Benign Gland Research Articles

Different clinical presentations of xanthogranulomatous prostatitis: A case series and review of the literature

Objective: Xanthogranulomatous prostatitis (XGP) is a rare entity that has different clinical presentations. This report of three cases illustrates the diversity of clinical features of XGP, together with a comprehensive literature review. Methods: Three elderly male Sri Lankan patients underwent transurethral resection of the prostate for severe lower urinary tract symptoms. Carcinoma of the prostate was suspected in two patients, and one of them had a very high prostate-specific antigen level (324 ng/mL), suggestive of metastatic prostate carcinoma. The third patient had a clinically benign prostate gland. The histology of all three resected prostate chippings revealed XGP. Results: This case series encompasses two cases of XGP that mimicked carcinoma of the prostate clinically and another case that had benign clinical features. Patients with XGP can have clinical, radiological and serological evidence of advanced prostate carcinoma. Other rare modes of presentation of XGP include prostate abscess and haematospermia. Many concerns of XGP such as aetiology, epidemiology, natural history, risk of malignant transformation and possible treatment options remain unclear due to the paucity of the literature. Conclusions: XGP presents with a variety of benign and malignant clinical features. The possibility of encountering XGP in patients with clinically malignant prostates should not be overlooked.

Feasibility and efficacy of partial superficial parotidectomy with V-shaped incision

Objective: To evaluate the feasibility and efficacy of partial superficial parotidectomy with V-shaped incision by comparing with the Blair incision and hairline N-shaped incision. Methods: From January 2015 to January 2016, 60 patients (47 males and 13 females, with an age range of 25- 63 years) required for superficial partial parotid gland resection were randomly divided into three groups: V-shaped incision (VI) group, Blair incision (BI) group and hairline N-shaped incision (NI) group, with 20 cases in each group.Intraoperative, postoperative and follow-up indexes were compared between three groups. Operative time and drainage volume in the surgery of tumors at different sites in VI group were compared. SPSS18.0 software was used for statistic analysis. Results: There were no statistically significant differences among the three groups in operative time, drainage volume, postoperative hospital stay, periauricular numbness, fistulas, pain score, facial palsy, and scar score at the 3rd month after surgery (P>0.05). For appearance satisfaction score at the 6th month after surgery, VI group was better than BI group or NI group, with significant differences(VI group vs. BI group: 9.00[8.00, 9.00] vs. 5.00[4.00, 5.25], χ(2)=6.629, P<0.001; VI group vs. NI group: 9.00[8.00, 9.00] vs. 7.00[6.00, 8.00], χ(2)=2.942, P=0.010; BI group vs. NI group: 5.00[4.00, 5.25] vs. 7.00[6.00, 8.00], χ(2)=-3.687, P=0.001). For tumors located in the front, upper and middle of parotid gland, there were no statistically significant differences in operative time and drainage volume between the three groups (P>0.05). For tumors located at the lower part of parotid gland, the difference in operative time between the three groups was statistically significant (F=7.278, P=0.01). With pairwise comparison, operative time in VI group was longer than that in BI group or NI group, but there was no significant difference between BI group and NI group (VI group vs. BI group: (181.00±22.89) min vs. (132.50±9.01) min, t=3.694, P=0.004; VI group vs. NI group:(181.00±22.89) min vs. (149.00±15.94) min, t=2.585, P=0.025; BIgroup vs. NI group, (132.50±9.01) min vs. (149.00±15.94) min, t=1.257, P=0.235). For tumors located at the lower part of parotid gland, the differences in intraoperative drainage volume were not statistically significant between three groups (P>0.05). There were no statistically significant differences in operative time and drainage volume in the surgery of tumors at different sites in VI group (P>0.05). Conclusions: By use of V-shaped incision for the surgery of benign parotid gland tumors, the operation time of tumors located only in the lower part of the parotid gland will be prolonged. For tumors in different sites without increasing surgical complications, this modality can get good cosmetic effect.

