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Results for “Neoplasm Grading”

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PubMed1988

Volumetric stereotactic surgical resection of intra-axial brain mass lesions.

From August 1984 to August 1987 at the Mayo Clinic, 226 computer-assisted stereotactic resections based on computed tomography or magnetic resonance imaging (or both) were performed on 203 supratentorial and 23 infratentorial lesions in various deep-seated or essential brain locations. Histologic examination revealed 112 glial neoplasms, 70 nonglial tumors, and 44 nonneoplastic lesions. The overall morbidity was 9.3% (21 of 226 patients were worse after the procedure), and the 30-day operative mortality was 1% (2 patients). The procedure provides maximal cytoreduction in high-grade glial neoplasms but is most beneficial to patients who have histologically circumscribed tumors, such as pilocytic astrocytomas, metastatic neoplasms, and miscellaneous nonglial and nonneoplastic lesions.

Adolescent↗

PubMed1990

Undifferentiated carcinomas of the major salivary glands.

Undifferentiated salivary carcinomas are defined as primary epithelial malignant neoplasms that are devoid of any phenotypic expression by light microscopy that would allow them to be otherwise classified. A clinicopathologic study of sixteen so-defined carcinomas of the major salivary glands is presented. The carcinomas are unquestionably high-grade malignant neoplasms. Ten of the sixteen patients were dead because of their disease within 4 1/2 years of histologic diagnosis. Cell size and ultrastructural features have little bearing on prognosis. The single most important clinicopathologic factor relating to patient outcome is size of the primary neoplasm. All patients with carcinomas larger than 4 cm died, and these carcinomas had nearly two times the incidence of perineural invasion, extrasalivary extension, and locoregional failure of control.

Aged↗

PubMed1997

Primary leiomyosarcomas of the lung: a clinicopathologic and immunohistochemical study of 18 cases.

We studied 18 patients with primary malignant smooth muscle tumors of the lung (7 women and 11 men, 5-76 yr old, with a mean age of 50 yr). Lesions varied from 1.7 to 10 cm in greatest diameter. The tumors were classified as low (4 cases), intermediate (2), or high grade (12). Low-grade lesions were characterized by an orderly proliferation of fascicles of spindle cells that intersected at right angles and showed oval-to-spindle cells with cigar-shaped nuclei, minimal pleomorphism, and low mitotic activity, without hemorrhage or necrosis. Intermediate-grade lesions retained the fascicular configuration but showed increased cellularity with atypia and dense chromatin pattern, occasional pleomorphism, and mild increase in mitotic activity. High-grade lesions showed high cellularity, marked pleomorphism and atypia, frequent areas of hemorrhage and necrosis, and high mitotic activity. Immunohistochemical studies in 16 cases showed positive staining of tumor cells with smooth muscle actin in 12, desmin in 5, and coexpression of actin and/or desmin and keratin in 3. Six patients with low- and intermediate-grade lesions were alive and well from 2 to 12 years after diagnosis (mean follow-up time, 6 yr); 8 with high-grade lesions died of their tumors with widespread metastases from 1 to 24 months after diagnosis (median survival time, 5 mo). One patient whose tumor showed features of high-grade leiomyosarcoma was alive and well 12 years after surgery. Three patients with high-grade tumors were lost to follow-up. Our findings suggest that histologic grade may be the most reliable prognostic parameter for predicting clinical behavior in primary leiomyosarcoma of the lung and that smooth muscle actin is the most sensitive immunohistochemical marker for establishing the diagnosis in these tumors. Primary leiomyosarcoma should be considered in the differential diagnosis of pulmonary spindle cell neoplasms; histologic grading may be of value in the planning of therapy and assessment of prognosis for these lesions.

Actins↗

PubMed1999

Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low-grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases.

