scholarly journals Testicular sparing surgery in small testis masses: A multinstitutional experience

2016 ◽  
Vol 88 (4) ◽  
pp. 320 ◽  
Author(s):  
Andrea B. Galosi ◽  
Paola Fulvi ◽  
Andrea Fabiani ◽  
Lucilla Servi ◽  
Alessandra Filosa ◽  
...  
Keyword(s):  
Tumor Markers ◽  
Malignant Tumor ◽  
Frozen Section ◽  
Intraoperative Ultrasound ◽  
Testicular Tumor ◽  
Pathological Examination ◽  
Small Lesion ◽  
Benign Lesions ◽  
Tertiary Center ◽  
Small Testis

Introduction: The incidence of benign testicular tumors is increasing in particular in small lesion incidentally found at scrotal ultrasonography. Primary aim of this study was to perform radical surgery in malignant tumor. Secondary aim was to verify the efficacy of the diagnostic-therapeutic pathway recently adopted in management of small masses with testis sparing surgery in benign lesions. Materials and methods: In this multicenter study, we reviewed all patients with single testis lesion less than 15 mm at ultrasound as main diameter. We applied the diagnostic-therapeutic pathway described by Sbrollini et al. (Arch Ital Urol Androl 2014; 86:397) which comprises: 1) testicular tumor markers, 2) repeated scrotal ultrasound at the tertiary center, 3) surgical exploration with inguinal approach, intraoperative ultrasound, and intraoperative pathological examination. Definitive histology was reviewed by a dedicated uro-pathologist. Results: Twenty-eight patients completed this clinical flowchart. The mean lesion size was 9.3 mm (range 2.5-15). Testicular tumor markers were normal except in a case. Intraoperative ultrasound was necessary in 8/28 cases. We treated 11/28 (39.3%) with immediate radical orchiectomy and 17/28 (60.7%) with testis-sparing surgery. Definitive pathological results were: malignant tumor in 6 cases (seminoma), benign tumor in 10 cases (5 Leydig tumors, 2 Sertoli tumors, 1 epidermoid cyst, 1 adenomatoid tumor, 1 angiofibroma), benign disease in 11 (8 inflammation with haemorragic infiltration, 2 tubular atrophy, 1 fibrosis), and normal parenchyma in 1 case. We observed a good concordance between frozen section examination and definitive histology. Any malignant tumor was treated conservatively. Any delayed orchiectomy was necessary based on definitive histology. Conclusions: The incidence of benign lesions in 60% of small testis lesions with normal tumor markers makes orchiectomy an overtreatment. Testicular sparing surgery of single testicular nodules below 15 mm is a safe option, but requires a standardized pathway in diagnosis. Our pathway has shown good reliability and security profile to be applied in a multicenter management for small scrotal masses. Our study has shown the reliability of the diagnostic-therapeutic pathway in the management of single testicular masses. The higher incidence of benign lesions in 60% of patients makes often orchiectomy an overtreatment.

scholarly journals Fibrous Pseudotumor of Tunica Albuginea Testis Mimicking Testicular Neoplasm in a Young Man

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Syed Muhammad Nazim ◽  
Ayesha Nusrat ◽  
Zehra Kazmi
Keyword(s):  
Frozen Section ◽  
Tunica Albuginea ◽  
Testicular Tumor ◽  
Testicular Neoplasm ◽  
Ultrasound Scan ◽  
Lower Pole ◽  
Benign Lesions ◽  
Left Testis ◽  
Neoplastic Process ◽  
History Of

Intrascrotal lesions are common findings with a majority occurring in paratesticular tissue. Fibrous pseudotumors are rare, benign lesions of the testicular tunics and present with mass lesion(s) in the scrotum. Preoperative clinical and radiological diagnosis is challenging. We report a case of a 34-year-old man who presented with a 3-year history of left testicular swelling and was advised left radical orchidectomy by another surgeon. Physical examination revealed a firm, nontender mass attached to the lower pole of the testis. Testicular tumor markers were all negative, and ultrasound scan showed a relatively hypoechoic lesion closely associated with the left testis and suspicious for neoplastic process. The patient underwent a testicular sparing surgery. An intraoperative frozen section biopsy confirmed the lesion to be benign and this was reported on permanent section to be fibrous pseudotumor of the tunica albuginea. We also present the clinical, sonographic, and histopathological findings of this condition along with the literature review.

scholarly journals Diagnostic-therapeutic pathway for small lesions of the testis

2014 ◽  
Vol 86 (4) ◽  
pp. 397 ◽  
Author(s):  
Giulia Sbrollini ◽  
Daniele Mazzaferro ◽  
Asim Ettamimi ◽  
Rodolfo Montironi ◽  
Marco Cordari ◽  
...  
Keyword(s):  
Radical Surgery ◽  
Frozen Section ◽  
Tissue Loss ◽  
Clinical Implications ◽  
Small Lesion ◽  
Intraoperative Diagnosis ◽  
Best Management ◽  
Frozen Section Analysis ◽  
Small Testis ◽  
Section Analysis

