Tumour-like Lesions Research Articles

Fine needle biopsy with cytology in paediatrics: the importance of a multidisciplinary approach and the role of ancillary techniques

Fine needle biopsy (FNB) with cytology has long been regarded as an excellent technique as the first choice for diagnosing adult tumours. Being an inexpensive minimally invasive technique with high accuracy and diagnostic immediacy through rapid on-site evaluation, it is also ideal for implementation in the paediatric setting, particularly in developing countries. Furthermore, it allows complementary and advanced procedures such as flow cytometry, polymerase chain reaction (PCR) or fluorescence in situ hybridization (FISH), among others, which enhances the diagnostic capacity of this technique and gives it a key role in risk stratification and therapeutic decision-making for several tumours. The advantages of FNB are optimized in the setting of a multidisciplinary team where cytologist, clinician and radiologist play leading roles. Paediatric tumours are rare and most ancillary techniques are cost-effective but complex to be implemented in small centres with limited experience in paediatric pathology. Therefore reference centres are essential, in order to establish teams with extensive experience and expertise. Hence, any child with a suspected malignancy should be directly referred to a paediatric oncology unit. Focusing on a practical approach to the assessment of paediatric lymphadenopathies and non-central nervous system solid tumours we review the effectiveness of FNB as applied concurrently with ancillary techniques in a multidisciplinary approach to the diagnosis, prognosis and therapeutic decisions of paediatric tumours and tumour-like lesions.

Enfermedades menos conocidas de la mielina: lesiones desmielinizantes focales seudotumorales

IntroductionFocal tumour-like demyelinating lesions are defined as solitary demyelinating lesions with a diameter greater than 2cm. In imaging studies, these lesions may mimic a neoplasm or brain abscess; as a result, invasive diagnostic and therapeutic measures may be performed that will in some cases increase morbidity. Our aim was to analyse and characterise these lesions according to their clinical, radiological, and pathological characteristics, and this data in addition to our literature review will contribute to a better understanding of these lesions. MethodsThis descriptive study includes 5 cases with pathological diagnoses. We provide subject characteristics gathered through reviewing their clinical, radiology, and pathology reports. ResultsPatients’ ages ranged from 12 to 60 years; 3 patients were female. The time delay between symptom onset and hospital admission was 3 to 120 days. Clinical manifestations were diverse and dependent on the location of the lesion, pyramidal signs were found in 80% of patients, there were no clinical or radiological signs of spinal cord involvement, and follow-up times ranged from 1 to 15 years. ConclusionBrain biopsy is the gold standard for the diagnosis of demyelinating tumour-like lesions; however, their clinical features, along with several magnetic resonance imaging features such as open ring enhancement, venular enhancement, the presence of glutamate in spectroscopy, and others, may be sufficient to differentiate neoplastic lesions from focal tumour-like demyelinating lesions.

A rare case of ‘histiocytoid haemangioma’ of the hand

Histiocytoid haemangioma has been identified by Rosai in 1979 as a group of vascular tumour-like lesions. This lesion can occur in a wide variety of sites. Surgical excision is the treatment of choice. We present the case of a 35-year-old man with a swelling in the thenar region of his right hand. Preoperative X-rays, magnetic resonance imaging (MRI) and angio-computed tomography (angio-CT) demonstrated a lesion invading the radial digital artery to the index finger without any bone erosion. It was excised 'en bloc' with the artery itself. The radial digital nerve to the index finger and the main digital artery to the thumb were preserved. No local recurrence was observed at the 3-year follow-up. Histiocytoid haemangioma of the hand is a rare disease, and patients should undergo early surgical treatment to achieve complete excision of the lesion without any functional deficit.

Endometrial Polyps in the Bitch: a Retrospective Study of 21 Cases

Endometrial polyps (EPs) are tumour-like lesions reported frequently in domestic carnivores. The present report describes the clinical and pathological features of EPs in 21 bitches. Most affected bitches had a regular reproductive history. Five bitches had no clinical signs and eleven showed clinical signs of pyometra. Four bitches had a large EP which resulted in compression of the abdominal viscera. One bitch had an acute uterine torsion. A clinical diagnosis of EPs was only made when the lesions were large and identified by abdominal palpation or ultrasound. Grossly, the EPs were 5-25 cm in diameter and were single, sessile or pedunculated. They were often associated with cystic endometrial hyperplasia. Microscopically, the EPs were fibroglandular with the stroma sometimes being haemorrhagic and infiltrated by inflammatory cells. In one case, there were areas of stromal smooth muscle and epithelial squamous metaplasia, which may have been consistent with preneoplastic change.

