Preoperative Clinical Impression Research Articles

Clinicopathological Correlations in Enucleated Globes of Late-Stage Coats Disease with a Review of the Literature

BackgroundCoats disease may cause diagnostic dilemma because of its variable clinical presentation that can be suspicious of retinoblastoma. Late sequelae of the disease are blinding with possible enucleation. We demonstrate the main histopathological findings of Coats enucleated eyes with literature review.MethodsThis was a retrospective study of all enucleated globes diagnosed as Coats disease over 30 years and were reviewed by two pathologists. The corresponding demographic data, clinical presentation, pre-operative clinical impression, and indication for enucleation were collected. Descriptive analysis of our own series data was performed. Our findings were then correlated to published data that were collected from 1983 to 2021 from the PUBMED database in English-written language. Shields classification was used as an inclusion criterion for the published reports to be analyzed.ResultsWe had seven enucleated globes with Coats disease. Mean age at presentation was 3.2 years (range 3 months to 9 years). Male predominance was observed in 6 and all cases were unilateral. Strabismus was the most common initial presentation (57%, n = 4), followed by leukocoria (43%, n = 3). Indication for enucleation was mostly suspected retinoblastoma (57%, n = 4). Four eyes were classified as stage 4, and 2 had advanced stage 5 changes. Histopathologically, subretinal fluid with lipid-laden macrophages was seen in all cases, the anterior chamber was shallow in 5/7 with angle neovascularization in 2/7. Telangiectatic vessels were clearly observed in 4/7. ConclusionCoats disease is a potentially visually disabling disease that is mostly unilateral in 95%, has male predominance of 81%, and wide age range with a mean of 17 years. In Saudi Arabia, the disease seems to present at younger age, tends to be more advanced, and may be indistinguishable from retinoblastoma at the time of diagnosis. Shields staging of Coats is highly recommended to be followed clinically to unify the pathways for treatment and to correlate the concluded outcomes.

Ovarian Gynandroblastoma with a Juvenile Granulosa Cell Tumor Component in a Postmenopausal Woman.

Ovarian gynandroblastoma (GAB) is an extremely rare sex cord-stromal tumor showing morphological evidence of both female (granulosa cell tumor) and male (Sertoli–Leydig cell tumor (SLCT)) components. Almost all GAB cases have been reported in children, adolescents, or women of reproductive age, and most of them typically have adult granulosa cell tumors as the female component. In contrast, GAB with a juvenile granulosa cell tumor (JGCT) component is a very rare condition; to the best of our knowledge, only one case of GAB with JGCT in a postmenopausal woman has been reported. In this report, we present an extremely rare case of ovarian GAB with JGCT in an elderly patient. A 65-year-old woman presented with an abdominal mass. Abdominopelvic magnetic resonance imaging revealed a large multiseptated cystic mass measuring 20 cm. No peritoneal seeding, lymph node enlargement, or hematogenous metastasis was identified. Laboratory test showed a slight elevation of serum CA 125 level (37.1 U/mL). Based on the preoperative clinical impression of ovarian cancer, she underwent a total hysterectomy with bilateral salpingo-oophorectomy. Grossly, the ovarian mass had a smooth and glistening surface without excrescences. The cut sections showed yellow-to-tan solid areas with foci of necrosis, myxoid degeneration, and hemorrhage, as well as multilocular cystic cavities filled with serosanguinous fluid. Histologically, the female component was characterized by JGCT displaying nodular growth patterns with follicle-like structures of various shapes and sizes. Most of the microcysts contained eosinophilic or basophilic secretions. The JGCT cells had indistinct cell borders, an abundant eosinophilic cytoplasm, and round-to-oval hyperchromatic nuclei with many mitotic figures. The SLCT component consisted predominantly of intermediately differentiated Sertoli cells forming lobulated solid nodules. They were arranged in cords, solid tubules, or nests, and possessed oval-to-spindle-shaped darkly stained nuclei and scant cytoplasm. In several foci, well-formed Sertoli cell tubules were loosely aggregated within areas of moderately differentiated SLCT. In summary, we described GAB in a postmenopausal woman with JGCT and SLCT as the female and male components, respectively. This is the second case of GAB with JGCT occurring in an elderly patient. Our findings can help pathologists and clinicians make accurate histological diagnoses of GAB with a JGCT component and plan an adequate treatment strategy for this rare tumor.

