Benign Soft Tissue Tumors Research Articles

Management of Hemangioma Buccal Mucosa by Sclerotherapy - A Case Report

Haemangiomas are the most common benign soft tissue tumours of the oral cavity. It often presents at birth or soon after and appears as a soft and vascular swelling in the lip, tongue, or buccal mucosa. It can be managed medically or surgically. This article reports a case of hemangioma of the buccal mucosa in a 13- year-old boy effectively managed by sclerotherapy

Insights into the Distribution Patterns of Foot and Ankle Tumours: Update on the Perspective of a University Tumour Institute.

The rarity of foot and ankle tumours, together with the numerous histological entities, presents a challenge in accumulating sufficient patients to draw reliable conclusions. Therefore, we decided to present an update of a retrospective analysis of their distribution patterns, comprising 536 cases of foot and ankle tumours presented to our tumour board between June 1997 and June 2023. Our aim was to provide a comprehensive overview of the prevalence and distribution patterns of benign and malignant bone and soft tissue tumours of the foot and ankle. A total of 277 tumours involved bone (51.7%). Of these, 242 (87.4%) were benign and 35 (12.6%) were malignant. In addition, 259 soft tissue tumours (48.3%) were found, of which 191 (73.7%) were benign and 68 (26.3%) were malignant. The most common benign bone tumours were simple bone cysts, enchondromas, osteochondromas, aneurysmal bone cysts, and lipomas of bone. Common benign soft tissue tumours included a tenosynovial giant cell tumour, haemangioma, plantar fibromatosis, schwannoma, and lipoma. The most common malignant soft tissue tumours were synovial sarcoma, malignant melanoma, and myxofibrosarcoma. In terms of anatomical location, the hindfoot was the most common site (28.7%), followed by the midfoot (25.9%), ankle (25.4%), and forefoot (20.0%). The distribution of benign entities often follows typical patterns, which may facilitate an early diagnosis even without biopsy (e.g., simple bone cyst, plantar fibromatosis). On the other hand, the distribution patterns of many rare or malignant entities are inconsistent. Individual soft tissue malignancies occur very sporadically, even over long periods of time and in specialized tumour centres. It is therefore important to recognise that any suspicious mass in the foot and ankle must be considered a possible malignancy until proven otherwise.

Economic evaluation of percutaneous cryoablation vs conventional surgery in extra-abdominal desmoid tumours in the Spanish healthcare system

BackgroundDesmoid tumours (DTs) or deep fibromatosis are benign soft-tissue tumours, sometimes locally aggressive, requiring intervention on some cases. Surgery has been the gold standard, but new less invasive techniques such as percutaneous cryoablation have proved their effectiveness, reducing health resources and complications. The study aimed to compare the total cost of percutaneous cryoablation and conventional surgery for patients with extra-abdominal and/or abdominal wall DTs, candidates for local ablative treatment in Spain.MethodsA cost-analysis model was developed. An expert panel provided data about resource consumption for the percutaneous cryoablation technique and validated the epidemiology used for target population estimation. Unitary resources cost (€ 2022) derived from local cost databases. A retrospective analysis of 54 surgical cases in 3 Spanish hospitals was performed to estimate the cost of conventional surgery based on the cost of the Diagnosis-Related group (DRG) codes identified on this patient sample, weighted by each DRG proportion. The total cost for each alternative included intervention cost and complications cost, considering debridement required in 4.5% of cases with percutaneous cryoablation and minor surgery for surgical site infection in 18.0% for conventional surgery.ResultsThe total cost for percutaneous cryoablation (€ 5774.78/patient-year) was lower than the total cost for conventional surgery (€ 6780.98/patient-year), yielding cost savings up to € 80,002 in 1 year for the entire cohort of 80 patients with DTs eligible for intervention estimated in Spain. One-way sensitivity analyses confirmed the results’ robustness.ConclusionPercutaneous cryoablation versus conventional surgery would yield cost savings for the management of DT patients in Spain.Critical relevance statementThis manuscript provides insight into the economic impact derived from the savings related to the use of percutaneous cryoablation for desmoid-type tumours from the perspective of the Spanish National Healthcare System, providing useful information for the health decision-making process.Key points• Desmoid tumours are locally aggressive and may require local therapy.• Percutaneous cryoablation procedure is less invasive than the conventional surgery.• Cost comparison shows savings associated to percutaneous cryoablation use.Graphical

