Multimodal Method for Differentiating Various Clinical Forms of Basal Cell Carcinoma and Benign Neoplasms In Vivo

Correct classification of skin lesions is a key step in skin cancer screening, which requires high accuracy and interpretability. This paper proposes a multimodal method for differentiating various clinical forms of basal cell carcinoma and benign neoplasms that includes machine learning. This study was conducted on 37 neoplasms, including benign neoplasms and five different clinical forms of basal cell carcinoma. The proposed multimodal screening method combines diffuse reflectance spectroscopy, optical coherence tomography and high-frequency ultrasound. Using diffuse reflectance spectroscopy, the coefficients of melanin pigmentation, erythema, hemoglobin content, and the slope coefficient of diffuse reflectance spectroscopy in the wavelength range 650-800 nm were determined. Statistical texture analysis of optical coherence tomography images was used to calculate first- and second-order statistical parameters. The analysis of ultrasound images assessed the shape of the tumor according to parameters such as area, perimeter, roundness and other characteristics. Based on the calculated parameters, a machine learning algorithm was developed to differentiate the various clinical forms of basal cell carcinoma. The proposed algorithm for classifying various forms of basal cell carcinoma and benign neoplasms provided a sensitivity of 70.6 ± 17.3%, specificity of 95.9 ± 2.5%, precision of 72.6 ± 14.2%, F1 score of 71.5 ± 15.6% and mean intersection over union of 57.6 ± 20.1%. Moreover, for differentiating basal cell carcinoma and benign neoplasms without taking into account the clinical form, the method achieved a sensitivity of 89.1 ± 8.0%, specificity of 95.1 ± 0.7%, F1 score of 89.3 ± 3.4% and mean intersection over union of 82.6 ± 10.8%.

Desmoid Fibromatosis of the Anterior Abdominal Wall in Pregnancy: A Case Report and Review of the Literature

A desmoid tumor (DT) is a rare benign neoplasm arising from muscle aponeurosis, associated mostly with trauma or pregnancy. DT has an infiltrative and locally aggressive growth pattern and usually does not metastasize. However, it has a high recurrence and complication rate. When it occurs in pregnancy, the pregnancy and delivery is taken as an individual case for optimal management by physicians and midwifes, who need to be cautious in finding the optimal delivery mode for the patient, which depends on the tumor size, location, behavior, and past history. The authors report a case of 29-year-old pregnant woman who previously underwent systemic oncological treatment for a large abdominal wall desmoid tumor and became pregnant afterwards. The history of DT presented a follow-up and delivery challenge. Observational management was chosen with an elective cesarean section at week 38 + 4 of pregnancy with uncomplicated postpartum follow-up. The authors detail the clinical management and chosen therapeutic approach; chemotherapy can be a choice in the treatment options for patients with DTs, although the majority of DTs are treated surgically with subsequent mesh plastic. Moreover, the authors provide a systematic review of the literature focused on the treatment management of DTs in pregnant women during pregnancy and the postpartum period, as pregnancy-associated desmoid tumors are a specific condition, where the optimal management is not well established, despite some guidelines for non-pregnant patients.

Phyllodes Tumor of the Breast Complicated With Mastitis

One of the rarest fibro-epithelial neoplasms of the breast during pregnancy is the phyllodes tumor (PT). It is typically a painless, bi-phasic, and rapidly growing neoplasm that resembles fibroadenomas. It is still unclear if the neoplasm is hormone-dependent during pregnancy. It is often challenging to diagnose and treat PT. Herein, we report a case of a 30-year-old female at 31 weeks gestation who was diagnosed with a benign phyllodes tumor of her breast with concurrent mastitis. She was first seen during her third trimester where the neoplasm was around 5 cm as reported by the ultrasound (US) examination. Her biopsy report was suggestive of a PT and she was advised surgery with excision of the tumor margin, but she refused. Ten days after her delivery she presented to the emergency department with a fever and a hard, engorged, erythematous, and tender left breast. She was diagnosed with mastitis of the left breast. She then underwent incision and drainage of the left breast that drained purulent milk; additionally, large necrotic grape-like tissues were removed and were confirmed by the histopathology report as a benign phyllodes tumor of the breast.

A rare benign tumor of the liver mimicking angiosarcoma: Anastomosing hemangioma

Anastomosing hemangioma of the liver (AHL) is a very rare condition and limited to a few cases. It is often confused with well-differentiated angiosarcomas and causes overtreatment. In this report, we present a 53-year-old female patient diagnosed with AHL. Since the tumor is rarely seen, it is important to define well the imaging and pathological features for preventing unnecessary surgeries and related morbidities.

