Cases Of Benign Tumors Research Articles

Diagnosis Accuracy of Fine Needles Aspiration Assessment in Bone Tumors in the Department of Anatomical Pathology FKUI/RSCM 2015-2019

BackgroundFine needle aspiration biopsy (FNAB) is a safe and rapid technique and has an important role in making the preoperative diagnosisof bone tumors because it can help clinicians determine treatment for patients. This retrospective study aims to assess the accuracyof the FNAB cytological examination compared with the histopathological examination in preoperative diagnosis of bone tumors.MethodsThe data comes from the archives of the Department of Anatomic Pathology, FKUI/RSCM 2015-2019 in the form of a cytologicalexamination of FNAB lesions on bone. Then the histopathological examination data were searched for each cytology preparation.There were 133 pairs of cytology, and histopathology preparations. The preparations were reviewed by the investigator andsupervisor, assessed for the suitability of the cytologic diagnosis, and compared with the histopathological diagnosis.ResultsThere were 84 (63.2%) cases of malignant tumors, 44 (33.1%) cases of benign tumors, and 5 (3.7%) cases of non-tumors. Thediagnostic test results showed an accuracy rate of 86.5% with a sensitivity of 85.9%, a specificity of 100%, a positive predictivevalue (PPV) of 100%, and a negative predictive value (NPV) of 21.7%.ConclusionFNAB cytology examination of bone tumors that have adequate sample quality, supported by complete clinical information andinformative radiological images can produce an accurate preoperative diagnosis

Cytological, Histopathological and Immunohistochemical Study of Canine Mammary Gland Tumors

The present study was carried out to investigate the cytological, histopathological, and immunohistochemical profiles of eleven cases of canine mammary gland tumors. Based on cytological characteristics, two cases of benign tumors and nine cases of malignant mammary gland tumors were tentatively diagnosed whereas one case of benign tumor and ten cases of malignant tumors were later on confirmed by histopathology. Considering histopathology as a gold standard diagnostic technique for tumors, one false positive and two false-negative results were obtained. For the determination of origin and nature of the tumor, immunohistochemistry was performed on all cases using PCNA, Ki-67, pan-cytokeratin, vimentin, and desmin biomarkers. All cases showed immunoreactivity with PCNA, Ki-67, and pan-cytokeratin whereas no immunoreactivity was found with the desmin. However, carcinoma mixed type and malignant myoepithelioma showed immunoreactivity with vimentin; the rest of the tumors did not show any immunoreactivity with the same.

Comparison of Cytological and Histomorphological Findings in Breast Tumours- A Study from a Tertiary Care Hospital in Southern India

Introduction: Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death in females. There is increasing awareness and the associated anxiety and stress among women, who perceive every symptom in breast as carcinoma, compels the patients to seek medical advice. Fine Needle Aspiration Cytology (FNAC) is a relatively simple, reliable, atraumatic, economical and complication free technique for the evaluation of mass lesions. Aim: To study the varied spectrum of breast tumours and to evaluate the diagnostic utility of cytological findings by comparing it with histopathological findings in breast tumours. Materials and Methods: The present study was a hospital- based cross-sectional study conducted in the Department of Pathology, Indira Gandhi Medical College and Research Institute, Pondicherry, India, from November 2017-October 2019. All cases of breast tumours, sent by surgeon, as out-patient or in- patient, who underwent FNAC followed by surgical biopsy, were included in this study. A total of 150 cases were studied. FNAC smears were stained using Haematoxylin and Eosin (H&E) and Papanicolaou (Pap) stains and air-dried smears were stained using May Grunwald Giemsa (MGG) stain. The excised specimen after surgery was subjected to detailed histopathological examination. Representative bits were taken from appropriate sites and stained using H&E stains, special stains and Immunohistochemistry (IHC) were carried out wherever necessary. Results: Majority of cases were in the age group of 21-30 years. There were 149 cases of female patients and only one case of male patient with breast carcinoma during the study period. Cytology showed 117 cases of benign tumours and 33 cases were malignant. Histopathology revealed 116 cases of benign tumours and 34 cases of malignant. One case was given as Atypical Ductal Hyperplasia (ADH) in cytology, found to be malignant Infiltrating Ductal Carcinoma (IDC) on histopathological examination. Five cases on cytology which were given as suspicious of carcinoma (C4 category) were found to be IDC on excision biopsy. Benign lesions were common in right breast, whereas malignant lesions were common in left breast. The diagnostic value of FNAC was assessed and showed sensitivity: 97.06%, specificity: 100%, Positive Predictive Value (PPV): 100%, Negative Predictive Value (NPV): 99.15% Accuracy of 99.33%. Conclusion: The present study was an attempt to compare cytological and histomorphological findings in breast tumours to know the diagnostic accuracy of FNAC and also studying the spectrum of breast lesions. The high specificity and negative predictive value showed high accuracy of FNAC in diagnosing the malignancy. It is an established method to determine the nature of breast lesions. In the present study, fibroadenoma was the commonest benign tumour and IDC- Not Otherwise Specified (NOS) type was the commonest malignant tumour.