Mucinous cystic neoplasms (MCNs) of the pancreas are uncommon tumors. The classification and biologic potential of these neoplasms remain the subject of controversy. Attempts to classify these tumors in a similar manner to ovarian MCNs remains controversial, as even histologically benign-appearing pancreatic MCNs metastasize and are lethal. One hundred thirty cases of MCNs were identified in the files of the Endocrine Pathology Tumor Registry of the Armed Forces Institute of Pathology from the years 1979 to 1993. The pathologic features, including hematoxylin and eosin staining, histochemistry, immunohistochemistry (IHC), cell cycle analysis, and K-ras oncogene determination were reviewed. These findings were correlated with the clinical follow-up obtained in all cases. There were 130 women, aged 20-95 years (mean age at the outset, 44.6 years). The patients had vague abdominal pain, fullness, or abdominal masses. More than 95% of the tumors were in the pancreatic tail or body and were predominantly multilocular. The tumors ranged in size from 1.5 to 36 cm in greatest dimension, with the average tumor measuring >10 cm. A spectrum of histomorphologic changes were present within the same case and from case to case. A single layer of bland-appearing, sialomucin-producing columnar epithelium lining the cyst wall would abruptly change to a complex papillary architecture, with and without cytologic atypia, and with and without stromal invasion. Ovarian-type stroma was a characteristic and requisite feature. Focal sclerotic hyalinization of the stroma was noted. This ovarian-type stroma reacted with vimentin, smooth muscle actin, progesterone, or estrogen receptors by IHC analysis. There was no specific or unique epithelial IHC. K-ras mutations by sequence analysis were wild type in all 52 cases tested. Ninety percent of patients were alive or had died without evidence of disease (average follow-up 9.5 years), irrespective of histologic appearance; 3.8% were alive with recurrent disease (average 10 years after diagnosis); and 6.2% died of disseminated disease (average 2.5 years from diagnosis). Irrespective of the histologic appearance of the epithelial component, with or without stromal invasion, pancreatic MCNs should all be considered as mucinous cystadenocarcinomas of low-grade malignant potential. Pancreatic MCNs cannot be reliably or reproducibly separated into benign, borderline, or malignant categories.

Adult↗

PubMed1993

Malignant epithelioid hemangioendothelioma arising in an intramuscular lipoma.

BACKGROUND: A malignant epithelioid hemangioendothelioma (EH) developed within a peripheral intramuscular lipoma. It was seen as a painful calf mass. At the time of biopsy and en bloc resection, lung metastases were observed. METHODS: Radiologic, histologic, immunohistochemical, and ultrastructural features of the neoplasm are described, and the literature pertaining to EH is reviewed. RESULTS: The features of this tumor permitted its classification as a malignant EH. CONCLUSIONS: This case illustrates the potential for aggressive behavior in an EH, often considered to be a low-grade malignant neoplasm. Because such tumors can metastasize, they should be removed with wide margins whenever possible. This malignant neoplasm was located within a benign intramuscular lipoma, demonstrating the diagnostic problem that may exist in such a complex lesion.

Epithelium↗

PubMed1995

Florid vascular proliferation associated with neural and neuroendocrine neoplasms. A diagnostic clue and potential pitfall.

We report the light microscopic and immunohistochemical features of vascular proliferations associated with 26 extracranial neural and neuroendocrine neoplasms including esthesioneuroblastoma, neuroblastoma/ganglioneuroblastoma, the primitive neural component of immature teratoma, mediastinal teratoma, primitive neuroectodermal tumor, intra-abdominal desmoplastic small cell tumor, Merkel cell carcinoma of the skin, and thyroid medullary carcinoma. These vascular proliferations were similar to those associated with high-grade glial neoplasms and were characterized by tufts of vessels with a glomeruloid configuration or by long cords of vessels. Immunohistochemical evaluation documented the presence of endothelial cells, perithelial cells, and basement membrane components within the foci of proliferating vessels. We propose that these vascular proliferations represent a characteristic feature of the neuroendocrine/neural neoplastic phenotype and that they possibly arise as the result of angiogenic factors produced by the neoplastic cells. The presence of these distinctive vascular lesions in the stroma of a poorly differentiated neoplasm should alert the pathologist to the possibility of the neoplasm being of a neural or neuroendocrine nature.

Esthesioneuroblastoma, Olfactory↗

PubMed2006

Dedifferentiated high-grade osteosarcoma originating from low-grade central osteosarcoma of the fibula.