Evaluation of Fine Needle Aspiration Cytopathology in Salivary Gland Tumors under Milan System: Challenges, Misdiagnosis Rates, and Clinical Recommendations

(1) Background: Salivary gland tumors are rare in the head and neck. To determine the need and extent of surgical intervention, fine needle aspiration (FNA) is a widely accepted tool to approach salivary gland lesions. However, the FNA cytology varies between entities, while the lack of uniform terminology makes diagnosis more challenging. Since establishing the Milan system for reporting salivary gland cytopathology (MSRSGC) has become an increasingly accepted reporting standard, further examination and detailed recommendations were needed. (2) Methods: Between April 2013 and October 2021, 375 cases with FNA and salivary gland resection were retrospectively collected. All FNA specimens were reclassified according to the criteria of MSRSGC. After surgical excision, the FNA data were compared with the histological diagnosis to estimate the risk of malignancy (ROM), the risk of neoplasm (RON), and the diagnostic accuracy for each diagnostic category. (3) Results: Our cohort's distribution of ROM and RON was similar to the MSRSGC's recommendation. Carcinoma ex pleomorphic adenoma (CXPA) has the highest rate (66.7%) of misdiagnosed as a nonneoplastic lesion or benign salivary gland tumor. Pleomorphic adenoma (PA) and Warthin's tumor were the most common benign salivary gland tumors, while the cytology diagnosis of Warthin's tumor seems more challenging than PAs. (4) Conclusions: Despite the convenience and effectiveness of MSRSGC, we suggest close follow-up, re-biopsy, or surgical removal for salivary lesions even in Milan IVA-Benign for possibly missing FNA of malignancy, mixed lesions, or prevention of malignant transformation.

Clinical and epidemiological risk factors for infantile hemangioma: A case-control study

There is limited data on risk-factors of infantile hemangioma (IH) in African and Arab countries. One hundred thirty-two patients with IH were enrolled and compared to 282 healthy controls. Female sex (odds ratios [OR]: 2.2; 95% confidence interval [CI] 1.4-3.6), low birth weight (OR: 4.5; 95% CI 1.9-10.6), and progesterone intake (OR: 38.6; 95% CI 5-296) were the only independent risk factors identified for development of IH, while no associations were found multiple gestation and preeclampsia.

Lipoleiomyoma With Bizarre Nuclei and Abundant Mast Cells

Lipoleiomyoma is an uncommon neoplasm of the uterus with a variable incidence in the literature. Histologically, it consists of smooth muscle cells intermixed with mature adipocytes. The histogenesis of this tumor remains obscure and the presence of atypical cells may raise the suspicion of leiomyosarcoma so it is crucial to distinguish between the two. On the other hand, tumor-associated mast cells are being recognized as tumor modulators and potential therapeutic targets. Here, we discuss the case of a 57-year-old female, who presented with a nonspecific symptom of postmenopausal bleeding. She was found to have a large uterine mass and had been treated surgically with a hysterectomy. Histological examination revealed the diagnosis of this uncommon entity. Considering the rarity of the disease, we report this case to add to the existing literature. Furthermore, the significance of these findings is still poorly understood and needs more investigation to fill in the lacking knowledge.

Cytological and histopathological features of recurrent calcifying aponeurotic fibroma of neck in an adolescent male-rare presentation of a rare tumour

Calcifying aponeurotic fibroma is a rare benign but locally aggressive soft tissue tumour. It is most commonly seen in distal extremities and very rarely seen in head and neck region. In this case report, we describe both cytological and histological features of this tumour in a young adolescent male.

Aggressive recurrent respiratory papillomatosis: A series of five consecutive patients successfully treated with adjuvant intravenous bevacizumab. A single Belgian academic center experience

BACKGROUND

Recurrent respiratory papillomatosis (RRP) is a currently incurable benign neoplasm caused by human papilloma virus (HPV) infection. It usually reduces voice, respiratory, and general quality of life, and is sometimes life-threatening. Patients usually need repeated operations. The use of adjuvant bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A, has been described in several case reports, with a good efficacy and safety profile.

METHODS

We report the cases of five patients with aggressive RRP who were treated with adjuvant systemic bevacizumab in a single Belgian tertiary center.

RESULTS

A complete response was achieved in four patients after a median of 4.5 months, and a partial response in one. In all cases, the number of surgeries was drastically reduced, and quality of life improved. Toxicity was easily managed.

CONCLUSIONS

Systemic bevacizumab seems to be an effective and safe adjuvant treatment for aggressive RRP.

Impact of the COVID-19 pandemic on surgery for benign diseases in gynecology: A nationwide survey by the Japan Society of Obstetrics and Gynecology

AIM

This study aimed to clarify the impact of coronavirus disease 2019 on gynecology practice in Japan, in particular, on surgeries for benign gynecological diseases.

METHODS

An online questionnaire was distributed to 966 facilities in Japan, including core facilities, facilities participating in perinatal and gynecologic oncology registries, and facilities certified for training by the Japanese Society of Obstetrics and Gynecology Endoscopy. The number of surgeries performed was compared between 2019 and 2020, when the novel coronavirus disease was prevalent.

