Postoperative Histological Diagnosis Research Articles

Gallbladder carcinoma: the role of p53 protein overexpression and Ki‐67 antigen expression as prognostic markers

The overexpression of p53 protein and the expression of Ki-67 antigen may affect the survival of patients with gallbladder carcinoma. This association has been tested in a series of 41 patients with relatively early carcinoma of the gallbladder. Forty-one surgical specimens from patients with a postoperative histological diagnosis of gallbladder carcinoma were studied. All patients were operated by simple cholecystectomy only because the tumours were not advanced and/or their general condition was poor. Patients submitted to radical operations were excluded. p53 expression was calculated from nuclear staining according to the intensity and extent of positive cells, as graded on a scale from 1 to 3; a combined score of >3 was considered as overexpression. Ki-67 expression was calculated by the MIB-I index: the percentage of positively stained tumour cell nuclei out of the total tumour cells counted (n = 1000); >20% of stained cells was considered positive. Twenty-nine gallbladder carcinomas (71%) overexpressed p53 protein in the cell nuclei. No significant differences were found in relation to cell differentiation on the level of tumour infiltration through the gallbladder wall. Five-year survival of patients with gallbladder carcinoma overexpressing p53 was 17.2%, while survival of patients without p53 overexpression was 30% (not significant). Twenty-four cases (58.5%) were considered positive for the MIB-I index. There were no differences between the grade of cell differentiation and wall infiltration. Five-year survival of the patients with a MIB-I positive index was 9.2% as opposed to 27.7% for those with a negative index (not significant). p53 protein nuclear overexpression and Ki-67 protein expression in gallbladder carcinoma were not related to histological differentiation, level of gallbladder wall invasion or patient survival.

Significance of asymptomatic tonsil asymmetry

Objective Asymmetry of tonsils that arouses suspicion for malignancy is one of the indications for tonsillectomy. The purpose of this study was to evaluate the incidence of occult malignancy in patients with asymptomatic unilateral tonsillar enlargement. Study design and setting A prospective controlled trial was carried out in two institutions, Beyoglu Research and Training Hospital and Karaelmas University Hospital, during a 6-year period. Of patients selected for tonsillectomy, patients with unilateral tonsillar enlargement were identified and were included in this study. Patients who had risk factors that were significant for malignancy were excluded. After excision , two tonsil specimens were measured before sending for histology. Matched controls with symmetric tonsils underwent the same procedures. Preoperative diagnosis of tonsil asymmetry with the postoperative histologic diagnosis were correlated for the incidence of malignancy. Results Of the 792 patients undergoing tonsillectomy, 53 patients (6.69%) with asymmetry of tonsils and who had no other risk factors for malignancy underwent tonsillectomy. The size difference of the tonsils ranged from 0 to 19 mm. In the control group of 51 patients with symmetric tonsils, the size difference ranged from 0 to 8 mm. The analysis showed statistically significant difference in the degree of asymmetry between the two groups ( P < .001). Most of the specimens contained reactive lymphoid hyperplasia in both groups (58.49% and 54.9%, respectively). No malignancies or unusual pathological findings were encountered on histologic examination in either group. Conclusion and significance Tonsil asymmetry may only be apparent in patients with an otherwise normal physical examination, secondary to benign hyperplasia or anatomical factors. Therefore, the presence of tonsil asymmetry without factors such as suspicious appearance, significant systemic signs and symptoms, progressive enlargement of the tonsil, concomitant neck adenopathies, and history of malignancy or immunocompromise, may not indicate malignancy, as a sole clinical feature.

The nodular form of hepatic tuberculosis: a review with five additional new cases

Background: Tuberculosis presenting as an isolated liver tumour, without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare. A greater awareness of this rare clinical...

