Malignant Neoplastic Lesions Research Articles

Differentiation of Benign and Malignant Neck Neoplastic Lesions Using Diffusion-Weighted Magnetic Resonance Imaging.

The most difficult diagnostic challenge in neck imaging is the differentiation between benign and malignant neoplasms. The purpose of this work was to study the role of the ADC (apparent diffusion coefficient) value in discriminating benign from malignant neck neoplastic lesions. The study was conducted on 53 patients with different neck pathologies (35 malignant and 18 benign/inflammatory). In all of the subjects, conventional MRI (magnetic resonance imaging) sequences were performed apart from DWI (diffusion-weighted imaging). The mean ADC values in the benign and malignant groups were compared using the Mann-Whitney test. The ADCs of malignant lesions (mean 0.86 ± 0.28) were significantly lower than the benign lesions (mean 1.43 ± 0.57), and the mean ADC values of the inflammatory lesions (1.19 ± 0.75) were significantly lower than those of the benign lesions. The cutoff value of 1.1 mm2/s effectively differentiated benign and malignant lesions with a 97.14% sensitivity, a 77.78% specificity, and an 86.2% accuracy. There were also statistically significant differences between the ADC values of different malignant tumors of the neck (p, 0.001). NHL (0.59 ± 0.09) revealed significantly lower ADC values than SCC (0.93 ± 0.15). An ADC cutoff point of 0.7 mm2/s was the best for differentiating NHL (non-Hodgkin lymphoma) from SCC (squamous cell carcinoma); it provided a diagnostic ability of 100.0% sensitivity and 89.47% specificity. ADC mapping may be an effective MRI tool for the differentiation of benign and inflammatory lesions from malignant tumors in the neck.

Sebaceous carcinoma of nasal ala: a case report

Nasal sebaceous carcinoma is an extremely rare adnexal skin tumor representing 0.2%-4.6% of all malignant neoplastic cutaneous lesions. It is seen most affecting the meibomian glands in the periocular region. Here we share a case of 65-year-old female patient with nasal mass over the right alar region, diagnosed as sebaceous carcinoma and managed with wide local excision of the mass was done defect was reconstructed with a nasolabial flap. Sebaceous carcinoma being very rare in nasal region we want to share the case details.

Association of benign and malignant neoplastic lesions of the eyelid with systemic inflammatory markers

ABSTRACT Clinical relevance The role and prognostic significance of systemic inflammatory markers in various malignancies have been the subject of investigation. The role of these inflammatory markers in eyelid lesions remains to be elucidated. Background Benign and malignant lesions of the eyelid are common presentations in eye clinics. Systemic inflammatory markers derived from a complete blood count may provide insight into the benign-malignant differentiation of the lesion. Methods This study included 134 patients who underwent surgery for eyelid lesions between 2021–2023. The lesions were evaluated by oculoplastic surgeons and operated on with a preliminary diagnosis of benign or malignant. According to the histopathological diagnosis, benign lesions were included in Group 1 and malignant lesions in Group 2. The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune inflammation index (SII) (NxP/L) based on neutrophil, lymphocyte, and platelet counts were calculated from the preoperative complete blood count of all patients. Results Eighty-eight patients were included in Group 1 and 46 patients in Group 2. There were 41/47 (Female/Male) in Group 1 and 19/27 (F/M) males in Group 2 (p = 0.345). The mean age was 62.91 ± 9.04 years in Group 1 and 65.41 ± 8.76 years in Group 2 (p = 0.127). The preliminary diagnosis and histopathological diagnosis were incompatible in 5 cases in both groups. In Group 1: NLR = 1.82 ± 0.72, PLR = 124.50 ± 45.19 and SII = 454.51 ± 220.20, in Group 2: NLR = 2.48 ± 0.89, PLR = 128.12 ± 49.58 and SII = 590.22 ± 271.09. NLR and SII differences between groups were statistically significant, while PLR was similar (p < 0.001, p = .002, p = .671). ROC curve analysis showed that the optimal cut-off values for NLR, PLR, and SII were 1.99, 119.16, and 475.21, respectively. Conclusion High levels of NLR and SII in eyelid tumours can be used as an adjunct to examination findings in the preliminary diagnosis of the lesion as benign or malignant and may influence surgical planning.

Cytomorphological Spectrum of Hepatic Lesions on Ultrasonography (USG) or CT-Guided Fine-Needle Aspiration Cytology (FNAC) in a Tertiary Care Centre, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India.

