Oral nodular fasciitis – A case report with a diagnostic schema

Introduction: The spectrum of myofibroblastic lesions of the oral cavity ranges from reactive to benign to malignant lesions with overlapping histopathologic and immunohistologic characteristics posing a diagnostic dilemma. Observation: A 30-year-old male presented with a spontaneous swelling over the right lower buccal gingiva giving a clinical suspicion of a benign mesenchymal tumor. The lesion presented with a varied biphasic microscopic appearance that posed as a challenge for diagnosis. Commentaries: The incisional biopsy of the lesion showed a highly collagenous stroma with spindle-shaped cells, while the excision biopsy revealed myxoid and hyalinized stroma. A panel of markers comprising of SMA (smooth muscle actin). CD-34, β-Catenin, and Alcian blue stain was employed to arrive at a diagnosis. Conclusion: Most myofibroblastic lesions present with diverse histological appearance which warrants a thorough assessment of the cellular and stromal components for an accurate diagnosis.

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A SWOLLEN MIDDLE FINGER IN A MIDDLE-AGED FARMER

Hand Surgery ◽

10.1142/s0218810412720112 ◽

2012 ◽

Vol 17 (01) ◽

pp. 121-123 ◽

Cited By ~ 1

Author(s):

Somprakas Basu ◽

Shilpi Bhadani ◽

Vijay Kumar Shukla

Keyword(s):

Proximal Phalanx ◽

Middle Finger ◽

Needle Aspiration ◽

Excision Biopsy ◽

Middle Aged ◽

Cytological Examination ◽

Diagnostic Dilemma ◽

X Ray ◽

The Right ◽

Bony Erosion

Hand tumors are not common and a swollen finger poses considerable diagnostic dilemma. We present a case of a middle-aged farmer who had presented with a painless swelling of the middle finger of the right hand without any neurovascular deficit or evidence of metastasis. An X-ray of the finger showed cortical expansion and bony erosion of the proximal phalanx. A fine needle aspiration cytological examination was inconclusive. He underwent a digit amputation in view of subsequent morbidity and chances of recurrence following local excision. Biopsy proved it to be a giant cell tumor of the proximal phalanx. Following six months of treatment he is doing well. We herein highlight an unusual tumor of the finger and its diagnostic and treatment challenges.

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Enchondroma in the Diaphysis of Tibia – A Case Report and Review of its Characteristics and Differentials in the Diaphysis

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i07.2292 ◽

2021 ◽

Vol 11 (7) ◽

Author(s):

Keerthan Ranga Nayak ◽

Sharath Kumar Rao ◽

Sharath Kumar Rao

Keyword(s):

Case Report ◽

Malignant Tumor ◽

Long Bones ◽

Incisional Biopsy ◽

Diagnostic Dilemma ◽

Radiological Features ◽

Cartilaginous Tumor ◽

Malignant Lesions ◽

Cortical Erosion ◽

Hands And Feet

Introduction: Enchondroma is a solitary, benign, intramedullary cartilaginous tumor commonly noticed in the phalanges of hands and feet with characteristic radiological features. Its occurrence in aberrant sites with atypical features lead to diagnostic dilemma. Enchondromas which are usually managed non-operatively can mimic other benign and malignant lesions, especially chondrosarcoma. Case Report: We report the case of a 31-year-old farmer who presented with long standing inconspicuous pain in his left leg which turned out to be a diaphyseal enchondroma even though it demonstrated aggressive radiological features mimicking a chondrosarcoma. Incisional biopsy was done from the scalloped areas to obtain the correct histological diagnosis. He underwent thorough curettage of the lesion and remains asymptomatic 2 years after the procedure. We attempt to discuss the differentials which the orthopedic surgeon should keep in mind for diaphyseal lesions mimicking enchondroma. Conclusion: Though classically found in metaphysis, Enchondromas are not uncommon in diaphysis of long bones. Enchondromas are generally benign, but can cause diagnostic dilemma when they present with aggressive features at rare locations and surgeons should be wary of the differentials. Despite a size of more than 6 cm and evidence of cortical erosion and intramedullary widening, the lesion could still be benign. Early biopsy will help to differentiate Enchondroma from a malignant transformation or malignant tumor. Keywords: Enchondroma, chondrosarcoma, diaphysis, multilocular, endosteal scalloping, chondroma.

