Cm In Greatest Diameter Research Articles

Application of 11/13Fr suctioning ureteral access sheath and 8.55Fr single-use digital flexible ureteroscope in one-stage flexible ureteroscopic lithotripsy: an initial experience of 900 cases.

To report our initial experience of one-stage flexible ureteroscopic lithotripsy(FURL) with 11/13Fr suctioning ureteral access sheath(UAS) and 8.55Fr single-use digital flexible ureteroscope(SDFU) in upper ureteral or renal calculi. We retrospectively collected the clinical data of 900 adult patients with upper ureteral or renal calculi treated by FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU from January 2022 to April 2024. Demographics, peri- and postoperative outcomes were assessed. In all, 40 of 940 cases(4.26%) failed to introduce UAS and required second-stage FURL because of ureterostenosis and were excluded. Mean stones size of the remaining 900 eligible cases was 1.68 ± 0.58cm in greatest diameter. There were 228 cases of upper ureteral stone, 456 cases of renal stone and 216 cases of concomitant ureteral and renal calculi. The mean operation time was 52.20 ± 20.21min and the postoperative hospital stay was 2.87 ± 1.37 days. The stone-free rate of 1 month postoperatively was 89.56% and only 2.44% of patients with residue underwent additional reoperation. The rate of postoperative fever, postoperative pain needing analgesic and slight ureteral mucosal injury were 5.11%, 8.22% and 7.78%, respectively. None of patient suffered from severe complications, such as sepsis or ureteral perforation. It's practical and suitable for the vast majority of adult patients to undergo FURL in single session with 11/13Fr suctioning UAS without preoperative stenting. FURL with 11/13Fr suctioning UAS and 8.55Fr SDFU is feasible, reliable, safe, and efficient in the management of renal stone and upper ureteral stone.

Inflammatory Giant Cell Carcinoma of the Lung: Clinicopathologic, Immunohistochemical, and Next-generation Sequencing Study of 14 Cases.

A distinctive histological variant of poorly differentiated, sarcomatoid, non-small cell lung carcinoma characterized by a discohesive population of giant tumor cells associated with prominent interstitial inflammatory cell infiltrates is described. The tumors occurred in 7 women and 7 men, 42 to 72 years of age (mean: 56y). They predominantly affected the upper lobes and measured 1.3 to 9cm in greatest diameter (mean: 4.6cm). The tumor cells were characterized by large pleomorphic nuclei with prominent nucleoli, ample cytoplasm, and frequent abnormal mitoses, and were surrounded by a dense inflammatory cell infiltrate, often associated with emperipolesis. Immunohistochemical stains were positive in the tumor cells for cytokeratin AE1/AE3 and CK8/18 and negative for TTF1, napsin A, p40, and CK5/6. Next-generation sequencing was performed in all cases using the Oncomine Precision Assay; the most common abnormalities found included TP53 mutations (9 cases) and AKT1 amplification (8 cases), followed by KRAS mutations (4 cases) and MAP2K1/2 mutations (4 cases). Clinical follow-up was available in 13 patients. Three patients presented with metastases as the initial manifestation of disease; 8 patients died of their tumors from 6 months to 8 years (mean: 2.7y); 3 patients were alive and well from 4 to 6 years; and 2 patients had metastases when last seen but were lost to follow-up thereafter. The importance of recognizing this distinctive and aggressive variant of non-small cell lung carcinoma lies in avoiding confusion with a sarcoma or other types of malignancy.