RESULTS

Five hundred and eighty (58.2%) facilities responded. The total number of surgeries decreased from 129 648 in 2019 to 118 565 in 2020, by 8.5%, for all surgical procedures. However, there was a clear increase in the number of robotic surgeries performed in 2020 compared to that in 2019 for all populations. The number of total hysterectomies decreased markedly from 15 385 in 2019 to 12 531 in 2020, a fall of 10.1%.

CONCLUSIONS

The number of surgeries for benign gynecological diseases decreased by 8.5% in 2020 compared to that in 2019. This value is among the lowest in the world.

Ossifying Fibroma in the Maxilla and Mandible: A Case Report With a Brief Literature Review

Fibro-osseous lesions in the jaw bones include fibrous dysplasia, ossifying fibroma (OF), cemento-ossifying fibroma, florid osseous dysplasia, and focal osseous dysplasia. OF is the most common fibro-osseous tumor that presents as a slow-growing well-encapsulated benign neoplasm composed of varying amounts of bone or cement-like tissue in a fibrous stroma well-demarcated from the adjacent normal bone. OF is most common in the jaw bones, with a predilection for the mandible. OF usually occur as solitary lesions and rarely as multiple lesions in a patient. We present clinical and radiologic features, histopathology, and surgical management of a rare case with large synchronous OFs in the mandible and maxilla and a brief review of the literature.

Multivariate Curve Resolution Alternating Least Squares Analysis of In Vivo Skin Raman Spectra

In recent years, Raman spectroscopy has been used to study biological tissues. However, the analysis of experimental Raman spectra is still challenging, since the Raman spectra of most biological tissue components overlap significantly and it is difficult to separate individual components. New methods of analysis are needed that would allow for the decomposition of Raman spectra into components and the evaluation of their contribution. The aim of our work is to study the possibilities of the multivariate curve resolution alternating least squares (MCR-ALS) method for the analysis of skin tissues in vivo. We investigated the Raman spectra of human skin recorded using a portable conventional Raman spectroscopy setup. The MCR-ALS analysis was performed for the Raman spectra of normal skin, keratosis, basal cell carcinoma, malignant melanoma, and pigmented nevus. We obtained spectral profiles corresponding to the contribution of the optical system and skin components: melanin, proteins, lipids, water, etc. The obtained results show that the multivariate curve resolution alternating least squares analysis can provide new information on the biochemical profiles of skin tissues. Such information may be used in medical diagnostics to analyze Raman spectra with a low signal-to-noise ratio, as well as in various fields of science and industry for preprocessing Raman spectra to remove parasitic components.

Giant Anal Fibroepithelial Polyp in a Healthy Teenage Boy: A Case Report and Literature Review

Background: Fibroepithelial polyps of the anus have been described as mucosal hypertrophy in response to chronic irritation or tissue damage. Lesions usually remain small and mostly present in elderly adults with local disease. Case Report: An otherwise healthy 15-year-old male presented with a giant pedunculated mass projecting out of the anal verge that enlarged over 2 years, causing discomfort. Results: Upon surgical excision and histologic examination, the mass resembled a fibroepithelial polyp with numerous dilated lymphatics. Conclusions: While literature describes the spectrum of pathology possible in such lesions, often consisting of a mixture of stromal and epithelial components, dilated lymphatics are less common. This giant anal fibroepithelial polyp characterized by edematous stroma and numerous dilated lymphatics is consistent with lymphangioma. To our knowledge, this presentation is novel in this age group with no underlying risk factors.

Urban Air Pollution and Emergency Department Visits for Neoplasms and Outcomes of Blood Forming and Metabolic Systems

This study focused on investigating possible associations between exposure to urban air pollution and the number of emergency department (ED) visits for various health outcomes. The outcomes were grouped into four chapters of the International Classification of Diseases Tenth Revision (ICD-10) system (i.e., Chapter II-IV: “Neoplasms”, “Diseases of the blood”, “Endocrine, nutritional and metabolic diseases”, and XVIII: “Symptoms, signs and abnormal clinical and laboratory findings“). The data were collected for the city of Toronto, Canada, (2004–2015, 4292 days). Four gaseous air pollutants (carbon monoxide (CO), nitrogen dioxide (NO₂), ground level ozone (O₃), and sulfur dioxide (SO₂)) and fine particulate matter (PM_2.5), and two calculated air quality health indexes (AQHI) based on Toronto were used. The statistical models were constructed by applying the conditional Poisson regression. The exposure was assessed over a maximum of 15 days (time lags 0–14 days). An analysis was performed with the following strata: sex, age, and seasons. Relative risks (RR) and their 95% confidence intervals (95%CI) were estimated for an increase in concentration by a one interquartile range (IQR). For the AQHI (composed of NO₂, O₃, and PM_2.5), IQR = 1, the estimations for lag 1 and all patients, are RR = 1.023 (95%CI: 1.008, 1.038), 1.026 (1.012, 1.040), 1.013 (1.003, 1.024), and 1.007 (1.003, 1.010) for Chapters II–IV and XVIII, respectively. The results show that in the four large, analyzed health groups, the impact of air quality mainly occurs over a short period (from current day to a maximum of 3 days after exposure).

