Home About us Contact
|
Home About us Contact | ||
|
|
||
Malignant Lesions (malignant + lesion)
Selected AbstractsDermoscopy Identifies Histopathologically Indiscernible Malignant Lesion of Atypical Melanosis of the Foot, an Early Lesion of Acral Lentiginous Melanoma In SituDERMATOLOGIC SURGERY, Issue 7 2008HSIU-HUI CHIU MD First page of article [source] Imaging of painful solitary lesions of the sacrumJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 6 2007WCG Peh Summary In patients with sacral pain, the painful symptoms may be caused by a variety of bony and soft tissue lesions. Benign lesions include giant cell tumour, neurogenic tumour, insufficiency fracture, infection and giant bone island. Malignant lesions include primary bone tumours, Ewing sarcoma, plasmacytoma, lymphoma and chordoma. Soft tissue tumours adjacent to or involving the sacrum may cause painful symptoms. A multimodality approach to imaging is required for full assessment of these lesions. This pictorial essay describes a range of common solitary sacral lesions that may cause pain, with emphasis on imaging features. [source] Is there an indication for initial conservative management of pancreatic cystic lesions?,JOURNAL OF SURGICAL ONCOLOGY, Issue 5 2009Stephen R. Grobmyer MD Abstract Background The management of small pancreatic cystic lesions presents a clinical challenge. Methods We reviewed our experience with 78 patients who presented with a cystic pancreatic lesion who underwent operative management between 1995 and 2005. Data on cyst characteristics were analyzed in the context of pathologic findings following resection. Results Among 78 patients, there were 55 (71%) females; median age 63 years. Patients presented with: an incidental finding (48%), pain (40%), acute pancreatitis (4%), other (8%). Operations were distal pancreatectomy (n,=,47), pancreaticoduodenectomy (n,=,16), and other (n,=,15). Most patients had a non-malignant lesion (n,=,65, 83%) (mucinous cystadenoma (n,=,29), serous cystadenoma (n,=,15), IPMN without invasion (n,=,8), pseudocyst (n,=,8), other benign (n,=,5)). Malignant lesions (adenocarcinoma, neuroendocrine tumor, and other) were found in 13 patients (17%). The risk of malignancy increased with size: <3 cm (n,=,25), 4%; 3,5 cm (n,=,23), 13%; and >5 cm (n,=,30), 30%. Pre-operative cyst fluid cytology was performed in 41 patients. The negative predictive value (NPV) of cytology for malignancy was 88% and the positive predictive value (PPV) was 80%. The NPV of CA 19-9 for malignancy was 90%; the PPV was 50%. Conclusions Initial conservative management of small cystic pancreatic lesions may be indicated in selected patients. J. Surg. Oncol. 2009;100:372,374. © 2009 Wiley-Liss, Inc. [source] Sensitivity and specificity of confocal laser-scanning microscopy for in vivo diagnosis of malignant skin tumorsCANCER, Issue 1 2006Armin Gerger M.D. Abstract BACKGROUND Melanoma and nonmelanoma skin cancer are the most frequent malignant tumors by far among whites. Currently, early diagnosis is the most efficient method for preventing a fatal outcome. In vivo confocal laser-scanning microscopy (CLSM) is a recently developed potential diagnostic tool. METHODS One hundred seventeen melanocytic skin lesions and 45 nonmelanocytic skin lesions (90 benign nevi, 27 malignant melanomas, 15 basal cell carcinomas, and 30 seborrheic keratoses) were sampled consecutively and were examined using proprietary CLSM equipment. Stored images were rated by 4 independent observers. RESULTS Differentiation between melanoma and all other lesions based solely on CLSM examination was achieved with a positive predictive value of 94.22%. Malignant lesions (melanoma and basal cell carcinoma) as a group were diagnosed with a positive predictive value of 96.34%. Assessment of distinct CLSM features showed a strong interobserver correlation (, >0.80 for 11 of 13 criteria). Classification and regression tree analysis yielded a 3-step algorithm based on only 3 criteria, facilitating a correct classification in 96.30% of melanomas, 98.89% of benign nevi, and 100% of basal cell carcinomas and seborrheic keratoses. CONCLUSIONS In vivo CLSM examination appeared to be a promising method for the noninvasive assessment of melanoma and nonmelanoma skin tumors. Cancer 2006. © 2006 American Cancer Society. [source] The sarcomatous guise of cervical ectopic hamartomatous thymoma,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2002Jeff Marschall MD Abstract Background Ectopic hamartomatous thymoma is a rare benign neoplasm occurring in the deep soft tissues adjacent to the sternoclavicular joint. Although clinical presentation and diagnostic imaging can be consistent with a malignant lesion such as a sarcoma, recognition of pathologic features can readily exclude such a diagnosis. However, this remains a challenge caused by their unusual histologic features and diverse composition. Recognition of this tumor is, however, important, because it follows a benign clinical course, and conservative surgical excision is the therapy of choice. Methods A literature review of all reports of ectopic hamartomatous thymoma was undertaken and compared with our indexed case. Results From this review, we identified 26 previous reports. Most patients were men, with a 4.5:1 predominance. There was a wide range of ages at presentation, from 26 to 79 years. All tumors were located in the lower neck, with the exception of one arising presternally. Treatment predominantly consisted of tumor resection, with no reported recurrences on follow-up. Conclusions We conclude that ectopic hamartomatous thymoma is an extremely rare neoplasm usually presenting in the lower neck. Correct identification of this tumor is important, because it follows a benign course, and surgical excision is