Change In Size Of Mass Research Articles

Microsurgical interfascicular dissection operation is a viable treatment of carpal tunnel syndrome caused by Lipofibromatous hamartoma: A case report

Lipofibromatous Hamartoma (LFH) is a rare and slow growing benign tumor affecting the peripheral nerves, which usually involves the median nerve. Median nerve involvement commonly causes pain, numbness, paresthesia and carpal tunnel syndrome (CTS). This article describes a case of lipofibromatous hamartoma in a 6-years-old girl, complained of the mass and numbness in her left distal forearm. Microsurgical interfascicular dissection operation was performed to remove the epineural proliferation tissue, numbness disappeared after the operation. At the 12-months follow-up appointment she remained asymptomatic and there was no change in mass size.

PSAT030 A Clinically Dormant Adrenal Incidentaloma Evolving to A Cortisol Secreting Adenoma, A Ten Year Follow Up Experience

Abstract Intro Adrenal incidentalomas (AIs) are found in approximately 3–4% of abdominal computed tomography (CT) scans performed for other reasons. Most of these masses are found to be nonfunctioning. Studies showed that subtle cortisol secretion in AIs and disruption in the hypothalamic-pituitary-adrenal axis are more frequent than expected. Here we report a case of a small AI progressing to a hormone-secreting adrenal mass causing Cushing's syndrome (CS) after a period of a decade, in which dexamethasone suppression test was the confirmatory diagnostic procedure. Case 66-year-old woman was referred to Endocrinology in 2007 for assessment of abnormal abdominal CT finding indicating minimal nodularity of the right adrenal gland followed by an MRI performed 2 years later with suspicion of a small adenoma measuring 1.4 cm. Patient's past medical history included coronary artery disease, impaired glucose tolerance controlled by diet. No reported family history of relevant endocrine tumors. At time of initial assessment, functional hormonal baseline workup was normal including ACTH: 23 pg/mL [5-27 pg/mL], AM Cortisol level: 13.6 mcg/dL [4-22 mcg/dL], 24h U-Cortisol: 16.4 mcg/24h/1g Cr [4-50 mcg/24h/1g], and DHEAS: 30 mcg/dL [<185 mcg/dL] Patient was re-evaluated annually. Over the course of the follow-up, she was found to have poor healing after surgical repair of ankle fracture in 2012, as well as depression necessitating medical therapy in 2015. Her previously diet-controlled diabetes significantly progressed, requiring combination therapy and ultimately basal/bolus insulin. Moreover, patient developed hypertension with antihypertensive medication doses increased from Valsartan 40mg to Valsartan/HCT 80/12.5 in a 5-year period. The patient was found to have normal ACTH, serum, and urine cortisol levels throughout her follow-up period. Annual CT imaging demonstrated no change in right adrenal mass. In 2017, overnight low dose dexamethasone suppression test was found to be 16.2 mcg/dL[<1.8 mcg/dL], which is significantly increased from 0.9 mcg/dL in 2011. In 2018, CT abdomen showed a marked increase in the adrenal mass size to 2.8 cm. In 2020, she underwent right-sided adrenalectomy with no complications. Both blood pressure and glucose levels improved postoperatively. The preoperative use of mifepristone therapy controlled her blood sugar and pressure and eliminated the need for postoperative glucocorticoid replacement. She is currently controlled on diet and lifestyle modifications alone. Discussion Our case highlights the limitations of current guidelines in the management of AIs that recommend discontinuing annual follow-up if no significant growth occurs after 5 years. Careful long-term follow-up of AIs provides an opportunity to detect the subclinical hormonal alterations, development of new hormonal abnormalities, or any change in mass size. These findings indicate the need for good communication between radiology, primary care, and endocrine providers to assure periodic hormonal and morphological evaluation. This case also suggests that the dexamethasone suppression test may be useful in the evaluation of CS in patients without significant hypercortisolemia. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Solitary Fibrous Tumor of Orbit: Changes of Tumor Size and Tumor Contrast Enhancement

Purpose: To report a case of solitary fibrous tumor of the orbit in a patient with changes in tumor size and contrast enhancement.Case summary: A 64-year-old male patient presented with dizziness, discomfort on eye movement, anosmia, and proptosis. Orbital computed tomography showed an enhancing mass in the right extraconal space, lateral to the medial rectus and inferior to the superior oblique muscle. The mass appeared to be a cavernous hemangioma and the patient was monitored for changes in mass size and eye movements. After 24 months of follow-up, the mass size and symptoms of right eyelid swelling, proptosis, and diplopia had increased. Excision and biopsy of the mass were performed under general anesthesia. The biopsy confirmed that the mass was a solitary fibrous tumor. The postoperative period was uneventful and no recurrence was observed at 6 months after surgery.Conclusions: Solitary fibrous tumor is a soft tissue tumor that rarely occurs in the orbit, and should be considered in cases with an intraorbital mass accompanied by increased size and changes in contrast enhancement on imaging.

