Fine needle aspiration and frozen section of salivary gland lesions

This report examines the role of fine needle aspiration (FNA) and frozen section (FS) examination in the management of salivary gland lesions, and is based on a review of 58 cases. FNA specimens were first classified as nonneoplastic, or as benign or malignant neoplasms. Identification of specific morphologic type of neoplastic lesions was attempted. Overall accuracy for assigning cases was 86%. Specific accuracy (histologic type of neoplasms predicted by FNA) was 72%. No inflammatory lesion was incorrectly diagnosed as neoplasm. Eight patients with histologically documented neoplasm had aspirates classified as nonneoplastic because the sample obtained was not representative. These data indicate that FNA is a highly specific method for identifying benign and malignant neoplasms. Applications of salivary gland FNA include (1) identification of nonneoplastic lesions that may respond to nonsurgical management, (2) identification of neoplasms that represent lymph node metastases rather than primary lesions of the salivary gland, (3) preliminary identification of lymphomas, and (4) preliminary separation of benign and malignant neoplasms.     

Sonographically guided core needle biopsy of bone and soft tissue tumors.

OBJECTIVE: To determine the value of sonographically guided core needle biopsies of musculoskeletal tumors as a reliable alternative to fluoroscopy and computed tomography. METHODS: A prospective study was performed in 74 patients referred for image-guided needle biopsy of primary or recurrent musculoskeletal neoplasms and suspected solitary metastasis. Imaging studies performed before biopsy established the feasibility of sonographic guidance in 65 lesions, of which 38 were soft tissue tumors and 27 were bone lesions with extraosseous masses. The lesions were located mainly in the appendicular skeleton. Tissue samples were obtained with a 14-gauge cutting needle coupled to an automated biopsy device under local anesthesia and sonographic guidance. Statistical analysis was based on 48 biopsies confirmed by successful clinical treatment (10 cases) or surgical resection (38 cases). RESULTS: An accurate diagnosis was obtained in 47 (97%) of 48 biopsies; sensitivity was 96%, and specificity was 100%. The method did not yield sufficient tissue to establish a diagnosis in 1 case. Considering all 65 biopsies, high-quality specimens were obtained in 96%. The procedure was carried out expeditiously, and there were no complications. CONCLUSIONS: Sonographically guided core needle biopsy is accurate and safe, obviating open biopsy in most soft tissue masses and bone tumors with extraosseous masses in the appendicular skeleton. In such patients, the sonographically guided procedure is the most prompt and effective method for obtaining tissue samples.     

Surgical method choice and coincidence rate of pathological diagnoses in transduodenal ampullectomy: A retrospective case series study and review of the literature

BACKGROUND Transduodenal ampullectomy(TDA) is not in wide clinical use due to its low radical effect and a high recurrence rate of tumors. However,TDA is still an effective treatment method; it has great clinical value in cases of duodenal benign tumors,precancerous lesions,and benign and malignant borderline tumors,and can avoid the risks associated with pancreaticoduodenectomy with larger resection range and greater thoroughness than endoscopic papillectomy.AIM To investigate the surgical method choice and the coincidence rate of pathological diagnoses in TDA for ampullary neoplasms.METHODS Ten patients with ampullary neoplasms underwent TDA based on the fact that their endoscopic biopsy results suggested benign lesions,and the endoscopic ultrasound(EUS)-assessed tumors were resectable. All cases underwent duodenal ampullary lesion endoscopic biopsy,intraoperative frozen-section pathological examination,and postoperative pathological examination.RESULTSThis study included seven patients with benign tumors and three with malignant tumors(1 pTis,2 pT1),according to the postoperative pathology results. The coincidence rate of the postoperative pathology results with the intraoperative frozen-section biopsy results was 100%(10/10),and the coincidence rate with the endoscopic biopsy results was 70%(7/10) based on pathological characteristics.The endoscopic biopsy false-negative rate was 30%(3/10). All patients were followed for 6 to 70 mo without tumor recurrence or metastasis.CONCLUSION The coincidence rate of postoperative pathology results,intraoperative frozensection pathology results,and endoscopic biopsy results is the restraining factor of TDA clinical application. Endoscopic biopsy results and EUS have importance relevance to surgical planning. Intraoperative frozen-section pathology results have a significant influence on the choice of surgical procedure.     

