Liposclerosing myxofibrous tumor: radiographic reporting frequency, pathologic correlation, and malignant transformation.

Image-guided, fine-needle aspiration (FNA) cytology is performed currently in patients with malignant disease who have suspected adrenal metastases. The objective of this study was to evaluate the usefulness and safety of FNA cytology in patients with incidental adrenal masses and functioning tumors. Computed tomography (CT)-guided or ultrasound-guided aspirates using 21-23-gauge needles were performed successfully in 70 patients with functioning (n = 38 patients) and nonfunctioning (n = 32 patients) adrenal masses (median size, 4 cm; range, 3-12 cm) that were detected previously by CT scans. Definitive histology was available in 68 patients (97.1%), showing 53 benign tumors (77.9%), 11 primitive malignant tumors (16.2%), and 4 unsuspected adrenal metastases (5.9%) in patients with unknown primary tumors. In two patients with aspirate reports that ruled out malignancy, the mass was unchanged on CT scan follow-up; thus, they were considered benign lesions. The benign masses were significantly smaller (P < 0.01), although seven malignant tumors (46.7%) measured 3-4 cm in greatest dimension, and eight benign lesions (14.5%) measured 5-6 cm in greatest dimension. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.7%, 96.4%, 83.3%, 91.4%, and 90.0%, respectively, for CT scan and 93.3%, 100%, 100%, 98.2%, and 98.6%, respectively, for FNA cytology. The morbidity rate of image-guided FNA cytology was 4.3% (two patients with self-limited, asymptomatic pneumothorax and one patient with spontaneously resolved adrenal hematoma). Adrenal FNA cytology represents a safe and specific procedure for evaluating patients with adrenal masses measuring > 2 cm in greatest dimension. FNA is able to reveal malignancies and unsuspected pheochromocytomas and should be performed in all patients with adrenal tumors whenever requested for surgical planning.

Introduction: Bone lesions are relatively uncommon in comparison to other lesions. For the correct diagnosis of bone lesions, charting out treatment plan and estimating prognosis, interpretation of biopsy material proves to be absolutely necessary. This present histopathological study helps us to understand the variety of bone lesions and gives an idea of their relative frequencies, age, sex distributions and site of occurrence. Materials and Methods: This study consists of 83 cases collected over a period of 2 years from October 2017 to October 2019 from patients admitted at Dr. D. Y Patil Hospital, Kolhapur a tertiary care centre with radiologically apparent bone lesions. Hematoxylin and Eosin sections were examined. Detailed microscopic study was done and findings and diagnosis were noted and compared to other studies.Results: Out of the 83 cases studied over the period of 2 years, 41 lesions were non-neoplastic (49.4%), and 42 lesions were neoplastic (50.6%), out of which 33 cases are benign (39.7%) and 9 cases are malignant (10.8%). Males were affected more commonly than females, with a male: female ratio of 1.37:1. Bone lesions were more common in between the age group of 25 to 50 years. Amongst non-neoplastic lesions, Chronic osteomyelitis were the most common (21 cases, 51.3%), followed by avascular necrosis (10 cases, 24.4%).Amongst the benign neoplastic lesions, Giant cell tumor (Osteoclastoma) was the most common (10 cases, 30.3%), Osteochondroma (Exostosis) was the second most common (8 cases, 24.3%).The most common malignant lesion was Chondrosarcoma (3 cases, 33.33%), followed by metastasis to bone (3 cases, 33.33%). Most of the lesions were found in the femur (24 cases, 28.9%).Conclusion: Histopathological study of bone lesions includes variety of non-neoplastic and neoplastic lesions. Although benign and malignant lesions of bone are distinct and well studied, there are some benign lesions that often mimic cancer-causing diagnostic dilemma. Therefore, if diagnosed with clinical, radiological and histopathology, proper diagnosis and treatment can be made.

