Non-neoplastic Lesions Research Articles

Correlation of Cytologic Features With Molecular TestingofIndeterminate Oncocytic (Hürthle Cell) Thyroid Lesions.

Indeterminate oncocytic/Hürthle cell lesions on thyroid cytology are reflexed to molecular testing. This study aims to examine the cytologic characteristics of thyroid fine-needle aspiration (FNA) smears with oncocytes classified as atypia of undetermined significance (AUS) with particular molecular patterns that can aid in determining a more conclusive Bethesda category upfront thus decreasing unnecessary testing and associated costs. Our pathology database was searched for thyroid FNAs with AUS for oncocyte predominance from 2019 to 2022. Sixty six cases that underwent ThyroSeq testing (33 positive and 33 negative) were selected. Two cytopathologists reviewed the smears for cellularity, colloid: cell ratio, artifacts, lymphocytes, microfollicles, and oncocytic nuclear atypia. Molecular results and surgical follow-up were obtained through chart review. Statistical analysis was done using STATA16.1 (StataCorp LLC College Station, TX). Among the 33 ThyroSeq-positive cases, 20 had surgical follow-up. Only 1 case was malignant. Hypercellularity, microfollicular architecture, and oncocytic atypia were associated with a higher incidence of molecular alterations. Five of 66 cases demonstrated microfollicles. Four of these had positive molecular findings, and one was negative. Twenty of 33 (61%) cases with positive molecular findings had no oncocytic nuclear atypia. Of the molecular positive cases with oncocytic atypia that underwent resection, seven of nine (78%) were neoplastic. RAS mutations were the most common finding detected in non-neoplastic and neoplastic lesions. Microfollicles were infrequently seen in nodules with oncocytic predominance; however, those that had microfollicles had high incidence of positive molecular findings. Oncocytic nuclear atypia was present in all the resected neoplastic cases. NRAS and KRAS mutations were the most common molecular abnormalities detected.

Low-Grade Appendiceal Mucinous Neoplasm vs. Appendiceal Diverticulum: Distinction with Histomorphologic Features

Background: Low-grade appendiceal mucinous neoplasms (LAMNs) are rare lesions of the vermiform appendix and characterized by mucinous epithelial proliferation, extracellular mucin, and the absence of destructive invasion. Appendiceal diverticulum (AD) is also an uncommon condition that may be challenging to differentiate from acute appendicitis when it is superimposed by diverticulitis or perforation. Some recently published studies emphasized that complicated AD with mucosal hyperplasia can be confused with LAMNs, leading to overdiagnosis. The present study aimed to determine the histopathological features which can be used in the differential diagnosis of LAMNs and ADs, particularly complicated diverticula, in a large cohort. Methods: Cases comprising LAMNs and ADs diagnosed between 2011 and 2021 were included in the study. All cases were evaluated for the epithelial lining, the wall of the lesions, and the presence of cellular or acellular mucin, with its localization in terms of level and site of involvement within the appendix also recorded. Results: The hypermucinous epithelium characteristic of LAMNs, fibrosis, and calcification in the wall and the absence of lamina propria and muscularis mucosa proved to be the most discriminatory features in the differential diagnosis of LAMNs and ADs. Conclusions: The distinction between mucinous neoplasia and its mimics is critically important, since mucinous neoplasia requires surveillance imaging and potential surgery or chemotherapy depending on the extent of the disease, whereas non-neoplastic lesions are treated by an appendectomy and require no future intervention or surveillance.