Distribution Patterns of Benign and Malignant Bone and Soft Tissue Tumors and Tumor-like lesions in the Hindfoot and Ankle: A 12.5-year Analysis.

Benign and tumor-like lesions of the hindfoot and ankle are common, whereas malignant entities are rare. Accurate evaluation and timely management of these lesions can be challenging, making it crucial to understand their incidence and anatomic localization. This study retrospectively analyzed the distribution of benign and malignant bone and soft tissue tumors in the hindfoot and ankle. This study included patient data from a single center, such as age, sex, histologic diagnosis, and anatomic location over a 12.5 year period. Of the 105 cases reviewed, 19 cases (18.1%) were osseous lesions and 86 cases (81.9%) were soft tissue lesions. The latter were divided into 77 benign and 9 malignant cases, resulting in an overall malignancy rate of 8.6%. The most common osseous lesion was the intraosseous ganglion (n=12). The majority of benign soft tissue lesions (75.3%) were located in the hindfoot, with TGCT, schwannoma, and ganglion cysts being the most common types. The nine malignant cases were distributed among seven entities and were evenly distributed among both regions and sexes. Malignant cases had a higher mean age (59.2 years) compared to benign cases (40.8 years; p=0.001). Tumors, tumor-like lesions, and pseudotumors represent an important aspect of ankle pathology. The majority of focal masses and swellings are benign soft tissue or osseous lesions, but malignant entities can occur and may be mistaken for benign conditions. Preoperative imaging and histopathologic examination are essential, and preoperative presentation to a multidisciplinary tumor board is recommended in unclear cases.

Tumours of the foot: A 10 years retrospective analysis.

The foot is a complex structure composed of several tissues, each of which can be the origin of the proliferation and development of the tumour. Most lesions about the foot are reactive or inflammatory, but some are true neoplasms. This is a retrospective analysis of 4997 patient records treated in the Orthopaedic Oncology Unit of University Malaya Medical Centre, Malaysia, between 1 January 2010 to 31 December 2020. Demographic data of 195 patients with foot tumours were analysed out of 4997 neoplasm patients. There were 195 cases of foot tumours: 148 were benign, and 47 were malignant. 47 were bone tumours, 4 were metastases, and 144 were soft tissue tumours. Six patients succumbed to the disease, two cases of giant cell tumour (GCT) and one patient with synovial sarcoma had a recurrence. Treatment of foot tumours was wide resection in general. However, in metastasis cases, amputation was done. The majority of tumours were in the toes and dorsum of the foot. Soft tissue tumours of the foot occur in the elderly population in contrast to bone tumours, mainly in the second decade of life. The gender distribution was almost equal for foot tumours. Ganglion and Giant Cell Tumour of the bone are the commonest benign soft tissue and bone tumours. The most common malignant soft tissue and bone tumours are malignant melanoma and chondrosarcoma. The amputation rate is 5.64% the recurrence rate is 1.54%. Mortality rate is 3.08%. The MSTS score is 79%, and the TESS score is 76.23%. Foot tumours are relatively rare, mostly originating from soft tissue and exhibiting a benign nature. Nonetheless, a noteworthy proportion-approximately a quarter of these tumours-demonstrate malignancy. The surgical interventions undertaken in managing these tumours and associated functional outcomes generally yield acceptable results.