Value of diffusion weighted and ADC value - magnetic resonance imaging in differentiation between benign and malignant solid parotid gland masses

Background: magnetic resonance imaging (MRI) is becoming an essential tool for assessment of parotid gland pathology. Diffusion weighted imaging (DWI) provides quantitative and qualitative information reflecting the changes in tissue cellularity and integrity of cell membranes. Objective: To evaluate the diagnostic accuracy of diffusion weighted -MRI in the differentiation between benign and malignant solid parotid gland masses using 1.5 Tesla MRI scanner and to obtain the best cutoff value of apparent diffusion coefficient (ADC) to differentiate between benign and malignant masses. Patients and methods: prospective cross-sectional analytic study was conducted in Al Imamein Al Kadhumein Medical City, at the period between January 2019 and January 2020, 50 patients were included in the study. DWI was acquired at following b-values [50, 1000 millimeter (mm) 2/second (sec)], in this study the results were obtained and depending on b-value 1000 mm2/sec. Results: The mean level of ADC value of malignant masses (0.599 ± 0.117 SD x 10-3 mm2/sec), while for benign masses (1.590 ± 0.363 SD x10-3 mm2/sec); According to Receiver operating characteristic (ROC) curve the optimal cutoff point of ADC value was (0.914x10-3 mm2/sec) with sensitivity 100%, specificity 97%. The association between MRI diagnosis and histopathological diagnosis was significant (P value< 0.001). Conclusion: Diffusion weighted- MRI and ADC values are highly sensitive and specific to differentiate between benign and malignant solid parotid gland masses and the best ADC cut off value was (0.914x10-3 mm2/sec).

A case of pure foamy gland carcinoma of prostate on needle core biopsy

Pure foamy gland carcinoma in prostate needle biopsy is seldom encountered. Majority of the prostatic carcinoma cases are acinar type adenocarcinoma. The features of classic acinar adenocarcinoma like large nuclei, prominent nucleoli and infiltrative pattern are not seen in most of the cases of foamy gland carcinoma. Foamy gland carcinoma (FGC) is composed of cells with characteristic abundant foamy cytoplasm and low N:C ratio. These low-grade FGC can mimic benign prostatic glands and thus serve as a diagnostic challenge. We here report a case of pure foamy gland variant of adenocarcinoma diagnosed on TRUS biopsy.

Prostatic Carcinoma With Aberrant Expression of p63: A Case Report and Review of the Literature

Abstract Prostatic carcinoma with aberrant expression of p63 is a rare variant of prostate cancer, which represents a potential diagnostic pitfall, as it may be easily confused with either benign prostatic glands or high-grade prostatic carcinoma. In studies of radical prostatectomies, these tumors appear to behave like low-grade carcinomas despite frequent poorly formed architecture. We report a case of prostatic carcinoma with aberrant expression of p63 with a review of the literature and helpful features in the differential diagnosis of this entity.

Evaluation of Total Thyroidectomy for Treatment of Benign Diseases of Thyroid Gland

BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this field of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase.&#x0D; AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis.&#x0D; METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology findings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively.&#x0D; RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement findings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignificant hypocalcemia in 10 (4.78%), temporary significant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%).&#x0D; CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative findings of benign thyroid glands.

