Non-neoplastic Soft Tissue Research Articles

Neoplastic and Non-neoplastic Soft Tissue Lesions Around the Knee.

Neoplastic and non-neoplastic soft tissue masses around the knee are often incidental findings. Most of these lesions are benign with typical imaging characteristics that allow a confident diagnosis. However, some of these incidental neoplastic masses are characterized by morbidity and potential mortality. This review highlights the typical aspects of these lesions, facilitating a correct diagnosis.

When Is a Two-Stage Surgical Procedure Indicated in the Treatment of Pseudotumors of the Hip? A Retrospective Study of 21 Cases and a Review of the Literature

(1) Background: A pseudotumor of the hip is a sterile, non-neoplastic soft tissue mass associated with total hip arthroplasties. Pseudotumors may mimic soft tissue tumors or infections, and thus a differential diagnosis is crucial, and biopsy is recommended. The purpose of this study was to compare the complications and functional results between one-stage and two-stage procedures. (2) Methods: We retrospectively analyzed 21 patients surgically treated at our institution with “pseudotumors” associated with hip prosthesis (8 male, 13 female with a mean age of 69 years). One-stage revision was performed in 10 cases and two-stage reversion in 10, with excision only in 1 case. Complications were classified as major and minor and functional results assessed using the Harris Hip Score (HHS). (3) Results: Five patients (24%) reported major complications. The survival rate for all complications was 75%. The overall survival rate was 95% at 5 years. The mean HHS ranged from 35 pre-op to 75 post-op, highlighting improved functional results in all cases. We recorded no differences in complications or functional outcomes between the one- and two-stage procedures. (4) Conclusions: In our experience, the two-stage surgical approach is preferable in cases with major bone defects and larger pseudotumor sizes. The use of custom-made 3D-printed prostheses is increasing and is a further reason to prefer two-stage revision.

Kutane Zubildungen beim Rind – Diagnose, Therapie und Verlaufskontrolle in 7 Fällen

In two calves and five cows of various ages, cutaneous masses were detected. Initially, neoplasia was suspected. All masses were removed under local anesthesia, in some cases with additional sedation. Pathohistological examination was conducted subsequently. Benign neoplasia was diagnosed in 5 of the cases. In the 2 remaining cases, histopathology revealed non-neoplastic soft tissue proliferation and pyogranulomatous inflammation. All patients recovered well from surgery and continued to be profitable for 3 to 57 months.

Prevalence of oral soft tissue lesions: A review

Statement of the Problem: Mesenchymal tissue origin is one of the most common lesion in oral cavity. Most of these lesions are exuberant response to local irritation produces a soft tissue enlargement which are similar to neoplastic pathologic processes. Due to this diagnostic challenge the present study was conducted for reviewing the prevalence of soft tissue lesions.
 Search strategy: The English articles in scientific databases including Google Scholar, Science Direct, Medline, and PubMed, published between 2007 and 2019, were searched by using relevant keywords including oral soft tissue lesion, oral mucosal lesion, neoplastic soft tissue lesion, reactive lesion, hyperplastic lesion and non-neoplastic soft tissue lesion. Finally, forty-nine articles were reviewed in this study.
 Conclusion: Findings showed that the most diagnosed lesions were benign in nature, and inflammatory in origin. Among this reactive/non-neoplastic lesions, fibrotic lesions, such as irritation fibroma or fibrous hyperplasia, were the most abundant lesions reported. There is a pronounced female predilection, and reactive lesions are most common in the fourth to sixth decades of life. Regarding the location of reactive lesions, the gingival mucosa was the most common site of involvement. Tumoral lesions with the origin of vascular, fibrotic and fat were the most commonly reported tumors.

Comprehensive analysis of transcriptome characteristics and identification of TLK2 as a potential biomarker in dermatofibrosarcoma protuberans.

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous sarcoma characterized by local invasion and recurrence. RNA sequencing (RNA-seq) allows the qualification of cellular RNA populations and provides information on the transcriptional state. However, few studies have comprehensively analyzed DFSP transcriptional data. Methods: Fourteen DFSP samples with paired non-neoplastic soft tissue from Chinese patients undergoing Mohs micrographic surgery were used for RNA-seq analysis. Differential expression analysis and enrichment analysis for RNA-seq data were performed to identify fusion genes, biomarkers, and microenvironment characteristics of DFSP. Results: This study systemically describes the transcriptomic characteristics of DFSP. First, we performed gene fusion analysis and identified a novel FBN1-CSAD fusion event in a DFSP patient with fibrosarcomatous transformation. Then, we identified TLK2 as a biomarker for DFSP based on functional enrichment analysis, and validated its accuracy for diagnosing DFSP by immunohistochemical staining and joint analysis with public data. Finally, microenvironment analysis described the infiltration characteristics of immune and stromal cells in DFSP. Conclusion: This study demonstrates that RNA-seq can serve as a promising strategy for exploring molecular mechanisms in DFSP. Our results provide new insights into accurate diagnosis and therapeutic targets of DFSP.