Hemmorhagic Cutaneous Ancient Schwannoma of The Mastoid: A Systematic Review

Schwannomas synonymously known as neurilemmomas or neurinomas are uncommon benign neoplasms of neural sheath origin. They account for 5% of all benign soft-tissue tumors. 6%–8% of tumors occur intracranially and 25%–45% occur extracranially in the head-and-neck region, of which cutaneous schwannomas located in the dermis or subcutaneous tissue in the head and neck are an unusual entity. Of the seven subtypes described by Erlandson, ancient schwannoma is a very rare distinctive histopathological variant resulting from long-term degenerative changes and accounts for 0.8% of all soft-tissue tumors. This seminal article is a systematic review of schwannomas in the ear in its entirety from 1977 to 2023 along with a case report of a profusely bleeding cutaneous ancient schwannoma occurring in the mastoid region in a swelling of a short duration of 6 months in a 75 year old female. To the best of our knowledge, this case has two firsts to its credit. It is the first reported case of an ancient schwannoma in the mastoid region and also the first reported case presenting with bleeding from the schwannoma. Due to its rarity, ancient schwannoma must be included in the differential diagnosis for any bleeding mass in the ear to avoid an erroneous diagnosis of malignancy.

Unique benign soft tissue tumor suspected pyogenic granuloma in a young female hard palate: a case report

Objectives: This case aims to report the finding of a unique lesion in the maxilla in a young female patient. Case Report: The patient, a 21-year-old female, presented with a painless swelling on the left palate for the past 3 months, causing discomfort during eating. On intra-oral examination, there was visible swelling in the left hard palate area, extending from teeth 23 to 26 and extending to the middle of the palate. The patient was referred for a CBCT examination. The aim of writing this article is to assess the findings of a unique case of benign tumor of the palate. The results of the CBCT examination showed radiolucent lesions in the palatal mucosal area without bone resorption. The density of the lesion was higher than that of the surrounding mucosa. The lesion does not damage the tissue of the surrounding area. This is unique because swelling of this size is usually accompanied by extensive bone resorption. Based on its nature, this lesion was diagnosed as a benign soft tissue tumor with differential diagnoses of pyogenic granuloma, pleomorphic adenoma, leiomyoma, and desmoplastic fibroma. Conclusion: The lesion found was a soft tissue tumor lesion at the time; it was found to have a non-aggressive and non-expansive nature, making it difficult to determine a specific radiodiagnosis. The differential diagnosis of this case has been established as follows: Pleomorphic adenoma, pyogenic granuloma and leiomyoma, and pyogenic granuloma, were the options for establishing a provisional radiodiagnosis.

BUKKAL OSTEOKONDROİD LİPOMA: OLGU SUNUMU

Aim: Lipomas are the most common benign soft tissue neoplasms that rarely contain osseous and chondroid tissues. Lipoma with osteochondral tissue is usually named osteolipoma or chondrolipoma. In this article, we aimed to discuss the differential diagnosis and clinical features of osteochondroidlipomas.
 Case: We present a case of osteochondroid lipoma of the buccal region. Radiologic examination revealed a well-defined, lipomatous lesion that contained rough calcified areas. Intraoral excision was applied for the surgical treatment. There was no local recurrence in the follow up.
 Conclusions: Lipomas with osteochondroid metaplasia are rare lesions in the head and neck region. Osteochondroidlipomas should be considered in lipomatous lesions containing calcified areas that are well-defined, and they do not show erosion and destruction in the surrounding tissues in radiological imaging.

Large intramuscular and parosteal lipoma of the upper limb: A case report and literature review

Although lipomas are the most common benign soft-tissue tumors, the intramuscular type is rare and the parosteal type is even rarer. These types of tumors can present like malignant tumors like liposarcoma. Unlike superficial lipomas, deep lipomas (intramuscular/parosteal) require magnetic resonance imaging to evaluate for and rule out malignant features. We report this patient with giant and mixed types of rarest lipomas (intramuscular and parosteal) that arise from the humeral periosteum and within the brachioradialis muscle with encasement of the radial nerve. We aimed to increase awareness to think outside the box and shed light on this giant, rarest mixed type of intramuscular and parosteal lipomas. Furthermore, it emphasizes the need for careful investigations to rule out malignant tumors like liposarcoma. Finally, many orthopedic oncology centers designate large, deep lipomas as low-grade liposarcoma due to the risk of local recurrence.

