Benign Tumors Research Articles

Management of the Nasolacrimal Duct in Expanded Endoscopic Approaches to the Maxillary Sinus: A Systematic Review with Evidence-based Recommendations.

Utilizing expanded endoscopic approaches to the maxillary sinus for the endonasal management of a variety of tumors is increasing in popularity. The nasolacrimal duct (NLD) may be injured inadvertantly or need to be removed during tumor resection or to augment visualization. Management of the NLD can take the form of transection alone, transection with stenting, or performing a formal dacryocystorhinostomy to avoid postoperative sequelae of injury. The purpose of this study was to review the literature and determine the optimal management of the NLD during expanded maxillary sinus approaches. A systematic review of Ovid, Embase, Medline, and Cochrane databases was performed to identify studies involving expanded approaches to the maxillary sinus and that explicitly reported the status of the NLD and postoperative outcomes. Nineteen studies were included in the analysis and divided into two groups: NLD-preserving (n = 9 studies; n = 191 patients in aggregate) and NLD-involving (n = 10 studies; n = 296 patients in aggregate). In the NLD-preserving subgroup, one patient out of a subgroup aggregate of 191 patients (0.5%) developed epiphora. In the NLD-involving subgroup, sharp transection alone was the most common method of NLD removal and was associated with a low rate of epiphora (study rates: 0 to 18.2%; aggregated subgroup rate: 7.0%, 21 / 296). Spontaneous resolution of symptoms was common (60%-100% cases). The NLD should be preserved when feasible from an exposure and tumor-control perspective. When pathology or approach requires the removal of the NLD, rates of persistent epiphora are very low, regardless of surgical technique. When expanded maxillary approaches are employed, particularly for benign tumors, and require removal of the NLD, sharp transection is the simplest method of removal, provides a low rate of postoperative epiphora, and is supported by the available literature.

Impact of uterine artery embolization on ovarian function and pregnancy outcome after uterine-fibroids treatment: A prospective study

BACKGROUND Uterine fibroids are benign tumors that originate from smooth muscle cells of the uterus. It is the most common gynecological disorder, affecting up to 80% of women of reproductive age. Uterine fibroids can cause various symptoms such as abnormal uterine bleeding, pelvic pain, infertility, and pregnancy complications. The treatment options for uterine fibroids include medical therapy, surgical intervention, and minimally invasive techniques. AIM To compare ovarian function of women with uterine fibroids who did or did not undergo uterine artery embolization (UAE). METHODS This prospective cohort study enrolled 87 women with symptomatic uterine fibroids who underwent UAE, and 87 women with the same symptoms who did not undergo UAE but received conservative management or other treatments. The two groups were matched for age, body mass index, parity, and baseline characteristics of uterine fibroids. The primary outcome was ovarian function that was evaluated by serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and anti-Müllerian hormone (AMH), as well as ovarian reserve tests, such as antral follicle count (AFC) and ovarian volume (OV). The secondary outcome was fertility that was evaluated based on the menstrual cycle, ovulation, conception, pregnancy, and delivery. The participants were followed-up for 36 months and assessed at 1, 3, 6, 12, 24, and 36 months after treatment. RESULTS The study found that the most common minor complication of UAE was postembolization syndrome in 73.6% of women, resolving within a week. No significant differences were observed between the UAE group and the control group in serum levels of reproductive hormones (FSH, LH, E2, AMH) and ovarian reserve indicators (AFC, OV) at any point up to 36 months post-treatment. Additionally, there were no significant differences in conception, pregnancy, or delivery rates, with the average time to conception and gestational age at delivery being similar between the two groups. Birth weights were also comparable. Finally, there was no significant correlation between ovarian function, fertility indicators, and the type or amount of embolic agent used or the change in fibroids post-treatment. CONCLUSION UAE resulted in significantly positive pregnancy outcomes, no adverse events post-treatment, and is a safe and effective treatment for uterine fibroids that preserves ovarian function and fertility.

