Detection Of Malignant Changes Research Articles

Dysphagia in an Adolescent with Iron Deficiency Anemia.

Dysphagia in an Adolescent with Iron Deficiency Anemia.

Surgical excision of a solitary osteochondroma arising from the lesser trochanter in an adult: a case report

<p>The occurrence of osteochondroma around the proximal femur is rarely reported as most cases are asymptomatic. We report a rare case of symptomatic solitary osteochondroma arising from the lesser trochanter in a skeletally mature patient causing significant impairment of hip function managed by surgical excision. A 32-year-old male labourer presented with pain and swelling over right hip region for nine months. Radiographic examination (X-ray, MRI, CT) revealed the pathognomonic continuity of the cortex and medulla of the lesion with the parent bone. Cartilage cap cover (measuring 15 mm) on MRI helped to clinch the diagnosis. CT guided biopsy was also suggestive of osteochondroma. The tumour was excised en bloc by posterior approach without the need for hip dislocation. The base of the lesser trochanter was osteotomised and the entire mass with the cartilage cap was removed. A two year follow up has shown no evidence of local recurrence. Surgical excision of a symptomatic osteochondroma is a successful form of treatment with low mortality. Adequate pre-operative radiographic examination is helpful to know the location and local spread of the tumour. Measurement of cartilage cap thickness on MRI is an essential tool to diagnose malignant changes. A safe and adequate resection should be carried out in an effective manner with attention to femoral head vascularity and prevention of local recurrences. Patients with solitary osteochondroma around the proximal femur should be kept under observation to help early detection of malignant changes.</p>

INFLUENCE OF THE METHOD OF SAMPLING ON THE RESULTS OF CYTOMORPHOLOGICAL STUDIES IN THE DIAGNOSIS OF TUMORS OF THE ORAL MUCOSA

The mucous membrane of the oral cavity (MMOC) and the underlying tissues have a complex anatomical structure that determines the specifics of the clinical course and treatment of tumors developing here. Malignant tumors that occur in the oral cavity, in most cases have the structure of squamous cell keratinizing cancer. In the conditions of a dental clinic, the diagnosis of precancerous and tumor changes presents serious difficulties, the main cause of which is the low oncological alertness of dentists, as well as the lack of necessary equipment and modern minimally invasive methods of early detection of cancer. Histological examination rarely is used in dentistry, as it implies a lifetime fence of the abnormal tissue (a biopsy) and has a number of disadvantages associated with the work sharp tool, the possibility of bleeding, mistakes in material sampling, waiting times result from a doctor-a pathologist. Taking into account the external localization of COR and CCG neoplasms, the procedure for collecting material for cytological research is simple and highly sensitive (the sensitivity of the method is 90-95%). Objective: to assess the possibility of cytological diagnosis in the practice of the dentist and the impact of different methods of sampling on the results of morphological analysis. Materials and methods of research. 114 samples were analyzed from 38 patients who sought dental care with complaints of tumors in the oral cavity. Material from each patient was collected in three ways, followed by cytological examination. Results and discussions. The obtained results indicate that the lowest percentage of detection of malignant changes in the cells of patients was observed when self-flushing with MMOC, and the highest percentage of pathologically altered cells was detected when sampling material by smear. The obtained results of cytological examination were compared with histological data, where different percentage matches were obtained depending on the method of material sampling. Conclusion: the use of cytological research method in dental practice with adequate sampling of the material allows to identify malignant cell changes in more than 80% of cases.

Foot Squamous Cell Carcinoma: Grieve Lessons from Diabetic Foot Ulcer Misdiagnosis

