Common Benign Solid Tumor Research Articles

Hemorrhagic renal angiomyolipoma: An analysis of 6 cases with review of the literature

Renal angiomyolipoma is the most common benign solid tumor of the kidney. It can occur sporadically or in association with tuberous sclerosis, which is an autosomal dominant inherited disease. Hemorrhagic rupture of renal angiomyolipoma with retroperitoneal hematoma is the most serious complication that can be life-threatening and requires urgent management. The aim of this study is to review, through 6 cases and by means of a review of the literature, the diagnostic criteria of renal angiomyolipoma and the particularities of management of hemorrhagic renal angiomyolipoma. We carried out a retrospective study which concerned 6 patients with hemorrhagic renal angiomyolipoma, unilateral or bilateral, during the period between January 2019 and August 2021, in the Urology Department of the Hassan II University Hospital in Fez. The average age of our patients was 53 years with an F/M sex ratio of 2. Bourneville's tuberous sclerosis was diagnosed in 3 patients. The circumstances of discovery of renal angiomyolipoma were: acute flank pain associated with anemic syndrome in 3 patients, incidental discovery in 1 patient, clot hematuria in 1 patient and abdominal mass in 1 patient. Clinical examination revealed hemodynamic instability in 1 patient, flank defense in 2 patients, lumbar mass in 1 patient and lumbar tenderness in 1 patient. The abdominal CT angiogram allowed us to retain the diagnosis of renal angiomyolipoma in all the patients, with a bilateral form in the 3 patients with tuberous sclerosis of Bourneville. Renal embolization was performed in 5 patients, while total nephrectomy was performed in 1 patient. Renal angiomyolipoma is a rare tumor in daily urological practice. Its hemorrhagic risk requires a good knowledge of diagnostic, therapeutic and monitoring methods.

Current status on robotic assisted myomectomy

Uterine leiomyomas are common benign solid tumors of the uterus. While the presence of fibroids is rarely life threatening, they are associated with symptoms affecting quality of life and fertility. Myomectomy is a standard fertility-sparing surgery which should be considered for women suffering from fibroid-related symptoms who do not desire hysterectomy or any alternative treatment option. While open surgery is thought to be reserved for large and numerous myomas, mini-invasive methods as laparoscopy and robot-assisted surgery have evolved in the hands of experienced surgeons to also deal with these more complex cases. Robotic myomectomy has its advantages in lower blood loss, fewer complications, and shorter hospital stay over open surgery, whereas the comparison outcomes with laparoscopic myomectomy are still uncertain. Advantages of the wristed instruments, three-dimensional vision along with the incorporation of correct surgical techniques could emphasize the benefits of the robotic assisted approach in large and numerous myoma cases. Careful and detailed assessment should precede the surgery to recognize risks and steps to reduce operation time, which tends to be the most presented drawback of robotic myomectomy. As the tendency of robot-assisted surgeries is growing, many authors share their experience or publish comparison studies with other surgical methods. Our article describes the current status concerning robotic myomectomy, reviewing publications from the past five years (2016-2021).

Current concepts in ablative procedures for primary benign liver lesions: a step forward to minimize the invasiveness of treatment when deemed necessary.

With increased use of medical imaging, the incidental detection of benign solid liver tumors has become more frequent. Facing with benign disease, the indications for surgery are still object of discussion in light of the stable natural course of most lesions and obvious drawbacks of any surgical intervention; therefore, in most situations, a conservative approach is recommended, and surgery is mainly reserved for those cases with persistent or worsening symptoms, or who are at risk for complications as malignant transformation. The advent of ablative techniques has widened the range of treatment options available to these patients, presenting as a valid alternative to resection in terms of safety and efficacy in selected cases, particularly in patients who are considered poor surgical candidates and with smaller lesions. This review outlines the role of percutaneous ablative methods for benign solid liver tumors that are encountered in adults, providing a per histology analysis of the existing evidence. The up-to-date strategies for management of the most common benign solid tumors are recapitulated.