Risk Factors for Recurrence after Surgical Resection of Sinonasal Inverted Papilloma

Abstract Introduction Sinonasal inverted papilloma (SNIP) is a rare benign epithelial tumor of the nasal cavity and paranasal sinuses that accounts for 0.4% and 4.7% respectively, of all tumors of this anatomical region. Objective To analyze the outcomes after surgical resection of SNIP and identify the risk factors for recurrence in a Swiss tertiary center. Methods We conducted a retrospective review of all cases of SNIP treated at the Lausanne university hospital between 2005 and 2018. All data available on the patients and tumors were collected for analysis. We studied the recurrence rate and looked for risk factors. Results We included 57 patients with a mean age of 55.5 years. There were 46 primary cases (80.7%) and 11 recurrences (19.3%). Maxillary sinus was the most frequent location (33.3%). Approximately half of the patients (52.6%) presented with a T3 tumor according to the Krouse classification. The mean recurrence rate after surgery was of 17.5% and it was more frequent among the patients in the recurrence group (45.5%) than among the primary cases (10.9%), reaching statistical significance (odds ratio [OR] = 6.8; 95% confidence interval [95%CI]: 1.5–30.8; p = 0.0165). Most patients were treated endoscopically (94.7%). Frontal sinus location, higher Krouse stage, and combined approach seemed to increase the risk of recurrence, but without statistical significance. Conclusion Difficult surgical access, as in the case of tumors located in the frontal sinus, higher stage of the disease, and previously operated cases carry the higher risk of incomplete resection and recurrence.

Clinical case of genous schwannoma

Schwannomas are benign tumors that arise from Schwann cells and account for approximately 5% of all benign soft tissue tumors, are characterized by slow growth (1–2 mm per year) and are clinically asymptomatic for a long time.Material and methods. A review of literary sources for 2000–2023 was carried out, sources from the Russian scientific electronic library eLIBRARY, RSCI databases, and PubMed were used. A clinical case of patient with geniculate ganglion schwannoma is presented.Results. Schwannomas can occur at any age, no gender specific characteristics have been identified, the incidence most often occurs between the third and sixth decades, and there is an association with genetic disorders, in particular with neurofibromatosis. The dominant diagnostic methods remain MRI and MSCT of the brain.Conclusion. The presented clinical case demonstrates a long-term, asymptomatic course of geniculate ganglion schwannoma with intracranial spread. The surgical treatment contributed to improving the patient’s quality of life.