Background Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of the liver is a primary diagnostic procedure for primary and metastatic hepatic lesions. Despite histopathology being the gold standard, the outcomes of ultrasound-guided fine needle aspiration cytology are encouraging. Aims and objective The purpose of the study is to determine the diagnostic utility of ultrasonography (USG) or computerized tomography (CT)-guided FNAC in the detection of liver lesions, to investigate cytomorphological patterns of liver lesions identified by guided FNAC, and, wherever feasible, to correlate FNAC diagnosis with histopathology and imaging modalities. Materials and methods This was a hospital-based observational study of 62 patients carried out in the Department of Pathology, Rajendra Institute of Medical Sciences (RIMS) Ranchi during a period of 1.5 years from August 2020 to February 2022. The patients with suspected hepatic lesions were subjected to ultrasound-guided or CT-guided fine needle aspiration cytology (FNAC) following clinical and radiological evaluation and cytomorphological features were analyzed. Results Cyto-morphological diagnosis of 62 cases was categorized into 19 (30.64%) non-neoplastic lesions and 43 (69.35%) malignant neoplastic lesions. The different neoplastic lesions were 17 (27.41%) hepatocellular carcinoma, 1 (1.61%) hepatoblastoma, 1 (1.61%) cholangiocarcinoma, 23 (37.09%) metastatic adenocarcinoma and one case (1.61%) of unclassified malignancy. Histopathological correlation for confirming the diagnosis could be done in 33 malignant neoplastic lesions and the concordance rate of FNAC with respect to histopathological examination (HPE) was 92.11%. Overall diagnostic accuracy of the FNAC of liver to detect malignant lesions was 98.39%. Conclusion Compared to ultrasonography alone, ultrasound or CT-guided fine needle aspiration of the liver has a more promising role in the diagnosis and classification of hepatic lesions as it demands a higher level of precision to achieve diagnostic accuracy.

Premalignant and Malignant Ocular Surface Squamous Cell Neoplasia: A Retrospective Hospital-Based Study Spanning 18 Years

Abstract Ocular surface squamous cell neoplasia can arise from a premalignant lesion (conjunctival intraepithelial neoplasia or ocular surface squamous cell intraepithelial neoplasia). Their respective magnitudes will provide an indication of early treatment or progression of the disease. This study, therefore, aims to determine the frequency of premalignant and malignant ocular surface squamous neoplasia. This is a retrospective study of all cases of premalignant and malignant ocular surface squamous neoplastic lesions histologically diagnosed over an 18-year period at the Department of Anatomic Pathology, University of Benin Teaching Hospital. The results showed that there were more malignant ocular surface squamous neoplastic lesions relative to ocular surface squamous cell intraepithelial neoplastic lesions. Also, the latter occurs at a relatively lower median age in comparison to the former. In conclusion, our findings suggest that late presentation of symptoms may account for higher frequency of malignant ocular surface squamous neoplastic lesions.

"Modernizing Cervical Cytology Screening with Liquid-Based Methods at Community-Level Hospitals: A Much-Needed Breakthrough for India".

Cervical cancer still ranks highest causing cancer-related morbidity and mortality in women in India. It is prudent to emphasise and implement cervical cancer screening strategies in the population efficiently and with regular intervals. Conventionally, PAP smear cytology is obtained by wooden spatula-Ayre's spatula. To improve sensitivity and specificity of the procedure and detection rate, better techniques of cells retrieval are available mainly liquid-based cytology (LBC), with help of cyto-brush. Literature has consistently proven efficiency of the technique and also reduced the proportion of inadequate sampling. We conduct this study to compare both the techniques and efficiency in a community hospital from data over 6years,to asses its role and benefits among Indian women. To compare conventional PAP smear and liquid-based cytology techniques analysing detection rates of positive lesions (CIN and also includes ASCUS and malignant), incidence of inadequate sampling, efficiency and cost-effectiveness. This is retrospective study at tertiary care obstetric hospital affiliated to government-run medical college in a metropolitan city of Mumbai. Data are retrieved from the Pathology Department, Medical Records Department, laboratory books and OPD registers. Pap's smear sampling was done mainly from OPD with all indications including routine tests as a part of gynaecological evaluation and screening, as well as for suspicious lesions on inspection. Group A consists women who had conventional PAP smear test for 3years (Dec 2015-Nov 2018) and Group B had women who benefited by LBC method for 3years (Dec 2018-Nov 2021). COVID-19 pandemic majorly affected the routine gynaecological OPD practice during 2021 as hospital was COVID facility hospital. Demographic parameters and presentations were comparable and similar. LBC methods have higher detection rate for positive reports, including ASCUS. But results were comparable in both groups and not statistically different. Importantly, incidences of inadequate sampling are reduced significantly with the LBC method. Unsatisfactory smears war high in Group A (7.752%) compared to Group B (3.712%) p-value 0.005, stating the increased rate of requirement of sending repeat smears, which involves higher engagement of time, resources and active participation from healthcare personnel. Good detection rates and significantly low rates of unsatisfactory smears make LBC rational and cost-effective. These are the times to switch to liquid-based cytology techniques, especially at the community level hospitals; in order to detect more women with cervical premalignant as well as malignant neoplastic lesions and to save lives. This can be made possible by emphasising the policy makers to incorporate these services through quality resources.

