Small Asymptomatic Tumors Research Articles

Trigeminal neuromas: modern diagnosis and treatment

Trigeminal neuroma (TN) is a benign neoplasm arising from trigeminal nerve sheath. The tumor can grow from any part of the nerve from the root in posterior cranial fossa to peripheral extracranial branches. Symptoms of trigeminal neuroma are variable and usually depend on location and dimensions of tumor. We present a review devoted to the problem of TN. Surgery was the only possible option in patients with TN for a long time. However, radiotherapy became one of the options and sometimes alternative to surgical treatment since the late 1980s. Besides active management of patients with TN, follow-up with regular radiographic control of small asymptomatic tumors also seems to be reasonable. When evaluating treatment outcomes, physicians consider quality of life and return to previous work and activity in addition to resection quality, neurological impairment, relapse-free period and tumor growth control. However, assessment of these indicators after certain treatment is rare. Thus, it is difficult to determine treatment strategy with maximum ratio of effectiveness and quality of life. Therefore, optimization of TN treatment is currently an urgent problem that requires further study.

Evaluation of Risk Factors for Distant and Lymph Node Metastasis of Pancreatic Neuroendocrine Tumors.

PurposeMetastases of pancreatic neuroendocrine tumors (pNETs) can be found at the time of diagnosis in 20–50% of cases. Small asymptomatic tumors may be left for observation; however, they can metastasize. The aim of the study was to evaluate risk factors for distant and lymph node metastases of pNETs.Patients and methodsOne hundred and fourteen patients with postoperatively confirmed pNET were analyzed retrospectively in a single ENETS Center of Excellence. The relationship between location, size, differentiation of the tumor, and occurrence of lymph node and distant metastases was analyzed.ResultspNETs’ location was pancreatic head – 38 (33.3%), body or tail – 68 (59.7%), and 8 (7.0%) involved the entire organ. Fifty-six (49.1%) tumors were graded G1, 50 (43.9%) G2, and 8 (7.0%) G3. Seventy-two (63.2%) tumors were ≥2 cm in diameter, and 42 (36.8%) <2 cm. Twenty-two (19.3%) patients had distant metastases and 47 (41.2%) had lymph node metastases. In ≥2 cm tumors distant and lymph node metastases were more frequent (p < 0.05). Distant metastases incidence was significantly higher in distally located tumors (p = 0.01) and in G2 and G3 tumors (p < 0.01). In 9.5% of <2cm tumors, distant metastases were present at diagnosis.ConclusionDistant metastases are more often found in larger, distally located pNETs grade G2 and G3, while a higher occurrence of lymph node metastases seems to be associated only with larger tumor size. A considerable number of tumors <2 cm in size have distant metastases already at the diagnosis, which might indicate the need for careful qualification of smaller lesions for observation.

Role of upper respiratory tract fibroscopy in patients with cervical lymph node metastases from squamous-cell carcinoma without the primary tumor found

Background. The detection of primary tumor in patients with cervical lymph node metastases without the primary tumor found is very important, because its location often determines the treatment strategy. The study objective is to analyze the capabilities of upper respiratory tract fibroscopy for the detection of primary tumor in patients with cervical lymph node metastases from squamous-cell carcinoma without the primary tumor found.Materials in methods. A total of 70 patients with cervical lymph node metastases without the primary tumor found, in whom cytological examination of biopsy specimens collected from cervical lymph nodes revealed squamous-cell carcinoma, underwent upper respiratory tract fibroscopy in N.N. Blokhin National Medical Research Center of Oncology between January 2017 and May 2020.Results. In 24 out of 70 patients, fibroscopy helped to identify the primary tumor and collect biomaterial for morphological examination. Twelve patients were found to have oropharyngeal cancer; ten patients were diagnosed with nasopharyngeal cancer; and 2 patients had laryngopharyngeal cancer. Fifteen out of 24 patients had tumors less than 1.2 cm.Conclusion. Upper respiratory tract fibroscopy is a highly effective method for detecting small asymptomatic tumors. It can be recommended for the examination of patients with metastases from squamous-cell carcinoma without the primary tumor found, if the primary tumor is believed to be located in the upper respiratory tract

Gastrointestinal Stromal Tumors (GIST): an Overview

Gastrointestinal stromal tumors are rare mesenchymal tumors of the alimentary tract with varied clinical presentation ranging from small asymptomatic tumors detected incidentally to large palpable abdominal masses which may present with gastrointestinal bleeding, perforation, or obstruction. CT abdomen is the imaging modality of choice. Treatment depends upon the size, location and risk stratification. Complete surgical excision is the treatment of choice for resectable tumours. The discovery of c-kit mutations and tyrosine-kinase inhibitors has revolutionized the treatment of locally advanced, metastatic and recurrent tumors.

Benign Tumors of the Anterior Cranial Base.

