Preoperative Incisional Biopsy Research Articles

Pre-operative incisional biopsy of oral squamous cell carcinoma: high podoplanin expression is related to perineural invasion and may be a useful predictor of disease progression

Immunohistochemical analysis of podoplanin expression as a pre-operative molecular marker for perineural invasion (PNI) may represent an attractive strategy for surgical management of oral squamous cell cancer (OSCC). We evaluated the relationship between podoplanin expression and PNI in pre-operative incisional biopsies of OSCC. After performing pathological staging and histologic and immunohistochemical evaluation of 83 surgical specimens, we performed multivariable logistic regression analysis to examine the relationship between PNI and independent variables. To evaluate the utility of podoplanin immunopositivity for discrimination of PNI status pre-operatively, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value. We performed receiver operating characteristic curve analysis to evaluate the diagnostic accuracy of podoplanin immunopositivity for predicting PNI alone and in combination with age, T stage, N stage, and index site. We observed podoplanin expression in 42 (50.6%) of all the 83 pre-operative incisional biopsies and 29 of the pre-operative biopsies of the 31 (93.5%) postoperative specimens with PNI. The rate of podoplanin expression was significantly higher in patients with pT3 to pT4 stage and pN+ stage disease. Podoplanin positivity in the pre-operative biopsy showed high sensitivity in predicting PNI in the surgical specimen. Podoplanin expression appears to be an independent pre-operative variable significantly related to PNI and a possibly valuable prognostic marker for therapeutical planning and surgical treatment of OSCC.

Sinonasal aneurysmal bone cyst mimicking hemangioma

BackgroundAneurysmal bone cyst (ABC) is a benign, expansile bony lesion, primarily found in long bones. It is uncommon in facial bones and exceptionally rare in the sphenoethmoid sinus.Case presentation: A 28-year-old male presented with complaints of bilateral nasal block and recurrent epistaxis. Rhinoscopy examination showed a lobulated lesion in the bilateral posterior nasal cavity and nasopharynx. A nasopharyngeal angiofibroma was suspected on radiological assessment. Pre-operative incisional biopsy revealed the tumor as hemangioma. With a probable diagnosis of hemangioma, the lesion was explored under general anesthesia. An endoscopic endonasal excision of a tumor mass attached to the sphenoid skull base was undertaken. Histopathological examination of the resected tissue confirmed the diagnosis of an aneurysmal bone cyst.Conclusion ABC should be considered a rare differential for a hemorrhagic sinonasal mass in a young adult. Histopathological examination of the excised tissue is mandatory for a confirmatory diagnosis. Radiologic assessment and pre-operative incisional biopsy are essential from the diagnostic point of view; however, they can often cause a diagnostic dilemma with other vascular tumors such as nasopharyngeal angiofibroma or hemangioma.

Oral Cancer with Verrucous Pattern is Not Associated with Human Papilloma Virus in Indian Population

AbstractBackground: The etiology of verrucous lesions of the oral cavity is debatable, and many western studies attribute it to human papillomavirus (HPV) infection. Although most Indian studies have found a strong association with tobacco chewing, the role of HPV has not been studied in the Indian context. Materials and Methods: A prospective study was conducted on the clinicopathological profile of 21 consecutive patients of verrucous lesions of the oral cavity. The patients were evaluated on the basis of addictions, pretreatment biopsy, p16 immunohistochemistry (IHC), and histopathological parameters. Results: Preoperative incisional biopsy revealed no dysplasia in 52.38%, mild-to-moderate dysplasia in 19.04%, and invasive carcinoma in 28.57% of the patients. About 67% of patients underwent surgical excision in our institute all of whom had invasive malignancy on final histopathology. This included 42.85% patients whose initial biopsy was no or mild dysplasia. All of the patients were negative for p16 IHC. Conclusions: Verrucous lesions in Indian population are caused by smokeless tobacco unlike that in the western countries where HPV is the main etiology. Clinical distinction between benign and malignant lesions is difficult, and we recommend complete surgical excision of the lesion with adequate margins whenever possible.

Wide-spread ignorance on the treatment of subcutaneous malignant tumors; a questionnaire-based study.

