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Up to Date Management of DCIS and Future Directions

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Advances in Breast Cancer Research 2020年第3期9卷 78-100页

作者： rodrigo arrangoiz Fernando Cordera Eduardo Moreno Enrique Luque-de-Leon Manuel Muñoz Sociedad Quirúrgica S.C. at the American British Cowdray Medical Center Colonia Tlaxala Delegación Cuajimalpa Mexico City Mexico

Ductal carcinoma in situ (DCIS) is a non-invasive malignancy confined within the basement membrane of the breast ductal system. There is a lot of disparity in the natural history of DCIS with an estimated incidence of progression to invasive ductal carcinoma between 20% to 53% over ten or more years after initial diagnosis. The surgical and adjuvant management of DCIS has advanced significantly in the last couple of decades. Nonetheless, surgeons, medical oncologists, and radiation oncologists, along with their patients, still depend on conventional clinical and pathologic risk factors to make management decisions. Irrespective of the management strategy, long-term survival is excellent. The debate around DCIS relates to preventing either under-treatment or over-treatment. In this paper, we will review the incidence and management options of DCIS. Additionally, we will focus on several current disputes related to the management of DCIS, including breast conserving surgery, the role of radiation in breast conservation surgery, sentinel node biopsy in DCIS, hor

关键词： Ductal Carcinoma in Situ DCIS Management of DCIS Treatment of DCIS Predictors of Recurrence of DCIS Risk Stratification Schemes for DCIS Active Surveillance for DCIS

Parathyroid Embryology,Anatomy,and Pathophysiology of Primary Hyperparathyroidism

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International Journal of Otolaryngology and Head & Neck Surgery 2017年第4期6卷 39-58页

作者： rodrigo arrangoiz Fernando Cordera David Caba Manuel Munoz Juarez Eduardo Moreno Enrique Luque American British Cowdray Medical Center México CityMexico

Unregulated overproduction of parathyroid hormone (PTH) from an abnormal parathyroid gland is the origin of primary hyperparathyroidism (PHPT). Patients who have an elevated serum calcium concentration have a problem in one or more of their parathyroid glands. To understand this disease state adequately and provide appropriate treatment, a thorough understanding of parathyroid embryology, anatomy, physiology, and pathophysiology is essential. In this manuscript, we review our current understanding of parathyroid gland embryology, anatomy, histology, physiology, and pathophysiology.

关键词： Parathyroid Anatomy Parathyroid Histology Parathyroid Pathophysiology

Management Approach to Thyroid Nodules

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International Journal of Otolaryngology and Head & Neck Surgery 2018年第4期7卷 214-227页

作者： rodrigo arrangoiz Fernando Cordera David Caba Eduardo Moreno Enrique Luque de Leon Manuel Munoz Sociedad Quirúrgica S.C.at the American British Cowdray Medical Center Mexico CityMexico

Thyroid nodules are a major health problem worldwide. The prevalence of palpable thyroid nodules in the general population is approximately 5% in women and 1% in men living in parts of the world with sufficient iodine. High resolution neck and thyroid ultrasound can detect thyroid nodules in a significant proportion of randomly selected individuals, with higher frequencies in women and the elderly population. The importance of thyroid nodules lies in the need to rule out cancer. The majority of thyroid nodules are benign, clinically irrelevant, and can be safely managed with a good surveillance program. The detection and diagnosis of differentiated thyroid cancer have evolved over the years with increased use of high resolution cervical and thyroid ultrasound, fine needle aspiration biopsy (FNAB), molecular testing, and thyroglobulin as a serum tumor marker. An algorithm that utilizes high resolution ultrasound and, when indicated, FNAB, and molecular testing for the diagnosis of thyroid nodules, facilitates a personalized, risk-based protocol that promotes high-quality care and minimizes cost and unnecessary testing. Our paper reviews the current, evidence-based management of newly diagnosed thyroid nodules.

关键词： Thyroid Nodules Thyroid Cancer Thyroid FNA Thyroid Nodule Workup

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Thyroid Cancer

International Journal of Otolaryngology and Head & Neck Surgery 2019年第6期8卷 217-270页

作者： rodrigo arrangoiz Fernando Cordera David Caba Eduardo Moreno Enrique Luque-de-Leon Manuel Muñ oz Sociedad Quirúrgica S.C. American British Cowdray Medical Center Mexico City Mexico