EVALUATION OF HEPATIC MASS LESIONS BY DIFFUSION WEIGHTED MAGNETIC RESONANCE IMAGING

Objectives: The purpose of this study was to compare apparent diffusion coefficient (ADC) values for benign and malignant neoplastic hepatic lesions and also for suspected infective hepatic masses in which histopathology may always not be indicated. Methods: This is a cross-sectional study conducted in the department of radio diagnosis and imaging, army hospital research and referral, Delhi Cantt. All the patients coming for magnetic resonance imaging (MRI) scans for focal liver lesions detected on other imaging modalities were included. The imaging was done at the 1.5 Tesla MAGNETOM AVANTO A Tim system (Siemens Ltd.). Various parameters of the morphology of lesions in conventional MRI and parameters in diffusion-weighted MRI were evaluated. Results: A total of 75 patients were included in the study. The mean age of the subjects was 52.57±15.28 years, with a male: female sex ratio of 0.5:1. Among the 75 subjects, 20 subjects with hepatic cysts had no restrictions, and 12 patients with hemangioma were hyperintense on both diffusion-weighted imaging (DWI) and ADC. The mean differences between benign and malignant lesion ADC values. The difference was statistically significant (p&lt;0.001). In the present study, we get a cut-off for the ADC value of 1.581×10-3 mm2/s, which proved to be an optimal parameter for differentiation between benign and malignant lesions. Conclusion: DWI proved to be a very useful supplementary imaging technique in conjunction with conventional imaging sequences in the analysis of focal hepatic lesions and should be included in the imaging algorithm for such lesions.

Galectin-3 expression by thyroid neoplasms in a center in southwest Nigeria

Background: Galectin-3 (GAL-3), which is known to be expressed in certain normal tissues and is implicated in tumor progression and metastasis, serves as a valuable marker for distinguishing malignant thyroid lesions from benign thyroid lesions. This study aimed to assess the clinical and histopathological features of thyroid neoplasms at OAUTHC Ile Ife utilizing GAL-3 immunohistochemistry and to compare these findings with those of studies conducted in other regions of the world. Materials and Methods: Histology slides from 56 patients with thyroid neoplasms spanning a 20-year period were subjected to immunohistochemical staining with monoclonal antibodies against GAL-3. Evaluation was based on the 2022 World Health Organization Classification of Thyroid Neoplasms, categorizing marker expression as follows: 1+ (10–25% stained cells), 2+ (26–50% stained cells), 3+ (51–75% stained cells), and 4+ (&gt;75% stained cells). Negative staining indicated no staining, while localized staining (focal) represented &lt;50% of cells stained (1+ or 2+), and diffuse staining indicated &gt;50% of cells stained (3+ or 4+). Results: A total of 56 patients with neoplastic thyroid disease were studied, including 15 males and 41 females. Among the 16 benign neoplastic lesions, four (25.0%) exhibited focal GAL-3 expression, while 12 (75.0%) showed no expression. Among the forty malignant neoplastic lesions, five (12.5%) tested negative for the GAL-3 immunomarker, while 35 (87.5%) demonstrated positive expression to varying degrees. Among the positive malignant lesions, two (5.0%) displayed focal GAL-3 expression, while 33 (82.5%) exhibited diffuse staining of tumor cells. The diffuse and strong expression of GAL-3 was significantly greater in malignant thyroid neoplasms than in benign neoplasms (p&lt;0.05). The sensitivity and specificity of GAL-3 were 88% and 75%, respectively. Conclusion: Our findings align with the previous research indicating that diffuse and strong immunohistochemical expression of GAL-3 is indicative of thyroid gland malignancy. GAL-3 serves as a valuable tool in diagnosing thyroid neoplasms, particularly in cases where histomorphologic characteristics are inconclusive or unclear.

