Surgical Pathologic Findings Research Articles

Feasibility of robot-assisted radical prostatectomy in elderly patients: Comparative analysis of the peri-surgical/oncological outcomes with younger patients.

134 Background: Robot-assisted radical prostatectomy (RARP) has become one of standard treatments for localized prostate cancer. However, a feasibility of RARP in elderly patients has not been clear yet. We performed a comparative analysis of peri-surgical/oncological outcomes for younger and elderly patients underwent RARP. Methods: We reviewed and compared our initial 340 consecutive patients who underwent RARP from 9/2012 to 8/2015 for peri-surgical outcomes, including surgical times, blood loss, complications, pathological findings, continence recovery, and oncological outcomes stratified by age less than 70 and over 70 years. Results: In our cohort, 202 men were age less than 70 and 138 men were ≥70. Preoperative parameters (age, PSA, Gleason score) were similar in both younger and elder groups. Operative time (median: 167 vs. 171 minutes) and estimated blood loss were similar in both groups. One of elder patients (0.7%) needed transfusion. Peri/post-operative complications in both groups appeared to be minimal with no cases of intra-operative open conversion. One of younger patients needed a surgical settlement for port site herniation. Surgical positive margin rates in organ-confined (pT2) disease were also similar (5.6%, younger vs. 9.0%,elder). Continence at 3 months was 82% in elder patients as opposed to 87% in younger patients. Median follow-up period in in elder patients and younger patients were 15.2 and 15.3 months, respectively. Biochemical recurrence free survival rates in elder patients and younger patients were 89.9% and 93.6%, respectively (p=0.1026). Conclusions: In our study, RARP in elderly patients was relatively safe and yielded good oncologic results. RARP is feasible even in elderly patients.

Rare Leiomyoma of the Tunica Dartos: A Case Report with Clinical Relevance for Malignant Transformation and HLRCC.

Background. Genital leiomyomas fall under the broader category of cutaneous leiomyomas, which are rare smooth muscle neoplasms accounting for 5% of all leiomyomas. Genital leiomyomas arising from the dartos muscle are exceedingly rare with fewer than 30 cases reported in the literature. They are typically benign and adequately treated with simple surgical excision; however, previously reported cases of malignant transformation and a possible link to the hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome warrant closer follow-up. Case Presentation. We report a case of a 47-year-old male refugee from Rwanda found to have a mobile, pea-sized, mildly painful scrotal lesion near the left penoscrotal junction and 1.5 cm indeterminate vascular mass in the right kidney. Surgical excision of the scrotal nodule was performed and the diagnosis of a dartoic leiomyoma was rendered. The presence of moderate nuclear atypia, rare mitotic activity, and close surgical margins prompted a wide reexcision. We report the surgical approach, pathologic findings, and clinical follow-up related to this scrotal lesion. Conclusion. Scrotal leiomyomas demonstrate a high rate of recurrence and pose a risk for malignant transformation. They may also indicate an underlying autosomal dominant syndrome associated with increased risk for development of an aggressive form of renal cell carcinoma. When discovered, management should include surgical excision, screening for syndromic features, and routine follow-up.