Clinicopathological Characteristics of Ovarian Sclerosing Stromal Tumor with an Emphasis on TFE3 Overexpression.

A sclerosing stromal tumor is a very rare benign sex cord-stromal tumor of the ovary. Because its clinical presentation and imaging findings are similar to those of borderline or malignant epithelial tumors and other sex cord-stromal tumors, accurate preoperative clinical diagnosis can be difficult. The aim of this study was to analyze the clinicopathological characteristics of SSTs and examine the immunohistochemical expression TFE3, which has not been studied in SSTs. Our study cohort consisted of 9 patients diagnosed as having SST; the median age was 36 years. Radiologically, SSTs presented as multiseptated cystic masses, mixed echoic masses, pseudolobular masses, solid pelvic masses, or uterine subserosal nodules. In 4 of the 9 cases, the preoperative clinical impression was a borderline or malignant ovarian tumor. SSTs displayed the following histopathological features: 1) relatively well-circumscribed cellular nodules that were randomly distributed in the fibrous or edematous stroma; 2) a characteristic alternating pattern of hypercellular and hypocellular areas; 3) a hemangiopericytoma-like vascular growth pattern in the cellular nodules; 4) bland-looking spindle-shaped cells and round or polygonal cells densely clustered around blood vessels; and 5) red blood cell-containing intracytoplasmic vacuole-like spaces in the tumor cell cytoplasm, possibly indicating epithelioid hemangioendothelioma. Immunohistochemically, the tumor cells exhibited diffuse and moderate-to-strong TFE3 expression in 7 of the 9 SSTs. TFE3 was strongly expressed in the nuclei of round or polygonal cells and lutein cells. In contrast, neither luteinized thecomas nor fibromas appreciably expressed TFE3. In summary, our study describes characteristic histopathological features that may be useful for differentiating SSTs from other sex-cord stromal tumors and demonstrates for the first time that SSTs show strong TFE3 expression. Further investigations are necessary to clarify the role of TFE3 in the development of SSTs.

The Value of Pathological Examination of the Foreskin Following Circumcision

IntroductionWe determined the clinical impact and value of routine histopathological examination of the foreskin following circumcision. MethodsWe performed a retrospective study of 225 consecutive adult circumcisions. Indications for circumcision were categorized as benign or malignant based on preoperative clinical evaluation. Histopathological results were similarly classified as benign or malignant. Preoperative clinical impression and postoperative histological diagnosis were compared and reported as concordant (in agreement) or discordant (in disagreement). The cost impact of histopathology examination was analyzed with respect to study findings. ResultsOf the 225 patients 209 (92.9%) had clinically benign disease on preoperative evaluation and 16 (7.1%) had foreskin lesions suspicious for malignancy. Mean age was 57.0 years (range 23 to 92). Patients were younger in the benign group than in the malignant group (56.5 vs 62.8 years, p = 0.018). Black patients represented 65.8% of the study population and were similarly distributed between the 2 groups (p = 0.405). There was no statistical difference in patient height, weight, body mass index or comorbidities between the 2 groups. Preoperative clinical impression and postoperative histological diagnosis were concordant in all 209 patients in the benign group. Of the 16 patients suspected to have malignant disease preoperatively 9 (56.2%) had malignancy and 7 (43.8%) had benign disease on histopathological examination. ConclusionsRoutine histological examination of a foreskin specimen in the absence of clinical suspicion for malignancy appears to have diminished benefit in the setting of benign preoperative indications. Omitting this traditional practice in patients with benign surgical indications may positively impact health care costs without compromising quality of care.

