Preoperative Histopathological Diagnosis Research Articles

Predicting Histopathological Grading of Adult Gliomas Based On Preoperative Conventional Multimodal MRI Radiomics: A Machine Learning Model.

The accurate preoperative histopathological grade diagnosis of adult gliomas is of great significance for the formulation of a surgical plan and the implementation of a subsequent treatment. The aim of this study is to establish a predictive model for classifying adult gliomas into grades 2-4 based on preoperative conventional multimodal MRI radiomics. Patients with pathologically confirmed gliomas at Huashan Hospital, Fudan University, between February 2017 and July 2019 were retrospectively analyzed. Two regions of interest (ROIs), called the maximum anomaly region (ROI1) and the tumor region (ROI2), were delineated on the patients' preoperative MRIs utilizing the tool ITK-SNAP, and Pyradiomics 3.0 was applied to execute feature extraction. Feature selection was performed utilizing a least absolute shrinkage and selection operator (LASSO) filter. Six classifiers, including Gaussian naive Bayes (GNB), random forest (RF), K-nearest neighbor (KNN), support vector machine (SVM) with a linear kernel, adaptive boosting (AB), and multilayer perceptron (MLP) were used to establish predictive models, and the predictive performance of the six classifiers was evaluated through five-fold cross-validation. The performance of the predictive models was evaluated using the AUC and other metrics. After that, the model with the best predictive performance was tested using the external data from The Cancer Imaging Archive (TCIA). According to the inclusion and exclusion criteria, 240 patients with gliomas were identified for inclusion in the study, including 106 grade 2, 68 grade 3, and 66 grade 4 gliomas. A total of 150 features was selected, and the MLP classifier had the best predictive performance among the six classifiers based on T2-FLAIR (mean AUC of 0.80 ± 0.07). The SVM classifier had the best predictive performance among the six classifiers based on DWI (mean AUC of 0.84 ± 0.05); the SVM classifier had the best predictive performance among the six classifiers based on CE-T1WI (mean AUC of 0.85 ± 0.06). Among the six classifiers, based on ROI1, the MLP classifier had the best prediction performance (mean AUC of 0.78 ± 0.07); among the six classifiers, based on ROI2, the SVM classifier had the best prediction performance (mean AUC of 0.82 ± 0.07). Among the six classifiers, based on the multimodal MRI of all the ROIs, the SVM classifier had the best prediction performance (average AUC of 0.85 ± 0.04). The SVM classifier, based on the multimodal MRI of all the ROIs, achieved an AUC of 0.81 using the external data from TCIA. The prediction model, based on preoperative conventional multimodal MRI radiomics, established in this study can conveniently, accurately, and noninvasively classify adult gliomas into grades 2-4, providing certain assistance for the precise diagnosis and treatment of patients and optimizing their clinical management.

Pericardial and pulmonary actinomycosis, simulating inflammatory myofibroblastic tumor: the role of surgery

Background: Pericardial and pulmonary actinomycosis is a rare disease that remains undiagnosed during life due to a lack of clinical manifestations and a low positive culture rate. Actinomycosis can involve any part of the body. Thoracic actinomycosis is the second most common site after the cervicofacial. Patients with pulmonary actinomycosis usually present with a history of chest pain, cough, fever, shortness of breath on exertion, and sometimes massive hemoptysis. Pericardial involvement has been reported in the medical literature. It is written in line with process case series criteria. Method: From 2008 to 2021, 8 patients, 6 men, and 2 women (mean age 59 y) underwent surgical resection for thoracic lesion initially diagnosed as myofibroblastic tumor on true cut biopsy, but the final histopathologic report revealed actinomycosis. We reviewed preoperative clinical manifestations. Computed tomographic (CT) findings, preoperative true-cut biopsy report, surgical indications, and outcomes. Results: Five patients (62.5%) had poor oral hygiene; 2 patients (25%) had sinusitis, and 1 patient had bronchiectasis (12.5%). Seven patients were symptomatic (87.5%), with hemoptysis, shortness of breath, and weakness. One patient, 12.5%, presented with chest wall mass, chest pain, and fever. The basis of the imaging study (CT thorax). Six patients (87.5%) had CT guided biopsy that revealed a myofibroblastic tumor. In 2 patients (25%), CT scans showed the mass was close to the heart, so a biopsy was not done. We panned a surgical procedure based on the history of hemoptysis and a true cut-biopsy report. Four patients (50%) had a lobectomy, 2 patients (25%) had pericardial resection with a wedge of lung tissues, and 1 patient had chest wall resection enblock with right upper lobectomy. Conclusion: In patients with radiographic findings of pulmonary neoplasm and initial true cut biopsy report showing myofibroblastic tumor, surgery is mandatory. The final histopathology report showed actinomycoses. If the preoperative histopathologic diagnosis is available, then surgery has no role. The ideal treatment is the administration of systemic penicillin therapy. All our patients postoperatively received systemic antimicrobial therapy; they fully recovered and resumed back to everyday life.