Low grade central osteosarcoma is a distinct, rare low grade malignant neoplasm characterized histologically by a spindle cell proliferation associated with trabecular bone formation. This tumor usually carries a good prognosis. However, it has the potential to recur, dedifferentiate, and metastasize subsequent to surgical treatment. In extremely rare occasions, LGCOS presents with areas of dedifferentiation upon initial patient evaluation. In this report we describe one such case affecting the fibula of a 39-year-old female, presenting with pain. Initial biopsy demonstrated a high-grade osteosarcoma. No areas of LGCOS were seen histologically. Following biopsy the patient received 3 months of chemotherapy at a different institution. However, the patient continued to exhibit symptoms. X-rays indicated a very aggressive tumor in the diaphysis of the proximal fibula, MRI revealed soft tissue involvement. The tumor and surrounding soft-tissues were excised en bloc at our institution. Microscopically, the lesion consisted of high-grade osteosarcoma as well as an underlying LGCOS that involved the cortex and medullary cavity of the fibula. The two histological components of the tumor were sharply delineated from one another. No chemotherapy effect was appreciated histologically or clinically. Eight months following the surgery, the patient died from lung metastases. This is the third documented case of dedifferentiated LGCOS at initial presentation. This case reveals that the low-grade component was also evident on preoperative radiographs.

Adult↗

PubMed1983

[A clinico-pathological study of ovarian solid teratomas].

Sixteen cases with ovarian immature teratoma received our managements have been reviewed. After exhaustive tissue examination, those neoplasms were graded histologically according to the criteria proposed by Thurlbeck and Scully, in addition, to exclude the mixed germ cell tumors, alfa fetoprotein stainings by PAP method were performed. Ten of all patients are alive without any signs of recurrence and none of grade 3 patients could survive. In our small series, the histologic grade seemed to correlate with the prognosis. Now-a-days the prognostic significance of the grading systems, however, still remains controversial, and it is discussed in this paper. Of particular interest is that the immature teratoma containing glioblastoma element took most fulminant clinical course. It was suggested that special attention should be paid to the histologic components of glioblastoma in the neoplasm. Serum alfa feto-protein level, elevated in two cases, was not associated with the clinical situation and AFP value appears to have questionable diagnostic importance as the tumor marker. Although we had no standard chemotherapeutic programs for immature teratomas, it is believed that the more aggressive surgery followed by good combination chemotherapy brings better prognosis.

Adolescent↗

PubMedDate not supplied

Increased incidence of cervical intraepithelial neoplasia in young women in the Mitte district, Berlin, Germany.

OBJECTIVE: To investigate whether the incidence of cervical intraepithelial neoplasia (CIN), in particular of high grade CIN, increased in Berlin during the period 1970-1989 and whether the ages of women with CIN had decreased. STUDY DESIGN: In the former German Democratic Republic, which had a highly centralized public health system, all gynecologic operations performed on women living in the Mitte district of Berlin were carried out during the period 1970-1989 (when the Berlin Wall fell) in the gynecologic clinic of the Charité Hospital. RESULTS: The incidence of all CIN increased from year to year over the observation period: 0.04% (1970-1971), 0.10% (1980-1981), 0.39% (1988-1989). There was a particularly high increase in the incidence of high grade intraepithelial neoplasms (CIN 3): 0.016% (1970-1971), 0.056% (1980-1981), 0.25% (1988-1989). With a virtually unchanged age distribution for women in the Mitte district of Berlin, the median age of women with CIN 3 decreased significantly from 1970 to 1989, from 39.5 (1970) to 33 (1989) (P < .001). CONCLUSION: The increase in the incidence of CIN, especially of high grade CIN, as well as the reduction in age for onset of the disease, makes high participation in screening necessary, above all among young women.

Adult↗

PubMed1991

Intraepithelial neoplasia of the anal canal in hemorrhoidal tissue: a study of 19 cases.

The investigators report the clinical and pathologic features of 19 cases of intraepithelial neoplasia occurring in the anal canal mucosa of routinely excised hemorrhoidal tissue, a condition that has been infrequently described. The patients were 12 women and seven men having an age range of 21 to 74 years (mean, 48 years). Two patients had coexistent anogenital condylomata acuminata. Leukoplakia of the hemorrhoidal surface was noted in two patients. Intraepithelial neoplasia arose in the transition zone of the anal canal of 11 cases, in the squamous zone of three cases, and in both sites of five cases. All were high-grade intraepithelial neoplasms; one was classified moderate to severe dysplasia, 17 exhibited severe dysplasia/carcinoma in situ, and one contained microinvasive carcinoma. Both keratinizing and cloacogenic type neoplasms were observed. Associated koilocytotic atypia was identified in 16 cases (84%). In situ hybridization for human papillomavirus (HPV) messenger RNA demonstrated HPV RNA sequences in seven of nine neoplasms (78%) studied by that technique (five HPV type 16, one HPV type 18, and one coinfection with HPV types 6 and 18). Eighteen patients had no clinically evident recurrent or progressive disease at mean follow-up of 6.6 years. Residual/recurrent intraepithelial neoplasia was noted in one patient at 1, 2, 5, and 49 months posthemorrhoidectomy. Our data indicate that incidentally discovered high-grade intraepithelial neoplasia present in hemorroidal tissue is a clinically nonaggressive lesion frequently associated with HPV infection. Hemorrhoidectomy alone is curative in most cases.

