the presence of H. pylori (p < 0.05). CONCLUSION: There is a significant higher proportion of H. pylori in betel chewers compared to non-betel chewers but not between oral cancer patients compared to patients without oral cancer. Hence Betel chewing may predispose to colonisation with H. pylori in the digestive tract through swallowing the quid or during betel chewing.

Review of distribution of nodal disease in differentiated thyroid cancers in an oncosurgical center in Sri Lanka.

BACKGROUND: There are not many publications on the prognostic implications of nodal disease in patients with papillary thyroid cancers (PTC). This study explored the distribution of nodes with respect to the levels, optimal management of the neck for patients with PTC, and its survival advantages. METHODS: Followup of 79 patients with thyroid cancer (59 with PTC) at the National Cancer Institute, Maharagama, Sri Lanka, was analyzed. RESULTS: The most common histologic type of all thyroid cancers presenting to the Institute was differentiated PTC which affected 59 patients (74.7%). Of them, 29 (50.0%) had positive lymph node metastases in the neck these nodes were found on clinical examination and confirmed by ultrasound in all. Therefore necessitating a comprehensive neck dissection. Among the patients with nodal disease, 5 had nodes in Level 1 at the time of presentation. All patients in this group had multiple levels of positive nodes. Metachronous nodal disease was found in 9 (31.4%) patients, with a disease-free period ranging from 2 months to 37 years. Among the patients with nodal disease, 13 had a single nodal group involvement and the majority of these were Level 4 nodes (46.2%). Central node (Level 6) involvement was found in nine (15.3%) patients. Multiple nodal group involvement indicating multifocal disease was present in 16 (27.6%) patients. Extracapsular nodal spread at presentation and extracapsular thyroid disease at presentation was 10 (16.9%) and 17 (28.8%), respectively. Nodal neck recurrences during followup were present in 2 patients. CONCLUSIONS: Level 1 nodal metastases was present if 5 (8.5%) patients in our group. It is recommended that Level 1 nodes be explored during neck resection for PTC. Because 27.6% of the patients had multifocal disease, it may be important to recommend inclusion of a Level 1 clearance in the presence of multiple nodal involvement. There is a subgroup of patients who had highly aggressive nodes, indicated by extracapsular penetration, which even after radical clearance and external beam radiotherapy have a tendency to recur locally. This indicates an important prognostic feature of the nodal disease in PTC. Because 27.6% of the patients studies had multifocal nodal disease, we consider a comprehensive nodal clearance is necessary for patients with clinically positive nodes.