Soft tissue sarcomas (STS) of the hand are exceedingly rare. The aim of this study was to review our institution's experience with STS of the hand to identify factors affecting outcomes and survivorship.

Aneurysmal bone cysts are an uncommon form of benign primary bone tumors; affection of the hand is very rare.

Myxoid liposarcomas of the head and neck are mostly metastatic in nature, with the primary lesion usually in lower extremities or retroperitoneum. Primary mediastinal liposarcomas are even rarer. Although there have been previous cases reporting their incidence, there is no evidence of any case comprising of both the neck and the mediastinal region yet. We here present a case of a 43 year old male with a primary liposarcoma of the myxoid subtype originating in the anterior mediastinum. This is the first time such a case has presented in literature. The patient presented with a right sided neck swelling associated with pain and shortness of breath upon lying down. CT neck revealed an enhancing mass extending from right cervical region to axilla and encasing the subclavian artery and involving a portion of the right lung. The patient underwent wide local excision of the mass along with chemoradiotherapy to prevent recurrence.

Background Cervical cancer can be controlled to a greater extent by screening to improve morbidity and mortality. Pap smear is important screening method, which has proven to be highly effective in reducing the number of cases and the mortality from cervical carcinoma. Any abnormality detected in pap smear has to be confirmed with cervical biopsy, which remains the reference investigation. Objective To find the changes of cervical cytology by pap smear, to classify cervical lesions into malignant and benign groups on cytological and histopathological basis and to correlate the changes observed in cervical cytology with cervical biopsy. Method This is a prospective cross sectional study done in between July 2014 and July 2015 in Dhulikhel Hospital, Kathmandu University Hospital. During the period, all the samples requested for pap smear were studied. The cases who had undergone both pap smear and cervical biopsy were compared. Clinical data were obtained from requisition submitted along with the cytology and tissue specimens received in the department. Result During the study period, total 1922 pap smears were performed and out of them 75 patients were advised to do cervical biopsy. On cytology, out of total 1922 number of cases, 67.90% were normal, 27.90% were inflammatory smears, 3.80% were unsatisfactory (inadequate) and 0.40% were high grade intraepithelial lesions. Highest numbers of patients screened for pap smear ranged from 31 to 40 years. On histopathology, 78.70% had chronic cervicitis, 8% had normal findings, 1.30% had moderate and 6.70% had severe squamous intraepithelial lesions. The frank malignancy was found in 5.30%. The mean age ± SD for carcinoma was 52.75±6.29. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value of pap smear were 77.80%, 100%, 100% and 97% respectively considering cervical biopsy as the gold standard Conclusion This study revealed a good correlation of cervical cytology with cervical biopsy. Pap is a cost effective screening method for early detection of premalignant and malignant cervical lesions. However, biopsy is considered as the gold standard for the confirmation of abnormalities detected in cervical smear.

Background Selective neck dissection in multimodality treatment protocols is slowly being accepted for the management of N+ neck in many centers. This is because the functional disability is lower than modified radical neck dissection. Objective This study compares the regional recurrence rates between patients who underwent selective neck dissection and patients underwent comprehensive neck dissection for node positive oral squamous cell carcinoma. Method A retrospective study comparing patients with node positive oral squamous cell carcinoma who underwent either selective neck dissection or comprehensive neck dissection between August 2011 and January 2014 was done, with a mean follow up period of 12 months. Regional failures were assessed to whether they were isolated neck failures or associated with a local or distant failure. Result A total of 131 neck dissections were performed which included 93 selective neck dissections and 38 comprehensive neck dissections. A total of 17 patients developed regional recurrence, of which 11 patients had ipsilateral neck recurrence. Of the 11 patients with ipsilateral neck recurrence one patient also had contralateral neck nodes and in two patients there was associated distant metastasis. Conclusion Selective neck dissection for management of node positive neck disease is based on sound scientific principles and a randomised controlled trial comparing it with modified radical neck dissection would probably give the answer regarding the optimal procedure for these patients.

Adenocarcinoma of the prostate is the second most common cause of cancer-related deaths among males in the U.S. Metastatic disease commonly involves the bones, lymph nodes, lungs, liver, and brain. Rarely, colonic involvement is seen and it is generally due to direct extension to the rectum. It is exceedingly uncommon for distant metastasis to occur in the right colon and small bowel. We present a case of prostatic adenocarcinoma metastasizing to the appendiceal orifice in a 78-year-old male. Our patient had a history of adenocarcinoma of the prostate diagnosed four years prior to presentation. He also had a history of adenocarcinoma of the distal colon 30 years prior which resulted in a partial colectomy and permanent diverting colostomy. Prior to his presentation, follow-up colonoscopies failed to reveal disease progression or additional malignancy. During routine colonoscopy, he was found to have a 2.5 cm polyp near the appendiceal orifice. Histologically the polyp demonstrated colonic mucosa with an infiltration of the lamina propria by individual cells with abundant cytoplasm and round nuclei with prominent nucleoli. The neoplastic cells were strongly positive for PSA and negative for CK7, CK20, and CDX2 supporting a diagnosis of metastatic prostatic adenocarcinoma. Metastatic disease of extracolonic origin arising in a polyp is extremely uncommon, but metastases have been reported to involve breast, ovary, stomach, esophagus, and kidney. This case contributes to the scarce information available regarding metastatic spread of prostate cancer to the ascending colon and enlightens the community of pathologists, surgeons, gastroenterologists, and urologists about this unusual presentation of a common carcinoma.

