Hyperplastic Lesions Research Articles

Lingual Focal Hyperplastic Lesion in a Pediatric Patient: Report of an Unusual Case

Focal fibrous hyperplasia (FFH) is an oral mucosal localized non-neoplastic enlargement representing a reaction to chronic local irritations or injuries. The purpose of this report is to describe the management of an asymptomatic fibrotic lesion located in the tongue, in a preschooler boy. A 7-year-6-month old boy attended our clinic for the evaluation of an exophytic pedunculated tumor-like round mass located in the dorsal surface of the tongue. Based on the initial examination and the natural history of the lesion, the presumptive clinical diagnosis determined an irritation FFH. The lesion was surgically excised with a diode laser device, and the postoperative period evolution occurred without any complication. The appropriate treatment of FFH in children initially consists of the removal of local irritant factors. Excellent oral hygiene maintenance and close follow-up care are strongly suggested. Surgical excision is the most frequent modality for persistent lesions. Early diagnosis and proper management of FFH can reduce the risk of future recurrences or complications.

Regenerative hepatic pseudotumor: a new pseudotumor of the liver

Cases of new pseudotumors of the liver were collected from multiple medical centers. Four resection and 4 biopsy specimens were collected, including 4 women and 4 men at an average age of 48±15 years (range: 28-73 years). The lesions were visible on imaging but were either ill-defined or had indeterminate features for characterization. They ranged in size from 2 to 9cm and were multiple in five cases. The resection specimens showed lesions that had vague borders but were visible in juxtaposition to the normal liver on gross examination. Histologically, the lesions also had ill-defined borders and were composed of benign reactive liver parenchyma. Central vein thrombi were seen in 5 cases, and portal vein thrombi, in 2 cases. These vascular changes were associated reactive parenchymal changes including sinusoidal dilation, patchy bile ductular proliferation, and portal vein abnormalities. All lesions lacked the histological findings of hepatic adenomas, focal nodular hyperplasia, or other known tumors and pseudotumors of the liver. In summary, this study provides a detailed description of a new pseudotumor of the liver: a reactive, hyperplastic mass-like lesion that forms in association with localized vascular thrombi, for which we propose the term regenerative hepatic pseudotumor. This lesion can closely mimic other benign or malignant hepatic tumors on imaging and histology.

Optical simulations for determining efficacy of new light source designs for excitation-scanning high-speed hyperspectral imaging systems.

Positive outcomes for colorectal cancer treatment have been linked to early detection. The difficulty in detecting early lesions is the limited contrast with surrounding mucosa and minimal definitive markers to distinguish between hyperplastic and carcinoma lesions. Colorectal cancer is the 3rd leading cancer for incidence and mortality rates which is potentially linked to missed early lesions which allow for increased growth and metastatic potential. One potential technology for early-stage lesion detection is hyperspectral imaging. Traditionally, hyperspectral imaging uses reflectance spectroscopic data to provide a component analysis, per pixel, of an image in fields such as remote sensing, agriculture, food processing and archaeology. This work aims to acquire higher signal-to-noise fluorescence spectroscopic data, harnessing the autofluorescence of tissue, adding a hyperspectral contrast to colorectal cancer detection while maintaining spatial resolution at video-rate speeds. We have previously designed a multi-furcated LED-based spectral light source to prove this concept. Our results demonstrated that the technique is feasible, but the initial prototype has a high light transmission loss (~98%) minimizing spatial resolution and slowing video acquisition. Here, we present updated results in developing an optical ray-tracing model of light source geometries to maximize irradiance throughput for excitation-scanning hyperspectral imaging. Results show combining solid light guide branches have a compounding light loss effect, however, there is potential to minimize light loss through the use of optical claddings. This simulation data will provide the necessary metrics to verify and validate future physical optical components within the hyperspectral endoscopic system for detecting colorectal cancer.

