The Understated Malignancy Potential of Nonoperative Acute Appendicitis

Cancer of the appendix is rare and is most commonly found incidentally on pathology after an appendectomy for uncomplicated appendicitis (UA). The medical management alternative with antibiotics and observation remains an ongoing debate. The purpose of our study was to develop modern epidemiological data for adult patients completing an appendectomy for UA secondary to an appendiceal neoplasm (AN). ACS-NSQIP database was queried (2005–2016) to identify patients completing an appendectomy. Cohorts of patients who were diagnosed with UA and an AN were included in the study. Relevant perioperative clinical and outcomes data were collected. Type of AN, surgical procedure, and mortality were analyzed. A total of 239,615 UA patients were identified, of whom 2,773 (1.2%) met the inclusion criteria of AN. Patients with AN were predominantly white (79.5%), with a mean age of 54.5 ± 15.9 years, and 54.6 per cent were females. AN pathology findings included malignant neoplasm (64.5%), malignant carcinoid (17.3%), benign carcinoid (9.3%), and benign neoplasm (8.8%). The overall reported incidence was 1.2 per cent and the mortality rate was 0.7 per cent. Our study emphasizes surgical intervention in adult UA maintains a 1 per cent incidence of AN, and treatment with antibiotics alone will presumably lead to a delay in surgical treatment and progression of disease.

Download Full-text

A Case Report of a Solitary Fibrous Tumor of the Maxillary Sinus

Reports ◽

10.3390/reports4040033 ◽

2021 ◽

Vol 4 (4) ◽

pp. 33

Author(s):

Mattia Di Bartolomeo ◽

Sara Negrello ◽

Arrigo Pellacani ◽

Anna Maria Cesinaro ◽

Stefano Vallone ◽

...

Keyword(s):

Case Report ◽

Head And Neck ◽

Maxillary Sinus ◽

Solitary Fibrous Tumor ◽

Malignant Neoplasm ◽

Neck Region ◽

Benign Neoplasm ◽

Surgical Excision ◽

Purulent Discharge ◽

Fibrous Tumor

A solitary fibrous tumor (SFT) is a benign neoplasm, firstly described as a mesenchymal tumor of the pleura. Its incidence range in the head and neck region is about 5–27%, but only rarely does it affect paranasal sinuses. The differential diagnosis is challenging, owing to its erosive growth pattern and immuno-histochemical features. SFTs have an aggressive behavior and an important recurrence potential. Therefore, a radical surgical excision is the gold standard therapeutic procedure. A rare SFT originating from the right maxillary sinus is reported here. The 37-year-old patient presented to the outpatient clinic with a painful expansive lesion in the whole right maxillary region. The overlying skin was inflamed and the patient had no epistaxis episodes. The 1.5 dentary element tested negative for vitality; however, a puncture of the lesion led to a hematic spill and no purulent discharge. An endoscopic-guided biopsy was suggestive either of SFT or hemangioperictoma, excluding a malignant neoplasm. A multi-equipe surgical team was activated. The lesion was embolized in order to achieve a good hemostatic control and, after 48 h, the neoplasm was radically excised with a combined open and endoscopic approach. The patient was disease-free at 12-month radiological and clinical follow-up. Given the rarity of this lesion and the delicacy required in addressing head and neck neoplasms, we believe that the present case report might be of help in further understanding how to approach cranio-facial SFTs.

Download Full-text

Histomorphological Patterns of Lesions in Thyroid Specimens

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i1.1541 ◽

2020 ◽

Vol 24 (1) ◽

pp. 46-51

Author(s):

Kainaat Ali ◽

Sidra Bibi ◽

Aasiya Niazi

Keyword(s):

