Total Resection Of Mass Research Articles

The efficacy and safety analysis of endoscopic resection for infratemporal fossa benign mass

Objective: To investigate the efficacy and safety of endoscopic resection of infratemporal fossa mass and to determine the indications for surgery. Methods: A retrospective case series study was conducted, including a total of 29 patients who underwent endoscopic surgery to treat infratemporal fossa mass in the Department of Rhinology of Beijing Tongren Hospital, Capital Medical University, from April 2008 to December 2021. Ten males and 19 females were included in the study, with age of (46.5±13.7) years. Pre-and post-operative sinus CT, sinus or nasopharyngeal enhanced MRI were evaluated, respectively. The main outcome measurements were the total resection of mass and the incidence of surgery-related complications. Results: Among the 29 cases of infratemporal fossa mass, 22 were schwannomas, 3 were cysts, 2 were neurofibromas, 1 was pleomorphic adenoma and 1 was basal cell adenoma. Preoperative imaging showed well-defined lesion boundaries, and postoperative pathology confirmed the benign nature of all cases. The endoscopic transnasal approach was used in 28 patients, while the combination of the transnasal approach and the transoral approach was used in 1 patient. Complete tumor removal was achieved in all cases with a 100% resection rate. The average follow-up time was 38 months (7-168 months), and no tumor recurrence was observed. Conclusions: The Endoscopic transnasal approach is a safe and effective surgical approach for the treatment of benign tumors or masses in the infratemporal fossa.

Clinical and histopathological findings of a rare sinonasal glomangiopericytoma

Glomangiopericytoma is a rare vascular neoplasm of the nasal cavity and paranasal sinuses that occurs during the sixth or seventh decade of life. It is categorized as a borderline tumor with low malignant potential and classified as a distinct entity of sinonasal tumors with perivascular myoid phenotype by the World Health Organization (WHO). We report the case of a 50-year-old woman with nasal obstruction and severe epistaxis. The nasal sinuses computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a 3.1 cm soft tissue mass occupying the upper part of the left nasal cavity invading the left paranasal sinuses and nasal septum, and the left eye medial rectus muscle. A total mass resection was performed by nasal endoscopy. The histological and immunohistochemical examination yielded the diagnosis of glomangiopericytoma. This case report aims to contribute to the knowledge of nasal neoplasms. The need for more data on this entity is the main obstacle to developing standardized treatment guidelines.

Vertebral destruction in an 11-month-old child with spinal tuberculosis: a case report and review of literature

BackgroundThe incidence of tuberculosis is increasing especially in endemic countries. Spinal tuberculosis represents nearly the 50% of reported cases of skeletal tuberculosis. This is the youngest case of spinal tubercular disease that has been reported. The objective of this report is to describe a spinal tuberculosis case in an infant in thoracic spine, in order to show the importance of early diagnosis in this population, to limit the progression of this highly destructive disease and reduce the severe sequelae that this disease is associated.Case presentationAn 11-month-old infant previously healthy born in the northeast Mexico. Physical examination revealed a mass lesion in the dorsal region, fixed to deep planes, indurated. Neurological examination found Frankel C paraparesis showing muscle strength 2/5 on the Lovett scale in both lower extremities, anal reflex present, and preserved sensitivity.In the magnetic resonance of the spine, hyperintensities in the vertebral bodies of D6-D9 were observed in the T2 with destruction of the D7 and D8 bodies. A thoracotomy was performed with total mass resection with corpectomy of vertebrae D7 and D8, medullary decompression, and placement of fibula allograft between vertebrae D6 and D9. In the histopathological sample, a chronic granulomatous inflammatory process associated with acid-fast bacilli was observed, in addition to presenting a positive result in quantitative real-time PCR GeneXpert MTB/RIF sensitive to rifampicin. Twelve months later, he presented 5/5 muscular strength, without alterations in sensitivity, in addition to presenting ambulation onset at 18 months of age.ConclusionThe spinal tuberculosis is a disease that occurs in endemic countries. A prompt diagnosis is necessary to limit the progression of a highly destructive disease. In addition, the fact of presenting at an early age produces hard making decisions for the adequate treatment of the disease and reduces the adverse effects of these procedures.