NIMG-38. DIAGNOSIS AND TREATMENT OF BRAIN TUMORS USING METHIONINE PET

Abstract INTRODUCTION The usefulness of methionine PET examination in diagnosing brain tumors is widely recognized, and it is a frequently used examination method for distinguishing primary tumors from non-neoplastic lesions and recurrent lesions from radiation necrosis. In addition, during surgery, it has the property of being taken up by actively dividing tumor cells, which is useful for identifying the extent of resection. Method: Methionine PET examination was performed in 228 consecutive cases in our department from January 2021 to April 2023, and medical records and genetic analysis data were retrospectively analyzed. RESULTS Of the 228 cases, 146 cases provided useful data for clinical practice, such as the diagnosis of tumors and the differentiation of recurrent tumors from necrosis. On the other hand, there were 9 cases in which the pathological diagnosis of the resected specimen was “tumor” despite the lack of significant methionine accumulation. The details were astrocytoma, cavernous hemangioma, spinal ependymoma, etc. On the other hand, 26 cases were finally diagnosed as “non-neoplastic disease”. Of these, 13 cases had methionine accumulation. The details of the cases that were finally diagnosed as “non-neoplastic disease” were multiple sclerosis, cerebral infarction, dural arteriovenous fistula, inflammatory disease, etc. There were 12 cases in which a diagnosis of “neoplastic disease” was not revealed after methionine PET examination, and the patient was continuously observed. None of these 12 cases had an acute or malignant course. CONCLUSION Although methionine PET is considered useful for diagnosing neoplastic disease, there are cases in which there is no uptake, especially in astrocytoma, and a certain number of cases in which uptake was observed even in non-neoplastic diseases, so caution is required. In addition, in terms of treatment, it is possible to aim to improve surgical accuracy by integrating methionine PET images with intraoperative MRI and intraoperative molecular analysis techniques, and we report an example of this.

Clinical consequences of computer-aided colorectal polyp detection

Background and aimRandomised trials show improved polyp detection with computer-aided detection (CADe), mostly of small lesions. However, operator and selection bias may affect CADe’s true benefit. Clinical outcomes of increased...

Epidemiologic and Clinicopathological Characterization of Feline Mammary Lesions.

Most lesions found in the mammary glands of cats are malignant, with aggressive behavior and unfavorable prognosis. Studies on the epidemiologic and clinicopathological characteristics of mammary lesions in cats are scarce. The present study aimed to evaluate those characteristics and to correlate them with survival in cats. Mammary specimens were selected from 418 domestic cats that underwent surgical removal with or without lymphadenectomy. The cats and mammary lesions were evaluated for epidemiologic, clinical, and pathologic characteristics. Cats with malignant neoplasms were older than cats with benign neoplasms and non-neoplastic lesions; 858 lesions were identified, including sporotrichosis, basaloid carcinoma, and benign phyllodes, described for the first time in cats. Tubulopapillary and cribriform carcinomas were the most common malignant tumors found and were very similar in characteristics such as marked anisocytosis/anisokaryosis, high mitotic count (score 3) (p < 0.001), and presence of necrosis (p = 0.005). The association between advanced age and malignancy, as well as the description of new lesions, emphasizes the importance of population studies in cats to understand the behavior of the disease and to draw attention to diagnoses that should be considered in routine care.

Lesions of the Palm – Mimickers of Dupuytren’s Disease

Background and Aims: Dupuytren’s contracture is a prevalent, hereditary fibroproliferative disorder affecting the palmar aponeurosis, which can resemble various neoplastic and non-neoplastic disorders of the hand. This resemblance poses a diagnostic challenge for healthcare professionals. This observational study aims to evaluate the range of conditions that can be mistaken for Dupuytren’s contracture over a 12-year period (2008–2020) at a specialised orthopaedic oncology centre. Materials and Methods: A retrospective analysis of palmar lesions referred to our tertiary orthopaedic oncology hospital was conducted. Data were gathered from oncology, radiology and histopathology databases. We specifically examined lesions located solely on the palmar aponeurosis, excluding the thenar and hypothenar regions. Patient demographics, clinical features, imaging results and clinical management outcomes were documented for descriptive analysis. Results: A total of 21 palmar lesions meeting the inclusion criteria were identified. The average age of the participants was 48 years (ranging from 3 to 69 years). There was no significant difference in gender distribution, with 11 females and 10 males represented in the cohort. The majority of the identified lesions were benign tumours (16), with one case of malignant rhabdomyosarcoma. Among the benign tumours, lipomas were the most common ( n = 5). Other benign tumours included three neurofibromas, a schwannoma, a granuloma, a ganglion cyst, a giant cell tumour (GCT), an angiomyxoma, a myofibroma, a cavernous haemangioma, a non-specific fibrovascular lesion and four additional non-neoplastic lesions. Conclusion: A variety of benign, malignant or neoplastic conditions of the hand can closely resemble Dupuytren’s contracture, particularly in the initial stages of their development. A thorough clinical examination, combined with a high level of suspicion, along with supplementary investigations and histopathological analysis, is essential for accurate diagnosis and effective management of patients.

