Diagnosis Of Malignant Lesions Research Articles

High-Resolution Laryngeal US: Imaging Technique, Normal Anatomy, and Spectrum of Disease.

Although US is one of the most used modalities for head and neck imaging, its use in the diagnosis of laryngeal abnormalities is much less widespread. The standard assessment of laryngeal abnormalities currently involves direct laryngoscopy and cross-sectional imaging (either CT or MRI) but rarely US. US is readily available, noninvasive, and radiation free, and it allows real-time imaging (with video for dynamic assessment), higher resolution than that of cross-sectional imaging, and the performance of targeted fine needle aspiration cytology or biopsy. This modality, particularly with the advent of high-resolution US, has been found to be at least comparable to CT or MRI for diagnosis of malignant lesions and benign abnormalities such as vocal nodules, polyps, cysts, and Reinke edema. Furthermore, it has been found to be more sensitive for diagnosis of abnormalities such as small glottic tumors, and its dynamic capability can be used to identify functional abnormalities such as vocal cord palsy. The authors outline the technique of laryngeal US, which includes strategies to avoid calcified laryngeal cartilage by imaging through the thyrohyoid and cricothyroid membranes with a five-sweep strategy supplemented by cine film of the technique. They also provide US images of common laryngeal abnormalities such as tumors with and without extralaryngeal extension; vallecular, thyroglossal, and vocal cord cysts; laryngeal mucoceles; and vocal cord palsy. Online supplemental material is available for this article. ©RSNA, 2020.

Histopathological study of ovarian tumors in a tertiary care center

Introduction: Ovary is a complex structure and its neoplasms show a wide spectrum of histological types and clinical behavior. The present study was done with the aim of studying the histopathological pattern of ovarian tumors in women of various age groups. Ovarian tumors represent about 30% of all cancers of the female genital system. Ovarian tumor is the seventh leading cause of cancer death. Ovarian tumors are often difficult to detect until they are advanced in stage or size, as symptoms are vague and insidious. An accurate and early diagnosis of malignant lesions will go a long way in the optimal management of these cases. Aims and Objectives: To determine the frequency of different histological types of ovarian tumors in a tertiary care center. Materials and Methods: This was a retrospective study included 150 cases of histopathologically proven ovarian tumors, reported in the Sree Mookambika Institute of medical sciences, over a one and half year period (January 2018 to June 2019). These were classified according to the WHO classification of ovarian tumors. Clinical presentation of the patients was analyzed from archived case records. Results: Of 150 cases of ovarian tumors, 138 masses were unilateral (92%) and 12 were bilateral (8%). Benign neoplastic lesions were 58.7%, and malignant was 2%.In benign neoplastic, the most common neoplasm was serous cystadenoma followed by mucinous cystadenoma In malignant, the current study had 2 cases of mucinous cystadenoma with borderline malignancy and 1 case was serous papillary cystadenocarcinoma Conclusion: A more detailed prospective study include genetic profiling, to establish the reason for this low incidence of malignant lesions