The majority of patients with hepatocellular carcinoma (HCC) have coexisting cirrhosis or chronic hepatitis, often complicated by diabetes mellitus. In the current study, the authors evaluated the impact of diabetes mellitus on the prognosis of patients with HCC. Among 581 patients with HCC who had been diagnosed and treated between 1990 and 1999, survival was compared between those patients with and those patients without diabetes mellitus. The rate of disease recurrence after treatment also was analyzed. Ninety-two patients (15.8%) had diabetes mellitus. There was no significant difference with regard to patient characteristics (i.e., age, gender, or alcohol intake) or liver function between those patients with and those patients without diabetes mellitus. No differences were observed in survival between patients with diabetes mellitus and patients without it. Among the 195 patients with a solitary HCC lesion measuring < or = 3 cm in greatest dimension, the survival of the 32 patients with diabetes mellitus was significantly poorer than that of the 163 patients without diabetes mellitus (P = 0.0273), despite no apparent difference in liver function between the 2 groups. On multivariate analysis, diabetes mellitus was found to be an independent factor predicting lower survival after treatment (P = 0.0077) among patients with a solitary HCC lesion measuring < or = 3 cm in greatest dimension. No difference in the rate of recurrence was observed between the two groups in all the patients and in those patients with a solitary HCC lesion measuring < or = 3 cm in greatest dimension. The results of the current study indicated that the presence of diabetes mellitus worsens the prognosis of patients with a solitary HCC lesion measuring < or = 3 cm in greatest dimension; it appears to impact prognosis in patients with HCC when HCC is treatable, based on the size and the number of lesions. However, diabetes mellitus did not appear to affect the prognosis in the general population of patients with HCC. Based on the current study data, diabetes mellitus does not appear to modify the progression of HCC and its recurrence after treatment, but it does appear to worsen the prognosis of patients with HCC by means of a rapid decline in remnant liver function caused by repeated treatment of HCC.

BACKGROUND Evidence that avoiding axillary lymph node dissection (AxD) strikes an appropriate balance between morbidity and recurrence risk in patients with invasive breast carcinoma generally is anecdotal and without a formally quantified basis. The current study presents a decision analysis of the difference in 5-year disease free survival (DFS) rate between treatment scenarios with and without routine AxD. METHODS To derive quantitative estimates of the effect of avoiding AxD on 5-year DFS, the authors examined outcomes for women undergoing 2 treatment scenarios: AxD or no AxD with adjuvant therapy decisions based on risk factors in the primary tumor. Eligible patients belonged to 2 lymph node metastases risk groups: low (patients without palpable lymph nodes and lymphatic or vascular invasion [LVI] negative tumors ≤ 0.5 cm in greatest dimension) and moderate (patients with mammographically detected, LVI negative tumors, between 0.6-2.0 cm in greatest dimension or patients with palpable LVI negative tumors between 0.6-1.0 cm in greatest dimension with nonpalpable lymph nodes). Along with observed data regarding treatment and recurrence, the authors employed estimates of the efficacy of chemotherapy, tamoxifen, and regional radiation therapy derived from published randomized trials to estimate the 5-year DFS rate for treatment scenarios with and without AxD. RESULTS Patients in the low risk group had a 5% risk of lymph node metastases. In these women, eliminating AxD and treating no patients with chemotherapy and/or tamoxifen resulted in a < 1% decrease in the 5-year DFS rate. Patients in the moderate risk group had a 10% risk of lymph node metastases. Eliminating AxD and treating only those women with Grade 3 tumors > 1 cm in greatest dimension with chemotherapy and/or tamoxifen resulted in a 1.8% decrease in the 5-year DFS rate. However, if all patients in this group were treated with chemotherapy and/or tamoxifen and no AxD, the 5-year DFS rate increased by 2.7%. CONCLUSIONS In patients with a low risk of lymph node metastases, it was estimated that eliminating AxD may result in only minimal changes in the estimated 5-year DFS rate. Cancer 2000;88:1852–62. © 2000 American Cancer Society.