Predictive value of magnification chromoendoscopy for diagnosing invasive neoplasia in nonpolypoid colorectal lesions and stratifying patients for endoscopic resection or surgery

BACKGROUND AND STUDY AIMS: In nonpolypoid colorectal lesions, the presence of irregular, distorted glands in the colon (a disrupted crypt pattern) on magnification chromoendoscopy (MCE) is strongly associated with submucosal invasive cancer. The aim of the present study was to evaluate the ability of MCE to differentiate between an invasive crypt pattern and a noninvasive crypt pattern, including nonneoplastic lesions, and to assess the ability of this MCE classification to predict invasiveness and allow patients to be selected for endoscopic resection or surgical resection. PATIENTS AND METHODS: In a prospective study including 1560 colonoscopies, 153 flat or depressed colorectal lesions were evaluated with MCE among 534 colorectal lesions; the remainder had a polypoid appearance. The pit pattern was classified as nonneoplastic (type II) or neoplastic (types III - V), and the latter was subdivided into noninvasive (types III or IV) or submucosally invasive (type V). Lesions with a nonneoplastic and noninvasive neoplastic appearance were resected endoscopically if technically feasible, whereas those with a type V pattern were resected surgically. The resection specimens were analyzed histologically in relation to the Vienna classification. RESULTS: Using this management strategy based on the pit pattern, 86 % (n = 70) of the type II lesions were hyperplastic; the remaining 11 had low-grade intraepithelial neoplasia. Type III and IV lesions (n = 58) represented either low-grade or high-grade intraepithelial neoplasia in 95 % of the cases. Three patients had sm1 (n = 2) or sm2/3 invasive cancers. Among the patients with type V lesions (n = 14), 11 had invasive cancers (four sm1 and seven sm2/3). Endoscopic differentiation based on the pit pattern thus had a positive predictive value (PPV) of 86 % and a negative predictive value of 96 % for distinguishing between nonneoplastic and neoplastic lesions. The pit pattern criteria for distinguishing between invasive and noninvasive neoplasia (including nonneoplastic lesions), and hence the choice between endoscopic and surgical resection, had a PPV of 79 % and a NPV of 98 %. Excluding nonneoplastic lesions, the NPV would be 95 %. CONCLUSIONS: The endoscopic pit pattern on MCE has only a moderate predictive value for nonneoplastic lesions, so that leaving these flat hyperplastic lesions in place on the basis of the endoscopic magnification appearance alone cannot be generally recommended. However, MCE has a good predictive value for guiding management toward either endoscopic resection (if technically feasible) or surgical resection.     

Neoplasms and related disorders.

Spinal neoplasms may be primary or metastatic, benign or malignant. In adults, metastatic involvement of the spine will represent the most important neoplastic disease of this region. However, hemangiomas are the most common spinal neoplasms. The vast majority of intradural, extramedullary neoplasms that will be identified in the spine are meningiomas and neurofibromas. Both lesions may be sporadic or associated with phakomatoses. Intramedullary spinal cord and filum terminale tumors are relatively rare and are far less common than intramedullary brain tumors. As is the case in the brain, these are overwhelmingly glial neoplasms, with ependymomas and low-grade astrocytomas representing the majority of the lesions. Hemangioblastoma deserves mention because of its often characteristic imaging findings and its association with von Hippel-Lindau disease.     

Hurthle cell neoplasms of the thyroid: sonographic appearance and histologic characteristics