Historical Control Background Incidence of Spontaneous Nonneoplastic Lesions of Sprague Dawley Rats in 104-Week Carcinogenicity Studies.

Microscopic observation data collected from approximately 1800 male and female Sprague Dawley (SD) control rats used on 104-week carcinogenicity studies performed at North American Labcorp Early Development, Inc, Madison, WI, were retrospectively evaluated for spontaneous nonneoplastic findings. This study provides incidence of the most common spontaneous nonneoplastic microscopic findings in each organ system of SD rats encountered during 104-week carcinogenicity studies. Some of the most common spontaneous background findings were cardiomyopathy; chronic progressive nephropathy; uterine cystic endometrial hyperplasia; prostate inflammation; pulmonary alveolar macrophage infiltrates; hepatocyte vacuolation, bile duct hyperplasia, and basophilic foci in the liver; pancreatic fibrosis; splenic extramedullary hematopoiesis and pigment; decreased lymphocytes and epithelial hyperplasia in the thymus; ventral brain compression; cystic degeneration and hyperplasia of the adrenal cortex; and mammary gland hyperplasia. The most common nonneoplastic findings in male SD rats were chronic progressive nephropathy (80.9%) and rodent progressive cardiomyopathy (73.2%). The most common nonnenoplastic findings in female SD rats were cystic degeneration of the adrenal cortex (64.7%) and ventral compression of the brain due to pituitary neoplasms (62.7%).

Pathology and diagnostic approaches to well-differentiated hepatocellular lesions: a narrative review.

Well-differentiated hepatocellular lesions (WDHLs) are liver tumors or nonneoplastic lesions in which the cells closely resemble normal hepatocytes. These lesions often include focal nodular hyperplasia, hepatocellular adenoma, macroregenerative nodule, dysplastic nodule, and well-differentiated hepatocellular carcinoma. The diagnosis of these lesions remains challenging because of their morphological similarities, particularly when examined using needle biopsy. The accurate diagnosis of WDHLs is crucial for patient management and prognosis. This review addresses the histopathological characteristics and diagnostic approaches of WDHLs.

Histopathologic Patterns of Urinary Bladder Lesions and Associated Factors in Hawassa University Comprehensive Specialized Hospital, Sidama Region, Ethiopia

