The dilemma of managing thyroid gland after incidental diagnosis of malignant struma Ovarii. Is radical thyroidectomy and radioactive iodine Necessary? A case report and literature review

•Struma ovarii is a rare ovarian teratoma which consists of at least 50% thyroid tissue.•In 0.5-1% of cases the thyroid tissue in the struma ovarii undergoes a malignant transformation.•Patients should be divided into low and high-risk groups for synchronous thyroid carcinoma.•Patients with abnormalities on thyroid imaging should be considered as high-risk.•A thyroidectomy and radioactive iodine treatment can decrease the risk of recurrence.

[Treatment in XIIth c. Poland according to medical writings of Nicholas of Poland]

The authors present the person of Mikolaj of Poland, a thirteenth century doctor, connected with the Princes of Pomerania and Greater Poland, educated in France, and known from his two major writings, Antipocras (Anti-Hypocrates) and Experimenta. On the background of medieval medicine, the methods of healing he suggested appear as unusual and unconventional. He healed with amulets, mud, dung, river and sea water, frogs, moles, vipers, flies and worms. Using them, he produced powders, pills, ointments and oils which were to have outstanding healing results. They were to be used in lithiasis, skin irritations, nephritis, hepatitis, deafness, epilepsy, and toothache. Women might use them as cosmetics, too. Considering thirteenth century medicine, Mikolaj with no doubts represents medieval medical "empiry", creating an interesting alternative against official standards binding doctors of that time.

Identification of groin node metastasis in squamous cell vulval cancer using preoperative [18F] FDG-PET/CT. Can unnecessary lymphadenectomy be prevented?

INTRODUCTION

Vulval cancer is the 4th most common gynaecological cancer. The International Federation of Gynaecology and Obstetrics(FIGO) staging requires a histopathological dissection of the primary tumour and the inguinofemoral lymph nodes(IFLN).However, radiological methods of IFLN assessment often lack accuracy, leading to unnecessary IFLN dissections carrying significant morbidity.

AIM OF THE STUDY

To determine its accuracy of [18F] FDG-PET/CT as a pre-operative assessment tool for the groin lymph node in vulval squamous cell carcinoma.

METHODOLOGY

The predictive value of PET/CT in preoperative assessment of the groin node metastasis was assessed retrospectively in patients with vulval cancer, treated in St. James's Hospital Dublin (2010-2022). SUVmax of the nodal uptake of each inguinal area (if present) was calculated and correlated to histologically confirmed groin metastasis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT in predicating groin node metastasis were calculated. Overall survival was also calculated.

RESULTS

Out of the 200 patients 107(53.3%) had a full histopathological assessment of inguinal area and a PET/CT. Patients had either bilateral or unilateral IFLN histology, yielding 197 groins. The sensitivity of PET/CT for IFLN metastasis was 60.0% and specificity was 92.10%. The PPV was 74.30% and the NPV was 88.60 %. The mean SUVmax was 7(range 1.6-30.0 for metastatic nodes (true positive) and 2.18(range 1.9-3.1) for histologically negative nodes (false positive).

CONCLUSION

This study showed that PET/CT has a moderate sensitivity to identify those at risk of lymph node metastasis. Further prospective studies are required to validate the use of PET-CT in discriminating metastatic from non-metastatic IFLN.