Two benign adenomatous lesions are commonly recognized within the sinonasal tract, namely respiratory epithelial adenomatoid hamartoma (REAH) and seromucinous hamartoma (SH). We present 10 hitherto unrecognized benign polypoid nasal and sinonasal tumoriform lesions having in average 3.6 cm in largest dimension, which are histogenetically related to SH and REAH. In addition to typical structures of REAH and SH, these lesions contained an additional characteristic and slightly atypical adenomatous component, which we termed atypical sinonasal glands arising in SH (ASGSH). ASGSH often produced deep red colored secretion with peripheral clearing similar to that seen in thyroid follicles. In contrast to SH, ASGSH was endowed by both secretory and myoepithelial layers and had mostly angulated shapes with snout-like protrusions into the lumens. Both layers were formed by an irregular, disorganized, and often incomplete cell lining, which had slightly atypical cytological features without mitoses. In 3 cases, ASGSHs revealed sebaceous differentiation, and in 3 cases the stroma produced a well-differentiated cartilage. Neoplastic nature of ASGSH was supported by finding of various mutations as revealed by next generation sequencing in five cases. In two cases each, we found identical mutations in BRAF gene (Val600Glu), and RET gene (Arg912Trp), respectively and in one case FAT1 gene alteration (Pro1665Leu).
- MeSH
- adenom patologie genetika MeSH
- dospělí MeSH
- hamartom * patologie genetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- mutace MeSH
- nádory nosu patologie genetika MeSH
- nádory vedlejších dutin nosních patologie genetika MeSH
- respirační sliznice patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- adenom diagnóza terapie MeSH
- anastomóza chirurgická MeSH
- dospělí MeSH
- familiární adenomatózní polypóza * chirurgie diagnostické zobrazování komplikace MeSH
- kolektomie MeSH
- lidé MeSH
- meduloblastom * chirurgie diagnóza terapie MeSH
- peritonitida diagnóza terapie MeSH
- pouch MeSH
- tlusté střevo chirurgie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Respiračný epiteliálny adenomatoidný hamartóm (REAH) je zriedkavá benígna lézia pochádzajúca z epitelu sliznice nazálnej dutiny a prínosových dutín. V práci opisujeme prípad 51-ročného muža s anamnézou pretrvávajúceho sťaženého dýchania a pocitu upchatého nosa. Diagnostikovanú mal veľkú polypovitú masu v pravom nosovom priechodne so stopkou vyrastajúcou z čuchovej štrbiny. Makroskopicky išlo kompaktný polyp rozmerov 40 × 32 × 10 mm s hladkým povrchom. Histologické vyšetrenie potvrdilo diagnózu REAH s ložiskovo výraznou prevahou žľazových štruktúr s prechodom do seromucinózneho hamartómu. Po operácii klinické ťažkosti ustúpili a pacient je v súčasnosti bez známok recidívy. Napriek zriedkavému výskytu by mal byť REAH zahrnutý v diferenciálnej diagnostike sinonazálnych polypovitých más, najmä ak pochádzajú zo zadnej časti nazálneho septa alebo olfaktoriálnej štrbiny. Včasné rozpoznanie a správna diagnóza predchádzajú zbytočným agresívnym chirurgickým intervenciám a ďalším zaťažujúcim vyšetreniam.
Respiratory epithelial adenomatoid hamartoma (REAH) is a rare benign lesion originating from the mucosal epithelium of the nasal cavity and paranasal sinuses. We describe a 51-year-old man with a history of persistent difficulty breathing and feeling of stuffy nose. He was diagnosed to have a large polypoid mass in the right nasal cavity with a stalk arising from the olfactory cleft. Grossly, it was a compact polyp measuring 40 × 32 × 10 mm with a smooth surface. The histology confirmed the diagnosis of REAH with predominance of glandular structures with a transition to seromucinous hamartoma. After the operation, the clinical problems had disappeared and the patient was free of recurrence. Despite rare occurrence, REAH should be included in the differential diagnosis of sinonasal polypoid masses, especially of those which originate from the posterior part of the nasal septum or olfactory cleft. Early recognition and correct diagnosis prevent unnecessary aggressive surgery and other burdensome examinations.
