Tumor-like Diseases Research Articles

Benign Tumors and Tumor-Like Conditions of Ampulla and Small Intestine: The PathologyOutlines.com Review.

Small intestine and ampulla can be involved in a heterogeneous group of benign tumors and tumor-like diseases, potentially mimicking malignant neoplasms. In-depth knowledge of them is critical for practicing pathologists since they represent potential pitfalls in routine diagnostic activity. Such conditions include the following: (1) Brunner gland lesions, including Brunner gland hyperplasia and hamartoma; (2) polyps, such as adenoma, hyperplastic, hamartomatous, and inflammatory; (3) mesenchymal proliferations encompassing inflammatory fibroid polyp, inflammatory myofibroblastic tumor, leiomyomas, lipomas, and lipomatosis of the ileocecal valve; (4) fibrosis-associated diseases, such as idiopathic retroperitoneal fibrosis, reactive nodular fibrous pseudotumor, and sclerosing peritonitis; (5) disorders of lymphatic vessels, including lymphangiectasia and lymphangiomas; and (6) other rare conditions/miscellanea, such as enteritis cystica profunda, intussusception, ischemia, and pneumatosis cystoides intestinalis. This review, inspired by the content of the PathologyOutlines website (https://www.pathologyoutlines.com), aims to provide a reference point in this complex scenario, summarizing the essential histopathological features of all these entities for better addressing routine practice and differential diagnoses.

Evolution of the first metatarsophalangeal joint replacement

Introduction The diseases of the first metatarsophalangeal (1 MTP) joint that require surgical treatment include osteoarthritis (69 %), rheumatoid arthritis (26 %), tumors, tumor-like diseases and purulent arthritis (5 %). The treatment of arthritic 1 MTP is aimed at reducing pain and improving function. Joint replacement implants are meant to support body weight, maintain the length of the first metatarsal, provide metatarsal‑sesamoid joint functioning and restore joint motion. The purpose of the work was to analyze data from foreign and domestic literature on endoprosthetics of the 1 MTP, and briefly present analytical data on the results of using various implants.Material and methods The article presents the summary of the Russian and foreign publications on 1 MTP joint replacement. The original literature search was conducted on key resources including PubMed, eLIBRARY, MedLine, Scopus. The search strategy was comprised of keywords: “replacement of the first metatarsophalangeal joint”, “surgical treatment of hallux rigidus”, “osteoarthrosis of the first metatarsophalangeal joint”, “results of endoprosthetics of the 1st metatarsophalangeal joint”, "modernization of implants of the 1st metatarsophalangeal joint". Publications brought out between 1968 and 2022 inclusive were analyzed.Results and discussion The ideal implant should restore functional range of motion, improve function, maintain joint stability, distribute the stress across joint surfaces being wear-resistant. Over the years, various materials have been used to provide simple and reliable designs. Implants have been improved and divided into groups based on material and design, limited degrees of freedom, tribological pair composition, and the amount of articular surface replacement.Conclusion New generation implants have a more durable design, anatomical shape and improved osseointegration. The advances in joint replacement have resulted in greater patient satisfaction and increased service life. The complication rate for replacement of the 1 MTP joint remains high. This indicates the need for continued research and further work to improve implants to make them more effective and easier to use.

Difficulties in Diagnosing Volumetric Formations of the Spleen: an Example of a Clinical Case

Differential diagnosis of bulk splenic neoplasms, despite proper visualization in ultrasound, computed tomography and magnetic resonance imaging of the abdominal cavity, is challenging due to the lack of a unified classification, the extremely rare occurrence of some tumors and difficulty of preoperative morphological identification. The paper discusses a case of making an erroneous preoperative diagnosis in a spleen mass: the instrumental study findings determined the presence of multiple cysts. The latter among all the neoplasms of this organ are the most common and are represented by a variety of forms, subdivided by origin, histogenesis and content features. According to some classifications, cysts are classified as tumors or tumor-like diseases, other sources classify them as non-tumor formations of the spleen. It is not often possible to fully exclude the parasitic origin of the cyst before the morphological study of the removed organ. Surgeons of the Voronezh Regional Clinical Hospital No. 1 encountered this problem during the treatment of a 34-year-old patient with the spleen neoplasm. A diagnosis of lymphangioma was made based on surgical treatment and pathomorphological findings. The analysis of this clinical case demonstrates relevance of splenectomy both as a method of final diagnosis and as the final stage of treatment for benign tumors; it allows avoiding misdiagnosis in case of a malignant tumor.