Ovarian Endometrioid Adenocarcinoma Arising from an Endometriotic Cyst in a Postmenopausal Woman under Tamoxifen Therapy for Breast Cancer: A Case Report

Background. Ovarian cancer arising from an endometriotic cyst in a postmenopausal woman under tamoxifen therapy is rare. Case. We herein report the case of a 67-year-old woman with a history of breast cancer, taking tamoxifen citrate 20 mg/day for 4 years, who underwent an operation for left ovarian tumor. The postoperative histological diagnosis was endometrioid adenocarcinoma in an endometriotic cyst with a gradual transition of the degree of cellular atypia noted from typical endometriotic epithelium, to atypical endometriosis, and finally to adenocarcinoma. Conclusion. Tamoxifen may cause malignant transformation of endometriosis through atypical endometriosis even in the postmenopausal state. Atypical endometriosis may act as a precancerous lesion in the process of tamoxifen-induced malignant transformation of endometriosis.

A PATIENT WITH GASTROINTESTINAL STROMAL TUMORS OF THE SIGMOID COLON SURVIVING FOR LONG TIME BY SURGICAL RESECTIONS FOR REPEATED RECURRENCE

We report a patient with gastrointestinal stromal tumor (GIST) of the sigmoid colon who can survive by surgical resections for repeated recurrence. A 55-year-old man was admitted to the hospital because of a left lower abdominal mass. Abdominal CT scan and magnetic resonance imaging showed that the tumor occupied from the lower kidney to pelvic cavity. Angiography showed encasement and stenosis of the inferior mesenteric artery. The tumor was histologically diagnosed as leiomyosarcoma by a needle biopsy. Sigmoidectomy with combined resection of the jejunum was performed. During laparotomy, small nodules were noted in the omentum and spleen due to peritoneal dissemination, and then a removal of the tumor and a splenectomy were added. Postoperative histological diagnosis was GIST of the sigmoid colon. Five times of surgical resection were performed due to recurrences for 3years and 9months after the first operation, and thereafter, the patient is alive with no evidence of the disease. This patient is strictly followed up in the clinic because a histologic study disclosed a high grade of malignancy.

Postoperative MRI appearance after transsphenoidal pituitary tumor resection

BACKGROUND Knowledge of the magnetic resonance imaging (MRI) appearance of the pituitary fossa following transsphenoidal resection of a pituitary adenoma, in the early and late postoperative period, is important for detecting complications and for assessing extent of tumor excision. Few prospective studies have addressed this issue. METHODS Fourteen patients with pituitary macroadenomas were prospectively studied with MRI. Maximal tumor resection was accomplished in each patient, and the postoperative histological diagnoses included non-secreting adenoma in 11 patients, prolactinoma in 2 and necrosis in one. Early postoperative scans were obtained within 14 days after surgery, and late studies between 3 and 4 months, in all patients. Four patients also had delayed scans between 8 months and a year. The maximum coronal dimension (MCTD) of the sellar and suprasellar contents was measured on T1-weighted contrast enhanced scans. RESULTS All patients had normal or improved visual examinations and normal or improved hormonal function postoperatively. The preoperative MCTD ranged from 11 mm to 59 mm in height (mean 30.3 mm). There was little change in MCTD on the early postoperative MRI scans (range 7–49 mm, mean 23.5 mm). However, in all patients the MCTD decreased in height by 4 months (range 2–35 mm, mean 12.7 mm). This change represented a 58% mean reduction in size compared to the preoperative measurements. CONCLUSIONS We conclude that the appearance of the sellar contents on early postoperative MRI may appear remarkably similar to that seen before surgery, even after technically adequate resection. The postoperative mass may represent a combination of residual tumor, edema, postoperative hemorrhage and hemostatic material. Routine follow-up MRI after transsphenoidal resection of pituitary tumors may be delayed until at least 4 months after surgery in patients who are clinically stable.

The role of 18F-fluoro-deoxyglucose positron emission tomography (18F-FDG PET) in diagnosis of ovarian cancer.

