Benign Appearance Research Articles

Attitudes of Practicing Radiologists Toward the Management of Palpable Circumscribed Breast Masses.

To investigate the attitudes of radiologists toward palpable breast masses with benign features on US and to determine the factors influencing their decision. A 20-question online questionnaire was sent to radiologists with membership of the Iranian Society of Radiology and included questions regarding demographics, practice experience, and management approach to palpable circumscribed breast masses based on patient age and risk factors. Radiologists' management choice for masses in themselves or close relatives/friends was also queried. In total, 151 radiologists participated (response rate 16%). For palpable breast masses with benign imaging features in women at high risk, the majority of radiologists selected MRI (95/151, 62.9%) and core-needle biopsy (110/151, 72.8%). In average-risk patients, radiologists with >5 years of practice experience selected biopsy more frequently (33/79, 41.8%) than less experienced radiologists (17/79, 23.6%) for patients ≥40 years old (P < 0.001) and patients <40 years old (20/79, 25.3%; 11/72, 15.3%, respectively) (P = 0.014). Similarly, selecting biopsy was more common in radiologists who completed a breast imaging fellowship for patients ≥40 years old (23/45, 51.1% vs 27/106, 25.5%) (P = 0.04), as well as for patients <40 years old (18/45, 40% vs 13/106, 12.3%) (P = 0.02). Radiologists who were <40 years old selected biopsy more frequently if evaluating a mass in themselves (22/86, 25.6%) compared to patients (15/86, 17.4%) (P < 0.001). Radiologist experience and educational background, as well as patient baseline breast cancer risk, can predispose radiologists to choose biopsy for palpable breast masses despite a benign appearance on imaging.

Primary vaginal villous adenoma – A rare case report

Villous adenomas are known to occur in gastrointestinal tract; however, they are very rare in female genital tract. The pathogenesis is unclear but their origin from cloacal remnants has been hypothesized. Here we report a rare incidental case of primary villous adenoma with high grade dysplasia arising from vaginal vault in a 28-year-old female who presented with abnormal vaginal bleeding. The importance of reporting this lies in its pre-malignant behaviour and benign looking clinical appearance.

Small Cell Lymphoma of the Gastrocnemius Muscle: A Case Report

Introduction: The primary localization of non-Hodgkin lymphoma of the muscle is rare. Only the biopsy allows the certainty diagnosis. The aim was to report a first case of small cell lymphoma of the gastrocnemius in Mali and to do a review of the literature. Clinical Observation: It was about a 34-year-old woman who consulted 3 months after the onset of symptoms for swelling and pain in the left calf. On clinical examination there was a hard, painful and warm mass in the left calf, with paresthesias in the tibial nerve territory associated with partial functional impotence of the leg. The ultrasound revealed a hyper echogenic and heterogeneous non-vascularized mass of the left gastrocnemius muscle measuring 65 × 45 × 40 mm non-vascularized on color Doppler and pulsed in favor of myositis. Magnetic resonance imaging (MRI) concluded in a well-limited heterogeneous cystic mass in the left gastrocnemius muscle respecting the bone of benign appearance: remodeled Baker’s cyst? Considering the radioclinical unconformity, thoraco-abdominal CT was performed and revealed pulmonary metastasis. The biopsy carried out concluded with a small cell lymphoma of the gastrocnemial muscle. Marginal resection was performed associated with adjuvant chemotherapy. The advancement at 9 months was satisfactory.

LOW-GRADE FIBROMIXOID SARCOMА OF LOWER LЕG IN YOUNG FEMALE PATIENT- REPORT OF A RARE CASE

Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue neoplasm described for the first time by Evans in 1987. It may affect the subcutaneous soft tissues or subfascial space. It usually arises from deeply located soft tissue structures of extremities, head and neck, thorax, and retroperitoneum. We present a case of a female patient of age 24, admitted to the Department of “Surgical Diseases” of Medical University Hospital “ D-r G. Stranski” Ltd – Pleven in July 2022, with complaints of a slowly growing non-painful soft mass, located on her right lower leg, distal 1/3 part, anteriorly initially suspected for lipoma. After wide surgical excision grossing and histological and immunohistochemical verification of the specimen, the result was LGFMS G1 pT1. We perform a literature review for another case in the world with that rare tumor. The tumor is with distinct biological behavior. Despite its low grade and benign histological appearance, it has a high potential for metastasizing, years after the primary surgical excision of the tumor, and it has a high risk for local recurrence. Because of the high risk of late metastasis, the follow-up period should be long and monitoring of the lung and chest is mandatory.