Benefit of Using Both Ultrasound Imaging and Clinical Information for Predicting Malignant Soft Tissue Tumors.

Ultrasonography (US) is the primary imaging method for soft tissue tumors (STTs), the diagnostic performance of which still requires improvement. To achieve an accurate evaluation of STTs, we built the diagnostic nomogram for STTs using the clinical and US features of patients with STTs. A total of 613 patients with 195 malignant and 418 benign STTs were retrospectively recruited. We used a blend of clinical and ultrasonic features, as well as exclusively US features, to develop two distinct diagnostic models for STTs: the clinical-US model and the US-only model, respectively. The two models were evaluated and compared by measuring their areas under the receiver operating characteristic curve (AUC), calibration, integrated discrimination improvement (IDI) and decision curve analysis. The performance of the clinical-US model was also compared with that of two radiologists. The clinical-US model had better diagnostic performance than the model based on US imaging features alone (AUCs of the clinical-US and US-only models: 0.95 [0.93-0.97] vs. 0.89 [0.87-0.92], p < 0.001; IDI of the two models: 0.15 ± 0.03, p < 0.001). The clinical-US model was also superior to the two radiologists in diagnosing STTs (AUCs of clinical-US model and two radiologists: 0.95 [0.93-0.97] vs. 0.79 [0.75-0.82] and 0.83 [0.80-0.85], p < 0.001). The diagnostic model based on clinical and US imaging features had high diagnostic performance in STTs, which could help identify malignant STTs for radiologists.

Elastofibroma: a literature review and clinical case

Elastofibroma is a rare, slow growing, benign soft tissue tumor characterized by a typical location in the subscapularis. It has a mesenchymal origin and consists of proliferating fibrous and adipose tissue with elastic and collagen fibers in its composition. Pain and discomfort in the subscapular region, restriction on movement are typical complaints for patients with elastofibroma, however, the absence of clinical symptoms and difficult differential diagnosis make it difficult to choose treatment tactics. A 70-year-old patient applied to a surgeon at the Clinical Diagnostic Center of the Central Clinical Hospital of St Alexis with complaints of a painless tumor-like subcutaneous mass in the region of the lower angle of the right scapula. She noted the presence of this formation 5 years ago, during this time the tumor gradually grew. When viewed on the back along the lower edge of the right shoulder blade, a volumetric tumor-like formation in the form of a ball measuring 7.5 × 6.0 × 2.0 cm, soft-elastic consistency is determined. On palpation, painless, not soldered to the skin. The skin over the formation is not changed. A preliminary diagnosis was established lipoma of the back. The diagnosis of elastofibroma was established after ultrasound of the posterior chest wall, MSCT of the chest. For differential diagnosis, the puncture biopsy material was sent for histological examination, the result of which confirmed the diagnosis of elastofibroma. Observational tactics in this case is preferable, since elastofibroma is not accompanied by pain, limitation of mobility, and does not bring discomfort when moving. Thus, at the moment, imaging methods allow establishing an accurate diagnosis, but histological examination is necessary for differential diagnosis. However, a histologically confirmed diagnosis will not always be an indication for surgery. In most cases, in the absence of clinical manifestations, observational tactics are followed in the treatment.

