Thyroid Papillary Carcinoma in Paediatric and Adolescent Patients: Evaluation of Surgical Treatment in a Single Centre

ABSTRACT Aim: Thyroid cancers are the most commonly determined cancers in the paediatric age group. Although the rates of lymph node and distant metastases are greater at the time of diagnosis in comparison with adult thyroid cancers, with the appropriate treatment protocols, the prognosis is excellent. In this paper, we present the clinical characteristics of thyroid papillary carcinoma determined in children and adolescents in our clinic, the surgical techniques applied and the clinical results evaluated in consideration of the relevant literature. Methods: A retrospective evaluation of 12 patient records in the paediatric and adolescent age group from a total of 250 who underwent surgery for a diagnosis of thyroid papillary carcinoma at Ankara Oncology Training and Research Hospital between 2000 and 2007. Results: The prevalence of thyroid and papillary carcinoma in childhood and adolescence was determined as 4.8%. The patients were all female with a mean age of 17.9 years (range, 11-21 years). At the time of diagnosis, lymph node metastases were identified in seven cases (58.3%) and lung metastases in four cases (33.3%). Total thyroidectomy was performed on all patients and for those with lymph node metastasis; a modified radical neck dissection was also applied. Post-operatively, all patients were administered radioactive iodine therapy followed by levothyroxine therapy. During the mean follow-up period of 123 months, apart from persistent tumour in some patients, no recurrence was noted in other patients. Conclusion: As thyroid papillary carcinoma in childhood and adolescence is characterized by lymph node and distant metastases, even if the tumour is limited to the thyroid, because of frequent recurrence after treatment, total thyroidectomy and, where necessary, modified neck dissection are recommended for all patients rather than more conservative treatment protocols.

Bone fracture in breast cancer patients with isolated bone metastasis.

AIM: To analyse the incidence of bone fracture of breast cancer patients with isolated bone metastasis and its effect on survival. We tried to find an answer to the question of "Can the development of bone fracture be predicted?" METHODS: Between 1993-2006, 139 breast cancer patients with isolated bone metastasis were examined. Patients were divided into two groups depending on the development of pathologic bone fracture. RESULTS: Fractures were developed in 41 patients (29.5%)within 41 months of follow-up. The locations of pathologic bone fracture were vertebral fracture in 26 patients (63.4%),femur fracture in 11 patients (26.8%), and hip fracture in four patients (9.8%). Fracture rates in hormone sensitive and resistant patients were 31.2% and 14.3%, respectively. The fracture rates in 13 triple negative and non triple negative patients were 7.7% and 31.4%, respectively (p=0.07). High CA 15-3 levels at the time of metastasis in patients with and without fractures were 68.4% and 61.1%, respectively. The risk for fracture was also high in Her2-neu positive patients (38.7% vs. 26.5%). While the incidence of fracture with the presence of one factor mentioned above was 22.2%, it was increased to 36.1% in the presence of two or three factors(p=0.13). Median survivals of the patients with and without fractures were 48 and 39 months, respectively (p= 0.65). CONCLUSION: Hormone sensitivity, high CA 15-3 levels and positive Her2-neu status are slight risk factors for bone fractures. Survival was not different in patients with or without bone fractures.

What is the best treatment option in postmenopausal, hormone responsive breast cancer patients with isolated bone metastases?

BACKGROUND: Bone is the most common metastatic site for breast cancer. AIM: To determine the effectiveness of addition of chemotherapy to hormonal therapy in postmenopausal hormone receptor-positive breast cancer patients with isolated bone metastases. MATERIALS AND METHODS: Between June 2001 and January 2007, 101 patients were classified into two groups according to initial treatment modalities; patients who received hormonotherapy only (group I) and chemotherapy followed by hormonotherapy (group II). The effect of treatment choice on clinical course, time to progression, and overall survival were evaluated. RESULTS: There were 70 patients in group I and 31 patients in group II. Bone metastases in 27 patients (26.7%) were synchronous and the remainder were metachronous. The median follow-up time was 41 months. The two groups showed similar results when patients' tumor characteristics were compared. However, 81% of synchronous cases had upfront chemotherapy following hormonotherapy, whereas this ratio was only 12% in the metachronous group. All patients received systemic antiresorptive bisphosphonates whereas only 24 patients required palliative radiotherapy at some time during the course of their disease. In groups I and II, the median time to progression was 12 and 16 months (P: 0.96) and median overall survival was 41 and 40 months (P: 0.79), respectively. In HER-2-positive patients, a trend of prolongation of overall survival was observed in group II, but it was not statistically significant (P: 0.12). CONCLUSIONS: Anti-hormonal therapy still seems to be considered as the ideal treatment of choice for postmenapousal breast cancer patients with isolated bone metastases.

Clinical importance of preoperative detection of the apical lymph node metastasis in patients with breast carcinoma.

INTRODUCTION: According to the revised staging system for breast cancer, the infraclavicular node status has become more important because the involvement of the apical nodes now changes the stage of the disease for all tumour sizes. In this study, we analysed the stage migration among our patients treated with mastectomy for breast cancer. METHODS: 44 patients who were treated with modified radical mastectomy for breast cancer in our department during 2003 were reviewed for their clinicopathological features, including the status of the axillary lymph nodes. RESULTS: 11 patients (25 percent) were reclassified as stage IIIC according to the new Tumour, Node and Metastasis (TNM) classification system of American Joint Committee on Cancer that was revised in 2002. The mean age was 40.2 years and the mean tumour size was 5 cm. CONCLUSION: Patients with breast cancer should be properly staged preoperatively for choosing appropriate individual treatment, and more accurate evaluation of the infraclavicular region for metastatic lymph nodes should be done.

A clinical case and anatomical study of the innervation supply of the vastus medialis muscle.

The innervation supply to the vastus medialis (VM) muscle, a component of quadriceps femoris (QF), is provided by a branch of the femoral nerve (FN) running along the muscle. The course of the nerve from lumbar roots to the muscle has been described by many researchers. It is known to ride along the femoral vein, artery and saphenous nerve and enter the adductor canal (Hunter's canal), and then to divide into branches that supply vastus medialis and the knee joint. Femoral mononeuropathy is uncommon, and is usually due to compression in the spinal level. Hematoma in the psoas and iliacus muscles, drug abuse, lithotomy position and limb lengthening are the other associated reasons for a mononeuropathy of the femoral nerve. Isolated vastus lateralis (VL) atrophies have been reported by a few authors, suggesting that compression of the nerve and direct violation of the nerve with injections might be the reason for mononeuropathy. Isolated VM atrophy has not been previously reported. The purpose of the study was to identify the anatomical structures around the FN branch which innervates the VM muscle.

Liposarcoma in the epidural space.

STUDY DESIGN: A patient with myxoid liposarcoma in the lumbar epidural space is reported. OBJECTIVE: The subject was treated with marginal resection and posterior instrumentation. SUMMARY OF THE BACKGROUND DATA: Liposarcoma is a malignant tumor of the soft tissues. It is commonly seen in the thigh. Lumbar extradural space is an unusual localization. Two cases have been reported with this localization in the literature. METHODS: The authors have treated a female patient with myxoid liposarcoma in lumbar extradural space with marginal resection and posterior instrumentation. RESULTS: The histopathologic examination showed myxoid liposarcoma. Two cases have been reported in the literature. CONCLUSION: Myxoid liposarcoma is a malignant tumor of the soft tissues. The extradural tumor was probably originated from the epidural fat tissue. Although wide resection is advised in the thigh localization, extradural localization of the tumor can be treated with marginal resection if there is no invasion to the surrounding tissue.