Fast-growing Mass Research Articles

Primary reconstruction of neck defect after excision of metastatic melanoma of unknown primary site with regional pectoral myocutaneous flap

Metastatic melanoma of unknown primary (MMUP) is already a well described oncologic phenomenon in the literature, whereas tissue defects’ reconstructions on the neck region always present a challenge for the reconstructive surgeon. Two cases of giant metastatic, skin infiltrative neck tumor masses are presented. In both cases MMUP was diagnosed. Both intraoperative tissue defects were reconstructed using pectoralis major (PM) regional flap. The first patient was admitted with giant tumor mass on the right side of the neck. The fast growing mass appeared two months prior to the admission. Thorough examination showed no signs of primary tumor. Removal surgery was performed and the defect was reconstructed using the PM musculocutaneous flap. The second patient was admitted with large tumor mass on the left side of the neck. Thorough examination displayed no signs of any primary tumor. After the excision, the tumor mass and subsequent neck dissection, reconstruction followed, using the pedicled PM muscle flap and partial thickness skin transplants. There were no major complications in either case. The histopathological examinations presented metastatic melanoma diagnoses. Clinical outcome of MMUP described in literature is rather variable. Different studies have shown that prognosis in patients with MMUP is better than that in patients with diagnosed primary melanoma with metastatic disease. Therefore, the best initial course of action in those cases would be surgery, according to oncological principles, if possible. Neck defects’ reconstructions should fulfill both functional and esthetic demands. Due to the reliability and low cost of the procedure, PM regional flap presents a very good and trustworthy reconstruction modality.

Salivary Duct Carcinoma: A Rare Entity

Salivary duct carcinoma (SDC) is a rare malignancy that most commonly affects males in the fifth and sixth decades of life. Patients commonly present with a fast-growing form mass, often around the facial nerve. There are no known etiologic factors. Their most peculiar feature is morphological and immunohistochemical similarity to ductal carcinoma of the breast. Therapeutic approach is non-consensual because of the limited data but an extensive surgical resection has been advocated, along with postoperative chemoradiation in selected cases. Antiandrogen therapy may be useful in patients with advanced SDC. The rate of locoregional recurrence is high and the prognosis for survival is poor. We present the case of a 43 years-old patient with a right parotid lump of small dimension and rapid growth. Facial nerve deficits were not apparent and neck palpation identified no enlarged lymph nodes. MRI described a small lesion of oval shape and well defined contours. Fine-needle aspiration biopsy raised the possibility of a myoepithelial tumour and a superficial parotidectomy was performed. The patient experienced no complications during the postoperative healing. There were no facial nerve deficits. Microscopic examination concluded to a SDC. It was decided by a multidisciplinary team to apply radiation therapy to the surgical bed. At two years of follow up the patient remains with no clinical or imagological evidence of tumour recurrence.

Therapeutic Approachs To Breast Phyllodes Tumor

Phyllodes tumors are very rare tumors of the breast. They usually present in fast-growing mass form and are confused with diagnosis of fibroadenoma in daily clinical practice. The adequacy of treatment and follow-up may be hesitated in some centers which are not engaged with breast disease spesifically due to post-surgical excisional diagnosis in usual. In this article, we have reviewed the treatment options of phyllodes tumors of the breast.

Squamous Cell Carcinoma on the Upper Lip of a Patient with Discoid Lupus Erythematosus

Squamous Cell Carcinoma on the Upper Lip of a Patient with Discoid Lupus Erythematosus

PR72 Fast-growing mass in the breast of young women during pregnancy. A janus-faced disease presented by case reports

PR72 Fast-growing mass in the breast of young women during pregnancy. A janus-faced disease presented by case reports

Breast Sarcoma in Male: Case Report

INTRODUCTION: The primary sarcoma of chest wall is uncommon. Therefore there are a few series in the literature. Only 10% of all sarcomas are located in thorax and 1% of breast cancer is sarcoma. A small number of articles define prognostic factors of sarcomas from the trunk and less from the breast. In general, the highest incidence of sarcomas originating from thorax is in 47 years-old men and with fast growing. Tumoral size less than 5 cm and low histological grade are good prognostic factors. The adequate surgical approach is most important tool to treatment. We relate a case of breast sarcoma in 61 years-old man. CASE REPORT: A 61 years-old man has appeared with fast growing mass in thorax (right breast). No comorbities or previous thoracic irradiation. He had an exofitic mass in right breast measuring 13 cm in diameter and normal axillas. Core biopsy has showed fusiform cell neoplasia, moderate nuclear pleomorfism and histological grade 1. In March 2012, the surgical resection has done and the immunohistochemical and histopatological examination have concluded low grade sarcoma with negative margins, expressing vimentin and smooth muscle actin and his stage was T2BN0M0, IB. DISCUSSION: We related a sarcoma case in older man. This disease is more common between 45 and 50 years. In older man, this kind of cancer is associated to previous thoracical irradiation. Instead of that, our patient has never received any type of irradiation. He possesses only one bad prognostic criterion: tumoral size bigger than 5 cm. In general, the 10 years disease-free survival is about 63%, even though after surgical therapy. The surgical treatment maintains the most relevant therapy and the positive surgical margin can affect the prognosis.