We evaluated the clinical significance of 18F-FDG PET to detect malignant ovarian neoplasms and tumor spread. 40 patients (median age: 57.5 years) underwent laparotomy because of clinical suspicion of malignant ovarian tumors or recurrent disease. The results of the preoperatively performed PET were correlated with the postoperative histologic diagnosis and the intraoperatively assessed tumor spread. In 10 of 40 patients benign tumors were found, among which a tubo-ovarian abscess was the only one diagnosed as false positive. 4/30 malignant neoplasms did not originate from the coelomic epithelium, but all were correctly recognized as malignant tumors by PET, as was recurrent ovarian cancer in 12 patients. Out of 14 primary ovarian carcinomas, 2 borderline tumors and 1 well-differentiated adenocarcinoma FIGO stage I were not correctly identified. Considering the tumor type, sensitivity, and specificity were 90%, calculating for the positive and negative predictive value 96% and 75%, respectively, and 90% for the diagnostic accuracy. Those statistical parameters were slightly lower for PET detection of lymph node metastasis and peritoneal carcinomatosis. Although its diagnostic accuracy may vary depending on the clinical application, 18F-FDG PET is basically a suitable method for detecting ovarian malignancies, particularly in patients with relapsed ovarian carcinoma.

Enfoque multidisciplinario en el manejo de las malformaciones vasculares cerebrales

Cerebral vascular malformations (CVM) are a heterogeneous group of lesions. One way of classifying them is according to histological criteria, clinical features, imaging findings, electroencephalography and distinctive pathology. To report the results obtained in 16 patients clinically diagnosed as having CVM and operated on in the Centro Internacional de Restauración Neurológica (La Habana, Cuba) between March 1995 and October 1998. We also consider the usefulness of diagnostic tools for neurosurgical management and anatomo-pathological diagnosis. We review the clinical findings, images, electroencephalograms and diagnostic histology of 16 patients. The gender distribution was 10 men and 6 women who were aged between 9 and 48 years. Stereotaxic resection guided by CAT and angiography was done in all cases. The predominant symptoms were headache and generalized tonic-clonic convulsions. CAT and angiography were helpful in determining the clinical diagnosis and location. The most frequent electroencephalographic finding was focal slowing associated with inactive epileptiform disorders. Histological study showed that there were 3 cases of arteriovenous malformations (AVM), one angioma cavernosa and one mixed vascular malformation (AVM plus angioma cavernosa). The malformation was not resected (it was treated with a clip) in the remaining case. Our results show the importance of structural imaging studies and their relationship to functional studies in the presumptive diagnosis of CVM corroborated by post-operative histological diagnosis.

Pigmented Villonodular Synovitis of the Temporomandibular Joint

Pigmented villonodular synovitis is a proliferative disorder affecting the synovium and may be an aggressive local process with bone destruction and invasion of contiguous structures. Involvement of the temporomandibular joint is very rare. We report a rare case of pigmented villonodular synovitis of the temporomandibular joint that invaded the infratemporal fossa with bone destruction of the mandibular condyle. Magnetic resonance imaging was effective in delineating the extent of the lesion in the infratemporal fossa. Fine-needle aspiration cytology showed multinucleated giant cells and round or spindle-shaped cells with hemosiderin deposits. The tumor was resected en bloc through a combined temporocervical and infratemporal fossa approach. The postoperative histological diagnosis was a variant of pigmented villonodular synovitis. Fine-needle aspiration cytology and magnetic resonance imaging proved to be useful in the preoperative diagnosis of pigmented villonodular synovitis of the temporomandibular joint and in the preoperative planning that is required to obtain adequate surgical margins.