Evidence that avoiding axillary lymph node dissection (AxD) strikes an appropriate balance between morbidity and recurrence risk in patients with invasive breast carcinoma generally is anecdotal and without a formally quantified basis. The current study presents a decision analysis of the difference in 5-year disease free survival (DFS) rate between treatment scenarios with and without routine AxD. To derive quantitative estimates of the effect of avoiding AxD on 5-year DFS, the authors examined outcomes for women undergoing 2 treatment scenarios: AxD or no AxD with adjuvant therapy decisions based on risk factors in the primary tumor. Eligible patients belonged to 2 lymph node metastases risk groups: low (patients without palpable lymph nodes and lymphatic or vascular invasion [LVI] negative tumors < or = 0.5 cm in greatest dimension) and moderate (patients with mammographically detected, LVI negative tumors, between 0.6-2.0 cm in greatest dimension or patients with palpable LVI negative tumors between 0.6-1.0 cm in greatest dimension with nonpalpable lymph nodes). Along with observed data regarding treatment and recurrence, the authors employed estimates of the efficacy of chemotherapy, tamoxifen, and regional radiation therapy derived from published randomized trials to estimate the 5-year DFS rate for treatment scenarios with and without AxD. Patients in the low risk group had a 5% risk of lymph node metastases. In these women, eliminating AxD and treating no patients with chemotherapy and/or tamoxifen resulted in a < 1% decrease in the 5-year DFS rate. Patients in the moderate risk group had a 10% risk of lymph node metastases. Eliminating AxD and treating only those women with Grade 3 tumors > 1 cm in greatest dimension with chemotherapy and/or tamoxifen resulted in a 1.8% decrease in the 5-year DFS rate. However, if all patients in this group were treated with chemotherapy and/or tamoxifen and no AxD, the 5-year DFS rate increased by 2.7%. In patients with a low risk of lymph node metastases, it was estimated that eliminating AxD may result in only minimal changes in the estimated 5-year DFS rate.

Introduction/Objective Teratomas are germ cell neoplasms arising from three germinal layers. They are classified as mature or immature. Mature cystic teratomas (MCTs), also known as dermoid cysts, are benign lesions. Common locations include the sacrococcygeal region, ovaries, testes, brain, mediastinumand retroperitoneum. MCT is extraordinarily rare in the pediatric pancreas; only 11 such cases have been reported in the English literature. Methods This eleven-month-old female presented for evaluation of two cystic masses in the body and tail of the pancreas. These masses were initially imaged as anechoic cysts in utero by ultrasound at 19 weeks gestational age and followed carefully over the interval. Her past medical history included a left upper lobectomy for congenital lobar emphysema. The pancreatic cysts were excised by laparoscopy. Results Grossly, the two tan-pink cysts measured 2.5 cm and 3.1 cm in greatest dimensions, had smooth inner linings and contained clear fluid. Microscopically, the cyst linings included low cuboidal, columnar, ciliated pseudostratified columnar respiratory or fundal gastric epithelia with underlying serous/mucous glands and smooth muscle. These findings were diagnosed as MCT. Typically, MCT of pancreas have nonspecific clinical presentations, serum markers and imaging; all depending on the tissue types present; so, the diagnosis is primarily made postoperatively by pathological evaluation. Previously reported cases presented as single cysts, ranged 4 months to 16 years in age and measured 8 to 18 cm in greatest dimension. Complete surgical excision and careful follow-upare the mainstay of therapy Conclusion Pediatric pancreatic MCTs are extraordinarily rare, so the preoperative diagnosis and treatment is difficult. This case of MCT is the first reported multicystic presentation, the first documented fetal imaging and the smallest size in the English literature. This report shows that MCT must be considered in the differential diagnoses of fetal abdominal cysts and in multicystic pediatric pancreatic masses.

There remains ongoing controversy with regard to the optimal management strategy and the prognostic significance of small-sized nonsmall cell lung carcinoma. Therefore, in the current study, the authors analyzed the clinical characteristics of patients who underwent complete resection of these lung tumors, the follow-up data, and the significant prognostic factors. Of 1726 consecutive patients surgically treated for proven primary lung carcinoma, 265 patients underwent complete removal of a nonsmall cell lung carcinoma in which the greatest dimension of the resected specimen was < or = 2 cm. The cancer-specific 5-year and 10-year survival rates were 86% and 83%, respectively. Univariate analyses revealed that advanced pathologic stage, a tumor size of 16-20 mm, lymphatic vessel invasion, vascular vessel invasion, a high serum level of carcinoembryonic antigen (CEA), and extended resection were significantly unfavorable prognostic factors. Among these factors, multivariate analyses demonstrated that pathologic stage (P < 0.0001), vascular vessel invasion (P = 0.0040), and CEA level (P = 0.0291) were significant, independent determinants of survival. None of the patients with pathologic Stage I disease, no vascular vessel invasion, and a low serum CEA level died of their disease after undergoing complete resection. The preoperative level of serum CEA and vascular vessel invasion by tumor cells were found to be independent prognostic factors that were as significant as the well established determinant of pathologic stage for patients with a nonsmall cell lung carcinoma measuring < or = 2 cm in greatest dimension. These data may contribute to the explanation of the lower-than-expected survival of patients after complete surgical resection of such a small-sized tumor.