Factors Affecting Recurrence of Idiopathic Granulomatous Mastitis.

To investigate factors that may have an effect on recurrence by retrospectively analysing the data of patients who were followed up and treated for idiopathic granulomatous mastitis in this clinic. Analytic study. Department of General Surgery, Faculty of Medicine, Baskent University, Konya and Adana Practice and Research Hospitals between January 2010 and January 2021. The data of patients who were histopathologically diagnosed with granulomatous mastitis were retrospectively analysed. The patients included in the study were divided into two groups: Recurrence (Group 1) and non-recurrence (Group 2). Patients with underlying etiological factors that may cause granulomatous inflammation such as infection, trauma, tuberculosis, sarcoidosis, and autoimmune disease were excluded from the study. The effects of other parameters (involvement area, follow-up duration, the time from the onset of complaints to diagnosis, side of involvement, breastfeeding, oral contraceptive use, redness, ulceration and/or discharge, preoperative histopathological diagnosis, diagnosis by any of the preoperative imaging techniques, preferred treatment method) on recurrence, were statistically analysed. Furthermore, the analysis results showed no significant difference between the groups with and without recurrence with regard to any of the other variables such as follow-up period, size of the involvement area, presenting complaints, breast-feeding, preferred treatment alternative (steroid, steroid + surgery, surgery), and preferred surgical technique (p>0.05). The time from the onset of complaints to diagnosis was significantly longer in the recurrence group (p=0.001). In addition, the frequency of oral contraceptive use was statistically significantly higher in the recurrence group (Odds ratio=7.6, p=0.044). The results of this study suggest that early diagnosis could prevent recurrence in patients with idiopathic granulomatous mastitis. Prospective randomised controlled studies are needed to support this thought. Key Words: Idiopathic granulomatous mastitis, Malignancy, Oral contraceptive, Steroid.

Pancreatic ductal adenocarcinoma in a patient with pancreas divisum and gastrointestinal duplication cyst: a case report

BackgroundThe complication of duplication of alimentary tracts and pancreas divisum (PD) is a rare malformation and the development of pancreatic ductal adenocarcinoma (PDAC) in this malformation is also extremely rare. There have been some reports of complication of malignancy in a gastric duplication cyst (GDC) and PD. However, there have been no reports of complication of PDAC in cases with GDC and PD.Case presentationA 54-year-old woman was followed up at the previous hospital due to a history of ovarian endometrial adenocarcinoma. She also had a surgical history of partial excision for a GDC and pancreatic tail of PD in her childhood. A gynecological follow-up computed tomography (CT) examination revealed the pancreatic body tumor and the bifurcated main pancreatic duct dilatation. Furthermore, magnetic resonance cholangiopancreatography also revealed that the ventral main pancreatic duct communicated with the GDC. The initial levels of tumor markers were high, but we could not achieve preoperative histopathological diagnosis. The preoperative diagnosis was PDAC occurring in a case with PD and GDC. She received two courses of neoadjuvant chemotherapy with gemcitabine and nab-paclitaxel. A CT examination after neoadjuvant chemotherapy revealed the shrinkage of the tumor, and then we performed distal pancreatectomy with splenectomy and GDC resection. A histopathological examination revealed invasive PDAC and lymph node metastases; pathological staging was T1N1M0, stage III. Furthermore, PD and GDC were also histopathologically detected. The postoperative course was uneventful, and she was discharged on the postoperative day 25. She received S-1 monotherapy for 6 months, and no recurrence has been detected at 1 year after radical resection.ConclusionsWe herein presented an extremely rare combined case of PD, GDC and PDAC. We successfully treated it by neoadjuvant chemotherapy and distal pancreatectomy with GDC resection, and postoperative chemotherapy.