Retro-Odontoid Pseudotumor Associated with Rheumatoid Arthritis

Retro-Odontoid Pseudotumor (ROP) commonly labeled as “pannus” is a non-neoplastic soft tissue mass adjacent to the odontoid process of C2 that is frequently associated with rheumatoid arthritis. It is due to inflammation and thickening of the synovium surrounding the dens and may lead to ligament laxity, and bone erosion resulting in C1-C2 joint laxity and subluxation with possible spinal cord compression. MRI is the imaging modality of choice to assess ROP and evaluate its extent. Three patterns of ROP are described following histological features; distinguish inflammatory hyper vascular pannus (hyperintense on T2-weighted images and enhancing) (Figure 1 and 2), combined pannus (intermediate signal intensity on T2- weighted images and intermediately enhancing), and fibrous pannus (low signal intensity on all sequences and non-enhancing).

Utility of fine needle aspiration cytology (FNAC) in the diagnosis of soft tissue tumors and tumor like lesions

Introduction: Fine needle aspiration cytology (FNAC) forms one of the first diagnostic tools in evaluation of soft tissue lesions. Aim of this study was to evaluate the role of FNAC in the primary diagnosis of soft tissue tumors and tumor like lesions and to assess the effectiveness of FNAC in the histological subtyping and grading of soft tissue tumors. Materials and Methods: We reviewed FNAC smears of 170 soft tissue tumors and tumor like lesions over a 3 years period and correlated with the histopathological features which were available in 117 cases. Conventional Papanicolaou (PAP) and Giemsa staining was done in all cases. Results: 152 out of 170 cases [89.41%] were neoplastic, of which 130 tumors were labelled as benign. Lipoma constituted 83.07% of benign tumors. Based on the predominant cytomorphological features and background, the tumors were classified into myxoid (4), spindle cell (20), pleomorphic (2), small round cell(4), epithelioid /polygonal cell (7), lipomatous (108) and miscellaneous (7). The non-neoplastic lesions included tuberculosis, filariasis, actinomycosis, scar endometriosis and calcinosis cutis. Conclusion: FNAC proved to be helpful in distinguishing between neoplastic and non-neoplastic soft tissue lesions, differentiating metastatic carcinoma and melanoma in soft tissue from primary soft tissue tumors and differentiating benign and malignant soft tissue tumors. Accurate subtyping was possible in many tumors of myxoid category and round cell tumors. Spindle cell tumors of intermediate grade were difficult to grade on FNAC. Pleomorphic sarcomas were of high grade and their subtyping could not be done on FNAC. Keywords: FNAC, Soft tissue lesions, Soft tissue tumors.

Non-neoplastic Soft Tissue Tumors and Tumor-like Lesions.

Clinicians are commonly faced with patients presenting with a solitary palpable soft tissue mass. Most soft tissue lesions are benign, and not every mass is due to a neoplastic process. Many pathologies can mimic a malignant tumor. Despite appropriate clinicoradiologic assessment, these lesions can be mistaken for a soft tissue sarcoma and can lead to multiple investigations or an intervention, inconveniencing patients and leading to an increased health care cost. With the relevant clinical history, clinical examination, and specific imaging characteristics, the diagnosis can be narrowed. We present a pictorial review of soft tissue sarcoma mimics with guidance on appropriate differential diagnoses.

Non-inflammatory and non-neoplastic soft tissue lesions of the tympanic cavity

Objectives: Tympanic cavity (TC) is an anatomically challenging region for the diagnosis of lesions located inside it. Radiological diagnosis and demonstration of the anatomic localization of sporadic lesions such as vascular malformations and meningocele are essential for the prevention of complications that may occur during operation and recurrent unnecessary interventions. The aim of the present study was to demonstrate the radiological appearance of the vascular variations and the post-traumatic soft tissue lesions which are rarely encountered in TC. Methods: A total of 3525 temporal multi-slice computed tomography (MSCT) images were evaluated between 2010–2018. Twelve cases with non-inflamatory and non-neoplastic soft tissue lesions in TC were detected and 2 with meningocele were included in the study. Results: Of the 12 cases, 6 were males and 6 were females. The mean age of the patients was 26.16 years. Four cases had an aberrant internal carotid artery (ICA), being bilateral in 2 cases and right sided in the remaining 2 cases. Six cases had dehiscent mega jugular bulb (DMJB); and 2 cases had post-traumatic meningocele. Conclusion: Vascular malformations and meningoceles are rarely observed in TC. They may present nonspecific clinical signs and symptoms; however, they should be evaluated with MSCT and MRI before the surgical interventions regarding the middle ear to prevent possible complications.

A Massive Foot Ganglion: Case Report

The foot is a relatively uncommon site of neoplastic and non-neoplastic soft tissue tumors. Although it contains a relatively small amount of somatic soft tissue elements, the foot is considerably rich in tendons, fasciae, retinaculae, and synovium. Corresponding to this distribution of soft tissue elements, some soft tissue lesions, such as ganglion, giant cell tumor of tendon sheath, fibromatosis, and synovial sarcoma, are commonly seen in this location.

Imaging of benign and malignant soft tissue masses of the foot.

