Group Of Malignant Lesions Research Articles

Circulating immune parameters-based nomogram for predicting malignancy in laryngeal neoplasm

BACKGROUNDMalignancy prediction remains important to preoperative diagnosis and postoperative follow-up in laryngeal neoplasm.AIMTo evaluate the circulating immune population and develop a nomogram for prediction of malignancy in patients with laryngeal neoplasm.METHODSA primary cohort of 156 patients was divided into laryngeal benign lesion, premalignant lesion and malignant lesion groups. Peripheral blood from patients was measured by blood routine test and flow cytometry. A nomogram was developed and applied to a validation cohort containing 55 consecutive patients.RESULTSAge, gender and seven circulating immune parameters exhibited significant differences between laryngeal benign lesion and premalignant lesion. The nomogram incorporated predictors, including gender, age, smoke index, proportions of monocytes, CD8+ T cells, CD4+ T cells, B cells and CD4/CD8+ T cell ratio. It showed good discrimination between laryngeal premalignant lesion and malignant lesion, with a C-index of 0.844 for the primary cohort. Application of this nomogram in the validation cohort (C-index, 0.804) still had good discrimination and good calibration. Decision curve analysis revealed that the nomogram was clinically useful.CONCLUSIONThis novel nomogram, incorporating both clinical risk factors and circulating immune parameters, could be appropriately applied in preoperative individualized prediction of malignancy in patients with laryngeal neoplasm.

Cement Plug Fragmentation Following Percutaneous Cementoplasty of the Bony Pelvis: Is it a Frequent Finding in Clinical Practice?

To report the rate of fragmentation of the cement plug following percutaneous cementoplasty with polymethylmethacrylate (PMMA) in the bony pelvis (i.e., pelvic bones or sacrum). Post-interventional and follow-up CT scans of 56 patients (36 men; mean age of 68.4 ± 15.4) with a total of 98 percutaneous cementoplasty procedures were analyzed. Indications for treatment included painful malignant tumors (42.9%; 42/98) and insufficiency fractures (57,1%; 56/98). Fragmentation of PMMA was recorded for each cement plug. Mean interval between the procedure and the last available CT scan was 29.3 ± 18.8months. There was no significant difference between the length of follow-up of malignant lesions (27.6 ± 15.1months) and insufficiency fractures (29 ± 20.5months) (p = 0.69). Fragmentation was diagnosed following 2/98 (2%) procedures, both in the malignant lesions group. The time intervals between the procedure and the first visualization of cement fragmentation were 6 for the first and 24months for the second patient. Fragmentation of the PMMA plug following percutaneous cementoplasty in the bony pelvis is a rare finding at midterm follow-up. It was only observed in cementoplasty performed in malignant lesions and seems to be more a consequence of local mechanical stresses than as a result of porosity.

3.0 T Magnetic Resonance Functional Imaging Quantitative Parameters for Differential Diagnosis of Benign and Malignant Lesions of the Breast.

Objective: To investigate value of quantitative dynamic contrast-enhanced magnetic resonance imaging (MRI) parameters and apparent diffusion coefficient (ADC) value in differential diagnosis of breast benign and malignant lesions, and their correlation with prognostic factors of breast cancer. Methods: The study collected MRI images and clinical data from 232 female patients suspected of breast cancer. Philips INGENIA 3.0T superconducting magnetic resonance scanner was used for imaging examination. Complete pathological data of patients were collected, and the expression of ER, PR, HER-2, and Ki-67 were further investigated. Results: Kep was higher in malignant breast lesion group than that in benign breast lesion group, and ADC value was lower in the former group than that in the latter group (both p < 0.05). The areas under the receiver operating characteristic curves for Kep, ADC, and extravascular volume fraction (Ve) were 0.904 (95% confidence interval [CI]: 0.863-0.945), 0.813 (95% CI: 0.752-0.875), and 0.774 (95% CI: 0.707-0.841), respectively. Furthermore, according to the maximum Youden index, the specificity of Kep and the sensitivity of ADC were high, which were 97.20% and 96.00%, respectively, with a cutoff value of 0.314 and 0.151, respectively. Kep value in ER-positive expression group was significantly higher than that in ER-negative expression group (p < 0.05). Kep value in PR-positive expression group was significantly higher than that in PR-negative expression group (p < 0.05). There was positive correlation between Kep and expression of Ki-67 (p < 0.05). ADC value was negatively correlated with Ki-67 expression (p < 0.05). Conclusion: Quantitative parameters Kep and ADC of 3.0 T MR functional imaging can be used as reference indexes for differential diagnosis of benign and malignant breast lesions and for biological behavior evaluation, indicating potential clinical value for noninvasive preoperative evaluation of breast cancer.