Combined treatment of a giant palpebral keratoacanthoma

Aims/Purpose: To highlight the relevance of a therapeutic approach adapted to the clinical characteristics of the eyelid lesion found at the time of surgery to ensure an optimal functional and aesthetic result.Methods: Clinical case assessed, intervened and followed up at our centre.Results: A 76‐year‐old woman consulted for a nodular umbilicated lesion of recent appearance on the outer third of the upper eyelid of the left eye (UELE) measuring 0.5 cm in greatest diameter and 0.5 cm in elevation. The patient was placed on the waiting list for surgical excision and subsequent pathological examination (PE) of the lesion to confirm the initial clinical suspicion of keratoacanthoma (KA). One month later, the patient went to the operating room for surgery. During this time the lesion increased its initial size by more than 4 times, had a large necrotic centre, active borders and generated an evident left mechanical ptosis. As an alternative to the complete excisional surgery initially proposed, we offered the injection of neoadjuvant intralesional chemotherapy (CT) with the aim of reducing the size of the lesion to obtain a better functional and aesthetic result. The patient accepted this therapeutic alternative. KA was treated with weekly intralesional injections of 1 mL of methotrexate (MTX) 12.5 mg/mL. In our case, 3 injections were necessary to achieve a 78% reduction in the diameter of the lesion to allow reconstruction of the UELE with grafting of the contralateral upper eyelid. One week after the third injection of MTX, reconstruction of the UELE was performed after excisional surgery with wide margins for PE. One week later, the PE result ruled out malignancy and the graft had a pink appearance with complete vascular permeability, so the sutures were removed. Two weeks after reconstruction, the functional and aesthetic results were satisfactory.Conclusions: Therefore, in our experience, we recommend the above combined treatment for giant palpebral KA and stress the relevance of a therapeutic approach adapted to the clinical characteristics of the palpebral lesion at the time of surgery to ensure an optimal functional and aesthetic outcome.

CTNI-14. NEOADJUVANT STEREOTACTIC RADIOSURGERY (NASRS) FOR LARGE BRAIN METASTASES (BRM): RESULTS OF AN INTERNATIONAL MULTICENTER PHASE II TRIAL

Abstract BACKGROUND We conducted an international multi-center phase II trial evaluating NASRS for BrM. We hypothesized that radiation necrosis (RN) would be lower than post-operative cavity radiotherapy since the tissues receiving the highest radiation dose are resected in NASRS. METHODS BrM patients with 1 index lesion ( >2 and <5 cm in greatest diameter) suitable for resection, and 9 or less additional BrM (< 3 cm in greatest diameter, not requiring resection) were recruited across 3 centres. SRS was administered a median 3 (range: 2-21) days prior to surgical resection. A single fraction of 15-21 Gy was delivered, targeting the index tumor with a 2mm margin. From a sample of 30 patients, the primary endpoint was the 1-year rate of grade 2+ (G2+) RN from the index lesion. Secondary endpoints included local failure (LF), leptomeningeal disease (LMD) and overall survival (OS). RESULTS We enrolled 35 patients [Mean age (SD): 58.9 (12.9) years, 46% female] between 2018 and 2022. The most common primary histologies were lung (40%), and gastrointestinal (20%) cancers. The median BrM volume prior to surgery was 16.6 cc (range 3.2 -38.0); median index lesion size was 3.2 (range: 1.9-4.5) cm. All participants received planned protocol treatment; n = 30 are currently available for 1 year outcomes. No patients developed G2+ RN; 5 had a LF (1-year rate 38%) at 5-12-months following surgery, all of whom had an en-bloc resection. One patient each developed classic LMD and pachymeningeal failure 3 and 11 months after surgery, respectively. Median OS was 11.5 months. CONCLUSION No patients in our study experienced G2+ RN. The 1-year rate of LF was higher than anticipated, indicating the potential benefit of considering a higher radiation dose or larger margins for improved outcomes.

Chromophobe-like carcinoma of the thymus: A clinicopathological and immunohistochemical correlation of 5 cases

