Anatomopathological Exam Research Articles

Assessing the risks for stillbirth in São Paulo, Brazil: protocol for a multidisciplinary case–control study – FetRisks

Stillbirth is a fundamental component of childhood mortality, but its causes are still insufficiently understood. This study aims to explore stillbirth risk factors by using a multidisciplinary approach to stimulate...

INTRAOSSEOUS CAVERNOUS HEMANGIOMA OF THE ZYGOMA: A CASE REPORT

The incidence of intraosseous hemangiomas is low; they represent less than 1% of all bone tumors. The most common locations are the calvaria and vertebrae. Lesions affecting facial bones are rare and can involve the maxillae, mandibulae, nasals, and zygomatics. In zygomatic location its a slow-growing tumor that primarily affects adult women. Herein, we report a case of intraosseous hemangioma of the zygomatic bone in a man aged of 55 years old. The diagnosis of intraosseous hemangioma was made following radiological examination due to the characteristic imaging findings and confirmed after surgical excision by anatomopathological exam.

A Two-Step Approach to the Surgical Treatment of Soft-Tissue Sarcomas.

Background: Nowadays, limb-sparing procedures are the gold standard in the treatment of soft-tissue sarcomas of the limbs. Wide tumor resection with appropriate oncological margins, reconstruction, and stabilization of the involved bone and joint and restoration of the soft tissue lost are essential in order to obtain good clinical and functional outcomes. Tumor excision and soft-tissue reconstruction performed in one-step surgery is chosen by many centers as the preferred approach; however, according to our experience in some selected patients, two-step surgery performed using a dermal regeneration template first and then a margin revision, taking into account the definitive results of the anatomopathological exam conducted over the surgical specimen from the previous surgery, associated with definitive reconstruction surgery over a healthy bed of granulated tissue, showed many potential benefits. Methods: A retrospective observational study was conducted on thirteen patients who underwent a two-step reconstruction procedure using dermal substitution after soft-tissue sarcoma excision. Results: Clinically, the enrolled patients achieved excellent contour and cosmesis of their surgical wounds, with a mean VSS value of 3.07. During the follow-up period, no local recurrences were observed in any patient. Conclusions: Two-step surgery represents the most suitable solution to allow surgical radicality with minimal recurrency and adequate soft-tissue reconstruction, avoiding the possibility of wasting autologous tissue. Our patients generally embraced this approach and the management that followed.

Predicting individual outcomes after radical cystectomy in urothelial variants with Cancer of the Bladder Risk Assessment (COBRA) score.

To validate the Cancer of the Bladder Risk Assessment (COBRA) score in patients with urothelial variants. Epidemiological, clinical, radiological, and anatomopathological data were collected from patients with urothelial carcinoma who underwent radical cystectomy at the Institute of Cancer of São Paulo between May 2008 and December 2022. Patients with the presence of at least 10% of any urothelial variants in the radical cystectomy specimens' anatomopathological exam were included in the study. The COBRA score and derivatives were applied and correlated with oncological outcomes. A total of 680 patients [482 men (70.9%) and 198 women (29.1%)]; 66years (IQR 59-73) underwent radical cystectomy for bladder tumor, and of these patients, a total of 167 patients presented any type of urothelial variant. The median follow-up time was 28.77months (IQR 12-85). The three most prevalent UV were squamous differentiation (50.8%), glandular differentiation (31.3%), and micropapillary differentiation (11.3%). The subtypes with the worst prognosis were sarcomatoid with a median survival of 8months (HR 1.161; 95% CI 0.555-2.432) and plasmacytoid with 14months (HR 1.466; 95% CI 0.528-4.070). The COBRA score for patients with micropapillary variants demonstrated good predictive accuracy for OS (log-rank P = 0.009; 95% IC 6.78-29.21) and CSS (log-rank P = 0.002; 95% IC 13.06-26.93). In our study, the COBRA score proved an effective risk stratification tool for urothelial histological variants, especially for the micropapillary urothelial variant. It may be helpful in the prognosis evaluation of UV patients after radical cystectomy.