Amyloidosis is a rare disease encompassing the accumulation of abnormal and insoluble amyloids systemically or in specific organs. This is a case of a previously healthy 60-year-old male complaining of fatigue and chest pain who proceeded to rapidly decline in functional status within six months from the onset of these symptoms. Cardiac evaluation demonstrated characteristic changes on EKG and echocardiogram was consistent with cardiac amyloidosis. Muscle and gastrointestinal biopsies confirmed multisystem amyloidosis. Monoclonal kappa light chain was identified by serum electrophoresis and the diagnosis of multiple myeloma was confirmed by bone marrow biopsy. The process of amyloid deposition secondary to multiple myeloma was managed with chemotherapy after the patient was referred to a center specialized in amyloidosis treatment. This case highlights the diagnostic challenges, non-specific signs and symptoms, and treatment dilemmas involved in managing amyloid light-chain cardiac amyloidosis.

Conventional eccrine spiradenoma is a benign, slow growing and painful tumor of the skin. While the tumor does not usually present a diagnostic dilemma, a rare variant with marked stromal lymphedema can be a challenge to interpret. We present a case of lymphangiectatic variant of eccrine spiradenoma in an 82-year-old white male who presented with a persistent left flank lesion for several months. The patient was initially asymptomatic and subsequently developed a suspected abscess that was excised to reveal a 6.5 cm subcutaneous mass. Microscopic examination reveals strands and cords of dark, epithelial, round to oval cells with inconspicuous nucleoli streaming between prominently dilated and congested vascular spaces. Within the cystic component there are small ductular structures. Additionally, prominent stromal lymphedema is present. To the best of our knowledge, there is only one reported case of this entity in the English literature. This case represents a diagnostic challenge and the purpose of reporting it is to alert surgical pathologists, dermatopathologists and dermatologists of the existence of this unusual variant of eccrine spiradenoma.

A recent study reported an overall survival benefit for patients with metastatic urothelial carcinoma of the bladder (mUCB) managed with high-intensity local treatment (LT) of the primary tumor (chemotherapy plus radical cystectomy and/or radiation therapy ≥50Gy). Given the non-negligible morbidity of these procedures, adequate patient selection is crucial. Our objective was to identify patients who might benefit the most from high-intensity LT. Data for 3044 patients with mUCB at diagnosis were extracted from the National Cancer Data Base 2004-2013, and patients were categorized on the basis of treatment: high-intensity LT versus conservative LT (chemotherapy plus transurethral resection of bladder tumor and/or radiation therapy <50Gy). Multivariate Cox regression analysis predicted baseline 2-yr overall mortality (OM) risk among patients who received conservative LT. We then assessed the interaction between predicted OM risk and LT type. Compared to conservative LT, high-intensity LT yielded a higher observed OM-free survival rate among all patients with pure mUCB, irrespective of their predicted OM risk (nonsignificant interaction, p=0.7). These findings underline the need for further retrospective and prospective evaluation. PATIENT SUMMARY: Among patients with metastatic histologically pure urothelial carcinoma of the bladder, we found an overall survival benefit of high-intensity local treatment directed at the primary tumor, regardless of predicted baseline 2-yr overall mortality risk.

Controversy exists whether Leydig cells recover after testicular cancer (TC) treatment or whether premature hormonal aging will occur.

The S3M (Stockholm-3 Model) test improves discrimination for high-grade (Gleason score ≥ 7) prostate cancer compared with prostate-specific antigen (PSA) testing. Published results from the Stockholm-3 study represent a snapshot of possible outcomes for prostate cancer detection using the S3M test. In this brief report, we show how the full range of cancer detection rates and percent saved biopsies depend on the chosen S3M cut-off for recommending prostate biopsy. Using data from the Stockholm-3 validation cohort (n=47 688), we calculated the cancer detection rates and percent saved biopsies for various S3M test cut-offs in men with PSA ≥1ng/ml. Cancer detection rates decline and fewer prostate biopsies have to be performed with increasing test cut-offs. Primarily, S3M test values between 7% and 14% can be considered for biopsy decision cut-offs (10% risk of Gleason score ≥ 7 corresponds to PSA=3 ng/ml); the exact cutoff can be chosen to fit different healthcare systems and, indeed, individual men. PATIENT SUMMARY: The Stockholm-3 Model test improves the detection of high-grade prostate cancer compared with prostate-specific antigen. In this brief report, we show how the cut-off used for recommending prostate biopsies affects the number of detected cancers and performed biopsies. The exact cut-off used can be chosen to fit different individuals and healthcare systems.

It can be challenging to predict the risk of biochemical recurrence (BR) during follow-up after radical prostatectomy (RP) in men who have undetectable prostate-specific antigen (PSA), even years after surgery.

Urothelial carcinoma (UC) is the most common malignancy of the urinary tract. Upper tract (renal pelvis and ureter) urothelial carcinomas (UTUC) account for approximately 5% of UCs but a significant subset are invasive and associated with poor clinical outcomes.

The literature is lacking randomised controlled trials comparing robot-assisted (RARP) and laparoscopic (LRP) radical prostatectomy, especially for follow-up >1 yr.

Data regarding clinical node metastases (cN+) in patients undergoing radical cystectomy (RC) are scarce.

The clinical diagnosis of urothelial carcinoma (UC) relies on invasive methods in patients with hematuria. Although more sensitive and noninvasive screening methods are required, a specific serum biomarker for UC is lacking.