Centromere Protein F (CENPF): A novel marker for salivary gland pathology.

Salivary gland tumours are relatively uncommon, and there exists considerable diagnostic difficulty. This is due to individual lesions having diverse histopathological features, presence of number of types and variants, and overlapping histological features in different tumour entities. The current study aimed at assessing the expression of centromere protein F (CENPF) in benign and malignant salivary gland tumours and to evaluate the efficacy of CENPF as a proliferative marker to aid in the diagnosis of malignancy so that it will help in surgical pathology practice. The study group involved 20 cases of benign salivary gland tumours, 20 cases of malignant salivary gland tumours, and 10 normal salivary gland tissues. All the cases were subjected to immunohistochemical analysis for CENPF expression and were assessed by two independent observers and further taken up for evaluation. The results were analysed statistically among different groups using analysis of variance (ANOVA) or Kruskal-Wallis test with Chi-squared test using IBM's Statistical Package for the Social Sciences (SPSS) version 17.0. CENPF expression in normal salivary gland was negative with gradual increase in expression from benign salivary gland tumours to malignant salivary gland tumours. CENPF expression was high in malignant salivary gland tumours. Findings of the study suggest that CENPF can be regarded as a new cell proliferation marker for malignant salivary gland tumours.

Hepatic Mesenchymal Hamartoma: Report of two cases of benign hepatic tumor in childhood

Hepatic Mesenchymal Hamartoma: Report of two cases of benign hepatic tumor in childhood

Characteristics and Outcomes of Parotid Gland Tumors in Adolescents.

Parotid tumors are rare neoplasms in adults but are exceedingly infrequent in adolescents. We aimed to determine the clinical characteristics and outcomes of parotid tumors in adolescents under 20years old. Between 1999 and 2020, 979 cases of benign parotid tumors and 236 cases of malignant parotid tumors were treated surgically in our department. Of these, 12 benign cases (1.2%) and 9 malignant cases (3.8%) were in adolescents. There were no benign or malignant cases for those aged under 10years. Regarding the histological type, all benign tumors were pleomorphic adenomas. About half of malignant tumors were mucoepidermoid carcinomas, and excluding one high-grade case, the grade of malignancy was all low/intermediate. The accuracy of fine-needle aspiration cytology among adolescents showed no significant difference with that of adults. In contrast to adults, adolescent benign tumor cases showed a markedly high rate of pleomorphic adenomas and no postoperative facial nerve palsy. Malignant tumors in adolescents had a different trend than adults; low/intermediate-grade malignancies were common and thus few symptoms/signs of malignancy could be observed. As well, the accuracy of fine-needle aspiration cytology was poor. All cases had a good prognosis and are disease-free survival. Parotid tumors in adolescents are rare but have several characteristics that are distinct from adults. As long-term observation is required posttreatment in adolescent patients, recurrence in benign pleomorphic adenomas and poor long-term prognosis in malignant tumors, especially for those with low/intermediate-grade malignancy, are more likely to be observed.

