Conservative Excision Research Articles

Peripheral Ameloblastoma: A Case Report and Review of Literature.

Peripheral ameloblastoma (PA) is a rare benign tumor that can occur mostly in the mandibular gingiva of the premolar area, originating from the residual odontogenic epithelium. The patient is usually asymptomatic and the lesion can be an occasional finding during routine intraoral examination. Due to the lack of clinical and radiographic pathognomonic features, the diagnosis is based on histopathological analysis, associated with 3D computed tomography (CT) imaging. Here, we report the case of a middle-aged man showing an asymptomatic, sessile, normochromic papillomatous mass of the lingual alveolar mucosa, in correspondence of tooth 4.4, which was histologically diagnosed as peripheral ameloblastoma. After the complete excision of the lesion, there were no recurrence and no symptoms during the 3-year follow-up. The treatment of choice for PA is a conservative surgical excision, which usually results in a good prognosis, together with a long-term follow-up, necessary to intercept possible recurrence or, more rarely, malignant transformation.

Squamous Cell Carcinoma In Situ-The Importance of Early Diagnosis in Bowen Disease, Vulvar Intraepithelial Neoplasia, Penile Intraepithelial Neoplasia, and Erythroplasia of Queyrat.

Cutaneous squamous cell carcinoma (cSCC) is the second-most-prevalent malignancy in humans. A delayed diagnosis of cSCC leads to heightened invasiveness and positive surgical margins. Bowen's disease (BD) represents an early form of cSCC and presents as a small erythematous, photo-distributed, psoriasiform plaque. Although certain dermoscopy features in BD are quite characteristic, histopathology remains the gold standard for diagnosis and provides a severity-scoring system that assists in guiding appropriate treatment strategies. The classification of precancerous lesions of the vulva and penis has undergone multifarious transformations due to variations in clinical and histopathological characteristics. Presently, erythroplasia of Queyrat is categorized as a clinical variant of penile intraepithelial neoplasia (PeIN). The diagnoses of vulvar intraepithelial neoplasia (VIN) and PeIN present significant challenges and typically necessitate one or more biopsies, potentially guided by dermoscopy. Aceto-white testing demonstrates a notably high negative predictive value for genital precancerous lesions. Histopathological examination represents the gold-standard diagnosis in VIN and PeIN, while p16 and p53 immunostainings alongside HPV testing provide crucial diagnostic clues. The histopathologic features, degree of differentiation, and associations with lichen planus, lichen sclerosus, and HPV guide the selection of conservative treatments or surgical excision.

Management of Soft Tissue Upper Jaw Tumor in a 51 Year Old Female Patient at Sultan Fatah Hospital, Demak Regency: Case Report

Background: Benign tumors are collections of cells, tissues or organs that grow slowly and usually enlarge with peripheral expansion, pushing on surrounding structures. Squamous odontogenic tumor (SOT) is a very rare benign epithelial intraosseous tumor, which can cause arising from the neoplastic transformation of Malassez epithelial cells on the lateral surface of the periodontal ligament. Objective : To discuss the management of odontogenic squamous tumors using conservative surgical excision. The goal of treatment for oral myxoma was surgical excision. Case management : A 51 year old female patient came to the SULTAN FATAH Hospital Polyclinic, Demak Regency on May 26 2023 with complaints of a lump on the upper left gum of the jaw. The patient felt the lump about 1 year ago. The patient does not feel pain in the lump. Clinical examination showed a lump in the upper jaw on the front of the patient's left side.Conclusion : Management of the patient undergoing surgical excision of the tumor with general anesthesia and infiltration in the case of odontogenic squamous tumor, based on subjective examination the patient complained of a lump with a tumor mass measuring 10 x 8 cm, redder than the surrounding tissue, round, not moving, attached to the gums of the upper jaw.

Umbilical pilonidal sinus with the urachal tract: A case managed with umbilicus-preserving laparoscopic urachal cyst and tract excision.

