Home About us Contact
|
Home About us Contact | ||
|
|
||
Unnecessary Treatment (unnecessary + treatment)
Selected AbstractsRespiratory cytology: Differential diagnosis and pitfallsDIAGNOSTIC CYTOPATHOLOGY, Issue 4 2010F.R.C.P.C., Ph.D., Reda S. Saad M.D. Abstract Pulmonary cytology can be challenging and has its share of diagnostic pitfalls. Reactive atypia can occasionally be alarming, leading to diagnostic pitfall for a false-positive diagnosis of malignancy, even for experienced cytopathologists (Naryshkin and Young, Diagn Cytopathol 1993;9:89,97). In addition, cytologic preparations can show an absence of architectural clues, leading to diagnostic difficulties. Some conditions can cytologically as well as clinically and radiographically mimic malignancies, making these pitfalls even more frequent (Bedrossian et al., Lab Med 1983;14:86,95). A recent report stated that "no laboratory that aims to make definitive diagnoses in pulmonary cytology can be spared from false-positive results"(Policarpio-Nicolas and Wick, Diagn Cytopathol 2008;36:13,19). A false-positive finding could produce unnecessary treatment and morbidity, whereas false-negative diagnosis could result in delayed diagnosis and treatment. This review analyzes and illustrates cellular changes and benign entities that can mimic malignancy in respiratory cytology as well as neoplasms that could lead to a false-negative diagnosis. In addition, some specific challenging and difficult aspects in classification of pulmonary malignancies will be discussed. Guidelines and clues are presented to avoid such pitfalls. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Consequences of misdiagnosis of lymphomatoid papulosisEUROPEAN JOURNAL OF CANCER CARE, Issue 2 2006S. LAUBE mrcp We report two patients with lymphomatoid papulosis (LyP), who were initially diagnosed as systemic T-cell lymphoma. The patients presented with recurrent self-healing cutaneous lesions and skin biopsies showed a lymphocytic infiltrate with malignant features. Clinico-pathological correlation of findings was not performed and results of staging investigations were misinterpreted. Consequently, both patients were unnecessarily treated with multi-agent chemotherapy, radiotherapy and stem cell/bone marrow transplants and sustained long-term adverse effects. The clinical and histological features of LyP are described and appropriate management discussed in detail. Factors leading to the unnecessary treatment of both patients are examined and several learning points highlighted such as the importance of a multidisciplinary approach. [source] Sentinel node biopsy in squamous cell cancer of the oral cavity and oral pharynx: A diagnostic meta-analysis,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Vinidh Paleri MS FRCS (ORL-HNS) Abstract Background. The sentinel node biopsy concept has been gaining support in the head and neck cancer literature during only the last few years, and several pilot studies have been published. This procedure aims to avoid unnecessary treatment to the clinically negative neck by identifying the patients with occult neck disease. Methods. We performed a systematic review and a diagnostic meta-analysis of all published literature regarding sentinel node biopsies in head and neck cancer until December 2003 using established guidelines. Using the pooled sensitivity rates obtained from the meta-analysis and treatment outcomes from published literature, we created a decision analysis model to identify the treatment arm with better payoffs. Results. A total of 301 patients with oral cavity primary tumors and 46 patients with oropharyngeal primary tumors from 19 articles were included for the meta-analysis. The pooled sensitivity result using the random effects model was 0.926 (95% confidence interval, 0.852,0.964). The cumulative payoff for the sentinel node biopsy arm was lower than that for the elective node dissection arm by about 1%. The payoffs were assigned for the recurrence and mortality rates only and did not take into account the morbidity caused by the procedures. Conclusions. The sentinel node biopsy procedure has shown high sensitivity rates in pilot studies for oral and oropharyngeal squamous cell cancer across the globe and is reliable and reproducible. This study provides a firm evidence base for forthcoming trials on the role of sentinel node biopsy in head and neck cancer. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Myoepithelioma of the soft tissue of the head and neck: a case report and review of the literatureHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2004Antonio Galvao Neto MD Abstract Background. Extraglandular myoepitheliomas are neoplasms that seldom occur in the soft tissue of the head and neck region. Misdiagnosis of these neoplasms as more aggressive tumors can lead to unnecessary treatment. Methods. We describe a myoepithelioma of cervical soft tissue. The histopathology of the tumor, its immunophenotype, its differential diagnosis, and a review of the literature are presented. Results. Histopathologically, the tumor was composed of epithelioid cells with eosinophilic cytoplasm and eccentric nuclei arranged in cords and files. On