Frecuencia de genotipos alto riesgo del virus papiloma humanoen lesiones bucales

Some genotypes of the human papilloma virus (HPV) in the oral cavity cause genetic instability that may lead to cancer. Clinical and histological diagnoses are key tools; however, molecular techniques allow predicting, detecting and monitoring the disease. Objective: To identify the frequency of four high-risk HPV genotypes and their association with lesions in the oral cavity. Materials and Methods: Descriptive cross-sectional study with a sample of 48 patients diagnosed with hyperplastic lesions and others currently classified as potentially malignant disorders (PMDs) of the oral cavity, who underwent biopsies, histopathological analysis, and HPV16, 18, 31, and 45 detection and genotyping by polymerase chain reaction (PCR). Results: Epithelial hyperplasia was the most frequent lesion found in 45.8% (n=22) of patients. Nicotine palatinus and leukoplakia were found in 8.3% and 6.2%, respectively; oral cancer in 6.2%. The total frequency of HPV was 12.5% (6/48). Oral papilloma was found in 6.1% (3/48), and nicotine palatinus and oral cancer in 2.0% each (1/48). HPV16, HPV31, and HPV45 were detected, while HPV18 was not observed. HPV16 was the most frequent genotype found (4 out of 6 patients), while HPV31 and HPV45 were found in one patient each. Only one genotype per lesion was found. The presence of HPV was associated with lesions (χ2=11.810; p=0.0375). No significant association with age and gender was found. Conclusion: High-risk HPV continues to be present in oral lesions. The HPV16 viral genotype was the most frequent in the studied lesions.

Vocal-fold leukoplakia and dysplasia. Mini-review by the French Society of Phoniatrics and Laryngology (SFPL)

Vocal-fold leukoplakia and dysplasia are together designated “epithelial hyperplastic laryngeal lesions” (EHLL). Work-up and follow-up are founded on optical examination with high-definition imaging, stroboscopy and narrow-band imaging. Diagnosis is based on pathology, using the new 2017 WHO classification, dichotomizing “low grade” and “high grade”. Statistically, the risk of cancerous progression is 20% within 5 to 10 years of diagnosis, or more in over-65 year-old males; risk for any given patient, however, is unpredictable. Research focuses on the genetic criteria of the lesion and characterization of the tumoral microenvironment. Treatment is exclusively microsurgical. Resection depth is adjusted according to infiltration. EHLL is a chronic disease, necessitating long-term follow-up, which may be hampered by residual dysphonia and surgical sequelae in the vocal folds. Sequelae need to be minimized by good mastery of microsurgical technique and indications. When they occur, biomaterials such as autologous fat and hyaluronic acid can be useful. Tissue bio-engineering is a promising field.

Prevalence and Intensity of Salmincola edwardsii in Brook Trout in Northwest New Brunswick, Canada.

Parasites can compromise the health and fitness of individual fish, and it is important to generate baseline information that can then be used to document changes in the abundance and distribution of potentially pathogenic parasites. The ectoparasitic copepod Salmincola edwardsii was assessed with respect to prevalence (percentage of infected fish per site), infection intensity (number of parasites per infected fish), and attachment location on Brook Trout Salvelinus fontinalis in northwest New Brunswick, Canada. Ten sample sites were assessed, with six sites on two streams in the Quisibis River basin and four sites on three streams in the Restigouche River basin. Parasite species identity was supported by 100% sequence identity with S.edwardsii in a variable region within 28S rDNA. The prevalence of fish infected per site ranged from 19.0% to 79.6%, with an overall prevalence of 48.5±19.1% (mean±SD) per site. Mean infection intensity was 1.5±0.9 copepods/fish (range=1-7), with parasites almost exclusively surrounding the dorsal fin and/or adipose fin (97.6%). There was no influence of trout age-class on parasite prevalence. Some fish presented with fin erosion at the site of parasite attachment (12.5%), and 6.2% also presented with hyperplastic skin lesions where no parasites were observed, that could be misinterpreted as secondary bacterial or fungal infections. Skin and fin damage were significantly more common when fish were infected with three or more individual parasites. The pathogenic potential of this parasite makes its presence noteworthy as a risk to salmonids that are both recreationally and ecologically important.

