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In canine mast cell tumours (MCTs), distant metastasis (DM) occurs infrequently. However, high-risk MCTs or tumours with certain negative prognostic factors (NPFs) are those more prone to develop metastatic disease. Accordingly, a thorough workup might not be necessary for MCTs lacking NPFs. The objective of this study was to evaluate the rate of DM and, therefore, the benefit of extensive staging in dogs presenting with and without NPFs. Furthermore, the association between the selected NPFs and DM was assessed, and factors that may have influenced outcome were evaluated. Dogs presenting with at least one NPF (Patnaik III/Kiupel high-grade, LN metastasis, rapid growth, ulceration, recurrence, high-risk location) were defined as high-risk and without as low-risk MCTs. Ninety-nine dogs were included, with 49% of MCTs in the high-risk and 51% in the low-risk group. All seven dogs with DM were identified in the high-risk group; 43% were Patnaik III/Kiupel high-grade tumours. The median survival time (MST) for this subgroup was 84 days. Patnaik III/Kiupel high-grade and rapid growth were NPFs significantly associated with DM at staging. Furthermore, a significant difference (p < .001) in MST was demonstrated between the high-risk and low-risk groups (899 days vs. not reached). NPFs significantly associated with outcome were rapid growth, presence of DM at staging, and surgical tumour excision. These results indicate that extensive staging in the absence of NPFs does not seem to be beneficial. On the other hand, by using the selected NPFs, a subset of MCTs prone to DM can be identified.

Objective: Analysis of preoperative predictors for pituitary adenoma operations and their impact on results after endoscopic endonasal transsphenoidal surgery (EETSS) Methods: We carried out a prospective study of all the patients (99), who were endoscopically endonated transphenoidal at the Department of Neurosurgery, Benha University, Egypt and Wuhan Union Hospital, and China between January 2018 and December 2019. Medical data were gathered and evaluated, including information on sex, age, tumour size, hormone level, preoperative MRI brain and sella, resection scope, result (clinical and endocrinological) and complications. Results: 99 patients with PA were endoscopic transsphenoidal endonasal treatments, 52 males (52.5%) and 47 females (47.5 percent ). Average age 42.5 ± 11.2 years, Irregular menstrual behaviour was the highest in the study populations in 22 patients, followed by visual disturbance in 17 patients (17.2%), acromegaly and increased intracranial pressure in 14 patients, followed by 11 (11.1%), 8 (8.1%) accidents, and 5 (8.1%) cases (11.1%), followed by headache with 11 (12.1%). Conclusion: the size and scope of the tumour excision are only important postoperative determinants (hormonal, radiological & postoperative complications).

OBJECTIVES Chest wall sarcomas are rare, aggressive malignancies, the management of which mainly revolves around surgery. Radical tumour excision with free margins represents the optimal treatment for loco-regional clinically resectable disease. The objective of this study was to review our 11-year experience with chest wall resection for primary and metastatic sarcomas, focusing on surgical techniques and strategies for reconstruction. METHODS Retrospective analysis of a comprehensive database of patients who underwent chest wall resection for primary or secondary sarcoma at our Institute from January 2009 to December 2019. RESULTS Out of 26 patients, 21 (81%) suffered from primary chest wall sarcoma, while 5 (19%) had recurring disease. The median number of resected ribs was 3. Sternal resection was performed in 6 cases (23%). Prosthetic thoracic reconstruction was deemed necessary in 24 cases (92%). Tumour recurrence was observed in 15 patients (58%). The median overall survival was 73.6 months. Primary and secondary tumours showed comparable survival (P = 0.49). At univariate analysis, disease recurrence and infiltrated margins on pathological specimens were associated with poorer survival (P = 0.014 and 0.022, respectively). In patients with primary sarcoma, the median progression-free survival was 13.3 months. Associated visceral resections were significantly associated to postoperative complications (P = 0.02). CONCLUSIONS Chest wall resection followed by prosthetic reconstruction is feasible in carefully selected patients and should be performed by experienced surgeons with the aim of achieving free resection margins, resulting in improved long-term outcomes.

Purpose: The purpose of this study was to compare the effectiveness of endoscopic vs microscopic excision of pituitary noninvasive adenoma.Materials and Methods: The current prospective comparison study was carried out at the Department of Neurology, Apex Hospital, Jaipur, Rajasthan, India among 40 patients who had been diagnosed with noninvasive pituitary adenoma Group I (n=22) had endoscopic trans-sphenoidal surgery performed on them. Group II (n=18) had trans-sphenoidal surgery using a microscopic approach.Results: An overall total of 40 individuals with pituitary nodules had transsphenoidal surgery as a result of this study. Endonasal endoscopic trans-sphenoidal surgery (Group I) was performed on 22 patients, whereas microscopic trans-sphenoidal surgery (Group II) was performed on 18 patients (group II). Complete tumour excision was accomplished in 14 (63.6 percent) of the patients in group I, while it was achieved in 10 (55.6 percent) of the patients in group II.Conclusion: Both techniques are valid for the treatment of pituitary noninvasive adenomas. However, endoscopy proves to be superior for resection followed by less post-operative complication in comparison to microscopic technique.

Introduction Due to a relatively high recurrence rate of facial basal cell carcinoma (BCC), its morbidity is very significant. Aim To analyse the expression of α-SMA, E-cadherin, Ber-Ep4 and MOC-31 as predictors of local recurrence in a group of patients with primary and recurrent BCCs of the face in correlation with histological and clinical data. Material and methods The study cohort included 79 patients with facial BCC (52 with primary BCC and 27 with recurrent BCC) who were treated at the Department of Cranio-Maxillofacial Surgery of the Jagiellonian University, Krakow in 1997-2009. Results Significant risk factors for local recurrence included: recurrent tumour (p = 0.001), multifocal BCC (p = 0.01), incomplete tumour excision (p = 0.02) and the aggressive infiltrating histologic subtype of BCC (p = 0.05). In the group of primary BCCs, positive expression of stromal α-SMA (p = 0.03) correlated with a statistically significant higher recurrence rate and so did positive expression of α-SMA in tumour cells of recurrent BCC (p = 0.002). In the group of primary aggressive BCC subtypes, reduced expression of MOC-31 was also associated with a higher rate of relapse (p = 0.02). Conclusions Our findings provide information about α-SMA and MOC-31 expression in primary and recurrent BCCs. These data may contribute to the formulation of a more targeted treatment plan and follow-up strategy for patients with facial basal cell carcinoma.