The umbilical pilonidal sinus (UPS) is a rare clinical entity and is not easily diagnosed unless there is a high suspicion. Pilonidal sinuses are most frequently seen around the gluteal cleft, but occasionally can be observed on other areas of the body, including the breast, webs of fingers, axilla and umbilicus. UPS is one of the rarest subtypes. Risk factors for UPS are similar to those for gluteal cleft pilonidal cysts and include young age, male gender, obesity, hairy body and poor personal hygiene. The traditional approach of treatment is usually conservative or surgical excision of the sinus with or without umbilectomy through the open technique. We discuss a case of UPS in an adult male having a concurrent urachal cyst with the urachal tract. We report our experience in laparoscopic management of this case after the failure of a conservative approach, with favourable outcomes at 1-year follow-up.

A case series of post-tuberculous Baker's cyst

IntroductionThe gastrocnemius-semimembranous bursa of the knee, which connects to the posterior region of the joint capsule, becomes distended in a Baker's (popliteal) cyst. In adults, it is nearly always secondary to pathological changes in the knee joint that cause an effusion. Baker cysts are mostly asymptomatic, but they may have presentations ranging from mild swelling, a picture similar to infective arthritis, to massive swelling leading to rupture and causing lower limb ischemia. We have presented these cases of post-tubercular baker cysts and evaluated their post-treatment outcomes. Material and methodsBetween September 2018 and September 2021, 12 patients with post-tuberculous baker cysts who presented to the outpatient department or emergency department of our institute were treated with conservative or open excision and followed up for 12 months at regular intervals. The functional assessment was done by VAS pain scoring and Lysholm knee scoring at the start of treatment, 1, 6 and 12 months after the surgery or conservative treatment. Results8 patients with post-tubercular Baker cysts were managed conservatively with aspirations and medications. Four patients with large multiloculated post-tubercular baker cysts were managed operatively. The mean age of patients with complicated post-tuberculosis Baker cyst was 44.92 ± 5.07 years. VAS The scoring of all the patients improved with each visit and 1-year follow-up. The Lysholm Knee score of patients also improved with each visit. All patients had excellent scores, with 3 patients having a score of 100 at 1-year follow-up. ConclusionComplicated Baker's cysts with multiloculated post-tubercular cysts need surgical management in most cases. Excellent to good functional outcomes can be achieved in these unusual cases with prompt intervention, detailed work-up, and medications.

Management of compound odontoma associated with unerupted maxillary permanent incisors: A case report

Introduction: Odontomas, the most common odontogenic tumors, result from developmental abnormalities where epithelial and mesenchymal cells grow, forming functional ameloblasts and odontoblasts. Typically asymptomatic, they are often associated with unerupted or impacted teeth. Odontomas are categorized as complex or compound, based on their tissue composition and structure. The preferred treatment is conservative surgical excision, followed by histopathological analysis for confirmation. Case History: A 13-year-old female patient came to the Pedodontic Clinic at RSGM Airlangga University with the chief complaint of unerupted upper front teeth. Intraoral eximination revealed no facial asymmetry. Intraoral examination revealed the absence of maxillary right central and lateral incisors with an asymptomatic swelling and no inflammation of the overlying mucosa. The patient had no history of systemic diseases such as heart disease or blood disorders, and there were no known allergies to food or medications. Discussion: Odontomas are generally asymptomatic and associated with unerupted or impacted teeth or retention of primary teeth. Removal of obstructions like odontome results in a spontaneous eruption of the impacted tooth. Another method currently being undertaken involves surgically exposing unerupted teeth and placing bonded attachment along with ligatures/e-chains for orthodontic traction so that it will speedup eruption process. Conclusion: The odontoma must be removed so that it will not disrupt dental growth and development, especially tooth eruption.

Oral Squamous Acanthoma – A Histopathologic Entity Or Not

Oral squamous acanthoma (OSA) is an uncommon benign epithelial lesion of the oral cavity, presenting as a solitary, painless, sessile or pedunculated mass. It is considered a variant of oral squamous papilloma, characterized by acanthosis without papillomatosis. Although typically asymptomatic, OSA can cause discomfort or functional impairment depending on its size and location. Diagnosis is primarily based on clinical and histopathological examination, with characteristic features including hyperkeratosis, acanthosis, and elongated rete ridges. Treatment involves conservative surgical excision, with a low recurrence rate reported in the literature. Here, we present a rare case of OSA in a 55-year-old female patient, highlighting its clinical and histopathological characteristics, differential diagnosis, and management. This case underscores the importance of considering OSA in the differential diagnosis of oral lesions and the significance of histopathological analysis in confirming the diagnosis.

