Erythema Ab Igne with Histological Features of Keratosis Lichenoides Chronica

Erythema ab igne (EAI) is a localized, hyperpigmented and reticulated dermatosis at sites of chronic heat exposure. Within longstanding skin lesions of EAI, hyperkeratotic lesions may emerge and can potentially transform into pre-malignant or malignant skin lesions. A 55-year-old woman presented for the evaluation of multiple hyperkeratotic lesions along with a reticular patterned hyperpigmentation on her right knee, an area that had repeated and prolonged exposure to a heat source over a period of several months. Based on her clinical history and the physical examination of her lesions, she was diagnosed as having a hyperkeratotic form of EAI. A skin biopsy was performed to rule out malignant alteration, but the histopathological findings were supportive of keratosis lichenoides chronica.

Choledochal Cysts Resected during Childhood Show No Mutations of KRAS and BRAF as Early Markers of Malignancy in Cholangiocytes

Introduction In patients with choledochal cysts (CDC), a hyperplasia-dysplasia-carcinoma sequence can lead to biliary tract malignancy. The limited data available suggest that the risk decreases considerably after excision in childhood. We analyzed samples of resected CDC from pediatric patients histologically and performed mutational analysis of the proto-oncogenes KRAS and BRAF as early markers of malignant alteration in cholangiocytes. Materials and Methods After institutional review board approval, patients undergoing resection for CDC in our center from 2011 to 2019 were retrospectively identified. Histopathological reports were searched for inflammation and endothelial alteration. Cases with sufficient tissue specimen were tested for KRAS codon 12/13 and BRAF codon 600 mutations by pyrosequencing. Results In total, 42 patients underwent resection for choledochal cyst in the study period. Median age at surgery was 2.4 years (range = 18 days–18 years). Histopathological analysis showed no malignancy, but various degrees of inflammation or fibrosis in approximately 50% of the patients and in all age groups. Sufficient tissue for mutation analysis was available for 22 cases, all of which tested negative for KRAS or BRAF mutation. Conclusion In our series, chronic inflammatory changes were frequently present in CDC of infants and children. However, the lack of KRAS and BRAF mutations suggests that no malignant changes have been initiated in this group of European patients undergoing early resection.

Mucinous cystadenomas of the liver

Introduction. Biliary cystadenomas of the liver are rare benign tumors prone to malignant alteration so that a total excision is recommended. Objective. The aim of the paper is to present our experience in treatment and to evaluate whether a simple ablation represents the appropriate treatment. Methods. Over a 10?year period 25 patients (24 women) of the average age of 58 years suffering from cystadenomas of the liver, 18 in the right, 4 in the left and 3 in both lobes of the liver were operated. Twenty?three patients had a single lesion, while two patients had 3 and 6 lesions, respectively. Pain was present in 20, occasional vomiting in 4, discomfort in 2 and a sense of fullness in 2 patients. Three patients were jaundiced, 1 due to cystadenoma of the liver, 2 due to concomitant tumors of the head of the pancreas, while 5 patients had concomitant diseases. Results. A total ablation was performed in 22 patients, left lateral bisegmentectomy in 1 and partial excision in 2 patients. Six additional procedures were performed. Five cystadenomas of the liver had ?ovarian like? stroma, all in women. A focal malignant alteration was found in 2 patients aged 66 and 79 years, respectively. Recurrence was registered in 1 female patient in whom a partial excision had been done. Two patients with concomitant malignancy and 1 patient who developed malignant histiocytosis six months after surgery, died after 1, 2 and 3 years, respectively. Conclusion. Biliary cystadenomas of the liver may be misdiagnosed as simple liver cysts, so that ?frozen section? histology is highly recommended. In most cases the tumor may be successfully treated by ablation up to the healthy liver tissue. Major liver resections are rarely necessary.

Ultrasound diagnosis of gallbladder polyps

The most frequent benign gallbladder polyps are cholesterol polyps. Next in frequency were adenomas, which may have malignant potential. The aim of this study was to assess the possibility of ultrasonography in the diagnosis and differential diagnosis of cholesterol polyps compared to adenomas. Patients were examined during the period from October 2006. to December 2008. In Department of Ultrasound, Clinic for Gastroenterology and Hepatology, Belgrade. The group of 54 patients analyzed consisted of 30 women (56%) and 24 men (44%). Most (59%) had solitary polyps. In 92.6% of patients the size of polyps was below 10 mm. 74% of respondents were over 50 years. Ultrasonography is the method of choice and gold standard in diagnosis of gallbladder polyps. Based on echoic properties cholesterol polyps can not be distinguished from adenomas. Malignant alteration of polyps also could not be detected. Appropriate ultrasonographic characteristics such as size of polyps, appearance of a broad base that sits on the wall, concomitant lithiasis findings and patient age may be indicative for malignancy.