MP16-11 HISTOLOGIC AND ENZYMATIC BACKGROUND FOR BIOSYNTHESIS OF ABERRANT GLYCOSYLATED PROSTATE-SPECIFIC ANTIGEN

You have accessJournal of UrologyProstate Cancer: Basic Research & Pathophysiology I (MP16)1 Apr 2020MP16-11 HISTOLOGIC AND ENZYMATIC BACKGROUND FOR BIOSYNTHESIS OF ABERRANT GLYCOSYLATED PROSTATE-SPECIFIC ANTIGEN Tohru Yoneyama*, Yuki Tobisawa, Tomokazu Ishikawa, Tomonori Kaneko, Takatoshi Kaya, Shingo Hatakeyama, Hayato Yamamoto, Mihoko Sutoh Yoneyama, Takahiro Yoneyama, Yasuhiro Hashimoto, and Chikara Ohyama Tohru Yoneyama*Tohru Yoneyama* More articles by this author , Yuki TobisawaYuki Tobisawa More articles by this author , Tomokazu IshikawaTomokazu Ishikawa More articles by this author , Tomonori KanekoTomonori Kaneko More articles by this author , Takatoshi KayaTakatoshi Kaya More articles by this author , Shingo HatakeyamaShingo Hatakeyama More articles by this author , Hayato YamamotoHayato Yamamoto More articles by this author , Mihoko Sutoh YoneyamaMihoko Sutoh Yoneyama More articles by this author , Takahiro YoneyamaTakahiro Yoneyama More articles by this author , Yasuhiro HashimotoYasuhiro Hashimoto More articles by this author , and Chikara OhyamaChikara Ohyama More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000841.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although we previously reported that the prostate cancer (PC) diagnostic performance of serum aberrant Siaα2,3Gal-glycosylated prostate-specific antigen (S2,3PSA) test or LacdiNAc-glycosylated PSA (LDN-PSA) test much superior to conventional PSA test (Ishikawa et al., IJMS, 2017; Yoneyama et al., Cancer Sci. 2019), histopathologic and enzymatic background for biosynthesis of aberrant-glycosylated PSA in prostate tissue has still unknown. In this study, we investigate the origin of aberrant-glycosylated PSA in prostate tissues. METHODS: Total RNA and protein were extracted from benign prostate gland and each Gleason pattern of PC tissue that was macro-dissected from FFPE prostate section in 102 patients who underwent radical prostatectomy in Hirosaki University. The expression level of sialylated- and LDN- synthesis-related glycosyltransferase genes were evaluated by droplet digital PCR, and also %S2,3PSA or LDN-PSA/total PSA levels were analyzed by automated immunoassay systems. RESULTS: The expression level of Siaα2,6Gal- synthesis-related α2,6sialyltransferase (ST6GAL1) was significantly decreased in Gleason 4 & 5 tissue compare to Gleason 3 and benign prostate gland. Siaα2,3Gal- synthesis-related α2,3sialyltransferases (ST3GAL3,4,6) was not vary from tumor malignancy. The %S2,3PSA level was also significantly increased in Gleason 4 & 5 tissues suggesting that upregulation of the Siaα2,3Gal- ratio on PSA regulated by ST6GAL1 expression. The expression level of LDN- synthesis-related β1,4-N-acetylgalactosyltransferase 4 in prostate tissue was higher than that of β4GALNT3, and β4GALNT4 expression increased in Gleason 4 & 5 tissues compared to benign prostate gland, suggesting that LDN- synthesis in prostate tissues mainly regulated by β4GALNT4. LDN-PSA/total PSA level was also significantly increased in Gleason 4 & 5 tissues compared to benign prostate gland. Thus, LDN-PSA was mainly synthesized in cancer tissues and increased in high grade Gleason 4 & 5 tissues. CONCLUSIONS: Aberrant glycosylation (Siaα2,3Gal- or LDN-) related glycosyltransferase expression significantly increased in PC tissue with higher Gleason pattern and aberrant glycosylated PSA mainly secreted from PC tissue. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e218-e219 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tohru Yoneyama* More articles by this author Yuki Tobisawa More articles by this author Tomokazu Ishikawa More articles by this author Tomonori Kaneko More articles by this author Takatoshi Kaya More articles by this author Shingo Hatakeyama More articles by this author Hayato Yamamoto More articles by this author Mihoko Sutoh Yoneyama More articles by this author Takahiro Yoneyama More articles by this author Yasuhiro Hashimoto More articles by this author Chikara Ohyama More articles by this author Expand All Advertisement PDF downloadLoading ...

