Exophytic Growth Research Articles

Verrucous carcinoma of the vulva: About a case report

Introduction: Verrucous carcinoma of the vulva is a rare lesion, mainly affecting postmenopausal women, this lesion is a distinct and particular entity in the classification of vulvar carcinomas and its progression is uncertain and unpredictable. It is characterized by its extensive exophytic growth without infiltration of the basement membrane. Case Report: We report a case of verrucous carcinoma of the vulva collected at the Mohamed VI cancer treatment center in Casablanca, we will discuss through a literature review, its therapeutic and evolutionary diagnostic modalities. Conclusion: Therefore, verrucous carcinoma is a rare entity and its evolution is mainly local, rarely metastatic. It is the indication for exclusive surgical treatment with wide excision without lymphadenectomy in principle. Radiation therapy provides no survival benefit. The prognosis is relatively good but burdened by local recurrences.

Risk factors for conversion from endoscopic resection to laparoscopic resection for gastric gastrointestinal stromal tumors

Endoscopic resection (ER) of gastric gastrointestinal stromal tumors (gGISTs) is a commonly used treatment; however, it is associated with a risk of conversion to laparoscopic resection (LR). This study was performed to identify factors influencing conversion from ER to LR and the effects of conversion on outcomes. The clinicopathological features of patients treated for gGISTs from March 2010 to May 2021 were retrospectively collected. Endpoints included the determination of risk factors associated with LR conversion, with comparisons of surgical outcomes with and without conversion. Propensity score matching was performed to compare the two groups. In total, 371 gGISTs were analyzed. Sixteen patients required conversion from ER to LR. Propensity score matching demonstrated that invasion depth (muscularis propria with exophytic growth) and gGIST size (≥3 cm) were independent risk factors for conversion to LR. The procedure duration (median, 160.5 vs. 60.0 minutes), postoperative hospitalization duration (median, 8 vs. 6 days), and postoperative fasting duration (median, 5 vs. 3 days) were significantly longer in patients who underwent conversion to LR. Accurate preoperative measurements of tumor size and invasion depth may help determine more appropriate surgical approaches for patients with gGISTs.

Characterization of renal artery variation in patients with clear cell renal cell carcinoma and the predictive value of accessory renal artery in pathological grading of renal cell carcinoma: a retrospective and observational study

ObjectiveTo explore the characteristics of renal artery variation in patients with renal cell carcinoma and to evaluate the predicting value of accessory renal artery in the pathological grading of renal cell carcinoma.MethodsThe clinicopathological data of patients with clear cell renal cell carcinoma diagnosed in the Department of Urology of the First Hospital of Shanxi Medical University from September 2019 to March 2023 were retrospectively analyzed. All patients underwent visual three-dimensional model reconstruction from computed tomography images. All kidneys were divided into two groups: the affected kidney and the healthy kidney, and the incidence of renal artery variation in the two groups was analyzed. Then, according to the existence of accessory renal artery in the affected kidney, the patients were divided into two groups, and the relationship between accessory renal artery and clinicopathological features of patients with clear cell renal cell carcinoma was analyzed. Finally, univariate and multivariate logistic regression analyses were performed to determine the predictors of Fuhrman grading of clear cell renal cell carcinoma, and the predictive ability of the model was evaluated by the receiver operating characteristic curve.ResultsThe incidence of renal artery variation and accessory renal artery in the affected kidney was significantly higher than them in the healthy kidney. The patients with accessory renal artery in the affected kidney had larger tumor maximum diameter, higher Fuhrman grade and more exophytic growth. The presence of accessory renal artery on the affected kidney and the maximum diameter of tumor are independent predictors of high-grade renal cell carcinoma. The receiver operating characteristic curve suggests that the model has a good predictive ability.ConclusionThe existence of accessory renal artery on the affected kidney may be related to the occurrence and development of clear cell renal cell carcinoma, and can better predict Fuhrman grade of clear cell renal cell carcinoma. The finding provides a reference for the future diagnostic evaluation of RCC, and provides a new direction for the study of the pathogenesis of RCC.

