Thyroid surgery has been characterized in the last years by significant innovations which are well codified and standardized. Although the mortality rate is remarkably reduced (0.065%) compared to the early 1900s (1), thyroid surgery is still not free from risk of complications such as those related to the injury of laryngeal nerves and parathyroid glands (2, 3). The two most common early complications of thyroid surgery are hypocalcemia (20-30%) and recurrent laryngeal nerve injury (5-11%) (2). Bilateral recurrent nerve paralysis resulting in adduction of the vocal cords is a rare life-threatening complication occurring in less than 0.1% of cases that requires emergency management (2). To prevent or reduce the incidence of these events it is of primary importance an excellent anatomical knowledge of the neck as well as the application of a meticulous surgical technique (4-6). Thus, the rate of these complications is directly related to the extent of thyroidectomy and to a radical thyroid excision (without macroscopic thyroid residual) as well as to the surgeon's experience (7).Microsurgical technique with the use of microscope is usually performed to make microvascular anastomosis of limb replantation and free flap in many surgical specialities (8-10). Starting from 1975, and to the best of our knowledge, only few works have been published about the use of microsurgical technique and magnification as a support to traditional thyroid surgery; interestingly, though, the results show that such treatment approach helps surgical performance and prevents complications, especially in reinterventions, thyroiditis, cancer and cervical lymphadenectomy (4,(11)(12)(13)(14)(15)(16)(17)(18)(19)
BackgroundPrimitive sarcoma of the breast is a rare and challenging disease at high risk of recurrence and with poor prognosis. There are controversies in the diagnosis and management of such solid tumor due to its rarity and heterogeneity. This sarcoma is poorly responsive to both chemotherapy and radiotherapy, thus, surgery is the first and most important therapeutic approach. However, given the rarity of this type tumor it has not be possible to standardize unique guidelines for the proper surgical strategy to adopt. Here, we performed a retrospective study of new 10 cases of primitive sarcoma of the breast that underwent either mastectomy or a more conservative quadrantectomy, in the attempt to better standardize correct surgical indications.MethodsTen new cases of primitive sarcoma of the breast were registered between 2002 and 2012 and constituted the study group. They underwent either mastectomy or quadrantectomy and the clinical, prognostic and survival characteristics after surgery were analysed.ResultsWithin the group of patients treated with mastectomy, two had metastasis and died because of that. Among the five patients treated with quadrantectomy four are alive and free of disease after 3 to 5 years follow-up, while the patient with sarcoma arising in pregnancy, although is still alive, developed lung metastases four years after surgery.ConclusionsThe first and most important therapeutic approach to primary sarcomas of the breast is surgical which has the purpose to achieve radical tumor excision to prevent local recurrence and skip metastases. However, given the rarity of the condition and the consequent small number of cases in this, like in similar studies, it is not possible to draw any definitive conclusions and further studies with larger numbers are necessary. However it would appear that performing a larger procedure such as mastectomy rather than performing a more limited one such as a quadrantectomy, has no advantage in terms of overall prognosis.
Soft tissue sarcomas are rare tumors with a dismal prognosis. Among the most common histological types of sarcomas of the extremities, malignant fibrous histiocytoma (MFH) is the one with the highest incidence. Surgery is considered to be the first choice of treatment for MFH. To the best of our knowledge, this is the first case report in the literature of a patient with MFH within the abductor pollicis longus (APL) muscle. This unusual location was also unexpected by the treating surgeons, as the preoperative magnetic resonance imaging localized the tumor inside a different muscle. A 79-year-old Caucasian man presented with a swelling in the middle third of the dorsal aspect of the left forearm. MFH was diagnosed following biopsy and instrumental diagnostic examinations. Surgical excision and simultaneous reconstruction was performed by the same microsurgical team, achieving an excellent functional outcome. The present case highlights the significance of microsurgical approach for improving strategic planning in oncologic surgery. Accurate surgical dissection, performed by a team of microsurgeons, allowed for the identification of the unusual and unexpected tumor localization within the APL muscle. For this reason, a change of surgical strategy allowed for preservation of the extensor digitorum communis muscle, which would otherwise have to be resected, with tendon transfer and successful restoration of the thumb abduction function.
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