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Background Oral squamous cell carcinoma (OSCC) is the sixth most common malignancy in Asia. Most patients in Cipto Mangunkusumo Hospital have been diagnosed with an advanced stage. There had not been any survival study for OSCC in Indonesia. This study aimed to investigate the survival rate and prognostic factors of OSCC in Cipto Mangunkusumo Hospital. Methods A retrospective cohort study was conducted on OSCC patients diagnosed and treated in Cipto Mangunkusumo Hospital from 2014 to 2018. Data regarding age, gender, site of the primary lesion, clinical stage of the disease, tumor differentiation, invasion, and surgical margins were collected. The main outcomes measured were overall survival (OS) and disease-specific survival (DSS). The predictors of survival were then determined. Result 169 patients were included. The majority of patients were male (51.5%) and above 50 years old (55.6%). The most prevalent tumor site was the tongue (72.8%) followed by buccal mucosa (13%). The majority (82.2%) of patients had advanced (clinical stage IV) disease at diagnosis. A smaller majority of patients had a well-differentiated tumor (60.4%) and a low-grade tumor (53.8%). The worst one-year and two-year overall survival rates were found in the stage IV group (53.5% and 37.5%, respectively). The disease-specific survival rate was 66.9%. Conclusion The one-year and two-year overall survival rates of OSCC in Cipto Mangunkusumo Hospital were 58.6% and 43.1%. Moreover, clinical stage, tumor size, and lymph node involvement were the most significant prognostic factors for OSCC.

Parathyroid carcinoma (PC) is a rare malignancy that accounts for 1 % of cases of hyperparathyroidism. Data regarding PC in Indonesia are scarce, which poses challenges to diagnosis and treatment. This study aims to describe a series of PC cases from a tertiary health care center over 12 years.Retrospective data of six patients with hyperparathyroidism diagnosed with PC between 2008 and 2020 were reviewed. Clinical presentation, diagnosis, management, and short-term outcomes of PC were analyzed. All six PC patients were diagnosed postoperatively. Four of the patients presented with symptomatic hypercalcemia, and two presented with neck swelling. Elevated serum parathyroid hormone was observed in five patients. Only two patients had imaging results corresponding to PC characteristics. Ipsilateral parathyroidectomies were performed on 5 patients where invasion and metastasis are not evident. Four frozen section samples suggested PC, and two suggested parathyroid adenoma. Further histopathologic examination confirmed a diagnosis of PC in all patients. No metastasis to the adjacent lymph nodes or distant target organs was found during surgery.Preoperative diagnosis of PC remains challenging. Suspicion of PC is appropriate in the presence of severe hypercalcemia, elevated parathyroid hormone level, and a mass observed either during imaging or intraoperatively.Ipsilateral parathyroidectomy seems to be feasible compared to total resection in order to preserve function and structure. Incomplete excision may lead to an increased risk of recurrence, emphasizing the importance of routinely following up on PC cases.

Highlights • Traditionally, the surgical approach for primary hyperparathyroidism in MEN1 is either subtotal or total parathyroidectomy. • Advances in medical imaging allows more accurate preoperative localization of abnormal parathyroid gland. • Recent studies showed less than subtotal parathyroidectomy has comparable outcome compared to subtotal or total parathyroidectomy. • Further studies are needed to determine whether there are subsets of MEN1 patients that can benefit from less than subtotal parathyroidectomy., Introduction Multiple endocrine neoplasia type 1 (MEN1) is a rare syndrome with common presenting signs and symptoms secondary to primary hyperparathyroidism (PHPT), which is managed surgically. Traditionally, either subtotal parathyroidectomy (SPTX) or total parathyroidectomy with autologous transplantation (TPTX) is the approach of choice. However, recent studies showed comparable persistence and recurrence rate in a subset of MEN1 patients (two or more concordant preoperative imaging results) who underwent less than subtotal parathyroidectomy (LSPTX). Presentation of case We report a case of patient with PHPT and delayed diagnosis of MEN1, who underwent LSPTX without intraoperative parathyroid hormone (IOPTH) measurement. The approach was chosen based on the preoperative imaging studies. Unfortunately, the PHPT persisted and the patient was reoperated. To further elucidate the issue, a systematic search of the literature was conducted on Cochrane library, PubMed, and Scopus; articles relevant to the case were reviewed. Results are conflicting results with most of the studies showed LSPTX is inferior compared to the other two approaches. Discussion Therefore, given the current body of evidence, we consider that subtotal or total parathyroidectomy is still the preferred surgical approach for the treatment of PHPT in MEN1. Conclusion Further studies are still needed to see whether LSPTX is comparable to SPTX or TPTX in regards to persistent and recurrent hyperparathyroidism if the conditions are met.