Study on the Effect of MRI in the Diagnosis of Benign and Malignant Thoracic Tumors.

In order to investigate the effectiveness and accuracy of magnetic resonance imaging (MRI) in the diagnosis of benign and malignant thoracic tumors, the research retrospectively selected 80 patients with thoracic tumors admitted from May 2019 to May 2020 as the study subject and all patients were underwent MRI detection. Using pathological diagnostic results as the gold standard, the research analyzed the detection of benign and malignant thoracic tumors by MRI, as well as the diagnostic sensitivity and specificity. After pathological diagnosis, there were 35 malignant tumors and 45 benign tumors. 41 cases of malignant tumors and 39 cases of benign tumors were diagnosed by MRI, with a diagnostic sensitivity of 80.00%, a diagnostic specificity of 71.11%, and a diagnostic compliance rate of 75.00%. In the MRI diagnosis of tumors in different parts of the chest, the diagnostic sensitivity for lung tumors, mediastinal tumors, chest wall tumors, and esophageal tumors was 83.33%, 71.43%, 83.33%, 75.00%, and 87.50%, respectively, and the specificity was 66.67%, 77.78%, 57.14%, 50.00%, and 91.67% according to and breast tumors, respectively. And the accuracy was 73.33%, 75.00%, 69.23, 62.50%, and 90.00%, respectively, with the highest diagnostic sensitivity, specificity, and accuracy for breast tumors. MRI has a good effect on the diagnosis of benign and malignant thoracic tumors and has a high diagnostic value, which is helpful to identify the location, nature, source, and lesion scope of the tumor. It is safe and worthy of promotion.

Preliminary application of transoral robotic thyroidectomy: experience from an initial 30 cases

Objective: To examine the surgical outcome of transoral robotic thyroidectomy. Methods: Clinic data of total 30 cases of transoral robotic thyroidectomy at the Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army from May 2020 to December 2020 were analyzed retrospectively. There were 3 males and 27 females, aged (31.5±11.0) years (range: 17 to 55 years), including 6 cases of benign tumor and 24 cases of malignant cancer (all papillary thyroid carcinoma). An inverted U-shaped incision 1.5 cm in length was made over the end of the frenulum of the lower lip. A wide subplatysmal space was created by bluntly passing with a vascular tunneller (8 mm diameter), and a 12 mm trocar was inserted through the lip incision for the camera port. Lateral oral mucosal incisions 8 mm in length were made near both lateral labial commissures, 8 mm robot trocars were inserted through the incisions. An 5 mm trocar was inserted through an incision made along the patient's right axillary fold into the subplatysmal working space and was connected with 5 mm ProGrasp for counter traction during the operation and for later drain insertion. Numerical scoring system (NSS) was used to assess cosmetic effect 1 month post-operation. Results: All the 30 transoral robotic thyroidectomies was successful, no case conversed to open operation. Postoperative hospital stay was (6.3±1.2) days (range: 4 to 10 days). The tumor size of thyroid cancers was (5.3±3.0) mm (range: 2 to 15 mm). Lymph node metastasis was observed in 12 cases. The retrieved central lymph node number was 10.5±4.4 (range: 4 to 20), while the central metastatic lymph node number was 2(2) (range: 1 to 11). Postoperative transient hypoparathyroidism occurred in 2 cases. Permanent hypoparathyroidism and vocal cord palsy didn't occur. Other surgical complications included hematoma, surgical site infection and perforation of chin flap, retrospectively in 1 case. Local regional lymph node recurrence wasn't developed during 1 to 7 months follow-up. All patients were satisfied with the postoperative cosmetic outcomes,NSS was 9.4±0.8 (range: 8.7 to 9.6). Conclusion: Transoral robotic thyroidectomy is safe and effective, suitable for early thyroid cancers without lateral lymph node metastasis, and has superior cosmetic results when the patients are selected carefully.