OBJECTIVE: The purpose of this study was to determine the sonographic features of Hürthle cell neoplasms (HCNs) of the thyroid. METHODS: We retrospectively analyzed the sonographic appearance of 15 histologically proven HCNs in 15 patients aged 16 to 70 years (mean age, 44 years). Sonographic features that were reviewed included the size and echogenicity of the tumors, the presence of cystic areas or calcifications, and detectable blood flow on color Doppler imaging. Correlation of sonographic findings with pathologic results was performed. RESULTS: The tumors ranged from 0.4 to 7 cm in diameter, but most were less than 3 cm in diameter. Four (27%) of the 15 tumors were homogeneously hypoechoic. Two tumors (13%) were predominantly hypoechoic with isoechoic areas to thyroid parenchyma. Two (13%) neoplasms were isoechoic to thyroid parenchyma. Four (27%) tumors were predominantly isoechoic, containing hypoechoic areas, and 3 (20%) tumors were hyperechoic. Three neoplasms contained cystic components. None of the tumors contained calcifications. One tumor was avascular on Doppler examination. One neoplasm showed only peripheral blood flow. Thirteen tumors showed internal vascularity, 7 of them with peripheral blood flow. Twelve HCNs were benign, and 3 were malignant on pathologic examination. CONCLUSIONS: Hürthle cell neoplasms show a spectrum of sonographic appearances from predominantly hypoechoic to hyperechoic lesions and from peripheral blood flow with no internal flow to extensively vascularized lesions. Pathologic criteria differentiating benign and malignant HCNs (absence or presence of a capsular breach, vascular or extrathyroidal tissue invasion, nodal involvement, and distant metastasis) are beyond the resolution of sonography and fine-needle aspiration biopsy and require removal of the entire lesion. This precludes diagnosis and characterization of HCNs by sonography.     

Brenner tumors of the ovary: sonographic and computed tomographic imaging features.

OBJECTIVE: The purpose of this study was to describe the sonographic appearance of ovarian Brenner tumors with computed tomographic (CT) correlation. METHODS: Twenty-two female patients (age range, 32-78 years; mean, 58 years) with 25 ovarian Brenner tumors were identified from pathologic records from 1990 to 2005. Corresponding pathologic reports and images (17 sonographic and 14 CT) were reviewed independently. RESULTS: Tumors ranged in size from 0.3 to 12 cm (mean, 2.5 cm); all were benign. Sixteen (64%) of 25 were found incidentally. Eight (36%) of 22 patients had a total of 12 associated benign ovarian neoplasms (1 was contralateral); 3 patients had bilateral Brenner tumors. Eight (47%) of 17 tumors were not seen on sonography, and 5 (36%) of 14 were not seen on CT. Of the tumors seen on imaging, most were solid (67% on sonography and 78% on CT). Four tumors appeared at least partially cystic, of which 3 had coexistent cystic ovarian lesions. CONCLUSIONS: Brenner tumors are most often solid neoplasms found incidentally and frequently seen in association with other benign ovarian epithelial neoplasms.     

Surgical options for patients with deep-seated brain tumors: computer-assisted stereotactic biopsy

The histologic nature of deep-seated intracranial lesions can be determined by using a computer-assisted stereotactic biopsy technique. The procedures are performed with use of local anesthesia. A data base consisting of stereotactic computed tomographic scans and stereotactic cerebral angiography is acquired. Target coordinates and trajectory approach angles are calculated by using a computer system in the operating room. Since July 1984, 36 patients with a variety of pathologic lesions in various intracranial sites have undergone this procedure at our institution. Of the 36 patients thought to have neoplastic lesions preoperatively, 6 were found to have nonneoplastic lesions, information that was of importance in the therapeutic management of these patients. Of the 30 patients with tumors, 24 had astrocytomas of various grades, 3 had metastatic lesions, and an additional 3 had lymphomas. Computer-assisted stereotactic biopsy with arteriographic control is an accurate and relatively safe method of determining the histologic nature of any suspicious intracranial lesion.     

Monoclonal endothelial cell proliferation is present in primary but not secondary pulmonary hypertension.