Foot squamous cell carcinoma (SCC) is rare and preponderance towards DFU misdiagnosis is very likely given the high risk of developing DFU among diabetics. This case highlights the needs to identify atypical features observed in any given DFU to avoid misdiagnosis and late detection of malignant changes. A 63-year-old gentleman with diabetes presented with non-healing right DFU for more than two years. The ulcer was hypergranulating over medial surface of mid-foot, had minimal slough and irregular edges but no callosities. Treatments include debridement, dressing and strict offloading of right foot, but the ulcer remained unchanged. Skin biopsy confirmed the diagnosis of SCC and surgical resection was done but complicated with bone metastases at 4 months post-surgery. The patient died secondary to bilateral pulmonary embolism in less than a year since the diagnosis of SCC. Atypical features that triggered the possibility of DFU misdiagnosis are: 1) prolonged non-healing DFU despite appropriate ulcer management and addressing factors affecting wound healing, 2) foot ulcer pain with no callosities typically observed in DFU, and 3) hypergranulating ulcer in a well-controlled diabetes. Reported cases of foot SCC were primarily over the heel, an area with high contact and pressure load during walking. In this case, the absence of great toe (acquired from old trauma) had possibly altered pressure distribution of the foot leading to atypical ulcer’s location. Prolonged non-healing DFU despite appropriate ulcer management and addressing factors affecting wound healing, with atypical clinical features should raise caveat of DFU misdiagnosis. © Copyright 2019 by Gazi University Medical Faculty

Is There a Role for Genetic Information in Risk Assessment and Decision Making in Prostate Cancer?

ObjectivesProstate cancer is a neoplasm with a variable natural history and clinical behavior. There is much debate on the use of inherited genetic information in clinical application including risk assessment and treatment decisions. This study was performed to evaluate the relationship between clinical parameters of prostate cancer (PSA, Gleason score, and metastasis) and expression of NKX3.1, AMACR, TMPRSS2-ERG, ERG, and SPINK1 genes.MethodsNewly diagnosed cases of prostate cancer were selected for this study. Thirty four tissue samples were obtained via open radical prostatectomy and 9 samples were obtained via needle biopsy. Each tissue sample was sectioned into two parts, one used for detection of malignant changes and Gleason score determination, and the other immersed in RNA later solution (Qiagen). The expression of NKX3.1, AMACR, TMPRSS2-ERG, ERG, and SPINK1 genes were assessed by real-time PCR assay. Correlation between expression of each gene and PSA level, Gleason score, and presence of metastasis were examined.ResultsA total number of 43 specimens were studied, from which 9 were obtained from patients with metastatic prostate cancer. The expression of five examined genes had no correlation with PSA level and Gleason score. The expression of AMACR decreased in metastatic prostate cancer (P = 0.02). The expression of other genes showed no difference between metastatic and non-metastatic tumors (P > 0.1).ConclusionsGenetic information combined with clinical data can be useful in risk assessment and treatment planning. Based on the results of the current study, the decreased expression of AMACR was a sign of poor prognosis.

Detection of cervical lesions by multivariate analysis of diffuse reflectance spectra: a clinical study.

Diffuse reflectance (DR) spectroscopy is a non-invasive, real-time, and cost-effective tool for early detection of malignant changes in squamous epithelial tissues. The present study aims to evaluate the diagnostic power of diffuse reflectance spectroscopy for non-invasive discrimination of cervical lesions in vivo. A clinical trial was carried out on 48 sites in 34 patients by recording DR spectra using a point-monitoring device with white light illumination. The acquired data were analyzed and classified using multivariate statistical analysis based on principal component analysis (PCA) and linear discriminant analysis (LDA). Diagnostic accuracies were validated using random number generators. The receiver operating characteristic (ROC) curves were plotted for evaluating the discriminating power of the proposed statistical technique. An algorithm was developed and used to classify non-diseased (normal) from diseased sites (abnormal) with a sensitivity of 72% and specificity of 87%. While low-grade squamous intraepithelial lesion (LSIL) could be discriminated from normal with a sensitivity of 56% and specificity of 80%, and high-grade squamous intraepithelial lesion (HSIL) from normal with a sensitivity of 89% and specificity of 97%, LSIL could be discriminated from HSIL with 100% sensitivity and specificity. The areas under the ROC curves were 0.993 (95% confidence interval (CI) 0.0 to 1) and 1 (95% CI 1) for the discrimination of HSIL from normal and HSIL from LSIL, respectively. The results of the study show that DR spectroscopy could be used along with multivariate analytical techniques as a non-invasive technique to monitor cervical disease status in real time.