Perforated Colon Cancer Complicated with Necrotizing Fasciitis

Case Presentation: A 38-year-old Taiwanese woman had a 7 month history of abdominal pain over right lower quadrant and microcytic anemia. Upper gastrointestinal (GI) scope revealed gastric ulcer. Lower GI scope was suggested, but she hesitated to it and lost followup. This time, she visited our institution due to dyspnea for 2 days with episodic fever up to 39.4° C. Pale conjunctiva, hypoactive bowel sound, a protruding lesion with tenderness and subcutaneous crepitus over right flank and buttock were noticed on physical examination. Significant laboratory findings were white blood cell counts of 19.5 ×109 /l with segmented neutrophils of 88% and band forms of 3%, hemoglobin 3.5 g/dl, C-reactive protein 21.2 mg/l, albumin 2.3 g/l, and calcium 1.85 mmol/l. Contrast-enhanced computed tomographic scan of the abdomen demonstrated ascending colon cancer with abscess formation and subcutaneous gaseous infiltration (Figures 1A-1C). Right hemicolectomy (Figure 1D), ileostomy and debridement with rotation flap were conducted. This patient was admitted to surgical intensive care unit for postoperative critical care. Cultureof abscess grew Escherichia coli and Streptococci viridans. Surgical pathological findings showed advanced adenocarcinoma of cecum, moderately differentiated, with invasion to mesocolic soft tissue, ileocecal valve and metastasized to mesocolic lymph nodes. She was discharged on the 25th postoperative day under uneventful condition. Discussion: Necrotizing fasciitis (NF) is a fulminant and life-threatening gangrenous soft-tissue infection with mortality rate of 20-40% [1-4]. NF is usually caused by trauma to the skin or surgical wounds and less common due to underlying intestinal diseases such as perforated colonic diverticulitis or cancer [2-4]. 3.3% of patients with colon cancer had localized perforation and 0.3-0.4% of these patients had abscess formation [3,4]. Fewer cases of retroperitoneal abscess and NF caused by perforated colonic cancer have been reported and potentially fatal in immunocompromised patients with mortality rate of 50% [3]. It most commonly occurs in the abdominal wall, extremities and perineum. Clinical features of NF include fever, chills, tenderness and crepitus on the involved region with skin discoloration [1-4]. Early diagnosis by US or CT and treatment with broad-spectrum antibiotics and surgical debridement can reduce the mortality rate associated with abscess and NF [1-5]. We highlighted that colon cancer could be a cause of unexpected retroperitoneal abscess followed by NF.

Agreement Between Computed Tomography and Pathologic Nodule Counts in Colorectal Lung Metastases

Computed tomography is the most common technique used to estimate the number of pulmonary metastases and their resectability. A lack of agreement between radiologic and surgical pathologic findings could potentially lead to incomplete resection or to rejection of patients for potentially curative treatments. The objective of this study was to estimate the disagreement between the number of radiologic lesions and the number of histologically confirmed malignant lesions excised from patients with pulmonary metastases from colorectal cancer. This was a multicenter longitudinal study using a national registry. All patients underwent open surgery for pulmonary metastasectomy. Radiologic unilateral involvement was documented in 345 of 404 patients (85%); 253 (73%) presented with single nodules. The radiologic and malignant pathologic findings were concordant in 316 (78%) patients. The two independent predictors of discordance between computed tomography and the number of pathologic metastases were the bilateral involvement and the number of radiologic nodules. This model explained 28% of the variability in the disagreement frequency and discriminated between agreement and disagreement in 85% of the patients. Discrepancies increased with the nodule count with an odds ratio of 6.17 (95% confidence interval, 4.08 to 9.33) per additional nodule. For similar nodule counts, a lower disagreement frequency was observed among bilateral cases (odds ratio, 0.2; 95% confidence interval, 0.07 to 0.55). Differences between the radiologic and pathologic findings were documented in 1 of every 5 patients. The correlation was very accurate in patients with single radiologic nodules. However, half of the patients with more nodules showed discrepancies.

Adnexal Mass Requiring Surgical Intervention in Adolescent Girls

Adolescence starts with the beginning of physiologically normal puberty, and ends when an adult identity and behavior are admitted. This period of development corresponds roughly to the period between the ages of 10 and 19 years, which is compatible the World Health Organization’s definition of adolescence. Most of the adnexal masses during this period are functional ovarian cysts and benign neoplasms, and conservative surgery is suggested in the case of a cystic mass smaller than 8 cm. In all adolescents with adnexal masses, the preoperative evaluation should include a comprehensive medical record, physical examination, and imaging methods such as ultrasonography and laboratory examinations. The aim of this study was to evaluate preoperative findings, surgical procedure and histopathologic findings of the adolescent patients who had surgery for adnexal mass in our clinic. Totally 41 patients were included into study. Age, menstrual history, complaints during admission, images of the masses that were detected with different modalities, laboratory findings, applied surgical procedure and pathology findings were recorded. Among the symptoms that lead patients to admit hospital, abdominal pain was the first that was in 23 patients (56.1%). As we evaluate type of operation, 12 patients (29.3%) had laparoscopy, 29 patients (70.7%) had exploratory laparotomy operation. Mini laparotomy was the most often used incision type in 17 patients (41.5%). 34 patients (82.9%) had only cystectomy as an organ preserving surgery and most common histopathologic diagnosis was functional cyst in 14 patients (34.1%). In conclusion; since most pelvic masses in the adolescent period have benign character, surgery in this period should be minimally invasive and organ preserving for future fertility concerns and avoid from premature menopause.

Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score

PurposeTo determine the accuracy of ENZIAN score, as detected on MR imaging, compared to surgical-pathologic findings. Materials and methodsThis retrospective study was approved by the investigational review board and the requirement for informed patient consent was waived. 115 patients were included according to following criteria: tubo-ovarian and/or deep endometriosis suspected at physical examination and transvaginal ultrasound; availability of MR examination; histopathological results from laparoscopic or surgical treatment. Exclusion criteria: lack of available MR examination, and/or (b) lack of a definitive histopathological results.Histopathological findings from bioptic specimens obtained during laparoscopic or laparotomic treatment were considered as reference standard.For all detected lesions a score according to ENZIAN score (revised 2010) was assigned both for MRI and histopathological findings.By comparing MRI-ENZIAN score and histopathological-ENZIAN score the overall sensitivity, specificity, accuracy, positive and negative predictive values in relation to presence/absence of deep endometriosis in each patient were calculated. k-Cohen to evaluate the degree of concordance between MRI-ENZIAN score and histopathological-ENZIAN score was also measured. Moreover the sensitivity, specificity, accuracy, positive and negative predictive values for each specific localization provided by ENZIAN score were also calculated. ResultsAt histopathology, the diagnosis of deep endometriosis was confirmed in 82/115 (71.3%) patients.The sensitivity, specificity, accuracy, PPV and NPV of MRI were 94%, 97%, 95%, 99%, 86%, respectively. The highest accuracy was for adenomyosis (100%) and endometriosis of utero-sacral ligaments (USLs) (98%), slightly lower for vagina-rectovaginal septum an colo-rectal walls (96%), and the lowest for bladder endometriosis (92%).The concordance between histopathological and MRI ENZIAN score was excellent (k=0.824); in particular it was 0.812 for lesions in vagina-rectovaginal space, 0.890 for lesions in USL, 0.822 for lesions in rectum–sigmoid colon, 1.000 for uterine adenomyosis, and 0.367 for lesions located in the bladder wall. ConclusionMRI correlates with the ENZIAN score and has an accuracy of 95% in the detection and localization of deep endometriosis, allowing to minimize false negative results (4%) in patients with deep endometriosis and to obtain a correct preoperative staging.

Cancer tracking: Clinician compliance and program outcome.

Certain laboratory tests are critical for patient care and must be communicated rapidly. Professional societies have developed guidelines for reporting of "critical values" and significant or unexpected surgical pathology findings. Urgent diagnoses requiring rapid reporting include new or unexpected diagnoses of malignancy. The University of Missouri established a "cancer-tracking" protocol in which all diagnoses of malignancy require acknowledgment by the responsible clinician. We reviewed 5 months of compliance with the cancer-tracking protocol. The protocol requires the Department of Pathology to send a letter to the responsible clinician requesting acknowledgment of the report. In total, 1,155 confirmation requests were sent to the physicians named on the request form. Following the first letter, 692 acknowledgments were received, and 356 acknowledgments followed the second letter. In 107 (9%) cases, no response was received. Confirmation that the physician caring for a patient receives a pathology diagnosis is important for patient management and quality assurance. While the surgical pathology report was placed in the chart, it was impossible to confirm that the responsible physician had reviewed the report in 9% of cases. Techniques for communication and confirmation of transmission of anatomic pathology diagnoses need to be developed.

Value of the patency capsule in pre‐evaluation for capsule endoscopy in cases of intestinal obstruction

Patency capsule (PC) is a tool to screen the patency of the gastrointestinal (GI) tract. Capsule endoscopy can be performed after the patency is confirmed by the patency capsule. We aimed to estimate the diagnostic value of PC based on the existing trials. We searched PubMed, CENTRAL and EMBASE for studies that included patients with suspected small bowel stricture who were evaluated by both PC and a reference standard (following capsule endoscopy and/or surgical pathology and/or endoscopic findings) and who were eligible for inclusion. The quality of the eligible studies was assessed using the Quality Assessment for Diagnostic Accuracy Studies-2 criteria. Sensitivity, specificity, likelihood ratios and the area under the receiver operating characteristic curve (AUROC) were calculated. Five studies including 203 patients fulfilled the eligibility criteria. The pooled data showed a PC sensitivity of 97% (95% CI 93-99%) and a specificity of 83% (95% CI 65-94%). The AUROC was 0.9557. PC may be of diagnostic value in confirming the patency of the GI tract before capsule endoscopy. The routine use of PC might eliminate the contraindication of capsule endoscopy in many cases of intestinal obstruction.