Pseudotumoral Calcinosis: A Soft Tissue Tumor in a 14-Year-Old Male

Pseudotumoral calcinosis is a rare benign tumor, characterized by deep calcium deposition in peri-articular soft tissues. A numerous list of calcium deposit diseases exists making the calcinosis diagnosis very challenging. There are three principal forms or etiologies; primary or idiopathic forms followed by secondary forms due to chronic renal failure or hyperparathyroidism, then genetic forms such as Hyperphosphatemic Familial Tumoral Calcinosis (HFTC). We report a case of 14-year-old boy with primary tumoral calcinosis of the right hip. Total mass resection was performed without any recurrence at one-year follow-up.

L’astroblastome : une tumeur gliale rare

Astroblastoma is a rare neuroepithelial tumor most commonly seen in children and young adults. Due to its rarity, this tumor can be easily misdiagnosed as its classification, histogenesis and therapeutic management are still being discussed. We report the case of a 21 year old man, who presented at the Emergency Room for loss of consciousness. He reported a history of headaches, vomiting and decreased visual acuity. The CT and MRI showed a left temporoparietal solid-cystic mass with heterogeneous enhancement and perilesional edema. The patient underwent a total mass resection. On histopathological examination, tumor cells were organized in perivascular pseudorosettes which are typically encountered in astroblastoma, without neither necrosis nor endothelial hyperplasia. They had broad processes and rounded nuclei without any mitotic activity. Immunochemistry stains confirmed the diagnosis by showing a positive reactivity for GFAP, EMA, vimentin and S100. Astroblastoma is a rare glial tumor of uncertain origin. Clinical presentation and imaging are nonspecific. Therefore, its diagnosis is based on histopathologic findings: typical perivascular pseudorosettes. However, similar histological pattern may be seen in other glial neoplasms. In the 2016 WHO Classification, astroblastoma is among the "other glial neoplasms" without a grading system. So far, there are no reliable prognosis factors for this tumor; however, two entities have been described: well differenciated astroblastoma (considered as low grade) and anaplastic/malignant astroblastomas (considered as high grade). Gross total resection is the treatment of choice for astroblastomas. Adjuvant therapy is still controversial. This case illustrates a cerebral tumor which is rarely encountered in practice and that can cause diagnostic problems and subsequently, inadequate treatment.

Surgical Treatment of Childhood Inflammatory Myofibroblastic Tumors.

Aim A retrospective study was performed to evaluate the clinical features, diagnostic methods, and treatment alternatives of childhood inflammatory myofibroblastic tumors (IMTs). Patients and Methods Patients who underwent surgical treatment for IMT between 2000 and 2015 were evaluated for age, sex, presenting symptoms, physical examination findings, diagnostic methods, treatment modalities, histopathologic findings, and results of surgical treatment during long-term follow-up. Results Eleven patients who underwent surgical treatment were included in the study. Male:female ratio was 7:4 and the mean age of the patients was 6.09 years (1-10 years). Presenting symptoms were respiratory difficulty, cough (n = 7, 63.3%), abdominal pain, vomiting (n = 2, 18.8%), loss of body weight (n = 1, 9.09%), palpable mass (n = 1, 9.09%), and rectal bleeding (n = 1, 9.09%). Ultrasonography (n = 4, 36.3%) and computed tomography (n = 9, 81.1%) were used for diagnosis. Localizations of tumors were lungs (n = 5, 45.4%), mediastinum (n = 2, 18.1%), spleen (n = 1, 9.09%), neck (n = 1, 9.09%), colon (n = 1, 9.09%), and rectum (n = 1, 9.09%). The mean size of mass was 6.6 cm (2-12 cm) and six patients were diagnosed with preoperative biopsy. Lung lobectomy (right lower lobe; n = 3, right middle and lower lobe; n = 2), total resection of mass with adjacent bowel (n = 2), partial splenectomy (n = 1), total resection of neck mass (n = 1), and incomplete resection (n = 2) were the choice of surgical treatment. Incomplete resection was performed in masses closely adjacent to atrium and mediastinal structures. In histopathologic evaluation, surgical margins were free of tumor in four cases, positive in six cases, and were not reported in one case. Anaplastic lymphoma kinase (ALK) positivity was detected in six cases, negative in two cases, and was not evaluated in three cases. Two cases who had residual mass with positive ALK received chemotherapy. Mean follow-up time was 68.2 months (5 months to 12 years). During follow-up, there was no recurrence or distant metastasis. Ten patients survived and one patient was lost to follow-up. Conclusion IMT is a rare tumor of childhood with a spectrum of clinical findings because of variable localization. Surgical treatment is the first choice of treatment. Patients with residual mass and ALK positivity may require medical treatment. In our series, long-term survival of patients was favorable in patients with total resection.

