Nonulcerated Mass Research Articles

Spontaneous fibroadenoma in a twenty-one-week-old female Wistar rat – a case report

We describe the characteristic macro- and microscopic findings of a new case of spontaneous fibroadenoma in a 21-week-old, non-treated female Wistar rat. A mobile and non-ulcerated mass was detected affecting the caudal inguinal mammary gland. At necropsy, the mass was 5.5 cm in size, spherical in shape, and well demarcated with a smooth surface. The cut surface was pink, with a multilobulated pattern. Microscopically, fibroadenoma was composed of dense connective tissue surrounding luminal epithelial tissue, organized in tubular structures. The luminal epithelial cells were typical and, in some areas, presented lipid vacuoles in the cytoplasm and proteinaceous material in the lumen of the tubules. The interlobular and intralobular stroma showed variable amounts of mast cells. Immunohistochemically, epithelial cells expressed both oestrogen and progesterone receptors in the nucleus. Fibroadenoma is a frequent tumour, but it is uncommon at an early age.

Nodular Lymphoid Hyperplasia of the Colon in an Adult Patient after Covid-19 Infection: A Case Report and Literature Review

Nodular lymphoid hyperplasia of the colon (NLHC) is an uncommon pathology in adults. The disease can be asymptomatic and discovered incidentally or symptomatic, which is often manifested by abdominal pain and motility disorders (diarrhea, constipation). The clinical presentation can also be alarming with rectal bleeding and obstructive symptoms that may be misinterpreted as a neoplastic process. In this paper, we report the case of a 58-year-old female patient with a previous history of appendicetomy. She presented with persistent abdominal pain, chronic constipation and black colored stools, following Covid-19 infection. The physical examination was unremarkable. Colonoscopy examination found a bulging, non-ulcerated mass, measuring 3.5 cm in greatest dimension, located at the right colic angle. Thoraco-abdomino-pelvic computed tomography was performed and showed right colonic wall thickening and enhanced nodule formation. Furthermore, metastatic localization was not detected. After a multidisciplinary meeting, a laparotomy with right hemicolectomy was performed. Histopathological examination of the surgical specimen revealed nodular lymphoid hyperplasia with CD20+, CD5−, CD10+ and BCL2− phenotype on immunohistochemistry. Besides, lymphocytes in interfollicular area are CD3+ T cells. Patient outcome was favorable after surgery and no additional treatment was necessary. Nodular lymphoid hyperplasia of the colon is a benign process whose endoscopic appearance can sometimes raise suspicion of malignancy. The diagnosis can only be established by histological evaluation. Immunohistochemistry is also essential to confirm the diagnosis and to rule out low-grade lymphoma. Clinical evolution is often favorable. However, endoscopic follow-up is necessary in all cases.

Incidental finding on the posterolateral border of the tongue in a 16-year-old female

A 16-year-old female presented for routine dental care. On initial examination, a single, well-defined, sessile, firm exophytic submucosal lesion was detected on the right posterolateral border of the tongue. The lesion presented as a smooth pink dome-shaped nonulcerated mass. It was non-tender to palpation. According to the patient, it had been present for several years (Figure 1 and 2). At the time of presentation, the patient didn't have any fever, fatigue, airway obstruction or lymphadenopathy.

S2095 Gastric Extramedullary Plasmacytoma Presenting as a Solitary Gastric Mass

INTRODUCTION: Extramedullary plasmacytomas (EMP) are a subcategory of plasma cell neoplasm that involves organs outside the bone marrow. We report a case of an aggressive extramedullary myeloma invading the stomach. CASE DESCRIPTION/METHODS: An 84 year old lady with PMHx of DM, hypothyroidism, HTN and GERD presented to the ED with abdominal pain, nausea and vomiting for 2 days. Patient was found to be anemic with Hgb of 10.7 g/dL, hematocrit 32.4%. Patient’s electrolytes and renal function tests were within normal limits. Imaging (US) of the abdomen showed gallbladder calculus with positive murphy’s sign and no pericholecystic fluid. A CT scan of the abdomen and pelvis showed a large hiatal hernia with suspicion of cholelithiasis. A HIDA scan showed no evidence of cystic duct obstruction or distal biliary obstruction. After cholecystitis was ruled out GI was consulted and a EGD was planned for intractable abdominal pain with intermittent vomiting. During the EGD findings [Figure 1] were noted for a 4 cm non-bleeding, non-ulcerated mass on a very large stalk that appeared to be blocking the pylorus. The pylorus was normal appearing once past the mass. The polyp was partially resected. A small polyp was resected but the larger polyp was not able to be removed due to getting stuck at the cricopharyngeus so it remained in the stomach. Biopsy findings were noted predominantly of well-differentiated plasma cells with some of the cells extending to the mucosa. The immunohistochemical stains were positive for CD138, CD 79 [Figure 2] and showed a low Ki-67 proliferation index of < 5%. The neoplastic cells were lambda light chain restricted [Figure 3]. Rare plasma cells are positive for kappa. They were negative for PAX5, CD20, CD56, c-KIT, cyclin D1 and pankeratin. CD3 highlights background T-cells. Based on the findings a plasmacytoma or secondary involvement by multiple myeloma was favored. DISCUSSION: Plasmacytoma can be primary or secondary with secondary form more common. The most commonly involved sites are the liver, spleen, and lymph nodes. The prevalence of GI system involvement was found to be 0.9% in a recent systematic review done with 2,584 Multiple myeloma (MM) patients. This is associated with a poor survival of less than seven months from diagnosis. [1] Favorable outcomes in cases of EMP have been linked to tumor size < 4 cm, age < 50 years, patients with head and neck EMP, and serum M protein negativity. [2]. We have described a rare case of gastric plasmacytoma without symptoms of MM.Figure 1.: EGD finding of a mass obstructing the pylorus, injected with epinephrine and clamped before excision.Figure 2.: Cells stained with CD79A.Figure 3.: Monoclonal population lambda +.