BACKGROUND A 65-year-old female patient with a histologically confirmed basal cell carcinoma located at the right lateral lower eyelid was referred for surgical tumour excision and reconstruction of the periorbital area. The periocular zone was reconstructed in a two-staged procedure with bilamellar repair of both eyelids. An autologous chondral graft, mucosal advancement techniques and a periosteum-temporalis fascia hinged turnover flap were used for reconstruction of the posterior lamellae. A modified Tenzel flap and a paramedian forehead flap were used for reconstruction of the anterior lamellae. An acceptable functional and aesthetic outcome of the reconstruction was achieved.

The current pool of organs available for transplantation does not cover requirements, for this reason non-standard risk donors need to be incorporated into the pool. In this way, donors with small renal tumour are considered for transplantation after bench tumour excision. The aim of our study was to analyse our experience in using these grafts for transplantation. Retrospective analysis from our prospective accrued database of donors with incidental renal mass used for kidney transplantation between January 2007 and August 2018. Twenty kidney transplantations were performed, thirteen cases received the affected kidney (after tumour removal) and seven the contralateral kidney; from six living and eleven deceased donors. Donor and recipient median age was 58 years (range 22–82) and 56.5 years (range 38–74), respectively. Mean tumour diameter was 12.7 mm (SD 9.5). Tumours resulted in two benign lesions and fifteen renal cell carcinoma. Surgical margins were negative. Two cases presented with bleeding after reperfusion was solved without repercussion. One case presented with immediate vein thrombosis. None of them present delayed graft function. After a 69 month follow-up none of the donors or the recipients presented tumour recurrence. Kidneys with small incidental tumours seem to be a good option for kidney transplantation in selected patients after bench surgery excision with good functional and oncologic results. More studies and longer follow-up are needed to confirm these results.

Benign bone tumours of the hand are frequently seen by hand surgeons and may cause symptoms or result in pathological fracture. These tumours are usually managed with surgical curettage with, or without, grafting. The surgical approach is determined by the geometry of the tumour and the affected bone, and by the surrounding soft tissue envelope. Whilst curettage of the tumour can be undertaken openly, potentially with the assistance of fluoroscopy, the addition of endoscopy to visualise the tumour cavity (osteoscopy) can aid in tumour removal and makes complete tumour removal more certain. This chapter describes the author’s technique of endoscopic benign tumour excision in hand.

ObjectiveSinonasal inverted papillomas are challenging benign tumours of the nasal cavity because of their high recurrence rates and the lifetime malignant transformation risk of 10 per cent as well as their locally aggressive behaviour. This study aimed to describe treatment strategies for inverted papillomas with intracranial or intraorbital involvement.MethodThis was a prospective case series study of 18 patients with inverted papilloma with intracranial or intraorbital involvement. Patient demographic data, imaging, pathology, surgical technique and recurrences were recorded prospectively over a period of seven years.ResultsA total of 83 per cent of the patients in this study had been previously operated on, consisting of 8 cases with intracranial involvement, 1 case with intraorbital involvement and 9 with both. During follow up with a medium of 37 months (range, 13–115 months) there were two recurrences.ConclusionIt was postulated that intracranial or intraorbital involvement observed in this series was the result of multiple revisions. However, using accurate imaging protocols and the pedicle-oriented approach for tumour excision, complete tumour removal was achieved in most cases with minimal post-operative complications.

We describe here the first dorsal metacarpal artery propeller perforator flap, used to cover a full thickness, radiopalmar defect of the index finger after tumour excision. By associating a propeller design to the dissection of the first metacarpal pedicle, this flap can be effective in coverage of proximal index and web space defects, with primary closure and pleasant aesthetic outcomes. Harvested together with a superficial sensory branch from the radial nerve, this flap can provide effective coverage and sensory recovery.

Soft tissue sarcomas (STS) are a group of rare malignant tumours that can occur at almost any anatomical location in patients of any age, which often present to health care professional working outside a recognised sarcoma service. A review of foot and ankle STSs was conducted, reporting on patient and tumour characteristics, and patient outcome following surgery performed within and outside our sarcoma service.A retrospective review of all foot and ankle STSs managed by our sarcoma service over a 14 year period was performed. Patient demographics, tumour characteristics, management and patient outcomes including recurrence rates and survival were analysed.Twenty-six patients were analysed (16F:10M) with a mean age of 57.7 years (range 17-87). The mean follow-up was 6.3 years (range 1-16). Sixteen tumours involved the foot, nine the ankle, and one spanned the foot and ankle. Mean tumour size was 4.3 cm (range 0.8-15), although 61% of cases were smaller than 4 cm, and almost one third of cases smaller than 1 cm. Seven of 26 (27%) cases were diagnosed after an unplanned excision performed by non sarcoma surgeons. These patients were more likely to undergo an incomplete tumour excision (p0.001), suffer local recurrence (p = 0.001), and eventually undergo a secondary amputation (p = 0.034) than those patients managed exclusively by a sarcoma service. Overall, 12 (46%) patients died of their disease during follow up, equating to a five-year survival rate of 69%.Our data shows that unplanned excisions continue to be performed on foot and ankle STSs, and that these have detrimental effects on patients. Despite this, our results also show that these complex patients can be managed successfully when referred appropriately to a sarcoma service, prior to any surgical treatment. This highlights the importance of vigilance amongst all health care professionals managing any foot or ankle lumps, regardless of their size.

