Multimodality management of incidentally detected gall bladder cancer: long term results from a tertiary care cancer centre

BACKGROUND

Gall bladder cancer (GBC) is the most common biliary tract malignancy in India. GBC present either with incidental diagnosis after simple cholecystectomy (SC) or with a primary gall bladder mass. Incidentally detected gall bladder cancer (ICGB) has traditionally been thought to be a relatively early stage disease but there are controversies associated with various aspects of its management. In this article we describe our experience with multimodality management of ICGB.

METHODS

A retrospective analysis of incidentally detected GBC patients was performed to analyze the profile of presentation and treatment outcome. After initial radiological evaluation for operability, all the patients underwent surgical exploration. If found resectable, revision surgery including 2 cm wedge resection of liver and lymphadenectomy was done followed by concurrent chemo-radiation for tumors T2 and above stages.

RESULTS

A total of 54 patients with incidentally detected GBC with a male to female ratio of 1:3 and mean age of 47.5 years were included in the study. Thirty-four (63%) patients underwent curative resection followed by adjuvant chemoradiotherapy. The remaining 20 patients had metastatic/unresectable disease. The 5 years disease free and overall survival (OS) for patients receiving curative treatment was 64% and 72% respectively. On univariate analysis, presence of residual disease in the gallbladder fossa and liver were significant risk factors for disease recurrence. Depth of invasion, adjuvant treatment received and stage were significant prognostic factors for OS.

CONCLUSIONS

Incidentally detected GBC is increasing in incidence. A multi-modality approach with revision surgery and adjuvant chemo-radiation treatment may yield better outcome. Presence of residual disease is a poor prognostic factor. Optimal evaluation before SC and early referral to specialty center is therefore important in patients with suspicion of gallbladder malignancy because first chance is probably the best chance.

Surgical experience of primary salivary gland tumors of lung: A case series

INTRODUCTION

Primary salivary gland type tumors of lung (PSGTTL) are rare intra-thoracic malignant neoplasm. Their description in literature is largely limited to a few case series/case reports. We herewith present our surgical experience of and review its clinical presentation, management options and survival outcomes.

METHODS

This retrospective analysis of prospectively maintained computerized data-base of patients was conducted in a tertiary teaching oncology centre in North India. The case records of all the patients who underwent surgery for PSGTTL were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, histopathological examination, postoperative complications and outcome were retrieved from the case records.

RESULTS

There were seven patients who underwent surgery for PSGTTL during the period from January 2012 to December 2014. Hemoptysis (n = 6, 85.7%) and dyspnoea (n = 6, 85.7%) were common presenting clinical features. Fiber-optic bronchoscopy revealed endobronchial growth in all patients - five patients had growth in left main bronchus while one each had growth in right main bronchus and right intermediate bronchus. Biopsy confirmed adenoid cystic carcinoma in 4 (57.1%) and muco-epidermoid carcinoma in 3 (42.9%) patients. All but one had R'0' resection - pneumonectomy in five and bilobectomy in one patient; one patient was found to be unresectable in view of dense adhesions between lung and heart. Median pathological tumor size was 3.5 cm; none of the patient was found to have metastatic spread to lymph nodes. Overall, six patients are alive after a median follow up of 5 months (range 1-30).

CONCLUSION

Radical surgery to achieve R'0' resection is the main stay of treatment of PSGTTL to achieve prolonged survival.

Internal jugular vein thrombosis: an uncommon presentation

Internal jugular vein (IJV) thrombosis is a rare entity. It is usually secondary to various etiologies such as ovarian hyperstimulation, deep vein thrombosis of upper limbs, venous catheter, malignancy, trauma, infection, and neck surgery and hypercoagulable status. We report an unusual case of internal jugular vein thrombosis with cerebral sinus thrombosis, postpartum in a 22-year-old female patient who presented with a painful swelling on the left side of her neck. Diagnosis was established by color Doppler ultrasonography and magnetic resonance venography. Thorough evaluation of the patient revealed no etiological factor leading to thrombosis. Patient was treated with low-molecular-weight heparin.

Post-traumatic skin and soft tissue infection due to Aeromonas hydrophila

We report a case of posttraumatic skin and soft tissue infection in a patient who sustained laceration after being hit by a water tanker. Aeromonas hydrophila was isolated from pus and was identified to the species level by Vitek 2 and a battery of biochemical tests. The patient responded to thorough drainage, debridement of wound and 2 weeks of intravenous antibiotics. The patient was taken up for split skin grafting of the raw area. She was discharged with satisfactory graft uptake after 1 week without any further antibiotics advice. Follow-up after 3 weeks was satisfactory with healthy cover on the raw area and normal weight bearing on the left leg.