• The M category refers to melanoma distant metastasis and is classified as stage IV:
  • Within the M category, there is only one stage, M1:
    • In contrast to the three M subcategories in the 7th Edition (M1a, M1b, and M1c):
      • There are four subcategories in the 8th Edition AJCC melanoma staging system. 
  • M1a:
    • Distant metastases to the skin, subcutaneous tissue (including muscle), or distant non-lymph nodes:
      • They are associated with a better prognosis than metastases to other anatomical sites. 
  • M1b:
    • Metastases to the lungs are associated with an intermediate prognosis.
  • M1c:
    • Visceral metastases are associated with a worse prognosis:
      • M1c now includes patients with non-CNS visceral metastasis.
  • M1d:
    • New to the 8th Edition is the addition of a subcategory for CNS metastasis (i.e., brain, spinal cord, and/or leptomeningeal disease):
      • This category of disease is generally associated with worse survival compared to the other M categories. 
• The subcategories reflect survival differences among patients with metastatic disease, depending on the anatomic sites of metastases.
• Serum lactate dehydrogenase (LDH) level also continues to be included in the M category:
  • An elevated LDH has been shown to adversely influence survival across patients with stage IV disease. 
  • LDH level is denoted with the suffix (0) in patients without elevation, or (1) for those with an elevated LDH (i.e., M1a(1) …M1d(1)). 
  • In patients in whom LDH level is unknown or unspecified, no suffix is added  

• The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed:
  • Relative survival rates take into consideration the fact that people may die of other causes besides melanoma:
    • With relative rates, anyone who died of another cause, such as heart disease, is not counted:
      • This is considered to be a more accurate way to describe the prognosis for people with particular types and stages of cancer. 
  • Of course, 5-year survival rates are based on patients diagnosed and initially treated more than 5 years ago:
    • Improvements in treatment often result in a more favorable outlook for recently diagnosed patients.
• Stage 0:
  • The 5-year relative survival rate is 97%.
• Stage I: 
  • The 5-year survival rate is 90% to 95%:
    • If a sentinel node biopsy yields findings of melanoma in the lymph nodes:
      • The 5-year survival is approximately 75%.
• Stage IIA: 
  • The 5-year relative survival rate is approximately 85%:
    • If a sentinel node biopsy yields findings of melanoma in the lymph nodes:
      • The 5-year survival is approximately 65%.
• Stage IIB: 
  • The 5-year relative survival rate is approximately 72% to 75%:
    • If a sentinel node biopsy yields findings of melanoma in the lymph nodes:
      • The 5-year survival is 50% to 60%.
• Stage IIC: 
  • The 5-year relative survival rate is approximately 53%:
    • If a sentinel node biopsy yields findings of melanoma in the lymph nodes:
      • The 5-year survival is approximately 44%.
• Stage III: 
  • The 5-year survival rate is approximately 45%:
    • It is higher if the melanoma has spread to only one node
    • It is lower if it has spread to more than 3. 
    • It is higher if the spread can only be seen under the microscope. 
    • It is lower if the melanoma was ulcerated.
• Stage IV: 
  • The 5-year survival rate for stage IV melanoma is approximately 10%:
    • It is higher if the spread was to skin, subcutaneous tissues or distant non-regional lymph nodes.
• In a study from Alabama, patients with 1, 2-4, or more than 4 positive node(s) had survival rates of:
  • 58%, 27%, and 10%, respectively. 
• Patients with spread to the lymph nodes have an 85% chance of developing occult disease. 
• The worst outcome is predicted for patients with distant metastasis (stage IV):
  • With a single metastatic site, the 1-year survival rate is 36%, but this drops to 13% with 2 sites.
  • Patients with 3 or more sites of metastatic disease essentially have a 0% survival rate in the first yea:
    • These rates all vary somewhat according to the prognostic characteristics.

• The superior parathyroid gland (PIV):
  • Because of the limited embryologic migration:
    • The PIVs are relatively constant in their position.
  • In more than 80% of the cases:
    • The PIVs are located on the posterior aspect of the thyroid lobe:
      • In an area 2 cm in diameter centered 1 cm above the intersection of the inferior thyroid artery and the recurrent laryngeal nerve:
        • In strict proximity with the cricothyroid junction (i.e., the junction of the cricoid cartilage and thyroid cartilage).
  • The PIV often has a surrounding halo of fat and is freely mobile on the thyroid capsule:
    • The surrounding fat may represent atrophic thymic tissue originating from the ventral diverticulum.
  • Occasionally, the PIVs are closely associated to the thyroid capsule:
    • In about 15% of the cases:
      • The PIVs are located on the posterolateral surface of the superior thyroid pole:
        • Hidden between the layers of perithyroidal fascia:
          • In such cases, it is bound on the posterolateral aspect of the thyroid lobe and is therefore less mobile.
  • The PIV could also be located further in a caudal position:
    • Sometimes partially obscured by the recurrent laryngeal nerve, inferior thyroid artery, or tubercle of Zuckerkandl.
  • They may be found even further down:
    • At a considerable distance posterior to the lower thyroid pole.