Breast MRI: an illustration of benign findings.

Despite its unparalleled sensitivity for aggressive breast cancer, breast MRI continually excites criticism for a specificity that lags behind that of modern mammographic techniques. Radiologists reporting breast MRI need to recognise the range of benign appearances on breast MRI to avoid unnecessary biopsy. This review summarises the reported diagnostic accuracy of breast MRI with particular attention to the technique's specificity, provides a referenced reporting strategy and discusses factors that compromise diagnostic confidence. We then present a pictorial review of benign findings on breast MRI. Enhancing radiological skills to discriminate malignant from benign findings will minimise false positive biopsies, enabling optimal use of multiparametric breast MRI for the benefit of screening clients and breast cancer patients.

Giant dermatofibrosarcoma protuberans head and neck: a diagnostic dilemma.

Dermatofibrosarcoma protuberans (DFSP) is rare, generally slow growing tumor, originating from dermal stem cell or undifferentiated mesenchymal cell. DFSP primarily occurs on the trunk and proximal extremities, with reported only 10-15% occurring in the head and neck region. There can be varied presentations of DFSP in atypical sites mimicking a benign appearance and history due to which diagnostic dilemmas can occur. The underlying malignancy needs to be unveiled by histopathology and immunohistochemistry which reveals bland spindle cells in sub epithelium arranged in whorled storiform pattern which was CD34+, suggestive of dermatofibrosarcoma protuberans. Surgical excision is the treatment of choice, wherever possible. We herein report two intriguing cases of DFSP in uncommon sites.

SINGLE CAVITARY LUNG LESION IN A HEALTHY YOUNG MALE

SINGLE CAVITARY LUNG LESION IN A HEALTHY YOUNG MALE

S2227 A Rare Case of Primary Diffuse Large B Cell Lymphoma of the Colon

Introduction: Primary colorectal lymphomas are rare and account for 0.3% of all large intestinal malignancies, with Diffuse Large B-Cell Lymphoma (DLBCL) representing the most common subtype. We present a case of primary colonic DLBCL that was diagnosed after surgical resection of the sigmoid colon. Case Description/Methods: An 86-year-old White female with a past medical history of diverticulosis and atrial fibrillation presented to the emergency department complaining of abdominal cramping and rectal bleeding. Physical examination was significant for mild abdominal tenderness and vital signs revealed blood pressure of 151/83 mmHg. Laboratory investigations were significant for white blood cell count of 10.56 x 10^3 cells/uL and potassium 2.8 mmol/L. Abdominal and pelvic computed tomography with contrast revealed sigmoid colonic diverticulosis with interposition of colon between liver and right hemidiaphragm. The patient underwent colonoscopy that showed a stricture of benign intrinsic appearance in the sigmoid colon measuring 10 cm in diameter and 3 cm in length. Histological analysis of tissue biopsies taken at that time were only significant for mild to moderate colitis. After colonoscopy, she was taken for laparoscopic low anterior resection of the sigmoid colonic mass that was later converted to an open approach due to the size of the mass. After the incision was extended, the sigmoid colon was further mobilized and the uninvolved portions of the proximal rectum and descending colon were transected. After the sigmoid colon was removed and sent to pathology, the proximal rectum and descending colon were anastomosed with no air leaks identified. Pathology report of the surgical specimen later showed malignant lymphoma with transmural invasion and involvement of numerous adjacent pericolonic nodes with negative tumor margins. Immunostains revealed the tumor to be positive for BCL-2, BCL-6, CD10, and CD20 but negative for CD3 and BCL-1. High proliferative activity was discerned for KI-67 staining in 90% of tumor cells; all evidence supporting the diagnosis of DLBCL. After an uneventful postoperative period and clinical improvement, the patient was discharged to home for close follow-up. Discussion: Primary colonic lymphomas are rare and usually present with nonspecific symptoms. Although in the case discussed, the patient did not present with any obvious predisposing conditions for DLBCL, further data is necessary to determine other possible associations and develop a standardized treatment regimen.

Histological patterns, subtypes and aspects of prostate cancer: different aspects, different outcomes.

