Breast hematoma with active bleeding due to seat belt injury

Breast emergencies are not frequent but play an important part in routine breast imaging applications. Diagnosis and identification of seat belt injury in emergency department are essential for patient management and early treatment of advanced cases. Herein we reported imaging findings of a patient who had prominent swollen at her left breast accompanying tissue edema and painful palpable mass formed by active bleeding hematoma as a result of seat belt injury due to a car accident. Radiologic examinations revealed hematoma in the breast accompanying active bleeding.

Predictive Factors for Unnecessary Axillary Dissection According to SLN Metastasis in T1, T2 Stage Breast Cancer

The axillary nodes' status is essential in determining the treatment algorithm according to complete clinical staging. Unnecessary axillary lymph node dissection (ALND) has been prevented after sentinel lymph node biopsy (SLNB) has occurred in current practice. However, approximately half of patients with positive SLNB do not have axillary metastatic lymph nodes. Our study aims to predict unnecessary ALND in patients with SLN metastases by evaluating the patients' clinicopathological data. In total, 221 patients with macrometastasis in SLNB who underwent completion ALND were evaluated retrospectively. Patients were divided into two groups: patients with metastases only in the sentinel lymph node and additional axillary lymph nodes. Univariate and multivariate logistic regression analyses were used to analyze the correlation between SLN metastasis and axillary lymph node metastasis; clinicopathological characteristics, including patient age, menopause status, tumor size and grade, receptor status proliferative marker status, and molecular subtypes of the tumor. In the evaluation of T1-2, cN0 breast cancer patients with SLNB in the form of macrometastasis, only SLNB metastasis was found in 118 (53.4%) patients. In 103 (46.6%) patients, additional axillary node metastasis was observed. The risk of additional nodal spread correlated with patient age older than fertility age (age of 49) (p = 0.015, OR: 1.96, 95% CI: 1.14-3.39) and the number of increased metastatic sentinel nodes (p < 0.001). In line with the data shown by our study, the rate of axillary metastases increases in patients over the age of fertility and as the number of metastatic SLNs increases.

Intra-operative parathyroid hormone evaluation is superior to frozen section analysis in parathyroid surgery

BACKGROUND

Surgery is currently the only treatment option for patients with primary hyperparathyroidism (PHPT). Recently, minimally invasive parathyroidectomy (MIP) has begun to replace traditional bilateral neck exploration (BNE).

OBJECTIVE

The aim of this study is to compare the results of parathyroidectomies performed in our hospital over the past decade that were guided by intra-operative parathyroid hormone (IOPTH) sampling or frozen section (FS) analysis.

MATERIAL AND METHODS

Data on 697 patients who underwent parathyroidectomies in the Department of Endocrine Surgery, Dokuz Eylul University between January 2005 and 2018 were included in this study. Patients with malignancies other than thyroid papillary microcarcinoma and parathyroid cancer were excluded from the study.

RESULTS

The concomitant use of neck ultrasound (US) and technetium 99m Sestamibi (^99mTc MIBI) scintigraphy successfully localized the hyperfunctioning parathyroid glands in nearly 96% of cases. As compared with the IOPTH group, the operation time was longer in the FS group (p < 0.001), and the need for postoperative calcium (Ca) supplementation was higher (p < 0.001). The duration of hospitalization (days) was significantly higher in the FS group (4.2 ± 3.4 vs. 2.6 ± 1.9) as compared with that in the IOPTH group (p < 0.001). In addition, the recurrence rate in the FS group was significantly higher than that in the IPOTH group (p = 0.002).

CONCLUSION

IOPTH sampling is a safe and effective method when performed by experienced surgeons and with appropriate preoperative screening. This study emphasizes that IOPTH sampling. We believe that the success in parathyroid surgery is due to three factors: correct indication, accurate localization and experienced surgeon.

Conventional Imaging and Sonoelastography Findings of Oncocytic Breast Carcinoma in a Man

Oncocytic breast carcinoma (OBC) is one of the rare types of invasive breast carcinoma in according to the classification of The World Health Organization. Herein we represent imaging findings of a case of 69-year-old male patient with OBC.

Hyperthyroidism with thyroid cancer: more common than expected?

OBJECTIVE

Hyperthyroidism is a group of diseases with many different etiologies and clinical manifestations. The most common causes include toxic multi-nodular goiter, Graves' disease and toxic adenoma. The prevalence of thyroid cancer developing in patients with hyperthyroidism has gradually increased in recent years. The aim of this study is to detect the incidental thyroid cancer rates in patients who have undergone a surgical operation due to hyperthyroidism, and to specify the patient groups in whom surgical treatment should come into the foreground.

METHODS

A total of 591 patients, who had surgical excision of the thyroid due to hyperthyroidism between January 2007 and June 2017, were retrospectively analyzed.