• The area of dispersal of the PIVs is limited by their short embryonic course.
• In less than 1% of the cases:
  • They may be located higher, above the upper thyroid pole.
• Rarely (up to 3% to 4% of the cases):
  • Normal PIVs are found more posterior in the neck in a retropharyngeal or retroesophageal location:
    • Whereas pathologically enlarged parathyroid glands may be found in a retropharyngeal of retroesophageal position in up to one third of the cases:
      • As the result of migration related to the parathyroid weight. 
• Major ectopic locations of PIV are rare:
  • They may result from descent failure or laterally directed descent:
    • May lead to a superior parathyroid gland adjacent to the common carotid artery.
    • A rare case of a superior parathyroid adenoma located in the scalene fat pad lateral to the carotid has been described.
      • These locations account for less than 1% of the cases.
• Superior parathyroid glands are sometimes found in a subcapsular position or hidden by a cleft of thyroid capsule:
  • True intrathyroidal superior glands are rare and less frequent than PIII, even if the PIV may become included within the thyroid at the time of fusion of the ultimobranchial bodies with the median thyroid rudiment.
  • If the superior parathyroid primordium fails to separate from the remaining endoderm of the fourth pharyngeal pouch, it may migrate to a retropharyngeal location with the pyriform sinus primordium:
    • A few cases of pathologic parathyroid glands localized in the pyriform sinus have been described

• The inferior parathyroid gland (PIII):
  • As the pathway of embryologic descent of the thymus extends from the angle of mandible to the pericardium:
    • Anomalies of migration of the parathymus complex, whether excessive or deficient, are responsible for high or low ectopias of PIIIs.
  • When the parathymus complex fails to descend fully:
    • The inferior parathyroid may become stranded high in the neck:
      • Typically along the carotid sheath:
        • Thus, during parathyroid exploration if the inferior gland is missing:
          • It is usually found with a fragment of thymic tissue above the thyroid gland and superior to the PIV. 
      • Often the gland is situated adjacent to the carotid bifurcation, approximately 2 cm to 3 cm lateral to the thyroid superior pole.
    • The undescended PIII can be found even higher in the neck, above the carotid bifurcation, adjacent to the angle of the mandible, near the hyoid bone.
      • In all these cases, the superior thyroid vessels would provide vascularization.
        • The incidence of this high ectopia resulting from defective embryologic descent of the parathymus does not seem to exceed 1% to 2%.

• On the other hand if the separation from the thymus is delayed:
  • The PIII may be pulled down in the anterior mediastinum to a varying degree:
    • In approximately 4% to 5% of cases, the inferior parathyroid gland is situated in the chest, within the retrosternal thymus, or at the posterior aspect of its capsule or in contact with the great mediastinal vessels (the innominate vein and ascending aorta):
      • Only a few are located outside the thymus adjacent to the aortic arch and the origin of the great vessels. 
      • An even lower position results in the inferior parathyroid being in contact with the pleura or pericardium.
  • Most of the ectopic PIIIs, which descend below the level of the innominate vein and aortic arch:
    • Develop an ectopic arterial blood supply:
      • Generally, this is derived from the internal mammary artery.
      • Occasionally the blood supply may come from a thymic artery or a direct branch from the aorta.

• The inferior parathyroid gland is truly intrathyroidal:
  • Within the lower pole of thyroid in 1% to 3% of individuals 

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:

• He is an expert in the management parathyroid diseases.

