1,720,994 research outputs found
Role of computed tomography in the preoperative diagnosis of giant benign solitary fibrous tumor pleura
No full textSir,
We read with interest the article entitled “Giant solitary fibrous tumor: Clinical dilemma and diagnosis” published in the April-June issue of Lung India.[1] Solitary fibrous tumor pleura (SFTP) is a localized, well-circumscribed, mesenchymal tumor of uncertain cell origin. Though the majority of these tumors are benign, about 22-36% can be malignant.[2,3] The majority of benign SFTPs are cured with local resection. Even patient with massive benign lesions may do well with re-expansion of the compressed lung after surgery. The average size of benign and malignant SFTP is 13.2 cm and 14.4 cm, respectively.[3] Sixty-two percent of SFTPs are >10 cm.[2] Sometimes SFTP grow to a diameter of 30-40 cm. Numerous reports described “giant” benign SFTP but the precise size has not been established in the definition of “giant” lesions. We believed that benign SFTPs may be defined “giant” when the lesions have a diameter >15 cm and benignancy criteria have been established with accuracy. The mitotic-figure-per-10-high-power fields (HPFs) index was determined by counting two to five sets of 10 consecutive HPFs (×400) in most cellular tumors and then proceeding randomly. Benign SFTPs may fill the hemithorax, compress the adjacent lung and produce symptoms, but they are slow growing and do not invade adjacent tissues. We recently observed a 61-year-old female who was referred to our hospital with cough and dyspnea. Computed tomography (CT) showed a large mass, with well-defined borders, occupying the left hemithorax with partial saving apex of ipsilateral lung displacing the mediastinum to the right. A thoracotomy with complete surgical resection of the tumor was performed. Histologically the tumor showed a “patternless” architecture characterized by the coexistence of hypo- and hypercellular areas separated by fibrous stroma having “hemangiopericytoma-like” branching blood vessels. The lesion appeared as a sharply circumscribed mass pushing, but not invading, the borders with the adjacent lung parenchyma. Mitotic figures were 15 cm SFTPs have been described with accuracy only in few cases. In conclusion CT scan is the diagnostic preoperative procedure of choice for benign SFTP. CT scan may establish the complete excision of the lesion and the presence of a distinct peduncle. Fine needle-aspiration biopsy is not a reliable diagnostic tool.[17] Symptomatic presentation and the impression of a nonpleural tumor by CT have been reported to be related to a malignant pathologic diagnosis.[18
Resection of Congenital Cystic Intrapulmonary Lesions Is Always Necessary
No full textRecently we correlated histology and computed tomographic imaging of intrapulmonary congenital cystic lesions of the adult, including intrapulmonary cysts and congenital cystic adenomatoid malformation type I.
West and colleagues [1] described a carcinoma after a congenital lesion in a young patient. They underlined the possibility of underestimation of these lesions.
Then Lantuejoul and colleagues [2] confirmed the relation between carcinoma and this kind of congenital lesions in their study.
These two studies unequivocally demonstrate the carcinogenetic potential of type I congenital cystic adenomatoid malformation (CCAM).
This finding will radically modify the therapeutic approach to the congenital pulmonary cystic lesions in the adults.
Beside CCAM, other pulmonary cystic malformations are: congenital lobar emphysema, pulmonary sequestrions, bronchogenic cysts, and other foregut cysts, including intrapulmonary cysts [3].
The intrapulmonary bronchogenic cysts may be asymptomatic and are identified in the adult on routine imaging. All the other cystic malformations are symptomatic and found in the childhood.
In our recent experience when they are intrapulmonary lesions, the bronchogenic cysts are radiologically indistinguishable from large single CCAM type I. Only histologic examination can establish the cystic nature of the lesion. The presence of parietal cartilage islands, bronchial glands, smooth muscle, and occasionally calcifications and ossification is conclusive for intrapulmonary bronchogenic cysts in the differential diagnosis with CCAM type I [4].
Because the differential diagnosis between solitary IBC and type 1 CCAM is not possible by radiologic procedures, generally a complete surgical resection is advisable in solitary cystic congenital intrapulmonary lesions in adults at the time of diagnosis, even if asymptomatic. A delayed or incomplete resection may expose the patient to tumour development in the case of type 1 CCAM
Uselessness of percutaneous core needle renal biopsy in the management of small renal masses.