PET / CT in the early and differential diagnosis of adrenocortical cancer

The objective of the study was to develop criteria for the early diagnosis and differential diagnosis of adrenocortical cancer (ACC) during positron emission tomography combined with computed tomography (PET / CT) with 18F-fluorodeoxyglucose (18F-FDG). Materials and methods. Diagnostic tests were performed on a General Electric the Discovery PET / CT 610. After scanning 60–90 minutes after the administration of the radiopharmaceutical, PET-grams were formed showing the distribution of the radiopharmaceutical throughout the body in both physiological and pathological areas. Using software, automatic fusion of images obtained on PET and CT scanners was carried out. Initially, a radiologist performed an analysis of structural pathological changes in organs, followed by an assessment of the level of accumulation and determination of CT densitometry of pathological adrenal formations. Subsequently, metabolic activity was determined by the level of SUV (standart uptake value). Results. A retrospective analysis of PET / CT data with 18F-FDG was performed in 50 patients with adrenal tumor formations. Based on the data studied, all patients were divided into 2 groups: 1st group (n = 21) with a subsequent diagnosis of ACC, 2nd group (n = 29) with benign adrenal neoplasms. The age of the patients was 68 (32–76) years and did not statistically differ in both groups (p ˃0.05). After check up tumor parameters the following results were obtained: the average tumor size in patients of the 1st group was 4.5 Ѓ} 0.75 cm, of the 2nd group – 4.9 Ѓ} 1.1 cm, no significant difference was found (p ˃0.05). The diagnostic model obtained by constructing and subsequent analysis of the ROC curve of the SUV level in patients with malignant and benign neoplasms of the adrenal glands showed a high quality model with a sesitivity of 90 %, specificity of 95 % (area under the ROC curve (AUC) 0.93 at p <0.0001 (z = 27.37)) and a cut-off point of 3. When studying CT densitometric parameters of a tumor in patients of the 1st and 2nd groups, a direct correlation relationship between these parameters and the diagnosis of malignant lesions was also obtained (Rs = 0.67; coefficient τ Kendall 0.64; p = 0.001). Interpretation of the results of the ROC analysis of the tumor density level (CT density in Hounsfield units (HU)) in patients of the 1st and 2nd groups showed 80 % sensitivity and 90 % specificity (AUC 0.89; p <0.0001) with clipping point equal to 10 HU. Conclusion. Obtaining integral information on the SUV level together with the measurement of CT density during PET / CT with 18F-FDG is one of the most modern diagnostic methods that allow both diagnostics and differential diagnosis of ACC in the early stages of the pathological process. The above factors currently indicate the high diagnostic value of PET / CT with 18F-FDG and the priority nature of this study in cases of suspected ACC in patients with adrenal neoplasms of 1–5 cm in size.

Application Value of Detection of High-Risk HPV Infection in Early Cervical Cancer Patients in Disease Diagnosis and Prognosis Evaluation.

To analyze the relationship between HPV infection and early cervical cancer and postoperative survival outcomes. A total of 556 women were recruited to receive TCT and HPV tests from October 2017 to October 2018. The type of disease was pathologically diagnosed. The HPV positive rate, HPV-DNA, and E6/E7 mRNA quantitative level were detected, and the diagnostic accuracy of the subjects was analyzed by the receiver operating characteristic (ROC). The cervical intraepithelial neoplasia (CIN) and early cervical cancer patients were radically cured and followed up for 12.0 months to analyze the recurrence rate. Seventy-two cases of chronic cervicitis, 54 cases of CIN, and 51 cases of cervical cancer patients were pathologically diagnosed (32 cases in early stage and 19 cases in middle and late stage). HPV positive rate increased gradually in chronic cervicitis, CIN, and cervical cancer group (p < 0.001) and HPV 16 + 18 subtype. The positive rate was significantly different (p = 0.009). HPV-DNA and E6/E7 mRNA quantification also showed significant differences (p < 0.001). ROC analysis indicated that the accuracy of HPV-DNA and E6/E7 mRNA quantitative diagnosis of malignant lesions (CIN+ cervical cancer) were 0.865 and 0.879, respectively. There were 4 cases (7.41%) of recurrence in CIN group and 5 cases (15.63%) in early cervical cancer group. There was no difference (p = 0.401) among all of the patients. All patients with recurrence were HPV positive. HPV detection is an indispensable screening method for early cervical cancer and precancerous lesions, and comprehensive HPV 16 and 18 subtypes. DNA and E6/E7 mRNA quantification assay would further improve the accuracy of screening.

Melanonychia: Etiology, Diagnosis, and Treatment.

Melanonychia is a very worrisome entity for most patients. It is characterized by brownish black discoloration of nail plate and is a common cause of nail plate pigmentation. The aetiology of melanonychia ranges from more common benign causes to less common invasive and in situ melanomas. Melanonychia especially in a longitudinal band form can be due to both local and systemic causes. An understanding of the epidemiology, pathophysiology and clinical details is necessary for adequate patient care and counseling. It not only helps in the early recognition of melanoma but also prevents unnecessary invasive work up in cases with benign etiology. An early diagnosis of malignant lesion is the key to favourable outcome. Though there are no established guidelines or algorithms for evaluating melanonychia, a systematic stepwise approach has been suggested to arrive at a probable etiology. We, hereby, review the aetiology, clinical features, diagnostic modalities and management protocol for melanonychia.