Is the fear of malignancy in large adrenal masses realistic?

Objectives: Adrenal masses are more frequently detected in autopsy series in recent years and are more frequently detected in clinical practice due to the development of radiological examinations. After the detection of an adrenal mass, the first two important questions come to mind. Does the mass hormonally active (functionally) or not active (non-functional), and this mass is a benign formation or is it malignant? The answer to these two questions is the obligatory questions that clinicians must answer in order to make an operation decision. The decision of operation in non-functioning adrenal masses is directly proportional to the mass's neoplastic potential. If a preoperative histopathological diagnosis is not available; this potential is predicted by the size of the mass in radiological imaging. It is shown that the malignancy rate in adrenal masses is higher in lesions 6 cm and above. In this study, we aimed to determine whether the rate of malignancy is really high in histopathological examination as a result of adrenalectomy operations performed in our clinic between the years of 2010-2012.Methods: Fourteen women and 4 men with 6 cm or higher adrenal masses patients which performed adrenalectomy by Eskişehir Osmangazi University Faculty of Medicine Department of General Surgery between 2010-2012 were included in this study. The results of the final histopathological analysis were classified retrospectively. Results: The rate of malignancy in adrenal masses of 6 cm or more supported by the literature was found to be high in our clinical series. Conclusions: As a result of our clinical retrospective study, we think that the extent of the formation in the related gland is highly effective and significant in making an operation decision before adrenalectomy.

Splenic Primary Solid Tumors : Does a Preoperative Histopathology Diagnosis Really Matter?

The present study aims to present a case series of patients who underwent splenectomy for splenic primary solid tumors without preoperative histopathologic diagnosis. From 2013 to 2019, 12 patients underwent splenectomy for solid primary splenic tumors at 3 different academic medical centers. All electronic medical records were retrospectively reviewed. Seven (58.3%) patients were women, and 5 (41.6%) were male. The median age was 48 years (range: 25-72 years). In 8 (66.6%) patients, a conventional approach was performed. In 2 (16.6%), a hand-assisted laparoscopic surgery procedure was completed, and in other 2 (16.6%) patients, a laparoscopic approach was auspiciously achieved. Median operative time was 135 minutes (range: 60-210 minutes), and median blood loss was 500 mL (range: 200-1500 mL). Procedure-related morbidity was found in 2 (16.6%) patients, and the mortality rate was 0%. The final histopathologic diagnosis was lymphoma in 5 (41.6%) patients, lymphangioma in 3 (25%) patients, hamartoma in 2 (16.6%) patients, angiosarcoma, and sclerosing angiomatoid nodular transformation (SANT) in 1 (8.3%) case each. Splenectomy should be the treatment of choice when encountering a primary splenic tumor without the need for preoperative fine-needle aspiration biopsy, avoiding the complications this technique entails.

Renal Tumors in Young Adults: Is Preoperative Computer Tomography Imaging Suggestive for the Nature of the Tumors?

Renal cell carcinoma (RCC) accounts for 2–3% of all adult malignant neoplasms and is even rarer in patients under 45 years old. Clear-cell carcinoma represents most of the pathological subtypes. Our study aimed to investigate the association between preoperative computer tomography imagistic evaluation and histopathological diagnosis of renal tumors in young adults. Patients younger than 45 years old with renal tumors who were referred for medical treatment at the Clinical Institute of Urology and Renal Transplantation Cluj-Napoca from 2012 to 2019 were considered eligible for the study. Medical charts were retrospectively reviewed, and patients with complete data regarding preoperative diagnostic, histopathological evaluation, and follow-up data, regardless of gender, were included in the study. Sixteen patients younger than 45 years fulfilled all the inclusion criteria and were evaluated. With two exceptions, the evaluated patients were in a T1 and T2 stage, with no vascular invasion or of the adjacent organs. Two-thirds of our patients had a clear-cell renal cell carcinoma. None of our patients fitted in the low complexity surgery category of the R.E.N.A.L. Nephrometry Score and 37.5% of them benefited from partial nephrectomy. Half of the suppositions made based on imaging were concordant with the histopathology report. Fifteen of the patients showed no recurrence during the respective follow-up interval. Computer tomography imaging reports showed on our sample a higher concordance with the histopathological report in the more common subtypes (namely Renal Clear Cell RCC), with typical appearances.