Efficacy of Ultrasonography in the Evaluation of Suspected Appendicitis in a Pediatric Population

Background The purpose of this study was to evaluate the efficacy of ultrasound (US) for the diagnosis of acute appendicitis in children. Patients and methods We reviewed all sonograms for acute appendicitis in children suspected of having appendicitis from January 2009 to December 2012. Sonographic findings were positive when the largest axial diameters were >6 mm. The sonograms that were unable to find the appendix were classified into an other group and were considered separately. Sonographic findings were compared with surgical pathological findings or discharge diagnoses in cases of no surgery. Subgroup analysis in the surgical group, including patient age ( Results The appendix was identified in 270/428 cases (63.1%). The overall sensitivity was 71.2% [95% confidence interval (CI): 56.9–82.9%], specificity 97.7% (95% CI: 94.7–99.3%), positive predictive value 88.1% (95% CI: 74.4–96.0%), negative predictive value 93.4% (95% CI: 89.4–96.3%), accuracy 92.6%, and receiver operating characteristic = 0.84. The specificity (47.1%), negative predictive value (61.5%), and accuracy (76.3%) were significantly lower in the surgical group. The efficacy of US between the sexes and age groups showed no significant difference, except the lower positive predictive values in the younger age group. Conclusion US efficacy for the diagnosis of appendicitis in children is high enough to use as an imaging modality of first choice to reduce complications, hospital stay, and negative appendectomy rate.

Prostate sparing robot-assisted laparoscopic treatment of leiomyoma of the prostate

Leiomyoma of the prostate is a rare mesenchymal tumor arising from smooth muscle cells and though benign, an increase in the familiarity of this pathology may lead to less invasive treatment in the future. We report imaging characteristics, operative technique, and surgical pathologic findings of the first case of a leiomyoma of the prostate treated by robot-assisted transperitoneal laparoscopic approach.

Extraction bag lavage cytology during video-assisted thoracoscopic surgery for primary lung cancer

Sample extraction from the thoracic cavity through an intercostal space during video-assisted thoracoscopic surgery can result in cancer cell contamination by tumour crushing and tumour cell extravasation, and may have adverse effects on the surgical outcome. Lavage cytology of the sample extraction bag was investigated to clarify the risk of cancer cell spillage and identify the clinicopathological features associated with susceptibility to cancer cell spillage during extraction. Lavage cytology of the sample extraction bag was investigated in 464 patients with negative pleural lavage cytology who underwent lung resection for primary lung cancer via video-assisted thoracoscopic surgery between January 2010 and December 2012. The surgical procedures, pathological findings and clinical course were evaluated by hospital record review. The incidence of positive bag lavage cytology (BLC) was 13.6%. Statistically significant factors associated with susceptibility to BLC positivity were tumour size, standardized uptake value of positron emission tomography, pathological features such as pathological N score, pleural invasion, vascular invasion and papillary-predominant adenocarcinoma. Among patients with Stage I lung cancer, the survival rate was significantly lower in the BLC-positive group than in the BLC-negative group. BLC positivity can be related to oncological characteristics such as tumour invasiveness and adhesiveness as opposed to tumour size and surgical margin, and may help to determine the prognosis of Stage I lung cancer. The sample extraction bag must be carefully manoeuvred through the intercostal space to prevent cancer cell dissemination to the chest wall or thoracic cavity.