Breast Sarcoma in a 16 Year-Old Girl

INTRODUCTION: Sarcomas are histologically heterogeneous nonepithelial tumors, which may develop in the connective tissue of the breast, only in around 4, 6 cases per million women/year. They represent less than 1% of all the breast cancers; however their grim prognosis implies an importance in the study of these tumors. Sarcomas usually occur in women over 45 years of age. Furthermore, these malignancies can be classified according to their histology, as fibrosarcoma, angiosarcoma, and pleomorphic sarcoma. The patient appears with a fast growing mass in her breast. The prognosis depends on stage and histological grade, and treatment is mainly surgery. This case report is of a teenager without any family history who developed this rare malignancy. CASE REPORT: APLV, female, 16 years old, white, natural from and resident in Rio de Janeiro, Brazil, student, single, was referred to the senology department for further investigation of breast mass. The patient denied any previous illnesses, contact with Tuberculosis or anything important in the family history. Her physical exam presented with a 20cm tumor occupying the whole left breast, stretching the skin but without infiltrating it, with a hard consistency, and an areas of fluctuation. This area was drained and the liquid was sent to pathology for research for neoplastic cells, Tuberculosis, and other pathogens. The axillary lymph nodes were not palpable. A core-biopsy of the tumor was performed for diagnosis, and the patient was submitted to a breast sonogram and mammography. The cytology showed no signs of disease. The result of the core- biopsy was malignant mesenchymal neoplasm. The sonogram and the mammography showed a large hypoechoic/hyperdense mass occupying all quadrants of the left breast, of about 14 cm, suggesting a solid lesion. The immunohistochemistry research showed fusiform cells neoplasm with intense pleomorphism and necrosis, positive for vimentine, and negative for CD31, CD34, estrogen receptor, progesterone receptor and CK5. The screening for metastatic disease was negative, and the patient was submitted to mastectomy with immediate reconstruction with skin graft. The final result from pathology of the left breast was a malignant mesenchymal neoplasm with necrosis, and pronounced nuclear pleomorphism and high mitotic index. Nipple, skin, and surgical margins free from neoplasm. The patient was followed up at the hospital for one year and she has had a favorable outcome, with good healing and no metastasis so far. DISCUSSION: The diagnosis of breast sarcoma is very rare, and it is usually followed by a poor prognosis for the patient. It is important to report the rare cases in order to further understand and to clarify the aspects of this disease. The patient in this case report, epidemiologically different from the usual breast sarcoma patient, shows that anything is possible in oncology.

Giant sternal metastasis secondary to follicular carcinoma of the thyroid gland: report of a case

A 70-year-old woman was admitted to our department for investigation and treatment of a progressively enlarging multinodular goiter and a fast growing mass infiltrating the sternum. The patient was euthyroid, but computed tomography (CT) and ultrasonography showed a mass in the anterior mediastinum infiltrating the sternum, with a dominant nodule in the right lobe of the thyroid. Fine needle aspiration biopsy results from both the cervical and the mediastinal masses were suggestive of follicular thyroid carcinoma. The patient underwent total thyroidectomy, thymectomy, and total removal of the mass, along with parts of the sternum, sternocleidomastoid muscle, and attached ribs. The thoracic wall was reconstructed with gortex dual mesh covered by muscle flaps from both pectoralis major muscles. Pathological analysis of both masses confirmed the fine needle aspiration findings and the patient received three cycles of radioactive iodine treatment. She had an uneventful postoperative course, but died of a stroke 8 years later.

Metastatic bladder transitional cell carcinoma presenting as a vascularised cutaneous right arm lesion

A 65-year-old man presented to the emergency department with a 3-week history of a fast-growing and painful mass in his right antecubital fossa. He felt otherwise well. Four months earlier, he had undergone a radical cystectomy for transitional-cell carcinoma (TCC) of the bladder (grade 3, stage pT1). Two months after the cystectomy, at another hospital, he was diagnosed with, and treated for, a pseudoaneurysm in his right antecubital fossa. Duplex ultrasonography of the presenting lesion revealed a highly vascularised mass with no pseudoaneurysm. Histological and immunohistochemical analysis preceded a diagnosis of cutaneous metastatic TCC. Whole-body CT revealed widespread metastases. This is the first reported case of a highly vascularised cutaneous lesion being the presenting feature of metastatic bladder TCC.