• Publication on parathyroid embryology and anatomy:

  • Parathyroid Embryology, Anatomy, and Pathophysiology of Primary Hyperparathyroidism:

    • Arrangoiz, R., Cordera, F., Caba, D., Juárez, M.M., More- no, E. and Luque, E. (2017) Parathyroid Em- bryology, Anatomy, and Pathophysiology of Primary Hyperparathyroidism. International Journal of Otolaryngology and Head & Neck Surgery, 6, 39-58.https://doi.org/10.4236/ijohns.2017.64007

      • https://file.scirp.org/pdf/IJOHNS_2018071317420392.pdf

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

#Cirujano

#ThyroidExpert

#ThyroidSurgeon

#CirujanodeTiroides

#ExpertoenTiroides

#ExpertoenParatiroides

#Paratiroides

#Hiperparatiroidismo

#CancerdeTiroides

#ThyroidCancer

#PapillaryThyroidCancer

#SurgicalOncologist

#CirujanoOncologo

#CancerSurgeon

#CirujanodeCancer

#HeadandNeckSurgeon

#CirugiaEndocrina

#EndocrineSurgery

#CirujanodeCabezayCuello

http://www.cirugiatiroides.com

http://www.sociedadquirurigca.com

http://www.hiperparatiroidismo.info

• Based on the classic paper by Norris and others:
  • The development of the parathyroid glands in humans can be divided into five stages:
    • Preprimordial stage
    • Early primordial stage
    • Branchial complex stage
    • Isolation stage
    • Definitive form stage

• The preprimordial stage:
  • Indicates the period between the formation of the pharynx and the earliest appearance of a recognizable parathyroid anlage:
    • During this stage, at 4 mm to 8 mm in length:
      • The third and fourth pharyngeal pouches show a slight dorsal extension.
    • The third pouch:
      • Which has the form of a tubelike lateral expansion of the primitive pharynx:
        • Makes contact with the ectoderm of the pharyngeal cleft and then continues its growth in a downward and ventral direction.
• The early primordial stage:
  • When the embryo is about 9 mm in length:
    • The parathyroid tissue can be recognized
  • Proliferation and differentiation of large, clear cells occur in the third and fourth pouches:
    • Resulting in:
      • A thickening of the third and fourth pouches
      • Formation of a budlike nodule of the fourth pouch
• The branchial complex stage:
  • The derivatives of the third and fourth pharyngeal pouches become separated from each other to reach independent positions. 
  • During the early phase of this stage:
    • The pharyngeal pouches are still joined to the primitive pharynx by pharyngobranchial ducts:
      • These latter, subsequently, narrow and finally divide:
        • Which determines the definitive separation of the third and caudal pharyngeal complexes from the primitive pharynx.
    • At the beginning of this stage:
      • The primordial thymus and PIII are intimately joined:
        • Subsequently, the thymus begins a period of rapid ventral growth:
          • Until the lower pole comes in contact with the pericardium.
        • On the other hand, the growth of the PIII is not as rapid, and it remains a budlike projection from the superior end of the thymus cord.
        • Finally, it takes a sphere shape, intimately attaching to the upper pole of the thymus cord.
      • The position of the caudal pharyngeal complex in relation to the median anlage of the thyroid depends on:
        • Changes in form, size, and position of the rapidly growing lateral lobe of the median thyroid.
        • During this stage, the PIV rudiment is still attached to lateral thyroid body. 
        • When the embryo is 13 mm to 14 mm long, the PIII and PIV migrate together with the thymus and ultimobranchial bodies, respectively.
        • Because of the extension of the cervical spine and the descent of the heart and great vessels:
          • The complex derived from the third branchial (parathymus) is drawn toward the superior mediastinum and, thus:
            • Migrates in a medial and caudal direction through the entire length of the embryonic neck to reach its final position, and separation of the PIII from the thymus begins.
        • The PIV follows the thyroid migration of the ultimobranchial bodies, which travel toward the lateral part of the main median thyroid rudiment:
          • Their descent in the neck is thus relatively limited. 
          • They remain in contact with the posterior part of the middle third of the thyroid lobes.
    • The complex branchial stage ends when the embryo is approximately 18 to 20 mm in length.

• The isolation stage:
  • Is characterized by the separation of the parathyroid rudiments (PIII and PIV) from the other elements of the third (the thymus) and of the caudal pharyngeal complexes (the ultimobranchial bodies), respectively.
  • The isolation of the parathyroid glands is usually accomplished when the embryo is 20 mm in length. 
  • After completing the descent through the neck:
    • The PIII increases in size and separation from the thymus occurs, because of cephalic regression of the last.
    • PIII is thus abandoned at the level of the anterior or posterolateral region of the inferior poles of the thyroid lobes, or at the level of the thyrothymic ligaments, vestigial structures indicative of their former connections.
  • The two elements of the caudal pharyngeal complex also grow separately and are conjoined by a connecting stalk:
    • The interruption of this stalk, determining the isolation of the PIV, occurs once the lateral and the median thyroid become incorporated. 
    • The final position of the PIV in relation to the thyroid gland is determined by the place at which the inclusion of the ultimobranchial body (lateral thyroid element) occurs.
• The definitive form stage:
  • Indicates the period from the end of the isolation to the time when the parathyroids assume their definitive form.

