Non-neoplastic Causes Research Articles

Utility and Clinical Implications of Appendicular Skeleton Magnetic Resonance Imaging in Multiple Myeloma: A Single-Institutional 15-Year Experience.

The aim of this study was to evaluate the utility of appendicular skeleton magnetic resonance imaging (MRI) in the management of multiple myeloma over 15 years. A total of 107 appendicular MRIs were obtained from 67 patients. Variables including age, sex, diagnosis, stage, indication, transplant status, MRI result, and treatment course were analyzed. The most common indication was pain (76.6%). The most commonly affected bone groups were the proximal lower (54.3%) and upper extremity (47.6%). Most (83%) positive examinations demonstrated focal disease. Advanced Durie-Salmon stage was associated with increase in appendicular disease (P = 0.0056). Increasing age and prior negative positron emission tomography/computed tomography were associated with a decrease in appendicular disease (P = 0.0036 and 0.0011). When neoplasm was seen, 58.5% underwent management alteration. Advanced stage and history of relapse were associated with treatment alterations (P = 0.0096 and 0.0031). Appendicular MRIs comprised 9.6% of MRIs ordered. Appendicular MRI elucidates both neoplastic and nonneoplastic causes of pain. Most examinations with MRI positive for myeloma had subsequent skeletal disease and resulted in altered management.

How I investigate dysgranulopoiesis.

Dysgranulopoiesis is a condition in which granulocytic production is defective and is most often described in neoplastic conditions. However, it can also be frequently seen in non-neoplastic conditions. Early suspicion and detection of these non-neoplastic causes may prevent further invasive and expensive interventions. In this review, we take a look at the various causes of dysgranulopoiesis with an emphasis on non-neoplastic etiologies, followed by a detailed outline of the laboratory approach for determining its many causes.

The Clinico-histopathological Spectrum of Tumors and Tumor-Like Lesions in Adult Intussusception.

Intussusception is an uncommon cause of intestinal obstruction in adults. The etiology of this disease differs from the children. Thus, its management depends on the possible etiology and is different from pediatric cases. We aimed to study the clinico-histopathological spectrum ofthe tumors and tumor-like lesions in the intussusception in adults. A retrospective review of the adult (> 18years) intussusception cases was performed. The clinical data and follow-up were obtained. The histopathology was reviewed along with the special stains and immunohistochemistry for ascertaining a histopathological diagnosis. Fifteen cases of adult intussusception were identified from 107 resected specimens of adult intestinal obstruction. The mean age was 44.5years with a male/female ratio of 1.1:1. A definitive pathology could be ascertained in 80% of the cases (n = 12/15). Eight cases had benign non-neoplastic etiology (53.3%) (33.3% tumor-like lesions) while seven cases (46.7%) had neoplastic etiology (20% benign neoplastic; 26.7% malignant neoplastic). All cases of colonic or enterocolic intussusceptions were associated with neoplasia whereas 90% of the enteric intussusceptions occurred due to benign non-neoplastic causes. CONCLUSIONS: Non-neoplastic causes are predominant in the enteric intussusceptions while neoplastic causes are more commonly associated with colonic or enterocolic intussusceptions. The post-operative histopathological examination concludes on the adequacy of the index surgery or the provision of further management if required.

Mucocele of the Appendix: A Case Report

Abstract Appendicular mucocele is an infrequent entity that constitutes a descriptive term to define an enlarged cecal appendix with accumulation of mucus in its interior, which can be due to both neoplastic and non-neoplastic causes. Patients are usually asymptomatic, becoming an incidental finding. However, in other cases the symptoms are highly variable (abdominal pain, palpable abdominal mass, digestive bleeding...) and differential diagnosis can become a challenge. In this way, imaging studies as ultrasound (US), computed tomography (CT) or magnetic resonance imaging (MRI) play an important role in preoperative diagnosis, since they provide information that can be decisive when it comes to select the most appropriate surgical intervention modality. We report a case of a patient who presented an incidental mass in lower right quadrant that turned out to be an appendicular mucocele.

Management of Pulmonary Nodules in Oncologic Patients: AJR Expert Panel Narrative Review.