Thyroid Gland ◽

Follicular Adenoma ◽

Malignant Neoplasm ◽

Inflammatory Lesion ◽

Benign Neoplasm ◽

Hashimoto Thyroiditis ◽

Cross Sectional Study ◽

Thyroid Disorders ◽

Neck Swelling ◽

Cross Sectional

Background: The thyroid gland is an important endocrine organ required for the regulation of the basal metabolic rate. It also plays a very important role in growth. Thyroid disorders have great importance because most thyroid diseases are curable. In any area, thyroid gland disorders have a variable incidence and prevalence depending upon several factors. The objective of the study is to find out the relation of age and gender with the frequency of various thyroid lesions.Materials & Methods: It was a descriptive, cross-sectional study carried out on thyroidectomy specimens received at the histopathology laboratory of Holy Family Hospital, Rawalpindi. From January 2015 to June 2018, 242 thyroidectomy specimens were selected based on non-probability consecutive sampling. Reports with no clear-cut definitive diagnosis were excluded. Data were analyzed using SPSS 22.Results: In our study of 242 thyroidectomy specimens, patients' age ranged from 4 to 70 years. 40 to 49 years was the peak age and the mean age was 37.1 years. The female to male ratio was 6.4:1. Of 242 cases, 18(7.4%) were neoplastic thyroid lesions and 224(92.6%) were non-neoplastic ones. Hyperplastic lesions were the most common in our study. The frequency of the inflammatory lesion was 4.1% with Hashimoto thyroiditis (80%) being the most common. The frequency of benign neoplasm was 2.1%. A follicular adenoma was the only benign thyroid neoplasm in our study. The frequency of malignant neoplasm was 5.4%. The most common subtype of thyroid malignancy was papillary thyroid carcinoma (76.9% of the malignant cases). Among a total of 242 cases, 83.1%(n=201) patients had only one presenting complaint (neck swelling). Conclusion: Thyroid disorders are more common in females compared to males. The hyperplastic lesion is the most common type seen. In this study, the most common benign neoplasm is follicular adenoma and the most common malignant neoplasm is papillary carcinoma. Neck swelling is the commonest presenting complaint in our study participants.

Download Full-text

Resección endoscópica de hamartoma gigante de glándulas de Brunner. Reporte de un caso

Acta gastroenterológica latinoamericana ◽

10.52787/gput6166 ◽

2021 ◽

Vol 51 (3) ◽

Author(s):

Karina Yonamine ◽

Cecilia Curvale ◽

Raul Matanó ◽

Alejandro Hensel ◽

María Fernanda Yankowyez

Keyword(s):

Histopathological Examination ◽

Duodenal Bulb ◽

Malignant Neoplasm ◽

Benign Neoplasm ◽

Duodenal Wall ◽

Large Size ◽

Brunner’S Gland ◽

Low Incidence ◽

Brunner's Gland ◽

Brunner’S Gland Hamartoma

Brunner's gland hamartoma or hyperplasia is a rare benign neoplasm of the small intestine, usually small, that is discovered incidentally on an upper digestive endoscopy or imaging tests. When it reaches a large size, it can cause digestive bleeding or intestinal obstruction. The pathogenesis is unknown. The endoscopic presentation can be nodular, polypoid or a diffuse glandular proliferation with thickening of the duodenal wall, and may be mistaken for a malignant neoplasm. Endoscopic resections of large Brunner's gland hamartomas in the duodenum is little reported in literature, due to its low incidence and diagnostic difficulty. The surgical approach is associated to greater morbidity compared to an endoscopic approach. The case of a 62-year-old patient is reported, who presented melena and symptomatic anemia, secondary to a giant polyp in the duodenal bulb. The polyp was successfully resected endoscopically without complications, which made it possible to avoid a more extensive surgical procedure. Histopathological examination of the whole specimen showed a Brunner's gland hamartoma. Conclusion: Brunner's gland hyperplasia or hamartoma is a benign neoplasm that rarely produces symptoms. Large lesions can become symptomatic and a high clinical-endoscopic suspicion and an evaluation of the extension are necessary before applying any therapeutic procedure, in order to avoid complex surgeries and favor a complete and safe endoscopic resection.

Download Full-text

Interdisciplinary Approach to Improving the Organization of Surgical Care for Patients with Thyroid Pathology

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.05.276 ◽

2021 ◽

Vol 6 (5) ◽

pp. 276-284

Author(s):

I. A. Klimenko ◽

◽

O. K. Tolstanov

Keyword(s):

