Benign Solid Tumors Research Articles

DIAGNOSTIC VALUE OF MULTI-SLICE CT SCAN FOR RENAL ANGIO- MYOLIPOMA DETECTION: A CASE REPORT

Background: Angiomyolipoma (AML) is a rare solid benign tumor that occurs at many sites, more commonly in the kidney, which arises from either the renal pelvis or the sinus, also referred to as renal hamartoma. AML is composed of blood vessels, smooth muscle cells, and fat hence the name. They are seen 80-90% as isolated lesions that occur sporadically and seen 25-50% of patients with tuberous sclerosis. AML may hard to be distinguished from renal cell carcinoma because of its presentation as enlarged lump. Computed tomography may help to diagnose AML. To get a definite diagnosis of AML, excision and histopathological examination is recommended in symptomatic patients, especially to prevent rupture hemorrhage. Objective: The purpose of this study was to evaluate multi-slice computed tomography with contrast in a male patient aged 49 years with Angiomyolipoma Case description: We herein present a case of renal AML in a 49 years old male patient, who presented with left flank pain for ~1 year. He has no history of hematuria and dysuria and tuberous sclerosis. Multi-slice computed tomography with contrast demonstrates a hypodense inhomogenous mass measuring 11x9,3 cm in the upper pole of the left kidney, hypertrophy of the left kidney, and hump sign of left kidney. At the later date, the patient underwent total left nephrectomy at another hospital and the postoperative histopathological examination confirmed the lesion as an AML. Conclusion: Angiomyolipoma is a rare benign tumor which usually occurs in the kidney that can be confused with malignant tumor. Ultrasonography and computed tomography can help to diagnose AML. The symptomatic patient requires surgical intervention.

Opere edilen 51 fibrom/fibrotekom vakasının klinikopatolojik bulgularının değerlendirilmesi

Aim: Ovarian fibroma, fibrothecoma and thecoma are benign neoplasia of the ovary. The aim of this study is to analyze the clinical characteristics, histopathological results and surgical management of ovarian fibroma/fibrothecoma.Materials and Methods: This is a retrospective study of 51 cases who underwent surgical treatment because of adnexial mass. The cases reported as ovarian fibroma/fibrothecomas were analyzed.Results: The mean age of patients were 58.7 years old. The avarage diameter of tumours was 8.23 cm. The final pathological results were fibroma, fibrothecoma, celluler mitotic fibroma, respectively 45.2%, 35.3%, 13.7%. Ascite was viewed in 6 (11.7%) cases. Ca-125 levels were high in 12 cases (23.5%). 11(21.6%) patients underwent laparoscopy and 40 (78.4%) underwent laparotomy.Conclusion: Ovarian fibroma/fibrothecomas are rarely, benign solid tumors. They can be mistaken as myoma or malignancy because of the apperance of tumor with high level Ca-125. These tumors can be treated succesfully by laparoscopy or laparotomy.

Cross-sectional imaging assessment of renal masses with emphasis on MRI.

Magnetic resonance imaging (MRI) is a useful complementary imaging tool for the diagnosis and characterization of renal masses, as it provides both morphologic and functional information. A core MRI protocol for renal imaging should include a T1-weighted sequence with in- and opposed-phase images (or, alternatively with DIXON technique), T2-weighted and diffusion-weighted images as well as a dynamic contrast-enhanced sequence with subtraction images, followed by a delayed post-contrast T1-weighted sequence. The main advantages of MRI over computed tomography include increased sensitivity for contrast enhancement, less sensitivity for detection of calcifications, absence of pseudoenhancement, and lack of radiation exposure. MRI may be applied for renal cystic lesion characterization, differentiation of renal cell carcinoma (RCC) from benign solid renal tumors, RCC histologic grading, staging, post-treatment follow-up, and active surveillance of patients with treated or untreated RCC.

