Differential Diagnosis Of Benign Tumors Research Articles

The diagnostic value of Superb Microvascular Imaging in identifying benign tumors of parotid gland

BackgroundWe compared the ultrasound features, superb microvascular imaging (SMI) and micro vessel density (MVD) of pleomorphic adenoma (PA), Warthin’s tumor (WT) and basal cell adenoma (BCA) to explore the clinic value of SMI in differential diagnosis of benign tumors of parotid gland.MethodsThe vascular distributions and grade by color doppler flow imaging (CDFI) and SMI, as well as vascular index (VI) of 249 parotid gland masses from 217 patients were analyzed.ResultsThe internal echogenicity of BCA are more homogeneous in comparing with WT and PA(P < 0.05). By SMI, the vascular distribution and vascular grade in PA were mainly peripheral (33.1%) and avascular (25.7%), Grade 1 (27.8%) and Grade 0 (25.7%). WT were mainly central (31.3%) and mixed distribution (34.9%), in Grade 3 (37.3%) and Grade 2 (36.2%). BCA was mainly peripheral (33.3%) and mixed distribution (33.3%), in Grade 2 (33.3%) and Grade 3 (33.3%). The overall detection rate of SMI for vascular Grade 2 and 3 was significantly higher than that of CDFI (P < 0.05). Both VI and MVD were lowest in PA, highest in WT (P < 0.001). The VI by SMI was correlated with MVD (P < 0.001). The correlation index between vascular distribution and grade by SMI and MVD were significantly higher than CDFI.ConclusionSMI can provide low-velocity blood flow information, which is helpful for the differential diagnosis of common benign tumors of parotid gland, and is expected to be more widely used.

Comparison of the Validity of Quantitative and Qualitative Methods of RASSF1A Gene Hypermethylation Molecular Test in the Diagnosis of Thyroid Malignancies.

Within the past two decades, the incidence of thyroid cancer has increased across the globe. In the differential diagnosis of benign tumors from malignant tumors in the thyroid gland, hypermethylation of the RASSF1A gene is used. The aim of this study is comparing the validity of quantitative and qualitative methods of the RASSF1A gene hypermethylation molecular test in the diagnosis of thyroid malignancies. One hundred sixty samples from patients with malignant thyroid tumors (80 samples) and benign thyroid tumors (80 samples) were entered into this study from all patients referred to Ahvaz Medical Centers. First DNA was extracted from samples embedded in paraffin. After DNA extraction, hypermethylation of the gene was done by COBRA method. Finally, to calculate the effects of sensitivity, specificity, predictive value and accuracy of the test, epidemiological calculations were done. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the qualita-tive method of the RASSF1A gene hypermethylation molecular test in the diagnosis of thyroid malignancies are: 91.25%, 15%, 51.77%, 63.15%, and 53.12%, respectively and for the qualitative method are: 27.5%, 98.75%, 95.65%, 57.66%, and 6.12%, respectively. The quantitative level of hypermethylation differentiated groups of benign tumors from malignant groups better than the qualitative evaluation but the qualitative studies are not applicable for this purpose.

Differential Diagnosis of Benign Tumors of Bone Rich in Giant Cells, Based on Immunohistochemistry

Abstract Introduction. The aim of this study was to investigate several cases of giant cell tumor of bone (TCG), chondroblastoma and aneurysmal bone cyst (ABC) by immunohistochemistry (IHC) with a panel of markers: p63, S-100, CD68, CD56, DOG1, Galectin-1, D2-40, CD34, CD45 and ki-67, some of which proved to be specific for a certain entity. Material and methods. The cases were retrospectively selected from cases processed in our facility where the surgical excision material was histopathologically analyzed in optical microscopy using the usual staining hematoxylin and eosin. The immunohistochemistry exam was performed at INCDVB by indirect method avidin-biotin-peroxidase complex (C-DAB) with polyclonal antibodies (Dako) for S100; CD56, p63, DOG1, CD34, D2-40, CD45, ki67, and Galectin1 were performed in 14 cases out of which 10 were TGC, 3 chondroblastomas, and one primary ABC. Results. Five out of ten TGC investigated showed p63 diff use nuclear expression in the mononuclear cell. None of the 3 cases of chondroblastoma or ABC-primary or secondary (associated with the above mentioned tumors), expressed p63. Other variables, non-specifically encountered in all of the tumors, were emphasized by CD34 (vascular network), ki-67 (index of proliferation), CD45 (inflammatory infi ltrate). DOG1 expression was found positive in all chondroblastoma cases. Conclusions. p63 proved to be a useful biomarker in differentiating giant cell tumor of bone from central giant cell granuloma and other giant cell-rich tumors, especially chondroblastoma and ABC. Chondroblastoma was particularly rewarding in this investigation by demonstrating the dual immunohistochemical phenotype of the neoplastic cells, both chondroblastic (S-100, D2-40) and osteoblastic (CD56 and Galectin -1). DOG1, which is mainly used for the diagnostic of GIST, was found by many to be also specific, in the proper morphopathological context, for chondroblastoma.

