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328 Renal Cell Carcinoma (RCC) Metastasis to the Coracoid Process. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A 51-year-old man was diagnosed with renal cell carcinoma (RCC) of the left kidney seven years ago. The tumour was staged as T2N0M0 and the patient underwent an uncomplicated open left radical nephrectomy. The RCC was classified as clear cell and he was kept on biannual renal surveillance thereafter.
Six years after the nephrectomy, the patient had reported a 5-month history of worsening pain and globally restricted movement in their right shoulder. A palpable mass on the coracoid process was noted. MRI imaging had shown a 27x30x17mm lesion suggestive of an expansile osseous mass in the coracoid process. An ultrasound guided biopsy was performed for definitive characterisation. Histology had reaffirmed that the lesion was in fact metastatic clear cell carcinoma in keeping with the patient’s renal primary. CT chest/abdomen/pelvis and NM-Bone SPECT CT scanning had shown no other sites of metastasis. A marginal resection of the lesion was performed with a good macroscopic clearance.
The common sites within the skeleton implicated in RCC include the spine, pelvis and femur. Tumours of the coracoid process are exceedingly rare. From the literature, only four cases of metastasis to the process have been noted: two from breast carcinoma, one from hepatocellular carcinoma and the other from basal cell carcinoma. Thus, this case denotes an extraordinary presentation for a metastasis of RCC many years after the nephrectomy. Furthermore, it emphasises the criticalness of regular follow-up and early intervention as delays could lead to systemic metastasis and a poorer prognosis.
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1181 Thoracic Outlet Syndrome - A Miss(Ed) Diagnosis-Delayed Diagnosis Of Thoracic Outlet Syndrome Is Common And Leads To Poorer Functional Outcomes. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Thoracic outlet syndrome was first defined by Peet in 1956 as “compression of the neurovascular structures in the interscalene triangle corresponding to the possible etiology of the symptoms”.1 Diagnosis of TOCS still remains controversial due to lack of clear referral pathways and our study aims to create one to prevent adverse treatment outcomes.
Method
A retrospective audit in a single vascular centre over a 11-year period correlating time of onset of symptoms to delivery of care and post intervention benefits
Results
Total of 50 patients were analysed during the study. 30 percent of the patients analysed were noted to be referred to a vascular surgeon 3 years post the initial presentation of symptoms. 60 percent were noted to be referred between 6-2.5 years post initial presentation. Remaining 10 percent were noted to be referred in less than 6 years. It was noted that patients belonging to the group Acohort were noted to have recurrence of symptoms, albeit minor post intervention and treatment of TOCS. Whereas recurrence was noted to be nil/ reduced in the patients intervened in less than 2 years from onset of symptoms. Furthermore, the study also noted that more than 50 percent patients with neurogenic/ venous TOCS had a history of preceeding trauma/ shoulder injury and were noted to be not investigated for TOCS.
Conclusions
Our study lends evidence that delayed diagnosis of thoracic outlet syndrome is common and leads to poorer functional and treatment outcomes. Hence a diagnostic pathway must be proposed and implemented at primary care which caters to diagnosis of TOCS, to avoid delays in delivery of adequate care and treatment.
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