Pseudotumoral Lesions Research Articles

Aggressive granulomatous pseudotumor following total hip prosthesis: Diagnostic and therapeutic strategies from a single institution experience

IntroductionGranuloma formation following total hip arthroplasty (THA) can occur regardless of the bearing surface. In very rare cases, extensive granulomas mimicking tumors may develop which are known as pseudotumors. The aim of this study is to report on these rare yet complex situations to stimulate reflection in diagnostic and therapeutic approaches. MethodsA retrospective case series study of 5 patients (2 females, 3 males) of aggressive granulomatous lesions on primary prostheses and 4 revision prostheses for aseptic loosening, implanted at a mean age of 74.8 years (range 64–83). A clinical, functional, radiographic, and anatomopathological analysis were conducted. ResultsFour patients underwent revision surgery, while one died before intervention. Functional impairment was significant with a mean pre-reintervention Postel-Merle d'Aubigné (PMA) score of 8.2 (range 4–11). Femoral involvement was constant, associated with acetabular involvement in only one case. bony involvement was major, with a minimum of 5 Gruen zones affected, showing complete cortical lysis. Histopathological analysis consistently revealed multinucleated giant cells and macrophages, predominantly with metallic wear particles. In 2 cases, vascular involvement was suspected without a clearly delineated tumor. Two cases required femoral resection prostheses, one necessitated inter-ilio-abdominal amputation due to extensive soft tissue involvement, one underwent implant removal which failed to prevent progression, and one patient died before reoperation. ConclusionThe volume of lesions in these 5 cases appears markedly larger than reported cases.Extensive pseudo-tumoral granulomatous lesions following THA are rare but carry poor functional prognosis. Evaluation to rule out infection and neoplastic pathology is imperative. Surgical management often resembling tumor treatment should be considered. Early diagnosis is crucial to allow intervention before reaching the stage of massive prosthetic replacement. Level of evidenceIV retrospective study.

Retrospective Evaluation of Primary Bone Tumors and Their Incidence in the “Ignacio García Téllez” Specialty Hospital CMN IMSS

In 1948, Steiner conducted an analysis of cancer registries in the United States of America, estimating that primary bone tumors constituted approximately 1% of all fetal malignancies. For its part, in Great Britain, a similar incidence of primary bone tumors is observed, fluctuating between 0.8% and 0.9%. A later statistic from the United States at v of 1.87:1000 000 deaths among children under 14 years of age, increasing to 11.97:1000 000 deaths in people aged 11 to 19 years. Since all bone components are derived from the mesoderm, they have the potential to be composed of any of the four basic types of cells: fibroblasts, chondroblasts, osteoblasts and the reticulo-myelogenous series, to achieve a correct diagnosis it is necessary to have the complementary radiological and pathological support to part of biochemical and hematological investigations. The present investigation focused on a retrospective, observational, quantitative, risk-free study, based on the review of records and tracking of histological reports of patients who were treated at the “Ignacio García Téllez” CMN IMSS Specialty Hospital in a period of 5 years, including all those cases with primary tumors of bone or cartilage origin, both benign and malignant of bone marrow and vascular, in addition to pseudotumor lesions such as fibrous dysplasia, metaphyseal fibrous defect, solitary bone cyst. A total of 182 histological records and reports were recorded in a period of 5 years where a total of 93 women and 89 men were recorded, with ages ranging from 3 months of extrauterine life to 87 years. With a mean of 56.53 years and a standard deviation of 18.48 years. 129 benign tumors were reported in 63 men and 66 women; Meanwhile, a total of 53 malignancies were counted in 26 men and 27 women. The current study facilitates the evaluation of the most common neoplasms in our environment, with the aim of raising awareness about the importance of having adequate resources to develop a timely diagnosis and treatment plan for the benefit of patients.