THE MULTIDISCIPLINARITY IMPORTANCE IN REHABILITATION AFTER THE VERRUCOUS CARCINOMA DIAGNOSIS: A CASE REPORT

Verrucous carcinoma of the oral cavity is low-grade and a rare variant of squamous cell carcinoma. This lesion is described as malignant, exophytic, slowly growing, and locally invasive. The following case aims to report how the lesion localization and tissue healing led to a difficult rehabilitation. An 86-year-old, Caucasian female patient was referred for rehabilitation after having performed partial maxillectomy. Before surgery, a unique lesion with an irregular appearance and with papillary projections was observed. Histologically, it has shown epithelial ridges without significant dysplasia and keratin plugs. Her clinical history was collected and confronted with the anatomopathological exam, confirming verrucous carcinoma in the anterior maxillary ridge. A second surgical intervention, using high-intensity laser therapy, was necessary to improve the maxilla into a better prosthetic bed, increasing retentive areas. A healing guide plate was installed in the immediate post-surgery time to support the tissue before implementing the reparatory prosthesis. Verrucous carcinoma of the oral cavity is low-grade and a rare variant of squamous cell carcinoma. This lesion is described as malignant, exophytic, slowly growing, and locally invasive. The following case aims to report how the lesion localization and tissue healing led to a difficult rehabilitation. An 86-year-old, Caucasian female patient was referred for rehabilitation after having performed partial maxillectomy. Before surgery, a unique lesion with an irregular appearance and with papillary projections was observed. Histologically, it has shown epithelial ridges without significant dysplasia and keratin plugs. Her clinical history was collected and confronted with the anatomopathological exam, confirming verrucous carcinoma in the anterior maxillary ridge. A second surgical intervention, using high-intensity laser therapy, was necessary to improve the maxilla into a better prosthetic bed, increasing retentive areas. A healing guide plate was installed in the immediate post-surgery time to support the tissue before implementing the reparatory prosthesis.

Síndrome de Bart: relato de caso e revisão

MAB, newborn male, e.t , gestational age of 37 weeks and 5 days. During his initial care, no changes were noted, except for skin lesions: cutaneous aplasia on limbs, back, inguinal region and mucous membranes, as well as bullous lesions and nail alterations. The e.t o nt the anatomopathological exam was epidermolysis bullosa. The patient had a bad e.t o nt and developed neonatal sepsis, and several antibiotic therapy and dressings were performed. After presenting n e.t o ntent clinical worsening and refractoriness to the proposed treatment, he died at 57 days of life. Barts syndrome is a genetic condition, and its diagnosis is clinical, made through the triad: cutaneous aplasia, epidermolysis bullosa and nail dystrophies. This syndrome is linked to autosomal dominant inheritance and occur e.t oto a mutation in the type VII collagen gene. Despite having a good prognosis, its diagnosis must be early, so the treatment, which is based on topical dressings and antibiotics, can be started as soon as possible to prevent possible complications such as: sepsis, hemorrhages, hydroelectrolytic disorder and death.

BART SYNDROME: CASE REPORT AND REVIEW

MAB, newborn male, white, gestational age of 37 weeks and 5 days. During his initial care, no changes were noted, except for skin lesions: cutaneous aplasia on limbs, back, inguinal region and mucous membranes, as well as bullous lesions and nail alterations. The result of the anatomopathological exam was epidermolysis bullosa. The patient had a bad evolution and developed neonatal sepsis, and several antibiotic therapy and dressings were performed. After presenting an important clinical worsening and refractoriness to the proposed treatment, he died at 57 days of life. Barts syndrome is a genetic condition, and its diagnosis is clinical, made through the triad: cutaneous aplasia, epidermolysis bullosa and nail dystrophies. This syndrome is linked to autosomal dominant inheritance and occurs due to a mutation in the type VII collagen gene. Despite having a good prognosis, its diagnosis must be early, so the treatment, which is based on topical dressings and antibiotics, can be started as soon as possible to prevent possible complications such as: sepsis, hemorrhages, hydroelectrolytic disorder and death.