Background. Intraoperative frozen section (IFS) is often utilised in the surgical treatment of nonmelanocytic skin cancer (NMSC) in sensitive facial regions when Mohs micrographic surgery (MMS) is not available. Objective. To compare the outcome of NMSC patients with excision performed with and without IFS. Materials and Methods. A retrospective, single-centre study was performed on all patients who had undergone resection of NMSC with and without IFS control at the National University Hospital (NUH) from 2010 to 2015. Results. 116 patients were recruited, of which 86 had IFS and 30 did not. The complete excision rate of patients with IFS was higher at 87.2% ( p = 0.0194 ), need for secondary operation was lower at 1.2% ( p = 0.005 ), and need for postsurgery radiotherapy or chemotherapy was lower at 1.2% ( p = 0.001 ). The average duration of surgery in patients who underwent IFS was 95.4 minutes compared to 70.1 minutes in cases which did not undergo IFS. Conclusion. Our study showed an increased complete excision rate and reduced need for secondary surgeries and adjuvant therapy in patients with IFS. However, a longer operative duration was required. Use of IFS may be useful in patients with NMSC lesions in sensitive regions requiring complex reconstruction after tumour excision.

Objective: The aim of this study was to present our experience with a kite flap in reconstruction of facial wounds after malignant tumour excision. Method: From October 2008 to September 2017, patients with facial malignant tumour were treated in the Xinjiang Uygur Autonomous Region Bazhou People's Hospital with kite flaps after complete excision. The survival rate, colour, cicatrix of the flap and patient satisfaction were recorded after surgery. Results: A total of 95 patients were included in the study. During follow-up, from six months to 8 years, all the kite flaps achieved primary closure and survived well, and the colour and texture were similar to the surrounding skin with no obvious scar. Dysfunction, complications and recurrence had not been reported. Conclusion: The kite flap may be a good option in reconstructing facial wounds after malignant tumour excision (diameters 1–5cm). It is a simple surgical method with sufficient blood supply and extensive adaptability. For patients in this study, no obvious scars were formed and the recipient site matched well with the donor site.

Leiomyosarcoma of the renal vein is a rare tumor of complex diagnosis. We present a case of renal vein leiomyosarcoma in a patient presented with left flank pain. The patient underwent radical nephrectomy with tumour excision.

Aims and Objective: The aim of the present article is to highlight how reconstruction with free flaps is different and difficult in cases with robotic head-and-neck cancer surgery. It also highlights the technical guidelines on how to manage the difficulties. Materials and Methods: Eleven patients with oropharyngeal cancer having undergone tumour excision followed by free-flap reconstruction been reviewed here. Nine patients had tumour excision done robotically through intraoral route while neck dissection done with transverse neck crease incision. There is a problem of difficult flap inset in this group of patient. Two patients had intraoral excision of tumour followed by robotic neck dissection via retroauricular incision. With no incision directly on the neck, microvascular anastomosis is challenging in this set of patients. Free flap was used in all the cases to reconstruct the defect. Results: Successful reconstruction with free flap was done in all the cases with good outcome both functionally and aesthetically. Conclusion: Free-flap reconstruction is possible in robotic head-and-neck cancer surgery despite small and difficult access, but it does need practice and some technical modifications for good outcome.

Summary Objective Perineal defects are encountered ever more frequently, in the treatment of vulvar cancers or abdominoperineal resection. The surgical treatment of vulvar cancer leads to significant skin defect. The aim of the reconstruction is not to provide volume but rather to resurface perineum. We propose a new solution to cover the extensive skin defect remaining after excision. Methods We report 3 patients who underwent large excision for vulvar cancer, with lymph node dissection. For reconstruction, we performed 3 advancement flaps. Two V-Y flaps cantered on the infra-gluteal folds and based on pudendal perforator arteries were used to cover the postero-lateral parts of the defect. The third advancement flap from the superior aspect of the defect was a Y-V Mons pubis flap. Results The defects were successfully covered by the 3 flap technique. The first patient suffered a non-union that slowly healed by secondary intention. For the other cases, we used the same technique, but applied negative pressure wound therapy on the sutures, with excellent results. Conclusion The 3 flap technique is a simple and reliable method and the donor site morbidity is minimal. It can be realised without changing the position of the patient after tumour excision, and does not require delicate perforator dissection. This surgical option can be easily applied, allowing better management of these cases.

Purpose Overall local recurrence of oral squamous cell carcinoma (OSCC) is estimated at 20%. Incomplete primary tumour excision contributes to localised postsurgical recurrence of OSCC. The purpose of this study was to report on patient outcomes following resection of OSCC using Narrow Band Imaging (NBI). Materials and methods Patients with OSCC requiring resection were visualised under conventional white light (WL) then NBI using an Olympus NBI ENF-VQ nasendoscope with CLV-180 light source and processor (Olympus Medical Systems, Tokyo, Japan). OSCC tissue was resected to the NBI-defined surgical margins, and patients followed for a minimum of 5 years postsurgery to assess local recurrence rate (LRR) and disease-free survival (DFS). Results Of the 20 patients recruited for this study, one patient (5%) declined follow-up. At the latest follow-up period (up to 7 years postsurgery), 14 of 19 patients (73.68%) were alive with no recurrence. Two patients (10.53%) had died from metastatic disease with no local recurrence, one patient (5.26%) had died from disease with local recurrence, and two patients (10.53%) had died disease-free from other causes. In total, 16 of 19 patients (84.21%) who were followed for a minimum of 5 years were still alive and had not developed local recurrence. Only one patient developed local recurrence. Five-year DFS was 84.21% and LRR was 5.26%. Conclusion Resection to NBI-defined margins improves survival rates and decreases recurrence rates of OSCC compared to traditional methods and should be adopted as the new gold standard for determining mucosal surgical margins for treatment of oral cavity cancer. These promising results have set the scene for a multicentred randomised controlled trial comparing NBI to WL currently underway.

Sarcomas are a group of rare malignant tumours of the connective tissues. They can occur in almost any location, but more frequently in the extremities. The occurrence of sarcomas in the head and neck region is less than 1%. We are presenting a case report of a very large cranial sarcoma. Gross total tumour excision was done with pedicle skin graft and titanium mesh cranioplasty. The excised tumour weighed approximately 1.1 kg. Histopathological examination showed primitive intermediate-sized tumour cells arranged in sheets, nests and cords with focal palisading. Postoperative MRI done 2 weeks post surgery showed no evidence of residual tumour.