Trends in Office Visits for the Five Most Common Skin Diseases in the United States

Objective

We sought to determine the outpatient visit rates for the five most common skin conditions among dermatologists and non-dermatologists.

Methods

We conducted a population-based, cross-sectional analysis using the National Ambulatory Medical Care Survey between 2007 and 2016, the most recent years available.

Results

The five most common skin diagnoses among all medical specialties were contact dermatitis, acne vulgaris, actinic keratosis, benign neoplasm of the skin, and epidermoid cyst, respectively. Actinic keratosis followed by acne vulgaris and benign neoplasm of skin were the three most common visit diagnoses among dermatologists, whereas contact dermatitis, acne vulgaris, and epidermoid cyst were the most common among non-dermatologists. Overall, visits for the five most common skin conditions seen by dermatologists and non-dermatologists remained constant over the study interval.

Limitations

Misclassification bias could be impacting the results of this study. Additionally, the NAMCS samples only non-hospital based outpatient clinicians, and thus cannot describe hospital-based outpatient visits or inpatient hospital care.

Conclusion

Visits for contact dermatitis, acne, actinic keratosis, benign neoplasm of the skin, and epidermoid cysts have remained constant over the last ten years. These conditions represent the most common diagnoses of the skin at both dermatologists and non-dermatologists outpatient visits. Non-dermatologists continue to see almost half of visits for the five most common skin diagnoses. Patients are often referred from the primary care setting for growths of skin and skin lesions; thus, it is not surprising that actinic keratosis has remained the most common diagnosis among dermatologist and benign neoplasm the third most common dermatologic diagnosis.

[The experience of interdisciplinary interaction in elimination of midface deformation (clinical observation)]

Fibrous dysplasia is a hamartoma appearing as a benign pathologic process in which normal bone tissue formation is replaced by overgrowth of fibrous connective tissue. The problem of diagnosis and treatment of patients with fibrous dysplasia remains unsolved in the absence of a uniform understanding of its etiology and pathogenesis. Treatment and rehabilitation of patients with midface fibrous dysplasia is a complicated medico-social problem, which requires interaction of specialists of different fields to resolve it. The disease presents a practical interest for doctors of more than 20 specialties, as it can lead to disability. The present article describes a clinical case of interdisciplinary interaction of specialists in the fields of maxillofacial surgery, ophthalmology, otorhinolaryngology, plastic surgery and radiology involved in complex treatment of a patient with midface fibrous dysplasia accompanied by eyeball dislocation, decreased vision, as well as progressive impairment of nasal breathing function. The performed treatment resulted in favorable functional and aesthetic outcomes including elimination of exophthalmos, vertical strabismus, lacrimation disorders, nasal breathing disorders, increase of visual acuity and improvement of external appearance.

Adenomatoid tumours of the gastrointestinal tract - a case-series and review of the literature

AIMS

Adenomatoid tumours are mesothelial-derived benign neoplasms with a predilection for the genital tract. Extragenital sites are rare and can cause significant diagnostic challenges. Herein, we describe the clinicopathological features of a cohort of adenomatoid tumours involving the gastrointestinal tract and liver in order to more clearly characterise their histological findings and aid in diagnosis.

METHODS AND RESULTS

The pathology databases at four institutions were searched for adenomatoid tumours involving the gastrointestinal tract or liver, yielding eight cases. Available clinicoradiological and follow-up data were collected from the medical records. Six tumours were incidentally discovered during imaging studies or at the time of surgical exploration for unrelated conditions; presenting symptoms were unknown in two patients. Histologically, the tumours were well-circumscribed, although focal ill-defined borders were present in four cases. No infiltration of adjacent structures was identified. Architectural heterogeneity was noted in five (63%) tumours; an adenoid pattern often predominated. The neoplastic cells were flattened to cuboidal with eosinophilic cytoplasm. Cytoplasmic vacuoles mimicking signet ring-like cells were present in five (63%) cases. Three (38%) cases showed involvement of the mesothelium with reactive mesothelial hyperplasia. Cytological atypia or increased mitotic activity was not identified. The surrounding stroma ranged from oedematous/myxoid to densely hyalinised. Immunohistochemistry confirmed mesothelial origin in all cases evaluated. No patients developed recurrence of disease.

CONCLUSIONS

The current study evaluates the clinicopathological findings in a collective series of gastrointestinal and hepatic adenomatoid tumours, correlating with those described in individually reported cases. We highlight common histological features and emphasise variable findings that could mimic a malignant neoplasm.