Dural and Leptomeningeal Diseases: Anatomy, Causes, and Neuroimaging Findings.

Meningeal lesions can be caused by various conditions and pose diagnostic challenges. The authors review the anatomy of the meninges in the brain and spinal cord to provide a better understanding of the localization and extension of these diseases and summarize the clinical and imaging features of various conditions that cause dural and/or leptomeningeal enhancing lesions. These conditions include infectious meningitis (bacterial, tuberculous, viral, and fungal), autoimmune diseases (vasculitis, connective tissue diseases, autoimmune meningoencephalitis, Vogt-Koyanagi-Harada disease, neuro-Behçet syndrome, Susac syndrome, and sarcoidosis), primary and secondary tumors (meningioma, diffuse leptomeningeal glioneuronal tumor, melanocytic tumors, and lymphoma), tumorlike diseases (histiocytosis and immunoglobulin G4-related diseases), medication-induced diseases (immune-related adverse effects and posterior reversible encephalopathy syndrome), and other conditions (spontaneous intracranial hypotension, amyloidosis, and moyamoya disease). Although meningeal lesions may manifest with nonspecific imaging findings, correct diagnosis is important because the treatment strategy varies among these diseases. ©RSNA, 2023 Online supplemental material and the slide presentation from the RSNA Annual Meeting are available for this article. Quiz questions for this article are available through the Online Learning Center.

Multimodal algorithm for differential diagnosis of tumors and tumor-like diseases of the ocular fundus

Diagnosing pathologies of the ocular fundus and performing differential diagnosis of intraocular tumors along with conventional ophthalmoscopy can involve additional visualization methods such as ultrasonography, fluorescein angiography and optical coherence tomography (OCT). Many researchers note the importance of employing a multimodal approach in differential diagnosis of intraocular tumors, but there is no universally established algorithm for a rational choice of both the combination of visualizing methods, and the sequence of their application with consideration of the ophthalmoscopy findings and the results of first-line diagnostic methods. The article presents author's own multimodal algorithm developed for differential diagnosis of tumors and tumor-like diseases of the ocular fundus. This approach involves the use of such methods as OCT and Multicolor fluorescence imaging, with exact sequence and combination determined on the basis of ophthalmoscopy and ultrasonography findings.

Zero Echo Time vs. T1-Weighted MRI for Assessment of Cortical and Medullary Bone Morphology Abnormalities Using CT as the Reference Standard.

Conventional MR pulse sequences result in poor signal from low T2 cortical bone because the minimum achievable echo time is limited. A sequence resulting in improved bone contrast is desirable. To evaluate the image quality and diagnostic performance of grayscale inversion zero echo time imaging (GI-ZTE) and grayscale inversion T1-weighted imaging (GI-T1WI) compared with computed tomography (CT). Prospective. A total of 50 patients with musculoskeletal tumors or tumor-like diseases of the lower extremities having MRI and CT studies. GI-T1WI and GI-ZTE sequences at 1.5T. Assessed cortical and medullary bone morphology abnormalities using CT as the reference standard. Three radiologists scored the images quality and recorded nine metrics to assess the diagnostic performance. Differences in image quality were calculated using the Wilcoxon signed-rank test. The intraclass correlation coefficient (ICC) was used to analyze the agreement of quantitative lesion parameters between CT and MR sequences, as well as the interobserver reliability. A P value <0.05 was considered statistically significant. Image quality score was significantly higher for CT images than GI-TIWI images. Except for radiologist 3 [4(0) vs 4 (1)], there was no significant difference in scores between CT and GI-ZTE [radiologist 1: 4 (0) vs 4 (0), P=0.133; radiologist 2: 4 (0) vs 4 (0), P=0.085]. There was good-excellent agreement between both MR sequences and CT for size, lesion number, location, sclerotic rim, expanded shell, destruction pattern, and matrix mineralization for all radiologists (ICC: 0.636-1.000). The consistency of periosteal reaction and penetration of the cortex was fair to good (0.481-0.729) between GI-T1WI and CT and good to excellent between GI-ZTE and CT (0.682-0.852). GI-ZTE images had superior intermodality agreement with CT images and allowed visualization of more cortical bone detail than GI-T1WI images. 1. Stage 2.