Case Series and Review of Uterine Lipoleiomyomata

Introduction Uterine lipoleiomyomas are benign neoplasms that are not often seen in clinical practice. First described in 1965, these entities were recognized by a composition of intermixed smooth muscle, mature adipocytes, and fibrous tissue [2,4]. The incidence of lipoleiomyoma has always been accepted as 0.03-0.2% by Willen et al. in 1978 [1,4]. However, recent studies propose a higher incidence at 2.9%, such as Akbulut et al. in 2014. Most commonly found in the uterus, these neoplasms can rarely be associated with the cervix, broad ligament, peritoneum, ovary, as well as other extrapelvic locations. These benign tumors present similarly to uterine leiomyomas in peri- and post-menopausal women with obesity, with symptoms of pelvic/abdominal pain, mild abnormal vaginal bleeding, constipation, increased urinary frequency, and possibly a palpable mass. Methods This case series, diagnosed in February and March of 2023, includes the presentation, clinical management, and ultimately pathologic diagnosis of two separate uterine lipoleiomyomas. Results A 51-year-old, G3P2, female presented with six months of severe post-menopausal bleeding, severe left-lower quadrant pelvic pain, and lightheadedness. A transvaginal ultrasound revealed a heterogeneous, thickened endometrium of 3.9 centimeters and a probable left ovarian dermoid cyst. CT showed distension of endometrial cavity due to polyps and/or submucosal masses, as well as a fat-containing mass in the uterine corpus. Hysteroscopy with dilation and curettage was performed with pathology of high-grade malignancy. Differential diagnosis at this time included high-grade stromal sarcoma, undifferentiated carcinoma, adenosarcoma, or malignant mixed Mullerian tumor. Patient underwent MRI due to concern for malignancy, which showed FDG-avid endometrial thickening with no other FDG-avid areas of concern. Histopathologic diagnosis found carcinosarcoma of the uterus, two positive lymph nodes, and an incidental finding of lipoleiomyoma. Further medical management will include chemotherapy and vaginal cuff brachytherapy for uterine carcinosarcoma. A 50-year-old, G5P5, female presented with increasing vaginal spotting and worsening urge incontinence. CT showed increased size of heterogeneous mass in right lateral uterine wall, consistent with previously identified fibroid/leiomyoma. An adjacent fat-containing lesion was identified within the uterine wall. Patient underwent MRI which revealed large uterine mass at fundus with associated fatty component. Due to abnormal rate of growth of fibroid and fat component, there was concern for uterine sarcoma and/or malignant transformation of leiomyoma. Histopathologic diagnosis found lipoleiomyoma with benign atrophic endometrium, paratubal cysts of bilateral fallopian tubes, and follicular cyst of the right ovary. Follow-up in one year was recommended. Conclusion Lipoleiomyomas are uncommon benign entities, occurring most commonly in post-menopausal women, similarly to uterine fibroids. While asymptomatic patients can be managed conservatively, these tumors can cause vaginal bleeding, pain, and urinary or fecal incontinence and can be definitively treated with hysterectomy. While imaging is necessary to initially characterize the lesion and determine malignancy concern, histopathologic diagnosis remains the gold standard for diagnosis. Lipoleiomyomas are associated with other gynecologic malignancies, metabolic disorders, and rarely tumor-to-tumor metastasis. For this reason, careful clinical evaluation and surgical management are required for complete evaluation of the patient.

Comparison Between Hypnoanesthesia and Local Anesthesia in Minor Surgery

Background: Hypnoanesthesia is a state of anesthesia achieved through hypnosis techniques. Meanwhile, local anesthesia is anesthesia carried out by injecting local anesthetic drugs in or around the surgical site which causes temporary obstruction to the conduction of afferent impulses. Objective: This research was conducted to prove that there is no difference between hypnoanesthesia and local anesthesia in minor surgical procedures, with the indication of pain relief. Methods: The research subjects were patients with benign soft tissue tumors consisting of 40 people who were divided into 2 groups, namely treatment and control. Minor surgical procedures with hypnoanesthesia were performed in the treatment group, while in the control group, minor surgical procedures were performed with local anesthesia using 2% lidocaine. Pain is measured with FPS (Face Pain Scale) and monitored with a vital sign monitor. The intervention process was recorded with camcorder video. Changes in serum levels of excitatory neurotransmitters (Glutamic Acid and Substance P) and inhibitory (Beta Endorphin, Enkephalin, and Serotonin) before and after intervention were analyzed using ELISA (Enzym-Link Immunosorbent Assay) in both groups. Results: In the treatment group, it was discovered that patients did not feel pain after undergoing hypnoanesthesia intervention by providing suggestions for the relief of pain in the area where surgery would be performed. In the control group, patients also did not feel pain after local anesthetic intervention in the area to be operated on. However, the results of research and statistical tests showed that there was no significant difference in changes in Beta Endorphins, Enkephalin, and Serotonin as inhibitory neurotransmitters (p > 0.05) or Glutamic Acid and Substance P as excitatory neurotransmitters (p > 0.05) before and after the intervention in both groups of research subjects. Conclusion: the results of this study show that there is no significant difference between the treatment and control groups, they have equality in the final result, namely the relief of pain.

Characterizing colon lipomas: Insights from a retrospective analysis of clinical presentation and management strategies.

