Benign Tumors Research Articles

Treatment of fat-poor renal angiomyolipoma with ectopic blood supply by fluorescent laparoscopy: A case report and review of literature

BACKGROUND Renal angiomyolipoma and renal cell carcinoma are the most common benign and malignant tumors of the kidney respectively, and the preoperative differential diagnosis is crucial due to the wide difference in treatment methods. Fat-poor renal angiomyolipoma is a relatively rare type of in renal angiomyolipoma. Its fat imaging features are not obvious, and it is easily misdiagnosed as renal cell carcinoma. CASE SUMMARY We report the case of a 41-year-old man who complained of osphyalgia. Subsequent abdominal computed tomography scans revealed that a heterogeneous mass was seen in the lower pole of the right kidney, with the size of about 53 mm × 47 mm. And showed two right renal arteries, with the mass supplied by an ectopic vessel from the abdominal aorta. Fluorescent laparoscopic blockade of the right renal heterotopic artery and partial nephrectomy was performed. Based on histological and immunohistochemical findings, the tumor was diagnosed as fat-poor renal angiomyolipoma. CONCLUSION The use of fluorescent laparoscopy can effectively help intraoperative management, and the fluorescence pattern provided by intravenous indocyanine green can help suggest the final diagnosis, effectively guide the surgical decision-making, and avoid preoperative imaging diagnosis leading to nephrectomy for benign renal tumors, through fluorescent navigation of tumor supply vessel precise block, minimize the loss of renal function.

Comparison of robotic vs. laparoscopic treatment in pediatric ovarian benign tumors

Comparison of robotic vs. laparoscopic treatment in pediatric ovarian benign tumors

Malignant Transformation of Recurrent Benign Phyllodes Tumor: A Case Report and comprehensive review of literature

Introduction: Phyllodes tumors (PTs) of the breast are rare fibroepithelial neoplasms, accounting for less than 1% of all breast tumors. The World Health Organization (WHO) classifies PTs into benign, borderline, or malignant categories based on histological features. While benign PTs generally have a favorable prognosis, they carry a risk of transformation into malignant variants, particularly in cases of recurrence. Case Presentation: A 33-year-old female presented with a recurrent benign PT, previously treated with lumpectomy on two occasions. Recent imaging suggested possible malignant transformation, and histopathological examination confirmed a malignant PT. Discussion: This case highlights the crucial role of imaging in the early detection of malignant transformation in PTs. Surgical management strategies are discussed, with an emphasis on the potential for recurrent benign tumors to progress to malignancy. Conclusion: Regular imaging and close follow-up are essential for early detection of malignant transformation in recurrent PTs, guiding timely and appropriate surgical intervention.

Detection of BRCA-1 gene mutations in epithelial ovarian tumors at tertiary care hospital Karachi

ABSTRACT Background: Ovarian cancer is the most common and lethal gynecological malignancy. Ovarian malignancy is the 3rd most common cancer in Pakistan. More than 90% ovarian cancers are of epithelial cell origin, about 24-40% such cancers have hereditary or sporadic mutation in the BRCA-1 or BRCA-2 genes. The present study was designed to detect BRCA-1 gene mutations in different histological sub-types of epithelial origin of benign, borderline and malignant ovarian tumors. Methods: This cross-sectional study was based on the analysis of BRCA-1 gene mutations in the epithelial origin of benign, borderline and malignant ovarian tumors received at the department of Pathology, Basic Medical Sciences Institute, Jinnah Post graduate Medical Centre, from 01-01-2011 to 31-12-2015. A total of 80 diagnosed cases were selected and analyzed for PCR. Results: BRCA-1 gene mutations were detected in 22 (27.5%) cases out of the 80 randomly selected epithelial ovarian tumors. Serous cyst adenocarcinoma was the commonest including 63% cases. BRCA-1 gene mutations were also positive in other epithelial ovarian tumors, including Mucinous cyst adenocarcinoma (13.6%), Endometroid adenocarcinoma and Mixed Mullerian tumor (4.5% each). In addition mutations were also detected in borderline tumors including Mucinous borderline tumor (9.09%) and Seromucinous borderline tumors (4.5%).The observations and results of the study were elaborated with the assistance of tables, figures and photomicrographs. Conclusion: BRCA-1 gene mutations manifestations were identified in a large number of serous malignant ovarian tumor cases. Small percentages of borderline and malignant mucinous tumors, endometroid adenocarcinoma and mixed mullerian tumor were also positive for BRCA-1 gene mutations.