P307 Colorectal neoplasia risk in patients with inflammatory bowel disease and serrated lesions

Abstract Background The presence of serrated lesions (SLs) is an established risk factor for colorectal neoplasia development in the general population. However, the impact of SLs on the colorectal neoplasia risk in inflammatory bowel disease (IBD) patients is unknown. In addition, SLs might have been misclassified in IBD patients in the past, in part due to revisions of classification systems. Presently, SLs are categorised as hyperplastic lesions, sessile SLs, and traditional serrated adenomas. We aimed (1) to compare the colorectal neoplasia risk in IBD patients with SLs vs. IBD patients without SLs, and 2) to study the subclassification of SLs in IBD patients before and after histopathological review by two expert gastrointestinal pathologists. Methods We identified all IBD patients with colonic SLs from 1996 to 2019 in a tertiary referral centre using the local histopathology database. Patients with neoplasia prior to SL diagnosis were excluded. Clinical data from patients’ charts were retrieved until June 2019. A subgroup of 135 SLs was reviewed by two pathologists. The log-rank analysis was used to compare the cumulative (advanced) neoplasia incidence in IBD patients with SL vs. IBD patients without SL undergoing surveillance in the same time period. Patients were censored at the end of surveillance or at colectomy. Results We identified 376 SLs in 204 IBD patients (61.9% ulcerative colitis (UC)). In the original reports, 91.9% was classified as a hyperplastic lesion. After histopathological review, 120/136 (88%) of the SLs were confirmed (16 were no SL). Of the 120 confirmed SLs, 62.2% was classified as a sessile SL, 37.8% as a hyperplastic lesion, and 0.8% as a traditional serrated adenoma. The mean time from IBD diagnosis to the first serrated lesion was 14.3 ( ± 12.3) years. A total of 41/204 (20.0%) of patients developed neoplasia (3 CRC, 3 HGD, and 35 LGD; including 2 HGD and 17 LGD at the moment of serrated lesion detection). In the 304 patients without SL (52.6% UC), 63 developed neoplasia (20.7%; 8 CRC, 5 HGD and 50 LGD). Patients who received follow-up colonoscopies after SL (n = 127) had an increased cumulative risk of neoplasia (p < 0.01), but no increased risk of advanced neoplasia (p = 0.50) compared with the group of IBD patients without SL (Figure 1). Conclusion The presence of SLs in IBD patients was associated with a relatively high risk of synchronous colorectal neoplasia as well as an increased risk of subsequent neoplasia, although not with an increased risk of advanced neoplasia. Histopathological review confirmed the SL diagnosis in the majority of lesions, although a large proportion of the hyperplastic lesions was reclassified as a sessile SL.

The location of premalignant colorectal polyps under age 50: a further rationale for screening sigmoidoscopy.

The incidence of colorectal cancer (CRC) among young adults has been dramatically rising, with guidelines for screening recently adjusted to start at age 45. However, knowledge of the precursor lesions is limited. We recently reported that 83% of CRC diagnosed under age 50 are left sided. Our aim was to analyze the location and histology of benign colorectal lesions found in a cohort of patients younger than 50, documenting the presence of advanced histology. We used the database in the Department of Pathology to retrospectively review the location and histology of all benign colorectal neoplasms in patients under age 50 submitted to pathology examination during 2006-2016. A total of 8364 lesions were examined from 4773 patients, and 3534 (65.5%) of the patients had only one polyp and the rest had multiple. Mean age was 41.9years (range 16-49) while 3843 (72.8%) of the patients were between the ages of 40 and 49. In total, 4570/8364 lesions (54.6%) were distal to the splenic flexure. The most common pathology was tubular adenoma (63.7%), then hyperplastic polyps (16.6%), sessile serrated lesions (SSLs) (13.1%), and tubulovillous adenomas (6.3%). Tubulovillous adenomas, villous lesions, advanced adenomas, and adenomas with high-grade dysplasia were all predominantly left sided (left colon and rectum = 77.6%, 85%, 78.3%, and 87.6% respectively). Of the SSLs, 71.5% were in the right colon while 16.6% of hyperplastic lesions were right sided. High-risk advanced adenomas are predominantly left sided. This focuses attention on the rectum and left colon where carcinogenesis is strong in the young.