Surgical treatment of colorectal endometriosis: an updated review.

This review aims to summarize recent literature on the surgical treatment of colorectal endometriosis. The last decade has seen a surge in the number of studies on bowel endometriosis, with a focus on preoperative evaluation, perioperative management, surgical approach, and surgical outcomes. Many of these studies have originated from large-volume referral centers with varying surgical approaches and philosophies. Colorectal surgery for endometriosis seems to have a positive impact on patient symptoms, quality of life, and fertility. However, these benefits must be weighed against a significant risk of postoperative complications and the potential for long-term bowel or bladder dysfunction, especially for more radical procedures involving the lower rectum. Importantly, most studies regarding surgical technique and outcomes have been limited by their observational design. The surgical management of bowel endometriosis is complex and should be approached by a multidisciplinary team. Methodical preoperative evaluation, including appropriate imaging, is vital for surgical planning and patient counseling. The decision to perform a more conservative or radical excision is nuanced and remains an area of controversy. High quality studies in the form of multicenter randomized controlled trials are needed before clear recommendations can be made.

Forestier disease: A possible cause of decannulation failure

Diffuse Idiopathic Skeletal Hyperostosis (DISH) [1] also known as Forestier disease, is a noninflammatory, systemic skeletal disease of unknown aetiology. DISH is a common but underdiagnosed disease that is usually observed in elderly people and has been reported to affect up to 10% of patients over 65 years of age [2]. The diagnosis is primarily radiological characterised by the ossification of the anterior longitudinal ligament, with osteophytes formation along the spinal column of at least four contiguous vertebral bodies, a minimal degree of degenerative disc disease and absence of apophyseal joint ankylosis and sacroiliac joint fusion, erosions, or sclerosis [3]. DISH is usually asymptomatic but may compress the posterior wall of the aero digestive tract and lead to dysphagia, globus, hoarseness, stridor, dyspnea and neurological problems. Although dysphagia is not uncommon among the presenting symptoms of DISH, dysphonia and stridor are rarely reported. Cervical hyperostosis in patients with DISH is responsible for 17%-28% incidence of dysphagia, and about 8% of patients failed to respond to conservative treatment and surgical excision through an anterior cervical approach was required [3]. Many studies have been conducted on the surgical approach [4] and anaesthetic evaluation of patients with DISH [5]. Less known are the difficulties in weaning from the tracheostomy tube in these patients, especially when the diagnosis of DISH is unknown.

Rare presentation of pyogenic granuloma: a case report

The pyogenic granuloma (PG) Also called lobular capillary hemangioma, is a prevalent tumorlike growth and vascular hyperplasia of the skin and mucous membranes. The condition arises in reaction to a chronic, recurring tissue injury that stimulates an exuberant or excessive tissue repair response. It can manifest at any age. The most common site is gingiva, extra gingival occurrence of PG is rare, although have been reported. Management of PG Depends on the area, size of lesion and patient preferences. However, the conservative surgical excision usually the curative treatment of PG. Alternative treatment modalities that have been employed include laser therapy, corticosteroid injections, cryosurgery, and sclerotherapy. In the case report has described an extra gingival PG which occurred on the lower lip in a 19-year-old female patient. The clinical and histopathological assessments confirmed the diagnosis of PG.

Late recurrence of calcifying odontogenic cyst: Report of a rare case and review of the literature

AbstractCalcifying odontogenic cyst (COC) is a relatively uncommon cyst of odontogenic origin, occurring in the second decade of life, with no jaw predilection. Radiographically, it typically appears as a well‐defined unilocular radiolucency containing irregular calcifications of varying size and opacity. Treatment consists of conservative surgical excisions with low recurrence rates. The purpose of this paper is to report a rare case of late COC recurrence and review the pertinent literature. A 42‐year‐old female patient presented for evaluation of a painless swelling in the palate, which had been present for 5 years with a gradual, slow increase in dimensions. Twenty years before, a lesion at the same site was surgically excised with a diagnosis of COC. Clinical examination revealed a hard‐in‐consistency swelling in the anterior segment of the hard palate. Radiographically, a radiopaque lesion with an irregular outline was noticed in the left palate adjacent to the left maxillary canine and first premolar, along with a well‐defined radiolucent lesion between the maxillary central incisors. Both lesions were surgically excised, and histopathological examination revealed that the main lesion in the left palate was consistent with recurrent COC, while the lesion between the central incisors was compatible with a nasopalatine duct cyst. Even though the recurrence rate of COC is low, estimated at 3.4% based on our review of the relevant English‐language literature, the current case highlights the possibility of a late recurrence, even several years after the initial diagnosis and treatment, and therefore the need for long‐term follow‐up.

