Benign Inflammatory Process Research Articles

Sinonasal and ventral skull base inflammatory pseudotumor: a systematic review.

Inflammatory pseudotumor is a benign idiopathic inflammatory process often misdiagnosed as an infection or neoplasm. This review analyzes all reported cases of sinonasal and ventral skull base inflammatory pseudotumor to date, and provides a framework for evaluation and management of this uncommon condition. MEDLINE/PubMed database. A search for articles related to sinonasal and ventral skull base inflammatory pseudotumor, along with bibliographies of those articles, was performed. Demographics, presentation, radiographic findings, treatment, follow-up, and outcome were analyzed. Thirty-three articles were reviewed, including a total of 87 patients. The most common presenting symptom was vision change (58.6%). Sinonasal and ventral skull base inflammatory pseudotumor was found in the cavernous sinus in 46.0% of cases. The lesion appeared isointense (66.7% of cases) and homogeneously enhancing on T1-weighted magnetic resonance imaging (MRI), whereas it appeared hypointense on T2-weighted MRI in 90.7% of cases. Inflammatory pseudotumor appeared hyperdense on computed tomography in 78.9% of cases. Histopathological analysis of biopsied specimens revealed presence of inflammatory cells (94.4%) and fibrosis (80.3%). Corticosteroids alone were the most common treatment modality (55.2%), resulting in disease-free patients in 22.9% of cases over a median follow-up period of 17.6 months. Surgical management alone was uncommon (8.0%), but showed high success rate (57.1%). This review is the most comprehensive analysis of sinonasal and ventral skull base inflammatory pseudotumor to date. Radiologic findings and histopathological analysis are essential for diagnosis. Corticosteroids are the most common treatment modality. Surgery, although uncommon, appears to be an efficacious treatment modality.

IB-07 * HISTOPLASMOSIS WITH CNS INVOLVEMENT: CASE PRESENTATION WITH DISCUSSION AND LITERATURE REVIEW

Histoplasma capsulatum is one of the most common fungal respiratory infections in the world. CNS histoplasmosis is rare and difficult to diagnose because it is often overlooked or mistaken for other pathologies due to its non-specific symptoms. Failure to quickly diagnose CNS histoplasmosis leads to a poor prognosis. A 32-year-old homosexual Hispanic male with advanced AIDS presented with an altered mental status and reported confusion for the past three months. He had a GSC scale of 12, repetitive non-fluent speech, and a disconjugate gaze with a right gaze preference. Lung-CT findings indicated a pulmonary histoplasmosis infection. An MRI of the brain revealed a ring-enhancing lesion in the left caudate nucleus. A CT guided left retroperitoneal node biopsy was performed and indicated a benign inflammatory process with organisms compatible with fungal yeast. Treatment with amphotericin B followed by itraconazole was initiated in spite of negative CSF cultures and proved effective in mitigating associated CNS lesions and resolving neurologic deficits. The patient was discharged three weeks later in stable condition. Six weeks later, his left basal ganglia mass decreased from 30 x 36.9mm to 28.3 x 23.3mm. Early recognition of symptoms and proper steps are key in improving outcomes of CNS histoplasmosis. Aggressive medical management is possible in treatment of intracranial deep mass lesions, and disseminated histoplasmosis with CNS involvement can be appropriately diagnosed and treated, despite negative CSF and serology studies.

Acute right lower quadrant pain beyond acute appendicitis: MDCT in evaluation of benign and malignant gastrointestinal causes

PurposeTo evaluate the role of MDCT in identification of various GIT pathologies beyond appendicitis that cause acute right lower quadrant abdominal pain and characterization of various distinguishing CT features as well as their predictive values in differentiating benign from malignant pathologies. Materials and methodsThis retrospective study included a total of 64 patients (34 females and 30 males with age ranges from 21 to 78years) who presented with ARLQP (acute right lower quadrant pain). MDCT was done for all the patients; inclusion criteria included the presence of clinical, laboratory, and radiological evidence of the pathologic process. Pathological confirmation was obtained in 44 cases. All cases proved pathologically to be appendicitis were eventually excluded from the study cohort. Various CT morphologic parameters were recorded including the location of bowel wall involvement, the extent of involvement, the thickness of bowel wall and pattern of bowel wall thickening, the presence of stratified enhancement pattern, the transition from normal to abnormal wall, the degree of mesenteric fat stranding relative to the degree of wall thickening, the presence of excavating masses, and associated findings. A multivariate analysis was performed using covariates among the variable morphologic CT features. ResultsA stratified enhancement pattern of the bowel wall was the most reliable to indicate a benign active inflammatory process with the highest −ve predictive value of 91% and an abrupt zone of transition also proved to be the most significant in indicating a malignant process with a +ve PV of 74%. ConclusionUsing a systematic pattern approach MDCT has proved to be an extremely useful noninvasive method for evaluation of patients with acute RLQP, allowing diagnosis and management of not only the most common conditions such as appendicitis but also less common conditions.