The most common prostatic cancers (PCa) are acinary adenocarcinomas. Histological subtypes have been variably defined. The purpose of this review is to discuss unusual histological patterns and subtypes of acinar adenocarcinoma, as well as other types of PCa and their prognostic and therapeutic relevance. The new term 'subtype' for morphologically defined tumor entities replaced the term 'variant' in the new 2022 classification of the WHO to allow for clear terminological distinction from genetic variants. The 2022 WHO classification mentions prostatic intraepithelial neoplasia (PIN)-like carcinoma, signet-cell-like adenocarcinoma, sarcomatoid carcinoma and pleomorphic-giant-cell adenocarcinoma of the prostate as true subtypes of acinary PCa. Other forms of acinary PCa are termed unusual histological patterns and include atrophic, foamy-cell, microcystic, pseudohyperplastic and mucinous patterns. Nonacinar forms of prostate cancer include other glandular PCa, the ductal adenocarcinoma and the treatment-associated neuroendocrine carcinoma, and nonglandular PCa, the adenosquamous carcinoma, the squamous cell carcinoma and the adenoid cystic (basal cell) carcinoma of the prostate. True subtypes of acinary PCa and other forms of glandular and nonglandular PCa show relevant differences in prognosis and treatment approach compared with classic acinary PCa. The relevance of unusual histological patterns mainly lies in their deceptive benign appearance and the need for pathologists to know about these entities for accurate and timely diagnosis.

Neck Imaging Reporting and Data System: More Than Just a Template.

The Neck Imaging Reporting and Data System (NI-RADS) is a guide developed and introduced in 2017 by head and neck radiologists who worked in an academic radiology department. Based on the Breast Imaging Reporting and Data System, the initial goals of NI-RADS were to make posttreatment head and neck cancer imaging dictations more succinct and efficient, guide treating physicians in the next appropriate steps when recurrence was suspected, and encourage institutional and national research. NI-RADS is more than a dictation template, and it is best instituted after a head and neck imaging practice is established. We support the use of NI-RADS once a radiologist understands the nuances of head and neck cancer, including the biology, common subsites involved, essentials of tumor staging, common posttreatment benign imaging appearances, and subtleties of recurrent disease.

Giant cell tumor of bone: An update, including spectrum of pathological features, pathogenesis, molecular profile and the differential diagnoses.

Giant cell tumor of bone (GCTB) is an enigmatic tumor. Despite its benign histological appearance and clinical behavior in most cases, it is associated with recurrences, uncommonly metastasis, and rarely with a malignant transformation. During the last few years, there has been a significant evolution in the diagnosis and management of GCTB, including discoveries related to the underlying pathogenesis (RANK/RANK/OPG pathway), with treatment-related implications in the form of denosumab (approved inhibitor for targeting RANKL), leading to improved surgical resections, especially in cases of recurrent, large and borderline resectable tumors. Lately, a specific Histone mutation, namely H3.3G34W underlying almost all GCTBs has been discovered, further leading to the identification of a highly sensitive and specific immunohistochemical antibody marker, H3.3G34W, which is very useful for an exact diagnosis of a GCTB, including its differentiation from its various mimics, which has significant implications. This review describes clinicopathological features of a GCTB, including its variable features, recent concepts, underlying pathogenesis, post-denosumab related changes and various entities that constitute its differential diagnosis, including their molecular signatures, with treatment-related implications.

Hydrofluoric Acid, an Unexpected Surprise.

We report the case of a 37-year-old man presenting with pain out of proportion to the exam with hydrofluoric acid burns to his upper extremities after he spilled a wheel-stripping compound on his forearms while working at his powder coating business. His burns initially appeared mild and superficial, but over the course of several days, these evolved from simple erythema to significant partial thickness tissue destruction and ulceration. He required substantial topical, intradermal, and intravenous therapies to control the unseen burning process during his index visit to the emergency department. We transferred the patient to a burn center given the location of his burns and the causative agent. The burn center clinicians observed him over the course of two nights and then discharged him with instructions to come for multiple follow-up visits during the subsequent month. Following nonoperative management, he had an uneventful recovery with full function retained in the affected extremities. Hydrofluoric acid burns require prompt treatment with calcium to neutralize the burning process, despite a potentially benign initial appearance. The emergency clinician should use an aggressive diagnostic and therapeutic approach to patients presenting with pain out of proportion to their exam, as this finding is associated with various serious underlying pathology.

The Pathogenesis of Giant Condyloma Acuminatum (Buschke-Lowenstein Tumor): An Overview.