Cancer survivors are at higher risk than the general population for development of a new primary malignancy, most commonly lung cancer. Current lung cancer screening guidelines recommend low-dose chest CT for high-risk individuals, including patients with a history of cancer and a qualifying smoking history. However, major lung cancer screening trials have inconsistently included cancer survivors, and few studies have assessed management of lung nodules in this population. This narrative review highlights relevant literature and provides expert opinion for management of pulmonary nodules detected incidentally or by screening in oncologic patients. In patients with previously treated lung cancer, a new nodule most likely represents distant metastasis from the initial lung cancer or a second primary lung cancer; CT features such as nodule size and composition should guide decisions regarding biopsy, PET/CT, and CT surveillance. In patients with extrapulmonary cancers, nodule management requires individualized risk assessment; smoking is associated with increased odds of primary lung cancer, whereas specific primary cancer types are associated with increased odds of pulmonary metastasis. Nonneoplastic causes, such as infection, medication toxicity, and postradiation or postsurgical change, should also be considered. Future prospective studies are warranted to provide evidence-based data to assist clinical decision-making in this context.

Gonadotropin-Releasing Hormone Analogue Stimulation Test Versus Venous Sampling in Postmenopausal Hyperandrogenism.

Postmenopausal hyperandrogenism can be due to excessive androgen secretion from adrenal or ovarian virilizing tumors or nonneoplastic conditions. The etiology of postmenopausal hyperandrogenism can be difficult to discern because of limited accuracy of current diagnostic tests. This systematic review compares the diagnostic accuracy of the gonadotropin-releasing hormone (GnRH) analogue stimulation test against selective ovarian and adrenal vein sampling of androgens in distinguishing neoplastic from nonneoplastic causes of postmenopausal hyperandrogenism. Diagnostic test accuracy studies on these index tests in postmenopausal women were selected based on preestablished criteria. The true positive, false positive, false negative, and true negative values were extracted and meta-analysis was conducted using the hierarchical summary receiver operator characteristics curve method. The summary sensitivity of the GnRH analogue stimulation test is 10% (95% confidence interval [CI], 1.1%-46.7%) and that for selective venous sampling is 100% (95% CI, 0%-100%). Both tests have 100% specificity. There is limited evidence for the use of either test in identifying virilizing tumors in postmenopausal hyperandrogenism.

Sclerotic bone lesions caused by non-infectious and non-neoplastic diseases: a review of the imaging and clinicopathologic findings.

Bone sclerosis is a focal, multifocal, or diffuse increase in the density of the bone matrix on radiographs or computed tomography (CT) imaging. This radiological finding can be caused by a broad spectrum of diseases, such as congenital and developmental disorders, depositional disorders, and metabolic diseases. The differential diagnosis can be effectively narrowed by an astute radiologist in the light of the clinical picture and typical findings on imaging. Some of these lesions are rare and have been described as case reports and series in the literature. This article aims to collate the clinical-radiologic findings of non-infectious and non-neoplastic causes of bone sclerosis with relevant imaging illustrations.

Which is the optimal management for locally advanced gastric cancer patients with TRG 0 and 1 after R0 resection?

BackgroundNeoadjuvant chemotherapy (NAC) followed by surgery currently offers promise as a strategy for patients with locally advanced gastric cancer (GC). However, there is limited evidence to guide treatment for TRG 0 and 1 patients with locally advanced GC after R0 resection. This study set out to explore the optimal management for TRG 0 and 1 patients with locally advanced GC after R0 resection.MethodsThe retrospective data of 154 TRG 0 and 1 patients with locally advanced GC following R0 resection who were treated between January 2012 and December 2018 were collected and analyzed. The Kaplan-Meier method was used to estimate the survival rate. Multivariate analysis was performed using the Cox proportional hazards model.ResultsThe median follow-up was 34.1 (range, 6.6–90.9) months. Six patients (3.9%) were lost during follow-up. Of the 27 patients who experienced relapse, 12 died, including 2 patients who died of non-neoplastic causes. The 5-year recurrence-free survival (RFS) and 5-year overall survival (OS) were 71.6% (95% CI: 68.5–79.6) and 82.9% (95% CI: 76.9–86.1) for the whole cohort, respectively. Univariate analysis revealed that patients with carcinoembryonic antigen (CEA) <5.0 ng/ml after NAC (77.7% vs. 20.1%, P<0.001), distal gastrectomy (91.7% vs. 67.5%, P=0.046) had higher 5-year RFS. Meanwhile, combined resection (55.6% vs. 73.1%, P=0.042), major complications (42.7% vs. 80.50%, P<0.001), and lymph node metastasis (ypN+) (52.0% vs. 83.7%, P<0.001) had lower 5-year RFS. The multivariate analysis showed that CEA level after NAC (HR =2.876, 95% CI: 1.051–7.872, P=0.040), major complications (HR =2.432, 95% CI: 1.062–5.567, P=0.035), and lymph node metastasis (ypN+) (HR =3.183, 95% CI: 1.242–8.161, P=0.016) were independent prognostic factors.ConclusionsTRG 0 and 1 patients with local GC after R0 resection following NAC had a good prognosis, especially patients with CEA <5.0 ng/mL after NAC, and those without major complications or lymph node metastasis. Monotherapy or no chemotherapy may offer options for treating TRG 0 and 1 patients without adverse prognostic factors.