This retrospective study aims to examine the characteristics and treatment approaches of colon lipomas, which are benign tumors found in the colon. We analyzed a cohort of 25 patients, focusing on demographic characteristics, clinical presentation, location and size of the lipoma, concomitant pathologies, and treatment methods. The average age of the patients was 67.3 years, with 36% being male and 64% female. The majority of lipomas were located in the ascending colon (52%), and their median size was 2 cm. The predominant presenting symptom was constipation, affecting 83.3% of the symptomatic patients. Surgical resection was undertaken in only 1 patient due to obstruction. Statistically significant differences were observed between symptomatic and asymptomatic patients regarding various parameters, including the size of the lipoma (P = .033). Colon lipomas are generally benign and frequently asymptomatic but may necessitate different treatment approaches depending on their size, location, and the presence of symptoms. Further studies are imperative to refine treatment strategies and enhance patient care outcomes.

P.068 Malignant transformation of a spinal dermoid cyst into carcinosarcoma

Background: Spinal dermoid cysts are uncommon, benign tumours of ectodermal origin, often associated with spinal dysraphism. Malignant transformation of spinal dermoid cysts is an exceptionally rare entity, with transformation into carcinosarcoma not previously reported. Methods: Case report and literature review Results: A 41-year-old male presented with a recurrent lumbar intradural mass, 28 years after resection of a dermal sinus tract and associated dermoid cyst. Intraoperative appearance and subsequent pathology were again consistent with a dermoid cyst. The patient re-presented 2 weeks after surgery with diplopia and headache due to hydrocephalus, thought to be due to chemical meningitis. Following ventriculoperitoneal shunt implantation, the patient rapidly deteriorated with progressive neurologic deficits and widespread leptomeningeal enhancement. A repeat spinal leptomeningeal biopsy was pursued, which revealed malignant transformation of the dermoid cyst into invasive carcinosarcoma. Without curative treatment options, the patient was palliated and died 85 days after admission. Conclusions: Malignant transformation of spinal dermoid cysts should be considered in the differential diagnosis of patients with dermoid cysts and progressive leptomeningeal enhancement. False negatives can occur with initial tumour pathology and repeat sampling may be warranted for diagnostic clarity. To the authors knowledge, this is the first report of a spinal dermoid cyst with malignant transformation into carcinosarcoma.

Spinal epidermoid cyst associated with limited dorsal myeloschisis

Background: Epidermoid cysts (ECs) are rare benign tumors arising from epidermal cells, associated with congenital abnormalities or acquired through trauma, surgery, or lumbar punctures. They represent <1% of all intraspinal tumors and may be associated with limited dorsal myeloschisis (LDM). Case Description: A 7-year-old neurologically intact male had a dorsal skin mass since birth located posteriorly in the midline of the inferior thoracic spine. The mass was palpable, painless, mobile, vascularized, and could be transilluminated. Thoracic magnetic resonance imaging showed an extensive intradural extramedullary cystic lesion extending from D6 to D8 that did not enhance with contrast, accompanied by a subcutaneous fluid collection at D8–D9 communicating with the subarachnoid space. The patient underwent gross total resection of the lesion, pathologically confirmed as an EC. The postoperative course was uneventful, with no recurrence 1 year postoperatively. Conclusion: LDM may be associated with ECs. Early diagnosis and surgical resection of these lesions are essential for favorable outcomes.

Epidemiology of primary brain tumor among adolescents and adults in Palestine: a retrospective study from 2018 to 2023

BackgroundsPrimary brain tumors (PBTs) are uncommon, but they significantly increase the risk of disability and death. There is a deficiency of data concerning the epidemiology and anatomical distribution of PBTs among adults in Palestine.MethodsA retrospective descriptive study in which data were collected from the clinical reports of Palestinian patients diagnosed with PBTs at Al-Makassed Hospital during the period (2018–2023).ResultsIn Palestinian adolescents and adults, the incidence rate of PBTs was 3.92 per 100,000 person-years. Glioblastoma (18.8%) was the most common type identified, and it was more common in males. Non-malignant tumors were more common than malignant tumors (2.41 vs. 1.52 per 100,000). The mortality rate from PBTs was 4.8%. The most common initial symptom was headaches, and it occurred more with non-malignant tumors (57.28% vs. 42.72%, p-value < 0.001). Cerebral meninges (26.3%) were the most common location for primary brain tumors (p-value < 0.001).ConclusionThis is the first study of primary brain tumor epidemiology in Palestine. The overall incidence of PBTs in Palestinian adolescents and adults was 3.96 per 100,000, which was lower than the incidence rate of primary brain tumors worldwide. More studies on the epidemiology and distribution of PBTs in Palestine are recommended.