Meigs syndrome with pleural effusion as initial manifestation: A case report

BACKGROUNDMeigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor, ascites, and pleural effusion. In postmenopausal women with pleural effusions, ascites, elevated CA-125 level, and pelvic masses, the probability of disseminated disease is high. Nevertheless, the final diagnosis is based on its histopathologic features following surgical removal of a mass lesion. Here we describe a case of Meigs syndrome with pleural effusion as the initial manifestation.CASE SUMMARYA 52-year-old woman presented with a 2-mo history of dry cough and oppression in the chest and was admitted to our hospital due to recurrent pleural effusion and gradual worsening of dyspnea that had occurred over the previous month. Two months before admission, the patient underwent repeated chest drainage and empirical anti-tuberculosis treatment. However, the pleural fluid accumulation persisted, and the patient began to experience dyspnea on exertion leading to admission. A computed tomography scan of the chest, abdominal ultrasound, and magnetic resonance imaging confirmed the presence of right-sided pleural effusion and ascites with a right ovarian mass. Serum tumor markers showed raised CA-125. With a suspicion of a malignant tumor, the patient underwent laparoscopic excision of the ovarian mass and the final pathology was consistent with an ovarian fibrothecoma. On the seventh day postoperation, the patient had resolution of the right-sided pleural effusion.CONCLUSIONDespite the relatively high risk of malignancy when an ovarian mass associated with hydrothorax is found in a patient with elevated serum levels of CA-125, clinicians should be aware about rare benign syndromes, like Meigs, for which surgery remains the preferred treatment.

Evaluation of vitamin D receptor expression in uterine leiomyoma and nonneoplastic myometrial tissue: a cross\u2010sectional controlled study

BackgroundUterine myomas are the most frequent benign solid pelvic tumors in women of reproductive age. At present, uterine myomas are the most common indication for hysterectomy because of the morbidity they cause, including intense bleeding, compression of adjacent organs, pain, and infertility. Some studies show that vitamin D receptor (VDR) expression is correlated with the etiology of uterine leiomyomas. This study aimed to assess the expression of VDR in uterine leiomyoma and nonneoplastic myometrial tissue.Methods A controlled cross-sectional study involving 40 women who underwent abdominal hysterectomy the Department of Gynecology of the Getúlio Vargas Hospital of Federal University of Piauí, Brazil, was performed to compare the immunohistochemical expression of VDR in samples of uterine leiomyoma tissue with adjacent nonneoplastic myometrial tissue. The mean percetages of stained nuclei in the two groups was compared by Student’s t teste, with significance established at p < 0.05.ResultsThe percentage of cells with nuclei stained by anti-VDR in the myometrial and leiomyoma tissue was 79.52 % (± 4.32) and 60.22 % (± 7.24), respectively (p < 0.0001).ConclusionsThe mean percentage of nuclei expressing VDR was significantly lower in the uterine leiomyoma than in nonneoplastic myometrial tissue.

Focal nodular hyperplasia mimicking hepatocellular adenoma and carcinoma in two cases

Focal nodular hyperplasia (FNH) is a solid benign tumor of the liver, predominantly in young women. A correct diagnosis of FNH is essential for making appropriate clinical decisions and avoiding unnecessary liver resection. Herein, we reported that two male cases with FNH, who initially presented with persistent abdominal discomfort, were misdiagnosed with hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC) on contrast-enhanced magnetic resonance imaging and computed tomography scans, respectively. After surgery, a histological diagnosis of FNH was finally established. In this paper, we also reviewed the knowledge regarding diagnosis and differential diagnosis of FNH on imaging examinations, which are helpful for avoiding misdiagnoses and guiding clinical interventions.

Concept of Granthi with reference to uterine fibroid: An Ayurveda review

Uterine fibroids are the commonest benign tumor of the uterus and also the commonest benign solid tumor in the female. It can cause significant morbidity in women of a reproductive life span. The exact cause of uterine fibroid is unknown. Prevalence of uterine fibroid 5 -20 % of women in the reproductive age group. It can cause significant morbidity in women of a reproductive life span. Not all fibroids cause symptoms. 50% of women are asymptomatic. Fibroids mainly cause symptoms like menorrhagia, dysmenorrhea and cause pressure symptoms on adjacent viscera i. e. bladder, uterus, rectum which affects the everyday activities of women. In Ayurveda all gynecological disease explained under the term yonivyapad. It can be explained as the anatomical and functional abnormalities of the female reproductive system. In Ayurveda granthi can be correlated with the uterine fibroid. In modern science uterine fibroid treats medically, surgically. But it is challenging to establish a satisfactory conservatory medical treatment to date. so in Ayurveda the main purpose is the management of granthi by samprapti vighatan by use of medicine.