Inflammatory myofibroblastic tumor of the bladder: Computed tomographic features.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor with intermediate biologic potential, in which lack of understanding often poses difficulties in preoperative diagnosis and treatment. The aim of the present study was to characterize the computed tomography (CT) features of the bladder IMT. The CT images of nine pathologically confirmed bladder IMT were retrospectively reviewed. All patients underwent both unenhanced CT and contrast-enhanced CT. The diameter, location, contour, growth pattern, margin, boundary, density and enhancement pattern of the lesions were assessed. The mean Ki67 value of an irregular blood clot was 18% and that of no blood clot was 12%. A total of eight (89%) patients had one tumor and 1 (11%) patient had multiple tumors. An endophytic growth pattern was observed in 4 (44%) patients, an exophytic growth pattern in 2 (22%) patients, and a mixed growth pattern in 3 (33%) patients. The tumor manifests morphologically as either polypoid (n=5), or cauliflower-like (n=1) soft-tissue mass with a wide base in the cavity, or a limited thick-walled (n=3). The tumor margins were smooth (n=8) or lobulated (n=1), and the tumor boundaries were either clear (n=7) or ill-defined (n=2). The lesions showed either ring-shaped (n=3) or heterogeneous (n=6). The polypoid and cauliflower-like soft-tissue mass showed a symmetrical change in the center of the lesion after enhancement. The bladder IMT is mostly a single polypoid nodule in the superior wall, mostly endophytic growth, with ring-haped enhancement and symmetrical change after enhancement as its characteristic manifestations.

A case of hepatic intraductal papillary neoplasm of the bile duct

Introduction: Intraductal Papillary Neoplasm of the Bile ducts (IPNB) is a rare entity characterized by exophytic growth of the bile ducts. Case presentation: In this report, we present a 57-year-old male with no prior medical history consulted for upper right abdominal pain, jaundice and pruritus. Abdominal Ultrasound (US) and magnetic resonance imaging/Bili-magnetic resonance were performed. They revealed that the circumferential parietal thickening of the common hepatic duct had extended approximately 4 cm with moderate dilatation of the left intrahepatic bile ducts. Computed tomography showed no evidence of distant metastasis. Biopsy revealed a high-grade intraductal papillary neoplasm. After 40 days, the patient had left hepatectomy with resection of the main bile duct and the gallbladder. Macroscopic examination of the surgical specimen showed a dilatation duct at the hilum with thickening of their walls. The histopathology report revealed multiple intra-hepatic papillary neoplasms with high-grade dysplasia with an invasive carcinoma component in the left hepatic duct without extending to the biliary wall, classified as pT1N0. Conclusion: This premalignant lesion has the potential to transform into invasive carcinoma if not properly diagnosed. Our case illustrates how early identification can lead to potential surgical resection.

Giant schwannoma masquerading as other soft tissue tumors: A series of three cases

Schwannoma is a benign peripheral nerve sheath tumor. It commonly occurs in head and neck region, upper extremities and dorsolumbar spine. The giant schwannoma as such is a rare occurring tumor. We present a series of three cases of giant schwannoma in unusual locations, masquerading as other soft tissue tumors.: Case 1: A 40-year-old male presented with a large exophytic ulcerated growth on his left thigh. The lesion was deep dermal in location. It was well circumscribed, partially encapsulated with extensive areas of hemorrhage and cystic change. Histopathology and immunohistochemistry (IHC) revealed the diagnosis of Benign Schwannoma with ancient changes. A 30-year-old woman presented with mid back ache and a mass in paravertebral location at T8 to T10 levels from last 2 years. The lesion was dermal in location. It was well circumscribed, partially encapsulated with extensive areas of hemorrhage and cystic change. Histopathology and IHC confirmed the diagnosis of Schwannoma with ancient changes. A 24-year-old male, presented with a 6x6 cm lesion over the scalp. It was well circumscribed, partially encapsulated with solid and cystic areas. Histologically, it turned out to be a Schwannoma. Giant schwannoma is a rare tumor which occasionally presents at unusual locations and poses a diagnostic challenge to both, the operating surgeon and the pathologist. These lesions clinically may mimic dermatofibroma, dermatofibrosarcoma and even trichilemmal tumors. These cases are being presented for their unusual presentation.