Cystadenocarcinoma of the gallbladder: A case report

Cystadenoma and cystadenocarcinoma of the biliary duct remain a rare diagnosis, the localization is intrahepatic in 97% of the cases and extrahepatic in 3%of them [1]. Cystadenocarcinoma of the gallbladder is the rarest localization, it's usually diagnosed late because of the poor symptoms and the nonspecific lesions in the different imaging.Only hundreds of cases have been reported for cystadenocarcinoma of the gallbladder.This case report has been reported in line with the SCARE Criteria. We present a 70-year-old woman, with no family or personal history, who was complaining of pain in the right hypochondrium and an altered general well-being, with no other clinical abnormalities.The imaging including abdominal sonography, CT scan, and MRI concluded at a budding lesion formed in the gallbladder wall which measured 65×15mm.Cancer of the gallbladder was suspected and the patient was operated. A resection of segment s4b and 5 of the liver was performed with lymphadenectomy. The post-operative clinical course was uneventful.The diagnosis of cystadenocarcinoma of the gallbladder was confirmed on an anatomopathological exam of the specimen. Cystadenocarcinoma is a rare diagnosis.There are no specific symptoms or lesions at the imaging.The confirmation is obtained on an anatomopathological study of the specimen.

Robotic-Assisted Laparoscopic Treatment of Bladder Endometriosis

<h3>Study Objective</h3> To show the combined surgical approach of cystoscopy and robotic-assisted laparoscopy for a complete and safe resection of bladder endometriosis. <h3>Design</h3> A clinical case and surgical cystoscopic and robotic approach of bladder endometriosis resection demonstrated by video. <h3>Setting</h3> Bladder endometriosis is defined as the presence of endometrial glands and stroma in the detrusor muscle and is the most common site affected in urinary tract endometriosis. Surgical treatment should guarantee complete removal of the bladder nodule to minimize recurrence, so transurethral surgery alone should be avoided in favor of segmental bladder resection. Robotic-assisted laparoscopy provides advantages as 3D visualization and facilitation of suturing techniques compared to conventional laparoscopy. <h3>Patients or Participants</h3> A 32-year-old nulliparous patient, complaining of sensation of incomplete emptying of the bladder and dysuria, with worsening in the menstrual period. Patient had been using combined oral contraception but reported worsening of symptoms since she stopped the use in 2019. During letrozole treatment for infertility she discovered a bladder nodule of probable endometriotic origin. MRI showed signs of deep endometriosis in the vesicouterine recess, with infiltration of the anterior uterine serosa and left round ligament, measuring around 3.0 × 2.0 × 0.9 cm, in addition to the nodular lesion that infiltrates and retracts the upper wall of the bladder, projecting to the bladder lumen of 3.8 × 2.5 × 2.1 cm. <h3>Interventions</h3> It was performed cystoscopy and bilateral double-J catheter passage, followed by robotic-assisted laparoscopic resection of bladder endometriosis with partial cystectomy. Surgical field was prepared and the paravesical accessed to the bladder nodule. Bladder was sutured with barbed thread and surgical specimen removed by colpotomy. <h3>Measurements and Main Results</h3> Anatomopathological exam confirms endometriosis. <h3>Conclusion</h3> Endometriosis of urinary tract can have an appropriate surgical resection by laparoscopic management with or without robotic assistance. Having knowledge of the surgical technique and the platform allows a safe and complete resection, minimizing complications.

Cartilage Degeneration of the Metacarpal Condyle and Enthesopaties of The Collateral Ligaments of Equine Metacarpophalangeal Joint

Articular degeneration can be characterized by fibrillation and eburnation of the articular layers of the metacarpophalangeal (MP) joint. Structural changes within the articular joint predispose the development of osteophytes, enthesophytes and, in many cases is associated with changes the collateral ligaments of the MP joint. The aim of the present study was to investigate the relationship between degenerative processes of the articular cartilage and the enthesopathies of collateral ligaments (superficial or deep portion) of the equine MP joint, using radiographic, ultrasonographic and anatomopathological exam, as well as establishing their sensitivity. Thirty equine forelimbs were selected from animals that died due to various clinical conditions with an average age of 5.7 years which came from a private clinic or sent to the Laboratory of Veterinary Pathology of UFSM. The specimens were placed in a hydraulic press and submitted to radiographic evaluation of the MP joint (lateromedial, flexed lateromedial, dorsopalmar, dorsolateral-palmaromedial oblique 450 and dorsomedial-palmarolateral oblique 450 projections). Transversal and longitudinal ultrasound images of the dorsal and collateral aspect of the MP joint were obtained using a Sonosite Edge machine with a 5 to 10 MHz linear transducer. Subsequently, the specimens were sent for gross and histopathological examination. A highly positive correlation (P value <.001) was observed between ultrasonographic and macroscopic techniques, showing a relationship between the cartilaginous degenerations of the MP joint and the medial and lateral LC enthesopathies.