Correlation of Biomarkers and Frozen Section Diagnosis with Paraffin Histopathological Diagnosis in Suspected Ovarian Cancer

Introduction: Ovarian cancers pose diagnostic dilemma and is problematic for decision making for the gynecological oncologist as well as the pathologist. The use of intra-operative frozen section can aid significantly in decision making and assist in choosing the correct operative path once a mass lesion of ovaries is discovered. Materials and Methods: Over a two-year period, 50 cases of Suspected Ovarian cancers were examined by intra- operative frozen section as well as followed up with histopathology in paraffin sections. Results were categorized in two strata—benign and malignant. Results: A comparison between frozen-section diagnosis and findings on paraffin section showed that the sensitivity of frozen section in diagnosis of malignant lesions is 97.14%, with specificity 93.33%, positive predictive value 97.14% and negative predictive value 93.33%. Among 50 cases, one case was reported as false positive and one was reported as false negative. Conclusion: Intra-operative frozen section is a highly sensitive and specific modality for the diagnosis of malignant lesions of the ovary.

Diagnostic accuracy of shear wave elastography – Virtual touch™ imaging quantification in the evaluation of breast masses: Impact on ultrasonography’s specificity and its ultimate clinical benefit

ObjectivesTo evaluate the diagnostic performance and the clinical benefit of Shear-Wave Elastography - Virtual Touch™ Imaging Quantification (SWE-VTIQ) as a complement to ultrasonography (US). MethodsFrom October 2016 through Jun 2017, B-mode US and SWE-VTIQ were prospectively performed in 396 breast masses in 357 women who consented to undergo this study. Quantitative elastography values were recorded: Vmax (maximum elasticity), Vmean (median elasticity), Vratio(max) (ratio of Vmax and surrounding parenchyma) and Vratio(mean) (ratio of Vmean and surrounding parenchyma). The histopathology of the lesions was considered the reference standard for benign or malignant definition. The performance of the four elastographic parameters was evaluated trough sensitivity, specificity and AUC. The parameter with the best performance was tested in six different diagnostic approaches defined based on clinical practice. ResultsOf the 396 masses, 122 (30.8%) were benign and 274 (69.2%) were malignant. All SWE parameters were significantly higher in malignant masses (all p < 0.01). Vmax and Vratio(max) performed significantly better then Vratio(mean) (p = 0.01 and p = 0.03, respectively). SWE-VTIQ improved US specificity in all diagnostic approaches, except when applied to BI-RADS 3 lesions. SWE-VTIQ reduced the false positive rate in 25% if applied only to BI-RADS 4A masses, maintaining a high sensitivity (98.9%, 95% confidence interval 97.1–100%) and a negative predictive value of 95.5%. When applied to BI-RADS 4A and 4B masses, SWE-VTIQ reduced the false positive rate in 54.4%. However, 13 malignant cases would be missed in this approach (4.7% of all malignant cases). ConclusionsSWE-VTIQ increases US specificity when applied to BI-RADS 4 A lesions, significantly reducing unnecessary interventions and preserving the diagnosis of malignant lesions. When applied also to BI-RADS® 4B lesions, SWE-VTIQ increases the number of false negative cases, which should be evaluated with caution.

The Clinical Value of DWI and T2WI MRI in the Detection of Transitional Zone Prostatic Cancer