Atrophic and Microcystic Limited Prostatic Adenocarcinomas.

Atrophic carcinoma and microcystic carcinoma have previously been classified as variants of conventional acinar adenocarcinoma. In this article, we studied 4 cases of atrophic carcinoma and 4 cases of limited microcystic carcinoma. We found an incidence of 0.8% in 250 needle prostatic biopsies and 1.3% of atrophic carcinoma in 150 radical prostatectomies. Microcystic carcinomas were found in 3 prostatectomies (1.2%) and in 1 needle biopsy (0.67%). The useful histological criteria for atrophic carcinoma included the irregular disposition of the glands, infiltrative pattern, "rigid" luminal borders, and intraluminal secretions. Cytological changes included scant cytoplasm, nucleomegaly, hyperchromatic nuclei, and visible nucleoli. The glands of the microcystic carcinoma differ from the benign glands because the malignant ones show a markedly greater dilatation and exhibit rigidity of glandular lumens. In some cases of microcystic carcinoma, the nuclei were flattened, small, and hyperchromatic; therefore, they can be difficult to recognize as malignant.

Distinct Histopathology Characteristics in Empty Nose Syndrome.

Empty nose syndrome (ENS) is a controversial disorder and the change of histopathology has never been discussed. This study aimed to conduct a structured histological review to improve the diagnosis and understanding of ENS. Further immunohistochemical staining of transient receptor potential channel melastatin 8 (TRPM8) was performed. A prospective case-control study in a tertiary medical center. Consecutive patients with ENS who were diagnosed and received surgical intervention after failure of conservative management were included. Patients with benign pituitary gland tumor receiving transsphenoidal excision were enrolled as control group. Biopsy of inferior turbinate was obtained during surgery for histological review and immunohistochemical staining. Seventeen patients with ENS and six patients as a control group were established for structured histological review. Patients with ENS presented significantly more squamous metaplasia, a higher rate of submucosal fibrosis, and a lower submucosal gland number grading. Additionally, a unique histological change called goblet cell metaplasia was found in the ENS group. The respiratory epitheliums of ENS were mostly intact with preservation of ciliated cells and goblet cells. The ENS group had a significantly lower expression level of TRPM8. The nasal mucosa of ENS experienced some airway remodeling and thermoreceptors downregulation, which contribute to clinical symptoms. The distinct histology of ENS included preserved respiratory epithelium and goblet cell metaplasia, accompanying with characteristics similar to atrophic rhinitis. Biopsy of the inferior turbinate may help diagnose ENS. 4 Laryngoscope, 131:E14-E18, 2021.

Abstract P1-12-01: Prevention of BRCA1-associated mammary cancers by selective progesterone receptor modulators (SPRM) in mice

