The aim of this study was to present our experiences with patients operated on for the recurrence of papillary thyroid cancer with the combined use of preoperative ultrasonographic mapping and radioguided occult lesion localization (ROLL). Twenty patients who had already undergone total thyroidectomy and central/lateral neck dissection for papillary thyroid carcinoma were reoperated on due to locoregional metastasis. The patients with proven recurrences and high Tg wash-out levels in cytopathologic aspirates were operated on. For each patient, numbers of marked and non-marked lesions, and the metastatic and total numbers of marked/non-marked and non-mentioned lesions in the maps were recorded. Thirty-four of 40 (85%) lesions removed with ROLL were found to be malignant. In addition to the marked lesions during mapping, 60 additional lesions had been defined as suspicious. Fifty-six of these lesions were found at exact anatomic sites and localizations described and removed. Of 56 lesions, 36 (64%) were found to be metastatic. During postoperative follow-up, chylous leak with spontaneous regression in 7 days and seroma occurred in one patient. Radioguided occult lesion localization and preoperative mapping contribute to the safety and comfort of patients in planned reoperations on lateral and central neck regions.

The main basin for breast lymphatic drainage is ipsilateral axilla. However, extra-axillary drainage may be seen in some patients. The most common extra-axillary site is internal mammary chain, while contralateral axillary drainage is an extremely rare situation in previously untreated patients. We describe a case of untreated right breast retroareolar carcinoma with contralateral axillary drainage detected on preoperative lymphoscintigraphy. Contralateral axillary dissection was performed based on the result of frozen section examination of the sentinel lymph node (SLN) which turned out to burden micrometastasis. Postoperative histopathological examination revealed invasive ductal carcinoma metastasis in 17 out of 22 lymph nodes from the ipsilateral axillary dissection, whereas 14 lymph nodes from contralateral axillary dissection other than the SLN were nonmetastatic. In our opinion, determination of contralateral axillary metastasis in primary staging process had a major contribution to the management of the patient.

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Generalized lymphadenopathy is a rare manifestation of metastatic prostate cancer. Here, we report the case of a 59-year-old male patient with supraclavicular, mediastinal, hilar, and retroperitoneal and inguinal lymphadenopathy, which suggested the diagnosis of lymphoma. There were no urinary symptoms. A biopsy of the inguinal lymph node was compatible with adenocarcinoma, whose prostatic origin was shown by immunohistochemical staining with PSA. The origin of the primary tumor was confirmed by directed prostate biopsy. We emphasize that a suspicion of prostate cancer in men with adenocarcinoma of undetermined origin is important for an adequate diagnostic and therapeutic approach.

Quantitative analysis of the myocardial perfusion SPECT increases the specificity in evaluating the significance of intermediate degree coronary lesions.