Central and lateral cervical lymph node dissection are associated to severe morbidity. Correct indication, surgical expertise, high volume of patients and early multidisciplinary management of complications is the key of an acceptable balance between oncologic benefits and surgical morbidity.

The outbreak of the COVID-19 pandemic has led to a disruption of surgical care. The aim of this multi-centric, retrospective study was to evaluate the impact of the pandemic on surgical activity for thyroid disease among the Italian Units of Endocrine Surgery. Three phases of the pandemic were identified based on the epidemiological situation and the public measures adopted from the Italian Government (1st phase: from 9th March to 3rd May 2020; 2nd phase: from 4th May to 14th June; 3rd phase: from 15th June to 31st). The patients operated upon during these phases were compared to those who underwent surgery during the same period of the previous year. Overall, 3892 patients from 28 Italian endocrine surgical units were included in the study, 1478 (38%) operated upon during COVID-19 pandemic, and 2414 (62%) during the corresponding period of 2019. The decrease in the number of operations was by 64.8%, 44.7% and 5.1% during the three phases of COVID-19 pandemic, compared to 2019, respectively. During the first and the second phases, the surgical activity was dedicated mainly to oncological patients. No differences in post-operative complications were noted between the two periods. Oncological activity for thyroid cancer was adequately maintained during the COVID-19 pandemic.

HighlightsMale breast cancer (MBC) is a rare disease representing less than 1% of all malignancies in men andonly 1% of all incident breast cancers.Management consisted especially of radical mastectomy; followed by adjuvant radiotherapy and hormonal therapy with or without chemotherapy.Future research for better understanding of this disease at national or international level are needed to improve the management and prognosis of male patients.

Although some patients are currently referred with a severely advanced disease, the indication for tracheotomy, salvage procedures or supportive care has decreased over time. Resection is feasible for differentiated tumors with an overall good outcome.

Floseal + HS can be effective at reducing postsurgical drain output and provides a complementary hemostatic approach in patients undergoing total thyroidectomy.

Total thyroidectomy via cervical approach is the treatment of choice for MG in the elderly. It should be treated only in referral centers with adequate caution for elderly patients to achieve complete cure with limited complications.

Abstract. Breast metastasis from extra-mammary malignancy is rare. An incidence of 0.4-1.3% has been reported in the literature. The primary malignancies most commonly metastasizing to the breast are leukemia, lymphoma and malignant melanoma. We present a case of metastasis to the breast from a pulmonary adenocarcinoma, diagnosed concomitantly with the primary tumor. A 43-year-old female presented with dyspnea and a dry cough of 3 weeks' duration. A subsequent chest radiograph revealed a massive pleural effusion. Additionally, on physical examination, a poorly defined mass was noted in the upper outer quadrant of the right breast. The patient underwent bronchoscopy, simple right mastectomy and medical thoracoscopy. Following cytology, histology and immunohistochemistry, primary lung adenocarcinoma with metastasis to the breast and parietal pleura was diagnosed. Histologically, both the primary and metastatic anatomic sites demonstrated a micropapillary component, which has recently been recognized as an important prognostic factor. Although the patient received chemotherapy, she succumbed to her condition within 8 months. Accurate differentiation of metastasis from primary carcinoma is very important as the treatment and prognosis of the two differ significantly. IntroductionThe National Cancer Institute of the USA estimates that, based on current rates, 12.7% of females born today will be diagnosed with breast cancer in their lifetime (1). Although primary breast cancer is the most common malignancy of adult females, metastatic involvement of the breast is rare, with a reported frequency of 0.4-1.3% in clinical series (2-5). Despite its rarity, metastatic breast disease is an significant diagnostic clinical problem, as its treatment differs greatly from that of primary breast cancer. In 1907, Sitzentfrey was the first to publish a case of ovarian carcinoma metastatic to the breast (6). To date, a wide variety of malignancies have now been reported to metastasize to the breast and according to the literature, the most common primary tumors are melanomas and haematological malignancies (5-7). The lung is the most common cancer site in terms of incidence and mortality; however, there have only been a few published cases of pulmonary carcinomas metastasizing to the breast (8-12). Carcinomas with micropapillary components have been reported at several anatomical sites, including the breast, urinary bladder, ovary and major salivary glands (13). Micropapillary components are being increasingly recognized as prognostic predictors in lung adenocarcinomas and according to many studies, this may be a manifestation of aggressive behaviour (14,15). We report the case of a patient with breast metastasis from a pulmonary adenocarcinoma characterized by a micropapillary pattern and diagnosed in conjunction with the primary tumor. Written informed consent was obtained from the patient for publication of this case report and accompanying images. Case reportA 43-year-old, non-smoking housewife presented to the Emergency Departme...

Healing of a cervical chylous fistula can be achieved by conservative medical therapy (nutritional and pharmacological) but in case of therapeutic failure with rapid decrease of general condition, the surgical approach is necessary. In our experience, duct ligation after unsuccessful conservative treatment, is the only resolutive treatment.