The International Society of Urological Pathology held a conference on issues in testicular and penile pathology in Boston in March 2015, which included a presentation by the testis macroscopic features working group. The presentation focused on current published guidance for macroscopic handling of testicular tumors and retroperitoneal lymph node dissections with a summary of results from an online survey of members preceding the conference. The survey results were used to initiate discussions, but decisions on practice were made by expert consensus rather than voting. The importance of comprehensive assessment at the time of gross dissection with confirmation of findings by microscopic assessment was underscored. For example, the anatomic landmarks denoting the distinction of hilar soft tissue invasion (pT2) from spermatic cord invasion (pT3 category) can only be determined by careful macroscopic assessment in many cases. Other recommendations were to routinely sample epididymis, rete testis, hilar soft tissue, and tunica vaginalis in order to confirm macroscopic invasion of these structures or if not macroscopically evident, to exclude subtle microscopic invasion. Tumors 2 cm or less in greatest dimension should be completely embedded. If the tumor is >2 cm in greatest dimension, 10 blocks or a minimum of 1 to 2 additional blocks per centimeter should be taken (whichever is greater).

Recently, peripheral lung adenocarcinomas (PLA) measuring < or = 3 cm in greatest dimension often have been diagnosed using diagnostic radiology. The objective of the current study was to determine which cytologic factors are associated with a favorable outcome and an unfavorable outcome in patients with PLA. Imprint smears from 134 patients with PLA were examined. Sixteen cytologic factors, including necrosis, cellular distribution, overlapping of cell clusters, cluster aggregation, cluster size, cluster thickness, nuclear irregularity, nuclear size, variation in nuclear size, multinucleated cells, intranuclear inclusions, type of intranuclear inclusions, appearance of nucleoli, eosinophilic nucleoli, multinucleoli, and mitosis, were evaluated using univariate and multivariate analyses. A counting method was used to determine the prognosis for individual patients. In the univariate analysis, a cluster size that measured > or = 831 microm in short dimension (P = 0.0011), moderate or severe nuclear irregularity (P = 0.0030), > or = 5 multinucleated cells per 100 tumor cells (P = 0.0047), moderate or severe variation in nuclear size (P = 0.0061), medium or large nuclear size (P = 0.0169), and > or = 1 mitotic cell per 100 tumor cells (P = 0.0412) were associated significantly with a poor outcome. In the multivariate analysis, cluster size in short dimension (P = 0.0018), multinucleated cells (P = 0.0066), and nuclear irregularity (P = 0.0310) were found to be independent prognostic factors. The combination of cytologic features using intraoperative imprint smears, namely, cluster sizes < or = 830 microm in short dimension, < or = 4 multinucleated cells per 100 tumor cells, and mild nuclear irregularity, may provide favorable predictive information in patients with PLA.