Pulmonary abscess with atypical topography - computed tomography assessment before and after treatment.

We present a clinical case of a patient with neurological sequelae, dementia, gastrostomy and tracheostomy with a metal canula, who developed a lung abscess in an atypical topography, in the anterior segment of the left upper lobe, being attended to in the emergency department. A 79-year-old man who was bedridden and with neurological sequelae resulting from a hemorrhagic stroke, with gastrostomy and tracheostomy with a metal canula, was attended for daily fever and increased secretion trough the canula, and a diagnosis of bronchoaspiration pneumonia was made. The chest X-ray was unremarkable with an evaluation impaired by the patient's posture. The chest CT showed a characteristic image of an abscess in the topography of the anterior segment of the upper lobe. Improvement in the patient`s clinical condition was accompanied by an improvement in the CT imaging results. And the other exams carried out did not show any other associated lung disease. Chest X-ray is still the initial method for studying infectious lung lesions, and CT is indicated in cases where the appearance of the lesion is not well defined, if doubts persist, whether the patient is immunosuppressed or oncological. CT can provide better definition of abscess imaging findings and is particularly useful for visualizing cavities not well delineated by X-ray, especially when a malignant neoplastic tumor lesion is suspected or when there is an associated pleural collection.

The diagnostic performance of ultrasound in the diagnosis of indeterminate adnexal masses based on the O-RADS US scoring system

BackgroundOne of the most frequent reasons for gynecologic imaging is adnexal masses. The aim of the study is to assess the diagnostic performance of ultrasonography in the identification of ambiguous adnexal masses using the O-RADS US scoring system.MethodsThis study included 108 cases and involved females with indeterminate adnexal masses, with any age group who were sent to the diagnostic ultrasonography department for evaluation of a worrisome adnexal mass lesion. We excluded patients who refused the examination despite informed discussion with the sonographer and patients with a previous history of operated adnexal lesion.ResultsBased on the O-RADS US score, more than half masses (52.8%) were diagnosed as O-RADS 3, which is low-risk malignant, and 47.2% were diagnosed as O-RADS 4, being intermediate-risk malignant. Regarding US O-RADS categorization in relation to the reference results by pathology, 57 lesions were categorized as O-RADS 3 by the US, and 18 of them was diagnosed as malignant according to pathology. Out of 51 lesions categorized as O-RADS 4 by the US, 30 were diagnosed as benign by pathology. At cutoff 4, the O-RADS US score for malignancy gave a sensitivity of 93.13% (95% CI 25.13–80.78), specificity of 66.72% (95% CI 34.49–76.81), PPV of 93.18% (95% CI 26.07–58.16), and NPV of 75.42% (95% CI 52.13–81.17) with an overall accuracy of 92.56% (95% CI 38.10–72.06).ConclusionsIn order to distinguish between benign and malignant neoplastic lesions, the US O-RADS classification system is a crucial non-invasive diagnostic tool for suspected ovarian tumors.

Clinico-pathological study of sinonasal masses at a tertiary care hospital of southern Bihar

Background: This study focuses on sino-nasal masses (SNMs) and their presentation with their radiological findings and corroboration with initial diagnosis and histopathological examination (HPE). Methods: A prospective study conducted in total 62 patients with SNMs presenting between the period (September 2020 to October 2022) in medical college, southern Bihar. Patients were subjected to detailed history and battery of tests with all necessary investigations. Final diagnosis was concluded after HPE. Results: Age distribution ranged from 10 to 64 years with mean age of 34.2 and M: F ratio of 1.14:1. Demography suggested predisposition in low socioeconomic strata (N=36; 58.06%). Majority fell in category of farmers (N=16; 25.8%) followed by housewives, laborers. Majority presented within a time frame of 1-2 years of onset of symptoms/appearance of the lesion (N=25;40.3%) followed by 6 months to 1-year. Most common presenting symptom was nasal obstruction (N=59;95.16%), followed by nasal discharge (n= 49, 79.03%). HPE concluded 45 samples (72.58%) as non-neoplastic, 15 samples (24.19%) as benign neoplastic (96.7%) and 2 as malignant neoplastic lesions (3.22%). In 58 out of 62 patients (93.54%) the clinical diagnosis was corroborated with HPE diagnosis. Conclusions: Nasal polyps, the most common benign lesions and SCCs, the most common malignant lesion of SNT. Malignant lesions common in elderlies should be differentiated from non-malignant lesions. Due to similar presentation of diversified aetiology, a clinical and radiological evaluation is of prime for initial management. HPE remains the gold standard for final diagnosis and definitive management.