Background: Urinary bladder lesions, non-neoplastic and neoplastic, are collectively responsible for significant morbidity and mortality throughout the world. Bladder cancer is a prevalent disease affects a significant number of individuals each year worldwide. The most common non-neoplastic and neoplastic lesion of the urinary bladder is non-specific cystitis and urothelial carcinoma respectively. Objectives: The aim of this study is to describe histopathologic patterns of urinary bladder lesions and associated risk factors in Hawassa University Comprehensive Specialized Hospital from January 2017 to December 2023. Methods: A 7-year cross sectional study was conducted to describe histologically diagnosed bladder lesions and associated factors at Hawassa University Comprehensive Specialized Hospital from January 2017 to December 2023. Results: This study comprised a total of 182 patients who have bladder biopsies at Hawassa University Comprehensive Specialized Hospital, Pathology department from January 2017 to December 2023. Out of which 21 cases (12.1%) are non-neoplastic, while 152 cases (83%) are neoplastic. Nine cases (4.9%) have a descriptive diagnosis. With 139 (90.44%) cases, urothelial neoplasms have the highest frequency form all neoplastic lesions. Ninety-seven cases, or 69.8%, of urothelial neoplasms were invasive; of them, 78 (80.4%) were high grade cases. Low-grade noninvasive papillary carcinomas, which accounted for 24 instances. One case is a cystectomy specimen, and the remaining 181 cases are TURBT. The age range of 50-59 years was the most frequent accounting for 39 (21.4%) of all cases, with a male to female (M: F) ratio of 2.9:1. The most frequent presenting symptom in 146 (85.7%) of patients was hematuria. Conclusions: This study demonstrates that 139 (90.44%) of the neoplastic bladder lesions were bladder neoplasms of urothelial origin, 97 (69.8%) of which are invasive urothelial carcinoma with rising numbers each year and implying the burden in the region.

Cytological Evaluation of Palpable Non-Neoplastic Breast Lesions among Women attended from Rural Community of Bangladesh: A Retrospective Cross-Sectional Study

Background: Non-neoplastic palpable breast disease is one of the most common disorders from which women suffer throughout the world. The use of fine-needle aspiration cytology (FNAC) method has proven to be quick, simple and cost-effective with minimum risk of complications in the evaluation of breast lumps. Objective: This study was planned to find out the common causes of various types of non-neoplastic breast lesions of female at different ages through fine needle aspiration cytology. Methodology: The retrospective cross-sectional study was carried out in the Department of Pathology at Monno Medical College&amp; Hospital, Manikganj, Bangladesh. It lasted 2 years 6 months from July 1, 2019 to December 31, 2021. This study examined all breast lumps found in female patients. For data analysis, the patient's age and FNAC report were recorded. Aspirates were done using 5ml/10ml syringe and 23-gauge needle. Smears were stained with Papanicolaou stain. Results: The study included total 349 female patients with breast lesion. Among these, non-neoplastic lesions were 183(52.44%) cases and neoplastic lesions were 166(47.56%) cases. Among the lesions, 105(30.08%) cases were in fibrocystic changes; 28(8.02%) cases were in non-suppurative mastitis; 24(6.87%) cases were in suppurative mastitis (abscess), 14(4.01%) cases were in granulomatous mastitis. About 45(42.88%) cases of Fibrocystic changes, 13(44.84%) cases of non-suppurative mastitis and 9(37.5%) cases of Suppurative mastitis (abscess) were in the age group 21 to 30 years, 21 to 30 years and 41 to 50 years respectively. Conclusion: Fibrocystic changes are the commonest lesion in this study. Journal of Monno Medical College June, 2024; 10 (1):07-12

Unexpected Presentations of Histiocytic Disorders as Mass Lesions in the Central Nervous System and Spine

