Natural History Of Lesions Research Articles

Natural history of lesions with the MR imaging appearance of multinodular and vacuolating neuronal tumor.

Multinodular and vacuolating neuronal tumor (MVNT) have been recently added to the WHO classification of CNS tumors and has not been extensively reported upon in the radiological literature. We report the first radiological and the largest series of cases, aiming to highlight the natural history of lesions with the imaging appearance of MVNT with long follow-up time. In this retrospective study, we collected cases with the imaging appearance of MVNT. All lesions were evaluated by using routine MR imaging, with follow-up of up to 93months. Patient demographics, clinical course, and MRI features of the lesions were recorded. Twenty-four subjects were enrolled, f/m=16:8, age range 24-59years, with a median age of 45years. The patients' symptoms were often episodic and most frequently due to headaches in 12 (50%), visual symptoms in 6 (25%), seizures in 5±1 (20-25%), paresthesia in 4 (~17%), cognitive difficulties in 4 (~17%), in addition to other variable neurological symptoms, or incidental. A total of 30 lesions identified, 77% of the lesions had gadolinium-enhanced MRI and only 13% showed enhancement. A 6.7% of the lesions that had MRI followed up showed progression, while the rest remained stable up to 93months interval. All patients had intact neurological examinations (except one case that was diagnosed with optic neuritis), were managed conservatively, and did well. The natural history of lesions with imaging features of MVNT is overall stable from a clinical and imaging appearance over time.

The Natural History of Gastrointestinal Subepithelial Tumors Arising From Muscularis Propria

The majority of lesions originating from muscularis propria of stomach, duodenum, and colon are gastrointestinal stromal tumors (GISTs). Surgery is indicated when endosonographic criteria of malignancy are met, but little is known about the natural history of lesions with benign endosonographic features. Aim of this study was to evaluate the natural course of benign-appearing lesions originating from muscularis propria in organs where GISTs significantly overcome leiomyomas. A total of 49 asymptomatic patients with hypoechoic lesions originating from the fourth layer of the gastrointestinal tract entered a follow-up program by means of endoscopic ultrasonography. All lesions were nonulcerated, <3 cm in maximal diameter, with regular margins, and cystic spaces of <3 mm. After a mean follow-up of 31+/-20.8 months and a median of 2 (range, 1 to 5) endosonographies/patient, no change in echostructure or dimensions was seen in 44 subjects whereas in 5, an increase of at least 25% in 1 diameter occurred. Surgical removal was proposed to all: 1 patient refused (she is still alive and symptom-free after 4 y), 3 of the 4 lesions removed proved to be GISTs with very low or low risk of malignancy and 1 lesion was classified as a glomus tumor with no malignant appearance. Even small and benign-appearing lesions from muscularis propria may increase in size over time but this increase cannot be considered as an index of malignancy. As most of these lesions are GISTs, a policy of surveillance is advisable.

P070 - The role of preoperative optimalisation before surgery in IBD patients

P070 - The role of preoperative optimalisation before surgery in IBD patients

Recurrent primary vulvovaginal malignant melanoma arising in melanomain situ– the natural history of lesions followed for 23 years

Multifocal melanoma and melanomain situof the vulva and vagina are uncommon lesions, and our understanding of their natural history is limited. Vulvovaginal melanoma appears to be biologically different from cutaneous melanoma and has more in common with mucosal melanoma. A 60-year-old woman presented in 1977 with a pigmented vulvar lesion. Histologic examination revealed melanomain situassociated with focal invasive melanoma. She re-presented with recurrent primary melanomas arising in melanomain situin 1990 and 1998 and died of widespread metastatic melanoma in 2000. Melanomain situof the vulva and vagina is rare and appears to have a relatively slow but definite progression to invasive melanoma. All suspicious pigmented lesions in this region should be biopsied, and if multifocalin situmelanoma is identified, vulvo(vagin)ectomy should be considered.

Natural history of polypoid lesions in the gall bladder.

Although polypoid lesions of the gall bladder are frequently observed in asymptomatic subjects, the natural history of these lesions has never been studied using ultrasonography. The natural history of polypoid lesions of the gall bladder was investigated using ultrasonography. Among 4343 patients who presented to the outpatient clinic of Tsuchiura Kyodo General Hospital in 1988, 111 subjects were diagnosed as having polypoid lesions of the gall bladder by ultrasonography. Among these patients, two had gall bladder carcinoma. The remaining 109 subjects (58 female; age: median 54, range 25-89) were enrolled in this study. The subjects were followed up by ultrasonography once or twice a year until 1994. Four patients received cholecystectomy and two patients died of other causes during the observation period. In one patient, gall bladder carcinoma was found, but its location was different from that of the pre-existing polyp. The size of the lesions did not change in 88.3% of the other 130 patients during this period, even among those in whom the initial size of the lesion exceeded 10 mm. There was no apparent correlation between the change in the diameter of the polypoid lesions and patients' sex or age. Most polypoid lesions of the gall bladder detected by ultrasonography are benign.