MUCOEPIDERMOID CARCINOMA ON THE FLOOR OF THE MOUTH: A CASE REPORT

A 60-year-old man sought out our dental service with a lesion in the oral mucosa. The intraoral examination showed a nodular, painless, normochromic, and non-bleeding lesion with approximately 30 days of evolution, affecting the right region of the mouth floor with a clinical hypothesis of adenoma. The biopsy was performed and the histopathological analysis revealed a malignant neoplastic lesion of the salivary gland characterized by the proliferation of mucous cells, epidermoids, and intermediate cells arranged either in sheets or in islands, forming cystic spaces with eosinophilic content inside, which were often covered by basaloid mucous cells. The diagnosis of mucoepidermoid carcinoma was established, and the patient was referred for treatment at the oncology referral center. A 60-year-old man sought out our dental service with a lesion in the oral mucosa. The intraoral examination showed a nodular, painless, normochromic, and non-bleeding lesion with approximately 30 days of evolution, affecting the right region of the mouth floor with a clinical hypothesis of adenoma. The biopsy was performed and the histopathological analysis revealed a malignant neoplastic lesion of the salivary gland characterized by the proliferation of mucous cells, epidermoids, and intermediate cells arranged either in sheets or in islands, forming cystic spaces with eosinophilic content inside, which were often covered by basaloid mucous cells. The diagnosis of mucoepidermoid carcinoma was established, and the patient was referred for treatment at the oncology referral center.

A CLINICOPATHOLOGICAL STUDY OF 100 CASES OF SALIVARY GLAND LESIONS AT A TERTIARY CARE CENTRE.

Background: Salivary gland shows varied types of pathological lesions ranging from inammatory lesions to neoplasms. We have studied the salivary gland lesions with correlation to clinical and histopathologic features. Objective: Aim of this study was – 1. To study the epidemiology of salivary gland lesions in a tertiary care centre with respect to the age, sex and site distribution. 2. To study the histomorphological aspect of these lesions. 3. To correlate between ne needle aspiration cytology and histopathology of these lesions. Materials and Methods: The present observational study was conducted in the department of pathology in Dr. VPMCH&amp;RC, Nashik. Total 100 cases were studied over a period of two years with particular reference to age, sex, site, cytological details &amp; histological types as per WHO classication. Detailed FNAC &amp; histopathological examination was done in all the cases. Correlation between the cytological &amp; histopathological diagnoses was assessed. A total of 100 cases were studied, comprising of 62 Results: male &amp; 38 female and 16 cases were malignant. The parotid gland was the most commonly involved site (70% of cases). Of the 46 non-neoplastic cases, 38 were of chronic sialadenitis and 8 cases of mucous retention cyst. Among the 38 benign neoplastic lesions, 32 were Pleomorphic adenoma and 6 were Warthin's tumour. Mucoepidermoid carcinoma (8 cases) was the most common malignant neoplastic lesions. Correlated in 95% of instances. Salivary gland lesions, are most Conclusion: nd th commonly seen in 2 to 6 decade of life with more male predominance. Parotid gland is the most common site. Lesions have more frequent occurrences compared to neoplastic lesions, with chronic sialadenitis having highest incidence. Histopathologic examination is fairly accurate in making a diagnosis especially in non-neoplastic &amp; benign neoplasms.