The etiology and pathogenesis of the vascular lesions characterizing primary pulmonary hypertension (PPH), an often fatal pulmonary vascular disease, are largely unknown. Plexiform lesions composed of proliferating endothelial cells occur in between 20 and 80% of the cases of this irreversible pulmonary vascular disease. Recently, technology to assess monoclonality has allowed the distinction between cellular proliferation present in neoplasms from that in reactive nonneoplastic tissue. To determine whether the endothelial cell proliferation in plexiform lesions in PPH is monoclonal or polyclonal, we assessed the methylation pattern of the human androgen receptor gene by PCR (HUMARA) in proliferated endothelial cells in plexiform lesions from female PPH patients (n = 4) compared with secondary pulmonary hypertension (PH) patients (n = 4). In PPH, 17 of 22 lesions (77%) were monoclonal. However, in secondary PH, all 19 lesions examined were polyclonal. Smooth muscle cell hyperplasia in pulmonary vessels (n = 11) in PPH and secondary PH was polyclonal in all but one of the examined vessels. The monoclonal expansion of endothelial cells provides the first marker that allows the distinction between primary and secondary PH. Our data of a frequent monoclonal endothelial cell proliferation in PPH suggests that a somatic genetic alteration similar to that present in neoplastic processes may be responsible for the pathogenesis of PPH.     

多排螺旋CT诊断小网膜囊病变的价值

目的 探讨小网膜囊正常解剖及病变的多排螺旋CT（MDCT）表现,评价小网膜囊病变的CT 诊断价值.方法 对24 例小网膜囊病变进行上腹部CT 平扫及三期增强扫描检查,均经手术病理证实.结果 小网膜囊病变中：原发肿瘤6 例（神经鞘瘤2 例,平滑肌瘤1 例,血管瘤1 例,脂肪肉瘤1 例,淋巴瘤1 例）,CT 表现为小网膜囊内边界清晰肿块.邻近脏器的良、恶性肿瘤8 例（胰头癌4 例,肝左叶肝细胞癌2 例,胃间质瘤2 例）,CT 表现为小网膜囊肿块与邻近相应肿瘤边界不清.转移性肿瘤2 例.结核1 例,CT 表现多个病灶融合,内见钙化.积液（腹水漏出液、炎性渗出液、脓液、血液、胆汁、淋巴液）6 例;假性囊肿1 例;CT 均表现为小网膜囊内液性密度灶.结论 多排螺旋CT对小网膜囊病变具有重要的诊断价值.     

Detection of bladder tumors with 3-dimensional sonography and virtual sonographic cystoscopy.

OBJECTIVE: Bladder tumors are among the most common types of malignant neoplasms of the urinary tract. The purpose of this study was to evaluate the potential value of 3-dimensional (3D) sonography and sonographic cystoscopy in detection of bladder tumors. METHODS: Thirty-one patients with suspected or known bladder tumors were included this study. All patients underwent 3D sonography and conventional cystoscopy within 15 days. The number, size, location, and morphologic features of the lesions were evaluated on gray scale, 3D virtual, and multiplanar reconstruction images obtained from the patients. The results of 3D sonographic cystoscopy were compared with the findings from conventional cystoscopy, which was considered the reference standard. RESULTS: Twenty-eight (90.3%) of 31 3D virtual sonographic cystoscopic studies had good or excellent image quality. Conventional cystoscopy revealed 47 lesions in 22 of 28 patients; 3D sonographic virtual cystoscopy showed 41 (87.2%) of 47 lesions. Three-dimensional virtual sonography alone had sensitivity of 96.2%, specificity of 70.6%, a positive predictive value of 93.9%, and a negative predictive value of 80% for tumor detection. The combination of gray scale sonography, multiplanar reconstruction, and 3D virtual sonography had sensitivity of 96.4%, specificity of 88.8%, a positive predictive value of 97.6%, and a negative predictive value of 84.2% for tumor detection. CONCLUSIONS: Three-dimensional sonography is a promising alternative noninvasive technique for use in detection of bladder tumors, their localization, and perivesical spreading. The location, size, and morphologic features of the tumors shown on 3D sonography agreed well with the findings of conventional cystoscopy.     