Histological-cytological reports correlation and reliability of papanicolau test for the detection of malignant changes in the cervix

The incidence rate of cervical cancer in Serbia is among the highest in Europe and is 23.8 in 100.000. Papanicolaou test, colposcopy and pathohistology report are the basic method of secondary prevention of cervical cancer. The aim of the study was to examine the correlation between histological-cytological findings and reliability of the Papanicolaou test in detection of cervical lesions. We analyzed cervical smears (Papanicolaou test) in 3868 women. Among them 190 women had suspect finding and because of that they were underwent to cervical biopsy. We detected premalignant or malignant changes of the cervix in 77 women. LSIL was found at 43 (22.6%), HSIL at 25 (13.2%) and carcinoma planocellulare at 9 (4.7%) women. There is a statistically significant positive correlation (Spearman=0.829; p<0,001) between histological and cytological findings of the respondents. Most estimates of diagnostic performance of Papanicolaou test in discrimination of LSIL, HSIL and carcinoma planocellulare in accordance with cervicitis are for cytological findings of ASCH (PA IIIa) (Sp=90.6% and Sn=100% for carcinoma planocellulare; Sn = 96% for HSIL and Sn=86% for LSIL). In discrimination HSIL from LSIL the best discrimination is achieved by finding LSIL (PAIIIb) Papanicolaou test (Sn=72.0%, Sp=67.4%), and in discrimination carcinoma planocellulare from LSIL best discrimination is achieved by finding HSIL (PA IIIb/IV) Papanicolaou test (Sn=77.8%, Sp=97.7%). Based on our results we can conclude that there is a positive correlation between histological-cytological findings and that the Papanicolaou test more reliable in detecting severe premalignant lesions. Cytological diagnosis of ASCH (PAIIIa) and LSIL (PAIIIb) can reliably indicate the presence of premalignant cervical lesions in women, and patients with these findings must be more controlled and treated.

Exfoliative cytology as a tool for monitoring pre-malignant and malignant lesions based on combined stains and morphometry techniques.

Prevention and early diagnosis have the greatest potential for public health and are the most effective method in the long-term to control oral cancer. The aim was to apply PAP staining together with AgNOR staining and morphometric analysis in oral exfoliative cytology, to determine the sensitivity and specificity of these methods in the detection of malignant changes for the purposes of both initial population monitoring and follow-up. AgNOR, Papanicolau, and morphometric tests were conducted in samples of patients with oral cancer, oral potentially malignant disorders and controls (opposite side of lesions). Specificity and sensitivity values for each stain method and the curve under ROC area were estimated. The diagnostic variables which allowed greatest accuracy in identifying malignancy relative to the healthy control were cluster (76.92%), satellite (75.64%), and total (90%). The diagnosis was seen to be associated with PAP and total AgNOR, total AgNOR and PAP, total AgNOR and satellites and clusters, and total AgNOR nuclear area/cytoplasmic area ratio. The total number of AgNOR is a reliable marker for detecting neoplastic cells; this method increases sensitivity and specificity by decreasing the likelihood of false negatives or positives, as the accuracy obtained was 90%. It is also a low-cost, non-invasive, simple methodology that can be recommended to help the early detection of oral cancer and monitoring of patients with a first diagnosis of cancer.

Fetus-in-fetu: a pediatric rarity.

Fetus-in-fetu (FIF) is a rare entity resulting from abnormal embryogenesis in diamniotic monochorionic twins, being first described by Johann Friedrich Meckel (1800s). This occurs when a vertebrate fetus is enclosed in a normally growing fetus. Clinical manifestations vary. Detection is most often in infancy, the oldest reported age being 47. We report the case of a 4-day-old girl who was referred postnatally following a prenatal fetal scan which had revealed the presence of a multi-loculated retroperitoneal mass lesion with calcifications within. A provisional radiological diagnosis of FIF was made. Elective laparotomy revealed a well encapsulated retroperitoneal mass containing among other structures a skull vault and rudimentary limb buds. Recovery was uneventful. Here we discuss the difference between FIF and teratomas, risks of non-operative therapy and the role of serology in surveillance and detection of malignant change.

