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Results for “Neoplasm Grading”

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PubMedDate not supplied

Tumor markers (CEA, TPA and CA 19-9) in urine of bladder cancer patients.

This study was carried out to evaluate the usefulness of determining urinary levels of carcinoembryogenic antigen (CEA), tissue-polypeptide antigen (TPA), and gastro-intestinal cancer antigen (Ca19-9) in addition to the usual diagnostic procedures for bladder cancer. Sixty-seven patients with transitional bladder cancer, 40 healthy controls and 20 patients with inflammatory diseases of the urinary tract were considered. All urine samples were obtained from patients with intact renal function and no urinary tract infection. TPA and Ca19-9 urinary levels in patients with G3 bladder tumors were significantly higher than in those with lower graded neoplasms. The sensitivity, specificity, and predictive value of a positive (PV+) or negative (PV-) test and the diagnostic accuracy were also evaluated. Ca19-9 was the best urinary marker for bladder cancer (sensitivity 71.6%, specificity 91.6%, PV+ 90.5%, PV- 74.3%, diagnostic accuracy 81%).

Adult↗

PubMed2005

Treatment options and paradigms in childhood temporal lobe epilepsy.

Temporal lobe epilepsy in adults is a relatively homogenous syndrome with hippocampal sclerosis being its most common pathologic substrate. In the pediatric age group, low-grade neoplasms and cortical dysplasia are much more common than hippocampal sclerosis. Pediatric temporal lobe epilepsy has distinct semiologic, electrophysiologic and imaging characteristics as compared with its adult counterpart. The various treatment options for pediatric temporal lobe epilepsy include antiepileptic drugs, resective surgery, vagal nerve stimulation and the ketogenic diet. In spite of the multiple antiepileptic drugs currently available, 5-10% of all newly diagnosed cases will remain intractable to medical therapy and should be referred for presurgical evaluation. Resective surgery offers the best chance of seizure freedom in carefully selected patients. Future areas of research include new drug development, better imaging and localization techniques, and brain stimulation.

Anticonvulsants↗

PubMed2005

Surgical management of temporal lobe tumor-related epilepsy in children.

OBJECT: Slow-growing, low-grade temporal lobe tumors are one of the most common causes of epilepsy in children. Although there are numerous consistent features in this patient group, consensus about the management and surgical approach is lacking. In this study the authors review the clinical, pathological, and radiological features as well as outcome data obtained in 29 pediatric patients with temporal lobe tumor-related epilepsy and discuss the surgical treatment strategies. METHODS: In patients who presented with intractable seizures secondary to mass lesions and underwent comprehensive epilepsy workup, the tumor was resected and the diagnosis confirmed by pathological examination. A minimum follow-up period of 16 months was required. Medical records were reviewed for details of seizure type and duration, electrophysiological data, imaging studies, operative notes, pathological examination reports, and follow-up data. The surgical approach was as follows. The lesionectomy with/without cortical resection was performed in all cases of lateral temporal tumors. Lesionectomy was performed with/without cortical resection in cases of basal temporal tumors if the mesial structures were radiologically normal. Mesial temporal tumors were excised, as were the remaining mesial temporal structures in the nondominant hemisphere; however, if the tumor was in the dominant hemisphere, lesionectomy was performed only if the remaining mesial structures were radiologically normal. Twenty-nine patients between 2 and 18 years of age were identified. Most tumors were located in the mesial temporal lobe. All patients underwent resection of the tumor with or without mesial and cortical structures. The most common pathological entity was dysembryoplastic neuroepithelial tumor. Sixty-nine percent of the patients remained seizure free (Engel Class I) and 14% experienced significant improvement (Engel Class II) after surgery. Outcome was better in the patients who underwent gross-total tumor resection. CONCLUSIONS: Mesially located low-grade neoplasms were the most frequently observed mass lesions in children with temporal tumor-related epilepsy in this series. Resection of the tumor with or without amygdalohippocampectomy provides a high rate of seizure-free outcome. It is the author's opinion that temporal lobe tumors should be managed based on the subgroups defined by their anatomical locations. If the tumor is located in or in proximity to eloquent cortex, we recommend functional magnetic resonance imaging and invasive monitoring techniques to map the eloquent cortex and epileptogenic zone, thereby tailoring the resection.