Stereotactic histologic correlations of computed tomography- and magnetic resonance imaging-defined abnormalities in patients with glial neoplasms

In 39 patients who harbored previously untreated astrocytomas (21 patients), oligoastrocytomas (9 patients), or oligodendrogliomas (9 patients), computed tomographic (CT) and magnetic resonance imaging (MRI) findings were correlated with stereotactic serial biopsy findings. The 39 patients were classified as having one of three types of tumor: type I (1 patient), which consisted only of circumscribed tumor tissue; type II (26 patients), which consisted of tumor tissue and isolated tumor cells; or type III (11 patients), which consisted of intact parenchyma infiltrated by isolated tumor cells. (In one patient, the biopsy sampling was inadequate for determining the type of tumor.) In high-grade lesions, tumor tissue was obtained from CT contrast-enhancing regions, and the area of enhancement accurately defined the tumor tissue volume. In low-grade lesions, tumor tissue was hypodense and indistinguishable from parenchyma infiltrated by isolated tumor cells on both CT and MRI. Isolated tumor cells usually extended as far as the prolongation of T2 on T2-weighted MRI of high-grade and low-grade tumors. CT and MRI detection of boundaries and stereotactic serial biopsies are necessary for the demarcation of glial neoplasms into tumor tissue and isolated tumor cell volumes as well as for the determination of the spatial extent of each component. This information is important for determining appropriate treatment.     

Metallic stent placement for malignant airway stenosis

Abstract

The purpose of this study was to evaluate the utility of metallic stents for treating central airway stenosis caused by malignant tumors. The subjects were 72 patients (16 women, 56 men; mean age, 61 years; age range, 28–87 years) treated with metallic stents for dyspnea due to tracheobronchial stenotic lesions caused by malignant tumors between May 1990 and August 2010. The underlying disorder was primary lung cancer in 42 patients, metastatic lung cancer in 29, and mediastinal tumor in one patient. In 69 of 72 patients (95.8%), dyspnea began to improve following completion of the procedure. The average Hugh-Jones classification score improved from 4.2 before stenting to 2.8 after stenting. The patients' average survival following stent placement was 3.6 months (two days–33 months). Thirteen lesions developed re-obstruction during follow-up. Of these 13 lesions, eight patients with dyspnea underwent re-interventions with metallic stent replacement and improved. Airway stent placement is an immediate and effective method of treatment for dyspnea caused by stenotic lesions of the central airway due to malignant tumor. It is effective for treating stenosis due to either tracheobronchial intraluminal tumor or extrinsic compression. Restenting is also useful to treat dyspnea caused by restenosis following stent placement.     

Sonographically guided core needle biopsy of soft tissue neoplasms

PURPOSE: This study was conducted to evaluate the usefulness of sonography (US)-guided needle biopsy in the diagnosis of soft tissue masses. PATIENTS AND METHODS: Thirty-seven patients with a mean age of 49 years were enrolled in the study. The size of the biopsy needle was selected according to the kind of tumor suspected (ie, primary or metastatic). In patients with suspected metastases, smaller biopsy needles were used; in patients with suspected primary tumors, larger needles were used so that larger specimens could be obtained. Prebiopsy color Doppler sonography (CDUS) was routinely used to guide the cutting needle to areas of the lesion showing sufficient vascularity. From 3 to 6 cores were obtained, depending on their quality. We compared the diagnoses yielded by the core biopsy and the final histopathologic analysis of the resected tumor by classifying the results as "concordant" or "discordant." RESULTS: A total of 37 tumors were examined. Final diagnoses were 24 malignant tumors (6 metastases and 18 primary tumors) and 13 benign tumors. The lesions were diagnosed correctly as either benign or malignant in 35 of the 36 cases for which needle biopsy specimens were adequate, with only 1 misdiagnosis. The diagnoses were concordant in 33 cases (17 primary malignant tumors, 6 metastatic tumors, and 10 benign tumors) and were discordant diagnosis in the other 4 cases (1 primary malignant tumor and 3 benign tumors). No complications were attributable to the needle biopsy. CONCLUSIONS: US-guided percutaneous core needle biopsy of soft tissue neoplasms is an easy, safe, and useful procedure. It can be considered a first-line procedure for the acquisition of tissue specimens adequate for histopathologic diagnosis.     