Clinical analysis on the differential diagnosis of gastrointestinal neoplasms by real-time endoscopic ultrasonography

Abstract: objective: to study and analyze the effect of real-time endoscopic ultrasonography in the differential diagnosis of gastrointestinal tumors.Selection methods: between January 2014 and January 2015 xinyang 53 cases of digestive system cancer patients admitted in hospital, a total of 79 substantial tumor of the digestive system lesions, all patients were diagnosed by endoscopic ultrasonography real-time tissue elastography, use elastic imaging score, for patients with lesions and their surrounding structures control the elastic strain rate ratio of measure and comparison analysis.Results: compared with the malignant lesion group, the difference between the benign lesion group and the benign lesion group was statistically significant (P&lt;0.05).The ratio of elastic strain rate in benign lesion group was lower than that in malignant lesion group (P&lt;0.05).The diagnostic accuracy, sensitivity and specificity were 91.14%, 94.74% and 81.82% respectively.Conclusion: endoscopic ultrasound real-time tissue elastography is effective in the differential diagnosis of digestive system tumors, and can effectively determine the benign and malignant tumors and improve the diagnostic accuracy.

Clinical analysis and prognosis factors of malignancy in the patients with mucinous cystic neoplasms of the pancreas

Objective: To examine clinic pathological features of mucinous cystic neoplasms (MCN) of the pancreas and explore the prognosis factors associated with malignant transformation of MCN of the pancreas. Methods: This multicenter retrospective study included all patients with pancreatic MCN underwent surgery at Department of Pancreatic Surgery, Zhongshan Hospital of Fudan University between January 2008 and December 2018 and patients with MCN who confirmed by postoperative pathology from Multicenter Pancreatic Cystic Tumor Database. There were 50 males (14.4%) and 297 females (85.6%) and the mean age was 48.6 years (range: 24-77 years). According to the pathological results, all patients were divided into benign lesion group (including MCN and which associated with low/medium grade dysplasia) and malignant lesion group (including MCN with high-grade dysplasia or invasive carcinoma) . The preoperative clinical pathology and imaging features of the two groups were analyzed, and the risk factors associated with malignant transformation of MCN were statistically analyzed. Results: This multicenter retrospective study included 347 patients. Twenty-four of the 347 patients were malignant, including 7 males and 17 females. Univariate analysis showed that age, gender, carcino-embryonic antigen (CEA) , CA19-9, CA125, tumor maximum diameter, and tumor location were remarkably different in the two groups (P<0.05) . Logistic regression analysis found that the preoperative tumor maximum diameter (OR=1.023, 95% CI: 1.002-1.045, P=0.035) was an independent risk factor for MCN malignant transformation. Conclusions: Age, gender, CEA, CA19-9, CA125, tumor maximum diameter, and tumor location are important features of MCN malignant lesions.The maximum diameter of the preoperative tumor is an independent risk factor for MCN malignant transformation.