MRI findings of benign tumors and tumor-like diseases of the tonguewith radiologic-pathologic correlation.

Benign tumors or tumor-like lesions of the tongue are uncommon lesions that comprise a heterogeneous group of neoplasms. Although there are a variety of benign tumors or tumor-like lesions, the imaging appearance of these diseases is not well defined because of a paucity of scientific literature on this topic. Most benign tongue tumors usually appear as submucosal bulges located in the deep portion of the tongue. Their true features and extent may only be identified on cross-sectional images such as CT and MRI. Thus, CT and MRI play an important role in the diagnosis of these unusual lesions. It is important that radiologists be able to identify the characteristic CT and MR imaging features that can be used to narrow the differential diagnosis with increased diagnostic confidence, suggest specific histologic tumor types. In this pictorial essay, we provide insights into the MRI presentations of benign tongue tumors and tumor-like diseases and their radiologic-pathologic correlation. Benign tumors or tumor-like lesions of the tongue described herein include papilloma, lipoma, hemangioma, venous malformations, schwannoma, neurofibroma, epidermoid cyst, and dermoid cyst.

Preservation of lower extremity function followed by pelvic tumor resection

In 192 operated patients with tumors and tumorlike diseases functional results were analyzed. In 162 patients radical sparing operations were performed according to oncologic demands and with preservation of static-dynamic function of pelvic girdle and lower extremity. High efficacy of those operations was confirmed by clinical and biomechanical data. Long term results showed the necessity to perfect reconstructive surgery on pelvic posterior semi-ring. Elaborated variants of plastic operations for the substitution of acetabular zone allow to restore the hip joint function after resection of pubic, iliac and ischium bones. When the anterior pelvic ring is disturbed bone defects should not be repaired as static-dynamic function is preserved due to compensatory mechanism of sacroiliac ligaments.

Evaluation of the effectiveness of the use of the double mobility in oncological hip replacement

Introduction. Currently, the achievements of oncological hip replacement play an important role in the treatment and rehabilitation of patients with a tumor lesion of the proximal femur. The study objective – to evaluate the effectiveness of the use of the acetabulum component with double mobility in oncological hip replacement. Materials and methods. Our prospective study included 108 patients operated in the Department of Bone Oncology of the R.R. Vreden National Medical Research Center of Traumatology and Orthopedics, Ministry of Health of Russia for a tumor lesion of the proximal femur in the period from 2014 to 2019. There were 65 (60.2 %) women, 43 (39.8 %) men. The median age was 52.1 years. Primary malignant bone tumors were identified in 19 (17.6 %) cases; benign aggressive and tumor-like diseases in 18 (16.6 %) cases; metastatic lesion in 71 (65.8 %) cases. Patients operated with bipolar heads were included in Group 1B – 53 (49 %). The 2D Group included 55 (51 %) patients operated with the use of the acetabulum component with dual mobility. Classification and analysis of complications was carried out according to the international system International Society of Limb Salvage 2014 (ISOLS 2014). The functional result was evaluated using the international Musculoskeletal Tumor Society (MSTS) system and the Harris Orthopedic scale (Harris Hip Score) in terms of 3, 6 and 12 months. Results. The total number of complications detected during the follow-up period from 2014 to 2020 was 13 (12 %) cases. Type I complications (ISOLS 2014) were represented by dislocation of the endoprosthesis – subtype IA, which was detected in 7 (6.4 %) patients operated with bipolar heads. There were no cases of dislocation of the endoprosthesis in the group operated with the use of double mobility (p = 0.006). We were able to identify a statistically significantly better functional result in patients operated with using of double mobility at all follow-up periods, both on the MSTS scale and on the Harris scale (p = 0.004). The five-year survival rate for aggressive benign tumors and tumor-like diseases was 92 %; for malignant primary tumors – 82 %; in patients with secondary bone lesions – 60 %. Conclusion. Today, oncological hip replacement, is still lags behind in functional results from primary standard hip arthroplasty, and the number of complications is still several times higher. We consider that one of the solutions of this problem, is a wider use of acetabulum components with dual mobility in oncoortopedic practice.