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:

• He is an expert in the management parathyroid diseases.

• Publication on parathyroid embryology and anatomy:

  • Parathyroid Embryology, Anatomy, and Pathophysiology of Primary Hyperparathyroidism:

    • Arrangoiz, R., Cordera, F., Caba, D., Juárez, M.M., More- no, E. and Luque, E. (2017) Parathyroid Em- bryology, Anatomy, and Pathophysiology of Primary Hyperparathyroidism. International Journal of Otolaryngology and Head & Neck Surgery, 6, 39-58.https://doi.org/10.4236/ijohns.2017.64007

      • https://file.scirp.org/pdf/IJOHNS_2018071317420392.pdf

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

#Cirujano

#ThyroidExpert

#ThyroidSurgeon

#CirujanodeTiroides

#ExpertoenTiroides

#ExpertoenParatiroides

#Paratiroides

#Hiperparatiroidismo

#CancerdeTiroides

#ThyroidCancer

#PapillaryThyroidCancer

#SurgicalOncologist

#CirujanoOncologo

#CancerSurgeon

#CirujanodeCancer

#HeadandNeckSurgeon

#CirugiaEndocrina

#EndocrineSurgery

#CirujanodeCabezayCuello

http://www.cirugiatiroides.com

http://www.sociedadquirurigca.com

http://www.hiperparatiroidismo.info

• El cirujano moderno de cabeza y cuello / cirujano endocrino / cirujano de tiroides deben tener un conocimiento completo de la ciencias básicas detrás del desarrollo de la glándula tiroides y paratiroides, así como de las posibles anomalías congénitas que surgen de estas glándulas, ya que pueden afectar a la integridad de la cirugía, así como las complicaciones de la cirugía:

  • La glándula tiroides es la primera de las glándulas endocrinas del cuerpo que se desarrolla y aparece como una evaginación de los primitivos primarios alrededor de la tercera semana de gestación (aproximadamente el día 24):

    • La glándula tiroides se forma como una proliferación (engrosamiento) de las células epiteliales endodérmicas que se encuentran en la superficie media del suelo faríngeo en desarrollo:

      • El sitio de este desarrollo se encuentra entre dos estructuras clave:

        • El tubérculo impar y la cópula, y es reconocido como el foramen ciego.

• El foramen ciego ubicado en la base de la lengua es el lugar de origen de la glándula tiroides en la unión entre la primera y la segunda bolsa branquial (faríngea), inmediatamente dorsal al saco aórtico:

  • La glándula tiroides tiene un doble origen embriológico:

    • La faringe primitiva y la cresta neuroectodérmica / neural.

  • La glándula tiroides inicialmente surge caudal al tubérculo impar, que también se conoce como la yema media de la lengua:

    • Esta inflamación embrionaria se desarrolla a partir del primer arco branquial y se produce en la línea media del piso de la faringe en desarrollo:

      • Finalmente, ayudando a formar la lengua a medida que las dos hinchazones linguales laterales la sobre-crecen.

    • El foramen ciego comienza rostral a la cópula:

      • También conocida como la eminencia hipobranquial (hipofaríngea):

        • Esta hinchazón embriológica mediana consiste en un mesodermo que surge de la segunda bolsa branquial (aunque también están involucradas la tercera y cuarta bolsas branquiales):

          • La glándula tiroides, por lo tanto, se origina entre la primera y la segunda bolsas branquiales.

      • El precursor de la tiroides inicial, el primordio de la tiroides, comienza como un engrosamiento simple de la línea media (endodermo) y se desarrolla para formar el divertículo de la tiroides o anlage de la tiroides (este anlage mediano forma la mayor parte de la glándula tiroides):

        • Esta estructura al principio es inicialmente hueca:

          • Aunque luego se solidifica (formando los elementos foliculares de la glándula tiroides) y se vuelve bilobulado.

      • La división de la glándula tiroidea en lóbulos laterales, si no está presente desde el principio, se produce tan temprano que es imposible establecer si la tiroides surge como una sola unidad o como un órgano pareado.

      • El tallo generalmente tiene un lumen, el conducto tirogloso, que no desciende a los lóbulos laterales.

      • Los dos lóbulos están ubicados a ambos lados de la línea media y están conectados a través de un istmo.

