Tumors Of Low Malignant Potential Research Articles

ABSTRACT Bladder cancer diagnosis is challenged by invasive monitoring and workflow inefficiencies impacting diagnostic reliability. This prospective study enrolled 150 patients (January 2020–December 2022) and evaluated a novel liquid-based immunocytochemistry platform, coupled with integrated machine learning, for detecting urothelial carcinoma in voided urine. All 150 cytology slides met the adequacy threshold of ≥2,644 urothelial cells and showed preserved cytomorphology. Eight cases of papillary urothelial neoplasm of low malignant potential (PUNLMP) were set aside a-priori, yielding an analytic cohort of 142 patients (115 urothelial-carcinoma, 27 benign) for performance analysis. hTERT (sensitivity 92.2%, specificity 66.7%), GATA-3 (67.0%, 88.9%), and CK17 (89.6%, 66.7%). In multi-marker analysis, sensitivity reached 100% (95% CI 96.8–100) when any marker was positive, whereas specificity reached 100% (95% CI 87.3–100) when all three markers were positive. The workflow-optimized platform standardizes specimen preparation and multi-marker interpretation, offering a robust foundation for urine-based bladder-cancer diagnostics. Larger, multi-center validation studies are warranted to refine specificity estimates and facilitate laboratory integration. This study demonstrates that addressing fundamental workflow challenges in bladder cancer diagnostics before implementing artificial intelligence creates more effective diagnostic tools. By prioritizing specimen integrity and standardization through a novel liquid immunocytochemistry platform, exceptional diagnostic performance was achieved with 100% sensitivity and specificity under defined marker parameters across various cancer stages. This workflow-first approach to integrating machine learning with advanced biomarker analysis offers a model for developing clinically practical diagnostic innovations that can reduce reliance on invasive monitoring procedures while improving detection accuracy.

Introduction. Chronic kidney diseases are attributed to a variety of etiologies, including diabetes mellitus, hypertension, vascular diseases, cystic kidney diseases, chronic tubulo-interstitial diseases, chronic pyelonephritis, and glomerular diseases. Simple nephrectomy is indicated when the loss of renal function in a unilateral non-functional kidney is permanent in a persistently symptomatic patient. Uncommonly, a non-functional kidney may develop neoplasm unsuspected pre-operatively and be diagnosed only during histopathological examination of nephrectomy specimen. Material and methods. We examined 275 simple nephrectomies performed between 2019 and 2024 in patients with non-functional kidneys confirmed by DMSA scan. All nephrectomies done for diagnosed or even suspected tumors by pre-operative imaging were excluded from the study. Results. Chronic pyelonephritis (79.3%) was the most common histopathological diagnosis, followed by xanthogranulomatous pyelonephritis (8.7%) and granulomatous pyelonephritis (5.4%). In five (1.8%) patients, microscopy revealed non-specific chronic interstitial inflammation and interstitial fibrosis. One patient (0.4%) was diagnosed with large solitary pyelogenic cyst and renal nocardiosis. Eleven patients (4%) were diagnosed with neoplasms. Clear cell renal cell carcinoma was the most common diagnosis (27.2%), followed by urothelial carcinomas of renal pelvis (18.2%), one patient each of collecting duct carcinoma, squamous cell carcinoma of renal pelvis, and multilocular cystic renal neoplasm of low malignant potential. Three patients had papillary adenomas. Conclusion. Diligent histopathological examination of simple nephrectomy is crucial in establishing the final diagnosis with important further therapeutic implications. This is especially important in neoplastic pathologies developing in non-functional kidneys that may rarely be unsuspected by pre-operative imaging and diagnosed only during histopathological evaluation.