Dentine matrix protein 1 (DMP-1) is a marker of bone-forming tumours

Dentin matrix protein 1 (DMP-1) is highly expressed by osteocytes and is a non-collagenous matrix protein found in dentin and bone. In this study, we determined the expression of DMP-1 in mature and immature human bone and examined whether DMP-1 is useful in distinguishing osteoid/bone-forming tumours from other primary and secondary bone tumours. DMP-1 expression was immunohistochemically determined in paraffin sections of a wide range of benign and malignant primary bone tumours and tumour-like lesions (n = 353). DMP-1 mRNA expression was also examined in osteosarcoma and fibrosarcoma cell lines as well as bone tumour specimens (n = 5) using real-time PCR. In lamellar and woven bone, DMP-1 was expressed in the matrix around osteocyte lacunae and canaliculi; osteoblasts and other cell types in the bone were negative. Matrix staining of the osteoid and bone was seen in bone-forming tumours including osteoma, osteoid osteoma, osteoblastoma and osteosarcoma. DMP-1 staining was also seen in fibrous dysplasia, osteofibrous dysplasia and chondroblastoma and in reactive bone in solitary bone cysts and aneurysmal bone cysts. DMP-1 was not expressed in the tumour component of other bone neoplasms including Ewing sarcoma, chondrosarcoma, leiomyosarcoma, fibrosarcoma, giant cell tumour of bone and metastatic carcinoma. DMP-1 mRNA was expressed in osteosarcoma cell lines and tumour samples. DMP-1 is a matrix marker expressed around osteocytes in human woven and lamellar bone and is useful in identifying osteosarcoma and other bone-forming tumours.

A case of ano-rectal tuberculoma simulating cancer in Aids

We report a case of ano-rectal tumour clinically diagnosed as cancer in a 36 years old male AIDS patient. Pathology analysis of the biopsy specimen revealed tuberculosis. The tumour regressed enormously and the general condition of the patient improved during the follow upwith anti-tuberculous and ARV therapy. Not all tumour-like lesions that occur in immune depressed patients are neoplasia. This is a case of a rare localization of a common diseaseand highlights the importance of pathology analysis of specimens in diagnosis and management of patients even when clinical presentation of the case appears so obvious.

Bone tumours and tumour-like conditions of the head and neck and jaws

Almost all variants of malignant primary and secondary tumours of bone have been described as occurring within the head and neck and jaws. The most commonly occurring primary bone tumours affecting the jaws include osteosarcoma, Burkitt’s lymphoma and multiple myeloma, while secondary or metastatic tumours to the jaws are rare in contrast to the remainder of the skeleton. Management of patients with bone tumours and tumour-like lesions requires a team approach. Good communication between radiologist, attending head and neck surgeon and pathologist is imperative for accurate interpretation and diagnosis of these neoplasms. Pathologists who attempt to make a diagnosis of bony neoplasms without the clinical and radiographic information are at a distinct disadvantage and this is strongly discouraged. The objective of the slide seminar is to address some of the common as well as the less common bone tumours and tumour-like conditions of the head and neck and jaws.

Oro-facial tumours and tumour-like lesions in Greek children and adolescents: An 11-year retrospective study

ObjectiveTo determine the epidemiology, histological diagnosis and treatment outcome of oro-facial tumours and tumour-like lesions in Greek children and adolescents. Material and methodsThe medical records of patients with oro-facial lesions who presented at the Department of Oral and Maxillofacial Surgery at “A. & P. Kyriakou” Children's Hospital from 2000 to 2010 were reviewed. Data was analyzed in relation to age, gender, location, histology, treatment choice and outcome. ResultsTwo hundred and eleven oro-facial lesions were identified. Age ranged from 14 days to 15 years (mean 8 years); the male-to-female ratio was 1.09: 1; 90.05% of the lesions were benign and 9.95% malignant. Vascular anomalies were the most common benign lesion (22.1%) and rhabdomyosarcoma was the most prevalent malignancy (28.57%). One hundred and ten lesions (52.1%) involved soft tissue, most commonly the tongue and 96 cases (45.5%), involved hard tissue, most frequently the mandible; 5 lesions (2.4%) involved both hard and soft tissue. Surgery was performed under general anaesthesia in 198 cases (93.84%). Some malignant lesions were treated with chemotherapy and/or radiotherapy. ConclusionsOro-facial tumours and tumour-like lesions are not uncommon in the Greek paediatric population; although most frequently benign, these may cause considerable morbidity. As such early diagnosis and treatment are imperative.