Epidemiological analysis of patients treated for benign tumors and pseudotumoral lesions in the femur

Epidemiological analysis of patients treated for benign tumors and pseudotumoral lesions in the femur

Myxœdème prétibial pseudo-tumoral après une maladie de Basedow : un diagnostic différentiel du lymphœdème

IntroductionPretibial myxedema is a rare manifestation of Graves’ disease, and pseudotumoral forms may be confused with lower limb lymphedema. ObservationsWe reported 3 cases of pretibial myxedema in 2 women and 1 man, aged 72, 66, and 49 years, treated for Graves’ disease 3, 25 and 32 years previously. Two patients were active smokers. Lymphedema diagnosis of the lower limbs was suspected in the presence of bilateral pseudotumoral lesions of the feet, toes and ankles and the presence of a Stemmer's sign (skin thickening at the base of the 2nd toe, pathognomonic of lymphedema). Lymphoscintigraphy in one case was normal, not confirming lymphedema. ConclusionPretibial pseudotumoral myxedema is a differential diagnosis of lower limb lymphedema. This diagnosis is confirmed by questioning the patient about preexisting Graves’ disease, the underlying etiology, to decide the appropriate treatment and to encourage cessation of smoking, which is a risk factor for pretibial myxedema.

Epidemiology of benign tumors and pseudo tumoral lesions of the femur based on an analysis of patients receiving orthopedic care

Benign tumors and pseudo tumoral lesions of the bones belong to the largest group ofan abnormal growth of tissue in bone, which is characterized by many specific clinical, radiological and histological features. The study of data on the spread of pathology, localization, frequency of recurrence depending on gender and age characteristics helps to determine the category of people who need a more detailed examination. Aim: Determination of the incidence of an abnormal growth of tissue in bone, the most typical localization, as well as the likelihood of recurrence and malignancy in patients with benign abnormal growth of tissue in the femoral bone. Materials and methods: Materials obtained during the analysis of casesur, as well as radiographs of 465 patients operated in the Department of Traumatology and Orthopedics of the Astrakhan State Medical University from 2 years old to 70 years, from 1977 to 2018, using nonparametric analysis methods. Differences were considered significant at r 0.05. Results: Studying various tumors depending on age, it was found that the median age of patients with aneurysmal bone cyst (13.5) was significantly lower than the median age of patients with giant cell tumor (osteoclastoma) (25), respectively. When comparing persons suffering from a metaphyseal fibrous defect (non-ossifying fibroma) and a chondroma (enchondroma), a difference was noted in the average age values, which amounted to 13.5 years and 45 years, respectively. A significant difference was also found between those with a solitary bone cyst and chondroma (enchondroma), where average was 45 years. When analyzing the significance of differences in the incidence of tumors of certain localizations depending on the patients gender, it was found that the differences are not significantly significant in any of the compared groups. A certain dependence of the tumor localization on gender is not determined, which indicates that the localization of the tumor is not related to the sex of the patient. The frequency of recurrence of an abnormal growth of tissue in femoral bone is also not related to gender. Conclusions: The primary incidence of femorals tumor is predominantly characteristic of patients aged 15 years. In the groups of patients with aneurysmal bone cyst, osteochondroma (bone and cartilage exostosis) and solitary bone cyst, the median age of a person is the smallest. In the comparison of patients with giant cell tumor (osteoclastoma), metaphyseal-fibrous defect (non-ossifying fibroma), osteoid osteoma, chondroma (enchondroma), female patients predominated, and in patients with osteochondroma (osteocartilaginous exostosis) and osteoma, male patients predominated. The incidence of recurrence in the compared groups with a diagnosis of aneurysmal bone cyst, giant cell tumor (osteoclastoma), fibrous dysplasia and chondroma (enchondroma) was significantly higher than in other groups.

Incidence of spontaneous tumours in guinea pigs: a retrospective study of 153 cases

The aim of this study was to investigate the incidence of spontaneous tumours in guinea pigs in biopsy and necropsy samples in the monitored period (2016–2022) on a representative number of cases and to determine their occurrence in relation to age and sex of the animals. A total of 204 samples from various pathological lesions were examined, while 153 cases (75.00%) were true tumours and 51 cases (25.00%) were pseudotumorous non-neoplastic lesions. The distribution of the incidence of true neoplasms in relation to sex was uneven. In the examined group, more neoplasms were diagnosed in males (n = 88, 57.52%) compared to females (n = 65, 42.48%). The mean age of guinea pigs with diagnosed tumour in our group was 4.2 years. Thyroid adenocarcinoma was the most frequent tumour. The majority of thyroid tumours (67.86%) were diagnosed in animals aged 4–5 years, as a significant result in terms of incidence in this age range, as well as a predisposition to tumour formation in males (78.57%). Mammary gland tumours occurred in the age range of 2–7 years, with a mean age of incidence of 4.7 years. In all cases, these were malignant variants and showing a significant higher incidence in males, in the age range of 4–5 years. The processing of a representative number of samples and epidemiological data on the incidence of spontaneous tumours in guinea pigs can contribute to the overall expansion of knowledge about this topic in veterinary medicine.