Tophaceous pseudogout of the temporomandibular joint: a series of 3 cases

We report a series of 3 cases of tophaceous pseudogout of the temporomandibular joint (TMJ). Three patients, two men and one woman, ranging in age between 60 and 75 years, presented with unilateral painful swelling of the TMJ area associated with limitation of mouth opening. Radiographic and computed tomographic images showed opaque masses in the supracondylar region of the TMJ. The preoperative clinical impression was a "neoplastic lesion" in the 3 cases. Microscopic examination revealed numerous deeply basophilic masses of calcified deposits, exhibiting birefringence under polarized light and morphologically consistent with calcium pyrophosphate dihydrate deposition, referred to in these cases as "tophaceous pseudogout." Tophaceous pseudogout is a rare benign arthropathy that presents with clinical and radiographic features mimicking neoplastic conditions of the TMJ. Therefore, it is recommended that tophaceous pseudogout be considered in the differential diagnosis when a TMJ is involved with "neoplasm-like" lesions clinically and radiographically.

Recurrent osseous choristoma of the masseter muscle: Case report

A 1222-year-old Turkish man was seen at the Dental Clinic on August 5, 1995 for evaluation of a painless, slowly enlarging, swelling of the left facial region of 5 years in duration (Fig 1). There were no significant findings in the medical or dental history and no history of trauma to the region. Palpation revealed a firm, slightly tender, well-circumscribed, mobile mass approximately 5 3 3 cm, covered by normal skin and apparently not attached to the underlying bone. The serum levels of calcium, calcitonin, and parathyroid hormone were all within normal range. Results of hematologic and urine analyses were also unremarkable. Radiographs revealed several well-circumscribed, radiopaque, spheric masses in the soft tissues of the left face; these did not appear to be attached to the mandible or maxilla (Figs 2, 3). Both T1and T2-weighted magnetic resonance images (MRI) were obtained to evaluate the vascularity of the lesion. These images also revealed the well-circumscribed, spheric osseous masses (Fig 4A), surrounded by hemorrhagic areas (Fig 4B). The lesion in aggregate was located entirely within the left masseter muscle. The preoperative clinical impression was that the lesions represented a benign osseous process, possibly teratomas, osteomas, calcified lymph nodes, osseous hamartomas, or calcified hematomas. The masses were surgically excised under general anesthesia through an extraoral approach (Fig 5), and the specimens were sent for microscopic examination. GROSS FINDINGS

Microscopic examination of routine tonsillectomy specimens: Is it necessary?

Controversy continues to exist regarding the routine histologic examining of tonsillectomy specimens. Proponents suggest that among other reasons, missing an important diagnosis such as occult malignancy or granulomatous disease and possible medicolegal consequences argue in favor of routine histologic examination. Others state that we should consider the very low yield of significant histologic findings in routine tonsillectomy specimens and its added cost. We performed a retrospective evaluation of all cases of patients who underwent tonsillectomy with or without adenoidectomy between January 1992 and July 1996. Two hundred eighty-eight charts were evaluable. Group 1 consisted of all tonsillectomy specimens that were subjected to gross examination only. Group 2 consisted of all tonsillectomy specimens that were subjected to gross examination as well as microscopic examination. In group 1, no abnormal gross findings were noted. Group 2 consisted of specimens from an older population with a mean age of 21.6 years. There were 43 patients older than 20 years old in group 2, and in all cases except four the preoperative clinical impression correlated with the microscopic findings. Occult malignancy was found in only one of these four patients. No cases of granulomatous disease were discovered. Overall, no patients except one had any change in postoperative treatment on the basis of the results of microscopic examination. We believe that routine microscopic examination of tonsillectomy specimens results in unnecessary cost and consumption of resources and time. Microscopic examination should be done in only selected cases such as in patients with grossly asymmetric tonsils or in patients with a history of malignancy. (Otolaryngol Head Neck Surg 1998;119:361-3.)