Clinical spectrum and histopathological analysis of cervical lymphadenopathy: a rural hospital study

Background: The analysis of lymph node enlargement in the neck is not an easy task. These diseases which can be neoplastic also demands correct diagnosis for further management. The study intended to find out systematically the various pathological conditions presenting with enlarged lymph nodes in the neck, also the various modes of clinical presentation and behaviour of these conditions.Methods: The study population consisted of patients above 12 years presenting with cervical lymph node enlargement. The proforma which was drafted is used. Patient was examined systematically giving utmost importance to local examination. After making a clinical diagnosis, further relevant investigations were done to confirm the diagnosis. Treatment was instituted appropriately and followed up the patients.Results: Majority of the cases in this study had non-neoplastic causes for cervical lymphadenopathy in which tuberculosis is most common. Posterior triangle group of lymph nodes was most commonly affected in tuberculosis. Variable results were noted among the groups of lesions, with regard to local characteristics like number, laterality, mobility and involvement of other group of lymph nodes, etc. FNAC by virtue of it being inexpensive, quick in getting the results and easy to perform, is one of the important and essential diagnostic procedures.Conclusions: As cervical lymphadenopathy is an important disease, it always calls for meticulous attention, analysis and treatment. FNAC is found to be a frontline investigation of choice with biopsy and histopathological examination done for confirmation. Most of the non-neoplastic lesions are medically curable with limited role for surgery.

Pitfalls of Computed Tomography in the Coronavirus 2019 (COVID-19) Era: A New Perspective on Ground-Glass Opacities.

AimTo study ground-glass opacities (GGO) not only from the coronavirus 2019 (COVID-19) pneumonia” perspective but also as a radiological presentation of other pathologies with comparable features.MethodsWe enrolled 33 patients admitted to Policlinico Universitario G. B. Rossi who underwent non-contrast-enhanced (NCE) or contrast-enhanced (CE) chest computed tomography (CT) between March 12 and April 12. All patients with CT-detected ground-glass opacity (GGO) were included. All patients resulted as COVID-19 negative at the reverse transcription-polymerase chain reaction (RT-PCR) assay. We studied the different pathologies underlying GGO features: neoplastic diseases and non-neoplastic diseases (viral pneumonias, interstitial pneumonias, and cardiopulmonary diseases) in order to avoid pitfalls and to reach the correct diagnosis.ResultsAll CT scans detected GGOs. Symptomatic patients were 25/33 (75.7%). At the clinical presentation, they reported fever and dry cough; in six out of 25 cases, dyspnea was also reported (24%). Thirty-three (33; 100%) showed GGO at CT: 15/33 (45.45%) presented pure GGO, and 18/33 (54.54%) showed GGO with consolidation. The RT-PCR assay was negative in 100%. We investigated other potential underlying diseases to explain imaging features: neoplastic causes (8/33, 24.24%) and non-neoplastic causes, in particular, infectious pneumonias (16/33, 48,48 %, viral and fungal), interstitial pneumonias (4/33, 12,12%), and cardio-pulmonary disease (5/33, 15,15%).ConclusionsGGO remains a diagnostic challenge. Although CT represents a fundamental diagnostic tool because of its sensitivity, it still needs to be integrated with clinical data to achieve the best clinical management. In the presence of typical imaging features (e.g. GGO and consolidation), the radiologist should focus on the pandemic and manage a suspect patient as COVID-19 positive until proven to be negative.