C76. Primary Cardiac Tumors : Benign or Malignant ? The Importance of Clinicopathologic Confirmation : a case series

Abstract Background Cardiac tumor is a rare condition of space-occupying lesion mass in cardiac chamber. The incidence of clinically diagnosed Primary Cardiac Tumors is approximately 1,380/100 million individuals. Majority of cases are benign, with nearly half of them are cardiac myxoma. Although early clinical symptom of benign and malignant cardiac tumor are similar, the management and prognosis are much different. Objective To present serial cases of benign and malignant primary cardiac tumor. Case Description Mrs. RH, a 60-year-old woman referred to heart failure clinic National Cardiovascular Center Harapan Kita with chief complaint of short of breath on exercise. Echocardiography confirmed a huge mass obstructed her left atrium. She was hospitalized urgently with giant Left Atrial Myxoma with normal coronary artery, then underwent surgery of LA myxoma extirpation, Mitral Valve repair and Tricuspid Valve repair. Histopathological analysis confirmed of LA myxoma. Mr. RBM, a 42-years-old man came to emergency unit at National Cardiovascular Center Harapan Kita with chief complaint shortness of breath and palpitation in about 1 month. A history of a cardiac tumor extirpation and mitral valve replacement was done in Penang Adventist hospital 10 months before. Transthoracal and transesophageal echocardiography found solid mass obstructing mechanical valve. Histopathology analysis showed undifferentiated cardiac sarcoma and against LA myxoma. Discussion Clinical course and management of cardiac tumor depends on early detection and histopathologic analysis. Although surgery is the cornerstone for cardiac tumor management, but confirmation of histopathologic findings is important.

C76. Primary Cardiac Tumors : Benign or Malignant ? The Importance of Clinicopathologic Confirmation : a case series

Abstract Background Cardiac tumor is a rare condition of space-occupying lesion mass in cardiac chamber. The incidence of clinically diagnosed Primary Cardiac Tumors is approximately 1,380/100 million individuals. Majority of cases are benign, with nearly half of them are cardiac myxoma. Although early clinical symptom of benign and malignant cardiac tumor are similar, the management and prognosis are much different. Objective To present serial cases of benign and malignant primary cardiac tumor. Case Description Mrs. RH, a 60-year-old woman referred to heart failure clinic National Cardiovascular Center Harapan Kita with chief complaint of short of breath on exercise. Echocardiography confirmed a huge mass obstructed her left atrium. She was hospitalized urgently with giant Left Atrial Myxoma with normal coronary artery, then underwent surgery of LA myxoma extirpation, Mitral Valve repair and Tricuspid Valve repair. Histopathological analysis confirmed of LA myxoma. Mr. RBM, a 42-years-old man came to emergency unit at National Cardiovascular Center Harapan Kita with chief complaint shortness of breath and palpitation in about 1 month. A history of a cardiac tumor extirpation and mitral valve replacement was done in Penang Adventist hospital 10 months before. Transthoracal and transesophageal echocardiography found solid mass obstructing mechanical valve. Histopathology analysis showed undifferentiated cardiac sarcoma and against LA myxoma. Discussion Clinical course and management of cardiac tumor depends on early detection and histopathologic analysis. Although surgery is the cornerstone for cardiac tumor management, but confirmation of histopathologic findings is important.

Pulmonary tumor with Notochordal differentiation: a case report and morphologic, Immunohistochemical and molecular study of benign Notochordal cell tumor originating in the lung

BackgroundExtraosseous benign notochordal cell tumor is extremely rare, and there are only five reported cases worldwide. The presented case of pulmonary primary benign notochordal cell tumor is the sixth case, but the first to report the deletion mutation of EGFR gene exon 19.Case presentationThe patient was a 50-year-old asymptomatic woman, who had been followed up for 3 years for a nodule in the right lung. After ten months of the wedge resection, the patient is alive without evidence of recurrence or metastasis. The tumor was 7 mm in diameter and was well demarcated. The tumor was consisted of a sheet of large round vacuolated cells with small and bland nuclei. No connective tissue containing blood vessels or inflammatory cell infiltration was detected in the stroma. The tumor was positive for CK AE1/AE3, Vimentin, S100 and Brachyury. EGFR gene mutation and amplification were not detected.ConclusionsWe firstly reported the positive immunohistochemical staining for EGFR and the negative molecular results of EGFR gene of pulmonary primary benign notochordal cell tumor. Due to the rarity of this tumor, more reports are needed to explore pathological characteristics, especially the molecular characteristics, in order to better understand the nature of tumors.