Abstract Introduction/Objective A number of neoplastic and non-neoplastic hematolymphoid lesions can involve the CNS and spine. The majority are lymphomas, but some are rare lesions that mimic primary neoplasms clinically, radiologically, and even pathologically. Here, we present our experience of such cases. Methods/Case Report Pathology archives were searched, and five cases representing different challenges were identified to review clinical, radiological, and pathologic features. Case 1. 31-year-old female presented with vision changes and hearing loss and numerous supratentorial extra-axial masses, suspicious for meningiomatosis. Extensive lymphoplasmacytic infiltrate was seen at Intraoperative consult (IOC). Final diagnosis was Rosai-Dorfman disease with features of IgG4 related disease. Case 2. 31-year-old female with Chronic myeloid leukemia (CML), which progressed to AML presented with a right frontal brain mass. IOC displayed atypical hematolymphoid infiltrate. Final diagnosis was myeloid sarcoma. Case 3. 29-year-old male presented with a T10 vertebral lesion. IOC showed hypercellular tissue with atypia and was deferred. Subsequently, histiocytic sarcoma was diagnosed. Case 4. 22-year- old male presented with a T3-T4 intradural, extramedullary mass radiologically thought to be a meningioma. No IOC was requested. Final diagnosis was juvenile xanthogranuloma. Case 5. 36-year-old male presented with a C7-T1 dura-based mass. IOC revealed granulomatous inflammation, eventually resulting in a diagnosis of non-necrotizing granulomatous inflammation, suggesting sarcoidosis. Results (if a Case Study enter NA) NA Conclusion These cases highlight the importance of incorporating all clinical and radiological findings into pathologic evaluation, while being alert for mimickers and pitfalls. Both practicing general surgical pathologists and neuropathologists should remain alert to such unexpected and unusual cases especially at the time of IOC and initiate appropriate work-up with expedited diagnostic protocols such as intraoperative cultures, flow cytometry, and cytogenetics, as the differential diagnosis is broad with inflammatory, infectious, and neoplastic possibilities, presenting a variety of challenges.

Podoplanin Expression in Early-Stage Colorectal Cancer-Associated Fibroblasts and Its Utility as a Diagnostic Marker for Colorectal Lesions.

(Background) Cancer-associated fibroblasts (CAFs) are major cancer stromal components. CAFs have diverse functions and cell origins. Podoplanin (PDPN), a lymphatic vessel marker, is also a CAF marker in certain cancers. On daily diagnosis of early colorectal carcinoma (CRC), PDPN upregulation in the stroma is often encountered, suggesting PDPN-positive CAFs have emerged. However, PDPN-positive CAFs in early CRC have not been studied well. (Methods) On immunohistochemistry, PDPN expression in the lamina propria or stroma of adenomas, early CRCs, and neuroendocrine tumors, their normal neighbors, and non-neoplastic colorectal lesions were compared. Single-cell RNA sequencing (scRNA-seq) of CRC was used to explore PDPNhigh CAFs' cell origins. (Results) Reticular cells or pericryptal fibroblasts in the lamina propria of adenomas and early CRCs showed higher PDPN expression than did normal mucosae and non-neoplastic lesions (p < 0.01). Pericryptal PDPN expression was a diagnostic feature of adenomas and early CRCs. scRNA-seq of CRCs highlighted that PDPNhigh CAFs had distinctly higher COL4A1, COL4A2, and WNT5A expression, unlike well-known CAFs characterized by high FAP, POSTN, or ACTA2 expression. (Conclusions) We demonstrated that pericryptal fibroblasts and reticular cells in the lamina propria are origins of early-stage CRC CAFs and thus have potential as a diagnostic marker for distinguishing colorectal non-neoplastic from neoplastic lesions.