LYMPHOMAS WITH ORAL MANIFESTATIONS – 18 CASES IN OUR INSTITUTION AND REVIEW OF LITERATURE

Lymphomas are the heterogeneous group of malignant diseases characterized by proliferation of malignant lymphoid cells or their precursors. Lymphomas are the ninth most common cancer worldwide and constitute 3.2% of malignant tumor. Lymphomas are generally classified to two main categories: Hodgkin's lymphomas (HL) and the non-Hodgkin lymphomas (NHL), and about 90% are NHL. Non-Hodgkin lymphoma represents 4.3% of all new cancer cases in the U.S. and the ninth most common cancer in male patient of Taiwan. Lymphomas may arise in lymph nodes or any organ with only 3% of them occurs in oral cavity. However, lymphomas represent the third most common group of malignant lesions in the oral cavity, following squamous cell carcinoma and salivary gland neoplasms. Here, we reviewed clinical features, radiologic appearance and diagnosis of 1035 cases of lymphomas with oral manifestations (18 cases in our institution and 1017 cases retrieved from literatures). We found that oral lymphomas affect patients aged 4-96 years (average, 55.1 years), occurring about 1.3 times as often in males than in females. The most common sites of involvement included tonsil, maxilla, mandible, palate, tongue, gingiva and buccal mucosa. The most frequent symptoms are swelling, pain, ulceration and paresthesia. Tooth displacement and hypermobility were also frequently seen when the alveolar bone were involved. The radiologic finding was non-specific as an osteolytic lesion. Thickening of periodontal ligament, loss of lamina dura and tooth displacement were also mentioned in some cases with invasion of jaw bones. The most common diagnosis was diffuse large B-cell lymphoma, which accounting for 30% of all cases. The oral lesions of lymphoma are often a component of more widely disseminated disease. An early detection can result in a higher cure rates and better long-term survival for the patients.

Diagnostic value of endoscopic ultrasound elastography for benign and malignant digestive system tumors.

Objective:To investigate the effect of endoscopic ultrasound real-time tissue elastography in differential diagnosis of benign and malignant digestive system tumors.Methods:Forty-two patients with solid tumors of digestive system who were admitted to our hospital between October 2017 and October 2018 were selected. All patients were diagnosed by endoscopic ultrasound real-time tissue elastography. Elastography score was used. The strain ratios (SR) of the lesion and the surrounding control tissues were measured and compared.Results:Lesions with elastography score no more than two points were evaluated as benign, while lesions with elastography score no less than three points were evaluated as malignant. The difference of the elastography score between the benign lesion group and malignant lesion group was statistically significant (P<0.05). The sensitivity, specificity and accuracy of endoscopic ultrasound elastography in the diagnosis of malignant tumors of digestive system were 91.4%, 88.9% and 87.5%, respectively. The SR of the benign lesions ranged from 0.01 to 7.34, with a median SR of 7.33; the SR of the malignant lesions ranged from 1.01 to 47.66, with a median SR of 20.07. The SR of the benign lesions was significantly lower than that of the malignant lesions (P<0.05).Conclusion:Elastography of benign and malignant tissues of digestive tract tumors has different image characteristics. Endoscopic ultrasound real-time tissue elastography is effective in differential diagnosis of digestive tract tumors as it can effectively determine whether a tumor is benign or malignant and improve diagnostic accuracy.

Evaluation of the Usefulness of Differential Diagnosis of Breast Mass using Elasticity Score and Elasticity Ratio in Elastography

This study evaluated the usefulness of the elasticity score and elasticity ratio in the differential diagnosis of benign and malignant lesion in breast elastography. We performed a retrospective analysis based on the results of core needle biopsy histology. The Mann-Whitney U test was used to confirm the difference between the 5-degree elasticity score and the Fisher's Exact test. ROC curve analysis was used to determine the elasticity score and the best cut-off value of the elasticity ratio for the prediction of malignant lesions. There was a statistically significant difference (p= .000) between the homogeneity of the elasticity score and the difference of the elasticity ratio between the benign and malignant lesion groups. On the ROC curve analysis, the elasticity score and the elasticity ratio for predicting benign and malignant lesion were determined as AUC 0.806, 0.824, cut-off value 3, 4.4 (p= .001). Therefore, the elasticity score and elasticity ratio may be useful in the differential diagnosis of breast mass.

Value of breast vascularity in differential diagnosis of benign and malignant breast lesions