Significant difference between coagulation parameters and clinicopathological characteristics in breast cancer.

The purpose of this research is to investigate the correlation between coagulation parameters and survival on patients with breast cancer. A total of 244 patients with breast cancer and 84 patients with metastatic advanced breast cancer admitted to the Second Affiliated Hospital of Chongqing Medical University from January 2017 to February 2019 were selected as the research objects. Their age, tumor size, status of estrogen receptor and progesterone receptor status, status of Her-2 receptor and lymph node were evaluated. Additional 99 cases of benign breast tumors were selected as the control group. All patients were newly diagnosed. PTA, PT ratio, PT, APTT, APTT ratio, TT, TT ratio, PT-INR, FIB, and FDP were detected on all patients. There were significant differences in APTT, APTT ratio, FIB, TT, TT ratio, and FDP between breast cancer and benign tumor control group (P < 0.05). The changes of FIB were correlated with age (P = 0.007), PR status (P = 0.017), and Her-2 status (P = 0.008). The older the age, the higher the FIB level. The FIB level of Er negative state is higher than that of positive state, and the FIB level of PR negative state is also higher than that of positive state. Survival analysis showed that PR negative status, the elevated level of APTT, APTT ratio, TT increased, and TT ratio were the indicators affecting 3-year DFS of patients (P < 0.05). Multivariate COX regression analysis showed that APTT and TT were independent prognostic factors affecting 3 years DFS (P < 0.05). Blood hypercoagulable state in patients with breast cancer, abnormal coagulation system plays an important role in the progress of breast cancer.

HISTOPATHOLOGICAL SPECTRUM OF SKIN LESIONS: A TWO YEAR RETROSPECTIVE STUDY.

INTRODUCTION: The skin being largest organ of the body has vast spectrum of disorders which can be difcult to diagnose correctly solely on the basis of clinical features. Hence histopathological examination is necessary to categorise skin lesions. The aim was to study relative frequency of various skin lesions and distribution of these lesions according to age and sex. METHODS: This is a retrospective descriptive hospital based study. The skin biopsies samples which came in the duration of two years from January 2019 to December 2020 at the Department of Pathology, Sardar Patel Medical college and associated group of hospitals, Bikaner, Rajasthan were taken in this study. All skin biopsies that showed denite histopathological diagnosis were included. After proper xing and staining procedures these lesions were examined under light microscopy and categorized as non-neoplastic and neoplastic. Relative frequency of various lesions, distribution of lesions according to age and sex was analyzed. The data collected was tabulated, interpreted and compared with other similar studies. RESULTS: Out of 346 patients, incidence of neoplastic lesions 259 (74.9%) were higher than non-neoplastic lesions 87(25.1%). Males were affected more compared to females with male to female ratio 1.45:1. Non-neoplastic lesions were mostly caused because of infectious etiologies among which leprosy was the most common infection. Keratinocytic tumors 99(52.2%) constituted most common type of neoplastic lesion. Benign tumors 191(73.7%) outnumbered malignant tumors 68(26.3%). The cases of benign tumors were seen more in younger population while that of malignant tumors were seen in older age groups. Among the keratinocytic type of malignant skin tumors squamous cell carcinoma (63.5%) was the most common variant which was followed by basal cell carcinoma 19(36.5%). Male predominance was observed in both squamous cell carcinoma and basal cell carcinoma. CONCLUSION: A wide heterogenesity of skin lesions was observed in the present study . These skin lesions were mostly affecting age group of 10-30 years. Inspite of extensive programmes and research, leprosy and tuberculosis remains a rampant cause of infectious non-neoplastic skin lesions. Sometimes ignorance by patient for a very small appearing skin lesions becomes life threatening. Hence early clinician consultation with proper examination and accurate histopathological diagnosis becomes the mainstay in early treatment and recovery.