Xeroderma Pigmentosa: High Risk for Ocular Neoplasia

Aim of Work: The aim of our work was early cytological and laboratory detection of any ocular surface malignant changes in xeroderma pigmentosa. Patients and Methods: Eighteen cases with xeroderma pigmentosa were included in this study. All cases were subjected to full ophthalmolog-ical examination, conjunctival biopsy from any abnormal lesion, polymerase chain reaction assay and impression cytology. Results: All cases were boys; the mean age was 11 years old. The main ocular presentation was dryness and abnormal epibulbar masses in different locations. Polymerase chain reaction represents precipitation of malignant cells which was confirmed by impression cytology. Conclusion: PCR and impression cytology are beneficial investigations for detection of any malignant changes in xeroderma pigmentosa.

Effect of Culture on the Management of a Pregnant Fulani Woman with Ovarian Cyst: A Case Report

Interactions between clinicians and patients towards pain assessment and management can present a problem due to some differences in perceptions between orthodox medicine and lay beliefs and practices seen in different cultural groups. The Fulani people found in Northern Nigeria and all over West Africa present a unique group in cultural pain perception, in both the male and women folk. This is the report on a case of a large (&gt;24cm) right ovarian cyst seen in a sixteen-year-old teenage woman of Fulani descent, presenting with abdominal pain in her sixth month of pregnancy. She had right cystectomy without conservation of the ovary on that side. Histopathological diagnosis was serous cystadenoma. She however, had abortion on the third postoperative day without any warning signs of labour. Although postoperative abortions may be seen at this stage, they are more common in the first trimester of pregnancy. The early diagnosis and treatment or follow-up of ovarian cystic lesions is necessary for the detection of malignant changes (2% to 5% of cysts) and the prevention of other complications involving either the ovary or foetus, in the presence of pregnancy. However, the culture of the Fulani that forbids the expression of pain may complicate the early diagnosis and treatment of both benign and malignant ovarian disease and other similar conditions seen in and out of pregnancy. The objective of this paper is therefore, to help practising clinicians and oncologists, especially Obstetricians and Gynaecologists, towards the early detection, diagnosis and treatment of these conditions by paying attention to both verbal and non-verbal communication of pain, when dealing with this and other monocultural group of people. This may also serve as the basis for further research on cancer and non-cancer pain management among different cultures in our environment.

Diffuse reflectance spectroscopy: diagnostic accuracy of a non-invasive screening technique for early detection of malignant changes in the oral cavity

BackgroundStrong proof-of-principle for utilisation of diffuse reflectance spectroscopy, a non-invasive tool for early detection of malignant changes, has emerged recently. The potential of this technique in distinguishing normal tissue from...

Autofluorescence Spectroscopy for the in Vivo Evaluation of Oral Submucous Fibrosis

The goal of this study was to analyze the autofluorescence spectrum of oral submucous fibrosis (OSF); in order to find out whether the technique is effective for the in vivo detection of OSF and for the early detection of malignant changes in OSF. The feasibility of autofluorescence spectroscopy to detect subtle alterations in tissue architecture and biochemical composition induced by dysplasia and inflammation has been studied in the field of oral oncology. Because early detection and proper treatment of common oral precancerous conditions such as OSF and any malignant transformation are important, autofluorescence spectroscopy was applied to detect OSF in this study. In vivo autofluorescence emission spectra were collected at excitation wavelength of 320 nm from buccal mucosa from patients grouped as normal, OSF, or OSF with malignancy. The emission spectra were recorded and analyzed for variations from normal spectra with respect to spectral profile and intensity. The emission spectrum of OSF had a significantly higher emission peak around 380 nm and 460 nm when compared with the normal mucosal spectrum. The carcinoma spectrum also had two peaks around 380 and 460 nm regions with reduced intensity. The spectrum of carcinoma in OSF was significantly different from spectrum of carcinoma arising from otherwise normal mucosa and also from the spectrum of normal mucosa. The difference in spectral intensities between normal, OSF, and carcinoma in OSF was found to be highly significant (p < 0.001). Autofluorescence spectroscopy has been proved to be a promising technique that can successfully differentiate precancerous and cancerous changes from normal mucosa. The spectra from each group studied (normal mucosa, OSF, and OSF with carcinoma) showed distinct features that made it possible to differentiate OSF from normal mucosa and also to detect malignant changes in OSF noninvasively and in real time.