Objective To study the value of breast vascularity in differential diagnosis of benign and malignant breast lesions. Methods The data of 37 patients with benign and malignant breast lesions in the Second Hospital of Shanxi Medical University from February 2017 to November 2017 were respectively analyzed. The number, diameter, length and breast-feeding arteries of bilateral breast vessel were recorded in the maximal intensity projection (MIP) of magnetic resonance imaging (MRI) and were scored according to Sardanellie. The patients were divided into the benign group and the malignant group according to the pathological results. Besides, ≥2 cm group and <2 cm group was also divided according to the maximum diameter of lesions. The differences in number and score of vascularity in both groups were compared. And the diagnostic efficacy of MRI was evaluated based on Sardanellie score and breast-feeding arteries. Results There were no significant differences in the number and score of vascularity between bilateral breast in benign breast lesions group (1.11±0.35 vs. 1.22±0.45, t=0.19, P=0.85; 0.89±0.38 vs. 0.95±0.21, t=0.25, P=0.80). The number and score of vascularity of the affected side were higher than those of the healthy side in breast malignant lesions group (2.61±1.29 vs. 0.61±0.21, t=6.18, P=0.00; 1.78±0.65 vs. 0.61±0.21, t=6.30, P = 0.00 respectively). The number and score of vascularity were statistically different between benign and malignant breast lesions (t=8.57, P 0.05); The number and score of vascularity in the malignant group were higher than those in the benign group with the maximum diameter ≥2 cm (0.92±0.63 vs. 2.64±1.50, t=47.5, P < 0.05; 0.92±0.33 vs. 1.73±0.79, t=53.5, P < 0.05). There was no significant improvement in the diagnostic efficacy of MRI based on the score of vascularity and positive breast-feeding arteries in the identification of benign and malignant lesions when the maximum diameter of lesions were < 2 cm, and it had a high diagnostic efficacy when the maximum diameter of lesions were ≥2 cm. Conclusions The vascularity of breast can be clearly seen by using breast dynamic contrast enhanced (DCE) MRI. The increase and score of vascularity in the differential diagnosis of benign and malignant breast lesions have a certain application value. The positive of breast-feeding arteries may increase the diagnostic efficiency of MRI. Key words: Breast neoplasms; Breast diseases; Diagnosis; Magnetic resonance imaging

Six year review of malignant oral and maxillofacial neoplasms attended at Muhimbili National Hospital, Dar es Salaam, Tanzania

Background: Cancers of the head and neck constitute an important group of human malignancies. It is estimated that head and neck cancers constitute about 5–8% of all malignancies world-wide. These neoplasms affect speech and deglutition due to their location and might result in tooth mobility, expansion and destruction of adjacent structures.This study aimed at determining the types, prevalence and demographic distribution of malignant oral and maxillofacial tumours among patients treated at Muhimbili National Hospital (MNH).&#x0D; Methods: This was a retrospective study where by histological results of lesions that occurred in oral and maxillofacial region from 1st January 2008 to 31st December 2013 were analyzed. The lesions were grouped into carcinomas, lymphomas and sarcomas; histological diagnoses of the top ten lesions with higher frequency of occurrence were picked for analysis.&#x0D; Results: Malignant orofacial lesions accounted for 37.8% of all lesions that were biopsied from oral and maxillofacial region. Males comprised 51.4% of the patients. Age distribution was 3 to 98 years, mean 50.86 ± 19.89 years. Lymphomas and sarcomas occurred mostly in the patients below 40 years of age, while carcinomas were predominant above age 40 years. Squamous cell carcinoma was the most common malignant lesion (62.2%) followed by Kaposi’s sarcoma (13.1%) and adenoid cystic carcinoma (7.4%).&#x0D; Conclusion: Our analysis demonstrated 51 different types of malignant lesions in which squamous cell carcinomas were the most common. In general, carcinomas were prevalent group of malignant lesions, with its incidence increasing with advancement of age. The results provide a clue to the clinicians in establishing differential diagnosis hence aiding in correct identification and early diagnosis of orofacial cancer in Tanzania.

Quantitative evaluation of intravoxel incoherent motion diffusion-weighted imaging (IVIM) for differential diagnosis and grading prediction of benign and malignant breast lesions.

