Small Incisional Biopsies Research Articles

Utility of CD44/CD24 in the Outcome and Prognosis of Oral Squamous Cell Carcinoma: A Systematic Review.

Cancer stem cells(CSCs) are characterized by their capacity for self-renewal and differentiation. CD44 and CD24 are two commonly used markers to identify these CSCs. Despite the enormous amount of data available in the literature, their specificity and coexistence remain elusive in oral squamous cell carcinoma (OSCC). In the present review, we aimed to assess the diagnostic utility of the CD44/CD24 combination in tumor development and metastasis in OSCC. Two investigators independently performed a systematic search to identify all the relevant studies from various electronic databases. Out of 694 articles, 9 were found eligible for further evaluation. Details including the number of patients, gender, site, tobacco and alcohol consumption, histological stage, CD24 expression, CD44 expression, CD44/CD24 expression, nodal status, disease-free survival, and overall survival were extracted.CD44+CD24- expression was noted in 35/207 (16.9%) cases, CD44+CD24+ in 53/207 (25.6%) cases, CD44-CD24- in 49/207 subjects (23.67%), and CD44-/CD24+ in 70/207 (33.81%) cases. CD44 or CD24 or their co-expression did not correlate with the disease-free survival rate, and double negatives (CD44-/CD24-) demonstrated a higher overall survival than other immunotypes. CD44/CD24 profile may be used on small incisional biopsies to predict the outcome and treatment planning. This finding may help in developing new therapeutic targets to suppress cancer metastasis and provide a better long-term prognosis for patients diagnosed with OSCC.

Atypical Squamous Verrucous Lesions of the Oral Cavity: Challenges in Interpretation of Small Incisional Biopsies.

Squamous verrucous proliferative lesions of oral cavity can pose a diagnostic challenge for the general pathologist, especially on small biopsies. The superficial nature of incisional biopsies and inconsistent histologic terminologies used for these lesions contribute to often-discrepant clinical diagnosis, resulting in delayed treatment.This study aims to explore the proliferative squamous lesions of oral cavity, correlate biopsy & resection diagnoses, and evaluate possible reasons for discrepant diagnosis (if any). A retrospective review of oral verrucous squamous lesions was undertaken. Pathology database was searched for oral cavity biopsies from January2018 through August2022 with the keywords: atypical, verrucous, squamous, and proliferative. Cases with follow-up were included in this study. A blinded review of the biopsy slides was performed and documented by a single head and neck pathologist. Demographic data, biopsy and final diagnosis were recorded. Twenty-three cases met criteria for inclusion. The mean patient age was 61.1years with a male: female ratio of 1.09. Most frequent site was lateral border of tongue (36%) followed by buccal mucosa and retromolar trigone. The most common biopsy diagnosis was "Atypical squamoproliferative lesion, excision recommended" (n = 16/23, 69%) with 13/16 showing conventional squamous cell carcinoma (SCC) on follow-up resection. 2/16 atypical cases underwent repeat biopsy for confirmation of diagnosis. Overall, conventional SCC was the most prevalent final diagnosis (73%, n = 17), followed by verrucous carcinoma (17%, n = 4). On slide review, six initial biopsies were reclassified as SCC, while one final diagnosis was reclassified as a hybrid carcinoma (on resection specimen). Diagnostic concordance (biopsy and resection) was observed in three cases, all three were recurrences. The primary reasons for discrepant diagnosis on initial biopsies were found to be 1. Obscuring inflammation, 2. Superficial biopsies, and 3. Under recognition of morphologic features (e.g., tear shaped rete, loss of polarity, dyskeratotic cells, paradoxical maturation) that help differentiate dysplasia from reactive atypia. This study highlights the rampant interobserver variability in diagnosis of oral cavity squamous lesions and emphasizes importance of identifying morphologic clues that can aid in correct diagnosis, thereby helping in adequate clinical management.

Small Biopsy Samples: Are They Representative for Biphenotypic Sinonasal Sarcoma?