An Observational Study on The Role of Magnetic Resonance Imaging in The Evaluation of Soft Tissue Tumors with Histopathological Correlation at Tertiary Care Centre

Background: The primary aim of this study is to evaluate the role of magnetic resonance imaging (MRI) in the assessment of soft tissue tumors with histopathological correlation at a tertiary care center. Methods: An observational study was conducted on 75 patients (n = 75) in the Department of Radiodiagnosis over 18 months. The targeted population comprised patients who presented to the Radiodiagnosis Department for radiological imaging of soft tissue tumors. Results: Out of 75 cases, 20% were found to have benign tumors, while 80% were found to have malignant tumors. The most frequent benign tumor was fibromatosis, with n = 10 cases (13.33%), and the most common malignant tumor was synovial sarcoma, with n = 14 cases (18.66%). The benign age group ranged from 11 to 20 years. T2-weighted heterogeneous hyperintensity was noted more frequently in malignant lesions, demonstrating a high positive predictive value; that is, 83% of malignant tumors exhibited changes on diffusion-weighted imaging/ apparent diffusion co efficient (DWI/ADC). Low-grade malignant lesions showed no restrictions. Most benign lesions displayed restrictions, with a high positive predictive value of 98.14%, specificity of 93.33%, and sensitivity of 88.33%. Conclusions: Soft tissue tumors can be detected and locally staged using MRI; thus, this technique has proven its value. Intralesional hemorrhage and calcification are two parameters that have been shown to have no substantial association with cancer. Due to its high sensitivity, MRI is a viable option for evaluating soft tissue tumors.

Angiofibrolipoma in the Head and Neck Region: A Case Report and Literature Review.

Angiofibrolipomas are rare, benign soft tissue tumors composed of mature fat cells, blood vessels, and fibrous connective tissue. Typically occurring in subcutaneous locations, this case report presents a unique instance of an angiofibrolipoma arising in the pharynx. According to our review of the literature, it is the second reported case in the pharynx and the sixth in the head and neck region. A 58-year-old woman presented with a 1 year history of globus sensation and an incidentally-discovered extra-oral polyp. Endoscopic examination revealed the polyp originating from the upper esophagus and extending into the pharynx. Magnetic resonance imaging confirmed the nature and extent of the lesion. The polyp was successfully removed via endoscopic resection, and histopathological analysis confirmed the diagnosis of angiofibrolipoma. This case highlights the rarity of pharyngeal angiofibrolipomas and underscores the importance of endoscopic evaluation for patients presenting with ambiguous pharyngeal symptoms. While surgical resection is generally recommended for such tumors, endoscopic removal can be a safe and effective option for smaller pedunculated lesions.

Parotidectomy Trends Toward Outpatient for Benign Disease.