Background:That breast carcinoma is the most common malignant lesion in women. This study aimed to differentiate benign from malignant breast lesions and to predict grading of the latter by comparing the diagnostic value of different parameters in intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI).Materials and methods:Retrospective analysis was performed utilizing imaging and pathological data from 112 patients with 124 breast lesions that underwent IVIM-DWI examination with 3.0 T MRI. Out of 124, 47 benign and 77 malignant lesions were confirmed by pathological diagnosis. The diagnostic performance of f, D, and D∗ value to distinguish benign from malignant breast lesions, was evaluated using pathological results as the gold standard. Correlation between D value and Ki-67 index was evaluated to predict grading of malignant breast lesions.Results:The D value (0.99 ± 0.21) of patients with malignant lesions was significantly lower than that (1.34 ± 0.18) of patients harboring benign lesions (P = .00). The D∗ value (7.60 ± 2.10) in malignant lesion group was higher than that (6.83 ± 2.13) of the benign lesion group (P = .113). The f value (8.50 ± 2.13) in malignant lesion group was remarkably higher than that (7.68 ± 1.98) of benign lesion group (P = .035). For differential diagnosis of benign from malignant breast lesions, optimal diagnostic threshold of D value and f value were 1.21 and 7.86, respectively. The areas of D and f values under the ROC curve were 0.883 and 0.601, respectively. The sensitivity, specificity, and accuracy of D value were 83.0%, 86.7%, and 85.5%, respectively. Accordingly, those indexes of f value were 64.9%, 57.4%, and 62.1%, respectively. Furthermore, the Ki-67 staining index of malignant lesions was robustly negatively correlated with D value (r = −0.395, P < .01).Conclusion:Concrete parameters of IVIM-DWI can help to improve the specificity and accuracy in differential diagnosis of breast benign and malignant lesions. D value is most relevant and valuable in predicting the grading of malignant breast lesions.

Accuracy of CESM versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation

AimAssess accuracy of contrast enhanced spectral mammography (CESM) versus conventional mammography and ultrasound in evaluation of BI-RADS 3 and 4 breast lesions with pathological correlation. Patients and methodsThirty female patients with 35 breast lesions diagnosed by conventional imaging as BI-RADS 3 and 4, presented to Women’s Imaging Unit of Radiology Department between January and December 2015, age ranged from 23 to 70years. All patients underwent conventional mammography and ultrasound then CESM. ResultsPatients divided into two groups, benign and malignant lesions group according to histological analysis. Mammography results that malignant lesions detected in 18/35 (51.4%) while benign lesions 17/35 (48.6%). Ultrasound revealed 27/35 (77.1%) lesions were malignant and 8/35 (22.9%) lesions benign. But CESM, revealed 25/35 (71.4%) lesions were malignant & 10/35 (28.6%) lesions benign. Among 7 patients with multifocal/ multi-centric histologically proven malignant lesions, all detected by CESM 7/7 cases (100%) versus 2/7 cases (28.6%) and 6/7 cases (85.7%) detected by mammography and ultrasound respectively. Based on, CESM had 95.2% sensitivity and 82.9% diagnostic accuracy. ConclusionCESM has better diagnostic accuracy than mammography alone and mammography plus ultrasound. CESM has 82.9% diagnostic accuracy in comparison to 51.4% for mammography and 77.1% for ultrasound.

Improving breast cancer diagnosis by reducing chest wall effect in diffuse optical tomography.

We have developed the ultrasound (US)-guided diffuse optical tomography technique to assist US diagnosis of breast cancer and to predict neoadjuvant chemotherapy response of patients with breast cancer. The technique was implemented using a hand-held hybrid probe consisting of a coregistered US transducer and optical source and detector fibers which couple the light illumination from laser diodes and photon detection to the photomultiplier tube detectors. With the US guidance, diffused light measurements were made at the breast lesion site and the normal contralateral reference site which was used to estimate the background tissue optical properties for imaging reconstruction. However, background optical properties were affected by the chest wall underneath the breast tissue. We have analyzed data from 297 female patients, and results have shown statistically significant correlation between the fitted optical properties ( ? a and ? s ? ) and the chest wall depth. After subtracting the background ? a at each wavelength, the difference of computed total hemoglobin (tHb) between malignant and benign lesion groups has improved. For early stage malignant lesions, the area-under-the-receiver operator characteristic curve (AUC) has improved from 88.5% to 91.5%. For all malignant lesions, the AUC has improved from 85.3% to 88.1%. Statistical test has revealed the significant difference of the AUC improvements after subtracting background tHb values.