Five cases of primary thymic carcinoma with distinct histopathological features resembling chromophobe carcinomas are presented. The patients were four men and one woman ranging in age between 43 and 72 years. Clinically, the patients presented with non-specific symptoms of dyspnea and chest pain. Diagnostic imaging revealed the presence of anterior mediastinal masses. All patients underwent complete surgical resection of their tumors via thoracotomy. Grossly, the tumors measured between 4.0 and 5.5 cm in greatest diameter and were ill-defined neoplasms with infiltrative borders; they were light brown in color and had a lobulated surface. Areas of hemorrhage and necrosis were not identified. Histologically, all tumors shared similar histopathological features, mainly the presence of infiltrative tumor islands separated by a fibrocollagenous stroma. At higher magnification, the neoplastic cellular proliferation was composed of medium-sized, round to polygonal cells with eosinophilic or granular cytoplasm and a clear perinuclear cytoplasmic halo, which imparted a chromophobe-like appearance. Nuclear atypia and mitotic activity were identified. Histochemical stains for colloidal iron were negative while immunohistochemical stains for pancytokeratin, cytokeratin 5/6, and p40 were positive in all cases, supporting squamous differentiation in these tumors. Clinical follow-up information was obtained in three patients all of whom died between 3 and 5 years after initial diagnosis, while two patients were lost to follow-up. The cellular characteristics of these tumors represent an unusual variant of thymic carcinoma that may pose a diagnostic challenge in small biopsies and that could be easily confused with other primary or metastatic tumors.

Up-front single-session radiosurgery for large brain metastases-volumetric responses and outcomes.

Patients presenting with large brain metastases (LBM) pose a management challenge to the multidisciplinary neuro-oncologic team. Treatment options include surgery, whole-brain or large-field radiation therapy (WBRT), stereotactic radiosurgery (SRS), or a combination of these. To determine if corticosteroid therapy followed by SRS allows for efficient minimally invasive care in patients with LBMs not compromised by mass effect. We analyzed the change in tumor volume to determine the efficacy of single-session SRS in the treatment of LBM in comparison to other treatment modalities. Twenty-nine patients with systemic cancer and brain metastasis (≥ 2.7cm in greatest diameter) who underwent single-session SRS were included. Among 29 patients, 69% of patients had either lung, melanoma, or breast cancer. The median initial tumor size (maximal diameter) was 32mm (range 28-43), and the median initial tumor volume was 9.56 cm3 (range 1.56-25.31). The median margin dose was 16Gy (range 12-18). The average percent decrease in tumor volume compared to pre-SRS volume was 55% on imaging at 1-2months, 58% at 3-5months, 64% at 6-8months, and 57% at > 8months. There were no adverse events immediately following SRS. Median corticosteroid use after SRS was 21days. Median survival after radiosurgery was 15months. Initial high-dose corticosteroid therapy followed by prompt single-stage SRS is a safe and efficacious method to manage patients with LBMs (defined as ≥ 2.7cm).

Aplasia cútis congênita no couro cabeludo: relato de caso e revisão de literatura

Introduction: Congenital Cutaneous Aplasia is a rare skin lesion, usually restricted to the scalp, characterized by a focal absence of cutaneous tissue, sometimes involving muscles, periosteum and dura mater. There are several etiologies described, such as poor neural tube closure, vascular anomalies, pressure necrosis in the localized embryo, among others. Method: We report the case of a newborn at the first physical examination with an annular vesicular lesion, in the occipital region, of 0.8 cm in greater diameter, with hyaline / bloody content and peripheral hyperemia. After a clinical diagnosis was made, we opted for conservative treatment with topical application of hydrogel until complete healing. The patient was then discharged from the hospital, with subsequent Residência Pediátrica; 2023: Ahead of Print. DOI: 10.25060/residpediatr-2023-566 return and resolution of the lesion at 30 days of life. Conclusion: Congenital cutaneous aplasia is a rare disease, which can affect only the scalp, but can also present with the absence of part of the skullcap, which increases mortality due to the increased risk of complications such as liquor fistula, meningoencephalitis and bleeding.

Aplasia cútis congênita no couro cabeludo: relato de caso e revisão de literatura

INTRODUCTION: Congenital Cutaneous Aplasia is a rare skin lesion, usually restricted to the scalp, characterized by a focal absence of cutaneous tissue, sometimes involving muscles, periosteum and dura mater. There are several etiologies described, such as poor neural tube closure, vascular anomalies, pressure necrosis in the localized embryo, among others. METHOD: We report the case of a newborn at the first physical examination with an annular vesicular lesion, in the occipital region, of 0.8 cm in greater diameter, with hyaline / bloody content and peripheral hyperemia. After a clinical diagnosis was made, we opted for conservative treatment with topical application of hydrogel until complete healing. The patient was then discharged from the hospital, with subsequent return and resolution of the lesion at 30 days of life. CONCLUSION: Congenital cutaneous aplasia is a rare disease, which can affect only the scalp, but can also present with the absence of part of the skullcap, which increases mortality due to the increased risk of complications such as liquor fistula, meningoencephalitis and bleeding.