immunohistochemical analysis, the cells expressed cytokeratin 14, calponin, glial fibrillary acid protein, and p63 and showed focal positivity for S-100 protein. Together, these markers identified the cells as myoepithelial type. A literature review identified only five cases of myoepithelioma in the soft tissue of the head and neck region in which detailed clinical information was provided. Conclusions. Myoepitheliomas can have cells with variable morphology arranged in different histologic patterns. Immunohistochemical analysis is crucial for unequivocal diagnosis when myoepitheliomas occur in extraglandular locations. © 2004 Wiley Periodicals, Inc. Head Neck26: 470,473, 2004 [source] Meningioma presenting with only urinary symptoms which is diagnosed by magnetic resonance imaging followed by urodynamic studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2004C. Ozkurkcugil Summary Neurological tumour processes when involving bladder organs or innervations may give rise to urological symptoms. Depending on the organ or nerve tract affected, and emptying capacity of the bladder, the clinical signs manifested may be extremely varied, simulating different pathological entities that may lead to unnecessary treatment. [source] Two cases of dermatomyofibroma (plaque-like dermal fibromatosis)INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 8 2010Elisabeth Gomez-Moyano MD Background, Dermatomyofibroma is a rare but distinct benign cutaneous mesenchymal neoplasm of fibroblastic/myofibroblastic differentiation. It is more common in adolescents and young adults, with a female preponderance. In most cases, the lesions are asymptomatic and small, measuring from 10 to 20 mm. Early and active lesions tend to be actin positive. Case report, We present a) a new case of dermatomyofibroma in an 11-month-old male infant, the youngest case reported to date, and b) the second reported case of a giant annular dermatomyofibroma, measuring 10 cm × 6 cm, in a 52-year-old woman. In both cases, histological examination showed a spindle-cell proliferation embedded among the collagen fibers of the dermis, arranged predominantly parallel to the skin surface. In both cases the spindle cells stained positive for smooth muscle actin and the elastic fibers were increased and fragmented. Conclusion, Dermatologists and pediatricians should be aware of this benign entity in order to avoid unnecessary treatment. [source] Pagetoid dyskeratosis of the prepuce.JOURNAL OF CUTANEOUS PATHOLOGY, Issue 8 2000An incidental histologic finding resembling extramammary Paget's disease Background: Pale cells resembling those of paget's disease have been seen as an incidental finding within the epidermis in a variety of benign papules most commonly located in intertriginous areas. This lesion, called pagetoid dyskeratosis, is considered a reactive process in which a small part of the normal population of keratinocytes is induced to proliferate. Among the inductors friction is suspected. As far as we know, these cells have not been reported in the penis. Methods: Here we describe the location of the lesion in the foreskin and the incidence of this lesion in a group of 281 unselected patiets surgically treated for phimosis. In selected cases histochemical staining and immunohistochemical studies were performed. Results: Pagetoid dyskeratosis was found in 105 cases (37.4%) but only in 5 cases (1.8%) the lesion was conspicuous. The cells of pagetoid dyskeratosis show an immunohistochemical profile different from the surrounding keratinocytes characterized by premature keratinization. Pagetoid dyskeratosis cells must be distinguished from the artefactual clear cells of the epidermis, from reactive melanocytes, and from pale-cell acanthosis. In cases in which pagetoid dyskeratosis shows a florid expression there is a hazard of overdiagnosis to the patient. The main differential diagnosis includes extramammary Paget's disease, pagetoid squamous cell carcinoma in situ, epidermotropic metastasis, superficial spreading malignant melanoma, clear cell papulosis, and penile koilocytoses. Conclusions: The pathologist should be familiar with the histologic features of pagetoid dyskeratosis in the foreskin in order to avoid misdiagnosis and unnecessary treatment. Routine histologic study is usually sufficient to identify the lesion. [source] Food intake increases liver stiffness in patients with chronic or resolved hepatitis C virus infectionLIVER INTERNATIONAL, Issue 10 2009Ingmar Mederacke Abstract Background and aims:, Transient elastography is increasingly being used in patients with chronic liver disease. It has proven particularly useful to identify patients with advanced fibrosis or cirrhosis, while classification of no or little fibrosis appears to be difficult. In general, stiffness values <6 kPa are considered normal, whereas patients with higher levels are candidates for a disease-specific treatment or further diagnostic evaluation. Parameters influencing liver stiffness may include food intake that increases liver blood flow. Methods:, In a pilot study, transient elastography was performed in eight patients with chronic hepatitis C at fasting and serially for 180 min after intake of