      • Este anlage tiroideo sigue el corazón primitivo a medida que desciende caudalmente.

      • A principios de la quinta semana de gestación, el conducto atenuado pierde su luz y posteriormente se rompe en fragmentos:

        • La parte proximal se retrae y desaparece, dejando solo el foramen ciego en la base de la lengua para marcar su origen, y el extremo caudal se desarrolla como la glándula tiroides encapsulada bilobulada y alcanza su posición adulta final en la séptima semana de gestación.

• Los anlages laterales apareados se originan en las porciones ventrales de la cuarta y quinta bolsas branquiales y se fusionan con el anlage medular de la tiroides aproximadamente a la quinta semana de gestación:

  • Aportando hasta el 30% del peso de la glándula tiroides.

  • Los anlages laterales son de origen neuroectodérmico / neural (cuerpos ultimobranquiales) y producen las células parafoliculares o C que producen calcitonina (desde la cresta neural, estas células C migran a los cuerpos ultimobranquios), que se encuentran en la región posterior superior de la glándula tiroides.

  • La fusión del anlage medular de la tiroides y los cuerpos ultimobranquiales explica por qué las células parafoliculares o las células C no están dispersas en toda la tiroides, sino que están limitadas a una región profunda entre los tercios medio y superior de los lóbulos laterales a lo largo de un eje lobular central imaginario:

    • Las bases para la fusión de la mediana y la anidación lateral de la tiroides no están claras, pero se afirma que el lugar de la fusión de estas dos estructuras ocurre en el tubérculo de Zuckerkandl.

    • Las células parafoliculares o C pertenecen a un grupo de derivados de la cresta neural conocidos como células de captación y descarboxilación del precursor de aminas (APUD).

• Las células foliculares de la tiroides se desarrollan a partir del anlage medular de la tiroides y se hacen evidentes alrededor de la octava semana de gestación y comienzan a producir coloides y absorben yodo radioactivo alrededor de la semana 11 de gestación:

  • La evidencia de tiroxina viene con la aparición de coloides.

  • El desarrollo del folículo tiroideo se anuncia por la aparición de un material intracelular periódico ácido-Schiff (PAS) positivo:

  • Lo que conduce a la formación de folículos por brotes o división de los folículos primarios:

    • La diferenciación histológica de la glándula tiroides se puede conceptualizar en tres etapas:

      • Pre-coloide (7 a 13 semanas)

      • Coloide (13 a 14 semanas)

      • Folicular (después de 14 semanas)

• Sebaceous gland carcinoma is an aggressive, uncommon, cutaneous tumor:

  • First well-described by Allaire in 1891.

• This tumor is thought to arise from sebaceous glands in the skin and, thus, may arise anywhere on the body where these glands exist, including the genitalia:

  • Approximately 75% of these tumors arise in the periocular region:

    • In this region, sebaceous gland carcinoma represents 1.0% to 5.5% of eyelid malignancies:

      • Fourth after basal cell carcinoma, squamous cell carcinoma, and melanoma.

    • Women tend to be affected somewhat more often than men:

      • With 57% to 77% of patients being women in several large series.

    • Most patients present in their sixth or seventh decade of life:

      • Although the range is from early childhood through the nineties:

        • The youngest reported case arose in a 3-year-old child.

  • • An area rich in a variety of types of sebaceous glands:

      • Sebaceous gland carcinoma resembles normal sebaceous glands.

      • One may reasonably speculate that sebaceous gland carcinoma arises from mature sebaceous glands.

      • Histologic studies have suggested that periocular sebaceous gland carcinomas arise from the sebaceous glands in this region:

        • The following five types of sebaceous glands are seen in the periocular region:

          • Meibomian glands of the tarsal plate

          • Glands of Zeis of the cilia

          • Sebaceous glands of the eyebrows

          • Glands of the caruncle

          • Glands of the fine hair follicles of the eyelid surface

• This tumor exhibits an aggressive clinical course:

  • With a significant tendency for both local recurrence and distant metastasis:

    • Reported local recurrence rates range from 9% to 36%, with larger series reporting recurrence rates in the 30% range:

      • Local recurrence tends to occur within 5 years.

    • The rate of metastasis in extraocular and ocular sebaceous gland carcinoma is thought to be similar, occurring in 14% to 25% of cases:

      • First to the draining lymph nodes and then to distant sites:

        • Sites of distant metastasis include the:

          • Liver, lungs, bones, and brain

• Diagnosis and therapy tend to be delayed because sebaceous gland carcinoma is frequently mistaken for more common benign entities, further complicating treatment of this aggressive malignancy:

  • In addition, a varied histologic appearance may occur, and delayed diagnosis or misdiagnosis following a biopsy is not uncommon.