Benign tumors of the anterior cranial base may originate from intracranial, cranial, or extracranial sites. Intracranial tumors such as meningiomas may secondarily involve the cranial base and extend into the sinuses or nasal cavity. Bony tumors arising from the cranium include benign fibro-osseous lesions such as osteoma, fibrous dysplasia, and ossifying fibroma. The most common extracranial tumors that may extend to the skull base include angiofibroma and inverted papilloma. Symptoms are nonspecific and diagnosis is often delayed. In most cases, a diagnosis can be established based on the clinical presentation and radiographic features. Some small asymptomatic tumors may be observed for growth (meningioma, osteoma), whereas others should be treated due to continued destructive growth (angiofibromas) or potential for malignancy (inverted papilloma). Surgery remains the predominant treatment modality for benign tumors of the anterior cranial base. The major advance in recent decades has been the adoption of endoscopic techniques. Advances in endoscopic transnasal surgery have dramatically altered the surgical landscape, enabling the removal of tumors of the anterior cranial base with minimal morbidity. Due to decreased morbidity in comparison to transfacial or transcranial approaches, endoscopic transnasal surgery has lowered the threshold for surgery for benign tumors and can be applied to adult as well as pediatric populations. Anatomical limits include the anterior cranial base from the frontal sinus to the sella and optic canals and laterally to the mid-plane of the orbital roofs. Large dural defects can be reliably reconstructed using local (nasoseptal) and regional (extracranial pericranial) vascularized flaps.

Rhabdomyoma with pericardial effusion in a new bornRequiring emergency pericardiocentisis – A Case report

Cardiac tumours are rare in neonates, most are benign hamartomas (rhabdomyomas) of the muscle cells. Due to large size, they may cause homodynamic instability and even death in neonatal period. They are rarely diagnosed prenatally and are found in multiple forms. We report a neonate 1st of the twin, who was found to have a rhabdomyoma attached to right ventricle free valve measuring 3x2.6 cms seen compressing right ventricle, with significant pericardial effusion soon after birth with poor perfusion requiring inotropic support and emergency pericardiocentisis, following which child’s condition stabilised. I. Case report A neonate, 1st of the twin born via LSCS at 34 weeks of gestation with a birth weight of 2.02 Kgs. Antenasal USG at 31 weeks had shown Rhabdomyoma in Right ventricular (RV) free wall. Baby was delivered via normal vaginal delivery, baby cried immediately after birth, APGAR at 1 min and 5 minutes was 9 and 10 respectively. At 2 n half hours of life, on examination child’s capillary refilling time was prolonged and child was started on ionotropes. ECHO was done, which showed Rhabdomyoma arising from RV free wall measuring 3 x 2.6 cms compressing right ventricle with large pericardial effusion measuring 1 cms posteriorly. The effusion was partly tapped by needle pericardiocentesis, following which child’s condition stabilized and there was no increase in effusion Gradually inotropes were tapered and stopped. II. Discussion Primary tumors of the heart are rare in infancy and childhood and are most often benign1. Clinical manifestations depend primarily on the location of the tumor and, to a lesser extent, on the histologic type1 . Most common benign cardiac tumors in children are Rhabdomyomas(4060%)2, Fibromas(12-16%)2, and Myxomas (2-6%)2 . They often remain clinically unimportant and regress with age. Rarely they May cause mechanical obstruction, heart failure3, pericardial effusion or arrhythmias. Incessant ventricular tachycardia in a child younger than 2 yr should raise suspicion of a small endocardial or epicardialrhabdomyoma or Purkinje cell tumor. Treatment of rhabdomyomas4 depends on their location and size, i.e...Small asymptomatic tumors in the myocardial wall or ventricular septum may be observed for growth or regression. Rhabdomyomas associated with tuberous sclerosis often resolve as the child grows older. Large tumors that show signs of obstructing blood flow and those producing ventricular arrhythmias should be removed.

Serous Cystadenoma of the Pancreas

To define the natural history and optimal management of serous cystadenoma of the pancreas. Serous cystadenoma of the pancreas is the most common benign pancreatic neoplasm. Diagnostic criteria, potential for growth or malignancy, and outcomes are not well defined. As a result, management for patients with serous cystadenomas varies widely in current practice. A total of 106 patients presenting with serous cystadenoma of the pancreas from 1976-2004 were identified. Hospital records were evaluated for patient and tumor characteristics, diagnostic workup, treatment, and outcome. Twenty-four patients with serial radiographic imaging were identified, and tumor growth curves calculated. Mean age at presentation was 61.5 years and 75% of patients were female. The most common symptoms were abdominal pain (25%), fullness/mass (10%), and jaundice (7%); 47% were asymptomatic. Mean tumor diameter was 4.9 +/- 3.1 cm, which did not vary by location. Tumors <4 cm were less likely to be symptomatic than were tumors > or =4 cm (22% vs. 72%, P < 0.001). The median growth rate in the patients who had serial radiography was 0.60 cm/y. For tumors <4 cm at presentation (n = 15), the rate was 0.12 cm/y, whereas for tumors > or =4 cm (n = 9), the rate was 1.98 cm/y (P = 0.0002). Overall, 86 patients underwent surgery, with one perioperative death. Large (>4 cm) serous cystadenomas are more likely to be symptomatic. Although the median growth rate for this neoplasm is only 0.6 cm/y, it is significantly greater in large tumors. Whereas expectant management is reasonable in small asymptomatic tumors, we recommend resection for large serous cystadenomas regardless of the presence or absence of symptoms.