Rare Case of IgG4 Related Disease Masquerading as Meningioma

Rationale: IgG4-related disease (IgG4 RD) is a fibro-inflammatory condition that can affect any organ and can lead to the formation of pseudo tumoral lesions requiring differential diagnosis with various malignancies. IgG4 RD can rarely present as an intracranial space occupying lesion. We are reporting a rare case of central nervous system IgG4 RD which presented as seizures with mass lesion. Patient Concerns: A 78-year-old man with bronchial asthma and type 2 diabetes mellitus, well controlled on bronchodilators and oral hypoglycemic agents presented with recurring seizures for 1 month. He gave history of a fall and had sustained a wound over the right forehead. At presentation, he was conscious, oriented, and didn’t have any focal neurological deficits. Diagnosis: Due to the recurring seizures and fall, a contrast enhanced MRI brain was done and was reported as a right temporal space occupying lesion in the lateral sphenoid wing. Meningioma was considered as a possibility and right frontotemporal parietal craniotomy and excision was performed. However, biopsies revealed characteristic findings of IgG4-related disease, including 1) dense lymphoplasmacytic infiltration, 2) fibrosis arranged at least focally in a storiform pattern, and 3) obliterative phlebitis, which confirmed the diagnosis. His IgG4 levels were normal 0.58 g/L [normal range: 0.03 – 2.01 g/L]. Intervention: Patient underwent right frontotemporal parietal craniotomy and excision of mass under general anesthesia. Histopathology was suggestive of IgG4 RD and the patient was started on immunosuppressive therapy including dexamethasone and mycophenolate mofetil. Antiepileptic medications were continued, and he responded to treatment.

Tumor-mimicking musculoskeletal infectious lesions: Experience of a single referral center

Introduction/Objectives. Bone and soft tissue infections might mimic bone and soft tissue tumors. Therefore, differential diagnosis is important to prevent errors in treatment. This report aims to present the data of patients with indistinct clinical and radiological findings mimicking benign and malignant bone and soft tissue tumors, which were later diagnosed as inflammatory infections. Methods. A retrospective chart review of the clinical, microbiological, radiologic, and pathologic findings of patients presented with a presumed diagnosis of a possible malignant lesion was performed. Results. The study included 21 patients with a median age (IQR) of 37 (1 month ? 72 years) years, and 13 (61%) patients were men. In total, 16 (76%) patients were admitted to the hospital with complaints of pain. The diagnoses were hydatid cyst, tuberculous osteomyelitis, cat-scratch disease, chronic osteomyelitis, subacute osteomyelitis, and soft tissue abscess. All patients were treated depending on the diagnosis of the lesion. Conclusion. There are chances of misdiagnosis due to shared common characteristics of tumoral and infectious lesions which might be mildly increased inflammatory markers with deeply seated non-mobile soft tissue masses and aggressive periosteal reactions and/or bone destruction patterns. So, each pseudotumoral lesion due to possible infectious causes should be histopathologically examined and correlated with other clinical and laboratory data in order to achieve a final diagnosis

Tocilizumab for severe refractory primary central nervous system vasculitis: A center experience.

Primary Central Nervous System Vasculitis (PCNSV) is responsible for 3%-5% of strokes before age 50. It presents with clinical, radiological, and pathological variability. Optimal management is unknown given the absence of randomized clinical trials. Explore whether tocilizumab, an anti-interleukin-6 monoclonal antibody, is an effective treatment for refractory PCNSV. Patients with PCNSV treated with tocilizumab in a single tertiary center were reviewed. Three patients were identified. In two of them, MRI-revealed ischemic lesions. The other presented with a subcortical hemispheric pseudotumoral lesion. Brain biopsy was inconclusive in two patients. Due to a significant number of relapses and clinical deterioration despite other immunosuppressive drugs, tocilizumab was initiated and induced a long remission period up to 44months. Observed side effects were a fungic infection, neutropenia and thrombocytopenia (both transitory), and a pulmonary embolism in one of the cases. Tocilizumab might be a therapeutic option for PCNSV (Class IV evidence), given its efficacy and safety. We propose a novel pathway for diagnosis and therapeutics of PCNSV with the purpose of improving the diagnosis, monitoring, and prognosis of this heterogeneous disorder, setting the framework for future use of tocilizumab in this condition.