adequate therapy. © 2002 Wiley Periodicals, Inc. Head Neck 24: 800,804, 2002 [source] New insights into the role of extracellular matrix during tumor onset and progressionJOURNAL OF CELLULAR PHYSIOLOGY, Issue 3 2002Serenella M. Pupa Recently, a view of the tumor as a functional tissue interconnected with the microenvironment has recently been described. For many years, the stroma has been studied in the context of the malignant lesion, and only rarely has its role been considered before carcinogenic lesions appear. Recent studies have provided evidence that stromal cells and their products can cause the transformation of adjacent cells through transient signaling that leads to the disruption of homeostatic regulation, including control of tissue architecture, adhesion, cell death, and proliferation. It is now well established that tumor progression requires a continually evolving network of interactions between neoplastic cells and extracellular matrix. A relevant step of this process is the remodeling of microenvironment which surrounds tumors leading to the release of ECM-associated growth factors which can then stimulate tumor and/or endothelial cells. Finally, tumor cells reorganizing the extracellular matrix to facilitate communications and escape the homeostatic control exerted by the microenvironment modify response to cytotoxic treatments. © 2002 Wiley-Liss, Inc. [source] Progressive up-regulation of genes encoding DNA methyltransferases in the colorectal adenoma-carcinoma sequenceMOLECULAR CARCINOGENESIS, Issue 9 2007Wolfgang M. Schmidt Abstract Epigenetic silencing is a prominent feature of cancer. Here, we investigated the expression of DNA demethylase and three DNA methyltransferases during colorectal tumorigenesis comparing the genes encoding DNA methyltransferases 1 (DNMT1), 3A, and 3B (DNMT3A and DNMT3B) with methyl-CpG binding domain protein 2 (MBD2), recently described as the only active DNA demethylase. Total RNA isolated from normal colonic mucosa (n,=,24), benign adenomas (n,=,18), and malignant colorectal carcinomas (n,=,32) was analyzed by reverse transcriptase-PCR with subsequent quantification by capillary gel electrophoresis. In contrast to MBD2, expression of DNMT1 and DNMT3A increased in parallel to the degree of dysplasia, with significant overexpression in the malignant lesion when compared with mucosa or with benign lesions (DNMT1). Pairwise comparisons between tumors and matched, adjacent healthy mucosa tissue (n,=,13) revealed that expression of all three genes encoding DNA methyltransferases increased by two- to three-fold. Our data suggest a relevant role of the DNA methyltransferases during colorectal tumorigenesis. This increase is not counterbalanced by enhanced expression of the demethylating component MBD2. As a consequence, epigenetic regulation in the adenoma-carcinoma sequence may be driven by increased methylating activity rather than suppressed demethylation. © 2007 Wiley-Liss, Inc. [source] Ten cases of sebaceous carcinoma arising in nevus sebaceusTHE JOURNAL OF DERMATOLOGY, Issue 11 2008Miki IZUMI ABSTRACT Although nevus sebaceus is known to develop various types of secondary neoplasms, it rarely causes carcinoma and only 14 cases of secondary sebaceous carcinoma have been reported. In this study, 10 cases of sebaceous carcinoma arising in nevus sebaceus were collected. The clinicopathological features and results of immunohistochemical examinations with adipophilin, perilipin and p53 were summarized. Sebaceous carcinoma arising in nevus sebaceous predominantly occurred on the scalp (8/10) of elderly women (mean age, 67.7 years). No case was associated with Muir,Torre syndrome. We found several pathological features of sebaceous carcinoma; that is, made up mainly of germinative cells, moderate nuclear atypia without pleomorphism and many mitoses (4,28/10 high-power field). Adipophilin and perilipin antibodies highlighted lipid drops in the cytoplasm of the malignant cells in all cases. Overexpression of p53 was seen in all cases. In two cases there were coexisting benign-looking sebaceous lesions at the periphery of the main cancer nodule, and in these lesions p53 showed low positivity compared with the clearly malignant area. There was co-occurrence of another neoplasm in three cases with trichoblastoma, sebaceoma and syringocystadenoma papilliferum, respectively. All cases were treated by excision of the malignant lesion, with or without inclusion of the nevus sebaceus. In a follow-up period of 1,7 years, there was no case of recurrence, lymph node metastases or distant metastases. With these specific pathological and immunohistochemical findings using adipophilin, perilipin and p53, we have to consider the possibility that there is a tendency to underdiagnose secondary sebaceous carcinomas in nevus sebaceus. These clinicopathological features of sebaceous carcinomas developing in the nevus sebaceus seem to indicate different biological entities from de novo sebaceous carcinoma. [source] MRI tumor characterization using Gd-GlyMe-DOTA-perfluorooctyl-mannose-conjugate (Gadofluorine MÔ), a protein-avid contrast agentCONTRAST MEDIA & MOLECULAR IMAGING, Issue 3 2006Hans-Jürgen Raatschen Abstract The rationale and objectives were to define the MRI tumor-characterizing potential of a new protein-avid contrast agent, Gd-GlyMe-DOTA-perfluorooctyl-mannose-conjugate (Gadofluorine MÔ; Schering AG, Berlin, Germany) in a chemically induced tumor model of varying malignancy. Because of the tendency for this agent to form large micelles in water and to bind strongly to hydrophobic sites on proteins, it was hypothesized that patterns of dynamic tumor enhancement could be used to differentiate benign from malignant lesions, to grade the severity of malignancies and to define areas of