Objective of our study was to define a diagnostic-therapeutic pathway for proper treatment of not-palpable testicular masses, that may be benign in 38% of cases. Since the intraoperative diagnosis is difficult to reach in particular in small lesion (< 8 mm) and the risk of tissue loss in frozen section analysis occurs frequently, we propose a diagnostic flow chart for the best management of small testis lesions. This proposed protocol has to be shown in details to physicians and patients, who must understand the clinical implications and the risk to undergo a second radical surgery.

scholarly journals Frozen-section examination in the management of paediatric testicular lesions

2021 ◽  
Author(s):  
E. O’Connor ◽  
C. Roy ◽  
S. Annavarapu ◽  
H. O. Gabra
Keyword(s):  
Frozen Section ◽  
Pathological Examination ◽  
Benign Lesions ◽  
Single Centre ◽  
Frozen Section Examination ◽  
Paediatric Patients ◽  
Benign Pathology ◽  
Age At Surgery ◽  
Testicular Lesions ◽  
Paediatric Practice

Abstract Purpose Paediatric testicular and para-testicular lesions have traditionally been managed according to adult protocols. Testis-sparing surgery (TSS) has gained popularity as it has become apparent benign lesions predominate in childhood. Frozen-section examination (FSE) for intra-operative diagnosis has been extensively utilised in adults, though its use in paediatric practice remains limited. We reviewed our experience of FSE in paediatric patients with an aim to identify the utility and efficacy of this tool in the management of testicular and para-testicular pathology. Methods A retrospective, single-centre review of paediatric patients who underwent intra-operative FSE for a range of testicular and para-testicular lesions was performed. FSE results were compared to final pathology. TSS was performed if appropriate, and was utilised in adolescent patients, and in lesions with a diameter greater than 20 mm. Results Nine males underwent FSE from 2013 to 2020. Median age at surgery was 9 years (range 1–15). Eight (89%) patients had benign pathology. FSE result correlated with the final pathological examination in 100% of cases. FSE facilitated TSS in 7/9 cases. Conclusion FSE has 100% diagnostic accuracy for paediatric testicular and para-testicular pathology. We would recommend all lesions be evaluated by FSE to guide intra-operative decision making and facilitate TSS in appropriate cases.

scholarly journals Real-time intraoperative glioma diagnosis using fluorescence imaging and deep convolutional neural networks

2021 ◽  
Author(s):  
Biluo Shen ◽  
Zhe Zhang ◽  
Xiaojing Shi ◽  
Caiguang Cao ◽  
Zeyu Zhang ◽  
...  
Keyword(s):  
Neural Networks ◽  
Real Time ◽  
Fluorescence Imaging ◽  
Convolutional Neural Networks ◽  
Frozen Section ◽  
Fluorescent Imaging ◽  
Pathological Diagnosis ◽  
Pathological Examination ◽  
Deep Convolutional Neural Networks ◽  
Fluorescence Images

Abstract Purpose Surgery is the predominant treatment modality of human glioma but suffers difficulty on clearly identifying tumor boundaries in clinic. Conventional practice involves neurosurgeon’s visual evaluation and intraoperative histological examination of dissected tissues using frozen section, which is time-consuming and complex. The aim of this study was to develop fluorescent imaging coupled with artificial intelligence technique to quickly and accurately determine glioma in real-time during surgery. Methods Glioma patients (N = 23) were enrolled and injected with indocyanine green for fluorescence image–guided surgery. Tissue samples (N = 1874) were harvested from surgery of these patients, and the second near-infrared window (NIR-II, 1000–1700 nm) fluorescence images were obtained. Deep convolutional neural networks (CNNs) combined with NIR-II fluorescence imaging (named as FL-CNN) were explored to automatically provide pathological diagnosis of glioma in situ in real-time during patient surgery. The pathological examination results were used as the gold standard. Results The developed FL-CNN achieved the area under the curve (AUC) of 0.945. Comparing to neurosurgeons’ judgment, with the same level of specificity >80%, FL-CNN achieved a much higher sensitivity (93.8% versus 82.0%, P < 0.001) with zero time overhead. Further experiments demonstrated that FL-CNN corrected >70% of the errors made by neurosurgeons. FL-CNN was also able to rapidly predict grade and Ki-67 level (AUC 0.810 and 0.625) of tumor specimens intraoperatively. Conclusion Our study demonstrates that deep CNNs are better at capturing important information from fluorescence images than surgeons’ evaluation during patient surgery. FL-CNN is highly promising to provide pathological diagnosis intraoperatively and assist neurosurgeons to obtain maximum resection safely. Trial registration ChiCTR ChiCTR2000029402. Registered 29 January 2020, retrospectively registered