We evaluate the safety of outpatient parotidectomy. We evaluate factors that lead to planned admission and compare costs. We evaluate trends toward outpatient, and the outcomes of switching admission status, total versus superficial approach, and ambulatory versus hospital site. Retrospective cohort study. Single tertiary academic center. Retrospective review of patients who underwent parotidectomy for benign tumors from 2018 to 2023. Of 370 parotidectomies performed, there were a planned 162 admissions and 208 outpatient procedures. A travel time > 60 minutes (odds ratio [OR] = 0.487, confidence interval [CI]: 0.296-0.803, P = .005) and total parotidectomy (OR = 0.448, CI: 0.226-0.89, P = .022) decreased the odds of a planned outpatient procedure. In a multivariable model, longer operative time increased the odds of switching to inpatient (n = 29, OR = 1.02, CI: 1.007-1.033, P = .002) and drain placement decreased the odds of switching to outpatient (n = 15, OR =0.035, CI: 0.004-0.298, P = .002). There was no significant difference in surgical complications, phone calls, clinic visits, readmission rates, or recurrence between outpatient and inpatient. This remained true when comparing surgical facility and superficial versus total parotidectomy. After COVID was declared an emergency, there was a trend toward outpatient parotidectomy (72.7% vs 48.9%, P < .001), but no change in complication rates. At our institution, outpatient parotidectomy saved $3838 compared to overnight admission. This study supports that outpatient parotidectomy is safe. This remained true for patients switching admission status, undergoing superficial or total parotidectomy, and having their operation at an ambulatory site. We demonstrate that institutions can safely increase outpatient parotidectomy rates and outpatient parotidectomy is cost effective.

The role of elastography in determining the risk of malignant thyroid nodules in children

IntroductionUltrasonography is fundamental method of diagnosing focal thyroid lesions. The additional element of ultrasound examination is Strain Elastography which allows for determining the degree of elasticity of the nodule while comparing it to the surrounding thyroid parenchyma. Pediatric thyroid nodules have a higher malignancy risk than in adults, warranting the consideration of fine-needle aspiration biopsy (FNAB) in children.Material and methodsA prospective data analysis of children with focal thyroid lesions treated from 2021 to 2022 was performed. The patients underwent ultrasound and elastography examinations to obtain the Strain Ratio (SR) of the nodules and were qualified for FNAB. SR was determined by the windowing method of relative strains in a semi-quantitative assessment. The FNAB score was determined on the Bethesda scale and the histological examination of the thyroid nodule was performed. The SR values were stratified in three groups: I - thyroid cancer, II - low-risk thyroid tumors, and III - benign lesion. The Kruskal-Wallis test was used to find the relation between the value of SR elastography and the malignancy, with the p value &amp;lt; 0.05 considered significant. The data were analyzed using the multiple comparisons test.ResultsThe 123 FNABs were performed in 100 patients. The final analysis included 119 nodules in 96 patients. In 19 cases, the nodule was malignant, in 5 cases they were low-risk tumors, and in 95 - benign lesions. A difference of the SR value between groups in the pairs of malignant and benign tumors, and malignant and low-risk tumors was revealed. Since no statistically significant difference in the level of elastography was found between benign and low-risk tumors, both groups were combined and formed a group of benign tumors. For the combined groups, the Man-Whitney test was performed, confirming that there was a statistically significant difference between the groups of malignant and benign tumors in the value of SR elastography. The cut-off point for SR for malignant tumors was &amp;gt;3.ConclusionsThe SR index of elastography is significantly higher in malignant nodules. and might be used to select changes with an increased risk of malignancy in thyroid ultrasound of children.

Clinico-dermoscopic and Histopathological Evaluation of Benign Skin, Soft Tissue and Appendageal Tumours of Skin: A Cross-sectional Study from a Tertiary Care Hospital

Abstract Background: Benign skin, soft tissue and appendageal tumours of skin are one of the most frequently encountered skin disorders. An organised systematic approach along with dermoscopic and histopathological examination can aid in the diagnosis of these diverse disorders. Objective: To evaluate clinico-dermoscopic and histopathological findings of benign skin, soft tissue and appendageal tumours of skin in patients attending a tertiary care hospital. Methods: Cross-sectional hospital-based study where patients of all age groups irrespective of gender suspected of having benign skin, soft tissue and appendageal tumours were enrolled. Clinical, dermoscopic and histopathological findings were recorded and the agreements between them were evaluated using the Cohenʼs Kappa coefficient. Results: The study included a total of 415 patients with a mean age of 37.9 ± 15.59 years and a male to female ratio of 1:1.3. The mean duration of the disease was 4.3 ± 2.14 years. Soft tissue tumours were the commonest (60%), followed by benign skin tumours (24.3%) and benign appendageal tumours (17.1%). A good agreement between dermoscopic and clinical diagnosis was found (Cohenʼs Kappa = 0.879) and between dermoscopic and histopathological diagnosis was also found (Cohenʼs Kappa = 0.789). Conclusion: This study infers that benign tumours of the skin include a heterogeneous group of skin disorders affecting a heterogeneous population. Dermoscopy improved the diagnostic accuracy of this large group of skin disorders and reduced the number of unnecessary excisions; however, histopathology remains the benchmark diagnostic tool to differentiate these tumours from other benign tumours and their malignant counterparts.