tumor necrosis. Gadofluorine M, 0.05,mmol,Gd,kg,1, was administered intravenously to 28 anesthetized rats that had developed over 10 months mammary tumors of varying degrees of malignancy as a consequence of intraperitoneal administration of N -ethyl- N -nitrosourea (ENU), 45,250,mg,kg,1. These tumors ranged histologically from benign fibroadenomas to highly undifferentiated adenocarcinomas. Dynamic enhancement data were analyzed kinetically using a two-compartment tumor model to generate estimates of fractional plasma volume (fPV), apparent fractional extracellular volume (fEV*) and an endothelial transfer coefficient (KPS) for this contrast agent. Tumors were examined microscopically for tumor type, degree of malignancy (Scarff,Bloom,Richardson score) and location of necrosis. Eighteen tumor-bearing rats were successfully imaged. MRI data showed an immediate strong and gradually increasing tumor enhancement. KPS and fEV*, but not fPV obtained from tumors correlated significantly (p,<,0.05) with the SBR tumor grade, r,=,0.65 and 0.56, respectively. Estimates for KPS and fEV* but not fPV were significantly lower in a group consisting of benign and low-grade malignant tumors compared with the group of less-differentiated high-grade tumors (1.61,±,0.64 vs 3.37,±,1.49, p,<,0.01; 0.45,±,0.17 vs 0.78,±,0.24, p,<,0.01; and 0.076,±,0.048 vs 0.121,±,0.088, p,=,0.24, respectively). It is concluded that the protein-avid MRI contrast agent Gadofluorine M enhances tumors of varying malignancy depending on the tumor grade, higher contrast agent accumulation for more malignant lesions. The results show potential utility for differentiating benign and low-grade malignant lesions from high-grade cancers. Copyright © 2006 John Wiley & Sons, Ltd. [source] An audit of ,equivocal' (C3) and ,suspicious' (C4) categories in fine needle aspiration cytology of the breastCYTOPATHOLOGY, Issue 4 2001R. A. Deb An audit of ,equivocal' (C3) and ,suspicious' (C4) categories in fine needle aspiration cytology of the breast We have audited the frequency of use and outcome of the ,equivocal/atypia probably benign' (C3) and ,suspicious of malignancy' (C4) category for breast cytology in our Unit. A total of 14 935 cytological specimens were reported by at least one of the three pathologists with a special interest in breast pathology, according to five categories of the NHSBSP guidelines for cytology reporting, 1992; 3.7% (555 cases) and 3.9% (587 cases) of cases were classified as equivocal (C3) and suspicious (C4), respectively, giving a total rate (C3 + C4) of 7.6%. Of the C3 cases, 68% were subsequently benign and 32% were malignant. Of the C4 cases, 19% were subsequently benign and 81% malignant. The commonest benign lesions in both categories were fibroadenomas (7.6% of C3 and 19.8% of C4), fibrocystic change (14.3% of C3 and 12.5% of C4), radial scars (6.2% of C3 and 10.4% of C4) and papillomas (6.2% of C3 and 6.3% of C4). Of the malignant lesions (particularly those classified as C3), a high proportion were low grade or special type cancers. The categories of atypia probably benign (C3) and suspicious of malignancy (C4) in breast cytology provide a strategy for classification of problematic or uncertain cases; this maintains the predictive value of the benign (C2) and malignant (C5) categories, and allows separation of these difficult cases into clinically useful groups with differing probabilities of malignancy. [source] Patients Spend More Time With the Physician for Excision of a Malignant Skin Lesion Than for Excision of a Benign Skin LesionDERMATOLOGIC SURGERY, Issue 3 2004Steven R. Feldman MD Background. Currently, there is a difference in reimbursement between excision of malignant and benign lesions. There is concern that there is not sufficient rationale for differential reimbursement for these two procedures. Objective. To assess whether there is a difference in physician work involved with excision of benign versus malignant skin tumors. Method. We searched National Ambulatory Medical Care Survey data for visits at which excision of benign and malignant skin lesions was performed. We compared the time spent with the physician at these two types of visits. To exclude confounding issues unrelated to the excision that would affect the time of visit, we excluded visits at which multiple diagnoses were addressed. Results. The mean time spent with the physician at visits for excision of benign lesions was 22.9±1.0 minutes. The mean time spent with the physician at visits for excision of malignant lesions was 30.0±1.7, 30% longer (p < 0.001). The longer time for excision of malignant lesions remained significant after controlling for age, gender, and race. Conclusion. Excision of malignant lesions involves more physician work than does excision of benign lesions. Elimination of differential compensation for benign versus malignant skin lesion procedures would not enhance the accuracy of reimbursement. In the absence of any compelling rationale to change the existing differential reimbursement, the proposals to do so are not warranted. [source] Use of topical immunomodulators in organ transplant recipientsDERMATOLOGIC THERAPY, Issue 1 2005Bradley T. Kovach ABSTRACT:, Solid organ transplant recipients are a growing population at increased risk for the development of cutaneous premalignant and malignant lesions, resulting in significant morbidity and mortality. Topical immunomodulators, in particular imiquimod, have shown efficacy in the management of multiple malignant, precancerous, and viral conditions. The ability to locally induce an immune response, presumably against tumor and viral antigens, and induce apoptosis makes topical immunomodulators a promising therapeutic option in organ transplant recipients. Although limited, data have