The Utility of Lower Endoscopic Ultrasound-guided Fine Needle Aspiration for the Diagnosis of Benign and Malignant Pelvic Diseases

The utility of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for the diagnosis of pelvic masses has been suggested but limited data are available in the literature regarding its diagnostic accuracy. To report our institutional experience with EUS-FNA for the diagnosis of a variety of pelvic diseases. Patients who were referred for the evaluation of pelvic lesions using lower EUS-FNA were included in this retrospective analysis if they had available surgical pathology (obtained after EUS) which was considered the gold standard against which the EUS-FNA findings would have been compared. The diagnostic accuracy of EUS-FNA for pelvic masses was analyzed and any early or late complications after the procedure were reported. A pelvic mass was defined in the study as any mass seen with an imaging modality in the pelvic area including those involving the colonic wall. Twenty patients had EUS-FNA followed by surgery for whom FNA cytology and surgical pathology findings were available. EUS-FNA reached the correct diagnosis in 19 out of 20 patients, whereas for the missing 1 malignant lymph node wherein FNA revealed benign cytology, surgical specimen confirmed metastatic colon cancer. The sensitivity and specificity of EUS-FNA were 90% and 100%, respectively, with positive and negative predictive values of 100% and 90%, respectively. No early or late complications were encountered with this procedure for the sampling of cystic and noncystic masses. EUS-FNA has excellent diagnostic accuracy for pelvic masses. It represents a safe procedure with excellent yield and thus may be used as a first line modality for the evaluation and diagnosis of pelvic masses within its reach.

Primary Urethral Clear-Cell Adenocarcinoma: Comprehensive Analysis by Surgical Pathology, Cytopathology, and Next-Generation Sequencing

Primary clear-cell adenocarcinoma of the urethra, a rare tumor that histomorphologically resembles clear-cell carcinoma of the female genital tract, occurs predominantly in women and is associated with a relatively poor prognosis. The histogenesis of this rare urethral neoplasm has not been completely resolved, but it is thought to arise from either müllerian rests or metaplastic urothelium. Herein, we present comprehensive surgical pathological and cytopathological findings from a patient with primary urethral clear-cell adenocarcinoma and describe next-generation sequencing results for this patient's unique tumor-the first such reported characterization of molecular aberrations in urethral clear-cell adenocarcinoma at the transcriptomic and genomic levels. Transcriptome analysis revealed novel gene fusion candidates, including ANKRD28-FNDC3B. Whole-exome analysis demonstrated focal copy number loss at the SMAD4 and ARID2 loci and 38 somatic mutations, including a truncating mutation in ATM and a novel nonsynonymous mutation in ALK.

Bi-Focal Retroperitoneal Paraganglioma in a Young Patient: A Case Report and Review of the Literature

Extra-adrenal paraganglioma of the retroperitoneum are rare neuroendocrine tumors arising from specialized neural crest cells, intimately associated with sympathetic nervous tissue and distributed along the aorta. Here we present a case of multiple extra-adrenal retroperitoneal paraganglioma in a 16-year-old boy. The clinical presentation, imaging characteristics, and surgical pathologic findings were reported. A comprehensive review of the medical literature concerning multiple extra-adrenal paraganglioma in the pediatric and adult population is also discussed.

Incidental detection of microfilariae on fine needle aspiration cytology smear

<h3>Introduction</h3> Lymphatic filariasis is a disabling parasitic disease that is a global health problem endemic in Nigeria. Peripheral blood smears are frequently negative for microfilaria. In such individuals conventional diagnostic methods may fail to identify the disease. The demonstration of microfilaria in fine needle aspiration cytology smears is not a very common finding. <h3>Patient and method</h3> We report the incidental finding of micro-filaria in a fine needle aspirate from a patient presenting with a groin swelling suspected to be a lymphoma. The clinical notes of the patient were reviewed and all relevant information extracted. The surgical pathology findings on gross and microscopic examination were also reviewed. <h3>Results</h3> A 49-year-old male farmer, domiciled in one of the south-western states of Nigeria, presented with a one year history of a right groin swelling which suddenly became painful about 2 weeks before coming to the hospital. A clinical assessment of lymphogranuloma venereum was made to rule out a non-Hodgkin lymphoma. Initial laboratory investigations only showed mild eosinophilia and haematuria. However, a fine needle aspiration cytology performed on the swelling showed microfilaria of <i>W. bancrofti</i> for which appropriate treatment was commenced with excellent outcome. <h3>Conclusion</h3> Although the vast majority of microfilariae are incidentally detected in cytological smears, aspiration cytology still plays a significant role in the diagnosis of filariasis, especially in resource poor countries.