Data Exchange ◽

Circulatory System ◽

Malignant Neoplasm ◽

Surgical Care ◽

Interdisciplinary Approach ◽

Benign Neoplasm ◽

Endocrine Surgery ◽

Multidisciplinary Teams ◽

Surgical Interventions ◽

Thyroid Pathology

The interdisciplinary approach is recognized as the gold standard for organizing medical care for patients with oncological pathology. It is declared at the normative level in Ukraine, but the forms and methods of work, channels and methods of communication of specialists are not detailed. This requires further research, in particular, when providing surgical care to patients with thyroid pathology. The purpose of the study was to investigate the state of activity organization of multidisciplinary teams in the provision of surgical care to patients with thyroid pathology and to propose approaches for its improvement. Materials and methods: accounting forms No. 003 for 2019 (1208 units), constituent and administrative documents for the institution, department regulations, job descriptions, clinical pathway of patients (15 units in total). The base of research was communal non-profit enterprise "Kiev City Clinical Endocrinological Center". The methods, which were used, are systematic approach, medical and statistical, medical and geographical methods, content analysis, graphic. Results and discussion. Patients of the Department of Endocrine Surgery were from almost all regions of Ukraine. 3.5% of patients were referred by a general practitioner, 55.7% - by an endocrinologist, 40.1% - independently applied. Malignant neoplasm of the thyroid gland was detected in 33.9% of patients, non-toxic multinodular goiter – in 25.2%, benign neoplasm – in 16.3%. In 448 (37.1%) patients, 687 concomitant diseases and complications were identified. Their structure consisted of diseases of the heart and circulatory system – 40.0%, eye diseases – 3.1%, diseases of the nervous system – 2.0%. In order to meet the needs of patients, instrumental and laboratory studies, consultative examinations, consultations and surgical interventions were carried out. The low level of communication between inpatient doctors and outpatient doctors has been shown. This was the reason for the excessive length of stay in bed – 12.6 ± 2.7 days. There is a separate participation of specialist doctors in accompanying patients in the hospital. It was proposed to formalize the official status and develop a typical provision for a multidisciplinary team of specialists; joint discussion, debate, data exchange within the team and with outpatient doctors; afford access to corporate information for the team and coordinate the work of authorized employees. Conclusion. Improving the efficiency of multidisciplinary teams is possible by strengthening collaboration within the team and communication with outpatient doctors

Download Full-text

Clinicopathological study of breast diseases: A hospital-based study

Journal of Pathology of Nepal ◽

10.3126/jpn.v9i1.21991 ◽

2019 ◽

Vol 9 (1) ◽

pp. 1460-1463

Author(s):

Ramesh Chavan ◽

Anil Prasad

Keyword(s):

Ductal Carcinoma ◽

Malignant Neoplasm ◽

Benign Neoplasm ◽

Breast Diseases ◽

Microsoft Excel ◽

Clinicopathological Study ◽

Neoplastic Lesions ◽

Malignant Lesions ◽

Hematoxylin And Eosin ◽

Tissue Specimens

Background: Breast diseases are more common in women than men. Breasts undergo perpetual physical and physiological transition from puberty till death, which are related to menstruation, pregnancy, and menopause. The aim of this was to classify different types of the breast lesions, and conduct its clinicopathological study. Materials and Methods: Breast lesion tissue specimens were collected either as needle biopsy, lumpectomy, or mastectomy. For specimens fixation, 10% formal saline was used. Tissue was processed into paraffin blocks and stained using hematoxylin and eosin. Data were entered into Microsoft Excel spreadsheets and analyzed using percentages. Results: Out of 150 patients, 97.3% were female and 2.7% were male. Nonneoplastic lesions and neoplastic lesions accounted for 11% and 89% of the cases in patients, respectively. Among the nonneoplastic lesions, chronic mastitis (47%) was most common. Fibroadenoma (76%) and invasive ductal carcinoma (91%) was the highest encountered benign and malignant neoplasm, respectively. Maximum (43%) of benign neoplasm incidence was encountered in the age-group 20–30 years; whereas in malignant neoplasm, it was 40–50 years (38%). Out of 150 patients, 55% were diagnosed with Nottingham grading system grade 2 of breast cancer. Conclusions: Occurrence of neoplastic lesions in the breasts is comparatively higher than nonneoplastic lesions. Differentiating between benign and malignant lesions would be useful in the management and treatment of patients.