Real-time intraoperative ultrasound imaging of the posterior pituitary gland during endoscopic endonasal approach.

Pituitary adenomas are amongst the most common benign central nervous system tumors, and often require resection via an endoscopic endonasal approach (EEA). Two of the most common associated complications are central diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH). Both are thought to be caused by manipulation of the posterior pituitary gland (PPG), making intraoperative visualization and preservation of this structure critical. Intraoperative endoscopic endonasal ultrasound (IEUS) may present an optimal tool for this purpose. This study aims to describe the appearance and morphology of the PPG on IEUS. This study included all pituitary adenoma surgeries during which IEUS was utilized and the PPG was visualized between 1/1/2022, and 12/31/2023. Demographic, clinical, pathological, and radiological data were retrospectively collected. The PPG was described as either hypoechoic, isoechoic, or hyperechoic as compared to the anterior pituitary gland and adenoma, and the morphology of the PPG was further classified as ellipse or crescent shaped. The PPG was hypoechoic in all 43 cases included in our final cohort (100.0%). Morphologically, the PPG appeared elliptical in 27 cases (62.8%), and crescent shaped in 16 cases (37.2%). The PPG can typically be visualized by IEUS as a hypoechoic structure immediately anterior to the posterior wall of the sella turcica, with elliptical morphology being the most common appearance. These characteristics can be used by the skull base surgeon to more confidently identify the position and morphology of the PPG intraoperatively for its' preservation.

Repurposing of PSMA-targeted diagnostic and therapeutic agents for the detection and treatment of giant cell tumors of bone

Giant cell tumor of bone (GCTB) is a rare bone tumor often necessitating surgical intervention, radiation therapy, or treatment with bisphosphonates or denosumab. 99mTc-MDP bone scintigraphy for GCTB has limited specificity, and the relatively high uptake of 18F-FDG in GCTB makes it challenging to differentiate it from other benign bone tumors. More specific detection and treatment modalities for GCTB are needed to enhance patient monitoring and outcomes. Prostate Specific Membrane Antigen (PSMA) is present in the neovasculature of various tumors, yet unexplored in GCTB. PSMA-targeted imaging and radiotherapeutic agents Locametz and Pluvicto are a powerful theranostic pair for detecting and treating PSMA-positive metastatic tumors, including those in bone, and thus have considerable potential to be repurposed for GCTB. This study aimed to determine if the vasculature of GCTB was PSMA-positive and whether targeting it with PSMA-specific agents was feasible. Using bone core samples from 28 GCTB patients and 9 negative controls, we present the first robust detection of PSMA on the tumor vasculature of GCTB. To demonstrate the potential repurposed use of PSMA-targeted agents in detecting and treating GCTB, we used a PSMA-specific fluorescent probe (FAM-C6-1298) as a model for these radiopharmaceutical agents. Incubation of fresh GCTB tissue samples with FAM-C6-1298 showed increased fluorescence intensity compared to controls, indicating successful targeting of PSMA in GCTB tissue. In conclusion, our data established that PSMA is not only present in the tumor vasculature of GCTB patient tissue but can be effectively targeted with repurposed PSMA-specific radiopharmaceuticals for diagnosis and therapy.