Primary cervical malignant teratoma with a rib metastasis in an adult: Five-year survival after surgery and chemotherapy: A case report with a review of the literature

We report a case of a man presenting with a cervical malignant teratoma and a chondrosarcomatous rib metastasis. He was alive and free of recurrence five years and 10 months (= 70 months) after resection of the primary mass, followed by chemotherapy and subsequent resection of the rib tumor. This is the 35th patient reported in the literature and the first description in which an 'adjuvant' or primary chemotherapy was used. Previous patients with a cervical malignant teratoma, reported after lethal outcome, had survivals of one to 22 months (median nine months). In all patients with a preoperative clinical impression of an aggressive, differentiated or undifferentiated malignancy, the definite diagnosis of teratoma could only be made histologically. By analogy to germ cell tumors, the prognosis of malignant teratoma might be improved if complete excision is combined with new, adjuvant chemotherapy protocols for germ cell tumors. Lessons learned from this case are placed in the context of germ cell tumors in general and of non-gonadal malignant teratomas in particular.

Benign soft tissue masses of the wrist and hand: MRI appearances

We reviewed 20 cases of soft tissue masses of the hand and wrist, and compared the impressions from the original magnetic resonance (MR) imaging reports with the preoperative clinical impression and postoperative pathological diagnoses. The most commonly occurring masses were ganglia, lipomas, and giant cell tumors of tendon sheaths. MR imaging suggested the correct diagnosis in 16 of the 20 cases, whereas the clinical impression was correct in 10 instances. Confident was correct in 10 instances. Confident preoperative diagnosis may be made with MR imaging due to the characteristic appearances of many benign soft tissue tumors.

Chairman's remarks

We report a series of 3 cases of tophaceous pseudogout of the temporomandibular joint (TMJ).Three patients, two men and one woman, ranging in age between 60 and 75 years, presented with unilateral painful swelling of the TMJ area associated with limitation of mouth opening.Radiographic and computed tomographic images showed opaque masses in the supracondylar region of the TMJ. The preoperative clinical impression was a “neoplastic lesion” in the 3 cases. Microscopic examination revealed numerous deeply basophilic masses of calcified deposits, exhibiting birefringence under polarized light and morphologically consistent with calcium pyrophosphate dihydrate deposition, referred to in these cases as “tophaceous pseudogout.”Tophaceous pseudogout is a rare benign arthropathy that presents with clinical and radiographic features mimicking neoplastic conditions of the TMJ. Therefore, it is recommended that tophaceous pseudogout be considered in the differential diagnosis when a TMJ is involved with “neoplasm-like” lesions clinically and radiographically.

Subhyoid midline ectopic thyroid tissue in the absence of normal thyroid gland

Subhyoid ectopic thyroid tissue existing in the absence of a normal thyroid gland is a rare finding. The preoperative clinical impression of this lesion is nearly always thyroglossal duct cyst and its excision results in myxedema. Radioactive scan of subhyoid midline spherical masses is the only means of preoperative assessment of ectopic thyroid tissue and the presence of normal thyroid gland as well. In the absence of a scan, suspected thyroglossal duct cysts should be bisected at the time of surgery to prove they are not thyroid tissue. No midline subhyoid ectopic thyroid should be excised unless there is a normal thyroid gland.

Intralobar Bronchopulmonary Sequestration Demonstrated by Aortography and Selective Arteriography of the Anomalous Vessel

Case Studies1 February 1966Intralobar Bronchopulmonary Sequestration Demonstrated by Aortography and Selective Arteriography of the Anomalous VesselCHARLES A. RIBAUDO, M.D., F.A.C.P., PLINIO ROSSI, M.D., JOHN V. COMER, M.D.CHARLES A. RIBAUDO, M.D., F.A.C.P.Search for more papers by this author, PLINIO ROSSI, M.D.Search for more papers by this author, JOHN V. COMER, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-64-2-381 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThis report of a patient with intralobar pulmonary sequestration demonstrates that this clinical entity can be diagnosed antemortem (1-14). Preoperative demonstration by aortography and selective arteriography of the anomalous arterial vessel and the venous drainage into the pulmonary veins and left atrium confirmed the preoperative clinical impression in this case (5, 9, 11, 13, 14), and these findings guided surgical therapy.Intralobar pulmonary sequestration is recognized as a distinct clinical entity (1-14). It is a developmental anomaly in which a portion of the lower lobe of the lung is separated from the remainder of the lung. The sequestrated portion is...