Benign course of tumour-like multiple sclerosis. Report of five cases and literature review

BackgroundMultiple sclerosis (MS) with initial neuroradiological features suggestive of brain tumour (tumour-like MS) may represent a challenging diagnosis. MethodsAmong the patients seen at the MS centre of our Institution between 2000 and 2010, we identified cases presenting with a large (diameter>2cm), well-defined lesion, suggestive of brain tumour on initial brain magnetic resonance imaging (MRI). Only patients with at least 10years follow-up were included. ResultsFive young women with MS who presented with a tumour-like lesion on initial brain MRI are described. All cases presented with sudden-onset neurological deficits due to a single large brain lesion compatible with neoplasm at MRI. Two cases underwent brain stereotactic biopsy, both misdiagnosed as astrocytoma. However, the subsequent clinical and MRI follow-up was consistent with MS in all cases. Unnecessary surgery and radiotherapy were responsible for disability in two cases. In three cases, the course of the disease remains benign after more than 13years from symptoms onset. ConclusionsOur report of clinical, radiological and pathological features of five tumour-like MS cases confirms that it is mandatory to consider a demyelinating process in the differential diagnosis of tumour-like brain lesions. Many tumour-like MS cases may have a favourable long term prognosis.

Modern histological and clinical classifications of tumours and tumour-like lesions of bones, peculiarities of their use and some aspects of orthopaedic oncomorphology

The article deals with examination of the WHO International Histological Classification of Tumours (2002) and some clinical classifications (TNM, ІCD-O, Ennekіng). From these positions and also on the basis of a great number of his own bioptic-histologic studies and many years of experience the author elucidated some aspects of clinical-morphological diagnosis, which are of great importance for orthopedic oncopathology practice. The history of creation of the WHO International Histological Classification of Tumours, the structure of its last 3rd edition (2002) and differences from the previous edition are briefly described. Peculiarities in the application of the above classifications of bone tumors are noted. Methods for revealing degrees of tumour malignancy and chemotherapeutic pathomorphosis of malignant bone tumours, detected with pathohistological examination, are assessed. The necessity of a close cooperation of doctors of different specialities (orthopaedists-oncologists, specialists in visualizing methods of examination and pathomorphologists) in the process of diagnosing and treating tumours and tumour-like lesions of bones is emphasized.

Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review

Miscellaneous tumour-like ovarian lesions are histobiologically diverse, and are often mistaken for the more common ovarian cancers, leading to aggressive management. Knowledge of characteristic clinical, laboratory and imaging findings of these select non-neoplastic ovarian entities allows correct diagnoses and permits optimal management.

A 19-year audit of benign jaw tumours and tumour-like lesions in a teaching hospital in Nairobi, Kenya

Background: The diversity of benign jaw tumours may cause difficulty in a correct diagnosis and institution of an appropriate treatment. Data on the prevalence of these tumours is scarce from the African continent. We present a 19-year audit of benign jaw tumours and tumour-like lesions at a University teaching hospital in Nairobi, Kenya. Methods: Histopathological records were retrieved and re-examined from the Department of Oral and Maxillofacial pathology, University of Nairobi from 1992 to 2011. The jaw tumours were classified according to the latest WHO classification. Results: During the 19-year audit, 4257 biopsies were processed of which 597 (14.02%) were jaw tumours within an age range of between 4 to 86 years. There was greater number of odontogenic tumours 417 (69.85%) than the bone related lesions 180 (30.15%). Of the odontogenic tumours, the epithetlial and in the bone related types, the fibro-osseous lesions were frequent. Conclusion: Ameloblastoma and ossifying fibroma were the most frequent tumours reported in this audit. The information regarding the prevalence of these tumours is scarce from the continent and can be useful in early detection and management before they cause facial deformity.