Fibrosarcoma in a Goldfish (Carassius auratus): a Case report

Neoplasms in fishes are generally less aggressive than neoplasms in mammals and are most commonly discrete and focal. Although tumors were originated from connective tissue are frequently seen in the fishes, but dermal fibrosarcoma is rarely found in fish. A moribund four years old Goldfish (Carassius auratus), was referred veterinary hospital of Shahid Chamran University of Ahvaz with an exophytic non-ulcerated mass near the caudal peduncle. Microscopic examination of the mass revealed proliferated spindle cells and the interlacing, loose and eosinophilic bundles. For differential diagnosis, Masson’s trichrome staining was performed and the fibers stained blue. According to histopathological and histochemical results, tumor identified as fibrosarcoma. It is the first report of histopathological features of cutaneous fibrosarcomas in a Goldfish in Iran.

Surgery for Malignant Sublingual and Minor Salivary Gland Neoplasms.

Malignant sublingual gland neoplasms are rare, early-stage neoplasms presenting as painless non-ulcerated masses in the antero-lateral floor of the mouth. The majority of patients present with advanced disease, with symptoms of pain or anaesthesia of the tongue. Malignant minor salivary gland neoplasms are more common, the majority (>80%) of which present in the oral cavity, most frequently in the palatal area, as painless masses or as obstructive symptoms in the head and neck region. The most frequent pathologies are adenoid cystic carcinoma and mucoepidermoid carcinoma (>85%), with the majority presenting at an advanced stage (III/IV). Wide tumour-free surgical margin excision is the treatment of choice, followed by radiotherapy, after discussion of the multidisciplinary head and neck cancer tumour board. Improvements in survival and quality of life have been achieved since the introduction of endoscopic and robotic surgeries for many minor salivary gland malignancies.

English

Liposarcoma is the most common soft tissue sarcoma in adults, which usually involves lower extremities, trunk, retroperitoneum, or abdominal cavity. Till date, only a few cases of enormously huge liposarcoma have been reported. We report a case of huge mass of size 60 × 45 × 35 cm in scapular region in a middle aged person; which developed from a preexisting lipoma and was gradually increased in size as sub-mucosal non-ulcerated mass and which ultimately become ulcerated and infected with gas forming organisms. This tumor was successfully resected in toto under general anesthesia and after follow up to two years no recurrence was reported.

The clinical characteristics of benign oral mucosal tumors

Objectives: To investigate the clinical characteristics and pre-biopsy provisional diagnoses of benign oral mucosal tumors. Material and Methods: A 10- year retrospective analysis of all benign tumors of the oral mucosa, from a university- affiliated oral and maxillofacial surgery department. Results: 146 benign tumors were included. The mean age was 49.6 years, with an approximately equal gender distribution. The most prevalent tumor types were lipomatous tumors (27.4%), vascular (23.3%), and salivary gland tumors (16.5%). Tongue, labial and buccal mucosa were the most frequently involved sites. The vast majority (98.6%) presented as non-ulcerated masses. Only 2 (1.4%) presented as ulcerated masses. The clinical provisional diagnosis correctly classified lesions as non-malignant in 93.3%. In only 9 (6.7%) suspicion of malignancy was included in the provisional diagnosis. However, benign neoplasia was unsuspected in 42.1% of tumors. These cases were clinically classified as reactive. Conclusions: Benign tumors were most likely to be clinically correctly classified as non-malignant, but even in the setting of experienced oral surgeons, neoplasia was unsuspected in more than 40% of cases. This data strongly supports the need to biopsy every oral mucosal mass, since inaccurate clinical evaluation of the lesion’s biological nature was a frequent event. Key words:Malignant, benign, reactive, ulcerated mass, non-ulcerated mass, clinical diagnosis.

