Surgical Treatment Of Benign Tumors Research Articles

Salivary Gland Tumors: A 20 Year Review From a Single Community Practice.

Objective: Salivary gland tumors are a heterogenous group of lesions with variable pathology and clinical outcomes. Most published data are derived from studies conducted at tertiary care centers. Our study analyzed the experience from a community setting to determine significant differences, if any, in pathological distribution and clinical outcomes compared to the existing literature. Methods: We performed a retrospective analysis of all major salivary gland tumors that presented to a large community practice over a 20 year period. Retrospective chart analysis was performed for demographics, clinical presentation, imaging, cytology, histopathology, and clinical outcome data. Results: Of 806 patients, the parotid gland was the most common site in 683 patients (84.7%), followed by submandibular in 78 (9.7%) and sublingual in 45 (5.6%). A total of 203 patients were managed conservatively with observation without definitive diagnosis or lost to follow-up. A total of 495 patients underwent surgical intervention within the community practice. Twenty-six patients underwent surgical excision at an outside hospital. Eighty-two patients were determined to have a benign diagnosis based on ultrasound-guided fine needle aspiration or excisional biopsy alone. Final histopathology was benign in 505 cases (83.7%), while 98 tumors (16.3%) received a diagnosis of primary or secondary malignancy. For the parotid gland, pleomorphic adenoma (155) and Warthin's tumor (155) were the most common benign diagnoses, while mucoepidermoid carcinoma (13), adenocarcinoma (8), and acinic cell carcinoma (8) were the most common primary malignancies. Conclusions: We found a higher rate of benign tumor pathology compared to the existing literature. While the outcome data on surgical treatment of benign tumors are comparable to the existing literature, the same conclusion cannot be drawn for malignant tumors, given relatively small numbers in our series and likely disparity in the complexity of the surgical cases in tertiary care centers.

Osteochondroma of Dorsal Scapula: A Case Report and Review of Literature.

Osteochondroma of the scapula constitutes only 3-5% of all osteochondromas; osteochondroma on dorsal aspect of scapula is a rare entity. Diagnosis is almost always clinicoradiologically. Additional computed tomography scan and magnetic resonance imaging may be required for osteochondroma of flat bones such as scapula. Indications for surgery include pain, deformity, dysfunction, neural or vascular compromise, failure of conservative management, or in clinical settings with the high suspicion of malignant transformation and occasionally cosmesis. Outcome of a surgery should be assessed by Patient-Reported Outcome Measures (PROMs) which appraises what "matters to the patient." A 10-year-old boy presented to us with painless swelling over the right upper back since 3 years of age and discomfort over the area while sleeping on his back for 6 months. Diagnosis confirmed it to be a pedunculated osteochondroma arising from the dorsal scapula. Here, we report the diagnosis, treatment, and successful Patient-Reported Outcome using QuickDASH© score for an osteochondroma of dorsal scapula using CARE© case reporting guidelines. We report a rare site of osteochondroma, review the relevant literature, and also stress upon the necessity of analyzing PROMs after surgical treatment of benign tumors of bone which would enable us to evaluate the result of surgery on symptoms, functioning, and health-related quality of life from the patient's perspective.

Complex physiotherapy for the rehabilitation of patients with postoperative facial muscles paresis

Was the increasing the effectiveness of treatment and prevention of postoperative complications in the patients with benign tumors of the parotid salivary gland through the combined use of medications, acupuncture, hirudotherapy and a complex of physiotherapy. The study comprised 94 patients with postoperative complications after surgical treatment of benign tumors of the parotid salivary gland. All patients suffering from paresis of facial muscles were prescribed a physiotherapy complex developed during the study consisting of two series of exercises with alternating execution of the series every other day. The exercises begin with the upper third of the face, gradually descending to the lower third. A series of exercises is performed every hour and a half, the session duration is twenty minutes, the course is 14 days. The exercises are performed by the patient in front of the mirror, gently and at a slow pace. The duration of the recovery period of motor function of the facial muscles on the affected side was 31.2±19.6 days, with the amplitude of the M-response 1.45±0.28 mV, the duration of the M-response 8.04±0.27 ms and the latent time during EMG 3.18±0.86 ms. Conclusion. The combined treatment, which included surgical and conservative treatment complex with methods of acupuncture, hirudotherapy and physiotherapy, was significantly more effective (p<0.05) in terms of the severity of paresis of facial muscles than in the control group.