Clinicopathological Study of Supraglottic Laryngeal Malignancies

Background: Laryngeal malignancy is the second most common malignancy in head neck region worldwide. Incidence of supraglottic carcinoma is more common in this country which interferes with most vital functions in the sufferers like voice, respiration and swallowing by virtue of its anatomical location, local infiltration and direct extension.
 Objectives: To find out the clinicopathological profile of supraglottic laryngeal malignancies of the patients attending in a tertiary level Hospital.
 Methods: A cross sectional study was conducted among seventy eight cases of supraglottic carcinoma who were histopathologically proven selected from the in-patient department of ENT and Head -Neck Surgery Dhaka Medical College Hospital, Dhaka during January 2020 to July 2021.
 Results: Among 78 cases in this study, male: female ratio 10.1:1 and mean age was 52.1 (± 4.6) years with the range from 40 to 78 years. Majority of the patients came from low socioeconomic condition (79.5%). Regarding habit 93.6% of cases were smoker and 59% are habituated in chewing betel nut and leaves, 3.8% were with chewing tobacco and alcohol 2.6%. Most of patients presented with more than one symptom and the commonest was change of voice (87.2%), which followed by dysphagia (78.2%), neck swelling (55.1%), irritable cough (32%) and dyspnoea (20.5%). A big portion of the patients (39.7%) had T2 lesion followed by T3 lesion (38.5%), T1 lesion (11.5%) and T4 lesion (10.3%) clinically. Clinical nodal involvement presented in 55.1% cases and there was no distance metastasis. 56 (71.8%) patients had exophytic growth and 22 (28.2%) patients had ulcerative growth. A large portion of the patients (65.4%) had growth in Aryepiglottic fold followed by False Cord (34.6%), arytenoid (29.5%) and Epiglottis (25.6%). On histopathological evaluation, Squamous cell carcinoma (SCC) was present in 85.8% cases, well differentiated (14.1%), moderately differentiated (53.8%), and poorly differentiated (17.9%). While Adenocarcinoma found in 7.7% cases and Non-Hodgkin Lymphoma present in 6.4% cases.
 Conclusion: Supraglottic carcinoma usually occurs in 5th decade with male predominancy in poor socio economic group. Smoking, chewing (tobacco and betel nut) habits and alcohol consumption have got strong relation in the causation of supraglottic carcinoma.More than half of the cases has nodal metastasis and predominant histological type was squamous cell carcinoma. 
 Bangladesh J Otorhinolaryngol 2022; 28(2): 141-148

Pleomorphic Dermal Sarcoma on Burn Scar: A Case Report

Pleomorphic dermal sarcoma (PDS), a cutaneous form of undifferentiated pleomorphic sarcoma, is a rare, aggressive sarcoma that is known to develop on locations exposed to ultraviolet light. Here, we describe a unique case of PDS that developed on a burn scar with little ultraviolet light exposure. Most neoplasms from burn scars have an ectodermal origin, but our case was distinctive in that the neoplasm originated from the mesoderm. The 52-year-old patient, who had sustained a burn injury 40 years earlier, had suffered a small abrasion on his burn scar 3 months prior; the scar underwent rapid exophytic growth after repeated insult. After wide excision of the tumor with a clear resection margin and reconstruction with a skin graft, neither recurrence nor distant metastasis was reported. To our knowledge, this is the first case of diagnosis and successful management of a PDS originating from a burn scar. We discuss the diagnosis and management of this rare type of sarcoma, as well as its probable pathophysiologic mechanism related to burn scars. This case highlights the need for clinicians to promptly investigate patients with chronic wounds on their burn scars and to include PDS as one of the differential diagnoses.