Background: The prostate cancer is one of the commonest non-cutaneous cancers detected among elderly men. The difficulty in interpretation of the transitional zone prostate MRI arises mainly from the presence of benign prostatic hyperplasia (BPH) nodules in the transitional zone. Objective: The objective of this study is to evaluate the clinical efficacy of DWI in combination with T2WI for the detection of transitional zone prostate cancer, compared with T2WI alone. Patients and methods: A total of 58 patients with clinical suspicion of prostatic cancer were evaluated by 1.5 T MRI. Two diagnostic protocols were designed, protocol A consists of only data obtained from T2WI, protocol B consists of T2WI and DWI. The likelihood of the presence of prostate cancer in transitional and central zone was assigned using a 5 point scale after evaluating the entire prostate in each reading session, scales of 5, 4, and 3 were considered positive results and scales 1 and 2 were considered negative results. Results: Transitional zone prostate cancer was identified histopathologically in 23/58 patients. MRI diagnostic performance: In protocol A, the sensitivity is 56.5%, specificity is 62.9% and accuracy is 60.3%. Positive predictive value PPV is 50% while negative predictive value NPV is 68.8%. In protocol B, the sensitivity is 91.3%, specificity is 80% and accuracy is 84.5%. Positive predictive value is 75% while negative predictive value is 93.3%. Diagnostic protocol B has a significantly better sensitivity and specificity than protocol A (p˂0.05). According to ROC curve analysis, the cut point of protocol A scale is 2, so protocol A scale (≥ 2) is predictive for the diagnosis of malignant lesions (AUC=67.5%). The cut point of protocol B scale is 4, so protocol B scale (≥ 4) is predictive for the diagnosis of malignant lesions (AUC=87.3%). The cut off ADC value is 0.99 × 10-3 mm2/sec, so ADC value (<0.99 × 10-3mm2/ sec) is predictive for the diagnosis of malignant lesions with 91.3% sensitivity, 76% specificity, and 83.3% accuracy. Conclusion: Combination of DWI (ultra-high b value) with T2WI significantly increases the diagnostic accuracy of transitional zone prostatic cancer and scale ≥ 4 is associated with high proportion of malignancy.

Orbital Exenteration: A 23-year Report.

PurposeOrbital exenteration is a psychologically and anatomically disfiguring procedure which indicated in some patients with malignant or progressive diseases of orbital and periorbital area. In this study, we reviewed 176 patients that underwent orbital exenteration.MethodsThis was a retrospective study of medical records from all patients who underwent orbital exenteration from March 1991 to March 2014 in oculoplastic department at an eye care center. Demographic data, diagnosis, site of primary involvement and technique of surgery were determined in patients.ResultsOne hundred seventy-six cases of orbital exenteration were included that had documented histopathology. The age of patients ranged from 1 to 91 years (mean age ± standard deviation, 55.43 ± 27 years). Ninety-seven (55.11%) males and 79 (44.88%) females were included. Fifteen different tumors were identified. The most common indication was patients with basal cell carcinoma 49 (28%) followed by 41 (23.5%) squamous cell carcinomas, 35 (20%) retinoblastoma, and 13 (7%) adenoid cystic carcinomas. In total, adnexal malignancies were the most common tumors, secondarily involving the orbit. Eyelids 89 (50.5%) and the globe 43 (24%) were the most frequent site of involvement. Three types of exenteration were performed, based on available data of 129 operation sheets, 46 (35.7%) subtotal, 62 (48.1%) total, and 21 (16.3%) cases of extensive exenterations. In total 97 cases were evaluated pathologically for perineural involvement, of which perineural invasion was noted in 9 (7%) reports.ConclusionsFrequency of exenteration in our center has increased in past 3 years and the majority of cases were eyelid basal cell carcinoma. Patient education considering periocular lesions can help in earlier diagnosis of malignant lesions and therefore reducing the number of exenteration.

Estudo comparativo entre imagens de câmera fotográfica convencional e smartphone para o telediagnóstico de tumores palpebrais.

to compare the accuracy of eyelid tumor diagnosis obtained by evaluating conventional camera images with the ones obtained by evaluating smartphone images. from January 2016 to July 2017, 36 patients underwent face-to-face external assessments and biomicroscopic examinations to establish clinical diagnoses. The lesions were photographed using Canon PowerShot SX530 HS Digital Camera (16.8 Megapixels) and Samsung GALAXY S4 smartphone camera. All lesions were resected and submitted to anatomopathological examinations. Preoperative images were sent to two specialists in eyelid diseases and then remotely analyzed. Data from in-person diagnoses and telediagnoses were compared with the gold standard of histological diagnosis. the most frequent lesions were basal cell carcinoma (33.3%), actinic keratosis (19.4%), and nevus (13.9%). Kappa coefficient for the diagnosis of malignant lesion showed agreement between the two tele-evaluators in the conventional digital camera images (0.68) and in the smartphone images (0.78). The face-to-face examiner's accuracy was of 94.4%; the tele-evaluators' accuracy in the conventional digital camera images was of 83.3% and in the smartphone images varied from 80.6% to 86.1%. Comparing the in-person diagnoses with the telediagnoses (obtained by evaluating conventional digital camera images or smartphone images), there was no significant difference in the hit rates. for eyelid tumor telediagnosis, images obtained using smartphone camera were equivalent to those obtained using conventional digital camera.