Adolescent↗

PubMedDate not supplied

Salivary duct carcinoma of the palate.

Salivary duct carcinoma is a rare high-grade neoplasm that more frequently affects the parotid gland. Though neoplasms of this type are infrequent in minor salivary glands, they are less aggressive and may lead to early diagnosis before distant metastases could occur. Salivary duct carcinoma is also the most frequent epithelial component of carcinosarcoma. The present article reports a case of SDC of the palate in a 26-year-old male and discusses SDC as a malignant epithelial component in carcinosarcoma.

Adenoma↗

PubMed2002

Hyalinizing clear cell carcinoma of minor salivary gland: case report.

Hyalinizing clear cell carcinoma is a low-grade neoplasm of the minor salivary gland composed exclusively of epithelial cells and not myoepithelial cells. It predominantly affects the oral cavity of adult females. It is microscopically characterized by hyalinizing stroma and clear cells, which are typically positive for cytokeratin markers and negative for S 100 and smooth muscle actin (SMA). Cystic degeneration can also be present. Pathologists should be aware of this new entity so as not to misdiagnose otherwise. To our knowledge, this is the first case report of its kind from Malaysia.

Adenocarcinoma, Clear Cell↗

PubMed1992

[Flow cytometry in primary renal tumors in childhood].

A group of nineteen primary renal tumors in childhood was analyzed by flow-cytometry. All clinically important entities were included. Paraffin embedded material was used. Two anaplastic nephroblastomas and a case of renal rhabdomyosarcoma had an aneuploid DNA content. One Wilm's tumor showed a moderate DNA-hyperdiploidy. One of two rhabdoid tumors showed a marked right-sided shift of G1/G0 phase from that of a control and was considered as probably hyperdiploid. All other tumors including high grade neoplasms such as rhabdoid tumor and bone metastasizing tumors were found in the DNA-diploid range. Proliferation index was high in most tumors and in six it reached or exceeded 40. Mitotic index counted in the histological sections correlated with the percentage of G2 + M phase in most cases. Although small, the group of tumors under study shows that prognostic criteria cannot be based on the DNA content or on the proliferation index only. The only relevant result may be an overt DNA-aneuploidy in anaplastic nephroblastomas. Difficulties in interpreting the results of flow cytometry are discussed.

Child↗

PubMedDate not supplied

[Squamous metaplasia as a prognostic factor in urothelial carcinoma of the bladder].

The Authors report a retrospective review of 224 cases of transitional cell carcinoma of the bladder observed between 1986 and 1990. Squamous metaplasia was present in 45 case. This histological feature was found especially in association with poorly differentiated and invasive tumours: the presence of extensive areas of squamous metaplasia (metaplastic areas = or greater than 50% of neoplastic surface) was always found in association with high grade neoplasms and with a disease-free period shorter than transitional cell carcinoma. The Authors conclude that squamous metaplasia in transitional cell carcinoma of the bladder is a really unfavourable prognostic factor.

Carcinoma, Transitional Cell↗

PubMed2003

[Case report: Radiologic findings of retroperitoneal malignant mesenchymoma].

Malignant mesenchymomas are rare soft tissue tumors that contain two or more distinct histologic subtypes of sarcoma within the same tumor. Although experience with these tumors is limited, they are generally considered high grade neoplasms and are associated with a poor prognosis. Here we present radiologic findings of a case with malignant mesenchymoma in the retroperitoneum.

Aged↗

PubMed2004

Polymorphous low grade adenocarcinoma of the parotid gland. Cytological, histological and immunohistochemical features and review of the literature.