2260 Management of a Massive Liver Hemangioma: Does Size Matter?

INTRODUCTION: The majority of “giant” hemangiomas remain asymptomatic with no cause for surgical intervention; however, this may not hold true for massive tumors. The following case will review the challenges facing both patients and physicians when managing these atypical tumors. CASE DESCRIPTION/METHODS: A 49-year-old male with no medical problems presented with complaints of post-prandial bloating, early satiety and mild epigastric discomfort. The bloating was intermittent for several years; however, symptoms have recently curtailed his eating habits. CBC, BMP and liver enzymes were unremarkable. An ultrasound highlighted a massively enlarged liver extending into the pelvis and displacing surrounding organs. The liver parenchyma appeared to be replaced with a homogenous, hyperechoic lesion. An MRI then illustrated a 29.5 × 20.1 × 19.4 cm, strongly hyperintense mass on T-2 weighted sequences consistent with the diagnosis of a hemangioma. He was referred to a hepatobiliary surgeon and an extended right hepatectomy was eventually performed. Histopathology results described vast endothelial lined channels supported by thin fibrous stroma without features of malignancy. The patient returned to clinic four weeks after surgery reporting complete resolution of his symptoms. DISCUSSION: Hemangiomas are the most common benign solid tumor of the liver with little to no risk of malignant transformation. Often discovered incidentally on imaging studies, the majority of these tumors remain indolent without the need for routine surveillance. Rarely these tumors become symptomatic, often correlating with tumor size. The definition of “giant” liver hemangioma remains controversial, with most authors assigning the label to tumors greater than 4cm or 5cm in size. It is for this reason that management of giant hemangiomas remains highly debated (i.e. observation versus resection). Recent studies have shown that tumors greater than 20cm in size pose a higher risk for GI symptoms related to mass effect on surrounding organs as well as causing a disturbance in the hematologic and coagulation systems. Surgical resection should be considered for symptomatic or complicated lesions, or when the diagnosis remains inconclusive. It is our belief that size classifications for giant hemangiomas requires further subgrouping to consider the danger of these massive tumors as well as the increased morbidity of surgery. Proper management of these tumors should be individualized to each patient and include a multidisciplinary team approach.

A Quantitative Ultrasound-Based Multi-Parameter Classifier for Breast Masses

This manuscript reports preliminary results obtained by combining estimates of two or three (among seven) quantitative ultrasound (QUS) parameters in a model-free, multi-parameter classifier to differentiate breast carcinomas from fibroadenomas (the most common benign solid tumor). Forty-three patients scheduled for core biopsy of a suspicious breast mass were recruited. Radiofrequency echo signal data were acquired using clinical breast ultrasound systems equipped with linear array transducers. The reference phantom method was used to obtain system-independent estimates of the specific attenuation (ATT), the average backscatter coefficients, the effective scatterer diameter (ESD) and an effective scatterer diameter heterogeneity index (ESDHI) over regions of interest within each mass. In addition, the envelope amplitude signal-to-noise ratio (SNR), the Nakagami shape parameter, m, and the maximum collapsed average (maxCA) of the generalized spectrum were also computed. Classification was performed using the minimum Mahalanobis distance to the centroids of the training classes and tested against biopsy results. Classification performance was evaluated with the area under the receiver operating characteristic (ROC) curve. The best performance with a two-parameter classifier used the ESD and ESDHI and resulted in an area under the ROC curve of 0.98 (95% confidence interval [CI]: 0.95-1.00). Classification performance improved with three parameters (ATT, ESD and ESDHI) yielding an area under the ROC curve of 0.999 (0.995-1.000). These results suggest that system-independent QUS parameters, when combined in a model-free classifier, are a promising tool to characterize breast tumors. A larger study is needed to further test this idea.

Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

Introduction: Hepatic hemangioma (HH) is the most common benign solid tumor of the liver. The aim of this study is to review our experience of surgical treatment for giant HH and to show the impact of HH size and type of surgical resection on surgical outcomes. Method: This is a retrospective study of the cases who underwent surgery for giant HH during the period from January 2000 to April 2017. Result: Elective surgery was performed for 144 patients who had giant HH. The median diameter of resected HH was 10 cm (5 – 31 cm). Enucleation was performed for 92 (63.9%) patients and anatomical resection was required in 52 (36.1%) patients. No statistical significant differences between enucleation and resection as regards intraoperative and postoperative findings. The amount of intraoperative blood loss is significantly more in HH > 10 cm (300 vs. 575 ml, P = 0.007), the need of blood transfusion was significantly more in HH > 10 cm (P = 0.000), and the operation time was significantly longer in HH > 10 cm (120 vs. 180 min, P = 0.000). The size of HH had no significant effect as regards the development of postoperative complications. Conclusion: Giant hemangioma can be treated surgically with low incidence of morbidity and mortality. No statistical difference between enucleation and resection as regards surgical outcomes. In left lobeHH,HH located deeper in posterior hepatic segments and in multiple HH, hepatic resection is preferred. The size of the HH had significant impact intraoperative blood loss and operative time.

Surgical Management of Giant Hepatic Hemangioma: Single Center’s Experience with 144 Patients

BackgroundHepatic hemangioma (HH) is the most common benign solid tumor of the liver. The aim of this study is to review our experiences of surgical treatment for giant HH and to show the impact of HH size and type of surgical resection on surgical outcomes. Patients and MethodsThis is a retrospective study of the cases who underwent surgery for giant HH during the period from January 2000 to April 2017. ResultsElective surgery was performed for 144 patients who had giant HH. The median diameter of resected HH was 10 cm (5–31 cm). Enucleation was performed for 92 (63.9%) patients and anatomical resection was required in 52 (36.1%) patients. No statistical difference between enucleation and resection as regards intraoperative and postoperative findings. The amount of intraoperative blood loss is significantly more in HH > 10 cm (300 vs. 575 ml, P = 0.007), the need of blood transfusion was significantly more in HH > 10 cm (P = 0.000), and the operation time was significantly longer in HH > 10 cm (120 vs. 180 min, P = 0.000). The size of HH had no significant effect as regards the development of postoperative complications. ConclusionGiant hemangioma can be treated surgically with low incidence of morbidity and mortality. No statistical difference between enucleation and resection as regards surgical outcomes. In left lobe HH, HH located deeper in posterior hepatic segments and in multiple HH, hepatic resection is preferred. The size of the HH had significant impact intraoperative blood loss and operative time

An Unusually Big Cervical Fibroid Polyp : A Case Report

Fibroid Uterus is the most common benign solid tumor in female. Most of fibroids situated in the body of the uterus, cervical myoma account 3% -8% of uterine myoma. Cervical myoma are uncommon in different presentation, resembling inversion of uterus, malignancy & various sizes are reported in literature. A case of big cervical fibroid polyp has been reported here. Patient presented something coming down per vagina with foul smelling discharge. On examinations there was a hugely enlarged, infected mass about 15cm x 12cm which was arising from posterior lip of the cervix & outside the introitus. As the patient was 45 years & had menorrhagia, Non Descend Vaginal Hysterectomy (NDVH) was done without resecting the polyp priorly. Patient was discharged in good condition. Histopathology confirmed the diagnosis and reported leiomyoma with areas of degeneration which was mainly composed of involuntary smooth muscle cells & fibrous connective tissue from cervix which probably expelled out as a polyp attached to posterior lip of cervix.Chatt Maa Shi Hosp Med Coll J; Vol.15 (2); Jul 2016; Page 65-67