The management strategy of renal angiomyolipoma.

The purpose of this study is to analyze the management strategy of renal angiomyolipoma. From 1990 to 2002, a total of 62 patients with renal angiomyolipoma were treated at our medical center. Angiomyolipomas were found in 44 female patients (71.0%) and 18 male patients. Of these patients the age ranged from 18 to 87 y/o (mean: 46.9 y/o). Four of 8 patients with bilateral angiomyolipomas were associated with tuberous sclerosis (TS). Nine (14.5%) of 62 patients had got spontaneous rupture. However, 54.8 per cent of patients were asymptomatic. The mean tumor size was 4.83 cm. Tumors larger than 4 cm had a greater incidence of symptoms (60.7%) and a higher nephrectomy rate (43%). Clinical management was based on tumor size and clinical presentation. Treatment consisted of conservative observation in 30 patients (group 1, 48.4%), selective embolization therapy in 2 patients with hemorrhage (group 2, 3.2%), partial nephrectomy and other surgical procedures in 14 patients (group 3, 22.6%), and total nephrectomy in 16 patients (group 4, 25.8%). Nine of 62 patients were associated with spontaneous angiomyolipoma rupture under conservative treatment in 3, TAE in 1, partial nephrectomy in 1, total nephrectomy in 3 and laparotomy to check bleeding in 1. Neither mortality no major complication was noted. Generally the outcomes were smooth and acceptable. Beyond the total nephrectomy for patients with highly suspected malignancy, we suggest conservative treatment with observation strategy for small asymptomatic tumors, selective arterial embolization as the first choice for hemorrhage or rupture and partial nephrectomy for renal sparing strategy.

Outcome Analysis of 42 Cases of Renal Angiomyolipoma

Angiomyolipomas were found in 42 kidneys in 23 female and 8 male patients at our medical center. Angiomyolipoma was diagnosed by computerized tomography (CT) alone in 55% of the cases, and by a combination of ultrasound and CT in 36%. Nine of 11 patients with bilateral angiomyolipoma had associated tuberous sclerosis.Treatment consisted of observation in 22 patients, selective arterial embolization in 6, partial nephrectomy in 6 and nephrectomy in 8. A total of 17 patients who were observed had tumors smaller than 4cm. and 4 had angiomyolipoma of 4 to 10cm. With a mean followup of 3.8 years, no observation patient had subsequent renal hemorrhage and only 1 (tumor larger than 10cm.) had radiographic progression. Despite progression, the latter patient remained asymptomatic for 18 years. Selective arterial embolization (3 tumors 4 to 10cm. and 3 larger than 10cm.) resulted in preservation of renal function at a mean of 1 year. All patients treated with partial nephrectomy (6 tumors 4 to 10cm.) maintained stable renal function without recurrence during a mean 4.7-year followup. Similarly, all individuals who underwent nephrectomy (4 tumors smaller than 4cm., 3 tumors 4 to 10cm. and 1 tumor larger than 10cm.) have stable renal function.We recommend renal conservation for patients with renal angiomyolipoma using a strategy of observation for small asymptomatic tumors, partial nephrectomy for moderate size tumors and selective arterial embolization of large tumors not amenable to partial nephrectomy.

Hepatocellular Carcinoma

Hepatocellular carcinoma is the most frequent cancer worldwide, responsible for approximately 1,000,000 deaths annually, most of them in the Far East and in sub-Saharan Africa. It usually presents at an advanced stage and has a poor prognosis. There is evidence of an etiologic role for hepatitis B virus infection in the etiology of hepatocellular carcinoma. Carriers of the virus are 94 times more at risk for hepatocellular carcinoma than noncarriers. In many cases hepatitis B virus DNA is integrated within the cellular genome of the tumor. Programs have been established to detect hepatocellular carcinoma at an early stage; persons at high risk are regularly screened by measurement of serum alpha-fetoprotein levels and ultrasound examination of the liver. Surgical resection offers the only hope of cure at present, as chemotherapy, radiotherapy, and immunotherapy have not shown promise. Ideally, surgery should be done on small asymptomatic tumors.

Liver resections in cirrhotic patients: a Western experience.

AbstractSystematic screening for hepatocellular carcinoma (HCC) in cirrhotic patients by alpha‐fetoprotein and ultrasound permits the detection of small asymptomatic tumors. Owing to the small tumor size, more liver resections can now be performed than in the past. These resections are performed in a more economical way in terms of loss of functional parenchyma and in a more appropriate manner with regard to carcinology: surgical techniques of liver segmentectomy and use of intraoperative echography are mandatory. Favorable long‐term results obtained in Eastern countries by resecting such lesions are encouraging but remain to be confirmed in the Western hemisphere.