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Unilateral proptosis in a child-need for prompt diagnosis

10.25259/srjhs_10_2021 ◽

2021 ◽

Vol 1 ◽

pp. 34-37

Author(s):

Suman H. Kalantri ◽

Subalakshmi Balasubramanian ◽

Latha M. Sneha ◽

Sonam Nisar Poonam

Keyword(s):

Correct Diagnosis ◽

Significant Morbidity ◽

Diagnostic Dilemma ◽

Childhood Malignancies ◽

Pediatric Age Group ◽

Common Causes ◽

Orbital Neoplasm ◽

Malignant Lesions ◽

The Right ◽

Unilateral Proptosis

Proptosis in a child often presents as a diagnostic dilemma. Proptosis can be secondary to infection or childhood malignancies. It warrants urgent and relevant investigations to facilitate correct diagnosis and treatment. The common causes of proptosis include infection and malignant lesions. Any delay in intervention in either of the causes can lead to significant morbidity or can impair the vision of the child. An orbital neoplasm in the pediatric age group is an uncommon clinical finding which can initially manifest as proptosis. Here, we report a case of a 2-year-old girl, presenting with progressive swelling of the right eye. An incisional biopsy confirmed the diagnosis of embryonal rhabdomyosarcoma (RMS). RMS is an aggressive tumor; hence, early diagnosis and prompt treatment are highly essential to prevent significant morbidity and can save the vision of the child.

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Oncocytic Lipoadenoma: Report of 3 Rare Cases Involving the Parotid Gland, Including a Synchronous Presentation With Paraganglioma of the Right Carotid Bifurcation and Literature Review

International Journal of Surgical Pathology ◽

10.1177/10668969211021966 ◽

2021 ◽

pp. 106689692110219

Author(s):

John L.S. Cunha ◽

Marco A. Peñalonzo ◽

Ciro D. Soares ◽

Bruno A.B. de Andrade ◽

Mário J. Romañach ◽

...

Keyword(s):

English Language ◽

Smooth Muscle Actin ◽

Salivary Gland Tumor ◽

Surgical Excision ◽

Carotid Bifurcation ◽

Alpha Smooth Muscle Actin ◽

S 100 ◽

The Right ◽

Adequate Management ◽

Adipose Cells

Oncocytic lipoadenoma (OL) is a rare salivary gland tumor characterized by the presence of oncocytic cells and mature adipose tissue. To date, only 30 cases of OL have been reported in the English-language literature. We present 3 additional OL cases involving the parotid, including a synchronous presentation with paraganglioma of the right carotid bifurcation. Microscopically, both the OLs were composed of a mixed population of oncocytes and adipocytes in varying proportions surrounded by a thin, connective tissue fibrous capsule. Oncocytes were positive for pan-cytokeratins (CKs) AE1/AE3, epithelial membrane antigen, CK5, CK7, CK14, CK18, and CK19. Calponin, p63, alpha-smooth muscle actin, and carcinoembryonic antigen were negative. Vimentin and S-100 protein were positive only in adipose cells. Despite distinctive morphologic features, OL is often misdiagnosed, given its rarity. We hope to contribute to surgeons’ and pathologists’ awareness and knowledge regarding the existence of this tumor and provide adequate management through conservative surgical excision.

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Primary pulmonary epithelioid sarcoma: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02940-0 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Eiki Mizutani ◽

Riichiro Morita ◽

Keiko Abe ◽

Makoto Kodama ◽

Shogo Kasai ◽

...

Keyword(s):

Tumor Cells ◽

Lung Tumor ◽

Smooth Muscle Actin ◽

Asbestos Exposure ◽

Epithelioid Sarcoma ◽

Whole Body ◽

Health Examination ◽

Positron Emission ◽

Primary Lung Tumor ◽

The Right

Abstract Background Epithelioid sarcoma most frequently occurs in the dermal or subcutaneous area of the distal extremities. To date, there have been three cases of primary pulmonary epithelioid sarcoma reported. We report a case of epithelioid sarcoma that is considered a primary lung tumor. Case presentation A 65-year-old asymptomatic Asian male patient underwent chest radiography during a routine health examination, and an abnormal mass was detected. His past medical history was unremarkable. He smoked 40 cigarettes every day and had slightly obstructive impairment on spirometry. He worked as an employee of a company and had no history of asbestos exposure. He underwent partial resection of the right lung by thoracoscopy. A histological examination of the tumor revealed a cellular nodule of epithelioid and spindle-shaped cells. Some of the tumor cells displayed rhabdoid features and reticular arrangement in a myxomatous stroma. Immunohistochemically, the tumor cells were positive for vimentin, smooth muscle actin (SMA), CD34, and epithelial membrane antigen (EMA); loss of the BAF47/INI1 protein in the tumor cells was also confirmed. A diagnosis of epithelioid sarcoma was established. Careful screening by whole-body positron emission tomography for another primary lesion after surgery did not detect any possible lesion. He had no cutaneous disease. Conclusion To our knowledge, this is the fourth case of a proximal-type epithelioid sarcoma considered as a primary lung tumor.