Surgical treatment of benign tumors of parapharyngeal space

Background: Neoplasms of the oropharynx and parapharyngeal space are quite rare, characterized by nonspecific development of the disease, and the involvement of important anatomical structures in the pathological process. Problems of diagnosis and choice of tactics of surgical treatment are relevant today. Aim: To evaluate the effectiveness of transoral approach when removing benign tumors of the parapharyngeal space. Materials and methods: In State Institution “O.S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Sciences of Ukraine” in recent years, 92 patients underwent surgical treatment with benign tumors of the parapharyngeal space. Men – 39 (42.4%), women – 53 (57.6%). All patients underwent total removal of the tumor in the parapharyngeal space by transoral approach. Results: In patients evaluated the postoperative period, the type of postoperative wound healing, the presence of complications and the quality of life. The following postoperative complications were observed: in 13 (14.1%) patients lockjaw was observed, which regressed on average for 2-3 days, bleeding from the postoperative site in the early postoperative period – 4 (4.3%) and acute cerebrovascular accident in the early postoperative period in 1 patient (1.1%). Conclusions: Given the good blood supply to the parapharyngeal space, bleeding is one of the most common complications. Vascular complications are more common when neurogenic or vascular tumors are removed. Angiography is useful in evaluating post-styloid lesions in order to demonstrate their connection with large vessels and differentiate neurogenic and vascular lesions. The advantages of transoral removal of the tumors of the parapharyngeal space are the absence of cosmetic defects, the rapid healing of postoperative wounds and the rapid restoration of the patient’s working capacity.

The Transcervical Extended Access, a Feasible Approach for the Surgical Treatment of Benign Tumors of the Posterior Mediastinum?

Transcervical approach for tumors of the posterior mediastinum is traditionally thought not to be indicated. Hereby we report on a case of a patient with a huge neurogenic tumor of the posterior mediastinum which was successfully excised through a transcervical extended approach and, additionally, the variety of surgical approaches used to remove tumors of the posterior mediastinum is discussed. The new refined techniques of transcervical extended mediastinal operations, which are recently gaining popularity among surgeons, allowed for a safe dissection of the tumor, thus patient could benefit from a short painless postoperative course. The authors suggest that surgeons trained in these particular techniques should consider the choice of the transcervical extended access in selected cases of benign tumors of the posterior mediastinum.

Surgical treatment of benign tumors and tumor-like diseases of hand bones

Surgical treatment of benign tumors and tumor-like diseases of hand bones

The use of Tutoplast implants in the treatment of benign neoplasms and tumour-like lesions of bones in children

The purpose of the present research was to analyse the experience of using Tutoplast implants for determining their place in the surgical treatment of benign tumours and tumour-like lesions in children. For the analysis, 26 clinical cases were chosen. We found out that the osteoinductive and osteoconductive properties of this material had the most balanced proportion for its usage in childhood orthopaedic practice. The obtained data demonstrate good prospects for using Tutoplast implants in the treatment of the above category of diseases.

Endoscope‐assisted supraorbital keyhole approach for the resection of benign tumors of the sellar region

The objective of the study was to evaluate the effectiveness of the supraorbital “keyhole” approach with endoscope assistance in surgical treatment of benign tumors around the sellar region. Thirty‐five patients, including 19 pituitary tumors, 11 craniopharyngiomas and five tuberculum sellae meningiomas, were enrolled in this study. The tumors were resected through an endoscope‐assisted supraorbital keyhole approach via a small skin incision within the eyebrow. Complete removal of the sellar region tumors was achieved in all 35 cases by endoscope‐assisted supraorbital keyhole approach. Mean length of hospital stay after surgery was 10.2 days (range 5 – 17). There was no patient with evidence of residual or recurrent tumor during the follow‐up period. There was no infection, bleeding, further vision impairment, oculomotor nerve injury or other cranial nerve injury symptom owing to surgery. Though some patients suffered from insipidus, hyperprolactinemia, subcutaneous edema or other postoperative complications, they eventually recovered with or without drug administration. The supraorbital “keyhole” approach with endoscopic assistance in the surgical treatment of benign tumors around the sellar region is an ideal pattern.

Pancreatectomía central en tumores benignos del cuello del páncreas

The surgical treatment of benign tumors of the neck of the pancreas usually consists of enucleation or formal pancreatectomy. Central pancreatectomy has been put forward because it has fewer major complications and can preserve endocrine and exocrine function. Between January 1999 and march 2003, three patients with benign tumors of the neck of the pancreas underwent central pancreatectomy. all patients underwent computed tomography scans, intraoperative ultrasound and frozen-section analysis. pathologic examination showed two mucinous cystadenomas and one serous cystadenoma. after a mean follow-up of 34 months, none of the patients has shown major complications or local recurrence, or has developed diabetes. In conclusion, central pancreatectomy is a useful technique for selected benign or low-grade malignant pancreatic tumors of the neck of the pancreas.

Current management of benign parotid tumors--the role of limited superficial parotidectomy.

