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The authors discuss the results of surgical treatment of 105 patients with benign neoplasms of the mediastinum. Cysts were encountered in 22.9% and benign tumors in 77.1% of cases. Two complications occurred during the operation: injury inflicted to the intercostal artery in removal of a neurofibroma and injury to the lung in removal of a mediastinal cyst. The authors conclude that surgery of mediastinal neoplasms is a radical method of treatment.
Granular cell tumors are rare, usually benign neoplasms of soft tissues which most commonly occur in the tongue, skin and subcutaneous tissue. Although the histogenesis is still object of debate, recent immunohistochemical studies and ultrastructural findings support the origin of this neoplasm from the peripheral nervous tissue, most likely from Schwann's cells. Occurrence of this neoplasm in the breast, although uncommon, warrants special attention, since its clinical, mammographic and pathological appearances on frozen sections "may often closely resemble" hose of breast malignancy. The authors analyze and commenton, with special reference to clinical aspects and surgical treatment, a case of benign granular cell tumor of the breast occurring in a 42 year-old woman. The mammographic and clinical findings suggested a breast carcinoma. The correct diagnosis was established by definitive microscopic examination of the paraffin-embedded specimens and the treatment was a simple local excision of the tumour and a small rim of surrounding breast parenchyma. Although the granular cell tumor of the breast is a rare entity, surgeons and pathologists should be aware of its existence in order to avoid inappropriate radical surgery not justified by the benign behavior of the neoplasm.
Literature regarding neoplasms with sebaceous differentiation is confusing, particularly concerning the concept of sebaceous epithelioma, accepted by some observers as a specific neoplasm but defined by others as basal cell carcinoma with sebaceous differentiation and still others as sebaceous adenoma in which undifferentiated basaloid cells predominate. From our study of 19 benign sebaceous neoplasms within this spectrum and a critical review of the literature, we conclude that (a) "sebaceous epithelioma" is a nonuseful term; (b) the term "basal cell carcinoma with sebaceous differentiation" should be used only for an otherwise conventional basal cell carcinoma with histological evidence of sebaceous differentiation; (c) "sebaceous adenoma," as described by Troy and Ackerman, represent polar ends of the spectrum of a benign neoplasm with varying degrees of sebaceous differentiation, for which we propose the term "sebomatricoma"; and (d) sebomatricoma, so defined, embraces such diverse benign neoplasms with sebaceous differentiation as superficial epithelioma with sebaceous differentiation and previously "unclassifiable" sebaceous neoplasms, often found in patients with Muir-Torre syndrome or within nevus sebaceus of Jadassohn.
In a 45-year period (from 1948 to 1992) 291 patients with histologically proved benign neoplasms of the larynx were observed and treated. The most frequently occurring tumors were papillomas, being 95.2% in whole material. In most cases of benign tumors of the larynx intralaryngeal excision of the tumor was used. Clinical data and results of treatment were presented and discussed.
We reviewed the clinical records of 38 patients with benign neoplasms or tumors of the larynx that were examined in the Department of Otolaryngology, Kurume University Hospital during the 10-year period from 1971 to 1980. There were 24 patients with papilloma, 4 amyloid tumor, 2 hemangioma, 2 chondroma, 1 neurofibroma, 1 pleomorphic adenoma, 1 eosinophilic granuloma, 2 non-specific swelling of the ventricular fold, and 1 so-called prolapse of the ventricle. Some of these conditions, such as chondroma, neurofibroma, pleomorphic adenoma and eosinophilic granuloma, are vary rare.
IgA, IgG, IgM and IgE were studied in 61 carcinomas, 24 tissues peripheral to carcinomas, 16 benign neoplasms and 15 dysplasias of the breast. Mono- and double-layer direct immunofluorescence procedures applying FITC- and TRITC-conjugated antisera were used on cryostat and paraffin sections for evaluation of immunoglobulins in plasma cells, cancer cells and ductal epithelium. Plasma cells of all Ig classes were more frequent in carcinomas, especially of medullary and poorly differentiated ductal types, than in benign lesions. In all groups of benign lesions and in carcinomas with scanty lymphocytes and plasma cells there was a predominance of IgA-synthesizing plasma cells. Carcinomas with marked local response had an increased proportion of IgG cells. IgE plasma cells were rare. IgA and IgM were more frequent in ductal epithelium than in cancer cells, especially of poorly differentiated tumors. No appreciable IgG was observed in ductal or cancer cells. Our results indicate a correlation between immunohistologic patterns of immunoglobulins and histologic characteristics of carcinomas.
Over the last decade, the use of stereotactic radiosurgery (SRS) for the treatment of intracranial lesions has grown significantly. In addition to malignant brain tumors and vascular malformations, benign tumors have also been treated with SRS. Although surgical resection has long been considered the gold standard in the management of such benign lesions, the outcomes of SRS in various benign neoplasms appears to be comparable. In this review, we will examine the literature as it pertains to the treatment of benign brain tumors with SRS. Of particular note, we will examine the results of SRS in acoustic neuromas, meningiomas, pituitary adenomas, and other benign tumors.