8719 Epidermal Inclusion Cyst Masquerading as Obstructive Craniopharyngioma

Abstract Disclosure: M. Murugesh: None. F. Thelmo: None. J. Watari: None. The most common cause of a sellar mass is notably pituitary adenoma (84.6%), followed by craniopharyngioma (3.2%), cystic nonneoplastic lesion (2.8%), inflammatory lesion (1.1%), meningioma (0.94%). Epidermoid cysts are benign congenital inclusion cysts that can occur anywhere in the body, with about 7% percent occurring in the head and neck region. Very rarely, they can present intracranially, accounting for about 0.3-1.8% of primary tumors. We present a rare case of epidermoid cyst growing as a suprasellar mass causing hypopituitarism.A 58-year-old female presented to the emergency department with dizziness in the setting of an ear infection. CT head showed 2.8 cm complex suprasellar mass, with adjacent 1 cm nodule at the cerebellopontine angle. MRI showed 2.7 x 2.4 x 2.7 cm suprasellar mass along with “a lobular component along the left posterior aspect extending to the cerebellopontine angle which measures about 1.3 cm, causing mass effect on the midbrain, pons, and optic chiasm”. The differential included craniopharyngioma, macroadenoma and meningioma. Notably, she denied any vision changes. She was evaluated by neurosurgery and after extensive multidisciplinary discussion with ENT and ophthalmology, the patient proceeded with endoscopic surgery for mass resection. Intra-operatively, the mass was noted to be densely adherent to the basilar artery, and sub-total resection was performed. Surprisingly on pathology the mass was identified as an epidermoid cyst, as evidenced by debris with cholesterol clefts and no lesional cells. The patient was started empirically on hydrocortisone 50mg three times a day post-resection. Endocrinology was consulted postoperatively with initial concerns of diabetes insipidus in the setting of hypernatremia, however, the patient’s sodium levels normalized. Pituitary panel at this time was concerning for central hypothyroidism (TSH 0.53 and FT4 0.8) and central adrenal insufficiency (ACTH &amp;lt;9 and AM cortisol 0.9). She was ultimately discharged on prednisone 5mg and levothyroxine 75 mcg with outpatient follow-up. While epidermoid cysts are present in the head and neck region about 7% of the time, they rarely occur in intracranial regions, with about 1.5% of intracerebral epidermoid cysts occurring intracranially. They tend to be slow growing and are often found only when they grow large enough to become symptomatic, as seen in our presented case. Our case highlights the importance of recognizing epidermoid cysts as a rare cause of sellar masses. Presentation: 6/1/2024

Clinical Impact of Radiologist’s Alert System on Patient Care for High-risk Incidental CT Findings: A Machine Learning-Based Risk Factor Analysis

Rationale and ObjectivesEfficient communication between radiologists and clinicians ordering computed tomography (CT) examinations is crucial for managing high-risk incidental CT findings (ICTFs). Herein, we introduced a Radiologist’s Alert and Patient Care Follow-up System (APCFS) for high-risk ICTFs. This study aimed to analyze the ICTFs detected by this system and the factors associated with them. Materials and MethodsThis retrospective study was approved by the institutional review board. We analyzed 52,331 CT examinations conducted between 2019 and 2021. In cases where high-risk ICTFs were identified, radiologists utilized APCFS to prompt ordering clinicians for further patient care. We assessed the frequency, affected body organs, presence or absence of therapeutic interventions, and diagnoses of high-risk ICTFs. An automated machine learning platform was employed to analyze the factors associated with high-risk ICTFs. ResultsAmong the 52,331 CT examinations, 507 (0.96%) revealed high-risk ICTFs, primarily affecting the lung (18.0%). Of these 507 high-risk ICTFs, 117 (23.1%) underwent therapeutic interventions, while 362 (71.4%) required only follow-up. Of the 117 cases undergoing interventions, 61 (52.1%) required surgery. Of the 219 high-risk ICTFs leading to a confirmed diagnosis, 146 (66.7%) were neoplastic lesions, including 88 (60.3%) malignancies, and 73 (33.3%) were non-neoplastic lesions. The top three risk factors associated with high-risk ICTFs in the regularized logistic regression model were the imaging protocol (especially aortic valve implantation planning protocol), imaging area (especially whole-body imaging), and clinical department (especially cardiology). ConclusionUtilizing APCFS, high-risk ICTFs were detected in approximately 1% of all CT examinations, likely associated with specific imaging protocols, areas, and clinical departments.

Large vocal polyp causing dyspnea to young patient

The vocal cords are primarily responsible for voice production and the risk factor for non-neoplastic vocal fold lesions is usually multifactorial, laryngeal trauma (endotracheal intubation), hypothyroidism, cigarette smoking, alcohol abuse, gastroesophageal reflux (GERD) and also including phonotrauma etc. we report a 30-year-old female presented with the complaint of dyspnea and hoarseness of voice. endoscopic examination showing, the very large vocal cord polyp was seen to be arising from the left vocal cord, partially blocking the glottic chink, with minimal residual airway. ML Scopy excision of the polyp was done and size was approximately 1.5 cm.