Ocular Adnexal Adenomatoid Sebaceous Gland Hyperplasia: A Clinical and Immunopathologic Analysis in Relation to the Muir-Torre Syndrome.

The purpose of this study is to codify the microscopic diagnostic criteria for ocular adnexal brow and caruncular sebaceous gland hyperplasias (pseudoadenomatoid) that distinguish it from an adenoma. Clinical records and photographs were critically reviewed and microscopic slides were stained with hematoxylin and eosin and immunochemically stained for adipophilin, androgen receptor, p16, p53, a spectrum of cytokeratins, Ki-67 and mismatch repair nuclear protein expression for MLH1, MSH2, PMS2, and MSH6. The patients and their close relatives had no history of cancer. Cytokeratin 7 and especially cytokeratin 17 highlighted the presence of ducts in the hyperplastic lesion, which are not present in adenomas. p16 and p53 were negative and Ki-67 immunostaining demonstrated similar low proliferation indices for normal and hyperplastic glands. The mismatch repair nuclear protein expressions were preserved in both lesions. Histopathologic misdiagnosis of adenomatoid sebaceous gland hyperplasia as an adenoma can lead to the impression of an association with the Muir-Torre syndrome. Cytokeratins 7 and 17 immunostaining can be helpful in highlighting compressed ducts that in exuberant sebaceous gland hyperplasias may lead to a diagnosis of an adenoma (in which ducts are absent). Negative immunostaining for p16 rules out a possible etiologic role of human papillomavirus in hyperplasias and the negative p53 staining indicates the lesions are not truly neoplastic. The preservation of mismatch repair nuclear protein expression rules out the likelihood of the Muir-Torre syndrome. The current cases convincingly establish that sebaceous hyperplasia is not associated with the Muir-Torre syndrome by both clinical findings and immunohistochemical testing.Two yellow lesions, from the brow and caruncle, were examined microscopically and immunohistochemically to establish the diagnosis of sebaceous gland hyperplasia and to rule out the Muir-Torre syndrome.

Oral verruciform xanthoma: The great imitator

Oral Verruciform xanthoma (OVX) is an uncommon benign muco-cutaneous lesion having various concepts regarding its etiopathogenesis. Intraorally, this usually occurs on the gingiva and alveolar mucosa. Often asymptomatic, this lesion presents with a flat to verruco-papillary surface morphology. The clinical features of OVX can be misleading and resembles diverse hyperplastic, non-malignant, potentially malignant, and malignant lesions of the oral cavity. Histopathological examination is a key for the diagnosis of this lesion with xanthoma cells being the hallmark. Surgical excision remains the treatment modality and recurrence is rare. This paper presents a case of oral verruciform xanthoma on the buccal mucosa, mimicking a potentially malignant lesion, and a review of its major clinical, histological features and differential diagnosis.

Pyogenic granuloma: Clinicopathological and treatment scenario

Background:Oral pyogenic granuloma is a soft-tissue lesion of the oral mucosa. This lesion has a tendency to reoccur after surgical excision.Materials and Methods:A total of 28 patients underwent surgical excision of pyogenic granuloma in the period from September 2014 to May 2016. Two surgical techniques were used to remove pyogenic granuloma: simple excision with root planing and modified excision with deep curettage.Results:Females (54%) were slightly more predominant than males (46%). The upper and lower jaws were almost equally affected by the lesion with more predilection toward the posterior region. The size of the lesion ranged from 0.5 to 3 cm in diameter with slow-growing rate. Rural residents were more affected (57%) than urban people. The lesion appears clinically as a small red mass with sessile base, and these clinical features were similar in pregnant and nonpregnant women. The recurrence rate was 14.8% and seen only in patients treated by simple excision. Histopathological feature was consistent with inflammatory hyperplastic lesion, and there was no radiographic evidence of bone resorption associated with the lesion.Conclusion:Modified excision with deep curettage prevents the recurrence of the lesion after 1-year follow-up.