Parotid tumors are mostly benign, but their evaluation and treatment require a thorough knowledge of the relevant anatomy and pathology. Surgical treatment of benign tumors is aimed at complete removal of the mass with facial nerve preservation. The aim of this study was to evaluate the results of treatment of benign parotid neoplasms when surgery entailed limited superficial parotidectomy. All patients with benign parotid tumors treated by the author from 1988 to 2002 were reviewed. Data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, RPAH. Limited superficial parotidectomy was carried out in all previously untreated patients with tumors superficial to the plane of the facial nerve. Median follow-up time was 6 years (range, 1-14 years). A total of 363 parotidectomies was carried out on 355 patients, 29 of whom (8%) were previously treated. Tumors arose deep to the plane of the facial nerve in 40 patients (11%), and, of these, 16 occupied the parapharyngeal space. Pleomorphic adenoma (70%) and Warthin's tumors (15%) were the most common pathologic types. Temporary postoperative facial weakness occurred after 98 operations (27%). Facial weakness was permanent in 2.5% of patients (9 cases) who had normal preoperative function; however, in this group the facial nerve was intentionally resected in 2 patients, 3 others had had previous surgery, and 1 had a deep lobe tumor. Tumor recurrence developed in three patients (0.8%), two of whom had been previously treated. Complete superficial parotidectomy is unnecessary in the treatment of benign localized parotid tumors. Limited parotidectomy is associated with very low rates of morbidity and recurrence. Preoperative investigations should be used selectively; however, the author recommends routine (or at least liberal) use of fine-needle aspiration biopsy.

Medial pancreatectomy.

The surgical treatment of benign tumors of the midportion of the pancreas usually consists of enucleation or formal pancreatectomy. To avoid extended pancreatectomy, a limited resection of the neck of the pancreas has been proposed when enucleation is not feasible. Seven published series report a total number of 78 patients treated by this technique. No postoperative mortality was reported. The operative morbidity ranged from 0% to 40%, mainly due to pancreatic fistulas, which mostly healed spontaneously. In the long term no diabetes mellitus and/or exocrine insufficiency was observed. After resection of low-grade malignant tumors, there was no local recurrence. Medial pancreatectomy is a safe method for the treatment of benign or low-grade malignant tumors of the neck of the pancreas.

Role of Tissue Culture in Prediction of Malignancy

It is now clear that tissue culture has a role to play in the prediction of the degree of malignancy of human brain tumors. The fact that virtually all human brain tumors grow at least for some interval in culture allows application of tissue culture to the study of all tumors. This almost universal culturability of tumors is truly a singular virtue of intracranial neoplasms. No other human solid tumor group has been so amenable to in vitro growth or study. Up to the present time, despite our experience with over 1100 human brain tumor cultures, we have been extremely conservative in altering patient management on the basis of in vitro data. As is now apparent, the basis for direct input into the clinical milieu exists and it is necessary to work on a patient by patient basis to see how well the existing criteria can be applied to help guide management. Indeed the emphasis given to tissue culture by Rubinstein already confirms the current interest in the applicability of tissue culture data to neuropathological study of tumors (48). Clearly for certain tumors which tend to be benign, tissue culture can serve to alert the clinician to the perhaps unexpected malignant potential of the lesion. For the malignant tumors, the degree of malignancy, the probable biological behavior, the role of host defense factors and therapeutic agents can all be more quantitatively defined for the individual patient by the detailed study of the patient's cultured cells. With improvement in the surgical treatment of benign tumors and with better chemotherapeutic and radiotherapeutic measures for malignant neoplasms this more detailed and precise characterization of tumor behavior has become increasingly relevant to the optimization of the clinical management of the brain tumor patient.

Tumors of the submaxillary gland

Study of 128 cases of neoplasms of the submaxillary gland in which operation was performed at the Mayo Clinic from 1936 through 1955 with careful attention to classification of the lesions and comparison of findings in the literature on other salivary tumors yielded the following observations and conclusions. 1. 1. Benign mixed tumor is the most common tumor found in the submaxillary gland. Its predominance, however, is less than in the parotid gland. 2. 2. Cylindroma is the most common malignant tumor in the submaxillary gland and is relatively more common in the submaxillary gland than in the parotid gland. 3. 3. Benign tumors of the submaxillary gland are found in younger patients than are malignant tumors. 4. 4. Benign tumors tend to be smaller, more stationary in size, give less pain and show less tendency to local invasion than do malignant tumors. 5. 5. Both benign and malignant tumors, that later recur, begin at an earlier age than tumors that do not recur. 6. 6. Removal of the entire submaxillary gland with the tumor is the treatment of choice for all benign tumors and well encapsulated malignant tumors. More radical surgical procedures are preferable for locally invasive malignant tumors. 7. 7. Recurrence is rare after surgical treatment of benign tumors of the submaxillary gland. 8. 8. Following adequate surgical treatment, approximately half of the patients with malignant tumors of the submaxillary gland will live five years without evidence of recurrence. 9. 9. Recurrence may develop in patients with cylindroma more than five years postoperatively, but a ten year follow-up without recurrence should be synonomous with cure.