begun to accumulate on the use of imiquimod in transplant patients for the management of superficial, nodular, and infiltrative basal cell carcinomas; in situ and invasive squamous cell carcinomas; condyloma acuminata; and common warts. As more experience is gathered, the role of imiquimod and other topical immunomodulators in the care of OTRs will be clarified. The authors reviewed the existing data on the use of topical imiquimod in OTRs with mention of its presumed mechanisms of action and other immunomodulators with potential efficacy against cancerous and precancerous lesions. [source] Immunohistochemical expression of E-cadherin in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma of the breastDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010Gil Facina M.D., Ph.D. Abstract E-cadherin (EC) is an important glycoprotein cell-adhesion molecule that appears to play a significant role in the progression of breast lesions. The objective of this study was to evaluate EC expression in sclerosing adenosis, ductal carcinoma in situ and invasive ductal carcinoma. Samples of breast lesions from 44 women were used in this study, comprising cases of sclerosing adenosis (n = 11), ductal carcinoma in situ (DCIS) (n = 10) and invasive ductal carcinoma (n = 23). Immunohistochemical evaluation of EC expression was assessed semiquantitatively and considered negative (<10% of cells with stained cytoplasmic membranes), positive+ (10,50% of cells stained) or positive++ (> 50% of cells stained). Fisher's exact test was used to compare the distribution of staining intensity in the lesions (P< 0.05). There was a progressive loss of EC expression from benign to malignant lesions. This difference was statistically significant when sclerosing adenosis was compared with DCIS (P < 0.0002), when sclerosing adenosis was compared with invasive ductal carcinoma (P < 0.008) and when DCIS was compared with invasive ductal carcinoma (P < 0.007). The present findings point to a significant association between reduced EC expression and the progression and aggressivity of breast lesions. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Fine needle aspiration cytology in a case of fibrous dysplasia of jawDIAGNOSTIC CYTOPATHOLOGY, Issue 12 2009Nalini Gupta M.D. Abstract Fibro-osseous lesions of the jaw comprise of a spectrum of diseases which include osseous dysplasia, fibrous dysplasia, and ossifying fibroma. The differentiation amongst these individual pathological lesions is difficult and a combined clinico-radiological and histological correlation is essential for exact categorization. Fine needle aspiration cytology (FNAC) is frequently carried out to distinguish between benign and malignant lesions of the jaw as is a quick and reliable modality of investigation which guides in further management. We report, a case of a jaw swelling in a young male, diagnosed as fibrous dysplasia on FNAC. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Aspiration biopsy cytology of extraabdominal desmoid tumor concurrently occurring in a patient with tumoral calcinosisDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2008F.I.A.C., Husain Saleh M.D., M.B.A. Abstract Extraabdominal fibromatosis or desmoid tumor (DT) is a slow growing locally aggressive soft tissue tumor that can occur anywhere in the body. We report the aspiration biopsy cytology features of a case of DT of the right neck area in a 35-year-old man who had a long standing history of tumoral calcinosis. The aspirate was interpreted as "benign spindle cell lesion" and confirmed as DT on histologic examination of the resected mass. We discuss the possible differential diagnoses of other benign or malignant lesions on fine-needle aspiration (FNA) biopsy and especially discuss the aspiration cytology features of DT compared with those of tumoral calcinosis. We also discuss the value of immunohistochemical markers that help in differentiating DT from other entities. Diagn. Cytopathol. 2008;36:624,627. © 2008 Wiley-Liss, Inc. [source] Cytologic features of müllerian papilloma of the cervix: Mimic of malignancyDIAGNOSTIC CYTOPATHOLOGY, Issue 9 2007Monica L. Hollowell M.D. Abstract Müllerian papilloma is a rare benign tumor of the cervix and/or vagina that occurs predominantly in young children. The cytologic features of benign müllerian papilloma have never been described. We report for the first time, to our knowledge, the cytologic findings of a benign müllerian papilloma from the vaginal fluid specimen of a 15-mo-old girl using touch prep, ThinPrepÔ, and cell block preparations. The deceptive cytologic features of a cellular specimen with complex papillary fronds composed of overlapping and crowded small hyperchromatic cells, with a high nuclear:cytoplasmic ratio, and feathering in this case resembled a malignant neoplasm. The clinical findings and cytomorphology of a benign müllerian papilloma can mimic those of malignant lesions of the female lower genital tract such as sarcoma botryoides and adenocarcinoma. An awareness of this entity and its potential to mimic these more aggressive neoplasms is essential for accurate diagnosis and to avoid over-treatment. Diagn. Cytopathol. 