Vulval/vaginal teratomas are rare occurrences in newborns. We report a case of a neonate that was born with a vulva teratoma, a rectovestibular anomaly, and a bifid T12 vertebra. To our knowledge, this combination is the first to be reported in the literature. The patient had a tumour excision in conjunction with a Primary Posterior Sagittal Anorectoplasty (PPSARP). She had post-operative complications of a wound breakdown that was managed conservatively. She is now being followed up on out-patient basis.

Laissez-faire following excision of peri-ocular tumours has been described, but is not universally well established. We describe our experience with laissez-faire for managing medial canthal defects following tumour excision and compare our outcomes with full thickness skin grafts. Retrospective comparative case series of 68 patients who underwent reconstruction of a medial canthal defect using laissez-faire with sutured Sorbsan (LFS) (n = 36) or a full thickness skin graft (FTSG) (n = 32) at the same centre. Tumour diagnosis, defect size, time taken to epithelialise, functional and cosmetic outcomes, complications, follow-up duration and any secondary interventions were recorded. Basal call carcinoma was the most common neoplasm excised (63/68, 93%). Defect size ranged from 7 × 5 mm to 25 × 10 mm. Mean time for wound epithelialisation in LFS group was 33 days. Mean duration of follow-up was 32 months (range 1-80 months) for LFS and 30 months (range 6-60 months) for FTSG. Good functional and cosmetic outcomes were achieved in all 68 patients. Review of clinical photographs showed epicanthic fold in 2 patients and visible scar in 1 patient in the LFS group and 3 cases of hypopigmented scar and 7 hypertrophic scars in the FTSG group. No cases required secondary intervention. There were no cases of postoperative infection. LFS in the medial canthal region is less likely to lead to hypertrophic scarring or cicatricial sequelae compared to FTSG (p = 0.02). Both techniques are associated with excellent functional and aesthetic outcomes even for larger defects.

Background Periocular malignancy is common and in most cases will undergo excision with pre-determined margins and subsequent histological examination. Intraoperative margin control (IOMC) modalities such as fast frozen section (FFS), fast paraffin (FP) and Mohs micrographic surgery (MMS) are being increasingly widely used, though there is a lack of information regarding utility. The aim of this study was to survey members of the British Oculoplastic Surgery Society (BOPSS) to determine attitudes and access to different modalities of IOMC. Methods A 12-question online survey was disseminated via an e-mail to full members of the BOPSS. The survey was hosted using Qualtrics software via the University of Sussex. Results The overall response rate was 64 of 165 (38.8%). MMS was readily available in a neighbouring trust to 23 of 64 respondents (35.9%). Seven respondents (10.9%) reported no regional access to MMS. Twenty-nine members had readily available access to FFS (45.3%) and 37 of 64 to FP (57.8%) in their own institution. There is variation in what tumour types would be considered appropriate for IOMC, though most thought clinically ill-defined (morphoeic) basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) should undergo one form of IOMC (90.6% and 81.3%, respectively). Conclusion This study highlights variation in availability and utilisation of IOMC amongst oculoplastic surgeons and in different regions of the UK. While the exact place of IOMC in periocular tumour excision is debated, there is a consistent view that it should be available for some tumours. Greater consistency in provision may improve patient outcomes.

Background To achieve radical tumour excision in non-palpable breast cancer accurate tumour localization is essential. Historically, this has been achieved by wire localization (WL). Recently, new techniques like Iodine-125 seeds (IL) have become available. The aim of this study was to determine whether the results in case of IL are better than when WL is used. Method A consecutive series of patients operated on because of non-palpable breast cancer was analysed. Between January 2007 and April 2011 WL was method of choice. From April 2011 till January 2013 IL was introduced and became the standard procedure. PRIMARY OUTCOMES WERE: success rate of (peri-) operative localization and radicality of the excision. Secondary outcomes were duration of operation and volumes of the excised tissue specimen. Results A total of 236 women were included; 149 women underwent WL and 87 women IL. The overall success rate for WL was 93.3%. In 10 patients (6.7%) WL failed because of peri-operative dislocation of the wire compared to only one failure to locate the seed in de postoperative specimen in the IL-group (1.1%, p = 0.098). Radical resection was obtained in 126/149 (84.6%) of the WL-patients, in comparison with 81/87 (93.1%) in the IL-group (p = 0.054). Median operation time and volume of the specimen was not significantly different between both groups. Conclusion Localization of non-palpable breast cancer using Iodine-125 seeds is, at least, as good as the standard wire localization procedure.

Scrotal skin loss can occur following trauma, Fournier's gangrene, post tumour excision, burns, etc. There are many techniques described in the literature including residual scrotal skin mobilization, skin grafts, pedicled and free flaps. The management is complex and challenging shown by the multiplicity of flaps and techniques described in the literature. We used a modified pudendal thigh flap to reconstruct scrotal defects in five patients. This study describes the vascularity of the flap, technique of elevation and the inset of the flap. The elevation and particularly the insetting make it different from other flaps raised on this vascular network for scrotal reconstruction. This pedicled flap is robust, reliable, resilient and produces a neo-scrotum that looks natural in appearance, offers good-quality skin cover and cushion to the testes as well as protective sensation.

New tools for monitoring response to primary melanoma treatment are needed to reduce recurrence rates and patient anxiety. A previously developed plasma-based microRNA signature (MEL38) was measured in four melanoma patient samples obtained before and 12-14 days after treatment (i.e. surgical excision), as well as in two nonmelanoma controls. The value of the MEL38 score and selected individual genes were compared between the time points. The MEL38 scores of the four patients with melanoma became more 'normal like' after tumour excision, with a statistically significant 15% mean reduction. MicroRNAs involved in tumour suppression were upregulated in the postexcision samples and those involved in facilitating treatment resistance and tumour invasion were downregulated. Based on these limited preliminary data, the MEL38 signature may have clinical utility in assessing an individual patient's response to the most common form of melanoma treatment. Additional studies are needed on larger, clinically diverse patient cohorts, sampled over longer periods of time.