Nodular skin problems encountered in a first-opinion equine clinic

Over an eight year period (2004-2011) 68 horses with nodular skin disease were diagnosed with 70 tumour like skin lesions. Diagnoses of the 70 nodular lesions were based on clinical features (5), cytology of fine needle aspirates(4), histological examination of either a biopsy or a complete surgical specimen (59) or on a combination of cytology and histology (2). Fifty-nine (84%) of the nodules proved to be genuine tumour like lesions and eleven (16%) were different forms of localised inflammatory dermatitis. Owners (93%) were very supportive of the need to perform histological or cytological investigations (65/70). Sarcoid was the most common nodular lesion (21) followed in order of occurrence by; melanoma (8), squamous cell carcinoma (8), nodular necrobiosis (7), mastocytoma (3), papilloma (2), maligne lymphoma (2), fibroma (2), naevus (1), botryomycosis (1), calcinosis circumscripta (1), collagen tumour (1), follicular hyperplasia (1) and follicular cyst (1). In the present study there was no breed predilection and the mean age of the group was 10.8 year (range 3-23 years). Melanoma occurred in 62.5% of the grey horses (5/8). Nodular necrobiose was only diagnosed in 10% of the cases , because when the nodule was noticed in the girth or saddle region no therapy was performed. Melanoma, nodular necrobiosis and sarcoids were in this relatively small study found on aspecific locations. In 70% (49/70) the nodules were surgical removed with either sedation and local anaesthesia (38) or general anaesthesia (11). Most patients (60.6%) were surgically treated at the practice (42/70). Of the 70 tumour-like lesions 61 lesions were scored for follow-up (for 8 cases no follow up was possible and one case had just started therapy); 64% (39/61) of the horses had no recurrence of the skin lesion(s) and the owners considerd their horses to be cured. Satisfaction rate as judged by owners was even higher: 80% (49/61).

Pediatric jaw tumors: Our experience

Background:Reports of series of central jaw tumours in children are rare hence predicting their biological behaviour as well as treatment, prognosis have not been documented from this part of the world.Aim:To study retrospectively, the paediatric central jaw tumours, reported to our institute with relation to site of occurrence, presentation and biological behaviour.Materials and Methods:All consecutive patients (<18 years), between 2004-2010, histologically diagnosed as having an intraosseous tumour or tumour-like lesions formed the study population. Patients fulfilling the inclusion criteria were only considered for further study. The entire study material was analyzed and grouped into various categories for logical conclusions. The data accumulated were grouped, entered and analyzed.Results:Sixty-one cases fulfilled the criteria. Gender distribution was equal, with mandible predominance (2.2:1) and a predominance of non-odontogenic lesions (2:1). There were 4 malignant and 57 benign conditions. Anterior jaw lesions were 23 while 38 were present in the posterior region of jaws (1:1:6).Conclusions:The pattern of central jaw tumours presentation in children from this part of India has been documented. In this study, paediatric jaw tumours are less common compared to those in adults with non-odontogenic tumours being common. The finding of the present study indicates that an impacted tooth, beyond the eruption time deserves more attention for the reason of associated pathologies in children.

Clinico-pathological study of 50 cases of tumours of larynx.

The larynx serves to protect the lower airways, facilitates respiration and plays a key role in phonation. Based on anatomic location, the larynx is divided into the supraglottic larynx, the glottis or glottic larynx, and the subglottic larynx. The tumours of larynx can be divided into benign or malignant. Laryngeal granulomas, Vocal cord nodules, Vocal cord polyps are tumour-like lesions of larynx. Benign laryngeal tumors include a large number of lesions like papillomas, hemangiomas, fibromas, chondromas, myxomas, and neurofibromas. About 95% of laryngeal carcinomas are typical squamous cell tumours. Rarely adenocarcinomas are seen, presumably arising from mucous glands. The exact cause of laryngeal cancer is still unknown. Diagnosis is based on direct or indirect visualization of the larynx, supplemented by CT scan and confirmed by histopathological examination. The aim of the present study was to study the clinical aspects, histopathological patterns of tumours of the larynx to study the various predisposing factors of laryngeal tumours. The present study was undertaken on 50 patients clinically diagnosed as cases of tumour of larynx. These patients were made to undergo direct laryngoscopy and the biopsy taken from the growth in the larynx was sent to the department of pathology for histopathological examination. Smoking played the main role in benign growths (25%). The main predisposing factor (73.2%) for malignant growths was smoking, tobacco chewing and alcohol abuse. The most common benign tumour of larynx was the vocal polyp. Out of the 30 cases of squamous cell carcinoma, 15 (50%) were well differentiated, 8 (26.6%) were moderately differentiated and 3 (10%) were poorly differentiated. The symptoms of laryngeal tumours can vary from mild hoarseness of voice to life threatening respiratory distress. All available methods of study should be utilized to make the diagnosis as early as possible. Early diagnosis of the lesion can lead to effective management.