A rare case of plantar lipoma

Plantar tumors of soft tissue are rare and are characterized by their slow evolution which delays the patient consultation period Lipomas are among the most common benign tumors which often serve in regions rich in fats often in the face of the hands and feet We report an exceptional case of plantar lipoma Surgical treatment has laid the histological diagnosis of certainty and restores a normal and painless plantar support Lipoma despite its exceptional location at the foot level should be mentioned as differential diagnosis of benign tumors of the foot

Leiomyoma of the sinonasal cavity: CT and MRI findings

Aim To determine the computed tomography (CT) and magnetic resonance imaging (MRI) features of leiomyoma of the sinonasal cavity. Materials and methods Six patients with histology-proven leiomyomas in the sinonasal cavity were retrospectively reviewed. All six patients underwent CT and three patients also underwent MRI. The following imaging features were reviewed: size, margin, CT attenuation, MRI signal intensity, and lesion extent. In addition, the time–intensity curve (TIC) of dynamic contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI) were analysed in two patients. Results All leiomyomas had well-defined margins. The mean size was 36 mm (range 20–51 mm). On unenhanced CT, the lesions appeared isodense to cerebral grey matter in four (67%) and slightly hypodense in two (33%) patients. Leiomyomas appeared isointense On T1-weighted imaging (WI) and slightly hyperintense on T2WI in three patients. The lesions showed moderate contrast enhancement. Two patients underwent DCE MRI, and the TIC showed a rapidly enhancing and slow washout pattern. The mean apparent diffusion coefficient (ADC) value were 1.66 × 10 −3 mm 2/s and 1.78 × 10 −3 mm 2/s for the two lesions, respectively. Conclusions Well-defined, homogeneous, expansile masses without bony erosion are typical features of leiomyoma. Althrough rare, this entity should be included in the differential diagnosis of benign tumours in this region.

Comparative evaluation of plasma levels and diagnostic values of macrophage‑colony stimulating factor in patients with breast cancer and benign tumors

Macrophage-colony stimulating factor (M-CSF) is one of the glycoproteins called hematopoetic growth factors. The direct production of this cytokine has been reported in tumor cell lines in vitro and in solid tumors in vivo. In the present study, the levels of M-CSF in patients with breast cancer and in those with a benign breast tumor were evaluated. Moreover, diagnostic values were determined through assessing diagnostic sensitivity and specificity as well as predictive value of positive (PV(+xe)) and negative (PV(-ve)) results. The results obtained were compared to the CA 15-3 and a control group. The study group was made up of 70 patients with breast cancer and 20 patients with benign tumors and the control group of 30 healthy women. M-CSF was assayed using an ELISA method. CA 15-3 was measured by means of an immunoenzymatic method (MEIA) from ABBOT. Statistically higher levels of M-CSF and CA 15-3 were found in breast cancer patients as compared to the benign tumor and control groups. These levels were also significantly higher in patients with more advanced stages of cancer. A positive correlation between M-CSF and CA 15-3 levels was observed. The diagnostic sensitivity of M-CSF (58%), a specificity (93%), PV(+ve) (94%) and PV(-ve) (43%) were higher or equal to the values obtained for CA 15-3 (49%, 93%, 93% and 40%, respectively). When both parameters studied were determined jointly, sensitivity increased to 72%. The above data suggests that M-CSF might be useful in both diagnostics and differential diagnosis of benign tumors and breast cancer (except for the lowest degree of the clinical progression).

Juvenile xanthogranuloma presenting rapid progression after curettage: a case report with clinicopathological findings

Juvenile xanthogranuloma is a relatively uncommon benign cutaneous fibrohistiocytic lesion that shows spontaneous regression. We report a case of juvenile xanthogranuloma, which formed a relatively large nodule and rapidly progressed after curettage. A 9-month-old girl had a mass in the skin over the lumbar region of her back that extended to the fascia. The lesion was histologically diagnosed as juvenile xanthogranuloma after total resection of the mass. Although preoperative diagnosis is quite difficult, plastic surgeons should be familiar with this entity. Juvenile xanthogranuloma should be considered in the differential diagnosis of benign tumours and tumour-like lesions in infants. The clinical presentation and histological findings are discussed.