Magnetic resonance imaging characteristics and changes in hemostatic agents after partial nephrectomy

To evaluate the characteristics of images generated by magnetic resonance imaging (MRI) and changes in the mass-like lesion (MLL) during the follow-up of patients who underwent partial nephrectomy (PN) with the intra-operative use of hemostatic agents (HAs). The records of patients who had undergone PN in our clinic due to renal mass between January 2013 and August 2018 were retrospectively reviewed. Our study included 47 patients who were administered one or more HAs during the PN and who received diffusion and dynamic MRI at the post-operative 2nd/4th Queryand 12th month. MLL is defined as T2 heterogeneous, intermediate-signal intensity bolster-related mass with a pseudocapsule in the renal parenchymal defect. When we looked at the morphological changes of MLL, the mean largest axial dimensions of masses were 27.3 (range 12.2-44.7) mm in the first follow-up period (2nd/4th months) and 21.2 (range 11-44.7)mm in the 12th month follow-up period. The average change in size of MLL was - 0.66mm/month. We did not see any significant relationship between observation of MLL in the post-operative follow-up MRI images and the use of HAs such as Surgicel®, Spongostan®, and autologous fatty tissue as well as the amount of the agents used in PN operations (p = 0.405, p = 0.159, respectively). The distinction of MLL causing bolster-related mass and granulomatosis tissue from relapse/recurrence can be made based on the change in mass size observed in the MR images and image characteristics.

A New Model to Predict Benign Histology in Residual Retroperitoneal Masses After Chemotherapy in Nonseminoma

BackgroundPostchemotherapy retroperitoneal lymph node dissection (pcRPLND) is indicated in testicular cancer patients with normalised or plateaued serum tumour markers and residual retroperitoneal lesions >1cm. Challenges remain in predicting postchemotherapy residual mass (pcRM) histology, which may lead to unnecessary surgery. ObjectiveTo develop an accurate model to predict pcRM histology in patients with nonseminomatous germ cell tumours (NSGCTs). Design, setting, and participantsA retrospective review of 335 patients undergoing pcRPLND for metastatic NSGCTs to develop a model to predict benign histology in retroperitoneal pcRM. Our model was compared with others and externally validated. InterventionChemotherapy and pcRPLND. Outcome measurements and statistical analysisMultivariable logistic regression to evaluate the presence of benign histology, and fractional polynomials to allow for a nonlinear association between continuous variables and the outcome. The final Princess Margaret model (PMM) was selected based on the number of variables used, reliability, and discriminative capacity to predict benign pcRM. Results and limitationsPMM included the presence of teratoma in the orchiectomy, prechemotherapy α-fetoprotein, prechemotherapy mass size, and change in mass size during chemotherapy. Model specificity was 99.3%. Compared with Vergouwe et al’s model, PMM had significantly better accuracy (C statistic 0.843 vs 0.783). PMM appropriately identified a larger number of patients for whom pcRPLND can safely be avoided (13.9% vs 0%). Validated in external cohorts, the model retained high discrimination (C statistic 0.88 and 0.80). Larger and prospective studies are needed to further validate this model. ConclusionsOur clinical model, externally validated, showed improved discriminative ability in predicting pcRM histology when compared with other models. The higher accuracy and reduced number of variables make this a novel and appealing model to use for patient counselling and treatment strategies. Patient summaryPrincess Margaret model accurately predicted postchemotherapy benign histology. These results might have clinical impact by avoiding unnecessary retroperitoneal lymph node dissection and consequently changing the paradigm of advanced testicular cancer treatment.