AIM: Polymorphous low grade adenocarcinoma of the salivary glands (PLGA) is a low grade neoplasm that predominantly occurs in the minor salivary glands. In this site is amenable to biopsy and histologic diagnosis. However, experience with cytological findings in these tumors is limited. We describe the cytology of this entity. EXPERIMENTAL DESIGN: Touch imprint cytology of a primary parotid PLGA is specified and correlated with histology. RESULTS: Smears were hypercellular showing branching papillae, sheets and clusters of uniform cells with bland nuclei, dispersed chromatin and no nucleoli. The cells had a scant to moderate amount of eosinophilic cytoplasm. They formed tubular structures containing hyaline globules. CONCLUSIONS: The cytologic differential diagnosis of PLGA includes adenoid cystic carcinoma, pleomorphic adenoma, and monomorphic adenoma. PLGA should be considered in the differential diagnosis of head and neck tumors, where the cytology suggests on of the above mentioned tumors, even when the clinical findings (involvement of a major salivary gland, lymph node metastasis) is not typical of PLGA.

Adenocarcinoma↗

PubMedDate not supplied

Recurrent Lhermitte-Duclos disease: report of two cases and association with Cowden's disease.

Two cases of Lhermitte-Duclos disease (LDD), one associated with Cowden's disease, are reported. Both demonstrated recurrence long after initial surgical resection. There is a propensity for occurrence in the left cerebellar hemisphere. On MR there is hypointensity on T1-weighted images and moderately high signal on T2-weighted images, with parallel linear striations on the surface of the lesion felt to represent dysplastic cerebellar folia. LDD is felt to be a low-grade neoplasm and potential component of Cowden's phakomatosis.

Adult↗

PubMed1990

The relation of prostatic acid phosphatase and prostate specific antigen with tumour grade in prostatic adenocarcinoma: an immunohistochemical study.

This study examines the relationship between the presence of prostatic acid phosphatase (PAP) and prostate specific antigen (PSA) in tissue, the serum PAP and PSA levels and tumour grade in prostatic adenocarcinoma. Thirty-three tumours were studied by the indirect immunoperoxidase method for PAP and PSA production. Thirty-one of them were stained positive for both markers. The remaining two which previous histopathological studies suggested were transitional cell carcinoma, stained negative. In primary tumours there was a weak trend for poor immunoreactivity in high grade neoplasms but the correlation was not significant. The elevated serum PAP and PSA levels did not correlate with the intensity of staining in the tissue.

Acid Phosphatase↗

PubMed1989

Fine-needle aspiration in the management of breast masses.

The exact role of FNA in the diagnosis of palpable breast lesions is still uncertain. False-positive and false-negative cytological diagnoses occur and raise questions regarding the diagnostic utility of FNA as a replacement for open biopsy in many clinical situations. False-positive diagnoses may result from atypical epithelial proliferations, fibroadenomas, or inflammatory lesions. False-negative aspirates may occur because of technical errors, cystic lesions, and underdiagnosis of low grade neoplasms. The triple diagnosis protocol has been suggested as a replacement for open biopsy of palpable breast masses in many clinical situations. Following this algorithm, the results of palpation, mammography, and cytology are combined to guide management. Mammography should precede FNA or follow the cytologic procedure by 2 or more weeks. Patients with a positive triple diagnosis should undergo open biopsy or confirmatory intraoperative frozen section. Positive FNA results would be useful for preoperative counselling as well as serving as a diagnostic procedure for clinically suspicious lesions in patients wishing a confirmatory test before open biopsy is performed. Patients with discordant triplet results should be referred for open biopsy. The management of patients with negative triplet results is less clear. From the available data, it appears that approximately 2 percent of patients with negative triplet results have carcinoma. Based on these results, we cannot recommend replacing open biopsy by the triple diagnosis method in most patients with a persistent dominant mass. In most cases, a biopsy is indicated. Surgeons, who plan to follow a breast mass with clinical examination, may be able to reduce their false-negative rate by performing FNA. Further study is necessary to establish the best way to use FNA in the diagnosis of breast carcinoma, to determine the cost effectiveness of the triple diagnosis method as a substitute for open biopsy, and to assess the utility of aspiration cytology in the mammographically directed diagnosis of nonpalpable breast lesions.