Recurrence risk after Ivor Lewis oesophagectomy for cancer

ObjectiveThe aim of this study was to analyze the profile of tumor recurrence for patients operated on for cancer of oesophagogastric junction or oesophagus by Ivor-Lewis oesophagectomy.MethodsPatients undergoing potentially curative Ivor-Lewis oesophageal resection between January 1999 to December 2008 at a single center institution were retrospectively analyzed. Their clinical records, details of surgical procedure, postoperative course, pathological findings, recurrence and long term survival were reviewed retrospectively. Univariate and multivariate survival analyses were performed.ResultsOne hundred and twenty patients were analyzed. Fifty three patients (44%) presented recurrence during median follow-up of 58 months. Five-year relapse free survival (RFS) rate was 51% (95%CI = [46; 65%]). On multivariate analysis, pT stage > 2 (HR = 2.42, 95%CI = [1.22; 4.79] p = 0.011), positive lymph node status (HR = 3.69; 95% CI = [1.53; 8.96] p = 0.004) and lymph node ratio > 0.2 (HR = 2.57; 95%CI = [1.38; 4.76] p = 0.003) were associated with a poorer RFS and their combination was correlated to relapse risk. Moreover, preoperative tumor stenosis was associated with an increased risk of local recurrence (HR = 3.46; 95% CI = [1.38; 8.70] p = 0.008) whereas poor or undifferentiated tumor was associated with an increased risk of distant recurrence (HR = 3.32; 95% CI = [1.03; 10.04] p = 0.044).ConclusionpT stage > 2, positive lymph node status and lymph node ratio > 0.2 are independent prognostic factors of recurrence after Ivor-Lewis surgery for cancer. Their combination is correlated with an increasing risk of recurrence that may argue favorably, in addition with preoperative tumor stenosis assessment, for adjuvant treatment or reinforced follow-up.

Acute aortic dissection type A with acute coronary involvement: A novel classification

Acute coronary involvement (ACI) due to acute aortic dissection (AAD) type A is potentially fatal. We examined selected patients with AAD type A, which had evolved over 14 years, and acute coronary involvement. The purpose of this study was to determine the characteristics of patients with ACI due to AAD type A. Between 1997 and 2011, we recruited 20 patients (14.1%) with ACI (14 men, 6 women; mean age: 51.8 ± 11.8 years; age range: 35-79 years) from 142 patients who had undergone surgical repair of AAD type A. We propose a novel 4-category classification scheme based on the surgical pathological findings. The right coronary artery was involved in 15 patients, and the left was involved in 5 patients. Fourteen patients had preoperative myocardial ischemia. In the other 6 patients, acute coronary involvement was found intraoperatively. Patients with ACI were significantly younger than those without ACI (51.8 ± 11.8 vs. 61.0 ± 11.8; p = 0.001), a lower prevalence of intramural hematoma (5.0% vs. 32.8%; p = 0.011), a higher aortic regurgitation rate (95.0% vs. 53.5%; p = 0.001). Patients presenting with ACI had an in-hospital mortality rate of 20.0% (4/20), while those without ACI had an in-hospital mortality rate of 19.7% (24/122). Acute coronary involvement due to AAD type A is not always associated with coronary malperfusion. Patients with ACI were much younger, had a higher aortic regurgitation rate, and, less commonly, had intramural hematoma. This new classification scheme would make it more convenient for surgeons to decide on treatment options for this special cohort.

Long-term follow-up is crucial after treatment for granulosa cell tumours of the ovary

Objective:The aim of this study is to evaluate the long-term outcome of granulosa cell tumour (GCT) of the ovary in a large series of patients treated in MITO centres (Multicentre Italian Trials in Ovarian Cancer) and to define prognostic parameters for relapse and survival.Methods:A retrospective multi-institutional review of patients with GCTs of the ovary treated or referred to MITO centres was conducted. Surgical outcome, intraoperative and pathological findings and follow-up data were analysed. Kaplan–Meier and Cox proportional hazards analyses were used to determine the predictors for survival and recurrence.Results:A total of 97 patients with primary GCT of the ovary were identified. The median follow-up period was 88 months (range 6–498). Of these, 33 patients had at least one episode of disease recurrence, with a median time to recurrence of 53 months (range 9–332). Also, 47% of recurrences occurred after 5 years from initial diagnosis. At multivariate analysis, age and stage were independent poor prognostic indicators for survival; surgical treatment outside MITO centres and incomplete surgical staging retained significant predictive value for recurrence in both univariate and multivariate analyses.Conclusions:This study confirms the generally favourable prognosis of GCTs of the ovary, with 5-year overall survival approaching 97%. Nevertheless, prognosis after 20 years was significantly poorer, with 20-year survival rate of 66.8% and a global mortality of 30–35. These findings support the need for lifelong follow-up even in early-stage GCT.