A Rare Case of a Retroperitoneal Leiomyoma in the Obturator Fossa

Introduction: Uterine leiomyomas are the most common benign solid tumors of the female pelvis. Retroperitoneal myomas are extremely rare and usually malignant with the common location being in the pelvis. Case Presentation: Our case involved a woman who was suering from dysparonia and radiculating right pelvic pain. The pelvic examination revealed a palpable tender mass of about 3-4 cm in size in the right adnexa near the pelvis bone. An orthopedic con- sultation was in favor of the mass being of gynecologic origin. A retroperitoneal approach on the right side revealed a 3 cm mass in the right obturator fossa. Conclusions: The most common place for a myoma is in the uterus. However, other sites have also been presented as case reports. Most smooth muscle tumors originating in the retroperitoneum are malignant. Retroperitoneal sites for myomas are mostly in the pelvis (73.1%). The frequent symptoms of retroperitoneal masses, including myoma, are discomfort, fatigue, weight loss, and radiating pain. The common sonographic findings in these patients is a pelvic solid mass with heterogeneous features. Surgical excision is the main treatment of retroperitoneal smooth muscle tumors.

SU‐G‐IeP4‐10: Microimaging for Different Degrees of Human Cavernous Hemangioma of Liver by Using In‐Line Phase‐Contrast Imaging CT

Purpose:Cavernous hemangioma of the liver (CHL) is the most common benign solid tumor of the liver. In this study, we quantitative assessment the different degrees of CHL from microscopic viewpoint by using in‐line phase‐contrast imaging CT (ILPCI‐CT).Methods:The experiments were performed at x‐ray imaging and biomedical application beamline (BL13W1) of Shanghai Synchrotron Radiation Facility (SSRF) in China. Three typical specimens at different stages, i.e., mild, moderate and severe human CHL were imaged using ILPCI‐CT at 16keV without contrast agents. The 3D visualization of different degrees of CHL samples were presented using ILPCI‐CT. Additionally, quantitative evaluation of the CHL features, such as the range of hepatic sinusoid equivalent diameters in different degrees of CHL samples, the ratio of the hepatic sinusoid to the CHL tissue, were measured.Results:The planar image clearly displayed the dilated hepatic sinusoids in microns. There was no normal hepatic vascular found in the all CHL samples. Different stages of CHL samples were presented with vivid shapes and stereoscopic effects by using 3D visualization. The equivalent diameters of hepatic sinusoids in three degrees CHL were different. The equivalent diameters of the hepatic sinusoids in mild CHL, range from 60 to 120 µm. The equivalent diameters of the hepatic sinusoids in moderate CHL, range from 65 to 190 µm. The equivalent diameters of the hepatic sinusoids in severe CHL, range from 95 to 215 µm. The ratio of the hepatic sinusoid to the mild, moderate and severe CHL tissue were 3%, 16% and 21%, respectively.Conclusion:The results show that the high degree of sensitivity of the ILPCI‐CT technique and demonstrate the feasibility of accurate visualization of different stage human CHL. ILPCI‐CT may offers a potential use in non‐invasive study and analysis of CHL.

Embolización de las arterias uterinas como alternativa de tratamiento para miomas uterinos. Experiencia en 60 pacientes

IntroductionUterine fibroids are the most common benign solid tumors of the female genital tract. Uterine artery embolization (UAE) is presented as an alternative to surgical treatment. ObjectiveTo evaluate the efficacy of UAE in the management of symptomatic fibroids, establish the success rate, and evaluate the safety of the technique by detecting complications during the procedure. Material and methodsA retrospective dual-center study was performed in 60 patients undergoing UAE from 2000 to 2011 in Albacete and the Puerta de Hierro General Hospital in Madrid. ResultsThe clinical success of the technique was demonstrated in 41 of the 60 patients (overall success rate of 68% at 4 years of follow-up) Complications occurred in 7 of the 60 patients (11.6%), consisting of embolization syndrome and transient ischemic pain in the first and second, which resolved with medical treatment and without further complications. ConclusionUAE is an effective treatment for women with symptomatic fibroids, showing high reliability and a low rate of minor complications.