- Klíčová slova
- respirační epitelový adenomatoidní hamartom,
- MeSH
- adenom chirurgie diagnostické zobrazování patologie MeSH
- diferenciální diagnóza MeSH
- endoskopie MeSH
- hamartom * chirurgie diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nosní polypy chirurgie diagnostické zobrazování patologie MeSH
- paranazální dutiny * chirurgie diagnostické zobrazování patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Primární hyperparatyreóza (HPPT) je generalizovaná porucha kalcium-fosfátového metabolizmu důsledkem dlouhodobě zvýšené sekrece parathormonu (PTH). Nejčastější příčina nadprodukce PTH je adenom jednoho či více příštítných tělísek. Trombóza mozkových splavů tvoří asi 1–2 % cévních mozkových příhod a jejím důsledkem může být ložisková ischemie s prokrvácením. V tomto článku popisujeme unikátní kazuistiku pacienta, který byl akutně přijat pro progresi náhle vzniklé poruchy řeči a progredující poruchu vědomí na podkladě trombózy splavů a intracerebrálního krvácení. Vedlejším nálezem při vstupní diagnostice byla hypofosfatemie a hyperkalcemie při elevaci parathormonu.
Primary hyperparathyroidism (HPPT) is a generalized disorder of calcium-phosphate metabolism resulting from long-term secretion of parathyroid hormone (PTH). The most common cause of PTH overproduction is an adenoma of one or more parathyroid glands. Cerebral venous sinus thrombosis accounts for about 1–2% of cerebral events and its consequence can be focal ischemia with intracerebral hemorrhage. In this article, we describe a unique case report of a patient who was urgently admitted for the progression of a sudden speech disorder and progressive impairment of consciousness on the basis of thrombosis in the cerebral sinuses and intracerebral hemorrhage. Secondary findings at the initial diagnostic process were hypophosphatemia and hypercalcemia with parathyroid hormone elevation.
- MeSH
- adenom klasifikace komplikace MeSH
- hyperkalcemie etiologie krev MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory příštítného tělíska * diagnóza klasifikace komplikace MeSH
- primární hyperparatyreóza diagnóza komplikace metabolismus MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- trombóza nitrolebních žilních splavů * diagnóza etiologie MeSH
- žilní tromboembolie diagnóza etiologie krev MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
Oncocytic renal neoplasms are a major source of diagnostic challenge in genitourinary pathology; however, they are typically nonaggressive in general, raising the question of whether distinguishing different subtypes, including emerging entities, is necessary. Emerging entities recently described include eosinophilic solid and cystic renal cell carcinoma (ESC RCC), low-grade oncocytic tumor (LOT), eosinophilic vacuolated tumor (EVT), and papillary renal neoplasm with reverse polarity (PRNRP). A survey was shared among 65 urologic pathologists using SurveyMonkey.com (Survey Monkey, Santa Clara, CA, USA). De-identified and anonymized respondent data were analyzed. Sixty-three participants completed the survey and contributed to the study. Participants were from Asia (n = 21; 35%), North America (n = 31; 52%), Europe (n = 6; 10%), and Australia (n = 2; 3%). Half encounter oncocytic renal neoplasms that are difficult to classify monthly or more frequently. Most (70%) indicated that there is enough evidence to consider ESC RCC as a distinct entity now, whereas there was less certainty for LOT (27%), EVT (29%), and PRNRP (37%). However, when combining the responses for sufficient evidence currently and likely in the future, LOT and EVT yielded > 70% and > 60% for PRNRP. Most (60%) would not render an outright diagnosis of oncocytoma on needle core biopsy. There was a dichotomy in the routine use of immunohistochemistry (IHC) in the evaluation of oncocytoma (yes = 52%; no = 48%). The most utilized IHC markers included keratin 7 and 20, KIT, AMACR, PAX8, CA9, melan A, succinate dehydrogenase (SDH)B, and fumarate hydratase (FH). Genetic techniques used included TSC1/TSC2/MTOR (67%) or TFE3 (74%) genes and pathways; however, the majority reported using these very rarely. Only 40% have encountered low-grade oncocytic renal neoplasms that are deficient for FH. Increasing experience with the spectrum of oncocytic renal neoplasms will likely yield further insights into the most appropriate work-up, classification, and clinical management for these entities.