Re‐evaluation of common paradigms regarding the clinical appearance of oral mucosal malignancies

To evaluate the clinical appearance and rate of ulceration of oral mucosal malignancies, and to investigate the accuracy of clinical provisional diagnoses. A 10-year retrospective analysis, which included diagnostic biopsies of malignant tumors of the oral mucosa. The clinical provisional diagnoses were compared with final diagnoses. Two hundred and twenty-seven oral mucosal malignant tumors were included. Squamous cell carcinoma and its variants accounted for the majority (78%) of all malignant tumors. The most common clinical presentations were non-ulcerated (59.7%) and ulcerated masses (20.4%). Only 11.9% presented as indurate ulcers. The highest ulceration rate of all malignancies was recorded for SCC, with only about half of SCC and its variants ulcerated at the time of biopsy. 31.1% of all malignancies were not clinically suspected to be malignant and did not even include a request to rule out malignancy. There was a better agreement between the clinical provisional diagnoses and microscopic diagnoses in the SCC group than in other types of malignancy (P < 0.001). Within this study sample, non-ulcerated masses rather than indurate ulcers are the most common clinical appearance of oral mucosal malignancies, and even for SCC, that showed the highest ulceration rate at presentation, half were non-ulcerated. Approximately, one-third of oral mucosal malignancies were not suspected to be malignant prior to biopsy. Thus, the level of suspicion currently reserved for mucosal ulcers and ulcerated masses should also be applied to non-ulcerated oral mucosal masses.

The Significance of Surface Ulceration as a Sign of Malignancy in Exophytic Oral Mucosal Lesions: Myth or Fact?

To compare the spectrum of pathologies in ulcerated versus non-ulcerated exophytic oral mucosal lesions and explore the significance of surface ulceration as an indication of malignancy. Retrospective analysis of exophytic lesions of the oral mucosa, 2009-2011. 713 biopsies of exophytic lesions of oral mucosa were included, of which 9.4% were ulcerated. Significant differences were found between ulcerated and non-ulcerated lesions. Of the ulcerated lesions 67.2% were reactive, 31.3% malignant and 1.5% benign, compared to 86, 8.4 and 5.6% respectively in non-ulcerated lesions (p < 0.0001). Malignancies were most prevalent in ulcerated lesions, in patients over 50. Malignancies presented the highest ulceration rate (36.8%, p < 0.001), compared to reactive (7.5%) and benign neoplasia (1.8%), however, the majority of oral mucosal malignancies (63.2%) presented as non-ulcerated masses. Squamous cell carcinoma presented the highest ulceration rate among malignancies, but even these were only ulcerated in 50% of cases. Non-epithelial malignancies were non-ulcerated in all cases. One-third of all malignancies were not suspected as such clinically, however, there was a better agreement between the clinical and microscopic diagnosis of malignancy in ulcerated lesions. Although the statistical likelihood of ulcerated masses to represent malignancy was higher than non-ulcerated lesions, especially in patients over 50, the majority of malignancies presented as non-ulcerated masses. Thus, all exophytic lesions should be submitted for microscopic analysis, and the status of ulceration should not be regarded neither as a factor in the decision to biopsy, nor a reliable indicator for malignancy.

Glomus tumours in the skin and subcutis of three horses

Three horses presented with variably painful, nonulcerated masses of the head or neck that were diagnosed as glomus tumours. Grossly, they were fleshy, pink to tan masses ranging from 0.4 to 9 cm in diameter, involving either the deep dermis and subcutis or the subcutis and underlying skeletal muscle. Microscopically, neoplastic epithelioid cells were arranged in sheets, cords and packets within lobules. The neoplastic cells frequently abutted and formed nodular bulges into large endothelium-lined vascular spaces, especially around the tumour periphery. Large nerve branches were associated with each tumour. As determined by immunohistochemistry, the neoplastic cells consistently expressed α-smooth muscle actin and vimentin, and some cells in two of the cases expressed desmin. A laminin- or collagen IV-positive basement membrane was demonstrated around individual tumour cells or small groups of cells in all three cases. Morphological features and immunohistochemistry supported the diagnosis of glomus tumour, most consistent with the solid type in humans. Applying a classification system used in humans, two of these tumours met criteria of malignancy (glomangiosarcomas). One horse was euthanized due to complications associated with recurrence and treatment-related necrosis and secondary infection.

Suprapubic Mass in Patient With Neurogenic Bladder Due to Spinal Cord Injury Managed With Indwelling Suprapubic Tube

A 57-year-old quadriplegic man with a history of neurogenic bladder (NGB) from a C5-C6 spinal cord injury (SCI) was initially treated at an outside institution with an indwelling suprapubic (SP) catheter for 26 years. The patient did not undergo routine bladder surveillance at the outside hospital but then transferred care to our institution. He initially presented with a roughly 1-year history of increased “tissue” at his SP site and increasing difficulties with SP tube changes. Physical examination revealed a firm, exophytic nonulcerated mass arising from the SP tube site approximately 5 × 3 × 6 cm in size (Fig.