Intraosseous Epidermoid Inclusion Cyst in a Great Toe

2003 ◽  
Vol 127 (7) ◽  
pp. e298-e300 ◽  
Author(s):  
Beverly Y. Wang ◽  
Jesse Eisler ◽  
Dempsey Springfield ◽  
Michael J. Klein
Keyword(s):  
Frozen Section ◽  
Inclusion Cyst ◽  
Great Toe ◽  
Imaging Studies ◽  
Benign Lesions ◽  
Work Related ◽  
Frozen Section Diagnosis ◽  
History Of ◽  
Radiolucent Lesion ◽  
Epidermoid Inclusion Cyst

Abstract Epidermoid inclusion cysts are benign lesions that occasionally occur in the distal phalanges of the fingers but are less frequently identified and underreported in the toes. We describe a 55-year-old man with a history of work-related trauma followed by painful expansion of his right great toe, resulting in great anxiety. Imaging studies revealed a radiolucent lesion in the distal phalanx of his right hallux. Clinical differential diagnoses included the possibility of an intramedullary inclusion cyst and other various radiolucent lesions. During surgery, a cystic lesion that contained creamy material was discovered. Frozen section diagnosis of the lesion was an intraosseous epidermoid inclusion cyst. The lesion was removed and the patient recovered uneventfully. Although it has been reported that an unduly large number of phalangeal cysts have been treated by amputation, the judicious use of intraoperative frozen sections can prevent this scenario.

Ultrasound Elastography in the Diagnosis of Malignant Cervical Lymphadenopathy in Children: Can It Replace Surgical Biopsy?

2021 ◽  
Author(s):  
Ahmed Elgendy ◽  
Eslam Elhawary ◽  
Mohamed M. Shareef ◽  
Marwa Romeih ◽  
Ahmed Ebeed
Keyword(s):  
Prospective Study ◽  
Color Doppler ◽  
Cervical Lymphadenopathy ◽  
Ultrasound Elastography ◽  
Pathological Examination ◽  
Benign Lesions ◽  
Surgical Biopsy ◽  
Cervical Lymph Nodes ◽  
Benign Nature ◽  
A Prospective Study

Abstract Introduction We aimed to assess the accuracy of ultrasound elastography in detecting pediatric malignant cervical lymph nodes, and if this modality can obviate the need for surgical biopsies. Material and Methods A prospective study from September 2017 to September 2020 included 64 children with persistent cervical lymphadenopathy. Patients were evaluated by meticulous history and physical assessment. B-mode ultrasound, color Doppler, and sonoelastography were conducted thereafter. Elastography scans were classified into five patterns, and patterns from 3 to 5 were considered as malignancies. All children underwent open biopsies followed by pathological examination. Results of tissue diagnosis were compared with patterns of elastography to determine its accuracy. Results Twenty-eight patients (43.8%) had malignant nodes and the remaining 36 (56.2%) were due to benign causes. Elastography patterns of 1 and 2 were documented in 30 patients, and all of them were diagnosed as benign lesions. Patterns of 3 to 5 were demonstrated in 34 patients. Out of them, 28 were confirmed as malignancies, while 6 children were of benign nature (false positive). Ultrasound elastography achieved sensitivity and specificity of 100 and 85.7%, respectively, and an overall accuracy of 90.6% in the differentiation between malignant and benign entities. The overall accuracy of B-mode and color Doppler were 75 and 82.2%, respectively. Conclusion Elastography is a useful tool that should be added to ultrasound modalities during the diagnosis of pediatric cervical lymphadenopathy. Surgical biopsy in eligible patients is imperative to commence proper therapy or to discharge the child. Despite favorable results of elastography, it cannot replace surgical biopsy or change its indications.

scholarly journals Rare presentation of a testicular angiofibroma treated with testis sparing surgery

2016 ◽  
Vol 88 (4) ◽  
pp. 330 ◽  
Author(s):  
Luca Leone ◽  
Paola Fulvi ◽  
Giulia Sbrollini ◽  
Alessandra Filosa ◽  
Enrico Caraceni ◽  
...  
Keyword(s):  
Case Report ◽  
Malignant Tumor ◽  
Gold Standard ◽  
Conservative Surgery ◽  
Pathological Examination ◽  
Benign Tumors ◽  
Frozen Sections ◽  
Rare Presentation ◽  
Final Histology

Introduction: Testicular benign tumors are very rare (&lt; 5%). Testicular Angiofibroma (AF) is one of those, however the gold standard of treatment and follow-up is still unclear. Case report: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. Conclusion: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