BACKGROUND: Partial nephrectomy (PN) has become the dominant treatment modality for cT1 renal tumor lesions. Tumors suspected of malignant potential are indicated for surgery, but some are histologically classified as benign lesions after surgery. This study aims to analyze the number of benign findings after PN according to definitive histology and to evaluate whether there is an association between malignant tumor findings and individual factors. METHODS: The retrospective study included 555 patients who underwent open or robotic-assisted PN for a tumor in our clinic from January 2013 to December 2020. The cohort was divided into groups according to definitive tumor histology (malignant tumors vs. benign lesions). The association of factors (age, sex, tumor size, R.E.N.A.L.) with the malignant potential of the tumor was further evaluated. RESULTS: In total, 462 tumors were malignant (83%) and 93 benign (17%). Of the malignant tumors, 66% were clear-cell RCC (renal cell carcinoma), 12% papillary RCC, and 6% chromophobe RCC. The most common benign tumor was oncocytoma in 10% of patients, angiomyolipoma in 2%, and papillary adenoma in 1%. In univariate analysis, there was a higher risk of malignant tumor in males (OR 2.13, 95% CI 1.36-3.36, p = 0.001), a higher risk of malignancy in tumors larger than 20 mm (OR 2.32, 95% CI 1.43-3.74, p < 0.001), and a higher risk of malignancy in tumors evaluated by R.E.N.A.L. as tumors of intermediate or high complexity (OR 2.8, 95% CI 1.76-4.47, p < 0.001). In contrast, there was no association between older age and the risk of malignant renal tumor (p = 0.878). CONCLUSIONS: In this group, 17% of tumors had benign histology. Male sex, tumor size greater than 20 mm, and intermediate or high R.E.N.A.L. complexity were statistically significant predictors of malignant tumor findings.
- MeSH
- angiomyolipom patologie chirurgie MeSH
- dospělí MeSH
- karcinom z renálních buněk chirurgie patologie epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory ledvin * chirurgie patologie MeSH
- nefrektomie * metody MeSH
- oxyfilní adenom patologie chirurgie MeSH
- předoperační období MeSH
- retrospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Autoři uvádí případ 77leté ženy s pomalu rostoucím verukózním anulárním ložiskem, u něhož byla histopatologicky potvrzena diagnóza hidroacanthoma simplex. Po 8 letech se ložisko dvojnásobně rozšířilo a dosáhlo průměru 8 cm. V diskusi je pojednán klinický, dermatoskopický a histopatologický obraz hidroacanthoma simplex a je uveden současný pohled na problematiku nádorů ze skupiny poromu.
The authors present a case of a 75-year-old woman with a slowly growing verrucous annular plaque, in which the diagnosis of hidroacanthoma simplex was confirmed by the histopathology. The lesion enlarged twice in subsequent 8 years with the diameter of 8 cm. Clinical, dermoscopic and histopathological presentation of hidroacanthoma simplex is discussed. Up-to-date view on the topic of the tumours of the poroma group is added.
Pituitary adenomas (PA) represent the most common type of sellar neoplasm. Extracting relevant information from radiological images is essential for decision support in addressing various objectives related to PA. Given the critical need for an accurate assessment of the natural progression of PA, computer vision (CV) and artificial intelligence (AI) play a pivotal role in automatically extracting features from radiological images. The field of "Radiomics" involves the extraction of high-dimensional features, often referred to as "Radiomic features," from digital radiological images. This survey offers an analysis of the current state of research in PA radiomics. Our work comprises a systematic review of 34 publications focused on PA radiomics and other automated information mining pertaining to PA through the analysis of radiological data using computer vision methods. We begin with a theoretical exploration essential for understanding the theoretical background of radionmics, encompassing traditional approaches from computer vision and machine learning, as well as the latest methodologies in deep radiomics utilizing deep learning (DL). Thirty-four research works under examination are comprehensively compared and evaluated. The overall results achieved in the analyzed papers are high, e.g., the best accuracy is up to 96% and the best achieved AUC is up to 0.99, which establishes optimism for the successful use of radiomic features. Methods based on deep learning seem to be the most promising for the future. In relation to this perspective DL methods, several challenges are remarkable: It is important to create high-quality and sufficiently extensive datasets necessary for training deep neural networks. Interpretability of deep radiomics is also a big open challenge. It is necessary to develop and verify methods that will explain to us how deep radiomic features reflect various physics-explainable aspects.