Dysplastic nevus - a risk factor of developing skin melanoma clinical and epidemiological study with retrospective review of literature

Dysplastic nevus is a risk factor for developing skin melanoma. The aim was to analyze patients with both skin melanoma and dysplastic nevi. A 10-year retrospective analysis (1999-2009) was conducted at the Department for Plastic and Reconstructive Surgery, Clinical Centre Vojvodina. During the observed time interval, of 482 patients treated for skin melanoma, 165 (34,2%) had also dysplastic nevi. Melanoma developed more often de novo (67.9%) and 32.1% by malignant alteration. The most dominant type of melanoma was nodular one (70.3%), the most frequent depth being 3.1-4mm (40.6%). The highest incidence of melanoma (32.1%) was in patients aged from 51 to 60 years. The 5- and 10-year survival rates were 72.7% and 50.3%, respectively. Our results correspond to those found in literature except for the fact that the majority of diagnosed melanomas were of nodular type with worse prognosis.

Role of mucinohistochemical analysis in verification of malignant potential of colorectal adenoma

Background/Aim. It is a general opinion that the biggest number of colorectal carcinoma (CRC) develops with the malignant alteration of colorectal adenomas (adenoma carcinoma sequence). Malignant potential of adenoma is in the function of its size, histological structure and the grade of dysplasia. An adequate analysis of colorectal adenomas helps their definition and timely removal, which significantly decreases carcinoma incidence. Mucin analysis can provide results which support the adenoma carcinoma sequence theory. The aim of the study was to present histochemical characteristics of adenomas and emphasize the significance of these analyses for the precise adenoma definition. Methods. This prospective study included analysis of 117 colorectal adenomas obtained by transcolonoscopic biopsy or polipectomy in 82 patients. The biopsy samples and the removed polyps were coloured by hematoxilin-eozin (HE) staining and histochemical stainings by Periodic Acid Schiff (AB-PAS) and High Iron Diamine/Alcian blue (HIDAB; pH=2.5) to prove mucins. Results. Sulphomucins are more often found in adenomas of the left colon than of the right one (p < 0.001). Sialomucins are more reactive in adenomas of the right colon (p < 0.001). Sulphomucins are more reactive in adenomas of < 10 mm diameter (p < 0.05). The reactivity of all mucins is in negative correlation with the degree of dysplasia (p < 0.001). There is a significant difference in the reactivity of sialomucins in adenomas of the same histological type but different degree of dysplasia (?2 = 25,743, df = 6, p < 0.001). Conclusion. The difference in the presence of mucins between adenomas of the left and right colons supports the theory of adenoma carcinoma sequence, since adenomas of the right colon are more protected by sialomucins and therefore less malignantly altered, which is consistent with CRC topography. Histochemical analysis of colorectum is significant for more accurate gradation of dysplasia and confirmation of malignant alteration. The negative correlation between the degree of dysplasia and the production of mucin indicates the significance of the degree of dysplasia in malignant potential of colorectal adenomas.

Alveolar adenoma: A rare lung tumor

Introduction Alveolar adenoma belongs to the group of benign epithelial tumors. Histogenesis of alveolar adenoma is a combination of proliferation of alveolar pneumocytes and fibrous tissue originating from septal mesenchyma. Case outline A sixty-nine-year old female patient was hospitalized for clinical examination and surgery of well defined and homogenous timorous lesion in the right middle lobe causing pleural pain. Bronchoscopic examination with biopsy did not resolve etiology of the disease. Tumorectomy was performed. Timorous nodule had a multicystic appearance and histologically, histochemically and immunohistochemically, an alveolar adenoma was estimated. Five years after surgery, the patient feels well, without respiratory symptoms and signs of recurrence or malignant alteration, respectively. Conclusion Alveolar adenoma is a rare benign lung tumor, most frequently presented as a solitary pulmonary nodule. After complete surgery, the tumor neither relapses nor malignantly alters. Surgical excision is curative. It is necessary to take into consideration alveolar adenoma, too, when a solitary pulmonary nodule is diagnosed.

Mucinous cystadenoma of pancreatic head with focal malignant alteration in a 52-year old man

Mucinous cystadenomas of the pancreas are rare tumors appearing usually within the body and the tail of the pancreas in a young and middle-aged women. They rarely communicate with the pancreatic duct and occasionally may become malignant. The authors present a patient with a number of rare features. In a 52 year-old male, we did a radical pylorus-preserving cephalic duodenopancreatectomy for a mucinous cystadenoma within the head of the pancreas, which perforated into the main pancreatic duct causing chronic obstructive pancreatitis having few foci of malignant alteration. The postoperative recovery was uneventful, but three months later the patient died due to exacerbation of the underlying serious heart disease. .