Can patients with mild non-neoplastic lesions diagnosed at baseline screening be safely exempt from surveillance: evidence from multicenter community-based cohorts.

Surveillance recommendations for gastric cancer (GC) in current guidelines focused on advanced precancerous lesions and were based on precise diagnosis of severity/extent of baseline lesions. We aimed to develop a less endoscopy-related equipment-dependent risk-stratification tool, and assessed whether mild-precursor-lesion patients can be safely exempt from surveillance. In the multicenter community-based cohort, 75,051 participants receiving baseline endoscopy were enrolled during 2015-2017 and followed-up until 2021. Cumulative incidence rates (CIRs) of GC for precancerous-conditions were calculated by Kaplan-Meier method and compared by Log-rank tests. Mixed-effects Cox regression models were used to detect potential factors for progression towards GC. A risk score was calculated as counts of selected factors. An independent cohort, including 26,586 participants was used for external validation. During a median follow-up of 6.25 years, CIRs of GC were 0.302%, 0.436%, and 4.756% for normal group, non-neoplastic (atrophic gastritis/intestinal metaplasia) and neoplastic lesions (low-grade/high-grade dysplasia), respectively (Ptrend<0.001). Four predictors, including male, ⩾60 years, smoking, and limited vegetable consumption, were selected for risk-stratification. High-risk patients (⩾3 risk factors) with non-neoplastic lesions showed higher GC risks (adjusted HR=7.73, 95%CI: 4.29-13.92), and their four-year CIR reached the one-year CIR of neoplastic lesions. Further categorizing non-neoplastic lesions by histological grade, both patients with moderate-to-severe lesions (aHR=3.07, 95%CI: 1.67-5.64) and high-risk patients with mild lesions (aHR=7.29, 95%CI: 3.58-14.86) showed higher risks. Consistent trends were observed in validation cohort. High-risk mild-precursor-lesion patients should receive surveillance within 3-5 years after baseline screening. Our study provides evidence on supplementing current guideline recommendations.

Rathke's cleft cysts: from pathophysiology to management.

Rathke's cleft cysts (RCCs) are benign, non-neoplastic lesions located in the sellar and suprasellar regions of the brain, originating from remnants of Rathke's pouch, an embryonic precursor to the anterior pituitary gland. Although RCCs are frequently asymptomatic and discovered incidentally during imaging studies, they can present with a variety of symptoms, including headaches, visual disturbances, and endocrine dysfunction due to the compression of adjacent neural structures. The management of RCCs is particularly challenging, as the decision to pursue conservative monitoring or surgical intervention depends heavily on the cyst's size, growth potential, and the severity of symptoms. Transsphenoidal surgery is the primary treatment for symptomatic RCCs, offering effective relief from symptoms through decompression of the cyst. However, recurrence remains a significant issue, with rates reported up to 33%, prompting debates about the extent of cyst wall removal during surgery. Recent advancements in minimally invasive endoscopic techniques have improved surgical outcomes, yet the risk of postoperative complications such as hypopituitarism and cerebrospinal fluid leaks persists. Additionally, stereotactic radiosurgery has emerged as a potential alternative for patients with recurrent RCCs or those who are not suitable candidates for repeat surgery. Despite its promise, the long-term safety and efficacy of radiotherapy in RCC management require further investigation. This narrative review aims to provide a comprehensive overview of RCCs, integrating the latest research and clinical guidelines to discuss pathophysiology, clinical presentation, and management strategies, emphasizing the need for a personalized approach to treating this complex condition.