Management of perennial pyogenic granuloma by platelet-rich fibrin membrane in a 62-year-old patient

Pyogenic granuloma (PG) is an inflammatory hyperplastic lesion of the oral cavity with common etiological factors such as low-grade local irritation, traumatic injury, or hormonal factors. The lesion is nonneoplastic in nature with the recurrence rate of 15.8%. Moreover, as it is a benign lesion, the choice of treatment is surgical excision with the removal of underlying cause if any. The present article highlights the use of platelet-rich fibrin (PRF) membrane in the management of PG. This case report presents a 62-year-old female patient who had reported with PG that recurred twice in 7-year period. The lesion appeared with a sessile base and was diagnosed clinically and histopathologically as PG. The PG was surgically excised exposing the underlying bone. The exposed bone surface was then covered with PRF membrane. At 6-month follow-up period, the patient did not show any further recurrence of the lesion.

Oral pyogenic granuloma: An unusual presentation in tongue – Case report and comprehensive review

Pyogenic granuloma (PG) is a reactive, hyperplastic lesion of the skin and mucosa in response to chronic irritation. It clinically presents as sessile or pedunculated growth, most commonly in the gingiva. The clinical and histopathological spectrum of PG depends on the phase of the lesion. Healing lesions are pinkish white compared to reddish lesions in the established phase. Long-standing lesions show features of fibrosis and calcification. We report a case of PG extra gingival in location, on the left lateral surface of tongue in a 45-year-old male with an insight into etiopathogenesis, clinical presentation, histopathological, molecular, and immunohistochemical features. Novel concept of isolation of stem cells from pathological tissues such as PG might help future research in regenerative dentistry.

Peripheral ossifying fibroma of the anterior maxillary gingiva

Background: Peripheral ossifying fibroma is a rejuvenation of the reactive gingiva, usually occurring in the anterior maxillary gingiva. The condition is often clinically ambiguous when diagnosed on the basis of gingival hyperplastic lesions such as focal fibrous hyperplasia, peripheral giant cell granuloma, peripheral fibroma and pyogenic granuloma because peripheral ossifying fibroma has a tendency to recur with a ratio of around 20%. The literature on the subject predominantly classifies peripheral osifying fibroma as an epulis type, but it has also been identified as a peripheral mesenchymal tumor presenting similar clinical symptoms to ossified fibrous epulis. Purpose: The purpose of this article is to explain the rare case of peripheral ossifying fibroma in the anterior maxillary gingiva which can be clinically misdiagnosed as reactive gingival hyperplastic lesions. Case: A case report of peripheral ossifying fibroma in the left lateral incisor and canine of the maxillary gingiva in a 26 year-old male. The patient chiefly complained of a painless, slow growing gingival enlargement on the upper left jaw during the previous five years. Clinical examination confirmed it to be a single, hard swelling in the 21-24 region, pale in color and with a rough surface. Case management: The procedure constituted a complete surgical excision of the lesion together with the underlying periosteum curettage intended to prevent recurrence. The histopathologic examination results indicated tissue with squamous epithelial lining, stroma consisting of fibroblasts, and immature trabecula with osteoblastic rimming between collagen tissue without signs of malignancy. Osteoblastic rimming has specific features in histopathologic examination of ossifying fibroma. Conclusion: Peripheral ossifying fibroma is a rare solitary enlargement in the oral cavity frequently misdiagnosed as ossified fibrous epulis. A definitive diagnosis is made by means of histopathologic examination. The condition has a low reccurance rate.

