Author: Rodrigo Arrangoiz MS, MD, FACS, FSSO

👉The sonographic image in this patient shows a fairly round, well-circumscribed, microlobulated lesion with posterior enhancement.

👉The most reliable sonographic feature of medullary carcinoma is enhanced through transmission.

👉This results from the highly cellular lesion with a paucity of desmoplastic fibrous tissue, in addition to areas of cystic necrosis and hemorrhage.

👉Medullary carcinomas are classically well-circumscribed, but most of them have some area of angularity.

👉High-grade, colloid (mucinous), and papillary carcinomas typically have a sonographic appearance similar to medullary carcinoma.

Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

 Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉Un ejemplo de una mamografía normal. En virtud de que no hay mujeres con mama idénticas, las mamografías de cada mujer pueden verse un poco distintas.

¿Qué pasa si la mamografía es anormal?

👉Una mamografía anormal no siempre significa que haya cáncer. Sin embargo, le tendrán que hacer mamografías, pruebas o exámenes adicionales para que su médico pueda tener alguna certeza. También es posible que la remitan a un médico especialista en mamas o a un cirujano. Esto no significa necesariamente que usted tenga cáncer o que necesite una cirugía. Estos médicos son expertos en el diagnóstico de problemas mamarios. Los médicos harán pruebas de seguimiento para diagnosticar cáncer de mama o para determinar que no hay cáncer.

Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

 Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉To assess the utility of mutational markers in determining the most appropriate initial surgery for patients with thyroglossal duct cyst carcinoma (TGDCCa) and a normal thyroid gland.

👉Our sample comprised 15 patients with a diagnosis of TGDCCa and a thyroid gland histologically negative for any malignant involvement, who underwent surgery between the years 1994 and 2017.

👉Clinical records were reviewed and tissue specimens were genetically tested for the presence of the most commonly encountered mutational markers in differentiated thyroid cancer: BRAF, N-RAS, and H-RAS.

👉The primary outcome of interest was the correlation between mutational marker positivity and the T-stage of the primary tumor and its potential implication on therapeutic decision making.

👉All 15 cases were papillary carcinomas with a mean tumor size of 17 mm (2–40 mm). According to the 7th edition of the American Joint Committee on Cancer TNM staging system, these represented: T (n= 3), T (n= 1), and T (n= 11). Cancerous invasion of the pericystic soft tissue and/or hyoid bone was considered T3. BRAF was the only mutational marker identified (7 in 15 cases). All BRAF-positive lesions were T, necessitating radioactive iodine ablation (RIA) therapy, therefore, total thyroidectomy. The correlation between BRAF positivity and extracystic cancerous extension was statistically significant [1.0 (7/7) vs. 0.5 (4/8); p value = 0.0035]. BRAF positivity seems to be predictive of locally advanced disease mandating RIA therapy.

👉Therefore, it could serve as a preoperative tool that predicts the need for total thyroidectomy, in addition to Sistrunk’s procedure.

#Arrangoiz

#ThyroidSurgeon

#ThyroidExpert

#Surgeon

#HeadandNeckSurgeon

Check out these Parathyroid-related articles published online or in print last week!

The Significance of Histologically “Large Normal” Parathyroid Glands in Primary Hyperparathyroidism. Krawitz R, Glover A, Koneru S, Jiang J, Di Marco A, Gill AJ, Aniss A, Sywak M, Delbridge L, Sidhu S. World J Surg. 2019 Nov 26. PMID: 31773224 https://www.ncbi.nlm.nih.gov/pubmed/31773224

Robust, quick, and convenient intraoperative method to differentiate parathyroid tissue. Kikumori T, Inaishi T, Miyajima N, Shibata M, Takeuchi D. Surgery. 2019 Nov 18. PMID: 31753324 https://www.ncbi.nlm.nih.gov/pubmed/31753324

PRIMARY HYPERPARATHYROIDISM DURING PREGNANCY: A CASE SERIES OF 8 PATIENTS. Song A, Wang W, Chen S, Wang Y, Liu S, Nie M, Jiang Y, Li M, Xia W, Meng X, Xing X, Wang O. Endocr Pract. 2019 Nov;25(11):1127-1136. PMID: 31414909 https://www.ncbi.nlm.nih.gov/pubmed/31414909

Timing of Parathyroidectomy Does Not Influence Renal Function After Kidney Transplantation. van der Plas WY, El Moumni M, von Forstner PJ, Koh EY, Dulfer RR, van Ginhoven TM, Rotmans JI, Appelman-Dijkstra NM, Schepers A, Hoorn EJ, Plukker JTM, Vogt L, Engelsman AF, Nieveen van Dijkum EJM, Kruijff S, Pol RA, de Borst MH; Dutch Hyperparathyroidism Study Group. World J Surg. 2019 Aug;43(8):1972-1980. PMID: 30798418 https://www.ncbi.nlm.nih.gov/pubmed/30798418

American Association of Clinical Endocrinologists Endocrine Society

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon / endocrine surgeon / surgical oncologist and is a member of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center in Mexico City:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Teacher

#Surgeon

Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉Rodrigo Arrangoiz MS, MD, FACS es especialista en Cirugia de Mama / Cirugía de Tumores de Cabeza y Cuello / Cirugía Endocrina y Cirugía Oncológica compleja.