Respiratory Epithelial Adenomatoid Hamartoma

Respiratory epithelial adenomatoid hamartoma (REAH) is regarded as a rare tumor of the nasal cavity. The mechanisms driving the development of REAH are unknown, and its nature as a benign tumor, hamartoma, or reactive inflammatory process is still open to discussion. A total of 150 consecutive patients operated on for nasal polyposis (NP) were extensively checked for the diagnosis of REAH. The profile of REAH occurring in association with NP was compared with solitary REAH in a series of 19 cases. The possible role of tryptase-producing mast cells (MC) and of metalloproteinases MMP2 and MMP9 in REAH development was investigated by immunohistochemistry. REAH lesions were identified in 35% of patients who had surgery for NP (53/150). The distribution of the lesions suggested that REAH originated in the olfactory cleft. Solitary REAH occurred about 20 times less frequently than those observed in an NP context but shared the same microscopic characteristics. Tryptase-producing MCs were recruited at high density in REAH (135/10 hpf), compared with inflammatory polyps (45/10 hpf; P<0.00005) and hypertrophied turbinates (51/10 hpf; P<0.0005). REAH also showed constant MMP9 expression and to a lesser degree MMP2 expression in epithelial cells. If solitary REAH is a relatively rare lesion, we demonstrated that an exhaustive sampling allows the detection of a high proportion of NP-associated REAH, sharing the same clinical and histologic characteristics with solitary REAH. Tryptase-producing MCs, possibly in association with MMP expression, may play a central role in REAH formation.

Necrotising sialometaplasia in the floor of mouth

Necrotising sialometaplasia is a benign self-limiting inflammatory process which occurs in the salivary gland tissue. The condition is a diagnostic challenge mimicking malignancy both clinically and histopathologically. Commonly, it presents in the hard palate. Here, we report an unusual case in a 56-year-old man which presented in the floor of the mouth.

Sonography of fat necrosis of the breast: Correlation with mammography and MR imaging

Fat necrosis (FN) of the breast is a benign nonsuppurative inflammatory process of the adipose tissue. The radiologic appearance ranges from benign to suspicious for malignancy; therefore, it is very important to know the distinguishing radiologic features of FN on different modalities. Mammography is more helpful in identifying FN than ultrasonography in most of the cases, and MRI may also be used to rule out malignancy as an adjunct to mammography and sonography. Even when modern diagnostic modalities are used, biopsy may still be unavoidable for some cases. In conclusion, an accurate history and familiarity with the radiologic findings are crucial to recognizing FN and avoiding unnecessary interventions.

Quantitative Ultrasound Elastography of Sclerotic Fat Necrosis After Autologous Fat Grafting for Augmentation Mammoplasty

Fat necrosis is a benign inflammatory process resulting from autologous fat grafting and may have several appearances at imaging. Ultrasound findings of sclerotic fat necrosis (SFN) can present as speculated mass and mimic those of malignant lesions. Virtual touch tissue quantification (VTQ) of acoustic radiation force impulse (ARFI) imaging is a quantitative technique used to measure tissue stiffness. The present study was conducted to assess the usefulness of VTQ in the differentiation of SFN from malignant masses. 14 pathologically proven cases of SFN after fat grafting and 32 malignant breast masses were examined using both conventional ultrasound and VTQ. The tissue stiffness for VTQ was expressed as shear wave velocity (SWV) (m/s), and receiver operating characteristic curve (ROC) analyses were performed to assess the diagnostic performance. The average SWVs of the SFN cases and the malignant masses were 2.117 m/s (range: 0.61-9.00 m/s) and 4.615 m/s (range: 2.32-9.00 m/s), respectively (p < 0.001). ROC analyses indicated that the area under the curve was 0.871 (p < 0.001). VTQ of ARFI imaging provides quantitative elasticity measurements of the tissue stiffness of fat necrosis. As such, VTQ could be a valuable complementary method for differentiating between SFN and malignant breast lesions.