Ovarian Stromal Hyperplasia: A Rare Cause of Postmenopausal Hyperandrogenism.

Ovarian hyperthecosis and ovarian stromal hyperplasia (OSH) are two uncommon non-neoplastic causes of ovarian hyperandrogenism, whose etiology is still unknown. These conditions are characterized by obesity, hyperinsulinemia, acanthosis nigricans, and even virilization, mainly in postmenopausal women. Here we have reported the case of a 67-year-old patient with a diagnosis of OSH, which was resolved after bilateral laparoscopic oophorectomy. In this case report, we have discussed two different conditions posing a diagnostic challenge and requiring a high index of suspicion.

Non-neoplastic cholangiopathies: an algorithmic approach.

Cholangiopathies are chronic diseases that affect the bile ducts, comprising a heterogeneous group of progressive and potentially fatal entities. The diagnosis of these diseases is a great challenge for radiologists because of the overlapping of their clinical, biochemical, and imaging findings. Nevertheless, identifying the precise etiology is crucial, given that the therapeutic options are distinct and influence the prognosis of the patient. The purpose of this review article is to discuss some of the non-neoplastic causes of cholangiopathies and to provide a useful diagnostic algorithm.

Laparoscopic Approach in Management of Renal Cell Carcinoma During Pregnancy: State of the Art.

Renal cell carcinoma (RCC) is extremely rare in pregnant women. However, this is one of the most reported urologic tumors during pregnancy. The aim of this review was to evaluate RCC during pregnancy in terms of epidemiology, risk factors, diagnosis, natural history of disease, and the safety of laparoscopic approach in the management of this tumor. RCC presentation is frequently made incidentally during an ultrasonography performed for other reasons, such as hydronephrosis owing to non-neoplastic causes. The optimal time for surgery during pregnancy and the consequences of surgery on the maternal and fetal well-being are major considerations. Risks for adverse pregnancy outcomes should be explained, and the patient's decision about pregnancy termination should be considered. Ultrasound is good in diagnosing renal masses, with a sensitivity comparable to that of computed tomography only for exophytic masses larger than 3 cm. Magnetic resonance imaging is reproducible and a good, though expensive, alternative to computed tomography scans for the evaluation of renal lesions in pregnant women. Radical nephrectomy or nephron-sparing surgery are essential treatments for management of RCC. Laparoscopic surgery has historically been considered dangerous during pregnancy and avoided whenever possible, because of concerns regarding surgery-related risks, such as uterine injury, miscarriage, teratogenesis, preterm birth, and hypercapnia. The laparoscopic treatment during pregnancy is becoming increasingly accepted where feasible with low morbidity. However, the combination of a multidisciplinary approach, multi-specialty communication, and skilled surgeons can give the best possible outcomes for mother and fetus.

Neoplastic and Non-Neoplastic Causes of Acute Intracerebral Hemorrhage on CT : The Diagnostic Value of Perihematomal Edema.

The aim of this study was to investigate the diagnostic value of perihematomal edema (PHE) volume in non-enhanced computed tomography (NECT) to discriminate neoplastic and non-neoplastic causes of acute intracerebral hemorrhage (ICH). In this retrospective study, from 560 patients with acute ICH 91patients fulfilled the inclusion criteria and were classified into neoplastic and non-neoplastic ICH. For each patient, ICH and total hemorrhage volume (ICH + PHE) were segmented semiautomatically. The PHE volume and relative PHE were further calculated and all parameters were compared between the different groups. Additionally, hematoma density was measured and compared between the groups. The PHE volume and relative PHE on NECT were significantly higher in neoplastic vs. the non-neoplastic ICH (p = 0.003 and p < 0.001, respectively). Absolute ICH volume, symptom time onset to CT and ICH localization showed no significant difference between the two groups (p > 0.1). Univariate receiver operating characteristics (ROC) analysis revealed ahigh diagnostic performance for relative PHE in the discrimination of neoplastic and non-neoplastic ICH with an optimal cut-off of 0.50 (area under the curve, AUC 0.81, 60.0% sensitivity, 91.8% specificity), followed by PHE (AUC 0.69) and hematoma density (AUC 0.68). Relative PHE with acut-off of >0.50 is aspecific and simple indicator for neoplastic causes of acute ICH and apotential tool for clinical implementation. This observation needs to be validated in an independent patient cohort.