Metachronous bilateral triple-negative breast cancer associated with neurofibromatosis type 1: A case report.

The present study reports a case of metachronous bilateral breast cancer associated with neurofibromatosis type 1 (NF1). A 67-year-old female, who had undergone a radical mastectomy of the left breast 34 years ago due to breast cancer, presented with a tumor of the right breast. The clinical stage of the original breast cancer was T2N0M0 stage IIA and adjuvant chemotherapy had not been not administered. With regard to the right-sided breast tumor, on physical examination, multiple neurofibromas and café-au-lait spots were found to be scattered over the skin. A 2-cm tumor was palpable. The preoperative histopathological diagnosis of the right-sided breast tumor was invasive ductal carcinoma, T2N0M0 stage IIA, with negative results for hormone receptors and human epidermal growth factor receptor 2. The patient underwent a modified radical mastectomy and axillary node dissection, and received adjuvant chemotherapy. The bilateral tumors were similar in histology and immunophenotype, each being histological grade 3, triple-negative and with a basal-like subtype. Based on a literature review of 90 breast cancers in 84 patients with NF1 (84 patients, 90 breasts), younger age onset, advanced clinical stage and hormone receptor negativity were characteristic features. Bilateral cancer occurred in 8.3% of patients and was characterized by ER negativity, earlier stage and younger age compared with patients with unilateral cancer.

Computed Tomography and Magnetic Resonance Imaging Findings of Inflammatory Pseudotumors in the Abdomen and Pelvis: Current Concepts and Pictorial Review

The group of inflammatory pseudotumors (IPTs) encompasses a variety of rare neoplastic and nonneoplastic entities described to occur in almost every location in the body and whose clinical features and aggressive imaging findings (varying from infiltrative to mass-forming lesions), frequently mimic those of malignant tumors. The radiologic features of IPTs are variable and nonspecific, the imaging findings depending on the body location and involved organ. Abdominopelvic IPTs are rare and the purposes of this review, therefore, are to familiarize the radiologist with the wide spectrum of computed tomography and magnetic resonance imaging findings of IPTs in various locations throughout the abdomen and pelvis, discussing the imaging features that allow consideration of IPTs in the differential diagnosis of soft-tissue masses within the pertinent clinical setting. Radiologists should be aware of this group of entities, as a preoperative histopathologic diagnosis upon radiological suspicion may help to differentiate IPTs from malignancy and to allow the most appropriate clinical work-up for these patients.

Preoperative Diagnostic Strategy for Parotid Gland Tumors Using Diffusion-Weighted MRI and Technetium-99m Pertechnetate Scintigraphy: A Prospective Study.