Effect of blood glucose level on standardized uptake value (SUV) in 18F- FDG PET-scan: a systematic review and meta-analysis of 20,807 individual SUV measurements.

To evaluate the effect of pre-scan blood glucose levels (BGL) on standardized uptake value (SUV) in 18F-FDG-PET scan. A literature review was performed in the MEDLINE, Embase, and Cochrane library databases. Multivariate regression analysis was performed on individual datum to investigate the correlation of BGL with SUVmax and SUVmean adjusting for sex, age, body mass index (BMI), diabetes mellitus diagnosis, 18F-FDG injected dose, and time interval. The ANOVA test was done to evaluate differences in SUVmax or SUVmean among five different BGL groups (<110, 110-125, 125-150, 150-200, and > 200mg/dl). Individual data for a total of 20,807 SUVmax and SUVmean measurements from 29 studies with 8380 patients was included in the analysis. Increased BGL is significantly correlated with decreased SUVmax and SUVmean in brain (p < 0.001, p< 0.001,) and muscle (p < 0.001, p < 0.001) and increased SUVmax and SUVmean in liver (p = 0.001, p = 0004) and blood pool (p = 0.008, p < 0.001). No significant correlation was found between BGL and SUVmax or SUVmean in tumors. In the ANOVA test, all hyperglycemic groups had significantly lower SUVs compared with the euglycemic group in brain and muscle, and significantly higher SUVs in liver and blood pool. However, in tumors only the hyperglycemic group with BGL of >200mg/dl had significantly lower SUVmax. If BGL is lower than 200mg/dl no interventions are needed for lowering BGL, unless the liver is the organ of interest. Future studies are needed to evaluate sensitivity and specificity of FDG-PET scan in diagnosis of malignant lesions in hyperglycemia.

Diagnostic value and influencing factors of endoscopic ultrasound-guided fine needle aspiration for space-occupying lesions of gastrointestinal adjacent tissue

Objective To investigate the diagnostic value of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) on malignant lesions in gastrointestinal adjacent tissue, and further to analyze the risk factors influencing positive rate of EUS-FNA. Methods The clinical data of 171 patients undergoing EUS-FNA from January 2009 to May 2016 were collected. The lesion location, size and characteristics, the number of needle passes, puncture suction negative pressure, size of puncture needle, and years of operator experience in EUS were retrospectively analyzed. Results The overall sensitivity, specificity, and accuracy of EUS-FNA in the diagnosis of malignant lesions were 78.3% (83/106), 100.0% (65/65), and 86.5% (148/171), respectively. The univariable logistic regression analysis demonstrated that the risk factors of EUS-FNA were lesion location, lesion characteristics, and lesion size. In multivariate analysis, larger lesion size (OR=1.029, 95%CI: 1.011-1.047, P=0.001) and lesion characteristics of solid (OR=5.098, 95%CI: 1.324-19.633, P=0.018) were independent factors affecting the positive rate of EUS-FNA. Among 171 cases performed by EUS-FNA, the incidence of postoperative complications was 1.75% (3/171) included 2 cases of fever and 1 case of acute pancreatitis, which were improved after conservative treatment. Conclusion EUS-FNA is a safe and effective method of cytological and histological diagnosis with high accuracy and sensitivity, importantly in distinguish malignancy from benign lesion in gastrointestinal adjacent tissue. Positive rate of diagnosis on malignant lesions by EUS-FNA is positively correlated with lesion size, and EUS-FNA positive rate of solid malignant lesions is significantly higher than that of cystic lesions. Key words: Endosonography; Fine-needle aspiration; Diagnosis; Influencing factors; Space-occupying lesions

Role of Imprint Cytology in the Diagnosis of Malignant Lesions- A Hospital Based Study

Role of Imprint Cytology in the Diagnosis of Malignant Lesions- A Hospital Based Study

Role of Ultrasound Imaging in Hepatic Lesions and its Correlation with Fine Needle Aspiration Cytology