Late mortality and causes of death among 5-year survivors of childhood cancer diagnosed in the period 1960–1999 and registered in the Italian Off-Therapy Registry

IntroductionAdvances in paediatric oncology led to the increase in long-term survival, revealing the burden of therapy-related long-term side effects. We evaluated overall and cause-specific mortality in a large cohort of Italian childhood cancer survivors (CCSs) and adolescent cancer survivors identified through the off-therapy registry. Materials and methodsCCSs alive 5 years after cancer diagnosis occurring between 1960 and 1999 were eligible; the last follow-up was between 2011 and 2014. Outcomes were reported as standardised mortality ratios (SMRs) and absolute excess risks (AERs). ResultsAmong 12,214 CCSs, 1113 (9.1%) deaths occurred. Survival at 35 years since diagnosis was 87% (95% confidence interval [CI]: 86–88) and at 45 years was 81% (95% CI: 77–84). CCSs had an 11-fold increased risk of death (SMR 95% CI: 10.7–12), corresponding to an AER of 48 (95% CI: 45–51). Mortality decreased by 60% for survivors treated most recently (1990–1999). The most frequent causes of death were recurrence of the original cancer (56%), a subsequent neoplasm (19%) and cardiovascular diseases (5.8%). Among those who survived at least 15 years after diagnosis, a secondary malignancy was the leading cause of death. ConclusionsThis study confirms the impact of recent advances in anticancer therapy in reducing mortality, mainly attributable to recurrence but also to other causes. However, overall mortality continues to be higher than in the general population. A long-term follow-up is needed to prevent late mortality due to secondary neoplasms and non-neoplastic causes in CCSs.

Black and Brown: Non-neoplastic Pigmentation of the Oral Mucosa.

Black and brown pigmentation of the oral mucosa can occur due to a multitude of non-neoplastic causes. Endogenous or exogenous pigments may be responsible for oral discoloration which can range from innocuous to life-threatening in nature. Physiologic, reactive, and idiopathic melanin production seen in smoker's melanosis, drug-related discolorations, melanotic macule, melanoacanthoma and systemic diseases are presented. Exogenous sources of pigmentation such as amalgam tattoo and black hairy tongue are also discussed. Determining the significance of mucosal pigmented lesions may represent a diagnostic challenge for clinicians. Biopsy is indicated whenever the source of pigmentation cannot be definitively identified based on the clinical presentation.

Diabetes Mellitus And Glycosylated Hemoglobin A1c

Diabetes mellitus is a global health problem in 21st century. The incidence of diabetes mellitus is in rise and is estimated to be more prevalent in coming years. It is becoming one of the most common non-infectious and non-neoplastic causes of morbidity and mortality. Various complications are associated with diabetes mellitus. With control of blood glucose level, complications of diabetes mellitus can be minimized. In different time frame, different parameters and level have been used to diagnose diabetes. Glycosylated hemoglobin A1c is one of the reliable indicator of chronic hyperglycemia. In 2011, World Health Organization has included HbA1c in the diagnostic criteria. Various methods are used to detect the level of HbA1c. Glycosylated hemoglobin is being used in the management of diabetes mellitus. Various studies have shown its prognostic implication in micro and macrovascular complications. Here we discuss various methods of estimation of HbA1c, various role of HbA1c in the management of Diabetes Mellitus and limitation of the test.

Aettiiollogy off Hoarrseness iin Pattiientts above 40 Yearrs off Age (Across Secttiionall Sttudy)