GIANT OVARIAN FIBROMA WITH ASSOCIATED PSEUDO-MEIGS' SYNDROME: A CASE REPORT AND LITERATURE REVIEW

Meigs' syndrome is a rare condition characterized by the presence of a benign broma of the ovary, ascites and pleural effusion. When either of ascites or pleural effusion is associated with the broma it is termed pseudo-Meigs' syndrome. Though bromas are the most common benign solid tumours of the ovary, they rarely present in clinical practice and diagnosis is made difcult by symptoms that usually mimic disseminated malignancy. The gold standard of treatment is laparotomy, denitive diagnosis is by histology, and by denition of the syndrome, the symptoms resolve after removal of the tumour and the patients become asymptomatic. We present a patient with a giant ovarian broma with associated pseudo Meigs syndrome who was successfully managed without any complications.

Liver Transplantation for Hepatic Adenomatosis: The First Case Report in Thailand and Literature Review

Hepatic adenomas are benign solid liver tumors commonly found in young females and usually asymptomatic. Hepatic adenomatosis is characterized by more than 10 adenomas in an otherwise normal liver. Bleeding and malignant transformation uncommonly occur especially in tumor larger than 5 cm and in male patients. The authors reported a case of a young female with large multiple hepatic adenomas from hepatic adenomatosis that presented with abdominal pain, large abdominal mass, weight lost, and abnormal liver function tests. She failed transarterial embolization. Surgical resection was not offered due to extent of the hepatic adenomas. She received orthotopic liver transplantation as rescue therapy. Her explanted liver showed multiple foci of hepatocellular carcinoma (HCC). Her post-operative was uneventful. The authors reported a case of liver transplantation for the treatment of unresectable hepatic adenomatosis. Keywords: Hepatic adenomatosis, Malignant transformation, Liver transplantation

Hepatic epithelioid angiomyolipoma: a case report

Angiomyolipoma (AML) is a rare benign solid tumor, of mesenchymal origin. Angiomyolipomas can be subdivided, according to their predominant component. The predominance of epithelioid cells characterizes the epithelioid variant (EAML). These express a more aggressive clinical behaviour with a greater potential for malignant transformation. In the absence of specific radiological features, the diagnosis of hepatic EAML depends on the pathological and immunohistochemical study. We present the case of an 80 years old female with a computed tomography (CT) scan showing a hepatic nodule at the transition of segments 5 and 8, and a left kidney nodule previously biopsied and confirmed to be a renal angiomyolipoma. A liver nodule biopsy was performed, whose histology revealed a probable gastrointestinal stromal tumor (GIST). The patient underwent a 5/8 subsegmentectomy and pathology report revealed epithelioid angiomyolipoma. After discussion of the case in the multidisciplinary tumor board, it was decided to perform a left nephrectomy, whose pathology revealed leiomyomatous angiomyolipoma. No further treatment and surveillance on outpatient clinic were decided. Hepatic EAML is a rare lesion that, although mostly benign, can exhibit malignant behavior with distant metastasis and local invasion. Its identification is of paramount importance. The definitive diagnosis is only possible through histological and immunohistochemical analysis. Additional studies are needed in order to establish diagnostic criteria and predictive characteristics of malignancy.

Current status on robotic assisted myomectomy

Uterine leiomyomas are common benign solid tumors of the uterus. While the presence of fibroids is rarely life threatening, they are associated with symptoms affecting quality of life and fertility. Myomectomy is a standard fertility-sparing surgery which should be considered for women suffering from fibroid-related symptoms who do not desire hysterectomy or any alternative treatment option. While open surgery is thought to be reserved for large and numerous myomas, mini-invasive methods as laparoscopy and robot-assisted surgery have evolved in the hands of experienced surgeons to also deal with these more complex cases. Robotic myomectomy has its advantages in lower blood loss, fewer complications, and shorter hospital stay over open surgery, whereas the comparison outcomes with laparoscopic myomectomy are still uncertain. Advantages of the wristed instruments, three-dimensional vision along with the incorporation of correct surgical techniques could emphasize the benefits of the robotic assisted approach in large and numerous myoma cases. Careful and detailed assessment should precede the surgery to recognize risks and steps to reduce operation time, which tends to be the most presented drawback of robotic myomectomy. As the tendency of robot-assisted surgeries is growing, many authors share their experience or publish comparison studies with other surgical methods. Our article describes the current status concerning robotic myomectomy, reviewing publications from the past five years (2016-2021).

