Soft Tissue Biopsies Research Articles

Spontaneous external endometriosis in a De Brazza's monkey

A spontaneous case of external endometriosis in a 22-year-old female De Brazza's monkey is described. During diagnostic laparotomy, peritoneal adhesions of the uterus to the urinary bladder, ovaries and abdominal wall were seen. A surgical biopsy of soft tissue attached to the ventral surface of the uterus was examined histologically and consisted of endometrial glands and stroma. These findings were compatible with a diagnosis of endometriosis.

Retained surgical swab debris in post-laminectomy arachnoiditis and peridural fibrosis.

We examined soft tissue biopsies from 26 patients with symptomatic nerve root fibrosis and arachnoiditis after a previous laminectomy. Dense fibrous connective tissue was found about the nerve roots and in 14 cases (55%) fibrillar foreign material was seen within it. This material had the histochemical characteristics of cotton fibres from swabs and neurosurgical patties. In two other cases nerve root fibrosis was associated with residual radiopaque lipid thought to derive from earlier myelography. Our findings suggest that risks may be associated with the introduction of foreign material into the vertebral canal, and that microscopic fragments of surgical swabs and patties may have a role in the pathogenesis of postoperative periradicular fibrosis.

The condition of the soft tissues at tooth and fixture abutments supporting fixed bridges. A microbiological and histological study.

In 10 partially edentulous patients provided with fixed bridgework supported by the combination of tooth and titanium fixture abutments, the condition of the soft tissues surrounding the abutments was examined. Sampling of supra- and subgingival plaque was performed from both teeth and fixtures. The samples were analyzed regarding the total bacterial counts, the relative distribution of bacterial morphotypes and the cultivable microflora. From each patient, soft tissue biopsies were obtained from 1 tooth and 1 fixture abutment, and the specimens were analyzed for the presence and extension of inflammatory cell infiltrates. The microbiological examination showed that the distribution of bacterial morphotypes in the supra- and subgingival plaque both at teeth and fixtures were similar, irrespective of localization and type of abutment. Nonmotile rods dominated the microflora, whereas spirochetes were either not detected or occurred in very low proportions. From the histological analysis, it was found that a majority of the soft tissue biopsies (75-80%) from both tooth and fixture sites contained only very small inflammatory cell infiltrates.

Marginal tissue reactions at osseointegrated titanium fixtures: (I). A 3-year longitudinal prospective study

16 consecutive totally edentulous patients were provided with 95 osseointegrated titanium fixtures in 7 upper and 9 lower jaws. Facultatively removable bridges were later connected to abutments, attached to the fixtures. The marginal soft and hard tissue reactions were investigated at a baseline examination and after 6, 12, 21, 30 and 39 months by standardized clinical and radiographical methods. At the last examination, microbiological samples and gingival biopsies were also analysed. The % ratios of abutments without plaque, 70–75%, and without any gingivitis, 80–85%, were almost constant throughout the study. The mean probing depth was 2.9 mm at the final examination. About 75% of all probing depths were 3 mm or less and none exceeded 5 mm. The bridge-gingiva distances increased during the investigation. Attached gingiva surrounded 65% of the buccal and lingual abutment surfaces. Only 0.9 mm marginal bone was lost as a mean during the first year and not more than 0.05 mm annually for the next 2 years. After 6 months, no significant changes in marginal bone levels occurred. The perifixtural bone gradually became more radiopaque, especially marginally in upper jaws, indicating a successive load-related remodelling. The microbiotia comprised coccoid cells and non-motile rods to 93% in 32 samples. Healthy tissues were present in 35% of the 14 soft tissue biopsies. In a further 29%, only a slight inflammation was observed. No constant correlations could be established for any of the investigation parameters used. It is concluded that the marginal soft tissue reactions were mild and not significant for a progressive periodontitis. Mobility tests of separate fixtures combined with quantitative and qualitative standardized radiological examinations of the surrounding bone appear to provide a truer comprehension of longitudinal events at osseointegrated implants than conventional clinical soft tissue observations. The prognosis for the osseointegrated implants appears excellent, especially with regard to the microbiotia, the small marginal bone height changes, and the radiological indications of remodelling in the perifixtural bone.

Limb Salvage in a Diabetic with Necrotizing Fasciitis: Case Report and Literature Review

Necrotizing fasciitis must be considered in a diabetic with cutaneous ulceration. A case report of limb salvage in a 48-year-old diabetic female with progressive necrotizing fasciitis is presented. Methods of early diagnosis including clinical signs, radiographs, and soft tissue biopsy of the involved extremity are reviewed. The microbiology of the disease is also discussed. A modification of the Orr technique using infrequent dressing changes in the management of necrotizing fasciitis is presented. In our case this resulted in preservation of life and a functional limb.

Correlation of tissue reaction to corrosion in osteosynthetic devices.

