Lipomatous soft tissue tumors (STT), ranging from benign lipomas to malignant liposarcomas, require accurate differentiation for timely treatment. Complementary to MRI, Contrast-enhanced ultrasound ...(CEUS) is emerging as a promising tool, providing insight into tumor microperfusion in real-time. This study aims to explore the potential of preoperative CEUS in differentiating benign lipomatous tumors from malignant liposarcoma subtypes.
Eighty-seven patients with lipomatous STT scheduled for surgery were enrolled. Clinical and MRI assessments were conducted to obtain general tumor characteristics. CEUS was used for a standardized tumor perfusion evaluation. Perfusion analysis included peak enhancement, rise time, wash-in perfusion index, and wash-out rate, reflecting the perfusion kinetics. Histopathological results were obtained for every STT and compared to perfusion characteristics.
In total, 48 lipoma, 23 ALT and 11 liposarcoma were identified. Significant differences in tumor microperfusion were demonstrated, with higher perfusion levels indicating higher malignancy (Peak enhancement a.u. of Lipoma: 145 ± 238; ALT: 268 ± 368; Liposarcoma: 3256 ± 4333; p (ALT vs. Liposarcoma) < 0.001). A perfusion-based identification of a benign lipoma or ALT versus sarcoma resulted in a positive predictive value of 93%. Patient-related factors (age, gender, BMI, ASA score, smoking status) had no significant impact on the CEUS-based perfusion parameters.
Our study suggests CEUS as a capable non-invasive tool for improving preoperative assessment of lipomatous STT. It can assist in the distinction between benign and malignant STT, accelerating treatment decisions and enhancing patient outcomes. Significant correlations between CEUS-derived parameters and malignancy highlight its risk assessment potential.
Background
Controversies exist regarding the biopsy technique of choice for the accurate diagnosis of soft‐tissue sarcoma (STS). The objective of this systematic review and meta‐analysis was to ...compare the diagnostic accuracy of core needle biopsy (CNB) versus incisional biopsy (IB) in STS with reference to the final histopathological result.
Methods
Studies regarding the diagnostic accuracy of CNB and IB in detecting STS were searched systematically in the MEDLINE and EMBASE databases. Estimates of sensitivity and specificity with associated 95% CIs for diagnostic accuracy were calculated. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS‐2).
Results
A total of 17 studies comprising 2680 patients who underwent 1582 CNBs and 241 IBs with subsequent tumor resection met the inclusion criteria. The sensitivity and specificity of CNB and IB to detect the dignity of lesions were 97% (95% CI, 95%‐98%) and 99% (95% CI, 97%‐99%), respectively, and 96% (95% CI, 92%‐99%) and 100% (95% CI, 94%‐100%), respectively. Estimates of the sensitivity and specificity of CNB and IB to detect the STS histotype were 88% (95% CI, 86%‐90%) and 77% (95% CI, 72%‐81%), respectively, and 93% (95% CI, 87%‐97%) and 65% (95% CI, 49%‐78%), respectively. Patients who underwent CNB had a significantly reduced risk of complications compared with patients who underwent IB (risk ratio, 0.14; 95% CI, 0.03‐0.56 P ≤ .01). Quality assessment of studies revealed a high risk of bias.
Conclusions
CNB has high accuracy in diagnosing the dignity of lesions and STS histotype in patients with suspected STS with fewer complications compared with IB. Therefore, CNB should be regarded as the primary biopsy technique.
A systematic summary of the current literature demonstrates that core needle biopsy is the superior method with which to differentiate soft‐tissue sarcoma subtypes, with lower rates of complications compared with the incision biopsy technique. Core needle biopsy should be regarded as the primary biopsy technique.
Vascular leiomyomas are infrequent benign soft tissue neoplasms arising from vascular wall. These lesions are more frequent in females, predominantly seen in lower extremities presenting as slowly ...enlarging freely mobile palpable soft tissue lesions, often painful. The role of imaging in small peripheral soft tissue masses is often limited to preoperative mapping with a long list of potential differentials. We are presenting 2 case studies of palpable masses with similar pathology, soft tissue vascular leiomyomas where its MR features can be helpful in inclusion of this entity not only in differential diagnosis of enhancing small peripheral soft tissue masses but can suggest a diagnosis in appropriate clinical scenario.