Spindle cell thymoma (WHO type A) - Choriocarcinoma: An unusual association: A clinicopathological and immunohistochemical study of 3 cases.

Three cases of an unusual association between spindle cell thymoma (WHO type A) and choriocarcinoma are presented. The patients are three men between the ages of 58 and 68 years. Clinically, all the patients presented with non-specific symptoms of cough, dyspnea, and chest pain. Clinical history and physical examination did not reveal the presence of any prior malignancy. Diagnostic imaging showed in the three patients the presence of a large anterior mediastinal mass. A core needle biopsy was obtained in the three patients. In two patients the biopsy showed the classic histology of a spindle cell thymoma while in one patient the biopsy showed the association of two tumors - spindle cell thymoma and choriocarcinoma. Surgical resection via thoracotomy was performed in the three patients. The mediastinal tumors measured between 9 and 17cm in greatest diameter and were described as solid and lobulated with areas of hemorrhage. Histologically, all the tumors showed similar histological features of spindle cell thymoma (WHO type A) associated with a high-grade neoplasm composed of round and multinucleated giant cells compatible with choriocarcinoma. Immunohistochemical stains showed positive staining for keratin 5/6, and p40 in the spindle cell component, while the choriocarcinomatous component showed positive staining for human chorionic gonadotropin and human placental lactogen. The cases herein presented highlight not only the unusual association of spindle cell thymoma and choriocarcinoma but also raises some issues regarding the histogenesis of germ cell tumors, in this case choriocarcinoma.

Desmoplastic Adamantinoma-like Thymic Carcinoma: Clinicopathologic, Immunohistochemical, and Molecular Study of 5 Cases.

Five cases of a heretofore unreported rare variant of thymic carcinoma characterized by a striking resemblance to adamantinoma of the mandible are described. The tumors occurred in 4 women and 1 man aged 58 to 76 years (mean: 67.8y); they arose in the anterior mediastinum and measured from 5.3 to 12.0cm in greatest diameter (mean: 8.9cm). Presenting symptoms included chest pain, shortness of breath, and in 2 patients, pleural effusion. One tumor was asymptomatic and discovered incidentally. Histologically, the tumors were extensively desmoplastic, and the cellular proliferation was characterized by multiple islands of squamous epithelium with striking peripheral palisading of nuclei and central areas containing clear cells resembling a stellate reticulum. Areas of preexisting spindle cell thymoma were identified in 2 cases; these areas gradually merged with the higher-grade component of the lesion. Cystic changes were noted in 3 cases. Immunohistochemical studies in 3 cases showed the tumor cells were positive for cytokeratins, p40 and p63, and all showed a high proliferation rate (>50% nuclear positivity) with Ki-67. Next-generation sequencing was performed in 2 cases that showed amplification of the AKT1 gene (copy numbers 6 and 13). Clinical follow-up in 3 patients showed recurrence and metastasis after 1 and 2 years; 1 patient passed away 2 years after diagnosis due to the tumor. Desmoplastic adamantinoma-like thymic carcinoma represents an unusual histologic variant of thymic carcinoma that needs to be distinguished from metastases from similar tumors to the mediastinum.

MP37-04 PROSTATE ABSCESS: CLINICAL FEATURES, MANAGEMENT, AND OUTCOMES OF A “MASKED” INFECTION IN COVID 19 PERIOD: A CASE SERIES