Pseudotumoral forms of multiple sclerosis: About 6 cases

Multiple sclerosis (MS) is the most common chronic disabling disease of the central nervous system (CNS) in young adults. It is characterized by the presence of multiple demyelinating inflammatory lesions disseminated in the CNS. Pseudotumoral lesions (PL) are rarely observed in patients with MS. The aim of this study is to describe characteristics of PL in patients with MS.

Gastrointestinal: Diarrhea and bowel thickening in elderly patients: A diagnosis to keep in mind.

An 81-year-old man was hospitalized due to a 2-year history of bloody diarrhea (four to five bowel movements per day, including nocturnal) and significant weight loss (20% body weight), associated to an occasional crampy left abdominal pain. He had a personal history of arterial hypertension and chronic obstructive pulmonary disease and no relevant family history. Blood analysis revealed anemia (hemoglobin 10.9 g/dL), normal white blood cell count, and high C-reactive protein (56.4 mg/L). Investigations for chronic diarrhoea, including screening for infectious aetiologies, were negative. The computed tomography scan showed marked thickening of the duodenal and rectal walls (Figure 1c). Endoscopy study revealed a pseudo-polypoid appearance, edema and friability of the duodenal (Figure 1a–b) and rectal (Figure 1d–e) mucosa. Duodenal and rectal histological evaluation showed amorphous eosinophilic deposits on hematoxylin–eosin stain (Figure 2a), which were Congo Red stain positive (Figure 2b). Immunocytochemistry analysis was positive for transthyretin (Figure 2c). A diagnosis of senile amyloidosis with gastrointestinal presentation was made. The neurologic assessment revealed bilateral carpal tunnel syndrome without any other signs of neurologic involvement. Cardiological evaluation was unremarkable, excluding cardiac amyloidosis. Renal function was preserved. The patient was discharged with no specific treatment and maintained the clinical picture, despite symptomatic interventions. One year after the diagnosis, endoscopic reevaluation showed progression of the disease, with an increased pseudotumoral rectal lesion with spontaneous bleeding. Senile amyloidosis is associated with tissue deposition of wild-type transthyretin and occurs in the elderly. Carpal tunnel syndrome is the main neurological manifestation, which frequently precedes cardiac disease, which is typically the main organ involved. Clinically significant gastrointestinal involvement is rare. The most frequent symptoms are diarrhea and weight loss, resulting from small bowel and colon involvement. Endoscopic changes are nonspecific and include erosions, ulcers, and polypoid lesions. Unlike the cardiac and neurologic forms of the disease, there are currently no specific approved therapies for the treatment of gastrointestinal wild-type transthyretin amyloidosis. The case presents an entity uncommonly seen in clinical practice with extensive gastrointestinal involvement with paucity of cardiac and neurological manifestations.

Periodontoid pseudotumoral lesions

Background: Periodontoid pseudotumoral lesions (PPL) are an uncommon cause of cervical pain and myelopathy. In addition, they may be associated with atlantoaxial instability (AAI).Case Description: Two patients over 60 years of age presented with neck pain alone. Their MR scans showed expansive lesions involving the odontoid process. One patient with AAI required an occipitocervical arthrodesis, while the other patient without instability was managed with an external orthosis (Philadelphia collar). Both of them experienced full resolution of pain and remained neurologically intact an average 36 months later (range 24–48).Conclusion: Here, we discussed the clinical, MR, and non-surgical (without AAI) versus surgical management (with AAI) for different types of PPL.

What Do You Know About Arborescent Lipoma?

Lipoma arborescens is an uncommon pseudotumoral synovial lesion usually located in the suprapatellar pouch of the knee. This diagnosis should be considered, particularly in patients with chronic joint effusion. Magnetic resonance imaging confirms the lipomatous nature of the synovial proliferation. When limited to the anterior compartment of the knee, lipoma arborescens can be treated by arthroscopic synovectomy.