Introduction and importance Thyroid hemiagenesis (TH) is a rare congenital anomaly where one lobe fails to develop, especially more frequently occurs on the left lobe. The exact mechanisms for thyroid morphogenesis remain unclear. In this paper, we report a rare case of right lobe TH associated with Hurthle cell carcinoma. Case presentation A 59 years old woman was admitted with a neck lump increasing in size in the last 20 years. There were no symptoms of hyperthyroidism and hypothyroidism. There was a palpable, painless 5 cm mass in the middle of the neck. Initial thyroid ultrasonography (USG) revealed an enlarged left lobe, with hypoechoic lesion with cystic component and calcification (TIRADS 4). However, the right lobe was non-visualized. Fine needle aspiration biopsy result tendency was a malignancy. Hence, isthmolobectomy was conducted. Pathology result was Hurthle cell carcinoma. On the ninth month, USG revealed fibrotic tissue in the right thyroid bed and bilateral lymphadenopathy. Due to discrepancy, the patient was planned for a neck exploration surgery and a right lobe incision. Intraoperatively, the right thyroid was absent. Intraoperative USG also confirmed no right thyroid lobe. Discussion Thyroid hemiagenesis can be visualized by using USG due to its practicality and cost effectiveness reasons. Follow up evaluations consisted of systematic monitoring of thyroid morphology and hormonal functions should follow the diagnosis of TH. Neck exploration surgery might need to be performed to clarify any discrepancy and confirm the diagnosis. Conclusion TH can be recognized through supporting examination; however, discrepancy may occur., Highlights • History taking and physical examination is mandatory yet might not adequate to diagnose hemiagenesis accompanying thyroid diseases. • Ultrasonography is easily performed, cost effective, and without any radiation exposure to identify thyroid hemiagenesis • If discrepancy occur in ultrasonography examination, neck exploration surgery can clarify and confirm the diagnosis.

A thyroglossal duct cyst is a lesion that occurs as a result from failure of the thyroglossal duct to obliterate during fetal development. Malignant progression is a rare event that might occur in less than 1% of all cases. Because of its rarity, there are conflicting opinions regarding the management of the case. In the present study, a 46-year-old male presented with a painless neck mass that had increased in size over the last 6 months. There was no difficulty in swallowing and breathing, change in voice, significant weight loss, or any signs of hyperthyroidism. Laboratory workup showed that results were within normal limits. Thyroid gland ultrasonography and cervical contrast CT scan revealed a complex cystic mass that pointed towards a thyroglossal duct cyst. We performed Sistrunk procedure. Postoperative pathology examination revealed microscopic appearance of the thyroglossal duct cyst with a classic follicular variant of papillary thyroid carcinoma. Our latest follow-up showed no signs of tumor recurrence or any complications following surgery on locoregional status. As a fine needle aspiration biopsy cannot ensure a precise result in all of cases, it is essential to perform a solid physical examination and thorough supporting examination in deciding the precise management for the patient.

(Abstract)During this uncertain time, the COVID-19 pandemic has caused significant changes in the dynamics of the health delivery system. Cancer care is one of the impacted parts in this situation as patients with cancer require elaborate attention to their treatment regimen. Breast cancer is the most prevalent cancer found in Indonesia, and most often patients came in with a locally advanced stage. Similarly, patients with head and neck cancer also present with a locally advanced stage. The consequence of this fact is that disease progressivity must be taken into consideration as it may worsen the cancer burden. However, affected by this unprecedented pandemic, patient visits, surgeries, and other aspects of cancer care are heavily regulated as an effort to reduce risk and potential harm for COVID-19 transmission for both patient and healthcare workers. A surgical oncologist, despite acting as a front-liner in health care delivery, is exposed to a high risk of COVID-19 transmission as they are interacting with possible aerosol-generating procedures, especially in treating cases of head and neck cancer. With ongoing issues and challenges in this rapidly changing era, strategic approaches must be applied to deliver optimal care for the patients without increasing the potential risk for each patient and the medical personnel involved.