19. Folliculotropic mycosis fungoides with cysts and comedones

Mycosis fungoides (MF) is the most common primary cutaneous T-cell lymphoma. Folliculotropic MF (FMF) is an uncommon variant, characterised by folliculocentric T-cell infiltrates. FMF shows a tendency towards more rapid progression than conventional MF and a relative resistance to skin targeted therapy, warranting its separation from conventional MF, which is reflected in the current WHO classification. The majority of cases of FMF present clinically with follicular papules, alopecia, mucinorrhoea and pruritis. In uncommon cases there can be an acneiform appearance. These cases show histological evidence of prominent milia, infundibular cysts and comedones. This uncommon form of an uncommon disease poses a significant diagnostic challenge, as there is close clinical and pathological mimicry of a number of benign folliculocentric inflammatory processes. We present a case of FMF with prominent follicular cysts, comedones and secondary granulomatous inflammation which was clinically and histologically mistaken for a benign process, including epidermal cyst, on two separate biopsies reported two years apart on two continents.

Orbital Psödotümör Tedavisinde Cyberknife® Fraksiyone Stereotaktik Radyoterapi Deneyiminin Ön Sonuçları

Orbital pseudotumor is a rare tumor of orbit which concerns a benign inflammatory process with an unknown etiology. They account for up to 10% of orbital masses and can involve any part of the orbit. Systemic steroids are the accepted as first line treatment modality. External beam radiation therapy has a well defined role in cases of failure, recurrences, persistent disease or medical contraindications for administration steroids. Management of orbital pseudotumors with stereotactic robotic radiotherapy was evaluated in a few studies. We aimed to describe a case involving the management of an orbital pseudotumor with the use of fractionated stereotactic radiotherapy using the CyberKnife® (Accuray Inc., Sunnyvale, CA).

Inflammation and preneoplastic lesions in benign prostate as risk factors for prostate cancer

AbstractBenign changes ranging from atrophy and inflammation to high-grade prostatic intraepithelial neoplasia (HGPIN) are common findings on prostate core needle biopsies. Although atrophy and inflammation may be precursors of prostate cancer, only HGPIN is currently recommended to be included in surgical pathology reports. To determine whether these benign findings increase prostate cancer risk, we conducted a case–control study nested within a historical cohort of 6692 men with a benign prostate specimen collected between 1990 and 2002. The analytic sample included 574 case–control pairs comprised of cases diagnosed with prostate cancer a minimum of 1 year after cohort entry and controls matched to cases on date and age at cohort entry, race, and type of specimen. The initial benign specimen was reviewed for presence of HGPIN, atrophy (simple, lobular, and partial) and inflammation (glandular and/or stromal). HGPIN significantly increased risk for prostate cancer (odds ratio (OR)=2.00; 95% confidence interval (CI)=1.25–3.20). Inflammation within the stromal compartment was associated with decreased risk (OR=0.66; CI=0.52–0.84), and diffuse stromal inflammation of severe grade had the strongest inverse association with risk (OR=0.21; CI=0.07–0.62). In a model adjusted for prostate-specific antigen (PSA) level at cohort entry and inflammation, simple atrophy was associated with a 33% increased prostate cancer risk that was marginally significant (P=0.03). Clinicians should consider patterns and extent of inflammation when managing high-risk patients with negative biopsy results. Identifying benign inflammatory processes that underlie high PSA levels would help to reduce the number of unnecessary repeated prostate biopsies.

Lymphomas of the head and neck in dermatological practice

The number of newly diagnosed cases of lymphomas of the head and neck region has been continually increasing over the recent years. The symptoms of these lymphomas are commonly similar to benign inflammatory diseases and thus frequently lead to clinical misdiagnoses. Many consultations, including dermatological one, and repeated tissue biopsies are often necessary because of the coexistence of necrosis and inflammation in the tumors. Biopsies should be deep enough – punch biopsies are not recommended. The classification of lymphomas has undergone dramatic changes with the increasing understanding and progress in immunohistochemistry and molecular biology. We describe five patients with lymphomas of oral and nasal cavities: 2 derived from B-cells, 2 from T-cells, and 1 from NK/T-cells. The initial presentation of these diseases often suggests an inflammatory process, such as an odontogenic inflammation, sinusitis or benign inflammatory process.