Computed tomographic findings may be useful for differentiating small intestinal adenocarcinomas, lymphomas, and spindle cell sarcomas in dogs.

An improved understanding of the CT characteristics for histologically confirmed primary intestinal tumors would be helpful for guiding prognosis and treatment plans in affected dogs. This retrospective, multi-center, analytical study aimed to evaluate the CT characteristics for the differentiation of adenocarcinoma, lymphoma, and spindle cell sarcoma (SCS) in dogs. Thirty-seven dogs who underwent contrast CT and histopathological examinations were included (adenocarcinomas, n=11; lymphomas, n=12; SCS, n=14). Quantitative and qualitative CT parameters, including tumor morphology, contrast enhancement pattern, Hounsfield unit (HU) value, and presence or absence of intraabdominal lymphadenopathy, were evaluated for each included small intestine tumor CT case. Adenocarcinomas tended to show endophytic growth, intestinal obstruction, and a heterogeneous enhancement pattern. Lymphomas tended to show exophytic growth, contrast enhancement of the intestinal tumor mucosal layer, a homogeneous enhancement pattern, and the presence of lymphadenopathies in the abdominal cavity. SCSs tended to show lobulated growth, a large cystic portion within the tumor, a heterogeneous enhancement pattern, a large size with fat stranding sign, and lower HU values in postcontrast images. Cut-off values of the minimum diameter/fifth lumbar vertebral mid-body height (≥5.80; area under the curve [AUC]=0.97, P<0.001) and minimum HU value/HU value of the aorta (≤0.26; AUC=0.96, P<0.001) were derived to discriminate SCS from the two other tumor types. In conclusion, contrast CT characteristics may be useful in differentiating small intestinal adenocarcinomas, lymphomas, and SCSs in dogs.

Multifocal Gingival Squamous Cell Papilloma: A Case Report and Literature Review

Squamous Cell Papilloma (SCP) is a benign, asymptomatic, exophytic cauliflower-like growth of mucosal mass. It is mostly associated with Human Papilloma Virus (HPV) subtypes 6 and 11, and has a very low virulence and infectivity rate. The papillomas are commonly known as warts or verrucas when found on the skin. The typical lesion is a single mass with finger-like extensions, resembling a soft, pedunculated growth supported by a stem or stalk. If keratin, a skin protein, accumulates around the lesion, the projections can be long and pointed or short and rounded. Intraorally, the most common sites of occurrence are the tongue, lips, buccal mucosa, palate, and uvula. Hereby, the author present a case report of 25-year-old male patient with a 4x9 mm exophytic growth exhibiting a pebbled surface in the upper left first premolar region, with no signs of radiographic bone loss. Additionally, smaller pinpoint lesions were observed bilaterally in the interdental region of the first and second maxillary molars. A nevus on the right side of the face was also noted. Histological analysis confirmed the diagnosis of SCP. The presence of multifocal gingival squamous papilloma, along with an extraoral nevus, represents a novel finding that warrants reporting. The gingival lesion in the maxillary left first premolar region was surgically excised, along with 1 mm of healthy surrounding gingiva. This resulted in complete healing, and no recurrence was observed during the 12-month follow-up period.

Expansile mandibular radiolucency in a young adult female

A 20-year-old female patient was referred to the department of oral and maxillofacial surgery at King Saud University for evaluation of a painless, expansile mass in the left mandible of 3 months duration. The patient's past medical history was unremarkable. Head and neck examination revealed left facial asymmetry with no paresthesia. Intraoral examination revealed the presence of an ulcerated exophytic nodular growth in the left premolar-molar region. The mass was red in color, firm in consistency, and bled minimally when touched.