The critical role of neuroimaging in hemicrania continua: Asystematic review and case series.

Hemicrania continua is a primary unilateral headache characterized by ipsilateral parasympathetic and sympathetic autonomic features. A key diagnostic criterion is its dramatic response to indomethacin treatment; however, various vascular or structural abnormalities have been reported to cause secondary hemicrania continua, presenting with clinical features similar to those of the primary headache presentation. We reviewed the literature to compile secondary hemicrania continua cases, highlighting the importance of imaging during the evaluation. Additionally, we also contributed our three cases to the existing studies. We conducted a review of articles from the PubMed and EMBASE databases that described reported cases of secondary hemicrania continua, covering the period from 1993 to 2021. Our review included detailed patient information, signs, and symptoms of hemicrania continua, as well as information on indomethacin usage and headache resolution (if pertinent). Secondary hemicrania continua can result from a remarkably diverse range of structural and vascular lesions, yet clinical reports on long-term follow-up are lacking. Notably, cases may exhibit a classical response to indomethacin, emphasizing the importance of neuroimaging in excluding secondary cases. Our search yielded 41 cases meeting our criteria. We excluded six cases that were not treated with indomethacin or were unresponsive to it. Additionally, we present three cases that highlight the necessity of neuroimaging in evaluating hemicrania continua, along with short- and long-term clinical outcomes following indomethacin and lesion-directed treatments. Case 1 presented with daily right-sided headaches and cranial autonomic symptoms. Her pain completely resolved with indomethacin use. Neuroimaging of the brain revealed a laterally directed saccular aneurysm of the right internal carotid artery. Case 2 presented with continuous left-sided unilateral headaches with superimposed exacerbations. She complained of left-sided photophobia with a dull sensation in the left ear. Her symptoms decreased after 2 weeks of indomethacin use. Neuroimaging of the head indicated a benign tumor with mass effect into the left lateral medulla and inferior cerebellar peduncle. Case 3 presented with a right side-locked headache with daily, severe superimposed exacerbations. She had photophobia in the right eye and a right-sided Horner's syndrome, along with tearing during her exacerbations. Neuroimaging of the brain revealed a pituitary tumor and her pain completely resolved with indomethacin. Hemicrania continua is a rare headache disorder that can be either primary or secondary. Importantly, response to indomethacin can still occur in secondary hemicrania continua. Thus, neuroimaging should be considered to rule out underlying structural etiology in all cases, regardless of their clinical responsiveness to indomethacin therapy.

Rescue of impaired blood-brain barrier in tuberous sclerosis complex patient derived neurovascular unit

BackgroundTuberous sclerosis complex (TSC) is a multi-system genetic disease that causes benign tumors in the brain and other vital organs. The most debilitating symptoms result from involvement of the central nervous system and lead to a multitude of severe symptoms including seizures, intellectual disability, autism, and behavioral problems. TSC is caused by heterozygous mutations of either the TSC1 or TSC2 gene and dysregulation of mTOR kinase with its multifaceted downstream signaling alterations is central to disease pathogenesis. Although the neurological sequelae of the disease are well established, little is known about how these mutations might affect cellular components and the function of the blood–brain barrier (BBB).MethodsWe generated TSC disease-specific cell models of the BBB by leveraging human induced pluripotent stem cell and microfluidic cell culture technologies.ResultsUsing microphysiological systems, we demonstrate that a BBB generated from TSC2 heterozygous mutant cells shows increased permeability. This can be rescued by wild type astrocytes or by treatment with rapamycin, an mTOR kinase inhibitor.ConclusionOur results demonstrate the utility of microphysiological systems to study human neurological disorders and advance our knowledge of cell lineages contributing to TSC pathogenesis and informs future therapeutics.