Benign but troublesome: A case study of irritational fibroma in the oral cavity

In the oral cavity, fibroma is the most common type of connective tissue tumor. The size of these proliferative benign connective tissue tumors varies from tiny to large, contingent upon the degree of presence of one or more components of the inflammatory response. They are usually asymptomatic.It is a locally confined hyperplasia of fibrous connective tissue brought on by persistent inflammation or local trauma. This lesion is more typically observed in men, with a preference for buccal mucosa, labial mucosa, and tongue . This lesion preferentially affects the tongue, buccal mucosa, and labial mucosa. A traumatic or irritating fibroma develops from an inflammatory hyperplastic lesion that can occur at any age and in almost any soft tissue location.

Multimodal classifier of medical risk based on a multielectrode bioimpedance converter

The purpose of the research. The aim of the study is Russian and foreign studies have shown that malignant breast tumors have significantly different impedance from normal tissues. However, bioimpedance analysis has limitations in resolution, as well as in the imperfection of bioimpedance models required to generate input vectors for machine learning systems.Methods. The presented study proposes a multimodal classifier, the raw data for which are obtained through an electrode matrix. It also has three channels for processing the results of bioimpedance analysis, with subsequent aggregation of their solutions. An impedance model of biomaterial is proposed, which allows forming descriptors for medical risk classifiers.Results. Hardware and software for bioimpedance studies have been developed, which include a data collection device for bioimpedance spectroscopy based on an electrode matrix, a device for communication with the object of study, and a device for bioimpedance spectroscopy using an electrode matrix. The software includes interface windows for setting up the bioimpedance research program and training and testing fully connected neural networks. An experimental study of the multimodal classifier on a physical model was conducted using inclusions of higher conductivity (tumor imitation) of various types and sizes in the conductivity range from 1.1 to 1.9 of the background. Based on the obtained images in the two-level neural network of the first channel, the integral risk of breast cancer was determined for all pixels of the image. Statistical studies (ROC analysis) showed sufficient sensitivity and specificity for the screening method - &gt; 0.75. Conclusion. Thus, a new model of intelligent support for medical decision-making has been created, integrating the capabilities of bioimpedance spectroscopy, convolutional neural networks and expert assessment of images generated by bioimpedance mapping. However, current data confirming the possibility of separating benign and malignant breast tumors using bioimpedancemetry methods are very limited, which requires further research in this direction.

The experiences of women diagnosed with uterine fibroids in the Kingdom of Eswatini

Background: Uterine fibroids (UFs) are benign uterine growths that significantly impact women’s daily activities, quality of life, fertility and expenditure.Aim: This study aimed to provide in-depth insights into the lived experiences of women diagnosed with UFs.Setting: The study was conducted in Eswatini health facilities across the four geographic regions.Methods: An explorative qualitative design was used; participants with confirmed UFs diagnoses or surgery related to UFs were purposively recruited for focus group discussions. Data collection was guided by the revised Wilson and Cleary model of health-related quality of life (HRQOL), which was iteratively analysed using Braun and Clark’s thematic analysis framework.Results: Sixty participants with confirmed UFs diagnoses or surgery related to UFs were included in this study. Five themes emerged: awareness of the disease, symptoms experienced, treatment and care, perceptions and beliefs and health-seeking behaviour. Most participants experienced physical symptoms, abdominal pain and vaginal bleeding. Among the emotional and psychological consequences experienced by the majority of participants were fear, worry, tension and (perceived) disrupted body image. The majority of the participants lacked knowledge of UFs, and their perceptions and health-seeking behaviour differed.Conclusion: Findings showed that most participants experienced physical, psychological, emotional and social challenges.Contribution: These experiences were influenced by lack of knowledge, symptoms experienced, poor treatment and care and perceptions and beliefs about UFs. Health education, client involvement, early diagnosis and effective treatment are recommended to improve the experiences of UFs.