Histomorphological Study of Nephrectomy Specimens with Assessment of Prognostic Parameters in Renal Cell Carcinoma

Abstract Background: Kidney is a major organ that is affected by vast spectrum of non-neoplastic (NN) and neoplastic lesions. Simple nephrectomy is done for nonfunctioning kidneys in inflammatory/ benign disorders, radical / partial nephrectomy is done for neoplasms. Aims: This study aims to study the different histomorphological features observed in nephrectomy specimens and to assess the significance of prognostic parameters in the evaluation of renal cancers. Materials and Methods: This is a retrospective study that includes 71 nephrectomy specimens received in our department. Results: Among the 71 nephrectomy specimens 57.7% were NN lesions. Chronic pyelonephritis and Clear cell type of renal cell carcinoma (RCC) were the commonest NN and neoplastic lesions respectively. Majority of RCCs were histologically grade 2 (50%). A significant correlation was found between tumor size and grade, tumor size and renal sinus invasion (RSI) and RSI was frequently seen in higher grade RCCs. However, a larger sample size is needed to generalize these results. Conclusion: With early interventions of NN lesions and detecting RCC in early stages the need for surgical management and radical procedures can be brought down to spare this vital organ.

Histopathological changes in testicular lesions in cats.

The aim of this retrospective study was to describe the neoplastic and non-neoplastic lesions seen on histopathological examination of cat testes in Hong Kong between 2018 and 2024. A total of 26 single or dual testes samples were collected from 18 cats by veterinarians at 14 veterinary clinics and submitted for histopathological examination. Laboratory records, including signalment, lesion location, age, breed and histopathological findings, were reviewed for each cat. Neoplastic testicular lesions were seen in three older cats (median age 8.5 years; range 3-17) compared with 18 non-neoplastic lesions in 15 cats (median age 1 year; range 0.5-3). The most common non-neoplastic lesions included inflammation (in the testes, epididymis, tunics and ductus deferens), cryptorchidism, and one case each of polyorchidism and epididymal cyst formation. Two of the testes with inflammation were identified on immunohistochemical staining as feline coronavirus-infected and one pair of testes was associated with the presence of extracellular Gram-negative bacteria at the lesion site. Three different neoplastic lesions were identified, one each of Sertoli cell tumour, leiomyoma and fibrosarcoma. Non-neoplastic testicular lesions were most common, including inflammation, cryptorchidism, polyorchidism and epididymal cysts. To our knowledge, leiomyoma and fibrosarcoma have not been reported in cat testes before and represent important differential diagnoses for testicular lesions.

Prevalence and Clinico-pathologic Profile of Biopsied Gingival Lesions from 2 Thai Dental Schools.

Gingiva can be afflicted by several pathological entities apart from gingivitis and periodontitis. There have been limited number of studies on gingival lesions, especially from Thailand. Aim: To analyze the prevalence and distribution of biopsied gingival lesions from Chulalongkorn and Rangsit Dental Schools, Thailand. Biopsy records of the participating institutions from 1995 to 2020 were reviewed for gingival lesions. The demographic data, site of lesions and diagnoses were collected. Data were analyzed by descriptive statistics. From a total of 16,207 biopsies, 1,589 cases (10.2%) were diagnosed in the category of gingival lesions. The mean age ± SD of the patients was 42.3 ± 18.6 years with the highest prevalence being in the fourth decade of life (17.4%). A male-to-female ratio was 0.48:1. The most common location was the posterior mandible (27.4%). Regarding the type of gingival lesions, non-neoplastic lesions (88.5%) outnumbered neoplastic lesions (11.5%). The most common lesion was pyogenic granuloma, followed by irritation fibroma and peripheral ossifying fibroma. Among the neoplastic lesions, squamous cell carcinoma was the most prevalent lesion followed by papilloma and lymphoma. Gingival lesions mostly occur in the fourth decade of life and have a predilection for female patients. The majority of the lesions are located in the posterior mandible. Non-neoplastic lesion, especially the reactive subtype, is the most prevalent group and pyogenic granuloma is the most common gingival lesion. Data from this study represent biopsied gingival lesions from Thailand which may be different from those of other countries. Key words:Gingival lesions, prevalence, demographic, clinico-pathological correlation, gingival biopsy.