Introduction. Breast cancer is the most common cancer in Indonesia with incidence rate 40.3 per 100.000 women and mortality rate 16.6 per 100.000 women. On early stage, the decision for operative procedure (i.e. mastectomy) requires intraoperative frozen section to assess malignancy; which is mostly unavailable in secondary hospitals. The triple diagnostic (TD) test consists of physical examination, breast ultrasonography and fine needle aspiration biopsy is an accurate and simple preoperative diagnostic method that may solve the problem. The study aimed to find out conformance of the triple diagnostic to histopathology findings in those with breast lump where the malignancy was suspected. Method. A study of diagnostic accuracy conducted enrolling subjects with suspected malignant breast lump managed in dr Cipto Mangunkusumo General Hospital (RSCM) and Persahabatan Hospital (RSP) in period of February 2016 to August 2017 who met the criteria: those underwent preoperative triple diagnostic, intraoperative frozen section and histopathology examination. The conformance of TD and frozen section were compared to histopathology findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were the focuses of the study. Results. There were 33 subjects enrolled (prevalence of 4.3%), mean age of 49.6 years ± 10.9, were above 40 years (78.8%). Tumor size of 2–5 cm found in 63.6% subjects, and the most histopathology finding was invasive carcinoma (84.8%). Frozen section showed sensitivity of 96.8%, specificity of 100%, PPV of 100%, NPV of 66.7% and accuracy of 97.0%. TD showed sensitivity of 77.4%, specificity of 100%, PPV of 100%), NPV of 22.2% and accuracy of 78.8% (p = 0.016). Conclusion. Triple diagnostic reaches up to 78% accuracy on early stage breast cancer may be used secondary hospital in Indonesia whenever frozen section is unavailable

Brown tumor is a bone lesion that arises in the setting of excess osteoclast activity in hyperparathyroidism. It consists of fibrous tissue, woven bone, and supporting vasculature, while contains no matrix. The characteristic of brown-colored lesion is a result of hemosiderin deposition into the osteolytic cysts. Two cases of young women aged 26 and 29 years old, respectively, are known with a history of end-stage renal disease (ESRD). Dialysis is performed two times/week over the last 7 years. Our patients presented with an intraoral mass of the hard palate since 12 months ago and decreased body height of 10 cm. The lesion causes difficulties in swallowing and talking. Laboratory workup showed elevated parathormone or PTH (3.391 pg/mL and >5.000 pg/mL). Neck ultrasound showed enlargement of the parathyroid glands. Supporting examination to diagnose brown tumor are neck ultrasound, CT of the neck, and parathyroid sestamibi scan. We performed parathyroidectomy. Pathology revealed hyperplasia of the parathyroid. The tumor regressed significantly within 2 weeks following the surgery, and we still observe tumor regression as well as reduction in PTH level. As clinicians, we should be alert to other possible causes of bony lesions. Clinical examination, laboratory finding, and imaging present important information to diagnose brown tumor.

The aim of the study is to evaluate the accuracy of triple diagnostic test on thyroid nodules. The data from patients’ medical records who came to Cipto Mangunkusumo General Hospital for the first time or for evaluation of thyroid nodule and patients who underwent thyroidectomy during 2010 to 2011. Clinical examination was scored by McGill Thyroid Nodule Score. ROC procedure was performed to obtain clinical cut-off scores of diagnosis of malignant. Ultrasonography (USG) result was considered malignant for TIRADS 4, 5, and 6. If clinical, USG and histopathology examinations of triple diagnostic give positive results, it will be classified as concordant malignant whereas if all those three show benign results, the classification is benign. Thyroid carcinoma was found in 134 out of 161 patients with thyroid nodule. There were 84 patients with concordant results for all three elements of the triple test. Out of 84 patients with concordant triple diagnostic results, there were 53 malignant cases (32.9%) and 31 benign cases (19.3%). Main histopathological findings among patients with thyroid carcinoma was papillary (90.3%), follicular (3%), medullary (0.7%), and anaplastic (6%). The sensitivity and specificity of triple diagnostic was 77% and 94%, with positive predictive value of 98%, negative predictive value of 51,6% and accuracy of 80.9%. Combination of clinical findings, USG, and FNAB gave malignant probability of 92%, better than combination of clinical findings and USG (81.6%) or clinical findings and FNAB (87%). Triple diagnostic cannot be used as an ideal test to replace frozen section examination in managing thyroid nodule. However, in cases with concordant results of each triple diagnostic’s element, the positive predictive value (98%) and malignant probability (92%) is high. &nbsp