Benign ovarian neoplasms have the capacity to undergo malignant change and are difficult to diagnose in the early stages. Although rarely life-threatening, they can cause patients considerable physical and psychological distress. This article explains the structure and function of the ovaries and why they sometimes undergo benign neoplastic change.
Recent carcinogenicity studies conducted and evaluated by the National Toxicology Program/National Institute of Environmental Health Sciences were examined to determine the frequency of chemically increased incidences of neoplasia. Many of the chemicals originally selected for study were chosen because of an a priori suggestion that they might be carcinogens. Of the 143 chemical studies evaluated, usually involving male and female rats and mice, 42 (29%) did not induce any neoplasms, 20 (14%) gave marginal or equivocal neoplastic responses, and 81 (57%) showed positive neoplastic responses in one or more of the 524 species-gender experiments. Of these 81 positive studies, 60 (74%) were considered positive based on malignant neoplasia, 16 (20%) were positive due primarily to benign neoplasia, but had supporting evidence of malignant neoplasia in the same organ/tissue, and 5 (6%) were positive based only on benign neoplasia. These five chemicals are a) allyl isothiocyanate (transitional cell papillomas of the urinary bladder in male rats), b) 2-amino-4-nitrophenol (tubular cell adenomas of the kidney in male rats), c) asbestos intermediate range chrysotile (adenomatous polyps of the large intestine in male rats), d) decabromodiphenyl oxide (neoplastic nodules of the liver in male and female rats), and e) nitrofurazone (fibroadenomas of the mammary gland in female rats and benign mixed tumors and granulosa cell tumors of the ovary in female mice). For all but one of these lesions (mammary gland), the occurrence in historic controls is low. Thus, only 5 of the 143 chemicals studied (3.5%) induced benign neoplasia alone, and those observed benign neoplasms are known to progress to malignancy. Accordingly, we consider chemically induced benign neoplasia to be an important indicator of a chemical's carcinogenic potential in rodents, and believe it should continue to be made an integral part of the overall weight-of-the-evidence evaluation process for identifying potential human health hazards.
A case of cellular schwannoma originating in the left lumbar paraspinal region is described. The diagnosis was originally made on needle biopsy material. The histological examination is usually not sufficient to correctly diagnose this benign neoplasm. Bone erosion, neurological symptoms, caused by compression of the spinal roots, together with hypercellularity, pleomorphism and an occasional increase in mitotic activity, may lead to an erroneous diagnosis of malignancy. Immunohistochemistry and ultrastructural analysis are helpful in confirming the diagnosis. The recognition of this entity avoids unnecessary overtreatment of these patients.
BACKGROUND AND PURPOSE: The choline (Cho)/creatine (Cr) ratio has been shown to be a reliable proton MR spectroscopy metabolic marker for differentiating squamous cell carcinoma (SCCA) from normal muscle in the upper aerodigestive tract. However, it is unclear whether the Cho/Cr ratio can be used to differentiate a malignant tumor from a benign neoplasm in the extracranial head and neck. Our purpose was to determine whether the Cho/Cr ratio can be used to differentiate benign from malignant tumors in this region. METHODS: In vitro one-dimensional proton MR spectroscopy (2,000/136,272 [TR/TE]) was performed at 11 T on tissue specimens obtained from glomus tumors (n = 3), inverting papilloma (n = 1), and schwannoma (n = 1). Cho/Cr area ratios were calculated and compared with similar, previously reported in vitro (11 T) findings and with samples of SCCA and normal muscle. RESULTS: The Cho/Cr ratio was elevated in relation to muscle in all benign tumors at TE = 136 (glomus tumors = 4.52, inverting papilloma = 3.85, schwannoma = 2.2) and at TE = 272 (glomus tumors = 8.01, inverting papilloma = 2.1, schwannoma = 4.28). The average Cho/Cr ratio for benign lesions was 3.92 (TE = 136) and 6.11 (TE = 272). The Cho/Cr ratio was significantly higher in benign tumors than in both SCCA and muscle. The average Cho/Cr ratio for muscle at TEs of 136 and 272 was 1.16 and 1.31, respectively, whereas for SCCA the average Cho/Cr ratio at TEs of 136 and 272 was 1.67 and 2.45, respectively. CONCLUSION: In our small group, the Cho/Cr ratio was significantly higher in benign tumors than in muscle and SCCA of the extracranial head and neck.
This article describes a case of nodular fasciitis with the karyotype 47,XY,+4/46,XY,add(15)(p11.2), t(16;16)(p13.3;p11.2). The presence of clonal chromosomal abnormalities in this case, as well as in three previously reported cases, indicates that nodular fasciitis is a benign neoplasm and not a reactive lesion.
Benign tumors are sometimes mistaken for neoplasms, so this article describes common benign skin lesions that usually require no treatment other than reassurance. If treatment is requested, modalities available are discussed with associated side-effects.