👉Fue egresado como Médico General de la Universidad Anahuac Suma Cum Laude.

👉Es miembro de Sociedad Quirúrgica S.C. que es el único grupo quirúrgico en México en donde todos los socios se entrenaron en las mejores instituciones académicas de los Estados Unidos de América. 

👉El Doctor Arrangoiz es experto en el manejo del Cáncer de Tiroides, Patología Quirúrgica de Tiroides, Hiperparatiroidismo Primario, Tumores de Cabeza y Cuello y Cáncer de Mama. 

👉Fue entrenado en las mejores instituciones académicas de los Estados Unidos y mantiene certificaciones por los Consejos de Cirugía General y Cirugía Oncológica en México y en los Estados Unidos de América. 
 

 👉Es miembro de la American Society of Breast Surgeons:

👉Es miembro de la American Thyroid Association:

👉Su entrenamiento es el siguiente:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉The sonographic appearance of a normal lymph node is:

-Elliptical with a thin, hypoechoic cortex and an isoechoic to hyperechoic fatty hilum.

👉Metastatic carcinoma in a lymph node would usually have an:

-Asymmetric thick cortex or have near-total or total obliteration of the hilum resulting in a rounded, hypoechoic mass.

👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

 👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉Papillary lesions of the breast are common.

👉These highly vascular lesions are intraductal and may transform into malignant variants.

👉In benign papillary lesions, a vascular stalk may be demonstrated on color Doppler scanning while multiple feeding vessels may be seen when imaging malignant papillary lesions.

👉When papillary lesions infarct, the vascular stalk will not be demonstrated.

👉The ability to reliably distinguish papilloma, in-situ papillary carcinoma, and invasive papillary carcinoma is not possible with ultrasound and is quite challenging even on core biopsy.

👉Open surgical biopsy may need to be performed to distinguish malignant from benign papillary lesions.

👉An “acorn” cyst is lined with papillary apocrine metaplasia which can form a mural nodule.

👉The nodule in an acorn cyst is less echogenic than papillomas or papillary carcinomas, is usually concave, following the contour of the cyst (thus the appearance of a cap on an acorn) instead of convex, and does not have a vascular stalk.

👉The mural nodule caused by papillary apocrine metaplasia also would not extend into the duct as the papillary lesion shown in the image does. 

👉Tubular adenomas and fibroadenomas have a similar sonographic appearance and are frequently round or oval, although tubular adenomas can be fusiform or spindle shaped.

👉Both lesions occur during reproductive years and would not commonly present as a new finding in a postmenopausal patient.

 👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

 👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉Breast hamartomas most likely result from an overgrowth of a portion of normal breast tissue, or from fibrous and glandular elements getting incorporated into a lipomatous growth.

👉Thus, they are sometimes called a “breast within a breast.”

👉They are also variously called adenolipofibroma, lipofibroadenoma, adenolipofibroma, and fibroadenolipoma, because they contain fibrous, fatty, and epithelial tissues.

👉They may present as palpable masses, but are more commonly discovered on routine imaging.

👉They are round, oval, or lobulated and are usually well-circumscribed.

👉They have a mixture of water density and fatty elements and frequently have either a capsule or the appearance of a capsule resulting from surrounding compressed breast tissue.

👉A mammographically classic hamartoma does not require further imaging, short interval follow-up, or biopsy.

👉The presence of a breast hamartoma should prompt further questioning of the patient to be sure there is nothing to suggest she has multiple hamartoma syndrome (Cowden syndrome), a rare disorder caused by a deleterious mutation in the PTEN gene.

👉Patients with this disorder have an increased head circumference, multiple trichilemmoma skin lesions, intestinal hamartomas, and an increased risk of cancer of the breast, thyroid, endometrium and kidney.

👉If there is a personal or family history suggestive of the disorder, genetic testing should be done.

 👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

 👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer

👉The patient has a BI-RADS 2 simple cyst.

👉To be regarded as a simple cyst, a mass must meet three criteria.

1. The margins must be circumscribed, ie, a margin “that is well defined or sharp, with an abrupt transition between the lesion and surrounding tissue.”

2. It must be anechoic , ie, “without internal echoes.”

3. It must show posterior acoustical enhancement, (ie, “a column that is more echogenic deep to the mass.”

👉Simple cysts are almost never associated with cancer in the absence of other abnormalities seen on mammogram or ultrasound.

 👉Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:

• Es experto en el manejo del cáncer de mama.

 👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

#Arrangoiz

#Surgeon

#Cirujano

#SurgicalOncologist

#CirujanoOncologo

#BreastSurgeon

#CirujanodeMama

#CancerSurgeon

#CirujanodeCancer