Ceruminous Adenoma: A Rare Mass that Impair Hearing

Ceruminous adenoma is described as a glandular neoplasm of ceruminous glands. It is seen for less than one percent of all external ear tumours. Ceruminous adenoma cases were reported to have recurrence and residual tumour, however there was no malignant transformation known in ceruminous adenoma up to this date. Here, we report a young adult woman with two years history of progressive reduced hearing and tinnitus of the right ear. She was proven to have right moderate conductive hearing loss with pure tone audiometry. There was a cystic mass with serous content arising from the posterior wall of the right ear canal. We proceeded with wide local excision of the mass via trans-canal approach. Ceruminous adenoma was confirmed with histopathology and immunohistochemistry of CK7 staining. The hearing impairment was resolved completely post excision and there was no recurrence of the tumour on one year follow-up. We concluded wide local excision with appropriate margin of the mass is adequate to prevent recurrence in ceruminous adenoma cases.

Incidence of Adnexal Torsion in the Republic of Korea: A Nationwide Serial Cross-Sectional Study (2009-2018)

Background: This study aimed to evaluate the incidence and risk factors of adnexal torsion (AT) in the Korean population from 2009 to 2018 (10 years). Methods: We analyzed the 2009−2018 data obtained from the Health Insurance Review and Assessment Service National Inpatient Sample (HIRA-NIS) database. AT was identified by both diagnosis codes and surgery codes of adnexal surgery. Results: A total of 6,262,910 women were recorded in the database. The incidence of AT was 6 per 100,000 women (95% confidence interval (CI), 6−6). The incidence of AT tended to decrease with age after peaking in the late 20s to early 30s. In the weighted logistic regression analysis, women of childbearing age, especially in their 20s and 30s, had the highest AT incidence. Corpus luteal cyst (p < 0.001) and benign neoplasm (p < 0.001) increased the incidence of AT. Low socioeconomic status (SES), Charlson comorbidity index (CCI), and pregnancy were unrelated to AT. Conclusion: The incidence of AT is 6 per 100,000 women and peaks in the 20s to early 30s.

Bilateral Mirror-Symmetrical Giant Cell Tumor of the Tendon Sheath in the Foot and Ankle: A Case Report

Giant cell tumor of the tendon sheath is a slowly growing benign tumor. It usually arises from the tendon sheath and periarticular soft tissue of small joints. However, it may infrequently involve the large joints emerging around the knee, elbow, and hip joints. Giant cell tumor of the tibialis tendon sheath is rarely reported in the foot and ankle joint. Here, we report the first case in the medical literature of bilateral mirror-symmetrical giant cell tumor of the tendon sheath in the foot and ankle. A 12-year-old male presented with a bilateral and mirror-image mass on his ankles extending to the foot. It was painless but affected his gait and footwear. Staged complete resection was done first on the right then on the left side, with no recurrence after 1 year. The role of genes can be argued for this presentation and giant cell tumor's etiology, owing to the bilateralism and mirror-image presentation. Studies are needed to explore this genetic aspect and its role in management.

Cryptosporidium baileyi Pulmonary Infection in Immunocompetent Woman with Benign Neoplasm

Cryptosporidium baileyi, a bird-specific parasite, infects gastrointestinal, pulmonary, and urinary tracts of its host. We report on a C. baileyi infection associated with pulmonary hamartoma in an immunocompetent patient in Poland. Further work is needed to investigate the association between Cryptosporidium infections and tumors.

Pilomatrixoma of the Left Scapular Region in a Young Male: A Rare Case Report

Pilomatrixoma is a benign and rare neoplasm derived from the cortex of the hair follicle. The head and neck region's involvement is relatively common and occurs in the upper extremity, trunk, and lower extremity in decreasing tendency. It is usually encountered in younger age groups, usually in children and adolescents. Management of the pilomatrixoma involves surgical excision of the mass. A 15-year-old male presented with a history of an isolated left scapular mass. The lesion had appeared two weeks before the presentation. His parents brought him to the emergency department due to continued bleeding from the mass. He denied any pain, fever, night sweats, weight loss, chills, appetite changes, and numbness to the area. Physical examination revealed a bleeding non-tender mass measuring about 2.5 x 3 cm, with the fluctuant inferior surface. Baseline investigations were normal. Cyst, abscess, and neoplasm were the initial differentials. Ultrasound findings were suggestive of neoplasm, and contrast-enhanced MRI was highly suspicious for progressive neoplasm. The surgical team was consulted, and surgical excision of the mass was carried out. Biopsy results confirmed pilomatrixoma. In conclusion, the pre-surgical diagnosis of pilomatrixoma is difficult. Hence, this case report's main objective is to raise awareness among clinicians about this rare diagnosis and its clinical features. Furthermore, our case highlights the need to consider pilomatrixoma in the differentials of the head, neck, and back masses in children and adolescents.

Bladder lipoma: Moroccan case report

Lipomas are encapsulated benign tumors typically found in the integument, central nervous system or gastrointestinal tract and represent the most common benign mesenchymal neoplasm in adults. Bladder lipoma is a rare tumor that has been reported in a handful of cases in medical literature. A literature review from PubMed, MEDLINE, EMBASE and Cochrane databases of bladder lipoma yielded less than 20 cases. We report a case of a 69 year-old Moroccan male patient with hematuria as a chief symptom. The diagnosis of bladder lipoma was suspected by flexible fibroscopy and assessed by transurethral resection. Macroscopic and histological examination revealed a lipomatous tumour with no sign of malignancy. There was no recurrence after one year of follow-up. Although bladder lipomas are rare entities, they must be considered in the differential diagnosis of bladder tumor. However, we should always keep in mind that any bladder tumor is malignant until proven otherwise.