163例输卵管性不育症盆腔粘连腹膜的病理观察

目的　探讨伴有输卵管和盆腔病变的不孕妇女粘连腹膜活检标本的病理特点。方法　通过光镜对 16 3例不孕妇女的粘连腹膜进行组织学观察。结果　 36例伴有第二苗勒管病损 ,包括 19例输卵管内膜异位、16例子宫内膜异位和 1例浆液性交界性乳头状腺瘤。 14例伴有砂砾体形成 ,5 1例伴有间皮增生 ,113例有活动性炎症改变。统计学上第二苗勒管病损与活动性炎症无关 ,但间皮增生与活动性炎症有关。结论　输卵管炎症所致粘连的盆腔腹膜可伴有间皮增生和第二苗勒管病损 ,二者需与间皮瘤和继发性肿瘤鉴别     

Computed tomography of malignant tumors of the osseous pelvis

The medical records, conventional radiographs, bone scans and pelvic CT scans obtained in 50 consecutive patients with malignant lesions involving the osseous pelvis were retrospestively reviewed. In 21 patients with primary bone tumors or with osseous involvement from adjacent pelvic neoplasms, CT provided additional information, in 17 patients (80%) which had direct bearing in the clinical management. CT was less useful in 29 patients with bony metastases. Although more information was obtained, this was of clinical significance in only 12 patients.     

实时谐波超声造影在肝肿瘤消融治疗中的应用

目的探讨实时谐波超声造影在肝肿瘤消融治疗中的价值。方法对112例肝脏局灶性占位病变患者进行实时超声谐波造影、增强CT/MR和/或病理检查。34例进行了手术治疗,32例进行了射频消融治疗。结果实时谐波超声造影诊断肝脏恶性肿瘤的敏感性、特异性和准确性分别为97.1%、95.3%和96.4%。超声造影显示病灶数增加,病灶范围增大;射频消融后10min和1个月超声造影分别有5例和3例患者见动脉早期病灶部分强化。病灶最大直径超声造影测值与手术标本测值无差异。结论超声造影有助于肝脏肿瘤非手术治疗适应证的选择,提高引导穿刺的准确性和确定治疗范围,以及术后疗效监测。     

~（18）F-FDG PET/CT显像在原发性小肠肿瘤中的诊断价值

目的：探讨18F-FDG PET/CT全身显像在原发性小肠肿瘤中的诊断价值。方法：总结38例小肠病变患者18F-FDG PET/CT的显像资料,均经手术或活检（37例）以及3年内随访（1例）证实,将18F-FDG PET/CT诊断结果与病理结果进行对照分析,评估18F-FDG PET/CT的诊断价值。结果 ：38例患者,FDG高摄取病变33例（另外2例SUVmax分别为1.6、2.3,在小肠生理性低摄取的背景下亦能准确发现病灶）,其中肿瘤性病变占87.9%（29/33）,良恶性病变代谢SUVmax值无统计学意义。CT以小肠新生物为肿瘤性病变最主要征象,包括肠管的局限性增厚（17/31）和软组织肿块（20/31）。3例假阳性（均有明确高代谢病灶,均发生肠梗阻）和1例假阴性（新生物及高代谢均不明显）,18F-FDG PET/CT全身显像诊断原发性小肠病变的敏感度96.8%（30/31）,特异度57.1%（4/7）,假阳性率42.9%,假阴性率3.2%,准确度89.5%（34/38）。结论 ：18F-FDG PET/CT对原发性小肠肿瘤具有很高的诊断效能,但对于部分代谢较高的良性病变和代谢较低的恶性肿瘤易误诊,需引起相关诊断工作人员的重视。     

以原发性静脉血栓形成为首发表现的恶性肿瘤22例分析

目的探讨以原发性静脉血栓形成为首发表现的恶性肿瘤临床特点，以及其对恶性肿瘤诊断的提示意义。方法回顾性分析我科2007年8月-2011年6日收治的22例以原发性静脉血栓形成为首发表现的恶性肿瘤的临床资料。本组均为中老年患者，均以肢体静脉血栓形成收住血管外科，4例合外肺栓塞。结果本组经规范抗凝治疗效果差，病情反复，均在住院或随访期间诊断恶性肿瘤，其中消化系统肿瘤8例，妇科肿瘤5例，血液系统、呼吸系统及胸部、泌尿系统肿瘤各3例。结论临床遇及原发性静脉血栓形成患者应积极查找病因，对规范抗凝治疗效果不佳者要警惕恶性肿瘤，及时完善肿瘤相关检查，以早期诊治。