Are Current Technical Exclusion Criteria for Clinical Trials of Magnetic Resonance-Guided High-Intensity Focused Ultrasound Too Restrictive?: Early Experiences at a Pediatric Hospital.

Certain technical criteria must be met to ensure the treatment safety of magnetic resonance-guided high-intensity focused ultrasound. We retrospectively reviewed how our enrollment criteria were applied from 2014 to 2017 in a clinical trial of magnetic resonance-guided high-intensity focused ultrasound ablation of recurrent malignant and locally aggressive benign solid tumors. Among the 36 screened patients between 2014 and 2017, more than one-third were excluded for technical exclusion criteria such as the anatomic location and proximity to prosthetics. Overall, patients were difficult to accrue for this trial, given the incidence of these tumors. To increase potential accrual, screening exclusion criteria could be more generalized and centered on the ability to achieve an acceptable treatment safety margin, rather than specifically excluding on the basis of general anatomic areas.

Current concepts in ablative procedures for primary benign liver lesions: a step forward to minimize the invasiveness of treatment when deemed necessary.

With increased use of medical imaging, the incidental detection of benign solid liver tumors has become more frequent. Facing with benign disease, the indications for surgery are still object of discussion in light of the stable natural course of most lesions and obvious drawbacks of any surgical intervention; therefore, in most situations, a conservative approach is recommended, and surgery is mainly reserved for those cases with persistent or worsening symptoms, or who are at risk for complications as malignant transformation. The advent of ablative techniques has widened the range of treatment options available to these patients, presenting as a valid alternative to resection in terms of safety and efficacy in selected cases, particularly in patients who are considered poor surgical candidates and with smaller lesions. This review outlines the role of percutaneous ablative methods for benign solid liver tumors that are encountered in adults, providing a per histology analysis of the existing evidence. The up-to-date strategies for management of the most common benign solid tumors are recapitulated.

2260 Management of a Massive Liver Hemangioma: Does Size Matter?

INTRODUCTION: The majority of “giant” hemangiomas remain asymptomatic with no cause for surgical intervention; however, this may not hold true for massive tumors. The following case will review the challenges facing both patients and physicians when managing these atypical tumors. CASE DESCRIPTION/METHODS: A 49-year-old male with no medical problems presented with complaints of post-prandial bloating, early satiety and mild epigastric discomfort. The bloating was intermittent for several years; however, symptoms have recently curtailed his eating habits. CBC, BMP and liver enzymes were unremarkable. An ultrasound highlighted a massively enlarged liver extending into the pelvis and displacing surrounding organs. The liver parenchyma appeared to be replaced with a homogenous, hyperechoic lesion. An MRI then illustrated a 29.5 × 20.1 × 19.4 cm, strongly hyperintense mass on T-2 weighted sequences consistent with the diagnosis of a hemangioma. He was referred to a hepatobiliary surgeon and an extended right hepatectomy was eventually performed. Histopathology results described vast endothelial lined channels supported by thin fibrous stroma without features of malignancy. The patient returned to clinic four weeks after surgery reporting complete resolution of his symptoms. DISCUSSION: Hemangiomas are the most common benign solid tumor of the liver with little to no risk of malignant transformation. Often discovered incidentally on imaging studies, the majority of these tumors remain indolent without the need for routine surveillance. Rarely these tumors become symptomatic, often correlating with tumor size. The definition of “giant” liver hemangioma remains controversial, with most authors assigning the label to tumors greater than 4cm or 5cm in size. It is for this reason that management of giant hemangiomas remains highly debated (i.e. observation versus resection). Recent studies have shown that tumors greater than 20cm in size pose a higher risk for GI symptoms related to mass effect on surrounding organs as well as causing a disturbance in the hematologic and coagulation systems. Surgical resection should be considered for symptomatic or complicated lesions, or when the diagnosis remains inconclusive. It is our belief that size classifications for giant hemangiomas requires further subgrouping to consider the danger of these massive tumors as well as the increased morbidity of surgery. Proper management of these tumors should be individualized to each patient and include a multidisciplinary team approach.