Two-year follow-up of thirty-two non-functional benign adrenal incidentalomas

To evaluate the risk of developing endocrine hyperactivity and carcinoma during a period of up to 5 yr in patients with apparently benign and non-functioning adrenal incidentalomas. Thirty-two patients (mean age: 57.0+/-8.3 yr) were investigated in a prospective follow-up study for a median time of 24 months. Twenty-eight patients had unilateral and 4 had bilateral masses. Initial average mass diameter was 17.47+/-6.60 mm. All patients were followed up yearly by physical examination, metabolic parameters, hormonal evaluation [morning cortisol after 3-mg dexamethasone suppression, urinary metanephrines, and upright aldosterone/ plasma renin activity (PRA)]. Among the clinical characteristics, 48% of patients were obese, 20% were hypertensive, 13 had Type 2 diabetes and impaired glucose tolerance. During follow-up period no significant change in the functional status was observed and nomalignant transformation occurred. Only 1 patient developed subclinical Cushing's syndrome at the end of the 1st year and referred to surgery. Change in mass size was correlated with homeostasis model assessment of insulin resistance (p=0.002), upright aldosterone/ PRA (p=0.041), cortisol after dexamethasone suppression (p=0.048) and 24-h urinary normetanephrine (p=0.005) levels. Gender, body mass index, glucose metabolism, and blood pressure were not found to be correlated with change in mass size and functional status. Due to the extremely low risk of developing malignancy during up to 5 yr of follow-up, conservative approach for the management of adrenal incidentalomas is thought to be appropriate. However, possibility of evolution to hormonal hypersecretion makes long-term follow-up of 2-to-5 yr seems to be obligatory.

Hormonal activity of adrenal incidentalomas: results from a long‐term follow‐up study

To investigate the natural course of apparently benign adrenal incidentalomas with no overt hyperfunction at diagnosis, as their clinical significance and appropriate management are still controversial. Prospective long-term follow-up study of patients with adrenal incidentalomas with periodic hormonal and morphological evaluation. A total of 77 patients with incidental adrenal masses, diameter 1.0-6.0 cm (median 2.5 cm), were submitted to a hormonal assessment of adrenal function at diagnosis. This was repeated, together with an adrenal CT scan, 12 months later and then every 12-24 months, for a period of 12-154 months (mean 62.7 +/- 31.9, median 60.0). At diagnosis, 57 patients had normal adrenal function and 20 had subclinical Cushing's syndrome. During follow-up, adrenal function remained normal in 49 patients, subclinical Cushing's syndrome was confirmed in 12, whilst intermittent subclinical autonomous cortisol hypersecretion was found in 12 patients. Overt endocrine disease was diagnosed in 4 patients (Cushing's syndrome in 2 and phaeochromocytoma in 2). A change in mass size (> or = 0.5 cm) was observed in 26 patients (enlargement in 20--including patients who developed overt hyperfunction--with no signs of malignancy and reduction in size in 6). Subclinical autonomous cortisol hypersecretion is the most frequent hormonal abnormality in patients with adrenal incidentalomas, and may be intermittent in a significant percentage of cases. Few patients develop overt endocrine disease. A growth tendency is observed in some adrenal incidentalomas without evidence of malignant transformation and occasionally can be related to development of overt hyperfunction. These findings indicate the need for periodic hormonal and morphological evaluation for several years.

Predicting Retroperitoneal Histology in Postchemotherapy Testicular Germ Cell Cancer: A Model Update and Multicentre Validation with More Than 1000 Patients

ObjectivesSurgical resection of postchemotherapy retroperitoneal lymph nodes is often performed in patients with advanced nonseminomatous testicular germ cell cancer. We previously developed a model to predict the probability that the lymph nodes contain only necrotic or fibrotic (benign) tissue versus mature teratoma and viable cancer (tumour) to identify patients who actually need resection. The present study used an updated model with new patient data and studied the validity of the updated model across various settings. MethodsWe combined data of 544 patients from the original model with data of 550 new patients and performed a new logistic regression analysis, which included the same six predictors: histology of the primary tumour, prechemotherapy serum levels of α-fetoprotein, human chorionic gonadotropin, lactate dehydrogenase, residual mass size measured on computed tomography, and change in mass size. The validity of the updated model was studied in individual centres. Calibration of the predicted probabilities was assessed graphically and with the Hosmer-Lemeshow test. Discrimination was studied with the concordance (c)-statistic. ResultsThe updated model had slightly different, although more precise, regression coefficients. Statistically nonsignificant Hosmer-Lemeshow tests confirmed good calibration in most centres. The c-statistic for all centres except one exceeded 0.80. The updated model was valid over the complete range of predicted probabilities across a broad spectrum of centres. ConclusionsThis finding gives confidence in the applicability of the model to select patients for resection, particularly patients with small residual masses and low predicted probabilities of benign tissue (i.e., substantial predicted risks of residual tumour).