• When arising in the periocular region, the clinical presentation is often variable, and sebaceous gland carcinoma is often not initially suspected:

  • Instead, patients may receive multiple courses of incision and drainage for chalazion before a definitive biopsy is performed.

• Most sebaceous gland carcinomas have no obvious etiology:

  • Only a few are associated with Muir-Torre syndrome:

    • Although sebaceous adenoma and epithelioma are more specific markers for Muir-Torre syndrome:

      • An evaluation for this syndrome is advisable once sebaceous gland carcinoma is diagnosed:

        • In approximately 40% of cases, patients with Muir-Torre syndrome develop some type of sebaceous tumor before or concurrent with visceral malignancy.

• Merkel Cell Polyomavirus (MCV) is one of seven currently known human oncoviruses:

  • It is suspected to cause the majority of cases of Merkel cell carcinoma, a rare but aggressive form of skin cancer:

    • Approximately 80% of Merkel cell carcinoma (MCC) tumors have been found to be infected with MCV:

      • Polyomaviruses are small (~5400 base pair), non-enveloped, double-stranded DNA viruses:

        • MCV is the fifth polyomavirus that infects humans to be discovered.

• El poliomavirus de células de Merkel (MCV) es uno de los siete oncovirus humanos conocidos actualmente:

  • Se sospecha que causa la mayoría de los casos de carcinoma de células de Merkel, una forma rara pero agresiva de cáncer de piel:

    • Aproximadamente el 80% de los tumores de carcinoma de células de Merkel (MCC) se han encontrado infectados con el MCV:

      • Los poliomavirus son virus de ADN de doble cadena, pequeños (~ 5400 pares de bases), sin envoltura:

        • MCV es el quinto poliomavirus que infecta a los humanos por descubrir.

• El cáncer de mama inflamatorio es una forma rara pero altamente agresiva de cáncer de mama:
  • Se considera una entidad distinta con características clínico-patológicas únicas.
• Los síntomas de eritema y aumento del tamaño de los senos generalmente se desarrollan en el transcurso de unas pocas semanas:
  • Los signos clínicos son el resultado de una embolia tumoral linfovascular, que es patognomónica para el cáncer de mama inflamatorio.
• El diagnóstico oportuno puede ser difícil, ya que el cáncer de mama inflamatorio puede simular una enfermedad infecciosa como la mastitis o un absceso mamario:
  • Sin embargo, el diagnóstico y el tratamiento oportuno son muy importantes para proporcionar una intervención multidisciplinaria lo antes posible.
  • Se debe realizar estudios de estratificación para descartar metástasis a distancia en el momento del diagnóstico.
• Una combinación de terapia sistémica neoadyuvante, mastectomía radical modificada y radioterapia adyuvante es un tratamiento estándar para el cáncer de mama inflamatorio.

Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y miembro 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.

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

http://www.sociedadquirurigca.com

Abstract

Context: The impact of Hashimoto thyroiditis (HT) on the risk of thyroid cancer and its accurate detection remains unclear. The presence of a chronic lymphocytic infiltration imparts a logical mechanism potentially altering neoplastic transformation, while also influencing the accuracy of diagnostic evaluation.

• Un nevó congénito gigante se define como:
  • Un nevó que mide al menos 15 cm de diámetro o al menos el doble del tamaño de la palma de la mano de la persona afectada.
• Los pacientes con nevos congénitos gigantes tienen un riesgo de por vida estimado del:
  • 4% a 10% de desarrollar un melanoma.
• Aproximadamente la mitad de los melanomas que se desarrollan en nevos congénitos gigantes se desarrollan dentro de los primeros 5 años de vida.
• Las decisiones sobre el manejo de los nevos congénitos gigantes son difíciles porque tales lesiones son a menudo tan extensas que la excisión quirúrgica profiláctica es imposible:
  • Cuando la ubicación y el tamaño de una lesión permiten la excisión profiláctica:
    • La excisión debe considerarse antes de los 2 años de edad.
  • Aunque la evidencia es limitada:
    • Los posibles indicadores de pronóstico negativo que pueden ayudar en la toma de decisiones incluyen:
      • El tamaño de la lesión
      • La presencia de lesiones satelitales

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

#CancerSurgeon

#CirujanodeCancer

http://www.sociedadquirurigca.com