Highlights • Florid cemento-osseous dysplasia (FCOD) is a rare, benign fibro-osseous tumour. • We describe the case of a 39-year-old woman with FCOD and sensory paraesthesia. • Biopsy was necessary for diagnosis to exclude malignancy and relieve the symptoms. • We suggest that the paraesthesia resulted from nerve irritation caused by the FCOD. • To our knowledge, this is the first report of paraesthesia combined with FCOD., Introduction Florid cemento-osseous dysplasia (FCOD) is a rare, benign, slow growing, multifocal fibro-osseous tumour originating from the periodontal ligament. The lesion is characterised by regular bone-structure replacement with fibrous tissue and dysplastic bone. The initial characteristics of FCOD, depending on localisation, resemble those of periapical lesions of inflammatory origin, potentially leading to misdiagnosis. In the absence of infection signs, the treatment of choice is conservative therapy with antibiotics and regular follow-up examinations. Presentation of case We report the case of a 39-year-old Caucasian woman with sensory disturbance along the inferior alveolar nerve for >2 weeks. The involved teeth were vital and the digital orthopantomogram indicated multiple bilateral periapical brightening. Biopsy was indicated to exclude malignancy and to confirm the FCOD diagnosis with predominantly reactive calcification and cell-rich connective-tissue reaction. The sensory disturbances disappeared after the biopsy. Further conservative therapy included regular radiological examinations every 2 years to prevent surgical intervention due to infection risk. Discussion Sensory disturbances around the nervus alveolaris inferior are well-known complications of dental and maxillofacial operations and of malignant tumours. Sensitivity disorder as a first symptom of fibro-osseous dysplasia has not been previously described. Although uncommon in its clinical behaviour, FCOD was finally diagnosed after thorough clinical, radiological, and histological examinations. Conclusion Paraesthesia combined with FCOD has not been previously described. Correct diagnosis is essential for proper treatment and to avoid further complications even when the clinical symptoms appear unrelated.

The first description of skin lesions suspicious for melanoma was made by Hippocrates, the father of medicine, in the 5th century BC. The famous Biblical quotation 'Noli me tangere' (Do not touch me) was a rule over the centuries, since it was thought that diseases could be spread or get worse by touching. The first nail blood vessels microscopy was done 1663 by J.C. Kohlhans. The term melanoma was introduced by Robert Carsswell in 1834. In 1858, Oliver Pemberton described 60 patients with melanoma and noted that the disease is also common among black race people. W.S. Hadley established the surgical treatment that was being implemented for almost a half of century and involved a wide tumour excision. Mc Govern, Clarck and Breslow described the stages of melanoma and Breslow, moreover, introduced the measurement of tumour thickness as a basic parameter of the disease. In 1916 C. Zaiss built a binocular microscope. The diagnosis of melanoma was notably improved in 80's of the last century by introduction of modern examination technologies, as well as using specific paths to analyze the tumour lesion, which all together made easier to come up with the diagnosis of melanoma. The use of standardized terminology for the description of skin structure started at the end of nineties, together with the use of algorithms for the differentiation of benign from malignant melanocytic skin lesions. Nowadays, there are four different algorithms for the diagnosis and determining of malignant melanoma-change: The ABCD rule (Stolz method), 7-point checklist (Argenziano), Menzies' scoring method, Structure analysis (Pehamberger et al, Kenneth et al, Argenziano et al.). The increasing influence of risk factors and the genetics have come to be the imperative for higher qualifications of medical professionals with the aim of early and proper diagnostics of melanoma.

Purpose of review Partial nephrectomy provides equivalent long-term oncologic and superior functional outcomes as radical nephrectomy for T1a renal masses. Herein, we review the various vascular clamping techniques employed during minimally invasive partial nephrectomy, describe the evolution of our partial nephrectomy technique and provide an update on contemporary thinking about the impact of ischemia on renal function. Recent findings Recently, partial nephrectomy surgical technique has shifted away from main artery clamping and towards minimizing/eliminating global renal ischemia during partial nephrectomy. Supported by high-fidelity three-dimensional imaging, novel anatomic-based partial nephrectomy techniques have recently been developed, wherein partial nephrectomy can now be performed with segmental, minimal or zero global ischemia to the renal remnant. Sequential innovations have included early unclamping, segmental clamping, super-selective clamping and now culminating in anatomic zero-ischemia surgery. By eliminating ‘under-the-gun’ time pressure of ischemia for the surgeon, these techniques allow an unhurried, tightly contoured tumour excision with point-specific sutured haemostasis. Recent data indicate that zero-ischemia partial nephrectomy may provide better functional outcomes by minimizing/eliminating global ischemia and preserving greater vascularized kidney volume. Summary Contemporary partial nephrectomy includes a spectrum of surgical techniques ranging from conventional-clamped to novel zero-ischemia approaches. Technique selection should be tailored to each individual case on the basis of tumour characteristics, surgical feasibility, surgeon experience, patient demographics and baseline renal function.

Closure of large wounds may require full‐thickness skin grafts, but their use is burdened by donor tissue availability and morbidity; the use of the purse string technique is an elegant way to overcome this problem. The study highlights the gain in terms of graft donor site morbidity and oncological radicality. The study included a group of 47 patients who underwent surgical excision for skin cancer and whose wounds were covered using a purse string suture and a skin graft. Radius of the defect left was measured after the lesion's excision and after the purse string suture. Thereafter, the difference between the initial defect area and the area after purse string suture was calculated. Initial defects ranged from 3.85 to 61.5 cm(2). After skin graft, the purse string suture ranged between 2.2 and 40 cm(2) (mean area = 14 cm(2)). Gained area before the graft measured from 1.3 to 21.5 cm(2) (mean gained area = 7.1 cm(2)). Average reduction was 33%. The technique allows a reduction of the size of the area to be grafted and the skin graft donor area, thus increasing the possibility of the feasibility of full‐thickness grafts. In addition, it allows an optimal observation both of the area of tumour excision and margins during follow‐up controls.

Background: Direct closure of large scalp defects is not an easy task. Complicated flap designs or staged surgeries over a period of 6 months are often required. A case of a large scalp defect that was closed directly in 3 months by applying a simple external tissue expansion technique is presented in this report. Patient Profile: A 28-year-old male patient presented with a painful swelling of about 13 cm × 14 cm, on frontoparietal scalp. A biopsy done elsewhere reported it to be a neurofibroma. He sought tumour excision and scalp defect coverage by hair-bearing scalp in a period of less than 5 months. Materials and Methods: The tumour was excised and the adjacent scalp was gradually expanded with the help of an external fixator. The patient had immediate pain relief after excision. The goal of repairing scalp defect and replacing it with hairy scalp was achieved in 3 months. Conclusion: The mechanical device required for this technique is relatively easily accessible. It is not difficult to achieve desirable outcomes, and the same can be applied to large wounds on other areas.