Soft tissue tumors are not uncommon in childhood and comprise entities that range from common to very rare malignancies. Infantile fibrosarcoma (IFS) is a rare pediatric malignancy mainly seen in the ...first two years of life. The data about the incidence of infantile fibrosarcoma occurring in the neck in the Indian subcontinent is scarce. To the best of our knowledge, only one case of infant cervical IFS has been reported previously in the Indian subcontinent. We present another case of an eight-year-old male patient with a rapidly growing mass on the left side of the neck. He was successfully treated with a combined modality of surgery and chemotherapy with a good outcome. Among the soft tissue tumors of childhood, IFS is a rare entity. It has a good prognosis and lesser chance of distant metastasis as compared to adult fibrosarcoma. Though surgical excision is the mainstay of treatment, chemotherapy also has a significant role in the treatment of primary tumor and metastasis. We discuss the stated case to bring to the notice this uncommon cause, which can be considered as a differential diagnosis of upper cervical swellings. A better understanding of this entity would help in early diagnosis and aggressive treatment, reducing the overall morbidity and mortality.
BACKGROUND: Soft tissue tumors (STT) are rare, heterogeneous neoplasm, derived from the mesoderm. The wide range of STT and absence of recognizable architectural patterns on cytology makes the ...diagnosis of STT through fine needle aspiration cytology (FNAC) difficult. METHODS: This laboratory-based, non–interventional, observational, retrospective study was conducted on 526 diagnosed cases of STT between 2015 and 2019, for cytohistological correlation. In all the cases, complete clinical details, radiological and clinical data, and cytopathological and histopathological diagnosis were recorded from the Hospital Information System and pathology records. The cytological smears were examined and were categorized as benign, suspicious for malignancy, and malignant. Corresponding histopathology slides were examined for diagnostic concordance considering histopathology as the “gold standard.” Cytohistopathological correlation was assessed in all cases and the diagnostic accuracy of FNAC was expressed as a percentage. Statistical analysis was carried out using SPSS software. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated using the respective formulae. P values < 0.05 were considered to be significant. RESULTS: Overall accurate categorizations of benign STT and malignant STT were 61.96% and 17.05%, respectively. The overall diagnostic accuracy of FNAC was 93.5%. Its sensitivity, specificity, PPV, and NPV were 83.68%, 97.39%, 91.47%, and 94.20%, respectively. Correlations with a p value < 0.001 were considered significant. CONCLUSION: FNAC is an important preliminary diagnostic tool in STT and is helpful in the diagnosis of local recurrence and metastatic tumors in the soft tissue. FNAC has a high degree of correlation with core biopsy, thereby avoiding significant clinical complication associated with it.
To evaluate the diagnostic yield of ultrasonography (US)-guided core needle biopsy (CNB) in the diagnosis of soft tissue tumors (STTs) and to analyze the failure factors.
139 patients with STTs that ...underwent both US-guided CNB and surgical resection were collected retrospectively. Compared with the histopathological results of surgical resection, the biopsy failure was defined as the following conditions: indefinitive diagnosis, including insufficient samples and unknown subtypes with correct biological potential classification; wrong diagnosis, including wrong biological potential classification and wrong subtypes with correct biological potential classification. Univariate and multivariate analyses from the perspectives of histopathological, demographic and US features together with biopsy procedures were performed to determine risk factors for diagnostic failure.
The diagnostic yield of US-guided CNB for STTs in our study was 78.4%, but when only considering the correct biological potential classification of STTs, the diagnostic yield was 80.6%. The multivariate analysis showed that adipocytic tumors (odds ratio (OR) = 10.195, 95% confidence interval (CI): 1.062 - 97.861, p = 0.044), vascular tumors (OR = 41.710, 95% CI: 3.126 - 556.581, p = 0.005) and indeterminate US diagnosis (OR = 8.641, 95% CI: 1.852 - 40.303, p = 0.006) were correlated with the diagnostic failure. The grade III vascular density (OR = 0.019, 95% CI: 0.001 - 0.273, p = 0.007) enabled a higher diagnostic accuracy.