Background Squamous cell carcinoma of the oral cavity (OSCC) is the sixth most common malignancy. Surgery is mainstay treatment for oral cancers. Surgery in locally advanced OSCC presents many challenges primarily because the head and neck have critical structures that can be damaged by tumor or treatment. It is thought that neoadjuvant chemotherapy (NC) in locally advanced OSCC is able to shrink tumor size. Chemoresistancy is a problem due to hypoxic microenvironment characterized by increased expression of HIF-1α. It is also regulated by miR-210 as well as increased expression of CD44 and CD133. Melatonin has a powerful antioxidant and oncostatic effects that are expected to improve tumor hypoxia and clinical response. Fifty patients with OSCC were included and randomized. miR-210 and CD44 expression were measured before and after intervention using qRT-PCR absolute quantification, and clinical response was evaluated according to RECIST 1.1 criteria. This study aims to determine the effect of melatonin in improving the clinical response of patients with locally advanced oral squamous cell carcinoma (OSCC) after neoadjuvant chemotherapy to miR-210 and CD44 expression. Results Melatonin administration reduced miR-210 levels but not significant (p = 0.767). CD44 expression also decreased in the melatonin group compared with placebo yet was not significant (p = 0.103). There was a decrease in the expression of miR-210 and CD44 followed by a decrease in the percentage of residual tumor but not significant (p = 0.114). Conclusion In OSCC, the addition of 20-mg melatonin to neoadjuvant chemotherapy (NC) reduced the expression of miR-210 and CD44 and decreased the percentage of tumor residue; however, no statistically significant result was observed. Trial registration This study is registered to ClinicalTrials.gov under trial registration number: NCT04137627 with date of registration on October 22, 2019—retrospectively registered, accessible from: https://clinicaltrials.gov/ct2/show/NCT04137627

Background Most patients in Indonesia present with large-sized thyroid nodules, which need surgical removal to exclude malignancy. Many surgeons prefer endoscopic thyroidectomy to avoid a large and visible surgical scar on the neck and to reduce postoperative complications. This study aims to evaluate and analyze surgical feasibility, safety, oncologic outcome, and patient satisfaction of endoscopic thyroidectomy via the axillary-breast-shoulder approach. Methods Between August 2010 and September 2015, 42 endoscopic thyroidectomies via the axillary-breast-shoulder approach with carbon dioxide insufflation up to 8–10 mmHg were performed and retrospectively reviewed. Results Mean tumor size and operative time were 3.11 ± 0.99 cm and 189 ± 45 min, respectively. Mean blood loss was 68.3 mL. There were temporary complications such as hoarseness (19%), emphysema (2.3%) and hematoma (2.3%). Mean hospital length of stay was 3.98 days. Most subjects (61.9%) were very satisfied with the postoperative scar. The visual analog score of postoperative pain decreased from 4.83 on day-1 to 2.28 on day-7. The tumor recurrence was 9.6%. Conclusions Endoscopic thyroidectomy via the axillary-breast-shoulder approach is feasible, safe, and minimally invasive with excellent postoperative results.

during follow-up, from 20 patients with benign urological disease, and from 20 healthy volunteers. RNA was isolated from exfoliated cells in urine by use of an RNA purification kit, and real-time PCR was performed with specific primers for the amplification of CK20, a marker for TCC urothelium. Findings: A strong correlation was found between tumour grade and expression of CK20 in urine. All patients with grade III and IV tumours showed positive CK20 expression in the exfoliated cells, with 100% sensitivity. The sensitivity for lower grades was up to 83%. Out of 13 TCC patients, CK20 expression was found in nine patients who were previously diagnosed by biopsy and had a negative biopsy following treatment. These nine patients were followed up for 6 months, and TCC recurred in four patients. Interpretation: Quantitative detection of CK20 in exfoliated cells of urine is a simple and non-invasive method for monitoring and follow-up of TCC in patients with bladder cancer. However, more information is needed regarding CK20 expression in non-malignant urological diseases to use it as a marker for routine screening. Funding: PKS is a recipient of Independent Senior Research Fellowship (SRF) award from the Indian Council of Medical Research (ICMR), New Delhi, India. The authors declared no conflicts of interest.