Abstract Background: It was previously demonstrated that mifepristone (MFP), an SPRM with anti-glucocorticoid receptor (GR) activity, blocks mammary tumor formation in a BRCA1 deficient mouse model (deletion of exon 11). We sought to compare tumor prevention efficacy of MFP with other SPRMs having less GR binding, using a different BRCA1 deficient mouse model (deletion of exon 22-24). We also compared the efficacy of multiple SPRMs on suppression of cell proliferation (Ki67) in benign mammary glands, to evaluate early effects in unaffected glands. Methods: At 4-months-old, the female mice (Blg_Cre Brca1 f22-24/f22-24; p53+/-) were randomized to four treatment groups (n= 14-21 per group): no treatment control, MFP, telapristone acetate (TPA), and ulipristal acetate (UPA) and treated subcutaneously with a pellet containing 30mg of drug. Pellets were replaced every 90 days. The mice were monitored for tumor formation and growth until 15- months of age. When the tumor burden of mice became 1 cm2 or at age 15-months, the mice were euthanized to collect tumors and mammary glands for histopathologic evaluation. Ki67 and PR expression in mammary tissues were measured by immunohistochemistry and images were analyzed by ImageJ/Fiji software. Total RNA extracted from benign and tumor tissue was sequenced to discover SPRM-modulated genes and molecular pathways, in comparison with no-treatment controls. Results: The occurrence of invasive cancers (adenocarcinoma) was similar in MFP-treated and control mice in a time-adjusted analysis (72% of MFP group vs. 74% of controls, p= 0.55). TPA-treated mice displayed a non-significant lower tumor incidence (56 %) compared to control group (p=0.11). However, UPA-treated mice showed significantly less tumor incidence (43%) than controls (p=0.04). These results were supported by suppression of %Ki67 labeling Index (LI) of benign glands. Median %Ki67 LI of benign glands of tumor-affected mice were: controls (18%) = MFP (18%) &amp;gt; TPA (16%) &amp;gt; UPA groups (10 %). Median Ki67% LI of benign glands of tumor-unaffected mice were: MFP (16%) &amp;gt; TPA (13%) &amp;gt; controls (12%) &amp;gt; UPA group (6%). Reduction of cell proliferation by UPA was significant in benign glands of tumor-affected and un-affected mice compared to controls (p=0.007 for both) while reductions in the MFP and TPA groups were not significant. All of the invasive cancers were PR negative; PR is expressed in abnormal and benign lesions adjacent to invasive adenocarcinoma. To determine whether PR expression is related to tumor progression, we are evaluating PR expression in both benign and abnormal glands from all mice. Furthermore, RNA sequencing is underway to determine genes differentially expressed by UPA and MFP treatment compared to no treatment. Conclusions: Our mouse model (BRCA1 Δexon22-24) displayed a spectrum of sensitivity to the three SPRMs we have tested: UPA&amp;gt;TPA&amp;gt;MFP, UPA showing higher potency than TPA. The reason for the lack of efficacy of MFP may relate to its strong affinity to GR, resulting in mixed effects on both PR and GR as a reason for its failure in this model. Understanding mechanisms underlying the different anti-tumor efficacy of UPA and MFP in our model will provide important insights that will aid the clinical development of PR-directed strategies for breast cancer prevention in both BRCA1 mutation carriers. Citation Format: Oukseub Lee, Limin Sun, Maarten C. Bosland, Minhua Wang, Ali Shidfar, Omid Hosseini, Irene Helenowski, Susan E. Clare, Seema A. Khan. Prevention of BRCA1-associated mammary cancers by selective progesterone receptor modulators (SPRM) in mice [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-12-01.

Intraoperative 68Ga-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy: A Feasibility Study.

Our objective was to assess the feasibility and accuracy of Cerenkov luminescence imaging (CLI) for assessment of surgical margins intraoperatively during radical prostatectomy. Methods: A single-center feasibility study included 10 patients with high-risk primary prostate cancer (PC). 68Ga-prostate-specific membrane antigen (PSMA) PET/CT scans were performed followed by radical prostatectomy and intraoperative CLI of the excised prostate. In addition to imaging the intact prostate, in the first 2 patients the prostate gland was incised and imaged with CLI to visualize the primary tumor. We compared the tumor margin status on CLI to postoperative histopathology. Measured CLI intensities were determined as tumor-to-background ratio. Results: Tumor cells were successfully detected on the incised prostate CLI images as confirmed by histopathology. Three of 10 men had histopathologically positive surgical margins (PSMs), and 2 of 3 PSMs were accurately detected on CLI. Overall, 25 (72%) of 35 regions of interest proved to visualize a tumor signal according to standard histopathology. The median tumor radiance in these areas was 11,301 photons/s/cm2/sr (range, 3,328-25,428 photons/s/cm2/sr), and median tumor-to-background ratio was 4.2 (range, 2.1-11.6). False-positive signals were seen mainly at the prostate base, with PC cells overlaid by benign tissue. PSMA immunohistochemistry revealed strong PSMA staining of benign gland tissue, which impacts measured activities. Conclusion: This feasibility showed that 68Ga-PSMA CLI is a new intraoperative imaging technique capable of imaging the entire specimen's surface to detect PC tissue at the resection margin. Further optimization of the CLI protocol, or the use of lower-energy imaging tracers such as 18F-PSMA, is required to reduce false-positives. A larger study will be performed to assess diagnostic performance.