Human papilloma virus genotypes in dysplasia and epithelial hyperplasia of oral cavity using the luminex xmap technology. A multicenter study

Background Oral cancer associated with high risk (HPV-HR) human papilloma virus (HPV) has been increasing. HPV-HR has been associated with epithelial dysplasia, however, little information exists on its frequency in epithelial hyperplasia lesions. The aim of this study is to compare HPV genotypes in dysplastic and hyperplastic lesions of oral cavity. Material and Methods Two hundred and fifty oral lesions: 131 dysplasia and 119 hyperplasia from two regions of Colombia were evaluated. One hundred seventy-four coming from urban area and 104 from a high risk population to oral cancer from a rural area. HPV was identified by qPCR and Twenty-four HPVs genotypes were evaluated by Luminex® technology. Logistic regressions were performed to establish the associations between HPV infections with oral dysplasia. Results Twenty-eight percent (70/250) of the samples were positives for any HPV and HPV-HRs were more frequently than low risk HPVs. HPV-16 was the most detected genotype (16%) followed by HPV-31, 53, 18 and 45. HPV, HPV-HRs and HPV-16 were only associated with dysplasia in urban area; OR 3.28 (CI 95% 1.49-7.17), OR 7.94 (CI 95% 2.97-21.2) and OR 5.90 (CI 95% 2.05-17). Individuals in rural area showed more HPV and HPV-HRs infection in hyperplasic lesions than urban population. The majority of HPV+ lesions had multi-type of HPV (52/70) and the urban individuals showed more genotypes than rural population. Conclusions HPV-.HRs are frequently found in hyperplastic and dysplastic epithelial lesions. HPV-HRs and HPV-16 were associated with dysplasia in urban population. Rural high risk population and urban population differ in the frequency and variety of HPV genotypes. Key words:Human papilloma virus, epithelial dysplasia, epithelial hyperplasia, HPV-genotypes.

P-mapa, a promisor immunomodulator against tumor cells of colonic tissues: An investigation of the action mechanism over the TLR4 signaling pathway

Colorectal cancer (CRC) is a multifactorial syndrome that drives to uncontrollable cell division, genetic alterations, and functional alteration. In the present work, we evaluated the immunomodulatory properties of P-mapa, a compound extracted from Aspergillus oryzae fungus, versus Fluorouracil (5-FU) treatment in chemically induced CRC. CRC was induced by DMH in F344 rats. Animals of treated groups receive weekly 15 mg/Kg of 5-FU or 5 mg/Kg of P-mapa, over 10 weeks. Tissues were stained for aberrant crypt foci (ACF) counting and histopathology evaluation, immunostained for TLR4 pathways and quantified for TNFα Cytokine assay. DMH was efficient to induce hyperplastic lesions and ACF. Both treatments reduced significantly ACF formation and tumor aggressiveness. Immunohistochemistry for TLR4 signaling reveals that both treatments had no effect over the TLR4-NFκB signaling pathway. On the other hand, both succeed in increase interferon signaling, with activation of the TRIF-IRF3 pathway and consequently inducing IFNγ synthesis. The present results show the immunomodulatory properties of P-mapa in chemically induced CRC model. P-mapa induced a significant increase in Type-I IFNs synthesis and subsequently immune cell recruitment, resulting in an increase of IFNγ concentration in colorectal mucosa and its inhibitory effects over tumoral growth. In this scenario, P-mapa showed an interesting antitumoral effect by inhibiting tumor growth.

GRANULAR CELL TUMOR ASSOCIATED WITH SUBGEMMAL NEUROGENOUS PLAQUE—A CASE REPORT

This study reports the occurrence of a granular cell tumor (GCT) and a subgemmal neurogenous plaque (SNP) in the same anatomic location. A female white 59-year-old patient presented with an asymptomatic fibrous nodule located in the right posterior border of the tongue. A second, slightly erythematous, hyperplastic lesion behind the first one was identified. Both lesions were submitted for excisional biopsy. Histopathologic analysis revealed a GCT and an SNP. GCT is an uncommon, benign, soft tissue neoplasm. It presents as an asymptomatic fibrous submucosal nodule. The SNP is a biphasic structure found in the lateral posterior region of the tongue, characterized as nerve plexus aggregates and ganglion cells. The patient is under follow-up care and after 1 year, no relapses were observed. The authors believe that this is the first case showing the association between GCT and SNP.