Value of intravoxel incoherent motion diffusion-weighted imaging in differential diagnosis of benign and malignant hepatic lesions and blood perfusion evaluation

Objective: To investigate the value of intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) in the differential diagnosis and blood perfusion evaluation of benign and malignant hepatic lesions. Methods: A retrospective analysis was performed for 86 patients (96 lesions) with pathologically or clinically confirmed hepatic lesions or hepatic lesions diagnosed based on follow-up results, among whom 48 had malignant lesions (53 lesions) and 38 had benign lesions (43 lesions). The patients underwent conventional magnetic resonance (MR) plain scan, contrast-enhanced scan, and diffusion-weighted imaging (DWI) with different b values (b = 0, 50, 100, 150, 200, 400, 600, 800, 1 000, and 1 200 s/mm2) to determine the parameters of the double exponential model for intravoxel incoherent motion (IVIM): fast diffusion coefficient Dfast, slow diffusion coefficient Dslow, and percentage of fast-diffusion constituent F value. The patients were divided into groups according to the blood supply to lesions on conventional MR plain scan and contrast-enhanced scan, and there were 47 lesions in abundant blood supply group and 49 in poor blood supply group. The data for analysis were Dfast, Dslow, and F values of benign/malignant lesion groups and abundant/poor blood supply groups. The independent samples t-test was used for statistical analysis; the independent samples non-parametric test Mann-Whitney U test was used for the comparison of F value; the receiver operating characteristic (ROC) curve was used to evaluate the value of above parameters in the differentiation of benign and malignant lesions and blood supply evaluation. Results: Compared with the malignant lesion group, the benign lesion group had significantly higher Dslow, and F values (P< 0.001 orP= 0.001) and a higher Dfast value (P= 0.053). Compared with the poor blood supply group, the abundant blood supply group had significantly higher Dfast and F values (P< 0.001 orP= 0.001) and a higher Dslow value (P= 0.185). According to the ROC curve, the cut-off values of Dslow, Dfast, and F values in the diagnosis of benign/malignant hepatic lesions and evaluation of abundant/poor blood supply were 1.18×10-3mm2/s, 27.20×10-3mm2/s, 20.25%, 1.17×10-3mm2/s, 20.30×10-3mm2/s, and 17.80%, respectively, with sensitivities, specificities, accuracy, and areas under the ROC curve of 90.69%/92.45%/91.66%/0.938, 46.51%/73.58%/61.45%/0.589, 74.41%/50.94%/62.50%/0.653, 59.57%/57.14%/58.33%/0.559, 55.32%/63.26%/59.37%/0.618, and 93.61%/89.79%/90.62%/0.961, respectively. Conclusion: The parameter of the double exponential model for IVIM, Dslow value, has a certain value in the differential diagnosis of benign and malignant hepatic lesions, and F value can show blood perfusion in benign and malignant hepatic lesions without the need for contrast-enhanced scan, which provides a reference for the qualitative diagnosis of liver tumor.