Serial magnetic resonance imaging changes of pseudotumor lesions in retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations: a case report

BackgroundRetinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) is an adult-onset rare monogenic microvasculopathy. Its typical neuroimaging features are punctate white matter lesions or pseudotumor alterations. RVCL-S is often under-recognized and misdiagnosed because of its rarity and similar imaging manifestations to multiple sclerosis or brain malignant mass.Case presentationHere we report a case of a 36-year-old Chinese man who developed multiple tumefactive brain lesions spanning over two years leading to motor aphasia, cognitive decline, and limb weakness. He also presented with slight vision loss, and fundus fluorescein angiography indicated retinal vasculopathy. He underwent brain biopsies twice and showed no evidence of malignancy. Given the family history that his father died of a brain mass of unclear etiology, RVCL-S was suspected, and genetic analysis confirmed the diagnosis with a heterozygous insertion mutation in the three-prime repair exonuclease 1 gene. He was given courses of corticosteroids and cyclophosphamide but received little response.ConclusionsThe present case is one of the few published reports of RVCL-S with two-year detailed imaging data. Serial magnetic resonance images showed the progression pattern of the lesions. Our experience emphasizes that a better understanding of RVCL-S and considering it as a differential diagnosis in patients with tumefactive brain lesions may help avoid unnecessary invasive examinations and make an earlier diagnosis.

Suture thread: An unusual etiology of tracheal pseudotumor

A 66-year-old man ingested sodium hydroxide in a suicide attempt in June 2018. In emergency room, he presented burning of the tongue and uvula and supraglottic and vocal cords edema. Because of the risk of airway obstruction, the patient underwent endotracheal intubation and started invasive mechanical ventilation. Five days later, a surgical tracheostomy was performed due to a large laryngeal necrosis including extensive epligottis involvement. After prolonged mechanical ventilation through tracheostomy, the patient presented a favorable clinical course allowing ventilator weaning and decannulation 2 months after initial presentation. In February 2019, cervical Computed Tomography (CT) revealed a polypoid lesion occupying 25% of the tracheal lumen, with contrast uptake and suggestive of malignant etiology (Figure 1A-B). The patient was asymptomatic. Rigid bronchoscopy showed that the pseudotumoral tracheal lesion corresponded to granulation tissue around suture thread from the previous tracheostomy, which were successfully removed during the procedure (Figure 1C-E). Pathological examination showed granulation tissue with extensive inflammatory infiltrate and foreign-body giant cell reaction.

More than ancillary records: clinical implications of renal pathology examination in tumor nephrectomy specimens

BackgroundNephrectomy is the management of choice for the treatment of renal tumors. Surgical pathologists primarily focus on tumor diagnosis and investigations relating to prognosis or therapy. Pathological changes in non-neoplastic tissue may, however, be relevant for further management and should be thoroughly assessed.MethodsHere, we examined the non-neoplastic renal parenchyma in 206 tumor nephrectomy specimens for the presence of glomerular, tubulo-interstitial, or vascular lesions, and correlated them with clinical parameters and outcome of renal function.ResultsWe analyzed 188 malignant and 18 benign or pseudo-tumorous lesions. The most common tumor type was clear cell renal cell carcinoma (CCRCC, n = 106) followed by papillary or urothelial carcinomas (n = 25). Renal pathology examination revealed the presence of kidney disease in 39 cases (18.9%). Glomerulonephritis was found in 15 cases (7.3%), and the most frequent was IgA nephropathy (n = 6; 2.9%). Vasculitis was found in two cases (0.9%). In 15 cases we found tubulo-interstitial nephritis, and in 9 severe diabetic or hypertensive nephropathy. Partial nephrectomy was not linked to better eGFR at follow-up. Age, vascular nephropathy, glomerular scarring and interstitial fibrosis were the leading independent negative factors influencing eGFR at time of surgery, whereas proteinuria was associated with reduced eGFR at 1 year.ConclusionOur large study population indicates a high incidence of renal diseases potentially relevant for the postoperative management of patients with renal neoplasia. Consistent and systematic reporting of non-neoplastic renal pathology in tumor nephrectomy specimens should therefore be mandatory.