Diagnostic dilemma - sinonasal organizing hematoma

Sinonasal organizing hematomas are benign lesions often mistaken for malignancy due to their aggressive appearance on diagnostic imaging and endoscopic findings that favor advanced disease. The destructive nature of this pathology paired with the rarity of the presentation often results in diagnostic deception that may escalate intervention planning and affect discussion of prognosis with patients. Herein, we present a case of a 56-year-old male with left-sided nasal obstruction and daily epistaxis, where computed tomography imaging revealed heterogeneous opacification of the left maxillary sinus, erosion of the left inferior orbital wall and extension into the nasal cavity. Although clinical and radiographic presentations of sinonasal organizing hematomas can be managed definitively with endoscopic intervention, there is a need to increase awareness of this entity among clinicians to improve our prognostic counseling with patients.

Ectopic immature renal tissue presenting as a pedunculated sacral mass in a neonate

Ectopic immature renal tissue (EIRT) has been reported in a variety of tissues of mesodermal origin, including the dermis of the skin. We report a case of a newborn with a congenital lumbosacral mass with pathologic findings consistent with EIRT. This report highlights the clinical and pathologic considerations of EIRT, including associations with spinal dysraphism, teratoma, and Wilm's tumor.

A novel treatment for idiopathic knuckle pads with cantharidin-podophylotoxin-salicylic acid

Knuckle pads are benign subcutaneous nodules that appear most frequently on the small joints of the hands. In children, they are often idiopathic, and no universally effective treatment has been reported. We present the case of an adolescent successfully treated with a combination of topical cantharidin -podophylotoxin -salicylic acid.

Application of the Milan System for Reporting Submandibular Gland Cytopathology: An international, multi-institutional study

BACKGROUND

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6-tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular gland FNAs.

METHODS

Submandibular gland FNA cytology specimens from 15 international institutions (2013-2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow-up was performed, and the ROM was calculated for each MSRSGC diagnostic category.

RESULTS

The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%-50%); nonneoplastic, 24.2% (9.1%-53.6%); AUS, 6.7% (0%-14.3%); benign neoplasm, 18.3% (0%-52.5%); SUMP, 12% (0%-37.7%); SM, 3.5% (0%-12.5%); and malignant, 13.9% (2%-31.3%). The histopathologic follow-up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%.

CONCLUSIONS

This multi-institutional study shows that the ROM of each MSRSGC category for submandibular gland FNA is similar to that reported for parotid gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular gland FNA.

Mucinous Cystadenoma Causing Abdominal Distension: A Case Report

Mucinous cystadenomas are a common benign neoplasm of the ovaries that can grow much larger than other adnexal masses. We report a case of a 28-year-old female who presented with one month of increasing abdominal distension and upper abdominal pain; she was found to have a 30-centimeter (cm) adnexal mass. Pathology showed a benign mucinous cystadenoma with no evidence of malignancy. The authors discuss the initial evaluation and management of adnexal masses in general, as the variety of etiologies and severity can make this a difficult task. The characteristics of different adnexal masses and the indications for gynecologic consultation and surgery are also discussed.

Duodenal Schwannoma as a Rare Association With Membranous Nephropathy: A Case Report

Membranous nephropathy (MN) associated with malignancies is a well-known entity. However, its association with benign neoplasm is not broadly recognized. A 69-year-old man with recurrent nephrotic syndrome presented with pedal edema and proteinuria of 5 months' duration. Laboratory results showed hypoalbuminemia and hyperlipidemia. Proteinuria was estimated to be protein excretion of 3.5g/d. Studies were negative for viral hepatitis, syphilis, human immunodeficiency virus, autoimmune diseases, and paraproteinemia. Kidney biopsy disclosed MN with negative phospholipase A₂ receptor (PLA₂R) staining, favoring a secondary form of MN. Computed tomography detected a 7.6-cm duodenal schwannoma. Elective surgical resection was performed. Pathologic study showed that THSD7A (thrombospondin type 1 domain-containing 7A) was positive in both glomeruli and schwannoma. Commonly, secondary MN is related to underlying conditions, including lupus, hepatitis, and neoplasm, and can be medication induced. The risk for developing a concomitant neoplasm among patients with PLA₂R-negative MN is up to 12 times higher than in the general population. Most of these neoplasms are malignancies, and the presence of autoantibodies directed at similar tissue targets is hypothesized as the potential mechanism. In our case, THSD7A may be the autoantibody that has linked the schwannoma and the development of MN. Although benign tumors rarely produce renal manifestations, effective treatment may lead to resolution of nephrotic syndrome.