Objectives: this study is designed to determine the most common causes of hoarseness in patients above 40 years of age and the relationship between hoarseness causes and its duration.&#x0D; Patient and Methods: the study is cross sectional study. It considers 80 patients with hoarseness who were assessed between april 2011 and December 2011 at E.N.T. outpatient clinic ;department of otolaryngology in AL Diwaniya Teaching hospitalIn AL Diwaniya city. Ira&#x0D; Results :out of the 80 patients ,57 had hoarseness because of non-neoplastic causes giving an incidence of 71,25% (infective laryngitis n= 23,28.75% ,acid laryngitis n =17,21.25%, allergic laryngitis n =13,16.25,%, vocal cord palsy n =2, 2.5,%, psychogenic n =2,2.5%, ) while hoarseness occured in the remaining 23 patients as aresult of neoplastic causes, giving an incidence of 28, 75% (laryngea carcinoma n = 12, 15 % vocal cord polyp n =6, 7.5 %,voca c. nodule n = 3, 375%,laryngeal cyst n =1 1. 25% granuoma n = 1,1.25%, benign tumor n = 00 %) we also found that hoarse patients for aduration of more than one month were; likely to have aneoplastc cause more than non-neoplastic cause Conclusionsthe incidence of non neoplaic causes of hoarseness in patents more than 40 year d are more common han neoplastic causes. Moreover hoarse patients who have alonger duraton of hoarseness have amore chance to have neoplasic cause than non- neoplastic cause

FET PET in the evaluation of indeterminate brain lesions on MRI: Differentiating glioma from other non-neoplastic causes – A pilot study

We aimed to determine the utility of FET PET in the management of indeterminate CNS lesions found on MRI. We performed a retrospective analysis of patients with FET PET at a single tertiary institution from 2011 to 2015. FET PET images were processed using usual methods and measurements taken including SUVmax, TBRmax, and analysis of dynamic series where available (Kipeak, Vdpeak, as well as tumor:background ratio for these variables). Correlation studies were performed using ANOVA between cohorts of high-grade histology, low-grade histology, and benign histology/stable on observation. Thirty-five patients were included, of whom 34 were suitable for analysis with median follow-up of 5 months. The positive predictive value of FET PET in this cohort was 83.3%. FET SUVmax differentiated between patients with high-grade (mean SUV 3.38, 95% CI 2.21–4.55), low-grade (1.88, 95% CI 1.33–2.43) and benign/observation (1.42, 95% CI 1.13–1.71) cohorts (p = 0.0003). Similarly, tumour to brain ratio was significant (p < 0.0001). Kipeak distinguished between high grade and observation cohorts (p = 0.036), as did KiTBR (p = 0.025). Vd peak was not significantly different in these two cohorts (p = 0.057) but Vd TBR was (p = 0.041). In conclusion, FET PET demonstrated a high positive predictive value for glioma in patients with indeterminate brain lesions on MRI. The combination of negative FET and negative FDG PET scans may predict an indolent clinical course. Confirmatory trials are needed to establish the potential value of FET PET in guiding surgical management in this cohort.

A clinicopathological study on cervical lymphadenopathy: an institutional experience

Background: Despite advances in modern technology accurate diagnosis of cause of cervical lymphadenopathy remains a challenge. It leads to substantial morbidity to patients and sometimes even mortality. Uncertainty in diagnosis can lead to wrong diagnosis and increases cost of treatment. The objective of the study was to conduct a detailed evaluation of cervical lymphadenopathy in tertiary care set up and to enumerate the causes so that appropriate and adequate treatment can be initiated to reduce the morbidity.Methods: A prospective study was carried out on 100 patients of cervical lymphadenopathy and were evaluated clinically. Detailed history was taken of every patient followed by physical examination and appropriate investigations. This was followed by disease specific treatment and surgical intervention wherever necessary. Patient data was collected and evaluated to draw conclusions.Results: Most patients were young (between 12-40 years). Most common cause for cervical lymphadenopathy is due to non-neoplastic (82%) and less commonly from neoplastic (18 %). In non-neoplastic causes most, common cause is due to tuberculosis (51 %). In neoplastic causes, most common cause is due to lymphoma (10 %). In tubercular lymphadenitis the posterior triangle group was the most commonly involved group of cervical lymph nodes (31.3%), followed by upper jugular group (21.5%). FNAC by virtue of it being inexpensive, quick in getting the results and easy to perform, is one of the important and essential diagnostic procedure. Surgery should be to diagnostic biopsy, for treatment of abscess/sinuses and for a lymph node that do not resolve with chemotherapy and as an adjuvant to chemotherapy.Conclusions: Cervical lymphadenopathy can have varied manifestation from non-neoplastic to neoplastic condition. Proper history examination and relevant investigations and disease specific treatment can only cure the patient and improve the prognosis.