Surgical outcome of Acoustic Neuroma Surgery in a Malaysian Tertiary Hospital

INTRODUCTION: Acoustic neuroma (AN) or vestibular schwannoma, is a benign, slow-growing tumour that arises from the Schwann cell of the vestibular branch of the vestibulocochlear nerve. Treatment options are mainly conservative or surgical excision. The aim of this study is to describe the clinical characteristics of AN and the surgical outcomes in a Malaysian tertiary hospital. MATERIALS AND METHOD: Records of 73 patients who were diagnosed with AN from January 2008 until December 2019 were retrieved. All patients were analyzed for demographic data and clinical characteristics. In all 52 patients underwent AN surgery and had normal preoperative facial nerve function. A descriptive analysis was used for the surgical outcomes of each patient. RESULTS: The median age of patients was 51.5 (15.8 SD). Hearing levels pre-operatively were severe to profound in 74.0% of the patients, followed by moderate to severe in 15.1%, mild to moderate in 6.8%, and mild hearing loss in 2.7%. Retrosigmoid (48.1%) was the most common surgical approach used, followed by translabyrinthine (44.2%) and middle cranial fossa (MCF) (7.7%). The translabyrinthine approach is associated with the least incidence of facial nerve paresis postoperatively (21.2%) when compared to the retrosigmoid and middle cranial fossa approaches (40.4%). However, there was no significant association between surgical approaches and facial nerve outcome (p=0.07). CONCLUSION: AN surgery is a safe procedure, regardless of the surgical approach used. There was a significant relationship between tumour size and facial nerve outcome.

Human Papillomavirus-Associated Oral Epithelial Dysplasia: Report of 5 Illustrative Cases from Latin America.

Human papillomavirus-associated oral epithelial dysplasia (HPV-OED) is a distinct oral epithelial disorder characterized by viral cytopathic changes caused by transcriptionally active high-risk HPV. The aim of the present study was to report 5 additional cases from Latin America. Clinical data from five patients with HPV-OED were obtained from the archives of three oral pathology services from Brazil and Chile. All cases were submitted to morphological, p16 expression and in situ hybridization (ISH) for HPV analyses. Four patients were male and one patient was female, with a mean age of 55.4 years. Four patients were HIV seropositive and two were smokers. Three cases affected the buccal mucosa and commissure, one of which had an additional plaque in the soft palate, and one case each occurred on the floor of mouth and lower labial mucosa. Most cases presented as well-demarcated white plaques with a verrucous surface. One case presented multiple lesions ranging from normal to white-colored slightly elevated plaques with a cobblestone surface. Peripheral mucosal pigmentation was observed in two cases. All five cases presented with the characteristic microscopic features of HPV-OED, including severe dysplasia with numerous karyorrhectic and apoptotic cells, full-thickness "block positivity" for p16 and high Ki-67 index (> 90%) sharply demarcated from the adjacent non-dysplastic epithelium. Wide-spectrum DNA ISH-HPV was positive in 4 cases. All patients were treated with conservative surgical excision with no signs of recurrence after a mean of 39-month follow-up. This represents the first series of HPV-OED from Latin America; most cases presented as well-demarcated papillary white plaques affecting the buccal mucosa and commissure of HIV-positive middle-aged men, two of them exhibiting peripheral pigmentation caused by reactive melanocytes. The typical microscopic findings of HPV-OED were observed in all cases, which also showed strong p16 positivity in a continuous band through the full thickness of the epithelium and high Ki67.