(1) Background: Biphenotypic sinonasal sarcoma (BSNS) is a rare low-grade neoplasm of the sinonasal tract. It is characterized by specific PAX3 gene rearrangements and both myogenic and neural differentiation. The purpose of the study was to describe the histologic, immunohistochemical and molecular features of BSNS and indicate important clues for small incisional biopsy diagnostics. (2) Methods: Archival samples from patients with nasal cavities or ethmoid sinuses tumors were searched for BSNS cases. Inclusion criteria were the presence of spindle cell morphology and low-grade appearance. Both biopsy and resection specimens were stained for identical IHC panels including, i.a., S100, SMA, SOX10 and PAX3. FISH for PAX3 and SS18 was performed on biopsy specimens. (3) Results: BSNS diagnosis was made in 6 cases included in the study and confirmed by PAX3 rearrangement by FISH in 5 specimens. The pattern of IHC expression was identical for paired biopsy and resection samples apart from one BSNS case. (4) Conclusions: Incisional biopsy seems to be a sufficient method to establish BSNS diagnosis in most cases. Characteristic morphological features together with S100, SOX10 and SMA as the screening markers are useful for confirming the diagnosis. In cases of divergent morphology and immunoprofile evaluation of PAX3 rearrangement is vital.

Metanephric adenoma: molecular study and review of the literature.

Introduction: Metanephric adenoma (MA) is an uncommon benign tumor accounting for 0.2–0.7% of adult renal epithelial neoplasms. The clinical course is often indolent, but diagnosis should not be delayed since clinical symptoms (hematuria, fever, palpable abdominal mass, and flank pain) may be non-specific and overlap with those of a malign renal neoplasm. We report on 4 cases of AM, for which morphological and mutational analysis were performed.Material and Methods: Immunohistochemical staining was performed on sections cut from paraffin blocks to assess expression of WT1, vimentin, racemase, CK7, CD10 and RCC. Testing for the BRAF gene mutation V600 was carried out using real-time PCR (Cobas® 4800).Results: In all four cases, tumors were visible as well-circumscribed, non-encapsulated masses located in the renal cortex and extending towards the medulla. At immunohistochemical examination, tumor cells stained negative for CK7, CD10 and RCC and positive for both WT1 (nuclear, intense) and vimentin (cytoplasmic, intense, and diffuse). Molecular analysis revealed the BRAF gene mutation V600E in three cases and wild-type BRAF in the fourth.Conclusions: BRAF molecular mutation analysis may aid diagnosis in cases with atypical histological features, especially in small incisional biopsies when reassessment of surgical treatment may be considered.

Collision Tumor in the Lower Eyelid: Basal Cell Carcinoma Adjacent to Trichoepithelioma.

The coexistence of 2 neoplasms in a single cutaneous specimen is unusual. We describe a lower eyelid lesion in which the biopsy revealed a trichoepithelioma (TE) and an adjacent basal cell carcinoma (BCC). A 57-year-old female patient reported a 5-year history of lower eyelid pruritus and had been treated for blepharitis elsewhere. She was referred for eyelid evaluation due to the presence of a plaque, loss of eyelashes, and areas of inflammation in the right lower eyelid. She underwent tumor excision, and the eyelid was reconstructed using an orbicularis muscle advancement flap combined with a free tarsoconjunctival graft and a skin graft. Preoperative photographs show an extensive lesion, with madarosis in the right lower eyelid (Fig. A and B). Biopsy specimen from the right lower eyelid revealed 2 different tumor types: a TE and an adjacent BCC (Fig. C and D). A focus of TE is seen (left) juxtaposed with a focus of BCC (right). The area containing the TE was composed of basaloid cell nests and horn cysts, embedded within an organized stroma. Areas of cicatricial fibrosis and foreign body-type reaction were also observed. These histopathology features were consistent with that of a desmoplastic TE (DTE). The adjacent BCC area showed proliferation of atypical basaloid cells with peripheral palisading. Cytoplasm was basophilic and relatively scant, nuclei were large and mildly irregular, and contained grumous chromatin and mitotic figures. Trichoepithelioma is a benign tumor of follicular origin with 3 distinctive variants: multiple familial, solitary, and DTE. DTE is a rare benign adnexal tumor, derived from basal cells in the outer root sheath of the hair follicle, histologically characterized by narrow strands of basaloid tumor cells, keratinous cysts, and a desmoplastic stroma. TEs and BCCs both present with nests of basaloid cells. Histologic features that favor TE include the following: architectural symmetry, horn cysts, and associated giant cell reaction (rare in BCC), papillary mesenchymal bodies, no high-grade atypia, no or very low mitotic activity, monomorphic nuclei, no tumor necrosis, no peripheral clefting. The presence of peripheral palisading of basaloid cells, clefting between the epithelial and stromal components, necrosis, and high mitotic activity are associated with BCC. When histologic examination does not permit to differentiate a TE from a BCC, immunohistochemical stains, such as BCL2, CD10, CD34, AR, may be useful. Transformation of TE to BCC is rare and usually occurs in the setting of multiple TEs. A possible way to investigate transformation would be to compare the DNA of both tumors to find a common mutation. In our patient, it is more likely that this is a collision tumor (coexistence of 2 different tumors in the same lesion). Concomitant presence of a TE and a BCC is rare, and, to the best of our knowledge, this is the only case showing a DTE adjacent to a BCC, involving the eyelid. This case highlights that benign and malignant pathology can coexist within the same lesion. Special attention should be addressed to collision tumors since, in these cases, a small incisional biopsy might not be sufficient for accurate diagnosis.Fig.: Basal cell carcinoma adjacent to trichoepithelioma. A and B, A 57-year-old female patient presented an extensive lesion, with madarosis in the right lower eyelid. C and D, Hematoxylin and eosin stain of the biopsy specimen (100× and 200×) revealed 2 different tumor types: a focus of trichoepithelioma is seen (left) juxtaposed with a focus of basal cell carcinoma (right).