a standardized breakfast. Confirmatory, 56 patients and 19 controls underwent liver stiffness determination at fasting, directly after meal intake and 1 h after breakfast. Results:, Liver stiffness significantly increased immediately after food intake for up to 60 min (P=0.01) before normalizing after 180 min. An intraindividual analysis showed a significant increase in 22 out of 43 patients with an initial liver stiffness ,10 kPa. An increase of at least 1 kPa after food intake was found in 24 out of 43 (56%) patients with initial stiffness ,10 kPa. Notably, nine out of 23 (39%) patients with normal initial liver stiffness (<6 kPa) had a value of >6 kPa after food intake, potentially leading to unnecessary treatment or diagnostic procedures. Conclusion:, Food intake increases liver stiffness in patients with hepatitis C virus infection and healthy controls. To standardize liver stiffness evaluation, we suggest measurement in the fasting condition. [source] Noninvasive prenatal diagnosis of fetal blood group phenotypes: current practice and future prospectsPRENATAL DIAGNOSIS, Issue 2 2009Geoff Daniels Abstract Fetuses of women with alloantibodies to RhD (D) are at risk from hemolytic disease of the fetus and newborn, but only if the fetal red cells are D-positive. In such pregnancies, it is beneficial to determine fetal D type, as this will affect the management of the pregnancy. It is possible to predict, with a high level of accuracy, fetal blood group phenotypes from genotyping tests on fetal DNA. The best source is the small quantity of fetal DNA in the blood of pregnant women, as this avoids the requirement for invasive procedures of amniocentesis or chorionic villus sampling (CVS). Many laboratories worldwide now provide noninvasive fetal D genotyping as a routine service for alloimmunized women, and some also test for c, E, C and K. In many countries, anti-D immunoglobulin injections are offered to D-negative pregnant women, to reduce the chances of prenatal immunization, even though up to 40% of these women will have a D-negative fetus. High-throughput, noninvasive fetal D genotyping technologies are being developed so that unnecessary treatment of pregnant women can be avoided. Trials suggest that fetal D typing of all D-negative pregnant women is feasible and should become common practice in the near future. Copyright © 2008 John Wiley & Sons, Ltd. [source] Paradoxical vocal fold motion dysfunction in asthma patientsRESPIROLOGY, Issue 5 2009Kursat YELKEN ABSTRACT Background and objective: Paradoxical vocal fold motion dysfunction (PVFMD) is a disorder of the larynx characterized by adduction of the vocal cords during the respiratory cycle leading to symptoms of extrathoracic airway obstruction. PVFMD mimics asthma and patients with PVFMD (PVFMD+) are often diagnosed incorrectly as refractory asthma and receive unnecessary treatment. This study determined the prevalence of PVFMD in asthma patients and describedthe relationship between asthma and PVFMD. Methods: A descriptive study of 94 asthmatic patients and 40 control subjects, all of whom were examined via laryngoscopy and had pulmonary function tests were performed. Results: The prevalence of PVFMD was 19% (n = 18) in the asthmatic group and 5% (n = 2) in the control group (P < 0.001). No relationship was found between presence of PVFMD, asthma attacks and asthma severity (P > 0.05). Laryngopharyngeal reflux and allergy were significantly more prevalent in the PVFMD+ group than in the group without PVFMD (PVFMD,) (P < 0.05). The most common symptoms in the PVFMD+ patients were difficulty in breathing (88%), inspiratory stridor (66%) and a choking sensation (50%) and the most common symptoms in PVFMD, asthmatic patients were cough (63%), dyspnoea (55%) and wheezing (51%). Conclusions: Asthma seems to facilitate the formation of the paradoxical dysfunction in the larynx as the prevalence of PVFMD in asthma patients is significantly higher than in patients with out asthma. [source] Clinical and biological significance of CXCL12 and CXCR4 expression in adult testes and germ cell tumours of adults and adolescents,THE JOURNAL OF PATHOLOGY, Issue 1 2009DC Gilbert Abstract Interaction between the chemokine CXCL12 (SDF1) and the G-protein coupled receptor CXCR4 is responsible for the maintenance of adult stem cell niches and is known to play an important role in utero in the migration of primordial germ cells. We demonstrate expression of CXCL12 by Sertoli cells and confirm CXCR4 expression by the germ cell population of the adult human testes. CXCR4 is also known to mediate organ-specific patterns of metastases in a range of common cancers. We identify consistent expression of CXCR4 mRNA and protein in testicular germ cell tumours (TGCT) that accounts for their patterns of relapse in sites of known CXCL12 expression. Extragonadal primary germ cell tumours express CXCR4 and their sites of occurrence are coincident with areas of known CXCL12 expression in utero. We show that CXCL12 stimulates the invasive migration of a TGCT cell line in vitro in a CXCR4-dependent fashion and activates ERK. Furthermore, we demonstrate that expression of CXCL12 in stage I non-seminomas is significantly