GOLD NANOPARTICLES REFLECTANCE DISCRIMINATE BENIGN FROM MALIGNANT SALIVARY GLAND NEOPLASMS

Background Nanoparticle-based contrast agents have been used as an imaging tool for selectively detecting cancerous processes. Epidermal growth factor receptor (EGFR) has been found to be dysregulated in malignant salivary gland tumors (MSGTs) and can serve as an ideal target for nanoparticle-based contrast agents using gold nanoparticles (GNPs) bio-conjugated to anti-EGFR monoclonal antibodies. Objective To evaluate the detection sensitivity of reflection measurements of anti-EGFR conjugated gold nanoparticles (C-GNPs) in discriminating benign tumors from MSGT. Methods Tissue sections of 37 cases were investigate. Nineteen cases of MSGT and 9 cases of benign tumors and 9 normal salivary glands were incubated with C-GNPs and the reflectance spectrum was measured using hyperspectral microscopy. Results A significant trend was found to correlate the severity of the lesions (Cuzick's test for trend, P = .018). Reflectance intensity was significantly higher (P Conclusions The GNP reflection measurements were able to discriminate benign tumors from MSGT, suggesting an objective, non-technique-sensitive method that is not dependent on the qualification of a technician and with fewer interpretation errors.

Analysis of the clinical value of multi-slice spiral computed tomography (MSCT), magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of retroperitoneal tumors.

BackgroundTo compare the differences in the diagnosis of retroperitoneal tumors among multi-slice spiral computed tomography (MSCT), magnetic resonance imaging (MRI), and ultrasound (US).MethodsSixty cases of retroperitoneal tumors admitted in our hospital from January 2016 to January 2019 were collected and related data were analyzed. After admission, patients were examined by MSCT, MRI, and US, and the pathological results of the patients were used as the controls. The differences in the diagnosis of retroperitoneal tumors were compared with the results of MSCT, MRI, and US.ResultsThirteen cases of benign tumors were diagnosed by MSCT, 47 cases were malignant, and 1 case was false benign, with diagnosis accuracy, sensitivity and specificity of 98.33%, 97.92% and 92.30%, respectively. Thirteen cases of benign tumors were diagnosed by MRI, 47 cases of malignant tumors, and 1 case was false benign, with diagnosis accuracy, sensitivity and specificity of 98.33%, 97.92%, and 92.30%, respectively. Fourteen cases of benign tumor were diagnosed by US, 46 cases were malignant, and 2 cases was false benign, with diagnosis accuracy, sensitivity and specificity of 96.67%, 97.92%, and 85.71%, respectively. There were no statistically significant differences in the accuracy, sensitivity, and specificity of MSCT, MRI, and US in the diagnosis of retroperitoneal tumors (P>0.05).ConclusionsMSCT, MRI, and US tests are highly accurate, sensitive, and specific in the diagnosis of retroperitoneal tumors.

Symptoms and signs of parotid tumors and their value for diagnosis and prognosis: a 20-year review at a single institution.

Detailed clinical features other than parotid mass have not been investigated in detail for parotid tumors. Symptoms and signs are useful for the differentiation of benign versus malignant, and may also be of value to determine the grade of malignancy and histological type as well as the assessment of prognosis. We reviewed symptoms and signs of 965 patients with benign tumors and 200 patients with malignant tumors. Symptoms and signs included pain/tenderness, adhesion to surrounding tissues, and facial nerve palsy. We reviewed the incidence in benign and malignant tumors, in histological type of benign tumors, and in grade and histology of malignant tumors. For each symptom or sign, covariates were analyzed, and their correlation with the prognosis was investigated. The incidence of symptoms and signs was significantly higher in malignant than benign tumors, and more frequent in higher grade of malignancy. Facial nerve palsy was observed in 18.0% of malignant tumor cases, while none occurred in benign tumor cases. Pain/tenderness was more commonly observed in adenoid cystic carcinoma, while adhesion to surrounding tissues and facial nerve palsy were most frequently noted in salivary duct carcinoma. The prognosis of patients with these symptoms and signs was significantly poor. A detailed investigation of symptoms and signs in parotid gland tumors is the first step that leads to the diagnosis of malignant tumors. Symptoms and signs are also useful for estimating the grade of malignancy and histological type, and they are important information for predicting prognosis.

