Use Of Preoperative Biopsy Research Articles

A Single Center Experience With Bilateral Wilms Tumor.

Wilms tumor (WT) is the most common pediatric renal malignancy and bilateral disease (BWT) occurs in 5% of cases and is associated with poor outcomes. Management of BWT includes chemotherapy and oncologic resection while preserving renal function. Previous literature has demonstrated variable approaches in BWT treatment. The aim of this study was to examine a single institution experience and outcomes with BWT. A retrospective chart review was performed for all patients with WT treated at a free-standing tertiary children's hospital between 1998 and 2018. Patients with BWT were identified and treatment courses were compared. Outcomes of interest included need for dialysis post-operatively, need for renal transplantation post-operatively, disease recurrence, and overall survival. Of 120 children with WT, 9 children (6F:3M) of median age 32months (IQR: 24-50months) and median weight 13.7kg (IQR: 10.9-16.2kg) were diagnosed with and treated for BWT. Pre-operative biopsies were obtained in 4/9 patients, 3 of whom received neoadjuvant chemotherapy and 1 who underwent radical nephrectomy. Of the 5 patients who did not undergo biopsy, 4/5 were treated with neoadjuvant chemotherapy, and 1/5 underwent upfront nephrectomy. Post-operatively, 4/9 children required dialysis, of whom 2 subsequently underwent renal transplantation. Two patients were lost to follow-up, and of the remaining 7 patients, disease recurrence occurred in 5/7 children and overall survival was 71% (n=5). Management of BWT varies regarding the use of pre-operative biopsy, neoadjuvant chemotherapy, and extent of disease resection. Further guidelines on treatment protocols may optimize outcomes in children with BWT.

Diagnostic Utility of the PD-L1 Immunostaining in Biopsy Specimens of Patients with Biliary Tract Neoplasms

BackgroundAnti-programmed death 1/programmed death ligand 1 (PD1/PD-L1) antibodies have been successfully used as treatment agents for several solid tumors; however, it is difficult to predict their effectiveness. We evaluated whether biopsy specimens could predict the positive status of PD-L1 in surgically resected tissue. MethodsAmong 91 patients who underwent tissue sampling with endoscopic or liver biopsy before surgery for biliary tract neoplasms in an academic center, 45 (49%) patients were selected for retrospective analysis because the quality and quantity of their biopsy specimens were adequate for histologic evaluation. We performed immunohistochemical staining to investigate the PD-L1 expression in both resected and biopsy specimens. The percentage of the positively stained cells was calculated for subsequent use in the correlation investigation. ResultsThe biopsy methods were endoscopic retrograde cholangiopancreatography (ERCP) in 28 cases, percutaneous liver biopsy in 10 cases, and endoscopic ultrasound fine-needle aspiration in 7 cases. Among the 45 patients, when patients with > 10% positive tumor cells in surgically resected tissues were regarded as truly positive PD-L1, the positive and negative concordance rates between surgically resected tissues and biopsy samples were 56% (5/9) and 100% (36/36), respectively. With regard to the use of preoperative biopsy as a diagnostic tool, all (5/5) PD-L1-positive patients had a positive resected specimen. The accuracy of each biopsy method was as follows: ERCP, 89% (25/28); fine-needle aspiration, 86% (6/7); and liver biopsy, 100% (10/10). ConclusionsBiopsy samples could be a surrogate material for the assessment of the PD-L1 expression with substantial positive and high negative concordance rates.

Retrorectal tumors: A challenge for the surgeons.

Retrorectal or presacral tumors are rare lesions located in the presacral area and considered as being derived from multiple embryological remnants. These tumors are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. The most common among these are congenital benign lesions that present with non-specific symptoms, such as lower back pain and change in bowel habit. Although congenital and developmental tumors occur in younger patients, the median age of presentation is reported to be 45 years. Magnetic resonance imaging plays a crucial role in treatment management through accurate diagnosis of the lesion, the evaluation of invasion to adjacent structures, and the decision of appropriate surgical approach. The usefulness of preoperative biopsy is still debated; currently, it is only indicated for solid or heterogeneous tumors if it will alter the treatment management. Surgical resection with clear margins is considered the optimal treatment; described approaches are transabdominal, perineal, combined abdominoperineal, and minimally invasive. Benign retrorectal tumors have favorable long-term outcomes with a low incidence of recurrence, whereas malignant tumors have a potential for distant organ metastasis in addition to local recurrence.