Giant Ganglioneuroma of the Lumbar Spine: A Rare Cause of Radiculopathy

Background. Ganglioneuroma (GN) is a rare, benign tumor that originates from neural crest cells and can potentially affect any anatomical site within the sympathetic nervous system. Typically, GNs are more frequently reported in children and young adults, with a slightly higher prevalence in females. We are reporting a rare case of a giant lumbar spine ganglioneuroma by outlining the clinical presentation, radiological finding, management, and outcome. Case Description. A 37-year-old female presented with low back pain radiating to the right lower limb for few years. Neurological examination revealed bilateral lower limb hyperreflexia (+3). Lumbar spine CT and MRI revealed a right paravertebral soft tissue lesion with heterogeneous signal intensity and enhancement at L1 to L3. The patient underwent complete resection of the lesion via a retroperitoneal approach. The surgery was uneventful. The histopathological sections were suggestive of mature ganglioneuroma. She was discharged in stable condition with follow-up at neurosurgery clinic. Conclusion. Giant ganglioneuromas are rare, benign tumors of sympathetic neurons. Complete surgical resection is the most effective therapeutic option for ganglioneuroma to avoid recurrence. Given the benign nature of ganglioneuroma, chemotherapy and radiotherapy tend to have a limited role following surgical resection.

Deep learning driven diagnosis of malignant soft tissue tumors based on dual-modal ultrasound images and clinical indexes

BackgroundSoft tissue tumors (STTs) are benign or malignant superficial neoplasms arising from soft tissues throughout the body with versatile pathological types. Although Ultrasonography (US) is one of the most common imaging tools to diagnose malignant STTs, it still has several drawbacks in STT diagnosis that need improving.ObjectivesThe study aims to establish this deep learning (DL) driven Artificial intelligence (AI) system for predicting malignant STTs based on US images and clinical indexes of the patients.MethodsWe retrospectively enrolled 271 malignant and 462 benign masses to build the AI system using 5-fold validation. A prospective dataset of 44 malignant masses and 101 benign masses was used to validate the accuracy of system. A multi-data fusion convolutional neural network, named ultrasound clinical soft tissue tumor net (UC-STTNet), was developed to combine gray scale and color Doppler US images and clinic features for malignant STTs diagnosis. Six radiologists (R1-R6) with three experience levels were invited for reader study.ResultsThe AI system achieved an area under receiver operating curve (AUC) value of 0.89 in the retrospective dataset. The diagnostic performance of the AI system was higher than that of one of the senior radiologists (AUC of AI vs R2: 0.89 vs. 0.84, p=0.022) and all of the intermediate and junior radiologists (AUC of AI vs R3, R4, R5, R6: 0.89 vs 0.75, 0.81, 0.80, 0.63; p &amp;lt;0.01). The AI system also achieved an AUC of 0.85 in the prospective dataset. With the assistance of the system, the diagnostic performances and inter-observer agreement of the radiologists was improved (AUC of R3, R5, R6: 0.75 to 0.83, 0.80 to 0.85, 0.63 to 0.69; p&amp;lt;0.01).ConclusionThe AI system could be a useful tool in diagnosing malignant STTs, and could also help radiologists improve diagnostic performance.

Overview of Characteristics of Parathyroid Tumor Patients at Dr. Hasan Sadikin General Hospital Bandung, Indonesia: A 5-Year Study