Translated article] Poroma: A Retrospective Series of 80 Patients at a Tertiary Care Hospital

BackgroundPoroma is a benign, exclusively cutaneous, adnexal tumor with a predilection for palmoplantar skin. ObjectiveTo analyze the clinical characteristics of poroma in our population. Material and methodsRetrospective study of patients diagnosed with poroma between 2002 and 2021. We conducted a chart review to record age; sex; number, location, and diameter of lesions; time since onset; clinical characteristics; suspected clinical diagnosis; resection margin status; recurrences; and follow-up duration. Categorical variables were compared using the Fisher exact test. Continuous variables were compared using the t test or the Mann–Whitney U test depending on whether they were normally or nonnormally distributed. ResultsWe studied 80 patients (31 women and 49 men) with a median (interquartile range [IQR]) age of 65.5 (29) years. Median time since onset of poroma was 12 (21) months. Median lesion diameter was 8 (7)mm, and none of the patients had multiple lesions. The lesions were located on the head and neck in 13 cases, the trunk in 13, the upper extremities in 11, and the lower extremities in 43. Twenty-three lesions (28.8%) were located at acral sites (5 on the palms and 18 on the soles). Women were more likely to have scalp lesions (P=.041). Acral lesions were more likely to be erythematous (P=.014). Five patients experienced local recurrence. ConclusionsAlthough poromas are particularly common in acral locations (especially the feet), most of the lesions in our series (71.3%) were located elsewhere. Acral lesions were more likely to show the classic clinical features of erythema and exophytic growth.

Analysing 11 years of incidence trends, clinicopathological characteristics, and forecasts of colorectal cancer in young and old patients: a retrospective cross-sectional study in an Indonesian national referral hospital

ObjectiveTo obtain annual incidence trends, understand clinicopathological characteristics, and forecast the future burden of colorectal cancer (CRC) in Indonesia.Design11-year retrospective cross-sectional study.SettingA national referral hospital in Jakarta, Indonesia.ParticipantsData from 1584...

Management of A Case of Fibro-epithelial Hyperplasia of Gingiva

ABSTRACT:&#x0D; Fibroepithelial hyperplasia/fibroma is an exophytic growth which occurs due to any reactive or chronic inflammatory condition of the gingiva by plaque, calculus, overhanging margins, trauma and dental appliances. These can cause discomfort to the patient and often causes difficulty in oral hygiene maintenance. This case report presents a case of a fibro-epithelial hyperplasia in a 37 years old female, who presented with a localized diffuse type of gingival enlargement in the left maxillary posterior teeth region. Based on clinical and histopathological evaluation the diagnosis of fibro-epithelial hyperplasia was made. The patient was then kept on regular follow-up and no recurrence of the lesion could be appreciated till date.

An exophytic growth over the alveolar ridge

CLINICAL PRESENTATION

ORAL SQUAMOUS CELL CARCINOMA, VARIANT CUNICULATUM: A CASE REPORT

Oral carcinoma cuniculatum is a rare low-grade variant of squamous cells carcinoma, with distinct clinicopathologic outcomes. In the present case, a 63-year-old Black male patient presented with an exophytic mass in the posterior mandible gingiva for 6 months. The lesion appeared after removal of a third molar. Oral examination revealed firm exophytic verruciform growth. Radiographic exam showed irregular radiolucent lesion in the mandible, evidencing bone invasion. A biopsy was carried out with the diagnostic hypothesis of verrucous carcinoma. The initial histopathologic report was inconclusive of a mucosal fragment with papillomatosis and moderate dysplasia. A second and large incisional biopsy was conducted. Microscopically the lesion revealed atypical proliferation of keratinocytes forming multiple, complex, branching keratin-filled crypts, with a burrowing pattern. Mild cytological atypia, few mitotic figures, hyperchromatism, and low cell cohesiveness were also noted. With a final diagnosis of squamous cells carcinoma, subtype cuniculatum, the patient was referred for treatment.