Non-Melanoma Facial Skin Tumors—The Correspondence between Clinical and Histological Diagnosis

This paper consists of a retrospective study that includes a total of 186 cases with facial skin tumors diagnosed and treated between January 2015 and December 2017. Our aim was to correlate the initial clinical diagnosis with the histological results, in order to observe the success rate of our clinical experience, but also to underline that certain clinical tumor aspects can be misleading as the histological findings can result in different final diagnostics. From the total number of cases, we counted a total of 226 tumors (both benign and malignant), from which 194 had the clinical diagnosis confirmed by the anatomopathological exam and 34 had a different laboratory result from the clinical presumption: 10 benign tumors and 22 malignant tumors (eight BCC and 14 SCC, 12 of the latter being confused with ulcerovegetant BCC). Detailed correlation data were presented, as well as different situations of incongruence between the clinical and the histological diagnosis. The long-term goal of the study was to use our experience of correlating the clinical and the histological diagnosis, in order to improve the existing knowledge on the clinical differential diagnosis of both malignant and benign facial skin tumors.

Intracholecystic Papillary-tubular Neoplasm after Cholecystectomy: What Should We Do?

Purpose: Gallbladder cancer (GBC) is the most common cancer of the biliary tract and 60-70% are discovered incidentally by the pathologist following cholecystectomy. Less than 0.5% are intracholecystic papillary-tubular neoplasms (ICPN), a relative indolent neoplasia when compared to pancreatobiliary-type gallbladder carcinomas. Since literature evidence is limited, the aim of this work is to present an ICPN case and its surgical management. Methods: A 64-year-old women with ulcerative colitis, which is associated with primary sclerosing cholangitis and cholangiocarcinoma, is scheduled a laparoscopic cholecystectomy due to adenomyomatosis. Anatomopathological exam showed a papillary neoplasia with microfocus of invasive carcinoma, without cystic lymph node in the piece (pT1bpNx) (Figure 1). According to guidelines recommendations and tumor committee decision, extension study is performed and unresectable disease is ruled out. A radical surgery (4b/5 normal liver margin) and regional lymphadenectomy is indicated. Discussion: In ICPN, high-grade dysplasia, cell type (biliary or foveolar) and papilla formation are factors associated with invasion. Bibliography shows 90% of 3-year survival for cases without invasion, meanwhile, for cases with invasion, it decreases to a 60%. Hence, an aggressive approach is necessary. Nevertheless, ICPN with invasion had a far better clinical outcome compared with pancreatobiliary-type GBC (27% 3-year survival). Conclusions: ICPN is a rare neoplasm of the gallbladder with a relative better prognosis than gallbladder carcinomas, even when invasive carcinoma is found. It should be kept in mind that when invasive carcinoma is identified, it should be staged, and if the disease is resectable, a radical surgery is mandatory.

Intra-Diverticular Bladder Tumor about a New Observation in the Urology Department of Chu Cocody—Abidjan, C&amp;amp;#244;te d’Ivoire

This case report is about a 61 years old woman who consulted for hematuria, the cystoscopy performed revealed an intra-diverticular bladder tumor. After tumor resection, an anatomopathological exam revealed the urothelial carcinoma pT1. A few months later she presented with a local reccurence of bladder tumor. We proposed her anterior pelvectomy but she refused it and she was lost to follow-up. The aim of this study is to show the anatomopathological and evolutionary characteristics and the therapeutic difficulties of IDBT. These tumors are in the majority of cases infiltrating from the outset with a high potential for recurrence after transurethral resection of bladder (TURB). The standard treatments are TURB and total cystectomy.