The objectives of this study were to clarify risk factors for local tumor recurrence and to determine which patients with hepatocellular carcinoma (HCC) are most suitable for a single session, single application of percutaneous radiofrequency (RF) ablation. Fifty-six consecutive patients with 65 HCC tumors measuring <or= 3 cm in greatest dimension who received a single session, single application of percutaneous RF ablation and who achieved optimal tumor ablation, as assessed by an immediate computed tomography scan, were enrolled in this study. Six possible factors for local recurrence were analyzed using a Cox proportional hazards regression model: tumor size, tumor location, proximity of the tumor to intrahepatic large vessels, types of electrodes used, prior treatment, and observation of impedance rises. Local recurrence free intervals were estimated using the Kaplan-Meier method, and differences between groups were compared using the log-rank test. The Kaplan-Meier estimates of overall cumulative local recurrence free intervals after a single RF ablation treatment were 76% (95% confidence interval [95%CI], 70.9-81.7%) at 12 months and 74% (95%CI, 68.2-79.6%) at 15 months. The log-rank test revealed a statistically significant difference between the local recurrence free intervals according to tumor size (P = 0.001) and tumor location (P < 0.001). Further investigation with a Cox regression analysis indicated that a greatest tumor dimension > 2 cm (risk ratio [RR], 4.9; 95%CI, 1.3-16.4; P = 0.019) and subcapsular location (RR, 5.2; 95%CI, 1.7-16.6; P = 0.005) were associated independently with local recurrence. The other four factors were not associated with local recurrence in this study. A single session, single application of RF ablation produced favorable local control. Patients who have nonsubcapsular HCC tumors measuring <or= 2 cm in greatest dimension may be the most suitable candidates for a single-session, single application of RF ablation.

BackgroundWhile the characteristics of pathologic nipple discharge (PND) are well documented in the literature, comparative clinical and risk factor analyses across different pathologic subtypes are lacking.MethodsMedical records of patients with nipple discharge were retrospectively retrieved from an electronic medical record database and analyzed. In this study, 375 patients with a postoperative pathologically confirmed diagnosis of PND were included.ResultsAge serves as an important independent risk factor for precancerous lesions and breast cancer, with the median age increasing alongside the severity of the pathology. Individuals under 45 years of age predominantly exhibited non-neoplastic and benign neoplastic lesions, whereas those over 45 were more likely to have precancerous lesions or breast cancer, with statistical significance (p < 0.01). Discharge color was a significant factor in distinguishing between different pathological findings (p < 0.01). Discharge color serves as an important independent risk factor for breast cancer. Bloody discharge was associated with a significantly higher incidence of breast cancer and precancerous lesions compared to non-bloody discharges. Upon dividing bloody discharge into brown and bright red for in-depth analysis, no significant difference was observed among the different pathological types (p > 0.05). Ductoscopy has a higher diagnostic rate for breast cancer and precancerous lesions (p < 0.01).ConclusionThese results suggest the clinical characteristics of PND patients across four pathological types: non-neoplastic lesions, benign neoplastic lesions, precancerous lesions, and breast cancer, at the same time emphasizing the importance of age and discharge color as independent risk factors in the prognosis and management of nipple discharge.

The objective of this study is to compare T1-weighted gradient echo (T1W GrE: control technique) chemical shift imaging (CSI) with T2-weighted fast spin echo (T2W FSE: experimental technique) CSI for differentiating non-neoplastic and neoplastic marrow lesions. Patients undergoing MRI for various marrow lesions were investigated with T1W GrE and T2W FSE Dixon CSI. Signal intensity (SI) change between in-phase (IP) and opposed-phase (OP) sequences was calculated, and SI drop > 20% considered to represent non-neoplastic lesions while SI drop < 20% considered to represent neoplastic lesions. Final diagnosis was based on imaging features (n = 42) or histology (n = 43) and classified as non-neoplastic, benign neoplastic, and malignant neoplastic. Inter-observer and inter-technique agreement between 2 readers was calculated. The study included 85 patients (44 males and 41 females; mean age 41.1years, range 2-83years). Final diagnosis included 19 (22.4%) non-neoplastic lesions, 27 (31.8%) benign neoplasms, and 39 (45.9%) malignant neoplasms. On T1W GrE CSI, 19-21 lesions were classed as non-neoplastic and 64-66 as neoplastic, while on T2W FSE Dixon CSI, 22-24 lesions were classed as non-neoplastic and 61-64 as neoplastic. Lesion classification matched between the 2 techniques in 91.8-96.5% of cases. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T1W GrE CSI for differentiating non-neoplastic and neoplastic marrow lesions were 66.7-72.2%, 88.1-89.6%, 61.9-63.2%, 90.9-92.2%, and 84.7%, and of T2W FSE Dixon CSI were 72.2-77.8%, 85.1-86.6%, 58.3-59.1%, 92.1-93.4%, and 83.5%. T1W GrE CSI and T2W FSE Dixon CSI produce similar results in the assessment of non-neoplastic and neoplastic marrow lesions.