Assessment of stromal eosinophilia in cutaneous squamous cell carcinoma

Background: Tumor associated tissue eosinophilia (TATE) has been described in a variety of neoplasms. In regard to squamous cell carcinoma, some studies worldwide done to assess stromal eosinophilia in oral and cervical squamous cell carcinoma. The objectives of this study is to evaluate the association of stromal eosinophilic infiltration of cutaneous squamous cell carcinoma and to detect the significance of this association.
 Aim of the study
 The aim of our study is to establish the relationship between the degree of stromal eosinophilia and the level of invasion and the histological grade in cutaneous squamous cell carcinoma.
 Methods: In this retrospective study done at the histopathology department of al Wasity teaching hospital for orthopedic and plastic surgery in Baghdad, all paraffin embedded blocks for excisional biopsies diagnosed as primary cutaneous squamous cell carcinoma from December 2015 to January 2017 were retrieved. Incisional biopsies and those with margin positive tumor cells were excluded. After a careful evaluation for histological grading and assessment of level of invasion according to an established histological criteria , the assessment of tissue eosinophils was done by three pathologist through counting eosinophils in tumor stroma in 10 high power field using a light microscope and categorized as none (0,),low (1-4),medium (5-19)and high (more than 20).
 Results : of 56 cases of primary cutaneous squamous cell carcinoma 48(85.7%) cases were conventional .The mean age was 43.14 ± 1.76 .Regarding conventional squamous cell carcinoma ,of 48 cases 30(62.5) were well differentiated,16(33.3%) had clarck level III,18(37.5%) had clarck level IV and 14(29.1%) had Clark level V .There is a significant statistical relationship between histological grading of tissue eosinophilia and level of invasion with p value 0.044 and a non-significant relationship with degree of differentiation.
 Conclusion :The majority of cutaneous squamous cell carcinomas were conventional well differentiated with a mean age in the fifth decade of life ,a male predominance and often had a degree of stromal eosinophilia that is strongly associated with the level of invasion .Thus more Intense tissue eosinophilia is correlated with a higher level of stromal invasion. The significance of such an association should be regarded as either a potential predictive tool for stromal invasion in small incisional biopsy or as a prognostic indicator that could be included in the pathology report for conventional squamous cell carcinoma

Oral mucosal dysplasia vs reactive atypia; benign hyperplasia vs verrucous carcinoma

There are many occasions when diagnosing oral mucosal lesions that a decision needs to be made between reactive atypia and tissue dysplasia, with the implication that the latter may progress to squamous cell carcinoma. Similarly it can be very difficult to distinguish a verrucous hyperplastic response from verrucous carcinoma, particular with a small incisional biopsy.

Plasmacytoid-Type Cellular Differentiation in Polymorphous Low-Grade Adenocarcinoma.

Polymorphous low-grade adenocarcinoma (PLGA) occurs more frequently in minor salivary glands. The diagnosis of PLGA, in general, is not difficult but in occasional tumors showing limited invasion or in small biopsy specimens, PLGA may be confused with cellular pleomorphic adenoma (PA). Plasmacytoid cells, a usual component of PAs, have been considered helpful for correct tumor identification. The aim of this study was to verify the frequency (if any) of plasmacytoid-type cellular differentiation (PD) in PLGA. Thirty-two cases of PLGA were reviewed. PD was recognized in 2 cases (6.25%), in which immunohistochemical expression of AE1/AE3, CK7, CK14, vimentin, α-SMA, p63, S-100, calponin, GFAP, and Ki-67 was evaluated. The 2 cases presented conventional areas of PLGA and variable quantities of cells with PD forming aggregates in the stroma and lining ductal structures. Cells with PD showed positivity for AE1/AE3, CK7, S-100, and vimentin and were negative for CK14, calponin, and GFAP in both cases. In case 1, cells with PD did not present α-SMA and p63 positivity whereas in case 2 they were positive, but for α-SMA such reactivity was restricted to cells forming solid aggregates. Although PD in PLGA is rare, it is necessary to be aware of this possibility, particularly in small incisional biopsies and in PLGA with limited invasion, to avoid confusion with cellular PA.