Introduction: Ultrasound is cheaper, effective, quick, painless, non-invasive with no radiation hazard. Guided FNAC of the liver is a safe, simple, cost-effective and accurate method for cytological diagnosis of hepatic lesions. To study the role of sonography findings including color doppler in Hepatic Lesions and its correlation with Fine Needle Aspiration Cytology. Materials and Methods: Patients referred to the department of Radiodiagnosis for Sonological evaluation were screened for hepatic SOLs. Patients with liver SOL were included in the study . Protocols included History, Routine laboratory and conventional radiological investigations, Ultrasonographic and Colour Doppler examination for size, margins, and color flow, intrahepatic bile duct status and lymph nodes followed byUSG guided FNA of the lesions and cytological co-relation Results: Out of 54 patients (28 male and 26 females), 37 patients had malignant (metastatic/primary) lesions and 12 had benign lesions. In 5 patients samples were inadequate for analysis. Maximum no of malignant cases were 15, in the age group of 41-60 years and benign cases were 5 each, in age less than 40 years and in age group 41-60 yrs.On ultrasound, 28 patients had single lesions while 26 had multiple lesions. Most of the patients (30/54) had lesions in right lobe while only 10 patients had lesions in left lobe. In 14 patients, lesions were present in both lobes. Conclusion: The sensitivity and specificity of ultrasound findings with Fine needle aspiration cytology was 78.4% and 91.7% respectively for diagnosis of malignant lesions.

Cytopathology of Pulmonary Lesions: A Tertiary Care Center Experience.

Background:Cytological evaluation of specimens from respiratory tract is the initial investigation in patients suspected to have pulmonary diseases. The various cytological specimens submitted for analysis include bronchoalveolar lavage, bronchial wash, brush smears, transbronchial needle aspiration, guided fine needle aspiration cytology (FNAC) smears and pleural fluid. Present study was undertaken to study the spectrum of lesions diagnosed by cytomorphological analysis of various cytological specimens.Materials and Methods:Centrifuged and direct smears from received samples were stained with MGG and PAP stain. Special stains (ZN and PAS) were used wherever required. Cytohistological correlation was done wherever biopsy was available.Results:This study included 671 samples from 583 patients suspected clinicoradiologically of having a respiratory pathology. A male preponderance (65.87%) was noted with 73.59% of patients in age group 40–80 years. Cytological diagnoses were classified as non-diagnostic (14.90%), negative for malignancy (59.76%), specific benign lesions (5.22%), positive for atypical cells (3.87%) and malignant (16.25%). Tuberculosis (TB) was found in 17 cases. Adenocarcinoma (both primary and metastatic) was the commonest malignancy of the 99 cases positive for malignancy. Incidence of primary lung adenocarcinoma and squamous cell carcinoma were found to be equal.Conclusion:Lung carcinoma is presently the leading cause of cancer deaths while TB is still a common cause of death in developing countries. Cytopathology has a definite role in diagnosis of malignant lesions and also contributes in diagnosis of unsuspected chronic infections. Cytological diagnosis is fairly accurate if the specimen obtained is adequate and representative.

Evaluation of Cellular Proliferative Activity in Patients with Actinic Cheilitis through Silver-stained Nucleolar Organizer Region Method

Introduction: Actinic cheilitis (AC) is a lesion potentially malignant that affects the lips after prolonged exposure to solar ultraviolet (UV) radiation. The present study aimed to assess and describe the proliferative cell activity, using silver-stained nucleolar organizer region (AgNOR) quantification proteins, and to investigate the potential associations between AgNORs and the clinical aspects of AC lesions. Materials and methods: Cases diagnosed with AC were selected and reviewed from Center of Histopathological Diagnosis of the Institute of Biological Sciences, Passo Fundo University, Brazil. Clinical data including clinical presentation of the patients affected with AC were collected. The AgNOR techniques were performed in all recovered cases. The different microscopic areas of interest were printed with magnification of *1000, and in each case, 200 epithelial cell nuclei were randomly selected. The mean quantity in each nucleus for NORs was recorded. One-way analysis of variance was used for statistical analysis. Results: A total of 22 cases of AC were diagnosed. The patients were aged between 46 and 75 years (mean age: 55 years). Most of the patients affected were males presenting asymptomatic white plaque lesions in the lower lip. The mean value quantified for AgNORs was 2.4 ± 0.63, ranging between 1.49 and 3.82. No statistically significant difference was observed associating the quantity of AgNORs with the clinical aspects collected from the patients (p > 0.05). Conclusion: The present study reports the lack of association between the proliferative cell activity and the clinical aspects observed in patients affected by AC through the quantification of AgNORs. Clinical significance: Knowing the potential relation between the clinical aspects of AC and the proliferative cell activity quantified by AgNORs could play a significant role toward the early diagnosis of malignant lesions in the clinical practice. Keywords: Actinic cheilitis, Proliferative cell activity, Silver-stained nucleolar organizer regions.