Adult↗

PubMed1991

Salivary neoplasms of the jaw bones with particular reference to central mucoepidermoid carcinomas.

Intragnathic salivary-type neoplasms are few in number, are of debated histogenesis, and are most often classified as mucoepidermoid carcinomas. Two generating tissues have been proposed for the origin of these central (intraosseous) tumors: enclaves of salivary tissue and a metaplasia of the linings of odontogenic cysts. They are not mutually exclusive. Although most mucoepidermoid carcinomas have been low grade, these neoplasms nonetheless have a very respectable recurrence rate and can be fatal.

Carcinoma↗

PubMed2025

Methylated ARHGAP40 in renal cell carcinoma associated with tumor necrosis and grade: a potential biomarker for non-invasive early detection.

This study investigated the expression, methylation patterns, and clinicopathological implications of ARHGAP40 in renal cell carcinoma (RCC), the most common urinary malignancy. A total of 60 clear cell renal cell carcinomas (ccRCC), 30 papillary renal cell carcinomas (pRCC), 30 chromophobe renal cell carcinomas (chRCC), and 13 other RCC subtypes were enrolled. ARHGAP40 expression was analyzed in both RCC tissues and matched paracancerous normal tissues using immunohistochemistry (IHC). The methylation status of the ARHGAP40 promoter region was assessed in both normal and tumor samples by bisulfite sequencing PCR (BSP). Circulating tumor DNA (ctDNA) extracted from peripheral blood samples of RCC patients (20), patients with benign renal tumors (1), and healthy controls (14) was quantitatively analyzed for methylation using quantitative methylation-specific PCR (qMSP). ARHGAP40 expression was significantly downregulated in RCC compared to matched normal tissues (P < 0.001). This reduced expression correlated with tumor necrosis (P = 0.009) but showed no significant association with age, gender, tumor location, tumor diameter, TNM stage, or vascular invasion. In the ccRCC subtype, ARHGAP40 expression exhibited a progressive decrease with larger tumor diameter (P = 0.045), advancing histological grade (P = 0.032), and tumor necrosis (P = 0.011). The methylation status of ARHGAP40 was consistent with its expression level in both tumor and adjacent normal tissues. Methylated ARHGAP40 DNA was detectable only in RCC patient ctDNA samples. ARHGAP40 is epigenetically silenced in RCC through methylation-mediated downregulation, which correlates with tumor necrosis and grade. The detection of methylated ARHGAP40 in ctDNA holds promise as a potential biomarker for early RCC diagnosis.

Humans↗

PubMed1999

Invariant chain expression in colon neoplasms.

Invariant chain (Ii) is a chaperone molecule that inhibits binding of endogenous antigens to class II molecules. High levels of Ii in cancer cells may prevent tumour antigen expression with class II and render the tumour less immunogenic. To correlate the expression of Ii and class II molecules in colon carcinomas with the density of tumour infiltrating lymphocytes (TILs), surgical specimens from a total of 48 patients with well-(WDAC), moderately (MDAC) and poorly differentiated adenocarcinomas (PDAC), adenoma with high-grade dysplasia (AdHGD) and adenomas were immunostained for Ii and class II antigen (HLA-DR). Aggregates of TILs were graded in H&E-stained sections. Normal colon epithelium was negative for Ii and HLA-DR. Invasive carcinomas showed a linear increase in the expression of Ii in the progression from low- to high-grade tumours, while there was no significant difference in HLA-DR expression across the groups. Invasive carcinomas showed a disproportionate increase in Ii over HLA-DR. Frequency of TILs showed inverse correlation with expression of Ii and tumour grade. This is the first demonstration that expression of Ii increases in the progression from low- to high-grade colon neoplasms and is most marked in the poorly differentiated carcinomas. Ii expression by carcinomas is inversely related to the frequency of TILs. The findings suggest that increased Ii renders the tumour less immunogenic and less likely to stimulate a host immune response.