Peripheral Nerve Schwannoma: A Review of Varying Clinical Presentations and Imaging Findings

A schwannoma or neurilemmoma is a benign, isolated, noninvasive, and encapsulated tumor originating from Schwann cells of the peripheral nerve sheath. The incidence of a schwannoma occurring in the foot and ankle is rare, with prevalence rate of 1% to 10%. Schwannomas have no sex predilection, and they commonly occur in patients in their fourth decade. Malignant transformation of benign schwannoma is unusual; however, it is important to note that malignant variants of schwannomas do exist and account for about 5% to 10% of all soft tissue sarcomas. We present 3 cases of benign schwannoma in the lower extremity. All 3 patients presented with varying clinical symptoms, including pain, paresthesia, weakness, and a palpable mass. A schwannoma was eventually diagnosed in all 3 patients. We discuss and review the known entities of peripheral nerve schwannoma and describe the clinical and imaging findings and therapeutic strategies for treating and diagnosing peripheral nerve schwannoma.

A Solitary Fibrous Tumor of the Subglottic Larynx: Case Report and Literature Review

BACKGROUND

Solitary fibrous tumors (SFT) arising from the larynx are extremely rare; most occur in the supraglottic larynx.

CASE REPORT

Herein, we detail a new case of a subglottic SFT presenting as a well-encapsulated soft-tissue tumor with hoarseness. It showed isoattenuation, similar to the adjacent muscle on pre-contrast computed tomography (CT) images, and strong, heterogeneous enhancement following contrast material administration, which may reflect hypervascularity. On pathological examination, it consisted of spindle cells, squeezed between abundant collagen, and focally prominent vascularity in a staghorn feature. The tumor cells were immunoreactive for CD34, BCL2 and CD99. Based on the combination of architectural and immunohistochemical criteria, we ultimately diagnosed this case as an SFT.

CONCLUSION

Until now, only 14 cases of laryngeal SFT have been described in the literature: 13 located in the supraglottic areas and only one located in the subglottic/tracheal area. Therefore the present case is the second case of a subglottic SFT reported. Although rare, SFT should be included in the differential diagnosis of a well-marginated laryngeal mass with highly intense contrast enhancement, which suggests rich tumor vascularity.

Melanotic neuroectodermal tumor of infancy arising in the temporal bone

Melanotic neuroectodermal tumor of infancy is a rare melanin-containing neoplasm with locally aggressive and rapid expansile growth, usually involving the maxilla, skull, and mandible of early infancy. Radical surgery is critical for a long-term outcome. We present a case of 14-month-old girl with rapid-growing subcutaneous mass arising in the right temporal bone and extending intracranially on computed tomographic scan. Radical surgery was performed. A brownish-black tumor composed of large pigmented epithelioid cells, positive for cytokeratins and HMB-45, and nests of small neuroblast-like cells positive for neuron-specific enolase and synaptophysin, was diagnosed as melanotic neuroectodermal tumor of infancy. The patient remained well without evidence of recurrence for 1 year after surgery. Clinicopathological features, management alternatives and outcome were discussed.

Papillary Cystadenoma of Minor Salivary Glands: Report of 11 Cases and Review of the English Literature

Papillary cystadenoma is a rare, benign salivary gland tumor which is well-circumscribed, containing cystic cavities with intraluminal papillary projections. Only 19 cases arising within minor salivary glands (MnSG) from the oral cavity sites have been reported in the English literature (PubMed 1958-2014). We report 11 new cases of MnSG papillary cystadenomas in conjunction with a review of the literature. Demographic information, clinical and histologic features, treatment and prognosis are compiled and discussed for all 30 cases reported in the English literature.

Case presentations and review of plexiform schwannoma in the foot

Plexiform schwannoma is a soft tissue tumor that rarely presents in the lower extremity. We have reported on 2 cases of plexiform schwannomas that occurred in the foot and ankle. Owing to the relative obscurity of this condition in the lower extremity, we have also provided an overview of plexiform schwannomas and discussed the differences between this and other suspicious nodular soft tissue masses. The first patient was a 38-year-old female, who had a soft tissue mass located on the lateral aspect of her right foot that became symptomatic. The second patient was an 11-year-old male, who had a symptomatic soft tissue mass on the plantar aspect of his right foot. Both patients underwent surgical excision of the tumor.

Mandibular adenomatoid odontogenic tumor: Radiographic and pathologic correlation

Adenomatoid odontogenic tumor (AOT) is a rare tumor of epithelial origin comprising 3% of all the odontogenic tumors. It is a benign, painless, noninvasive, and slow-growing lesion, with a relative frequency of 2.2-13% and often misdiagnosed as an odontogenic cyst on clinical examination. AOT affects young individuals with a female predominance, occurs mainly in the second decade, and usually surrounds the crown of unerupted teeth. This lesion is most commonly located in the anterior maxilla and rarely in the mandible. It is usually associated with an impacted canine. AOT frequently resembles lesions like dentigerous cyst or ameloblastoma. AOT has three variants, follicular, extrafollicular, and peripheral. The intraoral periapical radiograph is the best radiograph to show radiopacities in AOT as discrete foci having a flocculent pattern within radiolucency even with minimal calcified deposits. These calcified deposits are seen in approximately 78% of the lesions. Herewith, we present the report of four unusual cases of AOT located in the mandible, with an emphasis on radiographic findings and on pathologic correlation, and on reviewing the existing literature on this tumor.