To describe the epidemiological profile of women with breast cancer, in Pernambuco, from 2009 to 2014

Introduction: Breast cancer is a serious public health problem, due to its high incidence, morbidity, mortality and its high cost of treatment. It is the second most frequent type of cancer in Brazil and the world and the most frequent among women. It is perceived that its incidence is higher in developing countries. In Brazil, breast cancer mortality rates remain high because the disease is still diagnosed in advanced stages. Objective: To describe the epidemiological profile of women with breast cancer, in Pernambuco, from 2009 to 2014. Method: A descriptive cross-sectional study was carried out based on the quantitative data from the public domain of the Ministry of Health, referring to the incidence of breast cancer from July 2009 to February 2014. Only Cases of malignant neoplasm in women, considering the following variables: race, schooling, age group and histopathological grade. Results and discussion: During the period considered for data collection, there were 2,281 cases of breast cancer in the Pernambuco Region, with an increasing trend over the years. Regarding the age group, the majority of women (17%) were older than 70 years at the time of diagnosis of malignant lesions, followed by women between 50 and 54 years (14%). Regarding education, 87% is ignored, followed by incomplete elementary education (6%). Brown women (26%) represent the largest part of the contingent diagnosed. Regarding the histological grade, 67% was invaluable, while grades II and III represent 31%. Conclusion: It is evident the need for continuity in investments in the development of comprehensive actions for the control of cancer, in the different levels of performance, as well as the continuity of feeding of the Information Systems, since it is knowing its epidemiological profile through the years that the actions May be better elaborated.

Localized gingival enlargements. A clinicopathological study of 1187 cases.

BackgroundTo describe the incidence, demographic and clinical features of 1187 localized gingival enlargements.Material and Methods1187 cases of localized gingival enlargements diagnosed during a 20-year period were retrospectively collected. The patients’ gender and age, as well as the main clinical features of the tumors were retrieved from the biopsy report forms.ResultsThe 1187 localized gingival enlargements represented 6.23% of 19.044 biopsies performed during the study period. 756 females and 427 males were affected with a mean age of 41.92±19.68 years. The lesions appeared as smooth (52.4%), granular (17.9%) or rough (13.16%) tumors, elastic (50.73%) or soft (29.56%) in consistency and red (60.8%), normal (28.58%) or white (8.17%) in color. The majority of the lesions (85.17%) were reactive in origin with pyogenic granuloma being the most common. In 1.1% of the cases a diagnosis of malignant lesion was rendered.ConclusionsAll localized gingival enlargements should be submitted for microscopic examination because in approximately 1% of cases they are malignant. Key words:Localized gingival enlargements, gingival mass, gingival lesions, gingival reactive lesions, gingival malignant lesions.

Diagnostic Panel of Markers CD45, CD20, CD3, CD138, and CD56 for Oral Solitary Plasmacytoma of Bone