Spontaneous Abdominal Bleeding from an Infundibulopelvic Ligament Tear in a Patient with Large Ovarian Fibroma

Ovarian fibromas are rare benign solid tumors of the ovary which are often difficult to differentiate from uterine leiomyomas preoperatively. The symptoms usually include abdominal discomfort and may have ascites and/or an elevation in CA-125 levels. There have been no publications of associated abdominal bleeding to date. The treatment is surgical removal via a laparoscopic or laparotomic approach. We present a case of a 19 cm unilateral ovarian fibroma with abdominal bleeding from a spontaneous right infundibulopelvic ligament (IPL) tear who underwent a laparoscopic and mini-laparotomic right salpingo-oophorectomy. Patients with large ovarian fibromas should be cautioned that abdominal bleeding and/or acute abdominal pain can occur and that a minimally invasive surgical approach is feasible.

Renal angiomyolipoma.

Angiomyolipoma is one of the most common benign solid renal tumors. We investigated the characteristics of renal angiomyolipomas and the clinical outcomes of patients in the last thirteen years. The medical records of the patients who underwent nephrectomy were reviewed retrospectively from July 2005 to May 2018. The laboratory data, radiology, and pathology reports were recorded. Patients diagnosed with angiomyolipoma were included in the study. A total of 28 patients were included in the study, eight of them male. The mean age of the patients was 55.89+14.49 years. The patients were treated with open and laparoscopic techniques. Partial nephrectomy was performed in 12 patients(42.85%). After pathological examination, 23 patients were diagnosed as fat rich, four patients as fat poor, and one as epithelioid angiomyolipoma. There were no recurrences in the follow-up 91.21+48.31 months. Angiomyolipoma is a rare renal tumor in daily urology practice. Clinicians must be aware of its complications and manage patients well.

A Quantitative Ultrasound-Based Multi-Parameter Classifier for Breast Masses

This manuscript reports preliminary results obtained by combining estimates of two or three (among seven) quantitative ultrasound (QUS) parameters in a model-free, multi-parameter classifier to differentiate breast carcinomas from fibroadenomas (the most common benign solid tumor). Forty-three patients scheduled for core biopsy of a suspicious breast mass were recruited. Radiofrequency echo signal data were acquired using clinical breast ultrasound systems equipped with linear array transducers. The reference phantom method was used to obtain system-independent estimates of the specific attenuation (ATT), the average backscatter coefficients, the effective scatterer diameter (ESD) and an effective scatterer diameter heterogeneity index (ESDHI) over regions of interest within each mass. In addition, the envelope amplitude signal-to-noise ratio (SNR), the Nakagami shape parameter, m, and the maximum collapsed average (maxCA) of the generalized spectrum were also computed. Classification was performed using the minimum Mahalanobis distance to the centroids of the training classes and tested against biopsy results. Classification performance was evaluated with the area under the receiver operating characteristic (ROC) curve. The best performance with a two-parameter classifier used the ESD and ESDHI and resulted in an area under the ROC curve of 0.98 (95% confidence interval [CI]: 0.95-1.00). Classification performance improved with three parameters (ATT, ESD and ESDHI) yielding an area under the ROC curve of 0.999 (0.995-1.000). These results suggest that system-independent QUS parameters, when combined in a model-free classifier, are a promising tool to characterize breast tumors. A larger study is needed to further test this idea.