- MeSH
- adenom * diagnostické zobrazování MeSH
- deep learning MeSH
- lidé MeSH
- nádory hypofýzy * diagnostické zobrazování MeSH
- počítačové zpracování obrazu metody MeSH
- radiomika MeSH
- strojové učení MeSH
- umělá inteligence MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
Systémová léčba maligního pleurálního mezoteliomu bez možnosti chirurgické resekce byla dlouhé roky založena na kombinaci chemoterapie platiny a pemetrexedu, a to až do příchodu imunoterapie. Imunoterapie zásadním způsobem změnila prognózu pacientů u celé řady malignit a její přínos byl prokázán i v případě maligního mezoteliomu pleury. Klinická studie CheckMate 743, provedená u pacientů s inoperabilním mezoteliomem pleury, jednoznačně potvrdila superioritu kombinované imunoterapie ipilimumabem a nivolumabem v porovnání se standardem léčby, tj. kombinací platiny a pemetrexedu. Imunoterapie je v současnosti beze sporu standardem v léčbě maligního pleurálního mezoteliomu bez možnosti chirurgické resekce a získala jak registraci, tak úhradu z veřejného zdravotního pojištění.
The systemic therapy of malignant pleural mesothelioma without the possibility of surgical treatment was previously based on the combined chemotherapy with platinum and pemetrexed until the immunotherapy was introduced. Immunotherapy has significantly changed the prognosis of the patients with several tumour types and its benefit has been proved also in the case of malignant pleural mesothelioma. The CheckMate 743 clinical trial in patients with unresectable pleural mesothelioma showed superiority of the combined immunotherapy (ipilimumab and nivolumab) compared with previous standard of care in the treatment of the pleural mesothelioma (platinum and pemetrexed). At this moment, immunotherapy represents without any doubt the gold standard in the treatment of the unresectable malignant pleural mesothelioma and the combination gained the registration as well as the reimbursement in this indication.
OBJECTIVE: Stereotactic radiosurgery (SRS) is used for the treatment of residual/recurrent nonfunctional pituitary adenoma (NFPA). The aim of this study was to evaluate the factors related to long-term tumor control and delayed endocrinopathies following SRS. METHODS: This retrospective, multicenter study included patients with recurrent/residual NFPA treated with single-fraction SRS; they were then divided into two arms. The first arm included patients with at least 5 years of radiographic follow-up and all patients with local tumor progression. The second arm included patients with at least 5 years of endocrinological follow-up and all patients who developed endocrinopathy. Study endpoints were tumor control and new or worsening hypopituitarism after SRS and were analyzed using Cox regression and Kaplan-Meier methodology. RESULTS: There were 360 patients in the tumor control arm (median age 52.7 [IQR 42.9-61] years, 193 [53.6%] males) and 351 patients in the hypopituitarism arm (median age 52.5 [IQR 43-61] years, 186 [53.0%] males). The median follow-up in the tumor control evaluation group was 7.95 (IQR 5.7-10.5) years. Tumor control rates at 5, 8, 10, and 15 years were 93% (95% CI 90%-95%), 87% (95% CI 83%-91%), 86% (95% CI 82%-90%), and 69% (95% CI 59%-81%), respectively. The median follow-up in the endocrinopathy evaluation group was 8 (IQR 5.9-10.7) years. Pituitary function preservation rates at 5, 8, 10, and 15 years were 83% (95% CI 80%-87%), 81% (95% CI 77%-85%), 78% (95% CI 74%-83%), and 71% (95% CI 63%-79%), respectively. A margin dose > 15 Gy (HR 0.8, 95% CI 0.7-0.9; p < 0.001) and a delay from last resection to SRS > 1 year (HR 0.9, 95% CI 0.7-0.9; p = 0.04) were significant factors related to tumor control in multivariable analysis. A maximum dose to the pituitary stalk ≤ 10 Gy (HR 1.1, 95% CI 1.09-1.2; p < 0.001) was associated with pituitary function preservation. New visual deficits after SRS occurred in 7 (1.94%) patients in the tumor control group and 8 (2.3%) patients in the endocrinopathy group. Other new cranial nerve deficits post-SRS occurred in 4 of 160 patients with data in the tumor control group and 3 of 140 patients with data in the endocrinopathy group. CONCLUSIONS: SRS affords favorable and durable tumor control for the vast majority of NFPAs. Post-SRS hypopituitarism occurs in a minority of patients, but this risk increases with time and warrants long-term follow-up.
- MeSH
- adenom * chirurgie radioterapie diagnostické zobrazování MeSH
- dospělí MeSH
- hypopituitarismus etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lokální recidiva nádoru * MeSH
- nádory hypofýzy * chirurgie radioterapie diagnostické zobrazování MeSH
- následné studie MeSH
- radiochirurgie * metody škodlivé účinky MeSH
- retrospektivní studie MeSH
- reziduální nádor MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