The first experience of using the biocomposite material "Osteomatrix" in the clinic of bone pathology

At CITO Clinic of bone pathology new biocomposite material Osteomatrix was used in 15 patients (mainly with tumors and tumor-like diseases) for the plasty of post-resection bone defects. Osteomatrix is composed of bone collagen, hydroxyapatite and sulfated glycosaminoglycanes. Osteomatrix is produced at CITO together with Conectbiopharm Ltd. in the form of granules and blocks. Observation in dynamics with roentgenologic control showed good tolerance of Osteomatrix by patients and distinct accelerated bone regeneration in the zone of bone plasty.

Результаты хирургического лечения доброкачественных опухолевых и опухолеподобных заболеваний костей конечностей

Frequency of bone lesions appears from 2% to 28.5%, depending on the detection of tumors in various bones. Timely diagnosis and surgical treatment of tumor and tumor-like bone lesions do not lose relevance among orthopedists either.Purpose of our study was to search results of surgical treatment of benign tumor and tumor-like diseases of lomb bones.Materials and methods. The study was based on 112 patients with tumors and tumor-like diseases of limb bones, who were treated from 2015 to 2018. The results of treatment were evaluated 1, 3, 6, 9 and 12 months after the intervention according to the functional scale we proposed.Results. In adult patients before surgery, average score on the proposed scale was 17.02±0.15 in the main group, and 17.71±0.12 in the control group of patients. After 12 months of observation, sum of points was equal to 0.94±0.4 points in the main group and 1.44±0.19 points in the control group of patients.Conclusions. Analysis of data of patients in the postoperative period showed an improvement in the condition to good in both main and control groups. From 12 months after treatment, dynamics of assessment revealed an excellent condition of patients. In the long-term period, no signs of relapse of the disease were noted in patients.Key words: benign tumors, bone tumors, lower limb, tumor-like diseases.

MicroRNA in refined diagnosis of choroidal melanoma

Epigenetic studies of the level of microRNAs in human oncogenesis indicate their signifi cant role in the development and growth of malignant tumors of various origins. The fi rst works on the role of microRNAs in patients with uveal melanoma appeared in 2008.The aim: to analyze the expression level of miRNA-126 and miRNA-223 in the plasma blood of patients and to determine their signifi cance in the refi ned diagnosis of choroidal melanoma. Materials and methods. We examined 84 patients with choroidal melanoma (CM), mean age – 63.4 ± 1.2 (35–86 y.o.). Localization – a single CM node with a thickness of 0.77–17.19 mm. The control group consisted of 28 volunteers, age – 62.9 ± 1.42 (45–78 y.o.). Plasma miRNA expression levels were determined by real-time PCR.Results. An increase in the level of expression of miRNA-223 and miRNA-126 in blood plasma was confi rmed in all 84 patients with choroidal melanoma N0M0 compared with the control group. An increase in the expression of miRNA-223 and miRNA-126 was proved with an increase in tumor prominence.Conclusion. The obtained results of an increase in the expression of miRNA-223 indicate an increase in cell proliferation, and an increase in the expression of miRNA-126 on the activation of angiogenesis in a growing tumor, which makes it possible to recommend a study of the level of miRNA-223 and miRNA-126 for a more accurate diagnosis of small CM in cases of difficulty of differential diagnosis with other tumor-like diseases of the choroid.

The first experience of applying laser ablation in patients with benign tumors, tumor-like and inflammatory diseases of the skeleton

The researchers discuss the first experience of treating 9 pediatric patients with osteoid osteoma (3), primary chronic osteomyelitis (4) and aneurysmal cysts (2). Selected patients had complex treatment which included unloading of the diseased segment of the skeleton and laser ablation of the pathological focus. Laser ablation was done with medical laser «AZOR-ALM», emitting light at wavelength 1.55 μm. Registration certificate No. RZN 2015/2720 of Roszdravnadzor. Manufacturer – LLC «AZOR» (Moscow). Small tumors and inflammatory diseases of the skeleton were surgically treated with high-level laser light in the computed tomography room. Patients with lesions of lower extremities and pelvis previously had spinal anesthesia. If a pathologic focus was located in bones of upper extremities, regional brachial plexus blockage was preferable. In all cases, positive outcomes were seen. Follow-up lasted for 6 months.