2007;35:607-611. © 2007 Wiley-Liss, Inc. [source] Fine-needle aspiration cytology and immunocytochemistry of orbital massesDIAGNOSTIC CYTOPATHOLOGY, Issue 1 2006Edneia Tani M.D., Ph.D. Abstract A series of 85 fine-needle aspiration (FNA) biopsies from orbital space occupying lesions of 82 patients are reviewed. A total of 32 benign lesions and 49 malignant lesions were conclusively diagnosed. In two cases the aspirates were insufficient for diagnosis. Of two cases, which were cytologically suspicious for lymphoma, a repeat FNA resulted in a conclusive diagnosis of lymphoma in one case, while the second case proved to be a pseudotumor on an open biopsy material. Of the 32 benign lesions seven were fibrosis, six pseudotumors, four epidermal cysts, four meningiomas, and three pleomorphic adenomas. The remaining cases included two hematomas, one granuloma, three inflammations, and one malformation. In 43 of 49 malignant tumors cytomorphology was corroborated with immunocytochemistry. Thirty five of these were low- or high-grade lymphomas, nine metastases, two sarcomas, two plasmacytomas, and one chloroma. All lymphomas were of B phenotype with monoclonal light chain expression. The rate of cell proliferation as measured by Ki-67 immunostaining varied between 4,25% and 30,80% for low- and high-grade lymphomas, respectively. These results confirm previous reports on the usefulness of FNA biopsy in diagnosing orbital masses and emphasize the value of immunocytochemistry in tumor characterization. Diagn. Cytopathol. 2006; 34:1,5. © 2005 Wiley-Liss, Inc. [source] The significance of the diagnosis of atypia in breast fine-needle aspirationDIAGNOSTIC CYTOPATHOLOGY, Issue 5 2004Jennifer C. Lim M.D. Abstract The diagnosis of atypia in breast fine-needle aspiration (FNA) continues to be an area of debate in cytology practice. The aim of this study was to assess the clinical significance of this term and to evaluate potential morphological criteria, which would determine the patient's outcome. A computer-based search was carried out to retrieve breast FNAs performed between 1990 and 2000 that were diagnosed as atypical. Cases followed by surgical resection were reexamined for the presence of morphological features potentially differentiating benign and malignant lesions. Out of 1,568 breast FNAs, there were 64 cases (4%) with a diagnosis of atypia. Thirty-eight cases had surgical follow-up material that revealed malignancy in 14 cases (37%) and benign lesions in 24 cases (63%). The benign diagnostic categories included fibrocystic change (12/24), fibroadenoma (3/24), tubular adenoma (2/24), and nonspecific findings (7/24). The malignant diagnoses included ductal carcinoma (9/14), lobular carcinoma (3/14), ductal carcinoma in situ (DCIS; 1/14), and tubular carcinoma (1/14). The evaluation of cytological criteria used to differentiate benign from malignant lesions (i.e., cellularity, loss of cohesion, myoepithelial cells, nuclear enlargement, nuclear overlap, prominent nucleoli) revealed significant overlap between benign and malignant cases, particularly in cases of fibroadenoma, tubular adenoma, and proliferative breast disease. The surgical follow-up of four hypocellular cases revealed lobular carcinoma in two cases and ductal carcinoma in the remaining two cases. Our study confirmed that the diagnosis of atypia is clinically significant because it is associated with a high probability of malignancy. No morphological criterion is able to reliably differentiate benign and malignant lesions in cases diagnosed with atypia. Diagnosis of atypia is particularly significant in hypocellular cases. We recommended that breast FNAs with a diagnosis of atypia be evaluated further histologically. Diagn. Cytopathol. 2004;31:285,288. © 2004 Wiley-Liss, Inc. [source] ENDOSCOPIC MUCOSAL RESECTION AND SUBMUCOSAL DISSECTION METHOD FOR LARGE COLORECTAL TUMORSDIGESTIVE ENDOSCOPY, Issue 2004Yasushi Sano ABSTRACT The goal of endoscopic mucosal resection (EMR) is to allow the endoscopist to obtain tissue or resect lesions not previously amenable to standard biopsy or excisional techniques and to remove malignant lesions without open surgery. In this article, we describe the results of conventional EMR and EMR using an insulation-tipped (IT) electrosurgical knife (submucosal dissection method) for large colorectal mucosal neoplasms and discuss the problems and future prospects of these procedures. At present, conventional EMR is much more feasible than EMR using IT-knife from the perspectives of time, money, complication, and organ preservation. However, larger lesions tend to be resected in a piecemeal fashion; and it is difficult to confirm whether EMR has been complete. For accurate histopathological assessment of the resected specimen en bloc EMR is desirable although further experience is needed to establish its safety and efficacy. Further improvements of in EMR with special knife techniques are required to simply and safely remove large colorectal neoplasms. [source] New modification of the mandibulotomy approach without lip splittingHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2006Chung-Hwan Baek MD Abstract Background. A lower lip-splitting incision has traditionally been performed with different types of mandibulotomy approaches for obtaining wide access to oral and oropharyngeal cancers. However, lip splitting can be associated with unfavorable aesthetic results. We describe our new modification of a traditional mandibulotomy approach without lip splitting to avoid these morbidities. This is a case series in a tertiary referral center. Methods. The primary tumor site was the oropharynx in four cases, the oral cavity in two cases, and the parapharynx in one case. Each case was assessed for TNM staging, perioperative complications, status of the resection margins, tumor recurrence, and the aesthetic and functional results of the lower lip. Results. All the tumors were safely removed by means of our modified non,lip-splitting mandibulotomy approach through the combined intraoral and transcervical routes with adequate resection margins. There were no troublesome difficulties in reconstruction of the surgical defects with various major flaps. The cosmetic results were excellent with intact lip function. Conclusion. We believe this new modified non,lip-splitting mandibulotomy approach could replace the conventional mandibulotomy approach