Giant epidermoid cyst in the breast: A common benign lesion at a rare site—A case report

A 35 year old male presented to our outpatient department with a slow growing swelling over the left gluteal region for more than 10 years. There was no history of pain, tenderness, fever or previous trauma. On examination there was a 10 cm x 10cm swelling in the upper outer quadrant of left gluteal region. It was soft, cystic, mobile swelling and adherent to overlying skin with a punctum. Ultrasonography revealed a well-defined hypoechoic heterogenous cyst suggestive of an inclusion epidermoid cyst (A). FNAC was done for confirmation. A complete excision of the whole cyst (B) was done with uneventful post-operative recovery.histopathology showed no signs of malignancy. Epidermoid cyst is one of the commonest benign lesions of skin. Size may vary from a few millimetres to few centimetres but cysts more than 5 cm are known as giant epidermoid cysts and are rare clinical occurrence. Giant epidermoid cyst (A) up to 17 cm in greatest dimension have also been reported. They are slow growing lesions and patients tend to neglect them only to present at a later time. These cysts are usually seen over gluteal region but may be seen over the extremities and scalp. Malignant transformation is a known complication leading to squamous cell carcinoma, basal cell carcinoma or melanomas (C). Clinical examination, USG, FNAC will clinch the diagnosis in most cases. MRI gives additional information in cases of atypical or suspected malignant lesions. Complete excision is the treatment of choice.

Background: Neoadjuvant chemotherapy plus trastuzumab results in a 30% to 50% pathologic complete response (pCR) rate in HER-2 positive breast cancer and has been associated with improved therapeutic outcomes. Thus, the pCR rate can be useful in evaluating novel agents in this patient population. Albumin-bound (nab)-paclitaxel can reduce the toxicity of Paclitaxel while maintaining its efficacy. We reported that neoadjuvant therapy using Anthracycline based regimens (EC,AC,FEC) followed by a combination with nab-Paclitaxel and Trastuzumab was effective and safe by OMC-BC01 Study (Tanaka et al. Clin Breast Cancer 15:191-196). The pCR rate was 36% and 71% in the patients with estrogen receptor-positive and negative cancer, respectively. In addition, Tolaney et al. showed that adjuvant Paclitaxel and Trastuzumab for node-negative, HER-2 positive tumors measuring up to 3 cm in greatest dimension was associated with patients outcomes that were better than expected on the basis of historical data (Tolaney et al. N Engl J MED.2015 Jan 8:372(2):134-141). We conducted a clinical Phase II, multicenter, neoadjuvant trial of combination with nanoparticle albumin-bound Paclitaxel and Trastuzumab in patients with node-negative, Her-2 positive, estrogen receptor-negative breast cancer measuring up to 3 cm in greatest dimension. Patients and Methods: nab-Paclitaxel and Trastuzumab as neoadjuvant therapy in patients with Her-2 positive, node-negative, estrogen receptor-negative breast cancer measuring up to 3 cm in greatest dimension. Patients are treated with neoadjuvant nab-Paclitaxel (260mg/m2) and Trastuzumab q21d x 4, and undergo surgery 4-6 weeks later from completing chemotherapy. The primary endpoint, pCR is defined as no evidence of invasive tumors in the final surgical sample both in the breast and axillary lymph nodes. Secondary endpoints include objective clinical response rate, histological response rate, disease-free interval, rate of breast conserving surgery, and the safety of the treatment. Accrual: Presently, a total number of 1 patient have been included since start of the study. The expected end of accrual of 30 patients will be the last quarter 2018. Citation Format: Iwamoto M, Tanaka S, Koda C, Kawaguchi K, Terasawa R, Sato N, Fujioka H, Kimura K, Uchiyama K. Phase II neoadjuvant trial of nanoparticle almumin-bound paclitaxel and trastuzumab in patients with node-negative, Her-2 positive breast cancer (OMC-BC04) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT1-02-01.