Adenofibroma↗

PubMed1995

p53 protein immunoreactivity in extrahepatic bile duct and gallbladder cancer: correlation with tumor grade and survival.

Forty-five extrahepatic bile duct carcinomas (i.e., tumors of the region proximal to the duct junction, including Klatskin tumors, tumors of the lower mid-region, and tumors of the ampulla of Vater) and 11 gallbladder carcinomas were immunohistochemically examined for p53 protein expression, using the DO-7 monoclonal (mAb) and the CM-1 polyvalent (pAb) antibodies and an antigen retrieval method. Because the DO-7 mAb was found to be significantly more reliable than the CM-1 pAb in detecting p53 immunoreactivity, the immunohistochemical results obtained with the former antibody were used for comparing p53 protein immunoreactivity with tumor site, tumor grade, and survival of patients. Approximately one third (3 of 10) of the proximal tumors were found to express weak p53 immunopositivity, whereas moderate immunopositivity and higher rate (18 of 29) was observed in tumors of the lower mid-region. Finally, moderate and marked p53 immunopositivity was observed in tumors of the ampulla (5 of 6) and gallbladder (8 of 11). In tumors of the lower mid-region of the ampulla and the gallbladder, a significantly higher p53 positivity was noted in high-grade compared with low-grade neoplasms. For the cases in which complete follow-up was available (11 tumors of the low mid-region), median survival of patients with p53-negative tumors was 25.7 months, whereas survival of those with p53-positive tumors was 5.2 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Ampulla of Vater↗

PubMed1994

[Prognostic significance of epidermoid metaplasia in urothelial carcinoma of the bladder].

A retrospective review of 186 cases of transitional cell carcinoma of the bladder observed between 1987 and 1990 is described. Squamous metaplasia was present in 37 cases. This histological feature was especially found in association with poorly differentiated and invasive tumors: the presence of extensive areas of squamous metaplasia (metaplastic areas = or > 50% of neoplastic surface) was always found in association with high grade neoplasms. For these reasons the authors conclude that transitional cell carcinoma of the bladder showing squamous metaplasia is more aggressive than pure transitional cell carcinoma.

Carcinoma, Transitional Cell↗

PubMed1994

Retiform hemangioendothelioma. A distinctive form of low-grade angiosarcoma delineated in a series of 15 cases.

Fifteen cases of a distinctive type of low-grade angiosarcoma of the skin are described. Most tumors presented in the second to fourth decades of life, the youngest patient being 9 years old and the oldest 78 (mean age, 36 years). There was no sex predilection. Six tumors arose on the lower limb, four on the upper limb, three on the trunk, and one each on the penis and the scalp. One case arose in the setting of chronic lymphedema and another following radiotherapy for carcinoma of the uterine cervix. Distinctive morphologic features were the presence of long arborizing blood vessels arranged in a retiform pattern (reminiscent of normal rete testis) lined by monomorphic hobnail endothelial cells, a very prominent lymphocytic infiltrate in most cases, and the focal presence of papillae with hyaline collagenous cores, similar to those seen in malignant endovascular papillary angioendothelioma (Dabska's tumor). With a median follow-up of 7.25 years in 14 cases, retiform hemangioendothelioma has proved to be a low-grade neoplasm that recurs frequently but has a very low metastatic rate. The single regional lymph node metastasis in this series was from a case with a biphasic pattern in which only the spindle cell component was represented in the metastasis. There have been no tumor-related deaths, underlining the importance of accurate distinction from conventional angiosarcoma. This distinction is facilitated principally by the absence of dissection between individual collagen bundles and the absence of endothelial atypia or mitotic activity. The precise relationship between retiform hemangioendothelioma and Dabska's tumor is uncertain, possibly because cases of the latter may not be homogeneous.

Adolescent↗

PubMed1997

Spindle epithelial tumor with thymus-like differentiation: a case report with cytologic, histologic, immunohistologic, and ultrastructural findings.