THE APPLICATION OF NANOMATERIALS IN DIAGNOSIS AND TREATMENT FOR MALIGNANT PRIMARY BRAIN TUMORS

Malignant primary brain tumors have a very high morbidity and mortality. Even though enormous advances have been made in primary brain tumor management, in the case of malignant primary brain tumors, current diagnostic strategies cannot identify exact infiltrating margins, surgery alone cannot achieve total mass resection, and adjuvant therapies cannot improve survivals. Therefore, there is an urgent need to explore novel strategies to diagnose and treat such infiltrating brain tumors. Nanomaterials, particularly zero-dimensional and one-dimensional platforms, can carry various compounds such as contrast agents, anticancer drugs and genes into brain tumor cells specifically. Thus, contrast agent-based nanomaterials can selectively present infiltrating tumor outlines, while anticancer agent-based nanomaterials can specifically kill malignant tumor cells. In addition, dual-targeting nanomaterials, multifunctional nanocarriers, theranostic nanovehicles as well as convection-enhanced delivery technology hold promise to increase drug accumulation in tumor tissues, which could largely improve anticancer efficacy. In this review, we will mainly focus on the application of nanomaterials in preoperative diagnosis, intraoperative diagnosis and adjuvant treatment for malignant primary brain tumors.

Primary Leydig cell tumour of epididymis: a rare case report with review of literature

Leydig cell tumour (LCT) is an uncommon tumour that typically occurs in the testis. Primary epididymal LCT is extremely rare. To the best of our knowledge, only two cases have been reported in the world literature. Herein, we report a case of primary epididymal LCT in a 41-year-old Chinese male. The patient presented with right epididymal swelling for 3months without endocrine manifestations, including gynaecomastia and decreased libido. Scrotal ultrasound demonstrated a mass about 1.5cm in diameter entirely in the cephalic region of right epididymis. No abnormality was found in his bilateral testes. The patient underwent total mass resection without post-operative therapy. Histological examination revealed that the well-circumscribed tumour was separated by conspicuous hyalinised fibrous stroma; the tumour cells were large and polygonal with round nuclei and abundant eosinophilic cytoplasm. Immunophenotypically, the tumour cells expressed four markers of sex cord differentiation (calretinin, melanA, CD99 and inhibin). There was no recurrence at 2-year follow-up. Our observation once again confirms that LCT could primarily occur in the epididymis, and we suppose that it probably originates from the ectopic Leydig cells. As little is known about the pathogenesis and prognosis for such a rare disease, accumulation of more pathological and clinical data can help to better interpret this tumour.

The relation between surgical cleavage and preoperative neuroradiological findings in intracranial meningiomas

Background Meningiomas are generally benign masses, and in many cases they do not invade the brain. Therefore their potential to provide cures is high. The most important cause of the development of recurrence in the post-operative period is subtotal resection. Any information that will allow us to perform total mass resection will be beneficial in terms of long-term good clinical procedure. Our aim in this study is to obtain the radiological data from which we can obtain accurate information in terms of the surgical cleavage between the tumor and parenchyma during the surgical planning of the meningiomas. Methods We evaluated 85 cases with intracranial meningioma that were treated by the same microsurgical technique. All posterior fossa and skull base meningiomas were not included in the study. Results Tumor size was smaller than 3 cm in 19 cases, between 3 and 6 cm in 46 cases, and bigger than 6 cm in 20 cases. The cleavage line between the tumor capsule and the cortex underneath was extrapial in 32 cases, subpial in 29 cases, and mixed in 24 cases. Dominant arterial supply was dural in 46 cases. Thirty-three cases were predominantly mixed and 6 cases were predominantly corticopial. At magnetic resonance images, 16 of 28 cases which showed clear tumor-cortex interface, had an extrapial cleavage line. Conclusions When surgical treatment of intracranial meningiomas are considered, it is necessary to examine if there is a surgically safe border between the cortex underneath in the preoperative images. It can be concluded that it is appropriate to operate small meningiomas which are on the sensitive regions of the brain when they are in their earlier stages and still have an extrapial cleavage.