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P043 Fascinating phosphate: seek and you will find

Rheumatology ◽

10.1093/rheumatology/keab247.040 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Jyoti Bakshi ◽

Clare Batten

Keyword(s):

Back Pain ◽

Degenerative Change ◽

Nasal Bone ◽

Rare Condition ◽

Whole Body ◽

Excision Biopsy ◽

Small Lesion ◽

History Of ◽

The Right ◽

Fgf 23

Abstract Background/Aims A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods The case is discussed below. Results Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR < 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure J. Bakshi: None. C. Batten: None.

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A Clinicopathologic and Epidemiologic Study of Chronic White Lesions in the Oral Mucosa

Ear Nose & Throat Journal ◽

10.1177/014556131709600804 ◽

2017 ◽

Vol 96 (8) ◽

pp. E13-E17

Author(s):

Sampurna Ghosh ◽

Sudipta Pal ◽

Soumya Ghatak ◽

Somnath Saha ◽

Surajit Biswas ◽

...

Keyword(s):

Oral Mucosa ◽

Epidemiologic Study ◽

Significant Risk ◽

Significant Risk Factor ◽

Premalignant Lesions ◽

Excision Biopsy ◽

Severe Dysplasia ◽

Cross Sectional ◽

Malignant Lesions ◽

Tobacco Chewing

Invasive oral squamous cell carcinoma is often preceded by the presence of clinically identifiable premalignant changes of the oral mucosa, including white lesions. We conducted a cross-sectional, observational study to assess the clinicopathologic and epidemiologic aspects of chronic oral mucosal white lesions to determine the necessity of early biopsy in these cases. Our study population was made up of 77 patients—50 males and 27 females, aged 15 to 70 years (mean: 42.9)—who presented with white lesions persisting for at least 4 weeks. All but 3 patients underwent a biopsy; the 3 exceptions were diagnosed with smear-proven candidiasis. Patients with moderate or severe dysplasia underwent an excision biopsy. The buccal mucosa was the single most common site of white lesions, occurring in 15 patients (19.5%), although 21 patients (27.3%) exhibited a diffuse involvement of the oral mucosa. Of the 77 patients, 59 (76.6%) had concerning findings: premalignant lesions in 45 patients (58.4%) and malignant lesions in 14 (18.2%). Also, dysplasia was seen in 8 patients (10.4%), all of whom had premalignant lesions. Tobacco chewing (p = 0.008) and betel quid chewing (p = 0.029) were significantly associated with the development of premalignant and malignant lesions; a longer duration of tobacco chewing (≥10 yr) was significantly associated with a higher risk of malignant but not premalignant lesions (p = 0.031). Finally, illiteracy was a significant risk factor for premalignant and malignant lesions (p = 0.03). Our findings support the necessity of biopsy in every case. Early detection of oral carcinoma by biopsy of all oral white lesions would not only prevent patients from undergoing disfiguring surgery and chemoradiation, but it also would increase the 5-year survival rate.

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Role of MRI in Detecting and Characterizing Small Hepatic Focal Lesions

QJM ◽

10.1093/qjmed/hcab106.035 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Rania Ali Maarouf ◽

Ali Haggag Ali ◽

Mahmoud Abdelatif Onsy

Keyword(s):