Mastitis granulomatosa crónica idiopática

Chronic idiopathic granulomatous mastitis (CIGM) is a benign inflammatory disease with a low incidence. This entity has been associated with an abnormal immune response, oral contraceptive use and the existence of an infectious organism as a possible cause of an allergic reaction to a foreign body. CIGM mainly affects women of childbearing age, is usually unilateral and is manifested by one or more inflammatory masses. The mammographic appearance may mimic the development of intraductal carcinoma, Paget's disease or benign inflammatory processes of the breast of various etiologies. Histopathologically, CIGM is characterized by chronic, necrotizing, non-caseating lobulitis, which shows formation of granulomas. The diagnosis of CIGM should be established on the basis of this pattern, combined with exclusion of other granulomatous lesions of the breast. Although various medical and surgical therapeutic options have been proposed, the optimal treatment of CIGM has not yet been established. The most commonly used treatment is surgical resection of affected tissue with or without oral corticosteroid therapy.

Idiopathic orbital inflammation with a rare parotid extension: a case report and review of literature

Objective: Idiopathic orbital inflammation (IOI) is a benign inflammatory process usually confined to the orbit, with preponderance for extraorbital extension (EOE). We describe a case of IOI with possible extension to the parotid gland, a presentation yet to be reported in the literature.

Current Surgical Treatment for Chronic Pancreatitis

Chronic pancreatitis (CP) is a painful, yet benign inflammatory process of the pancreas. Surgical management should be individualized because the pain is multifactorial and its mechanisms vary from patient to patient. Two main pathogenetic theories for the mechanisms of pain in CP have been proposed: the neurogenic theory and the theory of increased intraductal/intraparenchymal pressures. The latter theory is strongly supported by the good results of drainage procedures in the surgical management of CP. Other possible contributing factors include pancreatic ischemia; a centrally sensitized pain state; and the development of complications, such as pseudocysts and stenosis of the duodenum or common bile duct. Common indications for surgery include intractable pain, suspicion of neoplasm, and complications that cannot be resolved with radiological or endoscopic treatments. Operative procedures have been historically classified into 4 categories: decompression procedures for diseased and obstructed pancreatic ducts; resection procedures for the proximal, distal, or total pancreas; denervation procedures of the pancreas; and hybrid procedures. Pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy, once the standard operations for patients with CP, have been replaced by hybrid procedures, such as duodenum-preserving pancreatic head resection, the Frey procedure, and their variants. These procedures are safe and effective in providing long-term pain relief and in treating CP-related complications. Hybrid procedures should be the operations of choice for patients with CP.

Secondary follicular mucinosis associated with systemic lupus erythematosus

A 61-year-old woman presented with a five-month history of an intermittent eruption of papules and nodules on her face and neck. Past medical history included systemic lupus erythematosus. Histopathologic examination was consistent with secondary follicular mucinosis in association with systemic lupus erythematosus. This rare entity has been described in one prior report as a precursor to the clinical onset of systemic lupus erythematosus. Follicular mucinosis occurs as either a primary idiopathic form or a secondary form associated with either benign inflammatory processes or malignant conditions, such as cutaneous T-cell lymphoma. Numerous treatments for primary follicular mucinosis have been described, which include isotretinoin and glucocorticoids, whereas treatment of the underlying disease is necessary in the secondary form. The association with lymphoma mandates long-term clinical monitoring of patients with particularly recalcitrant, widespread, or chronic follicular mucinosis.

Focal myositis of the tongue presenting as macroglossia

Focal myositis (FM) is a benign localized inflammatory process of unknown aetiology, which presents as a rapidly enlarging soft-tissue mass that evolves into a localized lesion. It is most often mistaken for a neoplasm. Histologically, it is characterized by marked myopathic changes of the muscle fibres, lymphocytic infiltration and interstitial fibrosis. We describe a case of focal myositis of the tongue and review this rare condition.