BackgroundBorderline ovarian tumors (BOTs) are neoplasms of low malignant potential that predominantly affect women of reproductive age. Fertility preservation through fertility-sparing surgery is widely practiced; however, concerns remain regarding the risk of tumor recurrence and the reproductive outcomes following in vitro fertilization (IVF). This study aimed to evaluate IVF/ intracytoplasmic sperm injection (ICSI) outcomes in BOTs patients post-FSS and to assess the association between ovarian stimulation parameters and tumor recurrence.MethodsIn this retrospective cohort study conducted at Sixth Hospital of Sun Yat-sen University from May 2010 to May 2023, 65 women with a history of FSS for BOTs who underwent IVF/ICSI were identified. After propensity score matching, 61 BOTs patients were compared with 181 control patients without ovarian tumors. Key outcomes evaluated included ovarian stimulation parameters, live birth rates, neonatal outcomes and risk factors for tumor recurrence.ResultsThe BOTs and control groups exhibited similar outcomes regarding the number of oocytes retrieved, the quality and number of embryos, and live birth rates from the first IVF/ICSI cycles. The cumulative live birth rate over 13 years and neonatal parameters (gestational age, birth weight, and body length) were also comparable between groups. Tumor recurrence was observed in 8.62% of BOTs patients, with no significant association identified between recurrence and ovarian stimulation parameters or peak estradiol levels.ConclusionsIVF/ICSI following fertility-sparing surgery for BOTs patients yields reproductive and neonatal outcomes comparable to those in patients without BOTs and does not increase the risk of tumor recurrence. These findings support the safety and efficacy of IVF as a fertility treatment option for BOTs patients after conservative surgery. Further prospective studies with larger cohorts are warranted to validate these results and refine ovarian stimulation strategies.Clinical trial numberNot applicable.

Glomangiopericytoma of the sinonasal type is a rare sinonasal soft tissue tumor of low malignant potential. Its nosologic nature was controversial after it was first reported by Stout and Murray in 1942, who termed it as sinonasal haemangiopericytoma. It behaves very indolently as compared to its soft tissue counterparts, and now its cell of origin is known to be a perivascular modified glomus-like cell with myoid features. Clinically, it has many mimics ranging from inflammatory nasal polyps to epithelial neoplasms and vascular tumors. Here, we report a case in a 52-year-old male patient who presented with epistaxis and sinonasal polypoid mass. CT/CECT showed a polypoid lesion involving the right nasal cavity between the right middle turbinate and bony nasal septum with the possibility of a small mucosal nasal polyp. Total resection was performed by endoscopic nasal route. On histopathology and immunohistochemical examination, it was diagnosed as sinonasal glomangiopericytoma (GPC). We discuss the histology features and differentials to help in the diagnosis of this rare nasal neoplasm that presents with common symptoms of epistaxis diagnosis.

Background: Urinary bladder cancer is the most common malignancy involving the urinary system and the ninth most common malignancy worldwide. Proliferation marker kinase inhibitor (Ki67) is a nuclear and nucleolar non-histone DNA-binding protein that is encoded by the MKi67 gene in humans. Human epidermal growth factor receptor 2 (HER2) is a transmembrane tyrosine kinase receptor that is involved in cellular growth, survival, and migration. Materials and Methods: The cross-sectional study was conducted for the duration of one year in the Department of Pathology, BPS Medical College for Women, Khanpur Kalan, Sonepat. Tissue sections, after proper processing, were stained with haematoxylin and eosin. A total of 50 histopathologically proven cases of urothelial tumors were included in the study. Correlation of urothelial tumors was studied with age, gender, smoking, and tumor grading. Urothelial tumors were classified according to the WHO classification of tumors of the urinary bladder (2016), and IHC markers Ki67 and HER2/neu expressions were evaluated. Results: Among 50 cases of urothelial tumors, 25 (50%) cases were low-grade urothelial carcinoma, followed by 22 (44%) cases of high-grade urothelial carcinoma. Two cases of squamous cell carcinoma and one case of papillary urothelial neoplasm of low malignant potential were also observed. Ki67 expression was significantly associated with urothelial carcinoma (p-value = 0.01). HER2/neu expression showed a significant association with muscle-invasive tumors (p-value = 0.02). Conclusion: Positive Ki67 and HER2/neu expression correlated with tumor grade. Assessing HER2/neu status could identify patients with high-grade disease who might benefit from adjuvant HER2/neu treatment after radical cystectomy.