Hibernoma mimicking a lipoma: A case report of a rare benign tumor

Hibernomas are rare, benign soft tissue tumors developed from fetal brown fat [1]. They account for around 1.6% of benign lipomatous tumors and present as progressive, slow-growing, painless subcutaneous masses [2]. Hibernomas resemble lipomas in their clinical behavior, but their unique imaging and histopathologic features may aid in differentiating them from each other [1]. We report a case of a 19-year-old Emirati woman who presented with painful lower back swelling for one year. The lesion was excised, and the histopathology revealed a diagnosis of hibernoma. The patient had an uneventful postoperative course and was discharged on the second postoperative day. The management approach of hibernomas varies as per the symptoms, our patient was managed with surgical intervention whereas asymptomatic patients can be observed. Surgical resection is the definitive treatment. No local recurrence has been reported.

Synchronous presentation of giant anterior neck lipoma and interarytenoid hamartoma

Giant lipomas are benign soft tissue tumor found rarely in the neck and are still rarer in the anterior part of neck. Laryngeal hamartoma (LH) is a very rare lesions and the number of reported cases is limited. Herein, we report a case of 68 years old male with a history of painless, slow growing swelling on anterior neck for past 8 years and also complaints of dyspnoea and stridor for past 6 months. FNAC from anterior neck swelling was suggestive of lipoma. USG and CT findings were suggestive of soft tissue lesions. Indirect and flexible laryngoscopy shows a large pedunculated, globular mass in interarytenoid region. A complete surgical excision of the anterior neck mass and interarytenoid polyp was done. Diagnosis of lipoma and hamartoma was confirmed on histopathology. Patient was followed up for 2 years with no evidence of recurrence.

Large Sublingual Lipoma: A Case Report.

Lipomas are benign soft tissue tumors frequently observed throughout the body. Lipomas rarely cause health concerns; however, when symptomatic, it is often related to their location and size. A 65-year-old male patient presented with a non-tender, enlarging mass in the anterior floor of the mouth, which was otherwise asymptomatic. Computed tomography evaluation revealed an unusually large hypolucent mass, posterior to the inner table of the right anterior mandible. Surgical excision was uncomplicated. Upon follow-up, the right anterior floor of the mouth wound healed without compromise of the lingual or hypoglossal nerves or Wharton's duct. This discussion highlights the infrequent occurrence of lipomas in the oral cavity, particularly in the floor of the mouth, including patient presentation, preoperative evaluation, and surgical planning.

Gossypiboma left behind in a cesarean section ended up with a failed laparotomic excision, which demanded another laparotomy to remove it: a rare case report

Introduction and importance: Retained surgical items are an uncommon complication for surgical operations, with an estimated incidence of 1 in 5500 to 1 in 18 000 operations. Retained surgical sponges are the most common retained surgical items, accounting for nearly 70%. In 1884, Wilson reported the first retained foreign body after laparotomy. Case presentation: A 22-year-old woman was referred to our hospital complaining of a feeling of abdominal bloating and heaviness associated with pain, fever, fatigue, and severe stink vaginal discharges. Past surgical history included a cesarean section followed by laparotomy to remove a foreign body left behind; the obstetrician denied the presence of any foreign body. The diagnosis of retained surgical sponges was done in our hospital, according to the clinical history and radiographic study. The second laparotomy was performed, and the surgical sponge was removed. Clinical discussion: Retained surgical items' symptoms vary according to the site and types of materials. The diagnosis may be difficult because it resembles benign or malignant soft-tissue tumors of the abdomen and pelvis. Ultrasound and computed tomography have been used for the diagnosis of retained surgical items. The minimally invasive surgical approach appears to be most successful if the object is located early in the postoperative course. Conclusion: Retained surgical items are serious problems of surgical operations and should be among the differential diagnosis of any abdominal pain in patients with a history of prior surgery.

Diagnostic Superiority of Dual-Time Point [18F]FDG PET/CT to Differentiate Malignant from Benign Soft Tissue Tumors.