The foot is a relatively uncommon site of neoplastic and non-neoplastic soft tissue tumors. Although it contains a relatively small amount of somatic soft tissue elements, the foot is considerably rich in tendons, fasciae, retinaculae, and synovium. Corresponding to this distribution of soft tissue elements, some soft tissue lesions, such as giant cell tumor of tendon sheath, fibromatosis, and synovial sarcoma, are commonly seen in this location. Vascular tumors represent common soft tissue masses of the foot as well. Magnetic resonance imaging is the modality of choice in the assessment of soft tissue tumors. The presence of a suspected lesion can be confirmed and tumor margins can be defined accurately. In general, MRI does not provide histologic specificity, but considering some MR features may often help in correctly distinguishing benign from malignant lesions. In addition, characteristic features of the most common benign tumors (i.e., fibromatosis, cavernous hemangioma) and reactive processes of the foot (ganglion cyst, Morton's neuroma) often suggest a specific diagnosis.

Soft tissue aspiration cytopathology

Fine-needle aspiration (FNA) biopsy as a diagnostic modality for the pathologic evaluation of soft tissue neoplasms and non-neoplastic soft tissue mass lesions is uncommon and controversial. This procedure contrasts with more traditional diagnostic methods such as marginal excision, incisional (open) biopsy, or even core biopsy to procure tissue from somatic sites. The authors reviewed the results of cytopathologic diagnoses obtained by fine-needle aspiration biopsy over a consecutive 11-month period in patients that presented primarily with a palpable soft tissue mass. A few patients with deep non-palpable soft tissue masses also were evaluated by radiologically guided FNA. Cytopathologic diagnoses were verified by different means including tissue examination either by concurrent cell block or subsequent surgical biopsy, flow cytometry, clinical outcome, or repetition of the FNA procedure. Patients were followed for a minimum of one year to evaluate the mass clinically, to determine whether any further therapy was administered, and to assess disease status. Eighty-two aspirates were performed without complications from 77 patients ranging from 12-88 years of age (mean = 50 yrs.) with men outnumbering women 1.5:1. Soft tissue masses were most common in the extremities (41 cases), followed by the trunk (34 cases), retroperitoneum (5 cases), and head and neck (2 cases). Fine-needle aspirates were diagnosed as malignant in 42 (51%), benign in 32 (39%), nondiagnostic in 6 (7%), and atypical in 2 (2%) cases. Malignant aspirates were comprised of 24 sarcomas (57%), 9 carcinomas (21%), 6 malignant lymphomas (14%), and 3 melanomas (7%). Twenty-two aspirates (52%) had an initial diagnosis of malignancy, whereas 18 (43%) represented metastatic and 2 (5%) recurrent neoplasms. Confirmation of the cytopathologic diagnosis was by concurrent or subsequent tissue examination in 57%, flow cytometry in 5%, clinical outcome in 34%, and repeat aspiration in 4%. One false negative and no false positive diagnoses were issued for a sensitivity and specificity of 100% and 97% respectively in distinguishing benign and malignant lesions by FNA. Of the malignant aspirates, 83% could be subtyped whereas 72% of benign aspirates were correctly subtyped. For primary soft tissue sarcomas, 12 of 19 (63%) were accurately subtyped. In 48% of cases a concurrent cell block was obtained and found diagnostically useful in 54% of them. Aspiration cytopathology of soft tissue mass lesions using FNA biopsy can be an accurate and minimally invasive method for the initial pathologic diagnosis of primary benign and malignant soft tissue masses, for the pathologic confirmation of metastatic tumors to soft tissue, and for the documentation of locally recurrent soft tissue neoplasms. FNA cytopathology is capable of specifically subtyping a large percentage of primary and metastatic soft tissue tumors if cellular material either in the form of a cell block or flow cytometry is obtained in addition to cell smears.

Myositis ossificans of the foot

A 37-year-old woman with myositis ossificans of the left foot is reported. A faint density was seen on foot radiographs, whereas computed tomography images showed a rim of mineralization inferior to the second and third metatarsal bones. On short tau inversion recovery-weighted magnetic resonance images, a hyperintense lesion was demonstrated with hyperintensity extending to the surrounding soft tissues. The rim of ossification appeared hypointense. Other non-neoplastic soft tissue processes with bone formation such as pseudomalignant osseous tumor of soft tissues, florid reactive periostitis, and bizarre parosteal osteochondromatous proliferation occur more commonly in the foot than myositis ossificans. A differential diagnosis of these lesions including periosteal and parosteal osteosarcoma, periosteal chondroma, and osteomyelitis is discussed.

Radionuclide imaging of nonneoplastic soft tissue disorders

In the decade since the introduction of the first 99m Tc phosphates, bone imaging has become a popular diagnostic tool. Early on, it became apparent that many tissues other than bone accumulated these pharmaceuticals. A list of nonneoplastic extraosseous conditions with demonstrated affinity for 99m Tc phosphates, derived from a literature search and the author's experience, is presented. Several cases demonstrating features that have not been previously described or are not well known are presented. Finally, mechanisms of localization of these agents are discussed.