Adenocarcinoma↗

PubMed1987

Correlation of histopathological, cytological and flow cytometric findings in neoplastic and nonneoplastic lesions of the bladder.

Biopsy diagnosis, urine cytology and flow cytometry features of urine and bladder washings were compared in 81 cases of benign and malignant bladder disease. Some patients were followed by urine cytology and flow cytometry during treatment of tumors. There was a good correlation of the 3 parameters in relatively high grade tumors (II and III) but an inconsistent appearance of cells in the urine diagnosable by either urine cytology or flow cytometry for low grade lesions. High grade flat neoplasms may be detectable by urine cytology and flow cytometry before they are visible on endoscopy. Flow cytometry may indicate urothelial proliferation before it is apparent on urine cytology. Exfoliative benign lesions are diagnosed readily by the combination of urine cytology and flow cytometry. In benign and malignant lesions shedding of viable cells and, therefore, accessibility to urine cytology and flow cytometry are inconsistent. The need for repeated examinations in the case of low grade lesions suggests that the method is not reliable for single test screening programs but it is a valuable means of followup in cases of suspected or diagnosed disease.

Biopsy↗

PubMed1992

Treatment of children with progressive or recurrent brain tumors with carboplatin or iproplatin: a Pediatric Oncology Group randomized phase II study.

PURPOSE: The Pediatric Oncology Group (POG) conducted a randomized phase II study to evaluate the activity of carboplatin and iproplatin in children with progressive or recurrent brain tumors. PATIENTS AND METHODS: The study was designed to evaluate the activity of these agents and to compare the toxicities associated with their use. Treatment consisted of carboplatin 560 mg/m2 at 4-week intervals or iproplatin 270 mg/m2 at 3-week intervals. RESULTS: The major toxicity observed was myelosuppression, particularly thrombocytopenia, for both agents. Ototoxicity (grade 1 or 2) was seen in 2.5% of patients treated with carboplatin and 1.3% of patients treated with iproplatin. The majority of patients with low-grade astrocytic neoplasms treated with carboplatin (nine of 12 patients) or iproplatin (eight of 12 patients) demonstrated tumor response or prolonged stable disease that persisted off-therapy. The duration of stable disease produced by carboplatin was particularly striking, ranging from 2 months to 68 + months (median, 40 + months). Neither drug demonstrated appreciable activity in the treatment of medulloblastoma (two of 26 responses to carboplatin, one of 14 responses to iproplatin), ependymoma (two of 17 responses to carboplatin, none of seven responses to iproplatin), high-grade glioma (two of 19 responses to carboplatin, one of 14 responses to iproplatin), or brain-stem tumors (one of 23 responses to carboplatin, none of 14 responses to iproplatin). CONCLUSION: Carboplatin is active against low-grade gliomas. Further evaluation of the role of carboplatin in the preirradiation treatment of children with low-grade gliomas of the optic pathway is currently underway in a clinical trial.

Adolescent↗

PubMed1990

In situ hybridization analysis of human papillomavirus DNA segregation patterns in lesions of the female genital tract.

Various histologic features may be used to divide human papillomavirus (HPV)-related lesions of the genital tract into two groups: condylomata and "low-grade" or grade 1 cervical intraepithelial neoplasias (CIN 1) versus "high-grade" or grade 2 and 3 intraepithelial neoplasias. Using in situ hybridization analysis we correlated HPV DNA type with histologic features in 350 biopsies of lesions from the cervix, vulva, and perianal region. HPV DNA was most commonly found in vulvar and perianal condylomata (39/46, 85%), whereas the rate in CIN 1 lesions was 72% (86/120). The rates were 53% (40/76) and 57% (12/21) in CIN 2/3 and vulvar intraepithelial neoplasm (VIN) grades 2 and 3, respectively. The HPV type in all but 2 of the 39 perianal and vulvar condylomata which contained HPV was 6/11. Despite their similar histologic features, the HPV type in only 23 of 86 (27%) CIN 1 cases with detectable HPV was 6/11 compared to 31 of 86 (36%) which contained HPV 16-related DNA and 32 of 86 (37%) which contained HPV 31,-33, or -35-related DNA. The viral DNA in the majority of CIN 2/3 lesions and all of the VIN 2/3 lesions was HPV-16 related; no CIN 2/3 or VIN 2/3 lesion had HPV 6/11-related DNA. It is concluded that although cutaneous genital tract condylomata are highly associated with HPVs of low oncogenic potential (types 6 and 11), these HPV types are not as frequent as the oncogenic HPVs (16, 31, 33, and 35) in CIN 1 lesions. Further, HPV 6/11 appears to be very rarely associated with CIN 2/3 or VIN 2/3 lesions.