[18F]FDG PET/CT is used in the workup of indeterminate soft tissue tumors (STTs) but lacks accuracy in the detection of malignant STTs. The aim of this study is to evaluate whether dual-time point [18F]FDG PET/CT imaging (DTPI) can be useful in this indication. In this prospective study, [18F]FDG PET/CT imaging was performed 1 h (t1) and 3 h (t2) after injection. Tumor uptake (SUVmax) was calculated at each time point to define a retention index (RI) corresponding to the variation between t1 and t2 (%). Sixty-eight patients were included, representing 20 benign and 48 malignant tumors (including 40 sarcomas). The RI was significantly higher in malignant STTs than in benign STTs (median: +21.8% vs. -2%, p < 0.001). An RI of >14.3% predicted STT malignancy with a specificity (Sp) of 90% and a sensitivity (Se) of 69%. An SUVmaxt1 of >4.5 was less accurate with an Sp of 80% and an Se of 60%. In a subgroup of tumors with at least mild [18F]FDG uptake (SUVmax ≥ 3; n = 46), the RI significantly outperformed the diagnostic accuracy of SUVmax (AUC: 0.88 vs. 0.68, p = 0.01). DTPI identifies malignant STT tumors with high specificity and outperforms the diagnostic accuracy of standard PET/CT.

Submental Lipoma – A Case Report

Lipomas are one of the most common benign soft tissue tumors encountered in adult patients. It can occur anywhere in the body but is not commonly seen in the head and neck region. Malignancy must be ruled out especially if the swelling is significant. Detailed clinical examination, fine needle aspiration, and imaging can aid the diagnosis and surgical planning.

Angioleiomyoma - A Case Report.

Angioleiomyoma is a rare benign soft tissue tumour arising from smooth muscle, representing <1% of upper limb soft tissue tumours. We report a 54-year-old male presenting with a progressively enlarging atraumatic lesion along the palmar side of the base of the ring and little finger. A biopsy was done to determine the diagnosis. Intraoperatively, the lump was found to be intimately related to the radial digital artery, it could not be excised en-bloc without transecting the radial digital artery of the little finger. Following excision, the ends of the digital artery were anastomosed. At 10-months follow-up, the hand was fully functional without any evidence of cold-intolerance or neurological deficit along the distribution of the digital nerve. We review the literature on angioleiomyoma and report careful resection of the tumour with digital artery transection and repair as a treatment option for angioleiomyoma of the digital artery. Level of Evidence: Level V (Therapeutic).

Giant Lipoma of the Hypothenar Eminence A Case Report and Review of Literature

Lipomas are very frequent benign soft tissue tumors. They are ubiquitous in the human body but their incidence in the hand is rare. This is a case report of a 20-year-old female who presented with a 10-month history of painful swelling over her palm. Surgical excision of the tumor was done without any consequences on the hand’s function and no signs of recurrence at the latest follow-up of 2 years. Although hand lipomas are rare, they should not be neglected. The anatomic particularities of the hand require special care in the diagnostic and therapeutic approach to these tumors.

An Unusual Presentation of Angiolymphoid Hyperplasia with Eosinophilia as Postauricular Mass: A case Report.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare, benign, reactive vaso-proliferative condition in the dermal and subcutaneous tissues of the head and neck. A 28-year-old female presented with slow-growing painless swelling behind her left ear. FNAC revealed benign soft tissue neoplasm and histopathological examination after surgical excision revealed angiolymphoid hyperplasia with eosinophilia. ALHE origin has been variously attributed to prior trauma, hyperestrogenemia, infectious agents, atopy, reactive hyperplasia, and benign neoplasia. Retroauricular ALHE has been rarely reported. However, on the basis of our case report, it should be a viable differential diagnosis when large subcutaneous tumors of the head and neck are encountered. When big subcutaneous tumors of the head and neck are present, especially in females, a valid differential diagnosis for angiolymphoid hyperplasia with eosinophilia, a rare condition marked by dermal or subcutaneous endothelial cell proliferation, should also be considered.