Introduction: Renal cystic lesions are the most commonly encountered kidney pathologies, which can fall into developmental, acquired, genetic, infectious and neoplastic categories. Prompt histological diagnosis, in co-ordination with radiological findings, is very important for the further management of these lesions. Aim: To study the histopathological features of renal cystic lesions and to examine the immunological expression of Cytokeratin 7 (CK7) in cystic renal tumours. Materials and Methods: The present study is a cross-sectional study conducted in the Department of Pathology, Narayana Medical college, Nellore, Andhra Pradesh, India. Study was conducted over a period of five years, from June 2018 to May 2023, both prospectively and retrospectively. It includes 38 cases of cystic renal lesions out of 147 kidney specimens, which included cyst walls and nephrectomy specimens. Out of the 38 cystic renal lesions, 11 cases of cystic renal tumours were identified. Cytokeratin 7 Immunohistochemistry (IHC) was performed on these 11 cases of cystic renal tumours. Only diffuse membranous or cytoplasmic immunostaining in tumour cells is considered positive, while weak or focal immunostaining is considered negative. The data was entered into Microsoft (MS) Excel sheet and descriptive measures obtained included frequencies and percentages. Results: Among the 38 cases of cystic renal lesions, the most common were 17 cases of simple cysts, followed by 10 cases of clear cell renal cell carcinoma with a cystic component, three cases of acquired cystic disease, three cases of renal dysplasia, two cases of hydatid cyst, one case of mucinous cyst, one case of adult polycystic kidney disease and one case of a cystic renal neoplasm of low malignant potential. All 11 cases of cystic renal tumours exhibited clear cell morphology. Cytokeratin 7 immunostaining was performed on the 11 cases of cystic renal tumours, of which only the lining cells in a single case of cystic renal neoplasm of low malignant potential showed both intense and diffuse cytoplasmic positivity. The remaining 10 cases of clear cell Renal Cell Carcinoma (RCC) were negative, showing no immunoreactivity. Conclusion: Renal cystic lesions encompass a broad range of pathologies that have many overlapping features on histopathology. The use of immunohistochemical markers aids in differentiating low malignant potential cystic renal tumours from malignant ones.

Background: Urinary bladder neoplasms encompass a wide range of benign and malignant tumors, with urothelial carcinoma being the most prevalent histological subtype. These tumors pose significant diagnostic and therapeutic challenges due to their high recurrence rate and potential for progression. Histopathological evaluation remains the cornerstone for accurate diagnosis, grading, and staging, all of which are essential for optimal management. Objectives: This study aimed to evaluate the histopathological spectrum of urinary bladder neoplasms, classify them according to WHO criteria, and correlate histological findings with relevant clinical parameters. Materials and Methods: A prospective study was conducted in the Department of Pathology, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, from September 2022 to July 2023. A total of 132 bladder biopsy and resection specimens were included. Detailed clinical information, including age, gender, symptoms, and radiological findings, was recorded. All specimens were formalin-fixed, paraffin-embedded, and stained with hematoxylin and eosin. Tumors were classified and graded based on the 2016 WHO/ISUP classification. Invasion status and variant histologies. were also assessed. Results: The majority of cases were urothelial carcinomas, accounting for 88.6% of all tumors. Among these, high-grade urothelial carcinoma constituted 54.3% and low-grade 34.3%. A small proportion of cases were squamous cell carcinoma (4.5%), adenocarcinoma (3.0%), and papillary urothelial neoplasm of low malignant potential (PUNLMP) (3.8%). The most commonly affected age group was 51–70 years, with a male-to-female ratio of 3.2:1. Painless hematuria was the most frequent presenting symptom. Muscle invasion was noted in 42.4% of urothelial carcinoma cases. Conclusion: Urothelial carcinoma remains the predominant histological subtype in urinary bladder neoplasms. High-grade lesions with muscle invasion are common in the older population and indicate poor prognosis. Routine histopathological analysis of all bladder lesions is crucial for diagnosis, risk stratification, and planning of further management. The study highlights the importance of early detection and pathological classification in improving clinical outcomes.