Gut Microbiota’s role in lipoma development: evidence from mendelian randomization

BackgroundLipoma, a benign tumor derived from mesenchymal tissue, significantly affects patients’ physical and psychological wellbeing. Increasing evidence points to a strong link between the gut microbiome (GM) and lipoma incidence. This study utilizes Mendelian Randomization (MR) to assess the potential causal relationships between the GM and lipoma development.MethodsWe conducted a two-sample MR analysis using genome-wide association study (GWAS) data from MiBioGen and FinnGen to explore the causal relationship between GM and lipoma. The GM dataset included 18,340 participants with 14,587 single nucleotide polymorphisms (SNPs), while the lipoma dataset comprised 412,181 participants with 21,306,349 SNPs. We employed 5 MR methods: Inverse Variance Weighted (IVW), Weighted Median, Simple Mode, MR-Egger, and Weighted Mode. Additional assessments included Cochran’s Q test for result heterogeneity, PRESSO analysis for horizontal pleiotropy, and sensitivity analyses through scatter plots, leave-one-out analyses, funnel plots, and forest plots.ResultsThe IVW method identified 18 gene predictors trans-genus associated with lipoma risk. Protective effects against benign lipoma (BL) were observed in the Eubacterium rectale group, Desulfovibrio, Ruminococcus1, Clostridium sensu stricto1, and Lachnospiraceae UCG001; conversely, Lachnospiraceae UCG008 was linked to increased BL risk. Desulfovibrio provided protection against TS-BL; however, the Family XIII AD3011 group, Eubacterium coprostanoligenes group, Lachnospiraceae NK4A136 group, and Parasutterella were associated with an increased TS-BL risk. The Clostridium innocuum group, Eubacterium rectale group, Anaerotruncus, Ruminiclostridium6, and Lachnospiraceae UCG001 offered protection against LS-BL, while Lachnospiraceae UCG008 was linked to an increased LS-BL risk. The Eubacterium brachy group, Odoribacter, Butyricimonas, Subdoligranulum, and Clostridium sensu stricto1 were protective against HFNS-BL; Ruminococcaceae UCG005 was associated with an increased HFNS-BL risk.ConclusionCompared to malignant tumors, research on lipomas has been relatively limited. This study, through MR analysis, provided new evidence of a causal relationship between specific GM and the development of lipomas. Certain gut bacterial species may act as protective or harmful factors in lipoma formation, offering new avenues for future treatment strategies. However, additional research is required to unravel the complexity of how GM influences the pathogenesis of lipomas.

A case series on caesarean myomectomy

Uterine leiomyoma is the frequently identified benign tumor and its incidence is about 10%-20% in pregnant women. Treatment of myoma during caesarean section remains a debated subject in spite of advancement in medical treatment. A patient who undergoes myomectomy during cesarean section will not require a second operation, anesthetic complications and increased expenditure. Here, we report a series of 8 cases where myomectomy was performed during caesarean section for large anterior lower segment fibroids ranging in size from 4 to 12 cms.

Update on Pediatric Surveillance Recommendations for PTEN Hamartoma Tumor Syndrome, DICER1-Related Tumor Predisposition, and Tuberous Sclerosis Complex.

PTEN hamartoma tumor syndrome (PHTS), DICER1-related tumor predisposition (DICER1) and tuberous sclerosis complex (TSC) are rare conditions which each increase risk for distinct spectra of benign and malignant neoplasms throughout childhood and adulthood. Surveillance considerations for each of these conditions focus on patient and family education, early detection and multidisciplinary care. In this manuscript, we present updated surveillance recommendations and considerations for children and adolescents with PHTS, DICER1 and TSC and provide suggestions for further research in each of these conditions.

Oncological safety of fertility preservation treatment in ovarian cancer: A Spanish multicenter study.