Thyroid tumors include those that originate from follicular cells and those that arise from parafollicular cells (C cells). Differentiated thyroid cancer, which originates from follicular cells, includes papillary carcinoma, follicular carcinoma, oncocytic cell carcinoma (Hürthle), poorly differentiated carcinoma, and anaplastic carcinoma. The incidence of thyroid cancer has been increasing significantly, with an estimated incidence in the United States of America of 53,990 cases by the year 2018. This neoplasm is listed as the most common endocrine tumor and represents approximately 3% of all malignant tumors in humans, with 75% of cases occurring in women, and two-thirds of cases occurring in people under 55 years. The increase in the prevalence/incidence of low-risk thyroid cancer over the last 10 to 20 years has required a re-appraisal of the standard one-size-fits-all approach to differentiated thyroid cancer. This adaptation to a more individualized management of the patient with thyroid cancer has led to a much more risk-adapted approach to the diagnosis, initial therapy, adjuvant therapy, and follow-up of patients with differentiated thyroid cancer. This paper with review the current understanding of the clinical presentation, diagnostic workup, and management of thyroid cancer centered on evidence-based and personalized medicine.

关键词： Thyroid Nodules Thyroid Cancer Thyroid FNA Thyroid Nodule Workup Thyroid Cancer Treatment Molecular Studies for Thyroid Cancer

Comprehensive Review of Thyroid Embryology,Anatomy,Histology,and Physiology for Surgeons

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International Journal of Otolaryngology and Head & Neck Surgery 2018年第4期7卷 160-188页

作者： rodrigo arrangoiz Fernando Cordera David Caba Manuel Munoz Eduardo Moreno Enrique Luque de León Department of Surgical Oncology/Head and Neck Division of the American British Cowdray Medical Center Mexico CityMexico

Emil Theodor Kocher and Theodor Billroth pioneered the surgical management of thyroid disease. Their surgical techniques, knowledge of thyroid anatomy, embryology, histology, physiology, and antisepsis practices transitioned a life-threatening operation to one with acceptable morbidity. The modern head and neck surgeon should have a meticulous surgical technique, combined with a thorough understanding of thyroid embryology and anatomy that is central to the understanding and treatment of the different disease processes of the thyroid gland and the consequences of thyroid gland surgery. In this manuscript we will be examining thyroid gland embryology, anatomy, histology, and physiology that is essential to the practicing thyroid surgeon.

关键词： Thyroid Gland Embryology Thyroid Gland Anatomy Thyroid Gland Histology Thyroid Gland Physiology Thyroid Gland

Breast Conserving Surgery: Has the Standard of Care Enhanced Outcomes for Patients?

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Advances in Breast Cancer Research 2021年第1期10卷 1-23页

作者： rodrigo arrangoiz Jeronimo Garcialopez De Llano Maria Fernanda Mijares Gonzalo Fernandez-Christlieb Vanitha Vasudevan Amit Sastry Adrian Legaspi Center for Advanced Surgical Oncology Palmetto General Hospital Hialeah FL USA Center for Advanced Surgical Oncology Palmetto General Hospital Hialeah FL USA

Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publication of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma In Situ (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. Conclusion: The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survi

关键词： Breast Conserving Surgery (BCS) Disease-Free Survival (DFS) Recur-rence-Free Survival (RFS) Distant-Disease-Free Survival (DDFS) Overall Sur-vival (OS) Ductal Carcinoma in Situ (DCIS) Neoadjuvant Chemotherapy (NAC)

<sup>11</sup>C-Choline PET/CT in the Management of Primary Hyperparathyroidism

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International Journal of Otolaryngology and Head & Neck Surgery 2020年第5期9卷 149-160页

作者： Maria R. Alvarez rodrigo arrangoiz Miguel Á ngel Olarte Cecilia Carreras Maria M. Leó n S. Fernando Cordera Anahuac University Huixquilucan State of Mexico Mexico Sociedad Quirúrgica S.C. at the American British Cowdray Medical Center Mexico City Mexico American British Cowdray Medical Center Mexico City Mexico Hospital ángeles Lomas Huixquilucan State of Mexico Mexico

Primary hyperparathyroidism (PHPT) is a relative common medical problem caused by the inappropriate secretion of parathyroid hormone (PTH) by one or more parathyroid glands. The diagnosis is established by serum calcium and PTH levels and once the diagnosis is established imaging studies help localize the hyperfunctioning adenoma in preparation for curative surgery. Until now, the imaging studies most commonly utilized in PHPT are ultrasonography and 99mTc-Sesta-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. However, these studies often fail to localize the adenoma and inappropriately delay patient referral to a potentially curative surgery. We present the case of a 64-year-old female with symptomatic PHPT who had 3 negative 99mTc-Sestamibi Scans over a period of 5 years who eventually had a PET/CT with 11C-Choline that identified a right lower parathyroid adenoma. She underwent a right lower parathyroidectomy and had a successful outcome. We present a review the current imaging techniques used in the management of PHPT including 99mTc-Sesta-MIBI scintigraphy and its limitations and novel use of PET/CT with 11C-Choline and 18F-Choline in this disease and emphasize the fact that, according to current guidelines, failure to localize the adenoma should not delay referral for curative surgery.

