Ganglioneuroma is the benign representative of peripheral neuroblastic tumors, with localized and predominant thoracic presentations in older children. They often have an excellent outcome with surgery alone. A 12-year-old girl presented with an incidentally detected abdominal mass, which was clinicoradiologically a renal mass. Laparotomy revealed a mass adherent to the anterior surface of the right kidney. The mass was carefully dissected out, sacrificing a portion of the inferior vena cava. Histopathological diagnosis was that of a ganglioneuroma. She was kept under follow up.
Objectives:To analyze the effects of pathological T stage, grade, extent of surgery for primary tumor, and age group on the risk of developing lymph node metastasis in clinically node-negative penile cancer patients. Methods: We performed a retrospective analysis of 200 clinically node-negative penile cancer patients who were kept under surveillance, after treatment of the primary tumor in our institution. The primary outcome parameter was cytologically or histologically proven lymph node metastasis. Logistic regression analysis was used to compute odds ratios in univariate and multivariate settings. Results: Lymph node metastasis occurred in 31 patients at a median time of three months. Histological grade 3 and grade 2 tumors had a statistically significant increased odds ratio for lymph node metastasis, (7.1[P < 0.001] and 2.7 [P = 0.04], respectively), compared with grade 1 tumors. Although increasing pT stage was associated with increasing odds ratios, the differences were not statistically significant. Nor did the extent of surgery of the primary tumor or the age group significantly influence the risk of developing lymph node metastasis. Conclusions: Histological grade is the most significant parameter influencing the risk of lymph node metastasis in clinically node-negative penile cancer patients on surveillance. Patients with grade 3 and grade 2 tumors may benefit from elective inguinal lymphadenectomy.
We present here a rare case of synchronous adrenocortical carcinoma (ACC) and renal cell carcinoma (RCC). A 27-year-old woman presented with gradual abdominal distension, hematuria, and loss of weight of 3-months duration. She gave a history of treatment for hypertension. The computed axial tomography (CT) scan revealed a large retroperitoneal mass. Her urinary VMA was slightly elevated. Her 24-h urinary metanephrine level was normal. The patient underwent left adrenalectomy, left nephrectomy, spleenectomy, and distal pancreactomy with segmental colonic resection. Postoperative pathology revealed ACC of left suprarenal measuring 22 × 19 × 18 cm3 and RCC involving the left upper pole of kidney measuring 3 × 2 × 1 cm3.
In an effort to overcome shoulder morbidity from the classical radical neck dissection, modifications preserving the entire spinal accessory nerve, were described. When there are metastatic upper jugular nodes with potential extracapsular spread, modifications that preserve the entire XI nerve may be oncologically unsafe. We describe a technique wherein the XI nerve is preserved based on the contribution from the cervical plexus, while allowing resection of the proximal part of the nerve en bloc with the specimen. This modification may preserve useful trapezius function without compromising oncological safety.
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