You have accessJournal of UrologyCME1 May 2022MP37-04 PROSTATE ABSCESS: CLINICAL FEATURES, MANAGEMENT, AND OUTCOMES OF A “MASKED” INFECTION IN COVID 19 PERIOD: A CASE SERIES Harmanmeet Singh, J.V.S Prakash, P.V Thiruvarul, S. Vetrichandar, K.V. Arasi, V. Natarajan, and ArunKumar Paranjothi Harmanmeet SinghHarmanmeet Singh More articles by this author , J.V.S PrakashJ.V.S Prakash More articles by this author , P.V ThiruvarulP.V Thiruvarul More articles by this author , S. VetrichandarS. Vetrichandar More articles by this author , K.V. ArasiK.V. Arasi More articles by this author , V. NatarajanV. Natarajan More articles by this author , and ArunKumar ParanjothiArunKumar Paranjothi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002591.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate abscess (PA) is uncommon and the diagnosis is often delayed or missed. Traditionally, PA has resulted from acute prostatitis or ascending genitourinary (GU) infection due to gram-negative bacilli but S. aureus is an emerging cause. The objective is to study the clinical features, management and outcomes of PA in COVID 19 period. METHODS: A prospective review of all adult patients admitted with a diagnosis of PA between April 2020 and July 2021(in COVID period) were conducted. Inclusion criteria included age ≥18 years, a GU infection syndrome, and imaging consistent with PA. RESULTS: Fifteen patients with PA were identified. The median age was 54 years. Four patients (22.7%) were immunosuppressed and 11 (50%) had diabetes. Fever (66.6%), dysuria (60%), and urinary retention (20%) were the most common presenting symptoms. Pelvic CT revealed PAs in all patients with 8/15 (53.3%) were >2 cm in greatest diameter. Urine cultures were positive in 13/15 (86.6%) patients with 4/13 (30.7%) growing S. aureus (MRSA). Fourteen patients (93.3%) were managed with antibiotics alone whereas 1 (6.6%) underwent abscess drainage. The median duration of antibiotic therapy was 32 days. CONCLUSIONS: PA is relatively uncommon and may be difficult to distinguish clinically from conditions like acute prostatitis. Optimal management usually requires both antibiotics and drainage. With the advancement in the field of radiology, newer antibiotics and early diagnosis, effective conservative management of PA has become possible. Noticing the trend of frequent occurrence of S. aureus as a cause, coverage for MRSA should be a component of empiric treatment for PA. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e608 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Harmanmeet Singh More articles by this author J.V.S Prakash More articles by this author P.V Thiruvarul More articles by this author S. Vetrichandar More articles by this author K.V. Arasi More articles by this author V. Natarajan More articles by this author ArunKumar Paranjothi More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Large True Brachial Artery Aneurysm in an Infant.

A 6-month-old male was admitted to the children's hospital for management of an underlying gastrointestinal illness. During his admission, a large, pulsatile mass was incidentally noted in the left upper arm concerning for an expanding pseudoaneurysm. Vascular surgery was consulted, and further workup with a CT angiogram demonstrated a brachial artery aneurysm 3cm in greatest diameter. The patient was taken to the operating room, where lateral aneurysmorraphy was performed without complication. His neurovascular exam remained intact postoperatively. The presented case demonstrates a viable approach to the surgical management of this clinical challenge in infants. Although reports of brachial artery aneurysm in this age group are rare in the literature, resection with primary repair and interposition grafting have also been described. Long-term outcomes are not available in these cases. Lateral aneurysmorraphy allows for ongoing monitoring and future resection and bypass of the aneurysm as the patient continues to grow.

Primary Rosai-Dorfman disease of the thymus and lung: A clinicopathological and immunohistochemical study of three cases

Three cases of primary Rosai-Dorfman disease of the thymus and lung are presented. The patients are 3 men between the ages of 42 and 47 years who presented with non-specific symptoms including cough, chest pain, and shortness of breath. Clinically, the patients did not have any other pertinent clinical history. Diagnostic imaging revealed in one patient a cystic anterior mediastinal mass, while in two other patients the imaging was that of an intrapulmonary mass, one in the right upper lobe and the other in the left lower lobe. The three patients undergo surgical resection of the mass. In the cases in which the tumor mass was in the lung, both patients had a lobectomy while in the patient with anterior mediastinal mass, surgical resection via thoracotomy was performed. The intrapulmonary tumors were described as soft and yellowish measuring 2.5 and 3.0 cm in greatest diameter, while the mediastinal mass was described as cystic measuring 4.0 cm in diameter. Histologically, all tumors show similar features in terms of a proliferation of large histiocytes admixed with an inflammatory component composed predominantly of plasma cells. Immunohistochemical stains show positive staining for CD68 and S-100 protein, while negative for keratin, CD1a, and langerin. The cases herein presented highlight the ubiquitous distribution of Rosai-Dorfman disease and the importance of keeping this entity in the differential diagnosis of histiocytic proliferation in the thymus or lung.

