Benign and Malignant Conditions of the Skin
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
The differential diagnosis includes a range of benign conditions such as seborrhoeic keratosis, sebaceous hyperplasia, trichoepithelioma, lichenoid keratosis, BD or intradermal naevus, but also malignancies such as SCC, sebaceous carcinoma (SC) or melanoma. The diagnosis is confirmed on histological examination. Due to their slow growing nature, it is acceptable to perform a small punch biopsy for confirmation before fully excising the lesion. Histology shows islands of basaloid cells in the dermis with peripheral palisading, and clefting or retraction artefact surrounding the tumour. Perineural invasion, if present, signifies higher chances of recurrence following surgery. Imaging techniques such as computerized tomography or magnetic resonance imaging may be employed to assess invasion of bone, nerves, orbit or parotid gland.
Paranasal sinus and nasal cavity neoplasms
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
Minor salivary glands are found within the lining of the sinonasal tract and give rise to all types of salivary gland tumours, ACC being the most common. It affects individuals across a broad range of ages, between 20 and 91 years at presentation (47). Approximately 60% originate within the maxillary sinus and 25% within the nasal cavity. These are low-grade tumours that are often insidious. ACC has a propensity to spread perineurally in up to 50% of patients (48) and may present with facial numbness due to involvement of V2. 65% of patients present with T4 disease. In a large meta-analysis of 520 patients, 5-year OS was 62%, local recurrence was 36.6%, and regional recurrence 7%. Distant metastases were recorded in 29.1%, most commonly in the lungs (47). Late recurrence is common and may occur over 15 years after initial treatment. Positive/close tumour margins and tumours of sphenoid/ethmoid origin were associated with dismal prognosis compared with negative tumour margins and tumours of maxillary or nasal cavity origin. Perineural invasion had no significant impact on survival (47). Low grade tumours are seen as solidly enhancing, well-defined soft tissue masses that may remodel bone and mimic simple polyps. High grade tumours are poorly defined, with bone destruction, heterogeneous attenuation/signal intensity, and a heterogeneous enhancement pattern. Images must be carefully evaluated to assess for perineural tumour spread (Figure 2.6). PET-CT is of limited value because of low metabolic activity and low FDG uptake (49).
Malignant Solitary Fibrous Tumor of the Pleura
Wickii T. Vigneswaran in Thoracic Surgery, 2019
With a nondiagnostic FNA, the patient was referred to thoracic surgery for surgical resection. Given the radiographic appearance, our differential diagnosis included schwannoma, sarcoma, hemangioma, and a solitary fibrous tumor of pleura. She was taken to the operating room for exploratory thoracoscopy. A vascular appearing mass was identified arising from the eighth intercostal space. The seventh and eighth intercostal arteries were directly entering the mass. The mass was excised with a circumferential rim of pleura. There was no obvious osseous invasion of the eighth rib. Final pathology demonstrated a 5.1 cm malignant solitary fibrous tumor with a mitotic index of 2–5 mitoses per 10 high-power field (hpf) and a focally-positive inked margin. There was no evidence of lymphovascular or perineural invasion. Final pathology was consistent with malignant solitary fibrous tumor of the pleura. Given the positive margin, a wide chest wall resection was performed of ribs 7 and 8, and a polytetrafluoroethylene mesh was used for reconstruction. Her postoperative course was uneventful. Surveillance will be initiated with a CT chest six months postoperatively.
Perineural invasion on biopsy specimen as predictor of tumor progression in aging male treated with radical prostatectomy. Could we use it for pre-surgical screening?
Published in The Aging Male, 2020
M. Vukovic, P. Kavaric, A. Magdelinic, P. Nikomanis, S. Tomovic, D. Pelicic
Perineural invasion (PNI) is identified as carcinoma cells along or around a nerve in the perineural space [1]. The clinical significance of PNI remains controversial. It has been suggested that PNI is a predictor of extraprostatic extension (EPE), which is the local spread of prostate cancer (PC) beyond prostate boundaries [2]. PNI could also be a strong predictor of worse oncologic outcomes, including biochemical cancer recurrence (BCR) [3]. However, the independent value of PNI as a predictor of tumor stage has not yet been established. Further, mandatory reporting of PNI differs among countries [4]; the Royal College of Pathologists requires reporting of PNI, but the College of American Pathologist suggests it is optional [4,5]. Although extensively evaluated in radical prostatectomy (RP) specimens, where it has been presumed that PNI relates to worse prognostic factors, the predictive significance of PNIs in prostate biopsy specimens (PBs) is understudied [2].
A direct transcutaneous approach to infraorbital nerve biopsy
Published in Orbit, 2022
Kelly H. Yom, Brittany A. Simmons, Lauren E. Hock, Nasreen A. Syed, Keith D. Carter, Matthew J. Thurtell, Erin M. Shriver
Cutaneous squamous cell carcinoma (SCC) is one of the most common cancers in the United States and can be associated with serious morbidity and even mortality with tumor spread. It is estimated that over 1 million Americans are diagnosed with SCC every year, and this number is expected to rise as the population ages.1–3 The outcome for most of these cases can be favorable with prompt diagnosis and surgical resection.4 However, a small proportion of patients do experience local recurrence, incomplete resection with invasive disease, and metastasis.1 SCC can spread by perineural invasion (PNI), whereby cancer cells propagate directly along or within the nerve sheath of local nerves. First described in 1835, the reported incidence of PNI in cutaneous SCC has ranged from 2.5% to 14%.5,6 Perineural invasion can severely impair or destroy the innervation of local structures, causing marked loss of function and facilitating spread into the central nervous system (CNS).7 Often misdiagnosed,8 PNI is associated with a poor prognosis.7,9 Three-year disease-specific survival for patients with SCC without PNI is 91% compared to 64% for SCC with PNI.10
Locally advanced sinonasal adenoid cystic carcinomas: endoscopic endonasal surgery-centered comprehensive treatment provides benefits
Published in Acta Oto-Laryngologica, 2023
Jin Wang, Meng Zhang, Wenqi Yi, Liang Li, Liangyu Li, Chuan Pang, Lei Chen
The tumor margin is another exciting topic for locally advanced SNACCs. The current goal of surgical tumor resection is to achieve negative margins with maximum preservation of important anatomical structures. Prior studies have emphasized the importance of perineural invasion and microscopic surgical margins in patients with SNACCs, with positive margins independently associated with poorer outcomes [14,15]. When locally advanced SNACCs invade other functional tissue compartments, it is often challenging to obtain negative surgical margins. Even with negative margins, the potential for local recurrence cannot be avoided entirely. In addition, the areas surgeons reached and the tissues provided determined the sight of pathologists and largely influenced their conclusions. The degree of perineural invasion and histological descriptions in these patients appear somewhat operator-dependent. Therefore, PORT should be considered no matter tumor margins are unambiguous or not. Silverman et al. found that while patients with advanced disease exhibiting positive margins attained benefits from PORT, no similar benefits were conferred to patients with negative margins [16]. However, other retrospective studies have not reported any differences in local control rates in patients who were and were not treated with PORT [2,17]. According to European Society of Medical Oncology guidelines, patients who have undergone ACCs resection should be provided with the option to undergo PORT [18]. However, data regarding the benefits of combined chemotherapy and PORT in patients with unresected salivary gland tumors are lacking.
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