Epstein-Barr Virus (EBV)-positive inflammatory follicular dendritic cell sarcoma (EBV-IFDCS) is a rare tumor of low malignant potential. Abundant lymphocytes and plasma cells often infiltrate into this tumor tissue with lymphoid follicles and sarcoid-like granulomas, so that the differential diagnosis of this tumor includes inflammatory lesions such as IgG4-related disease, morphologically. This tumor typically arises in the spleen or liver, and shows follicular dendritic cell (FDC)-like immunophenotype. Here we presented a case of EBV-IFDCS arising in intrapancreatic accessory spleen, which was preoperatively considered as a pancreatic tumor. Immunohistochemistry revealed its fibroblastic reticular cell-like phenotype, namely alpha SMA, l-caldesmon, tenascin C, and transglutaminase II positivity, while FDC marker expression such as CD21 and clusterin was focal. Positivity for EBV-encoded small RNA in situ hybridization (EBER ISH) distinguished it from inflammatory lesions or conventional FDC sarcoma. The differential diagnosis of EBV-IFDCS is broad, ranging from non-neoplastic lesions to sarcoma, particularly when it arises in unusual sites. Therefore, careful gross and microscopic examination and adequate immunohistochemistry application including EBER ISH are important to diagnose it properly.

A 27-year-old woman underwent 68 Ga-pentixafor PET/CT for primary aldosteronism localization and characterization. No functional adrenal nodules were detected by 68 Ga-pentixafor PET/CT, whereas a hypodense nodule with focal pentixafor uptake was incidentally discovered in the head of pancreas. Retrospective analysis of contrast-enhanced CT scan revealed a subtly enhancing nodule devoid of calcification in the pancreatic head. Pancreatic cancer cannot be excluded. 18 F-FDG PET/CT was suggested, and the scan showed an FDG-avid lesion in the same region. Needle biopsy was performed, and the pathological result is solid pseudopapillary tumor, a rare pancreatic tumor of low malignant potential.

Multilocular Cystic Renal Neoplasm of Low Malignant Potential (MCRNLMP) is a distinct type of clear cell renal tumor. The diagnostic histological criteria for this entity have evolved, and specific histological features have been modified over the years. The WHO 2022 of Male Urinary System and Male Genital Tumours respecified diagnostic histopathological features. Maximum tumors are asymptomatic and are incidentally detected on radiological examination. Computed tomography using contrast agents is still the gold standard for classifying cystic tumors of kidney. The Bosniak category of renal cystic lesions is crucial for the management of other imaging modalities such as magnetic resonance imaging (MRI) and contrast-enhanced ultrasound, which can be used with the same effectiveness. The prognosis is excellent in MCRNLMP, and there are no reports of cancer progression or metastasis. Minimally invasive nephron-sparing surgery with strict clinical including imaging follow-up with contrast-enhanced computerized tomography and magnetic resonance imaging is a choice of treatment.

Background: Solid-pseudopapillary tumor of the pancreas (SPT) is an exceptionally rare neoplasm in children. Its origin remains enigmatic. It occurs most frequently in young females within the second or third decade of life with only a small minority concerning children. Frequently described as low malignant potential tumors, surgical resection remains the main treatment. Case: The authors present a case of a SPT diagnosed in a 12-year-old with vomiting and abdominal pain localized to the right upper quadrant 2 week before admission to hospital. The patient also became yellowish since 1 week before. The patient undergo MRI scans and showed the presence Heterogeneous solid mass with components of necrosis and bleeding in it in the head of the pancreas. The patient undergone surgery with the histomorphology result Solid Pseudopapillary Neoplasm of pancreas, low grade malignancy. Conclusion: SPT is a rare differential diagnosis of a pancreatic mass in children. It is mandatory to establish this diagnosis since complete surgical removal of the tumor even in case of metastases or local invasion offers an excellent prognosis

Long-Term Recurrence Risk, Metastatic Potential, and Length of Cystoscopic Surveillance of Low-Grade Nonmuscle-Invasive Bladder Cancer.