Background: Parathyroid tumors are the most common endocrine neoplasms, with hyperparathyroidism as the main clinical manifestation. Parathyroid adenoma is the most common benign neoplasm, while parathyroid carcinoma is relatively rare but difficult to differentiate from benign disorders. This study aims to describe the characteristics of parathyroid tumor patients at Dr. Hasan Sadikin General Hospital (RSHS) Bandung over the last 5 years. Methods: This descriptive observational research was carried out by collecting medical record data from parathyroid tumor patients at RSHS Bandung for the 2019-2023 period. Parameters identified included age, gender, and histopathological type. Data analysis was carried out using SPSS univariately. Results: There were 12 patients with parathyroid tumors with an increasing trend in cases over the last 5 years. The average age of patients was 37.33 years, with the majority (9 cases) being women. Parathyroid adenoma was the most common histopathological type (8 cases), followed by parathyroid carcinoma (2 cases), osteitis fibrocystica (1 case), and bone deformity (1 case). One patient with parathyroid adenoma was also diagnosed with fibrous dysplasia. Conclusion: The majority of cases of parathyroid tumors at RSHS Bandung occur in women, with the incidence of parathyroid carcinoma being the same in men and women. Parathyroid adenoma is the most common histopathological type, and bone abnormalities complications can occur in patients with parathyroid disorders (3 patients).

Vestibular Schwannoma and Tinnitus: A Systematic Review of Microsurgery Compared to Gamma Knife Radiosurgery

Background: Vestibular schwannoma (VS) is a benign tumor of the eighth cranial nerve formed from neoplastic Schwann cells. Although VS can cause a variety of symptoms, tinnitus is one of the most distressing symptoms for patients and can greatly impact quality of life. The objective of this systematic review is to comprehensively examine and compare the outcomes related to tinnitus in patients undergoing treatment for VS. Specifically, it evaluates patient experiences with tinnitus following the removal of VS using the various surgical approaches of traditional surgical resection and gamma knife radiosurgery (GKS). By delving into various aspects such as the severity of tinnitus post-treatment, the duration of symptom relief, patient quality of life, new onset of tinnitus after VS treatment, and any potential complications or side effects, this review aims to provide a detailed analysis of VS treatment on tinnitus outcomes. Methods: Following PRISMA guidelines, articles were included from PubMed, Science Direct, Scopus, and EMBASE. Quality assessment and risk of bias analysis were performed using a ROBINS-I tool. Results: Although VS-associated tinnitus is variable in its intensity and persistence post-resection, there was a trend towards a decreased tinnitus burden in patients. Irrespective of the surgical approach or the treatment with GKS, there were cases of persistent or worsened tinnitus within the studied cohorts. Conclusion: The findings of this systematic review highlight the complex relationship between VS resection and tinnitus outcomes. These findings underscore the need for individualized patient counseling and tailored treatment approaches in managing VS-associated tinnitus. The findings of this systematic review may help in guiding clinicians towards making more informed and personalized healthcare decisions. Further studies must be completed to fill gaps in the current literature.

An analysis of health-related quality of life in children and adolescents after parotidectomy based on patient-reported outcomes.

To assess health-related quality of life (HRQoL) and its influencing factors in these pediatric patients undergoing parotidectomy. This was a cross-sectional study that included 37 children and adolescents (≤ 19years) with parotid gland tumors who were treated in Sichuan Cancer Hospital between January 2006 and November 2021. HRQoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). The Wilcoxon rank sum test was used to analyze the factors influencing patients' HRQoL. 37 children and adolescents were included in the study, including 22 cases of benign tumors and 15 cases of malignant tumors. All patients underwent surgery, and some patients with malignant tumors received radiotherapy or chemotherapy. Malignancy, permanent facial palsy, and Frey syndrome were associated with worse HRQoL in children and adolescents with parotid gland tumors. Radiotherapy and no cervical lymph node dissection were associated with worse HRQoL in pediatric patients with malignancy. The surgical approach of parotid is not a factor influencing HRQoL. Factors associated with HRQoL in children and adolescents with parotid gland tumors include pathological types, permanent facial palsy, and Frey syndrome. In addition, factors affecting patients with malignancy include lateral lymph node dissection and radiotherapy.