Hematopathology in the new decade: what to expect

At the beginning of a new decade, it is a good moment to reflect on the direction pathology, and especially hematopathology, is going. This is a risky business: you are probably all aware of the main problem foreseen for the twentieth century: an explosion of transportation (which indeed happened) resulting in the impossibility of removing the vast amount of horse manure from the streets in big cities…. At a speech celebrating 40 years of the Dutch pathology society in the 1970s, my promoter foresaw that clinical pathology would soon be fully based on enzyme histochemistry and electron microscopy; and how many have predicted that expression arrays would make pathologists an endangered species. We do see huge changes in our profession: a hematopathologist now uses, as a routine, histology, immunohistochemistry, and cytogenetic techniques. Often there is good access to clinical data through electronic patient records, so there is no need for complaining on lack of clinical data anymore. We are appreciated much better since our diagnosis is much more refined and also much more relevant to patients, thanks to better and variable treatment options. And we deliver faster: rapid tissue processing, speech recognition, and electronic transmission have made 1-day pathology feasible. What will happen next? Deep sequencing is now done in the research laboratories, and within 3–5 years, we will be able to have full knowledge of genetic changes in tumor and normal tissue of our patients. It is not easy to predict how this will affect our work, but it will be at least another tool; another layer of knowledge that pathologists can incorporate in their diagnosis. A large amount of biologicals is being tested in preclinical and early clinical studies, and we will see some patients that benefit, and others that do not. We need to develop tools to predict how a tumor responds to specific drugs, and use that knowledge as well. Within a few years we will all have slide scanners, and thus it does not matter anymore where we are when we make our diagnosis. Will we be carrying around I-Pads so that we can make a diagnosis even when we are enjoying a day at the beach? For sure, patients will ask for their tissues to be evaluated by specialized pathologists. In a nostalgic mood, I sometimes think back how things were 5 years ago: no Blackberry or I-phone, dictation on tapes, overnight tissue processing and another day before immuno came, bone-marrow biopsies in plastic after a week, airplanes that flew even when volcanoes were active, slide seminars with glass slides, poster areas that were bigger than commercial exhibitions, banks that were safe, pathologists who could work in peace in the cellar…. But soon my mobile rings, it is Friday morning, and a child with a fast-growing mass comes about: I am glad that I can tell the pediatric oncologist that when I get the biopsy in the morning I will be able to deliver a reliable diagnosis by the end of the afternoon, without stress and a free weekend coming up. Hematopathology is more interesting and more fun every year!

Malignant lymphoma of the thyroid.

Eighteen cases of patients with malignant lymphoma of the thyroid are analyzed. Patients were treated by irradiation and/or chemotherapy and in 9 cases the operation of the thyroid was realized. Two patients of operated group and two patients of non-operated group died after 1-365 days due to malignant lymphoma. The mean follow up of living patients is 66.8 months. In 5 cases, the coincidence of malignant lymphoma and lymphocytic thyroiditis was proved. The diagnosis of malignant lymphoma of the thyroid in all cases but one was based on cytology gained from fine needle biopsy and then confirmed in most cases by histology. We advise to use fine needle biopsy as a simple and safe method in all solitary nodules of the thyroid of uncertain origin and urgent fine needle biopsy in cases of fast growing mass on the neck. Fine needle biopsy reliably differentiates between primary thyroid carcinoma, anaplastic carcinoma and malignant lymphoma of the thyroid. Difficulties can arise in differential diagnosis between malignant lymphoma and lymphocytic thyroiditis.

Role of surgical management in temporal bone fibrous dysplasia

Conclusion: Surgical treatment of fibrous dysplasia of the temporal bone (TBFD) revealed relatively good outcomes. Also, active surgical intervention is necessary to prevent the formation of secondary cholesteatoma or other complications. In particular, FD involving the inner ear may require greater caution when deciding on the resection area and timing of surgery. Objectives: The purpose of this study was to analyze clinical manifestations of TBFD and its surgical outcomes. Patients and methods: Nine patients diagnosed with TBFD after surgery at three tertiary referral centers were included. Pre- and postoperative clinical, audiological, and radiological findings were analyzed retrospectively. Results: Most patients (88.9%) showed FD involving the mastoid and adjacent area. Radiological patterns consisted of six pagetoid and three sclerotic forms; seven patients were monostotic, whereas two patients were polyostotic. Canalplasty (CP) was performed in six cases and intact canal wall mastoidectomy was performed in three of them; hearing gain was achieved in five and one patient maintained preoperative normal hearing. Two patients underwent revision CP and showed no recurrence. In addition, one case had secondary cholesteatoma formed by an obstruction of the external auditory canal; another with a fast-growing cystic mass in the petrous bone underwent transmastoid labyrinthectomy and had no recurrence for 11 months.

Liposarcoma mixoide en el hueco popliteo: Presentación de un caso y revisión de la literatura.

Es el caso de una mujer de edad media sin antecedentes de importancia que presenta una masa de crecimiento rápido en el hueco poplíteo izquierdo, cfinica y radiológicamente interpretada como una neoplasia de tejidos blandos, bien circunscrita, posible lipoma vs. tumor fibrohistiocítico. El estudio de patología quirúrgica corresponde a un liposarcoma mixoide. Los reportes de la literatura llaman la atención a la presencia de este tipo de tumor en el hueco poplíteo. Por ello, recomendamos considerar esta posibilidad diagnóstica en masas localizadas en esta región anatómica.

Fast-growing pericardial mass as first manifestation of intrapericardial teratoma in a young man

Fast-growing pericardial mass as first manifestation of intrapericardial teratoma in a young man