P0559 INFECTIOUS ENDOCARDITIS OVER 10 YEARS IN AN INTERNAL MEDICINE DEPARTEMENT

parasitic and mycotic infections), malignancy (breast carcinoma) and other causes of granulomatous disease (as sarcoidosis, Wegener’s granulomatosis, giant cell arteritis or polyarteritis nodosum). Case report: A 38-year-old pre-menopausal woman presented with a twoweek history of a left breast mass. She had no particular medical records, there was no history of oral contraceptive use and she breastfed her 3-year-old child for 16 months. Concerning family illness, she had two aunts affected with breast cancer. The woman was apyretic and on physical examination there was a hard and painful mass, with 10cm diameter, on her left breast. The overlying skin showed signs of inflammation, and a 2cm palpable lymph node was present in the ipsilateral axilla. She began therapy with a broad spectrum antibiotic, which showed no success in resolving the lesion. Radiologic data was suggestive of a malignant process. Fine needle aspiration cytology was performed, as well as a skin, breast and lymph node biopsy, but the histopathologic results were inconclusive. Therefore, a wide excision was done, which revealed an inflammatory nonspecific mastitis with all microbiology and serological tests being negative. She was than treated with prednisone 60mg, gradually tapered in 6 weeks, and after 1 year had no recurrence. Conclusion: IGM is a rare and benign inflammatory process, commonly mistaken for malignancy and consequently can lead to unnecessary surgical procedures. Correct diagnosis requires the exclusion of malignancy, other granulomatous disease and infectious etiologies, combined with definitive histopathological confirmation. There is no clear clinical consensus regarding the ideal therapeutic management of IGM, but corticoid therapy should be an option.

Abstract No. 8: Clinical Significance of Post Renal Transplant Ureteritis Following Treatment with Multi-Purpose Biliary Drainage Catheters

A mainstay of percutaneous treatment of urological complications following kidney transplantation is drainage via multi-purpose biliary catheters. The effect of the large side-bores on these catheters on the adjacent ureter is not well understood or described. This study retrospectively evaluates the hypothesis that the presence of internal biliary drains correlates with the secondary radiographic appearance of ureteritis. Further, the study attempts to assess the clinical significance of this finding. Ureterograms performed on post renal transplant referrals for percutaneous nephrostomy (PCN) were retrospectively analyzed for 1) ureteral appearance, 2) position/type of prior PCN drainage, and 3) corresponding plasma creatinine (Cr). Patients were excluded for: 1) incomplete follow-up, 2) referrals after surgical revision of the ureteral anastamosis, and 3) underlying lymphoproliferative disorders. Patients were categorized: Group 1 (internal-external drain only), Group 2 (external only), Group 3 (internal-external drain followed by subsequent external drainage), and Group 4 (external drain followed by subsequent internal-external drain). Assessment of ureterograms for changes in ureteral appearance was correlated with Cr to quantify the clinical significance. From April 2000 to June 2007, 1619 renal transplants were performed. Thirty-four of 44 referrals for PCN met inclusion and exclusion criteria. Ureteral irregularity (n=15) occurred either after internal-external drain placement or after conversion from external to internal-external drain in 14 patients (93%). Eight of 15 (53%) patients had persistent ureteritis until conclusion of treatment; 7 of 8 had eventual nephrectomy or stricture resection. Seven of 15 (47%) patients had spontaneous resolution of the finding on subsequent imaging. Diffuse ureteral irregularity may accompany refractory strictures; this finding may also reflect a benign inflammatory process. Presence of this finding is associated with prior internal-external biliary catheters. Our study suggests further investigation into transplant-specific drainage catheters to differentiate benign processes from those requiring definitive treatment.

Inflammatory Myofibroblastic Tumor of the Nasal Cavity

Inflammatory myofibroblastic tumor is an uncommon tumor composed of myofibroblasts and various types of inflammatory infiltrates that rarely undergoes malignant transformation. It commonly involves the lung, liver, mesentery but rarely affects the head and neck region. Although inflammatory myofibroblastic tumor is generally considered a benign reactive inflammatory process, it may present clinically and radiologically as an invasive mass destructing the surrounding structures. Therefore, it should be considered as one of several differential diagnoses from malignant tumors. We present a case of inflammatory myofibroblastic tumor involving the nasal cavity, maxillary, ethmoid, and sphenoid sinus with a fatal outcome. Korean J Otorhinolaryngol-Head Neck Surg 2009;52:1005-8 Key WordsZZInflammatory myofibroblastic tumor·Nasal cavity·Steroids.

The Hysteroscopic Approach to Sterilization

Permanent sterilization is the most common form of contraception in the United States today. Previously, this was accomplished via the laparoscopic method. A new less invasive method has been developed, in which the Essure microinsert is inserted through a hysteroscope into the fallopian tubes. A subsequent benign inflammatory process results in tubal occlusion within 3 months of insertion. Approved since 2002, this method offers high efficacy without incisions, general anesthesia, or a prolonged recovery period.