Gastric biopsies that keep you up at night

The diagnosis of gastric carcinoma can be challenging in several situations. Diffuse-type carcinomas can be readily overlooked, especially when inconspicuous tumour cells infiltrate between benign gastric glands and elicit little, if any, stromal response. Metastases, particularly from the breast, bear striking similarities with gastric carcinomas and should always be considered in the differential diagnosis when poorly cohesive tumours develop in women. Benign mimics of diffuse-type adenocarcinoma can also result from artifactual or inflammation-induced disruption of non-neoplastic gastric epithelium. Benign foveolar epithelial cells assume a globoid appearance (i.e., signet ring cell change) when they are not confined to the basement membrane. Tubular adenocarcinomas show glandular crowding, branching, villiform or cribriform growth, and cystically dilated crypts that can simulate regenerative atypia. Rare tumours are extremely well-differentiated with minimal architectural abnormalities and only slight nuclear enlargement. Distinction between primary carcinomas and their potential mimics will be discussed during the presentation.

A Case of Malakoplakia Mimicking Prostatic Malignancy

Malakoplakia is a granulomatous inflammatory condition commonly involving the urogenital tract. Principally it involves the urinary bladder, prostate is a rare site. Clinical and radiological examination sometimes mimics malignancy. Histology remains confirmatory modality for the diagnosis. Hereby we report a case of prostatic malakoplakia in an elderly male who presented with lower urinary tract symptoms in the past fifteen days. Urine routine microscopy showed pus cells; culture report was positive for E. coli. Serum Prostate Specific antigen (PSA) was 4.6 ug/ml. Magnetic Resonance Imaging (MRI) showed a bulky prostate. A 12-core biopsy was done to rule out malignancy and the histopathology showed benign prostatic glands and the stroma with a predominant population of epithelioid histiocytes and the characteristic Michealis-Gutmann bodies. After a course of antibiotic Nitrofurantoin, transrectal ultrasound was repeated which showed reduction in the prostatic volume. Subsequently Trans-Urethral Resection of Prostate (TURP) was done to relieve the persistent lower urinary tract symptoms. Histology showed similar features. Special stains – Von kossa and Prussian Blue highlighted the Michealis-Gutmann bodies.

Cross-sectional study on the occurrence of Frey's syndrome following superficial parotidectomy or extracapsular dissection

BackgroundMost studies that examine postoperative outcomes after parotidectomy in patients with benign parotid gland tumors are based on retrospective chart reviews. Data about long-term results in patients with parotid gland surgery with patient contact are still sparsely published. MethodsDuring the period of 1960–2005, a total of 127 patients underwent either extracapsular dissection (ECD) or superficial parotidectomy (SP) and were available for interview. Patients were questioned about their postoperative outcome after parotid gland surgery. ResultsThe mean follow-up was 21.5 years. A total of 42 and 85 patients underwent ECD and SP, respectively. No significant differences were observed in the rates of permanent facial paralysis (SP 1.2% vs. ECD 7.1%; p = 0.1053) or recurrence (SP 4.7% vs. ECD 11.9%; p = 0.1557), and Frey's syndrome was diagnosed only after SP (10.6% vs. 0% after ECD, p = 0.0293). Frey's syndrome was detected more often compared to retrospective chart analysis. ConclusionWe conclude that Frey's syndrome is underdiagnosed after SP without standardized follow-up examinations. Long-term follow-up should be applied to detect and treat gustatory sweating.