Experience with surgical treatment for primary malignant adrenal tumors

Background. Adrenal tumors occur in 3–10 % of the population and are mostly benign adrenal cortical tumors. Adrenocortical carcinoma is a very rare tumor and has an annual incidence of 1–2 cases per million people. The U.S. National Cancer Data Base registered 4275 patients with adrenocortical carcinoma in 1985 to 2007. It is extremely difficult to assess Russia’s epidemiological data, as reports on adrenocortical carcinoma are not presented separately. Materials and methods. A total of 133 patients (49 men and 84 women (1:1.7)) with adrenal tumors were operated on at the clinics of the Siberian State Medical University in the period December 1998 to March 2015. The patients’ mean age was 51.3 (16–80) years (median age 51.0 years). The right and left adrenal glands were affected in 49 (36.9 %) and 77 (57.9 %) patients, respectively; both adrenal glands were involved in 7 (5.3 %). A group of 21 (15.8 %) people with primary malignant adrenal tumors was identified among all the patients. The clinical manifestations of the disease were evaluated from the presence of hormonal activity, gastrointestinal symptoms, pain syndrome, and hypertension. All the patients were operated on under endotracheal anesthesia. The data were statistically processed using the program package Statistica 6.0. Survival rates were analyzed by the Kaplan–Meier method. The Gehan–Wilcoxon test was used to compare the groups. Results. The investigation analyzed treatment results in 21 (15.8 %) patients with primary malignant adrenal lesions (Group 1). The most common morphological form was adrenocortical carcinoma in 15 (11.3 %) patients (5 men and 10 women (1:2)); their mean age was 48.1 years. The right, left, and both adrenal glands were affected in 4, 9, and 2 cases, respectively. In Group 2, other malignant adrenal involvements were identified from 1 case of rare malignant adrenal tumors: malignant pheochromocytoma, sarcoma, melanoma, squamous cell carcinoma, Castleman’s disease, and oncocytic carcinoma. According to the tumor stage, the patients with adrenocortical carcinoma were divided as follows: Stage T1 (n = 3), Stage T2 (n = 3), Stage T3 (n = 4), and Stage T4 (n = 5). In the patients with adrenocortical carcinoma, the size of an adrenal tumor was 8.7 ± 4.9 cm; hypertension as a main clinical manifestation occurred in 5 patients; pain syndrome was observed in 10; hormonal activity was noted in 8, blood electrolyte disorders were seen in 3, and gastrointestinal manifestations were in 9 patients. In Group 1, 8 (38.1 %) patients were survivors and 13 (61.9 %) patients died. Moreover, the overall 5-year survival was 37.9 %. Five-year survival in patients with adrenocortical carcinoma was 42.4 % (6 (53.3 %) survivors and 9 (46.7 %)) dead persons); that in patients with other malignant adrenal tumors was 33.3 % (2 (33.3 %) survivors and 4 (66.7 %) dead persons). Conclusion . Surgical removal of an adrenocortical tumor is the only treatment option that can cure a patient or considerably prolong life particularly if the disease is detected at stage I or II.

Early‐stage diffuse large B‐cell lymphoma of the submental region: a case report and review of the literature

Lymphomas represent the third most common group of malignant lesions in the oral cavity and maxillofacial region, following squamous cell carcinoma and salivary gland neoplasm[1, 2]. Traditionally, lymphomas are divided into two subtypes, Hodgkin lymphomas (HL) and non-Hodgkin lymphomas (NHL)[3]. The diffuse large B-cell lymphoma (DLBCL) is a rapidly aggressive NHL constituted by big lymphoid cells that can appear as a nodal or extra-nodal disease; about 4% of DLBCL are initially confined to extra-nodal sites[4]. The oral and maxillofacial region is the second most common extra-nodal site, and half of the cases are located in Waldeyer's ring[3]. The tumour may present clinical symptoms and radiographic findings as local swelling, pain or discomfort, ulcer and bone resorption mimicking other pathologic lesions such as periodontal disease, pericoronitis, apical radiolucencies or dental abscesses[5]. We report a case of a patient with DLBCL of the submental region staged at I AE according to the Ann Arbor lymphoma staging system.

Primary Cutaneous T-Cell Lymphoma Treated with Electron Therapy

The primary cutaneous lymphomas are a group of rare malignant lesions involving the skin, representing only 2% of new cases of NHL per year; Distinct types of cutaneous T-cell lymphoma and cutaneous B-cell lymphoma can be distinguished. In the Western world, cutaneous T-cell lymphomas constitute 75% to 80% of primary cutaneous lymphomas, with mycosis fungoides the most common type, and cutaneous B-cell lymphomas 20% to 25%. Radiation therapy of primary cutaneous lymphomas requires the use of special techniques. Here, we present the case of a woman of 27 years with cutaneous T-Cell lymphoma, which was treated with electron therapy with good results.

Breast MRI background parenchymal enhancement (BPE) correlates with the risk of breast cancer