Retroclival hematoma secondary to pituitary apoplexy

In Rathke cleft cysts (RCCs), inflammation by the cyst contents infrequently spreads to the surrounding structures. Calcification, which is regarded as a result of chronic inflammation of the cyst wall, can rarely be found in RCCs. Moreover, ossification is extremely rare.A 60-year-old woman experienced headaches, fatigue, and weight loss owing to pan-hypopituitarism. Magnetic resonance imaging revealed a mass lesion in the sellar region, which was composed of two different parts, with hypointensity anteriorly and hyperintensity posteriorly on T1-weighted image, and the rim with significant hypointensity entirely on T2-weighted image. During the transsphenoidal surgery, the cyst wall was so rigid that it was difficult to cut and remove it. The cyst contained mucinous fluid with both old and new hemorrhages, and a yellowish, elastic hard, solid nodule. Postoperative histologic diagnosis was RCC with unusual lymphocyte infiltration, massive granulation, and mature bone formation. Six months later, the fluid in the cyst reaccumulated, and the patient complained of headaches. Removal of the entire cyst wall and the aspiration of the cyst content were performed to collapse the cyst cavity and, consequently, to prevent further recurrence. Postoperatively, panhypopituitarism was unchanged and the symptoms were treated with hormonal replacement. The cyst has not recurred for 2 years after the second surgery.Persistent, long-term inflammation induced by the RCC content, mucin-containing fluid, and several phases of hemorrhage presumably promoted the formation of mature bone on the cyst wall and of the elastically solid nodule within the cyst.

Histological heterogeneity of neuroradiologically suspected adult low grade gliomas detected by Xenon enhanced computerized tomography (CT).

Xenon-enhanced computerized tomography (XeCT) was performed on 14 consecutive adult patients presenting with seizures showing supratentorial non-enhancing radiologically uniform appearing low grade gliomas on CT/MR images. Pre-operative XeCT patterns were compared with postoperative histological diagnosis, grading and Ki67 proliferation indices (PI). After gross-total, subtotal resection or biopsy, 11 astrocytomas, 2 oligodendrogliomas and 1 oligo-astrocytoma were diagnosed and graded: Grade I: 2 patients (Ki67-PI = 0.5-0.8), Grade I-II: 4 patients (Ki67-PI = 0.3-1.5), Grade II: 3 patients (Ki67-PI = 0.5-3.5), Grade II-III: 4 patients (Ki67-PI = 3.8-6.8) and Grade III: 1 patient (Ki67-PI = 5.2), (Kernohan Classification). Xenon CT studies revealed different flow patterns, correlating with the postoperative histological diagnosis, grading and proliferation indices: A tumour group with well defined, delayed, only minimally enhancing tumour area (5 patients, Grade I, I-II or II), a second group with less well defined low-flow-area borders and inhomogenous, strong enhancement within the tumour (4 patients, Grade II-III, III) and a third group with fast enhancing tumours was identified. The third pattern was exclusively shown in the 2 oligodendrogliomas (Grade I and II-III) and 1 oligo-astrocytoma (Grade II). The preliminary report identifies the Xenon enhance CT as a beneficial pre-operative investigation for patients with radiologically uniform appearing suspected adult supratentorial low-grade gliomas, which may give information about the presence of anaplastic foci or oligodendroglial components.

Minimally Invasive Neurosurgery Using CRW-3 Stereotaxy

The Cosman-Roberts-Wells (CRW-3) scanner independent stereotactic system is a recent arc-radius design developed from the Brown-Roberts-Wells system. The results of 74 supratentorial non-basal tumor suspect cases treated with this second generation computed tomography (CT) guided stereotactic apparatus are presented. Using a simple stereotactic target classification coupled with biopsy, trephine or mini-craniotomy, it has been possible to biopsy, excise and develop new strategies using microneurosurgical techniques with extremely low morbidity.

Preoperative diagnostic imaging of normal-sized ovary carcinoma syndrome

We treated a patient with a massive amount of ascites, the cytology of which contained adenocarcinoma (class V). The left ovary was slightly enlarged and the preoperative diagnostic imaging (PDI) suggested the presence of a malignancy. The right ovary was of normal size and the PDI presented no evidence of malignancy. The intra- and postoperative histological diagnosis was serous cystadenocarcinoma of the right ovary and fibroma of the left ovary. Therefore, this case can be classified as one of a normal-sized ovary carcinoma syndrome. Difficulties involved in the preoperative diagnosis of this syndrome and drawbacks of PDI are discussed.