Malignancy in Sinuses, Scars, and Chronic Ulcers, Invading Bones: A Review of 14 Cases in a Black African Population

Background: Malignant degeneration of chronic wound inflammation is a rare complication which almost always develops late. This study examines cases of squamous cell carcinoma developing in areas of chronic inflammation among blacks. Aim: To evaluate the patients that presented with histopathological evidences of squamous cell carcinoma in sinuses, scars, and chronic ulcers with bone involvement Methods: A retrospective review of 14 cases of squamous cell carcinoma of the extremities managed at Federal Medical Centre Azare and University of Maiduguri Teaching Hospital between July 2002 and June 2007 was carried out. The clinical, histopathological and radiological records were evaluated. Results: Out of the 14 patients diagnosed with squamous cell carcinoma, there were 9 males and 5 females. The predisposing lesions were chronic osteomyelitis in 8(58%) patients, and 3(21%) each for burns scars and chronic ulcers. The average duration of lesion before the diagnosis of malignancy was 23 years. The leg was the most frequently affected part of the extremities 10 (71%), followed by the feet 3(21%) and the forearm 1(7%). The most common radiological findings were soft tissue mass, osteolytic destruction and cortical thickening . The biopsies of all the lesions were exclusively well differentiated squamous cell carcinoma. Treatment offered were mainly amputation in 13 (93%) patients. Conclusion: Chronic osteomyelitis was the most common predisposing lesions to malignant change in our centers. Well differentiated squamous cell carcinoma was the common histological pattern. Chronic ulcers and sinuses require biopsy at regular intervals for early detection of malignant change.

Utility of Bile Duct Brushings for the Early Detection of Cholangiocarcinoma in Patients With Primary Sclerosing Cholangitis

In patients with primary sclerosing cholangitis, there are no reliable markers or imaging modalities to detect malignant changes or early cholangiocarcinoma when curative interventions may still be possible. Clinical features and outcomes were evaluated for 47 patients who underwent 101 endoscopic retrograde cholangiopancreatography (ERCP) procedures with bile duct brushings and cytopathologic examination for the detection of malignant changes between January 2001 and 2004. Bile duct cytology was characterized as unsatisfactory, benign, atypical, or malignant. Fifteen patients had at least one sample that was abnormal. Patients with abnormal findings were older (P = 0.03); otherwise the groups were similar. Three of six patients with marked atypia have undergone transplantation for these abnormal findings, and of these, two had cholangiocarcinoma and one had no cancer detected in the explant. Of the nine patients with focal atypia, seven are doing well, one underwent transplantation for marked atypia seen on brushings at another hospital, and the other underwent transplantation for decompensated cirrhosis. Two patients with benign findings developed cholangiocarcinoma, whereas 29 others have not. Cytopathologic examination of bile duct brushings taken at ERCP may be useful for the early detection of malignant changes in patients with primary sclerosing cholangitis. However, long-term prospective studies are needed to confirm the utility of surveillance ERCP and brushings.

Supravital staining: It's role in detecting early malignancies

The efficacy of supravital staining in the detection of malignancies in oro and oropharyngeal lesions and its role in the detection of malignant changes in premalignant lesions were studied. This prospective study comprises 90 cases of clinically suspicious lesions and it was done over a period of 3 years. Most of the patients had multiple risk factors for the development of malignancy. All underwent staining with a modified solution of 1% toluidine blue (TB). In our study the overall sensitivity was 97.29% and the specificity was 62.5%.

Quantifying the relationship between microbial attachment and mineral surface dynamics using vertical scanning interferometry (VSI)

The correlations between semi-automated sputum cytometry (ASC), conventional cytology and the final diagnosis was investigated in industrially-exposed workers. Slides of sputum samples from 201 former uranium miners with silicosis, 100 patients with asbestosis, 103 workers resected for lung cancer, and 200 controls (50% smokers), were stained using the Papanicolaou (Pap) method and the Feulgen reaction with thionin. Cytometry was performed using the Cyto-Savant automated system. Atypical nuclei were found in 72 of 404 patient samples, 327 samples were normal and five were inadequate for ASC analysis. Thirteen tumours (Pap IV, Pap V) and 11 cases of severe dysplasia were identified by cytology. Lung cancer was confirmed in 20 patients. Compared to the final diagnosis of lung cancer, the sensitivity of ASC was 75% (15 out of 20) and specificity 89.8% (520 out of 579). The results represent a diagnostic efficiency of 89.3%. The combination of ASC with cytology increased sensitivity to 80% (16 out of 20) without significant loss of specificity (89.7% or 523 out of 581). In this investigation of a limited number of patients with occupational radon or asbestos exposure, semi-automated sputum cytometry appears to be sensitive and reliable for the detection of malignant changes in the tracheobronchial mucosa. Together with conventional cytology, it would be reasonable to test the validity of the combined methods in a large-scale feasibility study of early lung cancer detection.