ABSTRACT Aim The present case aims to emphasize on the role of immunophenotyping in plasmacytic malignancies. Introduction Solitary plasmacytoma of bone (SPB) is a rare entity often encountered in vertebrae and less frequently in long bones. Its presence in jaws is extremely rare, accounting for 4.4% of cases only. About 5% of patients with plasma cell dyscrasias present with SPB. Case report An elderly male patient reported with a chief complaint of growth in the anterior region of the lower jaw since 3 months. The histopathological features following an incisional biopsy were suggestive of pyogenic granuloma. Serological investigations revealed seropositivity for human immunodeficiency virus (HIV)-1 antibody with hypergammaglobulinemia and hypoalbuminemia. Histopathology of excisional biopsied tissue revealed a round cell malignancy with plasmacytic morphology. Further, to arrive at a specific final diagnosis, immunohistochemistry (IHC) was employed with a panel of markers CD45, CD20, CD3, CD138, and CD56. This panel enabled us to establish a final diagnosis of SPB with clinicopathologic correlation. Conclusion The present case posed a diagnostic dilemma as it presented with overlapping features of non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), extramedullary plasmacytoma (EMP), and plasmablastic lymphoma (PBL). A thorough clinical, radiological, serological, and IHC panel helped to diagnose the present case. The CD56 enabled differentiation between SPB and PBL. Thereby, this article emphasizes on the need for a panel of IHC markers that permit definitive diagnosis of lymphopoietic malignancies. Clinical significance Timely diagnosis of malignant lesions is an essential concern for effective management. Thus, we emphasize that the IHC is a valuable investigative tool in the diagnosis of round cell tumors with plasmacytoid morphology. How to cite this article Abraham M, Augustine D, Sagar P, Rao RS, Prasad K, Sowmya SV, Haragannavar VC, Nambiar S. Diagnostic Panel of Markers CD45, CD20, CD3, CD138, and CD56 for Oral Solitary Plasmacytoma of Bone. World J Dent 2018;9(1):53-58.

Hepatoid Adenocarcinoma of the Rectum With Liver Metastasis in Patient With Ulcerative Colitis

Hepatoid adenocarcinoma (HA) is a rare malignant tumor of extrahepatic origin that morphologically and immunophenotypically resembles hepatocellular carcinoma. We report a case of a 38-year-old Caucasian male with 13 year history of ulcerative colitis who initially presented to an outside facility with three months of diarrhea, mild abdominal pain, and ten-pound weight loss. Outpatient colonoscopy revealed severely ulcerated rectosigmoid mucosa with necrotic features and he was transferred to our facility for further workup of presumed ischemic colitis. CT abdomen showed a large, 8.1 x 9.4 x 6.6 cm hepatic mass with portal vein thrombus and rectosigmoid thickening. Liver protocol MRI did not demonstrate characteristic contrast washout seen in hepatocellular carcinoma (HCC). Alpha-feto protein (AFP; 15,523 ng/mL) and carcinoembryonic antigen (CEA; 20.3 ng/mL) were elevated. The patient subsequently underwent triple phase CT which was also not consistent with HCC. Scrotal ultrasound to rule out a primary testicular malignancy was negative; however, human chorionic gonadotropin (beta hCG) was elevated, increasing the concern for extragonadal yolk sac tumor. The patient underwent liver biopsy and repeat colonoscopy with rectal biopsies. Histologic morphology and immunophenotype from both specimens were consistent with hepatoid adenocarcinoma. Given these findings a diagnosis of hepatoid adenocarcinoma of the rectum with hepatic metastasis was made. The patient was subsequently started on palliative FOLFOX chemotherapy. Hepatoid adenocarcinoma is a rare malignant tumor of extrahepatic origin whose features mimic those of hepatocellular carcinoma. Most cases have been reported as arising in the stomach, though HA has also been described in the small and large intestines, lung, ovary, uterus, bladder, pancreas, and gallbladder. HA is often metastatic at time of diagnosis and carries a poor prognosis. Most cases of HA arising in the intestines have been described in patients with inflammatory bowel disease, who are known to be at increased risk of developing adenocarcinoma of the GI tract. Hepatoid adenocarcinoma should be considered in the differential diagnosis of malignant lesions in the IBD patient.Figure: A. A liver core biopsy low power image depicting diffuse infiltration of the tissue by carcinoma. B &C. High power images reveal a mixed hepatocellular/trabecular and glandular architecture composed of cytologically atypical eosinophilic cells vaguely resembling atypical hepatocytes. Immunohistochemistry (not shown) exhibits positive staining for pankeratin, cdx-2, polyclonal CEA, monoclonal CEA, alpha-fetoprotein, glypican-3, SALL-4, and focal positivity for CK20, and is negative for CK7, HepPar-1, Vimentin, CD31, and CD34.