for some selected malignant lesions, with excellent cosmetic and functional results of the lower lip. © 2006 Wiley Periodicals, Inc. Head Neck, 2006 [source] Head and neck cancer patients with pulmonary nodules: Value and role of CT-guided transthoracic needle aspiration biopsiesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2003Benoît Mesurolle MD Abstract Background. To evaluate transthoracic needle aspiration biopsies of pulmonary lesions in patients with squamous cell cancer of head and neck. Methods. Retrospective series of 85 patients with squamous cell cancer of head and neck cancer and pulmonary nodules who underwent CT-guided needle aspiration biopsy. Results. Diagnostic samples were obtained in 85% of patients. There were 8 benign and 77 malignant lesions. Among the 73 proved cases, 4 were false-negative cases. CT-guided biopsy had an accuracy of 81%, a sensitivity of 94%, and a negative predictive value of 60%. Accuracies were 68% for lesions of 20 mm or smaller and 89% for lesions greater than 20 mm. In a subset of 45 solitary lesions, among 30 positive biopsies, 15 were categorized as primary malignancies, 3 as metastatic, and 12 as indeterminate malignancies. Conclusions. In head and neck cancer patients, the prevalence of thoracic malignancies is high when a pulmonary lesion is detected. CT-guided biopsy of pulmonary lesion is an accurate procedure. However, a third of positive biopsies were categorized as indeterminate malignancies. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] Striving for a better operative outcome: 101 PancreaticoduodenectomiesHPB, Issue 6 2008A.W.C. Kow Abstract Pancreaticoduodenectomy (PD), once carried high morbidity and mortality, is now a routine operation performed for lesions arising from the pancreatico-duodenal complex. This study reviews the outcome of 101 pancreaticoduodenectomies performed after formalization of HepatoPancreatoBiliary (HPB) unit in the Department of Surgery. A prospective database comprising of patients who underwent PD was set up in 1999. Retrospective data for patients operated between 1996 and 1999 was included. One hundred and one cases accrued over 10 years from 1996 to 2006 were analysed using SPSS (Version 12.0). The mean age of our cohort of patients was 61±12 years with male to female ratio of 2:1. The commonest clinical presentations were obstructive jaundice (64%) and abdominal pain (47%). Majority had malignant lesions (86%) with invasive adenocarcinoma of the head of pancreas being the predominant histopathology (41%). Median operative time was 315 (180,945) minutes. Two-third of our patients had pancreaticojejunostomy (PJ) while the rest had pancreaticogastrostomy (PG). There were five patients with pancreatico-enteric anastomotic leak (5%), three of whom (3%) were from PJ anastomosis. Overall, in-hospital and 30-day mortality were both 3%. The median post-operative length of stay (LOS) was 15 days. Using logistic regressions, the post-operative morbidity predicts LOS following operation (p<0.005). The strategy in improving the morbidity and mortality rates of pancreaticoduodenectomies lies in the subspecialization of surgical services with regionalization of such complex surgeries to high volume centers. The key success lies in the dedication of staffs who continues to refine the clinical care pathway and standardize management protocol. [source] Diagnosis of pancreatic cancerHPB, Issue 5 2006Fumihiko Miura Abstract The ability to diagnose pancreatic carcinoma has been rapidly improving with the recent advances in diagnostic techniques such as contrast-enhanced Doppler ultrasound (US), helical computed tomography (CT), enhanced magnetic resonance imaging (MRI), and endoscopic US (EUS). Each technique has advantages and limitations, making the selection of the proper diagnostic technique, in terms of purpose and characteristics, especially important. Abdominal US is the modality often used first to identify a cause of abdominal pain or jaundice, while the accuracy of conventional US for diagnosing pancreatic tumors is only 50,70%. CT is the most widely used imaging examination for the detection and staging of pancreatic carcinoma. Pancreatic adenocarcinoma is generally depicted as a hypoattenuating area on contrast-enhanced CT. The reported sensitivity of helical CT in revealing pancreatic carcinoma is high, ranging between 89% and 97%. Multi-detector-row (MD) CT may offer an improvement in the early detection and accurate staging of pancreatic carcinoma. It should be taken into consideration that some pancreatic adenocarcinomas are depicted as isoattenuating and that pancreatitis accompanied by pancreatic adenocarcinoma might occasionally result in the overestimation of staging. T1-weighted spin-echo images with fat suppression and dynamic gradient-echo MR images enhanced with gadolinium have been reported to be superior to helical CT for detecting small lesions. However, chronic pancreatitis and pancreatic carcinoma are not distinguished on the basis of degree and time of enhancement on dynamic gadolinium-enhanced MRI. EUS is superior to spiral CT and MRI in the detection of small tumors, and can also localize lymph node metastases or vascular tumor infiltration with high sensitivity. EUS-guided fine-needle aspiration biopsy is a safe and highly accurate method for tissue diagnosis of patients with suspected pancreatic carcinoma. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been suggested as a promising modality for noninvasive differentiation between benign and malignant lesions. Previous studies reported the sensitivity and specificity of FDG-PET for detecting malignant pancreatic tumors as being 71,100% and 64,90%, respectively. FDG-PET does not replace, but is complementary to morphologic imaging, and therefore, in doubtful cases, the method must be combined with other imaging modalities. [source] Identification of stemonamide synthetic intermediates as a novel potent anticancer drug with an apoptosis-inducing abilityINTERNATIONAL JOURNAL OF CANCER, Issue 2 2010Ying-Yi Li Abstract We previously demonstrated that Pim-3, a protooncogene with serine/threonine kinase activity, was aberrantly expressed in malignant lesions but not in normal tissues of endoderm-derived organs, including pancreas, liver, colon and stomach. Moreover, aberrantly expressed Pim-3 can prevent tumor cell apoptosis by inactivating a proapoptotic molecule, Bad, and enhancing the expression of an antiapoptotic molecule, Bcl-XL. These observations prompted us to speculate that a chemical targeting Pim-3 kinase may be a good candidate for a novel type of anticancer drug. Hence, we screened various low-molecule compounds by examining their capacity to inhibit Pim-3 kinase activity in vitro. We observed that some synthetic intermediates of stemonamide can inhibit in vitro activities of Pim-3 kinase and its related kinases, such as Pim-1 and Pim-2. Moreover, these compounds inhibit in vitro cell proliferation of various human pancreatic, hepatocellular and colon cancer cell lines. Furthermore, the compounds can induce apoptosis of human pancreatic cancer cell lines in vitro by reducing the amount of phospho-Ser112 -Bad, but not total amounts of Bad and Pim-3. Finally, when the compound was administered to nude mice injected with a human pancreatic cancer cell line, it retarded tumor growth by increasing apoptotic cell numbers and decreasing proliferating cell numbers without causing serious adverse effects on blood counts. These observations indicate that the chemicals and its related compounds may be effective for the treatment of tumors of endoderm-derived organs, particularly the pancreas. [source] Huge epidermoid cyst of the spermatic cord in an adult patientINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2006VAGELOGIANNIS KATERGIANNAKIS Abstract, Tumors arising in the spermatic cord are uncommon and form a heterogeneous group of neoplasms. A variety of both benign and malignant lesions have been demonstrated. Benign tumors represent 80% of the total, but unfortunately clinical and sonographic features are not specific and they cannot safely differentiate a teratomatous or a malignant neoplasm from benign tumors. We report a case of a huge epidermoid cyst of the spermatic cord in an adult patient confirmed after local excision. The etiology, differential diagnosis, and management alternatives are discussed. [source] Can contrast-enhanced sonography distinguish benign from malignant breast masses?JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2010P. G. Sorelli Abstract Background We investigated whether microvascular enhancement on contrast-enhanced sonographic (CEUS) imaging can aid in distinguishing between benign and malignant lesions and correlated these findings with histopathological findings. Method Fifteen patients with a palpable breast mass were recruited. Following informed consent, 4.8 mL of the microbubble contrast agent SonoVue was injected intravenously. Digital video clips of lesion enhancement were obtained and reviewed by a consultant radiologist who scored each lesion on the following characteristics: homogeneous versus heterogeneous enhancement, the presence or absence of focal defects, well- versus ill-defined margins and vascular morphology score (VMS). Result Histologically there were 7 malignant and 8 benign lesions. The calculated sensitivity for CEUS in the diagnosis of malignancy was 100%, with a 37.5% specificity. There was no statistically significant difference in overall mean VMS between the malignant and benign lesions. Conclusion The results of our study have not shown any additional benefit in the use of CEUS over conventional triple assessment. The positive trend seen in the higher mean VMS for the malignant tumors needs further investigation with a larger cohort of patients. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010 [source] Characteristic imaging features of breast fibroadenomas in women given cyclosporin A after renal transplantationJOURNAL OF CLINICAL ULTRASOUND, Issue 2 2004Eun Ju Son MD Abstract Purpose This retrospective study was conducted to determine the characteristic imaging and histopathologic features of breast fibroadenomas in kidney-transplant recipients given chronic cyclosporin A immunosuppressive therapy after the transplantation and to compare these characteristics with those from a control group. Methods From January 1, 1990, through December 31, 1999, 486 women underwent renal transplantation at our institution. All patients subsequently received immunosuppressive therapy with cyclosporin A and prednisolone. Ten (2%) of these women had developed breast fibroadenomas during this chemotherapy. We compared the data obtained on this group's fibroadenomas with those obtained from those in the control group, which comprised 100 women with fibroadenomas but who had never undergone organ transplantation or immunosuppressive therapy. Results Twenty-two fibroadenomas developed in the 10 transplant recipients. Eight of those 10 had multiple lesions, and 7 were affected bilaterally. The mean diameter of the fibroadenomas was 4.2 ± 2.5 cm. Mammographically, the lesions were round or oval high-density masses with well-circumscribed margins and no calcification or spiculation. Sonographically, the lesions were relatively highly echogenic and had a lower ratio of the longitudinal to the anteroposterior diameter (L,/AP) than did those in the control group. Histopathologically, the features of these lesions were generally typical of fibroadenomas, but some were more typical of malignant lesions. Among the 100 control patients, 146 fibroadenomas developed; 33 women had multiple lesions, and 12 were affected bilaterally. Their fibroadenomas had a mean diameter of 2.1 ± 1.5 cm, and the imaging features of these lesions were typical of fibroadenomas. Conclusions The fibroadenomas that developed in kidney-transplant recipients given chronic cyclosporin A and prednisolone immunosuppressive therapy had a tendency to be multiple, bilateral, and larger than those that developed in the control patients. These fibroadenomas also exhibited some imaging features that differed from those of typical fibroadenomas that develop in women who have not undergone organ transplantation or immunosuppressive therapy. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:69,77, 2004 [source] Detection and differential diagnosis of hepatic masses using pulse inversion harmonic imaging during the liver-specific late phase of contrast enhancement with levovistJOURNAL OF CLINICAL ULTRASOUND, Issue 4 2002Cem Yücel MD Abstract Purpose The purpose of this study was to investigate whether late-phase pulse inversion harmonic imaging (PIHI) increases conspicuity in hepatic masses, helps to differentiate benign from malignant lesions, and demonstrates a greater number of and smaller metastatic lesions than do conventional (fundamental) sonography and helical CT. Methods Thirty patients (17 women and 13 men; age range, 35,77 years; mean age, 54 years) with known or suspected liver masses were evaluated using both fundamental sonography and contrast-enhanced PIHI during the liver-specific late phase of Levovist. The patients also underwent contrast-enhanced triphasic helical CT examinations within 1 week after sonography. In 4 of the patients, gadolinium-enhanced MRI was also performed as a part of their clinical work-up. Results The increase in the lesions' conspicuity on PIHI compared with fundamental sonography was significantly greater in malignant lesions than in benign lesions (p< 0.001). An echogenic rim was observed on PIHI in 8 (53%) of 15 malignant lesions. The mean number of metastatic lesions visualized on PIHI (5.5 ± 5.3) was significantly higher than the mean number visualized on fundamental sonography (2.5 ± 2.1, p < 0.05). Although lesions as small as 3 mm were observed on PIHI, the mean sizes of the smallest lesions demonstrated using fundamental sonography, PIHI, and helical CT were not significantly different. Conclusions Late-phase PIHI is a useful technique for characterizing hepatic lesions and demonstrating both a greater number of and smaller metastases. It may help to differentiate benign from malignant liver masses and may obviate unnecessary and expensive further imaging. © 2002 Wiley Periodicals, Inc. J Clin Ultrasound 30:203,212, 2002; Published online in Wiley InterScience (www.interscience. wiley.com). DOI: 10.1002/jcu.10053 [source] Borderline cystic tumors of the ovary: Gray-scale and color Doppler sonographic findingsJOURNAL OF CLINICAL ULTRASOUND, Issue 2 2002M. Angela Pascual MD Abstract Purpose The aim of the study was to determine the value of gray-scale and color Doppler sonography in distinguishing borderline cystic tumors (BCTs) from benign cysts and malignant tumors of the ovary. Methods The gray-scale and color Doppler sonographic features of 383 ovarian lesions in 374 nonpregnant women were retrospectively studied. Sonography was performed transvaginally for all but 7 lesions, which were imaged suprapubically. All of the lesions were surgically resected via laparoscopy or laparotomy. Results The histopathologic diagnoses were 27 BCTs, 35 ovarian carcinomas, and 321 benign cysts. Sonography diagnosed 24 (89%) of 27 BCTs as malignant lesions. Patients with BCTs, were younger than those with ovarian cancer (p < 0.001). BCTs showed intracystic papillae in 17 cases (63%), diffuse internal echoes in 11 (41%), intracystic septa in 8 (30%), a heterogeneous echo pattern in 7 (26%), and a solid pattern in 4 (15%). BCTs showed blood flow in 24 cases (89%) and lower pulsatility and resistance indices (RI) compared with benign lesions (p < 0.001 for both). Multivariate analysis revealed intracystic papillae as the only independent predictor of BCTs (p < 0.001). Conclusions When a cystic mass has papillae, this is the only abnormal finding detected by gray-scale transvaginal sonography, and color Doppler imaging shows low RI values within the mass, a BCT should be suspected. © 2002 John Wiley & Sons, Inc. J Clin Ultrasound 30:76,82, 2002; DOI 10.1002/jcu.10028 [source] Comparison of Seborrheic Keratoses, Inflamed Seborrheic Keratoses, and Inverted Follicular Keratoses Using P53, BCL-1, and BCL-2JOURNAL OF CUTANEOUS PATHOLOGY, Issue 1 2005C. Ko While cell cycle markers have been used to differentiate benign versus malignant lesions and to classify malignant lesions, benign keratoses have not been well studied using such markers, and the relation of the cell cycle to inflammation or irritation of benign keratoses is unclear. We compared the immunohistochemical staining patterns of 10 seborrheic keratoses, 10 inflamed seborrheic keratoses, and 10 inverted follicular keratoses using antibodies to p53, bcl-1, and bcl-2. Staining with antibodies to p53 was increased in inverted follicular keratoses compared to inflamed or non-inflamed seborrheic keratoses. Bcl-1 staining was similar in all lesions. A population of bcl-2-positive dendritic cells was seen within the epidermal portion of inverted follicular keratoses. Keratinocyte bcl-2 staining was higher in seborrheic keratoses compared to the other two keratoses. Bcl-2 may be increased in seborrheic keratoses as an anti-apoptotic mechanism while increased p53 may trigger apoptosis in inverted follicular keratoses. [source] | ||||||||||||||||||||||||||||||||||