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare and distinctive low-grade neoplasm of thymic or related branchial pouch differentiation. The tumor usually presents in the thyroid or lateral neck of children and adolescents and could mimic spindle-cell carcinoma, synovial sarcoma, or malignant teratoma. We report the clinical, cytologic, histologic, immunohistochemical, and ultrastructural features of a SETTLE present for 10 years in a 15-year-old boy. The fine-needle aspirate, initially interpreted as synovial sarcoma, contained numerous clusters of bland spindle cells, with a few detached sheets of columnar mucous cells in a homogeneous background of dissociated spindle cells. Mitoses, necrosis, and atypia were not present. The excised tumor was a well-circumscribed, white-tan mass, with occasional microcysts. Microscopically, the mass consisted of a lobulated, highly cellular, spindle-cell neoplasm arranged in intersecting, whorled, and storiform fascicles separated by fibrous bands. Entrapped within the fibrous bands were squamous-lined cysts and benign-appearing glands lined by columnar epithelium with goblet cells or ciliated pseudostratified epithelium. Immunohistochemically, the spindle cells showed diffuse reactivity for cytokeratins, smooth muscle actin, muscle-specific actin, and MIC-2, and they were negative for epithelial membrane antigen, calcitonin, and thyroglobulin. Ultrastructurally, numerous perinuclear tonofilaments, some aligned with mature desmosomes, were identified in the spindle cells. Occasional cells showed thin filaments with fusiform dense bodies occupying the peripheral cytoplasm. These findings distinguish SETTLE from ectopic thymoma, synovial sarcoma, medullary carcinoma, and teratoma, and they support a thymic epithelial origin for SETTLE, possibly with myoepithelial differentiation.

Adolescent↗

PubMed2005

Grading of CNS neoplasms using continuous arterial spin labeled perfusion MR imaging at 3 Tesla.

PURPOSE: To differentiate glioma grade based on blood flow measured using continuous arterial spin labeled (CASL) perfusion MRI, implemented at 3 Tesla for improved signal-to-noise ratio (SNR) and spin labeling effect. MATERIALS AND METHODS: CASL perfusion images were obtained preoperatively in 26 patients with brain neoplasms (19 high-grade gliomas (HGGs; WHO grades 3 and 4) and seven low-grade gliomas (LGGs; WHO grades 1 and 2)). The mean and maximum tumor blood flow (TBF and TBFmax) were calculated in the neoplasm, including surrounding infiltrating tumor vs. edema. Measures normalized to global CBF (nTBF and nTBFmax) were also obtained. RESULTS: Normalized measures of TBFmax provided the best distinction between HGG and LGG groups (Wilcoxon rank sum test, P = 0.01). Seventeen of 19 HGGs showed nTBFmax > 1.0, and 15 of 19 showed nTBFmax > 1.3. Four of seven LGGs showed nTBFmax < 1.0, and six of seven showed nTBFmax < 1.3. Absolute TBFmax also differed significantly between the HGG and LGG groups (P = 0.04). TBFmax in 11 of 17 HGGs was >50 mL/100 g/min (mean +/- SD = 94.9 +/- 71.7 mL/100 g/min). All but one LGGs showed TBFmax < or = 50 mL/100 g/min (mean +/- SD = 42.8 +/- 22.0 mL/100 g/min). CONCLUSION: CASL perfusion MRI provides a quantitative, noninvasive alternative to dynamic susceptibility contrast perfusion MR methods for evaluating gliomas.

Adult↗

PubMed1990

Histopathologic grading of salivary gland neoplasms: I. Mucoepidermoid carcinomas.

Histopathologic grading of salivary gland neoplasms has been done with various degrees of success and hence various degrees of acceptance among pathologists and otolaryngologists-head and neck surgeons. Given their histopathologic diversity, three carcinomas--mucoepidermoid, adenoid cystic, and acinic cell--would seem to be suitable candidates for grading. In this, the first of a three-part series, the authors present a three-level grading scheme for mucoepidermoid carcinomas. It combines histocytologic and growth features of the carcinomas that independently or together, in other grading proposals, have shown prognostic value.

Carcinoma↗