The nature of the characteristic cementum-like matrix deposits in the walls of simple bone cysts

Simple bone cysts (SBC) are benign tumour-like lesions, generally occurring in the metaphyses of long bones before skeletal maturity. Remarkably, in 10-70% of cases, a peculiar, amorphous and hypocellular matrix is found in the walls of SBCs which is usually regarded to consist of (calcified) fibrin clots in the literature. Because these deposits are strongly fuchsinophilic in routine van Gieson stains, the aim of this study was to investigate a series of SBCs using immunohistochemistry and electron microscopy. A comprehensive panel of antibodies against fibrin as well as collageneous and non-collageneous proteins of bone was used, and detected substantial amounts of collagen and decorin as the main components of the investigated matrix. Electron microscopy clearly underlined the immunohistochemical results and also showed abundant fibrils with a periodic banding characteristic of collagen. Adjacent to and in between these collagen deposits runx-2- and osterix-expressing cells were detectable, most probably representing immature osteoprogenitor cells. Although still stated in the literature and most current textbooks, we were not able to detect any evidence of fibrin as a component of the respective matrix deposits that seem to consist predominantly of collagen and decorin.

Incidental finding of a splenic hamartoma with tumour-like extramedullary erythropoiesis

Hamartomas of the spleen are rare benign tumour-like lesions that tend to be asymptomatic incidental findings. Splenic hamartomas with tumour-like extramedullary erythropoiesis are extremely rare. A 70-year-old male patient with dyspnoea and a nodular intrapulmonary lesion morphologically verified by CT underwent fibre bronchoscopy, which showed a pea-shaped foreign body that was retrieved without complication. As a secondary finding, the CT showed a splenic lesion of about 8 cm in size. An MR study showed an expansive process in the center of the spleen. The patient was completely free of clinical symptoms. Because of the unknown nature and the high risk for spontaneous rupture of the lesion, a splenectomy was performed. The histological analyses revealed tumour-like extramedullary erythropoiesis of the spleen. The patient was discharged in good condition ten days postoperatively. A hamartoma of the spleen with extramedullary tumor-like erythropoiesis should be considered in the differential diagnosis of a splenic lesion.

P86. Tumours and tumour-like lesions of the oral cavity and related structures presented in UKM Medical Centre: A two-year study

P86. Tumours and tumour-like lesions of the oral cavity and related structures presented in UKM Medical Centre: A two-year study

Healing of cavitary bone defects

Background It has been a retrospective review of healing of bone defects, due to benign tumours or tumour-like lesions. We evaluated the therapeutical outcome in patients after use of either autologous bone grafts, or β-tricalcium phosphate (β-TCP), or mixture of both components. We tried to find indications for β-TCP application.

Biphasic bone substitute and fibrin sealant for treatment of benign bone tumours and tumour-like lesions

Bone defects resulting from tumour resection or curettage are most commonly reconstructed with autologous bone graft which is associated with limited availability and donor site morbidity. Recent research has focussed on synthetic biomaterials as bone graft substitutes. The aim of this study was to assess the safety and efficiency of a bone substitute as an alternative for autologous bone in the treatment of benign bone tumours and tumour-like lesions. In the present study, a biphasic ceramic (60% HA and 40% β-TCP) combined with a fibrin sealant was used to reconstruct defects in 51 patients after curettage of benign bone tumours or tumour-like lesions. Patient age ranged from eight to 68 years (mean 29.7), defect size from 2 cm(3) to 35 cm(3) (mean 12.1), and time of follow-up from one to 56 months (mean 22.7). Radiologic analysis showed complete bony defect consolidation in 50 of 51 patients after up to 56 months. No postoperative fractures were observed. Revision surgery had to be performed in one case. Histological analysis showed new bone formation and good biocompatibility and osseointegration of the implanted material. In summary, the biphasic ceramic in combination with fibrin sealant was proven an effective alternative to autologous bone grafts eliminating the risk of donor site morbidity for the patient.