2 Cases of Intra-Labyrinthine Schwannomas With Different Treatment Options Based on Clinical Presentation

Vestibular schwannoma is a benign tumor that arises from the eighth cranial nerve and is the most common neoplasm in the internal auditory canal (IAC). It typically arises in the cerebellopontine angle or in IAC; however, in rare cases, they can arise within the labyrinth. These tumors arising in the labyrinth have been termed intra-labyrinthine schwannomas (ILS) and have different clinical features than the typical vestibular schwannomas. Clinical manifestations of an ILS typically include hearing loss, tinnitus, and vertigo, with unusual symptoms including a sense of fullness or imbalance. Temporal bone MRI is considered the most important test for diagnosing ILS. Tumors show nodular enhancement on T1-weighted images and filling defects on T2-weighted images. Treatment of ILS may include observation, microsurgical resection, and stereotactic radiosurgery depending on the location, size, and clinical presentation. In this paper, we present two cases diagnosed as ILS with different treatment options and provide a literature review for each case.

Thermometry mapping during CT-guided thermal ablations: proof of feasibility and internal validation using spectral CT

Objective. Conventional computed tomography (CT) imaging does not provide quantitative information on local thermal changes during percutaneous ablative therapy of cancerous and benign tumors, aside from few qualitative, visual cues. In this study, we have investigated changes in CT signal across a wide range of temperatures and two physical phases for two different tissue mimicking materials, each. Approach. A series of experiments were conducted using an anthropomorphic phantom filled with water-based gel and olive oil, respectively. Multiple, clinically used ablation devices were applied to locally cool or heat the phantom material and were arranged in a configuration that produced thermal changes in regions with inconsequential amounts of metal artifact. Eight fiber optic thermal sensors were positioned in the region absent of metal artifact and were used to record local temperatures throughout the experiments. A spectral CT scanner was used to periodically acquire and generate electron density weighted images. Average electron density weighted values in 1 mm3 volumes of interest near the temperature sensors were computed and these data were then used to calculate thermal volumetric expansion coefficients for each material and phase. Main results. The experimentally determined expansion coefficients well-matched existing published values and variations with temperature—maximally differing by 5% of the known value. As a proof of concept, a CT-generated temperature map was produced during a heating time point of the water-based gel phantom, demonstrating the capability to map changes in electron density weighted signal to temperature. Significance. This study has demonstrated that spectral CT can be used to estimate local temperature changes for different materials and phases across temperature ranges produced by thermal ablations.

Applying dynamic contrast-enhanced MRI tracer kinetic models to differentiate benign and malignant soft tissue tumors

BackgroundTo explore the potential of different quantitative dynamic contrast-enhanced (qDCE)-MRI tracer kinetic (TK) models and qDCE parameters in discriminating benign from malignant soft tissue tumors (STTs).MethodsThis research included 92 patients (41females, 51 males; age range 16–86 years, mean age 51.24 years) with STTs. The qDCE parameters (Ktrans, Kep, Ve, Vp, F, PS, MTT and E) for regions of interest of STTs were estimated by using the following TK models: Tofts (TOFTS), Extended Tofts (EXTOFTS), adiabatic tissue homogeneity (ATH), conventional compartmental (CC), and distributed parameter (DP). We established a comprehensive model combining the morphologic features, time-signal intensity curve shape, and optimal qDCE parameters. The capacities to identify benign and malignant STTs was evaluated using the area under the curve (AUC), degree of accuracy, and the analysis of the decision curve.ResultsTOFTS-Ktrans, EXTOFTS-Ktrans, EXTOFTS-Vp, CC-Vp and DP-Vp demonstrated good diagnostic performance among the qDCE parameters. Compared with the other TK models, the DP model has a higher AUC and a greater level of accuracy. The comprehensive model (AUC, 0.936, 0.884–0.988) demonstrated superiority in discriminating benign and malignant STTs, outperforming the qDCE models (AUC, 0.899–0.915) and the traditional imaging model (AUC, 0.802, 0.712–0.891) alone.ConclusionsVarious TK models successfully distinguish benign from malignant STTs. The comprehensive model is a noninvasive approach incorporating morphological imaging aspects and qDCE parameters, and shows significant potential for further development.