ObjectiveFine needle aspiration cytology (FNAC) for diagnosis of a parotid gland tumor is widely used but its sensitivity is low and non-diagnostic rate is relatively high. In contrast, core needle biopsy (CNB) has a higher sensitivity and lower rate of sampling errors but has a higher risk of injury to adjacent organs such as facial nerve than FNAC. Screening of patients with parotid gland tumors to identify cases of pleomorphic adenoma (PA) and Warthin tumor (WT) may allow CNB to be confined to patients without PA and WT. We established an algorithm for preoperative diagnosis and management of parotid gland tumor using diffusion-weighted MRI and 99mTc pertechnetate scintigraphy. This algorithm was developed with the goal of maximal reduction of the number of patients in whom CNB is required. The purpose of the study is to validate our algorithm prospectively.MethodsA prospective study was conducted in 71 cases who were newly diagnosed with parotid gland tumor and 53 cases were enrolled in the study. In the algorithm, PA (high apparent diffusion coefficient (ADC) mean≥1.5×10−3 mm2/s) and non-PA (low ADCmean<1.5×10−3 mm2/s) cases are first distinguished based on the ADCmean on diffusion-weighed MRI. Second, among suspected non-PA cases, WT and non-WT are distinguished using technetium-99m pertechnetate scintigraphy. CNB is then performed only in probable non-PA and non-WT cases.ResultsAlthough CNB was only required in 40% (21/53) of all cases, we made a preoperative histopathological diagnosis with an accuracy of 87% (46/53) and we correctly diagnosed whether a tumor was benign or malignant with an accuracy of 96% (51/53). Preoperative surgical planning had to be changed during surgery in only one case (2%)ConclusionsOur algorithm is valuable in terms of clinical practice with highly potential for preoperative diagnosis and with less risk of CNB procedure.

Abdominal Compartment Syndrome–Severe Complication of Giant Abdominal Tumor: Case Report and Literature Review

Introduction: Giant abdominal tumors, as a result of volume mass and dimensions , even benign being, can develop serious complications. The differential diagnosis includes cystic or solid disorders of the female genitals, ascites, cysts or hydronephrosis, pancreatic cysts or pseudocysts, gastrointestinal stromal tumors. Case presentation: A 44 years old patient, was hospitalized for an giant abdominal tumor formation, pain, weight loss, nausea and vomiting. Laboratory data show changes in the sense of acute renal failure. Ultrasound examination reveals layout of carcinomatous ascites and native CT scanning, a giant cyst, without being able to specify their organ affiliation. The central venous pressure monitoring showed low values (less then 1 cm water), and intra-abdominal pressure, measured indirectly using the urinary catheter, revealed an increased value (25 mmHg). Patient undergone a midline laparotomy and it was found a giant cyst developed from from the left ovary. It was performed cystectomy associated with hysterectomy and controlateral ovariectomyl. The postoperative course was favorable and the patient discharged on day 6. Histopathology confirmed a mucinous cystadenoma Conclusion: Abdominal compartment syndrome is a severe complication of giant abdominal tumors, which must be solved immediatly by medical therapy and/or surgery. Choosing the type of surgery (open or laparoscopic) depends on tumor size and the possibility and establishing the preoperative histopathological diagnosis.

Epitheloid Hemangioendothelioma of the Submandibular Region

Objective: To present an uncommon cause for a submandibular mass and review of the literature.&#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: Tertiary Government Hospital&#x0D; Patient: One&#x0D; Results: A 25-year-old lady presented with a painless chronic submandibular swelling. Ultrasound identified a solid mass, following which an uncomplicated core biopsy was performed obtaining an accurate pre-operative histopathological diagnosis. Pre-operative arterial embolization of this vascular mass led to a relatively bloodless wide local excision. Radiological imaging for distant metastases was negative.&#x0D; Conclusion: Epitheloid Hemangioendothelioma is an uncommon cause for a submandibular mass. A malignant vascular soft tissue tumor with morphologic characteristics similar to carcinomas, melanomas and epitheloid sarcomas, it has a high rate of metastasis and morbidity when it affects the soft tissues and viscera. Immunohistochemistry provides clues to differentiation, and recommended treatment consists of a surgical wide local excision with regional lymph node resection. As there are no established standard therapeutic protocols for this disease due to its rarity, an individual case-by-case approach and follow-up needs to be undertaken.&#x0D; Keywords: epitheloid hemangioendothelioma, malignant vascular tumor, submandibular mass

回腸inflammatory fibroid polypの1例

Inflammatory fibroid polyp (IFP) is submucosal tumor-like benign tumor and often detected after abdominal pain due to intussusception. It is rare that IFP is diagnosed before surgery. We experienced a 70-year-old female patient who showed right lower abdominal pain and elevated serum C-reactive protein. CT scan revealed thickened and edematous wall of ileum and colonoscopy revealed pedunculated lesion with defected mucosa in the terminal ileum. Histopathological exam showed granulation tissue of the ileum that provided a diagnosis as IFP of the ileum. Laparoscopic assisted ilectomy was performed and no relapse has been seen. The lesion located at the ileocecal area and chronic physical stimulation resulted in mucosal defection that gave us a rare chance to preoperative histopathological diagnosis of IFP of the small intestine.