DARIER-FERRAND DERMATOFIBROSARCOMA OF THE FACE: TWO CASES REPORT

Darier-Ferrand dermatofibrosarcoma or dermatofibrosarcoma protuberans (DFSP) is a cutaneous mesenchymal tumor of intermediate malignancy. It is a rare but not exceptional tumor, accounting for 0.1% of malignant skin tumors. Histological examination is essential for diagnosis. Wide surgical excision is the standard treatment. We report two cases of Darier-Ferrand dermatofibrosarcoma of the face. A wide local excision is the gold-standard treatment, with negative margins of 3–5 cm from the tumor edge including the skin, the subcutaneous tissue, and the underlying fascia. However, this is a mutilating surgery, especially for cervicofacial lesions which is the case for our two patients For cervico-facial localizations,some authors advise the Mohs micrographic surgery for its low recurrence rates described. Target adjuvant therapy with imatinib has been shown to reduce tumor size and improve surgical resectability and can be proposed as an option for our patients. However, its unavailability and high-cost limit its use in our context. A combination of conservative excision and adjuvant radiotherapy was reported to reduce the rate of local recurrence and should be also considered by practicians. To improve prognosis, early, codified, multidisciplinary management is essential for this pathology.

Segmental Rectum Resection for Deep Endometriosis and Excision Similarly Improve Sexual Function and Pain.

Segmental rectum resections for indications other than endometriosis were reported to result in up to 40% sexual dysfunctions. We, therefore, evaluated sexual function after low bowel resection (n = 33) for deep endometriosis in comparison with conservative excision (n = 23). Sexual function was evaluated with the FSFI-19 (Female Sexuality Functioning Index) and EHP 30 (Endometriosis Health Profile). The pain was evaluated with visual analogue scales. Linear excision and bowel resections improved FSFI, EHP 30, and postoperative pain comparably. By univariate analysis, a decreased sexual function was strongly associated with pain both before (p < 0.0001) and after surgery (p = 0.0012), age (p = 0.05), and duration of surgery (p = 0.023). By multivariate analysis (proc logistic), the FSFI after surgery was predicted only by FSFI before or EHP after surgery. No differences were found between low bowel segmental resection and a more conservative excision. In conclusion, improving pain after surgery can explain the improvement in sexual function. A deleterious effect of a bowel resection on sexual function was not observed for endometriosis. Sexual function in women with endometriosis can be evaluated using a simplified questionnaire such as FSFI-6.

LINGUAL SCHWANNOMA: A CASE REPORT

A 27-year-old female patient, referred for evaluation of lingual tumoration, with a 10-year evolution. Intraoral examination revealed an increase in volume in the left posterior region of the lingual dorsum, asymptomatic, firm to palpation, with no color alterations and maintenance of the mucosa integrity, measuring about 30 mm. Initially, an incisional biopsy was performed with diagnostic hypotheses of neoplasm of neural or glandular origin and lipoma. The histopathological examination revealed an encapsulated mesenchymal neoplasm, composed of fusiform and compound cells, either irregular or in palisade, around a central region. The immunohistochemical reaction showed that cells were positive for S100 and negative for CD34. Thus, the histological diagnosis was Schwannoma. The treatment was conservative excision under general anesthesia. Histological examination of surgical specimen confirmed the diagnosis of Schwannoma. After 6 months of post-op, there was no evidence of recurrence. A 27-year-old female patient, referred for evaluation of lingual tumoration, with a 10-year evolution. Intraoral examination revealed an increase in volume in the left posterior region of the lingual dorsum, asymptomatic, firm to palpation, with no color alterations and maintenance of the mucosa integrity, measuring about 30 mm. Initially, an incisional biopsy was performed with diagnostic hypotheses of neoplasm of neural or glandular origin and lipoma. The histopathological examination revealed an encapsulated mesenchymal neoplasm, composed of fusiform and compound cells, either irregular or in palisade, around a central region. The immunohistochemical reaction showed that cells were positive for S100 and negative for CD34. Thus, the histological diagnosis was Schwannoma. The treatment was conservative excision under general anesthesia. Histological examination of surgical specimen confirmed the diagnosis of Schwannoma. After 6 months of post-op, there was no evidence of recurrence.

Treatment and Management Experience of Idiopathic Granulomatous Mastitis in a Low-income Country.