associated with organ-confined disease post-orchidectomy and reduced risk of relapse (p = 0.003). This may be through the loss of CXCL12 gradients that might otherwise attract cells away from the primary tumour. We propose CXCL12 expression as a potential predictor of subsequent relapse that could lead to avoiding unnecessary treatment and associated late toxicities. Our observations support a role for CXCL12/CXCR4 in the adult germ cell population and demonstrate pathological function in germ cell tumour development and metastasis that may have clinical utility. Copyright © 2008 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [source] Diagnosis and treatment of small follicular thyroid carcinomas,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 6 2010T. Clerici Background: Follicular thyroid microcarcinomas (mFTCs) of 10 mm or less in size rarely manifest clinically and their clinical significance is controversial. This study assessed their characteristics and incidence, and analysed treatment modalities used for mFTC. Methods: Members of the German Association of Endocrine Surgeons were asked to review patients with mFTC operated on between 1990 and 2005. Results: Data for 90 patients from 26 institutions were reported. Histopathological slides were available for re-evaluation in 35 patients. Most initial diagnoses had to be revised because of incorrect size assessment or incorrect diagnosis (benign adenoma, papillary thyroid carcinoma (PTC), follicular variant of PTC). The diagnosis of mFTC was confirmed in only four patients. As a result of the incorrect histopathological diagnosis, unnecessary completion thyroidectomy and radioiodine ablation were performed in 17 and 20 patients respectively. The incidence of mFTC was calculated to be 0·12 per million population per year. Conclusion: mFTC is exceptionally rare. Such tumours are overdiagnosed, resulting in unnecessary treatment associated with avoidable morbidity. Histopathological re-evaluation by an experienced pathologist is recommended before embarking on further treatments when a diagnosis of mFTC is made. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Mild hypercalcitoninaemia and sporadic thyroid disease,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 5 2010M. Cherenko Background: Not operating on patients with mild hypercalcitoninaemia (MHCT) and sporadic thyroid disease carries the risk of omitting curative surgery for medullary thyroid cancer, but systematic surgery would result in unnecessary treatment of benign pathology. This study reviewed the management of MCHT and non-hereditary thyroid disease in one centre. Methods: MCHT was defined as an increase in basal and stimulated calcitonin levels not exceeding 30 and 200 pg/ml respectively. Over 15 years, 125 patients who presented with MCHT and sporadic thyroid disease were followed. Surgery was indicated only if there were local pressure symptoms or suspicious histomorphological changes in solitary nodules. Results: Fifty-five patients underwent total thyroidectomy and 18 unilateral total lobectomy. Histological examination revealed medullary microcarcinoma in six patients (two women and four men). C-cell hyperplasia was found in 54 patients (74 per cent) and 13 (18 per cent) harboured no C-cell pathology. Calcitonin levels stabilized after lobectomy and became undetectable following thyroidectomy. They normalized during follow-up in a third of patients who did not have surgery. Conclusion: Not all patients with MHCT and sporadic thyroid disease require surgery. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Cuterebra cutaneous myiasis: case report and world literature reviewINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 4 2008Elizabeth Delshad MD Background, Most cases of myiasis in North America are caused by fly larvae from South America or Africa, as these cases represent travelers returning from endemic regions. The etiology of creeping eruptions and furuncular lesions in North American patients who have no history of recent travel can therefore be a diagnostic problem. Among cases acquired in North America, Cuterebra species are the usual cause. Dermatologists and dermatopathologists should be aware that this unusual infestation may occur without a travel history. Method, Here we report a case of Cuterebra cutaneous myiasis acquired in New Jersey. A world literature review of articles on Cuterebra myiasis in humans, without age or year restriction, was performed. The pertinent references of those articles were also searched. Results, Most cases occur in the skin, as a furuncle. Sometimes a cutaneous creeping eruption is present. Children account for at least half of the reported cases. The infestations tend to occur in the late summer, and most frequently in the north-eastern and southern states of the United States. An overview of the clinical and histopathologic diagnostic features are presented. Conclusions, Though rare, myiasis can occur in North America without a travel history. Awareness of this entity, its epidemiologic patterns and diagnostic characteristics, can prevent lengthy delays in diagnosis and unnecessary treatments. [source] | |||||||||||||||||||||||||