Current guidelines recommend completion axillary lymphnode dissection (ALND) when sentinel lymphnode (SLN) contains metastatic tumor deposit. In consequent ALND sentinel node is the only node involved by tumor in 40-70 % of cases. Recent studies demonstrate the oncologic safety of omitting completion ALND in low risk patients. Several nomograms (MSKCC, Stanford, MD Anderson score, Tenon score) had been developed in predicting the likelihood of additional nodes metastatic involvement. We evaluated accuracy of MSKCC nomogram and other clinicopathologic variables associated with additional lymph node metastasis in our patients. A total of 334 patients with primary breast cancer patients underwent SLN biopsy during the period Jan 2007 to June 2014. Clinicopathologic variables were prospectively collected. Completion ALND was done in 64 patients who had tumor deposit in SLN. The discriminatory accuracy of nomogram was analyzed using Area under Receiver operating characteristic curve (ROC). SLN was the only node involved with tumor in 69 % (44/64) of our patients. Additional lymph node metastasis was seen in 31 % (20/64). On univariate analysis, extracapsular infiltration in sentinel node and multiple sentinel nodes positivity were significantly associated (p < 0.05) with additional lymph node metastasis in the axilla. Area under ROC curve for nomogram was 0.58 suggesting poor performance of the nomogram in predicting NSLN involvement. Sentinel nodes are the only nodes to be involved by tumor in 70 % of the patients. Our findings indicate that multiple sentinel node positivity and extra-capsular invasion in sentinel node significantly predicted the likelihood of additional nodal metastasis. MSKCC nomogram did not reliably predict the involvement of additional nodal metastasis in our study population.

Five percent of granular cell tumour occurs in the breast. They are benign in nature but mimick a carcinoma on imaging (mammography and breast ultrasound). We present radilogical and histopathological images of granular cell tumour in the breast.

Introduction: Papillary thyroid cancers that are less than 10mm are diagnosed as papillary thyroid microcarcinomas. There is a rising incidence of incidental microcarcinomas and the consensus regarding management and follow up is still evolving.

Thyroid-stimulating hormone (TSH) plays a key role in the growth and development of thyroid cells and also regulates the function of the thyroid gland. Apart from the multiple risk factors for thyroid cancer like age, male gender, exposure to ionizing radiation and family history of thyroid cancer, higher TSH levels have also been linked to increase the chances of thyroid cancer. This study is performed in a tertiary care hospital over 3 years with 338 samples amongst which 82 patients had DTC and 256 patients had benign thyroid nodules. Serum TSH level was measured by automated enzyme-linked fluorescent assay (ELFA) technique. Biomerieux mini-Vidas hormonal analyzer was used to measure the hormone levels, and the reference ranges were stratified into 4 different groups. Data were analyzed using SPSS 22 version software. Chi-square test was used as a test of significance and p-value of <0.05 was considered as statistically significant. As a conclusion, it can be said that no significant association between higher TSH level and DTC were found. Several authors have investigated the relationship but the results have been inconsistent. A prospective study with a large sample size will be needed for further outcomes.

Background: Differentiated thyroid cancer (DTC) is the most common endocrine malignancy. There is a rising incidence of DTC over the past few decades. This dramatic increase in incidence may be due to increased detection rate or because of factors like thyroid stimulating hormone (TSH) or thyroid autoantibodies which remains unclear. Our study aims to analyze the association between DTC and thyroid autoimmunity.Methods: This was a retrospective study over 1 year conducted at the department of endocrine surgery, Madras medical college, a tertiary care center in South India. During the study period, 364 total thyroidectomies were performed which includes 292 benign and 72 malignant cases. Among malignancies, 15 non-DTC cases were excluded from the study. Finally, we included 57 patients with DTC and 114 patients with benign disease (randomly chosen age and sex-matched controls) for analysis. Demographic data, TSH levels, antithyroglobulin (anti-TG), and anti-thyroid peroxidase (anti-TPO) antibody levels, histopathology were recorded and analyzed.Results: Histopathological examination revealed 47.4% of DTC and 63.2% of benign cases has associated thyroiditis. In our study elevated anti-TPO and anti-TG antibodies were not significantly associated with DTC (anti-TPO positivity 75.4% in DTC group vs. 74.6% in benign group, p=0.90, anti-TG antibody positivity 66.7% in DTC vs. 67.5% in benign group, p=0.90). Also, no significant association established between elevated TSH and DTC.Conclusions: Association between thyroid autoantibodies and DTC has been evaluated in several studies with inconsistent results. The present study did not show any significant associations between elevated thyroid autoantibodies, TSH levels, and DTC.