Giant condyloma acuminatum, also known as Buschke-Lowenstein tumor (BLT), is a rare disease of the anogenital region. BLT is considered a locally aggressive tumor of benign histological appearance, but with the potential for destructive growth and high recurrence rates. BLT development is strongly associated with infection with low-risk human papillomaviruses (HPVs), mostly HPV-6 and -11. Immunity to HPVs plays a crucial role in the natural control of various HPV-induced lesions. Large condyloma acuminata are frequently reported in patients with primary (e.g., DOCK8 or SPINK5 deficiencies) and secondary (e.g., AIDS, solid organ transplantation) immune defects. Individuals with extensive anogenital warts, including BLT in particular, should therefore be tested for inherited or acquired immunodeficiency. Research into the genetic basis of unexplained cases is warranted. An understanding of the etiology of BLT would lead to improvements in its management. This review focuses on the role of underlying HPV infections, and human genetic and immunological determinants of BLT.

Osteosarcoma of the jaws: A case report.

IntroductionOsteosarcomas of the jaws are very rare accounting for only 6 to 7% of all osteosarcomas and 1% of all head and neck malignancies.The clinicopathological characteristics as well as the radiological characteristics are not specific, which represents a diagnostic dilemma. Indeed, this lesion is often mistaken for benign lesions of the maxillary.Case presentationWe report a case of osteosarcoma of the jaws in a 45 year man who consulted in our service for a simple painless oral swelling evolving since a five months.The lesion was excised and histopathological report confirmed the diagnosis of osteosarcoma of the jaw.DiscussionOsteosarcomas are a rarely progressive tumor in the oral cavity that can show up as a case of a benign process of dental origin. During our practice, we often meet similar cases which are treated by usual medication, while a whole malignant process is in the progress and can be life-threatening. The case we present illustrates this perfectly, and owing to a deep clinical investment, the malignant process was stopped at its start.ConclusionThe objective of presenting this case is to draw the attention of the doctors that any lesions even of benign appearance can hide a malignant process. Consider this point and integrate it into its diagnostic approach should be undertaken and should lead to a deepening of the clinical examination by comparing the clinical, radiological and histological data.

Oral leukoplakia: A clinicopathological study and malignant transformation.

To assess the clinicopathological characteristics of a cohort of patients with oral leukoplakia (OL) managed in a Romanian dental hospital and to evaluate the risk of malignant transformation (MT). We conducted a hospital-based retrospective study using the clinical charts of patients diagnosed with OL that had complete clinical and histopathological evaluation followed up for 1-16years. From 120 included patients, 68 (56.7%) were females, and 71 (59.2%) were current smokers. The homogeneous form was present in 60% of cases; the buccal mucosa was the most frequently involved site. MT was observed in 9 cases, which was more common in females and in those with dysplastic leukoplakia. A significant statistical association was found between MT and dysplasia grade (χ2 test: p=0.007). MT occurred during a mean interval of time 75months in both treated and non-treated patients. In this leukoplakia cohort, most of the lesions encountered were in smokers, clinically homogeneous and 62.5% proved histologically benign. But despite the clinically benign appearance of leukoplakia, tissue diagnosis of some cases was carcinoma. The results of the current study advocate the necessity for biopsy even in apparently homogeneous, clinically benign lesions. The malignization rate was 7.5%; two-thirds were nonhomogeneous lesions.

LONG-TERM ULTRASOUND FOLLOW-UP IN PATIENTS WITH SMALL GALLBLADDER POLYPS

Introduction Gallbladder polyps often have a benign appearance by ultrasonography. Even so, the current guideline recommends follow-up in gallbladder polyps lesser-than 6 mm. The aim of this study was to investigate long-term follow-up growth of polyps in patients with a polyp size lesser-than 6 mm in a ten-year cohort. Methods Abdominal ultrasonography reports from 2007 to 2009 were reviewed, including reports on patients diagnosed with a gallbladder polyp (polyp size lesser-than 6 mm) during the 2007-2009 period. The patients were invited to a final follow-up ultrasonography of the gallbladder conducted during October 2019 to February 2020. A total of 154 patients were included (100 women and 54 men). Results In 53 patients (34.4%), the polyp was not visible at the ultrasonography follow-up. Gallbladder polyps were confirmed in 101 (65.6%) patients. A total of 49 patients had a single polyp (31.8%) and 52 (33.8%) patients had multiple polyps. The median size of the gallbladder polyp was 4 mm (range: 2.0-5.9 mm) at baseline compared with 4 mm (range: 1.7-15.0 mm) at the follow-up. A total of 15 patients experienced polyp growth of 2 mm or more. None developed gallbladder cancer. Conclusions Our study showed that gallbladder polyps lesser-than 6 mm has a low probability of increasing in size. None of the patients with small polyps developed gallbladder cancer. Funding none. Trial registration not relevant.