Histopathological Study Of Various Neoplastic And Non-neoplastic Lesions Of Small Intestine At Tertiary Care Centre Of South Gujarat

Introduction: Small intestine, the longest part of digestive tract, makes up about 75% of the total length and can be affected by various developmental, inflammatory or neoplastic conditions. Non neoplastic lesions like abdominal tuberculosis are frequently seen in small intestine. Although small intestine is an uncommon site for tumour nearly twothirds of these tumours are malignant, with most of them being adenocarcinoma. To study the histopat Objective: hology of various neoplastic and non-neoplastic lesions of small intestine and to evaluate their frequency and pattern with respect to age, sex, anatomical sites and clinical findings. This observational cross-sectional Materials and Methods: study was conducted on a total of 101 small intestinal specimens including biopsies and surgically resected specimen received for histopathological examination over a period of two years in the Department of Pathology affiliated with tertiary care hospital. In addition to Haematoxylin and Eosin staining, Immunohistochemistry and special stains were also done in required cases. This study showed a male is to female ratio of 1.97:1. Peak incidence of Results: cases was seen in the 31-40 years age group. Out of total 101 pathological lesions 87 cases were non -neoplastic that included Infective lesions like tuberculous enteritis, Inflammatory lesions like Non-specific Enteritis, Necrotising Enteritis and Congenital lesions like Meckel's diverticulum, Enteric Duplication cyst and Celiac disease while only 14 cases were neoplastic that included benign neoplastic lesions like various types of polyps and malignant neoplastic lesions like adenocarcinoma, GIST, neuroendocrine tumour and B cell NHL. This study showed a characteristic Conclusion: distribution of cases in the three different parts of small intestine and highlighted the clinical importance of timely detection of intestinal pathology by the means of detailed clinical study combined with radiological and histopathological examination.

HISTOMORPHOLOGICAL EVALUATION OF LESIONS IN NEPHRECTOMY SPECIMENS.

Background: Nephrectomy either partial or radical has become a common procedure in surgical and urological practice. In this study pathological reports were interpreted for the following parameters: age, gender, pathological diagnosis. An indication of nephrectomy depends on type of lesion, extent of damage, general condition of patient and status of contralateral kidney. Method: The present ambiceptive data analysis has been carried out in Department of Pathology in tertiary care centre under Maharashtra University of Health Sciences by histopathological examination of nephrectomy specimens. A Results: total of 59 nephrectomy cases were included in the study. Non neoplastic and neoplastic cases were 44 (75%) and 15 (25%) respectively. Among non-neoplastic lesions, total of 32 cases (72%) were diagnosed as Chronic pyelonephritis with End Stage Renal Disease(ESRD) . Others Chronic Xanthogranulomatous Pyelonephritis with ESRD 9 cases (21%) and Chronic Glomerulonephritis with ESRD 3 cases (7%). Neoplastic lesions constitutes 15 cases with peak in 6th decade. Renal Cell Carcinoma(RCC) is the most common neoplastic lesion. The distribution among the neoplastic lesions include: Clear cell RCC (40%), Papillary RCC (13.34%), Mixed RCC (13.34%), Chromophobe RCC (13.34%), Multicystic nephroma (6.67%), Collecting duct carcinoma (6.67%) and Renal Medullary carcinoma (6.67%). Fuhrman's nuclear grade II is the most common among the RCC. Rare case such as Collecting Duct carcinoma, Renal Medullary carcinoma and Sarcomatoid RCC were diagnosed during the study period. On IHC, Collecting Duct carcinoma is positive for HMW CK, PAX8 and Renal medullary carcinoma is positive for Vimentin. The histopathological Conclusion: examination is essential to differentiate between benign and malignant neoplastic lesions and in grading of malignant lesions which help in treatment and further management of patients.