US-guided CNB can be an effective modality for the diagnosis of STTs. The diagnostic yield can be increased when the tumor vascular density was grade III in Color Doppler US, but can be decreased in adipocytic tumors, vascular tumors and masses with indeterminate US diagnosis.
Myoepithelioma of the ankle: A case report Brutico, Anthony G.; Micciche, Mark; Chromey, David ...
Foot & ankle surgery (New York, N.Y.),
Summer 2021, Letnik:
1, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Myoepitheliomas are rare benign and malignant neoplasms composed of spindled, ovoid, or plasmacytoid cells. These tumors have been reported to occur in salivary glands and cutaneous, subcutaneous, ...and deep soft tissues of the head and neck, upper and lower extremities lung, and breast. Surgical resection with clear margins is the standard of care for the treatment of both low-and high-grade neoplasms. A 55- year-old female with no significant past medical history presented to an urgent care center with left ankle pain after suffering an inversion ankle sprain. Radiographs of the left ankle were reviewed and were negative for any bony pathology. She continued to have pain, edema, and developed a localized soft tissue mass at the retromalleolar area. MRI showed a soft tissue tumor adjacent to the peroneal tendons. The mass was removed and pathology confirmed it as a myoepithelioma, which is a rare tumor of the lower extremity. Myoepitheliomas are most commonly found in the salivary glands and can have a benign or malignant characteristic. Other common locations include the limbs and trunk region and the lesion typically presents in young to middle aged adults. Recurrence of histologically benign tumors has been associated with a local recurrence of 20% and rarely metastasize. Gene rearrangement at the ESWR1 (22q12) location is seen in >90% of soft tissue sarcomas. In this case, FISH analysis did not reveal gene rearrangement at ESWR1 22q12. The clinical significance is unknown and does not rule out a malignancy or other genetic changes.
Ultrasonography (US) is the primary imaging method for soft tissue tumors (STTs), the diagnostic performance of which still requires improvement. To achieve an accurate evaluation of STTs, we built ...the diagnostic nomogram for STTs using the clinical and US features of patients with STTs.
A total of 613 patients with 195 malignant and 418 benign STTs were retrospectively recruited. We used a blend of clinical and ultrasonic features, as well as exclusively US features, to develop two distinct diagnostic models for STTs: the clinical–US model and the US-only model, respectively. The two models were evaluated and compared by measuring their areas under the receiver operating characteristic curve (AUC), calibration, integrated discrimination improvement (IDI) and decision curve analysis. The performance of the clinical–US model was also compared with that of two radiologists.
The clinical–US model had better diagnostic performance than the model based on US imaging features alone (AUCs of the clinical–US and US-only models: 0.95 0.93–0.97 vs. 0.89 0.87–0.92, p < 0.001; IDI of the two models: 0.15 ± 0.03, p < 0.001). The clinical–US model was also superior to the two radiologists in diagnosing STTs (AUCs of clinical–US model and two radiologists: 0.95 0.93–0.97 vs. 0.79 0.75–0.82 and 0.83 0.80–0.85, p < 0.001).
The diagnostic model based on clinical and US imaging features had high diagnostic performance in STTs, which could help identify malignant STTs for radiologists.
Primitive non-neural granular cell tumor (PNNGCT)is a rare mesenchymal neoplasm of unknown lineage with prominent cytoplasmic granularity. By reviewing the relevant literature reported over the past ...30 years, we detail the clinicopathological features of these tumors and describe their immunostaining profile and differential diagnoses. These tumors are more common in children and young adults, and often involve the back and extremities. A panel of immunostains is important to rule out other differential diagnoses. For example, S-100 protein is the best differentiating marker to distinguish the more common “traditional” granular cell tumor from PNNGCT, and NKI-C3 and anaplastic lymphoma kinase (ALK) stains can be particularly helpful in confirming the diagnosis. In addition, an underlying ALK gene rearrangement has been reported in a small subset of cases. In general, the majority of these tumors appear to behave in a benign fashion, and conservative management is recommended.
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