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Objective This study aims to investigate breast cancer lymph node involvement in a West Indian population while correlating it with various histological parameters and evaluating the role of the sentinel lymph node biopsy. Method This is a retrospective study where histology reports for all breast cancer-related biopsies from 2018 to 2021, totaling 813 samples, were obtained. Histological parameters from these reports were extracted into a spreadsheet and analyzed using Statistical Product and Service Solutions (SPSS, version 28.0; IBM SPSS Statistics for Windows, Armonk, NY) software for TNM staging and axillary and sentinel lymph node dissections, among other fields found in histology reports. Results In 44.8% of cases, patients present at the T2 stage with associated lymph node spread. Each T stage had more lymph nodes involved than uninvolved for tumors sized T2 and higher. Inversely, for tumors staged under T2, there were generally more uninvolved lymph nodes than involved ones. Larger tumors were found to have advanced N staging, especially in the T3 category, where a significantly higher proportion of cases were found to have N2 and N3 staging compared to the other T stages. This trend is also seen in M staging, where larger tumors metastasize more than smaller tumors (40% for T4a, 0% for T1). Despite significant lymph node involvement being observed, sentinel lymph node biopsies were usually negative. Conclusion More patients in this population present with lymph node involvement than without. Larger breast cancer tumors are associated with greater lymph node involvement, particularly at T2 and higher stages. Sentinel lymph node biopsies can be omitted in smaller breast cancer tumors up to 2 cm in size, and the local recurrence rate is low despite a false-negative rate of around 10% in upfront sentinel lymph node biopsy.
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In recent years, the Rutherford Morison incision has become synonymous with renal transplant surgery. However, this incision was originally intended for access to the sigmoid colon and pelvis, particularly in the case of a midline previously scarred from operation. We present a case of a middle-aged female with a caecal tumour, requiring resection. Upon examination, this patient was found to have large concomitant diastasis of the recti. A right-sided Rutherford Morison incision was utilized in performing a right hemicolectomy. Although the advantages of a minimally invasive approach to colonic resections are well described, laparoscopy was not utilized in the case discussed. Due to the wide area of anterior abdominal wall laxity, herniation is likely to develop at both port placement and specimen delivery sites. A similar outcome would result from a midline incision. However, a paramedian is an acceptable alternative to a Rutherford Morison incision in a case like this, as it is known to have very low rates of post-operative incisional herniation. While in modern times, its use may have become repurposed, the Rutherford Morison incision is one which should be remembered and used in the surgeons' armamentarium to improve clinical outcomes when necessary.
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A case of dermatofibrosarcoma protuberans (DFSP) in a 22-year old female associated with blunt trauma of the mid-upper back is presented in the current study with a review of the literature. DFSP is a rare slow growing sarcoma of the soft tissue most commonly seen on the trunk and upper extremities with a low to intermediate grade malignant potential, high chance of local invasion and a high local recurrence rate. The literature search revealed that both non-congenital mutation as well as trauma serve a role in the development of this dermal neoplasm, but the exact mechanism by which trauma may predispose to development of DFSP is unknown. However, it seems intuitive that chronic inflammation and stimulation of the immune system at a local level may trigger the immunopathologic changes that could lead to the malignant transformation of dermal cells. Future research into the relationship between trauma and DFSP on a cellular level is required, as there appears to be a direct link present.