Endobronchial aspergilloma: Benign appearance of potentially fatal consequences.

Endobronchial aspergilloma: Benign appearance of potentially fatal consequences.

Dermatofibrosarcoma Protuberans: A Systematic Review of the Literature

Background: Dermatofibrosarcoma Protuberans (DFSP) is a rare slow growing cutaneous soft tissue sarcoma, that is characterized to be locally invasive with high recurrence rate. However, it has poor metastatic capacity.&#x0D; Objective: We are conducting this literature review to gather evidence-based medicine knowledge regarding Dermatofibrosarcoma Protuberans. Moreover, this study highlights the gaps of knowledge in regard to this disease entity.&#x0D; Methods: The literature search was conducted by searching the keywords “Dermatofibrosarcoma Protuberans” and “soft tissue sarcomas” in PubMed and Web of Science databases.&#x0D; Results: 1,769 potentially relevant results showed matched titles, of which 13 articles met the requirements and were included in the literature review.&#x0D; Limitations: Vague nonspecific clinical manifestations, makes it challenging to establish an early diagnosis and seek an appropriate counseling. In addition, it is difficult to diagnose due to the slow growing behavior and the tumor’s benign appearance. As a result of all of that there is no enough cases reported in the literature.&#x0D; Conclusion: This review highlights the need of high index of suspicion to help reach an early and proper diagnosis and to raise awareness. Dermatofibrosarcoma Protuberans needs a specialized center in order to identify and recognize the disease. The knowledge and awareness of the disease is low since it is rare.

Somatostatin Receptors in Human Meningiomas-Clinicopathological Aspects.

Simple SummaryMeningioma diagnostics and grading are currently based on subjective histopathological criteria given by the 2016 World Health Organization (WHO) classification. However, biomarkers may provide a more objective approach to diagnostics. This study was designed to elucidate the diagnostic and prognostic value of somatostatin receptors (SSTRs) as biomarkers in meningiomas, which could help to identify patients with a higher risk of recurrence and provide more personalized treatment. We have confirmed, in a population of 162 patients, that SSTRs have diagnostic value and may aid in the differentiation between WHO grade 1 and grade 2 tumors. Furthermore, SSTR1, SSTR2 and SSTR5 were associated with higher malignancy grades. SSTR2 expression was found to be characteristic in meningiomas. To maintain objectiveness, we scoped for a digital evaluation of immunoreactivity. We aim to impact and motivate researchers to further investigations towards more objective criteria in meningioma diagnostics, which in turn will improve patient care.Meningiomas have high recurrence rates despite frequently benign histopathological appearances. Somatostatin receptors (SSTRs) may be reliable biomarkers that could identify patients with increased risk of recurrence. Even though SSTRs are previously detected in meningiomas, their associations to clinicopathological features remain unclear. The aim of this study was to investigate the diagnostic and prognostic value of SSTRs in a large series of human meningiomas with long follow-up data. Immunohistochemistry was used to measure the expression of SSTR1-SSTR5 in tissue samples from 162 patients diagnosed with intracranial meningiomas of World Health Organization (WHO) grade 1 or 2. Digital scoring and a manual staining index were applied to assess immunoreactivity. All SSTRs, except SSTR4, were upregulated in our series of meningiomas. SSTR1 (p = 0.036), SSTR2 (p = 0.036) and SSTR5 (p = 0.029) were associated with a higher malignancy grade. SSTR2 presented as the most reliable marker. Only SSTR2 was associated with time to recurrence (TTR) in univariate Cox regression analyses. Manual staining index was strongly correlated with digital scoring for all SSTRs (r > 0.65, p < 0.001). SSTRs, and especially SSTR2, are useful in the diagnostics of meningiomas, even though their prognostic value appears limited. Digital scoring is valuable to ensure reproducibility.

Leiomyoma of the Inferior Vena Cava

Leiomyomas are benign smooth muscle tumors that can develop at any site where smooth muscle is present. The leiomyoma in the inferior vena cava is a rarely observed pathology. We report the case of a 50-year-old patient, an abdomino-pelvic CT scan was performed which allowed to specify the retroperitoneal location of the mass, lateralized on the right, at the expense of the inferior vena cava (IVC), with a benign appearance of the IVC, Anatomopathological examination is in favor of a leiomyoma of the IVC.