Tumor Staging ◽

Left Lobe ◽

Diagnostic Process ◽

Liver Imaging ◽

Focal Lesions ◽

Focal Hepatic Lesions ◽

Malignant Lesions ◽

Hepatic Lesions ◽

The Right

Abstract Background Despite the recent advances in liver imaging, the detection and characterization of small hepatic focal lesions is still a real challenge. Particularly in cancer patients where the characterization of a small HFL as thus the precise tumor staging is critical for optimal treatment planning. Aim of the Work To explore the effectiveness, and hence the clinical utility, of MRI detection and characterization of small focal hepatic lesions either only discovered on MRI or as a further work up of CT/US-indeterminate lesions. Patients and Methods We reviewed our database for individuals who underwent liver MR imaging between March 2018 and March 2019 for the evaluation of small hepatic lesions that were discovered for the first time or had been previously visualized on routinely performed CT and had been considered indeterminate. Results The present study included 44 patients of which 26 were males (59.1%) and 18 were females (40.9%). The age range of the study group was 19 to 77 years. The mean age for Malignant lesions was 51 years. The right lobe of liver was involved in 23 cases (52.3%), left lobe in 5 cases (11.4%) and both lobes in 16 cases (36.4%). There were 30 (68.18%) benign, 13 (29.54%) malignant lesions and 1 (2.3%) indeterminate, hemangiomas were predominant in benign lesions whereas hepatocellular carcinomas were predominant in malignant lesions. N'TRI could characterize 92% cases. Conclusion The diagnostic process of small hepatic focal lesions, either detection or characterization or both, continues to represent a challenge. Contrast-enhanced MR can accurately detect and characterize majority of small hepatic focal lesions.

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Malignant Glomus Tumour: A Case Report and Review of the Literature

Sarcoma ◽

10.1080/1357714031000081207 ◽

2003 ◽

Vol 7 (2) ◽

pp. 87-91 ◽

Cited By ~ 18

Author(s):

Annarosaria De Chiara ◽

Gaetano Apice ◽

Stefano Mori ◽

Giustino Silvestro ◽

Simona N. Losito ◽

...

Keyword(s):

Clinical Course ◽

Smooth Muscle Actin ◽

Tumour Cells ◽

Small Cells ◽

Glomus Tumour ◽

Recurrent Tumour ◽

Lymphnode Metastasis ◽

Histological Criteria ◽

Eosinophilic Cytoplasm ◽

The Right

Purpose:Glomus tumours are characteristically benign solitary tumours. At our knowledge, about 23 reports are present in literature regarding the malignant counterpart, but only a minority developed metastases. We describe a locally aggressive glomus tumour with lymphnode metastasis.Patient:The patient was a 40 year-old man presenting a 1.5-cm lesion on the right wrist incompletely excised and a recurrent tumour, 4 × 2 cm in size, removed after 9 months, for which he received radiotherapy. After 2 years he developed an axillary lymphnode metastasis.Results:Histologically, both tumours (primary and metastasis) were similar. There were sheets and nests of uniform small cells with scant eosinophilic cytoplasm and round to polygonal nuclei; there was some degree of pleomorphism and the mitotic index was high (up to 18 m/10 HPF). The tumour cells were positive for vimentin and smooth muscle actin, but negative for desmin, NSE, Factor VIII, chromogranin, cytokeratin. Remarkably, in the primary, the cells strongly expressed p53 (70%) and MIB-1 (35%).Discussions:In many reported malignant cases, the histology of the tumour cells suggested that they were malignant, yet the clinical course has been benign. Carefully reviewing the literature, it seems that actually we have enough histological criteria to identify the cases with biological adverse outcome. Those unfortunate cases behave as high grade sarcomas and therefore may deserve an aggressive therapeutic treatment.

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Complex fibroadenoma with focal ossification- an enigmatic finding in a less common tumor

International Surgery Journal ◽

10.18203/2349-2902.isj20211851 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1650

Author(s):

Subhransu Kumar Hota ◽

Ranjana Giri ◽

Hardik Kabra ◽

Devika Chauhan ◽

Prita Pradhan ◽

...

Keyword(s):

Excision Biopsy ◽

Radiological Findings ◽

Breast Lump ◽

In Situ Carcinoma ◽

Unusual Occurrence ◽

Malignant Lesions ◽

Breast Lumps ◽

Sclerosing Adenosis

Breast lumps have diverse causes including benign as well as malignant lesions. Fibroadenoma (FA) is a common cause of breast lump. Complex fibroadenomas, a particular subtype, pose diagnostic dilemmas due to confusing the radiological findings and hold higher incidence of transformation to malignancy. A 49 year old female presented with a painless lump in right breast for 2 years which appeared calcified on radiology. Excision biopsy was performed which grossly revealed an encapsulated grey-white firm to hard with cystic areas. Microscopically the sections showed a well encapsulated fibroepithelial tumor showing areas of sclerosing adenosis, hyalinization, cysts lined by cuboidal cells with eosinophilic secretions, areas of calcification and ossification. No evidence of lobular hyperplasia or in-situ carcinoma was seen. Patient was advised follow up. This case represents the unusual occurrence of complex fibroadenoma in a middle-aged female showing with ossification.

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