Lingual Schwannoma Involving The Posterior Lateral Border Of The Tongue In A Young Individual: Case Report

A schwannoma, also called neurilemmoma, is a benign, encapsulated, slow growing tumor arising from the neural sheath's Schwann cells of the peripheral, cranial or autonomic nerves. The etiology is unknown, there is no gender preference and the tumors occur most commonly between the ages of 20 and 50 years. Approximately 25-48% of these tumors occur in the head and neck region, with only 1% occurring in the mouth. The current case reports a schwannoma of the tongue, found in a 12 year-old boy. The lesion was present for 6 months. The clinical examination revealed a 1.5x1.0 cm, sessile, rubbery, non-tender non-ulcerated mass on the right posterior lateral border of the tongue. An excisional biopsy was performed under local anesthesia. The histological sections showed a circumscribed submucosal nodule composed of spindle cells with thin wavy nuclei arranged as typical Antoni A (with Verocay bodies) and Antoni B areas. Nuclear palisading distribution (typical of a schwannoma) was readily identifiable. The patient was recurrence free after one year.

Crohnʼs Disease Presenting as Fever of Unknown Origin

Crohn's ileitis is usually suspected when patients present with abdominal pain and/or diarrhea. There are few reports in the literature of Crohn's disease presenting primarily as fever of unknown origin (FUO). Case report: 4 years before diagnosis, this healthy 32yo male began experiencing episodes of fever to104F w/sweats once every 3–4 months. In between episodes he felt entirely well. More recently he noticed occaisonal mild dull periumbilical pain. He had a normal stool every other day. Previous evaluations for infectious and rheumatologic causes of fever were negative. Flex sig six and two years ago for evaluation of BRBPR were negative. PMHx, FHx, and PEx were negative. Significant lab studies: Hgb 12.2, MCV 74, WBV 7.9, plt 455, CRP 2.57 (0–0.82), alkaline phosphatase 258, ALT 70, AST 20, total bilirubin 0.4, albumin 3.5, ferritin 36, viral hepatitis profile negative. Abdominal ultrasound was negative. CT abdomen and pelvis: marked thickening of cecum and proximal ascending colon w/mild stranding of pericolonic fat, neoplasm felt most likely. FDG PET scan: intense radionuclide accumulation RLQ. Colonoscopy: unusual fungating, nonulcerated mass in ascending colon, ileocecal valve not identified. Bx: focal crypt distortion w/acute and chronic inflammation, no granulomas. Nonspecific, likely infectious. Ex lap: dense inflammatory mass involving cecum, TI, appendix, extending into retroperitoneum. Gross path: TI ulcerated w/6mm stricture, several fistulae noted between TI and AC mass. Histopath: severe ileitis w/transmural inflammtion and deep fissure formation involving right colon. Preop ASCA IgA ELISA 54.3 (<20), IgG 58.8 (<40) Discussion: The distinctive features of this case are the absence of significant abdominal pain and diarrhea, and the prolonged duration of intermittent fever before diagnosis. The findings at colonoscopy led to the differential dx of GIST, lymphoma, infectious enteritis or foreign body reaction. Double-ASCA positivity was highly suggestive of Crohn's disease, however, and confirmed at pathology. Crohn's disease should be in the differential dx of FUO.

Soft, Painless, Nonulcerated Mass in the Lower Lip

uring a routine clinical oral exami­ nation of a 28-year-old white male, a soft, well-defined, freely movable, painless, nonulcerated mass was found in the left mucosal portion of the patient’s lower lip (Fig 1). Digital palpation disclosed the le­ sion to be fluctuant and pressure would not empty the contents. No other signifi­ cant dental or oral abnormalities were noted, and the patient’s medical history was noncontributory. The patient said that he recalled biting his lower lip about one week previously. He smoked approximately one package of cigarettes per day and admitted to moder­ ate use of alcohol, primarily beer. An excisional biopsy was performed and during the procedure clear, viscous fluid was released from the lesion.

Nonepidermoid cancer of the gum.

Twenty-six cases of nonepidermoid cancer of the alveolar ridge or gum were found in a 20-year survey at the Memorial Hospital in New York. Most of these cases were varieties of cancers of the minor salivary glands that presented most commonly as nonulcerated masses frequently invading underlying bone. These cancers demonstrated local recurrence on many occasions and carried an overall poor prognosis. The clinical behavior of the various pathologic types of minor salivary gland cancers resembles those found in the major salivary glands. More aggressive local surgical treatment should be undertaken to provide local control and better cure rates.