Subcutaneous malignant tumors are often treated by non-specialized clinicians in musculoskeletal oncology. While the resection of subcutaneous tumors appears technically feasible, unplanned resection of malignant tumors can result in a devastating clinical outcome. The aim of this study was to evaluate the potential estrangement in the awareness of and the treatment strategy for the patients with subcutaneous soft tissue tumors between musculoskeletal oncologists and non-specialized clinicians. A questionnaire probing the clinical assessment of subcutaneous tumors was sent to orthopedic surgeons, dermatologists, plastic surgeons, and general surgeons. Results of the questionnaire were statistically analyzed. One hundred sixteen clinicians out of 150 responded to the questionnaire; the response rate was 77.3%. Among those, 46 clinicians had treated subcutaneous tumors. Thirty-nine of these 46 clinicians (27 musculoskeletal oncologists and 12 non-specialized clinicians) preoperatively performed enhanced MRI for diagnostic evaluation. Preoperative incisional biopsy to confirm the pathological diagnosis was performed by 36 of the 46 clinicians (29 musculoskeletal oncologists and seven non-specialized clinicians). These results indicate that musculoskeletal oncologists perform preoperative enhanced MRI (P = 0.08) and biopsy (P < 0.01) more frequently than non-specialized clinicians. The recognition rate of 'myxofibrosarcoma' was 60.8% among clinicians with an experience with sarcoma treatment (25 musculoskeletal oncologists and three non-specialized clinicians). The recognition rate of 'myxofibrosarcoma' between musculoskeletal oncologists and non-specialized clinicians was statistically significant (P < 0.01). Preoperative evaluations for subcutaneous tumors are more often inappropriate in non-specialized clinicians than those who are. Therefore, it will be mandatory to raise the awareness of this condition to improve the clinical outcome of patients with subcutaneous tumors.

Multidisciplinary approach to improving concordance in diagnosis of odontogenic tumors

Background: The diagnosis of benign odontogenic tumors (BOTs) may occasionally be fraught with problems. Diagnosis of BOTs includes joint consideration of clinical features observed, appearance on radiographs and histopathologic slides. Aim: The aim of this study therefore is to ascertain the level of concordance between preoperative and postoperative histopathological diagnoses of surgically treated BOT and highlight modalities that improve it. Materials and Methods: A retrospective review of all cases with postoperative histopathological reports of BOT seen at the Dental and Maxillofacial Surgery Department of Aminu Kano Teaching Hospital, Kano, Nigeria, from January, 2012 to December, 2013 was done. Demographic information, clinical, radiological (plain radiographs), preoperative incisional biopsy and postoperative excisional biopsy results were collated. The preoperative incisional biopsy and postoperative excisional biopsy results were analyzed for concordance. Results: Thirty-three cases of BOT were reviewed (male:female = 1.4:1). Age ranged from 11 to 70 years (mean = 32 ± 18.1 years). An overall concordance of 78.8% was observed between preoperative and postoperative biopsy results. Twenty-eight histology request cards were reviewed and this showed that 14.3% of specimens were <1 cm while complete clinical information was provided in 50% of cases. Conclusion: The interaction between the pathologist and other relevant specialties that are required for effective management of BOT may be best nurtured when clinico-pathologic conferences are made a routine practice.

Response to letter to the editors "Re: Byung-Do Lee, Wan Lee, Kyung-Hwan Kwon, Moon-Ki Choi, Eun-Joo Choi and Jung-Hoon Yoon. Glandular odontogenic cyst mimicking ameloblastoma in a 78-year-old female: a case report. Imaging Science in Dentistry 2014; 44(3): 249-52.".

Response to letter to the editors "Re: Byung-Do Lee, Wan Lee, Kyung-Hwan Kwon, Moon-Ki Choi, Eun-Joo Choi and Jung-Hoon Yoon. Glandular odontogenic cyst mimicking ameloblastoma in a 78-year-old female: a case report. Imaging Science in Dentistry 2014; 44(3): 249-52.".

Liposarcoma in the axilla developed from a longstanding lipoma.

Liposarcoma in the axilla developed from a longstanding lipoma.

Trends in Pediatric Ameloblastoma and its Management: A 15year Indian Experience.