This study evaluated the interaction of osteosynthetic plates to adjacent tissue. Eleven patients had 13 plates removed with simultaneous biopsies of the adjacent soft tissue. Four patients had pain localized to the area of the plate and 11 patients had routine removal or removal for fracture nonunion. Each plate was graded on a 0-5 point scale for the amount and severity of corrosion present at the screw-plate interface. The adjacent tissue was fixed in formalin and stained with hematoxylin and eosin. The tissue reaction was graded on a 0-5 point scale based on the inflammatory response. A positive correlation of corrosion and tissue reaction was found that was significant at p less than 0.005 in the asymptomatic group. The other good correlation showed that tissue reaction tends to decrease with time at p less than 0.005. There was no correlation of corrosion with tissue reaction in the symptomatic removal group. All patients with pain adjacent to the plates were relieved by implant removal. The findings suggest that stainless steel is minimally toxic to human tissue in most circumstances and that the toxic products are well tolerated. There was a significant group (4/11) that showed a different pattern of tissue response which did not appear to be toxic response. We do not recommend routine implant removal to prevent metal toxicity; however, there is a group of patients who have pain in the area of the implant that may be caused by an allergic reaction and is relieved by implant removal.

Early recognition of potentially fatal necrotizing fasciitis. The use of frozen-section biopsy.

Necrotizing fasciitis is a rare, rapidly progressing soft-tissue infection. Early clinical recognition is difficult, and there is often a fatal delay in appropriate treatment. We evaluated the use of frozen-section biopsies for the rapid diagnosis of this disease in its early stages. Nineteen cases of necrotizing fasciitis were studied over a 13-year period. In all eight cases in which frozen-section biopsy was performed within zero to four days (average, 21 hours) after the onset of symptoms, histologic study confirmed the diagnosis, and surgical d ebridement was immediately performed. Only one patient died. In 11 patients, the diagnosis was made on clinical grounds, and surgical therapy was delayed for 1 to 15 days (average, 6) after the onset of symptoms because of failure to recognize the disorder immediately. Eight patients died (P less than 0.02). Our study indicates that rapid performance of frozen-section soft-tissue biopsy early in the evolution of a suspect lesion may provide a definitive and life-saving diagnosis.

INTERVENTIONAL RADIOLOGY: THE MUSCULOSKELETAL SYSTEM

A discussion of interventional procedures involving the musculoskeletal system would focus mainly on bone biopsies and joint aspirations, although soft tissue biopsies, sinograms, and the occasional use of arthrography as a therapeutic procedure might also be considered. The radiologist also may be asked to assist during the repositioning of fracture fragments under fluoroscopy, particularly in transverse fractures of the surgical neck of the humerus in which rotation of the humeral head has occurred. However, since no needles are used for this procedure or similar ones, a discussion of fluoroscopy has been omitted from this article.

Renal Cell Carcinoma Presenting as a Skeletal Muscle Mass

A 62-year-old man presented with a 17-month history of a slowly enlarging biceps muscle mass. A diagnosis of metastatic renal cell carcinoma was made in the outpatient department using a soft tissue biopsy needle. Despite the rarity of muscular metastases in renal cell carcinoma, early definitive diagnosis of soft tissue masses is recommended.

A new biopsy needle and its clinical use.

A new aspirating and severing soft tissue biopsy needle that is small, disposable, relatively simple (3 components), and very thin-walled has been used percutaneously for many lesions of the chest, abdomen, pelvis, extremities, subcutaneous masses, and lytic spinal bodies. In the vase majority of instances, the tissue cores were sufficient for regular histologic cell block preparation. Among the 143 pulmonary biopsies, the diagnostic accuracy was 89 per cent. There were 16 cases of post-biopsy small pneumothorax, 6 cases of large pneumothorax, and 9 incidences of mild hemoptysis of no consequence. Of the 81 nonpulmonary biopsies, 71 (88 per cent) were diagnostically accurate; and there were no complications.

Arthritis and skin lesions resembling erythema nodosum in pancreatic disease.

The clinical picture of subcutaneous fat necrosis, acute synovitis, and subcutaneous nodules present in some patients with pancreatitis or carcinoma of the pancreas may mimic erythema nodosum. Predominant severe polyarthritis secondary to periarticular fat necrosis or relatively frequent great-toe involvement may make this clinical symptom complex difficult to distinguish from a generalized connective tissue disorder or gouty arthritis. Eosinophilia of 5 to 21% has been noted frequently when subcutaneous fat necrosis accompanies carcinoma of the pancreas. Definitive diagnosis of subcutaneous or periarticular fat necrosis by skin or soft tissue biopsy has been frequently recorded among the 36 patients documented in the literature to date. Unusual subcutaneous nodules often appearing in successive crops and exhibiting a diffuse distribution (buttocks, trunk, back, and even scalp) associated with signs of active synovitis should alert the clinician to the possibility of occult or unconsidered pancreatic disease.