RESULTS

Of all the patients included in the study, 377 (63.7%) had multi-nodular goiter, 132 (22.3%) had Graves' disease, 55 (9.4%) had nodular Graves' disease, and 27 (4.6%) had toxic adenoma. Thyroid cancer was determined in 131 out of 591 patients (22.6%) who were operated. The most common histologic type was thyroid micropapillary carcinoma (65/131; 49.6%). The accompanying pathologies to thyroid cancer were as follows: Toxic multi-nodular goiter (89/131; 67.9%), nodular Graves' disease (24/131; 18.3%), Graves' disease (13/131; 9.9%) and toxic adenoma (5/131; 2.8%).

DISCUSSION

Prevalence of cancer on a background of hyperthyroidism has gradually increased in recent years. It is not realistic to determine thyroid cancer prevalence only based on autopsy examinations. This rate significantly increases in the presence of nodule in clinical studies. Most of the carcinomas are microcarcinomas that do not have lymphovascular invasion and have very low lymph node metastasis. Thus, their treatment is still under debate.

KEY WORDS

Hyperthyroidism Micropapillary Cancer, Thyroid cancer.

Detection of the differences in the apparent diffusion coefficient values in different histopathological types of malignant breast lesions and comparison of cellular region/ stroma ratio and histopathological results

Background/aim

This study aimed to compare the apparent diffusion coefficient (ADC) values of malignant breast lesions with different histopathological types on diffusion-weighted imaging (DWI) and the cellular region/stroma (CR/S) ratio and histopathological results.

Materials and methods

Breast diffusion-weighted magnetic resonance findings of 59 patients were retrospectively analyzed for malignant breast lesions. The CR/S ratio was calculated using breast wide-excisional biopsy or mastectomy specimens.

Results

Receiver operating characteristic analysis was performed for malignant lesions and subtypes. An ADC threshold of 1.260 × 10 –3 mm 2 /s was set to detect invasive ductal carcinoma with 80.8% sensitivity and 81.4% specificity. An ADC threshold of 1.391 × 10 –3 mm 2 /s was set to detect invasive lobular carcinoma lesions with 88.2% sensitivity and 79.5% specificity. The ADC value for lesions with low CR/S ratio (n = 21) was 1.135 ± 0.429 × 10 –3 mm 2 /s and it was 1.155 ± 0.429 × 10 –3 mm 2 /s in the high CR/S ratio group (n = 18).

Conclusion

ADC value calculation does not seem to be used as an alternative for histopathological detection, which is the gold standard for the differentiation of subtypes of malignant breast cancer. In addition, since there is a positive correlation between CR/S ratio and ADC values, it may be a strong marker to evaluate the stromal component of lesions.

Porcine Dermal Collagen Prevents Seroma Formation After Mastectomy and Axillary Dissection in Rats

OBJECTIVE

Seroma occurs as a result of accumulation lymphovascular liquid in the dead space forming after tissue dissection. It is the most common complication after breast surgery. Collagens are the common component of extracellular matrix and have an important role in wound healing. In this study, we aimed to investigate the efficiency of the Porcine Dermal Collagen in preventing Seroma.

MATERIALS AND METHODS

Eighteen young female Wistar rats were used and divided into three groups. Mastectomy and axillary dissection were performed in each group. No other procedures were performed in Group 1 (Control group). Porcine dermal collagen was applied to 50% of the mastectomy field in Group 2 and to 100% of the mastectomy field in Group 3.

RESULTS

Seroma volume was significantly decreased in Group 3 in contrast to Groups 1 and 2 (p<0.001) and in Group 2 in contrast to Group 1 (p<0.001). Vascular proliferation, granulation tissue formation and congestion were significantly increased in Group 3 (p<0.05).

CONCLUSION

We conclude that the use of Porcine Dermal Collagen reduces the formation of seroma in the model of experimental mastectomy and axillary dissection. As the amount of Porcine Dermal Collagen applied increases the formation of seroma reduces.

Microporous polysaccharide hemospheres and seroma formation after mastectomy and axillary dissection in rats

OBJECTIVE

Seroma is the most common complication after breast surgery. Several methods have been proposed to prevent seroma, but none of these provided a significant effect. A prolonged wound healing process is the most important cause of seroma. Microporous polysaccharide hemospheres (MPH) are used to achieve hemostasis. They may also accelerate wound healing. In this study, the effects of MPH on seroma formation were investigated.

MATERIAL AND METHODS

Female Wistar rats weighing between 200 g and 250 g were used. There were eight rats in each of the control and study groups. Right breast mastectomy and axillary dissection were performed in all rats. While no application was performed after the operation in the control group, MPH was locally applied to the surgical site in the study group. Ten days after the operation, seroma fluid was aspirated and the total volume was recorded. The aspirates were analyzed and tissue samples were obtained from the surgical site.

RESULTS

Seroma was significantly lower in the study group (p=0.001). The mean albumin and lactate dehydrogenase levels were significantly lower in the study group (p=0.003). Pathological examination revealed that increase in fibrous tissue was significantly greater in the control group (p=0.032).

CONCLUSION

MPH may reduce seroma after mastectomy.