IgG4-related disease

IgG4-related disease (ER-IgG4) is a recognised systemic disease. It was described after patients diagnosed with autoimmune pancreatitis showed signs of extra-pancreatic disease. The clinical manifestation of these patients is subacute and is manifested by the appearance of pseudotumoral lesions, or inflammatory or fibrous tumours. Sometimes it can be serious as in the case of patients with cholangitis or large vessel vasculitis. Diagnostic criteria include, among others, serum IgG4 elevation and/or histological parameters. The 18F-FDG-PET/CT is useful in the initial diagnosis, biopsy guidance as well as in the assessment of response to therapy. It usually responds to steroid therapy.

CSF interleukin 6 is a useful marker to distinguish pseudotumoral CNS inflammatory diseases from primary CNS lymphoma.

Interleukin6 (IL-6) is a pleomorphic cytokine that can be found in the cerebrospinal fluid (CSF) in a wide spectrum of inflammatory pathologies of the central nervous system (CNS). Our aim was to characterize the diagnostic significance of CSF IL-6 among various CNS inflammatory diseases with pseudotumoral lesions (CNSID) and primary CNS lymphoma (PCNSL). We retrospectively analyzed the CSF IL-6 concentrations in 43 consecutive patients with suspected PCNSL. A total of 28 patients were positively diagnosed with PCNSL and 15 with CNSID. We verified the results with CSF IL-10, an established biomarker for PCNSL. In the PCNSL group, the median CSF IL-6 concentration was 8pg/ml, interquartile range (IQR) 5-18.5. For the patients with CNSID, the median concentration was 70pg/ml, IQR 5-1368. A group comparison showed significantly higher CSF IL-6 levels in patients with CNSID than in those with PCNSL (p = 0.032). Moreover, IL-6 was correlated with CSF cell count in the CNSID group (r = 0.56, p = 0.028), but not in the PCNSL group (r = 0.3, p = 0.13). We found significantly higher CSF IL-10 levels in patients with PCNSL than in patients with CNS inflammatory lesions (p < 0.001). Our study suggests that CSF IL-6 levels could represent, in addition to CSF IL-10, a useful biomarker in the differential diagnosis of CNSID and suspected PCNSL.

Enfermedad relacionada con IgG4

IgG4-related disease (ER-IgG4) is a recognised systemic disease. It was described after patients diagnosed with autoimmune pancreatitis showed signs of extra-pancreatic disease. The clinical manifestation of these patients is subacute and is manifested by the appearance of pseudotumoral lesions, or inflammatory or fibrous tumours. Sometimes it can be serious as in the case of patients with cholangitis or large vessel vasculitis. Diagnostic criteria include, among others, serum IgG4 elevation and/or histological parameters. The 18F-FDG-PET/CT is useful in the initial diagnosis, biopsy guidance as well as in the assessment of response to therapy. It usually responds to steroid therapy.

Intrinsic peripheral nerve and root tumor and pseudotumoral lesions at a tertiary care pediatric hospital.

Tumors affecting peripheral nerves in children are rare. Accurate diagnosis ensures that management is appropriate and timely. A review of intrinsic nerve tumors was completed to differentiate common peripheral nerve lesions based on clinical characteristics and investigations. A retrospective review was conducted for children (< 18 years old) diagnosed with an intrinsic tumor affecting peripheral nerve(s) or roots at the Children's Hospital of Eastern Ontario (CHEO) from 2009 to 2019. We report 14 children with perineurioma (N = 6), neurofibroma (N = 4), intraneural ganglion cyst (N = 2), or lipomatosis (N = 2). Mean age of symptom onset was 8.2 years (range 0.3 to 17.3 years). Presenting symptoms included muscle weakness (7/14), painless muscle wasting (2/14), contracture (1/14), pain (1/14), or the identification of a painless mass (3/14). Nerve conduction studies (NCS) or electromyography (EMG) were performed in 11/14 patients. MRI was useful at differentiating between these pediatric nerve tumors. Biopsies were performed in nine patients with additional surgical management pursued in four patients. The rare nature of peripheral nerve tumors in children can pose diagnostic challenges. NCS/EMG are important to assist with localization, and MRI is useful to distinguish more benign tumors. Key MRI, clinical, and NCS features can in some cases guide management, potentially avoiding the need for invasive procedures.