Incidence of and Risk Factors for Histologically Confirmed Solid Benign Tumors Among Long-term Survivors of Childhood Cancer

Survivors of childhood cancer (CCSs) face risk of developing subsequent tumors. Solid benign tumors may be cancer precursors; benign tumors and cancers may share etiologic factors. However, comprehensive data on the risk for solid benign tumors are lacking. To quantify the incidence of and treatment-related risk factors for histologically confirmed solid nonskin benign tumors among CCSs. This record linkage study involves the Dutch Childhood Oncology Group-Long-Term Effects After Childhood Cancer (DCOG-LATER) cohort of 6165 individuals diagnosed with childhood cancer at younger than 18 years from January 1, 1963, through December 31, 2001, in 7 Dutch pediatric centers and who survived at least 5 years after the diagnosis. Study groups eligible for record linkage from 1990 onward included 5843 CCSs (94.8%) and 883 siblings. Benign tumors were identified from the population-based Dutch histopathology and cytopathology registry (PALGA). Follow-up was completed on May 1, 2015. Data were analyzed from January 1, 1990, through May 1, 2015. Cumulative incidence of any subsequent benign tumor for cohort strata and multivariable Cox proportional hazards regression models (hazard ratios [HRs]) were used to evaluate potential risk factors for 8 major benign tumor subtypes. Of the 5843 eligible CCSs (55.9% male), 542 (9.3%) developed a histologically confirmed subsequent benign tumor after a median follow-up of 22.7 years (range, 5.0-52.2 years). Among women, abdominopelvic radiotherapy inferred dose-dependent increased risks for uterine leiomyoma (n = 43) for doses of less than 20 Gy (HR, 1.9; 95% CI, 0.5-7.0), 20 to less than 30 Gy (HR, 3.4; 95% CI, 1.1-10.4), and at least 30 Gy (HR, 5.4; 95% CI, 2.4-12.4) compared with no abdominopelvic radiotherapy (P = .002 for trend). High-dose radiotherapy to the trunk was not associated with breast fibroadenoma (n = 45). Of 23 osseous and/or chondromatous neoplasms, 16 occurred among leukemia survivors, including 11 after total body irradiation (HR, 37.4; 95% CI, 14.8-94.7). Nerve sheath tumors (n = 55) were associated with radiotherapy (HR at 31 years of age, 2.9; 95% CI, 1.5-5.5) and a crude indicator of neurofibromatosis type 1 or 2 status (HR, 5.6; 95% CI, 2.3-13.7). Subsequent risk for benign tumors was higher than the risks for subsequent nonskin solid malignant neoplasms and for benign tumors among siblings. This record linkage study uses a unique resource for valid and complete outcome assessment and shows that CCSs have an approximately 2-fold risk of developing subsequent benign tumors compared with siblings. Site-specific new findings, including for uterine leiomyoma, osteochondroma, and nervous system tumors, are important to enable early diagnosis; this information will be the first step for future surveillance guidelines that include some benign tumors in CCSs and will provide leads for in-depth etiologic studies.

Solid ovarian masses: Lessons and pitfalls

Solid ovarian masses have a higher risk of malignancy compared to other tumour types. In this lecture, we will discuss the ultrasound features of the most common benign solid ovarian tumour, i.e. the fibroma of the ovary, and more rare solid ovarian tumours, including metastases, Brenner tumours and non-epithelial ovarian tumours.

Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

Introduction: Hepatic hemangioma (HH) is the most common benign solid tumor of the liver. The aim of this study is to review our experience of surgical treatment for giant HH and to show the impact of HH size and type of surgical resection on surgical outcomes. Method: This is a retrospective study of the cases who underwent surgery for giant HH during the period from January 2000 to April 2017. Result: Elective surgery was performed for 144 patients who had giant HH. The median diameter of resected HH was 10 cm (5 – 31 cm). Enucleation was performed for 92 (63.9%) patients and anatomical resection was required in 52 (36.1%) patients. No statistical significant differences between enucleation and resection as regards intraoperative and postoperative findings. The amount of intraoperative blood loss is significantly more in HH > 10 cm (300 vs. 575 ml, P = 0.007), the need of blood transfusion was significantly more in HH > 10 cm (P = 0.000), and the operation time was significantly longer in HH > 10 cm (120 vs. 180 min, P = 0.000). The size of HH had no significant effect as regards the development of postoperative complications. Conclusion: Giant hemangioma can be treated surgically with low incidence of morbidity and mortality. No statistical difference between enucleation and resection as regards surgical outcomes. In left lobeHH,HH located deeper in posterior hepatic segments and in multiple HH, hepatic resection is preferred. The size of the HH had significant impact intraoperative blood loss and operative time.