Complex clinical and echographic assessment of the peculiarities of developmental anomalies of uterus and vagina in children and adolescents

The objective. To assess the structure of independent and combined forms of anomalies in the development of the uterus and/or vagina in children and adolescents, justifying the need for ultrasound screening in this age group.Materials and methods. The study involved 146 patients with malformations of the uterus and/or vagina at the age from 10 to 20 years. All patients underwent a clinical examination, which included anamnestic data, gynecological examination, and ultrasound examination. The calculation of indicators of the diagnostic information content of ultrasound was carried out taking into account the sensitivity, specificity and accuracy of the method.Results. In the course of the study, it was found that the largest proportion of all anomalies of the internal genitals was uterine malformations (37,0%), complete doubling of the uterus and vagina (17,1%), vaginal aplasia (15,1%). Genetic or chromosomal pathology was detected in 36 patients (24,7%), in the remaining 110 patients (75,3%) a multifactorial nature of the disease was assumed.Attention is drawn to the fact that 48 patients (32.8%) with uterine and/or vaginal malformations, who did not present complaints, were identified during the primary ultrasound screening, which indicates the effectiveness of this method in examining girls and adolescents. In 12 children (8,25%) in addition to abnormalities in the development of the uterus and/or vagina, ultrasound revealed tumors and tumor-like diseases of the uterine appendages. Also, 57 malformations of other organs and systems were revealed in 49 (33,6%) examined patients, and 8 (5,5%) had concomitant defects. In most cases, in 99 patients (67,8%) with anomalies in the development of internal genitalia, the anamnesis was aggravated by the factors of their parents (burdened heredity, disease, occupational health, etc.)Conclusion. As a result of a comprehensive clinical examination of patients with congenital anomalies in the development of internal genitalia, the diagnosis was clarified, the share of hereditary and some environmental factors in the manifestation of this pathology was revealed, which is one of the common gynecological diseases that are characterized by a variety of forms of anomalies, clinical symptoms and a high percentage of diagnostic errors. At puberty, the use of echography to clarify the state of the internal genital organs is of great practical importance. Non-invasiveness, absence of psychogenic traumatization, safety and high information content make it possible not only to diagnose congenital pathology, but also to use this method as a dynamic observation of the state of the uterus and/or vagina in girls and adolescents, which is very important when choosing rational methods for correcting this pathology

THE USE OF ASZ-5 AND FAR 5 BIOGLASS IN TREATMENT OF LONG-BONE DEFECTS

Summary. The use of materials based on bioglass and glass ceramics to replace bone lesions is a promising direction for the treatment of bone defects caused by traumas and tumor-like diseases. Objective. To analyze the results of ASZ-5 and FAR 5 bioglass application to replace long bone defects of traumatic and destructive origin. Materials and methods: the analysis of outcomes of 37 patients treated at the Orthopedics department of Andrew Novak Transcarpathian Regional Clinical Hospital from 2018 to 2020. To be included into the study, the patients should have bone defects of traumatic or destructive origin. The patients were divided into three groups. Surgical treatment of these patients included osteosynthesis and plastics of bone defects with ASZ-3 or FAR 5 bioglass. Results. To assess the results, we studied the outcomes of the 37 patients using a rating scale. The observation period covered 1 – 1.5 years after the surgery.43.24% patients demonstrated good results, 51.35% - satisfactory. The results of two patients (5.41%) were poor. Conclusions. The differentiated approach to the type of an implant to fill long bone defects of traumatic and tumor origin shall consider its mechanical, osteoinductive and osteoconductive properties. In turn, it improves the results of treatment by stimulating a bone’s reparative osteogenesis, and assisting its function.

Tumor-like diseases and retinal hamartomas in ophthalmological practice

The article provides a detailed review of the ophthalmoscopic picture, optical coherence tomography (OCT) of the retina and fundus autofluorescence in patients with such rare pathological processes in the fundus as torpedo maculopathy, retinal myelin fibers, retinal astrocytic hamartoma and cavernous hematoma.