Ex vivo fluorescence confocal microscopy: prostatic and periprostatic tissues atlas and evaluation of the learning curve.

Ex vivo fluorescence confocal microscopy (FCM) is an optical technology that provides fast H&E-like images of freshly excised tissues, and it has been mainly used for "real-time" pathological examination of dermatological malignancies. It has also shown to be a promising tool for fast pathological examination of prostatic tissues. We aim to create an atlas for FCM images of prostatic and periprostatic tissues to facilitate the interpretation of these images. Furthermore, we aimed to evaluate the learning curve of images interpretation of this new technology. Eighty fresh and unprepared biopsies obtained from radical prostatectomy specimens were evaluated using the FCM VivaScope® 2500M-G4 (Mavig GmbH, Munich, Germany; Caliber I.D.; Rochester NY, USA) by two pathologists. Images of FCM with the corresponding H&E are illustrated to create the atlas. Furthermore, the two pathologists were asked to re-evaluate the 80 specimens after 90days interval in order to assess the learning curve of images' interpretation of FCM. FCM was able to differentiate between different types of prostatic and periprostatic tissues including benign prostatic glands, benign prostatic hyperplasia, high-grade intraepithelial neoplasm, and prostatic adenocarcinoma. As regards the learning curve, FCM demonstrated a short learning curve. We created an atlas that can serve as the base for urologists and pathologists for learning and interpreting FCM images of prostatic and periprostatic tissues. Furthermore, FCM images is easily interpretable; however, further studies are required to explore the potential applications of this new technology in prostate cancer diagnosis and management.

Nodular Hidradenoma Case of Rare Localization

Hidradenoma is a rare benign adnexal sweat gland tumor with eccrine or apocrine differentiation. In the skin, it is usually in the form of a solitary skin nodule. The treatment is complete surgical resection with healthy margins, given the high rate of recurrence and the possibility of malignant transformation. We report a case.

PARTIAL LAPAROSCOPIC ADRENALECTOMY - ANATOMICAL BASIS AND OPERATION TECHNIQUE

The aim: To optimize the indications for partial laparoscopic adrenalectomy (PLA), to give a detailed outline of a PLA technique and to provide technical tips to ensure safe and highly-effectiveness, based on the knowledge of adrenal anatomy and blood supply. Materials and methods: Between January 2010 and September 2018, our department performed 47 adrenal glands surgeries. The operations included 29 total laparoscopic adrenalectomies (TLA), 4 open adrenalectomies (OA) and 14 partial laparoscopic adrenalectomies (PLA). Results: The histopathological examination of all operated patients detected 9 (19.1%) malignant tumors, including 5 metastatic tumors. Benign tumors includes 24 (63%) adenomas, 8 (21%) pheochromocytomas, 4 (10,5%) cysts and 2 (5,5%) ganglioneuromas. Post-PLA histopathological findings revealed 6 adenomas, 2 pheochromocytomas, 4 cysts and 2 ganglioneuromas. Conclusions: Keeping in mind anatomical features of adrenal gland blood supply in highly-selected patients, PLA can be performed in a number of patients. 2 mm of a minimal resection margin is enough to preserve a false tumor recurrence. Anatomically grounded PLA is becoming a new standard of benign adrenal gland tumors treatment, providing an opportunity to save more adrenal gland functional tissue and to prevent hipocorticism development in postoperative period.