Characterization of Left Ventricular Non-Compaction Cardiomyopathy

Left ventricle non-compaction cardiomyopathy (LVNC) has gained great interest in recent years, being one of the most controversial cardiomyopathies. There are several open debates, not only about its genetic heterogeneity, or about the possibility to be an acquired cardiomyopathy, but also about its possible overdiagnosis based on imaging techniques. In order to better understand this entity, we identified 38 LVNC patients diagnosed by cardiac MRI (CMRI) or anatomopathological study that could underwent NGS-sequencing and clinical study. Anatomopathological exam was performed in eight available LVNC hearts. The genetic yield was 34.2%. Patients with negative genetic testing had better left ventricular ejection fraction (LVEF) or it showed a tendency to improve in follow-up, and a possible trigger factor for LVNC was identified in 1/3 of them. Nonetheless, cerebrovascular accidents occurred in similar proportions in both groups. We conclude that in LVNC there seem to be different ways to achieve the same final phenotype. Genetic testing has a good genetic yield and provides valuable information. LVNC without an underlying genetic cause may have a better prognosis in terms of LVEF evolution. However, anticoagulation to prevent cerebrovascular accident (CVA) should be carefully evaluated in all patients. Larger series with pathologic examination are needed to help better understand this entity.

A rare case of metastatic esthesioneuroblastoma

Olfactory neuroblastoma, also known as esthesioneuroblastoma (ENB), is a rare malignant tumour of the basal layer of the olfactory epithelium, which originally develops unilaterally, accounting for 3-6% of all intranasal tumours. We present the case of a patient with a voluminous ethmoidal lesion that invaded the left basal frontal lobe and left orbit. The biopsy revealed a stage C KADISH, grade III neuroblastoma. The patient followed a multimodal treatment with chemotherapy and radiation therapy to which he responded partially, then returned after 11 months for sphincter disorder and bilateral sciatic type pain. An MRI showed metastasis of the filum terminale, the anatomopathological exam identifying also neuroblastoma. CT and MRI imaging are required for a correct assessment of the regional extension of olfactory neuroblastoma, response to oncological treatment but also for the detection of secondary lesions found in a small number of cases.

Ovarian Sertoli-Leydig Cell Tumors: Epidemiological, Clinical and Prognostic Factors.

To describe a series of cases of ovarian Sertoli-Leydig cell tumors (SLCTs). Retrospective review of 12 cases of SLCT treated at the Hospital do Câncer de Barretos, Barretos, state of São Paulo, Brazil, between October 2009 and August 2017. The median age of the patients was 31 years old (15-71 years old). A total of 9 patients (75.0%) presented symptoms: 8 (66.7%) presented with abdominal pain, 5 (41.7%) presented with abdominal enlargement, 2 (16.7%) presented with virilizing signs, 2 (16.7%) presented with abnormal uterine bleeding, 1 (8.3%) presented with dyspareunia, and 1 (8.3%) presented with weight loss. The median preoperative lactate dehydrogenase (LDH) was 504.5 U/L (138-569 U/L), alpha-fetoprotein (AFP) was 2.0 ng/ml (1.1-11.3 ng/ml), human chorionic gonadotropin (β-hCG) was 0.6 mUI/ml (0.0-2.3 mUI/ml), carcinoembryonic antigen (CEA) was 0.9 ng/ml (0.7-3.4 ng/ml), and cancer antigen 125 (CA-125) was 26.0 U/ml (19.1-147.0 U/ml). All of the tumors were unilateral and surgically treated. Lymphadenectomy was performed in 3 (25.0%) patients, but none of the three patients submitted to lymphadenectomy presented lymph node involvement. In the anatomopathological exam, 1 (8.3%) tumor was well-differentiated, 8 (66.7%) were moderately differentiated, and 3 (25.0%) were poorly differentiated. A total of 5 (55.6%) tumors were solid-cystic, 2 (22.2%) were purely cystic, 1 (11.1%) was cystic with vegetations, and 1 (11.1%) was purely solid, but for 3 patients this information was not available. The median lesion size was 14.2 cm (3.2-23.5 cm). All of the tumors were at stage IA of the 2014 classification of the International Federation of Gynecology and Obstetrics (FIGO). A total of 2 (16.7%) patients received adjuvant treatment; 1 of them underwent 3 cycles of paclitaxel and carboplatin every 21 days, and the other underwent 4 cycles of ifosfamide, cisplatin and etoposide every 21 days. None of all of the patients had recurrence, and one death related to complications after surgical staging occurred. Abdominal pain was the most frequent presentation. There was no ultrasonographic pattern. All of the SLCTs were at stage IA, and most of them were moderately differentiated. Relapses did not occur, but one death related to the surgical staging occurred.