Diagnostic characteristics of sinonasal organizing hematomas: avoiding misdiagnosis

BACKGROUND

Organizing hematomas of the paranasal sinuses are diagnostic dilemmas clinically and radiographically, mimicking benign or malignant neoplastic processes and causing patients and clinicians undue worry regarding these diagnoses. Diagnostic criteria for correctly identifying these lesions are not well known.

METHODS

A retrospective case series of 7 patients with sinonasal organizing hematoma was studied. Radiographic imaging, clinical characteristics, and pathology were reviewed for new insights.

RESULTS

Three patients presented with a primary complaint of epistaxis, 4 had masses visible on nasal endoscopy, and 2 had vascular malformations or small hemangiomas adjacent to the mass found on final pathology. Biopsy of these masses were consistently nondiagnostic prior to complete resection. The most diagnostic findings were "shells" of T2 hypointensity on magnetic resonance imaging (MRI) surrounding the lobules of each of the masses. These correspond to rims of fibrosis at the periphery of the lobules on pathology. Areas of fresh hemorrhage are located at the center of these lobules.

CONCLUSION

Sinonasal organizing hematomas are rare lesions of the paranasal sinuses whose clinical characteristics lead to misdiagnoses of benign or malignant neoplasms. Endoscopy, preoperative biopsy, and computed tomography (CT) imaging do not lend helpful information in differentiating these lesions from more worrisome neoplastic processes. However, MRI can lead to positive diagnosis by recognizing the distinct outer rims of T2 hypointensity typically seen in these lesions.

"Pyogenic granuloma - Hyperplastic lesion of the gingiva: case reports"

Pyogenic granuloma is a reactive hyperplasia of connective tissue in response to local irritants. It is a tumourlike growth of the oral cavity, frequently located surrounding the anterior teeth or skin that is considered to be neoplastic in nature. It usually arises in response to various stimuli such as low-grade local irritation, traumatic injury, hormonal factors, or certain kinds of drugs. Histologically, the surface epithelium may be intact, or may show foci of ulcerations or even exhibiting hyperkeratosis. It overlies a mass of dense connective tissue composed of significant amounts of mature collagen. Gingiva is the most common site affected followed by buccal mucosa, tongue and lips. Pyogenic granuloma in general, does not occur when excised along with the base and its causative factors. This paper presents some cases of a pyogenic granuloma managed by surgical intervention.

Leiomyoma of the nipple diagnosed by MRI

Leiomyoma of the nipple is a rare, benign, non-epithelial tumor that is thought to arise from smooth muscle fibers in the subareolar tissue of the breast. We report an unusual case of leiomyoma of the nipple in a 32-year-old woman in whom the diagnosis was made by ultrasound-guided core needle biopsy. She came to our hospital complaining of a recently enlarged nipple with discharge and erosion in the region of the left nipple-areolar complex. This mass was evaluated by mammography, ultrasonography, and magnetic resonance imaging (MRI). To the best of our knowledge, this is the first case of a leiomyoma of the nipple examined by MRI. MRI showed an oval mass with circumscribed margins that appeared as an intermediate signal intensity on both T1- and T2-weighted images. A dynamic MRI study showed a rim-enhancing oval mass with delayed persistent enhancement. Ultrasound-guided core needle biopsy revealed spindle cell proliferation consistent with leiomyoma of the nipple.

Vulvar lipoma: is it so rare?

Vulvar lipoma is said to be so rare that only a few cases have been reported. We present two cases of vulvar lipoma that were diagnosed within six months in our centre in a 28 year-old para 2 and 35 year-old para 1 woman both of whom presented with slow-growing masses in the vulva. A detailed discussion of the clinical features and current management options are outlined, with emphasis on the need to subject all excised lesions to histopathological evaluation; to ensure accurate diagnosis and differentiate this benign swelling from cystic swellings and malignant neoplasms in the vulva.

MIB-1, Bcl-2 and p53 in odontogenic myxomas of the jaws

Odontogenic myxoma is a rare benign neoplasm occurring in the jaws. Microscopically, it is composed of spindle or stellate-shaped cells arranged in a mucinous matrix. In some cases (20%), odontogenic epithelial islands may be found. The Authors evaluated p53, MIB-1, and Bcl-2 expressed by the epithelial and stromal elements in 12 cases of odontogenic myxoma of the jaws. The cells of the odontogenic epithelium were positive for Bcl-2, p53 and MIB-1. The stromal cell showed a high positivity for MIB-1. Proliferation of both the epithelial and stromal components could be related to the growth of this odontogenic tumour.