Incidental finding of tall cell variant papillary thyroid carcinoma on prostate-specific membrane antigen PET CT scan

Prostate-specific membrane antigen (PSMA) PET CT is widely used for staging and restaging of prostate cancer. Thyroid and other non-prostatic pathology may be incidentally identified by this imaging modality. Such findings warrant further investigation given their malignant potential. We describe the first reported case of PSMA avid T cell-variant papillary thyroid carcinoma incidentally detected on PSMA PET CT.

Outcomes of patients with metastatic cutaneous squamous cell carcinoma to the axilla: a multicentre cohort study

BACKGROUND

Metastatic cutaneous squamous cell carcinoma to the axilla is uncommon, with limited data to guide management. We sought to assess the outcomes of patients with this condition after surgery and radiotherapy.

METHODS

A retrospective cohort study of patients treated at two Australian hospitals from 1994 through 2016 was performed.

RESULTS

A total of 74 patients were identified, including 48 treated curatively with surgery-plus-radiotherapy and 15 with surgery alone. Compared with patients treated with surgery alone, a higher proportion of patients treated with surgery-plus-radiotherapy had lymph nodes larger than 6 cm (53% versus 8%, P = 0.012) and multiple adverse histopathological features (75% versus 47%, P = 0.04). The groups had similar 5-year disease-free survival (45% versus 46%) and overall survival (51% versus 48%). Presence of multiple positive lymph nodes was associated with reduced disease-free survival (hazard ratio 4.57, P = 0.01) and overall survival (hazard ratio 3.53, P = 0.02). Regional recurrence was higher in patients treated with surgery alone (38% versus 22%, P = 0.22) and patients with lymph nodes larger than 6 cm (34% versus 10%, P = 0.03). All recurrences occurred within 2 years following treatment.

CONCLUSION

Combined-modality therapy for metastatic cutaneous squamous cell carcinoma to the axilla is recommended for high-risk patients, although outcomes remain modest. The key period for recurrence is within 2 years following treatment.

Microscopic positive margins in papillary thyroid cancer do not impact disease recurrence

BACKGROUND

The prognostic significance of microscopic positive margins in papillary thyroid carcinoma (PTC) remains unclear. The aim of this study was to determine if microscopic positive margins are associated with increased risk of disease recurrence.

METHODS

This is a retrospective analysis of 610 patients with PTC using multivariate Cox regression to evaluate the association between microscopic positive margins and disease-free survival.

RESULTS

Microscopic positive margins were found in 67 (11%) patients and associated with extrathyroidal extension (P < 0.001), multifocality (P < 0.001), nodal metastases (P < 0.001), lymphovascular invasion (P < 0.001), age ≥55 years (P = 0.048), administration of radioactive iodine (RAI) therapy (P = 0.001) and a trend towards larger tumour size (18 versus 15 mm; P = 0.074). After a median follow-up of 3.4 years, there were 83 recurrences. Although involved margins were associated with increased risk of recurrence on univariate analysis (hazard ratio 2.6, 95% confidence interval 1.5-4.6; P = 0.001), there was no association after adjusting for age, nodal metastases, tumour size and extrathyroidal extension on multivariate analysis (hazard ratio 1.5, 95% confidence interval 0.8-2.9; P = 0.242). Similar results were obtained after adjusting for RAI and if margins were analysed as focal versus widely positive. In our study cohort, patients with involved margins generally had other indications for RAI. However, in the nine patients who did not receive RAI, there was no recurrence in the thyroid bed.

CONCLUSION

Despite a strong association between microscopic positive margins and other adverse prognostic factors in PTC, there is no independent association with disease recurrence on multivariate analysis. Microscopic positive margins are rare (1.1%) in the absence of other indications for RAI.

Sympathetic trunk repair following penetrating injury to the neck

There are relatively few published reports of Horner’s syndrome following penetrating injury to the neck. We present the case of a 19-year-old female sustaining a Zone 2 neck laceration with Horner’s syndrome due to complete transection of the sympathetic trunk. Nerve repair was performed with an interposition cable nerve graft using ansa cervicalis and resulted in complete recovery at 13 months follow-up. Neuropraxia cannot be differentiated from nerve transection clinically or radiologically and given the potential for complete recovery after nerve repair, we advocate for surgical exploration in all cases of penetrating neck injury with Horner’s syndrome.

Obesity-related chronic lymphoedema-like swelling and physical function

BACKGROUND

People with severe obesity (body mass index [BMI] > 40 kg/m(2)) have an 85% higher mortality than people with a healthy BMI. Poor physical function may contribute to this excess mortality. Lymphoedema-like swelling can affect the legs of severely obese people with normal lymphoscintigraphy.

AIM

We sought to determine the relationship between the presence of lymphoedema-like swelling and physical function in the severely obese.

DESIGN AND METHODS

In people with severe obesity, we ascertained whether lower leg lymphoedema-like swelling was present and determined the circumference of the lower leg, time taken to ascend and descend a 17-cm step 50 times and time taken to walk 500 m.

RESULTS

The 330 participants, 33% of whom were male, were aged 43.4 ± 12.7 years (mean ± standard deviation) and had a BMI of 51.7 ± 8.4 kg/m(2). Lymphoedema-like swelling was present in approximately one-third (n = 108) in whom a prior history of cellulitis and venous thromboembolism was more common (relative risks 6.16 and 3.86, respectively) than in those without lymphoedema-like swelling. Participants with lymphoedema-like swelling, compared with non-affected counterparts, had a higher lower leg circumference (35.0 ± 7.1 vs. 32.4 ± 4.8 cm), a slower step speed (0.40 ± 0.12 vs. 0.43 ± 0.10 steps/s) and a slower walking speed (0.97 ± 0.37 vs. 1.08 ± 0.30 m/s, P < 0.05 for all comparisons).

CONCLUSIONS

In this cross-sectional study, 33% of our severely obese participants had lymphoedema-like swelling. Participants with lymphoedema-like swelling had worse physical function than those without. This association was independent of BMI. The presence of obesity-related chronic lymphoedema-like swelling should lead to interventions that improve physical function.

Mitral Prolapse Caused by Lymphangioma

A 62-year-old female patient with known mitral-valve prolapse for the previous five years presented with progressive dyspnea and intermittent palpitations. This clinical presentation was investigated by two-dimensional echocardiography which revealed moderate mitral regurgitation due to a pedunculated mass oscillating between the left atrium and the left ventricle. Successful operative treatment consisted of en-bloc resection of the tumor from the anterior mitral valve leaflet and its primary cords and subsequent reconstruction of the mitral valve. Pathohistological examination revealed a cystic lymphangioma originating from mitral-valve tissue. To our knowledge this is the first reported case in the literature.

Orchestrating anaphase and mitotic exit: separase cleavage and localization of Slk19

Anaphase in budding yeast is triggered by cleavage of the central subunit, Scc1, of the chromosomal cohesin complex by the protease separase. Here we show that separase also cleaves the kinetochore-associated protein Slk19 at anaphase onset. Separase activity is also required for the proper localization of a stable Slk19 cleavage product to the spindle midzone in anaphase. The cleavage and localization of Slk19 are necessary to stabilize the anaphase spindle, and we show that a stable spindle is a prerequisite for timely exit from mitosis. This demonstrates the cleavage of targets other than cohesin by separase in the orchestration of high-fidelity anaphase.