Future directions of duodenal endoscopic submucosal dissection.

Endoscopic therapies for lesions of the duodenum are technically more difficult than those for lesions of the other parts of the gastrointestinal tract due to the anatomical features of the duodenum, and the incidence rate of complications such as perforation and bleeding is also higher. These aforementioned trends were especially noticeable for the case of duodenal endoscopic submucosal dissection (ESD). The indication for ESD of duodenal tumors should be determined by assessment of the histopathology, macroscopic morphology, and diameter of the tumors. The three types of candidate lesions for endoscopic therapy are adenoma, carcinoma, and neuroendocrine tumors. For applying endoscopic therapies to duodenal lesions, accurate preoperative histopathological diagnosis is necessary. The most important technical issue in duodenal ESD is the submucosal dissection process. In duodenal ESD, a short needle-type knife is suitable for the mucosal incision and submucosal dissection processes, and the Small-caliber-tip Transparent hood is an important tool. After endoscopic therapies, the wound should be closed by clipping in order to prevent complications such as secondary hemorrhage and delayed perforation. At present, the criteria for selection between ESD and EMR vary among institutions. The indications for ESD should be carefully considered. Duodenal ESD should have limitations, such as the need for its being performed by experts with abundant experience in performing the procedure.

Pulmonary artery sarcoma successfully treated by right pneumonectomy after definitive diagnosis.

Pulmonary artery sarcoma (PAS) is a rare and lethal neoplasm that is usually diagnosed during surgery or autopsy. Early diagnosis and radical surgical resection offer the only chance for survival. However, making a preoperative histopathological diagnosis is quite difficult. We encountered a 57-year-old woman presenting a PAS that mimicked a pulmonary thromboembolism. After confirming a definitive diagnosis using a catheter suction biopsy, we successfully performed a right pneumonectomy via a median sternotomy without cardiopulmonary bypass. Eighteen months after surgery, no recurrence was observed.

Preoperative histopathological diagnosis of GIST by mucosal cutting biopsy followed by LECS treatment

Preoperative histopathological diagnosis of GIST by mucosal cutting biopsy followed by LECS treatment

Cutaneous Angiosarcoma of the Scalp Masquerading as a Squamous Cell Carcinoma: Case Report and Literature Review

Cutaneous angiosarcoma is a rare tumor of the elderly male, most commonly affecting the head and neck region. It is difficult to differentiate this tumor from hemangiomas, hemangioblastomas, Kaposi sarcoma, squamous cell carcinoma and anaplastic melanomas. Case report and review of pertinent English medical literature. We report a case of a 60-year-old male presenting with multiple nodules over the scalp where a preoperative histopathologic diagnosis of squamous cell carcinoma was made by wedge biopsy from the tumor. Postoperative histopathology and immuno histochemistry of the wide local excision specimen proved the tumor to be cutaneous angiosarcoma and the patient completed adjuvant radiotherapy. He is now on regular follow-up for 1 year without recurrence. Cutaneous angiosarcoma must be kept in mind in view of its rarity especially in extensive involvement of the scalp by malignancy. The primary treatment is wide local excision with adequate skin cover and adjuvant chemotherapy and radiotherapy in positive margins and lymph node metastasis.

Functional Outcome and Quality of Life After Restorative Proctocolectomy and Ileal Pouch-Anal Anastomosis in Elderly Patients