Purpose of review Recurrent pleomorphic adenoma (RPA) is uncommon. Treatment selection is based on the likely possibility of minimizing the risk of tumour recurrence, avoiding local functional and cosmetic sequelae, and eradicates the possibility of metastatic or malignant transformation. Much has changed since the topic was reviewed in 2001, and this manuscript comments on clinical progress and discusses patient treatment options. Recent findings Surgery is the preferred treatment for head and neck pleomorphic adenoma. Over the recent decade the surgical radicality is favoured for parotid and submandibular gland pleomorphic adenoma, from total gland and tumour removal to endoscopic or minimal open extracapsular tumour excision. Currently molecular pathology and biomarker research has not identified any evidence that separates pleomorphic adenoma from RPA, thus supporting that tumour recurrence is likely associated with surgery. Revision surgery has been reported to be frequently noncurative depending on the extent of the primary surgery, with the added risk of local cosmetic and functional sequelae. Radiotherapy as a nonsurgical modality has advanced and has been shown to be effective in controlling, if not curing, high-risk patients who have identifiable prognostic factors of developing a recurrence and patients with RPA. Summary Current surgical management of pleomorphic adenoma is associated with improved quality of life and minimal disturbance to cosmetic and functional. The reported incidence of RPA has been reduced by 'expert surgeons' but with limited short-term follow-up following more recent surgical modifications. Patients with RPA should be offered treatment that includes surgery and/or radiotherapy and should be encouraged to partake of this decision making process.

Understanding of the biology of bone regeneration has been increasing rapidly, with greater appreciation for the importance of biochemical aspects as well as the mechanical requirements for bone to heal. There are a number of situations where there is difficulty in bone healing such as fracture non-union; or growth such as osteogenesis imperfecta; or a requirement for surplus bone to reconstruct defects such as following surgery for tumour excision or limb lengthening. There is a greater understanding of the complex interplay between osteoblasts and osteoclasts, and the chemical mediators that provide signalling along complex pathways. Although we have known about substances such as Bone Morphogenic Proteins and Growth Hormones for some time, their application in clinical practice is still not widespread, and we need to study them more to understand their role in bone healing. With newer technologies such as stem cells and gene therapy being developed there is the potential for vast improvement in bone regenerative techniques, although we are not at a stage where we can be confident that these techniques will work. In this review article we discuss the basic healing process of bone and how our understanding of this has led to improved techniques as well as the potential for future developments in new technologies.

Palatal defects following congenital anomalies, traumatic injuries, benign and malignant pathologies frequently require resection and reconstruction. Reconstruction of these defects is challenging and complex due to the amount of tissue left for primary closure after excision, compromised vasculature as on repaired cleft palate and limited pedicled flaps around the lesion. Tongue flap though doesn't fulfil all the ideal requirements of a flap, however because of its flexibility, good blood supply and position it can be considered as the best among other flaps for reconstruction of oral and palatal defects. In this article we describe two different cases in which tongue flap was used to reconstruct palatal defects, one an oroantral communication secondary to a tumour excision and the other an oro-nasal fistula secondary to cleft palate repair.

Mobile Schwannoma is a very rare entity and is reported sparsely in literature, with most of them occurring in lumbar spine region. We present a case of seventy-year-old male patient who had pain in lower back radiating to ipsilateral thigh. A diagnosis of migratory tumour was made based on findings of plain and contrast MRI preoperatively. We did a two level laminectomy and tumour excision. In this report, we intend to discuss various likely causes of tumour migration and various diagnostic methods to tackle this surgical dilemma, we have also attempted to review the sparse literature available till date on migratory lumber schwannoma.

Pleomorphic xanthoastrocytoma (PXA) is a rare, low-grade astrocytic tumour corresponding to WHO grade II that is usually diagnosed in adolescents and young adults with epileptic seizures. Pleomorphic xanthoastrocytoma typically appears as a superficial, often cystic mass lesion predominantly affecting the temporal lobe. Cases with typical pathology and total tumour excision have a favourable prognosis. Occasionally, the tumour reveals anaplastic features and behaves more aggressively due to local recurrences or subarachnoid spread. The treatment of PXA includes gross total resection followed by neuroradiological monitoring. The association between vascular malformations and cerebral gliomas is rarely encountered, especially if both such lesions occur as separate parts of the same tumour. The vascular pathology of such changes most often refers to arteriovenous malformation (AVM), less frequently - cavernous angioma. The coexistence of PXA and AVM is extremely rare, especially when dealing with two distinct patterns found within the same tumour mass. We present a 36-year-old woman with tumour of parasagittal localization in the right occipital lobe that was composed of two different and clearly demarcated components: PXA and vascular lesion of AVM morphology. The pathogenesis of such coexistence remains still unclear.

Nephron-sparing surgery for the removal of small renal masses delivers equivalent oncological outcomes and better functional outcomes compared with those associated with radical nephrectomy. All contemporary partial nephrectomy techniques including open, laparoscopic and robotic approaches involve the use of hilar clamping in order to facilitate haemostasis, and to enable accurate tumour excision and parenchymal reconstruction. Zero ischaemia was subsequently introduced as a technique to eliminate the renal ischaemia induced by hilar clamping. Following the introduction of zero ischaemia techniques, researchers have arbitrarily applied this term to techniques ranging from no use of clamping to selective clamping of renal arteries and/or veins, or their branches. Substantial variations exist in the way that zero ischaemia and other renal preservation techniques are described in the literature. Similarly, further diversity exists in the measurement and reporting of functional outcomes after surgery. The introduction of standard and reproducible classifications or guidelines will ensure consistency and uniformity. Establishing consensus on the terminology used to describe techniques and functional outcomes will not only facilitate improved communication and surgical practice, but will also enable critical appraisal of surgical techniques.