Reporting our experience of the management and treatment of Idiopathic granulomatous mastitis (IGM) in a low-income country by describing patients characteristics and therapy with emphasis on conservative surgical excision and postoperative care as the cornerstone of treatment. A retrospective cohort of women with histopathological diagnosis of IGM from 2014 to 2018 at Instituto Nacional Materno Perinatal in Lima, Peru. Patients' characteristics, clinical presentation, treatment, management, postoperative care, and follow-up were analyzed. Thirty-eight patients with histopathological diagnosis of IGM were identified. Their average age was 35.9 years and 23 (60.5%) reported previous use of hormonal contraceptives. Nine (23.7%) patients had chronic mastitis with previous treatment. The time from the onset of symptoms to the first clinic consult was 5.1 months on average. Twenty-one (55.3%) patients had the lesion in the right breast, with a mean size of 6.9 cm. Conservative surgical excision was performed in all patients. Additionally, 86.8% required corticosteroids and 78.9% were treated with antibiotics. Complete remission was obtained at 141 days on average (range 44 to 292 days). Six (15.8%) women reported ipsilateral recurrence and 5 (13.2%), contralateral. The latency time was 25.5 months on average. The conservative surgical treatment demonstrated and close follow-up made for a high cure rate, but with recurrence similar to that reported in the literature. Use of gloves is an alternative to manage post operative wounds in a low-income country. The most frequent adverse effect was breast surgical scar.

Prognostic Analysis of Patients With Extramammary Paget Disease Treated With Conservative Excision.

Extramammary Paget disease (EMPD) is a malignant skin tumor with a relatively good prognosis. The standard treatment is wide local resection or Mohs micrographic surgery. However, conservative excision may be a better option when radical wide local excision is difficult to perform due to the patients' mental or physical condition. There have been no studies on the prognosis of patients with EMPD who underwent conservative excision. To compare the prognosis of conservative excision cases to wide excision cases of EMPD. The authors retrospectively analyzed the clinical data of 69 cases of EMPD without metastases to lymph nodes or organs (11 cases treated with conservative excision, 58 cases treated with wide local excision) who underwent resection of the primary tumor from 2002 to 2022 in the Department of Dermatology at Hokkaido University Hospital. The log-rank test showed no significant differences in overall survival or metastasis-free survival between the wide excision group and the conservative excision group, although conservative surgery was often chosen in elderly patients or patients with lower performance status. This study suggests that conservative surgery should be considered as a treatment option for EMPD.

Intra-Abdominal and Retroperitoneal Benign Lipomatous Tumors-An Extremely Rare Mimic of Liposarcoma and its Diagnostic Challenge.

Background. Lipomas are common superficial soft tissue tumors of mature adipocytes. In contrast, well-differentiated/dedifferentiated liposarcoma typically presents in the retroperitoneum as large masses. We provide clinicopathologic and follow-up details of 9 retroperitoneal/intra-abdominal benign lipomatous tumors (BLT) and discuss the utility of ancillary fluorescence in situ hybridization (FISH) in distinguishing from their malignant counterparts. Design. Clinicopathologic details and histology of 9 intra-abdominal and retroperitoneal lipomas were studied along with ancillary CD10 immunohistochemistry (IHC) and FISH for MDM2 and CDK4 amplification. Results. There were 6 females and 3 males. Median age at diagnosis was 52 years (range 36-81 years). Seven were identified incidentally and 2 presented with primary complaints. On imaging, 7 were considered suspicious for liposarcoma. Grossly, the tumors ranged from 3.4 to 41.2 cm (median 16.5 cm). Histologically, all cases showed well-differentiated BLT, further classified as lipoma (n = 7; 1 with metaplastic ossification, 2 with prominent vessels, and 4 ordinary lipomas) and lipoma-like hibernoma (n = 2)-the latter 2 showed intramuscular lesions with interspersed brown fat. CD10 IHC showed strong staining in the 2 hibernomas, whereas the staining was weak in the remaining. MDM2 and CDK4 amplification were negative by FISH in all. Follow-up (median 18 months) did not show recurrence on clinical or imaging evaluation. Conclusion. Retroperitoneal/intra-abdominal BLT are extremely rare and are indistinguishable clinically and radiographically from liposarcoma. This necessitates molecular confirmation even when the histology is convincingly benign, for a confident diagnosis. Our cohort shows that conservative excision without removal of abutted organs is sufficient in most cases.

Acral BRAF‐mutated tubular adenoma should be distinguished from HPV42‐related digital papillary adenocarcinoma

Acral <i>BRAF</i>‐mutated tubular adenoma should be distinguished from <scp>HPV42</scp>‐related digital papillary adenocarcinoma