We evaluated assays of Tissue Polypeptide Antigen in serum and urine, as an index to the presence of cancer. In the assay, serum, which is first absorbed with human albumin-labeled sheep erythrocytes, or untreated urine (diluted with an equal volume of TPA-free serum) is incubated with antibody specific to Tissue Polypeptide Antigen and then reacted with sheep erythrocytes labeled with Tissue Polypeptide Antigen. We found an increased concentration of Tissue Polypeptide Antigen in the serum of 378 of 513 (74%) and in the urine of 49 of 77 (64%) patients with cancer, as compared with 40/112 (36%) and 7/29 (24%), respectively, for individuals with benign neoplasms. Normal individuals were defined as those with less than 0.09 unit of the antigen per milliliter of specimen. Concentrations exceeding this were found in 2/67 (3%) sera and 6/56 (11%) urines from supposedly normal persons. Tissue Polypeptide Antigen was found in above-normal concentrations in patients with cancer, regardless of neoplasm type and extension, with a higher proportion of abnormal values in patients with distal metastases.
BACKGROUND: Pancreatic serous cystadenoma, mucinous cystic neoplasms, ductal adenocarcinoma with cystic change, and pseudocysts are a spectrum of pancreatic cystic lesions. Their management strategy and prognosis are extremely diverse. Imaging study, cytology, and analysis of the tumor markers of cyst fluid are not always reliable in differentiation of these disease entities. MATERIALS AND METHODS: Fifteen patients with pancreatic cystic neoplasms (including six mucinous cystadenocarcinomas, two mucinous cystic neoplasms with borderline malignancy, two mucinous cystadenomas, and five serous cystadenomas), 4 patients with pancreatic ductal adenocarcinomas with cystic change, and 10 patients with pseudocysts were studied. Echo-guided or computed tomography-guided biopsies of pancreatic cystic lesions and their normal counterparts were conducted on all patients prior to operation or other management. The specimens were assayed for telomerase activity by using TRAP (telomere repeat amplification protocol). The level of telomerase activity in each specimen was semiquantitated as strong, moderate, weak, and none. The final diagnoses were made from histopathological examination of surgically resected or biopsied specimens. The efficacy of telomerase activity as a tumor marker to predict malignancy of pancreatic cystic lesions was evaluated. RESULTS: Three of the four pancreatic ductal adenocarcinomas with cystic change had strong or moderate telomerase activity; four of the six mucinous cystadenocarcinomas had moderate or weak telomerase activity; one of the two mucinous cystadenomas with borderline malignancy had weak telomerase activity; and none of their normal counterparts had detectable telomerase activity. In contrast, none of the two mucinous cystadenomas, five serous cystadenomas, and 10 pseudocysts had detectable telomerase activity. Based on these results, the sensitivity of telomerase activity for prediction of malignancy or premalignancy of pancreatic cystic lesions was 67%, the specificity was 100%, and the positive and negative predictive values were 1.0 and 0.81, respectively. The overall accuracy was 86%. CONCLUSIONS: The differential expressions of telomerase activity have been detected specifically in malignant and premalignant pancreatic cystic tumors, but not in benign cystic neoplasms or pseudocysts. The implications of these results are that telomerase activation takes part in the malignant transformation of pancreatic cystic neoplasms and that telomerase activity is a useful marker to distinguish malignant pancreatic cystic tumors from benign neoplasms and pseudocysts.
We present six cases of a distinctive soft tissue tumor which occurred in five women and one man. None of the patients had signs of neurofibromatosis. All tumors occurred on the fingers ( n=5) or the thenar eminence of the hand ( n=1). The mean age of the patients was 33 years. The tumors were 1-2.5 cm in diameter (mean size 1.6 cm). Three patients with follow-up were without signs of recurrence or metastasis. Microscopically the lesions were nonencapsulated and featured a multilobular architecture and both myxoid and pseudocystic change. The lobules varied in size and shape and were separated by variably thickened, dense, sclerotic/collagenous septae. The lobules were composed of two components: schwannomatous and perineuriomatous. The schwannomatous component was immunohistochemically S-100 protein positive and CD34 and EMA negative, and the perineuriomatous component had the appearance of retiform perineurioma. The perineurial parts were mostly S-100 protein and CD34 negative and EMA positive. These two components either formed separate nodules or the schwannomatous tissue surrounded the perineurial parts located in the centers of the lobules. We interpreted the lesions as hybrid tumors with features of schwannoma and retiform perineurioma.
Virtually all human beings have a number of benign cutaneous neoplasms. Many of these never come to medical attention. Patients who do show such lesions to a physician typically are concerned about the possibility that their growths may be skin cancer. With proper training and experience, the physician should be able to triage most such lesions with a clinical examination. In a medical setting increasingly influenced by managed care and dominated by cost consciousness, the primary care physician is expected to make these clinical judgments without recourse to consultation or histopathologic examination. Familiarity with these common cutaneous tumors, and in particular with their range of variability, is therefore required. This article reviews the clinical aspects of some of the common benign cutaneous lesions. Common clinical scenarios related to these growths are emphasized.
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