Lymphocyte-Rich Spindle Cell Thymoma: Clinicopathologic, Immunohistochemical, Ultrastructural and Molecular Genetic Study of 80 Cases.

A study of 80 cases of spindle cell thymoma in which the spindle cell component was overshadowed by massive numbers of stromal lymphocytes is presented. The patients were 38 women and 42 men, aged 8 to 81 years (mean=54 y). All tumors presented as an anterior mediastinal mass; 5 patients had myasthenia gravis and one had Good syndrome. The tumors were well-circumscribed, encapsulated, and measured 2.9 to 26.0 cm in greatest diameter (mean=7.3 cm). Using modified Masaoka staging, 66 tumors were stage I, 10 were stage IIa, 2 were stage III and 1 was stage IV. Histologically the tumors were characterized by a predominant lymphocytic population admixed with scattered small spindle epithelial cells. The neoplastic spindle cells in these tumors demonstrated 2 major growth patterns: in 33 cases, the tumors were exclusively composed of dense sheets of lymphocytes containing scattered spindle cells resembling a lymphocyte-rich thymoma (WHO type B1); in the remaining cases the tumors showed admixtures of a predominantly lymphocytic component with areas that were lymphocyte-poor and contained a pure spindle cell population similar to WHO type A. Immunohistochemical stains and electron microscopy corroborated the spindle cell morphology in both types. The GTF2I p.L424H variant was identified in 53 of 63 (84%) cases analyzed. Clinical follow-up in 27 cases showed that most of the tumors behaved in an indolent manner. Our study expands the spectrum of spindle cell thymoma by demonstrating the existence of cases that are predominantly composed of lymphocyte-rich elements and lack areas with a pure (lymphocyte poor) spindle cell morphology.

Effects of New Bayesian Penalized Likelihood Reconstruction Algorithm on Visualization and Quantification of Upper Abdominal Malignant Tumors in Clinical FDG PET/CT Examinations.

PurposeThis study evaluated the effects of new Bayesian penalized likelihood (BPL) reconstruction algorithm on visualization and quantification of upper abdominal malignant tumors in clinical FDG PET/CT examinations, comparing the results to those obtained by an ordered subset expectation maximization (OSEM) reconstruction algorithm. Metabolic tumor volume (MTV) and texture features (TFs), as well as SUV-related metrics, were evaluated to clarify the BPL effects on quantification.Materials and MethodsA total of 153 upper abdominal lesions (82 liver metastatic and 71 pancreatic cancers) were included in this study. FDG PET/CT images were acquired with a GE Discovery 710 scanner equipped with a time-of-flight system. Images were reconstructed using OSEM and BPL (beta 700) algorithms. In 58 lesions <1.5 cm in greatest diameter (small-lesion group), visual image quality of each lesion was evaluated using a four-point scale. SUVmax was obtained for quantitative metrics. Visual scores and SUVmax were compared between OSEM and BPL images. In 95 lesions >2.0 cm in greatest diameter (larger-lesion group), SUVmax, SUVpeak, MTV, and six TFs were compared between OSEM and BPL images. In addition to the size-based analyses, an increase of SUVmax with BPL was evaluated according to the original SUVmax in OSEM images.ResultsIn the small-lesion group, both visual score and SUVmax were significantly higher in the BPL than OSEM images. The increase in visual score was observed in 20 (34%) of all 58 lesions. In the larger-lesion group, no statistical difference was observed in SUVmax, SUVpeak, or MTV between OSEM and BPL images. BPL increased high gray-level zone emphasis and decreased low gray-level zone emphasis among six TFs compared to OSEM with statistical significance. No statistical differences were observed in other TFs. SUVmax-based analysis demonstrated that BPL increased and decreased SUVmax in lesions with low (<5) and high (>10) SUVmax in original OSEM images, respectively.ConclusionThis study demonstrated that BPL improved conspicuity of small or low-count upper abdominal malignant lesions in clinical FDG PET/CT examinations. Only two TFs represented significant differences between OSEM and BPL images of all quantitative metrics in larger lesions.

