The operative strategy for resection of malignant tumors of the liver should address the key components of the extent of hepatectomy including anatomic resection and optimal pathologic margins, use of the anterior approach, necessity for vascular resection, regional lymphadenectomy and measures to minimize blood loss and postoperative morbidity for maximal survival benefit.

Operative intervention for melanoma metastatic to the GI tract is recommended for palliative reasons and can be performed with low morbidity and mortality. It is associated with prolonged survival in patients rendered free of all identifiable disease following surgical resection and in those with a low preoperative serum LDH.

BACKGROUND: The objective of this study was to evaluate the impact of adjuvant radiation therapy (RT) on regional recurrence and survival after therapeutic lymphadenectomy (TL) for clinically advanced, lymph node‐metastatic melanoma. METHODS: Six hundred fifteen patients who had clinically advanced, regional lymph node‐metastatic disease underwent TL. All patients were appropriate potential candidates for adjuvant RT (enlarged or multiple positive lymph nodes, extracapsular extension) because of a high risk for regional recurrence regardless of whether or not they received RT. Patient‐related, tumor‐related, and treatment‐related variables that were associated with recurrence, survival, and treatment‐related morbidity with and without RT were analyzed. RESULTS: The median follow‐up was 5 years. The actuarial 5‐year regional lymph node basin control rate was 81%. On multivariate analysis, the number of positive lymph nodes, the number of lymph nodes removed, and the use of adjuvant RT were associated with improved regional control. Treatment‐related morbidity, particularly lymphedema, was increased with the use of adjuvant RT and an inguinal site of lymph node metastases. At last follow‐up, 268 patients were alive with actuarial 5‐year distant metastasis‐free survival (DMFS) and disease‐specific survival (DSS) rates of 40% and 48%, respectively. On multivariate analysis, DMFS and DSS both were influenced by the number of positive lymph nodes and the number of lymph nodes removed. In addition, DSS was influenced by primary tumor thickness and the receipt of adjuvant RT. CONCLUSIONS: Adjuvant RT was associated with improved regional lymph node basin control compared with TL alone in patients with high‐risk, clinically advanced, lymph node‐metastatic melanoma. Although it is a regional therapy, adjuvant RT also may have an impact on DSS. Cancer 2009. © 2009 American Cancer Society.

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A curative resection in the absence of both distant metastases and pathological T4 tumor provides the best survival outcome. Recurrence at distant sites is the predominant pattern of failure following a curative resection, suggesting a role for adjuvant therapy.

We report an instructive case of extraskeletal osteosarcoma in a 63-year-old African American male who presented after an episode of recent trauma, with clinical and radiological features characteristic of this neoplasm. Osteosarcoma is the most common primary malignant tumor of bone in young adults, but the extraskeletal variety is very uncommon. The radiological and pathological features of this neoplasm will be discussed, along with a review of the literature.

The diagnostic accuracy of fine needle aspiration cytology (FNAC) was evaluated in thyroid nodules in 100 consecutive cases, who subsequently underwent thyroidectomy between the years 1989-1991. FNAC as a diagnostic test for thyroid nodules demonstrated an accuracy of 90.9%, a sensitivity of 76.5%, a specificity of 95.9% with a false positivity of 2%, false negativity of 4%, positive and negative predictive values of 86.7% and 92.2%, respectively. A correct classification of the carcinoma type on the basis of FNAC was possible only in 69% patients. As a result, FNAC is the first line of investigation in most nontoxic nodular goiters and often the only procedure necessary to obtain an accurate diagnosis. However, it is recommended only as an adjunct to clinical judgment and is not intended to replace it.

CD24 has been described as an adverse prognostic marker in several malignancies. This study evaluates CD24 expression in cholangiocarcinoma and correlates the findings with clinicopathologic data and patient survival. Between 1996 and 2002, 22 consecutive patients with cholangiocarcinoma were treated at our institution. Demographic data, SEER stage, pathologic data, treatment, expression of CD24, mitogen-activated protein kinase (MAPK), phosphorylated MAPK, and survival were analyzed. The majority of the tumors demonstrated CD24 (81.8%) and p-MAPK (87%) expression. A negative association was noted between the expression of CD24 and p-MAPK. Median survival for patients with low expression of CD24 was 36 months and high expression was 8 months. Median survival for patients who received chemotherapy with low CD24 expression was 163 months, and for seven patients with high CD24 expression, it was 17 months (p=0.04). With the addition of radiation therapy, median survival for patients with low expression of CD24 was 52 months and high expression was 17 months (p=0.08). On multivariate analysis, the use of chemotherapy (p=0.0014, hazard ratio 0.069) and the CD24 overexpression (p=0.02, hazard ratio 7.528) were predictive of survival. CD24 is commonly expressed in cholangiocarcinoma, and overexpression is predictive of poor survival and possibly of lack of response to chemotherapy and radiation therapy. These findings may improve selection of patients for the appropriate treatment modality and the development of CD24-targeted therapy.