To assess the safety of fertility-sparing treatments for early-stage ovarian cancer in women younger than 40 years old. We performed a retrospective multicenter study including women aged 18-40 years diagnosed with early-stage (FIGO I-II) ovarian cancer in 55 Spanish hospitals, from January 2010 to December 2019. Benign and borderline tumors were excluded, as well as advanced stages (FIGO III-IV). All perioperative characteristics and follow-up data were collected and analyzed. Standard staging surgery (SSS) was compared with fertility-sparing surgery (FSS) in terms of oncological outcomes. In all, 366 women were included; 327 (89.3%) were stage I. Among all patients, 216 (59%) underwent SSS and 150 (41%) FSS. Up to 208 (56.8%) patients did not have children, but only 12 (3.2%) had oocyte preservation before treatment. Patients in the FSS group compared with the SSS group showed a non-significant difference in recurrences (8% vs. 9.3%, respectively; P < 0.711) and deaths (1.3% vs. 4.8%, respectively; P = 0.211) during the follow-up. No significant differences were found between epithelial and non-epithelial ovarian cancer both in recurrences (7.1% vs. 8.8%, respectively; P = 0.771) and in deaths (1.4% vs. 1.3%, respectively; P = 1) among patients who underwent FSS. FSS seems a safe option for treatment of early-stage ovarian cancer in patients who want to preserve fertility, either for epithelial and non-epithelial histology.

RARE TUMORS OF POSTERIOR CRANIAL FOSSA IN ADULTS

Objectives Tumors arising in the posterior cranial fossa pertain to a special category of neoplasm in the manner that they can cause cerebellar syndrome, obstructive hydrocephalus, brainstem compression – cranial nerve dysfunction – and herniation. In the cerebellopontine angle, the most common tumors are acoustic neuromas followed by meningiomas. Among the petroclival tumors, the most common benign tumors are meningiomas and the most common malign tumors are chordomas and metastases. Among jugular foramen tumors, the common tumors are schwannomas, paragangliomas and meningiomas. We report our unit’s experience with the neurosurgical management of rare posterior cranial fossa tumors as compared to the main literature results, taking into consideration the clinical, radiological aspects and the outcome. Materials and Methods Retrospective analysis of a single unit cohort of patients diagnosed with rare posterior cranial fossa tumors, who underwent surgical treatment in the Neurosurgery I Department of the University Emergency Hospital Bucharest between 2017 and 2024. Relevant literature review was analyzed, as well as serial clinical examinations, imaging studies, and operative records were taken into consideration. Conclusions Depending on the location, size, and pathology of the posterior cranial fossa tumors, there are different treatment options, which include microsurgical resection, observation, stereotactic radiotherapy. These type of lesions still represent a challenge and require electing the most suitable approach whilst preserving the neurologic function of the patient.

Nomogram for predicting testicular yolk sac tumor in children based on age, alpha-fetoprotein, and ultrasonography

ObjectiveTo establish a predictive model for distinguishing testicular benign or yolk sac tumors in children.MethodsWe retrospectively analyzed data for 119 consecutive patients with unilateral testicular tumors treated at a single institution from June 2014 to July 2020. The patients were divided into the benign (n = 90) and yolk sac (n = 29) tumor groups based on the pathological diagnosis. We recorded patient age, serum markers [serum alpha-fetoprotein (AFP), human chorionic gonadotropin], and tumor ultrasonic findings (maximum diameter, ultrasonic echo, blood flow signal). Predictive factors were identified using descriptive statistical methods. A nomogram was established for preoperative prediction. An additional 46 patients were used as a validation cohort to verify the model.ResultsPatients with testicular yolk sac tumors were younger (median age: 14.0 vs. 34.0 months, P = 0.001) and had a higher incidence of elevated AFP levels (93.1% vs. 2.2%, P &amp;lt; 0.001). Ultrasonography indicated that testicular yolk sac tumors tended to have larger maximum diameters (26.5 ± 11.3 vs. 16.6 ± 9.2 cm, P &amp;lt; 0.001), a higher proportion of hypoechoic masses (44.8% vs. 8.9%, P &amp;lt; 0.001), and a higher incidence of masses with strong blood flow signals (93.1% vs. 5.6%, P &amp;lt; 0.001). A nomogram based on age, AFP levels, and ultrasound blood flow signals effectively predicted the probability of yolk sac tumor in children, with an accuracy of 0.98 (95% confidence interval: 0.984–1.003). The Brier score of the nomogram was 0.0002.ConclusionA nomogram based on age, AFP levels, and ultrasound blood flow signals can effectively predict the probability of testicular yolk sac tumor preoperatively, aiding in clinical decision-making and patient counseling.