Common Pediatric Cerebellar Tumors: Correlation between Cell Densities and Apparent Diffusion Coefficient Metrics

To test whether there is correlation between cell densities and apparent diffusion coefficient (ADC) metrics of common pediatric cerebellar tumors. This study was reviewed for issues of patient safety and confidentiality and was approved by the Institutional Review Board of the University of Texas Southwestern Medical Center and was compliant with HIPAA. The need for informed consent was waived. Ninety-five patients who had preoperative magnetic resonance imaging and surgical pathologic findings available between January 2003 and June 2011 were included. There were 37 pilocytic astrocytomas, 34 medulloblastomas (23 classic, eight desmoplastic-nodular, two large cell, one anaplastic), 17 ependymomas (13 World Health Organization [WHO] grade II, four WHO grade III), and seven atypical teratoid rhabdoid tumors. ADCs of solid tumor components and normal cerebellum were measured. Tumor-to-normal brain ADC ratios (hereafter, ADC ratio) were calculated. The medulloblastomas and ependymomas were subcategorized according to the latest WHO classification, and tumor cellularity was calculated. Correlation was sought between cell densities and mean tumor ADCs, minimum tumor ADCs, and ADC ratio. When all tumors were considered together, negative correlation was found between cellularity and mean tumor ADCs (ρ = -0.737, P < .05) and minimum tumor ADCs (ρ = -0.736, P < .05) of common pediatric cerebellar tumors. There was no correlation between cellularity and ADC ratio. Negative correlation was found between cellularity and minimum tumor ADC in atypical teratoid rhabdoid tumors (ρ = -0.786, P < .05). In atypical teratoid rhabdoid tumors, no correlation was found between cellularity and mean tumor ADC and ADC ratio. There was no correlation between the ADC metrics and cellularity of the pilocytic astrocytomas, medulloblastomas, and ependymomas. Negative correlation was found between cellularity and ADC metrics of common pediatric cerebellar tumors. Although ADC metrics are useful in the preoperative diagnosis of common pediatric cerebellar tumors and this utility is generally attributed to differences in cellularity of tumors, tumor cellularity may not be the sole determinant of the differences in diffusivity.

Adnexal Masses: Development and Preliminary Validation of an MR Imaging Scoring System

To construct and undertake preliminary validation of a magnetic resonance (MR) imaging scoring system designed for use in pelvic MR imaging performed for characterization of adnexal masses that were indeterminate at ultrasonography (US). The institutional ethics committee approved this retrospective study and granted a waiver of informed consent. The study population comprised 394 women who underwent MR imaging between January 1, 2008, and October 30, 2010, for characterization of 497 adnexal masses that were seen at US. Then, masses were chronologically divided into a training set (329 masses) and a validating set (168 masses). Two radiologists who were blinded to the clinical findings retrospectively evaluated MR imaging criteria for characterization of adnexal masses. In the training set, the positive likelihood ratio (PLR) of malignancy and κ values were calculated for each criterion. The reference standard was surgical pathologic findings or findings at imaging follow-up of at least 1 year. On the basis of the PLR and multivariate analysis, a five-category MR scoring system called the ADNEX MR SCORING system was created and was subsequently tested by six readers with the validating set. There was almost perfect agreement (κ > 0.80) for each MR imaging feature except for grouped septa (κ = 0.558) and thickened regular septa (κ = 0.555). The classification was accurate in both the training set (area under the receiver operating characteristic [ROC] curve [AUC] = 0.981 for reader 1 and 0.961 for reader 2) and the validating set (AUC = 0.964 for reader 1 and 0.943 for reader 2). ROC curve analysis demonstrated that the optimal cutoff point was an ADNEX MR score of 3; an ADNEX MR score of 4 or higher was associated with malignancy with a sensitivity of 93.5% (58 of 62) and a specificity of 96.6% (258 of 267). In this study, a reproducible and accurate MR imaging scoring system that has the potential to improve patient care was developed and tested. Multicenter prospective validation of the score is warranted. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121161/-/DC1.