Download Full-text

Epidemiological Survey of Central Nervous System Tumors Admitted in a Reference Hospital in the North Fluminense Region in Brazil

10.31487/j.ijcst.2021.02.03 ◽

2021 ◽

pp. 1-3

Author(s):

Luisa Aguirre Buexm ◽

Danielli Aparecida de Souza Silva ◽

Bruna Areas Ribeiro ◽

Rayane Figueiredo Silva Moreira Carvalho ◽

Julia Moraes Ferreira ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Malignant Tumors ◽

Malignant Neoplasm ◽

Epidemiological Data ◽

Epidemiological Survey ◽

Central Nervous System Tumors ◽

Nervous System Tumors ◽

The North ◽

Reference Hospital

Cancer is a major worldwide health problem, being an important cause of morbidity and mortality to population. In global scale, nervous system cancers represent around 1.8% of all malignant tumors in the planet. From 2020 to 2022, it’s estimated around 11.090 new cases of this type of cancer in Brazil. This study aims to raise epidemiological data on central nervous system tumors admitted to the oncology department of a reference hospital in the North Fluminense region in Brazil. Forty-four patients were included in this study, who were predominant males (56.8%), aged between 41 to 60 years old (47.7%), with tumors located primarily in the brain (65.9%) and histopathologically classified as glioblastomas (38.6%). Patients had no family history of cancer (64.3%), were non-smokers (68.2%), non-alcoholics (70%), undergoing primary surgical treatment (34.1%), who did not undergo adjuvant treatment (84.1%) and who died from the disease (66.7%). Glioblastoma was the most incident malignant neoplasm, followed by astrocytoma for both sexes, corroborating with literature data. In summary, this work contributes to a better understanding of these tumors, focusing on their prevention, early diagnosis and treatment.

Download Full-text

An adrenocortical oncocytoma with unusual mitochondrial inclusions and cytoplasmic crystals

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100168980 ◽

1994 ◽

Vol 52 ◽

pp. 250-251

Author(s):

W.T. Gunning ◽

G.D. Haselhuhn ◽

E.R. Phillips ◽

S.H. Selman

Keyword(s):

Adrenal Gland ◽

Salivary Glands ◽

Mitotic Activity ◽

Diagnostic Criteria ◽

Vascular Invasion ◽

Benign Neoplasm ◽

Benign Tumors ◽

Nuclear Morphology ◽

Case Presentation ◽

Microscopic Evidence

Within the last few years, adrenal cortical tumors with features concordant with the diagnostic criteria attributed to oncocytomas have been reported. To date, only nine reported cases exist in the literature. This report is the tenth case presentation of a presumptively benign neoplasm of the adrenal gland with a rare differentiation. Oncocytomas are well recognized benign tumors of the thyroid, parathyroid, and salivary glands and of the kidney. Other organs also give rise to these types of tumors, however with less frequency than the former sites. The characteristics generally used to classify a tumor as an oncocytoma include the following criteria: the tumor is 1) usually a solitary circumscribed mass with no gross nor microscopic evidence of metastasis (no tissue nor vascular invasion), 2) fairly bland in terms of mitotic activity and nuclear morphology, and 3) composed of large eosinophillic cells in which the cytoplasm is packed full of mitochondria (Figure 1).

Download Full-text

Shoulder Pain at Work: Causation Analysis

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2017.janfeb02 ◽

2017 ◽

Vol 22 (1) ◽

pp. 11-16

Author(s):

Joel Weddington ◽

Charles N. Brooks ◽

Mark Melhorn ◽

Christopher R. Brigham

Keyword(s):

Epidemiological Data ◽

Case Law ◽

Individual Case ◽

Shoulder Injury ◽

Work Related ◽

Clear Cut ◽

The Individual ◽

Causation Analysis ◽

Injury Causation ◽

Relevant Factors

Abstract In most cases of shoulder injury at work, causation analysis is not clear-cut and requires detailed, thoughtful, and time-consuming causation analysis; traditionally, physicians have approached this in a cursory manner, often presenting their findings as an opinion. An established method of causation analysis using six steps is outlined in the American College of Occupational and Environmental Medicine Guidelines and in the AMA Guides to the Evaluation of Disease and Injury Causation, Second Edition, as follows: 1) collect evidence of disease; 2) collect epidemiological data; 3) collect evidence of exposure; 4) collect other relevant factors; 5) evaluate the validity of the evidence; and 6) write a report with evaluation and conclusions. Evaluators also should recognize that thresholds for causation vary by state and are based on specific statutes or case law. Three cases illustrate evidence-based causation analysis using the six steps and illustrate how examiners can form well-founded opinions about whether a given condition is work related, nonoccupational, or some combination of these. An evaluator's causal conclusions should be rational, should be consistent with the facts of the individual case and medical literature, and should cite pertinent references. The opinion should be stated “to a reasonable degree of medical probability,” on a “more-probable-than-not” basis, or using a suitable phrase that meets the legal threshold in the applicable jurisdiction.

Download Full-text