What's known on the subject? and What does the study add? The European Association of Urology (EAU) guidelines recommend an inguinal lymph node dissection (ILND) in patients with T1G2-3 squamous cell carcinoma of the penis (SCCP). To date, only four series reported the rates of cancer-specific mortality (CSM) after primary tumor excision (PTE) without an ILND in patients with T1 clinically node-negative (cN0) SCCP. We examined CSM rates in cN0 patients with T1G1-3 SCCP, in whom an ILND was not performed, relying on competing-risks analyses. OBJECTIVE • To quantify and compare cancer-specific mortality (CSM) and other-cause mortality (OCM) in individuals with stage T1G1–3 clinically node-negative (cN0) squamous cell carcinoma of the penis (SCCP) since there is no consensus regarding the need for an inguinal lymph node dissection (ILND) in patients with T1G2–3 cN0 SCCP. METHODS • Relying on the Surveillance, Epidemiology and End Results database, we identified 655 patients diagnosed with primary SCCP between 1988 and 2006. • Cumulative incidence plots were used to graphically depict the effect of CSM relative to OCM. • Competing-risks regression analyses were used to quantify the risk of CSM or OCM after adjusting for age, race, tumour grade and surgery type. RESULTS • The 5-year CSM rates after a primary tumour excision without ILND were 2.6%, 10.0% and 15.9% in patients with respectively T1G1, T1G2 and T1G3 cN0 SCCP. • The 5-year OCM rates were 29.5%, 27.3% and 29.3% in patients with respectively T1G1, T1G2 and T1G3. • Age failed to provide additional stratification. CONCLUSIONS • The CSM rate was highest in T1G3 patients and appears to justify ILND. • Conversely, the CSM rate was lowest in T1G1 patients, which justifies active surveillance in this patient subset. • A moderate CSM rate at 5 years was recorded for T1G2 patients, which brings into question the benefits of ILND.

Aims To evaluate if intra-operative guidance with ultrasonography (US) could improve surgical accuracy of palpable breast cancer excision, and to evaluate the performance of surgeons during training for US-guided excision. Materials and methods Thirty female patients undergoing breast-conserving surgery for palpable T1–T2 invasive breast cancer were recruited. Three individual breast surgeons, assisted by US, targeted and excised the tumours. The main objective was to obtain adequate resection margins with optimal resection volumes. The specimen volume, tumour diameter and histological margin status were recorded. The specimen volume was divided by the optimal resection volume, defined as the spherical tumour volume plus a 1.0-cm margin. The resulting calculated resection ratio (CRR) indicated the amount of excess tissue resected. Results All tumours were correctly identified during surgery, 29 of 30 tumours (96.7%) were removed with adequately negative margins, and one tumour was removed with focally positive margins. The median CRR was 1.0 (range, 0.4–2.8), implying optimal excision volume. For all breast surgeons, CRR improved during the training period. By the 8th procedure, all surgeons showed proficiency in performing intra-operative breast US. Conclusion Surgeons can easily learn the skills needed to perform intra-operative US for palpable breast tumour excision. The technique is non-invasive, simple, safe and effective for obtaining adequate resection margins. Within the first two cases, resections reached optimal volumes, thereby, presumably resulting in improved cosmetic outcomes. In a multicentre, randomised, clinical trial, intra-operative US guidance for palpable breast tumours will be evaluated for oncological and cosmetic outcomes.

Objective Schwannomas are benign tumours arising from Schwann cells of the peripheral nerve sheath. They are relatively frequent in the head and neck region (25–45%) but rarely involve in the sinonasal tract (4%). The authors outline the diagnostic difficulties and the problems in choosing the best surgical approach in two atypical cases of sinonasal Schwannomas. Methods In the first case reported clinical data, sex and age of the patient, nasal endoscopy and angio-MRI led us to suspect an angiofibroma; therefore, we approached the case without a biopsy performing a preoperative selective embolization followed by an endoscopic resection. In the second case, due to initial visual symptoms and to the ethmoid-orbital compartment involvement, we performed a sinonasal endoscopy and collected a biopsy which resulted to be fundamental in the diagnostic assessment. Tumour excision was then obtained throughout an intracranial/endonasal approach. Results The two presented cases revealed the presence of cystic Schwannomas. In the first case, diagnosis was made only post-operatively after histological examination. Patients underwent complete surgical excision by means of an endoscopic sinonasal approach, in the second case associated to a left frontal craniotomy. The patients showed no signs of recurrence at a 9 months follow-up. Conclusions Nasal endoscopy was extremely important in making the diagnosis, allowing an accurate assessment of the tumour extension and a biopsy. The diagnosis of sinonasal Schwannomas remains challenging; sometimes, clinical behaviour and modern imaging may be misleading. The diagnostic and therapeutic importance of sinonasal endoscopy is emphasised in the two presented cases.

A vascularised bone segment of the distal radius was harvested as a distally based flap to treat segmental metacarpal bone loss in three patients. One reconstruction followed resection of a giant cell tumour excision and the other two were to replace traumatic bone loss. The bone defects were in the second metacarpal in two cases and in the second and third metacarpal in one case and included three shaft and one distal metacarpal reconstruction. The mean length of the metacarpal defects was 6 cm. All of the flaps survived and no complications occurred at the donor site. Clinical and radiological union was established in all cases after an average of 3 months.

Cushing's syndrome (CS) is defined as a constellation of clinical signs and symptoms occurring due to hypercortisolism. Cortisol excess may be endogenous or exogenous. The most common cause of CS is glucocorticoid therapy with supraphysiological (higher than in the case of substitution) doses used in various diseases (e.g. autoimmune). One possible CS cause is ectopic (extra-pituitary) ACTH secretion (EAS) by benign or malignant tumours. Since its first description in 1963, EAS aetiology has changed, i.e. as well as small cell lung cancer (SCLC), higher incidence in other malignancies has been reported. Ectopic ACTH secretion symptoms are usually similar to hypercortisolism symptoms due to other causes. A clinical suspicion of CS requires laboratory investigations. There is no single and specific laboratory test for making a CS diagnosis, and therefore multiple dynamic tests should be ordered. A combination of multiple laboratory noninvasive and invasive tests gives 100% sensitivity and 98% specificity for EAS diagnosis. If the EAS is caused by localised malignancy, surgery is the optimal treatment choice. Radical tumour excision may be performed in 40% of patients, and 80% of them are cured of the disease. The authors present an interesting clinical case of EAS, which is always a huge diagnostic challenge for clinicians. (Endokrynol Pol 2016; 67 (4): 458-464).