SUMMARY Restorative proctocolectomy with ileal pouch-anal anastomosis is the surgical treatment of choice for patients with medically refractory ulcerative colitis, ulcerative colitis with dysplasia or cancer, or familial adenomatous polyposis (FAP), regardless of their age. The aim of the paper was to report our 6-year experience of restorative proctocolectomy and ileal pouch-anal anastomosis in elderly population at the tertiary referral centre. Chart review was performed for four patients undergoing ileal pouch-anal anastomosis from 2006 to 2010. Preoperative histopathologic diagnosis was ulcerative colitis. We collected data regarding patients’ demographics, type and duration of disease, previous operations and indications for surgery. We analyzed the operative protocols and postoperative pathologic diagnosis. Early (within 30 days after surgery) and late complications were noted. Follow-up was conducted upon annual function and quality of life questionnaire, physical examination and endoscopic evaluation of the pouch. Postoperative histopathologic diagnoses were: ulcerative colitis (n=2) and indeterminate colitis (n=2). The average age of the operated patients was 59 years. The mean duration of the follow-up was four years. We report two cases of steroid use prior to operation as well as two cases of extraintestinal manifestations. We report no septic complications and two cases of pouchitis. Functional results and quality of life were good to excellent in all four cases of ileal pouch-anal anastomosis. Restorative proctocolectomy with ileal pouch-anal anastomosis in elderly people is a safe procedure with low morbidity rate. Functional results are generally good and patient satisfaction is high.

Colorectal Cancer Complicating Inflammatory Bowel Disease

The aim of this study was to evaluate patient- and tumor-related characteristics for patients undergoing surgery for cancer complicating inflammatory bowel disease (IBD), and to assess differences between patients with Crohn's disease (CD) and ulcerative colitis (UC). Data on all IBD patients with colon and rectal cancer (CRC) undergoing surgery between 1980 and 2007 were evaluated from prospectively maintained CRC and IBD databases. Clinical presentation, tumor stage, presence of associated dysplasia, and short- and long-term outcomes after surgery were investigated. Outcomes for IBD patients were compared with a matched group of patients with sporadic cancer. A total of 240 IBD patients (64 CD and 176 UC) with CRC were identified. At the time of CRC diagnosis, 68% UC and 26% CD patients had pancolitis. About 92% of the patients who underwent preoperative colonoscopy were noted to have suspicious lesions. Although 92.5% of the patients had a preoperative histopathologic diagnosis of cancer or dysplasia, incidental diagnosis of cancer in the resection specimen was made in 3%. Examination of the resection specimen revealed synchronous dysplasia in 48% of the patients and synchronous cancer in 12% patients. Tumor location was rectum in 36%, right colon in 28%, sigmoid colon in 17%, transverse colon 10%, and left colon in 9% of patients. CD patients were diagnosed at a more advanced cancer stage than UC. Local recurrence and overall 5-year survival rates were comparable (5.6% vs. 6.7%, P = 0.78 and 77% vs. 72%, P = 0.5, respectively) for patients with IBD and sporadic cancer. Most IBD cancer can be diagnosed or suspected on the basis of endoscopic findings, biopsy of areas of active colitis, and an incidental finding of malignancy after colorectal resection for other indications is rare. CD patients present with a more advanced cancer stage. Optimal endoscopic surveillance may identify most patients with IBD cancer.

Bone Tumors of the Clavicle: Risk of Malignancy in the Elderly and Safe Needle Biopsy

The clavicle is a rare site for bone tumors and little is known from the limited literature about the prognostic factors and management techniques, including biopsy. The method of biopsy is controversial in the clavicle because of the risk of injury to the neighboring neurovascular structures. Twenty patients with clavicular lesions were retrospectively reviewed with clinical, radiological, and histopathological reports. A needle biopsy was planned in the presence of an osteolytic lesion providing nonforceful entry of the needle, detailed knowledge obtained about the local anatomy, and known availability of an oblique angle for the needle entry away from vascular structures. A needle or tru-cut biopsy was performed for preoperative histopathological diagnosis in 6 selected patients with no complications. Considering the histological diagnosis and prevalence of clavicular bone tumors, benign and malignant lesions had a similar prevalence rate; however, malignant tumors occurred in an older (>50 years) population (P=005). Statistical analysis revealed that the best cutoff point for age for discriminating malignant lesions was 50 years with high sensitivity. The main concern for these patients is primary lesion site treatment and symptom palliation. Every clavicular lesion in patients older than 50 years should be considered as malignant unless proven otherwise. This article demonstrates that needle biopsy can be performed safely in selected lesions with particular attention to cross-sectional local anatomy during needle insertion.