S1521 Solid Pseudopapillary Neoplasm: Case Report of a Rare Pancreatic Tumor

Introduction: Solid pseudo-papillary neoplasm (SPN) is a rare low-grade malignant cystic exocrine neoplasm of the pancreas with a distinctive pathologic architecture. It is usually diagnosed incidentally, and complete resection is mainly curative with excellent long-term prognosis despite a small malignant potential. Case Description/Methods: A 28 yo female with history of lumbar disc herniation and subsequent micro-discectomy, presented to the emergency department with a 1-day history of severe left upper quadrant abdominal pain, nausea, and vomiting. She denied any other symptom or previous trauma. On physical examination, the abdomen was soft with mild tenderness in LUQ, and no rebound or palpable mass. Lab evaluation showed a mild leukocytosis (16.5K), but otherwise liver tests and pancreatic enzymes were within normal limits. CT scan showed an obstructing ureteral calculus and a large 7.1 cm incidental mass in the pancreatic tail with chronic splenic vein occlusion. MRCP later confirmed a 6.8 x 7.5 x 7.7 cm heterogeneous but well defined/encapsulated arising from the pancreatic tail/distal body. The lesion had heterogeneous enhancement, diffusion restriction, and areas of T1 hyperintensity. The patient successfully underwent a laparoscopic distal pancreatectomy and splenectomy and was discharged home after 3 days. Pathology confirmed the suspected diagnosis of SPN of the pancreas with samples negative for foci of malignancy. Immuno-histochemical stains revealed tumor cells to be positive for beta-catenin, cyclin D1, CD10 and synaptophysin, while negative for chromogranin. Discussion: SPN is considered a low-grade malignant pancreatic tumor according to the WHO Classification of Digestive System Tumors, with reported malignant transformation of around 15-16%. Despite this, SPN still has a generally excellent long-term prognosis. SPNs have a characteristic appearance on cross-sectional imaging, appearing as a mixed solid and cystic pancreatic lesion, however cytologic analysis is usually done for confirmation of the diagnosis. The use of pre-operative biopsy or EUS-FNA has been controversial and is felt to be of limited benefit. In our patient, the post-operative cytologic diagnosis after surgery proved valuable for establishing the diagnosis with no need for pre-operative EUS-FNA. Treatment usually is surgical resection, which is curative; appropriate clinical follow-up is warranted due to risk of local recurrence. There is no clear role for systemic chemotherapy, hormonal therapy, or radiotherapy.Figure 1.: A. MRI abdomen and pelvis with contrast T2 Coronal showing a heterogenous well defined and encapsulated partially exophytic mass arising from the pancreatic tail/distal body. B. Axial LAVA (3D T1 weighted sequence with Fat Suppression) pre-contrast. C. LAVA post-contrast Figure 2-D. Solid sheet of uniform tumor cells showing focal loosely cohesive pseudopapillary architecture (Hematoxylin & Eosin, x 100). E. Nuclear and cytoplasmic immunoreactivity for B-catenin (B-catenin immunohistochemical stain, x 200).

Diagnosis and Treatment of Laryngeal Schwannoma: A Systematic Review.

Objective This review summarizes the clinical features, diagnostic workup, and surgical treatment of laryngeal schwannoma with the aim of providing guidance for the management of this rare disease. The collated data allowed the statistical testing of several hypotheses, including the efficacy of endoscopic vs open surgical intervention and the usefulness of preoperative biopsy. Data Sources PubMed, Google Scholar, Cochrane, and SCOPUS. Review Methods Basic epidemiological and clinical presentation data were collated together with details of diagnostic image modality, lesion attributes, and the use of preoperative biopsy. Surgical approach to intervention and outcome was also collated and simple statistical analyses applied. Results The 60 original articles selected provided a combined cohort of 74 patients for review. The combined data revealed that schwannoma with pedunculated morphology were always safely removed by endoscopic resection regardless of size and should be treated as a separate entity. Of the nonpedunculated schwannoma, larger tumors were more likely to undergo an open approach, which in turn was associated with higher rates of tracheotomy and postoperative vocal fold paralysis. The small cohort did not reveal a significant association between surgery type and persistent disease. Interestingly, the data revealed a significant association between the use of incisional biopsy and persistent disease. Cases exhibiting extralaryngeal extension of the lesion were shown to exclusively belong to patients with neurofibromatosis/schwannomatosis syndromes. Conclusions Taken together, these findings suggest that incisional biopsy should be avoided, and given the benign nature of the pathology, the least invasive radical approach should be employed.

Surgical Outcomes in Adults With Benign and Malignant Sacrococcygeal Teratoma

Adult sacrococcygeal teratomas are rare, and limited data exist on their management and outcomes following surgery. The aim of this study was to review the outcomes in adult patients undergoing surgery for sacrococcygeal teratomas. A retrospective review of our prospectively maintained surgical pathology and tumor registries was conducted. This study was conducted at the Mayo Clinic in Rochester. Information was collected on patients treated between 1980 and 2013. A total of 26 patients with sacrococcygeal teratoma were identified (19 female), with a median age of 37.5 years. Malignancy was seen in 5 patients. Data on demographics, clinical presentation, tumor pathology, adjuvant therapy, surgical approach, surgical margins, use of preoperative biopsy, radiological investigations, morbidity, mortality, and local recurrence was collected. Complications were assessed by using the Clavien-Dindo system of classification. Patients most commonly presented with pelvic pain (n = 16) and/or a palpable mass (n = 15). On radiology, 8 lesions were purely cystic, 14 were mixed, and 4 were solid; teratoma was suspected as a diagnosis in 8 patients. Preoperative biopsy (13 patients) had 100% concordance with final pathology. Median tumor size was 6 cm, and the surgical approach was posterior only (n = 15), anterior only (n = 5), and combined anterior-posterior (n = 6). Of 5 patients with malignancy, 3 died of recurrent disease. Limitations of this study include the small number of patients, the long study period, and the heterogeneous nature of these tumors. Presacral teratomas require multidisciplinary management and have a risk of malignant transformation. They are more common in females, and the majority are intrapelvic in location in adults. We recommend clinical evaluation, radiological investigation, and image-guided biopsy in all suspicious presacral lesions. A treatment algorithm has been designed to improve the management of these rare tumors.