UTILITY OF ERC WITH BILE DUCT BRUSHINGS FOR THE DETECTION OF CHOLANGIOCARCINOMA IN PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS

Purpose: Cholangiocarcinoma (CC) is a known complication of primary sclerosing cholangitis (PSC), with a lifetime risk of approximately 15–20%. In these patients, there are no reliable markers or imaging modalities to detect malignant changes or early CC when curative interventions may still be possible. In this study, we determined the yield of endoscopic retrograde cholangiography (ERC) with biliary tree brushings in the detection of pre-malignant changes and its impact on clinical outcomes. Methods: Clinical features and outcomes were evaluated in 47 PSC patients who underwent 101 ERCs with bile duct brushings between January 2001 and 2004. Cytopathology examination of these specimens for the detection of malignant changes was classified as unsatisfactory, benign, atypical (focal or marked), or malignant. Results: Fifteen patients had at least one sample that was abnormal. Patients with abnormal findings were older (p = 0.03); otherwise the groups had similar characteristics including their other demographics, serum tumor markers, MELD and PSC risk scores, and standard measures of hepatic synthetic function. Three of 6 patients with marked atypia have undergone transplantation forthese abnormal findings and of these, 2 had CC and 1 had no cancer detected in the explant. Of the 9 patients with focal atypia, 7 are doing well, 1 underwent transplantation for marked atypia seen on brushings from another hospital, and the other underwent transplantation for decom-pensated cirrhosis. Two patients with benign findings developed CC, while the other 29 have not. Conclusions: ERC with bile duct brushings and cytopathology evaluation is a plausible method for the detection of malignant changes in patients with PSC. Long-term prospective studies are needed to confirm these findings and to determine the optimal screening protocol.

Immunohistochemical versus Molecular Detection of RAK Antigens in Breast Cancer

RAK antigens p120, p42, and p25 exhibit molecular and immunological similarity to the proteins encoded by HIV-1 and are expressed by 95% of breast and gynecological cancer cases in women and prostate cancer cases in men. Binding of the monoclonal antibody (MAb) RAK-BrI to cancer RAK antigens has been found to be inhibited by a peptide derived from the variable loop V3 of HIV-1. Since MAb RAK-BrI has been developed against denatured froms of breast cancer proteins, and it binds to a short epitope, GRAF, this MAb does not recognize the native, three-dimensional structure of proteins. Subsequently Western blot, after electrophoretic separation in gels with SDS, has been used to detect these unique cancer markers. The current studies were focused on the immunohistochemical evaluation of the novel marker RAK. Serial sections, 5 μm thick, were cut from frozen or Formalin-fixed, paraffin-embedded tissue blocks and immunostained with MAb RAK-BrI. All of the 53 cases of breast cancer tested RAK positive and no differences were observed in the immunohistochemical staining of lobular and ductal carcinoma cases. In contrast, MAb RAK-BrI antigens were detected in only 3 of 15 cases of macroscopically normal breast removed during mastectomy for breast cancer. It is noteworthy that Western blots of breast samples from the same series demonstrated a high expression of three RAK antigens in 20/20 of invasive breast carcinomas, while there was only a very weak expression of RAK antigens in 2/7 of the macroscopically “normal” breast samples. Due to the suspected viral origin of RAK markers, immunohistochemical staining with MAb RAK-BrI might be a useful tool in the early detection of malignant changes occurring in breast tissues.

Early detection of malignant changes in premalignant endometrial and cervical lesions using P53 immunostaining and cytophotometric study of DNA nuclear content

Early detection of malignant changes in premalignant endometrial and cervical lesions using P53 immunostaining and cytophotometric study of DNA nuclear content