关键词： Primary Hyperparathyroidism Evaluation of Primary Hyperparathyroidism 11C-Choline 18F-Fluorocholine PET/CT Treatment of Primary Hyperparathyroidism

Mediastinal Liposarcoma: Case Report and Literature Review

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Journal of Cancer Therapy 2021年第4期12卷 208-220页

作者： Jeronimo Garcialopez De Llano Maria Fernanda Mijares Vanitha Vasudevan rodrigo arrangoiz Amit Sastry Frank De la Cruz Jennifer Fernandez Garcia Adrian Legaspi Center for Advanced Surgical Oncology Palmetto General Hospital Hialeah USA

Liposarcomas (LS) are the second most common type of soft tissue malignancies in adults;they arise from mesenchymal cells and account for 1% of all adult cancers and 15% of all pediatric cancers. The site of origin can be from anywhere there is fat in the human body. LS are classified based on the primary site of origin, and mediastinal LS are extremely rare. When mediastinal neoplasms are stratified based on histology, they represent less than 1% of all mediastinal tumors. To date, less than 150 cases have been reported in the English literature. This article aims to present an unusual case of an extremely rare malignancy and perform a systematic review of the latest literature. In this report, our group is documenting the presentation, management, and outcome of a 65-year-old male patient with a massive anterior mediastinal primary LS. The tumor was displacing the mediastinum into the right chest, occupying most of the left chest, and pushing the diaphragm into the abdomen. Mediastinal liposarcomas are extremely rare malignancies and can prove to be challenging to diagnose and treat. Aggressive surgical treatment with R0 resection is the gold standard, however, tumor biology in many cases is associated with variable growth rates and encroachment of adjacent vital structures and blood vessels. When complex anatomical structures preclude an R0 resection, there is a high incidence of local recurrence. In cases where there is a high risk of recurrence, radiotherapy is indicated and chemotherapy has a more limited role.

关键词： Liposarcoma (LS) Well-Differentiated Liposarcoma (WDLS) Dedifferentiated Liposarcoma (DDLS)

Metastatic Lobular Carcinoma of the Breast Presenting with Small Bowel Metastases:Case Report and Literature Review

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Advances in Breast Cancer Research 2020年第1期9卷 1-11页

作者： rodrigo arrangoiz María Cristina Ornelas Janet Pineda-Díaz Fernando Cordera David Caba Eduardo Moreno Enrique Luque-De-Leon Manuel Munoz Sociedad Quirúrgica S.C.at the American British Cowdray Medical Center Mexico CityMexico

Introduction: Invasive lobular carcinoma (ILC) is the second most common histologic type of breast cancer, representing 5% to 15% of invasive tumors. ILC tends to spread to bones, lungs, central nervous system, reproductive organs, and the gastrointestinal tract (GI tract). The most commonly affected organs in the GI tract are the stomach, small intestine, followed by colon and rectum. Case presentation: A 78-year-old woman who was referred to our institution after having a bowel obstruction that required a diagnostic laparoscopy where they identified an obstructing ulcerative lesion in the distal ileum that was managed with a segmental bowel resection. Pathology report showed an invasive lobular breast carcinoma that occluded 90% of the bowel lumen. A PET/CT scan revealed a left breast tumor with increased metabolism. The patient was staged as a clinical cT4b, cN0, cM1 left breast invasive lobular carcinoma (ER/PgR positive, HER-2 negative). She was managed with endocrine therapy with Letrozole (an eight-week course). A follow-up PET/CT showed a peritoneal hypermetabolic nodule adjacent to the previous ileal anastomosis. The lesion decreased in size and metabolic activity. In a multidisciplinary fashion, the endocrine therapy was extended for another three months. Another follow-up PET/CT scan was performed three months after the identification of the peritoneal implant that showed that the nodule increased in size and in metabolism. The lesion continued to decrease significantly in size and became metabolically inactivity. Due to the good breast response and the possibility that the ileal nodule could be a granuloma, she underwent an exploratory laparoscopy with excision of the peritoneal nodule, and a modified left radical mastectomy with immediate breast reconstruction (complex wound closure). The final pathology report of the nodule was negative for malignancy. She continued on endocrine therapy and underwent whole breast irradiation four weeks after the operat

关键词： Invasive Lobular Carcinoma of the Breast Metastatic Lobular Carcinoma of the Breast Metastatic Disease to the Small Bowel from Breast Cancer