No full textIn the paper “Differentiation of oncocytoma and renal cell carcinoma in small renal masses ( <4 cm ): the role of 4-phase computerized tomography” published online August 18, 2010, in World Journal of Urology, Bird V.G. and colleagues [1] write in the Discussion: “With the advancement of imaging techniques, enhancement patterns of renal tumors on CT have evolved to be the best, though limited, non-invasive technique to predict the pathological diagnosis of renal tumors. Implementing this technique to differentiate oncocytoma from the subtypes of RCC will have a great impact on the management of patients. In conclusion, non-invasive differentiation between benign and malignant renal tumors has paramount importance in determining the management plan for patients.”We do not agree with these statements. The small renal masses (SRMs) may be defined as neoplastic lesions <4 cm in diameter, which are more and more often found, especially in elderly and comorbid patients. Today, the vast majority of SRMs are incidentally diagnosed and therefore tend to have a better prognosis [2–4]. Nephron-sparing surgery (NSS) is the standard care for SRMs (stage pT1a). Patients with SRMs who are treated with NSS exhibit similar recurrence-free (0–3%) and 5-year cancer-specific survival when compared with renal nefrectomy [5–9]. SRMs include malignant and benign tumors. In the urologic practice, all SRMs should be removed with NSS independently from their histological nature. We believe that the differentiation of oncocytoma and renal cell carcinoma in SRMs is unnecessary because the tumor should be removed with NSS independently of its histological nature. Non-invasive differentiation between benign and malignant renal tumors has paramount importance in determining the management plan for patients only when the tumor is >4 cm in diameter
Oncocytic sialolipoma of the submandibular gland with sebaceous differentiation: A new pathological entity
No full textCase Report: We report the case of an oncocytic sialolipoma of the submandibular gland with sebaceous differentiation in a 73-year-old man. The initial symptom was a right submandibular painless mass. Ultrasonography showed a hypoechoic oval mass posterior to the submandibular gland. The tumorectomy was performed with preservation of the salivary gland. The tumor was composed of mature adipose tissue surrounded by a thin fibrous capsule, multiple nodules of oncocytes, normal ductal-acinar units with focal ductal sebaceous differentiation. Discussion: We reviewed literature of the reported cases of mixed tumors of the salivary glands composed of mature adipose tissue with oncocytosis, salivary ducts, and acini with sebaceous differentiation. Conclusions: Sialolipoma and lipoadenoma with or without oncocytosis and/or sebaceous differentiation should be considered organ-specific tumors with a distinct histological appearance and specific terminology
Needle core biopsy should replace fine needle aspiration cytology in breast lesions diagnosis
No full textExuberant type 2 pneumocyte hyperplasia: Mimic or forerunner of atypical adenomatous hyperplasia?
No full textNew advances on placental hydrops and related villous lymphatics
No full textFetoplacental hydrops is the final stage of several pathological conditions in which the placenta and umbilical cord become edematous and the fetus develops an anasarcatic state characterized by an excessive accumulation of extravascular fluids in at least two serous cavities of the body. It is a common histological finding of stillbirth, characterized by the appearance of markedly edematous villi, suggesting an increased interstitial fluid accumulation. The recent improved knowledge of lymphangiogenesis and the availability of monoclonal antibodies selectively labeling lymphatic endothelium lead to the hypothesis that villous edema is essentially a lymphedema from defective lymphatic function following inadequate villous blood circulation. Lymphedema is a morphologic phenotype found by our research group in a 24-case series of stillbirths from different morbid conditions such as chromosomal aberrations, congenital malformations, inherited hemoglobinopathies, and prolonged perinatal severe anoxia. Unlike long-lived organs, the placenta is devoid of innervation by the autonomic nervous system; therefore, the vascular tone regulation and the peripheral perfusion are modulated by the expression of the angiotensin converting enzyme (ACE) in the vascular endothelia. This finding may suggest to the clinician to search for a more suitable therapy in case of mother's hypertension during pregnancy
A new lipomatous entity: The cavernous angiolipoma of the subcutis
No full textAngiolipoma is a benign soft-tissue tumor which combines the morphological features of lipoma with those of hemangioma. The ratio of lipomatous and vascular components is variable, reaching the latter the highest percentage in the cellular variant of the tumor. Microscopically, the tumor consists of mature adipocytes separated by a branching network of small vessels, which often contain fibrin thrombi. We present the first literary description of cavernous angiolipoma of the subcutis in a 75-year-old man, delivering a new lipomatous entity. This entity should be reserved to subcutaneous angiolipoma with very large vascular gaps, haphazardly arranged and engorged by blood. The differential diagnosis of this tumor depends on vascular density: the hypovascular tumor can be mistaken with a common lipoma, while the hypervascular lesion should be distinguished from cavernous hemangioma and related variants, intramuscular hemangioma, spindle cell hemangioma, arteriovenous and venous malformations and Kaposi's sarcoma. Histopathogenetic theories about cavernous angiolipoma of the subcutis include a possible differentiation from a pluripotent mesenchymal cell into both lipomatous and angiomatous counterparts, due to inflammation or trauma, and a progressive development from a congenital malformation / benign hamartoma. In support of the latter thesis, there is a 5-10% familial incidence of classic angiolipoma and the frequent presence of many mast cells inside the tumor. Moreover, about a third of all angiolipomas express androgen receptors and this datum leads to suspect a hormonal influence in the development of these subcutaneous tumors
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