Primary soft tissue tumours arising from the abdominal wall are uncommon and surgical excision of such tumours can result in large abdominal wall defects. There are many techniques available for abdominal wall repair following tumour excision, each having its own advantages and disadvantages. The options range from direct closure to the use of tissue flap reconstructions and/or prosthetic meshes. Currently, synthetic material such as polypropylene mesh is a common choice for closure of abdominal wall defects after tumour excision. Biological meshes are an alternative option for repair, and this report outlines two cases of abdominal wall repair using the porcine intestinal submucosa biological graft following excision of abdominal wall tumours. There was no evidence of infection, recurrence, seroma or hernias at 2-year follow-up. Following excision of soft tissue tumours of the abdominal wall, biological reconstructions can be successfully used to bridge the defect with minimal morbidity.

Intraoral occurrence of Schwannoma is relatively rare. This report is of 4 patients with Schwannoma of the oral cavity. The presenting complaint for all patients was Intraoral submucosal swelling. The tumour arose in the tongue in 2 patients, the retromolar region in 1, and the buccal mucosa in 1. One of the tumours originating in the tongue was located in an unusual site, beneath the hyoglossal muscle layer All 4 patients underwent surgery for tumour excision and the tumours were then diagnosed as schwannomas. Histologically, Antoni A tissue was observed in all tumours and was the predominant feature in 3 tumours; Antoni B tissue associated with cystic degeneration and necrosis was also identified in 1 tumour

An aneurysmal bone cyst is considered as a locally aggressive benign tumour. Intra-lesional extended curettage and bone-grafting is the mainstay of the treatment for aneurysmal bone cysts. Grafting is used usually in cases where the lesion compromises the mechanical strength of the bone. However, the massive size of the highly vascular tumour and the relative inaccessibility of its deeper extensions into the femoral vessels and the intra-abdominal structures, especially the urinary bladder, make it a relatively challenging case to perform excision and curettage. Presenting a case of a 15 years old male patient with the complaint of a right inguinal swelling since the past eight months. The swelling had started growing since the past two months and it was associated with pain. X-ray showed a lytic blowout legion of the entire right pubic ramus. An intra-lesional curettage was done. Complete tumour excision which was done by intra-lesional curettage and biopsy yielded satisfactory results with low complications and low recurrence of aneurysmal bone cyst of the superior ramus of the pubis.

BACKGROUND Retrospective evaluation of the frequency of reoperations after amniotic membrane transplantation for different pathologic entities. MATERIAL AND METHODS We included 81 cases of amniotic membrane transplantation (AMT), which were operated on at the university eye clinic Tubingen since 1997 and which had been followed up for at least 12 months. Patient diagnoses were subdivided as follows: conjunctival defects after tumour excision (N = 2), bullous keratopathy (N = 5), external fistula after glaucoma filtering surgery (N = 3), recurrent pterygium (N = 5), symblepharon (N = 6), corneal ulcer with descemetocele (N = 3), non-perforated corneal ulcer (N = 51), perforated corneal ulcer (N = 1), other (n = 5). RESULTS The overall reoperation rate was determined to be 42 % after a follow-up period of one year. Most frequently, a second AMT (N = 16) and a perforating keratoplasty (N = 16) were performed after the initial AMT. The following reoperation rates were determined for the subgroups: Conjunctival defects after tumour excision (0 %), Bullous keratopathy (60 %), External fistula after glaucoma filtering surgery (67 %), Recurrent pterygium (60 %), Symblepharon (67 %), Corneal ulcer with descemetocele (67 %), Non-perforated corneal ulcer (49 %), Perforated corneal ulcer (100 %). CONCLUSIONS Particularly in patients with conjunctival defects after tumour excision and with non-perforated corneal ulcers, stabilisation of the ocular surface homeostasis can be achieved with a single amniotic membrane transplantation for at least one year.

This study was undertaken to evaluate the influence of radiotherapy (RT) on reconstructive flaps after radical excision of head and neck cancer. Eighty-eight reconstructive flaps were used in 82 patients who received RT either before (PREOP group, 14 flaps) or after (POSTOP group, 74 flaps) surgery. The success and healing rates of the flaps were evaluated. The success and healing rates were lower in the PREOP group than in the POSTOP group (86% vs 99%, P=0.026 for success; and 64% vs 95%, P=0.003 for healing). The rate of acute radiation reaction in flaps in the POSTOP group was significantly lower than in the surrounding normal tissues (35% vs 84%, P=0.003). Late side effects of RT were rare. Our results suggest good radiation tolerance of reconstructive flaps after radical tumour excision in the head and neck region. Success and healing of the flap are likely to be better if RT is administered after surgery.

We present a rare case of mesenteric lipoblastoma in a 16-month-old girl. The US, CT and MRI features of this unusual tumour are described and correlated with the pathology findings. MRI more clearly suggested the presence of fat components in the tumour. In addition, multiplanar MR images demonstrated the anatomical extent better, which was essential for successful complete tumour excision.

We report the case of a 72-year-old man with a right adrenocortical mass who had undergone complete tumour excision with the adrenal gland and around adipose tissue. Pathologic examination led to a final diagnosis of primary sarcomatoid carcinoma of the right adrenal gland. The patient was without recurrence at the one year follow-up. To our knowledge, this is the first case in China and the second reported case in English published studies.

Local treatment with transanal tumour excision has shown to be associated with signifi cantly decreased morbidity and mortality compared to conventional surgery (laparoscopic or open). Local treatment should be considered in select patients with early cancer or in patients with signifi - cant co-morbidity and in the very elderly patients with less oncological control as a compromise. Patient selection is important and highly dependent upon a multidisciplinary approach. The most important factors are correct preoperative staging and perioperative radiochemotherapy to minimize the risk of local recurrence. The role of local treatment in palliation of advanced disease is unknown.