Condylomata Acuminata↗

PubMed1991

[Malignant lymphoma of the spleen. Histological and immunohistochemical studies of morphology and differential diagnosis].

450 splenectomy specimens showing involvement by all save a few very infrequently occurring types of malignant lymphomas (ML) recognized by the updated Kiel classification of ML were investigated by conventional histologic and immunohistochemical methods. The results confirm and augment the findings of previous studies and facilitate a comparison of infiltration patterns of different ML in the spleen. These studies in conjunction with immunohistochemical detection of neoplastic cells may thus contribute to the diagnosis of minimal, i.e. early, splenic infiltration by ML and to the differential diagnosis of ML with advanced splenic involvement. Initially, most low grade NHL lead to nodular involvement of the splenic white pulp which may evolve into larger tumor nodules and/or diffuse red pulp involvement by invasion of adjacent red pulp structures. As a rule, the infiltrates are angiotropic, i.e. neoplastic cells accumulate in the vicinity of arterial and venous blood vessels both in the white and in the red pulp. Sinus involvement is frequently associated with leukemic generalisation of the neoplasm. High grade NHL are also localized predominantly in the splenic white pulp. However, their intrasplenic spread is characterized by the formation of large nodular and/or diffuse infiltrates which may efface the splenic architecture. Hodgkin lymphomas (HL), in contrast, cause coalescing tumor nodules which show expansive growth rather than progressive infiltration of the splenic parenchyma. These infiltration patterns of ML in the spleen are a constant finding. In conjunction with cytologic features and immunophenotype of the neoplastic cells they thus constitute reliable criteria for the differential diagnosis of ML in the spleen, although their anatomical and functional basis has not yet been fully elucidated. B and T cell lymphomas initially tend to show selective involvement of the original B and T cell areas of the spleen. Most high grade ML exhibit a similar behavior, although the size of the splenic lesions usually does not permit an exact identification of the ML's primary manifestation in the spleen. They thus exhibit a "homing phenomenon" to the two large lymphoid compartments of the spleen which is most conclusively illustrated by the "organoid" ML such as CB-CC or T zone lymphoma. This behavior has been interpreted to reflect the histogenesis of the neoplastic cells of the ML under study. In addition, specialised types of accessory cells such as CD35+ FDC and CD1/S100+ IDRC appear to be essential for the creation of conditions which are suitable for B and T lymphocytes, respectively. Progressive infiltration by neoplastic cells will lead to destruction of the normal microenvironment, i.e. alterations of FDC networks.(ABSTRACT TRUNCATED AT 400 WORDS)

Antigens, CD↗

PubMed2003

Atypical fibrous histiocytoma and atypical fibroxanthoma: presentation of two cases.

We report two rare examples of dermal fibrohistiocytic stromal tumors: one case of atypical fibrous histiocytoma (AFH) and another one of atypical fibroxanthoma (AFX), which can be confused in surgical pathology diagnosis with high-grade malignant neoplasm. Histologically, a proliferation of mononuclear, spindle-shaped, or histiocytoid cells and/or multinucleated cells, usually admixed with inflammatory cells was observed in both cases, but some clinicopathological differences allowed their distinction. Immunohistochemistry is of a little help in differential diagnosis between these two entities however, it is very useful in differentiating with other groups of tumors. Recognition of AFH and AFX is important, especially to prevent incorrect aggressive treatment in those cases that may be confused with high-grade sarcoma. Because of the potentially aggressive behavior in rare cases and the lack of clear-cut predictive morphologic patterns that would specify a poor clinical outcome, complete surgical excision in all cases is recommended.

Actins↗