Clinical Study of Adrenal Incidentaloma in Korea

BackgroundThis study was designed to evaluate the clinical, endocrinological and histological characteristics of adrenal incidentalomas.MethodsEighty patients (41, males; 38, females; age range 17-80 years) who were diagnosed with adrenal incidentaloma at Korea University Hospital from 1992 to 2003 were studied retrospectively.ResultsEndocrinological investigation revealed 16 pheochromocytomas (20%), nine Cushing's syndromes (11%), eight primary aldosteronism (10%) and 46 non-functioning tumors (58%). Forty-four patients received operations, and biopsies were performed on two patients. Pathologic examination revealed 16 adrenocortical adenomas (20%), five carcinomas (6%), 13 pheochromocytomas (16%), three metastatic cancers (4%), and other tumors (10%). The diameter of the carcinomas (mean: 10.8 cm, range: 5-19 cm) were significantly larger than the diameter of benign adenomas (mean: 2.84 cm, range: 1-6 cm) (p=0.002). According to the receiver operating charactenstic (ROC) curve analysis, the cut-off value of tumor size for discriminate malignant tumor was 4.75 cm (sensitivity 90%, specificity 58%). Twenty-four patients with non-functioning tumors were followed up for a period of 3 to 72 months. During the follow up period, two patients showed an increase in tumor size of more than 1 cm, and one patient developed Cushing's syndrome. Changes in mass size and function were observed only between 10 and 26 months after the initial diagnosis.ConclusionsThese data show that an endocrine evaluation should be performed in all adrenal incidentalomas, and an adrenalectomy is recommended for tumors 5 cm or greater or tumors with adrenocortical hyperfunction. In addition, these tumors should be monitored for changes in mass size and function for a follow up period of approximately 26 months.

Residual pulmonary masses after chemotherapy for metastatic nonseminomatous germ cell tumor

After chemotherapy for a metastatic nonseminomatous germ cell tumor, pulmonary masses may be seen on a computed tomography scan. These residual masses may contain one of three histologic elements: necrosis, mature teratoma, or cancer. Because surgical resection of masses containing only necrosis is unnecessary, the authors aimed to predict the histology of these residual masses. Six study groups contributed patient data on a total of 215 patients undergoing thoracotomy after cisplatin-based induction chemotherapy for metastatic testicular nonseminomatous germ cell tumors. Logistic regression analysis was used to estimate the probability of necrosis, mature teratoma, and cancer in relation to predictors known before thoracotomy. The pulmonary mass histology was necrosis in 116 patients (54%), mature teratoma in 70 (33%), and cancer in 29 (13%). Necrosis was found at thoracotomy in 89% of those patients with necrosis at retroperitoneal lymph node dissection (RPLND). Other predictors included the primary tumor histology, prechemotherapy tumor marker levels, change in mass size during chemotherapy, and the presence of a single, unilateral mass. Multivariate combination of predictors yielded reliable models (goodness-of-fit tests, P > 0.20), which discriminated necrosis well from other histologies, especially if RPLND histology was available (area under the receiver operating characteristic curve, 0.86). This analysis indicated subgroups of patients with a high probability of necrosis and a low risk of cancer for whom close follow-up of the residual pulmonary mass might be considered. In most patients, a RPLND should be performed before a thoracotomy is considered, because the probability of necrosis is generally higher at thoracotomy than at RPLND and the histology at RPLND is a strong predictor of the histology at thoracotomy.

Diagnosis of endometriosis by fine‐needle aspiration cytology

Endometriosis is a fairly common disease found in a variety of extrauterine locations. It primarily affects reproductive age women and has symptoms varying from occult to more specific complaints. Occasionally the lesions produce solid nodules and/or cysts that are clinically palpable and easily evaluated by fine needle aspiration (FNA). We describe three cases of endometriosis diagnosed by FNA. The patients ranged in age from 32 to 38 and reported cyclic symptoms of pain, bleeding, or change in mass size. Two patients presented with subcutaneous masses (one along the upper pubic ramus, the other in the lower abdomen) and had ultrasonically guided FNA. The third patient had a vaginal cuff mass sampled by transvaginal FNA. All cytologic smears contained characteristic sheets of epithelial cells and fragments of loosely arranged spindled stroma. One case also showed mild epithelial atypia and plump stromal cells. Hemosiderin-laden macrophages were found in only one case. The cytologic diagnoses were confirmed by tissue in all patients. Endometriotic nodules must be evaluated for possible malignant transformation and differentiated from other benign and malignant masses, especially when clinical symptoms are vague. FNA offers a safe and effective tool for identification of endometriosis and obviates the need for diagnostic surgical procedures in some patients.