Bladder cancer in patients under 45 is poorly characterized and rarely described, with variabilities in clinical outcomes and tumor properties. Our study aimed to elucidate the clinical and pathological features and outcomes of bladder cancer in this younger demographic to better inform management strategies. We conducted a retrospective analysis at the Urology Department of "Pius Brînzeu" County Emergency Clinical Hospital in Timișoara, Romania, on 60 patients aged 18-45 who underwent transurethral resection of bladder tumor (TURBT) during a 9-year period. The cohort had a mean age of 38.5 ± 5.6 years with a male predominance (70%). Most tumors were non-muscle-invasive (NMIBC; 80%), with 16.7% being papillary urothelial neoplasms of low malignant potential (PUNLMP), 50% stage pTa, and 30% stage pT1. High-grade tumors were present in 43.3% of the patients. Recurrence occurred in 40% of the patients, while progression was observed in 16.7%. The 3-year overall survival rate was 93.3%, and the progression-free survival rate was 83.3%. Patients with high-grade tumors had a significantly higher recurrence rate (61.5% vs. 23.5%, p = 0.003) and lower survival rates compared to those with low-grade tumors. Young patients predominantly present with low-to-intermediate-stage tumors, yet a significant portion exhibit high-grade tumors associated with poorer outcomes. These findings suggest that while bladder cancer in younger patients tends to be less invasive, aggressive follow-up and treatment are crucial in those with high-grade tumors.

Approaches to the Diagnosis and Management of Paediatric Ovarian Tumours and Oncological Outcomes in a Single-centre Study. Evidence in Support Of IPSO Reccomendations

Abstract Giant cell tumor (GCT) is a benign but locally aggressive bone tumor which usually involves the end of long bones. This occurs in both benign and malignant forms. Primary GCTs of soft tissue resembling osseous GCTs are uncommon but with distinct entities and is a rare benign tumor of low malignant potential. Only a few cases are reported in medical literature and much few cases involving ear. There has been no reporting of Indian studies till date, and hence in this article, we report for the first time in India GCT of pinna which is a rare condition.

Unraveling the Molecular Landscape of Uterine Tumor Resembling Ovarian Sex Cord Tumor: Insights From A Clinicopathological, Morphologic, Immunohistochemical, and Molecular Analysis of 35 Cases

This chapter reviews the clinical, histopathologic, and cytologic features of low-grade urothelial neoplasia, including urothelial papilloma, papillary urothelial neoplasm of low malignant potential, and low-grade papillary urothelial carcinomas. An overview of various surgical pathology and cytology classification systems, diagnostic criteria, and common molecular alterations will be reviewed.

This study aimed to explore the feasibility and safety of laparoscopic nephron-sparing surgery (LNSS) for complex renal cystic lesions. A retrospective study was conducted on 83 cases of complex renal cystic lesions treated with LNSS in our hospital. There were 32 men and 51 women, ranging in age from 24 to 73years (average, 47.22±9.03years). The diameter of the cysts was 1.5-5.9cm (average, 3.44±0.86cm). According to the Bosniak classification, there were 15 cases of type II, 23 cases of type IIF, 29 cases of type III, and 16 cases of type IV complex renal cystic lesions. According to clinical classification based on the difficulty of laparoscopic partial nephrectomy and the depth of the lesion, the 83 complex renal cystic lesions were divided into 48 cases of the extra-renal type, 15 cases of the centrally located type, seven cases of the renal sinus type, and 13 cases of the renal hilum type. Laparoscopic partial nephrectomy was successful in all 83 patients. The surgical time was 35-102min (average, 52.13±14.38min), the intraoperative bleeding volume was 10-200ml (average, 27.25±12.26ml), and the renal artery occlusion time was 12-28min (average, 12.46±4.45min). There was no significant change in creatinine before and after surgery. The postoperative pathological results showed 71 cases of renal clear cell carcinoma, five cases of low malignant potential multilocular cystic renal tumors, and seven cases of pure renal cysts with all margins negative. There is potential for the malignant transformation of complex renal cysts into renal cell carcinoma. For complex renal cysts classified as Bosniak IIF or higher, surgical intervention is recommended, and LNSS is safe and effective. The complexity of the surgical procedure varies depending on the location classification of the complex renal cysts.