Primary Giant Cell Tumors of the Lung: A Clinicopathologic and Immunohistochemical Study of 3 Cases.

Three cases of primary giant cell tumors of the lung akin to those described in the soft tissues are presented. The patients are 3 men between the ages of 43 and 54 years who presented with nonspecific symptoms of cough, chest pain, and shortness of breath. None of the patients had any prior history of malignancy anywhere else. Diagnostic imaging disclosed the presence of an intrapulmonary mass. All the patients underwent lobectomy. Grossly, the tumors were described as solid, slightly hemorrhagic, and measuring between 1.8 and 2.4 cm in greatest diameter. Histologically, the tumors were characterized by a dual population of multinucleated giant cells admixed with a mononuclear proliferation. Nuclear atypia was mild to moderate, and mitotic activity varied but was under 5 mitotic figures per 10 high power fields. Immunohistochemical stains showed positive staining for vimentin, CD68, and cathepsin K, whereas the tumors were negative for keratin, TTF-1, p40, S-100 protein, and SABT-2. Clinical follow-up was obtained in 2 patients who have remained alive and without evidence of recurrence or metastasis up to 12 months after surgery. One patient was lost to follow-up. The current neoplasms represent a tumor that to the best of our knowledge has not been reported as a primary neoplasm of the lung. The cases herein described represent an unusual occurrence and should be maintained in the differential diagnosis of primary pulmonary tumors rich in multinucleated giant cells.

Borderline Intermediate Thickness Cutaneous Melanoma Class B: Isn’t it Time for Personalised One Step Surgical Approach as Standard Clinical Behaviour?

We present a 40-year-old female who visited our clinic with a solitary lesion on the posterolateral aspect of the lower left leg (Figure 1a). She noticed a progressive change in the size and shape of the lesion and decided to consult a dermatologist in March 2021. The patient had a history of Hashimoto’s thyroiditis that was well-controlled onlevothyroxine. No other comorbidities were reported and she was otherwise healthy. During the clinical examination a single pigmented patch measuring 2.5 cm in greatest diameter was identified. Morphologically the lesion was asymmetrical with irregular borders and uneven colour. At the centre, an exudative, ulcerated nodule was also noted (Figure1a-f). Clinical and dermatoscopic findings were consistent with the diagnosis of a superficial spreading cutaneous melanoma. Ultrasound diagnostics of the abdominal cavity and retroperitoneal organs showed no signs of tumor spread. Chest radiography was also within normal limits. Laboratory testing showed an elevated uric acid level of 456 μmol/l (reference range 142 - 340 μmol/l), but otherwise all other parameters were normal. Following the recommended American Joint Committee on Cancer (AJCC) guidelines, we performed a primary resection with 0.5 cm margins in all directions. The resected tissue was subsequently sent for histopathological evaluation and confirmed the diagnosis of borderline intermediate thickness malignant melanoma - class B, 4 mm Breslow thickness, Clark IV, (pT4BN0M0) (Figure2a-d). There was high mitotic activity but no spontaneous regression, insignificant lymphocytic stromal reaction and clear resection margins. Post diagnostic workup, including chest and abdominal CT, showed no signs of metastatic dissemination. One week later, the patient was sent to the National Oncology Hospital for re-excision and Sentinel Lymph Node Biopsy (SLNB). The re-excision of additional 2cm from the previous surgical scar was conducted in parallel with removal of the draining sentinel lymph node (Figures 3a &amp; 3d). The closure of the defect after re-excision led to the unfortunate complication of wound dehiscence and failure to close successfully (Figure 3b-c). However, after several sessions of debridement, cleansing, rebandaging and administration of antibiotics, there was visible improvement with subsequent resolution(Figure 3d-f). Since that time, she has been in excellent condition, and no complications have been reported to date.