Current Concepts in the Biopsy of Musculoskeletal Tumors

A musculoskeletal tumor biopsy can involve fine needle aspiration, core needle biopsy, or incisional biopsy. Controversy regarding the diagnostic yield of these biopsy techniques continues. The purpose of this article is to summarize the current concepts in the biopsy of musculoskeletal tumors. We performed a literature review of clinical articles reporting on the biopsy of bone and soft-tissue primary tumors. Clinical articles were excluded on the basis on abstract content if they represented case reports, review or opinion articles, or technique descriptions. Eighteen of the thirty-nine articles that remained were excluded because the results did not indicate the diagnostic accuracy of the various biopsy techniques. Thus, twenty-one articles with diagnostic data on the biopsy of bone and soft-tissue tumors were included in this review. Core needle biopsy appeared to be more accurate than fine needle aspiration, and incisional biopsy appeared to be more accurate than both of these techniques, but the differences did not reach significance. Incisional biopsy was more expensive than the percutaneous biopsy methods. In deep musculoskeletal tumors, incorporation of ultrasonography or computed tomography for guidance is easy and safe and can be useful for increasing the accuracy of the biopsy. Advantages of a percutaneous technique compared with an incisional one are the low risk of contamination and the minimally invasive nature. Certain anatomic locations and histologic types were associated with diagnostic difficulty. Vertebral tumors had the lowest diagnostic accuracy regardless of the biopsy technique. Myxoid, infection, and round cell histologies were associated with the lowest diagnostic accuracy. The current literature has not clarified the optimal biopsy technique for the diagnosis of bone and soft-tissue tumors. However, core needle biopsy is usually preferable to incisional biopsy because of the low risk of contamination and the low cost. In addition, the use of imaging guidance increases the diagnostic accuracy of musculoskeletal biopsies and reduces the risk of complications. If the result of a percutaneous biopsy is nondiagnostic, a small incisional biopsy should be performed. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Les tumeurs myxoïdes des tissus mous profonds

Myxoid soft tissue tumors form a heterogeneous group. Their biological potential encompasses the whole spectrum from benign to highly malignant. The present article focuses on myxoid tumors of the deep soft tissues: myxofibrosarcoma, low-grade fibromyxoid sarcoma, myxoma, myxoid liposarcoma, extraskeletal myxoid chondrosarcoma and nodular fasciitis. The last two decades have brought into practice multiple powerful tools that support pathologists in making precise diagnoses, even on small incisional biopsies: detection of fusion transcripts by rt-PCR, detection of chromosomal fusion or breakpoint by FISH, detection of point mutations by PCR and expression of specific markers by immunohistochemistry. Conventional morphology remains the mainstay of diagnosis, and it is essential to obtain adequate clinical and radiological information before interpreting small incisional biopsies. The present article is a summary of morphologic features used to diagnose the most common tumors of the deep soft tissues.

Optimal handling of bone tumor specimens.

The diagnosis of bone tumors is challenging and depends on optimal processing of specimens as well as integration of radiographic and clinical information. The correct diagnosis will often require ancillary techniques such as immunohistochemistry, flow cytometry and molecular or cytogenetic analysis. From a pathologist's standpoint, optimal processing of specimens is paramount and often requires some foreknowledge of anticipated diagnosis in order to triage a specimen properly. The type of specimen, small vs. large, will often dictate the type of information that should be reported by the pathologist. Small specimens, including core biopsies and small incisional biopsies, are often obtained for primary diagnosis and as such, require a different approach to management. In addition to assuring the adequacy of the specimen for diagnosis, the pathologist will often need to triage these materials for appropriate ancillary studies. Large specimens, including amputations and large resections, pose a different set of technical problems for handling and processing. In this setting, information such as grading, staging, and marginal status become more crucial and the subsequent processing of the specimen should be handled in a very standardized manner to facilitate optimal pathologic reporting. This chapter offers a concise but detailed review for handling both types of bone tumor specimens.