THE STRUCTURE OF THYROID NODULES IN CHILDREN SUBJECTED TO SURGICAL TREATMENT

The article provides the literary information and the results of our own research on the structure of the thyroid nodules in operated children.The clinical significance of nodular neoplasms of the thyroid gland is determined by the relatively high risk of carcinomas. Along with this, the relevance of this research is due to the increasing of surgical interventions and the fact that the features of nodules in children and tactics of management of patients remain debatable.The aim of the work was to study the structure of thyroid nodules in childrenin various age groups. The case histories of 225 operated childrenfrom 4 to 17 years oldfrom 2007 to 2017 were analyzed. Nodular neoplasms of the thyroid in children were more common. Tumor-like diseases - colloid nodes in childhood were rare, only in 2.2% of cases. The high incidence of thyroid cancer (35.6%) under the mask of nodal goiter determines active surgical tactics in patients with nodal neoplasms in childhood.

Pathological fractures of long bones of the skeleton in children and adolescents in benign tumors and tumor-like diseases

This article provides an analysis of 82 patients for the period from 2000 to 2018 aged 5 to 18 years with pathological fractures of the long bones of the skeleton on the basis of benign tumors and tumor-like diseases. Most often, fractures were observed with a solitary bone cysts 24, an aneurysmal bone cyst 19, fibrous dysplasia 20, neosteogenic fibroma 7, Olliers disease 6, osteofibrous dysplasia 2, giant-cell tumor 3, hemangioma 1. On the basis of the Department of Pediatric Bone Pathology and Adolescent Orthopedics of N.N. Priorov National Medical Research Center of Traumatology and Orthopedics all patients underwent a comprehensive physical exams and surgical treatment. The clinical and radiological picture was studied and the features of the course of pathological fractures were revealed depending on the nosology of the tumor process. It is shown that when a pathological fracture occurs, the treatment approach should be individualized depending on the location of the focus, the patients age and nosology.

Edema Surrounding Benign Tumors and Tumor-Like Lesions.

Objective To explore the incidence and significance of intra- and extra-osseous edema associated with benign tumors and tumor-like diseases. Methods Magnetic resonance imaging (MRI) data from 300 benign osseous tumors and tumor-like diseases diagnosed by pathology were retrospectively reviewed. Borderline tumors, cases associated with pathological fractures, and skull lesions were excluded from the study. Bone marrow and soft tissue edema were defined on T2WI with fat suppression on MRI in all cases. The incidence rate of edema in benign tumors and tumor-like diseases was determined using the χ2 test. The preoperative diagnoses were reviewed, and the effect of edema on the differential diagnosis of benign and malignant tumors was analyzed. Results The incidence rate of bone marrow and soft tissue edema associated with benign tumors and tumor-like diseases was 35.7% (107/300), including 84.4% (27/32) Langerhans cell histiocytosis, 86.4% (19/22) osteoblastoma, 93.9% (31/33) osteoid osteoma, and 85.2% (23/27) chondroblastoma cases. There was no statistically significant difference in the incidence of edema among the four diseases (χ2 = 1.7, P > 0.05). Of 107 cases associated with edema, 49 (45.8%) were misdiagnosed as malignant tumors by MRI preoperatively. Conclusion Bone marrow and soft tissue edema are a common finding associated with benign bone tumors and tumor-like diseases, and they are frequently detected in Langerhans cell histiocytosis, osteoblastoma, osteoid osteoma, and chondroblastoma.

Differential diagnoses of osteonecrosis of large joints

Subchondral insufficiency fractures and idiopathic bone marrow edema syndrome are the most important differential diagnoses to be distinguished from osteonecrosis because they have a deviating and as a rule more favorable prognosis and also different therapeutic strategies. Osteochondritis dissecans represents adifferent entity in many respects, which should not be confused or unified with osteonecrosis. Based on recent knowledge intractable subchondral insufficiency fractures may be the underlying cause of rapidly destructive osteoarthritis at least in some cases. Septic involvement of bone and joints can eo ipso cause severe articular damage due to direct destruction but also secondary to septic vascular occlusion resulting in septic osteonecrosis. Whereas bone marrow infiltrating systemic diseases and the therapeutic regimens can lead to osteonecrosis, bone tumors or tumor-like diseases, rarely pose adifferential diagnostic problem with respect to the differentiation from osteonecrosis.