Parotid gland neoplasms presenting as discrete infra-auricular swellings

Background: Parotid gland neoplasms usually present as pre-auricular swellings. Sometimes, they present as solitary infra-auricular swellings which make their localization difficult as they may be confused with submandibular gland or other lateral upper neck masses. Clinicopathological reports of discrete infra-auricular parotid lesions and their surgical managements are few. Objectives: To describe the clinical features and management of discrete infra-auricular parotid masses in a series of Nigerian patients seen during a surgical outreach mission. Methodology: This is a retrospective study of all infra-auricular swellings managed by a Nigerian surgical mission over 6 years. Patients' demographics, duration of swelling, symptoms, treatment, histopathological diagnosis, postoperative complications were retrieved from patients' records. Results: A total of 124 facial tumors were seen, of which 15 (12.1%) were parotid tumors. Eight cases (53.3%) of parotid tumors presented as discrete infra-auricular masses. Age range was 13–57 years (mean = 40.9 ± 15.4 years) with male predilection. Duration of swelling was between 1 and 15 years. All lesions were treated with extracapsular dissection. One patient had postoperative facial nerve paresis, but no facial palsy and sialocele. The histopathological results were 5 (62.5%) pleomorphic adenomas, 1 (12.5%) Warthin's tumor, and 2 (25%) low-grade mucoepidermoid carcinomas. Conclusion: Discrete infra-auricular swellings may present as benign and malignant parotid gland neoplasms.

Clinicopathologic Characterization of Hidradenoma on Acral Sites: A Diagnostic Pitfall With Digital Papillary Adenocarcinoma.

Hidradenomas are benign sweat gland tumors that typically present as small nodules in adulthood. Their anatomic distribution is wide and rarely includes acral sites. In this setting, reliable separation from digital papillary adenocarcinoma is important, but notoriously difficult. Hematoxylin and eosin-stained sections of 25 hidradenomas on acral skin were retrieved. The clinical presenting features and morphologic findings were recorded, and follow-up was obtained. Immunohistochemistry was performed for AE1/3, CK5/6, EMA, CEA, SMA, S100, p40, and p63. The tumors presented as solitary nodules on the hands (n=17) and feet (n=8) of adults (age range: 20 to 81 y; median: 50 y), with an equal sex distribution. Histologically, the well-circumscribed tumors were lobular, with a solid and cystic growth within dermis. Duct and squamous differentiation and vascularized hyaline stroma were frequent. The majority (n=18) were poroid hidradenomas. Scattered cytologic atypia and mitotic activity (median: 2/10 HPF) were common, and a pseudoinfiltrative growth of strands in a hyaline to sclerotic matrix was noted in 5 tumors. No papillary structures, atypical mitoses, or tumor necrosis were present. Immunohistochemically, all tumors expressed AE1/3, CK5/6, p40, and p63 strongly and diffusely. Luminal differentiation was highlighted by epithelial membrane antigen and carcinoembryonic antigen staining. S100 and SMA staining was absent. Follow-up (1 to 288 mo; median: 61 mo), available for 20 patients, showed no local recurrences and no disease-related mortality. Acral hidradenomas and digital papillary adenocarcinomas share a well-circumscribed dermal growth pattern containing solid, cystic, and tubular areas with mitotic activity and at least focal cytologic atypia. Lack of papillary structures and the diffuse positivity for p40 and p63 in the absence of S100 and SMA expression are helpful features in favor of acral hidradenoma.

A Case of Oncocytic Lipoadenoma Arising in the Submandibular Gland

Oncocytic lipoadenoma is a rare salivary gland tumor composed of adipose tissue and oncocytic epithelial cells in varied proportions. We report a case of an oncocytic lipoadenoma of the submandibular gland, which presented as a submandibular gland mass. The patient was a 65-year-old woman with a right submandibular mass measuring 2 x 2 x 1.6 cm. As a sonographic evaluation and computed tomograph scan gave us the impression of benign submandibular gland tumor such as pleomorphic adenoma, we resected the right side submandibular gland. Grossly, the tumor was well circumscribed with yellow to brown cut surface. Microscopically, the tumor was surrounded by a thin, fibrous capsule and composed of oncocytic epithelial cells admixed with mature adipose tissue. Final diagnosis was an oncocytic lipoadenoma. We discussed here radiologic and pathologic finding of this rare salivary gland tumor. Key Words: Oncocytic lipoadenoma, Submandibular gland