Sinonasal masses: modalities, clinical presentation, and management in Sudan

BackgroundSinonasal masses are not an uncommon spectrum of diseases. They are frequently encountered in Sudan, sometimes with variability in modalities across the country. The objective of this study is to document the pattern of sinonasal masses in Sudanese patients and to highlight the knowledge of the modalities, clinical presentations, and management. As a consequence, this will raise awareness especially of the general practitioners and family physicians and hence the community locally and regionally. Early diagnosis and appropriate management can reduce the rate of recurrence, fatal complications, and hence morbidity and mortality.MethodsThis is a prospective descriptive, comparative hospital-based study conducted from January 2020 to January 2021. All patients with sinonasal masses, who came to Khartoum ENT Teaching Hospital seeking medical advice during the above-mentioned period were included in the study provided they satisfy the inclusion criteria. Enrollment was optional with the right to withdraw at any time. Consent was verbal with the reassurance about the aspect of confidentiality, privacy, and consent of the data. Ethical clearance was obtained from the ethical committee (EDC) SMSB and from the research committee of Khartoum teaching hospital. Analysis was done using a computer and the statistical package of social sciences SPSS V.25ResultsA total number of 244 patients were studied. The age group of 21–40 years was the most encountered with the disease (42.6%). Two hundred three patients (83%) had a non-neoplastic disease, (9%) benign neoplastic lesions, and (8%) malignant neoplastic lesions. The non-neoplastic group was dominated by nasal polyposis of which the fungal were the most common (50%). Among benign neoplastic lesions, pyogenic granuloma ranked first (24%). Among malignant neoplastic lesions, squamous cell carcinoma dominated the epithelial origin lesions (71%) and Rhabdomyosarcoma dominated the connective tissue cell types (50%). Nasal obstruction is the most common complaint (94.7%) followed by nasal discharge (64.8%) then anosmia (53.3%). Endoscopic surgery was done in (84.4%) of patients, combined approach endoscopic and open surgery in (5.3%) while open surgery alone was done in 2.5%. Radiation and chemotherapy were used in 2% each, while chemo-radiation was used in (2.5%). The rest of the cases (1.3%) were managed by surgery followed by chemoradiation.ConclusionPatients with sinonasal masses in Sudan especially the age group 21–40 years must be seen in specialized Otolaryngology clinics to pick, diagnose and treat significant diseases in an early stage. Radiology and histopathology are a must in sinonasal swellings to diagnose malignant diseases at an early stage. Nasosinus fungal polyposis being the commonest in non-neoplastic lesions, the commonest among all sinonasal masses added together, and a known reported endemic disease in the country must receive special consideration and investigation for early diagnosis and treatment.

Radiological Assessment of Retroperitoneal Neoplastic Lesions in a Tertiary Care Hospital, Rajkot, Gujarat, India: A Cross-sectional Study

Introduction: The retroperitoneum is an important potential space in the human abdomen. Retroperitoneal (RP) tumours are extremely vast in position, size, rate of growth and in pathological types. They silently grow before giving rise to symptoms or become palpable. Radiology plays a unique role in sustaining the optimum information for the diagnosis of lesions of retroperitoneal space. Computed Tomography (CT) is generally more superior in the diagnosis of retroperitoneal neoplastic lesions in comparison to X-Ray or Ultrasonography (USG) but later are cost-effective and readily available. Aim: To describe the clinical spectrum of retroperitonial neoplastic lesions and also to evaluate the radiographic features of different retroperitoneal neoplastic lesions with various radiological modalities. Materials and Methods: This cross-sectional study was conducted on 50 patients from November 2019 to April 2021, in Department of Radiology of Pandit Deendayal Upadhyay Government Medical College and Civil Hospital, Rajkot, Gujarat. Each patient had undergone CT, USG and X-ray as indicated. Descriptive data was analysed and presented in terms of frequencies and percentages. Results: In this study among 50 patients, males (60%) were found to be affected more than the females (40%) with a male:female ratio of 1.5:1. The most common malignant RP neoplastic lesion was metastatic nodal masses and lymphoma. 41 (82%) of cases were malignant while 9 (18%) were benign neoplasms. The most common benign RP neoplastic lesion was teratoma. The most common presentation in patients with retroperitoneal lesions was pain and lump in the abdomen with abdominal distension. Most of the malignant lesions were of average size more than 10 cm. Conclusion: Most of the retroperitoneal neoplastic lesions were malignant and seen in males. CT, USG and X-ray are helpful in the characterisation and diagnosis of retroperitoneal neoplastic masses.

Study of thyroid lesions based on cytological and histopathological comparison

Thyroid swelling is one of the most common indications for surgical excision. Since most of the swellings are benign and with euthyroid status, these patients do not require surgical excision. Fine needle aspiration cytology is a rapid, efficient, inexpensive and safe diagnostic method in these cases. FNAC has some limitations, particularly limited to representatives of samples and exact typing of benign and malignant neoplastic lesions. Thus, FNAC alone may not give a confirmative diagnosis regarding few thyroid lesions. Hence, histopathological study has been the standard technique for the diagnosis of thyroid lesions. To study the accuracy of fine needle aspiration cytology (FNAC) of thyroid swellings and to correlate with histopathology so as to avoid unnecessary surgeries for benign lesions.This was a prospective study done on 55 cases wherein Fine Needle Aspiration cytology was done followed by histopathology. The reports on both modalities were correlated and sensitivity, specificity and accuracy were calculated. In the present study, females (72.7%) outnumbered males (27.2%). Non neoplastic lesions constituted 83.3% in our study. Among Non-neoplastic lesions, Nodular goiter was most commonly reported and constituted 49% cases. The sensitivity and specificity for thyroid FNAC are reasonably good. FNAC is a minimally invasive, low cost testing modality. It accurately diagnoses malignant thyroid lesions. It has good specificity and accuracy but is less sensitive in diagnosing definitive etiology. However, it is an important diagnostic test to guide the management of thyroid lesions.