Follow-up of Oral Leukoplakia After Carbon Dioxide Laser Surgery

We evaluate the 3-year result of 145 oral leukoplakias operated on by outpatient carbon dioxide laser surgery at the Istituto Nazionale Tumori, Milan, Italy. The surgical technique that was used consisted of excision in 140 patients and vaporization in 5 patients. Cancer was found in 14 out of 140 patients who underwent excision (10%). In the analysis of the disease-free survival rate and of the unfavorable pattern of events, only 131 patients with benign postoperative histologic diagnosis were considered. Fifty-eight patients developed unfavorable events. The probabilities of remaining free of disease or of developing local relapses or new lesions at 3-year survival was 0.57, 0.27, and 0.19, respectively. Two patients had oral carcinomas after the operation. Forty patients modified their alcohol or tobacco habits or their teeth and/or prosthesis. Moreover, only two patients modified these factors before the unfavorable events occurred.

静脈石を伴ったきょう部血管しゅの２症例

Hemangioma is common in the region of the head and neck, especially in the tongue, lip and buccal mucosa. But the hemangioma which includes the phlebolith is relatively rare. The authors reported two such cases.Case 1 was a 17-year-old man who visited our clinic complaining of a swelling of the left cheek. The swelling had been there since his birth, and it had gradually increased in size with general bodily growth. He was diagnosed as a buccal hemangioma with phleboliths.The tumor occupied the entire left cheek. Subtotal extirpation was performed and a multiple ligature suture was done to the residual tumor. The postoperative histological diagnosis was cavernous hemangioma with phleboliths. Scanning electron microscopic findings of the phlebolith revealed a concentrical lamellar structure. Analyses of the phleboliths by means of infrared spectrometry and X-ray diffraction identified calcium phosphate as the component of the phleboliths, and suggested the existence of calcium carbonate.Case 2 was a 37-year-old woman who had noticed the tumor on her left cheek 16 years before and it was excised at that time. But it recurred one month later and grew slowly.Total resection of the tumor was performed in our clinic. The resected tumor was walnutsized and well-capusulated one. The postoperative histological diagnosis was cavernous hemangioma. Thrombi and phleboliths were also observed within the tumor.

Postoperative Histological Diagnosis in Two Cases of Unsuspected Bioprosthetic Endocarditis

Two cases of preoperatively unsuspected porcine bioprosthetic endocarditis are presented. Both cases, thought to be a sterile thrombosis and a primary tissue failure respectively, were correctly diagnosed only with histological examination. Cultures and histological examination of the explanted tissue are necessary for a definite diagnosis in every case of prosthetic malfunction.

Local radiation injury and its surgical treatment. Report of 170 cases.

170 cases of local radiation injury were treated by excision and immediate covering of the defect by various reconstructive methods. Initial diagnosis was in 32% benign diseases, in 44% skin carcinomas and in 24% deep malignant tumours. Postoperative histological diagnosis was nonulcerated atrophy in 24%, atrophic ulceration in 45%, necrotic ulceration in 9% and radiation-induced malignancy in 22%. The mean interval between radiation and operation was 12 years in cases of non-malignant radiation injury and 24 years in cases of malignant injury. In 81% irradiation had been given to the head and neck area and in only 6% to extremities. Basal cell carcinomas were six times as common as squamous cell carcinomas. As method of reconstruction, direct suture to eight by bone grafting. Cases of malignancy gen-41%, transposition flap in 8%, tube pedicle flap in 14% and bone graft in 2%. The mean number of operations per patient varied from one with reconstruction by direct suture to eight by bone grafting. Cases of...

BASAL METABOLISM AND VITAL CAPACITY

It is often observed that patients affected by exophthalmic goiter have a decreased vital capacity, and in taking the vital capacity of a number of such patients we noted that in several instances patients with the high basal metabolic rates had a relatively lower vital capacity than those with low metabolic rates. These observations prompted investigation to determine whether there is any fixed relationship between basal metabolism and vital capacity, and whether the thyroid secretion which causes the variations in metabolic rates likewise has an indirect compensatory action causing parallel fluctuations in the vital capacity. If this should be true, there would be at our disposal an easy method for determining thyroid activity. With this purpose in mind, eighty-five subjects with goiter were examined. The diagnosis as to the type of goiter in each instance was based on the clinical findings, basal metabolic rates and postoperative histologic diagnosis in the