Adenoma malignum of cervix – A case report

Adenoma malignum also called minimal deviation adenocarcinoma or minimal deviation carcinoma, is a rare disease. It is tricky to diagnose this condition because of its benign look. It forms a subtype of mucinous endocervical adenocarcinoma. Also, these lesions have an endophytic growth and are located deep in the cervix rather than an exophytic growth like any other adenocarcinoma of the cervix. Radiologically and clinically can resemble a benign, less harmful disease. However, it sometimes mimics multiple Nabothian cysts because of its benign look. In most cases, it had been an incidental finding when being evaluated for any other causes where hysterectomy was done. It usually presents between the age of 25-70 years and peaks at a median age of 42 years. Thus, this case report is an eye opener to keep Adenoma malignum is a close differential for watery discharge per vaginum. Although it is a rare tumour, it has an aggressive nature.

Poroma. Estudio retrospectivo de 80 pacientes en un hospital terciario

BackgroundPoroma is a benign, exclusively cutaneous, adnexal tumor with a predilection for palmoplantar skin. ObjectiveTo analyze the clinical characteristics of poroma in our population. Material and methodsRetrospective study of patients diagnosed with poroma between 2002 and 2021. We conducted a chart review to record age; sex; number, location, and diameter of lesions; time since onset; clinical characteristics; suspected clinical diagnosis; resection margin status; recurrences; and follow-up duration. Categorical variables were compared using the Fisher exact test. Continuous variables were compared using the t test or the Mann-Whitney U test depending on whether they were normally or nonnormally distributed. ResultsWe studied 80 patients (31 women and 49 men) with a median (interquartile range [IQR]) age of 65.5 (29) years. Median time since onset of poroma was 12 (21) months. Median lesion diameter was 8(7)mm, and none of the patients had multiple lesions. The lesions were located on the head and neck in 13 cases, the trunk in 13, the upper extremities in 11, and the lower extremities in 43. Twenty-three lesions (28.8%) were located at acral sites (5 on the palms and 18 on the soles). Women were more likely to have scalp lesions (P=.041). Acral lesions were more likely to be erythematous (P=.014). Five patients experienced local recurrence. ConclusionsAlthough poromas are particularly common in acral locations (especially the feet), most of the lesions in our series (71.3%) were located elsewhere. Acral lesions were more likely to show the classic clinical features of erythema and exophytic growth.

Peripheral odontogenic fibroma an uncommonly overviewed benign neoplasm: A case report and review of literature

Peripheral odontogenic tumors (POTs) are one of the rare neoplasms to occur on the gingiva. Peripheral odontogenic fibroma (POdF) is the most common POT constituting a prevalence of 1.2%. A plethora of lesions sharing similar clinical features makes the diagnosis difficult. Histopathological examination plays a key role in these types of cases. Here, we present a rare case of POdF in a 36-year-old female patient with a lobulated pebbled-like exophytic growth on the right gingiva. Histopathological investigation showed the presence of odontogenic epithelium and dystrophic calcification which are the pathognomonic features of POdF. After surgical removal, POdF is seen to recur, but the exact recurrence rate cannot be estimated due to the scarcity of reported cases. In this case, follow-up of the patient showed no recurrence at 6, 12, and 18 months post-surgery.

SYRINGOCYSTADENOMA PAPILLIFERUM OF SCALP – A CASE REPORT OF A RARE CUTANEOUS ADNEXAL NEOPLASM

Syringocystadenoma papilliferum is a rare benign hamartomatous tumor arising from apocrine or eccrine sweat glands with a predilection for head and neck. Here we report a case of a 30 year old female who presented to our opd with a nodule over scalp since birth which turned into a hairless , exophytic pinkish growth with blood tinged discharge slowly over the last 2 years . A punch biopsy of the lesion revealed syringocystadenoma papilliferum. Excision of the lesion is performed and specimen is sent for (hpe) histopathological examination which revealed syringocystadenoma papilliferum with no malignant transformation. Post operative recovery was uneventful and the patient was followed up till 6 months with no history of recurrence.