Chronic rhinosinusitis with nasal polyps does not harbor KRAS, BRAF, and EGFR mutations.

Chronic rhinosinusitis is a chronic inflammation of the nasal mucosa and nasal polyps are present in ~25%-30% of cases (chronic rhinosinusitis with nasal polyps [CRSwNP]). CRSwNP is associated with significant morbidity and decreased quality of life, making it clinically important. Inflammation leads to DNA damage and DNA mutations occur in some inflammatory diseases. Notably, mutations in KRAS, BRAF, and EGFR have been reported in different human benign and malignant neoplastic lesions. In addition, KRAS mutations have also been reported in non-neoplastic tissues under chronic inflammatory conditions. Importantly, KRAS mutations have been reported in oncocytic sinonasal papillomas and sinonasal squamous cell carcinoma associated with oncocytic sinonasal papilloma and EGFR mutations have been reported in sinonasal adenocarcinoma, inverted sinonasal papilloma, and sinonasal squamous cell carcinoma associated with inverted sinonasal papilloma. The molecular pathogenesis of nasal polyps remains unclear. Therefore, the present study aimed to investigate the presence of KRAS, BRAF, and EGFR pathogenic mutations in CRSwNP. Fourteen chronic rhinosinusitis-associated nasal polyp samples were direct sequenced, targeting KRAS exons 2, 3, and 4 (encompassing important hotspot mutations, including codons 12, 13, 61 and 146), BRAF exons 11 and 15, and EGFR exons 19 and 20. No pathogenic mutations were detected in the sequenced regions of KRAS, BRAF, and EGFR genes. This finding suggests that mutations in these genes are not a frequent event in CRSwNP, and, if they occur, they might represent marginal events at best.

Sinonasal mass lesions: A clinicopathological study with p63 and p16 immunohistochemical expressions.

The worldwide annual incidence of carcinomas of the sinonasal tract is 0.5 to 1.0 patients per 100,000 per year. P63 plays a role in epithelial development and is used as a marker for basal and myoepithelial cells. Expression of p16 occurs as a result of functional inactivation of the retinoblastoma protein (pRb) by the human papilloma virus (HPV) E7 protein. This study aims to study the histological spectrum of benign and malignant sinonasal mass lesions and to study the immunohistochemical expression of p63 in different type of sinonasal mass lesions. It also aims to ascertain the incidence of high-risk HPV in primary sinonasal mass lesions with p16 immunohistochemistry and delineate the histological spectrum of HPV-related sinonasal lesions. This cross-sectional study was conducted on 80 cases from June 2018 to June 2020 at a tertiary care hospital. Clinical history including demographic parameters were collected in the study proforma. The gross findings of the specimens noted and histopathological examination by H&E staining done. Immunohistochemistry staining for p63 and p16 expression was performed on all cases. Most common age group affected was 41-60 years with male:female ratio of 1.67:1. Nonneoplastic lesions (38.7%) comprised majority of the cases followed by benign neoplastic lesions (31.3%) and malignant neoplastic lesions (30%). Among the malignant neoplastic lesions, p63 showed positive expression in 75% (p = 0.005) and p16 showed positive expression in 41.7% (p = 0.023). Among benign and nonneoplastic lesions, p63 showed positivity in 21.4% (p = 0.000) and p16 showed positivity in 44.6% (p = 0.040). We analyzed p63 and p16 expression in varied lineages like carcinomas, papillomas, and neuroectodermal differentiation arising from the sinonasal tract and also in relation to other clinicopathological parameters. This study revealed p63 expression was associated more with the squamous cell carcinomas and nasopharyngeal carcinomas. Sinonasal tract malignancies are also associated with HPV infections that are identifiable by p16 immunostaining and, thus, could provide new prospects in identifying any definite biological and clinical characteristics associated with HPV as well as advancement in the targeted therapies for this patient population.