A comprehensive study of fibroepithelial lesion of breast with special emphasis on challenges in diagnosing phyllodes tumor

Background: Fibroepthelial lesions are one of the most common benign breast disease seen in day today practice. They comprise of a wide spectrum of tumors ranging from fibroadenoma to infrequent phyllodes tumor. Evaluation of fibroepithelial lesions on FNA material or biopsy material may be sometimes under interpreted as both fibroadenoma and phylloides tumor have few common morphological features. So a detailed histopathological study is necessary to identify the hurdles in diagnosis and management of patient. This study was conducted with an aim to stratify and classify various fibroepithelial lesions, to classify phyllodes tumor according to newer WHO guidelines, to study interobserver variations in diagnosing phyllodes tumor and other associated morphological features in fibroepithelial lesion. Materials and Methods: This was retrospective study conducted in Department of Pathology, Hassan Institute of Medical Sciences, Hassan. The study was done on all breast biopsy samples received from the year January 2015 to April 2020 for a duration of 5years. Archived slides were reviewed in detail by three pathologists and fibroepithelial lesions were classified according to WHO classification of tumors of breast 2019. Results: A total of 200 fibroepithelial lesions of breast were studied. 180 cases were fibroadenoma, 18 cases were phyllodes tumor and 2 cases were benign fibroepithelial neoplasm. Interobserver variation was seen in 6 cases of benign phyllodes tumor, whereas no ambiguity was seen in diagnosis of fibroadenomas. Conclusion: Over diagnosis fibroadenomas as phyllodes tumor may have been prevented, if standard criteria were in use. Fibroadenoma and benign phyllodes tumor can be difficult to distinguish in some cases where focal leaf like growth pattern and hypercellularity can be seen. It is a good practice to evaluate the lesion as whole to come to a definitive diagnosis rather than emphasising on focal features.

Intraoperative Sodium-Fluorescence Imaging in Peripheral Nerve Sheath Tumors (PNST)-A New Additional Promising Diagnostic Tool.

Background: Through the development and implementation of specific fluorophore filters to microscopes in 2012, sodium fluorescein (SF) is currently experiencing a remarkable renaissance in neurosurgery. The present study examines its intraoperative application during surgical removal of peripheral nerve sheath tumors (PNST) and metastases.Methods: This single-center study includes 10 cases of benign and malignant tumors as well as metastases of peripheral nerves (in total 11 PNST). Their surgical resections were all performed under microscope-based fluorescence with SF, which was administered intravenously (0.5–1.0 mg/kg body weight) during anesthesia induction. Microsurgical tumor removals were filmed and the collected data were retrospectively analyzed via ImageJ.Results: Microsurgical tumor preparation was possible under the usage of fluorophore filter. In seven histological confirmed schwannoma (n = 6 patients) tissue differentiation between tumor mass and not involved fascicles was statistically significant for the colors green and red. Schwannoma maximum mean for green reached 254.7 pixel and 179.4 pixel for red, whereas passing healthy fascicles revealed a maximum mean for green 94.91 and for red 120.76 pixel. One case of neurofibroma achieved lower amount of pixel. Similar to schwannoma, the two MPNST cases showed a strong homogeneous fluorescence (max. mean green 215 pixel and red 124.51) involving the whole nerve segment. Subcutaneous tumor remnants were visualized and therefore resected. Via fascicular nerve biopsy a B-cell lymphoma of the tibial nerve could be detected. SF led to variable stain intensities in single fascicles. The resected fascicle revealed a max mean green of 100.54 pixel, whereas surrounding fascicles came up with max. mean green of 63.0 pixel.Conclusions: Intraoperative SF visualization for PNST is feasible and of low risk. During resection of benign PNST, enhanced tissue differentiation between affected and not affected nerve segments is very useful. Tumor remnants can be detected safely and effectively. Its application during resection of malignant PNST is limited. Due to the infiltrative nature of those tumors, intraneural tissue differentiation is not possible. “Fluorescence-guided” biopsy can be regarded as an additional advantage in PNST surgery. Due to the encouraging experience in our institution SF was established as standard visualization tool in PNST surgery.