Neonatal hepatoblastoma in a newborn with severe phenotype of Beckwith–Wiedemann syndrome

Beckwith-Wiedemann syndrome is an overgrowth disorder characterized by neonatal macrosomia, abdominal wall defects, macroglossia, renal anomalies, organomegaly, hypoglycemia, and cancer predisposition. Hepatoblastoma is the second most frequent tumor and periodic serum alpha-fetoprotein (αFP) dosage is the cornerstone of the tumor surveillance for its early detection. In this report, we describe the outstanding case of a Beckwith-Wiedemann syndrome (BWS) newborn with severe phenotype and paternal chromosome 11 uniparental disomy (UPD11) associated with a high tumor risk. Based on the clinical picture and previous reports, a close monitoring of αFP was commenced. The marker was normal immediately after birth, but rapidly raised in 20 days, leading to the diagnosis of an extremely aggressive hepatoblastoma. The latter was successfully treated with pre-surgical reductive chemotherapy, gross total mass resection, and subsequent chemotherapy. Based on this observation, the tumor surveillance routinely suggested every 3 months should be more intense and with closer time intervals in newborns with severe BWS phenotype. We suggest monitoring neonatal αFP every 20 days in such cases.

Prognostic analysis of gastrointestinal stromal tumor by mitotic activity, size of tumor and mutational type of C-Kit protein

9046 Background: GIST is the most common mesenchymal tumor of the gastrointestinal tract. Methods: 53 GIST patients, underwent grossly total mass resection in Inha University Hospital, Incheon, Korea from March 1997 to March 2004, were included in this study. The median follow-up period was 34 months. The evaluation of C-kit mutation on exon 11 was performed. Three-year recurrence free survival rate and 3-year overall survival rate have been analyzed. Results: The median value of mass size was 6 Cm(range, 0.8Cm - 20Cm). The most common primary site was stomach with 30 cases(56%), followed by small bowel with 11 cases, large bowel with 6 cases and peritoneal dissemination with 6 cases. Twenty-one patients had disease recurred during follow-up period which marked recurrence rate with 39%. The rates of 3-year recurrence free survival and 3-year overall survival were 50% and 76%, respectively. Three-year recurrence free survival rate of patients with less then 10 mitotic activity under 50 HPF was 79%, whereas the rate of patients with more than 10 mitotic activity under 50 HPF was 30%(p=0.026). Three-year overall survival rates of patients with less than 10 mitotic activity and that of patients with more than 10 mitotic activity were 90% and 64%, respectively(p=0.0368). Three-year recurrence free survival rate of patients with tumor size less than 5 Cm was 77% and the rate of patients with tumor size greater than 5 Cm was 33%(p=0.0006). The 3-year overall survival rates of patients with tumor size less than 5Cm and that of patients of tumor size greater than 5Cm were 86% and 66%, respectively(p=0.023). The study on mutational type of C-kit protein showed missence exon 11 mutation with 4 cases(7%) and deletion/insertion exon 11 mutation with 24 cases(45%). Three-year recurrence free survival rate of deletion/insertion exon 11 found to be 35% as the rate of rest patients was 64% and the difference between these two groups showed statistical significance.(p=0.0383). Conclusions: This study showed that mass size and mitotic activity were important prognostic factors in GIST. Delete/Insert gene mutation on exon 11 was found to be poor prognostic factor. No significant financial relationships to disclose.

Adenocarcinoma de apêndice: relato de dois casos

The authors report two cases of patients with appendix adenocarcinoma, manifested as a syndrome of abdominal tumor of unknown origin. It was not possible to perform etiological diagnosis in the preoperative period for any of them. Literature data show that large locoregional tumor is a manifestation of appendix adenocarcinoma, although acute appendicites is the most frequent clinical manifestation. Preoperative diagnosis is rare and usually performed during laparotomy or through histopathological examination of the specimen. In large tumors, total mass resection including hemicolectomy should be carried out whenever possible. Whenever diagnosis of appendix adenocarcinoma is performed by the histopathological examination of the acute appendicites specimen, re-intervention is indicated for a right hemicolectomy.