Inflammatory myxohyaline tumor of distal extremities:Cytologic findings in a lesion simulating a high‐grade myxoid sarcoma

Fine-needle aspiration cytology has been shown to be useful in the diagnosis of lesions of the distal extremities with an accuracy of ∼70% for the specific diagnosis of tumors of the hand. Despite this accuracy, some cases may be misinterpreted as to the type of lesion present. A 34-year-old male presented with a 1.5 cm mass in the soft tissue of his right middle finger. Fine-needle aspiration (FNA) was performed and produced cellular smears with a myxoid background. The majority of cells were of a short "spindle" or polygonal shape but a number of large pleomorphic cells were also present. A diagnosis of pleomorphic myxoid sarcoma was given. Subsequent incisional biopsy revealed an inflammatory myxohyaline tumor of the distal extremities (IMTDE). FNA, core needle biopsy, and even small incisional biopsies may result in misdiagnosis of IMTDE as pleomorphic sarcoma, an inflammatory condition or even Hodgkin's disease. Careful attention to the myxoid background, prominence of inflammatory cells, nature of the pleomorphic cells, and location of the lesion should favor the diagnosis of IMTDE.

CD10 (Neutral Endopeptidase) Expression in Myoepithelial Cells of Salivary Neoplasms

CD10 is a cell surface peptidase expressed in a wide variety of normal and neoplastic tissues, including breast myoepithelial cells. In salivary glands, expression of CD10 has only been used to identify neoplastic myoepithelial cells of pleomorphic adenomas and myoepithelial carcinomas. However, its accuracy in other salivary tumors with myoepithelial component has yet to be analyzed. We examined 72 salivary tumors with myoepithelial differentiation using immunohistochemical technique to detect CD10. In salivary glands, CD10 expression was not detected in myoepithelial cells. Only fibrocytes within the intralobular stroma were CD10 positive. In neoplastic myoepithelial cells, CD10 expression was found in 25.71% of benign and 32.43% of malignant neoplasms. When the different groups of tumors were compared, epithelial-myoepithelial carcinomas (EMEC) showed a stark contrast with the others (83.3% of cases with CD10 expression). Surprisingly, adenoid cystic carcinomas and basal cell adenomas were negative in 100% of the cases. Myoepitheliomas, pleomorphic adenomas, and myoepithelial carcinomas were positive in 27.7%, 30.0%, and 40% of the cases, respectively. In conclusion, salivary neoplastic myoepithelial cells gain CD10 expression in relation to their normal counterparts. However, the gain of this protein is not a sensitive marker for detecting myoepithelial cells in the majority of the tumors, except for EMEC. The high expression of CD10 by this carcinoma can be a valuable tool to separate EMEC from the tubular variant of adenoid cystic carcinomas in small incisional biopsies, where the precise diagnosis may be impossible.

Protocol for the Examination of Specimens From Patients With Invasive Carcinoma of the Breast

Protocol for the Examination of Specimens From Patients With Invasive Carcinoma of the Breast

Diagnostic difficulties in lesions of the minor salivary glands

A wide range of lesions arise from the intra-oral salivary glands, which present a diagnostic challenge to specialists and generalists alike. Of the salivary neoplasms, pleomorphic adenoma is the commonest, but its morphological diversity may bring several other entities to mind, notably polymorphous low-grade adenocarcinoma, particularly in a small incisional biopsy. Polymorphous low grade adenocarcinoma in turn shares features with adenoid cystic carcinoma. When the differential diagnosis includes these three tumours, immunohistochemistry can assist in the face of overlapping morphology. The other salivary neoplasms most likely to be encountered in the oral cavity are canalicular adenoma, mucoepidermoid carcinoma and acinic cell carcinoma. Of the non-neoplastic conditions, necrotizing sialometaplasia is most likely to be misdiagnosed as neoplastic on both clinical and histological grounds. However, careful consideration of the clinicopathological features of an adequate tissue specimen will enable correct diagnosis.

Is maspin immunolocalization a tool to differentiate central low-grade mucoepidermoid carcinoma from glandular odontogenic cyst?