The purpose of this study is to put forth our 15year experience with pediatric ameloblastoma in the Indian population. This retrospective study was carried out in the pediatric group of 18years and below, presenting with and diagnosed for ameloblastoma, at our institution over the past 15years. The required data was collected by reviewing patient's case notes, relevant radiographs, histopathological reports, and treatment charts. The incidence of pediatric ameloblastomas with respect to age, sex, site of occurrence, histopathologic type, the type of treatment instituted, and recurrence rate was noted. Of the total 165 pediatric tumors, ameloblastoma was the most common, 29 cases (17.5%). It occurred commonly in the age group of 12-18years (mean age 14years) with a marked male predilection. The most common site of occurrence was the posterior mandible. Majority were of the unicystic type. Two ameloblastomas which appeared as unilocular radiolucency were diagnosed as solid type. Twenty-eight were benign and one was a rare malignancy (Ameloblastic carcinosarcoma). Only two recurrences were noted over 15years, of which one tumor interestingly recurred as a peripheral variety which responded well to local excision. Ameloblastomas were either enucleated with mechanical curettage or resected followed by primary reconstruction with either a reconstruction plate or free fibula flap. We conclude that ameloblastomas are not uncommon in Indian pediatric population. Unilocular, unicystic ameloblastomas in the pediatric age group can be treated conservatively owing to their growth potential. Emphasis must be given to a long-term regular follow-up, conserving a more radical approach in case of a recurrence. However, Unilocular appearing ameloblastomas may be of the solid type which needs to be borne in mind as it not only alters the treatment modality but also emphasizes the importance of pre-operative incisional biopsy. Solid and unicystic aggressive ameloblastomas must be treated radically. Primary reconstruction with the free fibula flap is a viable option.

Preoperative Incisional and Intraoperative Frozen Section Biopsy Techniques Have Comparable Accuracy in the Diagnosis of Benign Intraosseous Jaw Pathology

To compare the accuracy of intraoperative frozen section (FS) and preoperative incisional biopsy (IB) techniques to diagnose benign intraosseous jaw lesions. This is a retrospective cohort study composed of subjects with benign intraosseous jaw lesions. The predictor variable was the technique for establishing a preliminary diagnosis of the lesion, preoperative IB or intraoperative FS. The outcome variable was the accuracy of the biopsy technique when compared with the final histologic diagnosis and was classified as concordant or discordant. The comparative diagnostic accuracy of the techniques was assessed with the χ(2) test. A total of 71 subjects met inclusion criteria. The mean age was 39 years (range, 5 to 85 years), and 58% (41) were male patients. Of the subjects, 20 (28%) underwent IB. In 14 (70%) of these, the results of biopsy agreed with the final diagnosis. 51 (72%) underwent intraoperative FS and in 31 (62%) of these, the results of biopsy agreed with the final diagnosis. The difference in diagnostic accuracy between IB (70%) and FS (61%) was statistically insignificant (P = .48). Sources of biopsy error included sampling error (46%), insufficient epithelial tissue (15%), inflammation (15%), pathologist's experience (8%), and artifact (4%). Preoperative IB and intraoperative FS provide comparable accuracy of diagnosis in patients with benign intraosseous jaw pathology. Sampling error was the most common reason for discordant results.

Management of oral carcinoma: benefits of early precancerous intervention

Management of oral precancerous lesions remains polarised between interventional surgery and conservative treatment. We have previously shown the efficacy of carbon dioxide laser excision for both diagnosis and treatment of oral precancerous lesions. The aim of this study was to review the clinicopathological details of a group of patients in whom pre-existing but occult invasive carcinoma was diagnosed histopathologically in specimens excised by laser. We retrospectively reviewed 169 patients who attended the Maxillofacial Dysplasia Clinic at Newcastle General Hospital with single, new oral premalignant lesions over a 5-year period (2004–2008). They were all treated by laser excision of lesions that were confirmed to be dysplastic from examination of preoperative incisional biopsy specimens. There was a significant correlation between the results of diagnostic incisional, and laser excision, biopsy specimens ( p < 0.01), but 15 patients had signs of occult invasive carcinoma in the excision specimens (9%). In all cases the carcinomas were completely excised by the laser. Carbon dioxide laser excision is not only an effective treatment of precancerous lesions, but also facilitates early diagnosis and management of oral carcinoma at a stage when it is otherwise clinically undetectable.