Ameloblastic Fibroma: a Case Report

Ameloblastic fibroma is a rare benign odontogenic tumor in which both the epithelial and ectomesenchymal components are neoplastic. A 24-year-old male patient was referred to the Stomatology Department presenting with difficulty to chew and swelling in the right posterior region of the mandible. The panoramic radiograph showed a well-circumscribed, unilocular radiolucent lesion with partially radiopaque borders involving first and second unerupted molars. Computed tomography imaging presented a hypodense image with well‑delimited isodense content, bulging cortical bones and absence of rupture. The patient underwent an incisional biopsy. Microscopically, the lesion was composed of many mesenchymal tissue cells in strand form, arranged in cords, islands and nests of odontogenic epithelium; the diagnostic was ameloblastic fibroma. The patient was referred to the hospital for enucleation and curettage of the lesion and extraction of the associated teeth. After 8 months of follow-up, no recurrence was observed. This case emphasizes the importance of differential diagnosis, anatomopathological exam, and both clinical and imaging follow-up, since tumors of this type can recur and progress to malignancy.

Surgical Treatment Alternative to the Hip Disarticulation in Pacients with Malignant Tumor of the Proximal Femur

Abstract Background. Primary bone tumors are rare and affect especially young persons, being at the same time very aggressive and mutilating, often also implicating the disarticulation of the affected hip. That is why it is necessary to find alternatives of treatment, so that these young people to be able to keep their normal functionality and mental comfort. Objectives. The objective of this paper was to be able to offer a surgical treatment alternative to the hip disarticulation in case of malignant tumors of the proximal femur in young patients. Methods. We present the case of a 25-year-old female patient, who was hospitalized in our clinic for pain and functional impairment of the right hip. The clinical and radiological exams established the diagnosis of fracture of pathological bone of the proximal femur and it raised the suspicion of a tumor with malignant characters. We performed arteriography of the right inferior member, which showed a very good vascularized tumor, possibly vascular, localized to the proximal femur, arterially powered by the branches of right profunda femoris artery. We surgically intervened and made an incisional biopsy with anatomopathological exam, which established the diagnosis of osteosarcoma. Then, we practiced the segmental resection of the tumor, preceded by the embolization of the right femoral artery and after that the reconstruction with bipolar cemented modular prosthesis of the right hip. The patient had a favorable evolution, she did neuromotor rehabilitation, and then she presented to the oncologist for the initiation of adjuvant chemotherapy, which she followed conformably to the recommendations.

Tumor with Aggregate Cells at the Level of Radial Distance Pipe - Treatment and Evolution

Abstract A 20-year-old patient presented to the emergency service with radial distal epiphysis after a minor trauma. The radiological examination indicated a fracture at the radial distal epiphysis on the background of a tumor that occupied the radial epiphysis in its entirety, with cortical burglary in some places. When consulting the oncologist, a surgical intervention for biopsy material harvesting was performed. The anatomopathological exam showed: multiple fragments microscopically representing a tumor proliferation consisting of two cell populations, mononuclear cells, densely cellular and strobe pattern; areas of infarction, haemorrhage areas, rare intratumoral osteoid formation zones; appearance of giant cell tumor. The immunohistochemical examination confirmed the anatomopathological diagnosis adding, therefore, the aggressive character and the local relapse. The oncologist decided that it did not require oncology treatment but only orthopedic treatment. Orthopedic treatment required repeated surgery at intervals of about 5 months apart, caused by tumor recurrence. The first intervention consisted of 1/ 3 distal radius resection and replacement with a graft harvested from the peroneum. Tumor recurrence after 5 months required extirpation of tumor tissue and filling of caries caused in the graft with a fluid bone substitute. Recurrence after another 5 months required removal of the graft that was invaded by the tumor and cubitusmetacarpal arthrodesis fixed with a screw plate. Currently, the patient is undergoing complementary oncology treatment finally initiated by a medical oncologist.

La conjonctive tarsale une localisation exceptionnelle du carcinome épidermoïde conjonctival

We here report the case of a 48-year old patient with a family history of five deaths due to cancers with different localizations, presenting with ulcero-budding nodular swelling of the lower palpebral conjunctiva measuring 2cm long its longer axis, gradually increasing volume over one year. It involved the inner half of the lower tarsal conjunctiva closely with the lower lacrimal punctum (A). Tumor biopsy showed well differentiated squamous carcinoma of the conjunctiva. Treatment was based on tumor resection (B) with wide negative safety margins on anatomopathological exam.