The Usefulness of Preoperative Biopsy in Unilateral Nasal Masses

Unilateral nasal masses are considered suspicious for proliferative diseases. Several tools are routinely used to investigate unilateral lesions such as imaging and nasal biopsy. This study investigated the usefulness of nasal biopsy in predicting the actual nature of unilateral lesions. Preoperative nasal biopsy pathological results were compared with the final pathology obtained during an operation. Forty-six patients with unilateral nasal masses were included in the study group. In 40 patients the final pathology was similar to the preoperative nasal biopsy. In three patients the biopsy specimen was a benign polyp and the final pathology was of an inverted papilloma in two patients and hemangiopericytoma in one patient. In two patients the biopsy specimen was suspicious for an inverted papilloma and the final pathology was a benign polyp. In one patient the biopsy specimen was chordoma and the final pathology was osteosarcoma. The total agreement was 86.9%. The kappa value was 81.2%. Preoperative nasal biopsy is important and useful in evaluating unilateral nasal masses.

The role of biopsy of the nontumorous liver parenchyma in patients considered for partial resection of small hepatocellular carcinoma

We read with interest the article by Roayaie et al. reporting on resection of hepatocellular carcinoma (HCC) ≤2 cm in two Western centers.1 This elegant study shows that excellent results (e.g., up to 80% 5-year survival) can be achieved with adequate surgical resection in selected patients with small HCC. These results are in line with the study from our group published this year in HEPATOLOGY concerning potentially transplantable patients who were resected first in a strategy of salvage transplantation in cases of recurrence.2 In the context of organ shortage, we fully agree with the conclusion that resection should continue to be a first-line option in patients with preserved liver function.1 In addition to classical tumor factors, these two studies confirm that nonanatomic resection and presence of cirrhosis were associated with a higher risk of recurrence. In our series, for instance, 64% of the patients who did not experience recurrence after resection had stage 3 fibrosis. The feasibility of anatomic resection, which was independently associated with less recurrence, as well as postoperative morbidity, obviously depends upon the extent of underlying fibrosis. Although Roayaie et al. have shown that advances in the management of HCC could come from the underlying liver parenchyma, they do not mention the usefulness of preoperative biopsy of nontumorous liver parenchyma, to better select the optimal candidates for resection. The importance of nontumorous parenchyma is illustrated by the finding by the same group that gene expression signatures in the adjacent liver parenchyma, but not in the tumor, were highly correlated to recurrence and survival after resection.3 Overall, these data strongly suggest that in addition to tumor status, careful assessment of nontumorous liver parenchyma with preoperative biopsy of the nontumorous parenchyma should be incorporated in the decision-making of patients with small HCC who are potential candidates for resection.

Prognostic factors for surgical treatment of soft-tissue sarcomas in dogs: 75 cases (1986–1996)

Objective To determine results of surgery for treatment of soft-tissue sarcomas in dogs and to identify prognostic variables that can be used to predict outcome. Design Retrospective case series. Animals Dogs with soft-tissue sarcomas that had surgical treatment only. Procedure Records were examined for clinically relevant data. Histologic samples were reviewed. Follow-up information was obtained by physical examination or telephone conversations with referring veterinarians or owners. Results 75 dogs with soft-tissue sarcomas of the trunk and extremities were identified. Median age was 10.6 years. Malignant peripheral nerve sheath tumors were of a significantly lower grade than other tumors. Tumors recurred locally in 11 of 75 (15%) dogs. Evaluation for lack of tumor cells at surgical margins was prognostic for local recurrence. Metastatic disease developed in 13 of 75 (17%) dogs. Tumor mitotic rate was prognostic for development of metastasis. Twenty-five of 75 (33%) dogs died of tumor-related causes. Percentage of tumor necrosis and tumor mitotic rate were prognostic for survival time. Median survival time was 1,416 days. Clinical Implications On the basis of a low local recurrence rate and high median survival time, wide excision of tumor margins or radical surgery appeared to be an effective means for managing soft-tissue sarcomas of the trunk and extremities. Analysis of histologic characteristics for prognosis supported use of preoperative biopsy. Surgical margins should be evaluated, and early use of aggressive surgery is indicated in the management of soft-tissue sarcomas in dogs. (J Am Vet Med Assoc 1997;211:1147–1151)