ObjectivesTo investigate whether background parenchymal enhancement (BPE) and breast cancer would correlate searching for any significant difference of BPE pattern distribution in case of benign or malignant lesions. Methods386 patients, including 180 pre-menopausal (group 1) and 206 post-menopausal (group 2), underwent MR examination. Two radiologists evaluated MR images classifying normal BPE as minimal, mild, moderate or marked. The two groups of patients were subdivided into 3 categories based on MRI findings (negative, benign and malignant lesions). The distribution of BPE patterns within the two groups and within the three MR categories was calculated. The χ2 test was used to evaluate BPE type distribution in the three patient categories and any statistically significant correlation of BPE with lesion type was calculated. The Student t test was applied to search for any statistically significant difference between BPE type rates in group 1 and 2. ResultsThe χ2 test demonstrated a statistically significant difference in the distribution of BPE types in negative patients and benign lesions as compared with malignant ones (p<0.05). A significantly higher prevalence of moderate and marked BPE was found among malignant lesions (group 1: 32% and 42%, respectively; group 2: 31% and 46%, respectively) while a predominance of minimal and mild BPE among negative patients (group 1: 60% and 36%, respectively; group 2: 68% and 32%, respectively) and benign lesions (group 1: 54% and 38%, respectively; group 2: 75% and 17%, respectively) was found. The Student t test did not show a statistically significant difference between BPE type rates in group 1 and 2 (p>0.05). ConclusionNormal BPE could correlate with the risk of breast cancer being such BPE patterns as moderate and marked associated with patients with malignant lesions in both pre and post-menopausal women.

Increased number of volatile organic compounds over malignant glottic lesions.

Electronic noses can identify diseases, including head and neck squamous cell carcinoma (SCC) by the fingerprint of volatile organic compounds (VOCs) in exhaled air. However, whether these VOCs originated from the malignant lesion itself remains unclear. The objective was to test for the presence and properties of VOCs directly over the vocal folds in malignant and benign lesions, as a potential tool for noninvasive screening. Prospective observational case control study. Samples of mucus directly covering vocal fold lesions were analyzed using gas chromatography mass spectrometry for detection of VOCs, and evaluation of the properties and quantity of VOCs in the samples. Additionally, samples of oropharyngeal mucus were analyzed to exclude VOCs found also in the vicinity of the lesion. Benign and malignant lesion groups were compared using a nonparametric (Mann-Whitney) test. We studied 14 patients, six with SCC and eight with benign pathology. We found an increased number of discrete VOC types in patients with SCC both above the lesion (SCC = 4.333 ± 2.5, benign = 0.875 ± 0.6; Z=3, P < .001) and directly above the lesion with exclusion of its vicinity (SCC = 3.167 ± 1.9, benign = 0.5 ± 0.5; Z = 2.8, P < .003). VOCs detected in SCCs but not in benign samples included the straight-chain fatty acids: butyric acid, pentanoic acid, hexanoic acid, and heptanoic acid. Compared with benign vocal fold lesions, the environment of vocal folds in SCC is enriched with VOCs. These preliminary findings highlight a unique pattern that may contribute to the development of a future minimally invasive technology for screening vocal fold lesions for malignancy. NA Laryngoscope, 126:1606-1611, 2016.

Sacrococcygeal Teratoma: Experience with 36 Patients in a Teritiary Care Hospital

Introduction: Sacrococcygeal teratomas (SCT) are the most common solid tumours in the neonatal period, originate from embryonic totipotent cells. Most of them are benign however some that present later in life and have major intra-pelvic component have greater malignant potential. Complete surgical excision provides an excellent prognosis. The aim of this study was to describe the clinical profile, age of presentation, sex distribution, diagnostic evaluation and management of children with a histological confirmed diagnosis of sacrococcygeal teratoma.Material and Methods: Patients with histological diagnosis of sacrococcygeal teratoma during a period from January 2011 to December 2012 were included in this retrospective study. Data collected included age of presentation, sex distribution, symptoms, associated anomalies, diagnostic evaluation, operative approach technique employed, tumour histology, operative complications and outcome.Results: Thirty six patients with diagnosis of sacrococcygeal teratoma were included in the study. Of these children, 58.33% were females and 41.66% were males. The median age at presentation was four days. 69.44% of patients presented during the neonatal period. 77.77% of patients presented with sacrococcygeal mass followed by lower abdominal mass in 11.11%. The tumour was resected by sacral approach in 27 patients and abdomino sacral approach in nine patients. Tumour was resectable in 34 patients and two had incomplete resection. Follow up duration varied from six months to 24 months.Conclusion: Sacrococcygeal teratomas represent a group of benign and malignant lesions of children. Neonates present with benign disease and aggressive lesions are seen as age progresses. Overall survival of SCT is high.J Nepal Paediatr Soc 2015;35(1):89-93