POLYMORPHOUS ADENOCARCINOMA IN THE PALATE PRESENTING TYROSINE-RICH CRYSTALLOIDS

Polymorphous adenocarcinoma (PAC) represents the second most common malignancy of the minor salivary glands. Uncommonly, intratumoral crystalloid deposits may be visualized in PAC. The main types include tyrosine-rich, collagenous, and amylase crystalloids. Here, we reported a case of a 49-year-old black female who was referred complaining of swelling on the hard palate. Clinically, a nodular lesion was observed measuring 4 cm in greater diameter, well-delimited, asymptomatic, and covered by normal-appearing oral mucosa, with time of evolution of 2 years. After incisional biopsy, microscopic examination revealed low-grade PAC containing foci of tyrosine-rich crystalloid deposits. Immunohistochemical analysis revealed positivity for CK AE1/3, CK7, vimentin, α-smooth muscle actin, and Bcl-2, S100, and focally for p53, GFAP, and CD10. The patient was referred to a reference service for treatment, and there has been no evidence of recurrence after 8 months’ of follow-up.

Nodular lesion on the posterior dorsal surface of the tongue

A 47-year-old man was referred to the Oral Medicine Service of our institution complaining of discomfort during eating and speaking because of the presence of a painless nodule on the posterior dorsal surface of the tongue. The patient had noticed the tongue lesion 1 month ago, and it had gradually expanded until it reached the size seen in the current clinical presentation. The medical history was noncontributory. Intraoral examination revealed a pink, pedunculated, exophytic, well-defined nodule, with a discretely lobulated and substantial ulcerated surface covered by a yellowish pseudomembrane without any tendency to bleed; measuring approximately 2 cm in greatest diameter; and located on the posterior dorsal region of the tongue (Figure 1).

MULTIPLE ANGIOSARCOMAS IN THE GINGIVA

A 56-year-old white woman complained of "bleeding gum lesions." Previous medical history revealed systemic arterial hypertension, diabetes mellitus, cardiac arrhythmia, and surgery for a prosthetic heart valve placement. Oral examination showed 3 pedunculated nodules in the gingiva involving the 3 remaining upper teeth, about 1.5 cm in greatest diameter, with rapid growth and bleeding but otherwise asymptomatic. Diagnostic hypothesis was pyogenic granuloma. Complete blood count showed leukopenia and thrombocytopenia. Excisional biopsy of 1 of the nodules was performed with local hemostatics agents, after medical consultation. Histopathologic analysis was suggestive of malignant mesenchymal neoplasm with histogenesis to be elucidated. Immunohistochemical study was positive for CD31 and negative for human herpesvirus 8 (HHV-8), S-100, p63, and AE1/AE3. The final diagnosis was angiosarcoma. During the investigation process, the patient experienced significant bone pain and worsening of her general condition, resulting in an emergency hospitalization. Ultimately, the patient succumbed to her condition while hospitalized. A 56-year-old white woman complained of "bleeding gum lesions." Previous medical history revealed systemic arterial hypertension, diabetes mellitus, cardiac arrhythmia, and surgery for a prosthetic heart valve placement. Oral examination showed 3 pedunculated nodules in the gingiva involving the 3 remaining upper teeth, about 1.5 cm in greatest diameter, with rapid growth and bleeding but otherwise asymptomatic. Diagnostic hypothesis was pyogenic granuloma. Complete blood count showed leukopenia and thrombocytopenia. Excisional biopsy of 1 of the nodules was performed with local hemostatics agents, after medical consultation. Histopathologic analysis was suggestive of malignant mesenchymal neoplasm with histogenesis to be elucidated. Immunohistochemical study was positive for CD31 and negative for human herpesvirus 8 (HHV-8), S-100, p63, and AE1/AE3. The final diagnosis was angiosarcoma. During the investigation process, the patient experienced significant bone pain and worsening of her general condition, resulting in an emergency hospitalization. Ultimately, the patient succumbed to her condition while hospitalized.