Angiofibrolipoma of the spermatic cord

Dear Sir, I am Dr Qing-Li Liu, from the Department of Urology of the First Hospital of Qinhuangdao in Qinhuangdao, Hebei Province, China. I write to present a case report of spermatic cord angiofibrolipoma. Angiofibrolipoma is a histological variant of lipoma, which usually presents as a solitary, subcutaneous, circumscribed lesion in the back, neck or shoulders. Here, we report a case of angiofibrolipoma of the spermatic cord. To our knowledge, such a case has not been previously reported in the literature. A 3-year-old boy presented with a right inguinal mass that had first been noticed 1 month earlier. On physical examination, the mass was located in the right spermatic cord and felt elastic, with no tenderness. The transillumination test was negative. Ultrasonography of the spermatic cord revealed a cystic-solid echo mass lesion, 2.5 cm in diameter, with minimum blood flow. Under general anaesthesia, a 3-cm inguinal oblique incision was made and the spermatic cord was isolated and occluded with a noncrushing clamp at the level of the internal ring. A tumour was found under the internal spermatic fascia; the tumour had a well-circumscribed boundary and was not adjacent to the right testicle and epididymis. The spermatic vessels and vas deferens were identified posterior to the mass. A 0.2-cm-thick pseudo-capsule surrounded the entire tumour. After the spermatic vessels and vas deferens were securely protected, the tumour was completely removed. Macroscopic examination revealed that the cut surface of the tumour was a multilocular cyst filled with blood, and there were no necrotic or cystic changes. The pathological examination revealed mature adipocytes, blood vessels and dense collagenous tissue (Figure 1), without the evidence of mitosis or cellular pleomorphism. These findings were consistent with angiofibrolipoma. At 6-month follow-up, there was no evidence of recurrence and the right testicle size was normal. Figure 1 A histological study (H&E stain) showed the three characteristic findings of angiofibrolipomas: mature adipocytes, blood vessels and dense collagenous tissue. (A): Low-power and (B): high-power views. Scale bar = 125 μm Tumours of the spermatic cord are rare. Overall, 30% of such tumours are malignant; and the rest are benign. Lipoma is the most common benign lesion; among the others are leiomyomas, dermoid cysts, epidermoid cysts and lymphangiomas 1. The conventional lipoma is a collection of mature adipocytes arising from subcutaneous tissues of the trunk, neck and proximal extremities 2. Histological variants of lipomas include fibrolipomas, angiolipomas, angiofibrolipomas, angiomyolipomas and infiltrating angiolipomas. These lesions are categorized according to their content of fat, muscle, blood vessel and connective tissue. The growths are not encapsulated but are histologically distinct from surrounding tissues. They have low-to-moderate cellularity and are not clinically aggressive 3, 4. Angiofibrolipomas are a mixture of mature adipocytes, vascular tissue and collagenous connective tissue. To our knowledge, the present case study is the first report of a spermatic cord angiofibrolipoma. The patient presented with an elastic inguinal mass on physical examination, and the diagnosis required histopathological assessment. Perhaps a preoperative incisional biopsy of the lesion could have confirmed the diagnosis before definitive resection. However, as with any lipoma, complete surgical excision and histopathological confirmation of margins are adequate for both diagnosis and treatment. During the operation, we found a fibrous pseudo-capsule, which was formed through a desmoplastic reaction 5. The pseudo-capsule was helpful in the tumour resection and in protecting the spermatic vessels and vas deferens from damage. In such cases, surgical excision, histological examination and long-term follow-up for recurrence are recommended.

Cervicothoracic Malignant Peripheral Nerve Sheath Tumor in a 12-Year-Old Girl with Neurofibromatosis Type 1

We encountered a 12-year-old girl with neurofibromatosis type 1 (NF1) who developed a low-grade cervicothoracic malignant peripheral nerve sheath tumor (MPNST). Computed tomography of the neck showed an elastic firm tumor measuring 7 x 6 x 4 cm and arising from the upper mediastinum. She had no pain or neurological symptoms, but the tumor enlarged to ca. 8 x 8 x 4 cm over the following 7 months. Although we had diagnosed a neurofibroma by preoperative incisional biopsy, the resected tumor showed low-grade MPNST in the central portion of the tumor. In treating a tumor in a patient with NF1, we must recognize that partial biopsies do not necessarily establish a definitive diagnosis and that a growing tumor may indicate malignant transformation.

A CASE OF LEFT AXILLARY ANGIOMYOLIPOMA

A 55-year-old woman had been diagnosed as lipoma for a left axillary tumor 4 years before. This time she was admitted to the hospital because of the numbness of her left forearm. Liposarcoma was suspected by imagings. By a preoperative incisional biopsy, the diagnosis of angiomyolipoma was made. The tumor was resected preserving the function of the left forearm. An axillary angiomylipoma has not been mentioned in the world literature, so far. This rare case of left axillary angiomyolipoma with a review of the previous literature is reported.