Machine learning to identify lung cancer with tuberculosis from isolated tuberculosis (Preprint)

2021 ◽  
Author(s):  
Zhenhao Li
Keyword(s):  
Machine Learning ◽  
Lung Cancer ◽  
Cancer Patients ◽  
Tumor Markers ◽  
Learning Algorithm ◽  
Laboratory Data ◽  
Pathological Examination ◽  
Training Set ◽  
Lung Cancer Patients ◽  
Tb Pcr

UNSTRUCTURED Tuberculosis (TB) is a precipitating cause of lung cancer. Lung cancer patients coexisting with TB is difficult to differentiate from isolated TB patients. The aim of this study is to develop a prediction model in identifying those two diseases between the comorbidities and TB. In this work, based on the laboratory data from 389 patients, 81 features, including main laboratory examination of blood test, biochemical test, coagulation assay, tumor markers and baseline information, were initially used as integrated markers and then reduced to form a discrimination system consisting of 31 top-ranked indices. Patients diagnosed with TB PCR ＞1mtb/ml as negative samples, lung cancer patients with TB were confirmed by pathological examination and TB PCR ＞1mtb/ml as positive samples. We used Spatially Uniform ReliefF (SURF) algorithm to determine feature importance, and the predictive model was built using machine learning algorithm Random Forest. For cross-validation, the samples were randomly split into four training set and one test set. The selected features are composed of four tumor markers (Scc, Cyfra21-1, CEA, ProGRP and NSE), fifteen blood biochemical indices (GLU, IBIL, K, CL, Ur, NA, TBA, CHOL, SA, TG, A/G, AST, CA, CREA and CRP), six routine blood indices (EO#, EO%, MCV, RDW-S, LY# and MPV) and four coagulation indices (APTT ratio, APTT, PTA, TT ratio). This model presented a robust and stable classification performance, which can easily differentiate the comorbidity group from the isolated TB group with AUC, ACC, sensitivity and specificity of 0.8817, 0.8654, 0.8594 and 0.8656 for the training set, respectively. Overall, this work may provide a novel strategy for identifying the TB patients with lung cancer from routine admission lab examination with advantages of being timely and economical. It also indicated that our model with enough indices may further increase the effectiveness and efficiency of diagnosis.

Radioisotopic Lymphatic Mapping of the Sentinel Node in Melanoma: Importance of Immunohistochemistry

2000 ◽  
Vol 86 (4) ◽  
pp. 346-348 ◽  
Author(s):  
Luca Vaggelli ◽  
Antonio Castagnoli ◽  
Lorenzo Borgognoni ◽  
Carmelo Urso ◽  
Maria Matteini ◽  
...  
Keyword(s):  
Lymph Node ◽  
Sentinel Node ◽  
Primary Tumor ◽  
Frozen Section ◽  
Gamma Probe ◽  
Lymph Node Biopsy ◽  
Pathological Examination ◽  
Blue Dye ◽  
Node Dissection ◽  
Hematoxylin Eosin

Background Elective lymph node dissection (ELND) for patients with malignant melanoma is still controversial. A possible alternative could be biopsy of the first tumor draining lymph node, the sentinel node (SN), which can be identified by means of radionuclide techniques. Aim Our study was undertaken to assess the accuracy of lymph node biopsy and to stress the importance of immunohistochemistry (IHC) in the pathological assessment of the SN for improved staging of the primary tumor. Methods We performed lymphoscintigraphy (LS) in 183 melanoma patients (89 with melanoma of the legs, 11 of the arms and 83 of the trunk). Our protocol consisted of preoperative peritumoral i.d. injection of 99mTc-labeled microcolloid to define the regional lymphatic basin and identify the sentinel node by means of planar scintigraphy. In 147 of the 183 cases a gamma probe (GP) was used during surgery to trace the SN. Vital blue dye was used during surgery in all cases. The SNs were excised for pathological examination. The pathological status of the SN was defined by means of examination of frozen sections, hematoxylin-eosin staining and immunohistochemistry for S-100 and HMB-45 MAb. Results At least one separate focus of activity was identified by LS in 182 out of 183 patients; in all 147 cases where a GP was used, it was successful in tracing the SN. LS with cutaneous mapping of the SN successfully guided the surgical excision in 177 of the 183 cases; in the 7 remaining cases, i.e. 7 out of 83 cases with SNs in the axillary basin, GP was not used and no elective node dissection was performed. Metastases were found in 39 of these 177 cases. In all 39 cases the SNs were the only positive nodes in the basin. Of the 39 metastases 18 were identified by means of frozen section, 12 by means of hematoxylin-eosin, and 9 by means of immunohistochemistry. We therefore emphasize the importance of immunohistochemistry in the pathology of LS for improved staging of the primary tumor.

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