Clinicopathological features of notochordal tumors: a study of 48 cases

Objective: To investigate the clinicopathological features, diagnosis and differential diagnosis of notochordal tumors. Methods: The clinical, radiologic and pathologic data of 48 notochordal tumors were collected from 2008 to 2019 at Shanghai Jiaotong University Sixth People's Hospital. Expression of cytokertin, S-100 protein, vimentin, brachyury and INI1 was detected by immunohistochemistry. The pathologic differential diagnoses and biologic behavior of various types of notochordal tumors were analyzed using the new standard in the 5th edition of WHO tumor classification. Results: Four cases of benign notochordal cell tumor were confined to vertebral body. Histopathologically, they lacked lobular architecture and extracellular myxoid matrix. The tumor cells were vacuolated and had centrally or peripherally located round to oval nuclei, with small nucleoli, without atypia, mimicking mature adipocytes. No mitotic figures were seen. Two cases of poorly differentiated chordoma, from patients aged 12 years and 21 years respectively, were located in cervical vertebra, and were composed of cohesive sheets or nests of epithelioid cells, with focal rhabdoid morphology. There was relatively abundant eosinophilic cytoplasm and scattered cytoplasmic vacuoles. The moderately pleomorphic nuclei were round to ovoid with vesicular chromatin and mitotic figures could be seen. Extracellular myxoid stroma was observed focally. Forty cases of conventional chordoma and two cases of extra-axis chordoma had similar histologic features. All 48 cases expressed cytokeretin, 45 cases expressed brachyury, and two poorly differentiated tumors showed loss of INI1/SMARCB1. Conclusions: There are four subtypes of chordomas: conventional, dedifferentiated, poorly differentiated and extra-axis. Chondroid chordoma is no longer thought to be a distinct entity. Each type has its unique clinicopathological characteristics. Brachyury is highly specific and sensitive for the diagnosis of various notochordal tumors. Poorly differentiated chordoma shows distinct clinicopathological features, including young age and loss of immunohistochemical expression of INI1/SMARCB1, and its diagnosis requires the combined detection of brachyury and INI1/SMARCB1.

Factors Associated With Late Admission to Facial Plastic Surgery Among Patients With Long-Standing Facial Paralysis.

Facial plastic surgeons often encounter patients experiencing untreated long-standing facial paralysis who are unaware that their condition can be managed by facial reconstructive procedures. To promote timely admission of patients with facial paralysis for facial plastic surgery, factors associated with late admission should be elucidated. A retrospective chart review was conducted on patients admitted to our facial paralysis clinic. Late admission was defined by an onset-to-admission interval longer than the median value. Multivariable logistic regression analysis was used to assess the odds ratio of late admission with age, sex, etiology, referring physician specialty, and the time of first admission. A total of 199 cases from October 2017 to March 2020 were included. Onset-to-admission interval longer than 21 months (median) was considered late admission. Etiologies involving benign tumors and congenital diseases were significantly associated with late admission (odds ratio [95% confidence interval], 3.9 [1.0-14.4] and 31.7 [4.7-212.6], respectively). Most benign tumor cases were referred from nonplastic surgeons. Benign tumors and congenital diseases were significantly related to late admission of patients with long-standing facial paralysis. As the majority of benign cases were referred from nonplastic surgeons, spreading awareness on facial plastic surgery as a treatment option may be necessary in promoting timely admission.