Selected Papers: Neuroimaging

Abstract *Taketoshi Maehara, *Tadashi Nariai, †Nobutaka Arai, ‡Kensuke Kawai, ‡Hiroyuki Shimizu, §Kenji Ishii, §Kiich Ishiwata, and *Kikuo Ohno *Neurosurgery, Department of Brain Medical Science, Tokyo Medical and Dental University; Bunkyo-ku ; †Department of Clinical Neuropathology, Tokyo Metropolitan Institute for Neuroscience, Fuchu ; ‡Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital; Fuchu ; §Tokyo Metropolitan Institute of Gerontology; Itabashi, Tokyo, Japan . Purpose: We assessed the diagnostic value of 11C-methionine (MET)-PET in the differential diagnosis of benign tumors presenting with temporal lobe epilepsy. Methods: This series consisted of seven patients who had a type of complex partial seizure (CPS) associated with temporal lobe epilepsy, and were found to have benign tumors in the temporal lobe. They included three males and four females, ranging in age from 13 to 48 years. The age at seizure onset ranged from 6 to 26 years old, and the time to operation ranged from 2 to 28 years. High-resolution magnetic resonance imaging (MRI) with a 1.5 T magnet revealed organic lesions in the temporal lobes. MET-PET was performed in all seven patients, and 18F-fluoro-2-deoxy-glucose (FDG)-PET was performed in four patients. After presurgical examinations including repeated EEGs, video-EEG monitoring, and neuropsychological testing, three patients underwent invasive monitoring for focus detection and functional mapping. All seven patients underwent tumor resection together with focus excision under intraoperative ECoG guidance. Using the image analysis software Dr. View (Asahi Kasei Joho, Tokyo, Japan) on a personal computer, the region of interests (ROIs) were placed on the tumor and contralateral brain over the MRI, and then transferred to the PET images co-registered with MRI. The uptake of tracers was evaluated by the lesion-to-contralateral ratio (L/C ratio) and the standardized uptake value (SUV), a value calculated by dividing the brain activity of tracer per volume of brain by the injected activity of tracer per body weight. Surgical specimens were examined to investigate the tumor histology and Ki-67 labeling index. Microdygenesis of the resected foci was also examined. Statistical significance of differences in MET uptake between patients with dysembryoplastic neuroepithelial tumor (DNT) and those with ganglioglioma and gliomas was analyzed using the SUV and L/C ratio by the Student's t test. Results: After surgery, six patients remained seizure-free and one achieved a rare-seizure outcome for at least 6 months. The tumor was identified as high MET uptake lesion in three cases and was not depicted on MET-PET in four patients. Among the four patients who underwent FDG-PET, two patients showed high MET uptake in the tumor. However, all four patients showed low glucose uptake in the tumor and surrounding cerebral cortex. Pathological examination demonstrated DNTs in four cases, ganglioglioma in one case, low grade astrocytoma in one case, and pleomorphic xanthoastrocytoma (PXA) in one case. One patient with DNT showed a number of ectopic neurons in the white matter, a finding compatible with microdysgenesis. Ki-67 labeling index was 4% in one patient with DNT and 5% in one patient with PXA. The labeling index of the remaining five patients was 1% or lower. While four patients with DNT did not show visually high MET uptake, ganglioglioma and gliomas of the remaining three patients were identified as high-MET-uptake-lesions. MET uptake was significantly higher in patients with gliomas than in patients with DNT (SUV: P = 0.045, L/C ratio: P = 0.0079). The Ki-67 labeling index was not related to MET uptake expressed in SVU (P = 0.91) and L/C ratio (P = 0.38). Conclusion: In the seven patients with temporal lobe epilepsy and benign tumors in this study, we observed a high MET uptake in brain gliomas but not in DNTs. This high MET uptake was not related to the proliferation capacity measured by Ki-67 labeling index. MET-PET was useful for the differential diagnosis of DNT.

Metrical differential diagnosis based on location (Part 2). Differential diagnosis among various benign tumors.

An attempt was made to quantify the location of various oral lesions using panoramic radiographs of benign tumors (20 ameloblastomas, 5 myxomas, 26 odontomas, 10 cementomas and 4 osteomas). The metrical data (integers) were obtained from a conversion table and the abscissa values (to the first decimal place) were obtained from the centroid of each of the tumors. Differential diagnosis among these lesions revealed that in the mandible, it is possible to differentiate between ameloblastomas and odontomas or osteomas. Thus, the present findings demonstrate that data on lesion location can be changed into metrical data for differential diagnosis of benign tumors.