Up until now, no research has been reported on the association between the clinical growth rate of multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and computed tomography (CT) imaging characteristics. Our study sought to examine the correlation between them, with the objective of distinguishing unique features of MCRNLMP from renal cysts and exploring effective management strategies. To investigate optimal management strategies of MCRNLMP. We retrospectively collected and analyzed data from 1520 patients, comprising 1444 with renal cysts and 76 with MCRNLMP, who underwent renal cyst decompression, radical nephrectomy, or nephron-sparing surgery for renal cystic disease between January 2013 and December 2021 at our institution. Detection of MCRNLMP utilized the Bosniak classification for imaging and the 2016 World Health Organization criteria for clinical pathology. Our meticulous exploration has revealed compelling findings on the occurrence of MCRNLMP. Precisely, it comprises 1.48% of all cases involving simple renal cysts, 5.26% of those with complex renal cysts, and a noteworthy 12.11% of renal tumors coexisting with renal cysts, indicating a statistically significant difference (P = 0.001). Moreover, MCRNLMP constituted a significant 22.37% of the patient population whose cysts demonstrated a rapid growth rate of ≥ 2.0 cm/year, whereas it only represented 0.66% among those with a growth rate below 2.0 cm/year. Of the 76 MCRNLMP cases studied, none of the nine patients who underwent subsequent nephron-sparing surgery or radical nephrectomy following renal cyst decompression experienced recurrence or metastasis. In the remaining 67 patients, who were actively monitored over a 3-year postoperative period, only one showed suspicious recurrence on CT scans. MCRNLMP can be tentatively identified and categorized into three types based on CT scanning and growth rate indicators. In treating MCRNLMP, partial nephrectomy is preferred, while radical nephrectomy should be minimized. After surgery, active monitoring is advisable to prevent unnecessary nephrectomy.

The aim of study: to analyze the accumulated experience and try to identify those clinical situations in which the use of protons will be economically and clinically more effective than photon radiation therapy. Material and methods. The articles devoted to the study of the evaluation and comparison of the effectiveness of proton and photon radiation beams in the treatment of tumors of the central nervous system and published over the past 25 years were searched in the Medline, Embase and the Cochrane Library databases. Results. the analysis of available publications has shown that accelerated protons do not improve survival rates and disease-free rates in all forms of brain tumors compared with photon therapy. However, protons can significantly increase the level of dose distribution conformity and reduce the dose to critical structures (pituitary gland, cochlea, eye lenses, hypothalamus), thus reducing the risk of hearing and visual impairment as well as hormonal and cognitive disorders. All this is critically important for potentially curable malignant tumors, such as medulloblastoma and germinoma, for low malignant potential tumors (grade 1–2 glioma) or tumors with decreased metastatic potential, since proton therapy compared to photon therapy reduces the risk of late side effects that worsen the quality of life of cured children. Conclusion. central nervous system tumors are one of the most common solid malignant neoplasms in children. Radiation therapy (RT) is recognized as an important therapeutic component of treatment and is often used in strategies for multimodal therapy of tumors of the central nervous system in children. Proton radiation therapy is one of the attractive methods of radiotherapy with minimal dose distribution to normal tissues and a decrease in the absorbed dose. The precision of protons reduces the risk of long-term side effects associated with this type of treatment and the induction of secondary malignancies, which is of particular importance for the quality of life.