Mucoepidermoid carcinoma (MEC) of the salivary glands has a low-grade variant (LGMEC), which may be found within the jawbones. LGMEC shares a number of histopathological similarities with glandular odontogenic cysts (GOC) of the jawbones. Maspin has been identified in several benign and malignant salivary gland neoplasms. We investigated the immunolocalization of maspin in LGMEC and GOC and evaluated its potential to distinguish between these two entities. Cases of LGMEC (n=6), GOC (n=8) and various odontogenic cysts with marked mucous metaplasia (OCMM, n=7), which served as controls, were immunohistochemically labeled for the binding of an antibody directed against maspin. Immunomorphometry was performed separately for maspin-immunopositive epithelial cells and epithelial-mucous cells in either their nuclear or cytoplasmic compartments. Results were presented as the volume fraction (Vv) of each element. The Vv of the maspin-immunopositive epithelial-mucous cytoplasm and nuclei was significantly higher in LGMEC than in GOC and OCMM (p<0.001 and p=0.026, respectively). In the epithelial cells, no significant differences were observed among the lesions (p>0.05). It is suggested that the high levels of maspin in the epithelial-mucous cells (in both cytoplasm and nuclei) in LGMEC may serve as a tool to distinguish it from GOC. This may be useful especially in equivocal cases and in small incisional biopsy samples.

Glandular odontogenic cyst: a challenge in diagnosis and treatment

The present review analyzes the accumulated data from all cases of glandular odontogenic cyst (GOC) reported in the English language literature. In the 20 years since it was first described, 111 cases have been reported, an incidence of 0.2% of odontogenic cysts. The age range is 14-75, mean 45.7, with a M/F ratio of 1.3:1. GOC has a predilection for the mandible (70%), affecting both anterior and posterior areas. It is typically radiolucent, well defined, either unilocular (53.8%) or multilocular (46.2%). Frequent perforation (61%) and of thinning of cortical plates (24.4%) indicate aggressiveness. Sufficient follow-up indicates that 30% of cases can recur. Treatment by enucleation or curettage carries the highest risk for recurrence, especially in large and multilocular lesions. Peripheral osteoectomy or marginal resection can eliminate the risk. Defined criteria for microscopic diagnosis are described, which in addition to Ki67 and p53 can help in differentiating GOC from lesions with histological similarities (cysts with mucous metaplasia, botryoid and surgical ciliated cysts, low-grade mucoepidermoid carcinoma). Definite diagnosis may not be possible in small incisional biopsies due to the focal presentation of characteristic features required for diagnosis. There is now evidence to support an odontogenic rather than a sialogenic origin.

Update on Diagnostic Difficulties in Lesions of the Minor Salivary Glands

Update on Diagnostic Difficulties in Lesions of the Minor Salivary Glands

Solitary fibrous tumor of the oral cavity: the need for an extensive sampling for a correct diagnosis

Solitary fibrous tumor (SFT) is an uncommon but well-characterized soft tissue tumor that was first described as a pleural lesion and now is considered ubiquitous, having been detected at many extra-pleural sites (abdominal cavity, orbit, upper respiratory tract, and oral cavity). Histologically, SFT may show wide morphological variability of both its cellular and stromal components, which may lead to incorrect diagnosis especially when dealing with small incisional biopsies. We report on the clinical, morphological and immunohistochemical features of eight SFT occurring in the oral cavity. Microscopically all eight tumors showed widely variable morphological features in terms of cellular density and stromal architecture, thus simulating benign fibrous histiocytoma, schwannoma, hemangiopericytoma or low-grade sarcoma in distinct areas of the same lesion. Among these eight cases, five had been diagnosed as SFT, two as benign fibrous histiocytoma and one as low-grade sarcoma. In consideration of the heterogeneous morphological appearance of SFT, inaccurate sampling of the mass may lead to misdiagnosis and inappropriate treatment. Therefore, an accurate histological examination of multiple tissue sections is advised, along with the use of appropriate immunostains.

Artefacts produced by suture traction during incisional biopsy of oral lesions.

The aim of this study is to compare the artefacts ascribed to the technique of incisional biopsy using a punch or scalpel and the influence of suture use for traction and delivery of the specimen. A total of 160 samples were obtained from 10 fresh pig tongues by four experienced oral surgeons. Handling artefacts (squeeze artefacts): crush, splits, fragmentation and pseudocysts were assessed. No differences were identified in terms of crush, fragmentation or pseudocysts between samples obtained with a punch or scalpel. Splits were more frequent in those biopsies taken with a scalpel (chi2 = 9.26; P= 0.0023). Artefacts in the punch biopsy group were significantly less than in the group that combined punch and suture traction (P < 0.01). The scalpel and suture traction group showed significantly more artefacts than the group without suture. It is concluded the use of a stitch for traction in small incisional biopsies causes squeeze artefacts, so its use should be restricted to specimen orientation.