Bioarchaeological investigation of an obstetric death at Huigou site (3900–2900 BC), Henan, China

AbstractHistorical documents record that many young women died of pregnancy, delivery, or related complications. However, such cases are rare archaeologically due to the limitations of archaeological materials. Here, we report the case of an adult female buried with an infant in the Neolithic graveyard of Huigou (Yangshao Culture, 3900–2900 BCE) in China's Henan Province. The remains of the infant were positioned between the lower legs of the adult. Both appear to have died during or shortly after delivery, as the estimated age of the infant is full term. The adult female's pubic symphysis was unusually long compared with a modern Chinese reference sample, a trait that increases the risk of dystocia in modern clinical cases. The pelvis also shows a hyperplastic lesion on the superior margin of the pubic symphysis that might reflect a prior difficult birth that was survived. Taken together this evidence suggests a history of obstetric problems that ultimately led to the death of the woman and her last child. Our reconstruction offers a glimpse of an ancient life, suggesting the difficulties this woman suffered in childbirth before her death and illustrating the insights that osteology can offer into obstetric experiences in the past.

The broad and challenging landscape of extranodal lymphoproliferations.

Two sessions in the workshop of the 19th meeting of the European Association for Haematopathology termed "challenging extranodal lymphoproliferations" and "extranodal non-site-specific lymphoproliferations", dealt with a series of heterogenous cases. These included lymphoproliferations of all cell lineages, from reactive lesions mimicking lymphomas through indolent lymphoid neoplasia and tumours with unclear biological behaviour to aggressive and transformed lymphomas. The themes addressed included cases with borderline features between hyperplastic and neoplastic lesions, the diagnostic spectrum of IgG4-related disease, T cell lymphoproliferations arising in extranodal sites with presumed indolent behaviour, diverse clinical presentations of intravascular large B cell lymphoma, diagnostic problems encountered with tumours displaying plasmablastic morphology, pitfalls concerning rare entities like adult T cell lymphoma/leukaemia (ATLL) and extranodal natural killer/T cell (NK/T) lymphomas, and unusual clinical presentations of various lymphomas. Altogether, within the frame of these two sessions, 75 cases remarkably differing in their clinical background, genetic features and overall need for a meticulous diagnostic approach were presented and discussed. In this paper, the salient points raised during the discussion of the cases, current diagnostic concepts and recommendations relevant to the diagnosis of these lymphoproliferations are described.

Evaluation of the Accuracy of Liquid-Based Oral Brush Cytology in Screening for Oral Squamous Cell Carcinoma.

This study evaluates the accuracy of the results of liquid-based oral brush cytology and compares it to the histology and/or the clinical follow-ups of the respective patients. A total of 1352 exfoliated specimens were collected with an Orcellex brush from an identical number of oral lesions, then cytological diagnoses were made using liquid-based cytology. The final diagnoses in the study were 105 histologically proven squamous cell carcinomas (SCCs), 744 potentially malignant lesions and 503 cases of traumatic, inflammatory or benign hyperplastic oral lesions. The sensitivity and specificity of the liquid-based brush biopsy were 95.6% (95% CI 94.5–96.7%) and 84.9% (95% CI 83.0–86.8%), respectively. This led to the conclusion that brush biopsy is potentially a highly sensitive and reliable method to make cytological diagnoses of oral neoplasia. The main advantage of a brush biopsy over a scalpel biopsy is that it is less invasive and is more tolerated by the patients. Therefore, more lesions can be screened and more cancers can be detected at an early stage.